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Full text of "The breath, and the diseases which give it a fetid odor. With directions for treatment"

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THE BREATH, 



AMD THE 



DISEASES WHICH GIVE IT A FETID ODOR. 



WITH LIRECTIONa FOR TREATMENT. 



BY 

JOSEPH Wr HOWE, M. D., 

AUTHOR OF "ekergencies;*^ pbofbssor of clinical subgeby in bbllb- 

YUE HOSPITAL MEDICAL COLLEGE; CLINICAL PB0FEB80B OF SUBGEBY 
IN THE MEDICAL DEPARTMENT OF THE UNIVERSITY OF NEW 
YORK; YISITINQ SURGEON TO CHARITY HOSPITAL; FEL- 
LOW OF THE NEW YORE ACADEMY OF MEDICINE, ETC. 



FOXJBTH EDITION, EEVISED JJSTD CORRECTED. 



NEW YORK; 
D. APPLETON AND COMPANY, 

1, 8, AMD 5 BOND STEEET. 
1894. 






Dental Library 

736 
/S94 



Entered, according to Act of CongreBS, in the year 1874, 
Bt D. APPLETON a CO., 
In the Office of the Librarian of Congrees, t^t Washington. 









PREFACE. 



Marked changes in the breath have here- 
tofore received little consideration from the 
profession. Our medical text-books contain 
scarcely an allusion to their existence. I 
have endeavored, in the following pages, to 
give a succinct account of the diseased condi- 
tions in which a fetid breath is the most im- 
portant feature. The principal facts detailed 
concerning the production of the offensive 
odors are the results obtained from personal 
investigations, conducted both in private 
practice and in our city hospitals. 

J. W. H. 

88 West Twkntt-foubth St., ) 
September 1814, ] 



r 



CONTENTS. 



CHAPTER I. 

PHTBIOLOOY OP BEPAIB, DECAY, AND KE8PIBATI0N. 

General Considerations. — Sympathetic Connections. — Changes in the 
Food during the Process of Digestion. — Destruction and Repair 
of Tissue. — Compounds resulting from Physiological Decay and 
Putrefaction. — Composition of Air inhaled and exhaled. — Effects 
of Medicinal Substances on the Breath. — Causes of Fetid 
Breath page 7 

CHAPTER n. 

FETID ODOBS FKOM EMOTION, ETO. 

General Effects of Excessive Emotion. — Cases in which it destroyed 
Life, and produced Serious Disorders. — Emotion as a Cause of 
Bad Breath. — Class of Persons most subject to its Influence. — 
Prevention. — Constipation, its Effects on the Respired Air and 
Secretions. — Special Deodorizers 21 

CHAPTER m. 

FETID ODOBS FBOM DYSPEPSIA, 

Causes of Indigestion. — Symptoms. — ^How Indigestion affects the Air 
passing from the Lungs. — Relation to Constipation. — ^Examples. 
— ^Various Methods of Treatment. — Bad Breath from Congenital 
Deficiency of the Eliminating Apparatus of the Intestines 88 



B CONTENTS. 



CHAPTER lY. 

FETID ODOBS FBOM BAD TEETH AND I7LGEB8 OF THE MOUTH. 

Decayed Teeth as a Cause of Bad Breath. — Effects of DecomposiDg 
Food in the Cavities of the Teeth. — Causes of Decay. — ^Develop- 
ment of a Vegetable Parasite in the Mouth fropi XJncleanli- 
ness. — ^Accumulation of Tartar and its Chemical Composi- 
tion. — ^Bad Breath from InflammationB and Ulcerations of the 

Mouth PAGE 50 

CHAPTER V. 

FETID ODOBS FBOM OATABBHAL DI80BDEBS. 

Clergyman^ s Sore-Throat (Follicular Pharyngitis). — Peculiarities of 
the Inflammation. — Effects of Decomposing Mucus on the 
Breath. — Complications. — Treatment. — Cancerous Diseases of 
the Tongue and Pharynx. — ^Fetid Odors following Diphtheritic 
Diseases of the Throat, etc 67 

CHAPTER VI. 

OATABBHAL ODOBS (CONTINUED). 

Oaena depending upon Syphilis, Scrofula, Necrosis, and Caries of 
the Nasal Bones, and Herpes. — Character of Fetid Odors. — Bad 
Bi'eath from Ulceration of the Larynx and Trachea. — Putrid 
Bronchitis. — Bronchiectasis, etc. — Treatment ... 78 

CHAPTER VH. 

FETID ODOBS FBOM MINEBAL POISONS. 

Uie and Abuse of Mercury. — Organs which eliminate the Drug.— 
Effects on the Salivary Glands. — Quantity of Drug necessary 
to produce Salivation. — Mercurial Fetor. — Remedies. — Bad 
Breath from Arsenic, Lead, Antimony, Phosphorus, etc. — 
Treatment 98 



J 



THE BREATH. 



OHAPTEK I. 

EEPAIR AND DECAY RESPIRATION. 

General Considerations. — Sympathetic Connections. — Changes in the 
Food during the Process of Digestion. — ^Destruction and Repair 
of Tissue. — Compounds resulting from Physiological Decay and 
Putrefaction. — Composition of Air inhaled and exhaled. — ^Effects 
of Medicinal Substances on the Breath. — Causes of Fetid Breath. 

An offensive breath is a functional disor 
der liable to occur at all periods of life. Men 
are more subject to it than women. It is a 
prominent symptom of many morbid condi- 
tions. The affection derives its importance 
from the fact that it is a constant source of 
misery to all who, by force of circumstances, 
are compelled to associate with the unfortu- 
nate patient. In its worst forms it effectu- 
ally destroys the communion of friends, and 



8 THE BREATH. 



the pleasures of social intercourse. Even 
the harmony of the home-circle is invaded by 
a feeling of repugnance, which the best of us 
can scarcely control. Yet how few of the 
afflicted persons detect the cause of their iso- 
lation, or recognize the barrier which effect- 
ually prevents the approach of those near 
and dear to them ! With the best intentions 
in the world, we rarely whisper a word of 
their disorder or suggest a source of relief. 
This false kindness — this demoralizing weak- 
ness — is imiversal. 

In order to become acquainted with the 
sources of the fetor, to be enabled to prevent 
as well as to rehiove it, we must investigate 
some of the physiological processes mani- 
fested in the continual working of the animal 
organisuL In a work like this such investi- 
gation must necessarily be limited. Enough 
can be learned, however, to give a proper 
understanding of the disorder in its various 
phases. 

Each organ has characteristics peculiar to 
itself, and, though each process is distinct, 



SYMPATHETIC CONFECTIONS. 



there is no real isolation, for a multitude of 
nervous and vascular links bring all parts of 
the mechanism in close relationship. From 
the aggregation results one harmonious 
whole — a microcosm complete, and filled 
with exceeding beauty. 

The nerves constitute a telegraphic sys- 
tem, through which the most delicate impres- 
sion is transmitted from one part to another, 
with almost immeasurable rapidity, until it 
is registered in the great central oflSice of the 
brain. The net- work of blood-vessels per- 
meating the tissues throughout carries a con- 
stant stream of nutritive material to every 
part, neglecting none, and delivering its ele- 
ments, according to the special needs of the 
organ it traverses. Thus the brain abstracts 
from the blood the peculiar food which sus- 
tains the nervous ganglia in their varied func- 
tions. The lungs remove from it carbonic 
acid, which has arisen from the molecular 
decay of tissue, and give to it a fresh supply 
of oxygen for sustaining the vital forces. 
The kidneys take away the excrementitioua 



10 THE BEE ATE. 



materials which constitute the urine. The 
liver receives from it the ingredients of the 
bile, as v^ell as the nitrogenized substances, 
for its own sustenance. And so it travels, 
giving up one element here and another 
there, meeting constantly the diversified de- 
mands upon it, and creating a unity of ac- 
tion which makes up the life of the individ- 
ual. 

When morbid changes arise in the struct- 
ure or in the functions of an organ, the whole 
body gives evidence of the pernicious effects. 
If the blood which circulates through the 
encephalic mass is deficient in nutritious 
elements, or poisoned by adventitious sub- 
stances, the outflow or generation of thought 
is retarded, and the mental processes gener- 
ally weakened. We wander from the subject 
— we forget. Our ideas are incoherent and 
pointless. There is a general feeling of de- 
pression, weariness, and anxiety. On the 
other hand, over-excitation of the brain over- 
drawing the reservoirs of nerve-force, weak- 
ens the power of digestion and impairs the 



EFFECTS OF MORBID CHANGES. 11 

_. I I ■ 11 ■■ I -I ' ■_---■ — 

quality of tlie nutritious elements taken into 
tlie system. Consequently the blood becomes 
impoverished, and in its turn increases and 
keeps up the disorder for an indefinite period. 
Again, when the heart is filled with the de- 
praved blood, or when its nervous force is 
not sufficient to sustain its vitality, it be- 
comes irregular in its action and beats with 
diminished force. The distant organs which 
depend upon it for a proper amount of vital 
fluid to keep them in working order are en- 
feebled, and fail to fui'nish healthy secretion. 
In this manner the morbid action is commu- 
nicated to the whole human mechanism, until 
every fibre feels the change. 

It is mainly, however, to a disarrangement 
of the functions of digestion and assimilation 
that we must look for the origin of "bad 
breath." The starches, sugars, fats, inorganic 
salts, and nitrogenized bodies, constitute the 
different elements necessary for alimentation, 
or for the support of life. The most impor 
tant of these are the albuminoid bodies which 
are obtained from meat, breiad, cheese, etc. 



12 THE BREATH. 



The albuminoid substances contain nitrogen, 
and hence are known as nitrogenized bodies. 
The great mass of muscular, osseous, nervous, 
and vascular tissues, in the body, is made of 
these substances in varied proportions. In 
the stomach, the fibrine and albumen of the 
meat, the gluten of the bread, the casein of 
the cheese, are mixed with the gastric juice 
and changed into a substance called albumen^ 
086. In this state they are absorbed by the 
blood-vessels, and carried by the blood, to- 
gether with other portions of digested food, to 
the different tissues which they nourish and 
keep alive. With the process of supply there 
is also one of waste. Death of tissue is pro- 
ceeding with a rapidity equal to the amount 
of repair. Life and death go hand-in-hand. 
Absolute death is essential to a renewal of 
life. The products of decay or " destructive 
assimilation" are carried off by the kid- 
neys in the shape of urea, creatine, creati- 
nine ; by the lungs in the form of carbonic 
acid and water; by the bowels in the formes 
of excretine, and various gases, such as sid- 



PRdniTGTS OF DEGAY. 13 

phuretted, carbiiretted, and pbosphuretted 
hydrogen. Some of the gases are manufact- 
ured in the intestinal canal by the decom- 
position of undigested food. Sulphuretted 
hydrogen, which has an odor resembling rot- 
ten eggs, is found in greater abundance than 
the other compounds of hydrogen. These 
gases are secreted by the mucous membrane 
of the intestines ; sometimes they are thrown 
off by the glandular apparatus in the skin. 
This is often noticed when large doses of sul- 
phur have been taken internally. In some 
persons the quantity of sulphuretted hydro- 
gen passing off by the skin is suflScient to 
stain metallic articles carried in the pockets. 
Outside of the body nitrogenized substances 
undergo decay as they do inside. But in the 
latter case the changes are so gradual, that 
we usually fail to notice their extreme offen- 
siveness. They pass through similar changes 
whether decomposing in the intestinal canal 
— ^the follicles of the mucous membrane^ — or 
in cavities of the teeth. Coincident with the 
process of putrefaction, fetid gases may be 

2 



14 THE BREATH. 



secreted by the secreting apparatus of the 
intestines. 

The air we take into the lungs with each 
inspiration is composed of seventy-nine parts 
of nitrogen, twenty-one of oxygen, a trace of 
carbonic acid and of ammonia. In . certain 
localities adventitious gases are added, which 
render it exceedingly unhealthy. This is es- 
pecially true of parts of New York, where 
street-cleaning has become one of the "lost 
arts," and, as a legitimate consequence, sewer 
and garbage effluvia are constant elements in 
the respired air. 

The large amount of nitrogen in the 
air dilutes the oxygen, so as to divest it 
of all irritating qualities and make it re- 
spirable. 

With each inspiration we take in only 
twenty cubic inches of air. This passes 
with each act as far as the first bifurca- 
tion of the bronchial tubes. As the capaci- 
ty of the lungs is about two hundred and fifty 
cubic inches, it is therefore seen that but a 
small portion of the contents of the lungs 



PHY8I0L0G Y OF RE8PIRA TION. ] 5 

is changed by eacli respii'atory movement. 
There is, however, a constant interchange or 
diffusion of gases, by which the heavier oxy- 
genated air is carried down to the air-cells, 
and the heated carbonic acid carried up. The 
movement is assisted by the ciliated epithe- 
lium lining the walls. These cells "play" 
from below upward, thus creating a current 
at the sides, which assists the passage of the 
expired air through the bronchial tubes. The 
oxygen passes through the walls of the air- 
cells into the capillary ramifications of the 
pulmonary veins, and is carried off into the 
general circulation to the tissues in every 
part of the organism. 

The products of decay or retrograde meta- 
morphosis eliminated by the lungs, as before 
stated, are carbonic acid (composed of one 
atom of carbon and two of oxygen), water 
(formed of one equivalent of hydrogen and 
oxygen each, and a trace of animal matter). 
In a healthy state, when every organ is work- 
ing naturally, there is no unpleasant odor 
from the expired air; but, as soon as the 



16 THE BREATH. 



machinery gets out of order — as soon as ex- 
traneous materials are added — ^the breath is 
tainted. We may illustrate by taking the 
well-known effects of various volatile sub- 
stances intraded into the system. Balsam- 
copaiba, in small doses, passes off by the 
kidneys ; in large doses the lungs assist in 
its elimination, and its presence is then readi- 
ly detected in the breath. Sandal-wood oil 
will affect the breath in thirty minutes from 
the time it is swallowed. Turpentine may 
be noticed in from thirty minutes to an hour. 
Sulphur will produce a very marked odor 
in the perspiration and expired air in two 
hours. The characteristic and more familiar 
odor of alcohol is easily recognized in the 
breath of an imbiber in ten minutes. These 
drugs pass off through the lungs when or- 
dinary emunctories are overworked. 

Prof. A. L. Loomis, of this city, has at 
the present time under observation an in- 
teresting case of diabetes mellitus. The pa- 
tient has all the well-known symptoms of 
this disease, and, in addition, a breath which 



EXCRETION THROUGH THE LUNGS. 17 

gives off a well-marked odor of sugar. In 
diabetes^ there is a greater quantity of sugar 
manufactured than is required for the wants 
of the system. The surplus is thrown off, 
generally, by the kidneys. It is an exceed- 
ingly rare occurrence for the lungs to take 
part in getting rid of the sugar. In this 
case, however, there was probably an un- 
usual amount made, or less of it assimilated, 
than usual; therefore, every organ capable 
of excretion was compelled to assist in throw- 
ing it off. In Bright's disease of the kid- 
neys, v/rea is retained in the blood. This 
substance combines with the water in the 
circulating fluid to form carbonate of am- 
monia. In a short time the skin and the 
lungs endeavor to get rid of the poison, 
and then we can discern, in the perspira- 
tion and in the expired air, the character- 
istic odor of ammonia. 

In the same manner, gaseous results of 
decaying nitrogenized tissue may be carried 
off when the other gate-ways are closed. A 
little sulphur in excess, combined with the 



18 THE BREATH. 



hydrogen of the watery vapor going off dur- 
ing expiration, fonns sulphuretted hydrogen, 
and causes at once an offensive breath. A 
simple rearrangement of the atoms of cai'- 
bon and hydrogen will give carburetted 
hydrogen (CHf), which also communicates 
to the breath a peculiar and disagreeable 
odor. 

These facts being understood, it may be 
stated, as a general proposition, that any 
morbid condition of the system which pre- 
vents the elimination of metamorphosed ni- 
trogenized tissues through the mucous mem- 
brane of the intestines, or retards the pas- 
sage of the decomposing detritus through 
the bowels, will produce a fetid breath. 
The same result probably follows structural 
changes in the kidneys. Nature, to get rid 
of the poisonous accumulations, to maintain 
an equilibrium, must throw them off else- 
where, either in their offensive form or in 
modified, non- offensive combinations. Or, 
where the waste of tissue exceeds the re- 
pair, as in chronic, debilitating diseases and 



CAUSES OF BAD BREATH. 19 

low fevers, the eliminating glands are unable 
to do the work imposed upon them, and vica- 
rious elimination necessarily follows. Thus 
the gaseous products of the stomach, the ex- 
halations from the skin, become more or less 
poisoned and fetid from admixture with foul- 
smelling gases. The bad odor in the respired 
air is more noticeable than from any other 
part, but a close examination of the patient 
will show that the skin likewise gives off 
a very disagreeable fetor. 

The various diseased conditions which 
prevent the intestinal glands from eliminat 
ing the products of destructive metamorpho- 
ses are mental emotions, constipation, indiges- 
tion, congenital deficiency in the eliminating 
glandular system, general debility, and low 
forms of fevers. The local causes are decayed 
teeth, caries of the nasal or maxillary bones, 
ulceration of the lining membrane of the nose, 
mouth, pharynx, layrnx, trachea, or bron- 
chial tubes, or "putrid bronchitis." Chronic 
poisoning from lead, arsenic, or mercury, may 
also be enumerated as a common cause of 



20 THE BREATH. 



halitoaia.'^ In the subsequent chapters these 
various diseased conditions will be consid- 
ered, together with the appropriate treat- 
ment necessary for each. 

^ The term " halitosis '^ signifies diseased hreath. It is de- 
rived from the Latin halitus (breath), and the Greek n<mB 
(disease). — Eartard. 



CHAPTER II. 

FETID BREATH FBOM EMOTION, ETC. 

General Effects of Excessive Emotion. — Cases in which it destroyed 

Life, and produced Serious Disorders. — Emotion as a Cause of 

\ Bad Breath. — Class of Persons most subject to its Influence. — 

Prevention. — Constipation, its Effects on the Respired Air and 

Secretions. — Special Deodorizers 

The influence of mental emotion on the 
animal economy has never received the con- 
sideration which its importance demands. 
Accustomed to regard the mind as some- 
thing apart fi-om the rest of the human 
mechanism, we are apt to overlook it when 
investigating questions of animal pathology ; 
and we constantly underrate its power over 
the processes of growth and decay going on 
within us. It is the tendency of the times 
to accept only what we can see, feel, and 
weigh, and gauge by our own narrow, in- 
finitesimal conceptions the expansion of the 



22 THE BBEATH. 



infinite. We separate too widely mind from 
matter, and consequently come short of a cor- 
rect appreciation of morbid physical changes. 
This is not the place, however, for the illus- 
tration of this subject ; nevertheless, it wiU 
be necessary for illustration to give a few 
instances of the effects of mental emotions 
in totally changing healthy conditions, and 
replacing them by serious and even fatal 
disorders. 

A criminal, who had been condemned to 
death for murder, was given into the hands 
of a celebrated French surgeon. He was 
told that his judges had decided that he 
should be bled to death on a certain hour 
the following day. When the appointed 
time arrived he was blindfolded and placed 
in a bed. The surgeon then made a small 
incision through the skin, which did not 
involve any of the blood-vessels. One of 
the persons interested in the experiment 
placed his fingei^s on the pulse, another held 
a vessel of lukewarm water above the wound- 
ed arm and allowed the liquid to trickle over 



FEAIt AS A CAUSE OF DEATH. 23 

its suiface and drop on the floor. Meanwhile 
the surgeon, in his conversation with the as- 
sistants, alluded to the gradual weakening 
of the pulse, the fluttering of the heart, and 
the paleness of the countenance, until the 
criminal, fully convinced that his end was 
near, fainted and died, without having lost 
a single drop of vital fluid. 

A similar incident occurred in Moscow a 
few years ago. A criminal, who had been 
condemned to suflfer the death-penalty, was 
told that he was to sleep in a bed from 
which the dead body of a cholera patient 
had just been removed. He was then con- 
ducted to a well-ventilated room and placed 
in a bed perfectly clean, which had never 
been used. Toward morning he was taken 
with all the symptoms of cholera, and died 
in a few hours. 

Instances of less violent results from men- 
tal emotion are not uncommon. Terror has 
changed the color of the hair from black to 
white. Fear may excite the sweat-glands to 
such an extent as to bathe the skin in a pro- 



24 THE BREATH. 



fdse perspiratioiL The same emotion may 
so excite the action of tlie heart as to make 
its impnlse perceptible through the clothing. 
A single thought will often take away the 
appetite, or the remembrance of some favor- 
ite article of diet will create one, and also 
increase the secretion of saliva and buccal 
mucus. Excitement has been known to 
cause convulsions, dizziness, intense pain in 
the head, and dimness of vision, which dis- 
appeared on the return of calmer feelings. 

Mental excitement may also alter the se- 
cretions of the alimentary canal and affect 
the functions of the glandular system, so as 
to prevent the proper elimination of the 
disorganized, useless, nitrogenized materials 
through the ordinary channels; and then, 
as a natural consequence of the change, we 
must expect an alteration in the composition 
of the air passing off from the lungs, and a 
contamination by gases, which give it a fetid 
character. In such cases, the effect is brought 
about simultaneously with the excitement; 
in others, again, it develops subsequently. 



FETID BREATH FROM EMOTION. 26 

At one moment the breath will be sweet, 
at the next fetid and unbearable. The odor 
is not so penetrating or disagreeable as that 
arising from decomposing food in the cavi- 
ties of decayed teeth or from dead teeth. 
The patients are usually conscious of its ex- 
istence, which is not the case in many other 
varieties of the affection. They are subject 
to violent fits of temper, easily excited, and 
as easily depressed. The appetite is varia- 
ble. Sleeplessness is a common accompani- 
ment. The following cases from my note- 
book afford good examples of the class under 
consideration : 

Case I. — ^Mrs. G., aged forty ; occupation, 
singer. She is slight, but firmly built, and 
has an extremely sensitive nervous organiza- 
tion ; is able to endure fatigue without dis- 
comfort ; never had any hysterical mani- 
festations, although extremely liable to lose 
control of herself under provocation. , She 
has been subject at intervals to a bad breath, 
and is always conscious of its presence. It 
comes on suddenly, and is accompanied by a 



26 THE BREATH. 



peculiar taste in the mouth. It follows or 
accompanies fits of depression or anger, but 
never occurs from pleasurable excitement. 
Preceding the menstrual epoch it is aggra- 
vated ; it disappears with the flow. Once in 
two or three months an intense headache 
comes on, with vomiting of bilious matter. 
This sometimes occurs without affecting the 
breath. She calls it a "feverish breath." 
Her appetite is good, and she is able to 
digest her food, except when suffering from 
depression. Constipation is also present at 
such times, but it follows and does not pre- 
cede the bad breath, showing that the tor- 
pidity of the bowels is likewise an effect 
of the mental condition, and not a cause. 
She thinks the affection has lasted about 
five years. 

Case II. — ^Mrs. K., aged thirty-two. Is 
a lady above the medium height ; inclining 
to embonpoint. She enjoys excellent health, 
has a good appetite, and digests her food 
readily. She is not subject to any special 
manifestations of excitement ; fits of depress 



FETID BREATH FROM EMOTION. 27 

sion, however, are not uncommon at the men- 
Btrual epoch. The peculiarity in her case 
consists in this, that, whenever she is pre- 
paring to receive company, her breath be- 
comes perceptibly " feverish." The odor con- 
tinues imtil the excitement consequent upon 
the entertainment has subsided. Under simi- 
lar circumstances the same thing has occurred 
for four years. During the free interval her 
breath is pure and sweet. An examination 
of the mouth and throat showed (as in the 
previous case) that there was no local cause 
for the affection. 

Case in. occurred on the 23d of May last. 
On the morning of that day Mrs. R,, a lady 
of forty-five, was bitten by a pet dog ifiHEKe*^ ^ 
arml^ She was very much alarmed at the 
occurrence, and fainted, I saw her an hour 
afterward, and, while examining the wound, 
discovered that her breath was very fetid. 
Having seen her frequently before without 
noticing any thing abnormal in the breath, 
I questioned her concerning it. She stated 
that she had been in perfect health up to 



28 TEE BEE ATE, 



I 
I 



the time of the accident, and that her breath 
had not been affected before it. 

The suddenness with which the offensive 
breath develops in these cases may be ex- 
plained by the theory spoken of above, or 
it may be that unusual nervous excitement 
induces a greater destruction of tissue than 
normally obtains, and, before the intestinal 
glands can accommodate themselves to the in- 
creased labor, other organs must assist in get- 
ting rid of the overplus of noxious material 

Bad breath, arising from mental emotion, 
is less amenable to treatment than any other 
variety, because it often depends on the will 
of the patient whether the cause shall be re- 
moved or not. There is no local fault which 
can be grasped and removed. The treatment, 
consequently, must be directed to the gener- 
al system. All sources of mental irritation 
shoidd be removed. Cold sponge-baths daily 
are of great service in giving tone to the 
nervous system. In certain cases shower- 
baths are good, but delicate persons are 
over-stimulated by them. Plenty of exer- 



CONSTITUTIONAL TREATMENT. 29 

cise in the open air is also a requisite. As 
mucli vegetable food as is consistent with a 
healthy state should be eaten at each meal, 
and the animal food diminished, /when 
mental excitement is known to occur at cer- 
tain stated intervals, the following prepara- 
tion will be found of great service. It acts 
as a stimulant to the nerves, and enables the 
patient to pass the difficult date with ease : 

]J. Tinct.lavand.comp., fli> 

Tinct. valerian., f | ss. 

Mist, campb., f 3 iij. 

Aquae carui, f | j. 

Dose, fifteen drops on sugar every hour until the 
depression is relieved. 

In some cases five or ten grains of musk, 
repeated once or twice during twenty-foui 
hours, will be found efficacious. 

Or either of the following may be em- 
ployed : 

5. Tinct. Valerianae ammon., f3ss. 

Tinct. castorri comp., f 3 j. 

-<Etheris, gt. XV. 

Aquae anetbi., f | iss. 

Half of this preparation may be taken two or three 
times each day. 



80 THE BREATB. 


Q. Tinct. assafoetidse, 


• 


ffj. 


Tinct. hyoscyami, 




f3ij. 


Tinct. cinnam., 




f Siss. 


Aquas menth. pip., 




f3ij. 


M. 






Dose, one teaspoonful in 


water every 


three hours. 



Should the breath be affected in spite of 
the preventive remedies, a wafer or pill, com- 
posed of the following ingredients, may be 
allowed to dissolve in the mouth. It effect- 
ually destroys the bad odor. Before using 
it, the teeth should be thoroughly cleansed 
and the gums sponged with a solution of 
myrrh and water : 



J. Pulv. cinnam., 




Pulv. pimentae, 




Pulv. cardam., 


aa3ss. 


Sacchari alb., 


3j. 


Mucil. gum. acacias, 


q. s. 


Make fifty pills. 





Fifteen drops of oil of nutmeg, mixed 
with one teaspoonful of olive-oil, is a good 
deodorizer. It should be rubbed on the 
gums and cheeks with the finger. 

Sometimes it is necessary to act on the 



CAUSES OF COFSTIPATIOK 31 

bowels with a mild cathartic before the odor 
can be removed. When the secretions of the 
intestinal canal are increased, the other medi- 
cines are more certain in their curative ao- 
tioa. In such cases, a combination of rhu- 
barb), myiTh, aloes, and oil of peppermint, 
acts beneficially. This compound passes un- 
der the name of "compound rhubarb-pill." 
Two or three may be taken at bedtime. 

CONSTIPATION 

Is more frequently a cause of bad breath than 
the preceding. A diminished secretion of 
mucus from the lining membrane of the in- 
testinal canal, or deficient peristaltic action 
of the muscular coat, are its most common 
causes. Persons of indolent habits, who are 
accustomed to lounge in-doors, and rarely ex- 
ercise in the open air, are very subject to it. 
A watery condition of the blood (ancemid) 
may produce constipation by lessening the 
normal amount of the secretion, or deterio- 
rating the elements whidi enter into their 
composition. Nearly all forms of indiges- 



82 THE BREATH. 



tion have constipation as one of the promi- 
nent accompaniments. 

When constipation exists, the disentegrat- 
ed materials, which are thrown off through 
the mucous membrane, and the remains of 
undigested food, accumulate in the canal. 
The mass is passing rapidly through all the 
various stages of decomposition, and, by its 
pressure and irritation of the glands, it di- 
minishes the normal excretory function, and 
Nature, to maintain an .equilibrium, throws 
its surplus of excretory materials on the 
glands of other mucous membranes. Then, 
again, the gases, in solution, arising from the 
decomposing accimiulation, may be taken up 
by the blood-vessels, and thus increase the 
effluvia. 

It will be noticed, in most of these cases, 
that the skin is darker than is natural, or 
has a yellowish, semi -jaundiced hue, and 
that the odor of its secretion is percepti- 
bly changed. The tongue is coated. The 
mucous membrane of the lips may be dry 
and parched, and, in certain places, its epithe- 



FETOR FROM C0F8TIPATI0K 33 

Hal covering peels off, leaving the membrane 
denuded. The breath is fetid, but the pa- 
tient is generally unaware of it. When no« 
ticed by the patient, he usually expresses the 
fact by saying that the breath is ^^feverishP 
Other signs of general disturbance of the func- 
tions of the body may after a time appear ; 
but their consideration belongs to other de- 
partments, and will not be touched upon here. 
The treatment of this class of cases, when 
properly carried out, is eminently successfal. 
The fetor can always be removed. In the 
first place, however, the patient must be 
made to understand that medication alone 
will not produce any permanent improve- 
ment. An entire change of habit is required. 
Vigorous exercise out-of-doors shoidd be con- 
stantly enjoined. Where this is not practica- 
ble, sparring, dumb-bell, or club exercise, will 
be of great benefit. Fniit, such as oranges, 
peaches, pears, etc., should be eaten in the 
morning, before or during breakfast. Fruit 
eaten in this way is a valuable adjuvant 
in keeping up proper action of the bowels. 



34 THE BREATH. 



Friction of the abdomen with a rough towel 
after a bath, or at other times, will be found 
useful in promoting the same object. The 
patient should select for himself the most nu- 
tritious and digestible articles of diet best 
suited to his individual palate. What will 
answer for one will often interfere with the 
digestion of another; therefore no special 
diet can be laid down. In the majority of 
cases it will be found necessary to act on the 
bowels with gentle cathartics. They should 
be repeated every second day until the mu- 
cous membrane is restored to its normal con- 
dition. Active purgatives are rarely needed. 
The following tonic and laxative prepara- 
tions are exceedingly useful : 

;^. Pulv. aloes socot., grs. xij. 

Ext. nucis vomicae, grs. ij. 

Pulv. ferri sulph., 3j. 

Make twenty pills. One pill to be taken two or 
three times each day before meals, until the evacua- 
tions are regular and natural in appearance. 

If there be pain and flatidence in connec- 
tion with the constipation, it will be neces- 



TREATMENT. 85 



sary to tx)mbiiie carminatives with the cathar- 
tic medicine : 

5. Pulv. aloes sooot/., grs. xij. 

Pulv. rhei., 3ij. 

Ext. nucis vomicae, grs. iv. 

Pulv, zingiberis, 3 j. 

Make thirty pills. One pill before or after each 
meaL Or the following may be tried : 

9 . Magnes. carb., 3 ]• 

Sp. lavand. comp., f 5 ss. 

Olei anisi, 3 j. 

Aqu8B menthaB pip., f | vj. 

One tablespoonful four or five times each day be- 
fore eating. 

The officinal mixture of rhubarb, soda, 
and peppermint, given in teaspoonfal doses 
five times in tvs^enty-four hours, is also good 
in flatuleDce. A piece of rhubarb chewed, 
and the juice swallowed, will often answer 
the same purpose. 

As in the previous cases, the mouth and 
teeth should be cleansed thoroughly with 
the solution of myrrh and water (one tea- 
spoonful of the tincture of myrrh to a wine- 
glass of water), or the caibolic-acid solution 



36 TEE BREATH. 



(four grains to two ounces of water). The 
tincture of cinnamon, slightly diluted with 
water, can be applied to the interior of the 
mouth and gums with a brush. It will com- 
municate its flavor to the breath for a con- 
siderable length of time. Pieces of charcoal- 
cake as large as a hazel-nut may be eaten 
half a dozen times during the day with ben- 
efit. These things, however, only diminish, 
but do not entirely dispel the offensive odor. 
As a permanent deodorizer, the wafer men- 
tioned in a previous page may be employed 
in conjunction with the following : 

5. Pulv. oarui sem., 

Pulv. coriandri gem., 
Pulv. cinnam., aa 3 ss. 

Saccb. alb., 3 j, 

Mucil. gum. acaciae, q. s. 

Make fifty pills. Dissolve one in the mouth when 
necessary. 

Tlie root of Acorua Calamus^ or sweet-flag, 
when chewed, impregnates the breath strong- 
ly with its pecidiar aromatic principle. A 
piece the size of a pea will answer. The 
odor obtained by masticating the leaves of 



DEODORIZERS. 37 



the common partridge-berry (^Gaultheria pro- 
cumbeni) is exceedingly agreeable, and makes 
an excellent deodorizer ; or, one teaspoonful 
of tincture of gaultheria and one of tincture 
of myrrh, added to an ounce of water, will 
be found equally efficacious. 

Cigarettes, in which are mixed small pieces 
of cascarilla or cinnamon bark, may be smoked 
by persons who are in the habit of using to- 
bacco. 

Where the constipation and bad odor are 
kept up by a general lax condition of the 
system, a course of tonic medicines alone will 
often suffice to bring about a cure. Vegeta- 
ble tonics, as a rule, agree better with the 
stomach than mineral ones do. A mixture, 
composed of equal parts of tincture of wild- 
cherry and cinchona barks, is good. K iron 
is indicated, the following may be given : 

5. Ferri pyrophosph., 3 ij. 

Quinse sulph,, 3 s& 

Acidi sulph. dlL, q. s. 

GlycerinaB, | iv. 

One teaspoonful in a wineglass of water four times 
each day. 



CHAPTEK III. 

FOUL BREATH FROM HHJIGESTION, ETC. 

Causes of Indigestion. — Symptoms. — ^How Indigestion affects the Air 
passing from the Lungs. — Relation to Constipation. — ^Examples. 
— ^Various Methods of Treatment. — Bad Breath from Congenital 
Deficiency of the Eliminating Apparatus of the Intestines. 

The false mode of life characteristic of 
the nineteentl) century, the hurry, excite- 
ment, and worry, are generators of innumer- 
able ills. Their most common sequences are 
disorders of the digestive functions. Seden- 
tary habits, overwork, and the disgusting 
practice of "bolting" food, assist them in 
sapping the vitality until Nature gives way 
under the strain. Men eat as if they wished 
to get the food into the stomach in its most 
indigestible form. Their object is to save 
time — to save time, perhaps, for the cigar 
or bar-room. This is a great mistake. No 
reasonable excuse can be made for such a 



INDIGESTION. 39 



vicious practice, for all who indulge in it 
know, to their cost, the penalty, which, in 
the shape of dyspepsia and its kindred evils, 
constantly threatens them. 

The symptoms which characterize indiges- 
tion are, in some respects, similar to those con- 
nected with chronic constipation. In many 
instances, torpidity of the bowels is but a 
result of a poor indigestion ; yet, as indiges- 
tion frequently occurs independently of con- 
stipation, and, as habitual constipation is of- 
ten associated with excellent digestive pow- 
ers, it is but fair to make a distinction 
between them. There are, however, in addi- 
tion to the symptoms before enumerated, 
pain and weight in the stomach after eat- 
ing, and eructations of gas and acid liquids 
into the mouth. The gas may disturb the 
stomach and intestines so as to cause con- 
siderable pain. It rarely has a bad odor. 
Diari'hoea may be present, though the bow- 
els are usually constipated. There are often 
great nervousness and depression of spirits, 
amounting, in some cases, to melancholia. 



40 THE BREATH. 



The breath becomes fetid very soon after 
the commencement of the disorder. The of- 
fensive odor is worse in the morning and 
evening. Fatigue and nervous excitement 
invariably increase it. Immediately after eat- 
ing, it is scarcely noticeable. 

The odor may be due to the decomposi- 
tion of undigested food in the bowels, or from 
failure of the excretory glands to throw off 
the products of disintegration, or it may arise 
because decay of tissue is increased by the 
lack of support, resulting from the dimin- 
ished quantity of nutritious elements taken 
into the system. This deficiency of nutri- 
ment is a constant and necessary effect of 
indigestion ; and, with the excess of disinte- 
gration and the general torpor in the glands 
of the intestines, there is a demand for in- 
creased work in other parts to assist in 
throwing off the detritus. The following 
cases show the course of the affection in 
its various phases : 

Case I. — ^Mary M. G., aged thirty-one ; oc- 
cupation, nurse. Was first taken sick May, 



INDIGESTION. 41 



1870. At that time she began to lose her 
appetite and feel uncomfortable after eating. 
A heavy meal was always followed by a pain 
in the epigastrium and side. Solid food af- 
fected her more than any other kind. With 
the pain a burning sensation (heart -burn) 
was sometimes felt in the chest. Pressure 
over the stomach excited nausea and vomit- 
ing. Cold water taken at night caused a 
painful feeling of distention over the abdo- 
men, and a profuse flow of saliva into the 
mouth. On rising suddenly from the reclin- 
ing posture, her head would become dizzy 
and her sight dim. She attributed this to 
her weakness. In the morning her tongue 
was coated with a yeUowish-white fur, and 
her breath was exceedingly offensive. She 
was not aware of this latter symptom until 
informed of it by a friend, but since then 
the odor has been very perceptible to her 
own olfactories. 

On examination of this patient I found 
her face sallow and care-worn, and her breath 
very fetid. Her eyes were heavy, and the 



42 THE BREATH. 



edges of the lids red. The skin was dry and 
rough, like that of one convalescing from a 
fever, and the odor arising from it vras un- 
pleasant. While tinder observation, she ab- 
stained from all solid food, and confined her- 
self almost exclusively to a milk-diet. This 
resulted in complete relief from her unpleas- 
ant sensations. Afterward she went to the 
country, lived out-of-doors, and finally re- 
covered, without the aid of any kind of med- 
ication. 

Case II. — J. C, aged twenty-seven ; occu- 
pation, book-keeper. Has been employed in 
a hardware establishment. For two years 
past he has been in the habit of working 
from eight in the morning until ten or eleven 
at night. The only exercise he took was 
walking to the store in the morning. About 
two years ago he began to be troubled with 
flatulence. Every thing he ate seemed to 
turn sour on his stomach, and he was con- 
stantly belching up large quantities of gas, 
which had an unpleasant odor. The bowels 
were alternately constipated and loose. In 



EXAMPLES OF mDIGESTIOK 43 

*■■■■ ■ ■■ ■■ ■■■ M l mi ■ ■■■»■■ ■■■■■■■■»»■■- .1 i.^.^! I ■ I ■■■■ I ■^■—ii fc^i ■■ ^1^1 

about three months from the beginning of 
the complaint severe pain after eating was 
added to his other symptoms. The pain was 
burning in character, and almost unbearable 
until relieved by getting rid of the gas. 
He was in the habit of taking brandy after 
each meal, because it seemed to assist in di- 
gesting the food. His breath, he said, was 
feverish from the beginning; he noticed it 
was much worse in the evening than in the 
morning. There was a bad taste in the 
mouth continually. He thought the fetor 
was caused by the yellowish matter which 
accumulated on the tongue and gums be- 
tween meals. This coating was made up 
principally of epithelial cells and fine gran- 
ules. It gave off a slight fetid odor ; but its 
removal made little or no change in the char- 
acter of the breath. 

These cases are typical, and they consti- 
tute at least one-third of the practice of many 
of our medical men. 

The same general hygienic measures rec- 
ommended for the cure of constipation, and 



44 THE BREATH, 



the bad breath accompanying it, are neces- 
sary in every form of indigestion. Fresh air, 
nourishing food, change of habitation, rest 
from work and worry, do more toward pro- 
moting a cure than the most scientific medi- 
cation. Unfortunately, many of our patients, 
from necessity as well as inclination, remain 
under bad sanitary influences. 

When there are acid eructations, showing 
excessive acidity of the stomach, alkalies may 
be administered. Carbonates of soda or pot- 
ash, given in five or ten grain doses, and re- 
peated at short intervals, will give temporary 
relief. Lime-water is also good in certain 
cases, especially when there is nausea. 

To empty the bowels, and at the same 
time stimulate the secretions, the following 
powders may be given : 

5. Hydrarg. chlor. mitis, grs. viij. 

Pulv. rhei., x. 

Olei anisi, gt. v. 

Make two powders ; one to be taken at night, and 
the other in the morning. If the patient is robust and 
full-blooded, both powders may be administered to- 
gether. In the majority of cases it is best to com- 



TREATMENT OF INDIGESTIOK 45 

mence with a cathartic before resorting to tonics or 
deodorizers. 

A pure milk-diet, continued for several 
weeks, will often remove the indigestion, and 
with it the offensive breath. Pieces of crack- 
er may be soaked in the milk, or an Qgg may 
be beaten up with it once or twice each day. 
While pursuing this course, all varieties of 
solid food, except bread and light crackers, 
should be avoided. The quantity of milk 
taken must depend on the inclinations of the 
patient. In most cases, it may be increased 
until four or five quarts are consumed daily. 
When the milk disagrees with the patient, a 
trial must be made of other digestible articles 
of diet until something is found to suit the 
delicate stomach. The bowels may be regu- 
lated by the pills of iron, nux-vomica, and 
aloes, or by Kissingen-water, taken in the 
morning before breakfast. 

For the relief of the distressing sensation 
of weight and fullness in the stomach after 
eating, caused by flatulence, the following ia 
always useful : 



46 TEE BREATH, 



B. 



Bismuth, subnitrat., 


3ij. 


Pulv. zingiberis., 


3uj. 


Spts. layand. comp., 


fljsa. 


Aquae, 


f!ij. 



M. 

One teaspoonful four or five times each day, or as 
often as the distressing symptoms prevail. The medi- 
cine must be taken in water. Should the liquid prepa- 
ration not agree with the stomach, the bismuth and 
ginger may be tried in the form of powder. Strong 
peppermint-tea, made by adding half an ounce of the 
leaves to half a pint of water, is also serviceable. 

If this plan of treatment is followed ont 
faithfully for a few weeks, the oflfensive 
breath, with the other disagreeable symp- 
toms, will be entirely removed. When the 
patient recovers, the physician should insist 
on a strict observance of all ordinary hygienic 
laws in order to prevent a recurrence of the 
disorder. 

For the immediate relief of the fetid 
breath, any of the previously - mentioned 
medicaments (page 36) may be employed. 
The charcoal-cake alone, when eaten four or 
five times during the day, will often suffice 
to remove the odor. When the tongue is 



CONGENITAL BAB BREATH. 47 

much coated, it must be scraped clean, and 
the whole mouth washed with a solution of 
myrrh-and-lavender (one teaspoonful of tiuct- 
ture of myrrh to a wineglass of lavender- 
water), or with the carbolic - acid solution. 
Unless this is done, the coating will become 
decomposed and add to the general offensive- 
ness of the breath. 

CONGENITAL BAD BREATH. 

There are a few unfortunate persons who 
are afflicted with a bad breath from their 
childhood. At first, the affection is attrib- 
uted to indigestion. As the child grows, 
however, he exhibits the ordinary amount 
of flesh, strength, and capacity for digest- 
ing food that other children do ; he sleeps 
well, and has a good appetite, and, in all 
other respects, appears to be in perfect 
health. There is not one appreciable cause 
of bad breath to be discovered in the work- 
ing of any organ. A close examination of the 
patient will show that the skin gives off a 
fetor similar to that coming from the lungs, 



48 THE BREATH. 



but much less intense. In warm weather, or 
when under the influence of alcoholic stimu- 
lants, the breath of the patient is almost un- 
bearable. Like some other forms, it is some- 
times worse at night than in the morning. 

It is probable that, in these cases, there 
is some defect in the eliminating apparatus 
of the intestines, or a peculiar tendency to 
the formation of one class of metamorphosed 
decaying substances instead of another. If 
this view is correct, we may have a portion 
of the carbonic acid and vapor of water, car- 
ried off from the lungs, replaced by some of 
the fetid gases mentioned in the first chap- 
ter. Similar changes may also occur in the 
secretions of the skin and other organs. 

The treatment of congenital bad breath 
is more palliative than curative. We cannot 
remove the fetid odor completely ; we can, 
however, hide or modify it. The patient 
should take a tepid bath daily, and after- 
ward sponge the surface of the body with 
cold water. When the skin has been rubbed 
dry, a dilute solution of Florida-water should 



TREATMENT. 49 



be applied with a wet towel. An infusion 
of partridge-berry leaves, or cologne-water, 
may be employed in the same manner. A 
few drops of spirits of camphor act as a per* 
feet deodorizer in some cases. 

Every local cause which might add to 
the fetor must be removed. The mouth and 
teeth ought to be kept scrupulously clean. 
Charcoal, again, comes in here as a useful 
disinfectant. Sweet -flag, partridge^berry 
leaves, cinnamon - bark, etc., may be used 
constantly. A small portion kept in the 
mouth will hide the offensiveness of the 
breath. If necessary, all the deodorizers be- 
fore recommended may be tried in turn, and 
the most suitable for the case selected foi 
permanent use. 



CHAPTEE IV. 

FOUL BREATH FEOM DECAYED TEETH, ETa 

Decayed Teeth as a Cause of Bad Breath. — ^Effects of Decomposiiig 
Food in the Cavities of the Teeth. — Causes of Decay. — ^Develop 
ment of a Vegetable Parasite in the Mouth from Uncleanliness. 
— ^Accumulation of Tartar and its Chemical Composition. — ^Bad 
Breath from Inflammations and Ulcerations' of the Mouth. 

Premature decay of the teeth is often 
witnessed in persons suffering from scrofula. 
The teeth of such persons become discolored 
at an early age, and crumble with very little 
pressure. It is symptomatic of the general 
lack of vitality, which exists in scrofula. 
Teeth decay, likewise, from uncleanliness. 
Small particles of food accumulate in the 
cavities between the teeth, and in a short 
time decompose. The decomposed material, 
as it becomes packed and denser, presses on 
the enamel, destroys it, and then has free ac- 
cess to the soft bone beneath. In connection 



PAEASITIG FORMATION 8.— TARTAR. 51 

with this deposit, a minute vegetable para- 
site is developed in the mouth, called the 
Septoihric hticolUs. When examined under 
the microscope, it presents the appearance 
of a granular mass covered with filaments. 
On the addition of iodine, a violet-color is 
produced. In nearly every case of decayed 
teeth, these parasites may be found. When 
lodged between the teeth, they sprout with 
the same rapidity that other fungous growths 
do. It forms masses, which become harder 
and denser as the development proceeds, un- 
til it absorbs the enamel in its neighborhood. 
If a portion of teeth under it be examined, 
its surface will present a roughened appear- 
ance, and, in the course of time, a large cav- 
ity is formed, opening into the interior of 
the tooth. Another result of uncleanliness 
is a deposit of tartar on the inner surface of 
the teeth, near their insertion in the gums. 
It adheres to the enamel like mortar, and, if 
allowed to remain, causes destruction of that 
part of the tooth upon which it presses. Tar* 
ta?\ which may be recognized by its hardness 



52 THE BREATH. 



and yellow-gray color, consists of phosphate 
of lime, mucus, salivary matter, and a pecul- 
iar animal substance, soluble in chlorhydric 
acid. The density and compactness of tartar 
are due to the phosphate of lime, the mate- 
rial which gives to bone its hardness. When, 
in the deposit, the animal matter is in excess, 
small parasites will often be found. 

The use of acids for a length of time, 
either in the form of medicines or of unripe 
fruit, is another conmaon source of decay 
which is often overlooked. 

Decaying bone in all parts of the body, 
when exposed to the air, exhales a fetor. The 
same destructive process in the teeth occa- 
sions less odor than decay in other bony 
tissues. When a fetid breath is associated 
with rotten teeth, it is usual to assume that 
they alone are responsible ; this, however, is 
not the case. The decaying structures of the 
teeth are but accessories in producing the fe- 
tor. 

During the process of mastication, many 
particles of food become lodged in the mi- 



FOUL BREATH FROM CARIOUS' TEETH. 53 

nute cavities of the teeth. The heat and 
moisture of the mouth excite decomposition 
in the mass. The animal matters it contains, 
as well as the alkaline salts, assist in continu- 
ing the destructive process. In a day or two 
it is thoroughly rotten, and emits the foul- 
ness characteristic of putridity under other 
circumstances. Thus each decaving: tooth be- 
comes the receptacle and storehouse for de- 
caying animal matter in its most disgusting 
forms. The portions of decaying material 
near the carious cavity become condensed 
and fastened into the crevices of the tooth. 
Daily the rotten mass receives fresh layers, 
which form on the top, until it is very diffi- 
cult to distinguish the animal matter from 
the bone. As a necessary consequence of 
this putrefactive change, the breath becomes 
impregnated with foulness, so that it is al- 
most impossible to remain in close proximity 
to the patient. The odor is worse than most 
other varieties, but it is soon relieved by ap- 
propriate treatment. 

The proper person to consult in these 



54 * TEE BREATH, 



cases is the dentist. He should carefully 
cleanse the teeth from all incrustations of 
tartar, and remove the decaying substances 
from their cavities. These cavities may then 
be filled with what is known as '* softrjillingj'* 
or with gold. Amalgam fillings are not con- 
ducive to health. They do not make the 
breath any sweeter, nor do they preserve the 
teeth from decay. 

The particles of food should be extracted 
from between the teeth after every meal by 
means of a toothpick. The teeth may then 
be washed with a solution of soap-and-water, 
applied with a soft brush. Hard brushes in- 
jure the enamel. The soap-solution destroys 
the parasitic accumulations of the mouth, be- 
sides acting to a certain extent as a disinfec- 
tant and deodorizer. When from any cause 
recourse to a dentist is impracticable, animal 
charcoal can be pressed into the cavities, al- 
lowed to remain for half an hour, and then 
be removed by washing. A solution of car- 
bolic acid (two grains to the ounce of water) 
is an excellent deodorizer. It can be applied 



DEODORIZERS. 55 

thoroughly when the charcoal is removed, 
and repeated if necessary. As the odor of 
carbolic acid is not always agreeable, its ap- 
plication may be followed by the myrrh-and- 
cinnamon solution : 

5- Tinct. myrrhaB, 

Tinct. cinnam., aa f 3 ij. 

Aquae menthae viridis, | ij. 

M. 

This mixture may be applied with a tooth- 
brush. The tincture of myrrh may be used 
alone, diluted with sufficient water to pre- 
vent it from irritating the mucous membrane. 
Either of the following may be tried : 

5. Tinct, calami, 

Tinct. gaultheriae, aa 3j. 

Spirit&s myristicaE5, | j. 

Aquae, § ij. 

M. 

IJ. Spirittls lavandulae comp., § ss. 

Aquae menthae piperitae, f ij. 

These preparations may be used in a more 
diluted state if the patient is young. In 



56 THE BEE ATE. 



some cases a diluted solution of nitric acid 
(ten drops to two ounces of water), used in- 
side the putrid cavities, will destroy the ani- 
mal deposit. Hydrochloric acid (fifteen drops 
of the diluted preparation to half an ounce 
of water) may be applied to the incrusta- 
tions of ta/rtar. This is done by dipping a 
piece of match or splinter of wood, prepared 
for the purpose, in the solution, and then rub- 
bing it over the tartar until it is dissolved. 
It is better, however, to let the dentist attend 
to this also. 

When the teeth and mucous membrane 
of the mouth are kept clean by these means, 
the offensive odor of the breath will disap- 
pear. 

In all cases it is well to examine carefully 
the condition of the patient's health. When 
there is loss of appetite or general debility, 
fresh air and nourishing diet must be pre- 
scribed. A course of tonic medicines may 
also be found necessary. 

N^ecrosis of the Jaw comes more within 
the province of the surgeon. The fetid odor 



NECROSIS OF THE JAW. 57 

connected with it is of small consequence in 
comparison witli the pain and constitutional 
disturbance attendant upon it. It may re- 
sult from decayed teeth, syphilis, or mineral 
poisons. When it is caused by dead teeth, 
usually but a small portion of the bone is 
involved in the morbid process. If it follow 
the introduction of mineral poisons into the 
circulation, the disease is far more extensive, 
and may destroy the whole of the bone. The 
necrosis produced by phosphorus is located 
generally in the lower jaw. 

The treatment consists in removing the 
dead bone. When that is accomplished, the 
fetor will disappear. Should circumstances 
delay the operation, the bad odor can be di- 
minished temporarily by applying pure nitric 
or hydrochloric acid to the surface of dead 
bone. This cannot be accomplished, how- 
ever, unless the bone is denuded of its soft 
tissue, and then other deodorizers, such as car- 
bolic acid, creasote, etc., must be resorted to. 

Bad breath arising from putrid inflamma- 
tion of the mouth {stonacace) is a peculiar 



58 THE BREATH. 



and comparatively rare affection. It usually 
commences with congestion of the mucous 
membrane of the buccal cavity, followed by 
increased secretion. In a short time the 
gums begin to swell, and bleed from very 
slight pressure. Around the margins of the 
ulcers there is a yellowish exudation, which 
is thick and viscid, and not easily removed. 
The odor from the commencement to the 
termination of the disease is extremely offen- 
sive. It can be recognized at some distance 
from the patient. If the affection is not con- 
trolled by proper remedies, the cheeks be- 
come involved in the ulceration. Mastica- 
tion and deglutition become very difficult, 
and the life of the patient may even be en- 
dangered. The disease is said by some to 
be contagious. It is often met with in chil- 
dren. The treatment is simple and usually 
successful. A solution of chlorate of potash, 
used repeatedly, in the course of a day or 
two stops the ulceration and removes the 
fetor. For adults, the following solution is 
the best : 



SCORBUTIC FETOR 59 

$• Potass8B chloratis. 3j, 

Sjrup. zingiberis, | ss. 

Aquae, | iij. 

One teaspoonful in water every three hours. 

The moutli may be washed with the same 
preparation. Half the quantity of the adult 
dose may be given to children. 

Scorbutic Ulceration of the Mouth is pre- 
ceded by loss of flesh and strength. When 
the disease is fully developed, the gums be- 
come bluish-red, swollen, and painful. The 
tongue is coated with a yellowish exudation, 
and there is some increase in the quantity of 
saliva. Small extravasations of blood appear 
under the mucous membrane, and ulcers make 
their appearance, which bleed on slight press- 
ure. In all these cases the breath is fetid, 
but the fetor is not so penetrating as that 
arising from stomdCdce. 

The disease requires local and constitu- 
tional treatment. The local treatment con- 
sists in the application of astringent washes 
to the mouth, such as solutions of alum, tan- 
nic or gallic acid, uva ursi, and hydrastics. 



60 THE BREATH 



One teaspoonful of powdered alum may be 
added to four ounces of water, and the mouth 
washed five or six times each day. The car- 
bolic-acid solution also is good — it corrects 
the fetor. The constitutional treatment con- 
sists in the administration of lime-juice, lemon- 
juice, and vegetable acids. The diet should 
be made up mainly of fresh vegetables, such 
as cabbage, potatoes, carrots, beets, etc., and 
a moderate amount of fresh meat. 

Syphilitic inflammation and ulceration of 
the mouth and fauces are always accompanied 
by a bad breath. The ulcers rarely occur 
without signs of secondary or tertiary syph- 
ilis being present. There may be eruptions 
on the skin or periosteal inflammations at 
the same time. The ulcers are usually cii^ 
cular and supei-ficial. They are covered by a 
thin whitish or semi-transparent coating, and 
do not bleed easily. In their vicinity small, 
hard nodules or raised patches of mucous 
condylomata may sometimes be seen, or 
their margins may be indurated. The odor 
is not alone due to the secretion from the sur- 



SYPHILITIC FETOE. 61 

face of the ulcer, but also to some change in 
the secretion of the salivary glands. Per- 
haps the change is effected by the matter 
from the ulc^r acting upon the salivary in- 
gredients. 

Thib first thing to be done in these cases 
is to cauterize the sores thoroughly with ni- 
trate of silver. A strong solution of car- 
bolic acid and glycerine, in the following 
proportions, may then be applied over the 
ulcer and the whole mucous surface with a 
camel's-hair brush. 

9 . Acidi carbolicl, 3 ss. 

Glycerin*, § j. 

Aqu8B, § ij. 
M. 

Twice each day will be sufficient to make 
the application. The hldck and yellow wash 
(page 88) is often employed. Iodoform is an 
excellent remedy. The ulcers may be dusted 
with the powder two or three times each 
day. It is generally combined with gly- 
cerine (one drachm of iodoform to half an 

6 



62 THE BREATH. 



ounce of the solvent), and applied with a 
brush. Equal parts of myrrh and cinnamon 
(one teaspoonful each), added to a wineglass 
of water, can be used to rinse the mouth 
when the odor is bad. 

The constitutiooal treatment for syphilis 
muftt be commenced at the same time {see 
page 90), and continued until the ulcers are 
healei 

" Spontaneous Stomatitis " is said to occur 
suddenly, without any appreciable cause. It 
is ushered in with soreness in the tpngue, 
gums, and teeth, and an increase in the flow 
of saliva. Two or three days afterward there 
is considerable swelling of the mucous mem- 
brane. The whole interior of th^ mouth is 
of a deep-red color, and very tender on press- 
ure. The flow of saliva becomes very great. 
It runs from the mouth incessantly. It 
is fetid, and communicates its fetor to the 
breath. In some cases ulceration of the mar- 
gins of the gums takes place, but this is 
rare. 

This disease resembles in many respects 



FETID STOMATITIS. 63 

^1 ■ ■ ■ ' ■ -- — ■■-■ ■ ■ i^i - ' ■ ' I ^»^M^»^^ 

the stomatitis excited by mercury. The diag- 
nosis ^is made by inquiring into the habits of 
the patient, and ascertaining whether mer 
cury has been used or not. 

Treatment — ^The mouth should be washed 
with warm water containing a few drops of 
laudanum to allay the soreness. A solution 
of chlorate of potash (ten grains to the ounce) 
may be subsequently used on the inflamed 
surface, and repeated every three or four 
hours ; or the potash may be combined with 
glycerine and belladonna (see page 72). 
Chlorate of pot'ash is also useful as an in- 
ternal remedy. Ten grains three times each 
day will be sufficient. 

Follicular Stomatitis occurs at all ages. 
The inflammation commences in the follicles 
of the mucous membrane on the inside of 
the lips, near their lower portion, and the 
sides of the tongue. Small red spots, which 
are firm to the touch and painful, first ap- 
pear. Softening of the membrane, in the 
centre of the hard mass, then takes place, 
and a small excavated ulcer results. In some 



64 THE BREATH. 



cases the disease commences by a vesicular 
eruption (herpes). The vesicles heal, and 
leave small superficial ulcers. Hot liquids 
and solid food taken into the mouth cause 
much pain. The salivary secretion is in- 
creased, and the breath has an exceedingly 
disagreeable odor. Tliis odor is present from 
the commencement until the termination of 
the disease. 

As follicular stomatitis often depends on 
general debility, tonics are always indicated 
in the treatment. Combinations of wild- 
cherry, cinnamon, and cascarilla barks, are 
very beneficial. They may be given in the 
form of an infusion, half a pint of each mixed. 
A wineglassful, taken before each meal, will 
be sufficient. Tincture of gentian and calum- 
bo (equal parts), given in teaspoonful doses 
three or four times each day, may also be 
tried. If the bowels are constipated, mild 
cathartics can be used. Soothing demulcent 
applications are required at the commence- 
ment of the inflammation. Mucilage, or 
sweet-oil, containing a little laudanum, is 



FETID GUMS. 65 



usefol. Glycerine, with borax, is a common 
remedy, which brings good results. When 
ulcers form, they may be touched with ni- 
trate of silver; or sulphate of copper, or 
oxide of zinc, may be sprinkled over them. 
The preparation of iodoform and glycerine 
is sometimes needed. 

Gingivitis is an inflammation confined to 
the gums. It is more common in children 
than adults. The gums swell, become pain- 
ful, and finally ulcerate. The ulcerative 
process is confined to the junction of the 
gums with the teeth. The breath is intense- 
ly fetid from the commencement of the ul- 
ceration. If the disease is not stopped by 
appropriate treatment, the teeth may loosen 
and drop out. 

A strong solution of nitric or hydrochlo- 
ric acid (twenty drops to half an ounce of 
water) may be applied to the ulcers and 
their inflamed margins two or three times 
in twenty-four hours; or the ulcerated sur- 
face may be cauterized with the acid nitrate 
of mercury or silver. Alum, in solution or 



66 THE BREATH. 

powder, is also used. Chlorate of potash, 
employed as a wash, and taken internally, 
is one of the best remedies. Tonics should 
be given in all cases. 



CHAPTER V, 

OATAEEHAL ODOES. 

Clergyman's Sore-Throat (Follicular Pharyngitis). — ^Peculiaiities of 
the Inflammation. — Effects of Decomposing Mucus on the 
Breath. — Complications. — Treatment. — Cancerous Diseases of 
the Tongue and Pharynx. — ^Fetid Odors following Diphtheritic 
Diseases of the Throat, etc. 

Cleegyman's sore-throat is a chronic in- 
flammatory affection of the mucous mem- 
brane lining the pharynx. The disease is lo- 
cated principally in the follicular pouches of 
the membrane. It occurs in persons who are 
broken down from overwork and sedentary 
habits, or who have been compelled to do a 
great deal of public speaking. In its ad- 
vanced stages the disease is always accom- 
panied by an offensive breath. It may arise 
from repeated colds, or it may extend from 
an inflammation of the lining of the nose or 
mouth. Sometimes the injudicious applica- 



68 TEE BREATE. 



tion of caustics to the membrane keeps up 
and increases the disorder. At first there is 
more or less soreness in swallowing. The 
voice becomes husky when singing or talk- 
ing, and accordingly the act of speaking is 
painful. In the morning the patient feels as 
if a foreign body were sticking in his throat, 
and he endeavors to remove it by " hawking " 
or coughing. This sensation is caused by 
the thickened mucus which collects in the 
follicles, and on the surface of the mem- 
brane. After a time these follicles remain 
filled with the inspissated secretion. It be- 
comes cheesy in consistency, decomposes, 
and gives off a very penetrating fetid odor 
that is communicated to the breath, and 
which remains as long as the disease exists. 
It takes from six months to a year for the 
disease to make a marked change in the 
sweetness of the breath; occasionally the 
breath is bad from the beginning. 

On examination of the membrane, it will 
be found thickened, congested, and dark red 
in appearance. The blood-vessels in its sub- 



GATABRHAL ODORS. 69 



stance are dilated and varicose. The follicles 
are choked up with a whitish material which 
can be picked out or scraped from the sur- 
face. It is from this substance that the odor 
comes. In some parts the epithelial cover- 
ing which gives the membrane its smooth 
appearance is destroyed, and a rough, granu- 
lar surface is seen, resembling the conjuncti- 
va in " granular conjunctwitisr In the ma- 
jority of cases the mucous lining of the pos- 
terior nares will be found involved in the 
morbid action. 

The cases recorded below are fall of in- 
terest as examples of the usual course of this 
disease : 

Case I. — Martin 0., aged thirty; married. 
Patient has been employed in a large rail- 
way-station, in this city, for some years. His 
work consists in calling the stopping-places 
before the departure of each train. He has 
been in the habit of using tobacco to excess 
for some years. Two years ago he noticed 
that his voice was becoming weaker, and 
that, when leaving work in the evening, he 



70 THE BREATH. 



was extremely hoarse. A soreness followed 
tlie hoaraeness, which has continued with but 
little intermission ever since. At times 
there is a sensation in the throat as if a pin 
or piece of bone were sticking there. In thB 
morning it takes several minutes' hawking 
and coughing before he can clear his throat. 
Sometimes it is hard to swallow. He takes 
cold very easily, and every fi'esh attack is 
accompanied by a profuse expectoration. 
There is also a free discharge from the nasal 
passages. His breath has been affected for 
over a year. He did not know it untU he 
observed that persons turned their heads 
away from him while in conversation. 

Upon throwing a powerful light into the 
pharynx, I found that the whole mucous 
lining was studded over with grayish-white 
points, and between them the membrane was 
of a dark-red color. In some places the epi- 
thelium had been entirely destroyed. The 
tonsils showed similar changes. The offen- 
siveness of the patient's breath was percep 
tible at the distance of a yard. 



CATAEEHAL OBOES. 71 

Case IL — Mary A., aged twenty-two ; is 
occupied as a school-teaclier eight hours dur- 
ing the day. The room in which she teaches 
is very close and warm. Nine months ago 
she noticed a tickling sensation in the throat, 
which was soon foUowed by a hacking 
cough. The cough became worse toward 
the close of school-hours. The voice was 
clear in the morning, but at night it grew 
very hoarse. A short time before presenting 
herself for treatment, she expectorated large 
quantities of yellowish mucus, which con- 
tained small, firm masses of cheesy matter, 
that had a bad odor. 

On examination, I found the pharyngeal 
mucous membrane of a deep-red color in 
some places, and covered with whitish 
patches in others. Her breath was ex 
tremely fetid, yet she was not aware of it. 
The mucus scraped from the surface of the 
membrane emitted a pungent fetor. The 
lungs were normal. 

This variety of sore-throat is difficult to 
cure, because it is generally neglected until 



72 TRE BREATH. 

the mucous membrane has become infiltrated 
with the products of inflammation. But re- 
lief can always be afforded, and the offensive- 
ness of the breath completely destroyed. 
As the fetor depends, in a great measure, on 
the decomposition of the contents of the fol- 
licles, these must be emptied and kept com- 
pletely free from the abnormal exudation. 
This may be accomplished by means of gar- 
gles or by spraying the throat with various 
solutions. The instrument for vaporizing the 
liquids is easily obtained at any drug-store. 

One of the best solutions for either gar- 
gle or spray is the following : 

9. PotasssB chloratis, 3 ss. 

Ext. bellad., f 3 j. 

Glycerinae, | j. 

Aquae, | iij. 
M. 

To be applied four or ^\q times each day. The 
nose may be washed at the same time by means of 
a syringe or with the spray-producer. 

Another excellent solution, where the se- 
cretion from the throat is very profuse, is 
made by adding one teaspoonfal of the tinct- 



CATARRHAL ODORS. 73 



ure of the chloride of iron and one of gly- 
cerine to barely a pint of water. The appli- 
cation should be made as often as desired; 
or the following may be employed : 

5 . Tinct. myrrhae, f | ss. 

Tinct, hydrastis, f | j. 

Aquae, § iv. 
M. 

The mixture to be well shaken, and applied as before. 

When the fetor is considerable, the throat 
may be cleaned first with a strong solution 
of carbolic acid (ten giains to an ounce of 
water). A weaker solution may afterward 
be employed exclusively, with decided bene- 
fit. The deodorizers previously mentioned 
are also useful. When the secretion is puru- 
lent, a solution of permanganate of potash, 
thirty grains to five oimces of water, will be 
found of great value. It is to be used in 
the same manner as the other preparations. 
If the mucous membrane be much thick- 
ened, and the epithelium destroyed, a strong 
solution of nitrate of silver (four grains to 
the ounce) should be applied to the surface 

r 



74 THE BREATH, 



daily for a couple of weeks, and then be 
followed by the preparation of chlorate of 
potash and belladonna previously mentioned. 

These local applications must be per- 
sisted in for a long time, in conjunction with 
a course of tonic treatment. Tonics, fresh 
air, and exercise, are absolutely necessary to 
give strength to the system. So long as 
there is debility attendant upon the catarrh, 
local remedies have little effect. 

The use of tobacco should be stopped, as 
well as all other habits injurious to the 
health. 

If the disease has lasted so long as to 
prevent a cure, the constant use .of deodor- 
izers will be necessary to keep the breath in 
a good condition. 

Syphilitic ulceration of the pharynx must 
be treated in the same manner as syphilitic 
ulcers in the mouth {see page 61). 

Chronic enlargement of the tonsils is 
another source of offensive breath. The dis- 
ease is apt to occur in young persons with 
the scrofulous diathesis. It often arises indei 



CATARRHAL ODORS, 75 



pendently of neighboring inflammation. The 
offensive odor arises from accumulations of 
inspissated mucus in the follicles of the 
gland, and its subsequent decomposition. 
The odor is not as offensive as that produced 
by follicular pharyngitis. 

The treatment consists in keeping the 
tonsils perfectly clean with the gargles pre- 
viously mentioned. If the tonsils are en- 
larged, they may be painted with tincture of 
iodine, or with a dry solution of nitrate of 
silver. 

DIPHTHERITIC ODORS. 

Diphtheria and diphtheritic sore-throat 
have an offensive breath as one of their most 
prominent symptoms. Especially is this true 
of epidemic diphtheria. But it is the seque- 
IflB of these diseases, rather than the diseases 
themselves, that are under present considera- 
tion. When true diphtheria disappears, we 
find that the patient has a strong predisposi- 
tion to catch cold and develop a sore-throat. 
Slight exposure suflSces to inflame the mu- 



76 TEE BREATH, 



ecus lining of the fauces and pharynx, and 
produce an offensive breath. As soon as the 
secretion of mucus increases, as a result of 
the morbid action, there is present a well- 
marked fetor, not so pungent, however, as 
that occurring in the original disease. In 
the simple forms of diphtheritic sore-throat 
there is also a fetid breath. It is, however, 
more easily remedied than the odor of true 
diphtheria. The thickened mucous secretion 
found in these cases is very thick and viscid, 
and it adheres tenaciously to the membrane. 
In some parts it is collected in lumps, which 
stick like glue to the tissues beneath. It is this 
peculiar secretion which occasions the fetor. 

As general debility is a common sequence 
of diphtheritic disease, our efforts should be 
directed to building up the system by means 
of tonics, nourishing diet, etc. In addition, 
astringent washes should be applied daily 
such as — 

5 . Aluminis, 3 j. 

Aquae, § iij. 

M. 

Gargle the throat three times each day. 



DIPHTHERITIG FETOR. 11 

The muriated tincture of iron with gly- 
cerine, in the proportion of one drachm of 
iron to an ounce of glycerine, may be ap- 
plied to the inflamed membrane, with a cam- 
al's-hair brush, three times in twenty-four 
hours. A nitric or muriatic acid solution 
(ten drops to an ounce of water) applied 
with a spray-producer, or used as a gargle, 
will often act beneficially in restoring the 
normal secretions and diminishing the bad 
odor. A combination of carbolic acid and 
tincture of iodine, in the following propor- 
tions, is recommended by Dr. Beverly Robin- 
son: 

5 . Acidi carbolici, grs. x, 

Tinct. iodinii, f 3 ij. 

Glycerinae, § j. 

These preparations may be applied with a brush or 
in the form of spray. 



CHAPTER VI. 

CATARRHAL ODORS (cONTINUED). 

OiSDDa depending upon Syphilis, Scrofula, Necrosis, and Caries of 
the Nasal Bones, and Herpes. — Character of Fetid Odors. — Bad 
Bfeath from Ulceration of the Larynx and Trachea. — Putrid 
Bronchitis. — Bronchectasis, etc. — Treatment. 

The nasal mucous membrane is subject to 
a variety of catarrhal affections. Some are 
simple in their nature, and give but little 
inconvenience. Others are characterized by 
a profuse muco-purulent discharge, and a dis- 
gusting odor. The term ozcenu is applied to 
the latter class of cases. The fetor arisins: 
from this disease is more offensive than any 
other. According to French authorities, the 
odor in it is similar to that arising from a 
crushed bug. On this account they designate 
the patient by the term punais. 

Ozoena depends on a variety of causes, 
such as syphilis, scrofdla, herpes, foreign 



CATARRHAL ODORS. 79 

bodies in the nasal passages, and death of the 
nasal bones. The worst form of the disease, 
however, has no assignable cause. 

In syphilitic ozaena both nostrils are gen- 
erally inflamed. In scrofulous affections, only 
one nostril is involved. The discharge at 
first is thin, irritating, and not very profuse. 
If allowed to remain on the edges of the nose 
and lips, it causes excoriation. After a time 
the discharge is mixed with blood and pus. 
The odor of the breath is extremely offen- 
sive to the patient, as well as his friends. It 
sometimes fills the apartment in which he 
rests. 

If the interior of the nose be examined 
with a speculum, some portions of the mu- 
cous lining will be found ulcerated, and the 
bottom of the ulcers covered with a grayish- 
white exudation. The remainder of the 
membrane is generally much tumefied, exco- 
riated, and of a dark-red color. In the course 
of a few months the bones become involved, 
and the nose is consequently depressed, pro- 
ducing a peculiar deformity, which is pathog- 



80 THE BREATH. 



nomonic of the disease. Other signs of sec- 
ondary or tertiary syphilis are usually found 
in different parts of the body, which, with the 
history of the patient, lead to a correct diag- 
nosis. 

The following case affords a good illus- 
tration of syphilitic ozaena: 

Jane C, aged thirty-six ; occupation, seam- 
stress. Contracted syphilis from her husband 
in the summer of 1868. She passed through 
the secondary form without much trouble. 
Six months afterward she noticed that her 
nose was sore, and that small scales formed 
on the inner surface. There was also a dis- 
charge which was extremely offensive, and 
which affected her breath seriously. She 
went to one of the city dispensaries and 
had it washed daily, and also took some 
tonic medicine. The treatment relieved her 
temporarily. During the winter of 1872 the 
nose again commenced to smell and be pain- 
ful. The discharge was more profuse, and 
the breath more offensive, than at any previ- 
ous time. Small pieces of bone came away 



STPHILITIG FETOR. 81 

in the discharges. When I first saw her, the 
discharge was of a dark color, and the odor 
of her breath was absolutely unbearable. 
The poor creature was herself conscious of its 
painful character. Her nose was flattened 
near the upper portion. In passing my 
probe into the nostril, I found that the nasal 
bones, or what was left of them, were mov- 
able and dead. The mucous lining was de- 
stroyed in several places. Her general health 
was also very much affected by the disgusting 
odor, the discharge, and by the consciousness 
that she was an object of disgust to her best 
friends. As she had no means, and could 
not be cared for at her own home, I sent her 
to the hospital, where she remained four 
months, and was finally discharged cured. 

SOROFULOUS OZMSK 

Usually affects but one nostril. It is apt to 
attack young females who are broken down in 
health. It is preceded by all the symptoms 
of a common cold, such as sneezing, coughing, 
and increased secretion from* the eyes and 



82 THE BREATH, 



nose. In a short time the discharge becomes 
offensive, and affects the breath. It is sanious 
and watery, and excoriates tlie integument. 
It will often cease for several days, and then 
return with increased fetor. The fetor is not 
as offensive as in the syphilitic form of ozse- 
na. An examination of the mucous mem- 
brane shows that it is swollen and corru- 
gated. In some places there are fissures and 
ulcers from which a sanious fluid exudes. 
Occasionally the disease is situated so far up 
the nostril that its effects on the membrane 
cannot be seen. We then judge of the con- 
dition by the character of the discharge and 
the amount of fetor. The glands of the neck 
are sometimes enlarged, and there may be a 
deposit of tubercles in the lungs. 

IDIOPATHIC OZiENA. 

The worst form of ozaena is one which 
commences without any assignable cause. It 
usually attacks robust individuals who are 
accustomed to the use and abuse of alco- 
holic stimulants. Young children are also li- 



FETOR FROM OZ^NA. 83 



able to it. When once fully developed, it may- 
last for years, resisting all attempts at cure. 

The patient at the beginning of the dis- 
ease is conscious of a "stuffed" feeling in 
the nose, like that resulting from an ordina- 
ry cold. A slight soreness accompanies the 
fullness. In a few days, the secretion from 
the mucous surface is increased. It is at 
first clear and ropy, but afterward becomes 
opaque and purulent. During the night the 
discharge may pass backward into the phar- 
ynx and down into the stomach. This pro- 
duces nausea and vomiting. The breath is 
affected from the inception of the disease to 
its termination. The odor is sometimes so 
offensive that the patient is made sick by it. 
His wretched condition, only too apparent to 
his senses, causes great mental depression, 
and, unless relief is applied by medical treat- 
ment, he may become completely prostrated 
in mind and body. 

The affection may last several months be- 
fore ulceration of the mucous lining takes 
place. Some portions of the membrane may 



84 THE BREATH. 



be thickened and others atrophied. The lat- 
ter condition is most commonly noticed in 
the later stages. The ulcers which form 
are superficial, and rarely eat deeply into 
the substance of the membrane. 

HERPETIC OZ^NA 

Is a rare form of the disease. It may co- 
exist with an eruption of herpes upon 
the cutaneous surface. The affection is char- 
acterized in its early stages by a watery 
discharge from the nostrils, which is some- 
times tinged with blood. There is con- 
siderable itching at the end of the nose. 
After a time, small haemorrhagic crusts ap- 
pear in the discharge, and the breath be- 
comes affected. The odor is not so disgust- 
ing as that occurring in syphilis or scrofala. 
Still it is the most troublesome feature of the 
disease. 

OZiENA FROM POLYPI AND FOREIGN BODIES. 

Polypi situated in the upper part of the 
nasal cavities may excite inflammation of the 



FETOR FROM FOREIGN BODIES. 85 

mucous lining, and a purulent fetid dis- 
charge. The growth of the polypus is ac- 
companied by a sensation of fullness in 
the nose, and difficulty in breathing with 
the mouth closed. An examination of the 
nostrils will determine the location of 
the tumor. A cure usually follows its re- 
moval. 

Children of tender years frequently insert 
peas, beans, and foreign substances into the 
nasal cavities, which enlarge by the absorp- 
tion of moisture, and, by an increase of press- 
ure, cause great irritation. Peas and beans 
have been known to sprout in the nasal cavi- 
ties after having remained there several 
days, giving rise to serious inflammation of 
the mucous membrane and spongy bones. 
The discharge takes place generally from the 
nostril in which the foreign body is located. 
With the commencement of the inflammatory 
process the breath becomes more or less fetid, 
and continues so until the foreign body is 
removed. 

8 



86 THE BREATH. 



OZJSNA ARISING FROM DEAD BONE 

Is sometimes the result of injuries whicL 
destroy the vitality of the bone. The necro- 
sis may also be due to scrofula or syphilis. 
A diagnosis is easily made if small pieces of 
bone drop out of the nostrils, or by pass- 
ing a probe up to the dead structure. If the 
bone is dead, a rough, grating sensation will 
be communicated to the fingers. 

Cases, however, occur in which the soft 
parts covering the bone remain intact for a 
long time after necrosis has occurred. This 
prevents it from coming away, or from being 
made perceptible with a probe. In such pa- 
tients the nose, or the region occupied by the 
nasal bone, will often be swollen and pain- 
ful on pressure. The pain, too, is generally 
worse during the night. 

As the worst feature of all varieties of 
ozsena is the horrible odor of the breath, our 
first object should be to remove it and dimin- 
ish the unhealthy character of the secretions. 
Remedies for this purpose are applied indis- 



FETOR O'B OZjENA, 87 

criminately, without reference to the causes 
of the disease. The constitutional treatment, 
however, is directed to a removal of the cause, 
and consequently must vary in each case. 
Whether a complete cure is possible or not, 
the alteratives and disinfectants rarely fail to 
remove the disgusting features of the disease. 

An ordinary glass or rubber syringe, a 
nasal douche, or " spray-producer," may be 
employed in cleaning the nose, or applying 
medicinal agents. 

The nasal cavities should, therefore, first 
undergo a thorough cleansing with warm 
water, in order that the disinfectant may be 
applied directly to the diseased surface. K 
scabs, inspissated mucus, or pus, be allowed 
to remain in any part, the medicine will fail 
to affect the membrane underneath. 

When the cleansing process is completed, 
the nasal douche may be filled with a strong 
solution of carbolic acid (eight grains to the 
ounce of water), and a steady stream of it al- 
lowed to pass through the nose for fifteen 
or twenty minutes. If the disease is situated 



88 TEE BREATH. 



at the upper portion of the Schneiderian 
membrane, the liquid can be forced up by 
compressing for a moment the nostril oppo- 
site to the one in which the nozzle of the na- 
sal douche is placed. This process should be 
repeated at least four times the first day, so as 
to clean away every particle of bad-smelling 
material, and make a positive change in the 
secretions of the mucous membrane. Af- 
ter the second day, the operation may be 
repeated twice in twenty -four hours. If 
there is ulceration of the membrane, nitrate 
of silver may be used to cauterize the parts 
before any disinfectant is employed. A solu- 
tion of chlorinated soda is a very good sub- 
stitute for the carbolic acid. It may be used 
in the proportion of one tablespoonful of the 
solution to half a pint of water. Either the 
black or yellow wash may answer in some 
cases, but their disinfecting power is infe- 
rior to either of those mentioned. The black- 
wash is made by adding one drachm of calo- 
mel to a pint of lime-water ; the yellow-wash 
by adding half a drachm of corrosive sub- 



TREATMENT OF FETOR, 89 

limate to one pint of water. These mercuri- 
al washes are specially applicable to patients 
suffering from syphilitic ozaena. Creasote- 
ointment, or creasote in solution, is also ad- 
vised. Powders consisting of borax and su- 
gar, or of chlorate of potassa, may be blown 
up the nostril. Warm water, obtained from 
the White Sulphur Springs, is recommended 
by some physicians as an alterative and seda- 
tive to the ulcerated mucous membrane. As 
sulphur- water is not as irritating as some of 
the other medicaments are, it may be applied 
to the nostrils five or six times each day. 
The odor of sulphur, however, is not a good 
substitute for the fetor of ozaena ; it will be 
well, therefore, to follow the wash by one 
of the deodorizers mentioned at page 55, 
The combination of carbolic acid and iodine 
will sometimes destroy the fetor when the 
carbolic acid alone fails. The strength of 
the solution may be increased in proportion 
to the intensity of the odor. Coffee has 
lately been introduced to the notice of the 
profession as a disinfectant. If the beans be 



90 THE BREATH, 



chewed, the breath becomes strongly impreg- 
nated with their characteristic odor. In ozae- 
na, a cold infusion of coffee may be injected 
into the nasal cavities. It will be necessary, 
before using it, to strain carefully, in order 
to remove the small particles of coffee exist- 
ing in the liquid. Carbolate of zinc is highly 
spoken of. It is employed in solution (five 
grains to an ounce of water). Where there 
is much excoriation of the integument at the 
borders of the nostrils, cold cream, " glycer- 
ine-cr6am," or sweet-oil, may be applied con- 
stantly. 

When ozaena arises from syphilis, mer- 
cury and iodide of potassium must be em- 
ployed, in conjunction with the local treat- 
ment. If it accompany secondary syphilis, 
one grain of the protoiodide of mercury may 
be administered three times each day until 
the gums begin to feel sore. In. the tertiary 
form iodide of potassium, in from, five to ten 
grain doses, may be given four times each 
day. Tonics are also necessary. 

When scrofula causes the ozaena, the pa- 



TREATMENT OF FETOR. 91 

^1^^^— >——■ — ■ ■■— ^»,^ ■»■■■ .■■■ ■■!■ ■■■■» I.I. ..I ^^B^— ^»^ 

tient must have plenty of exercise in the 
open air, nourishing diet, and tonics. Cod- 
liver oil alone, or combined with prepara- 
tions of iodine or bromine, will be found of 
special benefit. If the stomach will not tol- 
erate the oil, fresh cream may be substituted. 
Among the best tonics used in scrofulous and 
other kinds of ozsena, are the following : 

'ijb . Tinct.. ferri mur., f | ss, 

Quinse sulphatis, f 3 ss. 

GlycerinaB, f | iv. 

Dose, one teaspoonful in a wineglass of water, four 
times each day, before meals. 

5. Tinct. sarsae, 3 iij. . 

Tinct. guaiaci, 3 ss. 

Tinct. cinch, comp., | iv. 

Dose, one teaspoonful five times each day before 
meals. Infusion of wild-cherry bark, and infusion of 
catechu, in tablespoonful-doses, are also of benefit. 

The idiopathic form of ozsena requires, in 
many cases, the same tonic treatment and lo- 
cal applications. 

Herpetic ozsBua is treated at first by 
strong alkaline solutions, such as — 



92 THE BREATH. 



9» Liq. potassse, f3ij- 

Aqua?, I ij. 

or — 

9. Liquor, sodae cblorinatse, f3ij« 

Aquae, | ij. 

These preparations should be applied to 
the membrane in the manner previously de- 
scribed. When the nose is clear, and the 
scabs cease to be formed, deodorizers may be 
applied. 

Ozaena from foreign bodies cannot be 
cured until every irritating particle is re- 
moved. If the patient is seen at the begin- 
ning of the inflammation, snuff, or other 
sternutatory, may be introduced into the 
nostril opposite to the one in which the ob- 
struction is lodged, in order to induce sneez- 
ing. This method will often dislodge the 
foreign body, and force it out of the nostril ; 
or a stream of water may be thrown into the 
nostril with the nasal douche, in order to 
wash 7t out. When these simple measures 
fail, a long ciu'ved polypus forceps may be 
passed up carefully to the foreign body 



TREATMENT OF FETOR. 93 



closed upon it, and drawn down. Subse- 
quently the inflamed membrane may be 
treated as in the previous cases. 

Ozaena from dead bone can only be cured 
by removing the irritating material. It 
may be reached with a forceps through the 
nostril, or an incision may be made un- 
der the upper lip, behind the root of the 
nose, and carried upward until the dead 
bone is reached. The originator of this 
method is Dr. Ronge, of Lausanne, Switzer- 
land. 



HALITOSIS FROM ULOERATION OF LARYNX, TRA- 
CHEA, BRONCHIAL TUBES.— BRONCHIECTASIS. 

There are two varieties of laryngeal ul- 
ceration liable to affect the breath ; these are 
the tubercular and syphilitic. The latter is 
more frequently accompanied by fetor than 
the former. 

Syphilitic ulceration of the larynx is an 
accompaniment of either secondary or ter- 
tiary syphilis. It is usually found in connec- 



94 THE BREATH. 



tion with inflammation of the periosteal cov- 
ering of bones, nocturnal rheumatism, gum- 
my tumors in various parts, and other signs 
of tertiary syphilis. The breath becomes 
offensive when the ulcers are fully formed, 
rarely before. The fetor is worst in the 
morning. 

In the tubercular form of the disease, 
there will be a history of long - continued 
cough, expectoration of blood, emaciation; 
and there will be signs of tubercular deposit 
at the apices of the lungs. The breath is 
more offensive in the evening if hectic fever 
is present. It is not so unbearable as that 
arising from syphUis. 

The offensive breath from syphilitic ul- 
ceration may be controlled, during the heal- 
ing of the ulcers, by the inhalation of vari- 
ous disinfectants. The following solution 
may be placed in a large-mouthed bottle, 
and the vapor inhaled for two or three min- 
utes at a time. If suflScient vapor does not 
aiise from the heat of the hands, the bottle 



FETOR OF SYPHILIS. 95 

may "be held over a spirit-lamp while the in- 
halation is taking place : 



5. Tinct. iodinii comp., 


f^ss 


Aqua5 aminoniae, 


f3ij. 


Spts. vini rectif., 


f!> 


M. 




Shake well before using. 





Another method of inhalation success- 
fally employed is to cover the patient's head 
with a cloth, place the dish with the solution 
under it, close to the mouth, and then insert 
into the liquid a hot piece of iron wire to 
vaporize it. Dr. John H. Ripley uses a pa- 
per funnel for the same purpose. The small 
end is placed in the patient's mouth, and the 
broad end held over a hot shovel, upon 
which have been placed sub. sulphur and 
mercury. The steam-atomizer is often of 
great service in these cases. A solution of 
carbolic acid, or of any other disinfectant, is 
placed in the chamber. The lighted lamp at 
the bottom in a few minutes generates steam, 
and an extremely fine vapor is thrown from 



96 THE BREATH. 



the mouth-piece. The inhalations may be 
repeated five or six times each day, unless 
they produce too much irritation. 

For the relief of the offensive breath in 
tubercular ulceration, any of the deodorizers 
advised in the second chapter will be found 
efiicacious. 

Putrid Bronchitis is a rare affection. 
We know very little concerning its origin. 
In connection with all the ordinary signs of 
bronchitis, the breath is exceedingly offen- 
sive, and the matter coughed up from the 
bronchial tubes has also a fetid bdor. 

This disease bears some relationship to 
idiopathic ozaena; the fetid secretion prob- 
ably originates in a similar way in both 
diseases. The remedies for the odor are the 
same as those recommended in syphilitic ul- 
ceration of the larynx. 

Bronchiectasis, or dilatation of the bron- 
chial tubes, is sometimes a cause of fetid 
breath. The mucus accumulates in the cav- 
ity of the bronchus until it decomposes. 
When the cavity is full, the foul matter is 



FETOR OF BRONCHITIS. 97 

expectorated in large quantities. Perhaps 
once in twenty -four hours the tubes are 
evacuated in this way. 

To remove the fetor, use any of the dis- 
infectants 



CHAPTER VII. 

FETII) ODOBS FBOM XCTEBAL POISOITS. 

Vm and Abase of Mercury. — Orgins which elimuuite the Dmg.^- 
Effects on the SaliTarj Ghuids. — Qnantity of Drag necessary to 
produce Saliration. — ^Mercarial Fetor. — ^Remedies. — ^Bad Breath 
from Arsenic, Lead, Antimony, Phosphoras, etc. — ^Treatment. 

Ma^jtt years ago mercury was considered 
a panacea for every ilL It was administered 
in all forms of disease. Whether the patient 
had fever, a chill, pain or nnmbness, wakeful- 
ness or drowsiness, or whether he was full- 
blooded or thin-blooded, short, tall, stout, or 
emaciated, a plebeian or aristocrat, the mer- 
cury was given ; and it was not considered to 
have fully accomplished its work until the 
" gums were touched." In those days, mercu- 
rial fetor and salivation were an ordinary oo- 
currence. Even at the present time, cases of 
poisoning by this drug are not rare. 



MERCURIAL FETOR. 99 

Mercury is prescribed for all forms of 
fiyphilitic disease; for sluggishness of the 
liver, and constipation. It is generally car- 
ried out of the system through the kidneys. 
When the blood is overloaded with the poi- 
son, these organs fail to eliminate a sufficient 
quantity. The liver, salivary glands, the mu- 
cous membrane of the alimentary canal, and 
perhaps the lungs, then assist in its removal. 
The salivary glands throw off the largest 
amount. A large quantity of liquid is se- 
creted by them in order to retain the mer- 
cury in a solution, and we have, as a result, 
the characteristic salivation. 

Mercurial fetor may be produced by tak- 
ing one grain of calomel three times each 
day for four or five days. It can be noticed 
when the soreness of the gums is scarcely 
appreciable. Blue mass, given in two-grain 
doses, with the same intervals, will affect the 
breatli in seven days. If the kidneys are 
diseased, a much less time is necessary to 
produce fetor and salivation. In such cases 



100 THE BREATH. 



I have seen a cathartic dose of calomel ca'?>:e 
Balivation in twelve hours. 

Mercurial stomatitis is apt to occur among 
persons who work in quicksilver-mines or 
looking-glass manufactories. 

At the beginning of the disease there is 
noticed a disagreeble metallic taste in the 
mouth, which the patient likens to the taste 
of copper. There is a peculiar feeling of 
soreness experienced at the roots of the teeth 
when the jaws are closed. The gums are 
sore to the touch. A disagreeable fetor is 
communicated to the breath, both from the 
mucous membrane and the saliva. It is the 
most disagreeable feature of the disease. 
Shortly after, the saliva flows profusely. A 
grayish white line appears around the edge 
of the gums. The gums swell and may ul- 
cerate. The teeth often become loose. If the 
disease is not removed by proper remedies, 
the tongue and cheeks become involved, and 
swell up so that eating is almost impossible. 
This condition adds an element of danger to" 
the case. 



TREATMENT OF FETOR. 101 

Treatment. — If tlie patient is taking mer- 
cury as a medicine, it should be stopped. 
Or if he has developed the disease working 
iu quicksilver, another employment must be 
chosen. The mouth should be washed thor- 
oughly four or five times each day with a 
strong solution of chlorate or permanganate 
of potash — the chlorate is the most suitable. 
Glycerine and borax may also be used. A 
teaspoonful of powdered alum in a wineglass 
of water is a good application when the flow 
of saliva is very great. Half a teaspoonful 
of tincture of opium in an ounce of mucilage 
is an excellent anodyne if the soreness is 
great. Belladonna may be substituted for 
the opium if desired. Twenty grains of tan- 
nic or gallic acid, dissolved in an ounce of 
water, may also be used to diminish the se- 
cretions. If these various washes do not 
destroy the disagreeable odor of the breath, 
any of the deodorizing liquids or pills, previ- 
ously mentioned, may be used. 

The internal remedies for chronic mercu- 
rial poisoning are iodide of potassium and 



102 TUE BREATH. 



chlorate of potash. The former is more fre- 
quently used. Either the iodide or chlorate 
may he giv«^n in five or ten grain doses, four 
times each day. The iodide of potassium 
is supposed to join with the mercury in the 
blood and tissues to form the soluble iodide 
of mercury which is eliminated through the 
salivary glands and other organs. 



ARSENICAL SALIVATION 

May result from a long, constant use of 
Fowler's solution, or arsenious acid, or from 
inhalations of microscopical particles of ar- 
senic which arise from the green surfa<;e of 
room.paper and artificial flowers. The sys- 
tem becomes saturated with the drug, and 
Nature calls upon the salivary glands, the 
skin, and other organs, to carry it off. 

The fetor and salivation may be preceded 
by a disordered condition of the alimentaiy 
canal, such as nausea after eating, pain in 
the epigastrium, and diarrhoea. The skin 
presents the waxy pallor of Bright's disease 



ARSENICAL FETOB. 103 

Eruptions, such as eczema, also occur, and 
are probably due to the attempt of Nature 
to eliminate the poison through the skin. 
Early in the disease the breath has a disa- 
greeable odor. It is said by some to resem- 
ble the garlicky odor obtained by burning 
arsenic. The fetor is increased by the indi- 
gestion, which is always an accompaniment. 
The salivation is not so profuse as in mercu 
rial poisoning. Small ulcers may form at 
the edges of the gums, and on the mucous 
lining of the cheeks and throat. Where 
these make their appearance, the fetid odoi 
is increased. 

The administration of preparations of 
iron is advisable in all cases. As a direct 
antidote, a teaspoonful of the hydrated ses- 
quioxide of iron may be given every three or 
four hours. Muriated tincture of iron is an 
excellent remedy in twenty-drop doses, large- 
ly diluted, every fom* hours ; or the prepara- 
tion may be given in combination with qui- 
nine and glycerine (see page 91). When 
mixed with glycerine, the iron is also useful 



104 THE BREATH. 



as a local application to the inflamed mucous 
membrane. It diminishes, to a great extent, 
the fetid odor. Fresh air and nourishing 
diet are necessary auxiliaries in the treat- 
ment. 

Half a teaspoonfiil of cajeput-oil added 
to half an ounce of sweet-oil is a good de- 
odorizer to use in arj?enical salivation. A 
small quantity may be rubbed over the 
gums and inside of the cheeks with the fin- 
ger. The application may be made every 
two or three hours. 

LEAD. 

A fetid breath from lead-poisoning is a 
comparatively common occurrence. It mani- 
fests itself generally with the constipation 
which is one of the first eftects of the poison 
on the system. 

Chronic poisoning may be caused by using 
hair-dyes, drinking beer or water which flows 
through lead pipes, constant handling of the 
tin-foil covering chewing - tobacco, manufac- 
turing or mixing white-lead. It is some^ 



LEAD FETOR. 105 



times produced by wearing Brussels lace, the 
material of which owes its white color to 
carbonate of lead. The symptoms which fol- 
low the fetor, and constipation, are intense 
colicky pains in the abdomen ; retraction of 
the abdomen, due to paralysis of the recti 
muscles; soreness of the gums, with a blue 
line around their edge ; increase in the flow 
of saliva, and " thumb drop " and " wrist drop " 
from paralysis of the extensor muscles. These 
symptoms vary in intensity with the amount 
of the poison taken into the system. Some- 
times the only symptoms manifested are the 
disagreeable odor to the breath, blue line 
around the gums, and constipation. The 
existence of constipation adds, no doubt, 
very much to the fetor. The bad breath 
from lead-poisoning is more easily removed 
than that produced by any other mineral. 
It often disappears when the bowels have 
been completely emptied by appropriate ca- 
thartics. Two or three drops of croton-oil, 
mixed with mucilage or sweet-oil, is a com- 
mon remedy where obstinate constipation 



106 THE BREATH. 



exists. The dose may be repeated in an 
hour if the first fails. Elaterium may be giv- 
en in quarter-grain doses, repeated at inter- 
vals of an hour imtil free evacuations ai'e 
produced. Warm water, with an ounce or 
two of castor-oil, may be used in the form 
of an enema for the same purpose. 

Iodide of potassium is considered by 
many the best eliminative. It joins with 
the lead in the system to form a soluble 
iodide of lead, which is carried out through 
the different evacuations. Sulphuric acid is 
often administered for the same purpose. 
The paralyzed limbs may be healed by fric- 
tion, electricity, and cold water. 

Any of the disinfectants mentioned on 
page 55 may be employed in these cases. 



ANTIMONY 

Produces a bad breath by increasing the 
waste and destructive metamorphoses of tis- 
sue, and by disordering the functions of di- 
gestion. When it has been taken in small 



ANTIMOmAL FETOR, 107 

doses for two or three weeks, the strength be- 
gins to fail. There are loss of appetite, nau- 
sea, pain in the abdomen, and looseness of 
the bowels. The pnlse becomes very small 
and feeble. As soon as the kidneys and 
bowels fail to get rid of the drug, and the 
detritus of nitrogenized decay — ^the mucous 
membrane of the mouth and lungs — the skin 
and salivary glands both fail in their work, 
and the breath is made fetid. The foul odor 
is sometimes associated with a metallic taste 
in the mouth. The principal medicine em- 
ployed as antidotes to antimony are the vege- 
table astringents, such as tannic and gallic 
acid, and strong infusions of green tea. One 
teaspoonful of tannic acid may be added to 
half a pint of water, and taken in repeated 
doses in the course of three or four hours. 
Green tea is probably the best remedy in 
chronic poisoning, because, in addition to its 
antidotal character, it acts as a stimulant. 
Where there is much nausea, mustard-plasters 
should be applied over the epigastrium, and 
iced champagne taken continually. Stirau- 



108 THE BREATH. 



lants and tonics are always necessary to sup- 
port the strength of the* patient. Any of 
the preparations of iron and quinine may be 
employed with benefit. 

PHOSPHORUS. 

Chronic poisoning from this substance 
usually occurs among the employes in match- 
manufactories, from inhalation of phosphor- 
ous vapor. Like the preceding, it usually 
manifests itself first by dyspeptic symptoms, 
such as loss of appetite, weight, and heat in 
the epigastrium and prostate. The breath is 
affected early in the disease, not so much by 
the drug, as it is carried out of the system, 
as by the failure of nutrition and conse- 
quent increase in destructive metamorphoses. 
When necrosis of the jaw sets in, the fetor 
becomes unbearable. 

Tonics, change of air, and exercise, are 
necessary to restore the general health. The 
constant use of disinfectants will be neces- 
sary until recovery takes place (see page 55). 

THB Ein>. 
\ 



EMERGENCIES, AND HOW TO TREAT 

THEM. The Etiology, Pathology, and Treatment of Accidents, Dis- 
eases, and Cases of Poisoning, which demand Prompt Action. De- 
signed for Students and Practitioners of Medicine. 

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Third edition. 8vo, 266 pp. Cloth, 12.50. 



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THE BREATH, AND THE DISEASES 

WHICH GIVE IT A FETID ODOB. With Directions for Treatr 
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By JOSEPH W. HOWE, M. D., 

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A PKACTICAL TKEATISE ON TUMOKS 

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A TEXT-BOOK ON 

THE DISEASES OF WOMEN. 

By ALEXANDER J. C. SKENE, M. D., 

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formerly Professor of G^flecology in the New York Post-Gradoate 

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The arrangement of subjects is such that they are discussed in their 
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Methods of operation have been much simplified by the author in his 
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treatise a practical guide to the gynaecologist. 

Although all the subjects which are discussed in the various text- 
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NeiTons System in the New York Post-Gradaate Medical School ; 

President of the American Neurological Association, etc. 



8vo, 767 pages.' Cloth, $6.00 ; sheep, $6.00. 



In this work the author has not only oonsidered the subject of Insanity, 
but has pre&oed that division of his work with a general view of the mind 
and the several categories of mental faculties, and a full account of the vari- 
ous causes that exercise an influence over mental derangement, such as 
habit, age, sex, hereditary tendency, constitution, temperament, instinct, 
sleep, dreams, and many other factors. 

Insanity, it is believed, is in this volume brought before the reader in an 
original manner, and with a degree of thoroughness which can not but lead 
to important results in the study of psychological medicine. Those forms 
which have only been incidentally alluded to or entirely disregarded in the 
text-books hitherto published are here shown to be of the greatest interest 
to the general practitioner and student of mental science, both from a 
normal and abnormal stand-point. To a great extent the work relates to 
those species of mental derangement which are not seen within asylum 
walls, and which, therefore, are of special importance to the non-asylum 
physician. Moreover, it points out the symptoms of Insanity in its first 
stages, during which there is most hope of successful medical treatment, 
and before the idea of an asylum has occurred to the patient's friends. It is 
believed that the issue of this work will constitute an era in the progress of 
the study of Insanity. 



New York: D. APPLETON & CO., Publishers, 1, 8, & 6 Bond Street 



A TREATISE ON THE PRACTICE OF 

MEDICINE, for the Use of Students and Practitioners. 

By ROBERTS BARTHOLOW, M. A., M. D., LL. D., 

Professor of Materia Medlca and General Therapeutics In the Jefferson Medical 
CoU^^ of Philadelphia; recently Prufessor of the Practioe of Medicine and of 
Clinlca! Medicine In the Medical College of Ohio, in Cincinnati, etc, etc 

Sixth edition, revised and enhirged. 8vo. Cloth, $5.00 ; sheep or 
I:ajf mssia, $6.00. 

The same qiialltiea and characteristics which have rendered the author's 
'* Treatise on Materia Medica and Therapeutics '' so acoeptahle are equally 
mai^ifest in this. It is clear, condensed, and accurate. The whole work is 
brought up on a level with, and incorporates, the latest acquisitions of medi- 
cal science, and may be depended on to contain the most recent information 
up to the date of publication. 



" Probably the c/ownlng feature of the tical guide for the general practitioner.'"—- 

work before us, and that which will make Medical Becord. 

It a fevorite with practitioners of medicine, u ^ ^^y be said of so small a book on 

Is its admirable teacAlng on the treatment ^ i„ge a subject, that it can be only a 

Sf*^'!SfwK ^'J^""^" K ,''"f*?**^^'"Pi5" sort of compendium or t?ad6ffwcww. But 

^^1 ^um*?® modern school of therapeuti- this criticism wiU not be just For, while 

cal nihilists, but possesses a wholesome the author is master in the art of conden- 

belief m the value i^d efflcacv of reme- gation, it will be found that no essential 

dies. He does not fell to indl<»te, how- points have been omitted. Mention is 

ever, that the power of remedies is Umited, made at least of every unequivocal symp- 

that specifics are few indeed, and that rou- torn in the narration of th? signs of dis- 

tine and reckless mediation are danger- ease, and characteristic sjTnptoms are 

pus. But throughout the entire treatise held well up in the foregrbun\l in every 

in connection with each malady are laid case.--<?in^nna/i Za«^ and Clinic. 
down well-denned methods and true pnn- i t% t> i. i j i_ ^ v 

ciples of treatment. It may be said with , "Dr. Bartholowls known to be a yery 

justice that this part of the work rests up- clear and explicit writer, and in this work, 

on thoroughly scientific and practical prin- ^bich we take to be his special life-work, 

ciples of therapeutics, and is executed in ^f O"* ^enr sure his many friends and ad- 

a masterly manner. No work on the ™ire™ will not be disappointed. \\ e can 

practice of medicine with which we are not say more than this without attenapt- 

acqualnted will guide the practitioner in "'g. 1® »i"0^ ^P **»« details of the plan 

all the details of treatment so well as the ^hich, of course, would be u&eless in i 

one of which we are vrviXxazr ^American brief book-notice. We can only add that 

Practitioner. '^^ '*^®' confident the verdict of the pre 

fession will place Dr. Bartholow's * Pra» 
"The work as a whole is peculiar, in S.^®' aniong the standard text-books of 
that it is stamped with the Individuality tho day."— Ctncinno^t 0!>st€iric Gazette, 
of its author. The reader is made to feel " The book is marked by an absence of 
that the experience upon which this work all discussion of the latest, fine spun theo- 
is based is real, that tne statements of the rles of points in pathology ; by the clear- 
writer are founded on firm convictions, ness with which points in diagncMsis are 
and that throughout the conclusions are stated ; by the conciseness and perspicuity 
eminently sound. It is not an elaborate ot its sentences: by the abundance of the 
treatise, neither is it a manual, but half- author's therapeutic resources ; and by 
way between; it may be considered a the copiousness of its illustrations."— (7Aib 
thoroughly useftil, trustworthy, and prac- MediccU Hecorder. 



New York : D, APPLETON & CO., 1, 3, & 6 Bond Street. 



TREATISE ON MATERIA MEDICA AND 

THEUAPEUTICS. Seventh edition. Kevised and enlarged. With 
Complete Index and Table of Contents. 

By EOBEETS BARTHOLOW, M. A., M. D., LL.D., 

Professor of Materia Medica and Tberapeatics in the Jefferson Medical Col- 
lege ; formerly Professor of the Theory and Practice of Medicine, and of Clinical 
Medicine, and Professor of Materia Medica and Therapeutics in the Medical 
Ck>llegeofOhio, etc 

3vo. Cloth, $5.00; sheep or half russia, $6.00. 

The work of Dr. Bartholow has commanded to an unusual degree the 
fr vor of the medical profession. Three editions were printed from the 
plates in the first year. In the new and revised edition a great many addi- 
tions to the text have been made at various points, and a number of new 
articles have been inserted. Although the work is comprised within six 
hundred pages, it will be found that it embraces everything of importance. 
Obsolete theories and chemical and botanical details, properly in tlie domain 
of pharmacy, have no place in this practical treatise. i?o details of any 
value to the physician are omitted. 

One of the most important innovations on existing methods in the de- 
partment of materia medica made in Dr. Bartholow's treatise is his chapter 
on Alimentation. The introduction of this subject, and its skillful handling, 
have been especially commended by the critics and by medical readers gen- 
erally. Th<^t no subject has failed to receive adequate attention, is evident 
enough on perusal of the Table of Contents, which will be sent to any ad- 
dress upon application to the publishers. 



** He is well known as a zealous student Dr. Bartholow, like another experienced 
of medical science, an acute observer, a teacher— Professor von 8chroff, of Vienna 
good writer, a skilled practitioner, and an — picks out the most important pb/sio- 
ingenious, bold, though sometimes reck- logical and therapeutical actions of each 
less investigator. Ills present book will drug, and gives them in a short and some- 
receive the cordial welcome which it de- what dogmatic manner. Having formed 
serves, and which the honorable position his own conclusions, he gives them to the 
that he has won eutitUs him to demand public, without entering so tlilly as Wood 
tor it. . . . Dr. Bartholow's treatise has into the experiments on which they are 
the merit— and a great merit it is -of in- toimded.^''— Practitioner {London). 
eluding diet as well as drugs. . . . His u;^^ n,ay admit, however, that Dr. 
riw ^^^ti?^* ^^1?^^''l ^l^P'*^/*^*® *^« Bartholow has, to a great extent, success- 
Zi^t ?l ?^ empirical facts of a well- f^n ^oped with the difficulties of his clas- 
grounded and rational professional expen- siflitioS, and his book has also other merits 
ence, but, as far as possible, it bases the to commend it It is largely original. By 
tlierapeuticalactionof remedies upon their th\B we mean that it giJes the results of 
l^X^}S^^'^^}^'f''j:'-'^mericanJour- the authors own study and observation, 
not <tf me Medical Sciences. jngtead of a catalogue of the contending 

*' After looking through the work, most statements of his predecessors.*^ — 2'^ 

readers will agree with the author, whose Doctor {London). 
long training shows itself on every page. 



New York: D. APPLETON <fc CO., 1, 8, & 5 Bond Street. 



Functional Nervous Diseases: 

THEIR CAUSES AND THEIR TREATMENT. 

Memoir for the Concourse of 18S1-1883, Academie JRoyale de Medecine de Belgiqtte, 
With a Supplement, on the Anomalies of Rtfraction and Accommoda- 
tion (tf ths Eyey and qf the CkA^r Muscles. 

By GEORGE T. STEVENS, M.J>., FluD., 

MEMBKK OP THB AMBRIGAN MEDICAL ASSOCIATION, OF THE AMERICAN OPHTHALMO- 

LOQICAL BOCIBTT, KTC; FOBMRBLY PROFESSOR OF OPHTHALMOLOGT AND 

PHTBIOLOGY IN TUB ALBANY MEDICAL OOLLBOE. 

Small 8to. 217 pages. With Six Fhotographio Flates and Twelye UlTutzationB. 

Cloth, $2.50. 



The main portion of this work is one of the several memoirs which were pre- 
sented to the Royal Academy of Medicine In 18S8, some of which were contributed 
by Europeans of pre-eminent' rank in the department of Nervous Diseases. To the 
present memoir the highest honors were awarded. 

Dr. Stevens does not In this work, present a treatise upon all the known flacts 
relating to the etiology and therapeatics of the disorders considered. He has, to a 
great extent confined the work to a discussion of the relation of ocular defects to the 
class of complaints known as '* functional nervttus diseases.'*' 

The relations of the accommodating and rotating muscles of the eyes, and of the 
perplexities arising fVom a want of harmonv in the performance of the function of 
acconamodation and of adjustments, are forcibly stated, and the author declarei^ that, 
in the absence of harmonious action, '^ continual compromising adjustments must be 
made and great nervous perplexity must occur ; for no sooner is one part of the ad- 
lustment corrected than the other is wrong. ^' He illustrates this principle by several 
interesting but well-known facts. 

The work takes up in order various forms of functional diseases, such as Cepha- 
lakia, Migraine, Neuralgia, Chorea, Epilepsy, etc., and after a concise description of 
the main characteristics of each, brings each to the test of his hypothesis. A number 
of illustrative cases are introduced under each heading. Photographs from typical 
cases of neuroses are introduced, in which the striking changes of physiognomy 
resulting from relief of the tension of the eye-muscles in such cases is shown. Some 
of these contrasts are very remarkable, and fully confirm the statements made in the 
text. 

In the general summary of treatment the author dwells emphatically npon the 
necessity of giving minute attention to the ocular conditions. He does not ignore 
other therapeutic measures, su3h as tonics, rest, change of air and scene, electricity, 
and other agencies known to exert favorable influences, but these measures, familiar 
to all students of nervous diseases, are too welt known to require discussion in this 
work, and the author refers the reader to treatises of a more general character lor 
the consideration of those agencies. 

In the supplemental portion of the work the subject of refractive and muscular 
anomalies of the eyes is tersely presented. These subjects are treated in so lucid and 
practical a manner as to enable the general practitioner, who would like to make ex- 
aiiiiuations of the eyes of his nervous patients, to accomplish it in a satisfactory man- 
ner. In the chapters on muscular anomalies very mucli that is new is presented. 
This work introduces the reader to anomalies of the eye-muscles in all directions, and 
It is claimed by the author that " insufficiency of the interni " is not only not the sole 
important anomaly of its class, but that it is not the one of the greatest importance. 
He has thoroughly systematized the study of this class of anomalies, in which respecl 
he has certainly made a great advance. 



New York : D. APFLETON & CO., Publishers, 1, 3, & 5 Bond St. 



TEXT-BOOK OF HUMAN PHYSIOLOGY, 

for the Use of Students and Practitioners of Medicine. 

By AUSTIN FLINT, Jr., M.D., 

Professor of Physiology and Physiological Anatomy in the Belleyne Hospital 
Medical College, New York; Fellow of the New York Academy of Medicine, 
etc. 

Fourth edition, revised and corrected. In one lai^e 8vo volume of 
978 pp., elegantly printed on fine paper, and proflisely illustrated 
with three Lithographic Plates and 315 Engravings on Wood. Cloth, 
$6.00 ; sheep, $7.00. 

"The author of this work takes rank standard text-books. The work has very 

among the very foremost physiologists oi few equals and no superior in our lan- 

the dAy, and the caro which he has be* guage, and everybody knows it" — HahM- 

stowed in bringing this third edition of numnian Monthly. 

his text-book up to the present position uThe student and the practitioner, 

of his science is exhibited in eyei^ chap- ^^iwe ^y^^ practice must be based on an 

5®^i.r^t^i^. ®"^ ^^^^*<^ ^'^fifyrter intelligent appreciation of the principles of 

{FhUade^pMa). physiology, will herein find all subjects in 

*^ In the amount of matter that it con- which they are interested fiiUy discussed 

tains, in the aptness and beauty of its and thoroughly elaborated."— C'o^^'^ and 

iilnstrations, in the variety of experiments Clinical Record. 

described, in tne completeness with which u ^^ ^eed only say that in this third 
It discusses the whole field of human edition the work has been carefuUy and 
nhysiology, this work surpasses any tert- thoroughly revised. It is one of our Stand- 
book in the English language. —DitraU ^^ text-books, and nophysician^s library 
-^nce^' should be without it. We treasure it high- 

'* We have not the slightest intention ly, shall give it a choice, snug, and promi- 

of criticising the work before us. The nent position on our shelf, and deem our- 

medical profession and colleges have taken selves fortunate to possess this elegant, 

that prerogative out of the hands of the comprehensive, and authoritative work.^* 

Journalists by adopting it as one of their —American SpecicUisL 

THE SOURCE OF MUSCULAR POWER. 

Arguments and Conclusions drawn from Observations upon the 
Human Subject under Conditiojis of Best and of Muscular Exercise. 

By AUSTIN FLINT, Je., M. D., 
Professor of Physiology in the Bel.'cvue Ilospital Medical CoUege, New York, 

8vo, 103 pp. Cloth, $1.00. 

ON THE PHYSIOLOGICAL EFFECTS OF 

SEVERE AND PROTRACTED MUSCULAR EXERCISE. With 
Special Reference to its Influence upon the Excretion of Nitrogen. 

By AUSTIN FLINT, Jr., M.D., 

Professor of Physiology in the Bellevue Hospital Medical College, New York^ 
etc etc 

8vo, 91 pp. Cloth, $1.00. 



New York : D. APPLETON & CO., 1, 3, & 5 Bond Street. 



A DICTIONARY OF MEDICINE, indndiiw g«». 

end Pathology, GeDeiml Therapeatics, Hygiene, and the Diseases pe- 
culiar to Women and ChUdren. By Various Writers. 

Edited by RICHARD QUAIN, M. D., F. R. 8., 

Fallow of the Bojal CoI]eg« of PhysicUuis ; Member of the Senate of the Uni- 
yeaitj of London; Member of the General Cooadl of Medieal Edncatkm and 
Beglatretlon ; Conanttlng Physician to the H<M|»ltil Am: Consomption and Dis- 
eaaea of the Chest at Brompton, etc 

In one largo 8vo volume of 1,8S4 pages, and 1S8 Ulustrationa. Half 
morooco, $8.00. Sold only by subscription. 

This work is primarily a Dictionary of Medidno, in which the several 
diseases are fully discussed in alphabetical order. The description of each 
includes an account of its etiology and anatomical characters ; its symptoms, 
coa»e, duration, and termination ; its diagnosis, prognosis, and, lastly, its 
treatment General Pathology comprehends articles on the origin, charac- 
ters, and nature of disease. 

General Therapeutics includes articles on the several classes of remedies, 
their modes of action, and on the methods of their use. The articles de- 
voted to the subject of Hygiene treat of the causes and prevention of disease, 
of the agencies and laws aflfecting public health, of the means of preserving 
the health of the individual^ of the construction and management of hos- 
pitals, and of the nursing of the sick. 

Lastly, the diseases peculiar to women and children are discussed under 
their respective headings, both in aggregate and in detail. 

Among the leading contributors, whose names at once strike the reader 
as affording a guarantee of the value of their contributions are the following : 

Allbxjtt, T. Clifford, M. A., M. D. Greenfikld^W. S., M. D. 

Babnbs, Robert, M. D. Jeniter, Sir Williaii, Bart, E.C. B., 
Bastian, H. Charltox, M. A., M. D. M. I>. 

Bixz, Carl, M. D. Leoo, J. Wickhah, M. D. 

Bristowe. J. Ster, M. D. Niobtinoalb, Florence. 

Browx-Sequard, C. £., M.D., LL.D. Paget, Sir James, Bait. 

Brunton, T. Lauder, M. D., D. 8c. Parkes, Edmund A., M. D. 

Fayrer, Sir Joseph, K. C. S. I., Pavy, F. W., M. D. 

M. D., LL. D. Playfair, W. S., M. D. 

Fox, Tilbury, M. D, Simon, John, C. B., D. C. L. 

Galton, Captain Douolas, R. £. (re* Thompson, Sir Henry. 

tired). Waters, A. T. H., M. D. 

GowERs, W. R., M. D. Wells, T. Spencer. 

**Not only is the work a Dictionary of a nntshell the aocnmulated experience of 

Medicine in its Aillest sense; bat it is so tiie leading medical men of the day. Asa 

encyclopedic in its scope that it may be volume for ready reference and careful 

considered a condensed review of the en- study, it will be found of Immense value 

tire field of practical medicine. Each sub- to the general practitioner and student."—' 

]oct is marked up to date and contains in MedkicU Beoord, 

New York: D. APPLETON «& CO., 1, 8, & 5 Bond Street. 



The science and ART op MIDWIFERY. 

By WILLIAM THOMPSON LUSK, M. A., M. D., 

Profes!>or or Obstetrics and Diseases of Women and Children in the Bellevae 
Hospital Medical College : Obstetric Burgeon to the Maternity and Emergency 
Hospitals ; and Qynecologist to the Bellevue Hospital. 

Second edition, revised and enlarged. 

Complete in one volume 8vo, with 226 lUostrationB. Cloth, $5.00 ; 
sheep, $6.00. 



^ It contains one of the best expositions 
of the obstetric science and practice of 
the day with which we are acquainted. 
Throughout the work the author shows 
an intimate acquaintance with the litera- 
ture of obstetrics, and gives evidence of 
lai^e practical experience, great discrimi- 
nation, and sound Judgment. We heartily 
recommend the book as a full and clear ex- 
position of obstetric science and safe guide 
to student and practitioner.'^— Zoncfon 
Lancet, 

** Professor Lask*s book presents the 
art of midwifery with all that modern sci- 
ence or ewlier learning has contributed to 
W—MediccU Record, New York. 

"This book bears evidence on every 
page of being the result of patient and la- 
borious research and great personal experi- 
ence, united and harmonized by the true 
critical or scientific spirit, and we are con- 
vine^ tiiat the book will raise the general 
standard of obstetric knowledge both in 
his own country and in this. Whether 
for the student obliged to learn the theo- 
retical part of midwifery, or for the busy 
practitioner seeking aid in the face of prac- 
tical difficulties, it is, in our opinion, the 
brot modem work on midwifery in the 
English language.''— Z>i/6/in Journal of 
Medical Science. 

**Dr. Lusk's style is clear, generally 
concise, and he has succeeded in putting 
in kss than seven hundred pages the 
best exposition in the Knglish language 
of obstetric science and art. The book 
will prove invaluable alike to the student 
and the practitioner."— -4m«rica» Practi- 
turner. 

" Dr. Lusk's work is so comprehensive 
in desigrn and so elaborate in execution 
that it must be recognized as having a 
status peculiarly its own among the text- 
books of midwifery in the English lan- 
guage."— iVew York Medical Journal. 

"■ The work is, perhaps, better adapted 
to the wants of the student as a text-book, 
ajd to the practitioner as a work of refer- 
ence, than any other one publication on 



the subject. It contains about all that is 
known of the ars obstetrica^ and must 
add greatly to both the fame and fortune 
of the distinguished author." — Medical 
Herald, Louistille. 

'* Dr. Lusk's book is eminently viable. 
It can not fall to live and obtain the honor 
of a second, a third, and nobody can fore- 
tell how many editions. It is the mature 
product of great industry and acute obser- 
vation. It Is by far the most learned and 
most complete exposition of the science 
and art of obstetrics written in the Eng- 
lish language. It is a book so rich in sci- 
entific and practical information, that no- 
body practicing obstetrics ought to deprive 
himself of the advantage he is sure to gain 
from a Arequent recourse to its pages." — 
Ameiican Journal of Obstetrics. 

^ It is a pleasure to read such a book 
as that which Dr. Lusk has prepared; 
everything pertaining to the important 
subject ot obstetrics is discussed in a mas- 
terly and captivating manner. We recom- 
mend the book as an excellent one, and 
feel confident that those who read it will 
be amply reipaid."— Obstetric Gazette, 
Cincinnati. 

"To consider the work in detail would 
merely involve us in a reiteration of the 
high opinion we have already expressed of 
it. What Bpiegelberg has done for Ger- 
many, Lusk, imitating him but not copy- 
ing him, has done for English readers, and 
we feel sure that in this country, as in 
America, the work will meet with a very 
extensive approval."— ^c/in&UTvA Medi- 
cal Journal. 

"The whole range of modem obstet- 
rics is gone over in a most systematic 
manner, without indulging in the discus- 
sion of useless theories or controversies. 
The style is clear, concise, compact, and 
pleasing. The illustrations are abundant, 
excellently executed, remarkably accurate 
in outline and detail, and, to most of our 
American readers, entirely fresh." — 6¥n- 
cinnati Lancet and (Mnie. 



New York: D. APPLETON & CO., 1, 8, & 6 Bond Street. 



New York Medieal Journal, 



-■ FRANK P. FOSTER, M. D. 



It it the LEADI.VO JOURNAL of America, «id conOinB tDore 
re*dJiig-iDatter thaa say other journal of ita claa». 

It is the eipODCDt of the nioKt adTuiccd sdODtiBc medical thought 

Ita coQtribuCora are nmiag the most Imrned medical men of thia 
country. 

Ita "Oripnal Articles" ar« the results of Bcientific obfti^wation and 
reBcarch, and are of inKaite practical value to the general pmctitioner. 

The "Reports on tho Progress of Hcdidne," which arc published 
train time to ti:ne, contain th; most recent discoveries in the various 
departments of medicine, and are written b; prsclitioncra especiallj 
qualified for tho purpose. 

The Society Proceedings, of which each number contains one or 
more, are reports of the practicil eiperience of prominent pbvBicianB 
who thua give to the profeSHisn the results of ccrlain modca of trcal- 

Tbe Editoriiil '^lutnns are controlled only by the desire to promote 
the welfare, honor, and advancement of the aciencc nt medicine, aa 
viewed from a standpoint laoking to the i)est interests of (he profeaaion. 

Nothing is admilled to ita column* tlint has not some bearing oa 
medicine, or is not possessed of some practical value. 

It is published aolely in the interests of medidne, and for the up. 
holding of the elevated position occupied by the profession of America, 



SabscripUon prtcOt 96.00 i>«r Animm. 

D. APPLETON & CO., Publishers, 
Hew ToTk, Boaton, CblooKO, Atlanta, San TranoiBoo. 



MONTHLY NURSING. 



By A. WOBCESTEB, A. M., HL D., 

Fellow of the Massachaeetts Medical Society ; Physician to the 

Waltham Hospital. 

SECOND EDITION. 



12mo, 250 pages. Cloth, $1.25. 



*' This little work, intended as a text-book for nnrses, is fw mociel 
of its kind, and it is a pity that its scope is limited, as its name 
implies, to obstetric nursing. . . . The book is issued in a neat and 
attractive style, and contains many practical hints which would not 
come amiss to the physician, which he would not otherwise learn, 
except through experience." — Weekly Medical Review, 

''This is one of the most practical little books we have seen. 
Not only does it reveal the duties of the nurse, but it contains an 
amount of useful details that will be invaluable to the young prac- 
titioner." — Practice: 

"... We regard this book as of great importance, and doctors 
should insist upon their monthly nurses adopting it as a text-book 
for constant bedside use." — Virginia Medical MmitMy, 

" This little volume is one of the most complete treatises of the 
kind we have seen. Mothers and nurses will find it invaluable." — 
New York Medical Times, 



New York: D. APPLETON & CO., 1, 3, & 5 Bond Street.