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or TMI 




■■•«>■ > * « • 


A. A. f^rEVKNS, A.M., M.D., 

lUCKNi «• ratMcai. nAoaoon ■■ tin cTtitLxnir or i«i(iim.*uiu, 
*m PM MWt iin twiB or rAiuciuwT is tuk woMtir* 

" ta »B «Rh vhcf* Ibreuib 

<i*HM« ibal iinmTsU«4 ir»cU «bM* mngto (kta 




Kh WtLMtrr 8TMUT. 

Coi-THioar, 1893. 

PBiiss or 


1 Q°>Z 


Pope aays, " Half our knowledge we must snatcli, not 
take." If this be true of general knowledge, it is certainly 
true of the knowledge of medicine as it is taught in the schools 
of to-day. In view of this fact, there seems to be a real need 
for bookH which present their subjects in an assimilable form. 

At the request of many students the author has written this 
book with the hope that it may serve as an outline of Practice 
of Medicine, which shall be enlarged upon by diligent atten- 
dance upon lectures and critical observation at the bedside. 

In its preparation the writings of the following authors 
have been freely consulted : Striimpell, Osier, Fa^e, Brlstowe, 
Frerichs, Liebertneister, Vierordt, Eicbhorst, Wood, Koss, 
Gowers, Sansom, Henry, Tyson, Pepper, Paul, Murrell, Starr, 
Hilton, Duhring, Stelwagon, Van Harlingen, Tilbury Fox, 
Hjtrdawsy, Seller, Cohen, firowne, Jacobi, Bruce, Bruuton, 
Charcot, Dujarden-Beaumetz, Pavy, Mitchell, and Trousseau. 

818 Sonra liria Stbut, PsiuDBLPBrA , 
SeptMnber, 1893. 


Diseases of the Diobstiye Ststeu. 


General Symptom atulogy— 

The Teeth 17 

The Tongue 17 

Fetor of the Breath 18 

The Appetite 19 

Dysphagia 19 

Voiniting, or EmeeiB 10 

The Vomit 20 

Acidity of tlic Gastric Contents 20 

Hiccough 21 

Abdominal Pain and TGiiderness 31 

The Stools 22 

Abdominal Distention 23 

Diseases of the Mouth, Tonsils, Pharynx, and CEsoph^us— 

Stomatitis 23 

Tonsillitis 26 

Hypertrophy of the Tonsils 28 

Pliaryngitis 29 

Spasm of the (Esophagus 32 

Organic CEsophageal Obslructiuu 32 

Diseases of the Stomach- 
Acute Gastritis 33 

Dyspepsia 34 

Atonic Dyspepsia 35 

Nervous Dyspepsia ;i5 




Catarrhal Dyspepsia 37 

Gastralgia 39 

Gastric Ulcer 40 

Gastric Cancer 42 

Pyloric ObstructioD and Dilatation of llie Stomach . 43 

Hainiatemesin 46 

DiscaseB of tlie IntcBtincs and Peritoneum^ 

Constipation 4S 

Intestinal Colic 47 

Diarrlia-a 47 

Intestinal Catarrli 48 

Entero-colitis 61 

I^sentery 52 

Cholera Morl)ua 55 

Choiem Infuntum 56 

Typlilitis and Appendicitis 58 

Intestinal Obstruction ; Ileus 59 

Animal Parasitic AfFeclions 62 

Peritonitis 66 

Ascites 67 

Diseases of the Pancreas — 

Pancreatic Apoplexy 69 

Acute Pancreatitis 69 

Cirrhosis of the Pancreas 69 

Pancreatic Calculi 69 

Cancer of the Pancreas 09 

Diseases of the Liver- 
Area of Liver Dulness 70 

Palpation of the Liver ... ■ ... 70 

Percussion of tlie Liver 71 

Jauntlico, or Icterus 71 

Icterus Neonatorum 72 

Acholia 73 

Catarrhal Jaundice 73 

Biliiirj- Calculi 74 

IIypcra.'mia of the Liver 76 

Cirrhosis of the Liver 77 

Abscess of the Liver 80 




Cancer of tho Liv«r 81 

AxDyJoid Lirer 8S 

Hjdalkl C>>U of the l.iv«r fS 

Acute T«llovr Alropliy of tltc Lircr 6i 


Ocnnal Symptonmtologjr — 

The Urine BS 

Polyuria SSi 

Urea es 

Lithuria 80 


Lcticin and Tyrosln . . , 87 

PhocphBUa 8S 

Chlorides 89 

OxalnriA 80 

UroliiMnuriA 90 

Gluuwiirin, cw Oljcmurin 90 

Alhiiniiiitiriit 9i 

AcntoniiriA 93 

Dlaceturia and Oxybnluria 93 

HiCDMturia D3 

Bteinoglobiiiuria 94 

iDdiouiuria B4 

Mile M 

Clijlurisi M 

Pyuria 06 

Diseases of Ibc KtdDeyi>, and PelviM of ttui Kitln«y^ 

Itcnal llypemmia 96 

Vncmia 06 

Acute Jtephrilla 97 

Cbrooio Paivi»:li\timlout> Xophrllb 00 

Chrouic lutt^rvtitial Nephrllla 100 

Amyloid Kidoej lOS 

Benal Colculoa 103 

I'yditis 106 



ByilronephroBis 106 

Floating Kidney 107 

Diseases ok the Blood. 

^reneral Symptomatology— 

Ttie Blood 109 

Oligocythemia 109 

Leucocytonia 100 

Foikilocytosis 100 

Microcytoais and Macrocytosis 110 

Diminiahcd Ilffimoglobin 110 

Melaneemta 110 

Liptcmia Ill 

Microbganisms in the Blood ' Ill 

Amcmia, Scurvy, Addiaon's Diseivac, Purpura HtBiuorrhagica, and 

Anicmia Ill 

Symptomatic Antcniia Ill 

Easential, or Primary Anicmia 112 

Pernicious Aufcmia 112 

Chlorosis 113 

Leucocythffimia 114 

Pseudo-loucffimis 115 

Addison's Disease 115 

llicraophiUa 116 

Sourvy 117 

I'urpum Ilicmorrhagica 117 

Diseases of tub Cibculatobt Ststeb. 

General Symptomatology— 

The Aiiex-beat 119 

Displacement of the Apcx-bcat 120 

Chaus^s iu the Force and Extent of the Apex-beat . , 120 

Abnormal Centres of Pulsation 121 

Jugular Pulsation 122 

Pra3cordia1 Promineacc 122 



I^Ipaion 123 

Pcrcnwion 12S 

AavcuItatiOD 123 

Tti« Intciuitf of the IIcart^oundB 123 

ItcdiiplicnCion of Ui« Ilcnrl-Bounds l£t 

AdvcTilitlous Sounds, or Murmurs 12i 

Ilirmic Murmun IM 

I'ttricnrJiiil FrictioDiKKinds 125 

Thr AncuriiRMt Munnur, or Bmlt 1-25 

Tbe I*oIim: 126 

Pklpitutiou 138 

lirop^ li» 

Oenenl Cyaoo^ 129 

DUettMa of tli« Pcricnrdiiini — 

Perlcardilis 130 

Ilj-ilro-imricanliuiu 133 

TIirnKvpcricnnliiiin 133 

Pa«unio-pcriranlium . , , 133 

INscasm of the Heart — 

SiMlocsrdltlB 133 

Chronic Valvulnr Affrclionii ISS 

Aortic Slcnofi)', ur Ai^rtio ObetruoUoD .... 139 

Aortic liuufflcwacy, or Aorlic lt«gtirgitatioa . 136 

Mitral St*DO»wi, or Mitml Utwtmctioa . . 13tl 

IDtml losuOldcncjr. or Mitml B«gur^tAtion . . 13" 
Tricii8])liil StODMis, or Tricu&i^ OlMtruclioii . . .US 

Trlewpld InHlfDcleDcy, or Tl1«;u>]ii(l lt<-i;urg[tAtioti . i:S8 

I*ulmo«Mry St«aotiH, or Putmonnry Otwlruction . . 138 

rulmoiMr^- IiuulBctrncy, or ]\i1iiii>iuiry BegtUKltaUoo . i:t8 

Afiute Ukuralirr. Kailucurditi* 141 

Aeute MjrocarillUs 143 

FlbnU Heart 143 

Hjpertrophj of llie Deart 143 

DilatAtioD of the Heart 144 

Fntt; Inflllmliim of tbc Ileaurt. t4fi 

Fattf DcseiKmlloD of th« Heart 14(1 

Angina Ptetorls 147 



Dincaaefl of the Arteries — 

Ancuriam of the Aorta 14g 

Thoracic ADCuriBiu 149 

Aneurism of the Abdomio&l Aorta 151 

Artcrio-sclcroeis ISl 


GuniMitl Myiiiptoniatologj — 

Till! lied 2,'osu 163 

FlnlLi:tiiiig of tlic Bridge of the NoBe .... 153 

Movement uf the AlcL' Nasi during Respiration , . 153 

Niinal I>iHcliar)-i; 153 

'I'hu SeiiRo of Smell 153 

l'J)iiHl,iixiH 164 

KiiUHtii of [lie Laryngeal Adciuctoru 154 

Apli'iniii, or Iiosb of Voice 164 

I'anilysi.t of tlic Laryngeal Muscles 156 

I lyMpiiii^ii 155 

Niiiiibi:r of ItcMpiratioiiH per Minute 156 

' 'hi'ytii'-Sii>ktB, or Tidal-wave Breathing .... 156 

r.<,w^\, 166 

fix |irr'(,rinitiori 157 

Till: Mkroji(i'j)iy of Sputum 158 

lii'.|]':r:t,i. Ill of the Chest 161 

riilliihiii'iid Client 161 

llai'hjtii! <Jh<rhl 161 

Kiiil'liyHi-iMUlolix ('lil'St 161 

t^n-M rr'iniiiM'ii<:'!H and Depressions I(i2 

Kxprtiixiim .......... 163 

I'lilfrfitioii • . . 163 

l'i:r(;iiH)<ioii ' , , . . 164 

AiiHciillalion 165 

.M'-TiHunitiou 169 

l>iMi'a»fit of the Nose and Larynx- 
Cory wi 170 

Chritnic Nasal Catarrh 171 

Aoutc (.^tarrhal laryngitis 173 




ChroDic LMrjngiUt 174 

Spasinodio Croo]) 176 

MemlmDOUB Croup 17T 

lAijrn^mua Stridulus 17t) 

<Eileins or U»e Lai^'ox Ittl 

DIseaan of Ibe Longs— 

Bronchitis IftJ 

Dilfttation of tbc Brooclilal Tubes IHO 

AsthRM IDl 

Hny Asthma l»l 

l^l1mI>nar>- Kuipl>js«iua IKi 

lIictuuptpiH 198 

PUlOKXUU}' -^ix*?'*'^? ^^' 

CongMlioo qf tlw l^ngs . *..... 'HiO 

Croupous PiKuntimia 3UJ 

Cntnrrhal Pneunti>nia 207 

CliroDic Intvrstitiai rRenmonin . , . . . .211 

G»DgreDo of Dm Long 3)3 

Abwecia of Uw Luog iia 

(Etleoia of ttie Luogs 2t-l 

Pulmoonry Collapse 'il-'i 

Pulinonnry Tnbcrculot'is iilU 

DiM<i«ei> of tbc Pleura— 

Pl«uri»y 223 

Tijrdrotbomx S37 

PocuniotJiArax 227 

llKDiotbonu . . . 23U 

ACCTR iKrECTIOtra tnsEAsEa. 

F«vcr 230 

Period of lucuhatiim 233 

Datt: at whidi ItjialM^o Appcnr 233 

Protection from Futurr- AlUckii 234 

Pfiriiidic nr.niiuioiii or IntcrnibMion* in this Fever . . 231 

Pcrcr> AwMHniilcii vritli JiiuoiJicc SA^ 

Tcrminalion by Crivis . ^Xi 

Sabaamial Tempcrntun; ,...,.. 23>'> 



Simple Contiuucd Fever 236 

Typhoid Fever 237 

Typhus Fever 243 

Itolnpsing Fever 24S 

Cerebro-npinal Fever 247 

Mnlnrint Fever 250 

Scarlet Fever 256 

MeaxleH 260 

Jtolliuln 262 

Sniitllpox 263 

■Vnri::<:llii 266 

Vacuiiiiii 267 

ErywiiJflus 268 

Yellow Fever 270 

Aciile (icneral Tuberculosis 272 

Diptillicriii 274 

WlioiJ|)iiij;-i.'OUi!li 278 

liilliKni-.a 280 

Muiii|m 281 

(;iioIi:ra 283 

Ti-liiiHiH 286 

Jh'iif,'!"! 288 

Ilydropliobia 286 


UlicuDiAtic Fever 290 

Obroiiie Itlicumnlisiii 294 

Muscular It lieu mat ism 295 

(ioiit 297 

Kbuumaloid Arthritic 300 

Itickele 3(12 

Lithifniia 303 

DiiibcLcs 304 

DiabctcB Insipidus 308 




]>ifiTi'BiiAiiaa or Uonoif. 

PualysiM 810i 

iTTcgniar Fmlyria 810 < 

MoQoplogla 311 

tlemipk^ 311 

PuHplejpa 313 

Convuliions 313 

K[iUcpUronn Convubihxw ...,.,. 313 

Tetanic CoDTutaioDii 314 

llTstCTOidal Conmlaiou 314 

Local Ooavul«m» 31S 

S«1bito<7 Rposm 31S 

SulMun CoDvabioDK 316 

('hnrcilbrm UovcmenU 31S 

Athctoeie . S16 

TrciDon 317 

TheGftit . 317 

T1i« Reflexes 318 

Paradoxical Contnictioa 330 

DnrORBAN-CKs or Sbnsatioh. 



Uomiuealhesia 331 

I^ransathwia 321 

nyperaaUuMB 3S 

FuiGsthMta t 332 



Uutictiliur ScQM 


MoMulnr Aimphy 323 

Bettctlon of l>cgci>o»Uoo 333 


Artfaropa.thie8 324 

Uyxcedema 324 

Ulceration BeauUiug from Perverted IfutritioD . . 325 


Coma 325 

Trance 327 

SomnaubuliBm 327 

Ecstasy 327 

Catalepsy 327 

Disturbances of tile Sfeciai. Senses. 

The Eye 327 

TlieEar , . . 328 

Psychical Disturbances. 

Deliwion 328 

lilusioQ 329 

IlaUucioation 329 

Imperative Conception 329 

Morbid Trnpulse 329 

Delirium 329 

Diseases of tub Braik, Cord, S'erves, and Muscles. 

Tuberculous Meningitin 331 

Simple Leptomcuingitis 333 

Chronic Pachymeningitis 333 

Hemorrhagic Fachy meningitis 334 

Hydrocephalus 334 

Paretic Dementia 336 

Cerebral Paralysis of Children 338 

Cerebral Ilypcrtcmia 339 

Cerebral Antemia 340 

Cerebral Hemorrhage 341 

Obstruction of the Cerebral Arteries .... 346 

Cerebral Softening 346 



Uoibld Growtlu in the Bruin 317 

AbMCM or the BniD S50 

CreUnbm 351 

SpiiuU Leflomrnin^tw 3fi2 

Cliionic Kiunikl Pachytncningitia 3S3 

Acute MyeUlis 354 

Otrmiic UriJilu 366 

edercwia of Um .Spimil Cord 357 

Locomotor AUxIa 357 

Priinttry Spattic IVrapkfti* 360 

Amy»lr»ii}iic T^trnil SctcroeU 361 

Alaxi<: I'uraplogin 361 

Dioeminntod Onibro^pinitl Scleroma . , . .301 

Herodilary AUuin .303 

BjTingo-mycIin SOS 

Aculc Aiittnor I'ljIiomyolilU 383 

Progreuive Muscular Atrophy 305 

Bulbar rnralj^ 307 

Acut« AecoDding Faialjrtls. 307 

CaiawM) DiwaKO 968 

Idiopathic MiLsciilnr Alropliy SOU 

neodo-hyp«rlti>|)l)ic Paralysis 37W 

Ncnrnlgi* 371 

MigmiiK S7i 

nentlAcbe 37A 

Ncuhtia 3T» 

Unltiple Ncuritia 381 

SctnUcft SSH 

Fadftl rnralyris 393 

Kpilcpsy 380 

Aphasia 387 

Vertigo 380 

UiSaiJtni'B Di8««9e 380 

Hjr«terU 3dl 

Kcanulhcnla 305' 

Chorea 3Dtt( 

PanUysis Ajiilatut 308 

Artimn's Ctxrop . JOO' 


Tetany 400 

Tho&uen'a Disease 401 

Exophthalmic Goitre 402 

Baynaud's Disease 403 

Acute Angio-ncurotic (Edema 404 

Myxoedema. 404 

racial Hemi-atrophy 405 

Acromegalia 405 

Stuutroke 406 

Intoxications — 

AlcoholiBiD 408 

Op ium- poison infr 410 

Chionic Lead-poisoDiDg 411 

Chronic Mercurial FoieoniDg 412 

Chronic Arsenical Poiaoning 413 


General Symptomatology — 

The Color of the Skin 414 

Hardness, or Induration of the Skin 415 

Ojklema, or Dropsy of the Sabcnlaneous Tissues . , 41G 

Glossy Skin 410 

Enla^mcntofthe Superficial Veins 416 

Cutaneous Emphysema 41)1 

Abnormal Conditions of the If ails ..... 417 

Cutaneous Eruptions — 

Macules 417 

Purpuric Spots 418 

Yesicles 420 

Blebs, or BullsB 42-2 

Pustules 422 

Papules 424 

Tubercles 425 

Wheals, or Pomphl 426 

Cniata 426 

Scales 427 

Ulcers 428 


of Um Swe«fr^ud»- 

AnmroaiB 430 

L_ Hyperidroeb 430 

■ BrotuMrtMi!! 431 

1^ Chrocaidrosis 431 

Sudamen 431 

FuncdoiMl Mmaus of the Sebacceu* GUpd« 

1^ Sebonbttt 432 

^m Comedo 433 

■ Uitium 434 

Wf Stcatomn 433 

rinaBiunwUirj INaeaaM of the SUa— 

Erythenui SiiDptox 435 

I EiyUicmft lutertrigD 49S 

^H E^OM UuUibriM 435 

^r rrticaria 487 

B Her]'*'* Simplex 438 

DtlpCsZosUir 430 

llcrpa Iria 440 

.Audi: Vulgari* 440 

AcaeUomca. 442 

FanmcalDi «43 

Cubrntcntai 414 

noilaaia *ii 

Eczvms 44S 

UcheoRaberandLUMoFbaiM 44» 

Prorigo UO 

SemutiUa HnpeOfinnte 4») 

IDwroaUUi V,l 

Ecthjma 45.? 

Peanphlgw 454 

Impetigo tOS 

Impetigo Con m i w 4SC 

Millwta tSJ 
Irofibk AOxtiem of the SUn— 

Ailiinuwu 40 




Vttiligp 4GB 

Atntpbt^AObciiotMof tbeHairandK&lla . . 45d 

llTpcrtn^ic Aflcctions of the Skin— 

LcDtigo «i 

CUoMna 4U 

Kanto^FHirls 465 

MoOiwaim EpiOielMe 40S 

CallMiUs 460 

CUTO8 467 

Coomu Cutuveiun 4aS 

VMroca 468 

Xfens 469 

IcbUiycMii 460 

Ilypcrlmphic AObcUouK of Ibc Hah- wnd Kailt . 470 ^J 

Uorphoft 471^1 

Elq>hanUa«M 471 H 

Dcrmalolvws 47* ^ 

New Growtltf of the Skin— 

KelokL 478 

J^broou 478 

Ai^oDW 474 

XaoUwoMi 41i 

Lnpia ErjUtenutoM 475 

LupueYul^ria 47dj 

SjFpliUU Cutanea 

Lcproaj 49l}j 

Epithelinnia mi 

Aitilium 4831 

NcutxMvN of the GUn— 

DcnnatalgU 483j 


BuatiUc AmcttoDB of tbe Skin— 

Tinon Tricophytina 48S] 

Tinea Vcnieolor 4fi7] 

Tinea Faroia 






Delayed demitjos, antl tht- cniptiun of biully-fornietl 
tvciU, wflcn nvult IWmi rickets or doiij^-nital »_v|iiiili», 

Carim of Ok trrth results fmni many Con<iition« ; tiombly, 
iin iiniiuliiml Huflnitw of tlic U<ctli, lack ul' di.iinlincsi!, iiy»- 
|w[>^i», \1k U)k uf cvrtuii) ^Irugs, and Jiuticlcs. 

fltUchirmm'ii ttfOt. — ■TUe luternl iiiciwrs wf tlic upper jaw 
nre iM^ggnl, aixl iIh^ wnlnil irK-iiMjni of t\w mnw jitw liiiv<> 
convex sidijw, ami '-n-Bwutir iiot''lii-» uii llii-ir niltiit); i*tlge«*, 
Tliiwe [M.nruliniiliiii irxli'iiU- lu-i'Ciiilary !«y(>lii !!.■<, nrnl are iiutwJ 
untr in llu; (K-rriiiiiiriit t'lili. 

A ft/ue lint- on the jiiiiiift war iltc itisKTljnn of tlic u«Ut 
iLttialty indicatf^ din^iic li-iul [XHitiinintE- ^Vipper iind silver 
poisoning (iw9»ioitnlIy [innliioi? similar iiiM>^. 

Bpong^, bfeftlitif) gums an* ntlt'n aswocialed with scurvy. 
SweJling of the eiims with tfmlei-w^^ ami salivation is indica- 
tive of mercartal poisouing (|ityal!eni). 


JW tm the (oHffUf. — Tliis L-oii<ii«lx Cor tlie nxMt port of ao- 
cumiilativ) vpitlidial <vlls {jartit-k^ of foo<l, und mici'w>rKan- 
i)i] rL«ulU fmni an ck'vatiua of Icnipcmliin! or fVtMa 
urbed innervation. 



A Hgil, imi/arm rt*i( b *>ft™ noted in ht'alili, paniciilnrly jn 
those wbu sleqt wtUi Uw moutfa open. Otiter caudal funtU* 
tionsi are: — 

(I) 111 Tebrilp discMis. 

('J) III (Ivs[>i-^iiHa. 

(3) In c«larni«] contlititMK of Ibe Doev and thmat. 

drftoMcrilfed fvrrim/ oRvn ipdk'mUs kwiil ciisUirtjaiHX', as a 
jaffl;nl toolh or toiiMtlitw. 

t'nilitUntl fiLrrtHy tnar rmilt fmm ditMnrhed innervation, tf 
in coutliliouii affc^-ting tlic axwnil aixl third branrhn* of Ibc 
G(Ui n4'n'(\ It Im$ (HtN) nvd-tl in neuralgia of ti»ee braurim, 
and ill fra^-turrs of tiic vkull invulvinj: tlie foramen rotuncium. 

7%p drv, liromt, amt^afurfd lonfftte ia omM in lovr fevei-»>, n» 
lyphoiA lever, ty|>l)oid pnvunHinia, ty[J>oid dy^nim'. 

A fW, Afi^ toitffut 18 DCiied in wrtain febrile diseaseti, ai 
t)'plu>id fever and murlet fe^*cr, and in diabetes. 

The: " Mrtiniifrrit Umtpt/' is diannieriaed by a white fur, 
tbroinrfi whic^ti jm>jr»'t Imglit red and jiroroineut papilla. It 
is seen in tlie early stage of starlet fever, 

A t/ratf-<^ili\1 tiiut jinf/fiy tonffve, with an ova] barr spot in 
tio wnire, whidi is red ami gtoasj-, is Kimetimes swn in chil- 
dren, and is iudirativeofgiifitro-iiitcsttnol catarrh, or "mncous 
disease." (Starr.) 

Tremor of the Ton^ie. 

7VoBiW»i3 of fhe- toMiptr i* iioK-d in many wndilionii: it b 
iicoiiltarly iniirke<t in low- fcvera (typhoid), in uh-olioliMii, nod 
m ]wretiti deni«fltia. 

Senni on tli» Toukiic. 

Sean on the tongue oAeii n»u\i from sji^bilitic k«ious, or 
from lh« tooth vroiinds of c]iilcp»y. 


This is often due tu local in Hum mat ion, as chronic rhinitis, 
tontiillitt)), etc ; to tlie n4entioa of d«compasii^ food, to rariea 



of Uie tfieth, to oMiain lung dweawji, especially gangrem? ami 
bronobieclasia, to dj.-i«j>e]wia, luiil tu tlic inga>tioD of venain 
food« ur dnigs- 


BoiJimia, or inordtHtite apptiUe, \a n (.'Oianion Symplon) in 
n«r\-oua dytpt^fxiiii, ilintx-Ur, worni», and in M-rt»in insaiiiliee, 
notably in pnix-tiv d«nientia. 

Anoraia, or Uf« t^appdile, \» a ttyniptoni cooimon to niuoy 

V'livi inacrnving for iiniialural nrticl^^oftood.nDd ix Dotod 
partial larly in chlcamLs, in-«aiiity, prognaiKA', umi wormit. 


I>jf»phaffia, or difficult swallowing, may rrault from : (1) 
Ijoral inilaroiiuttion&. (2) Stricture of tli« a?eophagii.s t)|ui»- 
HKxIic or organic. (■'{) I'amlvsis, local, as in diplitheritic 
paralysis ; or centric, as in bulbar disease. 


EnoLOOT. — (I) Toxic, from ptomain4<s, dniga, urwinia, 
ami Ihc *i>wific iVvertt, {'!) O-ntric disease, a"* oenrhnil 
ttiiiiont uiMi int'tiiiiuitis ; tliii) typo is oflen unaooouijunictl 
with iiaiisi'«, and docs not relieve the aasociatod licjuladie. 
{3) I>iM«8a« of the stomach, as ulcer, cancer, dilatation, dvs- 
uui)i>ia, etc. (4) Reflex, as fi"om pregiiancr, utcn'oe or ovarian 
<ltM>iin«-, irritation of the fiiiK«s, worms, liiiiury colic, etc, (5) 
lut<!!ttinal olistniction, this is otlen fecal. {&) Pistur1)cd ccre- 
tiral angulation, as in swinging and sca-eickDCVit. (7) T'crtnin 
tiervutia aflections, as hysteria, inigratiic, (8) i*cri<Kiiii vomit- 
ing may be in itwlf a nciirnsis, or may he uxsocililvil with \\w 
gastric orisee of lorouiotor ataxia. (9) fKiuiphnf^<nl vomiting 
nmlts from ubetrudion, and IIh; vomit i» alkiitiiH; in n-adivn. 




Ilfff^, or miKtMM nrnit, b ootcd lo chitxiic g»slritt», In 
nvtaiu forni.'* of nervous dy^iepeb, and sfttr pcfwuni Mitesiii, 
mf in Hwlern. 

Bilimt*, or ffrt*H romit, b Dot diagiMHtii' vt mnv specia] mo- 
ttilion ; it m»v (locur id anv ciuc wdi-fr vuntitiug uh stminiDg 
aiv (-ontiuiicfl. 

Btottdif romit (Hinmttrmfmi). — For i-ansc, see page -lij. 
When present in hup.' anKMtnt, it raui itiiuallv be rea^iiznl 
by till- iiiuii4lt?d vyv : Muall nittotiol^ may be detected by the 
micTdeoopo. epcctnKiieopv, or br cJwmtcal tests. 

TrMJor bloml. — K\-aiximie kimc of tbf filtrrwl coffpe-prountis 
votnit in » wttt»'h-pliL«, M-raixr nfl' some of tl»* dried mutcrini ; 
add a tnuv of fiiie]y-)>idvert>») salt ; jilatv the mixinn.' on un 
oIijwt-gla»s a»d twef. Allow one i>r two drops uf ^ln<-inl 
»eetK tw'td to ran under, ami ^ain evajwrate ; when drv allow 
one or two droio of diAtillfd water to flow under to niswlve 
itho cn-sials of salt. T'nder tbe niicnMcope minute brown 
iiombk' rrvftalfi of luemattii ap]M^r. 

I'unilnU ramit may revolt frxMii tbe nii>tiirc of an alw-ow 
into tlit^ (rmphagud or Hlomavb, or fruni pbki^iono*).- ptstriti^i. 

Fnat romit (^ervoran'ous) is iiKlicattve of inti'itiiial obiitruc- 

Profiue vomit. — Tbc noction of large qitanliliftn of fmiby 
fiameoted material ia bigbly ^ip:nilii.'ant of gaMrie dilatatioji. 

i'omitint/ irilhout nauM^t, d'vkrrM, or ol/irr u/tenomenti oceiirii 
In (rrliiin miirose*- of the atomatb, in liysiena, unemia, aDd in 
bniin diwaw. as tumor, or as a preciiraor of apoplexy. 


Normat tifitliiy is due to lartii- aini liydrviditorio acids, but 
flither acids are fnxiucnilv fonued during the digestive procMs, 
sitrti as butyric and acvtto acid^ 

For cbvintrail ex ami nation, tlw vomit i^hould bo pn.T«crved 
and (iltereil, or, wbieb i» far lirtttT, llw- eontrntji of the a*tomaoh 
Kbould be. drawn oJT after a lest^mcal and Bltered. 


t/or/ree hi/ili'w/iloricaeiii. — (1) PajterMniiKKtwitliaMtlii- 
lion of wngo red turuK blue. Not very relialilc (li) Pajxr 
)'Uiinc<l with an alcxjiolic solution of oo-trQ|>ieulin turm from 
a jellowiab-browu t« Uwp brown or red, (3) Giinzbiirg'a 
t<«t, vcfj reliable. 

9 rhlnmcluHM, 2 parte; 
Viiiiiiliii, 1 pnrt ; 
AUmiIiiIi; a)(^>1i'>!, ^0 pnrtic. 
Add one or tno i)ro|itt to u similiir quantity or llic flltrntci nmi- 
laiued id a poceebUn iliab, beat ccnlly, ftiiil if frcr )i)*<lroi.-liluriv nuid 
Ib present a ro»-rcd color ileveloja. 

llifperuciiUtg. — Tbin iHin<Iiliftn is f^jtiviuHy noted in iilcvr 
ofltu- ^lonindi, and in rertain t'nmii< nl' ntTvutis d_vflpc|)eia. 

SufxiciiUly or inncidiiif oa'iiis{l) in <rrl«in norvoiia nlV«0- 
tioDS, an in itoine forms of nor\'>ius dy!4[)C[)>(in, b^'!*k-rill, wid 
netirastJienia. (2) In extreme anitmia. (fl) liign.itj-ti!<tttarrii. 
('[) In piWrif «nitTr. (5) Iti mmt febrile diBmHW. (ft) Often 
in (naiisivf cungoslioti of ibe i^toniiKJi, 

b . 

^B JJiecough, or siwfu/liig, rwtiilts fiwiii a clonic ii{)fl6in of the 
^Ppanbra^nt, ainl Lh o1\cii notc<l as a teii){i«>ran- eondition after 
^teting or drinking. IVrsistent hiccongh ie liometiiitcs present 
in extreme exbaiu^tiou following omilc or chronic disenees. It 
results from irritation of the phrenic nerve, as lix>in the pres- 
sure of a thoracic unoiiri^ni. It may lie re6es from stomachH.', 
hepatic, inte:hliiuil, or piTiluneal disease. It may be due to 


DifuM aMominaH(Mirme»» is noted in (H-ritonitiH, in hys- 

ria, and in rlK-imnitivnt of tbe alicb>minnl innin-lcti. 

Pcrsidcnt (iMnmhuil juiin n>Mi1u fri>ni ibt- variciii» vbtreral 

Eseasea, rbn'>iiic |KTili)nili», abdominal ancuriani, and ditwaxe 

"' ihe s)>inMl vi^rli-bne. 

(Vie is • painfnl spasm of a mucons canal. Tbe common 

rietim are— biliary, inteutinal, renal, uterine, and pancrvntic. 




Pmnftd dffeealion n<tuill8 from onnMitKitiun, anal fissure. 
<l_vfi«'nt«»n,', i>il«t, iiWralion, sflicture, prolaiiw «f llic nvtiim, 
au<i iiiHsinniatorv cxmditions of oeigliWnug uigiiiii^, a» the 
ntenie or prostate glainl. 


Blood in tbe Stools {Ihirwrhagia or Mthraa). 

Tli<? Mood it- nearly nortnal in uiiiunmiKi} after prof 
lK-iiiorrIui^c«, or wtii-ii it lias Im«d uuickly dii^liar^ra, a^ in 
]>iki« and tWuru. Ritainitl blood inipiiiiit a black or Uavy 
upiH-flramT to l)iv elould. 

Alck'iiii itiiiiltK from : (1) Trunintit^ni. (2) Aciite 
llniDniiilion of lli« IkiwcIw, a» in entcrilis and (lysciitery, (3)' 
Oli.'^lriii'ti'd dn-nlatkm, 11^ in tliri'iiii- lican and liver diiicasc, , 
L(-l) N'tiiiriims in<-nMriiati<iii. {h) lilood d v-ti-i'asiB, lu* in M-«rv^-,^| 
pormira, iiilii-lioim liAci'ii, He. (<i) Kii|iCniv of an am-iirism.^l 
(7) 1 'kers in thv i)ite!<lineA, an siin|ili' diiridcnal iiWr, (vphoid, 
ilvEeDtt^ric, tubercular, or malignant iiU-ei-i*. (8) I nltiK>u)!CF|)-j 
tion. (II) The passa^ce of blood from thf. etomaoh in liivnia- 
lemcels. (lU) I'ilra, tisnre, fistula. 

WaUry, or nerou* atoola are noted in choleraic dwrnsps, ii _ 
ervons dinrrboca, in the oil Iic| native diarrhon whieti li'rmi- 
ffbates wastinp (liscasoi, in wverc enteritis, in corrosive poinoD- >; 
icig, as aisenie, antimony. fl 

(frtai stotjh may reaull from an excessive anwunt of bile.^^ 
Tlicy are ali<o common in tbc diarrboas of young childrrn, 
and in tlicw <-)i«m the green color may be due tu bacteriiU 
growth, (Haytin.) ,,, 

/f/(ti'^- «/Wj< may fi'IIow intotiniil bi'morrfi:i};p, and llic oa^H 
of wrlain dnig-s, a* cb«(Tt)al, bismuth, iron, tannin, etc. ^^| 

ttfd Hfonfa ii^natly indicate blofxl, Imt tbcy may be tin^ red 
aflcr [lie adminifllmlion of hn-matoxylin (lof^ood). ^U 

.Vhcow Mtmln aiv noicd in inU'Stinal catarrb. particularlj^l 
when th« lower bowel is afTedcd, as in ent«n>«oliti8 nnd dys-^ 

FaHi/ MtnAs residt from the ingestion of large 'jnantilics of 
fats, fmiD the absence of bUe, uhI from chronic jmnonutji 



iVrwfcnf «foo& result from li!<Uila m atw, djwDlcric, q'phi- 
ilirr, or luiilifi^nunt iilwrutioii, ur llii- ni[>tnru u( nW'i«^«w into 
Jio bowel, as (>r()»tjitic ami iM.Iviir iil)i<M-«<4?i. 
LiaiUrrie. MouU. — SUmiIm wiiii-li ruiituin ■nut.-li tiiultgcstvd food 
noted iu inltnmmutury comlition» of tli« 8toin«cli aud a[^r 


Causes. — (1) Enlargeniont of the "various orgians from 

imors or other causes. Recognized bv the history, irregular 

otaivGiueDt, and special svinptoma rc^rablc to the organ af- 

fctcd. (2) Asdtre, Recognized by movable dulne&s with 

A[)erincuu]bcnt tyDi]Miny, and flncliiation. (3) Tym|uinite8. 

jnizcd by universal tympany on [KTciissinn. (4) i*r<«- 

Kicy. RecogiiiKwi by supprciwion of nii.-iiKi'^, morning etucsw, 

ngmcutatioii of mammary an-ola, twIU'nint; of (he cervix, .in- 

riuitlcnt uterine cuulractions, etc (3) DiHtentiou of itie 

Jdvr, Recognized by the luntory, luuaiiou of diilD<««, and 

jlta of calhetcrizaliou. 


Definition. — InRnmuuUion of the month. 

ETiouxiV.— (1) McclianitwI.chemicnl, llKTinal, or [«nwilic 
irritatiou. i^l) .Mercurial ]Hji^ning. (•'J) (.'aftw«tic stat<s, uri 

ptilhliiis, i-«n«rr, and di»l)eli,>s. (■!) ll w most commonly 

vn in yoiinjr childn-ii in aitnociation with gascro-inte^tjiuil 
ili^turbaiiiMS, iirouglit uhuut by artificial feeding, warm wcAtlier, 
[)d bud hygienic mirroiindiQir^. 

VABiETri-».—<l) Catarrhal. (2) Aphthous. (:J) Ulcemtiv& 

) Parasitic (thniHh). {&) (Jangrenoua (G) Mercurial. 

Oknkkai, Sv.wi'r(>Ms.— Ileal and pain m the mouth, in- 
*-.%'«'J flow of siliva, fetor of the breath, rcstleasneee, languor, 
IbnincHnalion to nursf, and perhaps some fever. 

Catarrhal Stomatitis (.^implf niomadtU). 
Svimoii.s, — (ii'ucral svmptotns of stomatttiti, and, on iu- 
Kotion, a diffuK n«I swellin); of the mucous membrane. 
Trkatment. — Good hygienic conditions. Keeptlio mo«itli 



yenemtar tiom- 


Empk? a wnk aolotioa of bocic acid or of 
«f poteann Ma watt. 
Af U km mmaiam (FhtSaia 

SmPKHn.— Ocnenl gy m p toi m of gtmntitls, and, on um 
ipeeliciii, aoBeraoB enall, round Tnides <m the cbceW UmJ 
SBd 100^ ; that raocks aoon Utvak, sod kavc UttW, shallow ' 
nlon wttfa a red smla. 

FaoGvuiffiL— f>oo4. 

TnUTHEirr.— f)t«nluie tbe milk. Xurseat rrgnUr inl/r-^ 
vale. Vasb the loaiitb with a >Amn linen cly<Ji. Correct! 
aiiT gastric dktortMUioe. Vee locallv : — 

^ Add. boricL^er. x-sx ; 
Gljneeritae, (^; 
AqoK. q. a. ad f31J.~M. 
CUntaU sTpntaHlan (gr. xx-i«) nuj br snlMUutod for Iha I 
boric wad. "*■ 

moeratlTe 8t«itiatitis. — TbLi i§ itKi4i)>[it br aoaip to be oit 
itilttTtiour ■liti^a.'ip, because it nfteo miiirs in cpK]ttuj(>^ n,^ 
titarkR ixAU children and adiilu when coogrc^ltx) and sulv- 
jecl«d to bad bvgienic cooditions. 

Srjiprwsif'.-^Jtaeral cn-roptoms ofstotnatitb. 

lifSPButloy. — The gums of the lower jaw are diieflv sfibcted. 
Tbejf are swollen, i»d, and spoogr. Ijtnvnr ulcere, with ^rav, 
■loDi^uig beMea hood form, and ma^ extend to the ehvi^k. The 
glaods DDdcr the jaw are swollen. In severe cageo lotwrmtw 
nftha twill and iicrT(M:> of the bone may follow. 

PnoG>r*ls. — Guardedly favorable. 

TliKAnrEST. — Corrifl the liygi^w. Tonic doses of quiuin? 
by ihf Momaili r.r n-tlmn iin- indiiaKxl. Touch iIm; tiWrs 
with nilratr of fllvf-r, mid »«<• a-* a inoiitb-u-asli a mlution of 

liinitr ofpiflaivtiiim or |i"nixitk' of hvdrogf!]]. 

rarasitio {TAnwA, iltiguH). 

Ext:iTiN« Catsb. — LS««hnPomyo(« albicans. 

SvMPTOMH. — (icDt-ral ityniptoin:" of stomatilie, and, on in- 
cpw.lion, niiimrrinw miik-whi^; «-Icv»tioni* which, on removal, 
li«v<.- a raw siirTurc. TIh- di.-*t«si- itmv i-xtt-ini to the pliarj-nx, 
(KMplugus, and lur)'ti](. Mtcruwopic vxatuination re\'eaU tbe 

PROcyosis. — Good. 

Treatment. — Correct tlic livpicne Treal any gastric dis- 
lurlmnce. Tonics are oftpu iodltatwl. Locally, borax is of 
lluc, and mar 1x> u#cd in the I'ollowiDg luixtiira: — 

^ 8odii bofaL, ^ ;- 
G1;ccrinic. Jij ; 
AquR.', Jvi.— M. 
\ Sif[.— Apply Mvcntl tiuteit daily by m«ana of a came I'll- huEr bnwh. 

OaDgreaoDS Stomatitis [Citucrnm or!«, Noma). — This form 
is iii>iiiiny ^rii ill dcliilitntt.'d childn?ti between the Agm of two 
aDd six yt.>ars, and UMtially follows ono uf tbc i§(>cc]fic fevens, 
L-tally mcaslu) and whooping-coiigh, 

Syuttous. — Tbe gcocnd BvaipUmi* of stoniatitu are 

luai'BLmns. — ^Thc cheek is the |iHrt ufU^'tttl. ICxtcrnally, 
it IK swollen, liard. n'd, sml ghiM'^l ; intoj-nally, thetu is itolvu 
an trrvgiilxr, «lou);^liin<' iiloer. 

CoMl'LKATmNs.- -iVrrorotion, tte|>tii:n-inin, K.lmlar |HiCil- 
monia from aspiratt^l sluughs, aiiil dinrrhtra IVoni t!ic aual- 
lowiiig uf ft-tiJ matvrial. 

l*ROGN(n!». — flrave. Death is common ftxmi oxiiaufltitm 
or w>ni]>lii«tJoi». Itooovery b ofn'ii aitcniletl with ileformity. 

Tbbatmk.nt. — fioo<i Iiygiune, aI«>)Hilic atimiilaiits, nutri- 
lioii^ fi»Ml, tmiicii like iron and miinine. 

/.•tnilti/. — Evert the eheek aiifl ai>ply llit aetiinl cautery, or 
)tai-ic the Mirrouudiiig parts with oiled lint, a[>])ly to tbe ulcer 
htnin^ nitric aci<l, and •mliecquently netitralize wiUi bicarbo- 
nat<- of Aodium. As a moulb-At-ash, peroxide of hydrogen ia of 
extreme value. 

Btorcurial Stomatitia (/^j^iam).— This form of slomatitta 
ift net'ii iti arti-artN uiio work in mcrctiry, atlcr (be adtuinistra- 
tion of vcfT large dcees of memirialH, simI after th<f adniiniii- 
tration of small doeeit whvn Uierv ban been an UDuattiral 

SvsrproMB. Praaonitorg Sj/ntptanu. — TiM»dernc«s of the 
gums, manileeted by bringing the t^Hlli fort-iMy logi'tlier; 
mliKfia of the gums n«r the ii^crtiou of tli« Icvlh, a riu-tallic 
', and ao incnMe of eolix'a. 


Jjoier f<ymplom*. — Profuw «nlivntioi>, fdor of brcatli, iwl- 
, 8w<rlliii)r, iin<i IcimUti»C!*.s oI' the ^>nii<.. Tlic tongue may 
' Mmilsrly AfTcvltil iimi |irotru(Jo TrDtn (1h- inuiilU. In Kvcte 
ulflt'rnitoii of Uie tnuootu oiciiibnuw, I<»h uf tvctli, nod 
'^nocrooi.s of th« jaw m<iili. 

Tki:atmf:nt. — Use a^tringt-nl mouth-wa8l>«s. I'^ploy 
iodide of jKiiasriiiiiii in Hniall diHc^ ii> i-Iiniiiial^ die niercun'. 
OiHiini may be nHiuintl ai night to allay di^resd. UelladoDoa 
aids in arrcoting the MY^retion. 



'Etioi^jt.v. — Toretillitis oocwra at all ages, but it ia partieo- 
larlv common in the yomie, 

TT»e rheumatic diathesie exerts a predis[HMii^ ititliiei>e«. 
Exfioaure to cotd sikI ivet usually excites it, and such exposure 
U very effective when tlie w.'stem ib dcbititalcd, or the throat 
t« congested from improi>rr iiiK' of the vui<.-e. Impure air, a<t 
the rflluviiim from fuiil dniiii:< or m-wotx, sumctimt'S e.vt-itcs it. 

VAitirrifs, — (1) f>iu)ple, or »it»rriiid. (2) Follicular, or 
In^^'unur. (3) l*lili^muiioii» (r|iiii)sy). 

Symptoms. — i'ain in tlK ihrodit inciraaxJ by swallowing 
kWid talking ; miirk»I tewlen>vse bir»r»th the angles of llic jaw ; 
fvvcr with it» us»)ciate<l |itK'noiiKiMi ; in si: wro forma the 
U*in[K-mfiin' is (piile high, 101° or lO.'i". 

In ihc rtilurrhijl form ihe toiitiilH mv luiiforiiily ttwolldt, red, 
and mverr)! with t«iiadot» mneiii*^ 

In the /nt/ieuliir foim the tonsils are red and swollen, and 
prcKDt little yellow spots on their tuirfaoes. These ftjOTt* are 
found tu W plugs of degei>erated epithelium which are retaiited 
in till.* crypl-4 <»ii aecoiint of the ewetUng and oeiluxion of their 
outlets. 'I1iesi> plugs are often expectorated durii^ convales- 
centx ai« offoikiivf: cliees^' pellets. 

In t\te jMttffownous form the toni-iU are extremely swollen. 
often M> miieli that they almost meet, tlie pain is intense and 
of a throbbiDg charaetor. Ono glaitd soon becomes taig«>r 
than Ihe other, softens, Ri>etiial«i<, anil tnnis yellow from sup- 
pnrution. 8nnllowti^ \» almoxt im[iU-«iblc, the voice is lo«t, 
breatliing ix diini^iiU. 



DlAONfwis.— In chilclrcu tonnilliliA mny rcsHiihV wnrJot 
fever, eepecially w)iei] liic Ibriucr in aitMK'iaud ^vilh uii lu^ii- 
denlal ra^. 

Hvtrftt Ferer. — ^History of contagion, onset with vomiting, 
a punctated p«l rash, " strawberry' tongue, albuminuria, and 
p4il8e too rapid to be iiroportionate to the fever. 

Diphtheria. — The (ollirular form re^nibles diphtheria, but 
ill ttif hitter thei'e U t\ ThIr- rnem))niiic, tiol only on the toosila 
but un Hiin-utin<)in^' )iiirl«. mid iti< retnovit! leaves behind a 
raw siirfiuv. The hlMory of ojiitagion, the r^titii!, weak pulse, 
the marked i^welliiiu; uf llie itubmaxilhiry glanil:<, albuinimiria, 
and tin- Klel»-rx)Hlor liitcilhii>, deloek-d by cultivation, will 
alivi itidicntc diphtheria. 

I'HfXiSisw. — Fnvoralilc ; cvt-ii in grave c«a«« rupture of the 
nb^'i-iw oiviin* when dcflih M-t'ni.i tmintnoiil. Siiir<K»liim from 
nipliim during ^hvp, and dealli from uhti-ation of the oanitid 
artery are exiremt-ly rare term iualii >».'<. 

Tiii'LvTMKNT. — \ieM, light die), and pmtefaiou. In lli« 
Iteginning, salicylate of iuidinn) (jrr. xx thrice daily) may l>c 
given to shorten the attack. The ammoniated tincture of 
uuaiacum (5ij everv two Itoura) is a very effieient remedy. 
The benzoate of ntlinm ifi also highly reoomniended : — 

$ Sodli b«nxoitt.. S^alv; 

Ellx. caliuy.. U f^.— M. 
Sig, — A tcupoonful every liour or two. 

In Munc I'a.'ws i|uiniue (gr. v. ihrii'e daily) with small doeea 
of the tinetni* of aconite ami tbf linelui'e of l)elladonna is 
an effieient remedy. 

In severe cases opium is often required to relieve pain and to 
prodnne sleep. 

I,ora/ T)eiitmr»t (InternnT). — Pelletif nf iee give nuidi relief. 
The following reniwiies are cflirieul : S:>lutions of nitrate of 
silver, <\ry bi(arlK>uatc of sodinni, giutiae loxeiigM (gr. ij), 
saturated ethereal solutign of iodoform. Or: — 

^ PotAM. cbtor.. gr. xx-xxx ; 
Tine*. Ifcrri chlor., 
Glycerin., Oil \'%!f»\ 
Aqun?. <]. H. aJ fXij.— M. 
8i|L— Apply severvl times dally Kith a caniet'o-hair bruriL 



^Vhen the glands are vmt mucb snollen Bcarifi<atiuu will 
leHscii the |>ain and ot^^n sborteii the attack. When fliiclna- 
li'iD is dctix4vd ihv Uintdl tUiuuld be inciecd with a guarded 

Eitarwd Apptieaihng. —Aa ioe-bog, a poiillioc, or iodine. 

HYPEimtopinr of the toxsils. 

Etiology. — Cliildhood, tito mdiitiv nud tolicixmlar dia- 
lfa«ies, awl rcpiMlH nltiickM (if lu-iile toriwllilix are lh<' prtdin- 
piwiiig caiiFifV. It nwv arii*!.' without nt>vi<Mi.^ iitii«-. 

I'ATUOixxiY. — It innv liciitnio hvjKTtninhy, Iwl in most 
rnManccH mIIrt the ^liiiidulur ■.inH-tiiit' or thp <^>iin<vlive 
liwtiK- prKlumicwit* ; and Iho firnitM^^s of iho gland >i>prT'HM?H 
in pmiK^rliun to lh<r ovirivrowth of the latter. The fiillU'W 
aiT tiflen tlilniiil, and filled uitb Hieniy material »'hic!i n-niilif' 
fiiiiii lhi'int«iiiiiiluiii>iU'f falt_v-(lo;a!en*ratcd epithelium. 
jtiiun ii)r«-ul i-iituiTit and nifinoid growths in the naMi-|>harviix 
art- oflvii a««>riiifd mndilions. 

SyypToJtM. — Difficult sirallowing, moiith-brratliing, Boar- 
ing during tilecii, a thick voice with a nasal twang to it, and 
luahiiitrition. Suflerere are verv prone to acute attacks of 
latarrh of the nose and throat. In sc\-ere caeea, from inter- 
ference with breathing, tlw chcst iiwmnw tlic railiitic tyjje — 
tliat ia, flattened at tlie sides unti bii:^- anil proniirxiit over thv 

PitooKoeu. — Favorable tuidcr prolonged aiid carufu) trrat- 

Trratmest. (ifiural 7W«ftM«i/.— Build tip tlie tone of the 
patient Ity frequent Imthing wilii will wni<T, follower) by fric- 
tion, Ii(;ht g}-ninus(>n', dirp Im-jilbinp, and by thi- u» of 
nutrient tonit* sudi as (ii)d-liviT oil, hy|(opbotiiiibite«, and 
iodide of iron. 

iMtnii Trrtittnmt. — A Bohmoii of nitrate of silvif, or I<ugo]'s 
solution (liquor, iodinit ciini|i.), may be applied freiii>ently' to 
the touMlii : or dilute aoi-tie aeid (gtt. ij.) or a dilute ^dutiou 
of iodine {git. ij.J may l>e injected into tne tonftils. Wlie« tbc 

fllandn are verj- large they •■hould bo remnve^I by the tonsil- 
itome, aciaaoni, or galvano-cautery. Phar)'i^eB] adenoids 



should likfwi^c tx* rwuovixi hy thr fin^T-naii or curette 
whilu tlie jmUent i» wnU-t llic iiifJiK-mr <i( «>iiic Kcwral aiiii:^ 
iJii'tic, or niier Uie jmrts liavc been Uf«t«il willi cocaiue. 


Acute Pharyngitis (Anite " mrr throat" Simpit ungiim). 

Dkfixition. — All ii<;(iu> raiitrrliiil iiiflamntAlioH nf iW 
miK'itiH iiK'tiiltmiio 1)1' till} |>hai-viix, m)II |>alato, nnci uvula, and 
freiitifiitly iL44ooiatixl witti tonsillitU and larvngilis. 

KtioIjcxjy. — Kxnosiire to wild and wet, especially wlim ttw* 
ftyat*'ni U d<4)ililaii:n or Itie [timat is congested frnni iniftrojier 
use nf iJii- voif*. It may l>e rheumatic iu origin. It may Iw 
excited by local irrlLinttf, such aa Itot. drinks or tlie iiibalatioii 
of noxious gaacB. 

Exposure lo infectious fevers, tike nvlatins and meaales, 
may be followed by Rim|>!p |»barj*ngitifl. 

HvMlTriMS. — Chilliness and §l!g1it fpvcr with itt-ib^socinled 
filii'iiitniftkii ; »orcite»; in tbe throat, puinfiil di^Uitition. a wn- 
^tion of dryiK'Mt or (i<-klinff, with u hackit)g coii^h ; stJdiicss 
!ind tfiiik-rnf^s uf tlic niiii«'lts of tin; nwrk. Kxtonisioti to IIk- 
larynx may cuiuar lioanniw^w ; to 111* wr, liimn^)) thi.- Kin^ta- 
cbiun tube, dmftKwt, liixficttlioii ntvt<al.t a ix«l mid i^wollfii 
Ti)nii)U» iiR-mlirtme. 

\'AltHTriFS.^-(l) SimjJf ; nTii^iii/ni by tin* alH>vo ftymp- 
tomn. (2) /rt»-inwi/i> ; rii-ofriiixiil by tin- bislory, iiilciiM: tiaiii, 
and stlftmsii nf iln- nuM^b'H, witliont iiiiii-h L-ltnn^ tii tlio lornl 
appearant^e. {:t) FiMkufiir ^ t\tf. miK'oug nn-mbrane is red, 
swollen, and wivenKl with wliiti^^b spols wliicli rejirvsenl rp- 
tMiird secretion in the inllnmed follifl«<, (4) Jnfivtio*w pharyn- 
gitis is tJie Jbrin aitivociated with the infections fevers. 

Pitix I -Vfisis, — Favorable, 

Tiiti.viME.sT, — Liyht diet and avoidance of exposure. Hot 
drii)kt>. foltowrtl by liover's powder (gr. x), and a Haliae purge 
will sometimes abort it. 

Tiiirture of aconite (gtt. y) w"''' tincture of belladonna (gtt. 
v) every two liount is sonictinics useful. In the rheumatic 
form the Kilicylutv or bt-tuoutcof M>diuni is very effieient. 




Id sJDipic angina Pqiiwr rvfjommwuU : — 

IJL Potnss. chlonit,, jlss-y ; 
I'olBM. hromid., 3*8; 
Exl. iM'ilnddTiiiii:-, gr. iij-r ; 
Syr. linicinis, I'.^j ; 
Synipi, q. H. ad rjiv.— &L 
Sg.— Teaspoon All thrlcu dailj'. 

Load liemeilkn, — A st«um spray, pelletfi of ice, a gatvle 
of cliloratc of ]iota«<^iiiiii {'^t. x to f5j), the upitlkatlon of a 
wjliiliitri of iiitnik- of t-ilver fgr. v to f^j), or loitcDgee of 
ux'jiiiii;, <'iil<<riili; of iiiiitiioiiiiiiu, or ckloratv of polawitiDi. 

Cliroiiic Fliaryngitis. 

ETloi-ix;Y, — t'liroiiii- "sopct tliroat" iwukIIv itsiilu from re- 
pt^ik'd lu'iilo uitu(-i(M. iitijmnKT iiw; of tlic voice, or tlie oon- 
tiiiiioiiH ndioii of irrit«iil.>, like tolwuisi Miiukc. 

VARlhrriEt*. — (I) HyiHTtroiiiiii.'. (2) AtiiijJiw. (3) UI«?r- 
utivo. {4) FlilrfiiiKiniKiis, 

SYMPToiitt, — The vwioi- i» Kiisky ami its use is tbllowtnl by 
(lirtiVA* ; !«eciviioi» is iiK-nu'tcil st* llint lln-rc w ii foiistaiit d^sirti 
to drar the throat ; (lisa^rcc-Ahlo fteiisatioiis, »» fiiliK--^, ti<-kling, 
«n<i ihe liko, aix! frH[iieiilly noted. 

In the hipi-iinrfihirr fomi (^i^anular Boiv itinml, vlurfjj- man's 
ftiin: ihroat, chrooifi folUnilar |iliaryn(jitiH) llii- iiiiKvn» in«m- 
braiie is thick, swollen, tmversttl by (lilut<'<I \f\an, and 
Httidded with numemiiH elevations whieli are (i>in|)OBed ofdia- 
tended follicles and overgrown lymphatic tiwme. 

In the atrophic ffirin (I'haryDpitis Sicca), tlie mtlcou.'i mem- 
brane is pale, smoolli, glotey, and ilrj'. 

{'/eerali>:f I'hari/v^ilis, — Ulceration may be due lo »iinple 
inflammation, syphilis, mberculosis, cancer, Inmis, 

PhlfgmoHom iftar^tfilia {Hetrophaiyngfat ah»eeM).S\X^ 
pitrativc infUinimnticiii of the rctropiuiryD^eal connective tissue 
may occnr oa u miuel to one of the infcctiotm fevei^, or tdhy 
be due to c»ri<t> of the LT-rvi(«l vcrtcbne, or to tiic impaction 
of a foreign Iwdy. 

It may l>i> rwogiiiaed by sore (lirmit, weak voice, difficult 
dt^^lntilion, aiid lite n>snlt» of n di^titiil examinulion. 

TttKATMEST. — Chroniu phar^'n^itis do(« «wl r<.i<itU»>mticli 



from exMSMVe (t* of Hw voiw as frtuii ilfi iiiiprDHor use, aitd 
unlil this is oorrectM] no tnalmeiit will be sucet^sfiil. Pa- 
tients should be iiiHtrudcd to expel souitde bv iIm* aid of tlic 
diaphragm and abdomioal niiiscles, instead of the roiiaclen of 
tbf tiiroat and larynx. The habit of hawking and M^raping 
to clear the throat must l)e rijiidly interdicted. The intient 
must giiaH against moutb-bivalhiug. Sjx>nging the neek 
night and mormng, fii'st with tepid, llten with eold water, will 
rciider the ihrual le»i iicii<;itive. Tliv gciKnil health will re- 
<]iiire attention, attd HH-h touia» us iron, quinine, tttryehnine 
may be very u«eful. 

IjDdil Irfiitmrnt.—ThK n.i«o-pharynx »l>oiild be kept clenu 
by fnijtH-iit i<)iniyii>g ur<lou<'bing witli soiueuuCist-plic sulti- 
tiun like llie following : — 

5 Sodii bicarb.. 

Sotlii Intionl,, SA gr. xx ; 
Aciil. <»rbolio., gtU vj ; 

Glycerin., (Jvl ; 

AqiMC, q. 8. im rjvj.—M. (Doiuii.l,) 

Tlie na.'tal Hiamber^ ftltould Ik! iii.4[ic<:t()d aiid any oxititing 
diMflw tn-alnl. 

Astringent app!teation.-< areoflcn uwful ; Aolutioit.'i of nitrate 
of fiilver, fivo or ten per cent., .sulphate of zine, or tantiic 
•cid, ten to twi^nty per cent., may be employed for this pur- 
pose. Lympbatii! hypertro|)liiea aliould ne removed hy the 
gal vanoMMU te ry . 

lietropharifnutnl abscesses will require evactiation and treat- 
ment directed to the cause. 

Ulcerative pharyngitis will require approi>riate constitu- 
tional treatment, and ench local retitedies as nitrate of silver, 
iodoform, nitric acid, etc. 


Vabietib!, — (I) Functional obstniction, due to sfioHni 
(cesophagismus), (2) Organic olistniction. 




RnoijfXiV. — Fomale sex ; iktvoiib temjMjraniCTit ; hvBtoria ; 
peBox irrituiion. ft may oi-cur nc a flvm|»toni of hydro)Jiobia, 
tetaniw, mii! organic «*()|iliii}timl iiti«trintion, 

SvMPTOMwoF J=tM!-i.i:<l->"PHACJKAi. Spasm. — r^mxvBma) 
dvKphn^K, often aBsociulpil with a flense of conslriflion m Uie 
cticvt : Til(l« or iw lutw of fi(«Ji. Au (esophageal bougie cut 
be \wmfl without miiiJi difficulty. 

UlAr.NowiK. — The i^ aud sex of the pati<?nt, tlic parox- 
y»miil ifi:inK'tor of the obetnictiou, the ability to pass a bougie, 
thf alu^ncc of wasting, and the abeeiice of any o(her cattae, 
will feervf to !*«'pairatc it from orjianic obstrtirtion, 

Prognosis,— Good for life, but indefmito as regards dura- 

'I'keatmknt. — S?arrli for some exciting cause utd remove 
it when ptsiblc. The trratniciit is larpelv dietetie. hyKienic, 
and nioml. Tonics like iron, urM'nic, und (iiiiniiie arv uftcn 
imlicud-cl, attd may be <y)nibined with sm-li ant!spusmodi(« as 
vakTian, a^f<r(idn. or i>un)btd. Ttii> syslt-ntatie poMagi^ of a 
bongi<' may be of f^nfit vuttiv. A mild elMlrioiil current niny 
b« applictl tlirou;;li lite bougie. 




Ktioi-cksy. — (1) An external tumor prr««n^on ihe osuiph- 
agns. This is most commonly an anniriiim. (2) A tumor 
growing from tl>e oesophageal wall ; generally a mncer. (3) 
A rieatrix, from uleeralion. The tiloer may Ue <Ine to syjih- 
ilit or to eame corrosive poison, as a strong aeid or alkali. 
(4) A foreifto l)ody. 

Svuiiirtis, — A elowly increasing diffieutt)' in ckglutitl 
with lliv n-gtir)^tation ot food. The cefiophagiis is oficti mii 
dilat«-d ai>ove the conHtriction, and the food may collret in 
puudi ihiK ronnc), h> tlint re^uyitiition may be delayed 
sc^'t-ral hour<. 'I1ir pHK>«|::i- of a l)o«igie meets with a perma- 
jHiiI oU*trii(liiin. Thei\r i.' imiJi l.iw of flesh. 

I>iA(;x<isia, — The history of ■yptiili^ or lurrfwive [K>imnin|g 
will niiggistt a cicatrix. .Ani^uriMiinl obt<tnicttou can usually 





be detedetl hy ]ihysM'al cxiiintnntion. Amiirtsm should be 
oxdadMl liefun- u boiigii' ii^ [mi'Mtl. The hj^-, cachexia, pani, 
mi<J invulveiui-iilof oltiv-T tirgaiH will iiKlKTultt uniiticr. 

PntKiSOBis. — l>e|n;u<tH on tU<-- laiiw. Il is iinfnvorahli.- in 
auitirisui ttiid tviiver. In ciinlricial ooiitrni-tiuu the olmlruo- 
tiou may be ovun-winft ior »ii iiuletitiite |>i*rio«l. 

Tkkatment. — Aik-iii-ii'iu: l'ru!"iig<-(i n><, iiwlmlwl did, 
;iii(l]>i>t»s.-'iiini tmlMe. ('imtridal u>ntirad!oii : Kystciiialii; «)il- 
iiialioii with gr.wliialetl IjinipPt*. f'anrer: In tW c«rly Mitgi*, 
l!ii> (niitjoua use. of a buuffic is ailviaal>U>. In advaiiml t'ttws 
till- }tii(i<!nt may he fed tlirougli a tube, and wlien liiLi h no 
I'lnger iioflsible, life may be prolonged for a short tirae by 
m^tal alimentation or by fwdinj; through a gastric dstula. 


(Acat« Omtrfc CAtanh.) 

Etioixkjv. — (1) luj^iwlion of in'lijn^tibk- fwA, wpocially 
when followw] iiy cxjwsiin' lo imIiI iiihI ivt-t. (2) Toxic Mil>- 
s(»mii9t ill cxiTrt^iis aldiliol, stnuij^ nciiU, uixl allinlitTi«. (3) Il 
16 mi ai«w.'tiiiul mndiiion in <-<.-rCiun infeutiotu disuuse^, tn ycU 
low Fever, ni<^«lcH, and'scarlet tevci'. 

Fatwh-OOY. — The munon.t inombmnc is nil, swollen, nud 
<M> witli thick nincuii. It is s^imotiRu^ tlio ^oal of <MvJiy- 

SviriTOUs. — The syniplomH vary mnch in d<^ree. In se- 
vere eases there may !>e m^iderate fever (U)2''—UKJ') ami itsa.>oo- 
CHit«ii phenomena, with anorexia, I'oated toiigtte, inleniiG [tain 
IB the epigSHtrinm, which is tender to tlte touch, ix-rsisumt 
vomittOK, thirst, and coneidefable pro^ration. Jaundice may 
follow from the exteiifimn of the catarrh to the bilc-ductii, and 
diiirrliii<u from its cxteusJon to the intestines. 

IllAciNOsii*, — It may resemble tiie onset of scarlet fever, but 
tile history of «ints);ioiv. the " i^tniwbprry tongue," sore thi^Kit, 
very nipi'l pnW, and crutilion, eliarai^erize the Utter. 

pKOGSosis. — UMually Tuvorable; it mrely lasts more tliaii a 
few days. 

Tkeatmest. — Absolute rest. If tl»e stomach lias not been 
tv>nipK-u-ly cm]iti«d, tin emrtic KtK-h as ipecac may be employed. 



[>x»lly, a mtutAnl )ilsst«r or a tur[)en(iiie Mugtc will aid in] 
n-lk'virij; the dirtn-s*. In sevi^e coaes no AwmI aIuhiUI Ijej 
uivcii 1))' tlin nioiilli until Uie stomadi becoinies retfjiti\'<'.j 
Itiinit h1i<>iiI<I In> iillayf-d with cfBck<d ice. I.aicr, miltc witb^ 
linii-uatvr (a l«iti[)i)onlul of «u;h) may Itc eiven hmirly, aiuij 
tliii' may ))C rollQw<>d hy liglil bmlltii in Mmitar qtiautitia*^ 

I'erHititoiit vomiting may tic relieved by small dmi^ ul' calo- 1 
mel (gr. jtj), bismuth (gr. v.-x.), carbolic acid {gtL J- j), op J 
wii»e of )|X!cac (gtt. 1 ). 

llvilrnrc. clilor. mills, «r. j ; 
Biaiuiitl). auljuiL, aJ.-OJ. 

FL in citurl. No. xij. 
Slg.— One every liour. 

Or, . 

I) CrcuMti, gtt. iy ; 

Bifmiutli. aiilnilt., ^j.—U. 
FL in cbart. No. xl). 
Glg.-'OMi every hour. 


^ Vin. Ii)ecac., 

Tliict. nucla vom,, && (Sj.— M. (Pktfbb.) 
'iHg.— Two dropH iu water cvcr^- two bours. 

Scvi-iv [Ktin atidiilinliiinttr voiiiiliii)^ will often yii-lit to opiiin^ 
iu the form wf huiiicwituriiw. Tims : — 

^ I'liiv. opii, gr. vj ; 

Ul. tlicobroni., <[. %, — M. 
FL Id auppOB. No. vj. 
Sfg.— Obo every three hours. 

Tuxiv gustritiM will roc^uirc iu' addtliun njipixijiriutc- unti-^i 


DcFlKtTlox. — TIk- wun! <lys|i«|]eta menus ill digestion, and 
ia aii)ilt4?f| ton group of iiymptonui wbioh anx)Di|>anies every 
disca^ of (III- nUxiiacti ; wiiirn, liowovtT, tlic- iiymptoDu depend 
(HI nothing more than eimplo al^Mty, bypcrson^^itivcoees, or 
chtMwic catanrfi, the patient h Raid lo havi- dy8[)cp«ta. 

CorrespoiMliug to these conditiouH, ibrec varieties have 


been m'^i^ninx), viz.: (I) Atonic (2) Nervous, und (H) 
CUarrtiiil <)}Hi)cp«ia. 

ETiouxiV,— (I) Hflr«iiiv. (2) All vtw-i'ni! dtst'nw'ft, ns 
linirt, liver, nun kiilnov diiiease. (2) Ovorvrork, m«Ht»I or 
|i)iy»ii3il. (4) (iafitrio irrilantfl, an t<«, raflcc, am) aU-oliol in 
fxi-ww. (li) Dielette errors, wliiob incliid*— inftufficioiit nia»- 
tii^itioii tiitiii imd teeth or iHirricd eating, too riiiich futxl, in- 
.Mifticii-nl t"of«), poarse or im|»ni[>erl_v CT>f>keii fooil, excrasive 
dilution of tbod witb liquids, cxoeee of coDdimeuls, and irreg- 
ular eating. 

SyjirTDits op Dtsi'EPSIa. — Coated tongue, perverted ap- 
]»etite, fulueiM and distress after eating, eructations, flatulcuoe, 
" he:irt-biini," ]ial{>it4itio», lieadacbe, vertigo, disturbed slovp, 
and Ia«iitude. 


f'liABAiTKKihTic Syjiitom-S. — The tongue is pale, omted, 
flabbv, and to'ilh-tiuirked ; the ap|x-lite in loi^t ; there isaseuiie 
of ftiltHttsand dislrcMs uv<t the i!ilutua<.-h, isoiiie time atU-r eating, 
without actual jmin or lt-iHl<.Tiivi<«. Thu buwrls un; tvuHlijuited. 
Tliero K muoli tlatulcjicc. The palJcdit is jnde, the niuKclut 
are m(l, tl»c pnl.ti'' U waxk, mm] th«re is great lassitude. 

I* BOO N'(» IH. — ( i 1 11 >d . 

Treatment. — Th<? di<>t, must \» carcftiUv regulated, iind 
rk-li ukI heavy rinwl rigidly interdiotal. Tin- liygieniv snr» 
roundingi«uia4t be ao uitxlificd that thit general cotidttioD ut' 
ihe patient will l>o improved. Toni<s like iron, qninim-, and 
Mn'ehnine are often indi»ited. Dilute mineral adds with 
|>e|t4in will I>e refjiiiretl to afisint ihedipr-slive prooesfi. 

Purgatives -ihoiitd !» avoid*^, and a>nMi[«ktiuu relieved by 
diet, mineral waters, enemas, or luippoeitoriee. 


'n»ia type iisually ooeiirs in those of a distinrtly nervous 
lr'iu|ierament, and excessive mental strain and dietetic «rrore 
arc potent etiological favtore. 


Characteristic Symptoms. — Tin* |ik^i« is often cimn. 
Tlio appelilc i« vcn- tri>-gii1nr — nl oni> lin>e i( iti lost ; at an- 
othiT it is tuunliiistv : at Hiwillior it U )>crvt-rti.^l, the; jtatienl 
cravJDK nn uiiuultim) ttiH. 8evore rain in a pmtiiimiit >irm|»> 
torn wDK-h JM apt to npixar when the sloiu»;h »4iiiptv, and 
to bp ^■lt«^•wi w ('siting. Tlie li?rD» ga£tra%ta is aj)|)fi«l u, 
this |Ni>li. \'uni)tii)g U not mmman, )>n( it may occ-iir wtwn 
tli« etuiuacli in ftitl ur eiu|ity. Tike gaitrio m-klity may be 
normal ur Hiiliiwrinal, Ittit it in often excessive. 

Oliii^r iicn'oii^ plienumviia are oomnionly present, such as 
tidulai'lio, verliw), distiirlied sleep, faypoohaiHlriasis, n«iirnl^ia, 
[inipitnlion, aiM iM^n'ertod eeDBations. 

I)iAf;N<inis% — n»e history, nssodated nervous phenomena, 
lilt' lime thai the pain ap|K?an-. the periods of conijilettt rcliet 
tilt- ali«nw of hemorrha);^', wichc.xia, tumor, anil local lf.t)(|pr- 
neas, are the chief diagnoetio poiut«. 

I'lKxiNOtiri. — (iood, when the cause CHO be removed and 
thepatJent thoroughly controlled. 

Treatment. — The avuitlBnw- of excitement and cxocssive 
mental work mtist be enjoiiKil. Aii extendtrd voyage may 
i-ffitl a turn: In hmin-w<irk(;ri tin- vuliic of iicK"lar pbysim 
fxen-i«' ami frit|Ucnt batliii% fii!ioH'<'»l l>y fririion of the shin. 
<nnm>t be ovciy*lJiiijileiI. On iho other hand, the nitiemi« and 
cxhatiKN-il may iwiiiire tho " rcst-amV The lalicnrs experi- 
ence will n*«i?ii in the n^utation of the diet. Tonics like iron, 
arscnii-, <|iiiitini', anil .itryHiniiio arc otlen indicat^-d. Ktr^ 
trieity applieil o ihe^toniiu^i ha.'* ^iven^iKxI results I'epnia 
and minoi'nl ai-iils will lie of «pr\'irt* only in iho# c«ses in 
which exiimioat ion reveaU a laek ofaej<l in the gastric juice. 
In such coBcs Dr. Pppper peconiineiidti: — 

jft Quininir >itl|>1i., (jr. xsxij ; 
3lry<:hiiiiiBT siilph., fir. »■ ; 
And. hvdruvtilur. (lil., (^ij- 
KJL Acid. p)ioi<phur. <llt.. fS»i : 
Tr. cantainoD). conip., (^y ; 
Aqun.-, q, s. «d (Jiv.— M. Tiiter, 
Stg.— Teaspoon ful nficr nivals. 




fCbionlc Outiltls. Cluonlc Oaacilc CaUnb.) 

Catarrh i)f the t-tomucJi is oflon a [irinMiry PoiiilJtion result- 
ing from the oniiimry i5>ii.-*« of dj!^i»i-i»ia, hut it* fntiin'iit 
iIcpctxIciKX! on <Jii<1tirl)i.ij t-iiviibtJou rroiii hvurt, lung, uitd livi-r 
iIiM'aM.- shwikl »fvi'r \Mi furgoUcn. 

i*ATiioi/)ov.^ln ihe caily Ua^-x the tnitcouit mvnibranc 
in (iJthy-pmy in i»Iur ami ii)vciv'd with t^iincions iniicuit. 
EcKrhyHKw^^ are olUtn ni> MicnM-o)>i<' oxiLiiiiiuitiuii n.-- 
vc»]« di^MK-ration nf lh« ^laiKliilu* tnitliehiini uiu) itii ovrr- 
l^rowth of the (iitim^-Live lUe<iii.\ In anvawxtl caMS th<! waWs 
may be tliiii from extmuc 3tro)>hy of tfi« glan<liilnr .ttriK-dirp, 
bill iiion- ofleti lb«y are thick, wrinkhKt, and iii<Iiirnt(^l from 
exMS«iv<- ovei^rowth of ftinneoiive ttitsiie. 

CiiAKAiTKHfhTU^ SvMnxMiw. — The I<>R)^iio IS irr<!j;iilarly 
C«;aU?<l, thp tip often red, and the {iQ]>Il[te cnlai'j;;*!!. The a[>- 
[tetite is X'ariahle. After rating there is weight and dUtiysw, 
and often diffuse tendenicBS on paJ^uitioii. There are fre- 
quent eructations of wind and soiur liquid. 

Xausfa and vomiting are frequently present; the latter may 
occur in the morning ou rising, and the ejected material be 
composed of the frothy mums which has cullecteil in (he 
tttomiicb during the night, or it may occur some time after 
eating, and he <^um]x«e<l of |virtiatly-digc)>ted food mixed vritb 
acids of fermentation, «ieh us lactic, butyric, and acetic acids. 
The normal acid, hydrochloric, is invariably diminished tw 
aliMrnt. Tliv Ito^vclfi an- <i)ii.-'li[Kito<J, and the urine is scanty 
uud Ihnnvs down it JKUvy dejxiait of urates or phosphates. 
The nervous [^loiiomcim common to all forms of dyspepsia aie 

Protrat-li'd <»m», with atn>|>liy of ihu giislric tubules, present 
the >iymptonM of pernioioiis anirmiu. 

DlAtiNfisiR, Oireoer.- — After forty, liaiiiat<^inosis, e«chesia, 
tumor, tiieHhort duration, am) the involvfrnenl ofotlieror^ns. 

IJfetr, — HMHiiaIeme.'<is, phiirpiiaiuincn-aai'd liy nil in(f, vomit- 
ing mita after eating, local temlermt^, :ihtin<likn(ie ol' hyJiu- 
eliloric acid. 



Cure raiiNt Ih> taken to determine whether the catarrh >s 
primary or secondary to viawral disease. 

1'k<kis(»81H, — When not dn'iwiideiit on organic distrase of i 
other viscera, tho jiroguosie is gootl. 

TuEATMi;ST. — Cio<Ki hygifnic conditions. A regulated i 
diet; in severe caws an absolutti skimnied-milk diet, or piir- 
tially-digceted fotHlfi. Thitrk mucus and iimligestMl iood ntay 
be removed by tlic stoniach-tubc vrhen its introduction is vteil 
home. Pure or slightly idkaliiic water may be emiiloyed ; 
but when there is mncli fermentation, one per cent, of salicylic 
idd may l>c added with advantage. Irrigation should be 
prncfiwHl daily, or every otlici' day, prcfembly bclorc brcak- 
la^t, and ihc tnbc Khtuild be kipt in [Kxtition until the eis(-a|>- 
iiif' fluid i^ ijiiito cUtir. 

Wlien Ijivage is hot well borno, the patient may lie dint-ted 
to Nip lictijR- lirenklii»t a half pint of wjnie hot ulkiiHne water, 
such as Carli^bad, This is espixrially indieutcd when there i» ^ 

AniHcinl Carlsbad salt: — 

9 Sodii Hulph., gv ; 
SoJii bicarb., Jij; 
Soda chlorlil.. .5J.-M. ( 
Sig.— 3j In a half pint of water Imlf lioar Ix-tini? breukfuvt. 

Dilute hydrot'hloHo lu^id i» nearly always iudicaletl, and it 
may be oonibimHl adwintaj^eously wi(h ix-jisin. 

IJ Tinct. nucix mm., r.l»»i 
Auiil. hyilrochlor. itil., OiiJ ; 
Pepain. aftwlmr., I^iij ; 
Aante, q. s. a<). I^iv.— M. 
Sg.— A teaspoonnil afWr meab^ 

The RatnrHial prwt** in oftvii fiiviirably inflnciicnl by sub- 
nitrate uf iHHnnith, (ir iiitrutc of isilver. When there i:^ much 
fernientalion and HiilnhniT. i*alicyl«t« of biKmnth ((Jt, v-x), 
or siibnitniie uf biHinnlh willi mtme antifermeiit may be ^ 

^ Salol, iir. xl ; 

Bi»iuutl>. feubnitraL, S>a---M. 
FU In diart. No. xx. 
Sig. — One powder liitirnn tiour bcri>rc luenfe. 


(Oiutrodriila, NeiintlgU o( the Stonuich.) 

of the 


ntst&td of salol, ei¥a«ot<^ (j(lt i) may be ndil4?il to eadi powdiff. 
C-oDstipaliuQ ithoiild be relieved by diet, mineral natera, 
encmiH, tiuppoHitorics ut' glyocnii or f^Inlen, or by mild laxu- 
tiv«w. AchI eructations nnd " liwirl-bnn)" nmy lie rclievwl by 
di(:e»lant4 nnrl dtbitv iKtii)», tJtkcn ininHHliat^Iy nWi-r nienU ; or 
by allciiliut, with or witJiotil such antifri'ment^ an ti-cafote, 
.■>aIol, or iiii{tiilUol, lakftii oik or two hotira uCutr menU. 

^f DKPixrrm.v. — A painful paroxysmnl aflcrtion 
' <tUmia<^b, uiiasAocialM) with any ofgani(! IcAion. 

Etioi^xjy. — Nervous tr'iii[>orani«nt, overwoi'k, aniemia, nnd 
(lielrtic prrorH are the ])r«iispoeing taiiafs. 

SvMiToMs. — Paroxygms of severe pain in the ejiigaatriuni, 
usually mdistiog to tbe back, occurring when t)M> stomadi is 
eni|rty, and relicvetl by pressure and the it^estiou of food or 
warm stimulating drinks. 

DlAGNO^B. Gtulrie f'tcer. — In this disease the pain is more 
eontinuoiis, is madi* worse by eating, and is otlen as^KJabed 
unth local tetidcraess and batmatcmesis. 

Chncer, — Tlie agv, history', cinitimious pain whieli is in- 
cressod by oting, lueiniitcnH'sis, ttinior, <^aeliexia, anorexia, 
and ubMence of hydrochloric acid will Bcpnrate vunccr from 

Atffina Ptvbiru. — TImj mdiatiou rif (he [aiin fmm the boiirl 

down tlie arm, ttxalion of the txxiy, fi-ar <)f !m[N>i)ding di-ath, 

a»d tlic asitoeiattii i^-muloms of ntty heart, »n(-h an »rcn« 

Kenili*, rigid rndiab, aixi nltcred hcart-soniMiR, wilt ^panito 

angina jxylorH from ga.-Htralgia. 

^M The iimeinatinf/ JMUHM aj locomotor ataxia Aomolimft^ altiirk 

^Bm* slomaeh and produce what ari> tornti'd i/mdrie eri«f». 

F These can be difltingtiir'hed from simple i^'a.Htntl^ia by (he 


al»enee of the |>alellav n'Hes, by tbe Ai^ll-Uobertayn pnpil, 
(he loAB of coiirdii 
parls of the body. 

by t 
the loAB of coiirdination, and by jKimxysmal pains in other 

I*B(XiNU8is. — Favorable, but duration indefinite. 


TttKATMrNT. /Iffoot.— Hot fomcDtaliong shoul<l ite ap- 
pliiil kKTftlly, and Holliiiiinu'** luiwdyne (3s»), diloroform (git, 
x), (liliiU* liydiiK'vaiiic iidd (gtt. ij in !int water), or the follnw- 
ing mixtiiiv nmv Ik- ^iv<'ii iiitcrnallv : — 

IJ: St)^ viii. gaL 

1 iijct. Qpit campb., OS tin ; 
Ul. caryoph.. Rtt. X,— M. 
Sg, — A t«a)!ipoonful in hot iratcr. 

Tu aeveiv rases moriihia will be rE^uii^. 

The Interval. — Correct tlie hvglene, regulate the diet, aadl 
enjoin rest. Tinvel may Iw exlrcmclv valuable. Xeurad- 
tlivDia may require the " reet-cure." "foniw are o(\cn indi- 
cated. ^VheB there is hy|)cra«dity, sali«ylatc of bismuth, 
carbonate ofsuda. or aromatic spirits of ammonia, after ni«di>, 
may be \T>ry lierxiceable. Anwni<-, valerian, ami dilute hydro- 
cyanic acid arc remedies of great value. 

^ Sodli arKDlnt., }.t. n: 

Ext. cannabis ind., gr. iij.— U. (DaCo8TA.) \ 
FL inpil. Mdl XX. 
Slg.—One, lliree ilnies daily. 


[Simple Dlcoi. Pufforatiiie Uloot.) 

Definition. — An ulcer arising without obvious exoitinffi 
eauire, but wliicli ia probably due to the digestive aetion of] 
highly aeid gastric jnioe on a part of tlie stomach whose nutri-j 
lion has been impaired by eork local disturbanee of (be dr-j 

Etiology. — Female wx, age (between the fiftfeiitb and tlieJ 
fortieth year), overwork ^vitli poor foo<l, and anivmia arc theJ 
ItnHli^prjsiug (^uses. 

I'athology. — From some local distiirlMncc of tbevinrula-^ 
tioii— injury, hemorrhage, tiirumlxjiHH, embolism, or r>[)ai^m of ' 
tJie vojscU— llic purl is scll-dise^lwi. 

'Ilie ulwT ii* round ur ovnl, n^tiially ttituaicd at the pylonw,] 
on the [»M*tt-n<>r null, iK-a,r the l^•^»l■^ tnirvaliire. It has a] 
|>unelietl-(>iil apiM^ranoi', i.'< cxiiiical iu i^ia|K-, with U»c «l>exj 
towards tliu ]N>ritoueum, and \» without au iiiHamniatory aroola 



The floor of tlie ulcer is m^uully siniwlii. mwl nmy be (iirtn«l 
by iiiiy <>iic of the «>at« of tUv :'U^tiiiirli. A M-n>^ of iiltfrs i» 
Hot iiiironimon, so that inorc l.liaii one may be cU-U-oli'"!. 

Symptoms. — 'Die gciiei-il :<yiiiiiIoni!i of <lyi<{H-{«ia ; t<»8 of 
Hc»h uinl Mniijith ; and ihc following (rharauterbtio aymp- 
toma : (1) Scvi^nr |iiiiii, iii<'rt".tM'<l hy tating ; it may nuliate t« 
tho Inu'K ; it niay Ik piiriixysiiukl ; it may he worw in Mirtain 
)>a-«itiunK. (2)I»»il ti-iuli-nuw.. (It) iVrwUtoiit vomiliiiK after 
taking f(>od ; the ga.itmr juiii; iHunnaiiiratly arid. (4) llemor- 
i-hagt^ is common ; it vari^ii in amount from a Uave of blood 
to a r]uart or nl<>^1l^ 

111 some co-icft only the 8yni)>tuniH of dys{)e|K>ia are present, 
while in others all symiitoius may be abeent, and in the latter 
iifiiioirliage or perforation may lie the firsl indication. 

KvK>'ra, — (I) Iii?solution. {'/} Death from exhaustion, 
hemorrhage, perforation and [(eritonitie, or pyloric obstruction 
from rjratricial contraction. 

BlAUNtJBUi, (hnetr. — The age (after fortj-), hislory, down- 
ward course, short dnration, extrcuc cachexia, often oitt of 
proportion to gastric Bym(>toms, tumor, al«T«icc of hydro- 
chtorie acid aDclblood [om \a amount aiul more disintegrated. 

GtulrotffUt.—Thv puin usually appears when the i<lom&eJi is 
empty, and is relicv<id by foot) and |)n»siirc; uo kemorrhagi-, 
no Jock] tenderness; other nervous phcuomeim are commonly 

Okronic Gattriliii. — Heitwrrhap; rare, U-iulem(w» difluw, 
[Ain ](>«» ninrknl, vomiting h-^ fnxjiient and jMr^tiiteiit, gnittrie 
imidity lufs thnn normal. 

pRooxosiB. — (.Jiianh'dly favorable ; sin^i ooniplicntions a* 
hemorrhage or jK-rfi>ration may occur witJiout warning, aiMl 
ivIaiMcs from new ulcers are not uncommon. 

TitKATMEJiT. — Atisolute feet in bed and rectal filling. 

I^ater, and in less ses'ere cases from the Ix-ginning, prc- 
digcsted milk, milk aiul lime-water, buttermilk, broths, soft- 
boiled egga and preiai-ations of eoni-stareb mav be given by 
the mouth at regular and frniueot intervaU. t'his restrii^u-d 
diet shoutd l>e continued for eij^it or ten weeks, and the return 
to solid food should be quite gradual. The more eompletr the 
rest tile more rapid wiU be tiie cure. Lavage is oontraiadi- 



I cated, but lb<> stoinach roay be clttttted hy thn eipping of hot 
alkaliup water in ibe morning bofore brvaklwd. Iii(criu>Ur, 
subnitntte of bifimuih and nitrate of nilv«r are iivcftil rfrnKilia. 

9 Art^oti iiitnttt)^ gr. r ; 
Exu iij.-M. 
Fl in pil. Xt>. sx. 
Slg.— On« pUl tliricii daily half au hoar befcn umIb. 


% Btamnth. snbDllraL, srj-Sf ; 

OrauoC, gtu X ; 

Morpiiin. Rilph., jr. U^—V. 
Fc in chart. S". sx. 
ifig, — Odu pomler bcfiMu meftl*. 

InBtewl of moqibia cocaine (gr. ^) taaj be added b> ndi. 

\\Tien tbere is much pain counter-irritation will Ije of «r- 
vio?. Hcuiorrbugp will n«iiirc abstilute rest ; morphia (gr. J) 
and fiuid extract of enrot liy|MLMk>niiicall>' ; aa ice-b«e t» thv 
stonud), aud ptJlete of Ux und tannic tictd (gt. t-x) by tbe 


VAlilKTini. — 0) Hard cancer (sdrrbus). (2) Soft cancer 
(medullary or eucepJtaloid). (U) t^ltbelioma. (4) CoUoii) 

Eti<h/)GY. — Male sex, a^je (after forty), heredity, and nloer- 
aliuD of the &tomai-)i arc pn.-*lis[x><iiig catisee. 

I'ATlloixMiV, — Caiici-r of the stomach ifi usiiaily priinun-; 
other oi^ns being involvH iwcondarily. The K-irrhoiis (brm 
is the most oommou. As the pylunu is tlic usual scat, gastric 
dilatation is a nnlural sivpi«nvc. 

S^TiPTOMS. — TIk- gvnenil symptoms of d_\-spraeta, with ibe 
following chanct«>jisti<.- symfitoins: Continued |)aia, oft«o 
temk-nM-M : vomiting of )iarliaIly-4ligT-st«iI food; ahsptxv of 
free Iiydtwhloric n-id in the gastric jiiiiv (conlirniiilorT luilv); 
lurni»t<niK»8, tlic k«f being usually '''li^bt, and (>»■ blood so 
s]l«rcd by H» gastric juiw that it pn>»enta a " cofflce-giwind" 
apptaranoc; [imwnoeofaturaor; loto of flesh and atmigtJi ; ex- 
treme aiuemia ; iuvolvemeot of the superficial lymph ^landa. 



Whpn the pvlonift is involved, svmptoniH of caBlrici dila- 
tation will \k aad«d. Tticao iitv : VoDiiting, after tlii? 1h|wc 
of severa! houre or days, of large quantities of rermcnted ma- 
terial rich in sarcinie vcntriciUi, inmeaeed area of gnstric tym- 
jiany on |>erciiaBion, and a reversed |)eristaUi<: wave on inspec- 

plARKoeiK — ^The differential diagnosis of gastric caiKcr 
from uluer, gastralgia, and chronic gastriltn hao alrmdy been 

I'KtKiNosis, — Absolutely fatal. The duration la from six 
months to two years. 

Tkeatmest. I'nUintive, — A Ii<)uid or semi-lintiid diet. 
Rcj«t. f lydrocbloric at-id and pt'iiiiiii lire often required to as- 
sist digestion. When the stoniwli i^ dihUtl lavage may give 
relief. Pain should \k relicvctl l>v m(>q>hi». The other 
sym|>toni6 will require llie lrii>tm<'nt imliaiu-d in gaj«tric «i- 
tjirrh. At pre««it, oiK-nilive iiiterfereiKv coulil scureely be 



RrHll/MiV. — Tfif iviti/mt o/ fixitfiric obMruction : (I) Pyloric 
tumors, UfiAially nudignant. (2) Tumors of adjacent vi»)era 
pressing on tlie pylorus or duodenum. (:S) Cicatrix of an 
Jeer. (4) Fibroid thickening from chronic catarrh. 

Pyioric obstruction increases tlte resistance offered to the 
ipulsion of food, and in its efforts to overcome this, the stom- 
ach first liecomcs liypcrtruphicd and then dilated. 

CoiUfg of I}il<dalii)n nf thi; ^otnrich (Gattrcetasu).^^]) Py- 
loric obstnicliun. (i) lti.-laxalion of the nails from simple 
atony or calurrh. (3) Excessive ingestion of food or drink. 

Symptoms. — The gciR-ral symptoms of (lyspepia, with tlie 

following e)iAmd<.>ri»tH; symptoms, must of which relate lo the 

amit: Vomiting occurs long after eating, sometimes »v- 

id houre or duvii ; the nmouut is often excessive, sometinm 

tvcral quarts ; it is sour and fermented, and on standing w-p- 

«lu) into a Hedimcut of undigi'sU-d tuixl aitd a »upcniataut 



lifjiiid, vfUkii k Itirbkl mid frothy ; tlic vjuc-U'd materia) r« ndi 
in toriilic and !<uroituc v<.-ntriciili. Tlicrv iti obstinate ««jn»li)>a- 

Pig. 1. 



a. Sairlnaienlllnill, ^ TnruUnrFildv. 

Phybicai, SI(l^•M, Inmeetimt. — Bulging ov«r (lie cpi^- 
triiim ; in thin tmbjeeta tlio oiitlitie of the etomach may l>e 
visible. Sonietimeri a pcrislaltip wave i« detected. 

I'alpaii'm. — h splashing fmuinis. 

Perctution. — Increased arwi of p»¥tric ivmpany, Ariifir-ial 
diiit<-nliun of tUo stoniacb with (Tir(H>ni<'-a''i<J gas, evolvwl liv 
the adniiiiiHtratioD <»f tiicurbrmatf of bihIb and ianaric- acid, iB 
rarely iM*««an', and is Eomctimee Iiurmful, 

Ausfulliition. — Splashing soundu. These arc often audible 
at siinip diftfajire, and henot- an; a frwiucnt wurce of annoy- 
anw to llie patient. 

MenKunitiim. — Xornially an fi'S(>p!ian<^d sinind may l>c in- 
sert'it a dL-tanii' of t>0 ctm. fruni the tc^th ; in dilatation it 
may lie iaserted 65 or 70 ctm. 

i'tuMiNWiN. — Depends on the cause; it should always be 
guanUnl. It is more favorable in dilatation without ohstriic- 
tion. In cicatrieial conlnw-tion ogtenitivc interference hasffivon 
fair results. In cancer the prognosis ts ab»olntely unlavor- 

TitKATMKNT. — Tlic diet Hliould be light and nuti-itjoiis, not 
bulky, and should be given in small nmonnttiat fmiuent in- 
len-a'ls. Lavwo pnictiR'd two or three times weeKly is of 
great value. U cainocr llie tnwtnient iri jMlliative. In fibroid 

a)S!m PATTON. 


thi('keini)}( mill dcnlrioial <i>niitri4'(i<)ii, dilalatinii of the pytoriiK 
(l»i-f-ta'ii DjH^ralioii) (ir lli<- t-^ttilili^htiu'iit of a g«Dlro-diiixl<'nii) 
lifltiila may he Riiggt^u^. 'rtirM? ogwralions have ha-n (airly 
Micc«i«rul. In flirajilo dilaiation, tivnl die catarrti ai>d apply 

I nMaBage and olcdrinly ; t)ie latter may be applicf] to the in- 
I«?rior of llie stomaich hy means of a hijMilar »tont»ehal ('l«>- 
tvode. (Kwkwell.) Toii'ms, e^()e4^ially stryc-Iiiiia, are often 
valuable adjuncts. An alxlominal 8up[)on often relievm eonie 

^t»f the distressing syni[)<oms. 


^f ( Ga*tion bacia- ) 

I Etioiogy.— (1) TrBHinatism. (2) AcmU.' giBlrHia. (3) 
Ohi;tractioii to (tw oirvtiluliiiii, «.* In chronic htxri. Iiin^, una 
livtT tti(iuu<«. (1) VioarioiiR inenstnialion. (/>) Blood dy»- 
cTssiii, UK in (arnrvy, iiireflionH ft-vt^re, grave atucinJa, jtiirpitm, 
etc (6) Knplim- of an aiieiirUm. (7) CiaMric ul<K;r. (8) 
(iK.'itriu ■ttiHi.-r. (!>) Swallowing of blood front now, nioulh^ 

Kr Uironl. (10) Hy^'ria. 
I>iAn\(xiiA. //tmui/flN'ma. — Blood Is often clotted uid 
lixf'd with food, ia acid in reaction; the eubseoiient sIiioIh 
may be tarry, ai>d the a£«>dated symjrtoms usually jmint to 
Ibc Btomai'Ji or adjacent oi^ns. 
j HirjiKptt/KM. — Bluod is red, frothy, and alkaline in reaction, 
the subsequent expectonitionti arc streaked with blood, and 
pbvxical signs usually indicate tli« cause. 

rK>L\TUKNT. — Abmlnlc Tvfi ; ah«<incnoc frotn food by the 

I niouth ; an ice-hof; to the ftontueli. Pc)lct(> of ice may be 

I flacked. Tannic acid (gr. v-x) by the niotitli, bimI fluid cx- 

traet of «f«)t(5s<) »'''h moqihla (gr. )) hypijilcrnii rally. If 

the Itemomiagp has Ixvri ]irol'ii»e, tue mlx-iitaiicjus iniccttons 

I of weak saline twlutions ; give iron by the mouth, sdu advtee 

the UBe of salty broth*. 



•.\n unnatural detention of iaal uiallrr. 


BnoiXNiY. — (1) Many acute and chronic diwauM whidi 
lessen peristHbi* and secretjoii, as must obronic vioceral dift- 



easts, nil nvrvuiis (1i»»M'K, amcinin, nnd tlic iiifec-liou^ 
excqit (v|i)>iiii]. (2) StHlpridirj- ImlnU). (3) C«iu*«trm«l 
food. (1) C<Ttaii> driiK*, «» IvaA aitd opium ; itisannlh-r-, 
eScct »(' Htroiij; piiiyntivt^. (Jj) Atony of tJtf iii(e4inal wull,J 
common in tlic old and dt>l>ittialr<I. (li) Striiliirp. 

SvMin"OMrt. — IiifritjiK'-nt fttooln, dyspepsia, fetid )>pcatb^ 
hetidat-be. veriii^o, la^iltido, una'min. 

^{^»^l.■I>^. — In iiggravaud «f*<'« : d)'.*j>rpwa, diarrhoa from] 
irritation, fo-a) nocmnulalioii, h«iuorrlioids, fisgurc, fistnl 
[imla|>iK of llio rt<cti]in. 

TKEATMi-jtT. — A ix^ilar time for defecation nfaould be ob 
served. Systfiiiatic oxercihe, alidominal oiafiBagc, and elc 
tricitv are valuable aids. Kneouraj;i' Ibe tise of water, bran- 
breacl, {;reen vegetables, and stowed fruits. In mild cwsra a 
glass of water or an orange betiiro bi-caivfast will siiffiw. I!;qc- 
Uiata of water, or glyofrini' (3j-5'v), ov ^uppoeiturivs of glyc 
orine or of gluten may be required. 

Mineral waters, like KriedricliBluJI or Hunyadi, often g\\ 

In obfttinate ca&es mild laxulivLti must be employu) ; enseal 
fingrada is one of tbe best. Tbc dost' of tbc extrnrt is one to 
tbree grains; of the fluid exirad, Iinlf tu u Huid dmdiiu. 

Sometinies combinations are drai ruble. 

9 Aloin. ;:r. Iv ; 
SljTtbiiluw, gr. ii 
ExU bcUtwIonnw, 
Pulv. ipecac, iigr.ij,— M. 
rW. in pll. No. XX. 

[.—One Of two »• re<(uir«l. 


^t Tiilv. rlifi. gr. xl: 

I'mIv, iiloiJH, jir. XX ; 

Kxt, pliyBosltf;., gr, llj ; 

OL caryophyUl, git. iij.— M 
Fl. in pU. Na xx. 
Sf);.— One or two as rciiuired. 


(ZSnteialBi'>T Totmliia.} 

Definitios, — A iwiiilul gjmsiitoilio ttir«;ti(m of the intea- 

Etiolooy. — It uHimliy n-siilw Irimi irritiititif; fuixl, fljitii- 
leati.', or TikhI unriiiiiiil.iti<>ii. U is i^onidiiiu^ rlivuiunltc. It 
tuuy be ivllcx fruni oviirinn or iit«riiR' diHcti,^. It ia ulsoa 
»yiiiiitoiii or k^d-[KHSOiiing, in[«»Unal iiiflaiiiiimtiou,aint iiiU«- 

tiiuil otvlnittioi). 

Symptoms. — Piinjxysiiis of scveiv jiain of a twiiHiiiK i-liar- 
Stct«r, wnturiiig aroiiml tUo umhiliciw, oi>d relieved hv |tn:*f*-tirc, 
Tli« ^xloini>fl iit ii.tiiallv dii4t<?n(le<). Se\-cre attackii may lead 
u> incii>ieDt «olb{«e, iiiaicatcd by cold sweabi, pint^h^d re-atiires^ 
Ificl)Ie pulw, and vomiting. The attaok Jaste from a few 
minutea to aex'era) hours, and usually cods by a dischar^ of 

DiAO Minis. Laid fUu: — History, bint! line on the giiiUB, 
retracted obdomiiuil nalli;, and \viu\ in tliu urine. 

Biliary Chile. — I'ain radiutin); from the liver to the hack 
aod right shoulder, jiuindicp, and aUcuhm in the stool. 

lifml Chlic. — I'ain radiating down the ureter to pcuU and 
Uetide, blooil, mnvus, |hi.s, ormk-uli, in tliu urine. 

Abdomiiutl Aiftu-'J-m. — Tunior, pulMition, fiitul, 

pBOtiSi«i8. — J-'a vorablc. 

Tkeatment. — Ai>i>ly hot ni)pli<»tMiiu to nbdomco, and 
oil mill ister niorph. (^r. f;) with Mulphato of utrogtino (f^. y^) 
liy];()dcr[nicBlly. Suhsw(ueully ojiiploy u sulim: or mercurial 

Ijnul CUw. — l'i*e wiI]Jinie ()r niaf^x^ium a8 a mttinrtjc, and 
iodi<lc of putassiuii) (j^r. v~x, ihriou ^laily) to vliiuiiotc lh« 


I>EFlslTlox. — .\ oonditiiin in which llw i<.toolH are too fn.- 
quent or tiw li'iuid. [<ike dyspepsia, it ii u symptuiu of many 
pathological votidilioUK. 

Etiology. — (I) It results from inflamniation of tb« in- 


tefltinnt, iu> enteritis, entero-rrtlitis, dysentery. {Iiiflaniniatoi^- 
diarrhfca.) (2) It is a Bymptom of certain Infectious dis«niK«, 
as tj'ptioia fever, cholera. (SvmiHotnatic diarrfi<ea.) (3) It i* 
producetl bv ocrtsin dnig«, as laxalives ai>d purgatives. (4) It 
may beancxpr»»ioDoruiclioxiu ocrurriii;!; iw u fiual symptom 
in («ucer, diabck-s, awl ctiruiitv BrichrB disease. (Colliqua- 
tive diarriiaii.) (5) It may be a clusing: symptom in a<^iitt* 
Ivbrik- discatMi! wliJeJi i>na by crisis, as typlius fever, n>- 
mittcnt ll-vcr. (Criti<»l diarrliaik) 6. Jt may rwulc Inna 
IICTVOU8 cxritvinvnl or mi-nsnliminl diMluriwuix-. This is pn>l>> 
ably diiv to a viLM)-motor iMruis of tbc intitttinal vcsseU (an 
itilc^tinal " lilii^i"), mid Itie »ulKtequfrnt ootpouriug of ecnim. 
(Nervous diarrlma.) 


(DUrrbcVB, CatanlMl ButeriU*.) 

cf ftvi 

Etiology. — V\'ariii wcatlicr, childhood, aud bad h\ 

arc gcocnd pn.<(li>i]ii>«iii^'iieii. It is usually c:(cit«a oy 
sudden cliangv in u-[n|H-rutuiv, or by irritating producte in il>e 
iutc^titiiil (Tiitid, us harMh Iih»I, j)(on)ain<^!4, or biu^t-riu. It may 
be liidu<«d by eorrusivc poison.*, n« aniimony, anenic, mer- 

PATBOI/Xtv. — The R1II001H iiicmlimiio, ci^iMvially of die 
iipjKtr boivcl, h injoclttl, .swollen, and c(>\'i'r(?d with Irnacious 
niiioni<^ Tiie solitary ami agmiimted gtandi* are enlarged, and 
arc 80inetim«fi tlic mt^i of pinheati iilceration». 

In chronic enteritis the mueous membrane ia ofU-n tliickened 
from an iivii^rowlli of fonneclive tissue, but in wme instances 
it is unuMially thiu from atrophy of the coats aud dtsirtn-lioii 
of the (f lands. 

SvMi*T(i«s. AcuU: KnIerilU. — Frwjttent Btools, tJipce u> 
twelve or more a day; they are usually of a yellowish or 
KreeotHh color, and frequently contain UDdig:ested food. 
Colicky jiaiits, au'l rumbling uoisea (boHwrygmi), ixxttcd 
tongue, anorexia, and ^ttiietinic» «ll^Iit fever. 

('hrwiii- EnUriti/i. — Kre<|»nit tiiiui<l stooU which varj- in 
color awl fhararter aodjrding to Uic »eut of cntarrh ; mucJi 

DrT£erns*Ai. catarrh. 


Jig*8t«I TikhI (iiiiiU;rj) imliontiv involvement of tlie npjwr 
bowel : jwkI rniiHi mmtiis, iiivolvcim^nt of tho lower bowel. 
The '-xwAMtw <)min UwU tn nini^niia, cniucialiou, unci wenk- 

Kem/trajwiv J^td/i-itiK — Tliis ii-nn luu' Uvii ii{>|>li<.'<l lo Iwo 
ilioiw : (1) A true i;ixmi{ioiih itnU'iilu, wtitch is neexx-uilHl 
with the ronnalion of a false membrane, nnil nliidi is »ccii in 
«U'he<-lic Mslei), in amtte infeetioiii* diapascs, ami as a rcsuU of 
minenil ^(>isoiiiii<r. (l') JIucons colic, or innii)iii4 evliti.-^, n 
fhroiiii: litrin of oolifU, nwially ooaHTJKg in woinwi of a 
tniirltcil iiervo<i--i ttHn|ieraiiieiit, and eharactcrtKcd bv ])ar»xyMii» 
of itevi're |min, and the diiwharge of gray Iran-tlin-eiit laM,-* 
wliivh, Itowever, are not membranou», but mucoid iii ctjaraoun*. 

DlAGXOiaH. Dgngnfery. — Bloody and miiame (lischargrs, 
U-nc#roii!i, grcuter nroet ration. 

JCtttei-oeolilis. — -flioderate (ever, eroater pi-ostration, teudeiv 
IHW along the colon ; sloi-ils eontuiu mucus, blood, sod ma- 
^nel rftitimbling cho|)]>ed ai>iHiich. 
^^PutxiNOKiM. — Good, under favorable comlitionii. 
^^KKATMKST, — In udults. — Roit. Liouid diet. Wh«n 
there is retention of irritating material, indieated by the his- 
tory, t^iarp pniii, abdominal distention, and small HtooU, ad- 
tainistcr a laxative, ax calomel, or castor oil with iaudauum. 

^ Hydiarg. chtor. mit., gr, ij; 
Sodii bi«rb., 5j.— M. 
In ciinrt. Xo. xii. 
I.— One CTory Itour initil flru or six tiave been taken. 

^ 01. ricini, 

Syr, rhci nromni., U J3M ; 
'Tincl. oi»\, t;U. x-XX.~M. 
Rt, if newMary. 

'hen the bowel has been thorongbly vmpti^^, opium, u»- 

tringents, and intestinal ant4septi<;« will Ijo rwiuirod, TInia >— 

^ Biftinuih. subnil., j^m; 
Morpliio, »ul|>Ii., gr. J ; 
Crea*oti, git. vj.— M. 
Ft. In cluin. No. Jtii. 
;.— On« cvnry two liuun. 




B BiMiuuCi). aubiiil., 
Cn-we priepnr., U gij ; 

upli., SU»j 

Timt. opii caiur 
Tincl. kiuo, t^ij ; 
I'tilv, acnuiic, q."; 

Aquii> ciniiiimoiiii, q.n. lul. fjvj.— U, 
6i^ — A tablMpooiifiil vtl-tj UinH- liourA. 

CAnmtc Diarrhea. — Liquid dic^t. Rest. Inteslituil nnUsep-j 
tics (aalu^lale of bininutl), uaplitlialiii, salol), and i>|)iiini wilhl 
mineral astriDgciite. 

Diai-rhaa m Children. — Abwilute cleanliixss. FiwiueBl 
bathing. A change of air, if p.«sihle. If tUe child is b<4tle-"' 
hd, the milk must be steriliaKt and givon at regular intcTvaU. 

If the diarrlicE'a still persisls, millt Bhonid be aiiandonMl, and, 
llirs ditld fe<i for a few days on egg albumin, beef iiiiee, or] 
bpef i«'ptnnoidH. A flannel hinder shonld be applitd to the.1 
abdomen. The bowels i^iould be emptied with castor oil (Sj) 
to which may be added a few drops of paregoric j 

9 Hydrars. clilor. mil., rt- j i ' 

BUmiitli. tAtlkylat., gr. xxxvj ; 

Pulv. zlBgibor., gr. *y.— M. 
Ft. In chart. No. zii. 
St];.— One BVtry hour. 

After Ilii)« has operated, astringents may be employed. 

I) .'^uilii ulk>'ial., gr. xlj ; 
ItUmutb. ftubnit., gr. xxxvl ; 
Pule, aromal,, gr. vj.— M. 
Ft. In ctiart. No. xn. 
Sig.— One every two hnuix 

^ Sodii iHOArlv, ^ ; 
■S}rr. rii«i nromnL, S"* • 
An. luentb. pip., Syt&— M. 
Sig-~Sj ttvcTj two hour». 


9 Bisniutlt. nilniil.. cr. J'UJ; 
Tiiict. opii campti., gtl. Iv ; 
Mial. crotir. 

Aquir ani«i, U 5W. — M. 
Stg.— Emy two hmin. 




(FolUoulu BuWiitl*.) 

Dkfisition. — An influniniatian involving niainly llie 
iliHim ai)d colon, mid affpftingt-spt'ciullv'tlie lyuijiliatic inlands. 

Kti<iia;<jy. — Warm wcatlnT. (.Iiildliuoil, iin|m>fK-i- liKKl,and 
bad liv^ipnp arc |>re<liB|>osing futture. 

It uBii!illy follows caliirrlitil <-iik-riht- or <-hol(-ia inlaiiciim. 

I'ATHuUNiv. — The uiucutis nii'inbratK \a red, bhuHlii, and 
•i-d^natoiis. Tbe solitary and n^niiiiiktl glarnb arc swollen 
and ofU^M ulcerated. 

SyMPTt>M8. — Frrativut 8tuol7>. nt linst ydlow, later ^"eefl, 
and mixed wUIi c-iird. mitai^, tiiixx), an<l sonictioicfi inaterial 
rfsembilnji; <'liivjn)cd i>|)iii)i<'li. Tin- di-jwlit un- neutral or ackl 
in mi<:tion. TUvn is nuKli-raU' l^v.-r i ;H>r'-l02'^). with its 
iiBiml plHtiomcuii. Tiio alHlomen h di:<tt'ndi:-d, and t«nder 
»loiip the <M)lon. V'oinitini; in uMtallv ])reM.<'nt. The child 
anivit piilo, vTHfrtes, and ii.«iuine» a nenjlc n{)]»oarui]oc. Dcnth 
niiiy t)e |>ns't>diil l>y oonia and eonvnUHioNH. (8]>iirioii» hydi\>- 

J)rA(iSO(«ia — RoRrenee has already be«u made to its «i>|ia- 
ntliun fruiii cntari'lial enteritis. 

fiirileiit in/anlHm : Abrupt onaot, veiy high fever, )x>niel- 
eul vwroibt vomiting and purging, simJ carlv rolla)»(-. 

I'RoriNDBts. — Grave, yet recoverieB folfow under lavnndrlu 

'rRKATMKNT. — Mwch tlie same as in ratarrlinl enteritis 
f^limnlantB are frwiiicntly Wfjiiirfd. Weak 6tii|K^ or »iiioe 
Itoultioea sJiould lie applini to the iilKlomen. Topical ttval> 
Bient should not be nejjIcWed. Tl»c bowel should he irrigated 
uix* a day with a pint or morw of tepid water mntaining one 
per cent, of bcn»HitC of wxln or Milicylie ai-id. The irrigation 
may lie fullowcil hy the in}<;L-tiuii of Hii Mitiee uf water con- 
taining nitrate of tttlvcf (gi'-i-l). 



{Bloody Flnx-J 

DKfiMTrox. — An infUDimalorj' diH««e of the coti-n, cjiar- 
m-U-i-in?tl i)v teiii'SfltiM, and tlie paatage of sruall, mucutiTS aid 
bKxKl-strpakwl sUwIs. 

ErioUMiV. — (1) Wnini climntni niul warm wobiIht; (Si 
Uul hygifiice; {:i) m^attum of Jmiatiiig iboci ; (4) vx|NWiin- 
lo COM un<l wet ; (o) uu-bot-tic Ktutcis (H-tirvy, ttaiigrrndii* 
^liiinstiUit, sod Bright'^ dixcaw) nrv pmlts))iiMi>^ lacfons awl 
nluiH- limy iirmluw Miupli- ily^-iilm' ; but tlit- tnipical ri<nii 
(iilw) fxt'urs in n>Iil oltniaUw) fHK-mv to !«.■ pxciltil by a vcgrta- 
blc luirHsik', liicaiiuvbn wtli. 

'Dk- disi-ast' fn>|iifntly ijwntry in c|iiiU-nik- i'omi. 

Varieties. — (I) Acute ratiurliul or !^pi>rndic dyseuKTc. 
(2) Amtrbii^ or Impk^al dy^'itlcry. (3) Muli);naiit ur dipfi- 
theritie dyswitery. (4) Chixmip dywdiiery. 

I*ATHOl,o(tY. Oilui-rlinl f>if/if7tirrg.—'Muieu»x tllenibraiie »l 
tb<- euluii isivd, #wull«i, (nlcinaKMiM, aitd in sonic canea uUrr- 

Amal* onlL 

Atmrttif Dgtenkr^. — Tbe tiineuuii tiunil>riinci*>iwiilU-n Cnm 
n>d<>flui and cellular mfiltnitiun. Tlit- lallcr eaiist* i«ii|>i'i-liaHt 
necrosis, and tlie fonuntion uf irix-giilur ukt-re uliieh more iff 
1e:<A umlcmiine tbe miiTotindin^ nuKijna. Tlie amirbKi nn- 
foiind in tbe floor of ibe ukvrs, iiiid in llio HtirroiiiHlitig tii^itw. 
In »M>me (^i<(?!, thWi menibnine iiiid sluiigtis'a(>]>var. Ab^u)^ 
of IIk' liver 'm a ">ninion eonijtlinitiou. 

Dipfilfin-ilic Ot/xentetf/. — Tliv tniiciiii.* nienibrnne is inteiL'i«4y 
ewotuju, luid covered with n false inombnine, which nculu 



frvm roagti)atioi>-nf(TmH. Tin- soparutiou of tli« niembnuie 
i« folloWf«l l>y iilix'niltun mill Kk»iigliiii<;. 

Cfironie I>y«mlmf.^-SUiy In- wiiiiiK- or mna'bif, 'Die fiuitx 
at% i^rcnllv thiokciMHl iitid iiltrns urc iisutillj' fgtiud. Ci<ntri> 
c'itil wiitnurtioiiH ;<oiiu4iim's fultuw. 

SYMPTOAPi. Arnte i'alarrhj /"lynoi/ccy. — Motlcmlc fever 
•oil i(^ aiiiRM-iftU-<I |>Ik-iioii)ciiu, |in>4tnilii.iii, <i.i)ii.% Hlxlutiiiiml 
tjrrKli*rnftf9, tciK^itiii^ t'"l'><^<^ >" tlic n'crniii wiiti it ix>»i<uiut 
iKsin- to (l<i:f<HiiU-) widi ^iiiall, intKitttK, iintl IiIdikIv ntoul^. 

Auuiitic l>}f*iMttri/. — May lif^ti at nn iu:iit<; or 4-Iiroiii<! <]i»- 
txae. The avniptotu.'i are MRiilar to oilafTlml dy^nlerv, but 
tlie diBcaae ift Diore prolraelcd, »n<I oil«i nurkiHl by iiiU>rnii»- 
iiioiiii aiid exaoerbatious ; the utaola arc more fluid a»d ontain 
tbf aniceba coli, aitd alwieas of the livsr is a laore frecjueut 
enniplication than in oilier forms of dyscJ^t<?r^■. 

iialifftuit^ or iJijththerillc Offtfuferit. — To the ordinary 
symptoms the following typhoid phenomena aro added : Mut- 
tering delirium, tttupor, i^iibsulttit;, car)>hol<)gia, and a browo, 
SsBiiKd tongue. Tliv iftooU also (vtntain faUe aiembrane and 

Chronui Jiygentcry. — Gi-rat loss of flcsli and strength; cx- 
treoK amemin; lh<^' diM-hargis oontuin nm^idcrnblc niiKnis 
atid at limes an; bloody. Tenesmus mid fuiin may bo alK^cnt, 
The history of the iniltid «ymp4oni» will twlubli^h Iho dtngnoAis, 

D1AOXO8I1*. Diorrh'm. — Alwcnctr of t<.'ii«miw niid of 
mtinoi<l and litiM(ly «IooIti, 

hitiufU'Kf^diiitt. — \Mk dev^-lopHK-nt nf fevi-r, n1im>I^ iiioro 
MtHxIy than iiuii4>id, the pn^'t^-ni^o of a "witiMi{>e-lik<v' timior 
■nd |X'rMi9(i-iit vomiting. 

I'RcxiXOKt.s. — In atriit^ cnlan-hal dy!<<>nt«ry iIm^ pi-ogih)»UK tg 

fiKx) ; rcooven' Ui^uiilly fiillows in from a f<>w days to n week. 
11 ama?4>i<: m'aentm' tb« prngnoAis should be giiarthKlIy 
liivanibl«; relnpflm ai-o oommoi), aud nhsoese of the liver 19 
liable to occur. The duration in favorable taaes is from mx 
l« eight weeks. Malignant dysiiiterj' is always a grave dis- 
«a»i- and often proves fatal. 

Com PLICATIONS. — I'erilonitia from extension or perforation, 
beiMttc aljsccss, .stricture, and gkaralyius frtini neuritis. 

TkeATHKST. Acuie Dtf^nteiy. — Absolute rest and the eii- 
fbrecd use of the bed-pan. Liquid diet, .\pply externally 

nffiKAKfx OF THE maismvK sTiffrBJi. 

hot foimtntntion.'i, Diiislarrl-iKJullices or l«>cli«i. A mild laxa- 
Uvp is indiiviited in the hcginiiin); ; wilphat*^ ol" niagm^ia (3ij). 
or castor-oil and laitdannm might be stlected, and cither may 
be i-e|>eatcd until th? pffcct jg pi-iMliictxl. 

/iiiw)'n//y. — Bismuth in n vjiluahlf remedy, s&licyUte of 
bismuth (gr. x), or subnitriitc of liisniiith with mlol or creasutc 
may be employed. 

9 Morpliiii- eiilph., gr.J; 

Di^niulli, subnit., sjf; 

CrcaKoti, gtt, vj.— M. 
Ft. in piilv. No. xit. 
Sig. — (Snc overj" hour or two. 

ft Salol, Sj ; 

Blnoutu. fiubnlt., 

Sodil bicarb., ftftgr. c.-M. 
In twenty capAulot. (Di'jakoin^Bkaviiktz.) 

Sig,— One Uirc« or four lime* daily. 

Mii^ipr nnxtni mends — 

ft Quluina; sulph., gr. x) ; 

Est. opil, RT. V ; 

M.18B. itydtarg., gr. x.— 31. 
Ft, in nil. X(>. XX. 
Sig.— One or two every two or three lioiint. 

Ill ftome ctviC3, fkarticularly in those associated with bilions' 
sym])tom?, ijweaeiianha. in largo defies (gr. sx~xxx, repeated 
every three or fiitir liotirs), is very «'r\iecable. To prevent ' 
emesti!, twenty drojis of laudanum should he given hall' an hour : 
before the aduiimstralion of the ipecscuaiiha. Top!<nJ treat-] 
luent shoidd never be omitted. In mild attie* opium siipposi-l 
torics will prove wtv Wueficial ; in wverc cam^s ciKmaln of] 
thin phirch-wati'r with ItMidiinnm (gtt. .tx-xxx) i^hunld lie 
(till w^ti luted for llic MipiMwitoriiv. JI, C Woo«i higidy ret-oni- i 
iiKiids ihe n«o uf ice »n|i(Ki!*itoriw. one every two to five* 
miiintesi for hnlf an hour, loUowcd by «uppoeitoric« v( ergubJ 
aitd t(Khifom) : — 

ft Ext. <-i-got.,([r. Ixxij; 

]ocloFi>nn., .^m; 

Ol. tli«obrom., <|, 9.— M. 
Fl inauppm. So, vL 
81^ — One every two lifltir» until four or flw linv« been takes.' 



Astrin^Dt injec4ions of nitrate of silver or lend «ci-(at« sliuuM 
be nnervcd fur siibaculv ur <.-tironic owes. 

Ini<vtioii«of warm solutions of quinine (sgfinj to iVj^t) ''*^ 
recently been cm[)lo_viti in nmu■^Ji^; <l_v»wnkTv wilh »<Ivuntim>. 
(Oitlpr.) Ciwlin (u (inu'liiii lo {Ik- [>inl) Uiw given ffxA naitils 
m Hinnlur «iu<o<. 

In nialigniint <ly.-M''Ntor/^ quinine, nlcuhol, a»<l lur^nline 
art- indicaUil. 

Chrunie J)if»efUtiy. — R^^ ; )iqiii<l iliH ; intestinal anli.iej^ 
ti<« (Milicrylatt! of btAiuuth), and cx>{(i<Ht< inJK!lton.s of nitrate of 
MlviT in atiiioDiLt eolulion, aa nxxRiniondi^l i)y Wood. Kegiu 
vritli one ur two pinlB (gr. xx to tliu [>iiil), and injoct through 
u tnU- pushed far u|> the bow«l ; lat^r, increaMi to three or 
luurjiinta ^r. x\x lo the pint). The injections may be em- 
ployed once or twice weekly. 


(EngUali Cholera. Chol«ta Moatnw.) 

Dkfi.sttios. — An !Mmtc,i-|Kiradicdi9ea.«e,n?sMubIing Asiatic 
clioli-ra, hut not excited by the comma hacilIuH of Koni. 

KtioijOGY. — Tbc summer Beason prediHpo«s, ai>d irritating 
(ihk!, as nnri]»e fniit, and a sudden t-hnuge of tem|)eralure are 
(ti<> UMial exeiting (»U!>c^ A plomaine or a special baciUus 
pi-oliahly iiMlTi<x« the disease. 

Syuiioms. — Intense c-rumpe in tlic stomach, vomiting auiT 
|»urciog of biliotiit mulerial, moderate fever, and great pro»- 
tmtiua. In severe t-agtn Uiv disehai^es become serous, and 
symptoms of (x>IIa{K« dwi^lop. 

DiAoxciSlS. Afintu; Vholtra. — Tlie prcwnce ofan epitltinio; 
niit bilious, but rice-walvr di.-s<-hur(;t^3t ; ttH'dcU\tion of Kot'h'a 
L'oinmit bueillus. 

Cbrromve Fouohs (as antimoay).^Hi»tory ; tli« vomiliog 
preiixieii |>urgii% ; burning pain in (c»opliagiu( and reetnm ; 
and bloody mucous dtsehargis. 

1'r(jox(j6[s, — Favorable; death rartjy oecnrs. Dtirntion, 
Iwi'uty-four to forty -eight hours. 

TKti.vTUKNT. — H<.^ appliinlious to tlie ahdoioen. Morplita 
(gr. J) with atKipia (gr. j^n), hyjuidcrniiially, repeated if 


DIU^ASBB OP TDK niGtsmV*!-: KVfrrRM. 

ncneanry. When tlie ]inii) U Whs sexetv. opium may Ik^ given 
ttv the moutli or rectum. Ice is soothing and n-lioves tbe 
UiinH. Wlien vomiting ia iho incst trcmlik^^tniL- symptom tbe 
following will be beuelioial: — 

9 Ui>qili. HuIplL, gr. j I 

Creasoti, gU. vj ; 

KamuLli. Mibuit., sij.— 11. 
Fl. Ln chart. Xo. xU. 
Slg.— One every hoar. 

ProstntioD will rMjiiire MinuilaiiU, like aromMic BjiJritsof 
sinmonia or bnindy. 

lo many cii^ck the tbllvving mixltirv will bo all that is 
i-«]uirMl ; — 

Qt Tine*, ojni cnmpli., f$w. 
Sou aniinou. iimmiil., T^j ; 
UagneA. opttni.. Xj ; 
Aq. inenlli. pipei-fue, q. s. ad T.^lv.— Itl. 


Sl£.— A tcaspDoaftU evciy twonty niioutcs. 


Uepinition. — An acitlt <)!««»! of chtldhoud, t-liiiracteriixd 
by higli fever, vomitinf;, [mrpinj;, anfl ciillu(^ii«% aixJ (k-i>en(ieot 
Uj>on ini inRainm^jliou <■>' (ho |>e.ttro-inU'«iiia) tract, atxl aome 
fliiiturbamv of the !<yni|iHtiK4ii.r ^n^Ua. 

Etiology. — Hut wuilhcr, fiinlty feeding, d«ntttH>n, and Iml 
hyppiie ar*' {ireili^pusitig lactorft. 

PAxnoijOOY. — Tlio nunwiH memlininv of tho !<toi:iiadi and 
int4^«tii)m ii^ rol, bwoIIch, and .ixii'nuilou.'j ; tin- glniidT^ arc eu- 
largL-d or ulccmk-d. Tlw [m>fiLte sf-roiw diw lung's and mpid 
Oulm[i»v niiiKt l>c dne, iu [kart, to some disturUiucQ of Uiu eynt- 
|iath«tic tiorvci'. 

SvKPTOMK, — Tlie onset may be gradual or abrupt. Diar- 
rhoea is usually the initial symptom ; the stooln are thin and 

JUS, have a miii^y »dor aiwl an alkaliiM' rejirtion. Vomil- 

■ soon develom, and the gai-tric irritability is so gri>ut that J 
evorvtliing is rtijccted. Thirst 1* intcnik?, the tcmperalnre i^| 
very high (105° lo lO**) ; the pnl«; is rapid and feeble ; tli^ 
urine is Rcnnty. C"«llaiisc follown, and is indicated by the 



jMiiHtwl ri-udinv, li"lt.iw fyt-s, •uinken roiitanellf^ and «ild 
-Hurlaii-. l-AMi III tliii* time a ivaclioii may set in, but niort- 
c-omnH^iily tlfaih m^nlti^ t'ii>m exhauatioii. The end may Kt 
charartfriewl by the tiyn)i>tinnB of ttpnrioiis hydroocphaluti — 
restlessp««, (TonviilRtciii^, irrptriilar piipiU, and cunia ; awl as 
lliefie pheiioitiena are iinaiieuL'iated with any cerebral leMoii 
th«v are jirolMhlv- toxemic. 

DtAO.VtMlK. JCntfro-eolitis. — TinMlual OUMft, moderate level', 
votiiitiiig less marked, ^loolif more mncoiH than cei-oiis and 
Deutral or acid in reai'tioii, puW not so rapid, and uo t^ndew^ 
to sudden tx}lhi|)(K^. 

FitOGMOSts. — Oraivc. Under conditions mu«t propitious 
di^th may nwtdl in fniin one to t]ir«.- dnytf; ou (he other 
hiiud, wj a»]icct la too HvriotiH (u admit of rM'ovviy. Entero- 
oilitis is a eoninwn 8n|ueU 

Treatmlnt. — If |iu)«ib)c, the child nhonld !»*■ n-niovril to 
tho txMintry or stwhwR-. Il ^himhl Iw kept in tin- <>|M-n air. 
Cli-anlincsfl is vsm.i)tial to 8u<<<t7«s and frequent liathiitf; with 
cool water is di'simblr. A 8pi«yplasterc»r a weak slnpc i^iould 
be applietl to th<- alxldmcn. 

Tlic nouriiihuuitt ^lionld ntnsbit of harley-water, bwf-jtlice, 
witK-Hhoy, chiiki-n-hnilh, or frozen blocks of beef-lea ; tlicwr 
flHMiltl In- frtvcn in Hniail (piantitiee at frequent im4-rvul»>. 
Pvllvl« uf i<tt 8h(>tdd he given t» allay thirst. A few flrofw of 
bmndy or of nn>mati<! &piriig of ammonia may be required at 
fn;()iK-nt iutt^rvab In oombat prostration. 

'i oarn'«t vomiting; iiiu- calomel (gr. ■^), suhnitntte of bitunuih 
;r, iij-v), or oilrate of silver. 

3 ArgeutI nltrat.. gr- t^S > 
Syr. aeadw, T%\; 
AniMT. fSiJ.— M. 
Slg.— A t«a*pCH>nful every two houre. 

For th« dianboea, laudanum (gtt. ij-iij) with xtareh-wnter 
(5j) may be given every three or four hours by tliP rMlum. 
Or thp following may i» jtivfo by the mouth : — 

^ Li<|ui>r. lUDTpli. Hili>h., 1^ ; 
Acid, sulphur, aroinal., Ill xxlv i 
EIlX. curaow, fS"^ ; 
AquiF, «|. ». »']. I^iiJ.—M. 
Sl^— Odo tciw]XM>nfu)rrrty twiihoiiniroradiild ms moatlia old, 


When vomiting iiiHi [mrgin^ seem imcoiitroDable, nii>T^)hia 
r. fig ti) jJt,) liyiHxUnnii-alfv may be very 
IrnipUiun ul' iIk- Kdimadi ai»l Iwwe) with warm waliv luu 

Im-uti h!|;lily ivcumnu.'iKk-<l, nnd tlioiigh hpmic somiKiRH'S frive* 
Itrilliunt ruHiiltif. Id <tilla|iiM>, use a but butb to wbit-li a little 
iiiUBtunl or ]H>p{<<-r iins becii added ; (livn place Uie ohild 
ill » horixuiitiil [hinIuoii, lYiver with warm blaiikets, aud aJ- 
iiiiiiiAler Kliriiiitiint.t I'lvi'tv. 


DBPiMTir)N, — Ti)tlaitimatory aSertiona of the rigbt iliac 
fuNia liavi' IxBon divided int't: (I) Typhlitis, an intlaniinatioii 
lit' the cwcum. (2) Apppudicitic. an influmnuitioti of tlie ap- 
{H'lidix. (;i) I'erityphlilis, an iiitlammiitiuii of the serous 
covering of the oa!oiini. 

l^luuxiY. — TyphlUis, or CweUi*, is an utuxinimon di»ea.<)e, 
aiid iiHually nsult^ from traumatism or fecal im[KiciioQ (Typlt- 
litiii HtcrtTimlis). Cliiiinilly it uuiuot be (IiKtiiiguitibva from 

AftiirnillrilU iif a iwmmon nflis'tiuii, h^rly life, nisle box, 
irik'»liiial cuiarrii, iu);(^«lioii ul' ii'rila(iti)r fiiul, constipation, 
and prcvioiiH filtwks arv pn-<li.'«j>osing liu't(in<. Forvigu bodies 
or i%'KiA ttixtuiuulatioiia in tlieappitiidix or traiiinKtinm usually 
vxntb il. 

Pa-ili/plillth is alway:^ M>4\>iidary lo a]iiK-n<It<-!ti». 

I'atiihi^hjv. — In gravo (■asi* llic a|i[)(?n<)ix is tliickcnod, 
iiijird-d, nlocraliil, or nt-oniM>cl; and {icrittmitis or localized 
al»0"i!«« an^ foHiiienlly diMX)vor«l. 

SYMlTfiMs. — It may begin gradually or abruptly. The , 
iinua! mauiti?«tatinns are moderate ffvcr (lOI^-KM") witli its 
aawteiatt'd phi^iHtmena ; severe i>aiii iit the right iliac fonm, 
V hieh iii increaMd by flexing aiwl extending lite thigh ; oun^i- 
)iatiun, and, later, vomiling. 

I'ht/nical Slfftu.-r-Thii patient usually lies witli tlie r^Iit 
thigh flexed. 

Palpation elicits tciKlcrncw, and sometimed diffuse or <lr- 
cumxcrilied induration. When tl>e appeudix ifl favorably 

iNTtxriXAi, otifffBrcnoN. 


led, a finger ia die ivt^iiiii outy delnt fiilnoss nnd indil- 
ilioii In the riebt. 

I'erruation often yieltlfi a <liill nmc. 

Id some iustances tlie Bf^t maiiilt'statwii is general peri- 
touitts. It sbouUt be borne in niiud lltat abrupt ^leneral 
peritoDilis witJiodtubvioiis cause is usually due to appendicitis. 

Complications.^-^! ) JWUow'fu bv exietiaion or uerlbra- 
ti»n. (2) vt6«ccM, pointiiijicxtemully in ibeiluv-i-Hx.^IrefioD, 
ill tlie flunk ur buttock ; or ititernjilly, exritinf; perilonil4i<^ 

I*R<XiN<Deis. — Always ijimnifd ; («»os upjuuviilty milil miiy 
t4>nDttintc rutxlly. Mild «i^-)i, in wbicli Ibv »ymptoiii» arc 
prubftbly dtie to' typlilili^, ultiii romvcr ra|)i«)ly under appro- 
priftU* tre«Inu-nt. 

Tkf.atmi-.nt. — Alwolutc n-sft. Liqiiitl diH. The lower 
bou'ol .'iboiild )>i-eii)pii4i] by <fi4-itiiilii. Opiitin .'•ttnuhl )M>f^vc» 
for tin- n-Iii^r iif |>aiii. hi ib<- initial ^agi-, ^lim-H (iiution^Iy 
luliHiiiiitfvred utny yield exi-eltent m^iltti; K[isom rtall.'i (5>j) 
should Im> civ<-» e^cry two hours until two or tJirce vraiej}' 
Ht'wU have lieen produce^]. 

//Orti/ Treoiittenl. — An iocsliag may be placed on the ilco- 
<it.'<:al region, but if there is iniu-h cendernt-ss Iceobwi t'ullowed 
by (>.>ullices give the most relief. Inercsbing tendeni**! and 
indiU'atiuti, a stable or rising; temiierature, )N7[ststent Vomitinff, 
obstinate oonstipation, or iitereasiug nb<lominul tympany wul 
eadi demand sui^ical interference. Patients subject to recur- 
rent attacks sbotild be ^-rupulously careful an rc^nk liygieue 
and diet ; (Itey should be babilually clotlKil in flimiicl, and 
sliotild wear an alMloiitinul protcc-tor. Kcsiiti-ntM.- in u dry ami 
e()iuiblc i-lirii!itc HiiiK-tiimTt nfciircs ininitmity. 

A furnml o[K'nilio" for llw n.-iiiovnl of llio up[iondix limy Ijc 
«>u)ij<lerf<l iu tlH^ (».'«««. 



Ktiolooy. Ae»tr OMntiiioH. — (I) Conf^uital occlosioii. 
(2) IntU88nwxi>ti<>n(In\-agination). (:I) Si ion, internal 
(irvxtpmal. (4) Twbta (Volvulus) or Knotif. 

'Iliir follnnring are cottditions wbicti prxxinee chrmw- tj/udmc' 
tion, tfaoug'li at times the symptoms develop acutely : (l)Stri(v 


hire fmrn n liealtil tiloT. (2)>tiaiural acniniulniion^, a* 
fecal ma-t^en (< oiiirMta^i.^), fon-igii bcKlict^, gall-stoiwH. (3) 
Tumors, HJtiiiii or wiiltuiit. 

SviiPTDMS, Antit (ttMdniHioN. — (I) Sudden pain, at fitsl 
paroxysmnl, biit later aintmiioit!^. (2) Conshpation. {■i\ 
Vomiting, [iprsbleiit, and lM?c»niing ft«i! (sltTforaowHn). 
(0 Alxiominal di^Untion. (5i 0>lb)>«', indioiled by piiK-lnii 
(uatiiri'is. cjid cxti-eTiiilifs. aitd Iwblc jxilse. 

fAjwiic Ol ".'!■•< "I ion. — Tlicsf Mvnintoniii dovulop I'lowlj'. 

CuDgMuta] (hlolQ8lini< — Tliv iimial location is the aooa or 
ixrtiiiii, It i« drttctixi liy diR<ct •.■xiimiiwttun. 

Intnssusoeption. — Tlicflippini^ura iwrlioii of intestine inU 
aiiutlii-r jiui-tion ininii-diiitolv Ik'Iow il. It is mrtl-d diicfly in 
(■liildivii, hikI i>< iiiiiii' njiiiiiii.>ii in iiinU^. Itit ('Voiliii^ cause is 
|)i'i>lmlily iM'iVLTlijii jii-ri.'sHiIsis, Miicifliy oim- |wrt nf lln- boWTl 
i.t i-onlnitntil wliili- the adjiuH'Di [Mrt la diliit4-d. In nire in- 
ftlannt^it liiui Imm'ii indint'tl by the Irarlton oriiitesltunl pulypi. 
Tlie usual i»«it i» the iloo-iwoi! ri^on. 

Multiple iiiva^inutioii-1 are fiy^jiw'iitly foittid (>n»('inoHeia, 
whi<-li have n'sulii:il fnini tlie irn?giilar [>i-ri''iatMS >i<i-iin-ifiir 
just lipfiire (k-alli ; tJtey ]tnas«as iio iiiHanumitiTy dtai-intrn^- 
tics. Til iiiva(iinalionH no* cadaveiic, tlio jwnls are injcdod, 
swollen, ami oovei-etl with lynipli. 

l>iAi).N<)Kis. — The eymptoms of obstruction, with the npc; 
a " aniiNage-shaped " tumor in the line of the colon ; tbi- nirr 
detection of the invaginatv^l i>ortion in the rectimi ; IcnesititM ; 
and bloody mucous stools are I he din^noelic features. 

I*l»)(fN««ii*. — Death usually results from gangrene, [leri- 
tonitis, or collaise. A ravorable termination somi^tmes results 
from the e6ca|w ofthv incnrcerateil jKirt, or by a sluugliing nS 
of the !:tnin;;iil.'ited portion iiml uilhraioiiof thewroti^eurfaors. 

Strangulation.— This oAtn txviirs in cxienial hernia, \^ hen 
it (^u be reiLX)Knizcd by an oxnmiuation of the inguinal, 
tenmnil, und uniinltad rings, 

Inlrnxul Slnwyuliithn w due to the clipping of a coil of 
iul4.vtine tiiroiigh thv diaphnif^n, fomnK'n of Win.sluw, an 
abimntial oiM^uing in thi; uiiK-ntnm or nK^-iilery, or a loop of 
(nflnnintutuiy lymph. 


Diagnosis. — II might be Hus|iert«I by the absence of otber 
iiaii*M-, by tUi- fikUIpii oDiart, or by a liistory of previous 

Twist. — Otvure most comniODiy in ntiddle-agvd men. The 
iwiitil »oat is tlw tugtuuiti fk'xurv. A rclnxtid unci lvngtfa«iH'«l 
iiH'!wnU-n' U a yirvdhipuiaitg tmaor. 

OufiM^is. — Riircly |Ki»tibV. 

Striotore.— L"isii:>IIy n-siilt* frwm :?yi>bilittr', itilxTnihiii*, «r 
(iywiiU'iio iiltfrs. Tilt? rcftuin is tin- iuw<l cuiiiriiMii will. 

DiAtiNOHLs — Histor)-, i^ilual onwt, ix«iiiu of reiiiil 
I'xniuiiiittion, nml "pi|«-su;ni" ur " ribbciii-liki>" «toi)l.< aiv 
<liagn<K4ii- li^tiiixi*, 

UnnAtural AccnmillatlonK.— For«l inijuu-limi i.-* ntnogniiMxl 
bv tin- graiiiia! im^-l, inllii olistruirtive »vmj*t<niis, history of 
tiiiiiiti|iaiiiiii, ami a )NUitlnM>, invgiilar, doi^ny tumor in the 
Itiii- (if i\m <t>iun. 

(latt-Mona may obHtrurt the ileum ; tl>e history irill aid in 
their rtvognition. 

Ttunors. — The must n>mmon tumor within the bovrel U a 
cancer ; it ia ti§iially hx-ated in the piijrinoid flexure or irclutn. 

Dl.uiWJsis.^Age, gradual on«fl. join, blfKxIy dischutves, 
caelicxia, and a Innnir in tlie ret-tum are tlie clmractensltr 

Tumors of adjacent viscera may romptvs the bowel. Tltrir 
reot^nition Mrill dt'j>end n|Kin phyeical examination. 

Treatuhnt. — In all cases of anite ob^tnictioii, ojtcqitinp 
external beniia and oon^cnitul alr^^^ia. whether tlif cauAc \* 
I apjHtrent or not, ob»er\-e the filloMiri}; nik-s : — 
^h I. Adminintrr opium to relieve [min ami oh<-vk [)cri:!ilnUi». 
^B 2. 'Vpply hot foiitinitalt<>n« to tbo alMUxnfti. 
^B 3. Rt^riot the did tn iiuiitd^ tn xntult i|unniitiM, Nutri- 
^Mivc onemaia rtliould Ixr cni|Howl in Ihe wmk. 

■I. Avoid piir^tivo*. 

5. Klevnte Mn- iHiItotrk", inm-n a rcclai tulx-, and dltlend 
t4]c ciilun wilh fnini two to mx ({tinrlH of li'pUl uali^r, whieh 
shouhl flnw from a t^servtiir phiiiil from t4-n to tw*'nty feet 
aitove the juiliiiil. The ap^ will dctitmiine ihi- Ic^ugth of llu; 
tube and tbctutinunl of fluid. 

c\ an? diHlenikd 




put, HHKltiiig uiit uf ttiv ifluroaoh b iLieful. (Kitasmaul, Lielier- 

7. AlWr liulinv iu iIhmc metliod^ i»uutiiomy tilioiild not 
Im? ilclnycd ; tliv «-nrIier iltt |)ert<>riimw« llic jfreater tb« otiaiice 

In /mil tMi/>ri4itroii mliiiiiiUler salinca and inject water oroiL.j 
' JOWli'idlv i* niiiiiHinmi )iM-tiil. Iteotal aivuni illations nay be i 
'tviiiiivci) !>y tlio linj^^ra or aiuiitable acxxij). 

HIrirtwra require si]i|;ical interJercnc& 




VAlUBTltw. — TwnU soliiiin. Twntu saf^iiiutH. 
n-|i)inlii« liitiiM. T»'iiiH <^t:lii»ix-oc(-iiH. 

lIlH'rcniY. — Tlie ITJKS ol' ll'f taj>«-woriu are uigtwt*-*! Uy aii 
iiiiimiil, itnil uiiltryiw, ur pruwultoce, nre iibt-nitnl in ibt-l 
Hlmtiadi ; tint* ruigmie Ut olli«r orKatw, wIhtc they are. 
IniMtunikM] iiilo larvw wr ttculiiti^. 'i'Tic citevAtt^ lan-K, orl 
iv^Acx, h tcnucd a ■■^'-ttin-iviH ; the txuxlilion in known an 
" iiii^aiika." The nmliire worm devclopei in man fruin lla- 
lA'Miivri'iH iMiitnutnl it) infected lucait. 

' Tonia BoUum (I'ork- T'l/te-worm). — IsdcrivMl Onm iht! Iiiij;, 
and is two or tbnw yards in lenstJi. Tbe bend i» tlio tiw ot'j 
that of a pin, is i>rovidi>d nila four pignicnttKl riip-lik«! 
suckere, surrounded by a double row of luxikletn, and i* 
atlaci)c<l to tlic IkxIv by n thread-like ncfk. The sexual ori- { 
&IX is in the wntn- of tlio bnuid tiurfocc of tbe M.\riiu-nt. 

TsBIlia Saglnata (T'mla M€<l!oe'ine{lata). — la (Ierive<] from 
Uvf. iiik) U live or mx yards in lcu]^h. The bead ie larg^ 
than that of tbi^ ticnia solium, and Ims lour Ini^ Euekers, but 
no liooklel.t. Tho »«>gnK*iil« are liiltfr, and tbe iil«r!ne 
bnuK'lu^ are finer and niorv nnuK-ruus than in the tienia 

Bothrlooephalos Latus. — Ts found e^jMKinlly in Europe, 
and in derive«l fi'om lirOi. Tbe he;id ban no h<Kiklt-ts, but two 
lateral (irooves. Ti)e body in very long, Tbe sexual orifice 
narrow side of the wgrneat. 


Symptiims. — Often aliMtiit. KiiiiiiiMillv tUi^rv an- i]y«i>c("lK' 
8y[ii|it'>iiiH, o<>lk'l<y iKiii)^, Inns 111' At-At, (■jijiricioLL'i ji|i|)ctili\ iind 
Horiii-tiiiurA rt-fli'x nervouii jilieiiom^tia, sudi aa vertigo, pal[H- 
latioii, " II if^it- terrors," convulsions, itctuDg in (he noee, and 
chorcio inovonienu. 

The DiAcNot^iK rt<!it<> on the dtsoovcr^ of the aiggfi or seg- 
tiientci in t\w stoob. 

TRt:,VTiiKST, — A lij;til diet for a ilay or two, and a satine 
purge priiir to tlic ad in in lit ration of the mithelaiiolic. Afler 
an uiisubatantial hrcakfa'-t adminiftter out^ of Hie loltonHog 
efficient renwdies ; Puuipkiu seeds (two to tlircc oiinocs) ; ol«o- 
rvtaa of male fern (Sj-ij), pelletierinc, llie utknloid of pome- 
granate (gr. v) ; Koufio (Sbs). 

1^ Okorwiiii. filicis. fSJ; 

Pulv. a«tcine et fMcdiar., a q. s, 
Aquw clnonniofliL, i. n. ad f Jij. — M. 
,— UoB tftblmpooiiful, rcpcRlcd ir required. 

A purge should be given a fi^w hount after the vennifiigc. 
The treatment ts Bucnea»ful only when the head i» pn:s^-d. 


Asoaiig Lombiiooides {lioumi Womu). — Life tiistory un- 
known. Thfv an? of a palivpink color, and in form n-eemble 
earth-worms. Tlit-y inlinbit the small ii)tc«ttni-6, but occs- 
slonxlly migmtr into otiier ot^ans, viz., sloinMcli, bile-ducts, 
and htrynx. They niy mo^l commonly found in children. 

SYJinxjMs, — (MU-n abitont. N»iin>lim«» iIwto an- dy»]K>]»ia, 
miiroti* i^oiils, i'iili<'ky paiiiH, vonuioiH apjH-tito, nnicmta, Hnd 
rcfli-x nvrvoiis |ihi'iioiiii'nR, a.* " night -ierriir!«," grimliiigof lliv 
l«-th. pruritus of no»c and antis, cTioreic iuovenH>nt», and oon- 

TRJiATMEtn^-finnloniu l^r. \~gT. iij) ; vrorm-wrtd oil (git. s 
in ai|>sul« or im sugar); fluid extract of »pig«lia (f^-f^iij), 
ftre efficient reiix-the)!. 

1^ l^iiiiiuiiinl. gr, vj ; 

II}i)rars. clilor. mil., gr. vj ; 

Saccliari.. «. xsiv; 
[JL el ft. diarl. No. stij- C^taiir.) 
I bjig. — One powdor laoniiiix nui) eveniuK. 


* Oxyaaris Vonnicularis {Srat-Kwrn, fin-Kwrm). — This fe a 
sninll worm, m<w( itmimoiily acwii in clitUln-n, and ocf»i[»(* 
the oolon aiirl nx-lnni. It pnidtirrK iiiIoim? ildiini; of ilic 
sniw, wh>i<li if wor^e nt nighl. It may inifiraif into the 
vagina nn<l 4>]ic>t<! pniriuts or vaginltiii, and lead to nuutlur- 

Trkatmkxt. — An injei^tion of waitr, followwl liy ih<" in- 
jwliim nf two iir tlir** oiini*s uf an inlumoii of i]uat«>tu chti* 
(3ij-iij to ll«- [tinrj. 

ADotiyloetfHIlllin DnodBlUtls. — A small worm, not uncom- 
mon in the norlli of P^nrope and I^y[M. It lias bwn dHtii«l 
most i'lftiupiitly in miners and bricfemakers, who are prolKitili 
infeclixi l)y drinking «-ater containing the ciggs of llie {«ira!«ilt>. 
The worm iuliabilii^ the Mniall iiilci>tine. 

SvMi'ixijtt^. — Dvepepfiia and intense anfcmm. ITie latl«r 
has been termed I'^yirtian chlonwis, iuhI may berwiogniaed by 
the detection of ^e» m tho i^tuoU. 

Tkkai'mknt. — Santonin, nuik- fern, and lliynml have been 

Trioocephalus Dispar ( Wkip-ironn). — A fmitll worm, tbidc 
at one {-nd and thrva<)-)ikc at tbc other. Il oO<ii[Hi« tlio colon 
and ciL-ciim. mid proilixtti btit IJItk- di»ttirlia»<.t*. 

Fiiaria Sangmnis Homiiiis. — A ^mall thr(«d-Ukc worm, 
most («mnKnily iwxn in the Iropiti*. The adult owtipit-s the 
lymphatics, anil tlic femuk* brings fyrtii a groat number gf 
embryos, which «>on lind their way inlo the blnod-viirrcnt. 
It ifi noteworthy that (boy may l)e detected in ll»e bloud si 
night iHit n<A (hiring the dav. TSc mnlitim of infedion it 
urobably tlK musciiiito, wliiefi carries the embryo fr»ni the 
olood to i\w water. 

Symitoms. — Often abtvnt. Cliylnria, lueniaturia, and 
lynipit-semlnm sometimes nsnit frtmi lympkatie olistnielion. 
" Triidtina Spiralis.— A small worm clerived fi-om the bog. 
Man is infc^i'tl by eating insuftidently-eookwl pork eontain* 
ing the eneapenlatcd worm. 'I'hc worm is set free in ihe 
stomach, where it develops an<) brings forth living; embry<w. 
Thase Boon migrate into the iniiscte«, where tbey in turn dt^ 
velop. CT)il tlivniwlvt* up. imd beeonic enmpsulnled. Trie-b- 

au» cauMilus, imiutuiuiliil with linic-<iall<^. arc visible to 



t\vi naked tiyc, nud are BomeUmcs <lc4«ctccl accidenially n1 


SvMiTOUS OP TmcHixows. — SomotJmftt al)t«>nt. WJiwi 
largo mimbers have lieeu ingestpd, rfaMro-inU*liiui/ »ym}itoiw 
deyfilaji in a tew tUijs, Tliesc arc : I'ain, Daiii^^ vomiting, 
and serous cliarrboea. 

l/tMcu&ir Symptoma. — In from one to two wcoks muscular 
eyniptoms de\-elop, Tltc uitiai-lcs borome Hwolkii, tirm, vx- 
tr&aeiy tetuler ant! iHiinlVil. Movcmcot i^i inhibited, and 
dvspDoea results from tbt- involvement of mr|>ii-iiIory muscJca. 
CEdemSjesiK-eiully of tbf face, is a promiiieiit (-yniptom, Pro- 
fuse Bwtatiiig i« )Mjmclim<.-K oljei'n'cd, und bigli fi-vtr is com- 
monly prescut. 

PitUGN(»l». — Di'p(M>d8 ou the number of worms ingested. 
Tbe majority of |iiitictit.t p«5tvtT. 

Treatmest. — Pn-vfnt by Iboroiiffbty ciodkinp nil pork 
prodncis. In the finti mofft- u»e pui^tivci. Ai)or migmtiuu 
employ opium, itarni fomcjitations, and stimulants. 


Definitios. — tnlliinimatJoii of llie pcrilonviim, 

VARlBnER,— .XiM-oniiiig to cauHc, it may be priman- or 
McKHidary ; aowirding to extent, local or general ; aniirding to 
lime, utiile or chi-onie ; and according to the exudate, sero* 
fibrinutiA, fibriuMts, or purulent. 

KnoixKiv. — Acute pritonitb may be: (U Idiopathic^ 
ariiiiiig from csjHwmiT to odd and wet (rare). (2) Tranmalic 
(3) rVrfiiraiive, n^nliinp fnmi a perforating wotmd, or the 
rujxure of a gastric, lyphlitic, typhoid, or dysenteric ulrer, or 
a vtAcei-al aWegs, (■!) .Secondary to inllanimatorv diacawof 
adjncent vtsoera, as Beplic endometritis and typlioid tever. 
(A) Secondary to some gctterat morbid prooetiB, as rheumatbira, 
Brwht's disease. 

pATiioi-Ooy. — In the fii-st stage the mejnbrane is rwl, 
sticky, and Iiistreles; later, a soro-fibrinous, tibrinoii.'', or pnni- 
lent exudate ts fonned. In some cases the exudate is tinged 
ith blood. 



SyjiFTfiMw. AcuU General Perilonitu. — Chill ; modt^rale 
fever (lOti^-lOS**), with its associated plienunx-na ; a rnptd, 
wirv |)u]i§e; abdoniual psiti and taudenieaA ao iiiU-ose that 
abaomiDa] rcs]iinttioii ami body movcnientA are inhibited ; the 
patient lies nn Im bwrk with his thighs t)ose<l ; the fcatum 
are )iinclte(l ; tlic votuitlug b pei-sistcut j the boweU ore cun- 
sti paled. 

Inmeetimt reveals great abdomiDal distention. 

Palpation die-its trndenicss, and rart'ly a friction fW'niitu& 

Pertrumion at linA yields uutversal tympany ; hut lalw, 
dulnesB in the flanks froin the gravitatioa of the exudate, 

DiAGXOSiB, vlcufc- Efderilie. — Pain ai»d tendeniew imh » 
markfxl, absence of wity pulse, and diurrhcBU in«t«ad uf i\ja- 

Intridinai 0&»frucfM»i.— Unless u«K<K-iat«l vrith peritonitis 
there is iiu lever, no wiry piilBV, nor extreme tenderness ; the 
vomiting bcconice Jvcul. 

y/yrfmra/ AMomrtt. — Tliis vondilion may rcscmblt- peri- 
tonitis in all ]inrti<rii1nrft. Thv sex and pcreonal hisrory mud 
be (vnsiik'mii. Fever is ik4 tinuLlly ])re»ent, the piiW i» not 
rapid and wiry ; wlion tlH> attention is (li>tlruet<'d the |)oin miiy 

Proonosk, — G«»eTttlIy unfnvonible. IV-ath UMUilIy rntulc 
in a fciw day^ from exhaustion. VVlwn the pnN;cii« is neillKT 
septic nor eaclMisive re«i>veT\' fnH)iK-utly follnw^. 

TittUTM KXT. — KfiArict tiie diet. Administer ()|Hiim in Aill 
ch»»t to elieck |tenstal.'tiit and relieve {uln. In M^vere vxeet 
the drug may l>e pa'^hi^l unijl the ntipiraiion hax iHi-n rctbiced 
to twelve i>cr mimile ; apply lc«rlira tii die alnlonM-n, nml lul- 
low with light {H>ultice!). In .'Hinie voma mid ehithf arc moi<r 
gralelid than warm app1icsiion». In non-pci'forating cam. 
salines, as Epeoni or Itochelle salts (^ij), m-ay be givpn aim 
boweU move freely. These salts, while lu.i inemLMng ym- 
iAa\si*, nttrai^t wriini from the turgid blixidvcut^-Iii, and ro 
relieve' eongt^iou. In |)erfuruting (.-ases — and tbese ure the 
luwt froqueul — laparuloiny uffen tie only hope of our©. 



tThronic Peritonitis*. 

E>rioLUGV. — It M i»tnlly tnbmruWts; H mav Iw caneeroaa ; 
it may !«• svjiliilitic- (oocarrinc m ynrng dukfreo); it tajdr 
follows Briglit's tl'M«>c. tl mrely A>ll<iws an acute attack; 
it (x^-tirs ill diriinic aln.'liiilii'ni. 

PATnotJtx'.v. — TIiv iatu>iijif^ are maiud togetber bjr LantU 
of Rbniii.H lymph. Thtr inucotuiu U often oaotncted and 
gnatly ihickeowl. Kfliuidii !.« ibually }tr«»eDt, but it varies 
vrcatly in amount; in the tuberviil'rtbi a»d CBtwenHis \-ari«tie6 
It niav be bloody. 

SyMKnius, — Fever is often abeenL Puo is not aevere, 
and is wnimonly paroxy^ual. Tbere is nsually diSuse 

I.V8PBCTION, — Tbe abdomen ia f^eoenlly difitendt-d; often 
imviilarly, from i>a«:tilatcd eSuftioas, infisted int«>tiiial ooils, 
or ttii- projorlii);; mallctt omeatnm. 

PitJptition may lU-ux-t a fritlion fremitus, and tbe irregnlari- 
tiw lUfUii above. Tbe rwistaiKT is often grcal, 

Piri'iuwirm. — Dtiln^ in the flanks with supenDcuml)eDt 
lymp»iiy. When the flnid i» tJacctilatcd, lite dulnra8 may be 
irregularly distributed. FhH-t nation eun Miraetimoi be elicited. 

Plioii X<iH I s. — 1." n la v> I ruble. 

Trf..\t«k.vt.— Ki^t. Liglu diet and nntrient tonicB(m«]t, 
oud-liver oil). Iodide i)f [Mi(a'wi(im ii* given for ilii absorbent 
Cfffect. Itxline may U- n|)|ilied exirrnnilv. When the trflu- 
non is great, paraoentesLs will he reijuiretf. 

Dkfimtiox. — A eolleetion of tierutis Dnid in (he |wri(o- 
immI cavity. 

KTKiUKiy. — (I) It may result fiiiin oiti* lyf ibe e<:>ninion 
i^niiee of dri>p8v, vie: Brijjhl'.i di»iiw, ehriHiii- l»-nrt diwase, 
chronic liinj; disease, aiiKmizt, ami es{M-cially eirrhociiK of llie 
liver. (2) J'reafflire of a liimor or dij)ila«^ vixens ii]>on the 
portal vein. (3) Chrouie peritonitis. (4) Pivwiin- upon liw 
tlwraeic duct (Chylous iiedtee). 

66 DUiEAM>» or TUB DlGESnVE RYffTKil. 

$VMFTo.\ts. — ^^'hen the pITumou w large, 8 seoMitioii of 
wotght, dy6]>ii<ta, fKunty iiriiM.-, cxm^lipation, and uidotDa itf 
the feet usually result from pri'JS'iirc. 

I*h\f*ical Signs. IiuprHiot*. — Thv iilxiumcn is fliritendc'i. 
ibe ourfaoc is Hmoutli titx) sliming; llic Ittise of tht! thorax b 
brvaikocil; the imvf] im mur« or lew oblilcratecl ; ilit- istt\KT- 
ficial veins arc rm|in.-iilly «;nlar);ttl ; ami, when ll»e palii-ot ii& 
ill till' (luteal ]Hjuiiliuii, llio Itaiiks bul^. 

I'i)fixrlion amy e\'mt fluduatioii, and in the flanlct a ssmt 
uf rc8i»tnti<M:-. 

PtTvuninwt. — DiilnoM and rcsifi^anod in de])endoiit jjort*. 
willi »ij)r-riiioiituliciti tymjuuiy. Dulaeee is movabli;; it i* 
iU-t(#l(il ill till! tluukn when the patient occupies tJie dunat 

Afjiirtitum. — The fluid is iiBUally cJear, straw-coloird, aotl 
alhiiiiiiiioiM; the BiKvilic gravity is from 1012-1016, 

|>iA(iN(i»i!i. 'Ji/m}MnilU-a, or mfteoruni, — Tliis yields nai- 
Yvreal hviK-r-resonauce on pei^'usBiou, 

Omriun t^». — The etitargotucDl l>(.-|!iiM in t\w iliac f»«. 
The <liiliiei» is more or I''i^ imniuvahlv; us i1k- inlivniiieK on 
inished a^ide, there Is diilncss iinti-Hurly, !iislai<l of tya)[)aui, 
as in ascites. Vau:iiml exiiniiimtion riiriii^ilio iiii|>ui-(anr dais; 
(lie fluid has a higher Kjiccritk: gravity and oficu voogulalH 

Distention of ihe BlatMtrr. — Tin* hnniioii of tl»e duloees and 
rreistamv, the liir^tory, nitd tli<.- n-aulls of eatlieterizHtiun will 
raider iIk* dingnot^iN n|i|inii'iil. 

Tkkatmkst, — When jKwsihle, endeavor to niiiove th> 
canw. IJK'otiratttr fni- eatliar^is by the nse of <Hiiiifiitrat(«i 
■aline iHtlitlloiis, eoniiHHind \a\ap jmwder (gr. xx-xxx), eh- 
tvriuni (gr. i). Eiioonrage Iree diuresis bv the uae uf oitnil' 
of i«Heine((tr. ii}-v), infusion of digitalis (iSss), or Xiemcycr'j 
pill (i«ge 80). 

Qt ]*i>lnictii rilrnt.. ju ; 
Tine. Biillw. f3ti»: 
[iif. •liKllnllfl., ^l(|; 
Aflua-, ij. *. ail IjvJ.— M. 
Hg.— A Inbkkpiianful ilirior diiily. 

If the elVuiiiou in very large, if the stomach is irritable, ui 



if inl«nial remGdies Gul to give rrUcf, tupping will l>p 
rei) Hired. 


Until verv rfctnl ymi-s |>nt lioluj;!'^! coiiiJItiotis of the pon- 
cmu) have excited litik'ntK'uliuii, but curtl'iil ^tuly iwcali- iIr-, 
fact that tbe or^D U not it]l'i'«|ui-nlly tW Hnt of dvlinitp 
IcMom which excite weU-ioarkt^ vliiiiml pbi-iiomfna ; Iww- 
ever, in lh« present state of iitedival sctiMicc tbivc plicnutiicun 
i-an rarely be attiibiiteJ to their tnie <»iii<*^'. In ehi'uiiic ]iau- 
ereatic affections, wiM(iii>;, futly )«touI^ uiiil glyi-oi«iiriu ure 
notable syin|>t'>ni-i, 

Puioreatic &poplexy.~A prufim^ hemoHuige vxviU^ i^iid- 
den {Miin in t]tc jMUicivatic rvgiuii, vomiliiig, alxJoinitial dUtcn- 
tion, uml HvmptoriiA of eullit|M'. It id alnxist invartalily fatal. 

Acute Pancreatitis. — Caii^i^ unknown. The |iaiii?rta:i is 
eniiirp'fi, nilivninrMti. and !«>mi?tin»es the 6eat of faity dtyefte- 
mlinn or iitmi-.s-.^. Tlie HvmptooiB are fiain, tever, vnmiling, 
itixl I 111 la I tic. 

CirrhOBiS of the Pancreas (OAroiiiV InterMitial PancrraiUis). 
— It probablv results from tJie eonditionn which IikIuor 
liepatic eirrbosia, viz., alcoholism, syphilis, eie. Ttte panereBS 
18 contracted and hardened, and microscopic rxaniination 
reveals an ovei^rovrtli of connective tissue tvilJi atrophy of (he 
tteeretiog cells, (jlyooetiria, fatty Ktools, and inanition have 
Ifcen atlribnted t>.> il. 

PanoreaUo Calculi.— CuncretioiK from the panemttc juke 
mmetimea lod^e in the diu-t of Wiiwing aim excite coUc; 
their permauenl tnipin'tion V-juV* lo Uie fonnulion of cysts. 

Cancer of tbe Pancreas.— May U- |\- nr Mvondarj'. 
'I'lie inofl '■unimiin Milt 1^ ll>e \nw\ ; Ihf nioi*t uuiliniuii vurt«<jr 
1!' tbe scirrbiis. 

S^Tim>»is. — Pain, rapid ennu;Jiit1on. laity Kloulf, an im- 
movable tumor which ofiett iw«-ivi'>! ■ niilKHliuti from the 
underlying aorta ; smnetimes janndJiir and glyoii«jria. 




The lirrr n >>itiintccl in tlio riglit JiyiMwliondriiini, wJrii x 
wiinll |>iirt lUTtjwtiii^ llmtugh (hv ej>!gfl»lnimi m the MX IiyjMi- 

Ari^t '•/ Lii-rr JhUiifnii. — 1\w alNHilrtti* tliiliicsB (iwrt iiu- 
uovtTvf) l)v liiiig) uxUi>d>s iti iLv iiiuiiiniurv liriel'miii tiic iinper 
Ix)nl(-r uf till* »ixlti rib to (lie- ivi^tiil iiiui'};iii ^ in lli«-axif]an' 
liiif, frum tbc ei^lith rib to tliv friovcntii Hb; in tlic K-spiilu' 
iiiii-. from tbe nintb rib (o the cU-vnitli rib; in tlip median 
liiK!, the- upper iMixler k \vst in ihi.' <-»nli>K' <1iiUk?«, while tlic 
lower bonier lies midwnv iK'twceii liu- i-iwHiirtn curtitage and 
llie timbiliotw. (flight diiliicm iu tbe nmiiiuiarv Ii'm; btf^lns at 
tJw fifth rib. 


PaJpation of the liver ta practised to di-tcrtnino positjon, 
bIzo, form, and orioasteiKv ; aod to detect any tcndcnwm or 

ChnditioM in tthieh l/ir /ivrr i« pd/ptihle: — 

1. Iu tbiu iiubjecls, tJ>c edge is twiiietimut piil)>:ibl« und«T 
norninl uoiiditious. 

2. In very young childreo, in wliotu (h« liver is alw»)-a 
pro[Kirtionatf>ly lar^. 

3. 1 II (b-iireflsion of the liver, M by a i>l«iral effiisioa or lijr 
It eonsol idutii] ^ung. 

4. WUmi (he Ktis|>en9ory lignineiil h rcltixcd and the liver 
" wanders." 

6, In fiilaraemctit from «ny uuiKe. 

6. Ill ntrtaiD abnorniulilit^ of fomi, as in the " tight-law 

••^iiiirrfit'iul Irrtyiihrilinit. — Small irrej-iilarities may he 
iiotiKl in (SJiccr, sy^tliilii' of The liver, and ]itro|>hic nrrhoeia. 

/yinT^ piwnuMrMomiiri? hoinetiniesuuteii In lumore, ulMHvswe, 
uud hydatid cystM. 

(iiiM{i*<ai«,— The liver ia firm to the touch !n hypertrophic 
cirrliueis, cancer, oongeetiuu, and amyloid diiwiMi^ In abstwas 



■ixi hviiuiid ilimwc th« rcs(Htiiiic« is !«» marked, and eomc- 
liini^ IIiK-ltiiitiun mn bt- notrd. 

TnuitnuM. — 'V\w livi-r is K-iuIit in wruk" mriKwlion, ii!)i<cv»i, 
tuiittr, and in alTd-tiMt-'t (i>m|ili(» wtili [K-rilicpiililiit. 

Ptdiailion iiiay lio dctccuil in the vcftonn cuiigotioii rcKiillii^ 
from tricuspid ix^irgilation, alxluminal ai>o<irUin, in lanuim 
oftbe lell lobe resting un the uDita, rarely in a«>i'l40 n^irgi- 


Pcroiiwion (k-lertnincs »)»? am) nsistanot!. 

T^u■ lierr is uhi/cwW^ rnlaffffid in: (1) Con^^i«>n, active 
and Mmiive. (2) FaUy intiitnition. (3) Amyloid inliltnittun. 
(■I) Hyuortrupliic i^rrlios». (^) Hy)>crtropliy a» in Icuuctnia 
awl diaUiUs. 

tmgHiar etJarffeMi^d* of Oit fiver arc luiU^ in : (1) Cuwer. 
(2) Abwx««. {-i) Ilydaitd di§eai«. (4) Syjihilin. 

jTA* Iktr U dimiitidied in kUc in: (1) Atn»jihic cirrliwifl, 
late Maae. (2) Fatty di^neration. (■!) Acuteyellowatraphv. 
(4) 8(^ile atrophy. The area of befutio dulneas may fw 
dimiuiftlicd from certain exiriniiic cauaes, namely, pulmonary 
empliyiienia and exceesivo (yiupanitc«. 


Depinttiov. — [*iijn>cnta(iun of the tissues and serretionit 
with bilc-piumMiti*, 

Vauibtib*. — (1) Hi-|iiitiip-n<rtni, or obslnictivc janndice. 
(2) HwnintiJKvnoiif, «r in>n-iit>*tnictive jaundiot-. 

EtioIjixjv of HKPATtK>EKnt;8 jAt'XDiCE. — Obstruction 
to the ontilow of bil« IpwU to itit )M)C(tniulation and re-absorp- 

ObttnteUon may U- due m tl>e Rilli)vviii)f ratists : — 

1. Stricture oi'dti^ liiltvdiict, oongHiiliil or acjnired. 

2. Catarrh of the iiili^-dm^lti, or of ihc <hio<kiifl1 mucona 
mcmbnuie around tlic onfitv uf the dunlus rJioUiloohiiH. 

3. Foreign bodice in thi> dnd«i ; as ^tUHtom-«), panuitcs. 

4. TainorBof the liverorof adjacent vi.iceni4^mprvstiiigt]ic 



diirtii, Feca! aoRuniulalions, a pix^iant uterus, ilikI (li»|ilace(l 
organs may §iinilurlv compress the ductii, 

5. I»wcre<l blood pressure in llie vesfwls of th<; ii\-vr oniiHing 
inrrcii)>i-cl Iciisioti iti tlie bil«-duct«, an iu Uic simple ichriis of 
tlw nrwljorri, (FrLrit-lis.) 

Symitoms, — The skin, niiK-oiiif nicinbram'^, ftiid seerecions 
nix* stniiu-d ydluw. 'I'lic (li^col'inilioit is ti»tiinlly first noUced 
in tlifi wiijiinclivA'. Tin- fltouls are liglil, liw wriiie is dark, 
and in lia<i ra.t(-s ivMrmlilci* ptii-lpi". Tlit' piilw is URually slow, 
and Ihe C?ni|wratnre slightly sulMiornial. Tiif-re is always some 
iiiental dcprcftsion, and in pxireme i-asts di>liriuin, oonvulsiom, 
and coma may develop, liohin^ of die skin is oftt'U noted, 
and tirliiiiu'ia is n (Mmiilon complication. In grave rasee sob- 
ciiiaucous Gc«hyrao6cs may spixar. 

DiagkokU. — Other disoalorationa, like the bronze hue of 
AddisonV disease, unil the green tint of chlorosis, must lie dis* 
ttDgtiiahod from jaundice: but in those cases tlH-coiiJutietivu 
iit white and tlie urine laclES bile. 

Jaijshick. — This form r-suII" from » diwnl^-gTation of tlw 
Mood, or u deMnivlion uf the liver stibntance. It 'i» mmtiimvt 
nuud in peniieioiis unieiuiu, uuti other i^mvo nnaiiiian, Iku it 
mort- coniinonly mwdt:* from the iirtion of »onH^ toxic a^rent on 
live hloo<l; thu», it may be- oW-rvetl in jHiiMining by pho«i- 
|)tiorii4, arwtuic, and oth^^r miiiemU; in snak(^-lH>i^onin)c, id 
pyiemin, an<l in rvrliiiii infii-tiiiO:< fcvt-ri — as yellow fever, re- 
kjiHiiig fi-ver, m:diiniil fevi'r, and iicute yellow atrophy. 

^iYUl>1X)^t». — Mui-h the itunic ha in oluitrnclive jaundice, bat 
lite stainiii); oi' tiK :<kin i.s u.'tually not so intense, the stools 
!<lill cviilain bilt', and grave cerebral symptoms are mora apt 
to dt;vdo)>. 


Ph^tJogietil icifruM in the newI»om is slight, aitd probably 
results from the lowered pressure in the portal vessels cbusmI 
by ligation of the umbilical vein, and the Eubsef|iient abaoi]>> 
tion of bile from the tense capillary ilucl». 

PtUhtAoyieal idfiia in the newborn is mikrkcd, and 


txxn- fl 


nionly proves fatal. It resiiltH from «ot^«iital stricture of 
the dact, gypliilis «f the liver, or septic iutection through the 
lunbUical vein. 


(Cbolnmla. CbolaataxaBmLi. ) 

Thin t4>nn is appltnl lo a (;roup of syniplonw not«) lu (li»- 
ousett aMMKiuU^ with n destruction of tJtc hcpHtiv itulwtaiwv, 
Mill probably deprniicitt ii|Hiri ttiv n-1i'iitioii of puisoitt wliicli 
jMkkiIiI buvv U.VII viiniirmtixl by the iivi-r. 

Etioi/xjv. — Avholta OMriirs in flciik- ycllnw airophy, and 
aomdinK^s ut tli« eloae of cwiiaT, (rirrho(«s, unil fatly di^iie- 
mtton of ll>e liver. 

SVMPTOUR, — DcliriiiDt, ooiivulsion^, Ktupor, aud coma. 
JwindicN' niny or may not l»c present,. SulKUitaneout) ecchy- 
rmjws und hemorrhages from miiruun in«iiibntnc»t are frequently 


(CttwThat HepaUUa. C«Urrti of tbe Blls-duota.) 

Etioixkiv. — (I) Tin- moot common cause b the extension 
of a putt ttihI HOC b-iiul mlarrli into the dtivt». (2) Primarv in- 
flammation of the duc1« may n«ult frcKn ('X]>oHurf to oohf and 
wet. (3) It may bo in<hiiHii by irritalion fmni pitl-stoncs. 
(4) It mnv be iufix-lioiH, i.iiniplii'ulinji; "'"l"""! piKmnionia, 
rd«ijsing fever, and Htmilar dimfua^?'. 

Pathoixwy.— The largi; < arc imrtioularly afflhrtetl ; 
the miicouii membraiiti is i^wolli^i and a)verMl uitn tt-niiciouit 
■mints. When the gall-hladdt-r is oomprwwc'd, l)ilp is ijct-lHd 
with IcflH eaae thao m natnral through tbo diuMlcnal oriflii-. 
Wlicn the catarrhal prow?** is long-^ontinnej, ulccmtion of 
tlie du<:tB, or secondary drrboftia (biliary cirrhotiia} may rtfiult. 

SviinoMii. — (I) Symptoms of gastro^uodenal nitarrh 
usually precede. Th(iie are: Coatetl tongue, anorexia, filid 
hn.'Ath, epigastric distresfi, vomiting, and perhapa dinrrh(i>a. 
(2) Obstructive jauiidice, indicated by yellow skin and eon- 
junctivie, light st«ols, and dark urine. (3) In acute cases. 


slight fever and swelling of Uic liver, whivh U tender to tlw 

DiAOKosis. — LI*"imIly <«iy ; tiie cxclnsioR of oilier ranwos) 
of jiiiiii<)ic«, iLtid tin: <H»n^tUimt\on of tlit> ft&, w.alf onwt, aiid 
pif^rvutiun of ItoaUIi M-ill ii!«iially make tlie diagnoeia appa- 

Pi«XiS(t*iB. — Favoralile. It rniv\y iKjPonifs elimnic, aod 
Imwls lo l>iliai-y rirrho«is ami iilieralion of (he durts. The 
averag*- <liiration is fr>mi a few days to wvei'al weeks. 

TiiF^ATiCKST. — Hesl. Liquid diet. StU|)es of tiintcniitie 
or of dilute nitrohydrw^hlonc acid may be af^plied locally. ' 
Mikl laxatives are oflen inclicaled ; ealomel may be tjekcted. 

^ Hvdrarg. chlor. mit,, gr. Ij; 
Siidii bi<»rU., 3}.— it. 
Ft. incliarl. No. xit. 
fSig.— UiM erurj hour unlil n laxHltvo cfibct t> prodncsd. 

For the gastro-duodenat catarrh, mineral watem, subnitrate 
of biflDiiith (gr. xx), nitrate of silver (gr. i q. d.), chloride of 
aninionium (gr. x, tj. d.), phosphate of sodium {5J q. d.), are 
valniiljte adjuncts. In ptmislent OLst-tr the daily irrigation of 
the 1k(WcI with pohl water{l-2 quarts) ha!- l)«-n highlv reconi- 
mendcd ; tlio iiijo(rtion» stimulate pvrietulsii^ utid thus lavor t)»e 
expultiou of niiictis and bile from the duet& 


(Oall-Btonaa, CholeUthlaaia.) 

DepInitiok. — OmtTetionn formed in the )^l I -bladder, and 
conip'Wcd for tlm mo»t jMirt of bili>-clciufntn. 

I'^ioi/KiY. — Female «>x, age (alter forty), heredity, seden- 
tjiry habitus a rieli <)ict, di^««(S of the liver whielt ob«lniet 
tlie flow of bile, a* tumors, and (■nturrh of the d<(d». 

l*ATHniXKiy. — Till' aIi)IK» iimv lie found in the <liieti«, btil 
they are alway:* tonned in Ihe j.'sdl-Minidi'r. Then' may In- 
one or ."evoml ^Sllen nuiltijitf, they art* loitml with 
faoda, frtin] attrition. Tito stze varies fixim a j^rnin of tiand to 
a targe walnut. The color ^'antM l'n>m a light yellow to a 
dark green. The chief coQ.4tituent iti eholfisU-rin, bnt btli>- 



acids, bile-])igmeoto, litnc, and nutj^tXT^m al^o enter iuto their 
fviniiNisilioD. On ivcUon, thoy (wually present u oonrenlrir 
umuif^nient. The [iinlhi^emi^i^ !« tuA known ; n elicmlrsl 
eliMigie in the bite prolmbly Wt*ils U> » prwipilatiun of tlie 

KtimU. — (I) SloiHti (>fl<'n rern:iin Iiil^nt ii» llw blftHdcr. (2\ 
Titev ruiiy jmuw out with jKiiii atnl sivihid (NliHry OoIieV (3) 
rmjiai^liuii. A W<>m' miiy iil»ilriu-t \lw i-vstiir dwt niwl Wil to 
(li!>t<-tiiion of tlw liliicbli-r wicli iiiiimis. Mnn- rr«iiiiiiily it«? 
d^mniDii (itiet in oli^rnirtcd nrar icfi ilniMl^^nal onfiiv, when the 
following syniiXonis nsnit ; PernianenI janniliot', tond^mese, 
*tx8<<eTbations of |kain, and {tcniliar (ismxysnts af fever, chills, 
and H^veatA, rriwinhling nmlaria (Charcot's interniitt^ul). Sndi 
|xm)xyrfnis are no* neecBsarily dept'iidenl on suppuration, 
attliou^'h aliwMw may follow oljst ruction. (4) Perforation 
into the abdominal b.ic, etomuch, or intestine. Kxlernal wr- 
foratton is very rare, (5) After exit, i^ricture of the anct 
may restilt frota ok'vmliun, or intcoUnul ubetnictioD, from 
ioi paction. 

ftVMPTOMs OF Bir.lARY Couc. — Snddcn and mtettso pain 
over tbe liver, radtuliti); to thi' Ijotc^k mid lu llic riKtit shoulder. 
It usually ■»">-iir*nii ln«ir or two alli-r imtin;;. A rijpw with 
fever may nmrk llw wiNt't. Thfl .syni[)tt>nii< of inteiiHC puin 
arc obvioun — unxtiHH) fiuv, cold rtwmt, fcebli' pulw, utd vomit- 
Jaundiw uiav folU>w froRi obntrtivtion. If iJie stouc 
it may he found in the (itml. 
tAnN'<t»ir!4. Ucanl CWic— Pain ranltalcii from the kidnv^' 
>wn iIk- ure(«r to t)>e pc^niii ; bliH)d in th« urine ; no jaiiiMlioi-. 

Intfftinal f iVt>. — Pain radiates from the nuibiliitu); iUtu- 
!»«■; no jaundice, no sktnc recovered, 

GaMmlgia, — Pain referred to stomach and back ; no janii- 
dice ; no stone recovered. 

Pkogii(i6IB. — TIm? attack usually ends favorably. Hocuiv 
pence is common. The profrnosii^, as rc(pinLi ultimate r(wv<*r\-, 
sliould be guardedly (ii^'orablc; c(>mplicutiousarf<x>m|iiaralivviy 

TftKATMENT. The AUwh.—YUl fomentations. -MorpJita 
fgr. 1 to t) with «lro]iia (jjr. j-J-j) liy|MMlcrmicaIlj-. In agjfru- 
vtttcd fxnm aDHStiK-tim will be niiuirfd. 

76 braEAses op thb dioektivk sybtkk. 

Tlir Inltrra/.—A repilaltd tli«l, targdv v«g«lalJe. Srtten 
atieexeTGtM- »liiiiit<J Iw cnjiiiiwil, Tl«' now of hjic ohnuM t 
viKonn^od by iIh- iitf of mJiK-nil wnton>, ]>line<ji}iaic of sudiun 
ftr vpgcUible Wiuliij^pii', li kc ptido|iliyllin or monxiiiin. C^tarr 
uf dut-tfi xliuuld in: R-lk-%'c(l ku (lutt .-iliiiMS may eai3i|ie. 

In impaction the Mime troiltiifnt i» indioitvd with omtitei 
irritation, >ml tlir iiw oC ^umii' inU^tinal anti^ptjc, mtrii a 
mIoI, najtlilliol, ur tin? xalii-yialt- nf bieniui)), to n.-i)lupp iJi 
a(itiH-[>tir t'lcnwnts iif i1k* i«li\ 

In ainjrsivudil (iwmi nn t-x|>!oRslor>' in««cin ghouki b«? tnaik 
wIm'ii II rfonc ntiiy be rwufivetl rnini tiie«inimou diM-t (cfaole 
d<H>liii(<>itiv), ur fntm tiu- Mll-bladdcr (choltwy^otoniv), or tJii 
f{all-blad<t<;r removi-d MKiiwyetectomyJ. 

iiyi'ek/>:mia of the LuiaL 

VARrKTlR*.— <1) Active liy|H>ra?inia. (2) I'aauve hyper- 

t/noi/KiV. — Afiiiv htf/myiMM t» oomiixmly due lo diet«tiq 
indlwrt?ti(fii8 H>iliuu8ni'SH). It nmy reeiiilt Irum ovcr-iiidnlnrooe 
in alnohfJ. It ih oft*"!! piy^iwnt in llw >nfi\-tiuus fevers. B 
sjtprarti I'l nriRc idiopatliitally in hot clinuilctf. 

/'(uwiW htf/nnrmiti resiills from diw-asiw whiob obetntr^ the 
Vfiioim ciivnlalion, a.^ chronic lunrt and Inng rliM>ase. 

I'athouxiv, — Tlie liver is enlarged and filled with blood. 
In the juii«ivo variety, the centre ot the lobnlir, the aren of the 
iif\>alU: viMn, h deeply pigmented, M'hib llie [Kripher^-, tht 
ann of the jxjrtal vein, ia pale. This inoilhil n|i|Mnran/n- has 
Ifivrti riw lo thfi term " nutmeg liver." In jH-wistcnt ra^cs, 
pi^n)('n(atit>n, atrojiby of livcr-wlb, and overnruwlh of c siBti 
n<«tive tisauc result — a condition termed "cvaitutjc ind^H 
tioti." ^ 

SniPiXiits. Adivf hypefomia. — It iii a»inctal(«t with gn»tri<- 
IritI), and llio usual s>'m)>t»ms are: C(iat<-d tongue, lt:tid 
ill, anorexia, pain and lendemcsH in ilie fpifraatric utd 
M-bondrtm' regions, nauitea, vomiting, ^ick-lniMlnche, and 
aouii-limeii hitgbl jaundio^ The liver may beenlargwl 

In the pamre variety, the eyni])tonis are tlte ewut', though 



le» markfitl. Ttiv liv«r ii* oRcit qitit« Uirgv, aiict in extn.*ii>e 
CMes, suci) fL* foUoH- tri«u.-<|iiil n^iir^ilnlion, it may pnlvate. 

PiMXiX(wi8. — In siinpl« aa'tve congistjwi tli« iimiriicvii.'* is 
gaxxi. Ill ]ui»^ive cui^^e^tion Uie progoosb dcixiulA on l!h> 

'rRF:ATJlE.NT. Acttrr kifpera-mui fmm iiiftMlf aront — Re- 
slriH the diet, apply ooiinlei'^irrilanM, uid adinittiMer calt)imJ 
aiid soda, tlios : — 

H llydnuv. ctilor. mit., sr. j ; 
Sodti bicarli.. 3J.— M. 
Ft. In «harU No. vi. 
fitg. — One GTccy hour until Uircc or four hxrv bocn taken. 

Follow tlic nilomel witli a laxative Aofe ni sodium plws- 
phate, Oai-l§bad or UiKhclio salts. 

In rt«iirring iittaeks uC b! I i ohm )!';<,■(, in addition to dii>t«lic 
sihI hygivtiio dinxrlioti!*, llic IVtlkiw itif; will prove uttt-rul : — 

|( Uak*. li)-(lnirg.. gr. v; 
l*ulr. rliri «t 
Kxt. genUau.. Ba 3e« ; 

OL otnouhylL sti. iv.— M. (Hartsborkk.) 
TAi. In pil. So. XX. 

Sig.— Odo or tvo occnsIonaUy, a* directed ; to be contiiiued if re- 
quired, tUrice dniiy Tor Msvrral diiyn. 

Ill )Ki.«tiv<: (»itg(at>on, direti thi^- tniitmi^it to tin- original 
tiiM^L'tC. In mild eft^K» lh« niint^ral uati-rndu will ((.'iirlflKiil, 
Omnn--S3, ami P'riedericlisJiall), A mercurial Iiixativr iimy l«- 
il-<4hI frt>n) time to time. In oli^ttinate ca.^i^ tlic iinKraMiiralvtl 
uJiuea may be employed as purgatives, and wei <ni{ia applied 
to tJie liver. 


(Hott-naiMI Utot, Intecstitial BepaUtla, Oiu-ditnkn'B Uvm.) 

Dt:rtsiTioN, — A cbronic disease charac-terixed aiuitomitally 
h\ a liyperplasitt of the coiinwtivc tissue and destruction of 
t^e sei-r<!ting lvIIs, whI nuuifcsted chiefly by symptoms of 
portal obstHKlion. 

FTlOi/xiY, — Mall- wx and middle life are gentrally predi^ 
eing &c-tor«. (1) Tbv abuse of t^pirituoiis liquors is a cxrin- 


ntsKASts or thi: DiorsnvB srsTBif. 

mon csnw. (2) It folluvr» dironio <Ji.'<<!a>N« which a]l«r Uie 
rnLii.4 vi' tin; Itl^Hxl, vix : Sv[iliili)i, }^iil, mnlarin, and tubara- 
K>s». (■*{) Ii Rviilu Iroiii ilii; (iit^ive cinij^-Miuu inijiioed in 
cJininio lirart aiid Itiug; iliitcone. (4) It luay bo secoDiluTlu 
iiiflainDiftlioM iif tlti? t)ile<diti.-Ui. It is Mtmeiinics secti in 
oliildrcii; niul in tlieni, M>iigvitUai sv)ikiliH and the larectiuoc 
fi^v<^fs a)>|>Mir to bo th« exL-itiii)^ caiiACA. 

P.\TH(H^>OY. — Two vaii^-licft littvt' Wo rcH-ngnixcd: (1) 
Atrophio cirrhoHL^, and (2) tivj*Ttiit(>liiccirriio«i», i 

Alrojifiic Cinlioxiii. — In tnp parly slagts the livrr is soiik^ 
wluit large fmm hjpersiuia. In the advuno^^l Mnffi tJir 
liver ia fitnal), firm, gray iu color, and covenil with ■hiiiktuw 
granuktioDB (" hob-nnils"), A 6«-tion of the )iv<u- itni^iiis ' 
a network of fiiic an<l ot ccanie pearly luindi- <jf eouiu'rtivi; 
tissue. The coDtruetion of ti\\n eoniKt^ivc li««iK< is n^[ioit!i> 
bic for the rednciiun in Kize adiI granular ^irfui-e, 

lIlsTOUMiV. — ^An ovetptiwih of conntvlivL- tissue; and, 
from interference with nulrilion, fatty inliltnilkiu, fatty dc- 
geuerulion, atrophy of cells, and pigmrnlalioti. 

Jlt/pfilrophic C^rrkofie, — Thi:' t<'rm hiiis ln-cii applied (ci ihe 
first i-tage of the atrophic form, and to « Iiirp- liv<-r resullinn | 
fitiin the ojmhinalion of eirrhosii^ with liitly inRltniiion. 

More i-owntly, tliff lcrn» hyiK-rtrophiv, or hiliar)' i-irrhoNO, 
had licen restricted to a conditti'n in which the coiiim-tive-i 
tisiiio byperplasia starts frotn iIh- |>criphcry of the oipillary 
hite-duclH iRstcnd of from the mniifiiiitiuiis nf the poi-tnl vrio, \ 
a-* in atrophic oirrliiuiis. , 

As niignt be DXj>eeteil. the synilvtoniR of |>onaI obslnKHioD . 
ait- iii)t marked, but jaundice is w iiiximinmt feature. 

The liver is larRC, yellow in cvlor, and its surface is HnHHiili 
or fiiiely gniDnlar. Th« iiierciwwl wae is due to a great over- 
growth' of connertive (ifistte, anil to prtiwrvalitm of the Wpalic 

SvMiT-oMR — Ohelnictioa to tlir» portal cireulatioii indinss- 
conn«ttioii of the Mtomaeh and intirsliiies, ami bcnw the initial 
ayiuptoim arc iJios^of gantro-iint^linal laiarrh. Thtw? an?: 
C(Mt«d touRUe, aiiorpxia, fnlm-iW and distiTws after eolinv', 
vomiting of fmlhy mucus, flalitli^nce, nin>li|iatiou, and dark, 
urine. Those phenomena may last for-month»or yops. 


Aa the olwirucliiHi Ik^xhui-s j-iwiter, ttio (lurtal bl>in«l Itwl** 
uew dtaoDcts, smJ the siiiwrtinal ulxioiuinal v«iiis enlai^\ 
UotnUly arouml tlie iiiabiii(.-iiH, runiiiiiu; i1h< ao-ealkd "caput 
luotiib^." Ilenwirrh'mis i-fsiiU fmm llii' same cause. 

Engot^genient of Lite |M>i-lal svsteai Icadx lu asuiles and ^wrll- 
in^uftlio feet, to heiDurrliage frimi LheKtomacb, bowel, or sotne 
rlititant or^nii, and to cular^nKint of tlie »f>lcen. 

/'/iv«iVvi/ ^oYiMiwi/i'm.— Tke liver is at firet targv, btit is 
»iitrsi¥(iK-iiUv wintnw*"]. 

There h low of fliwh iimi MnMiKlh. Tht- skin U muddy in 
apiMnnuKie. •Iniitidi<t; U n<>t cumiiKm, iind wIh'h present, 
n<tuilt.s fmin <ntiirrli uf the I>ite-diii-t8. Death rei>iult« frora 
cxIuiiiMion, beniorrba<:<r, i«t«n'urn'!iit diwasc, or frwn a group 
of iiM\:hral flvin{>t'>nH (d^liritini, convul^^ionx, and n>mn) which 
an- iwiliably iUw lo the rrtjaition of 9oni« l«)ti« ui^-iit which 
tilt fiver xbould eliminate. 

i liffterirophic OtirAosw. — ■JiiniidJno U markoJ. TIk- Hver is 
enlarged, snioolJi, and limi. 8yiii|)U>iiut of jtortul olMt ruction, 
9nch as dni|»y and liemorrfaagea, are not marked. Tlte spleen 
is gw-olleo. Tbe disease may last one or two ymnt, but an iibrupt 
termination in cttnvubioiis and coma may onc^ur at any tinx.-. 

thmfJiraiioiin, — Tiilierculosis, iut«r!ttitial nepliriliit, cardiac 
hypertrophy, attd hemorrhage. 

r>lAUN<Jsl8. — In (be carlj- stage the diagnrai.t mil only be 
Muspec-Uil. In the dnmkara, chrooie j^stnc- ratarrli wilJi cu- 
lat^^menl of the liver would Btiwngly indjeate eirrhoctit* 

Oiiuvr. — HiMoiy, {jn-ater cnebexia. jaundit'c more cxmrnim, 
«nd aR-ilfSt 1»«* frc<iiii-nt, liver cuLii^frd and RlnddwJ with 
nodule:*, other ort^iii-H uilti-l^-d, pain, anil f\n\n dm-ation. 

O^rYniie l\ritonU'u' trilh rffanon. — Thtc is uvnally U)l)erctiIoH>t 
i>r I'linceroiifi. The sliort uiirulioii, ibenUioioinal tenderiie«a, 
the lack of a unifonn enlar^-mcat frtmi iHtmU of lymph, tbe 
absence of symptoms indii»tii>g (mrud olijInK'tiou, the normal 
•lize of the liver, afUr t.-ipping, and ili« Uirbid asniouH fluid 
will indicate dironic ))ertt<>iiiiiH. 

1'K()O.N(mi»-, — Unfavorable. It may iK-arrwdtd jn t)»eeaHv 
sla^. The cnlire duration may be man)' vouv, but dcatti 
IHualiy r^sidt^ in from one to three years al\cr tn-mptom!i of 
portal olwtnietion have appeared. 


TitEATUEitT. — Li^bi nutritiKis diet Rait. AlcaboJ mm 
be iDiertlided. Treat the gaark- aitarrb widi nitrate of sil»w, 
bismuth, mineral waters, aod antiseptics (creasiittr and saJio Uu 
of btsmntb). lodiile uf potaasitun in anuU doge*, well ililiiuil. 
may be of serviee in the earlv stage. Couiier-irritalinn om 
the liver filiould be frecjuentir pm^ised. 
[ ' Ancitem. — CootTnirnted ^iue purges in the morning { Krjeooi 
aalts Sss in euougli w aier to dtamlve it). Wureti^w, as digitalis 
or caB^ine. Niemeyef's pill may be Dwful. 

^ Miui. Iiyilrarg., gr. xij ; 

Pu!v. »cili», gr. xy.— M. 
Ft. In nil. No. xii. 
^Slg.— On« pill tbricc daily. 

i'lten the eSiuion is very la^, internal remedial &il, and 
paracentesis will be reqaiced. 

The Operation. — Emptj- the bladder. AnssthettTp a point 
in the lioea alba midway between tbe umbilicus and piibia 
Tap with a small inxar, ai>d have a long rubber tube at- 
tached to tbe cauiil-i for oonveyinj; ibe liquid iiUji a «tni-e- 
nient receptacle. When ibe liquid stops flowing withdraw the 
canula, cover the wound with adlicsive plaster, and u|>ply oo 
abdomiital binder. Ob()er\'o strict antisepsis. I'he operatioo 
w free from danger. 


Bttolooy. — (1) Tli« presence In tli* lix-cruf Ihcamrelra mil 
of dyscnt^n". (2) Tnuimatism. (3) ForeiRn iMdiea, gall- 
Htonea, retained t»h, aiul byduttd cyst«. (4) Septic embott; 
they may <iime tlinitigb ilii> hi-patic artt-ry, wit usually (hey 
come through the tKirtal vein fnim gastric iiltx*r*, or the nken 
i)f (iywntci^', typhlitis, or ty)>l)(>)d fVviT, aixi pnnliKx- a pnm- 
U'ut in Hum mat ion of tbe vein (^nppitnitiw pyle|itil<tbi (!«:). 

FathoijOOV. — Tbe aheceas following aimt-bic dywnterrts 
tiHen single, and usually oecnpies the right lobe. 

Kmboliu idiMTNK^ are nlwayn multiple. 

Et-rnU. — ]Ii-)uili« al>scT-«* may kill by exhaiiaiiiui or by 
rupture into wijacent viaoem. Recover}' may follow after 



operation or fi|>oiita]iemi» evacuation ; aiid tlie Utter may be 
estprnal Uirougli the broncliial tulxtt or lliroiiel) tke bowel. 

SviinntJiis. — Hertic syin|)tom» : Fever, higli in tJie evaHnj; 
and low in the morning, sweats, and t-hills, liocal synip- 
UtiTti : The livvr is cnlar^l, [laiurul, and tender. T)H?re may 
be bul;;ing snd even fl ltd nation. I'tis may Ije tleteetetl Ity the 
mpiratin;; iietille. Juunditv from ubetrndion is »uinetitiies 

DiAtJSUSis. Ilj/flatid (\pU, — Long dttnition, history, d«ir 
fluid on »()>iration, abiMiicc of puin, uix] nhsenoe uf hcvtici 

Omrrr. — Hirtory, uu;hi.>xin, tlie involvemcut of other orpnis, 
mnlliplc and linn iti^hiliw, an<l aluscmv of Inrtio symploini^ 

lulniiiilltrHl Fttt iIhi" In ittijuwinl '>(/<■«/(.— I't-riixi it', uf long 
(liinilioii, aliftciiw! uf fever in the iiitcrv«]», and fair [«\«or\-a- 
Uon of h«al(li. 

Pti'MiS'iiHtfi. — KnibolicaliM«i«««(inuUiplo) |>rov« invariably 
fatal. Traiimalie ab^^eflse^ or abaoeMeH due to a ani'cbu; 
dvi^nlory may texminate favorably after s)>nnlatieous or iit- 
ilnocd evacualton. 

Trkatuknt. — Hot applications, opium, quinine, and stimu- 
lante. Whenlhe history indicates a single abitccie, invoke sur- 
gical aid. 


Etkiuxiv. — Male sex, age (after forty), heiwUty, and traii- 
iiiatii^n) are prc^Iri|>o«in}!; factors. 

Pahiou)ov. — ^It is generally sccomlarj-. The liver Is en- 
larged, and studded with numerous grayish-white nodes, some 
of which project from the snrfaoe. The superfieial nudea are 
often depressed at the oonlrv. 

SyjiUTtiMS. — (1) Spvore |iain and teiidenK«s, (2^ Cachexia, 
I.e. loss of flesh and !s1i\ii<^h, with |>alW. (3) I'rDseure- 
BVtnptonis: jaiiudkTis (XiniiiKm lnilii.N-ilc» is rare. (4) Phy- 
sical examination : llw liver is enlar^L'd, its T^nrfacx.- is tHxIuIar, 
and tin; central dctiremtun, or unili!lK»tiuni>, van often be 
delected. {'}) Hyiuplonis uf itiv primary growth, whi(.4i is 
iisually in tht- sloniadi. 


Ftver is generalj- absent, but secoiwlary perihojiatiti^ orl 
8ii)>piinition of llie cant-erotis m)cliik'<) may ludiioe it. 

l>lA(iN<j!^ls, Ili/jtrrirophU- Cirrhomig. — Liver is siuoolliimdj 
puitil«s8, the durntiuii is luDf^t^r, ciu-licxiu is nub marked, ancT 
tlM;m is DO iiictitation ul'a |>riiimry ranver. 

llyiliitiH (.)fst«. — Ilvultb prwwrviil, tiiraur t-laittic or fliictiiat-1 
ing, no [min. juiindtw iiiicutnmnii, aspiration yields a dear] 
fiwid rxHitiiiiiiiiir liuukli-ti«. 

Afmcvu. — History, isliortditnitlun, liMitic fever, and resulta 
of ati])i rati Lin. 

Pwooxoew, — Absijluicly fatal. DunUioii, from a fiiw] 
□lontliH to a year, 

TiuiATMKNT. — I'al liati vc. 


(Wiuty UT«r, Ludaooona Uvir.) 

DEFramoN. — An wilnrjp»m«it of tJ» liver due to tlw de*] 
j)0»iiliiin of an albuminoid tiiiWanoe. 

r*>rioi.iHJV. — (1) [V>li>iigcd Mn|ipnration ; (2) Kvpliilin ; (3) 
luljpiiiiilosis, and (4) chronio malaria arc canwil fartinvi. 

Pathommjv. — Tlu' liver is very laiye, baiil, ami onuMitli.J 
The edge is blunt. On section, the Bur&ce is " waxy," and al 
dilute solution of iotline Ktrikee a nialiogany-rod i-olom-ith the] 
amvioid material. The dc^nei'ntivu pi'ucess bej^ina in tJiej 
wails of the capillarieH and sprtiidH to llie oonnwtivr tiHsiie. 

Symi'IX)MS.— Failure of ciuenil litidth with nnirniia. The 
liver i« cnlai^cd, snuwitb. firm. Jind painktw, and presents ai 
bhint ed^. The i-plwii and kidm-ys slum- in the ik-gcueratioDj 
and, as a reeiilt, the spjt-eii is enlar^ixl and the urine isalbu 

I)iAONU6i8. — The liistorj", the smooth, paitdcsii, cnlarjte-l 
niet)t of (he liver wilJioid janndiii', nn<l I lie involvement of llw^ 
kidiiev^ and 9<j))i.i-ii, are liic diaguoHtu' {ilii'nomonu. 

I*llOUN<*<l«. — I'niiiviimbli-. 

Tli>UTJii r.ST. — Kemnlii-s must Iw din^cti^l lo tht- inniMdj 
dii<<m«^. Niitrtefll.4 and Ionics are indicated. At)««>rbenlM, like) 
the iodidi'.'i, R>enniriali<, and ammonium chloride, have beeirj 
n-commended, but are valueleea. 




(Ecfalnoooccna of Um Liver] 

Etioi/x)Y ani> Patiioum)v. — IlydiitJd cyds are formed 
by ttu.- i-mbrvtM of tin- Iteiiia vrbinwxjc-ciM, a siimll laiic-wonn 
inliabitiiig the iritn4im« of (lie dof;. 

TIm; cjtB* of Uiv wwriii iin;!i'ii tally inp^^vtl by man, and 
embryo* «n; lilxrau^I in llw stomacb. wbcnw ibt-y may mifn'ilf 
Ui any or^an ; tlor livt-r Iiijwi-v<-r w nmsl oinniKinty ittltvle<l 
Ifaruugh tbo (Ktrlal v«n. Tlw (ixtil cnibno wion di-vi-loiBf 
inti> a (78t wlik'b i« niiii|x>s<:-d wf aii vxU'inal laminnt«-il luyur 
■nd an iitK-nml brvi^iitg layer. A oiiniicciive'lL'Miic layer is 
foriniil '>ii tbo iiiil.ti<]<- Tnicn irTilaliim. 

Tbo (■^'KL »iiiriiii).-< a i-bar iii>ti-nlliiiniinoiii> fUiid wbb'b lia^^ a 
"jKi-ilit! (^nivily of H>l"> tn I(»l(7, am) wbicb iri rirJi in rliloriib*. 

Si>liw!« or larva- ilev<rIoj> fmni llii^ bn-wliiig layirr; tbty 
art! |intvid«l witb tour miekcrs and a crin-lc nf liooklet^, aiid 
[ittidiMV daintbter-frk'-ita wiltiin ibe i«ii*nt-M'st. When ingmtnl 
iiy iIh* ibij: tbo larvw develop into maliire tjiiio-wonns. 

SvMl'ToMS, — Siiuill fVnU exrile no rtynij)C<mis. Tberc 'lit 
oticn a sloHly-developiiij;, irregular cnlai^enwnl of tbo liver; 
if the fvsi is hupcriiml, an dastir- or fludiiating mass niav be 
delected on pal|Uilion. 

On perrti'wion a |M<cidiar vibratory sensation (bydalid tbrilh 
may be im|)urtcd to tbe Jiand. A^|>iratioti yields a clear fliiiil 
amlainin;; booklriM and cbbirides. 

Fever, pun, and JHnndi<:v arc uenally al)«ent. 

A'mUs.— {]) It may kth-Ii a ivrtitin l»^^', and iben remain 
latent. (2) 'Irit)iH|; injiir%' msy convert it tiito an abHcesK. 
(■t) RupttiK of tlie ryM exfcnially or into nvigbboring organs 
may result in death or in nxitwry. 

DiAiiNosis*. — Slow devrlo|iment, imiridar enlarf^menl, 
elastic fivl, ibe retiull;* of a.'<|i!r.ilion, and the alKH-mt^ of |inin, 
fever, and jauiKliit? aiv lli<' <!i;ti^x*lio fi-al)irt'«, Sn|i|>iiniliri}; 
CVbt« will lie diaj^uuntt] alwiv_-,-^a. An n|nvaixl-gTiiwiiig cyst 
may |mr«-nl llie signs i>f a )>leiiral elVuHitni. 

I'i«»<iMKiJi,— fiiiardedly favorable. 

Treatmknt. — When lar^,a!^iiirat«. Iftbellnidn''<ullfieti«, 
o|Kri and drain. 



(U«U(naHt JUTindlctt.) 

DKKismoN. — A rare »ml ^mvo di^awx* nt: 
tomioally by a rapid <ln'lru<.-tiuii uf tli« li\'«r litwur, und um-: 
{&HeA l)V Jaiittdicv. Ik-iiu'itIiii^':', n radudion io itic sixL-urue 
liver, aiwl tnarkwl wix-lii-ul |i)u't;4»iieiia. 

Eth)I.(>gy. — Fi-iii»lf «sc, pregnamy, early life, an: pf! - 
posing fiUTton. 

Alcoltulic vxct«ac8, etnotinnal excitement, and iiyitlitli« hi** 
been Kivcn as cxwtiiiK 'Miniwa. 

The rapi<l <1)Udv, nidi^pread kwoOH, and tlic (net Uut t 
lias Mx^iirred ■■iiilcfitiially suggest an inrectioiis nrigin. 

PATiHtUKiY. — I'roin detitrurtioii of ite aibstaiw* tiic li\w 
is quite small. The rajeiilc, Ixring Um ]arpj for the slirunka 
ui^n, i« wrinkled. The siirfare is yellowish -nxl and mu(tlt< 

liiMoloff^. — Fat dnips, moloiiilar dibri*, fat crj-MaK 
crvstal* of leiicin and lypoein tal«c Ihtr place of nurnial It 
rAh. Tin: i.tln,'r iiisans reveal fatty dt^neration. 

Symitoms.— (I) Ilie initial symplmns, whiHi am ihow 
csitarrliiil jaundice, are: Malaiee, liliplit fpvi-r, cuni«I ton 
naii-wa, vomiting, and jaundipr. ("2) NVrvous nnipuinin CJ- 
low; lliese are; Severe lipadnt-hc, dcliniim, ixxiviilsioiLs ajiil 
coma. Sonietimefl these Bymptoiiw prwicdo tliv jniiiidiu'. pt) 
The urine is scanty", and t-untiiiuH nlWniin, btixxl, tnbe-i'a-t-. 
and cry!*liilfl of leucin and tyniwin. (1) Hernorrh«tr»T*arefiini- 
mon, tin- hkin may lie ciivcn-il willi iivhynuiiinii, »n<l bltx^liii-; 
from the niucims nwnibniiie« may octiur. (Ji) The area ■■f 
hepatio dnlne-ts is diniinii^hcd, bat the area of splenic dulnno 
is increflwd. 

DiAtiXiKis. — The gmve w-rebml Bymi>tom», rediuiod iH-jmtii' 
diiliWM, awl hetnorriiaj;^ vrill ee|>aralc it from ecUarrhal jtnim^ 
iliee. ^ 

l*hm}>horu»-pouomng. — Historj", ['liosplionis in the nrinc. 
priniarv enlargement of the liver, awl the gnat seveiity t>f 
the iniiial gastric bymjrfonw. 

)*l»x>N(»ts — AlnxHl invariably fatal. Pcath nsulu xi-ithiq 
a w<vk alVr llie ap|M.'flriin<-e of ivrebral syinptonis, 

Tekatmest.— Palliative. 





Nonna] urine is s pali-, uni!xT-culor«l fliii<l, of anid reaction, 
liavinc a 9|«ecifir gravity of I0I5 to 1025, and aniniiiiiing in 
qiinntity to abuiit fiHy oiiikt« in twiiity-lbur honni. 

PolyiirU. — An iiicrt^iM-d flww <if nriiiv. 

Tfuipoiurii juJifurin n^nlr.i fnini ; (1) Exi'csfiivc )ngt«4ion 
of llui<K (2) Ditirxdii-s. (-3) S4i|i[ii<i«^i<>ii uf gK-rvpirHtiun. (4) 
Crtiies of certain ft-brili- d't^-jtiiei*, oimI rcrtnin nourotic nianift»' 
latioQit, fiuch as i-xdUinont, Kfiirnlgin, and hysteria, (o) Ab- 
dominal 4-nlflrKcnM.-nte, »* in |in^nai>iy, dlnnti>n», and tumors. 
(ti) Removal of iHtnie leiii(i<rrary obslnHiivn tn itiv nriiian* 

J'fnH'inrnt jui/ifuria n-itnlrM fnim : (1) Dmbrtw) mellitn!). 

(2) I>iiiU'tM iiisi{)it]nft. (.1) (■(inmtf! intci^ trial iK-|>brLtLa. (4) 
Antvloiil ki<ltioy. 

I'lic- urine la'diminlslied or suppressed (anuria) in the fol- 
lorriug oonditiona: (!) Exnrwivp' secretion thrtMi^ nther 
chnnncU, as in frro pcrspiraliun and dinrrlifpa. (2) In fi-vor. 

(3) I'lissive renal «)n|p«tion, fntni oii^iriK-live heart, Innij, or 
livt-r diM>sAC. (4) Organie olcKntHion in the nrinary |i<»*- 
■K**'- i^i '" aeutc and clininj'- iiaix-nchymat'vuH iiegtliriti.t. 
(H) Nervous causes, as in bysU-ria, unit in (lie reflex inbibiUon 
nftt-r aUlntuinal injnrits or operatiim^ 

Urea — Un>a rcDuJts from Ihe ])erRH-l demtniioution of the 
nitrogenous elements of food and lbi!<n«>. It in m-rfectly boIu- 




ble in tiritiP, but the tiilraic nf urra cryHtalliKCfi in tii« ronn of 
tranatiarGiit iinbrirulcd ])Iatt« when nitric acid i» aildctt to utim 
that (mis Ijceti partially i'va]>oratL"d. 

Tlic umouiil of Hrca vxcretecl varicfi greatly in health. 2fo^ 
mill untie contains uIkkiI 2 to 2i j>cr i^nt. ot urea. 

It i« inrrmtKii: (1) After the ingestion of much alimintiuiiK 
tixwl. (2) After oscrtioD. Qi) In uciile inflaiiimatttrj- pn>- 
n-vfivs and in Ivvcrts. (4) In dialietes. 

It M iliminUlial i (1) In Dephritis, (2) In organic dJwa^a 
of thv liver. (3) In wasting di»eas<» and in anicmia. (4) In 

Fiitrln-'n HyiioefthrUr Tr/il /or Urrti. — Add lo 1 volnme of 
tlio uriiwr 7 voiiiinc-s nf ) jilMtrraqiir-'s eolulion of chlorinated 
siida. SliitUc- the jjir (Minliiiiiin)^ (Ik' mixttin- uciilsioimllv, ami 
stand ti asidw I'nr two hwun<, when tin- im<a will have been 
d«'om|)osKl. Xuw take lint spet-ificr gravilv of IIh* (]utc«cpi>1 

2d. .A^MVTtain tli<> Hpcci tic giitvitv of tttcmixlDiv of urine anil 
1 ,a ha mil pie's s'<liition IwlViredwiMiipn^tltun. To do tliiji. mul- 
tiply the Hpocifii? gravity <ii' the pnn- I .«ljarra(|iie'8 sohitimi liv 
7, a«ld this to tlw speeilW gravity of the pure nrine, and divttir 
liy 8. The result is the specific gravity of the mixed fluid. 
J-Vim this eiibtract the specific gravity of the i]uiescent mix- 
ture after decomposition of the urea, mnltiply tlte diflcrt-nce 
by .77, and the result is the percentage of urea. — Tvsox. 

UtbnriL — TTric acid or utntes in tlic urine. These Mtb- 
stanora are formed bv the iui|xTfoct niftamorphcBis of timins 
and nitnigenoUB food. When they arc in excess the urine 'a 
heavy, dark in color, and on cooling (hmw8 down a brick-red 
depi>sit, termed " lateritioiw" (fattr, a hrielt). 

Microscopiially, nri<r arid :)[)|H'an a* rrddixli-yi'llow rliombk 
prbms or lozenf;e-^hii["«l rry?niils. 

,\morj)hon:< unili* iip|Miir ii:* line, dark, aix) ojniniic granuk'^ 

Cn,'staUiiK- nrali-'* nppi-ar ii* nwille^, dumtf-Wlli*, or ns 
l^lohnlur nias^,« from wliich ishiirj) ftphK-s projefit. 

Munrxitlf Trid/or (Wit AciiI iiml ilnSiillx. — Kvaporate a little 
urine in a |>or<n-luiH dish, add a dn>n or two of strcmg nitric 
add, and li«il ii^iin to drynewi. Cool, and add a amp <tf 

TUB omsE. 


Itqnnr nniuioiiigD, iitmI Hh; IwniUirul purple color of muraxide 

i" lil.'Vt-InjHil. 

Fi(r. 3. 

tj'Tli: lulil knd arte aclil ulu. 

Urates. — TIh- uratw' an? prvsttit in ediuH quantity in oonnal 
iiriiio. They niny tHfiwne prrw-pliblc or transiently increased : 
< I) In )irii)c<.'X|ujr^f] to II ifilil ntiiKwplivrv. (2) In urine mode 
sianty by fr(f ji«'rii)n'raiiimiir iliiirrinM. (3) Wlirn the acidity 
•.f th« nrini- i:< t<'tni>otnrily iwnwaxl. (4) Afiur the exceBBive 
i ndulgmcc in iiitrt^swiis fwnl. 

Ttio nnibst UK in(^ry< [)atli<)ln);!(iilly in nuiny dlaeasffi 
whicJ) dirwilv or indirwtly tnlorfi'iv willi limMv or (ixxi metab- 
olism, notAbly in: (1) Litlnvniia ur th« gonty diathesis. 
(2) Fpvit. (3) Extrenw annmiia, (4) DIw&^a* ot'ltus lungs — 
iKim interfiTt-nre wjtli Dxidnlion. 

LeacinandTyrosfn. — TlKAcsnbstanrpAan.; found in iJir urine 
in M-rUiiii :<|K:i'illi: IVvent, in grave antemia, and ««|MM;iu)lv lo 
tatty d«geiM:mt)on of the liver resulting oitJier J'n>ni plioti- 
plioru.«-|H>im>ning ur aente yt^llow atropliy. 

Ttioy may be detected by ovaixiratinfi; a fcw drops of tlw 
urine on a glass slide. Lcndn appears in the form uf xmnll, 
rrxuM], Klisteniui; ephen?^, rcMfubling fat dn>]M, but unlike lliv 
UitU-r lliey are insoluble in ctlwr. Tyrn§in Hpjteare in llic 
I of inierwctiug UiiU of IIik ucimkr cr>'6taLi. 


«. TJiwtu trjitdL a,<dn nrjmlak. 

Fbospbates.-^Thcrc src twofurnis, iiiti<>r|>1tu<is aitd on-stal- 

Amorphous rarthy jtho»pkalf» arc Tuiiml iti nlkaliitc urine, 
and arc prM-tpitutcd L>y audinf^ » few droyi of liqiK>r ammoDts 
to llic urine. 

C\y»taSia;d pfumifiaU- uf lititc a|)|K«r»i ua Rtollor or tud- 
sbftp«xl crj'sUlA whic-li urc sulublo in at^tic scid. 




Trlplii (ihwiibMg. 

The ammoaio^moffnanan j>i>oiii>hnU, nr tritile pliottptint?, ap- 
riiH- Hfi tran-'^iKirent mnin-ftltaiKtl nrisne. 

tlio latter, are fnx\y iwIhIjIv in ni-rtio add. 

vtrnxfi in deconipusiiif^ iiriiH 

tran-'^tKirent mflin-tUtaiKtl prisne. 
may rwcmbic i-ryslaU ttl' nxalato of lime, Ui(, unlike 



Th<i pnwnw "f iitiiii!pliiit4-.* ill r!ic- tirimr U no iiidimtion of 
t!xert», ff>T win-ri iwirinnl jti uiiiniiiit llivy arc often pi-(>ri|iitatc(l 
in uriiif lluil ix ti-in|H)mnIy nikniiiio. 

Tl)'- dfiwtion of tripk- |>l)(>^|)liulm in ncwiv-voidwl tirine 
itwlK-aU^ docK^fnjMiAitiuii in lh« bladder, ii muditioii resulting 
from v(«i<!nl tafarrli. 

l'li(K<[>liai>:!> arc iii\m incrcfiwd in nprvoii^t dy8[)e{)Stn, mdiin* 
oli'ilia. :ifnl nciira'tltcnia. 

Chlorides. -TIk- '(unntity of ll)«<« ttaltM in incnwcd: {I) 
After exertion. (2) During itie nli»oq>tinn of mtvlianicnl <ii- 
ioflaniDiatorv effusions, (il) In intcnniUent lever, froiu tlie 
destruction of aintiisrlea. 

'file f|nantitv is dccrea^ ; (1) In moAt febrile diitpsws. 
(2) In nephriliH. (:t) In msDV waitting discaacs. (4) Eape- 
r-iallv in piietiiuonia. 

TeM. — We may tbns roiiKhly extinmte the quantity, A<W 
8 few droDs of §tru[ig nititc a<itl to the iiritie, rpniovo wiy 
albumin tnal may Ik> present, aiid then add (o the elcnr urine 
a little of a HtronjE solution of nitrate of silver. Ilie abund- 
anoe of the white precipitate will indtcnte tJie quantity ofcfalu- 
ridcs prt-wnu 


UiaUlc of lluir- 

Oxalorfa. — Oxalate of lime up]>cai8 in tlic urine tu; dumb- 
bell-shaped erydaU, or us minutv liij^ily rrfmcting octabedni. 


Many cotidittons i^ttxNliiop litem. They are found : (I) AIM 
eating cvrtain I'riiilfi ami vcpetablps, as rlmliarb, (auliflmnr, 
and jN.'an-. (2) In txTlain diMn^*, uutiibly ncn'ous dytpepiai, 
liytNx-}»»n<inii, tiicliinoholia, (]uibel«s ■"<' wasting (Iuvam^ 

In tlic»c (-usui tlio uxidiilut nsull from Utv iniperteit taettb- 
oliiun uf '.irF^nic «it»Uiiiv<«. - 

UrobilJIluria. — Urobilin is ii tijl')^!!^; priiiriple tlerivfii ft- [ 
thf I'lw-d. Wlirn iinxiit ill tin.' iirim- in liirj^- umouiil J: | : 
daw!' w r\xlilii«b-brwwii titltir : mIk-h d«-|iM>i)U^I in the Iimiiucs ii 
urodtin^ u l<>rm of jatinditT wtii^.'li lum ))n.'n (Tillecl urobilin- 
ictcnix (J sktH'ti). 

Urt^iliniiria ocvuiv: (1) Ocrwunniilly in iK^ltb. (2) b 
pyrpxin. (3) ARvt llw iil)wjr|iti«ii uf iHinorHingtc effusknih 
[4) In livir diHii-ii-. (.")) In )^niv(; BitiL-iiiiii. 

QlucoBOria, or OiycoBOna.— (Mukm- in dio nrine. 

H" <~iiK*tx. — ( I ) Nnrmal nriiK- i<onlsii)ii n tiwx. (2) DiatKW 
mellitua (:t) Ctfliiiii <)i>>va»o», a.'* gont, diomi, tctanuis and 
functional nervoui^ afiitrlioiM. (4) Ingestion of fiiii<-h eaaiiir- 
ine or amylacevrtiM iruitcrial. (6) I'n^uinoy. (6) Toxic soH- 
stances in ihc blwxl, ns llie iiitritw and cartxin nionoxido. 

Qtiiilitutirf Tdffor flltuMHH: — Thr (-oi^kt tesls arc ooduihmiIt 
eniplitypd, aiKl dv{K-iid on the power which gliioo«« pOMcsets of 
oouvcrting blue oxid« of cnjiiwr into tJie orang^-ycIlow sob- 

TVomwwr'd TeM. — Add to the ampwited urine Half it« \-dIuiiic 
of liquor |K)tasHiMind if any precipnialt^ fulla filter thf^^il'ir n 
tlieoadd xiifiir twiidnnwiif a wiak solution (l-;iO) of wiljii \ 
of ciipper,and beat the rwiiltiiig mixture. If sujiiar ist pn«i;iil, 
a deni« yellow or red precipitate falU. 

8impfe dccoloriKalion of the fluid is no proof of Mi^r. 

FMittff* T<M. — The solution should be fnahly pn^inrfil 
when mpiirc<l, by adding in equal pmportions the follnwini! 
BoluiionH: — 

Kirrf isiiliition : Diisolve 34.64 gnims of cupric sulpbiitO' iu 
diatilhtl water, and dilute up to a litre. 

Srx-ond wdiuioi) : ]>i&solve 173 f;nuns of Rodidle tialt ia 
350 c c. of dUlilled wat4>r, and heut to builii^; un cooling:, 
odd fiOO e. o. of a solution uf eatislic tMxbi (tqi. i;r. 1.12) that 


Inimi pTW'iiMial}' Ixiiki), niiil niukc u)) Ui a litn* witli di»- 

To alxxil ten inii)iin^ ol* cai'li iuilntion iti i\ UT^t-tiilic luld 
abijul a fluid dmrjiin ol'titiXJIIiKl waCitr, ami lioll lor a fi-w ^ee- 
oad.-«; if tli« sarliition i-cinaina dear, add th« stif^iK-cKt] uriue 
dntp by drop, and oiiikiHinallv' beat the tuU?. If taimr is 
abundant, a vellowhili-nxl d^-ixwit will be piixiiicetl. If no 
prcciuitale talU, coiitiniu! iho addition of tUe urine until an 
equal volume has bwn added, aud allow to ivol ; then if no 
pn.'cipiiatc falls, sugar is abeenl. 

Paeg's SoliUian may be used instead of Fehling's solution. 
It contains 320 graiuH of sulplmt^ of cupper, t;40 graius of 
neutral tartrate of poia-tsiuiu, 1286 graius of inutttiv ptiUutli, 
ami '2t) Hnidoiinocs of distilled water. As otiier cir^nic »ul>- 
si.-iiK-i^ and iii-oc-bluralicadd (alter udiiiiuitttnittun of elilunil) 
yi<-ld |irei-ipituU>s of rlif suboxide of vopiHT, Botlfp-r's tts^t yr 
tlw It-rmcntitliun li-*.! may be employetl sw giianJ k^ts. 

iSijHffey'« Test. — jVdd to a couple of tlrachiii^ uf sii»w«tod 
urine wtiivh in fnx from albumin an equal volumo of liquor 
uotaane and a fiTW grains of i-(ibnitruto of bii^inntb, und IkmI ; 
if sugar is prc«c-nl, it will redui« the salt uf bi^uiuih in liluitk 
lud.-illto bisitiiitli. Substances containing .■'ul|))iur, like albu- 
min, yield a.siiuiliir bliK.-k precipitate. 

Thf Fermtnlrilion 7btf. — Fill a four-imnw bottlu (lirec [m.n» 
full of urine, and add a fluid draclini of oniiiiary yi-a.*t. or a 
stnall portion of oompi>-:iLscd vml^, lightly cork, and e<ubj<!i.-l lo 
a temperature of 70" to .S(l" Kabr, fur tt>n or iwelve liourH. 
If sugar is present, fi>rmi'ntHtioii ri^ulls willi llie evolution of 
vnrbon dioxide, and tlif s|>ifific j;ravity of ibe urine fulls, 

(fwiiitilatire Tc«U. — Fermi-ntation test ; li^mploy two bottles 
uf urine, and to the one add the yeast ; at tlie eiM of twenty- 
four liount take the specific gravity of eadi specimen. Every 
dt'grcc lo«t iu the fermented urine imlicatcs a grain of sugar 
t'> lh<r flnidoiince. 

/■Wiru/jt Trtl. — To one cuHc centimetre of Fchling's solu- 
tion add four cubic oeuttmetree of distilled water, and boil; 
if iIm' dilution still n-ntains clear, add ^ v. c uf the uriiu.- 
fmm u grudiiali>il piix.'ttc, and gently ItvaU Coutimw tlic ad- 
ditiiK) of titu urin«, litlU: by liUlv, uutil all blue color ha« dis- 


Dn<RA.'>ra OF THE KtDKKMi. 

iimx-unHl, Ifone nibio wntiinotreof urine has bwjn addwl,il 
will Imvo iMiitaiiMHl Imlf of otw jx^r c<^nL of ftiigar. If twii 
i: V. are iimhI, it will bavc <x)ntainod oiuMjuarter per nciii. IT 
but a bair of a 4;ubic centimetre b iiwiE, it will have ouHljiimxl 
OIK- |M'r rt'nt. 

If t)H> iifici-ifio gi-avitr indicates that tlie amotmt of aiigar is 
grfat, (liluir the iiriue with a definite amount of water, and 
estimate aowrdingly (Tyson). 

Albamlnmla.— Albnmin in the tirine. 

Jia (xiHsca. — (1) All forms of neplmtis. (2) OoaECStton of 
the kidney, as tiie result of chronic heart, luup. or liver dis- 
ease. (3) Pregnancy. (4)'t'ycli<al. Tlic urine nwiy he albo- 
minuuii ut certain timL«, a» atler meals, heavy cxereii^r, bathing, 
or on rising in the morning. (5) AccTidcntal. Fnini th*.- admix* 
Inn- of flIbumtnonTf iMibtttunceN witli the urine, an pn$, scdku, 
and bluud. {d)Or(Hin nervoun dix^ttw^ ase|iihi>Hy, k-tanii«, 
and injury to Itu- bruin. (7) K][tr(>m« oiuiMnia. (8) Jngortiuo 
of hir^ ainonnU of albnminons iVxxl. 

Tf/ix for Album in. Ildler'if /"cW.-^l'onr a aniall ({itaniityor 
Milorliw^ uitrii.' U4:id in a list-tnlx*, and allow an eqiLtl i|iiiinl(ty 
of filten-d nrint- to Irii'klc fixmi a pijtette down the sidi'it of iJie 
tnlie and lo <i>ine t» etmlnel with the aei<I. If albuiuiu k 

P'iit, a flharjilydetinHt white ring is Ibrmcd at the line of 

Tur|)entine, eopaiba, and other oleoresins eliminated to tbe 
nrtix- yield sitnilai- ringH, but tbe latter are mliawlved on the 
addition of aleohot. 

Ifric acid produces an undefined pink ring, btit it i» not 
exactly at tbe line of contact, and is n^iatolvixl on tbe ap- 
plication of lieaL 

Johnson's TVrf. — Fill a six-inch test-tube two-lhirda Hill of 
filtered urine, and allow a cunpic of drachms of a cirar natu- 
rated solution of picric acid lo tlow down ihe side of tbe lnl>e 
and to nii.v with the urine. Turlmlily indtmtes the prt^'nn 
of albumin, and it incrcnm^ on jicnlly lu^tine the lube near its 
m»uUi. Certain nnlKitaiiiis in (Ik- urintt, like the alkaloitls, 
prodtice a similar turbidity, but tbi» diwipiteoiB on tbe applt- 
cotiiin of beat. 



Pohfrbfti SUri^ ilntjnri-iiin TrM. — \'cn- lii-lityilc anti relinltle. 
'[Ill- iR*t-fluid iii iiiaiK- bv milling oik- vylmin- ul' ttmn;; nitric 
at-iA ti) live %'ci!iime.'4 o^ a saturated ooliitioii of siilultute of 
maurHCPiiin), and U i;ini»lo^-ed in the itsnit- nmnner a« nitric uckI 
in HolUVs li'st. 

Aoetonillla. — AnH'in« rEsiilla fntni (ho inotniiM>r|>lMniiH <if 
albumin, and is fonud in tlie iirino in maity cDiidilionis 
notably: (1) A tra«; in DonnsJ nrine. (2) In (.^^iwvr. (3) 
Febrile diseases. (4) I'eyeljoses. (5) It may ari.-* as a jirimarv 
oooditiun. (\'un JaKsch.) (6) In diabctcB it is oDcn abuntf- 
ant. It IB not r»i>(>nBibli> for diabetic coma (Awlona-'mia). 

ItfijaTit Artinnf JrW. — To fuiirccof untie, reiidered alkaline 
willi lii|iior|Mi(:iHs»',«dil iift-u*dr(F]W(ifaKti'oii(;si>liitLnn[>r)'o«l!uni 
iiitr'>-|irii.<.-idi-. It" I lie nHl)>iili)r jirmtiicnl tiinv^i purple on llic ud- 
diii"!Mit :ifi-w iir"|y-iit'i>>t]i>'iilr.ili'il mvtifiurid, atvtoiic isprw*nt. 

Diaoetniia esa Osybaturia. — Diacetic avid and oxyt>iityric 
add are never found in nomial urine, but nR> rimnd uaooc-isttid 
with acetone in certain fevers, and Kini.i>inlly in diubi-tcs. 
Their dtHiwnpoeition yiekk ai.-etone, and iliey are pixiljably tlw 
cause of diabetic coma. 

Tftl/or /)(flcrf(c Add. — Boil tile uriue an<I adil a mliition 
of ferric cliloridc. If diatvtic- add Is present, a ltni^iiri<]y-red 
oi^lur dcvcloi>s. 

Hsmatona.— Blood in tlw urine, 

TIh^ trbief (WKgil <-onditiouti are: (I) Virarious menetma' 
tiou. (2) Trutimntimu appli4,-<l to any tnirt of llie genilo- 
nrinaiy Inurt. (-tl 4t>-wrml blixnl dyDcnuia, as tn the spexrifif 
(cvcTS, purpura, niiiliiriii, wnrvy, cti-. (4) CV>ugcsii<Ni of the 
kidiivy fruni ciironic boart, liiii(f, or liviT diwww. (5) Acute 
inflaminatinnofany jMrt of liM--);cniti^>-uriimn- Irw;!. (6) Stone 
in tlie genito-iirinary tract, (7) Variouse veins nt (ht ni-ck of 
Ifie bladder. (8) It may mi-nr jaroxv-imally witliont nbvimis 
mii.'ic. (H) ParBsites in tbe i;cni«>-nniiary tmol.a.-'lbv Filaiia 
ffant:iiini."honiinis, nnd tlie Distonia Itiematobiiim. 

UiACiMists. — By tbc ciilor of ibc urine aiw] by niii'mcwoptc 
and spei'tmscopic examinaiioii, 

Jfiilet-'g TrM. — !{>>!! the nrine with a solution of ranMif 
putasli, aini plKt«pliatc» an- pn-t-ipilalti! wbidi assmne a nal 
o^or ffwn Ihv fW*d bmnatin. 



Sottnx of the Hmnorrhatff. Urrlhru. — The urit>p first piiinsnl 
ia biwMlv, mill llit- uIIht ^yiiiptoin:* [loim to the urethra. 

IiUul<!'i: — Bktiiind nllcii iil llii? cinl of luk-turitioD, ami 
otiicr eym])(oiii>i, [miiit. to the IjlinIiWr. 

A7<'«ry.^lil<"i«l iiilinifil'ly nii\(ii. Tfn'if iiwy Ix? bluod- 
(SHtv iir clfitii, iiimI (lie rilln-r syntj>luinM |)itiiit In llic kitlnevii. 

HxDiQglobintiria.— ii[i>cHU|ii^iiiciit ii) ilic ni-iDi-. 

i'hi.' ciiii-l* iiiii-'ul niiiiliiiiiiis iin* : (1) UI'mm] 4li»int<.-^rati>in 
from (Jie !>|>oeillv f^vi-n^ w-urvy, puqiura, nialariit, air. (2i 
Alwinrplioii of ii)t<>nial Iieim>rma^ic ctrtiftiAiiii. (IJ) It foDuvrt 
traiiiifui^on oriiliHwI. (-1) I'arttxyamally, witlmtit obvkiu^ cautw. 

iDdtcannria. — Imliian i^ n rolorle^ (<<iii>fHmiu] rfntillinc 
iitiui Iht' di i'iim{MJ.Hi[i<m of ulbiimiiioiis eiil)titanec'd iii tlic Miutll 
inUistitK-, and by (jxidalimi is convened into indigo. 

It i>ci"iirH (1 ) tjctaaionally iu Iieallli. {'!) From undtu! n-lwi- 
tion of material in tlic sniall intestine, as in peritonitiH, iiitM- 
tinal obHt ruction, and obstinate constipation. (^} In wnaiitig 

Texl for Jiidktni. — Mix «[iial volumes of urine and fiwh 
nitm-livdrochlorir acid, and add, dro|i Ijy di'0|>, a ftvsU tyriH 
cenirated t^olution of cbloride of linic. Indican is indicated b^ 
tlie ap|K'uran(V! of an indigo-bluc oulor. 

Bile. — liik-pvpiiei\t is found in tlic urine in ull fomm of 

liilr-ttcid* in tliv urine imliuiltr lK-|iailof;(-iK>ue jauiidke, but 
tlii-ir nlMcutr in jaiindiiio is no [x-uuf tbul lti« lattiY in lisinuto- 
jjenou!* in i>ri(nn. 

GmtUiii'* fad fur HiU-uii/metit. — Allovr a few dniiHofnrioe 
nnd » few dn>|Ki of fuming niu-i<- aoiil to owiiif iu|^-llicr uii a 
wbite {>lalo. If bile iii pre-sent, llieiv will \tp. an iridrmiiit |ilay 
of <^)loi's — i^njeii, blue, violet, aitd rwl — ai tli(> lino of <yintai-t. 

Pfitfiikfiffrr'fi TeM for Hilf-airidx. — Add a fixv j^rain.tof^'nni*- 
sugiir and a driJi> of suliihniic a<id lo ibf wisfxH-it-d iirim- in ii 
tftil-tulM? ; Ileal (jently, and if bile-acids are jnfseui a viotd- 
nd color is produced. 

Chylarla. — <_1iylc in tlie urine. It pnKlnoes a milky tur- 
bidity wliii-li ^nuiiiully rite* in the Ion of ibe nrine in the fonit 
of pcllii-k-N of (incly-divid«l fat. lis i-liief ctnws ai-e : (I) 
Injury u> tlie lynipliatic ducln. (2) I*rcgiiancy. (.'i) 01)6ln>c- 


tton of thf! lymphatic diiot» hy the Filarin !«ii}!iiinis hnmini!!, 
a ilirr^-worm mtw «>mmoiily met witli iii llie tro|)ii's. 

Pyuria. — Vha in the (irine. It results (1) rmiii suppura- 
tive iuHnoimatiun of any nart of the geiiilo-iiriiiar)' tract, and 
(2) irdm the rupture of abscesses ioto the tract. 

It appmrs aa a dull, (rreeuish-joUow pi-ooipitalc whtdi is 
oQUverlcu into a clear K^'lutitions ma£« bv the Addition of litjiior 
potaase. It can always be d<-i<.vlixl bv the □itcro-^up'.-. 

Source, — When pus is fmai the kidney it i<i inliniaO-ly mixetl 
with the tiriue, the lalber )iu« on acid or nvnlnil niutioti, nixl 
tile ftwociatcd syniptwius point to the kidncy». 

NVIien ibe put is from llic bluddcr it \» itot «m intiiiuitcly 
mixtil wiih I)h' iirim^ ; lh« luttcr is uiutidly alliidini; in ruHtion, 
and till? iLtiuiciiilc^l .lyiiipkiiiis {loiiil Ut the lilwhUi'. 


VARiETitas. — (I) Artivo liy|icwnii«, «i>d (2) piweive hy- 

Active Iljiwni'mia. 

(Acute CoDBCsUoa.) 

CaI'SEr, — 0) KxiMwuif (ii oold vrln-n the Ixjdy is owr- 
healwl. (2) Knipltvc ft-vvrs. (;1) IViwuw, «» IIhj Mlimitlnlin^ 
(liiirvtii:!!. (1) Pft'gnaiK'y. 

T)k- iwiw «nu»e i^ravHtMl would iirtidniv acute ne)ilinti& 

PathoIjOOY,— Tbe kidney is swollen, of a d«^> rm poIot, 
and btccdfl freely on aedion. .Mk-iinsMipic examination rov»iU 
cloudy awt:])iug of the renal epitlielitim. 

SvMPTtnui. — Pain over ihe loin^. The urine is dark, 
Miuiiy, of hi^h sjjewfic gravity, and may <»niain a tra<* of 
albumin, a few h^'ali^e casts, and s>nie frre hlood. 

pKiJONwiii. — If tlie cause can be removed, the prognotMs is 

ThEat.MEST. — Ali»i>iiiti' rmK Wcl wji* or wann fcmietitu- 
lioos over the loins. Liberal use nf water. SiUne luxalivcB. 
Eoconni;^ swiatin^ by the viijuir Inith or mii:i1I tK)sis of pijn- 
carpin. The infuwuu i>f digtiali.-* may he ii^-d to iiK-rcww the 
quantity of uriuc^ 



Paxslvc U.vpei*rpinl». 

(Cbroolo Coti(«Mion.) 

EriOLutiy. — (!) Causes whk-h obstrnct ilie gGncmi cinsh- 
t).in, as chronic iK-urt, hma, and liver diseaae. (2) Pnam* 
of iiimors on the reual veins, (it) f{un>l,v Etiixunbontsof Ik 
renal veins. 

I'atiiolouv. — Tla- kidm-y is swollen iiiitl of n hliiifli-r>'l 
color, and later lxxx>nn'* luiH fnjoi un overpruwlli of oin- 
Dpclive tissue (c\'iinotiv imluratioo). In atlviinced rmf* At 
renal cpithrlium ix fiilty. 

Symptoms. — S,H»iiiiiin of wi*if;lil o\-er tlie loins. Tl»r urine 
i» u«iinll}- <liniiiii^lii'<l, but i^ rarely iui-rv^'ui) in (joatiliiF. 
Km- MwmI, II lillle nliiumin, uud occasioiiiiily ii fen- iisim* 
hyulinfr itutu ar^ tiHiml. 

UiAONCKiRi. — ^Tlie cnraparative abemioe of allnimin and 
vuM», tlie abwum of dropsy aud urKtuie symptoms, aod Hk 
nrmcnne of tirm in twrtual -atuouni will si^jiamlc cuogcetioa 
from ne|)l]ntis. 

Pmxi.v'isii*. — Depends on the cause. 

TanATMKyr. — Uca*. Light diet, l>ry cujis to the loins. 
The use of diuretiu) when the urine is stwiity. The rullowii^ 
tonic diutx-tic pill may be of service : — 

^ QuIniiMP aiilpli., gr. xxx ; 

Piitr, (licitalis, gr. xsx ; 

Itilr. Bfiilir, gr. xxx ; 

Ext. nucis voiniuic, gr. v ^ 

I'ulv. furri cdrli., j^r. xxx.— U { I'Wi-Kii,) 
Div. in piL No. xxx. 
Si;;.— Oue jiill uv«ry tlireo hours. 

nKtTsiTios. — Tlie name ai>])li«l to a group of flyruptoou 
rc.Milliutf from the retention of toxic rnalcriah in the dIooiI 
which should have l»en eliminated by the kidneVR. 

SvMl'mMs, — It may develop alnwly or ahniptly, and mav 
mnnife<it any of llie f"lliiwiiii; phenomena: Ilfwl.iche, ver- 
lij^u, delirium, cpileplitiiim cunvuUions, OHua, Hijikkii lilinti* 


(tmaseoriatod with any iriinal rlinnsic), and traunent 
JyiHit ftY>in congeslion or (rtlmin of the hrain or c-ord. 
Jatotiayfi fiymplrmtii, — D>'«piKDii, (tincnitcastlima), Cheyne- 
Ibdomimil fitpnptomg.—~l-\iax>\tgh, ohsthiuto vomi'tiDg, and 

_ef>enii fftpMplotM, — Tttv Hkiii ix dry; (he breath hiw a 

aww odor; the urine h wmity and (k'fioiinil in urcn. Ttiv 

if) «Iiiw unit full^ and the tcmperaturo i^ibnornml ; biit 

HnjT <v>nviiisiitiu Itif! ti-iti[>eraiiire may vise, and thu |>itlw 

>mir nipid anil fcl>h-. 

_JiA(i\fwis. — Thir variiiu-t RianitVstatiom may !» rt^cogniiied 
[UiwRiio iiy (ho hlflton', the tcmperattirc, toe odor of the 
ih, tJie higti arterial tension, the accentuated second boiiihI 
' of tiw heart, the (tiveenoe of cast« aud albumin Jn the urine, 
and by the absence of any otbt^ caitse. 

l'i{(Ki.\<wis, — firavc. but always guarded, for recovery is 
possible atW the must scrioiin; mimifcstatiun^. 
I TitKATiitLNT. — Kniwinifp; Bwvaling by the use of hot air, 
or va[M)r bathe. Encourat^ cutbur»U by (ho use of croton oil 
(one drop in a drachm of olivo oil), elatvrium ^r. }), or a 
conoentrateil solution of Ep»om sallH. 

Relieve n-ual enjtorRwm'iit by digitaliK ponltloc^L, or dry 
or wet cuu» to IIk- loins, Wh(rn IIk- pwlii-iit is rubu»t, and 
the pulse is »trouR, VMKWwition will Ito t>f [luninioiint imjwr- 
tnn(!e. If the puliH; i» very w«ik, ah.ijhol, >lry<-hm«, digitalis, 
and utnuiunia may be rcquinid hv|>odenni<nlty. 

In ponvulsivc acizurm, in adaifioii u> the above trentment, 
chloral (gT. xxx-xl) may be given by the rectum, and nitrite 
of aniyl or chlorofunn by inltalation. 



(Aonta Briglil b Dtooaao. Acut« Tubnlai Ncphiltu Aciitv Daaqua- 
inatiTe KfrpliritU, Acate Puenchymatous NeptuUlB, Acvta 
Cauntwl I(«plultla.) 

Dkfin'ITION. — An ai^ite inflammatory proe«« involving 
more or lw« iIm; wliole ki<inev, but eKi>e«ally afleetiiig the 
epithelintn of the (nb(ile8 and glomeruli. 


BrioixjoY. — (1) Kx|»wiim; tri «.M jiiirl wet. (2) The spe- 
cifu: f'cvei>i, iv[Kx;i»lly ^iiirk-t ievrr, (3) Poisong nhJch are 
oIiii)iniil(il tlimiigli tlw kiiliR>>'8, uit tiintharide*, Luqwiitiue, etc 
(4) I'n^iiiiiKry. 

I'ATHdixxiY. — TIk- kidney is »w(ill<-ii mid tlio c»|«ul« non- 
ndhcrrnt. At lirst lh« i>r^n in WigliL ir<) iti culur; it Hoon, 
bow(!ver, iMHunie^ pale and uiotttoci iti a|)pc«niWMr, iiltlioiigb 
the Mai{iig)iian wits still rttain their d«'i» ivd liril. 

tlisto/offi/. — The epitheliiin) nf ilie hdmlcji nnd f;tomt-ntli 
is liie seat of tloiidy swelling and, later, of lally (li-fxitivnilioii- 
DewiiianiatiHl epithelium, blood-corimscles, and an ulhnntiiiuti^ 
(ixudute block up the tubules. Tlie capillanM are dihikHl, 
their w-alls degeni-rated, aiid bloody pxtravafalionB are iwl iii- 
frujiieiilly »«;u. The interstitial tiBsuc b more or le*« iiiltU 
trutt'<i with leueocvles. 

SYMrrcrti.s. — >fuderate fe\'er and its aiwociated symplflras; 
dnil Itiinbitr (Min ; nunM^i urn] vomilinf;; dmpsi,-, bc^'imine 
in the taut- and bi'nmiing jrcJit-rul ; rapiil umcmiii. UrRinie 
Hyniiiiuma may develop at any lime. 

The Vrhe. — Scanty and at times Rippressrd. It is HmokT 
in appciiniQoe, of hi);h §pei:-ifie jfi-avity, rich in allximin. iml 
LthrowA a heavy Eediniciit. which eoiitaiit!i hvalilie, blood, tod 
[epithelial cai^ts, and free blood and cjjilliclial eelK 

DlA«S<ieiS, — Ah the general i?yinj)lunis ai-e often eliglil, ll»» 
diagtKsis must rest on the exuniiiiation of the nrine. Tbc 
biatory, and the iibi<cnoe in the urinv of wide, highly ikllr 

Is, will serve to dii>.ttii(;iiUh actUc nepliritU from an nmtr 
' itimt of chronir iturruchymalotu m-phrilu. 

I'iMKiXONis. — GnnnUiily tiivorable. It may kill by ex* 
bau;iliuii. iii-H-uiia, or iln>|isy. 

Tt:I':atmI':nt.-'AIihii]iiIi' rf*l in IhiI until all»iniin liutt div 
aplK-uretl fiiiiii the urine. Milk \* (Ik- beKt food: bnl biitltr- 
milk, urtielK, and light broths are admiswihle. The free n« of 
wnter .•"liould In- eiieiunage<l. Dry or wet eujis, or hot fomrii- 
tatioris shiitild be applied to the loins. To seettre vicarious 
lu-lion of tlte tUiin vajwir baths or Hiiiall d(n-es of pibxtirjiin 
(j»r. \ to yj) may Im? employod, C'otieentralwl <^li[ie draughl-s 
inadc of Uochelle or K]i!M>n] salts, may lie ;;ive]i to H 
watery disdiarge* from the bowelH. Coni|>ound jalap jk 



{er. xx), iir clau-rium (gr, \) may I"- wilntfitiitwl tiir the twtiivc. 
Stiniiiliiliii); (litirvtiiw »liijiilii ix? iivokltil, anil (Ihux^is cuixior- 
ii^-d iiy »lknIiiM^ witU-ni irnd inrtmon of di^tali:*. Uncmia 
will cnll for iu n|»|inj)>riale tnntmfiit. 

St^vere n\st^ in |>r(^iaii(n' ^vill ixHjiiire the intliK-tion of 
ah»r1i<)ii iir [iiY-niiiliire \a\mr. 

.Markril oflii-'iMnx into t}i« semta cavities will »«oDte4iinRi 
(iGniaiid a^|iiraiiori. f^)nva]iscenoe shmild l>e protraoKd, and 
lh« reAiiltinff auwmia will call for some pre)iaratioD of iron, 
sudi an Ba.iham'3 mixture. 


cimoNic i'Aui-:n('iivmatois nkphiutis. 

(CbiaDio CaUirhal Hepbiltia. Latgv White KidiivyJ 

Brioijoav. — (I) It may rc8nlt from acute nephritis. (2") It 
luay he chronic miin the be^ntiing. )hi1o sex, adtilt life, 
lre<)iient eX|KK>tire tn cold aira wet, iiloitiolism, Hnd )<^'philis 
are |)nxlrs|¥)pmji fai-tore. 

pATintiXKiY. — In the firet gtxge the kidney a lar^ and 
palcvy<-lIow in vulor ; the [mllor d<.-|MMxU on iinxmia oihI fatty 
d(-g^-tie ration ; tin- tiilxvi are lillc<] witli fulty epithelinm and 
mftii ; thciT i« always somo ovei^>wth of tint intenclitiat con- 
iicvtive lii«<iii'. 

Jn thr Htntnil Mftrff. the organ \» ^iiiall, |<alc in ndor, Ma eur* 
fwv n>ti{:li, ai>d its itiiroile Aomewliiit mUiiTitnt. The ivdtKT<c) 
»tt»> de|H-ndA on di-turuction of thi- n-uul e|)ilh<'liiim and tin- 
nrmlmetion of the overgrown n>iin«inivo tt^ue. 

SyMpn>«a — As it iMually b^rn^ as a rlimnio aflcdton, 
ihe following 8yni[Homa slowly nianifeei ihemselvcH : Vm- 
L'r>-i*ne loss of flesh and slrenglli ; markod antemia ; gsfliro- 
iii[(-(inal diBturbamics; dmi>ay, often first noted in the face 
iiti Hfiini; in the mom i tie ; increased arterial tension; sonte 
Iiypertrouhy of the left ventricle, bo that (he eecond sound at 
the aorlie (wrlilage w amtntuated. L'ncroic symptoms may 
■ If^'elup at any time. 

Tltf Uriuf, — Ufoally <)iRiinii^i-tl, allhon|;h it h) frequently 
iKtnnul in colur and in Ji|)iwiirann'. It i« hiithly HH>nminuuB, 
and thrown down nn alioiidanl frilinuiil, whiih •iinlaitiN hyu- 
lioe, fatty, am) i^rannlar niHt», atnl fulty cgiitlielial cells. 


EnsBAses i>p TUE inoxiiT& 



montin to 

CoMpiJCATioxB. — ^Tbeae «» namenicB and often mggat 
tfae diagncSH. Tlie mtaet amuuou are urwniia, extoisive 
drapAv into the tisBaeB or aemus anties, talent iuBammattotB 
ol' the aetooB nembcsDce, valvular bewt diwast-, albuuitnurie 
retUBtiB, aod acnte exacrrbatioiu^ 

PROOSOKIS. — Uo&vorabk. In the tmrly 
wmetlnMa leeuhs. Tbe duration a (rom a 

Tkkatm ks-t. — Tbe treat tnent ■ t^i^ly dietetic aaJ 
hj'ffieaic. BesHjenoo in a dry, waim, and tvjtiuLIe clinWr 
mzy prolong life or eSed s mre. Rest U an rts^cDtisl i^lftmnl 
in tbo treatment. The iiodcrclotliing aliould tw wutilkn or 
Hilk, 'Hio diet bhotild be non-oiirogeouus, and in )je\-en> cwn 
an utMolutc milk tlid luav he of extreme ^'alue. The Ixiweb 
slioiild be kqit motive l>y natural mitieral waters or xnUai^ 
laxatives. AVIieti the urine is scanty, Ji^itali^ or (nSeiiu' nmr 
jinive cffi<-i(fi1 iliiiretks. B(U-)iam'« mixture may be etuplut^ 
If a fJialvlxfliv and a diuretic. 

In €-xot5*i\'i^ dropsy promote cathar<-ia by K{i!<i>iu salt? in 
mneenlrnlid solution, or by compound jalaj) i«>\vder; aoH 
]irotnot« diapboresiH by tbe l>ot-sir bath, or bj- iiiliKtirpin. 

The fulluwing combination id oflcu very emcipjil in trouble- 
some dropAv : — 

^ Ma**. livilrarK., gr. xx ; 

I'ulT. disiUUfi. gr. XX ; 

Tulv. sciilse, gr. xx.— U. (Niembybr.) 
FL la ril. No. XX. 
Slg.— Ono pill thrice daily. 

Afuli' cxiiii'rbatiotia shonid be troauti ws primary atadu of 
lite nrpbriti-t. 


(R»d Onnulai Kldnay. ConUiict«d Khlnay. Ooiitr Kidney.) 

DKriNITtoN. — A chronic inBammatory conditioa of Uk 
kidiiev eliiinK-trrirrd by a re^bu-lion in its sise, due to an over- 
pn>«'lh iiti<I viilHotnt'til <i>ntraction of its oonim^ivtvt issue 
elrtiienlf. iniil inviirialily nf^iriated with general arterial adf^- 
ruHia uu<) midline by|M>rtru|>hy. 



EtioijOOV. — It niay be sccondarj" to pnifn«-liymatni)t< 
ni'|iliritiA, or riMtlt fri»m tlir [i&.-«iv(> ci>i))ri-«liiiM iil* ■■Imitiio 
Ill-art <)iM3i4t' ; bin ^tiit'mlly it u-ifw^ a.* a jirimur)' tiJiiditifiu, 
am) n^ults frwiu ttio imii.^s wbJch [>r«1is|H.!*e t(i Brieiyisis in 
■itber oTi^au!), viz^ mHliltc life, Diale ^-x, i^ynhiliM, llut pmly 
diathesis, cbrotuc aJcoliulism, and chroaic mineral poisoning, 
OS fhin) lend. 

Patiiouwy. — The kidneys are small, and red in coinr. 
The surface is granular, and tl»e irapeule adherent. The or- 
gan is firm, Ctlts with diffieully, and on section ot)en reveals 
anuiU CTsteor c«lc«m>us deposits. Tl>e eoriicTal r^iilistance is 
ffreatly rt-ducvd in thivknt^s. Mitrrowopic cxiimi nation shows 
BO ovcfj^ruwlh of Goiincilivr tiiwiie which has coDtnivlcd, nar- 
njn'cd iIh- lunuui of iIk' tnbidcs, utid inliTlt-rvd with the 
nutrition of the qittltclinm, ii»d lu ii nrsnll the iiitlvr may 
show iiiliy d<^-n(rrali<m witli d(-)>>|imtiitiliiiii. Tim art*Tit:s 
Uirou^rlHXit tlif' Ixidy r'-v<'»i fatly iKf^i'iH-ialton of iW UH'^lia 
and »u ovei^^wih of ix>niHH''liv« li^-ue in the iritima (antTio- 
)irlcnM>iit), and from the rnsiittaace tJius offered hypertn>]ihy of 
tbc^ hcait has retndt«). 

HvMFnmR — \ alow loos of flcdi awd strenpth with pro- 
greHsive anieniia. (iastric d!.<itiiriancct( arc ver>' cotninon. 
Tlie arteries are ri^d, and the pul-^ >» of hi'^h teni^ioii, m tliat 
the ^eoQDd sound of the heart is aocciitaat<-d at the aortie carti- 

Palpitation of tlie heart is often noted. Dyspnon is a 
prominent symptom, and may result from heart' wtaknrss. 
anemia, or tcdenia of the hings, Ileadaein-, vi^'rtip>. niiil 
iosomnia odea rmnit from dii^urbed cirmlatiuii, ami dimtitss 
of vision from alhiimiiiuric rT.-tinitis. 

DnitK>- is ofWo al»cnt, ur i» slight and appears late in the 


The uriw: Increadcd !ii <(itantity, |>«Ii' in oolor, and of low 
spiKiAf gravity (1010-lOOA), aifd rxnitaiiw huts tnioe of albu- 
min aniiu I'vw narrow hvalinc t-nnln. 

CoMn.irATioSR — .\ll>uiitinuri<- rvlinitix, valvular limit 
diseuM', a|»jili^xy nsiilliii^ front lli^ weakem-d arteries aitd 
lai^ lieart, unemia, latent inflammations of seraua raem- 
braiMs, |ioearoonia, aotl hronehitis. 



DlAiJNcniRi. — Tht! artorial I'tiang*^, caMa in the urii 
Dneniic Rvuiptoiu.'t, aud the ab^eine of imikilorytosin will Bern 
to diatiil^mn t-liniiiio no()hritiB from pi-miciows nueemia, 

('hronic piin-Hcht/iiial'/im itcpfiritin usually oocnra earlier in 
life, Ineivs ntiicti artL'Hul clian'r^', |ir>.iijiK!es (itneiclerabte ilruftfy, 
and uritK' tliat is rich in albumin »ml Uibe-tiucis, 

pRiXiNOSi^^ — It in incnrabic, bnt niuy liL>it many ycare, simI 
iiiidvr Hivontbl« utuJiliuuH cuuiparntivo cumfurt niuy be 

TbeatMEST, — ^TIk- dicK-tic siini bygit-nir tnwdnciit iit 
sotiMiUsiii f-broiiit^ pKr('iK'liyiiiiitutii< iitplniti:^, Kixijitciit lu _ 
ing witli frii^ioi) of tin- Mkiii ^lioiild hi cji<.viimgi.-«l, an<l [lie 
bowt'U ki-jit tv^nlar by itlkuliiiv waters. 

A)»i>rb<-nti<^ like the bidiloridc of m<>n-iiry iind iodide af 
polonium, nre of no value. If iW stutuai'h uill Itear it, it 
will be of Ht)i'vi<ie. Digiljilia, i-alfeine, and siryohnia will I 
very useful when (he heart awakens. Niironly*^*"". •" 
miuim doses, gradnally increaMd, haii been lecutiiniended 
the higli anetial tension. 


(Waxy Kldn«r. LaidaoMma Klduey.} 

IV. — (I) Prolonged snppnra[i<in, partinilaHv m 
(2) TulxTCulosis. (y) Syphilis. (4j MaJaria' 

Patiioi-OOY. — the kidney is larp; and pule, and on 
tiou pruEcntM a " bgiroti-likc" apjicurHnec. 

Lugol's ^<o|ltlion of iodine Ktrik*^ a mabogaiiy-ru) 
wilh (he amyloid nuUi-tiii). 

On'opio i'Miniiii:ili<>ii, llit: walls of ibo bbvulvc 
jnirtU-iditrly lhiM.-i>l' tliv .Mulpighian tun.i, art- fimnd thicken* 
un4l iiitiltralitJ tvitli a boiuogoneonn wax-like niateriiU, whiuli 
tum» i%d wbon tivati-d with a weak Miliition of gentian- viuld. 
Pan?^iiHiyniul(Mis and interstitial ehan^» are alwaya a<At<A. 
' er organs, c«]Kcially tbe liver and spleen, are situilarlr 
SYiiiTDMK, — Loss of fleirb and strenRlh, witli great pallor 
dropcty. Unciuic symptoms an; i 



Tbp liver iukI splccii arc often niiicb enlarged I'rum tlic tuiniL- 

Thf Crin/-, — Csiially Incred^od in nuHxiiit, pule in color, niwi 
i-cnlains I'uiisitli.-niblv ullininiii mxl wklo liynlini' iind (;riiiiijlur 

I)lA«xnsis,— -The tiiitlorj', iJie I'Dlai^t) livor and j'plwn, 
III titfi iiHix-ait^l ariKHitit of urine oonuiiiini^ uinsicU-mUlc 
allmmin stiggi^ tlw dia^uxii). 

Pit<xiKc»ii!i. — Wheu iiol lulvanoed, «ik] tltc <miM; can be 
removed, tlie disea^- may lie amslcd. An a nili*, tliC I'ro^ 
unnis is decidMlly iiiifavomlile. 

TBK.XTMtLvr. — 'I'lie primary di.^ca.-^ will claim atlfiilion. 
In Imot' diM^afte, guf^iL'ul inierleivn<« may be rec|niwlt-. In 
rivphilts, iodide of uoiaseiiim and mercurials will be indicated. 
In malaria] cat-hexia, iron, (juinine, and areenic Hhould be em- 
plnved. Tiitjerculosis will call for its appropriate reroediee. 

Ttie iTfalniirnt of the morbid i»ndilion is hy^eiiin^ and 
dietetic. Alterative tonics, like the iodide of iron, may i>rovo 
bencfidal in some csttes. 


(Rephitdltlilul*, Renal Orsvel.) 

Definition. — A precipitutwl urinary ixmcrotion IodikI in 
the kidney. 

Bru)t.ixiy. — <I) Alale ecx. (2) HcKtdity. (^) Miil-a.-«tnii- 

Jon. (4) InRntnmiition oriIi'-)«'lvisfir)li<- kidney. T>i>iii>l- 
niuous or d<^iii4iiiiiilixl upitlicliiim fonns ibe niic-leus upim 
wrbich tin- stone i" built. « 

Varictibs.— (1) I'rw; acid. Thifl may be pnwuxl as hand, 
or furni large rnddish-lmtwii atonea (2) Oxalate of lime. 
Tliis form* a ^'er^' lianl. dark, and uneven sUme (mulberry 
iftk-idii"). ('i) I*biit*|ilijil)^. TIm«i' are t3<)m]v««d of phoEpbate 
>if liuH-, uw\ arninonio-nia^m-riiuni pltu^pliaie, and air m>t\, 
uiiirtiir-lik*- ill ap[u«raix«% and are often de}xjsited on otliir 
cnleiili. (<) Xanliiine and cystine are rare eoii< ret ions. 

Kratln. — (1) A sioue may remain latent indeliuilely. (2) It 
may jklhs out, with or M-itltout tbe symptoniit of ool»v. (3) It 


fXinU« pyelitis, imd w>mi-tiriiiw uIimx^Kg of llio kidney, {-t) U 
Diuy ubi^truct tliv iirptrr uiu! pi-inliM^ liyilro-DctihrnHis nr pyo] 
ncplirutis. (&) It iniiy vxdtc |x:i-iti«[iliriii.-i, ana may ]>crffinitd 
in oIIht organ!). 

SvMPToJLH OF Kkn'ai. — Riiddcti (Hitiet, wilh sliar_ 
LpHin, gttnrling iti the liai'k and mdiatliig dawn the tirotpj*. llic 
'penis, teatide, or tliijfli. There may lie iK^raition of the teitti- 
cle on tlie affected side. 

The symptoiurt of intoiiw pain are often present, vizi 
pallor, cold sweats, weak pulfie, aud reScx vumiting. , 

The nrine aubso((ueiitly pas^ may contain rlie stone; orj 
sa a resnll of irritation, pus, blood and deKfiianiatcd pelvio 
epitlielinm. Ad attac-k may last from u few moinctits 
sevei-al hours. 

DlAGNttsitf, liiliary nmi lienal CvHe. — In the foimer 
pain ninH from the ri^ht hypiH-liucKiriuc n-^iou to llic rifcht 
(fliouldcr ; thiTC is often juiiridici-, iuhI the tirinv is negative, 
while liie i>tooU may ctmlniii llie .<l"n<-. 

I'RtXiKO^iH. — In vit-w of the (i<mpli<mioiu tho prognuti^ 
iniiKt lie ffiiiutled. 

Trkatmkxt. The Attack. — Ikforphine and nlnipiix-Khnnld 
\». employed hypodermically, and warm i>oiilli<t'ii appli<-<l ml 
the loiiw. The tree UKe of water should t)e e»eoura^<-(l. Iti| 
severe cases chloroform or ether niai' lie inhalfd in siiffieient 
quantity to obtund the scmiibilily ol the {uitient. 

'Ilie Interrnl. — When Bymptoins i^iei^irf, regulate the diet, 
and put the palieni under pood hyuieiiie i-omlitionK. Wlicn 
llie reaction of the urine indi<'ut(?« un a4-!d sloiie, the i^altH of 
lithium or the vegetable m\\» of (hiIkhIi may he employed in 
large doses, Over lonjr peritxU. A dnuOim of Ui* rilnite nfj 
IKitnivium or five Ut ten pniiiis of thv i«rl»onatC of Hlhiitntl 
may U- given, well dtliiUtI, Wfveral linii-** a <Iay. 'Pie natural 
mineral waters are of wime vuhie. Tin- Hntlalo liltiin walei 
may he employoi fur lhi< pnr|Kist', arxt ils juitalnbleiKii^ andl 
effirioney may Iw inena^ted by the addition of a ti>at^j>oonful 
of »omc rfferx'eitrjng prejiaration of lithium to each notation. 

When an alkaline .itinw is iiMlitnted, Ix-nzoic acid or boric 
add may l>e eni[tloy<d in a »miUir manner. 

In 8ev«re and persistent eases tJie stone may be excia 



diltn>-IiilioU>my); an<l if \hv Djwnttioi) ^otild n-vctil ii 
Iv-tliiiuo^il kidi>e)-, its n-iiKtval lucplircetooiy) wotiltt Ik- 


(Pytfonepfailtla, Py«Ni«phKMii.) 

DnnsmoN. — InHiitiinmtioii of the [K-IvU of the kkincy, 
Etiomkjv. — (It l( uiay re*ull frmn sioik? in iho pelvis (if 
tliit kidney (<iLli»loiifl py«liti.t). (2) It may lx> fiieoondan' tn 
uMhritiii or cytttiti-i i^xteudiog apnarrb llirough the ureters. 
(3) ll niay iolIuM' pregnanoy or the specific lewrs, (4) Morbitl 
l.'n>wili.% tnicli as tul»erc-le or <auicer. (5) Toxic doseti of the 
•liiuiilttiiiig diurelif* ((v>pail)a, ointharidcs, etc), (ti) It is 
njAy idiii|>atUic from exposure to eold aiid wet. 

I'ATHdUKiv.— The mucous meii)braiK> b swollen, injerted, 
snd covered willi a tpoacious secretion composed of mueiis, 

Sta, and desquamated epithelium. Severe cases miiy lead to 
ktatiou of the jjelvis, Bright's distni^-, or suppurative 

SviiiTOUS. — Mwleratc (ever aud its assuciatett pheDomenn. 
In suppurative nephritis the fevi-r may be inrf^ular and asso- 
vritb hvctic or lyphoid symptoms. Tttcir; is pain and 
[•ametitnes bundernnw over the kidneys. The urine is tiirbkl, 
>cid in reaction, and on Htaitfliii); ihruwK down u i^nlinient con- 
tainiof; coiwidenibk- inui-iis, pu.»-ii'jqHi«'to». [(elvto epithelium, 
»nd blo<xt-(x>rjmsi-k'3. The ])iis aim blood render the uriiie 
^tliglitly aJbiimiuDUA. 

t>iAGS<»tH. — 'Hh* nl>*'uw of m««h albumin, of lubo-easls, 
i divpKV exfrliidfl nrjihritu. 

t^nlUi^ may bo exeludwl by the nhtw-nne of lumlmr )uiins 
lud of lu-id uriiiP. and by the pwsemv offriiiiioiii lutd niiinrul 
aiieturitiou and alkaline urine efintainiiit; vcsii-iil epitli<.'iium. 

H^riiu-iilirUie aA«rrt« is atsmialcd witii liiitdKir |inin 
kml hftrtio fe\-er; but in addition there i^ ulleii utlema over 
Jte lumbar region, and the nrine may be noniutl. 

SUar|> pain over the kidney, inerea-^ed by jarrinp movement*, 
aiu) n;ficrted down the ureters, and the presetKM* of much blood 
in the urine point to caicvioiia pjfciitit. 



Tttbarfviovs pi/ftUu amy be icoogoiDed by the hinftotr, by 
the pivw-noe of tubercle in otlier «rgaii*i, und by liiberclo bacilB 
in tlie urino. 

J'gefUie Mcoitdary to cyMHUi it) recogniu'd bv Uie bi^-to^y. 

Pi»KiK<)MiR.— T>e|wj)(Ui on \h« Ka.a%i\ Klild fiiriim rcetiltini; 
from i>i'egnaii<:*'. sj)e<;ifi(; fevers, <>r expcMiire lo oold, itKuiiIb 
recover in a tew u'(<eks. The luberculous and siippiirntin 
varieties ai-e unfavoniljJe. 

TbeatmKSt. — Depends OH the raiise. Cjilcubjiti pvelili;. 
will require the inatnieDt indicated for renal caluulu^. lu 
simple pyclitiK k«op tlie patient at rest, restrict the diel to lif^lii 
foo<i. prvferubly to aiilk, apply warm potUtices locally, use 
ulkuiinc diluents :ukI simie i^'<uitive mixture, as tlie foUowttig : — 

f^ I'otJiiw, bromiii., 

Stidii bii^i'ti., fiii gr. clx; 
KxU bcl III dm I rite, gr. ir; 
Ext. bucliu, .'>]-, 

Syi-. ftanjx coiup,, q. s. ad (Jiv.— M. (I'KtVBn.) 
SIg.— T*blc»po6nful thiuo liino« » day. 

In pyelitis following cystiti^ tr(«t the latter Iw-nlly, and 
dK ettmulaling diuretics, like «(i<ttlyptu8, mndalwuod, and 


Definition, — Dilatation of th« pelvis of tlx; kidtioy, wilb 
tile aoL-umtitutiuu of a watery fluids n^nlting frcHD obfttniiAioa. 

Etiology. — (1) Cuttgenitiil «ric<ureof llie nit-ttT. (2) Im- 
partioD of u cuIoduK in tlie ureter. (3) Abdominal Uimon 
vonipr(«ding tlic un-ltr. (1) Ttimont giiiwing within llw 
urinary ptusogcs. {•>) An inflammatory tttrietiire of llie urdrr 
or nretlira. 

I'ATlioi/XiV. — ^The jxilvis reveals all grade* of distention. 
In extreme <**<« it nmy nonlain several (piarid of fluid, wliidi 
is at lirst urinous, luir Inter thin and watery. There id mot* 
or tprtt) atrophy of the niinl tii»ue^ 

SvMiTOMS, — Slight difltention yields no sym[itoni& In 
otlier caws a liiraor slowly develojw in tlw- rc^ou of llw 
affected kidney. On ])al|)at(oii it is eta.itio, and iwrbsps 



Budnstiiii; ; oa |wnni»iioD, tliill ; uid oa aspimtiun it yivUla a 
Avar fliit(l, wtitcli iiMiitllv contains urea and uric acid. 

OufiSoBis. — This will be baE«d oa the history, the cxclu- 
AiHi of other abdominal ciilar};cmeDtii, udJ the obcmival 
auulvHt^ iif the fluid <>l)taiiu>d bj- a<;|]iration. 

I'r(mimi]»ih. — Uwmlly uitravorable. When it is unilatcml, 
auJ Uiu ftlJi«r kidney fiecretes a oorinal amount of urine, con- 
uiniiie n uurmal arauunt of nn.<u, the pfxtgnvMa iti guanlcdiy 

Treatukst. — -Wlten Uie distentioo ia moderate the Ireat- 
ownl is i'X|>t«^(aol. When the liac is large, aspimti;; and if 
re^Accuniulatiou is rapid, eetahlieb a reniu listtila or rcnMve 
dke oi]gaD. 


(Uavabl« Kidtie/O 

Dkpisitios. — A distincily mobile condition of the kidney, 
de|M?iide»t upon a relaxation of the tisucx whteli mirroiind it. 

Kntii/MiV. — (1) Female a-x. (2) Middle lifL (S) Hupicl 
cmacialion leading; to the ab«ur|)<iun of tlie [H'n'iu'|>briti<' Jiil. 

(4) A uunxeiiital relaxed ODnditiun of the piTiiiqihritiv tii«u(^ 

(5) Muscular exvition. (6) K«>)>eAli^il {)rc{riiniK-i«>i. 
STi"Mpn>MS, — 'Hh; rif^il kidney is the one usually atllvted, 

IMvbnbly fnini iw n<Iatioii to the liver, vrhieh mov'i-» during 
tli(- rv^ipirriiorv wM, The kidney niav Ih- loiiinl in iiii\' piirt 
of the alxl»nH^ii, tix a niovnbli* tunuir, t\'iiili)riu ih sliii[)i-, 
aomcwhat latiidcr tu the luwh, and rar^^ly inijiailing tlie pulw- 
tiiin of llie ren^ artery, 

Then; may be no subjeetive syniptoiiw, btit u nense of un- 
m.'iinii'rt and a(tn''ks of neuralgic pain art- ofien noted. At 
tim<H Ihi- kidney may iM-come j^uollfn and wiy lender, pro- 
bably from lu'iMinguf (he it'IuiI vcsm-Ih induoing engorgement 
of the or^ii. KniuUunal dij<lurbari»^ are «f£u excited by 
the editditioii. 

DlAdNtMig. — The reijiform idiapo of tlw tumor, its free 
mobility, its etlationary ww', ihe li'A^x-ned resistance on perciis- 
sion over the renal region of iIh> affected side, and the absence 



ol'i'urlivxia will survv to diagnuttc u fioatiti}; kidiidy Ironi uther 
nlKlumtiuil UinioTx. 

Treatment. — In many «i*cs, u rcmilnlcd dirt, the a\-oi()- 
liiK-c of iiihIiic oxc-rtitLH), and the ««• of a broswl bitnler ii|>|>li('fl 
tirmly to tin; aUlonM-ii nil! bp ill* only IrcutnM'iil n-<|iiire<l. 
Wlii-ii Ihi- t^yiiiptums |>crei«t the kidney may be t-titciieil in 
itA m>rnial ji1a<x- (iK-plirorrliaphy) ; sihI if this Irtulniviit fails 
the otiending organ may be remowd (uepbrcctoniy). 



THE BIX)<)1>. 

In ht^lh the blixxl amounts to ubuiit oii<N(liirtfviiUi of tin; 
luxly-wcight. Xormiil I>KmhI tt>nt«in''iij>|itTix!iii;iU'ly -'ijfHHmoO 
ml corpuscles. an<l from fi'MlO to IS.fM'O wliilt- ivtrim-ii'les in 
IImt cubtc millimrtn-, tlir nilioof Iht- Inttor tolh«rvclcoqiii!vl(« 
licinft vnriuuKly «stiiiinl«() m 1 to 3(W or 1 to 700. 


OItpj«*ytli.Tmia, or a diminiiiion in ilie imnilwi- of rwl coriiiiK- 
•■los, ocdiR' ill nil furnis of anieinia, 1ml i» i-s|Kvially murkiil 
in pcrnicioiiii aiiiemta, where tJw imiiiljor may fall as low uit 
400,UOO Ut titc (!ubtc millimetre. 


Id-iioorytosM, or an aitnal orixlMtiw infii-nsp in thi" niiml>er 
of whiloi''>rjMi.wIpB,oivuisit'm|H>rarilyalU'r«'iitii»g, arterlMJmor- 
riugc, and |>crinaDeutly iu IctHwmia. 


Poiktiooytofii)*, or n condition in whirh the n?fl iiv>r)Hi«-Ies 
»rv irTTyiiliii" in !4hn|>i>, winy .Kitir in luiv form of «rvcrc unso- 
mis, bill i> i^]icL'iiilly iiiiirkiil in iM.-riiivioiii! unci-inia. 




rotklla-. nunh, nilof«7t«sls (■■ ftinwrntal \if IhalMUn d. ir,<|. a.ii(imil MoiNk 
airpa>cl«4 '. v"")'"'' uf iln:unit>»lil'iii ..r ■ tnl bliHxl Airpiiicla : /. oodwlul ml 



Miorocn'toeis and macii>cj't*wU «n> cinidilionii in wliiili the 
red coriMtades arc respectively dtiitinisJiixl aiid iiMrrcascd 
fixe. They may occur in any form of wvvrv ana'niia, btit 
es|)«.-ially uiark<<d in pernicious anemia. 



Tlio ditninntion of hwmoglobin is tiMmlly proportionate to 
tlic diminution of tlip rod pc)rpnselw, but tln'ii- an- iwoniarkwl 
exceptions, namely, in c-hlorxxutf, in whidi tli* rrii <xiri>n»rlw 
may he dinuuisbcd only twenty or thirty |ht wnt., while the 
liK-moglohin is diminit^hed finy orMxty per (vnt., and in )mt- 
tiicioiijt an;>-iiiia, in vrhii-h the nil eitqiiwcli^ arc frrvatly dimin; 
Uhed, but an; rt-lativeiy nVli in lneiinij;Iijbiii. 


Melausemia, the piwM^iK>4^ in tlic blood of frw pigment, n»u 
allv mftidts from chrunie malarial infiTtion. In ram imlani> 
it ItAH l>een fouml a»«oeia(<tl with im>^lano-Ranx>ma and Add 
Hon'H disease. 


Liraitiiii. ilic pn^'oni-c in thi; blond uf fiiK- rlnH>!« of fiit, 

may tx- iioti?«l iit ixttliti. It is u\m olKxrvi-d in iiUulioliKUi, 

trliylnria, ami t^jit-cially in <]ia)K-U«*. 



Th« fiilJowing niu-n)organt.s(DR liave been dotcctiHl in the 

Ifliind: Thfi ptib^nKicliiim malariie, tlit? filnriasangnitii.t Imminia, 

lltiL- ili.Htoma li&'niat<il)iuin, cl>e siiirilUmi of ifliiiiniiig fevev, 

Nod Uie l)a>.-ill(ta of anthrax, glanders, typhoid fever, and 



Dkfexition. — A condition in which the bluod \s diminli^liixl 
in quantity, ur i.; delidt-nt in one or mure of itti cutiKtituctit><. 
VMEiKi'its. — (I) Symptomatic or Eccoodun.' UDscmiiL {i 
^f^eential or primary niticintu. 

Syniptoniiitlc Anemia. 

ETini,ix)Y. — (I) Ctmgenilal — « 0(tnM,itntioiml t«KJen«y. (2) 

hygi<ttH> — exoGfaes, liuilty diet, impure nir, la<rk of sini- 

(31 Hemorrhage. (4)<Ji^iniiMlifti'a'«-— lamtT, Brij^hr's 

e, pli(hi.4iti. (5) Toxii; ayenls— lead, malitriti, syiiliiiU. 

Pathoixxiv. — Tlie blood is ck>ticient in Incnioglobin and 
pusi^leH, and llie tisKUCs bIiou- latty degeneration, 
■irurniua Qeiifral Symplomt. — Pallor of skin and muoous 
iieinbraoee, [o«s of flt'sii and strragth, and, in severe cnses^ 
i-hrile paraxrsma and e<.i:-hymu);eew 

Pircufcriion.— A full, soil, and nipi<I piil«% pu!»jition of (lie 
FTviml veweU, judpitalion of the hitul, lin-miu mnnnuni, and 
light dn»p*y liq^nning in (he feet, 
UfgfHnilum. — Hnrrietl breathing. 
Hifftxiion in weak. 

\Wrtm* S^rm. — Hi«dtu-hc, vertign, diitllirtnTd 8lwp, Wtu* 
J^ii! |«inH, and a teiiili^fM'y In ^'ruf'iM'. 



I>lAONnei& — I7!«u»11;r evidenl, bul anpesranoKi an drt>|>- 
tive, and on abeoluie ittagiM»b mHn <>n Uic examiiialiuD of tic 

I*B(XiN(Hi6. — Defieiids on the caose. 

TRtL\TM>LVT. — -Iteiuova! of tliB (sniup, when pfl»ibtf. ijwA 
bygienc Tbe Uf« uf irou, liraenic, aud geDeral tonicf^ 

Etewutiu], or I*riuiary Aiupiuin. 

PefiMTIOn. — Aniemia arieiiiK witbout obvious csiLV. <y 
dcpcnikiit u(wii funlty miioD of the btood-makiiic or^ii>. 

VAlUETlifH, — (l) Pernimms aiurmiii. (2) C'manieis. 
l^-lloix;v(LKmia. (4) IWudo-k'tK^ocvthfcmia. 

pERxiciors AN.*an.v 

{nUoptttbic AamtnU, PiogreMlv* Femlclona AmmbU.) 

DEFislTKts. — A grave lorm ofunwmia, often tniBHSocnUil 
with any dii^inct caiual ]«iun<^ 

Ktcuixigy. — Male SOX, middle- litV% |mi1iiril)(in ; and fioallr, 
syniptoiiiatic an:rniia, resulting from il8 variuurt caiii^cs, fn- 
dlMMJW to it. 

Pathoi/xiy. — A» a rosiilt of )Iw diiJrase llie nrpniu' n*v«l 
fiitty df^'JM'mtioii. NiA inrnvjuonlly olntpliy nf tin- pmt 
liil>iik-4 i.H tinirnl a.-* an ad<-(|iiuIo rau^r. Oil«i an cxttwiiv 
amount of iron |ii^mnit !>> tonnd in the liver and otbtTo: 
indii-atii)){; increased d«*iriH-lioii of red corpitwlcs. In an 
ca>«s changcit in the bone-marrow have been Jrtwtwl ; in otJ: 
d{^i.-iieTation of the i^ynipsthctic ^nj^lia ami of the |)ii-l<'ri>' 
coliiintu of the spina) cunl : but ihiwi- oonditioiM aru [iruliiililv 

SvMiTOM.s, — TIm- general ^ympttMnsof inU'nKcutimitia, w 
Uw liillowiii); [Ki-nliiir «vmplom»: A U-ui"n-y<!Jlow oolofwl 
xkiii ; febrilf paroxy-im*, lillli* wiislinp, nti<I ol)*-» ait iiKTiiiM- i: 
weitiht ; fnijiifiitlv git'tHc duitnrbniMx; nml I'oiina) hi-jiiorrhagi , 

The It/ifi't. — ^"rhfl nil <'oq)U!*cl(« aro exln'iiiclv niliKit! in 
nnMiU?r. somelinicM 80 or IK) per oijiit,; the )ift-ii>'>;;)ol)(n in ibitiio- 
is!v"t, lint not )>ri)|iriHinnntclv ; ihemlrorjujsflfsari-nf vari 
i>iiii)H>u»d !'ixt>, wiiH- filial 1 (niicriK-y t«??), some large(macnM'viffiV 



very larjte ami nii<-)(-ii((il (Eijpint'ih!ft>*ts), »ri<l tii.iiiv invf^ 
in oiirline (ix>ikiloe^-l<!s). Tin' mimlxT of wliilo mrjdi.'x^'lui 
t nmtvriallv dtaiigwl. 

'Hou.srjsig. — Xvry iiitravorablp, (h« average duration beii^ 
ODu lo tnu yr.'arf. Itccovcry ixvaflitmnlty oocure, 

TftKATMENT, — Ktinoval of any obvious cause. Good hy- 
git'iii'^ cdiiililioiui; n milrititntv uml easily ai^imilable did; 
tvni ; llw itM- uC iron iiix) arwiiic, fT<ixi;ialIy tlic lattrr, gnulu- 

Iy itK-iTft^il Iw iw ivliy^intogitul limil. 


(Onto SI^D«M. Pttmary AuwdUb.) 

iciLOGV. — Ftibt-rty, girls, rarely Uoj-b; bn<l liygit-ne, i.e. 
[toor r<md, inijiiire air, overwork, and lark ufisiinlii^it. 

pATHoiJXiV. — CJciii'rally, nu dcmoiMtmbk can^l tc^otis. 
In iH-ntidU^m Clip's, iii)[>crfci1 ilvv(-!o|mK'(il of tin.- Urj^ arU-rtm 
Hoof ih^ ^ciiituliii in MXtiHinx-s fonml. 

HpvufroMs.^ — (.iciif^'i-iil luiitiift'^tMlioits of nniemia, witli tlw 
" (bllowtnj^ pei^uliar itym|)toiti.4: Tlw^ bliHicI ^liutvn a nu>d(^rat« 
rvduc-lion of llie luimbiT of rnl <M>r|HiM;It=i, willi a mitcti grcstcr 
mluctioi) of the ba>ni(i^liibi», and .stmio irregiilaritv in tlic siiic 
Slid ah&pe nf the eorpiiaclt^ ; a |ial(vgreen tint to tlio Hkin, and 
a tendcwy lo by&teri«il outbreaks and to nien.ttrnal disordera. 
'['b»>e enndilioDR, ivith the age and sex of tbc patient, deter- 
iniiH' the diaga(«tf>. 

I CoMCLicATioKM, — Gaetria ulcer, phthisis, exophthalmic 
jr»itre, aiMJ amenorrhfea. 
PiMKi NUHIK. — Favorabl*. 

Tkratment. — Good hyifimceundilkHUi; Dutritioiu food; 
I ircm in a^oending doses, with thi- ucvasional use of Bomt: ealiui* 
i laxative. 
I 9 ^*"r\ «ulph., 

rolniH. cnrb.. ISgr. xxxvj.— M. 
FL in piL N'u. xsiv. 
Sg.— TbK« pills (tailx, Increnaed to nine ptUa daily. 





DEFlNirrox.- — A form of aiueinin lOiarai-berized by a great 
ex«C8S (if t\w vi'Uilf rtir(>iiscl(-ii, witli liyiwrplasia of tne s{il«en 
or of tb(' Ijiinjiimliis, or iliangty in the hoiiivnisrniM'. 

Ktioi-ooy. — Ttio <«usi-'» are iibnoiuv.. Male sex, niifldU life, 
DialuriH, hi^r»litv, bod hjgicne, and repeated betnoniuigGs are 
predisposing laclore. 

Pathoixmiv. — Tbree varieties are iiot4Ki : (1) Splenic len- 
oetiiia, in whicb the spleen is enlai^tl from otngcstion and 
hrperplasia. (2) Lvinuli«ti<- Icaciemia, in Mliidi iIh- lyiiiplmtir 
claads arc the s«il of livjRTpliisia. (;t) Mytlnjriiiie Ici)n«tntii, 
m which the iiK-didiM, cspt-^iiilly of tho rib<, F^tTiiiiii). lUid vertP* 
biw, is converted into u pulpy riinleriid, raiigiiif; (Wmi a dirty 
yellow to u deep ntl enlor, mit-nling a* IIkt tvti);i»iit>n or thv 
ex«*« of I'-iioijcytes pr(-<liiniiimlfS. 

lA-tKwniif liiniorH ((iilli-i-lioiis of jirdlili-nitMl leucwj-lw) arc 
rnijiii'iitly f»iiml in iho various organtt. The liver is ofUm 
eonnidcr.ilily ^'llla^[^1^. 

Tbu liHsnes flbow faUy degeneration. 

SvMPTOMs, — The general niaiiifeslationH of antcinia, willi 
the follovrine petiiliur !ryni|iionis : luilaivenienl of the lym- 
pUatiM or H|>leen, or tenderne7«i over the nones, fllighl fel'irile 

Croxysms, dimness of vision from henionliagic retinitis ur 
Kwniie de|io«)ts. 

7'fu- lil'ixl. — A nwrked and pereistent actual iucrease of the 
white wr[Ki^-U«. Thv proportion nuty be 1 to SO or even 1 to 10. 
The white ix'IU v»ry ni eize and olten lack amtelxiid move- 
ment. <Miilntlnd cn'ulai*, di«wer»^ liy Clmreot, aix.- often 
fiiond. Till.- ni) (iirj^iM'lvnrc^vnK-whai dimini^hi-d in number. 

l't«KiNiiKiN. — Itifovery raivly l'ill<ms. Ihmli usually re- 
snlls in from one to tlinf yeiir*". 

Theatmkn r. — fidoil hypienio (nnditions. The tise of iron, 
miinine, and urseiik-. Removal of the »]ileeii has ^veu ae^- 
tive results. 




(Bodjikiiis' Disease. LymplMtlo AtUMnia. HaUcnaat Lrmpboma.) 

Defisitio.v.^A frtrni of anEpniia clminK-lprixetl by a hypw- 
plHKtu of I)k! lyiii|>Juitie tOrutlures, without uoy iiicnase of lliu 

ETtol-o«Y.— Til* (-aiiaos arp (thstiire. Male sex, etaiy lifc, 
iin<i iiiiti|ilt: aih-iiilU seem In be prwlisjHJsiiijj liiuscfl, 

I'ATHtHJXJY. — Tlicrc is byporplosia of iho lyniphalic sinio 
lurtA; ^LhikU, Hf)!!'*?!], and Imno-itiatTow f^bariiig in tliv protiLMf, 
\cw fwi of lymnliatio tissue are often Dotetl- 

SvMiTDMw, — Ttve ^Deml nmnifpstations of anieniia, with 
the fbUowing periiliar sym|)tom§ : Knlar^menl of tlie lym- 
jihalii^ ^1:)ii<Ii>, which ii&iially begins in the neck ; the glandK 
oi>iu|i rifling the lymphulicr titnii>r<' remain (liftliiict and freely 
movable, and rarely !-(i|>i>uiiite. The spWn is generally 
gomewliat entailed. Febrile paroxyHnie arc eominun. The 
blood allows the Ki^nf of Himpkr unicnitu. 

DlAGSiiew. — Tubri-eiiloim (flnmU may resetnbic tlie j^Iands of 
|)eeudo-leiK«?iniA, but the foi'nicr ure usually ll4r^(u-iatnt xvith 
tuberele in Other |Kir(» of Uic body, and suuu fuse togt-tber 
■nd siip|>iinitv. 

Progno^i^ — Very iiiirnvornbh-. 

Tkeatucnt.— The .«ainc «.■• lor krucwniia. 


Pefisitios. — A <'<)n.'*tiuili'jnnl dtwane, eharacleriwil ana- 
(iiini<mlly by a dcgcm^nition of the sn|irari-nal i-ajwules or 
8(^niluniir ^nglia, and clinically l>y pi^nionlatton of th*! skin, 
Miu«^iiiia. and pniUmtion. 

Ktiommiv. — Male i^x, middle life, and lalx>rioiH work ure 
|in^lis(xxiing lacIorH. 

I'ATHoi^MiY.— In most instanced itiberculijt^i^ of tin* :<nprj- 
renal cajisuleB is discovered. Other afTentidn^, 8110I1 oi* tiininnf 
and dcgeneratjoo of tJie suprarenal cap^nilEs, may jimdiicv (In: 
disease. In a few instances degenerativo <-han^^ in Uiv 


abdomiiul ?ymp(Ub«tic leaiigla have bem die «ii1t diaawTg- a Me 

ST3(FTOMs^~M'J(lerat« annDts. with braanap of the skis 
and mucr^Q^ membraiKS, great weakncae^and ^asaic irritalMliiT 
arc iia chief naaifv^MvyoA. 

Pbog:«wi.~. — L'D&ronUe. IXitatioa is onr to two years. 

Treath EXT. — Best and DotriiioiLS diet, with inw, araenic, 
qainine, and -^rrciiDia. 

(Blsadar-s IHiBwa. nMirihi^k WiHiiJi.) 

DEFixm^x. — \n baedharr disease^ chanrterued by a 
tendcocT t>> bleed excesdveir from slight wooods, or eveo 

EnoLOGV. — The great cause is bCTcdity. It is ware oom- 
moD in males, but is usuaUr tnmsmitted by females, even by 
tbot^ who are nr-t themselves afflicted. 

l*ATUui/»GY. — Unknown. In some instaoces the arteries 
have been fuund smaller than normal, with their walls thin 
and degenerat«l. 

.Symptoms, — The chief symptom is ftee and persistent 
hleeiling after trivial injun'. Spontaneous hemorrhages from 
mucous membranes of the nose, stomach, bowel, etc, and sub- 
cutaneous extra vasal tons are quite common. The only other 
symptom is a jieciiliar iuHanjmation of the joints, resembling 

PitiKiSOsis, — I'lifavorable. Grandidier slatestliat one-half 
die bclore the eighth year, and less than oiie-«ighth 8ur\ivc 
their iHciily-tii^t, In si>me instances the tendency is out- 

TiiKATMKNT.— Pnitcctive and palliative. For the bleeding 
iij>|ily colli compresses and styptics, and use internally erpit, 
buriiuuu-lis, or erigerou. The resultiug an«mia will be bcne- 
ntod by iron. . 





EriouMiY.— l^afk of fre-Ai vogrtaWea aiiJ Imd liy^^icnic 
siirrMiiutliiigs aru ilie iiriiiUiMKtiiig i-auscs. 

I*ATHOl.(wy. — TJw (loniogenpsiH of sCTirvy is iiiiknouti. 
Fatty (lej^neratioit f'n>iii ltK> uiiscinia, and witlespretuJ cvcliy- 
UKKeii arc toiiiKl alitor dcnih. 

Svuii-ini". — TliL- j^-?M?raI manifisiatkinH of annmia, wilb 
ftreat wtiikiK-w; ; itpon^*, blccdiii); ^iims, (dor of tlie breSlli, 
and 1o<xf«-i)ii>^ of th^r te<.-th : »iiU-iitaii«uiis en-Jiynioecs, and 
licniun-Uujjc^ from thtt inucxmii nioiiibraiwtf ; UDc! finally, a paiiv- 
ftil, brawny iiMluruliuu uf the tnii:<<'l<->s dtiv to « «iiigiiini'uue 

l'R<K;siiK IS,— Favorable in its varlivr etagtw.«fnt.^Kiy---.Ii vi^-(al>lpi> iiti<l ilw (rrv iiw tif U-mon- 
juiM-. Imti iit iu<Hlonili.-diMn«. Wrulc lu.iluliiiiii'urt-biui'att* of 
p><ta#iiiiiii, or nitnUc of »U\kt may [k ai)|>lied to the blmdiiiii; 


(HoibiM MaciiIOBna 'V7«rltioai,) 

T)KFt.MTi«)N. — A (vindilion arUiiig without obviouit cniiw, 
and cliarai-1«riz<-d by extravaiiation of bloKl Id the skin and 
bleeding from iliennirtiiL'* iiwinbraiies, 

EriauwiV. — Bad liygie«e, earlv life, and female sex exeit 
BOtne predis|KHiDg intliicntv ; btit It may (Kviir at ai>v age andi 
in lite mufit rubusl of citlier sex. A mHitjurggntHauJ cause basl 
been ougt^-^lul. 

PATnoixx;Y. — Unknown. 

Symptijms, — Tlie oniwt inav he nmrkvtl by some fev'er, 
iKtiilni'bv, triulalr<', ami |ui)(i in iIk^ Itniln ; but (licAe Hymptotoft 
«uiy Ix- alwcnt, ati<l (be ilii>(-JL-«: iiiJicn'^l in wilb a copions crop 
of Miuill h'-niorr)iii^n* inlci iIm? ^kio, foltowi'd by blitiling fnini 
ibe iniiiv>ns iin-iubranesL Anemia and its a^ociUt-d pbaioint-itu 
dt-velop in severe uises. 



Diagnosis. — The absence of high fever and nervous symp- 
toms will separate it from typhus fercr and cerebro-splnnl 
meningitie. The history and the absence of Bjiongy gums and 
of brawny induration of ihe muscles will separate it from 
scurvy. Previous health and the absence of hereditary ten- 
dency separate it from fnvmopkiUa. 

Prognosis. — Dej>Gnd8 on the severity. Mild cases recover 
in from one to two weeks; severe cases may prove fata! in a 
few days from exhaustion or hemorrhage into the brain. Re- 
lapses are common. 

Treatment. — Rest. Light, nutritious food. Arsenic, 
iron, turpentine, and the fluid extract of hamamelis are the 
«tost serviceable remedies. 


or rvM 



losjiPrtion detects the ai>ex-l)eit, and drtennines its poHition, 
forw, aud extent ; anv abnormal ccntppe of pulsation ; and any 
imnaliinil prominence over tlic |)nr(x>rdial region. 

Tlic Apex-beat. 

Tlw nomal |Nwitioti of tltc AtM-x-boat lit in llu.- fifth inter- 
eonM spniv, idNHit an indi williin rlH- nuimmnrv- line (a line 
cimwn from the middk- or tht- iJavirK- iwrafU-l with tlie 
at«rnnm). The invX is uwwlly iletotod by iiiHio't-tion «r tinl- 
paltoa, but when thpw mi-rh'xU Ikil it inay Ije |(Maltre<I by 
atiRci dial ton, the |><>iiit in the n^on of th^ ajw-x wtitfre llu; 
first M'lirid \» htuixl with nmximnm int«fiiuty nrm»|i4oding 
to thi' Um. 

Tfn' l-^frl <tj Romintliwt ttnd PotUwn on the Aptx-heai.— 
The liKnlii.'Ki ami f'>iti; of the a]X'x<b»it are nir>diAe<] tiy llie 
ptMtum of the |mlM:iit mid the fMJge of ibe r(«piratorj' act. In 
the rectimbciit noniiton the n|R-x-lieat may be elevated an ineh 
or laore, aitd wli<-ii ihe Uoty in iii'liiM^ to the left, the heart 
beiDg a more or hw< niovalile organ, tlte iieal nia} be deleeltHl 
in the marainary IjtU', or tveii Aonie distanoe (o its outer aide. 

Dtiriug forced inspiration the beat may benum^ Imper- 
ceptible, or if WM-ii a not ibe eane it may b>.- finind «ome 
diatanre below it« cuual iilaee, on acx^junt of tbe npvrard 




movement of tlip ribs in Uip iiiitpinilory art. During foixvd 
expiration, I h« air Ix-inc drivoti I'ront tlu- liiii)|;-tii>«^m- in front 
of llie lirart, the U-»l licoonHK nmn' forc-ibk-, snd \ts puiitian 
vtn'btc*) on ucctMint ol' llir il<«vfiii of thv rilw uliioli occun in 

In vi*^ ol" tin- infliiciiw rxcrlcil l>_v n.'!«|)i™r.i(Hi iiikI [NiAilioti 
on the apcx-lKiil the jiatioitt, iu> n rtiUs sltntiU) lie irxaniiiici) in 
tJ»e erect or jilting jmsUii*, while breathing ciuiclly. 

Displaceiiieiit of the Ai>ex-beat< 

Digplaivmrtil to the Irjt niny ixsnll fn)m : — 

1. liviKTti-oi)liv uikI ditiitatii.iii uf lhi> henrt (down and to 
the Ion'.) 

2. I'erininliiil ofTii.iiiin {up ami to the left). 

'•i, (.'liriitiic dlf-.iiM'.i of the h-ft hin^ am! picnra, n.'t^x'istecl 
with i'ctra<^liiin — aH Bhn>id ])hthiiiiH anrl pleural adhesions 

4. Alidomiiinl tumnn> ana efTiiaionfl (up and to tho left). 

5. The priitfiire of a pleural efTimioii on the right side (up 
and to the left). 

IH*i^cemfi>l to the riffht mav he (aiistnl by ; — 

1, I'hmnii- disease of the right hmg i)r])leiiruasBo(-iai4d with 

2. Pressure of a pleural effusion on the left side. 
Di&piaeement dovniearft may reeiilt from ; — 

1. ilypertr«phy and dilatation of tlic heart, chiefly the left 

2. I'rc¥.siire of solid ^rowih)t in the tip)KT nK<liii«tinum. 

3. Anenrii^m oftltcaorti^- an-b. 

4. Knlarj^enicnt of lliv livvr, vau^int; tnii4ion through the 
<Mtntr&l teudou of tliv dtuphni);ni. (I'uiil.) 

IX'forniity of the viwst may unu^' ili><plui.ieuiei)t in aity 

(lianfircM in Force and Extent of the Apex-bcai. 

3Tlte Joreie tuut eitmt ma 
1 . ifypcrtfophy of the '. 

The jorce awl eitmt nwi v he increaant by i 




3. ExoitH nrtioii uf tlie itvAti, fn»a ilnigH, reflpx irritslion, 
excitement, or diwascv. ss cxoplitliiilmk- giHtrv. 
3, Sbriukiii); oftht- liingif. lu' in phthiMS. 
A wrat: np-rx-ifxit may In- notwi in : — 

1. IKiillhy |Mi)|>k'. 

2. l^t^ciM^mtioti or dilutuliun of tli<- l)i?ar(. 

3. IVricartliul eHiittioii. 

4. Eni)tii%'m-ina. 

5. 8JiiK'k ur cuUapM^ 

Abuoruitil CentrcH of Pulsation. 

E^tigaMnr piUealwit nuty rteiilt frr>m ; — 

1. Kxritcd lU'tion of lliv li«irt Tmni any cunw. 

i. EiilAi^L-riKiil oi'llK- riglit vt-iiirifJe, 

3. A [Milwtiii}; tuMr(;\ uoUil in 'x.T(ntii Dvrvuue hikI aiULinic 

4. Aoriii- nm'iiriiijii. 

ii. Tiimon of the left lolx? of ihe liver mttiii]^ on tho aona. 
Puiinit'mn <U Ote baiuf of the hrturt niay restilt from ;— 

1. Aiu-iiri.ini of tin- aortir nivh. 

2. C'aiiiiai' liyi»iTln>))liy. 

3. Slirinkitij; of tlic! luiw^'i *^ in phthisis. 
PvitalioR ia Oit (eft axiwtry rtgioix QiBV rtstilt fruin ^— 

1. Eiilai^nx-nt of iIip iK-urt. 

2. A teiii^ purulnil (■fl'll>^ion iti Ibo IvA piciirul ^c (puWt- 
ing i?iii|>yt.'nia). 

A. AiK-iirixni. 

4. Clironir <1ii^n»i» of tlw (i?ft Iirng an<l plciini, iii<.«ocialn! 
with n-lniction. 

UnnalurtiJ f»J»uilfin in the camtuU may result I'rora ^— 

1. Kxoiu-tiii-nt of thfi heart from any cause. 

2. Kxogiiitlialintc goitre. 

3. Aiiii^aiia. 
A. Valvular disease, efl(iecially aortio regu relation. 

5. Aneurisiu or dilatation of tlte vcsseR 

6. UnnatunU elafitiiity of the vessels, aoted iu w^taiu ner- 
voos am) ansroio patients. 


Jugular PulHiitioii. 

The jug:iilar vein often becomes dtstendwl in forced expira- 
tion and coughiug. DistMition of llip ji^liir vein is lionie- 
timuK Doted in adriervttt peri card i tint. 

A true, rliytlinii<-ul venous |)iili<alion tisuuUy re»(iltd frQin 
M'ieiiKpid rciiurjri tilt ion. 

A pul»iti<<ii limy Ik- Irunisniitled to tfwjiigiilurvcin from (be 
tindiTlyiii); ntn>(iil, but thU iulsc jtiilHntiou will i<lill eunlinue 
wlien li^lit imitt^iirc h nia<U- on lliv vi-in ut tlii- nxit of tlic 
nevk, wliile llic true vcnoiiM pitUt^ will tn-imc. 

Priecoitlial Promlueuce. 

Z^tttfirat prominaiee oftht prtrcordw muy result frum : — 

1, Defoitnity. 

2, Enlarpi'tnent of tl»e luwrt. 

3, I'eriiunliat iffiision. 


TliiH not oiilv ildeniiitii* iIk- |KK^il!iin, ftirc*-, pulent, lir 
rlivitim of llie nm-x-lx^l, Imt iil.*!! delods* Uio exintenoe of nny 
fmmiut^ or thrill. 

A thrili in a vibmlory i<cn.«ati<>n likeiMxI to thst rfN^ivcd 
when the hiind is plai^t^ on ll>e I)aek of n purring oat. Thrills 
jit the bsAeof tlie beni't may rraiilt fifim valvular legions, a the- 
ix>ina of iho aorta, aiionri.'^ni, and from R>iig)»Rii^ poricardial 
siirfaees, as iu peril 'a I'd it U. 

A vtrefiy.itolit: thrill at the apex in atmont jkathognomotiio of] 
mitral stenoHis. 


Hiis determims the ftlia|>e and extent of the cardiac dulnese. 

Tfif nonniit arm of miuerfieial or a/tKoiutt pcmmflon-ilulnfMi 
(ihe part uiMiDVorHi itj' limg) is detected by light jwrcussioo, , 
and cxt4-ndK from the fourU) left, ooeto-elemal jnD(4ion to the ' 


apex-beat ; from liie apex-beat to tlw junction i>f tlie xiplioid 
caitila^ with the Btcrnum ami lhpD(« up the left boruer of 
tile slcrDuni. 

77ir a'jmtai area of tUffi />f7ru«rroii-rfw/RfM (the lioart pro- 
j»««l on tlic «'lK»'t-wull) is (Ict«?t1e<J l>_v firiu i>ereii»ion. and 
i-xtend)! IVoin liw ihiix] Ii-ft ocwto-Mvntul urtk-iiUilJou to the 
api-x-b(ttl ; rruii) (he apvx-boat to the junction of the xinlioid 
cartil«^> with the flernnni ; and tiieixi- ti|> tW right 1x>rner of 
tliesu'rniiiii 111 Ihelhirdril). The l>iui-r level (>rth<-aiii)iai'du)- 
nflvt fii*ft< with ihft livf-r diilmyw, and <n» rarely l>e diiemiiiir^. 

Thfttrra of iiiiilimr ilulitfiot is iniTea.*!^ in : I'l) Hvjit-rtnyJiy 
and diLitatiou of the heart. {'2) I'cHcanlial cfTiLiion. 11 13 
ap|arently increased in fllirinkiii}; of tlie hmgs, ait in phtliisis. 

rA« arra 0/ cardiac dufnea la ditn!nish«d id : (I) Ein|^y- 
aenia. (2) I'lieuruothunix. (3) Pjieu[uo|»ericaraitu]i (rare). 
(4) Gaseous distentioa of the stomach. 



Thii? di^teniiine!* tlift qtmlity, intemily, «>m1 rlivthm of th« 
lH«rt-sonit(l?i, and diHiH-ta tlto pwsenw of any luIvemiltuiiK 
houimU, asmiintiiira. The twn siiiindslH'-anliiverthelHiirt have 
bcwi rei>n^serued by the syltaWes, " liibi>, tiii)." TIk- first Mxind 
(tin'atidie) results from contraction of the ventriele, lenMon of 
the aurietilo- ventricular valves, and the iiniiact of the heart 
against llicchest-n-all. and is synchronous with the a]>ex-l)eat 
and enrotid pulse. Tilts stHind is proloiij^l and tlull. After 
the linit sound there is u short jianse, and then follows the 
secotvd sound (diastolic), which rt«u1ls from the closure of the 
aortic ami pulnionarv valvnc. Thi« sound !h short and hif^ti- 
pttched. After the sctoikI ifuund a longer [muse follows be> 
fore tlic firat is a^in h<-anl. 

The Int^'iiHity of IIk? IIcart-»oiind». 

Bath mundji an acea\iiiaiixl in : (1) Kxeitemeni oflhe heart 
from any (»uaa. (2) Aiueniia. (3) (^rdiac hy|ierln)]ihy. 

14) Stil^eols with thin chest-walls. (5) Consolidation of ifie 
ling, as in phthisis and pneamonia. 



Aavntualiou Of' (tit aoHic MnioHtl mvnd nv'ithf i'r»m : (I) Hy- 
pcrlmiiliy <if the left vi-ntrii-Ii-. ("ii High nrlvriiil tiiisiuD, lU 
ill arK-riu-^^I^TiisiH nml Hrij;ht'!' liiMiisc. (3) Awriii-iiiivurism. 

Ae'ii^iUi'ilioii «;' the jiuhu'tiniri) nrrtnul muml rfwiilt!* frwni : 

(1) I'liliiioiian' rit>9tni<;ri(i», sm iu i'ni|ihyM-ii)n, j)ii«iiiuu>iiai and 
tlw ninji^tioti of tlio Iiingo t'olEomug mitral (ILsrwc (2) Hy- 
jifrtrfi(>hy of tlie rielit vcntriplp. 

H'eaknetK nj Ootn *oh»<U is noted in : (1) Ocneml ol>C«ilv. 

(2) Ot-'neral Jehility, (;t) D«^encralion or cli!nliition of lfi<- 
)iear1. (4) Pericanlial or pleural eifiiHiou. (•*>) l'!iu|i)iy»cnia. 

n4xlupIk-iit!oii of Uiv Heart -KoiiiidH. 

This is pnilsibly dm- (m a Im-k uf synchronous iH-tion io the 
vaivw- of lliclwo^sidwof thfhiTnrl. amlrcsiiItM from niunvfxm- 
dilitjiM, but notably from iiirn-asiil rLiiitetaiMv in tJw systemic 
or the pulmonary nri^ilution, lu^ iu arti'rio-«;)etxisis of cbrouJc 
neplirilis nud in i*mi>h)'»i.-fuii. Il is frcqui'ntly uoIc<] in mitnil 
KtviHuisund pcriuiniilis. 

Adventitinii!* Hoiincls or >liii*miir8. 

A initrninr in an ulnxinniii wmnd htqird over ihe liCMrt or 
blocdvitw.-ls ami nmy n^nU from : (I) (ll«(riietion or regur- 
IjitHtioii ut the vttlvfyi following cndoi-jiixttlifi. (2) Dilnlnlion 
of the vMitriek- or relaxation of its wall», rendering the valve* 
rehitively in^^iiflidenl. (:J) Aneurism, {-ll A cliange in tlj« 
Mood »>iiitliluent^, ni> in atmmia. (I'l) Hoiiglieflin^ of llie 
jiemanliitl MiHiwes, as in jK'ni'Hrdili)<. ((>) IrivguMir artion 
of the lnar(. 

Miinnnnt produced within tb« heart are t«rroKl endocardial ; 
thoM- prodiK-rtl oulitidc, exocanlial ; those ph>d<iced in aneii- 
ritiins, bniita; and ihow prodii(«d by auffiinia, liiemio tuunuun. 

II:eiiiic Miiriiiiirs. 

Hremic murmurs have the lollowing eliaraeterwtiro : They 
BTv soft and blowiiig in elmnnlor, iiMially «y»tolit" in time, 
heard be»t over the pulimmary valves, tmnsmiiti'd inU) Uie 






carotids, aoroni|«inietl ntth n hum in iho wns of ih^ wi-k, 
aasoinated witli ibe. sviuitlnnui urfuut^iuia, uik) di^pix-iii' w!lli 
the latter. 

Pcrlcanliiil Frietloii-Moumls. 

Pt'ricnrdiiil murmurs, or frictloii-ttuunds, are iniperfioii 
rough and cmiking tn quality, to and fro in lime, mrt trans 
mitt<:<l bcyoiwl tlic ]]necordia, and may Ix; mudilied by prereitre 
of the Ht«(lioHco|>e. 

The Aneiii'ixiiiiil ]>Iiiriiiitr, or Itrult. 

Tliii) i-1 ii!<iially limd hticI lHH>n)iiig in ihanu'lt'r, .■•yntolif? in 
tiiiK-, li«:ii>l l>etit over (In- aiirtii or iwM^ of (lio iK'iirt, ami t-> 
oili'n a-taociaif^ witli an altnonnnt nrea of dtilntsji and ixilwi- 
tioii, aiid witli i^ym{>C4>inri n^nlliiig fi-oDi |>ra»urA on ii«iglil>or-. 
idg Btruoturee. 


Tlie nv«fftg(! frequ«n4^'y of Ihv pulse in tlic odidl in between 
70 and 80 (tcr minut« At birth it is brtwoon 130 and 1 50 ; 
in the wmmd year about 100, utid so it {^dually Ictweua m 
the chiW gi-ows old. 

Increased frequency of Uie PoIm (Tiwhipymlia). 

l[al)im:il iK^|iiLii.y is i«.iiiKtiiiU'» iii>t(il in iHiilth. Th« 
freqiiancy may be tfiu|Kinirily it»iTi-a-»iil by treurl po^ure, ex- 
chetnent, ratin;;, and tlio ii»v of stimiiliuils. 

Abnormal jriYfiii-Hcy may nt^idl from^l) I*yn?\i«. Tlie 
ptildc uHiially bfurs a di-finilv i-fUtiiin to the t('ai|MTatun', but 
in vprtaiii ■lisfiu««, iw sinrln fwor and Mfititwinia, it ie dis|m»- 
portionntvly ntpid, {'2) KxDpblhalniii- ;iiiitre. (■'{) Orjtanii' 
li«irl-tli*t-ai»i'. (-1) I*ivj«un:-at llw base of ilio braiii mifficient t-i 
[«r«Iy«' tlM> pnfmri>ii[afttrics, a'* In <rI>H, tumor, and advauivd 
iiiriiitif;tii». (-'■) Slitx'k. (ti) I£otI«x irritation, as in tlyi^peiR^in, 
ovarian, or marine di.teasc. (7) An indopoitdenl jiaroxvHmal 
iipiiroais (" Rwcntial I'arosyginal Taohycanlia"). («) f.Vrtain 
dnigH — U'llmlonna, iiilritt^^, abT^JiDlr etc. (!>) Itheiimatoid ar- 
tlirilift (8a nsom). 



Infireqneuc; of the Pulse (Bntchyatrtiia). 

J'htfgiofoyicaJ (/otrmrw is notLxl in irpoDP, fastitif;, tbe puor- 
periuiii, old age, simI liabiluall^' tii u-rtnin |ic^>p)p (4l.t to Gt) per 

pit(hi>logieal infrftpteneif \« oiN^-r\'<.'<) !□ ntaiiy voaditions, 
□otnbly — {)) In organic limrl ili«iii>c, njuvialK' fattr (legcn- 
cnilliii) iiih) fibix>iil iiHltinttion. (2) In Juiimliw. (3) From 
|inwiin- al xhv bii»: uC brain Kiiflk-irnt lo trrilutc tbt- Ta^«, 
aa ill Ix^iuniiif; iiK-iiint;iti:<. (4) At UiccIum; of Mirili- <lt»- 
*»!*»??•, a* typh^iitl fi'\<T, priviiniotiia, via. {!>) After ihv iiw of 
oertain dnigs, «s digitalis, nvoiiitc, opium, vie 

Irntfirttlur Itliytliiit. 


Tbe IntennitteDt Pal8e.~TliiH prr m is not • of 
any iKitlioli'i.'it'.i] a'lxlilixn. It i» Iiubilnally iiolctf in certain 
jH-ople, aftkT exem'R-. uitin;;, cxnletnt-nt, or tlie nw of lybtieoo, 
tpa, or oofltr. It is iWtjiU'iilIy ruflcx from gastric, hepatic, 
uteriite, or renal dtteaia-. It M commuii in lilhu-fiiin and liilty 
d^enenitjon of tli« bi-ar1. 

There may Iw a fiilse inteJiiit<«ion or tiifn-oiiciiiy in iIm^ 
radial pulse wh^'ti the hi^art fails to (raniijiiiL all it" Ix-utTi to 
the wrist, Thin<"ondition in it!<nally iuditntivcof a ivcak li^'art. 

The Irregnlar Pulse. — TIiih iuia'lhe .-wnie fligiiifinin<»' as th« 
internuiioiu puW. It is also very common in myocarditis 
and valvular disease, especially mitral regutgitalion. 

Kg. 8. 

^^ffantgrtni vS tb* Iripfuilukl (iuIib. 

The Bigeminal and Trigembial Patsee.^ 
regular W-sU* followed by a bm;^ r |Miui»e. 
same ftigiiiricttiicc as the irrc^iW puK>. 

-Two or throe 
Tbey have the 



TbB Patens Farattoxos. — One wliidi ■!> more or ](:«>* riii))- 
preaseil at tbfr cli^c ut' each full iiizpintlitto. It in llioiiglit to 
be dae to the rotn)>r(«£ioii of tJic grcut vnwU by inflnnimatufy 
adhcHotis, th<? latter b^ing slrvtcliwl diiriiid llw" ii«l ol' inapira- 
lion. It is fn-qiiMitly notcil in aiUirniit jiork^ardiiini. 

The Diorotio Fnlse. — A ixiIm- in wWwb ihe niuiu be»t if 
qnifkly f'.ilK>w*i.'<l li)' ii M.niii<liinp' wnve nr ^light ii'boiiiid of 
tlie vessel. Tin.- stiooiidnry or ^icn>ttc wave wsults from a 

Fig. 9. 


recoil of thfi relaxed vveaeU afti?r the Utter have been ditt- 
tended bv a shar|) ventrit-tilar contraction. It is indicative of 
low arterial teijMJim, and is iiottxl esjieciaily in febrile disea.*?!* 
and low slatp» of the nervotu syttetu. 

Other ViiiiatioiiM In the I'ulae. 

Ttie Higli-tensioB Pulse. — One in wliidt tlto furoe of (he 
iK-at i» relatively irnTcw*d. The tension may Ix- rouphly 
uttimatetl by noting the amount of pn.fwttrv of 1\k fingvrs that 
if r(X)iiired to arniit tlte bi-at. 

A hiyh-frnMum fiiJuf i« obeerved in many conditions, notably 
ill mnliac! hyjjwtrophy, excitement of iIm! hmrt, diroim^ ne- 
pliritiit: in tiTcbrat iiltli-linn's irrilating tlie viu">-mott)r centre, 
.tucii aft a{M>)tl<'i:y. Imnor^, iind Ix-giniiing mcniiiffilii' ; after 
the nm of ivrlaiii driij^, nf (bgitali^, ergot, ami alcoholic 
t<timulant&; in diilU; in jm-gminoy ; in iT-rluin lu-iiruscH, n^ 
angina iMXAorifl, epilejittc and liy^iteriml «'ix«re« ; unt) fnun 
contraction of the ca(Hllarie< by irrilanli^gttnenited in tlielwdy, 
as in lithieraia, gout, unemia. 

The Low-tensiOD PlUM.^T)ibt is also obecn-ed in many 
flftiiilitionfl, iK>tal»l_v in (kgcntratiuu of the heart, in ooUapMe, 
in debility, in Itvtrs, aitd iu luw xlales of the nervous c^-&t«iu. 

Venous Pnlw. — A true jujipilar piilsaiiun is often noted in ' 
lri<.nia|iid iv)fii rotation. A vctiouK pvlix- in tliedorstim of lh(! 
(land may be due Hi (1) forcible propiii^ion of blood tlmiti);li 
the (npiitariiLti, as in aortic regurgitation with ^reat hygter' 
tropby of tlie left ventricle ; or (2j to <'XtrE-ruc relaxation of 
tlip arterioles and (:n|)illurie», |ierntil(iii)r the Iranirmiesion of\ 
the |niIse-M!ivt!, iv- hi triiivi- cnclii-xin and anR-inia. 

Asymmetrical Radial Pulses.— May n>nU from : (1) 
AiHniialies in tlic dtstribiitiun, «i»>, and divii<i(>n of one of' 
the veni*<'lB, (2) Aortlt- »nairi>ni. (3) An <-n)l>ul!i^n) or an 
titlierttiiiatont^ plale within iIh- vi-jwI. (■() Knu-ttirw«, htxalion^^, 
or intiumuialor^' e.\itdatiin)j< (Tiiiwiii}; CTHnpixwiiiin of (lie vessel, 
(5) Coni|)n;«ion of onr vc«M>l by tninor» nilhin or wiUiout 
the thoni.v. 

" Water-hammer Polae " ( ( hrriytin'* Pulw). — tlmractrrijteil 
by 11 Kliort, piwiriiil Ixal, wbieb suddenly (-o1Ia}wcs. The 
piK-nliiir i>ii)Miii<>ii may Ih> distinctly visible, not only in tb« 
carotid.'* bnt tbivrngbout the braehial aricry. Tim piilite ia 
dia^io-^lic of aiti-lie n'gnrgilation during (he j»erii>d of e»m|x>n- 
Fialtiin, and its force ih due to the os««fiive ventinoular liyper- 
tixijiliy and to the lai^e amount of blood cspelled with eadi 
svflUde ; its sndden reeeewon is diic to titc in<.-on)]>e4cnt valves 
failing to support the column of blood. 


r>KFt.NiTi«N. — A rapid and lumultitous actio^t of the heart 
[)enipj>tible to tlie [tatient. Itaptdity not perceptible to the 
jMitii'iit is not termed jialpilation. 

ETiOLOoy. — It may rreult from : (1) Uvttvx irritation, as 
from gas or acid in the stomach. (2) Kxdtement, mental 
or pliysitnl. (S) Organic heart <liKc«8L\ (4) Kxophlhalmie 
(Tiiitrt'. {!>) Over-work, a* in the "irrilablc Iwnrt" of un- 
trained reBTiiits. (R) Anii-miii. (7) Hysteria. (8) An indc- 
j)end<>tit oeiirusiii (i'l«*eiilial Punixywiail Tiu-byeardia), 





DEtTsmos, — An aanatiinil collectioa of serous fluid in 
tlie tii^iiefi or csvilks of the body. 

KxtOuxiV. — llropey irsulls from : (I) VcDom glaaU, from 
L-ltmnic Iwan, liwr, ami loni; din-wn^ and fntni tocal olkitniis 
tiitu to the VPD'MU ctmiliiiioii hy tiiawn, pirgnaiit uleH, nr 
laricuse cunditioti*. TIk- ]ai4 i» a cwttRum cause of oh]<-uui 
ill tlie tegs uf old pn>|ik-. (2) Alt<^nition9 ia the blood or 
capillaries, lu in Brigbl'it dinnse, aiurmia, iind iiifUnuDatioo. 
CtirditK ttmpny uauaUy bf^if in Ike /M aivi tueauU. 


DKFlxmo.v. — HIiH-nFsM of tlie Hirfsci- from insoffident oxi- 
dation of till- biixid. 

KTlOLOOV.—Cvanocti!* rcMtlts fn>Dt : (I) Conditioat wliich 
fibfelnift tlir i-ntninfn- of nir, ai iTwiji ; ifdoiim of tlie larynx ; 
Ujiuorsor fon-is" l»i«lin*iii |h«^iiir-]Bi.-Aiip«; tumors presHiugun 
tlieair-iNUSnp^; i-mitliVM-iua ; poeuiixmia; |)liniri<iy; paTaly:4ui 
of thv rLi>|iiRLlory niii^'b^ aa in bullur (lolHy ; and spasni of 
tbe n«pinilor>' muAi'les, a» in epil«)My, l^-binus, dc. (2) An 
tnalHlity to gei IiIimxI to ttte nir, as in nil lorms of dironk 
heart <iiw&-«' fikdini; in puiiuonnry cntige^^itin. 

Congeoital CyiUiOBis is luaiially a'^wx-iatu] with stfjious of 
(be iiiiliiitKiary orilu-e, an im|M-rffti-i viiiimnliir sejttnin, ora 
|iutiil<uiri toranicD ovale ; it prolwbly iTV<iiltti not ko niiirfi 
fn»m direct raisture nf venous and aiiori«l blood, an from ll» 
Giilnre of the blood to reacli tlie lung, ur from general veouiia 



Defikitiox. — All iulliiiiintutiou of tho pertcorditini, or 
seiiiiiM <x>v(triiig of tUf Iicnrt. 

Ktioi/kjy, — (1) [i)i<)|uiihii-, frwnn*!(|>OAiire. (2) TraunialHiL 
(;}) SooHidary In noi^lilMiriii^r inflimuimtioiie, lis |>leurif^, 
phthisU, {>m-iimi)iiui, me<IiH.->tiiiaI lil^'iiM-. (-1) Saiijiiflarr to 
soiuo general disc^fit!, ua rhoiinmlUin, Itri^hl's (itMii»-. H'pti- 
c^niia, tubeivuloeis, and the criipuv*- fevois, 

I'Ai'iioi.(MiY. — In the early btage tJic mrailimiK is n?d, 
Hlicky anil lusirelffiu; and if the procesH now oca-KW, lh« con- 
dition is l*frm«l dr^ perieanUtia. 

Il', however, the ioflaniniation oontinneit, a>i rxtidutf is 
forrnod which may Iip: (1) Sero-fihrinous, (2) tiUnnoiw, or 

(;t) |iiindenl. Jn the EtTo-librinunn tlirm ttuTP ij> Ijttlo 
ym[>h, the exndnle being muinly pomtKiseil of straw-nilorvd 
eeruiu (n few outw-es to scvti-al pints), which in favorable vafu* 
is jrradnally alworlted. 

In the lihrinoiis fiirm. sicnim is srant and the iiiMiihram' ia 
corored tnlh a butler-liki- exudate, whieh (tiil>;ret|ti<'iitly or- 
ganizes ami unite*! more or Ii^s tlnsely the )>prirardial surfaces, 
rauflitig adherent perieanifuin. The n<Ihi'*ioui> offer reetslaDFe 
to the ventrieular a>ntracltoiiit uml iillimntcly induee cardiac 
hyprrtn>|>hy. In rare iiutancvs the fibrinous exudate beoonwe 

In the pundent form, death nitiiiilly nt^iilU; htt evueim- 
tion of the pus may be fullow<^-<l l>y nuioii »if the (K^'riairKliai 
siirfin'cs, ami ultimate rvtivcry. 

Symitxhis. — Moderate fever, pnc^xmlial |Kiin and lotider- 
nc7«, dry eongh, dyspiia<a, awl |Kilpitu(i'>ti. Thv \)i\\»e is nt 
fn>t nipid iiml forviltlc, but later wiwk and imv"I«r. 

PllVsiCAl. HioNs, FiM I'y/iir/t. — Dry pcrit^aMitii); 

Iwjffiiii n. — N i-pl I i ve, 

/'ntiMilSmt. — KixiM-timi^ a frcmitai, frxKU tJie grating of the 
nHijfliHtril |H-rininlinl fiirtitn^ 

/'u-cuntMi. — Negative 



AuMttlMion — A Hii]H-rfi<:-iii[ to-anJ-fro friclioD-iMund, tisii- 
allv luurd li(!nl al iIk- Iham- of llio h<iirt an(t not UanEuiitlnl, 
to any oxtfiit, tx'vond lliv pnnxinlia. 

Setryiui Sliii/i^. — Sem-liliriii<iii.'i> rtrn«ioii. 

ln«iMviioii. — Biil^iDg of ilu- {miiTirtlia, 

Paijititioii. — Tlii- ajMix-lniii IB foeliii! <ir U^i. If <Jpt«1«l, 
it b ])uslutl iijmm'iU and U> the It-ii. 

J'trcassion. — iru-rea.'«d arta ot'diili)e§K, iriaiigular in dtape 
with the Itoap duwo. 

AfuKiUlatioH. — Tlie htort-eounds are mtifBcd, ffe1)lc, and 

Piirulatl ^iaion yields similar sienii, Uit in luldition,— 
(1) the «'inpUn)i'* of Uwlic fovt-r, vii;: high iiud irregular 
(ever, »wwit»s diiiljs «""l pTDgrpssiv* [taltor. {*!) Sonwtimea 
redc-tna over the pnecordia; aud, (3) in doubtful cnMv, tbe 
uspir-Jtiug iKcdIc rvvcaJs pri>). 

Fibrinous pericarditis (Adherent perirardium) is often dilTi- 
ctdt to riti3;;tiiiK', aiid while the f-illowing sigutf 8U}{j;(wl IIhj 
conditkin, ihev are iiot idwolutely dingn(»ti<; : — 

i'no-oniud bidf^in^, a wcnk a|>fx-t)«it with loud mxindri, a 
Mvstuiii; rvtriK-tioii or dimplln-; not only at the »|wx, Imt over a 
largt- [Kirt of iliv pnroonlia, a jMx-uliar <lia»lolio iidlH|x<e of the 
jiiguliir veiiH (Fricvlir-ich), u feclik' aiicx-hc^i, witlt a fi)rctl>le 
imiHilw over the lK«iy of the iM-art {l*n<d). 

Willi thc«- fiifjiw liiiTc utv often Mtii[>ion» of hom-failiirp, 
gueli n* i\v'*\\w\i\, ilrttjHv, and (-ynonni^. 

DiACJSfwtS. Avitte KnditninUti*. TIk" nmriniir is soft and 
blowing, tiot linrsh ; it Ih iiMiially sJn^lo, luil lo-aiid-fm; il \> 
itoiiiirwlial distant, not 8ii))rrfi<ial ; it i.i not necessarily lieartl 
Iwftf at the liaiu.^, but at one nf tli<- valve poititt* ; it is not etm- 
fined to tlie prwciirtlia, t>iit is iiMtalty transmitted; aud it ie nut 
fiillowed by the fA^n» <if eSnmon. 

Perieardiut rfftMion miist N- distin^iished from eanliac hif- 
perlrojifig. In hyiiertrtiphy llii>area of diilitess if invrcaw^I, 
Imt normal in outline; the afwx-lirat ih di)>plaecd dowmvanis 
ami lo llie left, and ik foHble; and the MXindB are Imu] and 

Prricatiliai ^niuon and rardlae ilUatatioH, — In dilatation is no rri<-tion-euitnd ; the ajH'X is neually diifpliuHil <lown- 


wanis, nevtir upwards; the area of diiluc»i is out pyramidal, 
but extends laKraUy ; lb« wwiKltf arts not muillvd, but dear 
and sharp. 

l*iUH>\'08is. — In the dry and tK-rofil^riiioiis funrnt the prog- 
itirais is pnxl iiiidiT faviirub[« wnditioiiH. In llw pnruleut 
form iIk- (uitlwiik in oxtiwnwiy gravo. 'Ma' tiliriiimis liirm, 
tlioii|^li n<i( iriHiiKliiitfly lalal, in vt-ry turiouH un wvoiinl ufthe 
m'^Niiidaiy chmigtv uhk-li it iiiduoee in tlie i-an!ia<! niu«Jc. 

TitKATURNrr. — Alicii>)utc nst. Light diet. Opium is umi- 
ally n-fjiiirwl to insure (juicl and to rrliev<^ pnin. WItCfl llie 
action III' rli« hi'art i» mpid aud irregnlar, eil)K-r aiixiite or 
(ligitaliii may be adniini&tured ai'vurdii^ to the strength of the 

Jjoeal Tteatmenl. — In severe caspa ai>|)ly a fcw wet mpe, 
leeches, or a blister to tlic pncordia. In other aaes, an ice- 
Ijiip or iMJultice may give relief. 

J'rriciiflidi elusion (('Iimnic ]>erinirdit!B). — ^When the effu- 
sion is ikviiK'<1, apply »iiihII blUd-nt uvi-r the pneL-unlia, iidmin- 
iMcr iDcliilc uf pi>liu<i»Tiirii (pr, x ihrifv daily), sik) cwoiiniKi' 
ditiiW-s wiiti digitiili-'t or iwlli-ini-, ninl c«tliar«i» with Ntlim- 

(I) WWn the frffuwoii i» very lar^v, (2) whon it rrdutw! 
iiMK'h disinrlMitee, n* rlyspnn-a, evonojii!*, anil thr like, (3) 
wiii'u itf< alHTpiioii i-Hiinot he aitimiplii^hul hy inu-mal rente- 
tlicK, or (■!) wIh-ii it, is pnrnli'tir, iiaratt-nlnyH of ihe peri- 
t-iki-illuni is indii-ntiil. TIte nei-dlt- ^honld Iw irittiKhiiirtl in tl>e 
liltti iiilen>j«uf, II htlif! to the ri^cht of tite [>oinl of ifit: normal 
apeic-lM-at. W'lien the (.'fliisiou i§ purulent, a free inebion oSen> 1 
a slight, aiHi th»> i>nly ehanee of cure. 

In a/lhftrni fierietmtiwtt. re|)cated small blisters may he I 
t'niploytd ami heart-failure should he combated with digrtali« < 
and similar tnnliac tonics, 


BydroporiMrdiam (Drc^isy of the pericardium) results fnnii 
pi-riiwniiti*, or (rifm out of llie (nuscs of t^eiieral droifcy, as 
L'lmmii:, kiilmy, or Itinj; dii^ase. 

l*t(YSu;ALNiGN!j. — Thu MUiiv a» Miro-RhrinoiiM pcric«rditi«,l 



HttinitpflriOArcUlUn (HIoimI in llm {MTi<9iixIiiil mr) itmiIm 
I'l-om tUv nipttiiv of an aneiirUiii, riipliin' »f ttii- iH'sn, tmii- 
maci.iiii, and canceniiit^ ntid I i(lH'r(-ul<Mt.4 iH-riiiiitJilifl. 

I'liYiiii'Ai. Shins, — TItc same aa liyuraperioaixliiioi. It is 
sj>pet]!lv tiilat. 

Pneuaopeiioardlom (Air in the pprHnrdinm).— This ran- 
oondition rt^nllK Irum i.<xt4.'ninl woiiml'i, or lite rupture of an 
uir-(.i)ntuinin); oi%!:)ii into iIk- ]iei'i<':ir<linni, as the jirrrorntion 
ufa |iyo-iinfiim»iliiinix into the [Krioanlial tac. Theeiitrancc 
uf a -it'ptiv irritant proilutrK pus uinl the vondition bcn>tnG« a 
pDcumu- py opL-fimnl i u in . 

Physical SicK!*.— I'vrviission uver the pneoonlia rieldif 
tympany ; und uiisciilljitiuii, itpliuliing and mctalltc s(>itiKli>. 



Piifr"iMTioN. — lullammatidi] of the lininp m«'nil)ran« of thv 
heart. The pOM^se is uMially wmfini'd to llw x-alves. 

VAHirritM. — (1) Exudative, or ve^tative endoranlitis 
( Endocanjitis vemi«'sa). Thb be^ns as an acute affection, 
hut usually lead* tochivHtie iiilorslitial valvulitis, (2) Sclerotic, 
or interstitial valvulitis (t'hi-ouic codocarditis). (li) ulca-ative, 
or niati^ant cndocaixlitiK 

Etiology. — Rhcuinatisni ts the rliicf rauiie. At least oO 
to 60 per cent, of all cusck of acuti> rhenmatism will be ooui- 
pltcxil'.-d with emhx^arditis. It w nioro liable to (.t>m plica to 
i'liciiin:iliv-ni in the youn)j than in the old. Tlicrr- is iw n-lw- 
lion Ix'lwwii (Ik- wrvirily of the rli<-nmiiti<; diiscn^c and the 
liability u> Imirt <^>nt plication. The ^pt'Cifie fevitv, ohoitii, 
M^lJoifiiia, Hripht'n <)iNti><e, syphilU, l»lxfi?«iI(WM, iilcoholiiiun, 
aiid cxiY^ve inns^-ulnr exertion, nn- nlmt predi-S)M)siitg mn^cjt. 
It may Ih' nxip-iiilHl. It randy, if ever, results from cxiri- 
Mire to ofild ami wet. 

Pathoi/miy. — Piiet-natal endoeanlitia most comniotilv in- 
volves tlte \'alves of the left wide of the hmrl. 

l*re-Datal cjidocaixlitij^ nK«t commonly involves the valves 
uf tlie right sid« of the lieait. 
' In the exudative Ibnn the valve is red, swollen, lue 


uik) Klti<)tl«d vrith niinicrotiit Iteacl-likv n^Hlions vrhirh are 
wiKTially markfHl alouj; it.-« J'lii' niar^fiiiH. 

Tlie&e v*'yflaiiiiii^ arc ivniiimstni uf jtmltfiTakil ooniiortivt— 
(Uatie (vlU, Itu^ hii|)erlii-iat lavvn i>f wliit-ti hav« iiiidergniH; 
ixiagiilatwii-neiTdtiis, and are ciiVfited wilh mure or Iisj* flliHii 
dnnvt^l tVoia the bloix). 

Tliev may be wliipi»«I off by the bUx.^l-tiim'iii, and be 
carried as emlM>li to distant orj^aits, as ihe brain, kidney, and 
Bpleeu ; but niure (tjnitnoiily, if life is iirewrvecl, they are 
IHirtially absorbed, ami lire rcmainiMg proliferated eonnective- 
tii!6tie cells torn] fibrous ttiwiK-, ami thus wlerutjc valvulitis is 
secQixlanly iiidtict-d. 

Scifrotie ralrtUHU iiuiy iiriM.- »» n priuiuiA' disease!, and is 
cliarac-tcrized by llii<'ki-ninf;. <"irlin(r and imrkcring of the 
v«lve from nu ovcrKn.'wtli uf flb^>ll:^ lissur, wbidi is often lu^- 
MK-intcd witli iiiort- or b^ fftlty dcp.Di'ratiim of tW wll» and 
n de|Kwiti(iii of liiiw kaII:^ in tlic-ir nii<lst. 

Symptoms op Acute Kndoc-arditis. — Snbjwiivc |Jmv 
n()im-»ii are oft^i iiluieiit, and aiitutillation may funiL^b ilu; 
only iiidiiiition uf <-iid<H'aidiii!>, itainr-ly, a {iroloiijjatiiiri of 1|m> 
lKarl-:«>uiid, M'bu'ii laKr develujH into u dinlinn miiniinr. 

In many ■ni^'H fever, an in'ejtnlnr and rapid {iiilsi-, nalpita- 
lion, prmnrdial distress, and dyspmi-a uill be a!)»oriaica syiii[H 

DiAO.vfHiiK. — By signs alone. In perkanlitis, the friction- 
M>iin<) is to-aiKl-frtt, suiierficial, pcrlia|« modified by pressure 
of (he stetliou^iiK-, in't iransniitlwl much beyond the pne- 
mnlia, ainJ is flilKmed by eijins of eftii^ioti. 

I'k(KiN(ki«. — In eimple cndonuxlitis the pre^rtKeis should 
be guarded. The Iceion rarely disappears, and pcrmauent 
damage tu the valve results. l'i>der fuvorable <^^nditions, 
hoMever, coin|icii9Btor>' hy)>(.'r1ro|)jiy of tlie bt^rt nvulls, and 
good health may U- prn><'rvc<l for un iiidelitiite pi-riod. 

TB»~iT»(LST.^.\bwiltitf ir^t. Treat tht- <^iusul condition, 
M'hen the Mytnptorni' uri.' inurkcd, iipply blisters, mtlslard 
[KXiltiw-!!. leccJu'*, or iiTvbmgs In tlir pwinrdiii. 

Suppr)rt till! »yitt*'ni wilh niodi-mte du«« of quinine. When 
thr- iiuIm- w w<«k and irrejrtilar, the tincture of digitalis (•*> to 
m drMii«) will bfi of great value. If the pulse i;* rapid and 


atronjt, aoonii* may be employed instead of digitalis. Abeoi^ 
bents liki' the iodixles are of no value. Convalescence sbodld 
Ik- proldiijjwi and guarded, eo that compensat^tn- hyjiertrophy 
may n:»ult. 


Period of CompenSEttiOD. — Br oompensalion in meant an in- 
crciu«>.- ill tiii^' <\/t.' anil slrcngto of certain <^-an)iai^ chambers 
siilliiicut to t-nabk- the arterial system to rec«ve it* normal 
anioniit nf blood, iMluritlistaiHling obsLnidioa or ivgur]gitatioii 
Ml one 'ir mure of IIh' vbIvw*. 

Tlii' dimitioii of thi^ ]H'ri(>(l I* irido-lintk', and do|>rnd^ htrgvly 
(111 IIk' iiniiKiiit of il:uii:ig(- !<iiKtiiiiK'il bv till* hfart and the hy- 
gii^iic ixintlilioiiM to which the [iiilicnt in .tiibjCH'tii). 

During [M-rlivti^mjicii.-alioiiiMiilijixrtive.^ymjitom.t arc aliM.iit, 
and phy^cal sugtts indicate the (lisuiM>. 

Aortic SUtiioniM, or Aorlie OlMtrui-ttoii. 

Dbkixitios. — Olittruction to the flow of blood into t]ii> 
aorta tmin thtekeniiig or atllif^^on of the aortic H^nu-nts. 

Physical Skins, IiuixdioH. — If the heart isstrow, the 
apex-beat U foreiblc, and la not«d don-uwani aiH) to the Tell. 

Palpaiioii ntnfirms inspfviion, and sometitueB delects a sys- 
tolic tnrill at the l>aBe of the heart. 

PerrwuioR may yield an increased area of cardiac dnlneaa, 
eepecially ti> the left. 

AtuieaHation. — A systolic niiirinnr with muximnin intoiv-tlty 
in the right scc^wl intri'coslul k|»iw, ami Iran^iniltctl into both 
carotid uncn». 

Pulse. — During wrfort ooniiwnstion, the pulse f« quite 
normnl, but when Iik- heart witikcni*, it bviijmt^ Nninll and 

OoMPEXSATloN. — From obMnn-tion to the Mitfluw of bhxid, 
the left ventricle Utimii?* liyjMTtniphiai. 

S»>ieESCE. — Mitni! n-giiixitation. Weakt^ingnnd dilata- 
tion of the left veiuri<'lc prtvMilji |ioriect dwim* i>f the mitral 
oriilcv, and relative in^iiffieivtiey rt^nlt^. 



Aortic luMufAclency, or Aortic Re^rxitiitlon. 

DuKlsmoN. — Failnre of the aortic viiUt* to prevcDl r nv 
tuni of bloixl ti> tlic ventricle, from rujttnrv ur inRamntiitorv 
contmcHiuD uf tlic vrgmcnls, ur from ililMtatioii oftlift nnii»-. 

Physical Sioss. Inmii'lhn. — Apcx-lx-ut fonalitc, and 
notix) fArdownn-nnl and to llu- Id), Tlu' {tniHimlin iitiiy Uilgc. 

I\U}Httlrm. — ( 'oiillriiM iiiAjHirlinii. 

I'emiMnimx.^iufwamA arfa of (nitliiio <]iitn«<R, »t|i«ciallv' to 

Aiummllnlion. — A iliaf^lolie miimiur willi maximum inti'nsiiv 
in the right ftocimd intercyiDtal a|>ace, aiid trai)fliuill«il down tlie 
sternum and towards the ajwx. 

Pi'i^K, — The arteries, es|ie(;ialty the «irotids, hmchials, and 
radiala, pulsate visiWv, ral|)atiou deiM^tii i\w " water-hammer," 
or CSomgan's puW, i. e., a fJioH, full, and rppt-dinc [ndse. 

The extreme cartliac enlai^'ment inal<c« the i>»\^ full, and 
the prompt leiikt^' hack into tlie vetitride makes it short and 
raceditv. Kl«vation of the arm, duriti}; palpation of the radial, 
makes this pulse more nppiirptit, as the portion favors regnr- 
l^tatton. A capillury [Htlee !« :u>tiictime>' pn^-nt. Itmavbe 
noted at the n>ot of thv (intn^r-iinil l>y nn iduniatv hlusliing 
and putiii);. syiK-hroinHw with the hwirt-Iiciitn. 

CoMPKSftATioN.— Diliiiolion and hyjH'rtrfijiby of the left 
vi'tilrick'. Dilatation rwiillft from (he rc«i)tion of such n liirf^ 
qumility of hlond dririnf; diiwt'>le, mid hyperlrwjthy folium's 
(Voin till! iiK-rmstil effort whirJi (Iw! venlrii-lc must put forth 
ill ("inivlviii); it-'^-lf i>r(htH e^t^H <|ii;iiililv iif hUxul. 

'I'hb^ i-xtn-ini'ly dil.-iliil .-iiid hyjH-rtropliidl tiiiirt hs3 Iifr-n 
cidliil tho rttr fMH-inuM, or u.\-ln-arl, 

Si-xiiiKM:K, — .Milral ri-uijrf;iUitioii. 'Hte dilnlation wrid 
weakening of the ventricle prpveni [K-.rfeiH dustirc of the 
oiilral oriAce, and relative in^inRteiency rrsidtit. 

MItnil SU'noslH, or Mitral ObHiniction. 

DEFjsmox. — OtxBtnirtion to the flow of Wood thriMigh tliT" 
mitral oriScc, fiutn thidtetiiug or aclhe&iofi of tltt- nijlml 



PiiYutCAL SlOM^. Jnweelion. — Apex-beal is not mtich 
(UHpla^iMl. There is annsUiuiw bulging over the lower jwrt (if 
lh« stcraiira. 

PalpatioH. — A rmigb pnwy^oliv thrill n«ar tbo apex. 
/*«r(ruanon.^lncruie€il nnti of <hiliK«s, i-spccially to (lie 

Auacu^alton. — A pr^'iimscil, rungh, i-hnniin^ nitirnitir, 
presjTHt'ttic Id time, lit^inl tu<j»t «liKliii<-t1y u lilllo abovo iiml 
to ta« left uf the n|K'X, aix) nut tniiksniiite<i. 

Tbeeeeoml sunml ul iIh* imlmuiuir}' csriilugr ii; accciittuite<I 
from the ealai^'incnt of tlii; right vt'iitrrclc. 

PtJi.<4t^. — During the [H-ntxl uf comjicniialion the pulw is 
small and reKtiUr. 

CoMPEN'SATlox. — -FriHii iitwlnn'tiou ty Hit yutflow of blotxl 
the left auricle Ixhiimiw i-nliirgwl ; when il ictBCS |>ower, tlio 
blood acxinmnliitcK in (Ik- hiiig, and to uvon^mii' rlitK pnlmoiuiry 
resistance tlte rigltl vviitrirlc In-^mhikw hyiK-rtropIiied. 

There is nu stniiii on Ihe IHI VMilrivle, mid Ihikv tliiit eliam- 
bcr is not etihir^il, 

Sequescj^ — Tric»w|Md rogiirgitalion. UilatntiiHt t»f the 
i-ight vciHricle pnwi-iit.s jiei-fwt eWurv of the triciiA|iid orifiw, 
and fvluaivu iiMnlfiiwii<--y iv^nlts. 

Mitral ItiHiifticif-nt'y, or Mitml Ko^irjcritnlion. 

DnnxiTliiN — Imi*rfkt <l(iisiire of tlte miiml orifice from 
rupturB or inHaniiualory niuiitrnelioii of tlte mitral st^nneDts ; <ir 
fn>ni dilatation or weakening of the left, ventricle, preventing 
jierfect coaptation of normal valves. 

PHVfilCAl. SitiNS, iHeperiion. — Apcx-bcat fiirwble, and 
Ikoted downward aii<I to t)ie lef). The pnecofdia may bulge. 

Pitlpnfloa eonliniLs iiLsncetion. 

Perctugion. — IncrvaKu area of dnlnou to tlie right aud 


AuatMil^tlion,—~\ syHtolie tniimiur, with ninximnm intm- 
nty at the apex, ami lmn»iiiittei) to the left axilla sihI to the 
angle of tlie sc^ipulu. 

Pui-sE. — Dtirinn |»-riml of oompensuliuii tiormid, but very 
irregular when the lieari woakenit. 


(^lit'KSKATios. — The left iiurirk wil«rg(« fixmi (ho exlni 
amount of blooil thul it rroi-iv«-s ; wlic-ii it w«<nl«-iiK, ilie Itii)^ 
become cuiip-stcd iiml ri^^ht voiiIritMilar Iij-pertmjJiv follous. 

Tlie loft vcntnVlf »Ibo bttviiiiiii liv|HTtru])hi<'4l fniiii U» olliiii 
to iiiovf tlio lai^jt- (|iiiui(i(y of Wmxi wlikli it n-cwvfs fnnu llie 
iliifti'inli'il niivti'lc iltiriiig i-Mi'li iliiLtliili-. 

St^LtUENCE.^ — ^Trii'ii.-<|i)J n-giir^iiation. \V<iil«>niiigai)H diU* 
tatioii of lltL' riglit vetilriele itivv«iit jwriWt closure of thy Iri- 
i»i«pi<l orifiov. 

TrietiH|>iit St<>iif»NiH, or TrifiiNpid ObNtnictloii. 

This lesion is rompatBtivcly ran.-. It givcH im- to vnlurgtv 
mentof the heart aiitl a pr(«y»toliv miimtur, wliivh ts heard 
most distinctly at tlic xiplioid (tiriiliq><c. 

TrIcnsi>i(I Insufflricnry, <ir Tric-nspid 

Petinitiok. — IiHfurrfci't rliisurf of ihc lri(-ii»)>i(l orill<« 
frvim iiitlHiHiiialory Khorli'iiiii}; of tho viilvd*; or, tnore octm- 
nmnlv, from <liliilatl<>n of the right vfntriric necondanr to 
initntl or to <'lironic liiii^ cltnnuN^. 

I'liYhicAt. SirjNH. — l*'nlarji<-inent of tli« hfart ; a s^-stolio 
mtirtiHir, U<-ard mo^t diMiiully jiii^t alxive the xiuhoitl nirtiln^, 
am) a^c^xriated with pulsation of tlic jugular vein, and in bod 
caseb, with pulsatiou of the liver. 

Piilmoiiiir}' StenoKiK, or I*nImoimry OlMitriietlou. 

This ver\' rarv lesion is always congcnila), untl may be »»»• 
xrtcd wlwn a riystolic miinnur w iKiird inotst distinctly nl the 
left w-otiid intertiovtiil spocr, and iii nut ttnnsjiiittvd into the 
v<«*«'ltt of live iKtk. 

i'liliiionary litHiifHrienry, or Pulmonary 
KcfiTitrgltat I on. 

This is very ran-, nod is idways congenital. It prodiir>« a 
diastolic murmur, uhieh is heard must dLitinctly in the left 
scvuud iDtereuiilal spa«<e. 





Period of Lost CompeasatiOB.— Lost fiompensation ueually 
resulterrom: (1) lucrcasing (iamafrp to tbe valvra ; (2) senility, 
leading to arlvrinl un'l (nrdinc (loj^pnerntton ; (^) Dome intcr- 
ciirrmt dtMiuM-, tliruwing ixlditionul Astniin un die lit^rt; und 
(4) iinduf (>ln:«i'ail cx'Ttinii. 

During tfiis |HTi<iiJ Milyrt'tivc i<yiiiptoiiiM appear. Whwi the 
Imirt wiiikcstN, till iiinllcr wliiit iIk- nriginul viilviiiiir lo<iuit 
was, it iMUUinca iinaiik- Ui Rll tlit; artcrii-n, Uim) lln; liluod is 
clumnKtl iiack in tl>e Iui>g9> and venoun congestion of th« 
urgnn0 folloifs. 

Symptoms, — Pulinonan' oongestimi pixxluoes dy-ipiinra, 
Huitlinia, lia!nio|>ty!>i»>, and MtVn chronic bronchial oilarrh with 
iwiigh and o.\|>«1iirali<tn. 

Ift^potic, Htouuu-'liic, and intrstinal ci>U);<«lion jinJcKice dvfi> 
pcjxiia. lieoa] oiapxtiou produces licanty albuminoua iinne, 
and later ncphriti«. 

General vcitoHH <x)nf^<)ttio<i prodiiocs qyancwus, nnci dropsy 
whidi l)cgini§ in the fiM and niuuntH upwonls. 

t'ert'bnd amciiiin <ir ■-i;)igi:«tiun prodiKH^ Iwftdachc, vt-rtigo, 
and synoiiiul ii[(ui-I<k. 

In aorlic di^niw, f^iK^i-iaUy aortic Mwwuij', <tcn'bnil i^ym|>- 
toniM lire oll«n iuark<>d. In luitml diMea«c>, ptiloionary symp- 
toms arv ii»4uily n>ark»). 

PRixiXdsis Of CiiHdNio VAt,vi:i.AR App»x^riox8, — The 
cxiciit "f damage can never t>e aix-itratcly <lrtfniiin«I by iho 
(piulity or intensity of ibc murmnr. 

All tilings being etjual, the following i» prolwbly tlw ordor 
of gravity in the varioiiH valvular lesions: (I) Tricuspid rp- 
gtirgilation, (2) aortic rtfEurgitalion {nflen ending in Mxldcii 
df^ll)), (:t) aortic BtenoMH. (4) mitral stenosis, and (h) mitral rtt> 

The (otiowing are unfa^-orablc condition^): l-jirly lift', «d< 
vant«d years, great cardiac enlitrgemcnt, irregular tit^rl-airtioii, 
liability tit rwrurring attacfca of rbennmliiini, lad liygitiiic 
flurroundings, and symptoms of congestion of lh« lung«, kid- 
ney or dipoKtive trad. 

In proportion to the absence of these conditions, the prog- 
nosis be(!on)i> favorulilc. Tn many cases life is not materially 


TBEATiiEJiT. — Wlion «-(iiupc-ri»ilioii i« ncrfort, Uk- treat- 
nn'iit i* [nin-lv liy{ri<-iii('. 

Wlivii tlun- ii< Mitlili-n Itmrl-lailim* in valviiliir tliwAM, in- 
4]ic«lc<l by urtlii)|iiKi-ii niid lyanimi.s n>!«t lOioiild Ix- aliw>l(iU'. 
\nA 3i]>p\i<ii\'u<n!i tihoiild lie a)>|ilkH) Ut tlio ]inax>nliii, anil dil]ii- 
Mlj1i'Htimiilaiit4 iuliiiii)iflt«n'<l hyjMxteriuiaally : itpiribt wf uni- 
inoiiia (UtK-W miiiiiii!)), wliixkey (>'t<MJO niininLs), tKiljthaU* 
of sirypliiiia (gr. j'j, rejieatwl one* or twice), niid i?<}Hx-iu)ly 
iiilro-glywriiie (1-2 drop;- of oik> per <^nl. alciiliolic »K>Uili(>») 
may !«■ so eniployed ; i1k' liiel, in uddition ut Ijciiig a Iii^lily 
difTticible ^tiniiiiunt, lnis tin- power of diliitiiif!; iti*- lu'riplicnil 
bltHxtvcKSolB. Vctwseaion (10-^0 uutirvii) is »f ^xtrcniu vuliiv 
iu thcfie caaee. 

"tt'beu compnaatloii i» ttradnidiy lost, rpfit, a liglit, »ulritioii» 
diet, and tim-t. (li):'Ft:ilis (10-20 droji* tlirreorfimr liinrtiitaily) 
are lb<r mu-it i[ii)><>rt:iiit tbcriipoiiliv iiica^Tii ■*('». TiiU't. slmphlii- 
ibiis fMiiictimes MK-cLTil*' ubcn di);ilaliK failirv ^lild laxativCiS 
sucb as tnassa liydniriiryri (pr. 3-6), givally liifltKnoe the 
alwwrplioo of digitalis. When Ihcn: ih moderate dropsy the 
following j)ill » vny r&'wivtil : — 

^ Miini. li^-ilmrjD'ri. 

I'lilv. iliiiJliiUs, 

IHiIv. ttcillw, tl& gr. xsiv.— M, 
Ft. in pit No. xxlv. 
Si^-One pill UiHlii daily. 

SirycJinine is often a valitabic ndjtincr lo diRilalitsOfipecially 
vtlien tbcrtt art- itiditBtronK ijf fally dt-gcm-nilion uf iltc h«irl. 
Wlii^n rlti-11- ix imii'miii, inm U iiidicaliil, inid it iiuiy be given 
wilti digil»li.-i iiixl Htryt'hniiKr, a^ in tbt- Jidlowiit^r pill :— 

9 Strvctiuiu. Hulpli., gt. J ; 
I'ulv. digitalia, 
Fcrri e»ib.. Ut gr. xxx.— M. 
Ft. In ]^1. V<h XXX. 
Kg.— On« pill thrice daily. 

Wlu-ri tlifix! is mitcb bruncbitis and dyspiHra, digitalis witr 
fimmonia and licni'gH \< an flliricnl combinuiion. (liartow.) 
Wbcn ilvitpixixi is niarl«-<l atid ili« pnlse in strong, nilm- 
glyis-vim- (1-2 dntjw lbri<v daily, tir gr. j4j tlirioe cUiily), if 
vrcll l>orii<-, tniy be of mncli ecrvicc, Iu extreme dm))6y 



fre? mtliarAk <t)t<)i(lil Vh^ indiKtxl liy oitin|Htiiii<l jaI»{i jNiwder 
(|ir. XX— XXX), or a liiixitiilmifl siihitioit i>f KjL4i>m KitU (|s»), 
and iliiiivsiii i-Hlabltntitil bv dto inl'iiflioii of ili^lalin (fa «s-f3J, 
tlirioe dailv). In )H.'niUufiil atiasarca, as|uration of serouii sans 
anil puiicUire of tin? \ef^ may \ic. rp4]iiir«l. 

Wfat-n there is excessive hypertropliy, irulitnled by prwoor- 
ilial ili!slrv?w and a full, rejuitiir iiiiIbc, without drG|»6y, aconite 
ID sntull doses will prove effidcDl, 


(Malignant ZlD4ocardltU. ) 

DBPI.vrnoN. — A rapi<fly-il(Slnirtiv« form of endixurdilw 
dtaractcrriu^ bv uwripii:* or uli^u-alioii of the viiiv<-J> and tlie 
dcpiMilion of wilonira of luiiixHiKvi, 

KTKJUKtv.— It may Ix^tn as » nriniary discsw, or b<^ 
m(rraft«l onasiinplt" cndomrdiliis. It may result iii the de- 
bilitated from overwork or exposure ; it Bomelimes eomplicatce 
tbi' uuerpcrium ; it (^uerally follows se]>ti(ti>ni>H or ot»e of the 
spnrific (own — Midi as pu(!iitii«uia, ei-ysipelaa, und starlet 

PatUOI/Xjy. — The viilves are the !«at of «lcrn«, deep ab- 
Mwwe*, and sofi, yellowish vc^Hatioits, u-hich have uiiderpoiK* 
(Wriial iMWTiMitf. Mkni^iugtic oxuminulJon nrvmlH myrinds of 

.Symptojcr. I. Gnurai. — lilf^i tutA inr^ilar fcv«r, re- 
pealed cbilbi, pri>rii-i- Hwi'al'', i;reiil pnnlralion, often delirium 
and fltii[M>r, liurriiil brt-ailiinir, nipid irrt^^^iibr piil.'«c, briiwii 
6.'<8iin-d tonjrtie. .latnidiiv and dinrrlio'ii an- ftitjiHiilly pitt^i-nl, 

2. (hi-diiii' St/it>fifoim. — i'rseix)rdial j>ain, )uilpilatiuti, bihI 
ofl«o a lilowinir munnar at one or more uf the \'alveei. Miii- 
miirs may be aWnt. 

.'J. Emffolic Sffmoloiiu. — Peri|iheral endwli yield a |)«teeliial 
rash; renrO eiiirKiHsni may yield bloody iiriue; splenio cm- 
Ixtlivn) may yield a pattifnl spleen ; «-rebral embolisiu may 
yield [(araly-*!?. 

DlAHXiwis. — Is often difficult. 

Mfnin^lti», — Ciirdiac eympt*>inH, high fever, proAiBO awottts, 
and chills will inuully separate it frum meningitis. 


7)/piiim{ Ftmr. — Abni[rt onttet, <sTxIiaF symptoms, embolic 
symptoms, ifvn-itlit, i'hilli, and thr »h(H.iK-c of an abtlominal 
row-ooloivl rasli will M:-]>anit<> it from typtioid fever. 

}ffili'rl<ti Frtfi: — In «ndiM»nlilts llu; jiliiMMiodinm mnlariai 
iii not li>«in<l in the IiIikmI. 

l'i»KiN<jNtR. — AlnxiHt iiivsrialily filial, Puimtion is from a 
fi>w liny* to several wwfks, 

Trkatment. — loe-bags to tlu> li<art. Liglit mitritioits diet. 


Depikitk»n. — Aeiite infiammation of the boart muscle. 

EtioIjOGY, — It ia almost always aeraiulary to et>dooirdittH 
or to pericardiliii. As a primary affection of iho b»irt, it 
may be due to rhoumatisni, or to one of tlie infectious fevers. 

Patiioijmjy, — The mii«'lc suhiflancc w pale, flabby, and 
friable. Microscopic cxuniiruition rcvoils fall)' dcKciKTatioo 
uf the iiinscic Rbrcn ami on infillmtioii »f tlK^ oonnrotivv tis- 
mie with Kimirytcft. 

Symptoms, — Tlic pyinptonw an' oflcn masked by the pri- 
mary diivaM^. Dyxpnn'n, pmiiirdinl imiii »n<i dit>lrct<ri, a W(«k, 
very rnpid^ miuilj, ami im'^uUir piiL-N-, » iii'Ui; impiiW, aikd 
wink jomiMl.t not^gfsr ihi^ conditiim. 

Tkkatmkxt. — AliexilDte rc^r, and the wfte of cardiac Htiniu- 
Ianl8, like .ttryclinta, caffeine, digitalis, and atoohoL 


(Myo-deeenaatlon of the Henit, Cbroolo Mjrooardltia. Indiuated 

t^Kii/HiY. — ^This ninditjoo is dvjM-iidcnt upon atheroma or 
sclerous of the roronarv arteries. The iiidinN-t miiws are 
rheumatistD, gout, syphilia, aloobcJism, endovardiliM and [teri- 

rATiiin/KtY. — The Ii«irt is itwially hy|>i^nmphicd or 
diluu-d, and i^ the scat of pray ("d -white imtotH-s, wliicli repre- 
sent oveiprnwii cuniioctivi- ti««i«. The papillari.- niu.'<cli», 


ooliimnif curtK-tp, un<) thr whII uf tho left vvntrk-lv nnr tJic 
apcJC nre i)k- ptrts mu»I frwiuvotty alToctvtl, 

Artvrinl K'lurueis cutism uet-nwi«, and tltiK iu Uini iis folluwcd 
bv n prolift-nilion uf tliw rwiiwrtivc ttwiii'. 

The fitjiMKi ar<^ft» )iomctiin«* vii-lii to tltc iiKlocnnliuI prc»- 
eure Mw\ tiiitMo niu-iinr>iii "f tin- Ih-miI. 

SvMPTOM.'i. — [l numiri^tn the Miiitr )tyiii|iU>iii]t ax fully dc- 
fri-iieruliun, viz: cly.sjiiwm, ntitg^, w<-ak ami irregular jmiI^, 
jialpitatioii, aitginoid |miiHi, diy>[i«)y, etc. 

TBj:.iTUh:NT. — Same as iu (ally henrt. 


DfiPDnnoN. — Eolarg«tnent of (he heart due to an over- 
growlb of its louscle. 

Etiolocy. — ft always rranlts from incrtaiwd work, and 
Ihis may Im dito to : (1) Too mucli blood to be moved from 
tbp heart.. a» in the refriii^'tnnl valviihir Icsiomt. {'2) OlietnK'- 
tion to tbr <mtfluw of blood at ihp vnlvw, in> m ibe itttncww* ; or 
in tin- piilmoniiry or the isyntrinic circulation, as in cm phy si.-ma 
and Brtgiil'i^ dii<(au!c. (3) Kutistaiiix In vt-utricular (t>ntnu> 
tion by (wricnrdial ndlMsion^ (4) 1':xIim> physical c^ccrttori 
long <<i*iitiiiu<^. (!>) Dbtiirhcd inn<>rvHti(in from dnt)^ »uch 
m t(i)ia(x-o ; or from din'aw^, ax exoplilbnbiiii- fjoiire. 

\'ARlfrrtJ>, — (I) Siai/tU fit/fiirfriiphtf. 'IliiL-kpHrtl muM-lc 
and i-aviilta of normal nizt. (2) I'W^ilrie ht/fierirojihg I hy|)i-r- 
trc)[4iy with dilatation). Tbiokencd moBt'Ic and ravilies di- 
latM. (^) (iHivd/Wff hgpertrophj/. Thickened muscle and 
i^vitiefldiminisbed in pixe. Always oonjiicDital. 

PathoIjOOY. — The averago weight of tiie normal heart is 
ei|^it (If nine ounc»; in hypertn^pby it may weigh two or 
threo tiueH as mncji. One or \mlU diumlKrv may lie enbirgnl ; 
llie left is the one most commonly afTi^ctctl. The mniwlc in 
6nn and of adm-p n^ color. Hii^ologically tliv niuwlv-v^lc- 
mciits art' iocn-a^-d inxixvand number. 

Symptoms, — Unb^ the by|"-rtropby is more tluin comiK-n- 
intory no CT-mpl'itiw n^iill. Kxlrcim- by|«-rtn)jihy i« indiuitcd 
by prsconlial iliHtn?«, imltiilalinn, a strong jmliii?, and M>me< 
timea by the pbcnomena of cvreliral liy|)cramiia, viz : fliii^btil 



tm-e, rinjpii); in Ok vurs ftnsbts of Itglit. hcndaehc, nnd 
tiir1»d s](v\i. 

i*tn"HicAi.Si(ixs. In»]>rtiiiiti. — Fneotnlial iitilj^n^. For- 
t^iUIc imptiW. The a)K!X-l>c«i in t)is|ita(Kil iIowiiuKril iind to 
the loH. 

I'alpalinH. — A limving inipiiW, 

Pereummx. — Ii)ci<(!Ils<hT ftn?n nf <<nnliar ctulnef^ 

AMiiniHntitm, — Soiiiid-t are ciull ai»d lond. 

Swiinu^t:. — Aixnili'xv, Ikttv rft-jteucraiiou of llie heart aiHt 
aii))s(><)iH?i)i()ilaIatHin, valviilardU(».'ie,nn(lartenald^iKratin)). 

DlMitiiifilii.—IImHttrojtiiii and ditatfitiou. TItese two con- 
<litiDns ari'oommonly associatwl. but the prcpoiidemiKc of di- 
latation will be iiMJitsicd by a tvfblo fliittcritig ini|>u1ee, weak 
«(Hiads, a vicak, insular, or inlennittrot pitlec, and bj- s^-inp- 
tomx of hcart'failiirir, »it(-]) as dvtipixru, (Irofiey, etc. 

Treatmum". — When tb<* byiwrtrophv 'n- cxcrseive, rooont- 

iwnd (•iiidmitrdt'XMxiw aiidalitilit di^t. iind ciniiKiysiidi stila-j 

tivt^s a* liiii-tiiiv of acwiiitf; (j;tt, j-ij thrice daily) or linvtiin- of] 

vi-rntriim viridc (gtt. j-tj). 

Thv )>roiui<k« arv oftc-ii vuluablu 


r>>»'tNiT[<)N. — Kulargcment of the lieart due to Rtretohlng;' 
of tie walU. 

VAitiETihS, — fl) Bilatatioo with thicketiinc of tin- walls 
((fwolrii- hyjH'rtrophy), atid (2) I>iln(Hliori with thinning of 
the walU. 

Ktioi^igy.— Dilutaliun rv«ult« front ox<M.i«ivc endocardial 
]>nw«iiro, U8 in sudden t-xtrcnK- vxvrtion und in ndvuW disease, 
nnd (2) ImgiairtHi iiiilrition of the cardiiu- mtisclr, a« in low 
fevfiv, valvular dts<ifw, and ulbrmnia of tli<- coronary arlerioK. 

I'ATiioi^iV. — (>K' or l«>lh ehutnlH-n< nifty U' dtla(«d j the 
right tx t he orw most eouinioniy alK-clifi. The iiMtditiun \s nsii- 
utty aewoiHted ivilh hypiM-lro|jliy and fatly ikgenetalion. The I 
iuut>rle may be iiurnml in iipiMitreiMv, biit vcf>' frv<|U«nlly it i» 
jMile timl tiiift. 

SYMfnuis. — Si long a.s the iiA^ociatt^l hyi>i;rtnii>hy !<«<![»' 
\mv with ihodilntalion, no >tvm|>toni--< n^ult ; hut when dila- 
tation [iiviHimleratni, llie following ttyni{ttoin» of venous! 




stasi" «]tin'«r : ilj-»iiii<rji, wiigh, dwiJOiMia, scanty arioe, dropsy, 
»ii<l II fiflilf, inr-jtiiliir (iiiIm'. 

[)ii<tiiriK'«l iniK-rvuliMi often cuiimm pnroonliul distress and 

PllVftU'Ai. SiGOT, — AjK-x-U-at ii^ diflfuM' and weak ; it may 
\») vUible mid vol not {uilimlilv (WiiUhc). Winn (he right 
heart ts iDvolvitl ait iuipulnc a noted lx.'luw tlic xiphoid mrti- 

I'ulpaiion. — A dilTiise, frehle, and niittcriii)! imnul^w. 

/'ft-ri(jw/i»i. — Th«! area of dnln^^Ki is im-niv'cu, C!*|H-ciully 

AtuaMatitm. — ^Tlio fioiindu are weak and «haqi. 'I'hc Kr^t 
sifiind leees ita miiMidar clonicnt and ret^frniltlea the mmwicI. 
Co-Psis4ing valvular Itsions induce niurmiirB, 

DiACiF><»;iK. — Ptrienniial eg'unitni. In this oondition a f^i^^- 
tinn-«oiind is frrancntlv nnecnt ; tltc outline of diihie^ is py- 
rifonn witli the luise beloiv, and is not nearly sti hroad as in 
djintntion ; and the sonmk are dlstanl and muffled ; aiid the 
ajK-x-bcat is dii^placcd ii|>M'ards. 

TiiEATMENT. — Hcst. Light und ntitnlioiiK dit-t. Jmpmve 
tlie general c-Dndtlion by carrftil liygi<-iito rt-gidntiuni^, aiMl thu 
use of Hueh tntiitsDif iivii, qiitiiiiio, ]in<c-ni<', and thv lil<o. Oir- 
diac tonics, a» d!git»ti<(, ^lUfcinc, Mrtiphaiitlitis, aiu] ^Iryoluiia, 
are imlicatnl. 

In «iiiddi-ii diliil.-ilion, ii.-«- dilliisible siiniiilaiilH, a^ hrancly, 
amnioiitii, slrji'hnia, hyiKJdcnijically. 


DpflNlTlos. — The term (Jitly heart l« applieil to (I) fatly 
inRItraliiin, in wliii-li an nhtumnal amount of fat is de|H>cji(e«l in 
iiiitl upon llif in'art ■ and (2) In fatty dejrmeratioD, in wliit-h 
lh<^ tanliat^ mtist^U: has ixxn nu'tan)or^>ho»ed into fat. 

Fntty liinifr»flon. 

EtioijOGV. — 1( i* a jiarl of gentral ohesity, and hcn<*> re- 
sults frvni an h^'ii-<iilary K-ndene)', a rich diet, and M-denltry 




PatiioijIhiv. — lliK heart may lie n»ni|r]etclr inilx^dHl iu 
fat, thi> aninvo^ nUitig iitf lai^r t)ltHMlrci»trlH hcin)i; Invorilc 
twatttof ueiMjciit. Fat m aim found lielntcji rli« musple (il>iv§, 
nlllio4igii tilt- latl«r may be- (K>rf(x;t1y iinnnal. 

Sv-MiTtiMs, — Slioniiesfi iif bn'ati) incrcaswl l>y excnkm, a 
vitiik inil it^'tilar jiiileo, pneoordial dUtrci*, alomlciw^- to piil- 
Tiioiiar>- iiiiiy;<'fltit>n, witJi a rasulliug olwtioate broncfaitta, and 
ttliiggiji di^^liiin. 

via M f S(W1H, — Favorable. 

Tkkatm K.NT,— A rejcnlatod diet, in which the ubc of fats, 
fltaroiies, am] eiig:urs is iwtrictcd. Gradiiiitwl oxerciH-. Th« 
Tnrkinh luith iiitdcr eu|>cr\-i'<iun. Ileuii tutiice, like digitalis 
aud )4(i'yehiiia, nil' trunR'tiiiics i»di<.iit<.<d. 

I'lilty I><'KoiK'rat Ion of the lloiirt. 

Etioi^kiy. — (1) It fo1l'»ws liyiHTtropby in vnlviibr di^wM'. 
(2) It is fr<t|iK'iilly diir Ii> ii(ln-rrniia ■>!" lb*- n-nioaiv artery. 
(A) It iif II <-(>iiii[i<»i n-Miilt of iiudniilriliiiii fmtii nKI a^, waiit- 
iug dintitM-, <ir ami-iDUi. {-1)- It h luvUH'iult-d uitli lan-iiehyina- 
t4iH.-< dc^-noratiiiii in tbe inle<-liiiti!4 li'ven^. (•>) It results from 
miiH-ral |ioL4»nin^, as by ai^onie, antimony, [Hiti>it»bor(ia. 

Hatiioi^miv, — The muscle is pale, soft, ami flabby, aiwl 
iiylH jtreaay tt) ibo band. M inxjstiiiiie examination rcv«ils a 
iIi'lHNittioii of gmaiilar fat in tbe niusclo-libres, 

.Sy«PTi»is.^\Vhen tjw? ctmditiou is markc?d, it is l■^ln^M^- 
leriTed bv all tin? syniptonts of heart- failure, namely, dy*- 
pncMi, aHtliiiia, eough, s weak, irrtRular )>nW, nJm-b nmy l»e 
ignite- rapid or imii)Mt»l1y clon-, |Kxir dr^i>lion, wmk hrart- 
«)Und9, a Iwtile aju-x-lR'at, tlropy, uttju^ks of M'n<n>|N', and, 
near the end. < 'lH-ym'-Stok''s liixiithing. 

I>iMnrlNil iniH'i^alioo olli-ii <iiiimi< judpitation, (treecnrdiat 
ilii5ln>.*, and attwkn of aii(:in:i ("tiori*. 

Tliavmay lie n-t-iiB-iulHl <-videnoe!< of atheroma, namely,] 
ri^id nrtiTies, and in tiin eorueji, a Ihlty areiB Henilio. i 

FiMKJNdfiiR. — Unfavorable. Death may occur siiddeuly otii 
»li|;lil exertion. I 

Thkatmkst. — litM of miiKl and bo<ly. \ (im-fnlly-rotrii-- 
jalcd diet, which t4)<>id<I lie lij^ht but nntrilion». Iron,, 



tj^iiiniDc, iiinl iirvi>.nk' an? somctitoM intlical^tl. In tliio <yiiidt- 
tion slrjfhtiiu (gr. ^g-j^j llirire dailv) is often of great vnliio. 
NitriKglyiiji-iuc (gr. jj, or one Dtinim of the (in« i«v (-eiil. 
tbricr daily) may relk-vt Uk- dl&trpesinia: sytn[>i<>Hi.< Ki^ln>«- 
at^<s, imiiimliiil <1hiix>^, and inHnmnta nill t^ill fur itiiirjthitt. 
In angina, h<il a|i|ili<-.iliiiiis fllionld Ix- ;i]i)<]i(-il lo ili<- iirnHMr- 
dia, and nitrite of ariiyl admin i.-liTCMl t>y iidtalaiion. 


(Renralgla <rf tlM He«rt, Stenocaidl*.) 

Dwixmox, — A inaroxviinial alVcclion oharadttriecH] by 
!M>Vt>re iKiin radintiiig from iIk- liearT t« ibo »^liiiiiI<)or, tlience 
down tlic arm ; liy gri?at imxicty, and lixatioii of the hiuly, mid 
apparently dqieudcnl upon some l»ioii of the cardiac arteries, 
w^lf, or valves. 

Ktiui.o<iy. — )Iiile H-\ an<l middle lifi> are gt'nemlly prcdis- 

i toeing facionf. SypliiliK, rlinimiUiism, p>iit. nltvtlKilifm, and 
trijrlii's diK-.iM' niiiy k-mi l*> it l»y indm^iii^ ntlifromii of the 
cortmar)* ii it cries. 

The attai^'kit may oonu- <>n wilhont jiniVfKmtion, init («(ing 
and exnteiuvnl, unntionnl or phyHtutl, iisnully imlura: ilx-ni. 
In «oiiH' inKtnncCi' tiic {oiit ap{M-iirH during ^li-i-^i. 

I*ATiioijx!Y. — AltH.-Mmm of tin- eoninary arii-iy, fany di.- 
genenilion of iIh- Iii-nrt, bimI valvular Ikbioua aii' tlw onmliiioiiH 
ttsnally liuind afwr deatii. Their relation to angina Ls ntill a 
niulli'r of iimjii-lnre. 

In i^ux- ii)Mimto?«i, the ooudititm m probably a pure neurosis, 
for no kt>ii>n» are lound. 

SVMITOUH. -Si'vere iiain radiat!i% fi\>m the pnecnrdia to 
the left HhonMii- and thence down Inearm. A sensation of 
tingling utien aoii.m|>anii-s Iho )niin, Tliere ii^ ureal anxiety, 
a fear i>f appnuidiin;; d<-ath. and fixation of tlic liody. The 
tfl(i< iH]>aU' or livid, and thobmw Itaihed insucat, [>yspna?a 
» often noted, and the puU' is variable, being ti«nally tense and 
n|>i(l. Tlie duration of the attack is from u few )«mnils to 
aeverai mimitC'A. 

IijAo-Vfisis, finMrtiltjin, — The pain dofs not mcltale (<i 
the sltonldcr and llieiiir- down iIm; ann ; tliere i;< no fmr uf 




»|)|>rnnchin^ death, and no ftsnlion of the body ; (ht- ultiivit 
i»(uilly ujijiearv wltpii tho stomuich ib ^mjity; then- is non'i- 
"ii'iHv of orpnnic liwirt <li«.ii«.'. 

IW»ihi-<tiujinit, lit- H^tin-'u-nl Antfina. — Tliii* iifli\-tioit wvun 
cliifHy in woiiM-n nf « iinircrtir t<-tn|H'nimiiit; ic iinii»'wi»twl 
ivilti oiyiinif licnrt diM-u»)'; tigiially wivin> lit niglil ; nirtly 
imtiKTS RiEiUioii of Uii> body ; i» of lonp-r <liinilii>ii than (ruv 
nnciiia; and U WWiM'iutn) with oniotionu) rxnli-tni-nl. 

I'Roosn«iR, — (inivv. SmUk-ii rUiilIi is lo In- t-xjiwitHl. 

Tlio <li:mii<>n is ••i\r» \tinp, mid in iumir iii-'iliintfn nitiv^ry 
I'ollriKii. The j)rti^nii.?in i.i inoK- t'aviirtililc when ihi- lunixyKniii 
an> mild, iiirr<i|iicMl, iina.'^4i>ciat(d wilti organic Icsiott^, and 
broii);lit on by <?x<'rli<in. 

Trkatmknt. T/ir AU*i^t. — Iittuilalion nf nilrit« of aniyl 
(a few dm{ifl on a hamlktrdiier) and bol afiidiralion-i to tin- 
jirwooidia. If |>romj>t rcliof does not fullow, ({ivfi niilphatt? of 
niorpliia (gr. J) with liiilphale of atn^pine (gr. j{ji) bypodcr- 

The Inltreal. — Rwtt of l>ody ami mind. A rtirffully-r^u- 
lateii diti, which should tw light hut nutritious. 

Iodide of ]>olaa§iuin (gr. x thri<f <laity) over a hag course 
liaH been hi|;hly rctx>nimondi-d. 

Nitroglycerine (gr. ^j to A) wht-n wfli borne Is Bome- 
tinKv cxlrtiiK-ly iiwful in wnniing off ibcuttiioks. I'at>Gflt& 
may be (tnividtd witJi ghiis* aiiHitlcs of nitrite of amy], 
(ii-iH-ral toniu*, lik«^' strychnia, iron, nixl ur^-nic, arc oncn jndi- 1 


I>KnNrTl(>s. — .\ rilvnntiii'rilMd dil»lntion of the aorta. 

i-lTtni/Mjv.- The mall- s<-x, iniildio liii-, and hilHirimm work 
an' goneml |iiv<lii^|)iHing tiwrliH-w. TIk- i-oiutilioiin whii-li hiid 
li> arterial d4?gon«niti<tn, like eyphiliH, rheumaliiui], gout, and 
aI(^>holigin, are itoteot predisfioning cniiBcs. 

Stiddcn exertion Is ronimnnly the extiting caime. 

PaTIIOI^iv. — Anctirisuis are dividcti iirronling In BlHl|)a1 
int" llif fii»ifi>nn, •!i(i'ii1:ir. ami oyliwlriwil forms. When all 
the arterial tunit-M huv<- yiilded, the dilatation is tcrmi-d a true : 


aneurism ; wbeii llu! iiilcnial (unio alone hm riiptumi, anU 
blcMxl has Kcvjied l>ctween tb« lavcrti, it is tenuml a falm or 
d!ijfiecting ane«irism. 

A tmo aneurism is fx>tnp(ii!«tl (1) of an cxu-nml oraflviii- 
t!ttons sac uhieli nwiiltt^ frum intbiinnmtion un<l cntKli'iiHiilion 
of the mtrmuiiiJiDg ^'oniKClivc tissue; (2) uf uiio or more of 
tlietlccenvrated coeiiif of the vessel ; aiul (3) of n do4, wtiivli i« 
often nrni nti<l laminatf?*!. 

Thv nrcti of l)ip aorta iif tiw most rikmnion maI. Abotit t4>n 
[)cr ocut. ofaortio unourisuis urc iiUloiiiIiml. 

Thoracic Aneurism. 

pM\*an:Al.SiONe. lanjHvfloH. — This often detects an abfior- 
miil iiromiiiefK-e and puliation in the (ip|>er sternal rri;ion. 

Dilatation of the suiierfM-ial veins may also be noted, and 
in advanced cases the skin over the prutuincncc may be red 
and t;;los8y. 

P'tfpcmon, — ^This often dvtrcis an expansile pulsation and 
a sviftolic thrill. 

if ihv criooitl cartilage is |^nL<|>ed bctK-eiii IIh- lin)^>ni and 
thumb, and dniwn iipwuril;<', » pulwtion or tng may Im- tnitis- 
miltnl to the Inwlicu. 

I't/vtuvuin. — 'I'hi*! iKTnMonally rcvuils ciroiinnHTiiietl diil- 
iii'.tH and iiii'n'iL'M'd'C. 

AuJsrulliiIuin. — If the «'lot i» iiut too lnT?.', ihfi tur may 
detect a systolic bniil or mnriiinr. Aocenltiation of llie h«irt- 
.'jioiiiidit til oft^ii noted. 

f'utit. — TIm^ pidsc ill i>no rmlial may be dtdayt^, and dimin- 
ished in volniiw fnira llif diRiiMoti or s[>endiri; of llx- ciinx-nl 
within the Hat;, or fri>ni the partial lavliifiion of the arterial 

SvurroMs. — DyspnoKi results from pressiipe upon th« 
traohea, bitHKhJ, or recurrent laryn^i'sd nerve, the laM rausing 
s))*sm or ]Hirali|-sis of the vih^I eord;^. CViiigli is rarely absent, 
and when due (o sjiastH of the vocul fords il is of a mctttllic, 
Imrkin^ cluiracli-r. 

Pain fnx|iicnlly n'sMdlx from prcMiirc on Uic Ikhik — rer- 
tcbne and stcniiim, or from irrilalion of nciglilMtnng ncrv(«. 


niUitAtton or lYmtraotion of ouo pupil mnv iwnill TrriTn p 
MiriMiii tli(- <wn'i<»l n\-iii|iniiii-lii-, nii<) uiiiliiit-nil .'<n'i.'iiiiit):iirili>! 
fiii^' U ^iiiiHinii'S imiiici'd liy iln- siimi> i-aiisi-. 

I>iniciitl. eu'iillowiiit; (ilv.->{i)iii^>Ia) rt^tilt.s fn»a pn'stitin; >m 
tiK- (i^(i|ilingiii<; and uilatalion nl' llm .lUiiGrtiWiil veirix, cvaniv* 
»ii>, and lot^al iLdcuia uiav rvsull fnnu prctistiro ujton tlic dti-)*- 
M?at«d veina. 

l>iAti XOKIK.^ — A Hoflil luiitor may vietd ii irniixtDilU-il |»i)i<i- 
tiiiii nnd »<imiil3«' aiK-iinHnt, hiit in \\u- fnniii-r iIk- ptiUittioii la 
ii)> am) dou'ii, noc cxiianf^ilc, (lie iii)|ifti-t itt Kss |>n>it>itii)i>tl, 
tlie bruit is ii§utillv «!»«»(, the heart-WHiiid.-* an not iwiv-iiLti- 
ated, tltore is do traclieal tug, simI the lioalili is fretH^mlly more 

rnturilinff f-'mpjfmia, — A left-Bid<Ml |uirn1«nt cflii8i<iii may 
ti-niiftmit a cardiuc piilNili'Mi, IhiI tin- latter is niK ex)>;ili!«ilc, 
the dtilii<-»i ix <lIirii>M.'. iIk- bniit is abeeiil, und the hifltory will 
ptiKKwst ])h'iiri*;y. 

.lit rj-iKtiiiid- aorfa inay simulate anetirlstn. Tliis cuntli- 
t!<jii iiMiiiilly iMx-ure in wutncn of a UMirotic (eni|ioRiiDent, mid 
liwtis i1k- hriiil and |irc«Hitrc'Sym]it<>ni». 

Pk(x;s<isi8. — Aiwayji f^nivc. The avciiifp- diinition ic from 
(tnv to iw\> yt-wrs. IX-atli may ixinilt (l| from riipltirr rxter- 
nally, or iiiti'nially into l)i<! |M-ricwixliiiiit, hrfirt, iiUnnid vac, 
UntfK-Ui, lung, nr o~«)|iltagus; (2) frum <-\l]aiii>(i<>i) ; (3) fmm 
liearl-fiiiliire, (iir somi-tiiiti'^t tla- aueiiriajii dilalLit Ihu aortic ori- 
fice aiul thereby eaiiM^ aoHtc iiLiuHicieiiey, 

TiEKATM t:.vT. — iletihanical treiitniiiit by litialion of distal 
arteries, aeupu net lire, and elwtndy.'iis, has iw)t oidy been iin- 
sattaftetory, but has often shortened life. 

The treatment eummoidy employed is a niodilinition of 
Tiifnell's methud. and wmsisis in alKroluie rest in Utl lor fmm 
eipht to twelve woekn, with a diy diet, aud the adminir^t ration 
ui io<l(dc of putuwiiim, wtitt'h ik iisrd empirically in doN<9 ut' 
ten to twenty ^ratn*. thrice daily. When the pulse 1* very 
ittruni:, iiiiiri Hihilivf.s like luxiiiile nml vrralrum viridi' may 
In- a(lnuniT<l<'i-eil, or ienir«e"-t4on ejinliwwly praetiMtl. I'siiu is 
olliii IctDpiir.irily relieved by ihe iixliile, Imt when it i« seven.' 
an iee-tKig may be applii^l locally aimI tnor[^iia given ))y|>od(;i'> 



Ailciirbtiu of the AtMlomLiial Aoi-tii. 

Sfot.—ll in mtimi rn.-<|ii<-rilly locntitl ikot tlie rxeliar axis. 

Symitomh. — Ii Hiav III- rrtt^niKul bv shaip pain in the 
liai-k, riuiiiUiiij: ulmii; llio s|>iiial rn'rvf-s nn*' iii<rea.*'d bv eat- 
ing and <lri«kiiij:, tiv a <!ila_v in lln- fi-iimral j>nl-*-, liy ca«iv- 
in1<?sliiial t-y in plunia:, and by itliymcal s\gas> similar to thoHe ut' 
thuracic aueurifim. 

DlA(iXiKls. — Ah tiMmi\iHiil rtinrrr may iWeivR n |iiilHatiim 
fnini tlic niirtn, uml >iiiii)Iaiit attiiiriMU, but in llio TornK-r, jml- 
.■tation U not i,-.\[nin.->ik', aw] i-i rre'{iii'nlly li^nt mIu'd i)ii^ {laliint 
i.4 |iliii^il in iIk- kn<i-bi-casl [Hiniun-; and llk-rt- is givalor 
ca<'ii4'jcia, and (rnstix^inretdinal aintnrliancL'. 

'J'he pulatittM/ QOfta «/ na-votm u-omcu may simulate aneti- 
risui, but then: are no i>rc-!eure-^ynipIom8, ordiEtim-t tumor, 
nnd it i« iu tiK sex in wliich abdominal aiwurisms iirc very un- 

PiciMJNusis. — Vciy gmve. IV-atii usually rpsulls from 

I'ltKATMeNT. — Saniv a^ in tiionu.-ic iimtiriKni. Compression 
of till' uurta, llic (Milii'iil having bc<-n miHWt Infixed, has given 
good roil It K. 


(Atbntottta. Onll and Sutton'* DlMsoce.) 

DKriMTtDN. — A thii-kt-ning of ll»? arteriw dno tn an ovcr- 
f^rowth of inniM'L-live tinsue, a.'utociat«d with mure or loM iiitty 
ileKeneration and ralcifiratioii. 

ExioijiMiv. — Old age, goiit, rhwimatiimi, altuholtani, Kyiih- 
ilis, lead-jHtiHoning, nephrilin, and lal>orious work aix- jirtili.— 
|H>6in^ causes, 

PatihiUhjv. — TIk artpjics are thickened, tortiioii», and 
rigid. The intiina reveals roughened and opaque an-as, whi<-h 
are often the scat of calcareims dcpopils. In extreme taw-i* 
there may he sjkiIs of necrotic M>Aening in tJ>e Buhcodotlx'liiil 
tisane, forming "atheromatous abscfsscs." M icrfjptcopic t-x- 
amitiation showii more or kf-s laity dc;^'ncration of the diiU'Dtnt 
vuatH, sml an ovei^rowth of coniiedive lissiie in the iiitiraa. 


Syhptou^. — Ri^dity of the |>eripfaeral vessels ; a slu^psb, 
high-tcasion pulse; acccntuatiun of the second aortic souikI, 
and hypertrophy nf the left ventricle. 

Seqiiei.£. — Cerebral cnngestion, apoplexy, angina pectoris, 
aneurism, interstitial nephritid, gangrene of the extrpmities. 

Treatment. — A careful regulation of the habits, clothing, 
and diet. Stimulants must be avoided. Iodide of potsHsium 
(^. V thrioe daily) has been recommended for its absorbent 
enecA. Nitroglycerine is sometimes valuable in overooming 
tbe high arterial tension. 


or TUK 



The Bod Hue. — A hom- wlik-h h \wrmanent\y and iini- 
fonaly rvt\ ^iicniliy iiitlimtnt uk-uholiiim or aaie roaaom. A 
none wtiicli Is peraiaiK-iitlv red mid nwulk-n at tbe extreniilira, 
and has a UroaduiK'd bridge, iudictsUCH cJiixhik bypertropfitc 

Flatteoing of tbe Bridge.— TIiw may rwmlt from trauma- 
tism iir urtiarv (-yiiliili-i. 

Movement of tne Ate Nasi during Hespiratiom — Playing , 
ftf iliir ata- is octiisicnially iiuttxl in liealtli, but it is |n.-ncra]lv 
an incUcatioD of some Qlietruction to tlie entraiK« of air. It is 
fn-cjuenlly obscrvwl in K|Kuimodic cronp, true croup, Ear^ugEal 
flMlenia, «ipillary bromliilis, and pneumonia. ' 

Nasal Discharge. — TcuijK>rary "nmning fmni the ihmp" ii« 
a Hviiiploiii (if aeute <.tir}'za, niea!)I(«, luiy-fcvcr, diplitliiTin, 
and inflii<!n?Ji. An ofTcnsivo diiichar)^- sliouhl sugj^lvt iuiniI 
diplitbei-ia, or tlw iin|Htction of a fim-ign body. 

Cktottie ilUcJiargc ttrcuK in clironi<^ rhinitis. In infantft, 
dironic naoal dimrhaif^* uilh month -bn^Llitnf; (" snuffltti") i» 
VPTf BUjojefltiw of ln-rnhtiirv »>'pliih». 

The Sense of Sroell— This it to-twi by hoIdinK odorifcpKis 
Hii)Mtaiiu(» U-fon- iHic noMti'il n( a finif? whilr tin; oUwr is ('Iiim-iI. 
I'uiigtrnt ^-n(M>I> iflHinid Ik^ MvnidiHl, imt Ihv irritaUnn which 
tliey exciltf, and not their odor, may lead to Uwir nTi>gnitkin. 



The *nue o/'itniW/ u hnpiiirrtf or tod (anoMiiia) froni : — 
I. KtiinilU or nioi-Uiil |;niu'lh». 

'2. Allmiuns of ilio niilcj-inr pnrt nl' llw bniiit, involving 
iIm? olfertory ncnee or biilhe — as injiin-, Itimor, meoii^itis. 

In. Ijtwioiis iif the t>lfarton.* cpiitiw. 
4. Paralysis of tlio tri^^iiiiDa! nerve (l»y itulunng dryness 
ofthe iniK-Diis tnetnbrane), 
5. (JI<1 (IP'. 

An f«cr«MT (liy|>*Tii*mia) <>/■ « ttrrrrri'hu (])iirii*niiii) *>/" tfw; 
.iwwtr of Miic// niuy uccur tti liystcrm, uiauiity, tind in iin jiuni 
I ol' wHl<'(»fy. 

EptstaxJS.— Hoinurrlm;^ from tlio now fwrnrn iiikJit Hit- 
[liillowinix iTiiiilitioii.'' : (I) Tmticiiali.Hrii. (2) Iiitlaiiiiiuilinti, 
U-i) <>liitrii<-li-() ciii'iilflliKii - m in ctiwuiii: licail, liuig.niid liver 
IdiHi'aAi-. (1) [{|<Hi(l-4)\ M-mi'iii — an in stiirvy, infiilioiw frvt-w, 
Jiifmi>)>ltilia, anil ]mr[>iir:i. (o) Oieet of Icvf^rs, ebiH^-ially 
[ty|>ltnid. {ft) Vi«irifiii!* nii-n^triiation. il) In rarefied alnio- 
I'fi'piu-re, as in nioinitaiii-fliniiiiii};. (8) Oficn nitliout obvious 



Spasm of tbe laryngeal ailduotors if t-liiuiu-t^-rizMl Ity intense 
()^'8pno^l imil tKvun tti t^raHniixlW (-roup ; in true cruuu; ju 
iilvonUion of <l)c- Inrynx ; in lar^'ngi«mtie etriiinlos; in wfioop- 
ii4;-congh ; in tdiuiy ; inliystcriu; in liy<)n<)>ii(>))iii ; in ll»o 
liirvrigi'iil mfw of IiKTm<i(or titiixiil ; when (int'ipl liiiclir> liuve 
1'kI^mI in rlw Innnx ; iind wlu-n itmnri-m^ or nudiu'-linHl 
liimor^ |m-.i-i nn lln' n< iirrt'nl bryiigeal nerve and irritate it. 

AphOOia or lOfia of voice nuiy o<x-iir: — 

I. In Kcv<-n: inflaniinntion oftlic lart'nx. 

'2. I'Vini liysicfia. 

li. In ii^nli'ii; immlyainnf tite iwurrcnt taryngwil nerves, as 
in bulliar |mbr ami in Inmors of ilir> nu'dulla. 

4. In |»pri(>iicnil [iaviilvi>iH of the iw-uri-ent laryngeal nerve 
eunx'tl ity llie ))i«;«iire of" an ancitriam, nHiliii>4ii'ml liintor, or 
^rioirdial cQimion. 

5. Fnim pruloni!;cxl ni* of the voice. 
U, Frtun tin- lo<fi.'nK'nt of foreiini Ixnli**. 
7. Kruni dcutrit-ial ::ifnui^i>: of tin- lun'nx. 



ramlysis of the l^irytiKcnl Miistrles. 

huth mffl 'If t|iinal 

■IjiU of (bb 

PncHurii rj|Hfii unu tt^ 

Ad iirii'Lirlint nr (r*- 
01 ur. 

CVurbAl l«r]inEllLt. 

I foiatTowt. 

VulCM wf«k mil rmiirb; 
im tough «r djv^aita. 

V«1» itu&i^ uAlQivl: 

lri.-<r>|ffllurT HEH4t>r 


I I<'KrrH7tf<t* : fLilric 
4int:r itirirtvrUf (lafLrf 
Lhv Vnlif ii'.(h( '1 Ji- 
lt U^KIh 

A|'hi^<iiiiH bnl ai> t'OBrb 

I i^ftvi>iri»cDrso 

Tbe fOF4> tr<« Dihlw^ 
I lH.-t«tY|i bMudiou 

Qutt corn] it uiudtr- 

mntU'tiW' ; lln'irtli»'r 
. \* iTrnvn Ipp^ii^i^'I iIii> 
I urr>Jim Muv iti yhi^ 

tint ociM- Am H«ir li*- 

' Mnr mrxl 1* t>r>r ihi> 
iiii^llmn hi'V. iniJ u 
iii»ii>-iiln* MB lni|tl* 

i~<fc«hla nrr "Imv jn>l 
aunt iialunU; «i] 
fcHilnAioiL, Init »fo 
miltfinlotB iLcrlirc sf- 

U<ID|4lftl Ith-inBlkOH^ 


DjIplUBa. — l>\'s[>iiii>a im|ili<^ difliiiiill Ltn-vlliing witli nr 
without tin incn'ast? io the numlM-r of n«|iiniti'>TH. Dyipnii^ 
which is so fM>v>re tm to necessitate a niitin^ {H»t(irc in tt-riiiwl 
orthopmni. Dji^piKea may <M%ur on iiLipii-atkiu, cxpinilitm, or 

I^spnaxt on expiralioH is oliiefly notfd in pulnioiiury cmitliy- 
Kcma und arthmu. 

Oi/vpiiira on iitJipindion, or on both inspiration or rrptra^ 
tioii. ill this (onii the Isijie of the diest is retracted duriiijc 
the viulciit iiis|iinit'jry cllurtH. 

/to chit;/ iytHitr« lire: (I) Olwtriii-lion id tlie larynx fniin 
s)i!i)iin, [)unilyi>ti<, fnUc im-mhruiiv, cedrma, or a fomga body. 
12) Vn^^utv of nil aiH-uriein, tumor, or \nr^; (•laiitls upm the 
inicht-a, limix'li), nr riH-iirrr-iit Iiirytif;ni1 iit-rvi'. {'-i] Af-llinm. 
(-1) DisiTBritt* of tlw hiii^, UK jxivnnnmis, cniiiiiyitpma, iwicm.i. 
jilithisis, abi^nait, ami ptiinniif. (-'>) t'lcriiral eflii^ioiiK ('ii 
(^nliiu> dinaw. (7^ I'araly^is of t\w riiiiKL'il(« of iv»(iira- 
tiou. (8) Abdomiuat diHtdutioit. (9) Auauniti. J 



The number of respiratioiui por Diinuto. lu the lieallhy 
muW' itilitlt tli<- niiintxT of irH|iinilii>n^ U nlioiil Ift U> 20 )wi- 
tniiiiiU-. Ill woiiicii itntl ('liil<li-t'ii, l)r<iilliirii; ia Aciinowlinl mtm 
ro{>i<l. TW mtio [xrtwccH rcspirali»iisana pulae-bnda is 1 ta 
4 or 4.6. 

liajnd rettpinUiom arc nittixl in exdtenieot ; in pjTexia ; in 
inflammaUtrvdiHtfLscHof Uie liiii^; in atiieniia; In pertain affw- 
tiouA invulviti}; tlio ba.'M! of the bniiu ; in [xiimniii); Trutn certain 
illil^ wliicli afli-ct llio rwjiinitorv centre ; in liyslcria ; in iwinfill 
nfTtflions »f' tlic i-('>i|)ir:ilory miii'elcfi, as iilciirtMlynin. pU>tirUy. 

In/rapiriU rajtiralhnt arc ^^l>scrv(?d in wrtnin fli»ra)ii3 of 
Iho hniiu, a» nK-iiin};iii4, tiiiuor, apupk-xy; in athiiitcixl fstty 
cli'grncration ortliv h«iii ; in cvrtuin loroM of ronui, tmrtimlarly 
nnniiK' rim! fiintx'lio; In jmi^nii)^ ivilh iwrtiiin ilnigji, w«pc- 
cialK- opium : in olMtriuiion to liic l■i^-]lnK!<l^;c«, "^ in nrtlinm 
ilhl iti liimiiriiil njittMn. ^M 

Ckeyue-Stokes, or tidal-wava breatlUng. In tliia type tW H 
roApiralinnH giwliiiilly iixTfa'tc in rajiidity and volume iinltl 
lliry ivnch a olimiix, then ^rnclualtv mlt^itlc and finally ccoMt 
entirely for fn>m ti\c to fifty .sM«nils, wh«n they bc^in agnin. 
ll <lfl[)eiids on sonip distiirlianw of the rt^piralory centre tlie 
pxwt natni* of whicli ie still nndderminen. It is UKiiallv a 
foivniiiiMT {••f doatli, liiit cases have \kcu reported in wbitji it , 
liilw latted »(?verHl iiionths. 

Jt» chief cannot are: (1) Certain wre)>nil dtseiiMv, uh a|>o- 
plexy, men inn it it), aiH) tumor. (2) AdvaiK-ed cardiac disease, 
(s|iccially fatty dep«iH'rHt ion. (3) CWtain fonnMof (i)ina,«ep^ 
c-ially tiiat produced by unvinia, opiuni>|KHi<uning, and 8un- 


Qniffh rraults from; (I) All ilifloaflcfl of itic luDtr^ and 
linkiicjii. (2) Many diseases of tlio Inryns. (3) Foivijini 
botliex in tbe air-pgiflaa^c^ (4) Certain infe<4ionH di^t^i.'^'K, 
nio^l »f whicli, liowvcr. are a9s<K-iatctl with ratarrli, iw wlioop- 
inp-<inigli, nnwilej', infltienm. (5) Inhalation of im'taliitg- 
vji|iorM t)r fpvKS. (6) Iteflex rawaw, wich m pix^ssiiri' on tin* 
fwiirrcnt lan'iiReid nm-c by an aneurimn, and ulwrin*- and 
giiAlni-iiiluttinid atrfdioni>. (7) H^'stena. 



Larynseal Coogb. — ^Thisowuuh lias a hard, nK-tullic, riiipiiK 
intonation, ami Uas l>ecii toriryal "croiipv". It b (>I)wrvw) in 
Innnpiti-i ; in Mln>i>|»iniiH;tnigh ; in nibpn'Mkisi" iui(l :*y|>ltiliit of 
lite laniix ; wIk-h ii finyi^ii IkxIv liix* I'tilj^wi in ilivliirvnx; 
wlit-n iin [UK'iimnt or im^lin^tinul liinior nn^jttw cm llic r«>uiii"- 
irnf liirviip-(il m-rve, tinil irrilutrs il ; uimI in lunloi'ill. 

Dry CiHl|^. — Coti^li witliniil cxprc-tornlitHi is «i[i»viallj ob- 
m-rvfxl in llii- tx^'nniit)! of intliimninlorv <lt.-<ca-'>e.4 nf ilto bronchi 
Hiid luii^ ; in |itctimv ; in niosi diUHt»eH of c-iirly child- 
SikikI ; ami in tJif nfli x vnrietv 

moist, or loose cougb (Hx^iirH in bruucJiitis, bronchiectasis, 
uTQvalcsceiit pneumonia, ami phthisis. 


Mueoid gpKtant h noted especially in tire Ite^nning of acute 
bmnrliitiFi ; in n-^tlnnn ; in the «irly Mn^c of piH'iinioiiiii ; and 
in pulmonary cedcma. In the last it is very frothy and watery. 

Mtieo-pttnt/rni Spubim. — This ik ohservwl in Kulxicntc and 
chruniv caturHiiil aflV-tltuni; of the Itinp; and bronchi, eitftc- 
ciully in chronic bronchitis, convuti^K-nt piHtimoiiiii. and 

FiimfnU ij/iuhtm. — S>|)iiliim is raifly oompowd of pnro pun. 
Kx[HVioratioii atniiic«t i-ntln'Iy jinriih-nl » oIscrvHl in l>roi>- 
(liiectatti.t, in phthi^iin with c-jvitit?*, in alncrsR of the lui^, 
and when an emjiyenia riiiitiircs into tlie lung. 

frune-jutee Sfnilum. — lOxpeetoratioii tinged vnth altered 
blood so aa to resemble ]»nine-juiee. It results from rf-ten- 
tion of the blood in the \»ng, ami iu okservitl in advamfti 
croupous pneuUHinia. ef^iieciully low form>^ in giuigrene of lln! 
Innj;, :ind in cancer in tfie lunj;, 

It'iM}! Sj/ufum. — \ nuty nnd h'miclouit eputuin 'i» strongly 
indicative uf cmupoiiit pnc«>niu»iu. 

Sputum (Vfittttliihii/ fifironn icftiw/jt is olwcrv'od in membra- 
noDH eniitp, in di|thl)iom, jind in fiUrinoiH bnmdiiti)*. 

Currtinl-jrllif »jiutum U imlicativi- of eann-r in ihe hingv. 

Fftiil tipiihim usually rrsnltw from bronchicctiwis. iidvaiuiMl 
phlhisi.q with cavitieti, gangrene of the lung, and aU<x?» of 
the lung. 



Sucb simtuni uhcn allowed to slaitd in » coDitn] ^am set~ 
ties in tliree layers : an uin«r layer of dirty fit>tb, » middle 
laypr of turbid miioii.* in whicb areeiispcndwl |Hinik-nt mriugs, 
ant) a U>ttoiii layer i>f dw>jiii|x)Mtl jhih, 

yauimutar >'^fi4/uM.— Split inn f^xnid in routnl, flat, coin- 
^pod masses, whidi arp htavy and eink in vriUw. This 
suutiiDi is otiecrvcd in udvunivd ])liUitsia, in utirutiic bniu- 
coitis, aud in broiidiif«.'4iisiH. 


Claatlo fibres nvi- limud in thi! fipntntn in phtJitsi.-., al 
gaii^'niit: of tlit- lungH, and in some casi^ of bruueliiectitfiiii. 

fix. 10. 


Vu- [Mertion o/ Ehtdie h'itirf*. — Place tlu* spntum which 
has coMwtrd ditrin}; tin? night in a j^liias beaker, an-l add to it 
an etfUid vuhime nf a sulntion of cnn.'itie hirda i'2^^ (jniiltB tu 
the uiinn.), and bwil over a spiril-lanip, rtirriiig it ixwisionally 
with a ;;]uK-< nxl. Ai> mum as it boilii ynonv inlu n ooniml );li^> 
and add t'onr or tivo tiinn^ the aniimntof oild distilled u^tor. 
Allow lliv mixture to stand for two to thni; liunrs, and oxnoi- 
im- the «^liinenl ii* tor lnt)o-«ists. (Fenwiek.) 

Spirals of nnGin.— Ti^fhlly-oiiltx) i>|iiRilH of innoin, wliidi 
prolflihly ivprcwnt. nx'iibU uf the fine brunelnole*, were fin^l 

fxiinteil ■.■111 by (.'nrselinuiini in the >jinltini of uxllinia. 'I1ti-y 
luve nliiw Ix'en oli^-rvcd in ihi' >>jiulnnt uf i-nHifioiM {Kx-nnioniii, 

THE SltORO«t)l'Y or (U'tTLfM. IM 

Cbarcot-Leyden's Crystals. ~TbcN> are sinull iraiis|iarct)t. 

(vrlnlitilral iTVHliils. simitar (o tlinso fmiiKl in llic hltxxl of t(^i- 
cituiia. 'I'hfty an: ulnierveil vnptvitilly iii llio ti{>ti1iim ■•!' a'^ilinis. 
Tbcv tmve aUiu lieeii noted in |)Iithlsis, in libritiuiis brou- 
diitis, aud iu actitc bruochitU. 

Crystals of Fatty AcWs.— TIicw (Kviir as line nrodlos, 
aiii(;ly i.r in Kiiri<)lc«, iind aiv of)(>ii ^barjily oiirv<i] nmr tbcir 
(•xtiTniiti<'». Tbcv an- oliwrvwl in i1h> f^^mttim wl' flirunic 
hnidcliilix, of iiKxi-Kt, mid of panprwic of iIr' liinirs. 

Crystals of HEBmatoidin. — Tbc^.' ticcnr u» snmll ydl»w 
nt'^illrv, rlionibii' pliil'i^ or UiDk, utxl arc found in ifjiiiln vvliidi 
(imtniii uIi'i-ihI bl«o<I. Tbtr may be ol««Tvitl in idK<ir^ 
gjni;rn-i"<-, -Tml mmrr of 11k- Iiui)^ 

Tubercle Bacilli. — Tin- ftn^ixir <>f lubrnrli' luKiilli in rh« 
H|in1tim i^ nn 8)i-«>bilo iinHif of KiU-n-uIiwUi, bnl a failnrR In 
d<'i<-i-t tiKm Hn4.T nn*> or Iho i^.xaRiiiiatium u no proof againal 



[iIilhiiiiH. TIk' Ixirillii^ U a fiiM' rod, in liingtb about luilT lli« 
dlaiiK'lcr iif II i¥<t-bl4Xfc[ voriMtSflc, and oftwi slightly Ir-uI and 
IkiuIhI. Ua rU-tei-tioii tlciH-ixis dh its ]»owxt, wlieii etaiuctl, of 
ri«i^tiiie ilk' likadiiiig »'ll>i'l tit'iiotdR. To vicwitsuocctmCully, 
a ,>3 uiriiuiiiicntiou kus is r«iuii%d. 

Keellc* «f t'anr Add*. (ARtr StranpA) 

7fa TWwrf/on.— Tlie ^Wigwt-EJirlidi ii>olho<l : Sdwl with 
a cl«ii» ncttlk-a miiiiile jmrtiuit fi»iu tliolhivk part of Hie spu- 
tum. «(>rcflti it out in a v<;rj' tliiii film on a cover- (jIb*', ami liry 
by lioliliit); it wvfial indir-s above tlie fiamr of a sjtiril -lump. 
\Vlu-ii (iiol i)Iacp il in the Maining flnSd, wliicli is |>n-]uirol as 
folloMH : M\x •} c. c. of aniline oil with 100 P. v. of dii^lillefl 
v-ntt'r, and filter, sih) tlim add 11 c. c. of a raliiratixl ak'oliolic 
solulinn of fnduinc-. The covcr-gtass slionlil n>muin in Ibia 
elatnin^ fluid aliont luilf nn htMir (in iloutxfnl (iim^ (wtiity- 
fnur liiiiirR); wlii-n KtaiiHil, Hum- in dislilK-d wntt-r, atxl Ihwi 
d(ii)l<iri»> l»y [iln<-in^ tin' sjwcimen for a few k'cuihI* in a 
thirty IKT «-nl. aiiiKiiitit Ritnlion of uilric acid. Wash otFtlie 
and with dit«ti]liil wal<-r, and again Htain by immeming the 
vovcr-cln.'v* foi-aUxit a minulo in an a<)nc4iufl sotution of mWhv- 
knt-'Miic, or in a one or two [kt wnt. afjitcons mlntion of Bjb- 
Qiarck<t)rown ; now rinse, dr)-, and mount in Omatla liataam. 



lilC.SI'lU.\'IX)HV 01{0.\>'S. 


Inp(>«liim <lrf(Tmm(s tlit^ shajie of llic cIicHt, any iiriti.-ilnnil 
HromimiKV xr (It^^prcseion, iIk' aiaouut ut' exjiauaioii, and any 
inequality vi' uxjauwion, 

FiB- 13. 

An nulling of tlw Kumul Tliiai. 

FhUiisiiioid Cheat. — Tlw imh-ro-iwstprior tUameter b short ; 
tlic tiiiirux lb Inn^ ami flat ; tlu- HlW aix- nhli<|ne ; the 6l-llpnlff^ 
art' pntiuiweiil ; llif ^jukx--^ alwvc and Mow tlio clavH'lt* are 
dvjnx-sHr^l ; and lltc anjflv foruK'*) by iho ()iviip.iiv(: oftbe <x»- 
tal inaiyin'^ rmni th»- »tvrnum w vi'n' ar'iiU-. 

Rachitic Cbest. — Tliis may ri^^H-nibk- llw funnt-r. Imt uflually 
tilt- si(ip« an' t^msidi'iiihty O.-itliiiHl, nt«l tlif i>riTniiin [»n>ini- 
ncnl, i^u that tlw Unn ptipwii-brfaft lias t«*n it|i{>lM-<I U> thin 
IHirlk'iiInr fiirm. Th« isti-rnul vinU of ||il- nlw an- snlargHl or 
" licadtsi," mimI ()ii« cliaracteri^io )iai< pivi-n rise- in tliv term 
" nuAitifr rtiswy," TIictu is ofh-n ii cinndnr (^iti^lrti-lion of 
the tli'ii:i\ ut till' li'vt'I of the xigilioid rtirlilap". 

EmphyBematOtlS Chest. — In advainfd ('iniyliviJCinft iIms 

ihcnix ih short ami miind ; ihc ;niti'pit-|)uM*rifir iliaiiict<rr is 

■ •rn-n a.* I'>n^ a» thr lr>in»v<;nt<- diaiii>(-k-r ; (Ik- HIh urv' horixnii- 

tal; (he angif funtwd l>v tin- divergeiiLTt of thecnstal margin 



Fig. 14. 

Bichilic Ch«it. 

from tbe storniim is very obtuse or ^uife obliterated. The 
term " barrel-sliaped chest" ia ai>plie<.l to this configiii-atioD. 

Fig. ID. 

Em|>hyiwiiintgiia Chcat- 

Local PromineiiceB and Depressions. — An tmnntm-nl (iroRii- 

iiciKi' iir (I('|iit'ssion is often ol»servc(l over tlie lower jail of 
tlie stcrnnni, and is fj^cneraliy tongenitai. The torni finincl- 
bix'ast or slKx?makor's-bn'ast (because it may result from llie 
pressure of tools) lias been applied to tlie sternal depression. 

A IJititakml or Liiiyid Deprcxuhn may be due to: (!) 
I' ('(nisolidation. (2) Cavity. (.'J) I'lenrisy witli 
fibrous adliesioiis, 

,1 I'liilii/i-ral or ImiuI Prominence vinij be <liir to: (1) 
J'jeunsy willi effusion. (2) Pneumothorax, liydrotliorax, 


hii'inotliorax. (3) An iiiicurUm or toniur. (■)) ( 'om|n'iiJa(ory 
(.'iiiptiysciiia, n¥ii)tii)g frurii imixiinn(;i>t of thi? <>j)|H36itc lUDg. 
(.^) Canluiic; cnIai);t<monU (k-ll Hide). (*>) f^ilar^'mcnts of 
Uic alMluDiiuiil oi^utLs »^|>mnlly llii: livrram) siiWn. 

ExpauiolL— In woinvu iiml in (.-liil<lR-ii, brEslhiug is lareelyl 
tliunu'i*', or («»tiil ; in mcti nnil in the oM of both sesee, it IS 
larg^^ly aMominiil, oriliuplini^ninlic 

/iV'rf'-'oW nifihiminol hn-iil/'ini/ w iiljserviil in |irE^nam'%', in 
aUlomituil tnniors uu<] HliiMon^: in [K'ntuniUH ; in ()i»))ll^ll^- 
matipJ^U■«^»J■ ; in (wnilysis of (ltf|itirenit' nerve from |irt^«ure 
iir from Imlluir ili^UM; ; And ocuLsioimlly in tliv " liyskTical 


PnljHilkiii wTVft) U» <lMwt«iiy ihonw-ii? tciMlrrin-sii, ii'<l««ni, 
frirtton-frvmiliw, or tSlft*, unit I" dcU'riiiiiic llit* vwa\ fivmitiis 
xn'l itri|[>iint iif oxjuinMnii. 

Thoracic tflodfiraess ia oWrveil in gikiirinv ; in )>litlii»i^ 
HI)') )ini'iitnMtiiB rmm U-ing s%NH'iitto(l uitli [ilitiirisy ; in pU-tiriK 
(lynin ; iti intf^rtxMtal m'liralgin (riitilini^d lo (X-rtMin ^jMitit) ; 
anil In .Mir^ml affHoiimu, like <9ri<« ami fnti-inrp of (he rilta; 
itixl in ntntiiMon nn<) inHaniniation nf thi- )nrirt(>ii. 

Qldeina of the chest walls i^ recn^iiju-d by " tMitinu;" wlM>n 
imv«iirt' i." nijtili' wiili iln' lin>rrr. It niay lie iiWn'Hi in I'm- 
pyomii ; in d<*j>-!«att'>l al)scvj««^ of iIk? jiarificii; aftt-r iho 
njmlii^itinii nl';! Iili-!ir ; :iiiil iti yt'Txral ilfx>|wv. 

Friotiou-fremitus and Rales. — 'ITio frioti»n-^>tni(i itf ))k«- 
risv anil harsh sonoixHta rales cau Bumotimcs bv (Idtvteil bv 

Vocal, or Tactile Fremitos.— The tnineuits^oii of ih« vibm- 

li.Mi- iif the v>>iiv In lUo hand. 

IndetcTtnininj; tit-.' vixnl fi-eniiliM oltwr\'e the fullowin); pre- 
<:anti<>nii : I*al[KiU' syninH>trii':il |«ris of the ehest ; make firm 
[(ftasiire ; when coio|fliring nsc the sinio iireestirc on the t«-o 
(tides; apply the hands as nearly parallel lo tlw rihe as 
possible : and n-memlier (hat the fremilUB is nonnally in- 
crea^iwl ovcrllie riglil ajH-x. 



Vocal /lymitw U tnrrctjvd in: (1) Phthincal ctjiisultdution. 
(2) I'lieiinniiiR' o)imoli<lutkiii. 

Vovit/ Jrniiil'ie ii' lirirniiuxl in: (1) Pleural t-fTiiKioiis — air, 
\n.\f; st^Tiiiii, lympl), ur Ijltx^l. (i) Kioplivi^iuu. (3) i*iilnni- 
iiun,' c^jllapsi' I'lvm an olj^lnick-d lirviK-liu«. (4) I'ultiionary 
oLtlvinu. (■>) Morbid givwilis "f tlu? '""R- 


PcivM!«i"Hi di-li-rmimw it^imainr, i>iti-li, himI rcf-iKtamv. 

luiMf-ili'itf f/fi-cii/tKion is (lurfiirnti'tl liv slrikliij; lln- i-lwst dt- 
nvlly Willi the tin^ji'i's. Il is nut i.lhii <<iiijil<>.v('(l, cxivpt over 
the elavicl«(, whei-o llw- lion*«* llicni>olv*s> ai-l. as j i lex i meters, ^y 

Mfttiate penruMtioH h [>erii>rnied hv ii!<m^ tlm Ungen ufoiifi^^ 
han<l as a plessor, and tliitse ol" the (i]i)ioeili! hand as a plcxi-^^ 
nwter ; or bv ii.4in|r a itkoeof ivorv, glans, or hard niblK-r an a 
(ilcxinieter, ami a >^iiiall hammer aw a [ilt'-snr. 

'I'he iiae of the lingers alone is [nvierahle, for only In lb!» 
iv:tv can ivsiMauee t)e delemiiiicd. 

Id pcrciiseioii lla- fulluuiniic precniitioos ehotild beobser\-ed: 
Pluco the fiirgcr wbidi is being used a» a plexiiueler firmly 
!il^in«t the elxwt, and pretembly (Hirallel tu (he ribe; make 
ltn' fiiigtT which is iimhI as ph*HH- islrike the one on llic ehc 
I«T()einlifiilarly ; fix itit' I'lmanii, awd use ii" more- fortv (hat 
i!ui lie ohtatiii'il i'nmi a gentle sxviiig of the wn»t. Wliiti pije- 
sible, peneusn all jniils of the clicjil aiilerioHy and imjleriorly ; 
pvn.^u« Ixflti ill inspiration mid in expiniitnii. In ('oni|iiinn|| 
ihc tvitt siiles, lie Burvtu pcrcuisJSvmnielriiBl [itiils 

jViw-rod/ Iffnonancr. — On llie rtglit i^'tAv, piilnuiTiiiry ivwoimtKx? 
e.vtciMis from n half ineh Iw iin im-li abine the i-I«\ii'li-. dowii- 
wanl to the iip|H-rl)>>ixIi'rorthi- !>i\th rih in front, and tv a liui 
(Idiwii (lin.ingh IIm' li-nlli .*]>iiw>ii.i jinnvw ]i>»teriorly. 

On Ihe li.-li »idi', piihnoiiar}- n^oiiiinee e\tendf> fmm a half 
inch to nn iwh uif ive the elavii^le, downward, within lite toai 
niorv lino to the third rit>, outside ofihe mammary line to the 
tcnlH rib, and )K;eileriorly to a line drawn through the tentl' 
spiiiims ptiKu:-^**. 

Byper-resonanee is oh^ervwl iti ihe following oomlitioDfti 
(1) I'lH'tiDiDthrtrax, (2) Cavities — inberenloub or bro)ichiec| 
tatie. (3) I^n)|ihy&rjna. (4) Lowetvd pulmonary icnftioD 



Ihc initial fita^i> of pneiimfliiia and above a pleiiml cITitsiaii 
(Mkcxla'fl rceoiianc**). (6) Flatulent distention of tlio stomach 
or (folon (treciucnlly olieerved over iho left base). 

A tympimilic nite ie a hollow, dniin-lilce soiittd like llmt, 
whidt ta uonnallv oblainod by j»emi»-iiig the larynx or empty 
stiimacli, TIio above cwmlilions arc aluo capable of productii^ 

Toe oraoked-pot sound, or bmil tU j>St jtii, i» n iuo(]ili<:'<) 
tymjHiny, and can be i^iniidatetl by mTCtissing over the (rlitvk 
wlicri tlic month ih partially ojk-u. it may bo normally hrani 
over the chest of n cryiriji infaiil (WuUhc). In the wliill it 
tiHiially imliailes a nivily ivlitcb hiw » free coniniiniital.ioii 
with a brondirut. It is lii-st l^l^^1■Il■(i by k(.t'(iiug (he ear near 
tho iHNfi iitonlh of ihi- jiittiiiil n liJii- iH'r(:ii.«>iii)r. 

Dtunoss or flataen in rc(iigi)i»Hi in (he following i^mdi- 
lioai 1 (I) I'iittii^iml t-outioiidniion. (2) Pneumnnin nin?«oIi- 
datioD. (:t) I'leiirnldrii^inii<iuf all kind)i, exnept air. (-t) C^l- 
Iu[>Ke of till- lung, (o) Coi^estion and ied«?ma of the hioij. 
(*j) Eiilarjri'liwnt of the liver or spleen (at the liaM^). (7) 
Morbid ;n"'(wthi- in the lung. 

PltclL— I'itdi depends lai^ly upon t!ie volume of air, upon 
the tension of tlic walls of the cavity, and ui»n the siw of the 
o])enin(; nbidi <.-nmmuni<^nte); with the cavity. The less the air, 
the •greater the tdbcioi), and the i^midler the o)]e»ing, the higher 
will I'c \\w pitj'b of this note. It is obvton*. therefore, that 
eondittoiu wliii-Ii an> nswM-tuIal with hyjicr-nw>niinee may 
yield eithvrn liigb- or a low-|»ili'lK'«l mttv. In l>cginning 

Jihthisical connolidation^ tlic nott^ over Ihi- ullW-tiil apex i« 
liglicr pitcJied ; Init it must \k Ixinie in inin<l llial nornmlly 
tlif note over the right a]>i-\ 'm higiit-r |iitdied Ihaii that over 
(he left. 

Resistance. — The ^'niitcr Ihc duhK-N« <h<- ijii'ater will l>c the 
ri'sLslaini- ; iit'oix^ then? i;* idwiivM niore n-sistaiiiT over a larg<? 
}>li-iiml efliisiou lluin over a [iiirtimoiiic or plitliiMicol wn- 


Aii»cii)talion determines the charader of tlie breathing and 
of the vocal reeouanw, and detects adventitious sounds, like rales. 



Td immfdialt a»»ivflntion llicvnr is (Jncud ^im-lly ovvr tli« 
ciiCiU a md towel only itilt^rvouitig. 

In maliiilc tiu/nruitalion Uif i^iiiMls nro lran«millMl througli 
A nU'llHMcopc, wliioJ) should Im" applied ta tlic bare ch«>t. 

[n inufuftnluyn ohscrve tlip I'ollnivin^ [HvoaiitioitH : J>i> ih>1 
i'x*-rt iDttiJi pm«iiin> willi lh« !>m1k>w4i[m^ ; whon tlipclii^t iit 
(■iivcrtil with hair ninistt-n the Inllir, otln-rwiM- ii will [in>di)ci! 
IVii^idti-tunimls rtwnihling raln^. Wfioii |iiiivtl)lc nuHciiIl all i 
ovL-i- ih<! olifsi, anteriorly imd )KM>t«riorIy ; aiisctilt on quiet ^M 
hrmthiug, on full inspiration, nn full rxpiralion, and after ^^ 
cwuglung. In comparing the two sitles ausctilt symmetrical 

.Voi-mai Ite^mlioH. — Veaieular breathing ia heard over tlte I 
luiciy of the hin^, and is <-htiniel»-riz«>d by a soft, btwy.v inspi- 
i-ation and a short, low-pileh«l expiration. Nornially, expi- 
ration i^ not more than cHie-lhird wf long as inHpiralion. Aus- 
cnitatioti oviT tlity trachea, ur over ttio main hruiic-hi in the 
interscapulur s\xnx; yivliU iironchiul bniitliing, (. c, liarvh 
lirwitliinii willi |ir>>ti'ni,'r-.I Iii-^ti-pitdiiil i-xpimtron. 

Modifications of the respiratory murmur. Pnn-ile Hrraih- I 
in//. — This tyi»c is lii-ard nurinally ovi*r the hiug? of i-hi!<In-n : 
it is loud, and rxpinittui) it* In^hrr pildied ihuii in vt-vinilar 
breathing, and uln»wt iw lung ii» inspimlion. 

IC.mffi/ertiffl liirtilhintf. — This ty]»i* hai> almniit tin; XBinc 
peculinriti<* as jHH-rilr hmtthiii^, ami io IiianI ov»t a lung! 
tluit iis doing extra work luti^Hitatcd by iwnie inipitirnu-nl of] 
it» ft-llow. 

Unmrhiaf or Tuttiilnr itrmlhiitff. — Hnmti Im'alhing. with 
a pnihmgiil higli-]iitch<.i) c-xiiiration, wbi<rli hat< wimritmosn. 
tubular ipiatily. Bronrhiiit hresilhing b ti^ni ox'er: fl)] 
Phthisienl <ii>nMiIidalton. (2) Fnenmonte eonMilidation. (^j 
Ijui^ whWt is itiniprcHoeil. (4) Lung which is inl)Ilral<Hi 
with a morbid gr))\v(ti. ^M 

Amphoric «)id f 1(imt?ioiw Rrraihlng. — These two arfl almost ^^ 
identical ; the sounds are lond. and ex pi ration i.'* pntlongwi ajid 
bollon'. Ttie pitch of amphoric bivulhing is a little higher 
than that of cavernous. Ampborie breathing may be imitated , 
by blowing over tho niotitli of «n empty jar. 

Amphoric or cavernous hrratbing may be beard in ihv fbl-j 



1owiii)> «<iM]itions: (I) PJilliUIcal or broiK-kifwtatio cavities 
('2) Pncitmorlxtmx, vhrn tlio u)Knin); in tht< liiiij; i^ patuloilSil 
(S) Arciw of <v>i)s»1it!nt)uii near a lan^ linini-inis, (4) .Sotijo- 
tiiiKV oviT liuii; (i.tnipr.>,'mi bv a iinxiinjl*- vfTiKioii, 

AeUitaiitu' ifrrw/Ai'tii/.—HanJi lin-ntliiiif; willi n proloiip-tl 
rliecxiii}; ex pi mt ton. It itiav n-jttnbir brunoiiiut UruiUiiiig, 
iriic. unlikv tlic LitU^-, it it ln'unl iill u\i.'r Um i-JiLtft. 

77i*- ltrfitO\i>uj <ij AmyiAyatiH'- — \\'t«k bn-JilIiiti^, wtlU pro- 

^ii^^il l>iw-i>it(-tii-<l ur iuaii<lil>li> fxitinilinti. 

i}ir/</ril-irJiffl, or Jri'tif llrriitliiiuj. — Tlu' r(«|iinit"ry miirmiir 

nol (^>iitinii>iii.% l>iit ih l)n)k(.>t) iiiin wavcH. It iit uot imltcative 

t>f any fijiK-ial dtitcase, Ixit it ia fntiDcntly itbscrvi'd in brooi- 

iltius and iu iiKijiiont iiliiliinis. 

Wrah or tAa/loie lirfnt/iiHtf.^^This is nolnl : (I) Wlien the 
Btiest-wallfi are ttii<:k, (2) In tite o\<i sikI fcnblo. (3) In 
empUysema. (4) In iikiirul I'lru^ion. (.5) Iii iiu-ipitnt 
f>htlii»iii«. (G) Id jviintiil ulTtx-tioti^ of iIr- ctK-)>t, likt^' pUiiru- 
Jyniii imtl Ix'^iiiiiiiig |>k-itrisy. (7f In pnliuuiiJiry ci-di'ma. 
Vocal Besonanoei — Tlie vilirurioiM of tlte voice tramoiiUoi) 
tin- (11 r. 

Vocal rc^mnik/^ u ROrmallg increased over (ho rijtlit apex. 
[l it* nfiiiorma/lt/ Itu-rfiiffft ia : (I) I'uonmonic coniuiliduhoii. 
(li) I'litliieioil oi>iiw>lidation, (A) C-uvitics wliit-li fn^'ly tnin- 
uiinicate with a bronchus. 

Vocal reaonance u <limmMf4fd or alMent in: (I) Plvnnil 
Tiisionii — air, piu, H-nini, lympli, or hlootl, (i) EniphyM-iiia. 
l3) Pulmotmry (filbjiw. (4) I'nhnonary (pdcina. 

BronehiijAnnii. — K\ti¥in<-pxa;n!<^<^'i*>"'>''thpV()cnlr(«oiuiUCp; 
HcsimmK bill iimI iIh- wimiKuii- inniMnitkil. It i«<'xp<viftny iivi-r iiuii'kiil (■iiiL-tH]t<l.iiii»iK nTxi <>vvr 'iMliiin iiivilicit. 

Pn^itritoijay. — 'I'lic ilii^lirii't tnini>tiiiHi>ion of wliit"|icml wnnU 
;i> tlie ear; tlic MnimU np|H-nr Iu ciiiiiiiulu fi-on> ihi' H|K)t whivli 
\ aiiMniltei). 
I'wtopiloqny is Iwardnvcr: fl) ravilioi which rotnmnnicBte 
witli a bronrhiis, (2) \t^» of ohmi ligation in \\w iifiighlior- 
It'KxI of a large t>n>neliii<^. (.Ij l*iieiiiu'>tliorax, tvhiii i\ni o|iet>- 
iu){ in thv Inii^ k (kiCiiIimi". (4) Kt>nic piciinil cfl'iiAiMH. 
.I'^fo/thoHii. — A in<>()ifi<-<l br>in<4ioph'>nv, chaRX'tcriziHl by a 
ibling, hinting souttJ. It in iiaualiy hvani ovur ali);ht 


OIl^eASES OF TItR ltl»PrRATOi:V !<V!n'FJil. 

near the iiilcrior iinglo of tlw »('Jt[>iilu. 

It ia iKTHxiunnlly \u-tin\ in iH'giiiiiiiig [>nHim'>ma. 

AdventitiouB Bo'imda. /W/m. or Jihonrlii. — 'I"hc«c urv abnor- 
mal suuml^ nlilrtt rL-{>lai-t-oi'iuiiiin|i»liy tlicn^piiiitury munuiir. 

VMlcalnr EX CrvpiUot. 

PBlinoii±i7 rlla 



I SalwToiilUat. 

ltxtr*-pulnir>n»7 riUnlii 

- Hul>tiling. 


Plniiiillc frktlon-raim-l*. 

Vrtpittinf l{/}/rx. — These are very fiiie riilcs, aw] ate Ix^nrd nt 
the eml of itt«p)ruti<rn. They iiiny In* siinulatol hy riibt>iii|f al 
ioek of hair Ijctwecii the fni^^crx. They hitve t«eeii espeeiiillr i 
ius(K:inIe(l with the fin>t Ktage of enHtjiittiH )ineiinioMia, and itj 
hn>^ In-Ill Hti])^"!**-!! tliJit they wen- due t^i the (iireihlc iM^|mntlion j 
iif lulinrtiit vesietiliir wiilU. Italts very niiiiihtr to, if not iden- 
tit'td ivitli ihew.-, ure heard in (n|iillary broiietiitisiiiHt in piil' 
munttry (Hletim. 

I)rif riilfn art! priihahly pi-odiKwl by tlie {irescnoe of vincidi 
wnivtion in lti« Inltcs; they have a more or \v^ whivithi));,) 
miL'Jteal, iirM]iieakiiig intonation. They nri- hiuni ]uirticnliiriyj 
in bniiM'hitiH and a^liirna. Sibilani Hilm aw \i\\\f\\\i}\z and i 
hiffh |>iU'he(l ; .toiioniiH rJili's hiive a huinniinj; ijiuilily ami nrc i 
lower ])itehii). Dry rfiles may be Iwurd on iitHpiiniion, i-xpi-| 
ration, or IhiUi. 

MoiM nVe» n-ntih fi»in the imwnee of Iit|ukt in the ttil)et> : i 
tlie tliinner llie liijiiid and tlti- lur^rer the tnia-, the (xMiiiiej' uilll 
be tltc rules. Tla\v may Im; henni on ini4(>imtiiin, tApirnliim, | 
or l>uth. 

.<ubcrf]Hf/inl, tir avtcUiHgr^liv are Rue moiAt iSleft, and heard ' 
in nil cxinditioiiH wliidi are a-tsoniated uitli liquid in tlie smaller 
IiiIk'jS a» brunehitis, eaplllar^- bi-oochitls, {Mitnwnary iHknia,J 
a»d U-piitiinj; phthieiih 

ItuhbVmij nVm ano (xxirser than j^idHTicpilant : and ar«' heard 1 
in ltn>ncliili«. in rcHilvinj; cruuiwim |mciiMii>iiiu, over phrhisiial , 
deponit^f nliicji arc eotlcniiig, aud u%'cr Biiiall cnvitiw. 



Oitrifliiuj rdtoi are vtry fnarrx'. rnxl rif«>mIjJc IIk- l«in-tinp nf 
lar^) Imliblcfl, They aiv hesinl <ivi'r liirp- riivilici* wliicli t-"!!- 
laiii lluiii, ami in tlic intt-lien in tlic sii-<3illiil '' il<-;i<li-r»iik-." 

FrietMH-»mintU are pnyliKsd by iJm- rubUiiij; tugvliKT uf 
I'DUghenecl ]ileiiral surla»». Tht^y may be Itcnnl Iwtli in iii- 
!>l>iratiod and expiration, an<l otlen i-eiiorable snWrojiiuni nltt^. 
Inif limy are more aii)>erlinal an<l lonilixitl lliaa the lailt>r. iiiid 
an) ii»t niodifiod bv oougli or deei) in^^piration. 

A n)ugh«o<!d pleura m the iieic;)ilM>rl)u(Kl of the liiart ntay 
protliitt! a frktion-eoiimi of canliac rlivthni, and otw wtui-ii 
will »till <»ntiniic wben tlie breatb is bcfd ; under otlKr oindi- 
tiooji nlfural fricti<>n-8rnipds (vaeo wbcti rcspiratjon is sus- 

Other AdeattiHoiM Soatuia, Mdaffh T^nkHnij. — Thi>i naniA 
i.s applied M silvery or t)c1i-]iko iroumis wbicli an> licani at iii- 
ti-'rvali' liver a jmeuiiio-bydrolhijnix nr laf);(- wivity, .S|>eakiHg, 
coughing, and dii>p bn'jthini; n-^iully indiKv them. Vare 
mnat be taken uol tu (t>ii1oiiii<I iIk-iii uitb siuiilar iwinHU pro- 
duoed by the pra!cn«-of li<|tiid in » dtstrndol irfoniai-lu 

Siiociunion'iiiilii'h, iir liijutfu'riUif tUtivaiuiiiia. — Tliis is a 
splashing siMind pnMlmiil by Uic pr»-*'n>t- nf'iiir iuhI liipiiil in 
Hw chest, [r may bi* i-li<-itc<l by jjiMitiy ahakinj; the luilit'nt 
while auiwulltit ill)!. '' iwarly aU-ayA iii<Ui-;it<^t'illu-r u liydi-o- 
vr a nya-pnciuiK>ihorax, although it has bcwu delected over 
very mrp> nivitica. 

Air uml li(]iiid in the Htaniaeh produce a similar sound. 


Jii nioikHurinf; thi>*ii<I*s nf tin' rhost oliw-rvo llw fiiliowinp 
piTcaiitioit : Mnkoirc frotn the middle of tltu stertniin to ilic 
Hpiniiiw p^•x1^»s4-i : miitsnre Ixith iuAt-^ aAi-r itL^piralinn iiiu) 
aftvroxpinitinn ; apply \\w \a\Ks with ii|iial rirmii<--ts (<> ()i<- Iwn 
sidiw. In <ximiiariu)i, mt^a.'uin^ «>rn^(>.>iidiin; li-veU, and m- 
memlKT thiU ilu- right tiide \f fnim half an tnch to an iix-h 
gr<«ti*r in firoMmfereinH; than the left. 

The cxinditions which rr^nder one side more prominent tliau 
tiie other have already bt-cn oou^tidercd. 



(Acute RblniUs. C«ld Ui the HMd.) 

DePtNtTlox. — An ii<-iili> iiiftiimiimtion of tlic luual cavities. 

Etioixkiv. — KxiKisiirc lo i-oM (]rafl» iiixl tu wrt, r»|M!ciaIljr 
wht-n th<r ImhIv itt ov<Tlic9(rtl, is a common caim.: Il niny l>e 
oxcilftl l>v the ill till lilt ton of irrilntiitg \-a|Mim or diitit. It is 
itii ■•.'cj)r<-H.Hi>iti of'iodi.ini. It h n ^vin[itom urocrtaiit infirvdutiB 
iit'»<'itM5. — i~>)>M'ialIv nyjihilis, iiii^asu*, ami inHii^iixii. 

I'ATtKit.onv. — riie miioMis mcDilirano ix rt'it ami suolK-n. 
In tin: fiiTiit sta^^e lh<'re is tw ik>crction, but later imlalintir, 
M-atery niiKtis ll«vrs Trom tho ooeo an^ escoriatee the Yip ; llnii 
in time is followed by a oupiwis in uoj- purulent discbaivie. 

SyiiiTOMS. — The cliseafit- i« u^ht-rwl in with rlnllinc^s, 
nmf'iisf, fniue»« in tlie Ik'.xI. am) i-neczirif;. The nofsl ehani- 
Inth are ob«tni<rlcd. cm llml the jHitii-iit i» oMijiiitd lo hrrathe 
through hiK month. At fintt thoix.- in no i<(vrrtion, bnl in 
tw<'nty-four or fortj'-i'ight lioiira a wntm- dii^churp- is oitab- 
lishol, trhivh Inter l)c«ctnw« niii(Xk])iiriik-nt. Slif^iil fcvvrand 
it)- anwM-iatcil i^viiiiitimw are (iinimonly prcucul. The duration 
is from il fc■^v dny." (o two wcJ-k:*, 

CVmi-r.KATliiNS, — Tin- di«li«r ii* oDin ncitintiumit-d wilb 
(-onjtiiH-tivilix', [ihan'iii^iti.s laiviigilis, hihI latarrh of the 
Kuittaohian luhv wkI nitddlc car whidi n«nlla in t«nip(inir>- 

I'ttnti amts, — l-'n voroitle. 

Trkatmrnt.— Ill iIk' •>nrly .sl:^;c a mid in the head eon 
fnvpK-iit ly Ik- nhorttti hy the lu'te of hot drinks, a laxative, 
miHli-mic diic*i'S oi' (juinine, niid rlie applii'Ution of menthol Ui 
tJii- nasiil ehamUi-s. S<>nm iTysiaU of menlhol may l>e plaeed 
in a wide^nKMilh )M>ltle, and their vajtor intiak'd lor fii>ni ten 
to twenty minutes several tin>es dimi^ tJie day. A spray of 
menthol may lie employed : — 

Q Mrtithoi, ^• 

l*\. iini.vKd. (iulciH. rrl benxolua], f^f)— U. 
Slg.— ^ray luKt Ibu uom Hcveral llinca daily. 



Coau»o is oflrn cffiditit ii> allaying tlic Tiilnt^is and dislrufs; 
a fbiir ]M7 eenl. iw>liilion ntny l>e a])|ili<Hl u> the iiuhc uu a 
plinl^^ ofmitonor by luraiiflof ft (niiK-IVI)airl>rii»li. 

W Iwn th« gyrojiloiii^ arc sovei-e IXiver's [n>^i'd«' (gr, v) may 
be given in t^uubinatiou witli ({iitnine (^r. v) llmoi^ dnily. 


(Chronic Rhinitis.) 

Drpimtion. — A vhroiiiv inflnittinuuou of the iin«ul iniicoiitt 
nuiiiliiaiK', <AamrtiTiw?(] by irK;rctt»o(i M-crcliuit iiiid intjitur- 
moiit of iIh^ !Ktii.*c iif smt'Il. 

BrioUMiv. — lto|«caud atliu-kii of snmU; vorym, iiii]irii* nil", 
tho t»nliiiii;il inlialalioR of im'tatint; diisD nr vnpxis, lowered 
vitality, and ntngeoilal or aiA|iiired oliiitninion of tlii:* niL-^l 
chaml>era are caiksal Jacloni. It U uL'to an «x|)ix>8io« of 

V-MUKritM. — ^Two varieties have Itecn recognizMl: Chrunic 
byi)ortrop)i!c rliinitU nnd iluxHiic- atro|)luc rhinitis. 
" Hypertrophic Rhinitla. .SyuproMs.— A (luck iim«>ns dis- 
chai^ from tlic now ; ^i-Liit liability to attacks of ai'^lle 
oryzn; olMtniction of utH' or both nasal cavities, «inBill)i 
luoulti-bn.'atiiint; : a ivi<al intoniition of the vuiw; fiv>nta1 
licailncho ; uiid iiiijiairiiifnt of thu «cii»t< of «(ucll. 

SymptoniM of rstarrti of tlic ncipliborinp orsans lire fre* 
qnoiilly jmi*'n(. Tiw miwl ntnimon of tlic.iu arv : dryiK!*« of 
tJiit tiirout uvcl liawkln^r fn)n) pharyngiltH ; (k-afiti-s.H from 
calarrli of thi> middle eiii' ; and uuli'iing td' the eye» from cntar- 
rlial tHfltiHton <'f iIk* liu'brvioid iiniul. 

IiuriMvli'jn. — Tin- bridjrt" *'f lln- inw is rii*(|Oeiitlv fl:itlcni:<l, 
and till! ahi; art- l)iit-ki-nf<| awl nti ; tin- lom-oit^ nu-ndiraiw is 
red and the i«vi(i(:« arv more or lew <iwliidc<i from hypfr- 
trofihr of the cnverntxiH tisv^u* twwn^ \iw tnrliinatfd Imnfti. 
Ill advanced <.tM^ vxi-fiO'M-* from tint Inaiy framework are 
»omc4in)C;< noUil. 

Proositwir. — llndnr jndidoiLs and itentlftiiit trwitnient the 
afl«Hiion i* eni-nble. EST. — The moo-Jiliarynx miist lie kept dean by 





mean!) of anliKcptic doiicbeii or Hprays ; o»i; of ibc following 
may be enijiloyou : — 

1^ AcW. carbol, llq., in. SXX; 
SiKlli l>ilx>RU.. 
,S(n]ii iiicarii,, lift 5J; 
(ilyccritHP, fsiij.-w ; 
AquK, (|. a. Nil f^iv.— U. 

^. I-Uliridi.-, 

Mild astriiigvnt «])rays arc often nwfiil, and eulphnte of 
zinc oiwilpliatf nt't-opiier (five t<> tt'o grntiw 1o lliv ouo«')inay 
tn- iin|iloyt-i! lor llns ))iii'[hi!«\ 

Tonkw Itltt (iMl-livrr uil, liyiwiiimspliitfSjnron, ameni^ untl 
t>tn,'diiiiM aro olUii iiidk-uiHl. 

To cllV-ct 11 nin> tlie Hai*ii-i>!inryiix miift be »in>lwtrurtMl ; 
liy)M-ni-<>|>hii^ aixl i^xiwlnw^ inusr !«• ri-iiiovKl iind (li-vbitionii 
oi'itM' ^'iiHiiu oirniU'd liv i^iirj^iral iiiiniH. 

Atropuic Rhinitis. ( 'tiim/i.) SYMtTdiiH.— A wnw of drv- 
iKtw in llif »"•«■ Jiiid rlimat ; a tliiik jiiiniK-m rlisdiat^, or tlio 
<-x|»ilMnii Mrdiiw()l(>rL<d mists ; an ntlbnsivo, pnlrid imW, whk'ii 
lias given ri-w to tlw' torm of Ifuvna : inijuiirrueut of the sent* 
of r>iiit-]l. Thf gi?»eral htalth is nl ways |>oor; &uch jKiltonlct 
niv ii.tiiaDy (liin and ao»^inic. 

/hv</«Wi'jji. — Tlif cliambci-a ai-o larjre; tlwmiirau!' membrane 
w jialo, dry, and >;laKotl ; adherpnt scalw arc generally iireeeiit. 
In advaiineil t-a-SH, ulceration and netrrosis are oliservcii. 

l*K<MJNOHt», — rcrfwt cure is ibrIv obtainable; b«il treat 
nieul may efiiv( jiwut improvement. 

THKArMKM'.— Criwt« unist be removed and the naral 
I'litintlxTS kept rlwin wilb anti»)-])tir "pniv'inr doiich«. Stim 
iibiliog npiiliraliDiis an- ntH-fnl, and tuiliilionii of nitnili' i> 
silver, sulpliatc of \rv\i, or :<iiijilmt(- nf zinr may be <'iii|il"y(il 
iieiiend ton>i.i< lild-rud-livin- uil, liy|iopl»o&p)iitu), iron, uiwuic 
etc. are indiuiled. 





DBPtxmoN. — Au acute eatan-hal inflamoiation of tlie 
iarynx, cliaRict<.'rm-() by hoatiieness, hard wiigh, aiid paiDfiil 

Etioukjy. — I[uprr)|)«r iiee of the voit* ; c!(|>okiir' to «tikl 
mid wft ; tJK- tiih.ilutiun of irritating tlii»ls or vapore ; llic ini- 
(luctioii of foi\-i)^i Uxlivs arc its (.■ommoii i-niKts. ll u ulsu an 
amnydntv*] i.i)iiilitio» in <vrluiii iiiftx-lioiii^ (tifLiiKcs, like whuDji- 
iiig-4-oiigb, nRW<ln<, <li|iIi(lMrm, tui<l iiilliiciini. 

I'ATiHHJXiV. — 'Hic diiK^iii< niiMtilmiiw is red, swollen, and 

Ill gmv« cttim iIk- (is^iK';* may l>c mnrki^lly nylciiinUKi!). 

SvMPT03dS.^H'iiirsfm-s.i of llie vtiiiv or n|iti(>iiia ; liiirrl, 
riiif^ii)! cough ; ))nin in tlio tlimal iii(-r(-i)M-<l by »|K^kiiig, 
iiMigliiiig, niHi.HwalloMJiig ; ('xiMH'toration, wliii^i is fimi ^■aiity 
and lalt-r nmwi-piinilcnt ; fi'vcr and its aj^ofiattxl itymjilmn!*. 
Ill sensitive itwjpli-, and fwiMi-ially in i-liildn-n, jiamxysan of 
iToii|>y i-ougii and dyspnu-a (falsrr crouj») may refill I'niiii 
Hj)a»a of (lie vocal cords ; ami when there is touch mleina, 
drspnon or as|»hy\ia will Ik? a prominent f(ntnrc. 

/n«p«i(toH,^Themii«iiiH tnt-'nibraiic of ttic laryngeal walls 
and vo<*d corrls ii- r«l and swollen. In gniveeaees the tiKttes 
are highly <(^IcmutoiiT;. 

Pwkisopii.'*. — In simple Inrynpli!! ntlhoni twlcnia tho prog- 
nosis is allogctlier luvortiblc. The ultiH-Jc n^^nally luslti from 
a week to ten ilayi^ WImiii ilicrc i» oHlenm of tl»c larynx, 
indiratcil by dyspnrryi or u-nphyxia, l(u> progiKHiH is gnivc. 

TrkatmkN'T. — TIh- iKitit'ni rthoidd Ik- ouifinitl lo his mom 
and prcfendiiy to ImiI. The ti-mj>praliirc of ihi' r>Hini ■'hotild 
l)e 70** or 70'^, ami iho alniiRiphffi- iihoiild lie nioLiiuied hy il«> 
gtinerattoii of sUam. 

Inline, or in xevi^ix- (-iim--i an ice-blatldcr, ahonld be applitti 
to the lhr(»l. The inhalation of medicated vapom is decidedly 
iDteful, mid one of tht- following may be employed : Liinc- 
watcr, I>olx'H'n Holiition, wine of ipecac (diluted with two 
vnlunns* of water), or the metithol mixture mentioned in the 
treatment of actnu curvai. 

174 UIHKASIK OK THE K»4I>I KATimV fitfrTFnf. 

Inlaital TVeaimfnL — Aaline laxitivo may Up ftduunwtt 
aC the beginnintr. and rnllowed byune otihe follntvin^ m-cIu- 
liv<^ mixliircs: Dover's powder (gr. v) witli quinine ^r. v) 
ihrice daily, or : — 

IJ I'i>la»ii i-itmti*, 

l'oifi»ii bnnutil., fill .^ij; 
A|>»iiii>ri>b. Iiyilrixlilur,. gr. J ; 
Aqiiiv t'l »j'r. sni-»iti.irillw oiiit)., US rSisft- M. 
SIg,— A b^Mpooiiful every two houn to a cliilj o( live yvnn. 

Or— ( >rn; i)f I In- fi.illowing tabK4« di;vi!wcl by Dr. Seller : — 

9 I'olnwi, clilor., 

]'i>liu>H. bniniii)., 

I'lilt'. i-xt. ifl.Vi\vrr)iisov, U ^ ; 

Tiiicl, r«rri clilor., ISw ; 

Sacdiar,, I'lc., q. »,— M. 
Fl. In trcMibiwI No xx. 
Sig.— One cvBiy tliroo or four Iwuta, 

(I'>](!nift of I)m> tar^'nx, in<IimtHl liy cxln-nio ilytipiirn, will 
ro<|iiiit; Mar i Rial ion of llie niucow iiM^ulimne ur traclieoluiuy. 


Sfmpla Cbronic Catarrhal Laryngitis. Svmptous.— Tlck- 

liii); ill l)ic ttimnt, hUKkinr^'^ nT lli<r iniix-, r[i(i);>i<- aitrl jiuin 
ailt-r iniM)erat« iiK'of tlic voi<'o, and tlKH-xixiriointiiKiiof vtnriti 
mudts are (lie nsual syni|itoinH. 

iMi-j/ngoaBopic cxamin'ilion rcvoels rMlii««( of ihc miloous 
n>fmbrai>c nnd sometiniPB nliglit ulcfiiiliontt. 

Tkkatmknt. — The ])ali«nt must l<apii lo ni-o iho v<>l<'c 
])i-o()erIy ; suiimiH must be i?x|k']|«] by ttie aUloiDtnal miiM;l«* 
and (liaplini^m, and mH by tlifi iimscltTi of (lif ibnKiI. Klan- 
iii;l ))ii>(<M-t(ii'H HboiiM be avuiil«<l, and tbt' a|i|ili<"<it!<>n of nxil 
water to tire neck, nigbt and niomiag, instituted in ilieir stoud. 
T.init-s are generally nidiratct). Expectorants witieli an? clini- 
inattxl bv Ui« respiratory niucotis otembrane are useful ; nnti 
line of the following may l>e ein|>loy«i ; Terpl)ene (gtt. v on 
Miipir), olc<on.i<iii of eiibebs (gtt. \-XX on sugar), oil of uucs- 
b I''"" 0>"- ^' '" ■-'n]"<*de). 





TnplntI Tmiliatyil. — A faniilic <'iirix-ii( lu llu^ mrk U ofliii 
U'lU'liciiil ; iiKiliciiltii M'ltiliiiMs^hoiiM U-itiiiilii-il Ut tlic Iiirviix 
bv iiM-uiii* of a bni.sti or nlotiiiiutr. 'I'iti* Hilliiu iiij; iin' |)h> 
ri'iiiixJii^ iviiiniiiiilv cin|>1i>v(^ : Nitratt^ of tulvor, (rliloi'idf nl' 
uniiiioiiiiini, vtilorntc nt' |>(;lai«iiiiin, fltil|)luite of xiito, iiixl titu!* 
turc <>r tii'Li/iitn. 

TuborciUous Laryngitis. — TitM h it(>arly nU-ays »(«i)n<Iiiry 
to {iiiIiiKiiiary tulKui-iiluHi^, but it ocraiuuiially iHx^uransu jm- 
niary aHi*lioii, 

Symitomh. — ] [carsciK^s of the vohm> or a|th»iiia; i»in in 
tlie tlinat i[Kn-:i§cd l>y coiighing, siieaking, or swnUnwii^ ; 
aiid hacking uoiigli are t)>o iif^uol flymptoDiTt. 

IjartptgoM'oiiie Kraatinaiion. — llie iinieons menibrant! 
pale and tliickcned ; ttie an'tcnoid ranilngcs are «iii«(knil>!y 
swollen ; Kniall, irrc^'iilur. i^liallon' tilt'er^ witli gray bai%s are 
freqiicntiy noted, mriiciilarly in tlw; inttT-ai^tPUoid Kiwoe. 

Tbkatmekt. — ItcDHKlicK niuiit bc dini-tM (o tlw primary 
pulmonary' dtscaiic. Ijoad applirations nix- rcfiuirtd to relieve 
the pain. I'owiU-rH of iwloform or niurptitji muy he dnstnl on 
llif iiWrs, or a «u[iili<>n nf nitnilo of Mlvcr, ul rxKninc, or of 
mentlitJ uiav !•«■ u[>[>li<tl by nu-uitsufa litryitf^l bruitti. 

flyphnitio laryngitis tmty inniiilV'Nt itwif in cntarrliaJ iii- 
Sumniation, or naitftii.-' [KttibcH, but ilic itM»t t'oniDiun oxpmi- 
ston is a );iininmtoiiH in lilt rat ton, wliidi bnntks down, ukiiutts 
till- cartibiiirt^, and tilrlmatitly ktuU to tiiitilrixation and dc- 

Symptoms. — H'<iix-ih-w of tin? voii-*', luH-kin^r mu^Ii, and 
M>Tiii- (bflii'iilly ill I i'"^!!)!! lion. Siibjcrl ivo .HviiifHumn an: often 
MiH<-nt, thongii cxainitialion may reveal exien.tivc Imotni. 

jAUrynt/tmvtpie J-Utunhuition. — Deep nlecnt uJtli raiwil wigii!', 
oft^n xyRimelnnaJly arranged. Neci'OMii of tlie eaUila^-s ro 
niilu ill advanctxt caai--*. 

l)iAi<N(»«t.-i. — Tlie hiMory, tl»n pixaen«> of oilier iiy[diiltliv 
li>Aion^ the deep symim-ini'ul nlceis, Ibo efiivt of Ii\iiiint-nt, 
and thc! alj9cni?c of marked iniin and of pnlmonuri- t<vt<>tiH will 
servfl to drstinguiftli it from twIiereuKms larynjiiliri. 

TkkATiikNT. — The syd«n) should be rapidiv bmnght under 
tbe iuflueDueof antn)y[iliilitic remcdiea; for tbis purjMcit- ni^r* 



oiiriii] inunnidtis niny be emplnved, and iodide» and aiercuria 
giveu inlL-mulIy : — 

[J llyili-ar,!. chliir. rtirro*., rT- ji 

I'lilJiB.i. iutlidi. 3i.l-3iv ; 

Syr. mirsMimrtlliPtiufuji.. fSi**! 

Aquiv, (J. 6. »ii rjiy.— M. 

Sifj.— A (c-ospoonrul twricc dally after rocal*. 

Lmiit apjiiioUumn, c«n-f'iilly applied bv ilie aid nf tht- \avyn 
KO«ou)»u! rnimtr, aiv nl-u) ivriuinKl. lotlnfunu, nraoid iiitrai 
of miToury (1 to 5 of water), i>iay lie sclccteil fortius (MirtinMu 

WIktii tlio Liryugml niovciikeflla inlerferc with tieaiiii^, 
ttiii-iii>F(()tiiy .-lioiild l)e |H'riitrniMl. The saoie o|(enili(m or 
nKi'lu'inic'iil ililantiioit is sonicliiueii nxiuircd for ttie rt-^dtiug 
nculnt^nl sleiiuflitf. 

spaSiMoi>k; c^roup. 

(FbIm Ctoop.) 

DKFiNiTinx. — ^{ULsni of the vocal eord», exrjted hy ntlai 
..rch(' larynx. 

KTKii/HiV. — Tlio atla^'k.i UMially ooour iit yming i^liildrtii 
and arc itMlnml by tlti- »iui<cii of catarriial larvn^itU. 

SvMITDMs.— fii-nerally there lias Iwrn a little hnarM'nns 
and oiiugh iluniig I)k' clay, simJ at ntithl the diild b amil<en«-d 
fi-oni nieop hy a fte\-en> jairoxysni of snfTitcarive ixwgli. TIi 
lattrr lia^ a iie^-nliar, haifl, imlallic cjiiality, ai>d Ls atv^Hiatctl 
with iht-'evidiiKi-sof dysjHuta, namely : Anxinnr^ fat*, diUliiig 
nostrils, prominent Blemt>-clei<lo-mastoi(U, and retraction ol 
the l30fie of the chest with each inspiratory effort. During t\\ 
puroxy&ni the i^in is hoi and the pulse ifl tense and rapid. lai 
from a few moments to an hour the eongh ocasee, frre pcnpi- 
ration follows, am) the chiKI falU to sleep. 

Two or three ximilnr iittaokti may oceiir in the ^me night, 
but on the following day t)>e eliild appears quite well. A 
nieiirrctivi' of the iwizurcK for several sttcres<ive uighta » not' 

DiAOWWis. hirgtv/iinnuii fUnihilm. — Tliia is a pnre m- 
riwis, and i.* ofli-n iiHNtH'tal<:-<i with the rei.4iitir dtatliesis. Tlw 
juiroxyHiri-t rcM'iiibU- lhof« of tiihse iTotip, hut are aa«ouiat«d 



wiili a [ipciuliar i-roMinj; iiwmratioit, and lui-k nitarrlxil i!vni|>- 
Iijui-s i'lK.'li ii" lioan^t^De^ nnu cough. 

I'lMMiMieiiK. — Always lavonibl?. 

TiiKATMK.vr. — A sponge moistened wilb hot wat/r may N; 
tt))[itit'(I to \in: Uiroat, or the cliiltl may be |>la4«t] in » Ixit Imth. 
It'ltii'si:- »Ini{>le mcnsiires tail, an emetii* nil! almiint iiiviiiJiiiily 
liritig n-lii'f. Wine of i|>«ac(5j)or tuqwih luint-iiil ij-r. iij-v) 
may be neleeted. Stibw^uent treatment should be directed to 
the lar}'n)ri-ul catarrh. 


(Ctoupou* liuyngltl*. Tiue Croup, P*eado-mcciibranou> 

Dekikition. — A non-infertjoit§ inflammatory (lii«eH^> of tlw 
larynx, ohai-aeleriKed anatomically by tlte formation of fiil^ie 
menibrnne, and clinically by hoarEenesB, bariiing eongii, and 
dysniuea of gradual (Ie\ eloprnt-ut, 

hxioi/MiV, — The fumiation of false membram? in the larynx 
nsnally results from diphllicria ; but a membranous intlammu- 
tion, nou-infecliona, is sometimes observed. Karlv dnldlHiixl 
(between two and five year«) and cxpomirc to eo)d and wet 
are the |iredi)i|M>!=i[ijf causes. 

A membranous larynsilJs may alw remilt from the direet 
aettoii of )4ron}; acids or alkalies, •waliliti^ water, or bleani. 

FATimi-iKiY. — The larynx i^ linul with a grayisb-whiu- 
pseiido-mcmbraiic (vbicb ie moro or lerv atilierenl. The laitces 
arc rarely involved, but the menibniiie oecUKionnlly cxteuds to 
tite truettcft. The escape of (l»e laiHi'S h » |>i>tnt of difTerenee 
Ix'lweeu utomlmuious cToiipiind diiihihcria, for in Ihe lattery 
the tani'eH are usually pntiinrily invulveil, The membrnno ' 
tjiiili? iiu|>erlii-ial, and raifly involves lln- submrnxiuN ttitiiue. 

I'uder the micn)^?><[M! a fibrilisr tw-twurk ii* foimd, in (he 
meshes of which air leuooeylw and eiHtlu-lial irlk. 

SvjicniMS. — The diw<i»cU!iuolly U^^inAwilh lhci(ym})tnm4 
ofcatarrlial laryniiitis, namely, h'nu-»fn<-*<, barkitif; >iiti^li,un<l 
>ili|£ht fever. Soon ]ion>xv.'«nv-<of !i|iiL-iinod«' rrou|>u|i|niu', ami 
in (he intervals dv^jmoM ^nuliially ili'veiojis. The ifriiiira* 
ijotis are rapid and noisy, uiid niv ofteu aijrioeiatetl with a 


n'Vistliiig, i^tridnloDH in^ipmitioti, TIu^rG is intHWrutp R 
Willi till' iricroaj-iii;; ilyspiura, the iliild grwwB cxtrtniply rert- 
kss ; ibe lit'a'l in (orciljlv cxtcmicd ; tl» utip of llic nwv |iliiy ; 
th« fitcnH>-<.'li>itlo-iiiu«luiOs htaiiil out pruiuinvtilly : iin<l (li« 
base of tito diost rctrnvbf niUt nit-li vJulcnl iit«|>init'>rv t-irort. 
In the |jai«.\\'«tii» ofiiMigiiinjj, ii iiiccv of fulw iiK-mfiniiK- tiiiiv 
be <]clac[ic<l uti'l rxiK-dynilr^l. llooilvuncs* gixHigivis [ila«> tu 
a|>}ii:>tiia ; ninl tlif (iiiirIi, hI fii>"t liijrxli, irmilnHlIy Ixiimw'^ in- 
iiiKlil>k-. Kiiiiilly, (Ik- lijii lti-<x>iiic lihii-; lln- piilst- uv»ki>ii.i ; 
tlif tcttiiK-cnlnrc fiilU; mxl tlio iv--<|>inttioiiH Inixitiu! ii)iiw]ibl«^ 
Doilii li often jiiTOwkil liy Mii[Hjr anil ounviilnkjnB. 

Diagnosis. Sjiagmodie ('roup. — 'l^lie tly8)>ii(i<n in {nrox- 
y«nal ; tlic ntlJU'k» tiHunlly ni>|)car at ni^lil, mid fiften iu the 
mitUl of a{)t>ai-<;nl httiltli ; ant) iki fats<' mcinlirnn<^ U ox|nw<o- 
mUfl. In ime rmii|i tin- dy^imn'o *i(rvi'luiK'* gnxliially and 
1ki!oii><5* cxIn'iiH-, ami titU- iiifiiibraix* may l» i>x|i«H<>raI«l. 

Itnryivjettl IHfitilhrrin. — Tlie ilrtrtrtifin of (i>Is<- nic-iiiiiranc in 
Uh; lliiiit«. It liUtory of coiiiagion, gravr* Hyiidtinii: n'iu|iloni», 
alhtiniimiria, and mich coni|>!ii-ationt) an inralysiit, MMMsixlitiH, 
and ne[^rilis would indicaU- diplillicria. 

IjaryngiamuStrUlHliu, — Tins is a nervoim affection, Wtaran- 
torix«d bv |i:)ruxv»[]i« of dyejituea aeoompanitil bv a jHx-nlinr 
crowing iii^ijii ration, Thf attacks occur |Miriodically in tUv 
luidsl of a|>]uirctil hiiillli, ain1 la«k fever aiid catarrhal sytnjw 

I'ROoyosis.— Unfavorable; from sixty to Mglity per cent. 
jK-risIi within u wtt-k or ten days. The more lix-al tliv dis- 
i-aR', the old'T iIm' patiful, and the inorv vipor^ms he ia, ihu 
Ix'tter the |jni(jiiosi», A n'liini of voitr and audible breutlv- 
iiiff, a \<jifai! citi^h, and |itiriileiit ex|KX-t oral ion nrc lavombli 
ii>di<«tii>ii.-^; but iiirnn'<in); ni|Hilily and wmkiicM of t 
]Hili«, Rvnnotuft, and di-btlity iiidiiittv a fatitl isiiic. 

TRBATMK.VT.— Tho (.iu [hi ratlin' of the nwin AiwM Ih- kc_ 
at 70", and tite alniu-<)thiini:' nbonld Ih- nioiMoti<i| by (he {;<-ih>- 
ration of Meam. A Meani :itiiini«-r iiiay Ih- rinjiloycd, or linic 
iiiay Ik- wlacki'd in thfirm>m. M(Hlt«il<tl spniyNam- !»inm-iiMic» 
ii^ijcuini-mleil ; sonic tiir|K-ntine or oil of (■ni,-aly|)tiiH tiiay be 
aildcd to the water in the receiver of ilie aloniiiner, or ntay Ik- 
plneiil on tlK' stirfucv of water which is kept Ixiiling over 



iitove i>r spirit-lamp. Hot fonieDtations or an i«>-blliddvr niuy 
Ix? ai>plie«! to the nwk. 

Tm^ bot iiilernal ^Ivettl lit our ounimaiHl is niiTPiiry. A 
liftielh of a ([rain of IIr' UtchlorMk- nmy Ix- H'^'''""t **'" <l''iH"l. 
cwevy lionr or Ihm Iu ai-liilH n yf«r ii|it,iir ii <iiiiirliT of m |;raiii 
iif palomi-l iiisiv Ix'ijivcii cwrv hoiir Icjtidiili) of tin- sJiim- ngo, 
and ifiti-'xnti:«<li)irrltim, a liuJepiux^urir may bv utliiiiiiiMercd 
with each <li>Nc. 

ft Ilydrarg. chlor. (!om»,, gt. t ; 
Ainnvni. dilor., gr. xij ; 
Aniin-, r,?iij, — M. 
Sag, — A IrJwpooiifnl ilitiilcd witb n ileHMTtspumiful uf nator uvei; 
hoiir lo n child n ytiir old. 

QtiintiK- 1,^. iij Id sn])|>o»ilory) n)»y In.' *.'iiiploy<il llirec or 
four times cliiily, 

Htimulitnt>^ an- fntimiitly inilu'iitti!. An fim-tic may lu^iitt 
in till- tJtpulMiiii of l<KKH^' iiK-iiilintnc. Tiirprlh tiiim-ral (gr. 
iij-v). alum, or iprtiu- mny Ik- wlitUil. 

T<>}ii<yil Mfiiciiluni. — 1(1 tin- viiy yotiiig it may be imnoH- 
sibU- (0 briii^ mKlitnUil itpnyr' in ronlm-t with tho nffM^ed 
jmrtM, lint wlu'ti it i" f<wibl(! miicli benefit aM-ruts IW>m Ihis 
iiii-tliiiil of tit^Iim-Dl. Anton|r the ftnliitinns n-commfrndul 
mny U' iiieiiiimH-d, lime-watiT, IWjell's solution, latlie acid 
i I to 10 id" 'Ki), and jx-roxide of hydix>gfn ; a fifty per eenl. 
solution of th*' last is uSien vury effirieiil. 

Wtien tbeiio reniu1ie8 fail, aiKl the dj-spncea and cyanosis in- 
<-reaHe, and the pulse grows rapid and irrq;iilar, intulntion or 
irai'beoloniy must be performed. TJic nvalts of iniulmlion 
are sonwMrlmt more eiieoura^in^ than iboEe of tracheotomy. 
Ftetween thirty and forty per rent, rerover after these c^nt- 


(Bp«Hun of Uie OlattiB. '■Cbild-orowiDs.") 

Defikitiom. — A paroxysmal neurosis, characterized by 
Bposm of the adductors of tltc larynx, and i»ot excited by any 
local iiiflimimatiun. 


vnKAses or tub respiratouy sv^riiai. 

Etioukjy.^ Early life (within (he first two A-earfi), nu 
)H-.\, »ik] tlir rn<-l)Ui<- duilticisi!^ lire the jn-ediHjwfsin); tnuia 
The Jisi-harRe (if nKklor (ijrw ii|)[niiviitly aripes in tlie iiitiltili 
(I)iilbar i'j>ili'|iiv>, Hinl iniiy he cxdted hv reth'x itritatioi], 
in teething iirit] ^■.■^rn-iiitc^titinl ih'soixici-s, 

Symi^ums. — 'Htc attiLt'k^ ufU-u t>cx.-nr on nakii^ from alet^ 
and arc chunu^lerixed by a ^iiddtn arr»i uF hn^thinfi; aitc) 
tonit^ tuuwiiiiir fpuKiDH. The i'wv i:< imiU-, und hitcr cyun^ieet) 
ih*' oyw arc rtillwi ii]>; the hody is arched ; thv Ihiimlis a 
tiirnoJ into the |>alin.« ; thv h-gs arc cxtiixkil, iiml the nolts 
turncxi inwunl. In a l(.-w m(-ih>ikJs the mhimii rL'luM-o, niid air 
is dnvrn thn>(i<;U tlie gh^ttiii with a shrill, cruwing wMirnl. 

The svizuit^ vary gniilly in rm)Uviiey ; Kivcral may occi 
in a day, or they may be uveks npiLrt. 

Iti.v«SWi3, — 'Hie intiTiiiiltoiil rJianw-UT of the nfTefrtioii 
the iHitiliiir cmwiiig iiLiinratioii ; tin? alitk-mv uf fcviT, eoiigli 
an<! li(H(ri«»it«« will wrs-c to di.Htiiiguiith Inryiifrisniiu frwn cmiyj, 

I'ltmiswisj. — Favarahk. In llie very young doilh ma; 
rcKtill fi»iii i>iiir<)oali<>n. 

T«EATMi-:N-f. The Partxeyim. — CoM wnUr nmy lie dashed 
iMi thn (aoo and head, or a few dmiM iif nitrite uf ainyl or 
diluntfiimi may be placed on a Itaiidkcnrhl^f and held Iwfon! 
the n>M>e. 

Tlte InierraL — C'flrefnl M>arrh Nlionid l>e nuide fur soin 
exdtintf caiLse; the ):nm« may recjuire lancing, urthc^ru^. 
inte-itinal tract may demand attention. The child Mhunld 
iIk<^ under the best hygienic conditinn.'*, Tho (iiud ^lunld 
w [)lain and mitriliouB; tunics, like md~liveroil, malt, hyjK>- 
j>h"«jihile», and arwnic, ai-e |;eneralty indicated. The hroniidu 
111' iH>ia.^iiim it; an efGdenl antiejiasmodic, and uiuy i>e udvau- 
lageouflly combined with anlipyriD : — 

IJ Antlp.vrin, rt, sxiv-xlvitj; 
Potaw. bromld.. Skw-sij; 
Syr. nnmiil. mrt,, fJO • 
Afluw, n.i. ml fa'U-^M. 
SIg,— A Icocpooiiful Uiricc iluity. 






(CSdoBu of Uw OlottiB.) 

DKPlxmox. — All intiltnittoii wF »orou8 fluid into the enb- 
minxHiis lissiic i>(" llif Iiirynx. 

Ktioi,(>civ. — li <iittu'ioiiiilly ri'wiills fivmi iicvcrv nttackfi of 
onlnrrliitl larvii(;iii!<. ll rniiy ^>l^ iitdiKti^l Ijv wvwx' iiiflnmnia- 
lioii of iU'i^t)lKiriD|r rir^iiH — iiA tlif liin»iU, |wiro(kl );lutid)>, 
and )>liarvnx. Il may Ik- a coiiiiilii-ntioii ot tttiiiiv ik-iiIi' jiifti'- 
lioimiliwriii.-.*' — likt' di|ilil)iei-ia, txiirli-f fcvrr, nr fiii-iiilcry&i|>cliifi. 
It is Aomelimis luisix-iiittx] wJili nli«ralivi- atlHliinw uf (lie 
larynx, liko tiilierculiwis aiul »y[>liilit^ It ntay Ut i-xciloi! by 
tlie iri'italiaii <if bums, w^ld", or cauhtica. Il utxtt^oiuilly 
occurs 3brii[>lly in (he coiirt« <if Briiclit'tt diwaite. 

Patiioiahjy, — Tlw pounwtivc (ii*>iie of tltf larynx is infil- 
1 rated uitit a i^emus'ir at'rn-|»iinilt'nl fluid. The mucous iiK'ni- 
brauc U If'SLic and elian^wl in it'hn: 

.Symitohs. — 1 Itiarsi>iH'*i nt* lh*> voiw, ami laltT agihonrii ; 
eslrHiu4> tlmnKsa, at lii^ on in^jtiralion but later nn cxnimiiui) 
alfio; itridulotiii rv-Miiiration : barking ruu^i; and llie evi- 
d(rn(«a of dyspiMTu, namely: Anxious fecc, protniding t-yf», 
bine lipa, fimmincnt sitrno-fleidi>-niastoids, and rt'trat-l ioii nf 
the Iwfie of tlio dti-rt. When tlw? epigloltis is involvcti the 
su'clliitg can he drtt.iled by the finj^r on the throat. 

lAiif/ni/o*copie J-^miiiation. — The uiuoous membrane is 
swollen and uf a r^hlish-pui-plc color. The epiglottis may 
n%eiable a ratmd traiifilucent tumor. In infraglotti<r <rdetna 
the up|>or (lart of the larynx niuy appear nurinal, but swollen 
and u?i)eniaio(it> UK-iidirunc ii> m-vu projivting tbroujih the 
gli.tlis. The vocal itjrtU arc rarely uflivtl'd. 

l'iMXJN4)Mii«. — Extremely j;™^*'- 

TftKATMKXT. — Wbrn the syinptums are not urgent, leeetics 
or btiKtcr«niay U.- applied over tbv Lirynx, and iLi>4rin)^nt iwln- 
tione {tuinic aeid or ninni) sprayed on the (f<l ini<( tiNtuea, 
When the fiymploms jn-rsi*(, the jwrl.-s ^honld be jKurified, and 
if tlnii liiiU til ixtlieve iIk^ dypnuu, tniv'lK-uluniy ebuuld be 


Definition, — An infliniiiniilton of the bmncbial tiitw^, 
I charactt'rij»«J by siibi<trrnii1 wini'nc»». couph, mtioo-jKinil<-rit 
I exneclomtioii, ami dri' uihI moisi riiU«. 

VAKlBriE».— (1) AomIp miorrlial brwndiiltt. (2) Chronio 
iLroncbitJs. (3) Capillaiy brondiilM. (4) FibriiiMut broit- 

Acute Catarrhal Itroiicliffis 

Etiology. — A <vl<i, diimji i-linrntf ; c-lioiif,'r3ibI(' wcnfber; 
■KnipatioiiM wbicit ntix^^ilnlo ix>iiltiK-mon1, or tbi- iiibtttiitiun of 
im'tatiiiii iltiKW ov vii[Hirii ; cjebilily ; lb<' gi'iitv (Jiiitbr^K ; nn<l 
diriHik- liciirt diseaw aiv geiii'ral piiediHiwiBiitf; fiU'Hir*. 

Kxputurft to «ilil ami wot, particitlarly wlieii lh«- body w 
i>vorli<4Ltiil, or ihe inbniution of irritating gasts ur diistH h ihv 
ii.-<tiiil <txdling raii»e. Aoutfi bmnrliitis is alrni an siuocijitt^il 
111 11(1 it ion in rerlain infections dispiisc-s, i?fl(>ecially hmmsU-s, 
\vb(Hi[>ing-oim)fit, tv]>boi<! ft-vrr, and inflncnan. 

»1'atiioijchiy. — In most caws tbe trarbca anH lawe (uii«< 
only are afTivted. The iimwus nienibraop is red, swwion, in- 
^Vd, and more or Kea covcrc-d willi tcnacioitft mu«>-pufi. 
Mi<!nM>co|>ic examiiiatiun nrvrals desquamation of epitlw?- 
litini and infiltration of the suljimiwus tit^iies with leucocytes 

ISvMnviMfl. — C'hilliiirs! ; malijiiu- ; a w-iim' of RonriieiM anil 
■constriction Ix'biiid tlic BtiTiitim. whiib is incrcajod by coii)ili- 
ing ; slight fever (I0(>°-I0'2°) wilti ils .Ti.*ofiatc<I sAiiiptonis ; 
cough at Bnit dry and piiiiilid, Ixit l;itcr ueeompuuied by 
nilliu-)>unili'nt exiK-ctoiiitiun which lx-(K>nie« (juilc five as llie 
inflammation siibtide*. 

I'llYHICAL S[tiN8. — l».«|M<(!tion, ixtilpatiou, uiid ]>en7ii!»iun 

t usually give ncgativo rtwill.'*. 
Au»p<iltatioii nt fin** revmls nibilanl iiiid »unon>UH fsk« on 
both Knles of iIk; fhi5*r, and in thi» wmxmmI i«tagi>, whwi mcrvliun 
iaGslablislHil, moist i-Ati-^ 

J DiAfiNosiR. In/lumai — High fever, i»|pii'<e imin in ti»e 

ni«wl, back, and limliA, and gn^at jiruHtration will mtvc to diit- 

tingiiiflii intliicnui from bruiivhitih when th« former i.-t |»rcvaleuL 



CalarrfiaH'nntmonlit. — StiMlcrately liighatid irr^ilar ft-vt-r, 
pro8tralK>i). nii>i<t lirealliin<;, (iyripii'ini.iiixl I'liyiiiiL-al ■■ii^im iiuli- 
catin^ culls' ilkiati' 111 will s^-rvo iti tlw^ rtt«)Knition of )»iKiini.jnia. 

I'in.KiN'.K*it^. — Fiivoruljk', III tbr M, ywnij:, iiml fwbic 
there is iJ»ii|;^T itf il« Kutliiig to rapilluiy l)inm-hi(H or ratur- 
rliiil ]inriiiiionm. 

Tkeatmknt. — The nlwrtivf tn«tiiiont cunMsts in the usv 
of lii>t f<K)(-limli.s, II iiitiMiuixl ]iIiL«iiT 111 Ihi" i'fi<'»t, rhe iiitcrnul 
ucltniiiiMlrati<>ii uriiiil ilrJiiks, iiikI n t'lill tlii,<! iif Iluvt-r'f jmu- 
drr ();r. x) wIili ^lirHi <|iiinim- iiiiiv 1m> ailvaiitagtw>iiflly com- 
liiiK-<l. Tliiri iiu-iIiih) U only ajipliiuUi^ in the initial stlape, and 
to thiiM- [mti<-nl<i whoatv wilMng to rcniaiu itidoont lor iliv fol- 
hiwiiifr twrnty-liinr hours. 

TW yoiiii);, «M, and enl<:«hl«I rihouM Ite coiiflnt^ to Ufd. 
A lnr|>i-iitii>c st4i[M>, niii^tanl plaAicr, or iodine may be applied 
tij ihi- ihi?"!. 

In till- i«rly Mag*? when then* is Mil)eiemal min with little 
111' rill ex iMHl oration, sedative expectorants, like ijiciTm', the v«;- 
c-tahlo mtts dI' |Ki4aM^iini, antimony, and a)K>morphia are inclt- 
cated ; and it i^ wtH to FumMne with tlietn an opiate to check 
ihe harawiii^ nHi^h. 

9 PoUt>8. c-ilral.. Js* ; 

Apomorphiic liydruclilor., gr. J ; 
Syr. ippcac. f As*! 
SiicH limi>ni», TJij ; 

Syr. )ilm|>.. q. ». iiu fjiv.— M, (WO0I>.) 
Sig.— A tlcsscriAjiooitlul, in wiit«r, every Itireo IxNitn, 


^ Vini ip«>«>ciiatihir. fsij ; imlniK citrnt., fjir ; 
Tinol. opii <ntii|>li., 
^^v^. acnciw, U r|J.— M. (DaCobta.) 
Slg.— Tabte«iraoulVil Uirice daily. 

In aevere vasv» with 4]yApnu>a, inhnlatioit-i fr»ai a ett^am 
atomizer often pive n-lier. Wine uf i|)e<»c {with twice its 
volume of water), lindure of I»l)elia, or tincture of coniuin 
mav l>eem|dayed for this [iur[«ieie. 

In the bter fl<agi», \t hen e.^|)ectonition has Iwen «fttaliUshed, 
stimulalingexpectoranLiare imUcnted ; ehloride of ammonium, 
BqiiilU, 6pn()^ terebeiK, tar, or c(ical)'ptiiB may be selected : — 



9 Ammmmu eUor., gr. xl ; 
Sjr. wilte. 
TiiKt. afi|cuR|ilL, 
Ext. pnim.Tnpfk 8., a fjm; 
SjT. aeMw et MpcK, 12 1]. «. ad (SU-**"'** 
^^— A taUnfMK<wil mrj time boon. 


9 Tind. npii «mpb.. f^^ ; 
Srr. pnm. riirui., Qb* ; 

~ I liii«SiLe, q. k. aid f jtT. — 3L 

Sig.— Pindrgpioatagw.frMlBRlli bacMMedloun thrice dailjr. 

niroufe BrottrhitK 



&rtoUMiY. — It aaj nsah fratn Ute ntBtiaualton of an 
ttoitc Ktiark ; bai it iwet ctMuraoaU <Jew)ii(eptadua]),v fnuu 
tbeauses wkieh itidimihe acuw dcw*^ namdv. a ailtl, ilatnp 
dituatp, dtaagBihle weatber, pfon* distbeeis, cfarcioM- wrplirilis, 
ukI btart Jiwiw. b IB MBMidlT wmioii n tbe old. 

It la ■nasmcntad wiwWiw m tsaghneiBM, pbthme. ctimiiH- 
iaterrtiCal poKiBMMa. ami in mnr taim. nf iKtiinuu 

PATllotj>6T.— Tbr tnaoMic mteaimnt of tbtr timnchi ta 
MWMiimrs tfatdkracd and PDOffaawd (nmi ma uvcrpniwth tif 
tbr cuoDccUTr tiamt ; m vUmt cnes tbe inmM in ibin from 
Utvpibk' cbngtK. Tkc Mriaor is awallr wv eied wUb tniico- 
|m» : akrt$ «t tPcaiiwHy waltA. 

LmyWw Ka g bw iw A i nt kad< to dtbtsliou of tire lnln< 
(BnMMWMtwtt) lad to nB{4ir«na. 

SvMFrw**. — ^IVrwslvM tooA and mwcr i* li's* inttii>-piini- 
katt «fMv1ontfMtii ; m »tt« af aotmcaB frfaitid thi^ Mcniam. 
F«irer v iwiUt akscM, aad mle» th« ilKwasc 'a nfr ^«rv-vn% 
thf (MMnl hnillfc Mvr be Guriy well nraavod. i>i-s|>D(ni 

tti IW mMltiav mfibvAma tUn to tbr broii d i i iiB. 

l^)^'sK^il ^n^.vs. — l'ntr<» rtnpbncaB bv d^rdnped, Jn- 
sjx'v-tiuu, |<nlfttii>tn. and pc ww i H o etw Mgative ii mllii 



A it<M-(iltatioii irvcnl* riiki*, wjmc of wIiiHi are drj" and 
wlKt?ziiifr, vrhik- i)tlK-r« urr iiioiitl ami liubbliiig. 

SpRiAL VaRIKtir*.— (l) Ktioumuik- bmiK-liitiH. (2) Bron- 
cliyrrliii.'n. (3) Dry mlnrrh. 

Ithr-uMitdir flrwioAftw, — This iorm <»c(iin! in tlwuse of a rhcii- 
iiijili*' (liiillufiH, «ii<l It (rlianicliTiiicti Itv !*i'*i>rf [»rr>xyKnial 
i.itit)*li, ttit- (-\{Mt'i(>rali<>ii of waiitv ((.-iiiwiiniit iii'K'iin, anil l>v 
iii'tiiiii; iKtiiis ill variiHH |ini-u ot'tlic i-Iii-!'t. It i« (w|ii.fijillv in- 
DiK-iKfil by aliiUH]>liori<' ciiaiijA^, urn! diH^ not yicUl lo tlic 
nnlinarv Inaliiu-nl of bmuohilis. 

/froiicA»WT/(f*H.— Tlili tonii is applied to c9M>!t of 4'liroiiip 
bnincliilk whidt are a.'<iN>cInIed with a very co|iiiiu.4 4'3C[Hx-ti>ra- 
tion. TliP «<]>iit(ini i'^ ^i>T>i>rallv miiKf<piiriiIeDl, aix) »i>iiiclinift> 
verv offcriftivo (l-Vliil brtimliiti.-). 

J}r}f fiitarrh. — This form, dt-sci-ilx-il bj- I^enuec as eatarriif 
sec, is cham(teri;!»l by eevere spoils of ooughiiic: which arc 
a(.-foni]iani^ by little or no expwioration. It \s (jenerally 
scvD in the old in aasociation with eniphvsptna or asthma. 

DtAUStK^iK /lft/Awt«.~ThcabBonccol fever, of bemorrliaKe, 
of Imeilli in llic t^piita, and of »rgii§ indicating crinsolidatioii 
will MTVe to (listin^fiiii^ti ehmnic broiidiitie from jihlhisi^. 

lifondiiciitifh. — ThiBoHen rcwtlls from cbroiiK- bronr-liitis. 
Vi^'iT jirufiiw fetid )-puta, expelled pcriodieally in gushes, and 
|H-rlia{i« phvHHid 8i};»8 of cavity uv^ tbc dmuu bronchi, juelv- 
rifirly, indimie broiicliiertasi*. 

EnxjihyMmit. — Miicli dyiipnn?a, distciitiun of thcdK'^t, bypcr- 
nw'iintn<v oil j>dvti!s«ion, «i)d j» proluiigix] fwblu expiration on 
aiiHeolliiiiim indii'Ult' enipbysi'rntu 

SRQtiBt„e. — Kinphriwiiiu, bmndiiw.-tasii', and dililatinn uf 
the riglit ^-etitricli; 

pRtxjN'otiilis. — PoHwt recovery h rarely attainable, bnt llic 
dint^'ie i^ nut iiK^iiii|iiilible with Kmg life. 

Thkatmkst. — A i^irful i-i-jnilatioii of the hygiene; ihiit 
inelndi?>4 ailt^ntioi) lo diet, (hilliiri^, bathing, exon-iw, *'ic. , 
ItronrliitiH <li>|K-iiih'nt 4iii h<art or kidney disease will require 
reniedieii dim-tcid to thtnv orgaiiH. Tl»e general vitality is 
frec|tiently rediiitxl, and tonics like ood-Hver oil, hyi»opln»- 
pbites, iron, oiiinine, and Btryehnia are often valuable adjiinctH 
to the e|>«nul treatment. A change of eliniate oftejt serures 



|)emmti<>nt relief. In tliis country the extromo Boulli-w'e8(*ni 
IcrriloM, iix?liKliii); New Mesico, An/oiia. aitd Sunltien] Cali- 
foniui. |i'<M)'$«c?' tDHiiy nliiiiispltpric iidvaiiliigpH. 

AlU'ralivo liko iodide of potaadum (^, v-x (l)ri(« daily) ati' 
uftvn stTvinnbIc in chronic brutichilb wilh liltU- ex^twitimlitiii. 

Connicr-irriunts — blisteis, tinclurc of iucliw-, or ctx)<oh oil — 
pm%-e iiwcf'nl. 

.Siitniilatiii^ Miiectorams— ciiloridc of ftraDtonium, t<'rpl>pn(', 
tar, (?4i<iilv|itui), twl of sandal wood, ami cio]]uilKi — are ^nerallv 
. indicaud . — 

9 Aminnn. chlnr., 

Ejii. j:i,v<-ifiThix!»-. u aif; 
Sjr. liiiHiiuir. l^t ui|uiC', iU q. k. lul rj^vj.— M. 
Sig. — A InklM-iKiotilul Uiriui ilutly. 


9 <'op«it>«.. 3iiJ: 

Aiiida? it Ka<vlinr. ulk, iiC q. a. ; 
h>l>l. la viiu'l (lift' (-0(11)1.. 1.^68; 
Aquw, q.s, a<) (,|vJ.^U. 
Sig.— A tAbk^poonful Uirico dnJIy. 

IJ Apnmorplilna? hj droclilor., gr, } ; 
Svr, jirun, virj;., f.^ij; 

Syr. pi<-U liijiitilif, f.^iv.— M. (MimEU.L.) 
Stg.— A UUiwpoonfuI tlirioc dully. 


1^ Terobvne, r.jsa. 
Sig.— Five to leu dtotis oii Hu^'sr ttiricc daily. 

The iik-IIkm) of liratinE; vh 
iscxInL-nicly iiiu'fid, tTtiMi-mllv in ]i»lit']it)> willi weak Klontadia 
in wiium •i_vrii(i» mIkxiM Ixr HV'>id"l. 

WtiK' nt' ijxvjio (willi twice itn v"lnnn' uf witter), tcr^>cn< 
(with ci^iiul [■urt.'^ •■I' bcnnoinul or lii|iiid vn^clin'). crvaratv, <i^ 
uirbuli^- ncid may be wo cmpluycd. 

ft Add. carbol., jjr. S)t\ ; 

Tint-t. opil campli.. Siij.— M. (N. S. OAVbi.) 
KiK-— A Uuiddraclimwitlihatra pint <if lint wnttM- in Um! ialmlrr, 
tlirii'i- duily. 

An ittcxiK-iui'i^'c inhaling a|>[>anitu» is made by Codmui A- 
SlnirtlttfT, uf IVwton. 

L-liniiiic Uix>i)i-liitii( bv inhiilationB, 
wliich luis lifcn j«» ablv adviKtitcd by Dr. Mnrrelt of London, 




OiipillHry Itroitchitlft. 

(SnfiooaUvv Cataitb.) 

Definition. — An inllammation of tlie »inallcr l)rniiclii, 
gfiivnilly Mtundur^' to simplv broiicliitie. 

I-hiouwv, — i^iuplc btunchitis is apt to iuvolve the papil- 
lury lulxTi ill Dm; yuiitiK, old. and debilitatctl. It i§ uOtii a 
wiupiicatiou of (vrlaiii inlectioiig fevers — like meaitles, wboo)>- 
lac-WUfih, iliiilillK-ria, utui iiilluenm. 

rATliOLOtiY. — Tlw; tuucoii& niembniDo of tlio finer tubes 
n.1], »wollt:u, Kiid injix-tvJ, and tlic tubes are 6lleil with Uih 
c-ii)ii8 niiKiiM. In muMl casat more or lem cotarrliul pnciunouia 
fx«iill« from the extension of the inflamnuition into tlii> 
uir-vt^niiOt^. Aruut of tullajjiso from oeeUii^iou of the bronclii 
an- often observitl. 

Symittims. — Severe spolU of ooti^iiuj;, wbidi in eliildnii 
ai\- iiii!ii'<i>ni|iiiuiiitl with 4>xtM^;tomtioii; mpid m«|)init!otui (60 
to 80 |Hrr iniinile) ; <)v»i)>i)ii'q ; bigli fever (I04°-I0ri''); nnu s 
wi'ak, ni|>id pnW. Later Ihe li|>4 liectiini' blue, th« irxtreniiiiest 
<)(ild, ana Ibe mind dnil, and ilitub froijneiilly rt^nlu in a few 
day.t fntni exbuiiiitiiin and ii.-<piiy xla. 

/'Ai(*/rti/ .Siyiw.— 1 DHiMrtion n'Vtals cvideiiw's of dyi)|rnti's : 
I'layiikjr iif tb« alii- of tlio n(i!<i\ blue lifm, anxionA fatv, jinimi- 
neut sterno-i-loiilit-raastoulii, ainl ri'traetion of tlie hose of tlte 
obest from olkdriielion to iIh* i^itrauoe of air. 

[*ER<:i:HstiiN. — 'I'lie ixwonanco may be itormal, IjiiI largo 
areai^ of MiIlaiK* or pnoMRwniiir consul !datii>n will yiebl dnIneakJ 

Aiuii'itltalio)t,—\\ fnk bri'aibiiig, and uhUtJin^ sibilant rdlesf 
or tine, rraekling, moist rales. 

I>iA<sN(>siK. (iitarrhul Pnmmoma. — ^Thls is a natural o«t- 
eome of cajiillanr' bronchitis awl neiially cunipticato It. Thv 
detection of areas of consolidatiou in catMTual pneumonia w 
tlie only diaiinostie differenee. 

(Kdema 0/ Ott Lungn. — Tlio bistort' of some dironic tan^ml 
disease and tite nlwetK'c of fever will aiiHist in the diugno^ii^ of 

l*iHXt.v<wis. — In young vliildrcn it is very grave. In older 
uikI mot« vigorous (talieiitH ibe iirognoKiH is mnrli moiv 



TiiEATMKST. — Alwoliite nei. Tlte lAmtK-raliiro nf llw room 
t>lioiil<l l>o kont iiiiilbniilv at 70' or 75". Tlic Atniiit«[tli«n- 
Hliuiiltt be wncleiiwl muiet bv th« generation of ^eaui. A tiir. 
pentiiw stupe may he applied to the dicsl, which nhould bv 
I Jirolei-tcti by a cwItMi jiieKet. The diet ought Iti \ie lii(ui<! t>r 
faea\i-l'u\xwi nitd iiiitmioiiH. Stimiilaiiiti aiv lri-<|iient)y iiidi- 
ca(e<]. (^niniiif may lie friveti in siiinmsitory an u Hiipjiort In 
the HVHtcru. TartHmatp nt'amiiioiiium i^ an invaliial)I<- (unltiu' 
aod n^gpiraiory stiranlant in iheae caseo : — 

I^ AiiiTiioii. Kirb., yr. xv ; 

I'ulv, acaclie it ttiiochar.. O q. 8. ; 
Spt. Invnntlulffi coiiip., fjlj-, 
Aqun, q. b, at) fSfJ.— 11- 
SSg.— A tcttepoonful every tnu Imum iv a cfailil i>r two or tUiee 

MHien the dy!i)>iKi-a ii> marked an einetic in use/iil in fiX[H-l- 
ling merliaiii<:allv nitictis from the (>ronchi. Wine of ijwcBC 
{5**-'*-3j fill" a cJiiid) may be selected. 

When lilt- fever in high, it should be reduced by 6|k0iig:t)i|r 
with cool watei', or bv the cold Iwtb. 

Fibrinous ItroiifhiliM. ■ 

(ftoopoo* BroDoUtls, P*«udo-m«mbraii<Kia BrottcUtls.) ) 

DKFismoK. — A prinian,- inflammatory diseaw of tliebrooelii 
fiflMM-ialiil with the formation of lulse membrane. 

IvTioi^ooy. — The eau^ai are unknown. >[ale eex, earlj 
nuinliood, ami eJimiiie |>ulmonan' dieeow, like plilhinis, emphy> 
Acutn, and pletirisy. apiH'ar to be predispo^inir fartore, 

I*ATH<ii.o(iY. — The diseiLse is often limited to a «'rtain num- 
ber of bronciii. Somn of the affected tubes arc fourol fiiU<dl 
willi u ltbriiM>ii» exudate, while oihera are found eni]ity anil 
show a tow of rpttlH-liiim. The tft^ts are u^iually ex|>ellc<l in 
the form of whiti>tti balls, and wlien unrolled in water prtisent^ 
l>nmobini> mmildji of tlie div!gion<i and subdivieiona uf tbd^| 
afTeHfil broix^hi. On dut* examination tliey arc found to li<*^* 
fwlliiw and biminattil. I'nder tlie mitroseopc, a li<unMjpnK'<HW 
Of librillated inend>ron« in obeerved, imbedded in wbieli 


]fiKij<'vk'^, r»t-<)n>jis, imrlick'N tiC pipm-nl, c|H(ltc-lial vdb, and 
(xx^ni^iomiilv lA'^v^k'ti's wtalifdral crj»«il». 

SYMrTOMH. — Avutv »iu\ dimiiK: funiis urv ncogiiizi-d. Tlio 
furmrr !» nirv, simI inoiiili^ls \iu: yyiiiptiriiis of u K-vvrv nttiu'lc 
ul' acute bn>i)diiti^, but (]i>; M)>iita ixfiiiuiii fibriuuiis caHt», iini) 
tli«rc U miirkfil <lv"[>i)iiii. 

Tim olitviiif tui'iu i-H i'hnra<-u-i-i«i] by si'vrrv i.'oukIi, |>»rt>x- 
rstns vf ■Iv.'tjind'a, niul tiiir fxiHt-diiiiLkin uf libriuulii* iiltip^. 
i'lit [itiv^iiul sigus arv iImjb« of ciimiii*: linnK-liili*. 'I'lio uiM^st- 
ufU-ii liustK a few we«)u), and thou duu|i|>eam lo rotiini again at 
defiuile (KTiods. 

]*ito<tNu^[!i,~-lii the ot-utc variety the proguotHS luiiet be 
giinnktl ; dwUli fntim-iitly iwiiltn fnim fiifl'omlioii. 

Tlic fhronii- \iirtHy riiii!« jt wry- juxjlnnicd roiirac. 

TitEATMENT. — Jn tiie M'lilc dii«aM% ili4! utuic<3i>Iierc of tlic 
n>oni !>Ji(iiikl ix kqit iii«ii« and uniloniilv wanii. C^lunu-l 
(^r. i cvt-ri' inu hoiim) tuny Ix- udRiiiiiHtenu as in otlwr nwm- 
hnuiuiiii iiill»iiiii)ali<^iii!<, and niny U- I'dIIowikI by iiMlid^ of 
)K>tA^iiiiii. liiltnlalii)ii.-4 III' alkaliiH- v»]KHii(liinc-ustcr) exeri 
a .iijKvnt <.-tlv(-t. riH)iitcr-)rriliiiil» t^hutiKI be a|>|>tic^l to lli« 
oh«fl. l-'iui'tii* simieliniw aiii iii (lie i^xinilsioii ol" «i.sta. 

In ih*- rJironic form i(Mli<)e of )M>tft»«ium may be given io 
ODnjuDctton with stimulating ex]>ectnraDte. 


{ Bt oudiiactaftia . ) 

Pepinition. — A iiiiivvnul ur cirainiacribcd dilutation of 
Iht- bmiiK-hi. 

KtiuI/wy.^ — Chronic infliinininliun «f ihc tiilifa hihI the 
i-outractkin of sunxxtmlini; |>n)niw)ury tiiwiv Hrr (Jir prini« 
cauH's ; Ir'iww, if i» ftcnenilly wtoridury to i-hmiiir bRHH-liitifi, 
|)Iithiifi8 — jiartkiilarly librijid- dtnuiic intentjtiid [iiK-unioaia, 
and chriMiic plfumy «-Uh ndh<«ioni!'. 

I*ATliOLDtiV. — The iliblalion rt^^ulls front uTakening and 
lUony of llw tnb(«, and from ibvir »ubJ4H'(ion to Mniiti in 
<ijii^hinp, or to lli« tntiliun of shrinking nmiKt-tivr tU*up, as 
in fibroid phthiKtu. 

X«t) fyrioe lire noted! (I) TI» tylindrical form, iti wbich 



tht: IiiIh')', i<articiilArlv' thoi«c of mvdiiiin size, nrc- unirormly 
(iil»ti>i) ill oiiu or Ih>|Ii Iuii^h; und ('i) the succiilur fumi, in 
trliivii Itht tiil>c» sn-L'll utit, hvrv nml then; into nniiiuscrtbed 
(liljilttlkHH wliivh may reach si'vcrnl iwlw^ in iliiiiiKtvr. Tliis| 
form t» l!^|H■l■ialI)■ miU'iI in tHuv^l jilittiiMit. 'I'lii- w.nlU i>r tliej 
bmnrhicc-latkr i«vit_v un; 4-xt r(iiK-l_v »[r<>[i)iii-(l, tin- juirliKi- is] 
H^nt-mlly emoutJt ittti] slitniii^, but nl<x*nitioi)fl nrc nut un- 

SVMPTOMS, — ("oiii'li, (Ivsmmw, ami cu|>iE>iii« c\ |Ht1i)tBlion. 
Tlic last i»; it tit n\il U> tuxtiir puriixlii-nlU- in j 
i;'ifIi<-4 ; IIk niiili-riul liiu it lii|i;hlj' oftV'tbtive Daor, iiiul wIm-o 
iiltowfl U> stand ill a gla-w v*«--«'l *-j>orati5* inn* llii-w lnvcr* : 
im "jiiMT liiv<i- Iff dirlv hntwn fi-mb, a midillL- layer uf tiirliij 
tniinis, iiti<) an mtrlpr layir nf dt-oiitiiMi^Hl jhih, jM irr< >(*■•( ijii- 
uilly it ctoiiiatiM ])iH (Y>r{iiii«.'li>», Gil crv'^lab, ery^^iaU uf liifm&- 
tuidin, uiid niiiiw-i-iiUH rnii^nfiifgauiuiiH, but mi iiiben-le bwHIli. 
Klit^tit^ fibn-" nrc rai-ply fontid, 

I'fiYSiCAi. Si<;SH. — In the ( variety llie eifcns are 
llmw oCi-limtiii' Iin>mliitis, The saccular variety tnay [iresent 
llie )*ijiiis >>(■ iiilH-rv'iiloiu «ivities, locati/*<l lynipany, mvemuuti ' 
bntilhiii);, ij^ir^linj; rftles, and |iortorilo(|uy. 

I>iAnx<iKis. — 'fho diflerriitiatioii of broncbiet-tiifiis Iromi 
jJithivui h difficult Olid uften imiiotifiible. Tlie diiwovcry of| 
lubemifi bin,-illi always indicates ^»flthi^i^^, BroiKrhiwitatic cnvi- 
ticrt are u.-*iially located iii the lower lobcn, and rarely in tb« 

1'iuKiM«iK. — This will dc|icnd on tlie primary disease ;^^ 
itim-e lii« winnion cnus^ are long-i^tfliidirig hruudiiliH and 
lihr<*id philiiAi^ there oin be little Iiojk' ut' c-uiv. Aincliurution ^ 
in all that ran be e-Xjiec^ed. ^M 

TiiKATUKNT. — Tonics are often ininnilf^il. Stiiiiiiliinl and ^^ 
nnliwjttic expeciorams like twriieiitiiH-, U-n-bnie, i-neatypUiK, 
oil of .-tniidalwdiMl. and lar are )M<ni(-tiiii<^ it.->i-fnl. 

lolialalioug of tea^U-tie, (wrUiliir iiciti, or dilute (lenixidv «if 
hydrogen lessen eou};h niid(k>Alniy iheft-iid odor uf the brcalli.j 
Owktu (gr. J) may be employed i<j allay eough. 




Defimtkin. — Pamxvsmiil dvsjmim dtic to ^lasm gf tin? 
tiilx^ or ti) swelling; of ilirir miictMH uM>n)linine. 

Ktioi^hiv. — Aslbtua U a HympUiiu ol' several dtscaiies, but 
n hvt>f'i-scn»rtivt' ciHidition of the luiioiiiix DK-mbrane of lli* i-e- 
Bj>iralorv iru<7t »]>|K'nrs (u bpee^iitial !o its pnxluction, \Vhe» 
thi.^ i^mdilioii |in>v:iiU, aittlimn iii.iv \tc indiict'fl (1) by the piil- 
monary (XMi^rcKtion ol' ctiniLai.' iiiiM.':i6c (('ardiae a-lhnia) ; (2) 
by tbe tira-mic intuxit^tioii or tmnsionl piibnonart' <«lfijia of 
Brigbi'H dift-'a;* (Keual astbrna) ; or {A) by maut irritant from 
witboiit, aa tbo pulleu of plants (Itay asthma ». (4) SumctiiaeK 
the {tan>xyHm« are excit<^^l by the must triviid raiiwti, as an 
al mo^pberie <-)iaiiKt- or a iKvitiiin- 'jJur. and l>> [Wis forni many 
writ'i-^ ri.isti-iot iIh- ti.'ini aKtbnm. Tbis l«i>l tvill be ditH-tiswi] 
under tlidiead ofc^^nlial u«lbuiu. 

f-lxHtMidal .\K(tim:i. 

(BroucUal Avthma, Neivoua AbUuhu, Spaomodic Asthma.} 

Btioucwv.— NeTvotistcmpt-ranient, an bcretlilary tcnd^iicy, 
titrly lifi-, iii>ren#e of tbe iia><>-pbun'iix, and Ow guilty (iiatbtwiii, 
are pn-dis(i")!'inK lai-linM. 

li^mtnelri'^ and llRTiiionKHrio ftmnp-s ; the inhalation rjf 
diirt; tlw odor of ivrtuin phtiitn, Hiiiinidx, nr fniiiit; exdto* 
tneot; n-flvx irritation, |Kirtienbirly a tiiadiil NtomiLeh ; a 
['linni^' of Uxahty ; and bron<-biat <»(arrb, ai-e o.veitin^ rani<(». 

I'ATHOtJxiY. — 'J'be iliiii'ii.Ht^ i-< a ptni' iienriRiiH, am] ibo jiar- 
o^vMii.* pivliably nsidt fnim n Ajxt^ni of tlw auinlU'r tubofl, or 
tiir>p!.7Hi-nn> itf (h<-ir iiiih^iiih nieinbrane. 

Symptoms. — Thtt |)cin>xyt<in)t ofien api>ear suddenly, but in 
H>imorus4^4M^ain Hympt'>m.s pivce^e ana ^ive warninK of tbe 
approai-liini; allai-k ; nnKHtg these are ehilliiie<«. thiulenee, 
ftHft-ziiiy;, tmd a nipions diHctiai^! of jwJe nrine. The patient 
IB otU-.a seiwii at iiighi. Tbi-rt? in a sea.'* of oppres-iioo and 
anxiety followed by dyHpnoa so intense that he nins to the 
window tor air, or aiUi iipri^cht wilb bis arms in sncb a |>osilinn 
thiU he<»n bring into play tbeanxiliary tnnsHcsof refipiration. 
The face is pale, the tips blue, tlw eyes pmmtitcnt and t»u- 


ni»F:A5(» or tiik ki»fikatobv (;y8TBii. 


g«st«l, Hiiil lite body rtild anti mvered with 8WJit. Tliv rv^ 
ii])iratioi» aiv nm mjiid, litil ]nli()iv>() and noinv. <^iu^li Uoltoo 
j)resciit and is a^^iK'ialcd witli ttic fX[itx-«>rati(tii of Mimtj' 
vi»nd niwiiit. Oii cluiie exaiiunation lilUe grnyi»ti iwlU ure 
itukil in tbi- ^pudim, ttiid when iiDi-avelled, iliey ai« fuuiid toj 
)a- coni|>iff<-<l ut* ilflii'HUt HiiiraU ^if riiirus, wlii<:h liav« Ikx 
iiiuuUk-u iu ihv liiKir UixHKtiiolcs ^Cutschiuann's siurali)). 

GUiMhvwHiliSplrtl*. a. ratnl flbrr. 

Mk'nMOopic (^xiimiimtion alsn revtttts octabctlral ci-y^itaW* 
similar (o tfmec fouitU in Uiikieniia (Cliarait-Leydep crysiaLi). 

'['ii4- |>»n>\y8ni« may \ast Imni a few minutes to manv lt<Hirt<, 
null iiuiy rt-cur fur Mrvt-ml Hiin^-ssivc nigj^lilH, ur ntny dt'^jipcar 
ciitiix'ly for w<t'k« or oionths. 

l*iiv&H'Al. SKi.v*^. - InfitcetioH revt-uk t-vidutccH of dyHpnria 
aixl ilisdiit ion of Uiv vIkvI. 

I'ertrwmnti piK-mlly )ield(i hvi»cr-ree<mJiiK«. 

AMeuHaliim.—A pruloiigp'], liigh-pitdHtl, ulicpxin^ expinw 
tioi). H-illi iilMindant suiioraiu) ami HibiliinE r£k«. The cxpira- 
torv wlioc/.inij; may be auditite over tlie entire room. 

PlAtisrwife. — Cttrilinr and renal tiaUima aiv lo be distin- 
l^iiiilitHl l\y>m es^eutial astlmia by tlie bistury, uud by die evi- 
iktiii' of iirfcnnii- heart or kidney disense. 

lliifi a^lhutn i§ rpwiBiiizod by tlic awifiatcd curyea aa^ by 
ilfl jreiiiKlie tx.'cnrrGiH.'C evt-ry i^iriiig or fall. 



fjirytt^fftl okMrtu-tion /rt/m fatrign htHiin, troup, poralvm 
of Ihe roiTtil lyinln, nr inliwi. — TIm; (lysiifitra \a willi io^piiu- 
tion, ami tlio oltcsl iiisKUM] uf being (lLitciidi?d ift retracted, 
esj>ei-iaUy at the ttnsc, 

SEiii?Ki,.»:, — Kmi>l),v»pma invariably follows whew the 
aAtbiiin is of long aurntion ; it itviilts from the tension to 
wliifh the Vesicles are suhjet-tett during the expiratory effort. 
Dihilulioii of tiie rijtlit %-eiitric!e is also a reraote Hecjnet. 

I'h(k;xi)mis, — The disease iloes not prove fatal exeppt 
tlii-i)ii);h i.»ni]ili cat ions or Heqiicln!. In young; |XTsons without 
an inherited teiiilentv llie prognoBis should lie giriirtK'dly 
fjivorable; it frvouenlly MilwiiW at puberty, ti^ases asmetatei^ 
with Home definite reflex cause, as nasal obstrnction, often 
rrxwver wlien the latter is removed. The older the patient, the 
Rn-ater the iiihented tendency, the inoi« iin&vnrable beoouiee 
the propiHwis. 

TitKA'rM»:xT. Tlir .ltf//ri', —Prompt relief often folloHs 
till' inliulutioii of nilrilc oi' amvl (five or :^i.\ dnips in a kIiss 
or on tlw hand kerchief). i«li(te of ethyl ftwrcnly to thirty 
dmprt), or a fi-w wliilfn of chlorofijnn. SinoKing ri}?irdt(« of 
lH>lhidotnm and sinunoniiini hiiv<.»i nnipiM.-d in nilrc-pupcr — 
[)UjHir wliidi has liii-ri sonkixl in a sjiltinitcd xiLihition of indl- 
jietrc and dric<i — will often »uftic<' In mild attm-ki^. Nitn- 
pajier may lie iiDniHl in the room nnd the ftniu-v^ inliak-d. 

The application of dry eiin«< or thin pnulticm to lliv eh<^ i» 
often a valuable adjunct to tlie tivatnient. Morphia (^. )|-{) 
with sulphate of atropine (gr. ,^j) nill often cut Nliort an 
attack. Inlemnflii, sedatives like HoSVuann's anodyne (5*)( 
tincture of lobelia ("l xx), aod bromide of potatKiium (gr. xxx), 
are sometimes usefuL 

R Polas*. tjroiniil., 5ilj; 

Tinct. lobcllic, fsilj : • 

8nl, tFlhor, oorop., f.ij ; 
fist, ):riti<l<;li«; n*. rt., f^w ; 
Sjr. Kiiriiiii'inllji- i-omp., q. «. nil fjiv. — M. 
K|C~A dflwnUiKKkuful in w-iti^r cvrn- two lioun. 

Th^" titterral. — Careful search i^bould be made for wrnie re- 
flex irritation, e>-"pccially in coniicrlioii with tlw? nasi i- pharynx. 
An ea-Kilv-ossimilable diet niUHt lie seleclcd : in noriurnal 



afflimn the evening nHiil kIkkiIiI Iw very light. OriuliuU«l ei 
cn-t»c uiiii rnigiii-iit Imtliii));, fullomttl hv tVii^tinit of die skill, 
will wld tu the genvral vietir. A L-ltaii^ of cliiuat4> in dn-^y 
Kinibli!, lull tlioiv la »n 6xed Tu\e iu lh<> aeloctit>ii of l<icalit}'.,^| 
Mftiiv iLvllimatio! clo well in iliu eitr, but a dry atnuxiiilicni^^ 
iiiid a high nllitiiile are betur »<iiitnt to tti« nuijoritv. Jhi.'n-v 
L'laim.-i i-X(»^ll<-iil i^esiilts from lli4> habitual wearii))! of an oil- 
Hilk jacket in aHlhnia a-e*K'iattHl wiih bi-oncbilis. ;\n)iiu)i; tlw 
remedies aiwiiic and iodide of |w(a's.aiiiui hold a hij;h plaiw a^ 
alterativftj. Fou-ler'sHdiititin (three ilnj|is, jfnidually increased ^^ 
to ten or more, thrire daily), or ten to twraty gniins of lhe^| 
iodide nay be administeml over long [wriod^. Nitroglyeeriii ^^ 
{gr. xi»). Of niiri'f of sixliitm (gr. iij-v tUriog daily) oft«i gives 
immuuity for long jKfiods. 


(Hay Fever. Autiumuil Catsnh. Rom» Cold.) 

DBFtNTTtON,— ,\ (nturrlial a/Tix-ltoU of tin* rrK|iimi"ry 1 
UMiallv '.N<iiirTiii}; |H-rio(limllv c-v<-ry HiiHiifr or aiiliiiiin, cxi-ittil 
by tlif,- wtioii of soTiK- i(iiiiiis|>}H-rii' irritant n)Hin a Ityfit-nrfl- 
ibrti*- iiiu(K>uit iiu-mhruiK-, and t-liunuicrtiEed by ooryza, brun- 
dhitii, am) aitllimalu^ m}i»ireft. 

Krioi/Kiv. — All inlicriiM) tendeney, male »x, nervoaa tem- 
perament, indoor lift-, and ehrouie nasal eaiarrh are predis- 
(Hi^in^ faeion*. Tbi- attack a.* a nile (xHtirs in tbe aiitiima 
(Atitiimoal catarrh), or in thespriDgtltotw^eold), and is eseitetl 
by certain daslt^ vapors, or odors. I'lic polleii of plants seems 
to be a eommon excitant. The seimice may otxur at any 
time if the |>eculiar irritant itt present. 

I'ATiiouxiY. — An csseutial ftiitnre is the bypcrsciBitivp 
oonditjun of the mitmn^ im-mbnuie, and this is often, though 
nut iiiviiriiilily, n-wixinlixi wtlh hyjUTtr^nJiii' rliinili^ 

SymitviMs. — lEcdiiiTv* <)f the winjiiiiilivw nixl xwvlling of 
tl»c eyelid.t; pnirittH of the pliumix, no:*, and eyt*; 8uecx- 
ing; olmininion of the iHwtrilff: watering of llie eyt»; »■< 
eopioiLi diwJiar^ of muaw fntm llw not* ; iKiulaclic ; «oiij^i ; 
and aH[|inmli<- altai-k.-duv- tliv iiHiitil {tliriviHienu. 

/I'tMc ro/(f n.-utnlly In-jfiiix iii ^lay or .iniicaiHl rune to thu 




l»tlpr rari of -Tiily. Auhimnat caUirrh bcgiux Id tlic Ititli-r 
jiail ol Aii);iist aiiilmd^ with the lir^t fnwd. 

I'lfOGMrfiH. — Tlw <lii«-,tw niiis mi JiKicliiiiU- trmrw, nix) 
rarely, if ov«r, pnivi^s futal, t'«M» wliicli lire usMKrinlftI willi 
chrunir rliiiittiii ulU-n |KTnuiiiciilly n-wjvi-r wti llii? rcutuval of 
till.- lutltT. Ill <A\ii-r tuHts lltt^ |>rngi>iMi< m regards iinmu- 
riily fri'm futiin- iiltiioki* i« uiifAV<frBi)li>. 

Trkathknt. — Cnn-fiil Miinli aIkhiM Ik- niiuli- for clininif- 
noKiil <)tN.aM-, uikI if fiiiintl, u|i|ir»)inalt^ Ii-i'iiriiH-iil iiislitiiKi). 

A Hiaii^' of cltiiiatf during iIk^ jtcriotl of Hi^tc(-j>tJI>ility 
t-Kctiijits inii«l piilivnt«>. A M?a-vuyagc or n si.>joum iii ^imv 
Iti^i-tiKMinlniii diiMrint, lik« llie White MonntaiiK*, AdiixMi- 
daiks, C-nti^killit, or Allf^hanioA may he reromm»-nci«l. 

T»iiii:!i aro iiMinlly in<lt<:altd, and (|iuniii<', arscuic, and 
str>'i'Iiiiia ar(- olltu very m^fiil when adniiiiisloreO heforo ami 
diirio^ an altaL-k. To allay itcliiiig and larlirymatioii, tin? 
e)c6 may be washed with a eoliilioii of Ijoric aikl (f;r, X lo 3J), 
or sulphate of zin<; (^r. i-ij to Sj). Soeexing, naeid fidofts, 
and disHiuiiEe are often n-Iicv«i by mnlHalcd epmys. A solu- 
tion of racaitK', or the following niuy be cfnplu>'cd ;— 

ft Iktunthnl, Sj-3ij ; 

<>1. nniypl. ilulr. [rnwtiEKiiKil, f.^tJ-M. 
Sig. — Ijpny into tbu num.' iiud lliruut every l<;w liourH. 


Den KIT ION .—Abnormal dislenlion of the Inngs willi uir. 

VAiiirriB*. — (1) Inli'i'lobular MnplivApma: TnU fm-m is 
mif, and results fmm tlip rii]Hnro of the lung and <wni|M' of 
air into the iiilf^rslitial tissue. (2) (\)mi>i'ii«ilor)' cinjihy-x-tna ; 
When a lung or a |wrl of a lung is disabled from any i-aiiM-, 
the henllhy |)i>ili»n!i diMend and do vicarious work. (3) 
Atrophic nr senile cmphyticina : In old peopio th« wlidit of 
llie long alropbr, so that a pplativo iitcniisc of air nstitts. 
(4) Ilyw'rtropbic emphysema. The lart llirrc varieties urc 
luvliidcu und<>r tt>e term vesicular cmjihyseina. 




Hypertroplifc Etephyseiua. 

Dgpcsition. — A milmtman* fii«ii»r iliiinti1<TiuJ imatnmi-^ 
inllj- by (Iil»l»tii>D uf lhcuir-vcsiflc*nii"i nln)]ihr uf ilir W4il!»; 
■iti'l cJiniollv bv liyi-niwwi, cnliir^ni(-ni nf iIm; tlionu, hj'P'^'^^^l 
n^miMKf, ati'l w<al( imillliint;. ^^ 

Etioi.i>GV. — (.Vinp-niUtl w«tikr*i-** of the Iwnj; !ilnu-tun> — 
|m*1iul>l>- a dcffrtivc development of fb.'ttH- ih^ue — is ut iia- 
)*i>HAnl pTwIi«n»«ittf' factor. The* i>reclisj>ftsiliiiii may l»e tnn»- 
tnittcd tunmifn lu^vcnil (jcDcnitiiin*. 

In fitwnX i'xpiniliori, th« ftir ramirt* ««capc vrUh suffiden 
rapidity ttiroiijtli tin- narrow gkjtliw, ai»d Uio ltt(?k»™r(l |>r 
Biirt i^rt-tiiluT* iIh- Str-vivirl«t ; ln-mv, llio ftl«<lioa[e cmgii 
HirrHiic brondiilir', Ow cxpiniton' Mrniiiing of asibnm, and 
owiipitttont whic-li iti«Ks»i(nt<; fim-cd expintlion, lifee playit 
on wind inDtniHHVtiLs luu) glmf-bUiwing:, arc caudal factors. 

Pathology. — Tl»e tnngs are fnlnrgKl, aiwl do noe eolla]: 
when llii' timrax in 0|>eiHil. In ticut cast-rt llio fr«<e mar^JDA ar 
rttiidded wilti laiK*' '"'"w! or I'Mh whioh iiavt- rt^ullHl fmn 
tb* ruptun* of a nnmlMT of vesjdts into a r.imnion fouu The 
iir^ns an* pale, ain) Imve a soft cotton-like fivl. .M icrufvuuii 
f.xami nation rev^iln atropliy of the %'esicular u'all.'i, a dimin-' 
iihiHl amount of e\a.^'K ti!««w, and more or lees obliteration of 
ibo p«lmon«ry mplllanc'H. This last conditioii Irads to in- 
cre»!«(l tension in the pulmonary artery and to sccD»dary 
liyncrtropby of thp rijrht ventricle. 

SvMi'TiJM^^Tbp diwasc s«ncni]lr manifests itselfin middl 
tiff, htil it iH not !nfn.>qupiitly obsen'od in the young. Dys 
)>nrjn, int'rtMM'd by *-x(ftion ; cyanoa», often extreme durinfi' 
allui-kit of Mn\Uy bronrhtlis : and eou^h, frcMii the aNHKinled 
bninchilix, an- tiie o^iisl symptoms. In a<K'an<vd (3iM«drop«y 
mav ivT^tilt fntrn mnliae (iiiliire. 

I'liVRicAi, SrtiSi*, — Thr nct-k is *iiiorl, jind liie (iternd 
i'leido-mai<luid» promiiwiit. Tin- tlwmx is likowiiwrfiort, but 
htfimd eKporiullr in iU anten>-jHijtt»'rior diameter. Thin oonH 
fijfumtion Ii!i» given rwe to the term "Iwm-l-dmped" obwtt,^ 
On tvApimiion tb<-n- in little ex|idinAion, but nil e]e\-a(i»n of 
tlie ibumx iiH a whole. Tiw aj"-x-li*at i^ invi.-<ible, but 
ahiiimiml pub^tou lioficu itutc-d in tiuM-pij^U'iuni. 








Palpation. — Pinimbhci] vwal fnoititii?. 

PcrciumoH. — IncTfaMd iv-wnaiipe. Tht- iip]»er levd of 
lippatic dulaeeit is (l('|ir(Bti(^, and llic area of canliac diilnctw 
iiuiy be almost (ibliicraiix]. 

Atuailtalitm. — Iitspiratiou is sitort, expiralioo is prolonged 
and low-pitcbcd, or iiiaiidiblo. R^cs resulting frutn theaam- 
nuted liTDDcbitis arc IHtjuentl y heard. The pulmonary- second 
MoiMiil is iK'oeDlualttl. 

Com PLICA Tioxs. — Broneltilis, sHtbnm, diladitiuo of the 
i-ij^liC vciitriclu, uuil Intt^r, tricusuid re^ti^ituiion and dn)|i«,V. 

DtAGSfisiS, Ctironi'! iJrwMcAtfw.— -I'hc tljepnoti, tlioratic 
cnlar^'mcnt, liyiwr-rts^muntx-, and prolonged e.tpiraUon si'p«- 
raU: einphyMiiia Intni hmnc-hitiK 

pHfum€ithotax. — Tilts is almot4 iiivariiibly imilalcnil, the 
n^nniicu is t_vn)|innitic, and iiK-lnllic tinkling and bcll- 
lympitny mt; obtaiiKtl on uii»cnlluti<?n. 

PiM>oso8ls. — Thf discOM' is gwH-rally innirabU-; bnl ils 
ndvancc may be »ttty<-d by n-licving tin- priiiiarv Mitidicioii. 
KniphvMiiia runs a long timrsc und is in itsr-lf rarely tiilal, 
bnl dcatli niay n«nlt Irom hcari loJlutv ainl dropsy, or from 
inlcrnirrent pneumonia. - 

Tkeatwekt,— Tlw rcn»«lMM nd%-ornicd in dironie bron- 
chitis and aslltma are ulU-n appli<niblv linv. Tlic italii'nt 
.«li<>nld be plant! under the most fiivonibb- bvjjirnie <'<in<)itiiin!t. 
tffllido of potaMJnm (gr. x thriw daily) is I'l'ten ns«l emiiiri- 
eally, and wnietiotcs relieves the dy!*iino'a and cungh. Inm 
is i»di<^»te<l in the ana-mio. Str>'ehnia (gr. ^is-^)iBa valu- 
able n^pirutory and <iLrdiac Htimnlnnt, and may l>e conibiiK?d 
with digitalis when iherc are nytuptoniA of heart lailure. 

9 Slrj'chniti. oalph., gr. i ; 

I'ulv. IU3)|W. 

F«rri redact, U gr. xx.— M. 
Ft. in pll. Ko. XX. 
Sig.— One Uuiee dhlly. 

The inhalation of oxyj^n, or the inspiration of iwmpn-ssed 
air followed by expiration iutu rarefied uir is suuietitucv a utH-ful 



(BrDnohonhaeU. Broncho-puimonary HmDOrrbag*.} 

Dkkisition. — The expectoi-ation of bluod. 
Etiouxiv. — (H Vicarious nKDfliruatioii (rare). (2) Traii- 
rinatism. (:}) Iiiflannnattirr diaensea of ibe raipicaloc^- tract, 
cvpecislly )>lithisi8 and uiieumonia. (4) The rapture of an 
aortic uiieuriBm. (o) ObHtruetioii to (lie v«nout; circulatioDj 
UK in (.-hronic iH-urt and liver diwaiM.-. (({) Mulij^imnt din 
of tin- hui)*, (7) A dm-nisiu of tliu blood, n!< in |>un>nra, the 
iiifectiwikt lovers, liwiiiopLilia (bktdcr's dJsi-jiKirj, jiud scurvy. 
(ti) It txxa^oiiully ixx^urM in youii|3; people witliMit obvious 

B HvMPTOiL'i. — S<iiiK'tin)ii< the bUttliiij; i» pr«ii.'<l«l liy cougb, 
^■dynpnira, or iiubiiUtriia] wiirtiitli or Ii'ikIitiio^s, biil odi'ii iIhto 
Bis no pn^monitioii, iuid tli<- lirnt iii<tiijitic>ti 'oi llio jin'^-tii'e of it 
wiu'iit ■■alty Hiiiil in the mouth. Thfi UimhI is ^finnilly nii.-uil 
by i^>iigliiii);, anil is bright n-d ami frutliy. It U alkaline lu 
ctiuu, and intinialfily niixod with air ai>d tiiueiis. Tbe 
beiuorrhatfe is rarely profitsi^ iinleHi itrctmlts fnmi the nt[>tiirT; 
pf an aortic aneurism or tlie ulfvralion of a laif;e vneel in ad- 
vanced pbtbi^a. AuMntltation of tbe tbi«it iwimls Lubbliiw; 
iles. The subeetjuent t-x [Maturations are tin^nl with blood, 
id if much is HU-alloMcd it may excit* vomitin|f or Msa into 
Uc intestine ai>d impart a tarry apifcurance tu titc stools. 
DiAQKOeis. — HmnoptgVM uust no dietiiigiiiahed from hama- 

History of aooto clitsst dl»eaae. 

The blood is cj«ct«<l lijr couching. 
the- blood i* briglit rod and 

fhe bliMMl is iniKnl witti njHiluni. 
The Uood [« alkaliuc in reacliim. 
The subsequont espcctorotlous 

an? tingmf with bimd, and Uk 

■tools are rarely t*nr. 
tuHcultation rvvcalu tiflca. 


History of Kini« abdominal ilis- 

Tbe blood is ^ocl«d by vomltlus. 
The blood Is dari:, and dense orj 

The blood in mixed with food. 
TIk- btoud \« acid in rc-jiclion. 
Ttiu sutiM.t)iM-nt cxpoutoratioDM^ 

rautatnuoUood, and tfaei 

aru frequently tarry. 
AtiKTiiltntioti gives negative re- 



I*tt'X>K<»ii)<. — I[)i-nK>|ilyMN )!« rniT'Iv the niii»c of dfdih in 
tltc ilin^'iiM- in wtiicli it (h^iii-h. In |>liltii^ii< llifi iivni[ttiimn 
'ifti'ii iirijiriivc atltT a iii(icl<Tali> lnfni'rrlmge. On lltf oilier 
tiiiiul, in niiisiri^m, ndvumix! {•Iiilii.-'i.'', aiid abscess um) gan- 
grene lit' tilt! lung, llto Itlrc-diiig may prove latal. 

Trkatukxt. — Absolute it-ri and the avoidancv of excite- 
ment. The t<hi>uldei>4 -ihoitld be elevated ; an itxvbag may be 
]>la<«d on tlM?ohi:*l,iin<i pieivp of ice may be held in the month, 
und hIowIv s^vallowed. Morphia is ijteiierully nxitiirc<l ai- ii 
M^^dativc; it may Ijc given hy|>oi1erniically with cfKolin '(g'', 
v-x) or with the Oiiid extract of ergot (m x-xx). (iaWu: m-Ul 
(gr. x-xx) may 1» giwn by the moutli. Astringent ii|«Tiy» 
arc iisclrHf. A saline piii^ may act betK-ficiiiUy by inviting 
IiIihkI away from the oongesital organ. A firm ligature aroiiiwi 
one or liolh Ic^'^i rctartlti the flow of vtnons blood, and SO aids 
ill Jirrcwling the heuKirrliage. 

When the bkt-ding is not prtifuR-. but frw^utntly ri?pcaitd, 
llie iiill<iwing inicmal rcnKiii*?' aix- eflici<'nt : Atvtaie of l<ad 
gr. ij with [tondcrcd oiHimi gr, (, galliciK-id (gr. x-xx), fluid 
extract of liiiinamclii* (oj-3iij), tnr|K'ntine (gtt. x), or — 

IJ Add. i^allic., sib*; 

Al-iiI. (vuIi)!). nixHunU,!^ ; 
Glyitrin., fjt* ; 
Annir, i\. "^ nd f.^iv— M. 
Sig. — A tablottMxmrnl tliri<^: <biil,v. 


(HsmoRlutsfc luforcttou of tho Iiiihb-) 
Dkpisitios. — An efftisiou of IdootI into tl»e ixdnionary 

EnoUKJV,— It may n^nll fnini diveneratton of the wil- 
tnoiuii'}' vcN«fl.'<, but it i« moot rretinenlfv due to an emboIifHni 
in one of llic liranch<-« of the pnlmonary arten-. The eni- 
tKilism is n.iiially n |x<nion of thmnduiii which naa formed in 
tlie lienrt it in unc of (he sy^tenli^-■ veins, Ocebii^ion of ihc 
vcflsel cuiis<s a bnckuaitl (\ow »)f bloiMl, the [tan l»ecomes cn- 
gotj^, anil efluAtoi) follows. 


Patiioi/xiy. — Tile infarrtion ia miially located in line 
IKnjiticrj' of i)i« lung; it is comical m t«li!i(>e witli it« ajics 
|xiiiiLii)g inwardfl. The portion affcctctl is nirleae, and revt-ab 
an tiililintliou ot'ilark blood. Micnjeciipio eKaiuiuutiun shuuit 
a ilfliiw aggre^tioii of blood-curpnBclts. 

It'ic does not pi<ovc tiiUil, alisorptioii and siibsctiueot fibroid 
indnration ivsnit. 

Symitdms,^ — W'Immi the inGirctioi) isi larg« tltc uwial ftvm|»- 
tunis are d_vn|ui<i-a, ii>ti;:li, aitd llie expectoratina uf dark I)](hhI 
mntaininj; totv air-bubblca. Theac syniptonm wviirnug in 
chronic heartKliseaae are cHpecrallv si^g«stive. 

I'hifiiica/ Siffiu. — Very targe in&rctioua give dtiltices aud 
broniliial breathing. 

TltE.vTJlENT. — Tbc condition itself is not amenable to treat- 
ment. Ittniwliwi !>bou1d be dii'cctt.'d to tlie primary diaaise. 

Active C4>ti§r(»ttion. 

T!hi<n.f)nY. — ^Tbis n^nlLi from incr«u*d afflux nf bl<xi<I to 
the lungs. lIy|K>rtropby of the lu'art. violent excrcbc, moiin- 
taiii-clinibinij, ihi> inhalation of irritants, and mi!n(al excitement 
ocoftsionally luYxhiw it. It iw an ai*o«at«^ otndilion in alt 
severe intuimmatory diE«a£es of tlie lungti. fn the vaei 
majority of oisgs it marks tbe initial stage of croupous piieii- 

PathoijOgv. — Tlie lung i& bright rwl it) color, kcuvr, ami 
lew rn'iHtant. When iiiviscd and pn.-!^:M.-tI, coptous frxitliv 
blood i.xndoi. 

SYMPrriMS. — Flmdicd face; dyi<]ui<m; »liort, dry ctMUth, 
titllowvd by tenacious blood-stnnki'd e.\|KY!l oral ion ; and a 
rapitl, full puliw. Phgmcal rMtmituUion rcv«a!« itlighL ()iiIihm4 
and civpilanl rAlv8. 

TRRATtiKNT. — JiiiVt ; li<iind diet ; wot cnjis to tbe ohest. 

JideriMJlff. — \'eratni[u viride and a saline pui^ 



Pn»<Ive Congestion. 

EriOLTifiY. — Tins ixfiiiitK i'njiu ol>^(riK-lioii U> the flow* "f 
liIfHwl from tin- Imifp' In 11k- Iniirt. TIm- ihicl" vuiisc if ciinliur 
(lihcaM-, cv|N.viullj' fatty «lt^ii(*niUo», diluliUiun, niiil niiliul 

I'athoixkiv.— Tli« lungH arc (Inrlt rwl in color, nmi ofton 
Mfirtcwhnt ii'domnlouH. ^^'t>en tlie iiinditidii tiatt la^lctt a loii); 
(inic, lln; urgniifl litviimc brown, dciiM-, aiid ti>ii|rli (Iti-uMii iii- 
ihtntiionl. SI iiTflfi4-<i])ic cxa mi nation ifvoals ii <limlnlioa of 
liKMtiitiltnriM, an ftvcrgrowili ut'i-onnertive tiwino, tVw |>igiiient 
gruniili's, and <ii'};t'neratiit- c-Iiangi* in the IiIoocIvcjpcLi. 

Symkioms. — l)yiipmL-aj hard loiigh ; macous cx[>ectnratioD 
<x>nlainin|£ pigmented ce\h. I'hytiieal aamination only d^ 
terminer tlio presence of riileB, 

Tkkathi:,st, — |{einedit.>H slitmld be dirKl<?d to the nndei^ 
lyin); canliac disease. The applii'ation of drv <-H]>s unctl gives 
lciiiiK>r3rv rdiff. Saline laxativett niaj- piove UM.>ful. 

]I}'|H>Kt]itt<! C*oiib«^m1 Ion. 

(HTpoatatiA PiMUmonta. Spleulsatiou of tba Lrm%.) 

Defikitiox.— A i-mtpwlion of dvjR-ndnit poTtiuns of tkc 
ItmgK uc-ctirring in aMli<-nic di»wa»GS wliic-Ji nocewitatt' n |>n>- 
trai'ti.'*! iwiimlx-nl (HRiilioi). 

KTK)ijiw;y. — II is p-ni-rally o1«»cn-«l in low ftn-orvnud in 
rlii-onic wjL*liiij; di.-<:iiM-!i. (I) HliKK)-dy>(Ta><ia, (2) a wtsik 
iK^irr, and (3) a rLviniilM-nt [K^aition are ll)i^ i-aii.'al lailor^. 

Fathouxiy. — 'I'be lungs are dark red and (MjemaKmn |>u»- 
teriorly. Tlic (cdeiua an<l increased aniotiol of bloud rtndt^ 
tlie organ.'t more solid and lese crcjiitaril. Tbe>' n«v«r &ltow 
Uie grannlar o|>[w-arancie of cron|ioii8 imcuinonia. 

Svm-l'ous. — 1>> 8|»n<ea, coiigb, and scanty eX|)*vto?atiou. 

Ph>)*irnt e.ntiittu'ition reveals sliglit dulneBH, subcrepitant 
ralcfi, and thvbh- bnviiditid bri'atliin}!. 

Treatment. — Kllorts i^honld iw nmdt- to prevent |)h.m)(>- 
\'clopnM;tit of Iiy|H>)*(Blii' ])iienuiot)ia in u^llR'nk' dtN^wc by 
frvqnout olimigi.' of iionition, and Uk- tiiuvly lax of sucb caidiAc 



xtimuluntj^ us nVxiliot, »trj-ohnia, digilAlifi, nnmiouiu, und tui^ 
jH'titiiif. Wh<-ii ain-iuly jinwiiUtiiriH-iKim'ittiiiMit or drvcups 
iiuiy be ai>|»lki! exlcniiilly, hihI one or more of Ilic abuvo 
stiniuluiils luliiiinUlci-cil Iiili-nuillv. 


(Iiobar PDmunoata, PrnmnoDttl*, Lung Pnvw.) 

Defimtios. — All awilK fiptviti*: (Itseftst!, ohararteriisctl ana- 
tuniK-ully by an iiilliitiiiiuilii<i) of the ]uag!>, folUwMul by a 
mpkl iiitiltnicioi) ul'tlioirnlvtHili ; and manifWrd cJiiiimlly by 
li!|;li fcvor, (^>it};b, dy.-<{iihi-n, " niHty" sjHiUini, aiul [iliyitkid 
a'n^tw iiidi<mivt- of (i>ii!iolidnrn>i). 

Ktioixhsy. — Aj??, f*x, sihI climate exert but liltU^ |Hvdt»- 
pcwirig iitttiK'ini?. l^iwered vitaliiy from laid hyeicao or from 
some jtn.'H'xiHtcnl diseoae, like diabetes, Bright 's disfaffe, Dr oni; 
of the iiiliytioiifl fevera, favors its developineiit. ()n« attack. 
nMnlers tlii> jiationt more liable to Eiibse<]itcf)t infertioti. AImj- 
lioliMti h a stixmg |m^!isposiiiff factor. Es|)cisiire to cold aitd 
wt't ofieii |mH'i(>il(ili-i* the iitt;u~k. 

The exeiiiut; raiiw ■« iiiiqiie!^tionably a micnKM^aniBm, (iro- 
Imlily Fraiikel's di|il<.ir<icx-us |iiicitiii<>itiiF. 

I'.XTluiUHiv,— Aiiut(Hiii«ilIy tliree stugiv Iwve been recng- 
niw-d ; (I) The «tii^' of nnif^'T'lioii ; (2) of red Iie]iati)»lion ; 
(a) of j^y hcimlimtion. 

Stoffc I. — The allV-cted |Hinion miiaiiK diMtentk-d when the 
cIh->*I is ujiencii ; il iri of a divjvnd <'i"li>r, and ix more ii>istant 
to the loix-ii llimi the normal \ni\^. On HH-tioi), a frotliy blixid- 
•itaiiH-d wrrnni fn^'ly exiiih's, Miei-oseojiio exarniiiiilion rcvwits 
a dtluteil am) loiliions mitditioii of the <apillari<^ itn-ellin;; of 
the alveolar ei'lU, and a s\\^\t eorpii!icidar irxndale. 

,S!«'/n 3. — Ttie hejratixetf portii>» is inerea^tl in vohmie, is 
(]nile firm, is of a darli-rtd eolop, and wi heavy (hut il tdnkH 
in water. It i;^ very friable, and the lorn Hnrfaii' |>n.«><-nti4 a 
granular am^ein-unee from the iirojeetioii of ihe tibrii)oii!i [>lugs 
in the alveul). 

Mieroscopic examination tvvpalj' a mesh of eoagitlntfd llbrtn, ! 
eneloHing nniui-ro(» n\\ \i\\nA-*nir\n\»(Av» aud sorae lenuocyt^s; . 




the latter arp nlH> tiutct) in llii- inlcrlobtilitr ti»iiio. In wdtoiis 
j>ropt-rlv IrraU'il tlic <li[il'xn(.\iia is Ji'lwrtwJ. 

Stoffe A — Thf Tvii otilur jiivi^ place to » iiioUIm) ^niv, nikI 
the- solidiBo] liiDg W-giutt lu sufdn. TIk- (-iiimirc- in tvloi' is 
iliK' to tbe comprvmiiin of tliv «ipill»rH'», to Ihu ai^ppcimiiK-r 
ui' Tvd (urpusclnt sihI thrir n-pluii-meut by loiinx^yU*, iind to 
(iitty d^iHfsli'Mi of wwiH* of thv clciiK'Hts. 

Ill fitVoniMc «t.*i* h-w^Itilkm (Hvun* Wforr gray Iic|>ali«itioii 
iim fur •dvamx-d, iIh^ cKiululkm b«-iiig u-niovi'd by ultMirpiioii 
nitd i-x[x-<^tonili<>ii. 

In iKitiivomblt! oaAm tJie cx>n!uili<Iated Inng may become in- 
filtratn) with |>iiii (FiiruU-nt infiltration); it may beconw 
gangrenous ; or, \'ory rarely, it may become tlie seal of fibroid 
loduralion (Oiroflu? initTBiitial pi>eum(inia). 

Dentil may nsait early in tbe ()i-<^t# from tlie ifeneraled 
bl<Hxl-|H)Lwii'i, or Inim nipi^) iliininuttoii of tbe rnipimluiy 

The consnlklation u^imlly bc^ns at the base »ad exlcndw 
iipwardH. The most fiYxjiiinit sent la (li« lower lobe of tl>c 
right Idtig. TIm' l>r'>iK-bi and tliu ailjacenl pleura tire involved 
in the inflammatory proivsi. 

Symiikuw. — The disi^iw tixntiltv U-i'iiiK wtth a divided 
ebill uml a ebarp imin in the wiile, tiilbnvi-<i by a rapid ri^ii- of 
U-nijH'nit^irc; tlieliilleroftrii iitlaini* ils maximum (_104°-10-!i'') 
ill 1-1 ity- foil r boiini, and generally eontimii'!> high, with ttlight 
rliiinml>>, until the ninth day, when it lalU by eriKi.i, 
riiH]ueiitly reaching (lie nonn by the tenth day. Oci-aHtonally 
the teniperaliire falU hv lyni.i. . There is marked tlyspim« ; 
tbe i'(^|iiraliiiUH are shallow and rapid, ranging fnim 40 (o Mt 
]ier niimile, lliiis making the ratio bclwcfii i^tipiration and llie 
poUe I to 3 or I to 2. ('owgh is a pioniineiit f-ymplom ; at 
fipBt it is short and <lry, but later it is ac-eompaniwl by bloody 
("rusty"), traimlucent, and tenueioiis soutiu M icnwcopitnlly 
the ^tultmi (»nlain»t red blood-^-qHis-W, their frif pigment, 
piis-ourpuwh'S, diploeocci, and other mirnKti-gjiiiiMti:*. Tbe 
fuin' is flushed; the li|a are rnmum'd and "ftiii ihe wat of an 
hrrpelie eruption ; the tongue in heavily furrtil ; the bowelx 
ttre coiHtJpntet) ; and lite tirine is w«nty, bigh-coh>red, de- 



floimt ill oliluruk^, and oflon ttliglitly albiiiainoua. In nevat 
i-UM^ ili-liriiifu i.'« mrvly nlift-tit. 

I'livsicAL SifiNK. lititp^ioH. — Diminished es^ianfiion, Iritl 
1)11 Imlgit^i; of tb<> ii)len>]>afli<ft ordi^ilaixniout of tneapcx-b 

J'alprtiioH. — Diniinisb<<() e.\|Kineion unci incivased vuoJ' 

I'creHxxion, — At tlie onset lliPrc may be tynijoiiy over (Im^I 
affected area fmni diminislipJ intni-|)uliuoiiary leihiion. A^H 
vonikiluliitim) atlvnncrs tiK uotc bcmines rcinarkahly dull. ' 
Kxaj^crntcd rcsonam-c is noted around tlie bc| areas. 

AHUttillation, — In tlie ela)fv of «.'on);i!&tion iitu.- <Tppilsiil raleit 
arc Ik^M »| tlio end of forced inspiration: tliov jm^lKiUlyHJ 
tvsull from tiip forcible »e|Hiiiitiou of adherent vesirtiliir walU^Hj 
and di-iiiiiH-arwJicn tbe bnij; b<xx>iiM% mj ltd i tied. AiiwiiIlRliim ^^ 
tlii-ii dciei'l" itifivwsed vmuil ix^oiiaiKis wk! Ii«r>li bmitbtng 
whi<;li it<, lii^b-pitolu'd, luid tuliiilnr in «xpinitioii 

Dni-iii); rettdbition thu i^mflvncd exudnto [>podn<«9 RiMi inoitil 
rS!t>*^iin' ii^Iii\-i'iv|iitiis. 

Atypical Cases. Senile y'tM-Nrtioitm.^Tlie syinjttoniK otivn 
develop iniiidioii^ly ; llif tonipeniUire may not lie lii^h ; ihc 
pnUc may not lie aweb'raled ; L-i(i»i>ctoralion is ofWn ai>KDt; 
the signs arv not marked ; delirinni is ooinmon ; weaknew \* 
exttfinc; and d<»tk from exbaustiun is the most treciDifit 

fntiiuujui'i in (ytltitrm. — It is oflcn ti>iher«I in with con- 
VuUiotis. I [eiidui-ltp, deliriitm, stupor, and n>nm arc promi- 
nent iiyniploniK, m tluit tlie diK-iuw may simnlal*- meiiinptic. 
Tlie Icutpi-niliirt^ is very bigb ; expt'i'tonilion i» oftrn »(»enl. 
'Hh- dilicaw rrtMjneiitly begin?) at Ibe a]N.-x of tli<; lui^. 

J\//iiiitifi I'nruitirmiii. — Pii<-timoiiin arwofintud wiln typhoid 
BvmploiuM, ■ ■ limdnoUi.*, mimfrinit di-lininn, dtiijior, a dry, 
browu longDc, ?iiti:tiillti.-> lendiiiiiin, curpliobigin, a rapid, ut-uk 
pnW, and bi^li fever whitli, In fiivombb- (u.'tt-)^, {iill-i by ly:^is. 
riie cxpeetoration is ofren like iirnm-juiee. 

Pnevmotiia of DrankuiiU. — Ttie on»-t is gradual ; the ex4 

Ee<-tomtion is like i>niDH<i>>^ ; tlie tem[x^rature is not high j 
lit a vioU-nt maniacal (jeliriuni eonimonly duvelope and ' 
foIloVieiJ by death from esliaiiiitioa. 

CBO«W>im PNEmoMA. 


f'(>MPi.n;.\TtoNK. — P]euriHy,|>oricftr(litif4,r>n(locanlitit>cfdcfoa 
of the lungs, dclaywl rp&nluliou (consolidatioii maj- Inst 6ve or 
six weeks, aiiij tlicn (:lisii>|x^r). iib^i-iv^rs of thv luitg, gnDgrmc 
of liie Itin^;, und (-hroi)ic iiiR-rvtitial piutiiiKiiiia. 

Diagnosis. J^furiny. — Hi-rc ttit- iiifttnl rliill is not so 
mnrked ; tlw fcviT is nut mi it'xj^i nor the pnlw wj rsi|iHl ; mid 
there is no " nisty" ifjjntiim ; Imt Inilpu); «n<l <Iiis])linriiwnl of 
tho A]Mrx-liai( nrt- often nof«-(I on uwixnlion ; rlie |iitn-ii.'«iiin'<)iil- 
n<-ft»> may c:hiin>ri.' with the |Ni»Uiri; of ltM> [uticnl ; vik-hI ii-r^f 
nautf itiid viH^il fninilM.s nrc dimini^ied ; ntid Mie biY^lhing 
In (li^-taiit and w<«k. 

A(^l* I'/tthinn. — IrK^nlar fi-viT, i)a<'illi in the i^piittim, iind 
the iwnlinuntinn of ^mvo jtymjitiniLri with si^t^ of iioftcniug 
after thp iiinih or tcjith day, will snggrst the diagn'iciiB of tiil>et^ 

iViHONot-v tlHana, — Hew there i» ahseoccof cJiiil, fever, 
and pain ; the exjHvtoration is watery, not " ntnty ;" I>oth 
Iniipi are commonly affedefl ; aUMidtation reveals abundant 
stiltcrr^taut r&U-^ and weak breathing. 

Ti/jj/iwd /■Vrrr, — Typhoid pneumonia may be rendilv mis- 
Ukeu for typhoid fever witli pt)«iimoni« ; but ]>neiiroonia as a 
(.i>n)|)liration uocurs late in the discaw, so that tho history of 
tin; oii>rl }nvi>- miH'h swttslan<v. 

Tlic nw'-rcJ rsj^h will in<li(Titc typhoid fever. 

I'nofJNTeii.s.— In jwlients previoii-ily hf^ltliy, llie proguoHis 
is good. At thf extniiM^ of life the onilook is grave. lu 
druukiihU the diiswi;** i» e*'|K!e»iilly filial. 

In iiiiiividnul caw-*, a very high fevi-r, great dyspiui-n and 
ej'nniisis, njj)idlv iniTi-.iKing i'<.>MM)Ii<Inti<in, involvMiiiMit of Iwlh 
liiiihrs, and .1 diirk sjMitnn) tin- unfavomliU- fai?IorN. 

Till- Hvi'iTige niiirliditv i:" 2" jx-r iwit. 

Tkkatmknt. — Abmhite re^t. A lifjnid or flrmi-limnd diet 
(milk, koiinii)tt<, vy;g», bn>ttis, l>oef jniiv). Tlte eheiit should he 
enve)o|>ed in a cotton jacket iiivcnti willi oile«l rtilk. 

AltliMigh nni-Muionia is an infivlioii:' diM«.'^- wliieh prodiiPtfll 
widesprend tiii«tnrbai>oe in tho (i-ononiy, Ihi- innDtOinic daiigi^r 
is generally oltstnteiion to the polinonnr)' <iriniLili"n ; ;*■> llial 
in the Hliige of ixiiigr<ilii>n, wlii'ii the (nil-ii! i> full ami ntronj;, 
venitnim viride ("t iij-v of the fluid extract every lionr until 



th« piilrw 'Koflcn^) IK n \'a1u»blp reiueily. Jt deprestics (Ik 
iK-rnt, iliUfii* iIm- s\>liiiiic v»i!^-K mid w iiivitrs (JIikmI away 
TnHii tlir t•llg^>^[^^l liiitg. In iht very njbuKt, vcDt'ercUon may 
WitulKililtitiHl for veralniDi. 

In (MiLioli<Iiilitin, tJte right V4>iitri<^lc » 8iibj(>ctO(l to u strain 
ntid llwtv tH (but]{or of iM'Jirt failiin- ; Itcmi- ninliac- i^linitilants 
an- iiulii'nIiHl in tlii.i i<L-ij£>-. Tli(> tiix-tiin' ol' {liplulif (j;tt. x 
I'vcry I«n i.r ilirtv hmirs, boin^ j^uidtil liy t)i<- |iiiIh-) tiiuy in? 
givi'ti l)v ttic inditti : when itit- sit.ntadi in irrituMi-, (lie «lnig 
b1>uuI<1 W a<]inini.4tcn'4] hypodt'nni«illv. StryHiriiu (f^, j^ui^J 
16 alsi* of ffKal value as a mrtliac and n'iiiiiralon' »liniiiluiit^^| 
Atumoiitu is useful in some t-oBt^ and cither itw- arviiui(i<i^1 
Spiriu or the rarlMiiiatc niav be piiipltiyecl. 

Ill milil rHM-Ti ((iiiniue (gr. V tbrioe daily) will be tbo uiilj 
intn-iiiil n-niwly nxniirwl. 

Asa ji^i-nvriil r^liniiilHnl and food, fllcoltol is oAcii indinMnL 
In tynliutd pnviintuiiia turpcntiw: ("l v) may be aaaocaatn] 
with (nc uln>jiul. 

I'lthi may Im- r>'lH>v<-cl bv o|Hi]ni. or by tliP appticatioii of 
n'd (')i{H, dry riijis, or hot fonx-DlAtioiM, 

JMiriiim. — A|i))!yan iitvl«g to tlw- Iwwl, ninl administer 
briiniidt' of iKiiastiiiini, liytcM^iiiv, iiiiittk, orcainpbor iiiterimllv. 
Wlu'ii tin- dfliriiim U nj^ocinted willi hi^h (ever, a cold pack 
or U-|»d biitU ^vill otioii <^intrcil iu 

Pgraia. — (M'a.iiounlly, Iiigb frviT will r(<>)ii!r7 trmtntcnt ; 
)i]M>n^iiii;, a rokl )iark, or n cuM lintb (80*^) may be t-ntjilnyetL 
.\nti|)\ rin (pr. vj) is a syifo ami cllicm'iit rwntily, 

(Jtinvali-.^t'iK^- nhtiiild lio ^naixlitl, ami kiii'Ii tonti':* iis iron, 
qiiiiiiiH', !tli-yi'Uni]i, iiiid cxid-livor oil will lieliiiind U)K_-riil a»to- 

In <)play<^ resolution, niuall bliMer^ may be appliisl over th? 
afTMed an^ns, and iodide of jHita-'vaim may be administOTMl 
inlemally. Thus : — 

I\it«)». tndiil., ^ ; 

jVmiiion. rhl"r.. Jis* ; , 

Sllsi. i-lycyrrlii»e i.-oni]x., fjrl,— M." (Da CoarA.] 
Sg.— Tsblc8poonl\il foiir Ume» n day. 




(BroDcbo-pueiuBORla. Iiobular Pn9umonU, Intulai Puvnmoiiia. ] 

DEFismoN. — All inftiimiDalioi) of llic U-i-miriiil l>roiioliM)l<'--« 
aihl iiir-vwicU*, H«ir«rtcri»)d unatuiiiicnlly l»y !»«iIUtiiI iinifc* 
itf ion \t(ii<-h aix! fHjni]>u'H'«l niiiHwI ciiiiiii'Iv of Imhyi- 
i-vt<% iind ik^iiinnuiUxt '-pitfieliiiiii ; iiix) iiiaMiti^t'a I'litiimlly 
hv (IKK i I -nil'.' I v iii;;ti h'hI irn-jinlur iI-vit, tlv^iiii'i'.i, tiiuyh, and 
jilivKJoil lii^iiH iiiilii'niivi- i>f iiLMilnr iniL^iilidiiiioii. 

Ktiomkjv. — TtifclUciLH- tspcm-rally.-n^HKlary tn tinmohitis, 
aixl U>e cHiiM^ \t )ii<-l) |iix-di»|)iitfv to an cxtcu^iou of ihe intUiiii- 
iimtion from tlic brtmohi to U>c itir<v<sictc6 are: Chililhood 
iirid otd agi'; llw infMrtiotiJ* fi-v*^, fisiKfinlly ni«ia[«i, whoop- 
ing-oHieli, (KphtWria, aixl iiitlm-iixa ; aixl low vitality. 

AiidtlifT (irtiiip of «ws ix*ijlt« fmm lli>* ah|iiranonof miic 
ims, or jonicW of fund into tli« &iiialliT l»nmdii. This 
lial)Ii> lo o«mr from anv f-aiiBe whioK rciKlorBexjiectoration itu- 
[»orfec», as the conm of aiwplpxy, the stu|ior of typlioid fever, 
l>iill>ar |«i»y, trat-hfolomy, and adxTiiiwd paretic dcmentin. 

I'athoi/ksv. — As a riile, both hinjrs arc involved. On 
section, )<tnal) projoctin); uriiis of roii.'soli<tulioii aiv milcd iitTe 
and there arcximl the fiiirr bronohiolfs. Itetwit patches aro 
r^ildtuh-hrown in color, finn, and sntuuth or finely j^nnuilar ; 
Inter the}' Ix-vKunv jiniyiitli Jtnd stft. The tcnninxl brundii 
nre lilUil with jmnili-nt nuilerial. 

In nddilton t4> tliftio Milidiliiil itrcnt>, thf-ro are niliM- small 
|Kit4'li(v of colliiimtl Innj; whidi arc iiirli'^, linn, and hhii^h- 
nil in c<)lor. 'J he i-ollaiLW ha** iit-hIiihI fiuni on-hi.-'iiiii of (he 
1 111 1 iM hit.*, anil <-l<iM-ly ivwmiiint ri>nn(ili(!alt»n ; l>iil it i-nn, ii« 
a ride, Iw ovi'ii'<)nie whoii inllalion i^ praili.-x,ii l)y inniiiii of u 
Idowpij))' iasorli-d in the supplying hninehn^ 

Mionjscopie examination revraln an oxndatc in the lortninul 
hronctii and nir-<v)l.4, which i» ixnn\n>i<-d of louoiicvtfs and d<'»- 
ijimmnlrd epilhelinni in various niagcji of m^-niTUliou. 
Tlie walls oftlw hiMnelii ai-t^alMi infillniUHl with hin-myli'*. 

U'l«'« ooni]miil Hiih eron(«nis pmiiinonia, ilw (i>ntra.«t in 
titrikiDg. In the latKT ihc long U invulvi^ en moMt ; ihv rtin- 
^oiidatHin m distinctly granular, atx) u composMl of ml bluoil- 



c<>rpi»oli>s, wliite blnod-oornusclee, fibrin, and cli|>locr>od ; the 
lining tjiiil»-liiim is Imt sliglitlj- involved ; and the walls of the 
l)ii>iiclii aiv it"t inliltmtiHl wilh leiicotrv-tffl, 

Tkhminatkixh. — (1) l{«rsci]itli(Mi ; ihe cxndatc nndergoes 
I'ii - - - - 



f-iilufiis, and in others tlic exudate became a g^xxl soil for (he 
ilevrlupnieiil of ttiberclo bacilli. (3) Abe^^v^s or pinnrcnc ; 
Ihoe terminuliotM un> niiv e.vorpt in [HMiimmiiiiv ri'viilling 
rn>ni lufpirulion. 

SYMPTOWft, — The «ymptoiiis ant nftcii niii«kc<l Uy tlw- pri- 
niiirv diM^aw.-. The itwvt i* iis^imlly giwinnl, mid i.s clmnwivr- by )>rivt| ration, <N>n)i;li, and t(-\Tr. Tlw laM is inf«tcnil<-1v 
liigli luid v*Ty irniridiir (Ii)l'-1M°). 'Iln- ilyAjiixiit ii* 
marked, ami lh« r(S|iinit»niis an^ mpid— 50 lo 80 (xr iiiiitiiKr ; 
ihc mdso is (^really a«vleratrtl--120 lo 180 i>er miitiiu-; 
uHigli is painliil aiul atxiimpaiiii.'d by a iuii(W<) tun dent kx- 
iMvtf^iration which is rarely KIoihI slrmki^L The fmv. is usii^^ 
u]W |iole ami anxious, aud the lips blue. ^H 

PiiVKirAi. Sioxs,— As ibe aivas of (<onM>Iidn(i«n are gtiic^ ii 
lallv small and scaiiered, the pliysieaJ signs are n*<t markM. 

JiupeHioii reveals c-videii«s of dyspitii-a, — Uvidity, playing 
of tiie nosInU, prumim-iiec of ihc stcnio-eletdo-inasloids, ana 
retraction of the luse of the elkret. 

i'aJfjalion usually gives negative r«<u1lii. 

PeTfutHion may reveal areas of dulness in one or botli Inng^ 

AHsftilMion reveals fine sibilant (H-irii>tlin<;) or suberepilant 
rAk-H, and aru]i» over nhieli tliv breathing is tubular, or l>n>»- 

pRfHiKDRis. — The following table will ^ow the dinici 
diHvn-tKCs bdweeti eatairhaJ and avujx/ue jmeumonituf- 




Catoi . . . , 
Otmr . . . . 
FaviR . . . . 

l{XP§Ct<IUTIOIi . 

lloat ooaiman ronn io ohtl- 

(Janallf fMmi'liiijr to ^^»l- 

(Iradi»l, a cblll ftrBdrallj 

Uodcrntvlf Uit;li. '•T i'- 

r^iilai, anil riiitluj; li; 

iytiu aflur an iiMl«l]ailB 


A Ulat^ral dtwaiwi. Pliy- 
■kill Minis an* iiiHUlinci 
and Uidkai* lottniKl 
aMaa of oonMillilaUdii. 

('nnittwrii PkrcHoxu. 
Kol Gomiuan ID cblldrm. 

A primBir <li>Ntt>e Micil*d 

iy llio dl]tlMocnii. 
Atirii)tt onwrt villi acMII. 

High, nuiilar, nnil MiuJia 
by rrwu at tb« prglilii oS 
ninth A^. 

"Ritsly.'" IrauiluMBl,! 

A iiuiUtrril •liiriUB. t'lij-' 
eivnl liKiiii atp distim-t 
and liidkaW a inr^n and 
unitonu Kiiieulidalioii. 

At^Uf PlUhiKln. — In (1)18 (li«ii*t! lh<-rv in u tulM-nnilotis 
brutioho-jim-diminia wliicli in ililli<-iilt to diiiliiigiiiiJi from eini- 
ple brHndio-|nn-iiirnmiH. A fiiniily liislory of (iibi-n-ulo^i!, an 
•■xtciwivi'' iiivolvi'iiii-iit ufllM' ujtirt^ Uilililiiij"; riiKif indicating 
!<i>rii-iiiii^, Kill); iliiratiiii), mill Imcilti nriH <-lH.'^tH' tiltrr^ in tlie 
npiiin Ufi' (Ik- tlia^nostir fitifiii'mc-na of {ihtlii^ii^. 

lirtmrhili*. — In ^imjilr Iir>>i)i^)iti8 the. ft-vfr is nut high, Uic 
ilys|)n<ra is rari'lv inarkt^, j>iv««t ration in nsnalU- uli*mt, luid 
tlifi'C arc nil {ilivHienl aipis imlimtin); i-oituilidiiiion. 

(lipi/lfiry JtroiieliUi* alwaj's jirwwlrt* ratarrlitil (iDciinionts, 
iiinl (lie (!iti);ii<KtJH (if the two is often ini|H>M<itil<^. Tlw ulK«fnw 
iiC |ilivM(al sigm indiniting cui)§ol>d»tiitU U tl>c only diagnostic 

PwKixiwm. — Always giisrdocl. In the very T'Nit^, very 
iild, and debilitated i)i« di&ease is rommonly lafaJ. Many 
ivoovnr from the jiitMinionin followinj; tl» infprtions (pvifs, 
AvHpiraliun-]im?um<>nin i.s (-omnionlv fatal. The mortality is 
ditlii'idi to istimaio, for aciite pmJiij<is ii^ often dia^n<i«d 
culanlial pneumonia ; it ia proliably (rix.'atiiT than in entiijHHiN 
iineiinioniu. and varies from 110 to Gt> |>er eent. The duration 
IB from one to tlirm u-edu> ; a toiler dumlioa would auggcM 

TilKATSiKNT. — Thi- (tifoiv'M' ivm ollfu he prwontal l»y t-aro- 
fiilly pnittrliiii; jwtit-iils .'•tilfi-riii^ fr>mi hnniehilit; ami iiifcc- 


mSKASIX op TltH Biau'lltATOUY 8YKTEU. 

be iii>plic^ 

my tiK-lml^l 

tioiiii li-vvni. In the latter it k al«» esscntiiil tlml llic u»p(>-| 
rytix xlioiiid l>c kpiit d<an witli M>me miKl aiitiMi-|i4ic »>>liiti' 

Tin- rrmin t'IiodM Im? well vciililatoJ, Ixil fr«! fnim Jnill. 
and Itw- ti-iii|H'i-nttiiT sIkxiIiI be kept uiiitoniily iit 70°. A 
mmM niiiii»jtl>fi'e is desirable, nm) an niiixinitliit Ibr j»r\HliK-ia; 
»t«Miti iiuty Ih- impmvii%d. Tincture of ludini; may 
lorally, ami Ow ljH^»t cnvcbipi^l in n <»tb>njaekct, 

Ttiv did i<lwnkl Iw li(|iiid or »-»)i<li<|(ii<l, mid tiuiy ttK-1 
milk, jtinkH, kiuiint«t, i-^gs linitlii>, kikI )iix-J-iiiiii-. StiiiiU' 
lantM, wine w tirantly, are iwiully mguinHl to oooilmt iW 
e\tn-UM^ [initU mill III. 

At tlteonw^t a Inxativo sImmiM W n<Iiniiii>tiTc<l, itnd rflliii 
nrav be spIh^wI (j*r, J evcrj- hour until it njieratw). 

Stimiibtii^ cxpMlorantR arc near^v always indicated, am 
chloride of ammoDiiim, earboitale nf ainmoDinai, B(|iiiU.H, 
lieDega raay Ix? enipl>iv«l. 

1^ Aniition. cliloriitl, at. 1 ; 
S|>t. tethertd nitroiu. t^tA ; 
Syr. WDcgir. (jiIm ; 
llttcL canlaiiinnu cnai|x el tuptn:, U q. ■>. nd fjf ij. 

Sif[.— A tMaiMOaful axeiy two or lhn:» liuun to a dtlUl oF tlinw 
years. ~ 



Ainmon. (iui>L. |^. xxiv; 

8yr. lolu., fsvj ; 

Spt. vini (»l..r.^iij; 

Ryr. iciM-gic. f S'ij** ; 

Syr. Bcni'iie, q. a. nd (jfiij. — M. 

((iOOUIIAItT im<1 ^ARR.) 

Sg.— T«aiii(>oonral every Ivro hours tua cliiki of two or tlmi; j-mir 

Stn'ehnia in wfti-ii invnbiiiblc ii* ii nw|iirali)ri- iiti<1 cunlis 
•timnbint ; for an mbill, gr. ,<g niuy Ik^ given Mtnr i^r fuuf 
lim<w daily. 

Tlifi an^umulalHin of munifi lo tlie bmnobial liiUt*, in'IinUr 
by extn<«i« cyanoHts, a UTuk puW, and biibbliiifr riil<^ wit 
mit fnr tin enictie ; wiiir iif i)M<eae f5j-3»*), "i" a|»niiorj>Iiil 
{fur tin adult gr. ■,^) inay l>c wIoct«l. Xorvini!* »iym|>l>>ni- 
restlnmnn^. delirinm, etc, will oflcn l>e n'lievi^ by a imltl 





ohloml in small tiows may l)e re<inirw!. In rfiildpMl the fol- 
lowing fiuppoeitory k ulV'n very effieieut : — 

9 Pu!v. assBrwttJat, jj ; 
QuiniiMc eulph., (-r. xxx -, 
Ul. Uieobroinip, q. k.— M. (t'KffKU,) 

Ft. in m|>po*- No. xli. (Cliild^ *;«■-.) 

Sig. — Onn cver^v Ihrve or fmir hour* for n diild of livn ycnra. 

Ill <lelayc<I rc6uIntK»n <H>nntcr-iiTitant* ntioiilil l»o ci]i|)]u<<l (o 
the atTocted amis, un<l iodkli- of [x>t]i«'iiitii should hv luiniinii- 
U-Tcd internally. 

Convalrawncv mniA be ^uanlcnl; tumrs like vod-liver-oil, 
iron, aracnic, ami l)y])0|>hoephit4!8 arc iMeful rvstorutjvut, A 
cbai^ of sciiw is (U«iniUIo. 


(CtrrlKMls of Uia Iiung, Ctiroitic Pnanmonia, PulmoitiUT 
Induiatlon. ) 

pKriNiTios. — A chronit; diantw of the Imig, t-liiiniclorijtfd 
liy »n ■iv(rr)iix>wtli of fiiinxiii tissue. 

KTKti/xjy. — Ii i<i a rare sctiufl of emiipoiLi piu^nmnnia. It 
is iMiiiinonly fiMind associated with liiben-fes in fibroid |>hllii^i.«. 
Tlifi ovecyrowih of connective tis^^iie is eomctimes indaocfl by 
an old librinoiisnlcurisy. It may bo an expr««sion of )n,-(diilii). 
It arises primanly from the ooui^ant inbalatioti of irritalinj 
dusta, as Monc-diiHt (Cbalicoetis), ntal-dust (Atitbracosis) 
niPtal-dust (SidemsisV 

Patuoukiv. — Wben tbp thorax i« ojiened the limp is found 
it-trarted ajid the brart displaced. 'Hie ot^n is tough, finii, 
and more or lens airiess. 8crtiun ^lowa an uvor^^wtb of 
libntns tifst»e,aml usually inHammatton ami considerable dila- 
1 at ion of tbc broncbt. 

SvitKniMs, — >[oderate dyspn<ra and chronio congh ; ttie 
cxpeetoratioo may be elipht, l>ut often it is pmfusc, and feti^ 
from having been retained in broncbi>^^<iitic cavities. There' 
is HO fever, and the gem-nil brullh may be well ]>resen*e<l for 
many years, 

PitYSH-'AL Sl(iN«. — Imtftfriinn rrvcals retraction of llw 
affected side and di^iiIamiK-nt at this aiwx-butt. 


Percaimon oRcn yklds cltilncss ; but uv«r nocular (liIiitiJB| 
tionn of tlie bixmc-Iii ttwre raay bo bypct-resonam*. 

A«»cutfalioH. — llic vMvI rcwonuiKo in imtra^etl and thp 
briMtbing is often bronchial ur <-uvcntous. 

DlAGNfWls. Fibroid Phthmn.- -InvoIvi-nMiit i>f l>i>lli 1rmp>, 
bacilli ill the s|>utii,aiKl fevvr would iinlii-ulu tibruid |>lilbUit^. 

pROGMoeii^ — InvuniliK'. The iliiraliun is rroni ten to twtmty 

Treatmrnt. — Palitativv. Ic (»iHij4)) in good hvfrieiiir 
n-giihitiuiiK uud the u*k uI' renKYlii« dirct^vd to the bruKclii- 


pEPlSmox. — A juitrt'factivo nocrosis of th« lunjf. 

Enoijouy, — Gaiigrcno is not a jirinmry eoodition, but \» 
Si-eundary to tujme inflnniniatory diiumiie of tlx? hing. It is vx- 
cited by tlie eiiti-nticp ol' hucteria of piilreliK-tion, but unless th<^ 
svHtvm is eoDsiderably reduptxl in vitality the tiiwtcw. even 
tlioD|;h di«-a»'d, kIiiiu' woiidvrl'iil resUtaiM'p, and escape putre- 

Pnetimoniii, r*|MyinIly iwjiimtion-pneiimoniii. plilhrKi*, pT«s- 
»iir«' of raoi'bici growth!*, bnim-liicv-lti^i*, ul>*iiim, niwi bf-mor- 
riuijiif iulaix^lion fnllDwinjj eniboli.-<iii of t1>C irnhninmrv artery 
arc the prvdinjiosiiij; prilmonary eumlitiuns; and Hrinlit'n dis- 
taxf, aleoholism, the infc<?t.ioiis fcvere, un<l i>arIi<nilnHy dtalwim, 
by lowering Iho vitality, redder thwt? ounililioiw rt[H-rativc. 

Pat»oi/X!Y. — Tlie prnwis' may Ik- drc-nMi!*Til)«l or dilTnise, 
mwt rre<|iii-iitly lii« fornior, Tlie BfTii-rwl |'ii« !.■* wiivcrtetl 
into 3 ureejiwh-Mmk, Mift niit**, biivtii(:nn*'\1rf-n«'ly fetitJ ihIoi-. 
When the i«.iftcm^! niatiriiil Jm* Ikvii cxiM-rtoralrtl lliciv is li-H 
beliiiiil II cavity with ragged walk, conlaitiiiiK a foid-i<iiic]liuf; 
iKpitd. Tho tiitsutd atntind the ravity are jntlanted and <vdc- 

Symptoms.— Thfr i^ymptomH of gangrene aiv ntvoriatiHl wilb 
llii* ori^iial dispa.-'c. CVmijiIi, dy!*pn(PB, moderate fcvw, and 
gni« piinit ration are goncnilly pniwitl. in 

The ex[wtoraliim is i-Iianwterwiic; it is pmfnsc, iind has i^| 
])eiK'lrutiiig oft'dtsive odor. \\'li«ii allowed to utaiid in a glasj^^ 

AlC^^GSe op TIIK l,tJKO. 


xvsaci it M'j>an«lr* into tlircp layers: a froiliy layer nn lop, a 
s<.'rnus luytT in the iniiliilr-, tliiuii^li u-hU-h liaii^ string of jtiiii, 
and at IIk- l>utkim ii liiycr i>t' ri'itili«li-|;recii |timilent mait^riul. 
Altered hlood nwiy [live it llic a(>|M?araiic* of |iriuie-jiiii*. 
Mk-iii60<>pi«lly it iiiiitdins shiinU ot tii^iie, crystals uC fatty 
acid^, crystaU t>f batmatoidin, and all eortii of lHi<-lcria. 

Phyneal fMiin!naHon may rc'V«il bubbling rSles, and later 
ra%-ennHtii bmtlhing, pectoriloquy, and localized t)-ni[ian^ on 

PiMKiNfisis. — (irave. Death usually nwultft from exliails- 
tion, btii oratiionaHy from hemorrliage or pvi>-prM?tinio£ borax. 

Tkkatmkxt. — Nutritious food, and tjiiiniiK', stn-chnia, and 
alcoholic »timnlaiit.H will be retjuired to aiippoit ttie sysu-m. 

Th*- offensivf odor of the breath may be destroyed by car- 
bolic acid ()!V. j everv four liour^] interniillv, or by iuhalalinUH 
of carbolic acid or creasote. Ttirpentine ("Lv even' lliree 
hours) ha-B been recommended a;> a' ^tiniidant. and aniirtrpti''. 
When the (katientH .sii-ength ivill pcriuit, eui;gH-ttl iuterieniice 
offers the l>efit etuuce of Hire. 

AHSt.^>S OK TIIK H'Nfi. 

Bkkinition. — ('irainiBfTibcd suppuration of tlw Inng. 

Etioixkiv. — (1) It is rarely a sequel to pneumonia. (2) 
Midtiple alKcew«es are often emlxtlie, and reault from pyieraia. 
(:i) Foreijju IkxHcs in tile lungs — sonietliine swallovred or an 
hydatid cyst — may excite suppuration. (4) Kxlernal obsoesses 
someiiiiK>s rupture into the lunj;, as an empyema, hepatic ab- 
scess, or mippiirating iiui^itis. 

SvMi'n>M«. — Hi^h and irn^ilnr fever, rigors, sweats, and 
(lallor indicate siippii ration. I>y!*pno-a, coufi;n, and pnmlent 
offensive sputa tvintainiii); sbrv^ts of Im^ ti^ue art? tlie pul- 
monary symptoms. l'bysit«I examination mav reveal bnb- 
hlrnj; rales, luid biti^r, lavcruons brentbini^ and riectorilofiuy. 
Multiple (inUilic alisii;e*i"s aiv rarely i-eoo^ui/ed diirin}; life. 

PnooxoHis. - -Many ttut^ following |ineumonia and the 
ntptiir(> nf io(l<-nial aliiweAHcs into the liui); recover. BaulNilir; 
absoesBefl geiterally prove fatal. 

MMKASKt op the nE8PIBAT(lBV BY.-rmi. 

Trkatmkkt. — N'mritiiiiis fowl uihI (|miiim', rirkcliiiia, nnil 
alixJiiiliu.-JiimiilitnU ivill 1m- n-([uii\Hl to support tlio i<_v8t4.iii. 
The ]il>Mi>i«ti RliodU U; OlH'iiol iiml tll-ttiitul, « lltt- plciiml Mr 
is iu oiupvcnia. 


Depikition. — An dniaiua of acroiLi fluid iuto llie air- 
vcNicW and into titt inientlitial tittauc of tlie lungo. 

EtlttlAtuv. — Piilmmian' cfidema is a rommon canse. of 
death in many amte and clirontn diwa^tes whi(!)i end by licurt> 
failnre sod tW aicciinitilatiou of bliiod in the hin^. 

It is frequently note«l iu the oMirsc of Itright'^ diseast? aiul 
cardinc disea^w. 

\ lotal ])iilmona>y <edema b often foui>d around |Milinoiiic 
cMHisolidstions, al)6cesses, and infarrlious. 

I'A'i'iiciuxj^-.— Tile Itines, esiKTially the <le(>eHdMit iKirtionft, 
art' heavy, ml in t'olor, iind bog^' to the lei'i. N^ hen tlii- 
aJTiT-Ieil jKirlion h indF^xl und |>rc'?«nre is lunde, uD abundant 
hliHHl -trained, fmlliy iwruiu exudes. 

SvMi-n>us. — Entretnc dyxpiHi-a; rapid, hibumi bniithiuK; 
<x)n);h with frothy, blood -HtaiiH-d expivtoniliun; cyuuoMft; aild 
mid cxtn-milicD. 

Phip'inif -fiffiu. Iw^ievtinn revenb* cviileiHK-^ yrdyi«plw«— 
Mitl)ii<; p'l^lniv hihI |>ix>uiiuvmv of the auxiliury mil»<;J(.!i4 of 

IWvu-ision. — Dulm.-«H over the \yHK». 

AujtntHaliim. — F«i>l>l« resiuratury mimmir; 8ulicrepitant or 
bubbling rX\v». 

DlAtiS'ists. l*nfumonia.—~Thtt aiicvnce of diitl, of fever, 
of " ru«ty" t<-tini-!iHH xpiiiu, of jKiln, mm] of signti indicalii^ 
t»ii»"iliil.'itioti will indicate ii-tleina. i,. 

Otjiilliufi lii'iHrUili*. — 'I'lie fever atu) mneo-pundent expec- ^k 
tonilion Mill .ti'iA'e to di3(ifl^nL'<h bmnclkitis fit>ni n?dcn]u. ^^ 

PltooNnHiiv— .\lwav8 grave. It if) often a linal symptom 
of siinie [Hdninnai-y diwit^. Wtteti not advanced, anti the 
eoiiditioti^ ari? favorable, recovery miiy follow. 

TitKATilKvr. — When tliein' is luneh evanosis, anil tho 
ilienl'A dtnniglh will permit it, the applioitiuii of wet «ip8 



to the diest or blt^Hing rmiii the arm in of great valtK. Hot 
runif-atatiuna Hlionid Ike »))|ilici) to tlie dicet. J tydniguj^ue 
miJiartirn are iDtl^-atwl. K(»om salle in eonecntrattd boKi- 
titiiiii, or olaterium (i^r. 1), niav bo frlM^eil, Cardiac mumiiliintfi 
lib(> ffllior, alcohoj, ammonia, di^ilnli>i, and fHfui-iallr str^cbDin, 
ape iwinirt'd, aitd may be given liyjwjdormiially, 

IJ Strychuii). Mil|>li.M!r. j; 
Aqunatttllllau. 1^. 
Solve 6t Hig. — la minims )iypodennically cvcrj- Ihm or four hours. 

<>ifl'cinc i« a iiM-rii) diim^ic, «»d cardiac and respiratory 

9 <::«!fciM.. sJ; 

Sudiltwiizuott., 3»8.— M. 
Ft. Inolinrl. Xn. \il. 
Sig.— Udc uvcry tin or three hours 


Definitioi* — An alwcnix- ol" air from u portion of lliciiing, 

KrmiXKJV. — It niHv In- <-<i(i<r<-iit(ul and r<-jiull frcin ilcfiiicnt 
rviipinition ; iu thtw tiiww lUr tU'l»ciKlcnt ]>ortioiiH of biith 
Inn^B an? commonly iiflViHtHl. Ap<) st<-Iodui*ii! rwiiltd 
from i>ccl"!-ion of a bi-oiii-bim by h fon-tirij Uxly or « \>\uff of 
niiii.'>i«, iLs iu (n|>ill:tr\- bnindiilis ; or truiii nim|im<»ion of itu: 
Iim); by u liinior or |i1i-tir:)l i-lfusion. 

Symptdm.s. — WIm'M a large area is colbpeed in some pre- 
existing fliwiL-ot like mjiiltani' bfonohili!), there igk an abrupt 
invreibw in t\w dvKpnrra and (■\'ano9is, witlmnt a ci>rre!4]Xinding 
riiw of tem|K'nitiirv, Pliysioil esamioatiou givts n<^ti\'e 
roidu eviv|it ovt-r (-xti^osis'e <-<>1Ia]>^-, which may give didne»ii 
on |K>n-o?v>ion mid ueiik bn-athiog on aii»cullation. 

I'lHXiNfwiR. — This dejieniis niioii the extent of cotlapoe and 
llic gmvily of llK-jire-exisling disea'*. 

Tbkatment. — In rongenital alelectafiis apply alleniately 
Iiot an<I «iM Hj>ong<s to ilie Rpin*- : licep np the extemnl lem- 
|M-mtim-. If these meai^nrcr' foil, gttitly inflalc the lung with 
a flallii'ler. 

Ill il»e aic4)uinxl vurii-4i«-H din^iL remedies to the original 



(Itscase. AtlmiHL-<trr I'anliac iiikI n>|nnit(try i4limiiluiil« likf 
aniUKinia, aiid prndiim eiiiuKis wilh i|)(!UiP ur iiliini. 


(Pbthl«l>, FolmoiiMy ConituupUon.) 

Depisition. — A siiecifip infiamninl'in,- difipaso of tbp Innira,! 
utniiot] livthcluiHIluH lul>crctiIuHt!); cliaraderizitlanalomu'allrl 
by n cclliilnr infiltratiou wliii-li &i)l>!«i{nciitly (^4i:iilo4, eulleit^ 
UDil k>m)B to ulivration ■>!' itiv liiii^ tiii8<K>; uml niaiiiro^edj 
(■lutimlly by UBstiiif;, cxIiiiiiMti^ni, fn-cr, and cou>:)i. 

Ktkii.ouy. — (1) ICcsidt'itif ill Um'j ()am|), sihI lnully-drainf^' 
lomlilirs. (2) Hvmlily (impurtant). (3) Agi>; »i\ agw, Iml 
c*i>ccially l>i-tw«ii twcDiy ant! tliirty y(«r». (4) (XwiiralinnB 
wfitcli iici.' IIk- linvtliini; of tm[>nn>nir und ttir iiiluila- 
li<ni of irritfiiit^ like <'*«il-<lii*l, filuin:'-<bi«l, in>ii-filii)^, eh 
(•')) Ciiturriiiil iiifltuiiniitlioii iinil tniiiiniitl'^in of tlu; liiii)^] 
(fi) I'liysiqiie. (7) Oviicm! (liju-ttmw wltkh kiwoj- (he vi(fllih> 
n» ■liuU.'k-K, lioiMilit- cirrliiiMi.i, am! lyplmid fvwr. 

Tlie «x<'iliiij' aiuRc is iKc liit<^iilii!t tiilxTiiiiU»ii*, wliicth ^iinJ 
i;iilrni)<'(- (I) l»y liiiwt paivntiil tmnj'riiin'<ioii{v<try m«'); (2) iiyf 
iiiliabtiou, (he iIihI. dI' ilrit-il spiitinii Ix'iiii^ i^iiiiiKtiily tlirtj 
iiiiTlitiiu of iMiitayioii ; {."J) lljruiif;h iiitls-Uxl Twocl, an tlte milkj 
ainl iiimt of liiIki-i^uIoiis iatil<-. 

VAKirriKH. — (1) Chmiiio uloeraiive phthisis. (2) Avai 
phitiiHis. (It) Fibroid i>hthl.'<i». 

1'athoijCMiY. — The baoilhu liibennilmiii » a very minmel 
roti, almiil oue-fourth or oin»-t>iilf «.■* Ii>ni^ iw a red blood- 
»irpii%]e, anil oft«n slightly l>ciit aii«l Ix^aded. Iih detortion 
■ioiiinds on the power of the siaiiu^I l«i('iihi!i to resist the do- 1 
''tiloi'iKinz effects of acii]^. Fur ^ti.-tfiictory exuninauuD aj 
one-twelnb o!l-imnier»oii lei» in required. 

The lodgment of Itaeilli in the tcmiinal bmnrhtokfi of llioj 
a|»ex excitee a pn>liferati«tn of tlie fixed ivlls, which bedomo 
iitopp or Iwa iHily)^>ital in shaix-. The new wlls are tcrni«r 
e|iithelioid, lux) frtMjiiently contain Inicilli. Giant cells arc oftoii I 
loi-nicd by a fi»ion or overRrowlb <if llicsc (vlK 

This iif^rvgntioD of new cells actK n^ an irntaiit and ii mnmi 
Ktirninndeil by a wall of knu-iH-ytw, the wliolv fwrniiiii; a gtayJ 



Irniwluwnl tiiib:^— IIk- pmy liiLx-iTk- of I^K-niirc. In a s.lHir[ 
time \\iv Ixirilli pxdU- « coogiiljilion-nwnwH wlmli t^tarU m 
iIh' it'iHn', spixnili' l<i tin- jB-rijilwrv, ftiwl nuuxTtit titc hiticnii' 
iiiNi a yellow, clinw ma.-w — llicytllo"' (uln-ixrli! of Ijuniiiv, 
Tlif (kf^tK'rakil ttilHTi-U:^ fuM; mid tiinii liiv iinirorni oluiriiy 
niiuiMtt m commonly ohwrvctl al tl»i> niiMjisy. At tlii.* Mimi* 
one of two tliiiif^ nwy oocnr: The titiuM.inay sofU-n, Im'olt 
into a ImnKliial tube, atui Imvo Miifi<l n cavity with nlc(>r4t- 
inji Willis, or it liuiy Inhduh- (-ii<'S[ip'tiIiitt-c] by aii ywriimwih of 
<x}niHTtiv« IiMHtKr aiKl MiliMfiiii'iiliy olfrifii^l. lit addittrm tt> 
ihf Jt[)«i(;ifi<! ]jnK"«so( oIIht .■M-(iiii<liiry (.■hitiigi'4 art" i>i>lc(). The 
lung lirnitit; in tliv iK-ighlMir)i<HHi oC tlic IuIk-ixiiiIoiis di'jKibii-i is 
iitien tWAenti>f'Atnte)ini:iin)(>ittciiifluniniation; ili(!C(iiiD«.-tive 
liiMuc is alvrav!* more ch* Ims |milil«m(oil ; li>o bi<(>i)diial tubes 
sre iiiflaniod ; iiiul tlkc plctiiw ov«r the aJIectcd aruii) are nearly 
alwavH ailhoivnt. 

Chmnif nlfvrative j>hthi''ifi nsually Ixyins at the apirt*>. 

Actilf jJiUiiJiM tuiA Ixi'n tt-'riucf] {/hittuau Jforidti, ciieegif /Mrn^ 
monia, aud e&ronic entarrhiil punmumiay bn( the priK-ess is 
invariably tubeiculoiis. Frunj extreme vulnerul>i)tty of the 
ti»iiies a lobo or whole lung, or even both lungs, aiv rupidty 
infiUialed, and death n«ultti U3 irora a few weeks to a few 

In some rari«^ the lung is 6olidifu<d by u detisf yellowish- 
gray iotiUnition com [KiSfd of clo^ly -aggregated tuber(;l*i^; in 
others the ooDSotiihitiou upponrs in more or le» discrete 
]iiite)ie8 whieh have hati tlieir origin in the siiialler brouehiul 
tiibcH; in a tiiinl form one or Wh lungi^ are Htudiled witli 
■liNt^ntc UibereJeK, luaiiy uf whieh an; etill gray aud tiiin»- 


In fihrniil jJilhiiin iIk- fisdies apiK^r to be rwi^tnnl, imd 
the (»Txx«M is liutiud by an ovi-rgrowlb of i-onncctivc tii^iie 
uhidi fonn-s dctuc liands a/xKiml the hihcr(.idoii» foot. Tlii» 
(iinn I.i.stJ< many yrais. 

Chronic Ulcerative Phthisis. Symptoms. — ^The onwt \» 
nxiiallv iiLMdiciiiit aiwl niarktil by [xdlor, gn^^ric diKltirl«iTter, 
li«s of titsh atiil slrenglh, and by a t\r\, hneking eoiigli wliii-h 
bi isjMH-ially KoKul in the morning. From some undue ex- 
[MiMire, iIm; oougli \» ollui aggntvnled, and to tliitt obstinate 



"ooW" the ilispaw is iiMially sttributod. Id mnva-aaes^ 
eyni|>tonis :ip]K'ar »bi-i)|itly with Iieinorrbagfi ar an acate 
plfuriHv. ^1 

Sligiil fever and awclfratHni of the piilsc are early fiyniptomsHj 
ofjirrnt tliimimstii- iinjHirt. The temiKnitDrc in niarfcwl bv ni) '" 
evening; exacerUitiori, diiriii;; u*hi(-]i the ftux in lhii!lie<l, lliv 
vyv» hriti:!it, and the nitiid aiiimatt^d. As the disease ad- 
viinnw llic coU);h bpeoii)ii< lixxibleHoine and tlie cx]icrt(>raHon 
luont abnudiint. In well-<k-^'olo|iixl niM-* the exfieetonittrin i» 
grt-etiiiih in (vlor, i» in (■'•in-^hB]it>d [dii-rs Iniiininiilnr), i* hnivv 
and pink* in \wili.r, iiidlU-n liUnKl-slniilsiii, »nd mh Hiieriiw>jiir 
I ><c II mi mil toil is louiid lu (.viiluin Iwi-illi atid fiiirM of eliulie 

I'hihiKii* !k ill ilwiOf nut a ivaiiilnl di.'««iu\ hut the n««uebilrd 
diy iiknmy nlWit eniiM-i much MiU'ering. HiiMiio|itvi>iit o<Tur« 
at iill litntien, hiiL ihi^ [>nttii.-« heniorrha^ei nenir lute. '^H^ 
IiIihh] in bright n-d in <i>h>r, frothy, anil mixed uidi ninenx. 
]>y9|iiiirn in niit a inartftd hvinptotn, :ii)d ili^ uIo^ikv h doidil- 
h-s* due l» ihe ^i-adiial developnieiil of llic dlHeaso. I'mfiiw- 
oweatiu); durit^ sleep b a tiY>uhi<'!=4>iUD feature uf advnnitxl 

The final stn^to is charscteriiml tty extivine etnar-iatinn, 
ivi'iikiie^, jKtllor, hij^h ■vmitleitt or inlennittent fever, and 
allium of the feel. The mJud iH iwiially ehiir, aiid peeuliarly 
hoiiefiil to tlK' end. 

I'liYSK-Ai. Signs. Im^m-tinn. — Tlic eh<-«l is tisnafly long 
Htid 6at ; the t^|ince« »bove luid 1h-1ow the elavii-le:* »re Miiikcti ; 
the Kupiilte an^ pn>miiM>Tit ; and the rilw am uhliqiip. 

Tlwre may !«; Ilnttiminj; or U-m fxiniiwinn wvi-r ime a|ivx. 

PaljKition. — I)iniini>iii(.-d cxjaiiifinn Btid inen-ased vocal fre- 
miti i». 

PrrrmvaOTt. — Diiliu^jts, 09 a nile ; Ihiw is imled rarlient above 
i>r ix-liiw (hi- Haviden, iu thi- t(iipni.i[iini)UA f(>«ue, hclwei^i) the 
m.ii|)uIh<, or in front neai' thi* ntenial border. 

A eavity, or vuniica, yield?) tympany, or a " en«4ied-|Hit" 
mwirtiani'e. Tlte latttTfan !«■ n>ore eleai-ly demonstrated witeit 
ll»- iiir i.t ))la(fHl iM-ar the [ralicnl's ojwn month. 

AiiifuflulioH. — In tlie early sini2f-rps|iiration may l»c innud- 
ihic over the alfeott-d area. I^ier the hmilhing is hanih 



ttiii) llw cxpiruliuti i>rt>I.inintl aiwl iiinli-j>ilclt«l ( briMifJiiiil). 
Till" vucai rewniiiiKV ii* iriim.')i«'<i. {.'nickiiiij^ rAli^ are- iwiallv 
iiiidihli.', iinil iirv pnaliiii-il \>v li((iiiil in itiv Miiall tiilM"?!. [f 
niX (m-M'iit, ii>iigliiii^ will iioiiiiilv (lev<'l<i|i iIm-iii. Aitnctilla- . 
ti<Ki over mvitira ntny detix-l onvoriHuu urumpliurio hn-atliiiig, 
[let'torilnquv, and lar^' )rit ruling riil«H. 

AsoMAi^jfH Phyhicai, 810XS. — 'n>i> vocal fmi]!ttt6 la 
(liiuinislH^I vi]wn lh«Tv U miit-J] {ilfiiraJ lUiekeiiiDg. Xornial 
resonaiire or liJiKT-n'^niiani'*' niav reiiiane Jiilnwia wlitn there 
is muoh enuplivMina lN'Mt<H^ii small tuljoniilmis fi)ci, \V<'»k 
breathiug may rc'plaw brcinctiial or raventoiiB when the (uIr* 
or cavity are filled witJi miico-jiiis. Tti* signa of tavitv ur« 
somctira^ nroduoed by oonsolidalion in the nei};bburlicKHf ut*a 
lartfe brom^iiii:. 

AoQtd FhtbifliS. — ClinicHlIy this form rpapiiiblv^ pnetiiiwiiiH, 
and i^ iii:irk«d by a cliill, high fovor, rupid piiliu-. dy^'pixra, 
Hpiitiim at first niK.1y aw\ tbrii ptinili-nl, fln^wl fiiot-, proftiw 
Hivt^nU, and tliu hii^us of oinf«)lidatiun. ]ii»tnul of viitliii); by 
m»i« ut tlic ci^hlli or tiinth diiy iw un ordiiiiiry |WK-iinKiiiiM, 
thff j^ympti^tiiM [jniw ni|Hilly wow, fij^w of soft»titii«; npprar. 
rhc i>^iiiliini $bow> liiK'illi mill cIusIh^ librwt, mid tli'ttlb iti^tillB 
ill fn>m ;i U-\\ »'ii-k?i ti> 11 few iniiiillH. 

Fibroid Phtliisis.— '['Iii» U a ili.M^^M' of long diiratioti. It h 
c)tara<-tt.'ri)!Ml by very gradual lo^of i\<s>h and Kttxrii^li mtil 
by au abundant miia>-|>iindMit pxiHi^omlion, wim-li In ut 
times fetid fmiu beii^ retainod in dilali-d hrondii. Ovxpnuti, 
swttttiii^c, ainl lover aw tiligbt. Tbere ia veiy uiai-WwI n-lnK- 
tion oD tbe atl'erted sjd* from the ^irinking of iIk- tibroiiM tis- 
sue ; witli ibid exceMiou (he |>t)yaiml tugiia ai« liiinilar to lUufH 
uf (ileenitive pbthiaia. 

CoMi'iJCATHWii up PiiTiiiais. — Hte'inoptyaia ; pnoiiuioiiia : 

f>lviirij4y; pn(<iimotlioras;>UontatitJH;ol)islinate voroitingindiKiil 
>y t*mfi\i ; diarrboa; amyloid dejicDeralioD of tbe visoera; liMida 
itianoUitlicnniIrm<i); undftpi-niMlary tnberculiigiRofotbcroi^nti, 
c«|wcinily tlic larynx, t-cncbral nieaiiit^. and iwritoixom. 

l)tAGK<)iii.s. — hVvrr, nmijb, t-DiaK-iation. signs of omfoilida- 
tion, W-illi and i-la»tii' fil>n'» in tltv »|HituiD are (be dia^iHj.iti<: 



l*iffHiNOST9.— G^'iMTttlly iinfavoinWo, liioiigh )li<> iltw>ii)w 
IM)1 inciinil>l<-. 'IIh- nr'irifU'iitiil iliMw>vcr}- ut ailHlicd iiilH-rclt-ii 
at iiiit')|)c^i('.'< fiinii.^iit?* nl>iiti(liiiil f^vklont*! of HjMtiiliiix'otH iiir<-. 
Maiiv iin]irc>vi'aml u (i-\t mttvcr iiimKt wflMirti-fii! (iTiitiixiit. 

A nti-oi)); tk-twiiUirv iMideriey, a Imti [>Iiy«^i4jiic, liij^li ft-ver, 
advaivMil <HiiiKili<lalion, tnvolveniHit ul' lx>tli lungK, «vfii if 
nliglit, un&voral)1e siirrmiitdings, mid, it might lie added, a 
slender purse, render the prognositi exlrr-mdy grave. 

Tkkatmknt. I'lvrntllif. — Kcwyiibjing the intWrtious 
naliire ol' tlio dit«o!tw, iho followinp pntpltvliu-tic iitfaflimv 
sliould bf'obwrved ; Spina of <N)n.»umptivt* Bitould Im* reix'ivetl 
in siiilalile vt?«eU cirntaiijin;; am i!<cpiit; Miliitionti, ami sub««^ 
queiilly destrovetl. C'atllc sliould be ngidly insperted, and 
tnl>eniiIoiiH iiH'at, and milk of tubcrciildiiii fuws declaml iin- 
marketablc, l')it)iit{i<'»I inutlterx tihoiiM itot niir^ tbeir oft- 
))])rit^. Tlic iiiiiltlty should not sl(«p in npartnteiilii ticciipicd 
l>v thosf afTcrlcd. 

I'irmmiil Jfyr/inut, — Good food, fresh air, frpqiiPnt balhinjr. 
avi>i(lat»cp of cxpoetin.', gnidtialod cxeix-isc, n.^idciH'p in an 
ck'vatcti locality, a dry, wcU-vcntilated bouse, uid plenty «f 
Bleep und rerrcalton, 

t\imtirr TVciifnimK—T^n* involves two objects: (1) Tlw? 
streu^thenitt); of itie piiticiit's vilaltly and n^t^iriing power. 
(2) TIh- d<^tntclion or diwdilinii of the tJibcn'lc Ijndllt. 

(icnmii Hmfth. — I'lic <iid. should U- enivftilly rr^iituted. 
JJntrietits like (nxi-Uver wil (3ij- — ^5'V two hours after nieuls), 
malt, aiiil liyjiuplKHfpbile? itre often very useful. Klim-rul aekis 
and bittere niny \w retpiinil (o i>tin)nlale di};n>.tion. Inm, 
quinine, and ar^-nio iin> s-imHinnf )n<liiiil<-d ; the liii^l, wImmi 
well borne, often exerts a lUi-id.iily fiivonilile infliiem'e, Alco- 
hol in many caw's isofgrtwt vahie, Imt the daii^'i-of indneiiig 
the liahit tnnat W bonie in mind, itcer, porler, ule. xim) wine 
aiv iisuully tlw most desirable |>re])nnilion'<. Si) lung m ak'ohol 
stiinidatvs Hr- »[>|N-titc, lowen* Uk' liiiii)cn»tnre, and strengthen" 
the pulse it dixw gocKl, Its re^iilir* siiotild 1«- ran-fiilly mited, 
and any nnlowiinl i-lft-ctis will <idl for its inniM-Uiale wiihilrawul. 

( 'hiiiu/f nf ( 'liimilr. — This tifleiv l« nixnv juilii-nts iht' 
t;r(iilr9l hn^ie of c-iirr. A* ii nt\<', it high allilnih- .thoiihl Itt- 
ei'W'tul ; the utinonplK'iv ribmdd 1k> dr\- and the t«mperatiiii- 




ecjiiabto. Personal <>\ppri{>»re mtirf (Wide tlw qufetion of 
tcn]|)er3turc; ^en(?railv, iKilienlf who fw] l>eltcr ID sumnier 
ivill do well ill It wanii climate, iuid i-*«r rrrtii. The physician 
ahoiild tuivc Hume knoivktlge vf iha I'H'nlity, whtcli should 
aSbrd ordinary vouvxtiicniTit, willioiit bciitf^ tuo crvwded with 
sitd^nt similarly ufflif-li'il. 

Id selected awwt, u «■« vi>y«g« In on«n very ii^Tiil. Accord- 
ing to noagla*" Powell, it is imwl. niiituliir lu [Mticntrt in ihp 
early stapw, wlm Itnvv Ixx-ii j>n.*viim.'<ly JKiillhy, who luivc 
ov'crworkii] nen'otiM i>y!<lcfli.'s nud in whom ihv disinse h 
more or l«« (jiiiewTni. 

i*aliiiit» ill udvnu<rt><l giiillii^is nhuiild not Ix' »ciit fiir from 

Spfrific TmitmniL — Tlio injoi'tion of iodine, mriwlie and, 
vU:, into iihtliiiiimt liinj^ a.« riMiniinH'jiiliHl by MiihIit, 'I*ltoni|>- 
(toH, wild Pi-j>|HM-, liii.-' iKil jriveii I'liiwuriif^injr ix-siills. The 
nwrtal injection of Milphide of Iiydmgen, as roconimendiHl \>y 
Bergnon, iim< lallen into disuiu-. Kocb'H tubercnliu han, for 
the miJcft |«rt, ixvn negative or d<>leterioiis in itsffflwt. Of 
all the sjiwial n-medits, ereasoie aIo»e continues to hoI<l i(i« 
proniiiKDt notiitioD in the ihcraoy of lihthisis. It may l>e 
given ill |)itl, in cmuli^ion cpf (ixl-li\-er oil, or with wioe. 

■^ C'r«i«, Hlxv; 
Olvi niortliuw, t^iij ; 
Calcll (it ftodll liyposphos,, Sts\ 
Olci ^ulthcrite, iHxx ; 
Aeaeiie, <i. *, 
Ai)tiir, <|. H. ml f^vj.— M. 
Sig.— A tiibleS|>oonful two huurs iifWr (umls, 

1^ (TrcnM^ti, TTtsv ; 

'nut't. ^I'uiitiiio., ITlxij; 
Si>l, villi nti,. I^vj; 
Villi xcrki. I5vj-— 51. (Frabktzei^) 
Sl^.— A Icnftjioonfiil Ihrice dnily. 

CrtA'Ot« is often \'aluahlc in iiiimlnlion)*. 

9 C:!rMMrti. 

K|tl. clilnrofiimii, 
AIvoliutJB, I'la AS)i.-->I. 
tSg,— Ten (o I'vi-nly tlrops in tiie Inlialer Mwral tiiiusi ilaily. 


1>I8EA«K8 OP TUK RfxriRATORT fiVfn'RM. 

Symplomatic TrftUtwftt. Ontgh, — Synips sliould be avoided 
n^ inr as |>Dfsibtp, and cough al)c\-mte4] by inhalations of wine 
ul' ipeiw.', crcssolc, i>rnKoin, or tcrebcne. 

Tar, tercbeiie, and rucalyptm) may be «oiploy4<d intenially. 
Coujfli asRoriutcd vnth the FX]M.-c4onition of much ofTfusive 
iiiaterisl ehould not l«c chfvktHl. 

A co1<l bed ol^cn Inds tu cough aud a wnkefid night ; in 
thcfc caM« the bed sitotdd be wamicd bcJun? tl i« occupial. 
Hot 8p)tliratiun8 to the chcst and a hot drink on reliring 
somdimes insnro rest. 

The following mixtiiro w vvty efficient in tbo vongb of 
phlhisifl : — 

tji C-'otlntnir hiI])))., or. iv ; 

Auiil. hvtlTix^riiiitc*. (lil., ITlxxxu; ^H 

Hyr. iDli'i.. rs'j.- M. (Da Costa.) H 

Si^— A tiMispooiiful tlireu or four tlniee daily. ^" 

HKmihuj.~Mn}[titw (^. jJa), (gr.^^^), gallic 
acid (gr. x), agnricink^ a<Ma(|;r, f-J)i s'd]>h«nal (gr, iy-viij), or — 

^ Almpin. lulplt.. gr. J ; ^m 

Aoiri. nitlph. 3tn>4uiil., ^ij ; ^H 

AquK rtintP, q. a. lul fjj. — Jl, ^^ 

SiK.~T«renty to Dnriy dropa al IK-Jtime, and n-peatcd If neoc*- 

Sponging with nUnn and whiiikpy it) Mimetimes v«ry4!fR<iM^ons. 

liirmtijififMJi.^WUfn profuse, »«* may Iw ht-ld in tlio niontii 
uiul Hwallowtnl slowly. The fluid extrat-t of (Tgot (gtt. xx~ 
x\x) and mor|)hia (gr. }) t'houM bo gix'en hvi><>demiic»llr. 
The internal adininiMmlion of gallic acid and other astrin- 
gcuw if id' liillt- value. Tho application of a temjKinin- liga- 
tnrp to one or tnore id" tho niend»cRi htndcni the flow of bloo*! 
in the veiaH,ajul may materially aid in cheeking tlie bleeding. 

\Vhen the heniorrliage in more or less continuous, but not 
proCiLso, tlie flui<I ■•xtrai't of IiamAmeliR (3ij-5'y) or fiUa ot 
airtato of lead and opium are efficient lenRtliefi, 

IHarrhtea. — Rest; li*jui«) diet; siibnitnite of bianntb in 
latge doses, or pills of nitrate of silver aud upiuni. 

9 Binmutli. HiUilt., 3vJ ; 

Siil«1. i!r. xxiv ; ^^ 

Motftiia. nulpti.. gr. j,— M. ^H 

Ft. Ineliarl. N<>, xVi. ^M 

Si^ — Odd powder every three boun. ^M 


PLECiaiT. l'iJ:i 

Pi/reria. — ^Tlte patian mnta i«<4- OciiiiiniK>UT hicii iivi-r 
will <^] for qninine. antijnTia. indJebno. or tluliin. %k;>iu:- 
ing with aloobcJ and oool «w<t. «(jii&1 pxrtK, ir a 3tsiral>ie 
met hod of ifdadng ferfr. 

Paitt.—yX'heo aevere. adminiaer opiam and ajiplj i--. tl.*. 
affected side adbesve ffinpe, bm aff>Iic«iic«i». drv oajt^ or 



Definitiox. — Inflammatnn of the jiknra. 

Varieties. — AocMding to t&iHv. ii hist hp diviHix] jnii^ 
jirimarr or seotwidary ; a«i»idiiig lo *-xi*-ni. ini" iin:l;ii< r:t;. 
[lilateral, or lucal ; aoxirding to lime, idio a<-iii*' r-r <-j,r";r!.': 
ami aoMirding tu the exudatioo. ini<> ><t-n>-tilini]-'ii~. tii>riii <ii-. 
■ >r iMiruleDt. 

Etiology. — Pleurisy may be: (1) Idii>{ni)ii<\ ari-in;: I'n'm 
p.tprjsure to cold and wet. (*2) Traiiniatic. Kti Sfs-xinlHrv i.i 
iiiflammatun- disease? of sdjaoent viscera, a- ]tn<-iini.'ii[:i -.wtA 
|)t]thisis. (4) SeeoodaiT to some jrcncnil iiii>riiiri j>r.i\>i-, :i- 
rheumatism, Bright*^ disease, tnl^rxTulo^is. ami tin- iiiUi'iii<tis 
fevers. (5) Tuberculous. (6) Camftrtns (nn-ii, 

Pathoi>x;v. — In the early Mago the iiiinilinun- i< ml. 
sticky, lustreles, and covered with a thin lihii ot' Ivnijih : il 
the process now«, the ronditiim i> icninil tlr:/ jJ.".-i.-.i,. 
If, however, the iDflammatioa contiiini>, :m > xiulaio i- t'lTuinl 
which may be: (1) Sero-fibrioon^, ("ii (iliriiniiis, nr (:'•) jnnu- 
lent (empyema). In ll»e ncro-fifirhions ll.rrii tln'r.' \< liilli' 
lymph, the exudate 1>eing mainly <-(ini|x>s4i) nl' stiiiw-ii'Inriii 
a<-nim (a few ounces to ncveral pint-) wliuh in liivi'ial.I.- 
< is gradually absortted. In large iirnsii.iis tlif :nlj:iiviii 
organs arc displaced and the lungs arc <-<>in[>i-i'~'.-t'd. In \h,< 
yiAriHfjiM form serum is scant anil the [iu>iiiln;me is rov- 
crcd with a butter-like e.xinlate wliicli sul)s.i|ii(Titiv iirL'ani/cs 
and unites more or Iws cl.isely the pleural siirrai-<>s, i'aif^in>^ 
iiiihasive plearimf. A liquid effusion. \vlii<>li is <>ireuniserilH'.l 
ami confim><l to pockets fiirmc*! of iiillicsiuiis, is (eriini! xm-i-u 
hiieil itfenr'uey. 


I}b;KAli»>i or THK Kf^PtRATORY KY8TK1I. 


In )h<> purulent form the sat; is more or \ee» fill«J willi 
greeiiish-vellow piia, Piinil«tit pU-urisv, or rvxptffmn, ie coui- 
nioil in children ; it froqiiontly iollnws the inlertious fi-vera ; 
it Ls oDcii secoiwian' tr» n sero-fibrimiiis pleurisy ; it m-siilli 
fri>m llie niplTirc of [xinilcnt a<vunnilationa into ihp pk'^ira, 
a* hv a luhenniloiis <avity ; aiul tiimliy, it mav l>e tlue to 
traumatism, as a penetrating wouml op fracture ol (he rilw, 

A purulent emision loft to itflfitl' Dwy kill by wpeis, may 
Ijpcome inspissated and eniysted (rare), or may iierfbrste into 
the bronchi, into ii«i|;|]boriu^ oiynns, or extenially, 

Hcmorrlui'jie I'tntrwy. — \ hfoody efliision is obt!(T\'cd iu 
tuberculous iiiiil i-anccrous pleurisies am) in i>lcitriKV nliirli is 
associated with »mrvy, grave ameniia, auu other cachectic 

An efiVialon of any kind rcinaiuii^ iinab«4r1>cd vonstitutes B 
chronie ^jfrurwy. 

SvMi-roMS, Acuff PUm-i/ty. — Cliiliinc»t; u Mabbinf; (Hiin 
or Nitleh in the afTeeted side, intenKtficd by \Uv\i bnutliinj;; 
nnd by eotigli; moderate fever {lOI'^-lOS*') ; cough «hoTt, 
dry, nwl giarttally &uppnK><il ; the fact! is ^eiHTnlly |>ateiuxl 
anxioiiFt; and the patient usually lie* oti tlio udt-dra fiidc. 

WIh'ii iJie efruvinu forms, the inllanicd MirlBn* wpnmio, no 
that tbejioin iKt^nnicn k«<; but dvHpuo'n nipidlv<leveli>]i«, nnd 
tin* n-Hjit rut ions iiri' of « .■•hori, jt'rkv i-hann-ter. 

I'livsiL'Ai. StUNS. FiriJ I'^Kj/c. — lA-jts f\\itin»wa on tlie 
ufTwliil »ide un nincuHiiit of IIk- iwiii ; occnstunally a frirtion- 
fremitns on p«l|inlioii, ami a hai-:ih tit-and-fru fri4;tioD-nib OQ 

Sbiffr of Eff^MOn. Iiutiiedinn. — Immobilitv and bnlgingnl 
the intcreustai Si|uiee8 on the aflW-tid side. ^The apex-beat is 
(ilsplacol upwanU, and to llic lefl or right aeconling to the 
pletini artertetl. 

I'lilfxUiott. — Immobility and diminislKtl vfieal freniitits. 

PtTviiMiim. — Pulnisat jrradually riwnn iw tl»e fluid increases 
The npper line of duln«)» is m>t horia>nlaI, hut is eiin'od and 
rises higher piirferiorly. In nKHleratc ilTnwons ttte level vf 
duliiess often Hianjfes with the piKiliim of ihi- jmtietit. Above 
lite eRiision iHTi'iission eivcd a tympnnitie ttote which has bccB 
t«ruied Skoda's resouauce. 





Au/HrufbtHon. The respiratory Boun<Iit an? weak and tlis- 
tam ; thoy may have a Uibailar or bii>ndiial ((iiality. Ttio 
v(n-a\ re.'i(iiiai)c« 19 usually diniiiiifhcd or abeent, but <xxx- 
KiiiimUy bix>i)HiopbonT, or iu modifii'slioii wgophoiiy (a bleating 
8ouuO), is heard over niMierati* cffiisifms. 

MenaaraiioR. — The airected side ia .sometimes ai) iovh or 
more larger than ihe sohihI one. 

AlW absorplioti of the efftision the frictton-'kHind rrtiirns. 

DlAanoKlS. I^cumt»\m. — The w-verr rbill, ruKty ex(ict'- 
toratiou, high fever, marked dyepuisa. the (iti<- cn-pilaiit mlra 
which are henrd milyon injfpinitiiin.dnUK-wtH-* (-huiii^'i)};u'ith 
the patient's (xistiirp, infrwiw.fl v^kbI fn'iiirlnn, iiicn'aMrl vixsd 
ri-sunaiK-e, loud biwthJnK. niiil the iili«i-ii<f of b«ljr- 
)»); uim) of a di»|iluixxl fi]K-x-b<-iit, nill htvo to di.Hiiigiii^li it 
frum plpiirittV. 

Pteitrotljinia, nr Rhtvmfitimu of the Iftteeeoidal Sftuirff*. — No 
fi^vcr, mitrh tlitVuw tcn<iii-iti-ss, uo friclion-fioiind.t, an*) no 

Ptirn/ittl pli-urUi/ is rerogi)i)u>d by hectic symptoms — liicli 
and irn^iiliir ffver, swcati*, chilU, ami anaemia; by the resiiTis 
of ar^pimiioii ; aiKl sumetiiiies by "pitting'' from (nlenia of the 

Fihriaoiu IHmrisy. — I'aiii is severe and conlinnous, the 
dutni>itti is immobilefaipiration jtives m^live result*, and later 
there i.i miicli retraction of (he afTccted )>ide. 

Tfiltert-uloiijt l*1eurag, — TolxTctdijsis is the mojft ojminon 
cause of pleurisy which is ajipanntly pnma^^'. II muy Ix* 
prinmry or secootlury to pulnioriury phthisii!. It u.iually pre- 
sents toe MUDC syin|iti>i]is nx onlinary si:TU<fibriiion)> ph-tirisy, 
but it often deVL'Ioiw insidiously, iw fi-efpuiitly bilnlenil, and 
till' ctfu^ion i» iipt to \>r litmiilv. Tin*"- fai-l«, ti^-lb(H' with 
tlir history, will tiMiallv iii<li<nli- the dtiiipftiiit. 

hiii/Jiniyiaiitif /i/i-iiriMif, or i ii Ham inii lion of tlii' diaiibni^- 
iiiiitio ptfiim. may pnwiit ibc following Avmplomn: lutenHi' 
jmin iindi'r the marf^ii) of iIh" Hits, with teudemt^s <fii prranin* ; 
thoranio bn<nlliin{;; tcMitkriH^tt) over the phrpnic n4>rve, which 
is mix^!«iible bctwti-ii tin' iwo roots of the steru<»-i'loidt:)-nia!iloid 
lit liiii Imm' of ihe HM-U; hiocoii^h ; and extremis dyi'pixt^a. 
The physical sitcns are not markra. 



Vhuosohk. — ^This dejienda lar^Iy <m the eliarerfrr *: 
the aniount of ofTusioi). In |iriniarv f«r<»- fibrinous i>l«'iiriinri 
llie |>n^iu»b is nstially kockI, btil tfiat pIuiirigK^, vliuti si 
ii|»]nrvntK |(riman-, are often lubpnuloiis, shoultl always I 
)>(>rnc in niim). In iinnilcni ]>l«iii'iey, Uk' prugnohtfl Ih gfrav 
lliotigb ivi-ovcry fi«|ii<-nlly occiire, 

III tbf fibrinous luriii, tlic |iix)gnua!i is good, but if Ititn 
linit b«'n miicb rxiiduu-, hiiLihijiiciiI rctnKiion and nioic 
Ifw in))iuiriuei)t ofllii.- iillk-twl (tide ace Kiirc to fiillow. 

Tbkatmknt. — Ab^jliitt' ro«t. Lipht dirt. If tbr lcni|KT- 
aliiiv in liigh iiihI the |>nU<' rii|>i(I. Hcoiiiu- iiiuy Itv adtiiinii^tcred 
ill "iiintl duM'W, (jiiinttK- (pr. v tbn<r diiily) will exon u favor- 
able iiilbiciKv. I'tiiii uiuy bi- isu wvciv II* to nci|uiti- morjibi: 

J^M-al A I'lJui'lion''. — W'licn tbc piiiii in wvcrv, |«.«ch€c 
»'el-<^i)>A. f<i[lijw)il by fltraiijiiii^ "f lb<- (-htft, will give (irrat 
n-Iicf. Ill otbcr lam'A, nidMara jtlatitfirH, liot funirnlutioDK, or 
itxiine may fx- a|)})li<-d. 

fSermia E^umoh. — Apply, I'lwjiitntly, small blislow, Indtdc 
of Dotassiiim (gr. v tlirict: daily) may be cnipliiyed for iu ab-, 
eoruent «0brt. 

Kuooiirage diurcstx with digitalis, caffeine, or acdotr 
{Mttatisium : — 

ft I'olaw, n«tat„ 5i»; 

Infiiii. dJKit'nti'', f^iij,— M. 
8^ — Two lviiii[H)(iariilN vvQTy Uikcmt four linura. 

Rnr^iiniin' i-iktbanii» with vuropoiind jjitap |Kivn)<'r (gr. 
xx,\) ur KjMiiiii ^altii. 

^ Mti;iiii-Mi Mi[|i1iMl., 3iV'3vj. (IIAY.) 
l)iv, in churl. So, viii. 

SjT,— Uiu- |Ki«ii,r 111 Iwo litltlMiMoiirula of wat«i- butoru TmhI, i 
uo fluids fur soiuc liiiic afu-rwardfc. 

The eflusion will rp(|iiiTv aspiration under the folUmiiifr 
emiditii'lM: (I) When it exeitts miieli dyapiKca ; (2) when iti 
ia veTT,' large, bevoud the Ihinl or fourth rib ; (;l) when it t«j 
purulent ; (4) when it reninins nnalisorbed after tbive or foul 
werks of careftd treutnienl : (6) when It !« bilateral, and tin 
total umoiinl iii sufficient to 611 one nvi^'. 





TA/ Opfmlhit, — A niefltlieliH* a p<iinl in tho seventli hitcr- 
sjwt* uear ch<- |»(islorior axillary tiitL' and iiitnxJiice the nwxilt 
with a ()iuek Bti«kc altmj; the upncr IxH-der of iho rib. The 
<-f)ii!«i<>i) ebmihl be drawa oft' slowly, and one or two pint* ro- 
innvH) tuwrnliii}; t" thconioiiiit of thei'xndutc. 

(Vtiigliiu); dnrinc the oitcration ts aii indication for tlic with- 
<]rawal of tlit- mMllc. 

Kutp^uu — Make nii incision in tlic filUi or sixth inU-r- 
H{>aee, outride of the nianinmrv line, evitiiiale (he- pns and 
insert a dniina^-'tnbv. 1 n iwme iii^es the excision ofonfor 
two rihs fueililnl(« irlnw^timi and the oWitcmtiwi of tlie 
|)lennil cae, wliioli k e«iH-ntial u>u cnrc. 


pErismox.— 'rhonwie dntjisy. 

Ktkii-oov. — It is ulwHyf iWH-ondiiry, and nmy miult frtmi 
one of tlic eauws of p'netnl di-oiny, iiiuneiy : Brighl's discasf, 
Ill-art diwww, cmphviu-niu or anivniia, or from l)i<' prt^Hniv of 
a Lunicir or nnL-tiriont u{)on th« th«)raoi<! veins. 

Sviirn^tMH. — Dytuptxea, cyanosis, and the ptiyMcal ^igns of 
a pleural eBuition. 

I)iAii.N<K^i& — The hiiAory of ihe primary di.'wa»>, the fact 
that the effusion is hilatcral, the ahpence of imin, and tl»e pres- 
encx- of a fluid whieli is only sli^hily alhnminoiu^ and whiiJi 
shows little or no tendency to sponlaiH'oiis ooagiilaliou, will 
serve to dintiu^ittsh it fmni pfenrigy. 

THKATMEST. — Kenicditti should bo diree1«J to the original 
disease. Wh«n there ia mtieh dyspnoea, aspirate. 


JiEFlsmoff. — Air in Ihe pleural sac, 

Ktiology.— It may rtwult from : (I) The mplure of the 
liinf; in health from a violent iftrain, or mplure in tnbcretdosi-;, 
hInwow, vmphy>femu, or pin^rene. (2) Trauinati><Ri, a.^ a pen- 
etrating wound or a fractnn.- of the ribs, (;)) The rapture ot 
an empyema into tlic lung. 



I'ATHauxiv. — Tito a(lja4.i?iit vU«cm aiv di^iilmiil, iiml tlie 
Iiinj; is i»iii[n>'«i«l, Kven when air nlon^ \ia> i^ajMtl inio 
ihc |>lciiral sac, an effiiaioii stwii dcveliiiie, ho tltai tii all riiM» 
the condition becomes n iiHcumft-hffdrothorax or -pifoOioraz. 

SvMi-TOMS. — The un^-t is mariied bv a sharji nain, cxtn-nti- 
dyspno-a, Gii-an<«i)^ and Hvniptonie of iimpiciit iollaijoc, iiniiR'ly, 
a fall of tempci-atiirt-, a weak rapid puW. cold cxtreniilitv, a»d 
pinclicd features. 

I*HVMKAi. SmSS. /iMywrfjom. — Jmmobilily, aud bulging 
of the iiilcremlal kihih.'*^ Tbe uik-x-UqI in usually diii|>]aa!a. 

I'afpalion, — Diiiiiiii»li<-d vuiiil fi^'mituiN 

I'avaeshn. — A lyin|)aiiitic iiuti.-, van'itig iu pitch witb the 
intmllioracif.' tiiisioii, 

KHuHiuu binkfi to tlic l)tt«c uiu) yicIdH duliKiM, lite outline gf 
whic^i clian;ips willi |!r' pcwili'iii of tlio patient. 

A'tMrnil'itinii. — Tin- mjiiiratory iiiiiniiKr and vocal ratoQaitcc 
arc utHwIly alit^^^K, l>tit vrhcn lliv o]Ktiin|; in t)i« lung reniaiite 
patuIo4i«, liniplioriv brt«ll)iiig niay Ik' dcU-vlul. Wlicn a silver 
(oin in \i\aiv*{ mi lb*- affii-li'd »>i«Io uikI i:^ tttriick with another, 
lite nusi'iiltiilor dt-tii'L'* a <'l<iii' iiK'tallii- Aound (U'll-lvtiifmiivi. 
WIk-ii tiiiiil in pnt^-nl, flJiakin^ itir [lutit'ni cxiilii' a ."{ilu^bin^ 
^tniw! (MipjHH.-ialie siinGUi<!<ioii). 

UiA(iN<<^iH. .1 laiyf I'hthmiiit f in-ify.— This is UMinlly 
kwatal iH-ur (ho a|M'x itii^K-Md xf ih^ Itnae; iW ^irGH-r \* 
8unk<ii, not pntitiincnt ; itte licari ia not dbiplaoed ; »itcc<w- 
(tton-s)>la)7li and bcll-lym|>atiy aiv usually abtuMil. 

/>iA(/<v/ SiinHiiefi,- ''niw may ijivi' a iyRi|uiiiilic itotc over 
tlie left piihiionary hiL-<«*, aii<) may ^imntatc » pm-uniolburux ; 
but lb<r lymitHiiilid luitt- i» ■■uiiliuui-<t down into the alHlnmcii. 
and lliv swaltovring of litjuid in dtnlinctly audible nvi-r tlic 
Ua«e of lite Hif^ 

l*R(K)\iK^iH. — It ia usually unfavomble, and oOcn terini- 
natoH lalally in a fi-w hours or dam Recovery is jMjaaiblo, 
espeHally in Iranmatic canes. It often excitos a pivurul efiii- 
nian aikd nina a chronic course. 

ThkatmknT. — At theonsetadminiatcrKlini»lanI)?,iiiti! apply 
straps to ttit! t:Itcs(. The |iain and diistrcas nin«l be relieved by 

HfHOTHOK&X. 329 

When effiiBion forms it should be treated, accordiDg to its 
diameter, as a serous or a purulent pleurisy. 


(HMmatothoTuc ) 

Definition. — The effusion of blood into the pleural sac. 

Etiology. — Traumatism, rupture of an aDeurism, or tlie 
erosion of bloodvessels by phthisical cavities or caries of the 

SrHPTOics.^&me as hydrothorax. 

Tbbatuent. — When there is great dyspncea the blood 
should be removed by aspiration or incision. 



Frrn- is an abnormal timdition charartori^rt) bv ("Irvsf 
tvmiKTiiitirp-, fjuickeoed mipiration iuhI i;tnii!alion, faulty kp- 
crrtiuiiR, an<l incKastd tiiwiie-wai^te ; unci (l<-pciKli>i)t hjkjii a 
porvcwiim of the physioiojiiral pi-ut'ceeeii wliereliy (lie gi^-jii-. 
ration and Ities of nui( are m uilunoed as to ntaintain n nni- 
lorin normal tcm]wratiirc'. 

The DoteoUon of Fever — Tlicre is onh* one sure way of 
ilct»i!Lin{r fever, aiul tliat is by nn-aiiH of the (rlini<-al uwt- 
inoiiKUT. Tlio iiistnitiKiit may b« pUcw) in the iixilla, 
nioiitli, iwtuni, nr vagina. 

Wlien tli« axilla is selecU>d the following i>recAutiot>i) miist 
be oheerved : Wipe ofF tbe i)crepinition and (Iry the ekin ; in- 
sert the bnlb of the instrument iJ<fp in tbe armpit, 3imI Hee 
that tlifl arDi in kept close In tlie eidc. The tlKTmometf-r 
sbonld be kejtt in position until iho inorninr' niaiotains the 
same level fur two niinutctt ; thi.f will itsimlly n-c|uire in all 
about six or seven niinut^.'s. 

When iX\c month !» sclettol the bulb should Im^ nlacnl 
timler tbe tongue and the lip« kept rluMt]. Hot nn<t cold 
drinks recently tukcn mar the results. For obvtuutt rcaiions 
the mouth ifhoidd not be mhA m delirious jxitirntii. 

The rectum may be selected in ehildren. The recta! tem- 
peiaturcr is aUmt a degree higher than lliat of tlie axilla. 

Febrile Stages. — The course of all fe%'ers is marked by three 
stagtw: (1) Invasion; (2) fastigium, or etadiuiii ; (3) (lef«r- 
viMcence, or decline, 

/nrfwt'oii.— Purinft this peri<)<l the tvnipcnildrc gradually 
v\i*^ until it reUL'lies it« maximum. 




Faiififfium. — hi this period, thongb \\ufiv tnav be marked 
variKlioii^ tlie icnipcrntniv shuns a teiulcttcy to toiirli Bguiti 
Hnil ugnia its hight^l |>i>ii)t. 

Dtfrrmnv-nt^.—ln llii.* |>cr!iMt the U'lupiTnturo gnultiully 
i'ulU iiniil it if-ju'!ii--> ific t»)rm. 

Terminationfl of Fever. — Fi!v«r UTniimilcs by \ym or 

y.jMw. — The t«'in|K^nitiiit> falls slowly by Hlight grailiitioiis 
until it ftwbe* tiun mirm. 

(VUin. — 'nM> u-nijM-ratun.' fJiMs siiAIcnIy, often four or five 
di'g[w» in IwcUt or iMi-niy-foiir hoim. 

Tha Degree of Pyrexia. — The fiAUivring is WuiKlerlicb's 
daaAitimlioii oi'tJ'linlf- tiiiijiiraliiips : — 

1. Subfcbrilts l^imiM-ratiire SQ-H'^-IOOA". 

2. Slijrlitly iHmh, t.-m|ienilim- HH).4'='-101.;J^ 
:S. Mf«l*-i-nU-lv feUrilo, lemin-ralure lOLrt^-lOS.!". 
4. Uewidfdlv'firbi-ile, l.>m|«-rature IWi.l'^-lIM". 
•'>. Highly Icbrili", tern jxtratii re above lUCt.l" in th<: morning 

and abovfi IIM.S" in tlie evening, 
fi. IIy(»rpyretic, i(>ni]>cmture above 10(t*. 

Febrile Remissions.- -All ffvers tthow a dinmal varintion. 
'I'lii' iiiaNliiiiim is iiHiially rcadiol at alMiul li l'..M. iiiid \\»- 
iiiiiiiiiiiirii at alxMit t> A.M. Siinietinns tlic**- extrcmi-s uw iv- 
vi'V-<tt\ iiiiil ibo initxiintiiii ih in Ibe n)(iniiii]||; ami lln' niinimiitn 
ill lJn> oveiiinir. Tlie daily difTercnoe anMunts to alumi T^. 

Types of Fever. — Acnordinii to th« dogn-c of tbi; diuronl 
variation thiK* ty|K-^ are ivcogniw^l : — 

1. fhtUinuL-d Ffirj; — The diurnal variatifni is slight, l°-l.fl*. 
TypliiB foviT, piiciiiiioiiiu, and •H.'arlct fever art' exainptes of 
(»Dliuuerl fovvfx. 

2. HemUtrnt Fetvr. — The diiinud variation is marlicd, but 
the minimum t^^mpcnilnn.- w sltll above the ncmn. TyplK'id 
fever, romittcnt lever, aikl hoctiv fever nre exain|dm of tlii» 

3. InlermUtent Frrrr. The ditinutt varintioii it itiiirkM, and 
the miniiDum 'm i*i>rnial or .-•aibuoniiul. The li>IIowiug fi;vi;ii» 
inti'rmit ;.— 



1. Ink-niiillfiit fcvor (malaria). 

2. I{cl»|<(<ji)g fever. 

3. llM'tii; finijr (i>ft<^n iuti^rniita, though ^tDrally rtmits). 

4. ('liarit>t'.-> iolerniiUent (the peculiar fe^er assuciatef] with 

liio im|iai1itin of gu)l-Htoiici>). 

Caaaes of Fever. — (1) I»uil innnnintiitiooa pxa'lnl hyi 
cxti-niul iL'au!»^, or the f»ruUue(t> uf liitilty nivtalHiliMal 
(;^tit, rhoutuutii^iii). (2) Th^ prveetiu> of iiiivruorKanisnii^ 

IitonuiitiM iu thv hody, u» iu t^pbuid fvvcr, |>yiciiita, Msrivt 
i-ver, etc (3) Panily«8 of Ui« hcat-i'ciitn-, tut id thermic' 

Symptoms of Pever.^ — Kii^c ot (cm|x-nitun>; nipiii ]>iiU(;;S 
r:i|>iil i>'?<{iiiiiliiiiis • ixmu-il torigiii:; ; niKirvxia ; iiiii^lijiiitmn.H 
Tho iinm- i.'i MMiity, high-ralarea, thnivm iluui) a hrnvy ^i- 
nri<-nt, »im] limy roixain a tra>.% of albumin. TIte ^^U'k- jiiic« 
i» dcfivii-tit ill oieid. If lite fever in loug^ooiiliniiol, lli« Uidy 

Tbe Pulse-temperature ratio :— 
A t^in|KTatUPC of 98.1° corn»|>on<l8 to a jiiilso of 70 

" " 100* " "it 80- no 



" 102* 






" 104*' 





Effecta of Fever on the Tissiwi.— High an<l ]on(:-<-.)iitinu«I 

fifVfri- [iMnIiKvH (jiily ami [aiiiirhyinatous (legeiicrutiou of lite ' 
tiiuu«>8. fl 

Treatment of Fever.— .\b^.Iiite K*t ; a cooj, wpll-ventilatcd^ 
room ; liqiml or »?mi-)iqiu(l <lirt. Slight fevi-r will require no 
Bpmal rLinvdics, btit (lie patit-nt may be made moiv tximforl-, 
alitc by s)K>t))nn^ uitU (\x)l watt-f, or wati-r anil aliiihol ; umlJ 
by till' iiK- ot suc-h dniK" a^ swcvl spirila of uitrv, a«vtfltt' 
utiiiuoniom, or iiviitnil mixtiin-. 

High fever is Ixst eonlmllud by the vxteriial n|i|>liniii<)n 
ofroM ; ihiH mefhi.wl inelmli-s i^poi^pii); wilh <.i>l(l wa' 
ciA<l iHiek, mill the <vl(l t>ut)i. 

Thf (.\Jd I'lu-i: — .\ niliber .-ihet-t issUpiirtl iiixh^r lh<- lialimt. 
And tlu> body is vavclo^xxi tit a »live< wruiijr nut in cold water, 





wliidi \» iitlowotl lo rontain iiniil tliii (cnipemture falls ono or 

Thf (bid BtUh. — Thoro iire iwo mrthork of ml ministering 
Uk> <vI(1 liaili. Tbi? first b w i)laix> the- luilH^nt ut (>tic« iuto 
wiitiT St 70° ; tite other in to place htm into vraler at 90** or 
SO". iin<l i\wn gradoallj' cxn.! it tIo« u t<i 70° nr Tf**^. While in 
(lie wiiti-r !»(• sliiiiilil 1k! gtibjwted to gentle fridJori or niasaa^. 
Ill- nliiiiiUl remain in tite liath fitr fifhyn or Iwenlv niinutes 
ftrter which he slwHiId Ix* plaopd iu a dry sliM-t and covered 
with a lii;ht Miinket. When jlie body is drj- tin- dnnip pliett 
should Xm: n-ninvcil. A stimulant is «>nietimes n?<[uiivil during 
or atler the biiiii. 

I>r<ii^ niity l>e eraployed to lower t«ro))ersture, but the bnlli 
is |in-ferubl<- when it U feasible. Quinine, antipyrin, [^le- 
Diurlin, and antifehriit are the anUpyrvtics mosl oominonly 

Pdliod of IncnbatllHl. — The perio<l elajwing between ihe en- 
tran<t- of ihe jwnson ami the devclopnMiil of symjit'Hns. 

It varii^ fiiiHidi'i'abtv in the same diaeiise, beiMg more or I 
influHHiil liy the *iw(?eplibility of tlie iiatient and the viruleDC 
of ilwt (contagion. The average jierioil of inc-ubalion in the iu- 
JbuUoiiH fevers ie as follows : — 

Typhoid fever: two to three weeks. 
Tvphns fever; a few hours to two weeks. 
&UdL'des: two weeks. 
Ki>llKln or rubelUi: ten lo twelve days. 
Scarlatina : a few honni to a week. 
8nia]l)Kix : one to two weeks. 
Erysipelas: three to seven days. 
Diphtheria: two to ten days. 
Varicella: ten to 6ftcen days. 
Tetanus : a few days to two weeks. 
MumjM: two to three weeka 
Yellow fever: fnim a few liouni to a week. 

The data at which rashes appear in th« variotu diseajwa:— ' 

T\'])hoi(l t'ever: peveuth to the iiintli <Iay. 
Tyjihufi fever ; fourth or fifth day. 

234 Acmr. isfectiodb wseases. 

Smalljwx : Uiird ot fourth day. 
JM<9i»l(«t: third or fourth day. 
Suurlutiiui: fir^t or second day. 
Uolhdii or rubcllii: Gnst or sectHtd day. 
Vftriwlln: first day. 

ProtecUim Irani Patnre Attaoka. — l-Vrvr dtwowx give hIwk> 
lute itnmuiiity front future ftttacko, btil thu fullowing itr^ fiiirly 
prolective : — 

Typtiuid fwcr: rciu[wc» urc wmntoii, and sttTind attark« i 

Univ^ occur. 
Tvftliiis fcvw: i«(«ond nltAvbi) x-cry rare, 
M(Ub(l<-''4: oecond alttirJti< (im'omnton; tvhul i8 mippogwd b> be ft 

TutitDil iiilnck is ti.siiiillv ri'ittiirhi. 
Iti.'thrln: M-njiiil ailiicloi hiiix'iniuon. 
Scnrhiliiui: si-ihukI hHikUs ran;. 
Sma11|)u.\: »tf.>oiHl utliK-kH oituisiunally <xviir, 
Miinip: seamd ullarks mrv. 
Yellow revcr: #nx>ii(l atlackft rare. 

The followiii]^ do not confer imninnlty ; — 

Krysi|»daB, Malaria. 

Kflaiiain^ fever. InRui^iai. 

Di|»lithcria. Cninjxitis piicnnionta. 

Ferlodio RemiasiDD or IntenoissioDS ia the Fever. — Sudi 

r<?niiHii<>n!f "r tnU-rrniH.sidtiF' ccitur id tlic following (l-vcrx : — 

MaJanal fever: e\'ery day, every Utird day, or «very foitrUi 

dav, according to the type. 
Kclaiieiiif^ fever ; intermissions occur at intervals of five or six 

daye, and larf five or six days, 
Smallimx : rDiiiisfion ocdire on the third day. 
Mcaali^: a dittlJiicl remitwlon often occtits on ll>e sraond or 

third day. 
Yellow fever: a marked reminsion on the second or third day. 
D^ieue: n marked remission on the third or fourth day, 

which lasts two or three days, and is repvutcd about tt© 

ninth or tenth day. 


The lofecUoiu Fermrs wbiob are Associated witb Jattn- 

YtJlow fevpr. 

liolu{)6iiw fever. 

Actite ydlow atmpliy of the iiver. 

Bilioua rcjuittent fever. 

Terminatioii by Crisia. — ^Tbv fi^lowiog inrcdiotm fovers are 
upt to cikI by crisis : — 

TypIiUB fever. IhltiUilcs. 

I'ncuaioiiia. Jt(-lu[)><titg firvi-r. 

Iti6uctiKu. Eryi^ijK'liu, 


TcmpnramrKt lielow 97.^'-' may be considered subnormal. 
They are observed in th« fallowing oooditions : — 

1. During otinval(«rciK« from certain febrile diseases ; after 
pneiiniouin and typhoid tcver ibe tem[>eniturQ may reiuaiii 
fliilmonunl Itifwviinil days. 

2. In iiillaiMe. Ttii-n may n^tilt from »liock ; from henior- 
rliage; from tiienetion of bome toxie agent ; from simple beurt- 
failure in the course of disease ; or from the ruplnreof a viscub, 
aa the bowel in typliuid, tlte King in jththiitif), or the etumath in 
perforsting ul<«r, 

3. In ebolera. In thin di>«aHe the temgx'nttiire may be very 
low (&0^-&^°) for (Wveral da> s. 

4. In certain ehronie diseases, espeeially diabetes, caitcer, 
chronic cardiac, cerebral, and spinal diseases. 




(PebilCuU. Bpbemoral Povn.) 

DEPISrrroN. — An acute febrile difiease, of sliort diiratjon, | 
and not fxcitcd by a special mia>n. 

ExiouxiV. — It is ^norally mpt with in young an<l sensi- 
tive intlividnalt^ H.x(x)«uire to llic sun, prolonged phy^i<«t or 
emotional cwitcnii-nt, and errors in diet seem to excite it. i 

HvMPTOMi*. — Tbo disease tisuaMy begins abruptly with 
rtiillinesH, heailacbe, nmlai»!, and fever whieb sonn nttainfi a 
maximum of 1U2° or 103". Tbe fare is flu«bcd ; tho pulse is 
full aiMl iiipid ; the urine is scanty nnd liigb rolored ; tbe I 
tongue is ct^t^tl ; the nppi^'tite is 1o»t ; and tbe bowels are con- I 
stijiattxl. Tlicn? ts no cbunKterUtic <;ruptiuti, but tivqwa is 
frequently obrscrv^-d oil the li|ii>. 

Tbe distssc bu<U> from a ivw ilnys to two wccJcs, and mayl 
end by crisis or Ivi»i3. i 

Diagnosis. — Can; must be tnbon to exclude Iwnl inl1ain-| 
mations, sucji a» f^tritts, tonitillilis, and {iDciunonin, 

TWiw'i/ FiTvr. — .\l first tlic diagnosis may {»• imjx's'ibli-, 
but Uic alN>ci)<« 111' diarrhon, tytnpunit«i, ubdiHiiinal l^'ndvr* 
ness, spk-nio eiilni^mcnl, and eniptiun will soon niiikc tliv 
diagnoHtn apjuirent. 

It/Tniltriil. >rr<T.— The bislory, locality, solenic cnlargcmcut, , 
and h:vm»t'iKoa iti ihe blood wilt torvc to aistJnguiiih tliis di#> 
eiwie from ^iinplt- i-imlinued fevei'. 

i*lM Hi SOS I f*. — Fa vo ra I) !c. 

TnKATMrsT. — AlwoUile rest in bed. A linnid diet. Ii«- 
pvatvd Mtinll doses of calomel may be employed to relieve tliej 

Tho fi'ver may be controlled by sponging with water and 
a1<x>l>iil or by the use of some mild refrigerant mixture like die , 
following : — 

Tinct. aoonit md., ett. i^; 
Spt. ntlwr. nitrond, ^h ; 
liquor. nt»ni<in. occUil., ij. a. nd r^tij.—U, 
Sig..— A dcMcii«|)0(>iirul cvnry two luium lo a diild ofroar ; 




(BnMKic Fevct. Typbus Abdomliialls.) 

Deoxitios. — An m-iitc infwtiiL>»s iii«-;i«-, t-xciusl liv a 
l^p(.>l:ial Ixinllu^, ohaniclrrixcd aiwtxiiiu^illy l)v ilt-liiiilc U^tuns 
ill I'vypr'it tntclifv, m<i«(rnloric ^liiiid^, and !i\t\(-cR ; iiii't niuiii- 
ihsted flintrally bj-fcver, lioailiiche, stii|M>r, abdomituil ilisttit- 
ttou aud temlcnie§B, diarrhcm, nilai-gfinctit of Ui« sptmn, unci 
a ruse-colored abdominal m-h. 

Etioumsv, — I'reilisiHifiing mitees: Aiitiitnn a-aw>n, earl)- 
wliiit life, and a |>ersi>nal suswWibilily. 

Esfiling iTaiiHC : The bavilUii^ of Bbpnil. The iiiloftiniil 
discharffes are the mni-cc of tlie aHita^ion. sih) drink iiic-u^cr 
cotiltuniiiated by them becomes the chief medium of Ininn- 

I'atholoov. — Till' ehai-actcriittic leeionn an? folii>d in llio 
idxlumiiial lymphaii'-s, namely, in PcyerV [xitrho*. wililury 
({IhixU, nml nic-scntcric ^landh, Thoeli«nRe« in I'cvurV nlmidn 
nre U^l «t<idkx] in the lower (xirt of the ih-niu, uliioh should 
ht: ojiCDcd on t)>v side of the mcHeotcric altueliinrnl. 

In IIk- first few dnvH Iho gliind^aTV iswolk-n uiid hy|><-ni?mi(; ; 
liik-r there i» n Hiarkeai tvlUprolilenilion, the I)1oin1v<iuw1» ttre 
wimpn^sjctl, ami llie f;bniU tiet-oMU- jud'' and ppmiiiMot (ine- 
dtdlnry inlillnilion). If llii- di-^'iiu^ diIvuikiii, mi'riwiH m'Ih iti 
.iImuii flic m'ii.vihI wfvk ; thf )>liiridK Imikxih' vcllnw mid fiii 
and dt^chargi^ ttu-ir vonlviil^ Iiiiviii); Miiiid irrt-piliir oval 
iil<«rH willi i^M'oUen and tiri<Ii>i'nitiM-d ctlgm, and witli unmolli 
iyoMH formed by llto fliibmiwoii.^ roat, miuailar oont, or jicrito- 
m-itni. Ill till' fourth we>'k cii-atri/jilion lH<)iinA,and llu- plaint 
iii idiintaii'ly npliui-d hy a .im""ih dcitre**-*! mur. 

In aildition lo itu-_Hf iflaixliilar lesions, ih^- niiiM>iiH mrmbranc 
of both large am) hioall iiil<rAlin<^ ahown catarrhal i-iianifw. 

In miki ca;«es the Ma^ of nl(«ratinn may not \m- nm-hed, 
ihe prolifarttdd eelU l*i>'iii;f n>ni'tv<>d hv fatly dt^fcnoralion an<l 
nlicu)r|jlion wilfioiit rnjitiirr^- of the cutNL Ttto Military atid 
m<34eiiteric glundn |ias>i tlinm^fh tiiniilar ciuui^rt^, but div Uitlfr 
nur-ly nipttin'. Other ti^iofw arn found nbidi are not •luinic- 
teristic. The spleeu is uift iind «wolleti, aud uumionnlly m\f 


tiirrs. The liver, kiditc)-;, livnri, aiid ruiiHcks rev«l |>tuvn- 
rliyninUH» tlf^^ieretiun. 'I'lic n:<iuralurv trad, h (Mtmiiioiiiy 
tho seat of cntavrhal iDfluiiiiiiution. 

Pkhiud ov IscfiiATios.— Two to Uia-e weeks. 

Fie. 17. 

I'Tinpvralurv <unv In t^pboJil fnV< 

Symptoms. Proilronuil Stpnplmw. — Orniinnl winkoeiK, 
h(«diu>li4-, vumti; ymii», i>o«t>-bl4>cn, iuh) ulUn .sli^lit ()iarrb<Bii. 

Thr ,1 tf((ci, Ferrr.—TUo. trmjwnil iirc ri«» KRvlimlly, Riich- 
ing a iimximuiii (104°-I05°) in fmm wnc to twu weeks; it 
CGRiaiiKi At tlita ekvntkm for another period of frum one to 
two wfH^kii, wh«n a gradual d<^l<-r\'eiN?ei)ce b<£infl mid oociipivx 
a thinl jimiid lasting from one to two we^«. Tliroughoiil 
its a>[ir»o th« fi'ver lh i-lmrarti-riKed by marked daily remis- 
sion^ tlie t-veniiig tt-mix'ratm"e Wing from one lo ilinv (lc);n«« 
hinder iJkan tlie mornmg. 

In Home ouu^, especially in the jonng, the tem|ierature riws 
<]iiite abni)>llv. Slight diumal remiwions inditatc a protracted 
caw. .Vfl deferveacenoe ad^'uices, the tejoiierntiire beeoiiw« 
more irregnlar; the remtasions are nion? derided, and not in- 
freipH-nlly the higher temperature is recorded in the morning. 
An aUnipt fall of several degrees sliould suggest inicstituU ^j 
hemorrhage or perforation. ^M 

Itftjiintlori/ Sf/mpto«u. — Hurried respirations, slight congh, ^^ 
and bronohiaJ Hiles. 

drctttalfjry SitMan, — Tlie pnW becomM rapid, weak, and 
dierotic. The rapidity is often less than hk-Ii temperslun^ 
generally ptxxiiiee. 'flie henrt-Ri>nit<Ls l>ecoinc feeble. The 
lirsi is especially weak and nscmblca llii- sewod. 

•nTiioiD »•^:^'KR. 

jTte //(f-r.— Tiw fx(>ret*i(>n la dull ati«! lii^ivy, lln- rhwks 
arc sumt.'wlmt tlu^iinl, (In; (xinjtiudivffi an> cWr, aiul liii.- |>ii|iils 

Tbu t»ii^)e iiit tremulous ; at first it is red at the liji unci 
i-tl^<H, himI uuvcn^ [MJi^toriorly with a wliitiah fur. lu seven; 
auvA tliu ton^no I>«ci>ii>Gtj dry, bmwu, and fiseured, wid tortta 
culKi-* on l]ii- it«tl). 

Tff Slimuicii. — (Jaflric HyniiilonjB are net wrtiimon, but ol^ 
tiliiin(«- voitiiiiiig toiiifiinics dt-velojis u04l bcoruiiti a sffuiim 

iHlMituii Sgmfitonu. — ^Tlio bellj- b <li»t«ndMl with gas^ Ten- 
dernefti is fraiuciitly not«d on |wl|ja(ton ; it tuay be general, or 
eiinBlieit to lliv ri){lit iliitc fuMO. I itir};lii>); niiiy also l*c detected 
in the Litter rcfn>>ii, btil it buM litllc Mi);iiilii»mv. Diarrbofi is 
eeuerully pr>>fi)l, (lioii^li it i» »<>t a ^xiiii^laiil sytuptum. The 
uischarKVS vary in iiuihUt rnim tiirw- U> tix or iiiorv a day; 
tlicy ar(^ tbin, wfli-iwivi-, and vf » yi'lkiwis^li (.ijlor (likened t« 
|N)a-6<>u|)) ; (Ml ?>iaiitliiig, a turbid it(]iiK] ritHii ta tiK' top and a 
gniiiuliir ^iriKHir liilU to lli<^ iHitUmi. 

The Kruf/lion. — TliiH ajiiR'am fttmi tin* scvMitb to IIm? ninth 
day, and 'n* iiH)ptt nbiiiidaiit mi ihc alxlDiiicti, tlioujjb it is not 
iiitni|iitnilv iil)«TV(-d nu tlte ebt^l and liiiclt. It is n)m|>o<«d 
of Miiall, Migbtly elevaleil, ■■oMe-<»liinil *]y}U< nhi<.-b disappear 
•Ml pressure. It comtsont in suconeive cnnM over tm'eral days. 
It may be absent partinilarly in the tdd and very yuuug. 
Rarely, in malignant raises, in tlte eniplion jtvu-r'btal, 

Siidamioa are also noted, and rcflult frotu the free perspira- 

Strroas Sifmpfoiiig. — Iltadaehe, j"lij;lil dmrnnxc, Btii|)or, 
muttering delirium, twitcliin;^ of tliv tvndiHis (subsulttts ten- 
dinum), pirkinn at tlio bedclothes or imaginary objects (ear- 
pUologia), aiHl ooina vigil (tiw eyes are open, but tbe jnlient 
is «mciuii»T)o«i«). 

The urine it fobrik and often sl^tly albuminous. Reten- 
tion is odiiunon. 

Oineiil''»^^iy is rnrnkfil by anieinin, falling nf the hnlr, de- 
w|Uainati"n of the <-utidc, and often mental enfeeUement. 

Vabibtiim, Mitil Typhi<kl. — There is modifutc feverwitli 
marked rv>mi**iiinft ; ilic diarrfaoen is dight ; nervous symp- 



tonis nrc ohca alnGiit; tli« rusli i« usually pnwcnl, aod oAea 

Abotiive Ti/jjiwl. — ^Tlierc is tm abnijit oiwi-t willi severe 
»yiiiptom», b»it crmviiU-wwHrtf rullu^t-^ in « tV-w (Uv». 

Il'd/Kriy Tyfhriiil. — 'Mh' svtii|>roiii.'ii iin* tiiild, aitd oflcn clis- 
ix-gunlwl hy tlic iiatictil, wlm n;t'iiik;> t<i go u> 1)«<I; ImiI )^vc 
syinptonu iiuty duv^loji suddenly, and cli^ili fmni perftiration 
i» not iiiu<ommoi). 

TtfjJio'ul ill Cfii/rfrm. — TliA rash iitofbn abaent; the fever 
riatK nbniptly ; corebral svinptoius are marked. 

C<mpj,iCATiosH.^ — Any ^vnijiloni ^^iravatnl cnnntitutes a 
r<>niplicat4(>ii ; thus high tV'ver, exce^ive diarrhoea, and lyin* 
[Hiniuw liet-onip oomplioationa. 

Unnorrhagf. — Tliis usnally ocMirs during the third week, 
aod is indicatcti by a sudden lall of tetuperattire, followed by 
darff TtiA or tarry stools, 

I'eritoiiitia. — This may n?6uk from pprforstion, or from ex- 
I^sion by roniiguity. The former if- lliv most «>mniou, and 
m rBcvigniXGd br a sudden piiin, a full of tcin|ierturc, dtstcn- 
tion of the belly, and sj-mptoms of peritouitiis. 

PneumMtia and ht/potitalie. eonifniion of (he liuiffs nm' com- 
mon (TompiitatiouK 

Anion;; ]cf» fiVKjiictit winpliuitiofiA or scqiH'lic Dtay be tiKO- 
liuned : S\'pbrilii-, pycltHv, t«bcr(rnlo«i», tumjxtmry imanity, 
lin<l pbk-}^nasiu dolons. 

UEI.AP4E AND UBcm'i»»»cESc»:. — /Wopi«» nri> fjuile or>ni- 
mon ; ihoy rep«tl tli*- 8yni|iIonis of the original attaek, but 
iIk-v an.' pMKTally mildtr and of tdiorter duration, ainl m-Jdoin 
pro%'(.- fatal. 

/f^yl•wf^*«^Mr, — This is a Huddiii teiu|>orary elevation of 
tfiii[K-nil(irf oocMrrinjt durinf; c-onvnib^sfX'iHV, and iti uol amo- 
oinU-<l witb n nctiirn of the other symirtoms.. It is usually dtie 
to ooiistijMiltoti, excitement, or irritaling food. 

DlAUKosLS. — Antlf miliar)/ fubfrntloeit often elosely resem- 
ble* typlxjtd fever. In tiiWreiilosis the tcm|x^ratHre is gen- 
erally more irrejritlar; the ulxinniitml nvniptomH am leas 
marfc«'d ; pulmonary symptoms, <^jicoialiy (lvf'i>n'i«, are more 
mariccd ; the ra»h 19 atuscnt ; tubcntle* may W detected on the 



retina; and symjiloms of iMsitar iiiiniirifiilis may be pretHMit, 
Mich aa irn^^tilar )>ii{iiU, jiUiHin, itixl MtrtiM^mii?. 

I'leertilire KHdricanlilix. — 'Viw diiifrfitMi^ may be imirassible, 
Imt the lullowing ieatiins wmiUI s'Ji^jt'nt wiildcnniitis: The 
history of a priiunry ■ii.'«!«w wlitvh iiii^hl iucluoe iiWratisT 
eitdocanlitis ; inf^iilar fever; iiiUTrrirttiit rijiors; praHio^lial 
|>ain ami 4rii(liHnnit»l mnniiiir!* ; ami (In- aljetnce uf a njsi- 
c'j[i>rt>d ra>ili and iiliiliiniimi) ^vtiii»ti>tu», 

EiUtrilix. — 'l"li« uW'iKv uf liij^li fi'Vfr,of t-niption, of B|>lMii« 
ciilaf]genu!iit, of ("nlHtaxi^, of bruiK-hial cuinrrh will iHirve to 
ilistiR^uiHli enbinliit fi\)iii typhoid fcvor. 

McniHtjUi*. — The nhnijit oiiwl, tin* rarly <lcvrlo|iirK-nl of 
'-orebral syiuplnni,-!. the ii-i^-y-iilar ii-vic, amf the nlKH-tnv of a 
rush am) of alxlomitial xyinpliimn will indimtv mi-iiiii^itiit. 

PiUMiMK^tH. — The priigiuislt -ihoiihl iJwiiyjf he pmnlvil. No 
C3W is too mild to piMve fatal, »ih) iio lU'^e 18 loo t^^veii! to 
ro(M>ver. The niortiality varien iit diffi-TOnt cpi(leitii<». In 
private piactice iJin average is probably Ix^twoeii fivonnd teti 
per cent., and in practice it is Aoinewhat more. 

Cominuwl high fever with slij^it ilrnrnal niiiire«<mj', ex«y«- 
jtiw duirrtiieii, *!verw eenrUmt symptom-^, and ii'iM-JitMi henior- 
rba£Gs ore uiifavomhk- fejitiirea. 

Tkkatu cvT. — Absolut*- rest in bed ami tlic eiiforoed use 
of IIh- hed-ptiii. 1'he stools should \w. reiulernl iimoouoii-i. 
This raay he done by dissolvhi^ a [Minnd of chloride of lime 
in fiiur i^allons of waliT, and addinjf a (piurt of the sohitioa 
to i>aeh di.tohar^^ and iilluwin^ it to remain in the veswl at 
least ail hour before diniMnin^ of it. Siiled heddotlies 
shituld tie tllorol^:)dy Itoiletl. 

The diet must be liipiid, nml preferably milk. From Iwn 
to four pints shoidd l«e givtm in tlw tH'eiity-fbur hours, and 
should be so dividc<I that the pailcnt shall mvive a small 
amount every two houi^, tiay ami ni;;ht. When it eatisc^ 
i-nit-lations or Ihilulenu', or is di«-hai^:ed undigestetl, it must 
be mixed with linic-vriitcr, or Im predigfstcd. Koumiiw iit 
often lu.'oeptalik-. Affat-broUw iiuiy he (I^^■«l to vary th<r 
luonotonv of a. milk diet. Cool wiHor or iw vrill \w reipiireil 
to idlay thintt, awl even if Ihr latl'-r in abtM;nl, it is well to 
give one or the other at n^ilnr iulervaU. Wheil tiie flr 




sound uC tlic ticurt vriuikt-nit aitd the pulae bewmcs 0OA, etimu- 
luittx i«limil(l Ix; lulmiiiiMcred, It i» desirable to give the 
al(.Kili<>] witik till* milk m itn to Ktimiilato ttio iUonuu^i (n dijji'sl 
(lie liittiT, and nt Iho j^aiiio linic to dinitnUlt lli<! niimlKT of 
All mill iM. nit iuiis <jf finul aiir! tiK-diciue. Froiu four lo wghi 
iKiiict^niif lirand}' nr H'hUkov nuiy t>e n^iiirwl in llic twi-niy- 
tinir lioiirm llie aniotiiit bdnj^ <li-tt-niiinHl l>y llto general cdW.-t. 
\Vh«ii additional stimulalioii ia nxiuired sCrj'chnine is a vtilu- 
able adjunct. 

Wlwn th« tongue bcwimes dry and brown, the b«Ily mm-h 
diiiti-ndcd, and low nei-viHts syiujHonis d«veloj), turjit-iiiirif 
will Itc found ati invaluable stimulanl. Five to ten niininis 
njay l>i> given in «i|ifliile or emulsion every two or lour Iimir^ 

Antiscjitie reinedie^s have been strongly advocated, but llH^ir 
eiHeienciy hna not been clearly demonstrated. Thymol, Qa|ihUiol, 
carbolii: acid, iodine, and calomel are the antiseptics wliieh 
have been recommeiKled. 

The ii»e of ihi- ei)Id Wtb or tlic twld pack will be found an 
i-xn-Ileiit m<-tb(Hl uf coDirxilltiifr lever sihI of prcveottn^ (he 
devt'lopmenl ofm'vore iii-ivim^!«ym|i|oni.-<. It iiM-^six-tniil ly val- 
uable an a Htiiiiulanl to the iicrve-eenlrcs, itnd niiiy Ic- ■.■mployol 
whenever the reinpcralure exeeedu 1IK2J". I [eniorrhitf^v and 
perforatioii conlrHiijdi<»te its iwe. 

Fever. — When cii-can»fl(ances prevent th<- u^ fif lh<r cold 
Ijuth, s]><>n^ing utth cool wnter and ihe udminiiUralion of riiidi 
ujitipyreticM as quinine (jjir. xx-xxx) or aniipyriu (gr. v—x) 
uiuy be i«ub»4iliite<^b 

Dinrrfum. — WIhii diarrim-a ex<iccd» more than three or 
four i^tools a lUiy, i> !» well to check it by an opium iui|>>i 
positorv, or by bi.^iniitb or nilmU' of ttilvor Hy the mouth. 

[> I'ulv. oyA'i, RT. iij ; 

<». tli«ol>roni., <|. ».— U. 
Ft. In soppoe. No. vi. 
Sig.— Oae, two or tlirue llmea dallj. 


^ Morpli. Bulpli., Kr. J; 
Croasot., gtt, vi ; 
Diimutli. (■ubntt., Jlij.— U. 
Ft. in chart. No. sit. 
bif;.— Uih: tvvry two or three hour*. 



9 Argcnti nit., er. v ; 
Kxt. opij, gr.1v.— U. 
Ft. in nil. No. xx. 
Sig. — One enry ibree bourA. 

Chadipaticm. — Tbi« may be ivli«veil by an enenu gf aoap 
and nuter, or by bmkou <]oen< ofcalonwl. 

TgrnpoHUa. — TurjH'iilinc »tii|K*, Tuqientine or tliyrool m- 
tenially. In gmvo <aM^, ni4») inliibiition. 

Hemorrhagt. — ■\ii io'-bap to tin- rittbt ilijtc Tcm's. Morphia 
(gr. |) with w^tinc {ffr. v-x) li_v|MMK-rnii«ilK. Tiir|»ciitine 
or niliic actrl (dhv Ik- mlDiiuiMcrcd by iIk- iiioiilli. 

Pfrjomlirr IWilouiliK. — Tliw is alriio^ iiivnrinlily fatiil. 
Ofuutii should Ik^ wbii tx-d Trcc-ly. Lu]«rutomy i» mix-ly 

}{rnrl-fiiUiu-r. — >\'hfln almltol is bt'injj pushed mid the 
symptonti* of bran-wfrakiusii »till [tei-^inJ, kiu-Ji rviuiiliiit ne 
aruawlk- ^pinu of aminmiiii, cthor, slrycliniiio, digitalis, or 
oouoinc iimv pr»vo um-IiiI. 

Ortw i\>/-cotw Stpit{Antw. — Doliriiim, wibiudtiw, i>iM>inDla, 
etc may be diii> to fevtT or lai-k of .tiimulatton ; culd iKilliiii); 
is indirati^ in ib^* t<>rm(-r, and (he fn^ it^- of aloiliol in llu^ 
latti-r. Xi-rvi' MxlitlivcH, like \\w Itmniid^^ orputafwitim, itiiutk, 
hyoscin«, and i»n]ph4>r are soroetinics rvr|uinia. 


(SUp Fe7tr. Jail F«v«r.) 

nKl'isiriON, — An atnte (nntagiouA diM.-«it^ imtUMxrintwl 
witli any oliaracteriiflic lesions of the HoltdA, and tnanifviHvl by 
gD'Hl nroetnition, a pelct^ia) ra^h, marked lutrvouit fiyiiipt4>nt«, 
ami lii^h fevei- wbich dcfeireooes by crub in front Irn U> 
Ii>tirt4«ti dayiL 

Knoumy. — It is cxcitod bv aii tmknoiirii |M>iMni nburb m 
•'npaltl« of faeiug tarned in c]o|1h» flijmitM). It i» rniv in 
America, but not uncommon in Enfrtaml hikI IrrlancL B>u) 
food, impure wal^r, uvenruwdin^. and Utn\ air *xr. pmli^ 
[xntng Gtcinrs. 



Pathology. — There are no characteristic kMniu of Ihe 
iwlkls. As in other fevers, the Uver and e])Wn are swdllen. 

»ii<l the tissues reveal fatly ami |jare4iehvn>atoiij4 dc^^xrutioti. 
The bloixl «liDM« a peeiiliar ehaiijfe ; it is dark, HuU\, uiul 
staiiitt I )k' lining of the hi^urt und great blood ve^i^'Is liriglit ixhI. 
riauoD OF IscuBATios. — A few hours to two weeks. 

P%. 18. 


SyMtTOMs, — Typhus fever Ix.'^inif nbni])tly with pain in 
the h<«d, luu-k, iiihI linilK'; extn-nie pruslratioit ; snd fever 
whieh ivacheM lis iiiuxiiiiuiit (1 04"- 1 0-1^) in Iwu or tliree days. 
Tin' foniperatiiiv n-iiuiiiiit higli for iiWut ten <hiys, when (t 
falls by t-rioi-i. 

The poL'M^ ia n)|>i(), weak, and iiflen dicrotie. Tlie tongue 
ia treiuiiUnM, and lunallr covered with a whiti^i fur; but in 
bad casett it tjooonies black and rolhitl u]) liken bid) in the bst'k 
of the mouth. 

Ttie faee i^ dnskv ; tlie e<mjii»etiv»> ore injected; and the 
pitpils are contrarlnl. 

AVreoiM SifrnjiioiiM. — Tlifse ar*- piimiiiioni, aiid mnHiNt of 
heada<-he, Htupur, (leliritim, Biibaidtus leudtnum, orjihohigra, 
and oomn vigil. 

The I-'rujAion. — Abont (lie fourth or fiAh day itifle-«>lont] 
9pol» npt>car over the Iwnly ; thi-se rapidly lieeonie heninrrhoi^ir, 
or |K-teenial, and Tail to di«a|>|>car on pressure. There is a 
ilistinet relation between the amount of eniption and lliir 
wvmty of Ihe allaek. In ad<lition to this " mulberry- riMgHt,'* 
titetv M often u ditfiw, dark-red siibculicuUir niottJiitg. 




Giij4ro-i»lrMimtf >Syni/rfoiiwr. — Tin? sliiniflcEi \s tvtrnlivp, ntid 
IIm^ In>w«-I» um runstijuitixl. 

t'rme. — 'IIh.- uriitc tH tuiinly, higti-4'ulon'd, au<l ofivu albii- 

C'-tmcLirATioss, — Hypcrpyirisiii, cnlarrhal ptK-unioiiia, 
liypoMatic twngottiui) ot tue lung», ii4-)iliritU, siid imnttid 

DiAONoeis. Crrrbr*}^(tiitnl .Hriiinffitiv. — In lliis aftivtion 
llie |iaiii ill the Iwn-k i» urcatcr. 'I'lic (vvvr if very irrcpilar ; 
tLero Ir grrnU-r toii<lc*iiiy Ui o|HStliot(>hc>« ami liK-ial ]uiUip8; und 
the <>ni|tliiiii, (limi}{)i it iimy rctu^nhli- lliiit of ly|i(iii8, in iiK-un- 
-Slant uiiil nillimil ii ii|Htriiil liriii- for ii|>|x^iriii^. 

Tiijti'oiil l-Wrr.—'riif i-i'*< '111 Milium- i« in llw- iicrvotifi |»lip- 
nonirna uiily. l?i ly|ili<M'(i tin- ii-vt-r hm-k iiimI Fa)h very 
graihmlly : lliv cruiitioii a]>[Hnn IhI<t, rtiiiniiit nuH'-ml, ami 
ilotw not IxHTitiK- iidcrliial ; lln* fiur ix nut <Iitwky, llic cytit mv 
itnt iiijrcltil ; utiil tticiv arv niarkt-tl nlxloiutnnl KytniidfniH, 

l*l«M)\'(Ni[s. — Tile iiiohiilily ih niii^ii ^milor IIibh in ty)>li<>iil 
fbvor. AilviiiKMiI vcarN iiiiil iiliiitmlUin n-mlor iIh- |>ni);ni>'<ir> 
dtvidefily nnlnvi>nil)li-. 

TuKATMKNT. — i^^laliuii ; al<t«iliit4> rrat; lir|iiiil dirt. Tlirrc 
is imMfwciRn tnwtinonl. Alitilxil !-■< iK-iiHy alwavH r(H)iiini). 
Quinine and nii»i-ml Bf-'n\» art- uiieriil Umiis. 

I'yrtxut, nerrfiiu jihrniruu-mi, and hiari-JaUurt diniikl Ite 
tmtcJ as in typhoid tcvvr. 


(SpbUltun rsTor, PnalB* T*wm.) 

Hf.fimtion. — An a'-iid- ")Ml«;,'i(ni« diMiw i-xiili-d by (he 
(■pinx^Iiivtc of ()l«Ttiii»icr, and i-luinK-t<Ti«<l liy nnnixvMiiH uf 
high fvvet witii-ji la:^ ftvv vr mx day* and are liillown) hy !»• 
tcrmirtflion^ ufii iiiinilur dnraliun. 

Etioi/WY. — The i-xrilinjf mtinc in the ii|>ir>x-Iiicl>> of ( )lii-r- 
niaiw, a spiral-tilia|"si nii(T<>l»- \\ifv or four tiii»-« an Ixn^r 
as the dtamrtiT uf a r>"l l.l<B«l-<i)r|iu»i'l('. Ba-I waf>-r, jMior 
ffiod, overprowdinjr, and Hud air |ireJi»|>i»e tu t'lMiUinlm. 
The dtMSsc e highly <iipl:igioiis. 

240 ACtlTK IXF£Cri(>CS durakis. 

I*ATHOi/>OY. — Then" are no diarnvteristio leaons. Th* 
liver and njilM'n nre dhioIi cnlai^ed, antl the latter iit fivqiivntly 
the Drat ol' inrarctioDH. Ttx-re in iiiuinllv rslan-hal inflamma- 
liwn of the sioniach and bile-diifts, Tlie s|)irocliirtc is foutid in 
the blood during Wfe. Imt only duriug the paroxj-inne ; aftvr 
death it is t'ouad in all the organs, 

Tebiod of Incudatioh. — Five to eight days. 

Triii)i<'r>lum:ii[T( In rTliii"'U( foor. 

SvMiTitMfi. — ^The disease liegins abruptly witli a cliill fU- 
lowed l>v lever, whieh rtwIicB its maxinumi (ll>5°-I0*J°) in 
nventy-tmir hoiiR, and remains high (or Croni five to seven 
days, when it fallw by (Tipie, After an intemiii^ion of five or 
six days it a^in risc^ Rijiidly and retnnini: high for a similar 
jieriticl, Oonvaleewnee usualfv beijina at lite eiwl of the »?C(in«] 
pan>xysm, but it may not bpifin until ufU>r the tliinl or fuurlfa. 
<>thfr nolenorthy syinptonvs arc itileiin.- |>uiiis in the liewl, 
luKtk, and linilnf ; the »|)iru<.'ti]elc in tlie blood ; and fn-qncntly 

(""Mi'!.icATioN"8. — Hy[>cr[>yrexiii, neplintits i>iHHiniunui,und 

l>IA»iXc»*lR, Itbfumiillr Frr^r, — The lii.-Jory, irrf-j;iiliir fever, 
iMrid »w-mr), and the iiIrMnu-e of K|itrllh and of Jimiulii^ will 
MTVi- u> diMini^iiNh rhi-niiiaii.-<m fmiri n'la]F4ing fi-ver. 

lli-ii,iU<-iit /'iiTc. — In lliis tlijieane the iW'er n^nnls, hut di»«* 
not inUrniit; the jiaroxyiin)!! are more fi-eunent; and iik^lend 
of ti])irilli, hKDiatozoa are IimiihI in the blood. 



Yeilotr Frrrr. — Tlio single remiwion on tho spoonJ or third 
day, the bl>x>«ly vomit, and the aliwnce of apirilli and of spteDlc 
vnlaiv^'nipiil will ioilk-atv yellow fever. 

J'ito(>N(iK[8. — Fiivunible in (incom plica ted ca£««. 

TiiEATUEKT. — Isolutiuti ; n¥t ; li(|iiid dwt. Ax a gcuenl 
tonic, <ininiiic is ittiffiil. For (lie [xiinic, iiiitij>yriii, iihciim-etin, 
or niur])hiH may hv ^jivcn internnlly, and nilu'linioiils iiscil 
kii'nllv. For llic irrilnble »loin»i')i hot fcinH-nliilioits niny i><' 
upiilidt to the ciiigitstriiini, uimI moiuII Aw.-* uf ctiUitnel uml 
kmIa mliiiinijttcrod intcrnallv. 


(Gptdonklc Cotclno-SpiDal H«nlngltla, Spntt«d Favor.) 

DKKisrrms. — A Bpceific infipctioua disease dtaractcriK«t 
anatomically hy inflanmiatioii of Uw fierebiT>-!<piiial ni^-ningcs, 
and clini>-ally hv intciiM' pain in tbe head, luu-k, and limlM, 
eonvuUiwH, irrtgtihir fi-vtT, &d(I Cn-qiteiitly by a |M?l«eliia) 

BriOLOOV. — Tlie di««!*»' may bo lutoradie or e])ideriiic. 
Ovcfvrowdin);, \kot f'^, foul air, ami Ijud drinkinj;- water 
mem to pn^liii{K>M- lu qiitU'ntii*. OnlbnwkM arvnwstaonimoti 
ill tile witit^T ami fj)riit[r. Tin- ymmg an- niort siiHcvptible 
thai) lilt' old. Tlic di.-UAii- in not i^oiitii^^one ; the nii-thod of 
tmiua)>t»ion h ^tll uuknown. 

The ErcUtHtf f liu*if. — This is tiniiui«tj<)fml>ly s niirro-of^pui- 
mtu 0.1-tAin ditth>»>c<n have bt^en n:-|>mt4'*llv fniina] in ttw 
exiidal>o[i», but tuey have not b«en |irvvvii tu tm Uiv trxalinf; 

FaTHoIxxiv. — [» m<»4 <■«."*» l\n- iwtnhmnn' of llii- brein 
and txtrd an- din-plv iiint^-sinl mid dpnrju'-- Lvniph und jhih 
a» fimnd both at thi" Ixtni; iind on thr nitvi-siiv of IIm* tirain, 
esqteitally in Ihr; flmunn and alixi); the b|(MHlvi9«wlo. 'I'hr- 
Hjtinal ou'ninp'H |iru)>-«t Mniilnr i-lunK^M, lite |Mat«riiir Hirfac*' 
i>f ibe i>7nl la-ini; }uiti/nilarly itivolveu. 

The liv<T ami T-pWu an- i-«irori^-d and Uk- miurl(9 rrvwJ 
granalar dggtn efa lio n . In njiidly falsi tama the lenJoiw an 
very sligfat. 


Acn-B isPEcrrors uibeasis. 

SvMlTOM-s. CoDUDOB Fomi, — Tiir iliMftscgirnfrniliy lie^iaa 
al>rii|)lly witliB vbill, foliowa-d liy voiuitiii^ aixl cKcriKiatii^ 
{>aiu in tbo UvmI, bui-k, aitil liruiirt. Tliv ii)ii^rli« of the nt^i 
an<l liat'k iK'comv np<l iind 4iii)lrei-Uil, tm tJiut tlie licad U tii-iit 
Itackward ami t\w liavk ih Mnii^)il«-IH-<1; iu severe cam^ the 
b<)(iy iiKiy be arcli«l in a »t«l« ol" opii'tboUmus. Th« uiici<l is 
ftaon affciJtM ; dciiriiitn is mrel}' itbwMit. au(l ui Severe coMsit 
U followed by stupor and wmiu 

Inv^eement of Ifie CVrmrW jWmra. — Pressure of I Im> cxudnlc 
iijKiii ihe eranial ikti'c^ may [mKliioc llie fo1b>wmt; Ryi)i|ii'kinA : 
>yt■taglmls^t^em«^ of (be cvcball): slnil)iftimii';|>i"-vis; irn^u- 
lar, !ibi^isb |>i)|i)l>f ; iiiiil [HirtinI (leiifiirsK or hliiKbie^ii. 

iHVofiviTicnl of Uk- Sphutl XrrmK, — Tbt-n-igi-.vlrrnioc-UtaneouA 
hy))one«t)u»iil, S" lluil tlic )>li^blnit toueb irxi'iteii pain. The 
D)(tS(rle»of ibe cxljrinitiM ure ^tiff aitil nmy twitf-li. I Hit are 
rnivly [inlsi<<il. TIh- mtolbir nflfx h« iiKiiiilIy dimliiUbtil. 
TlK'jointB awMTiwioiiiilly rvil, ttwdllcii. ami iniinful. 

FiJii'ilr Sifm/Jniii". — Tbv liriii»nitiin' is inryular in itit 
(^(inrw and iii(Minilir in il.i itiinilioii ; oiilioiirily it nini;»nlH"- 
Ivnxn 101^ and IO:i'^, but in sinnc twmw it ittabiinHt nnrmal. 
and ill odiers it i» very litgli. The [wUc ii< rupid and riill ; 
ihehowejHarenoiifltipatod ; and tbeiiriiM^mny <x>nUiiDHlbiimtii 
and Hi};ar. Polyuria is an oooit^ional Hvin|il4>ni. 

The KritfAion. — The eniptioii is iKilbiT ooiiiitnnt nor |«>ni- 
liar. In inaiiy eaae^ a blotchy piirpiiri<! nAx aj)(ic-ur4 owr \\w 
entire body. Ilentes faeialis is also fnt|nenlly oliM-rvcil. In 
otlwr casEfi urtimtLa, or a rust^ilitr or cr^tltciuatouH rush ap- 

The dumticHi U from a feu- hours lo .-^'vci-al vrcck^. [□ 
(avorabte cases, convaKucence is very p nit rail ihI. 

Fulminant FornL^Tbere is an aKnipt on.'^'l wilh a Hiill, 
fidbiwed 1>V vimiitin^, lii-diW-lK", imwlcralo fever, eonvulHtoiif, 
a petcchiaf or tMiq)uriv rmh, and death in a few hours fntm 

Abortive Fonn. — ^The dUeam begins abniptly with grav« 
iiyinpt<imu, but UrmiiuitrK in a few ilnyK in rfoiverj- 

Intermittent Form. — The fever is duinietcriml by ioler- 
T)iix!.iiiiis or inurlMx] n-uiistiouit which oecur daily or every 
oilier liny. 

CF.RKItEt<)-«l>iNAI, KKVEK. 


I hAnKOPiK Ti/if/t'riil /-Vrw. — The^nwliinl onset, iIk" rcgii- 
liir ti'V'T, (in> cliarHmui aitd tvmpauilcs, and IIh- atmc'iiiT' of 
rij;;itit_v, i»rinti'i!«' |'aiii in llio back and limhs, urin^'inl inlxkw 
anil iif lu'rins, will wimraU- tvi)lii)i<l inmi wi-cbi-o-spiiml fovvr, 

Ti/jifiUM Fcper. — 'I'ln' n-j^iimr tl-ver, tlio al)c*Dcic of itil<?nsL> 
fKkin ill line, \iac\n and Uuljii, ol' favial paUic«, and of 0)iL<Tcular 
ngidity, will dblji^ii^li typhiiti from cerebro-spinul feVLT. 

At-uii^ .arttMilar rhfumnimn may irfteiiildc nerebm-S[Hital 
mcnini^ilis, lint llie mrly invoivcment of tli« joints, llio acid 
8»<-iiU<, ami the alBteniv uf rigidity, of eruption, and of fa«.'tul 
jiaUif^, will diMiiigiiii^li it from cifrrhnv><j>titat ineningitiit. 

'i\i/ierculotis Maiinififi". — In lliia <liftfa*' ihe onset i» \&s 
alirnjit ; IIictc is Itus tendemn' to opiHthotono-i ; ]icr()C8 U riirc ; 
a[id netiTltiie am always abeenl. Tnbennilous mcningiliii in 
tiic ndnit b alwavfl eot-ondarv to lulirrcuKii^H ('Wwbcrc. 

PiUMi.vtKis. — 'riic nioiiiifrlv vaii«i in diftirint p|)idpn)icK 
from 'iO to 80 ikt cent, Tlic prujiintiFiM Hlionid always Iv 
l^mrdcd ; tiw ntiVii-st taK* inny |in»VL- tliial. S«^vtn- i'<'n'l»r:il 
symptoms iisnally indicate a fatal tcrniinalion. 

(V)Mri.lCATH>«« ASi> Skvi'ki-.i;. — IWli-tivc viMoti foHn 
inflammation of lite ennica or rctiim, or from ntropliy of Ihe 
o()tio nerve; defective liciiring fi-om inflnniniiitioii of (lie 
ati<lit«>ry nerve, or fn>m i-ci|i{inrulive iiillaminiilion of the 
intiTiinl or middle ear ; iimiimonia ; inlliritix ; ii|>li:L<i:i ; lotipli- 
end iKiUieit; chronic hydi<oce])liulu>t ; and {MrsiMcnt hend- 
ucjtc IroMi chronic nienini^lw. 

Tkkatmkxt. — A linuid or wmi-li(|nid dirl. Iiflaigs may 
l)t- aiiidiitl to the ht^ul and al<'n<; the fpinal cohimn. I'hin 
iiii'I n'Hthttsm'KS iihoiil<) \k n'licvcd l>v rimrjiliii), lirDinidiv, or 
I'liliiral. Miirj^iia ii< eH|K.vudly eHii'.iciotN, mid may Im iiiji-i'lHl 
«h»ng iho ixHirei' of |j»e mu»t ininfiil ncrvc-lmnlti*. I>ry or 
Mt-t enjK* ov»T llwj »|iiiie are isomclimtM nwfiil. fiNlidc of 

tK>t»H.<inni(gr. v-x (lirirv daily) tnuy he Hdmini»lrrr«] intrniallv. 
>r. IV|>|>er rueoninHiKls quinine (;;r. v llirif* daily) ivilli ific 
flnid exlract of ernut (5j every thm- or fimr li(Mint), Wln-n 
iJii^ piilM: W'likni'^, Htiinidaiilx t^hinitd In' ^tven fn-ely. IIi;!li 
(t-v*T may U- ti.ritrnlhil hy "iH-n^irit; willi ndd water, hy ihf 
euld }ia«:k, or by U>e iutcnial luo uf plwuou'tin or antipyiiiL 



Duriti); convalesnence, icKli<1e of jmiaHtuiim as an alworlwti' 
Umict), and blisters to tlie s|)in« are iiidioaUHj. 


{CfaUl* »a& Fevor, FeTcs and Acne. Swamp Fotct.) 

l>KnNiT»>N. — A aiiwific nun-oontiunous disoue, invnriaWy 
aj^xiaK-d wilb, aud probably exciteo by, tlie AtBiwateoa "f^ 
J^vcran, and diarocterixed liy splenk enlar^nient, by leve^J 
with [leriixlic intennisaioiis or remiautms, ami by a temlejioy" 
lo extwrne anioniia. 

KrittuxiY. — A warjii rliiimic and the dimmer spuson, 
nioUt atnnrie[)htTf ; low, b:i<Ily-d rained soil; and diiTiyinjj 
vc^'tablo matter arp tbc cunditiutis which iavor llie develo]»- 
iiieiitof the malarial gioiMiti. 

flpeehl I'rtiliiif>oKinff <\nwv. — Residents in tin; lowlands ; 
more liable to be infiHcd tliiin those who dwell on the hilN| 
our' attark kcpuis to proliKjHUi^- lu others; visitors to malarial 
(ii-irri'-l*' arc more ifiiwi-|'til>li' llinti |K'rmatieiit residents; it 
the nij^ht um! in tht- i-iirly niornin;; the air is thoixxijfldy im-i 
(H-egnat'il with the miiiMii, and vx)XNiurc at snch times is ver 
a(kt to b(.> fullowi')! bv init-clioit. 

ExuUimj fMtt*r. — The hnnudoajfrn fintt dcBciibcd by I-averan 
M nmbtibly thi- pxdtinjr nwMr of malaria. 

AIanikkktations, — Alubi'ial iutoxifnition may manifci 
itM-lfai« (!) inli-imiili-nt H-vi-r; (2) n-mitttni frvcr; (3) pemi- 
cioilit malarial ii-vt-r ; imd (■)) chi-imii- niuluriitl <tac-hexia. 

PATlloijOfiV, — The l«o«li.« Toiind in the blood of those 
ftiilTmnt! H'ith malaria) lever iK-ion); to iIk* ]irotoxonn«. Vari- 
ous f<>nii.'< arir nottn), notae of vvhieii an- distinct x|, whi)< 
OlIivrH tin- mcn'ly |ihat«>i of r-xtwivnei' in ihi- till* nf (Ik- sam« 
or);iini.-«ni. Thfttt> different (>[Hi-iiii und [i)ta.M»i htivf In a limit*-* 
fxli-ht JH'^n B»Mj(!tatnl with the different eliuical nianifcslatior 
nf tin: dt.-M>a.'u>. 

The oiyaniuus are most mnimonly fonml vrirhin the 
MiriMiscleH, and are mir^t abniidnnt during the |iinr<>xy»in8.| 
The liillou'in^ are the j>rini-i|ii)l fiiniiji: (I) A pipmenled anm- 
lioid (orm:(2)a non-iHKnic-ntnl am<t'l>oHl fnmi ; (;J)acn-!*iTii[i 
form ; (4) a flaj^ellate form, lutermittenl fever is gt>i)t-raityJ 


•wociati^ witli tire aiiKoboid fonns, Tlir cn««>ots are foimd 
uaHicularly in reniilUtil Tovcr ami id dironic nialariul cachexia. 
The fliigi'lliili- form is ran'ly loiiiwl in uinn. Wtirii pnwttir in 
the bKxjil, liioy dfi-ttn)y clio rtti oirpusclii*, lilx-raht lltt- [rig- 
tacnt, Hnd iiIticQately lead to extreme aiitemin. 

Fig. ». 


Variuiu driMi ur iKouloiu*. 


Ip aiIvan«Hl malnm llie liliiiil sIiowh a (liniiiiiHlreil iiiimlier 
of red Wt"<(l-iiirjiu«'lfS ami un almiMlaiKf of free |)i^iiienl 
(melameoiia). Tlie Bple*ii is greatly s^vollrn aiu) deejiiy pin- 
nitTDted {agiie-mke); llie liver U niodcrately enlarged niul 
[Hgioenled. All ln« oiyaDH, ineludins the brain and ii[>)iml 

ifd, are disoolum) by tbe liberated pigiueut. 

Iiitt'i-iiiHU'iit V«'V«r. 

Dkfixitiov, — ,\ form of ituiiarial fever, eharaoteri»?d hy 
(i^)rile ])arox>-suifi whidi nre attendud with a cold, a hot, and a 
HWeatinit sta^ 

Symitoms. CWJ St'i{fr. — Miilaiiac ; hpMlarhc ; great rfiilH- 
nesH. The fiHttin?^ are ptiteJKil ; (l>u l)p« are blue ; the tuirfaoe 
of tlR> boily in eoM uikI oi)Vire<l with niily niiM-riiin (jpwee- 
itenh), aIllio4i;;h the nvlal tom|<er.itiir\^ k hi>:)i (Ul-l'^~10>')°). 
Vomiting may ocnir. The chili hix4i« from a few minntee to 
an honr ur twa 

Ifot Situ/e. — The i^urfaee icmpeniturc gnultially risefi; the 
Kkiit Uiiiiimt hoi. ; the fare finished ; the eyt^ liijerted : ami 
the piit.'u- fnll un<l r.ipid. Tlie lem)>er»tnn? in the axil'a may 
naii^h lOli" itr 107". The [uitirnt complDin^ of sevcft' [lain in 
Ihtr hiuid, JHU-k, ami lindi^, nrtd of iiUeni>e thirst. Tlie tirine 
\* VL-uaiv and dork-coloreiL Tliiu itU^ tisuolly huts from uue 

livi! Iiuiirii. 




Huvalinff Sbu/f. — Tf>c fever emdnall)- nahNdrR; the nam 

awe less; I'lve ]>eR<{iiratii)n rnni>Vi~e; and tlii> [iati<>nt lalls (u 
Mcvp, I'nini v/h'wh lir- iiuakrrs fifling iairlj well, 

I'erciistiioii revpali- tnlai^nw-iit of llio 9f>l<?i.>n ; nnd an vx- 
BiniDStion nf tlic bSnud (luring tli« |Kinixyeni allows the livoia- 
ttoxoa undergoing lamentation. 

VAK1ET1B4. — Wueii thp parosysnia ownr every day, lite 
disease is termed quotidian iaiermiltent ; every other day, 
terliiin intcmiittenl; ever^' fourth day, (juarinn inlennitteiit. 
When tivu jMiroxysnis octiir in a single clay tlw disease is 
trriiu'd dixihk' quotidian intermittent. 

l>IA(iS<>«ls. — The pi-csenec of hR'MiatozoA in tln' lj!(">d will 
avrxf lu diittiiii^tiish niaUiria from all oUier inU-riiiiltiitt ty[K»^ 
of fever. fl 

I'lHXiNORiR. — .Mhuvs favorahle. Ev«n when no Ircnlnienl H 
in iuHtiliiicd, llif iHirDxysuif gnidiinlly wilwiide. Chnmii; lua- 
larial omtlivxiu ^init'tinti's nwihtt fn>ni tiiv wutu di^nM^. 

Komiit^'nt Fover. 

(BlUona RerultUnt Favor, Jnn^e Fever) 


>F.FiNtTiON-, — .\ form of malaria in which tlie temperahire 
(Il»ilitii-ll_v rcniils, hut do** not intermit. 

K-Tioi-iKiy. — This form oeeiirs etfieeiully in the marshy die- 
trit'tH of hut elimatc^ ICemissioUB, instead of intermisHions, 
indi<iilt> a jrroater \iniience of tile poison, or a greater suseeptl 
hilily (in tlie |itirt nf tlie patient. 

NVHiTOMS, — Miiliiisf wilii mMlemIe ehillinp)^ fidlowed b; 
H "mttnuons ffvi-r wliiili litiiiy rc-mits. Tlie maximnm tem- 
IK-mlun^ nmgut from hll** to 1(W, ami wliile this last i< the 
«kin i« hot, the fwv ii* fluiflH-<l, iJie i>yc8 xre injcf^rd. (In 
ptiW U full and rapid, Uie urine is* srsinly, and the |mt>iii( 
conqilftini* of |i»in in iW head and ItmljM. IX-liriuui in wime- 
tim(^ uotcil ; voniilini^ollfUiHvinx ; mid jiniT»<li<<i'nmv di-vclop 
fnmi di*itnu-lioTi of llw rrni lilmMl-oorpuHltw iind lilx-mtiou i 
tlieir pi;:in<<nt. The '•pli-ni is i-ulnr|^-(), ami ati exiuiiinalion o 
tile bl<HHl rc-v«il--« lufninioziin. 

In sonteeai»i the symptuin^ n'wmble typhoid Tavt-r, and 





Ibew tb« term typhotnalarial lever ium been aciplied. In 

severe caws the svD])>lunis r»ejnble pornioioiifi malarial lever. 
I DiAONtwis, TtfpfufiJ Fettr. — The alieeoce of <tiarrho?u, of 
• -|.yiu)moitc», of cmptiuD, aixl of a graduiil rigo i» IcitiiHtnilttre, 
■■pel lite ])r»>em'e of liieiiuiloiuia aixI of iiiiirki<l rciiiiioiiunM will 
^Bfer\'<' t» ^.■|uiriite rvnttlli'iil fi'Vi-r from 1V|i)ioiil. 
' Yi/lmr Firrr. — Tiii' n|ilcniir orilaip-iiM'Jil, tin; lui'iiiaUirjui, 

■1)1' inulli[ik-n*mi.-vioiH, nntl the aksiMtcc of l)l<XNly vomit will 

:^-)iai-»t« rcniilient fixmi vellow lever. 

I'mxiN'tKis. — Favorable ; the average diiratjoii in fmai one 

to twu weeks, 

I'lTiiii-iitUH Maliiriiil K«vt*r. 

[CoucaMiT* ChUla. MaUcD«nt Mftlaila) 

pKFlNm(}N.— A uinli^uuiL form wf Diiiliiria, otriirriug e*- 
|Kirinllv in tin* troiiwa, ami iliaracieriaitl hy 4'lnil<-rni(; urnip- 
torn*, l»y wiiia, or by a lcinl*^tii-y to bliH^I froiu tin; variotis 

VAniBTiKfl. — Arconling (o its expn^ston, the fullowing 
varivti*^ liavedeen uaile : (1) Algiil ; (2) ooniatOM; (3) hcm- 

HvMiTnUii. -^^^^ — T^^ sTOiptotDs resemble tlie cold 
»t«ge of rholrra. Tlie Hiirfuco is cold; the tem]M'rolun> innv 
be tuitmoruml ; tht-r*; if great |>roKtmtioii ; the leatiin^ are 
]iiiiehcd ; the piilxe \* fti-)ilc. VumilJiig aixl ]iui^ii|( may 
follow; death urim n-Millr^ in ojllujier. 

ComatiMC, — There ia delirium, rapiiliy fiiliowcd hy gjU|H)r 
awl coma ; (Ik- latter may or nmy »i>t U^ usHHrtiiled with eoa- 
viilisioDS. 'riie .■'kin \» luA ; the liw-e in tliii^heil ; tin- vycv in- 
jeetril : ami the teii)]>i'ratnn- iiij;)). The nvinptonix gniihiiilly 
diNi|>|Hiir, Imi tiiilii^ ihe jNal'unt in ^iietdily i-iii(-liooi»xl lliey 
rcttini noil eommoiily pnivi- fatal. 

Ilemorrhiuju'. — In this form hemorrhapes ooeiir IV^nn llie 
mii(»iiit menibmiKf, psjireially from tlw kidovya, stonuu:h, and 
lion-ela, anil the imtienl i« frvtinentty jauudicea. 

1 >I AciNOKW. — Mil' al(;)d fcrni mny ref»eml>le rhtJertt, Uit the 
hi^lorv. ili«- iitnti^ni'-v of iiii I'piili'toH', anil ih<- yri-rj-tui- nf the 
luematunia in the blood will ix-tider llit; tliago>iM)> H|i]iiu\-m1, 

AcirrE ixvacnovH VKKMttv. 


Yeiloic Fever. — The homorriiagic fomi raay resemble yellrtw 
fever, bill the splenic eiilar^iiieiil, the lale a|ijK:aTitiiee ol' jaun- 
(liec, the nres^uro nt' hi).-iimtoztHi in rite bliHxl, and (he ali»'iK« 
iifnn ejmlemir x\ill.-«Tvi:- U> diMiti^ii.ih ihc iwd (Iiniims. 

pR(K!\"<isis. — KxlrciiK-W (niiirtled ; liiu (iist |iiiim\v.-iu rartdji 
killrt, but iiiilea.1 ih^ {olient U thoroiiglily uiiiduinizeil a .tecon 
one iaa,y jirtjve fatal. 

i^bi-onlc M»1arfal Citcrhcxia. 

IlEFisiTloN. — A dmmir iu:inil<7itntion nf iimlnnN, cham: 
IrriKi.'il bv niiiciiiiu, byusulluw a|i|>v»nimK- of tlicNkiit, nml 
?*|)ieiiic ciiliirp'iiwnl, 

K'noi/KJY.-^h limy nwiilt fnnii r<-|Hiiii-ii ntiiK-k(« nC itie 
anite dis-iL*.-, UP it nmy tUwcltiji aw a iii-iimirj- ninditioii froo 
mIuw inli.T4i>>ii. 

Symitomj^. — The ]inli('iit is thill and ))ali>; ltioe<iinjilexi<K 
b of a dirty yi-llitw ur muddy hue ; fever is often ali^iit ; 
preMtit, it is itU^hl nnd invgiiliir ; the Hpleen is ninsidenihly 
enliirirrd. Tln-n^ ix gri^ii wtakniw* from the atteitiliiit; anaemia. 
Ilea(i.i>-)M- iind ticnrali;ta arc wmxixiti »yiu]iU>in4. Hieoialdria 
b sutiu'tiim^ iib.'>(Tved. 

I>iAOS<iHrs. i^iftrimia. — ^The histori', iheabaence nf leaoo^j 
i^ttKiM un<l of lyni]khatic eidaiyemeiit):, and the presence o^M 
heaiat'jiuxi in tlio blixxl will indiiiite malaria, ^^ 

pROGSOsLs, — Guanlod. When the lutlcen ta very Iai;ge and 
there is cxtrwne aniemia, pecoveiy mrely folluwH. 

Otiior MnnlfoxtnMoii.>4 of Malaria. 

One of the roUowinj; (■■indtlioiiH may tie llteihief mnnif 
tHtioii of inatnriul iiilnxiraiion : Neuralgia, htwlaehe, ha.-tuai 
tiirift, j»ur|mni, iir.-]iiiiB,ur (Kirajd^ia. 

Malarial inlV-rtion aeenu to (>r«ii»ipi»^ to rrrtain eases ni 
<lywnten', of jiiiitimoiiia, and of amyloid tiegenenition of the 

TltKATMKNT OC MaLARIAL 1*I«EA81». I^pitgfaxw.- 
I'alimt.^ liviii); in mal»nal dii^rict* «ho*il<l iivoid the night 
and eurly niorniii); nir, and ghtxild l^ike i|HiniMi- (-^r. Wy-v 
day) dnring the miusuu id which llio disviisu i» prevalcut. 



OJd fHatfe of />rffrm(//c«(. — (?i>vcr th<! patient with bkiikoiH, 
ant) »)>]>Iv liut canB or hot butllc-s to the Tcet. Wlien thf diill U 
Hpvcne and |>rolung«.>tl, inor^thia in very iiM>rii) ; it iitiiy Ix- given 
hv|Mxlfrini(nlly. Ilotriuanii's aiuidvne inav \w employed 
n» a i^dlxilittitc. InltulHliou^i of nitrite of umyl ari> tolhiwi^) 
by dilutatiun ut' the t>)n)C'rfK-ial htixHlve-i'ioK and in this way 
serve to sliorton the ehill. 

Hot Sfw/' iij Jittrrmilteiit. — Sjionge tli<' Ix-dy with cool 
water, hdJ if thc»yni[rtoniH are severe {tltciuu-etiD may be 
given to lower tin- tem]M.-raliire and to kf#en the fuiin. 

The Intcrml.- — It U well to begin the trtfltment by the 
iidniini^lmlkm of a liixalive, and i^loim^-1 may l>u H-leL-lnl. 
Thi» blioidd Im- Tollnwi'd by tjiiinirie [gr. xv-xx) in divid<'<l 
diMec, so llial IIk- doee i» taken two lioiir^ before (be time 
uf the exjN^led unrnxvsm. In ehildreu, (jninitH- may be given 
in losEengic made witli elioeolate and fin;:ar. Jn adnltis it is 
ixnt administered in fn-^li |>iliH or in ui)irfnle«. Tliese <]"^(^ 
f'Ciininine sbuuld l>e nmliniied until (he |ian>xyMn» disi)>iM'ar, 
wlicn the amount may Iw gradnally dimiiiHlied. Tlie 
nient i>honld be i»ntinued tor several weeks. During ctinva- 
Icweence tt ii« advi^ble to give nn?enir in the form of Fowler's 
solution with llie i|(iinine. The following |iill i? hIm> OM-ful 
ia tbc cuuvaleHcenee »f ntidartu : — 

^ Adil. arwniou. gr, m ; 

(juiiiiii. hill))!)., ,^; 

Fi-rri p3n>ptnBi,, ;ir. xxx ; 

t'lilv. cni»iL-i, UT. XV.— H. 
Ft. Inpil. No. xss. 

HfwMtMl Ftnrr. — Ahtuilnle reM. A light die<. Qninine 
(gr. xs-xxx) »honIil Ik given in divided df^rn in tin- nxirse 
of'aday. A laxative fhee of («l'>mel iii a valuable (uljniK4 to 
ihe anti)>eHodie treatment. When (he ^(omaeli ih irritable 
ealon)el arid m»\u ninv l>e given bv the month, am) thc(|uin!ne 
by the roeiiiin <>r hv|»odernii<nlly. In wmie tii*«* Wai'laii-g's 
tinetiin? is useful ; naif :in onniv undiluted may be given, aitd 
■vpealnl in two or three honrii. After its adniini«tnit)on the 
{latienf ."ilutnld l>e ihomnghly eovvrcd with blunki't»au ua lu 
tavur free dia{)horo«i». 




Pemitmua Mii/ariiU f'tvtr. — Frtjm fiflytui hiimlird grains 
of <niiiiin« iiiurt lx> givni iK-fun- tin- kwihI |mn>xrwii i.H-ciire. 
It is advisalilt' i<> Ih^-ih al luut- wJilionl wiiiiiiif; Hir (lie iiiti-r- 
ininNion ; ami twfniy u> lliirty ^rtiiim nmy be given hypo«lur- 
tiiii'ally every two or ilm« Inmrn. 

^ (juiuinic Milph., KT. xl ; 

Snt: Mil. acid, larlur., TDxlviiJ ; 
Aqutt) d»lll., q. ». u<l l^lj.— U. 
Sig.— l)lxxx=sgr, X, 

When tin- piilw ivi-«l«-iut, istiiiiiiltttitis lik* wliinkoy, uiiinK>i)iti, 
a»i1 At ry el mill, hJidiiIi] W- (-iii|il(iyi.-cl. IJigli IciiigK-mttire .-iliuiiM 
lie itiiitriilldl liv llii- cxtrniiil ii|>{)Iit!iiti<ji) ol' ttild. In (In; 
al^^kl funii, IhiiI iiiiiiniil \n' ii[>ji[i«-(l <-xleriiiilly, mill upiiiiit 
^iv'<-ii l>v liie iiH>iitli or liv|HHU'niii(!iilly. In lliv lii-iiKir- 
rhu^ic loriii, o|iiiiiii !.■< ali^o tiM't'iil, mn) it uiiiy lie a-^MivtaUtl 
with tuTfliti^laliiv like tiirjN-titine, I'n^nin, nr haiiinnieli^. 

( hruuir Mitlitrltil < 'wJii-jciit. — Iron, quinine, uuJ arst-iiic atv 
the reructliis iudiealed. 




Drpinitios, — All oedte eonlagioiiK diniiw, etiaracli-riKod 
bv hi);Ii li'ver, a rn|ittl |>itW, ii |i(indtt!>riii Mnrlet ru;Ui, mn 
tJiroai, mill iiii iitiiHiiul U'luleiii.'y Co ni-|ihritiii. 

l*>rt<il.i)(iY. — 'Hk' a|iei-itic ]M)Liitii iil' !*mrl>< fevi-r Iish iu>t liwn 
iwilatiil. The cuntagiunt i» lutuilly rarricti tlinuij^h (-)u(liiw ur 
oilier fiiiuiteH, or iu food like milk. Tlie dboaw titn W 
I rutin lit it ted Ity dircit iiK>euUitit<n. Tlw |Hii§on U tcnai-Joiw 
add of c.vtrame vil:i1ity ; iiilivttil elothn^, iiDiitied Tor yean, 
have VA to onibnraks. 'Die VMin*; aiv i^iH'cially priiliiiiHi-^d, 
but tiot c<|n:illy hu. I'ltcqieral wuincii and |K'rMiiini ittifliTin^ 
fnna wuniids iire iintKUfilly &ii«K.-pt)l)U\ Oih> nttai^k does uut 
^ive niMoltile iinniiinity, Init iiixM>itd ntlackit iiru iiDojinmuii. 

Patiioi/hiv. — ^Tlii^ tliruuti» inHiimcd and ismnt'timcii iilcer- 
altil : the liver mid njiki-u are eiigoi^tl ; (lie tniDM^es reveal 
gniniitiir d<'i:i.'nen>i ion. Klein hais ohsi-n-iil liy|N>neiDia and 
O'll'prolireruUuii, iit»t only in ihf Uinnl mm] kJdiit'ys, bat 




tliroiighoiit the inti'stiiial niiinl. Tlit> kiilixy-t fn^iiKtritly show 
(he IcsioUH of htiiiiorrliaj^r lu'iiliriiin, (In* gloiixnili lieing espe- 
inally inviilved. The rash is iaii-1^' ^ll^ft■twl ai\vr d^'alii. 

\ Aiti»7i'ii>i. — (1) Siiuiili- ; (2) nngiiioiil ; (:}) iiialignaut. 

L^KiiifiD UK I.vci'iiATiOK. — A Icw tiourt to a wwk. 

SvunxiJis, — Thfl disease gtntirally hc^iiia siiddenlv, cxxa- 
ttiunally Hith a eliill, hut lu^tn- <«in)iiioiily with vomiiiiig or 

T/t'iMii .^'yHlJrfoln*. — Vain and difliciiUy in 6«-alli3winR; fiil- 
nirrii and Icnclernes Itenealh (lie jaiv ; ciilarc^mcMit of Ihf 
lyinjihatic glatids. Tho ton^uv is ac liixt lH?avily mttiv^i luid 
ml at tJw tip and edges ; in a Cuv days the cniitiiip alnntst 
(entirely disaiiiMii^, niid tlic pa|>illi» boivmc hrifjiit ml aiwl 
HWolIcn. Tins Hii|«jariin'v has givai rUv to tlio tt-rm "rfniw- 
Iwrry t««fn«'-" Tin- pillars, tonsil*, iivii!:i, mid [ihiirvnti-.d 
vault !ir»' dwjily injti-tfil iiml nniy fvvwtl U [iiin<-l(liinii <-(llii- 
rcsrenoo iHifnri' thy nish <icvfl<;i|it yii tUc skin. In .-^'voro owtw 
the tun«l!( may lie the m.'M uf fuilicular itiUaiunuUuii, ur may 
be rwvcrwl witit faKt niiMMlinitiO. 

Krupllon. — A ««rl<-l-nil [iniirtifitnu rasit ap|)parft at tlw^ (■n4l 
of tim lintl, yr at iIk; lH:<;inning <if Llii- rtimiwi dav, i>n tlic lunk 
and rhcAt, anil ra|iidly ^nivuds nvrr iht- entire Ixnly. Il dls- 
upiH^imnn pnr^inf, a wliitt' line i-einaininj; for a sepoiid or two 
whi-n Uk' finger-nail is drawn throtigii it. It. may bo iinifomi 
iir it may occur iu diMTde [Httuhes HurruuiKlcd by lieallliy skin. 
Ill five or six day* the nil color ^dually fiid(« and scaly 
deiU[uamution »><>u fiillnw-i^ 

In s(>ni(.> (u^^ llienL-<h i* palu and ^rarvely vitiible, in uthers 
it is sli<;hlly |in|iidiir or v<«ii-iilitr(Miir)atina miliaria) ; in ma- 
lignant rt^w it may lie iK-ln-hial. 

j/Htrilf Sfimjiliiiiut. — 'File fever riswt abruptly, nm-liinjr Wn 
maximum (104''-I05") in tweiity-foiir or fnrtv*iiilit Iiouih, 
it'mainn iwnrly uniform for three or fottrdavs, antfllH'ii falls 
bv Ivsit The duration of the febrile |M?riod is from seven to 
nine days. The |nd«.- !* very mj)!*), — out of |]noj>orlitm to llie 
fever; the rfS(!< art- htirritil ; the aplM-Hite is lust ; tJie 
Intwels are ci'n*ti|iulid ; and the urine w »ixuity, higli-oilurtd, 
«]id often ountniiit* albtmiin. 

268 AcuTB iKFB(rrioi» diseases. 

Nemms SymjManu. — R«6tleesiie»>, h«adache, inanmiua, dv. 
liriiitn, nud <»nvuli-iong may occur in llie nnireeof the tltseu.^.* 
Conviikioris di-vclopinj- late iti (be liistase are very liignifiiaiit 
of ursLinin. 

An^oid Scarlet Fever.— This form is chanirt<?riz«J Itj^i 
sv%'cn; tliroat symptoms. Tliv tuosUs are much swollen nn^H 
arc ortcn covcn-cI with falw; ineoilinino. TIk lever is high^l 
iiiid (Ik- pruttjratiiiii t^ prcifijiiml. Ulwration of the throat Ire- 
ijiiciilly iNX'tirs. IViiUi rimy ixnitit fntii cxhiuiKliun, iLspiration- 
[iix'-tuiiiinia, or fnnii iK-niurrlinji^ due tu iikxrutioii of the 
(»iYiti(l lutiTv. 

Maligiiant Scartet FeTsr.— The onset isubnipt, with adiill, 
vomiLiiig, or oonviiUiou ; lite fi;v«r is \cTy bi)>;ii (106^-107°); 
the [hi1m> h rapttl and fecblo ; delirium M-tn in, and i.-i rullowxd 
by eoroa. Ih^alh iimy ixsult bcftirv! tlti- a])|Hairuni,'<e of iIh' 
rash, ill t.weniy-foiir or forty -eij;ht lionrs, 

(ViKpLii-ATiosH, Xephrili'>. — This usually develojie diiriiif; 
convalescence, and as it may be nnaM«M<iat«d with Mihjtietive 
eynintonui llie uriiio should be exaroine<l daily in order lo <li>- 
tcct Its presence; In other cases its advent is recugnixcd by tlw 
Mi)>prcKion of tiriite, by iineuiia, or by dni|By. Ne[ilir!ti-( 
uiiiy Ix' the iintnediate canse of death, hut more cotnmoidy it 
uhU in rocovcry ; it wmetinM* leads to dironic reiml diHeaw- 

Amoiiff other complications uiuy be meiitioDtxl hyjwriivivxia, 
niduumlttis, pericarditis, pneimionia, etipptiratJon of the lyio- 
pbxie glimds, uphthaliuJa, iuflnniniation of the middle ear, 
rhurr'a, niKl a ]M.t:uliar iuflamniultun of the joinl» mseoibliug 

UlA(JK«)8i8.— vlrW« ToiuilIiti« may rowmblc tocarlet fever, 
€J<|Hs-iiiIly when the former is ii»«>ci«Hii with an erytlwiiiatoiff 
ra.-«h ; Ihii in tonnillitis there i« no hUtory of oviitngion, the 
{MiL-w iM proportionate lo tbn (c\-er; tlic m»h, if prcm-nt, is not 
IMim-tifiirm ; (he I'ingnc luut not tli« strawberry «ppc*muw; mmI 
tlK-Tft is no tendiriKiy to nephritis. 

DifMifriii. — Th<' oiwH is h:i« abrupt ; there i« mom pr»»- 
tration ; falni- n)i'nd>rane i^ alunys i>n^*nt ; a viiliintvus nish 
is usually alxM-ut ; and tl>c tougtw aoei not pRwnl m atniw- 
Wi-ry apjicarance. 

J/«i«fe8, — The wire tltmnt is 1<«» marked ; catarrhal symp- 
tonts are prcwnt ; the ntth apixam later, is jiapiilar, and forma 




in cnsoeDtic-dHaad lalefaM ; Uw fi;v«r ■bom a decided nnw- 
MMKMtkeMMMsrliuiddBy; aixl tbe pal« ia prop at kuM te 
to thtSpns. 

Kaidm.—'nm Bwr be diScnk lo dudagndi fron aearb- 
tina, but thr fnvr i> noK «o bigb, ■MC tbe |Mhe so »{«) ; dw ' 
|Mj(»-<crviEal ^ead* an nan vwulleB ; then n do 
to nephrilis ; ami U deMBSBtino oeean it im braanr. 

A li lif ftB^ii-CntMJnipKheber ' 
ami enjab^ aad aain faodc, we ciafai 
|HalBD»aaA Oe tfal «r K«riift fever, btt it ■• Mt | 
form, aad i> h* a^acaMd with U|^ fem, < 
ra|i*d pdae^ 

PaoPTW Aiwiji gi^liL TW aartifitr 
diflenai «*idnia fti^ ^ !■ 40 1 

Tbe avfttt «r tfe baa* AnU W ] 
daflr vkbcaid 

frwlr. riMi iiaiiiTi. ■ ij ■■ f ■ »■■ iiwi ir 

Rtaiti«c,Ae MiaiKar Ae cUnie «r in* aar be 


H la «<M« «««irr ■*• w ■■■• aeBia 



Cardiac wcabcifiss will call for sliinulaDtfl like sloobol, 
monitt, strychnia, and digitalis. 

C»rivaIc«ociicc slimild T>e guarded and protracted. 


(RubMlo. MotbUU.) 

l)Kt'lxiT!«is. — \n ai-iite contagions disease, obsractcriznl 
Ijy (siUrrli of t\\« r<*i|Mratory travt, mtxlerate fever, and a rwl 
|Ki|iiilitr )'nii>tioii, whivh uiijxarH on the fourth day and t<'rmi- 
iiiHc.1 in two or three duys by hi-nniiy deM|Uainati<>D. 

KriiiUKiv. — Measles is highly conlaaionii, and tlic poiaoa 
may be ininsmiltei! through clothes awT other fomitwt. The 
nmtaginm is a[imrciitly iissuciated with llie nai^l an<l bron- 
chial secretion, but it liua not \tQeo iwlated. It u taoft 
nrnimonlv olwervcd in children, but unpratectt'd wlults arc 
%-ery liahle to Iw attjtckwi. It U I'w^rntijiIIy aii oiiidcmic dis- 
ease, but now ami then isjxjnulii; aiww <xxnir. (>n<-nl4u<:k is 
fairly ppotwiivc, but <i'>v» tmt pvc idwihili; immunity. 

pATiioiXKJY. — Th« k^onx cuiiriint in (wtnrrh of tli« Milire 
resin I'Htory tiiivt. (in^lru-ifitaj^clinal i.«lurr)i i* noi nncoiuinon. 
In ffllid ntMM mvi\ t^mipliailjunt* as (ii)>iniiry bn>n<4iitifi, 
cuturrhid prK-uuKmia, and jinhnunary txillitpiiv are fn.-(jUi-DtIy 

Pkiitod op Incpbation. — Almit two weeks. 

Symitoms. /*)■«! /rwuusf. — ChilliiM^w, (y>ryza, wateringoftlic 
eyw, jtliotophobta, oough, and dittw.iinoiM. 

7V M-RT.— The tcinjMTatur*- rbrs rapidly to 102* or 103°, 
Imt on Ititf seoond day iImtc is a d^^nditl remiuAion, whidi 
t'oniimies nntil llie fourth day, when tlio eruption appears ; at 
this linn' it a)^in rapidly rnni* up to, or beyond, its origiital 
heigitt, where it iviuaiiw for two or three daya and thoo foils 
by orisia. 

T/ie Cbiarrh. — liedoesa of the ronjunctivw, Inchrymation, 
MK-cxin);, hoarseness, ootigli, and <-xi»ecu>ralioa. There may 
Iw vomiting or diarrhow. 

Tftf f^rtijilioii. — This ap|H-arH nb<nit the fourth day on the 
faoi, jutd raptdly •'pnitdx over t]ie entire body. Il ik oun- 
po«ed uf sntall, durk-r(?il, velvety papulee, which I'ortn grouji* 



having cTeficentic honlors. liwl sjMtts aro froqitently twtictHi 
nil ibc pbaryux belore ilte eniptioi] devel(>|)ci mi tli« ^iu. lu 
two or Uirce days lh« eruplioD l>eg:iDs to fodt!, oiid branny 
destiiiamatioD soon follow.^. 

Inall£Daiit, or Hemorrhagic Measles. — ^This (bnn occurs 
under bad hjgieiiic coiidiliontv, and is cliaraoteri/jxi by a j»c*c- 
cbial nuili, by hemorrbagts fmm the iiuicoiib mcmbraneti, and 
by profound prostration. 

CuMrLicATioss AND Sbquei-.r. — Capillary brondjilis, 
catarrhal pncumunta, tiiben.-iilusi«, otitis, gastro-intcsliiial 
calarrb, luncnim ori)<, and nanilyMtH. 

I)iA(iN(«L'<, JMh'in. — -rrtHlnmii-s arc often absent ; fever 
and catarrh an.- slif^bt; tsurc Ibmal is ninrkc-d. Tho niHti 
apjicars on the (irsl i>r accitiH) day a.* a dil1ii»c rvA bUmli, or 
a« liniall |)nl<r-rMl »\K}tit wbidi do not lonn on.'t'Cfiitlc-HJiapcd 
patvhce; duM|iiania(ioii i.t msrcvly notictflble. 

.Swjr/d Ftrrr. — 'Ilw fever u high and lacks tlii> pi-c-i-niplivc> 
rcnii.-ipioo ; Son- thniat is presiint inMcad of guncnd ailnrHi; 
ihi^ i-niplioii ii|i|M.itrH on tlio lirst or »e<-ond day m a difAiMC 
puni-tifijnii nish ; tin- pol.^ is out iif pmjiortiim to iIm! fever ; 
and tinTO is mi«'h gn-iit^T t*rn<lc-ii(y to n«>[>hritis. 

Proosoris. — (iiiardedly favorable, (^mjilii'ntions are at* 
to i«!ciir uimI ri'itder tlie progiHwis yravfl. 

TnKATMKNT. — Isolation. A darkened wpll-ventilalwl room; 
uU<oliil« ixwi. A li<{iiid dit-t, Sueh refrigerant n-niMlies as 
nvrtt^ sjiirils of nitre and liquor animoniicau-laiiH an- indi^'atcd 
aiul may be combined with a little aconite. 

^ ^(it. i*'th<ir. nilrnsi, f A" i 

IJ(|. aiiiiiKiii. ucL-l»ti!<, <|, n. n«l f^iij.— M. 
ffiji. — A t«ajt|H>uiirul tvcrj two hours. 

For liw broncliiul ailarrb, a[>]))y a oitlwi jacket to tlie eiipsl 
ami give tut4?rnally c:(]H-cto rants with HcdalivvM like ]jarc^ric 
or broiniili! of |>olu8ifi(im. 

^ Htnmoi). acctat., rjn; 
Syr. ipccnc, M ; 

1^1). itiorpb. Bulpli. |I}. 8L p.), mx\ ; 
Syr. acada-, fjj. 

Aoaae, fSlsn.— M. (Mki«« and ritrPKR.) 
Big. — A teacpooDlHil wvry IwoboursforacbiUlof two juam. 


ACTirpK iNPRmotm Dinr-Asss. 

OoAtric irritability hIiouIi] be i«lipv«l by Nnall doitra of bi» 
nmtli or by calomel and soda. During d(^|uanmlion Uii! nkin 
8honl(l l>e anninled two or three tJiura rlaily. Hif;b (V'vcr 
h&i oi>i)tn)ll(Hi by iiitonging wiili Uipid waUr. During 
valffMvnoe iintrient^ lik<^ood-liv<^ro(l ami malt, ajtd luiiiis 
irou, <jiiiiiin«, and ittrycbiiia are indicBl«d. 


(Rabelta. Omuuui UvuIm. Bptdemlc RoMola.) 

Dbpikitiok. — All miitiT <^i)lfi^nii.'i (lisiaAe rfti<eniblin{r 
Morlet fffver aud iiicWtiit, but differing frcitn tht^! in ilsrilx 
floursc, slight lever, and fW-edom from swjiielw. 

KrinrjixiV. — The disease is bigblv mntagimia, and 
jtoi^^n way t>e carritii on clotlies or otner funiitea. It j:<-n<T- 
ally o<»iirs in epid«ui<s, bnt sjioradio cast* are not uihi>iiinii>i 
It in moat tmiucntly obterved in eliitdren, but unprotei 
adiilk* are not exempt. One attw^k usually jirDteet^ fi 
anntlmr, but not fii>m mcaslea or scarlet fever. 

Pkiuodok iNcra.VTiON, — About two weeks. 

SvMiitJits, — l*r<)drum(s are filight, or altogetlter a 
Tht: disearte Itej^ins ivitb dri.>Wfiiticw, flight fever, and sore 
throat. The eruption apiKurs ou tJa* first or K«vnd tliiy, and 
varies considerably in ilH <;haracter. In some casot the nudi 
is ntni{K>9ed of jNile-rcvl, scanvly elevated papule*, which ai« 
mure or less discrete (rubr/la tm/rlilltifnrmr) ■ in •>lher» the rash 
is bright re<i and difTiisc Hkc that of wurlct fever {ruhfll't uni 
liitimjoriney It bejiiii" oil tJw! fmv and nipiiily i'|)nwiii ovi 
the entire Ididy, but it fadcj* »> rajiidiy tliat the fiMv may ' 
clear liefuro the cvlrcmitiui aiv ull<i^t4-<l. Slight di^junituiti 
frequently fblhivm, thouich it is often ali^-nt. Ajuiil rmm 
sore throat, tlw catarrhal sympUims tuv sMghl. TJie m 
ficial ucrvical and posterior auricular gliuid» are luurc a 
than in m(^a:'les. 

The duration i» from tlirw to five days. 

PliooNosts, — Ci(»od. C-oitiphcslion(t are rare. 

Treatment. — lto«. hi^uiddict Kefrigerants. Spon] 
ing witli Icpid wat«r. 





I>Ki''ixiTiov. — An acute i!oiita;!toii!- dismM', oharaotf rixnl by 
vomiUiig ; Uinibar uniiiii ; an t'nipUtiti whk'h ie ut tii^t [mpiiLar, 
Uien vascular, an<l linulK- mMiiUr; iind bv Ti'Vi-r nhicli is 
marked by a tli(!linc-t iviniNtiuii lN-)>iiiiiin{; nilli the odvotit of 
l)io i'ni]>tion, rikI la»tiii); iinlJl tliv luU4-r U'ooiih'm nuHlutar. 

Etioijouy.— Tlif puison <if ^inullpox \* cxlrcinciy tt-tindovii ; 
it may runntin liilciit iti (-lutlu^ or ottu^r liHiiiliii lor a Ion); tiitiv, 
am] tlK-n Ik* («|ui1iIc hI' t'xi'itiiii; the iHvi-iim-. Tlic vtmlriU 
pniirii>}v i^ (.loiililli-Kt (■uiitjiiiii'<l ill lh<- uiiMtiili-H ntid in nil IIki 
f.vcri'tii.itMt of llio IkkIv, Iml it liif imt Wfji i^jlttUil. UnU-MB 
lirittiftni by vaw'iimtion ••!■ a [iri'viims attack, nearly cvtrv wn« 
i» Mii]«C(rptit>k-, froai lliv u^ft) to the child in ulero. 'I'lu: coliiivd 

PATHrn/x!Y.— Till? eruptiiin coDBiets in an infiUrntion of 
ivlls into Ih*? rde M'u-oMtiia or into the true skin. The <i-ll.i 
uUiiiiiiti'ly nmlerp) li<|iK'fai'ti"n-i>«cro8i!), when siipgmrntiiifi 
noon iollows. (iemiine puckn arc fnc-qiiciillv found in the 
niotlth, <c^)i>iia(pis, and lurynx, iin<l rarely in the stomach, 
trncliea, ana bronelii. Tlie splwn i» en^orfred. The ofgawt^ 
and muftelea reveal fatty and [ian-nchynmto(i« dF^iiK-nition. 

VAUiKi'iui. — l>i»eivlL-; iTuiifluent ; malignant; varioloid. 

Fig. 21. 

Tnnpinliin (^r** In Bwllr«*. 

Srin>TOU.i. Discrete Sioallpex. — The dtM-nw nNially 
iH-jrin^ villi a rliill oTBcriiitof HitHi, fiillnvrm] Itv V'>niiltn^nii(l 
inlciM; IiimlttT |ain3. The lever rifleo rmptdfy, R«rbii>i; JU 




maximum (lOP-lor)") in fi>rty-«);lit Ih.iiw, and mntiiiiw^ 
hiitli tinlil till- tliinl (tr litiiith day, wIhii >l lall-n scvc-ral (It4rivn< 
this nsmiwtiin Iitottt until l)H<acv4>nili orMglitli day, — tliat w, 
l.hc timi; of [lUMiiiIalion, — when it a^in rist*. The spwin<lttrj 
or .Mi|>)>iiral)V(t ti-v*-r slums iiiark«l fliu'ttuitiniH ; its heiglit U 
[>nipt)riionati' l'> itic niimljor of" uiisIiiIph ; an<l it falU l>y lyiiin 
uIhmii tho i^iglUfvnlli day "f iIm- tliseuse. Tlw? piilso in full aitd ^n 
rajwi (120-140) ; the hrKithlng is lHirri(>d; tin- skin L4<)rv;^H^ 
llio ImiwuIh are iit<nallr nnisti|iat«l, though dtarrliu-a is not a'n-^^ 
<H>niRioi) ; and tho nriiio in suanly and fn-ouciilly albuminous. 

The. Eri^lion.^- About the Ihinl or fotirth day small red^J 
upais are notifMxl on the forclicud, fao-, and wr!:<t4 ; tli»w ztv ^| 
rapidly converted into t^iiiDOth njiitid [xipukw which fot-I likp " 
shot under the skin. The pniiitiun rupiilly isprvwU over thr 
entire UkIv. Ahout lliv thinl day tin* j)n|iiih* are P"inverlc<l 
into clear vuudce, which |in:«cn( n (Ut|ini<nt(in ur itnil>iliutli«n 
at their eiimiuiL They arc ulwi liK^nhilod, i. e. divided int 
com|Kirlmciit.'> l»y (ihriium?! (uiriitionji, w) llkat wlicti |>rii-ki.d 
»-iih :i U'H-illo all nf the oi'iitaiiK-d Hnid <Iim^ nut (>«-n|>i-. In 
tn'u or tiirw- day:^ the cimr tlnid l)eo>ni<^ liirbid and the 
vtwtelM arc f^niduidly i\>nvi-rii«il into pnittiilt^ 'I'he tutier 
mum loiic the nnthilicated ai>|H>arance. Betwopit tin' hviono 
the «kin if iiNlenialotiii, mj litat tho biwly b t^wollcn and tin* 
fcutiirv)> an> unreco^nixable. In three daya more the |HiHtiih-< 
dry ii(>, or hn«k ami fiirni soft yellow ernsln whiH) exhale a 
|Hi-iilriir, ollen-!Vi' ■•di»r : they udlimo to the skin for a week or 
nnu-i', Whi-n lln- sitjIw fall o(f, ^nxrv. or ixick-iawks generally 
remain, cuu.-^litutinj^ it |kemmnenl derormity. 

At Uie h«vinuiii)i of tl»e di!«we, hefore the true varioliMtH 
eruption apjti-ars, either a red hlitsli or a nuu-idar ixsh is oftt-u 
ol>!<i;rv'iil on the inner side of tlH- ami'; iuu) lhij;hs, 

Ctoflaeat Smallpmc.— The jiaptiW im- abundant, awl so<in 
cKnloue. Ttx- ('.xtrt-milicK an- :4w<>ilen ni»d giain^l. The 
soi^tndarN' lever is vert' hls;h and irniinliir. Tniu [wicks nearly 
alwiiyn dftvohip in the air-jMLswjics and j^ive rhc to a nip^ons 
fetid dbcliarve from the niwi; and llmxit, to hoartiiKK^ nod to 
■■ou^h. fVJirium, ftn|>or. and Mil>Htil(u» arp fnHgiienl ftymii- 
tiimi If llie ixiticut ritwYcri, it is aliitr a Ivdioiia oon- 



v»1<f«<iii'i-, with firral Riml ili&figuremeot, and oAcu witli 
dvfcctivi- vUioii lull) lirariiii;. 

Blatignant Smallpox.^ in mhiii^ cane^ the diwaoa is ui<lti>fH) 
in wilii liii;li IVvi-r, liiiiilKtr |"aiiiw, and ( pntsiratinn. Kix.n 
(iilivini.s<-« ii|>)M-ai' oil tlu- skin ; blifilind t'rcni ihe niii«iHB 
nu'iiilinini^ litlli.WM ; and diiith n-silllfi Ix'titrP a true vnriojttiis 
nisli «[ij>«ir*. In 'illipr rasrs tlip iliseaiic advaiipcs like or- 
iliiiiiry t<tiiall)H>x ii|i to tiio pufituUir Elnge ; tlicn llic ptistiilra 
iMXHintc i-ft'iiMil Miih bliKxl, and bleeding from iIh- tniKoiis 
inc-mliraDP fiill<nY.< This form is also vtn,- fatal. 

TurlolMd. — 'I'his is nuMlified smaU|tc)x ocfumng in one who 
has bwii jjarliallv |tr« ilei-teii bv jircvioiis vatri nation. The 
syiniitoRis ai¥ milt) ; the eruption n^cuiblce that of cfiromoa 
Bn]ai]|M)x, but is uaually very Bcaiit; Gecondary fuver is 

C'oMi'UtUTltiSfi AXI> SecjUEI.J{. — Broncho-puMimonia ; 
pknris)' i inHamnmliuns of the eye (kenitJtis, iritis, cotijuno- 
tivitis); otitis; arlbriiis; and txnls. 

I)lAOS<"«i-lS. I*H/i(y//(t. — llic t;ym)tton)K are milder; pro- 
dn>uics an? getwrully abfK'tit ; lite pni]itiun apitearv earlier, is 
more snjieHicial, luekA iin inHanmiatory artolii, and is nut 

■S(T"H'/'trj HgphiiU. — ^The hiitJuiy; lh« aliiwm<c of fever; 
liie syniim-lri'-al dt!!lrilniti<m of itie i>riipltnti ; its dark- 
<»iijH'ry (iiliir; its |H>iynM>r|>li>>iis eliiirai-ter (|>iipiile», vtwieii-». 
And |H]!sliil<'K iinuN-iuit^ in A liinitt.'d art^i) ; luid iIk- alwDtc 
of ileliiiig will imliiTUle iiypliilis. 

pR(MJS*<»*is.— This de|H-n<l)i u|Km \\\v viriikufT' of the i*pi* 
deniii% Itu- tlcjrnt^uf pn>l(i'(i<>u bv vitrciniifiiiii, and llic animuil 
of the enipliiiii. In dijienHe ni.«e*, il is iri'neniilv luvurnblf- ; 
in tlif i^)ntbii-iil, ^nive ; tii the ntaliirtianl, aiiniMl l]<i[i>'h^j«i. 

Thkatmkxt, — The yritpityiiflic Imilmntt I'uni'ist.s in v«c» 
d nation. 

TSf Altnft. — iMtlnlion. Kvery prci-aniion mti*d lie taken to 
prevnnt t)M> s|>n?«d of th^ diHcaM-. TIh- fillier mmntx-r* of ihe 
family should In- vaociiiHt<il ut mwe. Tiie nn-m tdumhl Ix- 
iiool and wdl v4>niilAl<-d. Tin- diet mii-*! lie iiqiiiii or «fmi- 
liiinid. and may (rnsi^t of milk, nimt bm^hs, cirgx, i-h: Tin- fret' 
use of v-ater, leniouadtt, or sudu<M atvr idiutild be eoouuregud. 



Th« iiiH-nEH liimliar piirns titioiiM be- relieved bv opium and the 
3|)|ili(«tion of hot-water I«ip«. <tnMr»c imlahihty may call 
fir bt><miitli or i^alomel anil smla. TIm> na&o-pliarynx ahiMild 
l>e keyH cUkm by uiiliKC|>tir wa»b(« and »nrari^ aim) Duliell't^ 
Bobiciou, dilute linderitte, ur ilUiitc pfmxNie of bydrog<>|] may 
bo iiftol r»r tbin fHiqxM-. Tl>i> vy<-9 must lie ktjri dt-an by 
beiii-; wiwImiI •jpvcnd Iiiikw n diiy with a i^tiinit«l sidutiim nf 
l»orie Ill-id. Siimiihiit" ni'tr oniti indi<-ut(^l. High ftver tiiay 
lip tfinlrr>H«i by imlitiyriii or )iboiiai«-t4ii, or by the cold jiack 
<»r >x)ld Imlli. 

Tfir jrrtwiifiim of Pitiinff. — The r<»<>ni Hhonb) li«- <)ari»>nc^. 
Wtd ihv rxjMiMil )KirtA mvercd witli oliithM wmki-d in ilibitti 
carbolic airid or l>H-ltl<iriili- of inoniir)', or with iDa^ki* ii)N>n 
whii'ii hiw IxH-ii sjuxwl jmiiif !iiiii|ib-oiiiln)(-iit. asoiifiiriin-ntirv 
iir "f xiiu'. rHtiirliHiriti'ly, whi-ii iIm^ b«ioii« aiv rU><'^)1y silii- 
atM ibvn.^ tit no ni<raiM of fiivventing ]tttlin)[. The MiBimlicui 
of tlwr miilKt riiav be laoililat^d bv lite iim> of warm tiadi.t. 


( Chloken-pox.) 

I>KFtsiTioN. — An aMiteeoutaciousdisrase of sliort dtiration, 
»!!ian«l«-riwHl by sUnlit fever and a dratrrtc \-epicular eruptHin, 
w)iti-)i (]t!4ii|i|M'an) in two or ttim- <lays by ili^itxation. ^| 

Ktimi^niy. — Tlir diMiM-mvnrs ••|Himih<'nlly and p|H(Iraii-^H 
cjillv. It in ob«iTVwl rJiiHly in t-bihlrcn, Utt ndtiltw arc not '' 
cxi-iiiiil. One nttuvk iwiually jinitii-lK fmni ulhrrn. 1( Imre 
no ri'lalioii to Mnnll)H>x. 

l*KUiiM> oi-' I.vtriroATtON. — One to two wwko. 

SviiprtiMs.- Sltgtit fvv<'r and Ibi- H|ti«-nraiKi' of a v<«i<i)lar 
■■ni|iti<kn within the firot lwcnly-f<nir ho4irs. Tb<- vpMchw n|t- ill >"n>ji« ovi-r two or ibi'fM' davs ; iIm-v an- sn|H'rl5ri«l, mil 
iiiiii'ili<fil<'<l, »<■<) bK'k til*' rol un-ohi which h <tc-ti itnmml Ibr 
visiflo nC variola. '\'\wy lan^ly Ui-onif |t4Lattilar, and are only 
iHtTaBiotmlly followwl by nearn. The duration h about a w<K>k. 

TMaon<]sih. SMittfiivx. — The plight lever; Ibe absenoe of 


hiuibar (wto^; thoi-»rly a|i|>enran«> of the ern{)(ion; aud the 
ntiM-n'r of llx- fthot-likt- fcT-\, nmhihration, and red areula will 
v In dii^iiiguiiili variivUa I'rutn sniallpox. 




pROONOetK, — Always lavnrnhle. 

Tkkatuknt.— Ktf'l in liecl. A li<;ht ilipt. T1iea|>itlicntioii 
of soiuo eetbitivc lution or uintliH-iit to iiUay itoliiit); niiil to \vk- 
vvnl (icnibrbiog. 


(VaccdnaUoi), Cow-pox.) 

Dkfisition. — A gwicral diwa-oc wilh a local ituiniri>titati<>ii 
n-HCnibliii]; lin- |H»«-k nf variola, awl aiijiiiivd by imwiilutioii 
wilh Uic vinw uf w)W-|>«>x. 

HtKTORV ASH OBJixrr. — ^Thc- valup of vawiination an a 
mcaiM of ]init(ic-liiiii itpiiitiit Hmallpiix wum tint ina(l« knnwii 
to tliRvrorlil in a ix*)Rr pnldUlRi) liy Ww-anl Joniior in ITltH. 

Hvcpnt viu^citMli'iii fp\es alniin^l it>iii|il<-(c iniinimily t'l^mi 
variola; tlic tnortiility of >iiiiall[><i\- !K'(|tiin'<l after v:>ii-itMili>>n 
m nlmiitl invcivcly ]im|K>rliMMUc t<> tin; iiiin>l>irr nf tnie rac- 
cim- K3ii>. 

Ktioi/it. v.— Van-in ia i« imliicr') by inuc^iliiliu); tlw arni 
with frwii virnm (il>luim'<l fnmi Uk- iicltWr iil' a (iilf •iifftrin'^ 
rn>ni iim-iBtx (Imvino vtnix), iir fi-oni ibf v™i<l<' o( a |int)ci)( 
wbo bm «!««tly Ui-n %-»>■! -inatiHl (Inimiini/'tl viriif). The 
lyrniM- in i>rorerabW mi anxmnt i.l' ib(' i-di'liw" with whicb tbr 
I'naih artidc cnn lie obdiiiml, ami nil nraTiiinl i<( it* fimlitiit 
tn>m ot)M--r |Mitwinft, liki- >y|)liilit4. 

TiMK OP HKiti''(muANrK. — ^Ttie lir>t va<<af>alH>n itltiinM Iw 
niaib- alHuii llMt llnrtl ninnttt, tli<> M^vtiid ai lb** m-vi-hiIi ya-nr, 
anil Itit- iJiinI iil piiU'rty. It tilulilil alwuy-i be rr-ji'^lHl vrbrii 
!iniiiil)H>x IK pfrvali-nt. 

l*K]«ouMAXcK OF VAnnSATirts. — 'dtpami fbtrtiW Ij*- rpiH 
ilrnTl ai^-ptic,,&ml iIh' Hkin fwraU-httl with a lnn«-t nr wilh !)>» 
iv<»ry piint mntaininif lb*' lyinpb nnlit iwl Aimm licinns !« 
mar, wi»i-n Ibi- [noi-lrn"! viriw nbotihl Ik" can-fiilly worliMl in. 
'I1u- -[Hit miirt In- <-fln-l'ally prutect«I from (bf rbAluai nnlil 
tli>>n>n^bl>' dry. 

SVMPT^ms. — AUxit the M>c«<n() iir lliinl 'lay n/liT tbf f>(KTTi- 
fi(»n a fn|iulit ■itmxmlnl \iv a rwl amila form* at (t>" —'' -f , 
imxiitltfiiin. In tiro nr ifim dayi ibf papiilc U > 
inbi a dov vande, wliidi h ntnliiticabi) at ill aunint)i^ 


Kiirroiimlitti; tMsucx are rcil, tender, niiit nmsidpTBhly infillralt'd. 
ALmhiI tin- wvi'iitli orciftltlh tlay the vwck' Ikxiiiiii-* a luiHtitlv; 
tliii' laMf iititil l)iv Iwclllli ilnv, wlioii it (Irirw iiji utHl I'oniiH n 
seal), wiiicii si'iuinitt-s (liiriii<: tin- thin) week iinii )iiiv<^ l)rliiut( 
a iiillcJ WTir, I>iiriti(i llii- <iinr«c uf ihr itii|>Ihhi (Iwrr anr 
fli<;lit {vwr, iiiMliii<H-, i\wll«««iin«, iunI iMiIari^-nient of tlie 
iixillary ^liimU. 

Com PLICATIONS, — Kr}-si]wlfiK, ulwwe, aiul varinii* <>iitnn«K« 
(>rii|i(i(>iiK. Hv)>liilii« liatt mmKtuimlly iM«n trQi»n)illitl Uintufrli 
liiiiiiaiiia.«l virui^ 


(St. AntluHijr'a Fire.) 

DwixmriN. — An ncnle <^>nli^»tKi disMisc pxoitn) by 
ntnptt^i^Mvi, himI iIi!im<iiTi)!«l l>y a p«ititiar iikflnmnuilion uf 
tlio (ikin HtuI nnlH'iiliinM)ii.4 li.^iue, irrcjfiilar I'uvor, awl a Icii- 
liciny Ui iflujiso. 

I->ii>Uh:y. — Tho diuaw is Bom«wliat rnntaKioUH unci llir 
)M>i9i>n fan be carried in fomilco. CVrtaiu tamilim and <<eflain 
iii'lividiials swni jwrtioidarly inwliuiKiw^i. Tncrfienil wonipn 
i\iM.l vfiHiinVt] iKT&ons an? wry MiMfptiblc-. ninvais wl»M-h 
Itiwor the vitality. C7i)M?nally BnglitV di^-iix-. pn"ili(T[>o»*c Oiw 
atlwk tUten not jiriktcL-t nj^iini^t a nfiimiit'c, bnt mtluT favum 
it. KrvxiiMrliiti tvni^ fi>rtii(>rly divkU-t) into traninnliv iind idi<K 
])atliic varieties ; biit tlic two arc idcntiml, and it is |trolwUli> 
that in tiiosc c3»c» in n-lm-li tliorr is no conH)>inn(Min wiiund 
there is a t-Vif!:iit ubnwMin through wliii*!! tluj [loiitun gains ad- 

The fXfilinii ntiur !« c!iiul>tli-s.-> llii* wf rc^itiHiw^-ils |)vnpcneH, 
i'ATHi.fl.fxiy.— Krixipi'l:!;* mi«t frtiiiw-tilly nuinili'ntit itM-lf 
nn tho f«<T. Tin- Jiarl is liriuhl nnl in rtilor, '.twilUti, in- 
ilnraUil, and ^ilmriilycircnnM-rilxil, 'I1uf \-arittiiRKlrala uftho 
Mkirumr intillnili-d with Hr^nini, ar»d laiuxiytoK and Mn-iiliXYm-i 
iin- found in llic lynig>lfs)iaits. In Revere CEf«H llii- inllani- 
niiitory itriKhiiLs nn- <<(>iivi-r<c<l into pus, and ali-viHiti's limn. 
I'nttiin OF In(;ciut!OS.— Tlirw; lo bcvmi days, 
HvMiTfms. — I*ii>dit>ni«4 an? tuimetinift* jiniiPiit, and ftnisket 
(if sliglit fever, chilliness, nialaJM?, tingling of tlie jMit to bo 



afn^ctixl, ami Hnnie4in)m <^»Iiir)^iiicnt iif n(>ishlHirinj; Iviii|ili}tliii 
glands. In many ttiMn ti>o diMWN; in nslK'ntl iii Kiidiliotly 
with a t'liill, t<i)li.>w<>d l>v' \Kuti in the Imw*) nnti liniliHaiMl it 
liijib, irrqjiilar fever. Tlio U-niiwrainre iimy n^ai-h 10.1*' m- 
ItH"* in twelvfl nr tiventy-fimr fioiii^ Tli« pulfw; in Inll iiiiil 
ra|»iil ; the ton^no is htavily iiiaiwl ; the ajiiwtite is hwl ; llio 
ImiwcU :tro uin!<ti|(at«l ; aixl the urine in sauty utiil nliiii 
ith^lilly nlbuminous. 

tAtmt ItiemtmtTui. — 'V\w inllamnmlioo iiDiially lictrins in Ihc 
ni>i];hlMirh<KMl of tltc now, umt ti|irrs(U np\v:n-(l niid hilemlly ovor 
the btwl tu iho nvck, uhciv it I'i-ojihiiiIv KtofM, Tlio ufl'i'i-lttl 
]iurt )in»ui-nriiT^>n lute; it h nwuWvn un<l Uim; iiml rnt|iicnlly 
ends ill n filiarply-^ldtiKil ritifjc, U-yiiml whirJi, Iiuwcvi-r, jini- 
jpi'ttwiiB fiiii be Hi lulviint-in^ into \\ty NiiUiiiiinoitH lixAio'. 
Tht' 6ur^HV of the iiillotiKil ]uilcli im nl first f<niiii)tii nini ^Iiiml, 
hut hilpT it isw)\' witli ininiili' vi^ii-h'Sor IiIcIm. 'IIm; |iiitii'nl 
(■■>niphiiD8 <)f hurtling rikI lin^litifr ; ih^r MirriKiiKlin;^ |i»rtn inv 
cxtn-nKrly c[^U-iiiut<>itH, mi ihnt the fisltiivji riuiy Int M^irit-lv 
».■<:• iljn i XII ) ill*. In four nr livu linvH thi- n-(hH-nti Im^iiis to riHHi 
nml lhc:<wi-lhnt;ti>HiiIiMih- ; (I<si|uaHiulion futlowH; ihoiri-itinil 
Myraplonits iiiijiriiv*-; itn<l the fovcr I'alU hy i-rii^iA. 'I'lie uvemfcc 
iliimtioii \» fruiu II week tif Ua duyti. il«:lii|nte urv vxtreinulf 

fCrifttipe/iu AuifntlaM. — SHmrtiiiKw Oic iiiftnninuitioii (liui|»- 
|m;9R4 ill one plac)! and rciijiiN-tirs in nnnther. mid h> tvinliniin' 
iiiih-tinilflv. In ><iivh (ii?i<->i iy|ihiiii) KyiiipiKinH, Mch an niiit- 
ti-ring dcrliniini. a bronn, fii^irv^l tntigur, and t>nli^nli>iH l<-tt- 
dinun], dcvchj|>. 

OiuVLiVATutSH. — 1 nflaniiimtioi) nf tmotw in<>mlimnnt 
(iterkanliti*, pliiiriliH, itU'tiingitiM), (Mh^ma of the hirynx, tw- 
phritis, hy|HTpy[t'\in, iilivnilis'e t-juhfitinlitift, am! iu-pli<u<niia. 

DlAOMwin. f'^fftfii-mn. — Tlie iif»>icnw ■>!' liii;li fi-vt-r, id' 
marked siti-iliti;.'. :>iid of an abru|)t ridgu will Mfvi- lu du- 
tit4;aiab mill' »in fmni i.TyMiiclas. 

AeuU- /irRwt. — Tbcawdlioff i» U-m niarhnl ; i1k< itditnif m 
intctun : th<^ Hvrvt'in); aiwl fHliMM iirv n>fl rintiiii«-ri[>ul, IhiI 
ftha<]i' emhtally I'nln ^Ilhr liawie; and tlwn* it mi (evft. 

pB«K(S'^».it«. — In ihe roliti^ tlw pn' In 

tJie old, in alin'hiilic mi\:^wIi>, and a- 'ruai 

ACUTR INPramOtlB MflRAara. 

<-lii>tiiN- iicgiJiriti.s Iho |iriii|n><>^i'^ bo gtianlecl. Ainbiilatnry 
or}i<<|K-liL-> may kill l)v oxbatLsiion. 

TitKATM >:m'. — IfltiLttioii; aluMiIule rmb; a outritinns iIh-L 
\^ i.4 wfli Id \k%ih the ti-eai iiicnt with a saliiic ur momirixl 
laxative. Tbo tincliiif of iUc. ciiluride uf iron swms to pjt«rl 
II iic!M'(ii-iiil inlliiciKfr ; it may be given in tl()p«s of twenty 
ib-o)M i^vi-rv two lioiii's. Ifinniiie (gr. v tbmc daily) ia a\f<n 
[isrliil. Wtion ibere in much rest U'^iiese and iitaumnia, bm- 
luide nf |M)ta^tiini, c-hloraJ, or i))>iiim way be ailministcpwl. 

Locai Ti'nitmeiil. — Ono of tJie fcliowing a)>pbcatinnB may l» 
eii)]ili)V(yI : ('lotbs srnmg otit in a HiI)ilH)n o( biebloride oi 
iiKTL-ury il^-'><H)(|j.or in a MiliinitcKl «t>bittun of bom- acid, or in 
tcad-wu[4ft' aitil laudanum ; a diiftin^ {kowdvr uf atun-li and 
uxidc uf ziiiu ; or an oialiiicDt uf icliibyul. 

9 P?unibi acutatis, 5j ; 
Timri, opii, r;u; 
Aqiuf, I). K. Oj.~M. 
Stg,~SI)nku well ntid itl>i>ly uu Hut, 

H rdiUiyol, 5m; 
Vasi'liii.. .^ij. — M. 
Sig.— Spivnd llilckly ou lint nuil iipfily to tlic nnvct«(I pnrL 

Th« injortiot) of aiitJm^>tirn'm<<di<^nniiind ltM-ini)iuiiniiil<irv 
patcli, nitli tb(- view of ]ircvi-ii(iiig iln r<|iiv^, in vt-ry jniinfiit 
ujhI nmrly ut\*sflary. 



Dkkinitiox. — An awite inre<!ti<iie) discaw, <^)»ara<-t<»rrx«) by 
iniiiidiit', i-jii;ia*lrii; ieiidcrw», viimitinc, ht?tnoiThag«!ti, and u 
fi-lirib' (tKH'K' <-oiiMi4in|; of two |UM\isyKinH. 

lvn<>i.iiiiY.— A hot fliiimtL' and a wann tucaHon, Aalt watirr,. 
Inad <lniiiiaj{<.-, and uveiVTow<bng fiivur tliu devvli>|>nicnt nf: 
t'|>)dciuivB. Thti disease la not distinctly ronta);iu»s; ibo 
]iom)n ))roU(bly iindcr^;oL>s sntuv chan)^ outside of lli« body, 
tiiid is vurricd Ibroti^ii tlie almoi^pbcre, clollittt, or othor 
fiitnitiv. Tbf! w>loritI raw art- li^n fitiHX'|>4i)>1c tban 
wbitv- >Stiaii)^ra in uu infiM-lMJ dixtrit-t arc nion- liable I 




atl»i;kp(l tlmn mtidcutit. One ntbwJi usiiully (vhRsh iniiuuiiitv 

I'.iTHOUMiV. — The tiswKTt MIX- Ktiiim-d wrllow liy ilislii- 
liyriikii IiIwkI (I iici mill Influx 1" janiunn-). Tliv liviT U ]uil« 
and i.i i\w niit uf cxii^ikxivu tultv ilt^'iM'nilioii. Tlic ^u»tric 
iiiiiODiiit ntciiit)ram> U sMoUi^i, diugiirilMl, mill (Kvim-mlv et^-Jiy- 
iiuM4.ll. Thw mtUttn is luAoiibii^ctl. Tlic bwirl \» (mlc iiiul 
flablrt", I'lic.kiiliicyii are geitcrally the *al vf |uirvi»ct)j*iiuilu(ii< 

I'KHKiII Of I SCI -RATION. — A fi'W IliiUrs li> !» «wk. 
SvillTOMS. /■|>«( .Stillff. 'IIh' di.-MIW lH'gi|lr> uitti II 4-)iiU, 

fiillowed by )«tii iii Uie tiuitd, liack, ihkI liiiiijt*. The t(-tti[N'ni- 
lum rittts nt|>iillr until it rt^K» ks inaxinuiiu (^IIW— Ul^f"^. 
The face is t)iifi)>Ml, the n>i>jiin<:liv»- are injitltil, aiN) cIk- 
)>iipih small ; the toaa,U& U ocaled, lite ejiiganlriiiu) is leiiiW, 
iho sliHnacb is irritable aitd unrelcinive ; iIm- bowil.i art- ciixi- 
litipaied ; and the urine is soanly arwi ulbiiniinoiis. Thiw nlajte 
lasts from a few \vian to sc^veral tlayis mid is i<tllowi>d by a 
marked liill in tbe temiienit^irc and an iDiproveiiient in the 
gnictal symploms (stiif^e of rrniission). At this lime ntii- 
vn]i:Mn-n<v ntiiy iK-};iii, ur iIh- (mlietit may pasK into the hciihkI 
febrile i«in>Aysiii. 

^■niu/ .S/ni/r. — Tl(« frviT riiHH la its original heiKhl ; Ow 
skin IxiTHUW \rl\ow ; vcmiiltii^ i:" ji.-n«iii(rnl, simI iJie i^i^^lnl 
tuat4-risl may MjMliiiii dsirk blmKJ (■' blm-Jc voniir'). Himor- 
rlu^« mHiUTiimnt bccur fruni utber inumtui meDibraiHit. Tim 
\M\m: in rapid, though not pmiHirtiiniale In the lever. Tli« 
uftm- buviiues very HitDiy and cfniiaiiix albumiii aiid ivrtn. 
iJeath rni}ueiiilv resulu Iroui exli»iiMi>>fi or iineoiia, tixiuph 
ret^ivery may fiiilow Ibc jtnive«t miiijiUhils, 

pL'ttATiitN. — Fnrcn a tt-w boon' t" a vnxk. 

thxtiS**it#. Ilfiapjtiug Frv^. — TltU i» ■Itf4int(iti>h>*] liy 
tbe entaiyenwnt '•( ttic et4n-n, itw miilli)*]*- |uinixrHUS, me 
fipfrilti in the bliHid, and »nt alwniTf u( XAmiM Vfmit. 

.IcH/y YfBtM AlrVfJiy of Ihr /,!>*■<•,- Tin- i«ri* np|Miir»n<« 
of jaDndicr, tlte diniitiutiiiu in iht: Axk of itii- \ 'ti 

fe%Tr, ibc loarkH] t«r^)rul .-ymptiiiis, ai»l li; <,( 

Imnn ami t^rodia ia tbe nrim wtl). inlicale actu« jelluw 



nu'iit iif till! Hj)!!*!!, iIh- iniiltipU- nfiiiviiiwi", tlic jtniw-iK'c i(i tin* 
Moutl i>f lia'titiili Willi of l^vcjan, uml by llic ulirwiiw of blnck 

PlMKisiisrs. — AlwnvH gmvc. Tlie iivcnigt* nturtulily in 
ililli-n'jit fjiKli-iiiks in rn>iii twenty tn M'vcnty per ivnU In 
i III 11 V it) mil iivM-s, liijdi t't-wr, si-wi-e »-iylinii «vrii|ttiiiii«, blnck 
%'4iit)it, uiid .■iii]»])r(---mi<>ii iif iirim: oro iiiifuvurnlili' fcaliiii-i^ 

Tbkatmkst.— AIindIiiK- nst. A nml, «i'll-vt>ii(ilaiid nioiii. 
A liijiiiil «lio(. Tlio jiaiiii' in llio Imrk niid ItnitH may Ik- i-r> 
Im>v«I l>y liiil-waUT Iku^ nm) llie iKlmiiiinti-altiiii of tiioqiliia. 
Piri' tlio i^iHo irriuiliility a nxLHliin) jila.iler niity tx; ufigilk-'l 
t<i till" ojnya-itriiini, atid craoUwI Ut; itttl (-linni|ui^n4<, <-arlHiIic 
iwi(), or small ili^ts of nilmiK'I may 1* giv«i iuurmalty. Stiai- 
iilaiiu aiv fri:i|iK'tilly imiicaltii. <{i<inim' may 1» yiwii liv 
llie r>\>tiim, nis:li IWtT is l»««t wnirollwi by Ui€ vxlt-ntul 
ajililicatFun of wM, Tlic lilaek vomit rraiilta from blooal* 
ilyM-nMiii, uiit) while atcb ivniwIicB an (rallic acid, Moms^I's 
ttolnlion, vt^4, mihI (iirpcutiitu uiv ROomtDeDclccI, liny usually 
)>ix>vu iiMrk-Kf. 


(Aciite MltUiy Tnberculoals.) 

Dkfinitiok. — An acute infonlioiiH fliswiae exoiltxl by the 
tiiln-ii'Ie httcillutt, iind t-hanirtt'riwd aimlomH-ally by thti 
Hiriiiiltaneuiis formutioii of miliary mbcrflM in many parts uf 
(III- Uwly. 

Knoi/KiV. — Thp ilJKnsK- nfiinlly develops in early ailtilt 
life. Certain infM-tioiii^ dim^MV like iiH-a^lf«, vrhot^ting-aiu^i, 
iiiiil typhoid fever srcm to pn-ili^ixjsp. Gmeral tiiWmiloM-ii 
is ahmM alwayw K««iMlurv to Im^l liibcrculueie — pulnHinary 
pliihiAiH or a serofiilous lyniplmtic inland. The uaeiiti aiv 
|iO)l«bly diwtpiiiinatwl hy the vvini. 

l'.\TH'H.'HiY.--All the on^iiii? may lie tiuif'trmly inlittnited 
uirli discrete tiilx-Hw, but more eommmify iTrtniri orjcaiis,j| 
like lh« Itniin and Iiiti^.arc i»iir\-un>-< than irfht-re. ^H 

Syhitomj*. — IMiilily; loss of fltrli awl tilreni>lh; fp\Tr^^ 
inodoratcly high (102*-1 0*1''), irTrKiilar, awl markii) hy evening 

ALTTK liKNKKAI. Tflirilrri-OSIS. 


(>xn(Trhal>nn!i and morRUig r('mit«unn.i ; cougli ; tmrricil rn*pi- 
ratinns ; a bmwD, liaHiii-e<i longiie ; a weak, ntjiitl piilM^; t-ii- 
largomont of tJ>e s|tle«o ; dcJiriiim; sulsultiis iciiditmiu ; tinA 

Tubercle bncilli an- nin?ly fotuid in llic i>xi>ect<traliun or in 
the blootl. 

The cliirution is fruin two to four n'eeka. 

ii'ficn the lu»ff» riif chrfty a^f^-tetl tlierp aro : P_VBpn'«», 
inurke«l itui;!li, mti<.'0-|i(inilctil ami bloody e\pccUiniti(>ii, 
rvatmsiit, Mibtliitil :ukI Kubrix-jiilnnt rules, and jK-niape aitai 
over which brondi'ml i)ntitiiiii^ i^ dt'tt^^iU'd. 

When tAe tufniuyfA «ir chirfitf <(^Jr(nJ there Bn>: Intensn 
htwliivhe, conviilsivi^ Mvinin'^, pltutopliobtu, dcltritim, facial 
]iKki(«, stupor, mum, and Ciwyniv.Sloki'H bnuthiuK. Tubpfdes 
may U; di-ttt-tcil mi lliv n-tina. 

H'/i'*rj thr tHli-jdiiii-M (fill/ fifritimfam nrf. afftttnl thfrc are; 
Pniii, iciulvriN'^, iilnluniiiuil dL-^t^'iition, nitd diarrhoit. 

DiAGNOfits. — '\'\w iWmth^- doAcly rr>*i.'inbl<» ty/iiiwl /nvr, 
aud then! m »n doubt tliat the mortnlity of tli« hiltttr ison- 
hanci'd l>v inoliidt^ rim-h of luv^uAiH-rltfl ^-m^ml tulx'n-iiIoMs, 

The following' table will indli^itclbr jxiiiiUi of di'^tiK-t ion:' 

Typuou) Fbvbu. 

EitlslaxlR crnnnion. 
Tfic tciii|>iratun! rl»ca gradually, 
iinii tuns a rr-xuUr counv. 

Diitrrbiitt ia Tivqui-nl. 
Au eru|>lio(i 1b j^-ni-ntllv |>r«aeiiU 
N'o tubercles mi l)iv rvliiiK. 
Kopirntionsare litirrltd. 
t'liuini iKiUic* arc rare 



The t«iii|jurMtun! itMiiUly xwa 

abntplly, ami nina a very ir- 

tt^ilnr couree. 
RatcJv t>r<-M'nt 
Ooael-'iinUf ili-loctol. 
Slill nioN liurrieJ. 

pRorjKOsis. — Always fatal. 

Trkatmf.nt. — i'ulliulive. The diet shntild fwnsist of mi)li, 
•lis*. «»d bnitlifi, Stimiilantfi are indiialed. Iliub Ji-viT 
Tiiioiild lx;oi>nl rolled by anti|iT(in or by the ej[t«-itara]i|)lini- 
tion of cotd. 


274 ACUTE iSFKcnoDS ntet:A6Bj. 

■ 274 

^^ DlI'lITltERIA. 

^^Hn^theTltk. Mallciuuit Son Tluroat, Cyaancbe Cont«BkMM.) 

I>EriNiTii»;>. — Ad amtc vun1i4^oi:^ (liwaMt fx<.-ilH] bv Ibe 

Klebe-l-^fl<T bucilliitf, iiikI cJmnuKTiwiil hy ntinUTate (.-v^t, 
^laodiilsr fnUr^mciit)', i^rtat iin>Hti-uliuii, hih) a Obtiumis i-xu* 
(latioa wliidi U ii'iiiilly lixiiUi) in tin; rlmKiU 

KTioij(MiY. — <_1)iMli"f«l (tH'(wtx-ii tliixT hikI Hix)i,dcfecti\-« 
(Imina}:^, uikI uilurr)i:il r>>n(liti<>n!< of tliv Uirinil arc iir(Hli<i|x>» 
ing factonii. Tlit- {ii)iru.>ii ii« txiiiluiiHii in Uic tN:vrvtk)tis of Uh- 
tlii'ofit, uu<] niuy br IrnuKinilU-<1 lliiMiigh the utfn««plicfl: or 
llirou{;li foniit<«. <>iH- ntlauk docs out [»ruli-ct fr»in anot)i«r, 
but i^llicr prfdisiMimit, 

TIiL- cxcitinfT tt»K^- is llic K Ichs-I^flt-r liiti-illii^, wliich in 
foitnc] imlv in (liv im-iiibranuiis cxnilaliDii. 'Htv <-unbtitutiouul 
syiuptcMiiK nwiill frtHii the jwisoii froneraUil by l)if badUti-i. 

Patooi/xsv. — The false nicmltnine U n.'^nnUv fimnd on rlie 
tonsils, ((illans and iitiarvnx, 1ml it may t'xU'nd lo (he muuih,, di* tiuw. The [>acilUm ivming in ronlad willi t\tt 
throiil It^fls to the ilt-ath of the siiiK-Ttieial (t^lU, whioli nlti- 
nmtrly nmlfrjrfi (Tougnlation-iH-c-rixiis. The irrilalion rait-a>i 
n migralion of kHXHin-tn^ a»d tlii^e undei)^> a Nmilur nerntKiM. 
Th(- mombniiw thus fomH?d is of a jErByit^i-wliile rolor, aii^ is 
more or l<as adherent, so (hat whiii torn off it lonvtti a jaw 
wirfaee. Sometimes the nctrrosis ex(end»to llic dw|K-r (issaca 
and i"aiises widesprcnrl uhvmtion and even fjangrenf. Mit-ro- 
Kopit-ally, the pepiidit-nicnibi-apf ih fon)pi>s*d »( fibrin, h-tim- 
cvtes, biu'teria, and the- reuaitis of f]>ilheli8l cells. Tin- lyni- 
[iluitic glands are oonimlerably if\rotlei). Tlie Kjilit-n is 
entpirgcd. Tlw various orgam and the lutiscks revtnl faltr 
and iiareiK-liymatonw dvi^nrm(i<itt. Kxnnitnatiini of the hin^ 
fnxjiicntly shows i7t]>illury hrDtictiitiH, cHtarHial )iiii-iiinMma, 
aiul ixilhiise. 

In some t-osrs the blood ndark and fluid, while in olliiis 
fini) ch>t« aro olVrn fixmd within the hvEirt. 

Ti'I'RFi. — ]>i[ititheria may bo diviilu) avHinlini; to (bo lom- 
twn of |]h> vxn<liilo int'i: (!) Faiiml ; (2) Inryntrnil ; (3) 
nB!*ii! ; (-1) (•utiim-'nis. Aiimitlinir to the wn'enly of ihc iiKncIc 
it may U:diviil(Yl inio: (I) Mihl; {2) gmv«; (3) maligmtnt. 



PkBIOD op IsCfHATION. — Two to tPll daT«. 

SvMFn)Ms. F<nfint Diplil/urui. — The distase rommoDly 
\w^UR n-itli cbilU, tnodcrate Jvver, malaise, and sort- thiKiaL 
The fever, as n nile, U not very high (102°-104'') and ite 
cofirse a (jiiile irre|;iitiir. Tl>e piiliHJ hodii becnmes rapid and 
feeble; the l'')wels are ojri^tipatcl ; the urine i-i B<?inly Uiid 
frequpDtly HllxiniinoiiT:; and Ihe |<rminitiun and {iiillurai'eol^cn 
uiil iif !ill [mi[Vhrlii.tii t'j the M.'verity of the lehrile sym|>tonii^. 

tjiMiil Ph'iumu-iui. — The ('hild complains ufdil1i<.-iitt i^wallow- 
iiid ; tht; niiistrlc^ iif the nwk tc«l stiff; there h lendernw* 
iiiidtT the juw ; the lympiiHtiv ^lundsarecomttderahly auolh-n; 
aiid (he faitnvt arv oovvretl nith u gniyi^h-whitc niciiihrnne 
whli:ti \\'\w\i -■^rippni off Itovcj" a mw bh.-i'dinn wirliice, and i» 
WKin follow'il hy II iiimilar di'[><>nit. The mviilbniiiv limy 
sjiri'ad t'l th(! n<K<^ or larynx. 

Th<- <H>ni-Ai.> of the dL<«ea.-«- in in<lelint(e, tbe average diiratinn 
beiii^ fn>m nne to two wwkft, 

jMi'fiiifftiil l>ifililheriri. — This is usiially ae«m*l«ry hv cxten- 
won from the faiitx^, but it is occaeiunally primaiy. It is reo- 
oj;''i'''«l by h'tar-enens or aphonia, eroHpv roii|;b, pnigres^ive 
ilviijin'ija, aiul striiluhins brcalbiii);. The a)ie of tbe tiore pl»v ; 
the Hlcrno-eleido-iiui;^loid'$ Hr<> prominent; the Hiipra-tlerniil 
notch is dee)>eiie<] : and the \sise of tlie ehest !» relraet^-d. 
■ShnxU of faW membrane are tuxnetimeH cx|M.i4«rated in the 
violent fits of couching, Tbe lebrik- symptoms arc nsitally 
slij^iU IX^ith fixxjiietitly result* frcjm i^nlfiKWlton, and rv-covery 
wiUioiit u|>i.-raiion is tiiuiMml. 

.\iuutt /)iiVi//"'i-Mi.— Thin is nairly alwuvo 9Kcon<biry. It 
ii< re<ii>£niw«l bv f;mve ii'ii'«litiili'inol Mymptf^nii.-*-^bif;h fever, 
ntarktil ghtndiiUr invuK-eiiiriil, and gniit | mist ration ; by an 
otienitivo diwbami- from lh« »<l<«i?; by e^wHtaxis; ami by ex- 
i><>riAt4<in of tbe li]». TIic falst! membrane may Iw il(4cilvd 
un ins|(wiJon. 

fVni»«MM DijM/iiriii. - Tbi« fonn may lie primary* or 
»v»ndar}'. Tiu- eunsltiiitioital HympEi'm-s are similar lo ihtiw 
of fancial dipbtht-na. 

<'««pi,irATi<).vH A.Ni) SKycBt.*;. — Capillary brtim-hiltM, 
ralarrhal jineumonia, p^ilmcMtaiy collapse, ciKloairditi», Itcsft- 
elot, nepbritiB, and |Miraly»iA.. 



Dijihliwriiif PrnmlyaU.—'Wivn j^crally occurs daring cww 
vftlwd'WK'e aiul i# o))w.-n'<tl iiiuliout rifli>«ii [ktoeqi. uf alfcaAr^ 
TIhtc U no rotation lidwii^n (in; «-vfritv of the alia^k of 
(lj])litliorin iind \lw linbility to iKiral}')fi»; mitd <»»», which an' 
tlimiglil u> lie Mmplo jilinrv limits, iirc soim-tinHv followed by 
troiibleuiiiK! jmralysia. 'I'iii- plmnnx ii^ Ihc inoet common 
Aral, and tlx^ )iaUv ix n^tf^iiir^il iiy dtflicidl swnlluwini; aiid 
the I't^ui'jritation uf liijiiid.s Ihiim^li \\u: ikiw.-. Next in iVe- 
i^ueiw^' the o_v«t are invblvnl, nixl )>tmhitiiiiiut or ntoeifi dc- 
velojkA. Thi- heart may l»i> iiirw-If-d, mm) il' ^udd<-ii <iiiith dots 
not rcflidt, the t^indition may be iiiaiiUt^U-d iiy n rciiiarknble 
dlosvin^ of the jxilse. I'ho c.xtreiiiitM-^ are mrply pundyzed. 
The paralysis is due to a (oxk- iioiiriti)i. 

DiAit.Nosis, >SfYii7ri /■rtsT. — The fin«rt is nii>iy sikIiIcii ; 
the fever la hiph ; the pul=e ntore rapid ; ihe longnc |itTw«>nts a 
slrawlwrr}' apix-aranoe ; a i-etl puiK-tifonn ranh ajiiiean* on tfae 
lii-&t or second diiy ; and membrane is not often louiid in tli« 

Membranous Croup. — I^firyngeat diphtheria is pcnr-ralty 
secondary to faucial dipiithcria ; it is onntagioua ; it if nRun 
epidvfnic: it in associaktl with gn.-flter oonclitntioiia) db- 
t.nrhaiK^ ; and it is more u[>t to be followed by se<)uel)e. 

PBOGS41S 18.— Always giianlwl. The moriality varies in 
dift'cn-iit epidvmici? from 10 to 50 per c«nt. When the eon- 
HtiliitSuiia! isyinploiiis nri' mild, and the membrane is confioHl 
to the (JiiHirt and whowi* little u-ndrnry to ifpreiid, tlw proj^noMt^ 
ix (piitc iiiV'iralilc. XtL-uil diphilKria i» altVRy> a grave disease. 
I jirynj^nl di|>htlima provw iittal in 60 or 70 |rt tvnt. of all 

Treatmknt. — l^>latio<i. Ali»i)lute m>t, A iinlritious diet 
c«in»irtiiit! of mill;, koumiss, eggs, brotliH, and Mm- like. Stimn- 
hinlrt ari- ihtjiiIv always ni)iiirtti, and slioidd Ik- lutmiiiistera) 
;ii( iMN>n tuf I)k' pnl.'^- Millen.-i. Tonii'? like iron, i](iitiine, nnd 
tiiiiH-nil ai'idH un- tL-«-fiit when ^lell lK>nie. Of Ihe Kjipcinl 
reint>()it^, nienniry is the moM reliablf, and cither <nlomvI or 
the bi<^hl(>rid(- may l>e t'mployrO. 

9 Hyitnirjf. chlor. mil., gr.j ; 

PoU-. smmat., gr. vj.— M. (STARS.) 
El ft, in ctiart, Nn. xii. 
Sig.— One jKurdur every two hoois. 




9 Uydrar^. cblor. caitim., gr. J ; 
Spt. vim nxl., fS'i i 
Ktix. blniniitli. vl iwguiii., ail fliv. — M. 

<J, Lkwih SjnTH.} 
Si}[.~Ti»spooufii] every Iwo boora for a cblUl of six yean. 

[i»n nuty be givMi with the bkblurid^', as in ll>e following 

mixture : — 

^ IlTilnug. chlor. corros., gr. J ; 
Tfnci, ferri cUlor., 
SpL Tint reel., af^lj; 
Sjr. liniMifiiH. 
Aquir. ill fjij. — M. 
^.— TcwiMonful every lwt> vr tbrue boura Tor a child ot nix 

Tbo ntinotqiticre of tltc room .tbould l)e rciidenHl moist hv 
Hlitcitiii;: liiiio, by <'va{)(>nilir)i; water on the stove nr over a 
M(ilrii-!iiti)|), or by im-aiiH nf a Mt^m atomiTcr. The a<l(liiion 
(iC tiir|ii-iitine or of riil of eiH-alyptiia to tbe watf^r U fdlen rec- 
onitiK-tiilrd. Incline, or oil ointineiil of mercury, bt-lbulonna, 
or iciitliyol, may tte applied t» tt>e swollen simI temler glands. 
Tbe na.«iv|>tuirvnx stiould be keyA, clean by anli^-ptic apraya 
<ir dooi'tieei, and mie of ttie fotlowitif; may tie aclix-ted for this 
(Hirpirw : IV>lteir^ Mibitioti, dilute Ii)4erinc, or dilote |>croxidc 
i>f bydmjien. 

Alany solvents tisvo been recoiiiii>etHli'd : lliuae mtst (wni- 
nionly employed arc dilute Uc-tic uetd, dilute bydroclilorie 
aeid wilb pcjMiin, a solution of pa{iavoti», an alkaline ^iiilutiun 
of tr)'p>iin, and peroxide of bydrop-n. Tbt- lact is often ex- 
tremely useful, bot it is tiwcutial (bat it ftioiilil W frtfit, 

^ ilvilrot^cn perttxu\v iMarcluiiiU), f JJ ; 
Glyei-rin, fsij ; 
Aquie (Inlil, fSM,— M. 
8ig.— Use aa a spny oc mop. 

AVIien ttie ibnwt in not too flcnshive, tbe peroxide ofhy- 
drogiii may bft I'rajJoyed undiluted. 

In larynirtsi dipblbfTJa, when ibcsc means fail, Iracheufomy 
or intubation muM be n9<urlMi to. 







DKF'rMTioN, — All iiit<«4icHis tliiuaiie, rhai-iu^rixM] 
cainrrh of the n«|>imtoiT tnwl and [K^-nliai' |iftn>xvHius of 
mii^i I'lulini; in prolonged crnwiiijf or wh<Ki|iin^' inspiration. 
I'.TioUMjv.^Tlie disease oix'urs botli sjMiradifally kihI t-pt* 
demiially. It h< most lm|iieiilly ni«i with in <-liildrr-n, l>iit 
u»pn)trt--t«l adnltK are not exempt. The diseaM? is uni(iu-Mii>n-- 
ablv n^nUi^ioiis, and the virun 9een» to he. a^six.-iatcd with lliv 
8p«itiin). Otie nttaek pi-otects from olhen. 

PathoIjIigy. — No characteristic lesions are obs*rv«I uftet 
death. The poison eseitt-s an inflamntation of the i-espimttirj" 
niiicoiifl menibmne, and probably irritates the {XTi]ihi-itil flla- 
B]ent» of tde piKnniDgastric nerve, and so i-aiij^'s tin- (uinix- 
ystnal coU);h. In filial case^, |>ii)oHinary conipli<-nti<iii.-< un' 
usually diM^tvered, biich as cularrhal pneiininuia, iiuloMjiuiry 
ei>llH|MM>, and emphyeenta. 

SvMiTtiMa — ^Tlwrp are thrw stages : (1) The catarrhal 
frtnjre ; (*i) the paroxyi:mal stage ; and (U) (he stage of deilint'. 

(iilfirr-iiiil .STw/r, — Tlie di«'a»? begins with tlie Bvniptonis of ^| 
ft>n)!a, ami bnin<:hial t^tarrb — sli;;Jii fe\'cr, snerziiig, nuiniiigS 
fixxn the nose, dry o»ii);b, and rule». But it d<K-8 nut respond 
to th^ ordinary remedies for raturrh, and after lasling one or h 
two weeks ]>u»«h into tlie {xiroxtinial stage. H 

Parurii»miil Sl(tgf. — The cough beronwii more violent and 
)Hli\txyMiuil. r>urii)g the paroxysm tlie faoi- Ik i-yunueed, tl>e 
evi» are injcetti), and the veins distended. TIn' eoitgh frp- 
c|Ucutly induees vomiting, and, in severe (^ises, epSstaxis ur 
«*Imt iiemorrh^ieB, The cloee of the psroxTsni »» marked by 
n kinf;-dmwn, 3iril), wbooping iitspiration dne to tl»e ejpa»- 
niodio rhiHiin' of i)m> glottis. 

Tl»i> nnniber of paroxysma, or " kinks," varies fmm ten «?r 
tnvlvo to ti)rty or ndv in the t^venty-fonr hoiire. From tlw 
Ibrt'ibl*' priiptiUioii ol the tongue against the lower iiK^sor*, 
tin nlivr is fnxinently funned on titc fhcnum. The durolinn 
ofthi^ stage is Itiree or four weeks. 

iSagt of Iketine. — The ]iaroxysms grow lt«s frequent sod 





leas violent and finally came. Protracted cases are ri>llowod 
Ity anatiiia ami prtwtratiun, 

DnHATUJX. — TliG eiitiiw duration of the disease is from a 
fcvr vr<.-pks to four mouths. 

CoMi'i-icATioxH ASi) SwirEUK, — Caiarrlial iinciimonia, 
pulmonary a»llan»e, i>ni[i{iyst>nia, htmorrbage iiilo tlif conjunc- 
tiva, car, or brain, and cvnvuUiuns. Grave i-asea are eome- 
liuius lullowvd by dironic Uruwjiitis, tubcrcuUMia, or carnrum 

DiAGXixis, — Tbiscan mrt-Iy bt- iiiiulcwith ix-rtaioty diiringi 
till! '.'atnrrliai stu}^. IjuIw, IIk- jwmxysnwl "Higli uiiding in 
viiniiting or in wb(Hi|>in)r i'^«l'»«iluU'Iy diuf;ii"stit.-, 

I'rogwjsis, — Guank-iily InvonibU.-. ficvi-re ca»c« in the 
yoDO); ]mddvl>ilitak-'l not infrcipK'nliy pmvc fiital. 

Trbatmkst.^TIio rliilil nliould U: Had in flamwl nmlor- 
clotliis sik) iTin-fullv jtrolii-Utl fWiin clmnf;i>s of li'iiiiH^ntlon.'. 
I)i)nn;{ tlio (nlAM'lini or fi-lin'li- fitii^t tlir |iiiiii-ii[ -iliDuiti In> nm- 
tiut^l ti> \nt\. Tlitr ()ii-l >li<iiik) In:' linlilanil iiutHti<kiH. ( 'otiii* 
tpr-irriliuitii, liki- iiHliiH\ appliixl to llic <'liw)t s*'ni u>^rul. 
Cjuiniiw- in a n>Jiab!o louii^ iind umy ha employed tJiroii};houti 
tbe disMibw, The ordinary oxiMt-tonint mtxtiiro' un- \'nlucl(-Ha/ 
Ijoi-al apniicatiouH to tho n^oiratory intmuiH nwiubnirK- pive 
iiuicii reM'. Oitf of tlio foliowiii); n iiu-'Iii^ umy U- iulmUil : 
('resLsole niid (Uloruform, dilute jx^roxklc of bydmgrn, or u 
solution of menliiol. 

^ klontbol, ^. XI ; 
I,iq. vjo-i-linc, fSJ.— if- 
8ig.— Spray the niiHi-pliarjnx ni-'l iiilinU' wvoral timcn a day. 

To very youufr cbildrtii a «uliilioii of menlltol may be in- 
tuited from a rlotli hi-ld umUTlbc diiii. Wlien paroxysms are 
violent tile tiihulatiun of a few dni|i« of iiilritv of oinyl is div 

The follnwimi antisiKiMiiiixlio r*-iu*>dici< np]M'nr lo IcMHcn tiie 
w-vority ami (iif fnipKwy of lb«> (uu-oxyxni.* : Iwlladonua, luiti- 
pyrin, asulo'lida. lutil bromide- of |MtasHium. 

9 Sodii broniitli, glw; 
Unci. boUailonotr, f^J ; 
(JIvprriiiif, tS" ; 
Aoii«s '1- ^ imI fjij-^^* 
Sitf.— A tcai-iiowinil evury Uini« or lour hirtin. 




^ AntipjTin, gr. xxxij ; 
SjT. (Diulaii., I^i ; 
A(|U(U i|. iL. uu l^ij.— M. 
Sig. — A luui|M>oul'ul crvry lwt> of lhr«e lioura, 


(L« Grippe. Catanbol FeTCT, Bpldvmtc Catairb.) 

DE^■|,MTHl.^".^An acute iiifodioiis iliowmc, <'liMm<'t<'ri/«l tjjr 
f«ver, i>xtrpnip )>ri)iitnitioii, ]uiiii in i1m> licail anil luu-k, and 
gftnerally by aUnrrb of lliu m<|>ini(<>ry or gaotn^'intratiiial 

ExioiAXiY. — Thf dt!M<a;w <KXTiir» in qMihtnini wliidt lumnlh 
have their origin in Kuwin, wtit-tKX^ Uicy spread wiili witiulo: 
ful rapidity over both eontinvnlt. Tin- exdting ittUM- in «iill 
iinknowti, but the <-liiiiejil hi<>Iorv would letu] lo t\w iiifiTi'iK 
tliHt it i» a nikii-iiiirginiiHtn. Wlieii |)rfval<'iil, no ajj« an 
iK-itlier M.-X in exeni|i(. (.)iK*al(ark dvtu uolcooter imniuuil 
from other*. 

Fathoi/k)V.— InthiiiiTa diKS not oftcji kill nave by ii 
complieationti. Tlii! latliT are ruoHl frmuenilv aitiMicialM] with 
the iies|H'ratory txatl, and consist of ea|>illary nrmiehilis, calar- 
rltal pneumonia, and rr()U|x)ii!i pneiniionia. 

Sv.Mi'n)MH, — The di.'M^'^e lx?^iiiA almi[>tlv vnih la>«it(id' 
malaise, cliillineeis, severe pain in the iK'ad and luiek. fcv 
ntQtpns between 101° ano IW, and eslprnie )»rostraliuD 
which IS out of proportion to the fever and auy e3;i6ling locsd 
iiiflamtuation. Th« catarrhal symptomB are injection of thai 
eyes, aneeeing, hn8rHen»«, and hard jraroxyiinial coueh. Ic 
Sitnple ea.-ies the temp'ratiirc falls in two or throe aaye bj 
erisis, hot eonipli cat ions not iiil"re«|mntly prolong the case *" ' 
eevcral weekft. 

In some cases the catarrh of the i¥«piratAry tract U the 
diief leatiirc; in others the ga&tro-inlestinal tract is attacked, 
and the syniptonis resienible diolera nxfrbus ; in a thinl groiiji 
nctiral^'ic [laiii^ in the head, lia<^k, and Unilet arc the ui' 
Btrikine phenomena. 

CoMi'i.ifATio.vR — C'alarrha) piiennionia, emupoux iii 
nioi]ia, nephriti<), uoiriti^ meningitis, and insanity. 





DlAOS{i8l8. ,!'■"/*■ finmrhitis. — TIm? fever is not wi litgli ; 
llicru i?t liltle or no |1r(A^l^llil>l1 ; iind tlie [HiiDS in llic licud and 
liiti'k iirv iiol nmrlv m> iiiiirki'd at in infliietixa. 

I'BfXiXceis. — L'mT>iii[ili«ii«i niM« nvarlv always rcoover. 
In lliv vvr}- nld, utul in Uicuie dt-bilitated bv dircKiio dimnse, 
infliu-nm not mrrocjnenlU' |irov<» &ral. 

'ritr.ATMi;NT. — Alis.iliite frsI hi bed and a liquid diet. As 
dn'n- is iu> s|teoiHe, ibe treaiiin'nt ih BymiiumiatH'. ( jninine is a 
um-i'iil »Aimi]lant, ami wtien tbe Humiacti is irriiabU' il niav l»t 
givHi bv Ibe reetuni. 

'i'iu- PatM. — ifcft-nater bags to the head and spine; 
tiinriibia, or conibJnationH of antipyrin or phenaeetiu witli 
Rail)! or saliciu, tbus : — 

^ Sslol. 

I'hciuicvtiii, U .iW,— M, 
Ft. IncbtirU No. xii. 
8ig.— One every tiro houni. 


9 Otiliilna- !>ati<7laU, or. xl ; 
Ai«naoetlu, 31a.— H. 
In ao cnpniles. 
Sig,— One ev«ry two hmira. 

^ Salidn,5iU; 

FlMnnceiin, gr. xvj ; 
Ot«lgaalllwr..xU. xt; 
Syr. aeariK. r3vtj.--M. (Cprtix and Watsok.) 
Sij. — Tcaniwyinftif every hoar or two. • 

I Utk rl - In i bin.- vboold hv (iiiiiiliatt'd by alcxrlMil uiiil sirj'dinia. 
Hr^'iirbinl laliirrb will mpiin- tbt- ivnK'di<-.-< tudi'iiUil in t>iniplc 
bruucbiiiii. Sb-i-p may U: induced by opjuiii, Hulpbona), or 
bromide of poianwitim. 


(BpUtnOe PwotWa.) 

DEmsmo^. — An acute ccmtaeiotia di^eane, cliaracteriu-d 
by ioSainniatioD of tbe panjtid uiid oUirr ■ulivurr tilandb 

Etiouniv. — Tbf- dtiMM ■jci-iir' i>|K)nuIi'ally and i-picicmi' 
cal)y. Jt ts most frnfaentlr obNrrvou tti younp r)ilMn''t, hat 

MocTX isruj t mtv B mbkahgb. 

■pL MaW arr tntiiv MI-wm 
hiichlv dninfiifinii, anti It 
m thr ^iva, Iwt it lin.H nm Ihi!I 

■II Illll'Tl^ 

»T.— JL» tfa disnvp to- :ii fulnl vt-ry Itllli: 

far ^minoi: <t« iniinuttc )mli<>l<>'^'4 
thsfloMe^En tntloitiuuitorv iiitilinitioii 
liiwi Bet fson. Tbr iaAunnuituin sliows I 
ry to Icarr tLr pamtirbi ait<l In iovxlve the lcst« 
■BW* far*4r thr mnniiUif or n^-aric« in the female. 
RIB or LVCFKATH iV — (.tor ■•! twii wt«ks. 
Sr m w ta ec — TWrfwwc- ■> neilKnil in wiili cbillinraK, tnid- 
frwr (lol-lOl--), fiiUownl l>v swclltti'' 
of OM fmtodi gtsDiL Tbr «weUiiq> is oleerved liflo^- aiKi 
■■ 6«ak w£ tW (sr, » (wriiunii in -'-bs)M% mid lias n df>iiRliy 
teA. TW Mnvandbig tiasots an mlematoii^, ilip tiilM»axi^^_ 
lanr ekads 0e U ki w im swnlkn, an<l iW ft'niiin'K ntay Ik- <]iji^| 
lomt bmad rwa p M li iMi. Tbi^ niovenimi? of tli<- jiiw ai» 
nitnil««l mnA [T^tMi Hm* xiliva may Ik- m(-n:nM->l or dj - 
BUniiilinL In manT amm the <4hrr raiT<tiil bn^mtm similarl^H 

Oftro io do* cnuTW uf tbr »Ii(«w lll^itltfalml»llli^Hl Miiklvitly 
salMwk* in the pArtitid irbiml nml n-«|i]ii'ttrs in rlx- l(-:<ticU> if 
tbf tfwlr. lie iu tbr n\-!uy' itr uuiinn).i in Ute ft'iiml^. 

T^ ■ ■ .» ,if tfii- ili*vtw i" tLMially fivf nr six days, 
t'l' > ridMs. — Uypcrpyn'xvii, nw-tustik'^U to tite teslic 

or ovtry-. ami nrnit^tis. Aintplty of the testicle 

pRtm xceis. — Fa vofalile. 

TRK.XTiltL'iT, — Kr** in Iw'cl. Milil fcltrifiigM may !» uivf 
inlemallv. Lix-nlly. K-ai)<«»l(-r iiiid luiulantmi, nr f*mK- mix- 
lai'ieDt ii'mment liko thv fi4I'iwii^, may l»e«npl«yeJ; — 

B Ttnct. inJinii, 
Tiuii. Bi-nnii. nid., 
Tiiirt. n|>ii, SA r.^ij ■ 

I.tuiiDcnt. ililutuftirtii.. q. "^ «»l (si'j.— M, 
S;^._A|>pty fxlemallj- awl i.hi*it wllli (.-.rtton-wool. 

Tin? bwoHcd testicle should be i-lcvatwl and rwcrvd wit 
lint li turakO with lead-vfalef and latidaimm. If the swcllin 



npTiirfs. an oiiitmnit of mcrcary, belladonDa, and ichlliyol will 
bt' JijtiDtl iiHelui. 


(Aalatlo Cliolvtm. Bptdemlc Cbolera. Mntlgaant Cboleia.) 

Defimtios, — An acute infc<-tiMU) disease, gpntnlly epi- 
diHnic, excited bv Koch's conima-lxiciilu!!, and chuniclerixF<l| 
by vomitiiijf aod purging of a sci-ouo innk-risl, painful cram|)«,* 
and collupsc, 

KrioixMiv. — Cholera has Its origin in lndi«, nnd u carried 
thciice to olhcr (nrts of the vrorld. The cxciliiti; caiute is Ihv 
i'4>ninm-lMl(-ilIci» of Koch ; this ii«iiilly h;*s thv form of a 
wlinhtly-tiirv^-d rMl, btit it Is ocrawomdlv tv^ihuiw-d. Tlic ri««- 
wjit^T cvaoiiatioiw nnlv cuntaiii the Ii«i-ilii, whidi, iimhT fnvor- 
tthlv nHMllliiiii:', vontitinc to grow oiitHidi' of ihv txidy, iind 
by f!:niniii|r (-olrnncv into the hawlthy syAt4^i pn>]iH^ti> Dm; 
dir<^.4c. The dluiiM' atvrnyx KprttidN along l\x« lini.'^ of lmfFi<!, 
\wiitt' e[>i<)i-ini4^ in-;irly alwnyx iB-gin at itw wa-omwl and i-x- 
tt>nd iiilai»<l. Oioh-ra in i^lighlly, if at all, (iitila|rtmu> ; like 
Ivikhoid ffver, ihf- jtolxoi) is rml «nTiMi (htiuighatr, but chiclly 
through driiiktiiji-watfr. I^inidif-ss** and nun«s, from tht-Jr 
contact with the vvacuat ions, rt'adily a«iuire the diflease. Kpi' 
detnks are cwre fretiuent in Biimmer than in winter. \o age 
is exempt, but the old are moii' siim-i>lib)c thun tla* yonng. 
Tlic intern ))cralc, the deblDlnkd, and lli<«c siilTcrin}; with guii- 
tro-inteiitiiial <nliin-h are r>i|Kx:inlly (infli^iHiM-d. 

l'ATi!ul,<xiV. — The Uiiy is nlinvilhil ; nutvtinontw of the 
ctfrnw? arc ^inicttinut ob^.i^'wi ; rij^or niorliM w uiarkt'd and 
prolonged, lite tis«i>ct> an- dry, oim) tlw lai^ veins and right 
ddc of (he lioari <-iiulnin thick, dark Iduod. Ttie serous cavi> 
litw are cnij4y and lh*'ir siirlaotw (4icky. The intestines oon-i 
lain nion- or h-ss rice-waler fluid, from nhidi cultures of 
Ixicilli i-an \>f inach?. 

Thf iniKxnt!* iwnibrane hait a |i«nkif^h color and Is oAen tbe 
s<«t ofK-chyraosw; the »dilar^' ami IVyt-rV glands wr\' Bw<d- 
h-ii. Freijiiently extrnwivt- desi|iiaioati<>n of i1m; cptliieliui 
liiiii^ b obson-ed, Imt this b usually n^rded as a \ii>gl-taoT- 


twii fliniigfl. The kidiie^s reveal evidences of |)arcnidiyiiiiitoit» 
infliiniinaiiuD ; llie livtT i» the seat of fattv dogeneration. 

A» the )csioii8an> not Hnffieiciit to explaiu tlie clinieal [vlto 
Oonieiia, it has bn'ti «tiggu«le<] Ity Ki>eli that tli(* iHicilli rtiMe 
u |>ouoD tile ahsi^rption ol' nhidi tnti^M the ;:rave Rvnnitonts. 

I'erioixiI' iMiriiATKiW — A few hotire to licvera] <Uvr 

SvjnmtUtf.— Till- siverily of the fcyin[>toniii varies ronBi(l4'r- 
ahly. In well-nairkwl, i>iit GivoraWe, cast* (hew are Uirec 
slUf^: (I) Invitsiuii ; ^) ulf;kl orcollan'e; (3) reacttno. 

Siftffe of Iiinmon. — 'P«! dliseii^e iistmlly hegius with iiialatso, 
iK-adiiciie, 'linrrh'eu. niuiblinK iioisiti jii the inteEtiiios, anit 
tsilio, FiMineiUly lln^; tiytnpt>jtiis <i>nliniie a few days aud 
tln'ii iiiil>»ide: siieh caw* are temiefl rliolrrinr, uiidaieu>i infec- 
tiuiiis as the fiilly-ik-velojiwl di)!<:ai!C. 

Sfaift- of (hlhtfuv. — TliC diarrhan jnDVf* utorc niurkcd ; the 
evaeiiatioiii'lK'eomeoopiouit, Iww their fecnlml Hianieter, assame 
a riitt-wtitcr HjijKniranw. niiil niv di*flinrf;"i dimhly Init un'th- 
oiit jmin. \'>iinittti^ soini (hvcli'iw, aii<l llie ejwtci! material 
I'f^v'iiilili^ ihiil ]uij>.->r*l hv tile Ixiwc). ThimL in iimiDeDehable. 
Si-veiT i-raiiiiw wiw tlKTm»«<:Ii.i*of lh<; oilvesof iIh: lep*. thifilis, 
arniH, and alxloiiic^n. Tlti^ ^iirliu« U ral<) and rovcn'd wil}i a 
elanimy ^wettt ; the hn.iilii in nxtl ; the leni[>cralnrc in llw 
a.xilta niDges fixiiii !)o'^ t» M^, while in the reiniiii) it may ni<o to 
KK!" or more. The voice b hiinkv aiul Hnnlly nihitxd (o a 
whis|)er; lUe respii-ationa are miiekcntil : the iiiilj-t- lMXi>me* 
m"iv and more IV*bk ; the bocty io livi4l ami slii-iiclh-rl ; (he 
liaiids reteatble thow of a washerwoman ; lite fealun^ are 
pinched aad souK'tiuica distorted; tlie eyes an* frighlfully 
Fiunkei). Tl»e urine is more or less i^ippressed, and tlie liille 
that is passed eeiienilly coutains alhiimin and a trace nf aiignr. 
Coiis(HoiiHi>easiauMially retained until near the end, wlieii eunta 
set^ in. 

The duration of (his stag* is from a lew hoitrv to two day«. 

Sage of lieadion, — Sometimes, even when death seetiu im- 
miiient, the &ur&fie-(eni|>eruture Iw^ins to rise; the itrin« Jn- 
ci-cases; the pulse strengllietis : the vomilinK erases; ihv 
evaeuations from the Ixjnels Iweomc I'l*" fnf|Hcnt anil Itegiii 
lo asiiiime a fifiilerit elmnK'tcr, atnl eonvide^^vntv is established. 

Oceasionally, instead or<iiin-alc3M^'en<^-,i>yn)p{onis of a tj-jibuid 




Ivpe dt'vftloi), siiiJi as mtMlcrati? lever, a bmwn, li<«iir«) tonnie, 
fluUtiiltiift, luulteriiig ddiriiiiu, and ovnia. Thin cuitdittoo, 
^vliii-Ji i^ i^uerallv lata), IiaH been regarded a» uneiqK. 

i^olem Nm-a. — In very violeni oasM collajwe and dfAtli 
iiuiv follow without there having liw'n anv eva«-uati<>n. ATier 
iIi'Mth (he intestines >»iitaiii rice-w:iter tliiid, which was not 
(li:tchurj;i"d during I'tHv iimlablv on aitmint of paralvciis of the 
irtii!«iNiUr coal of the bowel. 

OtMPLK^ATiftNx ANu — NephritiH, pnciinionla, 
plenmy, pan>liti9, ulceration of the cornea, diphtlu'Hlic in- 
tlaniniatioD of the tliruat and fanc«e, absceeses, and liK'al guii- 

DiA«s<wis, Cholrnt Morb'w. — Tbis is always sporadic; 
tbi> diHeliargm are bilious in rharatHcr; a lii;<1»iA' of diclelio 
errors and ofeximsure uiii iiiHiully be obt»it>cd ; nnu tlievontma- 
barilliam no* ddected in the di»<^juir)p.'». 

pK*MiS08i«. — Gtitcrully unfavontblc. TUv iiiortalitv aver- 
agi.ti about 50 ]M'r cent. In IIh- ok), ynuii^, debilitated, and 
inlem|>erBtr it is vpry fatal. In indivitlitiit (m««, end v col- 
lajx^aiK) a lowsurfwcteniiH-nitnrL-amnithvoralil*' I'onditioa-'. 

TrkaTJIKVT. Pirfvntinn. — Thio iurindi-sf tJic iiadatton of 
tile sick ; alMuIiite cluinlim.-w ; tho ibMnfcvtion of ex<rr»ta and 
noilcd bnWlotlKTi ; iIk- ihoroHgli boilinf; of all watvr that is to 
bu used fordriukin" piir[x>it«; ihc lue of a bluu<l, unirriluting 
di«t ; the avimliimi; of nvi-rwoTk. cxiinHnre, mid iiridiii- t-xnte- 
tnvnt; Ai»d tlic {>n>ui{t[ Intumi'iit of any |^»ln>-inU'»tinul dis- 
tiirlmmv' fliiil niuv iirlie. 

Thf AlUifi.- 'Thi- vicdtrnt vomiliiifr aixl pnr^ine and the 
cnim|M 1^11 fiir iii<>q)hia ; lhi.'< is hvM adniini.-iiercil hyptNlcr- 
mindly. There are no ^[)eci6<9. A reriWHly fni|Ut'otly rr«>iu- 
iiiirfuli-«l hv eomiietent uliP<>rven* U Md{>bur(c a"-id, wbi<'h may Ik- 
yiveii wiili tuudnnuin or i4iliniidym'. 'fhir<t is 1>p-hI a.->Mitagc<l 
by rracki-d ice mi (ifiitum ami acidulated drinks. For the 
vomiting a mustard |w)idtice may Iw applied lo the t-pi^'asirium, 
ai>d iced cham|"3gue, carlMilic acid, creasole, or dilute hyilfi> 
eyanic acid may be given internallv. For the cranijH the 
application of hot-water Imgs, warm AmientaliiiU!'. or the nib- 
bing ill of warm oil may Ijc uwful ; whin ihey aiv vcrv sevei* 
a lew whiffs of <4iloroform may In; employed. When tlic pultie 


A€trre iKFerrious dis&aseb. 

wmlcens, Mimiilunte likv ak-obol, etbcf, aud anunaaia aIihuU 
Im." {;''■'«" frwlj'. 

Ci>|iiiiiL-< w.irm-wat«r enemata contnininfr tannic add (I |>cr 
iVHi.) mill biiidiilitiui are higlily rwuniiueiMiwi li>r the |»)r^Hg. 

Tlic: low tiniiKTnliii-c iiiiist bt* <vnit)atccl liv llii? use i»f \nA 
liliuikvt^ •<!', lienor siill, by inimeraion in wann baths (DJi" In 
104''). In <ijllu|iiM', iuibi;uIaiH-oiis or inlravcnoiM inj<i-iii(ni) of 
wilim- solutions lmv« U-cn highlv nn-omnK-niM. Thu fyllow- 
ing »uhitJon, whioh w well (>|>nk<'n of by Fuggi-, may K? 
injcdfJ diiwdy into the vein*, or mm W iillnw^il tn flow 
thix>ii);li H nib1>cr Uiln^ at(ac-h<-d W an iLHiiinitii^rminila, nud 
to wiUT llif wilx'iilumtiiis lisfliw by ilc own |)ii;s«unt ; — 

fjt S(»lii iih'H^, sj. iij ; 
Stulii clilurid.. 3j; 
I'oCttB. clil«r>d., gr. vj ; 
tktdii L'nrb., er. XX \ 

Aqtur (Ivstil., f^xx,— H. 

TIk- llniil xlioiild tx? wariu, iiikI tho injcclion iIkhiIiI be <Ma- 
Liiimil imtil Ihi- (hiIm; nlivngihenA ; an uuioii as i^gliLy unuMS 
may Ik? intmdiKiil at niif tinif. 

TIk! dii-t sliixild (-itt»ii4 iif the rotlnwing : Ijtjthl brnthn, milk 
with mrbonaltt] water, ktnimiM*, wine-nltcn', thin griifls, aiKl 
fixuK'U bluoka of beef-tea. 



DEFINITION. — An iK-iitc inf«T<inn» dim^nse excited by a 
H[H<ctal Iwilliia, oihI diarac^frimHl by (wintul tonic )^|iusiiis nf 
the voluntary uium'1c!<^ 

I'jTnMjiHiV. — In the Irtipi**, (wpmaily in iIk' coIotwI raw, 
the (iitrcasc ofU-ii arixcH idtogiulhtiidiy. In lcin|K'niti' clirunlcts 
the |M>iM>ii nearly alnuys gains cntnuiix' ihroiigd a wtHinU. 
Iiacerat*^] and p<nictiire<l wonnds, froM-bitnt, and hui'ns are 
e«|»ociaIly liable to licciinw' iufrfltxl. Exifianrt: to cold and 
wrt after traumatism M-enifi In iireilisjuifie. Since the intro- 
diK-lion of antise|rfic surgery- letauas u less eotniBon than 



Tlic cjioitiit^ mu»ii ifl a i^xwlnl ink-nmr^ni!*!!!-— Uw IHrntwi 

pATiroi/xiV. — (.'iiDf^siifHi o( tbo spinal wpni rikI uf lite 
iKTvwf l<^n<Uiig Ui tile wimiwi. 

SYUr-TOMs. — Ttw! (It^unai- I«^ins with u loeliog uf rigiditv 
in till- niiisi^l<7i uf tUo ii<rk aixl lontTJaw; by <l(f!rii> |}m> 
niuKcli-s 111' (tto tmi'k, niMlomrii, nritl lnwcr cxIn-Diilti-s nrv 
!«imiUrly involvoi. Tin- hmw is wHnkli-d, tin- <i>m(rr!* ol' ilii> 
tnoiidi arc ilniuti ii|i»at\U («*«« aniilnnu-u/<y, iho jjinc nni 
tightly cIiipc-H {Irumiw); and tli« body U-cnnu^ anlH-d, lh« 
]iut)(-iit ro^iu); on bin lund »ik1 tteels {opitilh'ilunoii). 'I'bcrc is 
o-xtretuo by|H'rti«lIit'«ia, f^o tluit tJic sfiutiic«t toui'lt <nuM^ a 
vi[>l('iil 03(Qi«T)iatioii of til*" sirasin, whi<Ti is nlli>nd«d by ex- 
I't'iK-iiuiii): jiaiii. ir ttic ii'S|)irali'ry niiiwlos aiv iiivolvifl, llw-re 
i.i ItiU-n!^T iiv»|in<i-fi. Tbo ttinpt'i'uiiirL- ii^-imlly n-inain!< norniftl 
iiiilil jn.ti iH-liii^ dmlli, whtn il may rise to 107'^ or mim^ 
Tlie mind is rlrar to the end. TIk> <)uraUon is frutu a fow 
days to HPvewl weeks, 

DiAiiNrMiti. .Sti!ic/mi<i-poimtung. — Tli* biittory of (be case, 
tbo complete rplaxaticni belwreti (be H|]asnis, and tiK' lato in- 
volvement uf tb<> jaw will indic-ate fdrydinia-lKiifMiniu^. 

yWdtiy, — Tbf bij-lory, (lip jiarr)\y-nial olianictcr of ibe 
spasms, tli« involvement of the kand!^, and tbo rur^pe of ibe 
trunk and jaw will survt- lo distin^uisb It-lany from letamis. 

pROGNijsix. — I'nfavorabir. Slight itivolvc-nieiit of tbe 
muscles of tbe trunk, alntntx; of fever, and a slow eource are 
favorable fcaCitrLrs. 

TfiEATiiEM".— The wound should be rmdi-ml swriitic. 
I\Iiir|tbia i» imliaitcd for lliv rvlief of llif |Kiiu. KromiiH- of 
{)»tii.v>iitni (3) evory two boiirnt and eblomi nbtiuki be Uhvd lo 
liintntl tbo nMivuI.iiimH. Wbeii afpbyxia is ibreuienetl bv llic 
viuleneif of ttt« ti]iartin, iiibalatioii^ of ddoroform ehoulil lie 
eiupiovcii. Wht-n (be patient bi (inable lo .iwallovr, bo uiatt 
W IWI ibrtMigb ibe iirr*' or by ihe rcrtuiu. 

Aniito\iiii9t <lerivcd fnini the iibuid of aiiiinals wliidi havi> 
I)een rondereil immune will <biiilMlt^« pnive to Iw a Valualih; 
a iiUtioii to iIh' tJierjpy of tliih ilrcail <lL-<i>iti«. 





(BtMk-bou« r«v6r. Duidy IVver.) 

OEflNlTloN.-— Anuiciite infectious tli«c«»e,duiiii<-t«rizcd by 
paiiiH in the mnwltr; utid ^ointt;, a variablp rash, unci a febrtlie 
t:<)Unw <>f two punnxy»iiw. 

KrioLiXiY.^IK'nf;"« is coiifimtl nlmu^t fotiivlv to Imt <'li 
mnU^. AItliuii!;li it ucc-im in cjtklcniics, il« uoDlugiouiUKflS i 
still A iiuitu-i' of (lif^pnt*-, 

PkRIOD op I NCL*BATlnS.--'niIW (O five ftttV*. 

SvupTOJis,— The invasion i* nmtiWy widfU-n jmmI » attended 
with la^itiKlc, chillincs*. hwwlaclip. iiiieii*- jmin in tho miiwWBJ 
and joinU, iind hi^h iVvcr. Tlxr iHlii-r ri.-w nij)iilly iind urii-n^^ 
rracht^ » ninximtiiii of I0t°-I05° in n (bw hotira. Thi- \M\»e 
IB rai>id aiti) full ; thi- ivsinralions are accclprntwi; th*- mind in 
oftmi di-liriou.'* ; thdiiHiM? In iionaty ; the jniriW arenwiilleii ntid 
stiff. Ill two or thn^ day.-« llut t4'm|N-niIi)iv falU, mid an 
afebrile |>enod follows iu whi<-ti llit^ {iali«tiit l* fnx* fmm (luin, 
bnt is pmtoiindly pniRtniLc-d. Dnring iho ren)i!«iio» a niMO> 
lar or a diffii-^ er^'thematoiLi nn\i goixratly a|>[Mnrs ; tliiti lasts 
two or tlirpe (layM and is followwl bv slight da<()Uanuiti(Mi. 
Shortly after the subsidence of the rash, the fever and paiiw 
again return, and perabt (or two or three days when mnva> 
icsi«nc«? b^ins. 

DiAti.vosw, — Actite rheiimattHm. The prevalence of an 
('|)idciiiic, and the ttiiitlnct remJKJon will itsiially nuider th\ 
(ttiiKni]«is upparent. 

Picoosoem, — l''a vorablc. 

Trkatmest. — There us do »j>ecific rvjnwly, Higli fever 
hIioiiI<1 Ik' controlled by the (txlenud a|i|>li<.-ation of oold or b} 
the ii^- of ariiljiyrin. Alorjibia, mIoI, tuilipynn, or plieiiacetiii 
may be •-ui|>loyi<d to n'liove iMi!n. Prostration niiii't U-i-om- 
IwImI by Mtimulaiitf, like nlooltol, qnioiue, ainl strydinia. 



DKfisiTHJS, — Aditn'nsi' nCdi-^ him! ktmlnil antmalf. <««n^ 
□iiMiitiated to man by dirtx.1 iiMx;tiliiliou, uixl cliarw-teri/A'd by 




slii^lit frver, lutinfiit ^]uism of the musclcsof the thmal, <)eli- 
riuaa, paraljsi*, anil coma, 

EriouxiV. — ltsb!» invariably rcmilts from tJie bite of a 
mbid animal, ^ui^mlly a <lii);. In tin? animal rlie diitntse \s 
ohaniclorizctl by (lepiTW-ioit of spirits, loiw of fl{)petilc, followed 
by rxriti'mcnt, aimloa roviiif;, a morbid desiro to bite, and 
tiriiilly by imi-idyi^is ai>d doitli fmm t-xlintislioi). Tbc i>oison in 
I'oiitaiititl in tlic Ntlivii un<l bl<Hid. I*»»tfiir has inJmt>d the 
<li.viui<v by dint-1 imtciilutiou, und liii« found lliiit l)if virus is 
utli'tnmtt.'d l>y jiniMing K-v^ntl tiiiM)ft llirotif;)i tliv inonkc>'. 
Hilt'H on the litix- aiM) on rx]>in(-d (uiils nro mure liuble to be 
followiii by inftiHiim. 

1'atii(ii/x)Y. — lutfOK- oiiii{r(tslion of the Hjiinal oord and of 
lilt- n^nfiiialoiy inix'oiirt nn-nibrano. 

I'kki<ii> Of Js( iiBATiox. — Sin uoeka to mx ntonths 

SYMPnjMK. Fini i^ufff. — l)flj>rc«flion of spirits, imtllftis- 
iH^s, nli^iil difRindty in swallowing, and pain in (be wound or 
ciraitrix. In n Irw days th«- fctaac of ex«tement hcgi»K 

SefOHft Stui/f. — f'liinic ponviilsions, involving (vimHallylhe 
mijsi'jen of the thiMal, ow^urring s|Kinlancoiisly or cxdtwl by 
(Itiiiking or by the Kijtlit of water; hyi>i'netthe»i8, delirium, 
moderate fever, and palivatton. This stage lasts a few day», 
and ia ffilIowe<l by jnralyeis. 

Tfiird li^dif/f. — Tnc \mise ncflketu ; the convnUions c^ase ; 
the i»tient li<« motionltss; the mitKl Ixx^v^mcw eloudinl ; and 
deatti reytilts in twelve ur twenty-four h<nir» fnmi rxhnustion. 

DlA(>S<>sis.— /7yjrf(T«i in pereons wliu liiive Uxn bitten 
may Bimulute hydrot)))obia. Stit-b perwnH iiWrn hiirk, try to 
bite, aiHl iiiunifnU other syniptomit wliieli arc no4 noted in Ity- 

I'm HI Siist». — I n var in I il y fiit ul. 

TiiKATMCNT. /Vfiy>AyHj-M. ^Sii»))ieinii!« lHt«* shMiId be 
th(iro»;;)dy dl^intVi-leii am! «iuKTiw-tl by the hot inm or caiw- 
ti(-pi)ta«li. iilti-r wliii'h ilK-i»iti<-nt r<Iionld U? aent to an iiiHtitiile 
where tnnculatiuii may w practiM-d atlcr tlie method of 

'ffif Al/'irl:. — Palliative. For th<^ eonvnlsive seizures moi^ 

Irhiiimay )i<:-em|i)uy<.-fl hyixxlennteally, and chloroform byinha- 
ntion. The Kln-fi);th may Im su<itaineit by rectal alimentation. 



(Acitte Artlcnlnr Bliotinxitlain, Infiaminatory Rbcnmatlan. 

l>Kri.\iTios. — An aciiU- cciieral dL'teaeo, oluiracicriwcl 
irrcifiilar li.-v'i?r, uoid Hntiils, in Ha lit mat ion of titc joints, and 
mni!(r-(l tciidi'iu-y to tnvolv*- the heart. 

Ktioi.ixiv.— H<'iiHlity, tompciiilp zone, occiipations whidi 
n(K.■(^*•iIat^.• cxjxiaurc t<i ooW and wet. wirly life (l-j—to), ainl 
»iie altjurk an- j>iiilis|Kising faptors, Tlic tliecuse is usuaf 
(»n>i;i[iitiil*-d liv suddmi (-billing of tlic body. 

The exi'itin;5 <aijfte is still unknown, Sunc nipii'd it as 
uennisiH ; ntlioi's lu'lieve it to Ix" inrwlimu, and cliissily i( vi _ 
{inoiimunia, ery^ijiela^, and i^iinilur di«ii'^'» ; uliiU- Ktill otlu-n! 
atU'ii)iit(> it to (krangol mctiibolistn. Av<.-ijnltn^ lu Ihu I. 
theory, the nitiNigenows priKiiiot«, inHtuul ot'l><.i'ng tuiivert«l ii 
urea, an? trausrurmiHl intu luutit; acid, nricnrid, and ntlirrallii 
fiubHianiva, and the^' dck-lfHuti^ a^iiitH arc tttKiHiti:<ililv tur 

Patiiologv. — Tlio itgamMitfi and tlie eynovial meinhrane 
and itK lrii));c« ait- cxm^^trslcd and swollen. The synovial faa' 
tilkd with a Ini'hid lliiid. The cmlila]^ arc ruu^lieiied ai 
omauiunally ulcerated, tirnvrally tin- process cnils in Jvstti 
tion ; simiclimus tli<r Mirroniidiii:; tiwMtoi Itoromo JnGItniti 
with iniliininial'tri' lyiii|ih, and fuln.' anchylosis rrsultt ; nrelj 
suii))iinitiiii) of (lio jdinl follow», .Stmirtiiues small snlxni 
ikiHiiLi fiSnms iiiididi-.^ aiv fliiiinl near the joints nixl lai^- te 
don». The Id'wid showtt an cxn^a of lihrin nn<l a cundd 
dtiuinutiDn of ttie nil (^r)>riMd<-.< I'ibrinuus vlots arc u 
t'ound in llie heart and t^val bloodv««eb, 

Stt^ndary infl animal ioiin an' fre^jMently diMKivcPwl, such 
eiidocanlilis, pemaixlitiii, nieiiriav, or nnotimoniu. 






Ryhptobih, — Tlie »vi>i|>tonu vary nnicli in tln-li- ■evcrily. 
The (lisi«s«- usiiallv iM'^iiL^aliriiplK', mimtn? nnAy riillow-s.-iiicli 
|ii'>Mliyiiiii-fl a"^ m:i1a!h(>, diilline^, and Mire tliivxit. 'Hit- iitr|;c 
joinr.-", esjwdally llio Byniiiietntal oiws, aiw ii.sually iitVt-iiHi ; 
tiicy are sightly ivddeno), »iwolIcii, cKtjiiisilfl}' [iRiniiil, anil 
trudor tn lh« tmich. The infUimiuatioi) Rhows a inark(\) ri n- 
dency nut only to Hpreiul frunn j<Mnt t»iomt, Imt li> di!-n|>[K-ni' 
ahrii|itly in one wmie it atliukfl anotticr. The joiiiifl ni<»«t 
ttimmtHily invulved iirv (lie kiieen, ellxiwe, ankles, and uHhi ; 
biit DO joint iH i-xi-nipt. lu sevein cases the muscles are j^in- 
fiil, tciwcr, ami sunxtinicK rigid. The fever rises rapidly loa 
modenitv height (lOS^-IDS^). nnd is iodelitiite in iltt duration 
and extremely irreK»Inr in it* wmrw, I'eisuiration is often 
eo|)i<)ii«, hat- a |)re(iliar tuitir »mvl\ and an acid reaction. The 
urine is wiinty, fiipli-txilorefl, and on HtaiKlinj^liironi-down an 
aliuiHtiint i><-diniiiit of nnite* iiml tiriV awil. Tin- tongue 'm 
heavily oi«ile(l ; the aj)|ielile is le>l ; and the bowel" arc con- 
»ti{uilK). The fueu i.-< at fint flnflKil, l>nt ni> lite dincafc 
wlvaiKX'it it l»«x:»>nii>s dwidMlly |iuk^ f'mni ana-niin. 

The duration i» indcHniie, varying fnini a few days tu 
several wci-k*. 

CoMpi.KATioss, — KiiiliM-nnliiiK (in 40 jierrtn). of all iiim-:*); 
plenriAv; iierienrdiri." : |itit-niiiorii» ; liy|>f-Tiiyrexia (1*HJ*-U>9^), 
which U (il^MinMXH-ialKl with mnniadil delirinm; elionn; iriliit; 
nieiiingiliii ; and ivriain cnlancoti.t phenonuiui, Midi an urticaria, 
p(ir|iiira, erythema nodosum, and Mil>cutaneum fibrous nodutcfl. 

DiAOXOKis. Sefilie Arilii-itU. — This may be recognized hy 
i(« awMieiiilTon with rtomcotlier sejili*" jiroccssand by the siwiial 
leiiik-n<-yof tlie intlammnlion to «nd in Bii|tpu ration, wliieli isa 
very rare temiinacion nf rheumatic fever, 

(ioHorrhatil /ilif^malum. — This may lie recognised by the 
history, by its obstinate eliaracter, and by its tendency to in- 
volve, not only largo jointn, but wrlain sinall joints wfaieh are 
rarely afr«cte<l in i-heunia(ie fever, like the sJenio-elaviciiUir, 
tem)mro-maxillary, and saero-iliae. 

IHifumatoSii Arlkrith. — This begiini in the f-mall joints, 
attacks one after nnotlter, leads to permimenl defonnily, is not 
associated with fever and sweats, and sliows ito tcn<lcnuy lo 
involve tho Iicart. 



GoiU.—Tbi» CMfiiK lator inlif^ iHually invulveo the 
Ux, »nd lacier liif;h fevtr, a«id HwcatH, nud ibe tendency to 
Itvurt vumpiicatioiLs, 

I^ROGXosts. — Gtianlnl. Most canes end iu raoovfvy ; aooie 
in rlin>n)(; riRHininti.-uii ; n very small iiiinil>cr die oflH 
exIiniiHtioii, or n.hiii! <i>mi>lii'ation, eiiHi at< l)y[)er]iyivxia. flH| 
is Vfry imirio t« reUi|)fle and to recur. Th« iiKwt fmiuent 
oim[iHiuti(m is i-»i)<KnrdUU ; this may ae<i'crr give rise in 
trouble, Imt frdiiuinlly it leadii to elow thickt^ning or retrao- 
tiou iif tlie vulvcs an*i to all the |ibenouK-ua of vliioDic heart 

Tkkatmkxt. — AiMoluton'st in a mora well-ventilated lint 
fn* JVoni drafl; tin- [latient Hlioiitd lie between blankets. 
The diet abotiUI eiKHist mainly of milk and ligtit brotha ; meat 
should I)e inlerdicled. Tlie live iwe of lemonade or mineral 
watem sltoiild be encoii rilled. ()]iium, phenacetiji, ur antipy- 
rin may be required to relieve tli<- jiaiii. 

Two remethe^ have oonHidoralili- |Miwer in eiinln>llin); Uiv 
diiiease: ^lieyloom|)oniid>viii)iliilkali<-.7i, like the snilit of p«>lB^ 
siiim ; these rera<-<li<!s niav be yivi-ii nefinnitt'Iy or iu contbina- 
tiou. The salicylates relieve U»e |iaiii, but do not |)n>\-cnt rv- 

Siilicylic a«id (gr, .\ in capfxdi^) or anlieylate of widium (sj.^^ 
X— xx) may be given every two hours. Iai^ doHe« may excite 
uanaea and ringing in the ears. 

9 Sodii ftaliuvlnl., SH ; 

Tiiict, cftnMinoin.'ciump., Jtv; 
(ilycerln., git ; 
Atiun^ ([. *. nd f^iv. -~M. 
Sig.— A t«l)lc«p)>i>nrul every two hoiirs. 

The oil of gattltheria (""ix every Ivro lioim) is another snli- 
cyl oomi>oiiinl of docidt-d value. If alkali<9 are i-jn|i!oy« " 
half u dnichmof bicarbouateof iKita-txiimi may l)e admiiiitttent 
fviiry two hoiini until the urine heconti«di.'4inetly alknlii 
It is a good |>lnn to combine alkalieH with salkylalw, thus > 

lapses or cardiac oomplicationa ; the alkali<» apparently It* 
the tendcnM- to endocarditis. 



9 Kodiiralif^Ut., 3i|; 
I'litaM. bicnrfa., 3iij ; 

TiiKL uirdamoiii. c«iii{i., Kn I^m ; 
Aqu» q. s. ail f^v-^M. 
Slg._A labktpooQlbl tvery two )Mun>. 

\V')i«ti tlit'iv in niiii-li niiK-niiii liiiKliiitriN itiixttiru (.^j-^saj 
niav Uc given willi tlie ealiryku.-, or Uie lullowiiig cviiiIht 
tiwn amy be enijiloyed : — 

IJ Acid, «ilirvlic., 3«s; 
Ftrri ptToitli'w^liat., 5j ; 
Siiilii {ilKHplinUit. ,';x: 
Aflua-, 13 vj.- M. (Pbabodt.) 
Stg.— Tableefoourui ewry two tiuurs until relieved. 

iMCni Tiratm^, — TIic jointe may be [Minted with iodine 
and wrapix^ in ootlon-wool. In iM^'cre iviwMnRll lilinlfiv 
are (if grwit utility. Cliloroform linimcnl, imonil*' ItiiiiiH-nl, 
l(iu]-w-at(T iiDil lauilaiitim arr nlx) rftii-icut n-inMlic*. Tlic 
(«ali('yl )>iT|i»nitioni<, whtn iipjilii:')! I'xiilly, ofti-ji nli*'vi; llie 
jKiin l>i-t(<T limn any ollii-r rwut-dy. The following mixture, 
may be etnployccl : — 

^ vEiticr.. 


(JL fp^atihtrim!, ill .Ij : 

Lin. MpciDi* q. a. ailOf.— H. 
8ig.— Apply locaUy. 

9 OL enulllMriat, 

(H. olivir, 

Lin. Mipoaiii, 

Ttnet. aooalL, 

TiBci. opil, U (3I<»-~M- 
Ft. UnlramL 
Sifr— Apply locaHy. 

SametinHs icflhyol prrnns wnricnble. 

9 Wnt.T0l.3ij; 

Eiu bnlUrf'ntDB'-. 3] ; 


JJgpaynfnria. — Tbb ■boald hr tnatcd 
ooU {ndt or Ibe aiU Imxh. 



-RW/orarrfflw.— This iisimllr causes no BiilHMfive dirturbanre'' 
and Uio general ursltiK'ut iRvd nut be modified. Wbvn tlw 
pnhe 19 rapid uikI trrc^tlar, un<I l\ny iKiticnt cutnplauis of 
[yrwiuHial di»ln.^!», ii blister iiiuy bo a|>i>lir-(I und dir;italts may 
bo ^ivoii iiiU-rnaliy. Absorbents tiko tlu' iodide uf [K>tii»ium 
aro u^li'iig^ CoimilcwcvuTO iiliuuld be pnitRu.-ted eo as to ulltrw 
time for iwrli-cl cx>iu]x;DMitioii. 

(!J>imi/fi(inr«w.— Such toni(» as bxMi, (|tiiuiDr, ond «trydinta 
are usii'iil diiriu^ ibis )>criod. 


Ktioi/xiy.— 1( uHtiully begins lu a (■hr'iniciiffi.'Ction. Ho- 
Fcdily, ailvmiix^d )'t«M, nnd habitual ex|K)Mirc to itild and wpt 
an; tt»- prcdii^jKjedng (hctom. It raivJy rvaiillti (nmi lui acul 

i*ATHOT/xjY. — Tbc fihnnii i^riKrliiri-s niMiittd llii> jmi>( n; 
j;rwnly lliickerHii, *» iJml in Iwis-^Uimiinj; «.■»>«» tint iinivt-im-n 
stir n.-strivted ; tbd iH>i);bbt.>nn); iiitiiK;l«8 wx; wa-4cd fmin di0iii*c; 
aiwl tilt! ti«rv4» "fU'n revuil vvklvncc!* of iiwiritis. 

SvsrPTOMs. — Pain, HlitTuc^K, dcfuniiity, aiid nncakiiig "f tbe 
joiiils tin:! llie uHiml |tIii.*iKiincnii. fVrvcnil juiiiU are uhiuiioiiIv 
ittTi'i-li'd, MIkI lliit ilLTX-iiJsit :«tKm> no iirctlilcclion fur siiy yav- 
tk-nliir joiiiU Ilic ttymplnnis grow ^vnrso mi iho apfiruaf-li uf 
Htorniy waitiu-r, und at 8Uob liiiKa uxaivrlMtii-iia are liable to 
oi;ciir, in wliidi Ur' jointit Umouie swollen aud tender. Tlie 
duration ii« imIcRnite. 

(,'niiPl,iCATioX!i, — A rlerial df^eiieralion and dironic euilo- 

1'IWK)S<1819. — (Jonerally nnfevoraWe. Mucti relief may fol- 
luw |K-nii«liT)t and jitdit'Hius irealtneiit, but perfect cure is 
rurvly ntbtiimblo. 

Tbkatjiest. — l->]teRiiil attention alwuld be piven to the 
hyijicnr, |Mirlii'iilftrIy «.■* rt^rds diet, liatbing, clolhing, exer- 
nlw, uiid ocicititalimi. A diangp of itsidonce to s dry, vrann, 
iind iijiinhlc rlimiiis may rfTii-t a cure. The tone of (liv fVf- 
Unn L'<itfU'ii rc-dwe«l;bwiiv, loniis likeiMii, ouinine, str\'flnita, 
and anwiiie may Iw of 4"oit'i<Jerable valiWf. The speoial n-iiir- 
dj«A arc iodide of potatinium, giiaiac, sulphur, Milieyliv atrid, 




niid nikulkv like (lie salts of jMilaasiiimiiiiil litliiuin. 
Hutt'i's arc MMnc-tinira it§i'rii]. 



Potass. loJld.. 3IJ ; 
SjT. simp., f.^iy.— M. (Da Cocta.) 
-A lcn»|H>unfiil tbrvu tiiiu* a liay iu water after liwals. 


Mnscular Sbeumatism (mifiilijiii, mifuhfnia). — An nfTv<-ti<»i 
III' ttie votiiulury iiiiiM'ic:<, (^iiarwrti-riwi) by |iiitii, ((-tKlc!ri]i>?{^ uud 

Tvi'tsi. — IWfferMit luuitra havi* bwn npplied according to 
the location, iiaoiely : 'fortlro/tu, or ifri/-rtft^. when it in- 
volves the Hi<-mir-<-leidn- mastoid niiwii'B; lumbago, when it 
involves the lunilmr niiiM'li-j; fJeur^lf/Hia, when i( involves 
the intcrci^lalii; and etftfiatodynia, when it involves tl»e «- 

Etioukiy — ^The gouty or rhenmalicdiatlieBis i« a prcdis- 
pD^ing cflUHo. RxfMBure tu cold aiMl n-cl or mnscular Btmiii 
lOiUiiily I'xcitFH it. 

SviinriMs, — Piiin is tlw chief Nymgitoni ; it i* tnailr woise 
hy use of llie iniit«'lc^, and i» avuicialwl witli (endcrn<-*»i winch 
ix c?|N-<HalIy nuirki-'l at the t<'iu)iiti><i.<( urigintt and in<vrliiins of 
tho miiwIfH. S>nK'tinii^ the iniiiwlw are cvntriKTtM uml rigi<I ; 
lliii« U |uirtii.-iilarly iIm?«ii«; in lorltculliK, or wry-nn^k. 

Tortimlfhi. — The ln-iid i.« fixtil nml iiiiliixHl lo oito side; 
every effort (•> Inni it i.^ ailrDilt-d uIiU p>harji piiin. 

i,um/i'ii/(i. — Tlii'i* is a dull, ai-liiai; |ini» ainws the loins. 
Tuniiii); the IxhIv or ri.iiii(^ fiimi the silling iKniiire fan.'w-inin 
exaeerlidiliMn, whieh is .tonietiines fm wvere that the jutii-tit 
crieAiiut. Cure niitst U- tnkfn tudistingnlih it from reual cal- 
eiiluA, ]*oU*fl, aitetirUn), j)erine|>lirilis, and uterine or 
ovarian disease. 

PfeHrodtfnia. — ^The ]«in is felt in the side, ainl is inereatcd by 
deep hrealhinfi:,conghing,ortwislinj£ the bixly; the res|HratioRs 
are n%trieit<l on tin- affwled side, j'here Ls difliise tei>dern<»* 
Kt the touch. TheahM-nee of fever and of pltVRicnl signs vill 
serve to dietinguislt it frotn p/enrimf. 


COKtflTri-TliWAl, UlSBAMES. 

btJr . 

Tbfl nlxKtioo of lender e|»ol8 where the nervee make their 
exit from tlic uin»-iilar n>vc'rinc?% the fael ttial (he natn don 
Dot fijJIon- t'luAi'lv tlic dUll'ibtitiun of the nerves, unci that llii 

Snin isineivuM^d by niovcmcnt, will tM?Tveto<lUtiii}j;ut£li [ilcur 
yaia from intfrcotlaf nruraft/ia. 

Ce/iltaiadyHia. — ^Tbis is eharaeteriiuil liv a superfieial h(wl 
patD whu-ii ia iiiereas^ by moving the tea\p mid wbidi i» 
SKsoeiated with tciiderneffi >iu pre&iiui'e. . 

]'i:(MiM)SiH. — Favornble uuder jiKlivrous und iKisisleD^H 
(nstmeiit. ^1 

TltKATllEST, — The afTfrted niii«-hi« )4ioidd be put iit rwt. 
In pletinidy niu this is bcist u^^^'umpliidiKl by »tnippiii]f ttii 
atfeirtcd side ii« for frof.-ture of the rilw>. In himlwg^n In 
pieiTiof ndhv»ive planter niiiy bt- nppliifl fn>in the flmiling riiii 
Id tlie itijM! cn-Kt)', lit niihl avfr* Ok- llxit^ni'^ti npplifiitioii 
liiiiineiila ix>iiliiiiiiii;;ciili>nifurtn, Bixwite, U-IIiidoiiiui, Jiiid luiida 
nnin will Ix* nil that i« ix^iitri'd. In other iwjii-:" pi-onipt nlic 
nilwi f<>liuw« the injeetion of morphia {er. J) with ainipia (g 
l-ii)< directly into ihc miieclc. Tlte c-onlinnrd etirreul is miuu 
tiiius iiMtliil. Tiio intnxhietioti of n<-(ille-s thrve ur four iiic-lx 
hiii<r, (ht'ply into (lie nuisolcA (iH<iipiiiuiur<>) orrKiionally gm 
brillimit rtwiilt^ 

Iiili-rimlly, in neiite cfuk's, chlnridn of ammi)niuni (gr. x foti^ 
tiii»<^ daily) may pn>vi> <rflieio»l. In elirunie cafen, iodide ' 
|iotiii«iHm, (rnainc, ciitrhic-iim, and lli« siha of lithium are tl 
reni«li<« imiialty t-ini>loyt<l. CJflseniinm |Hisl)ed to its phvMc 
Iii^rical limit luii- lxi-n suceessfid wheii o*ber remedies lia\i 

Neural IHaiiJfestatimi. — Rheumatism nppesK to be a &e-_ 
qiK-nt •■any Iff Kviirili-. 

Rbeamatic Affections of BInoons MembraneB.— It miut 
bonio in miiwl llwt itharynptis, toiisilliliw, lory-ngitiK, and 
tntMicJiitie an- ^mtptimcs dt'|>eLideiit nj^in ii rln iininii'' ilintbesisJ 

Bbeomatfo ASecUons of Borons Membranes.— Kndoear 
<]iti8,peri«ird)tiM,pIenrilts, iritis, undjieritoniliji nuty be vs&t 
by riM'umutii^m. 
' Cutaneous Rlanifestations.— Pnrptini, nniritritt, and pit- 

tlieinn iiudn^imt lire t^iinetiiiK'S at^NTialeil wlllt r)i«unuitt«ni. 





Dkkimtiok. — A gciK-ml <li««)iiT, i-hanidcrizt-d (>j- varieil 
on^ititiilioiial diMurUtiKx'ti, tiiv |>iTv«-ii<r of iimr ui.'iil in tlie 
IdiMirl, ibe cle|><if>iiioii of uralc of ^jkhIs in Die libnxiit sinK-tiim 
III' till- juintH, ami rrtiinvnl aiux^kftof w^iUi artliriti«. 

ETKiLiKfY.— Middle and advuicvd life, itiaic sex, hcKdity, 
a rich diet and tlu> iudulgeniv in liqin^rs (t^iHvially niult 
lirjiioni and strong wiitefl), want of i-scri'tM', anu workiii}^ in 
Itaii are general iii-Mli-i|HisinK; fiiitoi-s, 

I'ATHOUHiV, — Tho litiHiditiniain.'i iirirnictd,aiid ihfl fibmiis 
strnrtm-es of the joint urt> thettaiit of a dfi]>(»it of iiraleof Mida. 
It IB nm)>ablc tluit frcrni d«lbctive nerve-power the tij«nra 
^uerally are nnable to periW^t the roelaholiaiii of nitrogenous 
producta into nrea, atMl that nricaeid and atiiwi wil*itan<«s are 
thus fonncd. Awonling lu ElK^tdn, the uric iiL-id ejtdles a 
necmsis of the cartilages, wbereiiptin the iiratesare orystallieed 
ont and deposited, 

The cartilof^M tuec their gtcarly api»earanee and beeonie 
lustreleM and iDfittruled nich tullH ; simitar opaeiliefi appear in 
the sj-novial luembrano ; later rmmded musses of urate of soda 
(tophi)^ varying in «w fmm a fc^ to a niarhle, atN-iimiilale in 
the tifisnett siirronrulinglhc joint and may iili-erale rhroiigh Ihe 
skin and Ir- di«-hniX'^l. The fihnvu'i Mructnrcs l»ecome brit- 
tle and tindernu dc-5lnR-(ive ittungo;. The johit beeooies 
irregularly enixr^il, MtilT, anil fnuilly aiK-l)ylo«:«l. Tlie meta- 
t3i'»o-plialim<r'»l joint of tin- gn-ai to<r, esiwciully tho rijilil one, 
is first iifTix-t'^, lull iKOM olhcr Knutll jotnU arc involvol. 
Gouly depi»il^ Arc :«i7nti-tiniirKfi.>iind alon^lh<^ tcndiHis, In'mttlh 
(he iM-ntoni-iiii), in ihe |iiTic'hoitilriiini of tlio cJir, and iti liiv 
tanal airtil:i;^^4. 

The kidneys an- g^enerally thA seat of a ehronre intentfitial 
in flam motion, and »*er4ion freipiently reveals a defHwit of 
uratcn at the ajtiees of the pyramiils (goiliv btdney). The 
arterii'S an* sclei-oeed and the left side of tl>e neart is hy|H'rtro- 

Symptoilh. Acato Qottt. — Sodi prodmnws a.M re^lli'ssnesa, 
insomDis,iuorMiouc(w,andtrnlabililyofleniperma\ ' the 

ooNsrrruTiosAL tusr-AsES. 

allark. 'riicarltiritio)ilM>ttOD)<-nii(i8iiallya)i|H'artuKl<)enlr intbe 
mrlv imiriiiit{^ luxirs niul uiv vliara(1tTt»-<) bv [Ktiti anil ttwvlU 
iug in iln- Imll nf thi- gn'ot toe, TIh- iillixit-d juim i» vxnuU 
sitely [Kiiiiriil aiul U-ii(l(T, »> Ihfit the )^lij^ilc«t prrKHUrv rannot 
betxinw; it U uTn rttUli»}i-|i<ir]>k'colur ; it« mirfarc is gliuEt^; 
aiw] ilK-iii^i(:)ilNjriiij^ vfiiis nrv full and tlitilinri. 

'rti<t iHjrHiitiitiorml syiii|Ui>iiw aw rr^tk-Ksnixs. 4-iiilliim», 
inmlfrato fever, jn-rK^iration, fx>n)>li]iation, atni >*(ainty Iiij^k 
oolon?«l urine, wliieJi WMitatiw, ituriny Ihf. }ntrfixff*u\, lew* iimtrx 
that) iit hculth. TuwAnli* ilavltpl)! lh« sympiums ulnite iiixl 
tht! |>atit'ni liilU lo i>l'i-|>. Diiriii^; tliu iliiy lie \» o»nl(«^tli^-«■ly 
(V)iiifiifljihlf, iHit tlH-n* «ro wvei* ■■xiM'^TlxttJutM li>r JH-vi-ml 
Hiioii^vo ■ii<;ht.'4. At tlri(t iho nllar-k-i niny be u year iijuirt, 
Init an they iiiii]t:|ily the tnln-val gr(m"> h-w, iiiilil finally lh« 
patient is mIiIoiu eiilin-ly fixi- fmin sufFering. 

Hetroftilent (ItitU. — 'I'hbi l«rin it) ajipli^Ml (it n nonilition in 
which the arthrlltc plteimiiteim sudiWnlv Hillside nnd gravis 
jpistrie, i«p(ltiu', nr i-pn-hnil (*ynip(()mN ftillnw. 

Chronic Gout. — 'l'h« joinLn are afii-eKil ime by one, mid 
IxHuine HiilV, irn-gularly enlar^ied, and ik-li>m»«l, fbalW- 
Mtoiies, iir tn|>hi, atim-times iildprate iheir way llirmigh th** 
skill and are disehnipxi. Similar de{MXiit» are fretjueutly 
fiiiUMl along the tendnna and iu lite helix of tliA (ar. Tlic 
eonstitutioual syinptoini) vary much in severity aud in efaar- 

Nrrvow Phenmnena. — A''erligo, lieadadie, iitsomnia, irrita- 
bility of teiii])er, ao<t hyimciiDiMlriasif. 

G(utro-intf»Hnal Hwaomma. — Perverted ap|tciitc, dy8pe]wia, 
oanstijiatJoit, aiid a tendeac-y to liemorrfaoids, 

Unnaiy IHienonvma. — Tlie urine is at first sranly, litgh- 
colored, and thiitwedowti an abnndant bnck-dnst »edinient; 
hilt ultimately interstitial nephritis develops ami llie nrine 
Inx-omes |«Ie, wvpioiis, of a low speeifir ^ravitv, and contains 
:iHinmin and hyaliiR' eafllo. Glyooeuria is also fretiuently ob- 

Cfrrulfttory Phrnomma. — High arterial lension, arcentoa- 
tion of tlw nortie second sound, and later, arterio-srlcrosis and 
iiy|»ertn>|»Jiy of tlie loft ventricle. 



fV>jiPUrATi<>xs ANt> StXirKi^i:. — Tntorsfitial iiefhritis, 
arterio-HclertiMH, hypertrophy of the h^'ai-i, apoplexy, dironir 
bntnchilis, simI ciiran«nia eruptions, eB]>edaIly «."Wina. 

l)fA€«s<iei»,^The gymptonis of acute gout are so cbanio 
teristSc that an error in diagtio^s is ecnixiely ixieable. 

C'hroDic gout may be Rii&taken for chronic rheumatvm ; 
but tliv former attacks et^pec-inlly tlie ^niall joints; tt begms 
in tlic grvat toe ; the blood coiilaim an excess of uric acid ; 
an<i tbo ttymptouis arc not so tuudi influcoced by atmwpberic 
vhaii)^ u» by diet. 

Fru(;nosi8.-'As rt^rds the scute form, the prv^osis is 
goutl. The liability lo urtcriul d«j;eiM;nitioii iiml to ocptiritis, 
and llw ditliciilly in lavnnng «)0()er«titin tn fiirryinjj ont the 
Iiimtnii'nl it'ndiT llic prognoei»of elininic gout rather nnfiivur- 

'f RKATHtyiT. The AmtU AtUiek. — TW best reniMir is col- 
cJiioum ; ten to twenty dmpa of llie wine well diUitca ithuuM 
be given everv t wo hours, and ston[»«<d as soon as tJ»e symptoniB 
stibiiide. AlKaliet are vahiable adjuncts, and the i^itit of jMrfas-i 
Bium or of lithium may be given with the ooldiicum. Quinine 
is also useful ; it may )*c given in doses of five grains thrit-e 
daily. Tlte free use of water Hliontd l>e eitrouragrd. an*! a 
wat«r ouulainin-; litliium, lilie the UulTalo litbia water, niav 
be reouin mended. Conotiii'iiiofi ^Jtnnb) be rel!r%'ul by u full 
doM> of bine m.T>H or n oalitKt dniu)f)iL Opintn may be nvguin-d 
for the n-lif f of lint jKiin. The aifeefc'd part should lie elevated 
and wnipjMil in i*itlon-wiM)l, or covered with warm fomenia- 
liiin.s or \t itli clotb.H soaked in lead-walcr ai>d laudanuci. The 
dii-t xlioidd b« light and non-i^imnluling. 

iJtroitic Ootit. — The diet niust i« n*>tri€t«] nml earefully 
amtnged foreach patient. Lif'Ut tnttOn, fish, <^rgi>, and oyeter* 
may l>e used in moiii-rtlion ; nwi-el fruits stmu Id ta* avoided: 
starches and sngam miu4 Ih' limited ; and llie use of liijnon^ 
intenliited, Tlie mnitition of the tongue, stomach, ami iirini- 
will inditwtr tin- valiie of this or that dietarj'. Mineral Hatrr« 
are often Hcr^-tpealile, and f arlMbiid, \'iHiy, and ItutTalo lithin 
areank<>ngUi^besL Their utility uill In- eidmnnnl hyihe addi- 
tion of a tcaspoonfnl of Mine e(ri>rvc«ci»K ■nit of liihinro to 
cacJi potation. A frvc wcretioa of the sk-in ^h^iuM be eonjur- 



a^ hy frequent halliir^r fnllowcd by friction. Th« howrla 
i^liould lx> kept regular l>v Haliiii^ ur \>y lli« (H-i«iti(iii]|l iittc i>| 
a mercuriiil laxaUvi.'. (inuliuttti oxi^n-tM- LiulilHa pntniim-nl 
place in thi> tlicrapy of gt>ut. W'licii llto dif^tivc |miW4-» ar 
partit'iilarlv weak, miiwrnl aridn witli HU-yi-lnrut will pn-vc 
ufli'liit. Of'iici-iil liiiiks aiv .'MimetinicT) indi<«i«l. Tlio Kpt>(naJ.J 
re.RiMlii^ Hi« (-oU'lHiiiin, litliiiiin, aiul tiMlide of |Mitaiauuai. 

1^ Villi si'iii. eokliici. fjan; 
I'olAhB, iudidi.^ij ; 

Lll|. IHlUlM., ^S'^^i 

Tr. ziii<.'il)oris, fjlj.— SI. (Koikisok.) 
89g.— A tcMpoonTitl Iwkti daily in wurm wittcr. 

Or small d<xwvt nf cnlohioiim nuiy Iw giv«n vrilli— 

9 LiUiii licHKinl., 3ij ; 

All. d II tin mom., I'^ijit* M, (jACO0in>.) 

8\g. — &. teat.|>ooufui iu « wiuogliua ol water uver)' fuor titKint. 

T)it' itrtliriiic tiindiltnii tM IxsC treated by varvriil iiiuib>a|;« 
}ii»i vviirti) ^iilpliiir Ixitliik 

KiiF.rsrATOin AnTiritrns. 

(AiUalU* D»fona«na, RlMiimatlo Ooat.) 

I>F.Fismox. — dV Winmifatlix-tioiiof ll»c juiiilKi'iinrBtTtcriat 
by *tc»tnw:tion iif Idf cnrtiliimw. new «i8mi>n» (itrmittionis ini^ 
mubilily, niul difiiniiily. 

Etioixx(V. — Urnility : t-nriy imIiiIi life; fi-nwle wx ; ra»n- 
tiiinod cmoliuiiJil ili«liiiliiiin>w, ».* iinxirty aitil ("ritf; riirwhlf 
nieut of Iwiilth fnuii Isni liypciiio ciivinHiiiicnl, imtlou^iti 
Isctaltot), uiul from fniiiK'nl pnfrtBincim, are tlie jireilii^Miinii 

pATiioiAKiV.— Mnnv Itiok ii|>i>ii ritminiatoid arthritio tai 
diseaso whirJi i" n-lalitl Imtli to ipHit anil rlioiiiuatipni. OlIiorMl 
n^rd it it< a iiciini^iH ami alliiil l<i llit- anlimiKilliit^ \vhi<-ti[ 
ar« met witli in clinum' airccliiiiui of llio Hpinal mnl. 

Tlio cclU t'f (la- mrtilu^-s am) of llie .-ynovial metniimnfr 
prulifcratc and luul t<i villoiw dt noiliilar oitlgrowthit. TIh> 
centml |M>rliiiii]<i of tli<- imriilii^'gi ultinvaii-ly wnu* away 
Ii:ave tbc WiK« vipustHl, Tliv Ueonh of tbe boneu bt«ouie 



NiiHKith aitd hard ]ik« ivotv, aod thickeiK>d from excmVoKg. 
Tliesyaovial mi'mlirant- aim )M'riailKular titisuoi are liki^trtw^ 
tliiekeDed an<l smuetimf^ iiitilirjl<t) nilli Ixniv |in><lui-L-'. Ttw 
surrounding miL^clcs are gi^iit^nillv utn>|tlik-if. All jiiiiiM lire 
\u\U]f to be afferted. 

Sy»itTXJU«, — It mav Iw rither aciilc nr i-hronii^, llic 1a(I<t 
iH-ing tlie more mniinon fnnii. lu ihe acute /onn Mivt-nil 
joinlf are 6iniultanei>u.-ly iiivohitl ; iJiey become awDllej), ]niiii- 
f'til, and sligliilv red<leii>-<l. Tboiv in moderate lever. Tlic 
Mtiiptoms aooa subeiile, lo rea]ipcar, liowc\'vr, at firequeui 

In tbe ehroHir form, the UamU, ptutioularly tbc nK(a^r|N>- 
pbalangeal jwinte, arc tiMiully finit aRcdf^d; tl»on ihe wrisis, 
KiH.-c«, iocs, jaws, aiul ppiiK-. SymmHrinil juinlH are (isiially 
HitiK'kMl. Th«svm)itoiii«nre: Sivitliri^, {ciin, imtiiabilily, and 
di'forniity; t}ie jointfi urv x-lifl' iind vreiik wIkii mnv^^^l ; later 
cixiipU-lc aocbyfo^tt (k■^'4^1oJ1» ; tin- nittwUw waciv and <.x>n- 
trac-ttin» iocrmse Ibo di-1'orniity. In advniin'd aucs tbc fingers 
are bent baL'knanI, oDtm lot-kMl, simI turnttl towanl tbe nlnur 
Kule; tbc lliiifliv are drawn iii>; (Ik- k^are lulductcd and 
(Ifxcd. TIk' |Hi{)i-iit may In- n lwl|ili-s» in\-alid for many years. 

I^lAiiNiUlS. (jfMiL — Till- nn-tim-'taimT itiidcr ivbidi gout 
dvv».'!i>|w ; iIr- bi«4ory of »ii wtiU- allork in tin- prtyit Iik- ; iht- 
prwoncT of uric antti in th« bltxti ; lb<- ])rwHiiiT; of umlcur 
tHxU in llio jointttinxl in tliv (»rtili>p« of tbt- imv will sltvc to 
di>ilin)piish tbc Iwo di«w"'-'*. 

Vhrmtie Ilhmnutliimi. — I'nitkr riininii^ rhtioiuHtiiiin, rhon- 
tnntoid artbnii:« Uf^iw in lh<; umiill joini.-*. iiohmts from joint 
t4i joint, Hti(i !<9lv)i« iHTTnaiw.'iil <Iofunnily. 

I'lWXJNfif'i^ — Unfavorabfv. Snwitiru«» lb<? dl'««!M> is InrnI 
and ri'nwins in onv j->int {Mioito-articular form). Cienerally 
M>\-<rrsl joitil:* are nHivic<l, un<i nbik- jiKliciotts and jierMMftiit 
tn^itnienl may reliini (be prof^n^M of itie dinna.'te, a <:ure i» 
niii'ly alialnublo. 

TiiKATMENT. — Owxl bvjfN'm-. ToniiM liko iron, ajwnip, 
])ho«phornN, nitd nxl-livi-r oil nrt> it.«>fuL Tbt? \a«tH ^>od isJ 
to lie fxiiMrti-tl from lo<»l In^mi^fil. vrbich mmisbf of mu«»^, 
ebniriitity, KUwni )»ilb«, and inundioiiii of [>re))anUioiM voo- 
tttioiii^ i<«dtnc or mcmiry. 


oossrmrnoiTAL ui»ba8K8. 



DEnxiTios. — A oontttitwiional dispsse of early childhood, 
diamctcriKed chiefly by di-roctive iKitndon of the oneoiia 
St riK'tiirfw. 

Etii>I>h;y. — Rickrts is rarely ciDgeiiital ; it iiMiuIly de- 
Volt)i)8 ln'twwn llic first and swjtid year*. Poverty, uriifieiitl 
reediog, and bud hygipnic eondiliuns ara tlio prtxIiKpaaiug 

l*.\Tii(HXKsY.— Tile most marktsl <>tiiiii);(w arc observed in 
the I"n;r lionet and ribs. The cnrliijifriiniiw liiniiim l>e1wecii 
the qii[>by«i» mid Ibc eliaft are omwdenibly tbukcncd, and 
an^ spcmgy and irre^iliir in otitliix-: ni!>|>ic' t-\aminati<niH 
revf'ais an I'xwtwive pnjlirci-iitioii of thi; mrtiliip'-tt'lls wiilnV 
Hmily uileiliaitKHi. J'bv jX-riiMlonni in tbicktiH'd awl highly 
vaseuUir, and w!hii ittrijijNHl off sort [RittKh* bone u vx\ 
Tlw bones are »i>ft, iK'ing cistrciiiely defi<-icnt in lime-tnU 
wluiKwsifMfllion lliiiilly n^iillii th<* Umrs l^'eonx; Ikwvv, 1j 
nx"\ trrf^iiliir in untlino ; tli<?MM'Iiaik^ri4<'iini?i|H>iid to (herlinic 
[ibdiorni'iia — how-lept, kiiotrk-knvRt, S|>ituil ciirvalun-, [Mgt 
irruust, and Miiiiirt- rnrninm. 

11k li\'«r anil ttnleen »m oflcn oonniderahly eniaiynl, 

SYMpTfiirs, — The, early syniirtoms are: Restltjwnff* an 
Hiight ft-vcr at night; free pcr-Hj>iration alxviit the head; di| 
fli»C soreiMSfl and ti'ndentess of llie t>ody ; iiailor ; slipli! iliar 
rhnA: pnlargemeut of the liver and spleen ; delayed di-tititini 
and ibepniptjon of hod ly- formed leelli, 

iS'JtcWd/ llifNomata. — llie head is large and more or hi 
)U|iinre in outline; carefnl |)alpation may detect soft ar 
Thr ftidftt of tJtc thorax are flatlencd ; llie sternum ib pronii 
iMMit; nodnlci* ran hi- felt at the eternal ends of the ril 
" nii-hilji> rrwary" ; there inny l>e S diKtim-t transverse gnvive at 
the b'vel of tin- Mtiifnnii carlilajre; the )<]iinal oolumn is fre- 
f|iiiiitly eurx'wl antero-p«isteriorly or laterally ; the h>ng bones 
are enrved and pntminent at their extremilicK 

Ot«Pi.irAT!ON-n. — Green-fitiek frartnres, mnvnIeiotKt, 
t^tunnti Htridiiliu, paretilt of the cxtieiniUcs, and acute 



nary dbeaDct. In wnmiMi tlie racjiitio ]m>Ivm may Mrriodxly 
»>iu|ilii^te labor. 

PRixi,\(»)iM,— ltavhiliH(ii>e5iH>t kill din?rtlv, but dratli UinH 
unoiimmoii frura iiiU'nriirrinl <IU*(-a*«. Unoei-gDiid hv^ii-tiic. 
ooMlilions recovery, witli mura or leas defitrmiiy, generally] 

Tbeatukst. — The general nutrition must be im[>rove<I by 
lilaciuf tlic rlitl<l niider tlie itent hygienic rondition^ I'^gs, 
|>nrf milk, pre|iarc<l fixid, and ll^>tll»^ kIioiiIiI lie rt^eoni mended. 
(_Vid-liver oil is a valuable uutncut tonit-. Ironic indieaU<l 
f>>r tliv aiwiuiii. The liu-k of •.^lt'itiix>u§ luuterial iii the buiien 
slioultl be suppliul by IIh- iid mini fit rutiuu vf ptiuH|»lionij« and 

9 Syr. ferri Mid., rjlw, 

I ji<:tnplif». i^ldx, i|. *, »d Ijitj. — M, (ifTAKlt.) 
Kg. — From noc-tuLir Ui a lak-npoonlul Ibivc limuii a day. 


(Utblc-aold Dlatheidi. Dric-aoUl Dlatbeals. Latent Goat.) 

DF.Kisrrio.v. — A constitutional dis«L-«- (ii-jHrmU-nt njnm mal- 
n.-wimilalion of nitn:^noiii4 producttt and llie t'onuaiii'ii nf'iim 
afid Slid nlliid ^iib^ances iDslesd of un?a, mid characferiuKi 
by ait ejcoes; of nric acid in llic luioc, and varied digestive, 
irirculatory, and nervous uhenuni«ia, 

Etiulugy. — (_iwit witli An nciiK.- arlliritic csprvfieion Is un- 
common in Amemt), but tiitcnt ffmt, or lilha-niiu, if extremely 
Himimm. Ini|uiircd <lipi«liiin, inHutlicieut exerpiMi', mental 
strain, and ovcr-<-ultnif ««- tin- ti!<iial iniLiK!^, 

8VM[T(1MS. 'Mlit(ro-ifi(cjrfiii(l/ I'/invHttriul. — ^^M! lull^lle IS 
generally cualcd ajid ilie breaili heavy ; lli« apjH-tile is variabli^ 
»iinotirnci* it is lost, at uiticrs it is inonlinale ; aeid «nKlation», 
*'lH<urtlHim," and flmuleuce are fm^uenl gastric ayroploms; 
th<! 1h>wv19 are UB)ially coiintiputed. 

rViiwri/ Phrnouviui. — The urine i« sranty, hijrfi -colons I, of 
hij^h apecifii- pnivity (10i'» - IO;J'i). and on Rtandiu); itinm-x 
ilowii an nbiuxtitnt brii'fc-<!ii-l sitlimi'Mt. The Bi>)iiU renderd 
the urine irrilaliiig, so tliai dull acliiue in 'hi- loins and bun»-' 

oiUisTrnrnoNAL diseases. 


I mg in the pcnts after nncturitiou are rommon symptuina. A 
trace of su^r is soiiKtiim-s dckTlcd oo dH-iiii<Mil examination. 
The urine often staiiis llic clotlitw rwi. 

Cimi/afoi-ff Phmomi-na. — IIi(;fi iiilri'ial teDfiiun, iKtv'iittin' 
tiun of Uie w>rlic AcruiHl »ijiinJ, uml u tiMKlcuin' to atherotoa. 

AwTotM /'/muMiwwrt. — lldulnclie, vertigo, diHturUxl fil<«|», 
tiiiriiUMi niiriniii. ii>'|)n-s»iun of ^ptrilti, fuiliiif of UK'Hiorv, la-b 
of ftKTfi}-, irritaliility, »ih) iieiiml^i'* jiaiii in \itrioiiii {uirlH of 
the body. 

Sbqcri-k — .Vrtt.Tial (Kpticralroti, itiicntiiital nepbrhie, 
licMitin eirrho^i^ f^itlriti-s iitiuil or vnurai cnlitili. 

l)lAnK{iNts.- 'Dm n^H uti lliv gdu^al sj'RitituRis aud tira 
analysis of the urine. 

pHoo.VfKiii. — Favorahic niider praloiiged and jitdiaous 

Tm-:.xTMt'"J»T. — HiHX-ial nttfntioi) inust Ix" given tn the ili*-t. 

tTt i!>niiiiH(al(«toetit oGTsll niLrofCciioUA foods, lor ofti-n tlK-oliief 
<IilKiiilty is in di(!;<>sting the starcli«( and siiears. Ligljt iiMiita, 
irif«i v^etal)li>s (f^^, and oyster* are aanii.'wiltle. 1'hc owj 
of fills, heavy meats, .Kweets, siardtcH, and iilr»)lto)ic Ix^vi^^igiv 
raust lie n*tripted. Xext to diet, r^nlar rxcrnso is the iiuj«l 
itu|K>riiint tlierapeiitio tneasiin?; the mticni mnst tat ln<tt or 
hiirn np more niaterial, and the chief «tin)nlaut of lir^ne-nH-lJilK 

toliein jsexemHc. A change of iM^ne may etiect brilliant results 
Frequent bathing with salt water ibllowed by fnotion is a 
vabuible adJntK^t. M'hen the gastric- digi«llon is weak, mineral 
neidii. !4ry<-liniii, iind i)c|i<iin are iisefnl rcmedio. Tiie salts of 
potaKsinm and lithinni an' n>lvenl» of tirie oeitl ; eitrate of 
lithium (}i^. xx), Wnzoute of lithium (gr. v), or eitrate of |H)laa- 
ainm (gr. x\), may Ir- given, well dihilM), two liotint after 
itH-ulK. Mincral-walenn eonlutning thcve k\I18 uuty be rerom- 
itM'fKlnt. Thi* bowels slionld be kept regntar by )<onie simple 


(DUbetM M»llitn*.} 

Pefisitiox. — .\ nnlritional dincaj«?, (■h»m<-lt-ri»il by the 
i-msti i)t prxwnec of sugar tn the urino, polyuria, and torn of 
lit and tttreitglb. 



EnouwY.— tleretlity, adult life, mal^ !«x, llitr Ht-Invw 
nu*, pixJoii^TMl m^utul anxiety, awl ilieiclic (■rr'.is an: |>ix^- 
disp'wiiignuiBcs. It rarelv IoIIowh injury nf ihi- lu-ain urntrd. 

('ATlioUHiY.^Tlic l*«ions found atVr dracJi lave been m 
varied tlitit tlic voiiditiuti nltii'ti is really iie3|Miii!tibI(- iiir dialx-tn) 
is Htill uml«termi»eil. PiiocUiro of the flour of ilie fourth 
ventricle will produce elynwuria, but the comb are mre in 
nhioii IcstKTtH of t)it« region have- been found al^erdeatli. In 
a nutflblc niimlKT of m»e« the |uiiic-re3B is the H?at of cirrlioeiii 
and of fiilty di^^-ix-nilion, 1>ot ihi; rcblion of lliis omdition to 
diahdc* i* still init:iK>M*n. TIk- iivw i» frc«inontly cnlai^ed and 
tUtf Kwit of dcKrm^THion I'-tutn^nt. The kidnciys an- enlar^;«l 
and otti'ii n^vi-fl) I'vidoiKXt* of [lurrDdiyituitons inflanimution, 

Aocunling to ime viiiv, di»l)eUi' lut* lU origin in the KymiMi- 
tbi'tii' rit'r\'i)Ui> synli'in, iind ro<iIt» from ti viL'«i-ni<>l»r<ii1ntulion 
of the lii'jiatifr vi^'m-Ib faiwiiif; a ili-itiirUiiKv of llic nlvcugcnic 
fuiiutlnn of tho liver and the dii«-liui^' of ^Idi-usc in Ihv nriiiv. 

Aooonling to antXher tliiiiry, dinlx-tCTt rosnhit from a funo- 
ttonal or oivanio dimwe of tltnw ornins, (Huliinilarly Ihc (wi* 
cresm and Tiv«r, which are engagctt in the n.-^imilaiion of 
Btarehes and sngam. 

SyMiTDMK, rfi»fir^ Phemnnena. — The nrin<^ ii* iix^reaitrd 
in ■[iiantilv, the nmount varyins fpoTi three or four j);nts lo a** 
many gallons; lis color is pale; iu fi|>ecifio ((ravity ran)r(4 
from lUIo to 1050; it has a h-weelistt tasle and an aronintiu 
odor. In sutnmer it attracts flics aitd rapidly ferments. It 
may leave a whittl^tl rraidiK'onthodothes Tho |M!n«ntaji;e of 
gldco^ varies from a lialf Ikt cent, to ten (x-r wnl. ; the total 
amount Gxorvtoil in twculy-four hours varies front n few ouncoi 
to a poumi or morr. 

Grruriitl Ptii-noutfuri. — TIhtp it Uws of flwh aitd strco^^th ; 
the lcm|i>TUliirr- 'm nortnul or subnormal ; Ihc npix'tite la ofien 
inordtnat«>, and tin- lliintt uixjucnrlmbio; Uio toueue la 
gciionilty (K->urcd and boi-fy-nti ; tho bowcU are osttaliy cuo- 

Cubinrtnui Phfiifmiriiii. — Ttu'skin ia li.-ii^liaixl dry, nnfl fnv 
r|uontly 111* wait "f iuii-ii** ildilnii;. I'mritnn in cjux^cially oli- 
KT-rvi-d at llie genitalia, and thiR may Ix; the (ir«l Mtbjcdn-v 


DoNnTmrrioKAL diseases. 

Nerrow Phmomena.-^ Hnulache, drprenrioa of «pir 
dimlni'^Hil iir luet {mit-IIiir rellox(j<, im|«ire<] »cxiial gwwv^ 
dinifvt'ss <>(' vUi^Mi, jtiul iK-iitnl^. 

Tlic litimciitu vnrifH tVum h few w<«k8 in che acute rurm 
nuiny yiMi-;* in the clintnic fbru). 

CtoiiMJCATloNs. — PHlmormry tulM-noiliMU, pnvnmoni: 
)^n^-ni- of tW Iiiii;;; ((■.•fcx^livv vii*ktii from Mill i^lami,' 
n-titiilLS Ml' »ti-ii|iliy uf the Djilio niTVC ; oiilaiimti-s l(s«i<iii», im 
\k>>\h, c'Ou^iui, ■iirhiiiK-Ii.-K, iukI ^^greue; »c|)britU; hikI 
«lialx-tiv cimia, or m^oiunnia. 

Tliis bet <«>iiclitiun Li (-haraderixi-d It)' <>|>i^itri<! jhud, <\y.*r 
pnua,»BWWti»ho(I<)rorilu! hrralh, hctulw^he, (h-lirittni, KUi|M>r, 
Hud HMna; it |m>habK' rvfmllciti'oiii tlw |>nwiK«rif ciia*»iic«o(l 
ojtylMityriu :w'ut-i in llie bliMxI. 

L>M(iN<)HiA. — ('arr mii-Ht be taken to dUtiit^isli simfde ffb/' 
tMmiriu fr»ii) iliiilx-tfa. Tlie fiirnier i^ reoognitied bv being 
trnnRient, and iinasMfciatol with tlte constitutional symptoms of 

Pruritus and apparently ran!M>l(¥« loss or fledi and strength 
sliuuld lead to a siuipidon nf dintielat. 

I'lMKJweis. — Th* voiiii^-r the patient, tllP slrongor the 
hereditary lindeocy, tlw? larger iIh- iicnuunt <if sugar cxfrt-iwl. 
the ]ew tlie g;ly<.ymtria ran be coDtrolled by diet aloTic, the 
graver the prugitosis- On the other hand, when it ownrs after 
middle life in a^eociatiun with a gouty dtatlHMts, and tlio gly- 
ccM^ria IB not pn>»onnred. llie pragnosi^ tor a lung rbiratioa m 
eum[Kinitivvly liivoniMe. Absolnte cure in rarely attainable. 

TllKATMBXT. ftiiii-tic Tiifitrnettt. — iSiigars uiid sta^<^leB 
muHt bv H'ctrietvil. Siiiiv Ih*.' ]uiti(tii'iiappetitc tsofieu inunli- 
ualf, it i.'^ iKiiwNiry to rv^nltito iho oitiinrily ai»d diameli^r of 
thonc RkkU wliicji are irco^ninxl 03 adnitMiiblt.-, The lullowiog 
fwifU may be inolinkxl in the dietary : — 

AniiHiif Foixl". — bleats of varioui* kinds (exwpt IKtjt), 
giiiiK-, light bnilh* and »>iu]>%. IikIi, utMl ty^ps. 

I'tyftotttfu. — O-Utv. lettuce, caul i flower, ti'mat*><*, muxli- 
ruomg, Mring-lKiin«, voting oaton«, f>liv<-», watT-cnrst, tuxl 

Iifwraffe». — Rtiltennilk, skim milk, lamr wintA (Rhit 
wines), earhonat^l wnli-n*, ami oilT"! iiihI t<^ wilhotit Riigar, 



RflijJifJi.-—^}iatA of all Icindsi («][flFpt i-ii<»UiiilA), nn«iu flbwsi', 
aiul |uckl<-.-<. 

BrauL — Hw-iwl niiwle i>r^Iiiicii, lirnii fl»ur, nr alnKnid floiir. 
It should U- )>»i-i)i! ill mind lliai all itio gliiitii fl<»ii> iiro ritli 
ill Man^i. 

FruiU. — Cranbemps, sour cherries, limoa, lenw>ntt, and red 

SutuitUtdfs for flut/tir. — Sarcliarin aad (tlvrtriu. 

The fiiUowin^ foocU isliouUI be avoiiira : I.iver, oystvTR, 
wlii'at bri'di], biirculls, iici-^try, |>otiit(>i>!S If^l^. (urrnl§, jmiis, 
liinii|», |ianMii|)6, wwet-t Iruits, rici', Isiiloy, tajiimii. coni-siaix-h, 
<x)rn-ui<'al, vhocolatp, cixita, syru|)§, preeei'vcff, RIhI Di«iit liquttiN 

Jlifffiirnie Trm/atri\l.~(imduat€deX€mee; freqticnt bulliitiff 
with m1i water fnliowcd liy frictiun; tlic tisp iif ftnuiwl 
un(k<ri-li>tbii>g; pk-iity of rvrt nml ^efp; aod, if jKeBibtc, • 
change of sit'iM.*. 

Mf'Ufiaul Trf^ilmrnt. — Tuuice like Jn^i), iirwiiic. Hirvi'linia, 
ami (iKj-iivcr oil iirv ofU-n iixliniu^. TUc Mjxfial icmi-dira 
arc <>|iiiim sikI its ulkaloiils^nturphia uud iv<ii-iu^ bi'omido of 
ar»fnic, cr^, unlipynii. Milivylalo uf sodium, mid iiIkalicB. 
Opiom !» p-ix-ralK* tli" duk^ iL-H-fnl <ini^; it »)k)iiI<] bt- ^iveii 
in snintl dtiw* (jrwiiiiiliy iinT(w.«<.iil tin- {mticiit hikctt five 
orifix grniiiT; ilailv. Cmkria (j!r, i iiicifattil tnfn"- ^j »day) lis* 
Iwfn tbougbl |iiT(i.'raUi? to cither opium or niorpliiii. but atitjr- 
dinji; to the cliniral i'X|"'riiiK'nl<« of ItniiT ami Oflir, moqihia 
is much mim- reliable. The laln-r may !■■ I'lnptoyol in tli*i'« 
of oup-fotirth of n pniin ihnrc or iimr tiNM>ii daily. The bro- 
mide of arecim-Ui~ini»-iini«t of di' valiio; it may be giviii 
in tbc Ibllowinp solution : — 

9 nnwnici hrom. ((iPtnoiH), ffif. 
81^.— Two to Ave dmtM well diluM aftmr menln. 

Ill jro4ilr |iatienl^ a cruirsc of ( arMflid ivat<-r witb >(ali<'yUlP 
of M^ium (ir. iij-v thri'v daily) and autipyriii (jjr. v-X lliri<ie 
daily) may be reeommcndMl, or : — 

9 SodiltatlrjIaL. silj; 

Lit). polAM. flrMulllB, Ol) ; 
OljcerintP, 1?) ; 

Aq. dnnuBiioil. a'l f^iO-- M, <J. ('. Wo^m,) 
)Ug.— A tctupnonfii) II) a daMMtopaaanirtJirio* •ImIIj' 



IKabt-tic ootnn is always fatal, but Iho inlnivonous injedioD 
of a copioiiA »)Iiition (3 per wrnl.) of bi'^rbonate of nxlitini 
may give a few liuum' rtS)Ht«, id which oonttdoosiKHR retnniH. 



DefixITIOS. — A chronic; <x>in!i(iiiii cliJiractfriKod by 
cxcnrlion of larp- <]iiai>tittr« of p«|i-. limpid iirinr of low qjccili^ 
giBvity and fn.r from nlbuniin iiimI Hiij^r. 

{)riOL<x>Y. — ]>iiilH-t4« iiisiitiiliM iiiiiMt bcdiii^iiigtitiOicd froDi 
t^R- simple polviirin utN*(-rv*^<l in cbnwie miul iiim.-uM.>, in cer- 
tain (lifcasm of till' bmiii, aw) in »»w n\*f« of liystvriu. 

Diabctw iiwipidiii* smriii-rifm-s HcvcIhih wilboiit otjviyiii 
caii!)e. It is tnon.' coniMion in Uk- y^uiig, and more inaltw iif 
altai^kecl tliftti fi-rna!c». It i:* miivionullv li<;ri-»iilary. It lia^_ 
Iwcn iiKlmt-ti Uy injury ami by cfrliitn ilijtea.'Wi* of tbo brai^f 
I'rofiiiinil cinofiDnal disrurtttniift ban «X«it**l it, Sypbil^^ 
overwork, iinil tin* fr«> n.^- of miW water when the IkxIv lia* 
bocn ovcrlical"!. an- r>*]iiit»-<l <aiii*<«. 

I*ATiioi,<xjv.- — liiltlc is known of ibe patJKiIogy. TIii^ 
l(i(!ii<:'y>< arc frt'()uonlly «nUr^l and isongralra, am) Uit- iin;lrr» 

The iJioory whirfi is generally aoifptwJ it« mvminline for 
tbr )H)lyuria, is that it « dno to a vaw-m»tor panwiit of Ibi? 
renal v<^«wls, which permits a fn* iran^iidalinn of liipiid. 

SvMmiMS. — Thedisease may U-gin iusidioiislyoraliniirtly; 
the lallffr is the riiK The urine: Tin* rjiiantity i« incn5L-*'<i, 
(•nen a-* miioh as eight or ten qiiarls Wing oxcrrted in iht- 
twciily-fmir lioiir^ ; ft is palf, and n>wBiblcji water ; it ba.'* a 
^jK'cilic gravity of 1002-1(X^. Tbo total amoant orsolidn H 
not dtniniiMiotl. Albnmin and sugar are gfioonlly absent, 
lhoii);U iJiem may be a Iraco nf tbo latter. 

(j^ieiiil SgmpfomM. — Iitfatiablo thirHt ; gixxl appetite ; a 
burtb, dr>- skin ; a dr>- tongue ; MiDstijatiun ; mental ajiatby ; 
at»d emaciation, 

DfRATiox, — Wlwn nnasBoeialed with oi]^ai)ic disease tJie 
duration may be iadolinitc. 

CoMPi.»-ATio\«. — TIk-** art: ninoh li-ss «>nim*<n llian in 
dialx-tefl mclltUiH. ('atunu-l, pninliu:, Imilo, and liilK'rc<iliisU 
Iiavv liecn oUx-rvtil. 



1>1A«)>'»»IS, Diitfifti-* MfililuA.- TIh' ti>w sjiooifio jjravitv 
ut' tlic iirinv iiik) iIk- ali»<'ii('e oi'-'"i^r will mtvc Ui Ji.>4tii^iii>li 
(liiilH-t4f inHipiiliin from diaU'K^ iiicllittii>. 

Jnt&ylitiiil .\V-y»/u-<(«i.— 'I'Ik" pro^noe of albiiniUi, hynliu« 
ckmU, high arlitrial teimioo, aooi-nttialion of the iHtrtif sftxtiitl 
soiiihI. iiiid iIh) cnitliac ln'|M'ntti)>liy will ittdicttlf ne|iliritii). 

SifTiifilijtmitii' I'lilyurut- — -Tilt' liwliiry iiml a taivfiil jiliviiival 
i'Kiiniiiiiiliuii will tLiiuilK' prT-vi'iit mi i-mir in diagiiitHU. 

I'fKMiNosis, — I'wiiilly iinfiivomlile. A (lermani-nt curt' w 
siiriii-ti 111(^4 clfvcttHl. Ih^iUi iviiiiltH rmiii ojilmiiiilion, or ni4>n> 
Cn'yiii-iitlv, from siMiut iiiUtrxtim-Jil ilijK-iw, 

TbjiatMKST. — Tln! hygk'iiic tn-WiuoiJt i<iigw«t«l fi>r dtnlteteH 
iiir-llitiiA Lt n{)]>liial>le in ilii.i ili.-fn.^t. No iKnii-lit ifi ()<Tiv<<() 
I'niiu cutting ufi' t\u- ntno^iiiL of vnUr drunk. IjOinonatU' aiul 
i>[|ier at.-i<l di'inkh may wrv« Ut itieeu tin- aiiioiitit of lii|ui<] 

Tbe rempdics rfmrnniofxlfxl nm i^rg"*, Rtn'clinin, opium, 
%'aleriait, »nd nitric acid. Ualvanisni — one pole npplit^ to 
the ueck and tlie <ilti«r lo tl»c loiiiH — iiait gtvi-n i^hnI ivvuIIm. 
W'hou sypliilis » sii.H|wt>t4Hl, (ho nM)nriirial.-< und iixlidi-M may be 
ndmiaist4»«d freely tvilli giHxl Iiojm^ of u HKinwifiil inKuc; 

n Pulv. fltiii, itr. iv ; 

AciJ. Knllicf, Sij.— «. (II. C. Wwu.) 
Ft. In chart. So. itii. 
Sig.—Oae, t\me or toot liinc* daily. 




TTtPW «viit(i«l, fnrtlic iiuirt ]inrt, iif I1.4W of [wwcr, or _ 
h'BiB, and maiitfi-sliilion «( iiirtlur oxriluliiin, wioh a» ranvnl 
itioiiK, clioTcifuri)! tiiovcrDoiilii, mid livnitirs. 


'I'lie ))araI\-!iU may lic irn?|(;ularly diHtributed, or it iiiiiy in 
volvfi a single member, wh«n it b Icmied mmioplrgia ; n liiu-ml 
Iwli'ur llie IkmIv, when it is lernicil hemlpftt/la ; or llic body 
i'nym lh<> waist oown, when it is tcrniMl jioi-aiJegia. 

Irregular paralysis mjiy nsult f«>m : — 

1. l>iv-.i[iiTi:itiii l^^-i^^Iw in lliv niotor aivoB of the brain, 
wIiHi .tn- commonly eyphilitjc. 

2. 1 #>i(«w in the baHal )^ni;lia — {tuna, cmm wrebri, mt-du 
w[i<'n it is often aer^att'd witli headadie, vomiting, vrrii; 
and iijilje neuritis. 

3. A<nite ixiIiomyotilU. This d<>v«l(ii« abruptly ; it occtira 
in yoiinjiphildn^it ; and it !i> fMlowii) by mpid im|ir(ivnnciit in 
si>m« miisclt'.^ »nd |)^-rnianonl Atn)|>hy snd |inraly.-4i» in ollK-n, 

4. Clironi*! pidiomyelittii. Ttits dnvvlujM ill middle life; 
begins in \\w xmiill mii-'«'b>H nt tho band ; is asftocinU^] witfa 
atropliv ; anil iini(rT«-ss<n vt-rj- slo^vly. 

5. ldio|)ntIn^ inntwidar ntrii|>hY. This oommonly dovr-Io_ 
during w]cd«>siviiii> ; iuvulvi^ thAmaaale(ioril»eiirni,«t)onl<lcr, 




buttocks, and tliif^t: is at>)u>i-iated with atrupliy; and van be 
fi\i{iii-iitly InMvi lo InTwlity. 

(j. IViKiu-niiiwriiliir iiyiKTlniphy. TtiLs (lcvclo|)§ in rhild- 
rpii ; i» :v»>H-iiU*^i] >vitt) cDlar^'niciit of the affedeti niiiHclui ; 
and (tin Im.' fnx|iirnth' tnutxl tu iK-Tcdity. 

7. Miiliiplf nvtiritiw. This i» nptxt^nizfU by tJic hb^ory, 
paiti, disttirlwnocM ut* Mii^ulion, an<l t«.>n<)erri<«s uvvr thu nvrvv- 

f*. Syrinj^v-iiiyfliu- ThU in rair; develop* duriiif^ ado- 
h-stt-iifv; iukI i» n-<'<i;fiiiyiit l)v iKiiiii^, ntnijiliy of the iillW-ti^I 
iiiu.'srlra, n i^piLslic iiiihiiiiiiu of ihi- punilynni rminlM-nc, oihI » 
huM of (hvrnito und ininliil xiiisnlJoiM, whik- Utetilu tsL-nsatiou 
w n-fniinti. 

Monoplegia may n-milt rnjo) :— 

1. A iVical li-sion in th<- (fiftirti! mrtn of llw hrain. This 
may Iw r<■^t))It^m■^] by liic hUi>>n>', tlio [i1>«-ii<')' of wibilin^, of 
wujiiiry disiurlianivn, ami of tin- ii-jiitionn o('<|c;p-iii-ration. 

2. A lft>i<iii of (Ik )ieripiii-nii m-rvc, front tmuiiuiliHni, aeii' 
rltiri, or ih« irreoBure of a tumor. Iira<-hiul moiurplivia fnt- 

3ueiitly rE^iifls fniin llii" pn-flaiin- of (Itn \uiui on thi- arm 
nring slwp. il[onopli']iia of jN?ri|rltiTal oHi^iii U nx.«i|fni»il 
by tlie history, tho watiinj;. lli*" •tt-uMtry iluJuriianun, ami ihc 
pre^^noe of reactimi^ of d-^^i-rati'iu. 

3. Ilysjcna, TliU may be nixivniixied by ih* tiintofy, ant, 
and tempiTammt ; Unf psruxyEotal L-lander fA' \\k fnnlyiiK; 
tbedbitiirhamtv ofKUMtNin ; and unntnu4nr» viiltout alr»(il>y 
ur HiYtri'sil dbiliirliaiMKn, 

Fnnid iitf'.'ij>!'-ji'i may p^nll frotu a Miull li:*Mfn !n iIm; 
fill -ial <«n ire of tin- '■rrit-i 'If ill (tw mMlullB; w from involv*" 
ni<-nl of ilip Mt\- ill lix' ransi of ilxi- letD|naiJ Ifim; or niW 
it« i^it fnm tbr <4rl"-nn^'>id fitrsirw^i. 

Facial f/i/j^ptn iiifolile Iw-iaJ ptusljrai*) ggaunlly rawilu 
fnnn a knoo at the Lv«r nf the lirmin. 

Hemlplesta imy mnk frMii :— 

1. A 'lifTij'* leaino «f IW uMibyr enttn. 'JIm fMnhuu it 
on tlw QfipaMtd adr uT Um Ujjy kmI i« wwmvmImI Mdh 

2. A Wim of itiF 'OU^^ul '■■• 
(cnqna rtfi^WH »wl «»*« li-.—..— ; 



uommon Hciit of lumiori-hn^ ; llitr {Nimlysl? i.* nti |1m> n|)|H)« 
ndoof llio htxiy iukI ii^ iiiiiii<t4iic-iiiUtl vrilii tituisllM^iit. 

3. A Imon of IIk- <-riiit (x-n*iiri. TIim rii!i|m-iilly [trtMl 
liriiiipli^ia luicl ItiMiiiiiriiisttlH'niu oit lli« <j[t|.K)!<tt4' Ki(li% atit] 
iilvHtH <if' thv ■H'lilii-iiii.itor lU'rvi.- cii IIk' i^tk- til'lliu Itsiuii, indi- 
(■jili-d l>y dilnlitl |>ii]>il, MrahUntiiH, iitid jiKMitc 

4. A IcMoti 111' llif iKiDH. 'riii.i fi\i|iu-iitK' priiddns lit^ni* 
jiIcgLi and lu'iiimnmst(K-j>iii on ilie opixnile »ide, luid 
[■aralvab on tlie sidv of tlio Icnioii. 

•}. A Icftion in llie iixfttilla. Ttiit* i.t rare, and ii a 
with parnU'iiitt of llio i-Rtniiil uerv(«, dit1i<-iiit aitiinilatioa, 
dian aud rt^itiratorv diftiiriiani-ei*, nnil \'na)iliiig. 

6, A iiniliifral lewioti tiigli iu tin? lunl (veiy nn). Tliis 
prmliK-PH a hjmibIio jiaraKsiH on tlic ^idi' aflti-l'il, »iid bi-nnawefi- 
tlicsui oil llie opiH)!iiU' wdo (" Brovfn-St-iiiiaixi'H niiralviiis"). 

7. Hysteria. 'I'ltis niay be rco^iiizHl by (be history, 
and leniperanieiit ; by Ix-ing rrcqncnlly jmrosysnial ; by i: 
iifi-iociation wilb 6trii!^>rvdistiirliai)cira ; by tbi*al«*not' of wi 
ill); and of abuormal electrical nnctjons; aud by Ibecerspe 
tbe fiu'ial musdes. 

Paraplegia may rcMilt frum : — 

1. 1 Iciiutrrlin^ intfi tlie ntitl at llic donwl rpfnun 
jKiinlysis ik-vt-l'jfM abniptly, ai>d is u^«lKrilll<?tI wilti ojmpk- 
nnicdtlK'^ifl and invnlvcimtit of \hv blaihW hikI rvrliim. 

2. HeiiiorrhajH' inio ibv mi-uibnuH-* tiflbc t\irti. Tlic j 
alym dcvcliipx rapidly, \ml mon- t^lnwiy timii lb«- pixx-cdm^ 
in aN^wiatt-il uitti itiu-uiw l<.<nri»g |Kiiiij< uiid iiiM>iii|>li-1r a: 

3. SoiucliiniiH of mtiltipli^ nntriti^. This i.t rctv^iitml 
tJie patn^i, tlio distnrlmniv^ of tv-nsatUm, ihu litHltTm^^ ovi-r t 
tHTvo-lrunki), bikI tlir nbsctiue of " fiinDi^ |«iu" and Kphinvt 
i n vol veil lent. 

4. Fracture of tlw vi-rtebrw. 

5. Amte niyelititt. The [laralyaiR iWelopa in the «Hin« 
a few days, and is nitfuriated ^viih anieslhfiiui, bediMrea, iiivol 
ment of (he bladder and recUini, Icea of re^excs, and vmMi 
of the m)ii<-l<«. 

6. I^ndry's di»aiie (aciit*! nwiendinc [tarRtysis). 'niin <!> 
vi'U>jM in the (xmrse of a lew days, aii<l in unaMUMuaicd wt: 

bimntEiAScEs op uonoN. 


nnn-iiillM-Hta, vraMmguf thv niiiiKites, bedaons, or 8])bii)clfT in- 

7. <'lin>nii' umiitis. Tlits dcvclnjiM ovor scvi-nol years, ami 
in a-stMH-uitHl with tiiimbiK^s^ ami liii)|ltng, iiKii-aTiitl rcflexf?^ 
iiivols'puteni ut'lhv l>lHii<k-r nmi rtiluiii, anil atui-Htiii-Eia. 

S, Compi^Ksiua of tlie oircl i'roin nmrliid j^ruwthg, aiicurt^ni, 
tifApinal cancs. Thin may Ik; n-cntfrnizwi bv th« liifttorj-, the 
<«yiii|>lotus of l)i4' primHiy <li.'<i^viM-. IIk- iii)!i.')^ili<?sin or liyiH-r* 
a-s(he!iia, hihI IIk- inluiM; |)«iii.v rii<iiuliii); along rlic liut; i>f' iIm- 
fi|>iiial nerves. 

y. Lateral Kr^k-iTMtB. TIm« cWt.-lop!> slowly aiid is aBBociaIrd 
witl( a i^jiiiiMk; condition of tli<- miiwlcs and with iDerea6«) 
rcflfxw, ami IaeJc» «.tw">iy (iirt«rtjanct*, 

10, Injury of (In; lirwin in ili-liviTv (is|iii»Ih- jmraplegia of 
rnHitilN*^ Tin- nyiiijiliniis ii-!«-Hiltk> iaiiivl im:1ct(»^ii, aiid are 
iiHi'ii iLtMK-ialiil will) iiolHi'ilitv or !<ti(M'N'. 

1 1, Hyutt'ria. Tlii-< nuiy Im- nii.jjiiiwd liy tin.' Iiislon% sex, 
anil l(-iu{KfmnK-nt; by bi-tnj; frtHjut-nllv |>an)xy.-niiil: ami by 
tl)i' aliM-noe of woMliiig and of atmoriual eitxlricul rcaclioiis, 

12, Cai3»>a disease (divers' ihtralysisJL Tliu history vr!l) 
F)ttal)ltsli tlie dit^uosis. 


A convnbiion m a condition in whioh there are escnwivi^ 
in«»;idar contrartton«, <»nliniui) or inl«nniltenl, dependent 
u]>on an involimtar}' dii^Jtarge of motor impidsm from tite 
nerve-e'en t rtis. 

Intcrmilkiit ci>utr<i«ioii* arv termed r/ow/p; coutJuued «wi- 
Irai.'tions, tonn: 

C-on\-idition^ may be f;eiteral or liteiil. T1»c tcmi «jxr«m is 
«onii'tim<« applied to the laller. 

Tlirro IB iio rcflil line of distiix-tion betwwn ruiivnlaionN, 
('!nin.'!ri>nTi nii>vi.'iiir'ri(-, hikI ireniors. 

Varieties of ConvidsiouB,— Thn* varieti<w are freqapntly 
mini'': (li Ki'ilq'lift.rni ; (2) Maiiw; (:i) hy^teroidal. 

Epileptifonn ConTUlBJOOS. — In lliis form there is tincou- 
»uon!!nc!«», and the tnovcniciits are for the tuost part etonie. 
Kpileplijbrm convulstous may result from >- 



1. Idiopalllic (-pikikti,-. Tlii« coiKiJliuD uminlly <)cwlu|i 
before puberty, and Iht; i^iivulsions arc j{ciiL-ni] un<] miw 
uuassucmted with any (U-liiiiic nnw. 

2. Or^iiic biikin <lii«(iH»(-. In tliii* cvndiliuii llicrv niar 
a liistfiry nf »v|ihi1i.i or of iiijnrv ; IIm: ctitivtilHioiin niav U 
local, ur lii-j;iii as »iicli iiiiil liwonw; p-iiiTsI ; iiml lliv-n- iimy tx 
oun»>iiiit»iit ityiii|iU'iiw of (vnibnil diwti*'. 

3. 'l\)\ir ut;<^'r)t.t in lliv lilootl. Alwliulbuni, Uie i»i<M.-tio4ii 
fi^vens mid itnvnii« nn- rrt'r|iii>july tituHK.-i»U-<l vvilb oonvuLitiDii 

4. Rcliex irritation. Siidi (:i)iiviil«iiiim im- ti:4iiiLtly olMerv< 
in ynang (-Itildn-it, niid ix-^iiilt from (ra.-«lr!o irritntiun, ati a<l> 
licrent )in;|)ii«e, intt^^iiiial [)arft.-<ii(S, or (cHhiitg. l''<invulHi\ 
spiKurcs .wnielime-H n^idt fnnu (In- iiijtH-tion ui' nuliHtaixi^ inb 
the plt^iiral sap fiir the ciire nf livdroilmrax. 

5. (Vrcliral aatemia. Sufh tniiivulitioit!) are seen after pro-^ 
fuse hemorrha^, in fatty heart, and iu poiMiiiing front cardia 
jtaralyzanta liko aconite and veratntni viriile. 

ICcfampma. This term is aj)|>ti4<d to ilesignato accident 
ornviilfiioiu, such as the noiividHioii» of childhood tcsultiiio 
from reflex irritation, and the ocHivulsioiw of piegnancy in 
the |iiierporiiitu, n-eiiltin;;; frutu toxic malcriak rvtaioed in tl 

Tetanic ConTOlsioita. — In this form Ihc diiH-lmr^-M cRianflt 
from tJic spinal poru,ai)d arc not »«wci«l<yl with a ItMiuf < 
scioiisni!e8, Tcl»nic convnlnions may itwuII fnitn ; — 

1. TftaiHis. Tlii» i;< n.'^iofitiiwti by llic hii'lory ofn wound, 
the tonic chniui.-lcr uf tiic (•oiivnUioti.'", the (."iirly ilivolvc(ucnl_ 
(tf the jaw, ami tho al>i*cjiw nf fcvw. 

2. Spiiuil ui(.-niii]ri(iM. 'I'hu is n<(«qn)<nN] by exqiiiNite pati 
in the back, fever, ami Iittu involwinent of tho jaw. 

3. Si rj-dmia- poison! 1^. Thw is n-4.-0)rniBe<I by the histttryj 
the intcrmilleitt charairter of tht- (xinviii»<iiiii.'>, tin' nltMHiee uf 
fever, aiwl tiio twaijw of ihe mniti-U^ of th« jaw until vi-ry laie. 

4. Trtiiny. In this wndition the i-xtremitic* are chiefly in- 
vulvul; the convuUtoiM arc intermiltenl, and can Im; prixliiccdj 
by prcKHiirc on the »crvii« imd nrt<'ri4» of iIk* HlTecKH] liniha 

Hysteroidal ConTtilsionfl. -TUw*: arc numilV-stations of hys-J 
teria, and in thitii i^ma-ioifrKis* i" only |iartinlly or ai>)ian>iitl; 
hiet. Thtry art' not pritn'^Iul by un anni, but somcUnioi by r 



m>n°uition of a ball in iJm? throat — the "globus hyetcrkiiM ;" the 
in t^ are jwrtially cloired ; iho face expreasts eomc c-moliou ; 
tt\e tongnv is not bitteu ; th* movpmenta are toiii<;, or if doiik', 
appear wilful; the [loroxysm is of lonjf diinitioti ; and the 
juilii-ol frv-mienllv wet-fn* or laughs. 

Local CODirayaDS or Spasm. — Spam <^ the/aa may n«iilt 
I'mra a (I) conical lesion in the inferior portion of the iMcend- 
ing fniiital mnvohition ; (2) from He ermrfifiiij' — a cotKliliini 
i^tnrring in young diililren, affecting tin: facial and neighhor- 
ing muades, and a^ociated with miraicn,-, a leudeucj" to ut 

[trofane language, and varimia mental disliirUinccs; (3) froidl 
labit (fiahit-d)orea') ; and wmetiimfl from (4) tie douitMrma)^- 
ueuralgia of the fifUi nerve. 

Temporary gpaama of otte arm or one leg arc usually nuini- 
festations of Jot-ksonian epilepsy (focal c*pilv|Nn'), hut Ihi-y 
si:imctinies rrsidl fmni hysteria. 

Spium\ of tfie haml deveh-pinif when thr mrmhrr w }»U h WK 
may result from uritera' t-ranip, Thomsi-u's diM'UM-r or 

Sptum of (hr eirreicaf mturfm (wn'-m-ck, lortieotliv) may 
rtwilt from <-onf^-nitul idiort^-niiiKof ttic if4cmo-mu«toid, myal- 
gia, hysteria, cari<* of tlw: vcrtchni!, or litv irritatlou of rn- 
largal <!cr\'ii-al glnnd^. 

.Synijnivt of the Ifiri/iu, •rmmh'tijwi, and rfwi/iAiyi^i (liirvough) 
havi! aln'^ily U-i-n distmNWu. 

Saltatory Spasm. — Tiiiii t«rm is cniployKl to diiiigitalc n 
conililtoii nlliiii to hyrteria, in vrhicii u violent »\)as\i\ fti'iw-;' the 
muscles of the log as !«x>n na llic feot umch tin' gniiuul, ami 
as a r««nll the patient is llmnvn violently inio the air. 

Salaam CmtTnlsioilfl. — Tiie^K' <-<>tifsi»t of viok-nr pamxyiinuil 
bobbing movements of tliu h«flnl or Iniiik, ami may Ix* n^nif 
c'Jatetl villi Ityi>t(.-riu, i-hon.'a, or nuviy, organic bmin discaiw. 

Clioreifonn Movonii*ntH. 

'rhi'!»i:* arc coat^ie, }erky, irregular, iiivoUintary moveroenta 
wliicli (lion? or leas eimnlale pnrj>o«ivc movenieniK They may 
r(i*ntt from : — 

1. Idiopathic diorea (^ Viliia's daam). 'Hits dtsenst; is 



(wen in diilclrcti ; m u»mil1y itiikl ; mm a ooukc of MnTnl 
wwks; sn<l U ]tnitn' l<i k- riilltimril bv wtdotwrditij*. 

2. (.'Imn-a iiiMiiiiuis. A gnivc disi-a**- occtirring in mIiiIis, 
(s|MH:ially jufgnant «-i>iii«H, imd churactcrizMl by violent mov6- 
uii-iib, (li-li rill III, mid Ivvcr. 

% Hiinliii^lun'M dwrm (vhronicdwrca). An alllxlujii oc* 
r-iuririj; in udiitt life, gcnvntUy )i«-nxlilHry, and eliaracti-rixMl 
liy im^uliir movciiitiits, dirtiirlmiKx; of fitocdi, and incn^iMii^ 

4. Or^iiio bniiu diiKsiM*. Cliorraform movements are ire- 
(jiiMitly ob)«erv«l in cerebral {laJMes of diildren; tbey may 
nl^o develop on mie »ide nf the ImmIv Itefore an attack of a\Kf 
jiiexy ()ire-heniiulcgii' chorea), or in tlie (nralyzcd n>ciuliPt» 
after the liemorrbage (itost-heniipU^io ehoi-ea). 

0. Peripheral irritation. Oioreilbrni rooveinenfaisonietiniefl 
develop in prc^nanojr, and are occasionally noted in stuinpa 
after ampulation. 

6. I'labit. Cbildren frequently acquire, tfaroui^b witstanl 
repetition or mimicry, cfaoreiform movements wbidi may l&it 
!u definitely. 

7. Hysteria. The marked rbydimiml chara<'ter of tlie 
niovcnH-nlH and the history will aid in lliv r«x)^iition of 
liysleriwil chorrai. 

8. Ditv^cminutcd cerebro-epinal srleroeis. This dJwnsc usu- 
ally inducc-s tremors, btit not iittouinniouly tl»G DHivenienta are 
choreitorm. The incrcaseil rrflcxw, the (lyslajfrnoK. tlic loǤ 
uf iMwer, the Kjuistio giiil, and the inipuirnietit of iDlcUect 
will aid in its recognition. 

\). I'anunyoclonuH mtiltiplex. A ver^' rare dwean, of nn- 
knonn origin, characteriwd by ountinucd or paroxysmal 
choreiform moventents which develop or incn.tsc under ex- 
citement or movement. 


This t<no WMemploynl by Hammond to des^^nate tertain 
inovfincnt.'' ixwnrring chiefly in the bands and feet, and charao- 
tiTiMil by nU'W twiviinir. intertuinin^, ee|)aration, and exten- 
sion of tJ'ie lingers and UtcB. Athetosis is frequently obm^rved 





in the c«*ii«I p^^sics of eliiWfwi, aiwJ it ooca^ionaltv ocoiira 
in adults as a n^uli of li^iioiis in ilic liOfa] gaiiffliA. 


A tremor U a fine vibnitorv moviiiK-iit <)iii> lo ibp allvnuUc 
oontnution an*) n-laxutiou uf niiliLpxilttio miiM'lis. Tromon 
are oheenwl in Uic tullowiti}; coiKlitioiii': — 

1. Tb«^* mar exiel frum birtli iina.-«MM'i»UHl witli otlier 

2. They niay ckiNMid iijwn n lowenxl tone of the nervous 
SfBtt-tn, )<ein<; fntitx-titly i>lH-rv(^) in nc4irantli«nui and tu the 
COnvalrT^icmr Iniin »<'iit>' tii.-x «.■*»■. 

3. Thi-y may he toxic, rennltinj; fmni aloi>hi>liKin or mer- 
curial unuioiiin;;. 

4. They iniiy be due to old age. 

5. Thoy air- fnH|tienllr a .tvmptom of organic diaeaiw of iJic 
brain nn<l conl ; ax ituch, ihcy are i»e< with in [taretto di'iiumlia, 
and cs|H-<riiLlly in di8i>eiiiinat4-d M-lenxits. 

6. 'ItH'y may lie the <-hief iiymptoni in paralysis agitans. 

7. TIk'J' may I»e hysterwal. 

The Gait, 

Tbe Ataxic Qait. — In locomotor ataxia lh« iiaiHtit raises 
the fuol lii^li, ilirowT* it forward, and brinss it<)own MKldenlv, 
so that th« whitle 8ol« oomut in oontart with the fliHjr at oim^, 

BpaitiO Gait.— In f|iaetic ]iara|>lr^ia the niuvinienia are 
stiff, iho kiiiv? conic lugrtlicT, {Uv leg drags bi.'ltimi, au<l Ihe 
toe catdice Uie ground. 

FMUaAtin. — Thi» term is appliett lo the jrait of ad%-tiQn>d 
paralysis ajritaiis; in walking, the bc«ly inclines mow and 
niorv fonranl, and the steps grow iWrr and foMy-r until the 
jHitit-nt foils. stRii^'htens himt^elf liy an cflbn, or fimln siipitort 
111 wiiMi' ri''ti;fil»irinc object. 

Steppage Gait— In chronic nmltiple netiritis tin? nalient 
raises the foot high, tnms the toe up, and briiWH tlic be*-l dtnra 

The Gait of PMndo-mnMuIar Hypertnipliy. —The icrt Mi* 
wi.l.' amti. tlLc k-lly i>r.rtnidi-s,aiid ihu movcniL-nts ar.; .-Inm 
and waddling. 



Titubation.— Ttim t4;nn Unpplicd to (he (icculiur gait (J>- 
st-rviti ill li'siiirii'tjf liw; ocrclK'lhiiK. It n^cmbl^-a IIh' (jnit i>f 
lutvfiiotor nliixiu, but is iiiiipIi riinir Htag^-rine. It U n'rt Oc- 
pruleiit iipuii luss of ix>i>rtli nation, fur in I}~in|j; down dip 
patient can perfwtl.v control hie movpmenle. Tlti- aliscncc oi* 
tiip j\rg)-ll-lu)bcrtsuti pupil, of shar)) patnK, anil of diminif^lu-d 
n>tlexcs will separate ocKbcllar diseasv from locuinotor ataxia. 

The Iteflexcs. 

The " londiiii rHli-xii*" wert: fiirmc riy thmiglit to l>e a pirv 
reflex plifnonii^iion, bui the letideni^v at pnseiit ia to ii^ti) 
tht-m ai^ resulting from the eontravlion of tlie mnscle ilwlf. 
Jlut that the mnsclo tJiall Mtulnicl, it miiHt receive <«rtaia 
inipiiUes from tl>c cord, which kei^ it in u nrnditiofl of irrUa^ 
hilily. It fiillouiv therefore, that reflexea are de|ieiMlent Upon 
the mndilion of ihe ntnl a-* well as of the niitBck-A. 

The Kiiee-J«rk, or PatsUar Tendoti Reflex.— This is ob- 

taiiml \i\ lnj'pinj^ tin- qiiadri(V[>»« i-ikIoo iwiween Its itiserlion 

and Ihe |iiilell» wliilo lh« l»>g is mxiM^l over its fellow. 
't%i: i-wr-jV/i i» iiierewml in the following conditions : — 
1. Frwiiienlh' in organic dii«eaHe of the bniiu, probahlj- from 

irrttaliiin of the eonl. 

;;, In Icwoii of the cord above the lumber enlargement, 

proliahk from etitling ofl'tlw inflnenceof the reWcx tnhibiting 

ivnire in the iipiier part of the eyiviX. 

3. In di»)cminated eerebro^iiiial wIvniHu and in liitcral 

4. In irrilabilitv of the <wr<), as in mania, Itvicteria, »tr>'vh- 
nia-iHiisoninif, anti spinal inrntnt;iltH. 

1 he kiuv-jai: is (iiiiiininhe'l or alMmil in llw folluwing cmii- 
dilioiia : — 

I. Degeneration of tlic miiM'Je, &« in juwiidit-niiiseulHr lij'- 

1!. In lesions of the n«rv-c# which cut ofl* ibc impulac ftttin 
the coni— as neiirilU. 

ii. In lejiion of the postrrior wlnmns of the oo«l, an la hxio- 
motor ataxia. 

4. In )Milionn-rlili^ amtie nn<l chronic (the anterior grar 
mat(«r in |nrt of lliu reflex (vnlre). 



SI 9 

In advanced tnydilLi, when the onrd is sufficiently 

G. In oxhatistion of tlie spinal flentreft, as atler prolongi'd 
taburiouH ivork. 

7. Ill puistjtiing froni drugs wliicfa depress tb« curd, as anti- 
mony, colurnl, etc. 

Aokle-olonns.— This consisU of vibratorj- movctuents 
ul>tjiitit4 bviiii(ij)orling the Imdo- Ae/iiiiet liitii oue band, while 
ll»e lowl 11^ strongly flexod with the other. It can nirely he 
ohiiiiiKHl iu hcnltii, but tc oAcn marked iu hysteria and in 
htl^'nil Mrlcroeis. 

Ann-Jefk. — Tliw is obtained by iftrikiTig (ho bireps tendon 
■t IIh- vlbow, or the triceps tvudoti above the okviniMn. 

Jntc-jrrk, — This in obtained by tupping the jaw while the 
niuiilli i^ pEirlifilly oikh. 

The Superficial BeSexeft, — TbeM- nix.- jirutjably true reflexes, 
null iiiiiHisi iu uiui^tTulureuulnK-ttuux rcMilting from irritation 
ijI'iIk- fkin. 

The fullowing tabk- is Inwci ii[Mtit llic iKwriirfioii given by 
Itoos in hi« IlundUjok uI'Mervous l)if*u»«t : — 

Thr BRrux. 


tha «al« of 


'UinAi, . . 


Bhscydk iiruAv 




StimntsliDs ^''** A™ otit 

Ihn lilt I lock. 
KllmiiUiiiiK llio (kin iin 

llic iuii«r side of tbc 

Stroking the «kin an llw 

«1de of Ibn aMo<n»n. 
AIihuIrUiik till- tiilm of 

Iba cbcu Id Ibn flftb and 

ijxtli lnli!rni«Ul «|»<>tii> 
iTTllxlliia froio Ilia nagtv 

of t)i« ncnpnla to tkn 

111m: crwt. 
trrfuiion Df tbo •Mpnlar 

nckUoc UiH iwtiu. 

DxprnMcro* IvTMHtiTor 

Til* lowor «nd ot tbn card 
(oMiiia innlnllariAt, 

LuOfM (hruti|;)i llin (oult 
I niid llfUi lumtur ii*rvt«ii 

Finl luid Mcnixl puirc of 
lumbar imnrDi. 

Tli4 srat rrom Die pightb to 

tlie IWflirib d«n»l tiRmu. 
Tlio arr* rriKii lb-- fiitirlli 

la lliv m-vriilli pain et 

donol brrroi- 
Tliv »re« 1b Ilia don*l 

rtfion of tliiiocinl. 

Tbo am of Ihv npp** two 
nr IhrDO donal and llx- 
tovnrtoo OT ibm oml- 
oal ii«Tvni. 

Tbo nmt DiniOKli tbn 
ftrnilr-r pitt of ibn wrrl' 
Ml mluflfinDmt. 


Th« cliief craiiiiil roil«^xc« arc conlnu-tion of llir palatal 
niiiAcIra hy in-itAtioii of tin- latinri ; .-oiwizttig, by imltUJoD of^i 
itu! norcs; miigli, liy irritnliou of ilur larynx ; dtHiirrof tliRHj 
evfiiilfi, liy irriUiltoD of Uie MHijiioctiva; atxl conlnu.-ti<ia of "" 
the iri.-*, by lit;bl. 

Paradoxic^ Contraction. (\V(«t[iluil.)— 'nii" i« « pcwiliar 
}>henoiii<>iHiii tutiMi^ting of a Mmw n'nimi-thm uf tlio libinlU 
nntirufl, biKlinf; for scvunil iiiiniit«s, niid iii<ltiucd by furvibly 
tloxiiif^ Uii> fu<)t mi iIk' b'g. IM miiHi^ is iinkiii>wii. It has 
tx%i) obecrvcil in I'^rly ItHxiiuolor atuxia, Diiiltijilu Hclcnwb, 
hyittorift, niid [mmlysis ogitAns. 


These oonsiitt ciiicfly iit a Iikh of scavatioa^-mmMma ; 
■■[■eased scnaatioD — hifjir/yntlhtvin ; wrtain abnortnat Bonnljotis 
— paraOhetia; iui<l subjective iwiiiful licusutions — neuratgia. 


Onliiiary cutanoons a-nsibilily may be tested by the prick 
of u [Mil, by a pinch, or by tli« faradie Mirreiit. 

Atuw*thesia results from interni|iti()n nf (Ik sensoty tract in 
tin- iK'iree, as by neuritis; fnmi inlerruptioii of tlw wnsory 
tratrt in the cord or brain ; from orKaiite disease of tlie seiiwry 
111-)^ of the brain ; from the utiion of toxic siibstaiirce on the 
nervw or centrca; from evrlain fuiuitionul winditiono like 
livAti'riii; and from reflex irritation. 

IttmmitfFMhrgin. — A \o« of sensation on a lateral half of 
the body. It niuy n'siih from : — 

1. lIvEteria. ilii-'i is often nnasMK-ialfl w'ith (Mniiyns of 
motion, and may be rccogiiiwd by tin- bti^lon', sex, and trni- 
jH'rament of the |Xiliii)t : by thr |»rii3:yHniul ciuuaelvr of the 
:uiMF)tbe»ia ; mid by e.\eUi8ioii of oiIht emiM^. 

3. A iiniliitorBl lesion liijrb in tbi- <«i^d. Thi* i* very rare, 
and may I* reii^igiiizwi by Ix-ing a.>*soi:iaU>il with heinipli'^iia do 
the op|»uiitr e>idi>. 

S. A Iwion <>f Ihe nMHliiUa (very rare). 'Hie hcniinnnv- 
tli'%iu a ttanally ansoeiated with hem!])legia, jiamiy-sti' of tliu 





rranifll i)i>rvn<,<]il1ic-iiIliiwa]lowiRg,aiul (unliaciUK] rmiiinttury 

4. A It^iiin in tht* pons. Thi> lK>iiiiiitia>Ath«»i» in ofti-ii 
asfionated wilb hemiplegia on thtt flaiii« .side, aiid liicial f»i»y 
on die opposite side. 

5. A legion in the cros, or |»edHn<;le. Tite lieniiannHtlM^tA 
ifi often asmcintei) wiili hemi)ilegia im the aaino atiU- and 
puniljsis of tlio ocilloDlolor nen-e on tlio op]xisile sidp. 

6. A lesion of the |HWtenur Ii«il> of the internal capsule, OP 
uf the oi)t}e tUaluniits pressing on the csjieulc. 

7. A leiuou of the o««ipital uortex. 
^fotMnfedl^e»ia,—'A Iu8§ of sensation in cHtc member. It 

niU}' nttnlt frani liysleria, from a forni k«ion of Uie ocfipital 
(■orttfx, or fnim a leNiou of the nerves !^ti|iplyiiig tiic nuinlKT, 

PtitrjHtri^firMit.— A low of H_-iMati<>ii in all purls lielow ihv 
wftisl. It may nwilt from hyiileria, orj^iiic ili.-c-iws' uf ilie 
ofinJ, mtnrilbt of lh« lower cxlirnittirsi, or refk-x irritallun. 

Thatntt'ttnir>4hrma. — Inwetmbiitty to hciit or cold ownrriitg 
an an indciMtrnk^nt titiKlittoii. It \% coniAtitiu^ obiwrved in 
hysteria hiki syringo-myclia. 

.i iiiilt/fKlit. — Insensiltilily ii>|iiiin. It iAetonietioiPH observed 
in hysteria, in syring<»-mYclia, and in lesions of the »pinal 

lidardatiott of Smmlioiin. — This is fre<)iiently observed in 
ull forms of anteslhesia, but cspedally in the anesthesia of loou- 
niotor ataxia. 

T/ie Seiiff of Preumtre. — Tliis is teste<] bv blocks of W(M>d 
loaded with lead, of different weijfhts, the arm Wing held on 
a table m as to excbide the ninM^iilar wnse. Partial paralysis 
of this sense is often noted in h>i-otnotor ataxia. 

Tli£ finuK of Spacf, — The distance at whieh two ]X)inlff uf 
eontaet mn be reropnized as tno pointi^ Normally the di;«< 
lHn«: yarn's in difterent purte and in different iiidividuals. 

()ii lh<-<-lK-ek it w 11-15 niillimcten, 

On the forr-Iii'ad, 22 millimeleis. 

On iIk fiirvann, -10 niilHinotcn!, 

On Iho ohnct, IQ raillinH-trre. 

On Hw Illicit, 77 millimrtvn. 

(^ ihe I«ii, 40 millimden. 

On the mlm of 1)m> liami, 8-12 Diillinti<(«T«. 

On tlir luK-k of lliv lmii<i, ^I inillim<-t4>re. 

HyperastbiOSia i« incmuvd {<<-ii»iliilil}- to vxtvnuil impres- 

Il it> roiiinioni V (»lK*erved in hvxtcriii,(«|twi«]]y in <xinricrti<ui 
k'itli the juinlf, breaslii, gt-nilalia, aoA «piiH>. Hi* ulno olt- 
i>rvt-(l iu neura-Hihi^nia, and in Ix-^nning inflnDiniMkiD of the 
Inervps aw) of the MTf-lint-spinal menit^i>t 

PartBBtliesla.^Tbtii lomi in uec<! in iiKlimit' ncrtnm tliKi- 
cwnablc snbjertivt pli^nouiena, snrJi as nnnibui.i«<, tingling, 
Ttdiing, fitieepiDg, ami "pins and ncwllcs." 

PanoslJieeia ts obsen'cd in iitaur cx>nditioiis, an ln-»tlcria, 
linal ei-leroeig, t)cunistiM.iiiu, and injurr or inflanimalioit of 
,\ie ner\'U8. 

fimlff Smefttifin. — Tin* sense of liJivinp n girdle or tighL Ixinil 
jir"Hii<l tlic tnink. It is iWiim-nlly nb^rvwl in iniinnl feclf-nwin. 
Nenralgift. — Tbii* coni'ti'is of p(in>.\j>ui« of severe |iaiii 
Iriulintin^ »\tmg the )im> of tin* n«n'V-tniDki. Tlw pain in nv- 
jlit;v«l by pixjwurc, but tlierc aru t«nder *\vit» (poinU doufnu- 
Irnij-) wiwn (lie niTvc nmkot* its exit I'nini liony canals itr 
[uiiiM'ntnr (NivcHnj^ 

iAijlitHin'f-jKiiix*. — ^Tliis t«mi is applied u> the riuirp laticinat- 
[ing patnri iilm^ivod in looonuflor ataxia. Thev nsntilly oertir 
pu ibe exli>:>niiti<«, and mav Ix^ mistaken ti>i' rlH'iniiatiAni, 

OH«ti/(/to.— This terra lias been applied by S. Weir Mit- 
Echcll 111 an intitnitely buruii^ sensaliun generally nbnervi'd in 
I*" glossy skin." 

Mna'cular Seoalbflity. — This term is applied to iheapjin-ci- 
' atiitii 111" Itii- «ii>ati<ji) wbicb alli-nds the contraction of a ii)ii!sc)r 
rimli'i- llir Jiir.iiiii- current. 
MUSOOlar SBDS0> — Tbis i» tl>c hcdiw by nliioJi weight, niui*- 
lenlar eflort, and position am dptcrmiiH<<l. It m often dolertivf 
[in hysteria, lowmotor atnxia, ainl in nuuiy forms of paralytug 

DisrrriHtAXCEs op nutrition. 

Tlicse consiM in atmphy of the nmscloa, changes in eloclro- 
Ptniisnilnr ountractility, lissue-iuetaniorphoees, and in certain 
I tll>n«rnialiti4» of the appenilages. 

DI8rtVllBAN('.BS OP NlrrKlTU)S. 


Miisculiir A1ro|ib\. 

Atrophy, or waMing of the iiiti>%li% rcsiiUs from : — 

1. Iiia<!tivity. CV>ri>bnil [wLucs iiiu>' Uiiis be awiociftlet] with 
ulnte wasting. 

2, liesioiis of tlie Irophtc oella in tht- aiitvrior gray horn.t of 
the cord, as in aniEo and chronU'^ jH)tkiniyditiH. 

■1. L<Hion9 of the nerves, Hii^h iis nciiritix or tratinknitsni. 

4. Certuin diaeasce of tlic iniisclwi Uwrius-lvf*, iis ii)iui>atiii« 
muscular atrophy. 

Tile atrophy •xhwii attviKU chronic nSiffittons of (be joints 
probably rcMufts from iienritis. 

11i« Reuctiou of DoKciiorntion. 

In mnsiHitar pEaralvHifi there may be simply diminislietl «>Im^ 
trical exeitalHlity, This k (emiol n >pinnlil/ttiiy eliange. in 
some cases, hi)werer, there is a<i.ifTiplcle revenewl of ibe normal 
phenometta. This is termed a ijunlUfUiiv. cliutige, w the leaeiioH 
oj degewratioit. 

The reactions of dc^ienrratiun are oblaincd witli iho ffotranie 
eiirreiU apnttcd tomiMrla in thv itflmmxif riarfcof (UgfnenUiim. 

The 3ubjoine<l table, wttinj; furlb the elwtni-miifictilar 
phenomena iu health and di^^UN.-, tbiiuws ekiMly the Oc^riptiua 
of H. C. W.kkI :— 

The anode — the |wsilive pole; the ratliodc — the negative 
pole. When a galvanic current «f moderate strength is cm- 
|:doynl, an<) the cathode is platted over (he nonnni mn^ele, a 
strung conlradion oeenrs witeu ibe eimitt m eloscd ; M'bei) the 
anode i» plaral over the niiiwle the <-oiilrnelion ii* miieli Ivas ; 
m neither mw i* there any conlnu-lioii wIk'h ihe wirrcot is 
bnik<>>i, Whiii n strong wirreiit is used iT>nti-ueliont) are pro- 
duced, am) the aiiodal ixMitnictiou is greater (hiin the <»lhoduI. 
The rciurtion of degeneration 00Dttst« iu u ivvct^ of tbtml 


Normal mtacU. 

Amxlnl dosiitg vuntravtuin (AdCIC) is lac than the 
dill i:!iwiitf; omlnti-lioii (CiiClC). 

AikhIu) ojtctiiti^ cull [ruot ton (AdOC) is greater thati tiie 


Anodal doeing: cuntToctiuri (AuCIC) t'qinib' the cal 
oltMiiig u>ntrartKtii ((^(;H!^, 

cvlliutlul oiK^ning <x>iitniictiuii (CaOC). 

Jlunclr in Jirtt Moffe of degmeToiion. 


ADmlal (limning oontTnolioti (AtlOC) oqiwlB the rathod*!^^ 
ojjeoing cuntrai-tion {CatK^ 

Afuxolc in advanefd dage of <Ugmfnition, 

Anwiiii dosing wiilractioti (AiiCiC) b greater thui tin 
Cjillii»lal "Irwinu iHtiitDKiion (CnCIC). 

Anudiil u)>cii!n)i; (vnlra(.-ti<Hi (AnUC) is less tJian the cuhti 
upeniiig raiitraction (CaOC), 

11ip n'tUTliuii.sur<I('KciKfatioii urc observed indieoasM vbk 
(k^ruy the tn»(>liir wllit tii Iho aiildiur grny lioras of the cori • 
iir wliii-ti flit ofl' tiicir iiitliK-iicv. Tltii» (hoy arc obscn-Ml in 
«4'iitv iini) iiilviiiiwil <'lii\inic [lolioniycliLis, in JK-iik- cent ml mye- 
lilix, ill ecvtrv nvuriti^, nnd «fter ^eelioD or cx»ii[>iT:»sioi] of the 
oervi«. ^^ 

Arthropitthfeii. ^ 

An arlhritpathy is a d<>generatiw affection of the jointvj] 
c-hararteriBM] br marked andlinK duo to pR'nvinii, crmton ot^M 
t)i« (^arlilsKPs, ivlaxation and mldKcstion of tlw- itgniiic-t)l», and^^ 
atri>|>h V ot tlte headsof ihe bones. ArthniiinlliifjiarciibwiAcd 
(v|)o<-inlly tn locomotor ataxia and in ii-rebral li<'N)i|iIi?gia. 
8»m4- regard I)k' joint-plietKiniouu of r)ii]«iiiial<>id artbntisas 
belonginj; to this ctuaa. 


Myxtedcnia cx»i»Ul!) nf au nrergrowth of niiiix>id tifsae inl 
tbc fitibcutaueous tUatics ; it occurs as an idioputJiic affection j 

tllirrUlUlAb'CEB op OONSClOtWSEfiS. 


Hotuptimcs tidvr ()■<.- n-muvnl of tlw Uiyroid f;)aiK] ; and at a 
Bytujituni uron-tinUiu. 

Ulceration Kestiltltig Troiu Peirertw! 

AntU flfmbilux. — This lenu is applied to ulwis a])|)raring 
on |mrts sulij«cte<I tn |irE»Hire, in a few hours or ilavs, after 
ttit- iicininence nf a »vere cerebral or trpiiial lesion. 

Chronic fkcuiittu. — Thi<) term is a)i|ilie(l to t)i« tiloers wliidi 
ultituatelv appear on |iai-ts «iibjec4Ml to pR>s6ure in the oourw 
of chronw spinal aSix-tiotu. 

I'trforaiing Ulcer of 0»e FotA, — Tliis lonu U appIWl lo An 
undermiDini; ulcer of llio fixit ncist umnnonlv ol>»<Tvt^ in 
locomotor atti\Ia. It fn.f|uently iMiietnitvv tho deejj lUruoliirOK 
and involves the Iwnos. 

Sffmineirmil (.titn^rcHP. {UeytuiHiPg Ditnutf). — This Sk a fpiii- 
^■nous affet^ion involving ihc finger*, tix*. lip of the nu«c, 
or vax». It iirt.'^tst siwiiUineously, aiwl t* prulmblj- diK- (o a 

VHrlrt-niolnr ^<|1IL->I1I. 

Trophifi Afiections of the Skin. — Horpcit, M-lorodermn, 
vitiligo, Hiliin-Hinn, nn<l (i>i- "glossv ^Itin" following injnniit 
nf the intr\'e-lriinks, are illii.'^lmtioni^ of thiif eluas of tri>plii<; 

TrttpUc AffiMtloDS of the Hair and Nails.— ADi^r iitjnrT,- of 
tJie nervt« and in in^iirili.-* tin- nails oft<'n [■•oinif ilry, liriltle, 
and eraoked. I 'nder similar conditiouH llicn- may Ix- n lotn* of 
hair, na overgrowth of liuir, or a diangc in i1h> i»lor of iIm; 


Goms is s condition of uncoiuteioiisna« from wliidi ll»> 
paUeot cannot be arMtsed. 

Teni|>orary imconsciuufiness, due (o aiuemia of tlic bmin, 
IB termed syneope, whiib may be retitgnixed by tlie extreme 
jmllor, weak yuW, and feeble beart-souiidii. 


1. Coma uav nMiull rrom trnumali.Mn. Tlibi <«n on); be 
rcoogniTod by ilie lii^ory i>r the local evid«nc(> of injiin-. 

2. (hyatue Hutane of Ote Itrain. — The nwtit oninioii miisc 
under ttiU iKad in apttplexv, wlitch may be rcixnniiwxl liv ilie 
history, ihfi age, the 4-»n<iilk>n of (he arteries, aiKl bv evKb-ne™ 
of paralvt-ii-, &iii'}i as iinii:iliiRiI ivlaxatioii or rigidity i>ii (ini; 
side of the iKxly, cotijugate deviation of the ej'es, or a biglwr 
temperature in otw axilla. 

3. Epilrpty. — ^The eouiu of epitepHy ia u&nally o\' rfiort dura* 
tion. li ntiiy be re(vgni»^d by the history, bv the bI<K»dy 
ifalivii, by ibe prnwruoo nf ivars on (be toi))fue from previous 
attHekK. »tid by tlie exebision of other oiilseB. 

■\. Thrrmir (>Si(N«fra^). — The leniperaliire of tjw' day 
or or the nMim >ii vhieh the |i»tiri)l is found, llie extremely 
high t>ody-li-tn|teratnre, and ihe abseiivc of other cmusui will 
iDtnally previ-nl an error in diaf^noNi. 

J>. Vninin PrHijn. — Under tlii» head come aleahfJum and 
opium'piiiiifiriinff. In a/ctA'tfitm liw iwlieiil <an ^''"'''''■".v be 
atxHuAcfl by shouting in tbe i^iir, then- Is (h« odor on (lie birntb, 
aw) tbrri' is un absence of olbur mil**. 

In opium-poiarmmff the piipiU are »ii)all, the n'vnirulinns 
at? «low, (be totnpernture in miminl tvr ^nhiMtrnml ; llicn; 
may be tlie odor of laitdaiMini on tlte breath. The diagiuMJit 
will be aided by the exrltwiim of othitr eniimti. 

6. fitrmjrt.^In this eoiMlidiwt ibeiv is a nrinotis odor on 
the briKtb ; (Ih- aortic second >M»ind i^* neii-Dtiifttid ; th<> urim^ 
eondiiiiK ulbninin ; 11k- teniiK-rature mav tif above or Iwlow 
tiornuil ; Uie p(i])tU arv tisnally small, ai>d there is no evidence 
of o(her culler. 

7. Thf /i./fWif,(« frtY!^. — The history is suStdent to make 
the dia^ixjniK. HcrniciiHis nialnrbl R^ver may pmduce suddiM) 
oiini.-i, and in thiti roitditiou the examination of the blood 
would render a dini;noA» junsible. 

8. JIjfMTiii. — The hirtory, i^, and sejc of tite {wtient, and 
tl>e absence of other eauiie will usually preveat an error in 

DiSTK■I^IA^■C^■» "!■■ TIIK hl»«'lAI. hKNiiFS). .T27 


Id lh!s comlilkin tlio |iniii'iir lits for wverol ilavi* aptmrcntly 
desul, Itiv [itiU' ami i-(^)iiratkiii U'iiig impcrM-{>UI>ii-. It ia 
uMiially tt niaiiifntUtion of hysUiria. 


A di-eamlike slate, ia whidi the patient perfonns auto- 
mati<nllj varioiM fiails^such an walking, siu^io^, n-nting, eto. 
Milt) foniia, mit.'li n^ talking; uml walkln;; in sl<?Qp, may occur 
io health. .Morv marked oumifiMtatiiiDs uccur in hyMenu atid 
in hypnuci^oi. 

A onndition of apparent iuaenRiliility in whidi tbe mind tn 
wholly al«trl>'<i wit li a fancy or delusion. It occiire in the 
hystorit^aL The duncing mania of the middle ages is a good 
illuHttation of iL 


Thiii lurm m applied to nttiu-lct cliara^rizod hy n ]>oculinr 
HtitFnoiti of ilti^ mii^'li«, and vthea ihh i» overcome by foroo 
th<- limlKt <»n Ut ]ila(i-<l in unnatural ]M»<itions, whii-li tlioy 
ivtain fiir a loti); lime. There may or may n<it be a Inatt of 
ooninnion.'MM'iw and sonsation. It is ohserved in hyMcria, hyp- 
notism, in iutme eaaea of opitepay, iu some organic diM^ases of 
the brain, and in certain fonns of insanity — notably katatonia. 


Tlie Eye. 

Jijpwi*. — Contraction of lh«> ptipit iKvnrs in many concK'^ 
ttons, notably in hioomotor 3(a\>u, inrflir duntentia, ^iint- 
en8« of diAvniinatnl itok^vx^s, ukl age, urffimin, aitd opiuin- 

JUtf»lriiiJiU. — Dilatation of th*- [Hipil is tlw oltscrved in 
many (M)n<lition^ notably in ntrcijitiy of tlie optic nerve. 

3!iS niSBASRS nF TirB JfEllTOfB ST8TBK. 

IttRiIvKis of llio lliini iM-rvi>, <.-<ilIa]»P, Hcveiv pain, rpileptic] 
ncixiin^, livNlvi-tiiil allackit, Ix^llaHiiRiia-piiLiODtiig, amt in suok- 
vamfit uf iMcoiiifilor atnxia aa-1 iniivlic ilt-iucntiu. 

Ifkfjutilitii of the J'uiiiU. — TliiB niav iHviir in lioallii, in 
ocular (tolli-ts, in organic brain ditt^sitp, in ptirc^in il^mientis, 
in locomt4>r ataxia, and in anilatcrtJ paralvaft of tbc ovulu- 
Riotiir nerve. 

AraifU-HobfrbioH I^jmL — Tliiii 18 one wliidi fiiiU to n^MHtd 
to liglit, but fliill actnmmwIaifA for di^anco. Il i^ iHibxl Ktpc 
daily in l<)M>U)ot(>i' ataxia arHl |>an-nV dt^nu^ntia. 

Co»ju//iite Dfritition of Oie Aje*. — This lemi in aiijiltfil l<> 
tbe rotation of both oyts awa_v Jiwm tlie nwHliau line. It is ^j 
notod Objieeisll^ in apogilexy and in ooovulsious of organic ^| 
brain diEtase. ^B 

Ayrfaymw* {TWmor of Iht E)ffb<iH.) — It may be con- 
genital, a»^>ciRled with certain ociilur tnniblee, or due to 
diseaiic of basiU ganglia, cfi|)ec-ially difieeaiinatcd acIerDeis. 

Tho Ear. 

ThuiktiM Awium (.Votwi* m ihe Ear). — They arc observed 
in cvn^bm) hypi.-m>tnni and aitirmiu, in diwii»c« uf the ear, in 
M&ni&n''s diwiwc, and afler tiin ii!* of 4^TluiD drugs like 
qniiiitu; and saliuvlin aciil. 

Ilif/u^u-unin uf Utiirmrj. — Thii* is sumo! itnt-s oIi«;r\-«I id 
hysteria, in facial nam lysis, and in rcn'bnd liv|H-nuiiiu. 

iMafneet generally dejieiidH upon distuw ul' lh« var ilM^f. 


DelosiOD. — A (k'bision isa liinlty Iwlicf nHii\'rnin(t a subjert 
rft]ud>l<- of |ihy#!(iil dcnuMHli'ation, onl of wbt4-h the iwivon 
i-annot Ite reasoned by udotiuule nietlioda for the lime ueine. 

A KjfiianaiiKtl iMtminn \* oiie whii^i tlie natient eudeavora 
to 'Icfcnd by a pruwtiH of rfWMtninj; luiiro or less K^ical, Sys- 
tematized delusions arr- rs|iivially olis<rv«i in munomauia. 

An Hivt^analized iMunton is oin? which the jiaticnt niakefi 
no attempt to jiislify ; be aseerts bia belief without nawoa. 





Till' luikjnrity of iU-t(t.''i(>n.'i tin- iiri.tyMlcRUitJxcd ; uikI asi »iioh nrt' 
observwl in iiuiil li>m» iifin^aititv. 

A Jizetl lUlimon ia one wiiicrli tho |uilienl n>liiin.'i liii- a <:oii' 
^iderable length oflliuc ; it it> tri>i|i)i-iiilv hysrcinntized. I''i\e4l 
ileliLViona nre ub^rvcd in monomania, j>areti<' (lein4>nIJa, )iya- 
tL-rical inmnitv', and »>m«tiniefi iti melanclmlia. 

An e-Tpwviive dtliCKion, oi' a tleltuion of tfraniltw, is one 
wbich exalts its iweaatfior, Tlie Jiatit'tit «>nceives that Ih" is 
Mi»iac aotcd persona^', that tie is wortli ruillionis of dollars, or 
tlmt he \a rajmble of perfiimiine ct-rtaln tnarvi-Uoue feats. Ks- 
{Hiiuivv ildiisioiir' arp frwjueut^' ubeerved tn paretic dvmvnii a, 
mania, aud liyst<.'ritial insanity. 

A hyiHu-hnHiiriitcnl dei»gion is one wliidi dqiivsHcti its 
|Hi:«(»^>r. TUi.- jnlivfit IwlicvM lliat lit- ItiLS conimitKxl (bo 
iinpaitloDable 8in, timt be is Iwini; ix-r^viiliHi, »r t)mt liv w 
tlie viotini ofeomc <Ir«wl iliMa.*c. iry|nH'ln>n<lria™! ilcbisidux 
arc frwuHMitly olxwrvcti in nivbuK-bolin, iil">bolic insanity, and 
in ^r>riii^ nLsuA of niitiioni until and iwrr-lic <li'nK'ntia. 

DlllsioiL — An ilbiTiiiin i.s u ]H-rvcrtti| |<i.Tiv[itiijn. 'Duii' in 
(li^briuin li-enicn:^ ilio jiaticnt may lniiu>lijnii every pieee uf 
fnmitiin- inln a donion or i\-tittb-. 

HaUucisatioa. — ^An balim-inalion i« a ThIm' ]x-rcir[iti(>ii, 
vntirety .■<ulij>.vlive, and not luL-^cd njion Any knnwicd)^- dcnvtil 
from without. An individtuil wIm) btiin* voi«ro nnd m^at oh- 
jwt^ whfin none pvisl is llie siil>j<vl of ballu<rinaEioii«. 

Imperative Coooeptfon. — .\ oxtii'iriion u-hk-b ibo iicnwn 
knuwB to bo faliu^ bnt wbti-h, iKtvcrtlH^h^v*, duminatea bi» 
thougbla and ttfum directii bi.t actiiinri. Wtit^n b« faib to 
recognize the falsity of Imm w«K-o|i(titn, i1 l«-oi>mt?s a delnwon. 
A morbid ImpnlM i» an tn<eHii>libU- d<«irc to <-omn]it an act 
wbicji the patient kntnt's to be wrung. It in uitiially tbe result 
of an imperative eoRe<>|itii)n. 

Kfrptomania is a niorbid desire to St«al. fyrtnHtmia IS a 
morbid d<!sire to set fire t«> bnildiuga. 

I>4'Hriiiiii. fl 

Ddirinm i* a montnl slate i-hanKtcnztil by a rapi<l fli(;ht of 
idr&H whieb ai'tMnoobcrent ui>d uflen unintelligible. It may 
mtnit from : — 


mSFJiat« or TUK NKBVOUS SYin'Oi. 

AohU. lirtirium {BtJF* Ifania}. — A disoue ariiiing whhont 
nl>vioiiH cniiw, and clinracieriEe<I bv an abrupt onset, arlive 
(leliriiini, a c«>ni>tant repetition of («rtain [mrasei or ik^Ih, 
moderate fever, o)\eii a bullous «^j>tion, and I'xtianHlton. Il 
generally emis falally in llw com-se of a few NVdt-ka. 

Mania. — In this aBectiou tbe on^c-l is nut Blifiipt. Sj'm|H 
toms of ini|>aired licallh »ad menial cle|)r«r«ii>n, eoverii^ a 

Ceriod of seveml wecka or omotlis, geacnlJjr precede the o«t- 
ivak of tlie delirium. 

Utjuteria, — Tlie LisfoPv, aj^", sex, and temperament, and the 
interrailtcut dtaraeier of the ilelirinm will aid in the diasnoata. 

One of tlie litfediotLa Fetirra. — Pneumonia and tvplioid fever 
are oA]ieeially liable lo be as-toi-inled with deliritira. The 
phyijica] xigns in the fimner and the abdominal Hymptoma in 
tlie Inlter will usnnlly imlicale tlie diagmvila. 

f/nwiiM,— Till' urinous odor of the bnoth, the hijth arterial 
tension, ll»; luivntniil ion of ibe ru.vyind aortic emind, and llic 
pretH^'iK'O of iilbniniu iitid iilM--' in tin- urine will Migge^t iinemiH. 

.M'-oltiitiinn. — ^'nii- lii^lury, tbe npiK-iinini^ of llie patient, iIm' 
ninrkiil tremors, and fr<*(m-nt ly Icrritying linlhn I nations will 
indii-iite alti>lioliKni. 

InanUion. — A form of delirium iMxaaionally ariseB in the 
conrae of exlian^in^ diwa-ses. It b asaodated witli inllor, 
teehie pulse, arid eoVI exlreniitie!>. It ih fr^'nerrdlv ot i'li'>rl 
duration, and may be rei.x)guiy^ by tlic cirvumslaQCGii under 
which it de%*clopa. 




(Bullar M«nln<ltls, Aoata Hydtooepbalm.) 

iF-KixiTioN, — All iictik- itiUnnirimtioii of the cerebral mcn- 
infr(» «xrited Uy Uk- liilicix-k- Uu-ilUis. 

Ih-iouiGV. — In chiUIn'iJ tin- (listflse may be prinjary, but 
in odiiits it is alwuyt) wxiMxIai-y to a primary focuii of tiiber- 
riiltwis in some otlier [mrt of lliv IhkIv. The inajority of ca»»j 
are ol)serv«l bclwwti Ow iR'i'uiiil aud lh« fiftli Vfars. llerality, 
bad bygicnic f-iimL>nn4liii;r^, ami j»oor food (milk from a mber- 
cutoiis motbcr) aro prcdi^ixniiig factom. 

PatiioIjUOY. — Tlif bn^IarmcningwiareesjieciaHy invnlvwl. 
TliP poiw, cnira, lunl iiK-diilla are covered with soft lymph 
which mHt» l^i^-liici' in it (xinimmi inasH the adjacent iiervra 
and bliK>iK'(3t.-t(-U. TIh* tiilH^rutiliiii!* diarader of the inflam- 
mation \jt iiiHtiifiTitti) by (Ih- |iix-s4-ik¥ nf »>ii):ill yellowish 
Ii0iliil«s wliiob lire |Kirticiihirly nbuiidaut alm^ the bluodveaaeb 
ill the Sylvian iisiun'S. The amount of Hiiid in the ventr>cl<-3 
is int:n'9Med, and the epiiidyma is aot) and <edcinatoiia. The 
ooiiicnl substan(« underlying (he ailectcd meoingeB ifl aUo 
Bofl and infiltrated witJi leiuxxn'tcs. 

SYMi'nms. — 'Die diacafte iiMially begins iiHidiotwIy with 
certain |irodn>mal eyinptonis. The dispoMtiitn of t\w i-fiiM 
changes ; he ccosefi to pliiy ; he lMxi>iiie» dull and linilt^ot, aud 
when disturbed, irritable. Sleep ia broken ainl fitful ; the 
child twitches, u^rinda his teeth, or startB up with a <ty of 
i^roi. Ileniiaclie develops, and Li soon a^iaooiated with fcwr 
and Tomitin;!;: the toiig;ue is coated; the appetite bist; and 
the bowels (»tKli|)atctl. Vtlton the diaeose is fully develo]>ed 
the iuwlsrlie Ixyxniiw- intense, and frc<|iienlly i-aii'*s from time 
to tinK- a siiriil scream — the " hydriH^ejtlialir cry." The 
special SCUIK9 an- abnormally acute, so that bright liKhls and 
loud MMiiids uitiiiut be tolerated. The surface is alsi) hy|id>e»- 
thotic, nn<l wIk'II touched, the cliild l>eci>UK8 extremely 
irritahh'. Tlie tcmpitnturr is moderately high (I02''-I0;t°)'; 
thp piitit' is at firti rapid, but later slow and irrejnilar ; the 
abdominal wiiIIn art- r^-trtK-ted ; the muscles of the ihx^ rigid ; 
and tJ>e [Mipils wniraclwl. Convulsive scuures fre(|Ueatiy 



develop; ll»«y miiv \>c ^'iionil or local. The child lies on 
i>iK' !<iile wilh iho hmtn* (Irawii ii]>, thi- licnit itlri)nf;K' tt-lnw-twl, 
»n() the tln^-f^ cliiichtHl nvi.-r tlie ihiimb, wliHi U lumtil 
inUt (Im! palm. Towards [l>e oI«se of this stage delirium 

Wlici) tlu' exudate ii> siifhi-teiil in amount to cxort niarked 
pi-essure, paralvtic phci)<ini4>na d<?veIop, I<ocnl palura, e»i»- 
fialty «f ihe facial mii soles, take the iila*^ «f cunviihiionit ; 
wHiia lollows delirium ; the pupils dilate ami ihe eyes roll up ; 
jthotophobiii is replaced by bli&dne^ and iiitolE<raD(<e of 
sound by dcarucsa, If the finger is drewn aeroas the body, 
u bright r«I liiH> develuiM am) uogers fora>iue minutes; tW 
is till- tSi-Jit rtW&rtrfc of Trousseau. Tla- priW ik»w bccomett 
rapiil uihI irrcf^ular : th^.- I'ccpimliou iismnira the Cb^ne- 
Sl'jkm tyiM.', iiixj the tcnijH'rntiMV folK Tlie durntiun is from 
one lu Ihrw wwkp, 

I)i\tiN(»Js'. Tyiihoid F(x*r. — Typhoid fever may cIoe<ely 
Himiilnie RHiiingiti«, i.'^iH-eially in the yoimg; Uit the tnrty 
develdpnichi of (•ercbml itymplonis, the irrepilar fever, (lie 
slow \wl9e: of the first ctHire, the retmetwl iitMb)iiiiuul wallK, 
the eottntiiHiliiiii, lutd the tili.->eni'r of rupe-eolon'd i^poii^ will 
aer\'e tu dUliaj'tuHb to<-iiiii)^iliN from typhoid li'ver, 

Shniile MrniiiffUu. — An ftluM'hite (li.-i^niui» nuiy Ih' iinpo»> 
fiible, liul ita' hiHtDry of lulterrniliipiA in (he family, Ihe pietaenee 
of tulierculoua loci in other narts, tite detection of tnlierelG on 
the retina, and an onset nirhottt obvions eau»! will gcnenlly 
indieate ihe true natui-e of the case. 

I*lK»(;N<v-ls.^Al>so!iitely unfavorable. 

Tkkatmkxt. — The paiient should be placed In a t|uti-t, 
dark, well-vi-ntilated room. The diet sitould t>e liquid. .An 
iee-bag abcHiId )>e applied to tlie liead. Constipation sIionlH 
be relieved by cnemata. For the beadaehc, restlessness, aitd 
eonvtihuons, chloral and bromide of potassium are useful, and 
may be given by the ivctum. 

i Mo*cl.i, Rr. iU ; 
fiunphorn'. er. xv; 
t;iili>nii. IiyiirX., gr. viii*; 
Vilclli 'ivi, No. i ; 
A<|. ikMUlHt.. r.^iv.-M. (SnoK.) 
Sig.— Wash out the rectum witb a »iiupl« eoema and Inject two 




Tli« wlminiftniltiKi nftt^t and of io(1td« of potaB«ura, and 
thv «xu-rt)iil .i]i|ilKiitii)n nf ati ointment of iodoform to the 
i>1iuv4hI Kcalji Imvo been rcocjninieiided, but generally prove 


(Aeuw L«ptom«nlnsUis, M«olnsitia of tb« Couvoxlty.) 

DbpixitkiN. — An aentc influmituitiun of llic (hu mater 
not due to tiilx-ToU'. 

Ktioi/k)y. — Trniiiiiittt.iiii, ■inrLHtroke, rlicuniatLini, nright'o 
ilii?fji«', wiwl lliu iiitii'tiinis fi-vprs, are tlie iistial prctiiyjKfPing 
antstw. It wccusioiiitllydevi'luiin ri-i>iii lariefl of tlie boncwhicli 
is iMcundary t« middle-ear dbcaw. 

Patiiuumiy. — The merabmues are onaqtie, tliickeinxl, con- 
f((»ted, adherent, and niom or less innltnitcd with purulent 
iliiid. Generalh' the runvexily \s AfTaii.'d, but in i^orh- OMLVt, 
as those l>i|Ii>\rin|i iiiiddlc-vur dis(^i^, the base h i-hk-Jly in- 
volved. The jKJjauent eurtiud isiil)i><in)ixr m uIho (nlenuitouit, 
sort, and injected. 

SYJirroMS, — Mtidcnitc irrr-jjiilar fevor, lo«» of npiM-litr. con- 
Kti|tti(ion, intfiiM- hra'liu^H*, iniohri-anoe t4) |if;lit nnd t^oiind, 
oontnictcd piipil», dtriiriuni, rdreolion of tlto Ih^, ooiiviikioits, 
noil '-otiiit. 

When lite baiv. i» involved, the nvmplunisntvAlinuet identi- 
(ul with ihoM! of tiiben-iiloii.4 nu-iiiiij^itU. 

PR<M!.Nt»eis. — iMifaviirable, iJiuugli recovery \» not im- 

TKi:ATUK.s"r. — The patient RhouM be plaivd in n quiet, 
dark, well-ventilated n>om. An ii*-lia(; xlionhl Iw njipiied U' 
the lit-ad. When the patient in rrihn.ti, wet rti[)« nr k-tt'Ju!* may 
Ijc applied to thesnecfe. The diet must Ih- Ij^piid. ConN(t|>n- 
tiou flhmdd l>e ivHeved by eneninta. R4»iW>ih-«s, hradaehc, 
and convuJsionH ulII for cbloral and hmniidv of potaatiiitu. 


Drfisition.— Inflummalion of the dura mater. ^^ 

Rtii»Ij(h»v. — Inflammation of tlw external laver may reoult 
from injury, syphilis, iinnstrotce, or wiries of tie i»oue. In- 

3:M dkbases op tub ngrvovk nvmiai. 

flammfttion of t)>e internal layer (hemorfhagio padtynM>ninfi;itu)| 
may be eeoondary to chronic catxliaic or renal diAcaM-, oncofj 
th« iofectious if-vera, vbrouic ulcotwlum, or eeiKcially, iiuuiitj-.j 

Ilf'iiiori-liafcie Pacliyiiioiiinvritis. 
(Htematotna ot the Dura Hat«r.) 

Pathouhjv. — The membraiicB arc Ihit^kemxt, o|ur|iH', m 
more or lei« adherent. The hltK«UcsseU an* dilatM. Bo-J 
tween the nicmbrapoiis layere aro iVequputly oliHcr^'ed iit'tnur-j 
rliatfic oHiisionB ; these vary in extent from slight eo'liynniiMsJ 
Ut wots as large as a liew'a egg. In some ca«>s the preafiure at 
the ctola on t£e oonvolutioiiH Is tuiffivicnt to caase toe latter i 

SvMi'mMfi, — Often olisctire. In some tasea there an* no 
niani Testations durin;; life. When the condilJon is marked, 
the rollowin}; phenomena nuiy )w observed : lleadaehe, failure 
of mcmori', impainncat of intelloft, sl^ipor, contracted pupils, , 
local convulsions, or palnex. Tlie )<yniptonis may atternatelyj 
improve and grow worse for a long |>i;rind. In grave eases, 
a«<ocintcd nitli extensive hcmorrhs|rie cUnsion, the symplotus 
R-Scniblc apoplexy. 

Diagnosis,— This can rarely be made witli ccrluinty. 


Tuf^TMENT.— <>rave (Msw shonld be tmitefl as niwplexj. 

nvDKocEru .\ ix's. 

(Ooageinital Hjrdrooophaltu. WaU« on Uw Bralxi.) 

T)KFiNrrmx. — A condition in wliidi then- U un execesit 
Aix'iirimlaiion of fluid in the venlridcs or itnuhnoid lavity. 

l-'.TiouxiV. — Arqnirttl JJjfitmc^-phrilm may develop at any 
period wf life, and may result from nK'niiigitii>, the prctwire of ^y 
a tumor, or from one of tlic cansrs of f^-ncnil drop^-. ^M 

(kmofnital y/i^rocepAdiiM. the form now iiniU-r discussJon,^* 
dates m>m birth or develops in the first few yearn of lite. h» 
cause is unknowti : in wnne («*C!s it i?" prolwbly <1im> to a latent 
inilntnmntioii of the e|)cndynia of ttw veutridi.:*. 



Pathoi/jov. — ^The head is largo aw\ round ; the bones are 
thill arid trunHJiicciit ; Uie eiiIiii-ps sihI tontunellofi are enlarged, 
ami. if life halt boon pi-olunj^ni, arc filial with iiiimeroiM 
Wormian botkcs. Th« cxjnviiIiition>- of lUe hntin atxt tliiticm>d 
and tlie stilci oior? or Ipse olilitcnitod. In aiemal litfdro- 
cr/)A<t/tM th(-ao(-uinulation of tliiid is found in thcanK-hnoideao; 
but in intfTHtd Ay</i-(Myy»A«/M^— Iho nM»l uouimun form— the 
veil I rifle* Sft- prt-allv distnKlt'd with a wiiUtt iliiid of low 
"(K-t-ilii; [jruvity, mnilainiiij; ii Inrv of Hlbiimiii. 'V\k c|)c«- 
dymii is often ihicki-tKil nitd ruti^hi-mnl. Malformations are 
fi\>i|nnt[ly otxttrvd), and jiixibably rw»ilt fniiu (liv i!«m« cause 
which itidiiii?<l ilii^ t^ffii-^iitn. 

ftvMPToMS. — fiitmHiiiu^ lh« dinenw (l(^'i-lo]» before birth, 
iiiid tiM! lai^ head inlerfen» with the dt^livory of the ohihl. 
In other i^'w^ nothing jx^iiliar ix <)h*rv<Hl nntil thr-<^hild is 
ai>vi-ral months old, when thf ssvclling of the lu-ad allraott) 
thi; attrition of the parents. The Iiead i»^iimeB ii jflohular 
shape; the funtanelles aitd sutnrefl remain ojten ; the laoe he- 
comes tvlativcly small ; tlie eyea protrude and ore directed 
downward from the pn-aaure of the fluid on the anpraorbital 
plates; the scalp ap|>ears thin and stretched; the suwriidRl 
veins arc dititeudmi; and IIk' liaJr licromes .ocaiit. In »>mc 
ca«i.-s the bond is iui heavy that tlic thin neck can m> longer 
support it. and it falls fornuni on the breast, 

•Vs a nile, tlie iiitclli^^-ixx; is cx>usidcrubly impaired, but ex- 
cept ionul caseft are inurked by prvcocioiisntvs. Motor pbe- 
nonieitn are frwjnently jia-wnt : Uw reflcx^-s are exag^-rntcd ; 
iirn- or nwn- of tho m<'nil)ejw may 1m* the i»»iil of a spnetic 
IKiralv^t*; eon V It Iw ill IS tU'velop in ni.-iny niw)t. 

Till- duration variis in tlillV-niit cum^. Tho large miijority 
soon di« of inanition, oonviiUion.<, or ^ine intftmnrivnt diiwnsi^ 
to whidi thoir rediK^ed vitality niakc4 tlicm au eaaiy [iney ; bnt 
in a few, life ia ]>riilonj^-d fur tnany ycAm. 

DiAONiisis, — ITvdnM%i>liiiln.'> mnsl not be mistaken for 
jaMtS« enlnrfieaurtit of the hniil. In (he latter, iIm^ Itittd is 
sipiare iniiti-ail of tflolxilar; the in(illij?-nce is pmd ; \\ivTt- im- 
no ii»>b>r phenomena ; and Ihiiiv eti}at);einent» are ikiually 
deUH'ted at the ends of tho lot^ bones and at the junctioa of 
the eaitilages with tlie ribs. 


Pkcwixosih. — I'lifAVuruUlo. In a (W cwh-s •nt«t oC the 
liai< been i«])ontii»«uu«, or Km rv^iilUil from u»|iimUon 
'tbe fliiul. 

Trkatmknt. — ']'lie tmiliiKml is iinsiti»ftti<on'. C^jimter- 
trritnlion a»d tin* use of diiinHJi* nml uli»<>rLM-n(.-< exi-rt no 
iiiHiirititt oti iho ilbMWHC. In lliv umjority ••I' mM^ K^yund 
diflcliiMind liyjrioiiicoiML'^iirMtiiiil lliv (Hi'aHiotiiil ii^M.iftoiiti-;', 
litllt: (IIM l)u n-(K)iiiiilri)ik-i,l. Ill <tL-H» u'licrt- tlir; |tiTttniir<.-- 
^itvin|)tc){iK lire ntiirkitl, tujipirif; ofW-r* whiki Ii»|hs4 of Itun- 
E|x>iwy n-Iicl*. \tinr tli^ ii[H-mtioii iH>ni|in-HHiim uf the rtkiiU 
tthould Iw moAo. hj tlw aitpluiitioi) of (Muoentrio bouilA uf 
ad]teoiv« iilaster. 


(OWMral Poialfala of tho Iiumim;. Orawal PanMU, Chtonlo 
M etiln go ■ oacephalltls. ) 

IpKfixrrios. — A dironic inllaniroatory nfTectioa of l)tc 
wrcbral cortex, cliaraolcriKed by a diaogc of disposition, 
foiliirc- of memory, mental exaltation, deliisiowi of grandeur, 
tixrruont, epileptiform seizure?), ami paralyr^iii. 

KTiiii/^H'V. — Male sex, middle life, prolonged tneolnl Btrain, 
ami exu?t««»i iirt- ])redi6[)uKing factors. It may 1>e indiii^-d bv 
tho usual tauswt of wIcixmuh, iiaiudy, syphilis, aloubulititn, Icad- 
pcKSotiin^, ffynt, civ. 

Patiioi/xjy. — The mcmlmiiKit arc opuqtw, thickcnt'd, and 
at plaeef, milionMit lollir brain i^iibstamv. flu- (■ortex i» more 
or li-ss alni])liied mid tinTtw.H-<l in liriiitKiw. Mii-i\»c>pit^ 
rxamiitation n-vralu an »vi'r);n>w(li of iiKincflivc ti^wiie and 
dcReucriition of l>('rv<*-fil>K-s tiiid )r<i)gI>oiiir fv\\«. 

In wmio lU.'Tfl ■•iinitar dc^i^iicralivo rtiaiij^ut are obaorved io 
Itw (MMtcrior and lali'isl <iiliinms of Utc wml. 

SvMiTOMs. — Tho dtin'o^' iiMinlty Im^r^ inHtiliotLily witli n 
(■hsiific in dtH[M«ilioii ; (ho imhi»Irt>ni» bpoi'Mie T<lotlifiil; lhi.> 
MinbitioiiH, aiHithetie ; the cliiifile, il)««ohil<> ; the lilxril, jwrsi- 
monious; the ooniplnifiant, ehtirli.nh ; nml tito truthful, faW. 
TIm- energy retaxeH. the jndcnient weakens, and the im>Riory 

fAs tl)c fartdtieri be(»mc impaired, a (Ni-idiar <fri4i<^m 
iienlal (.'xulliitioii de\'elop; the ptitient beciinn* iHiAHifuI, 



lixiiiacidtii*, and iM.'*i)y piiivokKl tn rnrioiiK utitliri'akit. TIu' 
fkiliire of mentnry r« Htrly iiutt-d in wrifliig, t)y Itu- iikc- <it' 
UT(>i)^ Idtcm anil llic Hn|i|>i'o»ioM of i^yMuhk^ Al (liit< Iikk' 
nidtor jthennniviia may lie olwrveil : iho (("ngui- tn-iiitil<« wtwii 
it U jirutrudcd ; tbc speech m slow, lirailatiug, and itKltstiiiH ; 
llti> juipil.t aix! often unequal ; and Ibe ^t is 0onicwii«l 


Tltet most cliarartrriBiic ptndiical 8rni|rtom of fnlIy-iU>- 
velopetl jtaretic denieiilia is the delusion of grandeur: iIik 
piilient c-onoeives thai Ii« is some dislingiiished peramage, thai 
lie owns aiires of laud, or that he in the inventor of simie 
wonderful machine. The mind is usually serene and clieerfirl, 
hut periods of dvprcasion sre not infrequent. The eensihililics 
are bluntco) and tlu.- animal nature eniiihiuized. The mind 
beoHUM more and nion;invplv«l ; tfiere ii^ cxtrcnic imlifft fence 
to nil that tranif|)itT« ; ihv tippclilc is vonicioti!-, nml in ratiuK 
ihv jiaticnt bulls his food ami miU hix rlothtii. The tremor 
of the tongue iiHTivwi>, and ^pRiuU to lli^- ttjw and other i>arts 
uf the fan-; th«8poc(!h i» iu<li»tinet nml "scanning;" tlic pupils 
fail to lYWjHiud to light, hut t^ill anoomniodutv fur di^auec 
(ArKjIl-Kolicrtiwin pu]iil|; Ihc n-Hoxi'K are gi-nvnilly incrrawd. 
S|K'lNof Hnfouftfiouxiwssrt-t^i'uililiiijryY/f iMii/arciiol iiunjmniuu. 

In the fiiiul -mu^^i- uit'utal jxuvtr !-■> iihni>t<t oUlilcmrifl ; ihe 
hoallti failii ; the bladder and nvluui iHiunit- nuri'lvulivc : the 
uait is more uuHteadv ; and al IilH the (laliMit in unahlr to 
leave ht9 bed. Deatb usually results from exhanslHiu or in- 
tereurreat disease. 

r>t.viis<»iis, — Tlip innidious dmngc in dbpositiun, failure of 
meniorv, tremors, Ar^il-Itoiiertson [Hipil, and delltsEons of 
gnuideur are ihc diagtirisltr feiilnrcs. 

(WrAiytt Syiihilin. — In this dittoase the history, the oreiir- 
rem« of oonvuUions ami of pnrtial fami jiahtieH, the al)S4>n(« 
of delusions of grandeur and of " s(nni>ing" H]>(-(i-h, and iIk- 
efli.>ct of treatment will tisuiilly prevent nn rrrur in diugnosijt. 

PlKHiNOfts. — rnfavoriiblr. The couiiw i* f»ot nnifonn ; in 
some cUMu) there are iviuis'ion", or lucid intervals, which la.-( 
jcvcnil months or year". The avcraip- dumtion is thrro or 
iinir yean!, 

Tbbatmrnt. — K<s«t of Itody and iniml. Curcful attcntiDD 




Id the liygi«ii«. Wlipn there is » sospicion orsynhiliii, iudidnt 
anil mpn-uriiilw hIkhiKI lie (fivpn a tlwrougb trial. .As a rule, 
^icnU niiHi be remuVMl tu aaj-liiniH. • 


DkkimtiuN. — ileniiple:^!)!. diplegia, or |j>arn|t)c^a ap- 
jwariii)* al biitli or in tlic- tiret few yvar« of life, anJ usually 
aatiM-iuteil witli iilnj|ihy uud eclero»is of the cerebral cortex, 
ur iK>ren(.ief>liu)ijs. 

l'ATiiuiX»UY, — After (Itiklli one of tlie foU'iwin^ wmlitions 
is observed : Atropliy uiid M-lcnwis of the couvolulions ; |>uren- 
oe|)haltis (a t^'stie nmililiun of llu.- cortex) ; or more nirelr, 
ttomo loeal olKtriietioii to llie nervbral cimilulion, on from 
hentorriMifte, cnilxtlisni, or llimtiilxiMiK Tlic e\i-iliiii; iiiiiw of 
1\k port-Ill t' I it iu Ins uitd M-loroHis i.t »iill iiiHli-liTiiiiiK-d. HJ 

SYMPrriMS. — /« l/u- luiaiiJrtiiii Variety llie miwl is Mi(l<leu,H| 
Hru] U frD<|iu-(ilIy atliiKhil with Ivvei-, <:onviiUioii», or tinna. 
AfttT II lew lioiint or ilavs tht"*- wtvcRt 8vnuil«in)it «utMi<)e, niid 
thti child i-s left gNinilywd on ttne side of Utc body. In rarc- 
iiislatKCS tito paralvtiiH iilliimilely Uicapix-nra ami ifie child i!« 
restored lo liiialih, imt in the laiye oiajorilvof en.><« ii |M>rHisti> 
and in follnwc-d liy ftwond-iry rigidity. ]iiilK-<-ilily, epilMwy, 
and choreif^inu or aiheioid iiiovi^inonts in llie alfnted members 
are very comoioo seqiielie. 

Thft'diptegie or pampliv/ic form fiw)uently dales fmm hirtli, 
and is eliaracleriMa by rigidity and !'*« of tiower in all of iIih 
osln?niitie^ The Ic^a suHcr more than the arniK. C'horei- 
furm or athetoid inoviiiM'odi are ftxtjnently prcwnl. Chihirvn 
thiiJ) affec-lcd are n^nciidly idiots or inil>n-ilc». Meniii);ral 
hemorrhage, tnduce<l by ledio<i§ latmr or the use of iIm- for- 
ceps, apitcars to be prsnojisible for this varirty. 

Trkatukvt. — I>unn)r the convnUive »ta|^ an i<'e-E)M|r 
slionld be applied in the bead, aiMl dilonil or bi'omkle ndniin- 
tsti-rt-d by the moiitb or ixs-toni. TItt; iMiralyiiis ix^intji In^it- 
roi'nt; but suliseqiient rigidity may be li^vem^l by nia^'«a^- 
iiri'l puMtive niovenieiita, and IIk defoi'mity by nuirltanieid 

? llMalMTvflcacTipMDiiwtuuunliipoaOslttT'Helattotaleinonugraitli. 





(CougMtkui of tiMi Brain.) 

ETIOIxKiy. — Ariite amgeatioit refliillM fmm pxpoanrc to the 
«in : frum ttic use of certain <lrii^ lllii' iilo>lti)l ami nilrtt- 
plywriiic; I'mm cxetssiive braili-work; or Iron i some rdJfX 
diMiirt>Hi)(X-, us ii^^trie irritntioii. 

Vhroniv conycKtioii rtsulb) from sotue lix-dl obstruction tu 
tEic ratiirn uf blood frutu tlie brain, us bv n tuDii»r in tlip neck ; 
(mm obktnK'ttoii to the ^-ti^nil etrcitlation, as in dimnic Itcnrt 
mil) Inn;; ili^-.iw; froin tlic Rip|)TVMiuM ol' humk- luibiliiiil (]!)•- 
i-liiirgc, iw (Ik- mertslniiil fluw at lliv meiiii[>uii-»<- ; >ir fnini «ome 
p'nonil («uw, WM'h an prulnnj^-t! urisii-ly, i>vvrHiirk, cxfeiwes, 
irrt^iiliir living etc. 

I'ATHoiXKiV. — Thv vmm-Im of tlic nieniiijn-i^ nnd of iIib 
bmtii-Mibstann^ an- cfigoi^rfd. 

SvMlTOMS. Afttf Font. — Inli'iifW lii^itnetu' ; vertign ; 
intoIcniiKV III lifrhi and ttoiinti ; nxtUf^ini'M^ ; tinnilai iiiirinni ; 
an<l sli-epk-ssiK-**, or i»lti'|i disliirliwl by humble iln^nniH. 

(Iirouh Form. — \'erlipi; dnll hi'ttdnt^hc ; (iiiliin? of 
ni(>n]orv ; irritability; innbiiity to oonccnlmli^ the tbiitighl<t; 
awl disturbed slti.^|). Tho syniptonKi gro^v ivoiw wlicn tho m- 
cmiitM'nt jKMtnro in it.<iNnnmt. 0|ihlIialniiMeA|)i<-- cxaminutinn 
reveals ifiinal iiy|ierasmia. In mark«i caMn (hore may be 
esai*-rkiliiins clKselv rcsomhling aiMnplexy, in which tlwiv is 
iinoriwdnnHiH-H-S toliow«l iiy tein|H>rary jianr^ts. 

l*ii(Ki.\«)siK. — Iii'pcniU on the tause; wIkii Uibi mn be 
ppmovttl the jii'ognosie is favorable. 

Tkkatuknt. AchU ChHfffMion, — T)w ]jat»pnf shonld l» 
]>taoifl in a darkcni'd, uel I- ventilated ro<»m. The head nnd 
nhonlilei^ slutidd l>e Bliifhtly clettHCTl. .An ice-bas "h'M'id I"' 
a)>)ditil In till- head. I>eeehps or wct-*'n|i« may W- amiliul to 
the nock. Sctbiliven like bromide of potassium unt) a<x>nitc 
are uwfni. V.rgai may be employed for its |>ower to Lxuitnict 
the vefled,i. If there is constipation, it ^loakl be rcliovwl by s 
brisk .'^line pnrp>. 

Ill cAromV c»Mv the canK> libnnld be nifveiliiincd and, if 
]x>!«ible, removed. Tlie habitat of lliv |iutient miist he ri-gu- 



lilted. Hiedift must be light mtd ntitnlit)ni<>. CuiMtipntiim 
must («• relievwl by diet or br tin- wtiuioniil us»- of a twliop 
laxalivv. 8l'<lutivl■^« like brvriiiUv orpotaMitimnml ncoDilvan; 
uwfut. Ill tlH' upupk-dironn stlacks voiMaMctiou is iiidivutcd. 




H I'VrioiJxiY. — GciK-nkl o(rrol)nil ftiin-iDin tm a r^ronin agtttwm 

H may mailt from canliac diMwM', («p«-inily norlic titvnosig. It 

■ mny )h> ss-s<x-iatitl witli gi'iii>rai nnivmia. It may be (l»c to 

■ alhoroiiwioiM olwtnirtion of th« arlerits. 

■ OvYTwork, |iniloiigt-d cmotioDiit fxHu-ntoiit, irn>giilar living, 
and fxn-j^-a &rc al.-in ^id In jiivdisjKMO. 

Ai< an urate rondiliin it fxirts in svitcojwand shfick ; afiw 
homurrliiiuc ; aflor the sudd^'n witJiurawal of fluid fn>Di ibe 
abdominal sae; and afler ligation of th« carotid aiiery. 

SvMt'FoMs. Acute Form. — Pallor of tlio Caiv, vfirtigo, 
oonfuMon of idcai, rin^n^ in the rare, dimness of viaion, dila- 
tation of ihp pill>il, natisi^, ami a tcndom-v to yawn. In 
ejttrem* aiuemia tnen? may 1* €»Dvnl<<ion» and coma. 

The eftroiiic /oi-m is rharacteriz«] by vertigt*, licadaclu', dia- 
titrbcd lilecp, intolcmm-c to liehl atM suuml, irritability of 
temper, fsilitre of mcmorT, inaoility to concentrate the atten- 
tion on oiH- Mibject, a tcn<leitcy to KyiK-opc, and extreme laesi- 
tiuk". 'file i^yni|vtoniit improve wlien tl»e |iii(irnt tics dono. 
Uphtiiutmo«Kx)pie cxiimtiuititm it'veiilit piillor of (W irtina. 

I>lAGNO»l.S, — (Vrebnil luiH'niiii ibwly laitmtliittv ocrrfr/n/ 
(wiffoiHoH, bnt in the biltcr IIhtp is no IcndMic)- to eyucoi>e; 
tlie ^ymjitoniti arvve wonat- nlini lite imlicnl liri* down ; and lliv 
o]Jilhabiiiit«i>|)e irvwili* it-ttiuil hyjwniinia. 

I'lBXiNiTsin. — Tlepi-itils on tin- cnnMc; when dm can be n- 
movc'<l the |>ro^n<x'tf> i.t fiiV'>ral)le. 

TKKAT>l^a.T. — In ncnie i-a^is ditfn-iiblo Hlimnlant^ like 
Ditro-glyetTin, uninionin, and f<tryc)inia are iridiealed. In 
olironio nsea* tin,' mii:<e idtoiild tie awertained, and if piM<ibt(-, 
removed. WIteti it in dne to jifneral anemia, in>n, an>eiiti', 
arol ijoiitiiK- are uwfnl remedies. WlM?n dependent on vnliii- 
lar dlimw, rt'Ht and the tist- of digitalis, stropbantbit^, orj 
fltrydinia are tJic renxxlial measures. 




(CwobnU Apoplexy.) 

Ermi/xiY. — TItp affiflion is miint ctimmunly niPt witli in 
tilt- 1.1I1I, ill uliotii llti' btmHJvi.iiiH^U urc ulli<.-r<iiii:ilii(H, nitil in 
the v<T%' V'mup, in wlntiii lliey ai-c tMiUii-iilly vrrak. All 
tntiMV wliicJi litHi ti> dt^'m-nition of tin- arteries, shi-Ii vtA 
rliciimiili'tui, guiit, ttypliilU, iilitiliuIiMin, mxl Bri^litV (]i>H<iiKe, 
[in.HiiH|iiim' i<) il. Stiflbfi'iH fvutH I'liixaiii- iti*i<:)i('» <|ii><-]i.'t«' ure 
vi-rv liiililt- Ut dii- of &{i(i|il(-xy 011 titivmiil of tli«- u>m n'iui ioii *>t' 
(Tui-ifiiM' tiyjiortnuitiy with ailerisl iltvi-aentlimt. Ht-nility 
)ii-iHlii>|MH-A, iniisiniK'h an mc-iiiliers ul ocriniti fuiriilii-N un* 
)iitrtti-tihirly prune to st^eroKis of the vci«eia. Tlie nttiick 
limy Ite |)rm|litalt^d by mental or phyfiicBl exnttmonl, alttK 
holic exoucis, or Mime reDcx (iisturhamv, as gaein'c irritaiiou. 
Ill <rhilJn?ii it may l>c cxtritctl l>y a jiaroxyHni of KlKM>[>iii)c- 
I'ou^h or l>y 11 (DiiviilsiuD. 

I*ATIloi.u()Y. — In diiMrpii the licmorrha^> in numt eom- 
inunly cortical ; in ndults it is iwiully within the l>ruiii-nui»i. 
Tho blo(>(]ve««Ji« an- gcncmlly atlteminntuiis, aitti nre mudc^ 
times the scat of miliary aiiniriems. The dot varivs (ficatly 
ill liiijQ; somctiuK'S it U itin.-ill, nu-irly a (^jiillitn' oozing ; at 
other tiim-B it may fill a Iwiiiicciiere, It? tiio*t iiiuiiiioii "cat 
IB the internal «i|woli'— the nioior higJiwav U^w^.■^■ll tin- o|»tic 
thalamoH ami the "or|nii» niriatniii. In rtiviil lifniorrhu^^ 
tlie clot i» tlurk nnri »olt, uikI thv^tirniumliii); tiN<ii« slainod 
Miul miHT or lc«4 liu^cnittx]. If llie )HiiiorrIiiig<> has not Urn 
very eoiMoiis, the clot luMn it <-olor, shrinks, ami it* linally 
al<:^>rlie<l, nod llie (limiaj^il (vrchral filing are ivjiliicnfl l>y 
pn^lifcniliit (I'lim-t-tlve li.-wtie, wiii(-)i oititiaHii aiui foriii.t a 
wur iiiori- Of \f^ {M^'hti-iitiil with hifiiiatokJin. In other m.-m, 
ia'^lcidl of a !*«-ar,aoysi is tormod which eneloses a clfflr«tniw 
colontl Auid. I^rye etfiuiomt in the motor |ial)i may i>nMlti<<e 
•ecotulary dianfces — eillier a Bofteninp uf tlie ecretiral tJAHiie 
beyond, or a dt^iieration wlitdi travels down the lateral 
Ciitonin of ihe cord on the side o|i[>(«ite the lesion. 

Symptdms. — I'lTninnnnl tn/mpffrnK iiHiiratinj; nrn^^-al nin- 
geotion fre(|iiently ]irwnlc the altia-k ; thive are htwlnehe, 


.142 DisKABra ay thk kkkvoo svh-rKM. 

vrrtt^, disturbed i^lcvp, tinnitna auriiini ; nr thc^ro is » eetue 
of tnimUneM »r >V(-nkni'»! (Hi (lie eklf wliiHi i» to )ic afTeftM). 
I'ttxi^unl vomitiii]; H>mclitucs jirwttki) tlio liciiinrrhiigc, 

Thr Athti-k, — In iiinity casta ihv |iaticti( tiilli^ MHlilcrily iiu- 
oiiM-itxw willioiit prpviiiiiH wumiii);. Tlio liuxt ix fliirUit-d ; 
IIk- yyt% HR- itijcrfwl ; the ifw dn- ljlt«? ; lliv lin^Uiiiij; is »lEr- 
liiroii.i : tin' [luW' t» fiill uiiil »)()«- ; the t< ni|H-i«Iiiiv \» at (irvt 
Ml I >i ion I in I IVoiii MliiH'k, Imt IiUit il m i-lcviitttl Inmi irrilnltttn ; 
and till- iiriiti-iiiiii iWi-s niny If |ia.'>--x-ii liivi<ltiiilarily. Coitvtil- 
sivo M-ixtin:'!< nv« imt inrixijni-iit; iln-y n^-iill fri>m irriiittitiri 
tniiieiiiilttd b> the umlaniiii^tl iiiiXoi' im'^oiin. V.vvn wltih^ tin- 
(laiieiii is conialiKU' ilie [larsiK'.ttA van W (kt<vtei]. 'Ittr lii-nil 
aii^l pyee may l»e stronglv rotated to one si<te (4»)njupalff <lt'vin- 
Itimt; oriechwkotien najw more than tho other; the |>ii|>itH 
iiKiv hv im'<^itlar; any luovemenis wliidi (lie (uticut may 
tiinki- lire rrstrictnl 1>» the H>iin<) wle; when the a(rti't<^il iiiiij 
id va'it».i\ mill let tall, il <)ro)w lilVle«* or DianilistRatl iinnatiinil 
rigidity ; and o(i[wsi<Huilly there is a ilifTenin'e of tempt^'mtiire 
ill the two axillin. Jn |>nive t^uset! tliv (witleiit ()<w« t\*Ji awak<- 
fi-oni l}ii>oiiina: lhe)tiilM-givH')( ft-etjle; llie iy<'}>iralioni>a)>Miiue 
the I'hcyiM^'^liike.'i tyi«- ; llie reth-M-s lire idMdtKtKxl ; iiiih')k col- 
I(H!tS in the IIiiieU and |in>ihir^inii nitliti^ Nontid ; the t<in(ieni- 

ttiirc ri!<G8 high ; and di-alh n^tilt^ after the la)M! of a few liuiire 
or ouo or two days. 
Ill some ea»s the juaralyiiis dovi-Io]M ([iiile gnultcilly aixl w 
Dot atiendol with iineoiiftrionsne*. 
Sufiae^'iciil SyiH^oww, — ^A'lien llie nllack duvst not pro%-e 
fatal, eoiwcioniinei« ie 6i)ally restoretl, and if thi- Iipniorrhagc 
is in Ur< nI^1lHI location, iheiv reinain.^ a iKiiiiiilcLria on llio 
opposite side. In a few hours the nffeetcd uiiiscW heeome 
rigid from irritation of tlie motor fibres. This early rigidity 
termed primary rigidity ; It Ijists from a few da*-fi to He%-eml 
ecksandlia'4m>riigi)lfifai)ccfromaprogii«itic&lund]K>int. The 
ilily^is in rarely a niniplele hemijdegia ; the niiisclee of llie 
ler ]inr1 of the lii<« and tlioiiix iwnally esca|>e, iieeailH) they 
ri' ic til -tinned to :u'( in nation with their fellovvx on (lie o|)- 
iiHtite lide, und soch mni'cks are rarely involved in nTpbral 
ili-wia. When lh>- |i>ntn>e is pn)(riideil, itdeviati* toward 
lie [HimlyTcd itide. Th<' dwp n^flcxcs art' exa|3;enii4Mi on 

■"- - ^ -mJ 

CKUEBKAl, 11KJ|itltnUA<ia 


the afffvictl Me. Seii<vit>on \» iinimiKiind iinlc# tlif ihk^- 
H'liiir linibrtl'ihe inlt-nuil ^iiwtik- i« iil«" iiivnIvMi, hIrii llicrc 
is hciiiUiiiiP§tUi'»ta witli li(-iiii|>li-;iiii. 'I'lic ^;iiil !.-• jMHuIiiir: tii 
nalkitig lii'" jmliwit wi|i|Biri!i lli>' [lanilywi! iiriii.uml Mviiijp 
t)ir leg fiirwTtixi bv » rijliiry mi>vt<nii-nt iiii|iiin4-)l to it by tJw 
lnn)k. \Vli<-n lite 4:liit lia^ hc-cn Hmull, tlic ]uirolvM» may 
(xjmitlcU'lv ili!4t|>)ioiir. MitTc fW-<jiiratly rwovei-y i» tmiy \mr- 
(ial ; ilic (iiiwcr of the fi».-ial iii(i.'i'-)<^ U iitiiially r*-nU>ix-tl 
(tiliivly, aii4llh« le^ iinpnivw nion-lliiiii t ho ami. In iiiifiivor- 
nlilc I'SM'H till' mii.*i^li« a^in Imhihim' riiriit (siitmiliiry i-tj^iiiin ) 
fitmi a (Jejp^iit-rative procfwi travelling (lowii lUv liilfi-al (tihimii 
of llie pont; llii?* wmlilioii is itiditratire of |M'inmi)n)t dis- 
ability, (ipiterally ihc mvotal j>ower ruiHiinH iiiiiin)nin<d, 
but sontctitncs ibc symptoms of cvn-bral soflcning gratliially 

PlA<»'(i6t)^— TIic coruu of npojiWy niiiiU \» iiUt'inpuisiwd 
from unrmui, nfiinm-jntiiaming, nfiyitmli/mi, nixl /•iinMnilcf. TIlC 
age of the {iilteiit : tlw- t^iniililioii uf tin- iiru-riiw ; tbc eviJciiTO 
of iBiraIy»is ; tin- diflVtiMicc of li-iiiiK-Ritiii* in llio two iixillic ; 
iiikI iIm' uIkm^mv of nibi-r muso will ii;^iially prcvi-iit an error in 

/■jnfiofimi. — Tliis usually oreiirs in «irli*r life; it is com- 
Rinuly aflHociaK^ with valvular di^-aw; tin* paralysh is alinottt. 
invariably on t be rijtbtHde; :)]i)iai-iu is nioiv iiommoii ; tln-re 
is less (listtirbancc of temiKraiiirf ; ami co»seious]ie6e may ii4>l 
be loot, 

Thromhomi', — This also produces hemiplegia, but its 
veio|MnPDt is vcTV' f^ntdiiul. 

JtrmijJrtjiii fi-om othrr (Mhaoi.- — T»m"rfi ttwi abitctim in tke' 
brain may proiioiv hemipli'giii, but the latter d<:vtio|w t;nH]|i- 
ally ami i« twiially nnsoctiilml witli iitbrr ocrrbnd phfitomeua, 
siieh an |>ci«i)tU-ut hmbtfikc, venigo, ocular paloiuA, choked 
dull', otn. 

H^ri*^l Hrmiplrf/ki. — In liVfrttria the fiuy t^Hnprn; there 
ill fr^Tioi'iitlv aiui->lli(-i(iH on iho affii'ii<t nidi- ; iIh* |;ait if pecu- 
liar, in Ibnt ifit^ paiieni |in.ihf^ the jinrnlvnt) liinli iiiHlrad of 
swin-^nj; it. Thest- rinUin>s logelhor with iJte aj?% Ii<iii|mtb- 
ment, sex, and mode of oueet will nsually fiiig(^ tb« Iniv 


I'ROdXnais. — Alwavn iloitlxfnl. Pciwutont awl oomjilHi 
tiii(><)n.'wiii4Lsn(;», lii};li ti-ni]>i-nttiliv, IfWis of MIcxi*. iilwl I'liilMr- 
ra.'M'il iv.-i|tii'atiiiii uri' iinfuviirmlilir [.tlH'iiDiiiriiii. When tin* iit- 
t^'k (1(H?> iioi jiriivi- liiinl, tliciv if uUvavx a (trulMibilitv itt 
siiIrW'i|II('i)I <>m^, fur iIh* t-liolii^iMl <r)itiliiii>ii-s .'•till irtiiaiii. 

Trkathk.s't. l^mjthtfliuriif. — l^iriMK |in-ilis|>«wl In njHi- 
\Afxy Hhoiili] Imd a t\H'u-t lifi-, Cnv. rmrii >ni-iiliil iiiitl |>Iivm<«I 
Kxi<il4>inoril. 'llii- tViel olmtiUI Ih> iiiilritimi-s Ixit <-iL-<ily iii^ru- 
tible. Coiistijutiiin ^lioiiM be lylk-vtil liv iJii- (Hi^L-iimml n^n( 
A i^alinc laxiitive. To seourt- a fvtv n-tiini nf llie IiImkI fruta 
tlie brain ibo I'K^bM at tlie neck tOionId \» lixiee. 

The AftacL — Tlic head aiwl mIuhiIiIms slnMild lie eliglitly 
devat«d, and ati ice-bag a]>{>tieil to the tinul. (.'rnton ml 
^tt. j-iij) ill a little glroeria« or olive oil mav be platiil on 
tTie baicK of the tongue to eectire pminpl I'atltanis. If tlie 
piiW n istroiig, veii<-«i'otioD is iiidirattil nnd i^boiild bo nm- 
tiniHtl until till! piiltie liollens. IMcdling t-unnot undo the 
ibinmgo aliraily dono, but b_r nelifvinii ct'iicbral conf^ii*! ion it 
inay prwt'til a roncwol oiitjxmrrnfj. On tlir ollwr hand, wh«-n 
Iho faoi; i^ p»b) and iIil- piilic fti-blc IIk* liyjH>di.-riiuo injnrtioii 
of dilfiistblt; Klimidunls, like ammonia and r^lp,'<rbniH, 'i» indi- 
eattHl. WImmi (-iillnrtiunitof iiin<'ii)l iut'Tfvrt' willi bn-aibing, the 
[latii^it lOionId in- gently tiimol on bia itiik uiul Uui mu<xi« 

To [iiwciit the formation of bcd-sorcs fh« position »houbl 
lie rr»[iientlv obangi-d, and tbo pnrta subjected to prnMUn> 
thoroughly dianaed. 

S!!AseijufiU Treiitmati. — As other attaeks are liable (n ooenr, 
tlie pMphvIai'iie trentnieni alrrady refrrre'l to ih applicable 
here, lo^idf of i>ota«stum (gr v-x (hridr daily) may be ad- 
mi^i^te^tKl M-ilh the boiie of absorbint; the elol. Alter the 
priman' rigidity has disappenre«l, gaK'anii^m, massage, and 

easivc movetDcnls itltould Iw applied lo the affbcled miiHcles. 
rj'ohnia by the mouth or initx-tcd dirrrtly into llie mti^Iee is 
often very uwfid. Kven wlicu (Ih- panily»is remains, oon- 
tr.irtun» may be prevented lo a eousideiBblv extent by 


oBSTBircnos op tiib cerbbrai. aetkrkx. 



(BmboUiau, nuombo*!*.) 

Ktioixkiv. — fh^bral eiatm/i may hft derived from ti>e 
valvoi) of ()it^ licait in ciidocanliiiA ; fii>ni an alh«njtuat<iim plale 
in ttie lutrla ; or from a olut in ihe h«art or in the eac of an 
aiictii-iHiii. Obstruction fn>ni emboliftm niav ocx-iir at any 
aifc, but it is far nn>re commonly obBcrved in j-oting iwUills 
tlian at lire extremes of life. 

Thtombi are clots rortncdln llie veBsels, and a weak heart 
untl arterial detpjiieration are tlie piiJidiK|M using fiicton*. Tbov 
are usually observed in advanced ycani, but those dcfxtudenl 
on st-phiiitic arteritM frvquently occ-ur in eurlv adult ur tniddl« 

l*ATiini/xiY. — Kmboii tav must frr()n<>nlly found in a 
braiieh uf ihi- left middlo rcm-ltral artcrj-. Whvii tlie urlcri' 
iibslrmi<il it u lar^jc one, tho |«rl iK-yimd nitunlly lK*i>n>cit 
pale iiml wift ; but w>n»'tini<it it prcwnt* the «p[KWiiUH-e of 
un infiimioii imd ix inliltniu-d tvitli blood. Subseqnonlly, 
niii'r(H(x)pic exnmiimttiin rL-vwils fatty <le^-iK-niliu« of tlm 
iii'rvoit.-i ckint-iili' mid umri- vr Ur^ pi};nii-nlulti>ii fruin <-xt.'a- 
viL->aU-d I)1ihh1. If tlio nixn iiirci'tol i.-< ^iimll, ubsorjttiou may 
fi.illow iiik) M'Jir-ti^Muc be otib^>ti(iit(il. 

Tlir'iintii art' uMtnlly li>nml in Iho nikldln cer«l>ral, basilar, 
or vcrtobral ni-t«rii», and are followed by Mmilar eliaoges. 

SvuiToMs, — An embalun liMltrin}r in tlie middle cerebral 
artery uMially causes abru|)t lienijplefria, and freijitentlv 
anliasia. Tberp may be no prTM]n>nici), and ooAseioiisnees is 
onen jHieserved during tlio si'i;iure. 

When the basilar artery is obstnicied, there may be exten- 
sive [taralysis on boili side^ of the body, and later, symptoms 
of bulbar disease, namely, paralysis of the lip, pliar^-nx, 
and o?6oj)bagus, dieturbance uf tile heartland Cncyuo-StokeB 

In IhnmtfioiiU tlie aymtrtoms are Fiimilar to embolism, but they 
develnp ver>' K lowly, awl are Iri-niieiilly preceded by prodrutnoe 
indieatjnjf disturbei! cerebral ctn-ulation, siiftb as tmulaebe, 
vertjgo, diMuHied sleep, faibin* of uiemorr, niimbnew and 
tingling in itu- limits u> be affected. 



Sulmetiu^iil Si/vftpfom*. — In botb <>rabo)bi[u aad tbrotulxx 
if ihfi art«7,' (ibstnioK'd lins lippii largf, the paralj'sia 
and Avtuptoinn <if ot^n-liral softt-iiiiig ap|>car — namely, taun 
of nieintirv, vertigo, iK^adac-he, disturbed sleep, great irrita* 
bility, auci finallv derot-iitia. 

I>tA()X(HlK. — C'ereln-al eml»!isiu eloecly reeembW apoplexj/, 
and sometiniet^ it roar bo imixiMsilile to (ItalinKiiisb iM-tucra tbnd 
two eniwlitions. The fitllowin^ art' tiie diagn<i«4(c Ibatuns:-^^ 

EvibdO/nn is gciienilk a.'wociatcd with valvular diw^Jie; it 
commonly occurs in the young ; in-odronw* are f'petjuenlly ab- 
sent; the left middle cerebral artery Iwinc almost invariably 
involved, the bemipl^ia is on tlie ngbt side ; upbasiii ia more 
comuiou in cinbolitim thai) in bemorrbage; llierc is mndi lea 
distm-bance of tpui[)criitiirG aAer enibalivm than aflcr 3)K^I 
plexy : ix>n!K-tuuistu-!^ in Icks apt tu \»c lost in Miibulli-ut than iHj 

l*R00S08ift. — in pmlxiiii'm it in very duubtTnl ; rwoveir 
may follow, but i>ft<-n tho iMtnilysis rrmnin*. In tlinmitiwti' 
ibcrc id vpry little Ii"|m; uf niHjvtTy, iinl<t«.s ihf iiniw i» Hvphili^H 

TrkatmKNT. — AfttTOlwIriti-liciti fmni rmbolii'in (be )ialivH^| 
kIiouM 111- kept; .italiMibiti.' i>"<t liirit r«-Mi'dnv9,aiKl Mi).>»i-(pK'iillv 
ill*- |Minilynis ti'<Hiti-il an iil)i-r ii|Hi|ilt-xy. In l)iri>inlii»siis tniit' 
»K-nt i$ of nil avail, hAvo in Avphililic Kiilijct-l!*, wbi-n mcrcuml 
inunolinns should bo einplnyca friMJy ami lite bidiloridi' givf 
by tltR rootitJi. 


Dp.piNrrtON. — Degeneration of the btain-fiulwlanw rnstiltil 
fmm j>ervertcd nutrition. 

Kri»ij(Hiv. — Loral soEleoing may result from nlistni<4t 
to tl>e circiilaliou by a tumor, embolism, (bromlmeis. or ok 
Extensive suAeiiingmay rmult from prolongt?<l cert-bra 1 aniL-nifl 
or congestion. It is moRt frcriDcntly olM-rvcd tli old [leojile i| 
association with atheromatous artcr>i.-s. 

I'atiioi/hjv.— The affected i>ortion I* dull whito or tvddis 
yellow, lU'cording to tlie ammint of blxod- pigment pr 
and w lew Grni tbnn the viii-ronwliiig bniin'MiliT'laiK-e. Sin 
^aK» it Ui no soil llial wIk-o the brain in ciil a vmainv fliii 



(Idwa MIL Mk-nwiime oxiiminaliim rt*vi«l« iK'^itniHioi) <jf tlw 
ii<-rve-el«menls mid their MitMiUitiou bv gniiiiiUr (li-brin hu<1 
fill -<lii>pfl. 

SyMPnma, — When exteusive thfl symptom!! nw; Knihirc 
(it* inenion', initabUity of teDi|M>r, vertigo, hcailaoJic, |>itrlial 
jial.'tjoii, 4-titaneuUH annstJteBia or jiancsthesia, deluitiiitut, niid 
Ihmlly deiueotia. 

l^KXi\ mfteDini; may lie mani&stMl by loca) paralysis. 

l)lA(i.\(Mi[& Ca-ebra/ Tumor. — Tumors tieiiully dt.-v4>]u)> in 
yoting<^r subjects ; tlie headaclie is more »e\'cre ; choked disk 
is rn!*)iM?iitly obeci'ved. 

l'mxJXi)fil8. — -iriiiavorabln. 

Tkeatment. — Pal liati v«. 


(Tuinon of the Brain.) 

Frioi^xiy. — Early adult lifp, male sox, and perha|M tmii- 
Tti:»tism i>pt>diBi»oBe. Heredity also pmlUpmee to ih« extent 
llitit it favoi-s tlie di.-velo|)ment ornimrer, gumma, and lidjeivle, 

VAitiKriKS. — TidxTcIc, gumma, glioma, cy«te, §an^>ma, 
luid carfiiioma arv the mo^t <-ommoii varieties. ljee» frpquently 
tlhnima, inutmiuoma, ami lipoma are ob(>ervcd. 

P\Taoixyuv.—Tufjfmifotu tumors, or tyjtmMla, vary iti isiw 
rrtim a pea to an vgg ; t)ii>y mjiy be single or multiple ; aud 
an? usually olwt-rvwl in tin- yi>nnii. . 

fiuiRwirt,— Tliis apiH'iirw as a r>«irid, ydlow, wiwuui' ma»«, 
and is nearly idwav!' on tin- surfiiit- of the brain, into vrlnHi it 
grong from lh« overlying na-inbniiMS. It i« usually mrt with 
Iwtn-eeo thirty ami forty. 

Gifoma.— Tliis tuniiMp is found almiwt wrJiisively in ll» 
brain. It ari^os from the m-umglia, and may Ito sofl llk^ 
brain -Ml btUa nil- or tiriii like tibn>us tL'^iii'. It i.'^t^iirlly nu-l 
with in the yoniij:. 

C^iJm. — TlwMe arc usually oongvnital ()M>rciic(!plmlus), but. 
somelinKV Uu>y nsult from the tiniia echinocno^i.'i (hydatid 

' Sarcfimn. — Ttiisis usoally a diOTuDe tumor, and gmws from 
the roenibi-anes. 


Oui-cmoma. — This k itoarlr atu-aii-H sisntidan' anO iniilUpW. 

Svii[^>»*<;. — (!) Ikulaclic m nirvlv' HtMcnt; it. niMy Im- 
tix«lixF<J ami lUiiuKrinUtl vritli tcri'loriicwi on pruMiire. (2) 
Votiiitiii}; !k]i (»iiitiiiiu svin|iloni, wjipiiiiUy in hinwm i>f tlio 
linm.- 4ir tlic tiruiri ; it is oOcii ui)ii.'<»'i-riiuit with nniif-u iiihI 
ilix-a no! R-licvo (hf attcmliit}; litiidacfn'. (3) O-iiUr |it»c- 
i><>nKtui, ax u)>ti<- iHiiritiit, or cliokrt) disk, uplic utru])hy, dtitld- 

!)tu, licmiiuio|itii, l>liii<liK-m, unJ irrfgnW piipilx. (4) Vertigo. 
■1) Psvfhiiiil ])hi-n<Hucii», im lailnre of nRtnory, irritjibility 
wf tcni[)fr, (ifiirxwoii of !^|iiril0, uiid clcnH-iilia. (fl) Sviiip. 
Iwiiii rewiiitiiif; fnuii hx-n\ |)n?s"irr. *iicli ii» Itxid [MJsii^ i>r 
nKiviilMiiriK, iiphii.siii, uiiil I'.M^il iimcKltH'^iii. 

|>U(i\'(i»ls. — 'rtii> itioliuli-*: (1) tliv i-xistwice uf a liimor, 
(2) itit 4-lianK-tfr, niid (3) iu Kx-ution. 

Tke exiiif^tx nj a lumtir i* di-lM-ininMl hy the hcAdadie, 
voiiiititig, (t|ttio itciiriliK, iukI :iym|i(oni» of Kxiii pn^tHiire. 

Afmrt-im. — Cci'pln*! Iiiiimr timst I* discitiiriiislK-d from 
alwit^HA. 'ni4? latter usually rcAiilu from imiimaliKin or in 
HPt^iidary U> n Hmiw of sii|i)iiimiioii in some other jnit of the 
ImhIv; itn pmgrcHA in more rajikl ; cboked di&k is rare; aiid 
there \» oA<mi febrile dii«ttirhnnoi>. 

(fifotiic .ifaiinffUi*. — In tliis affoction the aymptoms indi- 
oate a (lifTuN.- lesion ; distiirlwnwwof teni[H^r, meraorj', and sleep 
are more marked ; and optic neiiriiirt h rarely ol>ser%'wl, 

'J%e Chart wtei- of the (irmrth^ — This i -an not always be deter- 
mined. Tlte early age, the mitid pniKreat, and the (auiily 
hifiton' may stijfjsest tuherelc. Th* early ape, slow pm^rrcM, 
and mild pre!<eiiro-»iymptoms may sugg(«t gliomn. The his- 
tory, age, ainl nmeomitanl symptoms will indirat« "i/fihilu. 
The pn^sonoe of a jtritnnry growlli will lead to tlif dii4niu8Js 
of rtmrfr. 

/Mcaiioti. — The ftdlowing faclw relating to crrfbrat Ittnilhii- 
tion will aid in ddcnnininjr the liKiition of the grxtwth. 

Motor area. This oui»^i>ilA of the narrndiiif; rroiital nnd 
ftwcnding parietal cnnvoliitionit, and the |iunui-ntiid lolmk' 
which liiv alon^ the omliiin fi«iire. When the tumor irrilativ 
the |iart, convulsion rcfiilti^; wIr'ii iI cxcrtit t-nough prcflHuru 
tt> dcttlroy fiiuction, jiaralysts n»(dt«. 



Paraf*nlmf Mtutr — ^jiaMii ar |iarnly!i» of a lower ex- 

(hUral porlioHof the niotoi' area— ^pnum nr |Mniiy9U<>r otto 

The toteer portion of the tiwior area — jiixbini or [naralyiiis of 
one BJde of the fiw*. 

I'oMerior pari of the third /ronial conrolHlion {Icjl mlf) — 

Anterior portum i^lfu/ronlat loba — murkcd iwydiical »)'tn|>- 

Temporal ItAe-, first and Awoiid amvobdioaii ((^ jm/f )—wonl- 

Parietal vfi-iptttil /'Ar — iin |i4viiltai- Avniptonis. 

Af>ff>iinr nnit mipniimiiyhuil yiii-i (liji eiilr) — woixl-blindiifra 
aiHl niincl-liliiwlni-i^w. 

ftyri/M/rt/ fiJ>r — licinianopia, and somrtimts ivanl-i>liii<iitraH 
nml mi n(M>l indium. 

Corjjm utrialtim—lar^ \e»iona prodiire bomijili^iii frooi 
prt-wim* nn the iiitfnuil ai|M)ule. 

Ojjtii: thitlnmuii — Inrgc lesions may pixxliK-*^ hci)iiinifi-Mlli<7<in 
fruiTi piwni-o ii]>i>u the jxialpiior limb of the tnteriinl <a|isiilc, 
mill Hi'inirliim-A liemiaiiopin. 

tbrpom qHadrigemina — Itemianopin, nyst^fmus, anil syni))- 
tome nsiilliug from prce&iiiv o» tl>c mini cerebri. 

Crura wrefiri — ^lieiniplepa and Itctiiiautesthreia on oiw 
Hide, and inrnly-Hiii of ibe tKiilo-niotor nerve on the oiIhv. 

Pr^itu — fmralvMs of ihe ernnial tiorven, ami in many mit* 
ht'tiiiplcinii niid hcmiana.'Htbe^iii oil one Hide, aiu] fadal jiaralysiit 
on I he otli(>r. 

Jn/mutl myiM/f — hemiplcfria on (lie oppodte sMe. 

Malul/a~-\i»ra\y»» of the cranial ^er^'eB, OiGlieult articii- 
Utiiin, (nnl'mr nwl n^piralor}' disturbanccB, vomiting, and 
liiimt-tinx^ bi-iiiipli-cia. 

CirtM/iim imiihlU /r>&r)— iitaggrrin); gait, vomiting, 
vertigo, ami niarked headaoJie. 

pRiHiN<K(i>>.^Wl)en the tumor \^ not gnmnintotix, and iit 
not tinitiible fiir ofn'i-ative interference, the pni|nHwi» is nn- 
favorable. The duration ia from a few ntonllm to )te%'eral 



Treatmest. — Localized oortJcal growths, which are 
malignaut or sypliiiitic, are Buitabte for operative intiH-ferei] 
I II cerebral gumtua iniuiciions of niercurj' sfa^tuld be employ 
iiti<) nK-nniry nod iodide of poiawtiiiin given by the iixMith. In 
iitiuT csi*!^ the trcatmcDt m palliaiivo. fold aiiplitratiniis ' 
the hcnd, bromides, autipyrin, uud murphia ace re([tiin;d 
nlieve pain. 


(BupfmratiT* Biic«q>biillUii.) 

Etiologv. — (I) It nmy hv truiimatia (2) It may b^st- 
oondary to euppoi-utive itillunHiiulion of mljiuviil |>arts, 
i^ariea of die teni|>unil buiic rolluvring irtitiii nMtlin. {A) 
may be M-coiidury to Home distant fuciis uf xiippiinittoa, as i 
pulmonary alwuvss, hi-pativ alwocMH, ii)oi.*nlivti MidocuditiJ 
(4) It may nriiu' witlioiil obvimw iniiAO. 

PATiiOLOCi v.— 'J'br ulRit^ variw in nixt from a ix-a to 
larjto enough to fill itn entire li(-iiit?ipliMic. Tlic stirnxindic 
tisi^ueH iin.' hvpcnriiiii', ■iHlcmaton.-s, and iiKire or ]<*»• innilnitv 
In the lU'iitv I'orm tlic nlitwt^s i.« ilillnfN^, litit in h>iifr-qt*ndin 
«iW3 tlic pii» iw eiKtipHulntiMl by a thif^li fibrous jnn-, Tli 
Icmporo-splienoidal lobe and the cerel>c4l<iRi are ttK< tnc 
frcHjiu-iit scjil.4. Ali«-(^t«ii-s iMvnndary to distant Htd of aul 
piinilion an- eoninionly midliple. 

SVMfToiis, — .\lisft-!>si-:» following injnry frequently nin 
tuaiti:- ismrsi', atxl art^ elmrni-iorixid by high fever, rigors, he 
Hclic, deliriiiiu, conviilttion.'*, vomitin|^ and ooma. 

In chronic eases llie tfi-nenil vyin/ii'onwt are lieadacJie, irnMl 
bilily, mental inipainnetil, vertipi, vomiting, irregular fcvi-r, 
Mii|ior, [lallor, aixl Iit«i of flHi and ■•Irength. The /nndtad 
/Jifiiontena vary with the lo'tition of the idiHcww. liivoK-o^l 
meiit of the motor area may Ih- iitli-iuli'd tvilb ii>tiviil?<iori7f irr 
paralysia in one limb; of the leiiipor\>-i))tlicnoidal lolic, willi 
deali]ost^ and i>erhnp«i aphitMa; of the ooripital lobe, witlt 
liemianopia ; of the cerebellum, with penrintcnt vomiting and 
loa« of cnord inn lion. 

PlAtiN4Bl». Oi-rhral Tumor*. — The histnrj- of trariiiiikliKn 
or of »niie primary K^iippiiratinj; <li*isise, sudi as otitis, 

CKtri'lN ISil. 


I'JiiwIiwis, otnpyeina, uWrativp eu(lorarditi.« ; lUe ivrescocp of 
ti-vi'i-, mill the absence oi'diokcd dink will iiKiitmtv iiImwcw. 
Aeiite vasts can rarely be distingiiubrd from mij/puraiiee 

pROONdMU;. — Grave. When the focal .lyniitltmii* indkute 
involvMuent of an acooiiHible region like llie niutor nix.^i, 
ti-iitporo-sphenoidal I«bc, or wrel)elliini, ojwralivfl inU'rioniKv 
niliinl!! n)ii^i<leiabte liojie of ^iKi-t^fi. 

TuKATiit:NT, — When the abscess js locatwl in one nf ibc 
n^iona HpedliwI, the §kull should be tiv(>hii«?d and tUo pn.i 
e^aeuateu. lu other catiuf the application ornett-tijM lo lite 
nec-k, of ive-b«g)4 to the hvad, ami llie internal use of o|Mum, 
bromide of poUissiiiin, or of cJitonil, may t«miK>rarily relieve 
the diKtreiw. 


DSFlltiTiON. — A (longciiitiil nUet-tion, rltiiructcnxed by a 
lack of pbyMcal deveiopiiK'nl, an abnuniinl condition of the 
thyroid f;l<^nd, myxiwlwmi, and idiwy or imbi-eility. 

KtiotjkjY- — IVvoikI bentlily no tuuw ic known. The 
(voidition w widemie in tho Afp* mid PyniKTi<. Sporadic 
«i.H« iin; iiIm) ol>?ervtid in other isirl,-" nl'lbc wurki. 

Symptoms. Undrmte ('irthihm. — The Ktalnrv ii^i bIichI 
(three or four ft^t); (he head in lar^^, flat an[4^rv-{KK4er»orly 
and brodul laterally ; tlte eyes are wide ajian ; the iii)i»e i» flat ; 
the li{w »rf thick ; the tongue i.« lai^' and may protrude from 
the month ; the Hiost in uiirmw ; the l>ellv U pmniiitciit ; the 
lin<rerH are ehorl; tlie g<-iiilidia are i»ol developeil ; lite .<ub- 
iiiiaueuiia tijwtie*, <?'jKt'iiiIly iit (lie root of the neck, are 
ihickvtMtl from niiieoid or latiy ih-|n»il8 ; the thyroid eland \k 
^lerallr eiilar)^^! ; and lite mental ixjndition ii< lliat of idioc}'. 

Sporadic <sii*i< pn^^it ihe .'uiuie featnne, but the thynjid, 
in«t<^itd iirtxtin^ hin^'r, i^ atrophied. 

Congenital condition;! pre^ntjng to a Uinilcd extent the 
pheixintiMia of cTetinism are not uncotuiuoD, aud are tenued 



(SpiiuJ MaoiuciU*.} 

r>K»*iNrnoK.^An inllHinniHtlon of Uk spinul p«s mater 
asnociatc-d witli uifixliu(ii> (vrvlxwi^jjintil ntcntitgilts. 

EnoijnGV. — Tin* iiilw-liyiw fevcre, cxin.wtirc u> wiM and 
iraiiniatiHin, am] (tilx-rmlnsi)* iin- the cliolojrioil faclnns. 

I'ATHoiiCJfiY. Afi'tr A'"mi,— Tlir im-fnbrniM"* uri- njiaiifi' 
tt)M^kMHHl, i:iiii};i^tetl, ami luliirrftit, T)h- fluiii i:i llit- ars>.-h 
noid »jtiuv i* inctxasiti. In \er\ w^iie caitK» therv i*i nu*ix ur 
le« |iunilent iulilimtion. Tl>e peripbon* of the cord i» 
wdvit involved. 

(Jkronic Form.~~T\n: iiiomhraDcs are very thtok and Tii 
ioli> one )ioin(ig<!ntH>iifl fibruiLi nutw. 

SyjilToitri. Aralf l-'min. — 'I'lie (iJMiL^n niav Wpii witli ii 
chill, which ib followed by niodiTdU- fi>vfr, 'llwre is iulonw 
iniu in the hack radialine ahme the ci>urec of tbe uvrw*, 
V\x back is excjiiiailely tender. The ftpinal musdee are ri^d 
and contracted, wDietiincs ao much mi ae to induce opi^tliiri- 
on<w. The reflexes are irxrreaaed. \\'ben the exudate i» 
Muflineiii !o nialce c'ou»j([erable pre»ure on tJic cord, uonilviiu 
plii'iiDtiioiu develop, sudi as fitight ajisstiwsu aoil partial 
{Hndyxiit of the cxtrcinitiee. 

Tlwn^ arv no cvrebnil Hymptofus nulcss llic meaJngve of tlie 
brain am itivolval. 

DlAGNOtm^. .{/jtWiVm.— I n this afTi-ctiou llicro arc marked 
IKinilyinii and atun>tbi«!a; invnIvciiKiit of tlic bladder and 
nvliiiii : attd tliv fornuilion of Ixtl^tn^ 

Ithi-Huntliim rij'fhf .\fiif<-lr« 'iiul tfhmw Tvuttt^M nf Ihr B'fh. — 
In t]ii» ttiiidiliun (he juintfi nn- involved; i)k- urine in highly 
a«-id ; Ihe |«in dont not follow the nervc-truukii; and llie 
)^ym|ilonii> yield to the wtUcylnloii. 

TritnixiK. — 'I'lie [msttmi- nf a unund ; (he atwcnre of lever ; 
tin' (tirly iiivolventeiit of iht- jiiw; and the alw^nce of exipiiiulc 
ti-iulcrm::^ it) the liack will ■ie)>arat(- tetunm from nK'niuj^iiia. 

I'icooKraits. — Extremely ^rave. Recovery sometimes fi>l- 
liivTii, btit rarely without |>artial itaralyMs. 

Vhmuic IjeplomminffUis. — Pain iu the back; stiDiuMS of 


muscles; hyiii-nwllif^iii uri<l panratlK^b of lln' lower i-xtrcini- 
turn, but ruri'ly any uiiwwthcsiN; iwiik.- lota ol' puw4;r; und 
itictinsi'd n-ik-xcs. 

Trkatmest. — All i«T-!>u(t, Irt-ciw*, or cii[j* may \» npplinl 
la tlif e|>iac. Sc<]utivn> likv diloral, liromi<l<jtt, lutd iiii)r)tliiii 
lire iiKiiiilly retuiirtil, Wiirni liiilJia rrlirvt- llw: paiii liiitl !c»«i» 
llic rigidity. Kr^Dlnml ifjilUk-of (Hitatwiuni iin- ntimiriMiKinl. 

W tlic uditr Hyni(>loiiis iiiilwiU*. ioiltdi.' of [>otiL'^iiim iiiuy Ik- 
udiiiitiiKtviTtl iiiUTiislly ; bliMcJ-^ uiid im-ftninul imiiKrliuiir' 
may in- apuliol to the epiut:, niu) maii^iigi.' and elixtrmty tu 
(tie aflcclra inti^leik 


(CetvlMl H ypor Oophtc FachyracalBeitU. Intenui] 
Faobymeiilagl tis . 1 

Dbfisitiox. — A chronic iiiflaoiiuatory aflectiou of the dura 
mater, «?Juirat1eri>*d by severe |>aiiifi in the head, slioiikkn^ , 
aiiiiK, and loins, followed by inaresis, wMliiij;, atid uniCKthcsia,' 

Ktiolooy. — JIale (wx. oiiddle life, pmloi»(r«l expt)«'iire to 
(•old, lowi-ned vJtnlity, spinal coiicussion, alcohol isiii, und syphilis 
arc pn?diapo(tiiig furloi^ It itiay he sefHjndar^' to iiiflamiuation 
of nciifhlmring BtnK-turcs. 

pATii'iUMiY. — Tho nienibraiii-K arc tliickcno], opaque, aiid 
nilhi'rcnt ; tlie vcpsela nrc diluted ; nud the Mpiiml iliiid is tii- 
crciiHcd. Ill advunt^til <-Ji»<* tlic inciiibi^tiiT* aiv glue*! Ioi^tIIrt 
and li>rni n ihit-k, hoiiio^-ncoiw. fibron" uiiuv. The wrvitiU 
region is niual vommonly nltixied. Ttiv tnnaiiiiualiou iiiay 
extend to the cord and periphenil m-rvct. 

SVMtTtiM!*, — Slmr]> pains nidialinj; into the head, nhtHiMers, 
amt>, and )i)<ii», f<illii\)\il by Iiect nl' jxiMer, anxvthraia, nitsl- 
in^, sihI rigidily, piirtii-nbily in the iip|K'r exlivmititts. Winn 
the liiwci- |iiirl of ilie ei>ni i.n iiivulved the miiih* ptiiitouieita 
aix- uliMi-ved ia the legs. The dumtioD of the disease is 
several years. 

DlAUNtiHix. C'hroHK Poliomydiii*. — ^Th« absence of pain 
and of aosslhesia will »rparat(t poliomyelitis from pachy- 

3M niSKAftfS OF THi: NKKVOItt K\*«riElf. 

Multi/ite XeHrkU. — In lliis o^ttUiD ibe loun is Im marked 
in ibf bndc aud tutirc marked iu tbe extremities, and the oen ' 
lruiik-'< an- Ifimler ou [»re!»iire. 

>y«n.i/ trriuakm. — Id this condition the spine is tender 
ft-rtJtiii spots, and llnTe is no ndiaiing [Min, uuestbesia, 

I'bouncmis. — 'Dha depeixU on tlic extent ni»l raiHv. M'ltpo 
U>(? invutveni«nl is slijjlit or is dno to iiypliilts, lltv |>ruguosis 
sbiniltl be giiardediv favorable 

Tliti^TAiKST. — Al^iltitf n>t, TiiHK'' atf <iflMi indu^itM. 
CuiiDter-in-iiuiii)ti >lii>iili) W m»\\f siomr tlii? ii>ni by fn-qw-nt 
blisters iir iIk- ni-ltiiil iwiitt-r) . M-irpliiii, luiliiivriii, nr |ili<-nii- 
rrtin may be n.-<)iitiT'<I tor llie rvlief of (mm. Jmlidtr of polw^ 
siuni mny lie j<)intiiiHien-d fur it« alMorlieiil etTtit, awl in 
sy|i)iiit(!c ivwv it alioulJ be given Trvely in eoujuuiliou iiritb 
suniv mercurial. 


DKFtKrnoN. — All octite inflamntaiioD of tl>G substance of 
tite wird, ciiaracteriasl by marked tlisturbanoes of luutiua, w\i~ 
lotion, and uulrition. 

VAKitrruJi. — ^\'hen only a tfsm\F«rsc section is involvrd 
llie e(>nditii>n is termed foynwrrr-w m^UU. When a latxe 
vertical liection is uflectcd the diiF«a«' is termed </(j^Hite my/itu. 
When the gray matter is cvjiedally involved it is temwd ceatntt' 

GtioIjOuy. — Tianmnttsm ; (^xpMmrctooald,espceially wlien 
the l»¥ly is o verb tilt k'll ; ovcr-t.-Jicrlion: alei>liuli»m; syphilis; or 
iIk' iufectiiHis I'even* may indniv il. It i* MUiielimis »nx)ndan- 
to a benwrrtui;^ «r a muri»d unnvlb in the nml. 

PATUuLiXiV. — The mcmbraiw-M nn- iMiiilly injertnl ami 
oiMnjuv. TI>e substance of the eonl i» rod »ihI mf[. and tl»' 
line of d«man»lt4>n lielwten lh4> gray and wlitic matter i^ iit- 
distinct. In very acute cmms the HiilviaiKi- o( the (»rd may 
Hovr utit Hit n n-(ldi>>li, creamy fliii<l >vlii-» lli<- meiobninra arc 
c-iU. tXtii-ioualiy tltcre arc i*iisjiitiioit.-i Ik iimrrluigie i-EHwon^ 
'i I iiiultiiiivi'lilis). 

.Viii'fii'^'upio examiitation reveals deetmctioa of lli« nei-VL- 





cU'mciit^ aiKl in their plaM- {granular d^iru, fa(-glul>ules, red 
bliHxI-oorpiisclov, aiHl tetKtM.-}-tc«, 

SystPniJts, Aeutr Tranmrme .l/vrfiYi*. — Moderate fcvw 
(10l'*-IOiJ°), kuMf of iippctilc, routed toiiRue, stid coitsltna- 
tion, rullowc<l hy jKiiii in (Ir- ImkIc nultiitin); rtito the lintlw. 
Willi the [wiiii llieix- iirv "Iten various (i>nit>^ of [lanwtlie^ia, 
:i£ [iTimhncw-, litifjliiig, hiiriiiii^, et<% The miiwl'^ iiiiiy he the 
scat of tremont or of eoiiviilMvc wiamrt^i. There i» frec|iieritlj' 
a spiiBC of |)aitifn1 eoiuslnctKiu — ";'ir<Mc jiain" — at tin* M'vd of 
tile <)twa»e. Pnrnlyftii* ^ntn devvli»|i«, ami may bwimic imm; 
or less <xniii>Iele, The refl^sw urr- pHtefnlly iiurn-asiil when 
the lenion i« nhovc l)i« lumlnr Riilai>r<:ii>i'iil ; hiil if ihe latter 
in iiivolvi;'*) (hey aro Iir4t. Tho jwraly/ixl miiM-K'fl aiv llnhhv, 
hilt do not yield the reartions of di^ceiiei-ntioti ; when, how- 
ever, the rx'Hexw are exaggerated the luitsda; often become 
ri^id mid i<on)ractod. At liret there niay !» retention of 
iiriw and fe<*s, hut later there w frequently ineontinenee. 
Atiaci<th<i4ia is more or less eomplete. Itedsoreti soon develop 
and add to the di^rirree of the jiatient. 

T>e.ilh may result in a few day ti from estciuiion upward and 
involvciuent of tl>e resilimtory niti»'h-M. In mutiy eases life 
ifl prolonged for sevcrsl wccki*, death liniilly ri«nltin^ front 
ejcnaufltion iiidnoed hy he<Uor«f ami c}>*>«titi». In mrecancs 
tiieiv is a s|iot)tan<-ouis amvt of iIk- in (lam mat ion, and t>low 
recos'ery fono\ti5, atlendeil with |i)irtial ■>anily<ii>. 

Ariilc fhxirni Mi/rlili-' — Thiif ri-;«-mlili^ (he toriiHT, luit the 
trophic distiirlminw* ;in; iniwh luoiv nuirkitl arid the ihira- 
tion isfihorter. TheditfwiH' tsehanirteri«il iiv moderate (i-ver 
and its aanociatrd ptienonteiui, pain in the l>a<rk, complete lim 
of power and of tK-nwilioti, luo» of reflexes, iim>ntincnoe of 
urine and fixi:s, nipid wivting of tlic mitai^lcA, and the early 
develu|Hiiciit of U-d.'iiin^. The diaofle invariably proves* 
fatal in from oiwt In twi> »veek^ 

DiAONtwtH. Afuie PiMotayelilig. — In this diiease the blad- 
der and rectum are not involved, and tltcro are no aemoty 

htwh-i/n Diitmite, fa- Acvle AticetiAing Parah/''u. — In tbia 
atli'ftii>n trophie distil rhances are absent ; ilie hliidder and 
rectum are not involved ; and the loss of sensation is slighL 

36fi niSKASBi OK THK SKBVonS sysTEii. 

AfuHiplt A'etirUU. — Th*^ "gir<IU'pnin" »abM-tii; l)i«ftphino- 
(ers are not aircclcd ; l>MU<ire>) are rare ; mid paiti iit more 
marked in liic t-xircmitks lliaii in lli« Imt-k. 

Jlcniiif/ilU — The girdle |ttiii Is al»<-nl ; the ftphiuntcrn um 
iMtt aHi-clMl ; the ijTJtativo |i)H-»ntueua are iiujit marked tliiui 
the mraUUc. 

jMnorrhafff inlotke Card. — The imralysis develops oIk 

rBiMiXOMls. — AlwBvs extremely grave. Acute central 
nivelitis is invarialily fatal. In oilier cases recover)' attended 
witli paniiil panilyniif (xxiLsionally follows. 

TiilLiTM KST. — if |)ij«'iltlf, the |>a(icnl slwuM bo placed on 
a wulrr-iM.'il, To ik-Iity llie funiiiition of lKtliM>mi exlTeme 
c-lraolincsB is (^«si-ultul. It'ith iii rcUiition iiud iiicontiiieiKe of 
uriiM.' the fatliMiT HhoiiKl lii; used tMuo duiiy. In iuountiiieuoe 
of tiritiv and focvs \hv diw'fuiif^ shi>u]<i be nxv^ived oi> rulton- 
wool oriflikum, wliirli J!iliotiId Ik- frt-ijUMitly iviK'wcd and the 
jnirts Ihoroiiplily »li'«n«'*l. In IIk' lH-;iiiuiiii<; an iw-hajj or 
wet i-ii]Ks may Ik- u|i)>liiil to iIk- s}tinc. Sofh rt^iiM->lic!i as t-i^ot, 
IH-Iladonuii, '|iiiiiini-, iimi nw-mtiry niv frii|iii-iiiiy i-mjiliiytil. liut 
they swin to cst-n litlht iitthK-iKX*. If iveovi^ry >hoidd fnllou', 
niassu^', i-lixrlricity, and stnvhnin may b« employed with the 
l>o|>e of restoring |H)wer to ilic lutrulyvM-d inu»cW 


EtioijOGV. — Middle lift-, continned exposure to cqld and 
wet, syphilis, alcoholism, gout, traumalUni, and extvsscs are 
the pn.-dU)>osin}; fucton. 

pATiioi/KJY. — The mcmbmnrs an- o]>ai|ne and adherent. 
Tile wtiok- ivnl litis u ^frnyish color ; it is Brmcr titan nomal 
and MinK'what dontniclni, 

,Micn«'t)pi<: examiiialioi) rcv««I* diftnu-tiou of nerve-t-k-- 
ineuls, anil tlioir rcptaucineiil by au overf^rowlh of ranucctivi; 

SvwtTXJMs, — Tlw di»pn.'*e hrpins (rmdiialty with niimhm'ss, 
liiipliiig, or hiirniii}; in ihi; hover exln'oiitiiv, follo\vo<l hv a Kms 
iif |>i>wi'r iiiu) M'liKalion. Tin- r('!li-x« an- iji-ncriillv exii^^T- 
iled. TIk' KphtiKHtrs «<■>» iKximio involvi-d. TIh- imi^rKVi do 


not wxflte until iIh' <liw.iUH- hn fur nrlvgiiKCii. A# in ollivr 
Mrgaaic affeettoni^ (ifllifi i^inl, tlion^ Li olicn a »^ii.-ic of coiifftno 
lioD, or "iprdle {miii," al lite level of tliR (lij«eAi«c. Ttiv dtSL-ase 
|im^ivt«c« verv ^owly, tlte duralion being I'ntm nix inoiitltH to 
ion _v<«rs. 

l)iA<!N«wiB, — 'I'lic (!iiit;inwH rests rrn tho )iiii<iiiii1 (k-vplop- 
niciii iif Hviii|>(<itii.4 iiulii-atiiijr a guwral iiiviilvi-itx-tit of tbe 

Trkatmknt. — The jwtii^t iJioiiM bo put ■! ttfit ; tonics 
are oHr^ indiraKvl ; ooiiiitcr-in-italioii to tbe it]iine Uy n-gitxliK] 
bli!>t4'n or iipjilKntiKiiH of ihfi a^Miinl canten,-, nllon yii-Mw ;;"mic1 
nvnill.-c. TIk; tn'i|tii-tit iim- of ff]ii<l tiatbs in aL-to iH-m'tiirJui. 
'I'be !<|K-<'inl ivniwlip* wbicb Ijave l>opn rwiMiinu'iiiiiil nrv 
ar^enii:, titryHinJn, jihtMinbonm, nitrate of silver, nittn^ny, nnd 
iodide of jwlosariini. Wben there is a suspicion of tiy|ibili» 
tbe Isiit two remedies should be given a tborouj^h trial, 


(Dncbotuio'n DiMiaaa.) 

Dfpikition.— A diyMMtnilive aCTti'tion of ti»e spina) t-ord, 
nbarneterixrd analoniietilly bv an ntni]ihy of the ner\-<--elcn>ciits 
and an ovei^rowth of conneotive lissne. 

Ktioi^hiv. — Middle lite, male ^-x, syplitliti, alcobotiiwi, 
mineral juiiaoning, excK»<«, and continued ex)(0(wre to iwld 
and wet am llkc usual cattses. 

IxH'otiii»lor Aliixla. 
(Locomotor Atucy, Tat>«a DoomIU. Po«t«rlot BclMOSla.] 

Definition. — A sclerowia aflecting ihe poKte-rior cnbimnv 
of tbe poni, and characteri/wl by inoodnlinatiou. loes of dtt-p 
reflexes, disturbances of unlrition and of senaalion, and varitHiii 
ocular ])lieti<>ii)nin. 

Pathoi.o<jv. — Till- membnmes over ilte posterior oolumns 
arf oDiMi 0|Aqne and iidberent. The posterior ndumns haw 
a ^mytHli rolor, and are Umi and shrunken. 

Mt<^nK4niptr examination re\'oals ulrapby of tlie nerve- 
fibim and an overgrowth of connective tissue. O^enerativi; 



t'lmnp<# lire frpqacnUr obecrred iu tJie basal ganglia and i 
llii- gx-riplicml ner\-c8. 

Hymitoji*. JH'itor Phewmena. — One of the carli. 
«viuptoiii« w luss (if voiJnliDatioii. Tbis ih firvt muntf< 
by 11 n$] till I i 11(94 wbcn tbc [Kitienl wulkg in iho tlnrk. Wbo 
l)c «taii<ls vnti, with t\w v\i% clusn] und fL<ct toi^llior, li 
»U^j;pn< uri<i t<rii<I« bu fall (Itumbcrgi'a sj'niptum). Wbfa tl 
arms an oiri.i-t«l tlirn- 1* inability to porfin'ni work rcfjiiiriii 
(lelicat<^ ccK>n)in:Ui<<i), snob ii» writing and piiinu-iilHyin^. 
Tbis I'K* of iiiimliiiiitiiin in lliv ii|»i>»t fxlrcinitiw )mi\>ii|' 
i>itiH}>iirii)ni4 wlicii lli<- juilit-tit, wbtlc bis i*vi.-^ tire, 
tonjiti* to tinu-b lUv li|i of bin now, 

Tlic t^ait is chnnu^ieriiitio ; in walking bo raiKs hiH ftiet bigh 
tlmiw8 tbcm forwunti, niitl l>riugi< Ibvni down fonjbly in midi 
n wiiy lliitt ibc wlmie snlo Mriki^ tlic Door nt onty. Alllimigf 
tbi- jKitittnt may Ik; iiiiabte to vmlk or to une. bis baniU wi 
|>n*isin(i, tbcn? is iiii uiHihI bu» of jutwi-r. 

Seriwrtf Phfnoiiiaui. — Pain is rai-t-Iy al).4cnt ; it iii fibnrp aoi 
laiuiinatin^ in iharactor, and a|i]K'ar* in jiaroitytfros. It usually 
involves tne oxtpemitips, but smietinjts it attacks the stocuai' 
and is aoromiianied with nbiilinale vomiting. The tenu j/nrfWi 
cruit is appliwi to thie pbcnoinpnon. 

Crisett may mv.ur in other organs, notablv the larynx, where , 
thi'y aiv manifcj^tixl by intt'nso dysjiiKea and stritbiloim brentb^H 
in^r. ^'ariuue f'uriuii of jiarR^sthcNa an? ub«^rvc>], savh atfV 
tingling, ninnbne^, " pinu and noL-dlw," and tb? like. Irregu- 
lar ai'cas of an!T?stii<ifiiu niv fn-qiiently di«tribntcd over the bodv. 

fi^.re*. — The pHttllar reflex 'v» lost vory curly in the 
discsVM?. The pitpii fails Iu re!^)>und to Hgbt wbib- it Htill 
acmm modules tor dis1uiK« (.Xrgvll-ItoWrtMuii pupil). 

Kyr y*A<^nom«irt.— Tbc nio««l ini|>oriHiit an- diplopia, con- 
tiaetcd iKiptlii, dimnvM of vision t'roin 0)>tK: utrvptiy, 
pareeifl of u>e ocular muMtkii. 

71-o/>Aw- /'Vworar/wt. — ^Tbe mort ciiriotts are tbi* »o-4nII 
artlirojialbiw, wbirb conitbit uf (iibii^imiit of tbft joints, 
Hiwoeiut'.'d with mtoo? cttiHion'*, alrnjiby of ibe bonilh uf tbv 
bone, vroriion uf the (iirlibigi'N, aiul eidi'ifiiittion of tbt^ b|?0~ 
inents. TiK;4C articular I'biuigi^ sunii^imcs lead to luxalioi 

Perfoniting ul(«r of tlic fool U 8omctini«y oluerved. 



8cli:rc»ih oy tiii: kpinai. ctiuD. 


Other n/mplOHU sonM-liii>w nlnwrveJ are: loes of sexual 
jwwcr, paralyses of lUv sj>liiHct<:i:s, e|)ilej>tilorni seizures, aiKjl 

ciATKU. — S[astic |nRi]>tef!ia, niu]ti|>le neuritis, pan-tic ik-mcD- 
tift, nud ohmDic ixjIioniyelUis. 

DiAfi.MjsLf, Jfulttpie XenritU. — In this nflW-tion tlw! 
[veriptH-ral nerves are tender; tJie tDtiK'le* niilv yield iIm- 
mietiuus of defeneration ; tlie pain ii; not laiK-iitntiiig )ik«! 
that of ataxia; and the Arf^ll-It'ilterliRHi pupil in h\iM-M. 

Titmnr of the IWebtHum. — In tliis (Hiudition llic- rfHexw arc 
not iiboli»hcd, liRhlntnf; |HitnH uiv iilxK-nt, nn<l in:itt(»d there 
are jHTsistent voiutlinp, )i<-ii<lRi-Iie, an<l o|itic iK-iiritis. 

(.iiiMriilijia. — A f^'iiKtrii'iTisisiiinv W minlakMi for ^laDtralgia^l^ 
I)iit tiK; Hsfn-iiiii-d jilii'uoiueuB of loooHiotor ataxia wilt prevent 
tui (•mu' in diitgiKisis. 

PB<x)Nost». — (reiierally unfavorable, allhougb arrest and 
even improvement are not iufre([nent. lite anra^on is in- 

'rK(-:,\TJiKNT, — The patient should he plaeed nnder the Ix-xt 
hygienic eonditions. Rest is dii^inihle. In the <«rly f^Ui^v a 
prolongwl vovajte may prcxhiee excellent rwiilts, Tlw dii-l 
niiut be nutritious, but easily ajv>imilable. Exees^^ of nil 
kinds antsi be ri^ly pruhibitcd. Touics nro fm|U<-nlly in- 
di<-ated. When tlivru is a suspinon of nypbili^, iodidi- of 
)Mjta««-iuni sliould Ikt ^wvn in fidl (lot^i:)^. In oth^^r iitiw todklo 
of potniwinm in small dor^v, mercury, and iinniiie, iirr- llw 
most reliable rttu4idi«>«. 11k; tolluwing |hII inay pruvo 
useful : — 

I^ S^hIH nnwnlnt.. 

/ini-. ptiosphid., lu ST. ij : 

Hvdniri;. lodUl. rulx, gr. j.—M. 
Ft. in pil. Xo. xsji. 
Sig.— Oue, three tinica daily after mcah. 

Coiintpr-irritation to the spine is useful at>d may bo made 
with Minull liliHtcr^ or the aetnal tsutery. 

Thr. FitiiiM. — When vm* inleuse, murjihia will he requirwl ; 
in other astn aiitipyrin, phc^iaeetin, and mnnnhis iuditn arr 
KimetimeB eflicii'nL 


5 Antip^rin, aj ; 
Syr. Jiiiijiilicr., (Si; 
A<|iuf q. s. uil l^ir.— U. (Grruajk 8BB.J 


S|£.-~A teati[ioonrul ev«ry onv to four houn for Uirec Id 

The Inri/nffeal erise* may be rcJieved l>y tltc inliulutiuii 
chlorofonn or amj'l Dilriu-. 

I*riinary Spastic Paraplegin. 

(Lateral S<d«TOal«, AiiMro-l«t«ral ScUroato.) 

Dekinition. — A nervoiis a6ec(ii>D pnibably cK>|M>it^ 
upon sclorosie of the lateral roluniQii, and rJiararterito-d I); 
lo«s of |M)wer, inc-rDaiicd reflexes, and a spastic ooudiciou of I 

I'ATiioi/XiY, — There is probably a sderosiB of tlie Islenl 
oolumiw t>f thv coni. ^^ 

HviilTojr^ — I»fie vF power is gencmlly the first fiymptoni^H 
This iHiiiiw in the lower oxtn-mitiw! and inrrtusui very slonly." 
Tli« k iKf-jerk K cxaggi-mUii, imd in nnwt vatva iinkK'-t-lonna 
»tm Ix- ilicilfil. WIhii i>ii( in Ukv tlir niii'^iU-s N-ciiinc- rtiff. or 
)f|Hii<ti(-, «ikI whvn llic ai«3i«r 'nt fully devflopwi ihi- piii im 
ptriilisr. In walking the knrc« an- (Imwii lijgctlter, the k-g8 
dnig tit-hind, «iirl the Itnw oilvli tin- i;n>ii»d. 

T)i4- riiiiwliv do not wiufto, but niilii^r tfiHl to iMNXiino hy[ 
tmptiicti Iron) (tmliuni^ n>llcx i(|iinii1iiti<Mi. Tlie ^[ihintlfr 
urv tiliimiitcly iifl'iTl4il. Sonwtion ti> )£>'tiemlly tiiKli.-vtuHHilJ 
but ^idijifiivv phi'iKinK-iia like iiiinibnrwi' ami (in^'Iin;^ nuiy It 
oUtorvnl. TIh- Hp|HT fxlri-niiliw iir<- not often iiivolvnl, bv 
finally lose of jMiwi-r aitd rigi<Uty may develop in them aho. 

pR<)OKO(>t8. — Uiiravoral>te. Iq rare instanuee the ditwose ij 

Tlio tliinilion is irwlefiiiitr. 

Thkatmknt. — The general treatment is the nine as 
Irieomotor nlnxia. For the Sjiasmodic (condition of llio mut-^ 
rieii, rubttin^, warm liaths, and tlie lullowinj: remedies arf 
rcoommendra : bromide of potawiuni, mlabar bean, and bel- 



Amyotroplifc Liitcnil H<-Ii>mMts. 

OKPlxmoN.— A iHTi'uiin ufTcction cluinK-tcrizcd aitalnmi- 
oiIK liv a (k-stiirmtiirti i>f iIh- Inirnil «i>liimn>i iiml adjao-nl 
f^y nuitlfr. ami iiiaDircxlitl diiiii-ally liy hvn iif {hiwct, 
wxoting, uimI a )«j<a'4»c <itiirlitioi) (if the iiiiiK'-li-e, 

l*ATiioi/K)V. — Tlt<- (liHm-« a|i|iain-ntly (li-|K-tKU ti|M>n a 
*(;li-tvnfi» involving; iiiaiiilv llio nmoriurlHiriisiif'llK-);my tnalU-r 
gnil the aitu-ni-laii-ml r<oliimn^ 

.SvjirniM?;. — l.<uM<ir|uisvor aitd witHliti);, ii»itally lMyii)niii|r 
in lltv ><liiall miiAcIra uf tlii> liaiu), oihI tfradiially A|in'.((lii)g nviT 
tbi> (-nlln; hrnly. The n>f1ex«it an-. cxi^i^iiiiIhI, When Uk- 
nriii>cl<M nn^ (>iit tiiu> iim% they Uiijine more nr ]<?m rif^d, or 
i'{iikk1hu The doj^noralivi- |>n>c^4>Ni cx(<-fi<t'> iijiwanh tiiitil it 
itiviilv4ia ll»c mc^iilla, wlicii nvriiplmtiH uf htiUxtr )iuUyu|i|H-tir. 

DlAOStihis, — The Hisi-iimnlir rixttliliiui oi ihtr iiitiHrli'it will 
di-tiiikpui'h it (mm pure /inf/nvoiirf lanM-utar ittnijAtf. 

I ' IMK) M « ifi, — I ' i» la vo rahl*'. 

Trkatmkst. — Siich rpiii«li«i its anwiiir; aD<l lottide of 
tmla-viuiii arp rectimim*nd«l, Ini) tliey iiiuuilly pnive iiselewi. 
['Ik- AjKistic oondition is improved by tnaasage. 

Ataxic Pnni|ilotiriit. 

DKFlMTroy. — A ftflcrmii- nffii-liiiii of tho. \tnnifni}r mid 
bicrul i,i>liiiiii)x roanitVHitii)r HyuipimiiM uf Ixtlh liH-oinuior ulnxiit 
ontl "iBWiir |«raiil<-gia. 

Syuptomk — It K^^niblc^ ''(Hiflio |)flrK|iIrgia in thn Iftwtor 
puwiT, j^w^lio iitiiditiim uf lh<- iiiiis4-I<-i>, iix-iy-a^ n-f1ox<«, aiul 
alMtciKv of wnnrvrr difiturlxiR^xfl ; ami loconurfnr ataxia in iIm? 
(lUliinH U*» of niordinalliiii. 

DiHM'iiilimttMl CV^it^bro-spiiial Sclerosis, 

(Hnltlpta Scl«toal*. Iiuulni Scl«roaU.) 

PKKINITION. — A diroiiic n^n'oiw »hrt«i>i* Hmni'1<Tiw^ ann- 
toniii-ally by [lal'-heA »f acleruslK <if vvryin}; iinxi smtK^rcd 
thn»i;:h the brnin aiid cord. 

Et(oi/xit. — The raiistti which \v9*\ t« olh<'r wlproees of Uie 
wmtI mav induce this diswwc; Uit; infwlioiia fevcre, howwer, 


are aftticned a prominent plwrv i» it8 t-tiolug)-. It U mc _ 
ooniDiniiTy u)iBCi-v«d in yuuii^T [i<h>(>Iv Itijin is liM'oniolor ataxia 
or Intei'al wleiviAitt. 

I'ATmiMiY. — Ar«ifl lit" (inn, ptny, sdc^rotic ti^ntc, of variotN 
aUK« and fbajtes, are t'oitixl llmxtgii lite bi-uiii ami vnni, 

SvMtTDMS, — The .tjiiiial ityiii|itont.4 iiinv rcM-iiiliIe cilh* 
loonniotor alaxia or latcnil M-Ii-i^wis, acvonlii^ as tlir jmisUtIc 
or IsK^nil (viliiiiinA nir- rliJi-fly iiliWltil. 'I'lic duiriui<?mli(| 
flymfiliiiii.t iiri: Uijw of jwwit, tiMtnlly mult inmrkii! in tlii> Ify*: 
ii>Mmii<^«i ix-fk'xcjt; v«pio |)«i»8; » mamn- tnnwr (li-vi-!u|i«ii i-fll 
m<>vi-itM.-t)l (vi>litioiinl titniur); a sluvr, iMfitHtiiij;, ''jM-uniiin^'"! 
spctvti ; iiyi<tag[iiiiH — tifnior of the cycbalU; awl mi-ntiil iuh' 
IMirniCJit. Hvn»ur)' und trophic di«ttirl>ajH'<.'« are ^-ucralljy 

DiAOXOtiiH.^ — nii<M*miimlt><l wlcrotiit) may be niiMakcn foi 
paraltfxU ui/iUnt«, htil (lie laik-r HiM-aw d<-vcli>|)A in lau^ life; 
tii« tn-niiir i.i liiK-, ran-ly itivnlvis the hi^, and !.» noc taaAe 
worse liy use of llic iimiidfs ; ami nystagniiis is alispul. 

l*i{(«iX(Bti8. — Until v'or»bl«. The duration is iwh-finite, ;im! 
lf>n^ reniiwiion.t with improvrnKnt uf Hm Eytuptoms arc nut 

Trkatmkxt. — The general tn?4linent is the Aaine sh that 
for |Misterior ■t(.'l<>rofli><. Jlrmnidis, liyoscine, hyotK-yunjim-, ami 
holladonna have been recoiuinendcd for tlie tn-mons. 

I Ilcnilitiiry Ataxia. 

(Frtcdifltdi-N DiMftM.) 

DEPIsmoS. — A sclerotic afCwtion of (he i^pinal coixl, otinir- 
ling in ^veml children of (he Nimc family, und •hariKti-riztd 
by symploms irticmblinK locomotor ataxia. 

ETioi.otiV, — ^The grt-altst ntin)i*er of truMW develop b«!tw*on 
the second and tifieenth yrars. Some can In- tniii-<I to hcrvdiJ 
tary infloenrt?; in others a raiine cannot be aMiiinined. 1 

pATii(»t-o<iY — Sclerosis of the posterior and lateral cwluinni] 
of the eonl. | 

SvMrrtiMti. — Ixiss of coiirdi nation in tbv nrni and legsb] 
nystagmus, im^nlar jerking mo%*enKnbs of tlic liniMls, loaa ofl 



B, n fxmnnin}; xprt-di^ iqiiiuil viii-vatiire, cquiDo-vurus (liifl 
tunA aiKl lliv w>lc tiirrKil in). 
It ilillt-n frum Itxvmutor uUixiA iii ttip iibsi-rwc of elmrp 
liiw, iuiicstlM«ia, iIk* Arg^ll^Kolx-rtiwii pti|tii, mhI in tlip 
tiim-ntv of im^ilar niovcriu-iilH vf line liattdit, »yt>ia)^niiu, 
■Duin;; i>jMTt-li, mill itiiii 111 >- varus, 
[*ltouN08ls. — L'tifiivorablc Th« diiml^oii i» niiiny ymni. 


Defdcittok. — A mveriioiifl omulilion of l)u> cord lutwx'iatnl 
vffh an ov«i^7X>wlli of the ittui^lia wmitiiiding die oeiitml 


ETtni.<xiy. — TIh' diMt-ft!*!: i.- iinilwbly of congenital origin, 
Dlliimgli it uay itut niaiiifi-^l ii.-tlf until »uberty. 
I SyjiPT*»MH. — Nciii-algii- jaiiis ; jiarnlyHis and wasting of the 
Rii9(^lei!, which ultinmtt'lv bcumw- ajM-itic; a U** of paintiil 
»m\ (iicrraic sensation, while tactile seimalion is (ireeei'ved, are 
il» rttief fiym|>totns. 
lUAGNiwis, ffn-onie Poliom^itu. — In Uiih affection there 
ao i^-uMiry disliirluiiiocs. 
_ .l/onvm'a lH»ctu<., — Tliis diflcose clusclv rc»enjbh» syriiigo- 
myclia, but tactile sen-'«ition in lost aiM thrrv 18 A markMl 
tpudciicy to painlu« wliitlows, 

i*it00N06i». — UnliivoniUc. Diinitiuii, nix moiittm to two 

ITrkatm ENT. — Palliative 
■ Dkkinition. — An nciite disease, occumnn ulmoei exoliN 
Aivr-lv in voting childn-D, charartcrixcc) Eiiiatoniitally by a d<^ 
I :ilnit'tion of tlie t!;3ii);lioii-ce|]<i in tlic aiilcriur ^ray honiH of tlif 
i'*)nl, and nianifcfitctl i-liuically by abrii|it patulysis and rapid 
wasting of cetlaia niusclra, 

H>r(0LOoy. — The grrati-st number of cases occur within 
liip lirvt three yeara, and the diycase is far more common in 
eumoivr thuii in wint4T. 'Ilx.* «uil<]cn onset, the alisruce of 


(Itifiuitllo Pamljraia, Atiophic Spinal PiualTala.) 



iiiir kiiuwi) exciting C8i»t>, and Ihe UuA tlial it liu uccurr 
t'piilvniicsilly ftiiggefit an iiiltHtioiLt origin. 

[*ATllor-ooy. — The siiddeii omel tuA \viilc-»{>reiKl 
IMiralvHis an- prolraltlv due to intc^tw mngi^itioii, nixl tin- pi-r- 
iiiam-iit jianilysis and wasting lodcslnwiitm <ii \W [rmpii^'i ~ 
(t'lU in the anlerior gray lutni?. MiiTimvipii' i>xiiminati<>» 
rf*(*nt tnant rev<fll.H ccdiymoacA, tl<«tnirtt«in of gnngliuo-crll 
and inliltnilinn <if li'iiifirites. 

Rxa mi nation lung alter the developnieot of the uai^nlvn 
pevml-i an al»en<* or atrophy of the Isi^ nnilti|M>i;ir <i-It 
in the gray honis.and in their stead an overgrowth of rtinin--- 
tive tisine. The anterior uerve-mota and niusdcs aUo reveal 
degenerative ohaiijiee. 

SvMtTOMi!. — Genciii])y lh« onM-t \t altriipt ; nften the Hiiti 
14 put to bed in apjnri-nt hi-iilth and in tht^ morning is fotir 
(KinilyKwl in one or more linihv. In wine aw?" fet»rile fivnt|>- 
toiuK prerc<l(> llti.- attiu-lc, ari<( more i-nrcly the diwase is uabem) ' 
in with a cliiil. a iMiiviiNion, or ilelirinm. { 

Tiie paniiyis nt lir»t iiijiy Ih' i|iiitc rxlenMve, hnt more com* 
ntrinly it (■onliiHU itM-lf to ocriain ^ruiiiMi of nniwh-M in tli^J 
uji)K-r and lower extremities. The lai(i-raree«{ifH-iaily pninptdH 
Miller ; Ihe nfltTled mntxrlcii are ti-lAxeil, and the Mirl'ni^ !» eojif^ 
and olU>n •■yano-xxl. The paralyai^i ift |ieculiar in iln tm-t^iiiir 
di.4<rii>iili<in and in its lendeney to imjirove !iiMinIan<'<jiisly up In 
n ivrtain Ittnit. Tlieiv aw no sensory disuirfiai>e«i, no tiivoiv>-_ 
nienl of the liladdcr and rertnni, and no lendeney to Ixibor 
The inn.4i-l<» which are ]jcnnauenlly alibied rapidly \va:tt«i 
yield ihi' reactions of defeneration. From eoniraeinrea of ll 
atrophietl mn^-les am) eontradion of their l>etdtliy anlagonis 
variims difi)rniitii*s develop, 

DiACJNtviiH. — The abnipt onset will distinguish it fmni bot^ 
idiojjtilAiir MH*rtitiir ahoptui and prnifir^K maaeuiar airotAj/i 
The ahwnnc of sensorj- cli^HirUHu*'*, )>ed»ireH, and jiaraly*'-^ 
of the bladder and rectum will scpiu-atc it fiimi myfliiU. Tli 
presc-ni« of <«rer)ral symplonu*, of chttiriform or atbetoid 
nH>vcnH'nls in iIh' affe<-t<d rnenilK-r», ami the ahsetKV of r«ac 
linn.« of defeneration and of early wiMtinj; will H^paratc 
bml paral^is nf cltUtlhood fVoui avule jioliomyelitiK. 

pnooHh»<ivK iiusan.AR atbophy. 


Pkoos^wi.",— I'nk** lUc initial svniiitimw are very wvcrc, 
Ilif priipii»*i.-s n* rt^inl.-. life, U i^mkL In all kwkk some of 
thr jutralyMHdi.inpiieara. OiH-aAiunallv (ho im[>niv(-nu'nl i^ >m> 
f^ul ittat lliv iiM^rulnras of the nu'nibor b nnt iiti|iuirt'tl ; but 
tlir mure freqiii^nlly llie residual lutralvBis is 8iiffi<-irtiit to caiiiie 
miL-iiderable dcfiirmiiy and dibability. 

Trjiatuent. — During llw aciile slage thcdiild fhoiiM be 
iiinliiMxl to bod. Torelit-vo the ociiij;i?stion, dry cii|w may U' 
iipplicd (o the spine and erjiot may Iw given inifmally. Tlio 
allctHed nicml>i'n> shoiilil be wrapped in flannel. 

After the Ia|jise of two or (lirEv vftvks cli-ctricat trmtmait 
(thonld be inKtitutc*] ; the furudic vurrent niay be empluved 
when it induu-K oonlnuTlion of Ibc afTcrtttl miit>rlcs, bnt wbeii 
it cxoitt* no ixw|Miii«; IIk- fi^ilvintir airrent ninst be Kiil>stitntetl. 
Miissipi- i* » very viilnshle iidjiiiK'i to llw elretriral treatmeiil. 
hiiirnnlly !»tryciinia(j;r, j^a I" a ciiild uf IwovKini) (^radiially 
incrvii^ttl in a in^efid iniiNtilar tttimiilunt. ^(u.'<t<»cr and (he 
:Kljii^tiiii>nl of nuvlmnitid uppliuiH.-<^ will l»c reajmnil (o uonibM 
tl<-lorniitv fn>in ontrat-Um-^ 



(Ctitonlc Spinal HuncuIm Abophy, Cluoiilc PoUoiiijretttta.) 

DKFixrnoK. — A chronic oervoiifi affection, eJiaractt-rixcd 
nnatomii^ly by de);eneration of the jfatigliun-ecILi of [|>e gray 
mutter in the cord, and ntunifevUHi dinit-ally by Ices of )M>wcr 
and atropJiy of oorresitonding muH-lt*. 

Ktioixxjy. — Male sex, middle life, and herwlitaiy lemlency 
are the tmilispiwing (iiiiMV. It »oa>ctiroc» follow prulon)^ 
emotiomt! ejtvit^inient, exfw^tirv to cold, UuuRiutiHm, and 

PathoIjOOV. — Microt^-opir examinnlicui iif tiMt gniy niiilter 
of the «>rd rx'VcaU aln-phy or i-Dtupletr iil>i>:ni«> uf tin' la«n»' 
nn:lli|>i>lar ciJU in Ifii- anterior i^irnim, and an nvcr^Towlh of 
(vniMflivt- tiwiu^. 'I'lii- nnti-nnr nnjt-lil>n-s an- alw» llic mmI of 
di-ficn^-mlive eliiMip<y. In :*onie oiM-ii the lat«inl colnninst arc 
likctvi^^ m-loriMOtl (aiiiyotniphie latei'al wriitnuiit). 

Kxaminalion of tlwafftv-twl mitM'Irs rcvralH atrophy of lire 
fibrts, falty tk-gnm-mlinn, an ovtjrgrowth of connwtive timie, 



and an silence of tniiiMvcree Ktriiitioii, Rud instead, Igi^tDfJi- 
nal Htriatiuii. 

SvMrroMs. — Not intrcfuniillv ])nMln>n>iil s)vn)|rf(>ri)pi nre 
nutpit in the juirlK to Ix-, siiWi ii-'< jtfiiit, ciiIiIdi-m^ i>r 
niiinhitcNS. Sdoii, linu iif |iciu'<-r iim) ivimliii); iH^in in tht- 
Mniiill mnsi'lis of tlit.- Iiiiiitl, iitimcly, tlie tlieiiitr aiio inU'roM^-i 
iiiiDU'W. Altliinigh line hand in uiuiaUy aA'crlMl licfont ibe 
<itlnT, the diwa*' U-iid.^ to t>ecotne svm metrical. Jifxl to the 
liuiidn till- iiiiiwlen 111' till' sliotiliitTi* and amis slowly wasitc, reo- 
di-ritig tin' Iwniv itromlneni'es marked ; and hi» the diwa-e 
advaiuin little bv little until the [iali«nt is nxluowl to « men- 
skeleton. The hands assume a charsrterislir apiH-aranre : from 
atrojihy i>fthpinleivi«*Mandci>utra<li<>»ol'tlie lui^extcnwtrand 
flesor miiseles they become "chiw-like" The wasted ini»- 
(■Ii>B are fivqiipntly the ««t of fihillary tn'more, TJie response 
to the g:ilvanic and fanwlic cnri\-nt« h diminii^liei], but lh° n> 
iidionsof dc^neratiou do not ilevelop until th«> disease is far 
iidvaiiced. Altlioii^h the patient may oomnlain of coldnm 
ami numl>iH-tw, Miisatiou is not imfuiiivl, TIm? legs are nirf 
involvwi until late, and often csmjie entireiv. 

The Ma!tlin)» pn^^wCT veiTi' slowly, kihI death may iwuk 
t'liini some inicreurniit ili«'Sii«c ; if i^neh in ntil the «isi-, exii-u- 
sion to ttiv ni<ihit1ii leiid» lu iivnij^tonis vf fmlhur jmli'if, Dticli m 
indiMinet nriietilnlion. iiud'ilily to pnokor llie lip", difficult 
8walliiwiiig, nn<t emharraNMil Rwpimtion. 

(\>MPi.irATii)SH. — It may hcafBUoiatodwith httinil fctmtif, 
when it m ti^miod amt/olrojttiio lateral AC&ra«K. Il may l<«il lo 
Ituitiar jKiUy. 

DtACJXONlK. Prim'irff }fu»fu/ar Atrophy. — This di^<afr 
dcvi'lo|M in earlii-r life, rarely heijinB in the haiul, and lla- 
hereditary teiidoney is moiv mai'ked than in |Ki!ioniyelitia. 

l'm«N<wis. — Always unfavorable. The duration b iitiMi- 

TREATMtafT. — Good hygiene. Niitrilious fijod. Tonioi 
Gowers claims pkmI rcsnlts from the hypodermic injection iif 
nitrate of stryi-Jmia (gi-. rj,^ increased to ^) oiwe dsih. 
MusHige and electricity yield no results. 




(OloMO-Ublo-Iuyngea) Pualj«is.) 

I>EFiNiTUjN. — l'iiniK>ii« (if ilio Ii|icf. I<jngiic, ]>tinrviix, and 
larynx fmui <]cslnii;(>uti of tlic ^mgliouic ix-IU uf lliv nieiiullu 

h>rioi-o<iY. — An inniti- (iirm t» olistcrvrtl wtiicli n^iilU i-illuT 
fnun lii-murrliiit^ or Irfxii iintn'iilv |iiiliiimvi*lili.4 uf tliv tiioitiillit. 
Tlu' «liri>iik- li>rm, or |>i^ij;nwtv>? iitillMT piiUv, tnay rcttiill 
fruiii rlironk- |K>lk)iiiy<'liti'7> iiivulviitj: |ii-imai-ily the luediilla, 
or (n>m llic cxItMnion ttf lli(! lU^-iiofHtive pnxwM in ))arelio 
ili'iiK-iilin, Aiiiy(ttni[>litc Inlvral M'lcneti^ pmgrnuiivo niiuunilar 
atn)|>!)y, or ftfiilt? ii.tLvn(tin); (nmlyniit (IxnidryV ilii^tnAo). 

Symitoms. — Iin|iiiinni'i>( >>f siMii-ti ; itiabilily (n |>n>tnide 
the toiigiift; dritil>lin}{ uftudrva; liitliciill .iwalloM inK ; <-h<>kiD|i; 
Rpt-Ils fi»in tltf cnlrance of tiiod or mucus into tlip larynx ; 
|>artial supprpiision of ll>e voire and niea.iured s|)eakiug; 
libritlar^- trcniora of tltc lips and tongue ; loss of reflex aotinn ; 
atn>i)hy of the lip§, tongue, and pharynx ; and, Bually, dif&cidt 
re^jni-ation and dii^tnrlietl canliac Hiythm. 

l*!MH>Nf)Siii, — Unfavorable. The aoute variety is speedily 
fiiliil ; the chronio funn may last several years, Deatn may 
result from exlmttstioD, cnrdiiu; failure, or a^pjtatiou- pneu- 

Tkeatjirst. — Electririty, rtm<iDiii, ami the OBt- of R 
KlomacJi-tubc when swallou-ing bcwomcndifliuiilu 


(Iiandnrs DbMtM.) 

PEPlNiTiny. — An anitr iliwiiw of run' txyriirivno;. cliar- 
nirU'rintl l>y utotor piinilv.'^i:', lit-^niinin*; in the f<vl imd rapidly 
Kpitwling until it invotvcit the iniii>cU<9torrefpinititin and d4^ 

EtioijOov, — Ttw^ ean.*i'!* are unknown. It in usually ob- 
wrved in yonng male adnhti. Tiw abnipl onttet, acute oourae, 
nii<1 abseniv of known ean»c and of dcfiniUt U'^ion.s have tuig- 
)^Ie<1 no infecti<HtB origin. 



rATiiOUKiV. — }io demouMirable Ic«»oiw have bceu Aw- 

Sv.MiTnMs.— l'V1)ril(^ 8viii|>iiitiii< iKumlly nolur in tlip altiK^k. 
The [Hillllvsis iKTjili* ill llii: It-gi" aitll tiiviilviw Btlrt<r*iivt'l_V ititr 
IninU, it|i]'<-i' i-xtix'iiiiiics, am) iiiii^kdr'H of cmpiralinii ant) 'If'^^'^M 
Iiitiiii'ii. Tilt- rt-tli-xi'n itrt- ulKilinttiHl. 11ie A|iliiiicli'ix :ir4^| 
nMcnlivo; »ciiN)ti<>i) i.« iiiiiiitlly nnnunl, l>tit ttiere inay lir 
p«n<»(li»>iu or M>nii- uim^tliciua ; tlie niu!<ol<-.4 are relaxed, Inii 
<]<> iiol wiLrilr or yk-ld llio ixwlinnit of cl<?gt-norali(>n. 

DiAnxiifiis. Artili^ .Ifi/elKiM.— A iia^sllieiiis, wajtini;, KWiiom 
of (Ivfii'tici-jiliiiii, and cnrly involvomait nf tlic spliincicrH will 
tut-rvi- III (lintiii^iiinh iitvclili.t fnim atiiU' ascending [taralysia. 

Ma/liiJi- Mi-iiritiit H'iil Ix- .-wjiaratwl from Landrj'a distsise b 
ltu> iiuii-kmI Mriituirv diAiiirlmiiHs in tJte fi>nn«r. 

I*K<>cjs<i8is. — Llnfiivoralile. TIte vart majority of «i»» i 
minalf fatally in ttio cinirso of a tow days. Oiwsionally tlici 
in a s|iiintan(H>nH' arrest, and a gradual rpstoratioo tu hcaltb. 

Ti(KATiiK.\r. — ('ui»s to ihf biiin*- and clwrtricity (« Uw 
aifectvd nium-les liave been employed with iudiflvrfat results 




(Divers' Fanly«l».) 

r)KKIXlTl(lN'. — A condilicn olx*er\'Ml in divers and nt 
sulijeeted to inen^awxl »lm'*t|>berii-' pressnre, and cbaracierined 
by motor and aeiiaory ^>ara1ysia, |iarticularly of tbe lower ex- 

Etiommiv. — A iiresBure of more than two atmuApbens is 
rMfuired t<* priMlnce tbe )iiii-alysiK ; and the time elajKing liefgni 
its a)i)K-ni'nnoe Icsseiii^ aft lite pressure incrrsHee. 

l*ATHoUxiy. — Tbe Kyni[»toni8 bave been n«Til>«i to tlv 
liberation in tlw ntTve-u'iitrra of gufltv wbieb bave Ihvi 
abeorbed by the bbwl iluriug oxposnre to (be lii;^ preiwiir 
l-V»bymoae8 and Jrrcgtilar fiwimt Iiavo bvcn <liiKwvird i 
the cord. 

Symptkjms. — TlK'n>ndiliiin may numifii-t itwlf immi-cliali-lj 
on rwu'liini; IIh- Riirfiuv or uftfr the la|is<' nf H«'Vi-nil boiir 
TIk' must inijMirlaiil plK'ni^nn-na an- pain^ in tin- jiiinl» tiil> 
b>w») by motor uiu) »eiwory i>aniKnis iu the loww exuvHiitic 



Tbr bi.vl^U'r uikI m-tiim iin- ;>iinM'lii»<w iiivolvMl. <^«m<iii- 
nllv ihr pRmliftis lakirn iltc fitrm of a iK'iitijiIcgiu inslctui ><( u 
mn\*\i%w. Ill ^-vrv t-aw-s ttunii tlcveliipi iiti<i AviU liilliiW8 
m B fcw IdHirs. (ienorally, Imwrver, tin- ^vnt|it<>iii.> gnidtmlly 
:mlr<i(]f nitil ili<- |HiwfT In fully rtistt>rfd in (Im! cutitsi.* nf a ft-M' 
<lu>--> itr a few wnke'. 

Trkat.mkxt.^Ab a prt-vpiiiive im'awirv ilio tmiiMttoii fmin 
li^ii Id Uiw jiro^un? ^Ixiiild Ik accomjAisU^ gnuitially. 
Marked cafxs sliuuld be tr«at(M] as acute tnvclilb. 


(Mtuoulu D<rstropbr. MjropatUo Atiopby.) 

rtEPisrrms. — An atrophic coudition of the niuiu^li^ de* 
ri.4u[>inK ill early life and not dcpeiHlcnt uj>on any Wion in 
iW i»«*rv<iiis lyrffiu. 

KTiOL«Miy. — Tiie tliscai* usually nuinifc^^ts itj*tf betjire 
uuberly. It i§ tuori' cunimoD in nialtfi tliun in iV'tuule^ It 
» freiiiioiilly tRinsmittnl Iniin gciicnition to gcnciaiion, and 
Bexeral members of tltc sanw family may be siinilarly alTtvlct). 

Patm<iUkjy. — No Icsiwn in tlic coni or ihtvw is obeciveil. 
Gowers rcfcaixlfi tlipdiKHM-a^of (I(-\'c-lo|micntul origin. Miiiti- 
Boonie examination of the nnisclps rc-vuiU utiviihy of ibcir Iibrc8 
ana au nnniitiinil nnwiiiil of fal and cunrwctivo tineuc. WlH'n 
tile Latter pletnrnln nix- (Xjni^iiUT.tbly iinniittil, a jisctKlij-hyjX-T- 
tmpby rwiilts (j>M-iKhKiniis«t(lnr byjUTlnijiIiy). 

SvaiTUMB,— Tht^ niiLM-lnf, w|MTiallv timeo of tlw fhw, 
ehunlden>, thi);liis btiUucks, and cnlvt!', Icuw povrrr anil wilsIc. 
Fibrillary twilditii<^ an; somctjuww iwlod. 'IIh' n«<?tioi»3 of 
di^eneniliiin art- prestiit. 

OlAtiSOSW. (Itrmiif l'n/i<iniifr/lliit.~~T\iw discaM- di-viloim 
later in life wilhi'itl intirL<'<l lK-ri-<liiary tuHleiioy, anil m-arlv 
always bcyin^ in IIh> ^inall nniM-lni of the liambt — parts vibidi 
are rarely aifcetdl in idiii|iialhii- atn>pby, 

MultifJr AViirtVin. — Th*- bi!*tory, distrilxitioit of the pntav, 
wid lliCM-nxory ptittkoniena will seive to distiiigutsb oiiiltip^e 

pRixiMKis.— Iln&vorablc. Tlio disvaw: i« ipcunilili^ but 
«r "-iow prolan**. 




(FModO'nrascnlM B/peitiopb^r, lUpomatoua Uuacutu Atiophy ) 

Defisitios. — A dieeuic of rhil<l)iotN], diararteriKal 
immlysb depending upon dt^icrolion of the muK-Ics, wh 
iiciw«ver, b«x>mc enlarged (rooi a de|>«»tiou of fat and 
iiet-tive tUHiie. 

{jriouHiV. — Male sex, childbucid, and an hL-rrrlitJtn- trml- 
encv are the only known prtsli^imiiiiig riiin^. lSovcriI ca«u) 
have fr«ii»>ntly Ijocii oliseived in tlic siinic family. 

Patiiowhiy. — TlicdiHauc is allied to idtu|ialhic luiiscn 
atrophy, with wliidi it i» frequently assoi^altN]. Hinw; 
louoiM are oImcivc*] in itie eitrd or periphcnil itervtw it w lo 
ivgardcd as a prinian* uBeotiou of tliv mii«-Ii'M. Mii-mmiij 
examination rcveaU an extT^wive ainoiint of fiu and nmrwrli 
tii^tie Ix-twc'n the miiiKlt-fihrvv, llic latter Ix-iri^ nlrij|iliii-i] in: 
more or Itss dej^eiieratcd. 

SvMiTOMs. — ^Tiif fir't Hvnintoni lu utti-nt^-t nllt^nlion is wealf' 
aom of tliv miutdcs ; tiiv child is awkuiinl, MnndiW, and in 
walking* m-cks «iipjH>rt. A» lli« imniiy^is in<'n«!*i-!*, tin? lui. 
i\*», I uirticn III Hy iliiR^t of the (nil', llii^h, hiilliM^k. and luw? 
rnlarp'. 'Iliv npjHT extn-niitii;^ rnt- I(r« fiiijiK-iitly affi-rtr 
WIk-ii tlii^t^httd itM.-<iiiiH3i lli« enH'l |HL-<liin> llti? tWt are uii 
ajiarl, ()ie txtlly pititnidra, and (ho apinnl oi>liimii showa 
nuirktti eiir\-Hliin> with the oimvexity fiinvard. llti* num 
of riifing fmni the rtHTiimbenl (HMilion ia charaeteriKtit; : He 
!<ln»itrlit(-ns Iiiinsi-If either hv gi-aspirig the knees, or liv resiJn); 
Die liandH on the lliK>r in trunt him, cxlei>din}^ tlie legii, ana 
pushing the Uxly hat-kwnrdK 

Allhuiigli iheivspunKtof tliemufidealoelctftri^al currents 
leflfl pnMinunoed, the naetions of (legcoenilion art* not | 
'11h- knctvjcrk \s least-ned or aboliiJwd. Theiv aiv no 
or m^nsiirj' distnrljanoes. 

Inlhccoui-seof afew vears, the paralvBiP (leeomefi^- mart 
tliat the patient i» unahle lo leave his hitl ; the cnlai^^enii 
of llie muscles ih followed by ntrojdiy ; and finally d' 
resiilta from some ioterctirrent disease, or ■ n Hani mat ioo of 
lungs indnoed by the weakened nepiratory power. 

'gii, and 






PnnosOHW. — AI»»I(itr]y unfavorable. 

Tbuvtmk.nt, — RMtiedifsgeiipraUv prove iivclnis. Orwltuitct) 
nerdw, inafiii^^tv, cl^rtrioitv, and uy]«xlcrnii<« of Nlnr-dntin 
rav lie «ti)[iluvctl witL the uope of staving tlic jirogmw of U»c 

Pefi.vitcos. — rarox,\-sDiul luiu nulinting iiloiif; l)iv count- 
<iC a ttcrvc-tnink, 

EnouMiY. — Ik-rwlitv, fcnmlc sex, i«tvoh» li-iiijK'ranM-nt, 
exi««.T, ovrrworfe, jiml ncrvmis pxiinii^iioii nii- pwral jn«- 
(li»])u«siti;; fiHloiw. I( is fnxuK-nlly iiji i-xiiivwioii i)i" aim-mia. 
ll may n'i'tiU fn»in llioiw-lioiiof some toxii- iiyi-iii in llio blood ; 
iJiua it i» otiiiinoii in muluriii, rliviimati^in, g"M, !<y]>bi)i.s and 
diruoH^ It«t)-)K>i3«>itiiif;. It uiflv Ix- <iiii!4(!i) by n-flis imtatioD ; 
ihn* It IrifaiL-uil Donml^^ia may (fviH-iKl on rtiHts of t\w teetJi or 
ey<'-«traiii. In souw «3Im« nHinilfriii n-nnlls frum oryanic diB- 
««; of iIm; iii'r\(t-rttiIro; tliii.-i olB*tinaIi- trit'.Kial neuralgia 
may l)e (ii-jwuilenl iijwiu sonip di^ji^nii-ation or tuuior of Uic 
{ iiix-ic-rian ga»gli"ii. 

Kx|>oiiur(> to cold aiKl wet frcijaeatLy aicts aa aii exciting 
imii^'- iu siu!(«-[>tibU' nco])!i^. 

l*ATH(HjiKiV, — Till' |iarlioIo([i<»I«"Klitif'n upon niiidi m-«- 
nlfiia dqiends is tiiiknown. In many cases, no doubt, it is » 
manifest at ion of ntunlis. 

SvMi'HJMw, — fVrtain prodromes frequently pivc warninf; of 
au a pprroching attack ; tnct-earechilline^. drpmwion of xptril^t, 
and porliapt* tin|;ling in tb» part to be iilTcf-teil. Tlio <-)iiff 
•ivBiptom in inteniic ]>ain, wkidi is itsnally of a xbnrp, islabbiiifr 
(jiarader. Tlie fin-n KiippHrtl by tlw nflraU-d iwvw i* RtiMT- 
ally liy|K'rn'»lIiHic. unii |ul|uition ililnln ."piitrt of vSipitMtt; 
ImibTnit^K wbcn- ttic ni-rvc makni its i-xit tbroupb ii Iwny 
canal ur tibfous 4i<'Ulb ; (lie biKcr linvo W-cn tcrmttl Vjillicx'n 
pointiiu In M)tue t^w4 tbv ginin is iitltiHled witb la'viiv elunic 
vr (iinic *|>iLHnw of I)k- miisck*, Ii>9[K-(1tuiiof tin- [iiirt iisiially 
rc\-cal« iHpilive rtwillj', but (■iti-'ionully diintimi wvrfllittg or 
un oulbn.'^ik of lH-r]H-HS in o)>c«i-r\'cd. 

Tbv altac'k la.-tH tVoiu a i'aw uiiuutiis to many bours, and Itft 



I)i> not iipply to anynbntion 


Koaitia, a smnll blister, nr a tiyjMxlerroic injeclHin of cocniiw, 
(-lili>n)lbmi. iir n)uq>hiu iind atn*]iia any bt> ejiiiiloycd. One 
of tJie fi»ll4»wmg ii(>|i)icatiuiw will prove serviceable : — 

Aconitlte. gr. iv ; 
Vcnilriw, gr. sv ; 
Glytxrinw. sij ; 
C-vriili, Svj. — M. 
Stg.—To be rubbiil ovur tliu |nrt>. 

^ nilonil. hjdmt., 
Pulv. (^m'plidf., ijl fi 
Ig,— Apply with ft cnnwl'ft hair bniali. 

Inl«!f»nltv, nnlipyriii, ptK'Darftin.tnmmbiiiiiNlkn. bromide of 
ttotUMuiii, mityl ohionil, ami oxitl^iix- nn- itlincnt ixnuilicH, 
Moqiliia i.s soiiicliiiitM ni^iiin-tl, but ihi- il:iti)>i-r of in<)iK-iiig tlii; 
lialiit nbiHiM i)lwa<>^ he Uinie iit iiiirx). 

'l/te lutervtiL — ('an-ftil Mflix-b fllioiiM tw iiui<k- for Jiii I'xcilinK 
roM^; wbieli, if fmind, uwim Ix! n^mnviil. Tbu Kt-lb, ovfH, 
lu*)-, ;;astm-iiiU9ti»nl tmrc, iiriii4>, ami bl<»i<l »boiibl Ih> rare- 
fiillv (>xamtned. 

lu aDKinia, imii aiid ariirfli<! are in<1icBt«d ; in 8\'pbilii>, 
io[li<l(> of pota-tsitim ; in riifiiinnii^iii, .lalioytntc "f !«idfiiim or 
HHtide of pota'wiiini ; in mnlaria, iiiutitm- and arsenic; in ^oiit 
cok-hicum and lilbiuni; in leud-|)<<i.'a>ning, io(]idcnrjK»tnA^iuni. 

TonioH like iron, niiinim?, stn'ctinia, (vm-livcr oil, and pho»- 

Shorud are frofjuenlly indiraUnl. Aninng lli« iij>mal mne* 
ip« may lie mcfiui>ncd arsenic, voK-rian, liynwyBtiin.'*, a»*nitia, 
geUoniiiim, cannaliis iodira, oxidp of y.iiu', nilni-jrlvri-rin, and 
asafoetidii. Tbe followinj; pill, deviled by Dr. S. t). Gruee, \» 
very useliil : — 

Sulnin. Rnlpb., gj 
orntiln. I'ulpb.. 
AHil. Rri>cni<i*i, Aft gr. lu; 
ExI. ncniiUi, %r. xv ; 
Slrycliiiin. aulp))., gr. j.— M, 
t'l. in jril. Ko. XXX. 
Sifi;.— One, tbrloe daily. 

I/<M-jil In'.-ifnicnl in tiie intorvnl may iKiiimpliAli mndi. 
Jfx-trii'ity, lu'upiiiidiin!, or Trpt-aiiil bliHifnt may Ik- cfliploynl. 


^ AnUpyrin, gj ; 

Syr. aumnt. cort., f^ ; 
Aqus, q. B. ad fjiij,— M. 
^. — A tableapoonfiil every two hours. 


1^ CafTein. ciimt., gr. xij ; 
Phenaceliu, gr. xviii ; 
Sodii broiuid., 3j.— M. 
Ft. in chart. So. vi. 
Sig.— Oiie powder every hour. 

gt Salol, 5j ; 

CafTein. citmt., 

Pheaacetin, iagr. xviij. — M, 
Ft. in chart. Na vi. 
Sig.— One every two hours. 

The IntervaL — Careful .learch should W iiia<lo for snnio ox- 
ciling cause, and when found, removod if jKissibK Tlic lialiils 
of the ]iaticnt trnist be regulated. Overwork and tlic use nf 
nlcohol, strong lea and t^Hbe must W iiiteixlirtc-<l. Systcmalic 
cxt-rcise and frequent Iwithing follinved liy frietiim arc valiialile 
adjuncts. The uicX must be adii|>ted to llic »iiiditioii nf the 
stiimach and the needs of the system. Internally, ai-sonic, 
i'xlide of )>ota3snim, bromide of )K>taisinni, valerianate of ^^ine, 
and cannabis indica are the most reliable rcinctlies. Cunnaliis 
indica is often very efficient, and a (|iiai-ler to half a ardjn of 
the extract may be given for a prolonged iHiriml. Little 
recommends . — 

9 Sodii arsenint., !![r. ij ; 

Ext. cannabis iiiditw, cr. iv ; 
Ext. bcUadouutu, gr. viij.— M. 
Ft. in pil. No. xsiv. 
Sig. — One, twice daily. 



Depinition. — Pain in the bead (generally resulting from n 
disturbance of the cerebral eireulation, a ix-rverhnl cijndititiu 
of the blood, reflex irritation, or [iressuii' on the brain by iu- 
flaninmiory exndale, deiirewsed Ixjne, or a tumor. 



Ol^auio Beadacbe. — Thin f^^mi is olMer\-M) ill nit-niiij^tia 
cerebral luiiior, alx^i'w, !«»rt<'niiig, etc., awl uwiv W ixx-vigiiix 
by its persifit«M-c luid by lli(> asBociatcfl cvtcltimv of oipm 
oerebnu «liHiiiHi', »tKU &■< vptir neiiriUs, nHtitnl alwrrali'in 
pamlysi^, csjKt-iiilly yif lUt- fatial luusdt^, nod %'omiliiii 
ariiHiiR iiKleiR-ixIt-tilly v( ollu-r jmi^lrio >iyiii{kl(>nis. 

Unuer tbie IkwI U tiK-Jii(I«il tliv iKfldaciie nl' tryfJiitin, whic 
may bedia^mwcd by lli«- biotory ; by lltt other evktemra* 
Ky|ilii1U ; by 'n» fruquvnt assuijiatiou with aoniDoleiice ; aiii! 
liy IIm- t-flirl (if io«li(k- of |Hittu«tiitn. 
'Headache of Cerebral Bypenemia. — Artiry cTfhmi mi* 

t/tKlinn Li^ii;ill\ n'>aUs i'mrii jiruhiti^'tl mental work, JVvM 
or ■■x]K»iiir- In Uio Mini. Tuxit; and n-flex h(^d»i-li(« an? oflt-j 
din-c-lly diK^ tu a«:tive cerebral ubtigestion, UiL Uicbc vi\\\ b 
di-Mnii^ed later. 

Piu»irt tfTtliml rtmytifliun may rc«u1l from olwtrutlioii i{ 
tbe reliim nf bliMid tn>iii the brain, as by a iiiinor of the oivkJ 
or cart;liaiT ill'^aiiic. It is also oummou lu elderly people fr*>r 
a relaxeil (Condition of the vcbwIs. 

Id eei-ebral congcstiou the headache is of a tlirobliing 
bursting eliaracter ; the Itatd is hot ; Ibc fate Hushed ; t 
eyt-prouiid injected ; and tbe dtsticee tt> iucre»«e«l by Inwcriiij 
the licad. 

The cxcitinj; c&iitM> tuitst be ddornitncd by the history and 
by a uireful c\'aiiiitiJiliuii uf tlw variuiiit urgaiis, r^jiocially tJn 

Headache of Cerebral Ansenda.— Thii* ;» fn^jntnily de^ 
]H'mlviit ii|Hin gt-m-nil iiiiieniiii. Il i* niott iixiimoii in iK-uni« 
tbeniii ri^iilliii)^ f'ruiii uvenvi.irk, iitiiloiiged emotinnal cxcitt 
nienl, exiws^i^ eta More rarely it Lt rtt'itendeut uiKin agrtid 

Ill (■fn-iiral atiitmia tbe juiin is frctjcieiitly vertienl ; it iii 
lhro)>bing, but it i» dtsi-ribed as a M-nsatiou of weight or pnaW'^ 
iog ; tbe estrpfniti«# am cokl ; the fare and cye-groautLi ar 
pale ; the taind i.i depr^w-*! ; tainting ejiells are often iir«*»('nl 
lowerinir tbe iti^ad nml the tnlmlatioii of nitrite of amy! relievi 
tlie [xii'ii. 

Reflex HeadaobA. — I{<'.i<Iaohe ir oftcu diw to e^w-^fmin 
siilliiij; from refraction errors, and iu obstinate cases a careful 




«tainin«li(Hi oi' the evw ^lioiild alwftys) l« maik'. Hi«<liu-lu- 
i<t' litis tlr^pu U fiv<|U<iitJv II hrowaoho, aixl nmy ha auruniau-d 
with nT!^lI(^«)n<>!4s, vomiliii};, aivl insomnia. It Ih iudiK^il ur 
aggnivim-d t>y jiiiili)uge<l' ciftlir syos. 

fMiriitii w iiltrim- iHnrmse* dtWii procliiw a reflex lieailaclif- 
[( i.t U'liiallv liHMt«d nt tito vcrtc,\, and in relieved l>_v pntiwun' 
'if the liaim. 

(Jn^ric irrilaHon U responsible for many iKadaohes; lite 
latter are invnriahly tvlieval by vntnitii^, and are aiiially 
:LH^H.-iated vrilb other evideooes ufetuiiuu-bio disorder. 

XoMil txitnrrh may induce pcrsi^itciit hcadacht!, uliicti JH 
jp-iitfriilly c»iifi[|(«d i<. tlie liireltead, temple*, or vcrlcx, and is 
li^iiravaltti by exaoerlMitioiH of ibe ratarmh. TIh' |Kiin id 
itlWii a>iHoeiate<l with trndvninw of the- intier wull uftJic orbit, 
and is inorcaf<ed by trritaliii];; the nHi>ul ntupuux nMwibrane 
with a prvibi-. 

Texsamio Headaobe — A iiereii^ctit ht-»<)»<-l»c often Tw\\\\ii 

friim Brij;lil's dii«-,i.«?, and in iiiirnw in <>ri<<in, It mny If 
n»>v;iii/'il by (lie hinh arl'-riiil tension iitnl by iht- allnimiii 
and ao*!" in the tirint-. .\ iiriiinrv aimlywjt Mtmnld Ik; nuidc in 
■II cuMs^ oi' jMrTsiHt<>iit Iti-ndik'hc. 

ffirit/ nr lllUirnua prodiKx-n an inlniolnble lu^iliK'tie n'liiHi is 
aituiuiutit^) wiib vertigo, gniiC irritubilily of (t-fii|H-r, and n 
•■ brirk-iliist'' de|>osit in iIm? oriin*. 

t^ironir mnlitrial fxiivniia;/ iivny iniinifctH ilwif in a Iteiid- 
ehi! which is usually oonfincd In iIh' Mipiwirbiial regiim. It 

ajft to ret-or at rc^:nlar intervnln, \-i nl^tii av-utoiaied wilti 
t<^uaemta§ over the ^ipraorbilal nerve, ai«] »6 only relieved 
by Ur^c dosis oftininine. 

A headacbo of rhewnatie origin •loroelimee de\-elopB in those 
Kiibjei't to rheumatism. Tt i^ fiTvpientlv excite*] by expiiMiro 
or a sudden clintigc uf lenipt^^tiire. It n&iially aflects ibe 
apooeorDSUi of the occ-ipilo-fntnlalis and {em)Kirsl muscles, tfi 
increased by uTinklin); the forehead and fuR-ibly moving (bo 
jawv, and is nssocialed with tendemcsn of tite scalp. 

Alcn/utliim iit ot)ci) us^x-inti-d with )>cadaclie. In acute 
nldifuilisin, Uie ItcadiulK- pnilxibly nviiltn from ccjvbml hyjier- 
wmirii ; in diruuic alcohulisiu it is odcu dtie to a low gnule of 



Among otlH-r hojidneliM of toxio origin niuv lie mMitiunn)^ 
tiKHR- <1(H- to curiiitiiiiitiiiii, liiMl-|KitiHi[iirig, dmljelcK, rnfcctiM^H 
It'vvt^, »inl «litiiir|rtit)n ul'titiil giine*. ^^ 

Hjrstflrical Headadu. — In h^*surin ib«r^ w oft<>u a pcr- 
sUlitit IkihIiu'Ik-, M'tiK-li ^niwK wanu- iit the iiM'ft8(nmi iwriutla^ 
and wiiirh improves iiiiiW jikiLitimliln r>xc-ilciiK-ii(. It muv b^| 
UHIiisi-, Uiit rin|iieiill_v it i^ liK'nliw^, and in dcMTilMtl ar 
ix3<<'ttd)liii)r IhcoA'ct-t »)tiWi U'<»tild U' {inxliioil by u nail lx-ii>c 
dn%'eii into lh<^ U&ul; lienti- it tuL^ liii-n Utmit'd rfarw'. 

Ih At) souls.— llaiAtu-he niiiHt 1^ diiUiii^uitdml from m^ 
ffrainf. In tlie Istler tliere arc iisitally prodromal :tiim[>lomi 
diHtiirlniKfn nf vi>i<>ii, ]i<it>illary chaiigtvi, and llie [Nitii i^ fr 
(Iticnliy ciM)tltH'd to uiic amv of the head. 

IIi'adiK'lii! in tlift ri'|rii>ri of t\w. orliit may bo miMnl«-ii R)! 
ae*Ue x/iiiu'-'iaui, hut in llic lalt4T itindiiion tht- fyo is infl»mc(l| 
tli<> corncA i.t Uazy ; tlit' pupil is sluvxioli ; virion is iiiipairi'd ; 
and on indnation ttit- att'ectal oycbull U found to lie tianl« 
than itft fMlow. 

Tkkatmjist. — In tiiP interval between tlie atl»r-kH «irffut 
Koarcli should bo niado tor tlii' (^iikh'. wliirli, if [Hw^iblc-, iniiMt 
ix romovwl. In the rcBox headaiiir of cvc-strain llif 
jiiblmcnt of proper glawcs is olUn all tlint is m|nired. 
gaHlric bcadaaie, tlio ufsoviiilcfl catarrli of tli'.-«4omflcli must I 
treated byaligbt dii-t and tii« iiii^ of Kiioh rt-nH-tliffiiiE biatnutll 
and nitrate of silver. In tliclK'udarbi'uf siui-uirii, u niilritioD)* 
diet, witb iron, arwrnic, and o<h<T tonic's will U- rHpiired. In 
hcadaeiieH of nncmic orij^in, u milk divt uilii mniMircv <al- 
enlalod to incmso tlie Hi4ion of tbi^! ekin, bone!)*, and kidncir-s, 
will often afford cunsidvniblf ivlivf. In nmlariul lind 
quinine in large dosn with nrm?ntc will vflcti a ciin*. 

The Attaci: — In htadache dt'jx-ndcnt n|ion ga,stri<' uciditj 
aticr unloading tlie stoinai.-ti with a non-irrilnting cmett 
broraidcD with antaeidK will pnivc iu>vful, lliusi— 

T^ SoJii hrotiii<1.,Stt: 

S|>l. »itin>i»i. tiiiininl., Ojij i 
Aqtiir q. a, ail t^iij.- H. 
8i^— A inblexiKHnirul Kwxy hour or two. 

In lieadiichi- nf acnto OTvliml i-oiijn'slion tlio Bvt nbonlr 
siKiknl f!ir ten or lifittt) nilnnli?' in vf ry hot wat«?f; un nii-_ 


■ lIMt I 




\mg jAaotA on tlie head ; and tuimc serlalivc like the fullowiog 
aiiiuifildipreH : — 

^ FheimoetlD. jj ; 

SodIL i>r*)ml<l., j«8.— M. 
Fu in cimrt Xo. xij. 
Sig. — One ponder every Ixxir or two iinlil Tvlieved. 

When iiw aUaek b very severe, aeoiiite (gtl. j-Ij) may Ix- 
pfen everv liimr or iwi>. 

In cerebral iina-nita jtmxl temporarily follon's Die iiw of 
aDiipyriii or pliiiiucciin, eMpeviiilly in combinutiou with cnOeine, 

tlius : — 

9 nicitiuwtln, sj; 

('nfliriu. ctUnt., gr. xsiv.— M. 
Ft. in chart tin. xii. 
!jig> — One oa n:<iuinsl. 

In rlietimaliR h(9daube aalul !» very ii^ftil ; il may be oum- 
hined witb antipyrin : — 

9 8«Jol,5W, 

Antipyrin, gj.— St. 
Ft. In cliArt Xo. x. 
Sig. — OiM! every bnur or two until rclleTrd. 

In nrsmic bead;u7he tbe diet sbotild bo restrided l<> milk, 
tion of the bovreb sceuretl by u ealinc dnkught. und diumus 

encouraged by digilalin, caffeine, or the vegetable wdts of po- 

taBBium: — 

1^ I'ututH. eilnt., 3iJ ; 
Atlver, iiilfoe., fSij ; 
lnrii«. mi)mrii, f^vj.— H. (llAT.) 
. wiMtgliMsful, Ihricc dAil}-. 


Dehnitios. — Inflammation of nervHt. 

EnoLoriv. — (1) It may result fron) traiimatj.wi — blown, 
woiiimIm, or eomprc!»ion. (2) It may lie due to cxptwim' to 
»iU] uixl wet. (.'!) It niny be seeondary to inllnmmation of 
luljiUT-nl Btnictnres. (4) It may I>e Bewindarj- to rlieuomtiitni, 
giMit, (typhiliH, or oik' of U»e infc4;titHt8 fevers. 


hbkabeb op Tire nkhvoto ststem. 

pATllOTXMiT.- — The HiK-fltd, iiitPKtitiiil i-oiinwtivo (ianw, I 
fibni* niiiy IfC imlqHuiiU'iiilv iilfW-lvd, btit an s nile, all yana 
tilt iH'ivi; «if iiivolvwi. WIk'Ii tht' procws is amntc tlw? ncrvi 
in TcA mitl nvrollei), Aiid micnwcoitiv uxaminalkiu n>veiiU : 
ill HI I ml ion uf IciicorvUs, villi moK or lc«s grauular dcgmien-' 
lion t)f ilii<' fiUrcni. 

In flii-onif nfuritU tin- nerv<Mniiik is gmv, slirivoUtsI, awl 
linni, and micrciMX>]m! oxaiiii nation kIiows ud oYcrgrowtfa t«f^ 
RMincetivR tissue ana granular degencntlinn ul' fibres. fl 

SvMiTfiMS Of AtxTK Nfa!RiTis.— 'nHW ftrc three sctoor 
pli(>n<)iiit-nn — seDBory, motnr, and tn>|Jiip, 

Setuor^ fiymftoma. — There h wvcn- poii) fdllnwiiip the 
course of the aHeeWd nerve, wlii<'li in lender In iJir toiK-li. Tlw, 
]>niu is iiDeii as»)ciatixl with vari<i4i9 nmnilislationit of par 
thf«ia, siteh as hurning, nninbnefla, tingling, nud ttie like. 1 
jiart is at first byi>eru»(tlwtic, but later it i» more or li«v aiw 

ifolor Svmplonu. — MuBfiilarjwwer in inijiain-d ; iImtc nwiy 
be fibrillar tremors; and the refiexfs are diminiHtu-d or bi*t, 

Tnphle S^jpltmu. — An eruption of licrpcs somctinKw folJ 
lows the afli?ct«l nerves. The skin may Deoonie gliM^v antlj 
the naii* lustrclpw and brittle. In advanced caws lhi.Tc at 
wai^in;; of uiu!^Im and imiwiiretl ele<:tri>-cuntraictility. On^ 
Moiviilly cH'iision into thcjointH is ot*ser\-ed, 

In ^mle «iKt* there may \x febrile Bvinptoms. 

Chmniii iwHrili* 'm ehunnteriwxi by min.nniesllieiua, parrsia,^ 
alrotiliy nn<i roiitincUire of lite iiiii»eW, reaetiuns of dweii- 
vnihoN, "g)o««y skin/' and thiek«>uing and briltl«nfiBB artlir 

I>iAOyosi8.— Nfturitis may bo mtttlakm for nrara/pi'a ; bti 
in tile latter the [unin U )uintxyHni:iI and ii> nnM)tociBt<<d wtthl 
li-ndenit^'i abin^ the eiiiir^ of (lie MiTve, (wmMbeina, aiUM-1 
IlK^ta, jiflRsia, and ebai^^ti in the eU-rtro -poiitmdility, 

I'liOfixcisiB. — In aciitP iiises tbo pmftomis is gnardwlly ^ 
favoral}t« ; t)i« dtirattun w from a few days \o iK-vend yegkn.M 
In elmmic! iiciiriliH, afti-r the developRHMit of marked tro)i)iii' 
ebaiiKii*, i1m> itnijrii"*'''' i" (jinve, 

TitKATMKS'T.— The aiii-ie Klinidd Ijcasecrtnined am), if ]»(•- 
Bible, rejuvved. Iti rfit-iiniutHiu, alkalies niid suli«-;)-late« 




indicated. Tti ^lypliilttt, iodidt- uf i^otius^inm Afliuiilrl W admin- 
iHlcrttl in lur^ du^vs. TIk- {>iirt k)i>>iiI(I Ik; (Hit nl ir»l. 
For tile (niti, M-<lulivp lutioiif 0(wi-u*nti.-r uimI liiii<l»tium), 
warm ronieDtiitwD», or Mirall l>li>s(i'n< rnav hv u))[>livtl lu tliv 
affected pttrt», uid niM-|))ii« arlminiMi-ml lujifMliirniii-nliv. 
When morplttA i!< nmtni-in<iic«t«i, .-uiiini,'latc of ^Kliiiin vr 
pliiiuKi'tii) nwy hv emiiloviil in iw sK-nd. Aftfr tin- niili- 
sidciKv i>( :ii-iitc Kyni|i1ontH, iotlidi- of ikohtSHinin iiuiy \Mr |riv('ii 
for iU (iliMicU-til vH'ii-t him] Hiiiitii ill inlcrtt U]i{ili*Hl ItKally. 
H«<torati<Ht of [towi-r will be aHBtsIud by iiiaauwt! aii<I c\i^^ 
iripily, mid by lti« ai)niini!<tral4on of Atrrctinia, inK^rnally or 


Defisition. — IiiRmnituitiiiii of acv^ral m<r\-c-1ninks, re- 
Ktilting fnjrii a f;i^iit-ral caiL-x;, Hi>d 4-linnii't(-ri».-<l hy pain, 
|iiini'silK?iiii, aiiii^llii^i), jiarc-iis and niuMMiIiir utnijiliy. 

Ktioum;y. — Alt-oholisin, syptuliA, rlK'iiiuiittAin, iIr- inft'L-- 
tioiiM fevers, i>x|MXiin; (o imM ami mvI, niid niiiii-nl )Hri«»ning 
nri' iXHiinion mitses. In theOrienI, miilliple iiHiritis occunt 
UK an fiiidemti* diiKSfie (Kakke or Beri'beri), which w prububly 
iiiicrobio in origin. 

SYJiim)US. — T\te acute toriii in dwinirlcrized by » ohill fol- 
lowed by mt)derate fevtr (H)'J''-I03°). b.-ada<hc,'i»ii» in llie 
Iwok, malaiiio, ooatod tongue, loss of npprtilc, i>>i)stif»(inn, 
fciirilo urine, and the tollowing lot-al plHiionieiia : Pain, iinuib- 
ncflfl, and tingling in the affectHJ UhiIm; Io«s of pow«r, espe- 
cially in lite legs utd extt^aor nitiiM'iiw ; alKilition of the 
reflexes ; atrophy of tl»e niii£clefl ; nion? or Ibw aitsiahefiia ; 
ami kiidertiras ovvr the tH>r^*e-triinkn. 

Chronic Form. — Febrile Hyniptoni:' arp iilivcDt and the di«- 
aue is niaiiifiiaecl by (tains in tlio limliH, hyixtncMbtwia, pamst* 
Ihcsin, irrti^iilar un.-»s of anastJit^ia, liicw of power, al)olit>oii 
of the dfoji rodcxw, totxlerneM over the iiiTv-istninks, waHting 
of till! niiwlfw, impsind vltxTtrical ctinlnu^ility, and ^dcma o( 
till' hand* and fii-i. 

(..VmiM-lcATloss.— IVIiriitin, delitnion-, 11114I 1 1:1 Unci not ions 
are lutt uiicNtmmoi), t-siH-oinlly iii the almboltr varit-ty. The 
disuaae is tHinK-tioKa atMociaiui with locvtmolor ataxia. 



OIAONO6I8. Ijowmolor AUiTtn. — llii- altsenw of the lij^il 
ning-[HiiiMt, |{!rd]c M-DNitJon, Ar^ll-KwlKTU'^iti |>ii[>il, and ih 
imT^jKi-ofiiitnilvKiK, uB.'tiii^, niui iw-iii-iil loiHkn>oi<8 will »orv 
U} (li!>tii)giiipli iiiiilci{)lo iiHmtii< IVom liMMiimror ataxia. 

I'ii<:kimx^i8. — (riiantitily rnvoral>lf, Aiiiu- iKurilUi xotot- 
litixvi ]inivf^ rnlitl rninii inv<jlveiit<iit nf die n^iiratun' miiit- 
i-1e!< III dtnMii<; rases of long diiralioD llio mitlook li 

Tkkatmkxt. — A<!U(e caitra Hltould lie kqit at al)e(>Iiile 
For tiic n-linf of |inin h<it fi'im-ntalionn, Itwl-^vatir ami landaJ 
niim, nud nilH-iiu-ioiil Uniiiit'iilH may U' a)>|ili(rl tn tin- aR<^k 
limlis; arxl iiinrjitiia, ai)ti|i_vni), jtiiPimi-Hiii, or nalii-ylio 
adiiiiiiisleft^ internally. Aller airiit*- DymjiiuiiKi Itavp sub 
sided, msSHagc, ckvtincity, and Swedish nit>venicnt>t »liiiiild ' 
*'inpioy«l lo iKTiire a rptuni of |>i>wer. An ointiitent of 
iiiorc'ury and iMlladuniia may be used for its abeoriM'ul ami 
aiKidyiic eOt-i'l. Stry<'liiiia livitodemiiinilv is an iiival(i:ihli 
niUM-u!ur tonir. Kigidity ih Ix^t n.-licvt'd by D)aHi[»i 
and ibi- framcDt use of warni Iiatlts. In eypliititic vam 
ploy inercunKl iuuncUutis and iodide of iwtossiuin. 


0F:FtsiTit>N. — Pain along tlie sdatic nerve, iBimlly rcsultiitf; 
fmiu neiiriti«, 

f^ioi.fKiY. — Alflle Bex, middle life, gottt, rlKTiinuiti«ii, and 
8y])hiliH arc iiredisiMwing causes. Kxjiusurt* U> n>Id and \n 
is tiiecomnwa exntiDg cause, Vm' niHy »ciaijca w a«- 
omiarv cottditton resulting from the |in>ciKyof an inlni-|ieU 
gntwlii or froto «ri« of the ixtne in jotnl diiHitM>. 

Syju*roMS. — 'I'hc diseiuif nmy U-ijiii nbni))lly tir gradiinllyj 
and is «-baRic4m>%-«] by a «ii»r]i HlnHtting [lain ntniiiiig dom 
IIh' liack of the Ihigh. Mi.venwtil of lW limb inten.'>ifi<'n llic 
snfTering. The jnin nuy \k- nniforntly distribute<t along Hie 
course of the iierve, but not infit-fiwntlv there are n-rtain 
!<|Mi(» nlierc it i" mure intcnM'. Subjective seiiifltioiiH, ftuetj^d 
iu> tingling aixl nombni'KH, aiv otleii notetl. The nerve lua]^^ 
\k' I'Xlivmi'lv m iiailive r>i trHicli. Tlie symptunis grow wor^r' 
At night and <»i the a|i|ii»acli id' stormy weatJior. The duiv. 



tioH ol' lh« Utltu^k vnrien fixmi n iVw tlnvs to several ntutitlut. 
Ill hutj^-i'tiiiKliit^ rtL-«T< (lie muscles beeitinc atmpiiinl and ri^jiil. 

niAO.Noeiiti. Oxnitffift. — III tliin aliei-tioii tii<- |iaiti U nxwt 
niiirkcil in iIm) hip- and kiu?e'jointe; prwwirr yv«r tlio Iru- 
cliatitvr <>ii<;it4 |hi)ii ; awl the nerve i» mrt (cmiiT tu thr tttiiHt. 

I'RfxJSneis. — liecwvetT follows in tlie ni«}i>rit_v uf mscs 
wlicH tn-Atuiont is institulod wirly aiwl i(t (HTWslciitl)' can-iwi 
out. In some cisra rela))er« orrnr frofiiviilly, nod Jioally tj>e 
|>iiiii l>i-i.'imi>?4 iii^ire or Irsa (x>ntinuoi>«. 

Thkatmhst. — In llw nculc stage it«t is <^9L-nlial. Hut 
foim>nlatio<i9 or liaear blisU-rs nmy Ik- n[>t>li(^^l itlrtn^ the 
course of the nerve, tkvp injections o\' itiurftiiiu, iifili[irrin, 
i>r oocaiiie may \» KHiniral tu ivlii-\'c iiw [min. In rlK-uiiuilin 
iiisfs lull dottes of tltc 8»l!<'yhilc itf ivHtium are v*iy iuh-I'iiI. 
In dimiiie cast's (Hviliwif^tii i\-*l w ilir-initilc. ('jiiinti-r-irrilaliun 
?^lii>iil<l bo made by (Kfiin-nt Kiniill lib^tt-n!, by tlie wiiiiil rjuitt-rv. 
»r by a«.-n|jaiictuT¥. iX^-p iiijnlion* iiloiig lbec<mrj«p uf the 
nerve give mticli relief, iiikI uim! of ihv fulluvriitg n.'mnlim 
inity be so «inj>Iuyod ; nx>r|>lil» an<l alnwia, cuuuine, iinlifiyrin, 
i>r pluin wji(.T. Klw-lrioily !iiimi-tiiiii7> U(X» pxid. IntrTnally 
i<>(]idv of jKttiwiinm in Kiimil diH?t i.s u^t-ful ; in syjihtblie 
c»»-9< it )>hi»tlil Ih' ^ivon in Urge d)»«(i. The iblktwing cum- 
btiiuliun M ai-o i-lliiiciK : — 

Ij: TiucU aconiti md., 
TltKU cokhki aetu., 
Tinct. holladonniv, 
Tluct. cinitci^gir, ii tali.— it 
Sig,— Twelve <lra|M uvcrjr fuur to ciglit liours. 



(BeU's Palay.) 

ErtoixKiY. — -IWalysiii of one side uf the fni« niay n'stdt : 
(I) KrtKu a liiiiior, clot orabt^oeHS involving (lie Gu-ial wnin; 
on tlie [-ortcx of the bmin or the nuutciiii of the lacinl ni^rve; 
(li) frtmi ibir |nvssure of inflammatorv pxiidiite on ilift iicrvc- 
triink (wlween the brain ami tbi' fkull ; (.'!) from juralvi^iK uf 
t\n- ntrvo within lite itt'trous |M>rti(Hi of ih^ l4'm|H>r:il bono, 
excited by a fiacttuv, or by itu cxtcnsioa of intlaiuiiuitiou of 



the mi(I<l)c «ir; {4) fmm inflHimiuitiun of (he peripheral RIs- 
niviitf, i-xrit(^ Ity cxpu^iire, injury, rliiHiniHtlKOi, or ttae of the 
tiiiix-tJoiis tV'vio*. 

SYMrTows.— Tti« sidi'aflVvloH i# i-xpn^siunk^x ; the natural 
liiin^ nix' oMilemtcd ; ihti nii^lo ofUtv moiilh druope; tlie (^mJ 
miitiol Ik uloMid ; li.>an» Bnw ovor llie cImxJc ; und spet^li ^H 
iiircclcil friiiii mi iimliilily t« prtmniiHT' llii- liiltinK AAhi-i^" 
tile |uilii-jit iktioiiipts (o laiigti nr wliistio, (he iiliscmf of iuovi-^m 
>ii<!nt <») iIk- aflVlitl side IkN'trnM-^ elill Iikiix- (XHMpK-iiuiiB. 1^| 
|H-ri|)ti4!ral neuritis tJie reJIexra aro alKilii<iii.-(l ; nnd utieti lb<^^ 
Di-rve )A inviiK'pd in Ili4! lom|Hiral bono tlicrc nmy be a torn af 
Ul'iIc ill iltf. ]ui«>ri(>r )mrt of lh<^ tongue. 

l>iA()Si»fiis. — When tbo WiiHi is in (he brain lh« paralysis 
U riin-ly timiiilHc, tbe ii|j|>i'r |wrt of Uif frnf uMially fsc-iipingi" 
iii.'ifllilNiritij; I'l-jiiitnl ncivts aif fi-cijutDtly iifl(!rt«l ; and otlie 
oviiK-iKM-i' of Dt^nic brain discniie are ffcncrally prcM-nt. 

Wbcii tlto iiervo \a involved within lli« Fallopian i-nni 
ihvrc is ofien a loe^s of tuste in the anterior part of tlie tvngue 
uiid luinie drMttirbnitcc of hearing — deuliiesa or perliapa hypcr^ 
Sfn^livt-nes?i to sound. .m 

In |>eripherul neuritis tbo history, tlw complelene^ of tlt^Hj 
[)anilyi>i>i, and lb« id>M-noe of reflexes will aseuft in the recx)g3|| 
nilion of the li^ion. 

PlEnfiNOSW, — The promitosis will varv with the pause. It 
sbotiU) \<v |:pi»rdvdly fiivomble whiii the juirulysiii ii^ dn« t<> 
(KTtpliml iK'iirilijt. 

T[iFAT«FST. — Tlio anise should be a^rertaiiied, and if pu^ 
sibic, TMUovwl. In lairalysitf of wnfno origin little can lie 
■lone, exM'iit in itypliititie casev. In middk-<iir disease renie- 
di<'r> i>li4>nl(l he dtree4eil lo that or]^n. WIh'u |iarelym reeulti- 
fi»in infbmnialion of l)i« |wriphenil filiinientH of th<r faeial 
iiiT\)', biisn-rs Hlioidd In- iipjilioil m-ar rlie stylo-ninstoid (ora- 
lUi-M, and asii otU-n a]i|H-iin< I<> Ih- iin i-xprcrdon of rhitunntiitni^H 
salicylaK^ nuiy Iv ijivcii Jnlonmlly. I^tvr, a (x>itrH- uf iodid^H 
of iHitaj^inm will he iim^ftil, and rtvclnmiiou ni' jxiwlt muy be 
nialerially assitited by niasttagc, doetrieity, and luinl iujcctiuDs 
vf strvebnia. 




(IdiopatUo SpUepay, FalUng SickneM.) 

Depinition. — A chronic discaao of the aervous s^'stem, 
clianu't^-ri/x.-d by luiroxyttms of iinctinsciousnvas wbicu) are 
iit<ii;illy n^-nx-ialM with p-ncrni convulsions. 

ETHUxXiY.^Hfrpclity jiriiiij'|Mif<:Ti, and the diwase 
iiiuy not liuvc Ikvd I'liili-imy but iii.<ii»ity, Iiyi«(':ri», or sniotlicr 
i)curusi>«. It g«twTiIIy U^tiw l>oliin,*|)*ibci1y, uim] very rarely 
allor llw Iwonlv-fiftI) vvar. All rAii#(« which impiiir tlio 
hmllh and f3thaii-''l lln* tiorvooi* sy^vm r-wrt u i)rMii*[)o*iiiK 
iiifltM-iKV. 'I1tiT n-llex mnviilsiom of t-Jithtn-n mMiIiiii); Troin 
i;aMtri(t irrilaiion, uomiH., H<:, >!' lon^ (H)nliniii?<I inny JiultK-i; 
o]iroiii<M'|>il<r{My. In lli«w caiCA, although ih<! i-xriling nmm 
h»» Uirri ir'niovitl, iho lial)il of A|x>tiianii>iiJ4 inoU>r (iM-har^-, 
ilirotigli (^onsUiiit rvjictitiofl, is Established, ami may oominiH; 
tliniiigli liti% In iltiBW ftiibjoct to uonvtiUioitfl, overwork, gm^ 
trif irritation, or exn(oiii<>nt may nrect|)itat« an altaok. 

I'ATllot/HiV, — No demonstrable caiii^l I<«t!ons are dftert«I, 
Till' ilis«tw apiKireJitly Jcnt'odB upon an inslabilily of the motor 
<«ntres, so that from trivial exdtii^ cauBco violent diiicliarg«i 
ocour frwm time to time. 

Symitoms, (frand MiiL-~-'T\w seizure is oAcn (irwwied by 
a {Kxniliftf M-nfiution Ivrnird an anra, lirfpnnins in a 6ntror or 
Kh.- and rii^ini; intlil it invoIvf« the hnul, when (lie patient ^ven 
a shrill scninn and iiill^ t>i tin- flo^r ■it)(-oni«rioTit>. At fir^t llic 
lac* is pall-, the {)U|iiU o«ilnii-l(il, uiu] (In- IkkIv thrown into a 
tonic tfniLsni in which the lirmi i^^ rrtrnclHi aitd rulatHl. the 
limbs fonribly rxtomh^, anil tho iliiiinlts Itinu^l into tliv jmlinK 
anil firmly (tlwiiJiwl by lh« flfxwl fingt^nt. In a fiw M-(«nilH 
the toniir »])a!4in iflaxes, the niovoments l>Ky>ioB cloiii« or 
irit>'rmilk-nl, the |>iipiU dilated, lli<^ 6u« ovu nosed, aixJ from 
the vi'ilt-nl i-ontrairlion of llie niafisctere Inrthy wilivn, ofl»t» 
liliiod-Htitaikfd, jw>nrs from the mouth. The clonic »|iil-iih 
iMiitintkr (iir u mmnte or two. and are Ki^iterally followed by ii 
[K-i'iod (ir»>iua lafltin); fmiu a few minutee to several hoiini. 
SonietinirA thf inatient rciums at oocc to ronscioasiies, aud 
I'-impIattii* niniply of wwiknessi. mtisciilar Airviiesi*, and mental 
iMnifu^iion. Mi'fi- ran-lv iht' iimvuMon is fiillnwtfl hv an oiit- 





Unttli, of innnia, nr of cpUtptic (iu(mnalimn, a condition 
nliK'li tiift |>ali('iil [lerform.i some iiicougrumis act. 

I'ftil Mat. — lu lliis t_v[>e lh<r t^cizure mttsuts uf imttncD 
iiiHiiiuscii)UMit^ willi palW, and perhaps twiUhiHg of 
iiitiM'ti-. Tli*;ii:iliffil siidiU'iily slojts in lltP iniilrt uf liu \\n 
oi' (XMiv^tnuiUoii, I'ciiiiiinn (]iiiet lor a ivtwn sccoiidn, and Ibeji ci>i 
tiniita \viK>re h<> lell oH', jierliapa UDct>a.'ictuu& of the iutemi 
t inn. }'etil tnal ma^ be a tureruiuier oigrund mat or may alti^ 
Diiio with il. 

]ti>twci'n tJuse two pxtre-nips, the seiznr«t manifest all (rradw 
t>fs(! verity. The fre<iUPno_v of tite paroxysDm varies ooiuiidef- 
ably ; tliey inav oooiiras neldom as onoc a year, or ae ufWii as 
ten or twi'Ive tunes a day. A uutrked periodicity ia tLeir ~ 
vurrence is often observed 

The tenn " staliw epileplii-ufi" is applied lo a series of 
vubiotici which follow eat-h other in rapid sucncssion, 
wtiii^h are as«>t«iated with liijfh fever, 

The epilcptii- may mimif<-sl no other symptoms beyond 
oonvulaion;), but wlmii the latlcr arc very frequent the l»ealtb 
faWs and llie menial jwwer deteriorutcs. 

DiAu>'(M:i|». — Ttut uonvulsionif of idio|>athic i^ilepey miiHt 
be distinguished fnim tiioM-iIiie tuori/rtiiiV Ar'im4/ui^(«ir(<ityBniaH 
epilepfiv). The hitter aSbetioii nirtrly d«'veli<)is iK-fbrc twenty^H 
live ; the aura may l>c eoniwi-ti'd with the spi-<'i«l »eni^», which 
is imeommuu in i<lio|cillnc epilejioy ; the (^vuviiIkioii is uflci 
coufineit to one memiKT ur tu one side of the bcMly, and tiia; 
not be associated with iiiKuusciousntvi* (JiicliMmiun Bpilfjiny 
the eonviili^KHi miiy lxi;in in onu niemlxT and then ben 
t^neralize<l ; aiwl (inally, in a lar^c pni|Kirt!on of tin- euHiw 
organie e|)ilcp»y, there will l>e u history or coiiiMmilant sym 
toms of ifyphiliis or th« cvideiice of ix-n.-lind injury. 

(.Vtriftia. — IJiwniic couvnlsions nuiy be reixiguiiccit lijr 
liietory and the n«ults of tlic uriiuiry mialysiA. 

PRoa.NOMi»i. — OiK'rally unfavorsbh>. Arrest of Ihi' d 
WMi' in nirv. iMit umelioriition is often Mir«ir«l by trt^tnjont. 

Treatment. IWrcntire, — ("nrcfni wnn-h i<li<nild l»e m: 
lor tliv c»i(w which excites the {Kimxysiit''; thU will ofU-n I 
IonimI in Nome di^lnrlKllleo of the (pistroHntcsslinal trwt. Tl 
diet »honld bi; lif;b(. and 371 a rule, lai^-ly vcgctalJe. O 



stipation must bo ivlN>\Tt1 hy diet, (>xpn-isp, or tlie um- of mtld 
laxaiivfs. Umlnr mviKul iiixl [ilivHcal uxcitemeot should be 
av<jidi!(l. HyxU'iiijilii- (■xcn-iw iintj fra^uent batliing foUomJ 
by friction v( (]><■ :>liiii U-y-tn tin- At^iiAilivi'ttcss of ltt>e mrvmi» 
svMeni. Tin- iiwicl n'iialilc ilrii^ an? itie ))i>>tirH)(»; one <»r 
iw>i (Inu'liiiin ol' II tMiinbuiitlioi) of iIk- bn.iniidi'r^ of si.rtliiim, 
[totussiuni, nml iininuintitai iimy In' ^ivon diiily. Thf UiMk'iicy 
ti> acnf nuiy U' mii»i<li*itdily l<!«iiiil liy tin- ndiliUuii of m 
dn>p t)r l»x> 111' KiiwiorH wjliitiun tvilli mrli ikiMc. A umaU 
niiiontit of u>i(i|iyi'iii uAon I»«(t>ih iUq otiiotinl vf Uie lirumiclc 
nimin-d In iliti-k the uinviil-uiui^ 

1} Aminoii. brinniil.. 3vj ; 
Liq, pobiM. STM-nltis, t^ ; 
An. ii)«nlha) pip., q. ». ad f^v).—ii.. IWoODi) 
K;:.~Tiibl««paonrul tu water night nod inurtimg. 

Whrti tin- litiimidt* Tail, oiie nf the foUovrinfi ri-tin-dit-s miiy 
!«■ (■ni)ili)y"l : >ixi*l<' nl' jsim- (kp. vj-xv a 'lay), jii>-n>(o\iii (gr. 
ijrn <hri<v daily), lM>rax i>v hc-lladnnita. 

N\ lii'ji uii iiurtt ipvcn wamiag 4>f a aeiaire, the inliolatioii uf 
Biirtlv r>r aiuyl may almrt it. 

Snrffititt hilcrftivn'f U i5di<at«l ill Jacksniiian ejii(i?|isy, 
and ill thii^<5u*!i in wliifh the oiovnlHion h^inii in ono lavtO' 
UthihI Miiictniiierilly l)e«mics gei»oraIiz«l. 

77m- AHitrk. — Injury of tlif tongue may be prevented \ty 
jJai-in;; a [lie** of cork between the teeth ; as the wiitiire in n( 
^lort duration no g]wcial tuMlitation is rHjtiired. In the Matiui 
'fii/f/iticMi, chloroform or nitrite of mnyl may ije utiiuinistei'n) 
In- iidtalatiuD, and hyoadn (gr. [^) or muT])bia given hy|K>- 



DBFlKlTinN. — All inabihty to express thoughto in words or 

III iiitiTjufl iKi-i't'iilious. 

nator or Ataxic Aphasia. — Id this form llie [Mti^'nt his 

81 tJie mediaiiiam wh>'rcby ihntipht* aiv cunvcriwj inin HonU, 

bou^i be may bo able to rrjxat the words a(i«r aoolhcr, to 



write tlieni, or lo read them. Tbo Iffiion prndiK-mg thi« Toi 
t>r apliasin is locuti^tl in the let) tliinl troiilaJ con votii lion. 

Affnifthiu is iiti iiHiUility to oxprtvs thotifflit in written laa- 
giiacit. It i» iiifiuilly aswK-iutci] with motor apliasia. 

Alexia is iin iiijiltilil)- to cxiJfww written language id word& 
It is niso iiiTiiitioitly tusiu-iiitod with motor a|>hasia. 

Sensory Aphasia. — 'Di'w is un iiuilMliiy to iutorpret pcnrp- 
ttuiifi. I'hcif art' thi- following viii'ictiws: — 

Woitl-bUiulnrMi.— Thin i» »n ttiiibilily to intvqirtt wriltrn 
lnnguag<t. Ttiv lv?iion h iisitiilly in tlie eupratDar^nal uiiii 
iLDgnktr i^'ri of fJii^ \vfi Hido. 

M'ord-flfi/nnui.^-Aa inmbilitjr lo inlrrpivt apokm lanmag'. 
The l(»ioii i» \a t\\f iKjettfior [Art of thv Qnt uixl twcoixl tim- 
|M>ral coDvululioiH. 

Jliifi-blhultu-M {Apnixi<t, ilimat AmwuM^—A n imihililv if 
rcwjpiiw IIk' iiM: or iinjtorl of uti ohjwt. Siviiig an I'lijot 
nwnkvnx ik> tnu-llijrfnt irh>» of it» iise. 

Min/l-tlmj'iu-ia {AudUitry Amnfuia).— An inability to inttr- 
pnt Mntwh. Tlte {taticnl Itfam (ho woniA, mn reoc>^'i)i»' 
mikI ri'jHiit ilictu, but (niiiiot Int('r]>rt>t tlicni. ' 

Faraphasicl. — An inability tmiM' the rifrhtwont inoi>ntinDP<i 
>t|H■•^-h. He can iDteq>n-t aiul use woixIr, but in onutitaiilly 
iniMfilai-in^ ibem, 

Atnaeslb Aphasia. — Tbis term !h employed lo designate i>ii 
cnliri' l««i lit' word-iuemoiy. It iiM^iidra both luutor unj 
»fn!«ory apb^ia. 

Fathomkiy. — T\k Iwiions which ppodooe aphasia are 
manitiild ; the most im|)orl3iit arc : Tumor, gumma, abaoms 
<Ur{tn««<(^i fractJiiv, cm)>iili)^i, tbrombiw. or aol^'uinti in liic 
liKaiities which corn^jtoiKl to tb« varions forma of niilu^i:!. 
Ill right- baud i<cl Ei>l)jivtJs the Iwioii ts on tlip left sidf (if tin- 
ttntiii ; in the Ipft-liuiulitl it may, howc%'cr, \w on the right ^ido. 
Ajitiaiua is mrt always dot.- to otpinio diseosL- ; il may l*o iiotol 
in conti4«tiofi of the bruin, in tuddvn fright, in the nonvnle^ 
ivnce of fi-ven, in inigniine, afltT e[Mlcpti<r Mtiznres, and in 

DlAGNwtii.— Apba-tin iiuM In- dintiDgnidiHl frvm ajAomu. 
The laUvr (<ondition us nn inability to ulttirBuumls, n puwrr 
iii)t loot in H[>ltaAia; momovKr, H|»l>onia is gviH>niilr dqMimh-iri 

VEvmm. -tSO 

iipiiii tvimo abnormality of Um> larynx or of Ihe nerves Icwling 
ilnwlo. • 

l'K<MiS(Kis, ^Tbis <lciM'iuU eulirdy on tiw rausc After 
aguiploxy tlie pnignusia aliould Ite giiatxied. lu a.Ti>bnil wtl- 
i-iiiog it is abwiliilely tinfavorabU. Wben anbitaia dcvvluiw 
in lh« young llto outlook ia iimcli more bopofiil. 

Tkkatmkst. — Till' tnuHal rondition will require attention. 
Tb(? |m(ivnl may I* iustriicu^ Ut bpeal; and to int«rprrt aftiT 
lliv luanuer eai]iloyed iu teaching tlt« younj^. 


(Dlxslnaaa, OiddliMH, BwimmUig tn Uw Hwid.) 

DEFlNlTros, — X ficnsc of unMablt- c(|iiilibritini in wludi 
the [KUi«nt himself or summadiii^ ol>jcc-tx apjKiir lo !»* in » 
Htat« of rapid oecillutioit or rotation, ft in a sym|)tom of 
many rOiHlitiutw. 

EtioijOOV, — Vertigo may rrj-olt from : — . 

1. tVn-bnil aiiM'mtaortvnp^tictii. TIk- dixwiH'^s pr«M»fling ' 
a fainting fit i.* an ilbciration of the foriwr, mtA that fiillow- 
ing cxpusiin- lo Uie rayi« of tin- itiin it* an illii'^raiKm of ibo 
lnlt«r. Vertigo is ullcii a |m>noiiiioe(t t(yi»)ilon] of rlironio 
uercbral oonf^attion and ntin-mia. TlK^viTtigo of obronic lieurt 
di.-u^'tc and of neoraailM'ola 'm im-ltiditl iiitder ihia bead. 

2. Iti-flex irrilation. Ttiv must i-nnimon i-xaninle of lliis 
form is the venij-o de]M?iHlent ii|»<in K^trii^ dLiiiirfjanws, It 
13 at»i noted ill eye-Btrain, nterine disease, eon:4i|ialion, and 
diwaae of the internal ear. The laat is termed labi/rmtlilttc 
Bfrffsro, or Mhtiere'n diataae, and has been rlescribed elscwherp. 

•1. Organic diaea>« of the braiu and eont. Cerehral tumor, 
meningitis, and sufiuiinj; are frecjuenlly a-.soeiste<l wilb verti^ro. 
It if) otten quite marked in cerebellar diK^Nc. It may lie a 
pronounced symptom in disseminated «e)cnjei» ant) lucomotur 

4. Toxie siiljstonue! in (lie blood. The %'ertigo olMcrvetl iti 
lilliiemia, unemia, and (lialH-tm is ineliKUil under tliU Ixiid. 
Whon taken in iarpe iIiim'k, ivrtain driip", n^ al'-oliol, Wlla- 
douiiu, canosbu indiot, lolx-liu, ajid eouiuin, luuy prudiKv thu 



synijitonLi. It is t>fl«n » niarkt<] symptom of ohruuic U 

poison inff. 

5, Epilepsy. Vortigo may prwede, f<>ltow, or (nice 
place 1)1 all epil<'i)tip apixiin-. 

G. Ilviileria. ()i'>-!i.'<uiiuilly marked vorltgiiioiis nttat'k^ ant' 
oonwctwl witli liysU'ria. 

7. (Jnkuown taiispB. The terra e/uftiHoi rrrttffo h»v 1k' 
applied la ihotie cases in ivhieh, alWr tlie moAt exhutieti 
study, no admtiate caune can be ascertained. Tbexe U sunic- 
tiincs an liereiiitarv tendency to this form ol" vertigo, 

DiAiimiNis, — Vcrti>to must l)edistinguislicd fivmi in-jiU mnJ, 
or minor ci^i'/iyMv- The history, the pr&ence of a <tefinit«r rat 
and ihc itbwiice of um^nsciousness and of wtnvubiivc nmvi 
nieiits will serve to separate vertigo fi-i)m epilc]i6y. 

Tile di'termination of the cause of the ver^go mn«( 
IjUMil iipou (he liietor)', the a)^ at \vhich it develo|», and a 
eritiral examination of Uie various ui^ans. 

l*R<xis«>si!<;. — Tins will dtjiend entirely on tite cause ; wben 
the liilt^-r eiiii W- rwiiovcd, llic pni^ncsis is tavoruble. 

TitUATMH>'T.~Thi8 muHt bcdirec-ted to tlie causal oonilitJon. 


(Lilliyriatliino V«Riso. Autal TattJco.) 

Depinttion. — Paroxysmal vertigo, probaUy dep«iMJti 
(iIK>n diwtuc of the internal car. 

Knr>i>wv AND I'athouwy. — Tlic exaet C8ti.4c^ ol 
M^nij^n-'w di«^i»c in »titl imdeterinined. In n>me casen, liotv- 
cvi-r, inihiininiilon' ehnngeit have licen nlwn'ix! in lite st^'mi-l 
drciihr i-.iniilK. It i" proliahh' (hut mild (iinnK t.f the di.Htt 
(wii Ih- iiidin-rlly iixliictil hy hyiionx of the middle i-ar. 

SvMi-m»tv — Kntjuenlly prodn>nM;« [inxxile Ihc attn*-k,^ 
Buoh tm diiifiM-JW or <-nmche. Tliose, however, may Ik absent, 
ami tile iilliiekH iichercd in with extreme vertigo am) UntiitnM-^M 
tiHi-ium, The luKer is often iiim|>«n'<I In the e^iitix- of v-tenm.fl^ 
the liiix/. of itii iiiseet, or ihi- lUschilif?' of a cannon. The patient 
ftid.« iw if lie or rtiirroiUMtiii):; objetiK were U-ing whirh^l 
leolly atvamd, and in never*- caMv the fare itt pale atiil iinxiau» : 



\he siirfa^-elB i-lanioiy ; tlKTcnrciiniisFiiand voniiliog; and tho 
jinlient lall§ iiiR'tinn<-i'>iiK. 

As a nilfi, tli^re is tU-alrn.*; in one «ir nt Iwist, Imt t-x- 
a?l>iionaUy, hearing niay Iw quiu- nuram]. At lirst tlio 
|uti-(>\yHa)s may ocmir at long inu-rvitlit, bill iw the- ■]!»««; 
wlvanufw they Impcoibg niiire fm|iM.iit and tins tinnitus nod 
il4ufi>cw9 l)e«>inp more marked. 

UiAONiMiK. — ^The paroxysmal vertigo, denfixwi, anrl linmluM 
HitriuiA arc tJie dia^noetio lialiirm. 

I'luxiN'JsiH. — The prognofliii slionlil always Iw giianle*!. 
Some casiM re«iver entirely, but in iJn- niajurity tlio vei-iigi- 
noiit) attacks continue unul die tleafncfiH in the afleelcd lar 
tjcnitoee coniplele. 

Tkeatukst.— The middle ear Bhwild be coivfiitly ex- 
iimiiieil, and anv existino; di(*«wc trctiUnl, .Severe e>mnter- 
irritation Ity blieterw, or the actiiul t^aiitery a|)[tliix) U'hiiid ihe 
ear^ niuy be uf Home scrvieB. Bromide of potswiiinii or Iar^> 
doact« of hydrabromic acid may give lem|>onin' relief. Cliarctit 
reoommcmts rjuiniitc in suffieient duHcs to «uise c-inchouieai. 


Depisitiom. — nyatcria is a functionsl ditwase of tho 
nervous invtetn, manifbitcd by »vroj)toitM of the m«rt varied 
character, vrhiith ap[Kircntly nvuft mim a lu«8 of oonlrul p>'«r 
the prod »rti«n of ncrvf-jwwiT. 

fc,rmuxiY.— l-Vm.-ik'j' an' i>*i>«;ially prt-illijwisnl. nl(li(vii$;)i 
it Dci.'a'iionallv <Icvi']o|k tn iiiah^. ll is mint ciiiimiiit in eiirlv 
a<Iiilt life aini nt the mcnoiiau^-- Tlie m-rvouA leinjMtranK-nl 
and xrirli aivi^ml dii^iiMM a» «pilepfly, itMauily, etc, fuvur Hi , 

I>niliiiig<-<lem(itiiiiin1 i-xfiK-iiw-nt.ftuohaswftrriment, anxiety, 
grief, and all niiiM-r* wliii;h lower tlie vitality sei-ve to exettc 
it in snsii'i^tilili- iii<lividualit. 

P,\TH<ti.(HiY. — Xo (auaal leetoiis an be detected after 

SvMinflMH. — Ttie variouB manifet^tfltions may l>e deKeribrd 
nndcr three heads : (1) Atotor, (2) scnwin.*, ami (.1) pevcliieal. 

Miilat Wknow^w*. — I'aralysis not tnrrc«|»ently rwufts from 



hy^LTia ; it nuiy lake tlie fornt of a )i«iiii|il<^iit, iiar]i))lcgia, 
lUtfiKiftli^in, alllioiigli lltc- firsi h hv fur Uih niocl (iiniiitui 
Tbe inaralv.-iiH i^ ^mmmhIIv )>ar«>XYiiii)iii, luul in t'lttjiiciilly a.i 
daien witJi vuiiiracliireH and itii»»(lii»ia. The HfTiH-tfitl ihum:! 
do not waAltf. 

I<ocal ]uinily.'ii.4 h aln.> mniDton ; thii» tli«fe may be aphoni 
fixiiu jBiralysifl III' Uje vii«il «n"da; dysiiltaKia, from (Kiralyai 
of tlif >iM>|>ltajpLt ; and inwntiiKucc ul uniic, fnmi paralyHi 
of the bladder. ^^ 

CouvuUive odzurea are ooniruun manifcststiout; of hysterai]™ 
aiid uiay closely siiDiilaie tbe pan>x}F~si]ia of tnie oinlfi«y ; Ui ^ 
tlKre is iKi aiira; like patient usually Cii\h in a LvinlorUibl'^' 
plaee; cunaL-ioumicfiB is only apparently Ii*i, tor arter ttie st'i^— 
ure she renicmbere all tliat hastnniqiireil; lf.e tonj^ncis rarei^ 
bitten ; tlie eyes are |)atlially cloeecl; tlic taw is expresiivo o/ 
eoine emotion ; acreatniitg orsolibiiigisof fr«|uentoceumne& ; 
tiic movements are ayA to be tonie, so tbat tbe patieni iiasumfs 
tlie position of opi-tthotouoH, or if flonie, tlicy are apt to Ix- 
violent and piir{H>sivt' ; llie seizur(« are of l(iti<; duration, am' 
may be ei>ntiuucd for ireveTsI hours orday*). aitd firm prc^urr' 
over ihe ovaries may exaggerate or re-ex(-itr them. 

'FliD spasms may be local ; thus there may bo retention oi 
urine, from spusnt of tlic bladder ; asthma, fmm spasm of ' 
l>n>iK')ii ; lii«x)U};h, from suwm of the diapliracm ; [>en^iNli'tit 
vomiting, from s]iasm of the stomach ; dys|iiiagia, fiimi is|ki'-iii 
of ibe a-sopli!^!!^ ; luid a " phaiiloni tnmor," fittni H[ni».m 'if 
atxluitiinal mu<Ti-Ie« iL»»«>ciut(sl tvitli tbtulcnt dislcnlioii ofilii- 

Among other motor [ttivnonicna nuiy be mcntioiKKl uWti- 
natc tremors, vhorviform movements, and wntnu-tun'S of ^'r* 
tain K'>>«|^>» of miwKif. 

Sriimvif I'henmiifnti. — 'I'Imtc may be a twmi)letc low of wn- 
Mlion ii) iit-rlain iiiirt", n^ one side of il»- Imkiv, A niv!tth<-:*ia 
without "tiler nervikiin phenomena in ifimlly bv»tleHi»]. In 
soiiM! (Miurf, lartili- n-riMilion i« |ini«rv<ii and lliere ia a Uet 
only of tbcrniir nr (loinfnl M-ntuiliotKt. Tlte aun^iltPiie iiart is 
ofl^n nuuMiully jiale, and wlien prieked with a m^ile lail." l-i 
bleed (isehn'mia). 

The s|ie>-ial scn.'ieii may lie involved ; tlms tliere nuy be con- 



traction ofthofic?!] of vwitm, •■■)inj>k'lc Minilmr*. Inssorr-nwill, 
Idrw ijf lii«ti-, wi- Kw» of hiiirinir. Tltcw- s()«:iiil-!s*-iii* |iai«><''' 
an- ii8uallv lmii?«ii-iil, umI ulU-ii iilk-riiiil<- with uim) anudici-. 

Indtciul uf uii)i^tl)(?<iu, lln-n- iiutv Ih- liypfn<-i>tli(«ia or juuit. 
Severe |Hiin in ihe sttiiii»e)i niny ^iiiiiilalo ^Lstml^'n. ^\ii ex- 
t|umilelv iminliil :iii(i tfixlvr it>»dilt(>» ol' iIh- alHloincii iimv 
Im.' DiiHtakeii fur jK-ritonili't. A KMitlinil [intii iti llie liraa, 
(IrMvilNHl a.1 i\«<^nil>Itng iIm' ofTec-t ol'a nail beiii^ilHveii inloil, 
is termed hysterical ciaruM. The juiuU MinietiRKTi lH^ell(uc 
swollen and very tender, reeembling arthritis (neiiruniinifsis). 

Iiiteniie pain over the heart may flimulatc angina [tecloriB. 
The sphie is often the seal of hy|x'ne*ithi«ia, cftjMY-ially in s{m>1s, 
and this tpinat irritation ia often askx-iated with imin in paila 
convspoauinj; to the diBtrihiition of nervea ivliieli have thdr 
orieiD ill theliyperEKtthetic ai-ca. 

A verj- common abnormal iKMiiuition is the globntt hyet^icns, 
t. e,, a fwling as of a ball ruting in the throat and impeding 
rwpi ration. 

pHi/ffiicat iVioiownMi.-^ Frequently tltB only cwnKpicuwis 
in<-Mt:il iihwiontcnon is th« Rrrat lack "f xvili-[M)wer ; hut ;^i»- 
entlly iIh- jiutient'' iirc more or Ui« cxdiiiliU-, liijjlily nHTt-iiriul, 
and nisily moved to UnBhtcr or tt«n». 'Iliey fn-fint-nlly maui- 
fi-wt a pn'at fonfliivs* fi)r itvni]mthy, and thie, in timnoi-tioii wilh 
tli<:irvr(4ik Kill-piiwer«»(l lowirrvtl montl toiH',oftrii lititl«tlKin 
to feign »iym|iii>nH wliii^h Iht-y iiiilty <ln not liiivv. Among 
the ntoro >frit>uii mental niiinitVstnlion.i imiy Ik.- mcnlion<il 
insanity, i-tsttarty.tMliiU'iwv, iind tran«-. 

I)iAr.N<«is, — Tin- reoognition of hv.ateria U often atlonthil 
with ^n-Jt dilHi-«ilty, <«[)erially a?i it is rrec|Uenlly af»K'iat<Hl with 
svmiUonis whioh renily have an organic basis. In making a 
diagn'i*iis, the history, sex, ami teni|M.>rament must bo rarefnlly 
considered. The nianilp-ilations iisnallv develop iihru|>lly ; 
are generally jraroxysmal ; ap|>oar Hitlumi obvioon caiiw ; 
often Bnluide ^[mntaiieou^ly nnder some emotionnl exoilemejil ; 
rarely Wd to any impairment of the health ; and art', usually 
aEHociated with ii hJElor}' of other h\'vli.Ticnl phenomena. 

Pb(xi,vosi8. — Af regnrd* life the |>nigiio«^ii« is goo<I. In 
rare ittstaiKee duith has t^jllowed cxliuiii'lion induced by re- 
peated convulsiooM or pndon^'d fiutiug- While hysteria 




iiiinally ctkIk in mcuvery, thv ilurutiou nf tiw illnrae is n ma 
{13- nt great iinciTtMiity. 

A !i|iw<l_r rccovcrj" is to bt- t-xpccttd m (how wwcs wlti- 
tii« hyrsUfitTil [ilH'iiiimciin nre cotiDct-Uxl with some obvicu 
<mi^.- whii-ii isiii !■: ri-movul. 

Trp;atmekt,— Can-fill .scAix-li e)ioiil<) lie mudc tor mm 
i^xtatinff «uw, wliicli, if f(>iiii<l, KtwuM Ix- rcimiv<-<l tis far 
|in«iil))i.>. 'I'lic jiIiysiiMl «tiidition is gviw-mlly ix-diii*'*!, »iu 
<-jin-rii) itttHly inii^t l>e f^iwn to tiiv <1i<-t, cxontiiaie, HiiiirM-iiii-iiti 
ololhinir, olv., u'illi the view of iin|)niv!ii<r it. 'I'viiifx likfl 
iron, nn^^nio, Ktn'i^inia, hy)io)ih(i»]ihiti^, cml-liver ni), *ai] 
mnll aro oflt-n iiidti'at^^], and ihoy tnity lie mlvnutAp-inKlr 
<i>ml)iiK'<] with nerve anlativi^ iikn voloriaii, oMfoitida, HiiiubuL 
aitd thfi liktf ; id Uie milder nianifestolions, the following {lii 
may jjrove useful : — 

9 Add. araeuioBi, gr. t '■ 

F«rriaul|>li. ci.. 

Ext. suiubul., u er. XX ; 

Aamfircldw, gr. xT,— M. (GoonRLU) 
Ft. in j)il. 3f«. XX. 
Sig. — Ouc allvr uiMib meal, 

9 tjiiinin. rali'riannL, 

Zi(u-i valcrianat., 

Funi ToluriMUt., iS gr. xxlv,— M. 
Ft. injiil. No. xxiv, 
St|[.— Oae, thritx daily. 

The mope thoniu);lily tLtf ptiysirfan is ublo U> iiwpire 
fldcnce and to <'<]tilrul hts jHilieiil, thr more likely is hi> 
cffei-t a cure. Fimim's>) Ivinpcrvd witJi kiiidlinett and 
Murajiemcnt is es-u^ntial tn iidiix^. 

While Iiyi>noti*in nppt'ftnt Ici h»vo Uvii i^iitncwltnt ujt»riil in 
France, in this wuniry, although <rm|ilnvod but to a limited 
extent, it has not given cncoiinigiitg rftiuftA, and moreover, in 
the event of fuiluiv, 8cems caijable of aggravating the byi 
ml condition. 


In long-cmltiHHHl oonvulsivc seiwires, add water may I* 
dn^hcl uu tlie fiunr and eli<«<t, or Iiyoseiop ndininisti-ixid 
hviMMlcnnically. In oliHtinate eo^ies an anwstlielie i 
tiii|)loye<l. In tlic vortiMLi form of paralysis electricity 



often iiivifiil. In (wmt- itiw« slutii* (■!(■<■* ri^-ity, i>'i doiiU fn>m 
ttu' nroluund ninital ifli'cl wliivii it Iuli ukIikhhI, liurt giveti 
vxM'llvnt nviillM. 

In uei;rHvaUtl cases llip " a-st-cure" introduced by S. Weir 
Mitchiil 18 often up]ilt<'abl«. It ooiiitliM in inolaikm from 
symjiatliixit^ frittKls mid rolntivrs; alHiiidant ItK-ding, c8|Ky 
ciitliy with inillc ; OTtil noni)>litto n?it of Ixxly and ntind with 
)m.-4!tive vxi:n;Ue oblaincd Ity iiiaiisage and cl<.<gtricily. 


(KarvoiM Pioatiatlon,) 

Defimtion". — A U-rm iijipliHl in n mmp of )<ympUiin« 
fipijurcntly nviiUiiig fnim r^lkiiiietiim of liu' ihtvo-^-ciuixs. 

KTrtn/KiV. — A ncnropaUitc lendcm^y, jimkingMl utunia) 
work, or vmntiouut <>S4^il«nM>nl, ext-aatM-w, und im^ilnr living 
are geneml predi-HprMJng laitora. 

SvMiTOMH. (WthriU Symptomn. — IVpr««si<>n nf spirits, 
indis|)inition, inability tn mnfvntralc tlw mind on onn Hulijetrt 
II ir luiy Ii-njfih of lime, insomnm, verti^, h4«<la<-ti4!, irritability 
of tamper, and hystcncal nianifeeiations. 

Spinai S^ptomi. — SonKtimcs these pmlaminato, wbon the 
condition is termed tmnal irrilatioH, and its thief nianifcKla- 
tioHB arn: I'aiu in the liaiAi, k]>o(s of tewlernes* along tlie 
sj)ine, "pakneas of tJie fxlrt-niities, gnat pnwtration after 
tnoderatc cxcrtioti, and vnriotiii Kiibject^ve plicnonit^na, tiiirb m 
nnmbiKsfl, tinj^bng, forniitslion, and neiinilgit.- ))3ii»^. 

Gn^tro-iMtalinai Sjpuptown. — Anorexia, <»atcd tongue, and 

(^rrulalon/ •'^vm/i/offu.— ~Pal]iitalion, cold extremities, and 
Komt'tinK's violent pnlailion of llie aorta. 

Srxiiuf Symfttt/j'ti'. — In friniilcn. nnK-norrlitra or dyrtmcnoT- 
Hif«i; in m:ik«, im[K>le»ec i>r sjnTinalorrfm-ii. 

The discuw- i» inwiMimbly HMsociulnd with tTrrhro-xpiiial 
iiinc'inta, hyntvria, and livpwth'Ktdriiwiit. 

DiAONosis. — Tin; <)tain)o«ii* i" nireJy diflWidt. Itefiirc 
n'li';:tkl!oi;B rwe lo tlibi claxs, cure mttNl Ik; taki-n to ejceluile 
uiyiinit- (liwttKC, and tmcJt ffenrTtd ili/xmlm on tUhmala. 


MHP^RE8 OP niK NKRVOtlS EnrsToc 

pROtiNoeiiK. — WItrn ti>rt caiiK- cnn be rontcrvxd a»l lk> 
{Mtknl ttintrullHl, tlic iirugnuSM t» (jtvoniUe. 

Trkatxibst. — Tlic Iniitniiiit m lurgfly h,v^ieii>c anJtT*- 
Uilic, wxl will vary ivrn'tiirralilv in tliili-rt-nt " '■■' 

tJioru luw UtNit inm-tivirv, ri.-j;iiliilf<l |i]iv-ui-ii] - 
of ^nnC viiliif ; on llu' oltiiT Iniix), the w«ak uihI ■luraiM.- will 
nt)tiin! Ti%l. Ill Itic l:i(U-r t'wv, tlw. plan of tmlmeot iium- 
diKvil by 8. Weir .Milclu-ll. nii<i kmiwii as Uie "rest-nm.' 
•■del) givtvt liHIIiniil ivxiilbt. In all (il«c» cnrcful 8ll£Dt)>: 
mii>d In- givt^ii U> llig diet, luittiiitg, aixl <rli>i)iiiif;, ainl t)' 
i>ft(Ii-n1 iiwiint) lliiil he iH .■•iifli-riii)' rrotu itn iiit-ttraldp dL'^au' 
riivjnonl l>»tliiii)i \vi(li Hall watiT, followcil by frir.-tion iif lif 
xkiii, will often mid to tbo gfnoral vigor. ToImki.-u and ul">- 
Jiol mur-t bti inU:rdii-Ui], and lea aiid ailfee u<«d vvr^- Ffarioelr 
Toiiii» like iron, arscuic, qiiiiiinc, (itr)'chnia, and itlioephtirf 
, arc otieu iudicatcd. 


(CbOtM Mlnot, St. Vltua'* Danoe.) 

r>Kl"l[HTio>. — A inTvoii* nnbt-tioii occarriag r»>nociaIIy in 
children, and clianu!U-n«'d by irn-giilur tnovetnenitt which' io- 
trrca*' under exdlenw-nt and iviise dnriii); sbrp. 

K'lroumv. — (.'liililluHMl (bc-lwic'ii five and (ifteen), fetuali' 
sex, Dcr\<utiN U'tn|H-Rini>'nl, »ii<l ibe rbenitiaiic diatlicvis sii' 
^em>nd iimli^jHwing (iiefoni. Il t^jini-tinief developb Hiidijctilr 
sfU'r nK-ntal or i-niiktionx) eicrik-ment, Hiicb as iinxicty, Cenr, or 
ffrief. It may be rxnted by ivAvx. irrilation, un aa adht^rml 
i)nj|Hiee, int<M(tiniI (Kim-ii)*^, vie, Il not tnln'tiiK-tilly clL-velnii* 
III tfie eiHirw of |>ri-gtiHiHy. 

IVnioi.'Kir. — It \» <iii>loniary to look tipmi rborea ue a 
nciinjititi, eitii'c no eon>4»nt k-^•!on': bavo Im.-(-ii tltnoovervd In 
mvount for llit clinitnl inatiife;<tHlions. In ^nne vasfH omfo- 
cardilia, uud vnitxili in (he niiniile (vrvbiiil v(#«le Itave Ittt-n 
dituovcred, UiL their ix-Ialioti to choittt hut nut yet been de- 

SyuiTiiMS. — The (ii>l iniinifeetalioii* arr iwiiallv tT-tflleR<)|Mtw 

and awkwanUif^iw in movetneiiU The diilil mniwt reinuin 

till, but iH eaiiotoittly ininit^ itti aliotildvrs, jerking iu litttd, 

H'Ulini; iU fiitgers, or shuffling its feet Fre(|uenUy theso 
rmptunis tlevelup so InNiIioiiiiily that th<- disi^afic tfi nut recog- 
I, and tiK- rliild is piiiii^hc^) tor lieiiig li([;;cly. 

When tlic 'liMiiw is fully eslabi iHlitil iIk' disonWly mow^ 
ntcnte Ik-cuiik' niorr marked, and may Ix' ixxifincd t4> one 
invnilipr or niuy involve (he entim body, WIkd the racial 
inuaelciiare ufR'rtcd, llie moet grotes<iiie cxpmwiuiui are [>«►- 
diiPiM] ; invrtlvvment of tlie arms may inlerrvre with filing 
iind drcHsiii);;; w*lH-n ll>c Ic^ suffer the ^ai't bpoonirc jcrLing 
»m1 i;tiimbUng ; mvulvcminit of the lamix caiiticti stammering ; 
niid •i|>ci'4ni ol' the raiii>cle4 of <k');litlilion imluit'iii difficult 
«wull(iwing and f4ii>king-gpclls. W'hcii the attention ie dinged 
to the movL-itK>nl« they invariably grow u-urap, bnt ihey 
dinnnisli during rojKvte ami C(.<a»o entirely during gleen. 
Si>tndinK<«, in luhlitinn to thv invutuntiir;' movements, there is 
II ilUtin(-t It"" "1" (xmor in ilic iifiVvtol nKinlM-n^ Tlie general 
lii'iiltli ii* ii-<iinlly iiMHf or lfs« imiwiirpd. The cliild is nnicmic; 
tlio ti'injK'r is irritable ; iind the nHtilu! power iK-ticittit. Aiib- 
ciiltulioM of llio heart oftoti drtiTt.-* a iniinniir whi'rh may bo 
citlirran i-ixpnisiiion of aiwtniaor of n.>m)>limtitqr t-ndocardititt. 

lit MHtif i-asfs (chorfvi inmiuirm) the imivifncntM an so 
violent that llm (xitient b unable (n wnllc, i-at, or oviti l<i lie 
down. Fever develojit, and iiltimatt-ly llii> itiJiKl hi-minw i\v- 
lirioits. De-ath frwjiieiitlv results frMUi-xliMiinlioii. Thii* fonn 
ia usually ohM>rved in adults, and csjM-cially in pnmi[iam!. 

[>iA(ix<KiH. — 'The reoof^nitiou of i^horea is ran-ly atliiiMk^l 
with difliailty. DuaemmaUd njtmal •o/croaia may be di»- 
tingtiiiih^ by tfie prcs^nee of nysta^ns, a scanning siioieh, 
incrcft!*)^ refli-xes, and a rhythiuieat tremor which a only vx- 
eitrtl hy movement. 

I'lEiKiNoisiK — In simple chorea recovery usually fnlli>w>« in 
tlH><xMinie of two or three months. Tlealh from hnutitim' 
plieations is a rare termination. IlelaiMes am not iulVniitent. 
Among tlie ptisaible seqnelie may be uwiitionol iinljcijliiy mid 
<!hrt>nie ctiorea. 

(Iiorea inmninu ftequently terminates fatally tJimugh ex- 

Thkatmext. — Rcet of body and mind ia an etwential ele- 
ment vf the tix^ntmenl. The child should he taken fhmi 

b ■fara|A,bat tutiR 

iiw iilj ll ii i r wi iiiiliijB w i Mr iii 1. T^leoAmietajim 

i» iMiiiHy • fine tnmar htgiiiaii; m tht band «r Cum, whWb 
nnv idcrtHf •f«nd mittl rt ntvuKva >B tl« OHniU-rt; thf 
btwl M twiy flffrrtnL At fint tbe tveoidr aay i*- [lumi- 
tmal, Iml «• ihi^ dMaVr Mlvncm-r it Uw ii awiw almiic* nintiim-'iM. 
KtritMOfnt i u t M ' mm» il, but it !• notovwlhr that i>)i\-.rj.i 

leuifionriif' dimtntidiai (ir i-faee^s it Tfar bn- LcnKnn 


t'X|ir(':^iitil(.ttH, atMl lliQ ^l»ect!h slow and measure]. I.«t(>r,'iilitr rij;iilily devcloiw; the bead is bowtxl, the UmIv bent 
lorvvuiil, tho iintm floxetl, the thiiiiibe turactl into ihi- jtalnis 
uikI giik^|wil hv tin: Unci's, uiiU ihc kooes Kliglilly lx.-iit. ^Vt 
llii^ liiue lh<! ^il i» chanieii'risik- : t)ie steps gruw fuller ami 
liiHU-r, Iho Ixjuy iiii-liiK^ inoiv mul more f<>i-n'iLtTl iiutil tlic 
(latitMit iitllf, r«iH.'ki) »ii}>]Mii't in mniK* ui^i^hlxiriiig ubj^l, or 
niraiglili-iw h)iii-'«i-lf by a sii)>ruim; effort of Ihv will. Tho teriri 
Jc»liniitltm liUH bii'ii apjilu'il to lliiw jMVttliar gntl. OtraHtoniilK- 
a ttiidftioy U> (all liork«ar<b — rdiopuUion — iv[>lauvt fc^liiia- 
tion. The- ri^i'lily luid Diuac-iilar ueaknesH rvudvr mil dh>vc- 
iiit'iilH slow ami lulmiit). 

Iiitolli^iu'4> ii* usually good. Tliere is no aiiuv^tiH-xia, bill 
there am vitiiniiH manifestaticns of jiiirmithcMia, tiii4-(i iw inttnli- 
tichH and lingliii)r ; a wii^itioD of heiit i^ iv[iet<iiiMy noki). In 
Millie RiH<^ rri« I K-i-H])! ration has been obfu-rvn]. 

I)iA<iNi>siK^Tho ti-i-mor, rijjidity, wcnkntw, flexion of llic 
Iwidy ami ntenibers, lack of facial expnwtion, an<l /rutiuiitiriH 
mv ihe (lia^n(i§iio featun.«. Ju some raws tho tremor is iili^r^it. 
J'aralyeiH agitane must be ilii^iiiguiHlivd fiwrn diuanimttfd 
ec/crmin. In the latler the tremor 'w cxnrec, in freqiieiitly ub- 
w-nt when the pattiiit it; qiitcl, aiul is mnde won^e by dforlii to 
(■oiitrol it J ccrelmd i^yni{itoin« an- p-nerally ])r(^iieitt ; iivaIhi;- 
iiiiiv U otien notfnl : mid itie attitude and ^uit are entin-ly 
<!iiri-rciit from thoee of |iuruly»!it iLfjituiitf. 

I'lKXisusis. — Kecoverj' nirvly, if ever, ix^unt. In Miniu 
cam'*, after n-jditng a ivrtnin |x>inl, ibo diwttto rpinaino ^u- 
tioaan*. The proj^rc^w ttt i*lon' und (Im* iliimtion indefinite. 

TliEATMENT, — SU-.i»ure» inluidi-d (o improve ihe tone of 
tin- dvisli-ni lire indinited ; thi-i"? «iv : A n-giiluUtl diet, nsl of 
Ixidy mnl mind, freipient Inilliiii;; folhwi-tl by rri<-lioii of thv 
skill, und Itie use of mvh tonics an irxm, ar^-iii<-, and [Jicmi- 
plmnui. 'Iliv rigidity aiM) irt;inors are sonicdimt^iniprnvMl by 
niibiMHge iind cki-lrinly. Anion)!: tha remeAitm rvivmnieitded 
for the tr«-in"rs lire biNjinide of [M>la.-t<inni, hyoM-yamino 
(gr, T^g), uti<l hyu«iiK' (gr. i1e)i '*"' ''"- improvtmcnt follow- 
ing their use i* only flight aitil temporary. 




Definition, — A K]ia.'-"nK><lii' iifTivliun of th* miiAotn) 
(luivxl bj- [HolonKMl work rcijiiiriiij; iK-licutc- roiintiitatioii, 
(iccuri'ing i»i>ly iu the {xtrlorin»)u<t> of Mini )nrtkiilar work. 

IvriouxiY,— It is mon? oiifumon in iiR-n iliun in womtui, 
and tliK oci'vous l(.>fnporaiii<-iil |in<liii|Kic<fts to il« <lcv(^|iipiiieiil. 
Th(- iHVii|iiiti<>iM ill u'liirh it ts inimi a\A to ovnir nrc writiiig;, 
])iami'[)lHviiig, ^^wiii;:, and Iel('^i-u|i)iiiig. 

PATIIOI/Viy. — The iliscas* in I'viiU'iitlv tml {H-Hgilirral, f« 
vrht-n llio otWr hand is aiilx^iitulcd the (.tmditioii Mum <\i-\r\off 
in that mejiihor. It is prubablv dejtendcnt iifton unnatural 
irrilalHlity of the uerre-ceatres. 

WrltorV Cmiup. 

(OiapbOBiNiiHn. SoDv«Dora' Paky.) 

Symptoms. — Tli« <«>Mditi»n iiMUilly U^inx with n wnac 
fati<^K*, weight, iir ni'ltiid pititi in tin- allixrtrd miiwli'Tt. .Shiq 
(h« lii^^TK are M'^mxl willi u lonio or vlimic »|i4u<iii wIm'im-^w 
Uip |K-n i« gni»pei\ (.t|HL4tJo l(>rin)L lo Honi« cB.«ffl ilic hund 
wli<>n [Hit intii i»t! lH^>me« the wat of a <l(>(!i<]ti] livm<>T 
(tnrmnlikiu form); in a lliiiil ^li>i)|i of atfu^ Uie Hiit-f [iliiv 
iMniM-fm an! (-xti-H^ive wdakitcna and I'aligne, wliidi diF<a|i{iiaiT 
iLS siM>n lu tho |H>n in laid aside (paraktitr tonu). 

Plux>N(wi8. — (Juardwily favorable. TJie disnose in olsti- 
nale, Init oiitx- g^'tu^rally foHowa ptxiti-acted rest. 

'I'rratmrxt. — Abiiolut« i^st is the essential element of 
trcsilnii-nl. 'I1n- ip'iipral oftodilion »hould he impn.vMl by 
inm, aixiiii-, strycliiiia. and eixl-liveroil. Massage, cI«Ttrici(y, 
and |iu!t<tve innvenients give good rasulta. 



(TManlDa, Intonutttnit TManni.) 

DEFlKmoN. — A niTVdiix afli-otion, ctiaracLerixcd by liioi 
KpuaniH whit^'h an- niiually )iaroxyiinial and invoK'e the 

ETltiUKiY.— It in most froqiieully ol»erved in tin* y ^ 

In woitH-ti it is fmiuently aasoeiatetf with prrgnaix-y or larta- 


TtlOMHttys IllHKAHR. 

t.ioij. U tH Aometinieit «xoitc<l liy cxjmAiin-, <^ni4>t>iiiial (^xcito- 
(luiil, or iiiH' of tlie infertiwB levpn*. An opidtimiir fiinn liiw 
Imi'h dcAcriUid, b)it iHiine of tlie oiitlinsk^ uttctn In Imvfi beim 
liy»l«rical. A very grave forin haA Ixn-a iiitluctrd l>v thyrutd- 
iH'toiiiy aivd by lnviigf in )j^Alrir<]iliil«tiiiii. 

Sympihiuk. — Till- jntit'iil U seinil wilh bilateral tonic 
I'jHii'ntK in lilt- nntiN nml Iipi. The jawxan? rarely inviIveH. 
T!k- ivnti'ui-iioiLs art-iiKmilly juin>.\vHniui and are alteiHlcd niili 
litiii). ,\» wiiK |>oii)l<.il 0111 tty Tmii^rH-flii, liwy <nn be indiHTil 
liy jmwiifo <ivi»r the artcriBf iinti iii-n-e* of like afleUcil limb, 
riio eKvtnwxnilnK-liiily of the miifH-li-* w greatly exagp'rated. 
I'Ikiv nuiv bo .-tligbl (iilcma. Scn^alion in nut disturbed ; (be 
iiitnd i.t ih-ar • ami fever i» svligiil nr enlirely alxipjit. 

I>lA«MiKLs. — Hjfuleriii nifty oiiiiubiU^ tetany, bill tbo bt«(ory 
tind tiie iiiiilaternl ebaracler uf ibe contRictioiiii vrill iliHtii]{;uii^li 
it frura tetany. 

Tiianus. — In this dioeaiie the Hpasmn are oootiouutu and 
early involve the jaw"B and trunk. 

I*itOGNoe(s, — Uanally favoralile. Attacks foUowing thy- 
ruiilectomy and lavage sonietimcs prove fatal. 

THKAT.HK.NT. — ( i<>od hygiene ; tonics ; elcftricity ; »dntives 
like bmmidc of jmtasiiiuni, bcUudouna, and cbloral. Wanu 
or cwld batbH, followed by friction. 


(OoogBiiltal Ujotonla.) 

nKFlNlTiON. — A dieoase confined to eirrluin families*, oimI 
dtarm-teriwcd by tonic Bposnis of tlw mkunJus in<Iu<.'fd by 
Vobinlai-y iiiovemeiits. 

KTiruxcv. — The dit*ii«! lit iMiially ivngenttal, and traits* 
inilKn] from i>netreiiemtiwt to iinulbtr. Several moinljers of 
the .same family are omiinonly Hlfcctcd. 

pATUoi^KiV. — Unknown. 

Srutnxiut!. — ^Tlic diwuM: appcura in cvly ehildhood, and is 
inanifei>t«l by a tonie :<)iiu>ni of lite lunwlrK even- lime they 
are |>nt in nw ; this iti e^[Ht-iiiIly niarkfxl after jM-riod)^ of irw 
activity. In a fi-w niomeuls tin* rigidity weani away ai>d the 
tnovemeiitu kxiome frve. KnHn re(>eat<Hl eontractiona the 



miiecIcA bwoiiie firio ami extremclj' well di'velopt-d. Under 
eleotriral stimtilntiou lh« mi>»clpfi (x>ittnu;t an<) max eluuly. 

I^lwKjWiKiti. — I iKnimbk-, 

TkKA'iMEST. — Tilt- cxMidition improves under pb^veiol 


(OtavM'B DlsottM), Baiedcnv's DiMiaaa.) 

DEnxmON. — A nervous afl'iHiimi, eliamrteriwi! by pnr- 
Ini»iii(i of lti« eyeballs, eiilargcnu-ut of Uil' tliyn>id ^-liimJ, uhI 

i-.TiouHtv. — toiTly ailiih lifo, (eiiuil4> sex, and iieivoiw If m- 
iiranieiit are ihe jimi is [losing «iiibcb. It soinetinif»i ilcv I j 
^ddcnly under ciuotiuiml pxcjIeiiicDt, such ae iri|rtit, giKi, 
and anxiety. 

I'atikhjmiv. — In nioet cm^vs do kvions are roiiii<) nilu 
death to uci^xint lor the M'iii)tt<inii>. It lius ffviierallv ixn 

garded us a diwaM' of iIk- tsymjuitiictic- e^'hIiii), and in 8(>i 
Ii^ances cha»};(« tiiivc bu-n Imitid in lh(^ (vrvic-al ganglia 
but tile mcnlul phcriotucriii utid the mii'Icnihtl pulses cnni 
In.- 4^'X|)lairH'd on llio itiwry of KViniHilhi'tie [i9nily--i(i. Tli 
[>romim-iKi- of llie evt'balU is iW the i»i«l juirl (lne< t» dilaia 
tion uf (he vr^iHi-N in iIh- Uii'k nf (lie orhils ; niii! the eiilar^ 
ni'rnt uf the lliyi-oid >r!:iiiil ii< due ti> « niaiilar (-niMlilion. 

tSVMlTHHiR. Oiniiua y*/i'-n/»mi-j«(, — Ar«lt-nstiii)i of ll 

f^diic (100°- ■•')0°) and [Mtlpilatioii, Uith gri'nily c-xagKeratr 
>y cxcit^metit ; liv[K-rlf»pny of ttw hmrl fbimi its rapid 
action ; occaxtonally a M>n sviilnlir mumini- at llie njM'x. 

(hulnr Phenomena. — Itilali'ml |irt>lrii.'iiit)t nf rlw ovfltelb 
and llie " Griife sigii," which I'tmsiMfi in a lailnre of ihv ijp)H>r 
Ikl to follow 111*' eyeboll whiii rlie lalter is diixilid ^lowinvnixls. 
Vision is iisnally nnim|iniix>d. 

Thyroid Phenomena. — Eiilat^g;efuent of tli« thyroid i» oflpn 
tlic lust syoaplom to appear; ooe or bolli lobce of the glnnd 
may Iw afTcctu). I if|icclion rrvt-alie oiiInrp;cii)C'nt with jiiilxa-: 
lion; |)itl|»liun <1<-ll^-l(^ a hiH swcllinij; and a piirriiig Ihrilli 
anMrulUtliuii nuty yivld a OruiL 

■ T It i; 



NentM* Phenomemi, — The fdllowint; ar« itninetiin«i ob- 
served : A (n'liior of tlie Ii»ik1h oi* uf tite Piitii* Ijodj- ; hjiw- 
chondriosis ; nciito mnnia ; ur vitiligo am] dilniuiiua. 

Oentrai Ptwnrmitin, — Aiiinmia, fuiliire of health and 
HtreD^tl), and Kli|r)it rvhrilc iiAi'oxyniii-^ 

r>i.uiN(»^is. — It -(jioiilil [h- Uiriio in mimi that one of Uie 
tliiX'e iinj>i)rtaMt HyiupitiiiL^ may U> iilisc-iit lliruiighout the 
dihoafte. Iti «»ni«; ism's |ial|)ilatiifii and lhnt))i)ing ol' tlie 
cei"vical vewtcU may [» ihe oiilv jiheiioaieDa. 

GoUrftitay bedi.ttiiiuiii.^hedli'om exophthnlniic^itrobj Uie 
absc'uce of cardiac, (K;u)ar, aiid iiervims sy[n[>tcini& 

I 'K(h;. >'<*>[». — TlteiliN.iise^iK'nillv nin>iH pmlracled uoiirac. 
Some caw-s rwover fiitirtly ; manv impmve and mibsL-qucnlly 
n<la|i6e ; a few di«, at^cr a tjtoit illuee^ fruiD bcurt failure ur 
ftciito ntania. 

TRtUTUBNT. — TliP gncncrnl nutrition roitst bv iitipmvixl ity 
rvnt, a iil>enil diet, ami thv niv uf Midi tuni<7> tat irun, ')iiiiiinv, 
and arsenic. Ttiv a|i)>licati(iti <>f mild galv'anH; ciirn-itlx to Die 
nerk is uften wry ii.'icfiil. \V)ieii llie |uili>itali<m i» murkrd, 
pn>mpt relief uflen fiillowH aljMiliite rv^t uih) tiie a pp !!<.-» tit >» 
of an icc-ltag to Hie pnworilia. The ino*! nliiildc internal 
remedies arc 8tropluinll)ui>, di^ilulis, bt-llndonita, and eiyot. 
Bromide of |iottUHiiim t* >w)nic4iin<» itwfiil in i^ttiilroliinf; tlte 
nen'ons ^yiii|ttoni». 

Oprrativf Inlrrfermce. — L^rurJon of lliP arteries and ex- 
tirpation of tlte gluiid oinnoi be rocoiuiikfiided. 


<8yiBiiMtricRl Oang^Mw.) 

DEflsmoN. — A va?*i»-inoti)r iiitinwiK, chanideruwd hy local 

ainetiiia, eijiiKe!^"'>n, or giiiipreiie. 

Ktiomwiy. — TIk- cuiise ii* unknown. The dtiwajte probably 
eonaistH in a l<"iil i^jitL'^n) or |Kin?ii< ul" the vtswln, 

SY.M1TOM!*,— In one form llie |>ni1. usually tliu (inp-r, Ikv 
ci>mes extrfOH'Iy |Hik', ould, aitd una-'tJiHie (IikhI i"ymTj|ie), 
After u variubU- tiiue tbim^ phenoDiena dimp|i<tir and are fol- 
lowwl Ity rciIiKiw, h«it, aixl tin|:liiti; ; sadi nttiu-ks may Ih- 
excitet) by i-old, ami it/nn- and gu niiJimit damaging the part. 


In anotluT form llto ntTt'ctett part heconire xwolk-n, ilaHl 
ami (Kiiiiliil </<«r[i/ a^jjiyria), stM if liie iiltack pcreiste bi 
may aji}>e»r bimI jtangn-np dev^ltiji. The jpmjrrpDotifi areas 
arc oflon symmetrital, involving a finger on eavh band, a lew 
un (wh foot, i»r Ixjili i-ai^n. Hieiuo^Uibmiiria is not iiacoauDoa 
during ibe atlack. 

I'RCMiKfHiiK. — Tbe attacka jiersiHt, but life is Dut endaDciGroc). 
In ixire inMtanurs cxtensivf- gangrene d<!V<'lope and U folToiretl 
\>y (loatli. 

Trkatuknt. — I*a(i<^i)ls liable to altacka should \» w( 

Erot£Pt«l atfaiiiHt culd. Tonics are often indicated. Frexjne 
Billing followrd by frirtioi) in iiset'iil. Itaynaud adviMV ll 
uae n{ a a)ntinii(tl current, one |M>le o%'er the spiae ood 
other over tlie aHeeted area, 


Dkkinitiun. — A neumftis oliararterijoed t>y lraa<iit'flt fiiprnm- 
scribM) iixleina ihtvelojiing \vitb(Mit obvioufj cause, 

Etioukiv, — Beyond a flistimt Iiei'oditary tend«'o<'y itMhin 
is known of iti; eaiific. A««i-ding to tiiiincke, tbon- it* a tem 
jioran- vaBo-motor dilatation of the vessclii fuUowed by tie 
tramndatiun of scnini. 

SvMi'n)Ms, — (]-»en)atotiR swelling suildt-nlv a])|M»n) in some 
ymt of the body, parlicularly in the face aixJ hands. Coino- 
dent with the oedema lliere may l»e nmrkcd gastro-intestiwl 
syniiiti'ms such as vomiting, gu-'tralgia, and m)1ic. The disctw 
is Billed to urti<nria and tue latter may precede the utitlimli^ 

The atlacks niav occur at iiitei-vals of a few weeks. 

['KOii.Ntwia. — The wtctiliar lewdciicv persists; unte« 
lan'nx is involved, it la tmatteiiditl with danger. ^ 

Tuh^jiTSiK-v r, — fieneral tonitsi, like iron, quinine, and sttyA- 
nia, are sumetiuHX asefnl. 


Pepinttion, — A nervous afTcdiDn, ehara<-teriBCTl hy mtio* 
dr^^enenilion of the subciitaneou!) Itssiitv, atrophy of llw tlif- 
roid gland, and miiitxl impairment. 



Kti"I.oov. — Thr witwcx arp iink)>owu. It w nf more- 

fmillleDt CMXTUITflK'T ill WUtlHMI tllllll ill tIK-tl. 

bVMiTOiis, — It If nuti)ii'«ri'<l liy sinrlliit^, tmrlinilurly 
riinrkcJ in tlw ftux kikI ii|>]nt <.>xtiyiiiilii.-«, tJnliki; )uiii|>lr 
<itl<-inu. the [Mrtit Ao nut pit on |>nv.-«nro. Th« Hkin '» liiirvli 
iiml dry. Tin- thyroid f;Iiiiid tit ntrojiliird. Aimni)' uIIht 
M*iiiploni)i urr fiiDnrr <»f mi-niory, »'!<hvikw of itmii^lil ntM] 
»|xivh, uiiKli-ady jpiil, uiiil, diwiinU On* <rliw, diim-tiriii. 

Ci.iii^iMiitjil invx'i-<l4-tiiii ijf olim-rvtil in <-n-liniHni, »iid a 
8imiliir condilii^n sunictintnt followA rcntiival nf tlie ihynttil. 

l'K<H!Xoei«ANl)Tltt:.\TMKST. — ^'l"l»fdi!*sf*ninHa Iwnpdrtirw, 
nml li»s \>vm tronsidcml inciimbk', btit it is now rluiiinil tlwt Div 
frcah Jnicp of tliymid glumU ih €ii)Mbli> of ffrc(4(iif; ii nirc^ 


(ITiiUaten] Prog^eMlv* Atropby ot Um Fac«-) 

Dkpisitkix. — A rare affcrtkin, diiu-artDrizctl by (migrtw- 
Bivi* wnsiing iif tissltcH — bonoi aiid soft ]inrtj) — on ww sidu of 
till- faw. 

KnouxiY. — TliP diw*M iMnftHy d«-vclo|w in vhiUUiood. It 
iias 1)^11 t-xcitetl by injnry ot'lln- Jiiiv. 

I'ATiioMKiV. — Jd iIh- tbw <tiN> rxiimini.-*) dinintc trigntiinal 
tKuritis or lesions of the (.ikiwerian gimglioii liuvo bcc» (l»- 

SYMrroMS. — The firet ph<>noiiir-noti L« (tften diM-olurultnti of 
ttie skill; thi« i» wioii f'c>ll'm'«<) by a tJow wiLMinjrof all the 
ItssnM on tlio afTtx-tit! tiih- of tht- Gui^ Thi^ hair fiilU; the 
eye is sunken ; ami tlio t^-i'tli iir»i|> out. 

I*BOU\'oei.s. — The disMDC U prugrt4«ive and incurable. 


(Haite'a DtMOM.) 

I>EPT?nTroN, — A nutrilioiml <Iiw>aso, c-barartfrienl by en- 
InrtirnKitt of tlie buiMW and overlyii^ tisnea, cJiicHy of the 
luimiit, r<vt,aii<l fiMv. 

t'TlDlxxiV. — I'nknnwu. It usually dvwlope in rariy adult 


Patuolooy. — KximtiiHiltoti uf tlic- boiiee n-vL-ulit a iroc 
hypertmpby, paitii-iilarly <if the caiMvllmi)^ rtnirtiirvi'. In 
s»Dic cases tlic piliiitar\' Ixxiy hnit Inx-n vvr^' miivh lirjicrltv^j 
pliini and tlie tlivtnits ^'^ikI iwreistviit. j^^ 

Symptoms. — I'hc harHl* ami fwl an? rtjiisidcmbly viilnrpw^l 
(«|XiL-iall_v ill brraillli ; Ihc ritip-i^' uiwl ttx-a an' si iuin>y tuiil (In- 
iniila an'flnl ntul »iiihI1. l]y]K'i-rn)|iliy of ttitt iiitimor miixil- 
Ixry Ikiik- IiwIh tn i-lntij^iitiiiu nf the Itioc ant) protniiiii^ii nl' ili<- 
lowT jnw. The li|w ai* largi* ant) cvorKHl. Atii<>ti^ "turn- 
»iuiittl .tyiii|)U>iiiH Diny ln' iiiciiLioiMxl >i|iiiial <:urvatun', iKiljiiril 
glycosuria, )ir-i-Hii«ti-i)t tieiuliu>lio, deafnoni, blindmfM (n 
aliv>|iliy of llio oi>tic uerve, locuof flcxua] |>ower, and in wuncn^ 
iiK-iMlnial (Itiuiraeni. 

DlAdNfiKiK. — Act'onxyalia nti^lil Ixr mii>tAl:(i) for myj 
ili-ttm, but iti tl>e lattt-r llic .tofl jKirt;* uiily ittv invoivixl ; tin 
skin h Gnu and adlieivin, liixtund oC mfl itml mobile a» ■■ 
aun>iu^;alia ; and liic lace is miiiKl. 

In Faffet'f o«teUia deforouift» ihc lnl^r lionfti am (ftiieciallj 
involved, and are mrt only oidargeil, but i-nnsidi^raldy ilMnnwe 
and tlic face han u (icculuir triangular -iluipt'. 

I'ltiHiNOiU. — ^Ttie allectiou is int-nrahl*-, but tbe duration '» 

Treatment. — Sg far, remeilicfi have been futile. 


(H«at-«trok«. ThennJo Fever. Coup de BoleU. Inoolatloti. HmI- 

Offinition. — An affecUoo resultiug fK>in exposure (o ex 
ccMiivo lieat. 

Varictijk — ^Two varieties are observed: Thermic fe 
anil li«fit^xliau.i(ioii. 

Thermic Fever. 


PAxnoLOoy. — After death from tliermio fever rig«>r mnrtJE 
develu{M wirly and is marked. Tlie variiMis nrgauti, i>.|iepHdly 
tiK' brain, arc deeply rtmttestt^l. Tbe left vt-nlriele is firmly 
vuntnidiil, and tbe rigtil In dilatixl aitd lilkxl wiili blwxl. rUc 




bltiixl is (lark Jinii iiiKxi«igiilnl<^il. MiiTnwrijiir i-xiimiivilion 
uf the tia-tHK rcveiila )KiR'ndiyiiiutoui> ik^cui^livi), or cloudy 

SYMrrojiii, — ProdniiiK's air frwjpontly piwnt and ot>nsi8t 
of cxIiuiiMtiou. vrilip), iiuii.-^'fl, aiid h<iiiclac-ii4'. TlK*t' »>'mp- ! 
Unas nm rolluw't'ti liv (Viiiii, ami in tliin Hdlc llw- fii>x- U (liii^lic'd ; 
(lie i-vr« iin- itij(i't(il ; riM- xkiii Lidrvainl l>iiri)iri^; |)k' luii- 
j«-niuire rniigi^ t'nim lOB" Ut 112" ; lli« imiiiin iiro (TiiiUtirtcd ; 
lfi(- n:tt|)inilui»» aiv rajiid aitd aoisy ; aiitl tfit- ftuhsu is full uimJ 
r»[Hii, Unlras lh« K'rujx'-rature wxin fall.t ilie rn>)tiratioiiiK 
bmim(> shallow, ihe pul»« wrakeiv), and death rcvtilli* in a 
few tioui^ There is u vei'V uialignaiit form in ulittli tlic 
paliciil i> HiidtlHily etricken cuoiatoec aiid diea in a Iiiw lioiire 
inmi <artlin«' fHiliiix-. 

S¥XiViKi..r.. — Mt'itii^iti^; epilcjiey; insanity; failure of 
memory ; aiitl exlivme »ewsitivcij(*a to hiitli tomjwratiiru. 

DiAtiNOHia — The cundiliotu iiitder whKli the conm hatt de- 
vi-lin>«l, tiigethcr witli llie (.'xlrpmely high trnifKraliirG of lh« 
l»«ly, will serve to distln^fiiisb siinHtrokc from a|»o|ilf.\y, alcu- 
liolifiin, and nncniia. 

I'liiHiXortis. — Very giuuxled. Prolwhly forty per cent, 

TicBATMBKT. — The patient dliould be promptly placed in a 
batli of ice water atid sliottid be nibhccl with i«. Ico-water 
cni'iiintii are a]fo ni^cfid. Anti|iynn liux Itvcti udminit^ered 
wilKTiitiuni>iifily with plhmI ri'Siills, WIh-m tht; piilse is full 
iiMil ^IruM); vem-Mvtion ni»y im a vnluablv adjuiivt lo tlw oati- 
pyrctic treatuivut. 

Hcat-exbnnfitlon. ] 

Patmoloov. — A«x)rdiug to Wo(m1, heat-<>xhau^lion doiK-nd:!! 
on a vaso-motor panbi-^, af a residt of which th(>re in a dt:t<rr- 
mioation of bkxxJ from the brain and eurfncc of tlie body (o 
the yreat blood vitiwls of the abdonicii. 

SYUFroilii. — The mind ta dased, but cooscionstM'HH is not 
lost ; the Mirfacc i» pale and cold ; the skin is m4»iHt ; ilie rc&- 
jiii-aiions arv »ha]luw and htirriwl; and the pulse is rapid and 
leeblc. I 



PkooN'wis.— Kccoveiy iM>on MlKWitiinckrajiproprislc 

Trbatuent. — 'I1ie (Kitient nlinuld be rov^red with 
l>lank<;t», And hot IkXIIw alioukl lie (ilartd (u^t thv ft 
Kraiidy, »mmoriin, fiiid Kiroiij:; nofTce are tiscfiil stimuluii 
Strychnia liyiKMicrmually is a \ery efficient remedy. 



Aoute Aloobolism.— Aft<.*r exoewive iiidtilKvnoe in ali 
the followifif; MMi|it"inB art' ohsTvwI : Hiwliinj; of thf it 
qiiivki-tiiiij; I'rilic |)iil>u.\ nml iiK-iitnl oxhilurution, lolluHtil 
iiioolicn-iit iti»i?t'''li, low of v<>n]iimt\>m, VDiriitiiig, d^-liriiiiu. 
sluw ptilw, Kiilitiormul kiii)M.<TUtiiix^, noil, liiially, nlripor x 
coma. Ovnuiorially tiw coma i» n'^)lA<«<l or interrupted li 
<N>nviil8tve soixtirc!*. In tha nmjontyofcnww. nn-ovpiy fiillu 
in ilu- cKHirm- nf ii day or two ; bill !'oim-liia« tlio oonin dw 
Hnd duitl) n-siilr". 

Clironic Alcoholism.— Tlii^ 4,'<in<lition i» cliitnutti^riMxl by 
f]m> Inmor, menial iinjiairnu-nt, dintiirl>ed s]i-r-\t, iiijot-ttoD 
tite <Xtnjiin4'tiva!, rodiiCAn i*r the nait- (iu'tm* i^iiutcfii), hihI tl 
Hyinptonii) of chronic )ra^Ln>~inl(»tiiinl <»tnrrli, namely, ano- 
rexia, coated tongiK, fi-tid breiiUi, iinuwn, vomiting, IuIik^* 
and dtstre« after eating, ai>d consiiiuilinn ultfrnntitif; nilli 
diarrhon. When Iho iuil»it is Jong omtinm-d, aihcnima i>f i 
arteriffi, cirrhosis of ihe liver, and chi-onic interstitial uephri 
are apt to develop. 

A very eotnni4>n complication of thronie nlvobolUin 
tifiirium trtmen* (mania a }M>tQ), This condition UHnully 
followij u protractf^d di'lunicji. or sproe, or is excited tiy nn ii^HJ 
jnry or some intercurrent di^raiir. Ite chief innnif<vtu(i<mii illt^H^ 
^[ental excitemenl, insomnia, im-oherenl specdi, di(u-ii-di-n'<f 
inteUecl, trvmors, uiid liallncinfllioni>, iiMtally of Biji^lit and lieni 
ing. The lu«t arc of » terrifj'inf! character ; the |ait Sent hrai 
thn?atenin|; voices, or «*» rc[Hd«\T' cmtiirtw — :<nakes, n|i 
!i<»th!4imc itiMWtA, or demon»— jvcrinj; at hii» from Itoliii: 
•'V ly pif*v of funiitim-. In wmw ciwcji the icriiir exHtwl I 
lii' -<' liuiliiciniitioiiK ia n> gix-jit thul, in a fituf maniiuml t 

ilh „ 




'itciin'iil. llw |iaticnl hibIks out into tho fftnt'X or junipx fmm 
tliu window. TIi« jHilne is rapkl and lii^iic ; Uic a|>jMttit4.- is 
nitirolv lot>t; lh« bowelttaiv <»n.ttijiatMl; and llu! u-in|M-miiire 
iiMjiilIy elevatwi (lOl^-IOS"). 

In fiiviirnhlf t-asra, in the rioiinte of a tew dayn or a wvclc^ 
till' <>xi-iU-Mii-iil alwtes, die aiijHtlite rfliiriis, sletji is n'slun-d, 
mill I'l nival (-.-HI -I til! cstabli.-ilHHl. In uiitavoralilecRM-.i, tvjilioid 
HVUiptoms are apt l<> develop; these ore: Irrppilar fi-vfT, 
wi>ak Mibe, dry, brown loogiie, Mii[>or, Diibfiultus tdHliuiitu, 
carphdiogia, and fiuallv, complete aima. 

Among other i-oni]tU(.'ationB or Aociiielv of dipeomania may 
be mentioned : ^fnlliplc neuritis, jineumooia, epile|isy. i-liniiii(> 
nuningitiii, purtlic denicutia, and rarioufi ))eyetii«(«, 

I'lAiiStHl!^. — The etrmii of alcoho/iitn musi \x ditrtiiigui^ied 
from the (wmn of other diseascti. The hirtory, the ateentv of 
|HiiTi]ysi>i, the ^ibDomial teroperatiire, the fad tluit ih* patient 
mn i>e aroused by bercaniitig in thv car, or by limi pix-wnre 
over some R'n^live Miot like the »iipnior)>iltil rMilrh, lliVMhir 
on the breath, and the nljM-un- of otiHT i-ailf: will ii^imlly 
prevent an error in diagnwfiH. 

Jirlirinm IrftitenA 'm rtt-opiizcd by tlie liii<torj', rtT<tItV»iHtut, 
delii'inni, tretitors, and terrifying ImlliK'inattoni^ 

Tfte froHon of Mron/e aJeohoHinn may im reeiiuniix-d by the 
historv, the sflaociated evidence of akvlioli^ni, nod by the (iw-t 
that tliey are wor&e in the inurninj;, and iuipru^'e alter ihfi uec 
of the atituulant. 

I*i!(KiN(«i«, — In (u-ule ((/ooAo/imw tl» progwws iJionld lie 
(fuardedly favorable. In tltHrium trenwna reooverj- |;<-nerally 
follows, unkss iIrtc i# great deWlity. In alcoholic tmetimonia 
the oDilouk is Rravc ; renn'crv is exccptioiia). /w aterJiotic 
Nmi-<V(« (hi* syni{>tonis nritially Hubfiide nnder appropriate 
rcnietliirs and ntN^iiKiKH,' from llie stimulant. 

In cfinmic ufcoWiVw ihe projfiioais is j^ncrally nnfavorable. 
Wlieti tito habit is fully »>talili!J)etl, it ts isrely permaneDtly 
broken ; temporary improvenaent ia only too often followed by 
n relnpw, 

Trkatmi^nt. Ai^U AftMhofiam. — ^The stomach should be 
emptietl by (lie iiloniaeli-pnmji, a ^itnulatii)); emetic, or the 
liy|KM)erniic inj«clion of ajmniorphia (gr. j^y- l ). If the coma 



pcrsi.4ta and l)i« [hiIw wf»kr-i», ranliao Hlimnlanls 
ummnnia, fttryohnin, nud digitalis nlimild bt^ adiutnii 
liy|MHl«rRiinilEy. I)i>iidiing aitd fla^'llatitjn way also 
eDiployed ut aii>ii^ the jiatieiit. 

JJehfittui TrfineHx. — iVIcoliul must Iw withltold iinlft» 
pulse is very weak. It b esMential that the [Kilieril Hhoiilit 
receive siifFivient iiourUhmetit, for n»ually little f'tod luia Ktv 
taken during the delxiuch whk-h led to ilie (lelirium. HighlT- 
seiuwiiod beef-tea and niHk willi l!me-«-aler are the best iMxJa. 
8leo]i niiiBt be seciiiti] by chloi-al {gr. xx), bruniide of pota.'eiiun 
(5»*-3j)' ti)'(W«"f (j:i-. j^), nutrpliia {gr. J, hikI iv[>eated mico 
or twiw), or |i!irald<.'tmlo {^j). When the pulst- is wfok, 
strychnia (^. ^, rt'ii«iled. u-atcliing the effwl) id often of 
grvat vuliie. In nio^t nuies iilivtiical nxlraint m (W^nlial ; it^I 
w bcHt swnn-d by elrspping IIr- ptMient to the bi-d with »heelil^| 
(ytrnnic AU'olHifmn. — It is nMH<»Miri' lluit nUtih'd I'liaU bc^l 
wilii<lrswti ; the mptdiiy with wbti'ti lln.* mn U- nc^coiiiphslHif 
will ik-)icti4l on thu oin'iiiiislami.i'. In iii'i<4 (3im^ the tcrciptu- 
liiin Id ilrink is »* ^Imng that (x>nliiH-iiK-iit in iin imliriiitc 
aiyhini h cw<-n(iai to the i«iioix«a of the tix-»Un<-n(. VxritmTi 
sitkitJIutts havu l>(«n rmxtinmendi^l f^tr iihithol, among whidi 
may he ntenUoiirtl bromide of pola^iiiiu, (■tilornl, cucnine, 
hy<L4ciiu-, am) cnnnnbU iiidi<n. A.-* m ruU; Uuy aii^>in|ili.-li 
little beyond (|iiietiu]; the jmliont ami (Hvu-<i<>tiiilly Mi-nrin^ 
I Bleep. The dJot .nli'udd tier iiiitrittntiH, and {iirefullv ada|>t<d 
' to the condition of the »i1nni:ii'li, uhicli ia imually the siai of 
chronic catarrh. Tonics like inm, nuiniite, and gtryelmia are 
often indicated. Graduated pliysical exerciite is oomctinus uf 
decided value. 

opirnii roisoN iNG. 

Aoote FoisoniiiS. Symituus.— A stage of excitement 
followed by stupor, coma, eontrstled ptipiU, slow respiration 
niii>;ciitar relaxation, and a slow pnlsc. In the final ^tage 
m^pimtionK )H'(v>nie sImIIuw niid irn^uliir, the pulnc rupid 
(w'l)Jc, and the pupils dilated. 

Trkatmknt. — The )4i>inui'h »lio(dd W emptied by a Blimu- 
lating eniilit; or the sloinncb-puin|>. Htrong ooRee may be 


fpvfn t)v the moulli. The ]ialipnt olioiiM he hnwM^] br 
llii;;i-IIatioD, (liiucliirig, fori'wi w»lkiiif;, *<r ihc fl«-ti'if hnish. 
Till' physHiIoKirai unlichiiU?' — .ttriij)iii aii<l ritrvHiiim — nlioiiM 
he fiivi'ii h_v|Mxici-inic;ilty in liill tlnw'!', ihi'ir «tlii1.t iM-injir carc- 
fiiliy wate'hcd. Kicdricity liiay be employn) to tdiiDiilule 
ixwni nit Kill, 

Morphine-habit. (Mor/ihiumt, Morphirmnnku) SvilP- 
TOMs.^Atwiiiia, -aillow «nii|ili'xi<ni, uii irn.-MHtiblo oruving 
I'lr till! 'Irii^, ililiilii) )m{iiU, trtiiiurK, Iijmk of ii|iii(-lil<-, n«ll<«»- 
inw, iiL-MiiiiiilA, iiK-titiil )ui|iiiiimKiit, inul ii <vni]ilHi' [M*rver«ion 
<if Itii; iiKiniJ imltirr. 

TiiKATMRST.— <^nfiri«(n<'iil in an iwyhini 'at m-nrly s]wayit 
rvx^se^Tv. TW4>|)iiim ithotiM Ik^ wtlliilmwn gnuliially. 8udi 
HiliAlitiiU^^ On vMunf, (-hloral, byii»ciiiv, iwralddiyde, and 
5i)I|>h»iuil may t>o cmjtlnvtH] tcnijKirarily. Rt*|iiralt>iy wlimu- 
laiiis like stiTHinia, anil isiilb<- ^lunulanl.i )ik(? dif^italU, an> 

' aiien in'liiatitl. Tii iho majority of caacs the Itahit i§ 

I uuly filiiipciiiled, not hroken. 


(PlnmblBiii, Satumiim,) 

EriouHJV. — Chronic ti-ad- poisoning rrtitilts fix>m i1m> Mow 
abHorption of lenil, and !» nurttl rojnn)oi)Iy obAerv^^l in Ntork- 
ni^n who liandli- titc nirtal. PnnttTH, tyiKyfoundi-i^ und 
workers in wbilc-lead aw <-«i)«-ially liablp to be alfeded. f)cv 
cflsiooallv it rcsnitii fn>R) lli« use of water which has been 
tarried liimtigh lead [>i{Kt( or uhicb has been stored in cbitemi) 
linttl with lead. 

Patiioloov. — The miiacleii are degenerated, and the pe- 
ri|ittcral ncr\'e8 frenuently reveal evidences of cbronie neiiritia. 
In Miscs a»UM-iutca n-itb marked muscular atrophy, polio- 
myelitis is discovered. 

SyjirTOMS.- — The fitltowing are the cLief manifestaliona : 
Ana-mia; i!<-v(.>re <<olirky paiiM ccnterinj; anxiiid Ihu iimliilinis 
ami <moC)Ht^'<l wilb n-ltactton nod rigKlity of the nl>doni)n»l 
walls ; oi>nsti(iuti<>n ; ii liltii- line un the f*imitt near the in- 
NeHion of the l<>e<h, lUic to tlu- dejKffiltun of a Milphnrc-t of 
lead; iiannlysiD; trumun; iutciuw huuilacbc; pnina in tho 



joiiiU (artiintlgia); artorio-sclmMis ; chroiiio ialciytitMl nc- 
[tlinti? J ai») grave oert'liml tiymjrtotim (ctKi-jiluilupatliiiv). 

The Pai^gMti. — Tliis in UKst iiistuu<x« involves Uii- ex 
Mom (>r botli romii-nis, and p\m riw to tlic vrell-LitowD vt 
dii»|>. In atlvaitccd esses the tDUseJm airupliy ant] yield 
rciiotinits i)f degmieration, .Si>atation a nut ufViTU'd. 

Knn'pluilujKLthiat. — Tiie^ are iiiiioiig tliv uioro nux- maiii- 
fi'station.H of |>tiirabt§(i), aiiil euii»ii^ uf iviiviiUiutiie, <.»ii. 
(lolii-iiiui, inu>i»c beadacliP, and bltudjicM fivni titn))>hy 
tiiL' <ijrt,ie nerv<'-'i. 

I'urxixtwiM. — Guard«dlv fovombla 

TKfrL\TJiFLST, — Prophvlaxis couatstii Id alisolute d^iilini 
ih* use of refi|>irat'>re in lead factories; tlip avoidanoe 
ailiii|f in all atuiosftiiere Laden with tlw dtist of the nieUl ; 
uiul in (h(! oocasioniil iihc of Kjisoiu salts. 

The cumtive tr«atm4>tit consisU iu tl»o adminirtnuioD of 
iodide of jtotasium {er. v-x thrice daily) and tbe um ti^^ 
8til|>liiir baths. CoiiHtijmtiun should be relieved by Epsn^H 
K»lt«. The I'olie tuay require the Iiy|KxIcrniic iiywlioii o^H 
morpliia and atropia, aiid tlie ap|)Iicnti<>ii of hot ronienlalitHM' 
to tiK' abiloMK'ii. The i»r.»ly«itf geiicraily vicldf lo tiiiMHi^^ 
ttw wtL^tuDt current, and liypodei-mtc injectiouM of Btryclin' 



Eti<hxh:v — T!tU is u.«iiallv olwcr^-cd in Oioae cjiijiluycd in 
(juic-k.'ulvi'r niinfft, urengaj^uci in making mirrors, hanniii-urre^i 
or othff fw^ieiitilie inslnimentii m|uirint: tho \>»f nf nierx;ury. jH 

Svjipnms, — Au^^min, Icth offlenh and strpngth, g:aflin>-in^^ 
testinal diatuffaanas, and marked tremors. The latter iiHually 
begin in the estreniitiea, and are at first slight, but later tbV 
vliole body is iuvilved, and tke tremors are violent. Ii» ad- 
vanced cases they mny continue <luring sleej). Grave eerelnl 
symptoms oocttSionally develoji, sneh a." vertigo, headaclie, im- 
{Niinnvnt of intellect, convtilsions, {lanUysis, and coma. ^M 

L)lAnM>^[8. — The biston,-, the inarkod tremor of iJie bead,^ 
and tlH! ubwDce of the pcctdiar gait (feHtinatiun) will distin- 
l^iiith it from pnrnlgnii* itgilana. 



^ Tin* liistorviiml Iho ahwnce of njAtaguiiLs n-iJI dislingtiieh 

TuKATMKXT. — Rfiitrtval from tlM? irifliiwiw of Ide iiiHsl. 
Tonics, Iodide of iH>tu^ium. Eleotricitr. tSedativu* fur the j 



EriOLOfiy. — It iKol«erv«l in workmen «ii[»Ioyctl inarwnic 
works nitd glajw (atrtoriett. [ii|ialiii)£ tlw (Inst of &l»ri<-s, 
paj^i-s, arliluqal Howera et*?., wliioli liave U-eii owlored will* 
aivcDic, imiy iixliKv p«ii»«iiiing. 

Syjii-njjis, — A i)ii.>iiiia, loss nC fl<r!.!i mid stretiRtli, cttnjiim^- 
tivilin, ):^^tn)-int<?HtiriaI catarrii, hi™ <if liair, culum-oiii' t-mp- 
lioH)-, and imiuIy.-ilB. Tho la.-t, iiiiliki' tliat oVwKTved in k-ad- 
jM>iNJiiiii^, neiially iiivolvtw llic extcuironi of \\w legs, but lal«>r 
it may aW involve (he arms. 

Tkeatmfst. — Reoioval frora tho influoiicr of araenic 
Tunics. Ekvtricity aud massage to the allectcd musdes. 


or TUB 



Pallor an a pcmuinntl coiutition b genrrnlly an oxprctiiiion xf^ 
ftna^nia; but it fihmild ix bontc in mind llial in mmo tUMv 
titf: .*iiHaop is [wUe wJwn the hlotxl is nonnally nvh iti oiqiivi- 
des and ha?m'>j;liibin ; and that in otltcr oases the Knrfaoe Iia- 
n natnral oolor wWn the IiIikhI is conHiilArahl v <li-li(-ii<nt in 
ix>r{His(^l<!g am] hicntoglohin. It fulluWfitltort'rurolJtal. an ahso- 
li)t« diaentwis of siiu^mia nittsl rpot on an analysift of tbo 

Pallor as & temporary eomlUum mny result fram<>iiiolional 
Dxcitetncnt, expotuire to oxtrcniu coU\, ebuck, e^-ncojtc, ur oA- 

Yellowness of the Bktn mny nn^ih fn>»i junn'lici; ill \viii<-h 
la."-- ihc LxinjiiiH-tiva: will also he yellow and die iirinL- will 
contiiin bile. YellownKw may also result ftwn r/i/onwrs or 
perniciow! antrmi'i, nitil in ihc^^ cni^n; Ihe ixtrmal colitr of the 
conJiinc-tiviD, Itiv luwuciiitcd vviiiptuniH of the 4}iiiea.-ie, uikI the 
iil)^'Tiiv iif bile in iIk- nnno will indii^ile the canHC. 

WhiteneSB of tbe Sldn. — A milk-white hue over extensive 
ariiw niiiy Iml- iil« in ',7'ir;ii"iii. rifilit/f). and in Iciiritx;/. 

Dark-browD or gray discoloration of tbe sUn UoUerv-ed jp; 
the following <i»nditioiM : — 

A'f'litin'i fUjviiJir. — ]n ihtt aflVviion the skin hasa hroim-d 
ai'i" 'miKv, whii:h is i^uwiuUv on exiwenl uurtti ; th« 




bnocat muoouB Diembrane may also rweal 'IiktoIoiwI i>Inqti«i ; 
and tiicre are in adOilion anipmin, piXK^niliun, atiJ gsstric 

Aryvria. — This (erm im a|)plio() to the (Inrk-Rray diHcoloia- 
linti qI the expiiecd tNirlH wiiicli rolluws lite pnjlongvd use of 
nilrnte of silver. Tfw! diw^lorolion is <1im; to a ucpoi-ition 
n{ the osido of Hilvcr, uixl tK iiioix- or IfM [KTiiiatwut. It m 
»it(l to W pix.ivfk'd by » ilurk line od tlte fi»iun, i<imilar to (he 
oae oliscrvfd in chiviito kwl-j">i-S"niiig. FornK-rly, wlieu 
nitrate of sivcr wits lu-cd fxt«iitiivoly in Ui« (rvatuieut of 
epih'psy, it was not an iinmmnuMi coiMitivn. 

\'iif/n/ionilumiu«.—TUiif ttnu in n[)|ii!itl t4> the (Inrk'bruvrn 
tlii^iiionitiiiti itl' (lie Hkiii whioh follnw^ piv>li>ii)^i) ('.\}H.iMirv to 
the wcuUii-r, iiiicli'nriliiii^KA, ami )HThii]it< ihir iiTiiuiioii of the 
skill resulting ff-m initiviilnr^iit. 

BbWMSs « the skin, as a [ici-tnaacnt cundilu^n, is gnrnvlly 
an oxjmWou of t^'anosia. 

lianliiAHH, or Iiiiliirittioii of lli<* Skin. 

Itidtinition of tlii* ckin is oliwrvwl in »ef/rtHlrrma. In tlit:« 
affrotiuii th<> ntkin i» tvfiM), bide-lKinntt, and more nr \^f» jiij^ 
iTicnkil. tiidtii-ntinn i.s nlsn (itw^rvcd iit mtiTfrdftua. In ihlt 
(condition tlie .ikin ht swollen tu* in a>(1cma, but it is Rr/n, itt- 
eitL^tic, nut) <loo.'> imt jitt on preaHurc. In addition, tlie f(ntni<rs 
nil' jHi'oiiarly bmadenctl and the menial power is im|aired. 
('ininn^i-rilxHl ik)I<*Ii(» of induration are olntorvnl in nwrjjiiea. 
The (■JrciiioftcriU-d jiatdtcs, with hyjR-iwinie or pisniented 
Ixirderx, and tJw emootb, Hluny, atruiiliii<«l skin arc tSc diag- 
UtMtie features. 

(Hiana, or rfropv 'if 'A« ftAatbtnmwi tiMua, wbcu extreme, 
al:io caiisM induration. 

A brawny, indurated ouudition of the mil«ele«, eHiKfiolly of 
the lej^s, is fn>|iwiilly wlwiT\-ni in m-urrtf. ]l probiinly rt^iiltH 
from 8 sun^cuineoiij exi»lBlton. Tbo aiuKinia, purpuric spots, 
and ep«mgy, bkcding guius will aid in tJie diiiguoai^ 



T,V>.i;oi,S TLS.SIES. 

CKilcmu nuiy be it«Of;iiuiO(l by » tm'vlling which pita oi 

twni-t, liver, and limi^ disniM^; nut) fhim Imnl obetnirtion to 
lh« vi-itoiii* (rirtiilutioii, «t» by h tumor, j)n|:iiaiit utvnts, or a 
vn^I^w■^ miulilioii nf tbo vi-ins. (2) Alirratiinu* in ibt- bl.MTd 
ur La]>illant#, oit in ltnghl'si)i.'k^'W,aiiK'miu,uiHl iniluuiuuitiuii. 


■■Glossy SUn." — Tliis Icmi \vif; a[i|>lif<] by raed (u iodi- 
cHtc ^ Mn<"<tli. alrxiibic}, nii<l ^liiiiy up[i«initi«- of tlH> skin. 
]t ih iiKHl IrmjuMitly '»<i) iifli-r Jriflanimaliuu ur injury 
the i>cr\'otruiik!^ It ii> mtuHitDc* nswciatttl with an intcji 
burnti^ I>ain, to which MitvlMJI has given iho muiM! oatuati 


Knlurp-m^nt nf tlic fniiwrfiml v«rw may r««tilt Awm 
chruuiu heart, hi a j;, or ItViT di*iiw; fr»im Iht; prf**nrt' uf a 
tumor ur anciirinin oti (Icvjt-TH-alnd vein* ; or, as a gcnonil con- 
dition, it niuy be vongiiiilal iind mmU fruco owliwion ol' di 

"Caput Badue." — Thit* l<rrn) isa|i}>1i«1 to a aiv]f ofdilnt 
voiiM sumnindiiie tiie umlittiini^. It in iniliuitivi^ of iilintnu' 
tion (o ihc portal uKulation, aiul may nt-iilt fi-om nlntpbii 
cirrhosis of liic liver, from (bixinilwit-is of ibo [Mirtal vein, (i 
Crota ttu! iinsaurc of a tmnor on lh« [xirlal voin. 


Oit«i>ooii» emiihywma nonii^t^ in an (-ju<ap(! of air iuto 
(vlhilar tiitHue. It i* iiuuitfi^lMl by a ctitTni«, |)a)lid swi>lliDg 
of tlic tikin, which cmi-kk^i on ]Ki!|inlion aiid which pita og 
pr»Hure ; but, nnlike ixdemn. tbo doprt^nn ituniedtalrly dht 
appears wb«n the finger is witMrawn. Il may result (1) " 



IrairmalMiu nf the nir-jm-sagea, as a gimshrtt wound nf the fit^t 
or a i'rarture of llw rib. (2) Fmm nijrturp of tht? linopliagiis, 
HtomaL'li, iutcstiut^, Iiiryux, triK-hea, or lungs. Th« rupliin^ of 
tlicsi? oralis is tifeually due to ulceration, as in cani<er nf Ute 
oHophaKiis, tuberculous mvity of tlie lung, or purulent pleurisy ; 
but ounufiuuolly the lui^ ruptures from violent strain. 


Atrophy of the Rails. — Tbo nailn may Ix-coinc dry, briUlc, 
dii^'iiluTTtl, aitd cinckcd in oq^uiu diMUM; of ibc ^tinal cord ; 
nlli-r iiitliuiiiiiiition or injury of thv rH-rifiJicnil ihtvi>; after 
pmlonpil fi-brilc dii>(W)i«, jikf lyjilioid tt-vor; aiid in ivrtain 
allit'tioiis of tbir skill wliii-It involve tin- matrix of tlu* nail, as 
Civ.i-iiia, (("iri:!,'!.", iiihI rinjrwntTU. 

Curving of thfl Nails.—! nctii-vation of the naiU is generally 
nj«Mieiatf<l witb dubbing of the terminal plialaneco. It is oIh 
MTvod in jtlithiiii!^ dironio cardiac disea^, and in many wast- 
in^r disi-aw-*. 

Onychia. — Inflammation of tlte matrix of the nail may re- 
t^iill tVotii injur}' ; fmm sypliilis ; from organic disea^te of the 
8|)inal wrd, as locomotor ataxia; from ailhritis deformans; 
and from cutaneous affections involving the matris, as leprusy, 
ringworm, and eczema. 



KfacuIfH are discolored spota which are neither dex-ated nor 

A f/enfrat rvd maadar eruptimt ia obvrved in th« followiag 
oonditiona : — 

Syphilis^ — Secondary syphilis may raanitest ibrelf ait nn 
eniiktion of small red niuciilnt. TlH-y arc neually alxindunt 
and frequently cover the entiit- Uxly ; tbcy lack subjit^ivi! 
aymptoms; they are twially assoCTatcil with llic bii<t'iry or 
witli the ex-idciHuw of sypliili*. "^nt-h as tin- W5ir of thi> L-hancre, 
bouc-pains, olupectu, swollen glundi!, and sore Ihroal. 


Erytliema multiforme may manifest it«<-ir tut s ntiM-«i|: 
eni|>liiiti, Imt the uuunile.'i are usually ajswiatcii wiili ilurk- 
|iai)uli'a ur uilteivles. The intiltilbrniily «f tin- k''sions; lb 
|>r«>l«renutt for the oxtn'toilii^fi ; tl>cir appvuninve in suucnw 
(rriMM ; die sltort dtiratiun of each Jesion ; tiiv hIispwv uf mi 
jective ptienonieno, BUt-b aa itrbinz and liuniin); ; and rlif 
pn-:^-ii<i' of rhi.'iimal!<.' lahm are the diii^uo^lic fentiireH. 

Pityriasis rosea. — The ciiiptini) Is wm-ciallv fonnd mi (li 
trunk; tliti U'sinns are rusc-ml in culor; tncy aiti sJigtil 
Hcaly, liifi fn-aUs hein^ dry ; suhjoctivo pliLitunicou am gi 
allv at«(-nl ; and ll>e duration is a lew woeks. 

tfldloulnsis CorpttriS. — Live may unMlui-u a niiniilo i>x] 
|iitrj)li! i-ni)ttt<>n. 'I'lie Miiall sin? of llic ln>ion» ; ihi-ir nonfi 
meut til the ooveixd yarts ; the lutitisc itditn); und Ihu [irt-fieDi 
uf si^raicli-marks ; and llie di!H»vi.-rj' of intlindt nii iht- clotl: 
aif the diugiKMlic fcatiires. 

Rbttaaln. — This uBV-ction prwIiMe* a niH<;nhir or mactii 

Stspiihir luah wbicb dl«i|>pi-«i^ in two ur thn^- iUvh hy sli|fht 
lesgiiaitinliuD. The im^iKnilv fever, sun- thniiit, kuoII'-m 
oerviokl ghindti, and li!»u>ry of conta{;i4>a will a-vivl in thi: 

MoUental Easlies. — IaX'uI intlaiumation likn t4>nRilIitt« iii 
acute gastritis, and cvrlain dnigHand footis utxaMoiially ji 
duu.' a muicidar ndu 

Purpitric tjiottt, or hmunrhafftp maoufei (pptpohiap), rvAiilt 
vm mimilo cxtmvasalinii of blood into the sKJn. 

fi-nfJion It obscrvL-d in tb« following cttndi- 





A purpuric 
tioQK : — 

Pupara HffimorrhaglM (J/or&iu ifacHloguit 
This nfiix'tiou ocrnn* «spedally in diildrwi ; it h 
with fever und blK<diog fn>m tbc mnoouH membranes ; 
[p;iierally run* a timrsp of one or two weeks. 

Scurvy. — 'Hiis diwca.-* results frwn a deprivation of 
ve>;etaUes. ami is ft-wmiatiil with sj>onp_v, bbf<lini; gun 
gr« weiiiiui-*', ainl n brawny indiiratioti of tin; ninfcleH. 

Rheninatisn]. — (hx'a.-iionally an eruption ol' piir|iurTc 
apiHttrs ill rheimiatio Hubjecta. It is iiitiially asxodalct) wi 
)iain8 in the limbB, but &vcr is generally abeeut. 



PeliOSte Rhenmatlca (S.Mitlfirt't />iAro»-). — Tliis is an acute 
allt.'L-ti<jii ('ii:u:i'-(<'Hz4Hl liv purpuric fi{K>t8, urtirairia, soiv throat, 
ruotleratc fevor, and aa inHammution of die joiaU resciubling 
rbcuDiatiiiiii. II}' sttme tite tliseasG is r^nli>Ll us u nmtiifeslu- 
tion of rbeimiatism. 

Extreme Annmia. — A petochla) raeli is no* nncomtnon in 

1M!rni('ioiL.4 aintoiiit, IciM.tK'vtiia.'inia, uinver, ami advanced 
trij^lit's <lt!tease. Tla* liiMory and (lie associated i;vni|>toma of 
ibo original disease will iiuliratc tlie diagntwis. 

Certain lafeotious Diseases,— In typbtts Tevcr a [Hirpuric 
cmptton a]>pear8 on the fourtli or fiiUi day. In t-enrbro- 
Hpinal nicniiigitie the eniption is frequently i»ctecliial. In 
malignant rocn&Ies and malignant smallpox iIk- nuth it often 
liemorrbogic-. In aeulc yellow alruphy of ibe livtT and in 
ulfcrative eitdoouxlttis s pctwliial grujiliwu is frctjucntly 

FoisDoing fr<HD CertaiD Substances, — Poisoning fruni pl><»- 
pboniK, tbe vims of vniomims sniikrs, nn'reui-y, and aiitJpyrin 
HKvy be aj«oriat«l wilb an eni|»liiin of [HirjHira. 

PedicoloBifl and Kindred Affeotiona. — HiMly-Ii.v, bwl-lmg", 

and llejis pix-diiw in-tiibiid Ic-jiori-. wliiili art- surrounded bv 
»li|j;lit aiTula-. TIh; IMiinK. wjBidi-nmrks, and discoveiy of 
tbc iinraaite urv tbe rlinnniiittif Itailiin^. 

£rowH mamtn luv olit-»!rv<-d in : — 

IiOntigO, or Freckle.— Tbf s]>i)U are tiniall. and are fonnd 
e»i)e(:ially on ■xibimiI jeTta — fJK«, neck, .Jionlder^, and hands, 

CUoasma,— |)urk cijHits niay rt^uh from irritation of the 
ckin from lliv srtioii of ebemicaLt, boat, sci-atebes, or blistoni. 
Tbey »M 80iu«Una<s noted in jcenera! diseases like Addison's 
diKuiM! and ayphilU. They also oecnr in primary affertious 
of tbe i*kin, a.-* vitiligo, morpbcea, scleroderma, and lq»n«y. 

Moles, or Navos Pigmentosa, — Tbcee con*>ist in mngvuiiol 

dcpisil-i uf pij;inenl on viiHons [iart« of tbe body. 
Wliiir nr jxtlr t/zV/oin niHctilcM are obeerved in :— 

Vitiligo,— A |wrl from llw^ al«-Dce of pigment, tbe skin is 
normal in ap|«>nuiiT- and runctinn. An exccw of pignHiit ta 
t;i-nt'ntlly nut«] at tUi- i>cn'ph<^rj' of the white patches. 

Leprosy. — In thin i-onditwn lliero an- Htmetnnd ebun}tf« in 
liic !«kin and niuc^bfwia in addition lu the while- ap))canuKi^ 


MorpbcBA. — In the late ntage of th!s affi>ctioD the «in'n 
SiTilHii fxitchcfi arc while or yellow. Tbc strrK'tun; \>( li» 
Hkii) i» ultcml, aiul tlie iteripoery of the patches in dutincO/ 

Facial Hemiatrophy.— Tlw onset of this <1i«oasG nuf btj 
mnrkctl by thu «pi>eanuiou of a >'elluw ur whit<; spuL uu i 
side of the laoc. 

IMflTiiBe Krythonin or Inflaiiiinatlon of the I 

jyitfiise erytbfiiua nr iiiflamnuttioa of the akin may : 
from :— 

Tho Action of Certain Drugs {DermalilU J/tWioimmtoa). 
RelUdontia, quiuiiie, chloral, cubebo, saliii^Uc acid, anii ar 
raav |»rf)cluce a diffiiitp red rash. 

dcarlet Fever. — The history of oonlaffton, hi^ fever, i 
throat, nwolton (^laiitl^, rapid ptil^io, and the punctifonn i ' 
t*r of (lie rash will iinliiali' the din$!ii<«iis. 

Rotheln. — III M>ii)e aun'n of mtholn (hcFnij>lion k rrdi 
diH'ii^'. T)i« history, slight fever, slight ratarrh, and 
swdliiig of tite iMst -cervical ^lantld will sugftest rothdii. 

Looai trritatioD I'rom truumatism, exvcesive hat, pui< 
plants or drugM. 

Hrythema Intertrigo. — This oocure whorv tvro mt 
surfui.i.« oome in votitac-t. Tito part is red, tii<>i)<t, and 
times matvmtcd. Tlio oomlition cxrit(-» ii htmiing 

EcuIDft.^ — ^Thi; tikin h tliickem-d and iiitiltnitc^l 
marked itdiing ; the nxltHwt idmdtii ulT^mditally ; aixl I 
no fever. 

Erysipelas. — Tlie [«»rt i* considcnibly xwollcn ; tlte i 
aiKl swelling lenniDate in hh Hbni])l ridge ; an<I Ute It 
turc tH hi;;h. 

Acne Rosaoea. — This is a cbrniiio diMiUMc; tbo 
upfxrans un thu tiicv, ead itt aswK-iatvd with acne lesiooei 
diiatod capilhirice. 


A veeiclo U a ninall nlt^vation of (h« nkin, oontoimnfE^ 
tltiid, and var>-iiig io six/e from a jiinhcad to a spiit-C 
Vi'mcIk arc "liticrved in tti« followii^ conditioaa :- 


Sudamen. — 'I'lii^' mnMHbt of an i^ninlion nf ntinale v»icl<>s 
wliich ntsiilt IVuni llii' imprisonment at Bw«it in ilie layers of 
lii« i-kin. It is iiRiiillv a-t-UM-iiilii! with fit* jK'rapiration ; Ihf 
vff'i<'lcs arc transliiwnt, liu-k inHanmuitdnr c-baraotcristics, aud 
tJiow in) tondenoy to rii)>tiirG. 

Herpes. — The vpsid«i apjirar in groups or dustimt; iIh-v 
aif hioudIm) on an inllunimatorvbasin; llioy bIiow no Icndiiic}- 
to niptnrc; they arc frequently awtociatvd vritli btinnn); or 
itt^iiml^io |>aJns ; and tbey are dtstribiit«] along llie line of the 
nerve- 1 runks. 

Dermatitis Venanata.— A vi^inilar eruption may mmll 
fruiu fuiitoct with )>ai^iiouH plants, Gi)ch Uf tlu* |H)tson ivy or 
oiik, Tlic cniption generally up]>i-ar« on the exiMMM^ parts — 
t'atx or liHudx ; tJw purt in nil anil )twollcn nnd Itiere Li inteiwe 

Denuatitifl Herpetiformta.— Tli** vosi^lrs are very irregular 
in "liJijit- ; till y uppt'ur In »:lii-iteiv< ; tlioy are very tense ; lliev 
show no tendency to rnj>t*ire ; ttiey are frrqn<'nlly ai^onati'd 
witi) other ledon^ — papnleg, pustules, and b«illa>; tliey cxdlc 
intense itcliina ; an<l tuey aj>pear in crops over a pt^noil of 
wtiks or mont1i)i. 

Impetigo Contagiosa. — Tbe eniptton conttiHle of smull v<#l- 
rlo)^ whii'b ijnbtie<|uenlly enlarge until tlioy rfneh tho »ixe of 
l)lcl>s; the vesicles appear in ■■ni|i(i ; arc commonly <lt*fi'eK' ; 
aw Hut and nmbili<^ute<l ; un- tilki) with u i4rau'<colorcd fltiid ; 
they »hovr no tetwlency to biuik, bnt dry np ami lorin Ihin 
yellow crnrfx, and Ihey excite bnt little iteiiing. 'I'ltc dii««*e 
in i^>ntagions and auto-iiiu<-nlablo ; (Wiirn eqw-'eially in chil- 
dren ; an<l last-s from one to two weeks. 

Veaioutar Eosema.— The vesicles are <i<iile wniall and are 
ajigrejipitL-d iu p:iti:b(s; the intervening skin is n-d and thick- 
eneii ; the vesicles tend to break and ponr forth a serwis fluki 
wliieh keeiw the i«rt imtist; and tlic «nii>tion is associated 
with intense itching. 

Miliaria, or Heat-rash.— TIib may npi«iir as an eruption 
of minute vt-^icli::' ; tlii'v are alway <iis<Tile ; ihey arc snr- 
ninnded by n-<l iircohe ; tliey usually apjiear on the Inuik ; 
ihcy are generally nAiociated with pin-lH-od papules ; they 



show no tLtulvncy to ruptuiv ; and titer ftxHU a litlk- b4in>it 
and itching. 

BoabieB.^In thi» aiTectioii t\u- vi'^nl<« ire small t Ilir>- ar 
usually iui)tooiuti'(l with piistiilnt »n<l burrouat; ihey exdtt* ia^ 
tcn»c itdiing ; iiikI lliev arc- iiximlly fmiml nti the lumdx, furv 
nrrns, in tlit- itxtllie, under iIm> niaiuiiui', and on thi^ iiiuci 
HKjwcte of tli« tiiigha. 


in ri 


Ble1>s, or Uiillo'. 

A IjIpIj, or Ijtilln, i;" n (.■itx-iiiiiw.riln-d i-Icvation of tJir skm, 
contflinin^ «'rvin.-< flui<l, luiil viiryiiig in tin: fmni » pea to sn 
Oi;g. !th'!« iirr oIimtvi-*! in tlic I'lllowing <iiiidili(>nji : — 

Impetigo Cimtasiosa. — Tho iili-l^ nrc flat and unibilttwUxJ 
tlii-y «i>nlaiti a .itraw-t'oloml Hiiid ; tii«y R)ii>car in en))** ; the; 
8R' rtimininily difta"et«; tliey sliow no lendencv to hri-nk. Imt 
dn.' uji and fiinn thiu yellow cnisls ; and they excite Ihie Ulllf 
il<:hing. The disrase is conto^itiUB and aulo-inociilable ; oceur» 
enpocially in cliilditn ; and lusts I'roni one to two weeks, ^i 

Dennatltte Herpetlformifl. — The Inilhe arc frec|Ueutly amn-fl 
cial«d with papules, v«ficJt«, and pu«tuleii; they are surrounded ^^ 
by iuHatned skin; they appear in clustem; ihcy show no 
tenttency to hrvak, but dry up and Inivtf ycliowisb- brown 
crusts; and they cxdte <x>nMidcnil>lc itdtini;. 

Pemphigus. — Thv bulhr apiH-ar in ri>>pn; I'xdtc bfit little 
it<4iing ; thi'V lack an inflaa>miit4>i-y an-uln ; and utt ■ nile ther 
dry up, an<i Icuve Iwliind a tliin peltidc. The dtseitM 
generally rhnmie. 

SyphiUs.^Th« hnlloii.') syphilid4> ia olt^rvf^l in hi-rrditaiy 
KypJiili^ mill v<Ty late in the a(K{ii!red diivcHc The nxitcntx 
of (he bultti- Mwa bio>me pustular; the blelM dry up, and 
form diirk-grwn, cune-shaiMxl, MratiliKl eniats, which Ikvohic 
detached and leave dl'teharging ideers. The hisluiy and tbi 
otlier evidcnwe of syphilis will aid in the diagDoeis. 


A p(istul« i» a mniidl drmim«TilK'<1 elevatioo of the skin 
contaiiiiug ])u». Pitstnle^ are ol«cr\-ctI in the roltowing tOa- 



Ecisma PastalosanL — The puMiiIrt* aro anmll ; are ajg^re- 
gati-il ill a ynHcU ; are geireiallv aasociatpcl wiUi minuto 
vesi<J»; tlH> inten-euing skin la red and thickened; and 
tboiv ni? marktxl iHiniing un<l itching. 

&ODe Vttigarig. — Tlip pustules are tisually confined to the 
&■%, liai'k, and HlioiiIden«; they liave their origin in tiw 
Hobnceons rollicle? ; l)icy are generally sssociatMl with ]Hi|iiih« 
aii'l ojmt'loiH'H ; and ilicv excite no itc^ntig. 

DermatiUs Herpetiftnuis.— The pustuUit un> fV«|iientJy 
a»^M?iatec) with {lapiilcs attd veBiclra; tlicy are Miirmniided by 
iiiflaiiu-d skin ; tliey ap|>eur in dustem ; uikI lh«}' exvitc con* 
aiderable itching. 

Impetigo Simplex. — This affection i--* n.-^iially o1»prved in 
chitdrcn ; tlic im-iiiW arc runnd, and nujgo in wm! from a 
|»ii I'l a cherry ; ihcfv w only n slight red anx)la, and tliis 
liriiilly di»app«irn ; ihc piistnle^ mnatn diwrete; they show 
litlle t^-ndciK-y to niptiire, but drj' up and form yeilowish- 
l)rown crusts; they Arv in«t<tlv >itiM«rv«i on the extrcmitiea ; 
thi'y cxirile no ittthing. The diiuxine hiats from a few days to 
a wi'i'li. 

Impetigo Coiltagto8a.~Th(> eruption is at firet vesicular, bat 
it soon tiwonies pustular; tlie pustules vary in size from a jx-a 
U) a largi> mai-hle ; tiiey an> flat and umhilicatetl ; they ap|x»r 
in ci-ops ; they arc comnionlv discrete ; they show no icndiMtny 
to hreak, hilt dry no and lorm thin yellow cniKts ; anil iIh'V 
excite but little itching, llic disease is contagiiitm and autn- 
inocuUble ; occtire etijiecially in children; and lai4« frxxn one 
to two weeks. 

VarJoeUa, or Chicken-pox. — The pustuk:^ n^tilt from veei~ 
cles ; they appear <*((cciallv on the trunk ; llicy are dniall and 
not nniliilimlcil ; ihey excite but IiUlc itching. Tttere is some 
fcvtr. The diKeaito la^ls but three or four liay.*. 

E<ithyina>— Tliis disease is obscrval c*|X'<'ially in poorly- 
iMiurishct) adults. The pustules var\* in «ixo from a yea to a 
cherry ; thej" are few in nnnibor ; ifiey are mounted on an 
inflauitnaton' Imwp, aitd are fRirmnnded by ii distinct infiani- 
matory areola; they excite hiit little itciiiug; ihcy seMom 
break, but dr>' up and torm broivuish crusts. 


Sm&Upox. — III (his {li.-«rase Hliol-liko pa|iiiks nati lit 
(mtExl v<»ick-!i i)riwdo or iire oranRialiHl wiili (Jir piiTiUiW. Thi 
latter are fuunll, giirroimdcil Uy a n^ anttia, ami ummllj' cxnl^ 
Borne \tch\ng. Th<> hi^h fever and liiatury nf coiitagiuu wil 
a'Mi'.Ht in iiiakiiiv' the diaenoeufl. 

Syphilis. — Ta<! pufltiiles an- rrrqiKntly aanoctatixl with otlv .. 
letiiiti^ ; tlioy are iineii mounted on a copper-oolonil tnflaciiiui- 
tnry leso ; thev excile no ileliing; and they are it.4iiuUy u*i>-^ 
dialed witli tlie liiat»ify and the other evidtnws of Ry|thilu. 

SoablML. — The pustults are small and iiiuially arcioctstKi 
witli iiapnii*, veaicIeB, and bmronv; tliev are enperially "I* 
eervfld on the hantls, forearms, in the a\illie, nnder the mam- 
ma, and on tlie inner ii»|)Gct« of the thij>j;liii, and they fxril 
considerabic itdiit^. Thcro is oAcu a btstozy of ooiitagiou. 


A papule in a rirniin»c-rit)(td nolid elevation of tlx; slcil 
v«ryinj» in »i«; fiwii a jiiri-Iirail tn a iiea. Fupulw arc oI>-" 
si_Tvit\ in the li>llou'ing<i>nditionH: — 

Erythema Multifonne. — The jtapnli-^ are ufifa .■K'Mx-ialix) 
wilii iiuicnii-s ;iiiil uilnn-tea; they are Hal, and an- of a hnnht- 
nxl or jitiriile eolor ; they apjH'ar eBjM.'cially <>it tlierxtmnitic* 
mid thoy !>liow no tendency to suppurate, t>ut giTidnally duap 
pear in tin? course of two or tliroe weeks; they ext-iu- n< 
ili^liin;;, Uit they are often associalci nith ptustration 
riiennialie inaini). 

After tKe Use of Certain Drne;s.— (tromides, t<Mlidii 
eojviilia, I'litH^b^, aii<) tar uiay produce a papular eniptiuD 
TIiv hiNton' will aid in tlic diagnoeig. 

Eoiema' Papolosam.— The pspides ai« very small, rhmeij 
aggreirati-d, and often SfitkKHated with VMicJa and pu!4idci)) 
llie -kill i^ tlii<kcmil ; and tlipiv is intMisc itchinj;. 

Miliaria, or Prickly Heat— Tlu- |iapuk* arc very antail ; 
they are ver^- often aaHK-iult-d with minute vc«ieles; ihey 
alway» remain discrete ; they ap|M.-ar <»pectaily tm tlie tnink { 
and they excite a little iHiruing and itchine. 

Acne Tnlgarls. — Tbo (apnlcs arc ntuiiilly confined to th< 
Guv, iKW'k, and shoulders; they arc gtiKrally ostudali'd will 


piii^liiW aitd ooRM^oKra ; tbov iitvulvc ll>o wbacemn rnlltdm ; 
uiid iIkv (III uut i->xcito siibjoiTiive Avniptoraa. 

Sojibns. — Tbi' (xiiiiiles are siuull and aro luually a'snciatnl 
with piLiKiloi, v«fii<-K», aixl fmrrou-*; llit'v are (Mjieirially oh- 
at>rvMi ou llie hain]!*, furramis, in tin; axiilie, under the niaui- 
Diif, and on tlic iuner aF|>ec1s of th(- ttiiutis; and (hey <-xdte 
«iniid(-rahk itching. Tltejv is iifttn a history of (y>Rlagion. 

Syphilis. — Tbe papides are (lark ia color ; ihev are widdy 
diBti'ili«ii£4], being especially marked on ihe trinik and flexor 
surfnt.'es of the extremities ; they are UDiiaily nsmciated with 
pUhtules; ami lliey excite no itdiin^f. Tlte history and the 
aix-fmiunyin); evidences of syphilis will aid materially in 
(Htabli-hin;; the diii^nusis. 

Smallpox. — The iMptiles am hani and huv'OR shot'likc lt«l ; 
Uwy KooD tcrmiimtv in tinibilitutixl vvMtolcx; iIk*}!' cxdie Borne 
itching, an^l tlivy arc OAKx-iutcd wtllt hi^h fever, jiniu in llic 
back, and oiU-n a hiilory of coiiia^on. 

IHeasldS. — 'Hic (mptiU-H an* Mnmll. and rnu luircthj-f lo form 
I (■nt<iviilii--'>lia|xtl juilclM'jt ; and lb*^y an- a-*<"'ial<-<l wttlt mud- 

tt-nilo fcvcr, swollen wrvi<nl i^laixU, n>rym, conjnneli villa, and 
bruiKJiiti^ Tiien; U often a liiftury of contagion. 


Tuberdee are lai^, dmmiscriljCTi, (ailul clcs'nlioni' of llie 
Hkin varving in *iiw from a liir-^c \wn to a widnnt. They are 
oI>xTVc<l in the fiiIIo«iiig<""nditioni«: — 

Erytlieina Modosain — The IhIrtcIi-h are hirge ; tliey nBiially 
appear on ihe exln-niitirji ; thev ure rw Id inIi- purple in eolor ; 
thiy ncviri- i^tippuratt'; niM) they are assudalra with malaiBe, 
fever, ftixl riieiintnlii' (miit-s. 

Erythema Hultifonne. -Thv tnlx-nrlt-H are ijenorally asan- 
ciatnl with macules and papuW ; they are Hat, and are of a 
bright-red or puqile eoW; they a|)pc«r esiK-cially on tlic ex- 
tremities, and tliey »Iiow no tMidcncy to suupnnile, hut gradit- 
ally disapprar in the eonrse of two or tlin-e weekx. Tliey 
excite no itching, bnt are often assiN-tali'd wtih pnnitrali<)n and 
rlietimatic jniiu. The disoiev is [inibably alliHl to erylheJiia 



LapUB Tn^aru. — Tliu mar begin as a jiapnlc or tnlieRle. 
It is («iK?ci]illy otiMTVcd on tlio duK. The l(it)erc-l«s ai^ of s 
]Hik--r(tl color mid arc <|iiitp sofl to tlio tonch. A.i a nile^ ' 
tlie>' »luwly break douii ami form eIiuIIow iiWrs niib xoii n'd 
inargms. The iilcfrs are jmialcKS and eecrde Uut Utile nia- jj 
tvriul. Tli<.-y may invade all of the soft strudDrra, bnt ilie'^| 

Syphilis. — TIk- tulKrrctitar syphilide nianifesta itoelf sb dark- 
red tiilR-n-U-^. 'J'hrre are i^idom nion? than three or fnur, and 
tbcy p-m-ndiy apjH-nr on tlio fiicc bikI extremities. Tln-y are 
very linn, and otV-n brt^ik down, (brmiiij; deep, pnnijjed-nut] 
uliyrs whicii wen-te ini abtindiint pundent material. 

Tinea Sycosis, or Barber's Itofa. — The tuberut^s appear i 
llie hwiri' p!trt« of the fare and involve the hair-follielei^ Sim-' 

(iiinttion iwon beptiit in the eentrc of the tubercles, and tiie 
iiiirH Ix-conic dry, bnltle, and looac. Tlie micrutKopc will re- 
\iii\ the lripi>])hyt(in. 

Leprosy.— Oin! (i>riii of leprosy nmnifastfi itwif ajt tiibcreles. 
The hitler are of a |ial*'-n.'d or yellow color, and imdcrfru pIow 
abitorjtliun or uln'ration. llicre is ufttially tuorc or la» aijie«* 
tlii^iu in tlie [lartfi alTecied. 

are ^j 

Tl'hcalK, or Poniplii. 

WheaU aiv e\'anescent eI«%'alionfl of tJ>e skin, gpnerally 
more or less round, and often white in the centre auci paI<^-n^ 
at tJie iierinbery. They excite oonsiderable itcbiu^. Tltcy 
are obtiervecl in tlic following conditioue : — 

Urticaria. — The whenlH apjtear in erops ; titer are of very 
flhorl (Iiii-ation ; they may a|)i>ear on any jiart of the body ; 
and ll«!v excite intense itching. 

Ergtktmti multi/orme, pc/io«« rhrumnHea (SdM'nlein'fi dis- 
e&w), and certain iusctrts like mot^quitocii also produce wlicals. 



Cnista eoiit-i»t in dried eMidalion, and may be rwJ, yellow, 
l)rown, or gref.'n in oolor. They are marked In tlte foUowingj 
diBCftBctt: — 



Eozema. — ^The crusts are gcnomlly atwx-tutctt wiUi puxtules 
and vesicles ; tlio siirroiiixlin^ skm i» rvd six) lbi<' ; mimI 
tfa<'rc is euiiHidvnibk- iU-l>tn^. 

SeborrluBa. — (_'rii.'<W of it^-borrltom »te g*noraHv ubacrved 
on iIk' Mii1{i. Itching h u)>!«dI, ai>d there sre ao <'vi<Icnn« nf 

SyphUifl. — Tlic oni«t» aro tliiok ; tlipv aw of » tlark-brown 
or ^mo color ; and lh<-v an> oUcn ai«o<-Jat«d willi uWrs 
whioh frwlv tlirn-Iiargc. fliii hiRlory and 4>ttt«r cvidciK.'cs of 
v^pliilis will iiid in Um! diagnoufl. 

impeUgO. — Tlx- onistfl are thin and yHii>w ; and llivy are 
■»f«iM^at«d with bMi* whioh apptar in cn>[«. 

Favns. — ^Tho <:nHtA gcncrallv apnear oti the wnlp ; they arc 
vi^liow, lintrlc, and ou[>-fthn|MMl ; tney are usaally jMM-ruraktl 
by a hair, aiid have a (x^iiliar niiistv odof. 
' Tinea Tonsurans, or Ringworm o^ Ut« Soalp.— 1 n tH^kvu^l 
cases thift ati"".ii<.ii may \» awiciatinl wiili ini-rinj^. ll in 
onlv rttB*prv'«l in chihiren. The grayi'tli scales, llie dry, tvrillli-, 
txni broken iutirs projecting thruiiuh tlie enists, the alojMtna, 
and the detection of tl>e trico[wyton are the diagnoftie 



Sralc» an? dry Mfolintion* rn)ni tin- itpjiorhiyCTBof tin- skin. 
They an- nlwiTviii in tin' tiillowinj^ disi-iist's : — 

Squamnis Ecuina. — The msiIca are ttritially aN>ix'iiilnl n-ilh 
pa|Hdi-:<; liw iinilcrlyii))!; i<kin in red and thi(-J<ciie<] ; and there 
t)t wfl«ii marked itching. 

Seborrhoea Sicca. — The sraJps are creasy, and the iiiMlfr- 
tyiiis; sliiii showK luiovidHH* iii" intlaniniaiioii. The m-Inkvous 
tolbi'I'.i an' I'ilt'M dilaied. 

Psoriasis. — 'Hie wulnt arc dry, and are of a pearly<white 
color ; Ihcy nrc a^nocialc<l with circutoscrilied, !jiarply-defin«I, 
elevated iiiflamnialory patches. TIte extensor surfaces are 
especially invi'lveil. TIktc i» little or Do itchinir. 

IcMhyOBis. — This ufTMinn lH>Eriiw in early life. The xruIeK 
an- ilry, and are eniifxrially markwl on lliir vxtensnr xnrfitu's. 
Itching is absent, uhI there i« no cvidenoc of inflanimatioD. 


Snihilis. — T\w fM^li-* nrc drj-, wxl «nj of a Hniywli nJnr ; 
DiDV nrv uRimily iu«>m'-inti'<l witli )uptil4>A; luuj they nrv ei>j«s 
oially nmrknl on Mm^ iihIiiin niid »oie», TIici% in tin itcliii^. 
Tlifi biiitoi-v Httil ntlior (ivitlciins of etypbilis will ta^isi in llu> 

Pityriasis Rowa. — Th«E*ral»Bro foand eipodully on die 
tnmk, uml nrc iVMiciari'd with »niall, ro^te-ml in»JitW. Tbert^ 
w iioiu-tiing. The UiactuM! runa an acute couree of a tew weekn' 
(It I ration. 

Ringwum. — Th« soalra are (In- and sraot ; ther are uxmd- 
aUiI wtlli i-irc'iimsL-rihtd rwl jmttaiefi whioh tend to diaapjK'w 
ill llic niitri'. ThiTP is often njarkal itching. Micn)»(X>p«o 
exttiniuattuu revcaLi the tricopliytou. 


TTlwrs arc olwrvorJ pspt-cialiy in the followinp dis*"*^ : — 

SjphUlSi — ^Thi- ulcers urn deep; tiM-y hnvo n |>iiifhcd-oiit 
apjKiimow ; ihcy scf.-n-lo itn nhiimlaDt ofTcntivc miil'-n'ul ; they 
ofleu involve lliv Iwmr ; th(?)' oxlonil nipiilly ; ifn-y !in> n>il 
)>ainfril, iind tin;' iin|irrf«'t cimtriA whic-li tJicy pnidu<v >■ m(i. 
The hi^ton- utid otlK>r evidences of sypbiliit will aid in Uie 
tl illy III i^iis, 

^itlwliama. — Thin npjx^ni in latn life; tlirrc in usually n 
Miii^lr (vntrv of tileeration ; tliii iiliK^r is irn^ilai' in ^hBjw; 
the i-<i(;i??i nrv tliid(('iH'«l iiml inliltratt^ ; tlie M^cn-ii'in in scanty 
»nd hliHKly ; ihi^ pnjf^tvi U Moinewltat slow, aiid tlicru in oH^-n 

Lupus Vulgaris. — Thin generally nppMni in early life ; tlM^re 
nn> oftfn w^vc-ral cvnlres of uloeration ; the ulcers are nsually 
smiNTficial ; tho etlgns are not thickened ; the pn^rreaa is cx- 
trftofly slow; the Iwhms are never involved; taere is very 
liltle wcretion, and aotl papniea oflen develop in the cicatrix, 
whii'li is firm and conlnH^ed. 

Simple Ulcers niny restilt from traiimntiitni. the &pnlii-ntion 
of i:£ii].-tl its, or the lu-lton of intense heat or cold. LHcers are 
froijiivntly ohservi'd on tlm K>ir» of old people in amooiatioii) 
willi vuicvKtc vein*. Sinijtk- iitnTs may l>e recogD!n>d l»y tite 
lii^ocy, looUiou, upiKArauue, and tlw abtvtoce of other cauwa. 




Ferfinrstiig Uloor of tbe Foot. — This term in njipliixl Ui ii 
deep-seated nloer appeariDg oo the sole of the flxit aiul iiiuHt 
frequently obeervea in locomotor ataxia. It imtmlly U'f^iiiH im 
a corn in the Deigbborbood of tbe great toe, and in gi'\u'.ra\\y 
aasodated with anoetheeia of the sole of the f<x>t. 

OBOaUtas. — This term is applied to the IxKlmn^fl wliidi 
form after the ocrairrenoe of grave cerehml or flpiiuil IcsinriH, 
They are generally observed on parts whicii are siilijccliHt ti> 
pressure, as tbe sacrum, buttocks, calves, and hceld, and uri; 
preceded by eryUiema and vesication. 





Dkkinitios. — A flcficieiioy of swi-at. 

KtiojaxjV. — It may Ik- a >»yn»]iUmi nf some general di 
liku tllitlK-li'K (ir Briglil'i* tlwwwt ; it limy Ik- un ib-Bociatnl wi 
ililitui ill nTluin t^i(tt»eijii» diiH'«iM.<9, kihJi as ivtitiiyosie or ymiri 
ia\» : uihI it limy duvvlup wilbunt obvious i-xvitiug cause as 
n-zMilt of di^iiirlHil innervntioii. 

'ritKATMKNT. — lU-iiiiiiiiM a1h>uI(1 he directed to the primary 


Defcnitios. — Kxopwive tiwMting. 

l*>r(f>iJtHiv. — As a geiieral condition it is ofttii ol)«TVpd in 
Iithi»i8 and io other diseasce chiirarlerizcd hy rniirkcd d 
ilitv. Local hyiwridrosis is most frequently observed in 
haiios, feci. Slid axilla, aad proluibiy n?Hilla frotii Mum- 
mugement of tlio gym|>athptio nvrvoua ayniem. I'nihitci 
sw.\»iug of tlie face iii«y iDdimte au aneurism or 
[HY-sning on the cer\Hcal Byiu|KilIietia 

SvMpTtiMS. — Ttie primary symptom is excessive swenlini 
and this oAeti leads to inti.Ttrigu or i-oEcma. BromidnMiK 
oftca a>)su«inte(i n-itli llio liypcridnwt)). 

Proomosi^ — Uumnlcd. I» umny cii«s tbe condition Es 
very ohstiimte. 

TrkaTMent. — Krocjiirntly thoro w nil evident impairment 
of tlie gciK-nil h<.-at(h which will rtipiin* appropriate trest- 
ment. Inlvnially, one of the following rviiMHli*^ may be em- 
ployed to diminisli lite amount of sweat: K<;]l«douiHi, pii 
toxin, uguricin, or i^rgot. 

LiHxU I^wi&wn/.— Diwting-powders of staroh, talc, or lyi 
]x)diuni witii bono or salicylit! aeid ; or lotions coiilaini 
siilpttate of xine, tannic aoid", or alum, arc often very useful. 

^ I'tilv. ii«i4L Mtif^ylio.. 
I'ulv. siud carh. (inecip., 
I*uW. luagnesli luUe. a jiv ; 
Pulv, nmvli, s^v ; 

Tulv. Utlc'i, SXX.--U. {IlAIIDAWAT.) 

Sig. — Dnfltins- Ikiw dur. 




In hypcndruMH of the feet the m«(liod ^ii^j;i«(<il Ijy l(«')>ni 
ii fifWii vi-ry cfiiuieut. Tbe feet sliould im wiL-ilitil, tlmivufjiily 
dried, «Dd Uitu larefully eDveluiied in etripa oC iiiu:<liii wliitli 
bvc bcMt] ii|>read with diacliylmt uinUiM^iit. TIic application 
fliiMild 1m.* luadv twin- daily. Iti the dreaiing im vrntcr should 
be employed, but the tWl must be carefully wiix^d tiud then 
datitcd with stunrh «t lycxipodtum hcforcr the miitiDcnt i» ra- 
ap|t]ic(l. The m^liiiciil should l>e oiiutiuiiod fur fmtii utic to 
Iwu WL-vkf, iitU-r uhk'li the ioet amy bv vnuhcd uad tlic dust- 
tBg-|i<>M'dcr iJuiic u^ 

Brora itIroHis. 


JiKFismos. — A ruiK-tional nlli'ctioii chanctcriiGMl by the 
(■x<Ti^lii»t of itwifUl wliieJi Una ii fetid udur. 

8v«iT««s. — U u gt-Hcmlly l<xal uml ofU'ii cuiiRiKsl to tho 
fort ; it IM fn^-fniiailly ii^auciulvd with hyiwriditjoia. 

THfykTHKJiT.— iiiuac as liyperidrosia. 


pErismoN. — A functional allfHtiou chai-arteriwd by the 

IsecrctioD nf colored Hwttat. 
.SvMiTijMs, — Tlte portB most fretiuently airect«d are the face 
aiid tnink ; the moat iwnmon ixilora are red and ydlow. Il 
is ofteu uij^ociated with hy[Jeridro9is. 


DkpisiTIOS, — A cntaueoDH alfeetion charadeiir^l by tJ)e 
eniptioD of niinulo vwieJes resulting fnwa the retention oi" 
EWcat iu the layers of die wkiii. 

Eti'jixxjy. — It ie often observed ia health in petsons who 
peixpire freely. It is fm|uently noted Ut, febrile diseases 
wliivli aro associatod with SHcatiug, lika ptKiunouia and 
ty|iltoid fever. 

SyMiTiWft. — Jtinute, irr^pilar. tranAluceut \'esioIeH apiwar 
iin the surface. The}' are not i^tinxHindtd by an infiaiunuilory 


Hnxla. 'ritei,- do not rupUirp, hiit dry up and are followol hy 
iJ iulit dp8(| oainnt ion . 

Fkhatm kkt. — The afiectmn lias little significauce and t 
mi^nt i.4 rarely required. 




Dki'INITIon. — A fiiDrtiouuI afi'wtion clinracteriHx] by ex- 
coHive seL-rctioD uf etbaoeouH nuitcrial wliiUi may be iioi 
or perverted. 

KtioijOGY. — III niuDv nwH tlK> «ui«o is not apparen' 
Oftpii tlic distWK- is iisMNnat<-(l with iiiitwinDiiil of tlie gene: 
iM-altli. By T^mw it is n-pinlKl a-" ul" iMimsitk- origin. 

VARiJmn<. — J^ht>rrini'<» .liiiii nml wlK>rrlnru nlp-jsa, 

fleborrhffia Sicca. — 'rhi.>i (wrm is most fmnK-nlly obaer\-ed 
oil tlic m;iI|i iiikI i»»rttitiilcit nlial L« p(i]mlarly termed da 
druff'. Examination reveals an iDcrnsiaitnii «onipt«L-d of thi 
vol low ii^li -gray, gniisy scali-H. In nniYtiiiplitalcil cases 1 
nkin if |«iU-, but fmni irritation it may snliwqni-iilly Imtoi 
iiyjR'ni-Jtiiv or intlanicid. Wh<-n allonX'<l to (»iii!iiiic, t 
niilritioii of the luiir is iiitcrfcn-d witJi and luililnrMs rwnlti*. 

On ih*- Ixidv wborrtuKi sicxa appears as voIIowi»li-Kra; 
etighlly i>Iovato( pulcliLis covwwl witu k"^**?' ^^<^ Tli'- o" 
ktji uf tlic folliclw are oflt-n dilated. n»-rp is gt^niruily ino 
or li:*^ pciIiMKiii.f till- !«liiii from iivjK-m-mia {iw4orr/«ii<i/ rt^rtW".' 

SeborrlUBEl Oleosa.— Tlii^ lonn i^ nmsl oummonly ol)»crv( 
on tlio faix-, |iiirii(-iil»riy iilKfnl tin- »<»«<■, ivliicli is Itabiliiiilly 
bulled in an oK'sginoiLt nialc-rial wliioh has exwled I'mm lla^^ 
fldiAoeoiu follicUs. From irritation the parts are often m^H 
Tilt! condition is frequently a-ssociated with soborrbcea iu«a|^ 
coin«do, and acnp. 

l>i,\c\<)sis. Eaana, — In thi?i disease the skin b nxl and 
ihiciiefled; there la marited itdiing; and the scales are nut 


/VorirtJti*. — III llii.* (ii-M-jw tin- wmIw nro dry nn*! ptarly niid 
lln*rv ATv evideiiiTw ol' iiillHmiiiiittuii. 

Progxohis. — Favornblv lUHlcr prolonged nnd judJctoua 

Tbeatmbst— Ttie gciu-ml brallli tnay he iin|>air«l ; Itence 
tunics like iron, t^trji-lniin, aivd rMil-liver oil ait> oflpn indi<n(ed. 
The ga^rv-iuluttiiiul Imcl wili often rwiiiin' («j>eaal aiteu- 
tiivii. (_ViiuU[«iioii )«iiould be relieved by di«t, eaemata, or 
mild laxHtiv*-*, 

IakiiI Tmilmmi. — Cni»t» shonid Ik- rt-niovcd liy B)>)>1i<9ittons 
iiC i)il, rollnwed liy »ihani[)0"iitif{ willi al">lnil mid gnt-n mkiii. 
Wlicii lh«- sitil|i ill iliiin>i:^hly dl-Jiii, ono ul' tiie fijlloniiu; 
ifruedii* may he- it|>|ili(id : Sulpbiir, luvrciwy, l«r, curbulic tuitd, 
or reson-iii. 

Hi Suljrfiur. lati, Jij ; 

Balaami I'eruvUui, 39a ; 
Vnaelini. 5s.— M. (li. 11. Fox.) 
Slg.— Aft«r bolbinK tbo part apply the oJutmcaU 


^ AcM. oirlKilic, nixxx ; 
Oici ricini, fjij ; 
Aleoholix, faJ-Srj.— M. 

(iJrmirso omi Stelwaoox.) 
St;;. —Fill tm ejn-iitopiper, Uitroduos bclwMn tbc h&in, aud tmb- 
sequently rub in by means or a Oauuel rag. 

Mild inn^ iif facial seborriioea often yidd (o the following 
ointnietit : — 

1^ llvilrnrg. clilor. rnlt., n. xx; 
Vaa. ziiio. oxitL, ^.— U. 

^.— Apply at bcdltUKt. 

Definition. — A fimdional dtsoase of tbo sebaoeous glands, 
characterized by the retention of discolored wluux'oiis materiat 
in the disteudt-d ducta of the gbnd. 

RTioi.<MiV. — ItiH most frequently oUscrved in young adiilta. 
rvbility, gattro-inteslinal diEonlci's, iinicmiu, and lack of 
I'leaulinv^ are prediiiposing factoru. 


I'ATiioixKJV. — Ttw luatMal in the diute is compiHid U 
w>I>uiii, aUrrwi epithelium, ami mgcDciit iimtler which is ppjb- 
nhly derived fn>tn nitliotit. Mtero^eopic (.■xuDiinHCiiili (if the 
malerial ofteu rcvcnU u tuiU' — the ifrvtoilcr /ollicuitJi-um — tiui 
its prestiiee !■■ an^idontiil anil of no etioloj;i(5il gigiiifitotiH^ 
Coniedii is giiienillv lL^■l■lc^aIe^l wiili sf-borrluwi, 

SVMITOMR. — Tlif ilij»«isi.r i* «h«nirtt:ri)ieii by an nt^refptioii 
of mtiiiitf l>Iack or jcilowii'h )^|M>t8 whtoli (!i)r«si[»i>nd to (br 
uulk'ttf of tlie sebaceouH •;lniKlis. Th« latoii us oltni sligbllr 
Hcvflletl, und wheii (bo itkin i« ikinoexnl n while filifurni mw^ 
exnik«, to which th« term " fltsfi-worni" hiw iKt-n pojuilaHr 
iipplicd. The parts most cumriionlyiiflectt^v] vlTv the Inw, ba>-jb, 
imd «ir«. The condition tmpieully exwltcs iin induniiuatjua— 
t)l*the folItekM, Itcuco it u oiUsa asHOciiitM] with arm*. fl 

lN[(XiS<)«i». — Favoroblo under pcrvistc-nl ilimI jiididoiM^ 

TRKATUKST.^AiMi-niin, dys(x;j>*iH, aii<l wiisiijiiition mn; 
Iw ln«lc<l i>y » i-arefiil n^uliition of the jN-rsiinal hyj^ienc, ai 
by lJ»e u*P of ajMiroprime rrniodiwi. Tunii-s like iron, qtiioitw, 
cod-liver oil, inul letrydiiiia un- uRcn imiii'niul. 

Ijontl Tffatnurnt. — hikrffc phtjr^ itiiiy he jmssed wit l»jr 
meaiM iif H Mfilch-kcy or » siwi-inl in^ilrtinienl \f>v ihi? [ttirpoM. 
SoAenin[r and ivniovnl of !>nmller pln^ in»y ix^ hasletti-il hv 
the appliinti'iii of eliilli-i vvninf^ivul in very Iwt water. Knnvl- 
in^ and the ujipliratimi i>t ntculiul aitd green soap will ulnt 
aseifll in their vx[>til!iiiin. Morc-ury nud sulphur are u«crul 

tfi Ilvdrari:. clilor. comciR., gr. Iv; 
Alcoholls, r^ ; 

AflitiB roete, q, s. a<t fjlv.— M. 
Sig.— Itek on twin daily. 



Defisition. — An affection ehnnirterizod hy iIr- nppearanec 
of small, i)rtirly, iKiti-inllumniatory elevations, whieli rcvttdi 
fr<iin Ike nccnmulation af inspL'tsaled sahtim iti dueta, Uie o 
lets of which have l»e»-n (>el^lKled, 


Symptoms, — It w RcniTttlly ol>9prv«i al)i»ut tli« fiK'c, (iikI 
i''.>tii<Ut7^i.>rtiix>ll*.Tlioii iif.-iiuiil), rtiiiiul, iieHi'ly <-li-viilionA, wtik'li 
viiry in .■•iw tWim ii pin-liviwl U} ii siiiiill (kii. Tin.- CKmli-nls of 
ihv 4li»ii-ii(l<.il (ItK-L (iiiiDut hv »)|Uirt-it«I oiit uiiltl III) o|)i-iiiug in 
mmlc, iiml tliiis it diflrn) TruDi conuido. It i« lroi|Ui-ntly ft»»o* 
ciiili'd witli <\)1iimIc> iind flcne. 

Tkeatuknt. — Incise Ihe k^iron, expre^ the rontenla, and 
Itiiit aa iu 9ctx>rrtKt3i. 




Pkfisitiox. — A HKntoiua, or wen, U a Aj-at resulting from 
the rctcaliun of ftwrc-iion in a sl>aeii>oiiH glan<l. 

SvMFTDMM. — One or mow roi]n<lo(I or oval elevations, vary- 
iijg in Biae from a pea to a larpc ualnul, slowly ap|iear on tlif 
malp, dux, or bock. They arv ))ainlcas, rather soft, and wh«ii 
opened an> fotmd to wotaiti a ycIIowish-while cawoiia niaAs. 

DiAu.Ntwis, Fatty TVmora. — Fatty tumors are rare on iho 
Healp; ibey are frequently lobwlnted; they have a donghy 
feel ; and arc not ho niovahle as wens. 

Thkatmi'.st, — The sH'k and its contents should be carcfuUv 
di>«eeled out. Sinipli" cxrisioa ami evacnation are always fi)!- 
lowed by a ratum of tlic cyst. 


DEPismos. — .\ctivc hyiHTTPmia of (he »kin. 

ETioi^XiV. — It niny n'i'till from cxjKX'tirf to h«it or cold; 
from traiinintiiim ; or fmiii the application of #unic irrtlaling 
MihwUinw. A ifyniptoinntic variety is ftwiucnlly oliscrvcd ui 
(fuslric irrilatioit and sv.'<li'inii- iIitii.iuii'M. 

SyjIprnMS. — IHtl'uw- nnifonn rc<lncw, di>iapi>earitig on pres- 
sure, and wilhonl ihJt konitij; or elevation of the §kin. When 
it i» murk^, rJiere may ix; flight Iximing, 

Tbbatmknt. — Sedative lotions or diigting-|>ow(Ien5. 

4-'16 P1K>;A8£B of tub skis AKD mi AVPBVUJkam. 



DBPl.vmoK. — Hy)M-r»>iiiui indtiretl Iiv the attrition of op- 
pmiuj; stirlii(T«i of the akin. 

KrvioUDay. — It 1-* whuiimjii in children and in fat tmlijn-t!. 
tl h I'vjMviallv iinui) wlii-re itH-'re are fric-tiou and jK-n^pimiiun, 
a* niidt-r |H'itiliil>'ti!t iiuinimw, lietu'efD the U)i|)er i>urt*t of tbc 
ihif^in, and »riiun<l tlio genitalia. 

SvMi>T[>Ma — It is (Tiarac(<7iK>d by difluw rednee», and 
often hv luiit ukI moiiMinv. It exnics a burning (M'tifaiiui. 
When tho atttv. i» (^iiitiinK-d il ina_v mMilt in deriilatilit*. 

Trf.atm^:n't. — A)>|ilv a lotiou of boric aci*) ami follow wilfa 
a ditAtiu]^-{>»tvili'r. 


(D«nnatltl> CoDtualfomtl*.) 

Depinitios. — An anilc iriilamni«l«ir)- dia(!fliw, charar-tt^rued 
by orops of lartp? bri^it-ixil ixid<*i whii'h in iIk j>i-<n.'gs8 it(evt>- 
liition AiKiimo difli'n-nl <X)liiri a.t in iho ^iii}( ofa bruise. 

KTfoMKJV, — Dnkiiou'ii 

SvMmiJiH. — 'I'livn' is n wnddtii ont[rttiin tif bntrbr-nd 
ihkIit* varying in siw IVimi a ]«« lo an i-jjy. Tin- t-strtraitiw 
are nxL^I miunt'mly atftx-ti«I. The i»iiviiii i^ marked by 
malaiw, hi^mlai^lie, .tli|;ht fovef, aimI rhonniattiid |intn«. At 
first the Ii<wiifu ncwmhh^ IxiiU, but unlik<! the taller, Ihcy dti 
not Mipptirate, but gmdiially turn yvllow, blu«, anil grvcn as a 

I'wHiStiNiK. — Favnmbli-. Diiralioii a Tew wwka. 

Trkatmkxt. — Iixiide of itoliu^iutn and ii)l<alii>ti have Iwro 
m-ommeudtd. Ixxally, lead-ualcr ant! laiulanuoi inukc a 
eoDtliin^ a{)|)licati<>u. 


nKFixmos. — An inflammatory disease <-banrtcnz«d by 
. ei;)'tbet]iutuus, paptdar, vceioular, ur bullous lesioiu. 


KtI')I/K!V.— It is more <x>oimiiii in womrn lliau in nit-ii. 
ll i^ iipl III (Ifvi'loji ill llif spring or lall. KlieiiumliHni iinil 
(iH.-'ini-tiiliidiiiiil <liAtiirbanoe8 stxiii t» )>m)i6]Hu«. 

Sy-M iTi>MH. — It is marked by au eruptiim, iifiiially on ihe 
oxtn'jniiU'it, tif tliefblluwiiig ksJuuH : tnnviiU>fi, iiapnlts, v(»i<'k^ 
111- bulla-. Tlw kmonx niuy agjrrcjtate "t trnunn iliscreic ; tbry 
k^t Kiu- or iwo weelu ukI ptwlMallv f«lf. There is liitleor 
ii'i Itcliiiig. In )W(i]c<wc« ihi.'rc is tk-ciiktl oon^itiilioital <li>>- 
KirliaiKv, iiuiiiit<?«tcd by maluuHr, htwiluirlu.-, flight fcvtr, ami 
rheumatic paiua. 

DlAONoeis, Da-matitU Herptti/ormis. — The niarbf^ 
ilcliit^, the grcatvr t^u^leucy Ibr llic kiftuiiK lo oliiKXiT, and the 
rhronrc-elmnu-tiT of (IcrninlitiM lic-riK-lifumiis will usually pre- 
vent an error in iliiiuno^ii^ 

i'rtimria. — lit tiiis diwiw the iniliviihiiil Ii-nimut liisl a very 
shuit lime ami are avK-iii1<->l with mnikcil ilciiing. 

I'Roososts. — F«vyniiiK% Diiniiion a fi-w wwk«i. 

Treatment. — IntlietU'biliraU-cl iron and <|uininvnn'iM-riil. 
In iIm- rlK-iiniatic, tU<- .skIih of lithium niiil of [H>in»iiim mny 
Ih- <Mn[>loy«l. CoaUiiMtion shuulil U- n^liev<^ liy rolim- liixa- 
liv(s. Ijocnlly, IntioiM of Iturioor rarbolio at-id loWuurcil by 
(lusting-powderH exert a lienelicial efii-cA. 


(HlTM. N«ttle Ra*Ii.) 

T^KFiKiTtoN. — .An inflaiiiiimtnry afT'Tlinn ilmnwtmzfxl by 
the i-nipliuii ul" luilc-rnl, i-vuiwwvnt mIhiiI^ whirli art- asitu- 
oialcil \villi imvvTv itching. 

KTtouxtY. — OiiMlix^-intrs^inal dieturlMUcM, cniutional ex- 
(rilemoni, ami (.•iin^nic- viw^ml di*iiM(-s' [tn-iliiiiiowe. In some 
it mny tic excili>d by certiiiit iirlich-M of ftnA micb ii>^ t>]H>ll- 
fisli, Hii-awberriiii, Hi'. TlM'bitii^of <'ortnin inwil* |iri>diK-e the 
diAm.'^i', !4iii-h a.* nui»)iiit>>«^, bt-d-bii^.-, and calerpillniy. Some 
dnijpt Indium iirtimriH in .MLttvjilibli- invijilc. 

I'athoi/miy. — Tile distaae eiHwisis inn vaso-motor 9[Hb>m, 
folliiwed by )Mr(«ii)i of the vcMeU and an onlfHHirinf; of M-nini. 

SYMKiftus. — There iii a stKlden ^neml <-ni)>lt<>n nl' |«iinlfH 
or wheals whivh b asRucialed with intense itohiitg. karh 



losioii la<«tK a few boure and is utcceeded by new ones in i 

Varieties. Uriietirin Pnpulonu. — In Uits fnrm llie w 
w fitiSowiii by a linj^riii^ |<it)»ilc wbicb i- altpndct) by coiui' 
erubU- itvliiitff. It is iimhsI (WDimonly uUwtvcx) m dHiilitatctl 

Urtioaria Hemorrhogica. — The lewoiw arc infiltrab'd witb 

l>IA»NO!<T». Kr}f(/wmn Multiforme nnJ Erytkenut Xi 
mtm. — -In l)ii(b of thivt! ufTixlion^ thv l»i<MU but m 
loni^T, mill tin- IVih^ frutii itchiiif;. 

I*i»xiS«)e<m. •^linrav(trabl<'. In ^onx; cases il tend* 
bevomn chmi'w. 

Tkkatmknt. — Tbe causm tdmiiUI \» nautvnl wberi )MH«>.ilil(>. 
In Ka^tric irritation biNniiitb, orcatonu-t and siida nn> itftenil. 

When tbeiv is oHutijuittoti a saliii*- lu\utivo riiay prove vm- 
pflicient. The sjiecial remedks usually rc(^imm<-tidi<l arealica' 
lies, Ralicylntc of s^Miium, quiiiiiic, iirdidc of |M>ta>taiiiQi, and 

IxMnlly, totioiLi of wat<'r and alcohol, enrboli*! acid, boriu 
acid, or hydrocyanio adtl are very useful : 

f^ Ad<l. cnrbolic, .■5|-3y ; 
G1)(;i;riuw, I3M ; 
Akiolio)., f^vj; 
Aqun, q. 8. Bd (>|.— M. 

Urfiviiria Pi^nieiitosa. 

This is a form of urticaria observed in youne children. It 
is characterized by an eniption of ^vhoult which are itdiy ami 
persistent, and whicJi leave behind a yellowiah or browniaji 
pig'mentation. The diiieasc nins a olirouic course of months or 


(Pcver BUsum.) 

DRPixmoN. — An anito noM-«ontaKioiM diflMiw, churacter* 
ixcd by groupti of sinall vcswIm niountMl oa inllauiitialuiy 



Etioumsy. — Ilcrpe h nxy oooitikoa in l«iiiil» di 


pnetunonis, infionusB, tBalaria, mnd n uliiii w iiiw l 
1 LJiiii;itU. Ivocal irritatioa sin pndiifajKs w 'n. It is de- 
f«D(lfjit upon DeuniticilieiuriaiKe. 

SvMFfuMs. — One or more cloilen ornBall Tsdoi appear, 
ii^uallv oa tlte ti*c« or ^uiiialla. Tlie vesidis are nioaDied ua 
an iiinunitnaitory ba^, muuin t-lpar fluid, and Ai'iw ou Mh- 
rtciK'V i>i ni|)tiire, Sion ilii^ir cualonu Imvitii^ |iurijf>rm, drr 
<iji. and I'orni nxl4tif>h-bron*n cnL-ig yrioch fall itfT in a fev 
tkvfi. BuniiDg and Uaiclhig preocde and aixumpanv the 

VAiiicnix. — When It npii^an no tlte &ee, it is tenned 
herpeg fnci'iti' ; on tlie genital-, hrrpa pruffaiitatia. 

tyiAiiSUirl^ — Ili-rpe^ pro^nitalrs must b>' dL^tingnisbed 
from ehaneroUt. The histon-, Ilie supertirial i-daradiT of the 
h-<!on, the burning (nin, and tl>e suleetjueDt oouise « ill indi- 
cate li^rpcK. 

Tkeathent. — ^The lesion may W painted wilb flexible 
coUvdioD, or llui (bllowing lotion eni[duy«d : — 

1^ Zinc. oxUI., jr. xv; 
Glywrinn-, 111 kt ; plunibi nutxicvtsU. dil,, TTl x ; 
Liq. cakia, 3VJ-|j. ' it. (TiLBDRT FOX.) 
Gi«.-Api»Ijr locally. 

Ukpinitios. — An iicnlv inflnnimiiton- di^^w i-Iiamrterijted 
by ^>n|i<i of fmiill v<wi<-k'4 tiiotiiiU'd on tntliimiiuiloni' hosee, 
aKf^Nr^iatiKl with nrtiml^c pain, and following the difilribntion 
wl'ivrtniii n»Tv('-lnink!», 

KTutijcuiY. — Thi- dinesite oonjmonly dcpcndH upon a ptTiph- 
t'fiil ni-iirili^ I»jury, exposure to coM, and luimp douus 
pr«]i«|»;n- to il. 

Symptoms. — (.lusters of vesMee motinli-<l on inflnmmatory 
Imw* tnay aiipcar on any i«rt nf the biHly ; Imt they are miMl 
i'l^^iiH-ntly olwerve"! alon;; the CMunie of llie intepeostal iMTvef. 
( )ii!v one' aide is afrrt'tc<I. Sbuqi i.i-iiral(iie juiin pmf.)es ami 
aeuimpuuiee tbo eruption. 'I'hi- fUii<l in the vi»icl<» soon In- 


oimwa turhiil, drifs tip, nnd fomw yellowish- b««rn «si» 
whioti fall oft' iu a few <iu}'S. 

I'wMjsnuts, — Favurablo. 

Trkatmkxt. — Toiiii'w ut« oflcH imiiratocl, JltiMdi'V rwim- 
m«n<lH )>li<>^i>hidt> ol'zim- in dwi-n of oiiLMliird of a prjuu L-wn 
three hotm. Morphia ix »>nirttnK« it^iiin-d f<ir llii' ralinfiif 

iMealiy. — Sedative HiijitKiitiDtw «rr ir-qiiired ; ilit' lirrt an 
ftoxihlp cullodion will) itiiir|>)iii), or a »<iitiit!oa of iin'iithol -e 
rarbttlic acid, l'olli>w«l by a diwiiiig-jK>H'(ier of axidi- uf txtn- 
or Htarch. 

ft Momlt. Miiirfi., irr. viij : 
Collodli. m.-M. 
Sg.— Apply with X cuinel'a-nair brusJi. 

iiERPics mis. 

Dkfiniti€)N. — An inflammatory- ditvAiie, ohnnitrtc-riacd Iw 
groii[M of vniiclps arranged in oooc^tric ringa whicli praut 
a somcwliat X'srieiicatnl ajipeai^nce. 

E'nouHiy. — The cauK« are unknown. TIw diacoMv is raw. 

SvMiixmti. — Oiw or more rings of vpnicK-s M)f<co»«ivHj 
aftpoar around a wfiitral vesicle or i»aimIo. The (lifiTert-iit t^n« 
of the rings which compose tin- palch impart to tlie tuttcrt 
variegated appearance. Burniu); and itching arc otlt'ii atten- 
dant H)-mptom§. The hands, arias, and feet arc the )iar1« mo«( 
frequently afTecled. The lesions appear in Hncwssivp cmixt 
over a period of several weeks. In »>nie intaanccs the vcndcliv 
are cpiite lanfc and rmcmlile the blcltv of peminlii^is. 

I'luxtNOwiw. — Favorable, hot iwiirrent Hitiicks are oomoHML 

Tkeaiment. — The samt as in hcrpi* zoster. 


(Acn« Tulgarts.) 

IITTOX. — An inllHrnmntorv iliwam of ibe tut 
g^Iands, ch»mi't('n7^-d by |>a]>ul€s and piifltiites aiid usually 
seated uti tlu' fa>« or back. 



tVrni/Kiv. — It gcncnillv (k'vclojis uIkmiI jmberty. A nipniia. 
i...ii9U'Mul ilijonlcm, and giii4n>-iiitutltiiu) UiMtnrbuiKiit |»mlis- 
)>'«(■. Cvrmiii tlrtiffi likv iixlHli; uad bmniHlv of ]N>tiU8iiini 
iiixl ix>|util)u ritiiv iiiilitce ilic ill»«t*c. 

I*ATu<)i>«iv. — Ai'iic Ii-sioiw fiwilt fnmi the irritation vx- 
cili-d liy n'liiiiiitl i«<-liA<^tiii)> niatlcr, lieiKv tin- inipiikw uml |him- 
iiil(4ian^<H>iiiiiiuiih' SMuduted wIlli blivklii-anle, ur i-umrduiictf. 

SvMPTovts. — All ngRrppitioii of «ntiil1 jiiiptili'V. piKiiltw, 
awl mmpdoiiiK iilumi (he (iiw, <-li«(t, hihI "^hmildcn*. I*iii>tiikw 
or |)a)>iitt? iiit-doiniiinl*.- WMH.'nltii}^ us tlir di.'oriM.- i* iii'^itc or 
r]irt)iiic^ New li^ionri (li-vi'I(>)> it* tli*.' old iliM|i|uiir, no tliiit 
the dit«oitHf iiAiinlly niiui a [>ix>tnH'liil iiiuis*-. .Sibjtvlivc ^)k- 
noaima are aiic^nt. 

VahUvTIKS. Acne PtifiutoM. — In lliUi fonn llie lesion 
reaches Ibv papidar stage aiid advaucra no fiirtJter. 

Ante /WtuoM. — ^la this variety the \ia\m\eH de\*do)) into 

Ariic fniiunitn. — Tiie inflamniutioii isilwidy H«ii«i. thobiuw 
oflhc ji!i[Hilc- ur ))ni4iik> ig firin, iind llic In-xin is slii^rjfisli. 

Ame Alrophiea.—ln this funn the InacHU arc luJIuMvd by 
xniall tXTure ur pittt. 

Acue Hgprrtrfiphir/i, — lit tlni^ form lltcre is an overgrowth 
nt't-uDnt'ctivt! tiMiu' nttil (hi- nkiii tNtiiimit thick<'n<xl. 

l)iA(;xosr.s,— Till' i|i:<lribiitti)ti, ibi- thronic i-liiini<-trr of (he 
afti-i-liiiii, till.' involvcnii-iit nt' |Ik> wtMUieoiiit ;;I:iii<I»>, nnil tin- U''- 
hiH'-inl i<»ii u'ilh <t>n)Hliim'M an- llii* diagnctstio ti^iliin^ wlii<-ii 
s(^|iunilc acne from all otlu-r afR-tnioiiit. 

PBOGScen*. — t>inibl« under [lentixtcRt In-ntRH'iil. 

Trkatmknt. — TIm' |j<'iifnil lii-allh nmst l« improved. Tlie 
did :<bmild In: niitritioii*. Iml c«^ily a^imilublc ; rich fiMxl mu"! 
I»e |iriihibtiwl. 0>ni^ti|Kiti«>ri kIhkiIiI Iw i-i-liovcd by mild laxn- 
tiv(«. In ihe aniFmic und dcbilil.-iUil iiiiii, <|(iiiiiii^, slryehnia, 
and (vxl-Iiver uil arc n»i'fiil [fmcilitt*. TW »(Kf iai dnigs which 
have Ut-n rc<iiii)m<-mlKlatr-an>ciiic,cr}rut, aiidialx oulphurata. 
Aru-nic \n lict ikiiit<-d to i1h> ^luggittb indiimlMl fi>rnit< ; and 
raU )iiil|ibiirata (gr. ^^~\ font liuH^ daily) to tho pii&iiiUr 

lMf<it Trenlment. — In the acatA fonn mild applications 
Bbould be employed, like Uie following ralaniine lotion : — 

442 DUEASBB or Tim skin and rra apvksvaob^ 

9 Vix\<r. zinc oxid. 
I'ulr. <3i1iuninK, 
Glycerinw, IJ 



Aquie culcis, l^vj 

In din)ni« au^c^ the sebacootis plt^ shouM be remov'vJ by n 
wul<'li-kfv nml the utisttiles iD^^Ufd. Iliyruiish vrnsbitij; wilb 
Very tioi water aiM gn-ca soap itt atsti ndvisable. Xkc hvfri 
1<N»I rcuitNlics are milpbtir, mcrcurj', nml ivsorciu. 

Sulphur, iiublimat.. Si*. 

Aqow, |x.— M. (Vlemiscki.) 
Braponile U> »Ix ounces and Dltcr. 

Sig.— Apply at Unit well ditulod and grndaslly iocrcBac tba 

^ Sulpliur. |niT«ip., ^ ; 
Vug. ttquK mtn; 

Viuji. pvtixilt-i, U ^ir,— M. {Vak Uari.ixokn.J 
8Sg.^Ai>ply nigbt muii inumiug. 

ft nydrarg. AinmonlAl., er, xx-xl ; 
I'ng. iiiiiiu* rnwc, S|.— M. 
^^, — Xjtm night und nioniii^. 

ft Ammon. suIphoichtbyoL, 

Dcslriiii, an 3).— 31 (UnnA.) 
8i^— Uw locally. 


Defikition. — A dironic afiWion, usually located on tli«> 
&ue Id tJie roffion of the nose, hikI cliaruc-tcrizixl by tnarlcci) 
^bypenctnia, <lflatation of Uic vctwvls, uvergrowtli of tissue, umI 

ie lesions. 

Etioi/xjv. — Aiuemia, menctroal liiwrtlcr?, eastric cliMiiH 
anves, expoHUiv to cxlrvmcs of tL'mjxradiif, and iDt('m|H'nLn< 
aw lltr UMifll [)rrtb«p<<Kiii}; niniWK 

SYMtTXJUji. — Tlte aflLvtetl art-a i« of a ilccp-rtd nilor ; tl' 
vcssi'Ih arc dilated ; tlic skin ia tbickiiHil and Uinipy, 



;«-rii^ lawns cwxist. In lulvanpcx) okfoi the nose mar Irwiiiv 
<>iln-mply Urge and lobtilnial (i{hin<>i>)iyma). 
<>ubjcc1i\'e plirnonicnu xn> f^cncrally absent. 
[iiAGNa"!.'^ lA'ptu Vulifnrin. — In tliia iW^^eaae there at* 
«ift palp-ml inpnlw, ul(-<.-nitiun, an<l vtctttrizalioo, ai>il no cn> 
bivciuent uf tin- blixxlvt-KHvIs, 

i'KODSfwis. — L'iil<«* the fiviwrtpoiiliy is marked, the di*- 
iWif K i-iiiiihk' iimlvr prutractcd trralmi'iit. 

Treatuent. — The gcnenii ttxtiliiH.-til w \\ie mmeaa in acne 

hwal Triw/MK-n/.— ^Stdpliiir nnd ni<;rcnr>" are the mi«t roli- 
kMi- retnciiim. VlcmJnckx'ii solution in very OMfiil. I'iUted 
vi^M'Ik should bv ik-slmvitl bv cW'tnilysia L«;ge bypcrtn^- 
fihiw may be rt-movvd by the knUe. 






T>EPismns. — A raiiiiiiltin; drrmitl alMceaL 

Ktioi,ik;y. — Singk Ixdln arc uMiatly due tw local irritaliiMi, 
Tlx^ir ajiiKarauoe in erune (FiiriiiMnit<Mii#) w u«itally indi<»livc 
Iff impninxl hralth. The entranoc of ptim oucui intu llic wkin 
ix always e^vu^nEial totlieir prrKhirticm. 

J)lAr;\(i«iJi, — Funincles miiMt he (\\M\u^\n»h«\ frum tviritin- 
fftx ; tin- lalltT &rc. -uiiglt^, largo, flatlt>i«il al tluMr»iimniiir<, aw) 
have nmlliple o])cnin((:a. 

T«f;atmkst. — III funineiiloHifl the raiise elioiild Ix- M«rchnl 
for and, if jMn^iljIe, removed. Tonirs like irjii, quitirni>, *itA- 
liver oil, and hypophosfihit** are often v^^ry nw.-fiil, Calx 
sulphnrala (I'mi K""- thrit* daily after mi-nls) s>mi-(inM« iimvi-n 
rvij-eablc. A doliition uf Ixiric at-id or of «)rro"ivf Hiibjiltiiilr 
lay be ap|ilied locally. TIr' following paste will "dU-n uburt 
tJieiii : — 

Urk. hydrara., 
Rxt. 1ic1lMl<>nn«, U ^^.-M. 
9i^ — Apply locnUyniKl inak<? imMiuru wllh Hlrlpi of ntlUuMlre 




Defikitios.— A nreuKWfritx-d itiflnnintatioii of tl« skin 
mill iKfjuT lii(MiK9i, (■Iinnu-U'ri»Ml hv a ilark-rHl, iiai»riil ui 
wlik-Ji brinks down uiid cvMcnaleii iIiithi^i »(-vcnir 3)WTtun«. 

Ktkiijxiv.— Lowwcd vilAlily fnim any mmc predis 
Thtiv lire wjXTiiilly ooiodioii in diaheU«. The exciting 
in a ^jHH-iiil niii-nilH'. 

SvMiToMs. — A dnrk-rcd, )iainful, flatt(^n<-d node appeam 
mirniiiiKli-it l>y n dii.'^kv-nil niva of induration. In u wi>ek or 
tt-n ilav^ siippiiraljoii Iwjiin^ ai>d tlie (wntcjita are di^cbar^rd 
thi^)[i^li wvcral oriRocs. Tlicre t'* gsiwrally ninrkod ix>u- 
Htitiitional diMurhiinoc. The moat contmoii ^^ate are ibe na]« 
of the neck, luick, nm) biitttitk^ 

I'tKH; N'netis. — (iiuirdMik favnrahle. IX>ath is not an 
frttitii'jit tt'rniiiiiititin in the old and ilchDttatei). 

TKHATUCXT. — (lenfrally Umiis like quinine, iron, 
whiskey an> indicated. 0|nuin inay he re(|uired to nAkve 

Loeai TnaimenL—Xn the early stage they may be alwrti 
by a i-cnlrnl iiijedien often to tneutv mininiii of a 5 or 10 
cent, si'hitiou of carbolic acid in |;ly«>nne. When not 
linlil abuHion is loo late, fimi iximprexeion may l>e made by 
»lriil>H applied (x>nccDlrieully, Icaviut; tlic ecntral uriBec free 
lor itie diHchurgv of slou^ti; an untt^vpilic dit«niig may hr 
applied over itiv Ktni)w. 






Dkkimtiox. — A ohroniv iniliininialory ditura'io, t^hnracU-r- 
iscd by red, .scsilv, iOuii-ply-einruiikM.-Hlx-d, elevati:-d l(«iuni'. ^^ 

GriotXHj v.— Psoria^i:^ usually dcveUipo in young U(liilt|^| 
Heredity, the gotity dialht^ii^i, pii-priuncy.atKl laetaiiiiii mt-ih (i^^ 

itredi^po^e. It is a^ coniniim in (lie iiibnnt ai> in Uk- di^liililatnl. 
I is nonH'on1ai;;iou!i. 
I'ATnoi^xJV. — A lotalir-ed liyiterlrophy of tl»e retc ui' 
OfHuuiuted with iuRammatioD. 



StmptoMB. — IjHte red Bixrts appear on lhi> huAy, mm\ 
erutfiixlly grow iiii(i) (Ih'v rwich iiif «»■ of n ilnllur. Tlin 
Inionit are of a <i<ili J)ink or red t-ulor, a)iar])ly dt'fitiiil, wiriic 
what clcvatt-d, MirnHin(W by bralttiy Mn, und ■■overnl with 
■bnmlunt dry, pearly, uwrlanpiiig iicnl4>i). 'I'Unti- h(<»I<« iint 
nadtly dtHat-'lKO, leaving ttchiitd a dn, Fnllj^litly exmriulol 
Bort'in^ Tlip k«ii>tH iiiiiy Ix- nnilonnlv tlixlrilniliil ii^r-r (In- 
■•filin- body, but iiMially liK-vxli.>n)4>riiiirlaif^(int iiiurcallUlHl ; 
a nymmetrii'al iirraii^ticot ih ofteD oliwrNi-d. Jlr-Iiiri|t !« 
filif;btly IIP eiitinly alncnl. After a variable linn- ||m< ciiitn- uf 
fill- pait^b (livupiK^m aud kavt-s bebiiKl n niHit nf Imllby itkiii 
•nUkh gradually iucrtiiKcs luitil no tracw of Uic kvioii n-niaiiii. 
Tbv diflDHMe rtiiiK a pmtnii-letl cntirw of motilliH or vi-am, iiii- 
pruviiifc in tbc niuiiim-r and (irowint; worK' in llw* hiiiUt. 

!)iA(iM»^ir4. Af^iiKt.— In tbts difwuHe ibv iniujiiii nn- nut 
sluiqily delim-<l, but *iliad« oil' Kindually iniw llie pnimHiiHlinii 
»kiii ; Uierc U niarkcl ihrbtiiff ; tliere m iiNiially a dtwitliil dU- 
char|r«', and tM<uliii){ Ix^tisat Iht- poriplicry iimrMid of u( llm 
centre as in [woria»w. 

fiWiorcAim.— In tliisiiirpction the kaiciit* arRtumnllycoiiDiM-tl 
tu tlio sralp aiH) fttif, wliib: iK^uriaHiM is i^fufral ; fliOMaliw an- 
gray and gn.'iwy ; tiio piil('.lR« are not circ-uniHrrilird, and locJt 
UkO inflaintuutory clianwH*-? ol' ]i»oriaifiH. 

Paifufo-mpunntnu SyfthlMirm. — The liintort-, lln' nMOohllMl 
symptonifi of ttvpliilix, the doiiiwry color of tlic litn'intH, iIki 
aoant ec-alinir, tin- ."[ii'i-iiil ri-mfincy fo invulvp Ihv lundw uih! 
Boles will n-iKli-r the dla^noMH iip|iiin-nl. 

riNMJN()Ar»<. — The di»(«NC di><«p)M-ure undvr litatninit, bul 
relapec geiicnilly follows after ii longer or shorter (icritK). 

Trkatmfj<t. — The gc-nerul hcallK nuiy nipiinr atleiillon. 
In the gouty alkali*^ nn- of value ; and in the una>nii<' in>n and 
uxl-livcr mI art^ itidii-alnl. Arwiiic !m ol^en of eoni>iih'iiili|i' 
vulite; it i^hiiiihl bo (fiven in rxiuill thtHM unitioui'ly in<-reii>ed. 
tudide of nirta.-«ium (gr. x~xx ibrlwi daily) in ninietiniii> niv 

//Mtii/ 'IWaimtnt — TIm* acalea BboiiH l)C n-niovctl bv alkaliiM' 
ImuIis before local applitatioittt arc made. Tltc Wftt local 
remedifti are tar, i-Jiryearobin, Halivj-lic acid, reton-in, sulphur, 
and auuuoDiated mercury. 


^ Add. chrjAopluuiic, ST. x; 
Adlj>lfl bctiEOAL, 3J.— M. 
Sig.— Apply twico daily. 

^ Sulphur. ftubllruaU, 
OL cadiDi, sa 3lv ; 
SaiHMi. virid.. 
Adlpis, U SJ ; 
CreUe pncp., ;fij«a.— U. (WtuuKBOM.) 



DEFiMTiitK.— A non-rnntjigioiii! infliiiiHntitorj' drseane of 
the fikin, ohararlon/wl hy iiiii!lili>nii ln^imiH — i-ritJifiim, |wi»- 
ul(s, vesirfes, }>ii8iiiU!fl, rttales, ami t-nwli* — uim] ussoiMiiU-d with 
infiltration, itchiii)^, ami mure or l»s dijytliai^. 

IvimuKJv. — It h mnst common in (lie yotinf; and lit the 
ajjicd. Digeilive (liattirbaiirt^, fipl>ilitv, pml, ami rlK-iinialtstn 
nivv)iH|)nM- tu its di^%i?loi>nK-ul, It may im i\u<- Ut cxtt-rna! 
irritants liis« ouIJ. Itnti, the rhnH-|ilaiit, liani !iim)N4, •XTtain 
dyvA, etc, 

PatudIXHjV. — C(>ug(stion and infiltTaiJon of tlte viirions 
layers of tUe dcin. 

Varietikj*. — K. crj-Uieniatofflim, E. papulisuiu, E, vcstcn- 
liwiim, K. iiiislnl>]!<iim, E. w)uam<>«im, and K. nibniia. 

Eoteina Erythematosiiin. — This form coitnisifi in irrej^ulttr 
|iatdit."i tii:irk<il l>y vncllin);, rvdnes^ and I'light w»ltiig, itml 
aixx>m[niiiLil liy itching and burning. Tti« dkhI commoa ncait 
IB the fail'. 

Eozema Fapolosiun.— >ln this furni then? is a chwo iggnya- 
tion »f iiiinnti.' nciimiiint'i) |>ii|itlli-7f juifimjunrHtl (ly Howro 
itt'httii;. It is fix-(|iii-iitly il-^k-JhUiI nith tlie vesi-nihir vmri«^h\ 
Till' mii^l ("iiMiinii ,-i;ii in tlic oxln'initii.-*. 

Eczema Vesiculosoni.— Tliit< <H]iL'iii.-<t^ in an ill-dvdntil rvi 
ptUvh Minminnt*^ by (iiimitc V49>ieli^ aixl 8Cix)m|>at)ied by 
inliiHC itohin^. Thi; vf«icl<>!< i¥xm niptiire and leave » raw, 
w.^-jMiifi ftiirliKv wliii-ti bocvtmoi^ more or less «ivcn;*d with 
nnittts. In children, it is niflst (ximmon on tJie fare; in adn 
(Ni Uic extrauiities. 



Eczema PustnlosniD (Eesftna Impa^inogim\—TliiB rtmsiMn 
ill HI) a^rt-gution of ?mull pustulee which breaK and lead lotlie 
fiinnatiiiii of thick vellowiah cnists, Itchin;; is not marked. 
If is frtfjijpiitly aiwixialtd wilh the vcslmlar varictj-. It ia 
ni'Ht commonly observed oa the &oc aixl scalp of pourly- 
■KiiiriMticd I'll i Wren. 

Eczema Squamosom — In this form there are irreviiUr ill- 
df^fiiiitl tit\ \Meiu-ii atx!0in|)anicd by contiiderable itraling. It 
ditrcrf) imiii the orythematous Ibrm in the lai^ amount nf 
scaling. Ila moAt common »«tt h tlie scaln. 

When there is a marked tendency to ftssurin^, as in chap- 
pinff, this form is termed fttema Jumm ; and when there ia a 
tendefuy (o the formatiuo of warty ex««)K«iive», it is termed 
eeiana verrVieognm. 

Eczema Rubrum {F^^jna Ma^idanis), — This is a st-condary 
varkly and is rti-ognizcd by a raw, dark-n?il, moist surface, 
more or low covered with tliiok yellow i»h-i"cd crtistK. The 
itching may he severe. In cbtldix-ri it is frecjui-ntly noted (Hi 
IIh' face, and in old pcoplu on the extroinitim. 

D1AQNO6IS. Smbirn. — Ttu* history ofc^ontagion ; the loca- 
tion of ibc IcKions — hclvr«.*ii the finj^tre, on lite wrirts, niider 
tfa« mumfflic, in the axillic; and iW pixaiciiee uf burrows will 
indiciil« Kcabicf. 

Pnorkm*. — The shaqily-dufinwl imldivr^, tlic dry «icnling, 
tlw ahscnct- of mnrkwl itcliing, liie ^ymmetrit^d diiilribiiUon, 
ami Uh! pn-clilMiun for extensor aitHaix'ii uill iiidi<wte 

Ai-Hf liomwti. — The presenec of aciw papules ai>d nwatnleii 
and of dihite<l blood vessels, si»d the absence of itchmg will at-ne rosacea from er^thentatoua ecu-jna. 

.SeAoi-rAflK/, — Tlie greasy scales aud the alwence of iteliing 
and of all inflammatory eymptoms will indicate seborrlwea. 

Si(eoifi». — The limitation of the lesions to the hair- follicles 
of the &ce and the absence of itching will distinguish sycueis 
from eczema. 

I'rou.vos!'^ — Generally favorable under penMstent and judi- 
cious treatment. 

TBE.4TMEST. Oturntl lyeatmenl. — The health rawst be 
improved. Tottiu) uro fnxitiently iitdieated. In strumous 




ctiililren iMd-ltvor nil may Ih- nroKtrftiK- vnlii«>. Pislnrlmnr 
of I)h- ^.■tiii-int«^tiiiiil tniH iiix- rniiii'iiily |>itm-iiI, uriil will 
rc<]iiin- i>])))ii){)rtnii- tn'iiIiiM-nr. In lltt* i^^iKy und rliftitnntk' 
thi-nlkii!irit^ iniiK-rnl uaitrs, <Hil<-)ii(-iiiii,aii<l llit^ nallK iiriittiium 
are imliiaK^. <.'(«nstijiatioii Ru»t aKvAyi* nvi-ivi- attrntivci. 
Of tiie i«|>ccia] iiilcniiil irnxnlirs, ai'iviiic i» ihi' initM iaiporlant ; 
it is, however, only inditnted in llic 4-hn>iiic cuki* in which 
briffht re<lnoei, ittJiiii);, and weopiii|; urv aWni. ^m 

JCxternal Trealmenl. — In aciile eBWs wilh iiinrlc«l in(liim^| 
niatory syni[rtoniH, MxiUiiiig apiilimtioiiii xhirtild Im> oin|diiyi-(l. 
A aniiii-atnl solution nf boric acid iiiav bcdabU'd im tiir fin' 
or ten minutes, and ntay be tulluned by zinc ointment i^iread 
on linl ; when there ie niiK-h itching carlwlic acid it) 
useful : — 

9 Add. cM-boltc., gj; 

Glyccrinip. jij ; 

Aijuw, <|. It. lu) f.^viij.— M. 
Slg.— Apgil.v locally. 

The fullowing isnli<i) fn-quonlly iiwxl:^ 
^ Zinc oxid., Jm;' 

Vu\v. cabmiiiH: iwwp., 3lv ; 

ntvcerlDffi, (Al ; 

Llq. calcl*. flrU.-M. 
Sig.— Shake nod npply Iwnlly. 

In dimiii*- <nws crusts and acaleH sbotild be removed hjr 
Boap nnd wfttcr or by : — 

R Saponin vlrtd..jllj; 
AlcoboUs. .lij.-M. 
SIk.— A|i}>ly tlmroughly an^ roiimvc. with warm wiUor. 

'I'lii; l)o>t external a|>j)licationa are ealicylJc acid, tar^ i 
mry, and resomn . — 

^ A<n<L Mlicylll^., gr. XX ; 
Uuguent. pcttntei, ^iv ; 
Zlnct oxid., BS .^i),— M. 

(SiTKLWAOON awl DruK(«o.) 
SIg.— Api»)y twice ibuly. 

9 HvdrAr);. animoDiiiti. ;fB«; 
Ht]. pldo nllmlin., aj ; 
Ui^. aqure TOWi-, 3J.— M. 

UCil£N RirBBK AKD l.lCtlKN ri^NUK. 



$ Ot. cadtni, Om ; 
(Jlycofiim-, Iji; 
Ung. diai^liyll, l^Ua^—lL 
Sif.— Apply louallf. 

(TiLinntT Fox.) 


Iiicheo Riibor. — ^This is an exln-nifly ram tlisnu'c, i-Iiiinuv 
U-'i-ized by th« eruption of small, rCTl,gl«iM.'(I,»aniiiDat«i pupuki' 
which show no tPitdvovy to cuu1ch«, niKt whidi urv ueMcialttl 
with ilrliing ami fuilutv uf p^iicnil hmllli. Thv cl).«-A:«e riitut 
u chronic lijui'^', tmd nuiy pruve fiital through fxlmiiHti<tn. 

LJOlien Planus. —Tliia funn i.™ chttnwt4-riw'cl hy an c>iiiptio» 
on llic t'Xtiviiiilit'^ of inmll, nil, tliil (Kioultv* vrtii<-li U'ud In 
eprfuil, itml by (imlwtciog fomi diill-n<l, irnpKiilai- pntdifH. 
Thv lutu,'i- 111 firfl hiiv« u smooth uul shiny »{i|H-uniiu«, hut 
litti.-r lire slightly smlr. TiM^> i.t mora or Its.'i itohing, bill no 
ini[)ainnont of the g<>neral limllh. Ah the old lesions disap- 
|n-ar m-w on«i tak« ihoir plaoo. 

Ktioukjv. — Thi-a:- allwiiuii^ arc nnwt freqnontly observctl 
ill |ji>i»rly-noumhctl, midilK-at^xl malt-H. 

TitKATMEST. — The gi>iK'nil health must l»a improved by 
pinKl Ibod and aiicli tonics as iron, ein-chnia, and eod-livcr oil. 
Arsenic It of conndeiable value. Locally, ointtuenta of tar or 
meruury am uauTiiL 

Uichen ScrofiilONiw. 

Tbb is a dirtniwi affttiiun ixviirrinii chiefly in eliildren of a 
HtritmouH ilialiK'Hiv, oixl <.-liunu-len//-d by lininll, j>«i[e-red, or 
>i;ilMiou-*'o!on.'<l wsily jui)hiIi-«>. 'Hh-v htw\ to fonu in Kruil|)s, 
and an; incwl fixtpH-titly oImitvi^I on llie trunk. Itching u 
nl»>ent. Th<- disease miict a <-hmiiic cotinw. 

TrtKATMKNT. — Itt^ntcditL-i like ir»ii, cjniiiiiw, And ciod-liver 
oil nn- iiidioted. Hthra reoomiuouda the last remedy as a 
local appliuUiou. 



DBFTXmoN, — •A<'lii'oiiiciRflainmaion»li(*ase,i"Imrarteri)! 
Iiy H )>ciivnil eriijiiioi] uf luiiiiitc, ducreCo pa|)uleB, aDoompBOie 
l)V iiuirkol jlciiiDg. 

KxtfiijiKiY. — It is most ooninurtily obwr\'od in tlio poor aiH 
iM-lti) III' Europe. It (li^rt-lujiii iu itirly ciiildhmHl aitu pei'tiiKlE 
timitigh lifi>. ^M 

SvMiTOifS, — An eruptioa ofBman,dif«cnrtp,«i<!P|ily-mtual«^l 
liAlf-roil ]«i|)ulcs ap[>euni on the bwdy, CKpeoiidly on llie back 
uiid eMoUMirsnrfaL'Hi of tW extivnittiis. Thv skin is Imn^lb^ 
dry, and lliickciicd. sud covered wUli minicrotut lu-nitch-nuirlaH 
)ndn<-cd hy tlir int<?nGc itcliing. " 

l'iM>GMKsiis. — Untavonilile; it (isimlly ]>ci«iiel« tlirough life 

TllH.vTMKST. — Tbo general licaltli must be inipr>vc<l hv 
eoDil IwnI aix] t)i<.' utte ul' uutritnl tuiiint like iron uiid onI- 
livvr oil. Kmjucnt hiiltiinf;, fulluwcd by oiiihuciitM of lar, 
(»il|>bur, or iwplitliul, gives relief. 



(HeopM OeBtntiotiia. Duhiinc's DiMa«« ) 

DbfiSITIon. — A chronic in<liiinitiiilunr'iii?R<a)H% chanictrrii 
by nndliforni Iomoiiti uliivb liirni in groniKi, iind which an 
OMwciati-d MJth in(cii«.* iUrhinj;. 

Ktioijkjy. — Women are more oommonly nfTwiU-d thiin 
men. Fn-(^)Sii<-y, liKrIulion, and ' meiisuiial disorders Wi-l^H 
to exert « ptX'dii^jHwiiiK inflitcnw. ^| 

SVMlTOMi*. lirtflhemtUoia Ffirat. — This is cl»nra<Hi'ri»'<! hy 
the ni^Hiirunoe in <-n>|M« of cryth^matuua iiatcbca which ace 
a^Hiiaunl with coatidfTable itcliing. 

l*iiinilar h'nrm. — ffntti|» of juipnles appear in rrops. ami 
are fretpioully asscKiiiilcd with crylhenia vcukkw and cratch- 

Vaiculwr F/>Tm. — Gi-onjw of irregniar-sliajjwl v«8icl«B racni- 
blinj; berpGH appmr in crops and are 0^111 iM^K'iutetl witli 
vO'tJtcma, pnstnlM, and scrateh-markH. 

fmiiilar Form.—Tli'w wwcniblfs th« fwrim^, lint lli« vtwU-Irt 
un: n-[tla«id by |)tt8t4ili:«. 



Bntinu* /''oral.— 1^1^ irregiilar-sliaw-d Wflw ap[K«r in 
vTv\w mtd iriKl u) gmiip. V«Nii-]e« ana j«tclic» of erytlKSia 
am alM> IrMjiwiitly nrfspnt, 

.ViwJ Form. — Vcwdes, eiythomatntu patdmt, nuMnks, 
|ka|Hil4?!<, Slid blehft apixwr in aAsctciatiuii, oome out in t-roiis, 
and ni'c aiiciKlotI wilii mictiK' itching. 

Ill iIm) piihtiilnr, bulloiii^, unci Diixitl formti llicre may be 
tnark*^ coiiHliliilionnl diMiirlKiiins. 

Pl{UtiN<«». — Guardedly tbvoniblv. The distiiso runs a 
t'ltroiiK Goiirae. Rfln|Ki« urv wry ounimun. 

Trkatment. — Toni« arc gciK-nillv indivnU'il. IjOtioDH of 
Wriror niri>i>lic add ninv W viii|iU>v«'d to allay ilcbin)^ aud 
inay bo Ivlluu't'd by u diisting-jMJwdcr. 


DKriNlTiiiN. — rnRantnuition of tlie skin rauilling from (lio 
adion of some trrilRiit. 
Dennatitls Tranniatioa. — Thi>« trim !« upplinl to inflani- 

mntiou ol* tlic sUin rtwiltrtifr fivni tntinii«ti!«m. 

TitKATMENT.— Ttic rtiii.ival of ilic i«iu-«- and llit ii|ip)iai- 
tioii uf i*<H>lliintr r<-tn(>dim wilt nsually Millii.'«. 

Dermatitifl Teoanatft. — The term id applifd to inRnmina- 
tion of tlio skill ii^iillinj; frtini tlio api>li<«tion of vi-jii-liiMo, 
animal, or ch«nti<9l ii-rilaiil^, Notal)li-<-.\ani)ileR of lliin f<irtti 
of dermatitift are oliservcd in Miwopliiilc peopk* aftor ex|Hl^lll^■ 
to iW infliicnre of poiwin ivy {llhuM Toxiroiifnih(rn\ iHiison 
oak (Wiut \'eneitala), or poison miniai-li (if/iiu I>iwri(ifUni}. 

Syjiptojw of UiiUu-PoiMOKlMi. — Ttie aHeclioii rc^tfiithk}* 
a^'iite eczema, ai>d may appoir in a few hours or not until 
llii- taj)«j of sovprat days after expoeiiiie to (he plant. It Li 
jfcncrnl iy obeer>"rd on (ho flifp or lianclfi. The jiarl beconn'.s 
reil aiui i^wolk'n, and soon minntc jKipnW and vcsidm apin'jr. 
It );ivni rise to coiiHidvnililc burniii); un<l itching. As a rilk', 
it Mib^ides in a few da\-fi, but in )«iivnljt willi unwilivc akiu 
it may Hiigrr for »p\Tnii wivkn. 

Tbbatmknt. — Thf \H\n should finiEt he bollxvl with casttlp 
Biwp iiinl (i^iid waUri-. and llnii In-siliil wilh wmc ^dative 
lotion or oiiitnu'til. KWik »w>li may \n: datibed on, sihI zinc 


ointnimt etibamiiently appli^l ; orii Riitiinitf^] solution of bond 
aoi<l tiiMv bcf<>lKiwo<) by zin(;i)intm4.itt. V)>i-ii Oiac is marked 
ildtiiig ft weak suliilimi uf iTu-bolic ncid (^ to Oj) is useful. 
Tliv llinit «xlni«t of f;riiHU'lia robiisia has been highly recMp - „ 
imixltx) ; it may 1x> njiplit^itl in thv atrcii^li of liaTf on ouac^H 
hi a pint of Hiitor. ^^ 

DermatitiB Calorioa.— This tcnu in nppIiMl Ut t)i« inflamms- 
lioii uf Uk' skill ntuiltiiifr frrwii extn-iitc li*«t or <roW. Prmh, 
or eJiiSiinin, in olinittdi^rixiHl by rediifets, Hwrlling, ititenm: 
bumiii)r 1111(1 iti'liing, and r-siiUa from a oiulcien cjiaiige fn>tu^| 
a low [o)ii|M^i-utiir« to a bi^b u-nipcratiire. fyott-hite ifU'lim-^M, 
a<!(erii»(] by oongelalion ; tlie mrt Uof a (Itill-w)tile color and 
is tmttsttietK ; minc<M)ue[itlv iunaniuiation or ganj^ne dcvelopu. 

liunm aiid »txdde result from th€ applimtioQ of heat, and 
are divided into degrees according to tJie depth to vrhicb the 
destructive proofs extends. 

Tkkatmknt. — lo pernio, or dtilbfatn, tln> part should first 
l>e rubt>ed with etwiv or bathed in ic<c--n*HUT tmltl tlic circula- 
tion ts re-establishnl ; and then an apiilicaliun nindi; of nilritr 
of silver (gr. v to tlic ounce of distiUod wator) or of tiiKturc 
of iodine. 

In »ii|icrficial biima or nt^ihh one of th* following rcmfftiP* 
may be iippliitl : I'hvnol Kodii|nc, carruii oil (upial imrt» of Itn- , 
seed oil and lime-water), powdervtl bicurlwnatc oraodtuni, or; 
IJ Acidi carbolic, %t. viij ; 

VllKlin., ]$ij.— A(. (llRLI.VrK ilOHHTAL.) 

8lg.— $ljin>Md un lint niiii itpiily wlteru tbu akin is brokpu. 

Dennatittfl lUedioaiDeDtoBa. — TI)i« term is ii[if>lii<d to thv 
varioiLt nilatteoiis emptions wbi«rh follow llifi iniernat ums 
cerlain drugs. 

Bdlniiotma or Alropi'i. — 'fliew drngs produce a diffhw. 
Ani'theinaton» iiitli rci^eflibliiig that uf scarlet fever, but it 
lacks iIk' (Miwrifdnn cliaracter of the latter. It itsnally aj*- 
poars on Ibc t'tuv, mi-k,iind cht'ttt, and ts aKSooiated with dry- Mi 
ncqe of thr tlinial, rapid piilw, and if the doee has been lai^-, ^M 
dibl4<d mipilA. 

f>iMi«. — 'Hiis dmg aometirocs produces an erythema aaeo- 
' with minute papules. 



(hpaibtt. — Thfl rasli may be inafriilar, pajxilur, or lik« that 
of urticaria. 

liromiili- o/ l*otiu»iiim. — The <rruplion K«ct»ijle« ncwc and 
(NjnsiHtd of pa|kiile§ nad piistiilcs. 

Jodide of I'olamium, — The (Tiii>tJon may lie prvtiippintoiis, 
papular, pustular, urtii'ariat, or jiiirpuric Tlie mnsi cwninKni 
cniittiou resctnblps ncnt; but lli« Iwtiiiiifi am brighl-rwl tii <ioli»r 
and widely distribtitc^l over tlie surface of llic- Uxly. 

Arncnlc. — The oniption may be eryilieiiiatons, papular, 
vesicular, or pustular. 

Aii/ipyrm. — This (Irug not lofivquently produoea a wide- 
t;prea<l papular eruption. 

QuintHt. — Tlic rash ifl usually erythematous, though an 
urtirariiil ernption has bccu obwrvcd. 

Sa/ie^ r ('in/xtuN(/«. — The eruption la usually eiythemotous 
or urticariul. 

Borax. — ^ThiHdnigoecusiunally produces an eruption rraem- 
blir^ pmriii^iit. 

CX/mi/. — The cni|itioii is iisunlly rrj-themiitous t>r Mrti<»r>iii. 

DcrniutiliH Exfoliativa. 

This is a rare nfr«iion, cJiaravteriiEed by difiiise redness of 
the itkin, high SvvvT aiH) its associates) phenomena, and dcs- 
([iia»mtion. ft is inli-n^tng from its eluec n-semhluiioe to 
m-nrlrt fffr, from which it itmy lKMiistinguiiflH>«! hy th« history 
and Ute abMHiec of »ore ttiroal, and a " stmwl)crry" tongue. 


DErrsiTlON. — An inflnmnMilory afFi-ction, (ilmraeterixwl by 
tin- ap[i«anuirc of diM-niU-, ftnl |Hi.'«idi-it, which vary in five 
from a |iea to a Avc-t^tiil pi^Y, and which un? .lumHiiidc^I hy 
a di^inet n-d areola. 

E'noi/Kiv.— ^[ale sex, niiddlt* life, hod hygiene, aiMldc- 
hilily are prediBpoiiing factore, 

.SyJiiTdiis, — ^Flat, yellow piMtules a])|M>nr in rrops. Tliey 
are surrounded by a (distinct i-«l areola and soon dry up, form- 
iug reddish-brown crusts. Sliglit exrariation and pi)^iiH-uta- 



PemjilLigtis Foliaceus. — This rare amt grave rorm nf peiti- 

[iLi„'US i.* i-hiiniii'-ri/jil l>v crup«uf blvbfi, wliirli nr*- fliiccid simI 

iJlW wiih a liirltiil tliiid alnioi^t fnim tin- U-fiimiiiig. TIk-v 

Ml ni))lun> iiml fiinii tliiok i-ni'^l!', wliicii »vj)«niliti;; l<;«vc 

bind mi w<^'[>iii|; MtHiuT^ Tin- (rr«i»!i follow Mcb oUilt in 

kjjid suonvsMiHi, and al (iiiu'^f tlic whole body nmy lie wtviTwl 

itii lilelia aud iwaliH. TIk^ di:its.-M> iiinv Usl mvoml yean, 

Mh ultimately resulting rmrii (■.\lmu'<tii>ti. 

Di-VdNfWL-i, IMliiuji Syjjilliiilrrm. — 'I'lio liiNtory, lli<> iiiwo- 

:«1 symjktcinis ot'^ypliili.-i, llic1liick,yclliiu-, Htratititil t-ruHls, 

sad ihi? iindorlyiii^ ulreratinn ^till serve to »e|ianilv tJili afTix- 

from i^pinplii^us. 

Impdigo CbnIaffioMt. — ^The ai'Ute cniirae, the coDluffinus 

laH imto-in<K;u tabic diaracier of tlic- nfTtvlioii, and tlii> lunbili- 

'■atii.m of lh« bIclM will fppamte in)|tetigo cuutligiusa frum 


Pitixi Nosi!*.— The |irujpiu«i-i f-liould be guanlwl. IVmph!- 
i;ii» vulfTtriH runsu loti}^ cutirgv iiml is otlpit iiilniolHbl*'. Poru- 
[ilil)pt(i foliai-cu>^ ofUtt proviK fiital tlivoii^li cxIinuHtion. 

Tkkatmkst. — The die* itbould In- iiulTilioui', luil mn>rully 
aila|it(il til itie Hdimiu'li. Tla* iHilicnl should 1h' |ilm'<-<l iiudi^ 
ilki' Im-kI hyi^it-nic i-imdittoiit^ Toiiiis liki^ inui, t|iiiniiK-, jilioti* 
jilMini.t, ciHl-ltvt^i' oil, imd tUrychtiia are imually indit-att-tl. In 

imie tiff» arseiiK- luny [irove ii»tf("ul. 
l»CAl. Trkatmknt. — The l)lvl« may lie pimcturMl upd 
ibiequendy dre^Med with nnc oiutmeuL 


I t>ei 

DEFlsmON.^A II noute inHnrnmatorv diBroM!, (.■Inimrti'riwtl 
by nil t-nipti(in of dihcreie [m!<tules valuing iu Niso Iruiii u i>ch 
til a fltwrry. 

Kthhj)OV. — Th* exciting cause ia unknown. It la nwnt 
MirauKtuly iil»ierve«l in diildren. 

Symitoms. — A piipliilar eruption iip|ir«rv j.fiui'nily on the 
lact^ and fxln>niitint The piii^tiiltf an- (."'H'l'il'ly 1'"' t" num- 
ber, and arc dkcnHe, (fiisc, am! «irroiii»d(d by a flliiriit iircnlu. 
a few days Unajlg-Hft.MMt J""" 'bin y<-llovfii<h>bi\twn 


cntste, wliicli 8IHK1 Anyp o(I and Intxt; bi-liiiKl u noimil HOrC 
Stity«4tvv piK-nuRHtiu nni aim-nt. 

DiAGSOsiR, AirfAywia.— 'nii« nlfortion txxiire moet fn 
qnonliy in ilcUililntiHl ndtitl^; t\w |mt>tii)<9' tav flnl, mif 
n>iui4)('<] l)v a ilUtiiK'l iirt><)l», iiiitl <|rv to bniwti cni»tit wllic 
wimriitc iiihI ktivc n pifitiicniwi ox<t>riiiU'<l fiirfiMT. 

Im]>rii<fo {hnlw/ir/nii. — A* tin- iiuhk' impluw, lliix iiffM-tiim » 
cui)tag;ioiiM ami i)^ni>l<>-ii)uoiil»l>Iv; U» jjimuili's aiv Hnlaml iini. 
l^liiiiltO, nii<l (In- lip iin*) form laim^llab^, lliiii, ycllnw cnnu. 

P(HtGKn(<t^ — ^^'''nvorabl4>. It temiiaates spontaneotuly in a 
low »l(i_V!^ or n «■«*. 

Thkatiif-ST. — Ojifri th<» piisUiIes Hwd apply some sinijile 
protenUve iiitititu:iil, like tlmt of oxidu of siuc. 


PEPrNiTios. — An arittc contiijnuiis infiummatory <U 
cjiurnctcnzcd by Hut, ycllowiiJi blrlm wliicli dry up iifnl 
(bin, yellow, liiiiu-llitli^l cnisli'. 

^>rii>i/:niv, — U" <'x<'ilii»)r raiiso it uiikmiwi). U i« now* 
fn-qiH-ntly uIih^tvhI in d<tbilirnt<-d Hiildrvn. 


S^'Mrrous. — Tbe ernptimi In mml fiv«juc»Uy nUHTX'td 
tlie face and cxtf^ntitim ; it generally appcnnt in orn|>H, am 
a*, fiwt vftiiOTitar. 'Ilio vesicles grow, and are soon convert^ 
into (Iftt, II nibi Heated piistides wbiob vary in siae from a iiea 
to a Isxrfft H»Ini)t. Tliey have a »!i^ht red arcofa. Itftun^H 
is sligbt or i-ntiivly absent. In somo casps ibciv !» nioderan^^ 
fever witb its asaociat.xl phenomona. In a fpw days tbe blel» 
dry up and form thin, yellow. iamdliUod crusts wliieb aqwrat- 
ing leave a slijibtly exporialod rar&ue. The dtMsae ta ood- 
tafiioiifi, and the lesions are aulo-inuciilable. 

PiAONOfit^. ICnfma, — In this dii^m&o Iho piiHtiiles an- 
rnmiliir, more confluent, excite iiiteti*e ilebiii^;, ami an- 
eiaUtl witb iiiRamniatioii and intilinition nf ibe HiintMindiK 

Sim}itr ImpfHffo.—Tiils uRbction is iiot voutAgtnii^i or aiil 
inontlablo; tlio piMtnlcit arc tcnw, not flat or umbilioitr 
iimt Uw HiitMiviiit'nl <'rti.'«ia are ycllowidi-brown and am 
foIluwi>d bv cxcurialiuii. 



VfirMi.vdKiK. — Favnraljln. It terminntett )t|MntWMK>iislj in a 
ft-w ibvflor weeks. 

'I'kkatmknt. — A Bllghl stimulating mntiiKriit lik« I)h- ful- 
luwiug ih sometimes useful : — 

R BrdntK- ainmon., sr. v : 
Adipia, il.-M. 
SIg. — Api^; to the »urfAca afUr removal of lh« cnute^ 


(Pdokly BmU.) 

Definition. — An acute inHammatory discftHe of the svrcnt- 
glund)<, dtanKivrizcd hy a diacrete eruption of minute jia)Hi)«s 
ami vwticlw. 

KTioixxt^'. — Tliildliood ami lii;;li temperature are (ho prin- 
fipiil pniiiK|K>!tinj; nttUM^ 

SvMPToat*. — Till* oriiplioM gcnvrnlly apjK^rH on the trunk, 
and «>ni»i*ts of minute rJi»i»t'1_v-i4!grfgal«l rwl piipii)«i or clear 
v<*irJc*. TIk? Ut:<ion3 arc diwixrU-, anil cxdtf »>mc burning 
and itdiiiif^. Il ix generally a'»"i-iat<'<i wilL free [)erMt>iralion. 

DrAfiXcjais. — A>;f«i« piti>ii!iiKiiia liifltr* from miliaiia in 
lliut tlio [uipiiW aiv Inrgt-r, aiiprnr mure {gradually, disappear 
more slowly, and excite inki»e jivliiiiir. 

Eewwa ecAhulomm diffent from miliaria in that the vesieles 
are large, disappear more slowly, sJiow a tendency to brvatc, 
and are assiieiat^-d with marked iteiiing. 

Sudauim difli-rri from miliaria in that it tacks all infiamnio- 
tofv eharacteriiMi(». 

PROONaKBS. — Favorable. Olistinatc cu'W^ may ])Vf«ttt for 
several weeks, 

Tkkatmknt. — The general health mav require altontiun. 
The diet ehouM be Ii[;ht, and easily aaiiinilable. Oii)KU'|mlii>N 
should be relieved by saline laxatives. Ixically, a simple 
duatiog-powder is generally all that is required. 

1^ Fulv. amyll, svj ; 
Zinc osidi, 3U8 ; 
Fulv. cmmph., 38B.— U. 
Sg.— Dnsting- powder. 




Dkftnition, — (Iraj-nwiB «f the hair. 

Etiojxioy. — fjixnl gnviioin may be congenital, or resiilt 
froiii ttuitic illMiii-Litttiw of inni>rvaltoD, as in neuralgia of lh« 
8Upniorl>ita1 iwrve. As a gi'iionil rao(]it(on it is usually an 
fxprc«Muu of swiility, nlthoufjh it occasionally develop very 
early in life. Profoniid vmotioiuil disturbances sooielinits 
induce an abrupt (U.-veIi>]>nicut of cauitics. 

PitOGMOHUt. — The condition is pcrtnaneut, and treatment is 
of uo avaW. 


Ettoloov. — Atrophy of the skin occurs under sevcnd am- 
ditiouH. A loeal atrophy muy resnlt from tntlanimalion or 
injury of a nervi'-tnink ; iu thc»c oims, tJie wriaklvs are absent, 
Ihc skin is thin, smooth, and sliiny, and IIhto i« often intense 
burniit); in the [nrt ("^r^wry tiin'f. Atropliy ts also ob- 
*T*'cd in Icpro«y, niorphaM, ihkI solerodcrniu. 

Uiiivcnml atrophy of the skin results from s«iility, and 
very nirtly as no idioj^uithiL- condition, ^ometiiDea the alro|Jiy 
o<x.-un* in liws or sjrats (atria: el ittacHtai atrophiar) as an 
idiopathic iiiitdition, or as the miiH uf stretching the skin, as 
in the linor albicatttn following pregnancy. 


RrTOLrmv. — Atniphy of the hair- may m*idl from local 
di.^eases whtdi interfere with the nutrition of the M^nlp, «uoh 
as i«eliorrl»ipa, eczema, ringworm, etc. ; or it very rare!)' Arimn 
as an idiopathic condiliou without obvious raiiM'. 

PiKKiNiieis, — Wlvcn the tmtw can be aseertaine<I and rp- 
movcd, the prognosis is favorable. 

TBluTMt:^T. — I<oral digram's will n>qnit« appropriate treat- 
ment. The general health itltould he improved. Stimulating 
applicationa of merairy, sulphur, or corbolip aetd are sometimes 



EtiOLOOY. — Occafiioually tliP condition is cfiiicenitsl, 
more t'rcijtioiitly it ih noquirctl, an<I r»>iilt(i frum iitjiiry or di 
f«i4? of tlie nerve-trtink ; rix>iii t>i>tuc gi'neral diK^ise, liko < 
uf thp fcvcrs, HV)>htli», or cauurr; or (ni'm in>me di«a»e of 
skin, OK psoriaHJK or ringworm. 

SvMPTOMi*. — Tlic luiiU lo«c their luvtrv, ceusp to grow, : 
bctvim; ojHiqiiL' utid brittle. 

PK(M)Xric«l8 AKI> TREATUEKT. — BotJl Will df[K>nd OR tl 
cxviliitg i.'ftuiw. 



EnoijcXiV.— (1) Baldi 




lijpss mav be ecmgPDitai 
it lA iiHiinlly [uirlial. (2) It may be an expression of MHiility : l 
ill U'liii'li tat* il generallv IteEins on Uie irrown or l»niw, and is i 
aesoeiaied with more nr less atrophy of tlie ecalp. (ti) It mar 
onriir early in tile, S-* an idiojKithic ntferlion ari^'ing witbout 
(ibvioitH uiiifio. (4) It may result fruin f^-iK-rul dii^asee, like 
Kyphlli^ ntid (he fevers, (b) In early life it u) ullen due to 
wmt^' Iwjil <lt«eii«.', Mpcciaily seborrliwn. ^j 

l*itOGN(i9lK— In <-'>ng<-nilul, <!milc, iind idio]iHtliic- alopeo^H 
the pnj|^u»i« i» iinfiivumblv. In tUi* nluptrin of geixTsl di^^ 
CUM* the prognosis w iimially lavoinbti-. In hI<>{>c(->h rennlt' 
irijf from Heb(trrh<en ntuch («n be ito(Mmpll'di«il by peesisteat , 
and Jiidirimi^ tiTuttTumt, 

Tb»;atmbst. — Ttie pem'ml lirallh Rhnnld be impnn-ed. 
Freijueut vmxliiii}; Ihe head with warm wal«r and i-aslili- suap 
H t<> be rcoummnnled. One of the fidlowin^ loenl i4imnlan(» 
may Ik- prwrilH^I: (lant)iarideft, quinine, aktibol, eajMieuin, 
snipliiir, or cariKilic mrid. 

9 Qiiimnie Mitp)i„ ^f* ; 
Tini't. tsiilli.triilis, (jj ; 
Slit, antmoii. arouiftt., fSf; 
Olricinl. (1l»a; 
Spt. iiivrciu;, fjvas; 
Ul. rotioMnni, gtt.v.— U. (GeiuiARi>.) 



9 Tiiict. catiUixridLe. t$j ; 
Acid. «irb"licl. gj ; 
O). ricini, ^ts^ ; 
Spl. niyti'iir, 
8pU laviiniiiilji', OA f^ij.— M. 

Q Tinrt. cnntlinridU, 3y ; 
(jiiiiiiiiiL- Hulph., fir. x; 
Cilyuirinic, fxve; 
OL nutinarim, stt.v: 
Spt. mjTcUc, q. a. Ml ($v.—iL 


(Alopecia Cfrcnmscilpu.) 

DEPiNTTtos. — Buliinos ;i|>|H3iriiiiriii cirounucnlxHl (uitrhm 
without any uliviiiiu> Iiv^ioii nf i)ii- »kin. 

Etiology,— The ctuw is iiiiknowu. Som(> n>gatxi it «* of 
l>am«itic uri)>:in, wliilo otlioni liMik iiimiii tt a.s a Deurotu?. It 
ia f^-u4;nilly oli^Tvcd lu eorly tultill life. 

SvMrroiiR,^ — Hie disi'a.'w is I'liaratlerizwl liy tli<> ttixkl^'ii itr 
f;nuliutl aiiiitura»i-e of divuiuJiorilK^l mund |iat<'h<^ nf tuiUI- 
nesii. At limt llicre U no change in the appcaratK« of iltc 
skin, but later it oiay lioronu! juile and atrojuiied. Although 
th<' M»l]> is the nM»t fncjiienl Heat, !l (Hxaeiunally involves 
orhiT hairy \iart8, as tlie eyebrows, bean), etc. 

DiAcjwiHiK. Jtittgworm. — UingwoTra is exceedinjfly rare iu 
adiill^, ai>d is cliaractcrixwl by elevated scaly patches thmu|£l) 
ivliirh prujert dry, brittle, broken hairs. If there shoukl be 
any doubt in the diiujno!;!'^, the nticroscoiw may be employed 
to iletwt tite trit'iipbytoii. 

I'uiwNiwi-s, — In tin- iiijijuriiy of (uses the bair retimiB 
iimler pn)lon;;rd .iimI |H-rsii4<-t)t tn^tmenl. The older tlie 
patient the luw favoivbh' the pro^^osis, 

TkeatMKST. — (ii'iHTiil |iiiii<-« liki' imn, iir«-nic, (piinitie, and 
strychnia are nstmlly indicutcd. Tiio bxTil Irratmeiit sbmild 
be MtimuUting am] ooiisiM^ in thv upplivuliou of btbteiv, etcv- 



trid^, rri<Ttion, nibefiunent linimeols, or oinlmente mnteinii 
fibrjrsarobia, tar, suljiliur, or ammouiated taenary. 

^ Tiit«U caotbaridis, 
Tluct. cawlcl. Si Wn i 
Olei ricinl, 1^11 ; 
Alcoholis, (Syj I 
SpU. rwouuiRi, bij.^M. 



^ Acid, chrjauphnoic, 3iwi ; 
Adlpta, Jlj U. 

ft Suluhur. loH. 5l» ; 
Ol. ladii 


(Sliitpi* BycCBb. FolUonlttte Barboi.) 

"DRFiNmoK. — A oon-contagious indaminalory disease 
tho hair-f(illk'Ii«. 

Ktiolooy. — Tlie aficctioD ]>m))ably rcMiltH from local irri- 

^YMPTaits. — Tlio dtopatte uHiially miinifotits itwir un the 
bownkil rrgion "f tho riuNMind ii oiiann-loriiwf bv an iutr 

{ration of iniptilcs and pii*ttiili*, «urh of whiili is im-nyil liv 
lair. Wlu-ii tlM^ UvtunA Mtji ili^^retfi ttii' int<'rv(-iiin[r skin 
often (|iiili' )ii-iillhy ; IhiI when Iti^ an chv; t<>{rt-th<T it 
ofl(^3> iiitiltrAliil and liy^wTHtiiio. l>uriitg; tin' |iia[HiUr fta^ 
thi- tiairs aiv iHit lixwc. but flmdy attarlii^l ; during the fMt 
tular Hiagp, however. tlM*y can bo n-adtly ejctnuited. Tr 

IiiiKtuloi Hhow no trndnx'y t" nijitiiiv, bill drv to yellowtiJi 
irown rrwst)^ Afiitf ftuvs oiv assiHtaKtl witli ronr« or If* 
bnmini; and itching. If tiie diwnse persists, it may K-ad 
exlroiiK' dwinivtion of the hair-foHielea and, act a <iiit.-«^|Ufnc 
to iN-nnnimit nlniMiuia. 

l>i.\nN(x4tH. /•Ja^ma. — ^The lemnna in ecnema are aotdi 
nrete, aiv not perforated by haini, am] are not confined to tl 
bairy paitB. 

Tinai Sifcimn, or SarlKr's /foA. — Tlie afTcctiuo begins as a 




nd bebIv patHi, and ia fbllawed by the il(>v«lopiuenl of laiw, 
decply-t#at«l mlfercles. The hairs wwn become (In-, brittle, 
ancl broken off, aud can be easily estrarted. lu dmibtrdl 
cases the mitrixxxx^ may be employed lor lite detection ofllw^ 

r*i«XiNt»L'», — The dweaw is eursble under pmtntq^l and 
jn'.iicil•1I^ treatment, Itelap^es are vi^v prooe to occur. 

TiiEATMKNT. — In aciite caficK Bootliii^ applieations are jn- 
ditulLtl : tbuH tlic parts may be dabbeanitii black watJi nr 
u MitiiRited MiliittoQ of bone acid, and anlneijtiently Hj>reftd 
wiili oxide of zinc niottnenl. In (Jironic cases (he cruftls 
^ll■■lll^l lie removed, and the hairs cut elow or preferably, 
-Ii^ivk). It isailvisable to puncture tbe pUHtiiW and to ex- 
irai-J tile bBin^ so as to preserve the follicles. When the jnm 
art' not irrituble stimulating applications are useful, aiid one 
of tht! fi]1lowing may Iw selected : — 

^ Sul|>))iir. pne<-i|>,, 3IJ ; 
Vng. aqUHj roue, jj.— M. 
Bin— Apply twice daily. 

1^ Ung. dinchyli. 

UnjC- xiiK'. oxitli, au ; 
TTng. bydtar};. aiuuiuu. jitj ; 
Blsmutli. Buboltralls, sUe.— M. (Roni."t«)s.) 
;,— Apply twi« daily. 

9 Irlithyol.. 3J ; 
Vtis. diachyli, 3j ; 
SIg.— Apply twice liaily. 



Poinpholyx is u very rare disease, uftinlly obBcnp-ed in tlinae 
who p<*rsj)in' frwlv, ainl chanu-terixod by an eruption of 
(bfply-seateil vesii-fw which rew'iiible sa|ro-trrains iml>cdd«I 
iit the ^kin. Tbe veHicli?! nnwt iiimtiKinlv appear on the han<)i>, 
(•i|Ki'ially between llie tingtjrs, and gradually inirrawe in imhj 

4ti4 mii»:ASi» of thk skin and its Ai>FKNi>Aut>% 

until they reach tlie dimntsions of blebs. Tbev show __. 
tendeiti^ ta rupture, but dry un, and are fhUowei]' by eiteo- 
Hive desqiiaiiiatioa of Ihe cuticle. Theeni[»tioi) often cxdt«s 
wnsiderable pain and tenderness. The diseaae tisiisllf dis- 
!i{>peant in the i»iir»! of a few weeks, but is jirotie to recur. 

Tkk.vTMknt. — (Jcnera! tonics like iron, stneliDUi, and 
Hi-senie are ot\cn iudicaled. iMiBlly, Dcdutivo lotions or uiut- 
laealfi should be employed, 



Dkhxitios. — A depoHition of pi^ent in the form 
Hmall, irr^ular-phiiped umwiiish spots. 

Ktiouhjv. — Itlumlui are mure i^tbjcct to tlie afTectiiHi tl 
brunettes. Kxposiirc to the siiirs nirs oHeii »>r^'es as an 
exciting cause. 

Symptohs,— Ex]MMu1 p(irl« — the fiK!C,slimi]dvns nnns,atMi 
liaiidif — ure niiwtlv ntl«ite<i. The jwIcIick vary in color fnim 
yellow til dark brown, and raugu in kIzc from n ptn-head to 

PnooN'oeis. — Freokles can be rwnovwl, but they olw 

TitKATMF.XT.^)nfl of tlie best remedira bi the bichloride of 
ni«'niiry in .^oliilion or ointment. 

IJt UydrarK. ehlor. corrciA., ffT. iv; 
Alcohol, et aquw, U ail Qiv.— H. 
Sig.— Apply twice daily. 


Dkfisitios. — An abnormal deposition of pt)nnent in tfa^ 
lumi iif lat^ brown or livcrMxitorc*} imtelR-!!, 

KtioIjOGV, — It may result fn>m Ihe application of exter 
irritantfi; from iteneral diM-awn like malaria and Addisou'd 
diM-ase; or frum aKuctioiM of Ihe utenis, u prepiancy, 
tumont, etc 

Symitoms. — The affection ixtn^ists in the iipixiimnee — 
especially on the faev — of liuige, rouiid, or irregnUr-Hli; 




imwnUh or blackiidi patdwi). A]«irt froia Ihc (liwuloraiioo 
the Hkin is ooniial. 

DiAu.NtKis, — In Lnteodenua tlu> iMrijihm- uf (Up )Mik-h(^8 
is picmentE-J, biit the oetitfal inilk-white a|i|M-iiniii(« i» nut 
aeen iii i-hluosoia. 

pROGN<jc*i3. — When the cause am be reniovwl the prog- 
nosis is favoiablc. 

TREATUliNT.— Whfn pos?il'Ip ttio ratisc should \tc removed. 
The best Iwal n-niwhcs are bii-bli>ndc of ui«viirv and wiii- 

9 Zinci oxidi, gr. iij ; 

Uydmrs. antnWfiMt., gr. Im; 
OC tiKobrotn., 
01. rlciol, iS3ii«i; 
B«MDt. roMc, gii. X.— M. (Mosix.) 
;,— Apply to Ui« fkco night and morning. 


(Lloben PUaria.) 

DEFiNmoN. — SmuII. pa])tihir cltvntioDB resulting frora 
hvprnrvphvof tlw; i-pidcrinic siirifjiiiKling ihp out lets of tlw 

Etioi.'XIV. — ll tjwKTally nwilfs rrom inrtvqiicnt liulhing. 

SvMlTOMs. — 'I'lio skin, ptirlii-iilarly on IJm; i-xlcii«ur sur- 
myi-n of till' tirm* mid !i'g>, ii* thv m«1 uf nmnvruris piti-h<ii<) 
elt'vatioiw, >vliii-li lia\'c a dirty-Kray ooKt nitil up.' picntil l>y 
hairs. It may sxriic M>nu- itohiii;^, (■t;»iTnlly thiTc- arc n<* 
evi<i«w*s <•!' inllumrniiiioit, but sointHiiiKS a fi?w rwl pupiili.-a 
»r f-vcn p!i-ct4il<^ mtidt from irritattun. 

DlA<iN<iHis. — It) CWu Ansfrinn, ur gixwn-flisb, tho h^sion^ 
are transknt aitd ltav« i1h> culnr of iiornial nV'tn. 

I'ltiMJNdnu-, — Kavorablo. 

Tk»:.\t! — III nK«t raiwa* nothing will !)« fpcinired he- 
ynnd fmjtKnt bnihiii^ with Minp, t^)ll»M'e<l bv friction of tbi- 
>>kin. In ob«tina(e cases some simple uJutment luay be ap- 
pliiil aftvr bntliitig. 



Moixrscni EPirnELiALE. 

(HoUuMnuD ConUctOBum. Molltuonm Sebaoram.) 

Definition. — A oitaoeouH allWtiou, rharactciwil liy the 
ap)M--ai%K-e of di^rete wax-likf? elevations ranging in »!»■ rn>iii^j 
a |>iu-!iEai1 to a pea, and v-ar>'itig in color frutn while Ut nwej^f 
pink. ^^ 

Gtiouwy. — ^Tlic dtsease is geot^raliy ofaeerved in diililrcn, 
and frrqiicntly alTects several incDibcn> of tltc same liiMiadtold, 
school, or asvlinn. It is prubably oontapKiuti. 

SvMiTuMs — lSiihiII whitfor |<nlf-pink. usx-Ulto dovaiii'na 
upiKur, i-^fxTiallv <in ihc faot-. They art- alnav!) dtHcrt-ti- aiiff 
rarvly alMindunL TIht i?i-ntrv of th« elevation is ilopntwedj 
and iT'V<.>aU a <lurk Kjiut whi<-h rurrm)H)nd» tu tlM> aperture i 
tile lollioic. At fimi Um> Icxionit uru quik- firm, but »n tltofi 
givtw old On-y iKiiHiHt Mid. When linnly Kjtm-zed rlnv 
cxnde a soft, ohf-wiy tnnl'>riHl. After n-nmininp lor grvcra) 
w«>ekt) tlioy hn-nk d»u'n or iimhTgn hIow ali.'«>rplii'n. ^t 

DiAOMMis. — 'I'lie mlor, tin- »»\'lik<- amx-sinimv, the nm-S 
biltration, and tlve central ajicrtniv an? the dtagiinstio fvalnn«. 

PK<KiN(»ii«, — Favorat)l<!, althotigli the rliiti'a.tic may run kij 
protracted course of months or yeara. 

TUKATJil'i.vr. — General Ionics like iron, h1r\'(-liniH, ar 
ai'senie are often indieated. Tlte leeions should !)*■ im-tscdj 
tbe <»nleiit!- expre«ied, and tlieir liases touched with nitrate 
silver ; ointments of mercury and eiUpfaor have aJsn Ik^h 


(Calltuk K«nto(iia. lyioaU.) 

I>F.FiN'iTinN. — A tbickeiMH], hnmy condition of llio »kin 
rebuking from liy|iortn>phjr of tlie mmeoitH layer of ll»e epi- 

Etiouhjv. — Oonstanl irritation fmm friction or priisiiireis 
the chief cause; hence it is frptjuentty aeen en itu- f(x.t fnim 
the rubbing of ahocs, and on the haiids from the friction ' 



SvMPTfuiR. — TliP oonditioD w chnraoUrlKed by the gradual 
appRirao^'e of tmril, Ihiclcoivcd, grajisli masses, which gradu- 
ally nM-rg« into hcalthr fikin. Tho soles and palms nre ihe 
parts most rreoiu-ntly affeetal. \V)h<1) slight it cai>iii.>s littl« 
iDcytDveuienoe, mit orraejonally it Ik^cooks hseuivd ami pain- 

PiMxjNOBls. — It yields rapidly to trwitiHent when the catisc 
If removed, 

Trkatment. — ^Mien excessive tlic parts shoiiM Iw soaked 
Hiid the ihiekened eimlemiis pared off. One of the lxt>t reme- 
dies lor lujDeriiiig the horny overgrowth is Balicylfc ueid ; it 
may be appliitl in ihe form of a plaster or in cullodion, 

9 Acid, wiliejii*., si ; 
Sig.— Appljr night and inmning, 



E>EPiKiT«>N. — (^avis t» n c-irenmwribed ihit^kening of tJic 
epidormi^i ii«tiiully iippetmng on lh« fi«t. 

Ktkh/kjv. — Corns g<'ncndly iv«ult from the friction of ill- 
fillinj; sIhjoh. 

SvMi-i-ojis, — Small, <'ircuRi«Til>eil, horny elevBliotw appear 
n|Kiti the feet and often excite »«evc re pain. When Uithi.4 in 
jM-rsjiiraticm Ihey beeonM- more or less nuiceraltd, and in this 
condition ronirtitute the so-called mfi com. 

Tui^ATMKNT, — A radical enre requires the use of welU 
filting shoea Tile corns may l)e removed by making, (wriuj^ 
and me application of some mild caiistte like salic^-liv add. 

Tlncl. ln.lii».j rtlx; 
Kxt, rnnnnliiK ind., gr. X ; 
CciHodii. r5«.— M. 
SI|^ — Apply night ami ri)iinii»f( for *«r<:nU tlayit, noil then MWk 
tn hot water. 




(Cnttmeous Boni.] 

DRriKlTlON.— A cin-iinuK.Tilx'd, |»rojocting oatgruvtli »- 
tuiltin^ fmui )iv|M.i'(ropity of (Im- (;))i<)(Tnit«. 

SvuiiyiMh. — Horii« gfiii>nil!v ff|i|i<«r on tkw fai-t.*, Malp. or 
pi.iii«, »ii<l arc UMiiall}' oI)*cr\-iil in ilw nlil. Tiwy ouiisiM <i 
dry, nni;;!), Iioruv, mim' tirli-wt.'ouiail jm'jwtions, whiHM-anr 
ill Iviiglh Cfim n (t-w liiiw to »c\-orBi iiK'.lk>. 

I'm lo N< jet iH. — Fa voniblc. 

Trkatmrnt. — Thv hum sbDuld be excised and ihc hot 
(ill Ihh.<c| lien tlv L-nutcrieod. 



DErtslTrcw. — A wart in a cirr-nmarrilwd elovation resull- 
ine f[\)ni liy|ioi-)ni])|iy of iIh^ jmptllw and epitkraiis. 

Kt[oixm)y. — Tin- raiu* U <iljftiiin>. A bacterial origin fan* 
b«H-ii wufgp-.-<i.-<!. 'I'bey are avMCt frequently riUt'rvtx) in 

Symptoms. — I'ittki^ Vuti/arU, or eoniinDii wart, is* p.'nr*- 
al!y nt»en-ed on Ihe bands of diildreii. Jl ooosiets of a finn, 
circiiroari'ibttl elevation, valuing iu sixc from a tuillet-rn^nl li> 
a ]wa. 

Verrum )>tftna, or flat wart, is a eirnirascribed, flul, jiIl 
niMitod <'lpvatiitn usually ulscn'ed on tlie Imolu of obi |Hii{>lr. 

\Wrurti J'Vifonnis, — This ie u tliread-like ovei^rowlli, ami 
^ts ^nerally otnen'Ml un tlic miH yartA, like tlie fai^ anil itn-k. 


VerrtiiYi IHt/ilata. — Tbis form h iiuide uo of iium 

s ai.p 
^roii|is about the genitalia. It is soft, r«l in (-olor. ami iiigbly 

brancbcfi, and h geiH>rally <>In<i.'i-vi-<1 on tlie sntlo. 
Verucca Afumhiula, iir Venrrtul HVirf. — Tnis 



I IV In I 

Vascular. It niav be <lry or moist ai-ooitling (w its locatmn 
(be latter condition often gives riAc to a (wculiarlv oScnsiv 

Treatmrxt. — Ortlinary warts may be removwl by 
&»m\, au\A\v», or elcctrcilysis. 



Venprcftl warts nhoiild l»e balh<^ in Mnif»iiti»pptk'>«l(ittun 
and siibAMiucDilv diiftlKl with iitlntru-l, iiHlurunu, ur lN>ric aad. 

[ in « 



DEFJStTlox, — A circumsmbed deposit of pigment, nsiually 
asfiociatcd with hv|>ertriopliy of (.-utaiiHiifi §1nictnre& 

Etioukjv. — Moles arc ti&ua)iy wnj^cnital. 

SVMPT(»M». — The iK-rk, (ucv, and tnink aro favorite locali- 
Thc nicvi vary in mimlxT from onv to several hundtvd ; 
in »!«', from a niilk-t-tNxi) to u filbert ; aud in color, fmtu vol- 
low to bUvk. ^^'hl■Il the fnrfiu'c- ix fniuotli, tJw gniutii is 
tcnncd narruM irpituv; wheii i1k- nurfut-c iavovcrwl with liair, it 
i* It'nnt-d luinm pilomig; w\wo tin- stirfarp is wartv, it ia 
tf-rnicd nirciui r^nwouM ; aivi) wltoji ihi-rc in much overgrowth 
«if <-i)iinoctive tiaeuM', it i.s Kmied wtrv\t» lipdiiuttotln. 

Trkatmknt. — 'ITiey may be ivmovoii by exclKion, the ap- 
titiii of catiiitics, or by d(\.1n>Iy8i^ 


(Fl>h-iOclii DUoaao.) 

Definition. — A chronto aftVi-tinn <'h«nirteri»fd by dryDe«t<, 
l)iick('iiin)^ iif the «-pidi^rm!H, am) KmliiiCiw. 

KTiotJKJY, — 'llu- afltv-tiun i8 otXeu benxlilary uiul is wually 
deteclwl in early childhood. 

SYMPTfuis. — The .skin is drv ojkI l»ai><h ; tlie stirtiuc is 
covered with adhorcnt iMilygimnI !M-ati«; and Iho papilla.' »rp 
more or less liy|»enntpliirtl. The Krni fehtfufmijt /iyrfi-i> is 
applies to the con<lition when lliere is ex«*sii<' h_v|M'rtrfi])hy 
of the i«pilla'. The extensor siir&ees of the extranitiesore 
the parts must involved. 

Diagnosis. — The abeenre of nil inflantmator\- symplotng 
till i>c|iaratc iciithvueii) fmrn ivjvamoua fcTfvta and itwri'wi*. 

I'RcWiN<i*l«. — Tilt' <iis(ase is iiK^indile; Imt ihe patient can 

rvndtT(!d coitifurtublc by appropriate treatment. 


Treatmkst. — TIm; m«1«s amy be remuvetl hr alkalioe 
baths or by Mi>|)]icalion« of grwn »oa]). The .■•kiu may be 
muknd |)l>abltr liy nibbing in M>riie »iiiij)lt> uiiituiciii. 

)^ Kulpliuri)!, gt. Kxv-I ; 

Una. iiimp., .|j.— M. (Uxma.) 
8i^~Bab In at iitgbL 


Onychauxis, or hypertn)pby of tbo nail, may be concpnitd, 
or may r»t*ilt I'rom tiTtiiiii ;>kin offK-tions, t-tiib u^ Srzeina, 
rinjiworm, orsypbilis; iiviu disottsuiorUicoi-rvce, asDc»riti«i 
ur frurn truiinuitixiD. 



Itywrlrirfuwi:*, or Iiy|)erl[\ijiby of th*" hair, inny he lixwl 
gcni-rai. Tlif term is njiplk-d notoiilv to an cxnftwivo ovw 
gniwtli iif hair, but to a growtli of hair in unusual ItHnlitiu), 
till the Guvs iiryoiini; women. 

Trkatm»;.nt. — The imir may be reinavecl tenipomrily b 
(iltaving, cnilAtiuu, or dG[)ilatur>es. Peruianent relief ctu only 
be aeootuplislied by electrvlyds. 


{Sclmama, BelwtMto.) 


DEFrsmoK. — A jHgmented, rigkl, indiimted oonditiou of 
the ^kin, ocic-urring in druumficribed jiaieh«s or involving tbe 
cntin^ body. 

Etioixkjv. — Tlw «>iiiw U unknown. 

Symptoms. — The afilt-tion may be difliuw or ttn'olve n 
nim«Til»"ii jialrhcs. It may u|)|H-»r qntlc imddaily, or develop 
very [•nuJiially in tin' iitiine »{ niontlu or ycara. Tlte skin 
ii.-e<ilRi<-s a yellowiiili-broHn nolor, Ixx-omn rigid, indoraled, 
un<l liiil*'-boiuul 1 the sitrti«ni> in tiiiniiKiriilly dry and tmiiioth. 
Whi-n ttte rondiliou h* ndvoiieeit liwt joinl* liMiinie mon; 
Im inunobilv. 




PftooNMHiH. — (iiiairlti). It often recovcre .ipontaneoiiid}' 
afit-r liaving iieisisit^ (»T a long tin»e. In rrflier tai&fti tlic [nx>- 
tt-.- cmiv tijm'ad until tlio iiQticnt Ixwmtes aluKM liil|>l<?«. 

Tm:.\TM t:,vr, — Tonics like iron, arsenic, and Mxl-livei' uil 
an- iitteii indicated. Locallv, tnaasuge, friction, electndtv, 
and inunctions arc n^uouituen^mi. 


(AddlMW'a Keloid.) 

l>EKismos. — A outanenUH aflVction, charartpriKed by cir- 
cujn^Tiix^l. rounded, ivorr-like palobes, which bavi>h)'perKmic 
or J>ignieiittid linrdere. 

K'i'ioijutiV. — Tbe csii>«e is imknown. It is generally re> 
gurdf^tl a» a circiiniKcritxAl rorm of leucoderma. 

S^liPTOMs. — The lesions usually appnr upon the tnnik 
and finwftt iil" Khar|ily-eirriiniwrilK'<l |iateh<«, which are at 
(in-i nlinhlly hyju'miiiif. TIk- wiriim- is ttniDuth ami rF»ii;tnnl 
ti> ihe lotii-)). Af llto [iiUcb cri>W!< old h» o-iitre tK.niitiK-.s ]udc 
uimI is'oiy-likc, wiiilu tin- [h ri|ili<!r\' n-inuinx liyjKni'niie ur bc- 
mnif?! |)igiwn1«l. 

I'lwxi xoHiH. — (i Harried. 

TuKATUKKT. — Thc same as Bderoderma. 


(BlAptumtluia Aratnini, BtMbantiaala PaobjdeniilB, Boibadoea 

I>Kt"tNiTin>". — irvi>crtro|>hy of the ekin and etitK-utaiieov 
tissues, usually ussocialetl with lynipbaiigitifi, cedcma, and pig-' 

Ernjtxjov.— While cloplmutiuniii may oecur in any part of 
llic M'urld, it is far niurv ciinniioii in llio tro|Hrs. It U mimt 
rrtviiK'nlly nbwrvcd in tbi- tiiiile a*'X, and niivly d<-vt'li>|n< 
Wl!>n- iKluit life. It n-KiiIl-^ fnr>m otx^niction of ihe lyui- 
pliutifti, and ihi- nuxt ctimiiuHi ciu^.' of siid) nliKtnietion \» the 
ftvaeiMX of a joTiuitL — -fllaria miiffuivU hommia. 



nt t&r aftdcd tisBnrr n^-mbil 

hmif vilJi n^irrinff nltm-kit of 
. Tbr part (• nil, fi«i.ilhii, ai>d 
; tk( l_iiii[Aifiiii OMr br twnl »a liraiu-liit^ ml IJuca 
tfa* ninn ; ual with ibut UnsI |>ben<>i»o»a t]>crc isj 
' or lew &>Tn-. After oefa «aaek tlH! iku-i Li Idl k linle [ 
iiilin,irf. B«3 finallr H pwjeMi the fidlovine HiaraL-tcristiel 
k » wacTfJy svnlba ; tbe ekm U tliiekcnulj 
attd pigiaiuiul ; and Uw [ia|wlbe aiv untmuilly ; 
Tht nsiuas (BensaUjr aMrted srp tfap Iqis ami 
■mital-. la dephanriaeis of tlie aepitum ((jmi/jA-wro^niDi) tlu- 
brpMtfuplued ms bk/ wb^ ae niadi as fiftv ur even shJ 
tmndmi pnwnns. ^H 

I^oasal^In. — In tfae eaHv rfiLr ll>r (liMtta> may be ain*cb<<I, ^^ 
bM wlwo fuDy eEiaUHiiod it is inconttlff. 

Tbr^tmcvt. — TSx aaXe i^aaiaialucy attai-k^i »ltr>iil<) Iw- 
tnatctl hy mt and the mpfScatioa of sedative lotiniLS like , 
teail-mln' and laiiilaouiiL SulK^M^noitly nu>n-arial iuiino-l 
tiuos toay be (oiploycd, atul the port Gnnty Ixindaj^ed nitii] 
tbe rimr of pmovitiiig ataauniiiiiD. Ani|Hitatiiin may Ini nh'- 
n^fully eai)ik)Ted io lyia))i)-«cn]tnm. Id ctephanlia^u 
tbe limtki Ugadon at' iIh- main artrry has fj^vn sonruwliatj 
enttiu raging Bocaaa. M>itv mwntly galvaatuu has given vciyj 
good results. 


(Padijdeonatooale, Ctitla Paodula.) 

DErnrmox. — A dmimsmbcd by]iet1n>|)hy nf tin- «kin 
and stibcntaDeiinn daeaes resu1tiii)f in a i)ont'm<tl nixl prnduloiisj 
omxJition of the inlefntment. 

SVMPTtjMs. — The jwn afFiwiod tB ttiiektMinl nttd pigmentwl ] 
it ii* (loft and fat-like !■• tlic toiidi ; ai>d wUcii llw condition b1 
inarkni, tite »kin luinpi in tolds. Tbe regions |[eQi>rally '■ 
affwled an? the HJiouldirs, iirniK, back, and biitlncka. 

Tkkatment. — Tlif lY'ditiMlaiiL tissue inay be removed by 
exciAJon or electrolyaia. 





(Cbelold. KolU.) 

DRFiNirroK. — A new growth resultii^ from hypertro)thy of 
the noDWclive tis8ii« of tiie conuin. 

Etiou)Oy. — It generalljr rfsnlta fnim ]of«l injiirj', thoiigb 
it is rJaimed tlmt it may arise spontaHrt-nsIy. Certain faroi- 
Vh'!- and intlividiinU air cspMrially predispofied. It ie mure 
rnxjiKDE ill iIk' «>lor«l raw. 

8ympt«m». — It begins as a uiile-red nodule, which slowly 
incmuws tn wn- and t(end« otit <.^w-like prmx^MV. Fruni its 
niH-riiblntK^v to u cruh il has bvcn termed keloid. It is linn, 
cliiT'iif, slifililly Hi'viitwl, i!Jiur|>ly dt-fiiHil, an*! ninfiw in ««• 
fntni a umaW bean to a Rnmth us larpc- n!" On- tiiiiid. It 
winiflimes pxci'tcii pniii nnd iu-hin^;, bnt {iviwrnlly siibjcotivc 
j)hirn>n».'na are absent. TIk- n'gii)n!* inin*) fiwjncnily iiivolvfd 
nn- tlic oli«st and btM^i. 

DiAONoeii^.— Ki-lnid mny tw difiin^iitthiHl ftv>ni a hi/p^r- 
trofihinf iftvu' by iho fiti't tlmt tJie lalier t\tw» no! t-xtcnd b«\'i<i»d 
thp limiu ufthtt injury, 

pRCKiN'(»ts. — Tn<' gnmtli is usually |)ernianent, and after 
removal invariably n^ums, 

TitKATUKKT. — It nmy be removed temporarily byexdsion, 
electrolysis, or outstic pastes. 


{UoUiwciim Ftbroitun.) 

Dekwitios. — A olpcumscribed overgrowth derived from 
the subriitaneous o«inncrtivo tis<^iie. 

KTiin>><iV — ^Jl^ly life aT»d heredity are predii^pOfinK factors. 

SYMinxiJis — The tumors are drcumscnncd : jminlcss ; soft 
or firm ; often multiple; range in size fn>oi « ix-a lo a lien's 
'•'VX i "^^ *lo not im)inir the general health. T Ih* overlying 
skin may be normal in apjKiininee or slightly liyponi'mio. 

I'mxiNueis. — They aiv permancDl uhI trcjiliiient is rurcly 



(HmTUa VaMoloniB.] 

Depin'itios. — A new growlli, <tiiujm»ed of oavermiuii t^ttiK, 
or a coii)]^Tiwt of wimll bliwdvuiscls, 

Ansionia CaveniosQiD. — Ttii:* fvrm is a>D^«jiital, U mra- 
of ntVLTDotin tWtiv, hikI n|){>«tr» as a cirruniaeriltAJ, 
ilevntol, tbrk-ixs) tumor, which nuigei iu Hze I'ruiii a |>ea to 
OIK- li-t liir^t- iv l>i«- haixl. it IH iiften l<>l>lllat«d and p4ili«iin]C. 

Angioma Simplex ((h/jiUary .Virriw, /*wV-«-iW Mark}. — This 
Ji>rii> if ii)m> <v>ii^iiiuil, and b) oumiioscd uf a cun;^-rif« of ra- 
pillarks. It U ii4>u~i-levatec), bngLt-n<l ur (turplorui in _ 
color, and iiinv oov«r aii arva of wvi-nl hicIim. U b K<^nrr-S 
ally fiiiiniX un (he fau>, and oouslitutn wlial i» |iu)tijlarlr 
ti'i-u}ed a nuit/ur'a mark. 

TsIanglaotaBlfl. — Thin form \a m'rjairud, and Is rotD|impd ••> 
dilaird or t»cwly-dcveIo|(«l (ii|>illai'i(H. It apptars its u Imgbt- 
re«l dot ftnm which )>raiidi dilated ouiillams. It is fiv-l 

aiieolly associated willi aaic roeariG: il i» aim «iiniii)uii ii 
tuscof » f!;iiiily dtuthcsis and in thotv tnucli cxjxiM-d to Uii 

TneATMKST.— CavcrnowBangionuUu may l» rcroo^'eJ 
li^ioti, cKoisi'in, or fi(t;lroIy»i». Simplf au|;ionialA Miid idui- 
pecUwi? Biv ifcat tri'utwl by (.•Icctrolyws. 


(vntUcold«B. Xanttieluiu.) 

DEPlxmo.v. — A art'iiitucnbed t-'oiinvc-tive-tixsuo new- 
gruwtii aiipvnring ait flat {nUvIics or Uibcrvles of a vcIIowm 

Ktiouwv. — Middle life and li'malr sex atv {{ihktbI pre- 
diBjMKiinj; fiu^ors. Hqialir di-^nxIrrM, i^pur-ially olKttmc^ivi* 
}ait»di<«, Mvm locxcrt a tk-ciiUtI |inili!t{>iHii>^' Iiiflimicv. 

SvMPTOHii. — Tbcm are Iwn foni»: A'<iHf/t"Nui fJ'tuuM, 
wlticli (puicrally ap|i«tni aUiiiL Um: in'elid-i and (y'IuuhIa oT— 
Kimiuth, cirr^imscrilied, §lig))tlv t>Wat«i, hiifT-coloni) ]>atcbe»s 
and Xaulhowa tuba-o^m, w\ucb may ap|M>ar uu tht! tieck, 


«houl(liT«i, trunk, or ex(rfniiti<ft, aiwl voiLsiMti of itruull, clastic, 
aiid vellowUh-oolored oodules. 

Trkatmhst. — Tbfte growths may be removed by cxcumod, 
electrolysis, or caustics. 


(Sebonhwa CongtBtlTa.) 

DKKlxmux — Lupus ervtbvDiatomm it^ a new-grouih resull* 
ing from s cellular infiltnitioti of tliv Kktn, und chamcteriBtd 
by cinoiinscribcd, rwl witcIwM wijk-b arc wore or Ies» <'ov(a'ed 
willi ypllowieli-jirjiy iidiHTt-nt kthK-ji. 

EnoLOtiY. — .MiiMIc life uml R-iunlc »x arc prcdit^posiDg 
factore. It fn.i|uciitly nrii<ca from diwrtU-n^ of iixc M'baceous 
gliuidi^, ii« »'i»orflHiM or ucuv. 

FATHotjOoy. — By many it fe n^gMiditl «* u cbronic di-rnia- 
titis which originates in (Iw («clinivi>us glaixl^ 

SvsipT<»M-s,— TIm! diM«.*«- li.Himlly i)iiiuile»l8 itwlf on the 
fun; in till* ii't^iiin of the urmt', and a)>[Kiii's tt!* 8midl, nil, 
slif^htly <-le\'ntt<I papules, whicli are more or l«« omly. An 
erylhenmtiMW |mti-l» is jnTidually formed by the oalesrt'iM'e of 
llic»' jwpults. Tho pexiplkery of the [mtch is ek-vattxl and 
sharplv ucfined, while tJie centre is depressed and atrophittl. 
The ducts of the sebaceous glaiHk are dilateil and oDen tilled 
with sebum. The disense s)ireads very slowly, shows no ten- 
dency to idcenttion. and rarely escitcH any >-iibjec(ivcBymploniK 

DiAGNtKilt*. — The Itxnlion. the (^harply-<iclitH'd red [laldi 
with an eh-vfitetl niiir^^in and deprcssctl centre, the slight sreh- 
ncw, the dilated Hi-baceouH duets, the ebronic cuurve, and the 
alKviin! of iilcenitiou are the dtagnuvtie featunrg. 

Lupus I'a/r/Hm, — Tlitu alI(-<'lion Itosio!* earlier in lift, is 
diarwrteriiKxl by luUTeh-i* and iiKt-ration, and liK-ks involve- 
inent uf the si-lui<tiitis );landH. 

pR(«i\0His. — Kiivondile under prolonged and judicious 
treat men I. 

TKt:ATU I';nt.— General tonira like iron, antciiic, plnw- 
pliorus, an<l cod-liver ml are oAen indicated. 

I»fAi. Tkkatmkst. — In maiiv tasea mild applii-ations 
auiorapliali tJte most good. Much benefit is often derivi:d 


ftnin washing tlie iiort Itioroiiglily witli i;nfa-»ou|> iin<l olrohcl 
for a lew dnys anti itieii ai)plvi)ig (l>6 fvlluwiiig lutioti r^ 

9 Ziiti!. *iili>hnlU, 


Alcobollfl, TS'-— M. (DCHBIXO.) 
Sig.— Shake veil, dab Uw {uirU Tor (Iftccii iui»ut«a twice daily, 
and allow to <li>' oit. 

In sliiggiati «u>c& stimulating ajiulkatioDs arc iiacAil, anJ 
one of tbe following may be selectcJ : — 




Acid. Mllcyl., 3M*, 

Acid. iHclic., ;;m; 

[Intcirc-in., gr, sir; 

Zino, oxkl,, gij ; 

Vaaeliu. pur., ssvij.— U. (Bboca.) 


Addi pvro^Uici, 3j; 
l-Vrati, 3ix.'M. (Kaposi.) 
-A|>i>ly locally. 

In ol»liiiaU' iii.-»«, sianfifation, nirptting, or biirnin)^ wii 
tile )^lviiiit>-i»tilei'y may be ciiijtloycd witli advantage. 


(Lupaa Exsdena.) 

DBM.viTlotr. — A Iwnl manifoUationof tubercoIoBis, ohtr- 
anteriiied by soft red tiibcrcW, vrliicb usually tcraiiiiato in uk 
<<eration and scarrinit. 

Erioi/xiv. — 1-^rlv life and female M'x an> cen«nil pi«- 
di=|K>=iiig fartore. II U com pMni lively rare in lliin rouiitry 
btit very oonmnjii in AuMria mid (tfrmany. Tl"> cxfiliii 
cause ie thp tnlxTi!lc Iwtlliis. 

SyjiMX>iis. — Lupus vulii^riii nii»( frw|UcnlJy nianifoMa it 
wlf on tb<! faco, pHmTinlly near ll>o n<x«o. It begiiiii as miiinle, 
iIcoply-s«»U'd, ivi!«li«li-l)r')wn iiapidi.'s, wlii«-h grow ven' slowly 
until tlicy ix-n'-h lln- liiincnsiimsot'lnlnTi'li*. They am soKHHlt, 
;jiiltc wifi. and .'^Idiun (uiiurul, At itiis sin^.i' tlioy may cilla-r 
undcTK'i siitw Bl«>i|ttiii» i<r, wliidi is iii'>n- JrcijiU'Ot, lnwik d>>wu 
and iMve chi»i)io ulcere, llie ulcere are juiallow, and their 




tiiges are soft and red. Thei* U very little discharge. Thej- 
ppn-fld slowly, mid may iuvoive all Inp sittl part«, Imt tiie l>oi»e 
w never iavmlcd. WUili- one |iiirl of tlif iilc«-r U .i|)r«uliRg, 
other iiaru aiv beiiii; filk-d vrilh ^lirivellcd euiitrii-inl li.%iiie 
wiiid) in luni in ofu-n l\n: f-at of ni-w liil>erciiIoii>i nodiili^ 

])lA<:N(iHiti. KfiiOitHtrma. — Kpitlichoma is a diw.'OM- i>f ml- 
vanwii life; it WyinHaKaHnii, wax-like nodule ; tlie ixwnlling 
ulcer Blttflif from n single ]wint ; lU borders are tliatiiictiv elc- 
vat<'«l iitid Imrd ; it iNvrelcs a btuutUftreakeii Rukl ; uiiu it \» 
often iminfid. 

t>i/jihi/if — Tin- aftr, history, atisoeiflleil cvidenccaof 8y])liiii8^ 
Hk- niiiid «iiir!tf', tin- dft'(i tilwrs, the nbundiiiit oftV-uiiive di;*- 
cliar^e, und iuler (lie iiivolveiueut Qf the ]x>net<, an Uie din^ ' 
no«4K r<ut(in». 

PnooKosis.' — Very guarded. Its removal is often followed 
by n'la|iee. 

Trkatmknt. — Goiiernl (oi)!i^ liko imii, arM-nic, pbott- 
phoniK, and tfid-Iiwr oil an' iMially indicated. 

I^ntvil JWnlmiiil. — Thogi-owlh may be removed by caiiter- 
ixalion, nin^tini;, exd.Moii, or electroh'sU. Odi: of the fol- 
lowing esiii^tiv a)>|ilicalioDS may l>e employed : — 

IJ At-iil. urHMii'wi, Jj ; 

llvJrari;. ■^uliiliurcU rub., si; 
V'as. «lnipllc>H..^J.-M. (HkbiiA.) 
Stg. — Spreatt (hide oa clmli. nnii npply to Itia pnlch Tor tiro or 
ihrw daya, uatil lupiuaixlulcanDd poihUtaroblackwh or (Icilroyed. 


IJ Acid, lactic. nuri,f3-—M. (Wichjiasn.) 
HEg.— Soak a nleilttrt of alMorlKnt cotton niHi iipply to ibc ulcer. 
CoT^r witti ffil-Mlk aiwl faniHlng^ i*roli.-cl ttomuil tiiuiuc wilb gnuiae, 


^ Acid, wilycilic, Jij ; 
Adipis bvusout., jj.— U. 
Big.— Apply locally. 

Ohea llifi Wxt mtiillif an; oblainvd by vut^tiii^ and sul 
qiM'DtJy applying ranstici<;. 

Koeli'a tiibercdlin luw lulnly been einployctl exieiwivcly in 
l\n- treatnitiil of hipn^. but it hn» mit pivi-n fiuch <:>ioil re»idl8 
as weix- i'X|NtTtetl. AIUt its uiw- Diuet «wwx iuipnivv, luaay ] 


rplapfie, » few recover. It aeems best 3da{rted to ra{iidljr- 
sprRMling fornifi of lupu& 



The MTOfuJory ngmptmoM a|ipr«r bctwpcn the Rist an«I fourth 
nM>nt)i followtiifp tlu- chancre, und sre chamcterized br a srtn- 
nti-lrknl arrani^inciit, i cop|M.-ry color, polymorph bm (mstiv 
fvtm* ut \X» fame time), iiiiu an ahtwnoo of itvhiii);. They arc 
iitiually wwiciatctl willi a-rlain pcwnil fijmjiloiiiK. such as Bore 
Ihroat, puin in iJh*- Uhh*, \<im of tiiiir, tnlargimctit of llw 
Kn)i)halh.' f;iaiM)K, and fuihm> of hmilh. 

Tne Irrliiiry nj/mjiitmut ap|K«r in fnmi !tix iitiiiilhv In wvcml 
years aft<-r tl>e priitiary sorc 'Hwy are aa ii nilc luniliiK'd, 
tubercular, gummatona, or uloerauve in fortu, aiid tend to 


Macolar Syphilodonn. — Thix t» a M^oondiinF- nuuiifr*4ntifm, 
bihI ii.'iisisi^ ill a p tural crii|ition nf dark-nt) mucitleH, vary- 
inj; in size from a miltetrseed to a Icii-ofint piec*". 

i>lAGSO»«ls. Mfaalea. — The ahseiKe «f lever, of catarrh, of 
a MTsrentic arrangement, together with the hiHlory, will [>«*. 
vent on error tn fliciKiiosiB. 

Papular Syptuloderm. — This may be an early or late man»- 
fcblation, and ii* ehamcterized by a general eruption of lar^e 
or i^nuill, diill-rrd [Mipiiles. A few piisttilee are sisu rre^ui'iilly 
pn.'scnt. It puniiieo a chroni*; rruirse, finally dit-apncnring by 
ih'vquamalion, and Iraviiij; tx-hinil Hli];ht pifinienlattuD. 

Diagnosis.- — I1ic histork', dii4rit>ution, dark color, and the] 
pn'wncr of put>tn1<« will M'liaratc >t ttwta kentlusbi pilaris, 
piipiilar ei-wma, and lii-Iwn nilxT, 

Tuberotllous SyphilodeniL — A lute miuiif'-stalron, I'faaniC' H 
Uri/ni I'v :i l(«:di/jil t'ni)itt<>n of dark-nil Mhiny papnlcH^ 
varyin(; in pixe fntm a jna to a Iiir;^' iH-aw. By some thow 
tnltentlf^ arc regnnhil a» i^mimutoiiM in dmruc-ter. The\- pur- 
**ue a chroiiie conrvw and (inidly disspiirar by abeorption or 
iiUvraliim. The uWni iIiuh funned, uhm »inglc, are ttMind, ^B 
IKim-hcd ont, and fn'<|ii>-iitly (i)veri'<) will) rni^8 ; when thrr ^| 
<i«il«j(i', liii'v ronii a iM-r|»igJnniKi Bore whieh poura forth a Ihiek 
ytil'iwish dcM-har^. 





I>[Ai>M%iiit. LuptUt T'u^rM. — This oonirs in earlier life; 
it pttnui(« an cxtrviiu-ly tjirofiic coarse ; the ulcer is superficial ; 
till" tiibt-n-Irs nn; *i>ft, imtl fntitirntly recleveIo]> in the arar tie- 
eiic; the si-cnHion is maiur ; :iiici itic bone In never involved. 

i)ii/AfyiViHi/(.— In liiiriHfTivliiiii {)k- pro^rewi is slower ; there 
ix only one pwnt ul" iiWnition ; lh« wcretlon is scanty; and 
iIm- Ixinler U niark.iiiy infillmiMl. 

BnHeiiB SyphileieniL — Thit* U n InM miiniri-!=tatioD, nnd is 
rhurat'tenzol by nn criijilion of wi-ll-lilliH) bk-lw viiryinp in *\7X 
rniniai-ofTw-bOTitoa walnut. ThefMnUmlf^of ihrblclwiirepiiri- 
furiii, 'IVy »««b«»qiieDtly fnnii dark, (niuiiii), xtnirilH-d rrtwis 
undiTuliich »rc uloera pouring ii^rlli a tliiclc, ])tiriiU-nl fluid. 

UrA(iNo«iB. t^fmjJiiffU'. — The iiistury, llw; (ifuiv>militnl 
svm()l(ini.4 of xvphili.'*, and thick, grei^iitsb «» will strvf tn 
clislingiiiAli Hir'pliilis from pcnipliigiis. 

OnmaUltiniS SypbUoderm. — This apix-ani ai> n lirm, circiun- 
wTibiil nriilule which pradnally turns rwl and softens. It 
may (iiHajijjfar by absorption, or break down and leave a deep 
)iiint7lie(lM>ul ul<vr. 

Uolst P^oleB {ifuonu PoffAa).— Titefio consist in 8oft fiat 
(apiiles covered with an ofiensive, grayisb secretiou. Ueai 
and moisture favor Uhi't dcvdopmcnl. i>o that their favorite 
M>at>; lire around the nrnis, tlio gi-nitalia, tlic nioulti, and tn 

Woni'TI aud(.T tlir' irl;iJiirTiri', 

Papulo-sqaamons SypliUodenn. — Tliis nwiy l>e au «u-ly or 
late uumife-tntion, and i.-t Hiunu^lerisi^^l bv a gcnrml iTiti*- 
tion of »nnll |iHpiilca whicli are more ur lint ^naly, ao ud to - 
rtititiubli; psorioiit)!. 

DiAOWwiK. — ^The hictory, the slight wtalinf;, tltc dirty-^ray 
(tilor of tla« .'»i'alHS the dari^-n^l color of the lesions, the esne- 
fiitl tt'u<lrtn^' tn involve ilw- palnu and soles will serve to als- 
liiiL;iii-!i syphilis from pfsimasis 

Squamdiu Ectoma — lu this affli-tion the dL<>tribulion, tlii; 
iulillnitlou of llie skin, ami the marked itcliiug will lead to 
a correct diai^iosi't. 

AontllU' Sypbilodsnn. — In this form iIm> InionK nxwUt uf 
ni>'les nr scnil-cinli-s •'I' fnuill ilariv-n''l [Mipuli'x, 

Pnstnlar Sypbilodflno. — Thi'< lorm u^mdly ap|Hiir« within 
the tlrst year, and isilmnictpriwil hyn){rinTal i-niptton of small 


or lar^, acumiDatod nr flat |)aBtiil<s wliirh finally dn- 
and form VGllDwiiiU-bixtwti cnisbi. I^ivc Iceioiis k«vc *ii_ 
ificial ulcers. TIk- term rupia is apulied to lai]^, conial, 
■ Mnililivd crusts whicli reel lotwdy i>n toe ulwrating bniu*. 

l>lAiiSOsit^ Wiriota. — Aleeuw ui' aygthililir' Ti'wUiri', t\f 
tfliot-like fifl, the imibilication, tbt' itthiiig, the liigti ji^vtT, am 
the actite ouuree will separate variola frv^ru syphilis. 

Ae«e> — This is usually limited to tJkc (iv^ and sbouLdMs 
thrre n tu> history of syphilis or ooDconiitant ciyinptonig 
that iiflix-tiot). — The intcmsl treatmeat coiisiats iu tJie ad- 
niiniBtrultoa of iodide of pota^utu, mercurials, and tonics 

« Hydrar^. l«; 
I'alan. lodJd.. 3IV ; 
Syr. »Rnapnrill(B co.. 
Aqua:, aK f^ij.— M. <It. W. TAVI.OR.) 
Sig.— Teaspoouful tfaree tlim^ & day after uunUa. 


lyt Itydnug. protlodUli, gr. v.x ; 

Ext, opii, gr, V. -M. (HaboAWat. 
8ig.— One morning Rtid evening. 

IxKjAL TnKATJl»yiT. — PapuloT cniptioDB may be wa.'ibt^ 
with QKn;urial lotions ; mucous pat<!he4 may be dusted with 
calomel ; ulocrs may be dressed with iodoform. ' 


(XiOjwa. Elepluintlaala Oimcoram.) 

PEFtNlTiON.— .\ ohroni<! conta^nm diM-nf^, exptted by tlir 
luicitlitsi iif lAfuxKiy, and i-liaractcriiuad bv Liil>tmilar toruiatioi», 
tiluerntiiin^ atrophy, diiUurbaiKis of wiisation, and an in- 
crtMw or decr«ise of pigment. 

KTiofjtNiY.— Th*^ diacaw is contagious, but direct iDonila- 
tiou is essential to its tranaminsion. It seems to be mo 
mmmmi iu hot climates. The excitiiifi: cause is tlio l>3t-illii 
leprw, whi<tb cloeelv resembles the tubercle bacilltis. 

Variktikh, — There are two varieties: Tubeimlar U'prwsy 
awl aniestitctic leprosy ; but the two liirms are ofl(!D assodat*^ 
iu the same patient 



SyuPTOMK. — Certain prodronufH may jirewde tlie outlirouk 
of 1)m- <)is(«!>c, surh ils malniee, liradu'-he, cliilliDrM, <)u[in^uii 
of sjiirilis. aiul niimlitH-M^ in tlii' iwirljs U> hv afrrckii. 

iSth'Tf^dur Lt^/mifi/. — lii t(ii>« thrtn c[n>l« iii' i.Tytlioma ap- 
|H>ar on thi^ ImmIv ; iIh'v wmn iHii.inii- jiifj:iii'titi'<i ami Iivjut- 
H-!itlii*l)c, aihI i!<'vi'lti|> into tiilnTi'kft vnryuig in iiiw tViitii a ]»« 
til a walniil, I'lio fiui% vxlivnitti«A, and goniliiU are tho parto 
niwt nomtnonlv nfTK-ltil, Itiit ootnt--'! anally t)i(> niiifoiis oieni- 
braivps, «s|>i<-ially of ihe iMx^e ami throat, are invaded. Ulti- 
mately till.- tiiliercU« may brrak do«n and leave sujiei-iicial 
indolent iilopi-s. In some casta a bullotis emiition apiK^ra 
from time tn lime. The hair, eyebrows, and ryelashea ftdl out, 
the cyce be>v>me infiamed, the features dislort4'<I, and the voice 
Iniskv'. 'ftte diwase may last many yoire, t!«atli ttnully retiult- 
hif; from exhaustion or some inti-n-um-iil iliiKtiK*-. 

AmrMtirlic J^prMi/. — In lliis form iIr- [KTi(ilicinl nervca 
arc invo<lc<l by tht- tuu.-illim iejini-. The uutbnak mnv \k 
prwxtiwl by mimbm-w, tloliing, or hndnatini: [