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O 


MANUAL  OF  TREATMENT 

A  CONCISE  PRESENTATION 


OF  THE 


MODERN  METHODS  OF  TREATING  DISEASE 

EMPLOYED  BY  THE   BEST 

AUTHORS,  TEACHERS  AND  PRACTITIONERS 

ARRANGED   WITH   SPECIAL  REFERENCE  TO   THE   NEEDS  OF 

AMERICAN  PRACTITIONERS. 

BY 

C.  F.  JAYLOR,  M.  D.,  editor  of  THE  MEDICAL  WORLD. 

AND 

W.  F.  WAUGH,  A.  M.,  M.  D., 

Irofeiiur  of  Praclice  and  Ciimcal  MedUint,  in  the  MtdUo-Ckirurgical  CalU^e  9i 

Pkiladtlpkia;     Phyticiatt   t»  Ihl   Mfdico-Ckintrgical  Hospital  of 

Pkiladclphia  ;  Memier  Amtrican  Aeademy  *f  Mtdicint ; 

Academy   of   Natural   SeitMcei ;    Micrascapical 

and  Biological  Sectian  ;    Viie-IVttident 

of  the  Medico-Legal  Society  of 

Philadelphia  ;  Late  of 

U.  S.  Navy; 

etc.,  etc. 


PUBLISHED  BV 

THE  MEDICAL  WORLD, 

15J0  Chkstnut  Stkbet,  Philadilfhu,  Pa. 

1887. 


Entered  according  to  Act  ot  CongrcM  in  the  /etr  1880,  in  the  office  of  the  Librmriut 
of  CoDgreas,  at  Wuhingtoa,  D.  C. 


•••  •      •      •>.  •    •     • 


PREFACE. 


MoK  tlittii  tvro  yeant  ago  [  berame  in)pn»»ecl  with  the  grml 
tinxl  uhI  pr<»i>e<rtivu  uwfuliieibt  of  ttucb  n  work  ub  Uiis. 

1  •'lBlionit«!«l  Ihf  pUri.  ami  in  .Imif.  18K.'i.  UK'k  iwlvanfage  <»f 
■  litlli-  ii|iurv  tiiuc  ttiid  Itejraii  llie  |trcpiinitiou  of  it.  Soon,  liow-- 
ervr,  preSHing  engag«inento  compel  led  tne  tii  lay  the  nmnuMcript 
Bude,  aitd  I  lui%-e  liot  niiiLiu  hatl  au  o|>|>ortuuitv  to  resume  iii>' 
labors  upon  it.  A  few  months  ugo.  I  hail  the  gootl  furtuuo  to 
indaoc  my  i»t<«iu«il  friciitU  Prof.  VTaugb,  to  revise  aud  hrmg  to 
date  m^  rnanQ»'rij>t  (tlieii  mnrr  than  a  vcur  old),  aitd  compWtc 
the  witrk  ujKin  the  liiri»  origiiiuUy  luid  down.  It  is  my  plcaeun:, 
then,  to  aajr  that  thu  book  is  the  rctiuU  cliiefly  of  the  exteutfivv 
fwcarcb  and  fin«  diM-rituinatitm  of  Dr.  AVaugh. 

It  haa  beeu  our  object  to  proeeiit  as  tersely  as  poraible,  first 
th*  troatindDt  generally  r»-^giiixc<i  and  um^A;  .«c<-ond,nny  pecattnr 
nutbod  of  treatment  ii«ed  by  any  prominent  author  <^  practitioner. 
PftiisineDco  hasl»een  given  to  Tnct)io«l.-i  iiiied  tiy  American  aatfaora 
«Bd  prsctitioDen.  although  the  work  id  by  no  mentis  confined  to 
nativ«  anthore,  bat  Engliiih.  rtcminn,  Fron«.'h,  Itnlian  and  othor 
MMuoea  have  f»eeii  (iniwn  n]>on,  whenever  they  offered  rfttQai>le 
inftUrialii. 

Our  chief  objert  U  lo  nave,  on  the  |«ari  <if  the  practitioner, 
the  time,  labor,  and  oxjwnw  iieoeBmry  to  niako  the  exteurii'c 
raMVche»,  the  nwiltA  of  whit^b  are  here  given. 

In  preporiug  the  article  upon  each  Dubjevt.,  the  treatment 
which  «ei*meil  moft  lyimpli'tp  \aw  Imhsii  given  first,  and  to  save 
trpetition,  all  matter  eonlaiui-d  in  tiio  fin>(  i{Uotation  lu  oniitUHl 
(Wrtn  ihowe  whit-li  follow.  Kxwptiomt  to  thin  nik-  are  made  in 
caaw  wlwre  great  diverBity  exit^lB  betwetm  %itrtou((  itulhont,a«  tn 

treatment  of  irii>ortant  diwauw*',  tmch  as  !i|M)]'lexy,  nr  t*rebni- 
fever.  H«'re.  ("Mb  (tide*  art-  prt'«eiiti-«i  liilly,  with  tin-  array 
Iff  aathoritics  foreach,  that  the  reader  may  cboono  aueording  to  hia 
Mtimatoof  th'Talno  to  he  asigned  In  t}ic  opinions  of  raiL'hantbor 
qaotsd. 

Aa  tlu*  tendency  to  ^iiuplitiaition  of  orthograpby  \»  becomit^ 
pnsraknL,  dipthongM  in  >>arh  wonli*  af>  amenia,  betnorthage,  etc., 
are  dlacarded  in  tbiii  work. 

C.  P.  Tailo*. 
J6gU  Chaitiiut  fH.,  Hiin.,  Oetal>rr  1511,,  JHSti. 


£££0. 


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MANUAL  OF  TREATMENT. 


ACNE 

The  fact  that  thU  annoying  a6«ctioii  occurn  «o  frequently  at 
thei^  of  puberty,  should  lead  us  iu  all  cases  to  investi^jHte  the 
condition  of  the  «?xnnl  organs.  Tf  nny  undue  BensitiveneM  exist 
in  the  urethtu,  a  metallic  sound  should  be  passe*!  every  other  day, 
sod  allowed  tn  remnin  Kome  mlnuteit.  In  fcnmlea,  hot  vnginal 
douchw.  with  cold  douches  to  the  spine  every  morning,  will 
frwjnently  prove  efteclive.  SucH  nieaiiturrs  will  not  preclude  the 
me  of  such  remedied  as  are  prescribed  by  the  dermatologlBts,  and 
will  often  cure  without  the  aidof  the  latter. 

Kiui'xrK  WiiJiOK  recommeiidti  that  the  exciting  cause  iihould 
firnt  be  Bought  and  removed.  The  gencml  bcnith  and  the  nutrition 
of  the  Hkin  nhoutd  be  improved;  diet,  exerc-Lte,  and  other  points 
in  jierMwial  hygiene,  should  be  careftilly  regulated.  Tonica  are 
hiditiated  ;  atpecially  Fowler's  solution  ni,  ij,  ter  in  die,  after 
meal»,  with  wine  of  iron.  [An  objct-tion  to  giving  arsenic  after 
dumIh  is  tliat  it  U  apt  to  he  Iomc  in  the  oonlents  of  the  tttomueh  and 
Toided;  eftpecially  if  iron  be  present,  with  which  it  forms  an 
inflolable  precipitate.  ^Iien  the  two  drugs  are  to  be  given  to- 
gether it  ia  best  to  tue  the  chloride  of  arsenic  and  tincture  of  iron.] 

Loitlly: 

H    6o)phnris  bTpocblcrkl^ 3  ^ 

Pmm.  arh, gt,  z 

Adipto  bcuaSsW Ij 

Simple  though  the  above  Beoms,  yet  general  practitioners 
have  niuoh  trouble  with  thisdiseafie.  '^Remove  any  exciting  cause 
thill  may  exiiit "  involved  vastly  ditTcrcnt  meaoa  in  dillerent  ca?C6. 


2  MAKCAI,  Off  TBBATMBST. 

Gonstipation  in  frcqiicutly  an  exciting  <-aui<e,  and  for  this,  R&Iine 
laiative«,  pnM'fraMy  in  the  form  of  mineral  watt-rn,  are  chosen. 
Sulphurous  waters  are  vastly  Hupurior  in  thiK  affection.  If  the 
exciting  cauec  ha  a  disturbance  of  the  uterine  fmictions,  tliis  most 
be  «^ori-ut:te<1.  Alootio  pUTgtttiveB  aiul  warm  hip  hatha  arc  indi- 
cated when  tho  cruptioiv  octiira  in  fcnialea  at  the  ago  of  piibertjf. 
Digwtivc  dilficiiltic*  must  be  met  by  appropriate  meaauree.  A 
uiriiple,  unetimulating,  but  nutritiouB  diet  in  to  be  recommonded. 
In  plethoric  ca^w  soino  restrictione  are  neooiwary.  A  large  propor- 
tion of  caaes  will  b«  found  to  depend  upon  a  depraved  condition 
of  the  blo(Hi,  which  will  be  materially  benefited  by  the  building- 
up  remedies— tonics,  cod  liver  oil,  iron,  etc.  It  will  I>c  aeon  that 
the  general  treatment  must  be  detenuined  by  the  iadicatioufi  in 
each  particular  (.itse. 

>IiKMB¥£R,  on  the  other  hand,  repudiates  the  use  of  internal 
remedice.  aiirl  pruistw  liwjil  inc^lifation.     He  recommends  lotions 

of  potash,  by  drarg.  biohlorid. ,  or  benzoin.    1 U--  quotes  Veibl's 

treatment  appr»«'ingly  ;  coiisiutliig  in  vigoroiw  bniehing  with  soft 
Boap  and  a  nail  brueh.  Kven  if  this  sliould  not  succeed  by  itself, 
many  aulhontics  recommend  it*i  uee  pi-evious  to  the  application 
of  ointment*!.  Thus,  llBBBa  rocommendu  vigorous  scrubbing, 
followed  by  the  application  of  a  paste  made  by  mixiug  precipi'- 
tat«d  sulphur  with  oqiml  part«  of  alcohol,  carbonate  of  eoda, 
lauifl  water  and  glycerine,  Nearly  all  authors  recommend  tlic 
applicatiooa  to  l>e  lett  on  over  night.  A  popular  formula  in 
Germany  is  aa  foUowa ; 

B      Ijulphnr.  pr«cip .,,. •....JU 

Cwiiphitne •-■*•« ■•■ fr,  x 

AcmciB  pair.. .f^-** 

A(|U»c«l  CM....!  >.>.........  ••.,..,,., 

AqiuvroHC i.A  II5  ij 

M-    B.    Bhllm  TTt'l    Applyalbrd  timSgUulnezlinoniingrnbofrvithout  w«uinf. 

The  treatment  pursued  by  Balmakno  Sqi^rr  differs  with  the 
varieticA  of  the  diaeaae.  In  acne  Hiniplex,  with  deep  red  areohe, 
he  recommends  low  diet,  ealines,  and  vapor  baths,  with  weak 
alcoholic  lotions,  ^\'^len  inflnnnniitioii  has  subsided,  he  osea 
weak  Bolution*  of  bichloride  of  mercury,  gi-.  j  ad  5j-  Amenor- 
rho^u  coiiictding  muet   receive  appropriate  treatment.    In  aone 


I 

I 

I 


^tM. 


ACITK. 


8 


. 


ioiltirata,  be  u»q»  sulphur  ointment  When  the  puatules  are 
large,  with  livid  an'r.liL-,  tlie  bmiodide  of  mercury  (^.  v-xxx 
a«l  3  j),  w  preferalrle.  TliU  t<lit>iilii  In-  usiil  nmi]  ilic  •*kiii  UH'umwt 
tendvr,  wlieii  il '»  to  bo  sit^peiwled  for  a  few  rlHVi'.  Chrysopha- 
nic  acid  5  ij  to  5  j,  w  also  nscnmnwiwKfl. 

Acne  ro°aci.'a,  more  than  auy  other  variety,  demands  atUin- 
tioD  to  th?  digvAttoii,  etc  Uterine  difieaw,  intemperance,  or 
sedentan*  habiti)  may  render  onr  but  eftbrta  nu^tory  until 
oorrcf^tcl. 

\Vlien  theskin  i»inuch  imliinittHl,  ihv  biniodide  of  mercury 
ia  the  bo(tt  local  remedy.  The  tiiberclee  which  show  sigtw  of  «up- 
puratitig  nhniiltl  tie  fnt-ly  Uiiitr^l.  CoIo^O  i^^  »  useful  lotion  in 
acne  punctata,  after  the  contenlt*  have  botn  evacuated.  Stronger 
local  AtiniulaniA  arc  needful  when  the  folliclo*  ga{ie  widely  open; 
such  as  croton  oil,  diluted  vrith  olive  oil. 

Aciii!  iil^imii  ileniandit  the  iVee  um  of  soft  SOap,  folIowi?d  by 
■dtrliigont^  HiiOKMAKER  treatin  obstinate  forniit  by  piinoluring 
with  a  needle  knife,  and  applying  oleate  of  zlnc  or  of  bismuth, 
until  irritation  ha«  suheidetl.  When  uHtringerit^t  are  indiuateil  h« 
uaes  a  weak  oininient  of  oleftte  of  iron. 

PtrFABD  suggests  that  arsenious  add  (gr.  ^  u  i.  d.  in  pill, 
before  mc&l«)  in  beat  Auiteil  to  (•UM'ti  wheru  the  pnpnle«arc  indolent, 
not  painful,  slow  in  couno  and  not  tending  to  xuppuration.  Sul- 
phide of  calcium  i^  the  reniMly  in  a^-'ute,  Dontdtive,  rapidly  sup- 
purating ca<*es.  The-  do^  of  the  latter  drug  is  one  grain  daily,  in 
divide  dflcwtt.  Bromide  of  arsenic  (gr.  „  t<*  w)  occupiea  a 
middle  g-i^sund  between  the»e  two.  The  duration  of  tlie  pUHtoles 
if  leneoed  by  i)uiieLuring  each,  as  luioti  at  it  apjieara.  In  aeiie 
indunita,  when  »uImiciiU>,  with  large  tuberelcM  and  much  infiltni- 
tion  of  the  surrounding  skin,  mercury,  phcwphorus  or  the  iodidtti 
will  prove  us*-ful  addition*  to  the  above.  Soft  soap,  a])plied 
nightly  until  the  patient  rcfusea  to  bear  it  any  longer,  will  raducw 
the  infiltration. 

^^A  Yax  Uablixobn  laye  stress  ui>on  the  retaliation  of  tbegeueral 
^^■AMlth,  and  tuw  iron,  araenic  or  mortury  internally,  as  maybe 
W      faidicntcd.    The  White  Sulphur  waters  huve  m>me  reputation, 


MATHTAt  OP  TBEATMINT, 

!  probably  due  to  the  pure  air  and  eurrotindrngg.    Sea  air  often 
•ggraviitce  acne. 

SCTMMART. — 1.  Correct  any  derangement  of  tlie  general 
[ItcalOi  wliit-'lk  a  thorough  examiimtioQ  may  disclose. 

2.  Regulate  the  general  aiul  personal  hygiene. 

3.  The  rigorous  application  of  soft  eoap  is  indicated  in  all 
'ttues  exoopt  the  rare  acuto  Ibnn;  but  eepct-iaUy  for  infiltration. 

4.  Kcorly  all  authors   recommend   aulph.ar  ointment*  for 
[  ordinarj-  eases;  mercuriala  ior  severe  ones. 

.5.    Kxcept   when   uleurly   indicated,   internal    remedies  are 
J  larely  of  use. 

6.  The  dirteose  ia  singularly  obstinate;  hence,  t-bangee  in  the 
htmcnt  adopted  after  mature  reflection,  should  not  be  made 
eoejit  lor  fnuse. 

Eigot  will  cause  the  indnmtinnsi  to  disappear  quickly;  bat 
they  will  retura  when  the  drug  ih  diecontinued. 

Electrolysis  lum  not.  proved  ftUf-ocsHfiil  in  niir  hand.4. 
The  benefit  derived  by  lancing  the  puetulee  and  scraping  out 
the  contenta  with  a  curette,  ban  not  been  sufficient  to  atone  for 
the  pain. 

Tlie  prolonged  use  of  strychnia  ivml  mtro-iuuriatic  acid 
iKimetiiaes  effects  a  cure. 

A    StrycliDue gr.  j 

Add.  nltr<>-mur. fj  iij 

Aqtw  dMi.  <i.i.tiA t^T 

6.— A  towpooaful  ia  wsUir  before  cadi  mral. 

We  have  more  than  once  faile<l  to  benefit  a  patient  nntil  he 
abstained  from  matt  liquors. 


ADDISON'S   DISEASE, 


In  the  tubercular  disease  of  the  euprurrenal  glands,  all  we  can 
attempt  ie  to  prolong  life.  It  would  be  going  too  tar,  however, 
to  athrm  that  no  form  of  supra-renal  diseaee  occurs  which  is 
curable.  SLiwe  we  cannot  always  be  sure  that  we  have  or  havo 
sot  an  incurable  form  to  deal  with,  it  is  our  duty  to  put  oar 


ADDISONS  DI6SA5K.  O 

patients  upon  such  a  n^x'inieu  a^  will  ^iv(>  the  bcttt  chnnco  of 
recoverj-,  if  it  be  a  curable  oiiw ;  and  prolong  lite  if  iucunible. 

Ilf  BRKEL  aays  that  patients  do  beat  with  perfect  net  from 
ixncotal  worry  and  from  pbyRioal  exertion,  llic  diet  should  bo 
rich  in  albumen.  A  good,  wine,  witli  plont_v  of  body,  Miould  bo 
recomniende*l,  and  in  mme  eaew  the  etronjy  ii()Uors.  The  gastric 
deranji^mcats  mast  receive  appropriate  trcntraent.  PurgatiTos 
do  hanii;  mild  aalinos  good.  Iron  and  quinine  are  uwfiil; 
morphine  w  mid  to  be  bonefiL-inl,  thnngh  it  U  diJIivult  to  seo 
why  it  ahould  be. 

lodido  of  potash    and    gnlvanitiTn    bare  attto  received    tbo 
amiiuns  they  usually  obtain  in  incurable  dieeasos;  with  the 
resnlL 

SiLTKR  states  that  cold  or  frozen  foo<l  will  be  lolerateil  when 
hot  gubstancee  are  rqjected.    In  certain  stages,  the  pharmacopteia 
,mii3t  be  laid  aoide,  and  the  cook-book  Hubstituted. 

WiLKs  eays  that  tempi^niry  imi-rovi'iuont  sAmotimcs  ^\■i^llf,'^ 
from  the  udminiDimtion  of  phosphoruB,  chloride  of  caiciaiu, 
or  anensc. 

KiKHKVKR  i4um»  Up  the  tn.>ntineni  in  thow  wonU:  gixid 
nourinhuent  and  careful  nursing. 

Bartuolow  advises  [iho-tphonw  in  «>d-Iiver  oil,  chloride  of 
calciam,  Hyrup  of  the  iorlideH  of  iron  and  matigano^e,  and  arsenic. 

QDEinciioTr  reports  dccidc<l  improvement  to  hare  followed 
the  administration  of  glycerine,  f  5U,  spirits  of  chloroform  and 
tincture  of  iron,  u&  %  xx,  three  tim<M  a  day. 

Fmkt  nayA  that  gcjicral  faradisation  and  galvnnintatiou  of 
the  ftyrapathetic nerve  was  followeii  by  iuiproveracnt  in  all  rft*[>ectii, 
which  continued  two  yi»re,  when  the  jiationt  suddenly  failed  and 
died  in  tweoty-foar  hours. 


Al.nUMINURIA. 

It  ia  a  great  mintakc  to  consider  iilbuniinuria  and  Brigkt'a 
dtaoaae  as  synonymous.     Albuminuria  w  but  a  symptom,  and  it 


6 


lATMRST, 


exista  In  many  randitions  &ei  w«1l  m  In  Briglii.V  dlKM9.  Ax 
a,  transient  foiidition.  it  frequently  fnllnwn  the  administration  of 
diloroforui,  clJitT  or  the  nitritt;  of  amyl.  It  is  often  t«miMininly 
pr«*ent  in  pneumonia,  intermittenta,  rheumatic  fever,  SL-arlatioa 
and  cholera — in  rthort  thf  felirilc-  inwl  inflainnmtory  distrasert  gene- 
rally. It  is  prt-sent  in  inHamniatioiis  of  llie  urino^eiiitat  mucoiia 
meinbraucs :  and  in  urine  coiitainiug  pus  or  blood.  Ifat  pctBUtont 
prtwenre  indimttw  atnirtnml  diwwi^e  of  the  kidnpys. 

Mtt-hanicul  oiuses  producing  iMwsivecongcatiouof  the  kidneys 
give  rifio  to  aUuimiiniriai  among  these  are  prognancy,  alHiominat 
tumors,  cnlorgementa,  ct-c.,  and  cardiac  and  jmlmonary  diseases. 
The  prew.iH;«  of  alhiuninnria  in  pneumonia  is  pn>l>al>ly  more 
dejMrudeat  ujwn  mechanical  oltstnictioii,  than  npoii  the  inflamma- 
tory anri  fehrile  (.-ondition. 

It  will  be  m>en  that  itd  treatment,  when  this  h  neceoaai-y,  muet 
depend  entirely  upon  the  eon<lition  which  give*  ri**  to  this 
symptom.  Astringcnt-s  that  reach  the  urino-genital  tract  throngh 
the  hlootl,  as  gallic  and  tannic  acidp,  tincture  of  the  chloride  of 
iron,  etf.,  reduce  the  quantity  of  albumen;  ergot  protliu-es  the 
same  effect  by  diniinisbing  the  calibre  of  the  arteriole*. 

When  do)>endent  ii[ion  mechanical  (ims*^,  thtir  n-inoval,  when 
po«"iblG,  is  of  L'oureo  the  leading  indication.  Digitalis  will  bo 
found  very  uHeful  for  patwive  congOHtion  of  the  kidneys,  ]»articD- 
larly  when  dependent  upon  eanliai*  dii*cai*e-.  It  in  Itest  given  \n 
infuai<ni.  Sijuibb's  tinctnreof  digitalit*  will  be  found  to  be  a  roU- 
able  preparation;  it  may  he  given  in  do»c«  of  from  three  to  as 
high  an.  ten  or  more  droji*.  three  times  a  d«y.  Tlie  warm  bath  is 
Qscfiil  by  attracting  the  blood  fmm  the  interior  to  tJie  Kurface  of 
tliebody;  eupping  over  the  kidneyi^  i^t  also  useful  on  the  same 
principle.  Ilydragogne  catbartips  may  l)e  nswl  with  benefit. 
Iron,  quinine  and  other  tonii-s  are  important  to  improve  the 
quality  of  the  IiIikmI  and  Htn>ngthen  the  general  ityatcm. 

R    Tinct.fcm  chloridi Q  >T 

IJiitulnw  lulphat. gr.  xi  iv 

Syrujii .*. q.s.  ad  f^  Ifl 

M.    8. — A  tewptitinfti)  after  tscli  mnd. 

It  i»  in  pregnancy  tJiat  alhuminuriu  of  the  kind  now  under 
corutidcration  is  of  the  greatest  coDeequence,  and  it  ^outd  be  met 


I 

I 


XLoonousM. 


I 


as  well  w*  may  \iv  1>y  Hie  nlinvo  iiitiH^iintM  (except  ergot),  until  tho 
caaee  t«  renrnveil  by  partiintion. 

"Wc  liBVC  for  many  ycun*  Iwen  in  llit-  hahitof  directing  preg- 
nant women  witli  alhiiminnria  tn  drink  half  a  gallon  of  butter- 
millt  fVtTV  lUiy :  ami  I  hnv«  never  liiul  (x-ca^ioti  U>  iwe  any  other 
trcntiui'iit  iit  Aiu-li  i-a^ioi,  nor  haw  1  hud  a  |iuei-]«ral  convuUioD 
occur  to  any  of  my  jwticDts. 

Imjx'rfeLt  ilii^tiun  has  btc-n  noticed  to  jfive  rise  t")  albumin- 
uria of  a  wmewliat  j.rotractcd  character,  lu  ouch  ca«»  Lapdee 
BacKTys  «iy8  that  tonie^  aod  artificial  (tigwtive  agents  are  iodi- 
cst«d.  T\ie  apiM-iinince  of  hnsmoplottin  in  tlie  urine  of  eourae 
indicated  that  albiinK^n  U  also  present.  'l*bi>!  (lcf)end«  upoii  the 
BUne  condition  which  pcnnittt  Mlntion  of  the  corpiiAclen  in  the 
Wood.    Qnininc  anit  genewl  i*u]»portiiip  ni«wnre»i  are  indittal«d. 


ALCOHOLISM. 


A— I>R0KKENNESS.  Bokum  recommends  die  use  of  the 
atomaoh  pump;  as  targe amonnts  n{  alcohol  often  remain  in  the 
etomocb.  In  alcoholic  (x>mji,  when  reHpiration  fnibi,  frictionK,  cold 
affiiAionii.  Hinapinma,  and  other  cutaneous  irritants  should  bo  ummL 

LotiMis  recommemlK  the  Rtomacb  pump,  energetic  frictions, 
and  galTfUiiszD ;  the  latter  in  coma;  for  llatnlence,  tho  ttimplo 
hitt«ra. 

yiBMBYRR  adviflce  cold  to  the  head,  and  irritant  foot  hatha, 
especially  brief  once  of  ice  water. 

Warwu  telk  lu  to  empty  the  atomach  by  meaiiui  of  emetics 
and  The  pnnip;  to  iiee  cold  atf'imions,  a  little  ammonia.  Htrong 
coffee,  and  fiubsequeiitly,  wanuth. 

CuRNOw  rwommendg  for  the  acute  gastric  catarrh  following 
ft  debauch,  wiuibing  out  thu  stonuu^h  with  warm  watery  a  mild 
■dine;  nimple,  fluid  diet;  un  alcohol;  and  exercise,  active  or 
passive,  according  to  the  acrongih.  For  coma,  the  eAmo  treatment 
heretofore  given,  with  foradiuLtioQ. 


8  MANUAL  OF  TREATMENT. 

Napokyp  treat*  the  irritable  stomach  with  ioed  milk  nr 
ferated  waters,  liiue  water,  or  ati  ice  ba^  to  tbo  epij,'n!itriuiii. 
Persistent  retching  calls  for  one  (Imp  (lo«ef>  of  Fowler's  solution. 
Nervous  proatratioii  and  apprehension  Indicate  tlie  uae  of  nux 
Tomica,  il.  exL,  gtt.  v-xv,  everj'  four  Iiount. 

v\.  McL.  Hamilton,  far  the  headache  and  wakofuhiesa  fol- 
lowing a  debauch,  pre«;ribes 

3     Cmmphor  brom  mono 5j 

Confcct.  rott,  c{.  g^ 

Vu  niM.  «  in  pil.  no,  xy  dii'. 
R — One  or  two  u  r«<inireil. 

B.— DELIRIUil  TKEMENS.  Boeiim  wiys  that  mniiy  «wo9 
do  very  well  on  nursing  alone.  This  is  all  that  is  needoil  if 
the  bodily  condition  be  good  and  no  complications  exist,  Oi'inm 
in  uontra-indit'aited  by  a  feeble  heart.  He  attaiihes  the  utmost 
importaiK*  to  the  dietetic  trontmont,  o*pej'iiiUy  in  U^liouw  ea»eft. 
The  raoflt  careful  management  u  requisite  iu  order  to  recruit  the 
strength. 

LooMIs  confine*  the  diet  to  milk.  Opium,  chloral,  Kmm- 
idft  of  potash  and  henbane  arc  nwd  to  produce  KK-ep.  Tartar 
emetio  is  somotimei^  used  for  thie  purpoac.  The  d.«lirium  may 
Tcqniro  cautious  iuhalatiou  of  chloroform. 

Davw  claims  that  forty-nlm'  <mt  of  filly  would  riicover  M'ith 
nursing,  rest  and  nouruthment,  without  medicine.  An  experienced 
nurse  is  to  be  acciired.  Hcstivint  and  argument  excite  tbe»u  cu.'wa, 
and  aggravate  the  trouble.  The  indications  are  to  quiet  the  nei-vea 
And  :tu^taiu  the  heart ;  hciiuu,  liti  advocittos  the  uac  of  hroinidca 
And  digitaJiii. 

B     I'oMs.  brum 5  *3 

Tinrt.  ili^italia, fj  v 

Eliz.  Nmp., tl  U 

AqoKr V tl  U 

M.    S.— 15  y,  e^*rj  two,  three,  or  (oat  boun. 

In  the  early  stagoa,  if  the  above  does  not  induce  tiloep,  be 
gives  chloral,  gr.  xv  t«  xx,  at  8  P.  M.,  repeating  at  10  P.  M.,  if 


I 


AUOUOIJHN. 


« 


If  the  patient  be  fcvcriith  at  the  start,  a  Tew  email  doaw 
fi)S  calomel  are  ^iven,  fi>llow€<l  by  n  laxative  euUuc.  VThan  tlio 
sabjcct  U  too  exeU«d  or  suspicious  to  tnke  medicine,  it  may  b« 
iry  to  qniet  him  with  u  hyi>o<kTmic  of  mori>hia  and 
futropia.  Great  care  U  iHxvswnrv,  a>i  nai\^<tism  i-*  apt  to  occiir. 
NnumhmcDt  is  moro  important  than  medicine.  Animal  broths, 
milk.  »iiil  mill)  lari tiiu-tMiii.'!  t'otMl  arc  suitabU>.  Cnrcfnlly  ^uard 
against  too  early  return  to  work. 

]&)iiRiLTit  recommendti  that  alcohol  be  tttopiMKi  abruptly  in 
young  subjects,  or  first  attack?;  butt]iat  in  8ubmx|tient  wixurea 
or  in  feeble  jwrsons  it  be  withdrawn  gradually. 

If  food  he  refuaed,  the  white  of  egg  may  be  pivon  in 
ice  water.  In  robust  caac^i  a  bri^k  hydmgogue  is  itaeful  at 
the  start.  To  ]>rocure  sleup,  hypodermics  of  morphia,  gr.  |  to 
|;  chloral  internally,  gr.  xx  cverj'  hour  or  two;  bromide  of  pot- 
ash, gr.  XX  nvery  two  hour^;  and  cimnabi^  Indica  are  recommend- 
ed, lie  agnras,  as  a  rule,  that  patients  noe<l  not  be  "narcotized 
into  sleep,"  bnt  haa  met  caKCfi  wliere  the  only  chiinoe  of  recovery 
aoemod  to  bo  in  procuring  tiilecp,  and  where  large  thy^i-s  of  mor- 
phine, with  good  feeding,  reninlto*!  in  twiving  Iivcj^  Adynamia 
calls  I'oraramotiia,  other,  niuak,  or  canijthor,  with  brandy.  Pneu- 
monia requirt-s  a  supporting  treatment. 

Taitner  belie\'e!i  thnt  ali*oho1  <ihonld  only  be  given  in  ex- 
ceptional cn>te«);.  lie  gives  it-o  luid  i^allnoa  to  t-ool  the  Httimach, 
and  alliuminouii  foodn  to  Hujiport  the  ntrength.  A  Hhowor-bnth 
sometimes  givee  m  much  relief  that  it«  re|>otilion  wilt  he  urgent' 
ly  demanded  by  the  |uitient.  Great  deprB.>u>i(>n  eallK  for  «tima- 
lants;  to  which  Dover's  powder,  or  opiimi  and  tartar  cmeitio 
maj  be  add^d.  0>iri!<tHnt  didirlum  Munetimen  requireB  the  cau- 
ttous  uw  of  chloroform  inhnlatioiH.  ilc  iipprorea  in  some  case* 
of  the  use  of  digitalis,  uit  recommended  by  JoNRif.  of  Jerray, 
in  398  doaes  of  the  tincture,  repeater!  in  four  liotir;*  if  iiei'»»twary. 
The  caaea  in  which  this  drug  ha^  pntveil  iniMl  useful  are  thoio  in 
which  the  »ymptoms  reecmbie  those  of  acute  mania,  and  in  which 
there  is  not  much  exhaustion. 

Tbodsseai;  cuIIm  chloral  u  prcciati»i  remedy  in  thitt  diaeaae. 
Thirty  to  forty-five  grains  are  given  by  enema,  iind   repeated  if 


10 


MANUAL  OF  TREATMENT. 


nctiftssary.  Ho  sijonki*  of  flim^ihi-tiiiii  06  Itwiefinia!,  amt  also  of 
digitalis,  titatiiig  that  in  t«ii  yea,K  he  \o^t  but  one  ca»e  umicr 
it*  uw?;  an<l  that  probably  because  ho  did  not  give  the  dni^  boldly 
enough.     The  same  doec  is  ariven  as  noted  above. 

lloi'SKAKii  itM-omniends  dcL-oction  of  cinchona  as  a  s^iccific. 

Lawson  Tait,  spenkiiig  of  women  boeoining  addictM  to  in- 
temperance, iay»  that  he  has  never  yet  had  aiieh  a  eoMe  in  which 
there  wa«  not  mme  Htnmg  indiicomcnt  to  tho  indnlgcnw.  The 
cause  will  genoiully  be  found  to  exist  in  some  [tbysical  sutttTing 
or  mental  diHtres-i,  or  In  cliinaet^'ric  insjuiity.  ITe  ha*"  ciirwl  one 
drunken  woman  by  introdui-ing  a  ivtroflexion  jiessary.  The 
neglcft  or  iniidflily  ot'  their  liu.sbund!i  driveM  iimny  woiiu-ii  to 
the  use  of  alcohol.  Those  who  adopt  the  habit  late  iu  life,  at 
the  eliinacteric,  whould  he  jtc^-ludcd  uiiti!  that  in-riod  liax  ]«Liac(l. 

Anktie  afiiruiti  that  in  nine  (Mmn  oat  of  ten  the  Kucce^fiful 
treatment  of  delirium  tremens  de|  lend*  ou  the  regular  and  continu- 
ous BUpply  of  nutriment.  Milk,  bou[bt,  or  very  hot  and  strong 
broth,  with  bread,  concentrated  meat  foo<ls,  and  raw  cgge  are  the 
articles  he  fevore.  If  the  etomach  be  irritable,  give  food  by 
enemu. 

PuigativeB  mx  indicated  when  sudden  delirium  tollowe  tho^ 
ingestion  of  large  amounts  of  alcohol  by  yoang  and  robust  per^ 
flone.  No  sneh  treatment  i«  aflmiiwible  in  weakly,  debilitated  or 
aged  persons.  CJaatric  irritability  may  be  eombat«d  by  ice,  and 
soda  water  with  milk.  After  careful  study  of  the  digitalis 
treatment,  he  concludes  that  all  the  good  etfeet  is  due  t^>  the  al- 
cohol in  the  tincture  given.  In  young  subjects  and  in  firat  at- 
tn<!ki<  he  givcti  no  alcohol ;  in  older  lioaea^  he  only  gives  HtiniulantA 
when  cannabiri  Indiea  and  morjthia  by|»oderiuic»i  fail.  Chloro- 
form, by  the  Inngii  or  stomach,  he  confliders  too  dangerous  for 
tlie  Hinall  amount  of  benefit  derived.  A  better  remedy  is  bro- 
mide of  potash.  It  should  bo  given  in  scrapie  do!W»i  every  two 
houni,  until  (fix  dosw  have  bf-eii  taken,  unle(«  sleep  be  produced 
sooner.  This  in  ineonipnnibty-  nafer  and  more  effective  than 
opium.  It  is  best  suited  to  young  and  vigorous  subjects,  with 
epileptiform  attackB. 


I 


I 


M 


ALCOnOLISU. 


u 


Chloral  cxactl)'  euit^  tlic  vofea  in  wh'u-li  broinidc  U  not  uwli- 
catinl.  Ill  fii-nipie  ii<isf»  crerv  hour  it  is  sttperior  to  any  drug 
hitlierto  ii^cd  iu  deliriutii  tivtnait<.  It  U  rure  thut  more  tliiui 
thtvc  (JuAes  are  ro^itiired  tn  produix*  i>tee]>. 

St-auty  urine  or  poit»}iiralioii.  with  a  Jttjx>iij(  |iiilw,  a*  hIiowh  by 
the  a]>liygtiiogTs]ih,  uuiicatcA  thr  ii^c  nf  antiiiiony ;  t  in  |  gr. 
every  one  or  two  hours,  until  relieved.  Tht.'  greatwtt  care  is 
rwjuUitu  in  the  ujte  of  tliU  ivniedy.  ITie  lewst  irregiihiriiy  nf  the 
puhtf  demautls  its  dijicoiitiDuajiiv.  SkiUi?d  mmiug  ia  uf  gtv&t 
valac- 

nARTsiio&NS  recoQuiieiidK  a  n»ideiice  in  a  Ruitable  asylum  for 
not  Iw*!  than  »ix  months. 


l)EyRprE  propodcd  bromide  of  camphor. 

H.  C  Wood,  speaks  of  the  ntw  of  lupnlin  t*(  promote  sleep, 
atrengtiicn  <tigc-Mtion,aiid  iillay  mTvouH  irritaliitily.  lie  xays  it  is 
oftvu  iH-ivwftary  to  ubc  opium  freely;  and  that  he  lias  fonnd  the 
com1>iriatinn  nf  nt()q>liiaand  chloral  Kinipilnrly  cflicicnt. 

Babtholow  says  that  no  hypnntie  in  twt  useful  an  chloral.    It 
best  Huiiwl  in  en-^n  f<illowiiij;  adobaueh;  and  is  dangi-miiH  In 
Id,  worn  nntdrurikunl:). 

HL*-<wtahlii*l)ing  digestion  and   f^iving  ^tuitahlo  nonrishment 
in  many  vhaw*  the  only  nH-aui*  n(<<>«ltxl  to  i|utet  ileltniim  and 

bI«>o|>. 
Ill  t)io  «tate  prwxfdinjt  delirium,  known  iw  the  " horrors."  bn>" 
mide  of  potash  in  mnat  ttatittfartory:  in  dfwee  of  ^  j  everj*  four 
houp<.     Ii  i^  h-vx  etiioiont  in  nuli?tLt|uent  attuckit  in  delirium,  and 
wh™  central  f<lnirtunil  changes  havo  orcnrred. 

Capsicuin  iu  3  »  doAe«  quiets  re«tl(WMiciw  and  induce»  »<lcep. 
Cold  Ktthn  arc  indicated  for  hyi*erpyrwxia. 

Qnimne  with  a  mineral  n(;id  Ik  ut<eful  in"borroht."  Oax^ 
honate  of  ammonia  i*  boot  given  wlt«n  Utoro  ie  anemia  of  the 
brain  and  wpakneas  of  the  heart. 

'Wahino  Mtyo  that  tartar  emetic  U  a  uiwfu)  adjunct  to  opium, 
proalucing  >«leep  where  either  lailn  if  given  alone. 


12  iUXQAh  OF  TRBATHKNT. 

Cftpeioom  is  fftvombly  niontioued ;  a»  a.ha  are  uhloral,  >»ro- 
mitle  of  jxitarili,  (in  the  t-arlier  sUigee,  und  to  remove  dclusioiifi 
remaining  after  the  attack  has  pa«^),  ioe-baga,  to  the  liuad  or 
spine,  or  the  wot  ptuik  in  furioun  maniacal  excitenioot. 

CcRNOV  rocomnientU,  in  ytmng  KiibjCirUi  and  l^nit  attacks, 
absolute  abstiiieucc  from  alcohol,  mild  purgation,  milk  diet, 
aiid  Ijirlar  emetic  in  J  gr.  doiies,  taiiTiriilly  watttliwl,  with  chloral 
or  bromide,  gr.  xx,  everj'  four  hours,  if  sleep  do  not  supervene. 

In  older  t-asoa  give  a  niild  |>urgi.',  light  but  vcrjr  nourishing 
diet,  and  ii'  tlie  rcatlesencn?  hhnuld  }>ei?iHt,  a  full  dose  of  landannm 
at  bedtime.  If  tliie  fail,  aild  alcohol.  If  greiit  doprcHsion  or 
pneumonia  en»ne,  Hiimnlante  inuHt  W  pushed.  Hypodermics  and 
dlgitalii^  are  daiigerous. 

Hammosd  preseribt-s  morpliia  bypodermically,  with  brandy 
if  needed,  wluMi  dcliriiini  liM.t  tnllim-ed  the  cessation  from  drink- 
ing. But  if  it  has  come  on  during  a  debauch,  he  gives  a  drachm 
of  bromide  in  f  3  hs  mfa^ion  of  digitalis,  every  hour  until  asleep. 

Crothers,  nf  Iliirtfonl,  stops  the  alcohol  at  once,  and  gives 
bromido  of  ammoniain,  gr.  xl,  every  three  hours;  with  or  with- 
oul  linci.  iiii('Ii<i!i«'-  At  Ixjiltimo  lillwn  gniin*  of  chloral  are 
given,  or  Hoffman's  anodyne  with  cinchona.  Aoiatod  waten 
&re  ffee\y  umhI. 

Phosphoric  acid  and  cinohona  fonn  the  basis  of  all  tonics 
gii'oii.  Bathing  and  electrieity  ai-e  good,  if  well  hnrne.  Rest 
itt  enforced.  Liipulin  with  aminonii  bromid.  is  used  for  in- 
somnia. No  alcoholic  preparatione,  titiclurGn,  etc.,  are  used  after 
Ihc  first  few  dayw;  but  infusinns  are  sulistituted. 

N.  K,  Morton,  of  the  N.  Y.  tnobriatc  Asylum,  eubatitutoa 
food  for  stimulants  at  the  earliest  poMible  moment.  He  givoa  ft 
double  seidlitz  powder,  and  followa  with, 

B    Aellieris  chloric ^tt  zr 

Gljfvrina: , fj  a 

Tr.  <»p»ki.... ,, gIL  iij 

Srr.  iiiiKib 

Tr.  cincA.  oomp^ u     f  5  *■ 

Aquw, ^Jj» 

M-    S.— At  once.    To  be  (riven  ««ch  moniing  fw  tlir««  dtjt. 


I 

I 
I 


\ 


AliCOBOLIaM. 

During  the  Hay  lactopeptine  with  muriatic  acid  is  given 
every  three  hoare. 

It.  iimnt  never  be  forgcitteii  that  chloral  is  a  dangerous  drag 
in  wenk  conditions  of  the  heart.;  to  which  drunkards  are  eKi>ecI< 
all  J  liable. 

C.~CHKONIC  ALCOHOLISM ;  OR,  THE  ALCOHOL 
ITABIT.  BoKHM,  jtppmising  thot  the  troatment  usually  ends  in 
failure,  layis  the  greatest  ^trc^^  on  tlie  diet,  and  tlie  trratmcnt  of 
the  goHlrio  disorder  present.     Moral  suasion  is  also  important. 

LooMlB  recommends  chloral  or  bromide  for  iosoninia. 
Opiam  may  relieve  the  craving  for  drink  by  tubatitutiug  a  worse 
habit.  Variety  in  iliet,  pleaeaul  eurroundings,  and  strong  force 
of  will,  oft'«r  the  only  means  at  our  wmmand. 

I>AV1S  confines  hia  rccommendatioi»  to  that  of  rcntraint,  by 
legal  enactment 

RoRKKTH  urged  the  importjuKre  of  naurinliment ;  especially 
aa  there  ia  a  dititaxte  for  food,  and  jiatienta  left  to  tlieniaelveci  will 
not  take  enough  food.  For  nniKtea,  effer^'esclng  mixtures,  or 
goda  water,  soda  bicarb,,  nitro-niuriatic  acid,  with  infusion 
of  gentian  and  liydroryanit;  acid  are  hcrviceaihle.  For  inaonmia 
be  gives  bromides.  Datha  are  often  useful,  aa  well  as  rcat  and 
change  of  air. 

MAttCBT  found  oxide  of  rino  useful:  gr.  y,  ter  in  die,  grad- 
ually incn-used  until  hixt(^;u  gniinn  were  lukcn  daily.  Goldlmq 
BiKD  also  favored  this  drug;  claiming  for  it  specific  tonic  eflccta 
on  the  ner\'ou»  system.  It  induce*  sleep,  rcmovca  tremor  and 
haliaciiuitioDs,  and  relieves  headaciie  and  dizziness^ 

Taskkb  doen  not  confirm  Xfart-et's  statements,  bat  profere  the 
general  tonics  with  ipecac  and  rhubarb. 

Altilic^  states  that  where  mental  depreaBion  leads  to  drinkf 
catelectrotonos  <>>'  (he  brain,  spine  and  cervical  sympathetic  haa 
eticceeded  in  curing.  Eleetro-thormal  baths  form  a  valuable 
odjavtuit. 


14 


UA.NVAL  OF  theathent. 


Anstib  Bays  Umt  wliui  tho  patient  merely  complRins  of  oer- 
voiisne^fl,  insomnia,  tremor,  hfilliicinotion  oi  sight,  ainl  dyitpepsla 
with  iiioniiiig  voiiiitiug,  tht)  ti^utiiiunt  confiiBta  of  abstinence,  a 
rich  diet,  and  tonica. 

Ckuinine,  onu  gmin  tJiritn;  daily,  is  the  tonic  preferred.  In 
the  few  cAses  where  tln«  fails  to  relieve  aU  the  s^-mpttiras,  he 
ordurf  ether  in  do:*<M  of  f  5  8«  Ihrioe  daily,  or  f  5  j  at  Ijedtime. 
Oxide  of  zino,  while  not  fulfilling  Marcrt'fi  hopes,  \«  soractiiuee 
valuable.  Tho  quantity  i<bould  not  exceed  hIx  gmitut  daily,  given 
after  mealo.    It  should  not  be  long  continued  in  anemic  cadee. 

Bromide  of  potash  i»  n  better  remedy,  somettmex  rulleving 
the  abtive  symptoniH  promptly,  when  given  in  (\o*o»  of  ten  or 
twenty  gniiiis  thrioe  daily.  If  sleep  be  not  iiidueyd  by  these 
remedies,  ^  to  }  gr.  of  a  good  extract  of  cannabis  Indlca  is 
one  of  the  bemt  hypnotics.  Larger  doses  do  harm.  If  opiates 
be  given,  it  »hould  be  hypodL-rmicuIly.  Half  a  pint  of  stout  ia 
juat  as  etiectuni,  given  at  bed  time. 

When  ])iiraIyniB,  spasms  or  mental  disease  ahow  the  nutmr^ 
rence  of  gnive  <«iitml  degeiieration,  the  b«*t  reme^lies  are  cod- 
liver  oil  with  phoephorua  iuhI  hypophosphite  nf  lime  or 
Boda.  I''iill  doses  of  oil  t^honld  be  given  for  months.  Even  in 
mivanced  stagcji  the  benefit  is  sometimes  striking.  \\'hou  mutwu- 
lar  ti-emor  predominateA,  strychnia  in  indicut^sl,  in  i^matl  do^tes. 

Bartholow  favors  the  uxe  o(  oxide  of  zino  with  pi|)erin,  to 
relieve  tremor,  gastric  distress,  and  the  appetite  for  drink.  For 
the  dyitpepxia,  vrith  tremor  and  uisnmnia,  capsicum  in  indicated. 

RiKOER  says  tliat  capBicum  U  the  beut  Hub>!tiiute  for  ah^ohol, 
when  an  attempt  it*  nnulu  to  break  up  the  habit. 

Cdbkow  pronounces  the  great  desideratum  an  easily  digested 
and  nuurifiliing  diet.  Ae  uicdicin&<,  the  bitters  and  ranuinativefl 
are  indicated.  Alkalies,  hydrocyanic  acid  and  etfervo<H;ent  mix- 
tures allny  nausea.  Bromides  are  beet  for  the  inBomnia.  Cod 
liver  oil,  arnenic  and  zinc  iire  useful  in  chronic  cawes  if  peraiated 
in  for  months.  Tho  craving  for  drink  may  be  alloyed  by  opium. 
Judicious  supervision  and  residence  in  an  asylum  are  the  only 
remedies  in  invetcmte  canea. 


JkliOOHftLTlU). 


IS 


HAHHoini  rec^mimnifLi  bromide  »i'  zinc,  gr.  y,  ler  iii  di«, 
r&pidly  increased  to  three  times  the  nmouiit. 

C  0.  O.  Napieh,  of  Kngland,  aXaX&i  tliat  a  vegetable  diot  Im- 
mMi9  the  donrc  for  alcoLol ;  especially  the  Ic^giiminoiM  I'oodd. 


From  thi»  iim»t  of  tuitiniony  the  reader  mny  dcdutv  htH  own 
conoliwioiw.  If  the  authorities  quoted  be  taken  c-hrouologioiUy, 
it  will  be  BCcn  Omt  opium  guvv  place  to  uhlontl  aod  the  bromides; 
which,  in  turn,  are  giving  way  before  the  tendetiL-y  u»  rely  on 
good  Quning  and  careful  dieL 

A.  The  preparations  of  ammonia,  which  have  loiig  beeu 
UMd  to  dla^ipate  int'bricty,  may  bu  laid  axidv  as  utwlt>s)<.  The  best 
meant  of  sobering  a  dniDken  man  quickly  ix  the  Tnrki^ih  liatii. 

B.  Fur  the  nuuceuilin^  licjuhii-'ht!  and  vertigo,  nau^«a  and 
other  ayiujitoms  of  gaatric  catarrli,  the  following  will  aiiillcv. 


»    KxLriwi  ft., rj  g 

Vin.  ipvcM^ fSJ 

PoiM.cub.r 5j 

Aqiuv q-i-til.  sy 

M.  a. — 5  »  [n  a  liulc  hM  mter,  cTBrjr  tvo  lioar^ 


^1  Bismuth,  gr.  v.,  every  half  hour,  ]»  also  an  effivsciotu.  as 

I      well  ua  a  much  pleamnler  remedy,  for  the  name  atate. 

P  C.    Delirium  tremem  is  ui  most  eases  amcitablu  Ut  rei^,  wise 

nuntiug,  and    caruful  feeding    with    nouriithing,  easily   digested 

food.     Popeinized  milk  with  the  whit*  of  au  egg  bealett  up  in  it, 

should  l»e  given  at  ithort  intervals.     Scalding  hot  heof-tea  is  borne 

when  uriiclce  merely  warm  would  be  ejected.     If  the  nloniaeh  be 

L      loo  irritable,  give  by  the  rectum,     liocf  pcptonoidrt  arc  peculiarly 

■      Mefal  here.     In  cWKe  of  debility,  to  thid  diet  may  bo  added  raw 

beef  minced  with  vinegar,  eoused  pigs'  tect,  pickM  tripe,  or  raw 

oyttters  with  nnegar.     Tlietto  will  bo  borne  when  nothing  else 

will.     FepBin  should  be  u^'d  in  enormous  do«os,  oc)  the  stomach 

it  wcroting  none.    Capsicum,  in  80  grain  dooca,  every  two  to 

four  hours,  is  thf  ImwI  i-.<!ii.'tiy  in  nunt  cnw*.     If  a  hypnotic  be 

•beohttely  needful,  luptilin  may  be  given  in  do^teH  ranging  from 

tea  grains  to  an  nuiiee.  We  Itave  given  the  latter  dose  hundreds  of 

tinwi,  with  benefit.     Hut  hot  baths  ulone  will  often  produce  sleep. 


MAKOAIi  or  TRBATMBHT. 


Veiy  few  cases  require  alcoliol.    AusUe's  rulea  concernnig  its  use 
are  to  1)e  coijiiiiuiidt-<I. 

One  may  practico  many  years  without  soeitig  a  ca*te  which 
re<iuirea  more  than  the  Kiniple  treatment  above  reiwrnmomleil. 

D,  In  the  rare  cases  of  mania  a  potu,  with  wild  delirium 
and  a  har<l,  t'liU  pulse,  the  best  rcmc<lie9  arc  llie  cold  pack,  and 
tartar  emetic.  Both  rcjquiro  nkill  in  their  use;  more  than  c-an 
be  put  int<»  woniH.  In  the*e  cases  chloral  and  the  bromide.-*  are 
U«el««8;  in  dGtirium  tremens  they  are  unnoeeasarj". 

K.  The  treatment  of  the  alcohol  habit  is  as  yet  exceedingly 
utiwiti.tfactorj'.  Of  the  nnmemiw  remedieft  proposed  as  specifics, 
scarcely  any  have  retained  a  place,  however  lowly,  in  the  treat- 
ment. The  niiraciiluiii4  rurw  of  which  we  rciul  in  works  of  fiction^ 
are  rarely  witnesse*!  in  real  life.  Almost  invariably  the  cycle  ho- 
comen  contracted,  the  relapses  iMicoimw  nii)^  rrwpient,  tlie  will 
power  grow!*  weaker,  and  the  victim  of  perioiiical  oinomaiiia  sinks 
into  a  druiikard'a  grave. 

Tiie  author  having  devoted  much  care  to  the  study  of  thia 
disease,  Iwgs  to  herewith  present  a  summary  of  his  observation* 
HH  to  treatment. 

A  number  of  drugs  have  been  recommended  as  possessing 
the  power  of  removing  the  a|i]Kt!ite  for  alcohol.  Fowler's 
Bolution,  in  drop  doses,  ha.-*  been  trie<l  and  found  wanting. 
Oxide  of  zinc  ha«  absolutely  no  power  whatever  in  this  di- 
rection. Quinine  is  useful  simj^ly  as  a  tonic.  Capsictim, 
by  itself  and  in  connection  witli  Myrrh  (No.  6),  ha.t  received 
the  sanction  of  high  authorities.  1  liave  given  No.  6  in 
doacx  beginuing  with  five  drojM,  and  ending  with  a  pint  taken  in 
twelve  hours.  It  was  worthless;  except  as  a  remedy  which  will 
aid  in  rcaloring  the  function  of  the  Btomuch  adcr  the  spree  is  over. 
Nux  Tomica  is  one  of  the  best  of  tonics;  nothing  more.  By  tho 
iwc  of  opium,  chloral,  or  chloroform,  nothing  is  gained  but  the 
Bubstitution  of  other  habits,  as  debasing  as  that  which  tlicy  are 
BUppoeed  to  cure.  The  chloroform  habit  is  tho  most  rapidly  fatal  to 
mind  and  hotly,  which  has  ever  been  formed  by  man.  Coca.  u«  a 
epecitic,  18  no  more  rctiublc  than  ita  predecessors.  jiSan  iiiatru- 
ment  in  the  rational  treatment  of  1hi«  di^^a^e,  it  is  tte  moi>t  pow- 
erful at  our  didpo^l.    Coea  is  useful  iu  every  case,  frtm  tte  power 


ALCXPBOUSH. 


1? 


of  sudtaining  the  strvugtli  aiid  giving  tone  to  the  nervous  n^iiten), 
nntil  lhe  eftWt*  of  fw-ding  arc  manifest.  Tt  is  of  special  valao,  in 
addition,  in  thoiie  caaea,  by  no  mimiu  rare,  where  the  »eat  of  tho 
craving  i«  in  tlie  mouth  and  stomach.  Just  as  in  irc-watcr  djs- 
pepua,  the  incessant  thirst  is  relieved  by  aufmtbetixing  thu  nerveH 
of  tlie  month,  thr(«it  ami  Rtomach,  the  fsame  effect  in  felt  when  the 
thirst  is  for  alcohol.  Xo  »uch  action  is  swcn  when  tlie  craving  is 
forH  jwralyzurof  HniM^ioUMU'srt.  For  tliis  condition  no  reniedy  has 
b««n  discovered  as  yet.  It  \n  singnlnr  that  I  have  not  met  a  caae 
of  the  cocu  habit,  though  the  journals  have  rej>ort<'d  a  nnmher. 
I  have  used  coca  myself  and  given  it  to  many  others,  for  thirteen 
yean ;  and  have  tMvcr  met  with  a  person  who  found  it  more  diffi* 
cult  to  ab(>t«in  from  coca,  than  fixim  the  imiming  ilraught  of 
cofffc.  I'crbaps  one  rea*«>n  for  this  is  that  I  liavp  never  used  it 
hypodermicoUy.  yrom  my  viewn  at-  above  expreiwird,  »a  to  itn  local 
action,  I  liave  prcferrM  the  ti5e  of  plugs  nia<le  of  the  coca  leaf.  In 
diewing  thcv>o,  is  obtAinctl  the  niaximnm  effect  of  tho  drug,  the 
local  and  general  action,  and  the  occupation  of  chevring;  which  is 
not  without  its  influence.  The  fact  that  the  pings  can  be  carried 
in  the  pocket,  and  used  without  attracting  attention,  renders  theto 
aviiiiablc  wbc-n  a  liifuid  mc^iicine  would  not  be  uihkI. 

In  every  catw,  it  i*  necessary  to  examine  erilicaJly  into  tho 
fitnction*  of  the  digeKtive  canat,  the  liver,  kidneys,  and  the  other 
organs.  The  sexual  organs  are  but  rnrely  and  iudirwrtly  at  fault; 
an  when  a  middle-nged  man  with  a  luttty  young  wife,  ruKorts  to 
alcohol  to  aid  bis  waning  [lowers. 

On  several  occasions  I  have  given  public  ntteranoe  to  my 

belief,  that  the  only  snccewi  t«  be  obtained  in  treating  the  alcohol 

habit,  is  by  studying  the  cireumstanocs  peculiar  to  each  case,  and 

applying  our  reniedim  t(»  the  conditions  found.     To  iUustrate: 

The  witc  of  one  of  my  patients  informed  me  that  for  some  days 

preceding  each  attitek    then'  wikt  a  n-d  de[iOiiit  from   bin  urine. 

When  thifl  again  occurred,  I  put  him  upon  (he  use  of  Carlsbad 

wattT.    Ho  wa«tt»tout,i>lethnric,  middle-aged  iniin,  willi  extx-llent 

digestion,    favoring  iiicat»»  in  his  diet,  and  of  cwlentory  liiibits. 

The  attack  was  prcvcutc<l,  and  he  ban  bad  none  since;  tlic  wife 

Tvm>Ti  ing  to  the  remedy  wltcnever  ehe  noticcH  the  deposit  in  tho 

chamber. 
It 


* 


I 


18  UAlfUAL  OF  TSE.\TM£N'T. 

lu  another  case,  ^e  patient  uifonned  me  that  about  t«D  dajs 
previouH  to  his  nt-tfli-k,  liin  feow  became  t'ctui  and  colorless^  bIjow- 
iiig  an  absence  of  bile.  Ue  bad  no  sign  of  jauudice  ;  so  that  tbera 
waa  a  Huppreiwion  of  the  furmaticni  of  bile.  A  few  diiytt  later,  he 
showed  symptoms  of  coryza  ;  and  then  hiB  spree  commenced.  I 
at  timt  thou^lit  t}i«  cnr^-xa  a  minuidcnoc;  but  after  otMurving  it  in 
five  ftucceesivc  spi-ees,  L  could  not  but  bolievo  there  was  »ome 
Conno«;tinn  between  the  two  iilicii<nneiiu.  In  tliis  ca-^e,  the 
adminieitration  of  nitri>muriaiic  ucid  with  chloride  of  ammonium 
sucuttdt'd  a  numbtT  of  timca  iu  warding  oft"  the  aproo ;  but  finally 
the  mixtui-e  hxHt  \U  cfiec-t. 

B     Amman.  cliloHil., > > 

Acid,  nilroniiirinl, a*     5  V 

Aqunr  B(i, f  J  iy 

M.    S. — A  tcMfJooaful  in  water  before  eacU  mcsl. 

As  a  general  rule,  it  will  be  found  that  a  country  life  will 
pro%"e  more  i^ondin-ivc  to  ciirr  than  a  rcsidcm-e  in  Ihe  city.  Morbid 
excitement  of  all  Icind.s  leads  to  drink.  Tiie  sober,  quiet  life  of 
the  fanner,  tlic  hanl  phyttiail  work,  lunl  the  neiirnciw  to  iiature, 
all  tend  to  lessen  the  desire  for  stimulants,  A  vegetable  diet  in 
also  Iwnefii^ial.  L'nqiif«tinnably.  as  the  jiower  of  celf-control  is 
IwHcned,  the  necessity  for  restmint  become.-*  more  manifest.  Here 
is  the  gist  of  tJie  difficulty.  Tlicre  is  no  law  which  allows 
inehrialcs  to  be  deprived  of  liberty  to  ruin  themselves  and  their 
families.  But  rarely  will  ihcy  go  vohintarily  to  a  «'treat.  Some- 
tiinca  one  is  found  wise  enough  to  flee  to  a  safe  haven  at  the  firat 
sign  of  the  coming  stonn,  but  "he  who  hosltate»s  is  lo*t."  If  he 
go  DOt  at  once,  to-mori'ow  he  will  be  unwilling  to  do  ao.  And 
even  if  ho  were  williDg  to  go,  we  bavo  not  in  I'ennsytvania  a 
suitable  place  to  aend  him.  The  reti-eata  are  all  designed  tor 
wealthy  patron.-*.  They  epend  some  time  there  la  idlcncas,  with 
every  eflbrt  made  to  amut^e  them,  while  their  friendti  are  ]>erha[M 
laboring  for  their  stipjwrt.  The  inherent  laziness  of  man  «00Q 
aBflerts  itself.  They  begin  to  like  a  life  of  [wuniienid  idleness. 
When  they  return  to  their  home-s,  it  i*  with  the  feeling  that  their 
friends  should  amuse  them,  ehield  them  from  every  cold  wind  that 
blow»,  help  llicm  <iver  evcrj-  cUfliculty;  while  they  lake  great 
credit  to  themselves  meanwhile  for  keeping  sober.    Iu  a  word,  a 


AVKMIA. 


19 


3r«ftr  in  an  inebriate  tutyliim  gftnerally  leavw  the  patient  thor^ 
ou^bly  epoiletL  On  the  least  cxcu»!  he  Is  oS*  to  hU  oM  hahtta; 
and  i«  ever  ready  to  blame  the  relapse  on  bis  friends,  who  haven't 
h«l;-e(l  liim  enough.  The  ideal  inebriate  asylum  U  yet  to  be  iniitt- 
tiitcd.  It  must  be  a  farm,  at  Bome  distanoo  from  the  city,  with  no 
rum-eho[>(*  too  noar.  The  inmatea  ttlioiild  T»e  compelletl  to  labor 
for  their  board  iw  iwon  a«  they  are  well  enotigli.  The  knowled^ 
that  one  IB  earning  bill  living  heljw  to  restore  hwflolf-rwpt><;t;  while 
the  benefits  of  the  institntinn  are  nI«o  brought  thereby  within  the 
reflfh  of  a  Iai*ge  eloss,  to  whom  there  is  now  no  refujfe  biil  the 
HotiM!  of  Correction.  Tlie  ])ericMl  for  which  the  |iutli>nt  residei  in 
on  aiiytum  should  not  bo  1cm  than  tax  nionthn;  oxeopt  in  easoH 
whi-rtt  the  diiipoflitiuii  to  drinlc  yoAie*  uff  (|uii'kly,  and  tlif  patient 
still  poueeaeA  sufficient  desire  tn  Ik-  (-tir«l,  to  impel  him  to  return 
of  his  own  accord  when  he  feeU  icmptation.  TV.  F.  W, 


ANEMIA. 

Cliloroiii:^  and  pemicions  anemia  will  1>e  coiLsitlernl  eepo- 
ntely.  Althou^rli  Ihw  atfwtjon  in  f|ue.*tion,  apart  from  tliesc 
formSf  is  simply  s^nuptomatic,  ><till  ii  will  be  wull  to  speak  of 
ita  treatment  at  length,  as  it  will  ttave  repetition. 

Common  »ea«o  tenrhi'-s  that  the  fintt  indication  is*  to  seam-h 
for  the  cause,  and  remove  it  if  possible.  S^'philli,  Bright'ti  diseaao, 
raalarin,  pbthiai?,  chronic  or  aente  dist^hargM,  together  with  di- 
gesiive  tlcfiL-iencie*,  over-work,  l»id  hygienic  conditions,  and  had 
habit«,  form  the  prineijial  gr<.>up  of  etiological  faL-tont. 

A*  iu  many  other  C8**e«,  while  a  removal  of  the  eauac  should 
be  oar  1ir<t  thought,  tliio  in  ilaelf  to  utlen  inHutHcient  to  efiect  a 
cure.  The  cause  may  be  removed,  but  the  eHect  reniaina  in  an 
iui[Nn~ur]8bi-d  Mlalvof  tlui  hluod. 

AH  authora  give  a  leading  plaee  to  the  dietaiy  Ircatnient. 
The  mot<l  noiin.tliing  food,  in  the  most  digtt^tible  form,  should  be 
given  at  tthort  inten'als,  in  small  cpmntities.  (Hec  Dyspepsia). 
The  aim  .iliould  be  to  order  such  food  m  will  rcplueo  the  elemenia 
which  are  lacking  to  the  blood.  The  intluence  of  mmlcrate 
cxercidc,  stojiping  short  of  liitiguo,  of  a  life  iu  the  open  air,  of 


20 


HANtlAL  OP  TKEATHKKT. 


exposure  to  the  euii,  of  sea  air,  of  chmige  end  travel,  and  of  agree- 
able tfurroundingi*,  w  urged  by  all  authors. 

The  U'liiffieia!  effects  of  iron  are  no  leas  universiilly  admUt«d. 

BRrcE  reeommonda  that  wlien  eoiistijiation  co-uxUts,  the 
Hulpliatet;  of  iron  and  itiagiiuHia  Ik!  givi-n  in  innjiiiictinn.  [ThiM  U 
a  useful  ooniljiiiutiou  when  anemiu  dropsy  is  present. 

I^     Fmi  mlph., gr.  W. 

MaglKn.  iiulpll 5  ^■ 

liiftJK.  txipiU,  f\.  ».  mI, fj  ig, 

M.    f^.^fj  ss  id  hair  a  gliuti  uf  ixAA  mttr,  one  Itaur  V'fore  idniIil] 

If  relaxation  exist,  Bri'CB  recomraemU  the  adtringetit  salt*; 
while  quinine  and  str/cluiine  shoidd  he  added  in  older  subjects, 
with  nervoua  dejiression  and  want  of  vigor.  He  niciitinris  among 
other  pre]iamtion8  suitjible  i'or  siiccial  owi-h,  Babuteaa's  dragees, 

LooMis  say**  that  alcohol  i"  food  to  aoemifa ;  preferably  in 
the  fonn  ni'  Burgundy  nr  Madoinu  In  ferimles  irialt  liipuin*  arc 
be«t.  Jlf  gives  the  prefereiR-e  to  V'allet's  inaas,  Blaud'n  ]>illB,  and 
in  children  the  citrate,  or  iron  by  hydrogen.  It  ahould  be  given 
after  meals.  If  imn  alone  tails*,  he  adds  quiuine,  ai-xeiiic,  strych* 
nine  or  jihospbrinis,  Eniulsion.t  of  t-od  liver  oil  are  utieful  if  well 
Ijortie.  Malt  extract,  with  iron,  pepsin  and  pancreatin,  is  usei\i1 
in  weak  ntoniaelm.  For  conf>tipHtion,  he  givca  alo'eit  with  bitter 
tonits. 

Immriimans  says  that  the  catiric-es  of  tlie  stomneli  must  ba 
hnmoru'd.  If  enough  food  eamiot  be  taken  in  tho  u«ual  wty, 
feeding  per  rtNrtiim  must  HH]t|»K-inent  it.  Beef  peptone  is  usefol 
f(M-  weak  iitoniai'hs.  In  lehrile  eoiidition8,give  milk  with  yolk  of 
egg,  brothj  wine,  or  hnuidy.  Butter  is  the  liest  fat.  Stan-hes 
are  best  for  extreme  dyspepsia  and  acute  dti^ea^es.  Alcohol  is 
important,  but  is  c-ontra-indiuated  by  corpulence  and  by  albumin* 
uria.  Tokay  and  Madeira  are  best  for  men.  but  malt  liquors  for 
women  and  childriii,  or  for  men  accustomed  to  the  use  of  U-er. 
Beat  lessens  wa.'ite.  Iron  in  contni-indicatwl  by  fever,  pyrosis, 
acid  fenacEilalion,  and  active  hemorrhage. 


ASEUIA. 


21 


TiOirBSBAD  Inj'ggrtmt  xtrotm  upon  tlie  importance  nf  removing 
gastric  aymptoms  before  giviii-;  iron.  lie  recommtnid«  Vxchy 
water,  on  reinnviiig  aeidity,  unil  iit  the  same  time  supjil^ving  A 
little  iron  in  a  form  whicli  Aom  not  disapreo.  He  claims  that 
imn  Is  forniallv  <Y>ii1ra>itHli(':it(-(l  In  t1ie<i>iulition  whit-liprv^liitjKMea 
to   pLthisia ;    lielleving  that  the  anemia  delays  tlic  oulbreafc. 

(That  tlM  admini»i  ration  of  iron  increajaea  the  disposition  to  pul 
nonai^'  hcmoirliogp,  which  is  so  ofl^i  tlie  Ktarting  |>oint  In  tlie 
chain  of  morbid  procouteg  which  leads  to  tubercular  phthisis,  thcro 
can  he  no  ilnuhuj 

German  authors  gonenillj  prtiUe  Blaud's  Pills.  Tlie  tbrroula 
u  aa  follows : 

R    Fcnf  inlph.  exikcu^ 

TolM.  twtKKwt.  purif-r U    Ij 

AoKw  piilr^ gr.  IxXT 

rlH                     A«iii«\ 5» 
^^                       Synipi 5  iftgr.xlT 
B            M.— A.  nuft.  H  in  pil.  bo.  cxx  dlr. 
^             8.— Two  |>ilU  ihNO  litBM  ■  d«]r,  nlUr  mMl*. 
Eight  crnii>9  of  &nlphat<?  of  iron  seems  like  a  large  dow  for 
the  delicate  Htomach  of  an  anemic,  bnt  we  have  tn  ttti  favor  the 
wtightT  anthorily  nf  NiKMuyKR,  who  even  incrca«!«  tho  dose  in  a 
few  davs  to  twelve  grains,  witliout  any  ill  pfsnltn. 

Many  of  tho  American  raincral  springs  cnnta^n  iron  in  qnan- 
titles  onituhlc  for  such  casos.  Of  Uieg«,  tlio  Saratoga  wateis  are 
the  mwt  |M>pn1ar,  nnd  can  W  most  n-adily  (ilitniin'^l.  All  contjiin 
iron;  tlit>  CongrvM  water  in  the.  emallertt  ]>ra|K>rti(>n.  Individual 
tartfis  mart  beoiituiultetl  in  electing  the  variouii  chalyWate  prepa- 
ntionn. 

I>DJAitDi»  Brauhiitz  found  that  cold  douches  notably  quick- 

Ibo  improv<?ment  of  the  bloml,  when  aMociated  with  tho 

lini"tn)tinn  of  iron.     The  douche  or  shower  slionld  not  at  first 

W  prrdonged  more  than  live  cie(M>ndfl.     Htt  deni4>i)  the  uffirmatioii 

of  Trr'U'«>*iin,aB  to  the  danger  of  jjivinj^  iron  to]H?psoiw  predit?posod 

10ph(hii»iH;  Imt  adnittri  iho  Tendency  to  bcniopty^iH  which  inm 

Incoa,  and  adviaet  improving  nn  trition  by  other  mcous  in  auch 


ss 


MANVAL  or  TSEATXBTT. 


m 


listeifl 


Bartmoilow  recommends  the  laoto-pbosphftte  of  lime  for 

the  aoeraia  of  pregnant-y  and  latrtatioii.     Wi-  liiiv  ti'  by  iimiiy  iriala 
■Btisficd  onreelves  of  the  value  of  th«  drug. 

He  abo  roeomrnetidH  inaiigiintwe  as  an  ai^avaDt  to  iroQ;  but 
the  expcriiiit'ntK  of  Hayem  show  that  iriitt«a«l  of  aiding  the  chaly- 
beate, nuuiganese  a<:ttially  rvtanU  its  action.  In  anemia  from 
paarive  hemorrhage,  Bartholow  recommend*  the  chiilyl»«ite  alum 
waters  of  Virgintiu  tialvunization  iit  a  useful  adjtivuot;  arsenic 
ui  beni*6ciHl  whore  iron  disagrees;  and  malt  liquors  are  rvcoiO' 
mended  in  convalescence. 

To  iliu  aljovc  we  will  add,  that  if  iron  as  first  odmiti 
disagrees,  it  will  be  wiser  to  Mudy  the  condition  of  the  <itgest 
arrange-  the  diet  and  other  hygienif-  mattem,  and  try  other  fvmt 
ginous  prepanitiouH,  rather  than  substitute  tiie  other  tonics  'Die 
good  eilcctd  of  cold  douche«,  of  chatige  of  air,  and  of  a  propcrij 
regulated  diet,  inrhiding  tlic  use  of  pejMin,  paacreatln  and  mull 
cxtrat-t  where  indicated,  camiot  be  overestimated. 

J.  Pollock,  of  Londou  spraks  in  high  terms  of  the  followii^ 
combination: 

B    Pcrrl  MomoDio-dlnUic. ...,., .....gr.  v 

ExLrbrilL «.■*..     ...gn.  t 

iDfa*.  qiiHMie .*.....• 

A<).  menlli.  ftp. U    f  3  U 

U.    g^Takaihriudkiljr. 

Da  Costa  bos  used  dialy^ed  iron  bypodermically,  la  do8eB( 
^IT — XIX.     It  la  not  clear  that  tJiU  methiid  otl'ers  pncticilj 
vaadagu  over  the  ordinary'  modes  of  administnitiou.    He 
ywirlj  found  that  the  double  salt  produeed  by  the  addilita^ 
n  bjpophoB.  to  a  Bolution  of  soda  citraU  was  leas  Viablcto* 
Two  puins,  om»  daily,  was  tlie  doeie  given.    Thei 
'Imb  reconLmondul  iiihalntions  of  iron. 

B    F«rri  ImUL gr.  y 

A(|tBc  d«*t ^1  j 

H.    SL— For  OM  InluUatloB.    To  b«  adnunktered  atvmH  Ubm  i 


Tkt  Bixir  gentiame  ferrata  \s  often  tiscd  as  *  gentle  ai 


AUSMIA. 


23 


8     Fmt!  |iymph«pl»t Jj 

AqUK  btlllicDL '  S  M 

U.rtKkl* 

EztgcntiuKA. J^m 

Ciin^oau. fSJ* 

Vini,  (|.  «.  ul '5  '* 

OnettPRR,  of  Pflr'w,  rocommcndfi  dried  blood,  taken  in  sweet- 
ened water,  n'itb  IWiuor  or  wine,  or  in  luillc,  with  oocoo. 

EAsmiir  of  (llasgow,  is  tb«  author  of  the  elixir  ferri  qnininie 
el  ■trjrt'kiiinie  ii1i(K<[i1i,it.,  iiiied  as  a  guueml  tonic 

Giues  preferred  the  tincture  above  all  utlter  preparations 
of  iron. 

Hatsm  observed  marked  improvement  follow  the  inhalation 
of  OXygeiL  The  good  vflt'ctn  were  buL  tentpoiar^,  uiilaw  iron 
waa  given  at  the  same  time. 

FornrftdiLL  wlvi^ies  that  wlieii  the  anemia  proves  intractable, 
tiw  patii-nt  i-liould  U-  sent  to  a  *^Iullyll«^tc  spring.  If  the  means 
%n  watitingtpvo  the  iron  before  meab»,  well  diluted.  The  addi- 
tion of  a  Inr^-  plaAtf  of  wuter  tn  the  «lut4e  of  imn  will  muki?  the 
difiarem-L-  WivvLfn  am.Tt«8  and  failua-;  the  iron  l>eing  a^imilated 
Mter  when  dilnted.  8<>metin)c«  the  first  rc«uk  of  the  adminia- 
timtion  is  heada<-tic.  due  to  the  inability  of  tlie  brain  to  bear  the 
irrilAtion  of  bIoo<l  richer  than  it  i^  ac<-a«tomc-d  to.  Epi»taxi»  may 
occur  to  rolicvc  thU.  For  thit}  be  advices  tbe  uddition  of  bromide 
of  ixitasli. 

R       PotUK.  bfOtUid i,.,., t RT.  Z 

1-Vrri  Mpolat.tart. gr.  v 

latn,  i|niMrr fjj 

U.   &— T«rindi«. 

The  couhinAtioQ  of  iron  with  pargatiros  ts  sometimes  nwfiil 
in  the 

B     Miinm.  folph gt,  X 

QuiD.  Riilp  h RT.  ■ 

Lii].  brri  pcffulpli ii|t  xw 

Inf.  quknUB .....f  J  J 

M.    &— Tw  u  die. 


24  MAKVAI.  or  TltBATHEirT. 

Wlien  anemia  is  amouiated  with  nmcuon-hceu,  iron  and  aloes. 
arc  given  in  pill. 

H      Acii).  nncniosi • ^.j 

F«rri  «u!]ilt.  eruc gr.  xxz 

Piilv.  piper,  utg 3  j 

Pil.  oluCTct  mjrrrh. 3  U 

Ol.  nbinn gtt.  ixx 

M.— ft.  msA.  et  in  pi\,  Ix  div. 

&^^ne  iwiM  ilniljr,  iifl«r  miiilt. 

Ani'iiiiti,  where  a  deep  impr(»»ion  lia*  Ixicn  made  on  the  ncr- 
voiu  syitU'iu,  irt  uftuu  ohtttiimt^u;  and  iim!L\>v<iuU!K  ]H5raisU>n(;e  in  tlic 
tonic  rugiiiien. 


PERNICIOUS  ANEMIA. 

HARTSnoRXE,  while  aeknowdedgiiig  the  lutilit^  of  treatment, 
reoaminends  the  plan  followed  in  ordiimry  ca»M  of  anenila. 

LooMis  reeommeiids  iron,  quinine,  stryehnine  and  arsttnlc, 
with  a  rich  ilaiil  diet;  i^haiige  of  air  and  sea-bathing.  Transfu* 
eioii  has  fulled;  though  one  cure  from  it  was  raported. 

Immbrmaxn,  while  nr^inp;  tho  omployniont  of  n  noiiri»1itng 
dict>  largo  dones  of  wine,  iruii,  qiiininc-,  e[-c',,  and  transfiitiion, 
admit**  that  expericnee  has  shown  that  none  of  thc«e  ivinodies 
cxertK  much  intlueiK%  on  this  form  of  anemia,  or  delays  the  fatal 
LsHiie. 

Gir.<3KKovr  nnggej^it^  that  when  tlie  diwaMi  appears  during 
pregnancy,  promnlure  labor  should  he  induced. 

C.  Cabby  i-eporta  a  case  in  the  Buffalo  Med.  and  Surg.  Jour., 
Jan.,  1881,  which  was  eurcd  by  transfusion  of  two  ozs.  of  human 
blcxxi. 

A.  Wbldok,  in  the  M»h1.  PrL'-w  and  Circular,  i-laims  to  have 
cured  four  vnaen  by  the  intravenous  iujoftion  of  milk. 

DcjARniK-BEAttMBT:!  thinks  that  while  tranitfuition  confei-a  no 
la.iting  benefit,  it  may  still  prolong  life;  yet  the  riaks  of  the 
operation  outweigh  it*  licnefits. 


Its  A   PBCTORU. 


26 


ANGINA  PECTORIS. 

(For  guiifml  trcatniwil,  (H.f  Neuralgia.) 
ANi^Tts  Bay»  that  in  nn^iua,  araenic  has  a  inmt  direot  efleot, 
which  is  rarel_v  niiwwi,  and  is  siniitflimcH  .■'uriiriiiing.  It,  xucc(?od« 
bcBl  ill  aiiemic  eaaoa.  The  dose  is  thre«  miuinia  of  Fowler'a  oola- 
tinii,  incrtiiBwl  to  ten,  tlirvt;  tiniw  a  day.  TIk*  I'mJonfied  imc  of 
arsfnic  ^eum  to  i-oot  nut  the*  tendGn€.y  to  antfina.  lie  believoa  it 
will  be  found  most  rnKx-csufiil  in  auvn  of  wvprc  anglmi  in  anemic 
males;  e«<peciallj  proft^tsionnl  men  wha-^  t^sireen*  imply  incoesant 
labor  and  great  anxii-ty.  Arw-nie  in  of  little  umj  in  angina  minor 
with  alcoholic  excess.  Id  thc«)e  snbjectfi  the  stomach  n-ill  not  bear 
thi.t  irrituting  dni^.  Quinine  KtiitM  xuch  vaM»  butter,  foUon'ud  by 
cod  liver  oil  in  large  and  increasing  dotwe,  given  for  a  long  time. 
Ab  |inipliy lactic,  hv  udvi^tes  avoidani-'e  of  violent  emotion  and 
rough  exercise,  especially  boating.  Indigestion  and  flatulenoe  tnay 
occnuion  un  attack.  Where  the  liwirt  t*oiind«  are  weak,  anil  the 
cirL-iilation  languid,  iron  and  Stzyclinine  pnxluce  initrkud  iio- 
prD%*cracnt.  Ht\\\  better  'ia  the  ayrupu^  quiiiiii',  ferri  et  Btr>'c]jDie 
ph<i"{<liat.  The  anginal  at  Lu-k  nnit^t  be  iiii-t  with  remcdicfi  cjipahle 
of  utfoixling  relief  miiiitt  itpecdily.  Ether,  a  teju]>tK*nfuU  it)  muci- 
lage, repeated  shortly  if  needed,  l^  etBeieiit.  If  the  attack  be 
provokL-d  by  indjfriwtiblc  food,  an  emetic  phould  bo  given;  prefer- 
ably of  mustard.  Chlni-oform  i«  an  unuece>«ury  and  dangerous 
peraody;  the  cflcct  of  hut  on«  or  two  inhnlntiona  of  n  poworfnilj 
ehar^cil  atnionpherv  being  instant  death.  Hot  appliciitions  t-)  the 
cpieiv--»trium  mid  hot  hottUw  to  the  feet  arc  nf  nw.  Nitrite  of 
amyl,  inbal(4  in  do!>cs  of  five  to  ten  drop«,  proilncv*  remarkable 
relief.  Tlie  oensation  of  fiillni«ta  in  the  head,  however,  i*  aodis- 
ftgrt-t-ahle  that  [witicnts  wmiotimcs  prefer  to  entter  the  pain.  If 
athtroma  Im  present,  the  remedy  might  prove  dangerous. 

I>rcnGX>*B  Aucoeoled  in  tnttting  tthort  the  attacks  by  applying 
itroiig  tiirodiiatiou  to  the  cardiac  region ;  iu  a  few  inetancCM  re- 
cover}' followed  the  continued  use  of  this  meaflure. 

EuLKNitKRo  profcra  the  contitant  current,  applying  the  anode 
on  the  canliue  region,  and  the  cathode  on  the  Ijaek. 

Davis,  while  admitting  the  speedy   relief  affonled  in  the 


2S 


hlANVAL  OF  TBEATUBITT. 


paroxysm  by  the  by]>odennic  use  of  morphia,  calls  attention  to 
the  Hprioiis  ohjwtions  to  this  iiioHe  of  treatment.  It"  tlie  heart  be 
woakeiiod  by  disi^asc,  fatal  atuj>or  may  ensue  from  the  sudden 
narcotism  which  iniiy  lie  produced.  If  tlie  gouty  diiithi>nie)  accom- 
pany the  angina,  five  to  ten  minima  each  of  acefated  tincture  of 
opium  niul  wiiio  of  oolchicum  n>ot  may  bt;  yiven  every  hulf  hour 
till  relieved.  Secondly,  the  danger  is  great,  that  the  patient,  re- 
sorting still  inorL-  fivi|ucntly  to  the  drug,  may  become  finally  an 
opium  habitne.  If  fatty  change  be  present,  a  more  etiitable  rem- 
edy is  the  following: 

t)     Timt.  clii;!l«liii. rjas 

Sp.  Ktli.  camp. ..,..., •■•■' 3  j 

H.    6.— Tirenlj  te  thiny  minima  errr/  hitif  honr  till  nltevnL 

To  prevent  the  re<:urrenne  of  attaclci*,  biwideM  the  general 
hygienic  regimen,  and  the  treatment  of  the  cause  when  possible, 
he  advi.sei)  the  palitMit  to  iibstaiu  frotn  the  free  u-si'  uf  tea  and 
codec,  and  from  any  use  of  alcoholic  beverngea. 

LooMis  eonsidera  it  doubtful  if  any  remediea  can  arrest  or 
greatly  relieve  a  pan>xyara.  Rest,  and  the  free  use  of  digitalis. 
are  of  the  most  service.  Au  enietie  if  needed,  or  hot  nml-lintliH, 
ir  due  to  cold,  ati!  useful.  Ho  mentioii!«  nitro-glyceriiie,  minim  ,in 
approvingly;  and  hypodemiioa  of  morjihino. 

Troussfau  adviReit  the  continuous  use  of  lK>lla<IiinTia,  in  ninall 
dosca.     In  the  paroxysms,  he  prefers  ether  and  ammonia  to  opiates. 

Brktonskau  cured  n  number  of  CIUW8  by  giving  bicarbonate 
of  Boda,  gr.  xx  twice  daily  before  meals,  inerfased  to  200graiiw  a  day, 
if  well  liome,  and  continue<l  iVir  «ix  iiionthti.  Tins  treatment  was 
(iupplemeiited  by  the  use  of  belhidouiia. 

OAtii>}fEii  etatca  that  with  heat  applied  to  tlie  feet  and  c])iga«- 
trium,  mutitard  to  t]ie  ehest  and  buck  of  the  neck,  togetlnir  with 
ether  and  other  dittWible  etiraulantji,  he  haa  often  Iieen  able  to 
dinjienM*  with  opium.  In  typical  raHP-S,  however,  opium  is  too 
valuable  to  be  discarded ;  ulthougli  i I  must  be  watched  carefully, 
especially  if  disease  of  the  lungu  or  kidneys  he  present. 


AraisiA. 


ST 


Kuchard  advisee  abstinence  from  tea,  coffee,  toliaoco» 
aloohot,  aoKual  uxceoaw,  uvuHiiiuling  tliu  MoDuch,  fati)|riio,  and 
climblug  hilts.  A  quiet  life,  in  a  drjr  climate,  and  on  occaaional 
resort  to  milk  diet,  form  part  of  hit  rvgiax&a.  If  inncope  bft 
imminent,  he  usee  ethereal  iitiiiiulantA  For  the  intervale  his 
remodv  i*  the  iodide  of  potash. 

Gbbmaix  Se8  rejectt  aniyl,  clilorofomi.  helliulomm.  and  clco- 
tricitj.  In  tho  {lamxysm  he  nx-.-^  morphine  hrpcKlcmiicatljr, 
followed  Iiy  an  ene-nia  of  chloral,  gr.  xxx-xlv.  Sometime*  spirit 
of  miiidiTi-Tiw  uidu  ix'-fpimtion  grpatl^.  Tli«  morphia  i«  reiieated 
for  eonie  dnrs  1o  prevent  the  recurrence  of  the  attack;  bcsidce 
which  he  um»  iit  the  intervals  digitalis  and  hroniide  of  [lotash. 

SgDtRB  recomniendcnl  hroinio  ether  intemally. 

For  lij;ht  attacks,  ether,  ammonia,  or  alcohol  are  snfficieut. 
To  obtain  the  maximiini  effi'ct.  they  itihouli]  he  diliiteil  as  little  as 
pOBsihle.  For  wverer  seizui-w,  amyl  hiw  won  the  finit  place,  in 
all  ciw«  except  where  atheroma  Is  present.  Nitro-glyCerine 
has  attracted  moch  attention  of  late.  It  \t  »\ov:  in  ita  at'tion,  m 
compareil  t«  nmvl,  btit  the  eflVx-t  U  (tiinilar.  HyiiodennicH  of 
mor|>hia  should  never  he  given  if  the  kidneys  W  diM-iiMil.  Kxeept 
in  the  worst  attacks,  whei'e  ani^d  \n  contra-indicatevl,  or  cannot  be 
procnrwl,  it  is  ht'tter  lo  give  the  niorjdiine  in  hoi  water.  Tlie 
effect  i«  nearly  aj*  Ri>«Kly  as  when  given  eubcnlaneousiy.  For  the 
trcatzufnt  in  the  intcrvalii  the  administration  of  arsenic  kaa  as 
yet  no  rival. 

In  The  yMietd  World  "f  Miijr.  1885,  Dre.  F.  A,  JouvsTOir 
and  VV.  B.  Stekke  ro|*ort  suoi'oss  in  the  nwi  of  nitnvglycerine,  and 
Dr.  K.  C  K»j'rnHiK:K  has  the  wmie  commendatiou  for  nitrite  of  amyL 


APHASIA. 

Bastiam  says,  that  when  aphasia  occurs  after  excitement  or 
overwork,  without  paralyHLii,  it  ia  a  precursor  of  graver  symptoms. 
The  patient  requires  absolute  rest  from  work  for  a  time,  and  care* 
ta\  watcliing.    Tvmpomry  aphakia  with  right  sided  spasms,  or 


88  UAinTAL  OF  TRBATMBXT. 

coiitiiiucil  aphiLKiH  with  right,  hemiplegia,  calls  for  the  treatni'ent. 
of  the  spasms  or  jialsy;  as  the  aphasia  is  relieved  the  other  coo- 
ditioiis  pasa  off.  Tlic  undue  uwi  of  utinnilontji  niunt  bfl  avoidal, 
and  bromide  with  sumbul  and  other  eedatives  should  be  given. 
If,  liowever,  apliaeiji  liari  t'o-cxie^tod  with  imrtial  htmiiplcgiu,  ami 
remains  after  th^  latter  lui-''  diiittp2>eared,  the  jiatient  must  be 
taught  to  speak  as  in  infancy.  Thie  may  eomotimes  be  done, 
though  only  after  great  paine. 

KosKNTiTAL  wiys  that  during  recovery  the  cure  may  be  has- 
tened by  teaching  the  patient  short  ivonii*,  and  by  using  writing 
exert-iftcs,  AphiLsia  due  to  traumatic  l&'^ions  of  the  skull  sHttue- 
times  yields  to  trephining. 

Altiiaits  says  that  aphasia  due  to  brain  diseaees  has  never 
W'n  tiured  by  electricity;  but  Abthics  claims  to  hiive  relieved 
it  by  fianklinism.  in  daily  oleetm  bathe  for  months.  In  one  ciuie 
wbi<-b  f!inh'  nndiT  our  not  tit',  :ipbiit«ia,  due  tosyplnlis  of  the  brain, 
for  a  week  pi"eceded  hemiplegia. 


A  PO  PLEX  Y—  (Cerebral)  . 

GoWEiut  remarks  that  the  tn^atnient  must  be  governed  by  the 
•iMtoo;  and  if  that  bo  not  manifest,  the  ca«c  must  be  trcatcii  as  one 
of  eerebnvl  hemorrhage.  The  patient  should  be  placed  in  the  re- 
ciimbcut  posture  with  the  hea<l  sliglitly  raised,  and  kept  iHjrfectly 
quiet  The  respiration  chouM  l>e  miimpeded  by  olotbing.  If  the 
feet  bo  cold,  apply  heat  to  them;  if  the  head  be  flusbod,  ai>ply 
cold  wattT.  Mustard  on  th«  neck  and  leg»  seem*'  to  hasten  the 
rcev>vory  of  consciousness.  Stimulants  should  be  used  when 
indifated  by  the  weakness  of  the  hairt.  In  thrombofiis  or  embo- 
lism, keep  the  heart  at  the  tioniial,  by  ciirefnl  uiw  of  alcohol, 
ethei*  or  ammonia.  Venesc'ctiou  and  entliartius  are  indicated  by 
high  arterial  tension  and  congestion,  shown  by  tlie  hard  pulse  and 
rtmilied  face.  If  the  heart  btrnt  atitMigly  with  a  full,  ban!  jiulse, 
bleed,  from  »  large  orifice  Purgatives  act  Icsw  iimniplly.  Tlie 
best  18  ci-oton  oil.  Paleness  and  a  failing  heart  forbid  their  use. 
Diuretics  are  then  useful. 


APOPLKXY. 


S9 


losexTiiAL  iidvises  for  light  attiK'Ict)  to  keep  the  hciid  olcvatedt 
■  And  afplr  cold  comprcMcs,  f^^uently  cliaiigtHl.  The  IkxI  aiul  room 
konld  bo  cool.  Cool,  acid  drinks  kHouM  be  given ;  but  oo  food, 
tbe  attack  occur  after  a  b«irty  meal,  produce  eiiKsiia.  If  ob- 
'stinftto  oonstijiRtion  exists,  give  purgative  enema*,  with  vinegar, 
Glauber'tt  itaJt,  or  Meriiia.  If  increased  vascular  tension  (indicating 
coDgc«tion)  appear  atter  the  attack,  with  red  face,  ir^cctod  con- 
junctivse.  airongly  pulaatiiig  arterieti.  and  fever,  in  ndjUKt  cwws, 
bleed  St  ««ice.  If  a  necond  attack  be  threatened,  ble«l  to  avert 
it  In  wt^,  cachectic  MubjecU  with  cold  nkin  and  feeble  pulite, 
anbfititute  leeches  and  cold  conipremee.  Rubefacients  are  »uper- 
fluoiu  in  light  caMes,  u^lewt  in  severe  onex.  Combat  depri'wion 
with  Btimulanta. 

Ill  the  reaction  stages  violent  symptoms  and  convukionn  niajr 
demand  venesection.  Usually,  repeated  leeching  of  the  mastoid 
processes,  and  cold  com]ire«*9e*  or  ic-c  hags  to  tlie  hernl  Huffioe. 
Generally,  moderate  catharsis  is  more  beneficial  than  the  applica- 
tion of  aiiiapisma.  Cold  bathing  and  small  dot*cs  of  opium  are 
of  benefit  iti  violent  excitement  and  inMunnia. 


Dr/AltniK'BlCArilBTZ  declares  that  bleeding  ta  not  to  be  thought 
of  in  tbe  seizure,  as  it  is  uiteleiM  and  [>crlmp!t  dungtmiufi.  It  can- 
not prevent  the  con»o(|uenc(»  of  the  rupture,  it  weakens  tlie 
patient,  huiden  the  fonnation  of  a  clot  at  the  itent  of  injury,  and 
tluiB  favors  renewed  hemorrbagex.  We  are  impotent  to  combat^ 
St  tbe  time,  the  efiects  of  urt«.Tial  rupture;  and  our  r&le  iM^iiMxta 
in  Treating  the  fymptonis.  Tbe  UoweU,  bladder,  and  the  hygieuic 
detaltd  iiiuiit  be  iiiiendi-d  lo. 

The  a]ipearance  of  fever,  liowever,  calls  for  blooding  or  loech- 
'ing  the  niai'tnid  procertuL'K.  Ice  may  be  aUn  applied  ta  tbe  heodi 
but  not  during  ihc  attack  itoclf. 

To  avert  new  hcmorrhagwt  and  to  allay  congeation,  dmxticet 

indii-ut«Hl.  Krgnt  imd  iiMlide  of  potawh  are  recommended  to 
congestion,  on  theoretical  grounds. 

Davih  rays  that  the  indicfttions  are:  1ft,  to  lessen  cerebral 
prcfwure;  2d.  to  linKtcn  renl>si>rption ;  Sd,  to  combat  tlio  oon- 
ditinui*  cAUtiing  the  apoplexy.  In  all  ca»ed  in  early  life,  origiuat* 
ing  iu   exctawive  fiow  of  blood  to  the  hraiu,  prompt  bleeding 


80 


BUSVAL   OP  IRBATUEIitT. 


is  the  remedy,  continued  till  the  pulse  and  respinitioti  b«cot 
stendy  and  nittnml,  aiiil  tlie  rciinew  Icavos  (lie  face.  Follow 
the  hloodiiig  with  veratrmii  or  aconite  in  sedative  do«e*t.  PnmipUy 
acting  eathartif-'i  i^houlii  be  pivt-n.  Unat  of  t!)e  head  calk 
for  the  UHC  of  eold  ftpiilii:atioiis,  while  hot  pediluvia  are  aUo  useful- 
After  the  bowels  hare  acted  ho  gives  iodide  of  potash,  with  aoo- 
nite  if  congestive  sviuptoms  coutinue,  or  digitalis  if  the  hcart 
weakcnif.  ReidtIeAt«nei>»  ami  insomnia  indicate  tho  bromides  and 
bclbdonna  rather  than  opimu.  A  return  of  congestive  symptonu 
Bliould  bo  met  by  leeching.  In  apoplexy  from  disease  of  the  cer- 
ebml  veseels,  the  question  as  to  bleeding  in  often  dil}ii!nlt.  AHTioii 
indm-ed  by  oxcewive  brain  work,  or  ineroaBod  cerebral  exeitability, 
or  impaired  vaso-mot^ir  power,  inoilepaie  bleeding  is  usually 
advantageous.  This  gives  temporary  relief,  and  time  for  the  aetion 
of  lh(!  other  i-enKidU^ii  to  itifivjun'  viiwinilar  tone.  For  the  latter  pur- 
pow  he  reeommond'  erg^otlne,  combined  with  digitalis,  bromides 
or  ioilirlvjt,  OH  iiidinirtHl.  The  most  dilRi-nlt  rHuw  iiru  tho»«  of  fatly 
degenemtion  of  the  cerebral  iirtenos.     They  nearly  always  die. 

The  treatment  of  (hrt-atened  apoplexy  eoniiiirtbi  in  moileratc 
cathartics,  nerve  tonicB,  quiet  and  spare  diet.  The  attack  may  be 
wurtluil  oft'  for  a  time,  bnt  finally  ot;cnrH,  and  proves  fatal.  Somo- 
timea  a  timely  venesection  wil!  post]>ono  the  attack  indefinitely. 

LooMis  recommends  for  threatened  attacks,  free  purgation, 
blisters  to  the  neck,  bn>mide  of  lithium  and  oxide  of  zinc  For  the 
fit,  hi*  treatment  is  moderate  bleeding  for  the  robust,  with  high 
arterial  tension.  The  bladder  mu»l  bo  exuniinal.  Place  the 
patient  on  his  side,  that  the  tongue  may  not  hinder  respiration. 
When  the  eonia  piu-wtw  olT,  the  strength  luurtt  be  siwinined,  absolato 
TOst  enjoined,  and  the  bowels  kept  open  by  mild  ealines.  Milk 
and  meat  Juice  are  to  be  freely  given,  and  Htinitilnnbi  if  required, 
a»  will  l>c  the  eaiic  quite  early  in  old  and  feeble  subjects.  K^tlefla- 
li»w  and  inMiinniii  wdl  for  imnwtic!*.  The  clot  i.i  now  a  foreign 
body,  and  nothing  external  or  internal  can  remove  it;  bliatars, 
kc.  an3  WORK!  tlian  uwlexs. 

RooBKTS  makes  the  vim  practical  suggestioti,  that  when  the 
sin  is  uncertain  flic  (*t<uuMch  should  be  emptied  by  the  pump, 
symptoms  may  be  due  to  poiM>n.     Don't  liiu-rftire  actively 


t 
I 


APOPLKXT. 


81 


anJeas  there  be  a  clear  iiidicatmn.  Oflen  all  that  is  ueoesMiy  u  tct 
plaoe  tiio  lutieat  in  thu  rcouuibcut  poutlon,  with  hu  hood  olcvatud, 
]ooa«n  the  c-lothinf;  at  hu  neck  and  cbeet,  allow  plenty  ol'  air.  and 
enjoin  perfect  quiet.  If  the  uttuck  be  due  tot-ougwtioii,  ivoovory 
will  8->on  follow.  If  it  be  due  to  hemorrhage,  witJi  marked  ple- 
thora, bleeding;  ttmy  be  ur<cfuUI>ut  u<  rarely  needed.  Often  tlio  con- 
dition is  one  of  tiho<.'k  ;  and  then  stimulatiU.  enema>*,  heat  and  eina* 
piams  to  the  feet, and  otiier  meaii.'t  of  rou.'^ing  the  piiticiit  are  nocdod. 
A  drop  of  croton  oil  on  the  tongue  is  often  U)»efui.  If  eomu  con- 
tinue loni;,  nniiri.'^hing  enemas  rati.st  1m>  ui«e<l,  with  mustanl  to  the 
aklfi.  The  bladder  mu^t  be  om]itio(l  regularly.  AVtieii  eoiucioaa- 
tt&ia  retunii^he  inuHt  lie  ke|)t  abiKilutely  ijniet  and  on  lovrdiut,  till 
the  stage  of  reaetioii  hai>  |iat«aed.  If  inllammatiou  ensue,  the  head 
must  be  ghavcd  iiiid  ice  a|>{ilie(l,  wilh  bliiilem  Ut  the  neck.  The 
mibi4eqncnt  treatment  depeutU  ou  the  progro^ftof  the  case,  support 
being  the  main  indication. 

NoTQNAifKL  eays  that  if  a  threatened  hemorrhage  depend  on 
miliary  aneuriism^,  we  have  no  means  of  prevention.  If  it  he 
due  to  cerebral  hypenemin,  the  treatment  of  tliat  aflection  is 
indicated.  \Vliy  fthould  we  bleed,  in  the  attack?  Xot  to  pro- 
mote al>3ori>tion,  vrhi-jh  bleeding  cannot  <io.  ^Jot  to  check  hemor- 
rhage ,wliich  itcunriot  do  unlviw  curried  tou  daii^roua  extent.  The 
true  Myptic  i^t  the  clot.  It  i^  iKiosible  that  when  tlie  arterial 
prc^urc  is  abnormally  great,  ita  dimlnation  may  eomewbat  help 
t»  restrain  the  bleeding. 

A  renewal  of  the  hemorrhage  rarely  occurs;  but  certainly 
bleeding  lea^iw  this  danger.  The  chief  indii.'ation  for  bleed- 
ing ii*  when,  from  cercbrsl  pressure  with  liypenemia,  lUiralysia 
of  retcjtiraliun  U  thrcatcndi.  Kapid  lorts  of  blood  ulouc  meeta 
thi)i  indication.  Beware  of  pushing  tlie  reiiiwly  to  the  extent 
of  proiliiciiig  CA.'rL*l>nil  ;UH'mia.  Tlie  turgid  fnce,  didlvnded  veins, 
pnlaitirig  cttrv'liil*,  [Kiwerful  action  of  the  hiairl,  tcnfiitm  of  pulfte 
not  below  normal,  pulse  slow  and  regular,  respiration  nnifonn, 
quiet  and  xnoring,  uml  the  juiticnt  .ttning  nnd  not  Um  old,  KUch 
ooam  are  beiK'tiled  by  blct^tliiig.  With  thece  condition*,  vene- 
aecti<m  i.i  indicated  if  the  cervbnil  prenure  begins  to  cause  rapid 
pube  and  Che^vn&fitokett  rc«pinttion.  In  all  caoee  not  conviipoiKl* 
tag  with  thin  deHcription,  venuiection  is  out  of  place.    It  la  often 


88 


MANCAL  OP  TRBATMKNT. 


injarioiifi,  hastening  death;  especially  in  dccropid  persons,  with 
rigid  arteries  or  valvular  disen-e,  and  feeMc  arterinl  teri«ion.  If 
used  at  all  it  shtmld  be  general ;  cups  or  leeehefl  do  not  peplooe 
rcncsection.  With  this,  but  not  inatead  of  it,  we  u«?  ainapinraa 
to  the  calves,  stinuilanti*,  cncmata,  ete. 

StimnlantH  are  calle'l  for  by  rtymptoms  of  failing  penpiration  or 
circulation.  Then  the  thee  is  pale,  pnUe  wtft.  and  weak,  reRptm- 
tion  hesitaling  and  intermittent,  or  of  the  Cheyne-Stokee  t>^>o. 
This  jfroiip  of  symptoms  may  he  met  with  in  the  feeble  or  robust 
Both  liniwof  tn-iitnieiit  iiuiy  bedoraandi-d  ttijjetlierorfiuecostiively. 
Among  the  *<timiilant*i  to  he  tiswl,  are  the  dmdiiiit;  of  cold  water  on 
the  skin,  aninmnia  to  the  iiostrile,  fric-tioiiii  to  the  skin,  dropping 
hot  ^Galiu[»  wax  upon  it,  etc. ;  or  cardiac  stimulnntR  aueh  as  miiek, 
ooSee,  wine,  and  ainmotiia. 

Ai'UfT  the  first  Kt«>nn  i»  pa«t,  the  less  done  the  better.  Rest 
and  (laiul  are  rv<iuired,  but  no  Btimulauts.  no  coffee,  no  rich  food. 

For  the  fever  of  reaction,  even  hx-al  liletHliiig  is  niivly  needed. 
Cold  to  the  head  is  usually  anffioieut.  The  bowels  niiiwt  lit-  kept 
open.  If  headachi"  i-nntinue,  witji  insomnia  or  delirium,  chloral 
or  opium  may  be  needed. 

The  reader  will  see  from  Iheabove  how  widely  ouraiitlioritiea 
arc  at  varianci'  on  the  tn'Jttnierit  of  aiioploxy.  Tlie  all-important 
question  of  bleeding  u  still  unsettled.  I'frhapH  the  aafe^t  guidance 
is  to  lie  found  in  the  trcutment  given  by  N'otusaobi.  It  is  certain 
that  the  eases  demanding  veni-seetion  do  occur,  but  not  often. 
TJsually  evi.'n  in  ai-ufe  Inriiui,  we  liavt;  timp  for  tbn  action  of  the 
speediest  hydra^'ogucs,  croton  oil  or  elaterium,  and  the  uae  of  the 
bn)niideH.  Wednn()lfiis»wliyliydix)linHin('iii*id,in  full  d<»«cs,  would 
not  prove  an  eft'eetual  remedy.  Whatever  i«  done,  dt-jtletion  or 
Ktimularioii,  Hhciuld  Iw  done  8{x^edily  and  efEi'ctually;  and  the 
physician  must  be  ready  to  change  tti  the  opposite  side  if  such 
a  connti-  he  indicated.  After  all,  aH  Xdtliniigcl  sagely  remarks, 
under  the  best  treatment,  manv  will  die. 


ATHEROMA. 

TjTTLKsaVft  thai  the  trejitmcnt  is  mainly  pi-eventive;  namely, 
the  avoidance  of  alcohol,  of  too  rich  a  diet,  of  exceswive  niuHcular 


ASCITRS.  38 

efforts,aipecialliF' in  ottiistrainodpositionsjoftiosturos  which  involve 
the  lonp  TOntinuciI  contmftion  of  tmiHt-lpa  wliit'h  Biirrmiuil  art^nw; 
anil,  aa  far  an  tin?  bmiii  ami  lii-arl  art't-oiitvruwiiof  all  gtatei^  ivhit-U 
isTor  overftilncflB  of  their  aiierU's;  such  ilm  excemi^'e  mental  efiVirt, 
Jefl^^ii'Tit  s*W[»  aufl  prolotigud  iiexaa]  excitement,  aud  efforts  whloh 
iuvolre  holiliiig  the  brenth. 

QtitNCKG  (>ontentB  hitHitelf  hy  Eiayin^  tliat  trt^fttmeiit  must  be 
directed  to  preventing  the  dweatu;  and  dotn^-in^  \U  pmgross. 
Ererj'thiti^  likely  to  cause  atheroma  must  he  avoided  ;  wiMX'ially 
whc-ii  it«  iirmptoms  arc  manifest  Ifo  wnnw  iw  i»artifiihirly 
ttgaiiLit  tliti  uae  uf  alcohol,  and  agaiuttt  anything  caueiug  violout 
exeitemoDt  of  the  vascular  system. 

It  may  bo  said  that  whatever  tends  to  the  production  of 
early  decay  tcniln  to  caiiw^  atheroma,  and  the  avoidanc'e  of  nuch 
ctttUKM  comttiluteK  its  treatmout 


ASCITES. 

RoscRTs*  method  of  treatment  may  be  6ummari7^Hl  as  follows 

1.  Treat  the  cousil  atFection  ;  which  ia  twually  inoaroble. 

2,  i*pomotc  ab«*rption  by  actinjf  on  the  bowels,  nkiti  or 
kidnej"!*.  At-tivo  pnrgntivoH  arc  mo*t  efficient,  Imt  mnst  be  iwcd 
with  caution.  Copaiba  is  wwnetime*  useful  in  peritoneal  <tro|»8y. 
Diaphoretic  btttliA  are  of  use  in  certain  formfl.  Di^talis  and 
8(|UiIU  may  l»e  of  wr\'ice  as  diuretiis;  or  jioultict-^  with  digitalis 
may  Iw  iipplied  over  the  abdomen.  lodido  of  potasb  moiim  to 
do  good  in  iwme  ease^ 

8.  Enrich  tlie  blood  by  naitalde  diet  and  toidc«,  citpecially 
iron. 

4.  A\1icn  no  eHtMrt  in  proilticod  by  the  almve  mea^Dnf,  tap. 
If  the  B«cit»w  lie  of  ren»I  or  <^rdiac  origin,  the  relief  will  l>e  but 
temporary  ;  and  the  o|K.'nttioii  should  1*e  <]eUyLHl  m  long  hk  (lOMti- 
ble.  In  ascitce  from  eaooer,  also,  tlie  operation  ift  only  for 
teraj-orary  relief.  If  due  to  lo^-ol  diwra-'K',  not  necoMttnly  fatal, 
tupping  rc|>eatedly  may  Ik:  tonttidered  a  curative  measure.  Hem- 
©die*  act  alter  tapping  which  failed  prcrioosly.  ParaccntoiiB  lias 
k      coreil  some,  relieved  all,  atid  prolonged  life.    Tlie  flystem  is  uot 


MAKOAL  or  rnKATsreKT. 


Ktti^;tcd  b^  the  (Iraiii  of  albnincTi.  A  few  days  afl^r  the  remove] 
•''I'  the  fluid,  tlie  application  of  a  bandage  a^lst^^  the  removal  of 
Biiv  remaining  fioid,and  urcrents  recurrence. 

5.  Symptoms  reaulting  from  ascites  which  require  attention, 
aiv  stwtro-iotfsttiial  diffieulties,  dyspncea  aud  micope.     TIicsc  de- 
iiiuud  the  ordinary  treatment,  except  dyapufra,  whioh  i«  an  indi- 
■ijimfor  tapping. 

It  will  be  found  in  all  fnrms  of  asciten  that  rstharttCR, 
^■iid'infitw  and  dinretics,  do  more  harm  by  reducing  tlie  strength 
iliau  tliey  do  gnwl  in  mmovin^  the  effuni(»n.  Kxpcrienre  will 
i-nnfirm  the  sage  remark  of  Nieurybr,  that  more  good  will  be 
ilnne^  and  IH'e  prolonged,  by  combat tinji  the  tendency  to  hydraimia,  ,j 
by  tlic  use  of  iron  and  rich  food,  and  by  letting  the  dropsy  take 
i'»n-e  of  it«clf. 

In  1882,  a  pfttient  witli  dropsy  of  canliac  ori^n,  tiring  of 
ii-j*-3;tetl  tap|)ing«,  rerjue-Ated  me  to  Iwive  ihe  cainila  in  plaea 
Sin:.;k  with  lite  ide.^,  I  lintl  a  »imatl  triH-ar  made,  the  size  of  a 
kitit:ing  needle,  with  a  silver  canula.  I  Inti-oducal  tliis  in«tru-_ 
ini-iii,  and  fjisteiied  to  the  caniila  a  long'  rubber  tub*?,  which 
I  f«iucln(Ticd  intu  a  vusml-I  of  water  on  the  floor.  This  allowed  u 
•Ttiidy  drainage  of  the  tltnil  as  fa-nt  as  it  exuded  into  the  peritoneal 
ijivity.  The  canula  wan  alio  wed  to  remain  in  its  place  until  in 
hb-riit  three  week«  it  waa  obslructeil  by  a  large  mass  of  lymph, 
wbii'li  formed  on  the  iieritortcum  around  the  point  of  puncture 
li  woB  then  rc-inti'odiiced  at  another  point.  AltogHher  the 
]uii.iciit  wore  it  about  »\x  weeks;  and  to  the  day  of  her  death  abo 
|inii-«-il  ine  for  the  great  relief  the  coiitrivaiu-e  bad  given  her. 

(\^".  F.   W.) 

In  caacs  of  oacitea  from  ein-hosis  and  from  disease  of  the 
jn-ritmeum  this  metho<l  otter;  some  advantage-^  over  that  of 
i-ef-Cii^cd  tapping. 

In  ascites  from  canliac  and  renal  diseape,  the  operation  of 
tjiiiping  is  exceedingly  wc-akening.  owing  to  the  loss  of  albumen, 
H'  rbe  fluid  re-tta;umulaf<«  more  quickly,  the  greater  the  quantity 
i"fiini'.'ed  by  the  o|>enition.  The  senim  already  ettused  hinders 
Inrtlier  trannudation  by  NUp]>orting  tlm  weakened  blood  vewetn. 
KcmoTe  this  Bupport.,  and  the  serum  and  albumen  traivude  much 
more  readily.    Hcnec  in  such  cot^ea  wa  tap,  not  to  remove  the  fluid 


AST1I3IA. 


S5 


6«1  to  rrtirve  dyspna-a,  and  vre  take  away  only  enougt  to 
Bocomplub  this  purpoHc.  Ta  keep  up  the  qiiulity  (if  the  Mood, 
the  fonntila  for  iron  and  magnesia  givMi  in  the  chapter  on  Anemia 
ii  cxcfwdingly  ut*cfuL 

Looms  flay»  that  while  the  -ase  of  Jaborandi  will  rapidly 
tho  accn mutation,  it  boatcns  the  fatal  iwuo.  He  ftdviec« 
tapping  1>efore  the  effusion  has  caused  prcMure  upon  the  Tiecem, 
nnlooe  tlte  fluid  con  be  romov4?<l  by  mild  cathartica  or  saline 
diurclica. 


ASTHMA— (Spasmodic). 

William?  anyi*  that  cnwn  ariKing  from  direct  caiiws,  irritant 
VBpt)n4,etc.,  are  cured  by  avoidamw.  Itroiichial  intlamniutton  calU 
for  mlinm  and  expcctonuit«,  with  bcltmlnnnu.  In  ehronic  cased, 
with  tbickeniiu;  of  the  brom^hiat  wiilU  and  eiilHr);«d  bronchial 
gland^i,  iodide  of  potash  i*>  useful  in  dottcH  of  gr.  ig  to  x,  long  con- 
tiuued.  Gout,  0ypliiU<i,  diseases  of  the  skin  or  of  the  kidneys  co- 
txiiiting,  innrit  roeeiTc  nppmpriate  treatment  Aisenio  i»  of  signal 
Vive  in  iwllinm  with  uczeiua,  etc  If  hei-odity  be  ibe  prediwpo- 
can-ic,  g^Tniui!*!  ic!*,  cnld  Hponging,  out-door  life,  and  moderate 
walking  or  riiliug  are  to  bo  employed.  For  the  attacks,  al«)hol, 
coffee,  (•th4'r  luid  amyl  nitrite  sire  iK-jtt  when  ci(iphy»enia  coexieta. 
Wlitfn  the  attack  ia  so  iwvci'e  tbut  th<;  patient  can  neither  HUioke 
DOT  twallnw,  we  may  inject  atropine,  morphine  or  clUoral;  but 
not  if  cmphy^ma  or  srmxjpe  be  prwwnt.  Chloral,  in  20  gr. 
dososever)'  four  houra,  baa  produced  relief  which  lOiiy  be  jierma- 
oent.  He  recommends  thin  an  hm  moet  KuiM--0(wfnt  remedy.  Min- 
eral wal»irfl  act  l»y  relieving  catarrh.  Comjireased  air  ban  afforded 
reliuC     A«tbmatic«  eltould  avoid  flatulent  dioL 

l>ivi3  rcniarks  tliat  the  caotiong  inhalation  of  «.bk>!v,form, 
teivr,  or  better,  the  nitrite  of  amyl,  or  the  vapor  of  eucalyptol, 
will  often  give  relief.  So  will  the  internal  iwe  of  any  mild  ano- 
dyne and  ex|<ectoiaiit  mixture. 

a    Stt.k^Ik  comp^.. fjj 

Tr.lohdii., f$M 

Tr,  opii  Gim|ili.r- f  S  J"* 

M.    Sl— ^  J  j  in  a  Uttlc  wuUt  tverj  oua  or  twu  hciun  tiU  ralwTod. 


iJS. 


VO  HAITVAL  OP  TBEATMENT. 

If  the  lobelia  |jrove  toodepressingjtlio  same  quantity  of  tin©, 
ture  of  wingiiiimrin  may  he  suljt*titut*?d.  Soiiictinitts  Ppoody  relief 
ensues  upon  giving  cc^ufll  imrw  of  imregoi-iL- and  fluid  uxlnu-t  of 
griiiilelia  mbiiuta.  Tii  tilillilrvn,  ij>wuf-.  given  to  nausea  (fufliees. 
Among  tbe  most  imjioi-tant  mea«ui'og  to  prevent  tbt-  »llucki4,  he 
mMilionii  wearing  Hannel  next  tlio  Kkiii,<litt.  gyuinHMtics,  and  out- 
door ex  erciee.  Inhaling  the  vapor  of  eue^lyptol  for  three  to  five 
minutiw  morning  and  evening,  iit  wmtctinic-H  u^-fu1.  It  allays 
hypeTBemitiveneM,  and  promotes  heulthy  stx-retiou. 

Loom:s  coramenees  his  trentmcnt  bv  ndniiniBtering  im  emetic 
or  enema,  it"  neeiietl.  "Tbo  beat  ])06itioii  for  an  attuek  w  the  sit- 
ting posture.  Some  old  people  nre  relit'vod  by  fitting  Ijcforea  hot 
open  fire  in  a  clothe  room."  "Etliier  and  ehlorofonn  togellu-r  are 
efficacious.  Quebrftcho  rt.di<>vi>H  (tome  i-:uies.  Troicii^kai'  udvo- 
cat«8  ammonia.  Orindelia  is  strongly  recommendod.  Opltuu  in 
full  dotted  givw  tli«;  l>e'«t  results  itf-iny  remedy  in  this  cluH^i.  He 
glTaa  it  alone  or  with  atropine.  Iodide  of  ethyl  has  iu  advo- 
cator    Among  slimulantH  tbb  bbdt  art-  L-ottee  and  a1i:i>bid. 

All  remedies  wear  out,  and  must  be  diangt-d.  tV>mpro8eed 
air  and  oxygen  be  found  uwliss.  To  tht*  long  list  of  remedies 
may  be  addetl,  painting  the  skin  with  iodine  over  the  course  of 
the  pnciiniogiLttrit;  nerve,  nitro-glyccriiie  and  ]iiIoL-aq>in  int^TmiUy. 
To  prevent  recurrence  he  gives  tfliiics  if  iieedeil.  arsenic  for  alter- 
nating wkin  d!«*iu«t.«,  or  lodidft.  In  a  number  of  caj^es  the  daily 
use  of  quiniiie.  gr.  x  v-xx,  will  prevent  the  recurrence  of  parox- 
ysms an  long  an  it  is  taken. 

Htdb  Salter  says  that  the  beet  guide  in  the  i^clection  of  a 
remedy  is  tlie  patient'^  experience.  Ascertain  what  bait  given  tbo 
most  i-clief  in  previous  cases,  lie  reliw  greatly  on  ipecat.,  tobuceo 
or  antimony,  given  to  produce  rddxation.  Tobseco  miiat  be  used 
with  great  care,  on  account  of  its  tondeney  to  produce  dangerous 
coUapee.  The  elfect*  of  antimony  are  the  same,  but  the  eolhipso 
is  longer.  E|«hiic.  entaili)  tbe  !eaat  sufffriiig.  but  tobat-co  in  tliq 
most  cftectiml  iiiid  tbe  most  prompt  in  its  action.  Tbe  soomTthe 
remedy  i<*  given,  tbe  better  it  aet**. 

Those  who  n^i  tobtu^eo  for  Af<tbma  should  never  iijie  it  at  any 
otlier  time;  for  it  has  no  etteet  in  tliose  habituated  to  it.     Coffee 


A8TQHA. 


S7 


I 

I 

I 


i«Uev««  nstlima  by  combating  sleep,  wluL-b  favors  the  paroxysms. 
It  nhotilil  Iw  given  strong,  pure,  very  hoi,  nn  an  rmpt}/  stcmach. 
Sometimes  notbiiig  but  alcohol  gives  any  relief.  It  mast  be  given 
in  the  ina<<t  o<mn<titnit4t(l  fonn  iKwible;  in  amonnt  siiflfitnent 
to  pmdncL'  pliVHolngical  (^ffeot.-i;  ««  hot  ait  can  be  tolerated  ;  and 
in  incnmiiiig  diwc.-i.  CMoroform  it  »iie  of  the  hmt  tvrowlitu; 
opiniu  i^  wnrtlili'As,  Tobacco  a*  a  sedative  is  u*eful  to  many. 
Stramonium  in  smnv  i>  M<-  n-niMly,  in  thi'  tnajnrity  iH  of  uitt, 
in  a  few  l-^  ininrioui*.  Inhaling  the  smnke  nyld  relieves  ftome 
when  thti  urdiuary  way  of  smoking  the  drug  faiti.  The  bust 
resnltft  arc  obtained  by  smoking  a  pipe  of  it  on  w tiring. 

Lobelia  muttt  be  givt-u  in  full  Aimis  to  obtiLiii  tta  benefits. 
Begin  with  ten  minima  and  repent  the  dixte  every  fifloon  minuter, 
adding  one  minim  eaeb  dotue  till  relief  11  i>x|>enenced  or  the  remedy 
diBagn<eH.     f 'jinnabls  and  ether  proved  in  hi*  haadi  of  little  vnlne, 

Hitre-Fapor  i^  the  remedy  for  pure  asthma  uncorapllcated. 

Aslhiuutic«  are  generally  dy»[ieptics,  and  should  be  treated 
for  tluit  afr«-f-(  ion. 

The  influence  of  locality  h*  sunu  up  as  follows: 

lilt.  1<«sidence  in  one  locality  will  cure,  radically  and  permo* 
flcntly,  iisthma  n»i>ting  treatmont  ifW-wbL-n?. 

2d.  The  hmt  localiticHHre  populoni<  nnd  amoky  cities. 

8d.  This  de[»eiidd  on  the  air. 

4th.  The  won*  the  air  for  health,  the  I»etter  for  aMhnia. 

6tfa.  The  rever¥«  is  exceptionally  the  awie. 

6th.  The  ukprttTA  of  anthuia  »rr  en<IU>i«. 

7th.  l'K.<diftion  is  imiH>seibk- ;  bnt  ae  a  rule,  the  most  oppo 
kite  to  that  in  which  tin-  H.-ithina  U  wontl,  will  core. 

8th.  The  slightectt  dill'vK-ncea  del^rmim:  the  pfttM&oo  or  euro 
of  Asthma. 

{*th.  Loc-iiity  alone  can  prodooe  oathma  in  persotts  not  pre- 
viotwly  eup|M»«,"d  to  U;  liable  to  ii. 

10th.  Bnmo  [tersons  who  never  bavo  hod  or  will  have  astbnu, 
wonld  have  had  it  if  they  livwi  in  other  localitied. 

lull.  Pondibly,  every  eaM>  of  asthma  might  bo  cttred  If  the 
right  air  for  it  could  he  procured. 

12th.  The  dixcitfe  i»  merely  ntu^wnded,  to  roap]ioar  od  ra- 
toruing  to  the  air  which  proves  iDJariooA, 


88  MANUAL  OF  TREATMENT. 

IStli.  CIiBDge  of  air.  simply  as  change,  it!  injurioos. 

14th,  From  asthmatic  capriw,  the  uuifomiity  of  reeulte  in 
Boy  ca^  does  not  obtflin. 

No  gi-cater  testimony  oan  be  adduowl  iw  to  the  value  of 
Saltor's  studies  than  llie  almost  univemal  manner  in  whidi  Uia 
conchisionn  have  lM3en  adopted  by  tho  imyority  of  the  text  bookg. 

DaCobta  recommends  for  the  aeiaare  tlie  following : 

9     Tr.lobeUae, 

Tr.  hFotcjraiiij , 

fip.  kflli.  iiimp^ 

Srr.  tolnbin., ua....fj  j 

M.    8.— f3j,  in  water  orcry  hnlf  hour. 

3     (Thloraformi, f  J  a 

Ot.  terebinth., TJ  j 

Bp.  roemu-in, f  I  P* 

M.    8. — Rub  on  chesl  Rereml  limet  %  d»y. 

* 

H      Potui.  iotlid., S   U 

Morithinnr  siilph., gt.  } 

Tr.  *cUlit, 

Tr.loWuE, 

Bynipi fc«....fjj 

SI.    8.-/3  j,  Ur  in  die,  [a  MtliBM  with  chronic  hraiK-hitis  and  «nph]r«6m£~ 

NiBMEYEB  was  partial  to  quinine,  especially  when  somewhat 
r^pilar  pericwiicity  <!hftr«c!erize<l  the  recurrenee  of  the  parox^wna. 

TR0us5BAr  favored  iodide  of  |inta--*li,  tij*  does  aUo  Gebwaiw 
BIe.  During  the  attack,  Seb  wva  iodide  of  ethyl,  hv  iiilmlatimi, 
in  five-drop  doses. 

Trahtour  recommends  lorsl  hlewling,  bliHtcni  to  tlie  chesii 
iodide  of  calcium  internally,  and  morphine  in  the  attack*. 

Dujabdis-Bkadmktz  advocates  tho  claims  of   bromide  of 
.^^itoKh  in  cardiae  asthma. 

MoNSLL  recommends  that  the  patient  force  all  the  air  out  o£ 
his  lungs  ho  po^ibly  can,  and  then  delay  iuspii-ation  as  long  as 
pOflsible;  tlien  take  a  long,  full  inspiration  to  the  utmost  cxtont  of 
iha  lung  power,  and  dtltiy  expiration  aa  long  as  poeaible.    l£epeat 


BAUNITIS. 


:i'.i 


N 


Hiw  method  till  relief  w  obtained;  which  will  "be  about  fin-.-i 
minutes. 

Maraoliaxo  ^ivod  aapidoapermine,  the  tilkaloid  of  *\*t>- 
braoho,  hyfKKlt'rrai<.-rtlIv,  in  tlim.'^  oi  ^t.  i.  Kelivf  itt  tVlt  in,  Hv.* 
mitintce.  Other  uutbont  rejiotl  gcKw]  reunite  from  the  twine  <inig, 
in  other  form*. 

SwBRtHCiKx  prcfen  to  all  other  dru^^,  petroleum,  giftii  In 
emulsion ;  the  doec  increaeeil  to  toleration. 

A  writer  in  The  MeiUaU  World,  .\fay,  1RB6,  contribiit***  ilie 
following  pre*.'rif»tiou : 

B    Caffviii.  hydrobrouiBt^ ,....^r.  |j 

EkU  cannabis  lodk, , gr,  j 

EiL  bclbdoaiw, gr.  1-lA 

^      Eit.  efgot-'.  (J!qulW«X gT.iy 

M  — Ft  ma^    S. — Uire  in  capnil*  on*  hour  bcforr  tbe  «zpecUrd  »U^l^  an4 
n>p«9t  ercTT  i  fo  hoiin  till  raliend. 


Gkkmain  SfcK  tulvocattw  the  inhnlatimi  of  pyridine.  AU^itr 
a  ilradim  is  to  be  jilaced  on  a  plate  iu  a  closed  n>om,  and  ili<< 
patient  lireathes  the  impregnattnl  air  for  twenty  ininnte«,  ihn-^ 
times  daily.  Dyspn<ca  i*  at  once  relieved,  and  sleep  follow-. 
Cigarettes  conipowiil  of  <v»ca  and  tolwrt-o  in  eijual  |iarta  n>np 
reconimended  in  The  Medical  World,  in  1885. 

R.  W.  Gbiswold  in  The  World,  for  September,  I8S5,  sp-alc* 
in  Oic  liighedl  terniK  of  chlonil. 


BALANITIS. 

Berkeley  Hill  elates^  that  after  washing  and  drying.  t}..> 
excoriations  ahonid  be  touched  with  a  ten  grain  solationof  nir-.i*  ■ 
of  silver,  and  a  bit  of  lint  laid  on  tbe  gtans  to  keep  tbo  furti;i<-<- 
apart. 

Thorough  cle«iuing  wiiJi  a  lUIute  lotion  of  borax  or  chlci-i- 
nated  aoda,  followed  by  doetinga  little  iodoform  over  the  aurfu-*?. 
will  be  found  effici(9it. 


40 


MANUAL  OF  TBEATMKST. 


BALDNESS. 

^Wilson  reconiniends  Rt'mi  uniting  liniments  to  the  scalp; 
s»  \'m.  ammonia,  lin.  camph.  comp.,  linimont*  of  L-hloroform  aiii 
of  niiintanl,  or  acetiini  riintliari(li«  c!iliit«I  for  general  alo[^)ecia, 
or  in  full  Btrciiglh  for  area.  In  llif  latter,  ammonia,  tm"pt'iitine 
and  imline  are  useful. 

For  svphilitiu  alopocia,  uug.  hjdrarg.  aminoniat.  with  cam- 
phor it*  th«  Iwwt  l(x;iil  Hpiilii^ntioii. 

,T.  W.  nuRNET,  in  r/w  Medical  World,  May,  1886,  gives  the 
following  hair  tonic: 

9     (JLiininip  stilphatiB,..., ^j 

Sp.  rnimcnti, OQ 

M.    etadde,  a^.  daK, (%  tiy 

Tr.  cunihftriiiis, ^^J^ 

Tr.  MTiftinnuriH;, ...rSJoB 

Tr.  niinin  vtiminc,   §  j 

3t.    et  tlL    S.— A|>i>lr  gtuUr  to  tbe  aealp  tvioe  » ir«dc 

PiFFAHD  myn  that  if  pityria^^is  he  the  cause,  it  must  be  firt 
reuiovt'il.  If  ihu  ulopfcia  In;  Nyplnlitif,  llu*  prini:iry  iitrwtitMi  miwt 
be  treatwl.  This  author  believes  tluit  the  internal  uae  of  arsenic, 
mix  vomica,  phnsphorns  and  co«l-Iiv«r  oil  has  some  eft'ect  in  pro- 
moling  the  growth  of  the  Imir.  The  main  depc-udence  however, 
is  on  local  trfntiiioil. 

Clipping  or  shaving  causea  a  sti-onger  and  more  rapid  growth. 

Begin  with  the  nirldcr  pn*pai-atl(His. 

1st.  In  the  beginning  of  alojiecia  sage  checks  the  Billing 
of  the  hair,  and  pri>motcs  a  stronger  growth.  It  dhould  l)cap]iliwl 
in  Uic  fomi  of  an  infusion,  every  other  night.  If  in  a  mouth 
there  i«  no  impnivcniwit,  it  may  lie  diHcontiniicil. 

2d.  Tinctore  of  Cantharides,  one  part;  alcohol,  twenty 
part«;  imrt'U^ing  thit  [in>pnrti(>ii  of  t.-anthand(;i4  an  the  scalp  will 
allow. 

3d.  If  the  walp  be  too  dry,  oily  ttp]dicationft  should  be  used. 
The  reputation  of  petrolemu  is  not  wholly  unmerited.  Oleatea 
of"  mercury  and  strychnia  may  be  of  uw. 

4th.  If  the  Bcalp  be  too  oily,  it  should  be  washed,  as  need- 
i\il,  with  fl.  ext.  soap-tree  bark  (quillaya  iuipoiiaria)  diluted. 

6th.    The  treatment  must  bu  varied  ocoaeioDally. 


BAUIKESS.  41 

Hebba  gives  tlie  fotlnwlng  treatment  for  iiln^iecia  furfuracea: 

1.  Sultra  tlie  »eules  witli  oil,  rubbed  well  into  tlie  ncalp, 
rof»«ilc<lly  if  noficsnary. 

2,  W'aeh  with  pure  »nap  dissolved  in  alcohnl.  Repeat  the 
niliiig  aiid  woHbiitg  till  llu*  it(-a1|>  ii*  cUiiii.  At  lintt  the  iKttitint 
will  lie  lialdiT  tlmn  ever.  a»  thlA  process  will  remove  all  tlie  dead 
huin^  wbicb  aru  still  udlicriug  to  the  Muilp. 

S.  l^ter,  t>tih!4titiite  tor  the  eoap  an  alcobolic  lotion  of  tan- 
nin, v«>rutnu,  itr  other  HtinitilHntM. 

4.    Finally,  fatty  prtporationa  nro  netydod. 

r*rrPARi>  retrommcnda  roralo]iucia  areata,  ]>titling  out  tlichuira 
at  tlie  margin  fitr  a  space  of  j,  to  J  inch.  If  the  patcli  be  con- 
gctcd — 

n     Ext  Ditrii  <romi(«, rs  ■ 

t'njt-rimis fjj 

H.    8.— Api^Ij',  wdl  rubbed  tu,  twice  ■  1U7. 

If  the  patch  be  pale,  paint  with  <'ftnthnrltlal  ooUodion. 

This  18  followed  with  a  mild  stimulant,  euch  M  castor  oil 
with  a  litlle  liuctiire  of  entilliaridt's.  If  in  two  wwkd  there  is  no 
t\fPi  of  hair,  rejKmt  the  iippIUiitioti.  An  *oou  as  Aims  haXn  show, 
uliAvu  thrtM)  times  a  wt^k,  ami  u»e  mild  stlniulanld. 

IlEftaA  recoinmonddfitiraulatinf;  ak-oholic  lotions  for  thin  form. 

Within  ikhw  ammonia,  uuniphor  ami  chloroform. 

SiioRMAKKR  my*  that  tlio  oleate  of  iron  mixctl  wttji  oil  of 
«nEot  or  other  oils,  u  useful  in  dry  rii.-burrhu!a,  and  in  certaiJi  forma 
of  a1o|ieeia  with  irritatod  Hkin-glandii. 

Van  Haiiusoes  f(ix.>aka  of  the  importance  of  genoral  treat- 
moiii,  including  the  ndiuiniatcring  of  tonics,  corrDcting  any  Av^ 
onler  whieh  may  be  foiiml,  and  rej;iila.liii^'  the  hygiene,  l^ocally, 
the  proper  rcmedicx  an.;  thonc  which  i^limiilnte  (ho  sikin.  lie  (|notc» 
from  Udurino  the  following  list,  which  both  authon  recommoud; 
Alcohol,  mnthariilc»,  tlie  (Kwntial  oiU,  glycerine,  castor  oil,  car- 
bolic acid,  tar,  iodine,  turpentiiio,  ammonia,  italta  of  mercury. 


J 


42 


UAKDAL  OF  TRBATHBNT. 


veratria,  arctic  acid,  tannic  acid,  nox  vomica,  pe|^r  aiid  sulplmr. 
To  tliosc  mav  Ix:  addeil  petroleum,  winch  he  con8i<icr«  ut^ttul. 
The  ecalp  should  be  waahed,  and  the  remedy  selected  applied  in 
lotion  or  ointment. 

Q     UI.  araTgdal,  araaiw, gtt.  x 

Acitl.  uu-bulicv fS  « 

01.   rii-ini, Q  ij 

Alcohol,  q.s.  id^ t%  u 

In  The  Medical  World,  August,  1888,  GsaUARD  recommend* 
the  following: 

^     Quininip fl>ilph., .......3  ■ 

Tinet.  c^ntbDridia. • ..f?  J 

Sp.  Dtninun.  nroitiiit, fj  j 

01.  riciui, ..(3  JM 

8p.  nijrriar^ {%  na 

01,  roemiirin, gtt.  v 

U.    B.— 9bake  w«lt.    .\|)|)ly  two  or  three  lima  ■  week,  witlikslifl'bnwli. 

In  treating  a  case  of  neuralgia  by  npplying  to  the  «calp  tlie 
tlnek,  oily  rupitd  rfsiilLiiif^  i'rom  th«  niixtiins  cif  caniphor  and 
chlonil,  we  found  tliat  it  had  a  marked  efieet  in  i*timuluting  the 
growth  of  tliu  hair.  Suhwjqnent  exiwriem-e  evolved  the  following 
formula : 

H     Quininir  giilph»Ua, 5  m 

Chlornl  liydntt, 

Cani[<iiorw, .....U....5  It 

01.  rj),;ii|)i]U., f5  ij 

01.  in;r «■!».,.. fj  j 

Alcoiiol,  t).  8.  ad., n  viy 

S.^Riil]  tliechlonU  aiidcaniiihur  ti)p-t)ier.  Iliuuilvv  th«iitiiuin«  in  tlM  alcohc^, 
ftdd  |]i«  oils,  ftod  luix  lti«  *r1ii)]a.  Appl^  n  liltle  to  the  aoolji  three  tiuM  a  WMk; 
rolluwrcd  hj  the  rigoroiu  use  of  a  siifl  bnish. 


BLADDER,  DISEASES  OF. 

1.  Acute  Inflammation.     (See  t-ystitis). 

2.  Chronic         "  " 

3.  Neuralgia.  Under  this  head  Sir  llB^ntT  Thompsox  claeRcs 
caeee  of  vesical  pain,  and  friM^uent  or  difficult  mioturition,  with- 
out an  appreciable  anatomical  lesion.  Quinine  iH^metimei*  gives 
relief;  oftener  it  fails.    Digutivo  dieonkni  should  he   removed. 


BOIUI. 


4S 


CoD^tiiiation  calU  for  Fnedricbeliall  water,  n  ith  laxative  diet  uid 
reginieii. 

4.  HTpcttropby  co^xi^U  with  aii  olMtructton  at  the  outlet, 
[and  is  compensatory. 

5.  Saocalation  tbllow^  bypertnipliy- 

6.  Atrophy  occum  later;  «ta{>ecial)y  after  ontiirgonioiit  of  the 
prostat*.     Till?  Ulie  of  tin?  iiitheter  i*  then  the  mily  expedient. 

7.  FaidUS  from  Ictw  of  nervous  [>awer  occurs  m  heiuiplegia, 
Ac,  lunljility  to  empty  the  bladder  may  be  the  ftrst  mgii  o*'  hIow- 
ly  duvoloptng  epiual  dieeaae.  Tht^  use  of  the  catheter  is  da- 
man dod. 

8.  Tumors   rtjquire  uo  medioal   treatment,  except  for  th« 
I  accompanying  t^ystUis. 

9.  Tubercle  of  the  bladder  calU  for  the  treatment  of  tuber- 
cular affections  generally. 

We  luive  met  two  casen  of  sjHwrn  of  the  8i>hiiicter  vo«ic»,  caas- 
iug  great  distress  from  the  difficulty  of  emptying  the  bladder.  Id 
both  coses  the  sphincter  ani  wbla  found  unduly  developed;  aiid  dl- 
latfttion  of  thia  mui^clc  to  tlic  fullest  extent,  while  the  patient  was 
lanseethctized,  resulted  id  a  penuancDt  cure  of  the  apoam  in  tti« 
sphincter  veslctc. 


BOILS. 

Bkbkeley  UiLL  directs  that  the  predisposing  canece  ho  first 
I«moTud,and  the  patient  iitreiigtluMied  by  excn-iHe, Turkish  hatlut, 
change  of  air.  et*-.  The  diet  should  he  moderate  and  varied. 
Alcohol  should  he  umkI  in  m<MlcraLioii  until  tlitr  con-  liim  ImmiticiL 
An  occa-'^ioiial  aaline  purge  i«hauld  be  given.  Quinine  nhotild  be 
given  in  dotww  of  five  graiiir*  every  hour  till  the  ears  sing;  it 
Bhoiild  then  be  lowered  gnulually  to  four  grains  daily.  In  obstinate 
catww  Vichy  water  la  thought  to  lt«m.-n  the  disiiooitioii  to  boila. 
For  t-be  exhauHting  and  dangerouB  boil  on  the  face,  large  doeea  of 
brandy,  with  quinine,  ar<;  rwiuiri-tl. 

When  the  boil  ia  (*iffnalled  by  itching,  it  may  be  stopped  by 
plucking  out  Iho  hair  of  the  iii6umcd  follicle.  If  the  areola  haa 
formed,  a  drop  of  caustic  solution  applied  to  the  centre  will  eome- 
timea  chock  the  prograee  of  the  boil.     A  better  plau  is  to  cover 


44 


MANUAL   OF    TREAT.MKST. 


it  with  gnlLiiiiMim  iukI  oiiiiiin  pliiKtvr  ttprend  on  loather.  Pain 
then  eciuH'jt,  tlio  ititiiimnmtioii  eiibBiik's,  iiikI  llie  wine  tfcpsrntea 
painleewly.  When  rifK),  a  hole  cut  in  the  plaster  allows  vent  to 
tho  jnis.  When  the  iwiin  in  Rtinginu.  m»l  rhe  aisiola  wide,  with 
lieailacThe  mini  nwtlH-isue^w,  warm  ntjin-lj  {Kiullife«  are  best;  catii^irig 
IcBS  pu?tulation  tlinn  Hnsocd.  They  should  be  stopped  when  the 
li^iilnettd  lieciniif^H  douifhy,  Incl»iioiiH  he  ilntw  not  ryeommend- 
They  relievo  pain  and  ohcL'k  the  spread  of  ditfnw^d  boils.  In  the 
fai'i*  hoil,  the  lautery  niay  be  of  iwe  if  appliwl  early. 

1*IFFARB  says  that  at  the  outaet  the  boil  may  be  aborted  by 
toat'hittg  it  with  a  white  hot  needle,  or  with  nitrate  of  silver, 
after  thoroui^h  washinj^, 

Aft«r  piw  has  forraed,  apply  a  little  bella'loiina  ointment  and 
poullicefl.  When  ripe,  the  contents  ehnuld  be  evacuated,  the  part 
dipped  in  very  liot  water  for  ten  mimit.&*,  and  the  oavity  filial 
with  aljAorliont  eotton.  Over  ihi>i  nhould  be  placed  a  piece  of 
sheet  lint,  with  a  little  belladaiinii  ointment.  No  jHKiltiuuH  should 
bo  used  after  opening.  Intornally,  bo  givoi  iron,  quinine  and  the 
iJiineml  urids. 

To  break  up  the  teiideiH'y  to  hoiI«  he  recnmnieiids  sulphide  of 
Boda,  <;r.  Kx  tor  in  die ;  syr.  liypophos,  Sij  tcr  in  die ;  or  sulphide 
of  ciiluium,  gr.  ,'„  four  op  live  times  a  day. 

Vas  llARLiNaBS  says  that  the  varii'ms  functions  of  the  body 
riiould  be  regulatod,  and  the  diet  should  be  good  and  varied.    Qui 
nine  may  be  jfiven  up  to  16  grains  a  day,  with  iron  and  strychnia. 
Other  remeiUcfl  are  Liquor  potassa,  "l  x — x.x  in  infusion  of  qiias- 
flia;  yeast,  in  Si«  dosc^ ;  tar-watur,  Olj  daily ;  aud  phoaphonus. 

DniRiXG  thinks  arsenic  of  uicwt  value  when  the  boils  appear 
^n  crops.  Sulphur  is  useful  in  many  cases.  lie  recommends 
aborting  by  applying  frysbda  of  carbolic  aeid,  aa  l)etler  thiui  the 
cautery.  If  the  btul  he  farther  advanc-ed,  a  drop  of  carbolic  acid 
and  glyecrine,  f<|ual  parte,  will  often  give  instant  relief,  iind  stoiis 
tlie  progrefifl.  A  tew  drops  of  ft  i>er  vent  ttolution  of  t,arl»olic  acid 
may  bo  injected  into  the  ai>ex  with  good  i-eaults.  raintjug  with 
camphor  or  iodine  i«  aUo  mod.  Atter  the  boil  is  open»  powdered 
boric  acid  is  recotumonded. 


4& 

Mauy  yeaiB  Biuce,  ati  uld  country'  pnu-'tilioaer  taught  lu-  to 
boils  and  st/cs  by  applying  »n  ointnicnt  of  rotl  oxide  of 
TV,  gr.  ij  ad  5j ;  and  to  break  up  Ibo  Huciroiwiou  of  boila  by 
giving  intpmally  b  dowertsptmnful,  tlirice  daily,  of  whitikey  entu- 
mted  with  sulplmtu  of  niaj^nenia.  In  anemic  cmto*  20  dntjw  of 
tincture  of  iron  wcrcaddetl  tocuch  dose.  Thin  method  wo  pumiiod 
with  uuvai^-iiig  Huccuu,  until  we  leamml  to  une  the  following  pre- 
Bcriptinn.  which  is  preferable  on  the  H«*ore  of  ta-tte.  and  which 
will  alKtrt  nesriy  every  bull,  If  given  bvforo  suppuration  has 
occnrred. 

K     C^IdiM)|>liiil ■ gr-  s 

Oklcii  l>«M|)lu»|>h«t,. gt,  C 

U.    M  la  dtBtt.  no.  z  diride. 
fiig.— Ons  powdn  to  b«  dlMolved  in  »  glas  of  wnlcr  and  Ukcu  during  iba  day 
In  nnalt  JaM»— Um  mora  dom  lh«  better. 

At  the  rame  time  the  general  hygiene  tthoiild  be  attendeil  to 
the  gi-eat  cau-w  of  holU  Ijuing  the  brvatlnng  of  impure  air,  espec- 
ially at  night.  BotU  are  tlie  loi.-al  evidences  In  luuuy  uuttanceii,  of 
Bewer  giu. 

li.  JoHiisoK  mya  that  tie  fia^  known  of  the  AInus  serrulatA 
being  U9e«i  iruiny  times  by  peraoiw  aHliuted  witli  cmpr*  of  buiU,  with 
the  happiet«t  etfeet. 


BRAIiN,  DISEASES  OF. 

L  Abflcees.-^.  llrTcnixsos-  «ayR  that  if  abeccea  be  diagtioMd 
with  any  eoniidonuc,  au  opening  should  be  made.  To  prevent 
ftbeG«8B  In  j>ersoQtf  ii^ured.  give  dtnall  doMs  of  mercury  repeated 
frequentlj',  with  purgatives;  and  keep  the  patient  quiet. 


2.  Anemia. — W.  R.  tiowsas  »tatcfl  that  the  treatnient  ia 
niAtaly  to  be  directed  to  the  cait^,  and  vhWh  tittcntion  to  the  good 
efibcta  of  the  rL-cumWnt  |KMture.  Chronic  anemia  calU  for  totiiod  of 
bon.  In  npnsm  of  the  twrebnd  vei^H^U,  tl^^  bromid(»  do  good. 
Garo(\illy  regulated  food  and  ittUuuluiita  arc  needed  in  all  cu^os. 


46 


siaxhal  of  trkatment. 


NoTHSAOFi  recninineiKlfl  lowering  the  head,  the  use  of  wine, 
warmth  to  the  body,  thu  removal  of  inanition  l<y  feeding,  and 
t!Htant>oiis  irritttnls.  Fopcxtroine  excitement  he  gives  Binall  doses 
of  nior))hine  (gr.  I'j),  or  chloral. 

3.  Atrophy. — Treatment  U  uttelea^ — E.  L.  Fox. 

4.  Coniprefl8ion.~Trcatraeut,   the  trephine  and  knife. — J. 

lIlITCHlN.sOX. 

5.  Concuasion.— In  tli*  «tage  of  collaiwe  do  nothing,  except 
to  place  the  patient  in  an  easy  iiostui-e,  and  prevent  ccoHng  of  the 
Ifody.  StiinulftulH  i^hoiild  In-  avoided,  except  in  extreme  coIla]»e. 
In  tlie  sleepy  stage,  spare  diet,  purgation,  cold  to  the  head,  and 
quiet  arc  indicated.  In  couvalesconce  keep  the  patient  quiet,  give 
no  filimulunta,  and  use  octasioual  purjraiivoa.— J.  Hdtchisson, 

6.  Hyperemia.— Rui»c  the  head.  Insure  perfect  rest 
Bleed  in  the  worst  oases  only,  whoii  there  is  a  turgid  face  and 
great  fuilnesa  and  tonBion  of  the  arieriea.  Local  bleeding  is  often 
needed.  Order  mustard  to  the  feet,  purgatives,  diuretics,  cold  to 
the  head,  and  avoid  alcohol,  ten  nad  coficc 

W.  R.  GowEBSsays  tliat  tlie  most  important  moaaurea  are  i»o«t«- 
nre,  bleeding, piirgatiim, cold  to  the  lieail, ami  wiirmlli  to  tlie surface. 
The  head  should  he  mist-d.  Bleeding  is  urieful  in  extreme  forms 
when  the  face  ih  greatly  Hushed,  but  not  wlieu  t}io  oongentiou  is  duo 
to  overwork  or  cold,  with  diluted  i/erebral  vessels  and  pale  faiw. 
Purges  arc  useful  in  all  formic.  OiureticA  are  useful  in  pletliora. 
Cohl  to  the  head  isof  most  value  in  reflex  orsecoiidary  ditaUition, 
at^er  mental  work,  insolation,  fatigue  and  mme  toxemic  states. 
Cutaneoui;  atimulants  are  useful  in  the  .'mme  class  of  cn^s.  Heat 
to  the  limbs  i*  best  in  active  congestion.  Alcohol  and  opium 
must  be  avoided  in  all  active  congestions,  but  may  be  of  use  in 
poiwive  forms.  Bromide  of  ]K)tash  is  useful  in  cases  of  vaso- 
motor origin.  In  passive  congestion  from  heart  disease,  the 
latter  affoetion  ealla  for  treatment..  Persons  liable  to  congostions 
of  the  brain  should  live  regularly,  avoid  hot  room,9,  and  attend  to 
the  Ktomat^h  and  bowels. 

In  all  forms  of  active  cerebral  hyfterwrnia  we  have  found  d  iluto 


I 


BBAIX,   DiaB4SB8   OP 


47 


hydrobromic  acid  of  sen'ice,  in  dosea  of  one  dmchm  every  four 
houre.  The  iHet  should  l>e  of  fruit  ami  fnwli  vceetahlc^,  avoiding 
nittugcnnuA,  atarehy  ami  saccharine  arlit-leg.  hot  eton\ii  aud 
bevoragce.  Tlie  inoaU  rfiould  be  always  light,  ami  care  nhould  be 
cxf-rciAod  to  avoid  increasing  the  blood  preaaare  by  iodulgeiico  in 
fluids  to  excvM.  The  ulkaliuc  n'uttre  an  the  beet  drinks,  but 
even  thoy  may  do  harm  if  taken  to  excess.  Everything  which 
teoda  to  excite  anger  or  any  other  strong  emotion  should  be  corefnUy 
aroided.    Interdict  malt  liquors,  above  all  things. 

In  coMM  resulting  from  overwork  of  the  br&in,  when  mental 
work  brings  on  confu«ioti,  headache  or  beat  of  the  head,  cveiy 
Turicty  of  brain-work  i>hi>iild  Ik;  intunlicted  for  a  long  period; 
while  efforts  shouM  be  made  to  iHvert  the  nervous  forces  , to  the 
other  part^  of  the  organism  by  exercise,  etc.  Tlie  bon-eli)  should 
never  be  allowed  to  he<comc  constipated;  but  pnrinilivt*  miwt  not 
be  given  iiKliseriniinatoly  or  txw  ott«rn.  SaUnes  are  V-xt  when 
general  debility  co^exlttit,  oolocynth  for  plethora,  aloes  for  tor- 
pidily  of  the  rectnra.or  for  amenorrh(pa.  "We  have  used  gelBem* 
inm  with  advantage  in  caMw  wbeii>  an  irrilnble  conilitioii  of 
the  brain  exiitted,  simitar  to  the  eretbiiira  witjietwed  in  spermator- 
rhcea.  Bromide  of  potiuih  is  not  bo  goo<l  as  hyilrobromic  acid,  as 
the  former  dnig  i^  apt  to  diaonler  the  stomach,  aiid  depreea  the 
musi'ular  fon-e  ncviUcsetly. 

7.  Inflammation. — J.  Htrrcnni^N  aays  that  when  tiymjv 
totna  of  ccrebriiiii  are  mnnifeiit  it  \*  usually  too  late  for  treatment. 
Hence,  njeaj>un«  of  prevention  are  inii>orlarit.  He  places  first  the 
early  u«c  of  meroory,  followed  by  cold  to  the  bead,  purgatives 
and  counter-irritation. 

6.  Softening. — W.R.<Jnwi:Ks  says  that  during  anacute  attack 
the  patient  miut  be  kept  at  perfect  re«t,  with  the  head  raised,  with 
the  room  at  a  moderatti  tenipt>rat.ure.  During  nhock,  hot  water 
hottlea  aliould  be  applied  to  the  skin.  Uontle  laxativea  ahould 
keep  the  bowultt  0|)en,  but  purgation  flbould  be  avuiJod. 

Give  email  doses  of  alcohol  to  stimulate  the  heart  to  iti 
normal  force,  but  no  mure. 

The  irritative  stage  is  to  be  treated  with  purgatives,  dry 
cupa,  and  rurcly  leeches. 


w 


MAimAL  OP  TBEATMEST. 


Early  and  rc|xnt«d  cmivulijioiui  demund  sinapums  to  tho 
neck,  and  tito  bromides  in  lai-ge  doetea.  After  the  Attack,  recovery 
is  aided  by  the  gcDcral  tonic  regimen. 

Chronic  Bot'tonin;;  neoda  tlie  aamo  treatment.  Tbo  arterial 
teiwion  iiiunt  be  kept  down  by  low  diet,  and  prompt  pnrgation 
wlicQ  an  increase  occurs. 


9.  SyphillB. — Fox  I.]ui«  epitomize  tlie  mediciil  treatment  of 
brain  tinnore:  If  thej  be  e.vphilitic  or  aneurii^inal,  large  duftea  of 
iodidu  of  potaab  miiy  l)o  iisotul.  This  drug  also  licli)s  to  diaiieraa 
the  results  of  accompanving  mcniiigitta.  Beyond  this  there  is 
little  to  be  done,  except  to  aupporl  the  etrength  and  relieve  pain. 

It  ia  well  to  renienii'er  that  in  all  cases  of  ByjihilU  of  thd 
brain.'though  wc  may  cause  alisorption  of  the  specific  growths, 
this  will  not  restore  the  nervous  tiwue  wiiich  lias  betn  destroyed. 
Hence,  the  most  energetic  treatment  should  at  onw  follow  tlie 
diaguosia  of  cerebral  syphilie.  Mercury  by  the  month  and  by  in- 
uni>tion,  ad  well  a.-t  tlie  largcitt  do»os  of  the  indidoi^,  forni!*  the  most 
etleetunl  tivatmeiit,  >Ve  prefer  the  uiereurial  piU ;  wliich  we  have 
given  to  the  amount  of  15  io  30  gmin«  per  day,  in  divided  doseft, 
for  over  a  year,  without  a  day  "a  intermission,  and  with  none  but 
good  resulrs.  A  drat'biu  of  mercurial  ointment  may  be  mhl>ed 
into  the  skin  on  the  iimer  side  of  the  thighs,  twice  daily.  Xow, 
wo  nm  an  nintnu'ut  nf  nlwite  tif  luertiurv  in  liinalin  for  that 
purpose.  Iodide  of  potat^h  or  soda  may  be  given  in  20  grain 
doscH,  well  dihitetl,  up  to  %tm  in  a  day,  if  the  stoinmdi  will  bear  it. 
By  such  heroic  measures  wo  endeavor  to  preserve  the  cerebral 
tiiMues,  and  destroy  the  s[)eci6c  proiluetA,  before  the  damage  i& 
done. 

IlKUBKKn  also  recommends  the  innnction  of  mercury.  Ho 
Bays  that  we  must  dwregard  the  usual  counter-indicatjons,  using 
tlie  drng  in  spite  of  de!>illty,  etc.  The  intmction  of  GO  ti»  80 
grains  daily  should  be  continued  tburteen  days ;  then,  if  better, 
every  otlicr  day  for  some  weeks,  and  finally  half  the  doBO  soma 
weeks  longer.  Yvarbs  truly  says;  "  The  trtiatraent  miiat  be  u 
obtttinuto  H»  (he  disease." 

Iodide  of  potash  i^  slower  than  mercury.  It  is  indicated 
when  the  atfection  ia  confined   to  a  itingto  nerve,  where  tt  is 


nUIN,  DI8BA8R6  OF 


49 


limtted  in  extent,  whero  grave  cerebral  sjinptoms  arc  absent, 
and  where  tlie  course  resembles  general  7>arnly!4id.  It  tthould  be 
given  in  doeee  ranging  from  lb  grains  to  two  drachms  daily. 
When  paralv^id,  c-ontractioni*,  partial  ^pnoiQ?,  etc.,  remain,  perhaps 
due  to  syphilitic  material  or  cii'atrioes  rcmitiuing,  the  iodide 
liiould  be  continued  for  nionthti,  with  steam  or  sulphur  hatlia. 

Insomnia  calls  for  chloral. 

Jfeuralgin  requin*  morjihine  injwaiond. 

Congestion  is  met  by  local  bleeding  op  to©  bags,  never  by 
Teneaoction. 

Somnolence  indtcalcfi  the  necessity  for  wine,  mnsfc,  etc. 

ParolyMi*  remaining,  is  to  be  treale«l  for  nionllw  or  yenrs,  by 
gymnastics,  maeaage,  frictions,  and  electricity ;  employed  daily. 

GoomiAN  givcA  lodidM  in  eiKirmous  amounta;  up  to  an*  ounce 
in  a  day. 

10.  Aneurism. — Lakornbeck  recommends  hypodermic  in- 
jections  of  crgotin,  gr.  \. 

GowE&s  advises  iodides,  rc«t,  and  regulation  of  the  vaa- 
cnlar  tension,  as  recommended  in  the  article  on  Boftening. 

In  some  t.-as««,  where  progressive  paralysis  of  the  orbital 
nervee  indicates  aneurism  of  the  internal  carotid,  ligation  of  the 
common  carotid  has  be«n  re^rtod  to  with  success. 

U.  Tumors. — Obrrnier  culU  jitt«ntton  to  the  fact  tliat  intri- 
mmtat  tiimora  »n.>  often  due  to  injuries  of  the  cranium.  To  pre- 
vent Buch  growths,  it  is  wise  after  uii  injury,  to  use  all  mcnna  of 
preventing  hy]4er»mia  of  the  brain.  Hence,  alcohol  and  other 
brain  irritants  must  Ije  avoide^l,  and  plenty  uf  slei-p  \te  itecurod. 
If  incipient  signs  of  a  tumor  appear,  the  local  hy|»onemia  must 
be  lessened  by  the  use  of  leeches  to  the  nasal  wptiim  and  the 
mastoid  proecw,  ice  to  the  skill!,  low  diet,  and  purgatives.  In 
ibom  predisposed  to  tubercle,  all  excitement  must  be  removed ; 
and  all  debilit«ting  measun^  laid  a-iide.  The  iteton  is  the  beet 
derivative.     Iodide  of  potash  should  be  tried. 

WuNnKRLicB  rocoraraended  the  long-continued  use  of  arsenic, 
bnt  it  is  of  doubtful  utility.  Headache  ca)U  for  morphine  injec- 
tims,  con^Tilsions  for  hromid**,  paralysis  for  the  constant  cur- 
rent, constipation  for  magneaian  waters. 


60  MANVAL  OP  T&BATMBKT. 

BREAST  DISEASES. 
1.— SORE  NTPPIiES.    roBDTCB  Babkkb,  twommenda, 

B    Flumbl  nitnL, gr.  zv 

Gljrcwriiw, f§J 

H. 

He  also  ordora  the  nipples  to  be  paiiitud  witli  tiuct  benzoixL 
comp.,  n^  600II  an  tJio  child  is  taken  from  the  brcoat. 

It'  ulcers  begin,  paint  with  nitrate  of  silvor,  gr.'x  to  f  5  j. 

For  infiamed  nipplua  ho  imJcrH  a  bread  and  milk  poultic  to 
be  applied  for  a  few  boari?,  and  th^a  covcre  the  nipple  with  a  soft 
linen  cloth  wet  with  the  following: 

B     Ext  ojiU  x) 5j 

Li<).  plumbi  »Qbac«t.  dii, t%m 

Aqomitmm, rji^jM 

'When  uureiiig  con  be  resumed  he  substitutes  the  following: 

B     Aciil.  tnnntc^ J^ 

Gif  c«ri(^ 

Aq.  "«i^ ^  n  y 

Bbocuard  du9t8  the  nipple  with  suberin,  after  first  washing 
and  drying.     Suberin  in  an  impalpable  powder  of  cork. 

HuRBXER,  in  all  lexioua  of  the  nipple  and  arer)lre,  useis  com- 
'PWBOOB  wot    with    Inki'wann    lead-water.     Fissures^  etc.,  are 
tonched  twioe  a  da^-  with  baUam  of  Peru. 

CaARRiBR  Tecomraends  picric  acid.  Al^er  thorough  e}can&ing> 
the  solution,  3  to  200  of  warcr,  h  pencilled  on  the  cracks ;  while 
after  suckling,  the  nipple  ii^  held  tor  four  minutes  in  a  solution  of 
ItclOO. 

Da  BoRDiBB  usee  011I7  quinine  intenmlly. 

Drtiitt  recommends, 

S    Ac{(Lt&nnI(^ gr.if 

AqiiR  df«t, 5  vj 

V.    8> — Aiijiljr  an  lint,  covered  wiUi  oil«d  lilk. 


BREAST   DrSBASn.  51 

BLACqOIKItIS : 

q    Est.  kraMierbt, p.n 

OL  amjgd.  duir,.... ^.  xxz 

Ot.  UirobrotiiK, 5  iH 

M,    &— Afiplj  ftftei  nuniog. 

B     ZincioxicL, 

fwdvborat, hk    gr.jm 

OLan/giLdubi, ^Sjm 

Ol.  Ibcobronue. 9  iv 

01.  bergstni, gu.  v 

M,  8.— Fot  wiM  nipple*. 

BouTD  prefers  tbe  civeolia  lerigata  to  all  other  sootlung 
powders. 

ILicsfoiAN  recommends  a  five  perocrit.  ttolutiun  of  carbolio 
add. 

Albeat  H.  Smith  Gmployod, 

B     ErnpUnU  pltimbi 3^ 

£lherlv J5« 

Collodion  Oesit, fjj 

Powder  the  plaster,  ndd  the  cthor,  and  mix  well ;  then  add 
the  collodiim.  Apjily  with  u  brush  over  evorj'  portion  of  llie 
carefullj*  dried  nipple,  eKCH>pt  tho  mouth*;  of  tho  milk  diiiTl^. 

In  the  VtKNHA  Hospitals  salicylic  acid  in  ni^cd,  in  four  per 
CMit,  solution. 

The  nipple  shield  is  a  nuisance.  Though  it  relievos  the 
inotlier  from  pain,  tlie  child  \»  rarely  able  to  nurse  tliroiigh  it 
«noagb  to  tiu.staiii  him,  and  af^cr  the  nvo<l  for  the  shield  has  paxeod 
aWBjr  the  child  ofV^n  refuses  to  nurse  the  breast  without  it.  Rather 
than  nuLlci:  use  of  it  we  would  recommend  tlie  mother  to'  ccane 
nursing. 

2.— INFLAMMATION".— BiBKETT  Bays  that  tfifat  attention 
shnuld  \w  given  to  the  nipples  of  primijnriB.  T)ic  infant  must  be 
compelled  to  nunu!  from  Imth  brcaste,  so  that  neither  will  beonmc 
too  full  If  the  ducts  be  obstructed  with  coagula,  the  latter  tthould 
be  removed.  FL-wurcA  ttliould  have  soothing  applications,  and 
iliould  he  protected  from  llie  friction  of  the  dresH.  If  tliere  be 
mnch  secretion  from  the  glandn,  a  little  drying  powder,  such  as 
arbonat«  of  magnesia,  should  be  dusted  over  the  nipple. 


62  HANBAI.   or   THRATMOT. 

When  congestion  of  the  glaud  exUu,  support  with  odhcsiTe 
BtrapB  is  uecful. 

Inflivmnmtion  calls  for  wamilh  iind  moisture.  The  poultice* 
should  be  contiuucd  after  the  pue  hii^  been  eviicu&ted.  The  breast  M 
should  he  supported  by  a  bandage.  An  ciinming  should  be  made 
m  sooti  11^  lluL'tuation  ean  be  detceteid.  The  gvtierul  health  demands 
supporting  meafliires  tlirwughout.  It  is  not  Eikely  that  the  moas-  ■ 
urea  usually  employed  to  harden  the  uij>p!es  betbre  confinement 
amount  tn  much.  Tht?  sudden  development  of  the  nipple  leavoa 
gjLpa  in  the  contumity  of  the  epithelium  whiuh  retiutre  time  to 
fill  up.  The  irritation  of  nursing,  the  mingled  ?alii'a,  docom- 
pofiing  milk  and  perepiration,  all  (.'ombliie  with  the  frii-tion  of  th« 
clothes  to  set  \ip  intlnnimation.  The  mother  dreails  to  put  the 
child  to  (he  raw  itipple«  and  the  milk  eolleetn  in  tin-  hn'-Uftt,  and 
becomes  lumpy.  I^erliajw  the  btwl  preventive  U  drawing  the 
nipple  out  and  nibbing  it  with  a  littlo  sweet  almond  oil.  Tliis 
should  be  done  daily,  for  a  month  before  the  child  is  bom.  A 
pump  may  be  uitwi,  but  it  ia  liettcr  to  draw  lh«  nipple  ont  with 
the  lips. 

After  the  haby  is  put  to  the  breast,  tlie  nipple  chmild  always 
be  washed  with  luke-warm  water,  containing  borax,  gr.  xx, 
at:etat«  u(  lead,  gr.  v,  sulphate  of  zinc,  gr.  j,  i»r  better  than  all, 
tincture  of  benzoin,  gtt,  xx.  to  the  ounce.  After  washing,  the 
iii(pj>U-  sliniild  l»i:  Well  dritnl  with  a  picec  uC  soil  linen,  and 
powdered  with  bismuth,  which  is  perfectly  hamilesa  to  the  child. 
When  lumjw  form  they  should  be  dijwijiated  by  gimtle  friction, 
with  the  fingern  dipped  in  hot  lard. 

Babtuolow  recommends  that  phs^tolacca  be  applied  when 
mipptimtion  in  threateni'd.  I  have  iiuiny  times  succeeded  in 
aborting  a  tlireatenod  abseosa  of  the  breast  by  eovoriiig  tJie  organ 
with  an  ointment  of  this  drug,  or  with  cotton  soaked  in  the  fluid 
oxtraet.  Of  l:ite  t  am  in  the  habit  of  adrainistt-ring  interualljr 
also,  the  sulphide  of  calcitun,  gr.  j,  daily,  in  dividwl  do«e».  I 
have  found  this  treatment  more  eiRcient  than  the  use  of  belladonna 
or  camphor,  and  tt^H  apt  to  Moji  the  Kecretioti  nf  milk.  The  hi%ast 
should  always  bo  8upix>rted  by  a  well-arranged  bandage.  Qni* 
nine  fihould  be  given  in  doaea  of  live  grains,  every  four  to  eight 
hours.     While  those  measures  will  generally,  perhaps  always. 


MIKAST   DISKASRS. 


&3 


cheek  a  threatened  mammary  abaccss,  they  are  not  tho  only 
weapons  at  our  command. 

I  WH6  once  called  in  to  sou  n  [loor  woman,  it  firw  davrt  over 
her  labor,  who  ha«l  juat  suftcred  a  chill.  One  breast  showeil  that 
ail  abHcCAA  wua  foniiing.  I  ofTcrt'd  Ut  pruM:ril>e,  but  fouml  tlie 
lamily  were  iienuileaa.  Unfortunately  I  was  for  the  motneat  in 
the  same  prediainu^nt,  Iiaving  forgotten  my  purse.  Accordingly 
[  directed  the  huijband  to  apply  to  bin  wife's  breast,  flannela 
wrunj;  out  of  very  hot  water,  and  cbangixl  L-vcry  minute.  The 
directiona  were  followed  duriug  the  day  and  night ;  and  the 
abecetis  luul  dieappcared  by  the  nuxt  uiuramg.  [W.  F.  W.] 

If  in  apilcof  our  ctl'orta  iiuppuration  should  occur,  the  ab- 
scess should  be  opened  early,  by  a  free  incifiiou  parallel  to  tJiv 
milk-ductjs ;  luid  tJie  catte  is  treated  subitequeiitly  on  surgical  prin- 
ciples. Qtunine  should  be  long  continued,  with  a  rich  diet,  not 
too  largely  tluiil.  Prolonged  Muppumtirm  in  an  inOauied  brcaat, 
with  the  fiirther  drain  upon  the  itystem  of  nursing,  oflern  an  uii- 
usually  suitable  opportunity  for  the  tuWrcle  Imcillua. 

Billroth  putti  tlie  [latinnt  to  bed,  on  low  diet,  ait  long  a»  there 
iM  fever ;  and  applies  a  Iwndage.  Poulticca  relieve  pain  and 
prt'Tunt  abseeut.  If  lai!tatinn  lie  interrupted,  apply  mercury'  or 
iodine  in  ointment  Abscemea  should  be  opraed  early,  with 
•trlct  anttftepiiiii,  and  a  drainage  tube  introduced. 

JKoBDrcB  Barker  endeavors  to  abort  the  abwees  by  applying 
todine.  If  tbi;*  fail«,  be  uses  i>ou!tice!«.  To  relieve  pain  and  give 
rtftit  be  orders  Dover's  jtovvdor  or  Tully'd  powiier,  which  i«, 

^^^^  111     OMa|>hocw  |««It, 

^^^^^^k  Vtttm  pr^, 

^^^^^^r  fi  Ijqrrrbift.  pulr., U    gr.  xz 

^^^T  M  orpb.  nlpb, gr.J 

^^B  11. 8> — Dm*  «aiaa  m  Dortc's  ftnriar. 

W  If, 

I       all  depn 
I       local  trc 


If  there  Ik>  an  epidemic  tendency  to  Huppuration,  he  avoids 
all  depre«6ant«  and  given  (quinine  in  full  doseH.  Ke  does  not  truat 
local  treatment,  but  opens  t]ie  uIml-um  early. 

In  wmte  caaes  be    reconimcnd.1  vascular  sedatives,  Kalines, 


anodynes  and  low  diot.  In  those  cases  which  panue  a  more 
chronic  course  he  gives  tonics,  stiiiiulanta  and  nntritioiw  dieL 
Nursing  is  forbidden.  If  tho  secretion  of  milk  be  active,  tho 
breaat  roust  be  rubbed  with  sweet  oi!  till  soft;  then  covered  with 

I  extract  of  beUadonna  goftcncfl  with  glycerine.  After  the  sbsccaa 
hm  been  opcncil,  udh^^sive  tilmpa  are  applied  ho  am  to  support  the 
breast,  and  compress  it  firmly  from  circumference  to  centra. 
Platkaik  eombattt  fever  with  aconite,  gentle  salines,  and  (|ui- 
nine;  and  relieves  pain  by  opium.  He  recommends  rest  in  bed, 
the  BUSpensory  hreast  bandage,  jwiultice-s  Mprinklcd  with  Iw-IIo- 
donna  liniment,  and  early  opening  of  the  abscess,  under  strict 
Liatdrism. 

CuvROHiu.  advittea  bleeding  or  leeidiin^  in  high  fever,  fol- 
lowed by  poultices,  and  brisk  saline  pui^^es,  with  tartar  emetic. 

Q.  C.  SatiTn,  of  California,  reuommcndti  the  following: 

n     Chlflrol  h^drat, $» 

OI.  liiii, f  J  i» 

M.  S.— Apply  on  Oannel,  to  cnver  the  breaHt,  leaving  the  ni|)ple  imn. 
Apptjp  WUtn,  and  koep  warm.  It  sliould  be  renewed  every  Tour  lioura  till  llie  tjta^ 
toau  aabods. 


I 


I 


UtreTEU  McGuiBE  thinks  that  proper  bandapng  will  cure 
moat  casea  of  chronic  suppuration,  without  slitting  up  fistuhe,  etc 

A.  TnoMPsoK,  of  London,  rofomraendB  Unct  aconiti  rad., 
fiL  j,  every  hour,  end  total  abstention  from  flnidn  for  some  days. 

C.  B.  KtiPEit,  of  Indiana,  recommends  no  other  application 
but  ammouitim  chloride,  5  j  to  cool  water  O  ij,  applied  con- 
tinuouKly  until  well. 

H.  MlLLBB,  of  Glasgow,  roeommcnds  a  very  strong  prepara- 
tJOD  of  belladonna,  kept  fluid  by  collodion,  and  combined  with 
camphor. 

Kdk£,  of  Tuebingen,  tre-ats  his  cases  by  applying  cold,  in  the 
ibrm  ot  cold  comprcAacH  or  ice  haga.     In  two  years,  not  one  case 


went  on  to  euppuration  oudcr  this  trcatraeot,  though  when  he 
relied  on  compiveeioD,  suppuration  oI^q  occurred. 

WlKCKEi.  upjilicM  dry  hi*»t  if  acute  pain  [lenjiHtfi  after  the  uao 
of  cold.  He  gives  also  large  doses  of  iodide  of  potash  for  head- 
ache and  coated  tongue. 

2.— HTSTERIA.  In  hysteria  of  Hie  breaat  the  ordinary 
trestmeDt  of  this  neorotic  eondition  is  indicated. 

3.— KEURALQIA.    (Mastod^nia). 

FoRDTCB  Babkbb  fouud  a  full  doite  of  quinine  an  efficient 
remedy. 

TaTOiEft  advocates  valerianate  of  iron  or  of  iiinc,  tinct  cin^ 

cifoga,  and  aeonit«  for  i^ugorgeiii^nt.  C<HMiveiH)il  Bomctimea 
eixree  when  other  rcmcdiee  fail.  Aaeuroacc  that  caucor  is  not 
pKAent  is  always  necwsary. 

A?isTiB  recommends  rest  for  the  organ,  and  morphine  hypo- 
dcmiiL-ally.  with  attention  to  nutrition,  and  iron  with  utrychuia 
internally 

4. — GAI..\(_TTORRTrCEA.  Atkinbom  recommends  a  gener- 
ous diet,  ab:itineui--c  from  fluidB,  and  the  u»u  of  uBtriiigcut  tonics. 
If  not  checked,  and  the  health  fails,  lactation  must  be  euapended. 

L.  Db  Sishty  eaya  the  best  remedy  ia  comproaBioD. 

HorTH  claims  for  four  remedies  the  power  of  checking  the 
flow  of  milk;  namely,  iodide  of  potash,  fjclladonnn,  coleliifuni  and 
iron.  Of  the  first,  it  leasens  the  milk  and  removes  knots,  if  the 
diild  Itt'  not  riiirsiid.     Tlie  dose  is  five  to  eight  graitw  dnily. 

Belladomia  will  completely  stop  the  Bccretiou  of  milk. 
The  extract  should  be  applied  freely  to  the  bnawt,  but  not  to  the 
nipple.  Cows  are  eaid  to  bo  dried  up  by  eating  colchicum. 
Drinking  furrugini)U!i  watvnt  hiM  nlno  been  known  to  cauev  cows  to 
go  dry.  In  pletlioric  women  iron  Iceeens  the  quantity  of  milk 
iccrctcd,  bat  iucrcaMs  it  in  aoemica.    Leaking  of  the  breasts  is 


tUNITAL  OF  TRBATUBNT. 


prevented  by  brushing  flexile  collodion  around  the  nippla  Aft- 
tringeiil.  ii]i|ilii':iti(m«  are  nho  tisoful.  Tnternally  stryehuine  is  of 
value.  Camphor  h:i.">  undoubted  powers  in  drying  up  the  milk. 
Ki^t  ha8  been  umnI  tur  the  Name  pnrpose. 

5.— INSirFKICDIKT  SECRKTION  OF  MILK. 

FoNSSAORivEs  gives  the  following: 

To  incroosy  thi-  milk,  jibundutice  of  succulent  food,  fresh 
plenty  of  sleep,  exert-isc  and  bitter  tonics,  are  rational  nuwturea. 
In    liritlany.  cidpr,  beer,  and   oatmeal   have  a  wide  rcput&tioa. 
Gallcga  officinalis  has  the  same  credit. 

To  eHtablirth  anew  the  iHicretion  which  has  ceased,  the  best 
remedies  arc  suction,  ejiator  oil  plant  Uaivtw  in  inflation,  and  far- 
adisation.  The  latter  i^hould  he  contiiied  to  the  gland,  and  should 
bo  continwxl  with  mo^lcmtu  force  for  twenty  minut^xt. 

RoDTH  caUa  electricity  a  jiowerfiil  Htiinuluti  to  the  breast. 
He  recommends  tVx«l  ric-h  in  phosphorus:  fish,  oyatere,  craba  and 
conger  eeln.  as  well  i\»  lentils,  i>ea*i,  beaiin,  and  mu8hrooni!(.  Th« 
beat  drink  is  milk,  with  or  without  i*tout.  Among  drugs,  he  hft» 
found  useful  tht;  rtn[)(umriii  vaut-nria,  riouuliUit  arvenxiii,  and  ricinut. 
communis.  The  latter  is  remarkablv  heneticial.  If  it  act  as  a 
diuretir,  tint  breast  should  Kr  kept  wiinn.  Tiw  tupioea  plant  is 
said  to  have  the  »anie  etlect.  Coronilla  juncia,  or  milk  weed,  ift; 
second  only  to  the  rieinuit.     Common  ttalt  i*  a  gulactagogue. 

WiNCKi:!.  rc(}uire8  good  diet,  tonics,  KtiiunlaiiTi*  and  fennol 
Bood  tea. 

EpiruAiM  CrTTER.  recommends  a  diet  of  imbtilted  flour,  meat, 
and  vegelaliliw;  llw  ininenil  cnnslitnents  of  ilie  bmii  contributing, 
in  this  author's  opinion,  to  the  fi-ee  formation  of  milk. 
Other  remedied  proiwKtol  from  time  to  time  are: 
Iiy'ections  of  caustic  potash,  .  .  .  (Kmiiek) 
IjOtiDiis  of  nitral*!  of  silver,  ....  (Huuck) 
Lotions  of  oak  bark,  ....         (Hatick) 

LactophoHphate  of  lime  and  inm,  .        .        ■      (Lange) 

White  Agaric (Joulin) 

Uterine  douches  to  produou  hemorrhage,         .      {Abcgff) 


EEEAST   DISKASWA. 


67 


^_  ha 


r 

^  ni 


bctiidut  quinine,  anunoniatcd  iron,  ulum,  quasHin,  belIa(loiina> 
gossTfiium.jaborandi,  fomentations,  and  chlorate  of  poto^a. 

Tlie  best  of  all  remedies  to  increase  the  flow  of  railk  is 
jaborandi,  given  in  do^M  of  fivo  dro|w  of  iho  fluid  extract  every 
two  hour*.  It  19  certititi  nnd  s[K*edy.  With  it  alone  I  have  re- 
stored the  i»ecretion  of  milk  when  it  had  disit'|>earcd  for  two 
weeloL  Bnl  (he  «iib:H.H(tient  history  of  this  catn;  v:a^  $o  peculiar 
that  I  will  n>late  it.  The  woman  was  one  of  a  tiimily  ofsisten, 
lar^e,  portly  women,  fat  and  plethorifs  who  bore  children  in  rapid 
suceeBwion,  who«e  vital  power  wan  defieieul,  Xone  of  the  eimten 
had  much  milk.  Finally,  in  Chig  case,  the  Kcc-rction  totally 
oeased  a  few  wi>ekd  after  the  hirth  of  ihe  child.  I  whs  noi  a]*- 
prteed  of  tliis  eirt^-unistanw  Cor  iwo  weeks.  T  then  ottlered  the 
jaborjndi,  and  in  two  days  the  milk  returned.  But  in  letu  liuin 
two  weeks  I  was  sent  for  in  haste,  u*  find  that  the  mother  had 
become  melancholy.  She  lay  in  bed,  fearing  to  trust  herself  oui  of 
tier  room  lest  the  impulite  to  kill  her  family  dhould  prove  irresist- 
ible. She  i*lej)t  none,  had  no  appetite,  anil  whenever  the  child 
nunted,  felLa.i  if  it  were  ''dmwing  her  Iiings  out."  I  took  Immo* 
idiatu  AtepM  to  dry  up  thti  milk,  and  when  tliiti  wan  done  the  melao- 

loly  disappeared,  to  uiy  great  relief.  [W.  ¥.  W.] 

Alcoholic  bevemgcti,  and  especially  malt  Iiiiuor4,4.".ta'?c  a  tem- 
ponufy  incpcose  of  milk.  The  mother  who  ie  falijpu-d  with  btr 
-work  will  Uike  a  glaas  of  beer,  ami  iti  a  lew  momentd  the  flabby 
breai<t  will  be  di4tende<l,and  the  infuntean  bo  fe<l,  Bnl  when  thid 
has  been  rejieated  for  noveml  <biyn,  the  breast  will  ceaxe  to  secrete 

cept  with  the  same  ^imntug.  This  converts  tho  oeetuioiial  habit 
into  a  ponnanout  one.  As  would  be  naturally  ex|*tct«i,  such  milk 
i»  not  whoIe.some,  resembling;  the  switl  milk  eoncemiug  whit;!)  a 
great  outcry  waa  made  some  years  Biiiee.  The  mother  will  grow 
floikrae  and  fat.  but  the  child  will  not  thrive  until  it  \»  weaned 
After  that  the  ditlerei]oe  in  the  health  of  the  child  is  eometimea 

riking. 

Stimulants  diould  have  no  place  in  the  diet  of  the  naniing 
mother.  Rii-h  mid  ubiitidant  PtkhI  'ia  tlie  only  true  and  ^afe  galao- 
tagojfue.  Cod'Uver  oil  with  lime  fornm  the  mnj^t  univcntally 
appropriate  of  foodn.  I^entil  mwip,  oatmeal,  meat  and  cheese,  are 
the  moat  essential  elements  to  enrich  the  milk. 


MAinJAl   OF  TBEATirein. 


BRIGHTS  DISEASE. 

t — ACUTE.  T.  a.  Stew/rt  prefere  to  subdue  tbe  cougea- 
tion  by  the  uho  of  Iceelics  or  cups,  liot  fomeu  tat  ions  and  counter- 
irritants.  Venesection  is  only  admbsible  at  the  beginning,  or 
when  severe  exacerbations  occur  with  anuria.  Iodine  and  croton 
oil  are  the  best  counterimtants  for  more  chronic  stjites.  The 
tubules  are  to  be  waahcd  out  with  diuretics,  siicb  as  water  and 
digitalis,  which  U  safe  even  in  hematuria.  It  may  bo  combined 
with  8W<ict  spirits  of  nitre,  Rcettito  of  potjish,  or  iron.  Its  action  is 
often  favored  by  sciuilt  and  ammonia.  If  diuretics  fail^  or  the 
Bymptoma  become  threatening,  he  gives  jiilap  or  platoriuin  in  full 
dosea.  To  oxclte  the  skin,  pilocarpine,  hot  air,  vapor  batlia  and 
the  wet  pack,  are  the  most.  efRrieitt  u^ent*t.  Tht*  imwets  and  skin 
must  he  kept  at  work  tliroughoui. 

When  dropsy  perfliata  after  the  first  etage  baa  passed,  cream 
of  tartar,  juniiier  and  bi*oora  are  of  use.  Iron  must  bo  given  to 
restore  the  wasted  blood.  Ergot,  gallic  acid,  and  belladonna  are 
believed  to  check  the  lose  of  albumen.  The  diet  should  bo  not 
too  atbitminous  at  first.  Milk  is  well  borac.  It  la  a  good  diu* 
retic  and  nutritioutt,  but  no  more.  In  chronic  atageSf  tbe  diet 
ehould  be  very  nourishing,  and  stimulants  may  be  needed. 

2.  In  tbe  waxy  fonu,  the  eatirial  atlection  is  to  he  treated ; 
carious  boni,  chronic  supiuirafiou,  syphilis,  eto.  Iron,  quinine, 
strychnine  and  syrup  of  phosphates  are  useful,  together  with  good 
food  and  an  oaiiy  llfeL 

Z.    Wo  podsc^  no  remedy  to  influence  the  cirrhotic  form. 

4.    Combined  forms  must  be  treated  on  general  principles. 

Nausea  is  bt-si  treated  by  t-ounier-irritation  to  tJie  epigastrium, 
by  iee,  milk,  and  bydrocyiinic  acid  internftlly. 

Diarrh(£a  must  olten  he  let  alone;  or  may  receive  the  uaual 
astringent  and  sedative  treatment. 

Ascites  is  lr«at«d  as  dn»psy,  and  may  require  tapping. 

Peritonitis  requires  hot  fomentations,  and  the  careful  u»e  of 
opium. 

Iron  and  other  hematic  tonics  are  demanded  throughout. 

Hemorrhage  calls  for  comhiiiatiotu  of  pemitrate  of  iroo* 
local  astringents,  ergot,  gallic  acid  or  acetate  of  lead. 


Hydroperiairdium   mid  pcrirardiiis  receive  the  utinal  tmtt- 
iL    Bronchial  catarrh  must  be  carefully  attended  to;  by  avoid' 
anco  of  cold,  by  counUir-irritation,  and  by  exjHxtonuitA. 

Oedema  of  the  lunga  demaDds  couDtcr-irntantH.and  remedies 
For  dn>[»y.     IfydroLhomx  may  domatid  puru<!c-iitcAiii. 

General  dropsy,  pneunaonia,  pleurisy  and  fihtbtfiiB  receive  the 
ordinary  IrcatmcDt  of  thofw  conditions. 

Headache  i$  relieved  by  iroii,  hot  or  cold  water  to  the  head, 
Lnitiiuc,  or  iuhalatiotia  of  amyl  nitrite. 

Uremia  demands  cupe  over  the  kidneys  firee  purgation,  hot 
~air  bnths,  blcoding*  in  pncrpenl  ooMe,  the  bromides  in  dmchm 
doe«,  and  inhatations  of  chloroform. 
L  In  chronic  uremia,  counter-irritation  is  of  service. 

^B      The  eye  afiections  are  benefited  by  the  iodides. 


^Toi 

OP 

■       mtt 


k 


W.  Roberts  recommends  wet  cup9  to  the  loins,  repeated  when 
nrcraia,  headache,  etc.,  oircur.  This  should  be  followed  by  poul- 
tices, hot  air  baths,  citrate  of  potash,  or  liq.  ammon.  acelat  with 
tincture  of  fayo^yamuB. 


Bablow  rocoramcndii  tartar  emetic,  gr.  { — |  every  four  hours. 
Compound  jalap  powder  should  be  given  every  other  day.  Mer- 
cury is  objcctionublc.  Citnitc  orjK)ta.-Hh  in  UHelcriH  when  hematuria 
remaius  after  fever  hafl  sub^^ided.  Meat  ehould  be  avoided  in  the 
early  itagoL  I>uriag  the  decline  diaphoretics  should  be  continm^. 
Iron  must  be  cautiously  eubetitnted  in  convalescence.  If  givea 
too  Boon  the  acute  symptoma  may  return.  Ilamburger  recom- 
mends quinine  iu  convalescence,  in  doses  of  gr.  viij,  daily.  The 
ftlightoet  cxpORorc  may  sufBoc  to  bring  the  eymptoma  back. 
Flannels  should  be  worn  next  the  skin.  The  patient  should  not 
be  allowed  to  h3flvc  the  rnnm  till  albumen  has  disappeared  firom 
urine. 

In  treating  oomplicntion«,  cantharidce  and  turpentine  should 
avoided.  For  the  vomiting,  ereowote  or  cidoroform  iu  ice  water 
y  be  given. 
InchrODicBrigbt'adtHeafietheobjeGtaart>to)rutdertlieexleniiioD 
of  the  diseoae,  to  prevent  uremia  and  inflamnintionH,  and  to  pnltiato 
symptoma.  The  occurrenoe  of  albuminuria  should  be  an  indication 
for  operative  rocasurefl  in  necroitis,  etc.      Countor-irri touts  are 


«0 


HANUAIi    OF   TRBATMEN'T. 


ttBoleea.  TTio  patient  slioiild  bHtrlolheKl  in  wool.  Tli«  iitiion  oPCbe 
Bkin  ghould  be  sustained,  the  liowels  n?gulut«d,  tlio  diet  light 
Milk  agreM  well.  Light  wi![ii3A  or  beer  are  allowable.  Saturate 
the  system  with  iron;  jjivo  twenty  drops  of  the  tincture  twice 
daily.  If  thiFi  jinxlucQd  headache,  ttuhstitute  the  milder  ehaly- 
beates. 

The  patient  must  be  made  to  eomider  liimxelf  :in  invalid 
who  niu?t  li^e  by  rule.  Dropsy  is  best  met  by  hydragoguea  and 
warm  baths.  DiuretiiM  are  of  little  uae.  Tension  of  the  skia 
is  to  be  relieved  by  incisions  an  inch  long,  penetrating  the  subcn- 
taneouB  tiitsuo.  The  limb  i-s  tlien  wrappctl  in  }iot,  moiitt  flimnclii, 
which  mast  be  changed  and  the  part*  washed  every  two  )iour». 
Tbaobe  washes  the  incisions  with  chloriue  water.  Krysijx.>hi9  vrill 
rarely  follow. 

Contracted  kidney  calb  for  iron,  tonics  and  mineral  acida. 
Broncliitis  and  other  inflammations  require  aconite,  antimony  and 
digitalis,  with  chloroform  epithems,  poultices  and  dry  cups. 

Dyspeptic  Byniptomfl  need  careful  diet,  bitters,  pruaeic  acid 
ftnd  antacidB.  YomitliLg  of  uremia  roriuirce  creosote,  morphift 
and  iice;  white  dlnrrbtea  must  be  combated  with  lead,  opium  and 
sulphuric  uvid. 

Uremic  symptoms  demand  speedy  action  on  the  akin,  kidneys 
aud  bowels.  Chlorofonn  'n  the  bc^i  palliative  for  the  courulttions. 
Venesection  i*  u  powerful  weapon  wlioi-e  the  strength  allows  ita 
use,  oe  in  acute  uaeea.  In  chronic  ca^oa  itB  use  i»  limited  t<>  thoao 
in  which  coma  comee  on  rapidly,  in  patients  who  are  aa  yet  reason- 
ably strong,  and  to  coses  where  there  is  an  absolute  necessity  of 
restoring  conscioueneBs  even  at  the  expense  of  shortening  life. 

Looms  condemns  the  treatment  by  diuphorcttca  and  hydra* 
gi^et.  He  cndeavora  to  remove  the  exudation  by  means  oi 
digitalis,  combined  with  spirits  of  nitrous  ether,  acetate  of  pot- 
«sttu,  iron  or  squills.  Dry  cups  should  be  applied  over  the  loins, 
followed  by  poultices. 

If  uremic  Hyroptonis  be  still  urgent,  hot  air  batlis  and  hydra- 
gogues,  or  pilocarpin,  may  be  temporarily  used  to  tide  over  tho 
danger.    Milk  should  be  the  only  diet. 

When  the  urinary  secretion  is  re-eatablishod,  digitalis  should 
be  discontinued. 


I 


BKieilTB  DISEA5B. 

For  coma  or  convulginns,  hypodermics  of  morphino  may  be 

naed,  but  not  dilorofurni.    If  one-eucth  of  a  gniu  °i>(>iil>l  not  arrest 

the  epttsms,  the  mnrphinc  must  be  iiicrducd  to  onct-half  a  grain,  and 

I    the  injcutimiH  repeated  every  two  hours.    The  objf^ct  m  to  control 

'     the  Bpasma,  aud  the  pupil  nncl  the  number  of  reHpirutiotie  ore  tiot 

reliable  guides  in  itA  adiiiiiii&tration. 

In  chronic  parenchytnatoun  ncphritiK  the  Rame  iliuratics  must 
bo  continued.  DigitaVu  may  be  •.•ombinc-d  with  iron.  Milk  is 
Btill  iliv  best  diet.  Wino  may  lie  uiwfully  taken,  with  food,  in 
■mall  am()unt5. 

In  the  later  gtage-s  the  debility  nerewilatwi  raretul  feeding', 
and  eod-lirer  oil.  Urgent  !»ymplomH  may  be  relieved  by  the  hot 
I  air  bath.  Pilocarpin  is  prompt  and  effectual,  but  dnogerouiL 
Depleting  mea.4ur«ti  should  only  Ik:  mted  when  abM>lut«ly  nece»- 
ntry.  Constant  care,  living  tn  a  warm  climate,  and  living  by  rule 
will  prolong  life  indeBnitely. 

In  cirrhotic  kidney,  mercniy  is  only  admiiwiblc  when  cii^ 
rbosiis  of  the  liver  co-cxiHtA  Alkaline  waters  are  rwximmcuded. 
Pemianent  reeidence  in  a  warm  climate  i»  tlie  licnt  remedy.  Iron 
a^nivatea  the  nervuos  symptonDt;  cod-liver  oil  with  hy|>opho»- 
phitcs  suits  some  cases.     Death  may  be  lon^  ])ostponed  by  cara 

In  waxy  kidney,  remove  the  cuuao  and  give  cod-liv«r  oil, 
iodide  of  iron,  and  other  tonics. 

Divu  recommends  in  acuto  Itright's  diitcaee,  in  addition  to 
other  remedies  alrKtdy  mentioned,  calomel  and  nitre,  uit  gr.  v,  re- 
peated ever}'  three  hours  till  four  do6(«  liave  Iteen  taken.  Tf  the 
bowels  be  not  thereby  moved,  he  substitutes  saUncK.  If  the  febrile 
symptoms  be  prominent,  he  gives  al^o  Uie  following : 

B     J.H)-  amnion.  mtttMt^ fj  ij 

fi|>.Mlb.iutroa, .t%\ 

Tr.  T«nL  ririil, f^  j 

M.    6.  — f  5  j>  «*«?  four  bmin. 

If  uremic  Rymptomn  BU[Ktr\'cnc,  he  gives  jaborandi  at  once. 

In  chronic  cofies  he  rigidly  excludes  aloohol,  and  gives  milk, 
forinaB,  iKime  vegctublot,  and  but  little  meaL  Buttermilk  or 
whey  are  tlie  l>e6t  drinks.  In  the  early  stages  alkaliuc  mineral 
watcra,  such  an  the  Qtithoeda,  arc  useful ;  aUo  the  following: 


6S  UAtmAi.  af 

B    PoUa.  nitnt. Sir 

E«.g»ltifl., tii]m 

EsLuTKum  fl, '3  Ij* 

Ext-  ergolK  fl, f  J  j 

IC.    B. — f  J  j,  four  timet:  dail;. 

He  has  seen  nmrkeii  iniprovcment  in  many  cases  follow  tb« 
use  of  bichloride  of  mercury  in  small  doses,  with  toiiica. 

"When  incirtioiiH  luTromt;  nucesfiary  to  relieve  teoBloDf  the  im* 
proyemciit  which  follows  ia  not  always  temporary. 

Baetholow  calls  attention  to  the  value  of  chloride  of 
gold,  gr.  1-24  ter  in  die,  in  gruiiular  and  fibruid  kidney  uud  de- 
pumtJve  disease. 

Da  Costa,  for  an  acuUt  ca^  following  scurlatina,  orders  the 
following: 

B     PiiIt.  iiiMuc.  romp, gr.  ijj 

Potiu.  nilraU, gr.  t 

M.    8. — ^Tak«  at  bcdiiiDBi 

B     Liq.  aniinon.  ocelaL, f  3  iij 

S(i.  »lli.  nltruiL, nj  is 

Syr,  tnlii., nu  Txxvii 

Tr.  cliiciulV-  ■  • ' •  ^  >ij 

M.    &— TLrice  dailj. 

For  chronic  cases :  • 

9    Trkfeiri  chlor, ffn 

Acid. »c«tid,.  f3> 

M.  el  adde: 

Liq.  ftinnon.  aeet., ff  r 

CiiriirofT, f|  y 

U.    S.— fSj,  llim-ediiily. 

S.  Weiu  MiTCHEti  calls  special  attt>ntion  to  the  importance 
of  the  milk  diet  in  chronic:  forms  of  Briglit'w  disease.  TAnsisa 
relies  on  it  exclusively  in  that  fonn  which  occurs  in  pr^nancy. 

The  following  nileH  are  to  he  ohserveil  t 

1.  Tl»e  diet  roust  be  exdusiveli/  milk. 

2.  It  may  Ije  nsed  in  the  form  of  skimmed  millc,  buttermilk, 
jMpsinized  milk,  or  in  some  cases,  koumiss. 


BBOKCDITIS,  ACtTTB. 


68 


™1 


5.  It  should  be  taken  overy  four  houre,  not  cold,  in  quantitioi 
lug  from  huU  a  gloai  up  tx)  a  pint,  iiccordiiig  to  the  npp«tit«. 
4.  It  should  bo  eaten  very  glowly  ;  each  portion  being  minglod 

in  the  mouth  with  8aliv&. 

6.  It  should  be  continued  until  all  traoce  of  ulbamen  have 
dieappcarcd  from  tlie  uritie. 

6.  Fruits  may  then  be  added  to  the  diet,  for  one  month; 
'hen,  if  albiiinen  be  Ktil)  ali^ient,  fariitaoea  may  also  be  ullowod. 
Af\er  another  month  of  froc^Dm  from  all  evidence  of  the  disuse, 
meat  may  Ix*  cautiounly  given,  but  on  the  reupiiearanoe  of  albu- 
men, meat  must  at  once  be  withdrawn.  This  treatment  is  beet 
suited  t()(!aMa  occurring  with  jiregiiancy  or  subetequent  tn  it.  One 
saah  cue,  in  which  ooovuUionB  had  occurred  during  labor,  and 
nremicKvniptoini)  with  albuminuria  and  fatfyca^U  were  prawn  t  for 
many  months  subsequently,  recovered  under  the  milk  diet.  The 
treatment  lasted  ncvcn  months.  The  lady  has  rcnuiincd  wttll  for 
eight  years,  and  ha^  t>nme  several  children  in  tliat  time.  Ex[H>sara 
lo  a  cold  wind,  however,  la  sure  to  bring  on  a  headache.  In  fact, 
anything  which  tends  to  incrcowe  the  work  of  the  kidneys  beyond 
tlteir  usual  taak,  suflit^s  to  cause  the  headache. 
(  For  the  dropHy  and  albumitiuria  occurring  during  pregnancy, 

I  nothing  has  in  our  liands  equalled  battermilk  in  uQlcieiicy,  a^  a 
J  diuretic.  We  ordar  two  quarts  daily,  as  a  beverage.  Next  to 
ij  this,  in  cases  where  it  can  not  be  obtained,  or  docs  not  agree,  the 
^ftdlowing  will  be  found  reliable; 

^^^  B    AdH.  bcfiBoin, 5w 

^^^^B  Ctalorafonni, fjn 

^^^P  PotM-Wftlt, Sj 

^^^^  Aqam,q.  t.*d, f  3  »j 

^H  In  the  treatment  of  conTulsions,  morphine,  the  dread  of  our 
"    fethora,  ia  pushing  chloroform  aside.    Filocarpin  is   replacing 

bleeding  and  hydmgogucs,  for  caAcs  where  a  speedy  effect  is  necea- 

ntftted  by  alarming  sycnptoms. 


BRONCHlTIS-(AcuTE.) 

The  patient  nhould  bo  contined  to  one  room,  and  if  the  case 
aevore,  should  be  put  to  bed. 


64 


MAKVAL  OP  TBBATHBKT. 


The  tomperature  should  he  kept  constantly  between  60°  and 
65**.  The  oir  should  he  moisteiifJ  lj;y  stt^m,  which  Hhoiild  be 
frequently  inhjUwl  \iy  the  patient  for  ten  or  fitteon  minntee  at  A 
time.  When  the  room  U  hejited  hy  tttcivea  or  li.y  u  furniiee,  a  wot 
towel  fihaiild  be  huii^  near  the  wmrce  of  heat  (in  front  of  the  ro- 
ister or  etove),  with  the  lower  end  dipping  into  u  biwiii  of  water. 
The  patient  should  drink  plenty  of  wnrni  drinkfi.  snch  as  ginger 
tea.  lie  should  not  be  put  into  u  cold  bed,  or  itlecp  In  a  oold 
room.  The  ehcst  may  be  rubbed  with  tho  linimentum  ammoniEe 
oftheU.S.  r. 

With  ibid  the  tnMtitumt  ends,  in  vaMe»  of  tinlinary  neverity. 
Before  going  out  the  [lalient  should  Imve  sevei-al  sjjonge  baths  of 
lukewarm  water  witli  a  little  vinegar  added.  If  Uie  congb  b« 
severe  we  may  s^ve  small  dose-s  of  mOTpbine,  ,1,  to  \  jrr.  every  two 
to  four  hour?!.  If  them  hv  much  soreiu's^  and  irritability  of  tba 
trachea,  bromide  of  potasb,  gr.  x,  and  cyanide  of  potash,  gr.  i 
may  be  adiled  t^  fuch  do»e, 

For  niodemte  fever  wo  may  g'lvo  citTO-te  of  potash,  ^r.  x 
every  hour;  or  if  the  fever  l>e  iiniisuiilly  sovi're,  we  add  to  thin 
tartar  emetic,  gr.  i^  to  i.  We  bavo  never  been  able  to  aatisfy  oar- 
bqIvcs  that  the  expoctomnts  wen-  of  any  n»e  whatever  in  ncnte  bron- 
cbititk  The  hygienic  mariagemeut  detailed  above,  espeeially  the 
inhalation  of  Hl«am,  snffices  in  most  cases.  The  diet  uhoiild  bo 
mainly  of  hot  soups,  tea,  cotFee  or  cocoa,  with  light  farinaceous 
Bubstance.s.  In  aged  ])entonK  alCohol  in  any  desired  form  ithnuld 
be  used  from  the  start.  The  food  should  be  rich  and  easily 
digested,  oyster,  iK^ef,  or  chicken  Honp,  tnilk,  soft-lKiiled  eggK  and 
^^^  milk  toast.  Antimony  and  all  other  depressants  must  be  watched 
^^m  carefully;  tliough  there  are  amci  in  which  they  arc  roquiaite. 
^H  The  frequency  aiid  force  of  the  respiration  should  be  noted  at 
^^        every  visit, 

I  In  young   infants,  ipecac  should  replace    nutimony.    An 

I  emetio  should  l>e  given  every  night  before  retiring,  in  order  to 

^^L  clear  the  lungs  and  give  the  child  a  chance  to  rest.  Feeble  infanta 
^H  whose  bronchial  mueouH  membrane«  are  not  much  irritated,  and 
^H  whose  cough  is  insufficient  to  clear  them  of  mucoB,  are  not  in&o- 
^H  qacntly  smothered  while  asleep,  fur  want  of  tills  evening  emetio. 
^^^        Morphine  is  a  dangerous  remedy  for  the  very  yomig,  as  for  the 


bkohchitib;  acotb. 


66 


wry  old.  So  macb  the  more  Rhould  the  hygienic  regimen  be 
carried  out  in  their  cane,  since  our  chief  reliance  must  be  plaoed 
upon  it.  Whenever  the  Htrength  hHows  Ktgnw  of  fuilure,  recoone 
should  be  had  to  cod-Uver  oil  with  lime,  hot  salt  baths,  and 
brandy. 

WjiTBUfi  recommends  the  rtereotypeil  Tnereurial  followed  by 
a.  nlioe  in  the  beginning.  He  give^  ipecac  in  the  first  atage, 
with  diaphorcttce,  bat  when  secretion  in  entabliahed  HobittitateB 
ammonia  and  other  stimulants.  For  the  cough  he  givG«  chlond 
with  ox_vmel  of  8(|uillt».  Thin  also  alliiyn  any  Kpa«m  of  the  linm- 
cbial  tube*  which  exists,  and  procures  sleep.  Alcohol  should  bo 
ppon  after  the  6rst  stage,  to  incren«e  exjiectomtion  and  prevent 
apncpa.  Thi*.  with  carbonate  of  ammonia,  forms  our  main  reliance 
in  the  aged.  Threatened  apniwi  hiu*  bven  averted  by  large  dnwa 
of  tnrpentine. 

Gonty  brouchiti<i  n*quirea  colehlcum.  BronchiiiH  with  dii> 
ease  of  the  mitral  valve  is  benefited  by  digitalis. 

RiBOBL  wiwiy  calls  attention  to  the  impnrtnnoe  of  avoiding 
the  causes  of  bronchitis;  such  a^  breiitliing'  nir  loiule«l  with  Hmoke, 
doflt,  and  other  irritants.  The  use  of  respiratora  by  those  whose 
occupationii  compel  thnm  to  breathe  iiiipiin>  air  should  be  enrour* 
aged.  The  best  respirator  h  a  flat  sponge,  which  <^-an  bo  moistened 
and  fastened  over  ttie  inoiitli  and  none.  An  incredible  amount  of 
dust  U  intercepted  by  this  contrivance.  "We  have  >>eon  assured  by 
workmen  that  ^ometiaies  the  Kpnnge  nin^t  be  wiu>hed  out  every 
fifteen  minute»;  the  dust  hindering  re^ipi ration. 

Children  Mhould  be  toughened  by  cold  wadhing.  douching, 
rubbing  aod  the  like.  Buch  methods  are  not  suitable  to  feeble 
children  during  their  first  year.  Here  we  should  improve  nutri- 
tioD  and  protect  fnim  catching  rnld.  Hot  i^It  liatbs  and  ctxldiver 
oil  with  lime  play  a  very  im|M>rtaiit  part  in  this  etrenglheuiug 
ptocem.  In  Hummcr  the  child  should  W  cxjHihcd  to  the  rca  air 
and  the  direct  rays  of  the  sun.  As  it  grows  stronger,  cold  baths 
should  be  gradually  subHiittLtcd  ;' beginning  with  tepid  sponging 
and  ending  with  cold  douche.  The  latter  ehould  never  he  pro- 
lunged;  the  child  being  simply  cxpcM-d  to  (he  cold  water  a  moment, 
and  then  nibbed  vigorously  with  towels,  until  the  skin  is  in  a  fine 


«6 


MAStTAL  OF  TRBATMENT. 


glow.  In  older  childrGn  or  adult*,  ooarse  crash  towels  should  be 
need,  whicli  have  beini  dipjied  inlo  stmng  brino  ami  dried,  lenving 
the  salt  in  the  meshes.  The  aged  must  he  oarol'ullj  protected 
againot  catching  cold. 

In  those  who  are  so  predisposed  to  colds  that  all  precantiona 
are  iniavailing,  a  [>ermaneiit  renidence  in  a.  wanxi  cUmittc,  at 
during  the  winter  months,  should  be  recommended. 

Ill  severe  cases  with  high  fever  RrsosL  used  cold  hatha 
bulkjr  doses  of  nuinhie. 

Tlie  best  emetic  is  apontorpMa  in  doses  of  ^  to  |  gr. 

When  the  secrt^tion  has  become  loose,  senega,  ammonia, 
and  inhalations  of  soda,  tannin,  or  lime-water  are  useful. 

Threatened  collapse  demands  wine,  nmsk, ether,  benzoic  acid, 
and  especially  camphor. 

In  young  c-hildren  it  JH  wise  to  clianj^  the  posture  ooca- 
Bionally,  to  prevent  hypoetasis.  Sometimes  it  is  ueceaaary  to  use 
cold  (louch(w,  to  induce  the  child  to  tako  free  inspirations  and 
free  tho  tubes  from  mucus.  Cold  packs,  hatha,  and  quinine  arc 
used  lor  fever. 

Exficctoraiits  are  useless,  uarcotica  unsafe. 

Looms  thinks  that  at  the  out«ct  the  attack  may  be  arrested 
by  a  Dover's  or  Tully's  jiowdcr  and  a  wann  bath  at  night, 
followed  by  a  brisk  saline  purgative  or  a  dose  of  castor  oil  in 
the  morning.  Quinine  or  salicylic  acid,  in  scruple  doae«  olloti 
aborts  an  attack  in  adulla. 

If  the  dineiiBC  »how  a  tendency  to  become  chronic,  or  to 
extend  to  the  smaller  tubeti,  ten  grain-s  of  i^uinine  sboold  be 
given  ;  or  in  childR-n,  cod-liver  oil  with  lime 

A  succession  of  email  blisters  to  the  jiosterior  portion  of  the 
chest  will  be  of  eervice  after  the  acute  stage  is  past. 

Davis  recommends  in  the  first  stage  in  acute  and  severe  caaee, 
in  robust  persons,  bleeding  by  the  arm,  leeching  or  dry  cup- 
ping, according  to  tlic  age  and  severity  of  the  attack.  After 
the«e  measures,  or  without  them,  he  envelope*  the  chest  in  hot 
poultices  or  compresses,  mid  gi%'ea  internally— 

0     Liq,  ammoa.  icttaL, Q  \i 

Tr.  ojiii  <:ainph., 1%  ^ 


I 


bronchitis;  acptb. 


67 


Via  uHimanil, fj  m 

Tr.  vcraL  vlrid^ f  SJm 

M.    fiu^rs  i,  ctery  two  to  four  koiin. 

For  a  coated  tongue,  constipation  and  high-colored,  scanty 
tuine  h«  g^rea  a  small  dose  of  oalomel  followed  by  a  BaUu«. 
As  eooQ  a^  tbt-  Hccnition  becomed  looee  he  g'iv<v — 

a    8jT.  «nll»  (OTip, f5j« 

TV.  BDitulDaifae^ ■•■■•kfS* 

Tr.  opii  csmph f  |  U 

U.    8. — f  5  Ji  f^trr  lhr««  haun,  in  a  litlJ«  wktcr. 

Sore  pain  !ii  the  head,  aggravated  by  coughing,  or  Dcrvous 
fCfiUefBiHaB,  calls  for  the  addition  of  half  nu  ounce  of  biomldo  Of 
potash  to  the  above.  If  the  tcm|)«ratiire  rises  tnvrardB  evening, 
and  the  eough  interferes  with  sleep,  with  early  rooming  sweating, 

Lhe  gives — 
S     Qnioiiuo  lulph., gr-  x. 
Pultr  «B(p)itwri*  Md*...  ,..■>..  ......  p.m 
_                              CodeiiiM , •  ■  - .  gr.  i 
■                K,   &— Tnke  at  btxltinie,  for  wr^ral  dif. 

CopioQB  muco-punileiit  expectoration,  with  deep  cough  aud 

weakness  are  bcAt  met.  by  the  following: 

H     8jr.  pnini  Virg^ 

SjT.  Mntip^ 

Tr.  opii  uAiph., U    t^} 

M.    R. — r  5  J,  mnrj  Iwir  to  lix  boun.    Add  lo  thia,  two  gruiw  of  quIbIds 
IhrMtiiDMadaj. 

When  naiuoa  and  vomiting  attend  the  parosysraa  of  cough- 
ing, he  orders — 

%     .Kcii..  cArboUcq gr.  vi^ 

Otfceiiiw. fjj 

Tr.  opii  mmph., 

AqoK, U     rj  ij 

it.    8.— f5ii  before  each  omI,  and  ai  b«<ltliue.     Oxiiitie,  gr. )  mf  be 
addad  t«  tht  «T«niag  doM  if  tttccamr  to  procure  alccp. 

In  acute  rheuniatit!  bronchitis: 

B     8odii  (a)ii.7Ut.,. 5  vj 

Uljrtvritw, fS  iv 

Vin.  cole  hud  rad, f  5  U 

ISjrr.  idllie  rampt, f]  Im 

Tr.  opii  amjili., fj  U 

H.    Si. — f  3  i,  ty*rj  llirw  hoiini,  in  ■  Utile  water. 


68  SfA^fUAL    OF  TftBATMEHT. 

'Wlen  the  ilineaiie  occurs  in  old  pereons,  with  severe  paroxynna 
of  coughing,  and  Bcanty,  vi&cid  sputa,  he  advieea  the  carbonate  of 
ammonia  or  Hoda,  gr.  v,  in  a  drachm  of  a  mixture  of  equal  parts 
of  fluid  extract  of  phytolatx-a,  Uq.  ammoii.  acetatl«,  and  paregoric. 
In  the  beginning,  a  dow  of  pilocarpin  followed  by  a  warm  bath 
and  quinine  will  often  break  up  the  attack. 

T.  T.  RoBBBTS  eaya  that  a  Turkish  bath  will  often  break  up 
an  attack. 

Baetholow  recommends  musoarine  in  doses  of  gr.  J,  every 
three  houn>,  to  breitk  up  the  attack  ;  a^  tJiia  agent  produces  con> 
traction  of  the  pulmonarj-  capillaries. 


CITRONIC  BRONCIITTIS.— It  is  of  the  first  importance  to 
conMider  the  general  condition  of  the  patient. 

Improvement  is  usually  manifested  at  onoe,  upon  confining 
the  patient  to  a  properly  heated  room,  with  the  air  moiatenwl  by 
steam.  We  may  advantageously  add  Huch  agents  to  the  steam  aa 
arc  indicates!  by  the  nature  of  the  cage.  Dry  catarrh  is  lienefited 
by  alkaline  inhalations,  of  soda  or  lime. 

Bronchorrhotia  demands  benzoin,  eucalyptol,  oil  of  o^eput, 
hydmetis,  or  oil  of  turpentine. 

In  gencrul  a  «upportlng  treatment  is  dcmamliHl ;  with  rich 
diet,  «)d-liver  oil,  tonics,  and  alcohol. 

Syphilis,  scrofula,  rickets,  the  paludal,  mercurial  or  Katumtne 
cacbexiffi,  rheumatifitn,  etc.,  require  each  their  own  proper 
treatment. 

Plethoric  men,  of  sedentary  habits,  arc  apt  to  sufter  with  this 
disease  after  passing  the  fortieth  year.  Sach  cases,  bosidcs  the 
nocoBsnry  change  in  their  habita,  are  greatly  benefited  hy  the 
saline  alkaline  waters ;  uucb  as  those  of  Ktstmngen  or  CarlBbad. 
Any  of  the  corresponding  American  waters  may  bo  used,  except 
those  which  contain  iron,  which  to  these  peraonti  is  dangerous. 

Watebs  recommends  digitalis  aud  iron  in  cases  complicated 

with  mitral  diacose. 

Serioufl  wasting  calls  for  cod-li  ver  oil ;  bronchorrbcea  for  tonics ; 
dry  catarrh  for  alkalies,  iodides,  aud  alkaline  waters. 


I 

i 


SHOIfCHlTIS ;  CHROKia 


69 


A  relAxed  insensitive  mucous  merabrene  needs  aenegft,  car- 
bonate of  AmmnniA,  etc.  A  dry  and  irntAl>lo  tmohou,  with  much 
WD^h,  calls  for  opinm,  chloml,  henbane,  or  hydrocyanic  acid; 
while  if  the  epasroodic  element  bo  prominent,  gtramonium  i»  pro- 
ferre«i,  or  lobelia,  ether,  or  hemji.  Ketid  expecttiratioii  iti  removed 
by  the  iuhalation  of  iodine  or  creaaota, 

RiBORL  recommt-ndit  in  dry  catarrh,  inhalation  of  compreeaed 
and  rarified  air  alternately. 

For  brotichorrhcca,  he  follows  yiEMBTBB  in  recommendiiig 
tliv  balsams,  oopaiba.  myrrh,  turpentine,  ammonia,  carbolic  acid, 
and  capecially  the  mist,  forri  compi. 

GsKDARD  recommends  mechanical  comprcsjion  of  the  cheat 
for  relaxation  of  the  bronchial  membrane. 

HiEORL  nddg  that  dangerous  engorgement  of  the  lung^  may 
D«ca»itate  venesectton. 

LoOMts  rw-tuunifiicU  a  long  wa  voyage  for  cnsee  attended  with 
enuiCLation.  lie  also  rcconimendd  the  nK*derate  cue  of  Rtimulanta, 
aa  a  rule.  CaM»  alternating  with  akin  afiections  yield  to  arsenic 
and  sulphate  n(  zinc. 

"Kfir  broiifhorrhiMi,  inhalation*  of  tar,  creosote,  copaiba, 
naphtha,  iodine,  ammouinm  chloride  and  the  balsams  are 
UHcfut.  Tlie  same  drugH  may  be  given  internally.  For  adhesive 
scanty  sputa  he  ukcs  nenega,  serpentaria,  camphor,  benzoin,  and 
the  alkalicii.  potash  and  soda. 

Irritability  of  the  muconn  membrane  with  scanty  secrution 
and  violent  paroxysmal  cioiigh  indicates  full  dosee  of  opitUD, 
hydmcyanic  a<-id,  liynAcyaninn,  iielliulonna  and  (x>ni»m. 

For  bronchial  8pai>m  inliale  a  little  ether  or  chloroform  j  or, 
if  lhit  rt|«HnH><H<-  rlcmctit  hi-  very  niarki^l,  give  the  nan^jtica  juat 
iuentione<l.    Cannabis  Indica  does  well  in  the.4e  casea. 

In  all  fonnsof  chrontr  bronrhititt  louiliziil  irritation  over  the 
disease  centers  may  lie  eniployctl  with  benefit,  using  cups,  blis- 
tera,  tiinapisms,  croton  oil  or  tur|H:utino. 

Davis  advii«es  the  same  line  of  treatment  a«  in  acute  cauetj 
tuuDg  tlic  some  fonnulee  as  indicated,    lie  disapproves  of  the  uM 


J 


70 


MAK17AL  OP  TRBA7HEHT. 


of  alcohol  ill  aiij  form.  He  nientionA  amotij;;  reinetliw  of  impor- 
tance, the  iodides,  grindelia  rob.,  eiicalyphitf,  (unotheni  biennis, 
cimtcifuga,  aaclepiaa  taberoaa,  tiie  hy|jophoi>phitc8,  etc.  For  liawih 
cough,  fwanty  expectoration  luid  dry  nllw  he  iiaft*  sal  nmnmniae, 
iodide  of  amnioniuiii,  sodium  or  potaeeium,  witli  aiitiniotiy  and 
aiiodyrien.  For  Bhundant  iiiueo-piirnlent  expe<!tonitirm,  he  adviitm 
the  balinanis,  etc.,  and  euch  tonies  as  koto-phoephatc  of  lime, 
phosphate  of  iron,  ipiinine  or  Blrychnia,  with  codeine,  hyot*- 
cyajnia  or  luputiu  at  night.  In  some  cases  good  efiects  are 
obtained  fiY)tn  the  fidlowing: 

IJ     S,»r.o«ldi  lodid^ f  5  y 

KsUiiumulifi., ..■>• f3j 

ii.    8j—t^  j  four  lime*  cUilj. 

Inhalations  are  most  uwful  for  laryngotrac^heal  ratarrbs.  biit 
are  leaa  beneficial  in  pure  bronchitis.  For  bronchorrbcea,  one  of 
the  be«t  combinationH  in  the  following: 

B     Acidi  cai-bolicl, , gr.  xxx 

Tinct.  opii  ouuph., fj  ilj 

H*    S. — K  teMpoonful  is  to  b«  put  in  ad  inliitkr  vitli  eight  outwca  of  kvt 
wfttfT,  Aai  Iktf  TBpor  to  Ut  inliilvcl  for  &m  miniHw  al  ■  lime,  thriw  timet  a  dtj. 

A  harsh,  dry  congh,  with  little  or  no  8puta,  is  relieved  by 
lidding  to  1h(!  alKtve  prudcription  a  draehrn  of  oil  of  BiTOtch  pina 

An  important  class  of  cases  is  met  in  young  persons  between 
twelve  and  twenty  years  of  age,  with  ill-devcUiptMl  fhe«t*(,  who 
contraet  catarrhs  most  readily,  and  in  whom  snch  afiections  tend, 
to  iHttrome  chronic,  rcHultiiig  in  intcretitial  pticumonia  or  fibroid 
phthisifi.  In  the  earlier  stages,  the  daily  habit  of  fwll  inspira- 
tions, with  exercise  of  the  arm  and  chest  nuiwles,  will  do  more 
good  than  medicinee.  The  Inbalatitm  of  compreaoed  air,  for  fire 
or  ten  minutes,  once  or  twice  daily,  produeea  marked  and  rapid 
iraprovoinetit  in  the  symptomfland  physiii»e.  Tti  he  [(omiaiient, 
this  must  bo  continued  for  many  mouths,  and  the  personal 
hygiene  miiet  at»o  be  Btrictly  regulated.  Such  i>crsoiie  should 
spend  the  winter  season  in  Southern  California,  New  Mexico, 
Wc«tem  Tcxai!,  Mobile,  Aiken,  8.  C,  or  the  interior  of  Qeorgia 
or  Florida. 

In  cases  wboro  scroftUa  or  other  cachexia,  or  general  innutri- 
tion, renders  sea  airadviaable,  the  Bermudas  otler  a  suitable  resort. 


4 
I 


M 


BBOSCEITlfi;  CnBONIC.  71 

CuK  should  be  takoo  to  avoid  a  wet  aoil  or  a  dusty  atmoa- 
plere. 

Roberts  advisos  that  when  paticut^  uaniKjt  <pond  the  winter 
\a  a  euitablo  climate,  thc-y  ghall  wear  a  respirator  when  com- 
pelled to  leave  the  faouiie.  Thtt*  is  a  valuable  ^!i;:Lr< -^tion,  aa  it 
ecabtos  (hoso  persons  to  obtain  the  Wnefita  of  open  air  exerciw, 
without  exposing  their  Inngs  1o  the  injuriom  ctTcct^  of  c-olJ.  The 
reepirator  may  be  medicated  with  any  substance  Buited  to  the 
ooudition  of  the  ]ung». 

Ho  al»o  advises  that  the  che^it  be  covered  with  cotton  or  wooK 
Other  articles  used  for  this  purpose  ore  oakum,  the  ordinaiy 
cbe«t  protectors,  and  shields  made  of  unwaahed  wool  Now  tliat 
we  have  Ifltinlin^  the  ordinary  wool  can  be  saturated  with  this 
aabstance-  ^\'hile  these  may  have  their  use,  it  is  certain  tliat 
wheii  they  liave  once  been  donncil  they  cannot  be  laid  aaide  for 
even  a  day,  without  espoeing  the  wearer  to  the  risk  of  an  almoat 
inevitable  aeeei«  of  frenih  catarrh.  The  oakum  niay  W  of  spe- 
cial ntility  in  bronchorrhcce.  Fhuiuel  should  be  worn  the  year 
round,  except  in  the  hottoi^t  nioiittii),  when  n  thinner  woolen  gar- 
ment may  be  gubstitutwl.  AVoolen  Btockinys  are  of  even  greatwr 
importanoe.  When  compelled  to  face  a  oold  wind  on  a  winter 
day,  some  additioual  protection  is  utwful,  but  with  this  excep- 
tion, we  believe  tlie  whole  nice  of  chest  prolectoni  w  lULHchiuvous. 
Of  vastly  grt^ter  benefit  would  it  be  were  wo  to  rotum  to  the 
CQstom  of  the  aneientx,  anil  anoint  the  body  daily  witli  some 
animal  oil.  We  have  frequently  doue  this  in  the  case  of  delicate 
persons  who  were  of  netwmity  exiKim?d  to  coM.  The  following  ia 
an  excellent  formula  for  the  piu^ioee: 

B    OI-«nwriniii f  3 -rig 

OI.auu|>«li,. 11  m 

Ol-bnipinE, J^m 

Ja* 

Aia>KBWs,  of  Detroit,  recommends  nitrite  of  amyl  for  8|>aa- 
modic  symptomB.  lie  mak&t  the  valuiihle  nuggestion  tliat  while 
tome  cough  is  advii^ble,  an  ridding  the  tubes  of  mucus,  yet  as 
patients  will  usually  cough  mure  than  in  nec^^twury,  they  nhouM  Iw 
taught  to  rcfltralu  the  impulse. 


71  UAHUAL  or  TRXATKIHT. 

Kabioh,  of  Qlapgow,  obtained  good  reaulta  from: 

Q    Amnxmiact, 5  U 

Add.  mlric  diL, f5  (j 

Aqu*,. ..fl«y 

H.    8^-r|  j  ID  gruel,  ihric*  duljr. 

ThU  is  auitu1)le  for  bronchorrlicea. 
Da  Oosta  prescribed: 

B     A minoD.  murist., <■ $  U 

Mict.  ([lynrrrhii.  conip .*.. f|  Uj 

If.    a— f5ULhrice<taU7. 

NiEMBYER,  however,  Haid  of  the  above  preBcription, "  When 
One  realizes  that  it  forms  ono-lhird  of  tbc  prescriptions  put  up  in 
ft  Gorman  drug  store,  and  that  phyaieiana  not  only  order  it  for 
others,  but  devoutly  take  it  themselves,  it  is  difficult  to  realize 
that  it  can  have  no  other  effect  than  to  diuorder  the  digestion." 

Da  Costa  orders  the  following  to  promot«  expectoratioD : 

a    FotM.  chlanit.„ 5U 

Tinct.  KillB. I  m 

HlxL  gljcynb-coTOf^ fj  jja 

U.    B^-i5  0  rourtimeadiilf. 

Gbbenhow,  of  London,  says  that  when  the  flow  of  mucut 

Itii  iKconie  habttiiAl  and  profuse,  the  following  proves  aerriceable: 

B     Vin.  ipacBctuD., 

Acid.  Bitro-murkt.  diL ii     ^  Z 

Tinct.  hjoar^aroi VK  xi 

Tinct.  i^ntian.  Cftinpi^ fj  |j 

TIncl.  laricia  Kiirop„ ^  xx 

IL    6L — Takt  al  on«  dusr,  tlircc  (imM  k  da;. 

Parisbl,  of  Parin,  recommends  the  following  fonnula,  to  b« 
nscd  with  an  atomizer : 


K. 


B     PuW.  oinehon.  Hav., 

Bulphnr.  loti, ia    J  n 

Sjr.  alUiMt^  q.  a 


Watsok,  of  London,  preferred  sulphate  of  iron  in  broo- 
chorrhcoa. 

NiKMKTER  also  rcoommcnds  this  drug,  in  the  form  of  niiBt> 
fern.  oomp. 


BROXCBITIS;  CAPILLABT. 


78 


yorniBaiLL  furnishca  the  foUomng  excellent  fonnola : 

%    Bp.  cUoroibrati, m  xx 

Add.  b/drobroo.  dlL, fjH 

8rr.  .dll*, fjj 

Aqiue,Mlr fjj 

7L    BL^For  on*  doM,  IhrM  tlmM  «  iMj. 

A  lata  addition  to  our  list  of  remedies  is  jerba  santa. 
suited  to  broncIioirhcRa. 


It  IB 


Stillb,  in  ommentinfT  on  the  reported  ciuras  of  phthisis 
credited  to  cimidfuga,  romiirks  that  they  wore  probably  c&ec^  of 
chronic  btoncbitia.  Unfortunately  tlie  drag  has  not  appeared  In 
oor  hands  to  be  pcaeeawd  of  much  (curative  power  in  bronchitis, 
though  it  Bometimes  proves  useful  iu  aged  jM^rMtid  and  in  those 
irhoee  circulation  is  weak. 

The  action  of  muscarine  in  contmcting  the  capillariw  ahoald 
wnder  it  pffit'iont  in  rDlaxntion  of  the  hronohial  mucous  mcnibnmea. 
FetToleum  in  pills,  has  also  been  advocated  lately. 

CHxRRnra,  in   Th  Medical  World,  Jan.,  18S6,  contnbuios  the 
£}llowing: 
B     EsLuekpiU.tubero.IL,.. 
Hzt.rruiuViTK.a^ u  nj 
I                                   OljrariDK, r?  U 
H.    S. — 5  j  ««ei7  i  to  roar  hcnn,  as  seedM  fbrmxigh. 
In  some  cases  he  substitutes  the  fluid  extract  nurrublam 
Tulg.  for  the  asclcpias. 

The  inhalation  of  oil  of  turpentine,  ouoalyptol  or  carbolic 
acid  corrects  the  fetor  of  the  cMitents,  and  Biiniulat^s  the  mucous 
membrane  to  cast  thom  out.  Whether  any  diminution  of  the 
Cttvity  rcanlts,  or  is  {MSHible,  la  questionable  at  least. 

It  is  certain  that  the  above  named  agents  give  great  relief. 


BRONCHITIS.— Capillakv. 

In  old  age  and  in  inlancy  this  is  one  of  tlic  mOHt  dan^rous of 
diseases.  Not  only  is  it  grave  in  it«]f,  but  the  fatal  Kymptoma 
come  in  eo  treacherous  a  fashion,  that  the  intieut  has  oftea  passed 


MANUAL  OF  TRSATMEKT. 


by  imperceptible  degwee  bej'oud  tho  rencU  of  help,  before  the 
gravity  of  the  caee  has  been  reeogimed. 

LoH>Mi.s  liilvcs  strung  ground  (iguiiii^t  tbe  ukc  of  (IcprcsaanU ; 
whieii,  be  rM^'i*,  lesaeii  or  destroy  the  cbauces  of  recovery.  Ho 
semis  the  i^mtieiit  to  bed,  c^ovora  him  with  flaniicl^  kt-ei)^  tbe  t«m* 
perature  of  tbu  room  nt  75°  to  80°  F.,  and  moislecs  the  air  with 
Bt«ain.  Children  ii;bi>iild  t>e  {ilaficd  in  llic  steam  tent  as  m  croup. 
The  cheat  is  dry-cupped  and  then  covered  with  an  oiled  aiUc 
jacket.  Tlio  inhiil:itit>tt  of  Btoam  ufiially  rclicvce  the  symptoms. 
Oxygen  iiilialutt'>nn  relii^ve  llie  lyanufia.  Chlorate  of  potaeh  or 
mnriate  of  ammonia,  gr.  x  to  ad  adult,  gr.  i^j  to  a  child  two 
years  old.  often  seems  to  control  the  cliscaiw.  WJieo  ateleetadia  la 
threatened,  the  iodides  arc  beneficial. 

Sometimes,  when  suftoe-atiou  threatens  and  the  cough  ia  in- 
sufficient to  clear  the  tubes  of  mucu*,  emetics  »re  of  servico. 
They  must  not  be  repeaU-d  too  fi-oquently. 

WTieu  debility  boeomes  raiinifejit,  quinine  and  stinuilante 
are  indicated.  The  latter  nbould  be  given  ejirly,  and  in  amouuta 
BUffieiont  tit  dissipntc  tlie  sijinn  of  eshaugtion.  For  the  dyspniBa, 
full  doses  of  hydrocyanic  acid  may  l>u  given. 

Oceurriiig  with  Bright's  dieeoeo,  tho  patient  ehould  be  given 
the  largcAt  amount  of  nutriinent  he  ean  Lake. 

Davis  say*  that  when  the  lobules  are  invaded,  aa  indicate*!  by 
undue  fever,  dilutioiL  of  the  alic  niu^i  during  in:4piration,  short  ex- 
piration, and  diniiniriheil  resonaiic-e,  with  fine  crepitation  over 
limited  portions  of  the  cheat,  certain  and  speedy  relief  will  follow 
the  application  of  a  blister  and  the  use  of  the  following : 

Q     AmmuD.  cbl^rid, 3  i>j 

AntiHioD.  rt  ]>ol«ii.ttiit., , gr.  ij 

Morph.  Milpk.,.. gr.  i^ 

Kit.  gljtytrkiut, , fj  j 

^JTujil tliij 

M.    8. — f3  j  ID  wal«r  ciery  time  boiin,  tot  uititlu. 

In  young  children  he  diHupproren  of  emetics,  on  ac<.-ount  of 
tlie  prostration  induced ;  but  recommends  the  still  more  dnn°:crou8 
and  useltMH  application  of  leeidici* ;  which,  however,  he  limit^t  to  tlio 
very  begimtiug  of  the  disease,  aud  follows  by  poultices. 


BKoxcirms;  nBRiNoro. 


75 


BoBBBTS  aajnt  tliat  the  mujority  of  caeiw  damatid  stimuIaDt 
and  supporting  trcntmcDt  throughout. 

In  one  ciwk  (an  iiifajit  mix  weeks  old),  recovory  fullowud  the 
administrntion  of  alnm  in  ometic  doses,  and  iodide  of  ammon- 
ium, gr.  one^eighth,  every  four  hours.  In  aubuwjueiit  ca^wt  iheeo 
remedtffi  were  not  no  fortunate.  Carbonate  of  amnioiiiii  Huh  been 
Iiighly  recommended.  Our  caien  treated  with  thU  agt'ut  ehow  an 
anfarolran  wries  of  failureis. 

Oplat«a  should  be  used  witli  great  caution,  if  at  all,  in  this 
diMaw.  It  is  all  important  th»t  the  khiuII  tulM'^t  ttliouM  lie  kept 
open  for  the  pa^aagc  of  air  to  the  celU,  and  the  obtuadiug  influ- 
ence of  opium  &TorBtlie  accumulation  of  secrutiofla,  thus  favoring 
death  b>'  asphyxia.  It  is  belter  that  the  fatieiil  struggle  and 
tire,  rather  than  to  be  Aoothed  into  doiUi. 


BRONCHITIS— Fibrinous. 

Watbrs  eayfl  that  the  chief  object  i«  to  mifltnin  the  health, 
&nd  he  prescribes  tlie  entire  tonic  regimen.  Iodides  arc  ^id  to 
be  of  U9«.  In  exacerbationi*,  ammonia  and  inhalants  should  bo 
reftorttid  to, 

RiEOBL  preitcril>cH  emetics  to  remove  the  Hbriiioiu!  ma«tiM 
whim  lotweticrd.  Tliey  should  be  preceded  by  inbulutiona  of 
alkalies.  Alkaline  waters  are  at»o  uscfu!  to  prevent  recurrence 
of  tlie  exudatioiL  Any  existing  cntarrh  should  be  removed  if 
poi^ble. 

BlBMKR  reoommendn  on  enorgetiu  raertnirial  treatment. 

LoDMis  trvatd  the  oculo  fonu  as  he  does  croui)OUH  laryngitis. 

In  the  chronic  form  he  rei^rts  to  alkaline  steam  inlialations 
during  the  paroxysms..  In  the  interval  the  general  tonic  regimen 
eliouUi  l>e  injitituted.and  all  sourcM  of  bronchial  irritation  avoided. 
If  thcM  measures  prove  unavailing,  n  loug  sea  voyage  or  rcai- 
denee  in  a  warm  climate  should  b«  advib«d. 

Davis  gives  allcrati%'c  dooos  of  calomel  altcmntely  with  the 
mixture  containing  paregoric,  wlue  of  antimuny  and  veratrum, 
whifh  will  be  found  in  the  article  on  Acute  Bronchitis. 


76 


KASPAL  or  TaEATMIirT. 


RoBSRTS  ueee  inhalatinnn,  rubefacients,  or  a  blister  to  the 
cheat,  and  HedativcB  with  antimony  or  ipecnc. 

There  in  no  remedy  which  will  prevent  the  recurrence  of  the 
exadation.  Antimony,  iodidee,  alkalies,  mercury,  inhalationB  of 
iodine,  etc.,  have  failed. 

The  recent  remarkable  suoceiis  attending  the  treatment  of 
diphtheria  with  large  dosex  of  calomel  (gr.  i,  everj-  hoar),  leada 
OS  to  hope  that  the  same  agent  in  similar  doses  might  prove 
eq^oally  ueeiul  here. 


BRONCHIAL  GLANDS;  ENLARGEMENT  OF. 

QuAiN  says  that  many  ciucs  of  simple  chronic  enlargement 
yield  to  the  prolonj^ed  use  of  iodide  of  Iron,  witli  iodine  exter- 
nally, applied  between  the  shoulders. 

If  the  enlargement  be  traced  to  &  syphilitic  origin,  the  treat- 
ment of  that  cochi-xiu  will  pnivc  cflicuciuus. 

Tlio  cough  is  often  relieved  by  aiiod}'no  linimcuta,  etich  aa 
the  following : 

B     (^lorAfnmif, 

Tinct,  ctLinpliurw, , 

TincL  D|)ii 

Lin.  b«lUdi>nnN^ U    fJu 

M.    S. — f  5  Ij  to  bo  ft]Mr)nk1«)  on  ■ponnriapiKne  ttad  applied  to  tb«  eti«M  ! 
»  few  iiuuul«s  u  A  tliub 

Other  fiymptnnis  require  their  ortlinary  treatment 

It  U  necessary  in  all  ca«ee  to  improvo  the  general  health  by 
good  diet  and  pure  air,  and  by  promoting  digetntion  and  elimina- 
tion. 

When  we  reflect  how  intnictable  are  the  diseases  of  external 
glands,  we  cannot  hope  for  better  euceees  in  treating  tho»ie  which 
arc  beyond  the  reach  of  the  surgeon. 

Aa  a  mean*  of  prevention,  the  early  and  thorough  extirpa- 
tion of  enlarged  glands  which  can  be  a-uched,  such  a^  those  of 
the  neck,  should  be  udvooutod  and  |>ractieed. 

For  further  iutbrmAtion,  see  the  article  on  Scrofula. 


11:   BEKAU 


CALCULI:  RENAL 


n 


Only  the  medicinal  treatment  of  calculi  will  be  disciKwed 
here- 

Petit  found  that  Vichy  water  dissolves  the  uric  acid,  cystine 
and  xanlhic-  nxide  (ralt-'iili.  lie  dotails  the  ca«e  of  one  patient, 
who  drank  on  the  first  day  pevrn  gla««e«  nf  the  water  ;  the  Bwond 
day  fa«  diank  fifteen  glasses,  the  urine  th«o  becoming  alkaline. 
In  a  few  days  he  rear'hed  his  maximani  of  (wenty-four  glfwwes  per 
day.  AfttT  Hevent*.-*!!  daya'  treatment  he  passed  the  st^ine,  \vhich 
bore  traces  of  dissolution.  The  nevcre  symptoms  enbdided  daring 
the  first  week  of  treatment 

The  very  elaborate  cxporimenta  of  Roeerts,  however,  showed 
that  the  potash  salta  are  the  bcAt  eolvcnt«  for  uric  acid  calculi. 
He  obtained  the  best  rwults  from  the  administration  of  tho  ace- 
tate or  citrate  of  potash,  in  do««  of  forty  to  fifty  gniin«,  in  four 
ounces  of  water,  every  thrt-c  hours.  The  rcmwly  nctii  not  be  dis- 
continued if  the  urine  lieoome  turltid,  but  if  it  becoracH  amiiioni- 
acal  the  triple  phmphat«s  will  be  deposited  on  the  stone,  and  the 
solvent  action  will  cease. 


CotTLSoK  says  that  only  calculi  composed  of  uric  acid,  cystine, 
or  nPo«t«elilh  are  amenable  to  the  action  of  solvents  given  by 
the  mouth.  Oxalate  of  lime  rosists  any  solvent  which  can  be 
intHMlnoed  into  the  bladder  by  any  meanK,  and  the  phnspliate 
of  lime   and  ammoniaeo-nuignesian    phosphate  require  acid    by 

Even  for  the  removal  of  a  small  stone  the  urine  nitiat  bo  kept 
eonataiitly  alkaline  for  six  u'(>ekH  ;  niid  this,  with  t1)L-<liiir(<Hiii,  causes 
waste  of  tissue,  and  ilehility.  l.i»i-ger  stunert  arc  iHually  composed 
of  layeni;  i«eriiiip«  of  oxalate  of  lime,  which  is  not  afi'cctcd  by  any- 
thing; or  of  phosphates,  which  arc  only  afl'w-tcd  by  acids.  Kor 
any  chance  of  success  the  urine  must  be  acid,  the  stone  small,  and 
of  uric  Acid  alone;  and  auch  auea  urv  admirably  suited  to 
lilhotrity. 

In  the  cuiM>  of  renal  coneretions,  which  are  usually  of  uric 
acid,  the  alkaline  tmLtinent  is  indiuate<l,  I'ho^phatic  calculi  have 
U.«n  readily  di«u»olved  by  waohiitg  out  the  bladder  through  a 


MAMIAL   OF  TREATMENT. 


douIiI«  catheter,  with  a  snliition  of  tliluto  nitric  acid,  two  dnu-hms 
Ui  the  i>iat  of  water,  used  every  sect^iid  or  third  ilay.  When,  after 
lithotrity,  the  lemleiu-y  ti>  the  forirmtion  of  now  calculi  is  very 
gruat.  this  method  U  uBeful  after  the  ojieration. 

UosKiss,  of  GuemBoy,  miggo3tc<l  the  nso  of  lead  solutions  for 
phosphatie  oaleuli.  'Die  b1]uld(>r  in  woHhud  imt,  with,  tepid  water, 
through  n  double  soft  catheter,  and  four  to  ei);ht  otiDeeB  of  the 
lead  builutidii  introduced.  It  should  be  renewed  every  ton  niin- 
Qt«f.  Exercise  and  wnrnith  fuvnr  the  iiction.  The  uohitlon  is 
made  hy  dbMolving  a  grain  of  aceijite  of  lead  in  each  two  ounces 
of  distilled  tvater,  iind  adding  live  or  six  drops  of  acetic  acid,  to 
supef^ut-iduluta 

T«  prevent  tlic  formation  of  calculi,  CotrLsos  give*  the  follow- 
ing indications: 

1.  To  remove  the  diathe'^ia 

2.  To  jiruvcnt  c-ulculoutt  material  from  being  deiK>8it«<l. 
8.  To  keep  the  urine  diluted  and  to  flush  the  (lo^dagee^ 
"For  the  first  object  strict  attention  must  be  paid  to  the  diet, 

excntise  nnd  tlie  fiocretioua.  J''erl'oct  digeutiun  ojid  metamorphutiis 
are  required. 

In  uric  acid  ciUculus,  the  food  must  be  simple,  digestible  and 
moderate.  Uut  little  meat  niiiHt  lie  taken,  and  not  much  at  a 
time.  A  strictly  vegetable  diet  rendera  uric  acid  calculus  imiK)»> 
Bible;  but  too  much  vegetable  f«Mid  often  aiuscs  indigi«tion."  Tlie 
aim  should  he  to  come  as  near  to  &  vegetarian  diet  as  possible, 
with  the  aid  of  artificial  iligestimtJ*,  such  as  malt  extract.  Malt 
liquors  and  strong  wines  should  be  excluded.  Durgiindy,  hock 
or  cluret  may  he  allowed;  but  one  vnriety,  however,  at  one  time. 
If  stiniuUuto  be  requii'ed,  brandy  and  i^oda,  or  eH'ervosiing  lithia 
water,  will  answer.  Exerciw:  in  of  the  utmost  importance ;  it 
should  be  modemtc,  habitual,  not  violent,  and  with  long  rwttA. 

Tlie  necosMity  for  attending  in  the  secretiouB  and  exererionn 
ifl  obvious,  Flaunel  frictioim  and  an  octw^ional  Turkish  bath 
Iceep  thu  wkin  in  pni|X!r  t-tindition.  The  best  purgatives  are  the 
oholagogueB. 

The  second  indicotiou  is  best  met  by  alkalies.  I'otash  id 
better  than  soda;  soda  i-*  superior  to  Hthia ;  ammonia  is  ueelesa. 


I 


WLCCli:  UVSAL. 


WTien  the  oombiiuitioDa  of  potash  with  vegetable  aci<l8  are 
ivcn,  the  acid  \b  oxidized  into  carbonic  acid,  aud  tho  carbonated 
Ut  appears  or  such  in  the  urine.  In  this  fomi  it  prevents  the 
depoution  of  uric  acid,  but  does  not  affect  the  tiMnM,  and  so  caa 
be  given  \rith  impunity  a  long  time. 

Liquor  potass  does  not  render  tho  urioc  m  (quickly  alkaline, 
but  iwwcrfuUy  acta  on  the  tii*sueH,  oxidizing  protein  ffubetancea. 
It  v>  therefiire  UAefui  where  eemi-ofl'ct^  rabatancos  nccumalate  in 
the  blood,  and  i«  most  injiirioua  where  wiwte  h  already  excussive. 
The  bi«irl>oiiate  ia  imona«liato  in  ita  etfocta. 

Combining  theMe  indi(9tionH,  we  have  tlie  folloix'iug  plan: 

Blue  pill  gi*.  ^j.  with  tAmxiitMim,  and  [terhapn  comiK>umi 
rbnbarb  pill,  may  be  given  to  regulate  the  bowels  and  act  on  the 
secretions.  The  potaffli  salt  choncti  i»  administerpd  in  infu«ion  of 
columbo.  Quinine,  iron  and  stry-chnia  may  be  given  as  needed. 
Taraxacum  ii^  he^t  given  in  the  form  of  infuBion.  Coexisting 
dy«pcp»ia  with  debility  may  require  the  mineral  acids  for  a  short 
period.  They  do  not  greatly  increase  the  acidity  of  the  arine,  and 
will  not  cause  precipitation  of  one  acid,  while  by  their  influence 
on  the  digeetion  they  may  prevent  ita  formation.  For  this  pur- 
pOM  they  should  be  administered  before  meats. 

*'lf  patient*  with  uric  acid  gravel  are  in  otherwi-«  good 
health,  all  that  U  nccclcd  U  attention  to  diet,  plenty  of  water  and 
Citrate  of  potash." 

In  oxulat«  of  lime  calculus,  Roberts  found  that  the  u:*e  of 
mineral  acids  prevents  tbo  de|ioMitioii  of  the  limo  salt.  The 
adniiniatratioii  of  lime-water  will  cauc«  crj'tttals  of  oxalate  to 
ap]jcnr  in  urine  previonsly  free  fnim  them;  huiiirc,  lime  shuald  be 
excluded  from  the  drink.  The  mineral  acidi*.  have  a  belter  claim 
on  us,  fn>in  the  fiwl  that  tlicy  uxi^rt  a  lMittotit:iul  inrtuentre  on  the 
peculiar  dysj^psia  of  osaluria.  The  exceae  of  urea  which  eo-ex- 
ists,  iiidiiraliiig  waste  of  food  or  tiseue,  atfordit  another  guide  in 
treating  thcr«e  caes. 

All  known  cau^C0  of  tmduo  wa^to  must  be  avoidd.  RuMt 
and  change  are  powerful  remedies.  The  fo<Ki  mui*t  be  nourii^hing, 
but  limited  in  amount.  Sugar  should  be  u^cd  but  little,  or  not  at 
all.    Acid  dyspe|)sia  must  be  avoided. 

The  akin  muat  be  kept  in  proper  oonditiun. 


80 


UAirUAL  OF  TRBATMBifT. 


GoLOiHO  BiBD  rcooniniends  for  the  dyapepeia  oitro-niiulatic 
acid  in  infusion  of  columbo.  Bismuth  or  alkaiirai  with  ummODiA 
are  aomctimes  useful.  Small  dwea  of  mercurial  pill  with  taraxft* 
cum  are  as  beneficial  here  aa  in  uric  acid  gravel.  Wlieii  the  dig«»> 
tion  and  licalth  am  improving  the  deposit  of  oxalate  diminiahea. 
When  this  salt  appears  in  octahedra  it  need  excite  tio  uncaaiiiMB, 
but  when  the  dumb-bell  form  is  scon,  every  measure  in  our  power 
■hould  be  used ;  a&  this  form  occurs  in  the  uriniferous  tubu[«a. 
Tho  kiduc^'8  (<hould  be  flushed  occasionally  by  drinking  largft 
quantities  of  lime-free  water,  on  an  empty  stomach. 

The  pftTOc  stringent  rules  should  be  adopted  whenever  a 
calculus  cxi»t€,  as  it  would  grow  larger  under  conditions  which 
would  not  cause  it  anew. 

Phosphatic  cak'uli  are  formed  in  ammoniacal  urine.  The 
indication  is  to  empty  the  bladder  and  wash  it  out  twice  a  day 
with  warm  water,  perhaps  acidulated  with  nitric  acid-  Renic 
colic  colls  for  the  umi  of  diluents,  biitlis,  morphine  hypodermioB, 
and  chloroform  inbalations. 

When  a  wdculus  lia^i  formed,  we  use  large  ((uantitiea  of 
liqiiidn,  with  tbe  alkuliei^,  etc.  Juniper  and  \te  confreres  Blioutd 
bo  avoided.  The  nrine  should  he  retained  as  long  as  posaible,  to 
distend  the  urinary  organs.  "Warm  hatha  favor  relaxation  and 
dlBlotlgcmont  of  the  ntone;  as  alno  do  moi'ementti,  riding,  etc 

Stricture*  of  the  urethra  should  be  dilate«^l  rapidly.  If  the 
calculus  have  jiasseil  to  the  bladder,  it  mu.tt  Iw  watclie*!  for ;  and 
if  It  ahould  not  appear  in  a  few  days,  surgical  measures  should 
he  aih)]»t«il.  S<iniL'tiiiu«  it  may  l«?  washwl  out  by  u^ing  an  aspi- 
rator aud  a  full  sized  injecting  catheter." 


I 

I 

I 
I 

i 


1 


CANCRUM    ORIS. 


There  is  much  confusiou  in  the  nomenclature  of  the  diseases 
of  the  mouth.  Some  authora  use  this  teriii  to  deisignate  thrush, 
others  diphtheria  of  tho  moiitli,  and  atill  others  as  gynionymouB 
with  noma,  nr  gangrene.  We  t<hall  follow  the  nomenclature  of 
Niemeyer, and  describe  under  this  head  the  treatmeiitof  ulcerative 
or  diphtheritic  slomatitiii. 


CAMCRUH  ORIS. 


81 


LMMte  recomnierulK  chlorate  of  potaah  »»  a  mouth-wash 
and  internally.  If  the  iikfration  spreads,  nitrlo  aoid  or  the 
actual  caqtcr>'  shoold  be  applied.  For  tho  profuse  salivation, 
b^Uadoima  ie  efficacious.  In  many  ca«ee  freeh  air,  cleanlineeB, 
and  a  restricted  diet  nre  alone  ncccesarj. 

Clakse  lays  grvnt  st.rctis  u|)on  the  diet,  whioh  should  lie  oare- 
fa\ly  re^lat»l.  ^niall  doses  of  hyd.  cum  creta  or  of  rhubarb 
and  ntagTHMia,  RhotiUI  Im.-  ^ivcii  to  regulate  tlic  bowcle ;  toget}ier 
with  chlorate  of  potash  and  Imrk.  Subtsequently  vnd-lirer  oiI> 
iodide  of  imii  or  Parrinh's  cliemioal  food  will  be  u.-M:-ful. 

LoL'ally,  he  ii»efl  moitth-watUieeof  bOTftX,  or  if  Uiere  be  fetor, 
of  myrrh  or  Condie'e  fluid. 

Lotrts  Starr  calls  attention  to  the  irajKirtaiice  of  cleauUneea, 
fresh  air  and  sunlight;  and  of  a  nutritious  liquid  diet.  Chlorate 
of  potasii  i»  almocit  a  specific. 

B      Potu«.  HilonL fT.  xItI^j 

A«l.hr<lf«dili>rtcidlL,--.    f  3  J 

Syn'r' '  J  •■ 

Aqwr,  c|.a.ad - f  J   i|j 

M.    R— f  5j.  diltwed,  e«ry  two  hoiira,  for  a  child  ihree  »»«»  old. 

Tf  a  more  rlc^?idt>d  li>nic  lie  re(|uired  be  adda  qaimiie,  gr.  ( 
to  I,  to  each  dose.     Loi«lIy  ho  uses: 

ft     I'otoA.  chtflTftL, B  It 

AoJ-rarbvlide gr.  U 

oit<i«ri&«>, r;  j 

Ai|(iK,  q.  *,  ti., r  5  TiU 

M.    S. — ^To  be  iboroughl^  applied  to  all  Uw  iilren  itl  ImaI  oi>c«  everj  hour. 

In  Kvere  and  protruded  caae^  tiuctUTC  of  Iroii  and  stijuu- 
huita  will  be  retjuired. 

Indolent  ulcers  may  be  lightly  touched  with  a  sUck  of 
nitrate  of  silver. 

Loodened  teeth  mui^t  he  let  alone,  as  they  become  firm  again. 

All  forms  of  f(MKl  and  medicine  which  have  decided  flavors 
will  be  found  objectiouable,  as  they  hurt  the  mouth.  Hence  it  is 
often  difHcult  lo  teed  a  child  wilh  ulcerative  stomatitis.  Beef 
peptonoidB,  mixed  with  a  little  luke-wanu  milk,  will  oftcu  bo 
found  of  great  value.    Bometimea  brandy  act«  U6  a  local  anesthetic 

F 


8S 


lUSTJAL   07  TR^XTJiKST. 


to  the  ulcerated  eurfn^c,  and  at  the  ejime  time  dis[iofteA  it  to 
lionl.  At  (itlier  times  we  hiive  l«en  oompollerl  tx)  npply  iodoform 
or  cocaine  to  the  ulceni  in  order  to  enable  the  ohild  t«  taku  fiKxl 
without  pain.  Meat  jellies,  like  calven'  ftjot  jelly  or  pig'n  feet, 
without  either  sugar  or  ewwoniiig,  are  Bomotimea  talceii  with 
comfort.  AVhf^ii  the<li«eaj*e  w  distiiiftly  diphtheritic  we  have  found 
diluted  chlorine  water  Ijetter  than  the  iiiiiversallTr'  extolled 
chlorate  of  jKita-th.  In  caac  the  latter  i*  usetl,  no  syrup  or  glyce-<  ■ 
riiie  iihould  1)6  directed  an  an  excipient.  but  the  salt  should  he  dis- 
solved in  water  alone.  Decoction  of  a&ge  i»  uiiother  useful  inouth> 
wash,  not  ueiuilly  painiul.  The  suggerition  of  nitrate  of  silver  for 
indolent  ulcers  is  very  bad.  They  should  ho  utiruululc*!  to  heal 
by  myrrh  or  benzoin,  and  by  a  rich  diet  with  plenty  of  good  wine 
or  ohl  »tock  ale. 


CARBUNCLE 

Two  forrriB  of  carbuncle  are  recognized — the  simple  earbuu- 
cle^  which  i»  simply  a  complex  raaas  of  furmiclea,  and  Anihi 
or  Malignant  Pustule,  a  diaea-iie  contracted  from  the  lower  animala. 

"We  treat  here  of  simple  carbuncle. 

Van  Hablingen  aays  that  the  treatment  should  be  strongly 
npportilig.  The  most  nonrlsbing  food  and  stimulants  should  bo 
I^TW  freely-  Tincture  of  iron  itud  quinine  are  the  be»t  medi- 
cine— ^the  latter  t^  tlie  amount  of  sixteen  to  twenty-five  gmiuB 
daily,  iti  one  do^e.  Sleep  should  be  tMscurod  by  anodynes.  Fresh 
air  and  exercise  are  iinportunt.  Wliyn  the  airbunele  is  tenae  and 
hard,  deep  cruciform  ineieions  arc  sinetionod  by  old  usage,  bat 
Paget  aays  that  most  tasen  do  efjually  well  witliout  them. 

AusBW  paints  cantharidal  coUodloD  around  the  carbuncle, 
in  a  broad  baud,  the  bliater  relieving  tension. 

Hebka  recommends  cold  applications  for  the  first  stage,  fol- 
lowed by  poulticefi  when  suppunition  lx!gin«. 

The  part  tihould  he  frequently  washed  with  a  solution  of  car- 
bolic acid,  and  the  elough  should  bo  removed  curly. 


CARBrNCLR. 


88 


PlKfARD  lays  grcnt  etrens  on  the  importunoe  of  the  diet, 
which  must  he  rich,  easily  digested  And  varied.  Aa  regards  stiin- 
tiUuite  hi»  rale  is  a  good  one.  Do  nnt  give  them  ex<-ept  ia  ut'cord- 
ftnce  with  the  ])aticnl'it  custom,  anicaa  a,  clear  tiidioation  arii«s. 
And  never  give  more  than  ia  neceesar}*.  Lato  in  the  di^co^  their 
need  bocoiuod  more  prcAsiBg.  Gangreuous  slough*  rajtiire  dis- 
infot'tiAii  of  the  ntt'-m.  Intemallv  ho  giroa  tho  Iwt  of  ii^nics,  aud 
I*rhai>^  sulphide  of  caloitim;  especially  when  sa[>paroti.".n  he- 
gind.    MorphinOi  wbeti  needed,  should  bo  given  hypodennically. 

Paoet  limits  litirgical  interference  to  the  tollonring  cases:  In 
the  tirwr  5(ag»;  great  [wiii  niiiy  be  present,  which  is  due  t"  li-noion. 
An  iucisiou  will  iijUeve  this.  When  a  pus  cavity  fomifl  beneath 
the  tdcin  it  dhould  \ie  oi>eiied  sa  usual.  lie  prefem  for  local  ircat- 
nient  the  application  of  lead  pla.stcr  and  jMiulticett. 

PippARD  states  that  ho  ha«  uwd  IwUudoana  ointment  with 
advantage  in  the  tidvanced  stages. 

To  any  one  who  ha»  ever  felt  tho  atrocious  pain  of  the  knife 
severing  a  carbuncle,  it  would  Iw  difficult  to  uouueive  that  that 
operation  nhould  bo  usoil  merely  to  give  relief  from  ]«in.  But 
mmctimes  the  teibdoti  in  no  great  that  gaiigreno  in  threatenetl,  by 
the  interference  with  the  circulation.  This  is  a  manifest  indica- 
tiooi  for  the  use  of  the  knife. 

pAuirr  mentionH  the  fubcutancouA  flection  in  tlie  ramc  termfl 
of  condcniiiatioii  aa  the  onliiuiry  cruvial  iuL-irtioii.  Tlie  suggestion 
of  admini^criiig  twenty-five  grains  of  quinine  in  one  dose  is  not  a 
good  one,a88uchd<»ciidepi'ea!;thealn.>ady  Weakened  heart.  If  this 
oznonnt  be  given  in  divided  i[m<»  througli  the  day  it  i»  far  better; 
bat  even  then  it  must  be  carefully  watched.  TLacture  of  irOD, 
OD  the  contrary,  can  scarcely  l>o  given  in  too  large  amounts.  A 
dnchm  every  four  houra  is  the  average  do«o.  In  a  bad  case,  where 
the  wcakne^  wan  extreme  and  cold  Rwoatu  nufiervened,  the  abore 
doi«e  woA  administered,  alt«niatoly  with  acid,  sulph.  aromat.  in 
the  Rorue  qtmntity.     The  |Kitient  reiMivered. 

Spougiug  tho  body  with  atcobot  or  hot  salt  water,  and  anoint- 
ing with  cod  liver  oil  are  useful  measures.  It  has  l>ecn  lately  pro* 
posed  to  excise  the  carbuneleat  the  licginning,  tliuH  wTing  the 
tient  the  pain  and  suflWing. 


84 


UAimAL   07  TREATMB!fT. 


Another  Auggeetion,  made  in  Frauce,  is  to  isolate  the  carhun- 
cle  from  the  surroundiag  ttasucd  by  iiiHcrting  around  ita  margin 
"arrows"  (flechefl)  of  cauetic,  and  thus  eepai-ating  the  carbuncuUir 
maes.  Wo  have  not  noticed  the  suggestion  to  diiisect  it  out  with 
tlic  galvano-cauterj,  but  from  the  inclination  among  French  eur- 
geoHH  to  ufto  anything  rather  than  the  kiiifi;,  vra  arc  certain  the 
opiration  has  beeu  tried.  At  the  very  begiiuiing  of  the  disease, 
it  has  been  proposed  by  advocate*  of  tbo  bflcillary  origin  of  car- 
buncle to  apply  pure  caiboUc  acidL  We  would  prefer  an  oint- 
ment of  finely  powdered  red  oxide  of  mercury  in  lanoHn,  which 
would  penetrate  to  the  bottom  of  the  hair  follicles  more  readily 
than  the  acid. 

Garretson  destroys  the  core  of  the  carbuncle  by  cauterizing  it 
with  London  paffUi ;  and  then  applieH  ponlticca.  Wo  have  never 
0«cn  a  uirbiiiivle  cured  as  rapidly  aa  by  this  process. 


I 


CATALEPSY.  .    • 

GowERs  reeommeiuls  a  pinch  of  onnff  to  be, given  during  the 
attack,  for  the  purpiwe  nf  restoring  con«i'iousnes«.  TanuUsation 
KometiniGs  answera  the  same  purpose,  as  also  do  ymetics,  morphine 
hyiKKlcrniicnIIy,  in  ver>'  umall  dnaes,  and  cold  douches.  In  the 
interviila  the  treatment  is  that  of  hysteria.  Removal  from  home 
is  often  npwssary  to  a  cure. 

KosRNTHAi.  KayA  that  the  best  ra^tultii  are  obtained  by  symp* 
tomatic  and  moral  treatment.  Tonics,  antiBpaemodice,  mild  hydro- 
thempy,  neutral  mineral  watera,  and  travel,  with  methodical 
education  of  the  will,  constitute  our  main  reliance.  Occurring 
atter  iigue,  it  may  re(|uire  quinine.  He  failed  with  tlie  oonliuuoua 
current,  and  with  ciiraVe  hypodermically. 

Calvi  relieved  ooe  caae  by  injecting  tartar  emetic  into  the 
brachial  vein. 

Mil-i'S  (G.  K),  sayi  that  tlie  treatment  of  tJte  seizuree  ia  nn- 
satisfactory ;  remedies  which  relieve  in  one  case  failing  in  others. 


TnhAlationA  of  vmjX  nitrite  ehoald  have  a  trUI.    Nitro- 
glycerine, in  doees  of  ,J,  «lrop9  may  prove  efficient,  hvpotlvrmi- 
<ally.    Mtuic  has  boen  used  iii  FraDce  with  8ucce«>.    Tur[>eiitiiiQ 
to  the  flMomeo  succeeded  in  one  <■««.    Meios.  whose  reported 
,cwe  was  due  to  opianit  suggested  ihe  u?>c.nf  pim^tivea. 

It  seems  to  ua  that  more  can  be  accoDi]tlit<h4.Hl  in  this  disease 
•ttenlivo  study  of  «ieb  c«*c,  thnn  hy  routine  treatment  of  any 
ription.  The  functions  of  the  digestive  syfiieiu,  nnd  eBpeciaUy 
sexual  status,  should  he  jwrticnlarly  inquired  tDto. 
Kbb  sugpestrt  the  jtowerful  irritation  of  the  Faradic  hnmh  in 
Iho  parosysma;  but  ndmils  the  failure  of  electricity  m  a  means 
of  preventing  their  recurrencG. 


the 


CEREBRO-SPlN.\L  FEVER.  OR  MENINGITIS. 

ZiBMsaBs  premi*ea  h'M  reraarks  upon  treatment  with  the  wise 

stion,  that  whenever, the  diwatw  n]if>eartf  in  one  family,  the 

shoiiM  be  alMtitdoiie*!  by  oOiera,  until  the  end  of  the 

le.    The  linen  and  other  artielcti  U!><^^l  by  the  ]iutient  ;>hould 

be  burned.    Pei-iton^  who  arc  much  alarmed  should  leave  the  in* 

fe<-te*i  diHiricf  immediately.     We  know  of  d<>  aWrtive  treatment. 

iBatioiml  treatnieut  of   the  symptoms   tavor&bly   iiidacueCH  the 

e<cMii»e  of  the  diM^uso. 

Leeches  hidiitid  the  earni,  nnd  ioe  bag;)  are  very  efKeocioiis. 

>ld  f-h'^ulil  ul-«o  he  o|>plied  to  the  nook  and  haek.     In  hyperacute 

icHiteA  ventiHtM^tioD  ia  allowable.     Lbydex  favors  the  suunu  mea--ture, 

also  in  eiue  of  general  re^tles^uesa.     Kxncerliatioita  should  Ira  mot 

by  reiteated   let-ohing.      IIu  giveu    meroury    by  inunetion,  and 

calomel  nnd  juhip  by  the  mouth,  to  prevent  the  extenf«ion  of  the 

lUesse,  and  the  exudation.  To  prevent  Htomatitiu,  mouth  waHheD  of 

Ichbiratoof  pnittiih  arc  umkI  at  the  same  time.    Though  the  ethmey 

of  inerL'ury  in  not  ceiiain,  wo  poiHc«M  no  rvnietly  whitdi  is*  more 

elTectiial.    Salivation  is  not  a  sign  of  mfety.    Cohl  batlis  arc  indi- 

,catet1  ill  but  few  easea,  as  the  teni[>erature  U  iiAimlly  nindi-mte. 

Quinine  may  be  used  in  hy|>c>rpyraxialeai4c«,  indoiM^ttof  lilY«en 

I  to  thirty  graina.     It  is  useless  against  exaeerbations  hi  the  tnt«r- 

niitumt  fonii.     Violent  headarhe,  iiwwimnia  nnd  rest  leanness  rail 

for  morphine  by  hypodermic  injection.     One-third  to  one-Iialf  a 


I 


66 


MANUAL  OF  TREATMEXT. 


grain  may  be  given  to  adults  fearleiwly,  and  smaller  do«68  ad- 
mioiatered  every  one  or  two  hour*  to  rolievo  tho  inocawnt 
jactitation.  For  the  recnrrin^  lieadaiihe  it  ia  better  to  iiyeet  a 
larger  doee;  which,  after  leeching,  will  ([uiot  tho  most  rt'stlcss 
delirium  into  sleep.  Morphine  is  one  of  the  most  indwi»eiisahle 
remedies  in  tlie  ti-eatmont  of  epidemic  meningitia. 

As  palliatives,  he  mentions  ether  spray  to  the  back  and  nook, 
and  chloroform  liniment  frictions.  Inhalations  of  the  alwve 
■gents,  aud  larije  (Io«es  of  chloral,  are  worthy  of  trial.  Later, 
when  the  course  has  been  protnicted,  iodides  are  pen'iwable  in 
promoting  abuorption.  Hydpot-opluilua  ilufu-K  troatnufnt.  The 
diet  miwt  bo  rognlated  by  tho  fever.  Se(i«elie  require  their 
usual  treatment. 

Stillr  fonnil  thai  leeching;  or  cupping  the  nape  of  the  neck 

'"'J516  of  essential  service  in  relieving  or  even   removing  tla- |>ain. 

'when  the  condition  forbade  the  losa  of  blood,  dry  eupping  was 

Butstituted  with  benefit.    This  was  in  an  unuitualiy  la'ild  epidemic 

Radclipfe  rtates  that  general  experienM  is  decidedly  ogainrt 
any  form  of  bleeding.  He  recommends  eold  to  tho  epine  and  bead. 
If  marked  depwtwion  be  present,  he  swathes  the  limbs  in  hot 
flannels,  and  nws  lient  in  other  forma,  while  the  ice  i*  applied  to 
tlie  spine.  He  agrees  with  Zikmssek  a*  to  (ho  use  of  opium ;  a« 
also  does  Stili.b. 

A  committee  of  the  American  Medical  Assiociation  reported 
favorably  on  the  uco  of  qaininc  in  large  do*cM  at  the  very  oiiteet; 
it  ftometimcs  aborting  the  dlseaae.  Krgot  and  tincture  of  iron 
were  also  approved. 

KlaPP.  J.,  reported  a  number  of  cures  from  the  early  and  free 
U9C  of  iron,  in  dosee  of  twenty-five  dropa  every  two  liours.  Hot 
baths,  followed  by  frietioiw  with  oil  of  tur|>eiitiMC  when  the  mip- 
facc  was  cold,  were  recommended  by  the  same  committee. 

VTiLSOS,  J.  C.  says  that  the  best  modem  American  authori- 
ties agree  in  advising  the  continuous  use  of  extu-ual  heat,  to 
Anticipate  and  comiteiact  the  early  depresdion  which  is  so  gravo 


I 


I 
I 


ravo    I 


CEBEBR0-9P1SAL   FEVER,  OB   HENISQ1TT8. 


87 


element  of  the  disease.     IIo  disapproves  of  the  use  of  mercnry, 
<l(tiil)iti  the  etliciicy  of  qiiininc  in  alKtrting  the  diiieiwe.    Opium 
u  the  one  remedy  on  whioh  his  rolianoe  U  placed. 

TBOi'SSBAt:  pronouiK-ea  all  traitmeiit  uselestt,  aiid  t«tateE4  that 
m  the  CUKCM  treated  eiit^rgL-tically,  dt^tli  HujterveuiKl  more  quiekljr 
thau  la  tho«e  where  active  tt'eatmeot  wan  omitted, 

Roberts  give>*  utimuloiit*  and  Uiws  exteiTiiil  hont  when  there 
mueli  deprvsaioii  at  the  out**t.     lie  ap]iroveh  of  il-o,  leeebc*, 
in  and  opium.    lie  evidently  looks  with  favor  on  the  uae 
of  stimulantt:. 

Tlie  rcmarks  of  Loosns  on  gonoral  regimen  are  of  valiw. 
pub*  the  i«tlwil  in  a  dark,  eool,  well-vetititatfil  i"oom,  removed 
3m  nniise  and  conftiMon.  Tlie  diet  nhould  ho  niitritioun,  und 
uly  digested;  milk  i«  to  l»e  preferred.  The  tonueiiling  thirst 
|niro«selUerori»sjiit  the  [mtivnt'ii  desire.  Coii-ttipation  callBfor 
B  calomel  purge,  aided  hy  a  tuq)cntine  enema;  free  ca.thanis  must 
early  ohtaincd.  The  hla«hler  re<"juir(!:*  attention  throughout. 
Opium,  hypodermlcally,  is  su^ierior  to  all  other  remediei,  if 
given  early  in  full  dfwcs,  keeping  the  patient  in  a  semi-comatoae 
1  itate  till  the  stage  of  effu^iou  is  reaehetl:  after  tliat  it  in  contiruied 
I  in  omall  docwR.  Tli<;  indiuution  for  Rtimulanta  in  Uie  name  aa  iu 
I     tf]^oid ;  weakness  of  the  first  cardiac  aound, 

^B      Davis  urges  that  the  tolcrauce  of  opium  shown  in  thisdincane 
'    proves  neithur  the  indieation  for  the  drug  nor  ita  httrmle«aneas ; 
but  rather  t*howii  thn  iietfl  of  Romething  Iietter  caloulated  to  arouM 
g«  general  Muw-'eplibility  uud  the  Vttao-ni()tor  activity. 

The  leiLiling  indication  is  to  obtain  abatement  of  the  morbid 

lion  and  vascular  fulne**  in  the  iier\-ouB  centers,  thereby  reliev- 

pain,  relaxing  mutM;ular  rigidity,  ai>d  preventing  fatal  pnral- 

For  this  tlie  most  reliable  ngeuU  ui-u  ergot,  phytKMtigma, 

id  iH'lliuIoiitiu. 

When  called  at  or  soon  after  the  beginning  of  an  attack,  he 
;teil  ico  or  cold  water  to  be  applied  to  the  occiput,  giving 

iutenially: 

B    Tioct.  pbywtiljjmiillv tUm 

£si.«tg(ita  fl^ ...f  J  ijM 

tt.    & — f  S  i  ever;  Iwo  or  thrvc  bMn  to  ui  adult. 


I      B  C 


88 


HAKVAL  OP  TBEATUEnrr. 


"Whenever  ihe  rigidity  nf  t!ie  iiet^k  and  tlie  lieadacbe  abate, 
the  clo!<e  id  given  lesa  fretiueiitly.  If,  as  convalescence  approaches, 
t!te  patient  is  restlesn,  ilelirious  or  uleeplesa  at  night,  a  single  or- 
liinary  Acme  of  "Dover's  powder  and  camphor  is  given  at  bedtime. 
A\'heu  convalescence  18  fairly  established,  tlie  ergot  mixture  mnat 
be  at  once  laid  aside.  ^\Tien,  after  the  crisis  has  passed,  daily 
exacerbations  occur  at  the  mine  hour,  two  or  three  moderate  dosea 
of  quinine  prevent  them. 

Dr.  Davis  very  ju»Uy  remarks  that  while  tlie  above  treatment 
Bavc<t  tivo  out  of  eix  cases  in  the  epidemic  he  treated,  it  does  not 
follow  that  it  wonld  ani^wer  in  ntla-r  cawa.  Ca«es  of  an  active 
inflammatory  type  would  call  for  Teneaeotion ;  with  an  attending 
epidemic  of  erysiiwlas,  the  remedie*  would  be  hot  applications, 
belladonna,  iron,  blisters,  cantharidps,  hyj»oauIphite  of  soihi,  etc 
In  attack>4  coiupliimtcd  with  uiularia  bo  would  u^c  ipiinine. 

Opium,  he  found  Ut  be  poeitively  ir\juriou3  in  the  active  eUige, 
but  in  the  stage  of  decline  it,was  found  uauful. 

Rausbt,  D.  C,  advocat«ii  the  use  of  salicylic  acid  in  large 

sod  frequent  doses.    Fifteen  grains  may  bo  given  every  two  hours, 

ud  increased  until  the  desired  eft'ect  is  obtained. 

Smith,  J.  L.,  relies  upon  bromide  of  potash.  Many  authore 
recommend  this  drug  for  children,  but  for  adultrt  it  has  not  been 
found  eflcctaal. 


Fuller,  W.,  recommends  hot  water  instead  of  cold. 

Bartiiolow   speaks  approvingly  of   the   administration  of] 
aconite  and  gelsemium,  but  other  authorities  do  not  sustain  hta 
&Toni,bIe  recommendation. 

It  is  simply  impossible  to  reconcile  this  discoi'dant  melange. 
Authors  of  the  Viighost  standing  recommend  diametrically  oppo- 
eite  methods.  The  auggesiioiw  of  one  are  found  worthless*  by  tho 
next  The  one  fnct  which  stands  out  most  clearly  manifested,  1«  ■ 
the  universal  UHeleaaness  of  the  medication  ado|ited.  Opium  oom« 
nearer  than  iinything  clBe  to  winning  the  approbation  of  all;  pro- 
bably from  ibt  {HHver  of  relieving  Iheoulwanl  nianife«tatiou»of  the 
diwniie ;  yet  Davis'  objections  to  its  nso  seem  to  bo  fbuudetl  on  sound 
reasoning.     Hie  experience  might  be  considered  an  exception  to 


CUOaS  OP  LITB. 


8ft 


the  aboTo  etAtement,  as  he  lost  only  one  caiw  out  of  sue,  bat  the 
one  e]>i(lemic  oil  which  his  observatiooB  were  baeed  was  of  uuuBual 
mildness.  His  remedies  may  be  atyled  the  phyniolo^csl  onea, 
anJ  in  the  absence  of  any  etiological  iiidieatiou,  ma}'  be  taken  as 
the  mo*t  rational  yet  suggested.  In  fact,  of  ad  the  views  pre- 
•ent«d  Ui  this  article,  thoae  of  Dr.  Baris  deserve  particular  attan* 
tiou. 

CHANGE    OF    LIFE. 

CLuncT  OoDSON  directs  attention  to  the  sei^retions.  Con- 
•tipation  and  fiorlal  cougegtioii  call  for  aaline  purgatives,  or 
mercurial  pill  with  ahK*. 

K«->a'hu'hf  and  reflex  nen'ous  phouomeua  are  beet  combated 
by  bromide  of  potash;  tht.<4  dnig  aHing  &»  a  sedative  to  the 
o^an8,aiid  k'^^^iinii;  thoir  blood  i^upply. 

OocaMionul  venesection  or  c-upping  gives  great  relief.  The 
diet  abould  be  plain  and  uustimulating,  the  ase  of  alcohol  being 
limited.  Tepid  batliK  are  useful.  Ttiitv  hour»,  heatL-d  rotims  and 
other  excitement  should  be  prohibited.  Local  troubles  arising 
■hoald  receiTc  their  usual  treatment.  Abslnicting  blcxxl  fn»m  the 
uierttB  is  i^jurioua,  but  Icechee  to  the  anus  are  sometimes  ueefdl. 

Barhrs  recommends  an  abdominal  bandage  when  the  abdo- 
men is  distended  with  gas.  Acetate  of  ammonia  itt  one  of  the 
beet  attenttivEia. 

SUSSDOBP  give3  this  excellent  nile:    In  no  aoso  of  g«neral  or 
Lloeal  disorder,Jiut  b^^fon'or  during  the  menopattse,  ehouid  local 
•xaminatioD  be  omitted. 


FosssAGRiVEH  atatee  that  the  inditatiom  are  as  followa: 

1.  Ti)  combul  gcncnil  and  Imral  plethora^  best  by  bleeding 
from  the  foot,  or  if  the  vitenis  h  much  congested,  from  the  arm. 
The  life  iihould  be  active,  tlic  diet  rcittricted,  the  *lecp  light. 

2.  To  combat  menorrhagia: 

B      Eigotiiur, 

Kit  ttmlko i!....U    ft.  t* 

it.     Fl.  mw.  e<  in  ptl.  ai>.  x  ■li*id«-, 
K— (Ine  etery  one  or  t«o  bouniL 


Cold  baths  (luring  (he  intermenstnml  periods  are  often 
service;  also  cold  va^iriHl  doncboa. 

3.  To  ooinbat  nervous  coniiilicationrt.  These  must  be  trent^ 
as  they  would  be  if  the/  ocxrurreil  at  other  timea.  Alcohol,  «])ioea 
and  venery  are  hiirtfiil.  AfWr  the  menopause,  sexual  connection 
■hould  censo.  as  it  induces  oongeetion  of  the  uterus,  which,  tiHclow 
tiieu,  can  only  do  harro. 


FoRDYCE  Habkbh,  in  cacefl  of  menorr4ia£ria  with  incrcaac  in 
the  f\7.v  and  weight  of  the  M'omb,  u»tsA  ergfotine  tiuppoHitories,  or 
iodoform  uterine  t>encil». 

Bahti.ktt  controb  cliiniu.'teric-  hemon-hnge  by  introducing 
earbolized  »;[tonge  tents  into  tho  cavity  of  the  uterus, 

JoiissoN,  W.  B.,  pniisw  tilt'  urtica  ureus  as  an  efficient 
hemostatii!.    Fo^s8AaRIVE8  joins  In  the  roconuneudation.. 

Lawson  Tait  say*  that  for  the  relief  of  most  of  the  subjec- 
tive phenomena  pc'i-uHur  to  Oiirt  e|io(-1i,  an  occaKionuI  drastio 
pui^ative  ia  his  Iicst  remedy;  together  with  removal  from  home 
at  I'rcfiuont  intervals. 

QcifiAO  recomnienda  the  efitablishment  of  a  seton  or  issue  on 
the  arm,  especially  if  carcinoma  threaten. 

LawsosTait  saya  that  women  who  become  addicted  to  drink 
at  thia  epoch,  fhouM  be  secluded  milil  the  time  of  trial  is  past. 
Many  patients  who  ^ufler  from  euch  depression  will  be  found  to 
have  8<.^mc  in^Minc  delusion. 


Tilt  thinks  tliat  flooding;  at  this  time  is  one  of  Nature's 
nielhofU  for  resetting  the  hc-idlh  upon  new  Hues,  and  should  not 
be  interfered  with  unless  excessive. 

Fptzbi.  rooomineuds  for  the  neuroses  of  thie  description 
bromide  of  potash,  gr.  xsx,  thriee  daily.  Whenever  the  molnn- 
cli«rK;  teiulvncy  i»  pretient,  he  uma  inhulatioiiit  of  nitrite  Of 
Binyl,  increaawl  a»  tlie  patient  becomes  habituated  to  it«  mo. 


Wariso  Htat<B  tlial  headaches  of  this  period  are  benefited  by 
salphuj.     Plethora  and  nen-otis  ext-itoinciit  Hrc  ulluj'cd  by — 

B    8ul|i>ii)rti^. IJ 

Bodwrtirfs. 3i 

Tpccwntaov • V-  > 

U.    B.— 9  J  lo  B  Ij,  to  tw  ulea  U  ni]jht  In  mltk. 

In  inehinchoIiL-  i^atten  cunioifuga  will  ftometimea  act  like  a 
charm.  If  the  patient  lie  fat  ami  plethoric,  Cnrlphwl  wntor  or 
aalcs  will  give  iimtaiit  relief.  In  other  ca«efi,  eharacterizcd  by 
TttrioiiB  anoioftloiw  iiervoiw  manifwtstionB,  the  im|iresflinii  made 
upon  tliu  iiiiiid  by  mofixuge,  hydrothemjiy,  or  fai'adiMtTioii  U 
frequently  nuefiit.  The  most  exact  mid  ran-ful  management  must 
be  kfjit  up  in  all  «uieifol'  tli'w  kind.  Every  source  of  irritation 
ahonld  be  avoide«l.  Members  of  tlie  tamily  should  W  wanie<l  not  to 
pay  attention  to  the  nerv<iiL>(  loanifustatioiia,  nor  to  provoke  thera. 
Freedom  from  anxiety,  travel,  change  «f  climate  and  agreeable 
society  should  be  enjoined  ;  while  the  functions  of  the  Hver  and 
kidncya  muHt  be  kept  in  proper  condition. 


CHILBLAIN. 


I 


ERASJirs  WiLj-os  eudoavora  to  restore  circulation  by  gentle 
friction  witli  snow  if  t!ie  jmrt  is  wvcrcly  cliille<t ;  he  then  uno* 
some  soothing  liniment,  and  finally  n  ntiniulnting  liniment ;  cover- 
ing tilt:  part«  aft(;rwai-d  uith  zinc  ointnieiit  uiid  cotton  wool.  lie 
&Tor»  the  Boop  liniment  with  chlornformt  the  compound  camphor 
luiimont,  turpentine  liniment  and  iotiinc.  Blietten  ehould  bu 
0|>ened  and  jKinuillud  with  tinct.  Wnxoin.  comp.,  and  then  dreieod 
ith  re^in  ointment.  For  general  debility,  a  generous  diet,  with 
m)Q  aiid  (Quinine,  aro  oasential. 

PiFTAHb  n*e»  the  galvanic  current  to  raiee  or  restore  vitality. 

SuoEMAKEK  rccoinmcnd*  the  ointment  <^>f  aluminium  oloato* 
We  have  lor  niuny  yt'iirH  u(»»m1  with  the  In-^t  n'^^nUn  an  nint- 

ment  of  cariMilic  actd,  conininiiig  thirty  graiu^t  to  the  ounce. 

It  may  \>e  \rell  to  cuution  tliow  who  u^m  kihiw  tu  rub  frozen 
embers,  (hat  iho  ^now  imut  be  iM,  as  dry,  li-oxeu  snow  will 

increoao  the  congelation. 


MANl'AL  OF   TRKATMKKT. 


CHLOROSIS. 

Instancea  of  the  peculiar  greenish  tint  which  gives  the  name 
to  chloroBis  are  very  rait-  in  America,  bat  the  disease  itaelf  is  any- 
thing but  rare,  and  aftects  nunibora  of  our  women  throiighoiit 
their  lives.  Wc  must  express  our  conviction  that  the  vast  majority 
of  the  casee  of  ill  health,  nervousnesa,  chronic  invaUdiem,  etc., 
among  women,  depends  on  the  coiulitiou  of  their  blood.  Women 
who  lire  never  well  are  chlorotica.  Noumigic  women,  dj'speptic 
women,  women  with  diHunlerH  of  the  sexual  organB,  are  eases  of 
chlomsin  primarily,  negleot^jd  at  fir*«t,  intensified  and  i-endered 
permanent  by  pregnancy  lactation,  lack  of  change,  exercise,  etc., 
and  the  burden  of  the  daily  duties  of  their  lives.  The  sludv  of 
sjiecial  orgiins  ban  of  late  years  thrown  the  enndidemtinn  of  the 
general  syelcra  into  the  back-groimd.  Tlie  pouduluni  has  swung 
too  far,  and  should  now  Mwing  bnek. 

For  these  reasons  we  have  separated  the  ti-eatnient  of  chloi-osis 
from  t!iat  of  anemia,  and  will  devote  sufficient  (i|»ace  to  it  li»  pre- 
sent fully  the  views  of  variouK  authors  on  thi«  important  iniibject. 

Immkbmann  calls  attention  to  the  importnnoe  of  Htrengthen- 
ing  the  constitution  during  cliildbni'Hl  and  at  puberty;  esfK-einlly 
when  there  is  any  licroditary  predisposition  to  chlorosis.  Hoftt 
should  he  given  in  abundance.  Women  of  a  relaxed  type  should 
be  compelled  to  take  open  air  cxeROse  ditily ;  they  should  do 
doineKtie  work  rather  than  sedoutary  tuskv.  Sleep  muftt  1>e  en- 
joined early  in  the  night.  Social  excesiios  do  great  liarm.  The 
hot  months  should  he  spent  at  the  Bea-sliore  or  mountaiius,  where 
•xercitH!  may  be  taken  wilbaut  undue  prostmtion  from  the  heart, 
flea  bathing  exerts  an  influence  hostile  to  chlorosis.  Tlio  denmnda 
of  "culture"  Khoulfl  nifver  l»e  all(iwe<l  to  interfere  with  health. 
Causes  of  moral  and  mental  depi'essioii  should  be  removed  if 
po««ible. 

Very  i-arely  d<»es  Bmenorrham  constitute  an  indication  for 
treatment,  as  thai  disorder  is  but  tht;  couscciucmrcof  thechinmsis. 
In  girls  ttl'  ciglitren  a  coniliinatioii  of  aloes  and  iron  in  pill  la 
eometimes  iLtcfiU.  The  bold  and  free  uite  of  iron  in  chlorrwis  ia 
more  imporbint  (ban  nil  Ihu  liygienii-  mnnagement.  In  many 
caaae  a  preparatory  course  is  absolutely  nccc*ettiry  beJbrc  the  iron 


1 


i 


CHLOROSIS.  98 

can  bo  RdmiDittcrcd.  Djnpcpeia  or  fever  mart  he  gntlen  rid  of; 
hypalhuminofi'iB  must  be  obviated.  ImraerDmun  agrees  with  Kie- 
mcver  in  the  opinion  thnt  when  the  dl-wo^e  u  uncomplicated,  elab- 
orate directions  are  superSuons — sho  cau  do  as  ehe  pleaAsa,  so  long 
as  fihe  takes  iron.  Hy gienio  nmuageinent,  however,  ih  nccesHir/ 
to  prevent  a  relapw.  Lu^  doses  of  iron  care  more  quickly  tluut 
amall  nne«.  The  dom  U  more  important  tlian  the  pro}«mtioQ. 
It  ia  well  to  choose  those  compounds  which  do  nat  interfere  with 
digwtion.     At  B^le,  Bland's  pill^  are  u-^ed: 

B    F«rri  sulplt.  |ial  r., 

I^lak cub. par^ U    Jb 

it.    Ft  maa.  et  in  pil.  do.  icvi  div.    S.— Thm  piUi  ihrka  AiXlj. 

The  attempt  to  claim  for  mangaiwee  a  place  bceido  iron,  by 
©Btablinhiiig  »  "rmuigrtneii*  chlorosi*,"  he  ohtiracterizcrt  aa  "anti- 
quated nibbidh,"  and  saya  the  experiment  had  complettity  failed. 
Iron  i*  contniindicBted  by  gastric  catarrh,  which  mnxt  tirst  be 
removed.  Atonic  dyspepujii  ia  beiie&ted  by  in.»n,  but  gastrio 
nicer  doo*  not  tolerate  it  even  ba  well  m  does  catarrh.  Cardial- 
gia  is  readily  cured  by  chalyboatee.  Fever  also  (xmtntindicotce 
iron.  Marked  Dorvoa^  symptoms  require  the  addition  of  the 
bromides. 

Chorea  calls  for  anenlo. 

Coi»iti|iation  may  be*  ubvi»ted  by  mild  salincff,  likcHunyadi 
vater. 


I,     " 

tG» 

r 


NiEMBTBR  agreeti  with  Ininicrmann  in  attributing  little  value 
to  anything  but  iron  in  the  treatment  of  this  dLAeane.    His  con- 
sions  are  a»  follown: 

1.  The  efiicucy  of  iron  in  chlorosis  docs  not  dc|)end  on  tb« 
form  in  which  it  itt  aJniiniittciTd. 

2.  Nearly  all  ferruginous  preparations  are  well  home  in 
chlorosis. 

3.  Special  indications  for  the  exliihition  of  one  or  tlie  other 
cannot  W*  laid  down. 

We  believe  it  i»  a  mlstjike  to  stop  to  relieve  gastric  dis* 
Ijlurhiuicert,  erethism  and   otlier  troubles  due  to  anemia,  before 
^HAnunibtcring  iron. 
^H     To  prevent  relapses  tixe  chalybeate  waters  ere  recommended. 


94 


HANVAL  OF  TRBATUEKT. 


CHOLERA:  ASIATICA. 

LfsitKRT,  tulmitting  thnt  tlic  good  eftl'ctd  of  quarantine  arc 
limited,  still  iiLsiets  ou  obtaining  whatever  benefit  is  i>o36il>l« 
from  that  [)rccAntioi).  Medical  o^ccr^  should  bo  tttatione-d  at  th« 
frontiers,  aud  at  the  i-entcrs  of  travel.  Every  case  of  diarrlicea, 
however  alight,  in  new  comers  from  suspicious  places,  must  be 
treated. 

People  tihoiild  be  tan^ht.  that  cholera  can  be  prevented  in  this 
way;  and  that  ]>)ijrii<-iaiid,  remedies  and  tnin8|)ijrti)lion  are  at 
public  sen-toe  at  thei«e  plaeei*.  Kiirly  iind  tlioroitgh  disiufcctton 
Bt  tliefle  plflfeK  rodueos  tlif  daniiop  to  the  minimum. 

Ti-avylers  uiid  othi-rKtrniigcra  iirteetwl  with  the  ilitieusc should 
be  isolated  at  ouce.  Qimrantino  huildingB  should  be  well  ventil- 
atcil  unci  diHinfocttHl ;  mitl  the  ^tamt*  direotlonK  slionlil  l)c  enforced 
at  all  «UFip('L-t«(l  railway  stations  along  the  lino  from  infected 
places.  The  threatt'.iierl  place  tihnnlil  Ih>  (UKinfected  in  tlie  moHt 
thorough  manner.  Cholera  hospitals  i>hould  be  erected  in  good 
Benson,  and  proper  vaults  constructed  for  the  di!tp<iKal  of  the  evao- 
uationa.  Tlie  be«t  rcftults  arc  obtnincti  when  the  most  thorough 
hygienic  ivginicn  is  iiistitiitwl  before  the  epidemic  begins*. 

Druggists  !>hoidd  be  forbidtlen  to  sell  emetics  or  cathartica 
without  li  prtwcription.  Special  instnitrtioii  should  be  j^iven  to 
all  on  the  poramonnt  impot^ance  of  the  preliiiiinary  d)urrhrKi,and 
its  isirly  treatjnent,  iLM  well  iis  the  ihuiger  (^xi.sting  in  the  stouts 
from  all  such  casee.  Bureaus  should  Iw  organized  to  give  relief 
to  the  ixmr  at  all  liouti*.  TIouw  to  lioiiiw  viriite  for  instruction 
aud  to  detect  early  all  cases  of  diarrhwo  are  vastly  URcful. 

The  Hisehargcs  mu«t  be  »[uifkly  ivniovcd,  tnix<'<l  with  car^ 
bolic  acid  and  buried,  or  better,  with  i^w  dust  and  burned.  (Idtch 
found  that  cholera  bacteiia  arc  killcn)  by  u  few  minutoet  inmiersion 
in  a  live  per  cent,  eolation  of  carbolic  acid.) 

If  a  cholera  center  dcvcio]),  the  inhabitants  must  be  removed 
to  a  place  of  refuge.  It'  wvoral  eai^cd  occur  in  a  house,  the  wells 
and  privies  must  \w  cIiMtd  tip,  the  dejecta  emptied  into  buckets, 
disinfected,  and  carried  away  daily. 

Tlie  linen  must  be  ili.'tinfecttH]  iK'foro  wn.-<liing,  by  exposiire  to 
dry  heat  or  to  the  fumes  of  sulphurous  acid  ;  after  which  it  should 
be  boiled  in  M'aler  befoiv  going  to  the  laundre*»cs. 


CUOLBttA:    AStATIOA. 


9fi 


Deail-booeea  aliould  be  provided  and  faneraU  regulated  by 
the  antbontiaa. 

OarboHc  acid  U  the  fxwt  nntisoptio  and  antimycetie  agent  of 
all  the  -well-knowti  and  tborougbl_j'  tested  nieansi.  Th«  pure,  un- 
mixed acid  is  the  beat.  For  privies,  ei^ht  omic«8  of  acid  diaaolved 
in  a  gallon  of  water  should  he  poured  in  om-e  a  day.  For  wntor- 
cloMti,  thi^e  to  BIX  ounces  diiily  will  suffice ;  for  largo  ni,i;ht-re- 
o^ttacltt,  an  ounce  aod  a  half  a  d»y.  and  foi-  orrlinary  rliatnWr 
pote,  during  the  atage  of  attack,  a  d  raclitn  may  be  poui-ed  in  from 
tane  to  time.  The  floor  should  be  apriiikletl  daily  witli  a  two  per 
cent  aolotion. 

The  wash-clothea  may  be  sprinkled  with  the  same  solution 
before  b*'injr  boilwl.  The  clothe*  may  he  put  in  nn  onlinary  oven 
■lid  the  heat  raised  to  212°  F.,  when  of  such  a  nature  as  not  to  bear 
boiling.  Thiii  dry  hi>«t  ut  aliio  to  lie  used  for  mattre««c»,  gnrmoutA, 
etc  Straw  beds  should  b«  burnt ;  and  this  is  al»o  the  beat  way 
to  trwst  excreta. 

SulphuTOtu  acid,  in  two  por  cent,  solution  is  efficient  in 
dntroying  protomycet«e.  This  solution  remains  for  wcck^  un- 
altered. It  is  the  cheapest  difiinfoctant.  ^veral  pint«  of  thi« 
flaiU  may  be  used  daily  in  privy  welU,  and  eniuller  amouDtc^  for 
other  purposes.  Clotbej*  nnd  bedding  may  he  disinfected  by 
baniiii^  pulpbnr  iri  a  doHed  room,  alter  sprinkling  with  Ihii^  solu- 
tion. Coppenw»  permanganates  and  chloride  of  lime  are  not 
recomniended. 

Boiling  dc^troyn  thu  germa  In  water.  Individually,  the  most 
carefxil  regulation  of  hygiene  comee  into  play  ;  avoidance  of  coMh, 
indigestion,  orrore  in  dict,ex(-cK«cd,  and  luuital  dintiuict,  htioiild  he 
whined.  Moderation  in  all  things  ehould  be  inculcatc<l,  and  the 
ordioarr  routine  of  life  shoidd  uot  be  interfered  with  tinnwHw- 
■ariiy.  Vegetables  which  induce  diarrhoea  should  he  uMnl  uith 
caution.  Unripe  or  decaying  vegetables  mu3t  be  ehunncd.  Fee- 
t^  {tenons  most  be  fed  up,  given  wine,  etc.,  and  kept  warm. 
UwlaH  viaita  to  the  eick  or  attendance  on  funersls  should  be 
forbidden. 

Kvery  diarrh'n-a,  however  Blight,  must  bo  treate<l  at  once. 
All  who  are  very  fearful  of  tlio  disease  ahould  leave  the  infected 
locality  early. 


MAITTAL  OF  TllEATHBKT. 

While  rest,  caution  in  diet,  BmHll  nionla  of  Uglit  animal  food, 
rod  wine,  and  flannel  uMoininal  blindages  are  all  ueoi'nl,  opimn 
is  llie  one  real  remedy  in  cholera  diarrhcea,  espe^^ially  in  tbe  uoPBe 
forms.  All  ROrtii  of  comhiimtionH  niuy  be  luade  bo  that  they 
contain  opium. 

B     Ant«nli  tiitnt., gtAz 

SoWe  in  aiiuwdcBl.  q.  e.  eladde: 

EzL  opii, gr>  ina 

Pulv.  ftltliMB, gr.  xxi} 

Kit.  gt-nliniiH-,  ti-  ». 

M.     Fi.  Dint.  Rl  in  pil.  xiz  Hividcntli. 

S. — One  pill  three  liin«  a  da^  in  liglit  cam^  two  plUs  in  eererc  < 

If  the  Btoola  oeenr  in  rai)i»l  flue<'«iBion,  lie  gives  two  or  three 
pills  every  hour  until  the  diarrhora  pelda.  Aft-er  it  ceaMsi,  n  pill 
is  to  be  taken  every  evoiiiiig  for  Home  days.  In  more  obBtinato 
cases  he  gives  one-thinl  grain  of  opium  with  three  grainB  of 
tannin  or  eight  of  biKniutli ;  and  aaflijita  these  romc-dies  with 
enemjw  of  one  and  a  half  to  three  grains  of  nitrate  of  silver 
and  ten  to  fifteen  drops  of  laudanum  in  throe  ounces  of  water. 
If  thiH  be  quickly  passed  a  eoeond  is  given  shortly ;  in  urgent 
cases  two  enemas  are  given  in  a  day.  In  cane  great  danger 
threatens,  he  glvuH  fifteen  to  twenty  drops  of  laudanum  at  onc& 
In  cases  of  great  nervous  diistreiM  and  anxiety  he  n^  equal  parts  of 
the  tii»;tuR«  of  ni»ium  and  of  camphor,  in  doses  of  «ix  tn  ten  drops. 
For  the  pains  and  colic  he  give«  warm  chamoniik'  tea  (matricariaX 
mill  ])nt»  the  jmticnt  to  l>L'd,  with  hot  pnnltices  or  cold  <^)inpn.M»e8 
to  the  abilomen.  If  the  dian'hcen  return,  the  patient  should  change 
hiK  locution.  luttuch  uusuh,  if  npiuni  fiulh,  nnld  laxativcS  havcsuo- 
ceeded,  hut  such  cases  are  exceptional.  When  nausea,  vomiting, 
or  hitter  taste  exist*  from  the  first,  they  are  met  with  ctlcrveficing 
powders,  ice,  ierated  drinks,  and  if  the^  fail,  an  emetic  of  fifteea 
to  twenty  grains  of  Ipecac. 

In  well-marked  cholera  the  foregoing  remedies  are  ufH'lc 
Keep  the  patient  composed,  give  wnmll  jiellctt*  of  ice  every  three 
miiiuteg,  and  moutiifuLa  of  very  cold  8oda  water,  or  small  sod& 
powdera  in  a  little  ice  water.    Soda  lemonade  is  very  useful. 

Hypodermics  of  morphine,  gr.  i  to  i,  allay  the  pains  and 
cramps  of  the  second  half  of  the  attack.  Internal  medicinee  are 
ttftclcBs,  and  enemas  will  not  bo  retained.     Frictions  with  pure 


CHOLERA:   ASIATICA.  97 

efaloroformort-'ouDtcr-irntniitti'are  asef'ul.  Wlien  tho  etools  btxinmo 
1«M  fnH|ueut,em;niaK  ot'  lamLiiiuiu,  twenty'  dn>|i*,  luid  night  or  ten 
dmps  of  the  strong  solntion  of  chloride  of  iron  (Br.  Ph.),  or  four 
gniiu  of  nitrate  of  itilvKr  muy  be  given.  If  iUarrhn>;i  Ih?  etiU 
present  at  the  end  of  the  attack,  live  to  eight  di-optt  of  lauJanum 
may  be  n!|)«ui(^ty  given. 

Hygienic  management  must  be  secured  tbroughoat  the  nttack. 
Precordial  anxiety  'a  heat  relieved  hy  compreaaeM  over  tlie  abdo- 
men ;  later,  by  mustard,  etc. 

Vcnoiu  iuJGctiotu)  are  imcIosa  and  daagerouit.  Stimulantu  at 
this  stage  have  been  ahiifleil.  We  cannnt  forro  renrtion  if  the 
strength  \s  mu.-<|uiLl  to  it  If  Uie  temperature  fall.  friotiniLH  of  the 
extremitien  ahotild  lie  instituted,  with  flannels  and  Htimiihiting 
liniroenta;  and  hydmiiafhic  wrap?,  warm  jug*  to  the  hand»  and 
feet,  warm  aroiuatic  driuki!,  and  ammonia,  may  hv  titwt). 


B     Ol.  ink^ 15  J 

Alcohol,. fsm 

StAr»  M  adil^ 

Aq,  aauBonw, f^r 

&— T«o  lo  flfteen  diopa  to  be  addtd  lo  srer?  cop  of  tea. 


f 

^H      Id  very  grave  and  rapidly  sinking  cases,  a  teaMpoonful  or  so 
^Bf  old  fiery  wine.  Burgundy,  Tukay  or  Khenish,  nhould  be  given 
HKrery  half  hour,  with  thirty  drops  of  the  ammoniutcd  tincture 
of  mnt^k. 

►  FiiIlneHA  and  pain  in  the  hend  calU  for  cold  comprewcs  to  the 
id  and  mu^turd  tu  the  It^ 
Sti'imach  dymptomit  in  this  Atage  d«n)and  the  same  remediee 
in  the  first. 
The  greatest  caution  ia  to  be  observed  in  giving  food.  A 
spoouiiil  of  good  beef  eoup  every  three  hours,  and  when  reaction 
foMowe,  tea  or  coffee  with  ot^ual  parte  of  milk,  may  be  ^ven. 
Only  uiimal  food  should  be  given,  simply  pruport'd,  and  not  even 
that  till  the  tongiic  is  i^lean  and  intottinnl  catarrh  ceases.     In  the 

kphoid  stage  our  cliief  doty  U  to  n?gii!ate  digestion.  Ice  and 
rated  waters  arc  needed  for  gastric  distroes,  followed  by  the 
bittera,  with  rhubarh.*  Constipation  requires  rhubarb,  and  per- 
haps aIo««.  For  alxlominal  [Hiins  we  give  enemas  of  other,  f  3  ifji 
four  ounces  of  water.    AVunn  aromatic  herb-baths  are  usefoL 


I 


9d 


tUMUAL  OP  TBBATHBST, 


The  diet  may  be  enriched  only  when  the  digcetive  organs  have 
become  porfeotly  nonnal. 

Brown-Sbqtjakr  9tat«8  that  h^'podcnnicB  of  morphine  at  tho 
outset  will  prevent  cliolem. 

L(H>Mis  recHimnieiiJs  hskI  bmidy  or  cliampagne,  given 
repeatedly  in  emal]  doaes,  ns  tho  boat  ritiuiulunts  in  i;oihi}«ie.  In- 
halations of  amyl  liavo  also  teen  found  efficient  in  the  advanced 
BtagoH.  If  death  threaten,  vhiskey  may  be  iiyectcd  hypodermi- 
cally,  or  milk  lie  introducwl  into  the  veins.  Cerebral  symptoms 
are  treated  by  applying  ice  to  the  head  and  administering 
bromides. 

T)a7Is  says  that  the  firat  object  to  bo  accomplished  by  treat- 
meat  is  to  restore  the  tonicity  of  the  tissuot,  increaiw  the  vaso- 
motor influence,  luid  lessen  the  raucouB  irritability  in  the  eariy 
Btagc^  Jailing  in  thia,  the  object  is  to  limit  tho  lo»w  of  seram, 
prevent  thickening  of  the  blood,  »nd  maintain  secretion  and 
elimination  in  activity,  Lat«r,the  most  pressing  need  is  to  dilut« 
the  thickened  blood,  and  maintain  the  action  of  the  nervous 
centers  of  organic  life.  Finally,  in  the  stage  of  reaction  we  roust 
combat  tho  inflammation  and  sustain  nutrition. 

For  the  preliminary  diarrhoea  he  gives: 

R     Acid,  milph.  kromst ....f3  Iv 

MaKOMiw  flulph. f  J  It 

Tinct-opU, f5  IT 

Elix.  niDti. rj  j 

Aqurr, tl  q 

M.    S.— r  5  j,  in  a  liltl«  wmtcr  txtrrj  ihrw  lo  nix  hoar*. 

The  doso  i»  repeated  every  three  hours,  until  the  paaHages 
have  been  prevented  for  twenty-four  botirH,  and  then  incrca^o  the 
interval  aiitil  they  occur  once  daily,  of  natural  color  and  oon- 
siBtence. 

If  malaria  be  pre^^ent,  or  the  stools  light  i^olored,  he  adds  to 
the  above  two  graitis  of  qainine  and  one  of  calomel,  twice 
daily. 

When  active  nyrapttmiH  iK^gin,  he  upjilius  mustard  over  the 
stomach  and   spine,  keeps  the  patient   lying  down,  with  diy 


cholera:  AaiATICA. 


wmnrith    to   the   QStrpiuilieB,  and   gives  every    liolf-hniir  j',  g^, 
-^'chuiiuf  and  ten   luiDims  of   oil  of   turpentine,  in  emulsion, 
r  each  act  of  romitiug  be  ^vee  moqibiiie^  gr.  |,  and  calo- 
mel, gr.  j,  witli  a  iwllet  of  ice  inHtead  of  aiijr  drink.      He  laya 
t  8tre8»  u[>on  giving  this  immediately  after  tlie  vomiting;  ag 
the  |Mtient  be  allowtjd  to  "rest  a  little"  before  taking  the  done, 
Btomach  will  have  regained  aomo  of  it8  eoutra<rulity,and  some 
1  serum  will  have  aociimulated.     At  the  Hame  time  he  givaa 
the  rectum  ten  grains  of  acetat*  of  lead,  and  half  n  grain  of 
tatc  of  Dioqttiine,  dissolved  in  two  ounces  of  water.     In  tlie 
iidenii<-  of  18t!C,  he  used  thlt*  mixture  in  umt\y  uaaeR  inftteail  of 
i-ulfniiul  and  moqthine  jiowdcr; 

%     Arid,  cmriioliia. gr.  ijj 

Ovoerinn, fS  |{« 

TincL  opii  tsmph., ....f^  J 

Aq.  diuuira, rj  Jm 

M.    & — f  5  j.  oAm  ««cIi  vontitinf. 

Ill  the  early  stageft  tlie  patients  are  to  be  kept  constantly  In 
e  rwnmWnt  ]iosit.ion,  the  tlnr«t  roliev«Nl  by  |ielletti  of  ioo»  hold 
in  the  mouth  until  timonth  and  then  »«\viillowed. 

If  the  nurface  hopoinos   whrunken.  feet  bluiiih,  pul»e  feeble, 

and  sweating  copious,  it  id  better  to  give  at  oiioe  a  Iiypodermic  of 

inrt>hine,  gr.  J,  and  ntmpino,  gr.  ,'j  ;  and  every  tifleon  minutes  a 

kbloHptMuful  of  stn>hg  (rollue  or  tea.  alteruated  with  the  K»nie 

quantity  of  well-ttalterl  hmth. 

If  the  hyiKxIennif  ho  itwufficient,  it  mny  ho  repeated  in  half 
hour  to  an  hour.     Dry  warmth  to  the  wnrface  anil  extremitiea, 
with  the  horizontal  f»o8ture,  must  he  maintained  thi-oiighout  this 
itage.     Wet  iipplii-atinns  re<luf«  the  beat  and  ii<>  liariii  therehy. 

Frictioiw  do  nxore  harm  than  good,     t'ranipeil  muaeleB  may 

be  held   in  ii  tinn  granp  till  they  ix-lax.     Advantage  luui  boon 

■■eriv'cd  from  iipplying  several  time^  to  the  whole  inurfiiee  dilute 

^^cn-urial  ointment,  with  a  lihcrul  addition  of  |>owdere[l  camphor 

^^id  capiiiicum.     If  collapee  ensue,  the  8inall  chance  of  recovery  ifl 

heat  promot««l  by  re«t  in  l»«d  and  the  otnitinuotl  uwj  of  tea,  cofl'ee, 

and  salt  broth,  as  above.     When  reaction  sets  in^  the  treatment  is 

the  same  aa  in  the  Koix>nd  stiige  of  typhoid  fever,  which  t*ee. 

The  (Te«  tue  of  alcohol  antl  heroic  dosage  are  only  productive 


qui 


100 


HAirVAL  or  TKBATMKIfT. 


FoTEBBoiLL  mentions  approvingly  the  8ugg€«tion  of  Dr.  H-AU.,] 
who,  basing  bin  |inii'ti<-e  on  the  ^]>u^m  of  the  arteriole^),  which  cat 
ofl'  the  blood  from  the  Malpighian  coi-pusplea  ami  stops  the  eecr&-l 
tioD  of  urine,  gives  hyjiodennicB  of  chloxSll,  with  HatL'tfoctoiy  I 
raeults. 

NiiMBTER  callB  attention  to  the  foot,  that,  in  tJie  M«cklenhiii^ 
epidemic  of  1869,  the  quftrantine,  which  had  been  pi-evionsly  de- 
clared uticlcai,  woa  found  to  ull'oi-d  full  ]>i-olet;tion  wh«n  envrgeti- 
cally  and  pereeveringly  followed  out.  Among  hie  hygienic  rule* 
ie  this  very  somihic  one :  never  use  a  strange  privy  iu  cholera 
timo8. 

As  doou  a«  pervious  arc  attackc<l  by  difirrhooa  they  i<hould  go 
to  bed,  send  for  &  phyi^ician,  and  drink  a  few  cup9  of  hot  coffee 
or  peppermint  tea,  and  fake  (tome  '"  cholera  drops."  It  cannot  be 
denied  that  energetio  diapliore^iii)  oeciwionully  avurtH  an  attack. 
This  Bwoating  mut^t  not  be  arrtwt*^!  too  soon,  and  the  patient  roust 
not  be  allowed  tu  leave  \m  bod  until  he  ba^  paibied  a  formed  »tool. 
The  Russian  cholera  drops  have  obtained  some  eelcbrity: 

A     Tiacl,  Tal«rwD,  «lh^ £5  U 

Vin.  ipeinciiniiq fS  j 

Tinouopii, K)!zx 

01- mcnth.  pip.,. , gtt.T 

M.    S. — Tw»iit;-fiv«  drapo  ertry  hour  or  two. 

Near  the  end  of  an  epidemic,  when  the  fatality  becomoa  loss, 
the  "specificfl"  win  a  reputation  which  they  are  certain  to  loee 
during  the  tiret  weeks  of  the  next  viaitatlon. 

For  cholera  diarrhea  he  giveB  Dovei's  powder,  five  grains, 
repesitud  olleu  till  a  formed  «tooi  Is  paasod. 

If  tho  patient  grows  worse,  opium  is  contra- indicated ;  and 
then  he  rec-omnLendt*  cold  compresses  lo  tho  nbdomoa,  and 
calonxel,  a  grain  every  hour.  The  loss  of  fluid  is  obviated  beet 
by  giving  small  pieeeri  of  ioe,  or  a  tittle  ice  water,  at  abort 
intervale. 

CollajKic  callti  for  stimulants;  the  licitt  of  all  being  iced 
champagne,  or  rum.  Sometimes  it  is  well  to  alternate  with 
hot  coffee. 

Friction*  relieve  the  cramps  of  the  muscles.    Sinapisms  are 


i 


CaOLBRA:     AilUTIOA.  101 

eleea  nt    the   t.iine^  and  iimsv  jtaiiilu]  M>rm  Inter.      Solid  food 
>uld  not  be  Bliowed  till  pulp^  stouU  appear. 

RoBSRTs  Tvcnmmonilit  opium  with  ncotmto  of   load,  tenmCi 
iillie  or  dilute  sulphunc  acid. 

BAftTnOLnw  strongly  reconkmend»  for  the  cramps — 

a     dilontl  IiTdnL^ 5    Ui 

Horpttuue  aolpb., jcr.  iv 

AqiBD  Uuro-ccTBai, f^  j 

H.    8. — PIAmo  to  UtirtT  nunima  to  b«  lty«c*e4  hjpMftnnicAll^. 

For  collapee,  IIcohbs  recommends  heat  to  the  sorface  and  the 
lue  of  stimoJlaiits  hypodermically,  with  hot  or  cold  bath«, 
the  intraveuouj  it\jectiua  of  saliiie  eolutioiis. 

li.  Q.  Jack  relies  mainly  on  morphine,  and  Fowler's  sola- 
tioxt  iu  drmea  of  five  dro[M  ovcr^-  tiltoun  minuU^  until  soiue  efrei:l 
is  produced.  He  also  raises  a  blister  over  the  ittomach  with 
nitrate  of  eilvcr. 

S.  T.  Chandler  speaks  very  wannly  of  the  value  of  boI- 
plinric  acid,  in  full  do«e«,  r«poated  every  qnarter  to  half  hour, 
ttil  tlie  vomiting  and  pnrging  oeaiteh 

Klt  -VIcClellas  strongly  ui^ea  the  use  of  solphatc  of  iron 
etxlphurio  aoid  a^  prophylnctim.    He  »tiilo«  that  tlic  mor- 
lity  amDni,;  patients  treated  with  a^nds  was  only  ei^t  per  cent., 
while  the  lowest  rate  when  other  romwlies  were  ui*o<l  wa«  twenty- 
per  oeuU,  and  the  highest  fifty-nine  jjer  oeut. 

W.  Stevkss  giivo  a  flcidlitz   powder  At  the  start,  and  the 
ilowing  when  the  algid  stage  aupervened— 

B     6odii  cblorid. 5  U 

Bodii  cartKMat 3  (j 

Pol  I  WW  ohlonl-,.  - .  •  - 3  ij 

Aiiws fjir) 

U.    S^ — Q  J  in  water  ewtj  half  hoar. 

W.  SFnawtcK  thought  thuf  phosphorto  acid  checked  the 
more  certainly  thau  ttulphurit.-  a^'id. 


HAITDAL  OP  THEATMBST. 


Q,  Jontfm>!<  rcc<imincn(led  cantor  oil  at  the  beginning.  We  onljr 
mention  this  treatment  to  warn  the  reader  against  it.  A  fall  tiial 
■was  given  to  it  in  India,  and  thcdoadly  rwult*  induced  th«  jihyfii- 
cian»  there  to  lay  down  the  rnle,  never  to  give  lazatiTee  in  any 
case  of  choleraic  diarrhcea.  Unfortunately,  thit!  dangerous  mode 
of  treating  rholem,  fotiuded  on  theory  and  damned  by  trial,  is 
continually  bciii>.'  brought  forward ;  e«|je<.'ially  tiuce  the  discovery 
of  the  uoinnm  buciiluH  Idia  given  ittt  »U[ipnrters  iinothcr  fallactoas 
theory  for  it.-*  employment. — that  of  (.•leariug  the  germa  out  of  the 
boweUby  purgation. 

rT,  MtniRAY,  of  the  Indian  Medical  Service  recommends  as 
a  laxative — 

8     Pulv.  opii, gr.j 

Pilaris, r.e 

AuifcHiiln, .,., gr.  Mj 

H.    S. — Al  one  do«c,  in  pill. 

Tliere  cannot  be  much  ]<urgative  action  in  thits  and  it  would 
be  safer  than  oaator  oil,  if  oircumittancoB  tthould  render  aperient 
medication  ncccaeary.    Camphor  ia  sometimes  added. 

Squibb'8  tliarrhea  mixture  is  a  uaefUl  household  remedy  for 
cholera  seaaona : 

B     Tiact  <>|>i!  <)pi>iir«t<,,... ..... 

Tincl.  (umphonr, 

Tind.  ci|Mid,. U fj  J 

Chlorororiu.  purlf., iS  lU 

Alociliol,  90  [HTcenl.,  q.  ».  mL <|  t 

M.    S^Adutt  <lo««,  s  t«ii»pooaful. 

For  the  preliminary  diarrhea,  Da  Costa  recommends  sul- 
pharic  acid,  opium,  and  acetate  of  lead.    If  the  diachorgea  ajp. 
not  eontrollcd  by  thcac  rcmcdie*  he  gives: 

B     Tioct  c^ici, go.  g 

Tioct.  opii, (It.  X 

AqiiiPc&niphoTB, , ....15  i 

H.    a—Take  cveiy  iwo  or  thm  boon. 

If  the  stomach  doea  not  tolerate  opium,  give  morphine 
hypodermically. 

VThon  true  cholera  develops,  with  cramps,  vomiting  and 


PK  man 


Efiop  Die  patient  at  rest, 
BO  frietionn  for  tlie  cranips;  if  not  relieved,  give  tvoi^ 
of  chloral  hyjuxlermically  over  the  abiloiDen,  and  apply 
moManl  pia»icr.    Thi-?*tr   mciinj*   will  arrest   the  craiii|>*  mid 
vomitinjr. 

When  reaction  begins,  b«  Kurv  to  look  to  thi^  kiiliteyti.  If 
vomiting  have  oeasod,  allow  fluids  in  large  qtumtitiw.  Act 
njtoa  the  skin  with  diaphnretiot. 

If  reaction  be  not  taking  ])lace  »iti»factorilv,  give  five  to  ten 
ins  of  calomel,  and  follow  with  half  a  grain  evcrj*  hour. 
If  eollapee  be  impending,  persist  with  frictions,  hot  fomenta- 
ip  mu-s-tard,  iurpentine,  whiskey,  etc. 

If  the  patient  bo  not  too  weak,  a  hot  bath  will  be  ver>'  bene- 
ial.    The  Mse  of  hot  applications  U  our  best  treatment.    Give 
imulante  as  long  as  they  will  be  retained  in  this  stage.    They 
lOtild  also  Ix!  ^vcn  hy]wwltrnuc'ally.     CaAVui,  in  dosw  of  one 
in  ftnd  u  hall'.ha^  been  u^ed  with  benefit  w*a  oanliac stimtilaDt. 
th&  patient  contintie  to  sink,  and  the  blood  become  very  thick^ 
iDtmvenous  ir\jections  of  fluida  may  be  of  benefit 

9     Sodiichtor., 5  J 

BodUcwh, 5  u 

Aqu«, 0*j 

H. — flMt  u>  109-'.    Ivjeri  two  fluid  ooncM  U  onee  Into  «  vein,  md  n^«Ml  until 
torty  Duncn  h«re  btta  iiuc-Wd. 

Bartiiolott  adds  hi?  testimony  to  that  of  his  many  prcde. 

)»  who  have  urge*!  the  use  of  opium  and  fiulphuric  acid  in 

preliminary  diarrhea.      He  states  that  the  aubcutaiieoiit^  itijco- 

n  of  morphine  i^  the  luont  vflicient  tn^tmont  of  tlie  pn.-lintlnarj 

Bturlfince,  and  of  the  fimt  i^togc  of  the  attack  proper. 

Tlie  utmost  *iuiotiuu«t  be  enjoined.  The  food  should  consist 
of  boiled  tnilk,  a  ^ft  boiletl  egg,  beef  or  mutton  broth,  or  a  little 
itMik  or  roftflt  beef.  If  Uio  symptoms  be  threatening,  the  aliment 
should  not  include  any  solids.     loc  should  he  given  iwl  libitum. 

EftorvcMing  powders  relieve  vomiting.  They  nbould  eotituin 
an  oxce«B  of  acid  as  remedies  for  vomiting.  This  author  men- 
tions mtiwtarcl   to  the   epignstriiim,  moq.hine   iniection?,  flying 


I 


I 


"IM  MAIOIAI,  OF  T81S1 

blisters^  carbolic  ftcid,  clilorodyne,  hydrocyanic  acid,  camphor, 
chloroforni,  nitrite  of  amyl,  etc. 

Of  all  remedieti  tor  I  tiin  Ktage  he  has  liad  the  beiit  results  &om 
the  hypodermic  injection  of  chloral,  in  dose*  of  twenty  graita 
every  hour  or  two,  in  water.  It  acta  best  when  given  with  mor- 
phine or  altematc'd  with  it. 

In  the  algid  e<t)ige,  goml  hiut  rCMtilted  Irom  the  injection  of 
atropiu,  to  cxuit*  the  heart's  action  and  restore  warmth.  Inhala- 
tions of  amyl  nitrite  have  been  used  tor  the  i«xnic  piiri>o»*i  with 
aaaertcd  benefit  Hyimderraica  of  whiskey,  and  the  intravenous 
injection  of  milk  or  of  saline  Bohitions  hiw  proved  Hucccanful  in 
promoting  reaction,  even  in  desperate  cases. 

During  reaction  the  Bt-nmiich  nmst  lie  liondled  with  care. 
The  dige(*tive  powera  are  so  feeble  that  nothing  can  be  p.ven  but 
a  little  milk  or  weak  broth.  For  the  troublceome  vomiting  and 
diarrhea  he  gives — 

B    Aeidi  cubolici., gr- *mt 

RiiiuiiUi.  HubiiiL, ...s  y 

MiR'il,  arsciw - 

.\quK  iK»to.«crui, ii  rjj 

U.    Sl— A  teoMiMOnful  evcty  hour  or  twu. 

For  fever  and  headache,  bromide  of  potash  will  ^ve  relie£ 
Efforts  should  be  made  to  restore  the  urinary  sccrotlon. 

The  dose  of  cherry  laurel  water  in  the  above  formula  is  too 
large.  In  fact,  the  drng  had  better  be  left  out  altogether,  cardiac 
aedatioii  not  being  itidi<»ted. 

The  recent  epidemic  in  Italy  hiw  given  iw  one  a^hiition  to  our 
therapeutic  reHOurcea,  in  the  ]>ractice  of  injecting  solution*  of 
tannic  ncid  high  up  in  the  bowels  by  means  of  a  flexible  tube. 
The  favorable  reports  of  this  method  have  since  been  queetioued ; 
late  obsorvera  alleging  that  the  mortality  is  not  less  than  where 
other  modes  of  treatment  were  followed.  The  fact  that  the 
comma  bacilli  arc  instantly  killed  by  any  acid  would  indicate  the 
value  of  this  clasn  of  remedies.  An  the  symptoms  produced  by 
the  disease  are  the  same  as  those  which  follow  section  of  tlie  vaso- 
motor uervcM,  tlie  ithyniologieal  remedy  is  a  stimulant  to  thja 
ner\'e.  i. «:,  nux  vomica  or  its  alkaloids,  or  ergot. 

There  is  a  popular  expression  in  India,  to  the  effect  that  if  at 


CHOLERA   MOABCS.  105 

be^nning  of  tl>e  dweiue  a  dn«e  can  be  a^hniiilitterec]  which 
bring  the  teara  to  Ihe  eyea,  the  nttiw-k  will  !«•  averted.     For 
thi«  purpose  Diixtnreit  arc  jireiiared  reitenihluig  the  fullowing: 

B     Tine).  capMci, rgj 

OLo^upntL. ....< f S  Iv 

Camf^one, 5  U 

CUoTotomi, rs  0 

AMharUfflrL, fJJ 

IL — A  Itw^oonfal  without  wotAr  «v««y  ftAMs  ininiitM  unlil  the  HMtioa 

We  have  frequeutly  j^^iveii  this  in  cholera  morbua,  and  can 
"^anew&r  for  its  atility  in  that  discaAeL 

l^LicNAMARA  gives  inhalations  of  ether  for  eerere  cnuupe,  id 
loe  to  ii)j«titiona  of  chloral. 


CHOLERA   MORBUS. 

It  must  not  be  forgotten  tliat  in  tlii»  country  cboleis  morbus 

is  not  a  vciy  fatal  didowo ;  henco  many  i>yst«nig  of  treatment  bavo 

;»rovcd  guecessfiil    Dr.  W.  S.  Janncy,  Coroner  of  Philadelphia, 

etAted  that  Id  a  man  of  reasonably  j*ood  health,  not  too  old, 

'cholera  morbus  is  never  fatal ;  the  deaths  attributed  to  it  being 

really  due  to  arsenical  poisoning. 

Tlie  prewrijition  given  in  the  preeecJing  article  will  bo  iVrnnd 

Tery  effectual  in  many  vaao*,  if  given  at  tho  outlet.  We  have  pro- 

ecribed  it  in  the  morning  to  a  man  who  wa«  writhing  in  agony, 

with  continual  vomiting  and  purging,  and  found  him  at  work 

in  a  rolling  mill  in  the  afternoon.    Tlu!  dot^  nhould  he  given 

immediately  after  an  attack  of  vomiting,  as  recommended  in  the 

icie  on  AKiati<t  eholera. 

Another  pnimpt  and  effcctiinl  method  of  relieving  tlie  dis- 

ing  Hymplonm  \»  the  hypoduniiit;  iiiJe<-tion  of  a  lull  ilosu  of 

morphine,  one-fourth  or  one-half  a  grain.     If  tho  eyringe  be 

■  not  ut  hand,  nearly  as  goixt  rcKultti  nmy  Iw  iibljiiru>'d  by  giving  the 

|drug  in  hot  water.    Tho  internal  use  of  chlorofonn,  five  drojja, 

|ln  ft  little  water,  every  five  mhiutes,  is  often  effectual.     As  adju- 

T&nts  to  these  remedies,  we  may  apply  mustard  to  the  epigiislrium 

and  the  nalveH,  rub  tlie  body  with  turjtentino  and  lard  (one  [mrt 


106 


TAl  OP  TRBATSIBST. 


to  tan),  wrap  the  patient  in  warm  flatinelii,  give  hot  mustard 
foot-bath»,  and  put  hot  water-bottlee,  btickB,  or  ssnd-bngs  to  the 
extremi  tit's. 

When  the  attack  has  resultccl  irom  the  ii»e  of  improper  food, 
ft  dose  of  castor  oil  will  i-i;movc  the  oflViidirig  HulwtariL-u,  and 
give  prompt  i-clicf.  But  this  is  iiot  e-iseiitial,  as  the  symptoms 
may  diitupj>oar  some  time  before  the  noxioutt  matter  is  voided. 
Calomel,  iii  doses  of  gr.  ,'0,  with  te«t»  preparatA  gr.  j,  every  half 
hour,  will  frttiuuiitly  cpiiet  the  vomiting  and  relievo  the  crumiWi, 
although  there  may  l>e  decomposed  !?ubstauce»  still  in  the  inte&- 
tinal  eanul.  NoverthulcM  it  in  wine  to  get  rid  of  nuch  mattere 
a(«  Hoon  as  posetible. 

Leube  says  tliat  no  remedy  is  as  cfiectual  as  opium,  iu  the 
dose  of  ft  third  of  a  gniin,  repeated  hourly.  Tf  the  extremities 
become  iey  cold,  he  umn  worm  fomentations  or  hot  baths.  In  ca«e 
of  extreme  dcjircssion  he  give«  hypoilermie  ii^jeetionn  of  ether, 
iTL  XV,  repeated  four  times  a  day  :  or  enmphor,  one  to  five  graiiUj 
musk,  four  to  eight  graine,  or  strong  wines. 

The  diet  should  eonMi»t  of  soup  aintie,  and  great  care  sbonld 
be  exercised  in  grudually  restoring  the  patient  to  his  ordinary 
food. 

Tliis  18  esjweially  the  ante  when  symptoms  of  gastric  inflam- 
mation arise  in  the  period  of  reartinn.  Hem,  tlic  food  should 
consist  of  beef  esseiieeB.  pepsinizod  milk,  boile<l  rice,  the  white 
of  raw  eggs  beaten  up  with  milk,  etc.,  until  the  return  of  appetite 
and  tlic  dittappmranee  of  the  oo«ting  from  the  tongue  warrant  us 
in  restoring  our  jiatient  to  full  iHet,  The  prcjH-Tijition  of  rhubarb, 
ipecac.,  and  carbonate  of  soda,  for  gastric  catarrh,  given  in  the 
article  on  alcoholism,  will  bo  found  useful  in  this  condition. 
It  is  of  tlie  utmoBt  importance  iu  such  eaaee  that  food  of  the 
nioflt  highly  nutritious  variety  be  given,  in  the  most  easily  digested 
form,  in  small  (|uaut>itit»  and  at  nhort  intervals.  Free  u.ie  should 
be  made  of  artiiit-ial  digestant« ;  a  scruple  to  a  drachm  of  pef^sia 
being  added  to  cacli  meal  of  albuminous  food.  Bismnth  i»  otYea 
invakiable  in  this  stage,  allaying  the  morbid  irritul>ility  of  the 
stomach  without  intcilcriug  with  digestion.  'We  usually  order  an 
onnco,  and  direct  our  fiatient  to  take  a  lai^e  pinch  whenever  ho 
fecla  any  imuaca  or  distress  in  the  epigastrium. 


mOLBIU   JI0R8VS. 


lOT 


Ai)otti<>r  ntteful  remnly  for  the  Himc  condition  !»  oxalate  of 
cnilUD.  Thi*  ii»c  i>l  l)ie  drug  is  new  to  ibt.  but.  from  recent 
triuU  we  ure  di?[X)Med  to  credit  it  with  powers  at  least  eqnal  to 
tboM  of  bismiitli. 

%     C«rii  <ix>l*l., gr.  xxx 

Surh  Inrii"  puir, -. 5  ij 

H.    el  [r  Chan.  no.  kv,  itiviiid, 
& — Ooe  trerr  ihf«  lioun. 

It  must  not  be  foi^jtteu  t.hat  the  hot  mixture  recomnieiidcd 
in  the  beginiiingof  thin  article  i«  only  to  l>e  lu^  in  the  first  stage. 
After  reaction  h»  set  in,  utitl  the  dyniptoms  are  those  of  inflam- 
mation, it  will  do  harm. 

Looxini  given  one-halt'  grain  of  calomel  every  hour  for  six 
boots,  when  there  is  hepatic  ten<lenie8«,  and  Hiuall  donen  of  the 
mineral  acidn  alter  the  vomiting  ha^  liecn  roUovcd. 

Uart^hornb  bose^hi^  therapeutics  on  the  gaati-ic,  heftatie  and 
intestinal  irritation  with  incrcai^'  of  the  necretiona  of  the  ritorimch, 
lirer,  and  liowcU;  aUo  spasmodic  action  of  the  etomauh,  and  ex- 
aggerated f)eriHtal9i».  In  accordnin*  with  thcM  eonditioiw  he 
gives: 

B     Bp.  unmiA.  amimt,. ^5  j 

Ui^nok- (rplioN 3j 

AquB  in*iitti.  pii^r f  S  iv 

iL    S^ — Sh&kf  vtil.    A  Uatpoonfut  to  t>a  ukoi  orarj  tweatf  miniiHt. 

If  the  CUM)  be  neon  later,  when  the  diarrlieu  id  ulretuly  copiotu, 
•oditun  bicarbonate  may  be  eubatituted  for  the  magnesia,  and  a 
tablefliKK>nful  of  pnrcgi>ric-  added  to  the  mixture.  Still  later,  he 
admini^tei-?  gostrii;  stimulants,  ginger,  cinnamon  or  olove«.  OlMti- 
nate  diarrhea  may  demand  an  enema  of  laudanum  and  starch. 

Bautiiolow  recommends  hypodermics  of  morphine,  gr.  |  to|, 
and  atropine,  gr.  ,^ 

In  caMH*  of  the  cholem  type  ho  nsoe  injections  of  morpluuc  and 
chloral.  The  medicines  moAt  easily  bonie  and  moeit  eflicieiit  are 
combinntionH  of  the  mineral  acids  and  opium.  Ho  gives  two  to 
6ve  drt)[i6  uf  dilute  mnriiitte  or  milphurle  mnil  with  an  equal 
amount  of  laudanum,  in  ooniphor  water,  every  hidf  hour  lo  two 
hoore.  Carbolic  acid  alone  or  with  biiimuth  is  an  etKctent  remedy 
for  vomiting,  fmm  ibt  properties  as  an  anti-ferment  and  a  local 


108  MANUAL  OP  TREATHENT. 

anesthotie.  Anotlicr  effectual  combination  ia  equal  parts  of  car- 
bolic a«id  and  tincturo  of  ioiliDo— oue  drop  every  half  hour.  He 
also  speaks  favombly  of  chlorodyiie.  Porhapg  oue  reason  why 
tliie  aullioroommendstheh^'podprmic  method  ro highly  (in  which 
we  agree  with  him  hh  regards  thia  di&eu^),  is  that  the  above 
formulaa  -are  «)  exceedingly  nauseous.  Still,  patients  will  somfr 
times  be  found  who  will  take  the  mixture  of  iodine  and  carbolic 
aeld,  and  even  retain  it. 

Macnamara  given  for  nevere  vomiting  a  ncruple  of  calomel, 
or  an  effer\-eHcing  mixture  with  liydrocyanic  acid-  If  the  diar- 
rhoea be  exoesgive,  he  givei^— 

R     Crtsaooli gtL  xx 

Ar^nU  nitnL,., gr.  w 

CftBipbcm, gr.  XX 

Pulv.  Ipecac  comp^ .....gr.  xl 

M.    ft,  TOM.  H  in  pil.  no.  xx  div. 

S. — One  »ft«r  wich  lotwe  motion. 


CHOLERA  INFANTUM. 


"We  have  often  recalled  the  imivete  of  the  expression  in  Meif 
and  Pepper's  work  on  "Dit^ea-ses  of  Children,"  where  the  authors 
wind  up  tlieir  treatment  of  this  disease  by  giving  an  Indian  prfr 
Bcription  containing  "Hallcr's  Aeid,"  and  remark  tliat  they  have 
not  as  3'et  given  it  a  trial,  but  "  intend  to  next  year."  Those  few 
words  speak  volumca  of  the  inefficiency  of  the  ordinary  treat- 
ment, and  the  unwillingness  of  the  earnest  practitioner  to  trust 
himself  with  untried  romoditw  in  the  fac^  of  this  terrible  disease. 
We  have  known  dozens  of  physicians  who  were  going  to  "try" 
Hallcr'a  acid  next  year,  at  the  dose  of  the  summer ;  but  the  next 
eeason  opening  with  a  ease  in  which  they  were  deeply  interested, 
thfty  go  back  to  the  old  remedies. 

The  following  scheme  for  the  treatment  of  cholera  infantum 
was  published  in  The  Medkal  World,  in  August,  1886.  We  have 
but  little  to  add  to  it,  except  these  hhita : 

It  is  imj>08sible  to  treat  cholera  infantum  upon  any  formal 
method.  The  ince*Mint  vomiting  characterizing  one  case,  the 
profuse  diarrhea  in  another,  the  hyperpyrexia  in  a  third,  demand 


i 


J 


CUOLBKA     i:«PAKTUM. 


109 


dift'prent  remorliua.  So  do  a  dozen  other  coiiditiorw ;  nud  an  atton- 
tivti  Btudy  of  ciu-'h  case  U  neuttstwry  Uetbru  deciding  upon  tUo 
nicthod  of  trc-ntnieiil  to  bu  adopted.  In  addition  to  this,  it  ie 
DoctuPury  in  evury  liim',  to  |«ty  tho  Kiinie  eUhoratv  nttcntion  to  tlie 
diet  and  tlie  hygiene  oi"  tlie  jmliont,  which  Luwoon  Tail  gives  to 
bla  vaaea  of  ovariotomy. 

The  diAcorery  of  tyrotoxicon  in  milk  l&ada  tut  to  queetioo  the 
pmprifty  of  altowing  that  ^ubfttam.-e  to  be  used  ai  food;  and  cer- 
tainly it  shnuM  leiid  us  to  iwe  the  utmost  care  in  it«  prestTA-atiou 
and  admiiiiittratlon,  if  it  be  not  forbidden  nltogcth(>r.  The  desi- 
rability of  thf  t<ul>stitution  of  Iwi-f  {H-[)ttuu)tdH,  or  digC)*te*l  cooked 
be«f,  for  mw  bet-f,  is  also  a  i^crioui*  question.  ]h»t  tMiu|w,  thiek- 
ened  with  the  beef  from  which  bevf-tea  bus  been  made,  and  which 
baa  then  been  dried  and  powdered,  should  take  the  yhux  of  arti- 
cles of  doubU'ul  vulne. 


L  ^*r  preliminary  diarrhea^  with  no  fever. 

1.  Guanl  against  impnii»bi-  fotid. 

2.  See  tbut  the  food  luu  not  had  a  i'hance  to  deoompow. 

3.  See  Uiat  it^t  digoittiou  U  insurail  by  mbling  to  it  pe^Min,  etc 

4.  Allow  n«  wiilL'p  1(1  Ik*  dmnk  wliicli  bin  not  been  previoosly 
tboiled  and  Bltered. 

5.  Use  h(»t  ilrinkn  frwly,  i-itld  drinks  Bi«iriogly. 

6.  Avoid  the  hcut  of  tho  day  by  keeping  the  vhild  in  a  cool, 
[dark  room. 

7.  Keep  a  thin  thinnel  bandage  over  the  abdoiDen  day  and 
ighL 

8.  Xowhcre  aro  children  tto  well  08  when  taken  upon  the 
rater. 

9.  Keep  the  stomach  iiniet  {a}  by  allowing  it  periods  of 
^•bsoliite  rest,  witli  no  iugejition  of  foo«.l  or  drink;  (6)  by  inter- 
fdiiHing  the  iM>nstanC  Kwilling  of  liqnidx,  wliit^h  koepii  ap  Uie 

irritatioti  which  cauwa  thirst ;  and  (c)  by  uniug  frequent  amall 
■ioaes  of  biamuth. 

10.  Frequent  bathing  or  xponging  tho  body  with  warm  water 
relieve«  the  ibirBt  and  koepK  tho  body  oool. 

11.  I>on't  be  in  u  hurry  to  itb>p  the  diarrhoja. 


no  MJCSVAL  or  TBB&TMHNT. 

12.  Keep  up  Die  flnw  nf  luailthy  digestive  fluids  by  givtng 
small  (loeOB  of  rhubarb,  ipecac.  »nd  poUtslt;  preferably  in  hot 
Wftter. 

13.  Oontiiiuc  this  until  the  stools  amitnie  n  natural  api>car- 
ancc  and  odor. 

14.  Nn  tonic  hi  this  condition  compares  in  ^caey  to  guiWHc. 

15.  If  the  diarrhea  lK>vomo»  «o  pn>t)i«c  an  to  require  stronger 
measures,  givo — 

K     Kxt.  hwmator.  B, fl  5     j 

Acii].  iiu]|ili.  mraroftt., >..•.. fj  M 

Tincl.o|iii  deodorat^ gtt.  rj 

Sjrntpi,  q.  *.  ad f^    lij 

11.    K. — .A  m»[>uoDfiiI  after  <?ach  paauge,  for  a  child  %  ytar  old. 

16.  If  this  prove  inefiectiial.  do  not  wiiste  time  trying  otlier 
aatringetits,  but  give  hu  injection  of  sulphate  of  zinc,  five  grains 
to  the  ounce  of  wann  water. 

17.  Uee  the  thermometer  daily. 

n.  for  the  severer  grades  o/  iUo-coUtis,  where  the  tempera- 
ture rises  to  100°  or  101°,  to  the  above  directions  we  add  the 
following : 

1.  Limit  the  food  to  milk,  white  of  egg  and  lean  beef. 

(a).  The  milk  should  lie  boiled  fifteen  niinuttis  over  a  alow 
fire;  then  put  in  a  bottle  tightly  corked,  ]ilaeed  under  the  ioe, 
and  tlic  portion  nued  at  one  time  warmed  to  ?IS'^  lx>fore  giving  it. 
It  Khoitld  Ite  given  every  four  houm,  witti  a  »4ii1fu-ienl  amount  of 
good  pepsin. 

(d).  Tbe  white  of  ejjg  Nhould  be  tMjaten  U\  a  fmth,  and  given 
raw  with  pepnin.     It  may  \w.  added  to  the  milk. 

(ff).  Tlie  beef  should  be  wntpal  from  the  nit  wurfiu-e  with  a 
sharp  knife,  and  given  raw,  with  jicpsin.  It  may  be  warmed 
through,  or  even  eooked,  if  rhe  ehild  will  not  take  it  raw. 

2.  Should  either  of  tbe?ie  three  food"  disagree,  ubc  only  tlie 
Othen. 

3.  If  the  force  of  the  disejwe  be  directed  ufwin  the  Htoma^di, 
give  tilt'  fooii  by  the  reetum ;  if  the  iHnvelM  be  mainly  attected, 
give  the  nutriment  by  the  mouth. 

4.  Setluloiisly  guard  ngain«t  the  cbild'pi  tendency  to  constant 
drinking.     Uive  small  pellets  of  ice  not  oflener  than  once  In  15 


CUOLERA     INFA!tTt'M. 


Ill 


miiiiitcg:  or  a  rio8»«rtni>oonful  of  cool  water  every  80  minutoe, 
A  little  hot  water  may  be  giveu  ocva»)otta1ly,  biuI  will  better 
relieve  the  thirst. 

5.  Thin  poiiltic-etJ  of  tlaxftewl  over  tlio  abdomen  ternl  to  allay 
'"tho  fever.    They  «honW  be  light,  flmngod  freqaontly,  and  covered 

with  dry  ihitmel*.     Don't  u»e  spiL-o-baj-s. 

6.  Children  nuy  istill  be  taken  in  the  uir  or  on  the  water,  hut 
cy  have  fever  they  must  be  protected  from  dmfbt;  specially 

le  asleep. 

7.  Thti  remedies  above  mentionetl  are  «tiU  to  be  used. 

8.  If  the  Btreugth  fuil,  ui  addition  to  quinine  give  coffee, 
tridy,  or  if  great  relaxation  9ui)er\'ene,  nux  vomica. 

9.  Tlie  utmost  care  must  be  exercuted  in  the  use  of  mor- 
jthiue;  which  uiay  be  given  in  minute  doa^  not  to  cherk  diarrkta, 
hut  ia  TfUev€  pain. 

10.  ByBenteritr  syinptonbi  may  be  met  by  using  ti^ectioiu 
»f  hot  water,  and  giving  ^irniiU  dooes  of  calomel  (gr.  ^)  and  testa 

Bp.  (gr.  j),  every  2  hours. 

11.  'Wleii  tlie  fever  nubiiideH,  the  following  fooils  may  be 
^tded  to  the  diet-lixt  in   the  order  uamed:  boiled  rice,  cutvw' 

foot  jolly,  maltnt  barley,  tritiimtot  and  sifted  before  being 
r>okMl,  cbickcii  jetly,  mutton  brofli  witb  riiv,  tnpii»e«,  sago 
»r  arrow-rcxit. 

12.  Malt-extniet  fliouhl    I>e  givon   with  all    starchy   foods 
Muriiig  L-onvalCfwenw!. 

18.  The  flannel  bandage  once  applied,  must  not  be  toft  otf 
itil  the  sickly  «ea«on  is  over. 

IIL  Cholcjii  Infautum. 

1.  Use  the  thenuometer  frequently. 

2.  Meet  a  tomiiemture  of  104°  with  a  wanu  bath,  cooled 
adding  colil    water   till    the  child's   teni{teruturo  has   fallen 

below  100°.  Ke|>eat  tlie  bath  uh  nf>en  an  tbe  tein]ienitiirv  riiiett 
to  104'. 

8.  Bewuro  of  opium. 

4.  Watch  the  coiiditiuu  of  tlte  nritie.  If  it  lN3conie  vory 
or   if  albumen   ap|>eur.  give  Rmall   dose«   of  acetate  of 


112  MAXFAl.  or  TRKATMKNT. 

5.  VsQ  quinine  boldly ;  giving  one  grain  ovory  four  hours,  in^ 
8Ujil>o8itory  to  a  child  one  your  old. 

6.  ('ollitiiHu  uiIIh  for  viiiiijihor  and  Miimoma,  rather  thm 
brandy. 

7.  Children  wit)i  tlie  (jbolem  intiiiitiim  intiHt  bo  kept  in  lied. 

8.  Keep  steadily  tx)  one  plnii  in  the  mnnit^mcut  of  a  case,] 
meetiiig  each  iiidi<!atioii  wbioh  ariee^  with  uii]iro|>riat«  ramcdioi; 
but  don't  sbilt  iihniit  ninilessly  from  one  awtringent  to  another,1 
trying  thifl,  that,  and  the  other,  till  the  child  die*. 

Stahr  rceommeudti  for  ilco-colitis  or  iutiammatory  diarrhea, 
the  Bftine  diet  giveu  in  cholera  iufantiini.  He  recommends  the 
treatment  with  a  laxative,  of  castor  oil  with  five  drops  of  pare- 
goric, or  of  epiced  syrup  of  rhubarb.  Aftenvards,  while  the 
etooU  are  yellow,  horaogeneoui*  and  not  very  tro<iueQt,  alkalieB 
and  antringentfl  are  alone  needed,  an — 

B     Sodii  bicArb ••■•• ft.xriij 

Kixinulhiiuljcftrh. gr.  ssxij 

Piilr.  aromai., gr.  TJ 

M.  et  ID  chart,  nu,  xij  dir. 

& — Ont  nerj  tvo  lioiirs. 

When  the  etoolti  are  greon,  nuracrouB  And  acid: 

B      Piilv.  ipecac.  lyimp.., fr-tj 

BiuQuth  Hiibcarb., gr.  xsxig 

M.  et  ill  clian.  no.  zij  div. 
H.— One  effcrj  Iwo  liniin. 

If  tibere  be  loo  much  pain  and  hent  of  skin: 

B      UacneK  sulphkU, , SJ 

Tinot.  opii  fl«od., ^^ 

Brrepi, 3j 

Ai).  meuib.  ]>Ip.,  q.nxd., f  J  i^ 

M.     S. — A  iMUpAonfial  (fVtrf  two  boun. 

When  the  stools  are  thin,  with  white  or  green  flakee,  and  the 
above  treatment  fails,  lie  givw  the  following  fi>r  twelve  to  forty- 
eight  hours. 

B      ftltv.  ipcrnc.  comp^ V'V 

11  v<lTug. chlor.  miL,,...... '•■••ST'j 

CrvUBpKp., gt.  xixtJ 

Bf.  el  in  chart  no.  x^  dir. 
S. — One  ererj  two  huun,  nr  vrcnr  r<rar  hotin  itlUrrnaiiiix  with  the  opium  and 
biamuth  miitur*. 


CDOLRIIA    I>rPAS7rM. 


113 


Tory   fnyinont  aud    serous    sUtoU  tlomaod  more  powerfiil 
astringenla ; 

9     Acid,  silph.  arain, n)C  ssiv 

IJ^.  mcrphiB  ailpli, ••... 1^  j 

£)ijc.  cora^oK, 'SU 

Ac|u«s  <).  1.  ad, tlM} 

H.    6.— 0»e  MHpoonftil,  dUtil«d,  vnrf  two  boon. 

H^;ia1  injections  are  very  useful,  and  may  be  the  only  avail- 

Me  loeauA  of  medication. — Three  drops  of  laiidiuuiin  may  be 

given  every  six  houre  or  oftf  ner.  wlieu  tlie  ftymi'toma  are  dysen> 

teric ;  or  nitrate  of  silver  when  the  otoolit  are  oerouH  or  contain 

ninuuA,  blotiil  and  }>ux^    Smith's  formula  is  a  good  one : 

B     AtgeMl  nltnL, gr.J 

Biamath.  aabniL, SJ 

Mtidl.  »cac^ 

Aqiia, U    S<* 

M.    6'^Far  oiM)  i^fccUon.    Rspcot  in  Iwctre  bxnn  if  aacMMrj. 

These  injections  must  Ire  preceded  by  eiieniataof  warm  water 

I  clear  oot  the  bowels,  and  mast  bo  diBcontinued  for  twenty-four 

3ura  every  third  or  fourth  day.     Inturtrigo  demands  the  keeping 

'of  the  partA  dry  and  clean,  and  the  use  of  zine  ointraeuL 

Progtrntion  call»  for  stimtilant^     Wine  of  pcpitiii,  whiskey 

good  brandy,  are  to  be  uimxI.    The  doee  must  he  reguhited  by 

the  nge  and  the  depression.    In  cases  which  ret-over  tho  diet  and 

hygiene  must  be  watched,  the  astringents  gradually  dropped,  and 

digestants  and  tonics  substituted. 

In  cholera  infantum  he  recommends  that  uuming  infants  be 

allowed  to  nurse  for  a  Tt-vr  minutes  only,  every  half  hour.    For 

older  children,  or  tho^c  brought  up  on  the  bottle,  he  r^xx)nunenda 

one  of  the  following  foodii: 

B    MUk, fSm 

Ckmb, tlm 

Lime  water ' S  U* 

Milk  augftr, 5j 

Mix  Id  »  dtao  ttitcup,  pour  iuto  botUe:,  luljiM  Up,  and  wuia  hj  plnngiiv 
.  into  Itot  water. 

5     Milk, fji^j 

Cream •..>•... f^  m 

MelUna  (bod, jy 

Hv(  wsu>r, n  Um 

DiMolve  the  McltiD'a  food  in  tba  hot  water,  add  ibe  milk  and  cnun,  aad  If 
f,  warm  as  before. 
H 


114 


HAKDAL  OP  THBATMRNT. 


B    Milk 


■ffUi 


Hodf-bftU, 5j 

Water, f  J  y«i 

Tlie  flour-ball  is  prepared  hy  t^ing  a  few  pounds  of  floor  up 
tightly  in  a.  cloth,  and  boiling  it  in  a  pot  of  water  for  twelve 
hours;  then  removing  die  «--lotli,  jieeliiig  nl!"  the  oiitwiile  coaling 
which  has  been  wet  and  grating  down  the  hai-d  ball  of  flour  a^  it 
is  ucctUd.  It  muat.  be  kept  i>ei-foctI,v  dr)',  and  in  a  lightly  cloned 
tin  1k»x,  when  not  being  used. 

'^\^icn  railk  preparations  do  not  agree  he  gives  whey^  atrip- 
pingfl,  or  beef-jiiice;  and  if  Ihese  fail— 

B    Flour-UU,. SU 

Water. .....fjij 

Mis  and  add  half  the  white  of  a  Creih  tgg. 

The  foods  should  be  given  In  aach  quantities  as  can  he 
retained,  and  at  infenraU  corresponding  to  the  amount  taken  at 
one  time. 

To  check  the  diaiTliea  he  gives  opium  and  astringente. 

B     Moqihiniv  Bulj>h.i K^-  i 

Acid,  sulfih,  orom, n)(  xxiv 

EUj,  mirapoo!, f  J  « 

Aqutt,  n.u, ad    f  S  Uj 

IC.    8^A  Uuui]>uunrul  cnrj  two  hour*  far  a  diildrix  month*  old. 

To  this  he  adds  the  administration  ever}'  three  hours  of  an 
enoDia  containuig  two  droj^s  of  laudatmni  in  two  tca«poonfuU  of 
elarch  water.  Two  or  three  times  daily  a  planter  consisting  of 
one  part  of  muatard  to  five  parte  of  flour  must  be  applied  over 
the  whole  surfaee  of  the  abdomen,  long  enough  to  redden  the 
akin.  Tlie  body  should  I)e  uponged  neveral  time*  a  day  with 
warm  water  (96*). 

The  clotliing  and  jiorHon  nuiHt  bo  kept  i>erfectly  clean;  the 
8tck  room  mu^t  be  lurgc  and  nir^',  and  the  hitant  must  lie  in  bed. 
If  powible  the  child  nhould  be  sent  early  t«  the  shore  or  the  coun- 
try. Failing  in  this,  it  Rhonld  be  sent  mit  in  a  coach,  morning 
and  evening,  or  on  the  water,  every  day.  Stimulants  are  needed 
from  the  first  to  ward  off  prostration.  Five  to  ten  drope  of 
whiskey  in  a  teaspoonful  of  lime  water  may  bo  given  every  two 
or  three  hours  to  a  child  aged  six  months. 


OBOLSBA    IKFAKTCU. 


lU 


When  ooll&pse  seU  In  the  quantity  must  be  incressed. 

H    8pu  frnoMiDti, fjM 

AiDiBoii.atTb.,. (r.  xxIt 

8yr- •(•«•, fj  j 

Aq.  iDcatb.  pip^  q.  o- ad    f]  ii) 

M.    8.— A  IcMponfljl  pro  n  uu. 

The  tempenitiire  miut  lie  maintained  by  hot  flannels  and 
vater-bottlus,  aud  the  child  kept  Id  a  recumbent  poeturo,  and  dis- 
turbed »A  Httlfi  aa  pocHible. 

Astringenu  are  still  usefal  in  this  stage,  hat  opium  must  bo 
used  with  great  caution,  or  discontinued  if  there  are  cerebral 
sjrmptoms  ajid  aemi-conm. 

Looms  says  thiat  the  trcatmcut  is  mainly  prophylactic.  Th« 
eetabli»bment  of  seaside  sanitaria  for  children  in  summer  is  the 
moit  important  advan<re  nuide  in  the  management  of  thiii  disease. 

lie  gives  a  few  drop*  of  brandy  in  a  little  barley  water  at 
the  outset,  and  insists  on  the  child  being  kept  in  ImkI  in  the  hori- 
zontal position,  as  long  as  the  vomiting  continues.  The  only  drug 
he  haa  fottiid  eflicactoiiB  in  controlling  the  vomiting  is  calomel^ 
which  nhould  he  given  dry  on  the  tongue,  gr.  ^,  every  hull'  liour. 
Bismuth  and  calomel  are  efficacious  wlion  the  stools  contain  much 
mucus. 

If  diarrho?*  porai8t8  after  the  vomiting  hnA  ccnsod,  he  gives 
five  to  ten  dmpa  of  |»regoric  every  two  hours.  For  exi-»wivo 
purging,  great  pro^trntion  imd  but  little  vomiting,  lie  gives  cam- 
phor and  brandy. 

Tlie  vegetable  a*tringcnt«  are  of  »ervice  to  control  the  diap- 
rhett  which  follows  a  severe  attack  of  cholera  irifantuiu. 

During  t-onvalescenoe  he  reutmtniendH  witie-whey,  cod.livor 
oU  and  the  phosphates  externally  as  well  an  by  the  mouth,  together 
with  a  resort,  to  the  (wapshore,  and  wait  water  buth!«.  Flannel  8hould 
be  worn  next  the  skin,  and  great  care  exercised  to  prcvetit  capiU 
laiy  brouchitinf  which  carrioi  ofl'  luuuy  convalauentn. 

ITARTituoiuvB  agrees  with  all  otbera  &&  to  the  Importanc*;  of 
eea  air,  whirh,  ho  sayg,  will  often  cure  without  other  treatment. 
But  if  tlie  food  be  IhmI,  or  the  water  bo  eontamiiialed  with  pri\'y- 
poison,  the  soa-nhore  will  not  prove  benelicial. 


U6  SXmjAL  OP  TRBATMBKT. 

If  a  mountain  resort  be  more  convenient,  it  will  answer  almwt ' 
an  well.  Anv  nitMlorutcly  eleviitcil  locnUry  out  of  the  city,  withj 
gtxxl  milk  and  pure  water,  is  iufinitel^'  preferable  to  any  part  of  J 
the  city. 

If  children  canuot  be  taken  from  the  cifjr,  they  should  be' 
taken  tu  the  purk,  the  oihjh  wpuirCM,  or  on  the  wattr. 

Iii&nte  should  not  be  weaned  in  the  hot  monttia, 

IIu  niakoH  the  valuable  suggt-atioii  that  whwi  voniilirig;  is  ob- 
stinate, all  footl  and  drink  i^hould  be  witldicid  for  six  to  ten  boura.  _ 
TfaiHalluwH  tlic  etomacb  to  rcet,  and  rid  itself  of  aocumulationK.      I 

Ice  is  the  best  remedy  for  thirst. 

Tlio  gums  may  require  lancing,  if  swollen  and  tinged  with 
blood,  with  the  ci-own«  of  the  teetli  near  the  surface,  and  if  ner- 
TOna  irritation  be  evident.  ■ 

Cool  baths  are  very  boneticial ;  placing  the  child  in  water  at 
86°,  and  gradually  reducing  the  temperature  to  75°.  Ton  minutes 
18  long  enough,  and  the  batli  may  be  repeated.  ^ 

If  the  rcct*l  temperature  be  very  high  while  the  cxtremitiell 
are  cold  and  shrunken,  cold  enemata  may  bo  beneficial.  1 

To  relievo  the  gastric  and  intestinal  dietroaa,  he  ases  apioe 
poultices  wet  witli  whiskey. 

Ho  uee8  calomel  in  the  oarly  etngo,  wh«n  diarrhea  ie  not  ex-  _ 
oesaive.     Doue,  one-twelfth  of  a  grain,  four  timet:  daily,  with  inag>  I 
ncflia  or  Roda,  and  ginger.     Ke  dinnpproves  of  emelies  and  cathar- 
ticfl,  but  iitid»  aromatic  tiynip  of  rhubarb  useful  in  the  early  atagee 
aa  a  oorrective. 

When  the  diarrhea  ia  exhaustive  and  re»itle*wiice8  wearisome, 
especially  at  night,  he  gives  five  to  ten  drops  of  paregoric,  or  a 
tea»iioonful  of  camphor  water.  If  the  diarrliea  should  not  yield 
to  thin  treatment,  he  give«  tincture  of  eatcclio,  or  the  following : 

6     Pulr.  gulls  ope,, |n 

P)ilv.  drnamam., ....5  Q 

Putr.  Einf;il>«r, }■ 

8p.  viai  Gallic, O  ■ 

Let  it  stand  in  a  warm  place  for  two  hours,  then  bum  off  the 
brandy,  holding  some  Uunpu  of  tiugur   in   the   Hamea.    Strain 
through  blotting  paper.     Doee,  Hfteen  to  forty  drops  every 
or  four  hours. 


CHOLBBA    INFANTtlM. 


117 


Nitrate  of  sitror  lias  proved  tuefiil  whoo  given  hy  enenui; 
one-U!i)th  of  tt  gniiit  lo  an  ounce  of  wuttjr. 

Acetate  of  lead  should  be  reserved  for  cases  where  a  positive 
astringent  effw^t  is  requiretl  hv  long  continued  diarrhim.  Alcohol 
must  be  used  with  the  same  caution  as  opium.  The  time  ibr 
fltimulaois  is  wlien  co1Ib|mu  ihreateiu,  or  when  the  titrcugtli  begins 
to  fail.    Thejf  are  best  given  in  food. 

Da7IS  eays  tbat  in  the  curly  stage  of  mild  cases,  witii  tUin 
Btoola  and  lassitndc  with  lAbnetiii  he  gives: 

H     Add.  hf  drobramio.  dil^ 

Elix.  nmp ..• 

Tr.  opLi  Gunpb., U    f  5  ij 

IL    fL— Six  to  ten  mtnJitwi,  Iwlee  to  foar  dnes  dsllj,  tii  tveeteoed  water. 

Tf  bile  t>e  aliaetit  from  the  itaasages,  and  the  uriuo  scajity, 
be  gives  one  of  the  following  powders  twioo  daily : 

B      JljdimT^.  olilor.  fflilii^ V- '(} 

Bodii  biorlxiDAt -gr.  vj 

Racch.  Uctis  pnlv, ^m 

H.    «t  IB  cb&tt,  no.  XV  Ait. 

S< — To  be  diaoooUniwd  «ih«i)  the  Btoola  beoome  jellow  or  graeo. 

Wlien  the  diHcaae  has  tautod  one  or  two  woclu  and  the  stools 
are  sour  and  cafieous : 

B     Add.  carbolic,.. (r.  ly 

<  OlTWrin., rsyii 

Tr.  opiL  campli., f  Jj 

Aqufe  cinnam., f  S  Jm 

U.    8. — Tea  minim*  In  a  little  titeMened  water  Kvmj  tout  to  elcKt  houra. 


tn  the  iMvere  attacks  known  aa  true  cholera  tufatitum  he 
gives:— 

9     Bodii  binarb., 5  j 

Iforpbiluc  fiilph., Kr.  j 

Aquff, f  $  ij 

11.    8.-^U  to  Rfleen  tnioinw  imutNliBlcly  after  owh  act  of  votniting. 

At  the  same  time,  if  the  stooln  are  fret^uent  and  very  tliin, 
be  gives  one  of  the  following  powders  every  four  hours  until  the 
BtooU  are  le«weuod : 


118  UAIOIAL  OF  TRBATMBKT. 

B     H/drwy.  diiOr.  mitii^ IT*^f 

PluDibi  iiccut.^ S^-Q 

Pulf.opii ff.j 

SBGdi.  alb, gr.  xxx 

H.    B. — For  ■  cliild  sis  montlia  old,  divide  into  tweUe  powders. 

It  ia  of  great  iniportanoc  to  give  the  mcdicmea  immediAtelj 
after  romititig. 

Some  eases  occur  which  ehow  too  mnch  bile  in  the 
Por  these  the  formula,  containing  carbolic  acid  is  efficient. 

If  the  urinary  socretioD  be  deficient: — 

ft     8p.  Stlt.  oilrcM., fSiT 

TiacL  digluaiv fSj 

Syr.  simp fjlr 

Ar]u» r|  Q 

PoUiu.  ivet&L 3  Mf 

H.    S.— Tl^a  miniins  erory  twc  to  (bur  houn. 

Sometimes  the  active  symptoms  of  the  limt  stage  pass  away,J 
but  a  low  grade  of  fever  in  iett,  with  [lain  before  the  pasttag 
which  latter  consist  of  feces  mised  with  mucus.    For  tliis  condi-] 
tiou  he  uses — 

ft     Ol.  terebinth., fSifj 

Ol.  piullh&riR, f  3  ■ 

Tinct.  opii,. tHH 

Mucil.  ftcoe. 1^  ir 

6aa:h.>lbq f  3  ir 

Sub  Uioroughlj  together  and  add : 

Aqua, f$m 

M.  K — Shtkc  th«  TlaJ.    Tennlnima  evefy  three  to  dxhaun  until  tbediKhLi^ 
becoiu«  natural. 

When  the  diarrhea  becomes  chronic  but  without  dysentciiaj 
mucus  or  straining — 

B     PltloriJiiti., 5  K 

S|>- smmoD.  arom., .....f5j 

Tr.  opii  umph., .>•••■»■*.•  •••■fSJ 

Sjrvi^ f|« 

Aqoi^ :  ...f|bi 

H.    8. — F!ft<«D  tnininu  foiir  Liroei  a  day. 


CBORI>BB. 


119 


In  very  protracted  caws,  vnth  flnemia— 

B     Quinuiv  Unnnl^ S^- >U 

Pulr.  opii,- ifr.ij 

HjA.eam  cret, f-^ 

BKch.  ftlbi, gr.  XX 

M.    Div.  in«hut.  na  *j. 

a— Om  al  b«>d  tim4s 

With  thU  he  givee  the  liqaor  ferri  nitratU  three  times  daily. 

The  ununuul  number  of  prvM^ripiionN  given  is  expluiiKn]  by  Dr. 
Davis  OH  the  ground  of  the  varj'lng  t-horacter  of  the  dueaae,  and 
tlte  importance  of  folluning  cloddy  the  itiilitatioiui  in  each  case. 

Barthoi^w  I'suitmis  against  allou-ing  the  child  from  tliirat 

to  overload  ite  etomach  with  unneceswry  footl.     To  phe<;k  the 

vomiting  and  jmiging,  and  l<««eii  the  fever,  he  givwi  brandy,  in 

of  twenty  minima  to  a  drac-hm  every  two  to  four  hours. 

Zinc  and  silver  are  uneful  when  the  diarrhea  prevaiU,  while 
for  exeCBUve  vomiting  he  prefers  calomel,  in  small  doees.  If  there 
be  much  straining,  with  mucouH  f.t6a]n  streaked  with  blood,  he 
givoe  Fowler's  wlution,  J  to  J  drop,  with  half  to  one  drop  of 
laadanuni  every  three  huure.  Very  profuse  diwrhargtM  require 
enemas  of  laudanum. 

^^P  CHORDEE. 

^^^^  BCTKE1.BT  Hill  roconuneude  nbetinonce  from  stimulant*  of 
^^^  kiiidd  and  from  late  auppcrs ;  light  clothing ;  and  a  hard  mat- 
^^^ren  at  night,  a«  the  best  means  of  preventing  chordee.  The 
bladder  should  be  emptied  frequently  during  the  night.  The  li«t 
medicine  ia  a  supposit'Ory  of  one  grain  of  crude  opium  at  bed- 
time. Or,  ono^ixth  of  a  grain  of  acetate  of  mor|>hia  may  be 
injected  into  the  perineum.  An  a]>erient  wline  tiliould  >w  taken 
^w|MXt  morning.  A  dmehm  of  tincture  of  camphor  at  IxKltime, 
^^ncp^ted  in  the  night  if  chordee  comiM  on,  in  an  uncertain  ixmiedy. 
"       More  truutwortby  ib  a  doee  of  chloral,  gr.  xx-xxv,  at  bedtime. 

Bathing  the  genitals  witli  very  hot  water  for  ten  minutea 
before  going  to  bod  somctimea  proves  ^ueccneful.  To  disperse 
an  attack,  the  best  remediea  are  voiding  urine,  applying  cold  to  the 
perineum,  and  tttanding  upright. 


120  UANUAt  OP  TRBATUBNT. 

Lesbrt  ordero  the  foltowiug : 

S     Ciiinphanc^ 

Lu]mliiue, U    gr.  xlv 

ExL  opLt gr.  IvH 

ExL  gl^cyirh^q. 

91.    Fttnu.  ti  in  pi\.  xxz  dir. 

S-^Two  or  tlirw  nt  bedtime. 

Bromide  of  potash,  t«i  or  fifteen  graiue  ut  bedtime,  oft«a 
gives  a  better  night's  rest. 

J.  W.  White  says  that  the  most  effective  of  all  preventive 
mWMires  in  to  wx^ure  n  Tiinvement  of  the  bowels  before  retiring. 
Monobromide  of  camphor,  thrco  to  five  grains,  is  a  most  useful 
remedy;  lupulin  in  twenty  grain  doses  \c  a  valuable  sedative  to 
the  genital  organs,  and  gcWTDiiim,  in  ton  minim  doses  of  the 
fluid  extract,  re]ieated  every  time  tlie  jiatient  waken  with  chordee, 
has  proved  eitpeniely  efficacioue.  None  of  these  remedies  are 
BO  effi(;aciouii  a«  bnnnide  of  i>ota>«iiim.  It  nhould  he  given  till 
decided  drowsinew  is  produceil.  It  should  be  given  during  tha 
day,  with  It  double  dose  at  bedtime,  iwrliaiis  witli  belladouna. 

Henry  Lke  says  tbiit  tiio  niowt  effective  remedy  is  a  Buppoai- 
tory  of  one  grain  of  opium  and  three  of  camphor,  nt  bedtime. 

Milton,  in  hia  carefully  prciiarcd  eha{)tcr  upon  the  treatment 
of  this  affection,  eays  that  eedativeft  are  objectionable  imlcM  there 
is  pain  hi  the  testicle  or  perineum ;  as  they  disorder  the-  stomach. 

After  trying  eveiy  antispasmodic,  he  finds  nothing  equal 
to  camphor  in  the  fluid  form — the  spirit,  in  drachm  doses.  The 
chordee  ehould  be  cured  as  quickly  aa  possible,  and  this  can  bo 
best  done  by  giving  the  full  dose,  repeated  several  timed  al  abort 
interrala.  A  teasjioonful  may  be  token  on  going  to  hod,  and 
repeated  every  time  the  patient  waketi  with  chordee.  It  may  be 
taken  in  water,  or  better  in  milk. 

Sometiiuef^,  when  the  [latieut  doee  not  like  camphor,  ha  uses: 

9     PotM.  bromid, fr.zx 

Chloral  IijdraL, gr.  r 

8p.  vini  Uftllio, Q  ij 

EiB.  cumplioncp 13  m 

Aq.  luenth.  p^. t%  g 

U.    BL— At  bodtiiM. 


OltOABA. 


CHOREA. 

After  (ynii»vl«'ring  tlic  qnwtion  of  tlie  eclf-lirnitotion  of  Ihii 
diseaae  Vox  Ziemsse?<'  couclud«s  that  ttvutnamt  U  of  decided  ilk 
and  often  dinKrtly  curative.  He  goes  on  to  reinnrk  thnt  the  entire 
Rgimeu  must  be  rejculatcd  with  care.  The  child  iiiiu^t  be*  taken 
from  achool,  and  nil  head-work  ut  huine  niu><t  be  stoppec].  It  is 
very  uaefbl  to  speud  a  long  time  in  the  country  or  at  the  seaehupa 
With  the  poor  the  effect  of  hospital  trmtinent  ii*  very  good. 

But  the  course  of  chorea  is  seldom  affect^  by  theae  rneans 
alone  The  IwmI  sbould  1>o  abundant  naid  t^trong,  and  the  child 
should  be  iu  the  open  air  a^  long  am  possible.  Sleep  U  most  im- 
portant, and  if  ordinary'  mean!*  fail  to  iwcun^  it,dhloTaI  should  Iw 
gtx'en.  This  drug  is  of  extraordinary  value,  e8[iecially  when  the 
jerkingD  prevent  or  accnmpniiy  Hleep.  It  is  Honietimcs  well  to 
pTDCOre  a  feu-  hour*  sleep  during  the  day  by  it«  uoe,  whon  the 
pftticDt  is  exhau))te<l  by  intentie  jerking.  Exercise  must  be  regu- 
lated by  the  nature  of  the  case.  When  the  chorea  is  violent  in 
the  trunk  and  limbs,  walking  must  lie  forbidden.  Qymiuu^ties 
should  be  postponed  till  the  declining  period.  Such  exerciHeit  are 
not  to  be  used  in  symptomatic  chorea. 

Anenic  i»  far  from  getting  the  crodit  it  deserves^  mainly 
because  the  doae  ^ven  is  inade([uate.  He  gives  five  to  eigiit  tiropa 
of  Fowler'A  flolutton  to  cliildren,  and  up  to  twelve  dropa  toadulta, 
thrice  daily.  If  gaatric  disturbances  follow  its  use,  the  drug  may 
be  suflpended  for  a  favr  day^  and  then  rcHumed. 


I 


R    Llq.  pottu.  aiwnilii, f  3  ij 

Aiom  cinnArnomi, ,...,,ftd    Oj 

8.— f  I  a  to  rS  J.  tbrivc  Aax\j. 


Tie  does  not  recommend  the  hypodermic  ubo  of  arsenic,  a«  the 
paiii  is  loo  severe,  lie  quotys*  Strlskk,  who  obtained  good  results 
fit>m  Bmaller  doses  of  arsenic,  by  using  the  following: 

9     Lu).  potM.  nrMoitf ..,..gtLvlfj 

Tincl.  apiv S^TJ 

Aqw rjif 

&.'—{$  m  fbiu  tiiDM  dailj. 

Ziemuffien  further  states  that  the  favorable  action  of  arF«nic  is 
Qsnally  manife«t  in  a  week,  and  two  weeks  suffice  to  nxluee  the 


U2 


HAXUAL  OP  TRBATHEHT. 


I 


I 


Bjmptome  to  a  miDimum.  Id  some  obstinate  ca«es  arsenic  suo- 
oeeded  after  iJie  failure  of  hrtiinicitw,  zim;,  electricity  and  hydro- 
patJij.  Theee  caaoe  were  all  idiojMithic.  He  ia  iiot  6o  *urc  ihat 
sinciiic  \A  a»  uxeful  in  Hjmptdniatic  chorea.  His  careful  trials  of 
bromide  of  potash  ahowed  it  Ix;  ti.-cful.  The  use  uf  atrychiiiahao 
ceased  since  Ssft's  cntieii«ni.  Chloral  i^  not  needed  iu  any  bat 
the  worat  caao9,  Ue  givea  it  tlicn  In  doeca  sufficieat  to  inaare 
Bleep;  fifteen  to  eighty  grains  at  ouee.  Chloroform  has  been 
Bupereeded  by  chloral  ui  the  treatmeut  of  chorea.  Electricity 
proved  uselees  in  his  hands.  Hydropathy  was  of  doubtful  beoefit, 
apart  from  its  effect  on  the  general  health. 

To  prevent  relapses,  Ziemnesen  recommende  a  long  residence  at 
tlie  coaat,  in  the  country,  or  among  tbe  mountains;  with  the  oso 
of  salt  baths,  social  stimulus  and  careful  avoidance  of  social  and 
bodily  evils. 

BoncniJT  rHport«  487  cases  treated  with  eaerine  sulphate  (gr. 
n  to  la  for  a  child  seven  1o  twelve  years  of  age),  given  for  a  long 
time.  He  ntaites  that  by  thw  drug  chorea  wan  cured  in  an  average 
of  ten  days,  but  ZieniAeieu  oxpreases  the  usual  German  doabt  of 
any  result  obtained  by  a  Frenchman. 

Wharton  Sinklkr  adds  his  voice  to  the  utroug  tentimony  in 
iavor  of  arsenic  He  give«  it  in  increasing  doaee  until  toxie 
effects  are  manifest,  or  convalescence  is  oi^tablifihed. 

Patients  often  iKicoinc  worso  for  some  days  after  arsenic  is 
given,  but  improvement  begins  in  about  a  week.  He  claims  that 
the  hypodermic  nsc  of  arsenic  succeeds  when  its  internal  admiuis- 
tration  fails.   He  has  seen  dmiolAiga  do  good  where'arsenic  failed. 

Gftlvaniziition  of  the  epine  produces  a  quieting  effect  in  some 
cases.    Inm  is  always  of  use  in  chorea.    Ether  spray  or  toe  to  the  ■ 
epine  for  ten  minuter  once  or  twice  daily  sometimes  assists  other 
means.    It  is  of  the  greatest  value  in  bad  cases  to  put  the  patient 
in  bed  and  keep  him  there  until  hotter. 

ZiEDLKR  reported  some  remarkably  speedy  cures  in  csaes 
traated  by  contineinent  to  bed,  and  tlie  iahalation  of  amyl  nitrite. 

Van  Bibber  added  to  i-est  in  bed,  the  influence  of  darkeniug 
the  room,  wit)i  advantage. 


CHOREA.  ^^^  123 

6.  WBia  MiT(fUBi.L  nwA  mVicylute  nf  wxla  with  bdomw. 

PBiLUPi)  recommoiidtMl  tiia^^Mtgc  &u<l  ffec  feeding. 

RoBEKTS  Btat«H  tluit  lie  has  found  no  one  remedy'  Hiiituble  for 
kll  cwetij  but  wtecta  odc  or  the  other  in  diflcrcnt  c-aites.    If  the 
'motions  Iw  verj'  severe,  he  suggest*  tliat  tint  {mtivnt  aluep  on  an 
_air  or  waU»r  lied. 

TaoceSBAO  speaks  favonibly  of  the  influence  of  gymnaetica. 
,Tbc  patient  should  koup  time  withaiiotlieri>crson(irwilli  :t  irl'-ik. 
le  exercieee  should  lai^t  half  an  hour,  and  be  repeated  daily.  It 
also  foutal  be^t  that  ttiu  i^xc-iviKC  tthould  be  participaToI  in  by 
>Lber  children  ;  the  influence  of  cla^  gymnastics  being  preferable 
to  t}io0c  i>erformcd  alone.  In  some  ousca  he  approved  of  the 
treatment  by  tartar  emetlB.  Kour  praine  were  given  on  the  first 
day,  eight  on  the  second,  and  twelve  on  the  third.  The  putient 
vaa  tbeo  allowed  to  rest  for  lour  <Uya.  If  neces^ry  the  drug  waa 
rosumed,  giving  five,  ten,  and  fifteen  gmin-i  in  three  days.  If 
after  another  interval  of  reel  the  Hyniptonw  perxist,  the  dnig  is 
reeamed ;  being  given  in  doece  of  six,  twelve,  uud  eighteen  grains. 
Bndt  a  treatment  in  only  to  be  uaed  in  the  most  severe 
irfaieh  have  rceieteil  ordinary  troiitment,  and  when  deittli 
ktened  fVom  the  violt^ce  of  the  diiuaM}.  Ilitt  favorite 
remedy  wng  sulphate  of  strychnia.  He  gave  it  in  dmea  of 
gr.  ^,  at  equal  iutervalH,  Lvvu;e  a  d^y.  iitcreiuiing  to  ^ix  tiiuis  a 
day,  if  well  borne.  Then  the  doe-L'  vni-i  dnnbled,  gr.  i,  being  given 
&Ke  to  six  timee  daily.  Then  gr.  I  was  given  at  one  of  the  six 
do«ef>,  thi.ni  III  two,  and  »o  on  until  six  timcK  daily  thii>  enormooa 
Io6«  was  administered  to  a  child  ! 

Tlie  treatment  wa^  [wniitfted  in  until  the  patieiit  wag  tetan- 
ced.  Tlii-oughnut  the  ease  the  effect*  of  the  drug  must  he 
irefutly  watohed,  oa  they  vary  in  different  caws. 

Taknrr  riays  that  the  two  great  remedies  arc  the  cold  shower 
douchf,  and  iron.    In  oUitinate  caacii  he  gives  arsenic,  xine,  or 
^arriah's  f<KMi  witli  the  chalybeate. 

Ebb  states  that  by  the  use  of  electricity  no  good  lias  been 


194 


MANUAL  or  TBBATHKNT. 


eff<Kt«d  in  old  cusfx  in  adults,  while  recent  choreas  in  childreo 
hftTC  bcou  (iucidedly  b«uefit<.il  aud  ekortcticd  in  many  ca«ee. 

lie  applies  tlie  large  electrodes  so  as  to  bring  the  motor  rogioos, 
directly  bctwooii  tliom;  the  a:iode  to  tJio  centml  oonvolutioua,  the 
cathode  to  the  opposite  3i<le  of  the  neck.  A  foeble  corrent  is 
transmitted  for  half  to  one  minute,  from  four  to  eight  c«Hb. 

Bgivihb  placed  a  bifurcated  anode  on  both  parietal  regions, 
and  the  cathode  to  the  hand  or  the  back,  and  continued  the 
application  for  five  or  ton  miriutea. 

I  n  addition  galvnni nation  of  the  mj'mpathetic  and  tho  oerrical 
cord  may  bo  iwrfonncd  to  produce  indirect  catalysia. 

ToBNBO'LL  obtained  good  roanlte  from  the  use  of  aniline 
Bulphate,  5  to  8  eontigramnies  thrice  daily.  Wlien  thin  drug  has 
been  long  used  it  pi-oduooe  an  alarming  diiwolomlion  of  die  lips, 
tongne,  nails  and  handi«,  anil  even  of  the  skin  generally.  Wlieil 
the  drug  is  discontinued,  for  one  day,  the  color  disapiieara. 

KesENTQAL  spoake  tavorably  of  ^Ivauization;  a  stabile  oup- 
i«nt  of  niodcrat«  intensity  being  passed  from  the  spine  to  tlie 
aJfected  parts  for  three  to  five  minntee.  He  also  reoommeoda 
moixt  packs,  followed  by  hnlf  baths  at  'Z2°  C,  gradually  cooled 
to  1S°  C,  the  body  being  frequently  douulied  and  rubbed  during 
tlie  whole  procedure. 

PuTZEL  waniB  us  ognitiBt  continuing  the  use  of  chloral  too  long, 
as  it  gives  rise  to  bad  after-efteot**,  eep&tnally  anemia. 

H«  usee  such  tonica  as  arc  indicated  in  each  cose ;  such  as 
ood-livor  oil,  simple  bitters,  or  iron ;  but  gives  none  of  them  as 
apecifics. 

Oray  and  Tuekwelt  found  ihe  average  duration  of  their  cilflHH 
to  be  sixty-nine  days,  when  treated  on  the  expectant  plan  alod^^l 
Begbie's  cases,  treated  with  anwiiic,  averagetl  about  seventy-three 
days.  B^'«  average  in  117  cases  treated  vnriously  was  the  i»me 
as  Gray's.  Putzel  favon*  the  arsenic  treatment,  with  chloral  and 
bromide  together  for  violent  cases.  lie  has  found  improvement 
in  the  symptoms  following  the  inhalation  of  amyl,  but  after  the 
finit  two  weeks  the  disease  i-uns  the  usual  course. 


'Cnxare  Im**  iirovwl  sucw>a^Jii1  iu  a  few  casw  of  eborea  in  old 
^e.  Uue-leutU  ol~  a  grain  is  givi'ii,  l)yjHirl«niiti»Ujr,  o^  when 
giron  by  the  month  it  U  oliiuiiiat^d  so  quickly  tliat  tio  eflert  is 
}irodui?ed  ou  the  iic>t%'ou»  system. 

If  otJier  lUeanrt  fail  to  control  tho  motiomi,  inlialalion-s  of 
chloroform  muftt  be  Uised. 


n 


* 


HexocB,  b^l'lcs  chc  dec  of  ai>icnti?  and  rhloml  oe  recommended 
by  Zie«x«st'ri,  ^'caku  (avorably  of  purgatives,  if  the  i.>atieDts  ar» 
Dot  anemic.  lie  adminivitcra  tlicm  at  tirat  for  two  days,  mid  thou 
dwcoiitiitucct  arsenic  one  day  in  each  week,  giving  castor  oil  or 
seiuui  instead. 


• 


NiBMBYRR  Miys  thtit  vrhcn  rlieuraatiam  compHcatos  chorea, 
baUi»  of  Butphuret  of  potaesium  (  S  j  to  Cong,  x^)  are  afi  much 
indicated  an  iron  ih  in  anemic  nwea.  Wlicnevcr  the  venehne 
are  Bcnsitive  to  prewure,  cupB  or  leechee  should  be  applied  along 
the  fipine. 


» 


Radclipfb  speuk.t  verj*  favorably  of  the  iodidfl  of  iron,  l>e- 
lieving  that  both  elements  contribnle  to  the  good  effects  He 
qaotei^  Barlow'B  recommenilatinn  approvingly,  to  treat  ordinal^ 
oife*  hy  kwping  the  hoivoU  freely  open  and  giving  sulphate  of 
zinc,  in  doi«eii  gnulually  increai«ed  from  one  gniin  to  twenty,  until 
it  cauaei)  aickneas  or  the  Hymptom^  are  ameliorated.  The  Einc 
shonltl  then  Ix^  gnuluully  decriiiMil.  He  mentioim  oeverul  cases 
which  were  l^netit^d  by  the  free  use  of  alcoholic  drii.k^ 


* 


Broaddbnt  t^ixakrt  favoraMy  of  the  xuw  of  tartar  emetic  in 
tboee  terrible  caaett,  ha]>pily  rare,  where  all  ordiimry  tn-atntunt 
foils,  and  life  is  enilangcred  by  the  violmice  of  the  movementa. 


Davis  gives  two  grains  of  valeriaiiaie  of  zinc,  in  coated  pill, 
foar  times  a  day  j  and  in  addition,  Fowler's  •olution,  nt  iij  to  v, 
in  a  tableflpoonful  of  water  alt^r  each  tiieul.  Iu  twenty  years  be 
met  fe<r  cnecs  which  did  not  yiehl  and  Ix^'ome  o<invalc4cent  in  two 
to  three  weeka.  If  the  patient  be  unusually  re^tlctM  ut  night,  a 
dose  of  valerianate  of  ammnnium  nt  iM^ltime  will  secara  rait,  and 
tribute  to  steady  the  miwelefi  during  the  next  day.    A  mixture 


128 


MAHUAL   OP  TREATMBKT. 


of  chloral  and  bromide  of  ainiuoniun)  is  also  effectual  for  the  fisme 
purix^w.  In  very  severe  casea  he  uaea  the  warm  douche  to  the 
ocviput  and  spine.  In  anemic  oasee  he  combiDefl  arsenic  with 
lat'topliOKphatd  of  lime  and  Iluxham'^  tincture ;  avoiduig  trou,  a« 
it  tendr)  to  cause  headache  or  to  iiicreaHc  the  movements. 

For  rheumatic  eaaes  he  prefers  salicylate  of  eoda,  with  cimici- 
togtt  and  geleemium.  The  uoe  of  cimicifi^a  he  believes  to  bo 
limited  to  such  cases,  and  in  those  it*  cflicacy  is  increased  by  the 
salicylate,  and  straiiioniuin  or  colchicum. 

Da  Copta  obtained  oioelleiits  effect*  from  tbc  use  nf  bromide 
of  iron.  He  gave  five  graiuH  thrice  daily,  rapidl}*  inciieariiiig  the 
do80  to  ft  8cmplo.  Otbora  have  boon  lew  HiiccGs^ful  with  this 
remedy.  In  an  oWtiiiutt-  ca^e  which  had  iNjoUted  ordinary  meaa- 
urei,  he  effected  a  care  by  the  hypodermic  iiyection  of  hyoscya- 
mine,  gr.  ^  three  timen  &  day. 

Bszrj.  Edbos  reported  in  The  Medicai  World  a  case  cured  by 

the  9ame  means. 

A.  W.  Hamilton  found  phosphorus  and  ixxJ-liver  oil  effectual 
where  all  other  remedies  had  failed. 

Stillk  conniderR  oimicifuga  one  of  the  mn«t  vabmble  rcme- 
die«  in  this  diwase.  H«  gives  it  in  do*M  suffleient  to  develop  its 
constitutional  effects. 


Ri>'oER,  however,  finds  it  only  lueAil  in  rheumatic  cases,  and 
even  then  inferinr  to  arHenic. 

Notwithstanding  this  high  niithoritj",  we  must  wy  that  we 
are  very  [wrtial  to  oimicifuga.  We  have  repeatedly  f'ntind  chorea 
rapidly  disappear  mider  its  use,  when  it  had  rcsLstcil  the  action  of 
arsenic  for  week.*  or  monthn.  It  in  not  eji^y  to  get  a  good  prepara- 
tion of  the  ilrug.  Wlienever  it  is  poiwiblc,  we  make  use  of  a 
decoction  of  the  frcfh  root,  ami  give  it  imtil  decided  »ymptonw  of 
its  action  are  manifeeted.  Of  the  proparatiotiB  in  the  shops,  none 
have  answered  so  well  in  (nir  ImniU  a«  Keifh'B  macrotin. 

IrVe  have  also  found  rest  in  bed  of  great  value,  in  the  first 
part  of  til c  dieco/Kv;  and   in  the  declining  Btagon  we  invariably 


OUTLttBIA  — CI  BRHOSie — COUC. 


127 


order*  coanc  of  light  pyraiiaetic  exercises.  This  should  always 
be  easy  and  i^reeable.  Tiit-  [wtiftnt  nhouM  W  in  a  diuw  of  non- 
dtoruc  cbildreii,  aud  the  cxercihc-  sboiiM  b?  maiie  attnictive  hy 
naMc,  flinging,  and  a  bright  and  tiuttc>ful  uiiirorm.  It  ithould  not 
1»  repeated  more  than  onoe  a  day,  and  should  always  stop  short 
irf  fiitigue.  A  country  Hfe  is  better  than  a  rcaidiaicc  in  u  city  or  at 
aea^ore.  A  diet  largely  composed  of  Iruit,  especially  grapes, 
lian  jimred  bencficinl.  Exi.'^pt  in  one  (^iteof  aymploimiLic  uhurea, 
etlicr  spray  to  the  back  has  produced  no  good  eH'et-te  other  than 
thoite  obtainod  from  the  cold  douche.  The  latter  \i  a  jiowerfiil 
a^eut  in  expenenc«d  lianda. 

Wc  give  aracnic  before  meal«,  well  diluted;  and  use  other 
Ionics  oDly  as  tQdicat«d. 


CHYLURIA. 

TntOTST  Lewis  aays  that  treatment  liatt  generally  proved  un- 
eaiU&ctoiy.  Iodide  of  potash  and  tincture  of  iron  have  aeomed 
to  be  Tuefal  occasionally.  In  Gutana  a  decoction  of  mangrove 
bark  hfta  some  reputation;  while  in  India  the  seed  of  nigclla 
BOtivft,  an  ingredient  of  cnrn-  powder,  lia*  a  local  celebrity.  The 
Utter  remedy  ha?  failed  on  extended  trial.  The  best  rMuIb*  yet 
cbtftinod  have  lH*en  from  (Im  u^e  of  gallic  noid,  i.>ne  to  two 
dimchme  daily. 


CIRRHOSIS— (See  Liver;  Diseases  of.) 


COLIC. 

Getjiuik  OLrvEH  adviitert  that  the  boweU  Khmtld  be  amptied 
by  a  purgative  dose  of  calomel  (gr.  v),  or  rhubarb  (gr.  xi),  with 
a  grain  of  opium,  followed  by  repeated  doaoB  of  xulphate  of 
magnfMia.  with  laudanum  or  tincture  of  henbane  and  apiritM  of 
chloroform,  until  free  action  of  the  bowele  is  obtuiiuMl. 

A  aujiiwaittirj'  containing  half  a  gmin  each  of  mor]>hine  and 
extittct  of  bolludonmt  or  a  hypodermic  of  morphinu  may  give 
immediate  relief. 


128 


MANUAL  OF  THBAniB»T, 


Large  warm  eiicmntft  often  relieve  <iui<rkly.    Other  soitabl 

mowiires  niv  llie  warm  Uith,  friction  with  warm  oil  or  li 
fonientatioEid,  Meamcd  flantieU,  tiir|ieiitini:  atupOK,  6inapiMni«,  etc. 

Davis  ooiumenbi  Htmi)gl_v  on  tlie  ab^iiirditv  of  the  allernation 
of  anodjnw  and  catliartics  in  this  afiection,  and  says  that  the 
lalter  k«e]>  up  the  {^uiin.  He  ntlmiiiistera  aiiotlyneA  until  relief  j 
enmiefl,  and  then  gives  large  enemas  of  warm  water.  If  several 
of  the  latter  fall  to  pfotlui*  evaeuatjons,  and  the  \mn»  ami  dis- 
tension begin  U>  return,  he  ntlviscs  injei-tions  of  ehloral  and  bulla- 
donua,  or  of  iufuBion  of  tobacco,  to  relax  tlie  sjmsm. 

Babtholow  aajB  that  the  flatulent  colic  of  infants  is  quickly 
and  rtafely  relieved  by  bromide  of  iwtaasinm  (gr,  v)  and  oil  ol 
anise  (gtt,  J)  every  half  h'>ur. 

For  inimttdiatc  relief  (in  adult«i)  no  remedy  is  comiiarable  to 
the  hypodermic  injection  of  morphine  and  atropine. 

He  rccommotidtf  <]^uinitic  in  intcrmitlcnl  colic,  iodide  of  potafr- 
Bium  in  nocturnal  colic,  and  for  hyeteric&l  colic  Hofinuiii'«  anodyne 
with  Talcrian.    For  chronie  cntcralgia.  arsenic  is  first  on  his  list. 

Louis  Starr,  speaking  of  the  colic  of  infanta,  insists  upon 
the  importance  of  not  feeding  too  fiw^uently. 

If  the  supply  of  breast  milk  be  dofioiomt,  itmurt  be  supple- 
mented by  the  use  of  artilicial  food,  like  the  following: 
«    Milk, fjii 

Cream, ..fSU 

Barlef-wftUr, fj  y 

C«rawnr'^*>t«r, • ..•••(JJ 

Su^  of  milk, 5« 

Mix  in  a  clean  vckwcI,  pour  in  a  clean  bottle,  and  heat  to  98^. 
If  eoiiB[i]*atioii  he  preneiit,  replace  the  barley-water  by  oatmeal 
gruel,  or  Mellin's  food.  The  body  should  be  anointed  twice  a 
day  with  wanu  olive  oil,  and  enveloped  in  a  flannel  roller.  Xjoug 
woolen  stockings  shimld  be  worn. 

For  the  attacks  of  pain  he  gives  ten  drops  of  gin  in  a  little 
warm  water,  or : — 

B     Soilii  hiiwli.,,.... gr.  zi^ 

Sjrupi, fj  n 

Aq.  nmitb,  pip,  q.  1.  id fj   g 

M.    9.— On«  UMpootiful  u  ntcdcd,  for  ■  elittd  of  one  month. 


i 


ooLic.  ^^^p  129 

III  Mv«Te  caifGrt  two  ctrO[w  of  Hminatic  aiiiiinMiiu  may  lie 
wlded  lo  each  doee,  or  one  drop  of  spirit  of  chlnroforni. 

B     FotM.  bnratid^ BT-xtJ 

Uitanl  hjdniL gr.  tmj 

6TT«i>i, fj  m 

Aq-meaih.  i^p^  q.«.  ad (^  y 

H.    8L— DoM^  (MM  teupoonful  «T«rjr  bait  hour  u  DMd«d. 

This  is  ODiy  to  b«  used  in  scvore  cfl»o».    Should  Uie  paroxysm 
ireaton  vo]hi]i«e,  the  infiint  iiiiiKt  Ik>  phiced  in  a  wumi  bnlh,  then 
ipp«d  in  a  bluiikct,  n  poultioe  with  mustard  applied  to  iho 
abdomen,  and  wunn  gin  ur  hnuidy  given,  and  continui^d  an  needod. 

^The  followin;;  ha)<  been  found  of  great  vahie  in  infant's  colic: 
R     TlncLoialMci , ,....fS  H 
^^                Tinct  opii  mmph., Q  ■ 
^^m                PoUu.  orbooaLr ^ t;r.  kzz 
^K              ejT.  rliei  ftToauU, t$  J 
H^r.  lOKiv,  <).  K.  ad - (^  Uj 
H.    S.— A  teaupoontbl  ercry  itro  hoars  as  aetdcd. 
For  severe  nttAckit  the  wnnn  hath,  the  spiec  jioultice  to  the 
abdomen,  or  better,  a  warm  enema  with  n  few  droiM  of  turj»eD- 
tinv,  prove-  effectual.    Tlic  digestion  will  usually  he  found  at  Jault, 

Kid  should  be  carefully  regnlatctl.    Small  dr»en  of  rhubarb  and 
tecHc,  with  an  alkali,  wilt  hv  found  more  eflicicnt  t))BU  pc^Min  and 
camiinativefi.     In  one  catie  the  attacks  ceaaed  when  the  child  was 
put  ujMMi  a  divt  of  Lattat^'d  FimkI,     In  other  caiw-t*  the  addition  of 
a  liltlc  malt  extract  to  the  fooil  waa  followed  by  cnnij>letc  ct^Mation 
^Bf  the  painful  6ympto»u. 

When  cotistipatiou  (.t)cxiHt«,  a  little  of  Koaaby  and  Matti^on'a 
malt  extract  will  bo  the  beat  corrective,  this  being  eomewhat 
laxative.  If  a  tendency  to  diarrhea  bo  prcecot,  wc  prefer  M&ltiiMf 
or  Wiley  and  Harris'  dry  granulated  malt  extract. 

We  cannot  too  Itighly  approve  of  Dr.  Starr'*  rccommondatioo 
to  anoint  the  body.  Any  animal  oil  will  aiittwer  for  that  purpoae. 
In  one  olx^tinatc  caitc  of  colic  in  a  child  one  year  old,  all  n.>mcdiea 

E-oved  UBclcm,  until  I  dilated  the  sphincter  ani  with  the  fingor, 
hereupon  the  pains  (i'ui*d. 
In  the  oolie  of  adults,  the  beet  remedy  is  the  hypodermic  of 
aiOiphilW.     In  CBSCK  whf>re  thig  iti  inailmimible,  or  unattainable, 
the  iotemal  qkc  of  ether  (f  3j  every  ten  mioutes,  with  but  little 
I 


130 


MASUAL   OF   TRKATMKST. 


wat«r),  or  of  chlorofonn  f^tt,  x,  evcrj-  ten  minutee),  will  prove 
elll«ieiir  eubstUutL-^  Chlorodyne,  in  (kwcn  of  five  to  thirty  dropA, 
and  the  "  hot  (Imps"  rccomniemled  m  tlie article  on  cboicro  morboa 
are  aUn  unelul  reraedie*  in  colic.  Our  own  experience  leads  iia  to 
sustain  Dr.  Davis'  vigwh  as  to  the  inadvisability  of  ffiving  purga- 
tives, until  the  aWack  is  ovop.  [W.  F.  W.] 


COLLAPSE.— (See  Shock.) 


CONSTIPATION. 

Th«  treatment  of  occaaional  constipation  needs  no  Attention 
here,  ijxcept  to  warn  against  the  poasibility  of  intcatinal  obstruc- 
tion beinj*  prceeiit.  The  limits  of  this  work  forbid  any  diaouseion 
of  the  diagiiotjis  of  thtd  cuudition,  btit  it  would  be  unpardonable 
for  a  physician  to  prescribe  purgatives  in  a  ease  of  atranguluted 
hemia,  intuiisusoeprioii  op  other  miwlmnical  occlusion  of  tli« 
bowels. 

For  chronie  ooustipation,  we  lay  down  the  following  rulos: 

Kxaniitie  carefully  to  a&oertaiu  whetlier  the  ditHculty  doea  not 
depend  on  retroversion  of  the  uterus,  epasm  of  the  sphineter  wii, 
stricture  of  the  rectum  or  obalruetioii  from  the  pre*«ure  of  a  tumor 
against  the  reotam.  If  none  of  these  (wndition.-*  are  present,  im- 
prees  the  patient  with  the  iinpopfauL-e  of  bpiiiiriiii^  to  his  aid  the 
powerful  influenw  of  liahit,  by  going  tfl  the  water-closn-t  at  the 
Bame  bour  every  day. 

Tie  should  be  told  to  iivolrl  straining,  and  t«  allow  himwlf 
pleuty  of  tinn;  for  thi*  impoi-taiit  fuiiorion.  The  Ixnhit  of  taking 
a  newspa[ier  to  the  doRet  and  reading,  id  to  be  ooinmeiidvd. 
Thorough  evaluation  of  ihe  Iwiwi*!!*  pivveuts  the  rectum  boeoraing 
too  tolerant  of  the  pre«enre  of  fet-al  matter.  If  sedentary  habits 
be  the  cause  of  conHtipation,  «uilable  exercise  should  be  recom- 
mended. Walking  is  in  our  opinion  the  best  form,  though  horwv 
back  riding  bait  many  advnt-at^'jt.  Cold  douebe  or  shower  baths 
to  the  9(>ine  and  abdomen  are  very  useful.  Frictions  to  the 
ftbdoulun  witli  stimiilatiiig  liniiucntH  aid  greatly  in  removing 
torpidity  of  the  intestiiiat  muscles. 


COXSTIVJITIOIC.  131 

WHiorevcr  it  is  possil^le,  reliance  should  he  placed  ou  auch 
meaitf ,  aud  a  suitable  diet,  to  the  exclusion  of  drug^.  laxative 
articlw  of  food  arc,  oatmeal  with  the  hulls  not  removed,  frcdh 
or  dried  fruit,  bran  bread,  craoked  wheat,  and  hominy.  Prunes 
have  a  rcputfttinn  th«y  do  not  datcrve. 

Smoking  has  a  benofioial  cflect  in  i*orae  cases. 

A  ffla.*  of  ice  water  before  bruaklast  will  prove  ert'cctual  in 
many  casea.  If  ^uch  simpio  mounH  prove  inelfectivo.  a  heajied 
teajtpnnnfhl  of  table-aitlt  may  be  added  to  the  matutinal  dmught 
of  eoUl  water;  or  a  glaas  of  Kia^eugen,  Moe^tietta  or  Coiigreea 
water  MuWtittited. 

Stronger  remediM  are,  a  teospoonAil  of  Epeoni,  R'u^helle  or 
61aulier*s  salts  iu  the  glaas  of  (Ntld  water,  nr  a  Iniir-lnnibler  of 
Friedrichahall  or  Ilunyadi  water.  If  thorc  be  abnormal  dryneM 
of  tbp  fwal  niuJiM,  6ve  or  ten  pmiriH  nf  (•hloriih'  nf  nmmonium  may 
be  given,  with  a  tea^poonfnl  of  eutphate  of  magnesia. 

None  of  the  above  remedies  nhould  hv  given  exi'ept  on  arising 
in  the  morning,  and  at  leant  half  a  pint  of  cold  water  should  be 
taktai  ut  the  «aine  time. 

»w  va»e»  will   resist  this  treatment,  and   the  dose  of  the 
line  will  rarely  ruquin^  tJ^  W  incrvaAed.     Ti\nien.  howevur,  (.•»«» 
Huchobetinat-y  do  occur,  the  following  preMTripli«m  Hbould  lie 
given : 

B      KxL  aliwm  iMirit,  ..„..,...-.. gr.  XX 

Ksl.WllMl<iniuF, ....»■.••..  gr.lv 

Oleora*.  apilcl,. gr,  \J 

H.    ft.  mw,  ct  in  piLnn.  x*  dUidc 

Si.-^)n«  |nll  bi  Iw  tak«a  aAcr  «u-h  mwl. 

As  "onn  at  two  pii>i.4;ig<>s  occur  in  niio  day.  tlif  pilN  are  to 
icrut  in  two,  and  ouif-lialf  pill  to  Ijc  takni  Ihrw  ttmcit  a  day. 
When  thin  caiwcs  two  daily  passages,  the  dtwc  U  lo  Iw  docreaxed 
to  ODtvfourth,  tlit-n  to  r)in»-ci^lith,  ont*-!«ixtwiith,  imd  «o  on,  until 
Qiass  can  l»e  divided  no  further.  Then  tlm  midday  doce  is  to 
I  dropped ;  thun  the  evening  dow,  and  the  morning  |K>rtioii  <:on- 
lued  for  some  montha 

It  in  ncw-A)Uiry  that  iht'.-n' directiong  be  followed  implicitly, 
no  j>ennauent  benefit  will  eiwue.     If  the  piU»  pn>duce  several 
daily  fvacnatiotu,  the  juticnt  is  apt  to  continue  the  fiill  dose, 


1S2 


MANUAL  or  TBUATMBNT. 


pftrticniarly  as  he  feoU  much  rctievcd.  In  that  case,  the  pilla  will 
floon  lose  tlicir  C'tfiH-t,  mid  be  jironouiiL-al  iuofficiout.  "When  iha 
instruetioiiii  are  iiiteltigontly  t^rriod  out,  and.  the  infliienoe  of 
regularity  in  going  to  tli«  t-'Io*i«t  mldeil,  1  hnve  yet  to  sec  a  caaa 
of  chronic  wiiistiimtion  whieh  the  above  pi-Mcription  tiiilcd  to  cure. 

Some  vein's  ngo  1  rewininicndefl  the  nbovc  rcgiinon  aud  pill 
is,  the  cjuie  of  a  lady  whom  I  gaw  in  eotutullutiou  with  a  young 
medical  friend. 

A fter  u  fair  trial  I  wag  informed  that  the  tniilineiit  failed. 
I  at  once  wrote  to  my  friend  that  there  ma'^t  be  n  mechanical  ob> 
Btruetion,  and  on  Pi:aiiiinatioii  a  tumor  waa  found  lM?twe*>n  the 
uteruB  and  rectum,  which  eompnssedtlie  latter  organ.    [W.  K.  W.] 

TnoiTsaRATi  was  very  partial  to  the  uae  of  belladonna  a*  a 
laxative  agent.  Oliver  i-ecfnimenda  (tmall  enemaB  "1  '"Id  water. 
Our  own  experience  ie  strongly  agninut  their  use  in  habitual  eoft- 
stipation,  a.-'  they  tend  to  produce  torpor  of  the  rectum.  In  the 
constipation  of  genenil  paruBiti,  or  of  ordinary  paralysit*,  an  excel- 
lent remedy  is  an  enema  of  a  pint  of  cold  water  in  whieh  a  hand- 
ful of  common  salt  has  been  diswolvud. 

Large  wann  injeetionri  are  only  proper  for  oce»flii>nal  use,  to 
unload  imptictctl  bowelfi. 

Bartiiolow  ea-ya  that  if  the  motions  imlitvtc  the  abiwnce  of 
bile,  phosphate  of  soda  or  sulphate  of  mHiigaiiose  will  \te  effoo- 
tivo ;  the  latter  in  gonty  habita,  the  fonner,  with  arseniate  of 
soda,  ill  cirrhosi«. 

In  habitnid  I'nndtipation  im  rtfeommendH  tiie  tinctures  of  phy- 

^liOHlijjma.  bt-llfldoniia  ami  nux  vomica,  ten  dm]*  of  eneh  three 

times  u  iluy.     [  f  the  rL-ctiaii  he  torj lid,  hv  mU\»  aloes  tn  the  above. 

If  the  subject  is  plethoric,  with  deiieient  socretions  and  slug- 
gish bowels,  he  give*  Huljihutx;  of  niiignesia  with  Hulphnric  acid 
and  strychnin  snlpliate,  gr.  jy,  in  ttolntiou.  In  anemic  caHes  he 
adds  the  fiiilpliute  of  irfin  l>o  tlu^  last  formula. 

Wlicii  we  have  to  treat  paresis  of  the  muscular  layer,  he  recom- 
mends belladonna,  mix  and  tin-  warm  purgatives,  with  the  uae  of 
electricity.  One  electrode  is  pWed  in  the  rectum  and  tlie  other  la 
attached  to  a  large  sponge  and  placed  on  ttio  abdomen.  A  alowlj 
interrupted  galvanic  or  u  faradic  current  is  thus  applied  dailj. 


OOVBTirATION. 


18S 


lea  thtttei  he  gtvea  a  nijrhtl^  doM  of  podophyllin  with 
nux  and  ei^t.     lie  has  6btau>ed  i^ood  r«Mul(«  from 
tamar  iDdien,a  combination  ot'eeuna  and  croton  oil.    Tbc  nightly 
doM  vi  gradually-  reduced. 

Davis  makes  luc  of  the  following  pill : 

R      Fenl  wiIpliaL, 

ExU  byoMTunir ■ U    gr.j 

Esbkioa  piilT^ 

ExL  micls  TORu, U    gr.i 

II.  ft  pU,  DO.  j.    8. — Tftk*  btJoN  Okcli  meal  sod  at  bodtimo. 

If  the  tongae  have  a.  yellowlih  ciHit,  and  tbe  urine  throw 

3wn  a  phoephaliti  or  amiuuniaval  sediment,  he  adds  one  third  of 

a  grain  of  bltio  pill  to  each  doec.     As  soon  as  more  than  one  pa»- 

■age  occurs   in  one  day,  he  omtti  one  pill;  still  later  another 

ty  be  omitted. 

FoTHEBOiLL  ^ves  some  excellent  points  In  the  use  of  various 

carhortics. 

Khubarb  !»  the  wontt  of  all  drugx  for  hiihittial  uiie.     [And 

^et  many  caees  of  chronic  constipation  find  relief  from  chewing 

a  small  bit  of  the  root  at  be<ltiuie.]     He  reoomniwidn  it  wliuru  any 

(^ration  on  the  bowel  or  pelvic  viscera  is  to  be  performed,  for  it 
^^teeiiM  the  bowcln  iitid  then  hwlcH  them  up. 

^B  Aloes  acts  chiefly  on  the  rectum,  a  little  on  the  daodmum 
^Bko,  and  is  alwayn  iiHefuI  with  iron,  or  in  allaying  pelvic  oxcite- 
'     ment  in  women,  when  combined  with  alkalies. 

lu  constriction  and  .tulMtMjuent  dilatation  of  the  bowclii,  a  full 
I      doee  of  laudanum  %vitb  large  doees  of  solpluite  of  magneeia  la 

lueful,  one  allaying  the  pnina,  while  the  other  liqutfica  the  fecal 
I     muAea. 
'  For  tlic  aged  and  fccMo,  and  for  women  at  the  change  of  life, 

salines  should  be  given  with  chloroform,  ginger,  capeicnm  or  caa> 

carilla. 

Looms  objects  to  the  daily  tMe  of  inline  watera,  claiming 
that  they  render  constipation  inveterate.  We  muat  «ay  that  in  thiji 
we  agree  with  him.  We  have  never  Kcen  a  cure  ruault  from  tlie 
admini»t.ratinn  of  eialines;  their  a»e  dimply  giving  relief  for  the 
le  they  arc  taken. 


184  MASCAI.  or   TRKATMENT. 

Ilirt  favorite  comlnnntioiui  are:  (1)  aloes,  myrrh,  colcHnmth, 
genfmu  and  quinine ;  (2)  nloo»,  rhubarb  and  stpj-chiiijie ;  (8)  slrycb- 
nine  iind  aloiii;  (4)  mix,  alo(M,  Iwlludonna  and  podophyllum. 

Belladonna  and  byoeeyamuB  he  rooomiueridfi  ](articularly  fori 
femnlcs;   podophylhiin  produce.'*  slow  and  painless  cvacuationa, , 
ftnd  acts  effieictitly  tor  a  long  time.    In  very  obstinate  csmcs 
eolocyntli.  wamniotiy  and  t-niton  oil  may  Imj  inquired,  until  the' 
liutll  of  daily  evacuations  baj*  b<*n  formed. 

Rhubarb  and  magnesia  t'onuH  his  favorite  combination  for 
daildren  and  young  girU. 

Da  Oo8Ta  recommended  the  following: 

^     Podophjrllin 

Kxt.  lielUdfintiK, U    gt.j 

Citptid gt.r 

Piilr.  rhw gr.  zx 

U.     Ft-iOM.  rt  itipil.  DO',  xz  diT, 

a.— One  plU  ItiK*  lime*  a  day. 

A  pleoeanl  laxu-livy  is  thf  followiujr,  which  ap]ieared  lirst  in 
The  ]ifeilieaf  Woriil.  under  the  name  of  Laxative  SugBr: 

R     SwIbcI  iHiiuo.  un, S     It 

Pola».  biuri, }     ^ 

And.  Urtario,, < 5     U 

01.  lj[iiulli%.. gU.  U 

Sacch.Mlli.  piilT., Ih.  j 

U.    & — On«  or  aum  linaped  UmbiKfoiifuls  to  l>«  takeo  in  a  kUm  «f  coM 
wbut,  on  ruing.  ^ 

CONVULSIONS.  ^M 

H.  Charlton  Bastian  myn.  that  during  the  Rpiuuu  yve  nhwild  f 

nee  tJiat  the  clotliiug  U  loose  about  the  neck  and  chest,  the  patient 
placed  in  the  supine  posture  and  the  head  wlightly  raiaed.  He 
sliould  not  be  restrained,  except  to  prevent  him  from  iiyuting 
himBclf  or  other».  If  jmssible,  noraething  tdiould  Iw  slipped  in 
between  the  hack  teeth  to  prevent  him  from  biting  his  tongna 
If  the  attjU'kH  follow  each  other  in  ra])id  suecuiMion,  ohloro* 
form  may  be  carefully  administered,  but  not  to  infants.  For  them 
the  warm  bath  is  aubBtituted.  An  emetic  or  purgative  should  be 
given  if  needed. 


ooHTULsioss.  is:* 

THurrhea  must  be  checked,  worms  must  be  driven  out.  and 
tbe  gums  lanced,  in   caflco  requiring  these   measurcfi.    Careful 
I      regnlation  of  the  diet  is  ofteu  ewmiitia]. 

^P        For  ;;«ncml  twefulm'M  no  TCtnodids  compare  with  the  bro- 

^inidea.   Quinine  or  Lullwlonua  may  often  be  added  with  advatitage. 

'/Am  may  Iw  tried  when  the  bromides  fail.    In  girls,  the  men- 

trmal  functiou  most  be  regiiUted. 
When  mental  or  bodily  fatigue,  or  any  other  obvious  CMUa 
f  the  couvuUioofl  exists,  such  cause  must  be  avoided. 
In  ByiuptomaticconvuUioQshoaleorccommeudd  the  bromides, 
»."ith  chloral  if  a  hypnotic  be  needed. 

^1  LouTR  Btarr,  «pi!aking  of  convulnioiutiH-ttumnfrduriiijj;  teeth- 
ing, aays  tliat  the  treatment  cott8iat«  in  lancing  the  giinut  and 
adniiniritiTing  cliloral  and  the  lironiidiw.  If  the  patient  cannot 
awitliow,  tliei*e  drugt^  ruay  be  given  by  enema. 

^^^^^^  B    Cklont  lifdrat., gr  sij 

^^^^^^L  PouiL  lnnniU.r 5  ■ 

^^^^V  Macil.  mokIh, 13  j 

H  A-,»«;q..»d nm 

^H  U.    a— A  UUeqwonfut  al  i  dose. 

^m       Thi*  U  to  be  rop««atfd  evcrj-  half  hour  for  a  child  one  year 
^old,  tmtil  the  oonvuLtive  tendency  \n  checked,  or  four  ilfves  are 
given.    If  this  fails  the  chloral   hiul  better  bo  omitted   for  two 
boura,  the  bromide  being  continued. 

Convwlsion*  from  ci'iIop<*y,  eclampsia,  etc.,  will  be  trmtod  in 

their  proper  place*. 

^^       Tn  rognrd  to  infantile  convnl^iona  I  \vi>>)\  to  call  attention  to 

^^10  im[«>rtanc«  of  examining  the  condition   of  the  intoctinal 

camil.     A  two  year  old  child  was  once  brought  into  my  office  by 

^ftlB  mother,  who  informed  me  that  he  had  liad  seven  H|iaAnu4  in 

^Hocfw.-ts'ion.     I  inqiiin>d  wbnt  the  child  hrul  oaten,  and   wax  told 

^^uolbing  but  a  French  ndl  iind  a  eup  cpf  iitiYw."     Not  feeling  ttat- 

Hfie<l,  I  gave  the  iHiy  an  emetic  of  ipecnc  and  mustard,  and  Mxm 

had  the  Mttisfnction  of  »ii>e)iig  him  tlimw  up  ituuntitiiM  of  mtten 

eaiiUilonpe,  rinil  and  all,  and  ffrren   Ikdogna    Rni]<iiige.     TIihm*  lie 

hiuJ  picked  out  of  n  garbage  re|K»«itory,  unkuiiwn  to  his  paiviit*. 

*rompt  recoverj'  eiwued.     fW.  F.  W.} 


r 


186 


lUKDAL   OF  TEBATMEHT. 


The  thermomeUT  will  oft^n  uliow  wJiether  we  should  givB 
hot  brandy,  orajiply  ice  to  the  head;  an  axillary  temperatora  of 
10S°  indicating  the  hitter,  while  a  euhiiomuil  decree  denoands 
the  atimulani,  by  tlie  mouth  or  rectum.  In  the  absence  of 
any  clcfir  indication,  prompt  «vaeuation  of  the  etomach  and 
bowels,  foUowed  by  Starr's  enemas,  the  hot  hip  bath,  reat  aod 
quiet  in  a  darktmal  room,  oiler  the  most  rational  trcatmeut  for 
infantile  conndstons. 


CORYZA. 

Camphor  \&  an  efficient  remedy  to  break  up  a  coryza,  at  t( 
start.  Three  to  six  grain**  may  hv  given,  with  or  witliout  one 
grAin  of  opium,  nt  one  done.  To  thin  may  be  added  the  UM  of 
a  hot  mustard  foot-bath,  the  patifint  bitalliing  the  ateam,  and 
immediately  wmpping  up  in  a  warm  blanket  and  going  to  bed; 
where  he  ehotild  drink  a  bowl  of  hot  ginger  ten. 

Quinine,  in  spite  of  its  strong  endoriwmerits,  is  ugcless. 

Cocaine  has  a  curious  effect.  A  four  per  cent.  («>]ution 
Applied  to  the  inflameil  menibmne  will  give  immediate  roHof, 
which  does  not  last  long.  By  conaUntly  reapplying  thi«  agent, 
we  kept  a  oorj'za  in  (.'hct'k  for  four  thxyn.  Aa  soon  as  wo  dlet^'ontinuod 
the  remedy,  the  di^asc  pursued  its  usual  course ;  so  that  we  simply 
post])une<l  itH  outbreak  by  the  use  of  cocaloo.  Stronger  solutions 
are  said  to  have  a  more  permanent  effect. 

The  tiioRt  etfifienL  jmlliative  for  this  exasperating  afflictitm  is 
morphine,  in  doses  of  one-tenth  gmin,  takun  when  the  congestion 
hwoinew  uri]»eaiable.  But  with  the  next  day's  headache  we  pay  dear- 
ly for  the  relief  experient-eci.  The  inhalation  of  ammonia  gives  hut 
the  briefest  relief,  and  increases  the  congestion.  ^S' ashing  out  tJie 
nontrild  with  a  little  tincturu  of  kino,  one  drachm  to  half  a  pUit 
of  warm  salt  water,  is  a  very  grateful  palliative. 

To  lenscn  the  liability  to  coryza,  the  best  remedy  is  the 
morning  cold  shower  bath,  or  cold  sponging  of  the  head  and  neck. 

Fbbbikk.  recommends  the  following; 

B     Morphiiue  m.nriat.,.,, • gr.  U 

Binnutb.  huIjiui., ■■>•• ■••■54 

AciKnwputv., 5  V 

H.    8. — Oiw-rounh  OF  oac-li&ir  tba  ijaantitT-  hmjt  tw  uKtl  durinf  the  diy, 
■■  s  uuill. 


OOETSIA.  ^^^^  1S7 

Bartbolow  recommeiidrt  fittwn  gni'iiw  of  quinine  with  half 
gnin  of  morphine,  nl  one  dose,  to  abort  (he  coUl.     \Vli«u    the 
attack  ii  estublishod  thu  b<»t  remedy  in  LugolV  mliition,one  drop 
every  hoar.     If  there  is  fever,  aconite  may  be  substituted. 

If  the  secretion  is  watery  and  profuse,  lieliatlonnH  may  be 

IgiTCQ  with  the  aoouife. 
W                         B     Ttnct,  wnnit  nd, 
I                              Tina.  belladoBDv. U    fSj 
I              K.    8. — Twn  dropt  cvvrj  hour. 
'        Sajous  ranlceit  the  following  reoommendatidnH:  After  taking 
a  hot  mustard  fooubatb,  the  potient  is  put  to  bed  and  glveu: — 

^B      Ammon. chloraLp rt.  xl 
Tinct.  opii,.; ^C  jjcIt 
Bi>GcJi.klb^ 5j 
Aq.  (smpborsv  >d f  S  j 
M.    8. — A  Uupoonful  in  a  hulT  glui  (kf  wimt  ^rttf  hoar  for  thr«*  dBld, 
Hia  vttry  two  hoarh 

The  Doae  slioulii  be  grcaee<l  with  lard  or  cold  cream,  while 
talc  KDuffed  up  the  noittiU  protects  them  from  irritation.  If  the 
foTer  be  great,  Hcunite  shoiild  repl&oe  Uie  nal  ammoniav. 

Other  remedies  sometimes  auoceitsfUl  iu  ahortiiig  the  attack 
are  purgatives  and  pilocarpine,  gr.  |,  everj-  two  hours  till  free 
Bwaiting  occuK.    Even  in  the  second  stage  the  following  will 

[en  abort  an  ordinary  crnte : 
H      Murphirae  nuirlat, gr,  ^ 
Alaminis, ■.....»..,.-.■• 
Biaiautb.  aKrb.,....4 > 
PiiIt.  t«lo, U    p.  XX 
IL    M  in  chut  BO.  xx  diTid. 
B.— Od*  to  be  aniiired  up  tb«  uootrila  vrttj  two  linun,  after  clearing  th«  now, 
The  inhalation  of  iodine  and  carbolic  acid  is  often  effectual 
catising  a  free  tlow  of  »crum. 
Mackbnzib  prefers  laadantun,  and  aays  that  five  or  aivun 
oitipe  taken  at  the  start  wilt  often  etirc  the  catarrh  at  once.     The 
opiate  acta  quicker  and  with  more  ccrtuiuty  if  taken  on  an  empty 
stomach,  and  may  be  re}M:ated  if  needed,  every  six  honra. 

If  at  the  end  of  two  days  the  eoryza  i>brgista,  cSbiia  to  abort 
stiaj  be  given  up.     Uiaphorotica  arc  theu  to  be  used. 


188 


UANCAL  OF  TILEATUBKT. 


Lower  called  attjention  to  the  fact  that  total  al«tinenoe  from 
liqnids  will  goiierally  quickl  v  i-heck  a  catarrh.  1«  twelve  hours  it 
be^intt  to  diiitiniiih,  and  a  cuiv  h  afXtctcd  in  two  davii.  Thtf  nygtjem 
iihonld  be  instituted  at  the  very  beginiiing  of  the  attack. 

SoLls  CouKN  gaytt  that  tlie  indiK-tion  of  anesthesia  by  ehloto- 
fomi  will  often  ahort  the  di^ense. 


COR'VZA:  CHRONIC. 

Sajotts  npeaks  of  the  importance  of  cleanlinefls,  but  adds  & 
OMtion  as  to  Uic  tncanii  employed.  Ho  prcfera  the  atomizer  and 
tuos  with  it  ttie  following: 

B    Sodjibicxrb., 

Sodii  biborat-, ia    gr,  Titj 

Kzt.  pint  L'anadeni.  A., <i|[  xr 

GIjMhritua, , ...5  4 

Ar|iin-,  q.  H.  ad .fj  tr 

H.    Thia  should  in/  iimiI  eiiRicieiitljr  oftm  lo  k«ep  th«  mimuu  momliraiM  o1«ma. 

For  va^6e>  which  re«it<t  tliii«  trcntiiieiit  he  haa  lined  the  follow- 
ing: 

B    lodi, 5" 

Acidi  tannid, $  « 

Aqiiv 3  ny 

Mil,  filler,  xaA  PVsponit«  V>  J  ij,  'oi  add 

QljTcriiiK, J  iv 

AciiJi  cubolici, ^  ij 

M.    Thiaahcuid  be  applied  aevenil  Umea  a  da;,  aft»r  llioroiigb  ctiAiuinf. 
Th«  fcan  Instrument  Tor  making  iha  Applkation  >•  a  fcnthor. 

At  limes  the  good  cftect  may  be  enhanced  by  alternating  the 
application  with  that  of  iodide  of  zinc,  gr.  v  to  5  j,  or  the  eulpho- 
carbolate  of  zinc,  gr.  v  to  3  j. 

8omeliinc«  pnw<lers  are  preierable,  such  as: 

B     Hydmrg.  chlor.  nut-, *•• 

Pnlv.  Bliiminifl,. ....(,.. •<•■•&&    3  ■ 

Mnrpliia.  hj-druablor., C- M 

Biamnlh.  fubnit, •■••5  j 

^iodi^  biborw, 5n 

tl.    FiNl  ptilv. 


coryza:  vhroxic. 


i8d 


may  I 


After  tliorou^h  cltiunsiri^,  a  plnvh  may  Iw  n«wl  as  wiutf.  It 
Jnay  bt'  i\'fH>Hb«l  (our  tHiie--i  daily. 

If  tho  limtitwU  be  liniat,  he  u-ppliw  nitric  acid  owrn  limited 
along  the  middlfl  or  inferiop  tupUiimtwl  l>nnf,  taking  vtiTo  to 
roid  the  septum.  To  |irei'em  tlio  HC'veiv  |mtii  wwuiiig  wlitm  [lure 
nitric  acid  Ik  ajiplied,  ii  lAttinitotl  ^lutinn  nt'  fncainc  miiy  bo  first 
lucd. 

]n«t«n(l  of  tho  fH^tl,  tlic  galvano-cautery  nuiy  bo  hmkI,  the 
Icnife  being  heated  to  a  t-ht-rry  red.  During  thu  treutnieiit  cam 
slioiild  bo  taken  to  avoid  catolting  (^hl.  For  [wrmanent  tnrges- 
oeuoeof  thenmcou*meinbrarH*,pre««iiri*by  niisiiwot' bougie*  iavety 
e^ctive.  lie  prcfera  flat  tnodicntod  gelatine  |konrilH  of  Nirh  coo- 
UBtency  as  to  allow  Kome  time  lo  elfljHM-  In^foit*  they  melt.  They 
thonid  only  be  allowwl  to  remain  for  two  mhuitos  at  finrt,  and 
filiould  be  used  twice  daily.  The  applicalionft  nhould  Iw  LHintinued 
two  minutt^  longer  each  day.  Cocaine,  in  two  per  cent  solution, 
may  bo  used  before  the  botifrie  ia  introduced. 

Tlie  niclicnmenta  he  found  most  wrviocable  were  liyilra«tl», 
coca,  belladounn,  boroglyceride  and  ergotin. 

Tiie  objection  to  this  mode  of  treatment  U  that  the  relief 
obtuned  w  but  temporary.  Unleas  e^rharotiud  ba  applied,  the 
mombnuie  will  return  to  itx  fomior  conditiim  within  a  year. 

tWhen  the  dioeaae  is  dae  to  local  irritation  from  ilu'^t,  meamt 
oald  be  used  to  prevent  itji  entrance;  Miii'h  uo  the  wearini;  of 
ttoQ  wool  in  the  noHtrila. 
[n  the  variety  eharacteri?^!  by  a  [irofViAe  ditu-hurye  frain  the 
DOStriU,  aj^tringent  apptication^i  Hhould  lie  used,  i  )ne  {inrt  of  alum 
to  ti^'o  of  talc  should  be  Uited  with  the  insulllator,  four  tiimxi 
daity^.  At  the  name  time  strychnia  may  be  given  inteniully. 
A  weak  taradic  current  pa^aed  through  the  notte  is  somelimes 
rotlowed  by  gratifying  rtwdta. 

In  aome  cases  twdative^  alone  can  be  borne.     Much  relief  ie 
obtained  from  tho  om  of  bromide  of  potassium,  gr.  xv—  3j, 
nth  the  atomizer,  as  a  eleanoiiig  agent.     Cocaine  is  excet'dingly 
Teotivo   ill   tbcsw  cjimw      When   tJie  raombmne  is  dry,  Htetim 
ihalatiuDi)  are  preferable. 


.AIai'Kknzik  calli«  uttontton  to  the  tact  Uiut  tho  iwaal  moc 


140 


MANUAL  OF  TRKaTMEKT. 


membraue  will  not  bear  &s  >i>trxing  luedicamcnta  as  the  pbaiyox 
or  lar^'nx.     Hin  favoriUs  applicotioD  is  the  tbliowing: 

B     9oAm  bicarb., • 

BoAm  bilwntL, 

8«dii  chlorid., U    gt.r^ 

Swch-Blk, p.  XT 

H.    8. — DinolT*  in  half  a  tumhleiful  of  t«pid  waUr. 

For  use  with  the  naKal  douclie  he  recommeods  tannic  acid 
(gr.  iij—  3j),  or  ahira  (gp.  iv—  3j). 

If  tho  nbove  coiiiw  pain,  s(iraya  may  be  aubatitut«d,  eepeciallj 
vhen  tho  secretion  is  thin  and  profuse.  The  solutions  of  alum 
and  of  taDnin  just  mentioned  are  suitable  for  eprays,  and  have 
cured  t-aees  of  years'  standing.  When  solutions  fail  he  tiaea 
astringent  or  sedative  powdern,  with  au  iiwuiilator,  or  aa  0nu£^ 
The  following  is  his  list  of  powdera,  with  their  dosen : 

BiiMtith.  nxTchloridi gr.  1-). 

AlumiDis  eixicali gr.  ^j. 

Oabehu  p&llidi  puIverUati. .  .gr.  f-^. 

Oummi  riibn one  |>art  to  two  of  corn  itAPtfe. 

Feirt  |ieTtiut|ih&tia. one  p»ri  to  tliree  or  com  iiarcb. 

KvrrD-aliimiDiB wilL  an  vqiinl  qiiROlilj  of  cnni  «larch. 

l<x)ofonDi gr.  i-^  huIi  ou  o^ukI  t^iiiuitity  »f  coraaUMk. 

Mori>blDEB  lulph gt.  ^. 

■tiamiitb  «iil>«ftrl> 5   j 

Un^|^lliTlIc  murUl gr.  y 

Ptilv.  acscife. 5    ^ 

Itiimulh  (Ubsit S    V 

Of  the  Itaiy  otii»-rourUi  to  onc-hair  may  be  uaed  In  tvenljr-feuT  lioutm. 

DoBELL  recommends  the  following  snuff  for  chronio  post-na 
catarrh:  Take  equal  parts  of  camphor,  tannic  acid,  white  sugar 
and  high  dried  Welsh  siiufF.  A  pinch  U  to  be  taken  four  UmM 
a  day.  On  tiie  occurrence  of  a  fresh  attack  of  catarrh  the  snuff 
is  to  be  diacontiiiucd,  but  should  be  resumed  on  the  Bubaideuce  of 
the  inflammiitory  Aymptonift. 

Porter  derived  great  iMjnefit  from  tlic  use  of  a  snuff  com- 
posed of  camphor,  tanaic  and  salicylic  avids.  In  long  standing 
vasea  medicated  bougieii  are  often  of  great  service.  Should  there 
be  much  swelling  of  the  roueoua  membrane,  an  elastic  bougie 
should  be  pasned  into  the  nose  every^  day,  and  allowed  to  remain 


cohtza:  chronic. 


[41 


a  few  miniitw.     T^ir^pr  irwtnimentP  nhoiiM  prradually 
intrtNluced,  aiid  allowed  to  ruiuuln  Imiger,  even  tor  tialf  an 
hour  finally. 

In  obettnat«  eaaes  and  in  the  aged,  the  tonic  regimen  muat  be 
itatod,  QDd  patidDtd  should  be-  rcooniiueud«d  to  M>ok  a  warm 
sd  dry  cliiuutf. 

Fnr  hj-jwrtrnphy  nf  tlie  luumbmtie  covering  the  turbinated 
>De9,  he  lint  rGsorts  to  the  u^  of  ela^lio  bougiet^,  as  above 
ribtyl.  Few  l-umm  will  n>|uin>  riiorx:  hemic  trualniciiL  W^hen 
they  do,  destruction  of  the  redundant  tissue  with  the  clcetn>cauteiy 
is  the  siiiiplcttt  mctiiotl. 

Chemical  L>aut«rant8  may  be  substituted,  bat  thov  are  1«m 
»ble. 

of  dcMtroying  the  di«3a«cd  li«siio»,  thoy  may  be  re- 
red  by  the  snare.    The  operation  ithould  be  done  very  alowly, 
sing  interrupted  from  time  to  time,  and  not  completed  in  leas 
than  iiatf  an  hour. 

In  using  Uie  galvano<uiiitcry  it  niu.tt  hv  ri'nienilx^red  that  the 
Wject  is  not  to  bum  away  all  tlic  hypertrophied  ti»aue,  bul  to  cut 
bU  through  thv  nwiw,  which  will  li«  fi_>Ikiwe<i  by  sloughing 
the  burned  tissues  with  cicatrization,  and  the  contractlou  of 
lest  L*icatna5<  will  rvtttmin  the  exntitimnct!  of  tlic  tisHut's.    Patients 
lUBt  be  cautioned  not  to  exjiect  the  perfection  of  relief  imioedi- 
L'ly  afler  the  operation  Iiom  Ikh;!!  iM>mpleted,  a^  citatricial  con. 
ction  requires  a  long  time  before  if«  eifect  is  lully  manifested. 

In  many  eaae:*  tlit^  application  of  ohromio  acid  will  auawer 
iiidiuktion.  Thovtc  who  arc  not  tiiniillur  with  tlio  aiition  of 
this  powerful  astringent  should  begin  with  very  weak  solutions; 
my,  6vc  gmiiu  to  the  ounce,  gradually  incrcuiting  the  strength 
\g  to  the  necessity  of  the  case. 
It  is  fiucntionuble  if  thin  agent  lie  not  ea[iuhl(!  of  iiecoinpHsh- 
i  much  good  &i*  the  cautery.  Care  must  he  exercised  to  keep 
the  healthy  ti*mcs.  It  should  l>c  appUed  on  ti  pmbe  wound 
Sth  ahsorlwot  cotton  dipped  into  the  Holution  and  half  dried, 
m  applied  only  to  the  hypertrophicd  tianue.  Rapid  and  perma- 
nent (wntnwtioii  fidlown  the  applirati«n. 

In  eases  of  atrophy  of  the  niuuous  membrauc  wlOi  abnormal 


142 


HAinTAL   0?  TREATUBKT. 


dryness,  some  relief  niay  In'  nbtaiiit>d  by  the  use  of  the  prepara- 
tiona  of  hydrastia;  especially  the  sotutiou  in  water  of  the  white 
alkaloid,  hydrastia  eulpbatc. 


CORNS. 

Ebashpa  Wilson  flag's  that  the  iudicationo  are  to  remove  the 
pressure  and  friction,  or  equalize  the  prcwurf.  The  latter  U  but 
done  by  applying  lefld-plaster  spread  on  wiwh-Ieathcr,  after  re- 
moving as  much  of  the  corn  ns  po-^ible  by  soaking,  sorapijig,  and 
turuing  out  the  core  with  a  blunt  iiidtniinont.  Manieurea  dissect 
out  the  com,  paying  osjiecial  attention  (o  llie  core  or  root,  which 
givea  rirte  to  the  pain  by  ppojoeting,  thom-Iike,  into  the  tender 
skin. 

A  very  oxe«lIent  combinnlion  is  that  which  is  sold  under 
Torious  names  u»  a  wni-cure. 

B     Acidi  Mlirtlici, gr.  d 

£xL  imnnHbis  Ind^ gr.  if 

CnlludiuD iS  A 

U.  8.— Ap|iif  to  lh«  mm  every  night  for  »  vkIc.  Th«n  M»k  the  foot  in 
hoi  water,  and  the  <.f>tii  luay  be  scni))cd  out  willi  Ili«  llriKct-iuit.  A  piece  of  Isad- 
plai««r  «lniuld  ilicn  bcijipliwl, 

An  old  Frenrli  dauLiiig  master,  who  had  datieed  willi  KHsler, 
informed  lu  that  liii*  only  remedy  vra,*  (o  glue  tfl  the  com  a  piece 
cut  (tut  of  a  kid  glove,  and  a  correitponding  piece  u>  the  other  too 
at  the  pouit  whicli  pre-iwed  u^fOti  the  corn.  The  kid  was  to  be  left 
until  it  ffll  ritr,  and  the  corn  usually  came  with  il.  In  many 
Buececding  cla-wcc  of  hi«  pupils,  tlii«  simple  remedy  had  always 
proved  rffuctual.  Inflaitmiation  pmi>ecding  from  a  (-oni  will 
tisually  subside  when  tin-  nffending  b<Kly  liim  been  removed. 

Tr  iit  highly  inipriibable  tliat  corns  will  iw^-ur  when  properly 
fitting  ahoeii  arc  worn. 


CROUP. 

Steiner,  sj>eakiug  of  the  merahruiiou.''  variety,  reiommends 
that  children  who  arc  pr»?<liMpO[M.fl  to  croup  should  be  euhjecled 
to  a  cautious  process  of  hardening,  by  cold  abhition»  to  the  neck 


CBOtTP. 


148 


mod  cSiett,  Itejj^u  early  iu  lifu  ami  imrHed  fitil  {>erHUt«titty.  If  the 
dothuig  be  adapted  to  the  uge  of  the  child  niid  to  the  f^eawa,  it  is 
miDeoewary  to  be  too  unxiouM  about  ex|K)Mun--  to  AimU  air. 

Suck  «hitdren  itlioiild  be  kept  iiidoois  during  the  provalonc« 
of  iNiId  diy  %x'mdK.  UTieii  diphtheria  is  prevalent,  tlie  throot 
ehnald  b«  in4pe<-ted  frequently,  and  U'  any  indication  of  the  dU- 
CB^<  be  detected  the  eliild  should  at  onue  lie  isolated. 

As  soon  as  an  exudation  nppwirs  it  must  }»e  treated  cnorgoti- 
callj.  He  reeommeuds  gargles  of  Hrae-watcr  diluted  to  otie-half 
tlie  full  Btreiigth,  or  f)f  ehlorat«  of  [KJtiwKa,  sixteen  grains  to  Uic 
ounce  for  children,  ami  fifty  grains  for  adulCa. 

If  the  [Sitieiiti*  he  too  young  to  gargle,  tlie  above  fluids  may 
be  injected  into  the  throat,  or  the  pai'ts  may  be  touched  with 
lunar  cauatic,  in  rtulMiance  or  in  25  jier  cent,  nolutiou. 

Aa  to  the  i*i»efial  treatment  of  croup,  we  have  no  reliable 
Temedfaa  wbic-li  dti-(n.-lly  intlueucc  tlie  morbid  procc«a. 

He  coodeninH  the  use  of  leeches,  not  believing  that  the 
sbf^traction  of  blood  can  chock  iuflomniation  or  prevent  the 
exudation . 

Cold  compresses,  freipiently  cIiangtMl,  eliould  be  applied  to 
the  neck  nrithout  interruption,  until  Bymptonut  of  carbonic  acid 
piitMtning  ap]«ar. 

lie  di-nit'--;  ilit-  ylfiaicv  of  tnlmnel. 

■ 

Emetics  iiri>  only  iiAcfnl  wlieii  tite  glottis  U  otxluded  by 
mciobnuiOi*  or  muco-pua  which  i^'aiuift  be  removed  by  coughing. 
He  pr&fets  ipecac.  (gr.  xj),  tartar  emetic  (gr.  i),  and  sugar,  and 
give*  this  do^e  every  ten  minuter  until  vomiting  occure.  If 
dianrfaoa  be  prosent  ho  eubstitat<»  enlphate  of  copper.  Somo- 
timas  the  emetic  will  act  if  mlminitjtered  in  wine,  even  though  it 
has  failed  when  given  iu  water.  If  the  treatment  n»  above  de- 
tailed fail  in  improve  the  condition  of  the  child,  if  the  intlamma- 
tjon  continoe  in  ndvnnce,  and  mnptomiJ  of  carbomc  acid  (H>i«oii- 
ing  occur,  the  ordy  rei^(JurL*u  in  tracheotomy. 

He  agpc*-^  with  tlie  nutiions  who  favor  an  early  operation. 

Thi?  Iieginiiiiig  of  the  third  atuge — tliat  of  asphyxia — is  the 
moDicitt  whei)  the  upcmtion  bet-oraos  necessary. 

After  ihu  o|>oratioo,  the  diet  nhould  be  carefully  regulated  by 
the  condition  of  the  child.    Milk,  atnmg  bnith*.  eggs,  c-oftee,  light 


144 


XANVAL  or  TBKATMBKT. 


moata  and  wheat  bread  arc  suitable ;  tmt  if  Bym^fH/aofijaf  ex 
tion  be  present,  wine,  rum  punch,  etc.,  i^bould  b«  gUvatk 

If  the  course  of  t-he  disease  be  ebccked  by  the  0]>eratioti,  no] 
further  roedit^^tion  is  rwiuisite.  If  the  fevor  coutinuc,  or  pul- 
moiiarj'  JnflHtiinmtioiii'  miperveue,  <;o)d  cvmprQeees  or  sinapiAiot' 
should  bo  ajipliod  to  tho  ohoat^  and  dij^italis,  vcmtruin  or  ^laiuiDe 
pivfii  intcniany.  If  the  ex peetx* ration  eca«e,  or  be  very  profuaft, 
ipecac,  wiih  uinmonia  or  beiiKoin  iihould  be  given.  If  the  du- 
chargGs  be  offensive,  (■im-hoim  u'lth  ('hlorate  of  potaaia  or  tincture 
of  iron  inav  bo  used.  The  respired  uir  nhrmld  he  moistonod  by 
placing  a  wet  sponge  Iwfore  the  caniila.  Should  «vore  reao- 
tion  occur,  the  sponge  may  be  umA  lu  a  ifoiiipn»H,  if  frequently 
changed. 

If  the  edges  of  the  wound  become  tinhealthv,  they  shoald  be 
treated  with  intrsitc  of  nilver. 

If  tracheotomy  be  not  allowed  by  tlio  ]MiTOiit«,  the  carbonic 
acid  poinornng  must  l>e  oombntted  by  stunulantl,  such  as.  ct^d 
afluiiions  in  a  warm  bath,  sitiapi^inB  U>  ilu'  hreaat  and  oalvM, 
musk,  or  ammonia.  Thest-  are  generally  n-seless,  but  thore  1b 
nothing  better. 

Davis  giveu  three  gimiDS  of  Bubstilphate  of  mercory  at 

once,  in  well-marked  casea.  If  this  fail  t4)  pnnlius;  vomiting  in 
forty-five  minutes,  he  repeats  the  dose.  I>irectly  after  the  vomit- 
ing he  givee — 

B     Byr.  acUlm  cQti){i^ JJv 

Sjr.  iiufaoiiunliw, |b 

Tiu<-i. oiiii  cumph., {^ 

H..  8. — Fifteen  to  lliirly  dropecvfry  two  boun. 

If  the  bowels  are  not  o]>en,  he  given  two  grains  each  of] 
calomel  and  bicarbonate  of  soda,  at  one  dose.  Tliese  measares 
are  followed  by  great  relief.  If  this  wmtlnue  twenty-four liouw, 
the  crisis  of  the  disease  is  imased,  and  the  case  requires  only  the 
contuinance  of  the  above  pri!N«Tipti<in.  In  mmiy  ca^es  the  relief 
IB  temiJorary,  and  the  dyspnea  recurs  in  (hrc-e  to  six  hours. 
"When  this  is  the  case,  he  rcpeatn  the  cnjctic  of  InrpetJi  mineral, 
and  keeps  the  front  of  the  neck  covered  with  cloths  wet  in  an 
iufiision  of  hojM,  or  aconite  lea vch,  with  muriate  of  anunooia. 


OUtUR 


145 


In  9ome  cases  of  robust  children  ho  tiM»  IckImb  with  iMnotit, 
curly  in  the  diiW(i««. 

If  a  harsh,  croupy  couf^h  remain  oftor  the  ncDte  stage  has 
pttwod,  he  8iibt«tituteii  ttm-ttire  of  sanguinaiia  for  Uie  i[>«uic.  in 
the  formula  ^iveu,  aiid  odds  two  drat-hni)>  and  a  half  of  iodide 

of  potassium. 

In  mcubraDous  croup  ho  begins  with  a  prompt  leeching  and 
the  aame  emetic  recommended  above,  and  a  cuthartic  tUtoe  of 
calomel  and  wmUl  The  same  exjieetornnt  mixtnre  should  bo  alter- 
nated nritl)  alterative  doM«  of  calomel  and  nitrate  of  potassium, 
from  one  to  two  hour8  apart.  Tlie  emetic  should  be  repeated  in 
from  three  t*)  nix  bourn,  anx^mling  to  the  degree  uf  dyBpneo. 
Lactic  acid  (n  xv —  5  jsb),  should  be  sprayed  into  the  phar^^nx 
freely  every  liour.  If  the  progresw  of  the  diueaite  l>e  (.'tiecketl,  the 
emetic  may  be  discontinued,  and  the  other  remedies  given  at 
tonger  intervala.  After  forty-eight  hours  the  calomel  may  give 
place  to  quinine. 

If  in  two  or  three  dsvA  nymptoniR  of  exhauKtinn  flupen'ene, 
discard  the  above  remediee  and  give  instead  the  lactate  of  iron 
(gr.  i  to  j),  in  solution  every  two  houra,  ami  quinine  (gr.  j  to  jas), 
alteroatcly.  Once  or  twice  in  the  twenty-four  houre,  if  the  ]ar}'ux 
be  obstmcted,  a  quick,  fn«  vomiting  may  be  induced  by  a  full 
doM  of  alom  and  ipecac  AS^co  the  strength  begins  to  fail, 
nourishment  should  be  given  as  regularly  iw  meilicine.  Through- 
out the  disca^i  the  temperature  i*hould  he  kept  ludfonn  at  QS° 
to  70°  F. 

As  to  tracheotomy,  he  has  found  death  result  in  every  ca»e 
coming  under  hie  observation.  Still,  he  reuonnncnds  the  opera- 
tion, when  the  result*  of  the  other  treatment  indicate  that  there 
is  but  little  chance  for  ftucccea. 

Looms  reeoromeiida  the  temperottire  of  the  room  to  Iw  kept 
at  75°  to  80'='  F.,  and  the  air  to  be  moistened  by  steam.  A  tent 
may  be  made  over  the  bed,  and  steam  passed  under  it  trom  a 
kettle.  Puring  the  whole  course  of  treatment,  epongef  dipjetl  in 
boiling  water  and  squeezed  as  dry  as  po««ibte  should  bo  applied 
over  i.lie  larynx.  When  UxKiened  uiembranee  cau^e  dyiipnea^  an 
emetic  of  sulphate  of  zinc  should  be  given,  but  not  ropcatoil,  tcAt 
depression  en^ue. 

K 


Kisru  or  TwiTurcT. 


)  fifl£  it  dUmitditttic,  sod  Btimoiaata  nur 
be  gms  fiady.    Bifim  aniatioD  baa  oocoircd,  thirtj  gruiu  • 
qmniae,  in  Srt  grain  Aeam,  to  «  duM  tkrw  jeare  old,  nay  1 
beM&daaj- grna  «D  ahoft  tfe  dMOMB, 

JUte  the  fnnilliiB  of  tke  fidie  nMmbnDe,  the  irapor 
IMB  and  uij(«i  9»  «ra  ttM  oaIj  dm«qb  which  oSbr  aor  hope  i 
wvii^  fte  psticftL    Hie  q»i>3  doidrtftdlr  o(  the  ralae  of  tncl 

kj,  bot  uODcnn  irith  aQ  odMr  «athoritiea  m  reconuuenii 

,  tiM  opmtioa  be  itoae  carij-  if  at  oU. 

BuTMiev  ^mb  JHTnmngljr  of  liin«*vater,  applied  b; 
the  qicar  cnatiinxioslj.  nr  hj  the  pnfaang  fiwiucntlr.  Kext  m 
tliiilie {iaoea  laatic  acid,  asa  Mfe aiad  efficient  nolvent.  It  «houM 
b*  added  to  irat«r  antil  the  latter  is  distinctly  soar,  and  the  •"'  ^ 
tioo  applied  by  tbe  spray  or  prohans:. 

QainiDe  »hoidd  be  given  in  fall  dosea*  five  graittfi  ercry 
fonr  boon  for  a  child,  ciiicbuahuB  bein^  kept  op  tts  fully  u 
poeiible,  with  a  view  of  ppereDtn^  caradatioo.  In  alteruAiion 
with  this  he  girofi  brDUude  of  ammonitm)  in  full  doMB.  The 
bromidei  being  dimiaated  by  the  brnochini  ninooas  membrane 
are  impposed  to  act  locally,  beMtde^j  <he<king  laryngeal 
For  the  latter  object  he  add«  chloral  to  the  hivmide. 

Fevp  have  had  the  temerity  to  treat  raembraiioiui  croap  ex] 
aotly,  bat  th<>:«v  wlm  huve  done  so,  obtained  results  not  loaa  favo 
able  than  tbo%  whoee  conrve  reserablee  the  energetic  prooed 
of  one  who  id  trmtiriga  case  of  opiam  poieouiiig.     .And  yetii 
b  a  vcimt  difficnlt  thing  to  control  odc>  natural  dediiv  to  W  u 
and  doing,  in  the  proKucc  of  this  terrible  diseasv.    The  hu^' 
doeeB  of  quiniuc  recomm^ided  are  tiscle^s  after  exudation  has 
occnired,  and  until  tliat  has  prweutt'd  itiK*lf  we  do  not  know  thai 
we  have  really  to  contend  with  true  croup.    The  introduction 
CDwyer's  tutws  nmrkfl  n  diiJiinct  era  in  the  tpeatinent  of  th 
diaeaflc,  aa  many  persona  who  will  not  j-ormit  traehcotomy  will 
allow  the  laryngeal  tubes  to  bo  introduced.    It  is  to  Iw  hopt^l  that 
theee  valimble  in^trutuent4  will  eoou  be  in  the  tiands  of  eri 
physician  in  active  pnu-tioe. 

Our  own  exporioneo  in  croup  is  not  moro  saoooBsful  tlian 
of  others.    Evcrj  cam  operated  upou  died.    The  conrictio]i  grows 


! 


lae 

I 

ill 

.  ..jai 

m 

that 


147 

»n  ii-t  with  every  case,  that  more  can  be  done  by  regulatitig  the 
it  of  the  room,  impregnating  the  nir  with  Bt<'«in,  portBihly  with 
Itxni-.  liifjiing  np  the  strt-iigth  in  every  way  poeeible,  giving  an 
sim.-tii.-  only  when  Iwwe  nurniliniiie  (HxjhuKi*  the  glottis,  aii<l  giving 
other  medicine,  than  by  crowding  down  the  throat  of  the 
ig'-'linir  child  nny  of  thti  litToii-  rumtiien  in  vogue. 
To  this  we  mtiBt  add  one  brief  note:  Hecently  the  aucce**  in 
'  tibe  treatment  of  diphtheria  by  the  tiac  of  onlomet  (gr.  x  every 
2iour)  haa  been  so  astonishing,  that,  the  identiry  of  the  two  di«- 
'Caecs  being  a<linitted,  tbc  inference  is  strong  that  the  «amc  remedy 
irould  piwe  oaeful  in  croup. 


DENGUE 

Zi'EU'Elt  Kays  that  the  treiUinent  in  g«iii?rally  )>egun  with  nu 
emetic  or  purgHti\'c;  then  qninine,  ditiphnn_>ti<!)4  nnd  warm  iMiths 
aru  employed.  Others  recominuiid  belladonna  in  large  dnscti  as. 
very  ellicjtcions  ngainut  the  |iains  in  ilu;  jn'uit.-i ;  alw  strj'chjiine, 
phuspliorie  acid  »rid  colchicum.  Cold  baths  arc  aim  in  repute. 
Afior  tho  di'^ip].(':irance  of  the  fever,  Christir  ami  others  give 
iodide  of  potassinin.  For  the  paiiu  in  the  limbii,  frietion  with 
Rjiiriturmg  and  p'tiniiilnting  lininientji  in  employ imI,  and  chloroform, 
electricity,  toniea,  etc*.,  todo  away  with  the  great  woaknon*,  whioh 
often  hutit  a  long  time. 

F.iVRBB  i«ay9  that  while  tho  (lii«?a«e  rtnis  a  definite  course, 
jodietoiiA  treatment  raitigatw  the  aulfering  and  avU  reeoverj*. 

Neither  emytiw  nor  purgativem  arc  of  mi}-  nsu ;  but  ou  the 
contrary  they  do  harm.  LaxiitivM  may  be  nsod  m  indicated  by 
the  rttate  of  ttie  UowuIh.  Sall&es,  ftufh  at;  eitnite  of  i»otii.-«<a,  with 
nitrous  other  and  aconite,  arc  good  during  the  pyrexia.  If  the 
t«inii«rature  be  verj'  high  (105**  to  107"^},  cold  sponging  or  cold 
bath>  aiv  indinitwl. 

Belladonna  soems  to  confer  great  relief.  Ten  dro|w  of  the 
tincture  may  be  given  every  hour  for  tliree  dose*.  For  Iho  pains 
and  iu»irturnal  rostleflsness  opiates  are  preferred,  Toniiw  niid  a 
carefully  regulated  and  nulntioiii*  diet  are  mIho  indtcutod,  and  dc- 
plertive  meoHures  must  bo  avoided. 


146 


MAHUAL  OF   TRKATMENT. 


When  there  is  a  teii<Jencjr  to  relajieMM,  qoinine  in  five  or  i«| 

grain  doses  may  be  beneficial  in  arresting  them.  Othcrwine  thb 
drug  iH  iiHeful  only  as  a  tnnit.-.  Bnmiitic  of  potasli  m  r(H--omnietided. 
hy  some  authorities,  especiallj  iii  children  with  (.-onvulsioiis. 

For  the  irrttatiuii  uf  the  akin,  i-aniiihuraied  oil  and  warni^ 
baths  are  suggtuted. 

LooMis  lays  stress  npon  the  Ixmefit  aflorded  l»y  anti-rlieu- 1 
matica.  TIg  administration  of  colchicum  with  epirite  of  nitrei 
and  nitrat*!  of  |iiilu«sa,  1o  produce  diiiphoresia,  with  eflerve«cing 
draughts,  wilt  usually  afibnl  relief  from  tlie  pain  in  the  head  and 
limbtt.  If  the  arthritic-  ]iiiin!(  [tentiNt,  opium  may  be  given  until 
relief  ensues.  Salicylate  of  soda  is  of  great  benefit  where 
arthritic  (tains  are  Keviin.'^ 

During  HxQ  remission  he  gives  snlines  and  quinine  witJi  an 
alkali.  Kor  ^fonvaiotceitt^e  lie  rfHtommends  wine  and  malt  liquors. 
The  lymphatic  enlargement  should  be  treated  wirh  i<Hlino. 

If  a  single  joint  remain  swollen  and  tender,  long  after  ilia 
eubsidencc  of  the  fever,  an  occasional  blister  is  of  value. 


Davis  naya  that  euico  the  fact  haa  been  recognize*!  that  the 
disease  is  but  little  affected  by  treatment,  iikml  physicians  pursue 
an  expectant  course.  Ue  speaks  highly  of  quinine  and  of  wli* 
cylic  a«id. 

J,  C.  WiLSflS  cousidorw  it  dtwirahlo  to  anticipate  elimination 
by  the  bowels,  by  recourse  to  mild  but  elBcient  purgotivcs.  1 1  la 
not  iic-ee»eury  to  bring  about  watery  diecliargea. 

For  the  distressing  iteliing  in  tlie  latter  (ttageci  he  reeom-l 
mends  I'- 
ll    Amman,  rhlorid, gr.  XK 

Itvdmrg.  kiclilorid., ■••>.  ...i,,,,,gr.  1 

M  isl.  nmygdnlic, JJJ 

M. 

Bartiiolow  fitiggc»jtpi  tliat  the  fimt  |iaroxysm  may  be  short*] 
oncd  by  pilocarpin. 


MARsm  ni8iFiDtn> 


149 


DIABETES  INSIPIDUS. 

Sbnatoh  directs  attention  iirst  to  tbe  aflectioua  ctinuDg  the 
Jise— Oi  saeb  a^  »vji}iiii^,  s]>iiial  ilii^t^ii^,  and  hysteria.  Thcdc 
dkoold  receive  appropriate  treatment  when  preeent. 

In  light  caM»  he  R^commcndtt  a  careful  nttcntion  to  the  skin, 
mnu  clothing,  warm  Iialh»,  frictions,  etc*.,  in  order  to  divert  the 
fluid  from  the  kidneys  to  the  ^kin. 

In  Mven-  vofvs  palient«  may  qucjich  thoir  thirKt  hy  taking 
bit*  of  ice  and  acids,  titi^tcad  of  drinking  exeessipcly. 

Among  the  romcdic*  to  l>e  first  hhnI,  bocansc  harmlces,  aro 
valerian,  rvoomracnUcd  by  TROttti«EAii,  and  the  constant  current, 
which  has  l»ocn  employed  Biicceaafiilly  by  Kcelz. 

HAxnPlBLD  JosKS  fouiMl  vuleriun  flHcaeions  in  diminitihing 
the  amonnt  of  nriiie,  %vhile  the  convulsionB  became  more  violent. 
Opiom  dimiiiiohw  tli«>  thirvl  and  ixOyiirin,  tliou>^h  only  tempo- 
rarily, hut,  oivinir  to  itJ*  lendt-ney  to  disturb  the  dige-stion,  Hlioidd 
only  be  pmplnyed  in  ab<io1uto  neeossiiy. 

Laxcock  repoi-tol  favorably  upon  jaborandl,  in  a  caM  in 
wbi^  U  wu  irictl. 

BCTioEK  found  Jabonindi  useless,  but  ergotin  efRcacious. 

IiACDEit  ItRfXTOK  has  hut  little  commendation  for  any  remedy ; 
while  admitting  tluit  eauiphor,  vali^rian  and  valerianate  of  zinc 
ftra  MmidtimeH  found  useful.  OalvaniBiii  may  lie  applied  by 
placing'  OD»  pole  on  the  nape  of  the  iieik,  and  tlic  other  on  the 
loin*  or  epiga-ttriiim,  or  by  one  pole  over  the  loinn  and  the  other 
pnned  deeply  into  the  oorreapouding'  hypochondrium,  first  on 
new  udc  and  tlicti  on  the  other. 

RoRRRTS  rocomniiendA  the  applicntlon  of  a  large  hliHter  to  the 
nape  of  the  neck  or  to  the  epigjtstrium. 

6n.TBR  mnkci  the  very  wnsiblo  auggwtton,  that  to  pounttr- 
l«laiice  the  draining  of  the  tissues  and  the  wa^te,  a  plentiful 
ivpplj  of  fluid,  and  good  nourii^hing  food  be  given.  Strj'chninc 
and  iron  do  good  by  improving  the  health.    In  one  case,  ttie 


150  MAKCAL  OP  TRHATMKKT. 

wljole  list  of  renieUioa  was  tried  without  benefit.  In  another,] 
chiiDgo  of  iiMidence  to  the  eeochore  was  (olloweU  by  alnioetj 
complete  disapjienram-e  of  the  polyuria. 


DIABETES  MELLITUS. 


Senator  cmpha-stzcn  the  caixlinal  point  in  the  treatment,  that 
the  withdrawnl  of  grainysugar,  aiiil  of  Huch  itubstanoea  a«  ara 
converted  into  grape-sugar  on  tlifir  way  to  the  blood,  is  to  be 
obtained  at  any  privc. 

We  can  nearly  attain  tliis  object  by  confining  the  patient  to 
animal  food,  but  this  eoon  becomes  rc^pugimnt.  It  h  found  that 
green  vcgctuhles,  such  as  cabltuge,  spinacli,  yellow  beets,  etc,  may 
ott«n  Vhs  eaten  with  impunity ;  and  sometimex  milk-«ngar  and 
glycerine.  Most  to  be  reconinicndcd  are  meat,  birds,  ehell-fiflh, 
atid  fUli ;  tlien  diee^,  while  of  egg,  cuounib^r^,  crcesed,  ueporagite, 
»ttsily,  radinhea,  ami  triifficA.  An  a  rule,  diabetics  bear  iate  well. 
Acid  finiitd  are  generally  allowable:  also  nuts. 

Grap«  and  (■aiic-sugar,  honey,  flour  bread,  potatoes,  pulae,  rice, 
gTOAt«,  sago,  com,  ehcetuut«  and  the  like,  tthould  be  avoided  as  iitr 
as  posaible.  Various  substituted  for  bread  have  been  propoacd, 
eueh  ta  gluten-bread,  almond  bread,  bread  treated  witli  malt, 
tnuline  bi^cuitd,  and  Iceland  moss  bread ;  the  Unit  being  preferable 
on  account  of  cheapness.  Sksatok  condemns  Klklz's  recommon- 
dation,  of  taking  all  the  bread  allowed  at  a  single  meal ;  as,  if  but 
little  be  used  at  &  time,  it  may  be  converted  or  uned  up ;  while  a 
larger  quantity  would  funiish  sngar  to  circulate  in  the  blood 
and  do  barm. 

Coflee  and  tea  may  bo  allowed.  Coeoa.BhollB  aj«  better,  but 
cliocolftte  muat  be  forbiilden.  Glycerine  may  be  suWUmtwl  for 
sugar  to  sweeten  those  drinks.  Milk  need  not  be  wiibhcld.  Aa 
to  alcohol,  he  biur  not  M>en  harm  renult  from  ibt  moderate  uh?. 
Preference  is  given  to  the  red  wIjmm  ;  beer,  sweet  wince  and 
liqueurs  beiTig  avoided.     Kouiiii^  in  worthv  a.  Irlal. 

The  ihiwt  ehoiild  bo  roeiste*!  an  far  as  [joiwiblo;  ioc  may  bo 
nicked,  but  aci<lii  must  Iw  avoided,  aa  ihey  tend  to  injure  tlie 
teeth,  whif'h  are  apt  to  decay  esirly  in  dialjetic*. 

The  diet  iiiu»t  be  varied,  and  due  regard  ]nitd  to  the  patient's 


HUBETES  UKULItrS. 


151 


i 


f5.  Particular  attention  uliould  be  paid  to  the  skin.  Wanu 
IS  ftre  very  sw'-n'iceable.  Wanti  clothiiijt  should  be  itwiflteii 
Qpou,  atid  gn?at  caro  should  be  shown  in  aroiding  coldii ;  on  bc- 
count  of  the  dimiiiishod  resistance  of  tliene  caaw,  and  the  tendency 
to  phthisis.  Exereise  is  very  iisefiiU  but  miut  be  carefully  rcpi- 
late<l  in  accordance  with  the  strength. 

The  iiniJortance  of  druj^a  is  far  leas  than  that  of  dii.'t<^tii-  regi- 
men. Tlie  Iwnefit  which  nearly  always  follows  the  use  of  opium 
1*  iniiisitcirj".  It  should  only  be  enijiloyed  when  the  patient  hiia 
tirerl  of  meat  diet,  and  if  fompelleil  to  return  to  luixcd  food,  the 
had  effect*  of  whith  may  bc  mitigate<l  by  thi.s  dnig.  I'retty  large 
doeea  shonld  be  given,  and  rapiilly  im-ivjiw^l,  until  the  sugar  di* 
appears  or  \*  diminislied  notably.  The  drug  should  then  be  dis- 
continued.    T>iai>ffi<-s  l>ear  unusually  large  diwuof  of  opium. 

From  alkalies  the  only  good  effect  which  can  be  expected  is 
that  which  afx-nit-ft  from  their  acti<in  U|)on  tho  digwtivo  orgiin^ 

"Belter  result:*  have  been  obtained  fi-nm  the  alkaline  thermal 
waters  of  Vichy  aud  Carisbad.  It  liiir*  bei;n  found  that  after 
n»ing  these  watent,  the  effects  of  a  mixed  diet  are  less  iiyurious ; 
while  the  excretion  of  sugar  is  diniinifhed.  The  good  effecitw  of 
lese  n'n]c)ii'«,  like  those  of  all  others,  an^  but  teru[K)rary. 

Lactic  add,  while  not  exerting  any  infliionce  on  the  disease, 
deMrvcM  some  eon-xiilemtion  us  the  only  direct  suhHtitute  for  sugar. 
The  benefit  derived  from  the  use  of  cod-liver  oil  is  -rreatly  due 
to  the  free  fatty  acids  i'ontjiine<l  in  it.  .^iveiiii'  KMiin-liiiic-'*  really 
diminishes  tlie  amount  of  sugar,  but  in  other  iiisf:*  t';ii!>.  Other 
remedies  which  have  Wen  usetl  with  asserteil  advantage  are, 
itiire  of  iuUine,  ([iiinine,  eucalyptol,  iron  and  airholic  acid. 


BotfcnARDAT'ii  rules  concerning  the  diet  of  diabetics  are  as 
Hows : 

1.  K»t  moderatoly  and  iilowly ;  food  should  he  well  luasti- 


■2.  As  long  OS  the  quantity  of  aruie  jiassed  in  24  hours 
cceiMJ^  three  pinl^,  drink  ut^  little  a^  possible. 

it.  Eat  s[;aringly  of  liquid  ftHxl-*,  such  aa  Mtupn;  take  yonr 
drink  in  sips ;  the  thirst  can  aoinetiiaes  ho  alleviated  by  riiwing 
the  moulii  with  icc-wuter. 


152 


HAiniAL   OF  TBEATMKXT. 


4.  Combat  thirat  by  cbowLiig  {Kirulicd  com,  roa^t«i]  coffee  or 
dUvm. 

5.  Two  meals  a  day  are  preferable :  one  at  10  A.  M-  the 
other  Ht  6  P.  M.  Kscliew  rcpone,  CHpiKiially  aft^r  iiiciils;  a  good 
long  wulk  after  the  repast  is  beuelicial. 

C  ICever  Ik  ilown  f<»r  four  hours  Bfter  the  last  meal. 

7.  Abstain  from  the  use  of  tobacco. 

8.  Avoid  Hlarchi?!)  luiil  migfars. 

9.  Aljstain  from  bread.  ]ia»iry,  rice,  maize,  potatoes,  arrow- 
root, sago,  tapioca ;  the  8tan:liy  i>art  of  vegeUbleei :  iwas,  beans, 
Kintils,  nutJ4,  radishes  turuipi*,  carrots,  Bquatthes,  fniits  ;  ef^iieciiilly 
such  a:^  pruiieM,  gnipcn,  tig?),  barmiiait,  \teti»,  iipplett,  melons;  and 
pixMervei*,  as  well  as  acid  or  saccharine  drinks. 

10.  Wlicat  or  rUv  flour  should  iiot  ht  employed  in  gravies 
and  Miuces,  bat  gluten  Hour,  yolks  of  eggs,  butter  or  crenin  (thonld 
be  used  iiwU;acL 

Since  Boucuabi»at  firet  formuUitcd  these  rules,  they  have 
formed  tin-  ba^is  of  the  trciittntml  iif  dialwlcti.  The  same  aiilhor 
has  tlie  credit  of  eiilliiig  attrition  to  the  grcnt  vahie  of  foivyd 
exercise  in  the  saine  diiiordtir. 


Ddjardin-Bbauuetx  ^ys  that  in  grave  caaes  when  the  skin 
19  dr^'  and  harsh,  warm  baths  followed  by  massage  arc  useful.  lie 
calls  the  alkalies  the  most  pi-ecious  pharmaceutical  iigont?*  in  the 
treatment  of  <li»boto8.    lie  prefer*  the  waters  of  Tale  '*r  Vichy. 

P^LiZET  Bhowed  that  in  some  cases,  by  following  the  dietetic 
regimen  of  H'iucuabhat  and  the  iilkalnie  medication,  by  bromide 
of  potassium,  one  may  entirety  free  the  urine  of  sugar.  Great 
depression,  however,  follows  the  use  of  this  drug. 


I 

1 

I 


FoTnKROiu.  s}>eakK  in  liigh  terms  of  buttermilk  as  a  stu|>lc 
article  of  (he  did.     It  may  be  replaced  by,  or  alternate  with,  m 
dkimnted  niilk,  whey,  or  koumiss.  V 

The  wat«F«  of  Waokeaha  have  been  highly  recommended 
for  ihi;*  diseiiMt-,  In  many  ciusu.'^  tlmir  u»«  is  followed  by  the  same 
marked  i-etief  seen  after  other  alkalies  are  given  :  but  in  do  case 
is  the  improvement  ]>crnuinciiL  The  reimlU  of  dietetic  treatment 
have  rendered    dialratea  a  much   less  formidable  diauaae  L 


k 


'omw'rlv.  While  coinpIeU>  ami  permniient  (njre  m  not  to  be  looked 
for.  Bkilfulnianagompnt  will  vorj' olVii  |iroloiig  Ulu  to  the  limit 
vehiiAi  wotiUl  probably-  luive  heeii  rwic-h«l  wore  the  dinbet«e  not 
preaeat. 

ITnwise  dragging  u  to  be  deprecated. 


Db.  AfSTis  Kmst  <ronsi<lers  diabetes  curablo  by  means  of  a 
!"f rii't  ftdhorcncc  t't  diet,  nnd  the  uac  of  Clomont'n  eolution  of  bro- 
mide of  arsenic.  1>r.  Lopis  Lewis  has  had  succeBs  with  thu 
pam*3  tiTJitiiicnt. 


DIARRHEA. 


Oi.n'Kii  advucg  that  fi>od  should  be  taken  in  Mnall  finaiititiM, 

and  tepid  or  t-uld,  Imt  never  hot.     Fariiint-^'U  art'  iDwftil,  tiik(>ii  wiih 

milk,  chirken  nr  mutton  broth,  or  iM>of  t^^a.     .\ninjnl  bnithti  aro 

apt  to  aggmvate  diarrhpn.     Mucilitgiiu^uei  and  astringent  ilrinks 

%y  be  given.     Brandy  with  BptL-es  in  often  of  service,  alwi  Umc- 

kt4U'  with  milk. 

Itoet  in  bed  seciiros  uniform  warmth  of  tho  skin,  and  fevore' 
cestation  tif  diarrhua. 

In  children,  orrore  of  feeding  should  bo  cnrroctod.     Tho  air 

iten  tilioutd   be  prtitected  by  a  llannel  bimditgi-,  ami  the  feet  uiid 

by  warm  clothing.     As  in  chronic  diarrhea  the  flui  is  per- 

tuated  by  the  debility  and  anemia  wliieh  it  indui-ex,  a  leading 

rinciple  in  to  prencribe  ft)od  rich  in  foiTnative  materials, and  such 

m»  iji  digei^ted  wholly  In  tlie  stomach.    Animal  food,  raw  or  ligbt- 

^^^  cooked,  with  |ippt*in  :ind  hy<lrochhiric  acid,  given  happy  rwnltn. 

^Khe  treatment  by  law  meat  ban  been  succceMfuUy  ap[ilicd  to  ncar- 

^Kf  every  form  of  chnmic  diarrhea,  and  cniiecially  to  that  which 

occuni  after  weaning.     It  \s  beat  to  begin  wilh  a  small  quantity 

gnulually  increase  it.     The  moat  may  \k  pountlcd  t4)  a  ]iulp< 

3ced,  mixed  with  ealt,  sngar,  fruit  jelly,  conserve  of  ro8»s  or 

iffiieod  thnmgli  clear  gravy,  «>up,  or  chocolate  made  with  water 

iwine.    The  only  drink  allowable  is  water  containing  the  whtto 

TrotUAMU  found  opium  in  Kiaall  do7>ert,  chalk  and  bis- 

math,  at  or  betweeo  meaU,  to  assist  this  regimen. 

Wben  the  flux  is  moderate  and  aalatary,  rcmoriug  uiidigctited 


154 


MANUAL  OF  TRKATMEST. 


mflterialB  or  irritating  Becretioiis,  relieving  an  engorgeil  ponul 
vain,  oriiu])[)l(>iiiuiitiiig  n  !«ii|>preHM(Hl  rt'cretiim,  iL  may  be  let  atoiie, 
op  eucourageil  by  laxatives;  it  wiiinot  be  checked  witLouC  risk. 
A»  a  rule,  the  treatment  of  (liiirrliwi  sIkhiIiI  liegiri  by  removing 
irritating  snbstantes  from  the  alimentary  aiiial,  by  aperients  guard- 
ed by  small  ibwes  of  opiinn ;  vehilc  astringents  arc  held  iu  rci*crv«. 
CaatOT  oil  is  best  for  children  or  ad  nit*.  In  fbnlemic  diarrhea 
the  boHt  I'ejtults  are  oblniiidl  I'miu  eastor  oil  and  Inudanmn  at  the 
coinment^meut,  while  astringent*  are  uwil  later,  when  the  stools 
are  copious  and  watery,  griping  and  tymfianile3  ab:*ent,  and  the 
tongue  (^IvflH.  Vomiting  Filutuld  In*  encinimgeil  by  drinking  warm 
wat«r.  In  cbildreu  when  the  motions  are  colorless,  profuse  and 
iiicftu^nt,  it  ir>  host  to  give  mercury  with  chalk  in  fsniall  tlneta 
every  hour  or  two,  and  a  very  small  enema  of  cttareb.  containing 
state  of  lead  or  snlpliato  of  cnpt}or,  with  laudannni.  If  the  caee 
be  urgent,  give  logwood.  In  the  cold  stage,  mustard  baths,' 
emotica,  atimalanti*  and  niL^potiriaU  have  been  recommended, — in 
the  stage  of  reavtiou,  saline  aperients,  or  calomel. 

In  ncr^'ous  diarrbeji  the  find  indication  ]»  to  allay  reHcx  ex- 
citability by  giving  the  bromides,  or.  if  these  fail,  opium.  If 
lUiirrbea  bo  exfilwl  by  food,  llif  dn«^  slimild  be  given  shortly  be- 
fore mewls. 

In  lienlprlc  diarrhea  arBenio  U  invaluable.  Indigestion  calls 
for  hydrochloric  ncid,  &e. 

In  vkariouei  diurrlien  the  ekin  should  he  excited  to  action  by 
vajiop  baths;  in  kidney  disease  counterirritation  about  the  loins, 
digitalis  and  nifi-c  arc  indicated.  The  diarrhea  shonld  not  be 
«-!i(ckod  niilu-*ti  it  id  profuse  or  exhannting;  eejfcially  after  the 
nkin  and  kidneys  are  oeting.  DJan-Jica  fmni  pas^ivewngc'^tionof 
iho  poKrtl  vein  domandu  treatment  for  the  ennse.  Chronic  diar- 
rhea cannot  as  a  rule  be  .stopped  by  astringviitji  alone-  The  gcu- 
eml  hcidth  must  bo  restored  and  anemia  roraovod.  The  secretions 
will  tbe]i  improve  and  Ibe  diarrhea  itubHide. 

Tonii-s  miiy  lie  given  with  ii«tringent>i.  Ipecacuanha  atid 
taraxaoum  are  useful  when  the  skin  and  liver  are  inaetiie;  from 
one  to  thnx  graiiw  of  i|«<-acH  being  givc-n  niglit  and  nioraittg. 
Podophyllin,  gr.  i,  should  be  given  four  times  a  day,  when  the 
iinitiuiw  are  watery,  isilu  or  high-colored,  and  paew,*"!  with  severe 


DIARRBEA.  155 

ntitif*  pain^    Small  Jcmm  of  saliOM  ehould  lie  taken  in  tlie 
I     gtfly  inoniing,  in  a  little  wator. 

^k  The  colU{(uative  diarrliea  ot*  boctic  U  best  met  by  liicniatoxy- 
^loii  am)  golphuiic  aciil,  or  opium  witli  t)te  salttf  of  ailvcr,  cu[){ier 
1     or  l«ad. 

^*  FoTitBBniLL  rcrommondd  for  tlio  dian-hca  of  infants,  castor 
lOO*  followed  by  alkalies  to  prevent  the  formation  of  caseous  ma-s- 
^■Bi,  CondcuiMKl  milk  may  often  be  advautagooiuly  niixed  with 
^Thoe  water. 

For  diarrhea  rraultiui:  from  a  chill,  ho  advisee  a  dose  of 
opiuxxL    If  there  be  follicular  ntceration  of  the  bowels,  and  each 
notion  i»*  precedc-d  by  severe  (rrii»iii)»  pains,  ccneiiig  aflcr  the  ovao- 
itiou  of  tile  ac-rid  mid  tilll'iisive  m(M>l,  he  gives — 

9     CrMK  prep. $t.  zt 

Timet.  calMhu, t^m 

TincL  oyii, m;  Z 

Aq.  cinnam^ TJ  j 

U.  S.— To  be  ukttn  aAer  udi  Butioii. 

AVlien  the  motions  are  loose  anil  copioog,  he  prefers — 
A    Tiikci.  ofiii mc  z 

Acid,  aulph  arid  dil^ 1|lt  XX 

lDfui.l>Ka)>U»v]i, f)  j 

M.    8.— Take  fkiur  tu  ux  tiuio  a  (la/. 

Etieiniita  of  iiUrx:h  and  opium  are  ofteij  very  nsefnl  ami  grntc- 

ll  to  the  ]intieiit,  twpeL'ially  when  there  w  fnllieiilur  ulceration. 

^ery  nfl4;n  it  i«  wist;  to  iidd  to  the  above  treatment,  a  [Miwder  at 

bcdtitne,  consisting  of  eomitomid  kino  [H)wder  und  hiNmuih.  leii 

gRiiiLH  eai-|j.     til  some  f:irt;s  lA'  jMirsUtent  loosenfWH  not  amtiiititing 

^jo  diurrhcH,  bismuth  and  myrrh  are  uM^tul.     In  nervous  diarrhea, 

^■inuing  on  when  the  ])ationt  w  about  to  start  on  a  jotinicy,  ho 

rwfminieiKls  that  tlie  Ijowels  l>e  well  o[M.-tied  Ihe  [ii'eeeduig  liay 

rith  rhuWrb,  aiid  a  iIuno  nf  bWuiuth  nr  myrrh  be  given  at  hud- 

To  Buch  ]K'nHiiis  bromide  of  potassitun,  with  wome  vege- 

b1>le  tonic  or  chiilyl>cnte  ttiay  Ix;  given.     The  wime  remedy  is  ttjc- 

imctidc«l  for  rertcx  diarrhea,  oocttrriiig  during  prfgnam-y,  Ac 

'RARTnoijavr  r[.>commemlH  a  pill  of  opium  aiul  eompbor  for 
ipio  acule  Uiarrbcu. 


156 


MASUAL  OF  TBEATMBHT. 


In  stiminer  diarrhea  the  mogt  efficient  treatm«it  is  the  uw  of 
a  miiienil  tu-iil  with  laiiihmiiin.  AlkaliiM  inay  twinetimee  do  be& 
ter,  but  they  merely  neuti-alize  acids,  while  the  latter  »top  the 
fermeiitalioii  on  whicli  the  pnMiuction  of  acidn  depeitd*.  When 
the  discliarges  an?  like  spinach,  he  {rives  one  drop  of  yowler's  so- 
lutiou,  witli  one  or  two  dro]w  of  the  deodori/x-d  tineture  of  opiom. 
Retention  of  irritant  matters  calk  for  castor  oil,  with  two  or  three 
drops  of  tiirjH^ntiiio  and  n,  little  landaimru.  In  cbronii;  cases  he 
gives  sulphate  of  copper,  gr.  ,"„  with  morphine^  gr.  «  to  (,  le- 
cording  to  h^l: 

Sismutta  is  the  bci^t  a^tnn^^ent  for  children. 

(For  the  treatment  of  diurrhea  in  children,  see  the  article  on 
cholera  infantum.  See  aluo  the  iirticlo  on  cholera  niorhua,  for  tlic 
treatment  of  eases  OL-ciimiig  suddenly,  with  tlinlcmie  symptonift.) 

In  gum-ia]  it  iiniy  lio  said  that  ordinary  diarrlitaa  get  well  if 
a  dose  of  castor  oil  be  given,  with  ton  dro]M  of  laudanum,  and  the 
patient  he  oonfincil  t^i  hiit  room,  with  tliu  diet  limited  to  stomach 
food.  Afitringenta  arc  uot  required  unless  the  disohargen  continue 
profuse  too  long,  or  arc  obvioualy  weakening  the  patient.  In 
Buch  eafies  the  following  formula  will  be  found  eft'ectual: 

B     Tinct.  o|)ii  dvml., fS  ') 

Add.«il|>b.aru[ii., f3  ■▼ 

Kxt-hirinalox.  fl,. . fS  KTilj 

M.    S.— A  t»up(Xinrul  in  wnter  nhtr  each  pMMfc*. 


Diarrhea  from  disease  of  the  kidneys  is  an  indication  for  din- 
Ijcs,  and  will  usually  be  relieved  by  giving  acetate  of  potassa. 
'Ito  occurrence  of  licnt^^ric  diarrhea,  when  the  tjikiuj;  of  Ibipd  or 
drink  cauae^  uneasy  Mnsations  and  pain  until  the  bowels  are 
moved,  should  attract  our  attcution  to  the  kidneys;  as  guch  a  con- 
dition froqiiontiy  attends  albuminuria.  Small  doses  of  calomel 
and  of  areienic  have  Ijeen  recommended  for  this  form  of  diarrhcfl, 
but  have  proved  uscleaa.  Sometimes  qoixune  has  done  good;  di- 
uraticft  relieve  promptly  if  the  kidneys  be  at  fiiuU,  but  the  beat 
remedy  is  cocaine,  in  doeo3  of  J  to  J  grain,  shortly  before  each_ 
meal. 

Diarrhcftii  due  to  cjit^-liing  cold  are  greatly  lienefited  by  giving 
the  patient  a  hot  mustard  tbot-bath,  and  wrapping  up  warm  in 


DIPBTitKHU. 

1,  after  dnnking  a  large  bowl  of  hot  ginger  tea.  The  oct-urronce 
of  &ec  perspiration  is  lbllowe<l  hy  a  ceMsaticm  of  the  disclmrgea. 

For  ihe  diarrhea  of  tubercular  uloerotion  the  beet  remedy  U 
silrei,  either  the  nitrate  or  the  oxide.  Xext  to  this  coniea  bi». 
miith;  which  is  on  excellent  reine<ly  also  in  the  diarrhea  of  ty- 
phoid fever. 

For  chronic  diarrliea  we  have  noUiing  to  add  to  tlie  preced- 
ing, oxeept  to  (.<iiU  attention  to  the  value  of  hydrastia.  Wc  give 
this  drug  in  half-tlmclim  dottes  of  tlm tiiii.-tur«,  diluttxl,  before  each 
meal. 


DIPHTHERIA. 


HOKKLL  M^cKKnziE  lavs  strem  upon  the  importance  of  Sustain- 
ing the  patient's  i^trc-ii^h,  eejHX-ially  during  the  night,  when  the 
powers  of  life  nm  low.  Nonrifthmeiit  must  be  6e>:ur(d  in  flpite 
of  ercrj  difficulty.  Alcohol  dbould  be  given  in  dnull  quantities 
in  the  early  stap-M.  i^omc  cases  require  large  dosed  frora  the  first, 
Failure  of  the  heart  is  the  signal  tor  the  unf^paring  uhq  of  this  drug. 

Of  recuperative  agentti,  iron  and  quinine  are  the  beet  Inn 
should  begivCT  often  and  in  large  drmee.  Thirty  mininu  of  the 
tincture  may  be  given  to  adults  every  two  hours,  and  i-pojiortion- 
ale  dosea  to  (.-hildreti.  Tlie  general  eftWt  is  often  c-xtreniwly  fav- 
orable, and  itn  [locul]  intiaonco  is  equally  well  marked,  the  sore- 
ness being  nmcli  relieved  by  eacli  dow. 

The  spi'i-ial  indicntionii  tor  quinine  are  hcodat>he,  with  high 
Tem|H>roture,  vomiting  and  tlte  sym|itoniHof  oeptic  poisoning.  lu 
mch  vaaw  the  drug  should   Iw  given  in  full  do»w,  for  not  more 

forty-eight  hours.     Quinine  ia  be^t  suited  to  llie  convalescent 

,  an  a  rule.  Morphine  mid  clilorul  are  HonietinieH  uddc<l  to 
procure  sleep. 

A*  to  9i(ocific*,  mercury,  etc.,  he  taken  dwideilly  strong 
ground  against  t-hem.  Of.  Ihe  luititteplics,  the  weight  of  evidence 
i»  Mrttngly  in  favor  of  chlorate  of  potassa.  Ten  to  twen^ 
grains  nhould  bo  givun  evury  l»*u*hoiir>.  Suli>h(>HairlH)Iatcof  soda 
and  sialicylic  oeid  are  al>K>  mentioned  aa  Imving  been  u»cd  with 
'^apfttn.'iit  udvantogc." 

CaosticBund  Bntringcnt^  he  layn  Aftifle. 


-^an 


158 


Of  the  RolventA,  lactic  add  U  the  be^t,  aii<l  fthouUl  1>o  apjilied 
to  the  t\i\m  membrane  witli  a  brush. 

Antiseptk-a  arc  very  usoiul.  The  best  are  carbolic  acid,gr. 
iij  t**  5  j,  iwrmanganate  of  |ioto«aa,  gr.  v  u»  3  j,  wkhUtoD  of  chlo- 
rinated flodji,  5  iv  to  3  X,  or  <?hloi-!il(>  of  pola**a  in  any  olrungth. 
Chloral,  gr.  xxv  to  5  j  has  al*o  been  recommended.  Ono  of  thcao 
sohitioiifl  should  he  i^rseveriiiffly  emphiyed  a«  a  gai-gle,  ajtraj  or 
nuiuth-wiirth,  hi  every  ciuse  where  there  18  much  false  membrane. 
While  tbey  ]>rnvBiit  fetor,  thuy  have  no  restminuig  iiiflueuee  on 
tho  exuiltttive  jiroecss.  Another  ln«i]  n?medy  is  tolu,  ono  part, 
dissolved  in  other,  four  parts.  In  many  cases  great  comfort  wlH 
be  derived  I'l-om  nucking  loe;  an  well  as  from  using  it  externally. 
So,  also,  the  pain  is  greaitiy  relieved  by  hot  fomentations;  u'hile 
steam  inlinlatidns  exereise  a  fiivnnible  intliience  on  the  local  process. 
The  steam  may  1>Q  niediL-attHl  wilh  earhdlic  acid,  etc.  For  chil* 
dren  who  cannot  ush."  an  inlialer,  a  croup  tent  may  lie  ntilized. 

To  8ummarize:  A  child  attacked  by  sore  throat  during  an 
epifiemie  of  dipthtlieria,  Hhould  l)e  put  to  bed  in  a  large,  well, 
ventilated  room,  and  ehotild  bo  made  to  .iuck  ice  constantly,  while 
a  bladder  of  it*  should  be  uppliod  to  the  neck.  A  diet  of  beef- 
tea,  eggs,  etc.,  should  be  ordered,  and  stiinulantA  an  a  rule,  team 
tiie  tirstt.  If  tliew?  be  evidence  of  primnrj'  l»lood-poiwnning,  twenty 
to  thirty  drops  of  tincture  of  iron,  witli  glyi-eriiio,  and  ten  graina 
of  chlorate  of  potassfl,  ahoiihl  l>e  given  every  three  hours;  if 
catarrhal  symptoms  pivdoniinate,  a  cap-snlc  of  cojniiba,  %  iv, 
should  he  given  every  I'lmr  houiN.  Tho  tln-oat  should  lie  fi]>mycil 
with  lactic  aeid  solution,  oue  part  to  eight  of  water,  every  two 
hours.  If  the  dist-aso  still  ad^Tince,  the  mendimne  shonld  I»e 
jminted  wiih  the  ethereal  solution  of  tolu,  tho  surface  fiwt  being 
dried.  This  may  lie  done  twice  a  day.  Ice  Rht>uld  now  he  gi^-en 
up,  and  warm  anti-septic.iiihalations  nsed  continuously.  At  this 
jieriod  tlie  sulplio-carholatew  «oni«tiniea  have  a  wonderful  effect; 
and  quinine  in  large  doses  may  also  be  given  with  advantage. 

Tho  im|mirod  innervation  of  the  lungs  sliould  l)e  prevented  Ijy 
009  IWe  of  foiHl  and  stimnlHiit.<.  During  eonvaloscenw  the  strength 
xnttst  be  carefully  nursed  back,  and  toniea,  food,  eea-air,  etc., 
should  tie  employeil.  l^ilsy  of  the  pharynx  may  require  tho  use 
o(  tho  stomach  tube. 


mpiiTnEBiA. 


159 


LooMta  keeps  the  patient  in  bctl  till  coiivaWeence  U  fully  en- 
tablUlii^l,  anal  tlie  [julse  w  normal  iu  force  and  frwiuenry.  The 
utmost  caru  bIiouIi)  be  uned  in  ka'piiig  [uiltcnt,  surromtdiiige  and 
all  ul<^i6iU  strictlj-  unli-scptjc  lie  (lii^approvea  of  llio  Im-al  u»c 
of  ice,  aiui  of  counter-irritantii,  nf  et^luirotititf,  of  ostriiigcDte!,  atid 
of  removal  of  the  inL-mhratic. 

lie  Irtok-t  with  mnrli  favor  upon  thehaatetiingof  Kupparation 
br  the  uae  of  steam  inhalations,  medicated  as  recommended  by 
Mackenzie. 

IntenmU.v  he  gives  brandy,  oue-lialf  to  ouo  dmcbm  orery 
hoar.  The  bcnefi^'^ial  otfcct  will  bo  shown  by  the  puUe  becoming 
«Iower  and  steadier,  by  increat>ed  appetite,  and  by  fionoral  improve- 
ment. .\u  intcrmitteut  and  irregular  pulw  demands  Ibe  freest 
tttniulatlon.  iDcrea^ing  apathy,  a  feeble  pulse,  irregular  at  timor^ 
a  dry  longne,  n  dark  and  ofltiisive  exwlatiou,  oiteei  indiirate  a 
«mia  which  may  be  tided  over  by  crowding  stirauliint*. 

If  tliere  be  dysphagia,  r(W4ling  |H>r  rectum  may  be  employed. 
When  the  tempcratiirt!  ranffca  high,  quinine  and  cold  pponglng 
iudic-aied.     Inin  and  chlorate  of  imUi^wa  are  the  remedies  most 

mllv  in  U80.  If  nutrition  bo  kept  nt  a  high  utandard  and 
touiot  bo  UiMjJ  i»>wu*tently,  the  |andytie  nofim-lie  will  not  be 
ver^'  todioaA.  Porter  w  otic  of  the  be«t  tonica  in  the  treatment  of 
the  aequelae. 

Davis  recommends  the  arpieoufl  solution  of  iodlnet  chturatc- 
of  ]»oiu.'«ui  and  benzoate  of  «>odinn),  to  arrort  infection;  and 
quinine,  iron,  (ttryuhDinc.  pure  air  and  nourishment,  to  increase 
idtitf  and  ^»iieral  vitality,  lie  jtayn  clo«e  attention  to  tbo  excre* 
tory  ot^tiM,  na  he  ulway«  doe*  hi  treating  any  diseBse.  He  object* 
TO  ali-ohfd,  fluiniiiig  iliat  (In-  lolcniticm  of  tlii^  drug  exhibited 
ui  diphlliieriiL  i»  dimply  due  to  the  iiiability  of  the»,>>tetn  to  respond 
lo  the  stimolaii  applied.  Be  dow  not  find  pi^mf  of  the  utility  of 
local  anliM:'j»*ia,  in  the  historj-  of  the  variousc  ijpidemicf  which  have 
come  under  his  nortioc.  For  idmple  diphtheria  of  a  mild  form,  ho 
hma  umxL  the  foUowing  fbrmnla  for  many  yean* : 

■     VaimkMonL, 3  yn 

Ada.  brdfoeUorici, fjj 

TfnO.  Mladoa, f  3  Ij. 

Afl"r nrtii 

M.    8. — '5  •  «•  f  5  9  **9tr  i«o  hoata  vidxxit  funhm  dUiaioit 


iLra  i: 
llwo 


160  MANUAL  or  TBEATIIBST. 

In  Mvere  cases  he  Bulwtitutc^  after  Uiroe  dayti^  three  mull 
doeea  of  calomel,  and  the  t'olluwing: 

»    »o<U, p.r 

PDbw.  lodidl, 5  a 

Afjiiip. fjjw 

M.    Sl— To  be  giren  in  (iilUbte  i1oh«  t^try  tix  boun. 

If  the  glands  at  the  aDgIc  of  the  jaw  hu  swollen  cxteroallj. 
he  applies  cIothB  wet  with : 

B     AconilifoL, |j 

AminoniiL-cliIor., , J« 

AqujT  bullicDL, Oy 

M. 

If  it  be  dtfiicalt  to  keep  the  cloths  applied  properly,  he  bq 

Btitutes: 

9     OleioUTK. Jiy 

OIqi  WnbintluQd, 3  ■• 

Chlnrofl>mii J  ■ 

M.    B. — Apply  to  >lt  ihe  swollen  pBTta«Tei7  thne  hoan. 

This  troatmeiit  sbonUl  bo  (.■oniiiiued  throughout,  nn!««  fetor 
supcn'cnt',  when  he  sulistitiittN  «iuinine  nnil  iron  in  inoderato 
(loses  fri'ijuently  rei)eatt?<l.  Extensive  ult^ration,  gHngrene  or 
offensive  iiti«iil  disi-lmrge  rnlln  for  tho  addition  of  carbonnt^?  ot 
amniotiium  and  cninphor,  with  imtntive  ciifiiiHs.  Furthfr  sujv 
port  may  be  nffonleil  by  iniinctinns  of  ood  liver  oil  with  a  little 
Btryclmine  {^r.  iij  to  O  \\).  X«irly  tlie  whole  body  may  Iw 
auoiiitL'd  with  this  oil  tliivt;  times  a  iliiy. 

In  cases  which  pre*teiit  a  very  maligtmnt  adpoct  from  tho  first, 
he  begins  wiib  quinine  lunl  iron,  nheniating  with  carboiuitif  of 
ammonia  and  c:ini[>hnr;  and  npplici*  the  vod  Uvcr  oil  to  the  whole 
hoily  )'re<^Iy,  with  ii  Uttk-  ludiiit;  addul  to  it  llicr  fintl.  day,  and  the 
strychnine  oil  the  next  and  sTih^eqiieiitly.  For  the  chlorate  of 
jH)tae»)i»,  be:  tia.s  lately  t<ubstituted  bensoato  of  Boda,  giving  five 
grains  to  an  adult  every  two  hours.  It  scorns  to  limit  the  exuda- 
tion, and  i»  itiiit*d  to  at-tive  and  flthenie  cii^ce. 

Ill  the  second  stage,  if  the  nasal  diwlmrgi;  become  irritative, 
lie  ban  tlie  nostriU  syringed  ont  with  a  weak  solution  of  carbolic 
acid. 

If  an  ano^lyne  ljeue&ie<l  ut  beil  time,  be  gives  Dover's  pow- 
der, gr.  V,  and  (^umpbor,  gr.  ij,  t*>  ati  adult. 


rSERlA. 


u\ 


Bartbolow  doe*  not.  proi*tnit  aii^'  (i[wciQc  [Xiinb)  In  the  Irt'sl- 
BKot  of  diphl!u'ri:i  wliirli  liuve  not  Ijepii  mentioned.  fXi-^-j't  llie 
iwiiffintioti  of  sulphur,  the  vcr^'  fnM{iiei)t  atom  mi  lion  of  a 
*'niaxiiniim**(?)sw>lution  of  muriate  of  quinine,  nml  the  aiJniini*- 
tnitioD  of  hrottiide  of  umnioiiiiUQ.  Hu  fuvon  the  ubo  of  alcohol 
in  large  (tnantitics. 

Some poiiit«iu  the  foR-goinjf  reBuni6.  rwjuirei-ommcnt.  Prof. 
Davis'  position  on  the  'jucMtion  of  giving  alc*th"l  in  nntcnahle.  If 
the  litlfraiicc  of  thu  Jni^  be  due  to  the  lowered  Mnutihility  of  the 
child,  hy  whirii  itK  {Hiwent  of  rtw{K)mling  tn  the  ntitaulnnt  Qn>  len- 
feencii.  we  ehould  see  the  toxic  ett'».-U  of  the  aU-^diol  producMl  mora 
>di\y  than  wh«n  it  w  given  in  liralth.  That  thia  i»  not  the 
if  a  matter  of  universal  obirtn-ation  by  physi^-iiutti  even'whero. 
Wlictlier  il  be  ai*  a  «ubfttitut<;  for  fo^td,  tvi  lui  uircstcr  of  nu-tainor- 
pbo^ts,  or  af)  a  direct  and  i^jwerfal  germicide,  or  all  three,  it  is  cer- 
tain that  the  free  w^  of  alcohol  U  artendod  with  the  best  r(MuIt«, 
The  beoefieial  effects  of  eulphtir  are  explained  bj  IJartbolowr 
dae  to  it4  {lattia]  ct:iDvenion  into  imlphnroiM  acid.  If  tht«  were 
,  why  not  apply  the  lutier  agvtit  at  otiec  to  the  diseased  tiA- 
iiutuad  of  pelTin^  on  the  im^lar  and  douhtfal  rcstilt  of  Huch 
cheniica!  exfieriiuent  ? 

The  trvatroent  t^  diphtheria,  tnu^^t  depend  greatly  on  the  view 

of  its  locat  or  ooostitulioruil  origin.    If  it  be  a  iiystemio 

from  the  filBtf  local  tnutmrait  is  nnin)portji.iit ;  while  if  tlio 

he^n  aa  a  etrictly   local  one,  our  ctfortji  Hhould   be 

to  the  prompt  dc«tniPtion  of  the  gernitt  before  they  have 

had  time  to  borrow  into  the  mocoaa  membnine. 

I  am  firmly  coavinL-ed  that  the  latter  aptnioa  vt  the  true  onsL 

adniitted,  the  qoeietion  cometi  np,  wliat  i»  the  moat 

agoil  for  local  O-te  in  the  early  ntage  ? 

After  trring  arcrj'  kiraJ  apftHration  whic-h  ha«  oome  to  my 

iee.  I   hare  faaad  none  to  o(Hupbi«  in  efficiittc}'  to  na^^^^nt 

chlorine. 

Mjr  fortnnla  ia  a*  folluwit : 

ft    naM.cUmt.rii)Y, Sj 

aaLb74fK^hrici,U.&P, fSM 


pfa 


y^ 


1«S 


MA»I7AL   OP  TBUATMKKT. 


An  experipnce  of  twelve  yeiirf.  with  ihU  prescri]>ti<ni.  and  b 
mnny  va^en,  liaa  confirmed  my  faith  hi  it.  I  have  luaiiv  times 
been  called  when  one  child  in  a  lainily  was  beyond  all  hnmao 
aid,  and  Imve  ljy  thin  remedy  KtuiijH'd  the  diwa^  a^  fa^t  as  it 
made  its  Rjij^'ai'aiK'e  in  the  throats  of  other  memWrs  of  the  same 
household.  The  following  cn«e  will  illustnite  ito  remorkahle 
powers  as  cnn]i>jiretl  with  other  antii*pptic»  now  in  vogue:  A 
boy  cijcht  ycai-a  of  uge  wus  wizcd  with  di[ihthcria.  lie  wafl 
unusually  rebclliotia  us  to  taking  medicine,  and  na  he  fiiiffcn.-*! 
but  little  with  the  dieea^  at  first,  could  not  ho  induood  to  tue 
tfie  remedy.  Acrnrdingly  I  substituted  a  solution  of  corrosive 
ftulilimatc,  one  part  lu  five  Imiidred.  (Geniiaii  niithora  rwcom- 
meiid  one  part  to  two  thousand.)  During  two  days  the  exadation 
slowly  increased  in  ext^ent,  creeping  hack  to  the  ijoptcrior  wall  of 
the  pharynx,  mid  ai>pearingon  the  other  tonsil.  The  euhliraate 
was  evidently  ineflectual  lu  checking  the  advance  of  the  didcaac, 
though  the  nienihrane  did  not  Increanc  in  thicknoaa. 

The  mother  then  riuggentcd  that  the  child  might  take  the 
chlorine,  if  syru]!  of  sarsapartlln  were  used  as  an  excipleut  instead 
of  water.  I  acted  on  tliia  hint,  and  the  boy  ttwk  the  inixrura 
readily.  Improvement  wa^  nianifeKt  from  the  first  dose,  aud  Iq 
twenty-fniir  iKUint  the  exudation  had  di^mjijicunKl. 

In  Bome  cases  thU  prc(>aratlon  glvod  ri^  to  paiu  Id  tbe 
stomach  or  onlor  urinnt.  I  then  dire<'t  the  patient  to  take  a 
small  ([Uantity  of  soda  before  each  doso  of  the  modicino.  In  nil 
c&»G»  it  is  well  to  take  a  little  water  immediately  before  the 
medicine,  ill  order  to  avoid  irritation  of  the  stomach  ;  but  when 
the  remedy  itself  is  diluted,  much  of  iIj*  efl'ectiveneas  id  lost. 

1  cannot  nay  that  all  c^lhcs  of  phar^tigual  diphthvrta  will  n>- 
cover  under  this  treatment.  Some  will  die  in  apite  of  it.  A\Tiea  the 
bacteria  have  mignttctl  deeply  into  thur-oft  titwtucK  of  the  phar^'ux, 
it  is  obviously  beyond  the  |x>wer  of  loi-al  remedies  to  destroy 
them.  Thia  cm]>ha»izci(  the  iiccciMity  for  prompt  and  vigorous 
treatment  at  the  beginning  of  the  dlaease ;  and  tiie  results  of  clin< 
ical  experience  fully  bear  out  Ibia  view. 

When  the  disease  begins  to  invade  the  nasal  pu«agee,as  soon 
tj  fts  the  first  sign  of  coryza  appears,  I  direct  the  nostrils  to  be 
\  iposhed  out  with  a  solution  of  nitrate  of  silver,  five  grains  to  the 


^ 


DRonr. 


163 


t     ltd 


ooDce.    This  should  be  repeated  every  four  hours  until  the  coryza 
diia]ipefira. 

If  the  naral  afiection  hiiM  |irogrf.»scd  until  hemorrhage  ocnire, 
diromic  acid  should  be  substituted  fbr  the  silver  salt,  in  the  *ame 
proportion. 

Wlicn  the  larynx  h  invaded,  the  condition  of  the  child  ia 
despeiute.  I  onc«  n»ki.-d  one  of  the  greatest  living  laryngologinta 
what  wait  the  best  thing  he  could  tell  nid  about  laryngeal  diph- 
lia.  He  ivplicd,  "My  biMt  word  is,  may  the  Lord  kec]>  me 
im  ever  seeing  another  ca^I" 

Intubation  of  the  lar\-nx  offers  the  great  advantage  over  tra- 

toiny,  of  presenting  no  open  wouml  for  eystemic   infection. 

This  aloDc  is  enough  to  decide  U9  in  favor  of  O'Dwyer'a 
tubes;  to  say  nothing  of  their  ea^^e  of  introduction,  the  avoidance 
of  shock,  and  the  possibility  of  obtaining  the  jwirents'  consent 
uch  earlier  than  it  would  be  giv«n  for  traeheotoniy. 

Dr.  Judd  ba«  informed  me  that  in  caite«  of  profound  systemie 
infection  with  diphthoria,  which  are  usually  con-^idL-nui  hojieleM, 
he  bas  Imd  remarkable  biiccc**  from  tbi?  use  of  calomel.     To  an 
adult,  ten  grains  are  given  evtry  half  hour,  ami  continue*!  until 
inach-colored  atools  are  produced. 

The  U!*  of  calomiil  has  been  diifcarded  long  since  lirctnnneou 
first  reoonimended  it,  but  in  such  desperate  iiisc>!*,thc  fact  that  tintf 
recovered  under  \U  use,  warnuiU  us  lu  giving  duo  eonxideration  to 
its  claims. 

In  conclusion,  support  the  patient,  in  every  pojwible  way. 
Rich,  but  easily  digested  food,  alcohol  pushed  witb  an  unsparing 
hand  when  requiMiie.quiniiie  gupitositoricR, cod-liver  oil  or  aluohol 
baths,  and  rectal  ii^jectionn  of  digested  fiKid,  should  be  considered 
of  aa  vital  importance  ait  any  other  part  of  the  treatment,  except 
the  germicide.  (W.  F.  W.) 


^^ 


DROPSY. 

Laudbb  BiiuxTON  says  that  the  first  thing  to  bo  considered  is 

ic  removal  of  tbe  cause.    Where  the  dropwy  i»  due  to  oWtruction  of 

vein,  wc  mti^t  hinder  the  nccuniulution  of  fluid  by  elevating  the 

part,  while  we  try  to  aid  abtwrptioii  by  gentle  upward  friction. 


164 


VAirOAL  OP  TRSATME^T. 


Where  it  is  duo  to  obstniction  of  the  circulation  in  tiie  lungR^ 

we  must  iliiiiiiiiKh  thiri  Uy  inLiilutioiut,  fiiiftii-K,  iiiid  cxpeutomiitti, 
pUfilieJ  il"  iiei.e**ary  so  tiir  as  to  canine  ii;iu»e«  or  evvu  vomitiuj;. 
"Where  l}ie  olmtruc-lion  la  due  to  heart  iliseiue,  we  tamt  aid  the  f 
organ  to  contract,  more  ]»oweriully,  by  the  uae  of  oirdiiie  »tiiuu- 
lant«,  KiH-li  HA  ult'oliol  mid  di^italiK.  M'lii>ti  di^italiH  iiUnie  doc-S 
not  sucL-eed,  the  a«ldition  uf  squill  and  of  n  ^niall  quantity  of  blue 
pill  fn-fiucntly  inunaiMw  itn  eiKiaicy. 

Bigitalis  siircee<ls  lHs»t  in  dn>]isy  c-Mniw^d  liy  valviilnr  di'^eane 
or  dikiiutiun  of  the  heart.  It  is  not  so  u.-Mjful  lu  drojisy  arising 
from  renal  dii4etu%,  and  here  other  diurctic»  are  pi-etenihle.  One 
of  the  best  ia  spirits  of  juniper,  given  either  ns  a  mixture  or  iii 
the  Ibnn  of  Holland  gin.  Sjiiriti  of  nilrmw  ether,  nitre,  bitar^ 
trote  of  potasea  and  broom,  are  uacfnl  in  all  forms  of  dnj[iity. 
Copaiba  ocisisitiTmlly  sut-cevils  wheiv  other  dinreti*-*  fail.  It  eeema 
to  be  lunat  su<x:eeeful  in  dn^psy  due  to  cirrhosis  of  the  liver. 
Hydmgogiie  catluirtiw,  hucIi  as  eomiHumd  jalap  ptiwder,  e!a- 
teriuD),  etc,  which  cause  vopious  watery  aecretion  from  tlie 
inte«tinc»»,  wnpplenicnt  the  action  of  diuretics,  and  by  removing^ 
water  from  the  body,  a:*  ivcll  a^t  altering  its  nutrition,  relieve  or 
remove  dropsy.  In  some  ■.a^es  of  iSrighfs  disease,  considerable 
relief  has  been  obtained  by  the  profupc  tsweutiug  uidmxHl  by 
Tajtor  hatha,  hot-air  bath«,  jaboi-andi,  or  pilocarpin.  When  the 
dropsy  duce  not  yield  to  other  remedies,  the  fluid  must  be  re- 
moved, by  iiameetitesifl  in  the  ca<i*  of  serous  eavitioa,  and  by  very 
email  supeftieiol  ineisioa'*  or  pnnetnres,  or  by  the  insertion  of 
very  tine  trocars  with  drainage-tubes  attached,  in  the  case  <^ 
the  liiubo. 

Tn  .^nawm-n  it  is  but  nirely  necf^aary  to  trent  the  gympfom  ; 
the  primary  disease  iiiniiahing  the  indicatioiii*  for  trealmwit. 
While  rliuretie^,  hydragoguoH  and  diaiihoretifs,  a^poeially  jabo- 
randi,  will  rapidly  reduce  the  dro|wy,  the  gonond  strength  will 
be  rx!(iui-u<d  to  a  Ktill  greater  extent ;  an  ihut  more  is  lost  than, 
gained.     (See  tlie  article  on  Ascites). 

Small  doses  of  the  salines  combinwl  with  iron,  help  to  keep 
the  etIiiNion  in  c4icck,  antl  at  the  «ai»e  time  keep  np  the  con- 
sistency of  the  btood. 


\ 


DVODEKAL  CATARRH, 


1S5 


DUODENAL  CATARRH. 

T>Aris  Aflvst  tliul  tlif  tpeatnu'dt  wMcli  he  ha-i  found  m(wt  effi- 
cient Inr  tho.s<?  piu^s,  is  a»t  follows:  If  llie  boweU  have  not 
Toovwi  for  twenty-f<)ur  hnnnt,  lie  givoa  t*itml«  of  mngnesia,  or 
ihe  »tilphate  of  ^lfl^nesifl■,  to  jirofuro  n  moderate  movement 
of  the  IwjweU.  ThU  is  done  for  the  piir|>o«3  of  frweing  the 
sJimentnr}*  canni  from  nwuraulHiiona  of  feces,  alllioupth  these 
reraetlles  have  ali«>  Mtiiit.*  iiifliience  in  depicting  the  vesscU  of  the 
niacoiH  mombmnir,  li'  the  bowelts^  however,  have  been  moved 
suffieiciill^',  he  ^Ivus  Bve  gruinH  of  Dover'x  powder,  uiid  iiii  utjuul 
quatititj  qf  nitnite  of  polaseiiim.  Sometimes  he  add*  to  this 
a  grain  of  ealrinud,  hut  more  fit^iiiontiy  it.  i.t  omitted.  If  the 
kitt«r  be  added,  it  ie  only  to  the  Am  four  dwes.  One  of  these 
powdere  is  given  every  four  houm,  until  fimr  to  aix  have  beeD 
taken.  In  the  meantime  (lie  patient  i*  kept  at  rent,  takitij?  onljr 
li(|uid  nonnsUmerit,  niii-h  im  hwl'-lf;!,  imtimuil  pruel,  BOUK-linien 
loilk.or  milk  with  lime-water ;  and  at  the  end  of  this  time,  ho 
fldn>inii*tei-8  anorher  mild  suliiw  luxalive.  In  the  large  proportion 
of  (utuss  the  evavujifioiis  followiiii;  this  btxative  will  be  freely 
colun-d  hy  the  prMen<%  of  hiV.  If  so,  it  in  tthniMt  always  the 
ciuiC,  that  nil  di»ag7T>euble  8yiti]>tom8  arc  deeideilly  relieve<l. 

Ry  junvirig  one  of  the  Kiitau  iMiwders  mnniing  and  evening 
for  two  aul)cM.-quent  days,  and  a  mild  laxative  when  recpiired,  the 
INttient  will  reach  tlie  bv^inniii^  of  eonvalt»K.vm'e.  But  in  more 
eeverv  cuiTCs,  tliere  will  be  no  appc»rnm-c  of  bile  in  the  ovaeua- 
ti(Nu>i  and  ordy  a  moderate  le.-«K.-ning  of  thu  fuhieiM,  heavinii^s  and 
diettrees  in  the  epiga-strium.  If  eiieh  u  the  efise,  instead  of  giving 
till*  jMiwdern  subsequent  to  tliif,  every  morning  and  evening,  re- 
peat th<;ni  at  the  eame  intervali  as  at  tir^t ;  namely,  once  in  tour 
or  five  boure,  at  the  >^me  time  putting  fomentations  over  the 
epigai*trie  region,  either  by  poultieos,  or  by  clot  lis  wet  in  warm 
water  or  in  some  warm  mirfotitr  infusion. 

Id  CAsee  of  more  deeided  ucvonty,  ho  applies  a  btietcr  over 
the  roost  tender  part  of  the  alwlonien.  After  this,  Rimply  keeping 
the  boweU  soluble-,  so  ne  to  have  them  move  onco  or  at  moat 
twice  iu  the  twenty-ftnir  hoiirH,  earefnily  guarding  againnt  exceas- 
ive  purging,  and  if  iho  urine  be  still  scanty,  giving  n  mixture 
of  lic^nor  nnimoni<e  ocetatiti  and    nititms   other,   in   do^es  of  a 


166 


MAHUAL  OF  TREATMENT. 


fur 

i 


teBSpoonftil  diluted  with  water,  three  or  four  timea  a  Aay,  will  be 
8uffi<'icnttot'f>n(lu(rt  tlie])iitii>iit  toconvaleKwiKTC.  One  of  tlie  mofct 
oh«tiiiiite  cases  finally'  necovered  umler  the  coutiuuoii*  uie,  for 
three  woeks,  of  the  following ; — 

K     Aninirii).  chltir^ 5  ijn 

HritrtirK.  biclilor., gr.  i^ 

Sj-r.  glycvrrhu.,  fS  UJ 

M.   S. — r  3ji  iliriM  iLiiiai  a  day. 

Two  patients  recovered  under  the  inflnencas  of  moderate 
dOMB  of  the  Bub-nitratc  of  bi.smuth.  bicarbonate  of  soda,  uid  s 
Bmall  pniportirtii  of  the  cnniiiomul  powder  of  opitim  and 
ipecftcuHiiIia,  with  an  occa-*ional  laxative  to  move  the  howi-Lt.  In 
some  of  tliiwe  (.-wtieji  of  a  (rhnmic  charat;ter,  c-oiinter-irritation  by 
the  application  of  a  eombi nation  of  croton  oilt  tincture  of 
i<^Hliiiu  und  vther  applied  over  thti  epigastnum,  api»ared  to  do 
good. 

Bartholow  says  that  the  most  rapid  proj^reas  can  he  made  by 
adhcritig  to  an  excliiHive  diet  of  milk;  and  an  there  ih  complete 
anorexia,  this  is  usually  not  difficult.  The  hyperemia  i«  relieved 
by  fialitie  laxativet,  but  e^ipecially  by  phosphate  of  soila;  which 
should  be  given  in  drachm  doses,  alraut  four  times  a  day.  Other 
renieirKw  at^ting  similarly,  are  sulphate  of  magnesia  and  bitar- 
trate  of  potassa.  The  general  principle  is  to  use  remedies  which 
will  promote  an  outward  osmotic  flow,  and  thus  relieve  the  cnn- 
gc«tif>n  and  a-dcma  of  the  mucous  membrane.  Mercurials  are 
not  hencficial.  Activecholagogucs,  an  the  resin  of  jioiiophyllin, 
riiubarh,  aliXM5,  etc.,  are  to  be  avoided  on  account  of  the  irritation 
which  they  induce. 

To  muse  the  liver — a  favorite  phrase — is  out  of  place  here, 
since  tlie  obstacles  to  the  outflow  of  bile  are  merely  mcchanicah 
When  malarial  infection  coexists,  quinia  is  indii^pensable  to 
restore  health.  Without  nny  complication  of  malaria,  <piinia  baa 
a  gfWHl  effect,  aiid  hastens  tlie  disappearance  of  the  jaundice. 
When  the  bile  enters  the  intestine,  and  the  integtinul  digestion  is 
restonxl,  the  jaundice  may  still  linger.  Piuretics  and  piirgativea 
may  then  be  emj>loyed  to  remove  the  last  traces  of  bile-pigment. 

Utmipletc  abstinence  from  food,  and  the  use  of  weak  alkaline 
waters,  taken  aa  hot  as  can  bo  swallowed,  with  sinapisms  or 


DySKNTERT. 


167 


iodine  applied  to  the  epigafltrium,  nntially  suffice  in  milder  coms. 
If  jaiindicu  (lupcrvcnc,  the  distrowing  itching  will  be  alleviated 
bv  ivjirni  iilkaliiit-  Ivaths ;  especially  those  t.-oiitiiining  au  ounce  of 
salicylate  of  soda  to  evcrj*  ten  gallons  of  water.  In  severe 
ea^e^  the  «ame  trtaiment  phonM  be  employed,  with  the  ndditinn 
of  phosphate  of  soda  in  thirty-gmin  dn^w,  every  four  lionrv.  in 
hot  vvater.  Uectai  foiviing  elumld  bo  rc4ort«l  to,  in  m-rlfr  that 
the  iluixleuum  shall  have  complete  ro:<t.  Small  doseii  nf  morphino 
give  the  gpoate.^t  relief.  Great  tondomess  in  the  epigastrium  ealls 
for  thecniplnymeiitof  lowheiorlmt  fonient:ilion«,  with  twriK-ntine. 
If  the  ease  threaten  to  become  chronic,  five  graint*  of  chlo- 
ride of  ammonium  nhnnld  be  nddod  to  the  pliosphato  of  8oda 
,  and  after  ilio  acnto  fiyniptom*  have  subsided,  hydrastis  will 
■SKii^t  materially  in  i-estoring  the  licnvcls  to  a  healtliy  I'onJitioii. 
This  should  bo  given  in  doses  of  not  more  than  thirty  drops  of 
the  tincture,  four  times  daily.  Throiigitoul  the  diwwMe  an<l  the 
period  of  couvaleAi-*onco,  llie  patient  must  avoid  pork,  veal,  fried 
food  and  tilts ;  as  well  as  all  articles  which  may  muchanically 
irritate  the  sensitive  mucous  membrane,  k itch  as  grafx^ceih.  An 
the  diteano  is  frequently  due  to  <*at*'hing  cold,  this  Hhoiild  Iw 
avoided  by  wearing  HanneU,  woolen  ttiockingx,  a  tlamiel  bandage 
covering  the  abdomen,  etc 


DYSENTKRY. 


EwABT  eays: — Sliould  an  aperient  be  requiretl,  the  readiest, 
Bimplcst  sad  ino«t  painter,  U  a  tepid  water  enema  of  from  two  to 
fourpiuts.  At>er  the  operation  of  the  enema,  or  whenever  the 
patient  pre-'ient.^  himself  in  thoec  ea3<s  where  no  preliminary  a|>©- 
rient  U  indicated,  a  tnr]>entine  epithcm  or  mufltard  iikster  eluiuld 
beapitiie*!  to  the  epiguslriuni  for  twenty  niinuten.  At  the  wame 
time  from  twenty  graiiix  to  a  drudini  of  ipecacuanha,  ■'lu^pciidctl 
in  two  drachms  of  syrup  of  orange- peel  and  four  drat^hnw  of  water, 
ehould  bo  adminifltere<l.  The  recumbent  posture,  with  the  head 
Tower  than  n«iml,  should  he  enforced.  Liquids  should  be  resisted 
as  much  as  posaiblo  for  ati  hour  or  two.  Tliirti  may  be  quenched 
by  (tu(-kiiig  pieri'B  of  ice,  or  when  this  cannot  be  procured,  by 
wator  in  teaMpoonful  dofiee  at  a  time. 


^'  /^|U^^<^«v 


^ 


.±Se^^ 


1«S 


MANUAL   07  TRBAntBTn*. 


Tfauaca  will  probably  occur;  i>orha]«  in  some  cases,  retelling 
aiid  vomiting.  But  as  the  romiting  w  erix-pticmal,  mul  when  it 
docs  occur,  seldom  iiapi«on«  beloro  the  l(ii»e  of  an  boar  afU>r  tbo 
exhiliitlon  of  the  drug,  tlie  ejected  matter  iwiially  consistB  simply 
of  feiiiall  quaiititiGs  of  piatric  aecii-tiori.  Should  the  ipecacuanha 
lie  rojevted,  the  (low  HhoiiK)  he  repeated  aii  MHin  a»  the  Ntomach  Itaa 
been  traiiqulliscd.  It  will  be  found  beneficial  to  time  the  large 
d<we»,  R)  »-■»  t<>  allow  of  one  l>eirig  given  night  and  morning,*© 
long  as  their  use  is  considei'cd  iiecoA-Hary.  The  signal  for  the  relin- 
quishment of  these  dos*'-*  i«  freedom  from  tormina  ami  tenestinis, 
with  the  uccurrence  of  refreshing  sleep,  leculent,  bilious,  or  ipeco- 
ciiaiiha  stooU,  and  reat*iration  *>f  tlie  primary  proccrt-^cs  of  assimi- 
lation. If  no  great  amount  of  disorganisation  of  the  mucous 
Diciiibnino  have  taken  place,  tbi^iw  favorable  changes  are  fre- 
quently noticed  after  the  administration  of  the  iJi-st  or  eecood 
du»c,  and  even  if  undoubted  uU'^nition  has  Hit  in,  tbcy  are  gciie- 
nilly  discenie^l  on  the  second  or  third  day,  or  earlier.  In  either 
case  the  drug  should  be  iibandoiicl,  us  the  dii^))|>c«nLnce  of  th« 
tonnina  and  Icuet<mii9,  and  the  absence  nf  mucus,  blood,  and  alime 
from  the  otoul^  iiidi(.-ute  the  cciwation  of  dysenteric  inHauimation, 
and  that  the  altt-cted  portions  of  the  bowel  have  been  placed  in 
the  moat  favomblo  condition  to  undergo  cure  by  'rosolutioo' If 
the  cfl.^  have  not  procectled  to  ulceration,  or  by  'granulation  and 
cicatrization "  if  ulctniliou  or  oven  sloughing  have  altwidy  taken 
place.  Chalk  mixture,  with  hyosc^'omus  and  ostringcula,  is  now 
quite  •fufticiciit  to  wind  up  the  euro.  In  some  ca«!s  fermginoua 
an<l  hitter  tonics  arc  denmndod  to  give  lone  to  the  digi-siivc  or- 
gans, and  to  iinprovo  the  condition  of  the  blood.  Cotiuter-lni- 
tfttion  by  nieanrt  of  tnrpenline  epitlieni't  and  inimrard  plaslers  to 
the  abdomen,  or  fomcutationa,  are  valuable  wljuncts  in  the  m»n- 
a^nient  of  t!iB  diseaw. 

The  diet  should  consist  of  chicken  bmth,  beef  tea,  essences  of 
chicken,  mutton,  or  beef;  sago,  arrow-root,  or  tapioca,  atid  small 
qiianlities  of  wine  or  brandy.  During  Ihc  active  iJcriod  of  tho 
diflCAH?,  all  food  should  be  given  in  a  liquid  form.  Tliu  disturbing 
effect  of  tho  ipecacuaidia  given  as  above  directed,  is  only  tem- 
porftty.  Abundance  of  time  U  therefore  available  betvvceD  the 
lai^  doses,  for  the  digestion  and  assimilation  of  Itt^utd  food.    As 


DTSBSTEBV. 


169 


,  become  mora  feculent  and  conmatcnt,  MM  food  iti  the 

tender  cbteki'D,  \u\nb  uii<i   tiiiittoi),  vnth   biscuit  and 

lireadf  aud  light  sago,  rice,  or  lapioca  pudding  ^ibould  be  allowed. 

I    Potatoon  aud  oilier  vegetable-')  should  be  avoided  uiiCii  the  tone  of 

I    the  dtn^estive  syatera  hiw  bwn  fully  re-c;*tubli«bcd,     Wljen  Ihe 

I    dyacniery  ie  comptieiited  witb  a  iitirfuirieormorhiitic  wndiiinn  of 

the  blood,  the  admtni'^tratioii  of  the  juice  of  the  grape,  onuige, 

pomegranate,  litiie,  ami  ImicI  rilivrlxil,  iirc  etueiitiully  ne<%4Aiiry  ua 

dietetic  rather  lliaii  therai>eutie  agents. 

^B       0}>ittni  by  the  mouth  is  twldom  required.     "When  AWallou'cd 

^^p  ''  loekft  up"  the  wcretioiix  of  tli(t  liver,  pMiK-n^iu*  and  aliiiii-nlary 

^Biucoud  tucnibi-unc,  rather  favoring  than  re>1iicing  the  itilluiuma- 

tion  of  the  solitary  and  tnhular  gliUKK     When  *lyneiit«ry  omtiire 

in  pregiuLiit  women,  large  dotsen  of  i|HH'acunnlin  are  not  uontra- 

I     iadicnted.     In  dysentery  compUfatAid  with  |ingnaiH*y,  opiate  ene- 

mata  to  ruliera  irritatiou  iu  the  reetuin  are  lunra  cEwntial  aud 

I 

permiiwiljle  than  undi-r  other  oir^-uni^taiK-e*.  In  the  ai-nte  dywu- 
cry  of  children  i[>cea<:Uaidia  13  invaluable.  For  a  child  of  six 
jtba  a  grain,  and  for  a  ehild  of  one  year  two  grains,  i^hould  he 
given  with  an  equal  quantity  of  carbonate  of  soda,  night  aud 
jming,  until  the  tormina,  tcne^inms.  and  slimy,  hl(M>dy  stools  are 
:ilais:Hl  by  relief  fn>tn  puin  and  by  feculent  evacuations.  It  will 
>t  ot^cn  l>e  neefwiary  to  eonthuie  the  drug  In-yond  two  or  three 
lys  at  a  titne.  Hut  it  f<houM  be  n.^;oHoetu<l  that  the  diwoM 
I  adheres  with  greater  tenacity  to  ehildruii  than  to  attult^;  sal 
^Hthntigh  we  nhser\'e  that  )]KKwunn)ia  him  an  immediately  Itcno- 
^neiid  cllb<rt  ill  di  >iirii-ihing  the  blood,  nnU'U^,  t!linie  and  frecpient 
^»t4NilH,  intill  we  lind  that  ilycienleric  i)r  slimy  mnrioiiH  with  nn- 
^■^gested  food  continue  to  \Ai>t.*,  In  tlmt  <Mm  the  tpccaeuanlia, 
^e(»mbin4Ml  with  eliulk,  hiAiuiitl),  carhoiiale  of  wida,  or  aromatic 
jwdcr,  Bhould  bo  rej'eatetl  once  or  twice  a  day  for  a  certain 
riod,  till  healthy  cvacuationft  ai-e  nwlored. 

The  gums  luu^t  be  lauced  when  ncue>«ary ;  turj>enline  lim- 
its or  stui>es  may  be  applied  to  the  alidomcn ;  weak  ehicken- 
>th  or  arrowroot  should  he  temporarily  aub^titutod  fur  milk; 
id,  above  all,  food  must  be  given  in  siuall  quantities  at  a  time, 
id  at  regularly  stated  periodic. 

From  t  he  age  of  one  year  the  dose  of  ij^tecacuonha  U  regulated 


* 


170 


UiRCAL  or   TBBATBtBKT. 


by  n<!<1iiig  pad  groin  for  each  year  up  to  eighteen,  when  the  doMS 
indicntod  for  adalte  should  he  employed. 

Where  malaria  ]>ervades  the  system,  quinine  is  indisponaable. 
Twenty  gmiiia  may  he  given  in  water  witli  &  little  sulphuric  acid, 
<mo  hour  before  giving  the  first  dose  of  ipeiAcuanha.  Ten  grain 
doses  should  be  given  midway  between  the  large  doses  of  i|>ccacu- 
anha,  or  during  tbo  apypcxia,  until  the  fever  hfln  eubsided.  The 
mildest  miiwninlic  febrile  reaction  will  bring  l>aok  the  dysenteric 
Bymptomfl.  When  ii^ocaouanha  faiU  to  preserve  the  life  of  t'he 
patient,  its  failure  may  Iwj  attributed  to  Bbscess  of  the  livflr, 
malariii,  onlargunient  of  tlie  Hvor  and  epleon,  incurable  oafhcxia, 
Addison's  disease,  tubcreula-^is,  scrofiihi  of  the  mesenteric  glands, 
poritonitl»,  or  gangrene. 

When  dysentery  becomes  chronic,  no  time  should  be  lost  in 
removing  to  a  non-injilarinl  and  mild  climate.  A  sea-voyage,  on 
a  atcamcr,  is  often  attended  by  the  happiest  results.  The  clothing 
should  he  warm  and  Hanncls  should  be  worn  around  the  abdomen. 
Mactcnn  recommends  the  use  of  a  water-belt  over  the  ahdomen 
for  some  hours  daily.  If  there  be  niuth  uneasiness  about  the 
fundament,  a  water  compress  over  the  anud  affords  more  relief 
than  an  opinte  enema.  The  food  should  be  chiefly  concentrated 
60Ui"8,  milk  and  lime-water,  sago,  eom-flour,  arrowroot ;  egg-flips, 
with  port,  sherry,  or  brandy ;  or,  if  solid  food  can  be  digested, 
the  tcnderest  chicken,  lamb,  or  mutton,  with  bread  and  biscuit, 
may  be  allowed.  Beyond  airing  in  a  carriage,  no  exercise  should 
be  BttemptwI.  The  position  should  be  recumbent,  as  the  oroct 
poeture  cxeit««  peristaltic  action  and  interferes  with  phyeiological 
refit.     All  forms  of  counter-irritation  arc  useful. 

Gallic  acid,  aixitate  t)f  lead,  sulphate  of  copper,  and  nitrate  of 
silver,  are  reputed  to  act  beneficially.  Maclean's  favorite  remedy 
is  t^e  pemitrate  of  iron.  As  nearly  all  chronic  cases  have  a 
malarial  taint,  r|uinino  should  form  a  \sar\.  of  the  management. 
Bathing  is  an  efficient  auxiliary  during  convaloecence.  Tepid  or 
warm  baths  with  sea-salt  or  mtro-muriatic  acid  stimulate  the 
accreting  function  of  the  skin.       < 

But  it  will  often  hajipen  that  in  spite  of  the  most  careful 
treatment,  no  substantial  progress  will  be  made  towards  repair  of 
the  olcers,  and  the  patient  dies,  worn  out  by  suttering. 


DTSESTERV. 


17t 


Looms  thinks  that  the  rtoolsshouMlK'imnwiiRtelydiHinfefted, 
as  in  typhoid  lever.  The  fuitiont  mnst  be  kept  in  Iwd  and  the 
bowels  flwirwl  hy  n  dcwo  of  t-astor  «il.  Tlie  diet  »ihould  b«  of 
milk»  with  light  meat  broths.  If  at  (ho  nutwl  there  he  nmt'h 
teneHmuii,  several  leeoiiw  alxmt  the  anii!i  will  give  great  relief. 
Opium  should  be  piven  to  sctni-iiaivotism.  It  is  diivtitly  nar- 
cotic, wflative  and  iistriiigont ;  and  it  <M)ntn>lH  the  inHaitinmtnry 
proc««t  by  it«  action  on  the  (tyro pat hetiu  iien'ous  eystcin.  If  tho 
rectum  be  t-hieHy  involvec],  it  ix  h<!st  t^i  administur  latidaniirn  hy 
eneina;  but  if  tho  tein(>eratiire  be  hi<;h  and  (he  tcDcsmiu  iiiteuM, 
the  rectal  use  nf  opium  t*  contni-indifati>4l. 

Ill  Boeh  ea«>a  ipecacuanha  has  been  found  most  cfBcaoiotia. 
He  given  one-fourth  of  a  gniin  every  lialf-liour,  with  aullici(.'nt 
morphine  hypodemiiL'nlly  to  reliovo  pain  ami  n^ttc!<«DCf«a.  Ipe- 
cacuanha is  marke«lly  lieiiefitMal  in  children,  when  combined  with 
bismuth f  chalk  or  soda- 

Uot  fomeiitutiouit  to  the  abdomen  are  always  beneficisil. 

In  chronic  dysentery  ho  has  ohtiiined  the  mtwt  benefit  from 
cod-liver  oil  and  pemitrate  of  iron,  long  continued. 


Babtiiolow,  in  mild  cancfl,  givw  sulphate  of  magnesia,  ?y  ij, 
with  twenty  minima  of  dilute  sulphuric  acid  every  two  houra 
tinti]  the  bowels  have  been  emptied. 

The  i«aiji  and  teiieamua  may  then  be  relieved  by  morphine 
hypoderniically.  If  there  beraiirh  tendcnn'tu,  an  ice-lwig  or  wunii 
fomejitations  should  be  applied  over  the  defleending  colon. 

In  chronic  catarrh  he  advises  topical  medication,  with  sola- 
tions  of  tannic  acicl,  gr.  xx  to  water  fl.  5  iv,  i>r  of  hy<lrastivi  or 
rhatany ;  but  If  ulceration  cxint  he  prefer)  nitrate  of  silver,  gr. 
iv-xx  tn  fl.  5  j.  of  water.  This  should  Ik;  injit-ted  Ihnmgli  a  tul»e 
up  to  the  fligiiioid  flexure.  The  bowels  must  be  kept  in  a  soluble 
condition.  Fermentation  hIiouM  he  pnn-entwl  hy  hi>t  eiioniiila, 
twice  daily.  If  tlie  digestion  be  feeble,  nnx  vomica  and  [fpsin 
with  mineral  arid«  sliimld  he  given.  Kxcellcnt  rcMiiIu  arc  nhtain- 
ed  by  the  uac  of  corrosive  sublimate,  gr.  ^,  or  Fowler'a  eolution, 
gtl.  i5,  Ibrice  daily. 

In  severe,  inflammatory  ca«ce,  he  also  rrcommonds  Bulplinto 
of  magncaia;  following  BftuioxNEAt;  and  TBOUgSB.\u. 


I 


172  UANDAL  or  TltKATMENT. 

Ipecacuanha  be  limlr^  to  thu  6ist  stage,  wlnlo  tbo  miico^ 
meiiilfnuie  is  still  inta^-t.  Its  utility  ceases^  with  tjja  occurreuce 
of  ipecaciuniliit  stooU.  Il  in  t;!giiull^'  IieiiuQemI  in  puerperal  dy»- 
eiiivry.  lie  gives  a  scruple  cwvy  four  hours  in  milk.  Next  to 
this  he  plufes  ni^tor  oil.  After  the  bowols  have  been  eiu|ilied, 
ho  recunitnenils  emiil»iout«  of  almond  oil  ami  tuqietitineTOOiubiaed 
with  opium  if  tliw  p:ihi  Itv  severe. 

When  <le*truiTtir)n  of  the  mucous  mcmbnine  begins,  the  moat 
eficctivf  iviiiedien  are  the  miiieml  salts ;  the  beat  being  those  of 
copper  ami  arsenic,  lie  has  had  excellent  results  from  the  use  of 
out  dro])  of  Fowler's  solution,  auil  five  to  twenty  drops  of  deodor- 
iz«l  tiiictiirt!  of  opium, every  three  hours,  lie  also  putrt  mueh 
■empliasis  on  the  value  of  uitrat«  of  silver  cucmata.  A  tube  which 
i»  not  acted  on  l>y  the  siUx'r  salt,  is  psisscil  up  In  the  Hij^moid  flex- 
ure ;  the  patient  lying  on  the  right  aide,  with  the  thigha  flexed 
and  the  bi]Kt  olevuted.  Kigbt  niiiuiiM  of  liie  soliitton  (coutaiuitig 
twenty  to  sixty  grains  to  the  ounce)  should  be  injecteil.  The 
eilvei-  i^t  mi  mpidly  converted  into  u  chloride,  that  no  dungcr  is  to 
be  a]>prehcnded  from  tlii^  enormous  quantity  of  the  drug. 

In  tliv  dyi^entery  of  cliiMreii,STARn  bogiuit  the  treatment  with 
the  ordinary  mixtinx!  of  ciialor  oil  and  laudanum.  If  there  should 
be  no  marked  im]»roveniout  in  one  day,  he  t^ubsiituteii — 

A     I'uW.  ipMflc.  comp., gr.  vj 

BIwQuUi.  Miboirih, 5  J 

I'ulv.  ArOMiit., ,....fr.  vj 

M.  «t  in  nhitrt.  no.  sij  div. 
8. — One  ovcry  tbn«  boun. 

Ho  gives  nlrto  an  cnfimn  of  three  drops  of  Uudanum  every  four 
houtfs  or  the  following  suppository : 

B     Piilr.  fppil,.. sr.B 

riiinibi  Kcetat,...,. gr.j 

01.  llieobroaup, 5J 

M.  M  in  BiippOBitorii  no.  tjdir. 
&. — One  ovtrj  four  to  sis  houn> 

Should  these  fail,  oitrat*  of  silver  should  be  gireo  by  the 
xnouth  and  rectum. 

In  the  preceding  pages  will  be  found  a  aufficient  variety  of 


VYJPKHIA. 


173 


pinion.    Of  ipecacuanha  it  iuji,v  be  said  that  it  has  won  itn  tucMt 
ii  victories  in  coiiiUatiiig  the  severe  dyiiciitorieti  of  the  tropics. 
use    18   extending,  however,    m   severe    cases  of   ordinary 
^aeiitery. 

The  authors  of  thia  work  agree  with  those  who  do  not 
)prove  of  opiateit.  ^'arcotisiu  is  readily  itiduoed  and  highly 
dangerous,  while  opium  fniU  an  ii  reinetly  for  the  tcnc»>niU8  utid  a 
nieaiici  of  reiitraiiung  the  intiatumation.  It  cannot  coiM|>uro  with 
injections  of  verj*  h<it  wster  in  thiw  respect.  X«irly  nil  the  indi- 
cations are  met  by  these  hot  injections,  of  a  hull-pint  each,  rv{)eated 
rerj'  two  to  four  hours.  !n  many  cjise-*  snmll  do«.i*  of  eitlphate 
luagneHia  and  arouiutie  t^utphunt!  aeid  give  the  botit  i>esulta. 
[louUiecM  or  stuiwst  are  of  verj'  great  vnluc. 

Db.  J.  T.  CovKHV,  m  The  Medical   World,  1886,  rceoimnendd 
lycopus  Virjfiuieiw,  as  a  spocilie  in  dysentery.    lie  directs  half 
"an  ounce  of  the  fluid  extract  to  be  boiled  in  eight  ounces  of  milk 
one  minute.    Of  thU  he  j^ives  to  a  child  a  teaeipoonful  every 
niiniitca  to  two  houra,  as  needed.    Other  writers  apeak 
rorably  of  this  drug. 


DYSPEPSIA. 


In  tJiii*  article  only  at«mio  dy«]>ei»ift  \b  eonrtiderod. 
ktarrh  will  be  considered  separately. 


Oatttric 


WiLsox  Fox  reeommend^  the  ino«t  easilr  Msimilablc  food  to  be 

* 

mi,  in  Hi/latl  i]usnlitieet,at  nlion  intervaU.  Milk  nnd  rifnfng  U'cf 
ten,  and  animiil  jellieei,  combiuei]  with  alLoholic  ^timulantit,  are 
tlie  forms  to  be  preferred.  A  eup  of  ten  may  oflen  W  taken  with 
adrantage  before  rising  in  the  rooming. 

Fredi  cooked  mt-at  should  be  eaten  twiee  daily;  beef,  mut- 
ton and  game  being  pr».*ferre<l.  Cliickeii,  <'alveH'  feet,  ttweetbrejula 
and  trijK?  are  also  ])onuii«ihle.  Kggx,  fish  and  oysturt  may  be 
used  if  they  agree.  Canlion  w  recjuisite  in  ilio  use  oi"  vegetable*'. 
len  they  cause  flatulence,  rice,  macaroni,  grapes,  berries  and 


174 


NANCAI.  07  TBKATMBKT. 


prunefi  may  be  siilMstif-uted.  Peacliw  agree  with  most  djBpeptics, 
applies  Willi  many,  a<^;coi'tling  to  IIaat^BOIink.  Potatoes  should 
bf  well  boiletl,  and  not  Um  youiig.  Spinach,  regotable  majrow, 
bw:t«,  preen  yans  ond  Frcucb  beam,  may  commonly  be  taken. 
Btvad  fvhoiilii  be  eaten  only  when  stale.  But  little  fluid  should  be 
talicn  at  meal*.  Cocoa  mad«  from  the  shells  will  agrve  better 
than  tea  or  coflee.  A  little  wine  should  be  taken  twice  daily;  the 
variety  bcin^  letl  to  the  taste  Sugar  may  be  uwd,  but  condi- 
ments are  to  be  nvoidcd,  cxfopt  by  thaec  a<x;u8t<»niod  to  their  use. 
Tlie  gcncml  rejiimcn  should  aUo be  tonic;  uicluding  sufiii^ient 
rest  nt  night  and  alter  mt^K  an  ojicn  air  lite,  (ravelling,  t*eH<voy- 
apiw,  cxfrcisc  not  pushed  to  fatigue,  with  cheerful  society  and 
change  of  wene. 

Cold  baths  will  be  uecful  if  reaction  occur  promptly.  If 
not,  tcj'id  sponging  should  be  substituted,  with  the  use  of  the 
fle^h-bruph. 

IiKU'iH?ndently  of  iheao  agencies,  drugs  are  of  little  vahia 

"When  anemia  is  present,  the  milder  preparatioiw  of  iron  are 
indicated;  but  when  there  ia  much  relaxation  of  tissue,  the  tinct- 
ure or  sulphate  is  preferable.  If  con:*1ipation  or  amenorrhea  co- 
exist, the  sulphate  of  iron  njay  be  cfinibmed  with  aloes. 

Til  other  instoncca  the  chalybeate  saline  wutt-re  prove  of 
greater  crtit-ac-y  than  any  known  reniediee. 

T1)L>  Piivilioii,  Kxceimior  or  Kmpiix'  Rpriiiga  at  Saratoga  an 
good  examples  of  aiicb  wnteii^ ;  in  fact,  all  the  Saratoga  watm 
come  under  thin  heud.  Their  benelicLat  eflectjt  are  greatly  en> 
hanced  by  the  plea.sant  circumstances  connected  with  the  life  at 
tliettc  reanrt^. 

Of  the  vegetable  bitters,  ho  places  in  the  front  mnk,  nuz 
vomica  and  quinine.  The  former  may  be  given  in  the  doae  of 
five  U)  ten  dro|w  ^>\'  rlio  tincture,  with  a  mineral  acid,  infuBion  of 
orange  peel  and  ^yru]).  Quinhie  in  uf  more  doubtful  utility.  Ita 
tendency  to  cause  heiuliichc  and  to  disorder  the  stomach  must  be 
watched.  It  is  Ijc-st  suited  to  vaiieii  of  convalescence.  Of  tJio 
uinple  bitten^,  calumba  ba.>4  perhaps  the  highast  plac^e. 

Alcoholic  Ktiiuuloiits  should  be  taken  before  or  with  the 
meals. 


4 


DrSFEFSIA. 


175 


As  adjuvants  to  the  procusA  of  digestion  Iio  rccntuuictids 
hydrochloric  acid  and  pepsin. 

Nniie  ol'  these  remedies  should  be  continued  vary  long;  as 
tlioj  lose  their  ofTcct,  and  disorder  the  stomach  al^r  a  few 
weeks. 

Bartuolow  sajb  that  in  tbii^i  as  in  other  efntnnch  disnn1erB,the 
firat  st^p  (?(^>n!tiBtB  in  regulation  of  the  diet.  It  xa  useful  to  uom- 
inence  the  dietetic  management  by  the  milk-cure.  Xext,  as 
rapidly  of  pcewililej  nutritioiut  hut  easily  diyesttMl  articles  must  he 
lidded.  Aa  the  digestive  powers  are  feeble,  food  must  be  given  iu 
■mall  quantity  hut  frequently.  Am  the  foods  disagree,  irreM[)eetivQ 
of  their  quality,  the  points  to  be  considered  are  obviously  quau- 
tity  and  frequency  of  iiigejtlion.  As  the  jiowcrs  of  digestion  are 
depreaaed,  the  epecial  aids  to  this  function  arc  indicatetl ;  pepsin, 
lacto-peptine,  ill  combination  with  muriatic  acid;  strychnia,  and 
the  bitters,  especially  caJumba,  with  or  without  muriatic  acid; 
and  the  niild  chalybcat^M,  oa  piL.  fcrri.  carh.,  tbe  cit.ratc,  malutt.%  or 
tartrate  of  iron,  etc.,  are  the  mo»t  appropriate  of  tbe  medical 
agenlA  A  small  quantity  of  acid  wine  at  dinner  is  a  good 
itimiilant  to  the  digestive  function.  A  modemto  dose  of  whisky 
taken  before  mcaU,  i^  a  capital  remedy  to  promote  the  ap[)utLte 
and  the  digestion ;  hut  it  is  a  dangerous  remedy,  for  it  so  over- 
cximee  the  foeliug  of  dupru-eion  aa  to  he  very  grateful,  and  tliure 
is  therefore  a  uonatant  temptatiou  to  repeat  the  doee.  As  in  these 
caees  llicrc  is  usually  more  or  Icati  mental  depression,  change  of 
scene,  travel,  and  agreeable  oceupatiou  contribute  niatcnally  to 

[     the  cure. 

^K      A  very  useful  prescription  is  that  known  a&  Liquor  I'epsinee : 

) 


M. 


Pp|wtm, 5  j 

Acid.  Iiydrochlorict  dil.,. .  > (5  >U 

Aqiu! ■{.  I.  ad.    fj  vj 

H. — ^A  ublsvpoonful  ftfl«r  M^h  tniaL 


Pepsin  should  not  bo  given  in  wine,  as  alcohol  precipitates 
this  agent  and  renders  it  inefficacious.  It  should  be  given  in 
lBig«  amounta.  Only  the  best  [tepsiu  in  effective  in  five-grain 
doses.  The  cfteet  of  the  vegetable  bitters  is  only  tempomrily 
beneficial.  They  may  be  given  for  a  perioil  of  not  more  than 
three  weeks.    If  continued  longer  thoy  disorder  the  stomach,  and 


17« 


TRBATMBKT. 


the  good  firxt  obtititiet]  fmm  tlimr  uhc  U  lost  Iron  cannot  as  a 
rule  be  given  ior  any  longer  perimls.  Tho  milder  prejiaratlone, 
aiicb  m  the  ftirmtwl  dixir  o(  cincliona  or  of  gentian,  the  liitter 
wine  of  iron,  or  Iwef,  wine  and  iron,  should  be  selected.  Wo 
ran-ly  jutTH-riljL'  ideohulic  beverages  for  iitonic  flys[»eiisia.  Tbe 
good  ertects  nct-niing  I'rnm  their  use  are  more  than  countcr-bal- 
ancod  hy  tlic  dnitger  of  tbo  jHitient's  contra4:Ling  the  liabit  of 
drink.  These  rases  are  nniiHiially  jirone  to  fell  into  tbis  habit; 
anti,  b(-guining  the  uito  of  ntiiniiluntii  under  the  iduu  that  tliev  arc 
beneficiiil,  the  hnbit  ia  contracteil  unconsciously. 

Tliu  wliule  fiiniily  of  sjiioce  i«l)ouId  be  tabooeil  for  another 
reason.  They  afTonl  tcmiiorary  relief,  but  leave  the  patient  in 
the  emi  wovM  than  in  llie  boginiiiug;  for  the  stomui-h  will  eea«e 
to  digest  without  the  stimuluit,  and  finally  oven  with  it. 

It  mny  be  laid  down  as  a  fundamental  principle,  that  a  euro 
mnflt  be  sought  by  improving  the  general  health,  and  not  by  loc»l 
atimulantt*  applied  to  the  gastric  mucous  membrane.  The  um  of 
the  artificial  digcstanti*,  pepsin,  pancrcatin,  malt  extract  and  ox- 
gall, is  strictly  in  accordance  with  this  doctrine;  for  by  digesting 
a  larger  quantity  of  food  the  blood  ia  ouriched,  and  the  nutrition 
of  the  stomach  will  be  improveil,  aa  well  aa  that  of  the  rest  of 
the  bfKly. 

Malt  extract  stioidd  he  given  half  an  hour  before  meab, 
with  a  bit  of  tousled  brunl  or  zwiobacit. 

Fancreatiue  is  moat  effectual  if  administorod  half  an  hour 
afttr  nicaln.  AVe  have  found  Dudley's  formula  exceedingly  uae- 
flll  in  tlivM!  cukch: 


I 


f^     Ol.  morrhuii", ^5  Ul 

Q)  T't-criiui', fSJ> 

Cblcii  liwlnphoa., jet-  xcvj 

l'.D^-r«ialn, (jr.  XXXTJ 

Fiiil  mist..  ([.  «.iid r|  vj 

S.—.K  4etMertit)Kii>nriil  aae-tialf  hour  aJter  each  in«al. 


The  eniulsioii  in  iiiadH  with  Irish  luotw. 

Too  mm-h  jimim?  cannot  Iw  given  to  the  h^'gieiiic  directions 
laid  down  by  Wilson  Fox;  and  especially  to  that  recommeading . 
cold  shower  bathrt. 


BMfilYSEJU. 


IT- 


EMPHYSEMA. 

Haktholow  (wyft.  us  we  li!i%-t!  lo  (Uiil  witli  nii  incurntile  (Us- 
caao,  uur  IrwutmoiiL  imiat  he  In,ri;fly  jiiillialivi.-.    Foe  tlic-  iisthnofttic 
attacks  there  \»  no  n>iiiMlv'  (*<>  L-lHeient  as  tlic  oulK-titjtiieftuit  ii^ec- 
tidii  of  morphine  uml  atropine  Cgr.  I  niorphitK-.  unU  ,^  utropint'X 
A  fiitiglo  iiiji-.rii.ti  niiiv  anv^t  a  paroxvsm,  V<ut  ihe  dofle  may  ]k  re- 
pcat«d  as  m*cei**ary,  niiel.v  more  frequently  than  once  iii  six  hoursL 
Next  to  the  iiijtvii'Jii  '^f  Tiior|ihinc,  m<»t  relief  is  attordi-d  hy  full 
doMw  of  iodide  of  potassium,  aloue  or  combined  n-iili  tlic  lironiido. 
From  firtwjD  to  twenty  grain*  of  the  iodide,  and  forty  gmiiw  of 
tho  brotnido,  evory  two,  threo,  or  four  lioiirs,  nivording  to  Uiu 
ur^K-y,  may  Ijo  prc^Tibcd.     Chloral,  whit'h  aA'onla  great  relief, 
ia  vcf}*  iinitafe  in  old  i:art»  with  dtlntcxl  rigtit  cimtic«;  if  givetk 
under  any  fin.'umstanoct»,it  should  he  eombiiKKl  with  moi^ibtoe  and 
atropino  to  prevent  the  dopn-fwing  eUec-l  on  the  heart.     A  coinhi- 
tiationofmorj'hinc,  chloral  and  atropine  i«  an  exceedingly  ^rvice- 
»bU>  conibinnlinn  for  the  rulief  uf  ihe  dirtienll  hrvatlnng.     Beeidcs 
the^tc  agents,  narcotic  fumigation  may  bo  practiced.    Pa>itilc«  of 
V>ellad*>niia,  ftniuioninm,  tubiicvu,  opium,  fuc:dyptn«,  etc,  may  be 
bumtvl,  awl  the  fnmos  inhaled.    As  the  aecont[miyirig  bronchitis 
ia  an  iin|Ktrtuiit  element  in  ihww  iiuh'h,  meatniu'CK  are  nceeapary  to 
relieve  it.    Tlie  best  result*  are  nbtaineil  fi-oni  i-oimiba,  tiirjiontin*, 
and  euenlyptol,  given  in  c-onjnnetion  with  iodide  of  ammonium. 
Excellent  nwulla  are  obtained  from  thL- eomhincd  ailniiiiistration 
of  iodide  of  ammonium  and  arwnic,  ccmtinue^l  for  B;ome  tiiuc. 
It  id  well  known  that  arsenic  imrea^ew  the  depth  and  vohime  of 
tie  iwpinition,  and  pnnrioU-s  the  nutrition  of  the  long,  and  tho 
iodide  in  an  ef!ccti%'e  reiue<ly  for  the  hroncliitiM.     In  thiwe  fauts 
wc  have  an  explanation  of  the  ntility  of  the  cnmbination.    Wlion 
the  bronchial  Mt-retions  are  in3uflicient,  hnaiH  down  of  (arlnito  of 
antimony  are  very  useful,  and  give  gmit  relief.    Qnebracho,  whieh 
ha*  hiiely  been  brought  forward  aa  a  remedy  for  dyspnea,  is  a 
raltiable  palliative      Atropine  i«  n  n-niedy  of  great  power,  and 
hsit  an  influence  over  the  linig,  iucreiwing  the  rmpinitinn  and 
promoting  the  nutrition  i>f  the  organ.     It  may  eoiiHe  ditttrc^  if 
tltcrc  ia  a  lack  of  bronchial  Beeretion,  but  UHUully  the  opposite 
fftate  fibtaini<,  and   (xinncquently  atropine  ran  l>e  given,  as  it  ought 
to  be  under  tLe^e  eircumstiincee,  in  email  doeoa  twice  a  day  for 
a  long  period. 


fcr 


MANUAL  or  TREATMRyr. 


Of  ftll  the  meaiij*  liilherto  pro|»oM'd  for  the  relief  of  emphy-l 
aema,  notli'mg  ha«  approHclieil  compressed  air  in  ofTectiveiicvsew 
Tmleeil,  tliie  w  the  only  seiouritit-   ronirKly  which  has  yot  1 
bi-ought  fonviinl  for  the  trnatiiUMit  of  c'liiiihywinii.    The  chaml; 
into  which  air  U  iiumped  until  a  prwwuro  of  one  And  a  half  to 
two  atnuwphitre^  in  ohtaiiiwl  h  the  h««t  urmii^mciit.  but   an- 
fortmiattly  it  is  acct-ssiliie  in  hut  lew  pluoc*.    The  gowl  cU'ects 
of  brealhiiig  ('orai)ro.-«»(c<l  air  are  eiihaticwl  hy  expiration   into 
rareiietl  air,  which  of  connfc  has  the  edix-t  to  draw  the  blnnd  into 
the  hmgs.  **  Expiration  into  nirefied  air  is  the  (t{>e«;ific  mechanirail 
antidntt^  to  emphysema,"     The  iiihulatioii  of  c-ompmwwl  air  or  of 
oxygen  nmy  he  ii^-d  hr  a  palliative  to  relieve  th^  attacks  of 
fijiaHiinnlie  difficulty  of  breathing. 

The  treatment  of  the  drntwy  requires  a  nice  adjiutmeiit  ol 
moon»  to  the  object.  Miieh  can  be  aetmniplisliwl  by  aeting  on  the 
gkin  and  kidneys.  Tf  tlie  ht-art  will  bear  it»  pilocarpine  mav 
be  employed  to  act  on  the  skin.  Hydragogiie  c-iithurtico  ean  W  ■ 
given  at  the  «ame  time,  of  which  the  piilv.  jalupie  eomp.  U  ^ 
beet.  A  tetL*]"rtoiiful  or  two  iJhoiiM  Ix*  taken  in  the  early  morn- 
ing, and  piloratriiie  in  tin*  afternoon.  If  the  dtwii-ud  nwtlts  can 
not  be  thus  olilairiwl,  free  diiii-eKis  maybe  attempted  while  thu 
hj'dtBgogue  is  aUo  administered.  BasltauiV  mixture  is  ati  exceb 
lent  combination,  containing  as  it  do««  a  chalybeate  with  a  Batino. 
XiRiiKVKR's  pre*icriptioii  of  vinegar  of  «nnll,  with  bicarbonate 
of  potasHi,  thiiK  forming  acetate  of  potassa,  w  a  good  diurotie. 
Tliere  i*»  no  more  certain  diuretic  tlmii  bitartrate  of  |«nta*!a.  and 
it  may  l)e  coniliinwl  %vith  infu-tion  of  junijier  and  sc^uilL  A  weak 
wilution  of  cream  of  tartar  may  be  drunk  ml  libitum. 

TiOOMis  calla  attention  to  the  imjiortance  of  improving  the 
nutj'ition.  lie  recommends  tlteetheR<al  tincture  of  thL-  acetate  of 
iion«  uontinudl  for  a  long  period.  Quinine  may  he  added,  with 
benefit  in  most  t-awp.  l)yH|H>[isia  calls  for  bitter  infii^ioiiB,  and 
emaciation  for  cod  liver  oil.  Alcohol  is  ol>cii  Iwneticial  when 
takeu  with  the  meals.  The  diet  should  ho  highly  nutritious,  and 
conipOHc<l  hirgely  of  lean  meat.  Flatulent  food  and  Ui|uidR  should 
be  avoided.  Exercii^c  in  the  oi>cnair  ^^hould  be  taken  moderatoly. 
K}£poBurc  to  cold,  and  at<thuiatie  localities  should  be  avoided. 


BMPSY8EMA.  179 

That  locality  nliould  bo  proferrod  wbecx;  tbe  patieot  can  live  in 
Uk  open  air.  and  where  he  teeU  the  Icjutt  dyspnea. 

Iodide  of  Potassium  has  proved  particularly  valuable  in 
the  bpoiu-liitii*  whu-li  ucertnipania*  emphyrfenia.  FiiWn  to  sixty 
graini*  Khniild  1h>  given  daily. 

Quobracho  ie  n&eful  for  dyi^piica. 

All  other  complicalioiw  require  their  appropriate  treatment 

RonKRTH  rtumn  up  the  treiitnient  us  follows: — 

1.  Kvory  preoHUtioii  must  be  takoa  against  the  occurronoo  of 
>nchittl  cBtarrh,  and  other  known  csms**  of  emphysema. 

2.  Tl»e  Hlinientajy  «mal  nnist  he  kept  in  order. 
S.  Complicutloiu  must  bo  treated,  mcb  a»  asthma,  cardiac 

%,  venon!)  sta^iit,  and  hnmchitis. 
4.  The  genera]  health  most  bo  improved  by  tonics;  iron,  and 
1- liver  oil. 
51h.  Direct  treatment  of  the  emph^'wma  itself  is  of  doubtful 
utility.    A  change  of  climate  iti  often  benellcmL    The  cUmato 
suitable  to  each  case  is  a  matter  of  pen>onal  experience. 

CnAMiiERS  prew-ribes  tincture  of  iron  and  of  lobelia,  and  adds 
It  nothing  calma  the  diatrcaaiiig  aiithuja  so  well  tm  a  few  whiffs 
'  Htrong  tobacco, 

sTA  thinks  that  iodide  of  potassitun  i^  useful  even 
tchitis  does  not  exit^t.    <Jiood  rui^uits  urc  obtained  £rom 
counter-irritation. 

^     PoMm.  cbtomlit, 5  Jn 

Tind.  belUdoDoav f  S  j*> 

KxL  jimni  Virf. fl 

TiacL  otnctioB.  Mmp.^ w    f  J  ^ 

U<    B. — A  (knerUpoonrul   four  limM  «  daj,  In  «mph7Nma  vith  chronic 

bnmdiitu  and  losof  aiipetiw. 

Another  preamplinn  of  tlie  Minie  distinguished  clinician  is — 

f)     Pom*,  iodidi, 5  U 

Exi.  Mnefpv  11^ r^  J 

^jt.  pruni  Virg^ f  3  Sj 

M.    8.— A  uupoonftil  tlirka  dall/. 


180  MASDAL  OF  TBKATMENT. 

Gbeesiiow  pTOscriU'd  Uie  following; 

R     i'ol««.  iodidi, gr.  xxxfj 

Amroon.  oub^ , , Jj 

Tinei.  »imK, 

Tinvt  byow^fsni, U    f  $  n 

AquR  cBinpbnrv, .....,...f  J y 

M.    8. — A  teblcapooD^ul  llirk'«  dniiy. 

A  stramonimii  (rigarette  is  also  to  be  emokwl  as  soon  as  an 
HSthmatic  attack  ia  threntcned. 

XiEUKYBft  flpokc  highly  of  the  habitual  weariug  of  flumiel, 
of  etiroulanta  to  the  cheHt,  warm  vaiior  baths,  atnl  the  alkaline 
muriiUic  wnten*.  such  as  those  of  Ems.  The  patient  should 
9pcn<l  tho  Bummcr  among  the  jiiiie  forests,  where  there  is  a 
heftii'y  fall  of  ilew. 

>'or  thQ  attacks  of  astlirna  he  peoommwidftl  camphor,  musk, 
beuzino,  and  port  wine.     If  these  failed  ho  gave  oil  of  turpentine. 

Mrrbditji  Cly»er  gave  the  following  for  tho  asthinatic 
attacks : 

B     Tln«.opiV f5j 

EUieria, fJU 

H.    B^ — Sixty  dropa  ATcry  tutcDly  ninuloi. 

To  o-aoh  do«e  may  be  added  twenty  divpa  of  ethereal  tineture 
of  lobelia. 

QEBnARiiT  advised  pressure  upon  the  cheat  walls  and  abdomen 
during  expiration.  Thin  is  not  rtcrviceable  when  the  bronchi  are 
occluded  with  vi»citl  secretion. 


Some  emphyaematouB  patients  do  well  in  Xfinnesota,  Color- 
ado, or  pjikola,  eK|MH;ially  those  who  are  not  niuuh  n^lueed  in 
general  hi>aUh.  But  the  majority  find  a  more  fiivomhle  cttmate 
in  the  pine  rori*st«  of  Xorth  Carolina;  with  a  winter  visit  to 
Florida.  There  is  no  doubt  of  the  popularity  of  compi-ossod  air 
in  the  present  treatment,  of  this  iiftV;rtion.  Of  its  true  x-alue  we 
cannot  att  yet  fonn  a  just  estimate,  l^e  reports  are  too  favorable 
at  present 


EPILEPgy. 


IBl 


EPILEPSY. 

Bartrolow  ea\-fl  many  cas«  liavc  been  cunyl  by  tlw;  iippliea- 
tion  of  the  trephine,  and  the  immber  \s  iiicivading.  So  favorsble 
have  heoD  the  rcBiilts  of  this  practice  tJint,  if  n  severe  blow  on  the 
cnninni  luishocn  followe^l  by  cpileiwy,ai»d  any  injury  of  tho  boue 
can  be  dotoote*!,  tin-  trephine  shoulil  bo  iiscfl.  CicatriccB  so 
situated  m  to  cxcrci^'  prewe^ure  on  a  nerve  should  be  dissected  oat 
— a.  practice  of  8|M«int  necessity  when  an  niira  or  any  ancasy 
scn^alinn  »<tarti)  from  the  atTeul^d  part.  Pernmnent  relief  has  been 
obtained  by  cnttin-;  domi  on  the  point  whenee  an  aura  proceeds, 
not  only  reuinvinguitoiireeof  irritutioii,  but  dividing  or  atretching 
a  ner^'e  tnmk.  Wlieii  tho  imprewlou  aris«t  at  the  epignstrium 
and  pasw*  ihunw  to  tlit  brain — jirobably  tho  moat  frequent  of  all 
prodromic  Byraptom*  or  waniings — most  careful  attention  must  ba 
given  lotliedifl.  K[tile|itiiMwit  largely  and  holt  their  food.  When 
etomachal  Byniptoins  exirt,  an  epileptir  shonld  Iw  n-Htrii.-te»l  U>  the 
millc-iltet  for  wverul  weekit,  and  atiould  then  gradually  iiave  addi- 
tions made  tn  it ;  but  the  peniianont  diet  »hotild  not  cxreed  niillc, 
eggs,  a  little  nieat  one©  a  day.  a  airigle  vegetable,  a  very  little 
bread  and  bntter,  and  one  fniit.  Restriction  to  thif*  plaji  nf  diet 
will  often  (.'ilVH-'t  rcrnnrkalile  iinjirovemont.  When  the  iittat:ks  are 
nocturnal  a  sufficient  fiutw  of  chloral,  or  better,  the  hy^Kidermatic 
iiyedion  of  mori>Iiiiie  at  bed-hour,  will  a<Tt  most  efliL-iftitly  to  pre- 
Tent  them.  The  nitrit*  of  amy!  by  inhalation  will  often  avert  an 
iii>[iending  attack.  Tho  ndrantuge  of  this  i-emetly  conaiste  in  the 
facility  with  which  it  ia  employed.  A  pear!  containing  three  to 
fiv«  minims  uui  lie  broken  up  in  a  liaudkurelticf  and  inhaled 
■withnnt  delay. 

AuL.\s  McLanb  IlAMli.ros  thinks  the  inlniotablecharueter  of 
the  diaesM!  has  come  to  be  greatly  exag^rateil,  through  failures 
due  to  the  imlistTirainatc  lu^e  of  thu  bromidee,  without  rvgunl  to 
tlie  indiiution  in  each  (11^0.  A  reUabic  Immiido  whoidd  he  selected, 
and  given  with  some  judgment.  A  Ui^  doac  at  bcd-ttmo,  iu 
ca^es  whi-'re  the  attacks  oet-nr  iu  the  morning,  will  do  more  good 
than  the  same  amount  in  divided  doses.  Iu  some  anemic  persons 
the  brontides  iiiercwK>  tlie  attacks.  Petit  mal  i*  not  so  untenable 
to  thiii  remedy  as  gr«n<l  inul.  He  pr(>fen4  iIk^  bromide  of  sodium. 
It  ehnnUt  bo  given  well  dilutod,  on  an  empty  rttonuu-h. 


183 


HAKCAL   or  TREATUBST. 


C-erebral  oongestion  in<l!catc«  tlie  a<Wition  of  aconite  or 
chloral  to  the  prescription.  Weakness  of  tbe  heart  tlemands 
digitalis,  nitn>-gly(%rinc  or  sLrvchriinc  CiiMid  ac^compnnieil  by 
polyuria  are  promptly  relieved  by  digitalis  and  iiitro-glyeerine, 
and  so  also  ure  tlH»u  following  inigruiiic. 

Bmmism  ia  to  be  avoided,  beyond  tbe  point  of  alight  faucial 
aneethenia  and  ucnc. 

If  the  done  must  be  increased  beyoud  this  point,  tonictt  should 
be  added  to  it  A  acriod  of  epounKHbould  be  mot  by  an  increaaed 
doia:. 

Thiit  treatment  should  be  kept  up  for  two  or  tliree  yearaalW 
the  fila  have  ceased,  or  even  much  longer.  Uysterieal  or  ovarian 
ooinpli^ationit  demand  the  addition  of  cannabis  Indlca  ;  which 
ifl  ftleo  useful  vrbcn  migraine  is  present. 

Next  to  tko  hroinldea  of  potiuwiinn  and  Aodiiim,  he  pret«rs 
the  bromide  of  nickeL  Leamas  reported  two  case*  *' greatly 
benclited"  by  it.  He  thinks  it  is  Kuited  t«  i'h.«*u.s  (-Iuini<-t«ri7e«l  by 
long  intervalfi  between  tbe  spasms.  Wkik  Mitchell  recently 
connnendeil  the  bromato  of  pntiLssinm,  in  d<K^j8  of  filYeen  to 
tliirty  grains  daily.  Ebi.kx>ieveb  reenmmendcd  the  mixed  bro- 
mides, of  potas.-'iiini  two  partw,  of  .•sodium  tw«»  parts,  mid  ammo- 
nium one  part,  lie  found  the  acne  oocasioitcd  by  a  single  salt 
disappear  wht'ii  the  (^()n)bi nation  wuk  sub.stitiitt^l. 

Belladonna,  so  highly  commended  by  Trousskau,  is  of  utie 
in  petit  mid,  mid  in  ohncuro  infantile  uonvnlsionst.  Ergot  is  of 
Dse  in  ihe  t<nnie  ea>tes.  For  tbe  [inrposo  of  aborting  a  tluxiatcned 
attaek,  Hamilton  coninu-iidH  nitro-glyoetlnf  in  dosnt  of  ^j-^  gr. 

When  an  aura,  is  distinctly  felt,  he  adviiws  a  circular  blister 
to  be  applied  above  the  point  whence  the  aora  proceeds. 

The  etatii^  epiloptictta  u  best  treated  by  amyl  nitrite. 

Baovrx  Skqcard  aiyn  that  aa  everj-  Httavk  eansen  change* 
which  pj-op»re  other  attaeks,  it  is  essential  to  produce,  if  [Kieeible, 
the  abortion  of  iittaek.-i  wlieiiever  warnings  occur.  The  treatment 
varies  with  the  warning.  In  caacs  in  which  a  real  aura  exUxa 
many  means  can  be  i^miiloyyd  with  the  greaiteMt  lienefit  The  »]> 
plication  of  a  ligattue  i-ound  a  limb  acts  by  ««nding  an  irritation 
to  the  nervous  ceutreit.    The  ligature  need  not  be  lell  applied,  lutd 


EflLKPSY. 


18S 


great^H*  aucoctts  i«  attained  bj*  tjiug  siiddeulj  and  very  ({uickly  a 
baadkenthief  or  n  Imnd,  and  repeating  this  tying  wvvnit  tiuifi« 
ill  tuicccat'ioji.  than  by  aiiplyiiig  tbe  ligature  even  very  tightly  and 
Ktaviitg  it  Ml.  Tliu  ligatun;  t-uii  do  gixnl  even  wliuii  upi'ltL-d  on 
another  limb  than  that  where  the  aum  u^  felt,  although  it  is  usu- 
ally titorv  i-tlinu-ioiiii  on  the  liiltvr.  Pincliing  or  titrikiii);  the  ukin, 
or  irritating  itti  nerves  by  heat,  by  cold,  by  galvanii^m,  or  by 
repeated  priclu  with  a  itcodle,  will  goikcrally  do  ob  much  goo<l  a^ 
th«  ligatare. 

lu  those  ca««e  in  which  an  involuntary  muscular  contraction 
taked  plaee  before  an  uttuek,  i>ne  of  tlie  most  elfi<:ieut  means  to 
pr  iduoe  an  abortion  of  tiio  fit  is  to  liraw  forcibly  on  the  eontnietwl 
mu»clc«>,  9o  ftfl  to  elongate  llieni.  For  instanee,  in  cai^te^  of  eontrao- 
tiou  of  tho  Hexor  niuack*  of  tho  forearm,  forcible  cxtciwinn  of  the 
hand  over  the  for^nnn  may  !iu<NN}ed  in  preventing  the  attack.  A 
Wow,  prensure,  or  frieliou  on  parts  where  pome  ninwles  Ixxome 
rigid,  may  have  the  i^ame  fav<inible  eft'eet. 

If  there  urn  diitturlHinceH  of  breathing  among  the  jiremouitor}' 
symptoms,  the  inhalation  of  ether  or  chlorofonn  may  prove 
•uceoActful. 

An  emetic,  a  purgative,  a  stimulant,  the  immersion  of  tlie 
bands*  in  hot  water,  the  application  of  a  lump  of  ice  to  the  back 
of  tho  ntK'k  or  bL'tweon  the  shoulder  blades,  the  «ubcutaneou>v 
ityectinn  ol'u  Molutioii  ofiufugniin  of  atrtipine  with  J  of  a  grain 
of  morj^hine,  powdered  amrum  taken  as  Miull',  a  dose  of  twenty- 
five  graifiM  of  hydrate  of  chhimi,  the  inliiihilion  of  a  Nmiill  duttc  of 
idtritc  of  amyl,  extremely  rapid  and  ample  volmilai-y  rej-piratory 
moreniuntM  fur  five  or  xix  minuted,  jumping,  runiiiiig  for  at  lea^t 
ten  miimtes,  reatling  very  loud  and  I'at^t — *u«"!i  are  some  of  the 
nicunB  which  he  ha-t  found  to  W  the  modt  i^uciTeitKful. 

The  BCtxind  point  of  importance  about  treatment  U  to  try  to 
diaoover  a  part  of  the  body  whic^h  van  by  irritation  give  rise  to  a. 
premonitnrr  nymptom  of  an  nttnek,  or  even  to  an  attack  itsolt".  Tf 
ouch  a  |>art  U  di-ucovunxl,  eounterdrritatiuii  of  some  kind  id  to  l>e 
applied  there,  tlant  proHeure  on  certain  piirt«  of  the  henil.  tlie 
the  breawt,  the  alMlomen  or  th«.<  limlw,  hait  in  a  nuuilwr  of 

^■prociuccd  an  attack  or  mmiw  syniptoms  of  it.  lie  liiw  wen 
the  paseage  of  a  galvanic  current  produce  the  same  effect.    lu 


184 


8iK!li  i-ases  a  blister  or  other  local  applioatiou  liua  done  good  in 
(iiioinislimg  the  violence  or  frcimmcy  of  attacks,  and  even,  in 
a  few  inrttaiicfw,  heI])L-d  notablji-  to  a  ture. 

The  modes  of  treatment  of  epilejwia,  gnivior  or  minor,  which 
chiefly  'leserve  to  be  (lolic-ed  are  the  following: — 

Agiiiiirtt  idioi^mthie  ej>ilei>sy  the  uiml  powerful  means consiirtB 
in  the  simultuneoiis  use  of  some  tonic  rcmed/  (such  as  (ttryelinine 
or  arsenii:)  in  a  sohition  to  be  taken  nfter  meals ;  an<I  of  a  mixture 
CompOBcd  more  or  It-tw  like  ILl-  followiug: 

ft      Pntmw.  iodidi, 3  'j 

Pvta».  bltiinllll, 3  J 

AmmoD.  Iiromidk, 5  >U 

PoUiM.  tfitarbon&Uii, 5  J 

TlncL  aluiubie, tl} 

Aijaw  ilMdIIfttn fjij 

Of  this  Mihition  mav  be  given  to  adults  four  dosvj)  a  day, 
three  of  one  t4»a-!|K)inifuI  ea<-h  before  meaU,  and  the  fourth  of  tliree 
teasfKKJii fills  !it  heil  time  with  as  miu-Ii  water  as  <Ic(»i red.  Accord- 
ing to  many  cireumstaiiccs  the  dose  of  one  or  another  of  the  uigr©* 
dienti*  i»  to  W  rhanged.  For  example,  if  the  j»flii-nuii  exist 
alone,  or  eoH^xint.-*  with  tin;  i-omjilnte  t'pili;p«y,  the  ihwe  of  the  bro- 
mide of  aininnniimi  must  be  larger,  and  that  of  the  otJier  bromide 
diminished.  If  theit;  be  ii  wejik  \i\tUi-  the  M'.-sr(iiiL-arboimtc  of  am- 
monia ifi  to  be  r^iib'ititnted  for  the  hicarljonate  of  iK»ta«aa.  Two 
a^jiential  rules  are  to  be  followed  when  oitlicr  such  a  mixture  or 
any  of  the  many  hromidefl  in  employed  agaiui't  ppjbpisy;  the  firfit 
iti,  that  theiv  ought,  to  bi-  no  intvrniption  whatever  in  the  use  of 
8Uoh  rcriietliew,  and  the  whole  berietit  that  may  havelK-en  obtained 
may  be  IopI  at  mivi:  after  an  interruption  of  even  only  a  few  days  ; 
the  second  U  that  the  treatment  inu)»t  l>e  pernjvcrcd  with  for  at 
least  two  years  after  the  ujiiiuaraucc  of  the  last  attack.  There  is 
no  marked  harm  in  the  great  mtyority  of  cases  trom  a  prolonged 
use  of  ft  mixture  like  the  above ;  many  patients  have  taken  it  for 
several  years,  and  some  fi>r  six,  eight,  or  ten  ycar»  without  any 
marked  bnd  effect. 

Idiopathic  epilepsy  has  been  eucce^wfully  treated  (vt-ry  nin^ly 
cured,  hut  often  bcnctitedj  by  the  use  of  a  number  of  remedies. 
Judging  by  his  own  exiierieoce,  the  writer  names,  as  tlie  most 
powerful,  atropine  nnd  the  ammumuted  sulphate  of  copper. 


BPILEPSY. 


rfil 


Although  not  able  generally  to  i-roctucc  ai>  miu-li  iuid  ospoclally  an 
prompt  a  good  etiect  sa  the  above  mixture,  the  two  remodies  have 
the  superiority  over  this  mixture  thnt  tlioy  need  not  be  coustAntly 
osed,  and  that  there  ie  no  neoeseity  of  oontiniiing  to  employ  them 
longer  tlian  eight  or  ten  nionthi*  after  the  lost  nttiifk.  Xcxt  in 
uniorlance  after  the  three  inomw  sjmken  of,  will  cnnje  the  coty- 
ledon umbilicus,  the  nitmtc  nf  silver,  nnd  zinr  prepsnitionH,  os|ic- 
ciaUy  the  br»>mido  of  zinc. 

The  other  forms  of  cpilejt^y  require  pretty  much  the  some 
modes  of  interna!  Ireatraent;  but,  of  coiinw,  nwonling  to  tbecnnne 
of  each  fom»  i«mie  sjteciiil  menn^  c»!ioul<l  Iw  enii^loye-l.  In  the 
above  preecripticm  the  dotnt  of  the  iodide  of  potassium  miii^t  1>e- 
come  as  Urge  n^  that  of  the  bromide  of  potii^i'itin),  when  t^vphilia 
id  conFiidcretl  to  be  llie  cauM:  of  epili'ii^y,  and,  if  noedud,  mercury' 
ehoaM  he  administered  aho.  If  epilepsy  dejiend  nn  some  visceral 
aScctiou,  it  is  clear  that  the  treatment  should  be  dire>:-le(l  againat 
that  aS'ectioi).  But  if  the  liver  be  diseasci.]  from  some  inttaenco  of 
malftria,  the  (fulphate  of  <|uiuino  should  not  bo  given,  (w  it  i*almoat 
alwiivii  a  bad  remedy  ugaiiL^t  ei>ile|wy,  often  more  hurtful  than  it 
can  W  useful.  Arsenic  then  tnhonld  be  the  remoily  u«xi  against 
the  se<(Ucln>  of  fever  and  ague.  If  <|uiii)ne  nnisl  bi>  iHiipioyod  in 
c»»ei4  of  dearly  [K'riodical  epilepsy,  the  vuleriimnt*?  -thniild  be  given 
rather  than  the  Kidplmle. 

TIic  WTiterV  ex|>eriwic>!  tthows  that  in  mo*t  ea.-'er'  iron  i* 
ither  harmful  than  nseful.  it  is  only  in  c-a«J8  of  epilepsy  tilliod 
with  or  causoi  by  chIon>i«iM  or  eoiwiderable  aiicinifi  that  it**  good 
effect  is  otlen  very  markeil.  liven  then,  wo  have  (lomctime* 
foaud  manganese  more  serviceal>le.  There  ii»,  however,  one  wit 
of  iron— tin.  citrate— wliith,  although  Iv&a  powerful  against  a  defi- 
ciency of  blood-globulos,  is  however  less  apt  to  give  riee  to  attacks 
than  arc  modt  ferruginous  preparations  in  a  number  of  cases. 

Of  other  internal  remedies,  ood  liver  oil  if  well  liorne  is  cer- 
laiidy  useful,  (*pe»-ially  ugiiiiiM  (he  itrdt-mal.  Tho  importance  of 
giving  fiimnllnneon-sly  with  the  bromides  either  an*nic  or  strych- 
nine ha.-i  been  already  mentioiie<l.  Aisenic  alone  can  do  much 
against  any  tbmi  n\'  epilepsy.  (ierha|  is  chieHy  againKt  petit-mal,  but 
the  writer  does  nut  {lersonully  know  of  a  single  ease  of  cure  by 
its  lue.     Str>*chninc  v&n  also  alone  do  good,  but  leM  than  ni'senic. 


186 


MANDAL  or  TBEATHENT. 


DigitttlU  or  digitflline  have  beca  credited  m  b&ving  efiected  cures ; 
eo  have  tur|>entiiie  and  a.  iiiitiibor  of  ntliur  niedic-inoH.  The  writer 
has  obtained  only  h  vory  liniita!  irood  frinn  the  use  of  digitalbor 
turpentine.  As  n-gurds  llie  utiriitivL-  inlliieiu.'e  of  tlie  nitrite  of 
amyl,  it  is  yet  sub  jiidtrt. 

From  counter-irritation  tli^re  is  a  gix^At  deal  to  be  expeclcd. 
Ice  {not  in  a  hag),  the  actnn!  cautery.  blUters,  Ac.  applied  to  the 
back  j>art  of  the  ueuk  and  l'etwe<.'n  the  ehoulder-bIade&,  are  most 
useful  in  any  form  of  epilepsy,  especially  when  there  i«  a  ^rcat 
deal  of  Iieadaelie  uml  coit/ulerulile  hout  in  llie  lioiul.  When  at- 
tacks arc  very  violent  and  i'requeiit,  there  is  some  good,  and  at 
times  a  decided  umelloi'aliou,  to  be  ohtained  from  croton  oil  a\*- 
plieatioriB  on  a  great  part  nf  the  slmved  head.  Sctons  and  iewiw 
very  rarely  do  anj'good,  and  olteii  weaken  and  irritate. 

A  rin-iilur  blister  round  a  limb,  a  finger  or  a  toe,  i:t  mo«t  use- 
fill  ill  caHBS  of  an  aura  utarting  from  tlioee  part^  It  is  knowu 
that  in  !«uch  niwi*  a  nerve  lias  been  divided,  rtfimctiniiw  with  great 
euw*j*.  Twjianning  the  cniniimi,  except  on  clear  rational  groond, 
is  cortuinly  to  be  avoided.  But  when  the  attacks  are  extreiady 
violent  and  fi-cqucnt,  e?i|K'cially  if  they  aeem  to  endanger  the  life 
of  the  patient,  and  when  there  is  a  clear  evidence  of  prtvwure  ex- 
erted on  the  bniin,  thnt  operation,  which  in  such  cn^cs  has  ofteu 
been  useful,  ought  to  bo  resorted  to,  after  the  failure  of  other  means. 
In  cases  of  larynfeal  epilepsy  the  writj>r  has  found  the  cauterisa- 
tion of  the  fauces  aud  of  the  larynx  it^lf  with  a  strong  solution 
of  nitrate  of  silver  a  very  UiM^fuI  raeunij,  aud  even  tu  one  cose  a 
^m  means  of  complete  aud  pcRii*teut  cure. 
^V  During  an  attack  of  ppilepsy,  except  what  simple  common 

r  Bonflc  suggests,  there  In  very  little  to  be  done.    Prei»ure  on  one  or 

I  on  both  carotid  arlcrie.>^,  which  we  now  know  to  act  on  account  of 

I  the  ntx'omiianying  pressure  on  the  {Mir  vaguni  and  on  the  ct^rvical 

I  sympathetic  nerves,  will  sometimes  considerably  phorten  an  attack* 

^H  ca)iecial]y  if  tlicre  is  rialuitt  action  of  the  heart  When  the 
^^  convnlHionw  ceaj-e,  the  tongue  ought  to  be  drawn  foi"wani  and  the 
^  head  of  the  jmtient,  if  not   his  body,  turned   sideways,  ao  as  to 

^B  avoid  the  covering  of  the  larynx  by  the  ha  If- paralyzed  tongue. 
^^  No  other  interference  at  all  with  the  piitient  eliould  be  the  rule 
^^        after  the  attack. 

^ ^ K^ 


I 
I 


EPHTAXIg,  187 

One  of  tbe  moet  common  sources  of  failure  in  the  trentmeDt 
of  e|ii1epKv  io  tbe  lenrKmcy  of  [MttieiitA  to  go  tiiv  roiindit  from  oiie 
phv^iciau  to  another,  not  remaining  long  enough  with  any  one  to 
permit  of  a  cnn.--  It  is  oltvn  wise  to  contrntrt  with  kuuIi  i^raons 
that  they  will  remain  for  a  definite  jwriotl  umler  treiitment; 
never  k««*  tliun  ii  ytiir.  Thin  will  ulKnv  tinit*  tor  utn-fiil  ftn<ly 
of  tho  case  and  of  tbe  exciting  cauncR  of  the  iitt^,  as  well  as 
of  the  ai:1  ion  of  ivniwliwa. 

We  desire  to  call  attention  to  n  drug  which  haa  never  been 
«nfKrii-ntty  triftd  iti  cpil<^K.v*  Fhysostigma  v/ae  bi-ought  for- 
wanl  as  a  i'liy:jiol«.>iri<-al  remwiy,  hut  after  a  very  cursory  tiial. 
wad  droiiju-d.  We  have  used  ii  lately  witli  butter  riMuIt>«.  Ono 
nuon  for  it^^  failure  may  have  U^in  the  poor  (juality  of  the  preiMk- 
nitioiL  \Vv  have*  jjivun  it  in  doses  gradually  increased  ui>  to  tvro 
dmcbms  of  the  finid  extract  without  obtaining  deoidwi  cfie<'tA. 

Xono  of  Ihc  authors  above  quot<Nj  have  ?urticiently  iiwxstod 
tipoii  the  vital  importance  of  so  regulating  the  diet  aa  to  avoid 
the  cxoitiiig  causes  of  the  »r>a«m'*.  One  casi;  of  nocturnal  epilei>?>y 
bufiliHl  e\-ury  cftbrt  to  curu  it.  until  we  tntcv^L  it  to  u  lunch  uf 
Svtes  chee^o,  taken  late  at  night,  which  v,-m  invariably  followed 
by  a  tit  In  one  ciiae  the  bi""mide  <»f  iH)la**ium  wrj*  given  by 
oe  in  doMw  varying  accopding  to  the  dwire  of  the  iwiticnt,  t'n.>m 
forty  to  thrpu  hundntl  graiiL'*  daily.  Thin  wna  continued  fur  nine 
mottlb-s  without  a  single  tit.  Tbo  drug  was  then  stopped,  and  in 
two  days  the  man  had  a  (convulsion.  The  brumide  wiw  ronmiwi, 
and  iu  eight  months  suljsG(|UontIy,  no  fit*  occurred.  The  csise  thou 
(mikmmI  out  of  unr  hands ;  tlie  tiuui  removing  to  another  city. 


EPISTAXIS. 


A.  E.  DctiUAM  speaks  of  thn  application  of  rold  water  or  ice 
to  tli'j:  nom-,  dashing  cold  water  against  the  bark,  elevating  the 
ftnni*  obove  the  head,  and  firmly  compressing  the  nostril.  The 
patient  should  not  be  allowed  to  blow  tlie  nose  or  in  any  way 
disturb  the  clot. 

If  thc-do  roeanA  fnil,  astringenttn  should  be  injcetcd  into  the 
nostril.  If  tbeee  bo  incftcctunl,  the  nostrils  should  be  plugged 
with   Belloeq'a  sound,  or  an  extern poraneou))  itubstitute.     The 


IBS 


MAITOAI.  OF  TRBATMltWT, 


/ 


plogs  should  not  l>e  allowed  to  remain  more  tlian  two  daya 
Fref|m'iit  rut'iipretioo  of  the  blooding  calls  for  hygienic  troatmont, 
rest,  and  paiti^-ularly,  lion. 

"Wo  bavo  foaiid  no  remedy  to  arrest  epiRtaxis  equal  to  Hia 
injection  of  a  weak  aolution  of  chromic  acid*  Eiiougli  of  the 
acid  should  be  added  to  the  water  to  render  the  BoUitioo  pink, 
and  thi^  may  be  aj'p''*'*  fi-ecly.  Wc  have  never  met  witli  a  case 
which  resisted  ihi>»  aii|>Ii«ition. 

An  old  surg:eon  in  CloveUmd  once  made  iwe  of  the  following 
novel  inothod.  He  took  a  pioco  of  solc-lyallier  and  («?rape<l  it 
with  a  eharp  knife.  The  soft  shavings  were  thrust  into  the  noa- 
tril  nntil  it  wwi  tightly  jiaeked  with  thera.  The  leather  swelled 
slightly  an  90on  as  it  lH>cRnie  moist  and  cffcctiinlly  stopped  the 
lieinorrhage. 

In  eas«si  nf  pn^rsistently  recurrent  hemorriiage  it  is  of  the 
utmost  imjMjrrAnoe  to  eheok  the  flow  as  soon  aa  [lognihle;  mt 
euch  It'flvi'K  the  Mmwl  thinnt-r  and  more  likely  to  escape  from 
its  ves)>els. 

We  must  enter  our  enrnest  dissent  against  the  use  of 
iniii  in  ihewo  cjwes.  TleL-iirring  eiiisliixis  indicate  the  sonifulous 
twliexift,  and  afler  pnlieity  it  is  replaood  by  bi-onehijil  hciaorrkage. 
Tlie  fault  is  priimirily  in  the  walls  of  llie  vessels,  which  aro  too 
wt-ak  to  retain  tlie  liiood.  The  use  of  iron  only  increases  the 
tendency  to  hemorrhage,  and  will  even  bring  it  about  in  cases 
where  epistaxis  tins  not  yet  occurred.  Ergot  is  the  best  remedy 
to  keep  the  hemorrhugic  teii'Ieiicy  in  check,  until  tlio  general 
health  haw  Iw-en  invigorated  by  judicious  hygienic  management, 
and  the  Te»sel-walls  strenglbmcd  by  a  prolonged  course  of  lime, 
in  the  form  of  the  lat-tnphnsphate.  Iron  should  only  be  used  in 
cases  of  true  anemia  from  loss  of  blood  or  from  exhausting  dis- 
caAC.     In  all  othtT  hemorrhages  it  does  harm. 


ERYSIPELAS. 

BSCE  roeommendii  the  following  plan  of  treatment: 
Clear  tlie  bowels,  but  avoid   violent  purgatioD.    Only 
dnigs  have  any  reputation  in  the  trofttTOont  of  erj-sipelaa. 


^. 


Hnotnre  of  percMoride  of  iron,  in  lar^e  ami  n-i^jtieil  doKon, 

liis  Ix-'fii  -tiuii^lj'  n,'<:i.»muieudcd  b^'  liKVNOLus  imJ  otLers,  aucl  is 

ited  hy  wreie  U)  act  rm  h  spM'iftc    To  be  of  any  uao  it  must  be 

given  in  do&ea  of  forty  minims  every  four  hours.     Aconite,  if 

Aiiuiinistcixtl  as  itoon  an  the  ti^mjit'niturc  bcginii  to  r\»e,  i»  muU  to 

cut  the  attack  short.    It  mny  he  given  in  half-minim  or  miDim 

doactf  of  the  tinctun;,  at  finit  vvt-ry  quarter  of  an  hour  for  one  or 

two  hours,  and  aftenvards  hourly  till  the  skin  becomes  moist  and 

the   tem|>c.'ratuiv   falls   Imt   iUi   eft'ecte    raust    be   very    carefully 

ralchedt  to  avoid  dangerous  dcpre^ion.      I'lie  did  must  be  as 

lurivbing  ad  potu^ililu:   Wf-l-ea,  «-ggrt  and  milk,  etc.     Solid  food 

in  never  be  taken  during  the  advance  of  tbc  di»oaj?e.     Stimulaiita 

Ui>^ually  ntiiiinMl,  and  the  amount  must  be  regulated  by  tho 

>ulse.     Large  t^uantitiee  are  often  necei^^an'. 

Ltxal  trealnient.  U  TariouH.     Warmth  aud  avoidance  of  vuri- 
Btious  of  tem[«rature  are  essentiaL     Cold  is  utterly  inadmist^ible. 
The  meet  important  sedative  applicatioD  u  beiladonna.    It  is 
it  apiilicd  as  a  paint  oompoBcd  of  equal  part*  of  tho  extract  aud 
flyceriiie.    Ii  it*  tM^vcially  useful  when  there  U  much  intlammii- 
ion  of  the  lymphatic  vmwIa  aud  glands.    Valettb,  of  Lyons, 
"iwjommendi*  ii  thirty  |wr  cent,  solution  ot  pfpililiiride  of  iron; 
liooiSBOTTOM,  a  solution  of  the  **  brittle  stick  of  nitrate  of  silver," 
irenty  grains  to  one  dnU'hm  of  water.    JJeforu  applying  either  of   ^^ 
ffe^  the  skin  must  be  carefully  washed  wit^  yoan  ami  veatap  trt  *^ 
;reaHO.     Tiie  pyrchloride  of  iron  most  be  rubbed  in 
wilinr^flSVSr^TAitsuALL  reeommonds  oreasote  made  into  a  paato 

t^it-h  kaoline;   Drwar,  tKjiial  ]iu,rta  of  sulpUorous  acid  (B.  P.)  and 
lyeerine;   tincture  of  iodine  \$  a  eonimni,!  a^tlu-jjtjon.     Tiately 
tcBTKR  ha«  prat'tioed  tlie  siibLMitaneoiis  injwtion  of  a  thirty  |>ep 
>nt.  solution  of  carbolic  add.    He  Ktatct  tlut  thi:*  cjinseK  an  im- 
lediate  arrest  of  the  inflanimution  for  a  small  distance  round  tha 
puncture;  if,  theretitn.',  the  trraitmeiit  ii4  lulnptcd  at  ho  early  a  stage 
K^mt  the  area  of  inilamniation  can  be  surrouinled  by  four  or  five 
^ntuiKrtnrts,  the  dimuuie  may  he  i^Iiockctd.     Beyond  this  there  vvmild 
Vlw  danger  of  carbolic  acid  poisoning.     Drawing  a  limiting  line  in 
frmit  of  the  advancing  raoh  has  bwm  done  with  mil'id  nitr 
and  with  bJtetcring  tli 

1  lieet  treated 


190 


HAKDAL  OF  TBEATMBKT. 


of  a  strong  solution  of  pen:hloriiJ«  of  iron.  If  fliere  Iio  it^At 
glottidii*,  tlie  i^wolleii  parte  must  be  8C4i.rifiod,  and  if  that  fail 
give  relief,  tniclirotoiny  may  W  nccufwary. 

To  avoid  the  cotn|)licntions  which  rnnj  nrise  in  even  simple 
cai^ea^  Babtrolow  givta  the  tincture  of  belladonna,  or  preferably 
a  aolation  of  atropine  (atropiaffisulph.  gr.j,  a(jufej.  M.  Sig.  Ot» 
drop  every  four  hoiins  in  aomc  water).  Aw  the  effect  of  tlrtj 
atropia  accuiuulatea,  the  interval  between  the  dose^  is  enlarged. 
Ill  the  more  severe  cases  quinine  should  always  enter  into  thfi 
treatniCDt,  and  in  ftill  me<licinal  but  not  antipyretic  doses. 

B     QiiiiiinivBulfili Qi^ 

Kit  hellndoiiDH, ......^,  i^ 

M.  ft.  X  pil. 
Big. — One  evary  four  Woan, 

The  delirium  of  anemia,  the  usual  form,  eapocially  in 
addii-ted  to  aleoboUe  exeeAs,  iH  bet<t  relieved  by  aleohoHc  stimii* 
lanta  and  innrphia,  and  belladonna,  if  the  latter  does  not  ent«r  in- 
to nonie  other  eombiuation.  The  sj-nteinatiL-  nee  of  milk  auil  beef- 
OBScnco  is  necewyiry  in  atl  severe  eaiws,  espocially  under  the  condi- 
tions named  above 

LooHis  does  not  approve  of  apeciiic  local  applications.  Cold 
diVBsiiiga  with  mihlly  astriiigoiit  anodyne  lotions  are  mwt  agree* 
able.  A  saturated  i<rohition  of  nitrate  of  silver  may  be  painted 
around  the  tiry!ii{>elHtomi  patch,  and  HOiueiime^i  ehet^kN  the  spread 
of  tiie  disease.  HubeutaneoiiJ*  iiyections  of  carbolic  acid  seem  to 
give  the  bLst  i-Cf*uIf.s  in  nurgic-ul  fry.iipfrhis.  Concentrated  nutri- 
ment shot! Id  I)e  given  in  t«inn.ll  amount«  but  fnx[uently,and  stimu- 
lants used  iw  ill  other  fevers. 


tiAHBBT^jON'ri  fanious  prescription  is  m  follows: 

H    ijuinliup  sulph., 5j 

Tinct-foni  chlorii, fj  y 

TincL  dncboD., ., fSJ 

H.    S. — I^int  a*c-r  tlii'  irbnl«  ervidpclkhin*  nurfiu*  until  bWk;  reneviog 
the  Kpjtlicutioti  vthfna>er  fkt  redneta  tkovx  through  the  blaet. 

Our  own  prefen'Tico  is  fur   the  flexUe  collodion   painted 
around  the  diseased  surface,  aud  pewiateutly  ruappliwl  whenovor 


KXOPHTBAI.MIC  GOITRE. 


191 


.  scales  otr,  or  Uie  erysipelas  pneses  the  circle.    As  a  dremiDg  we 
dry  salicylatcd  absorbeut  cotton. 

But  ret-ontly  an  agent  has  been  int«>rlin»(l  iti  the  treatment  ot 
rysiljelas  which  bids  fiiir  to  relegate  alt  others  to  oblivion.     AVe 
_allurie  to  jaborandi.     ItdiouW  W  given  in  d<»cfi  of  lil'tcvn  drup^ 
tlic  flnid  estract,  repealed  every  three  bonrs,  aud  im^reiaed  if 
iry  until  niodemto  «wi«tiiig  luw  been  iiro*lint«l.     In  the 
in  which  we  have  used  thie  drug,  ite  eftect  upon  the  ery6ii>e- 
lae  hai  becu  as  uniform  as  that  of  cold  upon  n  thermometer. 
I  If  the  heart  ahovi  sigtifl  of  wcakueds,  digitalis  luay  be  added ; 

L     while  fiuiuiuc  and  iroD  may  be  given  continuoudly  from  the  etort, 
I  -to  eoBtaiu  the  strength  and  nhorteu  convalesoenca 

^H     Da  Costa  hsA  also  obtained  good  results  from  the  use  of 

^HAxinuidi. 

^^      It  is  («id  that  the  application  of  white  paint,  in  order  to 

exclude  the  air,  will  relieve  all  ^win  aud  cauw  the  iufiaiuuiatiou 

to  enbeide. 

^H  Bartholow  says:  The  usual  arteriul  ^t'dntivoa  poHest  but 
^Htoall  value  in  the  tn-atnicnt  of  thiifi  (lisejisi'.  0<ii>d  n>siiltM  have 
^^een  obtained  from  belladomift  and  ergot.  They  should  bo  admin- 
istered for  ftevt'rul  moiitliK,  and  in  full  dottex.  The  anemia^  which 
8o  pronounced  a  symptom,  requires  iron.  Tkai'be  nchiered 
t  iiucc<!9fl  by  u  (xinibiiiiitioii  of  quinine  ami  iron.  Thin  iiurJior 
had  good  otl'ect^  froni  quinine,  belladonna  and  ergotin  in  com- 
latioii.  Oalviuiization  of  tlie  cen-ical  Mynipalhetic  and  pneu- 
oga*tric.  by  placing  the  anode  under  the  ear  end  the  cathode 
at  tlic  epiguKtriiiiii,  lit:  hat  fount]  to  bo  of  the  higluvt  effi- 
ciency. While  the  curreut  19  passing,  the  action  of  the  heart 
Hcfomcs  li*8  tumult II ou!«,  the  pn>tni«ion  of  the  eyes  dinrniiBlics, 
and  the  thymid  shrinks  somewhat.  Besides  the  stjibile  applica- 
tion just  indiuLted,  labile  applications  should  be  mudo  over  the 
thyroid,  and  a  weaker  current  ahouid  be  applied  to  the  eyo«. 
While  the  galvanic  ap))li<iiti(>it9  arc  being  made,  the  remedies 
soggestod  Duy  he  uned  internally. 


EXOPHTHALMIC  GOITRE. 


\ 


192  MA^UAL  OF  TREATMEKT. 

Papl  quotCH  T)e  M«s,»y  an  liavinsr  "btained  prompt  and  nn- 
os:]ie<--ie(l  8UOCCM  from  the  uhu  of  iodine.  Tlii*uc  to  six  dmjis 
were  given  tliw*  tinu<«  u  day. 

DcJARWS-BEArMETz  eiii]>loy«i  duboisiue  in  two  cattea. 
2^otAblo  improvement  followed  speeclilj,  but  nt  the  eml  of  n  week 
it  became  neeesflarj-  to  tli«»utiijue  the  drug-,  on  account  of  it* 
poieonous  eflVflw. 

Bfesi-BABKfi  ui^cs  tlif  UHO  of  cold  water,  in  the  form  of  the 
movable  douche,  used  generally,  cold,  iihort,  and  soincwhnt  fom- 
blc    OomplcUs  recovery  hon  t-nsncd  in  from  four  to  eight  months 

Traube  gives  five  grains  of  qninine  on©  day,  and  ten  grains  of 
"Valletta  mass  the  next, 

LooMiu  also  Bpeaks  oppn)viiigly  of  quinine  and  iron.  He 
IRJB  that  calvaniziition  of  the  ccr\*ic-al  s^-mpathetic  diminished 
tt.e  oxophthalinw  iind  Imvers  the  pulse  rate;  while  a  prolonged 
residence  in  Colorado  seems  to  arrost  its  progre^,  and  in  one 
instanec  led  to  apparent  recovery. 

RoiiEBTs  recommends  digitalis  and  Ixilladraina,  with  iron. 

T.  Lacdke.  Brlxton  Bays  that  the  treatment  chiefly  eousista 
in  securing  fresh  air,  gtnitle  exercise,  avoidance  of  fatigue  or  emo- 
tion, and  carGful  diet.  When  the  eyebalU  become  so  prominent 
as  to  he  liable  to  ulceration,  they  muat  be  protected  by  a  Mbade. 


FACIAL  PARALYSIS. 

Bartbolow's  treatment  iaaa  follows:  The  cause  of  pressure 
on  the  nerve  within  the  cavity  of  the  cninium,  or  diseaftc  of  tfae 
cor,  should  be  removed  if  practicable.  In  all  doubtful  caecB  a 
conree  of  iodide  of  [HttasKiuin  should  bi;  prcnixilxx].  If  the  attack 
be  of  the  rheumatic  variety — so  called — blisters  to  the  mastoid 
and  the  intcnial  ubc  of  pilocarpine  are  the  mo»t  effective  mcajsurce. 
The  ^plication  of  electricity,  the  galvanic  current  preferably, 
should  he  begun  at  once,  and  continued  taithfully  until  a  cur^j| 


FACIAL    PARALYSIS. 


193 


k; 


effected  or  discovered  to  bo  unattoinable.  The  application  should 
be  made  by  one  pole — the  anode — on  the  mastoid, and  the  cathode 
passed  ovur  the  terminal  Ulamcnts  of  Uie  nerve  as  distributed  to 
the  mu6cle«. 

HoasMTRAL  eays  that  the  trcatnieitt  iti  recent  caw»  con^iitts  of 
Tspor  baths  foIli«vc<l  hv  a  facial  douche  of  moderate  temperature, 

and  the  iite  of  iodide  of  potasaium. 

In  old  tbrms  he  prefers  etr>xlmine.  Electricity  he  consideni 
the  moat  efficient  remedy  at  our  comniand.  In  recent  cnsea  he 
applies  a  weak  faradie  current  to  the  paralyzed  tnascles  or  nerves, 
for  three  to  five  minutts.  To  relieve  dcformitioe  actjuired  during 
treatment,  Kbjiak  udCd  stabile  constant  currents  of  ten  to  twenty 
Siemerift'  elements.  Old  contracturea,  however,  will  require 
myotomy  or  faradisation  of  the  homolojcous  m«w.Ie.  lu  applying 
tbc  galvanic  current,  the  anode  la  plai-ed  in  the  nuutoid  foaaa  sud 
the  cathode  i*  movwl  over  the  p«  ann^riima ;  on  the  tcmjile  for 
the  auperior  muiulc^,  outside  the  zygoma  for  the  lids  and  upper 
lip,  on  the  rarout)  of  the  jaw  for  the  chin  and  lower  lip. 

A  good  method  is  placing  theiunMle  inside  the  check  and  the 
cathode  over  tlie  jiaralyzed  muftclen.     This  re(|nipes  fewer  cells. 

In  obfltinale  cascR  the  continued  and  interrapted  corrcnta 
should  bo  Qsetl  altenialely  or  »imultanuuusly. 

Trauroalic  paralynes  are  rebellious  imd  require  months  for 
recover)-.  The  bust  treutmeut  ib  the  altpmate  use  of  the  induced 
and  constant  currcnta. 

l^anilyttitt  due  to  diaeaae  of  the  auditory  apparatus  may  dis- 
apjiear  when  ihe  primary  dtHeiise  is  cureil ;  especially  if  electricity 
be  uited. 

Syphilitic  parnlj-sis  may  be  due  to  eentrie  disease  or  to 
Bpeeific  leHions  of  thv  nerve-trunk.  In  either  case  the  treatment 
of  cerebral  syphilis  is  indicated,  vC'hich  see. 


Miles  believes  iodide  of  potaseium  to  be  bcncSctal  in  cases 
depending  on  otitis,  apart  Irom  any  anti-syphilitic  action.  In 
rheumatic  cjises  ho  [ilai^es  lh«  pmilivt*  |k>U'  behind  the  ear  on  the 
nft'ected  aide,  and  the  negative  behind  the  other  ear,  ami  uses  a 
moderate  constant  current  for  two  minutes,  lie  al^  makes  uae 
of  both  currents  applied  directly  to  the  affected  muscles.  This 
H 


IP-t 


MAKt^AL  OF  TREATMENT. 


ahouM  be  repeated  daily,  from  iwci  to  tiva  mrnuien.  Stm-liuiije  he 
mentions  oiil.v  to  mU-fi-t  to  \t9  utter  ust'Iessuoss.  He  speaks 
I'avorftbly  of  mecliamcal  appf  minxes  and  manipulation,  a^  mains  ot 
preventing  distortioUi  Coiitractiuiut  luu!  rigidity  roquire  stKtcli* 
ingf  nia.^sage,  etc. 

GowERs  adds  lils  roiw  iti  favor  of  olectricity  \a  all  forme  and 
dtagGs  oi  tliifi  dist'ast.  lleepoaksof  the  difficulty  of  removing 
late  coiitraotioii,  and  Bugge«tH  inunctions  of  cileate  of  mori>hine  in 
addition  to  the  mejuis  mentioned  ]>pevio«sly. 


GALL  STONES. 

Babtholow  says:  Tlie  severe  pain  demands  immediate  tit- 
teotioii.  There  are  two  niethoils  of  rclioring  it;  by  the  inhala- 
tion of  ether,  and  by  the  hyijodermic  injection  of  moi'i'liine.  The 
action  of  the  former  U  temjiomry,  and  of  coarse  the  relief  is 
confiuod  to  tlie  period  of  uiu-onHcioiisnes*.  Thieraay  besnilioient, 
but  usually  prolonged  administration  ia  n6CGa*ary.  The  hypoder- 
mic injoetion  U  more  effective.  From  one-twolfth  to  ono^isth  of 
a  grain  of  morphine  w  usually  stitiicient  for  an  orrliiiarv  case,  but 
if  the  auttbring  Imj  very  great^  otie-fotirth  to  one-half  of  a  ^r»in 
iiniy  lie  rwiuired.  The  combiiuitiou  of  niorjiliinc'  and  atropine 
it)  both  more  ottective  and  wifer,  and  henee  atropine  uliould  be 
givert,  j^  grain  at  each  iiyection.  Not  only  does  thl*  remedy 
remove  the  pain,  but  it  \»  tlie  mowt.  efticinit  means  of  preventing 
ur  Bubdutug  peritoneal  inflammatioii.  Warm  liathA  and  dot  fo- 
meutatiotiit  to  the  riglit  hy[H>chondrium  eontributo  to  relief.  Un- 
doubted advantage  in  derived  from  the  uw  of  leeclies,  when,  the 
pymptoms  pen*i«ting,  tenderness  develo|>*i  and  fcvor  aii^ws. 

Prophylaxis  is  highly  important.  All  lata  and  artieles  con- 
taining lat  in  any  form  ai-c  to  be  rigoroiwly  exchided.  Saocharine 
mibHTanca*  are  also  prohibited,  and  the  staruhy  conatitnent^  of  rlic 
diet  are  reduoed  to  a  little  white  or  com  bread ;  potatoes,  beans, 
]«as.  and  rice  being  excluded.  Lean  meat  of  all  kinds,  ^ga,  fiah, 
Iruit,  and  the  succulent  vegetables  arc  ))ermitted  freely.     Wine  at 


BXLL  STOSES. 


195 


diiiDer  is  allowed,  but  malt  liquoi^  oad  »piriU  are  forbidilen. 
Dniljr  fixfivwe  U  dirwctiNl.  All  "irreguliintic**  oflifc  of  ever)'  kiud 
»«  given  uji.  TIiP  remedy  which  ohove  all  others  hfi!«  tht-  jkiwit 
to  effect  the  solutiou  atid  din^iKMitioii  of  (^Iciili,  h  phosphate  of 
soda.  Thia  U  pred«:nl>ed  in  the  dose  of  a  drachm  thrwj  limes  a 
diiv,  iliBBolvcd  iu  sufficient  witter,  and  tukcii  before  mcnis.  This 
Kmedy  is  eontinaed  for  Fcveral  weeks  or  months,  and  if  there  he 
preMDt  evidenced  of  gostro-intcgtiitnl  catarrh,  ^  of  a  grain  of  the 
arscniate  of  Boda  is  added  to  each  do!?e  of  the  pho*pUato.  Vit.-hy 
water  and  our  own  Saratogn  Vichy,  aa  well  as  the  alkaliue  watera 
of  thia  country,  which  are  eu  abundant,  should  be  used  dally  in 
connection  with  tlie  pliui  above  indicated. 

For  the  eulic,  J.  Wickham  Lmo  recranmendd  morphine 
hypodennically,  a  warm  liath,  and  if  tiiwe  fkil,  tlie  inhalation 
of  ether  or  chloroform. 

For  tlie  intervals,  he  mentioiM  the  ii.se  of  Duxande's  remedy 
{lim«  parts  of  ether  and  two  of  turpentine;  ten  to  twenty 
minima  thricv  daily,  Ln  capeules).  Carlsbad  water,  taraxacum 
and  aqua  regla. 


VoH  ScHUKi'PEL  nKwinmends  hypwlermics  of  morphine  for 
the  paroxysm,  and  1>eUadoii2Ui  au  a  Ftuccedanouro ;  in  BUppoaitory 
or«&n  UninH<iir. 

By  the  side  of  these  remodiefi  ho  places  chlorofonn  iir  dosee 
of  halfa  dnuihni,  internally  or  by  inhulnlion.  Thti  ].atji'!it  should 
at  once  be  pnt  in  u  hot  bath ;  ond  hot  i^tonlticet^,  fumentationit, 
flatmelfi,  etc.,  applic«l  to  the  seat  of  pain.  Some  patients  find 
greater  relief  from  the  um  of  cold. 

The  liett  nwulti«  are  obt»ined  by  giving  large  quantities  of 
hot  water  with  bieaHwnate  of  soda  added.  Though  thia  is  at 
first  vomited,  it  should  I>u  pcrsiMttid  with,  and  will  give  relief. 
Great  8eu;»itivene*s  over  the  gall-bladder,  or  marked  and  con- 
tinnoat  pain,  indicate*  the  new!  of  leeches. 

Syncope  and  collap^  call  for  stimulant(«,  wine  or  ammonia, 
with  Hinapijnnii  and  frictions.  Bufaum  recommended  podo- 
pbylLin  in  small  doses  for  the  colic  and  as  an  after  trcalmL*ut. 
Mercadib  eorruboratex  this  favomblc  rcjjort. 


196 


3UNCAI.  or  TBBATMBST. 


Emetics  may  he  usih]  in  case  the  persistence  of  jniindic^, 
after  nil  otiicr  symptomH  of  hepatic  colic  have  subsiiled,  shows 
that  a  calcuhu  h&»  Ijccomi!  impacted  in  the  ductui<  choledocbiM. 
By  this  remedy  the  stotie  may  \)v  tli«Ioilged.  For  the  Mme  pur- 
ptwe  Von  ScrirEPPKL  rci'ommeiids  purgatives,  etlicreal  inunctiom, 
warm  baths,  nbdominal  frictions,  and  cnpc<:ial1y  the  alkaline 
niincrftl  watcni  of  C^rUhacl,  Ems,  Kiasingcn,  Vichy,  etc.,  as  these 
increase  the  secretion  of  bile,  and  the  »tn)iigcr  flow  ma'y  dialodge 
the  8  tone. 

The  fe%-cr  caused  hy  impacted  calculi  is  amenable  to  treat- 
ment with  quinine. 

For  the  solution  of  Btoncii  rcniaiiiliig  in  the  biliary  posaegta, 
he  sUitcs  that  Diiraiide't*  remedy  produces  undeniable  good  rc»ult«. 
Tbifl  is  attribvited  by  Tlicimrd  to  the  anti-spiij'modic  action  of  the 
ether,  and  Frerichs  therefore  discards  it  for  morphine,  a  better 
aati-epaamodic.  Durandc  ordered  his  remedy  in  teaspoouful 
doses,  repeated  every  moitiinEf  until  500  doses  were  taken. 
Others  bolievo  that  the  ether  may  in  thi^  Icugth  of  time  exert 
Buch  an  infitieiic'e  on  the  surfaei^  of  tlie  caleiihis  as  to  ]oo««n  it 
from  its  place,  and  porhnpe  disiiitegmte  it. 

BucKLKR  give*  from  five  to  sixty  drops  of  chloroform  in- 
ternally, every  four  houre,  and  claims  tliat  by  this  means  the 
calculi  may  be  dissolved  a«  certainly  as  if  in  a  teat  tube.  The 
treatment  should  he  continued  for  sevt-ral  week*. 

OcTERLOXY  recommendod  the  Buccinate  of  iron  in  the  nme 
favomble  terms. 

The  alkalies  produce  a  Bocretion  of  thin,  watery  bile,  which 
has  a  strong  solvent  action  on  the  calcnU.  These  have  proved  the 
best  remedies  aa  yet  discovered.  They  also  i>ombnt  the  catarrhal 
affections  on  which  cholelithiasis  primarily  dejwnds.  The  dpringa 
which  have  won  the  hlghe.it  reputation  are  thoi«e  of  CarUbad  and 
Vichy.  Instead  of  these  waters  we  may  substitute  a  solution  of 
bicarbonate  of  mHla. 


BouciEARDAT  adviHOtl  the  use  of  the  citTfttes  and  acetates  of 
the  fixed  alkalto^. 

Tiiere  lii  no  qucBtion  as  to  tlie  superior  cfli<-acy  of  morphine 


QASTKAJAM. 


197 


an'l  atropine  Iiypodcrmu-ally,  in  t)ie  paroxynm.  Onc-fixtli  of  n 
grain  of  the  tbrmer  may  be  given  with  one-sixtieth  of  a  jfraiii  of 
tite  latter.  In  case  the  syringe  lie  not  at  hand,  the  name  do«} 
may  be  given  by  Uie  moutli,  in  a  little  liot  water.  The  effect 
will  be  alror>st  an  rapid  ik  when  the  drugH  arc  ii^jeoted  under 
the  »kui. 

To  prevent  the  ivcurrraKe,  a  long-continued  tfouree  of  pluM- 
phate  of  soda  is  certainly  lietieficial.  Half  a  rlrachm  may  be 
given  one*  tliiily,  before  hrenkfawt.  Tliis  drug  acts  by  removing 
the  duodenal  catarrh,  and  by  exciting  an  increased  flow  of  bile, 
the  natural  «olvent  of  cholesierin. 


h 


GASTRALGIA. 


N^IBHETER  Speaks  of  Ibe  value  of  iron  in  anemic  or  cblorotie 
caaei.  In  hvBterie  gnstrulgia  the  application  of  leeches  to  the  oa 
uteri,  and  appropriate  treatment  of  any  uterine  disease  which  may 
be  pretient-,  often  has  a  striking  efiect.  Malaria  must  lie  removtxl 
by  quinine. 

The  pain  call^j  for  narcotics,  the  best  of  which  ia  tho  acetate 
ot  morphine.    Tliu  following  haa  been  much  used  with  benefit: 

B     Tinct.  nncis  vom., 

TincL  outiorci, U    f  J  jj 

U.    tS.~TwelT«  drop*  wlien  ocHed  foe  paia. 

The  Haltd  of /.ini;,  biflmuth  and  silver  have  al^o  b«ou  recom- 
mended. 

RoMHKKi)  addod  to  the  internal  trcatjoent  the  application  of 
belladonna  piasters  over  the  stomach. 

Levbr  calls  attention  to  the  number  of  ciwcs  in  which  this 
alTectioti  is  eecondary  to  other  systemic  diseases,  which  require 
treatment.  Abunrmal  ingcsta  must  bo  removed  by  emetic-s,  or 
by  the  storaacli  pump.  Uterine  derang©ment»,  ehloroais,  onan- 
ism, hysteria,  malaria  and  arthritis,  are  among  the  ullectioiM 
which  thus  demand  attention.  For  the  paroxysms  of  acute  pain 
he  reuoiumendd  warm  batlis,  HinapinniD,  chtoroforni  iiihalatious, 


198 


MAHDAL   OF  TRKATME.NT. 


and  tlie  hypodermic  uso  of  morphine.  BiamuUi  U  by  many  coii* 
itidered  a  specifiv.  Otherx  have  obtaiiieil  striking  rexults  from 
areenic.  Electricity  should  receive  a  trial  Wfore  all  else.  H« 
nsw  ihc  ii-oitsmnt  (■nrrt'iit^  reii  u>  llfLy  elmnt-nta.  The  anode  is 
placed  nn  the  point  of  greatest  tenderness,  and  the  cathode  id  the 
left  axillary  line  or  nearer  the  rt£>inc  Tlic  current  should  bo  strong- 
enough  to  [trodnce  a  slight  prickling  sensation,  and  should  becon- 
tiniie*!  ten  minutes. 

Al^er  fultilling  the  duty  whit^h  comes  first  in  the  treatiuum 
of  ail  eufh  nervoua  allections,  of  curing  all  derangements  of 
faealtli  of  every  deticnption  whluh  we  can  find  and  can  cure,  the 
gaatric  affection  will  etill  occasionally  put  our  skill  to  the  tcet. 
Mach  dependi4  on  the  itifltiE-nce  the  jihyHician  ean  exert  over  h\» 
patient.  Iii  one  case  which  had  bafllcd  the  skill  of  a  number  of 
phyaieiann,  the  |>ati»nit  made  a  long  journey  to  a  eity  to  coiwult  a 
young  and  inexperienced  practitioner,  who  cnred  her  by  the  ad- 
ministration of  |)epsin! 

Oxide  of  silver  has  proved  more  iwcful  io  our  hand*  tboo 
any  single  remedy  t-esidofi.  Wc  give  it  in  dosos  of  gr.  J  four 
times  daily.  Oxalate  of  ceritun,  in  dosoa  of  two  grain*,  every 
three  hours,  was  recommeudo«i  t^  us  by  G*rrktso«,  and  has 
proved  in  sonio  cases  surprieingly  offieaeious. 

In  one  case  which  resisted  every  remedy  which  waa  tried,  the 
following  observations  were  made:  Intense  jiain  followed  the 
ingestion  of  any  form  of  food  or  drink,  however  bland.  It  waa 
foimd  that  a  large  bottle  <if  diarapagne  or  beer  wan  not  apt  to 
cause  i>aiu  if  taken  at  one  draught.  Morphine  and  brandy  wflle 
the  only  drugs  wliiuh  gave  reUef,  cocaine  and  iodofor^ failing. 
After  many  failure^t,  the  patient  wa»  linally  directed  to  t^c^^ 
ounce  of  milk  every  two  hours,  day  and  night.  Though Tffl^raa 
followed  by  the  moet  acute  pain,  it  eeemed  that  the  capacity  of 
the  gastric  nerves  for  suffering  was  (iimlly  worn  out,  and  after 
three  days  the  rebellious  organ  quieted  down,  and  the  patient 
rapidly  recovered.  Thi*  method  requires  the  asaidtance  of  a 
trained  nurse,  into  whose  hauda  the  patient  must  surrender 
bcreetf  absolutely. 


eL(»SO-PIIARVNtiBAL   PAILALyeiS. 


19«J 


GLOSSO-PHARYMGEAL  PARALYSIS. 

Bartholow  iiditt'd  thul  Cbcadle  r«|iorW  a  cure  by  the  five  ad- 
minitit ration  of  io<li*lc  of  jiottiwiuin,  but  tliis  must  have  Iieen  n  oi!*o 
of  guiauialu.  Iodide  of  jxttaAsium  hat*  never  arnntcd  tlic  pi-ogresn 
of,  mnrh  lui«  ctiral,  a  geiiiiiiiu  c-iuie.  Galvanism  \h  thf  moe^t  prom- 
isiug  remedy.  Stabile  opiilicutioiw,  tbr  ckvtrodt-s  oii  tlie  raftstoid 
pnK-eetKe,  and  in  th«  oppotiitc  ilin-ction,  gnlvanization  of  the  syin- 
pathetic,  and  applicatious  to  the  Iijjs,  tongue,  and  fauces,  ithouid 
bo  peivi»ti.-ntly  uk^iI.  Tbu  rtirn-nt  i^hunM  havt-  Hiifticicnt  tension 
to  caui*  slight  giddinesa  and  faint  flasliCi*  of  light.  The  swincea 
ehonld  be  «hort  but  dnily,  and,  if  siii^pendcid  oocasiomiHy,  cnn  be 
fcej.it  np  for  the  necefiyir}'  period,  llydi-otberapy  is  next  to  dec- 
tricity,  the  most  useful  renw^y.  A  wot  pack  con  be  worn  al>OQt 
the  neck  «ver>'  night,  and  a  hot  doucho  may  b«  directed  to  the 
uach*  for  five  minutes  daily;  or  better,  a  sponge  dipped  in  hot 
water  and  kept  iu  contact  with  the  h&ck  of  the  ne^'k  for  a  few 
minutes.  The  goo<1  effects  of  the  water  npptientionH  are  inerca^ixL 
by  the  daily  nee  of  a  muittard  pluritor,  kept  in  ooiitA<rt  loug  enough 
to  induce  a  little  ri^lncBS  and  nothing  more 

BcBMlDT  remarks  that  a  cure,  or  even  improvement,  can  only 
be  expected  in  the  early  stages.  KusssiAfL  n.ioiiiinend«,  at  this 
period,  wet  cujn  to  the  nape  of  the  neck,  the  shower  bath,  ami 
nitrate  of  silver  intemally.  lie  al^o  umm  the  eou^liiiit  ciirix'ut, 
first  through  the  nock  und  later  thmtigh  the  whole  spinal  ctilumii, 
and  alao  from  the  neck  and  hyijogloftsal  iicr>'c  to  the  tongue. 
DowsB  reporte<l  a  cure  following  the  u^e  of  tht-  constant  current. 
with  eubcutaneou?  iiyectiona  of  atropine  and  strychnine,  us  well 
•a  cod-lh^r  oil,  quinine  aQ<l  phoephorus  interiuiUy. 


lays  strew  upon  the  rogulntion  of  the  diet  and  the  habitu 
in  sncb  a  manner  as  to  avoid  nil  irritation  of  the  nervotiti  aj'stem. 
He  speaks  niso  of  tlie  gwwl  cileet  nj>on  the  nervous  gyatom  pro- 
duced by  stimolating  the  nntrition.  For  this  be  relien  upon 
faydropatliic  trentrnent,  and  galvanization ;  a  stabile  c-urpent  being 
iient  through  the  mastoid  proL*L'w*es  iiiKi  hUiiII;  gjiKuuiKatiou  of 
the  cervifal  itympathetie  (anode  on  the  niirlia,  cnibode  at  the 
angle  of  the  lower  jaw),  and  then  induou  movement*  of  degluti- 
tion J  besides  this,  a]>i.Iy  direct  galvonio  or  faradic  ('urrontit  to  the 


200 


UAittlAL  OF  TBBATMBEfT. 


toogue,  !ips  ami  [lalatc.  TJiia  must  l)e  rept'atecl  einily  for  a 
He  also  reco  111  mends  intenmlly,  iiitmto  of  silver,  iodide  of  i>oti»- 
»iara  uiu!  of  iron,  chloride  of  gold,  ergotin.  belladonna,  iron  and 
qainine. 


GONORRHEA. 

Wlicn  a  great  number  of  nimwlies  has  heen  recommended  for 
the  cure  of  ajiy  disewjic,  it  is  an  iiidiea'tion  that  the  affection  ia 
easily  curod,  is  self-limited,  or  ia  incurable.  Gonorrhea  may  be 
prolonged  iiidefinituly  by  carcleasness,  or  by  iujiidicions  manogo- 
mciit,  but  in  the  msyority  of  cases  it  cjin  Ims  claiwed  in  the  eecond 
categoty,  as  self-limited. 

One  of  the  most  im]>ortant  iiapers  recently  published  ujwn 
thifi  affoctiou,  is  that  ^vh'wh  appeared  \a  the  Iii'h'on  Mediml 
GazetU,  March.  1886,  from  the  poii  of  Mr.  R.  U.  Firth.  In  it 
he  tabulates  the  results  of  treatment  in  413  casies,  as  given  below. 
The  vehicle  cmijloyed  was  iwiially  mucilage  of  tro^cauth.  No 
medicine  was  given  excepting  a  cathartic  at  tlio  beginning.  For 
ten  da}'3  a  simple  diet  wa«  maintained. 

IiUe<:Uaii.  CaiML      Ouniluu. 

Chloral,  Er  iij  tojj 7 Sl.SJa.Ts. 

Sod.  wliwl.,  (TT-P  W  ji 13 31.      " 

Aeid.  borit-..  gf.  V  lo  y « 80.8   " 

Acad.  Uuaic,  gr,  r  to  jj lO SS.7    " 

Iodoform.,  KT.  T  to  ii U 2fl.       " 

Arg.nii.gr.  i  to  3b' U S8.4    " 

Zinc,  dihr.,  gr.  J  to  ^ 44 27.S    " 

Warm  water 28.....  S6.6    " 

Quinine,  gr.  u  i"  ij 28 28  J    " 

Kombl  «*l.,  RT.  iij  to  y » W.l    " 

Biimulh  and  glfccrine,  1  to  10 21 KA    " 

Zlntt«tilph.,  gr.  V  lo  jj 40 24J     " 

Acid.  ^Tiu-boiic^.,  gf.  xij  lo  ij 20 SS,R    " 

Hjd,  bichlor.  itr.  A>"5j Bl 20.1    " 

fotaLpemang.,  er.J  lo  JJ 30 19.9    " 

Uyd. bichlor, gi. A SJ«'{»r»fiii).. 49  ....  17.5    " 

413 

Milton  proposes  the  following  plan.  The  abortive  treatmeut 
may  be  instituted  when  |»atioiit*(  jire^'Ut  themselves  before  great 
pain  and  running  have  set  in ;  in  thuse  who  have  bad  gonorrhea 


aOKORBllBA. 


201 


prerioasly,  and  in  whom  the  prMent  attack  docs  uot  appear  to 
be  very  severe;  aiitl  in  tlioso  L-aset*  wbei-e  the  patient  ia  williug  to 
TOD  auy  rUk  in  the  bopo  of  an  immedukt«  euro.  If  the  patient  is 
wiwilliug  to  n>A  the  uest  day,  it  is  beat  to  lay  aaiJe  all  thoughts 
of  an  abortive  <.ure. 

If  this  eo-ojieration  on  hin  {xirt  can  be  uhtained,  the  {utient 
should  be  told  to  urinate,  and  the  «nrj»con  should  then  inject 
tt  M>lnlion  of  nitrate  of  silvert  ti^'e  gnunii  to  the  oum-e  of  di»- 
tilled  water.  Thi»  should  be  retained  two  or  throe  minutes. 
The  de(>[i,  huniirig  piiiii  which  enmies  will  be  relieved  by  bathing 
the  penis  in  hot  water,  and  by  taking  a  hot  bath,  lie  next  pra- 
8crih&)  four  grains  of  tailoun-l,  fallowed  by  a  saline,  every  two 
hours  until  sevcnil  \oogv  stools  are  procured.  No  fooil  should  b« 
al!owe<l  except  a  Utile  lea.  gna-l  or  tou-it. 

After  every  stool  the  ]iatient  should  inject  witli  n  solution  of 
Hulphate  of  zinc,  from  three  to  five  grains  to  the  ounce.  This  is 
to  be  kept  In  <t<>nlact  with  the  mucons  menilirnne  till  slight  hum- 
ing  in  felt,  loathing  the  peni»  witb  very  hot  water  will  relieve 
the  burning,  m-alding  and  weight. 

The  next  day  the  difieharge  is  thin  and  »4fanty,  and  the  cur* 
is  usually  completed  in  a  day  or  two  by  continuing  the  same 
mcanii ;  tlie  patient  using  the  zinc  injection  every  time  he  urinates, 
and  gnulually  incrca.*»ing  the  strength  to  ten  grains  to  the  ounce. 
If  this  doei  uot  sua«ed  at  on<-'C,  it  will  not  nucivcd  at  alt. 

But  few  cases  after  all,  can  he  treated  in  this  manner.  The 
majority  demand  the  following: — 

R      Putao.  »r«Ut., 3  f 

Sfi.  eth.  niUM.,.. fj  iy 

K|)l  junip.  romiv   f?** 

^^  A<|,  mcDlb., .q.  n.Bd    {%  ij 

^^B  M.    8.— Tw«  UlilMpoonrula  Iwioe  or  otleafU  duly. 

I  In  Bcvcre  <raae»  he  snhulituteK  the  chlorate  of  potaiwa  for  the 

acetate.  Lf  the  bowels  do  not  move  several  times  a  day,  give 
the  follow  u 


rmg  pnlH : — 

A     Ext.  colocirnlli.  c«npw,. 

PIL  Uyilran(„ 

ExLhyoHyani 

M.  T't.  mu.  ct  in  pil.  no.  li],  div. 
Sj— On«  or  iwo  lit  beddtne. 


-KT.  X 
■gr.  XX 


802 


MASPAI  OP  T11EA7MEST. 


If  they  should  not  act  sufficiently,  a  Baline  draught  maybe 
given  the  I'ollowiiig  morning. 

In  fortj'-eight  hours  the  (lierharge  will  show  eviiJenees  erf* 
iinprovement,  while  the  weight,  teiwion,  scnldiiig  and  vo^icol  irri- 
tability Income  less. 

It  ii  rarely  necessary  to  coutiime  the  |H>ta^aa  mixture  more 
than  ten  ilnyp.  Tonit-s  may  be  iMlniiniittered  at  the  sane  time,  if 
the  jwiticut  be  wcjik  and  low. 

In  most  cases  this  tnsitraent  must  bo  seconded  by  iiycpctions. 
In  order  to  make  tliese  aa  efficient  e»  poiaible,  care  must  bo  tnkeii 
to  select  a  snhition  of  such  a  strength  a«  to  aet  on  the  muoou» 
membrane;  to  ajuply  it  o\'er  the  wliole  of  the  diseaaod  sorfece; 
andlo  see  that  it  in  doing  no  iiyury. 

The  nitrate  of  silver  ehould  be  used  ly  the  surgeon  oniy,  every 
day  until  the  discharge  ccRseg.  Begin  with  a  solation  of  J- to  J 
grain  to  an  ounce,  and  gradunlly  rait^  to  two  to  ten  graina.  A 
slight  feeling  of  heat,  for  fifloen  minntett  after  the  injection,  w  all 
that  is  requisite.  Undue  irritation  from  any  eauee  aliould  warn 
U8  that  injeetions  of  all  kinds  are  to  be  8u«j>ende<l.  The  patient, 
meanwhile,  ie  to  use  the  eulplial^  of  zinc,  gr.  ij,  and  tlie  vhlortde, 
gr.  J,  in  an  ounce  of  water,  gradually  increasing  the  strength  so 
B«  jiittt  to  kee])  lip  the  same  (legi-ee  of  aetion  an  at  timL  The 
addition  of  ten  minlme  of  spirits  of  camphor  to  each  otutco  of 
the  Folution  appears  to  iiu^rease  ita  efficacy. 

The  patient  should  itlwnys  urinate  before  using  the  injection. 

The  syringe  should  be  fitted  with  a  silver  or  platinum  tube, 
two  inches  long.  Unless  this  be  done,  ityeflions  may  Iw  usied  for 
months  without  ever  reaching  the  seat  of  the  discharge. 

The  syringe  ^fhonld  contain  two  drachms-  'Whcu  the  injection 
is  made,  it  should  be  retjiined  until  a  feeling  of  warmth  is  pro- 
dnced. 

The  silver  iujeetion  should  be  ueed  daily  until  the  discharge 
ceases,  and  for  three  days  after;  then,  every  other  day,  for  eight 
days.  If  the  symptoms  point  to  extension  to  the  membranous 
urethra,  a  syringe  tilionld  ha  used  with  a  tube  long  eiioiigii  to 
carry  the  fluid  to  that  part. 

When  the  disdmrge  is  perjiistent,  but  has  not  extended 
beyond  the  penile  urethra,  he  recommends  a  live  gi-aiu  eolutitm 


* 


iTor  to  be  npiil'iod  on  a  slip  of  niiislm  or  a  sponge  iiitrmliiced 
>iigh  a  caimla. 

If  St  the  end  of  a  week  there  iJiaiihl  be  no  iniprovenieiit, 
.MiBter  nliould  he  u]iplti*d  to  tbc>  \>tinh. 

In  the  female  the  same  intenial  remedies  are  recommended. 
Local  means  iihonld  not  lie  eraiiloyed  nntil  the  syringe  can  be 
passed  into  the  vagina  without  ciiiisiug  j>ain.  After  a  few  days* 
rent,  itijoetioiw  of  warm  wuttr  will  be  bonic;  and  theac  may  be 
follower!  by  weak  sohitions  of  lead  or  zinc.  The  full-length  hot 
bath  in  L-tficavious  in  relieving  diHcomfort. 


yiKMEVEB  r(H.'oinmond«J  in  high  tonnsan  iiyeetion  eoijeisting 
of  half  a  drachm  of  tannic  acid  in  hulf  a  [lint  of  red  wine. 


We  have  used  thl't  in  many  casee.  When  the  discharge  has 
Dot  yet  become  yellowish,  the  tannin  and  wine  injection  will  very 
often  ahurt  the  discat<e,  'u\  forty-eight  houro.  If  not  used  until 
the  pus  lias  apf»carcd,  the  di>»a«;  will  frequently  be  ehockod,  even 
for  weektt ;  buta^  BOon  aa  the  tannin  ii^diacontintie'l,  the  gonorrhea 
will  go  etcndily  through  all  tlii' stages  whieh  would  have  follnwod 
if  the  tannin  hud  not  l)een  usied. 

Whore  motives  of  pnidcnee  demand  the  concealment  of  the 
for  a  time,  this  property  of  tannin  13  valuable;  for  by  it 
the  toll-talc  discharge,  with  its  stain*!  and  its  odor^  is  kept  in 
abeyance. 

Milton  givwt  the  details  of  a  prolonged  acrieB  of  experiments 
witb  various  remedies  given  internally.  A  fair  and, iudit-iu!  trial 
was  given  to  rubclw,  !=andabw<i(id  oil,  turjientine,  kava-kava,  matr 
ngan  plang,  gurjun,  erigonm  and  olhcr  so-oillcd  rcnicdica. 
Tone  of  thene  vraw  found  to  be  an  eificient  aa  L-o[>aib» ;  and  even 
tiiii  latter  provetl  uiic-erlnin,  often  incllicieiit,  always  diiiagreeable 
and  riomctimctt  dangeroui^  The  moRt  disaetroiiEi  cttcctit  wo  liave 
ever  witnessed  in  the  eoursc  of  a  gonorrhea  tbllowed  the  attempt 
of  a  pharma<.'ist  to  abort  the  disease  by  the  administration  of 

>paiba. 
_       Every  sulntaace  twed  locally  113  an  injection  was  also  tested 
by  Milton  I  bat  none  gave  reaulta  equal  to  thot^e  obtained  from 


: 


204 


MANUAL  OF   THEATIIENT. 


A  recent  writer  recommends  prolonged  waaliing  out  of  the 
urethra  with  dilute  solutions  of  corrosive  sublimate  (1  to  40,000), 
U!4t>(l  with  a  [letMitiar  form  of  syringe,  wliieh  allowa  a  cantlnuottfl 
flow,  (lii-octod  toioards  the  meatus  uriiiarins.  The  results,  however, 
were  no  Iffitter  than  when  simple  warm  water  were  iiswl.  Corro- 
•ive  sublimate  is  so  peculiarly  irritating  to  the  genito-arinatj 
muccuii  membrane,  that  it  Bhoiild  ho  used  only  with  tlie  utmost 
care. 

AV'o  have  n»ed  Millrm't;  nivtliofl  Hulficioiitty  cittcn  to  eoiiviooe 
oureelves  of  its  great  val  ue. 

The  u[i])lii-atit»i  of  cocaine  to  the  preput-e  anil  glaiis  will 
be  found  an  invaluable  moans  of  relieving  the  pain  and  distre^ 
attetidaiit  on  the  lU'ute  xtage.  Tlie  cocaine  itbauld  be  appHeil 
in  the  form  of  an  ointment  cont*inijig  five  grains  to  a  drachm 
of  lanolin. 

Ricobd'i!  abortive  treatment  condistH  of  rest,  low  diet,  and, 
where  there  ia  ]"aiu,  thirty  or  forty  Icechea  to  the  [wrineum,  fol- 
lowed hy  W4«iba  or  cubebs,  and  mild  iiyectiona  of  nitrate  of  sil- 
ver. When  the  disease  begins  without  pain  he  gives  dnutics, 
witli  astringent  iryections. 

Whatever  be  the  trentment  adopted,  it  will  be  of  the  grcatost 
assJBtance  if  the  patient  be  confined  to  his  bed  on  low  diet  for  th« 
first  week. 


In  the  July  number  of  Tht  Medical  TTorH,  1886, 1  introduced 
a  new  mo<le  of  treatment  tor  urethral  and  vesical  afiectionH,  which 
I  called  "subpreputinl  medicution."  It  conflists  of  inlroilnciiig 
ee«ily  absorbed  raedicuments  beneath  the  prepuce,  on  each  side  of 
the  frenum,  so  as  to  l>c  near  tho  urethra.  I  made  a  soriea  of 
experiments  some  years  ago,  but  they  wore  only  jiartially  suoeew- 
fnl  because  of  the  lack  of  an  excipient  which  would  be  readily 
absorbed.  The  discovery  of  lanolin  completely  lillod  this  want, 
and  last  June  I  began  niy  i-ipcriment**  anew.  I  found  tlmt  the 
|>aiu  of  gouorrhea,  priapism,  irritable  bladder  and  cystitis,  were 
greatly  relieved  by  hiHerting  beneatli  the  prepuce  a  pieue  aliout 
theeixe  of  a  grain  of  wheat  of  the  following:  lanolui,  thirty  grains, 
rubbed  witli  morphine  rivugmiim.    It  should  he  repealed  Mtvend 


tiraes  a  day,  according  to  iho  indicatione,  and  the  part  ahonid  be 
dcaneed  before  each  opiiUoation.  The  proportion  of  morphine  may 
be  increarscd  or  dinilnialied,  according  to  requircmcuts ;  but  be  sure 
to  have  the  mixture  stroog  enough  to  have  a  decided  effect — yoo 
need  not  fear  svtiteniic  poisoning.  Cocaine  iwed  in  the  same  waj 
completely  bcnumba  the  penis,  and  either  stojw  or  greatly  dimin- 
isbee  the  diacharge  of  gonorrhea.  1  found  one-fourth  of  a  grain 
applied  twice  daily  to  be  cfticient.  Morphine  and  cocaine  may  be 
adrautageouttly  combined.  Atropine  may  be  found  ueeful,  utied 
in  the  same  way.  Lanolin  tihould  always  he  u^uxl  as  the  excipient. 
The  lanolin  is  absorbed,  carrying  with  it  the  pcmedy,  nnd  the  full 
local  effect  of  the  rcme<ly  itt  obtained  witli  but  tittle  syRtemic 
effect,  and  without  dieturbnnca  to  the  urethral  memhrana 
Although  the  profetwion  hat  been  a  little  slow  about  taking  up 
this  treatment,  I  believe  that  it  has  a  future  of  much  usefulneaa 
before  it.  (For  ]iarticuhirs  of  ex|»«!ri»ienln  and  ai^umtnt,  Bee  edit- 
orial in  The  Medical  World  for  July,  1886.)  (C.  F.  T.) 

I  Although  hitherto  gout  has  been  almost  unknown  in  America, 

of  late  it  has  become  les«  rare;  nnd  aa  wealthand  hixurj*  im-rease, 
and  are  tranemitted  from  one  generation  to  the  next,  we  may  con- 
fidentially expect  to  become  more  intimately  acquainted  with  this 
dieeaae  in  the  future. 

LonrosTRKTU  says  that  too  much  stress  cannot  be  laid  on  tha 
enforcement  of  a  pro|>er  mode  of  life.  AVliat  this  in,  muKt  be  decided 
for  each  patient.  Starvation  is  <juite  as  injurious  a«  the  opposite;. 
The  v^etablea  which  corapoKe  the  bulk  of  the  diet  tttiould  not  be 
of  the  water}',  bulky  and  Innutritioue  sort,  and  the  meats  should 
lie  light  and  easily  digestible.  Fatit  and  oiIm,  eggn,  [totatoeH,  fiiri- 
nacea,  as  well  as  strong  tea  and  cott'ce,  must  be  avoided. 

The  heartiest  meal  should  be  the  breakfaot.  The  patient 
must  be  warmly  clothed,  but  not  overloaded  witli  wraps,  Exer- 
ciw,  valuable  as  it  is  in  the  prevention  of  gout,  is  uimuittKl  to  the 
chronic  malady  with  itH  visceral  and  articular  complications. 
Paauve  motion  should  replace  active  exertion. 


GOUT. 


206 


MASOAL   OP   TKE.ITMICXT. 


Tlic  Special  diet  treatments,  sucli  m  the  grape  or  whey 
cures,  »re  otten  awful  in  thcra&olvcs,  and  as  otlijriiip  means  oi"  oou- 
fining  the  ]inticnt«  to  reguliitiona  which  thty  nre  otherwise  j-rone 
to  overleap. 

M'^nter  is  too  olVm  omittah  Tho  alkaline  mineral  watere 
hove  a  high  rojmtation  in  this  dis«aso.  Thoir  fllLftrt  on  the  digeft- 
tive  ftppanitiis  rauKt  be  watched. 

The  iithia  i^alix  have  better  ctTcets,  witJioot  the  disadvant 
of  the  ordinary  alJcaliiie  waters. 

In  the  treatment  of  the  gouty  paroxysm,  oolchicuzn  is  the 
Bpeoifie.  Tt  should  be  jjivea  in  all  ciwes,  iinli-ss  there  is  an  irrita- 
ble condition  of  the  dige-stive  organs,  fatty  heart, or  kidney  diaeaw. 

The  more  chronic  the  disease  the  letts  useful  is  oolchicum. 
"We  must  guard  against  its  purgative  action,  it*  dinturbing  effects 
on  the  nen-oiis  system,  and  iln  deprwiisiiig  action  on  the  heftrt. 
With  tluB  drug  should  he  giveti  the  alkaline  carbonates  or  citrates. 
Local  remedieB  are  not  essential.  To  abate  the  inflammation  we 
require  heat  and  moisture,  conibined  with  anodyne  lotions. 

In  chronic  gout,  he  prefci-s  the  alkalies  luid  guaiac  The 
vegetable  bitters  are  oiWn  needed  to  aid  digestion. 

KnBERT3  recommends  as  preventives,  moderation  in  Cuting, 
with  a  limit*.-*!  amount  of  muivt.  Ct^Eery  is  sometime*  rotoarkably 
benctitiah  Pknty  of  water  should  be  taken,  hut  not  at  meals. 
Alcohol  should  he  tnken  in  snmll  amounts,  if  atall.  Malt  liqaon 
are  partieuIiU'ly  injnrioiis. 

Carefully  regulated  exercise,  care  for  the  skin,  bathSf  avoid- 
ance of  colds,  of  worry  and  of  excitement,  and  residence  in  a  warm 
climate  during  tlie  enid  season  are  n'cninnu'ndifl.  A  threatened 
attack  can  often  be  averied  by  a  Turkish  bath,  or  by  liydro- 
pathic  regimen.  Po1jLs»a  and  lirhia  are  the  most  nfoful  agents  for 
the  elimination  of  lilhic  acid.  Saline  aperients  are  often  of 
valuB.  The  waters  chiefly  used  are  those  of  Bath,  Huxton,  Ilar- 
n^te  and  Cheltenham,  in  England,  and  Carlsbad,  Vicliy,  etc.,  In 
Eurojie.  Wlien  any  nietlioil  of  [ircventioii  has  proved  etTectoaJ, 
it  should  bo  jwrsisted  in,  for  each  attack  of  gout  predispose*  to 
another. 

In  the  treatment  of  the  attack,  the  diet  should  be  as  low 
u  is  compatible  with  tlie  jmtient's  condition.    Colchlcum  is 


HAY  TSTEft. 


207 


tlie  most  valued  tlrug  in  the  iMi-oxycimit  of  gout.  Tliere  is  no 
foundation  for  the  belief  that  ita  use  predisposes  to  the  recurrence 
oi'  the  attack.  The  Imnxln  must  bu  kept  ac-tiiig  at  the  Nimetime, 
and  lithia  may  be  combined  'veith  the  colchicum.  Dilueutii  iihoiild 
be  given  freely,  mid  tewcittiii^  iitdiitrcd  by  the  hut  air  or  vapor 
bfttb.  Sleep  should  be  e^cui-eil  by  tlie  aid  of  opiates,  chloral,  or 
bromide  of  potiie»iiuni. 

The  aflecttd  imrt  ^hou!d  be  kept  at  rest,  elevate^l  on  pillowe, 
and  wrapped  in  t1aiiiii-lt<  and  uilod  dtlk.  If  the  [>aiD  Iw  eonudeifr- 
ble,  hot  applications  may  be  used,  with  locnl  anodyuea. 

UvDE  Salter  recoDimends  tlie  following  lotion : 

B     I'oias.  iodid^ , 3  j 

PotaK.  bicubooadi^ .....S  j 

Aq.  IralUniUi^ OJ 

Tincl.  opii, fj  ij 

If.    B.— Applj'  to  cli«  ftfl(M.t«d  [MTl  va  lint)  oovci  witlt  oiled  silk,  uul  vmtthe 
Uie  whole  in  a  Baonel  buids^c 

The  American  water*  whieh  approach  most  nearly  to  those 
of  the  greatest  repute  in  Europe,  are  the  Crab  Orchard,  of  Ken- 
tucky. Iodoform  has  been  used  locally,  and  \m  Kaid  to  give  much 
relief.  We  have  not  heard  of  eocaiue  being  employed  in  the  same 
manner,  but  have  no  doubt  it  haM  been  done. 


HAY  FEVER. 

The  Americno  Hay  Fever  yVftsociation  still  hold*  its  annual 
meetings  in  the  higliertt  attaiiuible  moinitiiin-tO|)K.  The  remedies 
which  nearly  every  year  neett  heralded  as  "sure  cures,"  have  not 
yet  vuoceoded  in  redu(;ing  the  memtierahip  of  the  Aiwociation  to 
iiiHignilicauee.  Cocaine  h»»  enrned  the  title  of  the  best  palliative, 
but  itA  efibct«  arc  not  i^iermanenL 

Dr.  h.  J).  JvuD  received  the  Lea  Vnze  in  1876,  for  his  theeia 
CHI  the  cure  of  liay  fever  by  galvanlo  baths.  In  this  essay  he 
detailed  a  caee  in  whieh  this  method  neeompIUhed  a  cure.  Xo 
aimilar  cures  by  the  wune  agent  liave  lieen  «ine«  reported. 

The  moflt  poptdar  method  now  in  vogue  coiisiets  in  the 
destruction  of  the  hyi)ertn>phicd  membrane  by  the  use  of  tlie 


SOB 


VANDAL  OP  TBEATllRNT. 


giilvanfj-ciuitery.  For  details  llie  reader  i«  referrutl  to  the  article 
oil  Chrouie  Catarrh.  As  a  imlliative,  eocoino  i»  (ni<|iic8tionably 
ihe  most  efRcient  agent  yet  intmdueed.  A  two  ]>er  L-ent.  solution 
maybe  iryeetetl  into  the  nostrilis  with  a  medicine  dropper.  The 
relief  U  more  lasting  when  four  or  eight  jttT  cent,  snlutioos  are 
applied.  Some  prefer  this  agent  in  tlie  form  of  gelatin  bougies. 
Dltika  are  also  used,  <--ontairiiiig  cocaine  in  a  concentrated  form; 
but  as  cases  have  been  reported  of  sloughing  of  the  tissues  to 
which  they  were  applied,  great  care  should  be  exercised  in  thu 
use  of  these  iippliances. 

The  specialistd  in  this  depflrtment  have  extended  their  prai> 
tice  by  endeavoring  to  remove  «]1  ohItfiniticH  of  the  sieptnm  or  of 
the  other  bones  of  the  na^nl  ftpparatus.  AVc  know  of  a  number 
of  cases  where  such  oblitpiity  hits  cxisl^Hl  for  many  year*  without 
doing  any  harm,  and  other  cases  in  which  the  obliquity  hoa  been 
corrected  by  operation  without  doing  any  good.  Unless  the  de- 
formity is  such  as  i«  interfere  with  the  liinctions  of  the  organ,  it 
had  better  be  let  alone. 

Some  patients  have  found  a  i-eAtdcnce  in  certAiii  localities  £av- 
orable  to  their  <axw.  Suuh  persons  i^hould  if  possible  make  such 
plaotsa  their  homes.  The  high  table  lands  of  the  Weat  should 
contain  many  localities  where  sufferers  from  hay  fever  can  exist 
in  comfort,  and  still  enjoy  the  comforts  of  civilised  life. 


HEADACHE. 

Dat's  treatment  of  the  various   forms  of  headache  U  em- 
bodied in  the  tbllowing  formulae ; — 

9    PotoM.  citnL B  j 

Inf.  di^iulis, 

Inf.  liuclm Ak    5  M 

H.    6. — To  b«  Uk«n  thrc«  timm  s  dxf. 

In  aremic  headache,  with  deficient  retul  actiou. 

B     Potw.  Wlart. 5  m 

Sjt.Vitoonh,.. ..J  a 

AauK  f«rv*nti*, 0  ij 

M.  S. 

To  be  taken  during  the  day  and  night,  in  the  eame 

where  the  urine  is  scanty  and  the  bowels  sluggish. 


HEADACHE.  209 

R     H^dnr;.  bichloride gr.j 

Tind.  IVrrt  p«ichl»T., 

Gljcvrnii, 4a    |  iS 

Acjuv , , ad     Jxtj 

v.    8> — A  UUopoonlti)  in  ut  aqail  <|'naDtitr  oT  watvr,  or  oae  ounM  of  In- 
Ibdon  of  qun^i^  ibree  lima  a  jar. 

In  anoKarea  antl  uimmiii,  where  the  houdai-he  U  due  to^renal 
congestion,  and  in  some  forms  of  syphilitic  hcadm^he,^when  the 
cttchtx-'tic  8tuU*  »  well  marked. 


B    Q"''^>w  dUnlph^ ' gr.  z-gr,  zt 

Arid.  Kilph.  (IIL,  1^  x 

ST^pi. -3  U 

Atitur, •■.■.••<<•> Mi    I  J« 

M.    B. 

To  bo  takoa  in  bcfldAcbe  from  malarial  poiaoniDg,  two  or 
three  hours  before  tho  expc-cted  paroij-sm.  Afterwards,  a  third 
port  three  times  a  day  till  cincLonism  is  produced. 


R    LIq.  cbMban^ H);  ii 

Liq.  potaa.  anenit. iq;  t 

A.i«K, ad    li 

is.    S. — To  be  uJieo  thne  Umca  a  Any,  after  (ooA. 

In  neuralgic  hcodiiclic  and  corvhral  aiitumia. 

R      Uqtior.  pDUU.M«»niL,. 5  J 

Tinct.  quinine,.. J  ja* 

MtH.c*Riph^  i.....ad    I  Tj 

M.    K^-}  ■  iKrva  liine*  a  dav,  in  a  lEttl«  wat»r,  after  food.. 

In  neuralgic  and  [tcnodic  headai-he. 

K     Liqnnr.  jintst.  antnit., J  J 

Tiiid.  qiiiniiiK, ^  jn 

U^dr.  btcblor., gr.  ** 

_  A*!'*, xl    3  *J 

9. — A  lat>lu|)0OBril  bia  t>i»«Klaii>fiiI  of  water,  llireetimaaadajr,  after  food. 

In  neuralgic  hoadacbo.  where  a  mervurial  is  desirable,  aud 
tliere  is  t)ie  history  or'svi'liilia^ 
O  "      -  " 


210  HANUAL  or  TRKATHIENT. 

B     Uqiior.  polkft.  aramiL,. 

Xiiquor.  polMMB, i4    3  j 

TLnct  colchici S  U 

Tlnet  tuvaod.  00^ 5  Uj 

AqiuB  iKim, »i    i  «j 

M.    8^A  ItbUspoonrul  in  a  wineclnMirul  of  water,  iwloe  a  da;,  after  food. 

In  oeuralgic  beadocbo  associatc-d  with  the  gonty  diathcfits. 

B    Tinct  quiDiiiB, 5  z^' 

Spl.  chloToTonni, ^  Q 

U.    8,— A  Uaapoonful  in  a  wincglanfiil  of  water,  twine  or  ibree  tinxaalq'. 

In  neuralgnc  and  n^r^ous  beadacbe. 

B     Tinct.  quininn, 5  '*] 

PntaMi.  bromidL 5  J*3Q 

Olycerini, ^  ij 

Mi«.  ciinipJiiinp, ad    5  ^ 

M.    8. — A  siitli  part  Lwic«  or  three  timca  a  dajr 

lu  neuralgic  and  uervoua  beadache. 

fi     Acid,  hjdrobmmici 5  Tl 

QuinlnK  ilUulpb., -gr.  x^ 

Inf. g*tit. cotnp,, ....i4    3  >V 

U.    S. — Two  tnblcspoonfub  twice  or  thnie  tlraea  a  day. 

In  neuralgic  and  uervoug  headaoho,  whcra  quinine  alone  dia- 
agrees. 

B     Sodse  ^icurl)., 

Bismutb.  subowb. 

PttW,  acacis, ai    5  J 

Spt.  amm.  arom., 5  ^ 

6yt.  ninsib., 3  i^ 

Xqiata, ad    J  vUJ 

IL    8. — TwQ  tableepoonfulf  tbrve  timei  a  dar,  half  an  hoar  before  food. 

In  dyspeptic  headache  with  flatulence,  acidity  and  pyrosis. 

B    AnuD.  csrb, gr.  It 

Aqu», S  j 

U.     8. — To  be  taken  «v«r7  tlirae  or  four  bvois- 

In  dynpeptic,  neuralgic,  and  nervous  headache,  and  in  some 
forma  of  gouty  headaclie. 


HBAHACUE.  ^M^M  211 

B    S|ki.  &mm.  vun^ ig(  zt 

Bpt.  chloToforml, y^  x 

AqiMB. ad    J  j 

M.     8. — To  btr  taken  erery  tlire*  lioutv. 

In  dyspeptic  and  uervous  headuclie. 

B     ficU.  eilr.vi.rt- ♦ftrr^ •■■5  jS  y  (B.  P.) 

S. — To  be  taken  while  eflcrvoKiDg  in  (ba  third  of  a  tumbltTful  of  cold 
wiMr,  nrlj  in  tba  raoraiag. 

As  a  mild  aperient  in  dyspeptic  or  'bniou*  headache,  with 
Datidea  aud  tsicknirstti,  ami  in  plethoric  himdache. 


B     MagDH.  ■ulphAt, 3  T3 

UMlin.  cvb., S  j 

Tint*.  Ift»ind.  ea, 3  iij 

Aqua  rntnth.  pip., nd    J  viij 

U.    8>— A  lizth  pirt  to  be  tsk«Q  tu\j  in  the  morning,  uid  repeated  aamajr 

In  dyKj>eptic  aud  bilious  headache  witli  tlatulence. 


B     Ijuinitut  diaulpli., ft.  xy 

Acid,  aulpb.  till, 3  » 

Tinct-farri  chlxr. , 3  U 

SpL  chlorornmii, 3  Ij 

U^na. aalph., }  Jn 

8jrr.«infih,  .j  j 

AqtMv, ad    3  x|j 

BL    8.^Two  ublMpoonfule  thm  timca  a  daj 

la  neuralgic  headache  with  cotistiputiou. 


R     $Tr.femplioepb.«iqulnin«elstrTclinlRC,  J  Jw 
8.— A  MMp->onful  in  a  wiueglaMfuI  of  water,  tlitto  timM  a  d»7,  aAtt  food. 

In  neuralgic  and  n«rvouM  heailache. 


B     SfT.  fcrrl  hypoplica J  jm 

&— A  laaapoonful  in  a  «iitegliw«ful  of  wattr,  Uin*  licoew  a  dav,  a^r  food. 

lu  neumlgic  and   nervous  headache,  whore  the  bypophos- 
phitcH  are  UKeful,  and  in  aorae  coiigtflttive  h^daclivs. 


21S 

fi    Syr.  fcrri  vl  cnlcii  lacto|))i(Miph^ 5  U 

S.— One  or  two  teui>ooufuk  in  a  wiiieglauful  of  <raicr,  tifloe  e  daj  mftor 
food.  Fift««[i  fit  tncnty  gruiis  of  braratido  of  poUxwuin  or  kminomiiiia  to»f  •oaw- 
timt*  be  B(ldnl  to  each  ilow. 

In  Bimilftr  vii^as  to  the  preceding,  marked  by  general  debUiQr 
and  detective  nutritiou. 


H    Fnri  citr.  et<)iiinin«, 3  ■ 

Spl-chlorufurnii, .•....•■■•• 5  j 

Syr.  «uniit., $  MJ 

AijiitP, kd    5  »3 

M.    ft^A  ■ixlli  pnn  ibrw  iSmt*  a  Anj,  »Iier  tanA. 

Id  nduralglc  and  n«rvoiu  headache,  with  anemia  and  de|iro»- 
»on,  and  in  some  congestive  headaches. 

Three  to  five  di-ofis  of  the  li<iuor  strychninse,  and  half  an 
ouiire  of  the  tineturc  of  columho^  may  be  soiuctimcft  added  to 
this  prescription  with  advantage. 


I)     Ijtjuor.  ferri  ditiljraaii, J  j 

S. — Ten  to  thirty  tnioinu  in  a  wineKtoM'^l  ol^  water,  Iwlct  or  three  timca 

In  Bimilar  cases  to  the  p(;eceding,and  especially  in  the  anemic 
heada^^he  of  children. 


B    Fcrri  Aoini.  citr., 9  y 

Liq.  [wtaw.  uMnit., ,1!IC  xl 

BjT.  Hngib^ 3  m 

Inf.  calumtm-, td    J  TljJ 

M.    S.— Two  tsbletiKtonfiila  t«ic«  u  dty,  tftvr  food. 

In  nervous  and  nearalgic  headache  with  anemia. 

|(     Anim.  bromi*]., 5  j 

Spl.  unni.  arofD^ .5  w 

AqiiiF, id    S  Ja 

H.    8.^To  he  taken  en  Hung  in  iho  earlj  morning. 

Id  some  fonns  of  nervous  and  congestive  heoduche. 


HBAOACHK. 


218 


S     PolSM.  brdmid^ 


kinm,  KTOrn., 


ByL. 

Aniin-  cmrb,. 

Boda  bicarb, 

Aqu*, 


5j 

5  y 

sm 


M.    S. — A  sitib  part  to  b«  ukt'O  t^try  four  hours,  «Mle  ^StmKiag  with 
acuL  dtrUx,  p.  xiv^  diawlTed  in  one  lahiospoonrul  of  water. 

In  the  early  stages  of  nervouB  and  uvuralgic  headache,  when 
there  is  nausea,  and  the  tongue  ie  coutod. 


I  fi    PoUh.  bromiil 5  U 

I  8pi.UDin.uoai. ..J  i^ 

I  Uiflkcsmph., ad    |  tj 

I  iL    8. — A  lixili  put  tlir«aUmM  adaj. 

[  In  nerrous  and  neuralgic  headaches,  and  where  there  u  ex' 

L  citement  and  irritabilitj. 


» 


Tinct.  Bcogiti  rad, S  w 

Aijus, ad     J  IT 

H.    S. — A  t«aspeoafal  in  a  tablNpoonful  of  water,  ttatj  balf  bour  till  tba 
pais  if  nlisTCid. 


In  acute  congestiTe  hendache,  w^ith  flaah«d  foc-c  and  fhll  pulse- 


^^L  B     Amm.  chlorid. gt,  i^  j 

^^P  AqiiK, ad    5  jm 

r  U.    8.— Tob«talEait)trMtimMada7. 

'  In  neuralgic  and  nervotu  headache,  where  Pti^aine  and  clavaa 

I       b  Bpecially  marked. 

i. 

^^^^^B  QuiaiaM  duulph, gr.  riy 

^^^^H  Add.  aiilpfa.di]_ hi;  x 

^^^^^P  laL  roMB  CO. J  riij 

r  1 1,    a— Two  labtnpoonfuU  twice  or  (hnw  tiniM  a  day,  after  food. 

r  In  neuralgic  and  congestive  headache,  with  constipation  and 

fuU  babiL 


H. 


a    lyxla  b7|io|ik<Mpliitu^ 5  m 

Inf.  olumbv, ad     J   tJ 

S.— A  ilxlb  ptrt  to  be  taken  three  timca  a  day. 


In  neuralgic,  tiervoua,  and  anemic  headucbe. 


S14  MANUAL   OP  TRBATMKjrT. 

^    Poian.  liicKrb., , 

6od»  bicaf  1i, , u    3  j« 

Vin.  »em.  cxilch., 5  j-5  y 

Byt-  linglb,, , 5  as 

Aqua, - ad     J  riy 

H,    8. — Two  tabl««{ioonfala  thrM  linua  ■  dajr,  with  odd  ubletpoonrnl  of 
lefloan -juice,  wbit«  eScrrcactng. 

In  gouty  headaohe,  and  the  headache  of  cerebral  hyperemia. 


%    PotaM.  iodid.^ 5  »3  j 

Pataaa.  bicub. 5  ^ 

Vin.  atm.  colch., IQ[  xl 

Amm.  carb, gr.  xzIt 

Sjr.  tingib., J  « 

AquK, ad    i  Tiy 

M.    &.—'Two  tableapoonfula  three  times  a  Aay. 

In  rheumatic  headache. 


B     Polasi.   iodid., 

Amm.  bjrdrochlor. , &a    3  j** 

tnr.  hiimuli, J  vj 

■C    6. — A  MbleBiwonful  thraaorfourlimeaBdaj,u)  a  wiixigluBruiof  wiMr. 

In  rfaeunmtic  headache. 


B     Potan.  iodid., 5j 

Tinct.  ciudi.  co, |  J 

Tiacl.  cokb., 5  j 

Aqnie  cinriMinoin ad    $  x|j 

H.    S.— Two  lablmpootifula  tbre«  limes  a  da;. 

In  rheumatic  headache. 


*Q    PotMiL  iodid., 3  U 

Ll(|iiar.  hjdr.  bichtor. 3  *j'l  J* 

Tincl.  i^nt.  cump^ S  jas 

Aqua  ciniiaroom., ad    J  xtj 

H.    8. — Two  tablf^pmnfiila  lhrc«  limes  a  dav,  1»  a  •riauBlavAiI  of  wstar, 
aflor  food. 

In  syphilitic  and  organic  headache. 

The  mercury  may  be  omitted,  accoriing  to  circumBt 


nBAT>AOHB.  ^^^^V  215 

B     PoUm. iodide 5  j 

Liq.  arMt)k«ll% 5  j 

Tlod.  qaioiMs ad    S  i^ 

H.  8.  'AtM«])Ocinfiilii>Bwin(flwifiilofwtt«r,thrMUBiMada7,tftaflMd. 

In  sjrphilitic  headache. 

g    Tlnci.  ferri  chlor, 5  l]n 

Acid,  lulfth,  diL  T«]apL  chlororonoi, 5  i 

Tinct,  Iftnad.  ca, 5  'J 

Syr.  saruit., j  n 

HiaL  cainph, ad     J  iv 

M.    8l— T'o  iCMjioonfub  lUrw  timei  ■  da^,  Id  a  wincglaailbl  of  water. 

Id  nervous  heaclacho  from  raciiorrhagla. 

One  of  the  preecriptionj*  contAining  araenic  or  ergot  may  be 
Deceaaary, according  U*  thcdiacrction  of  the  practitioucr,  or  cither 
of  theeo  remedies  may  be  added  to  the  formula. 


^^^^^h  9    Potan.  bromid. d  j 

^^^^^^  Syr.  toluUoi, 3  j 

^^p  Aquie, ad    $  JM 

^^  If.  S.— To  b«  uk«a  ev*rr  nigbt  at  bedtime. 

I*  As  a  sedative  in  the  pain  and  aleeplessneaii  of  nervous  and 

neuralgic  headache. 

B     Sodm  biMib^ -3  jm 

SpL  amta.  mnm^ 5  i) 

Hun.  gtnu  comp,. |  ■ 

Byr.  ttunnU, ■>*>...••.>. ^  m 

Inf.  g«nl.  CO.,  ad S  *i|i 

V.    9> — Two  lablMpoonful*  thi*«  timM  a  day. 

In  nerroufi   headache  with    dyspepsia,  furred  tongue,  aad 

n     Add.  nliric.  dU 5  J 

AmJ.  hyiiiw^hlor,  diL, , ......3  U 

Liquor  Btrrcliniiw, •.•11?  xzxTJ 

Inf.  qaaisiv,  ad ■•.$  z^ 

If.    6, — Two  tabl«ip^oDfuU  tkrcfe  tint«*  a  daj. 

In  □errons  headache  witli  a  clean  tongue  and  slow  digeetioo 


S16  UASVAL   07  TBEATMKNT. 

ft     Tinct.  dlfiiUlu, 5  at-S  U 

Uifll.  campboncod J  ij 

M.    S. — A  dxili  put  to  be  talten  Lbr««  Linm  a  day. 

In  the  hcadnc-hc  of  oercbml  iincmia  as  a  cardiac  tonic,  when 

the  puke  k  aiiiall  and  frequent,  or  tliere  U  palpiLatiou. 


R     Tion.lx'lUdoiituei 3  ^5  i^ 

Tinet.  nui?.  vom., 5  J 

Syr.  liogib^ j  m 

Aqu»%  Alt 5  TJ 

H.    S. — A  tablespoonful  in  a  wia^glaaaful  of  water,  Ihrae  timce  a  iaj. 

Id  some  forms  of  anemiu  headache. 

B     Strjcholiuetiilpti^ gr.  m 

TincL  farri  rhlortd., 5  g 

Gljn-crini }  n 

Inf.  gant.  comp,  ad J  vj 

JJ.   S. — A  tablMpooofulina  wiaexlnafalofwattr,  tlir«ctiiDMad>f,  aft8rm«alfc 

In  the  headache  of  ucruhiul  anuiuia  \rith  n<jrvous  exhaustioD. 

The  inl'usion  of  quaasia  or  calumba  U  preferable  to  gentian, 

in  conacqucncG  of   tho  d«oompoaitioii  of   tliu  iron  in  the  latter 

preparation. 

B      Amm.  cnrb., 5  m 

TlQi^t.  cnliuD'bsp, 

Syr.  BuraM., ia    SmJ 

Aqii»,md 5  ▼) 

M.    S. — A  BJiih  pftrt  to  1>«  taken  twice  a  dav. 

Id  the  headache  of  cerebral  aoftening. 

%     Spl.  chlorofciTmi, >••?;•■ V  V 

Liq.  exL  ergot., *?(  xx-5  ■ 

A<)ii«,  wi 5  j 

M.    S.— To  be  uken  three  tine*  a  day. 

In  the  eongegtive  and  organk*  forms  of  headache  in  advaaced 

m.  _^__ 

B     Hydrat  cbtort)., Q  i 

Aqiiir,  ad ^  >** 

K.    8.— 'To  bd  ulun  at  bedlime. 

In  the  headache  of  cerebral  h)'peremia  and  vascular  exdt^ 
ment. 


UBADACUB. 


217 


B      Mignwu  Mlph, 5  'U 

SoJaibicub^ 5  i^ 

liquor,  urkxwi, 5  TJ  ^ 

Tia«.tingib, 5  j 

AquK,  aA 5  »j 

M.    S. — A  sixlh  jkut  to  b«  miied  wiUi  mdA.  tarU,  3  j,  pKvioiiBlj  dinolvad 
!■  ■  taUc^toaoTal  of  water,  aad  taken  earl^  in  ihc  momiuK,  irliilc  cflcnrtaciii);. 

In  dyspeptic  and  plethoric  headaches  with  Hlu{,^iAh  liver. 


B     PqUh.  bromid., S 

TiDct  onnabit  Ind. 

Tittdk  hjTMCTMDi, is    J 

AquNkid S 

H.    R— To  be  uVvi  M  bedtime. 

In  the  sleepleasoess  of  hyperemic  headache. 


B     Hydnt.  cUorU^ 

I'otaa.  Irroojid., i*    gf.  X 

Sjr.  rlxEidui, 3  J 

Aqiiw,  ad  I  js 

IL    EU-To  Iw  uketi  si  bedtime, 

In  the  headache  of  cerebral  hyperemia  and  Derv*o-hyperemic 

Kche  with  nen'Uiuj  excit^meut. 


n     Potoos. bromide 5  tj 

8jt.  Hiiraui., 3  M 

Inf.  geiiUcaaip, J  It 

AqlW,*)] J  tj 

M.    S. — A  lUih  put  to  be  taken  three  timra  b  &kj. 
Ill   ncrro-hyperemic    heudiu-he    with    l().<w   of   appetite   and 
debility. 

^^^^^_  K     F»m  nnun.  citr^ Sj 

^^^^fe  Poiaai-bramid. 5  Uj 

^^^^^1  Tel  Amm.  bromid, 3  M} 

^^^P  8jrr.  iin«lb.. 3  ■ 

^^^^  AqDM,>d 5  Tj 

^P              M.  S. — A  uUfi^Kiaiifui  In  a  «rinq[lM»riil  r>r  wator,  twice  a  6aj,  M  11  A.  IL 
and  4  P.  H. 

In  the  headache  of  cerebral  anemia. 


218 


MINDAL  OF  TBBATMENT. 


ft     PotuK.  bromid, B  J 

T«I  Amm.  brontidi, ^  j 

Tlaoc  vmlwian.  oa, 5  j 

8rr.  unnLflor^ 5  J 

Aqiire  dnnamomi,  id |  jn 

U.    S.—T0  be  lAkcn  twiM  or  tliic«  time*  %  d&j. 

In  some  forms  of  neuralgic  beadaclie. 

B     PuW.  ipKiic.  comp^ (T.  z-gr.  zr 

Fiat  pulvia.— lb  tw  taken  at  bedtime,  in  gruel. 

In  rheumatic  lieatlache. 

tl      Ferri  milpli*!^ 

Fulv.  tingib. ii.    gr.  irj 

ExL  ftloet.  nqtica, 

Quininft  salpb, 

Soponi*, U    gt.  xy 

Hiice  «t  iliTiJe  la  pilulaa  xij. — One  to  be  tokm  twice  a  daj,  oiler  food. 

In  the  headaches  of  cerebral  anemia  and  neuralgia,  where 

the  bowels  are  sluggish. 


F^     Est.  aloee  Bu-Ik, gr.  i 

Fulv.  ipiecae,,..... gr-  j 

Pit,  rhei  oomp., gr.  Uj 

Ulaoe  «l  ftu  piluta. — To  be  lakcn  daily,  belaradinaex. 

In  the  heailache  of  cerebral  anemia  and  dyspeptic  headache, 
where  inteetlual  action  is  sluggish. 

B      Quiningraiilph., 

Kit.  kUivk  Hqiioft, ta    gr,  zy 

Pulr.  nptid, 

Pulr.  ipwac^ .,fei    gr.  vj 

Olj'cerini, q.  ■. 

M. — Ut  fiant  pUitiK  x^'-    Oi>«  to  be  Uk<n  dul;  b«roi«  food,  at  middar> 

In  similar  cases  to  the  preceding,  and  eepeciallj  in  women 

with  nniall  attsimilativc  power. 


B     Pil-hydrMs, gr.  z^ 

PiL  rbci  OQinp, 5  ■ 

Ext.  hyoscyami, gr.  z 

Mum  «t  divid*  in  pUiilkB  xij. — Otw  or  two  al  bedliiiM  twic*  a  w«ek. 

In  dyspeptic  headache,  and  in  the  headachw  of  adviuic«d  life 
with  a  «luggiab  liver. 


HEADACnB.  ^^^^  219 

B     EsL  nnc.  Tom, , ft.  m 

Pil.  rh«i  eomp^ gr.  ig 

Pulr.  upvid cr.  t 

MiaceetlUt  pUtila. — TobeUkcDdmilratlSo^clock.    (SanuriUn  Honpital.) 

An  excellent  pill  to  keep  tho  bowels  regular  iu  nervous  head- 
ache, where  the  mu^ular  fibre  of  the  uitestine^  requires  atimulfl- 
tion. 

B     Ferri  sulpha^. 

Qtiinina<itulph^ U    gt-  x^ 

Piilv.  rh«t, gr.  ix 

Pill*,  ungib., gr.  vj 

Hiic*  et  diride  in  pLlnlM  xij.— Tb1i«  one  three  UmcsB  ds^. 

Id  neuralgic  headache  and  atonic  dyepepeia  with  flatulence. 

B     PfLaloMMMtaiffitid., S  J 

In  pilolM  x^. — Om  or  two  U  bedtutic  «v«7  nlgbk 

In  nervous  Leadiufbe  with  dntulcnce  and  constipation. 

B     Pi).  aloM  et  ferri. 5  j 

In  pilalu  xij. — One  or  two  at  beiliime  Bray  night. 

In  neuralgic  and  nervous  headache  with  constipation. 

B     Pil. a1o«a  ttafrthm^ S  j 

Ferri  salphat, gr,  vj 

MIk«  et  lUrlde  la  pilutu  z^.— Two  oa^uiooallj  at  bedUioe. 

In  ncrvoue  or  anomic  headache  with  torpid  colon. 

B     Zind  valerlaiL, gr.  z^ 

Pulv-  rliei,.... gr.  xx 

Pnl*.  tiniib, gr.  tJ 

ExL  gentian., gr.  xij 

MImb  et  dirido  in  pilulna  il).    O&e  to  be  lakes  three  limee  a  i»j. 

In  neuralgic  hvudaclic. 

B     Ptionph.  pur., 

Sti7cknluc, ....ia    gr.  J 

Conf.  rowb %.». 

Vt  fiaat  pllulje  I^— IWke  otie  thtM  tioui  a  A».y. 

In  some  forme  of  neuralgic  headache. 


8S0  MAKC&L  or  TRBATUEKT. 

B     Pliosph.  par^ gr.j 

Conf.  mw,  <].  a. 
Ul  G&iit  ])ildn  xxATJ, — r*kc  oat  Utr*«  tiniM  k  d«jr. 

In  aimllar  caaea  to  the  preceding. 


B     rhosph.  pur. ft.  ^ 

Fcrri  r«diict gr-  u 

Est.  Dui'.  Tum., 8T'ij 

Muce  «t  liividv  in  pilulits  viij. — Oo«  to  b«  Ulwn  tvioe  n  daf. 

In'neural^ic  headache. 

These  pi-cscriplions  may  be  varied  occording  to  tho  BtAte  of 
the  patient,  yaloriatmte  of  zinc  and  caniialiid  In<lica  may  Bome- 
times  bo  addod. 


B      Phosph.  piir., gr.j  • 

Qiiiniiiv  nulEib^ 

Famaulph., U    gr.  nj 

EzL  rbei, 3  J 

In  pllulu  itxvj. — One  u>  be  uken  llirM  Umea  a  da;. 

B     Eii.  cwlotyuit, 9  y 

1^1 1.  rhci, 

Pulv.  notintuoiuii ia    gr.  x 

la  pilulaa  xij. — Take  one  cMwionally,  at  bedtiai«. 

Tn'nerroui;  or  dj'speptic  headm^he,  as  an  active  aperienL 

B     liiiid  Talisrian.,.. 

Fvrri  SHlptu, 

£xl.rbet, U    fp-.  xtJ 

MI«c«  «t  dWide  in  pUalas  xtj.— One  lo  lie  taken  ttirae  limca  a  dajr. 

In^nervoue  headache. 

B     Zincisulpli ■>... gr.j 

EiL  nuc.  TonL, , gr.  H 

Conf.  rows,  i[.  *. 
Ut  ftal  pUulo.— To  be  Ulcen  iwloa  a  day. 

In  nervous  headache. 

B     Pulv.  ipecao.^ gt.  Tj 

KxU  ftloea  Jlarfa...... gr.  xll 

£xL  Urazaei, 5  m 

Baponia, gr.  x 

Hiaoe  «l  divide  in  pilulai  z^.—Tak*  ona  eveir  night,  oi  before  dinner,  dailf. 

As  a  laxative  ui  iiervoiu  headache,  to  assist  digestion. 


UBADACUB. 


221 


B     Ext  geatiui., 

Kemaulpbn • 

Pulv.  iii|{iiali», U    gr.  x^ 

PolT.  cinnamoini, gr.  vj 

Misce  el  diride  in  pilulw  xiy — Taku  one  tbree  tiniea  a  daj, 

III  the  liettJaclie  of  coreliml  anemia,  where  digitalis  is  re- 
quired. Where  there  is  onateadincM  of  the  heart's  action  after 
food,  and  there  w  llatulenco,  the  iron  may  be  advantagooiisljr 
omitt«d,  aud  pulv.  zingib.  HahBtittited  for  ptilv.  cinnamomi. 

B     Ext  •coniii, ...gr.  tj 

EiC.  hjoi^nmi, gr.  xviy 

Am.  el  pot.  urt, gr.  j 

Misra  ct  diTidv  in  piluloa  vj. — Ttk*  vat  em/  Di)(ht. 

In  the  headache  of  aeitvc  cerebral  bvpcrcmia,  where  dcpreft- 
sants  arc  required. 

R     Bismcih.  wibmrh., ^  j 

To  be  Ukcn  in  a  winexlaMTtil  of  water  twice  a  ^y,  Mnrtt  meda. 

In  Kiiliacute  coiige«tivo  headache,  with  Haiuleiicuajid  discom- 
fort after  food. 

It     JQoc)  Milph., gr.  X 

Aq<w, 5  JM 

Fiat  haiwUiR. — To  be  Ukrni  as  an  «tnetic,  roUowed  hj  drlubiug  tneiy  of 
wamwakrtill  votnilinic  cnme*. 

Ill  some  form«  of  bilious  and  nervoiu  headache. 


B    Fi.It.  ipoi-M, Bi 

Ml"*. 5j» 

Flat  hauaiui- 

In  the  Minie  cancH  aa  the  preceding. 


^H  B     Ung.  vtratrina- 3  j    (KV.) 

^^B  A  liltle  to  be  nibbed  iom  iii«  nflecied  tample  till  ihe  pain  U  nslEcml. 

^H        In  neuralgia  and  some  forms  of  ner\-ouR  heiulnehe,  whore  the 
^^  pain  is  localized. 

R     Vbs  acotdliB*, ........ 5 j     (B.  P.) 

To  be  oMd  to  tlie  aacn  v«7,  and  for  ttie  aatnv  em*  at  the  precnllng . 

In  using  all  Utem  ointnieiite,  care  i.**  reynircd  to  a\i]>\y  very 

email  quantities,  and  never  to  the  broken  i^kin.     A  tingling  nenHa- 

Uon  commonly  precedes  the  eCdWition  of  the  pain. 


222  MANUAL  OF  THBATMmrT. 

In  general,  it  will  he  found  that  bromide  of  potassinm  \m 

tho  most  suitable  reniwly  fnr  congestive  lieadaclie,  fur  llmt  due  to 
sexual  exca»  or  excit^mRtit,  and  that  which  uomes  fivm  the  ad- 
ministration of  iron  in  ehloroflia. 

Aconite  finds  itK  most  appropriate  tisc  In  relieving  the  head- 
ache of  ovarian  conj^'ostion ;  esiieeially  that  which  comee  from 
♦'catching  cold"  at  the  menntriml  epoch. 

Hydrobromic  Acid  relieves  the  headache  wfaidi  Ibllowi  the 
use  of  (quinine. 

For  true  dyspeptic  headache,  which  U  comparatively  rare, 
the  alkaline  t-arbonatw*,  taken  in  hot  watf-r  before  menlp,  give 
relief.  In  nervous  beatlache,  due  to  mental  anxiety  or  prostra- 
tion, the  mo^t  dHcieni  retnedtu»  are  caffeine,  guarana,  theine  and 
kola,  given  in  small  doses,  in  hot  water  and  frequently  repeated. 
A  cup  of  strong  tea  or  cofl'oe  freijuently  proves  uwfiil.  Or  one 
grain  of  caffeine  may  be  given  every  hour.  For  the  headache 
which  follows  undue  mental  excitcraent  or  prolonged  exertion, 
coca,  in  the  dose  of  a  tcaspoonfiil  of  the  fluid  extract,  or  grain 
doHes  of  iodoform,  are  the  most  efficient  rcracdicss.  In  true  neu- 
ralgic heada(:fae,  or  hemicrania,  Anstie's  treatment  is  most  gene- 
rally indicated.  The  patient  ia  directed  to  take  a  hot  mustard 
foot-bath,  inhaling  the  steam,  and  get  into  bed,  wrappeii  up  in 
wariD  blankets,  with  hot  bricks  to  the  feet  A  scruple  of  ohlozal 
is  then  administered.  The  patient  goea  at  odc«  to  sleep,  and 
wakea  free  from  headache. 

In  the  severer  form«  of  hcmicrania  thie  will  not  avail;  aad 
recourftO  must  l>t>  had  t«  the  pernicious  and  dangemus  use  of  alco- 
hol or  hypiodermic*  ni'  morphia,  or  far  better,  Ut  the  Uf*  of  the 
galvanic  current  Thiaisoneof  the  mo«t certain  remetlics  known 
to  the  profess  ion.  After  a  neuralgia  has  been  once  conquered  by 
this  tnciuis,  it  is  u£ually  much  mora  ajuenable  to  treatment  subse- 
queutty. 

In  some  obrtinato  eases  the  following  prew-riplion  has  proved 
potent  in  breaking  ihc  severity  of  tho  acute  attack: 

R     Pfaosphori, 

(juioiii.  iiiliil) 

Str^L-bnii).  Huljih., 

H.     Ft-  mu-  «t  in  pil.  no.  xi  Alt. 

6.      One  pUl  Kn  hour  before  ««ch  mtsl. 


UATBrRM— HBART   DTSBASKS. 


228 


Headachw  of  the  oearalgic  type  occurring  in  plethoric  per- 
•ODS  (npecially  occipital  neuralgia-^),  ehoiild  he  rrushed  hy  large 
doM6  of  bromide  of  potawinm  (gr.  xxx)  refwated  every  half  hour 
nntil  relief  ia  exiwricuoed.  Headaohes  of  every  description  dne 
to  catching  cold  may  lie  dinsipate*!  by  a  Turkish  or  vapor  bath, 
followed  by  a  cup  of  hot  punch. 

Beard  recommende'l,  for  nerroux  headauIiM,  lialf  a  drachm 
of  caffeine  in  an  ounce  of  elixir  of  guarana— a  teaepoonful  at  each 
doee. 


HEARTBURN. 

Fehwics  recommendn  antacids  and  charcixtl.  Fat,  nugar  and 
etarch  must  be  avoided.  Tobacoo  will  keep  up  the  diiieaso;  alco- 
hol should  be  used  sparingly,  the  Iciutt  harmful  form  being  brandy 
with  Vichy  water.  lie  obtained  good  results  from  the  u«e  of 
glaten  bread.    Some  pregnant  women  fitid  Ivtluco  useful 

We  would  make  the  prohibition  of  alcoholic  beverages  abso- 
lute. Carbonate  of  potash,  with  small  dosca  of  rhubarb  and  ipecac, 
allay  the  pain  and  stimulate  a  healthy  eeoretion  of  gastric  juice, 
eiipecially  if  taken  hot,  on  an  empty  stomach.  Soda-mint  givcf 
relief  quite  speedily.  Nitro-muriatic  acid,  taken  before  meale, 
will  sometimes  cure  the  affection.  Oxide  of  munganeM  has  proved 
useful  in  our  liancla,  but  never  curative.  In  ouu  ease  complete  re- 
lief waa  obtained  by  limiting  the  diet  for  some  weeks  to  oat-meal 
"eoonea."  If  evtdenoea  exist  of  decomjjoflition  of  the  gastric  con- 
tents, the  following  formula  will  give  relief: 

B    Add.  aibolki, ....;gr.z 

T*«Ui>  firepantn^ 3J 

U.    8.    A  Urge  pinch  to  be  Ulen  vbvDQrcr  paid  ih  f«ll. 


HEART  DISEASES. 
1.    ACUTE  PERICAKDITIS. 

LoOMts  speaks  of  the  iniiKirtaoi-e  of  tPHBting  uremia,  rheu- 
inatiHin,  pyemia,  or  any  other  ftffection  which  coexists.  Stimil- 
lants  are  required  in  alt  acute  diseuneii  with  deprettHion,  e>tpecia1Iy 
in  septic  or  pyemic  C8.ie«.    The  &Torite  local  applications  are  hot 


2£4 


MANITAL  or  THEATMEHT. 


anodyne  pouUicee  over  tlje  lieart,  Ahsolute  real  in  bed  is  eiyoined. 
Opium  in  the  most  Tsluable  internal  ag«nt  It  shoald  be  given 
in  (I08O8  just  large  etiougli  to  relieve  pain,  and  allaj  irritable  car- 
diac action.  The  largest  doso  sLould  be  that  given  at  bedtime. 
To  promote  tbe  absoqition  oi'  tbe  fluid,  he  adviMs  iroa,  atima- 
lants  and  a  highly  nutritious  diet. 

During  conraleecetice  the  heart  is  weak,  and  over-exertion 
must  be  avoided.  Panvccnt^is  should  be  practised  if  it  be  certain 
that  puH  ifl  present  The  heat  points  are  in  the  fossa  between  ih« 
costal  and  enRifonn  cartilages  on  the  left  side,  or  in  the  fifth  left 
interspace  near  the  junction  of  the  sixth  rib  with  its  cartilage. 

Balfour  gives  morphine  enough  to  relieve  pain,  enjoins 
perfect  rest,  and  adds  digit»li»  tor  dicrotifim  or  failure  of  the  heart 

(ten  mintTOB  of  the  tincture  every  four  hours).  With  thia  he  oott- 
joins  the  uee  of  chloral  in  five  or  ten  grain  do*e«,  which  maj 
very  well  replace  the  morphine.  A  few  ieechca  often  give  great 
relief.  In  fierforming  pamocntetits  ho  cautions  a^raiust  the  u^  of 
too  powerful  an  iwpirator,  as  ayncope  may  be  induced  by  with- 
drawing too  rapidly  a  pressure  to  which  the  heart  has  become 
accustomed. 

Paul  recomnicndH  blisters,  (in  which  both  the  antliora  al- 
ready quoted  iHsscnt  I'mm  him),  and  ice  bagv,  which  are  gene- 
rally i^conimended  by  the  German  autliore. 

KfiALigB  ttUo  makes  uae  of  the  cold  applications,  without 
digitalis,  Jor  three  daye  only. 

Flint  iixcd  aitlin<>  piirgHtive«  in  the  early  stages,  followed 
by  opium,  mild  Inoal  applications,  and  finally  count«r-irritant8 
Co  pruinute  uliMirplifiu. 

RiNosai  i-ccommcndi?  aconite  for  cxtremo  pain  and  violent 
throbbing. 

LvNcu  reconmiendcxi  veratrum  viride  in  combination  with 
opium. 


HBABT  DISBA8B8. 


2.    ACUTE  ENTJOCARPITIS. 


225 


LooHis  etiforves  absolute  rest  m  bed,  with  the  tem|ierflturo 
tept  congtantly  above  70°.  The  chwt  w  covRrwl  with  flnnticl,  aud 
exixwure  is  »vni<le(l.  Small  doeea  of  opium  are  to  be  given,  but 
not  ae  frooly  a«  in  poricnrditin.  The  i>tn>ngth  mtiiit  be  giiBtaiiied 
by  eoncenti-Bte^l  f'HHl  anil  iron.  Xne>*i-ation  or  tteiiliL*  ema^  <iill  for 
liie  frc«  utie  of  alcohol,  quinine  ami  iron.  If  Bright's  diBea^e  be 
pnjsent,  the  iin»  Hlinnltl  he  eliminated  rapidly. 

Bbvcb  calls  attention  to  the  importance  of  preventing  the 
diMa^,  by  the  free  use  of  salicylic  acid  or  its  i<Alt«,  in  rhcaniatidm. 
Cuatiou  is  deioandcd  in  the  um)  of  ano<lync«,  tied  local  applica- 
tiotie  of  f>oulticca,  aconite  and  belladonna  arc  to  be  preferred  to 
opium  and  ehlorul.  In  uU-enitive  cusee.,  quinine  in  large  doecs  and 
ealicylic  at'id  art'  the  moi^t  promising  rcniedite,  together  with  enp- 
|>orting  treatment.  The  return  to  work  nhould  be  verj'  gruduol. 
Kest  for  Mvenil  weeks  at  this  stage  ii  of  more  importonee  tlian 
medical  treatiueni. 

8.    MYOCARPITIS. 

Bhdcb  say^that  Uie  indicationrt  are  toituppoi-l:  and  strengthen 
the  heart,  and  relieve  the  pain  and  dietretta  He  ue«e  poutiiucs 
and  belladonna  locally,  and  mustard.  The  KmalU^t  exertion  must 
be  avoided.  Food  must  be  given  in  email  qiiantiliet«,  and  of  Iiighly 
outritiouf  and  digestible  quality.  TIk' urine  must  be  kvpt  Dowing 
oa  freely  as  |K»9ibIe.  Alcohol  ia  urgently  called  for,  while  digi- 
talib.  ammonia  aud  other  cardiac  stitnulauts  should  be  given 
csutioualv. 


4    DILATATION. 


^^        Bristowb  8tat«8  the  general  fact  that  the  treatment  is  that 

I      of  canliac  debility  and  distention. 

The  chief  indications  are  rest,  avoidance  of  onld  and  wet, 
the  ui*e  of  niiiritionH  and  iTasily  digeAtciI  ffKnl,  attention  to  the 
bowels,  kidneys  and  skin,  and  the  use  of  cardiac  tonics.  In  the 
latter  category  digitalia  i»  the  most  popular  agent.  It  ehouhl 
be  combined  with  iron  or  vegetable  tonics.  Great  Uvidity  and 
lUtgnation  of  the  hUxid  nmy  require  veneseiition. 


326 


UAKCAL  or  TRSA'UUST. 


TxiOMi5i  my*  that  while  diUtAtma  iit  'mcurable  uih)  |uiUiutiou 
but  temporary,  two  olrjects  ruinain  to  W  attaiiietl ;  tlic  niuinte- 
tiiuioe  of  iiutritioi),  atid  tbc  preveutiou  of  irro^ulur  ami  violuut 
cardiac  action. 

All  Qxolusive  milk  diet  ia  often  moat  tidvaiitageoQa.  Biiroa- 
\&at8  must  only  b«  takoit  in  small  quantiticd  and  with  fixxL  Iron 
may  be  given  if  auemin  '"o  jtrweiit.  As  a  rule  it  is  a  «ife  dru^t  to 
adiiiiii'tbtbr  daily.  Stiychnme  and  anenicimiy  be  given  with  iron. 
The  gaflteat  uoiouut  of  fiv:*h  uir  and  the  bL-!*t  hygienic  iiurrouud- 
)0g$  &lkOii1d  he  secured.  Sudden  and  violent  exertion  nitut  be 
strictly  nvoidcil,  b*  n  single  strain  may  t.«ii:*e  death.  Flannel 
ehonld  be  worn  next  the  skin.  A  dry,  hraeing  nir  usiuilly  saits 
these  cases  lie^t.  All  cxhaiiating  difuihargei  niuM  be  cheeked. 
Abdominal  jilothora  necessitates  occasiomil  niild  pnrjrea.  Vege- 
table t.oni<t;  iind  niinoi'nl  acid?  should  he  givon  if  ntwded  for 
feeble  digcetiou. 

The  niuBt  ftervitieablo  vardiftc  tonic  in  digitalis.  Tt  tan  Ih; 
given  in  full  doses,  when  cyanosis^  and  oMlema  indii«tc  the  need 
for  this  drug.  Alt«r  these  rtyni])totn»  are  relieveil  the  same 
remedy  should  be  continued  in  i-inuller  do«?8  for  a  long  time. 
■Wlicn  digitttli.s  fails  to  control  th«  lieairt's  action,  betlnilonna  or 
opium  may  be  combined  with  it.  It  is  well  to  postpone  the  use 
of  digitalis  asi  long  rk  iio!(.-iiI)le.  For  the  Mj»elU  of  nervoiia  cardiac 
excitement,  antispasmodiia  or  morphine  may  be  used.  Dj'ttpnee 
may  bo  relieved  l>y  lobelia,  liydracyanic  acid,  csntiabiH  Indies, 
ether,  and  dry  cup]»iiig  to  the  spine; 

There  in  no  question  but  that  the  progrc^  of  this  diseoM}  ia 
delayed  most  surely  by  measures  whicli  keep  tip  the  nntrition  of 
'the  heart  The  avoidance  of  violent  exertion,  hut  the  systematic 
employment  of  moderate  cserciee,  specially  of  the  passive  variety, 
should  be  enioine<l.  Malt  Hquow  mu3t  Iw  forbidden,  as  tliey  tend 
to  proiluoe  tatty  dcgenerutiou.  Wine  in  «tnall  qiuintitiii^,  taken 
with  tho  food,  is  of  inestimable  value.  While  iron  and  quinine 
are  the  standard  remedies!  in  this  condition,  they  should  not  bo 
given  tmt  persiptently ;  but  judicious  intemiis3ioii--i  should  l>e  innde 
in  their  use,  when  they  can  bo  replaced  by  strychnine,  arsenic,  or 
end-liver  oil  with  Hme.  The  malt  exlnictrt  are  of  grvat  value, 
their  use  favoring  thorough  digestion  of  .the  stai-chy  elemeots  of 


227 


ihe  rt>od,  und  tlitiH  lessening  the  fonnatinn  of  fatty  tissues.  Rub- 
bing till?  body  with  hot  salt  witter,  mid  regnlar  nuuwage^  are  to 
be  jircferrwl  to  luont  active  modes  of  taking  cxi;ivi«r. 

DigitaJirt  t^hotiM  only  be  uaed  when  cyiimxais  and  (lro[i!iy 
deinnnil  tvliyf.  It  wiiould  then  Ix-  given  in  ftill  dow.-* — twenty  to 
thirty  drojw  ot*  tlie  tinrture  every  four  hoiire.  It  ehould  not  be 
given  for  more  than  three  duyft.  Ttio  cfiK-ttt  of  digitalin  in  eon- 
trufting  the  comniiry  Hrteriw,  if  rontinneil  long  wmdd  intertere 
■with  tlic  nutrition  of  tliL-  heart -^iibstanco.  AVTieii  digitalis  (inully 
ceaaca  to  relieve  the  debilitateil  nrgiin,  •affeine  vn\l  keep  n]>  the 
circulation  for  a  little  furtlier  tinit.  'Flic  liitter  drug  may  be 
pre:»cribed  in  doses  of  one  to  'hree  gniins  every  tour  hours. 
Nitnvglycuriitc  fulfiU  the  f*anic  iudit'atiou  as  ak-ohol,  but  'w  more 
available  for  hy[K>dermi(-  uoek  The  dose  la  „,  to  ft  grains,  in 
alcoholic  solution.  Ammonia  and  nitrite  of  aniyl  arc  iirtc-ful  in 
attackti  of  ts^-noopc.  Tho  tincture  of  quebracho  h  one  of  Uie 
best  remedies  for  the  dyspnea. 

By  the  judicious  u*:-ofa  proper  regimen,  of  tli©  above  tonics, 
uiid  the  oct-w-ional  iwliuinif^lnitiou  of  digituli:*,  life  may  be  pro- 
longed for  an  indefinite  period. 


5.    FATTY  I>BGEXERATION. 

QOAIK  recommends  the  Maine  general  dietetics  and  hygienic 
regimen  a«  in  dilatation.  ^Valking  up  b ill  or  hurr}'ing  np  .'«tain 
mufit  be  avoided.  The  mo«t  appropriate  toniifi  are  iron,  phoo- 
pborus,  and  BtrychniiiL'.  Special  attention  muHt  bo  |iiiid  to  flic 
kidneys  and  liver.  In  syiH:o]»e,  li&tideM  the  usual  ntiraulnntfi,  the 
galvanic  current  may  be  api.tied  intorniptedly  from  the  btiek 
ot  the  neck  to  the  precortlinra. 


ScHROBTTEH  «iyrt  tlint  ftir  those  who  tend  to  form  an  excess  of 
fat;  we  mut*t  institute  the  negimmi  «uitoble  for  i-orpulency,  avoid- 
ing particularly  the  fat.s  utanlie^i,  sugar  and  liecr. 

If  a  lai^  do]M>iit  of  fat  exists,  the  alkiUinc  ciirljonateo  and  the 
salphatcs  of  Mda  and  magiar^ia  are  intliojitod. 

In  the  other  forms  the  treatmeut  must  bo  nyniptxnnatic;  de- 
Aigiiod  to  strongthen  the  syrftom  in  general,  and  make  the  functional 
aecinty  of  the  heart  e<tual  to  its  demands. 


228 


MAKVAL   OK  TRKATMEXT. 


For  dyspnea  he  npprovw  of  the  treatment  dt«cribe<l  by  Si 
and  diiu^'OVtireU  by  a  piitieiit,  I'iz.:  bemltng  the  IkmuI  duwii\ 
between  the  knee*. 

LooMTS  stoiw  the  use  of  uli-ohnl,  ami  oomlenins  the  use  of 
digitalis.  "With  the  latter  BUg^stioii  we  coiricide,  for  the  reuBons 
nientioiietl  in  the  prec-etliiig  ttection.  lint  wh  atnnot  withont  ruic 
deprive  the  patient  of  \ui  accUBtomed  stimulus  Small  amounts 
of  good,  gt-neroiut  wine  do  not  favor  iatty  degeneration,  and  luaj 
be  permitted, 

6.    ITYPKT4TR0P1IY. 

"Wak-dkll  saya  that  Iiypertropby  being  a  cvinservntive  change 
tfao  object  is  to  remove  the  primary  disease  if  possible.  Any 
nieiiHiirtM  whinh  Iow^t  the  nutrition  dimply  favor  Ihe  occurrence 
of  dilatation.  All  mental  and  bodily  exertion  which  cxeite«  the 
cireulatioii  tiliould  l)e  avoided.  Alcoholic  stimulants  muiit  be  to- 
tordicted.  The  diet  and  digestion  should  roeeivoeare;  flatulence 
being  injurintm.  For  t>x<-'(>)U<ivu  i^rdtae  at-tlcn,  digitalin,  cuniuro, 
belladonna  and  bydi-oeyanie  acid  are  indicated. 

BcHRORTTKR  HiyK  that  all  vic  can  do  is  to  ward  oft'  injurious 
influence  and  tittack  the  symptoms.  Of  these  the  nio3t  important 
is  the  over-action  of  the  Loa.rt.  Severe  physical  exertion  mu^t  be 
avoided,  oa  well  as  the  use  of  strong  cotfee,  tea  or  n-ine,  and  strong 
tobacco.  The  bodily  fuuctions  must  be  maintitined  iu  pro] 
condition. 

The  persUtent  and  faithful  use  of  cold  is  fitted  most  woni 
fully  to  quiet  the  over-activity  of  the  heart,  and  is  best  applied 
the  use  of  ice-liags.  Di^talis,  aa  it  is  only  temporarily  r»)uired, 
18  quite  in  place  here.  Veratrum  viride  is  »  more  uncertain  reme- 
dy, and  apt  to  caiiiw  sudden  collapise.  Quinine  in  largo  doot-a  'a 
often  of  vuluc. 

We  cannot  agree  with  thcw  authors  in  recommending  digi- 
talin.  Tn  one  case  this  dnit;  waH  prescribed  for  a  patient,  and  after 
taking  the  second  diwe,  the  man  t'l-U  dead.  Ills  heart  wi-ighed 
twenty-six  onnuoa.  A  case  of  primary  hyftertrwphy  has  b«eo 
tmder  our  care  for  iive  yeani ;  during  which  time  the  [utient  has 


UEABT    DISEASES. 


229 


Talcen  im  niedioitie  excejit  aconite,  ^vhich  hf  hsos  at  his  own  rlis- 
jtion;  "mcrcnsing  tbu  iliwu  until  relief  is  i.'Xperiein.'OMl.     But  the 
ndjinve  of  alooliol,  coffee,  hot  »ouj«  iinJ  <lniiks,  violent  or  jiro- 
long^  oxcrtion,  hihI  iin-nlnl  excilemctil.  are  of  far  more  iiuport- 
tliaii  the  una  of  sedatives. 

7.    PALPITATION. 

Shaptkr  odvii^cM  avnidanco  of  tho  cnusc.  nnU  the  u^  of  intian» 
■lirnirilsli  the  [•usci'j.lilMliry  of  the  lufrvous  Kj'stoiii.  tn  severe 
atiuclcH  he  adipii listen*  an  alkali  with  T.4-nrm  rettorativea  Iji 
plxHracted  ami  ?i«'vew  attju-ks,  ether,  i»iiiiii<tiiia,  iligitjilia,  nconitp, 
jlthit'um,  chloral  aud  the  bromides  iiiiiy  be  nsortcd  to. 

ScnRftKTTim  Utb  the  wiracBtrcas  upon  the  impOTtanoe  of  pre- 
iting  the  attackfl  by  instituting  proper  hygienic  ralea. 
To  reliovo  the  paroxygms  he  recomincnds  the  npplication  of 
^ld«  in  the  torm  of  k-^  hafi^  laid  o%-er  tho  heart.  \ext  to  this 
he  \'\afQs  digitnlis  und  morphine.  IlydnK-ynnie  neiii  imd  irhloral 
arc  often  serviceable.  Chloroform  inhalations  should  only  be 
Ksortod  to  as  a  last  remedy,  as  jiotients  (luiekly  ucfiuiro  the 
chloroform  habit, 

LooMi:?  give^^  iron  for  nn^tnia,  relieves  uterine  derangementa 
in  hysteria,  and  nto[K«  the  excessive  use  of  aleohol,  tubaiwu,  tea  or 
eoflVe.  When  no  itpccial  caiiM  «ui  bo  discovered,  hc<tirect8  the 
hciix  to  bo  8|>ongod  night  and  morning  with  cold  water,  and  that 
tho  patient  nhall  take  excrei-e  moderately  in  the  open  air,  and 
Uve  on  a  nutritious  diet. 

During  tho  attack  he  gWcg  other,  ammonia,  chlomi,  camphor, 
iwsk,  valerian  or  aaafetida,  but  not  digitalis  uor  the  narcotics, 

An  important  element  in  Uic  nianagenient  of  a  parox^vsm  18 
be  phyMchm'n  eonBdeiit  jissununt-  that  thei"e  U  neitlier  disease 
of  the  heart  nor  tiny  danger  in  the  altnck. 

K'oue  of  thci*v  authoitt  n}>eak  of  tho    niiMT    n-liuhle  of  all 

lies  in  the  psiroxyrtnt — Ho£&nan'B  anodyne,  in  drachm 

but  littli-,  if  at  all,  diluted.    The  true  ittiudym:  it  dttlieult 

obtain;  n  eheaiier  imitation  Itaviug  foryear^  tiupplantod  it  in 

10  market.    We  would  advise  i>hy9iciaiis  to  pi-ocurc-  the  materials 


i 


S80 


UlNUAI.  OP  TRSATMBNT. 


and  [irepnro  thie  valnaljle  antispasmodic  vvifli  Uicir  own  liiutds. 
Nest  to  thiis  comes  tlie  aiimioniutwi  lin^^ture  of  valerian. 

For  the  iiiter\"al9.  we  have  ohtained  good  nvt\ilts  from  the 
long  coutiiiucd  UM  of  arsenic  in  full  dom^s,  &nd  Irallailonna  in 
verj-  small  oneH. 

8.    A'ALVULAR  DISEASES. 

ItALTiiAZAR  FosTKR  sa^vri  that  a»  valvidar  defects  are  prHCti> 
call^  incurable,  our  tix>atmeiit  must  be  directed,  to  aid  the  com* 
[KtisjiUry  hyiH-rtrophj,  and  chixk  the  dcvelojinieitt  of  the  con- 
sequences. The  maiutenance  of  the  nutrition  of  the  heart  id 
therefore  the  main  ^liittt  of  the  trcntracnL 

The  diet  liihoidd  contain  a  large  profiortioii  of  albumen,  wifh 
KOiue  wiuu.  and  it  diulybeiitu  watcT.  yiolenl  i.-xerciKe  and  emotion 
should  be  forbidden,  especinily  in  mitral  disease.  In  aortic  cases, 
steady  uxcrui^  without  strain  k  bunufieiul.  The  chief  object  is 
to  prevent  anemia.  Tobacco  is  injurious.  In  early  life  ove^ 
exertion  and  exposure  to  eold,  in  adult  life  emotional^  seosual 
and  dietetic  oxcesaed,  are  the  chief  daugera.  Womeo  with  val- 
vular disease  should  not  marry. 

The  first  syirtptoiii.'t  felt  arc  palpitation  and  pain.    Until  these 

arc  relieved  by  hy|«!rtrophy  they  KK[uirc  treatment  by  digitalifl, 

n],  X,  of  the  tincture,  with  chloric  ether,  in  mitral  diseoae.    In 

aortic  coses,  ether,  diffusible  stimulants,  small  dosoa  of  opitim  ftod 

belludomia,  with  the  latter  uppliel  locally,  are  valoable.  ■ 

The  pniti  may  require  leeehe-s  bnt  geiK'nilly  yields*  to  mild 
counter-irritfllicm.  Iiitenially  the  foromides  ure  UM^fnl,  with 
ether  and  ammonia  if  the  pain  occur  paroxysmally.  When 
compeusalion  hati  l»eeii  pstabliehed,  the  indiuation  ifl  to  keep 
up  the  nutrition  of  the  hetiri  with  the  regimen  detailed  above 
and  the  use  of  Ionics.  Prnmm  Virginians  is  ue«fu1  in  some 
caaC8.  The  bowek  and  kidneys  must  be  kept  in  gooil  working 
condition. 

Bn>iit:iiial  eatarrli  rc4|uire(i  tlie  ordinary  exlwmal  and  intumal 
trcatnioot,  Capillary  bronchitis  may  necessitate  bleeding  to  re- 
lieve the  over.diMtend».!d  hwirt. 

For  the  visceral  conire^tions  our  remedies  are  dioreticB,  and, 
later,  hydragogues.  An  (K-caKionnl  putative,  with  a  diuretic, 
aided  by  cupping,  poultices,  or  a  little  blister  over  the  loitu, 


witli  rv^t  anil  atimnlant.'*,  nlll  ot^^n  rave  the  worst  case  of  eanlinc 

For  tly^finea  niwl  iiiMinuiia  lie  recommeud.-^  morphine  liv^io* 
demiU'nIly.  It  often  avta  like  a  c-barni,  aiul  timy  Iw  nueiX  in 
tliii  worvt  cases*  of  iiiitral  and  aortic  diwaHe,  tliougli  («iitioiiely. 
t_!liliiral  and  tlie  Uniiindiw,  iilmiu  or  «>iiiliiuwl,  an- fwnnetiiiiw  tis»>- 
fnl  ill  Uiti  ineoninia,  bat  must  be  iit^  with  care.  Tbe  inhalatimi 
i.f  oompressed  air  sf-metinif?  rcHove?  dyi^imea.  "NVlicii  llie  diu- 
r\'tio  and  liy<inigoi;ueit  fail  to  relieve  the  droijny,  the  Uiidw  may 
he  punctui'cd  with  bei»e6t.    Frictions  often  relieve  the  aim^ai-ca. 

The  luaiii  reliance  id  fn  di|^talis.  It  U  mi*it  valuable  in 
mitral  di5ea<«,  wirli  cyanoeis,  diatcndcd  jugulars,  dyajmea,  con- 
gc^tixl  vi§ccra,  dro|»y,  scanty  uriue,  tumaltuous  heart  action,  and 
fiuick,  irregular,  failing  pulse. 

Id  aortic  dii^a^c  it  is  loss  valuable,  tmlee^  the  mitral  valve  is 

alfecteiL 

In  aortie  iiusafficieney  the  pulao  must  bo  inerea«od  in  frequency 
•y  the  uw  of  ether  and  ammonia.  Tf  the  hy]K?rtm[.liy  lie  excessive, 
digitalis  i«  u?*fiil  in  ijiiioting  [nilpitation,  rpdiieiiig  fi-equency  of 
tlie  piilm.',  and  relieving  Jaunhiehe.  Caffeine  «'"!  vemtrum  relieve 
these  symptoms  ati  well ;  but  tlio  qniekowt  and  m'^st  oertaiu  remedy 
the  inhalation  of  a  few  drojw  of  nitrite  of  amyl. 

In  aortic  stenosis  little  treatment  is  requirwl. 

This  author  elingi;  to  digitalis  ae  his  sheet  anchor  in  nearly 
all  vnnlijw^  atfectiom,  lie  judges  of  its  need  by  the  eftect  on  the 
kidiieya — an  increase  of  the  urine  being  the  best  t^i^i  of  the  l<oue- 
ficial  Qt-tion  of  tbe  <lrug.  He  clainu  that  digitalis  increaees  the 
nutrition  of  the  heart  by  its  fltimnlant  eftect  on  tbe  ooronai-y 
ttrios.  Tbii!  i»  not  in  accordance  with  tbe  present  teaching, 
Hiieh  8COS  in  the  continued  use  of  fox-glove  a  eau*o  of  huiutrition 
of  thecorilift<^mn!«'Ie,fronn.'ontractionof  tlit'valihivol'theeoronary 
arieric*.  Thi«  latter  viexv  hanuiinizes  with  the  ol»«epvationj*  of  the 
great  elinicnl  oUierveri  like  Nieuieyer,  who  cautiuntKil  nn  HgaitMt 
eoutiiniing  the  use  of  this  drug  too  long.  Probably,  also,  the 
notion  of  ltd  cuniiitative  at-tion  aro:M>  iVuii  the  wiiao  •'ourL-e.  It 
may  be  well  to  state  that  c-ontrary  to  goneml  belief,  the  iidusion 
of  digitalU  is  not  a  reliable  pre|>anition— the  digitaliue  not  being 
present  in  a  eoliible  fonn.    The  tincture  is  to  be  preferred. 


S82  UASltAL  OP  TftBATHBlTT. 

For  aortic  stenosis,  nitroglycerine  biib  fair  to  take  tbe 
highest  place. 

Ttie  rwulte  of  treatment  iii  \*a!vnlar  affections  are  very  e&tie. 
factory.  With  projjer  management  and  reawnaljle  docility  on  the 
pari  of  the  patient,  life  imiy  he  prolontiTcd  iiidetiuitety ;  in  feet,  so 
ionjr  that  it  may  be  douhted  whether  the  valvuhw  Ic«ioii  really 
sboi-teus  life  at  all, 

RosBSSTBiN  givea  a*  the  indications,  to  advance  existing  com- 
ptnsatioii,  to  maintain  it,  and  to  moderate  over-comiHrnsation. 

Ho  cautions  against  the  use  of  any  but  iho  woakest  tea  or 
coffee,  of  strtmg  liq^uors,  and  of  inudi  smokinHf.  He  favora  the 
UBc  of  light  beer  an<l  good  wine.  But  tlie  beat  meaoB  of  favor- 
ing digi'stion  are  frv^h  iiir  and  ext.'ii!i»e.  Severe  exertions  like 
mountain  elimbing,  should  bo  avoided. 

Tlic  a<»veivign  remedy  which  may  be  ui«ed  in  every  stage  of 
valvular  disease,  witli  merely  variations  in  the  da<<e»,  in  digitalis. 
Its  eomhiuation  with  ir<>u  is  specially  servieeablc. 

Itut  as  long  H*  possihle,  we  should  hesitate  to  use  any  drugs 
except  tonit-ri.  The  long  continued  nw.  of  digilalinnetH  injuriotuly 
to  the  digestion. 

Digestive  troiihlci^  may  at  fin^t  be  met  by  rhubarb,  quMiiA 
and  Ki3*iugcu  water.    For  droj^i'  ho  gives: —  ^'' 

B     P»1«M.a(«UL, 5U  /' 

TmcL  ftrri  nrriiit.  «ith inf  alv 

Sjr.  rubi  j<lffii^ f  3  r 

AquK...... ri«j 

M.    8.— f  5  n  w  Honied. 

Ife  recommends  also  the  vinegar  of  snuilU,  Hiitiiratud  with 
carbonate  of  jiotaeh. 

He  «|-Miiik!*  vej'v  favorably  of  the  liwitnient  by  «M>mpreseed 
air,  although  the  good  elleetH  are  not  aa  laatiiig  ae  those  of  di^- 
taliH.  Respiration  of  (!ompre.SAcd  air  would  tm  indicated  in  mitral 
disease,  and  in  aortic  stenosis  with  dcraugwl  compensation.  In 
ftortie  insufficiency,  digitali^t  i*  a  nicanti  of  iiioilerating  over-eoro- 
pensation,  and  must  then  he  given  in  larger  doi«!t.  Respiration 
of  rarefied  air  would  be  indicat«<l  when  we  wish  to  incronse  the 
tension  in  tbe  puImonai*y  circulation.    For  the  relief  of  paio  he 


patii 


■pwlera  ii!or]ihiri*?.    rh!"i-«l  uliouW  only  Iw  given  with  the  j^wAteat 
^Batiou.    Crotou-diloral  gives  lictter  rceulte. 

^^  LoOMi.*  liAfl  puWialiffll  several  cams  where  aortic  or  mitral 
diseasef  previoui^ly  tolcnitod  or  orL>n  iin«!U«|ieL-tod,  Ijocanio  f>^gni- 
vated  to  sach  an  extent  llmt  deuth  followml  dhortlv*,  when  the 
patieuts  ascended  to  a  height  of  2000  feet  or  more  above  the 
level. 

That  tlie«e  effect;*  are  not  uniform  ib  8ho^vn  hy  a  letter  of 

.  SroDCTir,  [iiihli*hed  in  TTtr  Sfedical  WorU,  Deiember,  1886, 

in  which  he  stales  thnl  although  suffering  for  years  with  mitntl 

steiiottitt,  he  hiul  jiiat  taken  a  walking  tour  among  tlie  A\\)»^ 

aecending  1'2,000  feet,  with  det-ided   advantage.    Dr.  Budduth, 

t>wever,  took  hi)*  exercise  wirtely,  knowing  how  much  he  could 
idertake  j  iidicioiwly . 
For  Aortic  discBae.  Loowia  sums  up  the  treatment  in  three 
onis:  rttft,  diet,  iind  n-gimeii.  For  high  jirlt^rial  t<'nsinii  he 
Y«j>  aconite.  For  aortic  incompetence  he  rccominciuU  arsenic, 
with  digitulia  and  iron.  Pulnioimry  engorgement  may  iiecotMitate 
venesectian. 


ik 


BErKs  found  convallaria  useful  in  mitral  olwtructjon,  before 
tty  di'geuL'nition  hml  ap[>f:inil.    Tt  ^a  more  elHcient  in  functional 
disonlere. 

Snk  trents  the  dropsy  with  squill  and  bromide  of  piotnsitiura ; 
ae  d}*8|>nea  with  iodide  of  |>otadaium  an<l  chloral. 

RiciURD^x,  alito,  (ipoaka  highly  of  iodide  of  jiotat^ium. 
We  have  more  than  ouce  obsen'ed  the  disapi>eamnoe  of  a 
tlrular  muriinir  under  the  intluonee  of  Urn  drug. 

Gbrhabdt  treata  fibrinous  deposit*  bj  the  uao  of  alkaline 
uLation?. 

&     PoUja,  busrb., gr.  ▼ 

A-|tiK  biiUicnt^ fJJ 

M.    K.— l''«r  inbalali^n. 

It  does  not  gccni  probable  tliai  ■utii'.-ient-  alkali  can  be  thus 
3trodu(»d  into  the  eiroulation  to  exert  u  solvent  action  on  th«se 
"'Tcgetationa,  but  Geriiarut  claims  good  results  for  the  practice. 


SM 


UAStTAL   OP  TRBATMBST. 


HEMATEMESIS. 

Fexwick  «iys  that  the  patient  shnuld  be  maintained  in  A 
rwuiiilioiit  [Kisliire,  mill  kvyt  |i«rlWtIy  <|iiiet.  All  i'tHnl  umst  be 
fbrbitldeii.  and  piecea  of  ice  placed  in  the  mouth  to  sock.  If 
fiiiiiriK-ss  Ik-  |in>M;nt,  it  ir  hotter  not  to  pivi'  hnindy,  wliicli  almost 
always  bring:*  on  vomiting,  but  to  apply  ammonia  to  the  nostnU; 
or,  if  neooenary,  an  encmn  cont^iining  hi-atidy  niny  t>c  given. 

The  best  Htyptics  are  gallic  acid,  aUini,  and  acetate  of  lead. 
Tlic  gallitr  ai'id  msiy  lie  given  in  ten  grain  doac-M,  along  witli  ten 
or  fifteen  minims  of  dilute  sulphuric  acid,  and  should  be  repeated 
frefiucutly.  Alum  mny  bu  ])rts«rril)ed  iu  infusion  of  n)«c*;  aud 
the  acetate  of  lead  in  two-groin  dows  iu  the  slmpe  nf  a  pill,  or 
combioed  with  ncctic  iu;i<L  Oil  of  turi«ntiue  U  also  used.  Where 
the  bleeding  is  flight,  and  there  is  gocxl  rea«m  to  believe  it  ariace 
irom  portal  congestion,  the  beat  trojitnient  is  to  give  a  small  dose 
of  calomel,  foUow<fd  by  flulplmte  of  magnetiia  and  dilute  sulphuric 
acid,  in  inftisioa  of  roBcs,  cver>*  throe  or  four  hours,  until  purging 
i*  produced. 

J  ACcoFP  gives  the  preferent-e  to  ico,  internally  and  externally. 
Dry  caps  on  the  limb«  aiLd  tniuk  are  useful  when  the  heroorrbaga 
copious.  3^1 

Hii.LER  callrt  attention  to  the  fact  that  hematenietds  fs 
Bometiraes  due  to  viaoeral  sj-phili^,  when  gpocific  medication 
in  iiidioiitol. 

JVpjirt  from  these  cases,  the  bieblorido  of  mercnrj-,  given  in 
doacs  of  gr.  j',  every  tour  lioni-s,  will  fiwiuently  prove  effectual  iu 
chocking  the  lioniorrhage. 

Bartholow  eays:  The  hemorrhago  which  is  a  vicariouB 
menstruation  is  relieved  by  diverting  the  flux  to  the  uterus,  its 
iiatiiml  outlet.  Thix  is  liest  aeeomplidhcd  by  the  oso  of  the 
appropriate  emniciuig()gnes  during  the  interval,  of  hot  eilz-baiha 
and  hot  vaginal  douches,  nt  the  time  of  the  cxpcctod  flow.  In 
the  case  of  married  wonieu,  leei-luw  may  tie  applied  to  the  cer^'is 
uteri  at  the  time  of  the  mcni^truiil  niolimen.  WTien  duo  to 
arrested  hemorrlioidul  disi-liarge,  leeches  tihoukl  he  applied  to 
the  aims  and  aloes  be  adminimteri'd. 

When  an  impovcrisbod  condition  of  the  blood  exists,  or  when 


tlEHATEME8ltl. 


2S5 


fhc  Po-cailed  hcinrtrrhnB-ic  dinthwis  is  tho  cauao  of  hcmorrliaire, 
effort  must  l>e  (iireei^il  to  inipMve  the  conijiosUion  of  Ibe  blood, 
and  to  olflvato  the  tonus  of  tho  ves^ls.  When  the  hemorrhage  i^ 
oocurriiig,  the  most  ahsohitw  «•]«>■■«  iniwl  Iw  tnjoiruHl,  tho  jmlieiK 
should  ewallow  as  rapidly  ac  jwweiblo  pollfts  of  r-g  ;  ergotin 
should  he  itijct-lcd  itnhcutuiiiHiiisly,  aK  much  nn  thii>o  to  h\k  gniiuA 
at  a  timo,  and  it  may  be  ropeatod  a**  often  as  ueeo»«ry ;  a  bog  of 
ice  shoriM  \tv  {nit  on  the  eii)^u»>triuni ;  and  liir^o  draiighls  of  iceti 
aloiu-wtiey  should  be  swalloivod  every  few  miiiiitoj^  Liiniliiro(<i 
amuud  the  thighs,  lietl  tightly  eiioiigh  ineruly  to  Ktoji  a  |sirt  of 
the  veuoii*  bhiod  in  the  lower  linihs,  are  excellent  adjiinctt*  to  the 
measures  alnive  pmiHTe**!.  If  thiw  he  nut  dtJiie,  the  legH  mhould 
hang  down  out  of  the  1)efl.  and  the  Hlionldeni  l>e  somewhat  raUett. 
Tlie  willM  of  iron  (chloride,  nitrate,  aubsnlpluitw)  may  be  admiu- 
irtered  tor  their  styptic  cHix-t  A  tcaspoonful  of  the  tincture  of 
the  chloride  may  be  given  in  four  ounces  of  ice  water.  An  objoc- 
tiou  to  these  ferrugintnis  styiititw  i«  the  very  voluminous  and 
DSUBcatiiig  eoagnla  which  they  form,  and  which  are  apt  to  excite 
vomiting.  Brandy  is  an  excellent  lotail  iwtringcnt,  atitl  le  general- 
ly serviceable  ill  the«'  caseti  owing  to  the  syncope.  The  stimulant 
is  benetieial  in  raising  the  arterial  tension,  by  furnifthing  n  force 
for  the  \-aso-moior  system,  which  is  in  a  stato  of  paralysii*.  Tannic 
acid  U  a  «»fe  styptic,  which  can  lie  used  fn^juently  and  in  rela- 
tively large  (ten  graiui*)  <niantity .  Sulphuric  acid  nmy  be  employ- 
ed succtii^fuUy,  aii<l  this  Iuih  tlic  uilvantage  lliut  it  suiull  i^uantity 
imimrts  astringent  property  to  a  large  araoont  of  water.  Next  to 
alum-whey  it  is  the  most  efKcient  hem'^tatio.  If  vomiting  he 
obstiiiuro,  the  oue-sixteciith  grain  of  morphine,  hypodermaticalty, 
will  <top  it,  aud  contribute  materially  to  the  arrest  of  the  hemor- 
rhage. 

If  the  hemnrrhflge  ha;*  Inx^n  Miiffiiient  to  mive  dangoron* 
syncope,  the  inlialHtion  of  nitrite  of  amyl  may  aixiuiH!  the  tailing 
heart,  or  the  injection  of  digitaline  may  W  tried.  Lbubb  ndviwM 
the  8H bcu tanooua  injei^'lion  of  ether— a  syriiigeful  every  tow 
miimtt^^i — in  amea  of  iIaiig<.'r<Mi!i  synccipe  fri>ni  llie  hnniorrhage. 
Voiy  greut  enrc  U  8ub<>«q^uently  requircil  in  tho  alimentation,  and 
in  the  use  of  renH-dies  to  remove  the  aneniiiu  Only  niilk  liliould 
be  permitte<1  for  iwme  days ;  but  tbi«  may  be  supplemented  most 
advantageously  by  the  rectal  injection  of  detibriuated  blood. 


S86  MANDAI.  OF  TBKATMRNT. 

HEMATURIA. 

Ttsox  reoommemls  tliaf  malariiil  hematuria  He  treated  like 
onlinary  apiii-,  wUli  quinine  hi  miti|*no«iic  doses;  sixteen  to 
twenty  grains  anticipaling  th«  |mroxy»in.  For  malignant  teases, 
qiiiniiif  mii«t.  Ii«  given  in  very  large  dfwes,  with  merciirial*. 
Btimiilaiita  are  neotlal  with  iii(n-|>hiiiP  and  carlwilic  acid  for  the 
Tomiting. 

Fknttiok  recommends  for  onlinary  licmaturia  tlut  tho  patient 
be  confined  to  hi?  bed.  Soinid  port  wine  i«  one  of  the  begt 
astringontfi.  Ergotin  may  Ue  injected  suWutaneousIy.  Internally, 
he  makes  use  of  the  foUowiug: 

9     EiLcr^iva., iqc  xlr 

Add,  KtkllicJ gr.  x 

Atj.caaiK, f  J  j 

M.    9. — For  oiM  (loM. 

B     Alumini*,. ....J  Ja 

Srrupl. fS  ^ 

Inf.  rom  MiH^  ftd .' fj  ^ 

M.    8. — One  or  two  tablcBpooDfala  u  nqnlnd. 

HoRiOK  proscribes — 

8      KthoUc  puW., gr.  IT 

Acidi  Unnici, gt.  1^ 

Digiulioic, gt.  k 

U.    f'l.  mm.  «t  in  pU.  iio.  x  dSv. 

S, — Pit*  pilla  ar*  to  h*  ukcn  «ich  Ahj. 

He  alao  uses  prolonged  eold  injcctioni;  into  tho  bladder,  aod 
cold  comprcAsoe  to  the  }}eritieiim  and  pubis. 

Bartholow  thinks  favorably  of  digitalis,  c-onibined  with 
«rgot  and  kramerla. 

StR  H.  TBQMPigox  c-onmder!«  the  infusion  of  matlco,  in  dosea 
of  a  wineglaBsfnl  every  two  hours  as  L><|tml  to  giillie  acid  or  ]t>iui. 

In  one  ease,  wliic-h  hail  redisUn!  nearly  all  tho  remedies  above 
■mentinnod,  i>rfiniiit  and  pemianeiit  relief  followed  the  admitnstra- 
"tion  of  oil  of  crigeron,  in  (\om'.»  of  tive  drojw  every  six  hours. 
For  thin  auggcsiiuu  wn  wciv  Indebti'd  to  Aonew. 


IIBMATCRIA. 


-237 


SOI?  snvH  (hnt  wIimi  the  object  ia  to  check  tlie  hemorrliage 

^luulua,  mst  iii  \he  horizoiitnl  ].io«itioit  U  tbc  mo^t  ett'eutive 

it.     Cold  is  in<lu-«t«tl  wliwi  tlie  heniorrliiige  in  from  the 

iladdcr.     Ice  bogs  may  be  applk-d  over  the  pul>is  aud  ioe  water 

iect«d  into  the  rertiim.    Opium  should  bo  given  to  nMtniin  the 

1  vesical  tenesmus. 

The  catheter  whould  not  be  iiitnxluced  unlet*  there  U  reten- 

:on  of  urine.     Tlio  coagulated  blood  cliecke  further  flow,  and  u 

If  difKolvet]  hv  the  urine.     If  the  blarlder  cannot  be  emptied 

through  a  full-sized  catheter,  an  cxhaustiug  syringe  should  bo 

used.    The  utimwt  gentleness  must  be  practino«l,  to  avoid  eiciting 

ftesh  hemorrbnge. 

The  most  Nervit^eable  intenml  remedies  art>  alum,  gallic  acid; 
acetate  of  lead,  ergot,  tiucture  of  irou.  tui^x-ntiiie,  sulphuric  acid 
.lul  niatico.    They  are  more  beueticial  in  renal  tlmn  in  vesical 
lorrhage. 


^Hiem< 


Sib  H.  Thompbos  usee  locally  in  veaical  homorrbago  one 
grain  of  nitrate  of  silver,  or  a  drachm  of  tincture  of  iron,  in  four 
oiitioc*  of  water.  Tht*o  reme<Ues  are  suitable  tor  hemorrliaga 
doe  to  tlie  presence  of  n  tumor  in  the  bladder.  The  inlermd  uae 
of  irou  and  quinine  ia  iudieated  when  there  ia  a  general  hemoiw 
rhagic  tendency,  and  in  mocit  (Tases  opium  may  be  added  with 
advantage. 


W.    Roberts  says  that  when  hematuria  is  duo  to  acute 

£nght'«  di.'«aise,  to  overtloeefl  of  turpentine  or  cantharidea,  to 

itemai  injury  or  muscular  etlbrta,  it  should  not  be  interfered 

with  unletw  excetwivo.    If  the  latter  Iw  the  co«e,  be  reeommenda 

cups  to  the  loins,  diaplioretlcs  and  bydrogoguw. 

Pfl««i\*o  hematuria  in  the  course  of  zymotic  dif^aso  calls  for 
sulphuric  acid ;  or  if  of  ve«ical  origin,  for  copaiba  and  turpen- 
tine. When  this  bleeding  takes  the  place  of  the  menstrual  flow, 
it  should  not  be  stopped  till  the  latter  ia  rc-estiibUshed. 

In  the  treatment  of  hematuria,  per  se,  the  first  indicatiooB 

fierfiH't  rtwt  mid  tin-  :i|>|>11(']iruiTi  of  i-old.  One  of  the  most 
aluuble  heniodtatt(^»  Ib  gallic  acid. 

JonxflOH  sayK  that  the  tincttiro  of  iron  an-c0t«  bomorrbage 


« 


288 


UANITAL   OF  TILKATUBXT. 


by  a  direct  astringent  action  on  the  vwwels  nr  l>y  corrpctiiig 
ttlkttUnity  of  tlic  urine. 

Paot'T  pays  that,  the  iiijeution  of  coUl  w«tftr  into  the  bladder, 
with  from  twenty  to  forty  gnuiia  of  alum  in  a  piut,  seldom  IJiils 
to  check  the  bloti<ling,  cvon  if  du<!  to  caacar. 

To  remove  blood  fnnii  thu  bladder,  an  ucid  aotution  of  [)ep»ui 
fihouM  be  injected  to  diitsolve  the  clota.  C  F.  T. 


HEMOPHILIA.— (The  Hemorrhagic  Diathesis.) 

Leoo  KavH  iiiat  mtyptics  are  of  little  use.  The  spontaneoiu 
form  should  not  be  inlerfurx-d  with  ;  but  the  Iraiinijitic  may  oftiai 
be  stayed  at  t}ic  outset  by  the  judicious  use  of  oompreMion. 
Iron  Beems  the  best  inlomul  remedy.  In  the  la^t  resort  tranit- 
fiision  niay  be  reeorttd  to.  In  the  interval  of  heraorrliagea,  meat 
did,  cod  liver  oil  and  iron,  and  residence  in  a  warm  climate  are 
the  niost  ai»]iropriat«  remedies.  All  wouuds  should  be  avoided. 
Marriage  should  be  forbidden,  Cfipecinlly  to  the  females  of  bleeder 
femilieri. 

Immeioiiakn  [ironounceti  acetate  of  lead  :uid  ergot  the  mrat 
reliable  of  the  internal  hemostatics,  when  given  in  large  driA«£>; 
frequBTitly  rem-ated.  WAcnsMUTii  praised  the  action  of  sulphate 
of  soda,  given  daily,  in  doses  of  three  drachms  to  an  ouuee.  He 
«*ed  it  at  once  in  traumatic  L-a-scs,  and  on  the  second  day  in  others. 
Other  laxatives  have  the  Parae  effect  Abtnlitte  rest  and  quiet 
ehoiild  he  niaiiitaincil.  Btimuhmte  may  lie  inijieratively  demanded 
by  the  deprciwiim  ;  hut  the  tcmptatiiai  t.i»  rewtri  to  their  enipjoy- 
ment  moat  he  resisted;  as  it  liaa  berai  i'reciucntly  found  that 
eyncoite  (>topi>ed  thu  bloe<ling  when  all  otiier  nieimH  had  failed. 

Tlie  aim  should  lie  to  restrict  the  expenditure  of  \ita.I  force 
ae  far  an  poAitiblo.  FixkI  should  ho  given  in  Muall  amounts  at  first. 
Tliirtft  may  l)e  allaye<l  by  fretpient  but  fimnll  draughts  of  cold 
water  or  milk,  to  which  a  few  dro[M  of  brandy  or  mm  may  be 
addol  when  deemed  advisable.  Xron  sliould  be  renerved  for  canen 
where  the  eubi^cqiicnt  anemia  persists  lui  UDU«aal  time  after  the 
hemorrhage  hae  ceu«ed. 


Hematomata  must  be  protected  from  iiyury.  They  alinuld 
\y  he  n|wiie*l  wlieii  gangrene  has  iK'giin.  Caustics  are  then 
preferable  to  the  knife,  lii  the  rheumatic  affections  mild  nilw>- 
facienta  ntuX  anodynes  btb  inclit-alecl,  with  jmnUices  or  alcoholic 
lotinns  of  iodide  of  pota.'*5ium.  liaadages  and  eplinfa  are  altto  of 
SltTfurj-  niuHt  1)0  iivoidwl. 


W 


TT.tRTitHORiTB  Speaks  of  the  cwcaiiional  raluc  nf  ioe  and  of 
hot  watar,  ns  Kwal  stA']itiej<.  Venieiiil  adviwjs  rjuiiiine  inter- 
luilly,  fiftwn  lo  thirty  grains  daily,  [lartieularly  in  dental  henior- 
rhageii. 

In  one  case  we  found  that  the  local  Uite  of  tannic  acid 
eheekcd  the  hemorrhage,  after  the  metallic  astringents  had  faileil. 
Thi^  i^ase  waa  thai  of  a  hoy  Iwlongitig  to  a  bleedor  family;  iind 
in  all  aubaequentattacks  in  which  this  hoy  was  under  our  care,  we 
fovmd  the  tuune  agent  a»  efficient  an  at  first. 

Wbonever  mecliauical  compreesioD  can  be  brought  to  bear 
n  tlie  bleeding  vei<itclfi  it  should   lie  ajijilied   as  quickly  an 
«iblc. 
A  writer  in  The  Pkila.  Mttl.  7\mcf  recently  recommended  a 
hitioti  of  antipyiin  aa  an  efficient  hcraostatie.    Muriate  of 
cocaine  is  wortli  trying,  aa  it  sncceedetl  in  stopping  tiie  hemor- 
in  a  case  of  purpura  hemon-hagicn,  which  oceurred   in 
.  Waugh'a  pmctico. 


HEMOPTYSIS. 

BAKTnni,<)w  say*  thiit  the  most  eftcetive  renii'dy  is  the  hypo- 
enuic  u\jt!ction  of  ergotin.    He  look^  on  ipecac.  u»  next  to 

]tin,  one  nf  the  inc»t  efticient  hemo»ta1ic!s.  Inhalations  of  a 
)my  of  Monsel's  aolntioQ  nnll  often  arrcet  the  hemonliage 

once. 

SETUotTR  Taylob  ^-autious  US  agaiust  undue  baate  in  using 
astringenta.  Opium  nct^  like  a  charm.  If  the  hemorrhage  be 
profuse,  twenty  minims  of  tincture  of  di^talls  should  be  added, 
icn  opium  is  eontra-indiontetl,  turpcntino  and  ci^t  are  useful. 


MO  JIAKCAl.    OF   TREATMENT. 

CAnaB  recommends  bath»i,  wltli  arseni(>  nml  r|umuie  Ibr  ttie' 
nervouii  cases. 

Oqblbu  also  advocates  qoinine. 

Ba  Costa  giveit  a.  xcnipW  of  gallic  acid  every  ten  minutes 

till  hemorrhage  ceaHea.     Al'ter  thia  be  oi'dera : — 

B     Ciijiri  aulph.,.. gr.  } 

F«m  siilph^ gr.  ^ 

£xt.  hyoKyva^., •C-J 

M.    S.*— For  one  pill,  le  bi:  tnken  thrice  dtilj. 

In  persistent  slight  puhnoiinrj  hemorrhage  oopper  oontroU 
the  pulmftnury  oirenlation  iind  arrests  the  ble(3(Uiig.  Cod  liver 
oil  should  not  be  given  until  the  hemoptygi«  luis  eea^ed.  He  also 
ruetmiiiiuiuU  tlie  following  I'oriuulie  for  nse  with  the  atomizer : — 

B     Furiehlor., gr.ij-x 

AijuK  Jwt.,. tii 

Q     Aci<li  uionid, gr.  x-xx 

Aijuw  desi., f  J  j 

M. 

B     I'iiIt.  nliiniiii., S  a 

Aijuii^  dt»L ••f)  J 

TtoBELL  pronouncen  the  following  the  most  pffi«icioH«  nnc 
rational  eombiniitiou  of  remedied  for  profuse  tuberL-ular  pulmonary 
hemorrhage: 

Q     Est.  erfobc  fl., fS  Q 

Tini'L  (lieiulii^ r5  ^ 

Acid,  i^lici, 5  j 

Magna. Hilplu,..,. 3  ▼ 

AcJiL  Miiliih.  lUU f5  j 

Inf.  rtitae  ootap., fj  lj 

M.    S,— fsJ,  OT«rj  lhr<«  hoiiniiimil  th*  h«iunrrh)ijt>>  in  uTMled. 

Tlie  ergot  eonlnK-U;  the  vessels,  the  digitalia  stendics  de' 
heart,  the  gallic  nt'id  flots  the  l)loo<l,  the  mitguesin  relievgg  cod-, 
geetion,  and  the  sulphuric  acid  helps  the  rest. 

I^^IEMBYER  prescribed — 

R     Co|>aib<r, 

S.vnipl, 

Aq.  ni«D(lun  pifk, 

Airoboi u  r|  j 

ep.«lheriB  oitroK, TS  w 

U.    S. — f  3  y.  t'tifj  tw»  to  four  hanri. 


HIOCVUeH. 


241 


The  knowledge  tlmt  patioiits  but  mrely  die  of  homoptysiB 
will  ft«*ist  us  in  reassuring  our  frightened  |«itient.  Tbe  head  and 
che«t  shimid  Iw  mieod  goniowhat,  the  clothing  about  the  neck 
opened,  and  nil  sjieerh  or  other  eftort  strictly  forbidden.  Serious 
hemorrhages  call  for  ieo  bags  to  be  applied  over  tJio  sternum. 
Solutions  of  siibetulpliHleof  iron  Hhould  he  uacd  with  an  atomizer. 
Though  hut  little  of  the  medicinal  agent  can  possibly  reach  the 
bronchial  miicouB  memhnine,  llic  efficiency  of  the  application  is 
uiiq  utwtionable. 

if  the  heart  lie  cxcitc-tl,  and  thumping  tunmttuouely  against 
thv  A'ii-  of  the  chest,  a  full  dose  of  aconite  will  give  relief. 
Digitalis,  in  doses  of  thirty  drops  of  the  tiuctui-c,  every  four 
hours,  is  the  most  eflicient  internal  remedy,  llie  after  etl'ects  of 
5nch  hf-niorrhflgc*  aliould  be  carefully  watched.     Fever  mils  for 

quinine. 

Tfcmon-Iiagcs  occurring  in  the  course  of  pulmonar)'  oonmimp- 
tion  are  often  beneficial,  their  occurrence  being  followed  by 
ainclioratioii  of  the  other  symptoms. 

In  those  who  are  prone  to  hemoptysis,  w©  have  found  the 
greatest  benefit  to  accrue  from  the  pi-olonged  use  of  the  lacUiphoa- 
phxite  of  lime,  with  carefully  regulated  hygienic  management, 
the  avoidance  of  auperfluoua  liquids,  and  of  violent  exertions.  A 
trip  upon  a  whaler  in  the  South  Atlantic  completed  tbe  euro  in 
one  ease.  The  use  of  the  fruit  acid»  has  also  proved  beueficiah 
We  hnvQ  learned  by  bitter  experience  to  dread  the  iron  prcpara- 
tiuni>,  Olid  the  ^ca  air,  in  9uch  eitses. 


HICCOUGH 


sayd  tlie  treatment  of  hiccough  will  depend  upon  the 

An  emetic  to  empty  the  stoninch,  or  a  stinmlwrir.  to  ii^ 

it«  natural  [leristultii;  acli<»n,  will  often  give  relief.    If  we 

can  auccee<l  in  prodticliig  a  forcible  aetion  of  tlie  diaphragm,  we 

^^Bay  often  euocced  in  curing  it,  aa  it  were,  of  the  trick  of  spas- 

^^nodic  action.     Altemptu  to  count  a  hundred  without  dniwing 

brt:ath,  or  to  bold  the  breath  for  a  miimtc,  arc  familiar  remediee 

for  hiccough,  and,  by  producing  a  fccUng  of  suftbcatton,  and  nccee- 

ptating  ft  violent    descent   of   the  diaphragm,  they  are  often 


MS 


MANUAL  OX  TRSATUBXT. 


•acceasfiil.  Wnrm  applications  or  couiitei-- irritation  applied  to  the 
dtaphmginaiic  rcj^ion  or  over  t}ie  curvicul  »iiiiu-,  may  occaaion&lljr 
give  relief.  Preseure  upon  the  trunk  of  the  phreuic  nei've  hj 
nicniis  of  thi3  finger  applied  over  the  senlerturt  aiiticiis  tniiscle,  is 
said  also  to  have  given  relief  oct'asioiially  iit  obstinate  caaes. 
Amongst  the  dnijTfi  wliich  have  l>ccn  recominciidod  for  tlic  rvUof ' 
of  hiccough  are  chloroform  (adtnini^^tered  internally),  either  alone 
or  combineil  witli  o|iiiiiu,ctiiu[>lior  in  the  fonnofa  spirit  solution, 
in  doses  of  twenty  drop**  ami  iipwAnlrt,  valerianate  of  zinc,  bella- 
donna, hi-omidf  of  potaasium.  musk,  unt-acidi*,  and  in  very  mvoto 
cases,  hypo<lei*mica  of  morphine. 

A  remedy  whicli  haa  never  fiiiled  ua  yet,  ta  the  ^cnuitu 
HofTman'B  anod3m6,  in  teiwpoonful  doses  undiluted,  hx  one 
ca-se  whieh  hiul  persisted  for  forty-eight  hours,  roaisting  all  cfforta 
to  relieve  it,  a  single  dose  of  the  ano<iyno  sufficed  to  cure. 


HYDROCEPHALUS. 

Bastiah  coudemiiB  blistering  the  aealp,  mercurial  ini 
and  strapping,  lie  advises  attention  to  the  general  health,  the 
use  of  cathartics  and  diuretics,  and  the  iodide  and  bromide  of 
potaaaium.  lie  also  thinks  it  worth  while  to  re<luce  the  amount 
of  fluids  taken  to  a  minimum.  Puncture  bos  not  proved,  a^  yet, 
very  Bucccwful,  but  in  such  a  grave  discaae,  may  be  performed  in 
the  hope  of  giving  relief. 


HYDROPHOBIA. 

GowKRS  flays  when  a  pei-Rou  has  been  bitten  by  a  suspicious  or 
doubtful  animal,  the  eireuhition  in  the  tmrtshuiitd,  if  possible,  be  at 
once  arrested  by  a  tight  ligalure  above  the  bitten  place;  the  wound 
should  be  wiiKhed;  and  then  it  should  be  allowed  to  bleed  freely. 
It  may  probably  be  fiuckc<l  with  impunity  if  the  mouth  is  rinsed 
with  water,  or  belter  Ktill  with  vinegar  and  water,  after  each  act, 
and  if  there  are  no  abrasions  in  the  mucous  membnmo.  The  act 
liaa  been  supposed  to  be  dangerous;  hat  all  experience  is  opposed 
to  this.  PoiBona  have  to  remain  for  some  minutes  in  contact  with 
A  maoous  membrane  before  they  are  absorbed,  and  daring  the  act 


BYDEOPHOBIA. 


of  suokiDg  there  \e  a  6ow  from  the  mucous  m«mbran«  into  the 
iDoal]i,  which  must  he  oppo6«d  to  al>wrption.  Ah  hood  as  possible 
tiie  wound  (thould  l>e  uatitorised.  Of  chemiea)  raii^tios.  iiitmt«  of 
nlver,  freely  applied  at  once,  is  pi-oUibly  effeetwnl.  If  any  time 
liave  eInjMed,  nitric  acid  or  liquid  eai-bolie  acid  is  preferable.  Tlie 
actual  cautery,  appUctl  deeply  aiid  freely,  id  iiii  efR<-iftnt  niid  ready 
umaiu.  If  practicable,  free  oxeigion  of  the  bite  ie  wiso;  aiid 
•hoiil<1  not  be  ncgleeUil,  even  tlioii^li  tli<>  i^iileri'  htui  before  Iieea 
Ofietl,  if  ihoiv  in  aiiy  doubt  a*  to  the  thort>ugLue»w  of  tlie  appli- 
cation. 

The  methods  adopted  for  the  t.peatmeiit  of  the  developed 
dWaM  liave  inwn  nutnemtiH.  All  Ki>-<uil!e(l  's]K<cif]i-*('  have  l*e«D 
proved  to  be  U8elei>a.  An  attempt  ban  been  made  to  eliminate  tlio 
poison  by  ailiiiinii^teriii^  lar^  doi^ei*  of  mercurj-,  and  by  diaphore' 
MS.  The  two  have  been  combined  in  the  mercurial  vapor  bath. 
Two  or  tliree  casea  are  on  record  in  which  tliitt  method  hojt  been 
succcH^ful;  many  in  which  it  has  been  powerlctiB.  Of  late  it  has 
been  but  little  tried. 

Attention  has  been  lately  ilirected  tx>  ciirara  a»  a  remedy  for 
liydropliobia.  In  a  case  rei»ort«l  by  OFFEsnuiuj  it  was  apiiarently 
BOecessful:  and  since  then  another  ca.-M?  lias  recovered  under  its  use. 
Id  iimny  ras*^  it  liii»  fuilod.  Tt  Hhuuld  be  iimhI  in  inji-ctinns  of  from 
i  to  J  of  ft  grain,  repeated  every  quarter  or  half  au  hour,  until 
the  se%'erity  of  the  iKintxyHUrt  if  letwi-nwl.  This  point  may  not, 
however,  be  reavhed  until  general  niUDtular  [jundyi^it^  in  imminent 
or  produced,  and  then  artiHcial  rcsspii-ation  may  be  neei'iifuiry  until 
the  effect  ha.-*  passed  awa}-.  As  often  as  this  is  the  ciie<',  and  the 
Apaanu  recur,  another  itijcction  mu^t  be  given.  In  hydrophobia 
there  is  remarlca)>le  tolerance  of  the  drug,  poiiionouA  do«ee  (one 
grain  i-cpeaied)  of  active  curani  having  in  one  oaac  been  without 
any  efiect.  This  is  porhaiw  a  hopeful  fact,  as  it  indicatee  that 
curnra  baa  an  action  to  which  the  change*)  in  the  central  ncn'oae 
system  are  opposed. 

Sedatives  have  bewi  the  pemedies  cciramoniy  employed,  and 
of  these  the  best  are  chloral  and  morphine.  One  ea»*o  (probably 
genuine),  in  whidi  morjibino  and  calabar  bean  were  used,  reeover- 
«d;  and  one  in  which  chloral  wa.^  employed  lived  for  ton  days. 
The  effe*'tof  the  two  on  the  respiratory  centre  in  animals  anggeste 
their  joint  use.    The  morphine  should  \te  given  by  hypodermic 


£44 


MANUAL  OP  TRBATMCNT. 


the  clilornl  by  rectal  injection.  Cklorofonn  i^  upcfiil  in  moderat- 
ing  the  paroxysms,  but  appears  somewhat  inferior  to  chloral. 
Other  aedativos — Indian  hemp,  Ac, — have  apjjeftred  of  inferior 
value. 

Cold  affneions  to  the  ccmcal  spine  and  head  were  used  b 
India  in  two  cases  which  recovered,  the  throat  and  spine  being 
"blistereil  with  nitrate  of  silver^  and  chloroform  administered. 
Ice  to  the  ?pino  has  been  tried  without  eflect.  Tracheotomy  was 
reeommemlod  by  Mausiiali-  Uall  in  one  case.  Death  from 
laryngeal  spasm,  is*,  however,  too  rare  to  juatifv  (ho  measure. 

Ill  all  CMOS  tranquillity  ie  of  the  greatest  importance.'  Kvery 
excitant  of  8pa«ni  slunild  Ipe  avoided ;  the  patient  being  kept  in 
a  dim,  atill  room,  and  fi-icnds  excluded  a«  much  as  pofwible.  Next 
in  ioijvortnnce  is  nourish iiu-iit,  which  should  be  given  by  the 
rectum,  if  spasm  bo  excited  by  the  attemjkl  to  swallow.  Rcntraint, 
which  may  be  necessary,  should  be  m  little  an  poseiblo,  but  it 
elioulU  be  ofiectual. 

The  wilivtt  of  (wrsons  siiflering  from  hydrophobia  has  bd«l 
proved  to  be  capable  of  commuiiicatitig  the  diMeiuw*  to  animals. 
Hence  the  attendants  should  be  cautioned  to  have  no  uncovered 
abrnMcin  nii  tlio  luiiids,  and  to  wit^h  fnun  the  cytsi  nr  face  any 
saliva  wliifh  may  liavo  been  spit  on  thoni ;  and  if  ihey  are  bitten 
by  the  patient,  the  wound  sliould  be  treated  a.i  if  it  ha<l  been 
inflicted  by  a  rabid  animnl.  These  iireeautiong  remove  all  dam^; 
and  any  anxiety  tlie  suljjtJCtM  may  feel  nmy  be  relieved  by  the 
asiurance,  that  of  the  thousands  of  pereons  who  have  attended 
on  patients  with  li^  dnipliobia,  no  authentic  instance  hiu*  ever  beea 
recoinJed  in  which  the  disease  was  cfjntracted  either  by  attendance 
during  life,  or  in»|)Ci:tion  after  death. 

RctrcnlJy  a  rtise  is  reported  as  having  recovered  under  the  oae 
of  vapor  baths.  It  secmB  unlikely  that  this  remedy,  so  popnUr 
in  Ku-j.-iii,  whurt!  chboh  of  rubies  are  fnf|iieiit,  should  not  have  been 
fully  tented  long  since.  However,  in  so  hopeless  an  aflection,  ooe 
may  be  excused  for  tiyingany  ex[ierimenis  and  we  would  suggest 
tlie  fruc  use  of  jaborandi.  and  the  vapor  bath,  with  the  assurance 
that  failure  will  leave  no  regret  for  not  liiiving  adoptt^d  any  other 
metliod  of  treatment.  To  assuage  the  paroxysms,  uolhing  has 
yet  e(|ua11ed  chloroform  by  inhalation. 


HTFOC&ONDSIA. 


24i 


HYPOCHONDRIA. 

^zzARD  says  that  morul  trcalmvnt  alone  is  of  uny  tnflucn«a 
in  moet^caMA.  Anemia,  8ypliiti»,  gout,  fecal  accumulation,  into- 
tiiial,'catarrb,an(l  hemorrhoids,  when  ccHJXWting  ahoiild  he  treated. 
Alcohol  should  be  avoided.  Travel, with  judii:iom  compaDionship, 
and  regular,  definite  and  useful  employment,  arc  the  most  potent 
mcan^  of  treatment-  Hidicule  is  rarely  of  Bervice,  and  too  clow 
attention  to  the  patient's  symptoms  or  sensations  is  to  be  depre- 
cated nhc, 

Hiraass   found   viHComl   disorders,  and   dlahetea  frequently 
pxisting  with  hypochondria.     Codeine  and  electricity  are  bta 
ivorite  remudie& 


^ 

ti 


Kkllooo  calla  attention  to  the  fact  that  over  work  is  frequently 
je  primary  cause,  and  that  rest  is  oilen  the  needed  reme<Iy. 

The  connection  between  hypochondria  and  apermatorrhea  is 
ry  eloM ;  and  a  common  cauae  for  both  will  frequently  be  found 
in  masturbation. 

As  in  other  nervous  aftections,  the  first  rule  is  to  treat  every 
iepartore  from  health  which  can  be  foumt,  however  Btiyht  and 
iuconeequential  it  may  appear. 

The  habit  of  masturlmtion  must  be  broken  u]);  the  passage 
a  boug'io  will  very  orton  inditmtc  the  presence  of  t^indcr  s[K}t8 
along  the  urethra,  which  niuat  be  cured  by  the  use  of  ttteel  sounds; 
the  digestive  canal  mu»t  bo  kept  in  fjood  order.  While  the  j>atient 
must  l>e  taught  not  to  let  his  thoughts  dwell  upon  his  health 
exclusively,  it  will  not  do  to  show  inditlcrenco  to  his  condition^ 
as  he  is  quick  to  feel  and  resent  neglect.  It  must  not  be  forgotten 
that  hypocliondrin  is  a  real  disease,  which  lands  its  unhappj 
victims  in  the  insane  asylum,  and  in  a  suicide's  grave,  too  frequent- 
ly for  us  to  hold  it  in  contempt. 

An  out-door  life,  field  eporb*,  and,  aa  the  strength  admits  of 
it,  the  life  of  a  fronticrBmnn,  are  to  be  commended.  "When  all 
alierrations  from  a  healthy  gtaiidard  have  been  eorrecte<l,  when 
the  sexual  functions  have  been  properly  regulated,  our  duty  is  to 

our  patient  to  forget  his  ailments  by  interesting  him  in  those 


£46 


UXVX3XL  OP  TRBATUBXT. 


of  Others.    Thio,  we  have  found  the  most  Buccesitful  method 
p8;ychtc  nuiiiageracnt.    \Vlicn  on«'e  own  troublce  begin  to  appeorj 
trifling,  beeide  the  profound  griefs  that  b«s«t  bamanity,  thereu 
hope  of  a  cure. 

Ekb  thinka  that  electricity  haa  not  reocivoil  the  attention  it.l 
deeerves,  in  the  treatment  of  this  nearosis.      Besides  general 
faradinatlou,  he  rccomnicucU  that  the  prominent  syniptoma  of  the 
disease,  8uch  as  ranstipation,  impotence,  and  insomnia,  be  treated 
witlt  electricity.    Be  careful  in  the  selection  of  a  currenl.,  aa  tbue  { 
patients  are  highly  eensitive. 


HYSTERIA. 

BartroloW  sayo,  in  tliiH  nialiidy,  nbovc  all  others  are  moral 
and  hygienic  measures  of  most  importance.    When  the  hysterical 
coD^titutioii  IK  inherited,  prophylactic  motlioilft  should  Imi  pursued 
from  au  early  period.     Self  control  should  be  instilled  into  the  M 
mind  from  tlie  6r»t  dawn  of  iiitelligcncCf  and  the  mu^mlurand 
digestive  nystenwdiould  boculiivatwl,  while  the  ncr^-ooa  system  ifl 
trained  to  subordination.      Early  houn,  gubstantial  foo<I,  plain  ■ 
clothing  adapted  to  the  n<Hidfl  of  the  body,  should  be  insisted  on, 
while  society,  the  follies  of  drcsa  and  fashion,  and  daintioe  shoold 
be  prohibited.    The  utmost  earc  is  necessary  in  tJie  selection  of  ■ 
bookfl  for  young  ladies.    The  modern  novel  has  done  much  mis- 
chief by  cultivating  morbid   fancies  and  false  iioti<ms  of  the 
relation  of  the  >;exe«,  etc.    Sexual  abuses,  although  1c»»  iufliiontial  I 
thon  they  are  usually  supposed  to  be,  have  an  iiy  urious  eflect  on  the 
nervous  system.     If  the  hyeterioal  condition  dovelope  in  «pit«  of 
the   preciiutiona  adviHtnl,    reinediul    iiieefiiireH  become  neeeaaaiy. 
The  condition  of  aiioniin  must  be  removed  by  chalybeatee,  a 
generoiis  diet,  and  Muitiible  cxert'ise.     Thoae  tonics  are  moat  suit- 
able which  have  a  special  direction  to  the  nei'voun  gVKtom,  na 
nrseniate  of  iron,  strychnine,  and  tlie  ]khosphiites.    Ah  the  opposite 
condition   or   pletliom.  mjiy  exist,  although    Ie««   common    than 
anemia,  iron,  anst>iiii',  and  Blrychtiine  idioiild  lie  avoided,  and  uiich 
remedies  aa  the  bromides,  gel^minm,  and  cimlcifuga  prescrilted. 
For  simple  hysterical  M^izui-es  without  convulsions,  the  elixir  of 


HYCTHRU. 


valerianate  of  ammonia,  a  camphor  julep,  a  little  fluid  extract  of 
valerian,  or  a  few  drops  of  Hoffman 'k  anodyne,  rejieated  every  few 
miuut<»,  will  tcnuiuatc  the  ^iziirc.  In  the  t-onvult^ive  form,  aa 
the  triomiin  is  difficult  to  overcome,  inhaklioiiM  of  amyl,  nitrite 
or  of  ether  may  be  practiced ;  rectal  injections  of  turpentljie, 
ammoniated  valerian,  tincture  of  aimfa^tidn,  or,  in  violent  cases,  a 
minute  quantity  (,',  ffi-.)  of  morphine,  hypodt-rmically  may  be 
administered.  For  the  various  coinpHcations  of  hysteria  tho 
tceourcca  of  the  therapeutist  arc  severely  tried.  Migraine  or 
clavns  may  bo  cured  by  attention  to  the  gcueral  health,  and  by 
BUch  remedies  as  guarnmi,  co<'ji,  mix  voiiiicii,  iirfieni(-,  ai-oniline, 
galvanism,  oto.  Hyfitcrieal  aphonia  and  dy>5j>hagia  may  8omo- 
tinios  be  cared  instantly  by  fanulit-  nppli^ationt*.  Anesthwia  is 
most  Bucce^fully  treatwl  by  the  electric  brush,  «  rtrong  wirrqnt 
being  applied  after  drying  the  jmrt  %vell.  The  varintm  fiirnis  of 
hyiiterk-al  iKiralyais  require  faradie  appliL-atioiin,  A  eiiigle  appli- 
cation may  overeotne  pnmlyiiiH  of  long  standing,  espeeinlly  if  the 
impression  made  by  ekx-'trieily  ie  nct-widod  by  laet  and  moral 
foreo  on  tlio  ]>art  of  the  physieian.  Mn'riiKi-i.  has  dcviiied  n  plan 
of  treatment  for  lK>d>fast  hyHlcrii-ul  subjueta  which  Beemn  very 
suceo^ful.  It  eon^^ists  in  the  eombined  nsa  of  massage,  fititnIiKa- 
tions,  and  fon^  feeding.  Ma!«uige  (HintiiKtH  in  tVi(-lioii,  kneading 
and  tapping  of  all  tJje  museles  except  thow)  of  the  face,  iit  passive 
motions  of  »U  the  juiniM,  ami  in  iniioiriilar  niolinnH  priHliu-t^I  by 
faradie  aftpliL-ationa.  The  frictions  are  mado  wUli  lard  oi'  oii'ao- 
buttcr.  Tlie  diet  oonsitita  at  fir^t  of  milk  oidy,  but  additionH  are 
made  to  it  from  timo  to  time,  until  ultimately  the  feeding  in  very 
libexal.  Ko  voluntary  exen-iKc  U  allowetl,  but  all  niovenienta  are 
made  for  the  patient ;  which  procures  exereiao  without  voluntary 
efTorL  Keniarkable  gain  in  weight  takes  plaoe,  and  when  the 
improvement  reached  a  certain  point,  Bynteraatic  volunturvexert-ise 
is  begun.  An  inijHirtant  point,  in  Mitclivll'H  trentnient  is  the  sepa- 
ration of  the  patient  fmm  all  her  former  associatiouft  and  the 
Buperabundaut  iiynjiMlhy  of  homo.  She  ih  placed  in  charge  of  a 
nurse,  on  a  diet  of  milk :  hunger  takes  tlic  plaev  of  her  indifibrenoe 
to  food.  She  ia  placed  in  bed,  and  not  jjennittcd  to  move;  the 
desire  for  action  grows  out  of  the  utterly  monotonous  idleness.  She 
is  acted  on  by  the  electrical  force,  and  by  the  moral  force  of  hor 


948 


MANUAL   or  TBEATUENT. 


new  environ moiits,  ai>d  stimulated  to  wise  thinking  by  the  in- 
genious suggentioiLH  uf  an  acute-minded  physician.  The  retnilt  ia 
that  Hbe  is  cured. 

* 

Jolly  sayi  that  the  i>ro|iliy1axiii  aliould  begin  in  childhood 
Careful  ti-aining  of  the  iiiiml  and  judicioua  hygienic  managemetit 
should  be  kept  up  tliroiigh  infancy,  youth,  and  csiMHrially  during 
puberty.  Marriage,  if  Iiappineflfl  results,  is  often  beneficial;  but 
more  frequently  it  provca  injurious,  cgpocially  to  weok,  anemic 
giris.  In  treating  the  disease  itself,  the  cause  should  be  sought, 
and  removed,  when  pojtsihlc.  Tlic  tonic  rcjjimon  plays  an  im- 
portant part  here.  Depleting  nioasuroa  are  rarely  requisite. 
Amenorrhtn  mny  require  ru€,  savliiei  &e.,  nn<l  Iceehw  to  the 
ccr\'ix.  The  eause  in  fi-wiuciilly  to  bu  found  in  aftWtiona  of  the 
genitals,  which  pwiiiii-e  their  ordinary*  treatment,  Oire  must  bo 
taken  that  slight  aftet-'tionti  are  not  over-treated. 

A  clotw  iiu|<iiry  ttliould  i>G  made  into  the  jiatient'e  rocutal  and 
emotional  state;  and  often  much  good  may  bo  done  by  judioiou* 
odviee  to  palienin.  Valerian  is  ilumght  to  bo  niiecially  utieful  for 
convnlMve  Ryniptonis. 

Musk,  castor,  nsafn^tida  and  galbunnm  are  valued  as  Rnti- 
hysterie  remedies.    Opium  is  even  more  highly  prized. 

Jolly  praiiwa  CHpc^ially  tlto  Kytttomatic  external  a])plicution. 
of  cold  water. 

Tliu  moral  management  i»  the  moat  im]>ortai)t  ]>urt  of  th« 
treatment,  ^'o  physician  ha«  lack  with  a!l  hi«  hysterical  cases. 
The  object  is  to  acquire  the  complete  confidence  of  the  patient. 
Her  attention  should  be  diverted  from  the  consideration  of  herself, 
to  the  griefii  of  others. 

Kidicule  U  uBelese.  "Faith,"  in  the  physician  or  otherwiae, 
will  sometimcfl  work  mimcleii  with  this  class  of  case*.  Strange, 
unuBual  or  aiifamiliar  remedies  often  aueceod.  Electricity, 
CBpfcially  when  applied  with  a  spico  of  mystery,  is  jiartlcularly 
effieac'ioua.  Throata  of  oold  doucliing,  of  the  actual  cautery,  etci., 
■omctimcH  do  good,  but  are  unsafe. 

CnARCOT's  method  for  convulsions,  of  strongly  compreasing  a 
semitiTe  ovary,  is  only  exceptionalty  eJlcctu&l. 


IMPOTKNCK. 


249 


Tor  hyf<ten>-ci)ilepsy  Uie  broniideti  arc  on  iiBeful  as  in  true 
niepsy.      lu  spa^m  of  the  glottis,  ether  or  chloroform  may  be 
inlialed.     Klectrteity  U  the  rcmody  for  hyMtfrtoit  puralysia. 
Anuthesiag  require  the  faradic  brush. 

Theoe  renicdieii  are  valuable  in  tlie  treatment  of  the  oymptoma, 
but  it  la  improbable  that  they  can  cure  hysteria.  The  danger  of 
forming  the  o]>iutii  habit  is  very  great. 

The  dietetic  and  hygienic  treatment  is  more  effectual.     As 

lis   involreit  the  treatment  uf   Uie  morbid  condition  present, 

generally  anemia,  it  will  save  repetition  if  we  refer  oar  readers 

ihc  article  on  Ihat  tlicmc. 

We  may  add  that   the  first  requisite  in   the  treatment  of 

hysteria,  ia  plenty  of  vit  on  the  [lart  of  the  physician,  with  a 

jfound  knowledge  of  the  devious  ways  of  the  female  heart 

Wktr  XfiTcnEi-L  is  Kaid  to  make  his  "rest  cure"  effective  by 

his  patients  in  such  a  manner  that  th^y  soon  become 

willi  one  over-inaMtenng  [mwiion — the    longing    to  get 

away' — and  this  truest  kindness  in  the  guise  of  harehne^^  is  very 

cfessful. 

The  reputation  of  aaafottida  is  hardly  deserved.  It  in  but  a 
feeble  hysteria  which  will  give  way  sooner  than  take  a  little  of 
this  drug.  One  of  the  most  enthiisiastic  endorsers  of  asafcctida 
claimed  that  it  wax  only  etliN:tniil  when  applied  to  tlic  vaginal 
mucoua  membrane,  and  rubbed  in  brii^kly  with  the  tingera.  This 
savors  of  the  advice  to  frighten  ofF  mad  dogs,  by  stooping  down 
uutii  the  head  looked  back  from  between  the  knees,  and  thus 
I  advancing  toward*  the  astonisbiHl  aiiiiiiitl. 
^^b  Valerian  is  often  u  great  tx)nifort  to  hysterical  persons.  The 
^^best  pre[]arution  is  the  ordinary  tincture. 


IMPOTENCE. 


CORLixo  aaya  that  there  are  certain  cases  in  which  canthar- 
les  art!  Utmful.  In  atony  of  the  orguna,  with  iVcblc,  unstable 
and  insufficient  erections,  ten  to  fifteen  minims  of  the  tincture 
may  bo  given  every  three  or  four  hours  for  a  short  time  before 
the  occaaiou  arises  for  the  exercise  of  the  sexual  fuactions.   Dilute 


260  MAKUAL  OF  TBEATMKNT. 

phosphoric  ncul,  plimpliBte  nf  iron.  Btrychnlne  and  ergot  am 
remedies  which  may  bu  given  in  ini})uii!iu-^*.  The  condition  to 
which  thewe  aphrodifiac  remedies  are  chiotiy  applicablo  is  when 
t])c  pt'uis  lit  liut  feebly  excited,  atid  doei  not  innintiiin  the  physical 
state  necessary  lor  penetration,  during  the  j^^^riod  of  conferees. 
Such  torpidity  may  exint  iii  pcrsoiu  in  whom  dMirctf  an.*  at  times 
strongly  felt,  and  the  tiinetinns  of  the  testicles  properly  performed. 
In  these  cases,  also  in  timid  i>er8oii8,  and  in  olhern  wlinne  orgnns 
are  incxritahle  from  hmg  diHUrtc,  stimulating  ti-eatment  may  con- 
duce to  BUfcesrt,  and  ensure  confidenoc  for  the  future.  Bui  those 
remedies  exert  no  influence  in  a  const itntional  apathy  of  the 
(HjxHul  functions.  They  Imve  rai-ely,  also,  more  than  a  tcinporarj 
eftect;  and  in  persons  advanced  in  life,  when  the  parte,  having 
fulfilled  their  office,  are  experiencing  their  natural  decline,  they 
operate  iTUurioiialy,  and  tend  to  prfiduce  eongeation  of  the  prostate 
and  local  disease.  In  those  cases  also  in  which  the  ecxuul  or^ana 
sre  wpiikcnod  or  prematurely  exliitustod  by  cxccm^,  they  are  like- 
wise hurtful,  as  well  as  fruitless.  After  aucb  obuscfl  a  jwriod  of 
rejioBe  is  required,  and  by  the  avoidaucc  of  all  sources  of  excito- 
mcnt,  and  by  diet  and  remedies  adapted  to  invigorate  the  body, 
such  as  the  preparations  of  etecl,  a  gnidnal  restoration  of  the 
procrcativo  functions  may  be  ho])cd  for. 

Electro-mag;neti8m  U  h  nrniedy  of  i*orae  efficacy  in  certaio 
forms  of  impotency.  Int«rrupte<l  currents  (Faradic)  may  be  paamd 
in  two  dtructionisfrom  tlie  jK^rineuni  to  the  glan»<  {X-'iiis  in  eases  of 
defective  erectile  power,  and  from  the  groin  idoug  the  spermatic 
eord  to  the  teitticlca,  in  cant-H  wlierc  th(»e  organs  arc  soft  and 
flaccid,  and  where  Hcrretion  is  laiignid.  The  results  are  often 
duap}H>iiitiiig.  In  i-u.-«cs  in  wiiidi  tlie  desires  uru  Htn)ng,  Init  tlio 
erections  feohlc,  tJie  wnsibility  of  the  glans  jieiiis  is  eo  lowered 
that  the  fnctlon  of  coition  irt  inaipable  of  maintaining  prolonged 
distention  of  the  oi^aii,  and  erection  sulwides  shortly  after  (leiie- 
tratton  and  betore  complcttoit  of  the  act.  A  few  applications  of 
the  electric  cun-cnt,  hy  rendering  the  glaiis  penis  more  sensitive, 
may  cau!«;  a  more  pereistent  distention  of  the  organ  imder  the 
natural  excitement.  Elect ro-mugnetism  fiucceeds  more  frequently 
in  impotency  of  this  chariicter.  than  where,  in  addition  to  dofco- 
tive  erection,  the  desires  ore  fwble,  and  the  testicles  soft  and 


JIIPOTENCB. 


inelastic :  uihI  yet  the  repctilion  of  the  remedy  haa  succeeded  in 
aoino  in.^tancefl  of  thio  low  hopeful  kind  in  nxiiting  a  donnant 
power,  causing  accretion  to  be  resumed  nnd  enH:tioiia  to  returo. 
The  special  treatment  required  in  vas&i  due  to  injury  of  tJic  twntrdl 
nervous  aj-Btem,  after  recovery  Irom  head-symptoms,  is  the  xme 
of  o]ectro-ma^etigm,  applied  from  the  occiput  along  the  Rpine. 

In  atonic  impotence  the  yonnger  Gross  advises  the  rcmoral 
of  all  existing  causes  of  urethral  hyperesthesia.  The  rediindant 
prepuce  must  be  circQmv:i3ed,  the  eontnictcd  meatus  enlai^ed, 
bcrpC8  or  balanitis  cared.  Certain  dieoaec?  of  the  bladder  and 
rectum  re'iuire  u  like  attention. 

The  patient  roust  be  warned  against  all  soorecs  of  eexua) 
excitement,  snob  ob  masturbation,  attempts;  at  inter^roume,  toying 
with  women,  and  impuro  books,  pictures,  thoughts  or  coiivereation. 
Tlie  sexual  appetite  may  alno  Iw  kopt  in  al>eyan<.'e  by  mental 
emplo^nncnt  and  iiymnastio  exercises. 

Lo<nlly  the  favorite  remedy  \b  tlie  Atcel  tiound.  Tliiti  ohonld 
Piu^-mkI,  of  full  size,  at  first  every  thrc«  days,  and  afterwards 
onee  daily.  It  should  be  rutainoil  but  »  tiiintite  at  fintt,  t>ut  (he 
time  may  b©  gradually  lengthened  to  a  half  hour.  The  treatment 
suitable  tn  Htricturcp  should  W  instituted  if  one  be  proRcnt.  In 
peychical  im[^>ot(^ncQ  from  undue  sexual  excitement,  a  placebo  will 
give  relief.  GROfts  mentionM  de  CauxV  case,  in  which  the  wife 
slightly  intoxicated  the  husband ,  which  removed  the  difKculty. 
The  aame  preomtioHH  are  necessary  aa  in  hypochondria,  to  gain 
the  patient's  confidence. 

tFor  (typhilitic  im|)otencc,  Kkyes  recommends  the  ordinary 
iti^yphilitic  regimen;  together  with  tonics,  sea-air,  fiictiona  to 
le  «kin,  and  xhowcr-bntliM. 
Ebb  prefers  the  galvanic  current.  Jle  places  the  anode  (Inig^ 
ectrodo),  upon  the  lumbar  cord,  the  cathode  (medium)  utabile 
)m1(1  labile  along  the  ttcminal  canal  from  tJie  inguinal  ring  down> 
wards  for  two  miimt<CB  on  each  side.  The  current  should  be 
strong  enough  to  cause  a  distinct  btiming  sontialion  in  the  skin. 
Then  follow  vigorous  labile  applications  of  the  cathode  for  a 
minDtc,  to  the  upper  and  lower  siirfuccA  of  the  i>eniFi,  and  Grially 
the  catliode  is  applied  labile  and  stabile  ni>on  the  perineum  iw  far 
rwanl  as  Ute  root  of  the  i)eni«  one  or  two  raimites. 


MAKVAL   OF  TftB&TMRKT. 


A  faw  intcrruptioHft  or  chingea  of  polarity  mcTeaae  th» 
etimulatioii.  If  tlie  glanH  be  aiieHthctic,  llie  oitliodc  may  be 
appliutl  to  it  longer.  If  the  testicles  be  atrophied,  flaccid  and 
cool t  the  current  may  W  portHod  through  them.  Ancstliedia  ii 
also  bciieiited  by  the  use  of  the  faradic  brush,  to  the  glans 
Bcrotuin. 

Treatment  muat  be  continued  daily  for  six  or  eight  weeks. 

For  deficient  erections  Bailtuolow  recommended  h^-podermio 
injcctionfl  of  ergotm  in  the  dorauni  of  the  i>ent3. 

Fhosphoms  has  some  power  in  restoring  the  waning  wxoal 
|H>wer8,  gold  ho-s  still  more-  Several  patients  to  whom  1  liad  been 
giving  coca  for  other  objects,  have  reported  to  me  an  increaee  in 
the  sexual  power  ittibaequent  to  the  uae  of  this  ahigular  drug. 

The  difficulty  is  not  so  much  in  restoring  the  power  of  sexaal 
congress,  aa  that  the  putient  will  tako  luivantage  of  his  renewed 
vigor  to  commit  such  cxvcsseg  as  will  inevitably  recall  his  ailment 
.One  gentleman  who  liad  heou  impotent  for  more  than  a  year  waa 
cured  by  the  use  of  the  chloride  of  gold,  given  in  doses  sufficient 
to  caum>  a  senKO  of  fulnesH  in  the  ean.  He  informed  me  aubaa- 
quently  that  ho  hod  performed  the  sexual  net  seven  times  in  a 
single  night.  From  this  I  augured  a  speedy  and  permanent 
return  of  bin  malady;  and  my  prediction  was  verified. 

Many  men  become  impotent  after  ])a.<Ming  their  fortieth  year. 
I  have  noticed  that  this  is  more  often  the  case  with  stout  and 
plethoric  men,  who  are  brain- workers,  fond  of  strong  food,  Mid 
who  lead  a  sedentary  life-  While  the  various  aphrodisiacs  will 
auct:eed  in  Htimulating  the  flagging  energies  for  a  little  while,  it 
is  far  better  that  the  ^mticnt  should  take  it  as  a  warning  that  the 
play-time  of  youth  is  past,  tlmt  ita  pleasures  and  follicA  are  for 
younger  men,  and  that  to  him  there  only  remains  to  devote  him- 
self to  the  working  part  of  his  existence,  and  the  more  elevated 
enjoyment  of  intellectual  pnrsuitB.  [W.  F.  W.] 


INFLUENZA. 

Baetrolow  says,  repose  iu-door&,  a  generous  diet,  and  the 
moderate  use  of  Btimulants.  arti  the  most  important  measures. 
At  the  outset  a  full  dose  of  quinine  gr.  xv,  and  morphine  gr.  sa, 


exercises  n  favoralile  influenoe ;  aiid  Uirougliout  the  diwswe  these 
aru  Uiu  moat  uiteful  remedies  to  quiet  the  iiurus^iiig  cough  »iid  to 
maintain  the  Mtrengtli.  If  there  be  much  secretion,  belladoniui  or 
its  active  ]jriiic')plc,  atropine,  may  be  combint^  with  morphine  and 
qninine.  It'  tbe  bmnchial  iuuct>u^  membrane  be  severely  uttacked^ 
Bxoall  doMS  of  tartar  emetic,  or  tperac.  and  morphine  are  usefuL 

Er  R  EiL  ip*cic.  fl., rs  ij 
Tinet.  opii  di>odftr, f  J  It 
TliMt.  ooon!  ll  ntd fjj 
M.  8. — Si  Io  ten  <Imp«  ifTory  iwo  htnm. 
If  the  finer  tubes  be  involved,  the  iofiide,  muriate,  and 
Mwte  of  ammonia,  should  be  freely  od  miniate  red.  If  tbe 
Btoniach  be  very  irritable,  aa  is  the  awe  in  many  epidemics, 
■the  most  useful  remedies  are  oxalate  of  cerium,  hydrocyanic 
acid,  minute  dosee  of  morphine  siibcutuncouitly,  carbolic  acid, 
■with  or  -witbont  bismuth,  et«,  For  the  violent  head  symptoms 
which  sometimes  etisne,  the  most  appropriate  r(;niedie«  are 
bromide  of  potaediom,  geUcmiura,  duboisin,  mor]>biuo  sub- 
cutaneooaly,  etc,  If  there  be  much  lix-al  dititress,  the  vapor  of 
hot  water  should  be  t^Mlulously  inhaled.  When  the  first  irrita- 
tiou  is  felt  in  tbe  nnre.';,  a  liolution  of  muriate  of  quinine  should  be 
applied  and  allowed  to  p&m  through  into  the  fauces,  after  the 
manner  of  Hei,uiioltz.  It  ]»  probuble  that  pilocarpine  will  be 
fbond  extremely  uselnl  in  eases  of  inHiicnza,  a(iiniui^i<,n''l  nt  tbe 
outiwt  with  the  view  to  aboi-t  the  malady.  As  &  self-limited 
i»eiwe  arising  fmni  an  nnliiiown  cauw,  it  niuy  be  Hafi'Iy  left  to 
e  reMiureoA  of  nature,  uule^  the  rise  of  complieations  demand 
tcrference. 


I 


LooMis  wants  against  exposui-e  to  cold  during  the  prevalence 
influenza.  Quinine  sometimes  abortit  it,  if  given  in  very  large 
loses  at  the  very  onHct.  lu  the  curly  sluge^  Lodmis  gives  one 
■grain  of  ipecacuanha  in  half  an  ounce  of  Bpir:t*i  of  Mindereras, 
every  three  hours.  Milk  with  an  alkaline  water  is  the  only  food 
for  tbe  tirst  two  days.  If  paticnta  bo  Mstlous,  small  do3C3  of 
^J)ovor'9  powder  are  adviecd.  Steam  inhalations  relieve  the  bron- 
lial  and  laryngeal  Hynipuim*  The  prostration  occurring  in  the 
Tory  young  or  old,  or  in  the  feeble,  is  lo  be  early  comljated  with 
tinmtanta.      All    depreBsants^  are^^eontrn-indicuted.     Colehicum, 


If  the  Attack  be  arreie.  Ae  p«1k  £nn,  and  tbe  temi^ratoR 
103^.  be  addi  ■  dmdiB  of  tiDCtan  of  THatlVB  Tizide  to  the 
*boTc  JbranUa.     Wba  tlw  SAcile  qrmpcoeu  afakte.  the  powi]«ii^ 
ar*  duoootiDD«d,  and  *  laxatirt  girm.    Afttr  tlu*  hu  operatedfl 
the  cxpedofint  ndxtne  m  eootiDaed,  and  fire  grains  of  quiniiw^ 
ipveo  cadi  tdgbt  sad  mamng.    In  Mine  elderir  pcmtms  be  auU^ 
ftitqtci  waegs  and  asdepias  fi>r  ibe  ipecac  mad  eqailis.     Vfan;^ 
mild  CUM  bare  beat  aboned  by  a  eii^le  do$e  of  Dover's  powder 
and  qoi&ine,  each  ten  gnun«,  witb  fire  grains  of  c^omel ;  fol* 
loired  bjr  a  lajulive,  and  three  £T«i»  of  qnintnc  aovenl  timet 
daily,  for  tome  dajL  ^^^M 

Tbe  nine  resii]t»  might  be  obtained  from  pQocarpuie^^M^ 
lowed  by  quuuiie. 

In  spile  of  the  variety  of  drags  which  have  Le«ii  adniinis- 
terod  in  inflaenza,  there  ItzA  not  aa  yet  been  fnaml  otic  wbitdd 
really  influence*  the  cour*o  of  the  (Ui«esi*e.  AVe  look  with  dia- 
favor  on  attcmptji  to  bnsik  tip  an  attjiek  an  u*e  do  n  cnniiuon  cold. 
In  ordinary  eaued,  cocaine  may  be  o^ed  as  a  palliative,  a  two  per 
Pont.  Nolution  l>fing  iiiipliwl  to  tlie  nose,  thrrjat,  ponjunetii-a  and 
laryngi>lrai;li«il  wijeouH  nioiubraoe  by  atomizattoiL 

In  the  young  and  the  aged,  the  utmoat  care  mmt  \k  used  to^ 
iiupport  the  Htrcnf^th.  So,  alfto,  in  those  who  arc  debilitated  by 
)>ruvio(H  diMsiuw.  lu  all  thcee  cnace,  wiDe,  ammonia,  and  hot 
Houjift,  with  cofi'ce  and  milk  punches,  should  be  used  with  on 
unA]>Aring  yet  cniitionA  hnn<).  And  yet,  hnw  singularly  ineffi- 
OQoiouit  arc  all  theee  mcfl«ure«i  in  tbe  worst  forma  of  infltiettsa  I 


INROMXIA. 


255 


INSOMNIA. 

Davis  calls  attention  to  the  imfKirtanco  of  removing  the 
loac.  The  exccaaive  use  of  tea,  coffee  or  tobacco,  rourtt  be  clis- 
^(ontimied.  Intense  or  protracted  mental  cxcrc'we  or  excess  of 
tmro  must  be  removed  before  succe&s  can  l>e  hope<l  from  ta*catinei]L. 
In  the  cases  where  the  jMiticnt  ''must  Hnieh  tliu  vrork  he  has  on 
Iiaiiil  b«fore  he  can  rest,"  there  is  a  gi-ent  temptation  to  obtain 
sleep  by  resortins  to  alcohol  or  to  hypnotics;  wliich,  once  com- 
menced, are  rarely  kid  aeitle. 

Niiictecn-iweDticths  of  all  cnec^  of  insomnia  will  yield  to  the 
bromides  and  pcrhap?  to  di^talis,  if  the  cause  be  removed.  Ten 
to  twenty  f^ins  of  the  bromide,  with  ten  to  twenty  minime  of 
tho  tincttire  of  digital)!),  olioutd  be  given  half  an  honr  before 
Itimc.    The  dose  may  be  repcotenl  in  two  hours  if  neceeeary. 

He  haa  abandoned  chloral,  on  account  of    the   unpleasant 
3sation»  following  it»i  uiw.    Sometimes  Taleiian  n\ay  be  eub- 
tituted  for  the  dij^italiH. 

Bastian  also  promises  hi«  remarks  on  treatment  by  8i»eakiag 
the   nowaaity  of    coiTCCting  the  physiologieal  conditions  to 
rhich  the  iusoronia  is  due.     Mental  repose,  bodily  comfort, 
warmth,  a  certain  decree  of  fatigue  and  quietude,  are  eiii^ntialfl. 
An  evening  walk  is  often  effective. 

A  cup  of  hot  bcef-tca  or  gniel,  just  before  retiring  may  have 
salutary  iutloence.  Monotoiioue  sounds,  frictions,  or  thoughts, 
iave  a  tendency  to  induce  "leep.  Besides  the  ordinnn-  hypnotics, 
le  speaks  of  the  sedative  influence  of  the  wet  packs. 

Mans  rm^unnuondrt  [iroh)ngc<l  wnnn  iMithn,  with  cold  to  the 
iiead,  for  insomnia  with  excitement. 

KlCKHOLt  pJacM  the  bromides  fii'itt  in  irritative  and  neurao- 
licnic  caceM.  Kighty  grains  kIkmiM  be  given  an  hour  before 
Btiring.  Opiimi  is  ronlra-intlii-jited  in  uremic  eases.  Chloral 
3t>uld    be   avoided    in    old   age,  an<l    when    the    heart    is  weak. 

CatiUAbis  is  useful  in  melancholia,  but  is  to  be  avoided  in  cerebral 

excitement. 


n.iUM>JKD  c»IU  attention  to  the  value  of  musie,  monotonous 


I 


S66 


HAWAt  or  TKUTUBKT. 


occupations  aniilpepetitions  of  words.     A  hearty  supper  predis- 
poses tu  Hloep.     Coffee  will  nomvtiniea  cause  sleep,  cepecially  ia' 

womeu  whose  circulation  ia  languid. 

C.  ITaitdfibld  Jonee  says  that  a  mustanl  ponUice  to  the 
CpIgttKtrium  will  c&u^  sleep  by  stiraulating  a  languid  solar 
pleins.  For  weakly  and  liyperesthetic  penrous,  exiKWure  lo  cold 
Open  air  is  an  ext-elleut  soiiorifie. 

WiLLKMiN  rocommcnds  codeine  for  elcepleMnesa  from  patn. 
Quinine  relieves  corebnil  congesuon. 

There  are  two  couditiona  which  give  rieo  to  insomnia^-cere- 
hral  anemia  and  cerebral  byperemiji.  The  treatment  must  be 
directed  hy  the  knowledge  of  the  state  present. 

The  physician  should  resohitely  set  his  face  against  the  use 
of  alcohol,  opium,  chloral,  ntiesthetios,  or  any  other  dniga  aa 
Bleep-prndui;cn<,  when  a  patient  is  deatrtiying  him»olf  by  over- 
■work.  When  exhiuistcsl  nature  gives  warning  that  ehe  has 
reachetl  the  limit  of  her  endiinuifC,  the  phy^tician  lina  no  right 
to  stc])  in  and  aid  in  the  ttuiL-ldal  coorec  of  his  patient,  by  enabling 
bim  to  rontiniie  hifi  occupation.  And  it  will  nearly  alwaya  be 
found  that  if  the  trasted  medical  adviser  gives  his  opinion  frankly, 
and  adheres  lirmly  to  liin  dfidsinn,  the  patient  will  acquiesce. 

The  most  etficient  drug  in  cerebral  hyperemia  is  hydro- 
bromlc  acid<  A  draclmi  of  tlie  dilute  acid  may  be  givcu  at 
bed  time,  in  a  wineglass  of  sweetened  water.  This  dose  may  be 
repeated  cvcrj'  two  hours,  with  anfoty. 

When,  after  a  hard  mental  tae'k,  the  forehead  ia  hot  and  tho 
temples  throbbing,  it  is  good  to  attract  the  blooti  from  the  brain, 
and  the  mind  from  its  engrossing  subject**  of  thought,  by  swing- 
ing  the  Indian  t'luhs,  or  taking  a  smart  run,  before  going  to  Iwd. 
If  the  forehead  by  cool,  or  a  eeiise  of  debility  Iw  manifest,  a  bowl 
of  beef-tea,  or  some  other  hot,  non-elimnlating  drink,  will  seaora 
sleep  more  siirc-ly  and  more  invigoi-ating  in  its  effects,  than  any 
drug  in  the  Materia  Modica. 

When  inability  to  sloop  results  from  over-fatigue,  after  mus- 
cutiu*  ciertinn  and  wukefuhiess  prolmiged  to  an  unusual  period, 
acu^i^  weak  coffee,  or  a  warm  hath,  will  produce  sleep.     The 


IKTEBMITIEST  FBVBR.  257 

€»ffce  must  not  be  too  strong,  or  tlie  cure  will  be  overdone,  and 
coftee-iDsomnia  result. 

Of  ihu  iiow  lijjinotic*,  piacidin  crytlirina  has  provcJ  unsatis- 
factory. It  U  a  uecfal  palliatire  iu  coughs,  but  not  a  hypnoti& 
^irftldehydo  iirovtH]  moKt  valuable  in  tlio  insomnia  followiug  a 
drunken  <leba«L-h.  The  dose  is  from  one  to  two  dmchms.  It  may- 
be admiiiidtercd  in  ayrup  of  orange,  with  tragocantli  and  a  few 
drops  of  cbloroforni.  Ui-etban  and  tannate  of  cannabine  have  not 
an  yet  eaineU  the  n^ht  to  i-eplacv  the  oMcr  roincdiua  wliich  are 
better  known.  Lupalin  ie  of  great  value  in  delirium  tremeua 
a&d  ID  some  fornix  of  mania. 

An  efficient  and  safe  hypnotic  may  be  found  in  the  foiadic 
current,  possod  simply  tbrougli  the  hands,  or  from  one  hand  to 
the  feet 


INTERMITTENT   FEVER. 

Baiitrolow  writes,  if  there  be  no  time  to  prevent  the 
paroxysm,  wc  i»0!WCf«*  ineniiw  to  aJKirt  it  at  the  cliiU  stage.  The 
expe4lie[]tB  resorted  to  for  Ibis  purpoae  are  very  numerous,  and 
include  nitrite  of  amyl  inhaJntions,  chloroform  by  inhalation  and 
by  the  fttomacb.  and  the  by(KMlermic  injection  of  morphia  and  of 
piloear[)in&  Fmrn  a  balf-dradmi  to  u  dinc-hm  (lluid)  of  cliloro- 
form,  given  in  some  sweetened  water  by  the  stomach,  or  adraini»- 
tered  by  iidialation,  will  u.-iuuny  urrent  the  chill,  and  gj-catly  Iciuion 
the  severity  and  duration  of  the  Succeeding  stitgc.  Amyl  nitrita 
14  abto  quite  e£Qcieut  in  bringing  ou  reaction  njid  abbreviating 
the  chill  etagc,  but  it  exorciiHw  little  or  no  influence  on  the  other 
atagee.  liecent  obser^-ationa  eeem  to  prove  that  pilocarpine,  of 
all  the  remedies  hitherto  proposed  for  this  purpose,  cxcroi&cs  the 
niD9t  remarkable  influence.  If  adminiistercd  as  the  chill  is  coming 
ou,  it  stops  it,  and  eubiititutes  a  sweating  stage,  thus  preventing 
the  full  evolution  of  tlie  ])«roxy»(m.  The  nioxt  n-nmrkidile  point 
is  that  the  discoee  Moms  arrested,  and  relup*e^  are  prevented  in  a 
considerable  proportion  of  Uie  canefi.  If  these  obf*t*rvulioii8  are 
confirmed,  we  shall  have  in  pilomrpine  tbc  most  useful  remedy 
in  the  treatment  of  iutermittenta.  From  one-twelfth  to  one-sirth 
K 


iBATMKinf. 


grain  of  the  nitrate  or  murUte  of  pilocarpioe,  given  hypodenni- 
c»ll,r,  i»  tlie  approprinte  dose  for  an  adult,  and  this  ebonld  bej 
given  as  tlic  chill  is  about  to  occur.  A  correspotiding  doac  {oo^  I 
nixth  to  one-fourth  grain)  can  I)e  given  by  the  stomach  half  ao 
hour  before  the  chill-time.  If  the  chill  Iiavc  anvthlng  of  tba 
pernicious  c:hiinii;t.<T  alN»ii{,  it,  the  most  efficient  remedy  is  tbe 
hypodermic  injection  of  morphine  and  atropine.  In  any  of  tie 
ino<icfl  in  which  tho  ]K!n)ii-ii)UK  Attacks  come  on,  the  reinediea  are 
two — morphine  and  riuiriine — and  the  mode  of  administration  sub* 
cutaneous.  From  one-twelfth  to  onc-fourtli  of  n  grain  of  mor- 
phine can  be  given  to  an  a<lult.  Maximum  doses  of  <[mninc  ore 
required. 

Much  difficulty  has  hitherto  been  experienced  in  preparing 
a  Huitubic  sohition  of  quinine.  As  the  muriate  of  quinine  and  the 
bromide  are  soluble  to  a  much  larger  extent  than  the  eulphate, 
thoy  may  bo  uaed  for  eohition  in  water  only;  but  a4  the  quantity 
required  ie  80  groat,  a  solution  of  the  eulplmte,  dissolved,  bj  tlw 
aid  of  sulphurio  aci<i,  is  generally  preferred. 

R     Quinine  dbulph, gr.  I 

Add.  sulpliQjic.  dU., '^K  < 

Aqiur,  — f$j 

Add.  L-arbol.  Uq.,. ^  ▼ 

&r.-8olre. 

The  dose  of  quinine  injected  in  a  peniidonft  caiie  should  not 
be  leas  than  twenty  grains,  and  this  may  be  repeated  two  or  three 
times  until  reaction  is  ei^tabliMhecL  In  the  abfience  of  the  method 
or  means  of  hypodermic  injection,  quinine  and  morphine  may  be 
administered  by  the  rcx-tuni,  if  iniM;n«ibility  or  irriUibility  of  Uie 
atomaeb  prevent  the  introduction  of  remedies  into  that  viaooa. 
If  the  apjiniiwh  of  a  jxirnicious  internnttonl  18  indicated  by  the 
presence  of  head-symptoms,  drowsiness,  headache,  vertigo,  etc-i 
the  administration  of  full  doftes  of  quinine  should  not  bo  delayed. 

In  the  treatment  of  ordinary  intermitlenta,  our  attention  is 
■directed  to  the  prevention  of  future  attacks  Although  no  pre- 
paratory treatment  is  actually  required,  better  Hwults  are  obtained 
jf  the  giistro-iiitestinal  derangement  ia  removed. 

During  the  intorvala  between  the  admiuietration  of  quinioe, 
the  remedies  boat  adapted  to  the  existing  state  of  malarial  cachexia 
Are,  besides  iron,  arsenic  and  eucalyptus. 


Vor  the  chill,  Davis  give*  thirtj  to  forty-five  minims  of 
obloroform,  I'v  the  aUimtuAi. 

Ill  ihc  Lot  Btage,  he  recommendi  spontrlug  with  oohl  wat«r, 
cold  cinihtt  to  the  head,  and  aconite  or  Teratrum  viride,  ouo  to 
two  miuims  of  the  etrong  tincture  of  cither. 

To  prevent  the  recurrence  of  (he  ohilU,  ho  gives  ten  to 
twenty  grains  of  qumine  on  the  firat  aod  second  day§,  and  eight 
to  twelvtr  grains  on  c-ach  day  suhsi:H[iicnlIj,-,  for  three  days.  lie 
divider  the  daily  portion  into  three  doses,  giving  one  in  the 
awcaiting  stage,  another  in  the  middle  of  the  intermiiwion,  and 
the  third  one  hour  hefore  the  expected  chill. 

Due  attention  should  be  given  to  tlic  eomlition  of  the  howela, 
and  to  the  general  health.  To  restore  the  tone  of  the  hlood  after 
the  paroxydms  have  ceased,  ho  gives : — 

9     Qolnuue  giilph 

Forri  citpml., U    3j 

ExUhjcMcruni,. 5« 

Ext.  ntida  vomioe, gr.  x 

M.     Div.  in  pil.  Tel  mpHil.  no.  >xi. 

S. — One  M  be  ukeii  beliire  cai-h  luenl  for  a  we«k;  oue  Iwioe  a  flaf  duriog 
tfc«  BMOoil  WMk ;  ftod  one  dailjr  during  the  tbml  week. 

The  practice  of  giving  alcoholic  hitters  is  periiicioiw.  They 
have  no  good  oflbct.  on  the  ague,  and  h'nd  fo  hidiito  of  alcolioligm. 

Maclkax  givGei  a  t4.li  grain  dose  of  quinine  at  the  end  of  the 
sweating  stage,  and  repeats  it  in  four  t<»  six  hours. 

The  cwlebrated  African  explorer  Livisbstonk,  whose  experi- 
ence in  malarial  fevers  wa«  nnjwralleled,  was  accuBtomed  to  give 
MX  or  eight  grains  of  re*tin  of  jalap  and  of  rhubarb,  with  four  graiuB 
each,  of  calomel  and  quinine.  Tn  Hve  linurt  fi-ee  cathai-sis  ensued, 
or  waa  produced  by  an  onvma.  Tlicii  he  gave  four  grains  of 
qninine  every  four  hours  until  twelve  grains  had  been  taken. 
He  considered  that  any  other  mode  of  dealing  with  tlio  levers 
of  AfHca  wiw  trifling. 

KArnsrs  Btatos,on  the  auUtority  of  Govs,  timt  if  quinine  be 
long  used  ae  a  prophylactic,  it  loses  its  power  over  malarial  di»- 
eaaea.  TIic  best  propliylactics  arc  a  generous  diet,  plenty  of  work, 
both  tnental  and  physical,  but  not  to  exhaustion,  avoidance  of 
night  air  aud  wet,  proper  clotbing  and  a  cheerful  diHpo«*ition. 


260 


MANUAL  OF   TBUATJiEKT. 


The  free  use  of  iwjiper,  and  the  taking  of  a  Bmall  cup  of 
coflee  on  rising  is  favorably  nientioueil.  Diiruig  the  night  the 
doors  and  vi-iudowfi  should  be  closed,  and  an  open  fire  should  he 
lighted  in  the  evening  and  early  monnng.  Tlie  drinking  wat«r 
should  be  filtered  or  thoroughly  boiled  before  being  used, 

EiigliBh  surgeons  in  India  found  tliiit  quinoidine  ranks  th« 
higheNt  of  the  cinchona  alkaloida  in  pro])bylactic  value.    Three 

grains  were  given  daily. 

• 

To  this  wc>  inay  add  that  persons  llviug  in  malarial  districts 
will  do  vrell  if  they  sleep  hh  near  the  top  of  the  bouae  as  possible, 
and  take  t!ie  moniiiig  eofl'ee  before  arising.  Tliey  should  reiuain 
io-doors  until  the  sun  has  diriHipated  the  noctnmal  mista,  and 
Hhould  not  go  out  after  sunset. 

Beutss  recomiuendi^  that  in  congestive  chilU,  or  ule^d  fonosi 
onc>-si:cth  nf  n  grain  of  morphine,  with  oue-fortioth  of  atropine 
be  injected  hypodermically.    Amyl  has  also  been  recommended. 

Akpebson  used  iodine  snccessfnlly  in  intermittflnts.  Ho  gave 
ten  tfl  fifteen  minima  of  tlu?  ct»iu]iound  tincture  before  each  meal, 
well  diluted. 

A  boHt  of  other  i-t'inedieB  and  combinations  have  been  used 
with  reputed  success  in  ague,  but  as  none  liavo  ef^ualled  quinine 
and  the  other  (^inehona  ulknloidR,  it  Is  not  deemed  advisable  to 
give  them  in  detail ;  cspocinlly  as  their  mention  is  apt  to  load  the 
reader  from  the  use  of  cintJiDna  Into  doubtful  exgwriment^. 

When  quinine  cannot  he  given  by  the  mouth,  it  may  he 
administered  by  the  rectum,  or  hyiwdormically ;  or  it  may  ho 
made  into  iin  ointment  with  lanolin  nnd  rubbed  into  the  skill. 
If  used  by  the  hypodermic;  method,  the  dose  shoidd  be  oneJialf 
that  by  the  mouth ;  but  for  rectal  ua«  the  latter  dose  ahoald  be 
doubled,  and  for  inunction  it  may  be  quadru]jled. 

Free  catliamla  at  or  near  the  time  of  the  expected  diill,  aids 
greatly  in  preventing  the  paroxysm. 


OBSTRTJCnOX  from.  inUmal  etm-ngaUttion. 

"Dtrbam  thinks  that  until  the  nature  of  the  caae  ie  fiilly 
aIc  out,  the  measured  to  be  a^loptcd  coiuist  of  perfect  reet, 
rehixation  of  the  abdomen  by  ponition,  hot  or  ootd  appUoAtionH, 
tli«  oee  of  opium  atid  belladoTiiia,  or  of  anesthetics,  a«  nmy  be 
indicated.  Knemata  may  be  uwd,  but  purgatives  add  to  the 
di8tre«s  and  daager.  Ice  may  be  sucked,  but  little  must  be 
swallowed  of  fond  or  drink. 

When  the  nature  of  the  case  U  determined,  an  operation  ia 
indicated,  and  the  <>Qrllt>r  it  iti  done  the  belter. 

Abdominal  taxia  under  chloroform  may  iirat  be  tried. 

If  tbitt  fail,  an  inf^iitluii  ohould  be  made  in  the  median  line, 
above  or  below  the  umbilicus,  and  the  obstruction  sought  out 
and  relieved. 

2,    OBSTRUCTION  from  impaetion  of  gall  alontf. 

Di'MixM  3Byrt,  pftlliation  alone  can  be  recommended  at*  a  rule; 
but  enterotomy  appears  to  be  justiSable. 

8.     OBSTRUCTION"  from  intussusceptiov. 

Dt'RDAU  says  that  acute  intusauseeption  Id  an  infant  dcmanils, 
first,  a  topioufl  enema  of  oil.  gently  and  nlowly  injeftwl,  tlie  body 
being  invested  and  moved  about,  while  taxia  ia  performed  at  the 
same  time. 

Insufflation  by  air  may  he  itubstitnted  for  the  enema.  Should 
thU  plaii  fail,  aiYvr  a  fair  trial,  la[Mrotoniy  iihuuld  be  |*errormed, 
before  adhwions  have  formed  or  peritonitis  supervened. 

In  chmnic  fomiK  in  adiill.i,  (■neniatn,  and  the  u%  of  opium, 
and  belladonna  are  often  of  the  greatest  service. 

4.    OBSTRUCTION  fr(m  eonittrictions. 

Durham  reeo?nracnda  soothing  mca-surcw  in  the  early  stagee, 
luring  the  ^nuflering,  and  luxativoa  during  the  period  of  relief. 

The  diet  must  be  uarcfully  regulated,  and  Huch  medicines 
given  as  render  tlie  iiitcKtiiial  contents  I'ulpy  and  soft. 
In  the  latter  stages,  surgiiial  measures  are  recpiUite. 


26S 


HBAIMimT. 


5.  CBSTRTJCTION  from  eompretaion. 

Tlie  treiitinent  ctmsistw  in  the  use  of  eneinata,  manipulation, 
aud  the  measures  put  in  executiou  by  the  eurgeou. 

6.  OBSTRUCTION  from  impaeHm  of  foreign  bodia. 

The  renie<liei  ar«  erieinata,  opiatea,  and  colotoroy  in  sorao 
easea  of  complete  obstruction. 

7.  OliSTRUCTION  from  impaeted  ftces. 

For  thifl  condition,  th«  treatment  consists  of  very  copious 
enemata,  with  ^Ivanism  of  the  abdomen,  and  laxative;  later, 
(^iatce. 

HARTaHOKSK  sfiys  (hat  ui  all  forms  of  ohstrucuon,  purgatives 
are  injurious,  and  morphine  hyj>otIemii(»  are  goixl. 

Hot  rectal  euemata  are  bettor  than  cold;  and  are  generally 
naefid.  Injections  of  air  are  sornt'tiine«  htineficiaJ.  The  recom- 
mendation which  ia  sometimes  made  to  inject  euoceasively  the 
two  solutions  of  n  Seitllity.  [Miwiler,  itt  very  dangerous.  No  one 
can  tell  juHt  how  nmcli  prcMsni'e  u'ill  thereby  be  brou};(ht  u|>on  tbc 
inloMinnI  wnlln,  nor  whether  tlio  latter  are  in  a  condition  to  with- 
Btaitd  BUch  pi-wwim-. 

It  ia  our  belief  that  an  early  and  bold  use  of  the  knife  will 
prove  more  Bucce«utriil  than  any  other  remedies. 

8.  INTESTINAL  UEMORRUAGE. 

Allciiix  onlent  rent^  ahAtineniie  from  food,  and  opium;  nnth 
cutoneoaa  stimulants,  and  local  a^^tringents,  such  as  turpentine, 
f  5j,  in  an  enema  of  starcth.  Tincture  of  iron,  or  acetate  of  lead, 
may  hf  injected,  but  tannin  ia  too  slow.  The  best  remedy  ia 
crgotin,  given  ill  UiK  dose  of  two  grains,  hypodermicany. 
Biturtrate  of  potasea  ui  doses  of  two  drachms,  with  the  local 
application  ol'  »  sjittimtcd  nohition  of  pcrchloriilc  of  Iron  in 
glycerine  are  useful  in  the  bleeding  of  ]iilcs.  For  this  also,  and 
for  vicarious  humorrliage«,  tincture  of  hamamellB  in  donee  of 
five  drops,  has  proved  useful. 

'When  tbc  hemorrhage  itt  the  roenlt  of  engoi^niont  of  veuela 
it  should  be  let  alone,  or  a  little  sulphate  of  magDeeis  given,  wi& 
sulphuric  acid.    Stimulants  should  be  avoided. 


JAUXDICR — iUDXBT   DISEASES.  26d 

8.    IKTESTmAL  INFLAMMATION. 

(800  dUrrbea,  d^iwaterj,  etc.) 

10.    DTTESTDrAL  ULCERATION. 

AiLcniK  wwommendfl  bismuth,  copper,  otc,  with  blond  diet, 
natrieat  eQemttta  and  rwt 

"Whon  the  ulcers  are  beyond  the  reach  of  Itwa!  treatment,  we 
have  found  the  host  rwulbi  to  follow  the  persisteiit  use  of  hydtaft- 
tJB,  thirty  minima  of  the  tincture,  I>cforc  each  mea.1 ;  together 
with  enemata  of  hot  wuter,  when  the  ulcera  were  in  the  colon. 


JAUNDICE. 
^See  Duodenal  Cntnrrh.) 


KIDNEY  DISEASES. 

•      1.    IIYPEKEMIA,  OR  CONGHST[OK. 

Stewart  recommends  dry  cups,  leechee,  the  vapor  bath,  or 
hot  apiilications  over  the  kidneys;  together  with  the  treatment 
indicated  by  the  causative  disea^. 

DiluoitB  and  weak  alkallac  waters  are  of  advantage  when 
albuminuria  exists  witliout  active  irritative  symptomx. 

2.    PYEUTIS. 

Stewart  puta  the  patient  on  a  diet  of  milk  and  diluents.  In 
acidity  of  the  urine  he  glvo^  ulkulii-H;  in  alkaline  uriuc,  mineral 
acids. 

Uvft  ur»i,  [Hiroira,  buchu,  tritieum  ro{)enfl,  copaiba,  and  aacidal 
ieem  to  diminish  irritation.  In  acute  cases  he  uses  poultices  to 
the  loins,  and  ^ivcs  opium  or  henbane. 

Id  chronic  pyelitis  the  ftame  plan  should  be  followed,  and 
ftstringenta  used  to  restrain  the  flow  of  pus. 

LooMU  calld  attention  to  the  neceaatty  for  tonics  and  a  nutri- 
tious diet  in  chnmii;  pyelitis.  Alkaline  waters  are  useful.  As- 
piration is  indicated  wbeu  a  tumor  can  be  reached  through  the  skin. 


264  HASUAL  OF  TRFAIMEM'. 

LARYNGEAL  DISEASES. 

1.    ACUTE  LAliYNGlTia 

Sajocs  orders  a  hot  mustard  foot-bath  Bt  the  beginning,  fol- 
lowed by  free  diaphoresif",  avoiding  nil  driuka.  Tiiiftun;  «f 
belladonna,  given  in  dosw  of  five  drops  over}'  hour  niitil  ita 
pliysiologifiv]  oft'cct.^  bornnie  rmirked,  ('Oiinterw'tii  the  tendency  to 
iuiiltratioii.  Steam  niiiy  be  inhaled  with  beuelit.  A  twoQty 
per  cent,  solution  of  cooiinc  sprayed  on  the  ]«rt,  ought  to  prove 
beiieSciul. 

ConKN  recoinmemlfl  flpraya  of  alum  or  sulphate  of  zinc,  five 
grains  to  the  ounce  of  water.  Leeches  may  be  u?ed  advantage- 
ously. Marked  oedema  with  morca*ing  dyspnea  calls  for  scarifi- 
cation. 

MoRKLL  Mackkxzik  recommouda  iulmlutionfl  of  benzoin, 
hemlock  or  hop;  and  prohibits  strirtly  the  use  of  the  voire,  and 
tlie  usf  of  initatiiig  food  or  drhik.  A  corapreae  to  the  neck 
often  arrcatd  an  attack.  The  cough  should  be  kept  iu  clicck  by 
opium. 

NiEMEYER  reeoinmenda   the  drinking  of   warm   milk 
EteltKer,  and  the  eating  of  wilt  birrini^.     ncniorrlmge  from 
lamyx  requires  the  applieation  of  tannic  add  to  the  ble<&di 

6|K>t. 

In  children,  MACKENzre  joins  in  the  recommendation  of 
Bteam,  by  the  use  of  the  croup-kettle  or  tent.  Emetics  of  zinc 
or  topper  maybe  occneionally  required.  He  does  not  approTO 
of  the  local  uac  of  nitrate  of  silver. 

STOER.K,howevcr,ciiiploye<i  it  with  advantage,  in  the  strengtli 
of  forty  gi-aiua  tn  the  ounce  of  wiitcr.  The  lattur  author  also 
apeaktf  favorably  of  the  use  of  ioe,  cxt^nially  and  iuterually. 

LooMts  thinks  that  few  jiraotitioners  Uavo  the  retjulsile  skill 
to  use  the  silvur  solution  topically,  without  doing  more  harm 
than  good.  Quinine  liaa  the  greatest  power  in  controlling  the 
disease.  Twenty  grains  shonld  be  given  in  the  first  twenty-four 
bouni,  to  a  child  three  years  old. 


LARYSOHAL  DI8EASBS. 


265 


Abeolnto  rest  from  Hpopch  and  from  rniigliing  must  T>e  wcurwl. 
Small  dijMea  of  Dover's  powder  ^boiild  be  given  during  tlie  da^^aiid 
a  full  dose  at  bedtime.  The  inhalation  of  stenni  is  n  givAt  comfort 
The  cold  coroiiress  may  be  used  in  all  easca,  as  follows:  A  folded 
hnndkerphief  ia  wjimg  out  of  cold  water  and  appHed  to  the 
throat.  Wanu,  dry  flnnneh  are  wrapped  around  tbe  neck,  and 
this  is  alloweil  to  remain  four  hoiira  before  it  !»  changed.  This 
ia  a  deservedly  popular  remedy  in  Germany,  where  it  has  sup- 
planted tliP  hot  (HKmge  and  the  bacon  rind. 

2.  SURACUTE  LARY^'GITIS. 

Sajoits  prescribes  abHolute  rest  and  tmnlinemeiit  to  the  room. 
An  attaek  may  be  cut  abort  by  a  dose  of  castor  oiL  Aconite, 
in  drop  doAus  every  lumr,  also  HUctwedH  otrwwionally.  When  the 
malady  has  existed  tor  some  time,  a  wineglnii»ful  of  wine  of  eocn, 
every  three  liotirH,  generally  brings  i-wlief  in  two  day».  In  aetora 
thia  may  bo  aided  by  the  use  of  a  two  per  cent.  Hohitiou  of  eoeaino 
iu  8i>n»y.  Other  remtHlies  have  bei^n  found  useful,  liUuh  as  eubeba, 
ten  grains  everj-  thix-e  houiH,  and  inhalations  of  camphor. 

3.  CETRONIC  LARYNGITIS. 

Mackrnzib  considerH  Im-al  jistringents  tbe  moHt  important 
remedied  iti  thia  atlcction.    He  mentions  the  following: 

F«rri  p«rchlor^  itr.  Ix;  vai«r  or  f[lvc«riD», f  {j 

IFerripcTBalpk,gr.  U;      "  "        ffi 

r«rriiulph,gr.cx»;  "  "         f  Jj 

Cujm  »«lplmr.  x;  "  "         f  S 

ZiDci  cblor,,  gr.xxx;  "  "        f  S 

Ziod  •eel.,  gr.  r ;  "  "         f  SI 

Zlud  sulrh..  gr.  X  ;  "  "         fj} 

Aluiniii..  gr.  «xi;  ■'  "         f  5j 

A!«iD.elilw-,|[r.lx;  "  "         f  Xj 

Glycerine  i*  a  better  solvent  when  a  prolonged  action  19 
doeired.  JIv  u^cs  the  chloride  of  zinc  most  frequently,  but  cot^ 
eiders  that  the  ftj^ent  use<l  id  immaterial,  provided  it  Ig  ap)>lied 
accurately  and  oHcn  enough.  It  should  l)o  applied  daily  for  a 
woek,  then  on  alternate  daye,  twice  in  the  thtnl  week,  and  so  on. 
In  came  with  profuse  secretion  turpentine  doeti  good. 

"When  the  membrane  is  dry  and  shining,  curbolic  acid  ia  tlie 


S66 


MAMUAL  OP  TAEATMBHT. 


beet  application ;  thirty  to  ^ixty  graiuH  of  Uie  ]>tire  acid  to  the 
ounce  of  glycerine.  For  spraying,  ha  prefers  taiuiic  acid,  one  to 
five  gmiiiH  to  an  ouuce  of  water.  It  sliould  be  used  for  6ve  min- 
ute!* anil  repeateil  four  times  daily.  Great  benefit  is  oftea 
obtained  from  eteam  iubalatioti^  impregnated  with  somi*  vulati]» 
ageut,  such  a»  piue  oil,  creasote  or  jiuiiper. 

9     01.  plnl  s^ItmL, VK  si 

M*gnM.  arbs gr.  iz 

A<]U»^ f5j 

H.  Sl — Add  a  inepoonfnl  to  a  pint  of  water  at  a  icm|>entDi«  of  140*.  To 
IwiBhnlod  fur  live  minutta  night  nnil  morning.  8iz  tnijiiniLioiiii  should  b«  takm  ia 
ft  minute 

Creaaote  may  be  used  in  the  same  streugtb,  and  juuipcr  in 
ODC-lialf  tlio  quantity. 

Paresis  from  persiateut  coiigeBtion  requires  electricity.  The 
voice  nhonld  be  ue>od  m  Uttlo  oh  jHit»iblo.  If  tiie  patient  ronat 
talk,  let  him  whisper.  An  elongated  uvula  may  be  antpuiat«d. 
As  thfi  ]iliarynx  u  gciicmlly  afPixitetl,  atftringont  lozengee  are 
useful. 

NiEMETKR  spolce  very  favorably  of  the  waters  of  Ober-8alz- 
bnmnen,  Eras,  and  Seltere.  The  French  laud  the  Bulphur  wat«n 
of  li!aux  BonncK,  Aix-le»-Bainti  and  Marlioz. 

If  suitable  atmospheric  conclitinns  cannot  be  selected,  the 
patient  must  wear  a  respirator.  The  b(xiy  must  likewise  be 
protected  by  prt>]>er  clothing. 

Skilkr  applies  a  sixty-grain  solution  of  nitrate  of  BiJver  to 
ulcerated  spota. 

Sajcus  makes  the  same  applicatioQ,  but  tiret  ancdtbetizcs  the 
spots  with  a  ten  per  cent,  solution  of  cocaine. 

4.     CKDKMA  OF  TIIE  LARYNX. 

Mackenzie  thinks  leeching  is  often  »cr\"iceable.  Tliu  inhaW 
tion  uf  tannin  Hnlut.ion  may  be  tried.  loe  should  be  swallowed 
niiinterruptedly,  ntiil  the  patient  kepi  eonataiitly  under  the  influ- 
ence lit'  bromide  of  potasBium.  Bcaritication  la  often  necessary. 
Warm  gargles  and  inhalations  ahould  follow.  Traehcot-oiny  may 
bo  Imd  reeouree  to,  and  should  be  performed  early. 


LA&YKUKAL   DISBASEfi. 


267 


The  introcliiotioD  of  O'Dwyer's  tabea  seeiiM  Uegtinod  to  do 
away  with  the  tiecesBity  of  acarlficAtioD  or  trauhuotouiy  in  thla 
affection. 

6.    TtJBERCULAH  LARYNGmS. 

BoewoKTH  outliiiea  his  very  aucceesful  method  of  treatment 
as  folloTCit : 

a.  Thorough  cleansing. 

6.  The  application  of  raild  astringents,  alteratives  or  reeol* 
venb. 

c.  The  applitstion  of  anodynes. 

(L  The  application  of  iodoform. 

Sajous  reconmieuds  for  the  first  ptirpoM,  a  solution  of  borax 
with  Bass'  «pray  tube. 

Cocaine  is  tho  greatest  of  anodynoa ;  and  may  he  tiprayed 
in  the  I'onu  of  a  two  per  aent.  solution.  N'itrate  of  silver,  two 
graiuB  to  the  ounce  of  dixtillod  water,  should  next  be  applied, 
by  upraying,  iib  the  aKtringent. 

Tlio  iodoform  is  boat  used  by  Elsbkro'h  method ;  sprayiiig 
a  saturattxl  ethereul  !<olution. 

Tlie  dyspliagia  is  heat  relieved  by  applylnf*  the  om-aine  nolu- 
tion  fthortly  before  eating,  or  by  using  the  same  agent  in  the  form 
of  a  loxeugG.  Wlien  ulceration  has  rendered  deglutitiun  iin|)08ai- 
ble,  the  patient  rnudt  be  fwl  by  a  st<Hnu<:h  tube. 

In  ca.se  cocaine  and  iodoform  cannot  be  used,  morphino 
gives  tiie  iuo«t  n.'Hel"  wliich  tan  bo  olitiiitK^I.  It  nct-ii  nut  lie 
inaofflated.  as  JItlackenzie  adviaes,  but  may  be  given  by  the 
stomadi,  didHoIved  in  hot  water. 

«.    SPASM  OF  LARYNX. 

Walker  pays  attention  to  die  diet,  bathing,  general  maiugft* 
ment  and  digestion.  He  Hdvo<-ates  the  persistent  use  of  bromide 
of  potassium,  and  haa  alao  found  ehlornl  of  value. 

For  tlie  attack,  tho  child  may  be  imnionted  in  a  warm  bath, 
and  an  emetic,  or  an  anesthetic  inlialntion  should  be  employed. 
Should  breathing  not  be  reiietabUi^hed  when  the  i«pa«m  (!<-a»c»,  dunh 
oold  water  in  the  face  and  cheat,  rub  the  body,  apply  ammonia  or 
yincgur  to  the  QO«trit0,  and  employ  artificial  rcapirution. 


fi68 


MAIIUAL   OF  TaSATMEXT. 


Tracheotomy  may  be  requwite. 

Ammonia  is  not  u  eiife  drug  to  be  inhaled  in  this  alfection, 
as  it  is  apt  to  be  used  too  freely  in  the  fright  of  the  nuwe,  and 
to  he  followed  by  sorioua  broiicho-larjiigcal  irritation.  Amyl 
or  bromic  etlicr  should  be  efficient  agonte  for  inhalation  in  this 

dlM&M. 


LEAD  POISONING. 


Ferrieb  Baya  that  in  acute  cases  the  stomach  should  be 
prorajttly  cini'tied  by  the  pump,  or  by  a  dose  of  salphate  of  ain«. 
Sulphate  of  magnesia  should  be  given  to  form  the  iusoluhle 
ralphat«  of  lead,  and  to  expet  it  from  tli'O  int«stiiial  canal. 

In  fihronic  poisoning,  prophylaxis  is  the  first  consideration. 
Cleanliness  miist  be  inculcated,  avoiding  eating  with  unwashed 
hands,  or  in  working  clothes,  or  in  work-shops.  Free  ventilation 
should  be  secured,  the  dust  shonld  be  intercepted  by  respirators, 
and  sulphate  of  mnguesinflliould  be  taken  occsutionally.  StUphuriO 
acid  lemonade  may  be  n^^d  an  a  drink.  For  lead  colic,  be  advises 
purgatives  nnd  opium. 

Iodide  of  potaBBitun  is  ^veu  to  remove  the  lead  from  the 
tisBupg,  with  good  results.    Sulphuric  baths  arc  also  recommended. 

LotiU  pAralvsiit  require  tlic  galvanic  current  applied  to  the 
muscles  and  the  nerve-trunk». 

HAHUO^^>  usee  tlie  iodides  for  all  forma  of  chronic  lead 
poisoning. 

In  lead  colic  he  injects  morphine  hypodcrmically  in  doees 
sufficient  to  keep  the  pain  iu  check,  while  the  iodide  is  doing  lU 
work.  In  paralysia  ho  prefers  the  induced  current  when  it  will 
act.    Frictions,  massage  and  pasi^ive  exercise  are  also  usefiil. 

PsppBB  recomineuds  str}'chuiue  internally  f^r  the  paralysis. 

Hay  prefers  the  chloride  of  sodium  to  the  iodides  beoauae  the 
chloride  of  lead  U  more  soluble  than  the  iodide,  and  is  readily 
eliminated  by  the  kidneys. 

Bristowk  adminiHtera  opiates,  but  uses  warmenemata  instead 
of  purgatives. 


LIVER  DISEjISRS. 


269 


Naunys  sftys  that  the  eliiKinative  action  of  iodide  of  potaaa- 
iaiu  IB  so  preat,  that  its  Labitual  use  is  n  sure  prophylactic  against 
lend  poisoning  in  tho&e  ex|iOi4ed  to  tho  action  of  lliin  metal.  Ho 
affirms  positively  that  sulphuric  acid  liji*  iio  ctHcacv  wliatever ;  as 
the  milphatc  of  lend  li  m  poinotioiH  a»  the  other  Mitumine  salts. 
Re«piraiore  are  too  grout  a  hiiidranw  to  the  work. 

For  paratyais  he  reconiinends  strychmne,  (luothig  Lanquer- 
hl's  statements  approvingly.  Tlio  latter  nuthor  gavo  this  dnig  in 
sufticictit  do«c»  to  «mi»e  wUght  t^uifK-  BpiMiiis.  The  dow  of  two 
grains,  which  Lanquerkl  gave,  was  undoubtedly,  a^  he  says,  of 
an  impure  niiecimen  of  utrvx-lmine. 

Alum  iH  a  very  etlectual  purgative  in  lead  colic.  It  may  be 
given  in  half  dmchm  doww  every  two  hours.  Opium  does  not 
increase  the  coiisti{)atioti,  but  on  the  contrary  as^iets  materially  in 
relieving  it.  Mnstiage  of  the  abdomen,  or  kneading  with  hot 
camplior  liniment, also  aids  in  removing  the  pain  and  stalling  tJie 
bowels. 


LIVER  DISEASES. 
1.    HYPEREMIA,  OR  CONGESTIOJr. 

T II lEiiF ELDER  difccts  attention  to  the  caiuses,  such  asgluttonyj 
with  sedentary  liabita.  Highly  seasoned  foods,  rich  in  fat,  bawl  to 
digest,  and  proijiiciiig  tliitulcnt'e,  are  to  be  avoule*! ;  iw  well  aa 
alcohol  and  utroiig  wftfue.     Milk  and  paetry  are  inadmissible. 

The  best  diet  consists  of  lean  inuat,  cggB,  white  hreiul  and 
tender  vt^etubles. 

Tlie  patient  should  nlternat^'ly  sit  mid  stiuid  while  at  work, 
should  fre"^ue»tly  take  a  long  breath,  should  take  plenty  of  varied 
exercise  and  drink  plenty  of  water. 

If  de|iendeut.  on  suppi-caeion  of  the  mouses,  moans  maybe 
employed  to  restore  this  flow,  esjtecially  by  tliu  usu  itf  hot  baths 
to  prevent  a  ret-'urrence,  or  by  venesection  to  relieve  a  hepatic 
afflux  already  cstabliidicc]. 

When  the  hyix-rcmia  is  due  to  mechanical  obstnictiou,  it 
ahw  should  re<'eive  il«  appR»priiite  treatment. 

AVlieu  the  causal  indication  can  not  be  met,  or  a  cure  has  not 


S70 


MANUAL  OF  rREATMKKT. 


been  olitained,  the  I)1o<m1  id  tbc  liver  tniist  be  reduced  b^  salioeSf 
BUC'b  H8  Carlsbad  water,  or  Fried  riclwliall.  The  herb,  grape, 
and  whoy  cui*^,  all  «ro  beneficial  but  loss  ajrtnin.  ^\Tion  those 
cannot  be  iisctl,  lie  recommends  the  oi-diiiary  catliartica. 

In  severe  acute  ca»^e»  leeching  is  indicated,  as  well  ms  ic^ 
bagn  ()v«r  tb('  liver. 

In  other  forms,  poultices  alleviate  the  BiifTering. 

Ward  recommen^b  chloride  of  ammoniuin  and  iodide  of 

po!afl*iiuin  for  chronic  coii[:^liijii.  Jii  acute  eases  a  single  fouf- 
grain  dose  of  calomel  will  often  relieve  vomiting,  and  aettlo 
the  Btomacli. 

2.    HEMORRnAOE  OF  THE  LIVER. 
TiriEiiPELriEii  says  the  treatment  consiflte  of  the  local  use  of 
cold,  with  anodyne*  and  roetorativea. 

8.    PETiinRPATITIS. 

TiiiKHFELiiKit  advisos  rest,  and  the  continued  applicatiou  of 
cataplasms  or  compresses.  loe-liags  are  preferable  to  moist,  warm 
Bulwtancei.  Severe  pain  calk  for  leeching;  in  feeble  iiereona  it 
is  better  to  aiib»litute  morphine  hypodfTmic:*.  Long  uontinoed 
pain  may  he  remedied  by  blistois  or  iodine. 

4.     IIKPATIC  ABSCESS. 

TutERPELKKR  objocta  to  vcupiiection,  but  advises  leeching  to 
relieve  t^ideniess  and  tlyspnea.  Cold  compresfies  clwngwl  every 
five  minutes  may  be  u*cd  for  the  same  pnrjMwe.  He  ganctioiw  the 
nw!  of  pmgatives  after  the  leeching.  Kmetii-s  are  of  doubtAil 
utility,  and  (he  same  may  be  aald  of  tai'tar  emetic,  calomel  and 
chloride  of  ammonium.  Blisters  api>ear  UHefiit  in  the  declining 
etagea.  After  the  fever  has  subsided,  warm  compi^esses  and  baths 
hasten  resorption.  Opiates  may  be  required  to  relieve  pain  aud 
sleeplessness.  In  dysentery,  all  lowering  meaaui'cs  are  conUs* 
indicated.  Tlic  diet  kIiouM  be  restricted  to  light  ooujNt,  dilat 
milk  and  other  liquid  uutrimenta. 

In  lcs3  acute  cilso-s,  Ronis    thinlts  an   emetic  Rhortenn 
hyperemic  period.     If  the  affection  nm  a  slow  courae,  the  troat* 
meut  should  be  that  of  chronic  hyperemia. 


LTTTR  DISBASBS. 


2n 


Wbeii  E^iippuration  takis  phioe,  all  weakening  measures  must 
Ih.*  laid  a«idL-.  For  inflammntorj  symptoms,  be  Oicn  dei)en(la  upon 
blisters,  f)OuUic««  and  laxatives.  Tha  patient  Aliould  he  au  vrell 
Doariahcd  a»  the  digestion  will  permit.  Beer  and  wine  ore  now 
allowed.  Quinine  and  iron  are  to  be  given  as  tonics.  The  Iiowela 
lire  to  be  kept  in  a  regular  condition.  Sleepieesneaa  and  pain 
require  oarcotice.  The  patient  elioiild  bo  kept  in  the  recumbent 
|X)Sturc  08  far  us  powible. 

The  abecees  should  Iw  opened,  by  De  C.ieTRo's  method,  with 
■  trocar  and  canula ;  the  IiLtter  being  left  in  tlie  wound  and  replaced 
bj  a  drainage  tube.  For  small  abscesses  the  nspinvtor  may  be 
employed;  in  larger  L'oneelions  free  dminage  w  prfr«nil)le.  To 
cure  the  fistula  remaining,  iodine  ho-s  been  injeeli?cl  with  sueeoss. 

Maclean  reeonimended  die  ubc  of  the  aspirator  before  »up- 
pnmtion  haa  occurred,  to  relieve  the  hyperemia  by  ahstnu'ting 
blood  directly  from  the  liver. 

Macphkrson  adviao^  that  the  openiug  shall  be  put  off  an  long 
u  possible,  and  made  a>>  low  down  m  convenient.  A  long  sett 
voyage  B.4tiHt»  the  healing  pi-ot'eua. 

$.    CtRRHOSIS. 

THrRRPBLUGR  udvi<t(>d  B.H  i>r(>phylaclic  treatment,  the  disuse  of 
ftll  alcohol,  apices,  and  strong  Roffee.  The  am  of  meat  ifhould  l>6 
limited ;  the  pnjper  diet  oonsiHting  of  milk,  fariiuiceouB  articloft, 
vegetables  and  fruit. 

Violent  ])aiti  may  be  relieved  by  rest  iu  bed,  bleeding  beneath 
the  right  ribi>,  and  leeches  around  the  anus,  followc>il  by  poultices 
over  Uie  liver;  with  tmline  purgatives  iulernally.  For  dull,  long 
persistent  pain,  a  cnur^e  of  Cerlshnd  or  Kiwiengen  u  uidicated. 
Malaria  and  syphilis  require  their  own  treatment. 

The  late  stages  permit  only  a  symptomatic  treatment.  Poul- 
tice* and  dry  eupping  are  to  be  employed  for  pain.  Nutrition 
must  be  main  rained  by  all  meanw.  For  gantro-intestinal  eata.rrh 
(he  carbonated  alkalies,  alono  or  with  the  aromatic  bittern,  Carls- 
bad Baits,  rhubarb  and  alix-M,  are  niipmpriate  remedies.  Frerichb 
recommends  the  choleate  of  soda,  to  regulate  the  digestion  and 
allay  tympanites 


272 


MANUAL   OP   IBBATMIST. 


Iron  18  often  beneficial,  tlio  nficitos  diminishinjs  under  ita  twe. 
Other  remedied,  Hueh  as  dinpetiw  (ire  r^ily  exceptionally  usefiiL 
English  phyelciai»  have  obttcrved  marked  benefit  tbllnw  thead- 
niinititratioTi  of  copaibO,  in  dose»  of  t«n  to  twenty  grains;  the 
urine  inercasinp  fourfold,  and  the  dropsy  di*appoarini{.  Wiles 
fonnd  lliu  reitin  of  eopailm  even  tnnru  etficaL-ioii!t ;  while  Klisqrb 
obtaineil  brilliant  rositlU  from  the  tiw  of  thi;  ethereal  spirits  of 
tuqientinc.  In  dc«e»  of  twelve  di-o]i«,  tliriee  daily.  Dmstic  <aith- 
artics  do  moi-e  Iiiirni  tbnii  goml,  except  in  oxeeprional  cases. 

Paracentesis  reduces  the  ascites  more  surely  than  any  other 
remedy,  and  with  loss  danger.  The  functions  of  the  stomach  tod 
ioteetine^  imjirove  at>er  the  operation,  and  tJie  removal  of  prw- 
sure  on  the  peritoneal  veins  Ic^iscns  the  fulness  in  the  portal  root- 
letfl.  But  from  this  results  a  renewed  and  increased  transudation 
of  the  nllniininous  pcriim,  and  consequent  furtJior  impoverishment 
of  the  blood.  Ilonee,  the  improvement  alter  tho  o|jeration  ia  but 
transitory,  and  nutrition  \m  niortf  nipidly  iinpainHl.  The  operation, 
then  shouU!  onh/  he  underlnken  to  rftiene  dt/spn^^  and  not  to  carry 
<yff  the  rxuflatkm. 

J.  WicKHAW  liEiKi  says  that  in  the  early  etage*  of  cirrhosis  it 
is  most  iinjiorlant  to  induce  tlie  patient  to  give  up  his  habits  of 
intemperance,  for  without  this,  ti-entinent  will  \>v  of  little  avail. 
Next,  the  um  of  alkaline  purgatives,  with  or  without  v^etable 
bitters,  such  iw  eliircttn  or  caluniba,  ivitl  be  very  usefnl.  A  i-ourse 
of  tlie  watei-s  of  Carlsbad  is  often  most  uaeful.  or  other  alkaline 
or  iodise*!  waters.  The  diet  nnist  he  mild  ;  and  exerci«e  on  horse- 
back or  01!  firiot  should  be  recommended. 

In  the  later  -stage*  of  the  diHease,  the  great  objet-t  will  he  to 
keep  up  tho  sti-ougth  of  the  jmtient.  For  the  asvitcs,  which  often 
bccnme.-t  Uie  p]itient*H  great  trouble,  diuretitss  es[iei;ially  e()]»aihA, 
and  meivuriol  alteratives  may  be  employed.  Paracentesis  should 
be  put  off  us  long  as  posnible,  mt  the  uid  of  the  dineium  often 
arrives  soon  after  the  tapping,  though  in  some  caseit  the  at<Tite8  is 
cure<l  by  ibis  oiteralion.  The  flatulent"  tthould  be  combated  by 
rogutatiou  of  the  diet,  by  charcoal,  by  small  doses  of  liydnK-hloric 
acid,  and  by  carminatives.  The  bowels  mu^t  be  kept  open,  but 
not  severely  acted  upon. 


UVBB  DISBA8B8.    ^^^^^^  27S 

IiOOMf:*  9Uitt»  t}iat  in  tlic  rarlj*  stagvf*,  if  tlic  rangctntion  lie 
intense.  loeche^i  to  the  Hniif^,Tnerctina1  ptirgPK,  and  nitro-miiriatio 
acid  will  III!  of  teiiiiM>r«ry  service.  The  iiiijiorlaiice  of  a  ri'«tri<:tf<l 
diet,a»d  tlie  free  nse  of  Baline  waters  in  this  stage,  cannot  be  over- 
wtiiiiiili'^l.  Cod'liver  oil  uli<o  in  now  indicated.  \\^ieii  conttuctinn 
has  taken  I'lace,  »tl  trrtitnu-iit  is  but  jvalliative.  Mineral  aH<Ifl 
with  calumW  assist  stomach  digestion ;  cre<^»ote  and  snlpliite  of 
eorlium  check  acid  feniiciitaTion.  The  mineral  w-atois  should  be 
diiK-'ontiiiued  iu  this  stage.  The  bowels  may  be  regulated  by  .small 
doisctf  of  rhubarb  and  ipecac.  I>iarrbca  and  hemorrhage  should 
not  be  Riiddenly  ch(>ck«d,  but  if  they  beeonie  exhaut^ting,  opium 
may  bo  cautiously  given.  For  the  dropsy,  drn^tics,  tnpj'ing,  dia- 
pborclicci  or  diureti>v  may  be  unied,  aecrtnling  to  the  ojieeial  indi- 
catioM.  Diurolio*  have  more  cfteH  than  in  any  other  form  of 
dnipoy,  but  will  not  act  unlcB»  the  [ii-e&»4ure  on  tJie  kidneys  be 
slight.  After  the  fluid  lias  liet>n  removed  by  tapping,  the  rough 
Hurface  of  the  liver  may  cause  peritonitia  by  friction  upon  tlie 
delicate  mesenterj-. 

The  following  prescription  will  be  found  of  service,  even  in 
advanced  cirrhosis,  while  iu  reoent  cases  its  uec  is  invariably 
followed  by  improvement:  ^m 

^^  B      Ammon.  cliliwitl, 5  U  ^^^1 

^^B  Add.  uiuomuriat.,..,.., fj  jj  ^^^| 

^V  Aqu*v  n.  »,  kI f  J  j  ^^B 

^^f  H.  8. — ^To  be  punicd  over  ih«  r«gian  of  th»  linr;  ftad  »laa  to  l>e  uken 

^^ntenuillj-  in  doMs  n{  tivoDt/  drops  iliricc  d>iljr,  well  itllui«<l, 

Several  eautett  have  been  rcpoi-ted  in  which  a  permanent  cure, 
or  at  \eanil  nn  arrest  of  the  progress  of  the  dL»oasc  has  followed 
pKracenleoiB.  hi  one  cade  a  »mal]  trocar  wiu  inrroduce<l  and 
allowed  to  remain  in  the  wound  for  w>mc  weeks;  thus  permitting 
the  fluid  to  dmiti  out  afi  font  us  it  exudeil  into  the  iwritoncal 
cavity.  If  the  di»i«tse  lui^''e  not  advaucc<d  too  far,  it  would  be 
well  to  give  this  method  a  trial;  although  it  U5  our  conviction 
that  it  will  only  exceptionally  mieceed. 

In  all  other  ca^es,  it  muat  be  home  iti  mind  tliat  the  oiteration 
of  tapping  i--*  not  undertaken  with  the  ohjei-t  of  removing  the 
fluid,  but  to  relieve  dyspnea.  Tlie  more  fluid  i*  removed,  the 
lesa  is  the  pressure  upiHi  the  outxide  of  the  mesenteric  veins,  and 
llie  more   readily  will    their    serous    contents  escape  into  the 


274 


HAKCAIi  OF  TRRATJdB.VT. 


peritoneal  cavity.  Ilence,  only  enough  of  the  attcitlc  duid  should 
be  romoved  t4>  relieve  the  breathing;  about  half  a  piut  at  each 
o))erntioii. 

Li  the  laMt  mnnthii  of  life,  when  pai-aceiiteiii«  luuHt  be  pu^ 
formed  nearly  every  week,  permanent  dniiiiage  has  in  our  bauds 
proved  of  great  tM.'iielit.  We  une  a  ^Tnall  ti-ocar,  the  size  of  a 
duniing  ueedle,  with  a  tiglit-littiiig  silver  canula.  To  this  \fe 
attach  a  rubber  tube  which  conducts  the  fluid  into  a  but-ket  of 
water  which  i»  placed  under  the  chair.  The  comfort  derived 
from  this  contrivance  is  very  great;  and  as  yet  we  have  found  no 
bad  effects  follow  the  procedure. 

6.  SYPHILIS  OF  TIIE  LIVER. 

There  is  uo  special  treatment  for  tliia  attWtioD  othor  tfaanj 
that  for  nyiihiliH  generally. 

7.  ACUTE  ATROPHY. 

TaiKRFEiLitL'B  treats  the  first  etage  as  he  doee  acute  gastric 
catarrh  and  caUrriinl  jaundice. 

In  LE!CHTK^•sTRBN'8  alleged  sucoesBfiil  cflae.  the  only  medica- 
tion conmated  in  a  raikl  purgative  of  ealomel  and  jnlap.  tn  other 
caee^  which  rei^nltcd  in  recovery,  diaBtic  Cathartics  were  uaed 
re[)eat(Klty ;  Inxatlves  would  be  therefore  still  Hdvioable. 

Looiiia  recommends  leeches  and  hot  fomenlattoos,  with 
morphine  hypodermjcally,  when  the  hepatic  pain  h  intenac 

Wlien  cerebral  eymptonie  develop,  chloric  ether  in  drachm 
d08««  every  hour  will  otten  quiet  the  wildest  delirium.  Hemor- 
rhages can  usually  bo  checked  by  aatrlngeutd  and  eold.  Bismuth 
or  strychnine  will  sometiJiies  relieve  the  vomiting.  Bicarbonate 
of  soda,  ill  ten  grain  dosca  every  hour,  has  beeu  giveu  mth 
Apparent  benefit. 

Frertchs  re]jorteil  a  recovery  under  the  use  of  mineral  acid* 
and  purgatives. 

Bartholoiv  thinks  that  if  the  diaaan  have  any  relation  to 
the  bile,  podo]ihyllin,  ouunymin,  i|>ecac,etc,  with  the  minenl 
acids,  are  indicated. 


LtVKR   UISKASE8. 


276 


Tho  best  roeulta  wall  be  obtained  from  the  use  of  a  large  doae 
of  quinine  and  morphine  in  the  incipiency  of  the  diseoee.  Ho 
also  advise*  the  use  of  very  smnll  doin*  of  pho3phorae,ag  early  an 
powiblc.    Alcohol  should  be  given  freely. 

8.  CANCKR. 

Lricbtrnster?!  simply  stated  that  treatment  van  have  no 
other  object  tliaii  to  j«iiRtain  the  sti-ength  of  the  patient,  and  to 
relieve  the  p»iu  and  le»wti  the  diacomforttt  of  the  disease. 

9.  AACYLOID  DKGKNEKATION. 

ScHUCPPKi^  sayM  that  when  oih-'c  lliu  dixcajte  Iiiifi  become 
leoognuuihle  there  is  no  pnwpect  of  arresting  it.  Hence  it  is 
imperative  to  combat  the  ufToL'tionM  whicli  Iciut  to  thin  iitFection  ; 
such  ?tA  chronic  suppurative  disease  of  the  bones  or  joints,  chronic 
ulcers,  and  dvphilii*.  In  all  thwe,  great  attention  must  hr  ptiid  to 
natrition.  The  diet  ehoul<i  tonsist  largely  of  meat,  the  clothing 
sbovild  be  warm,  and  tho  imtient  should  reside  in  u  jmre  and  mild 
atmoaphere.    Otherwise  the  treatment  is  eymptomatic. 

To  TL-ducc  tlic  size  of  the  spleen,  thw  beat  remedy  is  iodino; 
especially  in  the  form  of  the  iodides  of  potassium  and  of  iron. 

Bddd  got  good,  result*  from  the  muriate  of  ammonia,  ton 
graini),  thrioe  daily.  The  milder  wateni  of  Enu  are  ]*»»  debili- 
tating, and  therefore  preferable. 

LooMisspeuks  of  the  potaisie  Raltfl  rather  appravingly,  and 
says  they  may  be  given  witliout  fear  of  iiyury. 

10.  FATTT  1>EQEXERATI0N. 

Sciit'BPpiJL  says  that  when  tho  discoao  is  duo  to  luTcnrionsand 
inactivi;  habits  of  life,  or  to  alcoholic  excoBa,  we  niay  hope  to 
reduce  the  accumulation  of  fat  by  cutting  off  its  source  of  supply. 
The  diet  mncit  lie  limited  in  amount,  and  poor  in  fata,  »tan-h  and 
sugar.  Alcohol  is  objoctioiutblo,  especially  heavy  beer  and  ewoet 
wines.  The  {tatient  must  be  restricted  to  a  glaKs  of  light  rod 
wine,  and  bo  should  drink  water  freely.  ITo  must  not  steep  too 
long,  nor  after  dinner,  muttt  riae  early  and  take  active  exercise, 
physical  and  mental. 


87« 


iUSCVAL  or  TBSATilBST. 


If  fatty  beart  exists  likewise,  this  regimen  roust  not  Ite  iatro- 
dueeJ  ton  midilciil/;  iu»r  bIiouIcI  alcohol  be  withJmwu  loo 
abruptly.  The  dietetic  regimen  may  be  aided  by  the  oee  of  the 
ulkuliru-  and  HiiHne  iviitrm  iif  Carlsbad,  Vichy,  Si^uigCD,  etc 
Aucmic  Bubjccts,  and  womeu  Viho  are  tat  and  subject  to  ameoor- 
rhca,  can  iit^o  titu  chalybvaU)  wutc-ni.  Herb  aad  fruit  cures  are 
better  suited  to  weakly  persooa.  The  digestion  should  be  carcfally 
nmintuininl.  Iti  tulteniiilar  catiois  no  diet  treatment  U  available. 
Cod-liver  oil  and  milk  should  not  be  uaed. 

n.   ^^!:LA^'OTIc  or  tigment  liveil 

ScilUKrPRL  eayH  that  as  this  afi'eetioii  dui)endii  on  niuluria,  the 
tbempeutica  should  hf  directed  agaiiiat  that  dueaae,  and  benoe 
qninine  i«  otir  main  resource.    Otherwise  the  trcatniont  is  eymp- 

toimitiL-. 

12.    ECHINOCOCCUS  OP  THE  LIVER. 

Kcssmacl's  nutxiin  is  not  to  wait  until  the  growth  of  tho 
paraeite  threatens  life.  Conatant  danger  attends  it4  growth,  sod 
healing  ttiketi  place  more  readily  when  the  cyat  wull  has  not  had 
time  to  become  rigid. 


IlKLLBn  difimisses  medical  treatment  &8  uselees. 

The  surgical  mea.*ures  which  may  be  considered  are,  1st: 
slmplo  puncture,  ojipiration,  injection  of  iodine  and  clGCtroIysis. 
The  first  and  laf^t  are  preferable.  2d:  Opening  and  emptying  the 
Boc,  and  causing  ndbcBiou  of  it8  walU  by  cauterization,  the  intro- 
duction of  needles  or  of  trocars. 

Simon  recommends  multiple  punctures.  Four  trocara  are 
introduced,  live  centimeters  apart,  and  left  in  ])osition  until  Quid 
oscaiw*  beside  tlie  uiiiula.  Fifty  cubic  centimeter  are  reroo%-ed 
each  day.  In  tive  days,  Buppui-atioti  begin*.  If  reaction  be  slight 
ho  waits  u  few  da^-s  hinger.  If  not,  the  piiimtnrcs  fartltest  ajtart 
are  uiiite<l  by  an  incifiiou.  Subsequent  treatment  may  be  con- 
ducted untiscptically  or^not.  The  early  removal  of  the  cyat«  16 
thought  by  Siuo.v  to  be  of  special  value. 

It  is  n'commonde<l  that  only  a  portion  of  the  fluid  eball  b« 
withdrawn  at  the  tir>«t  aspiration.   Absolute  rest  should  be  enjoined 


UTHR   niSBABBS. 


277 


for  eome  days  after  the  operation.  It  is  not  ntxemary  to  wait  for 
adhesion  to  foriQ  between  the  tumor  and  the  parictca  of  the  cIimL 
It  was  found  accidentally,  that  when  bile  is  effused  into  a 
hjdatid  sac  it  occaaioui*  the  prompt  destruction  of  the  paraaites. 
Acctmlingly  nx-gii11  hn.-*  l)ern  injtx-teil  ioHtrad  of"  indinr,  and  tlie 
former  has  proved  more  effii-ieut  and  le^  painful  tliau  the  latt«r. 

13.    CATARRHAL  JAUNDICE. 

ScHDRpPEi.  refers  to  the  treatment  of  guHtriu  catarrh,  when 
that  has  h«cn  the  etartiug  point  of  tho  jaundice. 

If  due  to  colli  he  iulvis»i  the  [iittient  to  take  a  v&por  bath, 
and  remalD  in  bed  aftorwnrds,  drinking  warm  t&m.  Alkalies 
act  favorably  hy  increA^ing  tlie  How  of  bile,  and  i*on.'i(H|iientIy 
the  pressure  in  the  duct,  an<I  also  by  increasing  the  Kolveut 
power  of  the  bile  ujion  the  mucus  wiiich  liuljMto  occlude  the  duct. 

Ebvll  employs  large  injections  of  cold  water,  one  to  two 
litres,  at  59°  F.  once  daily.  If  used  oftener,  the  temperature  is 
gradually  raised  to  72°,  as  the  rectum  will  not  tolcrntc  repeated 
cold  injections.  The  water  must  lie  retained  as  long  as  {>ossib]c. 
Seven  iqjeetiotis  are  sufficient.  No  drugs  are  nserl  and  the  patient 
is  alIowe«l  his  ordinary  diet.  The  first  cflect  la  the  disapjtcaniuoe 
of  epigastric  pressure,  nausea,  headache  and  annrexia.  If  the  case 
be  not  too  chronic  this  result  is  achieved  in  one  day,  and  com- 
plete recovery  occurs  \vithin  a  few  days.  In  half  the  cafes  fccea 
covered  with  bile  were  paseed  after  IJie  second  injection;  in  all 
cases  this  occurred  within  four  duyif.  The  rapid  ditmppeanince 
of  all  gastric  symptoms  b  a  striking  feature. 

GEBtiABDT  r«M:ommfcudod  f&radlBation  over  the  gall  bladder, 
aod  emi'tyiug  that  viscus  by  comtJivssing  it  l>et\voen  tlte  fingera 
and  the  spiuo. 

ScutKPi'KL  recominende  in  roost  caws  n  purely  aymptomatic 
treatment.  The  patient  must  stay  in  bed  if  he  have  fever,  use 
lij^t  diet,  cooling  drinks,  laxation,  if  needed,  or  encraata,  opium 
for  diarrhea,  poultices  for  paina,  etc.  Fruritue  may  be  relieved 
by  lotions  of  diluted  vinegar  or  by  chloroform  iniinctinna.  Warm 
Ixitha  help  to  reraovo  the  bile  from  the  wkin  luid  relievo  tho  itch- 
ing. Tf  the  jaundice  continue  long,  nltio-iiiuriatic  acid  may  Ije 
used  internally  and  extomaUy,  and  Carkbad  or  Vichy  wat«r. 


S78 


MANUAL  OF  TRBATUBKT. 


LOCOMOTOR  ATAXY. 

Clarke  iirgea  the  importonw  of  protecting  the  patieut  fixim 
cold  and  wet,  aud  from  variations  in  the  tem|ienitun*.  A  gener- 
ouK  diet,  witii  Tine  or  beer,  seems  stiitahle.  If  itrate  of  Bilver 
eeems  to  have  the  most  spot-ific  influence  over  the  dinease.  One- 
eighth  of  a  gRiin  Khtnild  l»e  given  three  times  a  day,  and  gradu- 
ally increased  to  a  grain  at  each  dose.  The  oxide  is  a  uewAiI  «ab- 
Btituto.  Dry  cupping  along  the  spine  has  Ijeeti  found  u«eful.  For 
the  severe  paiiia  in  the  limbs  he  i-CL-ommcrids  morphine.  He 
believes  that  conittipation  ag:gravates  tbe  complaint.  Sulphur 
hatha,  cod  liver  oil  and  phosphorua  have  been  usoil  with  benefit 
So  also  has  the  galvanic  current. 

A.  M.  Hamilton  gives  ergot  and  bromide  of  sodium  in  tbe 
early  Htjtges  to  i.-uiiti-ol  the  puiii. 

Troitssbav  suggested  helladoiina  and  turpentine,  for  the 
pain  aud  vettical  tenesmus. 

B     V.xt.  hclliidonnie, If-  i* 

01.  hmbinthiiUB f S  jj 

Ol.  iheobromie,  q.  a. 

M.  ct  in  capnil.  no.  xij,  div, 

8. — One  Ittnce  dnil;. 

Mann  claimed  that  th'w  di»eiu«c  in  curable  in  the  early  etMgtt. 
He  relied  on  electricityi  using  both  currents  along  the  ^iD& 
He  also  used  bliMlcrH,  luid  the  clilipuvphopphide  of  arsenic.  For 
the  lightning  paine  he  put  much  faith  in  Qer%'o  etretcliitig. 

Ghaktille  rcjtortod  excellent  renultis  from  nerve-vibration. 
Pcreistence  in  the  vibration  of  irritable  nerves  exhuuntH  their 
excitability;  tltcy  tlirri  become  fiubmiiisive  t.o  the  will.  When 
the  ncrveA  have  become  dt'eiulier,  and  walking  eaay,  the  pcrctuaioa 
may  be  applied  over  the  spine. 


Erb]  advit^&t  aa  propliylactic,  tbe  combating  of  the  neuro- 
pathic tendency  by  diet  an<l  hygiene,  and  the  prevontioD  of  on&a- 
isni  und  Hiexual  excess.  Tlic  ciiuttal  indiaition  ciui  only  bo  met 
when  there  are  evidences  of  syphiUa. 


LOOOHOTOB   ATAXr. 


279 


Dry  cnp6  rony  be  used  to  relievo  ]>aia.  Ue  has  never  ob- 
tained benefit  from  the  cautery  or  other  coantcr-irritAntn.  Ther- 
mal bathtt  are  injurious;  and  neither  sulphur,  ttalino,  chaIylH>ate 
nor  mud  bnths  hnve  bt-cn  oonchiiiivoly  ehown  to  be  beneticiul. 

The  cold-water  cure  if*  osijeeially  eoDiTuended.  He  advises 
wet  ruhbings  (beginning  with  wat^r  at  77**  K.  nnd  going  dnwii  to 
eS*.  and  never  below  59"),  half-baths  at  86="  to  70*,  with  simulta- 
neoufi  wa--*hing  and  sprinkling  of  the  Iwn'k;  and  further,  mere 
wa.ihiug  of  the  bat-k  and  foet,  wrapping  foot  and  abdomen  in  cold 
compresses  (whi(!h  wann  themselvcB),  and  oei-aaionally  a  hip  bath. 

The  wet  pack  should  be  used  with  extreme  caution,  begin- 
ning at  Se'*;  it  18  seldom  borue  ImjIow  77*. 

CzEBWixsKi  recommends  only  tub  bath?,  at  8l|*^,  lowered 
gradually.  Still,  aomc  bear  cold  very  well.  Anemic,  weakly  and 
irritable  patients  are  the  least  titte*!  for  ttiis  treatment. 

In  choosing  a  water  cure,  preference  Bhould  be  given  to  an 
inj^titiition  8ituat«d  in  the  mountains,  with  eoDTenient  walktt, 
good  attendance  and  not  too  iioitiy.  Tlic  best  season  is  the  sum- 
jn«r.  Of  19  cases  treated  by  Erb  in  this  manner,  16  woro  bene- 
fited, two  were  not  improved,  and  one  grew  uliglitly  wonw. 

Of  66  treated  by  the  galvanic  current,  44  wore  inipr<)ved 
and  22  received  no  bonotit.  Aa  t«  the  nielhod  ynjployed,  almost 
all  aiithnis  agrM!  in  treating  the  bitck  dinx^tly,  with  moderately 
strong,  chiefly  stabile,  eomotimee  labile  currents,  with  short  ses- 
rions. 

VoN  KRAPT-EBBi>fa  advises  simple  stabile  currents  through 
the  spiuo,  of  four  to  six  raiiintes  duration ;  with  the  labile  action 
of  the  cathode  on  the  nerve  trunks  lie  claimed  that  six  or  eight 
BessionH  determined  the  result,  but  Erb  docs  not  agree  with  this. 
The  latter  fixes  the  cathode  over  tliuHnporinr  ganglion  on  one  side 
of  tlie  neck,  and  tlie  anode  on  the  opjiosito  i;ide  of  the  opine 
between  the  shoulder  blade*,  moving  downwanls  very  slowly  till 
Hw  terminal  tw)ne  is  rcjichwl.  This  is  repeated  on  the  other  side. 
To  this  he  adds  direct  treatment  through  the  spine,  anode  below, 
and  aitlKxIe  above,  slowly  changing  their  positions.  This  will  be 
morlified  in  various  individual,  as  far  as  the  diimtion,  intensity 
and  lofjilir.ution  of  the  currents  is  concerned.     In  irritable  persona 


1 


with  acvero  paina,  it  ia  well  to  use  weak  currents.  He  adds  to  the 
above,  peripheral  giilvanizatioiw  of  rhe  leg-nervea  (catWI*;  labile) 
twice  a  week. 

Tlie  "BiwioiiB  last  from  thrw  to  six  miiuitcs, strong  current*' 
are  to  be  avoiilcil,  iiii<t  truiLtiiicut  tHki>H  [ilHtw  dully  tor  tnoittUs, 

If  tlie  [mua  incrcam,  mid  iiiMmiua  sets  iii,  tho  galvanic  treat* 
inent  must  h<-  given  up.  ^1 

Among  inttnial  rorootlios  the  Bilvar  snlts  stand  fifHt,    Tli«^ 
doM  in  oiie-^Lxtli  to  oii<*-tlurd  of  a.  grain,  iM*venil  tinmt>  a  day;  so 
that  almost  one  grain  and  a  lialf  is  used  in  a  day.     It  niay  l>e  oon- 
tinut*d  iitilil  iwo  drai'hiiiM  :iiul  a  liitlf  havu  btjen  ntietl,  and  i;iay  be  ^ 
resumed  aftor  an  interval.  ^| 

BiBKiiKT  foinid  lliv  bromides  to  mitigate  the  paiiiH  and  the  iit- 
cobrdination  when  given  to  tlio  amount  of  two  and  a  half  dracht 
daily.     1  fe  Intiks  with  dirtfavor  on  ifMliile  of  pohuwiuni,  Iwlladojina,! 
ergot  {ill  Bpite  of  Waldmass's  cneoniinm^),  arsenic,  gold,  tdiloridaj 
of  barium  and  plio.'tphorui^.    f^trjrlinine  i^  decidedly  objoi^tionalilcui 
C<mI  liver  oil  appearrt  tu  liave  a  favorable  ellect  ou  the  ncrvou 
ayatcm,  l)C«ides  its  nonriiihing  qnalitioj^. 

Particular  attention  is  to  be  given  to  the  diet  and  the  habita 
of  life.     Moderation   !»  counseled   in  all   tilings    Tlie   utmost 
indulgence  in  fre*h  air  in  mountain,  foi-cst,  or  at  the  shore  ia^ 
recommended.     Ab  a  feeble  snhstitnte  for  a  Winter  in  the  South^ 
'WMim.Knv  laud*  oxygen  inbalationt*.      Over-exertion  must  bo 
avoide<l.      In  old   incurable  ta^'os,  we  should   difwnade   patient 
from  useless  attempt*  at  euiative  treatment,      .Attention  to 
gonerol  health,  with  cold  rubbing,  etc.,  will  prolong  life. 

In  trt^ating  the  eyraptoiu:*,  pain  demands  tin-  lirBt  attention.^ 
For  the  lanciualiiig  paiiu  n-u  uru  often  helitlesg.     SomotimeA  one 
remedy  out  of  the  foUowiiig  list  will  prove  uiteful:  sinapUi 
hli^lcriD,  warmth,  cold   trompreuse^,  oj^ium  or  betladanna'  pla^tteT 
rubbing  with  chlomform,  veiatrine  or  oil  of  hyobfyainu.H ;    fai 
disation  or  galvanization  (stabile  cathode)  of    the   pninfiil   arnL] 
hy]teruHtbetic  pulnl.s  of  the  t^kln;  bat  abovu  all,  the  auheutaneoas 
injection  of  morphine,  which  only  too  soon  becomes  a  oocosgity. 
Beiiideft  tbemj,  Krlrkmkyer  has  recnmniendeil  the  hydrubromate 
of  qninine,  and  Lkydkn  the  iodide  of  [totaitsium. 
^_      AguitMt  anerilliuitia,  motor  wcakncM  and  muscular  atioph/v^ 


th^ 


LOOOHOTOR   ATAXT. 


281 


electricity  is  tbe  only  remedy,  'llie  8ame  a^tit  U  iieeful  iti 
WitukrKtiK  of  tbe  bladder;  while  for  amuurrMis,  tbcrc  w  iiot}iing 
b«tt«r.  CoiiHtipation  should  be  treitted  by  tbe  mildciKt  i>oai4lble 
meaiu,  by  diet,  encmata,  and  faradi^tion.  Qa^tmlj^ia  rcqairea 
careful  diet  and  morphine. 

For  the  pollutions  and  iwxual  cscitabUitj'  the  remedy  is  bro- 
mide of  potA^iuni.  Lupulin  and  camphor  are  also  of  eerTice,aa 
well  as  cool  hip-baths,  iind  avoidance  of  fulne**  of  the  bladder 
imd  of  donal  decubitus  at  night. 

DrrjARDnf-BBAUMBTZ  forbidtt  prolonged  miitKruhir  fatigue,  and 
sexual  int«rtio«rye.  lie  I'ecoraniends  pmictifomi  caiiterizatioiia 
along  tbe  npine,  <-«i>ucially  whore  irritation  <ir  lUMi^eHtion  of  the 
cord  ap]i«irH,  He  givew  silver,  or  phosphoniH  in  the  remission-s. 
PhoBphoniB  will  nearly  ithvayit  prodiiLi;  un  uiuuliomtion,  percep- 
tible to  the  patient.  For  tlic  lightning  paina  be  luiea  mori>hiue, 
beat  or  cold.  Xcrve-^t retch iiiji;  in  not  approved.  Cold  douches 
only  auj^ent  or  provoke  spinal  congestion.  lie  has  abiuidoned 
hydrotherapy. 

lie  siteaks  favorably  of  thermal  treatment ;  especially  that 
practiced  at  Ncri?,  Balaruc  nnd  J^uialou.  lie  thinks  we  ought 
always  to  employ  electricity,  without  expecting  much  benelit 
ironi  it. 


BROWS-SBQtrARit  obtained  benefit  from  iodide  of  polaasium, 
belladonnu  and  er^ot;  but  Uosrstiial  fniled  to  verify  his  favora- 
ble result*.  In  bis  estimate  of  tbe  value  of  hot  and  cold  hydro- 
therapy, UoiSESTnAi.  agrees  with  Krb,  and  tJie  German  writore 
generally. 

Notwithataiiding  Ehb's  unequivocal  condemnation  of  atrych- 
nine,  it  Iih'?  the  eame  claim  for  favor  in  iliu  tliAcaec  ai^  in  myelitis 
gCQcruily.  The  observations  at  post-mortems  eimply  reveal  the  em- 
bers of  a  burnt  out  lire,  and  there  mu^t  l>e  a  stage  in  this  diiseot^e  in 
which  the  tiswues  are  not  yet  irrcpanible  damageti.  One  Ruch  chm 
came  under  my  notice,  which  recovered  under  the  persistent 
ndniiriiHlnttioii  of  HtryolmiiKi,  in  tlm  duHe  of  j,  to  ^  S'^<"  ^^^^ 
times  daily.  To  tbi^  wore  added  the  inlluonce  of  rest,  counter- 
irritation  and  a  full  alimentation  ;  all  which,  except  the  hut,  are 
remedies  of  tittle  utility  in  tbe  eyes  of  Ekb. 


282  KAVVAh   OF  TABATMBHT. 

LUNGS:    DISEASES  OF 
(Soc  KmphyRcnia,  Bronchitis,  etc.) 

1.    GANGRENE. 

E.  S.  TiioMPSox  di.-tiiiftfd((  t]]c  room  with  sulphurous ucid, and 
usee  Condj''^  ilnid,  suitably  diluted,  aa  a  lotinn,  gargle  nr  drink. 
Tlic  Bulpbo-carbolatee,  given  intcnmU^',  remove  the  odor  from 
the  ekin. 

The  introduction  ofa  druiiiugc  tulH;  Homctitiied  affords  immo- 
dia1«  relief.  The  danger  it;  Ism  when  the  f^fttigrenons  abfloees  is 
Kcor  the  chest  wall,  and  the  plem-rc  are  adherent  The  opentitt 
should  not  be  performed  when  there  is  a  rewonable  chance  for 
recovery  without  it,  but  muet  not  be  delayed  too  long. 

The  strength  must  be  supported  by  rich  food  and  stimulante* 
quinine,  ammonia,  acids,  iron  and  cod-liver  oil. 

Tlie  spray  of  crooBote  or  carbolic  acid  may  be  tried*  or  the 
inhalation  of  turpentine  from  hot  water. 

IIbrtk  advices  as  of  prophylaetic  value,  the  proper  treatment 
of  bronchon-hea  and  broncbiccUu^i!!,  »»  th«>e  conditionn  tavor  tba 
occurrencG  of  gangrene. 

fio,  also,  in  the  nianagenicnt  of  the  insane,  over  crowding  and 
all  the  other  eleraonta  of  deteriorating  health  favor  the  gangreooua 
proce»w. 

To  allay  the  fotor,  Tbaubk  gave  the  acetate  of  lead,  a  grain 
every  two  honm.  When  tlie  fever  nuhoided,  he  added  one  grain 
of  tannic  acid.  Others  recommend  chlorinated  lime,  twenty 
gmiiiH  in  fotir  oiimx^  of  water;  a  tablisijioonful  to  be  taken  every 
four  hours,  with  or  without  opium— (Stokes). 

TBOttMBAO  gavL-  cMoride  of  Bodium,  torty  to  eighty  grain*', 
in  water. 

Other  romcdice  are,  wood  rlmrw«»l ;  myrrh,  five  to  ten  grmins 
at  a  dose;  creosote  water;  carbolic  acid,  one  to  three  grains,  iQ 
water.  The  efficacy  of  thc«e  u  doubtful.  Hertz  thinka  the 
only  advantage  of  giving  carbolic  acid  U  in  ita  action  upon  such 
portions  of  septic  matter  as  may  have  reached  the  Btomach. 

inhalations   act  ditlerently.    Although  the  fongas  is  not 


LFNOS:    D1SRASB8  OP. 


283 


deetroyerl.  the  effect  of  turiicntine,  chlorine  ami  chloride  of  potas- 
siiUD  m  dimitiiskiog  the  fetid  sputa  is  undeniable. 

The  hv»i  and  aurvt^t  rcuultis  arc  obtained  from  oil  of  turpentine 
and  car1>oliO  acid.  The  latter  is  Uijed  »evernl  timis  daily ; 
eight  to  tii'tcftii  grains  in  three  ounces  of  water.  Tarpentine  xa 
bC6t  uaed  as  a  epray  with  an  atomizer,  ten  to  thirty  mininiB  in 
three  ounces  of  nait  solution. 

llie  gcDerel  treatment  coneiats  iii  improving  the  strength  in 
all  poeaibic  way». 

The  fever  ia  to  be  mot  by  quinine  in  lai^  dosos. 

A  full  do«e  of  morphitu!  inuttt  bu  giv(»i  at  bedtime,  but 
expectorants  give  tho  beat  roBulta  in  the  day,  by  stimulating 
eaqxKtomtion. 

Tlie  patient  fthould  remain  in  that  position  whieh  beet  &TorB 
the  drainage  of  tlm  gaiigii-'nouti  eentn;. 

LooMis,  while  expreesing  his  diabelief  in  the  efficacy  of  anti- 
eeptics,  say^  that  tho  best  is  coinponed  of  thymol  nnd  salioylio 
ftcid,  in  spray.  It  is  augge«t«d  that  the  cavitioe  bo  tap]M»I  and 
vaehed  ont. 


Bartholow  praises  the  effects  of  eucalyptol.  given  in  perls 
containing  five  minims  each.  Oxygen  inlmliitinns  relieve  the 
dj-fiimea.  mid  improve  the  blood.  The  benzoate  of  soda  should 
be  intrr)tlticed  into  the  lung»  by  atomizution,  in  a»  targe  (juanlity 
B8  jioeaiblt!. 

Id  view  of  tlic  tmpowibility  of  introducing  anti»<cptioi  into 
the  lung  in  a  strength  sulhcient  to  destroy  micro-oi*gani.sms,  the 
ragg(Stion  that  gangrenous  (.-avitiea  shall  be  tapped  and  waehc<l 
oat,  deser^'ea  a  full  trial. 

2.    irVPKREMlA. 

R.  J).  Powell,  nays  that  the  first  point  in  active  hyperemia 
IB  toBcctirc  absolute  rest  in  bed,  Rilem^e,  luid  reniovulnf  all  twiiirecs 
of  fcxeitement.  Mui^tard-poulticoH,  cups  or  loeclios  to  tho  chest ; 
warmth  to  the  legs;  xaline  pnrgntives ;  and  low  diet,  with  no 
Btimulauts,  may  bo  employed.  Astringente  BhouUl  be  avoided. 
Digitalis  in  utieful  to  (uilm  the  eirculation.  If  the  fever  lie  high, 
diaphoretics  are  indicated  to  meet  the  approach  of  pneainonia. 


SS4 


UAKUAL    OF   TRKATMKNT. 


Pftssire  hyperemia  cat!'*  for  nctive  utimnlntinti  nm)  high  fowling;. 
The  patient  mu^t  lie  fre(|ucnt1y  tuniuil.  Amimtnia^  ether,  and 
quinine  are  of  the  j;;reate8t  value;  and  luiiflk,  i<umbnl  and  lavender 
arc  uswftil  wljiivantii. ' 

In  obstrnctivG  heart  discaBe,  tlio  chief  indication  is  the 
avoidance  of  cairarrhn. 

Baktudlow  my»  rliat  uetive  congestion  in  a  plethoric  eubject 
may  demand  veaesectioii;  or  at  least  leeches  oroups.    Anactive 

emctie  Rlimilii  he  jjjiven  lo  clear  the  lnwichi  of  fluid.  Stimulant 
expectorant*  are  gfiven  for  the  ijauie  pui-pttw;  auch  as  Bquill,  eer- 
pentaria,  or  tienega.  To  diminish  the  viscidity  of  the  secretion 
he  recommends  the  iodide  of  ammonium. 

Urrtz  rcconimeiids  the  grape,  milk  and  whey  cores,  for  cum 
in  which  fllight  causes  produce  cardiac  erethism.  Such  patienta 
should  live  in  the  open  air,  and  bathe  the  chest  in  cold  water, 
followed  by  onergetic  rubbing*.  AcidB  should  be  given,  and  some- 
times digitaliB. 

Occurring  in  severe  a^tlienie  fovore,  passive  hyperemia  calU 
for  frequent  change  in  the  position,  ami  the  imI ministration  of 
stimulantjt.  In  very  grave  acute  hyperemia,  with  acute  CDdema, 
a  bold  Tonosection  i>hnuld  be  made.  Hydremia  contnuindicatea 
thif«  step,  bill  iiitc'i-i^tiiial  (cdema  dom  not;  ogpeeially  if  the  cedem* 
threat*tn  life,  and  emetics  with  derivatives  iail  Ut  give  relief. 
Venesection  is  aleo  indicated  when  oidema  of  the  hniin  is  threat- 
ened, but  must  not  liu  employ*'*!  when  somnolence  in  associated 
with  an  irregular  pulse  and  oecasionfll  intermission  of  respiration, 
showing  ffidema  of  the  medn]Iii;for  the  above  syniptoms  wonld 
increase  if  blood  were  drawn.  Tlie  fluid  exuded  into  the  alveoli 
Diay  W  removed  by  emetiCS,  and  Htinmliint  expectorants,  such  as 
senega.  Cnthartics,  sudoriflcs  and  diiireticTi  may  be  also  used  ai 
adjuncts;  with  siim]iiKmH,  hot  foot  and  hand  l>athtt,  kiu  ThoM 
remedies  arc  also  uscltil  when  blood-letting  is  contra-indicated. 

Diuretics  urc  chiefly  UKcfnl  In  cunliac-  cartes,  and  the  best  ii 
digitalis.  This  drug  is  contra-indicated  by  irregular  respiration. 
hKUKRT  gives  it  even  then,  with  ammonia,  camphor  or  lH;ii7oin; 
or  else  the  latter  alone,  followed  later  by  digitalis.  For  the  weak* 
ened  imiervation,  with  irregular  rcapiration,  the  tincture  of  musk 


LUNQS:    DISEASES  OF. 


286 


ma/  he  given  in  do«M  of  fifteen  drops,  bypodermicatl/ ;  and 
strong  wlue!4. 

For  the  same  condition,  Oppolzkb  recommends  qaiuine;  and 
Traubb  the  acetate  cf  lead,  in  (udenui,  tliruo-tburtlw  v(  a.  grain 
tKcry  hour.  In  chronii-  iiassivc  bjiiei-eniia  witli  cedema,  this  in 
but  rarely  applitaible.  In  IJrigltt'H  iliMaiM,-,  IIehtx  txtolii  warm, 
wet  javks  ibr  tlie  leg»,  prolonged  for  t*everal  houre.  In  cardiac 
diseoee,  digitulia  i»  Atil)  tlic-  hcAt  rmiMy,  with  luJinu  diuretica, 
«xpectorautf«,  and  quinine,  imn,  stimulantn  and  rich  food. 


8.    BRONCHO-PXECMONIA. 

T.  H.  Gkkkn  premiMw  liin  trp-jitrat^nt  with  the  «t«tcmciit«  that 
thitt  distia^  ill  invuriablv  a<«ocmtLHl  witli,  and  ofturi  indiiuisl  hv 
catarrh;  that  its  (Kcurrence  is  favored  by  nil  weakening  ngente; 
and  tlrnl  it  killahy  intwrfvring  with  the  resptrution.  'Hie  oljJLi'ttj  of 
treatment  are  to  cure  catarrh,  to  prevent  coUapse,  and  to  support 
fbe  Ktrength.  (See  Bronchitis).  The  air  should  he  nioitit«necl  hy 
Bteam.  Tlie  diet  must  he  regulated  hy  the  age;  it  must  be  easily 
digest«d  and  nutntion»,  and  calculuted  to  anp[>ort  the  itttvngtli. 

Following  mea-slf»,  the  ga.stn>.inte*tinal  irritability  must  not 
be  foi^tten.  Small  doses  of  i]>e<-iie.  with  itulinex  ithoultl  Ih*  given 
fraiueutly.  Warm  and  light  pnultices  should  be  applied  to  the 
dieaU  In  young  children  it  i^  Iwlter  to  apply  Htininlating  lini- 
ments to  the  chest  nTHp  it  in  cotton  wool,  and  cover  with  oiled  silk. 

When  ttit-  si'i-retinii  m  abunduiit,  iuf  removal  may  \n:  iiiilod 
by  givhig  ammonia.  The  i-hloride  may  be  given  with  senega. 
An  oci-utiional  emetic  givcjt  mlicf  when  Ioomu  rules  and  dyH])iH»i 
indicate  an  accumulation  nf  ?ecretion.  Opium  is  tiwially  contra- 
indicated.  \\nicn  violent  coiigh  wltli  little  sccivtitm  fnllowfl 
whooping  cough,  opium  may  bo  given  cautiously,  or  better,  bro- 
mide of  aininotiiiini.  The  u.-'c  of  Cold  extvrimlly  ia  valnuhlo,  to 
reduce  the  fever  and  to  expand  the  InngA.  <Jold,  wet  compreAsefl 
may  be  applied,  to  tho  chcitt  fi-om  one  lialf  to  four  hours.  This 
may  be  repeated  at  iiiterval.t  for  «mie  days.  Symploraa  of 
exliaudtiou  indicate  the  uccesxity  of  terminating  the  applicatiou 
for  a  time.  Ji'kr(ienskn  preferred  cold  hatbtt  and  atfusions. 
Tho  shock  of  oold  douches  relieves  tbrcat«ne<l  collapse,  but 
doee  not  reduce  the  fever  so  well  aa  the  previous  method. 


KAKt'AL  OF  TREATUEITT. 

Brandy  is  valnable,  especially  tn  diildren.  It  is  beet  given 
in  milk,  in  quantities  suituble  to  the  a^*of  the  child, and  repeated 
according  to  the  effect  produced. 

In  the  cbroniu  forma  of  tins  diecaao  attcotioti  to  nutrition 
is  of  the  fimt  importance.  Cod-lirer  oil  may  bo  given  even  before 
the  fever  haa  totally  diaap]i«iire(l. 

Convalescence  ia  slow  and  broken  by  relapses.  All  causea  of 
catarrh  are  then  to  be  avoided.  A  change  of  air  is  cepecially 
vflluflble. 

JvKAoiLssEX  HpeakH  highly  of  the  u»e  of  oil  of  turpentine, 
in  doM6  of  five  di-ops,  four  times  a  day,  in  milk,  in  the  chronic 
forms.  To  avert  thre^tentMl  f<>1lH]i«>c,  lie  ]tiaceH  the  tdiild  in  a 
bath  at  from  77°  to  86*  Fahrenheit,  and  allows  him  bo  remain 
for  Iwenty  niintiteH.  Tlu^n  from  ten  t*')  twenty  quarts  of  water 
are  poured  over  him  from  a  moderate  height.  This  water 
may  ho  rediieed  to  h  few  dogiees  above  freezing.  The  alfuiiiun 
must  bo  rfipid,  and  thoroughly  showered  over  the  neck,  back 
and  hreatit. 

If  a  thin  otreamof  water  be  directed  agaioet  the  back  of  the 
bead,  over  the  medulla,  a  spot  will  be  found,  the  irrigatiou  of 
which  produces  violent  respiratioti*,  even  when  a  high  grade  of 
carboiiit'  acid  poiMOniiig  i»  [indent. 

The  yonngcr  and  weaker  the  patient,  the  greater  the  need  of 
active  and  pmmpt  interference.  A  fvw  bouiM  atlter  an  alTusion, 
apota  previously  dull  become  resonant. 

For  tlic  cough  he  prescribes  Mtiega  with  \i(\.  ammoii.  aniHal. 

H    OLanfa. ..i.. put.  j 

Alcohol, part,  xxiv 

Aq.  BuiiiioakB park  v 

M.    &~-Liq.  uainon.  uiiwL 

For  obstruction  by  profuRe  secretion,  the  beat  emetic  ift 
apomorphine,  when  pure  aud  fresh. 

B     ApoiDiirpbliwr  hjilrt>c]ilor,.*... gr.  x 

GlTcerini,.... 

A<|UK,  U  t).  ■.  ad t f  3  j 

M.    a. — For  bypodcrmic  use. 

Never  give  tartar  emetic  in  divide<l  doHCa. 


Lt'KOS:    DI 


287 


LooMis  altogctlier  disapproves  of  the  cold  applications.  He 
prefers  the  U5e  of  jioultices  or  liiiimciU-A.  StimulailtS  iriunt  \te 
tiMxl  at  tlic  outset  Quinine  may  be  given  in  lull  doee^  during 
the  fever,  and  to  aid  resolution  in  the  activt-  stage.  Ten  to  twenty 
graiiiB  may  be  given  daily  to  a  child  three  years  old.  As  an 
emetic  be  prefers  ipecacuanha.  The  position  of  the  patient 
should  be  tivquuDtly  clmn^ed.  If  tJie  dLMjat^  be  prolonged,  uod- 
liver  oil,  iron  by  hydmgen,  or  iodide  of  iron  should  bo  given, 
with  change  of  air. 

BjIrthoix)W  i-eeommeiids  the  cnrbouate  (gr.  iJJ  to  vj),  and  the 
iodide  of  ammonium  (gr.  iv  to  viij),  in  solution  every  two  hours. 

Id  Bubauute  cased,  oi]  of  turfientine,  eucalyptol  uiid  cojiiiha, 
are  very  active  in  checking  the  secretion  and  expelling  it.  Co- 
paiba i*  the  best,  and  may  ho  pushed.  Am  an  eiuelie  thin  aiillior 
favorrt  subsolphate  of  mercury,  two  to  tour  graius,  in  sugar. 
High  fever  calls  for — 

B     Tinct.  Kcnniu  ntL, ...•>■ f5  j 

Tind.  beU&iloniue TS  ij 

U.    8^-8ix  dro|M  «v«i7  Iwo  tiourii  to  •  ctiilil  of  two  y«ftr«. 

Continued  fever  demanJji  quinine  nnd  digitalis;  five  grains 
of  the  former  and  one-fourth  of  a  gmiu  of  the  latter  tliriee  daily 
to  a  child  two  yenre  old. 

Tn  fiut»u:ul«  anil  clironic  cnttes  he  uses  iodide  of  ammonium 
with  the  lime  phoiiphates. 

Tlie  best  local  appliL-ations  are  turpentine  stu|»M. 

The  inhalation  of  oxygen  Bouictimes  gives  great,  though  but 
fcmporary,  relief.  The  inhalation  of  turpentine  vapor  might  bo 
useful. 

It  must  not  he  forgotten  that  the  undue  pushing  of  alcohol 
U  open  to  the  mme  objection  whicli  forhids  tiic  use  of  opium — the 
danger  of  narcotiem.  The  plan  reuomnieude<l  by  Jukrqex.srn  is 
oertMnly  efficient  when  t«illapsf  \»  twcurring  ext^jnHively,  when 
carried  out  by  the  physician  in  person,  but  it  is  rare  to  find  nurses 
to  whom  it  <»iri  \>v  untrusted. 

4.    CHRONIC  PNEUJIONIA. 

T.  II.  <iRKK»  remarks  that  when  tibroais  ta  Mtablished,  it 
is  Lanlly  neccsaary  to  say  that  the  new  growth  is  incapable  of 


288 


HANDAL   or   THKATMEST. 


removal,  and  by  treatment  we  can  only  hope  to  influence  the  ex- 
tension of  the  disease,  and  control  the  bronchial  catarrh  bo  nfteo 
prcaciit. 

Tho  niano^mont  of  this  catarrli  constitutes  the  mont  import- 
lUlt  pnrt  of  the  tn^atnient.  A  climate  should  l>e  Heleoted  which 
is  e<iuahlo,  dry  nml  nuidopatoly  hmcing. 

Tlie  patient  should  be  warmly  clail,  and  everytliing  should 
bo  donp  l>y  diet  nnd  exorcise  to  improve  the  health. 

Cod-liver  oil  and  ittm  are  often  useful.  Acute  catarrfai 
should  be  treated  promptly.  Profuse  secretion  demands  inliala- 
tion»  of  iodine,  imi*niiiie,  crooaote  and  capbolic  aoid.  Turpen- 
tine may  l»e  given  internally  with  the  name  objoet.  Opium  and 
(ibloi-al  are  to  bo  used  for  cough. 

RuKULK  speaks  favorably  of  counter-irritation  with  iodine. 

The  climate  of  Colorado  is  thought  to  be  especially  useful 
for  the  more  vigorous  case*  nf  this  diMMwe,  while  for  ihose  whose 
strength  is  aiready  much  impaired,  a  residence  in  Southern 
California  in  preferable. 

5.    CEDEMA. 

R.  D.  Powell  hiys  stress  upon  the  importance  of  dC'rtvauT«ii 
Mustard  poultices  or  dry  cups  f^ve  relief,  but  blisters  are  to  be 
ftvoidc<l.  HydraEfopicv  may  tw  given  net;onling  to  the  strength  of 
the  patient.  l>igiiHli3,  juttipcr,  broom  and  nitrous  other  are  UAe- 
ful  in  some  vaaes,  combined  with  acetate  of  ammonia  and  warm 
baths.  The  eoexisting  di>4>ase  of  the  heart  or  kidneys  will  deters 
mine  tlie  exact  treatment.  Lohs  of  tone  in  the  veMwI-walU 
dcmandij  iron  with  mineral  acidii.  In  all  cases,  rest  In  bud  U 
neoeeeary.    (See  Uyperemia.) 

6.  PSErMariioKAX. 

FowxLL  Hays  that  whenever  death  It  threatened  by  dyspnc*, 
t'^pnoentcsis  must  bo  pcrtbnncd  with  a  fine  trocar.  Tliis  msy  be 
Tepeated  if  nereeeary. 

Rest  to  the  atlcetcd  side  should  be  secured  hy  strapping  il 
with  adhesive  plaster.  Tlie  tdiock  and  dyspnea  are  beat  treated 
by  opium  in  small  and  rc|>eated  doses. 


3S:    DISBASBS  OP. 


289 


Fraiektzel  HAyi  thai  when  an  erapvema  has  b«eaino  a  pyo* 
pneumothorax,  we  must  at  once  operate  hy  incision.  The  same 
atJvice  ttppUt*  to  ca»c«  due  to  woumls.  But  iu  those  occurring  in 
phthiaii*,  his  results  have  l»ecn  unfavorahlc;  the  patients  rapidly 
Mnking  afVcr  the  oiicration.  In  the.'^c  latter  caaea  he  confines  him- 
Bclf  to  the  treatment  of  the  syinptonif,  ami  the  use  of  supporting 
mcasurcB.  The  best  results  from  puncture  are  obtained  after  three 
days  have  elapw<l  from  the  occiirrcncc  of  the  ixcrrfonition.  The 
woond  has  then  had  time  to  heal ;  and  the  withdrawal  of  the  gaa 
relieve**  the  hiiig4  from  enilKirraiwiiig  pn^tture. 

7.  HY£>ROTUOKAX. 

ZiEUSSEX  rccomiDcnda  puncturing  the  pleural  cavity  with  a 
fiiie  trocar,  and  removing  the  serous  accumulation. 

Fbaextzel  prcfvrtt  making  &  couple  of  inciiiiona  into  the 
0ubcutaneau»  tissue  and  letting  the  ana^mxtuH  fluid  drain  off, 
protecting  the  wouuda  from  infection  by  auitablc  dressings. 

Taavbe  introduced  mto  the  woumU  Httle  metallic  canuln, 
attached  to  nibber  tubes  to  conduct  the  scrum  away.  Tlic  ofl'ect 
of  this  iiro<.*duro  is  much  more  beneficial  than  that  of  tapping  thfi 
pleural  Bac.  The  medicinal  treatment  is  that  of  the  cauaal  afioo- 
tion. 

8.  HYl^OSTASIR 

JrKBOSKseH  makcA  the  recommendation  that  the  patient's 
position  be  frequently  changed.  He  flhould  even  lie  on  the  Imlly 
at  timcti,  The  action  of  the  heart  muRt  1h>  utimulated  by  ammonia, 
alcohol  or  digitalii*,  the  latter  especially  in  aged  pcraong.  High 
feror  may  necesaitato  tlie  use  ol  antipyretics ;  but  often  w©  are 
litnitcrl  to  the  prorootiou  of  nutrition,  especially  in  convalescence 

The  respiration  muBt  be  stinuilatcd.  Patient*  should  be  made 
to  bH  upright,  m7.fi  ttome  point  of  support  with  the  hands,  and 
make  a  stated  number  of  inspirations  to  the  minute.  If  fever 
pcrdLitK,  he  rccoinmends  a  cool  bath.  Tlie  eotmer  the  patient 
leafoe  his  bed  and  walks  about,  the  sooner  will  tho  hypoeta^ia 
ditiappear. 


4k90  UAWAL  OF  TBBATUEXT. 

9.    ATELECTASIS. 
IIkrtz  gives  a»  the  best  emetic  iu  collflpw  of  the  Iiiiiga,  the 
following; 

ft     lp««acuui. gr.  xziu 

Anliinan.  vt  polu.  UrL, 8T-M 

Soilltp  oxytn«l., , fj  Jjn 

Acjuw. f5* 

M.    S.— rthBktf.    Tnke  ono  icanpoonriil  cvwy  fifieeo  minuMt, 

(See  Bronctitia,  and  Broaebo-Piieumonia.) 


MEASLES. 

TnouAS  puts  the  patient  to  bed  in  a  darkened  rooin,Tentilat«d 
and  kq.t  tinilbnnl.v  at  63"  to  67°  K.;  with  the  diet  siiitab!}- 
rtgiilatecl,  and  water  givea  to  quench  the  thiret.  Patients  must 
not  be  kept  too  cool,  nor  foolishly  loaded  witli  bedding.  Too 
pale  an  crujition  demands  slightly'  more  warmth;  too  marked 
redtiess,  with  i^evcre  fever,  may  need  cool  applications.  The 
amount  of  light  admitted  must  be  rogtilatAxl  by  the  state  of 
Oie  patient's  eyes.  The  secretions  should  bo  frequently  removed 
with  hiktvivarm  water,  and  cold  employed  if  necesaary.  For 
severe  coryaa,  warm  water  or  vapor  should  be  drawn  throogh 
tlic  nose. 

If  the  coagb  be  violent,  tlie  air  of  the  room  [<hon1d  be  kept 
at  a  moderate  tompcratut-c  ami  frequently  clmngetl.  If  there  bo 
severe  nervous  irritation,  the  neck  may  be  wrapped  with  flannel, 
and  niuei!af:in(>u^  drinks  administered.  Simple  laryngitis  requires 
a  cold  ComprcBB  to  the  neck.  JN^arcotics  should  b«  given  only 
when  necOBsary  to  produce  sleep.  An  emetic  given  early  may 
check  the  cough. 

Gaatro-intcstiiial  irritation  is  best  prevontod  and  treated  by 
avoiding  indigentiblo,  flatulent,  fatty  and  laxative  articles  of  diet. 
Constipation  is  rarely  present,  and  requires  the  mildest  laxatives. 
Piarrhea  tihould  he  treated  by  cold  compresses,  frequently 
changed,  or  by  ieo^bags  to  tlie  abdomen ;  if  less  severe,  by  poul- 
tices and  regulation  of  the  diet.  NaruoticH  are  only  to  be  used 
in  extreme  cases;  emuUions  and  aiitringents  arc  preferable;  revul- 
sinti  by  ]iacktiig8  and  hip  baths  may  succeed.  The  mouth  and 
throat  should  he  kept  olean. 


MEASLBS.  291 

The  TOOflt  iini>ortant  point  U  tho  Biipprcsrion  of  too  high 
fercr  in  the  first  an<l  the  eruptive  stages.  Cool  baths,  parks  and 
comprt«9eA  arc  the  means  now  tiPcH  ;  the  hatliR  when  the  tompeiti- 
ture  reaches  103' ;  the  otlier  meiianreH  wlieii  it  is  Iwlow  thin  [Kiint. 
ZlBuesViy's  tnethocl  of  bathing  is  preferred;  the  patient  being 
ptnced  in  wnter  j\l  alxnit  90%  and  cold  water  gradually  added 
tinlii  the  heat  of  the  bath  hn.«  fallen  to  77% 

If  cold  water  Ilsk  been  uitefl  from  the  xtart,  it  will  do  no  liarm 
in  ihe  desquamfltive  ntnge,  ntherwiw  it  nhoiihl  be  made  lukewarm 
CHlty,  and  gradually  made  i(»oWr. 

As  long  ft«  fevor  in  present,  or  severe  cough  with  bronchitin. 
the  patient  niiifit  ket>p  to  \n»  b«fd, 

lyhere  the  hydropathic  regimen  cannot  l>e  employed,  he  sub- 
stittitcfi  inwnetioiw  of  lard. 

For  very  high  fever,  Bixr,  recommends  very  large  dotwj*  of 
quinine.  Roxcati  gives  two  drachms  of  sulphate  of  magne- 
sia dnily,  as  a  felirifngt'.  Hbown  nihbe^l  the  whole  Iwidy  daily 
w-ith  oil  of  tttrpentine,  diluted,  with  the  best  cffecta  ujkmi  the 
hronchitia. 

rnfKHAii  gave  cUoral,  two  jjrains  every  twenty  minutes,  to 
a  child  four  months  old,  with  violent  and  long  continued  convul- 
sions. Failure  of  the  hc-nrt  alter  brain  symptoms  have  developed, 
mav  bo  stayetl  by  the  uae  nf  WU16,  lienzoio  lu-id,  or  camphor; 
if  the  tfuriiu.*  !«  oold,  by  warm  bnthg  and  cool  douehea  to  the 
hc^.  BroDcho-pnctimotiia  hiw  I)cen  shown  by  Bartelr  t«  occur 
in  small,  low,  tigbtly-clo«ed,  Imil-^melling,  crowded  dwclHnga ; 
hence  free  venlilation  is  the  pi-ophylaclic.  Knieti<«  are  only 
uaeful  when  the  larger  bronchi  are  occluded  by  mucus.  The 
best  plan  of  treatment  U  the  following:  Several  cloUut  arc 
wrung  out  of  cold  water  and  laid  on  dry  flannel,  and  the  naked 
patient  is  placet)  iifton  and  wnipiit^d  tii  llit-w'.  Lively  kit-king 
and  eereaming  result,  the  re*>piration  becomm  freer,  and  the 
child  qiiietit  down  and  goes  to  sleep.  Tliist  Ik  repeatt^d  every 
half  hour  till  temperature,  puW  and  respiration  are  markedly 
reduced.  The  aiipUcatiou  should  be  repeated  whenever  the 
symptoms  demaml  it.  Byitenteric  symptoms  roquii-e  large  enft- 
niata;  with  ice  for  hemorrliage,  Paeudo-tToup  is  to  bo  treated 
by  diaphoretics  and  very  hot  sponging,  perhaps  ometioa.  Whan 


MAiniAL   OF  TREATMENT. 


the  laryngeal  affection   thrtiateDS  to  bocome  chronic,  the  sorest  i 
remedy  is  tho  inhalation  of  atomized  fluids.      Giuigrone  is  pre- 
veiitutl  Ijy  t;ltainHiit'(ui,    "When  presuiit  it.  denmuds  vary  euergwlic 
treatmeut ;  eautcrizutton,  followed  Uy  antiseptic  dresHiags. 


RiicusR  dwells  on  the  importance  of  a  suitable  diet.  He 
gives  an'ow-root,  gruel,  becf-tcu,  milk,  chickeu  or  veal  broth,  and 
jellies,  nt  the  imual  hours  for  meals.  If  the  [Mitient  be  very  weak, 
the  food  must  be  given  in  eruidl  qnantitiet*,  at  shorter  interval*. 
iJo  atiniulant  i»  so  importiuit  as  food.  If  there  be  mueh  %'oiiiiting, 
he  orders  raw  mont,  Liebig'H  extract  and  raw  white  of  egg  in 
water,  or  barley  water,  givou  ofteu.  Thii-Kt  may  be  atwuaged  by 
small  quantities  of  wat^r,  given  frequently.  Acid  drinks  are 
better  than  wat«r  aloue.  If  the  patient  become  pttMtraie,  with 
dry  tongue^  and  i^niuU,  fre<)ucnt  [iiils-e,  Btimulants  roust  be  given 
frequently  and  often. 

Davis  presoribce  for  the  cough  and  catarrhal  symptonu — 

H     Svr.  kIIIic  comp^ '  S  J* 

Tiii^t.  a.iiiguiDarJ)e, fi*t 

Tin«t.  opii  eninp'h., 'SO 

U.    K — A  tenspooitfiil  (to  itn  ailult)  tvviy  fciur  'hmirm 

In  severe  headache,  half  an  ounce  of  bronude  of  potassium 
is  add(Hl  to  the  above. 

If  tho  fever  Ijc  unusnally  severe,  he  add*  ouo  drachm  of 
tincture  of  veratrum  viride. 

In  a  very  severe  epiilemic  of  measles  in  the  Pbiladel]>lua 
Hospital,  it  was  found  tliat  brandy  wa^  the  most  efBcient 
remedy  when  syjnptonis  of  rmilignancy  appeared. 

1  have  been  fit-quently  struck  with  the  mildne&i  which  thia 
disease  as-sumoa  when  the  freest  possible  ventilation  is  permittai. 

Xoiie  of  tlie  aiithora  quoted  have  mentioned  the  great  value 
of  ipecacuanha  in  treating  niea.>)les.  In  the  compHcatious  gene- 
rally, whether  bronchial  or  g^tro-iiitcstinal,  thitt  drug  has  heu^ 
ficial  pn>pcrtiu8  which  I  have  never  noticu)  in  the  same  a&ctioni 
when  not  oucurriiig  with  measles. 

1  order  u  three  uiuicc  mixture,  witli  one  dtachm  of  wine  of 
ipecacuanha  for  uucli  year  of  the  child'e  age.    Of  this  the  patient 


MBS15CB8:   DIBBASBS  OF.  298 

takes  a   teuA[)Oonfii1   every  two   to  fix  hr>uni,  according  to  the 
grmvity  of  the  case. 

Opcasionall}'  we  see  rnnvnilsions  occurring  during  eotiTalM- 
oence,  «itf]  re[>eiited  acveral  time*  in  a  day.  Tliese  are  quickly 
relieved  by  the  administration  of  tincture  of  iron,  in  fimall  doflefl, 
repeated  six  times  a  day.  W.  F.  W. 


MENINGES:   DISEASES  OF. 

1.  PACnYMEXINOITIS  INTERNA  HEMORBHAG- 
ICA,  or  Hematoma  of  the  Dura  Mater. 

IIvuuBNiN  advises  Bymptoinat,ic  treatment.  Antiphlogistica 
arc  generally  uecd,  but  arc  unsatiafact^ry.  The  primary  disease 
in  the  lungs,  heart,  kidneys,  or  blood,  or  i-hronic  almholism,  will 
require  appropriate  treatment.  During  the  hemorrliage,  loechoa 
ehoald  be  nppHnl  to  the  tomplo^,  ami  eiipa  to  tho  neck*.  The 
bleeding  should  be  ample  to  be  of  any  benefit.  Venesection  is 
eoDietimea  reqnlrod.  The  cncrpctie  api>lieation  of  cold  is  never 
to  be  omitted.  Large  doses  of  calomel  and  ecnna,  or  saline  laxa- 
tives, are  to  bo  recommended.  All  cxeitemoiit  must  be  avoided. 
After  the  attack,  the  treatment  is  limited  to  regulating  the  haMte 
of  life.  Alcohol,  high  living,  and  all  active  exertion  of  body  or 
of  mind  are  t^  be  avoided.     Abtiort}cnts  are  uselcAs. 

'2.     HYPEREMIA  OF  THE  PIA  MATER. 

HL'ofenin'  ret^Hiimoml!)  venesection,  in  severe  (Marobral  llux- 
ion  with  full  pulse,  in  heal  thy  persoiiia.  In  other  eas**  the  usual 
train  of  snc-t^etlunea  tn  ucIvIklh],  (combined  nnd  morlitied  iih  iudi- 
eat«<d  by  the  age,  strength,  gravity  of  the  symptoms,  etc.  The 
regulation  o(  the  ImbitK  o(  life  i«  all  ira^Kirtaiit. 

8.     MENINtJITIS    TUBERCULOSA.      Acute    llydroce- 

pbaln»  or  Basilar  .Meningitis. 

HuiiUKViN  wtnrts  out  with  the  stntcment  that  we  know  of  no 
cures.  ]*rophylaxiB  is  consequently  of  the  first  iraportanee.  As 
there  are  forms  of  meningitis  not  tubertfuhir,  but  clinic-ally  indis- 
tinguishable from  ll,  wo  must  not  make  our  prognosis  gloomy 


SM 


UAKOAL  or  TBBATUR^IT. 


without  reserve,  (liildren  who  are  predisposed  to  tubereuUr 
ftffcctioiis  abould  have  the  full  benefit  of  [leriectly  arranged  hygi- 
enic regimen;  im:liidii]g  sea  air  in  rammer,  change  to  the  mooD- 
tainajiidifiouBlj,  salt  hathe.  cod  liver  oil,  etc.  Change  of  climatt 
is  markedly  bcneficijil,  even  when  tlie  new  hahitatiou  in  tw 
healthier  thau  the  old.  Too  early  mental  activity  should  be  pre- 
vented ;  whoop ing-eough,  measles  and  diphtheria  should  be 
Bhuiincd ;  bronchial  catarrh  must  be  treated  with  Llie  greatest  care. 
In  all  children 'g  complaints  unusual  care  muet  be  taken.  All 
twdUfi  lymphatic  glands  ichich  can  be  reaeked  ahmdd  ix  remoTxi  by 
operation. 

The  treatment  of  pronounced  mcQingeai  irritation  and  of 
compreesion  is  only  the  old  antiph  logistic  method,  regulated  by 
the  cxigenvicB  of  each  partieulur  ease.  I<eeoliing  gives  a  littk 
temporary  relief,  but  muslnrd  «nd  ifinnlitr  derivutivi>*i  dn  not  ereo 
llcconipIinli  thid.  PurgaliveB  are  of  more  value.  He(Kuguenin) 
uses  the  iee-blaiMer  to  the  sealp  hubiliially.  Mcn^-ury  and  iodine 
are  eonrinuully  b(>ing  I'ovivediand  thuir  UKeletwneott  demonstratod 
auew.  Cold  dourhes  in  a  lukc-warm  bath  arc  the  best  means  of 
dle8i]ml-iiig  oomn.  Xarcotiia  art;  iiidisjienHable  in  case  of  great 
jactitation,  delirious  unea:«ineei«,  screaming  and  objectleas  move- 
nients.  Opium  luid  chloral  are  uHeful  iialliatives;  the  bmruidw 
have  wo  eliwt  whu-tovcr.  Antipyretics  may  bo  used  energetically 
if  tlie  diagnoHiH  lie  doubtful. 

Gek  thinks  many  persons  recover  from  acute  tuberculoaie, 
aud  hence  eases  thought  to  be  of  this  disease,  should  be  carefully 
treate<i  to  prevent  the  meningeal  aflection.  In  the  invasion  period 
the  patient  should  be  put  in  a  dark  and  quiet  room,  and  be  carefully 
and  regularly  fed;  the  ayinptoms  should  be  treated  iw  they  nrisc; 
the  convuUi\'e  state  Icsiicne^l  by  full  do»es  of  bromide  of  potOfth. 
Continuous  applications  of  cold  to  the  head  Hhould  bo  miuLe,  if 
the  luwe  bo  seen  in  the  earliest  stage.  LeW'hea,  purges.  Ac,,  will 
hasten  death.     The  fical|t  iieod  not  be  ehaved  befoii>  applying  oold. 

UtJjAiiDiy-BEAUMET?,  clainiH  that  tubercular  meningitis  some- 
times aubsidcd,  just  iiu  tubercular  pleurisy  does.  He  reports  a  caaa 
in  which  recovery  cn^ucii,  although  ai]  ophthalmoscopic  examina- 
tion had  revealed  tuberelea  in  tlie  choroid. 


HBHISOBS:  msEAsits  OP. 


295 


Ho  prefers  the  flpplicMtion  of  ice  tn  the  head  to  the  employ- 
ment of  cotintvr-trritantd,  or  to  the  abstraction  of  blood.  The 
Kalp  should  be  shaved. 

The  flood  f  fFtvt>i  jiscnbed  to  mercary  or  io  qniniiie  are  really 
due  to  faulty  diagnosis. 

To  calm  the  iicn-ouB  manifMtiitiona,  he  givefl  chloral  and  the 
bromides,  as  ]iailiiitive)*. 

Iodide  of  potassium  hui*  had  such  atrong  teetimony  io  ita 
fcvor,  that  it  .-ihoiild  I".'  given  in  all  cases,  to  the  amount  of  tliirty 
grains  daily,  m  divided  doi^es. 

Diris  also  reeocomeuds  the  iwlido,  with  veratrum  viride  in 
scute  neni'otis  or  ft'hrile  pamxyiiiuH. 

LooBiis  einiply  etatee  that  prophylaiie  is  alone  eflfective.  Tho 
treatment  after  the  discnse  is  established,  is  only  polliattve.  He 
has  obtained  tho  betjt  n»ulu  from  opium  itcd  the  tiromido& 

Babtuolow  gives  two  drops  of  tinetiire  of  aconite  mttt,  and 
five  dro|ie  of  deodorized  tineturo  of  opium,  every  two  honre, 
during  the  stage  of  exeitatiou.  For  high  cerebral  excitotnent.  he 
adds  to  the  above  a  minim  of  fluid  extract  of  gelsemium.  If 
the  convulsions  be  numerous,  bromide  of  potaaeium  must  be  given 
6peely. 

During  the  whole  duration  of  the  diHeaae,  he  gives  Luudl's 
solution  of  iodine,  four  tt)  tm\  clro[ni,  three  timex  dally.  If 
deproBaion  of  function  occur,  the  best  results  are  obtained  fmm 
giving  two  grairu  of  quinine  and  one-aixth  of  a  grain  of  extract 
of  Iwlladonuft  every  three  hours.  "An  occasional  use  of  these 
nemedied  will  not  suffice — they  inuat  be  i>cn(iAte<i  in." 

Kor  will  they  '  suffice '  then ;  nuleas  the  physician's  object  be 
simply  to  keep  on  doing  sonjcthing,  without  eiptK-litig  to  cure. 
In  spite  of  DcJAfttus-HKAi'Mirrz'  case  (a  man  of  twenty-three 
yeara),  vrbich  was  not  verified  by  a  ftubswpicnt  auto|>sy,  we  must 
incline  to  the  belief  that  no  method  of  treatment  has  yet  suocreedod 
in  inhibiting  the  functioiuil  activity  of  the  tubercle  bacilli  iti  tho 
meningeal  Bac.  Nor  do  we  look  for  any  more  favorable  i-esulta 
from  the  latest  reported  "cure" — rubbing  into  the  eliaven  Bcalp  a 
Iwenty-pcr-cent  ointment  of  iodoform.     This  drug  has  not  yet 


296 


MANUAL   OF  TREATUKST. 


proved,  successful  in  the  treatment  of  tul>ci-cular  iitfec'tiona  wiUiin 
oasy  rvfich,  aii'l  it  lit  suur(-«ly  to  be  Huppoecd  tliat  it  acc)nlree  an; 
new  properties  in  passing  Ihrongb  the  seal]!  anti  tliw  Ikjiioi  <)f  th« 
crati'uiin  (providing  Huc-li  a.  thing  ooeurrGd),  to  reach  the  iiiemngBa. 
Too  much  stress  van  hnrdly  he  laid  uiM>n  tin*  irii|Hiiijnice  ot 
using  all  known  means  of  prevention.  The  one  tact  which  standi 
boIJly  out,  19  the  neeeasity  of  rv-inoviiii;  all  enlarge*!  lyinphotic 
glandn  which  cun  he  reached  with  the  knife. 

4.    NOy-TUBEliClTLOUS  BASILAK  MENTyOITIS. 

llnnnRNiN  iidvi.4(;A  local  bleeding,  ahniulaiitty  and  repeated- 
ly; cold  to  the  hefld,  .and  enei-getii*  purging.  If  there  he  a  tarn 
for  the  better  the  seton  may  lie  henefiuial ;  blisters  uitd  Usne?  ara 
without  eflect,  and  the  sunif  may  he  siiiil  of  c|ainine,  iodine  and 
mercury. 

The  terrible  hcadm^he  dcnmndu  the  free  iwo  of  opioiD. 
Chloral  hrings  nonie  sleep,  at  least.  When  the  9ym]»toin!»  Indicate 
a  le'^ion  of  the  nervoo  at  the  h:ute  of  the  hraiit,  ttyphillA  is  to  he 
BUBpecttid.    lu  all  cajses,  anti-sypbilitic  remwlies  shoiild  lie  tried. 

6.     MENINGITIS  OK  TUE  CONVEXITY. 

HrauBsis  enya  that  the  ti-eutmetit  is  mainly  prnphylacticj 
consiBtiiig  in  the  careful  treatment  of  every  otnirhea. 

When  Hymiitunis  of  brain  complications  arii*e,  the  ihoeI 
remcdio3  against  ccrebrnl  inftnmnmtion,  im  just  detailed,  ehould 
be  used  at  once. 

In  the  form  which  nrisos*  upontaneously,  venesection  ia 
indicated  ;  and  may  he  repented  aoveml  times.  Cold  baths  may 
be  employed  to  rcluce  the  high  fever.  Small  doseei  of  morpMne, 
or  rectal  injeetioiis  of  chloral,  are  often  of  service. 


MENINGITIS:  SPINAL. 

Bas7Ia»  recommends  that  the  patient  be  kept  in  aco61,q,« 
room,  tying  on  the  side  or  face,  on  a  comfortalile  bed.  Ho  abould 
have  spoon  diet  of  the  most  nourishing  sort,  witli  egS^,  and 
stimuUnta  in  moderation. 


MKS8TIKrATT0!T:   DiaBASR)  OP. 


297 


Blisters  or  iodine  may  be  appliixl  atong  each  side  of  the 
Kfilne  altenialel^.  Morphine  should  be  i^iveii  to  relieve  the  |)aiti. 
The  treatment  shoulti  be  directed  against  the  symptoms,  and  by 
fevtlin^  and  nuning,  the  patient  may  be  tided  over. 

Absorption  may  be  promotol  by  the  use  of  bichloride  of 
mercury  and  i<xlidc  of  ix>ta^ium. 

Babtuolow  rGcommouda  absolute  reat  in  a  darkened  room, 
leeches  to  the  spine,  the  ici>-bag  if  needed,  or  better,  the  hot 
douche  or  sponge.  Internally  he  gives  opium,  aconite  and  ergot 
The  effect  of  the  ojiium  Hhould  be  uleiulily  inaiiita-ined  during  the 
stage  of  excitation. 

Wlien  depre^tun  itupervenes  he  givet*  three  grainit  of  qui* 
"nine  and  one-tburth  of  a  grain  of  extract  of  belladonna,  every 
four  lionnt.  ParalyiiLt  during  con valcJHX-nce  n-ijuiivs  clL-clrieal 
treutmeut.    To  remove  depoaiu  he  dqteud^  ou  iodide  of  jiotjisaium. 


MENSTRUATION:    DISEASES  OF. 

1.    AMKNORIUIKA. 

Qc^ix  Bflys  tliat  thy  treatment  is  that  of  the  general  state. 
The  amenorrhea  should  not  bo  interfered  with,  when  duo  to 
phthitii!*,  Uriglit'e  dieeiwe,  etc. 

"VVheu  the  uterus  i«  undeveloped,  atem  pee^arie^  or  galvauiain 
are  advised.    Tit  ca^e  of  retention,  ati  outlet  must  be  made. 

ScnR<EtBR  opposes)  the  use  of  erameiiagogues.  lie  endeavors 
to  improve  nutrition  and  srengthcn  the  whole  orgmiisra  by  good 
foo<l,  meat,  beer  an<l  wiue,  and  by  an  invigorating  mode  of  life» 
open  air,  mndenite  lnHlily  labor,  cold  wa.'ihitig  and  rubbing,  and 
fresh  and  ^It  baths. 

In  (-•hlorotic  girl.-t  iron  i»  the  <inly  efficient  eminenugogiie.  If 
dependent  on  detit-ient  lilood  supply  to  the  genital  organs,  ho 
advisee  foot-baths,  silz-batbs,  douches,  leeches,  the  souud,  and 
intra-Htcriiie  j»essj»ries. 

Electricity  producex  favorable  results  in  aome  casos. 

Wlien  tlie  periods  are  abwnt  and  disturbances  conneoteil  with 
the  genital  system  are  manifested,  the  ommenagoguea  may  be  used. 


S98 


MANUAL  OF  TEKATUBKT. 


Wiu-iAMB  thinks  that  if  the  ment»w  hnvp  never  itfipcarei, 
the  uterus  iw  Hmall  and  the  best  treatniGtit  i*  noii-ititert'erenci'. 

When  scanty  and  irregular,  with  no  pnin  and  an  imdeTelopid 
uterus,  general  ph^'Hicji!  dcvflopment  is  recommended.  Hot  hiiy 
batb^  for  a  week  Uefnm  t)ie  motinien  are  iiiteful. 

Wlien  till-  (liBcharge  suddenly  stops  during  a  flow,  the  jntieBt 
most  take  a  hot  bath,  go  into  a  warm  bed,  und  take  a  Iktvtt't 
powder. 

In  chronic  fiuppression,  the  gcncml  health  should  be  attended 
to,  and  mnlimitiu  eneoumged. 

Thomas  reeommendH  the  intra-utcriiie  galvanic  pessary  for 
undeveloiH-d  uterus. 

Tilt  gives  pills  of  aloes  and  myrrh  at  bedtime,  witlj  hot 
hip-baths  at  night,  and  fool-batha  on  ri-ting,  miiHtard  to  the  inner 
aspect  of  the  thighs  and  breasts,  and  dr7  caps  to  the  breusia.  On 
Tetiring,  u  linseed  meal  piinltlce  il<i  hot  a^  can  be  1)ome  should  be 
applied  to  the  lower  part  of  the  abdomeu.  These  measures  are  to 
be  tried  for  three  days,  and  ugain  after  three  weeks.  In  the 
interval,  iron  should  be  given, 

Scarcely  any  one  nowadays  gives  the  old  emmer 
tansy,  rtie,  and  tuivine.     Indeed,  it  in  diflioult   to  formulato^ 
indication  for  their  use.     If  the  cessation  of  the  flow  be  di 
chloroHis,  the  remedy  is  Iron. 

If  it  be  due  to  debility  from  wasting  dUeaso.  3neh  as  phtht 
all  clfortM  to  restore  the  flow  an.>  U>  Ira  avnidtMl ;  m  ito  ceiwattou  is , 
due  to  the  laek  of  blood  to  spare. 

"When  a  Kudden  sUippage  occnn),  due  to  eatching  cold  while 
the  menstruation  is  in  progress,  the  following  prescription  will 
prove  serviceable: — 

a     Tinct,  nconiti  timL, I^m 

PuttM.  iiUniU\ 5j 

!jvr.  nn^ibrrU, q.  a.  ad     r|  vj 

M.    B, — A  tAbltvimonfiil  evenr  Totir  hmira. 

Hut  hip  and  foot  baths  are  also  of  uee.  If  the  cerebral 
congeslioti  bo  intense,  a  saline  cathartic  will  b«  advisable,  and 
perhaps  a  few  leocheR  about  the  anua.  Conium  ia  exceedingly 
useful  in  such  vtuws. 


UBSSTRDATION:    DISS  ASKS  or. 


290 


A  young  girl  of  twenty-two  years  h«d  never  menstruated. 
Bxaiuinatioii  i;howed  tliat  tbt>  oexual  org:uiH  were  nnrma],  and 
e  BTXual  ingtinc't  wfts  fully  doveloi^ed.  Subncutc  peritonitis 
appeared,  but  sulMitled  under  trvatnmnl  witli  calJ  Hppli<'atinns. 
A(teT  thiSf  variuus  ommenagoguce  wore  used,  and  a  ^Wauic  gtam 
peaeory  worn  for  uonie  montlH,  but  with  no  etToot  wbiitever.  Slio 
ifl  now,  at  the  age  of  twenty-tiix,  enjoying  eieellent  bcaltb,  but  no 
sign  of  menstruation  ha«  ever  ap|ieared. 

Tn   reganl    to   the  >itininlftting  etnmenagogues,  Bsviue,  rue, 

tan^y,  by<lropi{K^r  iiiul  upiol,  large  <|uantittc«  of  th&ie  clnign  aro 

taken  an  abort:)  ftK-i4?iii.«,  by  women  who  have  perhaps  gone  but 

a  few  day*  "'over  their  time."     In  such  caiiea,  it  would  l>e  well 

if  women  knew  that  these  dnigs  are  uselesa  in  pregnancy  and 

unnecessary  without  it 

I  In  all  caiws  of  apparently  caiiseleaR  ceifisation  of  the  men»M 

I    in  yonug  girls,  where  the  health  is  uniin]»aired,  the  golden  rule 

L    is  to  keep  dear  of  any  interfcnmce. 


2.     DYSMENOkRTIEA. 


k 


Qvxis  nays  tlmt  as  thin  diAeane  is  often  olwtlnate,  the  general 
health  bIiouM  receive  attention.  During  an  attack,  rest  in  bed 
should  be  eiyoiiie<l,  ;nid  hot  batlw  with  miodynest  employed  to 
r^ieve  the  ]iain.  Sulinea,  arsenic,  iron  uiid  bUmutb  are  of  benefit 
in  the  inten-aU. 

In  the  great  majority  of  ca^ea,  local  treatment  is  neccaaary. 
DtBplacementH  must  lie  corrBcle<i. 

Wlien  clots  are  found  in  the  cervical  canal,  thi^  channel  muat 
be  enlarged.  Thift  may  be  done  with  gnuluutcd  bongic-H,  dilatora, 
or  tcnt^,  of  sponge  or  laminnria.  If  these  fail,  he  recommenda 
Sims'  operation  to  divide  the  Htructurcs  of  the  extcmul  atid 
internal  m. 


Hart  and   Barbour  give  the  following  when  the  pain  ia 
slight: — 

n    &|).  dtloroToml, 

8p.  imniDn.  aroin.r UL    f  J  m 

IJq.  aiuu>«D.MeUt., ^Sj") 

M.    &,— A  lewpoonriil  in  n  wiimkI^*  o(  Itut  wiiUr,  occuiuu&lljr. 

On  no  account  allow  alcohol   in  any  form.    Do  not  give 


soo 


MAKDAL  OF  TBBATHIHT. 


Opium  xxnlem  ilriven  to  it;  and  then  administer  it  youraelf, but 
never  give  a  protwription. 

TllOMA»  reconiiiieiidit  apiol,  oiw  cH|Ktiil(.>  (containing  four 
minims)  night  and  morning.  Tincture  of  cannabis  Indica, 
gtU  XXY,  every  four  hoiire,  will  relieve  the  imin.  Where  th« 
Bpasmodic  element  exists,  he  gives  a  suppoditory  containing  oao- 
fourtli  of  a  gra-in  of  cxt.  bolliulonnti,  every  eight  hoiire. 

In  membranoue  dysmenorrhea  he  recommendfl  as  an  enema: — 

9     Tinot.  aurixtidf?, '?  Uj 

Tliict.  bclUdoEUiK, gtt.  XX 

TincLopil, gtL  s 

Aqiiir  t«[ii(l«<, f5  i^M 

K.    8.— For  one  iiijection. 

Instead  of  this,  he  give*  the  following  by  tho  mouth: — 

B     Chloral  hydnL^ , 

rotna.  bromide > 5  ij 

Morphiaie  sulphate S'-j^ 

%r.  miranL  corU. f  5  »y 

IC.    Bi — A  d«BMr1iipoon(ul  in  a  wineglnBTuI  of  wsler  ever^  foar  hotin. 

In  ovarian  dysraeriorrliea  he  prefers  tlie  bromideB,  in  fall 
doses,  commenulng  then-  ii^w  a  woek  hofore  the  mentitrual  period. 
Five  grains  of  iodoform,  by  snpiKwitory,  gives  great  relief. 

Lawson  TAtT  thinks  tliat  iron  has  a  speciSc  eflcct  on  the 
Hxual  organs.  Uc  gives  it  during  the  intcrmcnatmal  periods*  in 
email  doeea  of  the  tincture  (gtt.  j  to  v),  and  increftses  suddenly  to 
fifteen  drops  two  days  before  the  expected  flow.  Ilot  hip-baths, 
leeches  to  the  perineum,  and  blisters  to  the  sacrum  are  usefiil 
adjuvants.  Marriage  is  the  most  efficient  remedy.  The  most 
powerful  aid  w  mechanical  irritation  by  Simpson's  galvanic 
peeaary.  Thiu  »]iutild  be  used  in  eases  which  resist  simpler 
measures. 

ABAif  recommenciKi  opium  applied  locally  to  the  cervix  ateri. 

Dbspbes  rccommeuda  vaginal  injections  of  wann  water,  95° 
to  104". 

Davis  uses  the  following  in  cases  where  the  jtain  is  severe  and 
the  flow  scanty. 


hbnstrcjLtion:  oisBAssfi  op.  301 

B     "niMt  cimidfiigwt, f  J  iy 

TincLnlramonii ■ 

ViD.  colchid  ni., u    fjw 

M.    £.— A  tcupooufu]  ml  rtch  nival  tim«,  in  watn. 

For  ovarian  cases  lie  recommends: 

B     AmnitinE*!  muriat., Ji^ 

Tinct  slninanii T]  0 

Tinct.  vimicifugB^ ^lE  jt> 

SjT.  Kljcyrrhiae, fjy 

IC.    8.— r  5  three  liiBM  ft  d«7. 

Maby  Phtxam  Jacob:  found  great  benefit  from  the  use  of 
nitrite  of  amyl,  with  bclladouim,  bogau  before  tneos^iiatioa 
commenoee. 

ANsns  Bpoke  highly  of  belladonna  in  neuralgic  caeee. 

Philleps  recommenda  coculos  Indicns  for  thin,  nervous 
females,  with  tu-AUty  dinthargt-,  preowled  \>y  grijiiiig  pains. 

Atkissos  recommemlB  ergot  in  tbe  t'oujiestive  fonm,  in  dosea 
of  thirty  minims  of  the  fluid  extract  every  half  honr. 

Jrnks  stated  that  he  hwl  foimd  vihiinitim  pmnifoliura  l>ene- 
ficial  in  all  forms  of  d/smeiiorrhea  where  the  How  is  profuse. 

Mattuews  Ditncas  rec-omniended  dilating  with  graduated 
metallic  iM>tuuLt;  beginning  wltli  one  whirh  t-aii  luutily  be  iiaJSHed 
up  to  the  fuuduF,  leaving  it  there  for  a  few  minut^A  »iid  on  the 
next  day  inserting  a  ^ize  larger. 

This  approxiniatee  In  the  method  of  gradual  dilation  for  th« 
care  of  strloture  of  tlie  urethra. 


GoDnET.L  tntroducfD  a  duiall  dilator,  mid  expands  it.  This  is 
then  removcil  and  n  hirger  HKitrnincnt  introduced,  which  la 
expanded  tu  the  Aill  extent.  The  o{M>ra.tion  i»  done  under  ether. 
By  this  means  the  tibren  of  the  ntcms  arc  paralyzed  by  overdis- 
tention.  When  thi«  has  been  done,  s«veml  days  ela|»ne  liefore  tho 
capability  for  simmnndie  contraotinn  returns;  and  in  a  number  of 
t^sen  no  such  return  taken  place.  Titis  procedure  ut  Aiinilur  to  that 
employed  in  spaitm  of  the  sphincter  ani,  and  in  our  opinion  is 


SOS  ^^^TtAHUAL  or 

more  in  harmony  with  the  pathology  of  dyMnenorrhea  than  Um 
nielhofl  employe*!  by  Duscan.  Throiighmit  America  the  nse  of  ths 
dihitor  has  siijiei-wded  SiMs'  operation,  which  i»  iiuw  but  rarely 
pcH'ormed.  In  one  ctise  wliit-li  hiul  reeti^itecl  the  entire  groQp  of 
autispasmodics,  incUi<iiug  morphine  hypoderniically  up  to  two 
graini*  ut  one  injection,  u«iiig]t- 1  lirtnmgh  dilatation,  performed  two 
daya  before  the  expected  pnroxypm,  not  only  prevented  the  piln 
.at  tlmt  period,  but  for  years  aflcrwurdit  menHtmation  was  con* 
panitively  painleas. 

In  another  case,  n'herc  niembninotifi  dyHmenorrhea  had 
exii^tcd  ffoni  marriage,  the  following  plan  )>roved  Huocc«fal: 
Two  dayn  before  the  exitcctcd  paroxyrtOi  tli«  piitient  was  sent  to 
bed,  the  boweU  emptieil  by  a  liottle  of  citmte  of  niugnwio,  and 
forty  grains  of  broiuidc  of  potassium  witJi  five  tninime  of 
fluid  extract  of  gelsemium  given  every  four  lioure.  The  men- 
atnmtion  was  painle-^*,  for  the  tiret  time  in  seven  yean*  of  married 
life,  nud  when  the  next  month  f>aH»d  oromid  Ibc  lady  found  hor 
self  pregnant. 

Tiie  tluid  extract  of  gossypium.  ii*  a  valuable  remedy  in 
cases  where  the  menstrunl  flow  in  scanty, 

3.    \rK\ORRMAOJA. 

Barkks  considers  it  of  the  first  importance  to  maiuuin  a 
patutour;  condition  of  the  cervical  cunal,  :iiid  the  removal  of  sll 
clotu  and  shreds  of  nienibninc.  Tic  iutrotluce«  liquid  a^tinngraitfi 
into  the  cjivity  of  the  uteniw.  In  p«iislvo  hemorrhage  the  va«cn- 
lar  tension  must  be  moilcraled  by  the  \im  of  scdativw.  Ice  should 
be  uihhI  early,  in  the  vagina.  The  pelvis  should  be  elevated  above 
the  rest  of  the  body.    Saline  purgativw,^  are  useful. 

Intemally,  he  givea  turpentine  in  ca|wuleji,  ergot,  etc. 
■When  these  fail  he  use-s  styptics  locally.  In  the  after  treatment 
iron  only  addit  fuel  to  the  fire.  He  advice*  salines.  <;u<pccial]y 
the  freshly  prepared  acetate  of  ammonia.  To  this  he  add^  opium, 
digitaliH  or  aconite. 

TuoMAS  introduces  a  sponge  tent  into  the  uterus,  and  fills  the 
n^a  ^vith  a  tampon. 


OiLT  Speaks  highly  of  the  bromides. 


mnipg. 


303 


Hewitt  hae  an  equally  good  opinion  of  matico,  while  By- 
KRD  prefers  eigot 

Pasas  recommends  plogging  the  womb  with  cotton  ntceped 
ID  perchlortde  of  iron  eiilution.  dilutui  ontr-hnlf  tn  prevent  a  cor- 
rosive action.  He  then  introduces  n  vaginal  tami>on  of  cotton  to 
protect  the  viigina. 

The  u^  of  ergot  requires  a  good  deal  of  euro.  Wu  have 
found  thifl  drug  tt>  t-ftu»e  a  diminution  of  the  flux,  without  entirely 
stopping  it.  If  the  do»e  be  then  incrciu^)*!,  the  improvement  first 
gained  is  apt  to  be  loet,  and  the  hemorrhage  increoaed. 

We  agree  with  Barnes  aa  to  the  danger  of  giving  iron.  We 
have  known  hemorrhage  following  a  miscarriage  to  continue  for 
sevcu  months  while  tlie  patient  wa9  talcing  iron,  and  then  cease 
'Within  a  week  ut^cr  the  medicine  wnu  diBcontinued. 

Snlphuric  and  galUe  aoide  are  not  very  efficient  remedies. 
Cannabis  Indien  is  imcertain.  The  best  ny^temic  remedy  ie  digl* 
talis.  It  may  lie  given  in  llie  do^  nf  thirty  drops  of  the  tinctnre, 
every  fonr  hmin*.  The  hi|*  shonUl  iilwnj'g  be  elevated,  and  the 
patient  should  use  only  cold^aetdulatM  driuke. 

Too  much  time  should  not  he  lost  in  general  (rcntment ;  but  if 
the  hemorrhage  be  profueo  or  poreistt-nt,  recourse  aUould  Iw  liad 
to  local  measures.  The  condition  of  the  uterus  tihouM  ho  jnvesti- 
gute<l,  luid  any  affection  found  sliould  ho  treated.  Tliy  liest  oa- 
tringfflit  for  appliration  to  the  uterine  cavity  i«  chromic  aold< 
This  may  be  used  in  strength  sufflcioat  to  t-heck  the  lliix — twenty 
grains  to  two  dnu-hms  in  an  ounce  of  dintilled  water.  TIio  appli- 
cation should  be  made  by  means  of  a  jirobe  wnipi)»»l  in  alworbent 
cotton, and  saturated  with  the  solution.  TheoN  munt  be  patulous 
before  this  is  applied;  and  this  may  require  the  previous  nso  of 
a  dilator.    The  vagiim  niiutl  l>e  protoetvd  from  tlie  acid. 


MUMPS. 

MuinnBAD  considers  it  prudent  to  confine  the  patient  to  his 
l>ed  for  the  tirst  few  days.  The  bowels  should  be  kept  in  pn>per 
order  by  means  of  simple  aaline  laxatives.    Ice,  and  actd  drinks 


804 


MAKUAL  OF  TREATMENT. 


are  gmtcful.     At  bedtime  a  rlose  of  chloral  may  be  given,  one 
grain  lor  oat-h  year  of  the  cliiltl's  age. 

If  the  i»ain  Iw  BCvtMt,!,  iKtllmlonna  liniment  may  be  ftjiplttd 
locally.  If  there  be  the  Blightest  tci>deiicy  to  suppuration,  pcpii}- 
tices  must  he  at  once  applied,  aiul  tlio  gland  ojwned  aft  Mton as 
fiuctufttioii  is  discovered.  J^eche*  are  useleee.  The  same  mett- 
nres  may  l>o  uecd  in  mclastaats  to  tlic  t««itic1cs  or  ovanos.  Tepid 
epong'in^  and  warm  batlis  are  of  use.  Sometimes  stimulantd  tm 
rc«|uircil. 

The  debility  remaining  af^er  the  disease  haa  subsidod  maybe 
considerable,  nud  necessitates  the  use  of  iron  and  cod  liver  oil  for 
some  time. 

RlMiBK  stwakft  favoralily  of  leeches,  to  rclievt?  fmin,  especifll* 
ly  in  melastntic  cases.  The  jaw  or  testicle  afiectwi  should  be  k«jl 
at  rest  and  HUpported.    Sponging  witli  topid  water  is  grateful 

Tlic  diet  should  be  mild,  nourishing,  and  such  aa  re<iuim 
little  chewing. 


MUSHROOM  POISONING. 


Stkvkn80N  recommends  a  prompt  emetic,  followed  by  a  dom 
of  ca<(lor  and  olivo  oiK  Atropine  U  n  dim-l  antidote  to  mus- 
carine, and  should  l>e  given  In  smnll  dowtt.  Digitalis  ha«  tlie 
aanie  antidotal  effect,  in  n  lesser  degree.  If  the  latter  l>e  used,  we 
may  avail  ourselves  of  the  uw  of  iipiates,  to  restrain  the  exhaust- 
ing diarrhea. 

Vow  BoECK  mnkcs  a  diatinetion  l)etwoeu  [toisoning  by  de- 
cayed rautdiroorai^  which  are  otlierwitie  edible,  and  the  cffbctA  of 
those  fungi  wliich  i-ontain  a  specific  poisonous  pKnciple.  In  the 
former  case,  the  trentmeut  is  that  of  cholera  morbus. 

When  the  niusi-uniie-beariiig  fungi  have  been  eaten,  he  advises 
an  emetic  of  tartar  emetic  and  ipecaeuanlia.  Castor  oil  with  a 
drop  of  crotiiii  oil  will  prove  most  eflectuttl. 

Tannin  i^  partly  a  chemical  antidote  but  cannot  be  tmsled 
im]>iicitly.  Atropine  Ia  exiurtly  nn  antidote,  and  should  be  given 
iu  small  doses. 


HTAIjOIA. 


303 


MYALGIA. 

Oarbod  recommend 0  oupping  (or  the  acute  forma  such  aa 
lumbago.  This  gives  only  t^Mnporory  relief,  bthI  ib  not  essential. 
Hot  fonir'ntjjtioim  with  opium  ai«  valuable.  For  t-'hromc  foi-ma 
he  asee  'belladonna  liniment  with  oil  of  mnntanl.  Otawlonally 
blisters,  tur|K'Titine  nr  anodynes  may  be  substitutpcl  for  those  appli- 
catioiiJ.  liiloniRlly  he  e;ives  a^^etate  of  ammonia  and  bitairlmnat© 
or  iodide  of  potassiuio.  Quiuine  should  soon  bo  added.  For 
chronic  cn&f^  guaiactim  hendit  tlio  list,  followed  by  samafrss, 
mescereon,  the  iv^um  and  the  balsams.  Small  doM«  of  sulphur 
are  ofVen  useful,  am>ni(^  in  suited  to  oliKtinate  canet),  and  after  the 
|iain  liait  «ub«iide<l.  friction  and  electricity  leaden  the  sorenese  and 
restore  tone  to  the  muscles. 


Sbsatok  Qiakes  ub«  of  hot  drinks,  diaphorctioa  and  vapor 
baths.     Other  remedicn  arc  given  as  indicated  by  the  Kympioms. 

To  [irevent  the  recurrence  of  the  attacks,  he  advises  the  osuftl 
means  by  which  one  it«  iiiiirutt  to  i-old.  For  »:phulic  myalgia  he 
recommends  leeches  behind  the  ears,  diaphoresis,  and  when  obstl* 
nnU\  blistora,  the  contiunod  current,  and  opiates.  The  injection 
of  O&rboliC  ftCid  under  the  skin  may  turn  out  to  be  useful. 

In  torticollis  bo  recommends  warratli,  rubbing,  and  grwlual 
extension  of  the  muscle.  A  speedy  cure  may  he  often  obtuimtd 
by  a  thorough  application  of  the  Faradic  brush.  Horphine 
hypodermically  may  be  indispensable.  lu  intcrcoetal  myulgia  fho 
satnc  coarse  is  recommended.  In  lumbago  the  treatroent  should 
be  of  the  more  vigorous  methods  already  suggested. 

Akstik  »ays  that  in  most  emtm  all  that  U  required  ia  to  put 
th(>  affected  mui^i'le^  on  the  utretc-h  an<l  keep  them  so,  to  cover  tho 
akin  witli  Rpdngiopiline  so  as  to  keep  up  a  eteam  batli,  and  when 
the  acute  s^'mptom^  euheide,  take  a  ooupleof  vapor  baths.  When 
the  i<«in  rtsi.strt  tliin  trwirment,  by  far  the  most  efficient  remedy  is 
the  muriate  of  anuuoiiia,  in  twenty  gmin  dosee,  with  chloroform 
liniment  locally.  A  hypcHlermic  of  morphine  is  but  rarely  neoefl- 
aarj'.  Tlie  nutrition  must  he  carefully  maintained,  and  cod-liTOr 
oil  is  often  needed.  In  the  rare  cases  where  these  remediod  fail^ 
acupuncture  promises  exceedingly  well. 

U 


Hlft 


MAWAL  or  TRBATUSKT. 


We  n-ould  suggest  t]mt  the  galvuiic  oeedle  be  HijtMHtatal 
in  making  this  applicatioa.  AVe  Imve  usted  iaiiriat«  of  auiiiKmii 
ID  all  forttis  of  thU  tuinful  aflbction  with  such  good  refiulie  (hat 
we  rocoDunend  It  titrongty.  It  should  he  given  in  the  dose  recom* 
mended  hy  Anstis,  u  ftcruj)!©  every  six  houre  autil  congestion  of 
tlie  8cbnmderiaii  memhnine  is  jiroduced. 


MYELITIS:  ACUTE 


Bb.b  revommeDds  diaphoretic  meoKimn,  when  tho  disease  'u 
doe  to  oold.  AVhen  there  hits  lieen  exoeeeivo  fatigue,  alwolute  rcit 
and  a  warm  hath  inuy  check  the  ui  flam  mat  ion.  Siipprcseod  seeN- 
tiooa  should  be  excit«d  to  return.  When  myelitis  occura  in  > 
sypbilitiu  case,  au  energetic  mercurial  or  iodide  courao  should  at 
ODce  be  iniitituted. 

Wlien  patients  come  to  as  with  the  dlsesM  M\y  dsTeloped, 
the  treatment  will  vary  with  the  uu«cti. 

In  those  that  are  severe  an  energetic  anttphlogiatjc  treatment 
is  indiaitc«l.  Leeches,  cups,  ico-lmgs,  cold  Hpinal  compresses,  and 
men-iirial  inunctions,  are  the  mcasure«  n.'a>minended.  He  also 
gives  calomel  in  t«mull  di>Kcii,  and  later,  iodide  of  potavium. 
^BnowN'-SBQtARD  cmptoys  ei^t  and  belladonna;  and  these 
remedies  deeerve  a  trial.  In  mo^t  rn^cs,  ]tiirgiitivei«  and  diaratia 
are  better  suited.  Counter-Irritation,  when  properly  applied, 
does  good,  and  no  harm.  The  actual  cautery  or  blisters  should 
be  used,  according  to  tlie  severity  of  the  coae.  They  ahoald  not 
be  applied  to  anesthetic  regions,  or  points  subject  to  preeBore.  He 
(Ebb)  i-ccummends,  particularly  in  ascending  central  myelitis,  Uiat 
two  bold  streaks  bo  drawn  with  the  hot  iron,  or  pointa  o( 
cauterization  on  both  fides  of  the  spine,  repeated  every  day  or 
two.  The  more  robust  tho  indtvidoal,  the  more  energetic  the 
treatment  should  be.  Careful  attention  should  be  paid  to  the 
feeding  and  nursing.  Absolute  rest  in  bed  should  be  e^joinedf 
and  the  pationt  should  not  lie  exetuaively  on  the  bock.  (Bbowit- 
SftQUABD  pecnnitntmded  \m  (exclusively  alxlominal  decubitus.) 

Easily  digested  but  nourishing  tbod;  uo  spirita,  tea  or  coffee; 
-absolute  mental  ijuiet;  and  attention  to  the  skin,  comprise  his 
further  auggestions.     If  we  tide  over  the  first  few  wecke,  the 


SITBI.ITIS;  ACtm. 


cane  may  8»f«Ij  be  left  to  nature,  aided  by  proper  nursing.  Thon 
the  time  comes  for  qiumiie,  iron,  Lfood  food,  wine,  cod-liver 
oil.  fr^h  air,  etc.,  mild  hydrotherapy,  and  especially  for 
galvaniBm. 

Specific  rcnicdies,  such  sa  nilver,  gold,  iodides,  and  etrychnine 
may  be  cautiouely  tried.  If  the  patient  be  improving,  he  may 
practice  light  g^'mna-iticti.  Kinally  convalescence  maybe  hastened 
by  mountain  or  8ea  air,  cold-water  treatment,  or  soa-batlia. 

The  symptoms  may  call  for  the  treatment  of  cystitis,  painB, 
muscular  twitching  and  contractiirff  itr  inftomnia.  Agains^t  asphy' 
sua  and  cardiac  paralysis  we  are  powerless.  AriusLhiMia,  paralyeia 
and  atrophy  are  beet  treated  by  electricity. 

SptTZRA  says  he  hae  obtained  good  rcsalt^  from  derivation  to 
the  fett,  in  relapses  brought  on  by  chilling  the  skin;  and  in 
general  he  prefers  dcrivativee  to  the  cautery  or  local  bleeding  over 
the  fij.ine.  M  cold  to  the  feet,  but  not  cold  to  the  back,  has  been 
shown  to  cauM  myelitis,  it  is  reasonable  that  remedies  to  the  feet 
will  be  more  eftectual  than  thoae  applied  to  the  back. 

Rest  ie  imj>emtivc.  The  earlier  the  patient  goes  to  hia  hod, 
and  the  more  thoroughly  motionlunn  he  keeps,  the  better  will  be 
the  result.    In  convalescence,  excrcinc  should  stop  ahort  of  &tigue. 

Whenever  bed-soren  are  apprehended,  the  patient  shonld  be 
put  upon 'a  woter-bed ;  the  rubber  being  covered  with  a  woolen 
blanket. 

The  warm  bath  \»  the  most  useful  mcaeunj  in  acute  myelitis. 
In  cases  due  to  exposure,  it  cannot  be  applied  too  aoon.  The 
temperature  should  not  at  fimt  he  higher  than  88**,  nor  tlie  dura- 
tion more  tlian  twven  minutes.  This  can  be  lengthened  to  half  an 
hour.     It  should  be  re[>e»ted  daily,  or  ofVener  if  agreeable. 

Ret«ntion  of  urine,  if  complete,  ealls  fen-  eimtinuous  catheteri- 
sation.  The  catheter  U  to  be  dihiiifected,  and  at  the  slightest 
indication  of  cystitia,  the  bladder  should  Iw  IrrigBtod  with  a 
solution  of  corrosive  Bublimate,  one  part  to  2000. 

Both  the  galvanic  and  foradic  currontd  tihonld  he  uaed  early, 
and  continued  thnnighotit  thediseaws;  galvaniam  being  prwforred 
for  atnipliy,  and  faradiem.  for  anesthetic  conditions. 

When  the  blmhler  or  rectum  become  paralytic,  galvauiam 
should  be  applied  by  means  of  suitable  electrodes. 


808 


OF  TREATllENT. 


RosBiiTiiAL  relies  on  the  aiitiphlogiatica  and  purgattvet.  He 
dieapproves  of  count  er-irritantu,  and  dtiea  not  use  electricity  oatil 
inflammatory  Bymptoms  have  dieeppearcxl. 

Bastun  ie  Bkuptleul  in  regard  to  the  power  of  infiuQncing 
the  eouree  of  this  tliseaBO  much  by  drugs.  Local  bloodletting 
may  lie  of  some  use  when  there  i^i  local  tendeniewi.  Ice-bags  to 
the  spine  arc  preferable  to  counter-irritant*.  Bcside^i  thli,  be 
limits  hifl  recomnioudatioiiB  to  careful  nurHing,  liquid  food  aad  a 
little  stimulant. 

MYXCEDEMA. 

M.  Allks  Starr  says  that  the  Ireotmettt  i*  only  palllatiTe. 
Simple  nutritious  diet,  espeeially  milk^  with  iron  and  qninit 
have  been  fouinl  useful.  In  ii  very  wumi  t-Iiniato,  the  dis 
been  slatioimry  for  years.  Jaborandl  hsm  been  used  with 
Buccess.  Nitro-glyceriiie,  gr.  ,i„  has  also  been  found  beneficiaL 
For  ^mrostltesia  and  anesthesia  of  the  early  ataget),  the  faradM 
brush  ha.t  bt^un  a])pHed,  and  faradisation  for  the  weakneBs  of  | 
the  muHcle^,  with  benellt,  but  no  curative  effect.  For  the  paio, 
he  recommends  morphine. 

Obp  found  some  benefit  in  the  nw  of  vapor  baths.  In  other 
cases,  the  oymptoms  alitHMt  diRuppoared  uniler  the  us©  of  jabo- 
nmdi,  ten  to  sixty  minims  of  the  lluid  extract,  foar  times  a  day. 

AsDiiew  Clark  regarclH  the  disease  as  fairly  curable  by  care* 
fill  diet,  iron,  arsenic,  butlm  and  assiduous  frictions. 


NEURALGIA. 

Ahstib  recommended  that  neuraigice  should  consame  od»-1 
third  more  food  than  healthy  pm-NciiiH.    The  fal«  t^hould  form  a 
goodly  part  of  the  diet.    Syphili.i,  malaria,  and  other  caobexiB 
should  receive  tbeir  appropriate  treatment. 

Quinine  he  fonnil  uurciiable,  except  in  ophthalmic  neuralgia. 

The  utility  of  phosphorus  is  not  cxtoueive  or  reliable.  It  is 
most  useful  where  aueothesia  is  a  proiuiuent  symptom.  Tb* 
preparations  of  gino,  he  found  useless,  after  a  fair  trial. 


HBOBAUU. 


309 


Stryohoiae  waa  one  of  his  mo^t  highly  prized  weapons.  In 
ioternikl  nciirnlgiait  he  gave  five  to  tun  minima  of  tincture  of  doz 
Tomica  throe  times  a  day.  For  the  superficial  varieties  he  pre- 
ferred fitryehnine,  in  doses  of  one-fortieth  of  a  grain,  thi'ec  timoB 
•  day,  with  ten  minims  of  tincture  of  iron,  Thia  is  a  powerful 
remedy  to  prevent  the  recurrence  of  the  attacks  when  once  broken 
hj  other  means. 

H«  considered  the  action  of  tincture  of  iron  as  {>eculiarly 
benefidal,»pnrt  from  it*  ctfoel  upon  the  blood.  He  gives  it  in 
doace  of  thirty  to  forty  minims. 

Arsenic  i^  often  u>K:fu1,  espocially  lu  snomic  casefl.  Its 
pecnliiir  value  is  in  iingiim  pecloriit.  He  gave  Fowler's  solation, 
in  do«M  of  three  minims,  gradually  iner«L*ed  to  t«n. 

Tn  relieve  the  pan))tyFim,  be  iujectod  norpbino,  into  the 
painful  Hpoti*  by  preforcuce,  using  anuiU  doites;  ouo-sixtti  to  one- 
twelfth  rif  a  gniiii. 

Atropine  iu  do&cs  of  ,]o  to  ^  of  a  graiD,  he  found  espiecially 
Qsefal  in  dysnieiiorrlieiLl  neumlgia,  and  in  apjiroaehitig  iritis  or 
glautroma. 

For  niigraine  and  ctavua  he  gave  chloral  in  doses  of  twenty 
to  thirty  grains,  with  a  hot  mustanl  foot-bath.  Cannabis  Indica 
resembles  chloral  in  ita  ellVct*,  but  does  not  e^ual  it.  One-fourth 
to  one-half  a  grain  of  a  good  extract  may  be  given,  and  repeated 
tn  two  houm;  e4])ei;iiilly  in  yotitig  Kubjectn. 

Muriate  of  ammonia  is  aametimoa  aseful  in  the  mitdw 
ncunil^iiia,  if  ^ivi-u  In  Lwi-nty-gmin  diwe*. 

Bromide  of  potassium  is  suited  to  neuralgia  due  to  neglect 
of  the  sexual  functions,  in  fairly  vig»n)us  [tCRwma.  At  least 
ninety  grains  a  day  will  l)e  nere»sary. 

The  assertion  of  Vallelx,  tliat  blisters  arc  the  betit  of  all 
remedies  is  not  far  from  the  truth.  They  should  he  applied  as 
nearly  as  poasihlo  over  the  intervcrtcbnd  forammi  whence  the 
painful  nerve  iasue«.  They  are  particularly  u:*eful  iu  herpes  zoster, 
trigeminal  tic,  and  in  the  de^ixiralo  epileptic  ttu  of  old  age.  In 
sciatica  m-veral  anr<««wive  blirtters  should  be  n]ipliej  over  the 
sciatic  notch.  This  is  an  essential  in  Iho  trcnttncnt  of  wiatica  of 
middle  ago.  The  u»  of  blietera,  with  hypoderruiL's  of  morphine 
and  atropine,  is  an  exceedingly  efficient  combination.  In  milder 
forms,  sinapisms  or  chloroform  liniment  may  be  sulMtituted. 


810  MAHUAL  OP  THKATMKST. 

The  only  use  which  can  be  made  of  cold  ifl  i»  the  treatment  of 
nenrnl^a  of  the  testicle.  Bett«r  than  this  U  the  use  of  aconite  ot 
vcratrine  locally.  The  latter  is  useful  in  migraine  of  nuraing  md 
chlorotic  women.  He  did  not  fitvor  operative  measoras  for^ 
relief  of  neuralgia,  iia  ho  refcrroii  the  diBcase  to  a  centric  origio. 

lie  considered  the  galvaoic  corrent  the  only  form  of  doo- 
tricity  which  is  useful  in  neuralgia,  but  the  value  of  tliis  he  rated 
exceedingly  high.    He  n])pliod  one  polo  to  the  nape  of  the  nock 
and  the  other  to  the  painful  Riirra<!e,  hut  coii»iden>d   it  of  little 
importnnco  in  which  direction  the  current  pas«e8.     TJo  repeated 
the  a|iplii-iirion  at  l^itt^t  once  every  day.  'When  points  douloureax 
hail  developed,  ho  applied  the  positive  polo  to  the  pdinful  spota, 
and  the  negative  pole  to  the  Kpine  oppcxiite  to  the  point  of  origio 
of  the  nerve.      The  current  should  never  he  strong  enough  to 
cause  the  leiutt.  puin.      Kuli^niiurq  eoneiidered  acialica  tlie  moat 
readily  cnrabte  of  the  neuralgias  by  electricity.    This  require* 
a  more    powerful    current  than   other  neuralgias.      In   treating 
neuralgias  ol  the  head  with  electricity,  it  U  noceaaary  to  stop 
whenever  the  Hliglitcst  giddinesM  is  felt. 

Another  class  of  remedies  ig  intended  to  exclude  the  air  from 
the  affected  part.  The  best  of  these  is  flexile  collodion^  which 
he  recommends  for  herpetic  and  erysipelatous  iicurftlgia^. 

He  recommends  as  prophylactic-'i,  the  avoidance  of  all  known 
exciting  causes  of  the  attacks,  such  ns  oold,  ovenvork,  worry,  losa 
of  rest  or  of  meals,  and  the  use  ot'  all  known  means  of  keeping 
the  body  iu  the  highest  possible  state  of  health. 

J.  AsHBURToN  TiioMPseN  r&commends  phosphorus  in  the 
highest  terms.    Ho  gives  it  in  the  following  form : 

B    Phosphori., gt.'i 

Alcuhol  khcolut, fj  vj 

DiMoIve  with  heat,  and  add: 

B     GIjMnoi., , f5  im 

Alcohol, f5  y 

TincL  ol.  TiKinth.  pip HJJ  r 

H.    S.— One  ICMiicNuiful  rrproKala  one-Lwentietfa  uf  a  graio  af  phwphofBfc. 

PuTSAM  mentions  the  enbcutAneous  injection  of  water,  chlo- 
roform, ether,  osmio  aoid,  and  nitrate  of  silver.  These  are  some* 
times  aucceesful,  and  oometimes  dangerous.     Maraage,  meamerie 


NIUBALOIA. 


311 


mampulatioiia,  vibrations  from  a  tuning-fork,  cto.,  may  give 
reliel'.     Kor  migraine  be  prefers  cat)ii&bi&  ItiUica. 

We  huve  long  eincc  found  the  practical  value  of  Akstib's 
recommendations,  which  leave  but  little  to  be  tuldod  on'  the 
mibjeci. 

To  relieve  the  attacks,  we  have  found  no  remedy  equal  to  the 
ODHBtant  oarrent  from  a  foar  to  nix  cell  zino<arboii  battery, 
applied  sa  Ai^^tik  su|;i;edt8,  whotievor  the  ))ain  rocurfi.  We  have 
repeetcil  thu  apjiliaition  over  twenty  liiiieti  in  n  ttingle  day  before 
on  obstinate  attack  wm^  finally  (conquered.  But  the  next  paroxyKm 
gave  way  more  readily,  tvn  did  eucli  siic-eci'ding  one.  Aftur  miioh 
experience  in  the  troatmeot  of  the  opium  habit,  we  believe  that  ihe 
use  of  thU  drug  in  the  treatment  of  neuralgia  should  be  dropped, 
the  danger  out-weighing  the  beneliu  dcrivcHi.  Tlie  same  may  be 
said  conceniing  the  use  of  alcohol.  A  vtiry  u»efal  combination 
to  break  up  a  severe  attack  is  the  following : 

t^      Pho«{ih»ri, gr.  j 

r~                                        Slrjcbniaic  Kilpli, gr.  Jj 
Qiiinin«  xilpb., 5  j«i 
M.    ft.  roM.  At  in  pil.  no.  >1  div.         S. — On*  |JI1  kit  lionr  iMtfnrc  «ftch  kimI. 
After  the  force  of  an  attack  has  been  broken  by  this  combi- 
nation, milder  remedies  may  be  used  to  complete  the  care. 

To  prevent  the  recurrence  of  the  attackr*.  no  remedy  equals 
strychziine,  given  in  doses  of  ouo-forticth  of  a  grain,  three  timea 
a  day.    It  should  be  continued  for  months. 

For  the  jMinnysni  of  angina  pectoris,  the  inhalation  of  nitritO 
of  amyl  gives  instant  relief.  Nitro-glycerine  has  recently  been 
shown  to  poesefls  great  value  in  this  affection,  wheti  given  in 
doses  of  one  to  fivo-hundredths  of  a  grain,  thrice  daily.  Arsenic, 
given  oontinuously  f"r  n  long  i>erind,  fully  dencrvos  Anstik's 
approbation.  Oaaraoa,  cnfiee,  avena  and  valerianate  of  ammonia, 
are  auiteJ  to  the  milder  forms  of  the  disease. 

Dbbovb  found  the  chloride  of  methyl  nprayed  on  the  part 
effective  in  sciatica. 

Akstib  seems  to  have  overlooked  the  loot  that  neuralgia  is 
apt  to  affect  plethoric  persons,  and  in  them  his  system  of  super- 
feeding  is  unsuitable.  The  bromide  of  potassium  is  specially 
useful  in  such  cases,  given  in  forty-gmin  doses  every  hour  until 
relief  is  experienced. 


SIS 


MAStJAI.  OF   TREATMENT. 


OBESITY. 


lMHRiiMAN?g  starts  out  with  a  woU-eonaiderwi  cftntion  Jiguitti 
Ovenloing  ilio  ri^iliictioii  tif  fat. 

He  reeommondB  the  adoption  of  ft  prophylactic  reglnieuby 
thoso  in  whom  th«  teii<lwn-'_v  to  w(r[nile«ce  is  hisrwliuir^-,  in  wnmeit 
at  the  ehoiige  of  life,  in  the  young  who  nro  woH  padded  with  fit, 
ill  phlegmatif  ]»er»aiu,  in  HUi-klings  who  have  been  artifit^ally  fisd 
on  improper  food,  and  in  those  who  eat  and  drink  too  much.    The 
first  rule  is  to  avoid  over-feeding,      ^'^ryjtl^""  'mdmpy*  olij^ncy- 
fe?iHSa  which  favors  the  formntinn  of  fatty  tiseuee.    The  met 
must  only  he  rviii 1 1  i  ■■    ■     1:  ■  ir  nii;!! 'i  ;i  '  - .    It  U  b»t  to  restriti 
the  number  of  ili.-li-.>,  a---  ]'uti<:iii.-*  wlil  vui  more  if  they  have  t 
variety  to  tempt  tlie  ap[H;titc. 

The  amount  of  lat  should  he  limited;  the  hydrocarbon!, 
ftugar  and  «tarL'h.  iiii!  »carccly  less  objeutioiiaDle,  while  the  glatcoB 
are  fiit.-fonning  to  a  nnirh  smaller  ilegree. 

Tlie  nitrogenous  foods  are  nccesgary  to  keep  up  the  nutrition 
of  the  hmly,  l»ut  mi  uxc^jsh  of  these  elementu  will  result  in  the 
production  of  fat 

But  the  supply  of  ghit«n»,  hydrocarlions  and  even  fats  must 
never  be  bo  Lnirtnjled  a^'to  niaterijdly  lessen  tJie  atrength;  nor 
must  the  supply  of  albumen  be  sn  great  as  to  dinordcr  the  digea- 
tion,  and  pn>dnce  lithiasis. 

The  articles  mosl  permitwible  aa- :  meat  broths,  beef,  ve»l, 
lean  ham,  venictoii.  hare,  partridge,  grouse,  ehickeu,  pig«ou,  turkey, 
pike,  trout  (not  fried),  oy5t«n  and  anails. 

All  sorts  of  green  vegetables  are  permissible,  such  as  ospua- 
^s,  cauliflower,  gi'een  pca^  bcan«,  »pina«h,  eabbago,  and  a<dd 
fruitH,  raw  or  stewed. 

The  following  should  be  taken  in  only  email  qnantitiee; 
bread,  biscuits,  milk,  eg^,  potatcHw,  earrota  and  vegetuhlea  of  the 
Barao  elasti,  riee,  I>uekwhc«t,  corn  and  sweet  eonps,  sugar,  mutton, 
bccf'ittenkH  [fried  ?],  veal  cutlets,  carp,  ^alad  witli  oil,  and  win»- 
jellies. 

Articles  which  idiould  be  only  iwed  oxeeptionally,  and  in  very 
smalt  quautities;  butter,  ercam,  fat^  aauees,  pork  in  all  foniu 
(except  lean  hum),  go«>Be,  duck,  woodroek,  snijw,  qunil,  eels, 
Balmoii,  tut'bot,  crab»,  lobsters,  frogs,  slulfing  of  birds,  potato  and 


it  salada,  patties,  aweet  poatr)*,  confectionery,  creams,  icee» 
sweet  grapes,  raisine,  dates,  proeerred  aod  candied  truita,  and 
oats. 

Authorities  differ  in  rcgaiil  to  the  tuo  of  water;  Harvky  and 
Baktino  allowing  itd  unreBtrieted  use,  and  Daxibl  curtailing  It, 
and  refonniKiuling  the  use  of  dry  and  fompact  articles  of  diet. 

Tht'  tivttUutiut  h>'  tUiiiil  tihould  ^li^t  be  pushed  so  far  as  to 
deprive  the  ptitiont  of  appetite,  or  tlie  evil  effects  of  the  Lunger- 
cure  will  be  muuifeatod.  Ueiioe.  Immrrmanx  deL-lareu  agaiuat  this 
method . 

Coffee  and  lea  may  he  permitted  in  moderation,  but  chocolate 
and  coc5»areTnntesirahle.  Xcilher  nmit  liquor*  nor  spirit*  can  be 
allowed,  eveu  iu  Kniall  quantitit^.  Claret  U  the  lea^  ii^jurioug, 
and  when  it  is  deemwl  inadvisable  to  pmliihit  nU;ohnl  entirely,  it 
should  he  given  only  iu  this  form,  mid  not  until  after  midday. 

lie  doex  imt  believe  that  llie  t,-lu;wing  of  Lubuecu,  cocu  or 
hashish,  or  the  smoking  of  opium,  cau  have  any  other  influeuce 
upon  the  foniiation  of  fat,  than  whal  is  due  to  the  dyajicpdia 
>roduL-od. 

He  nMsommcuds  exercise,  esimciully  in  the  form  of  g^'mmw- 
Elderly  pereons  muet  be  wumeil  ugaiuHt  miy  exertion  which 
iight  cause  the  rupture  of  uit  ntht*n>ritiitini?'  vt^sst:!. 

The  jiowerful  tstinuilus  of  thi.^  oold  bath  l^  unfavorable  to 
corpulence.  In  all  anemic  formti  of  obesity  in  adulbi,  iron  id 
licatcd. 


VoGEL  adapted  HANTiKo'ti  system  to  Oennan  usages^M  shown 
the  Ibllinvlng  ditftiiry : 
Brealcfiist:  Coffee,  with  little  or  no  millc  and  sugar;  and  a 
ttle  butlerleivi  toast  or  biocnit. 

For  hij^h  livers  he  gives  a  second  breakfast,  consisting  of: 
Two  sort-boiltsl  t^gs;  n  little  lean  liam,  one  cup  qi'  tea,  or  of 
light  acid  wine. 

Dinner:  one  plalc  of  tliin  meat  soup,  lean  meat,  boiled  or 
Bted,  green  vegetables,  a  little  potato  and  bread,  and  caf^  noir. 
Supper:  meat  soup,  or  tea  with  cold  meat,  lean  ham,  sofV 
boiled  eggs,  salad,  and  a  little  bread. 

iMUKRMiurK's  objection  to  this  scbedulois  that  it  does  not  give 


8U 


MAMUA1.   OF  TRKATIIHRT. 


the  amount  to  be  n&od  of  each  article,  fiat  this  is  of  little  cotufr- 
qiiencc,  m  m  all  cased  the  amount  of  food  must  bo  regulated  "by 
tljG  iiatun?  of  the  cafle,  and  the  mnimer  in  which  tlie  patient  btsn 
the  treatment. 

The  BoUUlfia^OUrft  iu  Jkloricu^ntl  nml  Tari»p  in  ximplra 
Btaryj^r^jon-i'iin^.  a^  tin?  |nin;;ttivo  uutt.is  Ua»toii  the  food  out  of 
t)ie  alinieiimry^eanal  betbre  i  t  >f|Vh^'  tim^'in  he  rfinrtied.  Tto 
life  nt  tbcRo  roiwirw  ii*  favomhlo  to  ^clf-dt'iiial,  hecnngo  the  terriblo 
tal«  of  the  cvil-nwulM  cit'  iiifrat^tiim  nt'  tlio  Tu\&m  (ng}ilen  the 
patient  into  compliantx;.  In  plethoric  corpulence  these  "  cuna" 
are  allowably;  hut  not  in  anemic  maiM. 

For  the  latter,  the  waters  of  Kii*»cngen  are  preferable. 

Tlie  coId-wAtor  treatmoiit  as  a  water  cure  is  oqaallj^  effloieot^ 
and  prefernble  for  tho«»e  who  fenr  the  weakening  influences  of  the 
Bruuneii-cui-e. 

The  inhalation  of  compn.w»e<I  air  in  ili-serring  of  a  triaL 
Tbeoreticallj',  it  should  be  efficient. 

As  to  the  use  of  iodine^  IjiIMKHjiaxv  siniiks  favorably  of  it, 
although  not  poBitivcl^'. 

For  the  troublesome  hyporidrosis,  he  rcconimeodH  oold  hatha, 
ahtutionn  wUl)  vinegar  and  water  (one  to  throe),  or  sage  t«a. 

For  seborrhea  he  U.W3  alcoholic  and  ethereal  lotions. 

For  intertrigo,  jxiwderA  of  Ivcnpodiuni,  starch,  oxide  of  eiqc, 
etc.,  may  be  used. 

The  oecurrcnt-'C  of  dropsy  and  cyanosis  calla  ior  iron,  dig-italut. 
ealine  diuretics,  and  occattional  dra»ticft.  Tn  some  caoes  of  extreme 
corpulence  with  cai-diac  degeneration,  with  swollen  liver  and 
aecitee,  a  combination  of  dtgitnlis  and  calomel,  one  grain  and  ft 
hair  each,  twice  a  day,  proved  very  clhvAcious  as  a  diuretic  and 
drastic. 

When  corpulent  persons  arc  attacked  by  acute  fcvcn,  all 
modes  of  treatment  which  are  woakCQlng  should  be  avoided. 
On  the  other  hand,  fever  should  be  energetically  attacked  with 
euofa  antipyretics  a^  quinine,  th«  salicylates,  etc 

Paw  recommends  the  substitution  of  gluten  bincuits  for 
ordinary  bread.    Brown  bread  ia  better  than  white. 

Schwekkinoeh's  celebrated   cure   of   Prince  Bismarck  was 


d 


0BE8IT¥. 


31$ 


accoiDplishcid  by  directing  numborlcBft  little  nibbling,  of  a  singto 
Article  each. 

Okrtel's  method  consiats  in  MBtrit-ting  the  diet,  with  no 
&t,  very  little  liquid,  sntl  incnaw  of'  micli  exercise  an  tend«  to 
atreii^ieii  the  heart. 

So  gr&it  is  the  tendency  to  over-do  matters,  and  do  injury 
by  using  irnpro]mr  methodH,  and  jiUf^hinp  tboni  too  far,  that  in  an 
editori*!  in  the  PhiU.  Med.  'Pimi-s^  the  writer  deelarw  thai  the 
worHt  thing  which  can  liajipen  to  a  cor]>iilent  jterson  is  tliat  he 
will  attempt  to  bcootnc  thin. 

This  is  certainly  an  exag:geration.  It  is  not  neccRs^ry  to 
condemn  «  remwly,  biKrauHC  iinwiw  pcrwon^  may  do  Iiiinn  with  it. 
We  have  fonnd  that  the  weight  may  be  reduced  with  perfect  ease 
and  «aft:ty,  to  the  great  comfort  of  the  patient,  and  without  any 
sujjcrhunian  etibrt  of  will-power  l>eing  necefleary. 

.  tfiT'tHrwc^l  our  patient  to  eat  what  he  Hkea  for  breakfast, 
using  few  dishes,  and  rising  from  the  table  as  soon  as  the  appetite 
is  Kutintietl,  but  never  allowing  oneaelf  to  eat  until  a  (K>nM  of 

lBM  ^'"*'*  .^>-n^.-n  KBiiih  fi^nifr""  )  Xo  liquid  ia  to  be  taken  in  the 
moniing  until  the  breakfast  is  completed,  when  a  single  mip  of 
any  hot  Iwvei-age  may  \>v.  allowed.  Tlie  fiw>d  will  Iw  thoroughly 
masticated  if  the  patient  be  not  allowed  to  moisten  it  with 
anything  hut  nalivii.  During  the  forenoon  no  liquid.s  should  bo 
taken ;  hut  if  thiret  be  nrgcnt,  an  apple,  pear,  iiearh,  orange  or 
aimilar  I'niii  may  be  eaten :  or  a  little  coai  or  tt9i-le»v'(!<t  may 
be  chewed.  At  dinner  the  same  rules  are  to  be  observed  as  at 
breakfoML;  thu  uppotitu  boing  salinfiiMl,  Init  not  rioyeil  by  replo- 
tioD,  and  the  single  cup  of  drink  being  taken  juKt  before  rlniiig 
from  the  table.  During  the  atloniOHn,  the  deprivation  ot"  wnter 
will  tw  felt  moi-c  twvei'cly,  but  it  must  1h>  aIi»olut<.'.  Small  pellets 
of  ice  or  a  little  juicy  fruit  nuiy  be  uM.-d  if  tlio  tliintt  1h>  urgent. 

At  atipper  the  same  routine  must  be  observed  a^i  at  the  other 
meala;  and  notliing  may  he  eaten  or  drank  during  the  Hul»iequent 
evening. 

A  foil  dose  of  inalt-cxtrurt,  xvillmnt  bo|Ht  nr  any  otlier  mcfll- 
cation,  is  to  be  taken  at  the  beginning  of  eneh  meal. 


816 


HANVAL  OF  TBEATMBtfT. 


Tn  poisorui  who  are  etrong  and  plethoric,  a  Turkish  batb 
may  bo  nd  vL-wtl  oncu  u  WM>k.  In  all  inuuM  a  cold  sbuwi;r-lnUi 
ehoiild  be  takou  each  morniii<;  on  rising,  and  followed  hy  brbk 
ruhbiiig  with  a  «-oarsf  towfl.  The  amount  and  kim!  of  exenm 
muii  In*  reflated  by  the  caae.  In  anemic  and  olderly  peraooi, 
pivfiiix'ticc  i»  to  hir  givi-n  (o  ])iUw)VL-  inutioii,  inaHs^^  in  |«irticuUf. 
Confectionery  and  »uch  articles  aa  craclcere  must  not  be  esten 
butww^n  nicjtU. 

The  thiiaLituaii;y  liyiug  Ibr  »  single  day,  the  "f^fld  '^ff  '* 


is  Jxaukbh',  and  in  a  wc* 


^ttvn ;  and  in  many  eases  Hut 


patient  will  ceanc  to  avail  himself  nf  the  cu])  allowed  after  eadi 
iiitiil. 

Once  having  mastered  this  metlind,  Ihe  patient  can  regulate 
Ilia  weight  with  little  diffi(!ulty  ;  niakiug  the  regimen  atricter  or 
relaKlJig  as  may  be  Indicated  hy  hie  miiilitino. 


OPIUM  POISONING. 

SrKVKXsoN  advises  that  the  stomach  l»e  evacuated  hy  the 
sbimach  pump  or  by  emetics.  Warm  mustard  water  with 
ammonia  is  the  best  emetic. 

The  patient  must  be  kept  awake  by  walking  about,  alternate 
hot  and  cold  applit-atioiw  to  the  che»t,  slapping  the  feet  witli  a 
wet  txiwe),  and  the  use  of  faradisation.  In  the  last  resort,  artifi- 
eiul  respiration  must  be  instituted. 

Tannin  nuidcrf  the  tilkatoids  of  opium  insolnhle.  and  should 
be  given  li'ecly,  especiiilly  in  tlio  form  of  1«i  and  coffeo.  CaSein 
is  a  jMtwerl'ul  jniti-nnrcxitic.  Atropine  is  serviceable  as  a  direct 
antidote  to  morphine,  Bud  .-thould  hv  -iivcn  hypodvmiicaUy  in  tlie 
do«c  of  gr.  i.     Alcohol  should  be  freely  given. 

Flagellations  are  very  useful,  nml  donchc*  of  cold  water,  It 
inuftt  not  be  forgotten  that  atropine  d(»ea  not  antagonize  tlie  hyp- 
notic cfiectfi  of  mori^hiuc,  but  prolongs  and  d(.«p«nH  the  sleep. 
llencG,  if  the  respirations  be  uufBciently  frequent  and  dce{^  tho 
patient  may  be  allow(.*d  to  sleep. 

The  injunction  to  wash  out  the  stomach  is  of  the  utmoat 
importjuicc;  as  u  large  amount  of  the  poison  may  remain  in  the 
stomach  unab<sorbod. 


PABALY6IB. 


S17 


PARALYSIS. 


AGITAN8. 


Bristowk  j*j>eak8  of  the  importance  of  attending  to  the 
h^-gieue,  and  promoting  the  patient's  health  by  tonics,  if  nwdod. 
Si>ecific  treatment  han  proved  of  little  aervice.  Iron,  strj-chnine 
and  hyoecyamus  have  found  nnwt  favor.  The  systematic  uae  of 
baths  has  occasionally  pn»ve<l  i»f  teiuiKirary  Ixniclit.  Tiie  galvBiiic 
curreut  sometimes  eeema  aerrieeable. 

SiUKLBR  doubts  if  the  cni*s  reported  as  cnrod  wcpp  really 
in^tanoee  of  thio  di«c-aiui.  nyose^-anmit  and  eoriium  have  givtm 
temporary  relief. 

^  Tbocsseau  recommeuHod  Btrychnlne*  but  C'dabcot  dedarta 
Hfliat  it  agg^a^*at^  tliv  ^yiiiptom^.  lU»Moyo  usee  galTaniem,  in 
^Bonnectiofl  with  etryohuine  or  pliosphonts.  Sinklek  has  seen 
[  ^doc-idcd  I>enefit  obtained  from  the  hyi>odennic  use  of  arsenic; 
I  and  In  one  nwe  tbo  jiatient  waa  iMfnefited  for  a  long  time  by 
^tUe  use  of  utrychiiiiie,  ii-on  and  quinini*,  with  the  applicaliou  of 
^■ftUc  electricity. 

^H  KuLKXBURQ  my«  tlmt  the  beat  that  uin  be  ho|KHl  itt  that  tlio 
diaea^  &hal1  remain  a  long  time  stationary,  or  tliat  troublesome 
sympt<Hiii»  Kimll  Ik-  mitigated.  Yet  suuh  a  nwultcau  but  rarely 
be  attained.  Some  rejMirts  of  cures  have  appeared.  Kl,i.lOTsojf  ob- 
taini!<l  a  cure  by  the  u^\  of  carbonate  of  iron,  TtRow»-8BQCARD 
bv  chloride  of  bariiim,  Ueynolm  by  Pulvermacher'a  chain, 
^^EMAK  by  tli-j  constant  current.  Jokes  by  hyoBcyamu8,ViLLB- 
^■i>-  by  bromide  of  potassium,  and  B^rz  by  warm  batbA. 

^V  ScLEKurito  conAiilcra  tlutt  the  diagn^Riitt  in  tlu>!H'  ra-si-s  i^  doubt- 
ful, the  duration  of  the  improvement  is  not  assured,  and  at  moat 
only  a  tcniiKimry  diisappcamnw;  of  the  tremor  is  proven.  Tie  lias 
obtained  no  bene6t  from  hyoacyamin  or  the  con.stant  current. 
Tlio  warm  bath  doot  harm.  Lkbbrt  thinlcB  tliat  he  cltceked  the 
diaeaee  oneii  by  eea-bathiug. 

CuAROOT  found  DO  bc-uc-fit  in  the  use  of  ergotiu  and  bclladomia. 
To  this  liac  of  therapeutic  failures  Eitlbkbubo  adds  morphine, 


S18  HAcruAL  or  trbatmrict. 


oamre,  arBenic,eliIomt,phy«wtigTnn, nitrate  of  silver  and  brwnid* 
of  pcitnwiiiini.  Of  iht-Ao.  arsenic  produced  the  most  beiiuficul 
cflVet. 

Although  our  own  exj^rWticeiA  inhaniiony  with  thi-mcwhom 
wu  ha%'o  quoted,  we  ciiiinot  aci-ept  the  rea«^iiing  wliich  i-alU  the 
diagnosis  in  i|ue»(tioi)  whenever  a  cure  in  re|)ortcd.  It  has  nt>t  been 
long  Btuce  the  same  opinion  was  prevalent  in  regard  to  phthioi 
pulmonalis,  and  lay.  like  an  impniwable  liarrier,  acnwx  llu-  path  of 
the  eiiteriirifling  therai>c-uti9t. 

As  in  the  c»^  of  multiple  spinal  melciTMis,  there  rauHt  be  » 
dimMUe  proce**  which  precedes  the  development  of  eonnectJT^ 
tissue  no<litU>i«,  which  imr  after  all  but  the  hunit-4iut  ashe«  of  the 
former  fire.  AVith  additional  skill  in  the  earft/  diagnosis  of  tbcR 
atlectionH,  an  advance  in  their  treatment  should  ensue 

2.     DU'HTHERITIC. 

CoRUACK  ea^'a  that  preparations  of  iron  nuiy  be  used  with 
advantage,  such  ac  the  liquor  ferri  perchlnridi,  in  il<)t*e«  of  from 
five  to  tliirTj  iniiiimn  in  water  twice  or  thritv  a  day.  The  carbon- 
ate of  iron  ]jill,  in  doses  nf  from  thix-o  to  ten  grainii  twiee  or  thrice 
aday,iiimKKliately  before  orwitb  mvalo, often  aiu«weK  remarkably 
weD.     Bitter  erter%-e8cing  ironHlraughts  suit  some  i«tienta. 

Wlien  amendment  U  slow  or  absent  under  the  use  of  ordinaiy 
doses  of  ii-oii,  though  the  anemic  condition  of  the  patient  seem 
strongly  to  proclaim  tin-  neecssily  of  this  nti-dicinc  being  given^ 
ita  use  nnist  not  be  hastily  abau'loncd,  but  it  should  be  adminis- 
tered ill  very  small  iiiiuntity,  and  largely  diluted.  Should  wcntill 
be  disapijoinleil  with  the  result,  it  will  be  well  to  try  iron  io 
combination  with  iodine  nr  willi  arseniC  in  i*uitnble  fonns. 

The  cxtmct  of  nux  Tomioa,  in  smalt  dom.-^  t-akcn  daily  with 
eomc  ordinary  combination  of  laxative:^  in  pills,  should  conatitate 
part  of  the  latter  ti\«tment  in  nearly  every  easi-. 

In  addition  to  the  gtneral  treatmetit,  the  jiaralyais  of  diph- 
theria fre(jucutly  calls  for  other  incasurcfl  of  a  apeeial  eharacter. 

Pereiatent  and  carefully  regulute4l  local  stimulation  may  be 
required  to  restore  imi>airedinneiTalion,and  \o  sccareaiiadwiuate 
Bupply  of  artetial  blood  to  the  wanting  mtuclcs.  There  aro  nci 
other  moans  so  likely  to  arrest  and  prevent  degeneration  and 


^ 


PARALYSIS. 


81« 


atrophy  of  the  muflclee — morbid  change,  which,  if  imoheelrail, 
lead  inevitably  to  the  pcmmnenw  and  inciimbiHiy  of  the  paralysig. 
Local  stimulation  may  be  aceonipliahcd  by  blUtarS,  liniments, 
pastes,  or  sharapooing.  One  or  other  of  these  niiiuis  may  be 
employed  either  9e|>aratGly,  or  in  eonjunction  with  eome  of  the 
©there.  Tlie  oecasioual  applicution  of  bliRters  ia  nuwt  u*;ful ;  but 
euro  most  be  tukon  not  to  vesieate  too  targe  a  continuotiit  niirfaco, 
Ao  a«i  to  iuterrupt  tlie  iir^^'  of  swtemnlic  gentler  stimulation  by 
liniments,  pastcw,  and  shampooing.  Cart->  niu»t  almi  Iw  tAkeii  not 
lo  make  the  akin  too  tender  to  admit  of  the  mtisclefl  bein? 
exereined  from  time  to  time  without  paiiL  Lubrii-ation  with 
lininieuis  ei'mbiuing  anodyne  with  stimulating  piT>{K.Ttieii  ia 
partitnilarly  suitable,  in  (■imjunction  with  Hham|»ooing,  and  the 
galvanii!  exeitemont  of  contraction  of  the  [«inilys»eil  niiig<<lea.  A 
good  n))plicBtion  of  this  dnHcri|»tion  \h  cfm»|M:iae<l  of  one  part  of 
tiueture  of  cautharidea,  one  part  of  tincture  of  opium,  and  six  [larts 
of  compound  camphor  lininit^nl.  A  j^xl  stimulating  paste  is 
oomj»*JHe<l  of  six  drachma  of  powdered  ginger,  and  two  drachnm  of 
Englifili  murttant,  ihorouglily  rubbett  up  with  juHt  a  xuiUcieut 
qnaiitit^'  of  lard  to  make  a  paste  of  suitable  consiatence.  Circular 
bands  of  linen,  an  inch  in  breadth,  Hnieare*!  with  this  stinnilating 
paste,  are  ap|ili«I  at  inlervaU  of  five  or  six  inches  to  the  whole 
length  of  a  Hmh.  care  being  taken  to  change  the  [Misitinn  of  the 
borwU  once,  twice,  or  oflcner.  in  the  twenty-four  hoiir!*,  .10  that, 
whilst  the  surface  is  kept  gl<ming  with  wamitli  by  (he  jiaste.  its 
topical  action  on  the  skiu  is  not  allowed  to  exceed  llic  pr«ii»er 
limit.  \NTien  the  warm  tingling  wnsafioim  canwd  by  the  stimu- 
lating bands  induce  n-aticssnesw  and  ])rt^vent  slce|>,  the  ljund«  nmst 
be  nimoveil  for  eight  or  ten  hoiirw  at  a  time.  In  paralysis  of  tlic 
respirator}'  muscles,  large  sinupiams  a[ipli«l  to  the  eluttt  are  of 
mut-h  Msc.  Tn  («nliac  paralyflis,  JJucHBNNK  has  recommended 
fajradisation,  of  the  prQct:)nlial  region.  Galvanic  excitement  of 
contraction  in  the  i^amlyacd  nuiHcIcs  of  the  limbs  is  often  decidedly 
tisefnl ;  but  it  is  a  measure  which  ruiuin^s  to  be  employed  with 
modcmtion,  an<l  at  intervals  of  al>ont  twenty-four  ln»urs.  If 
rcftorted  to  too  early,  or  too  freely,  it  exhausts  the  i-ctuming  jKiwor 
of  the  atfectcd  muscles. 

When    the    paralytic    afiections    betrome    general,    or    the 


820 


MANUAL   OF   TBEATUEKT. 


iinproTemcnt  is  iinpcrccitliblc  or  vory  slow,  scA^ir.,  Ma-btUa, 
and  hytlrotbcrapc-utics  deserve  attention.  In  obstinate  and 
])roiract«l  cnsos— jmi-ticulnrly  in  strumoue  subject* — they  ofta 
prove  of  tnueb  iwlvantajjc  when  employed  together  with,  or  apart 
frora,  iithtT  meiwimv. 

Di])hthprltio   puralysis   ueiially   juMXti  oS'  in   h  abort  tine.! 
Faradiruitum  uf  the  ntfected  nius^-let)  hns  n|tpparcd  to  hasten  the 
return  of  |iowlt. 

AtteiitiiHi  t(i  the  genemi  licnlth  is  altrayfi  nccownry.    ThftI 
perHiAtent  iise  of  atryclmine  »iid  iron,  and  of  maseafi^  in  obsti-j 
nate  t'a^oa,  oifere  tJiu  hunt   fhaiit-e  of   hihtoss.     Th  diminish  tlwj 
tendeiicry   to   pnmlysis   of  the  heart,  digitalis  should  be  givw 
in  the  declining  xtaget;   and  during  the  early  convalefioence  of 
diphtheria.  [C.  F.  T.] 

3.    PARAPLEGIA.    (See  Spinal  Disoaaee.) 


4.    UESflPLEGIA. 

When  an  apoplectic  stroke  has  oocurrod,  the  paralysis  reeolt- 
ing  i«  due  to  Beveral  t-onditinns.  Some  of  the  fibres  of  the  ecnlial 
nervous  organ  are  ruptui-ed,  broken  and  destroyed.  It  is.  not 
probable  that  n'|>air  ofleii  fnicurs  in  Miieli  eaf^es.  Beyond  iho  iu- 
jui-efl  s^ection,  there  is  a  portion  of  the  uerv^ous  tii^ue  whose  liincv 
tions  are  inhibited  by  the  prc-sMun-  of  the  exudation;  then  cotoea 
a  zone  of  iiyjxTiriiiic  intiltration,  and  lastly  an  ce^Icnialoua  region. 
In  all  them.'  the  conducting^  power  of  the  ncn-e-libri*s  \»  fiimply 
snspeniled,  and  may  be  restored  by  time,  aided  by  suitable  treat- 
ment. There  is  little  doubt  but  that  the  ahsorplion  of  the  clot, 
and  of  the  |tn)dn<-t«  uf  inflainiimtion,  may  !«■  hastened  by  the  use 
of  mercury  and  iodine.  Wc  prefer  the  mercurial  pill,  given  to 
dofii^  itiKUflicient  to  aiw^-  Nilivation,  hut  [tcrHistently,  for  a  loof 
period.  If  for  any  reason  it  he  deemed  inadvisable  to  a«e  tbia 
active  agcut,  u'e  may  substitute  the  iodide  of  potassiuiQ  or  Bodium* 
in  full  doseA.  These  remedied  aiv  much  suiterior  in  tbidr  cffvcta 
to  any  of  the  cathartic,  diaphoretic  or  diutvtic  medicaments 
The  absorbenta  are  also  less  objectionable  on  account  of  the  vSect 
on  the  general  health,  than  the  evacuante.  Such  tonica  as"  are 
deemed  advisable,  may  be  used  at  the  «ame  time. 


PBIUCARDIAL  DROPST. 


as 


Bnt  it  doM  not  follow  thnt  when  the  inliil>itory  premiire  ia 
removetl,  tlie  affecltd  iier\'i«  will  resume  their  i'unctions.  To 
excite  the  renewal  of  action  in  Riich  ca«cii  wo  have  two  remedies; 
llie  galvanic  current,  and  strychnine.  Eithtr  or  both  these 
agents  may  be  eniploywl  as  intiiealcil  in  uiifh  awe.  Strvchnine 
should  be  given  in  doses  of  one-fortieth  of  a  grain,  gradually 
increfu<«d  until  flight  tetanic  syniptoni^  are  inaniffAtttl.  This 
trfalniciit  naturally  oomea  after  that  of  tlio  absorbents.  Fara- 
disation i.s  of  gix-at  vuhic  in  k<^-)iing  ui>  the  nutrition  of  the 
paralyziul  muscles  nntil  the  functions  of  the  attccted  nerves  are 
restore*!.  "Witliont  thin  agent,  fatty  degenL'ration  would  soon 
begin  in  the  niiiseular  tit<i^iie,  and  leiive  it«  function  perniniicnbl/ 
ini[iairfd. 

Another  prt*aution  shonUl  hf  takr-n  during  the  progruaa 
of  the  ctu^.  In  mnny  en.*e9,  when  some  disability  nFiiain« 
after  the  princir»ol  ctlccta  of  th*  stroke  hove  raised  off,  it  will  be 
found  that  thei-e  ai-e  adhesions  about  the  joints,  due  to  disuse. 
Ma^ieage.  and  otlicr  foniis  of  passive  motion^  should  t)e  instituted 
about  three  weeks  after  the  injury  \im  ofiourred. 

Claimfi  hove  been  put  fonvard  that  a  property  similar  to  that 
of  ttrychniac  resides  in  the  eommon  oat,  nvt^tia  witivn.  "We  liave 
U3ed  Keith's  concentrated  tincture  in  n  number  of  casoa,  and  whilo 
in  eome  donbl  a»  to  itti  huhIuh  opemndi,  wf  believe  the  drug  baa 
some  power.  In  diphtbcritie  pamlyeis  it  liaa  proved  useless  ;  but 
in  fi<>v(;nil  okM-s  of  hoini]tU'gia  iu  uku  [irovt-d  b^'neficinl.  It  failed 
also  in  a  case  of  syphilitic  hemiplegia.  Its  greatest  utility  bus 
IxM'n  shown  in  pam1y!;i<t  of  oenHatioii ;  4;H{>oeia1Iy  when  the  latter 
has  cxi-iited  long  nfter  the  original  ityury. 

From  the  almve  expoitltion  it  will  bo  nianilVst  why  paralysis 
will  diwipi'par  almosi  enniplpti-ly  in  time,  but  not  entirely;  as 
tliete  will  alwaya  ho  mrav  disability  ruiuaiiiing. 


PERICARDIAL  DROPSY. 

BALFOt;n  says  that  when  the  fluid  is  so  suddenly  effused 
that  death   is  thpi-att-neil  by  Biipprcasion  of  the  heart's  action, 
parucentesi>(  is  neoeMary.    Otlierwise  tlie  treatment  dc![>end3  upon 
the  primary  diaoase.- 
V 


82S 


tUtniAL  or  TRRATHBNT. 


Bacer  rcooTOmcndfi  cardiac  tonics.  IIc<  Miya  that  puncture  of 
the  iKricardiiun  U  uuattended  with  much  ridk,  if  care  be  taken  to 
«iclade  air. 


PERINEPHRITIS 

T.  Qbainobb  Stewart  fiivore  the  nso  of  blisters  in  the  earlier 
Btagee;  as  well  as  the  internal  U9C  of  iodide  of  potaMium,  ud 
iodine  extornallv,  to  prevent  suppuration. 

Whon  suppuration  ha»  taken  place  the  abticcM  may  be 
evactiatoil  by  th«  aii]>itutor  or  by  inciDion.  The  latter  ia 
preferable. 

F.  T.  Roberts  adviaes  leccliea  or  cupe  when  acut«  inflamma- 
tory aympUimrt  are  preaoiit.  Tce-haga  niay  he  eni|)l(>yed  very  early 
in  thu  disease,  but  kter  it  tscoms  better  to  use  hot  applicatit>ns. 
The  patient  ahoiild  be  kept  quiet  in  bod,  on  low  diet.  Ko 
medicine  hm  any  direct  influonoe  on  the  disoafle.  but  the  bowels 
ahould  bo  freely  o]>enc<i  hy  means  of  enemato.  Ife  prefcit 
aspiration  to  a  free  opening,  a^  the  latter  may  be  still  uswl  if  the 
former  fail.  IJeaidus  Iho  above  measurt-*,  wo  most  treat  the  pain, 
debility  and  other  symptoms,  iw  lliey  arise. 


PERITONITIS. 


i 


F.  T.  Roberts  dirw-ta  attention  first  to  the  im]>ortance  of 
removing  the  cnnse,  whenever  it  is  possible. 

The  lx.'d^;li)theB  :nay  be  i*aised  on  a  cradle.  Nothing  should 
be  given  a^  fotxl  except  sninll  bitii  nf  iee,  email  quantities  nf  iced 
drinks,  iced  milk  or  boof-t^  if  they  can  bo  retained.  If  the 
Bloniaeh  be  irntabli',  we  may  have  PHCourw  to  small  uutriont 
cncmiita  of  digested  foods. 

If  blood  letting  be  (leetned  aflviwible,  from  ten  to  thirtj 
leeclie!;  may  be  appliwl ;  but  the  use  of  a  larger  number  can  do 
DO  good,  and  would  pnihiibly  do  harm.  TIiIh  meaaure  is  only 
permiHttible  in  the  earliest  stages  of  the  disease,  and  in  stroag  and 
healthy  8ubJtH;tt*.  This  writer  doe*  nut  lielievo  in  mercury.  He 
oonsiders  opium  the  Hliccl-ane}iur.     Vrom  oue-half  (o  two  gralna 


H 


PBRITONITIS. 

may  bo  given  cverj'  two  to  four  Imuw,  Imt  not  if  reniil  disease  be 
pn^<eiit.  In  children  it  iniiflt  lie  given  with  care.  As  to  the  use  of 
heat  or  cold  i-\UTiiiilly,  he-  con^ulta  Uie  indiiiution  of  (hi>  i>aticnt. 
In  the  lat^r  stages  he  considers  the  cold  applU-ationn  injurioua. 

In  Hoinc  coBca  where  the  effusion  i.-*  eonsidcTuhlc  it  may  lie 
n;nK)ved  by  a  trocar.  Local  aecuinulatioiw  of  pus  should  be 
cvat;iiated. 

Whenever  a  tondoney  to  collapw  ftpT**"^.  stimulanln  should 
be  used.  Brandy  and  t-hampagne  ore  tho  beet.  Their  usm;  j-hould 
not  be  postponed  too  late.  They  arc  beet  given  in  Binall  quantities 
and  at  short  inten-aln.  Quinine  in  full  d(W03,  ether,  mn.*k,  cam- 
phor, ammonia,  and  tuqieiuine,  are  the  chief  medicines  which 
loaj  lx>  required  in  bad  eaKutt. 

Kausoa  and  vomiting  call  for  iced  aerated  drinks,  with 
hydrocyanie  acid  and  mOTphine.  ConKtipation  lUNr^t  not  be 
diitturbed ;  or  may  require  simply  nn  enemii.  Diarrhea  may  bo 
cheeked  by  enuinata  eontuining  laudanum.  Tympaniteomuy  bo 
reliuved  by  a  dose  of  calomel,  hy  tur]H>ntint!  In  enema,  or  by  the 
ioBertion  of  a  I'lng  luhe  in  the  reetum.  lu  extreme  eases  the 
intestines  may  he  punetui-ed  by  a  tine  trocar.  These  meana  also 
relievi'  the  dyspnea,  wliich  di-pfiids  ti|«on  tlie  lympnnites.  Hic- 
cough calls  for  narcotics,  ether,  iilnnpi»ni9,hlifiten*,  or  the  inhalation 
of  chloroforro.  Much  care  U  required  during  convnleHcence  ;  and 
the  absor]ition  of  morbid  residiwl  prodnct*  may  bo  liaatened  hv 
btister&,  imlim;,  bathx  and  othor  measures. 

Bavis  adviHca  local  bleeding  in  acute  caeca,  and  follows  it 
with  the  api'lication  of  wann  nareotio  fomentati<H»B.  For  the 
firet  day  he  givi«  one  j^raiii  of  calomel  and  omsthird  to  one-half 
a  grain  of  morphine,  every  two  to  four  Iiouth,  until  the  i-atient 
13  free  from  pain  uuil  iiicliatnl  to  etoop.  If  tliueo  powders  be  givoDt 
together  with  tlie  nw  of  liH'ches,  folloivi-d  hy  atiodync  Ibmcn  tali  one, 
the  first  thrf'e  dosoB  will  frerpieiitly  cause  almost  entire  rtdief  from 
pain  and  restlessness.  The  doscH  should  tln'ii  Ik*  given  less  frequent- 
ly, to  ki*!*  lip  tlie  effect  already  pnwiuced.  In  one  or  two  daya 
the  pulse  will  U'Conie  Mlowor,  the  tt'mperatiire  fall,  the  skin  will 
become  moist,  and  the  pain  and  tflndenieitH  ga-ally  diminished. 
Tho  opiate  i»  then  to  be  continued  without  the  calomel,  and 
diuretics  given  alternately.     By  the  end  of  the  thinl  day,  tho 


884 


IfAKIlAL    OK   TKRATME:(T. 


patient  will  be  quitw  ounifortnlili',  exwia  for  tlio  naustii  rGsultirig 
from  tlio  o|>iatGa.  ll'dtarrhua  ttu[X'n'ciu-\tlic  moi-pbino  U  n-pliKcd 
by  an  emiiUion  of  turpentine  and  luiiiliinuiii.  If  the  bon-els  be 
pot  fre«l}'  moved,  warm  water  onoinata  amy  be  ndmiiiistorcd- 

Sub»o([Uoiitly,  but  little  trcntinetit  is  rec|iiired,  excepting  rest, 
and  a  vurv  mild,  unstiiiiii luting  diet  fur  a  ll'w  days. 

When  the  coDC  ha»  not  l>ct>n  seen  at  the  beginning,  tb<*  MitM 
twatmeiit  U  institutwl  exft-pt  the  use  of  leeches.  The  thirst 
ehould  Ix-  relieved  only  by  bits  oC  ice,  or  by  BpnonfulH  of  milk 
and  lime  water,  or  of  animal  bruthis.  If  (he  tyuijjanitUM  itH.-reai[E, 
the  abdomen  maybe  painted  with  soap  Iinimi-nt  and  indinp,  or 
luri>eiilinc  diluted  with  olive  oil  may  bu  iippiied  8ulH<;ifiitly  to 
produTO  a  Binart  degree  of  irritation.  This  may  Iw  n>|M\it«>d  every 
three  hours;  light,  amwlyne  fomenlationa  being  twe<l  in  the 
intervals.  It  mny  lie  net-eswary  to  give  moiphine  hypodcrraically, 
if  the  stomach  be  very  irritable.  The  do^o  must  be  not  too  large, 
especially  if  the  tympanites  interfere  witli  n-spinitinn,  as  naiwo^ 
ism  is  then  quickly  induced,  even  by  doses  which  would  be  safe 
under  onlinnry  circumstances. 

"Soraetimes  dociiled  udviinfnge  ia  obtained  from  the  aee  of 
bliMer»  to  tiic  nlKlonien.hut  in  mmt  cases  Uie applicatioiia  already 
mentioned  arc  pivfenible. 

When  the  acute  stage  pa««e5  by  and  twrotis  efFticione  remaiD, 
it  may  be  dc^iraMc  to  iiiiply  a  suctx-^.-'ion  of  ?iniill  b1ij*tei"s,  and  to 
give  internally  tlu^  Iodide  of  potaseium  with  digitalis.  Ili* 
eamc  measures  are  tlic  most  suitable  when  the  dieeoso  bcocmui 
chronic.  If  the  efliwion  be  large,  and  sliow  little  disposition  to 
diminish  under  trtrotmcnt,  the  aspirator  may  be  emj-loyed. 

If  the  trentuicnt  above  iiuUeatcd  fail  to  nrrc«t  the  dtseuoi 
and  the  ptil&e  become  rapid  and  feeble,  the  extr^mitiee  cold  and 
blue,  and  the  abdomen  distended,  the  patient  will  probably  die. 
Opium  must  be  given  cauliouHly,  and  some  benefit  may  be  derived 
from  the  use  of  ammonia,  camphor,  catl'oine  and  iheitie;  with 
digitalis  aa  a  heart  tonic.  Tahlutii>oonful  doees  of  gruel,  bevf-tca, 
or  other  animal  brotlis,  with  warm  tea  or  cofiec,  constitute  the 
boat  means  of  sujiporU 

l>ii.  Davis  has  never  acen  the  slightest  bcne&cial  cfiect 
the  tise  of  alcohol. 


I 


PBRITOKITLS. 


S25 


Wardrli^  apprnvoa  of  blood-letting  in  nciite  casxw  of  the 
Bthenic  form,  when  it  «iii  be  }M.TlbniiL'd  at  the  coiiiraenoemcut  of 
the  malady.  The  tvpiuil  indicutinn  for  VL'tK-seotiun  in  a  constricted, 
hard,  sharp  and  wiry  ptiW,  which  becomes  sofUir  and  fuller  as  the 
blood  flowH.  Tim  only  reliablu  guido  m  to  the  quuiiUty  to  1>o 
drawn,  is  the  eflect  produceil  upon  the  heart.  The  jKttieiit  should 
be  bled  in  the  erect  posture.  A  rej)etitioii  of  the  vune^tction  inn/ 
be  needed. 

After  tlie  Jintt  day,  when  efTusion  haa  taken  pliice,  blood- 
letting is  more  likely  to  do  harm  thiin  good.  AlW  the  lancet  he 
applio;«  twenty  to  furty  Ict'clti-s  to  the  ubdona-n.  Flauiifls  wrung 
out  oi'  hot  Wiit<T  nhnnld  be  appMccl  ti>  cnirmimge  tlu-  flow  (if  blood. 
Thcee  fomentations  should  be  covered  with  oiled  silk.  Turpeatine 
applir*]  on  F>)Kingiopilhic  w  very  bciicticial.  AtW  the  {uUifnt  has 
been  bled  enough,  he  admiuidtere  opium,  in  dosea  of  two  or  three 
grainn. 

For  irritability  of  the  stomach  he  advises  hydrocyanic  acid. 
Wlicn  Uie  tyinpariitiM  is  very  cuii*id«;rablc,  two  drjichins  of 
a^r<£tida  maybe  admin  tslered  by  enema.  Or,  an  elastic  tube  may 
be  pit»«d  np  the  n»:tiiiii,  and  allowtHi  to  remain. 

Conati[>at.ion  should  generally  be  let  alone;  but  if  an  accumu- 
lation fonn  in  the  colon,  an  enema  of  oli\'o  oil  and  lurjunitine  may 
bo  given.  In  the  far  more  numerous  cases  ot  the  asthenic  type, 
opium  is  the  chief  reliance.  Two  or  thrc*  grains  may  bo  given 
at  Urr't,  and  followed  by  a  grain  every  two  to  lour  houre  at^rwardB. 
In  peritonitis  from  pcrtbration,  oi>iiim  may  be  givvu  in  tbo  largost 
doses.  Occurring  in  the  (wnr«e  of  Briglil'n  di-waM*,  the  treatnienC 
should  be  directed  mainly  against  the  latter  atloction. 

Id  puerperal  pcritx>niti«  the  time  for  bleoding  to  bo  beneficial 
isfarm'Te  limited  than  in  the  oi-dinnry  form.  In  childn.'^n,  the 
aame  geneml  plan  is  to  be  puntucnl,  due  regard  being  paid  to  the 
danger  of  depiction  and  opium.  In  strumous  cosga,  cod-liver  oil 
may  be  proitcribed. 

RoBBBTS  disapproves  of  the  nso  of  mercury,  hut  considcre 
opium  of  the  utmost  im[)ortnnce.  Alcohol  ii^  needed  in  manjr 
in^tanecB,  and  in  low  forms  of  peritonitis,  this  is  the  chief  remedy 
OQ  which  reliance  can  be  placed.  Adynamic  symptoms  call  for 
ammonia,  bark,  other  or  turpentine  int«rually ;  with  abundanco 


8S6 


MASDAL  OF  TRKATMntT. 


of  olcnhol  and  nutritious  liquid  t'oml,  and  in  ertTDmc  canea,  (lie 
Bubcutaneous  iiyectionof  other. 

NimiBYEn  sayg  that  where  ictcntion  of  feces  and  ulcemtion, 
or  strangulatod  liomia.haa  i-auaed  peritonitis, the  causal  inditatioa 
maybe  met,  tut  in  all  othercaaes  we  cannot  fulfil  it  Ue  upprov-es 
of  opium,  giving  half  a  grain  to  a  grain  every  hour,  at  first.  As 
to  bleeding:,  bt-  remarks  that  on  examining  the  bodit';*  of  tboae 
who  have  dittl  of  [icritonitis,  whether  they  had  been  hk-d  or  iiM, 
the  tistiiiPA  are  found  uncommonly  bl<KHlU?«»,  the  heart  and  arteriM 
almost,  eniiity  ;  the  roauk  of  the  exees«ivo  exudation?,  Tf  to  thia 
we  add  tlie  fiict  wliit!h  i'K[H'rienc'e  Bhows,  l}iat  a  gptat  loiw  of  blood 
during  lalior  does  not  afibrd  protection  against  epidemic  puorY<eral 
fever,  and  that  tlie  faiiHenitf  peritonitis  an?  just  ai>a<?live  In  wi'akly 
persons  as  in  tlie  sti-ong  and  well-uouzishod,  we  may  omit  other 
reasons  d^r  avoiding  vt-niwH-tion. 

Cfllomcl  and  mcreiiriat  oiiitmont  are  superfluous,  and  in 
purgatii'u  dasat,  injuriouii.  But  us  To  loeal  hlood-k'tting,  its 
benettcial  efiV-ts  are  beyond  the  R'aeh  of  doubt;  even  wheii  the 
peritonitis  is  due  to  [lerforation.  CW  is  even  more  officacioits. 
If  the  patient  can  bear  it — which  is  not  nlwuys  the  iraKe — wi'  rnay 
cover  the  iibiloiiu^n  with  rold  eoniprcssv's,  and  renew  tlieni  every 
ten  minutes.  Many  bear  warm  poukicea  better  than  cold.  Opium 
18  invalunhlr  in  all  fonns  of  |)enlonitif«. 

An  early  cyann(*ia,  with  excessive  dyapnoa  and  aymplonu  of 
oedemn  of  the  lungs  requirui  vencsectioa.  Thin  removes  the 
danger  to  life  but  temporarily,  but  no  other  remedy  dm-it  ercn 
that  niueb.  For  the  tympanites,  tur}K*ntino  and  absorbent*  are 
useUw,  and  aspiration  is  no  moi«  efTective  than  the  introduction 
of  the  rectal  tube. 

The  vomiting  is  most  benefited  by  swallowing  small  piccca 
of  ice.  Even  the  mildest  laxatives  whould  Ikj  avoided  until  the 
inflammation  ha«  subsided:  while  opium  ami  astringeutdare  alike 
useless  in  the  diarrhea  depending  on  OHlurua  of  the  inuuous  mein- 
brane. 

In  protracted  eases,  wo  should  give  quinine  in  large  doeMy 
Trine,  and  nutritious,  but  easily  digested  diet. 


Da  Costa  uses  local  bleeding  at  the  outset,  followed  by  oold 


PERlTOyiTIS. 

or  hot  applications,  as  preferred  by  the  paticiit.  In  adynamic 
aaee,  he  substitutes  dry  cupa  and  hot  anodyiio  foraoiitations. 
Following  these  remedies,  ho  administers  morphine  hypoder- 
mically ;  and  qninino,  Hve  grains  every  four  hours  until  exudation 
has  occurrccl. 

CcABK  gave  472  groins  of  opium  in  one  day,  to  a  case  in  hia 
charge.  The  opium  should  1)u  guuntvi]  by  sutSuieut  doaes  of 
atropine. 

Bartuolow  re^^^mmencltt  leeches,  followe«l  by  ioDi-hags  to  the 
abdnmen;  whitli  nhouUl  \m  roplitved  by  warm  applications  when 
exudation  has  taken  place.  Morphine  witli  atropine  should  be 
given  hypodei-mically  u|ioii  the  lirjit  riiaiiifwtlation  of  Ihe  disease. 
Here,  also,  the  use  of  quinine  in  antipyretic  doses  is  highly  bene- 
ficial, but  this  rcmcily  ecascei  to  be  useful  when  there  is  solid  or 
liquid  exudation.  This  nercssitntes  a  change  to  the  supp<)rting  and 
stinmlaiit  regimen.  Ten  grain*  of  the  carbonate  of  ammonia  in 
an  ounce  of  tlie  spirit  of  the  acetate,  ia  a  remedy  of  the  highoat 
utility. 

Tanner  places  his  patient  upon  a  diet  of  milk  and  water, 
arrow-root,  and  beef-tea;  allowing  plenty  of  iood  water,  tea,  and 
barley-water.  The  greatest  quivt  should  lie  maintained  iu  the 
Rick-room.  the  air  of  which  should  be  wann  and  pure. 

He  never  resorts  to  antiph  logistics.  Wc  have  one  remedy 
which  is  invaluable,  and  tiiat  is  opium.  It  should  be,  given  in 
Bufboient  doses  to  thoroughly  relieve  the  jiatn.  lie  believes  that 
by  it  alone  we  nmy  otten  save  the  |Hiticnt's  life.  Sedative  fomen- 
tations also  give  great  relief.  Covering  the  abdomen  with  ft 
mixture  of  four  jwn-ts  of  extract  of  i»oppies  to  one  part  of  extract 
of  belladonna,  and  then  fomenting,  will  prove  very  serviceable. 
He  Bays  that  he  doe*  not  inflict  venesiection,  blistcra,  antimony  or 
men-ury  on  the  sufibror.  Even  loec-hes  are  unnecessary,  provided 
the  fomentation  flannels  lie  applied  loade<]  with  steam,  and  changed 
every  fifteen  or  twenty  minutes. 

In  all  instances  purgatives  do  harm;  but  if  the  colon  be 
oppressed  with  fecnl  matter,  the  latter  should  bo  ramoved  by 
enemata.     Directly  great  exhaustion  Hets  in,  stimulants  must  Im 


828 


MAMIAL   OF   TREIATUKKT. 


given;  the  beat  heiuf^  brandy.  K->wc*iiue  of  \ieefy  craun^  raw  qigi, 
quiniiio,  and  ummonia  arc  also  often  invaluable  in  stsj'ing  tbit 
prontratioii  which,  unloaa  properly  treated,  soon  ends  iu  a  &tal 
collapse 

LooMis  followe  the  opium  plan,  first  inatitntcd  bj  Alohzo 
Clark.  As  soon  a^  the  symptoms  of  peritonitis  are  unmistakably 
de^'clopcd,  bo  giv<a  nt  one  do^e  from  one-half  to  one  grain  of 
XDorphint;.  The  jfatient  U  brought  as  soon  as  possible  fully  under 
the  influencD  of  the  drug.  Pain  and  infliimmation  niodily  tbe 
cfleetfl  of  opium,  eo  that  unusual  dosct*  aro  requisite.  Aa  the 
[rtitient  is  brought  fully  niider  the  influence  of  tlie  cijiiate,  tlie 
body  becomes  bathed  in  perepinilion.  In  twenty-four  hours  an 
opium  msb  appcaw  on  the  nock,  accompanied  by  itching  and  a 
dispoitition  to  rub  the  nose.  The  puplU  become  contraeted,  tbe 
eyeK  sufitised,  the  countenance  dull,  and  the  disjKisittou  to  sleep 
becomes  irresistible.  The  puUo  is  lessened  in  force  and  in 
fre(]uency,  luid  the  respinitUuis  fall  from  sixty  per  minute  even  to 
twelve.  In  this  coDditiou  the  patient  w  to  be  kept,  and  with  the 
reapiratioiis  at  twelve,  he  is  perfectly  safe,  and  may  I»c  allowed  to 
sleep.  But  if  It  be  found  difficult  to  artiuse  the  patient,  tls 
opium  must  be  euspended,  until  he  can  bo  easily  awakened.  Tha 
opium  must  be  given  solely  by  the  physician,  as  no  uurae  can  be 
truiited  to  know  bow  ninch  it<  ncetlful  at  each  doee.  If  the 
respirations  fall  to  seven,  the  ]>atient  will  be  fully  narcotized,  but 
will  recover  if  the  opium  lie  not  continued.  The  uftect  upon  the 
pnlac  in  the  best  indication  that  the  inflammation  is  coming  under 
uur  ciititnil.  TympiuiitcH  diminishes  at  the  luinic  time  and  Uft 
sure  indication  that  the  peritonitis  is  arre^^ted.  If  it  do  not 
dcpmtd  on  the  escape  of  intestinal  ga^'e.s  into  the  peritoneal  Bac, 
the  inflammation  con  be  conti-olled  within  fortj-eiglit  Koura,  if 
the  above  method  be  adojitnl  witliin  the  first  twelve  hours  of  tho 
disease.  The  ti-eatraent  must  be  continuwl  four  or  (lv«  dayi 
longer,  to  prevent  a  relapse.  The  opium  may  be  diminished  as  it 
ia  found  that  smaller  doses  are  required  to  produce  the  desired 
oficut.  When  convalescence  in  catabUshcd  wait  a  week  before 
giving  a  cathartic,  and  then  give  castor  oU. 

LooMts  prefers  warm  applications  over  the  abdomoa  to  cold. 


J 


l>f.UITOXITIS:  CIIROXIC 


829 


He  liaa  withdrawn  thv  gatf  causing  ili^tcntiou,  by  means  of  the 
emnllmt.  aftpiratnr  tic^-dlc,  without  any  had  rtMultA,  luid  witJi  tho 
Itroduvtion  of  jci-eat  relief.  In  asthenic  caaes,  he  comhin«a  with 
the  above  nicthtKl  the  u«o  of  stimulatita. 

It  will  be  Acen  that  while  venesection  haa  gone  out  of  iise, 
and  the  remainder  of  the  antiphlofiiiatie  armanicntana  h  rapidly 
becoming  obsolete,  the  use  of  opium  receives  the  almost  unani- 
XQOns  eanetion  of  the  great  authorities  in  all  part*  of  the  world. 

In  sharp  and  characteristic  confnwt  to  this  view,  Lawsox 
Tait  treats  a  threatened  peritonitis  oecurrlng  after  au  abdominal 
section,  by  administering  a  brkk  saline  catluirtic !  Tn  Gunitany 
the  local  appiii-Jitinn  of  cold  is  univcr»al;  in  Knglaiid,  hot  fomcQ- 
tstions  are  still  prt-ferred. 

L6€0he8  nre  still  lined  in  local  inflammations,  such  oi^  tlint 
of  fierityphtitis. 


PERITONITIS:  CHRONIC. 

F.  T.  UoDEitTS  recommends  the  iodideB  of  potassium  and  of 
iron,  and  says  that  in  some  instances  diuretics  may  be  useful, 
lie  also  recommends  mercury,  but  with  some  reserve.  If  there 
be  much  flaid,  advantage  may  he  derived  from  the  ui*e  of  diapho- 
retics, Buch  as  hot-air,  vajwr  or  Turkish  batlis,  or  jaborandL 
Counter-irritation  is  e*omet.ime«  of  service,  espoeinlly  [niinting 
with  iodine,  rubbing  with  liDiment,  and  pressure.  The  latter  is 
decidetlly  valuable  in  nidiiig  idMOrption  and  in  giving  support  to 
the  abdomen.  The  abdonifn  is  covered  with  cotton  wool,  and  a 
flannel  bandage  applied  Jinnly. 

If  the  effusion  bo  largo,  and  absorption  slow,  ho  roaort*  to 
paracentCHis;  repeated  if  necessary.  Loeal  collections  of  pus  must 
bo  treated  on  general  principles. 

General  treatment  U  ol\en  essential,  directed  to  the  condition 
to  which  tho  peritonitis  is  duo.  The  measures  indicated  arc  similar 
in  tlie  main,  conMiHling  of  good  nutritious  diet,  suitable  Kaniuiry 
oonditions,  change  of  air,  and  the  u»e  of  cod-liver  oil,  quinine,  iron 
and  other  tonica.  Wine  may  often  be  given  with  advantage. 
The  organs  generally  must  l>e  attended  to,  and  their  functions 
regulated.  Pain,  flatulence,  uuiistipation,  dy!<pe[wia  and  diarrhea 
will  need  attention  at  times. 


HAKITAL   OP  TRRATUKST. 


Datis  mentions  favorably  the  combinations  of  iodide  of 
potMsium  with  digitali*.  If  the  patient  suffer  mtioh  pain  or 
soreness,  conium,  hyoecyamus  or  belladonna  may  be  added ;  aod 
long  oontinncd  and  mild  ooim tor-irritants  applied  to  the  abdomn. 

Temporary  cxacerbutiona  showing  an  access  of  acnto  inflam- 
mation londly,  may  demand  the  application  of  a  bliBter,  or  of 
some  milder  remedy.  A  liniment  composed  of  tliree  parts  of 
soap  liniment  and  oiio  of  tincture  of  iodine,  may  bo  applied  over 
the  whole  abdomen  twice  a  day.  When  the  inflammation  is  cir- 
uumKcribed,  tlie  oleate  of  merctuy  may  be  used  locally  ibr  a 
limited  time. 

Ky  this  method  of  treatment  the  disease  will  be  enred,  or 
else  dclayeil  in  its  progress.  When  the  serous  distention  seriously 
embarraH»es  the  other  fum!tiDn.s,  and  is  not  much  relieved  by  tbo 
above  raentioned  measures,  the  fluid  should  be  removed  by  aspin> 
tion.     Thi»  ttliyidd  n«)t  be  rt'pciiled  oftencr  than  is  necessary. 

But  if  the  abdomen  contain  a  purulent  fluid,  the  physician 
must  decide  wht'Chor  he  will  simply  endeavor  to  palJiale  the 
symptoms  and  render  his  patient  as  comfortable  as  possible,  or 
whether  be  will  remove  the  pus  by  tapping  with  a  large  trocar, 
wash  out  the  cavity  with  antiseptic  lotioua,  and  establish  drainage, 
as  in  cnipyenia. 

If  the  patient  be  worn  oat  with  loss  of  rest,  and  if  he  be 
anxious  to  obtain  rcUuf  from  the  dyspnea,  the  operation  will  be 
justifiable  and  proper. 

(For  interesting  rcmnrka  on  the  effect  of  paracentesis  and 
drainage  in  chronic  peritonitis,  see  the  article  on  Ascites.) 

Tannkr  says  tlmt  the  treatment  must  consist  in  attention  to 
the  bowels;  in  allowing  a  mild  but  nutritious  diet,  with  plenty  of 
milk  or  cream,  mw  eggs  and  raw  meat;  and  in  the  employment 
of  blislers  or  stimulating  liniments  to  the  abdomen.  He  recom- 
mends Iodine  internally  and  externally,  cspetnally  the  iodide  of 
iron;  togetlier  with  cinchona  and  cod-liver  oil. 

8.    TUBERCtJLAR  PERITONTTIS. 

McCall  Akdkbsos  is  almost  the  only  physician  of  modem 
times  who  has  had  the  nerve  to  claim  a  cure  in  a  case  of  tuberca- 
lar  peritonitis.    In  the  case  of  a  child,  his  treatment  consisted  at 


pKBiTTpntnis. 

firat  in  a  careful  regolation  of  the  diet  and  of  the  digestive  organe, 
and  ID  tho  nse  of  pancreatio  emulsion,  in  doses  of  one  to  two 
drachms,  in  milk,  an  hour  after  the  meals.  Following  thie,  he 
gave  half  a  dmelim  of  Ryriip  of  iodide  of  iron  throe  times  n  day, 
before  raealA.  After  one  month  lie  addal  to  the  above  ood  liver 
oil  in  (loses  of  u  dnu*hm,  gmdunlly  incrt'oiti'd  t<>  half  an  nuiioe,  tlirce 
tiiues  a  day. 

In  other  rasea  tho  Mime  ti-oatnient  wiw  instituted,  with  the 
addition  of  the  application  of  icod  olotlie  to  the  ahdomt-n  for  half 
aa  hour,  every  two  hours,  opium  in  full  doses,  and  ijuiniiic  until 
the  aeute  fever  suhitided.  To  emphasize  his  viewsoftfieeumbility 
of  this  diseiKfo,  Anhkrsos  quotes  the  following  from  Sib  SrKvrEit 
"WELI.S:  "A  young  lady  liad  an  enlargement  of  the  abdomen, 
which  was  supposed  to  he  due  to  an  ovarian  cyst.  An  incisioa 
was  ma«le  in  lliu  |H.>ntr>iifuni,  a  largo  qtinntity  of  oimluiu-ent  tlutd 
escaped,  and  then  the  whole  of  the  peritoneum  was  seen  to  be 
Btudded  with  myriads  of  tubercles.  Some  colU  of  aitihU  intes- 
tines were  floating,  but  the  great  mass  was  bonnd  down  with  the 
colon  and  omentum,  all  nodulated  by  tubcrolu,  towunU  the 
back  and  upper  part  of  the  abdomen."  This  patient  made  a  good 
recovery,  and  halt  Mncu  marrii^d. 

I  liBVQ  made  USB  of  Anderson's  method  in  the  onlj'  cose  of 
this  di^ase  which  I  hnvc  met  Binee  rending  tho  above:.  The 
patient  was  a  young  girl,  of  a  tubereuliir  family,  wlio  presented 
symptoms  of  tubercular  ]writ<mLlis.  Tlie  eold  eloth^  were  applied 
to  the  abdomen,  and  changed  every  minute  for  half  an  hour. 
This  was  repealed  every  tw<i  hours  until  the  temperature  subsided 
to  the  normal  i>oint.  In  all  other  resjiec'ts  Andkhso.v's  advice  was 
Btrietly  followwi.    Tlie  lady  n-covered.  [\V.  K.  W.] 


PERITYPHLITIS. 

Allciiin  says  that  perfect  rest  in  bed  i«  of  primary  import- 
snce;  and,  since  the  symptoms  are  directly  relieved  hy  the  reclin- 
ing position,  the  imprisonment  is  readily  submitted  to.  Hot 
poaltices  of  linseed  meal,  or  fomentations  over  the  caecum, 
changed   aa  often   ait   ncccHittry,  almoflt  invariably  give  marked 


882  MANUAL  OP  TRIATHBNT. 

relief.  Wh«ii  an  absoen  is  in  proooesof  ronnation,the  hot  ii]>pUca- 
tious  favnr  iu  ttevelopnient,  aiul  so  promote  the  euro,  by  atlbnlit^ 
an  opiiortunity  for  iu  boiujf  oi>onod.  Thin  plan,  pursued  for  a 
week  or  ten  days,  may  be  Huflii^iunt,  In  chronic-  onsed  it  may  be 
neoeeeary  to  wmliiiao  it  tor  a  longer  period,  pveu  when  the 
terit<ion  iip])e»rt>  tn  he  letwenul,  and  the  pain  in  the  limb  decreased. 
When  the  acnte  inAnmmatory  Kymptoma  hnveHiilMidod,  rountar 
irritation,  hy  blisters  or  hy  a  wtliition  of  iodine  applied  over  the 
airc(-'tc<1  part,  tends  to  promote  absorption,  and  remore  thickened 
or  condenwd  tiHsntM. 

Attention  shouM  be  capecially  directed  towards  nuitntaining 
the  gcueml  health.  The  diet  sliould  be  i^mali  in  arnoant,  fre- 
quently admini8t«rod,  and  of  the  most  nutritive  quality.  AdvAD- 
tage  is  derived  from  the  administration  of  the  prei>aretl  dig:e5tive 
jaicea  of  the  stomach  and  of  the  pancrcojt,  ao  that  a  minimum  of 
indigestible  food  muy  reach  the  lower  bowel. 

StinuilanlA,  carefully  admiiiiatored,aro  oAca  ncccaaary.  Care 
is  required  in  giving  niterientA  when  the  b<in'iilt)  are  confined. 
This  condition  ia  beat  i-clievcd  hy  cuemuta  aud  geutic  laxative*, 
SDch  as  confection  of  eenna  or  castor  oil.  Constipation  is  more 
favorable  to  the  imtinnt  than  diarrlica,  which  is  ntlen  iincontrol- 
able,  or  obstinately  rcsi^tii  tlio  u^ual  treatment  of  a^^^ids  and  opium, 
tannin  and  other  afttringcnta,  wliothcr  given  by  Uic  moulh  or  as 
encmata.  It  ia  much  easier  to  relieve  the  bowels  than  to  arrest 
their  excessive  action. 

Tonics,  Bueh  as  iron,  ammonia,  and  bark,  are  of  value,  and 
should  be  given  fnim  the  outlet,  since  the  disease  isone  that  tends 
to  wasting,  and  it  is  usually  in  a  somewhat  enfeebled  condition 
that  the  patient  Hmt  prescntd  himttclf.  AN'^heii  the  acute  pha«2haa 
pasaed,  change  of  air,  a  sea^voyage,  and  other  aids  to  convaleacenoe 
are  ro<|uiped. 

LooMis  Bay»  that  the  most  ini|)orta,nt  thing,  after  aspiration 
has  determined  the  character  of  the  tumor  aud  the  praseooe  of 
pus,  is  to  make  an  inci-iion  into  the  abscess,  cutting  cautiously 
through  the  abdominal  wall  at  the  seat  of  the  swelling.  Free 
drainage  must  he  kept  up.  Previous  to  the  evidences  of  suppura- 
tion, leeches  may  be  applied  over  the  tumor,  followed  by  warm 


I 


4 


PBtt8PtBAT10N:     DIS0RDRE6  Of. 


333 


ponlticefi.  Abeolate  rest  is  all-important  in  the  nuuiagetneiit  of 
these  case?. 

After  oponiii^  the  abscess,  care  must  be  taken  tn  avoid 
pressure  iipnn  tbat  ]«irt  of  tlie  intii^tine  for  Home  time. 

The  exhatistion  Fesaltiiig  from  the  prolonged  suppuration 
must  be  Cdmbntctl  li^-  in>u  und  tlie  vugctablo  tuuii^  The  diet 
througlioui  lilioulcl  bo  highly  nutritious  and  digestible.  Opium 
ihould  lie  viiiplityi-d  wlieiievcr  tlio  least  iiidicatioii  of  local  or  jftne- 
nl  peritonitis  ap[)cara;  and  laxatives  munt  not  be  admini^tefcd 
until  tlie  repiirative  proecMea  an:  well  CMtnbliAbcd. 

Da  Cdeta  endeavore  to  allay  the  iiifluromation  in  the  first 
gtage  by  the  bxail  use  of  ico,  or  of  iodine.  If  siippnratimi  Ikj  evi- 
dent, be  applifTt  {votiUices,  evacualeri  the  pm,  and  administers 
{^iom.  a.nd  quinine. 

l!fiEUBY£R  applied  leeches  repeatedly,  and  followed  with 
warm  poultices.  The  abeH.-e89  should  be  opctie^l  as  soon  as  there 
is  fluijtuatiof). 

Baktbolow  approves  the  practice  of  Buck,  in  ovacoating  the 
pHx  by  a  free  opuniiig  hihI  eslabliRhing  drainage;  iwrticnlnrly  a» 
by  this  method  »»f  operating,  foreign  htidies  have  fi-equcntly  been 
brought  to  light  and  evacuated,  which  otherwise  would  not  bavo 
beeu  discovered. 


PERSPIRATION:  DISORDERS  OF. 

1.    ANIDROSIS. 

PlPrARD  says  that  the  pei-epiration  may  readily  be  inci-eaeed 
by  the  u-eof  any  of  tlie  diuplioretit-s;  ibe  most  powerl'nl  being 
jaborandi.  This  may  b«  given  ui  the  dow  of  a  dra4.hm  of  Ute 
fluid  extract  for  an  adult. 

The  uiost  agreeajjle  diaphoretic  is  the  Turkish  bath. 

Sotoe  pers^'iu  Kull'vr  I'rom  abnormal  drync»i  of  llie  Akin,  with 
a  tendeiH-y  to  crack  in  cold  weather.  This  may  be  remedied  by  a 
daily  cold  ahower-bath,  followed  by  vigorous  rubbing  with  a 
Turkidi  towel,  and  tbe  use  of  lotions  on  the  exposed  portions  of 


8M 


HAHUAL   or  TBHATHRNT. 


the  ekin.    The  best  Applications  are  thoso  which  contain  glyw- 
rine,  oil  of  rosos  ami  bay  spirit. 

2.     BROMIDROSLS. 

Vak  IIarlinges  siTcuksof  the  ueeot  permftiignnate  of  pot»- 
aium,  two  or  thi-oe  grains  to  the  ounce;  and  chloral,  twenty 
grains  to  the  ounce  of  water  or  ililiitetl  alt-ohol. 

lata  FccoTnniemU  tiie  une  of  cork  iiisoles,  which  hare  beta 
ionkod  in  a  solution  of  boric  acid  and  dried. 

Sparks  »a.ys  that  the  treatment  consists  in  extreme  cleanlineM) 
rcpeafod  wasliing  with  tar  soap,  tliorfmgh  drying  and  frequent 
change  of  the  uUKrkings.  Thu  [lurtii  should  b«  jtowderoil  with 
oxide  of  sine  iinil  riee  powder  (one  [«rt  to  four),  and  l)elIa<loaak 
ahouhl  lie  giveit  internally. 

Hebra  recommends  the  Ibllowuig  for  fetid  sweating  of 

9    Ol.  oliviKOpt, I  XT 

LitliargTii. S  >ii-5Ti 

Onjue:  ft.  unguttnluiu. 

This  is  to  bo  applied  on  strips  of  linen  every  twelve  hours. 

PtFPAUD  auys  thill  lie  knowA  of  no  drugs  which  are  vapnble 
of  directly  modifying  the  secretion  of  nial-odoroas  sweat.  Any 
debility  or  other  general  constitutional  state  tthould  be  treat**!. 
Locally,  he  uses  B  preparation  composed  of  freshly  prepared  aiUcio 
hydrate  and  rose  water  ointment,  one  [rnrt  of  tlic  former  to  nine 
of  the  latter.  This  is  to  be  nibbed  into  the  affected  parts  night 
and  morning,  the  Burface  being  thoroughly  cleansed  with  Map 
'  And  water  before  each  application, 

To  palliate  the  afJ'ection,  cleanliness  is  of  the  first  importance. 
If  thits  be  iriKiil£ciont,  it  will  ho  ncces.'^jiry  to  uoe  a  dininfectant., 
snch  as  thymol  or  chloral,  combined  with  on  astringent  and  absor- 
bent powder. 

WiijWN  paid  great  attention  to  the  regulation  of  the  general 
health.  He  reported  one  cure  doe  to  the  local  use  of  tannic 
acid. 


CRRSrilLATIOH:    DISOaDERB  OF. 


886 


SitoEHAKER  spcalcH  favorably  of  tiie  local  use  of  oleate  of 

In  tho  German  amiy  llie  soliliere  are  oompellod  by  regul»- 
tirni  to  apjtiy  to  their  foet  ao  oiutmMit  composed  of  salicylio 
acid  and  Kuet. 

We  have  found  DOiie  of  the  foregoing  reinetlii;!)  ra  satis&o* 
tory  as  the  following:  We  direct  our  pnlieiits  to  use  no  8oa|)  luid 
"but  little  water  on  the  parts  from  which  tht-  oihrnHw  jiernpiratioD 
k  derived.  Instead  of  thie  wo  have  the  p&rt«  nnoiiitcd  with  name 
inodoroiu  animal  oil  everj-  night,  scraimJ  several  tinien  a  week, 
and  the  n.>nmining  oil  well  ruWx^  away  with  a  i)iece  of  flannel. 
(Tlie  reader  of  Xenophon's  Annlwi^iM  will  renionilwr  ttiHt  among 
the  priiea  in  the  Greek  games  were  goltUn  Jlfsh'ScraiieTa.)  The 
stockings  sihoiiM  always  \*'  of  wool,  and.  ««  well  as  the  (thoes, 
alioutd  be  aired  every  alternate  day  ;  that  is,  should  be  worn  one 
day  and  aired  the  nexL 

111  some  cases  the  substitution  of  borax  for  map,  as  a  cleaiuh 
ing  agent,  in  followed  by  an  immediate  iropro\'emont.  PcrAons 
subject  to  fetor  of  the  feet  should  always  wear  ^loes  of  eloth,  or 
some  material  which  will  allow  of  free  transpiration. 

PiPTARD  calU  attention  to  a  curious  affcttion  which  he  de- 
nominates  bromidrosi phobia.  Persons  imagine  that  they  arc  mal- 
odomufl,  and  have  even  refused  to  apiieur  in  HOcicly  on  luxrount  of 
offensive  emanations  arising  from  (heir  jtermns,  which,  however, 
no  one  could  detect  except  themscU'e.-*. 

We  liave  met  with  one  siu-.h  ca«c,  in  the  perwon  of  a  Texan, 
an  ei -Con federate  officer.  He  eeemed  much  improved  when  a 
urethral  stricture  bail  lK>on  dilated,  but  left  uh,  Atill  [lainfully  con- 
scious of  the  had  odor  arising  from  his  body. 

8.    IIYPERIDROSIS. 

PiPFARD  States  that  beUadonna  will  temporarily  control  any 
case  of  local  or  general  hyg^Tidnj^^i^  Kut  no  i>crmaneut  benefit 
is  obtained,  even  if  iliiH  condition  be  kept  up  for  noma  time.  lie 
haa  found  the  prepamtion  of  sUicic  hydrate,  mentioned  under 
the  head  of  bromidroaia,  UHefiil  uUo  in  liiin  alil-ction. 

Hbbba  recommends  the  application  of  equal  j^arts  of  lead 


8se 


UANUAL  OF  TRKATIIRKT. 


pla''ter  and  liuseed  oil,  to  be  left  upon  the  pArt  for  twelve  ttoun. 
Thia  19  to  be  rc]>eat*d  for  tcii  day*,  and  then  the  foot  may  b» 
rubbed  with  some  astringent  powder.  In  a  few  days,  a  yellowish 
layer  of  cuticle  will  peel  oft'  from  all  the  nflectod  partii.Bnd  » 
healthy  surlaoewill  appoar.  The  foot  may  then  Uo  wa«hod,  for 
the  iirtit  time  during  the  rotirse  of  treatment.  Wlien  tJu-  aljcctjun  , 
retuma,  in  a  year  or  more,  the  same  cour^  may  be  repeated.  H 

SiiORHAKsa  rvcvimnionda  th«  oleate  of  zino,  mixed  with 
thymol  (onu  part  of  the  latter  to  &00),  m  jtarticuUrly  valuable  to 
those  who  flutter  from  incr«a.4od  swc^atiug  around  the  axiUiit 
genital  organs,  and  palmar  and  plantar  Burfaccs. 

In  one  ca^e  wc  found  all  lofral  remedies  incfHcicnt,  until  ih%] 
patient  undcnrcut  a  course  of  treatment  for  bis  corjmleiK-e ;  whi 
was  oxcOsdivG.  When  the  eurplus  f»t  had  been  (lii>po»L>d  uf,  the 
of  TIkbiu's  niethod  pntvcd  eucccssful. 


PHARYNX;    DISEASES  OF. 

1.    ACUTE  CATARRH. 

RiNORit  urges  tlic  UM-  of  tincture  of  aconite  root,  in 
doaes  every  quarter  hour  fur  the  lii'st  two  doaed,  and  aft' 
hourly,  if  the  case  be  ^een  at  the  very  beginning.    The  itinaninw- 
tion  rarely  fails  to  sncrnnib  within  one  to  twodayn,     M' 
eays  that  the  i«tient  should  be  confined  to  be<l,  a  Itriitl:  p^--..- 
givcn,  and  blaud  nourishment  allowed,  iuchullng  milk,  ico 
Btimulaiit^  if  re<{iilr(Ml.     Ponltlves,  fomeiitation^i  or  wt^t  cnnipr»«s 
may  bo  applied  L-xtcnially.    Steam  may  bo  iuhaleU,  and  a  wann 
solution  of  morphine  sprayed  into  thi>  throat  every  two  Incurs. 

When  tbcHwelliiigand  redn<«u)  Kub#ide,the  aHtringnnt  gargki 
maybe  used,  or  tlie  throat,  maybe  ]iaintod  with  ,t;ly<.-vriiK!  of; 
tannin  or  with  iiitrnte  of  nilver.     Tonics  will  ihon  Ix-  nu;fal. 

ilyiiELL  Mackkszib  eonsiders  confinement  to  lUo  boose  for 
few  dayi4,  reetri4>tion  to  a  tight  diet,  and  iho  avoiilanoo  of  a'xmt 
lautii,  iho  only   ines-iures  iKJceasary.      A  wtt  cutnpraaa,  lo    the 
liouk,  a  hot  foot  bath,  and  itucking  ico  cxpodito  tbo  cnro.     At 


PUARYKX;    DI8BASKS   OK 


33T 


opiate  tflkm  early  will  j>:en«mMj  abort  the  attack.  The  effect  is 
much  Ic^  if  the  patient  be  fallowed  to  Bleep  after  taking  the  opitim. 

A  Turkish  bath  will  fre<iueiitly  cut  abort  the  attack.  'Die 
disappearance  of  tLe  local  affection  may  be  haHtenocl  by  uniiig  a 
rbataiiy  lozciigc  every  tbree  boura.  A  few  applications  of  the 
pigment  of  chloride  of  zme  are  oepeeially  useful  for  the  eamo 
purpose. 

Tlie  disposition  to  catarrh  i«  bcwt  coinitcnwtod  by  tbo  u*se  of 
cold  morning  hatha,  rough  towels,  and  f1e«h  brashdR  \  while  hot 
looras,  lato  hours  and  all  relaxing;  hablttt  should  be  avoided. 

Sajous  applied  a  four  per  cent,  solution  of  cocaine  to  tbo 
ioflatncd  mueou*  membrane  every  two  hours.  The  wme  agent 
may  also  be  given  in  wine  or  in  lozenges. 

The  next  best  remedy  is  opiiuu ;  three  drops  of  the  tincture 
being  given  everj-  hour  for  throo  doses.  Two  drops  of  tincture  of 
belladonna  may  be  substituted  if  opium  be  undeeirable.  Ouaiao 
16  aby  valuable,  particularly  in  rheumatic  caws, 

7*0  remedy  13  nearly  so  effectual  in  aborting  tliis  disease  as 
the  chlorine  mixture  given  i[i  the  article  upon  diphtheria,  on 
page  161.  A  tea^f-oonful  of  tbie  may  be  taken,  every  hour;  and 
nflually  three  doaes  will  be  found  Bofficient.  As  a  palliative, 
DOtbing  is  so  useftil  and  convenient  as  a  lozenge  of  coca  and 
aeonite. 

2.    CHRONIC  CATARRH. 

MntRHEAO  says  tliat  if  the  disorder  be  dependent  upon  any 
otlier  affection,  then  of  course  the  primary  disease  must  ba 
attacked.  But  in  tlie  case  of  simple  chronic  pharyngitis  tt  will 
usually  be  found  that  tlie  sufferer  ia  <x>nKiderab1y  below  par  id  his 
general  health.  This  indication  must  be  met,  and  the  patient 
supplied  with  tonics;  bin  habita  of  life  altered,  bis  busineas 
auspended,  and  much  out-of-door  exercise  eryoioed.  Qood 
nourishing  diet  itbould  be  ordered.  Smoking  munt  irither  be 
entirely  prohihit«<l,  or  if  this  be  impoMible,  it  must  be  much 
reduced.  Locally,  the  affection  la  beat  treated  by  opraya  or 
Bwabhing.  Gai^lw  Heldom  rearb  the  parta;  but  if  theee  are  to 
be  uacd,  the  beat  are  thoae  of  alum,  taimiii,  chlorate  of  potoah,  or 

w 


388  UAKOAL  or  TKBATMKHT. 

bromide  of  ammonioiii.  This  latter  ut  ospeeially  VRluable  to 
relaxed  throat-s,  wltli  t-lcmgated  uvula,  and  irritable  cough.  Ab 
eprayti,  maiiy  different  remedies  are  employed,  ilie  moot  I'aliiabk 
being  solation^  of  the  follon-ing,  in  distitled  water,  iu  the  pm- 
portimw  indicated  to  the  oiuicc; — Nitrate  of  silver,  five  to  tea 
grains;  tannin,  five  to  fifteen  grains;  ainm,  ten  to  thirtj'  grains; 
sulphate  of  zinc,  fire  to  ten  grains;  common  suit,  ten  to  thirty 
grains;  or  glycerinu  diluted  with  water.  In  swabbing  the  Chiuat, 
glyecrino  of  tannin,  LroOL's  solution,  or  the  simplo  tincture  of 
iodinemaj  be  used.    In  nonic  catsea  mineral  waters  are  prescribed 

with  8UCC6M. 

MottSiL  Mackenzie  advisee  avoidance  of  the  exciting  cautet, 
and  that  the  {laticnt  ithciiild  reside  in  a  dry  mid  bracing  atioot- 
phtTO.  Hepatic  congestion  or  irregularity  of  the  bowclii  rwjuire  a 
morning  glass  of  saline  aiwricnt  water.  If  the  affection  be  slight, 
a  gargle  i>f  cliloralc  of  pota^sa  should  be  frequently  uaed.  Lozen- 
ges of  kino  and  rliatany  arc  very  tincful. 

Wlicn  the  affection  is  obstinate,  the  local  application  of 
astringents,  sncb  as  solution  of  pcrchloride  of  iion,  nne  pari  to 
eight,  with  tonics  internally  will  wjmciiinca  curt.  If  the  uvula 
be  elongated,  it  should  be  tsliortcticd.  If  there  be  any  follicular 
disense  of  tlic  throat,  this  most  be  cured  before  the  uvula  is 
amputated  ;  as  paticnto  may  not  bo  willing  to  submit  to  Airther 
treatment  after  tliis  operation. 

WaKtT  recommoods  flstringcnt  gargles,  and  poncilling  th« 
throat  with  nitrate  of  silver,  thirty  grains  to  the  ounce.  Tbe 
general  treatment  is  important,  " 

Sajods  prefers  nitrate  of  silver  as  a  local  application,  in  the 
Htivnglh  of  forty  graine  to  the  ounce.  The  appli(«tion  should  be 
precccled  by  thomugb  cleansiug.  'Weakersolutionsonly  dokano. 
It  should  b«  applied  once  dailj*.  Some  cnsce  wilt  not  bear 
astringents  at  all,  and  in  these,  he  applies  vaseline. 

For  catarrii  witlmnt  hypertrophy,  an  excellent  application  is 
tlie  solntion  of  bydrastia ;  two  to  four  graioB  tx>  the  ounce  of 
distilled  water. 

If  catarrh  of  the  nasal  possagce  co-exist,  this  must  be  treated 


H 


^ 


at  the  same  time,  or  the  pharyngeal  afl'oction  will  constantly 
re-appear. 

3.    FOLLICULAR  PHARYN'OITIS. 

MoRELL  NfACKENziK  recomtneiidr^  the  London  paste  for  the 
lijfiwrtrophtc  form.  This  tilinuid  hu  apjtlicd  t<i  wich  gruiiulutton 
separst«ly,  but  only  two  of  these  should  be  treated  in  one  day. 

The  iranUi  is  made  into  u  thick  cream  with  water,  and  applied 
ith  a  wooden  spatula.  The  throat  should  at  once  be  rhtsed  out 
with  cold  water. 

In  the  inten-aU  milder  remedlee  may  be  used,  ae  the  pig- 
mcnt(«  of  chloride  of  iron  or  of  zm<:  Wlieu  there  is  much  irrila- 
tioD  of  the  tiiucee,  inhalations  of  benzoin  or  hops  are  beneficial. 

Id  th«  exudative  form,  he  acrapes  away  the  white  apot^  with 
the  pharyni^I  curette,  and  applies  the  solid  stielc  of  nitrate  of 
silver  to  each  spot. 

In  the  meantime,  the  getieral  system  should  receive  ench 
treatment  oa  U  indicated  in  each  case. 

Afu»r  the  local  treatment  haa  boen  completed,  the  permanency 
of  the  care  may  be  c^tahlit<lie<l,by  change  of  air,  residence  at  the 
seaside,  or  by  ufling  the  arstinical  waters  of  Mount  Uore,  the  hot 
solphur  springs  at  Aix-leH- Bains,  or  the  saline  witters  of  Erne. 

Sajoos  prefers  the  g^vano-cantery  to  diseipate  h.\-pertro- 

phiee.  In  the  exudative  tonii  the  ».licfay "plugs  iihould  iinst  be 
remorod  by  the  use  of  forceps.  Six  or  seven  follicles  may  be 
burnt  at  wK-h  sitting.  Large  soporficial  veins  may  be  cauterized 
M  the  same  time. 

MriKHEAn  lays  stress  upon  the  imj)Ortancc  of  rest  tx>  the 
affecte*!  part.  The  clergy  man 'must  cease  his  sermonizing,  the 
■mokcr  lay  a»ide  hia  weeth  The  «trongth  must  be  kept  up  by 
eyst^mntic  coursed  of  Ionics.  Lovalh",  he  prefers  applications  of 
silver,  tannin  or  ahim.  Boro-glyveridc  ia  a  valuable  local  emol- 
lient. Gargl(»  are  worthless,  aa^tbey  never  reach  the  atlected 
part. 

We  have  used  both  the  London  paste  and  thegalvano-cautery 
in  theee  cases,  bat  prefer  to  both,  the  application  of  iodine  and 
phenol : 


840 


U. 


MASCAL  0^  TRBATMBNT. 

TfMCiwii, 5j 

Plii-aol  ftudique^ 3  1j 

GljoCTini. 5^ 


The  Btreiigth  of  this  mixture  may  bo  iocreoscd  or  diminiRhod 
acconling  to  the  seiwitiventttw  of  the  throat.  It  raay  Iw  applied 
every  day  to  the  hjpcrtrophlod  mucous  membmae. 

4.    ATROPHIC  PHARrNGITIS. 

&AJOUS  rccominonde  the  application  of  a  SAtorated  »o1utiod  of 
chlorate  of  jiotjuiHium,  as  a  gnrgle,  or  with  nii  atomizer.  A  tea 
^rain  flolution  of  nitrato  of  silver  ehould  bo  applied  every  day,  ob 

Igct  of  cotton.  The  inixtiirL'  of  e<iiin1  iwrts  of  iodiXW  and 
rine,  roL'ommiiiidcd  by  Fauvel,  k  I«s9  etficient. 

In  addition  to  the  locatl  renicdiEiH,  pilocarpine  may  bo  giveo 
intomally  to  stimidftte  the  aeeretory  glands.  The  oleore«in  of  CQ- 
beb^,  iifteen  drops,  on  riiigar,  in  another  nieritorioas  agent.  Chlo- 
ride of  ammonium,  in  t-hrec  f^ruin  tablets,  is  advautaguons  to  keep 
the  piiarynx  moist. 


PHLEGMASIA   DOLENS. 

Playpair  considers  over-active  treatment  nnadvisable,  ob- 
pecially  of  the  antiphlogistic  eort,  as  the  dlecaac  asnally  oocnra 
in  perrons  who  are  in  a  debilitated  condition.  The  cou«tant 
application  of  heat  and  moiatnrc  gives  great  relief  to  the  pain 
and  tcnaioii.  The  Hrob  may  be  wrapped  in  linaee<l-meal  poultices. 
If  the  weight  of  the  ponlticca  be  objectionnblc,  flannel  stupee  ma/ 
be  Biibatituted.  Laudanum  or  belladonna  and  chloroform  liniment 
may  be  sprinkled  freely  on  the  poultices.  The  most  absolute  rest 
in  bcl  muBt  be  enjoinod. 

The  constitutional  (rontnient  must  be  regulated  by  the  condi- 
tion of  the  [latient.  Milk,  becf-tca  and  light  eouj^is  may  lie  given 
in  abundance.  Itebility  may  make  atimnlants  net?e»sni-j'.  The 
tonics,  iron,  (juininc,  tho  mineral  acids,  ammonia  and  chlorate  of 
pota^sa  arc  apt  tn  be  of  HcrvU'e. 

The  U£e  of  alkalies  and  other  medicines  to  hasten  the  alKiorp- 
tion  of  coagula  nin^t  be  considered  aa  altogether  nseletw.     Pain 


■pleemMB  may  W  reli«vcil  I»y  Dover's  powder,  chloral  or 
le  subcutaneous  injection  of  morphine. 

Wlien  the  acute  aymploias  have  paased  by,  the  Hrnb  should 
swathed  firmly  in  ii  Hnimcl  l)Ilndagv^  Tin;  cqiialile  pivjtiure 
^awiatM  tliu  ubaorptloii  of  the  maguta.  Still  later,  weak  iodind 
ointment  may  be  gently  nibl»ed  inl<>  the  «kin.  Any  manipulation 
calculated  to  cause  looiwuing  of  congula  is  to  be  avoided.  Warm 
douches  and  the  occasional  use  of  electricity  aro  tlioughi  to 
promote  absorption. 

^W)le^  the  patient  is  well  enough  to  he  iriovc<I,  n\\G  ehoujd  bo 
xt  to  the  seashore.  Great  caution  should  be  ahowu  in  retiumiDg 
e  uee  of  tlie  limb. 
Ahann  thinks  that  the  propht/taris  m  this  dibiease  is  very 
important.  If  signs  of  fever  and  |«i(i  in  the  limb  appear,  the 
patient  should  rerniiin  in  \m\,  receive  no  visits,  and  observe  a  strict 
diet.  Every  precaution  should  be  taken  to  remove  all  causes  of 
eiteraent  or  irritation,  moral  or  physical. 

Tlie  patieut  should  lie  so  that  tho  affeclM  leg  is  more  elevated 
n   its  thigh.     The  bowols  shouhl   he  moved  by  u  moderate 
tive.    Venesection  is  out  of  date.     A  few  Wechta*  may  be 
ipplied  near  the  painful  point,  in  order  to  reduce  the  hyperemia. 

Of  local  spiilicatious,  the  most   efficient  are  clotlui   wrung 

ut  of  lead- water,  or  ice-water;  ami,  later,  inunction  of  et^ual  parts 

oi'  merctirial  ointment  and  lard.    A  piece  of  the  bitter  the  size 

of  u  bcnn  may  lie  riibljed  int^i  ibe  thigh  and  groin  twice  daily, 

mitil  a  mercurial  imi)rc3aioii  on  the  gums  ia  noticed,  aftt-r  which 

frictioni*  with  mmipiKinilwl  oil  anil  alcohol  may  be  substituted. 

Wheti  the  fever  luis  diptftpiMrared .  the  swelling  may   be  [tainted 

with  tim;tHrc  of  iodino,  and  the  Hiub  bandaged. 

I         The  patient  should  keep  her  bed  for  some  day*  after  all  fever 

Tias  disapjtcarod,  aH  a  part  of  the  thrombus  may  be  looaed  by 

live  motion. 

In  tliat  form  of  the  di«Ga»e  where  there  is  subcutaneous 

inflammation  of  the  limb  without  thrombo»w  in  the  veins,  the 

Mine  pi-ecautions  in  putting;  the  initicnt  to  Iretl  should  be  observed, 

the  limb  similarly  nihhod  with  dilute  mercurial  ointmenl. 

But  should  ep&cdy  imppovcment  ti"t  follow  these  mciwurea,  the 

hysician  eihoutd  not  delay  to  inukc  free  iiiciKloiui  in  the  tkin,  to 


inl 
■and 


J 


give  v^-iit  tn  the  pus  which  has  formed,  and  tn  lotncii 
and    sweliiiig.      A  rapid  change  for  the  belter  will  follow 
mcaauro.     AppUaitionit  of  clothn  wrung  outofwanii  cliouiomile 
t«a,  and  washing  the  wound  with  weak  carbolic  acid  lotion  (one 
per  rent),  will  ap]impnut*ly   follow.      Of   cour»c   the  gener^^ 
strength  must  be  supported  by  wine,  80U]>6,  milk,  etc.  ^H 

PowKiU!  has  found  great  I)ene6t  from  applying  a  tobacco  saItI^H 
or  planter  to  the  linib  throughout  its  whole  length.      Within 
twenty-four  hours  the  painful  atasiA  is  rKlieved,  and    in  a  few- 
days  the  patieiit  is  fully  leetorcd.    Thu  foimula  he  use»  is  the 
following:— 

B      Navy  plug  lobaccn, )  pouod 

T«Uow. I 

Bonn i       " 

Lud  or  olive  oil |        " 

BeeiH-tLX, I        " 

BnlMim  tir, 1  oaaot 

BuncuaJj!  jiilcb,.. \  pouml 

VinegB.T, , i  pints 

WftUr, I  pint 

Cut  up  the  ^olhM«n  «nH  tank  it  In  Hut  irnl«r  till  toft ;  mM  not  ptM  oT  the 
Tlnrinr,  Imtl,  Btmln,  anil  udil  the  efconil  pint ;  boll  aiid  slraiii,  mnd  wid  th«  nat,  nda 
uid  lAixi.    Uoil  till  all  i\w  waicr  cvupotnles  luid  ch«  ImUam  fir,  and  Rtir  lil)  <x>ol. 

A  phui  roeonimondod  by  Cricutok,  is  to  apply  a  Bolutimi  of 
the  sulphate  of  iron,  gr.  xxx  to  wuti-r,  fl.  Sj,  using  it  m  hot  as 
it  cau  be  boriici.  This  has  been  tried  by  some  American  phyn- 
ciBiiii,  and  ifl  itaid  to  be  followed  by  a  marked  diminniiiiii  of 
the  pniu  and  swelling,  and  to  be  one  of  the  best  local  applicatiou^H 

FoRuvcB  Barker  says  that  the  disease  tends  to  a  spoatanoous 
recovery,  and  genemlly  disappears  without  eerious  conftoquoDcoa. 
Henc-e  any  trt'atmeut  which  disturbs  the  Bystem  or  the  nomud^ 
funetiouB  is  objectionable.    The  itidioations  are :  ^H 

1.  To  allay  the  irritation  of  tlie  ncr\'ouii  eystcnt,  which  ca^| 
best  be  done  by  full  doses  of  opium  where  there  isnoidiosyncrasjr^ 
to  prevent  its  ubc, 

2.  To  support  the  system  hy  nutritious  food,  stimulants  and 
tonics.  Of  the  la^t-mentioned,  <)uinine  and  iron  hold  the  Brat 
place. 


PBLSaiUSIA    DOLBItS.  S43 

Onl^'  in  cases  wbcro  special  tndtcntions  exist  shonM  cathareis 
be  ioduoed,  or  uupii  Iw  ii|>|>lie<1  over  tlio  IcidiieyH.  lu  nearly  aU 
cftses  there  is  no  occa»«ioii  wliatever  for  tha^e. 

After  the  firat  two  or  three  daya,  the  disease  becomoi  mostljr 
local.  The  patient  phoiiM  keep  quiet,  the  limbs  be  elevatt«l  at  au 
»4jgle  above  the  trunk  hj  nii«iiig  the  lower  part  of  the  mattrsBe, 
and  where  there  ia  hypereAthe«ia  of  the  surfsce  and  pain  in  the 
deep-aeatod  nerves,  much  relief  will  be  obtained  by  gently  rubbing 
the  gorflBce  with  a  liniment  like  the  following: — 

B     LiniiDonli  Mponuco .....fS  yj 

Tinrt.  ofil fj  la 

Tinot.  wioiuU  radida, fj  m 

Ex.  btUadonnv, |  ■ 

K.    S.— For  A  tiaimtnt. 

The  rubbhig  with  this  ehoald  be  gentle  and  continued  for 
fifteen  or  twenty  minutes,  and  ahcai/s  toward  the  (rank.  This  may 
be  repeated  every  six  hours,  after  which  the  lop  should  bo  enveU 
oped  in  cotton  baiting  and  coveretl  with  raw  silk. 

After  the  period  of  acute  tension,  the  leg  should  be  oxamincd 
for  localized  phlegmon,  and  if  any  circumecribed  collection  ot 
pus  be  discovered,  it  sliould  be  evacuated  at  once;  otherwise  the 
tonicity  of  the  tisenes  will  best  bo  promoted  by  applying  a  roller 
bandage,  beginning  at  the  toes  and  (nrrying  it  up  the  whole 
length  of  the  limb.  Tlii:*  ohoiild  bo  worn  so  loug  as  there  in  any 
tendency  to  o^oma  of  the  foot  and  leg.  The  patient  fihould  not 
he  |>enuitte4l  to  walk  unfit  nil  cvidenco  of  local  disease  hua 
disappeared. 

TiXKBa  employs  warm  Hcdative  applications,  and  gives  opl- 
atOS  to  relieve  the  pain.  Subsequontly,  great  bcnvlU  accruea  from 
altempta  to  improve  the  condition  of  the  blood,  by  the  use  nf  wine, 
brandy,  milk  and  niw  egire,  animal  food,  aiinnonia  and  cinchona. 
If  there  be  oltenaivc  vagimil  discharges,  iigectiona  of  weak,  disln- 
footing  solutions  fihould  be  tiered. 

BU?ter?,  stimulating  liniments  and  haiidagc*i  to  the  limb,  are 
nsefol  when  all  the  acute  syniptoina  have  Bubsided;  at  which 
Btag©  benellt  is  derived  from  iodide  of  iron,  cuddivcr  oil,  and  t<e&- 
wr.     Roberts  also  speaks  strongly  in  favor  of  eupporting  the 


HAMVAL  OP  TRKATMKNT. 

puticnt  by  nourishing  food  and  atimulanU.  He  also  ase«  anodjiM 
locally  and  internally. 

ISli.kii^liii  Wallace  was  aocuBtnim-d  to  recommend  covcnni 
the  affected  limb  with  menniri&l  ointment  In  one  case  wheie 
stifiiieisH  and  lomenetw  n^iDiiinvd  for  yvare  utter  on  attack,  we  found 
the  greatetit  benelit  from  the  uae  of  large  doses  of  iodide  of  potas- 
aium,  togi-thrr  witli  the  uku  of  iiiaMUgu,  and  the  inunction  of  TCty 
hot  camphor  liniment. 


PHTHISIS:  ACUTE,  ou  Gallupinc  Consumition. 

LooMis  htw  iiotliiiig  fo  say  upon  this  head  except  that  hypo- 
dermics of  morphine,  gr.  ^<  prove  more  satif  factory  than  anything 
else  in  etuyitig  the  disease,  prolonging  life^aud  keeping  the  patient 
comfortable. 

NiKMEVKR  takuH  the  oairie  gloomy  view  of  the  prognuda. 
Ho  advises  large  dosQs  of  quinine  at  the  out^t,  and  at  a  later 
period,  digitalis,  nitre,  and  llie  mineral  acids.  For  tlio  dycpiiea, 
cold  is  tu  be  applied,  and  nai-coticx  are  to  be  used  for  the  coagh. 

McCall  Anderson  haa  reiwrted  some  enrea  of  this  diseaw. 
The  treatment  adoptwl  wa«  ufl  follows:  The  jmtient  was  fe«l  every 
boor  with  some  light  form  of  nourishment  Brandy  was  given  in 
moderate  quantities,  and  Htinnilating  expeeloninta  were  adroioift- 
ierwl  when  deemed  reqiiisito. 

The  high  fever  wax  tr(«tt>il  by  the  use  of  it^cd  cloths  to  the 
abdomen,  applied  as  follows:  The  nigbt-<lre9.4  is  pulled  well  ap 
over  the  chtwt  ho  an  to  a%'oid  any  {MwwibMity  of  its  being  wet,  and 
a  foldoii  blanket  is  placed  across  the  bed  under  the  patient's  body. 
The  bed-clothes  are  arranged  to  reach  only  to  the  lower  part  of  the 
'obest.  which  latter  is  covered  with  a  separate  blanket.  Two  pieced 
of  flatniel  arc  employed,  each  large  enough,  when  folded  Into  foor 
layoi-a.  to  cover  the  whole  of  the  front  ami  siiUat  of  the  abdomen. 
Ono  of  theae,  wrung  out  of  iced  water,  and  covered  with  a  piece 
of  dry  flnimel  to  prevent  the  bedding  from  lieing  wet,  ia  applied 
In  t]io  ubtlonien.  while  the  other  u  \e{t  in  a  large  basin  filled 


^tn 


I 


iced  water  at  the  side  of  the  bc<l.  The  flauiiela  are  elmiiged 
every  luiuute.  TbUcon  b«  iturii.'  with  the  greatest  ea^  ami  rapid- 
ity,  and  without  expaslng  the  patient  to  aiy  injiirioiw  extent. 
For  the  |)rofu§e  perspirations  he  ii.-**!!!  hypiKleriiiic  injections  of 

pine,  M*  **^  '  gniin.  repeated  ererj*  uigbl. 

Besides  the  appliimtion  of  iced  clotlin,  lie  made  ilic  of  Kic- 
mitrr's  pill,  composed  as  follows: 

B     Cjuinina>Hilph^. gr.  ss 

Digitalis  pulT^.. .  .•••,  i.> .■•••4..gr.  zx 

Opii  polv^ 

IpMML  pal*^ U  gr.  T 

U.  ft.  BDM.  el  In  |>n.  qol  XI.  illv. 

Sl~Ow  omwj  font  to  «igl)l  houn. 

To  those  who  do  not  believe  in  the  curability  of  tubercular 
it  may  be  etaid  that  all  cases  of  galloping  cotisumption 
are  not  tiil>ereiilnr.  "But  even  were  this  not  the  tnith,  the  very 
remarkable  case  reported  by  Sm  Spencer  Weils,  and  mentioned 
in  the  artiulo  upon  tiiliercular  peritonit.it;,  nhould  lead  us  to  doubt 
the  universal  iiicni-ability  of  these  afFeotions. 

In  one  ease  wo  have  had  an  opjiortniiity  of  putting  Anl'ER- 
aos's  syetem  to  the  test.  Unfortunately,  when  the  patient  came 
into  our  hands,  ehe  was  far  advanced  in  a  quick  consumption. 
For  three  weeks  she  had  been  unable  to  lie  down,  but  sat  in  a 
chair  with  her  head  on  a  bureau. 

Althongli  we  cannot  boaAt  of  a  cure  in  thia  case,  we  learned 
Icftmn  wo  have  never  forgotten,  in  the  greatncRs  of  the  relief 
which  followed  the  use  of  the  iced  jipplicationi*  to  the  abdomen. 
Until  the  day  she  diorl,  the  poor  young  girl  blesswl  the  remedy 
which  enabled  her  to  rest  quietly  in  her  bed  for  the  remainder 
of  her  life. 


2.     PimiTSTS:  CIIROXIC. 


Tlie  treatment  of  this  utlection  elalH^rattMl  by  that  great 
clinician,  Fklix  Voh  Xikmkvbh,  i«  so  mlmirablo  that  wo  shall  give 
it  entire,  in  biii  own  wonk  : 

**Thc  treatment  of  consumption  has  made  groat  advanceaaitwo 
the  recognition  of  the  lact  that  the  diHeaHedo[>ends,aaB  rule,  upon 
inflammatory  itction,  and  i><  only  now  and  then  duo  to  neoplasm. 
is  view  of  the  ca^  ha»  not  hd  to  the  introduction  of  any  new 


S46 


MANUAL  OF  TRBATMBST. 


remeilies  for  conflumptioii,  bnt  it  has  cnahlol  iii  more  definitdjr 
tn  establish  ind'u^tiorw  for  remodicw  already  long  in  use,  so  tiuit 
by  their  nietliodic-al  applicntion,  better  rwult/t  have  l>een  attaineil 
than  wero  formerly  gained  at  u  time  n-hen  consumption  and  cancer 
were  regarded  ai  e<]iialty  incurable,  and  were  somewhat  nimilartj 
treated. 

Pro/^A^Sur/s  against  con-suniptiori  rcc|uircs,  in  tbe  &nt  place^ 
that,  when  an  individual  HbowH  signs  of  defective  nntritioo  and  % 
feeble  foiiBtitution,  esjieinally  if  already  he  have  given  panitire 
evidence  of  nniisual  delicacy,  with  a  tendency  tn  dieeAsea  wiiich 
result  in  caseous  prodacte,  he  should  be  pUutd,  if  posaibU,  under 
infiuenees  -^Icnhted  to  invigorate  the  eoH^tution^  and  to  cctinguitk 
twh  morbid  tendency. 

Delicate  children,  eH{>ecia]1y  such  a«  are  bom  of  conaumptiv* 
or  otherwise  decrepit  parents,  should  not  bo  suckled  by  tbeir  ovm 
luothers;  Htill  lesa  ought  they  to  be  reared  artificially  on  "pap," 
but  should  be  confided  to  good  wet-miraea.  AfVer  weaning  the 
child,  let  ita  diet  consist  alniMt  excluiiivcly  of  cow*8  miUc,  ii]«tead 
of  the  cURtnmnry  pap  of  meal  or  bread,  and  atVer  it  is  done  teeth- 
ing let  it  eat  a  little  meat.  This  diet  must  be  kept  up  throughout 
the  whole  period  of  childhood,  whenever  there  is  any  indicaUon 
of  glandular  enlargenient,  moist  cutatieous  eruption,  or  any  other 
BO-called  scrofulous  aftectioii,  or  even  when  they  merely  give  evi- 
dence of  a  so-ciille<l  scniftdouw  hahit  It  is  betler  to  preiwribe  tho 
exact  amount  of  milk  the  child  must  take  (after  drinking  which 
it  may  cat  what  bread,  (KitatocM,  or  tho  like,  it  pitaiacrt),  than  merely 
to  warn  the  parent*  in  general  terras  against  the  immoderate  xxm  of 
braid  and  jKitatocA.  \Vlien  ttio  child  han  drunk  milk  enmigh,  the 
other  food  will  donohai-m.  The  common  direction,  that  a  "child 
sliall  not  cat  dry  food,"  i»  wrong.  It  i^  bett«r  tliat  it  Hhould  chew 
and  eat  ita  bread  dry,  so  that  the  starch  which  it  contain.-*  mar 
be  properly  combined  with  saliva,  whereby  it  is  more  thoroughly 
converted  into  sugar  and  is  easier  of  assimilation.  Bei>ide9  this, 
however,  it  will  drink  all  the  more  milk  if  it  cat  its  bread  plain. 
A  similar  plan  of  treatment  in  of  course  proper  for  children,  who, 
instead  of  inheriting,  have  acquirwl  a  feeblcncre  of  constitution 
which  oR«n  shows  itself  at  an  early  dote  in  tho  form  of  scrofula, 
and  oucasionn  a  prwlinpatition  to  coneumptinn. 


I 


fHTBIMB. 


MT 


A  proper  supplv  of  fresh  air  i»  of  eqiml  importance  with 
regiilalion  of  the  diet.  Tin'  (Hftn  iMlilin'e<l  above,  illufttrating  tlie 
beucful  effect  of  coutiiiual  in-door  life  iu  producing  scrofula  and 
consumption,  arc  not  sufBciently  tjiken  into  account  by  many 
pfajsiciaoB.  Tbcy  very  often  suffer  delicate,  sickly  children  t«  sit 
day  after  day  and  six  hourw  at  a  time  upon  the  benches  of  a 
crowded,  school-room,  after  which  they  liave  their  is^kn  at  homo 
to  prejwre,  private  leiwonK  to  tjiku,  the  i>iano  to  play,  etc.  Cod- 
liver  oil  and  an  occa.'iional  month  at  a  watering-place  i!amiot 
ponciibly  nrpair  the  injurious  ctre<;(M  of  finch  a  mode  of  life.  Aa 
Boou  as  the  iiiflueoce  of  this  immoderate  "whooling"  begins  to 
"tell,"  a  reduction  of  it,  or  even  a  total  ce«ftatiou  of  it,  should  bo 
imperatively  insieted  on.  Obstinate  opposition  to  such  dcmauda 
will  Ite  often  met  with,  but.  in  a  tH^ric^  of  instances  in  which  I  havd 
obtained  a  complete  and  prolonged  re^tpite  fmm  education,  and 
made  the  children  spend  most  of  their  time  iu  the  open  air,  I  ha\'o 
obtained  efiects  at  which  1  wa«  myself  Astonished,  and  which  com- 
pletely antiafied  their  parents  that  the  rosolte  fully  outweighed  the 
eeriourf  sacrificew  which  they  hml  made.  People  in  ea^y  cin.-iira- 
staace«,  who  have  delicate  and  scrofuloui;  children,  especially  if  sub- 
ject to  croup  and  bronchitis,  shnuld  be  inducotl  to  spcttd  their 
winters  in  the  South,  «o  ihat  the  children  may  also  pat«  thow 
montlis  in  the  o^ten  air,  which  in  our  elintate  would  be  too  cold. 
This  is  a  very  common  practioo  in  Ktia»^ia,  where  the  i>eniici<iua 
effects  of  indcmr  life  during  the  long  winter  are  very  cons]»icu(in8. 

In  adultti,  when  the  aigns  of  delicacy  and  woaknees,  combined 
witli  deterioration  of  the  blood,  ap{>ear,  the  uae  of  ferruginous 
proparationM  in  to  be  recommended,  particularly  the  chalybeate 
springs  of  Pyrmout,  Drihurg,  tinuau,  etc  I  think  lliat  this 
treatment  deserves  a  more  general  adoption,  aa  a  proidivlaotic 
measure  against  consumption,  than  it  hint  received  hitherto. 

Prophylactic  treatment  of  Ci-)ni«u  nipt  ion  further  demands  a 
careful  avoidance  of  all  agents  calculatc^l  to  cauisc  hyiH-rcinia  of 
the  Inngs  and  bnmchiaJ  catarrh,  and  which  we  have  etmmerated 
as  exciting  caTi«;*  of  phthiisis.  Persoits  in  whom  a  tendency  to 
consumption  is  rin.4f«fted,  should  be  strictly  forbidden  to  inhale 
an  atmosphere  charged  with  smoke  or  doat,  or  which  is  too  hot  or 
too  cold,  aG  well  as  to  make  groat  otlbrta  in  running,  flinging,  or 


HAHUAI.   OP   TIlKATMItirr. 


348 


dancing,  or  to  drink  }ii>t  or  spirituouii  beveragtie.  Cliillini;  of  the 
skiu  U  to  bo  guanlod  ogaiu^tt  witb  the  atmost  caro,  aad  the  potiimt 
sliould  iie  made  to  wtmr  tliuinol  iiexl  the  »kia.  What  we  liive 
Already  said  rcgardiDg  the  prophvlazU  against  pulmonary  by- 
pcrernia  und  tmmehml  (.-utarrli  is  etiuall^-  ajijiliuuble  iu  tLe  pR^ent 
iiiBtiuice. 

Filially,  n'hcuever  there  is  th«  slightest  sDspicton  of  u  pre- 
dieiKittitioii  to  coDBUmptioQ,  every  oatarrh,  no  matter  how  «Ugbl, 
18  to  be  treated  with  the  utmost  care,  which  is  not  to  be  relaxed 
until  the  catarrh  is  entirely  well.  Thi«  rule,  so  obviooa  from  oar 
point  of  view,  ix  very  frequently  violated.  Miiny  ]>atienta  lidl  ft 
victim  to  the  deeply-rooted  prejudice,  that  a  noglcctoii  catarrh 
never  leadti  to  con^uraption. 

The  rulM  which  wc  have  laid  down  for  tlie  prevention  of 
phthisia  must  be  carried  out  with  equal  3trietuca6,  whfther  Urn 
difieatte  tiaw  inervly  juat  eonimeni:iid,  or  whether  it  iilresiiy  have 
made  some  progrefie.  It  is  therefore  supei-fliioua  to  make  M]Hnite 
mention  of  the  indications  derived  from  the  caitse,  as  they  are 
identit-al  with  those  of  prophylaxia. 

When  the  air-veBieles  of  the  lung  become  involved  in  Uii 
bronchiH.]  cuturrh,  the  iridieatio  morbi  calls  for  the  tutiial  remedial 
applicable  to  chmnic  inflammation.     Above  all.  the  affeeted  hmg,^ 
like  iiiiy  other  inflamed  organ,  is  to  be  abieldod  from  the  neliooofH 
any  new  irritation.    It  ik  incredible  how  nnicb  tliia  siniple  ni1e(io 
obviouK  where  the  nature  of  phthUis  U  rightly  undenrtood)  t*^ 
disregardetl  by  many  phyi^icianti.    It  in  a  matter  of  daily  occor^V 
renoe  that  patients  from  the  better  cla88,  sufleriug  from  advanoed 
consumption,  are  not  sufticieiitly    urged    by    their   physician  to 
withdraw  from  their  occupation,  to  throw  up  their  [joaition  at  the 
counting-house  or  office,  and  to  keep  away  from  chth-rooraa,  with 
their  over-heated  and  tobacco-laden  atmosphere.     It  u  uftc*n  bv 
eipoeure  to  irril«nt«  like  the  aiwve,  whose  etle<:t  is  so  very  in- 
jurious to  the  inflamed  lung,  that  the  cxicnsiou  of  the  iuflamuuitory 
product  \i  aggravated  and  made  to  terminate  in  disorganization, 
while,  by  their  careful  avoidance,  the  diacase  ia  otlcu  promptly 
arroist4'd  and  brought  to  a  favorable  iw>ue.     Thi-  bciielicial  effect 
obtained  in  consumption,  by  protecting  the  atTeclcd  Imig  from 
further  dctrimout,  Ik  still  more  marked  among  the  poorer  claase^ 


I 

I 


piiTniBig. 


849 


wbo  seek  aid  at  the  hoMpitnlH.  Man^'  patients  are  received  in  a 
oondition  »o  wretcbtd  ihat  a  ajiewly  death  acema  lEam incut,  aod 
yet  tliey  leave  the  institution,  in  the  course  of  a  few  weeks  or 
months,  ill  much  stronger  and  better  coiidilion.  and  often  with  a 
tnaterial  incre-a-ie  in  weight.  Soon,  however,  they  retuni,  seeking 
readmission,  their  condition  haviug  grown  mpidly  worse  again, 
owing  to  inclemency  of  (lie  weather,  and  to  other  noxious 
induences,  to  which  tlicy  have  been  exposed. 

Were  it  not  for  the  very  grave  objections  already  detailed,  I 
should  conned  tnoit  consumptive  pnticnU  to  keep  the  house  during 
our  Northern  winter,  and  to  maintain  the  utmost  unifortnity  of 
teni[«rature  in  their  chamber,  in  order  to  preserve  their  lnntr»  fi-ora 
further  hanu.  ThU  dilemma  may  be  obviated  by  making  the 
patient  avoid  the  Xorthem  winter,  by  sending  him  to  Home  plaoe 
where  tie  can  H|>end  Iho  greater  part  of  the  day  in  the  ojMjn  air, 
without  risk  of  taking  cold,  or  of  inhaling  a  raw,  inclement  at- 
mosphere. This,  ill  tny  opiuiou,  is  the  real  benefit  derivable  fVom 
change  of  climate.  When  h  patient  hw  the  means,  we  should 
never  omit  to  ciyoiu  upon  him  to  make  the  Nicrifice,  but  the  matter 
mnKt  W  made  plain  to  him,  »o  that  he  may  not  suppoac  the  air  ot 
llic  place  to  which  he  la  sent  luis  any  special  ciiralive  power  upon 
hiB  InngB.  We  need  not  expect  any  benefit  from  a  residence  in 
NiK/Ji,  Mcntonc,  Pau,  Piaa,  Algiers,  Cairo,  or  Madeira,  unlcAn  tlio 
patient  fully  nndcrstnnd;;  that  he  must  lake  care  of  himeelf. 
Othenviee,  it  were  often  better  that  he  remained  at  homo.  Act- 
ing ui>f»n  thlrt  jirinciplc,  the  patient  should  Ih?  Rent  during  the 
autunui,  and  before  the  hnreh  winter  seta  in,  to  Soden,  Badon- 
weiler,  Wics-lMnb^n,  ami,  idMivt-  all,  t<»  the  lake  of  Geneva,  where 
be  may  try  the^rape-cure,  and  wliere  he  in  an  well  |>i*otccted  a^  ho 
is  nt  hciinv  during  tJie  nunmier.  ^(o^e  but  very  intelligent  and 
prudent  jKjrsons,  who  we  mnv  be  sure  will  i*tay  at  home  in  bad 
wtrother,  should  be  allowed  to  ajKinl  the  winter  at  Xizza,  .Montono, 
Piw,  or  I'au.  Wbcu  the  patients  have  the  means,  it  is  always 
better  to  eend  them  to  Algiers,  Cairo,  or  Madeira.  The  compara- 
tive merit  of  these  winter  abodee  is  not  an  yet  positively  deter- 
iQincd,  and  the  iudicntiona  for  preferring  Madeira,  Algiero,  or 
Cairo,  iu  particular  va^ee,  or  for  certain  stages  of  the  disease,  are 
BO  indefinite  as  to  be  of  little  value.    One  principle,  however. 


tso 


MAM'AL  OP  THEATMKKT. 


fllwavci  obtains:  that  tht p iUenl,u?hercrer he  may  U,  muHtthYdma^ 
speetty^  and  remain   under  the  charge  of  an  intdlujeni  and  j/rirt 

For  inatients  who  are  unable  to  seek  a  mililor  climate,  i!ie  xmt 
of  a  "res[nr»tor,"  nf  wire  ^uzc-,  waniiwl  by  the  brealb,  ibrongb 
wliifh  the  external  air  is  iiihalerl.  ie  adviimble.  A  Imiulkcrdiief 
held  before  the  iiioulh,  however, whiidi  also  io  stxin  wArraetl  brtbtt 
ex]>irc*d  air,  will  answer  the  eanie  purpose,  and.  imlciH].  is  really 
better  tJiaii  a  ''rwjiirator."  lus  it  \*  not,  like  the  latter,  liable  to 
hocomc  t«o  warm. 

Wlieii  the  iiu'asioii  of  ibe  air-vedides  by  acute  catarrh,  orth« 
rapid  epreaiiiiig  of  a  catarrhal  piiomnoiiia,  is  atvonipunied  by 
vioh'iit nympliiriis,  when  high  iWi-r  nets  in,  when  tht?  sputa  iMftoiM 
bloody,  and  the  pationt  cotDplains  of  Iniicionlitii^  paitt  upon  dnw- 
iDgbpealli,  and  npoii  coughing,  loml  dt-pletitm,  Ijy  moans  of  h-eche* 
oreup,  and  tho  application  of  oataplaenis,  should  h«»  re^iorted  ta 
At  the  same  time,  the  patient  must  be  reqairwl  to  keep  his  bed^ 
until  all  syinptomB  of  the  aimte  attaek.  or  of  ilie  exawrhntion  of 
the  old  inflamioatory  disonU-r  of  the  lung,  are  iiast.  Thofitsof 
ghivering,  which  forae  on  rtijidarly  every  evening,  in  rnniiy  cAjK* 
of  phtliiBi?,  and  which  !*ometimeg  actually  amount  to  rlgow,  hare 
often  hiwn  o])!=erved  to  eenAe  if  tlie  patiHit  reninin  in  InmI.  And, 
upon  closer  obBer\'ation,  it  ha.*  been  found  that  not  only  doea  the 
chill  which  heralds  the  evening  neca'w  of  fever,  but  all  t-he  otbar 
fehriU'  symptomn.  especially  the  rise  in  t^iiperature,  undergo' 
niarkinl  iinprovenient  while  the  [uitient  rcimiins  in  l»e<l  for  a  few 
day».  There  is  nothing  strange  abont  this,  if,  instead  of  regarding 
the  hectic  fever  of  consumptive:*  a*  somotliitig  jieouliar.  as  an  oi.* 
sxii  gfucris^wz  look  upnu  it  as  a  fever  due  to  chronic  in  flaimnation. 
The  fever  which  accompanies  bronchial  cutarrh,  inteumonta,  tw 
intlaininatioii  of  any  other  orgnn,  increases  and  diininishoa,  aa  the 
disMittC  gnwK  better  or  worse,  and  it  is  just  tlic  aaine  with  the 
hectic  fever  of  phthisia  Hence,  if  resting  in  bed,  euch  n<t  ire 
generally  rct^oumicnd  in  other  inthimnuitorx'  di»ordcrH,  have  a 
beneficial  effect  upon  the  pncumoni.i  of  (.imsuinjHivcs,  it  will  tend 
alio  to  mitigate  their  fevur. 

Tlie  Tise  f>f  the  alkaline  muriate  niineral  waierB,  whichjis  often 
so  beneficial  in  simple  <-]itarrh,  Ik  ©lually  UKeftil  in  oomc  casus  of" 


PUTHISIS. 


3«1 


consumption.  According  U)  our  view  of  tlie  discnse,  this  effect 
(whicli  cif  fourae  alt  believera  in  the  tlietirics  of  Ljjm*kc  will 
doty)  is  not  more  enigmatical  thun  thnt  which  th<«e  waters  pro* 
dace  u]joii  a  sim]>le  catarrhal  iuiiainiiiatioiK  which  docd  n<it  involve 
the  subetance  of  the  lung.  Tlic  idea  that  the  uae  of  the  waters 
of  Ems  aiitl  Oborealtzbrumier  is  contrainditaited  hy  thu  prwteiioe  of 
fever,  is  merelj  one  of  tho  rwulta  of  imperfect  olwerration.  It 
is  not  tlic  minomi  waters  which  dieagree  with  the  fcwr,  but  the 
jouroey  to  the  watering-place,  and  the  promenftdes  at  the  springs. 
A&  wc  have  said  before,  a  patient  with  any  appreciable  dcgi-ce  of 
lever  ought  to  be  tn  his  room  or  in  his  bed. 

A  conluined  abfxle  in  elevated  regioiw,  where,  without  any 
apparent  reason,  conRtimptioii  is  ntre,  is  also  advl^iable  for  con- 
9aniptive«,  when  their  diaeaae  depends  upon  chronic  [hic  union  in. 
I  fully  approve  nf  the  ciistomaiy  practice  nf  sending  phthisical 
patients  to  spend  their  sumiacr  at  Ilcideu,  Gais,  Wciiiahad,  Rruuth, 
etc.,  although  [  think  hut  little  of  tiie  "curds  and  whey  treat- 
Uieut"  which  is  practised  there. 

In  titberculoiiit  phthisi»,  aii<l  In  secondary  tuberculosis,  it  ie 
out  of  our  power  to  meet  the  indicatioiu  derive<l  from  the  dt^ciDW 
itself. 

Inrltcatio  St/mplomatiea. — Fevor  m  the  symptom  which  princi- 
pally domandg  treatment,  whenever  it  pentistji  at  nil  severely,  in 
spite  of  thu  remodiea  directed  against  the  aiain  disease.  Anti- 
pyreticB  very  pntperly  pUy  a.  mo«t  important  part  in  tho  thera- 
peusifi  of  oonMimption.  It  is  not  tliat  these  remcdieti  oxurt  any 
more  direct  intluence  ui>oii  clircmic  pncuinonin  than  they  do  upon 
croupoiw  pneuraonifl.  or  typhua,  or  upon  any  other  of  the  many 
maladtei*  in  which  they  arc  ao  mucli  jtrescribed,  often,  indeed, 
without  any  very  clear  idea  as  to  what  is  to  be  expected  of  them. 
But  if  M'e  know  tliut  the  dimrlmrge  of  niucu»  and  of  pns-cclls  has 
bat  little  to  do  with  the  exhaustion  of  the  patient  (indeed,  it  is 
oHen  far  more  pnifuiie  in  a  Eiiinplu  bronchial  catarrh),  and  that  the 
fever  is  really  his  most  formidable  enemy,  it  follows,  of  anirse, 
that  we  inii^t  use  evcr;t'  niciiiiH  ut  hand  of  comhaling  tliis  enemy. 

Digitalis  and  qninine  have  a  well-merited  reputation,  oa 
meoii!*  whereby  wu  often  suci-eed  in  arresting  the  abnormal  ealori- 
fication,  and  reducing  the  animal  hc<it,  in  spite  of  tho  coutinnatlon 


8A2 


KAKPAI.   OP  TR&AT1I£MT. 


i 


of  the  (lisease.  DigitalU  ie  the  principal  ingrwlient  of  the  much- 
employed  Hcim'B  pill.  {^.  piilv.  licrb.  digitalis  3  s&,  pulr.  rad. 
ipecac.,  pulv.  opi)  puri  aa.  gr.  v.,  pil.  no.  XX.  &.  a  pill  xhtet 
times  daily.)  fl 

Tb«  addition  of  a  scrapie  of  quinine  to  the  above  prescrip- 
tion bwomes  all  the  more  appropriate,  the  more  periodical  thp  type 
a^uroed  by  the  fever,  the  more  ecvcre  its  cveuiog  ezHtwrhaiiotis 
become,  and  the  raore  pronoatieed  the  ehilU  by  which  they  aio 
uahered  in.  I  am  so  innch  in  the  bnbit  of  iiaing  Heim'o  pill  with 
or  without  quinine,  in  eonsuraption,  whenever  the  fever  provw 
refractory  to  the  other  remedies  lieretofore  mentioned,  that  it  hu 
become  a  very  common  preaeription  at  my  clinic.  Now  and  thm, 
when  I  am  a  guoil  deal  cunRulted  by  phtliisiiral  patients,  I  prescriba 
it  tliree  or  four  times  in  one  day.  At  the  clinic,  eichibition  of  tha 
pills  is  BUfipendml  whi>iiev«r  h  di^tint^t  reduction  of  the  teropeia- 
ture  and  of  the  fretiuence  of  the  pulse  becomes  apparent,  and  it 
resumed  as  soon  as  the  eflect  sub^idea.  In  conaultation  practioi;, 
I  have  repeatedly  found  that  the  pntients  pretty  noon  leam  to 
judge  for  theniMelYe^  when  it  is  time  to  stop  the  pills,  and  wheu 
to  resume  them. 

The  subject  of  antipyretic  treatment  of  consumption  may, 
inth  great  propriety,  bo  immodintely  followed  by  that  of  the  diet 
of  pbthtsicftl  patientA,  for  the  ttame  reason  which  induced  ud  to 
treat  the  siibjeets  of  fever  and  emaciation  in  immediate  conjnno* 
ti(m.  A  nuin  wlm  haw  fever  which  w  i-apidly  consuming  him, 
ataude  in  far  greater  need  of  a  supply  of  nutriment  than  one  who 
has  no  fm'er.  The  fever  of  a  consumptive  patient  often  lasts  for 
monthtt,  8o  that  the  danger  that  it  will  wwir  him  out  is  gniiter  In 
hia  ea*e  than  in  one  of  acute  febrile  disenae  of  brief  duration. 
Hence  it  follows  that  phthisicjil  ]iiitient«  require  the  richest  joMihle 
diet  which  will  agree  with  them.  It  is  olteu  said,  bat  without 
any  proof  wlnitever,  that  food  excites  tlie  fever,  and  (inde[«ndently 
of  the  English  [iraetice)  even  here  (in  Germany)  we  only  keep  a 
patient  on  fever-<ii(>t. — tluit  iw,  we  only  deprive  him  of  nourishing 
fooil  until  it  becomes  evidently  dangei-ous  to  jwrsis'.  in  so  doing.  ■ 
A»  i^oon  H.1  thit<  U  evidtrnt,  the  so-called  law  of  nutrition  in  utleriy  1 
ignored,  or  rather,  it  is  flagrantly  violated.  In  selecting  suitable 
nouri»hmerit  for  connumptivv^,  articles  comTuended,  time  out  of j 


1 


puruisis. 


8&S 


mint!,  hy  rude  cx|)erieiicu,  arc  found  to  be  in  complete  agrecmcut 
■with  the  eiirreiit  physinlogiml  laws  of  assimilation  and  ntitrition. 
All  lliu  food  which  ii*  ivgiirdwl  an  cajioclallv  |iro[»LT  for  phthiiiical 
patientA  contains  large  quantities  of  lat  or  of  fat-generating 
niattvr,  and  a  cun)[iurntivu1y  Hiuidl  )>ortion  of  proteiu  itulistiuiooft. 
Thia  aci^onlfl  with  our  experit-iice,  that  the  pi-oduction  of  urea, 
and  hcucu  the  dcetructivo  aadimilation  of  Ditrogencoud  con^titucnte^ 
is  augmentod  by  an  increase  of  tlio  supply  of  protein  substanccB, 
while,  by  a  eimultoneoiw  fi-ee  sapply  of  fat  or  fattcDing  footi,  tho 
destructive  nssimllation  and  coni^uiuption  of  the  or^ns  of  moat 
importance  in  the  l<(«Iy  are  diniinifhe*!.  Thuw  the  ueo  of  milk, 
to  which  little  children  owe  the  planipne*>8  of  (heir  limbs,  and 
from  which  cor[iuIcnt  persons  do  well  tn  ulwtain,  cannot  bo  suf- 
ficiently urged  upon  consumptive  pcrfsniis.  It  ia  altogether  ueelese, 
huwtiver,  and  iiid»Hl  wrong,  to  minove  Llie  casein  of  the  milk, 
and  to  give  it  iu  the  form  of  witey,  unle««,  indeed,  the  whey 
ai^ree  with  the  iiutit-nt  bc1t«r  than  milk,  whii-h  is  mroly  the  case. 
I  often  order  my  patients  to  drink  a  pint  of  milk, "warm  from 
the  cow,"  thi-eo  timeK  a  day,  but  have  no  other  ubjcct  in  so  doin^ 
than  that  of  preventing  the  milk  from  being  gkimme<l,  which  is 
impOBsihle  inmiwliately  after  milking.  The  milk  of  animaU 
whidi  pasturo  in  the  mountains,  >i\xv\\  an  goat'ii  milk,  butatjove 
r1I,  hsm's  milk,  ta  in  especial  repute,  and  it  is  desirable  tn  eond 
patients  who  can  travel  without  danger,  to  plac««  where  there 
BJV  dairies  where  a  supjily  of  good  fivsh  milk  ut  to  be  obtniiiocL 
AVliere  this  cannot  bo  done,  the  "milk-cure"  must  be  practiaed  at 
home.  The  niinic  i»  of  importaiic«>,  in  order  tlmt  the  patients 
may  have  faith  iti  the  ti'catment,  and  follow  it  ont  punctually.  I 
have  tiTalod  a  great  number  of  patients  who,  as  socm  us  they 
fomid  that  they  increased  appreciably  in  weight,  for  half  a  year 
at  a  time  drank  three  or  four  pinttt  of  milk  daily  without  repug- 
nance. 

The  use  of  cod-Uver  oil  is  also  highly  commendable,  and, 
when  it  agrros  well  with  tho  patient,  may  be  combined  with 
plenty  of  mdk.  It  is  more  thitn  doubtful  whether  this  oil,  which 
is  hardly  ever  withheld  in  phthisis,  at  all  events  in  Uerinaiiy, 
exerte  any  si>ecllic  influvnue  ujion  the  disease.  Tlie  quantity  of 
iodine  in  it  is  mi  iritling  that  is  cannot  be  taken  into  account^ 


354 


HANUAl.  or   TREiTNENT. 


3ionoe  it  ia  prolwlile  tliat  all  U.t  licncliciiil  vfFcctdt  are  solely  due  tO' 
the  large  amoiini  nf  fat  which  it  nflbrds.  This  Is  all  thu  moreJ 
likely,  as  dog's  fat  is  a  popular  rcmoJy  for  cxjimiimption,  as  ancient ' 
and  well-tried  a»  c(>iI-Hver  oil. 

or  late  years  I  have  nbtalnml  very  gooil  etfcutii  from  aa  ex- 
tract of  malt,  prfparwl  hy  Trommkh.  Thia  prei«ration  of  Tbom-i 
MBR  w  not  a  titiYnig  beor,  coiituiniiig  a  largo  aiiioinit  of  alvotml  and 
carbonic  acid,  like  the  Hoff's  malt  extract  bo  greatly  extolled, 
"but  in  a  genuine  extni<!t  nisenililing  oilier  nflipiiml  exlnu-U,  and 
consists  of  the  soluble  coiistitueiits  of  the  malt,  and  of  the  bitter 
extractive  matter  of  the  hoiw,  and  can  be  prepared  by  every 
apothecary.  One  luindrt'd  parts  of  it  contain  about  geventy-«i 
part«  of  grajie  sugar,  or  malt  sugar,  dextrin,  hitter  of  hops,  reain 
of  hops,  and  laiirdn,  .seven  parts  of  albuminous  or  protein  aalv 
gtancc,  eighty-two  hniidredtha  of  a  part  of  pho:tphalc  of  limeand 
magiiegia,  eighteen  hundredths  of  alkaline  salti*,  and  sixteen  {uris 
of  water.  The  fiatieiiti*  almost  always  enjoy  two  or  tliree  lable- 
Bpoonfuls  of  it  daily,  and  it  usually  agrees  well  with  tJietn.  It 
may  be  diluted  in  spring-water,  mineral-water,  or  wann  milk  or 
Other  liquid. 

IJroLh,  made  of  eoantcly-brokcn  rye-meal,  which  contains  a 
good  deal  of  gluten,  bolide  the  starch,  is  a  gwnl  food  for  cou- 
Bumptiven,  and  han  long  enjoyvd  ttuuh  a  reptitatioii.  Soup  of 
lentils  and  bean-meal  (revaleuta  arabica),  aa  well  as  the  vanotts 
preparation:*  of  choeolate,  mixed  with  eaeao-mcal,  and  eold  andar 
variout*  names,  is  alM>  appropriate. 

Jellies  of  animal  or  vegetable  Nulwtant-ai  are  much  len  dMir* 
ftble,  Riich  aa  the  snail-soup,  and  the  jelly  from  the  Iceland  moes. 

"With  respect  to  the  e-ymptomatic  treatment  of  the  cough  and 
cxpcctoratiou,  wo  simply  refer  to  what  lias  already  been  eaid 
rcgttirding  tlie  treatment  of  bronchial  catarrh.     An  indiwriminate 
u,*e,  one  after  another,  of  the  so-called  expectorants,  is  as  absurd  in   M 
the  trctttmont  of  llie  ehmnic  bronchial  eatarrh  which  nceomi>aniM    ■ 
phthittis  as  it  is  in  any  other  form  of  <-atarrh.    Tlie  sweet,  rancil- 
aginoui),  ^Hooiiung,"  denmlcent  iirtioltu!  are  least  serviL-eable  of  al).  I 
Preoini'ly    aeeonling   to  the  conditions    laid    down    above,    thn 
alkaline  chlorides  may  l>e  re^iuiredat  one  time,at  another  Mnega, 
squilb,  or  other  stimulants  may  be  indicated,  and  at  still  another 


rRTnisi'S. 


S$5 


the  aritclctt  ivhich  <liniini«h  (Mxrcnon.  A«  we  have  aIrcad,T  ex- 
preeae"!  our  preferwii-e  Inr  llie  Imtsanw  ami  renins  I'or  tlie  latter 
pur|Ki«o,  I  riiuiit  Hjfiiiii  ^-  a  word  or  two  in  fuvor  of  Bacohamm 
myrrhs,  an<l  of  Gnflith's  mixture,  adding,  however,  iJiat  acetate 
of  lead  is  held  iti  great  esteem  hy  iiiiuiy  autlioi-ities  tks  a  remedy 
for  tlic  condition  in  (luestion.  (In  almwt  avory  <»**  where  acetate 
of  lead  is  MH-A  it  is  given  in  combination  with  opium,  to  which 
Bome  of  the  efiect  attributed  to  the  k-ad  is  eertfuiily  due) 

The  nan-otica  are  to  be  en)]»Ioyed  hi  oi-der  to  allay  the  coagb, 
aod  are  <iuite  indiMpeii^hle  in  con.'tumption.  Ai<  we  have  iaid 
alnnidy,  it  in  not  the  soothing,  sojioriSo  action  of  the  flntt  few 
doses  of  the  opium  or  morphine  which  gratifieii  the  [latlente.  but 
it  ift  iMxamse  ihcy  find  that  they  cough  le**  and  moreeasily.  "that 
their  cough  is  looser;"  and,  indeeii.  when  we  (consider  that  cough- 
ing ii*  an  irritant  to  the  bronchia!  mucous  membrane,  wlitch  i»  the 
principal  source  of  the  secretion,  it  seems  quite  pn.>hal>Ie  that  a 
diminution  of  the  uicVmation  to  cough  may  result  in  a  decrease  of 
the  exfiectomtion.  Nevertheless,  it  in  best  not  to  commence  using 
the  mircolics  too  wwn,  and,  instead  of  opium,  we  should  begin 
witli  email  doses  of  something  else,  as  extract  of  lactiicaria  virosa, 
gr.  m  lo  gr.  j,  in  powder,  or  in  the  form  of  a  syrup.  By  a  too 
early  report  to  narcotic*,  it  uiny  liitp|K!n  that  they  fail  of  efiect  at 
a  later  ])«riml,  when  the  need  for  them  ha«  liw-omt!  mo«t  urgent, 
as  when  the  tormenting  cough  of  a  laryngeftl  phthi^tH  deprives  the 
patient  of  rout  both  by  night  and  by  day.  It  M-ems  also,  that,  oe 
soon  aa  it  beoome»j  neMSsaiy  to  give  lai-ge  doses  of  opium,  the 
progress  of  the  consumption  becomes  more  rapid,  an  additional 
reosou  against  a  too  Imety  employment  of  a  remedy  which  becomes 
lDdi:;peiisable  to  the  patient.  A\Ticn  the  narcoties  are  not  tolerated 
by  the  stomach,  they  must  be  iiyeeted  suWutanoously. 

Tor  the  night^weata  we  may  order  flmall  doaoe  of  "Haller'a 
acid,"  or  the  pftticiit  may  drink  n  cup  of  cold  rtJigwlea,  iftheauti- 
pyrotic  troatmont  faiU  to  do  good.  The  efficacy  of  the  above 
articles  w  wnnewliat  tpioptionnble,  no  doubt,  but  it  would  be  cruel 
to  tell  tlie  patient  that  there  are  no  meauH  of  relief  from  this  dis- 
treasing  symptom.  Home  phyHieinns  ro(!ominend  tlie  boletus  laricin 
(a  very  imwtfe  article),  ns  a  moat  etHoiout  remaly  against  tho  night- 
sweats  of  cuiisumption. 


866 


■U^rCAI.  OF  TRKATJI-EJBT. 


■VVoODBtjJiY  eavB  that  the  beet  combiimtion,  where  the  expec- 
toration is  Bointy  mid  the  ev>«gli  8|tasmodiL\  i^  the  morphine  wnl 
ipecacuanha  U>z«iigti  (c-ontaiuing  only  the  tortioth  of  a  gi-atu  of 
morphine),  using  throe  or  four  in  Ibe  coiiree  of  the  day.  Trocha 
of  codeine  nt\?  u.-u^fti]  in  |iiipoxjsnmI  coughing.  Where  tlie  cough 
U  lootfo  and  broncho  it  boa  exist)?,  fluid  extract  of  ci^t  iti  dw-idoJ 
doncs  fiometiines  aetH  well,  both  directly  upou  the  veeseta  of  the 
mueous  memhrane,  mid  indirectly  upon  the  heart  wnd  circulation. 
The  Htcum  atomizei  may  ft]a<i  he  used  om-c  daily,  with  litue-water 
and  lelladouno  (gr.  j  to  I  iv),  or,  if  the  Hecretions  be  fetid,  with 
eolutionft  of  i-arholic  or  salicylic  acid,  thjTuoI,  or  benzoate  of 
«idium;  and  where  the  catarrhal  condition  i«  niiirked,nmcdit"at«l 
water  of  volatile  oil  of  ciicalyijtns,  or  eoni|>ouiid  liiiflure  of  Iwri- 
zoin,  1iLr]^eiitino,  or  iodine  can  be  siihiittitntcd.  Of  the  nSnal 
inhftleiT*  {uscil  through  a  7v.*pirafiirr  or  on  a  liand kerchief),  lite 
priiicii'iil  one  is  emjdiaiically  cUoroform  ;  but  it  lihould  be  con- 
trolled by  the  physi(-ian  liimHelf.  This  ha»  yielded  so  much  tvlief 
that  a  few  yeaitt  ago  It  wa«  lauded  as  ciinitive,  and  even  unw  ii 
believed  to  be  the  basis  of  u  |M>pulur  and  profitable  ozone  eure  for 
consumption.  A  iiiixtnre  of  ether  and  rtiu-de-Odngae  {oiio  |i«rt 
to  four)  may  bo  ^iven  to  patients  to  inhale  in  tlio  inten'ula,  if  the 
cough  he  spasnindic  and  weverc.  Imline  and  cartnilic  acid  fon»t  to 
tlirt'*-').  droj.ix-d  on  some  absorbent  cotton  alrvady  iuipn'-ginUud 
wirh  the  oil  of  nutmeg,  \«  rionictinnin  efficient,  the  vapor  being 
inhaled  once  or  twice  daily,  for  ten  or  fifteen  minutes  at  a  time, 

Wliei-e  a  cough  remedy  is  require*!,  he  prefers  attopill6, 
hyomyniniM,  op  hydrocyanic  acid  combinalious,  dihtml,  with  bro- 
mide of  anitnoniuin,  sodium,  or  jiotiueium,  ac^cording  to  circum- 
Btances.  Where  there  in  a  constant  luu-king  oongli,  the  bronudo 
of  potassiuxa  acts  magically,  but  u  too  depressing  for  coiiHtiint 
use.  Where  it  is  safe  to  use  opium,a  combination,  intro^luced  by 
Da  (^sta,  of  deodorized  tincture  of  opium  (gtt.  iy-v),  dilute 
Bulphurif  acid  ("ly-iij),  and  syrup  of  wild  cherry  (  5i-ij),  18 
pleowuil  and  very  efficient.  Tho  infusion  of  pruuus  Virginlana, 
properly  made,  is  a  good  antispusmodic  and,  at  tlie  fiame  time, 
tonic,  and  was  formerly  m^ed  in  consumption  much  oioro  than  it 
is  at  preiient.  The  lycopus  Virginica  intu!<ion  (f  Ssr  to  OJ)  en* 
joyed  a  high  reputation  at  a  former  period  in  the  ti-eatnieut  of 


FHTQIS16. 


8o7 


oonsiimption.  a.  wiiioglassful  Ix-ing  taken  tlirce  nr  lonrtimcsa  dny. 
The  fluid  I'xlract  imiy  Xtv  um;t\  iti  ilow*  ot"  t'roui  ciglit  to  tliirtj 
minima,  to  be  gradually  incrcflM:«l ;  but  the  recent  infueion  is  the 
be^t  iiictluHl  of  mlininiHtmtioii.  TIuh  reiiitKly  rtcciun  aUu  to  linve 
fallen  into  iindeieire.!  neglect.  Cases  tliat  bave  been  recorded 
HitUfiititorily  wtablinh  il»  gtKid  efi'M'ta  wben  iiitcd  iit  cniijuiic'tion 
with  |ir»>per  hygienic  care  of  tlie  patient. 

When  the  laryirx  is  ntlucttKl,  it.  »p|K.iLi-ft  irritated  and  MWnllen 
by  the  constant  efforta  At  coughing,  and  often  displays  ulcers, 
which  lire  usually  KCcondury,  atid  not  t uLcrcuIouit.  Much  rcliof 
M'itl  be  obtaincfl  by  habitually  i^-itmiiiiiig  the  E>)>elU  of  coughing; 
by  local  triMtnitrit  (cpravis  of  liiiie-ivaU;r,  etc.,  ov  uppUcationa  of 
iodoform  in  ether,  etc.)  gargles  of  weak  adtringentA,  or  lemonade 
coni.-iiiiiiig  white  of  egg;  or  by  demulcent  Iowiigo«{nuirihmalli»w, 
or  cliloi-ate  of  pfota^)),  etc.}  allowed  to  dissolve  bIowIv  in  the 
mouth.  Local  npplieatious  to  the  hirynx  arv  often  of  great  ser- 
vice, efijMjciiilly  in  tubercular  ulccnition.  In  men,  allowing  the 
Ijcard  to  grow  wmctirnc'^  grenily  relieve-'  ilic  tliiMat  iconble. 

J\iiji«  t«  the  rheM  may  lie  dissipated  by  liniments,  such  aa 
turjicntiiie,  vamiihomliHl  oil.chtnnil  in  Honi>litiiiucnt  (  is»  in  $vj). 
TIic  mild  continued  counter-irritant  eflcci  obtained  by  a  lictla- 
diuitiii  or  jKuiuiH  ptui«tvr  itt  a\M  valuable.  The  Aub^tcrtiitl  tender* 
uo^  and  sorenese  of  the  abilotninal  tnii»clcs  may  b«  obviated  tn 
Qonie  extent  by  lying  U|ion  t\w  front  of  the  biidy  and  alUjwingthe 
bead  to  bang  over  the  hiileilnring  the  moriiiiig  spell  of  expeclom- 
tion  and  coughing.  .\  Huiniel  batidagecon»tiiully  worn  around  the 
vai^t  B  inctimc*  afioisls  a  relief  not  to  be  obtained  by  drugs. 
The  i*cdativc  cflcct  of  thi*  constant  galvanic  current  will  not  only 
often  relieve  the  local  syinptomi",  but  aliw  atl"c*ct  thy  general  i>y8tem 
very  fttvorobly. 

Ilnnnj^f/sis  requires  rwt  in  bed.  ice  to  tlie  chest  (thirty  mih- 
utca  un  and  lijtccn  niiuutvi^  otl').  and  the  iuteniul  adiniiiii4tnition 
of  er^ot,  ipecacuanha,  acetate  of  lend,  or  gallic  acid.  Tincture 
of  iron,  or  Mniiacl's  solution  gi-eatly  diluted,  in  urgent  chsch.  \» 
reconiinendc'l  to  l>c  utHtl  in  the  band  or  ntcani  nl.4)nii/.i-r:  but  this 
excites  cough.  If  the  hemorrhage  be  serious,  ergot  or  ether  given 
fay|HHlennically  may  clurk  it,  aw  in  iK>Kt-parlurn  bletfliiig. 

Dyspnea,  or  air-Aitntfer,  when  it  indicator nnover-iiccuniuhition 


868 


MANUAL  or  TItRATMBNT. 


of  HetTPtuinB  ill  Ihc  tungs,  nml  (wpcciiilly  i  I' I'niphTspiiin  bo  pmwnt, 
may  W  *iuicklv  rcl'ievod  by  an  emetic  liku  i|iwafuaiibo,  whick 
lian  (?«iterial  mlvant«ges  In  pnlnionarj'  engorp^'nient,  (ir  by  tba 
yellow  Hijl|ilmtc'  of  mercury,  cir  by  ai>om"P])biiiy  given  hyiwdur- 
mically  (gr.  J). when  a  quick  ettK-t  U  (lesiitHl.  Wlipn  the  brpstb- 
iiig  ttipttojty  of  tbo  Imipi  is  greatly  rwluc«l.b»haUtiai»s  of  oxygen 
have  j>rr»veil  Iiighly  sen'iopalilc.  When  thr  liuigw  nit?  chnkwl  with 
catarrhal  or  lufliininuuory  pn>diicl«  tbat  uro  tt-tiaciour-  and  uu[h»- 
aaleil,  tlir  ijsi-  of  ammonium  chloride  in  twenty  gmin  doNM, 
frequently  re|icQt»tl.  or  given  in  Mnallcr  «lo^*  with  tbt  iodide  of 
aniniouitirn  t>r  j>otansiiini  yinlilst  remarkable  re»iilt«.  Thev  an 
comiift>iily  given  in  the  comitoinnl  liiiiioricc  mixture,  In  wbivli  tbe 
oyrup  of  wmgH  or  tincture  of  i|iefncu»nha  i*  often  acltli.it.  As 
tbe  (l_v[*]iiieu  may  be  due  (o  pleurisy  or  euapbyw^ma,  Uii*  i-hwl 
slioiild  be  cxaminetl  to  determine  any  physicii!  cauw;  tliat  periiafB 
uuiy  admit  of  removal.  Strapping  tbe  ubest  with  adhesive  planter 
wiU  Komctimes  aftbrd  great  relief  from  pleurodynia. 

Coti(j£stioits  cf  tfic  luii;f-^,  oii-urrinc  tin  Jdonly  in  ihe  course  of 
the  diseaiie,  require  rest,  dry'OUpS,  and  counter-irritation,  Aa 
they  generally  prooede  hemoptysis,  the  measuree  adapted  to  thi 
latter  will  often  need  to  be  called  into  requisition.  Chrc-nie  eon- 
Bolidation  of  a  cijxrumscribed  I'ortion  of  the  lung  is  often  bcDctit«l 
by  a  Bucecesiou  of  email  blisters,  whieh  may  be  conTOuiently 
made  by  the  appHeatioit  of  cjtiitliaridal  collodion.  In  all  foriusof 
cbronie  bronchial  diitonsc,  the  u^  of  inunCtiODS  "f  eoennnut  oil, 
walnut  oil,  sweet  oil,  lanl,  or  Kimilar  nubf^taiiL'L-s,  will  improve  the 
nutrition  and  roliovo  the  congestion  of  the  muenus  lining  of  the 
air-imiKSHges.  Ini-hildrtiri,ood-HveroUmay  hetliusadmiiittitered, 
applying  it  at  night,  and  eovcring  the  ehest  with  cotton-wool  or 
flaunt-l,  or  an  oiling  mity  he  madt>  after  the  moming  hatli  la  the 
whole  skin,  and  the  child  wrapped  up  loosely  in  a  hlankot  for  n 
hall-hour  or  w>.  In  thiH  way  a  eoiwidemble  amount  of  tlie  oil 
may  be  «b*orlK»d. 

Where  there  in  some  cardiac  h>-pertrophy,  the  use  of  tbe 
bromide  of  pota^aium  (especially  with  chloral  or  morphine,  in 
order  to  induce  sleep)  i»  serviceable.  When  the  heart  is  weak 
and  the  circulation  languid, a  cardiac  tonic  like  digitalis, 'luinino, 
boldo,  or  viflcum  album  will  pr»^re  neeessary ;  butvoratrura  viride 


niTDlSIS. 


S6» 


will  be  rcK^iiireil  if  hvjicTtnijiliy  Iw  iimrkwl.  Iti.s  in  the  cotidition 
of  fnilitig  cii-L-utiittcit  timt  a  »imill  iiimMint  nf  aU>iho1  in  a  hot 
drink  is  often  ol"  grwit  wjiricf.  Alcohol  is  really  roiitm-indifalwi 
ill  iilithi^if*  imlnu'imlis.  a-i  lur  ua  llit;  etaU:  uf  thu  ivn]>imtor>  ap- 
paratus is  L-one«me(l ;  but  t^mall  nimmnte  given  giianludly  may 
vicid  more  tlmii  a  Ivnipomry  lieiiofit  from  tlieir  uvtion  upon  th& 
stomach  and  heart.  Prol)ably  the  best  (because  mont  lueting) 
stimulnnt  for  tliusc  caiWM  iit  the  fluid  extract  oi'coca(  5)^)i  which 
lironiptl.r  exert«  a  marked  eftect.  A  bowl  ol'  meat-broth,  of 
houiUoitt  or  of  hot  eoficc  (vontaining  an  egg  beaten  ii])  with  creani)^ 
or  even  a  cujt  of  tea.  is  often  much  more  acrriceable  to  the  patient 
Uioit  hot  whij^kcy.  Wlicn  a  |mticnt  foelts  chilly,  exerciac  in  the 
ojien  ail-,  on  horseback,  or  walking,  will  often  quickly  restore  him 
to  warmth  when  a  hot  lire  and  oxtra  clothing  fail  to  make  him 
twnfortablc.  Food  ami  exercise  in  the  fresh  air  are  physiolopcsl 
flttmulantB  to  the  heart  and  circulation  that  dciservo  the  highest 
appretriation,  and  Ihls  fact  is  well  recognized  in  the  various  rcsortA 
f<»r  the  out-<)f-<ii>nr  treatment  of  phthiBis,  Where  the  heart  is 
weuk  and  irregular,  tlie  use  of  digitalis  in  combination  with 
quinine  and  a  small  amount  of  opium,  in  tJie  form  so  liighly 
pmitied  by  Xiemkyer,  has  ittooil  the  test  of  experionce;  but  in  all 
wich  cases  it  is  importaut  to  hear  in  mind  that  uninterrupted  rest 
of  sevMi  or  eight  hours  n1  night  \a  n  Iwlter  gtniend  timii-  than  any 
remocly  in  the  Pharmacopceia. 

Fin:cr. — Qiiinino  ia  sometimes  eervieealdc  in  tho  hectic,  or 
more  properly  soptie,  fevor  of  chronic  pulmonary  inflammation, 
but  often  faiU.  He  hat!  nion.>  faith  in  saltoln  (gr.  xx),  g^vcn  at 
\eaft  two  hount  l>efore  tho  on»ct,  wldrh  HiinictimeB  actx  like  a 
cliam),  88  it  greatly  rmhicett  the  fever,  and  make^i  the  jintientniuch 
luiire  com  fori  able.  It  should  be  the  rule  that,  while  the  fever  is 
on.  the  patient  should  lie  down,  and  not  l»e  allowed  to  xit  up  until 
it  hiu  passed.  Ah  the  hectic  is  symptomatic  of  chronic  intlam' 
mation  of  the  lung,  mid  adeu  of  twptic  poidoning,  it  admits  of 
[lalliation  nither  than  cure,  unleas,  indeed,  wo  succeed  in  ulti- 
mately removing  the  cauw;.  If  tliene  he  much  discomfort.  Spong- 
ing the  MOrface  of  the  b™ly  with  bay  rum  or  vinegar  and  water 
is  often  practised  :  either  hot  or  i:o]d  Mjtonging  may  be  IriwI.  By 
reducing  tJie  febrile  action,  tlic  same  remedies  are  prophylactic  aa 
roganlfl  sweating. 


860 


MANOAI.  OF  TaSATUBNT. 


Nighi'Swtata. — Of  nil  the  peiiie^liw  fm-  the  trPHttiieiit  of  tlw 
exbaostiiig  iiigbt-awi>aU  of  t-onsuniption,  atrapine  siaiuU  »t  the 
"head  of  the  list  for  efficienoy.  It  may  bu  given,  nn  reoomnicinlLii 
by  Da  Costa,  in  u  single  dose  nt  IxHltime  (gr.  oiie-Atxiielh  to 
one-eightieth),  or  in  snuilbr  iltme»  thruugh  the  day,  as  prvfcmd 
by  BARTitoLow.  Unfortunntcly,  it  greatly  increiuies  thiral,  anil 
pvcfi   the   imiient    a  part-lic*!  tliroat  in  tla-  mnmiug,  to  rumodr 

''irhich  its  (wmhitiatioii  with  ergot  or  jaborandi  has  Iteen  recmn- 
mcadct].  The  aromatio  nulphiirio  acid,  m  doecd  of  from  t«n  to 
twenty  drops*  i»  also  qaite  efBcient;  bo  is  tiie  oxtilc  of  zinc[gT. 
ij-iij  in  |iilt),  given  at  bedtime  ^riiM-arinciind  ])by^<rMtigniA  have 
also  been  ueod  with  good  n^^iiltA.  Tiie  hj-iKiilcruiiir  injei;li<Mi  of 
homatxopino  (.015  gm.)  has  recently  been  highly  laadvil  bj 
FR.f>XMuLLi:B;  and  the  inlenial  adiilinistration  of  fpgotiiK-  •T  fluitl 
exti-act  oi"  ergot  bin*  lately  Ifc-cn  ingtHl  in  ttoveral  quarters;  but  all 

[epecific  medication  will  be  of  but  temporary  benefit,  tinl«6s  4vm 
itioti  be  paid  io  tlio  bed,  ventilation,  the  clothing,  and  other 
liy^«nic  pointH  to  be  considered  farther  on.  Tho  atldition  of 
altim,  or  alcohol,  or  sco-salt,  in  the  daily  sponge-bath  will  grcntlf 
roduce  the  tendency  to  pei^pinition.  which  has  b«en  \vell  calM  ii 
"leaky  condition  of  the  skin.."  This  condition  may  Ixj  to  wm* 
«)ttoul  eorrect4Hl  by  sponging  the  surface  with  hot  water  at  bod- 
tUue. 

Diet, — ^Tlie  food  of  the  consiiniptive  ia  of  primary  import- 
ance. Core  must  be  taken  to  tec  thai  it  is  a  fomi  eaay  of  oicHmi- 
lation,  and  that  it  is  miflicient  in  ninount.  T(h>  nrt^-in  the  "flick 
one's  sickly  appvtite"  ia  satisfied  with  a  cup  of  tea  or  the  luiui- 
ntum  q^nantity  of  foo«l.  Such  inviilids  rarely  iisk  for  food,  and 
therefore  ruquire  pmviaion  t«>  be  made  by  otlier^.  On  account  of 
the  common  wicxistonce  of  Htomaeh  di»i>rder,  or  gastric  cataniu 
the  aanie  care  is  required  in  regard  to  etarvhy  articles  that  t/a^ily 
undergo  fermentation,  aa  in  ordinary  dyspepsia.  So  linportant  is 
this  point  considered  that  Salisbury  has  made  it  the  ba^ls  of  > 
treatment  of  conEumption*  tlic  auceoM  of  which  in  nutny  cawe 
cAtmot  be  denied:  wlicthor  it«^  fiucces^  likewise  ««tablii!he«  the 
truth  of  his  (lK«>ry  of  the  cause  of  consumption  w  unniliur  ques- 
tion. It  h  certain  that  yases  can  recover  wiOiont  reatriftinn  from 
utMfchy  food;  and  it  is  |)ro!iiible  that  a  diet  cNuitaiuing  nitrogen  lu 


^Hoeea  may  injure  the  kuhieyn  ami  Iiv«r.  or  at  least  hiteriere  with 
their  functions.  Wliere  there  is  a  ilwidcl  tendency  to  diarrhea, 
boiled  niilk  is  the  heet  article  of  fmni,  and  a  ntrict  mitk  diet  may 
he  teniixirurily  resorted  to.  Of  nil  the  forms  of  uiilk  where  tl>c 
digestive  tract  is  in  a  weak  and  irritjiblo  cnmliiion,  that  known  as 
"koumyae,"  or  milk-wiue  is  of  the  grcalcMt  ser^'ice,  and  umiiy 
conBumptives  date  the  Iwginninp  of  their  impmvement  from  its 
Uise.  Kxtmct  of  nudt.  llie  hy|io]>ho«i»hites,  the  eomjiound  syrup 
of  tJie  jihfMphates  of  lime,  ii-<"»n,  iwilinra.  ami  irf>tafiBiam  (Parriah'a 
chemical  food),  are  each  sorviceable  as  additions  to  the  ordinikry 
food ;  but  the  a*ldit  ion  of  Btrychzune  to  the  syrup  of  tlie  phoepbatea 
{gr.  j  to  3vj)  fjreatly  iucroajwe  its  value.  Boef-essonce,  m  Uitually 
prepared,  in  simply  a  iiervo-iiiusoiilar  atimulant;  hut  when  eoin- 
hiiied  with  an  egg,  a»  Ixmilivii,  it  in  a  valimMe  c-«>mtTit rated  form 
of  uouriahineut.  The  best  way  U*  extract  the  nutritive  juicBB  of 
tJio  in«it  iH  to  mince  it  line,  he-at  it  iinHlcnitely,  ami  Mjueexe  out 
tht!  juice  ill  a  small  wine  or  fruit-proas.  Iieef-hloo<I.  either  fresh 
or  iu  the  form  known  lus  dctiic»itv<l  hhioil,  exeitvK  ii  natural  repug* 
naiice  in  the  ordinary  mode  of  admiiiistnitiun,  hut  ns  an  enema  it 
ofler?  eii[<«^c:ial  atlvanlagi-x.  Tlu-  method  of  f(m-o<t  ft^ding  by  a 
luhv,  aM  pmctif'cd  hy  Debuve,  bus  uttractcj  much  utli*iitiiiu,  and 
appears  of  great  value  where  tlic  laryngeal  uleeration  lias  involved 
tlie  cpig^U>ftiM  to  such  an  ext<!nt-  that  swallowing  la  painful  or  im- 
posfiihle;  hut  aa  a  general  rule  the  trouble  with  nutrition  is  found 
nut  Ml  much  iu  the  udmiuislmtion  of  nutritive  fluids  oa  in  rctiiin- 
ing  them  after  they  have  been  pwallnwcd. 

He  pittciw  a  high  value  upon  eggs  given  aa  fi-esh  a»  poiwiUo. 
The  pho«*ph<»rixcd  yellow  fat(io'iMHi)of  the  yelk  of  eggs,  is  iifieful 
for  ImiMing  up  nervous  ti^uc,  while  the  nlbuiiieii  rejilacCH  the  lom 
by  ex|>ector&tion  and  hemorrhages,  lie  urgeA  u|ion  patients  Oie 
im[>urlunoe  of  taking  (r^nu  tuic  to  three  egg*  each  day,  cither 
lightly  boiled,  poached  or  raw.  In  the  latter  form  they  ma,v  be 
givfii  with  coflec  {loilange),  l»o<rf-teu,  wine  or  beer.  Cr«am  U  uliw 
serviceable  iu  consumption,  and  where  it  can  he  taken  freely 
Affords  n  good  mib<rtituto  for  c^xUlivcr  oil.  Sick  pcrwMis  should 
not  be  rigidly  rcwtrictod  to  the  formal  meaU,  but  flh«>uld  have  food 
suites)  to  their  dige--*tion  ut  times  most  agreeiible  1"  them.  It  jg 
»ometiraeH  well  to  give  n4>uri'*hinent  in  the  middle  of  the  oight,  to 
break  the  long  fast  fn»m  len-tim*"  tu  momitig. 


idi 


l|AVf*l.   OK   TRKATMEST 


Till?  lii'trr/'iii  III  liu--i'  ciiTii'iil--  iiiny  be  ki;|il  in  i-hivk  hv  the 
Dse  iif  !iU]>|K>Kitoritv(  of  bulluiliiiiiui  mul  extract  of  n|>iuiii,  iu  coo* 
junction  nilb  the  milk  iliet  relerrpil  tn  alxi^'o.  UtcersLiim  <4  the 
colon  itiid  n-rtuin  if*  Mt mit'liiiies  greatly  l>eiiefitai  hy  injection  of 
nitiate  of  Bilver  (^r.  )  to  sj).  If  ronstipation  fxist,  simple  one- 
mitlii  c-onUiiiiiiig:  u  i'cw  drups  uf  camphor  ore  preferable  to  tbe 
adminitttr&tioii  of  piirgativeo;  but,  lykmi  recjuiro^l.taticura  clixintr 
granules  of  [MKlopliyllin,  uloiic  or  with  titixfi'itic  and  atrj-cluiuie, 
are  better  tlinu  tli«  ntorc  violent  catliartii-A.  From  a  flui^inal  etand- 
IMiiiit  n  tiAtulc  cci-tainly  abouUl  be  i>]>on\tc<)  u|m>ii;  from  a  medical 
Btfliitl-point,  it  oboiild  not  be  liealed  too  quickly,  and  ou  thU 
account  he  juvfcrs  the  ligature  to  the  knife.  Thb  is  also  the 
teaching  of  Unoas.  Tlie  old  prejudice  against  eloeinf;  a  long- 
cetablishcl  drain  in  n  case  of  chronic  disease  ie  not  without  foaih 
datjou  itl  fact,  and  the  proftive  of  ojiening  an  iiwiie  ol*fwhcre  in 
the  body,  although  lately  fallen  inl<i  disrepute,  ban  Uie  ex]«rieiioe 
of  i)tuit  genonitirtiis  <if  phyBiciaus  in  favor  of  it,  a«  well  ft3  tbe 
authority  of  eminent  surgeons  like  the  late  Profftjaom  VasoOi 
and  Jab.  K.  Wood  t«  endorse  it. 

yermns  Sj/stPi/i. — AniiHig  the  peculiar  nervoua  aymptonifi 
been  riotieed  a  genernl  ei-efhisni,  with  elevation  of  all  the  tiu'nltiot. 
In  tiii't  (^i)ndtlion,  the  brain  tei^U  to  wiikefiih >».■».  Xow,  almost 
tbe  first  essential  to  healthy  nutrition  is  a  pro]H;r  amount  of  sound, 
uniuternipled  Klet'ji.  Snm«  of  the  iiieiiHiirtw  for  the  relief  of  9lee|>- 
le8siiC88  will  be  referred  to  hereafter,  but  of  all  of  them  tbe  ad- 
minii^t ration  of  opium  it  llie  miK<t  eilieieiil  and,  at  t}ie  tume  time, 
tlic  moi!t  tn  be  dreaded:  not  merely  on  account  of  the  danger  of 
forming  the  opium-habit,  but  fur  iX»  evil  eftectfi  uiHin  the  cerebral 
circulation  Hod  general  nutrition,  it  n  to  be  lOmnned  whenever 
piiHsible.  Chloral  is  ltel:tttr,  but  iei  still  o|)en  to  ttonie  objectjous; 
less,  perhajis,  when  given  in  combination  with  bromide  of  ammo- 
nium and  camphor- water,  or  with  cherry-laurel  water.  The  ad- 
minietration  of  nome  light  food  at  bedtime  sometimes  flivon*  uleep; 
and  lactic  or  ]iho.4phoric  acid  bat*  uliio  been  recommended  for  this 
puriKise. 

The  emticiation  and  debility,  in  bo  far  aa  they  can  be  attribu- 
table to  iiervmis  drficiwR-y,  are  treated  by  geneml  mcannres 
indifBle"!  in  I  ho  other  itirlloiiB  of  thi^  juipor.    "Where  a  tdok' i» 


I'HTIIISIS. 


36S 


rle»^ireil  for  tlie  iktvous  "VBtcni.  tlK-n*  i*  iioiu-  Ik'ttcr  tlian  nux 
TOmica,  gut-n  in  fninbiimtidii  wirh  ihc  |ilnit»iilii(lt  *>f  /iiir  (Ifara- 
Diond^s  pill)  or  the  ciimi»oimJ  !*ynip  oC  the  jiho8[iIiatos. 

(jn-nl  injustice  is  ai'^en  done  tn  eotiKiiniitriva-^  by  |iliiriii^thctn 
in  the  cn»wilt-<l  wanl  nf  a  li"W|»ital.  The  very  nature  of  the  case 
imporativuly  (IciiuintU  inoit;  ttxygun  anil  jntn-r  uir  than  iti  hculth. 

Tfce  elotbiog  rwniiit*  ntiontion.  Ii  sInMild  be  rtciwrniable,  oom- 
fortalile,  and  not  hi'HVv.  Th«  bcxly-lineii  Hlmiild  he  friM|iiently 
chaogcd,  esixsjially  if  there  be  niueh  [»eis|>inttio)i.  He  insiels  uj<on 
a  well  veniilated  room  to  itleep  in,  niglit-<rlotliing  that  is  airctl 
durin<i;  the  duy.  nnd  friction**  to  the  fekin  each  inoniinpwith  a  dry 
lowel  ur  flesh'bnifh.  Faithful  rubbing  will  i]r»  more  tn  keep  the 
ekin  in  good  condition  than  freqaeiit  ablutions,  and  of  the  two  the 
former  is  Ui  Iw  preferred:  (■onHUriiptives  rjinnot  bear  frecitient 
sluicing  with  water,  e»iiecialiy  in  winter,  on  account  of  their 
feeble  jiowcnt  of  ruaution.  No  hud  cun  Iks  bettor  than  u  good  hutr 
and  spring  mattresji. 

Olio  ineiiieritul  but  very  great  advantage  in  guified  by  !M;|«iml- 
ing  the  sick  fmm  the  well,  quite  ajwirt  from  any  hypothetical 
danger  of  mmmnnieating  tlic*  disease:  it  in  thu^t,  that  the  tcinpto- 
tion  to  nexiial  indulgence  is  gi-eatly  reduced,  a  form  nf  excess  that 
18  particularly  ubnoxitJUM  to  thccon.iuinptivc.  Tlie  loss  of  vitality 
from  coitu5  falls  heavily  upon  the  huuband,  but  the  sick  wife  is 
by  nn  iu«»n.i  oxeinpt  fi-om  evil  cnnAtnjuencu». 

The  tendency  to  chronic  enppmution  is  one  indication  of  the 
presence  of  what  has.  been  termed  the  tubercular  or  jtcmfUloua 
dyscrasia.  The  m^ans  of  treatment  tn  be  adopted  an?  (1 )  a  healthy 
reiiidencu,  (2)  cJiange  of  habitn,  eHpiMMutly  from  a  eedentary  to  an 
otit*door  life,  (3)  mai^nuige,  (4)  electricity,  and  (5)  the  use  of  ceilain 
r«medieti. 

An  a  health  resort,  Kane,  in  Northwe>*teni  Pennsylvania,  with 
an  elevation  of  2,200  feet,  hua  nlrcudy  scuni--  rcpuiatiun. 

The  climate  of  St.  Paul,  Minno»iota,  ih  well  adapted  to  the 
treatuieut  of  incipient  pbthiriiH,  in  young  adults  eHpeeially ;  and 
Colonulo  a\m  enjoys  a  reputation  as  well  earned  as  Davoiplatz,  in 
the  Alps;  but,  like  the  ilimalayui^  and  the  Andtu,  tJu<t»  fitmuua 
health  rewirtu  aro  in  nmny  cuse.-*  ton  fiir  from  lioiiie  lor  au  invalid 
to  visit  U'itliout  ti»«>  much  fatigue.      Whoiv  the  change  in  well 


864 


MAN»A1,  or  TRKATMBNT. 


bonie  a  dwiileil  nnprnvnmcnt  iti  niitrition  and  IxMlity  weifilit  is 
iioon  noticed.  If  ihfre  bo  au_v  I'ever  |«n?^ul  Oic  case  w  rcnilered 
worse  by  tliv  vliangu,  nliK>,  if  tberc  be  orgunic  eluirigcrt  in  the  blood- 
vcsseb,  heart,  or  kidne.va,  tbo  iwttoni  bad  better  not  veutare  into 
■n  elevRtiMl  regifm. 

Tlie  90111-aUorc,  alUiougU  u.  iK*wei-fnl  stimulant  to  nutrition,  is, 
on  iicwmiit  t»f  the  density  luid  ilniii|)ne5ii  of  the  Btnuwphcre.  ui- 
missiblc  tuily,  if  at  all,  in  Ibe  oarUc»t  stages  uf  the  dieease. 

When  piiticnts  jirc  iinnbb?  to  leave  home,  tlie  aclivi-  exerclscB 
recommended  hy  Dr.  Joe.  Parkisd  ofter  the  best  &nb«titute; 
and  a  c-biuip-  fntin  a  flcdenlar^-  to  an  active  ot«u)>ution  luu  moro 
tbiin  once  averte<l  a  thivutciied  coti^urojttiou  and  eetabli^beil  health 
and  vi^^r  in  lU  plate. 

With  I'O^iii'd  to  remedies,  lie  comiiiundA  the  iodide  of  ir^m,  in 
the  form  of  Blimcanrs  jiills,  wbivli  have  aIidwii  rcJUJirisatlo 
power  over  obstioale  courtolidation  of  the  Itmg.  Tlie  todidea  of 
potussiiim  uiid  II  in  lit  on  ill  in  are  ntrn^  valuable.  n'>t  nu\y  for  tht-ir 
alterative  influence,  but  al^o  for  tlieir  etfceta  upon  the  t^wollcQ 
epithelium  of  the  brouehial  ttihc«  and  nir-oclU,and  for  their  power 
of  liquefying  morbid  products  aod  seeretioiw  and  ftvoriug  ilieir 
romo\iil.  The  lacto-jihosphate  of  lime  aitd  ood-Ii^-ur  oil  are  very 
Mrvicf-'abie,  but  should  l>e  given  depiiralely,  the  tormer  in  Um 
•yrup  of  laeto-pbosplialo  of  lime,  and  tbe  latter  idone  or  in  ex- 
tern poram^ouB  cnnilf«ifin  with  Ihe  extniet  nf  ninlt.  The  benzoatw 
have  been  tried  and  found  wantiiijr.  Totwibty  they  are  hi  danger 
of  falling  now  into  uiuicrwrvcd  negluct. 

TjOOuis  t4pcak«  of  the  ini]>ortnn(X'  of  truatiiig  i-alarrhs  in  Hiaae 
prpdisi«»HHl  to  confinmptioii.  ami  psys  he  knows  of  nntliing  soi 
tain  to  assist  in  tlil'^  wt  a  clmiige  of  climate^ 

For  the  fcvi>r  he  eonsider^  qiunme  the  most  rclinhle  agent. 
Ue  gives  twenty  gmiiiB  every  ulternutt;  niorning.  firnt  taking  the 
precaution  to  ?end  the  i«ticut  to  bed.  OigitaU-s  and  salicyUte  of 
•oda  arc  not  looke«l  u|*on  with  favor  by  him.  Ariicme  act«  oAao 
antii>yretic  iti  aomo  mild  t-ases  where  other*  fail.  One-tenth  of  a 
graio  of  morphine  given  with  the  quiuino  increadce  the  etficct  of ' 
the  latter.  If  the  fever  can  be  controlled,  a  change  of  elimste 
will  often  eurrv  (be  patient  on  to  recovery,  or  at  leiut  will  pro- 
long his  life  iin-l  render  hitn  (--onifortaMe. 


PIITHI8I!'. 


365 


fcfimU  tlmt  cod  livei  oil  ii:  not  remedial  unloea  the  jiatietit 
gains  in  woiglit  while  u^ing  it-  The  gutii  in  n'uight  U  out  of 
all  ['report  1011  to  tlm  inuotitit  i>f  -il  taken;  but  l)u>  ]>litliieical 
pHX-tttu  may  program  in  tlie  nu'Htitiiue.  Somctiint'*  it  improves 
the  a|>]«etite,  or  diecka  dian-litT*  or  voiiiiniii.'.  Nn  e))e<-inl  Lciietit 
U  obtaiiK'tl  from  giving  lai-gtT  iloses  than  a  tuliUwjnMjiiful.  Lying 
down  will  ortcii  |irevent  it  from  disagi'ociiig  with  tim  atonuich. 
It  Ulll^;t  he  f^iven  rogulni-ly  und  ]K^r»cv'crtngly  in  onlor  to  obtain 
tho  full  luiwlit. 

PliDi^|>bi.irotLi,  ii;al]iliiir,  ttic  liy|H>j>liosphitcs  of  lime  aiid  tioda, 
sulphuiYiiis  iit:iil,  tliu  tiul|>tiiteK,  an<  all  excellent  adjuvantti  to  tlie 
oil,  but  cannot  take  it4>  ]»lai-L>. 

Alcohol  irt  tiHcfiit  only  when  it  increnseti  the  appetit4;  and  tJio 
strength,  and  givc«  rifiC  to  a  dcaiii;  for  exercise.  If  ibi  use  cause 
ferer  followed  by  weaknc^  and  tiervoue  depreeaion,  it  will  cer- 
tainly prove  harmful.  Expcrienoe  doc*  not  sustain  the  belief  that 
Alcohol  can  ari'cst  the  development  of  phthisia.  It  is  a  miaforttinc 
if  the  patient  Iwcome  addicted  to  the  ui«e  of  stimulnnt*.  If  an 
individual  i-ec-over  under  tlie  use  of  alcohol,  Jte  would  have 
recovered  more  quickly  without  it, 

Opitim  should  never  be  given  in  phthisia  unless  the  cnugh 
deprive  tho  patient  of  sleep,  <ir  diMtrutw  him.  Then  the  milder 
narcotics  should  be  first  tried.  The  inhalation  of  a  few  dn)ps  of 
chlorofonu  will  often  be  of  gruatcr  utility  than  opium.  Care 
should  Ix:  taken  lest  the  putient  bocnnie  habituated  to  the  usu  of 
chlon)form.  Chloral,  liydrobnimic  acid,  chlorodync,  urenHote, 
Btrumoiiium  and  belladonna  aometimca  act  well  Oxalate  of 
cerium  hutt  been  rcci;titly  employed.  A  ootistitnt  hacking  or 
paroxyf^mal  cougli  nuiy  often  be  relieved  by  anodyne  or  eedative 
aprayn.  Ammonium  carbonate  in  the  infusion  of  wild  cherry  ia 
One  of  the  best  f^timulant  ex(>ectorautd,  ae  it  never  naueeate^. 

If  iiuininv  alone  dooei  not  contnjl  night  sweats,  opium  may  Im) 
added.  Oxide  of  Kinc,  gr.  \j-iv,  gallic  or  sulphuric  acid,ar^niate 
of  iron,  gr.  J-J,  atropine  hyj«(idernii«illy,  muscarine,  picrotoxine, 
ergot,  all  may  be  tried.  Cold  !«[x>ngingw  with  acids,  astringents 
or  cuiMicum  mv  useful  and  agreeable 

Gastro<into6tinat  hyperemia  demand))  a  carefully  regulated 
diet,  tt  aaliuc  laxative,  and  tho  lacto-phovipbatc  of  lime. 


«66 


UAKUAL   or  TRKATUENT. 


For  iiitttdinal  tuberculosis,  we  may  give  cod-liver  oil  and  Uw 
hy]Kiphop[tbit«i  nf  lime  and  wnla.  If  these  fail,  ten  jjrains  of  bii- 
muth  uiid  oiie-twelrth  of  n  grain  of  ruori>hine  will  uhiioat  L-ertainly 
relieve  for  a  time. 

For  ulvepatiou   of  tlie  large  intestine,   tlie    grealast   relirf  j 
obtainablt*  it«  that  ili>riv(»l  from  tlic  u»e  of  opium  5iif(]>of>itorie?. 

Vomiting  ftftor  meaU  is  most  certainly  relieved  bv  giving  tb* 
patieut  a  glass  of  hot  wnt^r  every  two  hours,  followed  in  half  aa 
hour  by  a  tca^poonnil  of  raw  scraped  beef  made  into  a  eandwicli; 
the  patient  being  compelled  to  lie  down. 

The  best  reniediee  for  hemoptyniB  arc  rest  and  opium.  Tnr- 
pentiiw  cornea  ut'xt.  Local  chest  pjiins  rnny  be  relieved  by  bli*- 
ten  or  Hinapi^in.^;  or  by  strapping  the  chei<t  if  the  ]min)<  be  due 
to  pleurisy.    Dry  cupping  often  relieves  the  dyppnoa. 

Neither  the  treatment  by  antiseptic  inhalations,  by  by|>odi;r- 
mic  injections  of  the  ^amu  sulwtaDcct!,  nor  that  by  injecting  can- 
ties  through  the  ehosi  walls  or  through  larj-ngeal  or  tradlwAl 
canuire,  have  been  followed  by  satiBliicrtory  results. 

As  to  the  eflccts  of  elimatc,  he  believc«  the  finst  easential  to^ 
be  purity  of  the  air.    To  thi?  mniidy  U  the  benefit  of  in<»un1»iti 
regions  daeu    Turpentine  exhalations  convert  oxygen  into  ozone, 
and  the  presence  of  ozone  iaevidenceof  aiino.*pherie  purity.     But 
dii-ect  inluilation  of  ozone  bos  no  power  over  phihti^is. 

Some  patienta  thrive  in  a  warm  climate,  and  others  in  u  cool 
one.     Tlu!  ub^ieuec  of  f«udden  and  fropieni  <4)ange8  makes*  a  cli*] 
mate  benelicial  to  phthisical  invitlids. 

Paticnbi  In  whom  the  process  of  titwue  clmiige  needs  no  ha»>j 
tening,  and  thoM  with  exhausted  nervous  xy^tems,  with  overtaxtid 
brains,  but  who  still  retain  much  rauiwnlHr  power,  should  go  tn 
tiie  mountaiiut. 

Those  who  are  paat  middle  life,  who  are  incapable  of  much' 
muwiilar  cxercirtc,  and  who  re«inirc  stininlation  of  tissue-change, j 
may  go  to  the  seashore. 

Patients  abould   tiot  cliangt*  their  location  often,  as  a  pro-j 
lodged  residence  is  necfjwnry  to  produce  the  tiill  beneticial  i-flect*. 
Allfifflgesof  Gbmid  phtlii^irmrc  Iiuncfitwl  by  ihi-  high  ulritode« 
of  Colorado  and  altmg  the  Kocky  Mountains.     Hut  the  enormous  , 
monthly  and  daily  range  of  tem|icniture  there  is  trying. 


PHTHIBIS, 


867 


Catarrhal  phttiftis  is  not  IwnefiUxI  by  liig-h  llltUu(l(^i^  Before 
the  ctiige  of  cnnsoU<latiori  is  past,  patient-*  are  benefited  by  cli- 
matic iiillaeiicea.  For  theefc  he  rucoimuL'tuU  AHhcrillc,  N.  C, 
Kew  Mexico  and  the  Adimndacke. 

For  patients  c-frnvalfwins;  fnnn  uimiI**  |iiilnion«rv  afti^clions, 
he  prcfrrs  Aiken,  S.  C,  Piilatka,  Enterpriwr  and  (Jniiirtville,  Fla., 
Thomaeville,  ttii.,  and  NaMOiL 

Tent  life  iji  tlie  open  air  U  beneticial  for  all  those  who  can 
enjoy  aiich  life.     A  ilrcairy  HiKit  will  not  bo  very  botieficiul. 

He  advocates  eanitaria  for  consuraptives;  cottages  in  aheltci-cd 
^»ta,  in  appropriate  climatw,  at  a  given  clovation,  where  privacy 
and  finiet  are  possible,  and  where  nil  eball  be  eupervised  by  a 
capable  aiid  intelligent  physician. 

Minnesota  hae  &  dry,  cool,  exhilamting  elimate. 

Southern  Qdiloniin,  Geor^in  imd  South  C-iiPoIinn  have  a  dry, 
warm  atmosphere. 

The  Itcmiudnis,  BnlimniiH,  FInridii,  TiirkV  Island,  Santa  Criiz 
and  St  Thomas  have  a  warm,  moist  and  usually  healthy  elimatc. 

The  oxtmonlinarily  dry  bc-U  of  countn,-  running  north  from 
£fiii  Antonio,  Toxaa,  has  be^mu  to  endanger  the  suprcm)U<!y  of 
Florida  iv*  a  winter  health  rpunrt  for  i-onfiimptive*.  This  oircra 
aoini!  advantagos  over  thu  miKl  but  humid  air  of  Fltirida.  Xu'fau, 
in  the  Bahiinin«  «uit«  phthisical  patients  past  middle  lifc- 

Jlfatatizas,  Cuba,  hn*  a  dry,  wami  eliniato,  jtuitaWe  for  » 
winicr  home  for  tlie  enfeebletl,  but  not  for  phthisics.  Sea  voyages 
to  Auatmlia  and  New  Zealand  are  recommoaded  for  hemoi^ 
rhagic  phihisis. 

Davis  recommends  for  tall,  spare,  nnrrow-chcsted  young  per- 
sous,  a  residence  from  *2500  to  dOOO  feet  above  the  sea  level;  with 
a  dry,  mild  atmosphere,  and  a  drj'  «oil  sloping  to  the  south  or 
eaxt.  If  the  jiatieut  live  much  in  the  oiwn  air,  with  nirxleratc 
daily  exercise  ami  proper  feeding,  in  one  to  thi-oe  years  there 
should  bo  a  fair  respiratory  eajMioity,  witli  a  Hhrinking  of  the 
tubercular  deposits  alnauly  existing. 

The  long  continued  am  of  the  lactophosphate  of  llxae,  or 
of  iorlide  of  lime,  ban  produce*!  deeidt^l  hfin^tit.  Tbc  luhlition  of 
a  tablcBpootiful  of  cod  Ijver  oil  twice  a  day,  will  incroaKu  ihe  ben- 
efit if  it  agree  with  tlie  digentive  orgaim.    He  reganls  the  lima 


868 


UASrAt  OP  TllRjlTSIBNT. 


[ilioMiiliiittM  a.1  of  [>oculiHr  vftliie,  t»  favorobl^  infliienciDg  the 
defoc'tivo  cell  formation. 

AVtifii  tlii^re  ia  vvUlciitly  dt-feutivo  iligeKiioii,  with  dry  and 
unhealthy  skin,  and  shiggish  boweU,  be  givos  the  aymfi  of  tbo 
iodide  of  calcium,  »  u-aitjioonfnl  afivr  ea*.-h  meal.  For  cuugb, 
he  adds  to  this,  hah'  h  drachm  of  the  fluid  extract  of  hops. 

For  flutolcncy  and  acid  cnKrtatino  after  mcalt,  he  adi'iAei  the 

use-  of  carbolic  acid  before  meals,  and  at  bedtime  the  following 

pUl: 

B    Est.  li<ro«cr«cai, 

Ferri  ralpliai^ 

Est.*]ot«, U    p.  j 

1^1.  hvdrafg^ri, 

Kit.  niicla  Tomlcw, U    gr.  i 

These  comb  are  liable  to  henioiTha^^ca  in  the  Qrat  stage,  when 
going  to  high  altitiidtix.  When  thiH  is  the  ciite,  a  resideuce  in 
Florida,  Georgia,  or  hotter  still,  iu  the  Bermadaa,  brings  gnat 
relief  and  rapid  iirogrx^s  townrds  ret-'overj". 

Some  cases  are  better  in  thf  steady  cold  of  winter,  but  are 
apt  to  have  hemorrhages  in  aiimnier.  Them  ho  d  irecta  to  Colorado, 
Dakota, or  Korthcni  Califoriiia  and  Oregon.  Some  auch  instanoei 
are  arresteil  hy  the  cold  dry  air  of  Mitwesota. 

To  those  who  are  comparatively  comfortable  during  the 
snmmer  hut  who  bocnnie  worse  on  the  approach  of  winter,  he 
recomtncnds  Bun  Antonio,  Texas,  Florida  or  the  Ccrmudaa.  The»c 
caaes  are  of^n  bcneiited  by  a  Fiea-vnyage.  In  the  eeconl  stage  ibe 
indication  is  to  ward  off  the  inflammatory  attucka.  When  an 
oiacerbatinn  iKTurn,  with  ft'ver,  sorenew,  congh,  and  rapid  puUe, 
the  patient  must  be  plac^l  at  rest,  in  pure  air,  liniiiinl  to  u  proper 
diet,  and  given  mihl  anodyne  expe^^torante,  with  emollients  to  the 
cheat  until  the  soreness  disapiMmrs. 

B     Atninonii  chlorid., ■ gr.  vj 

Anliinou.  «l  poUK.  tvt.,  gr.  ^ 

Morpliiiuu  iiilph., gr.  ■^ 

*^J'-  (ctjrryThii fS  j 

M.    8.^At  on*  'Ion  ;  to  ht  Mken  eveij  four  to  «ight  boun. 

'When  the  active  oyniptoms  have  abate^l,  and  the  above  is 
required  only    night    and    morning,    cod-liver    oil.   the    lime 


PUTHI6U. 


369 


, iodide  of  iron  or  quinine  ehniild  be  lul ministered.  In 
ngOtilie  iH  niio  of  tlib  iMtttt  ruiiiedioA  Two  to 
three  grains  may  be  given  every  two  to  three  hoiim,  until  the 
benuirrhiige  has  ct^ascil,  ainl  then  continued  three  timc«  a.  dny  for 
some  weeks. 

Tlic  fiamo  doHc  inuy  he.  tnkcii  in  the  evening  if  there  be- 
Digfal>«weat8.  In  this  stage  the  queotion  of  climate  and  out>door 
exereiiw  de[)endK  on  tlio  cuiiditiun;^  i^nxcnt  in  ooch  case,  and  the 
extent  of  the  tub«rculari nation. 

Many  arc  benefited  by  i-esidoneo  in  a  mild  dry  climate,  at  a 
moderate  elevation;  below  ."iilOO  feet.  If  the  patient  find  a 
climate  in  which  the  tubercular  proceas  is  arrested  and  repair  is 
established,  he  abould  lu^ko  his  residence  in  that  place  for  the 
remainder  of  his  life.  Kor  experience  haa  abundantly  proved 
that  a  return  to  the  locality  in  which  the  disease  originated  is 
asuolly  followed  by  the  reajiiKsinince  of  tlie  malady.  When  great 
destnictiou  of  tlie  lung  tissue  has  taken  pUicc>it  i«  rare  that 
change  of  climate  is  of  um. 

In  the  third  stage,  when  a  well-marked  cavity  haa  formed, 
but  tlie  reniiiiniiig  I'lilmonnry  Ktructiinw  are  free  fnini  ciis«ii»e,  a 
judicioua  change  of  cliniiito  may  conduce  to  a  cure;  but  in  other 
cases  tliG  jwllfnt  bIiouIiI  not  be  doprived  of  the  comforts  of  homo 
and  sent  on  a  usclc^  qnent  for  an  imposaible  recovery.  In  this 
stage  the  name  anodyne,  oxpeelonint  and  tonic  medication  which 
was  advised  In  the  preccling  pages  may  be  continued. 

Bartuolow  speaks  very  approvingly  of  the  use  of  arsenic, 
in  two  drop  doses  of  Fowler's  Bolution,  aa  a  prophylactic,  and  in 
the  incipient  stages  of  phthisiTi.  It  should  be  continued  for  a  long 
period.  Small  Acmes  of  aJcohol  after  uicali)  promote  appetite  and 
tissne  formation;  but  the  <iuantity  should  tiover  exceed  an  ounce. 
"Whi-ikey  i«  not  antidotal  to  phthiaiH,  and  fibroid  lung  appears  to 
be  produced  by  dironic  nlcolioli:tm.  I,apgo  cputntities  of  alcohol 
impair  digestion  and  lessen  tissue  formation. 

The  utility  i)f  cod-Uver  oil  in  incipient  phthisis  is  very 
great,  A  toaspoonful  is  the  usual  do«e.  Il  is  not  useful  in  llorid 
phthisin,  or  in  caseouH  pht.hi.ii:»,  nhnraetorized  by  large  deposits, 
high,  fever  and  diarrhea.  Bernard  showed  that  the  addition  of 
from  twenty  to  sixty  minims  of  ether  increases  the  digenibility 

Y 


S70 


MAKITAL   OF  TRKATUKKT. 


of  the  oil,  by  promoting  the  flow  of  pftucreatic  fluid.  The  oil 
should  be  irivon  in  Gmuleioiie  with  the  calcic  phosphates,  preferv 
bly  the  laoto-pboBphate.  This  author  believes  that  in  the  cu- 
bonate  and  iodide  of  ammonium  we  have  agents  which  have  the 
power  to  cfliisc  noftcning,  absorption  and  extrusion  of  the  tabor 
lar  dopo«ild.  He  gives  five  graina  of  cither  dalt  four  times  a 
day;  when  a  blowing  murmur  is  manifest,  and  the  sonority  it 
diminifihinj;.  The  remedy  should  be  continued  for  tnontha  Sf 
iraproveinerit  be  luiuiifeiited. 

For  the  cough,  gargling  with  a  solution  of  bromide  of  potas- 
sium, painting  the  fauces  with  cliloral  and  esmphor.  and  the 
Btomizatiou  of  a  morphine  solution,  are  temporarily  beneficial 

FoTHKRo ill's  prescription  of  dilute  hydrobroinii;  ncid  ami 
spirita  of  chloroform  aomctimes  ai]9we»  well.  Codeine  \e  the 
least  objectionable  of  the  oiiiatest.  A  combination  nf  rouium, 
atropine  and  strychnine  is  highly  efficieut  as  a  remedy  for  cough, 
niglit  sweatit  und  reflex  vomiting.  Picrotoxine  iillHyit  the  vomi^ 
ing  and  baa  an  anbydrotic  effect.  The  fnucial  imtatioa  may  be 
relieved  by  sucking  randy,  or  by  ati  effort  of  tlie  will.  For  the 
fever  the  first  remedy  is  refit.  His  estimate  of  the  A-aluc  of  qni- 
nine  and  bis  method  of  ui>ing  it  correspfindEi  to  tlint  of  Loomis. 

For  the  sweats  he  givet*  atropine,  gr.  «,  at  bed  time,  or.gr. 
Ml  thrice  diiily.  Tio  fbiiikK  tliis  drug  has  »iK?cific  beneficial  prop- 
erties in  plitliisis,  apart  from  its  effect  in  retraining  the  piwiating. 
Pilocarpine  i^  ftomctiniM  remarkably  benoBcial,  but  oflener  faiU. 

For  the  laryngeal  symptomfi,  nitrate  of  silver,  oarlMjlic  acid 
or  iodoform,  in  to  bo  ajiplied  directly,  or  by  tbt-  atomizer.  By 
the  latter  method  the  mofit  popular  remedies  are  salt,  chlorate  of 
potassium,  muriutc  of  ammonia,  tannic  acid  and  tar  water;  ood 
lately,  the  benzoate  of  soda. 

For  the  diarrhea  he  rocommcndB — 


M. 


%     Llq.  potas.  anealL, f5  ^ 

TincUopit, fj  » 

S. — TwelTo  dmpB  oa  n«edcd. 


For  the  araenic,  f  5  xv  of  aromatic  sulphuric  acid  may  be 
substituted,  and  tlic  dose  increatted  to  twenty-five  dro]is.  Frequent 
changes  are  necessary. 


PlITBItflS. 

.T3  invntinTiH  nmang  veliielmt  frtr  the  administration  of 
oil,  tlio  Litter  or  acid  loijit-  mixtures;  usunlly  given  at 
the  snine  time,  tincture  of  iron,  syrup  of  the  [iliosphate  or  iodide 
of  irou,  luilk,  orange  wioe,  frothy  malt  linuurK,  or  cold  brandy 
uhI  water.  If  the  oil  vause  niukiiess  it  may  be  given  with  lime- 
wuter  and  milk.  For  chiltlren  it  may  be  made  into  an  emulsion 
M  is  done  at  the  Bnmipton  Honpital: — 

^A     01.  rnorrlinjr f5  TJ 
^^^                Liq.  potaiMD m  xl 
^^L              Liq.  •mmOfil*  furl, ^  i} 
^^n            OLcMiue^ >«IC  j 
sympi, rsy 
DoM. — Two  tea»iiM.i>fuIs. 
Small  doses  of  strychnine  pivvent  the  nn«3eating  effects  of 
the  oil.    Tiie  ([UiLiily  should  be  of  the  best.      A  giMMl  pale  oil 
geuemlly  answers  hoM,     Inunction  w  advantageous  with  children. 
I^xail  (itinmlunLt  t<>  the  ehwt  arc  ilecidedly  uj^oful,  xueh  as 
mustard,  iodine,  ilying  bliittere  or  crotoo  oil.    For  acute  exncerba- 
tions  iKtultift's  un?  otVeii  ixHjuirod.     For  the  [lyrexisi.  quinine  and 
digitalia,  cold  baths  and  tipongiug,  may  be  us«d.      Aleohol   ia 
rcquiml  for  cxhnUHttnn. 
Ifc        For  uight^wcats  the  chief   remedies  are  oxide  of   sino, 
^gr.  ij-v,  at  bedtime,  with  helladomia  or  moiithine ;  or  a  full  dose 
of  tj^uiuiue  or  gallic  acid. 

Pidns  m  the  client  are  relieved  by  wearing  M>me  anodyne  or 
warm  plaster,  or  by  strapping. 

(Viugh  nx^uirus  attention  lo  tlie  throut,  aotringent  gargles  or 
lozenges,  or  the  local  application  of  taonin.  For  irritable  cough 
we  may  choose  fnini  the  follawing  list:  opium,  morphine,  codeine, 
chloral,  croton -chloral,  bromide  of  ammonium,  t^onium,  belludonua, 
a&d  chlorodync.  Gelmimium  hoK  been  reL-omniended.  Anodyne 
inhalations  are  eer^'ioeable,  especially  when  the  larynx  ia  uSecLed. 
.AiitiMiptic  iiibnlutionn  arc  useful  when  the  cxj>c<;tonilian  ia  fe^d. 
For  the  nick  stomach,  strychnine  or  koumit^  has  hccu  found 
beneficial. 

For  the  diarrhea,  he  uses  carbonate  of  bismuth,  }ir.  x*  with 
Dover's  powder,  gr.  v,  or  cncmata  of  starch  am)  laudiitnun. 

When  patients  cannot  resort  to  the  cliiimte  which  is  oonaiJur- 
ed  adviaable,  they  should  kc«p  in-doom  at  night  and  in  bnd 


I 


»72 


tAHUAL  OP  TRBATUSNT. 


weather,  and  avoid  every  cause  of  colil.  The  judicioiw  iise  of  & 
reBpirator  ih  lulvinable.  Thc^-  KhouM  allow  the  beard  and 
mousUu'liu  to  gro%v. 

Aiitieeptic  treatment,  is  now  very  i>opu]»r.  Benzoate  of  soda, 
carlxilii;  iicid  and  the  Hiil[iht)-furl»otute3  are  given  iiitenially.  The 
air  breathed  may  he  impregnated  with  the  \*apor  of  tliette,  or  of 
enwtotc,  tar,  tur|K:ntluc,  or  iodine.  By  direct  iuhalation  the  aame 
agents  are  OBei!,  aa  well  na  thymol,  eucalyptol,  camphor,  terebene, 
oleum  piiii  itylvufltris,  chlorine,  linuturo  of  ht:U7.oiu,and  sulphunKis 
acid.  Several  of  these  may  be  combined  or  in  aoine  canes  mixed 
with  ether  t>rrtpirit«  of  eliliirofomi. 

When  antiseptic  treatment  is  practiced  judiciouflly.aiid  other 
CA8ctitial  m(!UMUrtM  are  not  ncglcctinl,  it  tnay  undouhtully  lead  to 
highly  beneficial  i-eaultts  Patients  should  be  warned  against 
Bwalhnving  their  tiputa,  and  that  whieh  in  cxpoctorot4xl  ahould  be 
imiaecliately  disin felled  or  destroyed. 

Bhk:4ETT  wanift  ua  against  taking  the  {jatieni'H  won!  an  to  iho 
appetitt-;  a«  the  jtecHMar  hoj^wfulnesi*  exhihitwl  in  this  iIim-jl^ 
leads  the  sutlerer  to  sjK-ak  of  a  coiwtant  improvemcut,  while 
rapidly  nearing  the  gnive. 

The  diet  should  he  generous,  with  plenty  of  animal  nuhisliim-es, 
and  a  glass  or  two  of  gooil  sherry  after  dinner.  The  tendency  to 
dysptrpsia  rthoiild  not  lie  forgotten.  ^^Hieitvcr  food  rich  in  lat  can 
be  taken  and  tolerated,  it  will  pi-odnce  good  results.  In  Aiutralia 
men  (Hire  ttihcrculous  hnigs  by  eating  fat  tntilton  and  galloping 
about  on  horseback.  In  Amerii-a  men  eat  the  marrow  of  but]*alo 
bimes  until  they  arc  Htm]ig  cnniigli  to  hunt  the  animal  down. 

Forty-fivo  years  ago  J>u.  Bkwsbtt  introduced  cod-liver  oil 
into  mc  in  the  British  iKliindtt,  and  then  itpokc  of  it  in  these 
worlB;  No  remedy  ho  rapidly  restoi*ea  the  exhausted  powers  of 
the  patient,  improvis!  nutrition,  checks*  cniadation,  fltojjs  i>er8pini- 
tion,  [piictH  the  cough  and  expocloratioD,  and  pixHluceet  a  most 
favorable  influence  on  the  diecttse. 

In  treating  the  »yniptoms  of  phthieis,  wc  must  beware  of 
giving  too  many  drugs,  and  thereby  disordering  the  stomach. 
Keposc  is  essential  to  the  proper  performance  of  the  functions  of 
tliat  important  visuus. 

Ton  drops  of  aromatic  spirits  of  ammonia  given  o\*ery  four 


PHTHISIS. 


873 


in  a  winc-g]flft*tiil  of  some  hitler  mfiwion,  with  a  little 
cajmiimtlve,  like  liiiotureof  orange  or  (sutlurmmi  will  give  an 
appetit<?. 


U. 


R      Nnplubtr, 5  J 

TincC.  caHamomi  minp., fj  j 

Miat.  ampborR, TJ  t\J 

Bf^A  Buth  part  erery  rour  houn. 


For  tlie  cfiiigli  iiinl  ex[»et--tnnitJon  he  does  not  ajipmve  of 
opium  and  uauitoaiiU;  their  effect  on  the  stomach  outweighiug 
the  tempmiry  relief  following  their  am.  The  apiil  teal  ion  of 
nitrate  of  silver  to  the  fauces  occasionally  \n  of  the  greatest 
wrrvii'f. 

When  tough  impis-sated  aputa  indicate  tlmt  the  cavities  arc 
cicatrizing,  and  the  [mtit^iit  complains  of  a  HCnse  of  con.<itnction, 
a  few  drops  of  ether  may  be  given  in  camphor  julep,  but  all 
«xi>cctonint4(  inii»t  l>e  strictly  avoided.  nARTSiiORNK  xnggests  feu* 
such  cnsoa  two  or  three  grains  of  ammonium  carbonate  iu  a  te^ 
gptwnful  of  «yrup  of  wild  irliurry. 

For  piittia  ill  tbu  chi-st  Bessktt  approves  of  8lra]»ping,  fomen- 
tationn  and  [Kiinting  with  iodine,  but  not  of  local  bleeding  or 
stronger  counter-irritants.  If  uiiodyncfl  be  al»oIutc'Iy  unavoida- 
ble, he  gives  chlorodyne  or  chloral  the  preference. 

Fordiarrbeu^occomiig  early  in  the  disease,  he  given  the  mild- 
ttt  combinations  of  chalk,  aromatic^  and  antacids.  In  advanced 
'phthtsifr,  the  stronger  astringents  with  opium  are  indicated. 

For  hotnoptyeiit  ho  recommends  abMilute  quietude;  but  has 
never  c^een  unquestioned  benefit  result  from  the  inteninl  um  of 
the  ao-callcd  hcmoataties,  Sometimes  the  blooding  will  be  found 
to  arise  )Q  the  pharynx  or  larynx,  and  will  then  he  rolievod  by 
the  local  nsic  of  nitrate  of  silver. 

Tlie  minutife  of  avoidance  of  draughta,  using  extra  coveriuga 
wlien  needc<l,  changing  the  shoes  when  wet,  riding  with  tho  back 
to  tho  horses^  etc.,  will  prevent  mueh  irritation,  cough  and 
sufTering.     For  febrile  attaeks  he  givm  the  wiliae  diuretics 

KosTBR  gives  very  strong  tostiniony  to  the  value  of  tho  addi- 
tion of  cthor  to  cod  liver  oil.     lie  gives  fifteen  minims  of  pare 


I 


I 


374  HATnJAL  OP  TRBATHKNT. 

ether  with  two  drachnia  of  oil,  flavored  with  oil  of  lemon  an 
glyL-eniitt;  or  clec  the  oil  ulouc  and  the  foltnning  mixture  a  fe 
minutoe  bcfoi-e  or  after  it: 

R     Potiw.  bicATk, 5t] 

Aciil.  hydtix-jratiicd  dlL, m;  xrj 

Sp.«4h«ri^ .....tSv 

A«|iu(^<|.  >.ad. fj  Ti^j 

M.    S.>-Two  ubleapoonGful  three  lima  iaX\j. 

"WiiLiAMB  treats  tho  fever  by  giving  largo  doses  of  quinuM, 
Balioine,  gr.  x,  and  Balicylate  of  s<»iia,  gr.  xi,  every  fcnr  hnnre,  if 
the  pyrexia  bo  cMiaidorable.  If  it  but  slightly  exceeds  IOC,  he 
gives  Fowler's  solution,  in  doses  of  two  to  five  drops,  thrice  daily. 
If  these  remedies  fail,  he  uses  oold  compresaos,  sponging  with 
vinegar  and  water,  wet  paelu  or  gradually  cooled  bath«. 

When  the  cough  ia  frequent  and  expectoration  ditHcult,  wiUi 
active  inAanunatory  action  going  on,  he  gives  an  effervescing 
saline,  with  email  do6cs  of  opium  and  antimony,  two  to  three 
times  at  night.  Tar  U  of  use  in  reclu^:iDg  prt'fuse  expectoration. 
Inhalations  of  iodine,  benzoin,  carbolic  acid,  creaaote,  Urd  and 
turpentine,  arc  useful,  if  the  cspoctomtion  be  offensive  or  require 
8timuliai<m.  When  the  cough  is  convulsive  and  dry,  iuhalatiooB 
of  chloroform,  conium  or  hops  nuiy  be  substituted. 

Diarrhea,  when  due  to  dy^pepBia.  requires  mercnrial  purga- 
tive* with  Boda  01-  lime-wnter.  Wlicii  cx(-'CflHive,  it  may  Im  checked 
by  the  vegetable  flHtriiigentft  mid  biBmutii.  When  due  to  ulcera- 
tion, he  prcft-ra  sulphate  of  copper,  gr.  1  to  |,wiUi  opium,  gr.  j, 
every  four  hours.  If  the  stomach  be  irrilalilf.  npistc  enemata 
afford  rcHtrf.  In  very  olwiitiatc  canea,  tftnuic  acidt  gr.  v,  or  tha 
eame  (luantity  of  acetate  of  lead,  may  be  added  to  each  enem^ 

For  the  d^-spnea  lie  recommends  diffuctble  ^timulaiitd ;  ether 
and  ammonia.  Pneumothorax  requires  o]>ium,  strapping  or 
aHpiration  of  the  chest. 

Bed-«orcs  may  he  prevented  by  the  use  of  a  water-bed,  and 
of  spirituous  lotions.  If  a  eore  forms,  it  is  be«t  to  protect  it  from 
friction  by  circular  cushions  or  felt  plaster,  and  paint  the  mw 
surtaoe  with  collodion. 

As  to  the  effecta  of  climate,  his  reoorde  show  tho  greatest 


PHTUISIS. 


87& 


benefit  from  sea-TOyages,  iht-  next  from  Ife^t  Id  catarrhat 
phthisis  Madeira  and  the  Blue  Ilill-H  of  Jamaica,  are  advisable. 

Dry,  stimulating  marine  climates,  like  Algiers,  are  recom- 
mended for  phthlsiB  of  inflamiiiatory  origin.  Wliere  stimulation 
is  undwiraiili',aa  in  jiatifnts  of  oxrltahle  tcmi>eramcnta,or  imtable 
BtODflachH,  the  very  dry  inland  climates,  like  Egypt  orSouth  Africa, 
are  to  be  preferred. 

Sea-voyag08  are  indicated  in  hemorrhagic  phthJais,  where  Urn 
patient's  stivngth  ia  unequal  to  much  exercise,  and  where  he  or 
the  has  suft'ered  from  close  confinement  in  a  crowde<i  city.  High 
altitudes  an-  Kiiltahle  to  <sincit  with  only  limited  loeiuns,  tkir  powers 
of  circulation,  and  able  to  take  exerri5c;  and  in  thet«  a  cumplctft 
arrcBt  of  the  cliHenai'  may  In;  confiflciitly  pnttliutocl. 

RtiKHLK  <«.ys,  in  speaking  <if  the  prophylaxw  of  oonHiiniption: 
"Would  that  the  stady  of  clasBic  antiquity,  especially  of  that 
model  people  the. Greeks,  might  at  least  induce  nn  to  imitate  Uiotn 
in  tlieir  gj'mnastic  exerciaes  and  their  outdoor  life,  bo  fiir  as  our 
climate  permits!" 

The  seven>  gymnastic  exerciaes,  on  the  cross  and  parallel 
barw  are  apt  to  over  tax  the  inijierfect  powers  of  respiration.  More 
HTviceable  are  out-door  exenriHen,  ivith  miming  and  singing  in 
particular,  since  trained  singers  rarely  become  consumptive.  The 
eitir]>ati<)n  nf  enlarged  lymphatic  glandH,wheu  accessible,  may  be 
recommended, 

In  the  treatment  of  diM'Aw  of  the  upcx,  the  oarbonate  of 
■oda  may  he  given,  with  infusion  of  digitalis  if  (here  be  much 
fover.  When  the  inflainiuatury  symptoma  abate,  local  counter- 
irritation  may  he  employed. 

RcHpinitory  cxen-iwR  may  now  bo  employed  to  eiimnd  th» 
aerated  part^nchyma  between  the  foci,  and  advantage  will  bft 
dcrivc<l  fmm  tbe  inhalation  of  compressed  air<  - 

When  we  have  to  deal  with  phthisis  proper,  the  indicjitiona 
for  treatment  an;  difl'orenl. 

Carbonate  of  soda  may  bo  given  iit  milk.  Limo-wat«r  ia 
employed  by  inlialation  to  modify  the  bronchial  affection.  The 
action  of  fats  improves  the  nutrition  of  the  affected  ves&ols  bo  m 
to  limit  the  tabcrculoas  formation.  He  prefers  the  extract  of 
cinchona  to  quinine,  believing  that  this  drag  is  poesoesod  of 


87< 


MAKCAL   or   TRCATMBNT. 


virtu«  not  weiding  exclueivoly  in  the  alkaloida  or  in  the  Umac 
acid.  Malt  extract  is  to  be  commended.  For  the  fever,  be  Kliee 
on  diet  Hini  reat,  reserving  digitalis  and  qainiD«  for  vi-ry  bi^ 
terapcrnttirca. 

Tasser  tb)nk»  tlie  irritation  of  li«tuIa-in-atio  in  much  mon 
it^tirious  than  the  operation  for  itd  relief.  But  Allisoiiaii  it 
rather  dubioutf  about  the  propriety  of  opcmting,  »ii<l  only  doet 
eo  in  selected  eaaea. 

Tannbr  remarke  further  that  only  mischief  can  result  from 
the  uae  of  aneiiic,  phoii]khHtc  of  time,  oxygen  inhalations,  bleeding, 
etc.  The  use  of  naphtha  hua  been  undeservedly  praised,  since  tt 
more  frctjuuutly  does  hiinu  tluin  gcMti]. 

Yko  recoiaraendi)  antiseptic  tnhalationd  very  highly,  basing 
bis  good  opinion  partly  on  the  favorable   results   roportod  by 

LSMAIRB. 


L 


Da  Costa  iwea  the  following  formula: — 

S    01.  morrbaxv fj  j 

Aq.  montliapip, fj  ■ 

TiDcU  aiinnlii, f}  m 

M'uL  Bcmciff, t%  iiJM 

Ol.  KsultlMriK. IDC  X 


I 


Another  method  is  lo  pour  iutoo  tnrahicr  any  preferred  Bymp 
(orgeat  or  BBiwaparillu  m  best),  and  fill  with  carbonic  acid  water 
While  etill  foaming,  add  a  tablet>)>oonful  of  the  oil.  It  is  astonidh- 
lug  how  well  the  taste  ia  diAguiAed  in  thiA  nuumor.  Leae  than  a 
tableapoonful  of  oil  ia  not  advisable. 

HiLLXR.  made  extensive  tilala  of  the  various  germicidoi 
by  inhalation,  by  «pru.y,  by  subcutaneoua  injection,  and  by  the 
mouth.  Whatever  the  drug  or  the  method  of  administration,  the 
tubercular  prooeeg  was  not  ebcckcd,  nor  did  tho  bacilli  dtttppcor 
fW>ra  the  sputa.  Corrosive  sublimate,  iodoform,  bromine,  ethylic 
alcohol,  methylic  alcohol,  sulphuretted  hydrogen,  areeoious  acid, 
boric  acid,  and  salicylic  acid  were  tried.    Of  tboae,  the  first  named 


d 


PHinuis. 


877 


gave  the  best  reaulta,  ased  hypodennically.  Tbe  majority  could 
not  endure  tbe  treatment;  of  the  WUmx^,  some  in)pro%-cd  but 
none  recovered.    Iii  advanced  plithisia  death  was  hastened. 

Albreciit  olainw  to  have  prolonged  the  Uvos  of  phthisical 
patients  by  inhuliitionti  of  jtiin;  ozyg6n.  Ho  KayR  that  th«  1<>«i  of 
weight  c«i»od,  and  tlie  baeilli  in  the  spnta  bceanie  loss  numerous. 
Guinc-a-pigs  inoctiluled  with  tubercle  Hvcd  six  months  when  tlie 
oxygon  inhalationii  were  usod,  and  only  four  months  whon  this 
remedy  was  withheld. 

Wabren  recommends  the  following  inhalation: — 


8 


M. 


Tbvmol, ft.  Tiij 

Sotlit  bont., 5  V 

aiyccriol, f5  x 

At). campborc,.... f|  ]jm 

Aq.pii'iii, fj  vy 

8. — To  l>«  uned  with  llie  Btomiier.  • 


f  Among  recent  writcre,  I'epper  hfts  revived  tlio  old  metliod  of 

I  treating  pulmonary  deposita  and  cavities  by  injecting  various 
subatances  of  fiuppo<Jed  curative  i>ower,  through  the  ehest^walla 
into  the  disease  ocnters.  Although  like  moat  novelties,  the  method 
has  found  advocates^tho'  results  have  not  up  to  the  present  elicited 
much  entbusiosni. 

It  is  difficult  to  sec  bow  any  other  result  than  Ubllek'b, 
oould  luive  been  expeeted  from  t)ie  hypodermic  iwc  of  c<»rro3ive 
aablimate.  What  curative  eft'eel  wiw  U>  be  derived  fi-om  the 
ii\|ectlon  of  tlie  fiftieth  of  n  grain  of  this  most  irritating  drug 
into  the  ti»«ucs  at  a  distance  from  tlie  dixease  foci  is  not  known 
1o  the  authoRi. 

BEVBntV  ROBISSOS  has  recently  written  favomhly  of  the 
sytiteiu  of  forced  feeding,  known  ks  gavage.  Thft  (mtient  U  i'ed 
•t  stated  intervals  with  liighly  nutritious  and  artificially  digested 
food,  adminiatered  by  means  of  a  etomach  tube.  It  is  said  that  a 
much  hiigcr  quantity  of  food  will  be  taken  by  thie  means  than  by 
the  ordimiry  manner,  and  that  nausea  and  a  distaato  for  food  will 
be  avoided. 

There  is  much  to  be  anid  in  favor  of  this  method,  and  wc 


878  MANTT41,   OP  T»RATSnnfl 

believe  it  will  prove  useful  in  some  oaw-s.  But  the  neoeffli^rf 
feeclinj^  frequently,  and  of  having  skilled  attendants  to  use  tbi 
tuhc,  will  itrnfinp  its  use  t«i  wraltliy  neraoii*.  Thi-  uncr  of  ru8(an> 
tors,  tiDpregnated  with  antiaeptic  BubBtauces  and  worn  constaotlf 
lias  also  rectiivoit  tJii;  Miuctiun  of  high  uuthorily  ;  noiwithstaQdiif 
the  fact  that  the  modiciual  Bubetances  n»e*\  rannot  ]io9Hib)}r  h 
inhaled  in  Aufficiimt  Bmuuuttt  to  exert  a  true  geruiicidul  action. 

VTo  have  veiry  many  times  proved  the  vnlue  of  'Siattcra't 
cel^rated  pill,  whirh  wi>  give  a^t  fnllowe: 

1(      Qaininir  siilph •)  j~3  ij 

Digiiiilis  |hiIt^>>...> ■•■•••gr.  X'xx 

Opil  pulv 

Ipccx::.  piitv^ U     gr.  T 

M.    et  in  pit.  no.  xx  Jiv. 

S.— One  to  be  giten  vrerir  four  to  eigbl  boon. 

Thew',  witli  rr/it  in  hedy  ji  dii>t  Ktnted  tn  the  pntientV  digcstii 
ability,  and  vi-ry  raraly,  tho  application  of  ic*d  elotlia  to  the 
abdomen  y»^•*^  article  on  ai'ute  plithiniH),  will  alinoBt  always  control 
the  fever.  And,  lirst  and  last,  this  ia  the  leading  indication  for 
treatment.  This  is  the  insidious  enemy  who  eteaU  away  oar 
patient's  strength  and  itewh,  and  renders  all  our  eflbrta  nugatory, 
unlew  we  subdue  him.  Better  to  disregard  every  other  symptom, 
than  to  treat  all  others  and  neglect  the  fever. 

In  Boiiie  recent  cases  we  liave  obtained  remarkably  good 
results  froni  the  use  of  antipyrln,  in  five  to  ten-grain  doses 
repeated  every  two  honn*  nutil  three  liave  been  taken.  It  haa  in 
one  case  permanently  dissipated  the  fever  when  Nibmeter's  pill 
fiiiled  to  do  s(».  The  case  required  hut  twelve  of  the  tcn-gTaia 
powder*,  taken  during  two  weeks,  and  the  patient  recovered. 

For  the  cougli,  we  may  uhc  iiiliulatioiut  of  soda,  liinowater 
or  borax  when  the  sputa  are  thick  and  viaciil;  hamamelis  (a  teft> 
s|ioonful  of  the  distilled  cxtraKt  to  an  ounce  of  water),  tincture  of 
benzoin,  cnmp.  (twenty  dropa  to  an  ounce  of  water  or  of  alcohol), 
or  turi>eotiue,  when  the  sputa  Ixicotno  ])rofuae;  or  chloride  of  am* 
moniuni  (gr.  x  to  the  ounce  of  water),  or  tincture  of  hyilraatts  (a 
tea-spoonful  to  two  ounces  of  water)  when  atimulatiou  is  rcqtisite. 
Kidd,  a  fmhionablo  London  phyeician,  pmised  the  effect  of  inhil- 
ations  of  iodine.    We  have  not  found  this  agent  nearly  so  valuable 


PDTnUIS. 


3^ 


us  he  affiriujt.  Wliatcvcr  ni^a^urue  are  eniplojcd,  it  U  wvU  to  ro- 
fisin  fVom  opium.  Patifute  should  be  tuugbt  to  look  Qpou  the 
ooQgh  as  useful  iii  freein<f  their  \aui^  of  a  imiteriul  so  Juugt'roas 
that  it  must  never  \>e  --ivvullowot),  but  mimt  be  liimtt  &»  fKK>n  ok  ex- 
pectorated. A  full  uiidoretanding  of  tho  bacilhu*  1  lieory  sh'HiM  h« 
implanted  in  tlic  miiiilm  ol'  tnith  |tatit>nt  iiiid  I'ricnil.^.  Kiit  L-ongh 
whivh  \h  not  n(H'<««iry  to  bring  up  ^putn  mu^t  bo  rostrainud.  Tho 
apjilicaiioii  of  cocaine  (gr.  v  to  two  dravlmiH  of  water),  or  of  gly- 
cerole  of  Uinnin,  li»mamoIis  or  hydrBj^tis  to  the  pharynx  is  otttsn 
Deeded,  when  the  oough  i*  ot-eaaioiifd  by  irrilatioii  of  tho  fauires. 

hozeup.-A  arc  objectionable  bccau^  the  sugar  ofUc-ii  uiuses 
acidity  of  tho  etomacli.  Tot  the  presence  of  some  Hmall  object  in 
the  mouth  often  does  good,  by  exciting  a  flow  of  wiUvn  and  keep- 
ing the  1  hroat  moiat.  Chewing  cocft  leaves,  Hpnice  gum,  or  a  small 
piece  of  gum  anibic  often  give^  relief  greater  than  would  be 
thought  possible  from  such  eimple  meajnire?. 

For  bronchorrhea  we  administer  GrifBth'ji  mixture,  laeto» 
phnnphato  of  limes  euvalyptol,  oil  of  cajeput,  copaiba,  cubebu,  or 
hjdronaphthol ;  by  atom iuit ion,  by  the  Momach,  or  by  both 
methodii. 

The  dyspnea  is  somotimv^  very  difficult  to  relii^ve;  but  wlteu 
the  fever  has  been  quelled  and  the  bronchial  tubea  freed  from  ol>> 
stnicting  eetretiou.-*,  the  tincture  of  qncbrftcha,  given  in  tea- 
^ootifu)  doflCfl,  will  generally  give  relief. 

For  tho  night-sweatri,  the  nio«t  efficient  remedioit  arr^  bonui> 
tropiBe,  gr.  ^  at  Uiltime,  or  agaricine.  The  ordiiuiry  donMwijo 
remedy,  sa^,  haa  scarcely  a  nuptrior.  A  cup  of  the  ci>ld  infus- 
ion nitty  In;  takvn  at  bed-timu.  When  the  iweating  in  rather  i}io 
expreasioD  of  the  profound  proetration  of  the  [latietit  than  of  the 
hectic  fever,  the  htcto-phcsphate  of  lime  U  an  efil<'icnt  rcmc-djr, 
given  to  the  amount  of  fifteen  graioii  daily  in  dividt«l  do«ea. 
Sponging  the  nkin  irith  Tine^nr  and  vatcr,  avoidance  of  fentbcr 
beds  and  of  over-lowliiig  with  clothing  will  SMiiit  DMteriall/. 
Nor  should  wc  dspUe  Uir  ancient  belief  that  |>lactng  a  Uutn  cff 
cold  water  under  the  bed  ha«  ifai  tnfluez»ce  for  good;  for  he  i«  bat 
a  bnugling  phyaaao  who  J»*J«ih«  to  amy  oo  hia  »\dt  tb«  gnat 
power  of  iaMjiinatiao. 

For  the  diarrliea,  if  coUiqaativot  tiia  Ucto-plMiapliato  of  liiM 


S80 


MAVt'AI.   or    TREATMENT. 


is  still  our  beet  remedy,  with  eage.  Lf  it  Itc  dac  to  the  doreUip- 
mont  of  tubercular  ulcere,  the  silver  salts  with  bi^itnuth  an 
efSuicnt 

I^    Argcoti  oxid^ gr.  ▼ 

liaa  oiid^  gr.  zl 

Bkaiaih,  inbMrb., 3  ig 

M.  el  In  ckart,  do.  xx  dir. 

S.— Otic  every  Ainx  boun. 

For  the  treatment  of  hemorrhages,  we  article  on  llcmoptyBk. 

In  laryngeal  [ilithUis  the  resourses  of  the  practitioner  will  U 
tried.  Local  apiiHcatioitii>  of  cocaine  or  iodoform  irho  former  io 
ten  per  cent  solutions,  the  latter  iu  powilcr,  undiluted),  will  give 
great  relief,  and  allow  the  patient  to  swallow  without  pain  until 
the  local  anesthesia  has  passed  off.  The  objection  to  tbie  is  that  it 
ifi  difficult  to  appi}'  the  remedy  Io  the  disoa^  surface. 

A  twenty  grain  to  the  ounce  solution  of  nitrate  of  silver 
has  a  more  lasting  effect,  but  tliix  aim  mu-it  Ih-*  applied  by  tlw 
physician.  The  greatest  relief  which  the  putient  can  obtain  is 
perhapH  derived  Inim  the  use  of  morphine,  gr.  jt  to  tin;  ounce  of 
water,  with  an  utomizer.  An  ethereal  ^lution  of  iodoform  may 
aUo  be  used  in  the  same  manner. 

For  Die  dyspepsia  and  adyuaniia  we  must  regulate  tlie  diet 
with  the  utmost  care.  "Wo  ioi^ert  here  the  culwljiDccof  an  article 
from  the  pen  of  LooMis  which  reueiitly  api)eur«d  in  the  JaurtMl 
<lf  Sa'onstriinUtvs : 

ITe  distiuguiuheii  between  patients  under  thirty  years  of  age, 
and  those  who  are  over  forty.  For  the  first  clajw  the  basis  of 
dietelie  tit-alment  inu«t  bo  the  hydroearhona  and  the  phcwphat«. 
They  are  often  the  curative  ageuti*.  In  the  second  class  the  albu- 
minoids constitute  tho  princijial  food.  Fat  is  readily  taken  by 
the  young,  but  not  by  the  old. 

Ill  selecting  sjiocial  articles  for  either  class  we  must  farther 
consider  the  stage  of  the  disease,  iw  regards  the  digestive  povrer. 
The  first  stage  covers  the  period  when  digestion  and  appetite  are 
still  unafFected ;  the  ttccond  l)egin9  with  the  commenccmoDt  ot 
septic  infection,  and  is  marked  by  fever  and  gastric  irritability. 
Tlie  third  stage  hegiiw  when  the  fitoroach  rofnsoft  solid  food,  and 
ends  with  tho  death  of  the  patient. 


I 


rUTUISlB. 


881 


I 


Systematic  dieting  Hlmiilit  lH>gtii  af  the  first  suspioion  of 
phthisis.  Young  paticut8  should  drink  only  milk;  two  to  four 
times  dailj.  Tbey  nhoultl  eat  meat,  butter  and  cream  freely. 
Otliur  articles  should  be  taken  simringly,  simply  to  avoid  mono- 
Inny.  I^arge  amounts  of  i-<m1  liver  oil  should  be  ui«ed,  and  the 
phosjjhatcs  in  special  prcpamtions.  Patients  over  forty  shnuld 
take  two  or  three  poniids  of  meat,  four  quarU  of  mitk  and  four 
eggs,  in  twenty-four  hours. 

In  thft  !H-<Tind  stage,  >i  rharige  in  rutpiirud  in  the  way  of  pre- 
paring the  foud,  rothcr  thau  in  it«  luiture.  Food  must  be  given 
in  fin<>  division  ami  prviiared  in  the  ntoitt  palatable  inainicr.  Beef 
may  be  scrape*!  or  chopped,  all  i-'oarse  fibre  being  removed  (Salis- 
bury nteak).  Milk  nuiy  be  tjiken  raw,  Ixuled,  0JK)kuil  in  custard, 
curdled,  or  shook  with  i.-rnA'cd  ice  and  a  little  suit  Koumisa 
nu»y  replace  milk,  and  ifptonoidi^  of  beef  and  milk  will  relievo 
the  dig«etive  organs.  Cod  liver  oil  wilt  require  cmulailication ^ 
especially  with  i>epsin  and  quinine 

In  the  thtnl  stage,  when  the  indication  is  only  to  prolong 
life,  the  forced  diet  must  be  abandoned.  Smaller  quantities  must 
he  given  nt  shorter  inter^nls,  and  the  food  should  bo  artificially 
digested. 

Artificial  liigeetantd  should  be  used  fnou  the  fin>t.  'Hiirty 
grains  of  pepsin  with  thirty  grains  of  muriatic  ncid  should  b» 
l^ven  directly  aHor  eating,  and  fifteen  grainii  of  paiicreatiu  one 
hour  after  tuking  fat.  If  starches  Ixj  not  digested,  diastase  (malt 
extract)  should  bo  given  wiih  or  after  the  meal. 

The  follon'ing  rul^s  are  formulated: 

1.  Three  full  meals  should  bo  taken,  bik  hours  apart^  with 
three  light  lunehes. 

2.  No  more  food  should  W  taken  at  one  time  tlian  cau  be 
digested  easily  and  fully  iti  the  timc^ 

8.  Food  fdiould  never  be  taken  when  the  patient  is  fatigued 
or  worried.  Ikying  down  ibr  half  an  hour  belore  ceting  aida 
digestion. 

4.  Each  moftl  should  consist  of  a  single  article,  or  of  each 
as  occupy  the  same  time  for  digestion. 

5.  Kach  meal  iihould  consist  wholly  of  fotwl  digested  in  the 
stomach  or  intestines,  and  tliCHc  two  classes  should  alternate. 


882 


HAHtTAL   OP  TRBATHXNT. 


6.  At  fin«t  littlo  fluid  »hoiil<]  b«  taken  at  meaU;   later 
use  of  Rolid  food  ahould  be  ctmt'muetl  an  long  as  [joMihle. 

7.  When  food  excites  wmgh,  or  congh  cause**  vomiting, 
meal  must  be  delayed  till  the  coujjb  ceasm^  or  a  audativ«  lutui 
given.     In  cane  every  attempt  «t  eating  causes  nausea,  vomidt 
or  cough,  feed  through  the  stoinnoh  tube. 

8.  Exercise  KhoulJ   be  continued  as  long  as  pOHsUile.  bik1| 
later  passive  exercise  shoulil  be  substituted. 

No  greater  t^'St  can  bo  mnde  of  a  physicianV  skill  tlian  iti  hij 
atteinjit  to  regulate  tlio  diet  of  jdilhiHtK.     However  tjan'Oitly  thl 
is  done,  it  will  be  found  nccc«-«ary  to  change  nimoet  daily,  an 
jwitieut  (juickly  firenof  any  one  article.    JCo  author  with  wl 
writings  we  are  conversant  mentions  the  meats  prepared  widi' 
vinegar,  and  yet  we  have  known  pig's  feet,  tripe,  laiiib'^  tonguM 
and  otJier  pickled  meats  to  agree  with  patients,  after  every 
form  of  solid  foo<l  was  rejected. 

It  Id  beiit  to  make  out  ii  n-gular  bill  of  fare,  not  nitoiring  an) 
article  to  appear  more  than  once  a  week,  niid  introducing  Dxrve 
ties  constantly.  Moreover,  it  i«  wine  tc)  kwp  the  piticnt  n 
ignoran**  of  what  she  ia  going  to  get,  until  the  mi-ul  if 
before  her. 

The  flu^odtion  of  Nikmhtkb  that  un  (^muhiion  of  uxl  Hi 
oil  and  malt  extract  should  he  given,  ia  not  a  good  one;  as 
oil  is  b&st  administered  half  iin  hour  alter  nioulft,  while  mal 
extract  is  only  active  in  an  alkaline  condition  of  the  t^tomaoh, aod 
hence  ii^  most  useful  given  before  meals. 

Tli(^   bi-iilirtnt  suggestion  of  C.\ST.isi.  of  introducing    the 
bacterium  tormo  into  the  lungs  iw  an  adversary  of  the  lubcKlaJ 
bacillus,  deserve^)  mention  mainly  because  there  seems  a  dispo6i-| 
tion  on  the  pn,rt  of  too  cnthusinstic  bacteriophilea  to  accept  th«| 
proposition  without  firet  calmly  considering  iie  merits.     Tw< 
things  ought  to  ))e  decisively  settled  before  »itch  a  method  is . 
enilly  adopted:  fiist,  whether  the  bacterium  tcrmo  it)  capable' 
destroying  the  tubercle  biiciilns;  second,  whether  the  first  nanwd 
micro-orgaui^m  can  with  safety  be  introduced  iuto  the  homau 
lung. 

The  first  question  should  not  be  difficult  to  sottlet.     Ii^ecti* 


mH-'RIST. 


883 


of  pure-cultures  of  l>»i.rtcriuni  Utriiin  Into  th«  liiiig!*  n|' tiibereuloua 
animals  can  ea-^ily  be  made  ;  and  should  be  made  beforii  lite  liuiuun 
subject  ia  uied  for  exiH^riuiciU.  The  )um-'»ii(1  ])r()|i«ti«Ui(m  hsA  in  nur 
case  Wen  aettlfd  bjr  a.  singular  accident  wliicb  bajujened  to  a  pa- 
tient, b^'  whicli  hia  rta()iratt>ry  trat-l  became  [xjojiled  with  bacteri- 
um termo.  The  result,  was  a  broiicborrhea  which  still  resists  all 
efforta  to  eure,  and  iu  which  the  «im(a  C(>ii»i«t  of  a  puiv^iilture  of 
bacterium  tcrmo.  The  patient  w  now  in  Texas,  iu  quest  of 
health. 

Far  more  in  acconlance  with  the  true  interpretation  of  tlio 
modem  germ  theory,  and  with  the  exiforiyiiL-c  of  every  age  and 
oountrj  in  the  tr<uitmunt  of  phtliiiiiK,  \s  the  application  of  the  ro- 
markahle  obeeiTatioiw  which  are  aunimamed  in  the  "  Hnttle  of 
the  Lflucocytcfl  and  the  Bacteria."  In  other  wordfl,  to  strengthen 
the  forces  of  the  system  in  their  efforts  to  throw  off  the  disease, 
is  the  task  laid  down  tor  ns  by  cliuicai  obsen'ation  and  by  mod- 
em science.  Aa  to  the  etTecta  of  drinking  warm  Wood,  lh«  most 
apt  illnstmtion  wc  have  ever  heard,  came  from  oue  of  our  patiente, 
who  said:  "I  really  belitive  it  would  have  cured  me,  but  I  be- 
came too  weak  to  go  to  the  shiughtcr  houae  after  it  any  longer." 

It  IB  said  tliat  many  yeam  ago,  the  faculty  of  Sicily  obtained 
the  paseago  of  a  decree  whii'h  compelled  tJie  isolation  of  phthisi- 
cal caiwe;  while  the  houiWH  in  whi{?h  Buch  (lasei*  occurred  were  va- 
cated for  one  3'onr,  and  thoroughly  cleansed  before  lieing  again 
occupied.  In  the  courwu  of  fifty  yeartt  this  law  fell  into  difiufie — 
becaiiRO  there  were  no  more  cases  of  phthisia. 

One  has  but  to  open  bin  eyes  to  tu*  the  evidences  of  the  eom- 
munit^hility  of  phthisis;  and  the  pi-oprioty  of  eomjielling  eon- 
sumptivos  to  sleep  alone,  and  to  destroy  every  particle  of  their 
sputa  cannot  be  rpie-stioned. 


PLEURISY. 

Tbabstxel  animadverts  in  forcible  terms  againet  the  expec- 
tant treatment  of  this  atl'ection.  The  antiphlogistic  method  of 
our  fathers  meets  his  full  approbation. 

In  the  beginning  he  generally  applies  eight  to  twelve  cupa, 
or  leeehft?  in  the  chao  of  children.    When  there  u  very  high  fever 


»S4 


MANCAL   or   TRKATMENT. 


And  vcey  rapidly  iticroosing  cfiu^ioit  ho  employs  TenesectiQn  to 
the  extent  of  six  to  t«n  ounces. 

To  this  h<*  ii3imlly  ndda  the  ndmiuistmtion  of  a  gmin  each  of 
digitalis  tind  calomel,  until  symptome  of  ealivation,  decided 
lowering  of  tlio  puli*e,  or  abatement  of  the  fever  oecnr.  If  aeveW 
gOBtric  coniplic-atioiid  oo-exiat.  M'  the  tongue  bo  thickly  fiirred,  if 
the  appetite  fuil,  or  if  diuHica  be  present^  these  drugs  are  oontim- 
indieatod,  and  must  bo  replaced  by  nitre.  This,  or  aoetatectfj 
pdtawfl,  may  be  used  from  Ihn  <mt«et  in  mild  chscb. 

If  mercury  amnot  be  give-n  by  the  htoinach,  ho  udvlsea  tho 
inunction  of  mercurial  ointment.     Fifteen  grains  are  to  he  rahbedj 
into  the  Kkin  every  two  liouni,  day  and  night,  until  the  symptomi-j 
of  salivation  appear. 

If  it  be  deumcd  undc»Lnd>lu  to  abaitrat^t  more  blood,  dry  cup- 
ping and  bliaters  are  a<ivian,ble.  The  latter  should  remain  but 
three  hours.    In  eeneitive  persons,  sinapisms  may  be  &ul>rtiriitod. 

These  applications,  may  be  made  from  the  first  when  the  at- 
tftck  i«  mild.  Tliey  may  bo  used  eontinuously  when  the  djaeaaej 
beoomee  ehrouic,  or  octti^ional  ebo«t  {>aiu>«  continue.  ]n  this  case, ' 
however,  flying  blisters  aro  best;  or  wc  may  p«int  Iho  nkin  with 
iodine.  The  u^o  of  cold  m  not  advi^ble,  beeautie  it  brings  OD 
fits  of  coughing.  But  atter  the  removal  of  thf  tlnid,  be  applies 
an  itxj-bladder  over  tlie  wound  for  a  day  or  two. 

Large  doces  <if  quinine  can  hanlly  have  any  good  effect  oo 
the  pleurisy.  The  adiuiiiii^l-nttion  of  diastiOS  in  moiit  succttdftfol, 
esjiectally  when  the  fever  begins  to  decluio. 

Emetics  and  antimony  have  been  rightly  discarded. 

Severe  ]»aiii  may  be  relieved  by  dry  or  wet  cup«,  by  a  blister, 
iinapimm,  rubbing  in  warm  oil,  with  or  without  hyoscyamu*,  and 
by  covering  the  side  with  cotton  wool  If  these  fail,  we  may  ap- 
ply warm  bandagc-i,  or  conipressai,  which  may  b«  renewed  every 
«ight  houre. 

When  the  dynpnea  le  caused  by  the  pain,  it  will  disapf^cor 
with  the  latter.  But  if  it  be  due  to  the  effusion,  we  must  thiok 
of  operative  mca*urcft.  We  must  never  give  opiatca  in  acutd 
pleurisy  for  the  dyspnea  and  in  the  chronic  form  the  dy»i»iie»  is 
apt  to  be  aggravated  by  tliis  drug.  Even  for  slcepleaaneea  it  modt 
be  given  uau  tiounly.    But  if  the  fever  and  dyspnea  are  not  enliauced 


n,ICDRISY. 


886 


opirnn,  the  whole  cotirw  of  the  attack  13  fiivorably  influenced 
by  the  ro6t  altbrtlcd.  Insomnia  may  M>uictimes  be  allcviatod 
by  putting  the  patient  in  a  cool,  quiet  room,  ami  taking  oare  to 
have  the  boweh  open  every  evening. 

Tf  the  congh  be  very  severe,  we  should  give  hydrocyanic 
ftoid  or  by<>»cyuinu9.  If  either  aboutd  fail,  give  morphine, 
hypodcrmically. 

As  long  as  the  fever  lasttt,  the  patient  must  be  kept  in  bed 
and  f<-d  on  milk  and  broth.  When  the  fever  aiibsidee,  egg«,  while 
bread  and  frtewcd  fruita  may  he  added.  Tf  the  effasion  become 
purulent,  or  if  the  pleurisy  bo  eecondnTy,  mtrat  and  wine  must  be 
given  ID  ei>ite  of  the  fever.  If  the  fever  have  (^uite  disappeared 
and  an  efiusion  remain,  we  may  give  the  diuretics,  though  they 
are  rarv^ly  effectual  unlesa  combined  with  tonicfl.  Decoction  of 
dnohonawith  acetate  ofpotaeaa  forme  a  good  combination.  But 
if  the  fever  nsippear,  this  muat  be  stopped.  Another  useful  com- 
binatinn  in  a  ]iill  of  murintn  of  quinine  und  fiquili,  one  grain  each, 
givon  tliroe  times  daily. 

ITr  disapproves  of  the  iodide  of  poUiAsium,  and  altm  of  the 
dry  diet,  eo  favoi-ably  mentioned  by  Nibdisyer. 

If  the  cffuMion  In;  ruducoil  to  a  iniiiinnim,  irnmpU'te  n-«tont- 
tion  may  be  obtaiiitd  by  a  prolonged  residence  in  the  higher 
Alps;  bccaut>o  the  mrelicd  air  compels  tlie  jtatiimt  to  take  fuller 
inspirations.  When  the  eflusion  is  eero-fibrinous,  hemorrliagic  or 
purulent,  it  -hould  be  removed;  by  puncture  in  cose  of  the  former, 
and  by  Jncidion  when  the  efl'uflion  ia  purulent  The  operation  i« 
called  for  when  there  is  danger  to  lilc  fn)m  suflbcation,  and  also 
when  the  eflusion  iu  ver>' large;  where  the  dulneas  is  absolute 
over  almost  the  whole  anterior  surface  of  one  aide.  Delay  w  then 
dangerous.  Kcmoval  of  the  fluid  is  also  indicated  when  the  ab- 
eorptiimof  a  motlenito  eflusion  is  long  delayed;  for  the  alworbcnts 
may  be  inhibited  by  prewturo,  or  delay  may  allow  caseation  of 
tlie  lung;  or  a  iibrinontt  i:iip»!ule  may  fonn  on  the  pleura,  which  will 
prevent  the  lung  from  over  again  exi»anding. 

The  fluid  should  be  withdrawn  by  the  aspirator,  using  a  very 
fine,  capillary  trocar. 

Unices  to  relieve  from  danger  to  life,  it  is  best  not  to  aspirate 
bcfoK'  the  end  of  the  third  week.    The  puncture  la  beat  made 


MAKUAL   OP  TREATMEKT. 


bctwi>on  the  mamniary  and  axillary  linen,  near  the  fornKr  jut 
above  the  tsixUi  rib.  On  the  right  side,  the  operatioii  sboold  bt 
done  above  the  fifih  rib  to  avoid  the  liver.  Bowihtcu  puQrtBW 
the  posterior  wall  of  the  cheat.,  betweeu  the  ninth  and  clevenlh 
ribB.    The  beat  jjoaition  for  the  pnticnt  is  the  gomi-rccumbont. 

Great  caro  must  bo  exercised  to  avoid  the  stigbtcdt  entrance 
of  air.  Xot  more  than  1500  cubic  ocntirootres  (SO  oano«fi)  should 
be  removed  at  once. 

If  the  pleuritic  effHsion  rioe  oontimioiiRly  nftcr  |iBnuvDtCitie, 
with  high  fever,  it  is  apt  to  be  purulout  or  hcmorrliagic.  The 
latter  i-s  usually  dae  to  liiberciilur  diHensc.  Tn  the  case  of  ODpy- 
cnift,  lids  author  prefer*  the  operation  by  iucisiou,  if  a  single 
aspiration  hat;  confirmed  the  diagnosis,  removed  50  onnoos  of  poa, 
and  has  yet  failed  to  cure. 

The  inciitioii  should  he  made  in  the  Maine  fii<ai-e  a^  the  punc- 
ture, midway  between  the  ribs;  and  drainago  cauulw  introduced. 

LooMis  says  that  the  only  remedy  which  seems  to  have  any 
control  over  ncote  pleurisy  U  opium.  !JIf<'ding  does  twt  givo 
any  more  marked  relief  than  a  hypodermic  of  morphine,  and  is 
otherwiflc  very  objectionable. 

All  that  is  necessary  iu  ordinary  casefl  U  to  put  the  jMUieat 
in  bed.  The  room  should  be  well  veutilntetl  and  kept  »t-aadily  at 
65°  F.  The  imtiont  may  lie  at  ease,  rau>((  not  talk,  nor  move 
unnooeesarily,  and  must  have  nourishing  fr>oil  but  no  etimulantB. 
He  may  have  a  few  loofhcs  to  relieve  pain,  if  he  be  strong  enougli. 
After  the  first  week  the  iur»rphine  may  be  diwontinued,  and  the 
patient  may  sit  up.  He  can  resume  his  occapatioa,  if  not  too 
laborious,  in  throe  weeks.  Some  pain  will  bo  felt  aftsr  actlTa 
exertion.  If  anemia  3>ersi«t,  the  syrup  of  iodide  of  iroD  abonld 
be  given  in  drarhm  doMett,  three  or  four  tinitut  a  day.  Couolcn^ 
irritation  is  rarely  of  service. 

Tho  conatant  current  somettmeei  give^  s|>eedy  relief  to  pains 
persisling  after  recovery. 

Iu  Bub-acute  pleurisy  with  cfTusion,  the  main  object  in  to  rfr 
move  the  tluid  as  soon  m  possible,  aud  at  the  same  time  to  sustain 
the  strength.  All  Ihc  cvacuants,  bydragogutt,  diuretics  and 
diaphoretics  he  lays  aside  as  iiaclees.  The  most  powerful  reme- 
dial agent  in  his  hands  is  the  iodide  of  iron.     Wi<h  this  he 


H 


PLIITKI8V. 


887 


gives  the  largeet  umount  of  tlio  raorft  nutritious  food;  and  »lco- 
holit;  ittiinulAnte. 

Ill  any  caao,  wbcrc  the  flnid  remain*  sfntionary  for  one  w<,'«k, 
or  is  increasing  al't«r  the  cavity  has  become  half  filled,  or  espe- 
cially wh«n  it  is  full,  there  should  be  no  delay  in  aspimting.  ITo 
rccouimeiids  a  enuill  needle,  and  Btn|w  the  flow  when  a  wnse  of 
couRtnctiou  about  tlio  ehcst  is  felt.  Tn  n  few  dny»  the  operation 
may  be  repeated. 

Ill  empyoma,  lie  aApimteiii  with  a  large  needle,  and  romoTM 
but  a  mnal)  (juautity  of  the  ptid.  In  three  toftix  daya  ihe  npurution 
IB  ri?|*ated,  a  little  Inrgpr  ]x)rtji>ti  beiritj  r«*m(>vi*d.  The  aspiration 
must  Iki  duM-tiiituiued  the  moment  dyspnea  in  felt.  If  the  treat- 
ntont  bo  prosperous,  the  fluid  will  at  each  n.>inova1  appear  thiniier 
and  less  purulent,  and  tht-  cbost-wall  will  potract.  If  the  fluid 
beeonie  thicker  anil  offwisive,  a  ]»erinanont  (ii»euing  tOuiuld  at  once 
be  made.  In  empyema  with  jiyemia  or  septicemia,  also,  a  free 
opening  should  be  maile,  an  the  awiminlation  of  pu«  will  exceed 
the  amount  removed  by  the  a^pimtor, 

Thcopciiiiig  should  be  in  the  B.tilkry  Hue,  in  the  sevcntli  or 
eighth  intercostal  spate.  A  quarter-inch  rubber  drainage-tube 
should  be  iiitroflut'ed  and  fa.-»tcncd  securely.  If  there  be  too  little 
apace  beween  the  rilw,  a  portion  of  one  may  be  removed.  Double 
drainage  is  mrely  tt<lvi«ible.  He  disapprovcA  of  washing  out  tho 
cavity. 

Tlie  diet  mnf^t  be  nir>st  nutritious,  with  moderate  atimulation; 
iron  and  qtunine  are  always  indiuated;  cod-liver  oil,  if  tolerated. 
The  patient  must  be  kept  in  the  o|)on  nir  and  a  chuiige  of  climate 
is  beneficial.  Tlio  majorily  of  empycinic  children  will  recover  if 
aspiration  Iw  [wrtbrmcd  early,  and  often  rcpcnteil. 

Li  most  adultA  a  permanent  opening  is  necessary. 

Li  adhesive  pleurisy  the  nu)«t  important  point  i«  to  improve 
the  nutrition.  In  feeble,  broken-tlown  ftlcoholic^cases,  cod-liver  oil 
and  the  hypoposphites  are  indicated;  while  in  gouty  subjects, 
inin  :ind  the  niini-nil  acids  are  preferable.  In  all  cHiie.<«  C0TT0»ive 
gnblimate  in  minute  doaea  will  prove  beneficial.  Climatic 
condition-*  an*  very  important  and  as  a  rule  a  high  altitude  with 
a  warm,  dry  atmosphere,  such  as  that  of  New  Mexico,  will  be 
found  most  favorable. 


S88 


XAHtlAL  OP  TRHATMEMT. 


Tlie  best  external  application  to  the  chert,  is  the  oleate  tf 
mercury,  continued  a  long  time,  but  avoiding  saUvatiou. 

Davis  .tayrt  thai  the  first  iDdiojition  U  to  relieve  the  vasculir 
fiilliieBs.  For  this  lie  ailviNes  venesection  in  i«uitable  ca^ 
folldwoci  }ty  Teratrtim.  or  aconite,  ^Wvu  in  auificicnt  doecs  to 
obtain  a  sedative  effect  beibre  reiietioii  fmni  tlie  bloeding  hu 
taken  ^ilaw.  To  i-elievc  the  p»iu  and  i-eatlessueas,  opium  should 
be  given  alternately  with  tho  setiative  mixture. 

S     Murpbiiu*  Hul|>k,, p.  ( 

UyilniV.  dilur,  milUy xr.  j 

Sodli  liitarb, gr.  t 

SsRcli.  alb.  jHilv.  q,  0. 

M.  S.    To  be  taki;n  crery  lUn*  or  feiirboun. 

When  the  skin  has  beeomu  moiitt  and  tlie  pulse  ttofter  and  Oi» 
local  AignB  are  favorably  modified,  the  eedativo  tg  giveu  lew 
jjncqut'Dtly  and  the  pitwd^ird  repliu^>d  by  valine  laxatives,  ituffident 
to  produce  a  moderately  five  movement.     He  then  oixlere, — 

B     Bp.  cthfirlx  uitrvi., 

L!i}.atnii]uni»«oelai, 

Tina.  oi>u  cnmph U     T)  g 

Tinct.  digiwlii^ fj  j 

M.  S.— .V  teaapoonful every  ibree  baan. 

A  doBe  of  Uie  iiomjioiiiKl  ]>owdor  of  opium,  ipecacuanha  and 
nitre  nmj  be  given  at  hed-timc. 

In  i'nim  three   to  tivo   dny«  the  patient  ie  oonvulefu-ing,  i 
requires  but  little  more  eare  except  to  avoid  expownre,  euU'iaf' 
mild  diet,  and  avoid  active  exertion  until  the  ntrengtU  has  returned 

To  insure  iinccc.'w  Ibi^  ti-eatment  ulionhl  !«•  romnipncwl  within 
twelve  to  eighteen  hours  from  ilie  beginning  of  the  ailjick. 

But  if  on  the  Bccond  or  third  day,  the  pain  nn  full  inspir**! 
tion  is  Rtill  •^uite  ^harp.  the  tevi-r  high  luid  the  effusion  markeilf  j 
ho  applieii  a  blister  to  the  affceted  part.  In  the  milder  caoaodn' 
venesection  may  be  omitted. 

When   the  ciise  is  not  seen  within   the  npecifie<I   time,  he  i 
advises  a  saline  laxntive.  and  the  di^italiti  mixture  given  «boT«i,j 
with  live  gminii  of  iodide  of  potasaium  added  tu  each 
The  blister  should  be  reapplied  evurj'  lour  day*. 

AVhen  thccBimioo  causes  dyspnea,  tlie  aspirator  should  bo  i 


PNKrUOMlA. 


889 


it 


PNEUMONIA. 

LooMlsnays  that  sny  plan  <•!' treotincnt,  rcHOrtwi  to  indiflcrim- 
inately,  will  ppove  unfMitisfnctorv.  Although  a  large  riPO[)ortioti  of 
cases  will  recnvorwiUmiit.  trcjilim--nt,yot  wkU  dircdtud  thi-rapeusis 
will  save  Uvea  and  haal«ii  reco%'ery.  Tlie  general  eomlition,  and 
not  tbe  Iik-hI  changes,  ^vi^ni  tliv  treatment.  lie  ilifciinlH  all  t^r- 
diac  aeilatives  from  veneseetum  down  to  nitre.  They  lower  the 
fever,  but  weaken  the  heart.  Bli^itcn  arc  injurious  in  the  early 
fltagcs,  but  may  be  used  in  the  third  litage  to  hasten  re^^olution. 
Very  severe  paiu  at  the  onset  may  be  relicve<i  by  loochc*  or  poul- 
tices, if  the  pittient'd  strength  permit.  It'  grout  (edema  occur,  dry 
cups  dispol  it,  and  relieve  the  dyspnea.  The  flannel  jacket,  -oTcrcd 
with  oile<l  silk,  doea  not  uhorteu  tlie  diwade,  but  is  grateful  to  the 
patient. 

Abrioltite  reet  u  im[tortaiit.  If  heiirt-railure  threaten,  talking 
or  flitting  np  in  hc<l  nnist  not  be  ellowud.  The  room  nhould  be 
wel!-ventilaUHl.  aud  ke|it  at  6a^  to  70^. 

The  food  should  be  highly  nutritious,  and  tluid  or  semi-fluid ; 
BDch  as  milk,  &g^,  and  thiuk  bi-oth. 

The  nervous  shock  is  very  great:  and  for  this  reawn  the 
patient  whoidd  W>  Itmnght  under  Uie  intluerioeol'opinm,  by  hypo- 
deniiiot,  and  held  there  in  eorafort,  until  intiltrntiou  is  uompleto; 
ustmlly  for  four  duyx.  The  opium  should  then  be  discontinued. 
Alcoliolf  judieiously  used,  la  the  most  efficient  agent  to  prevent 
death  from  heurt-failuii*.  In  the  rdd  and  feeble,  and  in  those 
accustomed  to  the  use  of  stimulants,  this  drug  may  be  required 
fivm  the  ntarl.  Hut  in  no  diwase  m  there  re(|iiireil  ao  much 
diacretion  in  the  use  of  stimulants.  The  quantity  required  is  to  be 
itimnied  by  its  eflect  on  the  pulae.  A  frerinenl.,  feeble,  irregular, 
termitting  or  dicrotic  puW,  calls  for  stimulanbu.  niey  are 
usually  rotiuirud  after  Oie  crisi.s.  Delirium,  muMcukr  tremor  and 
subflultus,  andcritienl  collapse  also  call  for  their  free  use.  He  does 
Dot  look  with  favor  on  ammonia,  camphor,  or  nmuk,  and  givee 
digitalis  only  when  renal  congestion  etiBties. 

Kordoes  ho  favor  the  use  of  cold,  for  Uiu  puquwe  of  reducing 
fever;  though  cold  sponging  may  be  allowed  if  it  give  relief. 

He  givi»  quinine  the  jm^ferenec  am  an  antipyretic,  believing 
that  this  drug  is  an  arterial  sedative,  that  it  is  a  tonic  to  capillary 


890 


MANUAL   OP  TKRATMKirT. 


circulation,  and  that  it  arrests  cell-derelopment  and  chocks  tho 
amajboid  movement  of  the  whit*  blood  colU.  He  gives  too  or 
fit^o  grains  lit  one  dow,  and  object*  to  larjcvr  amounts. 

For  rcatloiisness  or  wnkofnlno^  in  tlic  tbinl  t»tagc,  he  rwom- 
monda  chloraL  If  Hi^  cough  bv  diatrewing  he  gtve«  fivc-graia 
doBOa  of  rlilornl  with  niio-twoutieth  of  n  grain  of  mnrphioe;  or 
tweiitjr-five  An>]>st  nf  chlorodyue,  every  two  houra.  To  «UmuUt6 
expectoration ,  sencg^a  nnd  turpentine  ai-c  ui^cfal ;  but  if  the  fjntk 
be  tough,  thi'  iilkulieA  should  be  subelitutod. 

For  the  relief  of  the  dpliriuni  of  chronic  alcohntisin.  Uiti> 
UOny  and  digitaliii  are  recommendod  by  English  atithoritles. 

Tn  the  first  ntsgo  of  w>nile  piifunionia,  an  emetio  "f  ipeoto- 
uanha  is  given  ut  the  "Salptlritre."  Xitrat<?  of  {votasaa  and 
chloride  of  ammonitim  are  also  recoin mended. 

Ill  rhildrc'ii  the  chext  mhould  bo  protected,  and  the  diet 
regulated;  but  leeches  and  bUstem  should  never  U*  employed. 
Stimulating  expectorants  are  often  indicated,  and  the  moderate 
use  of  Rtimnlantji  iu  fcehlt!  children  is  always  ivtjiiin'd.  Daring 
convalescence,  iron,  rjuinine,  cod-liver  oil,  and  blood 'inakin;;  wines, 
should  be  given.  When  aseptic  elenientu  exist,  the  sulphites  are 
rcconinieiidcd  in  doses  of  twenty  gmiiis  every  three  hours.  Bot 
the  antiseptic  treatment  of  pneumonia  has  not  yet  awnimcd  a 
definite  aspect  or  been  sufficiently  tried  for  any  definite  statenioutfl, 

Davis  claimH  tliat  a  careAiT  exaniinatiou  of  the  results  ob- 
tained during  the  lust  half  century  show  tlint  in  the  fintt  HtAge  of 
the  in!tivi_'  rillicnii;  grade  of  pneumonia  one  prompt  and  ducisivo 
venesection,  followed  by  cardiac  sedativa*,  ha;*  Invn  follnwe<l  by 
die  higluMt  ratio  of  recoveries. 

In  tlie  same  t-tiiLie  .if  weakly  or  malarious  ca«es,  fmin  three 
to  five  gniina  of  quinine,  given  every  two  or  three  hours,  iilter* 
lutting  with  a  mild  uircliac  »eda(tve  and  altenmt.  will  often  avt  at 
efficiently  as  bleeding  in  the  first  class. 

In  caHCs  occurring  in  the  comlttion»  which  give  rise  to  typhoid* 

it  is  more  diiEcult  to  adjust;  the  i-emediea.    Depletion  is  iiguriciiis 

and  quinine  fails.     For  these  cano^  ho  orders: 

B     Quiiiinw  ^uItiIv, f '- ^U 

IlTilmric.  clilntiil.  niitlai -RT.  j 

1'iiIt.  bBngiiiimrio.-, . ..  ....•..,*,, S'-B 

Pulr.  g\yijTrbiiw., ft-i 

11.  Sl^Td  b«  ^ivcD  cvei7  four  hoan. 


PMECHOHIA. 


3dl 


Between  these  is  given — 

A     U«i.  aiumoall  w»Ut., .....f  J  U 

Tinct.  Oftii  camph^ '3U 

Tiod.  iiL-ttiiiii  rnij., ..f5j 

M.S. — A  IcMpoonfiil  every  roQT  honra. 

A  poaltice  is  applied  to  the  afleuted  side.    If  the  skit)  be  hot 
and  dr^',  it  19  sponged  with  milk'Wurra  water.     When  six    pow- 
ders have  been  taken,  if  the  bowel*  huvc  iKft  moved,  they  shoold 
be  ikcled  uiMHi  by  an  enema  or  a  mild  laxative. 
I  In  the  exmlative  stage    the  poulticta  should  be  continued, 

I     and  s^nietiniu)  a  blister  addeil ;  white  the  following  may  lie  given: 

■     may  I 


R     Ammonil  chloriJ., 5  lU 

Antifiiitnii  m  pctium.  Url. ^.  ij 

MoqiIiit>r  Kul|ih., .jcr  itj 

Bjr.  gljc^rrliiw^ f  5  »' 

kf.  S'^A  IckiiMMinlul  to  no  adult,  evtrj  ttircv  or  fciiir  hoiin,  in  a  Uul«  maXtt. 


If  the  urine  be  scanty,  a  dtorctic  mixture  like  the  following 
may  be  given  altvraaloly  with  tlie  above: — 


B 


Lirj.  amiuoQ.  scetaL, .....f  j  j 

8p.  etiieri*  nitron., f|j 

Tinct.  digital  k, fjrt 

If.  B^— A  Icupoonful  ever/  fi>ur  bouni. 


f  In  moirt  eases  from  three  to  five  grains  of  (|ainiDO  may  be 

I  given  with  benefit,  three  times  a  day,  until  eonvalewenco.  When 
nnivcival  i'iig<irgomeiil  of  the  lungs  follows  Ihe  initial  cbill,  with 

I  a  piirplii?b  or  leaden  hue  of  the  akin,  short  and  hiimo<l  breathing, 
small,  frecjuent  and  wt-ak  pnliie,  coo)  extremities  and  high  fever, 

I  venMoetion  should  bo  prnetivcd  at  once.  At  the  same  time  ten 
grain.-*  nf  quinine  Khonld  be  given  every  twn  hours  until  tliree 
doses  have  been  taken,  and  than  relocated  every  four  honre. 
With  this  erg^tine  nhould  be  altematud,  in  three  grain  doaea. 

Hut  if  the  venesection  fail  to  obtain  more  than  a  few  drac-hnu 
of  dark  blood,  the  whole  body  Kliould  W  wra]i|)ed  in  a  wet  pack, 
and  the  remedies  given  as  above.  When  the  Bret  crisiii  haA  [KaMW^d, 
Buch  caaea  are  easily  wmtrolled  by  llie  usual  remedies. 

In  the  lajii  of  the  Kecond  or  in  the  third  stages  when  a  quick, 
weak  pulse,  short  and  quick  ayatollc  action,  a  dingy  akin,  dull* 
new  on  pcrcuiwion  and  abundant  mucoua  riileii,  thin  itpnta  mixed 


89S 


MANUAL  OF  TBBATHEKT. 


with  blood,  or  mtico-punilent,  expiration  short  and  the  mintldall, 
drowsy  or  waudcring,  ho  up^liee  a  blister  to  tho  vht^t,  and  giva 
tbo  following : — 

B     Potiiee«  clUorau, S  ^m 

Aciaruv  pulv. 5  ■* 

Aqim, r  j  nu 

H.  S.~~A  ublcspoonriil  evcrj  ihn*  houn :  vlth  three  gniia  «t  qHiaii 

This  18  alternated  with : — 

B     L^. antnonuB  Bc«t«t, r •' S 4 

TiBM.  digiuL, u-rsi 

Aniruuiili  carbit.  ■ S  'J 

If.  8.— A  Inupouiiful,  diluted  with  ooe  ounce  ot  tTeeicaeil  water. 

At  the  same  time  he  orders  oue  or  two  oudcos  of  milk  and  k 
tableapoonful  of  stroug  cotfee  to  ho  giveu  every  two  hours. 


Bartholow  affirms  dial  the  oxpoctniit  plim  is  greatly  nior» 
euccoaslul  than  that  by  blood-Iettiat;  and  tartar  etnotio.  During 
tlie  iirst  stiige  he  gives  a  scruple  of  quinine  imd  linlf  a  grain  rif 
moqjhiiie;  applies  leeches  or  cu[)s  to  tlie  side,  and  ailininistera 
two  drcipH  of  tin<;titre  nf  iwonito  root  every  two  hours.  A  lai^ 
siuapism  should  be  a]ipIiod  to  the  chest,  and  the  feet  immoDted  in 
a  hut  mtiKtfird  foot  batli.  "Wlien  the  quinine  has  been  absorbed, 
au  active  purgative  ahouH  be  given. 

To  Iwsen  the  viMcIdity  of  the  exudation  he  givee  tivo  to  t«o 
graiutt  of  carbonate  of  ammonia  in  a.  t«hleB[>noiiful  of  tlie  ^irit 
of  the  acetate,  everj'  three  hours.  This  phould  be  continued  np  to 
the  crijtig. 

As  Hoon  a»  conxolidation  has  been  completed,  all  arterial  sed- 
ativea  must  be  taid  aside.  The  nm  of  antipyretics  then  heconwa 
nwfssiiry.  Tlic  author  iptotcs  Jdekokkskk's  remarks  on  the  n»e 
of  cold  baths,  but  docs  not  exprcsit  any  oi)iuion  upon  tlu 
icafturcL  !Ncxt  to  the  bulh,  quinine  is  most  useful,  in  doses  of 
twenty  grains  every  four  hours,  until  tlie  tcmiieruture  in  rcxiaoed 
to  a  pn)[H.-r  [wint. 

If  there  be  much  depreaeion,  quinine  may  be  givtm  during 
atagu  of  red  hepatization,  in  doses  of  three  graina  every  three 
ionis ;  and  suitable  amounts  of  stimulants  udmiuistercd — lulf  to 


PNEUMONtA. 


S98 


an  oancc  of  whlBky  every  tliree  hours.  Wbeii  the  criais  up- 
j>roftche3,  the  utnioet  earo  is  iicce8«iry ;  unJ  Buitiiblo  uUmont  and 
stimulaDte  niAy  then  save  life.  He  apoakii  etii{>hatiL*ully  uu  the 
evil  efl'ectfl  of  cardiac  Bodntivos  during  tliU  stiigc. 

The  imniodeniie  use  of  »«iiiindiuitA  is  nr)  Iumi  to  be  avoided ; 
these  uro  needed  in  full  doum  in  inebriates  at  crisis,  and  when 
the  stage  of  purulent  transformation  l'oiium  oh  with  weakiiesa  unil 
delii'luui. 

Protracted  wakcfnliie^saml  ileliriuni  dtunuiul  chloral;  filtceu 
^rairiK  at  night,  and  teu  grains  mora  in  two  to  four  hours  if 
required. 

AUraeiit  rauat  lie  administered  carefully  from  the  Ijeginning. 

Bcef-Juivc,  milk,  cgg-flipt),  wine-whuy,  4.rhiL>keit  or  muttoii 
broth,  should  bo  given  every  three  hours.  When  tlie  crisis  occurs, 
a  blister  ir  very  uHeful.  T>uring  red  he]Mttir.Htioti  a  flannel  jacket 
is  oaetiil  unless  the  fever  is  very  high.  Flying-blisters  promote 
ahnnrptlon  when  reiw>Iur.ioi]  i»  imperrecl.  ludidu  of  aninionium 
aids  in  the  same  condition. 

When  pniiitsjuice  Hputa  ajjiear,  witli  weak  pulM',  and  relaxed 
and  swejitijig  akin,  taq>entiiie  or  eucalyptol  is  extiiemely  uecful. 

RoBBBTX  does  not  apiirove  of  blood-letting  except  for  the 
relief  of  sudilen  npncui.  T,tM-aI  bleeding  may  l>c  u^^d  to  iiiitignta 
gymptonis.  Tartar-emetic  in  decidedly  Bcrvieeable  when  the 
patient  is  strong  and  pleth<iric.  One-fourth  to  oiio-half  a  grain 
every  four  lioun*  is*  enough  for  au  adult. 

Stimulants  are  uititit  valuable  in  certain  rn^es,  characterized 
by  delirium,  rapid,  weak  or  dicrotic  pulse,  adynamia,  collajia©, 
low  nervous  s^inptom?i,  in  the  old  and  feeble  and  in  secondary 
pneumonias.  In  all  low  forms  of  this  dbkase,  the  only  chance  of 
recovery  lies  in  free  stimulation.  At  the  eome  time  full  doses  of 
ammooia  with  cinchona,  ether,  camphor,  and  musk  must  be 
given. 

Palvbr  claims  that  if  the  psitient  be  rapidly  brought  under 
the  influenco  of  opium,  the  diseaAe  will  Ik*  arretted  in  many  caaM. 
A  mild  cathartic  ami  oUminative  will  complete  the  care.  He 
adds  to  the  opiatt  Itii  (jraios  of  qtlinine.  The  latter  is  rejicated 
every  two  or  three  hours,  until  thirty  to  Vixty  graius  have  been 


894 


TAL  OP  TREATURKT. 


taken.    When  trcnlinuitt  U  commeuced  after  cotiaolidatioa  baa 
occnrred,  the  quinine  should  be  given  without  the  mori>hin«; 

Juyrgi'iiKOo,  taking  afroug  ground  iii>on  the  classification  of 
pneumonia  as  an  etviential  fever,  dei)i(»  the  possibility  of  abortlog 
the  diM-ase.  TXath  i-caults  priiiciiwilly  fp>m  faihire  of  tbeh^ort-, 
and  to  avert  thin  i«  the  chief  aim  of  ti-catnicnt. 

To  prevent  cxhausliou  of  the  heart,  the  fever  is  the  first  point 
of  attack  for  treatment.  For  this  ho  rcconitnotid^  the  cold  bath, 
repeated  as  often  as  the  tcmiwrature  reaches  104°  ¥.  The  darar 
tion  of  the  bath  sliouid  dejicnd  upou  the  effect  produced,  and 
varies  from  seven  to  twcnty-fivo  niinutee. 

For  aged  or  tat  persons  lie  prefers  n  tepid  hath  of  twenty  to 
thirty  minutes,  from  four  to  seven  o'eloek  iu  Hie  morning.  TTa 
effect  may  be  continued  by  the  use  of  quinine.  The  bath  may  be 
repeated  nt  otlier  hoiins  if  necessary. 

AVitb  young  ehildrcn  the  wet  sheet  may  he  substituted. 

In  perm-uto  eiuieis  witti  a  lem[H>ratiii-e  above  105°,  tiie  ballis 
mtwt  be  redueotl  to  41*-  Stimnlant-s  must  be  administered  in  all 
caseti  befoiY!  and  after  ttie  Uitlitt,  and  when  very  cold  water  i« 
used  the  amount  of  stimulants  should  be  increased.  Thi»  tt 
particularly  noccswiry  after  the  batli,  betiuwe  the  cooling  proceei 
continued  fifteen  minutes  or  longer,  mid  is  apt  to  produce  aymp- 
toms  of  eolla[)se. 

In  cases  of  modemte  eeverity  he  gives  one  or  two  tahle- 
epoonfiils  of  re<l  wine  before  and  after  the  bath,  but  when  fliers 
IB  the  elightest  sign  of  heart-failure,  he  pnefcn*  port,  i\[adoira  or 
champagne;  one  to  three  tablc»[)oonful8  before,  during  and  afler 
the  bath. 

Witli  the  bath  ho  always  gives  qtunuie,  in  a  single  doee  <^ 
thirty  grains,  between  6  and  8  p.  M.  For  children  he  uaca  a  grain 
and  11  half  fur  every  year  up  to  five,  and  after  that  fram  seven  to 
fifteen  grains.  "When  the  fever  is  intenfio,  iscventy-*even  graios 
may  he  given  to  an  adult,  and  fifteen  grains  to  a  child  under  ona 
year,  alwaj's  in  n  t^ingle  dose.  Such  doises  are  only  proper  when 
smaller  ones  have  faiEed. 

JIiH  formula  for  \t&  adniinielration  is  as  follows: 


B     Qiiiiiinirkiilpli, 

Add.  hyd  roc h  tori ci,  q. 
Aijuacdflat, 


.gr.  zzz 


.fjyi 


FKRI'MOKIA. 


Sits 


If  thia  dose  be  vomited  within  lialf  ati  hour,  it  t'lionld  Ijo 
rei>eated.  But  vomiting  iii»v  uxually  bi;  prcvciik-d  by  directing 
the  patittit  to  b«ud  tbnvanl  ncid  allow  the  saliva  to  rtm  out 
of  the  motitli.  Small  ]»i«ew  of  ice,  KWHllowi'd  when  nausea  is 
first  felt,  will  often  prevent  the  vomiting;.  Korty-eigbt  hours 
flhould  be  nllowcd  to  elapse  before  »  second  dose  in  adminUtered. 

If  the  patient  will  take  food  at  all,  he  gives,  Bcveral  tinien  a 
day,  some  ran*  i«;nip<il  moat  wilh  hrvudiiiid  biit(er,aV)otit  an  hour 
aAer  the  l»atb.  He  nt-ver  lbri;e.*  it  iijion  a  patient.  In  severe 
e&nen  he  insiHtti  iip<pn  the  ]Mitii>nt  taking,  in  tttiuiU  doM(-:(,  a  titrang 
bouillon  with  one  or  two  e'^g^  daily.  Milk  should  also  bo  given 
ID  suitable  quantiiitjM.  An  ailnit  should  take  fmm  half  to  onii 
bottlt  of  light  wine  daily.     lie  may  rtUi>  liave  bet-r. 

For  pain  and  pleepleBanGss  ho  gives  one-fiixth  to  ono-qnarter 
^rain  of  morphine  hypodennically.  When  in^'Mniiiii  n-niU-'*  from 
the  cnexi«t«ni-o  of  di'liriiini  trementt,  he  give*  chloral,  up  to  two 
drachms,  if  smHltcr  dosoa  fail.  In  fobrile  cases  we  should  always 
give  wilh  this  dnig  a  done  of  dibit*-  hydrociilonc  iicid,  to  prevent 
deccimxwitioii  oC  the  L-bloml.  Nor  should  wo  forget  the  uw  of 
cardiac  Ktininlanta:  without  wliich,  energetic  medication  Hhoiild 
not  Ik>  adopted.  TIo  lays  tho  j^roatost  stress  u[)on  the  importanoe 
of  watching  for  the  nignH  of  cnnliae  wi-nlcneMi.  'Hicse  dyniptnnid, 
culminating  in  eodema  of  tlie  lungs,  hf  diw^  nut  treat  by  veneiteo- 
tion  as  Xilmkvrr  advi-^cd,  bnt  by  the  hold  admiiuxtnition  of 
stimulant* ;  hucIi  as  four  ouucea  of  jxirt  or  Maileim.  or  in  severer 
caMca,  three  grainn  of  t-amphitr  evcTy  two  bouit*.  If  tlic  Mynijilonis 
continue,  he  gives  the  camphor  every  hour  and  a  tablespoonfid  of 
strong  wine  alteniatcly  with  It.  Shonld  HiidiEcn  and  severe  eolljipse 
ensue,  he  gives  two  grains  oi'  mttsk.  with  an  ounce  of  cliampagiie, 
every  ten  to  thirty  miunteN.  until  impntvcnivnt  occum.  MukIc 
act*  more  quickly  than  cnmpiior,  but  the  ett'ect  of  the  latter  ia 
longer  felt.     It  may  hi;  given  Iiypoderaiically,  with  olive  oil. 

Even  more  rapid  is  the  effect  of  Iiot  frog;  crjual  parts  of 
liquor  and  hot  water;  a  tahleajioon ful  every  ten  minutes. 

As  t<t  the  propriety  of  Hiding  the  baths  after  such  an  attack  of 
heurt-faihirx!,  Lu  suys  that  unless  the  eoUajise  be  extreme,  most 
pationtB  can  bear  the  abstraction  of  heat  very  well,  pnn-ided 
sufHt^ient  care  be   used   in   the  choice  of  stimulauta  and   ia  the 


tom|iomtiirG  of  the  l>aths.    Quinine  in  largv  iloftoit  u  Uilented  U^ 
all  cu5«d.    It  must  never  be  turgotten  that  the  moi^t  daogerooi' 
«nemy  to  the  heart  i»  the  fovcr,  and  that  this  may  be  «afely  and 
quickly  lowered  by  bathing. 

Collapse  is  apt  to  occur  sufldetily  at  the  crisis  or  u  few  dayia 
aJ^envnrd^.    Thcitc  !>ympt^>nu  gottcmlly  di»uppocr  ApontaneouslyjH 
but  are  sometimes  dmigemns.     They  are  less  apt  to  iKx-tirif  rh«" 
■use  of  a  light  wine  be  wjiiltriut'd  six  days  after  defen-iswun!*. 
Tlio  attendants  should  be  taught  to  look  for  Ibis  oecanvnoo  and 
to  udminUitf-r  the  »Iiii)uhintK  mentioned,  when  they  are  ticedt-d. 

Convah-secnce  should  be    promoted  by  the   us«  of  abunihuit 
albuminous  food,  by  eautioii  in  the  us«  of  beer  and  \vitiL\  and  by 

the  use  of  iron : 

I 

B     P«rri  rxJul., 5  V 

Est.  dnehotui, 3  m 

PuIt.  cinnnmomi,  q.a, 

M.    et  in  |)iL  iiu.  c  ilir. 

B. — TUrtu  pill*  thi««  liintB  daily,  ton  ttinutM  aft^r  eating. 

By  the  adoption  of  this  plan  of  treatment,  Jukrhesskx  fon 
that  Ihe  mortality  in  400  caseit  wan  one-half  wtiut  hud  ntvurrcd  i 
a  like  number  treated  hy  other  methods.  He  ap{iend«  a  i^la< 
Rhowing  that  in  200  cases*  treated  by  him  at  Kiel,  there  weiv  34 
deaths.  Out  of  tliix  latter  lunnlier  there  was  searcely  one  in 
which  recovery  could  reasonably  have  been  hojted,  as  the  disease 
was  the  terminus  of  aincer,  gangrene  or  tubercle;  or  else  mi 
complicated  with  abortion,  delirium  tremens,  meniugltia,  acuta 
rheumatism,  or  old  age. 

Most  of  the  German  physicians  speak  favorably  of  the  applU 
tion  of  ice-bags  to  the  cliost.     Zikmasrn,  Nikhetrr  and  WsuE 
wor  this  mcaaurt. 


TTARTSitORUB  says,  that  six  out  of  ten  eases  in  pre\nouBty 
bealthy  [►ei-soiis,  betweim  twenty  and  lit'ly  year*  of  age,  may  be 
roasonably  expected  to  die  under  the  following  plan  of  practiee, 
viz:  truatirig  them  fnim  the  start  with  twt^ity  grains  of  quinine 
daily,  iialf  an  ouneu  of  whiskey  every  two  hours  and  a  quartac 
of  a  grain  of  morphlue  every  nix  or  eight  hount  J 

If  any  recover,  it  is  due  to  the  hot  poultices  applied  to  tha 
cheat 


1 


PHBUHOKIA. 


8»7 


Eight  out  of  len  of  the  euao  casw  will  recover,  if  buforc  Uie 
third  day  a  few  outioctt  of  bIo*)d  be-  drawn  from  the  arm,  or  by 
lc«chM;  ft  «aline  diaphorotic  given  i-vory  two  botm,  in  the  most  vio- 
lent cases  ono-sixteenth  to  one-twell^h  of  a  grain  of  tartar  emetio 
every  four  hours  during:  the  first  few  dayi*,  but  not  allowed  to 
cause  gastric  dicli-ess;  a  wanii  i«>iittico  being  kepi  over  the  whole 
front  of  the  ehost  till  tin?  worst  i*  over. 

In  our  opinion,  neither  of  thf  above  inethode  woold  1h!  necc*- 
flsry  in  such  nism.  We  give  scarcely  any  inedieine  in  ordiitary 
cases,  but  keep  the  patient  quiet  in  bed.  mnisten  the  air  well 
with  Klt^iini,  t'arefully  alttrnd  U*  ftxtling,  but  not  willi  niw  ment! 
We  prefer  hot,  rich  sonps,  milk  and  eoti'ee.  The  IkiwcIs  nn-  kept 
open  by  I  he  nee  vf  oitnttt;  of  niugiiiMlu,  and  the  Iiejirt  is  nirefully 
watebed  for  signs  of  weakne^w;  antl  not  nntil  they  are  indieuled 
are  titinnilantjt  allowed.  Hot  llninieU  or  fionltierc*  arv  ajiplied  to 
the  '■•htitit  eontinuou^lv. 

Tn  ni(Ml  (!aw!i  we  giv<*  no  drtigx;  but  if  the  initial  delirium 
bo  hijrh,  we  j;ive  Binall  dcwe*  of  morphine  nn<l  tartar  enietie.  It 
would  be  ditHt-nll  lo  ■.-onviiu'e  un  tliut  iIiIk  cunibiiuitioti  in  not  of 
use.  .  Nor  <^n  we  aKHenl  to  the  pn>iK)sllion  that  delirium  Ik  always 
a  sign  of  wenkne^.  and  un  indication  for  Klininlunt;^  lli^re  is 
fiueh  a  thing  an  deliriuin  fmiu  high  fever,  and  when  it  ih  Ke4>n  at 
the  beginning  of  the  fever,  the  i^anliac  de])n'.'*»anl*  are  noLHiKsury. 

Ilie  good  cfleetH  of  tiie  Iw-al  ittw  of  ooM  are  luideniable,  bat 
thi»  jiotent  agent  should  not  1k>  iit*eil  nnle#  the  discipline  of  the 
sick-nKini  in  jierfoel.  On  one  occasion  in  which  we  onlered  tho 
application  of  ioc  clotht!,  the  patient  waa  geixed  with  wild  deli- 
rinrii,  sprang  out  of  bed  and  out  of  the  house,  being  «tark  naked, 
and  alter  being  ehHM?d  through  the  Ktreebt  (un  a  winter  night, 
wlieii  the  ginund  was  covered  with  snow)  for  nearly  an  hour,  waa 
captnretl  and  returned  to  hiR  home.  R4X!overy  enxued,  at  the 
usual  time. 

Two  yeutw  subsequently  we  were  called  up<Hi  to  treat  the 
itaino  {laticnt  for  a  ttecond  attack,  litis  time  we  used  hot  ap]»li- 
cations,  and  quelled  the  delirium  by  the  nne  of  antimony.  The 
pneinnonia  jHi^^ed  off  in  about  the  same  number  of  dayit  a«  tlie 
preceding  attack,  but  there  wore  no  aucli  unpleasant  i-pisodea 
encountered. 


V 


^ 


Z9» 


BUKVAI.    OF  TRRATMKNT. 


In  very  young  infjiDtB  we  must  bear  testimony  to  the  value 
of  quinine  and  ammotiia  in  Iiirge  dnsw.  In  old  and  fc*lilc  su^ 
Ejects  tho  same  rem<Hli<»,  with  bijjiily  Ptiniulating  f<K»d,  are  indi- 
cated. And  yet  the  venerable  Pr.  Corbos  records  €a»«  of  miai  in 
advanced  life  in  whom  vouesociion  proved  beneficial. 

"When  tliv  fever  has  diaippearod  but  signs  of  consolidation 
porgigt,  tho  maIIb  of  nmnioniiim  eliould  be  given,  tojtether  with 
CwMiver  oil  and  the  Iacto-i>li03phBte  of  lime.  Tho  nppUcfttion  of 
iodine  t:ii  tlio  ohoiit,  the  use  of  hot  «alt  bathfi,  and  of  a  rich  imd 
vuried  tliutary,  are  indicated.  In  olj»ttnalo  euses,  in  persons  pr&- 
diFpngcd  tn  tiibemulosis,  the  patient  should  bo  »eut  for  The  winter 
to  Florida. 


PROGRESSIVE  MUSCULAR  ATROPHY. 

Clarkk  n.'i;oinincnfU  the  avoidance  of  such  exciting  causes  u 
over-exertion,  and  ex|io3iire  to  cold  and  wet.  Warm  clothing:  and 
wanii  liatlit'  arc  nwCtil.  If  there  be  reason  to  suspect  a  s_>'phiUtic 
tiiiiit,  iodide  of  potassium  or  mercury  eliould  be  adniini.-'tercd. 

Ill  other  r»>t^;>'  Cod-Ilver  oil,  pluwphoruB,  mineral  tonics,  and 
aTKCiiic  have  In-oii  luund  n^i'lu).  But  in  the  early  slagcH,  galvftn- 
ism  liaH  proved  the  mo^it  ufiefiil  of  remedies.  The  current  shouU 
b«  applied  to  the  cen'ical  part  of  the  spine.  !t  is  (|uc»tioiiab)« 
whether  blisters  have  had  a  mitlieient  trial. 

Bartihu-uw  reportrt  great  impntvcment  in  a  case  confined  \a 
tlic  left  arm,  by  the  iiyection  of  a  83  per  cent,  glycerine  eolutiut 
into  the  wa-tl.ing  niiiitcleM,  r<-]ic^t<-<l  tliivc  timcKa  week.  He  hai 
also  had  good  i-caiilts  from  galvanism. 

Kb.b  also  rx-'portft  favorably  upon  thecnnstant  ciim>nt .  Vigomus 
coiitnictions  must  bo  induced  for  about  two  miiiutcts.  Adecending 
current  should  uIho  be  applied  to  the  whole  toiiglh  of  the  KpiDSi 
daily,  for  ii  iiihintc  or  two.  Massage,  with  the  iniuiction  ofa 
fat,  is  also  highly  siTviceable.  Hot.  tiomJies  to  the  spine  and  the 
rubbing  wot  pack  to  the  aileeted  members  are  alao  to  be  highly 
commended. 

Jion£RTt$  Hiiggcsts  that  when  the  disease  is  due  to  exoeaaivo  oao 
of  certain  muscles,  thcec  inu»t  be  allowed  to  rest.     Iniprovemeot 


PSB0I»O>HVPEHTROPUIC    PAOALYSI». — PHRRPERAL  COKliTtSroSS.    399 

of  the  gonpm)  lionlth  i»  liiglily  iiii|Mtiijiri1,  by  inc»n4  tti'  iiutritioun 
diet,  t(>iiu»,  uliaiige  of  air,  aiiJ  jjciitli;  regular  oxerciwi.  Arsenic, 
iron,  strychnine  and  silver  jiru  tlie  tihief  ilnig;*  etnployed. 

DvoBBKNK  stated  that  tlie  more  a  miucle  19  atrophied  and  its 
contractility  diinini«hcd,  the  longer  it  sliould  be  ftobjocted  to  tbd 
electric  stimulntioD,  the  more  intense  ehould  be  the  cuiTent,  and 
the  more  rapid  ita  intcrmidaions.  A»  sensibility  returns,  tb« 
api>Ucationa  should  be  dttniniijhed  in  force  and  in  the  frequency  of 
the  iutermiB«ion8. 


PSEUDO-HYPERTROPHIC  PARALYSIS. 

Davidson  remarks  that  the  treatment  is  only  available  beforo 
the  hypertrophic  sjinptoms  are  marked. 

T)dchb!1>'e  recommendH  localir^od  fararlisation  and  ehampnoing, 
and  details  two  curat  nuulting. 

Krb  rccommcuds  peripheral  fnrndi&ation,  with  gslvanization 
of  the  epiue  and  of  the  sympathetic  But  tlie  naults  are  not 
good. 


PUERPERAL  CONVULSIONS. 

Godson  speaks  most  favorably  of  (he  adminUtration  of  cblo- 
rofonn:  given  fit*ly  on  the  firat  appeantnt*  of  the  symptuius, 
and  the  etl'ect  kept  uji  until  the  fit  ha«  Milwidttl. 

Chloral,  nlouc  or  with  the  bromide**,  may  be  given  by  the 
month,  or  by  the  reHum.  The  hyjindcnnif  iiycetion  of  moiphine 
haa  been  fi-equently  found  efficacioua,  notwithstanding  the 
presenee  of  alltiiniinuria. 

Vf.  8.  Stewart  advocated  the  uite  of  chloral  by  the  rectum, 
in  dosm  of  two  drachnis. 

Amann  Bay*  that  the  first  principle  i»  to  aecure  eorajileie  nar- 
oosia,  wilh  cblorofoi-n),  morpliine  or  chloml.  Of  the  morphine, 
OQo>thir(L  of  a  grain  sliouUl  be  given  nubcutunoouHly. 


400 


XAyPAI.   OF  TJIBATMrar. 


Venesection  rIiouW  be  ooofiued  to  wrtain  easefs  when 
iyniptoms  of  plothoni  are  ])re«eiit,  iind  then  only  beforo  bbor. 

I'LATPAift  Kcommends  compression  of  the  carotids,  u  * 
t«inporoi^'  expedient, 

FoRDvcB  }3arker  givea  a  qiiurtcr-gmiii  iloite  nt'  elatorium,  if 
ihc  patiftil.  bu  conmtose.  This  dose  it«  mixed  with  butter  uid 
placed  ou  thi;  Itack  of  the  tougiic. 

Duncan  sa^-s  Uiat  the  ti-eatincnt  i»  to  empty  the  uterui;  bat 
if  labor  be  only  commemring,  draw  off  the  iiriiWi  tido  over  Ui» 
crifiis  by  blee»Uiig,  by  chloroform,  and  by  chloral. 

Atkinsok  siidilu  favornhly  of  cold  to  the  bead  in  cwea  of 
''^OIKia,  und  ndx'ocatetii  veniMtHrtion  in  all  ittlicntc  cases. 

Pilocarpine  h  growing  in  favor.  Ono-iliird  of  u  grain  may 
be  injoc'ttnl  Iiy|MKicmiically  everj'  six  hours.  If  thu<  cnnnot  be 
obtained,  the  fluid  oxtraet  of  jaborandi  may  be  given  in  dravhm 
doscii. 

Vcneset'tion  is  falling  into  deserved  nc^lecL  In  one  case 
coining  niidor  our  noticu,  where  n  convnlgion  had  oceurred,  the 
patient  was  bled;  but  while  the  blood  wan  flowing  aiHither  sjosm 
oame  on. 


PUERPEIU\L  FEVER. 

Godson  dwells  npon  the  imcmrtance  of  prophylaxis.  Ereiy 
mcAtia  of  communioitin^  septic  poison  to  the  ]>attbut  sliould  bo 
aroidcd.  The  genital  organn  should  never  l>e  touched  withoot 
the  handd  having  been  first  thoroughly  ririse<l  in  a  solution  of  pure 
carbolic  acid,  one  part  to  twenty,  All  sponges  should  be  i>cnnft- 
neiitly  kept  in  a  einiilar  ^lution ;  and  all  syringe?,  catbetcre,  otei 
Bhonid  be  tiioroiighlj  soaked  in  the  same  beforo  nsc  A  pr^nn- 
eion  eontalning  a  drachm  of  pure  carlM>lio  aeid  to  two  and  one- 
half  oiincpi*  of  honzoated  lar*!  (ihonid  be  u*ed  for  Uibrii-oting.  The 
utmost  care  Hhduld  l>e  nhown  to  avoid  leiiving  the  t^nuillert  pieee 
of  placenta  or  mcmbraTie  in  the  utema  Sub»e(|uently,  all  wash- 
ing or  syringing  of  the  genitaU  should  he  done  with  a  Rolution  of 


PUBItPBRAL  FBVEJU 


401 


carbttlic  arid,  tmc  t«  fortjr.    Tlai*.-  pruiiaratiotis  rtliould  be  "rdciiod 
previous  to  delivery. 

The  giuiL-nil  Lrttttiiiciit  vurios.  At  fint,  auti-iihtogintio  remo- 
dies  may  he  indicated;  AometimeA  leeches  or  bltators.  Terar 
tnim,  nt-oiiitL',  Ui'jiluli.t  or  salicylic  ur'ni  itniy  be  useful  in  lowt-nuj; 
the  fever.  The  intenial  use  of  tnrpentme  bn«  been  extolled; 
ftnd  this  drag  is  often  very  efficacious  when  applied  on  hot  flannel 
to  the  abdomen,  or  used  in  enema  for  tympanites.  OpiTUn  is 
invariably  demanded  for  the  reatlessnesB,  pain  and  wakcfulnc«. 
X<audanum  may  be  used  in  poultices.  If  there  bo  mncb  tendor- 
nees  and  distention,  a  paste  eompoaofl  of  two  parte  extract  of  bella- 
donna to  one  of  glyecrine  may  be  applied  thickly  over  the 
abdomen. 

ftoinine  is  ollon  of  great  value  asan  nnfipyretic;  given  in 
dn^ee  of  ten  to  fifteen  graiiw,  twice  a  day.  Warburg's  tincture 
may  answer  still  better. 

Tbo  antiaeptic  douche  should  never  be  omitted;  and  a  long 
vaginal  tube  should  be  employed,  to  insure  tbe  fluid  passing  into 
tho  uterus.     If  used  warm,  it  is  oftou  very  eomfortin^. 

In  more  chronic  cases,  with  diarrhea,  tho  tinctiiro  of  iron 
may  1k!  given,  in  thirty  minim  dostes,  Tlie  frequent  iiilmini:((nb> 
tion  of  nutritiou.s  food  nnd  stimulants,  sueh  as  (^ti-ong  bwf-lea., 
milk,  eggs,  c'liampagne  or  brandy,  \m  moat  ira^Kirtant.  If  obstinate 
vomiting  occur,  the  nutriment  must  be  given  by  the  iTectum.  The 
moat  abundant  supply  of  fre^h  air  must  lie  secured. 

Each  ease  must,  however,  be  treated  accorfling  to  the 
indiuttioDs  pi-eseiit. 

Park  gives  ono-fourtb  of  a  grain  of  nitrate  of  pllocfirpin, 
hypoilenu!<Tally,  t«  cut  .-iliort  Ilie  initial  chill.  Ono-sixtli  yf  a 
grain  of  morphine  may  bo  iujeetod  at  tlie  uime  time,  if  there  bo 
localizetl  |iain. 

For  the  hyi^qtyrexia  he  adviseti  the  use  of  local  cold,  in  wet 
or  dry  ap|ili(Uitionn.  It  lumit  be  applied  with  firmness  nnd  detei-- 
mination,  and  accompanie*!  by  tho  use  of  liquid  food  and  stimu- 
lants. For  imenial  ll^L•  he  prefers  ([uiniue,  and  Warburg's  tinel^ 
are,  or  salicylate  of  soda.  He  also  states  that  NiemcyerV  com- 
bination of  quinine,  digitalis  and  opium  (see  Phthisis)  is  second 
to  none  in  the  treatment  of  hyperpyrexia. 

SA 


40« 


■AmTAL  OP  TRKATMENT. 


If  great  astfaeni^  be  preitent,  alcohol  and  opium  mnst  be  und 
bemicalty  and  mcthodicallj. 

When  [«erit/mitia  and  tjmpanites  form  prominent  featnra, 
toipentme  is  iuvaltmbla 

Atctxson  reoommendB  the  extract  of  belladoniUL,  one  gnda 
erety  two  liouts,  with  four  grains  of  Dover's  powder;  continaed 
till  tbe  fiill  effects  of  the  drug  arc  produced,  and  maintained  ontil 
the  urgent  ityiuj>tom»  have  pa»sc<I  away. 

J.  MATTHBW9  DuwcAH  8tatc3  that  an  almost  sadden  cure  may 
ensnc  by  removing  the  source  of  the  supply  of  poiaoo.  II«roio 
treatment  may  be  reqairod  to  reach  the  remote^  part  of  tht 
genitnl  tract  in  «««rch  of  decomposing  matter.  Mere  vaginat  or 
intra-uterine  washing  may  suffice,  or  the  volsclU,  the  finger  or 
the  whole  hand,  may  be  introduced  into  the  atenia  U>  search  for 
the  dewjm[)osii.g  hiiI stance*.  It  may  be  neccs*snry  to  first  ditat* 
the  cervix.     Anc-thcaia  may,  in  tbo  latter  case,  be  req^uired. 

He  use«  lotions  of  carbolie  acid,  one  to  thirty  or  forty;  tepid 
or  warm,  tt  ia  necessary  to  lie  vory  gentle,  to  avoid  tbe  introduc- 
tion of  air,  and  to  see  that  the  injected  fluid  returns  freely.  If  _ 
the  ora  he  not  0]>en  widely,  a  double  current  pipe  should  he  em-  f 
ployed.  The  whole  proceeding  cttuses  little  pain.  A  pint  or  two 
of  fluid  may  tie  uetcd  ordinarily,  but  if  the  dii%hargcK  be  coploua 
and  fetid,  the  injection  should  he  c*ontinuod  until  the  fluid  cornea 
away  colorless  aix)  odorless.  Cure  should  be  taken  to  avoid  weU 
ting  the  bed.  The  o[)ention  u  to  bo  repeated  two  to  four  tinwe 
a  day,  until  the  fetor  no  longer  recur*.  Tlien,  two  duilj  washii 
will  siifRce,  and  that  but  for  a  tew  days. 

The  metho  1  advised  by  the  last  author  quoted  may  be  tal 
an  the  prevalent  Ireatmcut  of  thin  diiwasc.  The  occarren<^«  of 
chills,  with  evidences  of  septic  infection  i.^  held  to  indicate  a 
thorough  cleansing  of  the  uteni-vaginal  cavity,  with  antiwptiQ 
lotions.  It  is  astoui^hing  to  the  old  ])hyeiii:ian  who,  under  tbe 
Ktuuc  circtimtitanccM,  ha»  been  aatustoiued  to  bleed  to  ayncopc, 
to  nee  how  the  symptoms  vanish  when  a  putrid  mass  is  washed  or 
w-i-aj^ed  out  of  the  uterine  cavity.  The  antiseptic  used  is  of  leaa 
condequenco  than  the  thoroughness  of  the  cluunaing.  Thus, 
BcaBABDT  obtained  excellent  results  from   the    u  of  biniodlde  of 


PPBRPBnAL   FBTBH. 


408 


merenry;  Platfair  from  Condy's  flatd,  and  othore  from  thymol, 
chloriimt«>(l  soda,  etc.  Portia|)s  tli«  most  oonvtmient  and  tlierefore 
the  best,  U  tliat  obtainerl  hy  minp;  the  tablets  of  corrosive  subli- 
mate and  chloride  of  ammoniuni,  prepared  by  John  Wyeth  A  Broi 
By  means  of  these  tablets  a  aolutioii  of  any  dosired  Btreogth  can 
be  prejiared  cxttmporaneouiily  at  any  moment. 

To  the  prophylactic  rules  above  mentioned  we  may  add  that 
the  utmost  cleaiiUness  should  be  eicrcisod  by  tbe  obstetriciaiL 
No  one  should  act  in  that  capacity  who  is  engaged  iu  diaaecting, 
in  holding  post-iuortems,  or  in  making  pathological  investigations. 
Fhyeicians  run  a  great  risk  who  attend  women  in  confinement  at 
tho  same  time  that  they  are  in  attendunce  U{)un  cases  of  septic^ 
mia.  of  sc&rlatina,  or  especially  of  eryaipelas. 

When  pueqHjral  fever  haa  ajipeared  in  u  physician's  practice, 
he  should  perform  the  most  scrupulous  diaiufuetion  of  every  article 
of  his  c1otliing,a£  well  as  uf  liis  |)er!>on.  A  case  is  on  record  where 
a  physician  took  every  pi'ccaution,  even  having  his  beard  and  liair 
Elmved.  ot^',  but  wai;  followed  by  pueqwrnl  fever  to  every  case, 
antil  it  suddenly  occurred  to  him  that  ha  was  using  a  pair  of 
driving  glovct  which  he  hail  put  on  after  attending  a  septic  caw, 
without  having  tirat  waahed  his  haiidit. 

Wlicn  symptoms  of  peritonitis  otx-ur  after  an  abdominal 
section,  Laitson  Tait  is  accuMomed  to  administer  a  brlak  cathartic. 
Frequently,  when  gjinptoms  of  this  kind  begin  after  a  confinement, 
with  eome  fever,  perhaps  rig-vrs,  anorexia  and  general  discomfort, 
with  some  fetor  of  the  uterine  discharges,  wc  have  given  a 
cathartic;  and  with  tho  movement  of  the  bowels,  a  foul  smelling 
lochial  maM  wiw  di«<rliarged  from  the  utcrua.  Immediate  relief 
ensued. 

Many  authorities  recommend  that  the  vagina  shall  bo  wo-shcd 
out  with  antiseptic  lotions,  after  every  case  of  child-birth.  The 
results  of  this  practice  arc  quite  satisfactxiry  in  lying-in  hospitals; 
but  in  private  practice  it  is  certainly  unnecessary.  When  one 
physician  can  report  over  three  thousand  cancH  of  midwifery 
without  a  single  instanoc  of  pueqieral  fever,  the  danger  from  that 
disease  is  too  remote  to  warrant  him  in  subjecting  all  his  caaca  to 
the  use  of  antiseptic  injections:  which  are  by  no  means  harmleea 
themselves.      For    we  have    aeen  recorded  cases    of  mercurial 


404  MANUAL  OP  THBATMKKT. 

poisoning  from  thc^e  tnjecttou«.  To  Uiia  nuiy  be  Added  theduigtr 
of  the  antisepsis  not  being  pcrfccti}''  performed ;  and  the  conaequent 
introduction  of  dieeaae-germa  by  the  very  mcttns  employed  to 
prevent  it.  Beeides  this,  the  annoyance  and  disturbance  of  rest, 
consef^ucnt  on  the  systematic  luc  of  thceo  injoctioiu  is  »omethiag 
which  maat  be  felt  to  be  appreciated. 


PURPURA  HEMORRHAGICA. 

LooMis  says  that  nt  the  present  day,  rest,  a  highly  nutritioM 
concentrated  diet,  and  moderate  stimulation  with  a  nntritire  wine 
are  the  principal  measures  employetl.  Tinctura  feni  perchloT' 
idi, — 15  lo  20  niinimt*  three  times  a  day, — in  vory  ufiicaci'me,  zai 
ahould  be  given  in  connoetion  with  wniie  nne  of  the  mineral  acid*, 
preferably  sulphuric.  Ergot,  turpentine,  gfallic  acid,  and 
other  hemostatics  ure  nil  highly  rei'mnrnemled  wlicn  ilie  homw- 
rhages  becorao  dangerous.  When  hemorrhage  from  tbo  luijgs 
occurs,  the  treatment  \»  the  same  as  in  other  forms  of  brnDchiil 
hemorrhage.  Ropcntly,  small  dofiee  of  mercury  have  been  gi*'en, 
and  np]Kiront1y  clt*co1eit  a  eurc.  Shand  has  obtained  excetleot 
resuhs  from  foxadlsation. 

Bartoolow  says  that  the  iisnal  treatment  consists  iu  the 
administration  of  the  mineral  acids,  es]>ccially  the  sulphuric^ 
and  of  the  preparations  of  iion,  especially  the  tincture  of  the  chlo- 
ride. "With  these  remedies  must  be  conjoined  a  «uitabIo  dietary, 
f>e«h  air,  Bunebine,  and  uio<lerate  exercise.  If  constipation  be 
present,  the  most  appropriate  laxative  is  sulphate  of  magnesia 
with  dilute  sulphurie  acid.  U  hemorrhages  tbai  are  thniatening 
corae  on  with  a  stnmg  pnlse,  flushed  face,  headache,  and  excite- 
ment, digitalis,  quinia,  and  etgotin  are  the  appropriate 
medieuiiieii  i». 

If  thera  be  weakness  and  debility,  quinine  and  alt>obolic 
stimulants  ino<leratcly  should  be  prescribed. 

TliolrK'id  ino:iii»<  fur  iin-L-ritiiig  bleeding  ooiiKLt;L  in  Bn1>Sttlphat6 

of  iron,  tannin,  alcohol,  ice,  or  may  be  hot  water,  which  is 
sometimes  more  effective  than  cold.  For  the  a^er-dueuiia,  iron 
should  be  piuthe<1. 


PUaPVBA   UBMORRHAaiCA. 


40& 


Spaurs  renoArks  tliat  in  the  tri>alroent  nf  purpura,  itb.<u>liite 
rest  in  be»l  is  necessary,  if  the  eruption  be  general;  elevation  of 
the  hg^  U  advaiilageoQs  if  the  disease  be  confined  to  thorn.  Any 
deranj^mont  of  internal  or^na  roust  be  renooilied,  if  possible. 
As  a  rulo,  tonics,  especially  quinine  :in'l  iron,  '!'>  most  good  in 
porpura  eimpk'x.  Tinctura  ferri  per  chloridi  \  xv~xx,  three 
times  a  day,  is  almost  a  e]>ocilic  in  many  casen;  and  the  mineral 
acids,  pHiMjcially  sulphuric  acid,  are  of  great  value.  The  nse  of 
piu^tive*.  as  recomniendetl  by  the  older  writers,  eajwdally 
Fluhbk,  liaa  of  late  fallen  into  dlHrepute.  Tti  pnrpum  heniorrha* 
gica,  with  copious  bleedings,  ei^t  baa  proved  most  effectual.  It 
may  be  given  either  by  tho  mouth,  or  else  hyjwdonnically,  as  a 
eolution  of  ergotitt.  Turpentine,  in  ten  minim  doeee,  guUic 
acid,  anil  other  henioetatica  also  deserve  a  trial.  Locally,  cold 
applicatioiia  or  injections  of  ieed  water  may  be  a'sortcd  to,  in 
severH  epitttnxid  or  hpinorrhage  from  the  bowel.  Todide  of  iiota.-*. 
riutt]  Fthould  not  bo  given  in  pnrpuni,  as  it  aggravalCH  it  in  some 
tsaaes,  and  haa  even  given  rise  to  serioaa  ulcemtlon. 

laiMERMANN  doubts  the  value  of  the  mineral  acids,  having 
never  obtained  any  noticuable  rc«u1ta  from  tlieir  administration. 
Tlie  vwgetablB  m-iiU  are  no  better.  Iron  and  ergot  exert  no  inflii- 
enre  worthy  of  mention;  and  lead  is  rather  of  problemation.1 
value. 

The  patient  ehonld  be  carefully  guarded  against  mechanical 
injnry,  and  against  aiiyUiing  wliicli  lends  to  exeite  the  action  of 
the  heart.  The  sick-room  must  Iw  ctiol,  the  dii-t  of  cold  milk, 
and  the  drink  iced  lemonade,  in  but  small  ijuantities.  The 
boweU  whould  he  kept  ojic-ii  by  niciuiii  of  cjLstor  oil. 

The  lienjonrliage-s  may  be  treated  as  in  other  hemorrliagic 
affectionrt.  The  articular  paiiw  rc<iuirt!  anoilyiie  liniments.  After 
the  faemorrhagefl  cease  the  resultant  anemia  mnst  receive  appro- 
priate treatment.  Stimulants  are  often  reciuired,  when  the  weak- 
neas  is  increasing,  and  the  heart  threatens  to  stop.  The  alter 
treatment  requires  quinine  and  iron,  and  nutritious  food,  liut 
the  iron  nnir^t  not  be  given  until  after  the  hemorrhage  haa 
completely  dieappeared.  for  some  dayo. 


406 


MANUAL  OF  TBEATUBNT. 


Woninu'RT  haa  nbtnhied  good  results  from  the  int«mal  oset 
hamamelis. 

IiuMt'KMAKN's  absolutc  contnt-indication  of  iron  b  fiilly 
corroborated  by  our  own  experience.  It«  use  has  tnvariahJlj 
been  followed  by  a  renewal  of  tbe  hemorrhage.  In  one  case  we 
gave  all  Uic  ordinary  jwtringente  a  trial,  botb  local  and  cotistitu- 
tional,  but  found  them  valucleaa.  Tbe  hemorrhage  wns  finally 
stopped  promptly  And  permanently  by  the  local  ubo  of  a  four  per 
ocDt.  solution  of  cocaine.  In  our  own  cxperieoce,  as  n-ell  lu 
WooDBUitT's,  the  UQC  of  quinine  has  been  followed  by  au  outbreak 
of  purpura  hemorrhagica. 


PUSTULE;  MALIGNANT. 

Qrrekfield  saya  that  the  snccess  of  local  treatment  depends 
upon  the  early  diag;n08ie.  Excision,  cauterization,  and  if  tbe 
pimple  be  tinmll,  a  crucial  incision  and  tbe  application  of  pure 
carbolic  acid  is  the  course  to  ptimue.  The  artificial  leech  may 
be  enipl()yed  over  the  incision.  When  a  distinct  eschar  fa» 
formed,  free  incision  followed  by  the  application  of  carbolic  add 
is  still  tbe  best  method. 

In  the  internal  form,  general  treatment  is  alone  available.  An 
animal  diet  should  bu  emplnycd.at*  well  lui  quinine  ami  carbolic 
acid  iuternally  iti  liberal  dosee.  When  death  ia  threatened  bj 
pleural  ell'usioii,  punHttntosiit  p^hould  be  perfonncd.  CollapM 
requires  tbe  free  use  of  ether,  ammonia  or  camphor. 

BoLLiHOER  says  that  the  most  esaenf  ial  point  in  the  treatment 
of  antlirax  is  a  thorough  destruction  of  the  local  afteclion.  When 
infection  is  suspected,  the  point  implicated  should  be  thoroughly 
cauterized  with  pure  carbolic  ucid,  caustic  potaiib  or  fuming  nitric 
Bcid.  Should  an  actual  anthrax  carbuncle  be  present,  the  treat- 
ment is  extirpation  with  the  knife,  followed  by  cauterization,  la 
Bome  cases  crucial  incisions  may  be  substituted,  with  cauterizatiwi, 
and  the  flaps  being  trimmed  ofl'.  The  actual  cautery  acts  leas 
certainly. 

This  treatment  u  often  successM,  even  alW  oouHtitutional 


PTKHIA. 


4ilT 


•ymptoms  buve  ap[)cared.  The  cautenz&ti«u  may  tben  be  repeu'-'l 
Hvcral  tiiiK's;  while  in  the  earliest  9tagc  a  single  thorou^ti 
application  i»  auflicient.  Antiaepttc  drecBioga  nfaould  be  pnt  ou, 
folInw«l  by  carboliz^  poultico«,  or  local  etimnlantii  Rui'h  aa 
Cttmpbor  3i>i*l  myrrh.  If  gmittral  RymptoniH  apjxmr,  quiuiiie  and 
carbolic  acid  ehoald  be  given  internally  to  the  amnuDt  of  luUf  a 
draebm  of  (luiniiie  and  filtwn  j^rains  of  carbolic  lu-'id  duriiij*  each 
day.  WbcD  the  aMlema  \»  ooiixidomble  and  gangrene  \»  thn'atenMl, 
deep  incbtlomt  nhould  he.  made  to  relieve  the  ten-^inn. 

VTq  have  known  of  two  ca>«os  occurring  iii  ri)it;iiK'ljibia.  in 
leather  dresserH  who  were  working  u[)on  imitorted  itkins  of  gouts 
or  dieep.     Both  cases  proved  fataL 


PYEMIA. 

C&LLBKDBR  reoommends  caut«nzatiou  followed  by  pOTilti««s 
for  reoent  wounds,  but  the  priwf>©ct  of  destroying  the  i)oiBon  in 
TOppupating  wounds  is  niutb  k>^.  All  fwurces  of  irritalion  musl  be 
remorctd,  and  fotnentattona  should  be  applied.  The  part  ebonld  be 
kept  dean,  and  m  arranged  ah  to  render  lodgmonl  of  pus  iropOHO- 
blc.  CharxxMtl  or  earbolic  acid  may  be  added  to  the  jjoaltioat 
Difluned  inflammation  should  be  treated  aa  phlegroononB  crjsipe- 
tee,  and  oe  it«  exioteito«  depends  upon  debility,  all  weakenlnf^ 
meatiurea  are  inadmiiwible.  If  the  infection  become  general,  kxml 
meiuanw  must  be  limited  to  simple  dresAingn. 

The  bowelH  should  be  ojioned  by  aperient«.  Kliminatiti 
deMrve  a  fair  but  (siutiouB  trial,  f^aline  lazative'4  with  bitartnite 
of  pota.4Hi  may  be  cinlcrcil.  \''apor  baths  may  prove  nwfdl 
Bonictimea. 

Nothing  soothes  nervous  depieamon  as  well  an  opiom.  Tt 
should  be  given  in  sm:ill  and  frequent  Jdmm,  aod  the  iKilieiit  kept 
well  under  its  influenL-e.  If  naintca  and  vomiting  finpervnne,  lh» 
stomach  Hhoiikl  t>e  ke])t  quiet,  aud  food  be  given  aa  conceotratfld 
as  possible,  and  frwiueiiily  n*j»pate<L  Chloroform,  hydrocyani'- 
acid  And  loe  wmetimcs  give  relief.  Dyi^Hiea  may  1w  relieved  b 
digitalis,  and  by  the  ivk  of  dianetica.  The  Htrength  rnunt  L'' 
BDp|M>rt«d   from  the  start  by  tbe  adminiKtratiori  of  toniia  *n  1 


408 


HAMDAL  or  TKEaTMBNT. 


stimulante.    The  same  refrimen  muitt  be  continued  iJnring  oonral- 
CKuenoe,  with  change  of  air,  ciiiehomi  nnil  iron. 

The  little  that  can  he  done  for  the  local  lefiions  niig;gi»ti*  that 
Uwy  should  ho  pn>ventml  hy  the  proijer  treatment  of  previoosly 
existing  diseaae.  The  strength  should  be  eerlnloiuiiy  supportod, 
atimulantd  t^iould  he  Htipplicfl  to  thoae  who  have  hecu  aecuatomed 
t<>  their  use,  rest  in  bed  should  be  enforced,  wounda  ahoald  bt 
kept  surgically  ctejin,  and  every  prc«--aution  ahould  be  t^keti  to 
prevent  the  affection  from  being  carried  from  one  case  to  another. 

Hattabd  calU  attention  to  the  importance  of  in^nring  to  sQ^ 
gical  cases  an  abundance  of  fresJi  air,  and  carefully  guarding  them 
ngivinat  exhalations  from  decaying  organic  matter.  Overcrowding 
of  enppuralitig  <.wcti  must  he  avoided.  The  careful  drainage  of 
wonnds  is  of  the  greatest  importance,  for  whether  genua  be 
admitted  or  not,  an  obvious  way  of  ])reventing  docompoHition  in 
a  wound  13  to  take  care  that  nothing  in  left  therein  to  decomiwiee. 

When  pyemia  has  developed,  treatment  is  of  little  iL-e.  Sul- 
phuroua  acid  nuiy  be  givun  in  Utc  more  chronic  cilms,  but  tb« 
most  u)>«fiil  remeily  is  quiuine,  in  full  and  fre<pieut  do«08.  Th« 
secondary  abwessc--*  Hhould  h«  oiH-acd  larly.  If  the  aScctiou  orig- 
tiate  in  intlnmmutiou  of  an  accessible  vein,  the  reawl  should  be 
divided  between  the  heart  uiid  the  iufliuued  part.  Bcdaoi-es  mwt 
be  guarded  ogaiiist. 


PYR(jSIS. 

Fekwick  Bays  that  all  &ouivc«  of  gaitrie  irritation  should  bo 
removed.  Astringents,  with  or  without  opium,  arc  the  rao^t  effi- 
cacious remedies.  They  should  be  given  in  the  intervals  betweoi 
digeation,  in  oHer  to  act  directly  on  the  uiueoua  membrane. 
Lime-water,  bismuth,  zinc,  kramoriii,  log\vo(Kl  or  tannin  may 
be  preferred,  but  the  :*i!v(jt'  salts  are  the  moiit  effieaoiouii.  Mercufj 
often  jfive  the  boat  results. 

Occasionally  the  use  of  tlic  black  oxide  of  maogaiieM  i* 
exc.tH.tling1y  Wnctii^iiil  in  ih\i^  ullection,  but  in  general  the  treat* 
meet  li  that  of  gastric  catarrh. 


RBLAPSJSO   rBVKR. 


409 


RELAPSING  FEVER 

Lebert  ])ay9  gnat  attention  lo  proph^'laxU.  lie  advises  air- 
ing, wliitewaidiiiig,  sulphur  fuiuigatiuii  ami  dittinfeution  geiierallj, 
of  the  apartnientj>  ami  of  the  beds.  Perfect  cleanliiiess  and  free 
ventilation  an;  neciw.'tury.  Soiletl  clothing  sliould  be  tlirown  at 
once  into  boiling  water,  and  bedding  purified  by  fumigation  with 
lulpbiir,  and  by  heat,  huh  and  air.  Tlit- timiic  [irfcuutioiiK  ulioulil 
be  taken  a»  in  the  i-tiae  of  cholera. 

No  dru(r  1:*  known  to  exeirisc  any  direct  influeitc-e  on  the 
oouree  of  thiH  ditfeu^e.  Rest  in  betl.  fresh  air,  cleaulinee?,  fever 
diet,  inilk,  souim,  meat  broths,  and  cooling  drinkit  arc  the  princi- 
pal things  to  be  attended  to.  If  Iho  [Ditient  hnvo  nn  appetite  be 
should  have  nioru  and  better  food, and  pniticiilurly  wine.  Water  \e 
the  beat  drink.  The  wevere  headache  if  bi-st  combated  by  bl&<ldera 
of  ice,  applied  during  the  [laroxysin-^.  Tlie  niUMrulur  jWina  may 
be  anicliomtod  by  frictiont;  with  oil  and  chlorofoim.  If  Uie 
pflius  be  severe,  hypwlermics  of  morphine  may  be  given.  In 
oplenk*  pain,  apply  cold,  or  poultices  continuously.  If  weakness 
iiicrea^,  give  more  wine;  if  collaj^se  thrcftteo,  the  followuig: — 

R     MoMhi 5j 

AiuEuonii  cub gr.  zzz 

Aq.  dot fl.  5  r 

Alcohol, It.  s  i) 

Ol.  [UBolh., irtt.  T 

M.    9. — Tiling  tlropa  eveiy  hour,  in  wine  or  wiler. 

Obstinate  diarrhea  is  to  be  combated  by  alum,  tsmnin,  nitrate 
of  silver,  aud  opium.  If  delirium  tremens  occur,  chloral  luio'  be 
given  in  doses  of  tirteen  giraina  every  hour,  until  two  dmehms 
have  been  taken.  If  pneumoDia  occur  aa  a  compUcatioD,  it  is  to 
bo  treated  by  counter-irritation  and  the  strongesl  Gtiraulanta. 
Absoi--TWfH  should  be  openwl  early,  and  treated  aotiseptically. 
EpiBtaxi*  requires  prompt  and  etiGctual  tamponing.  During  eon- 
valescwnce,  weakly  caseH  retpiii"*!  iiourinhing  rinwl  and  the  adminis- 
tration of  cinchona  and  the  lactate  of  iron,  three  to  eight  grains 
daily,  with  gentian. 

Kisss  claims  that  the  Balicylate  of  soda  not  only  roducea 
the  temperature,  but,  if  given  in  large  do«ca  Iq  the  iutcrmiasioti. 


410 


MAKOAL    OF   TRKATMKKT. 


lessens    the    severity   of   the    ralapne,  and    AomctiineR    ealiref 
prevontfl  it 

Pakry  thought,  that  quinintt  with  onrnphor  was  of  nsc  during; 
the  intcrmiesion  and  in  early  convalescence,  in  relieving  debility 
and  wAkcfulncee. 

Davis  gives  a»  a  gcnnicUlc,  carbolic  acid,  with  gelsemiom 
and  paregoric  If  weaknesit  aupervene,  he  substitutes  qninins, 
two  gmin«  every  four  hoiire,  altcmate^l  with  Dover's  powder,  five 
graiiiB,  and  camphor,  two  grains.  Digitalis  and  acetate  of  i-otaa- 
siurn  hIiouIiI  he  given  if  the  urine  become  scanty.  As  soon  a»  iha 
intermission  occurs,  the  moat  nourishing  diet  should  be  giveOf 
with  fiftiiun  grains  of  sulphite  of  «oila  at  each  meal  time,  and  two 
grains  of  iron  and  quinine  at  bedtime.  lie  most  also  be  kept 
qoiot.  The  rchiptio.  muKt  lie  treated  like  the  firet  attack,  with 
more  care  in  sustaining  the  etrength. 

MuKCHisoN   considers   uremie  poieoning  the  main  caaaaoi 

death,  aud  for  thto  reason  pret><:ribea: — 

B     tip.  ellierie  nitrc*^ 0.5  y 

Arid,  nilrici  di]^ ......fl.  3j 

Syn'r'i B-SJ 

rictcct.  lionlH 0.  Q 

M.    S^Tu  b«  ial(«n  in  (wctitv-fbur  haan. 

If  Bvniptotnn  of  jaundice  manifest  themselves,  liydrocUoriO 
acid  should  tie  substituted  for  the  nitric. 

HARTsnoiiEfs  reeommcndH  a  mild  cathartie  at  the  beginning* 
and  if  hewlache  be  severe,  a  few  leeches  to  tlie  nape  of  the  nock. 
Citrate  of  i>ota«h  may  be  given.  After  the  crisio,  quinine  may 
be  ^ivcn  until  the  relapse,  in  modemtc  doefca.  Bat  no  amoiint  of 
quinine  will  prevent  the  rehipse. 


REMiriENT  FEVER. 

K0BKRT8  boarfi  testimonj-to  the  value  of  the  external  applica- 
tion of  (wW,  by  sponging,  iiffuBion,  packs  or  bath. 

As  ftoon  as  the  remission  occurs,  quinine  moat  be  given  tn 


BBMITTBKT    FBVEB. 


411 


loeeB  of  ten  to  tivcnty  grains  everv  two  honrs;  if  tlie  Btoraaeh 
reject  tliis  renietly,  it  mutit  be  given  hy  enenm.  It  in  to  tie  pttclicd 
to  the  production  of  cinchoni^tn.  AiitiphlogiBtica  are  to  be  dep- 
recated. The  bowels  imwt  I»e  kept  ojffiii,  a  good  diet  given,  and 
gtimiilanU  nxAy  be  required  in  coniiiderable  qaantltiea. 

Davis  givc-i  aconite  or  veratrum  during  tlic  Imt  wtngc,  in 
doses  of  two  to  four  minimi^  of  the  strong  tincture  every  two 
houn,  and  altemulce  witli  this,  calomel,  gr.  ij,  u.nd  hicarbonate 
of  soda,  gr.  v.  Theee  remedies  are  diaoontinued  on  the  decline 
of  the  paroxyem,  and  a  laxative  given  if  ncccamrj. 


Barthoujw  recommends  the  same  general  plan  as  in  inteiv 
mittent  fevt^r.  The  antiperiodie  may  be  given  at  once,  but  it  "is 
more  efficient  if  given  during  the  sweating  Btage.  Thirty  grains 
of  quinine  Hhould  hn  administered  the  fintt  morning,  twenty  the 
second,  fiiYeen  the  tltirJ,  and  ten  the  fourth,  each  taken  at  a  siugle 
done. 

Masked  remittents  require  the  largest  dosce  of  the  anti- 
periodic. 

LooMis  gives  ten  to  twenty  grains  of  quinine  every  two 
hours  until  cinchonism  iit  produced.  Ho  then  stops  tlio  remedy 
for  twenty-four  houra.  If  the  symptom.-*  haw  hocoinc  wonwi  nnd 
typhoid  i^ymptoma  become  manifest,  etimulants  nmy  he  dcmimdcd 
in  large  doses. 

When  the  disease  has  rc!u:hed  the  second  week  witli  no  evi- 
deDCc  of  recovery,  he  gives  another  course  of  quinine  similar  to 
the  one  described.  If,  after  a  wicoiid  cinchoni«m  Ihe  fever  be  not 
arretted,  be  omit«  the  quinine  for  a  few  days  and  then  giv&s  a 
third  (rour.-u.-.  Thin  method  in  far  )>ctter  than  the  continuance  of 
cinclioninm. 

If  the  exacerbatioiiH  be  intense,  the  heaibiche  severe  aud  the 
restlessness  nnd  fever  not  relieved  by  quinine,  cold  niay  be  cra- 
ployed,  iiH  in  typhoid  fever.  Bromide  of  potassium,  Ui  full 
dosos,  promotes  sieep. 

For  severe  vomiting  he  uses  hypodermics  of  morphine. 
Othenvi»u  the  treatment  is  expectant. 


413 


MANUAL   OF  TREATHEKT. 


Maclkak  advises  a  [lurj^tive  cholaj^ogue,  such  as  a.  combio? 
tion  of  mldiiitfl,  c()Ux.-ynll]  and  Acammoijy,  with  un  aromatio  niU 
Quiniue  may  tlion  be  givou  at  oDce.  If  Uie  fever  be  bif(1),  aoo- 
Ilit6  may  be  ailniiriiHtered,  in  ilmp  (Uwcti  of  the  tinc-rure  evenr  lif- 
teen  minute  miti)  ten  or  tn'elve  doeea  have  been  takeu.  If  the 
fever  nae  to  10I)°-110^,  tlio  patient:  nhonld  be  plm^ecl  in  a  lialb  at 
90°.  which  should  be  cooled  down  to  83* 

He  appear*!  to  prefer  giving  the  quinine  at  the  first  reimadoa, 
b^  the  mouth,  rectum  or  skio.  The  grave  and  jieniicioiu  forma 
maj  justify  the  use  of  this  renialy  hypoclermicallr.  At  ]im( 
thirty  graine  should  be  given  during  the  remission.  This  must 
be  repeated  [Kirnistently  every  diiy  mitil  the  fever  luu*  beeii 
overcome.  Vomiting  is  the  troublesome  symptom.  It  ma;  be 
rclievii)  by  ice  imd  by  coiintei'-irritatiiiu  over  the  ejiigafitriura,  bat 
usually  aubeidce  with  the  fever. 

On  the  firKt  nigii  of  col]ap»c,  recoiirise  must  bo  had  to  Btunu- 
laBts;  white  wine  whey,  chan)]Kigne,  Rhenish,  or  ale. 

The  iicmHtjiisf  about  not  being  able  to  "iitand  <iu)uii)v"  should 
be  banished.  £lver>'body  who  lives  in  malarial  dit^tricta  can  aod 
mast  ntand  (piinine. 


RHEUMATIC  ARTHRITIS. 

Senator  says  shortly  that  the  onlinary  rules  of  hygiene  muri 
be  observed;  and  layn  Kpeoial  »treis  on  protection  agatiuit  the 
weather. 

Of  intenial  reineiiiea,  iodine  had  [iroved  tlie  DioHt  UitefaL 
Ten  dropa  of  the  tincture  may  be  given  three  times  a  day, 
gradimlly  increHMxl  to  a  maximum  of  fifteen  graum  of  ioditw 
daily.  Or,  iodide  of  potassium  imiy  be  given  instead.  In  acnae 
weeks  the  pain  and  MwcUiiig  arc  reduced,  and  the  discaac  may  be 
stayed  for  a  time,  iodine  may  aUn  be  painted  over  the  affected 
jointa;  avoiding  over-irritation  of  the  skin. 

Oalvanisiii  biiA  given  some  relief.  The  pniiitive  pole  of  a 
fifleen-ecll  buttery  is  applied  by  a  small  rhoophorc  to  tho  ufficcted 
joints,  while  the  nt^gative  pole  is  placed  on  the  fore-arm,  with  a 
larger  rbuophore.  Afauy  observcra  have  obtained  good  rMulta 
from  galvanization  of  the  cervical  sympathetic 


KHKCMATic  ARTWifrra:  418 

Warm  baths  tiLouU]  W  eni])1nv«il  aa  in  clinMiu!  rlieuiiiatiKnu 
Active  nml  jut^ivti  moveiueiiU  should  be  utilized  to  maintain 
mobility  of  the  joiuts. 

Brcce  rocommcnds  in  the  early  atagefl  a  visit  to  varions  liathe, 
or  a  voyage  to  the  tropiw.  The  climate  of  Eg^'pt  is  eometimee 
beneficial,  and  advantage  miiy  be  there  tjiken  of  the  caatcro 
method  of  treatment  by  nibhiiiij  and  bathe. 

The  most  vaUmblc  iiitemnl  ivniedies  are  Ood'Uver  oil,  iron 
and  nnwiiiii.',  t^mliiiued  for  moutlia.  Gabrod  recommends  the 
iodide  of  iron. 

Ill  thu  iJii^t,all  exveflM  Is  to  be  avoided, as  well  as  malt  liquors, 
wines  and  rich,  indigestible  diHhefi.  A  generotin  supply  of  mixed 
animal  and  ve;^etuhle  food  will  bo  found  mout  suitable.  On  the 
firet  appearance  of  the  disease,  the  joints  should  be  i«iinted  with 
iodiiie,arid  e«velo])ed  tn  wool  or  flannel.  Guaiacum  or  the  iodides 
nuf  be  ii!*c<1  int«ninlly  in  (ibKtinate  uu<et<,  while  the  jointH  are 
fomented  twice  daily  by  wrapping  them  in  flannel  and  sponging 
thitt  with  water  as  hut  as  can  \k  borne.  Then  the  joint  should  be 
robbed  with  a  Htimulating  liniment,  such  as  turpentine,  or  with 
mercurial  ointment,  cod-liver  oil  or  goose-greiuse.  In  v«ry  ad- 
vanced cased,  or  in  aged  men,  little  improvement  is  to  be  exjiected. 
Anodynes  aiid  tonies  comprise  Uie  projier  reniedios. 

Davis  lias  obtained  motit  benefit  from  rest  in  bed,  tliu  guntle 
application  of  oloctricity,  light  friction  over  tlio  aftected  joints, 
the  use  of  plain,  nutritious  fcKxl,  witliout  miu-h  tea  or  collW,  and 
the  entire  prohibition  of  all  alcotiolic  beverages  and  of  tobacco. 
"With  tills,  he  gives  the  following: — 

B     Sjr.  calcii  kxJidi, ....r|  iv 

Syr.  cnldi  uiiJi, f  j  y 

TiiK-t.  vitaiiicinii, fj  w 

U.  8.— ^hake  iho  v'rnl,  anJ  Kirn  a  twupoonAil  four  ticnM  daily,  in  a  iiula 
ntcr. 

Barvbll  employs  the  ctterve»icing  citrate  of  ammonia  or 
potowa  in  -thnse  case.-*  whirh  begin  with  ftbrile  symptoma.  He 
also  requires  the  patient  to  i-vst  ul>soIiitely  quiet  in  bed. 

To  any  joint  whi('h  is  especially  painful,  leeches  may  be 
applied,  or  a  hot  solutiou  of  bi-carbonatu  of  potaisium,  about 


414 


HAirOA).  Of   TRKATMEHT. 


thirty  gra'mA  to  the  ounce  of  water,  for  fifteen  minates  at  a  tinx. 
Or  fianuel  ma^-  he  eoakod  in  a  weaker  Holut:oD,  applied  to  dw 
joints  Mild  covered  with  oiled  tiilk.  To  tins  taay  be  added  di1ut« 
hydrocyanic  acid,  twenty  minima  to  the  ouoce,  camphor^  bell*- 
donnu,  couium  or  opium;  but  the  potassium  \a  the  moat  valuable 
ingredient 

III  chronic  ca^os,  it  must  be  remembered  that  the  diacaae  is 
essentially  one  of  debility,  and  all  depressiug  remetlios  must  bo 
Avoided.  The  bichloride  of  mercury  Iti  eimall  doses,  nob  bug 
continued,  has  provod  boneticiiil.  Quaiac  ia  especially  useful 
when  the  hautU,  feet  and  utlcctcd  joints,  are  cold  and  clammy.  B 
JB  \ttat  combined  with  ammorna.  Iodine  ih  very  valuable.  Iron, 
quiniue,  citrychiiine  and  arduiiic  arc  uUo  of  use.  Hot  alkaline 
hathfl  are  among  the  most  valuable  of  roraediee.  He  also  speaks 
very  iavombly  of  the  WuodhuU  Spa  Bromo-iodide  springs. 

LooMis  speaks  approvingly  of  tonics,  but  thinks  iodine  don 
more  harm  lliiin  good.  Fiictlond  witli  iodine,  mercury  and  i'jdo* 
form  sometimes  relieve,  iioth  the  constant  and  faradic  currenta 
-are  often  beneficial. 

Erb  treated  an  entire  series  of  cases  with  electricity,  with 
gearcoly  any  success.  Ho  recommends  local  treatment  of  tbe 
jointit,  galvanization  of  the  cervical  sympathetic  and  the  corre- 
sponding norvo-plexnses,  perhaps  of  the  cord  itself.  The  general 
weaknea>i  and  muscular  atrophy,  the  iiumtrition  of  the  fikin,  and 
the  anomalies  of  perspiration,  are  best  relieved  by  labile  galvanixa> 
tiou  of  the  plexus  atfected,  of  the  principal  nerve-triHik«i,  and  of 
the  muscles  of  the  extremities.  In  addition,  general  fanuliaatioa 
at)d  electrical  baths  may  be  tried.  Tlie  sittings  ahouldl  ant  fiiteoQ 
minutes  or  more. 


RHEUMATISM:    ACUTE. 

Senator  rocomnieuds  aa  prophylactic  measures,  to  oroid  sad- 
den violent  chiingcs  of  temperature,  to  wear  wool  next  to  the  skin, 
and  to  harden  the  system.  \\'licn  one  has  been  accideotally  wet, 
exerciiK  must  be  continued  until  au  opportunity  occurs  to  change 
the  clothes.    Frictions  to  the  skia  are  also  uacfuh    Tbe  expectant 


bbromatiem:  acotk. 

plan  was  tried  by  Lbiikkt,  but  the  confloquences  proved  graver 
Hum  wlicn  uvtivc  treatiueot  was  employed.  The  antiphlogUtic 
EDethcxl  ha^  aUo  proved  inadequate;  in  which  catt^ory  aro  in- 
cluded bleediDg,  mercuriale,  antimony  and  nitr*. 

Lebbbt  found  that  lemon  juice  tnittgatod  the  fever  and 
shortened  the  duration  of  the  illneeu.  lie  gave  a  tablesix>onful 
eight  times  a  day,  gradually  increased  to  twelve  times.  In  thirty- 
six  otscB  treated  by  thid  plea^^atit  agent,  tlie  average  duration  was 
28 J  days.    The  risk  of  compUoations  was  not  lessened. 

Fuller  ha  especially  identified  himself  with  the  alkaline 
treetmerit  of  rheumatism.  Ue  found  heart  dii^eane  developed  in 
only  nine  cases  out  of  417.  The  duration  of  the  di^ase  was 
also  shortened.  Sknatok  himiielf  obtained  better  rwiilts  from  this 
than  I'roni  other  methods. 

Btnve  the  alkalies  most  be  given  in  very  large  donee,  the  soda 
salts  must  he  L-hosen.  Ammonium  may  inflict  injury  ou  the  heart 
or  on  the  nerve  centres.  llegivcH  five  to  ten  dnit-hnts  diiily  of  the 
bicarbonate,  acetate,  tartrate  or  citrate  of  soda,  in  sugared  water, 
Qutil  the  urine  has  become  feebly  alkaline;  which  will  be  on  the 
aeetMid  or  third  day.  The  do^  ttUouId  then  be  reduced,  and 
increat^  whenever  tiie  urine  tends  to  become  a'-id. 

Skoda  spealoi  highly  of  the  influence  of  oolchicam  upon  the 
inflammatory  changes  in  the  Joints.    Ue  prescribes: — 

S     OolehlciD, gr.j 

A<ii>«, fl.  5  "J 

Alooho),  q.  •■ 

R^Fire  drops  Lwic«  or  thi«e  llmf*  a  day  anlil  tctive  purglBg  Beta  in  and  tli* 
ptim  nbaU;  wliicli  will  ba  Iwii  or  Uiti-c  daj*. 

Davies  particularly  advocates  the  treatment  by  blisters. 
Eech  affected  jolut  la  covered  with  a  blister.  He  claimed  that 
the  pains  subside  within  twenty-four  hoars,  together  with  the 
fever, and  the  urine  becomes  alkaline;  but  Senator  obtained  very 
little  benefit  from  tlic  use  of  blisters,  and  that  little  was  not  al- 
ways permanent;  while  strangury  and  fibrinous  cystitis  sometimes 


41S  UASVAI.  OF  TRUTHSHT. 

foUowetl.    He  Rninii  up  bj  roconi mending  the  alkalim  first;  while 
in  aged  poreons  they  m&y  bo  replacett  by  lemon  juice. 

In  all  ttiaes  the  pAtleot  must  be  kept  in  bed  and  in  an 
poeition.  Tho  t«inporaturc  of  the  room  should  be  moderate 
the  coverings  light.  A  wnter-bed  may  be  u«ed  with  a^h'ant 
Heavy,  tlatulcnt  food  flhould  be  prohibited,  but  otherwieo  tho  ■ 
sliuuld  not  be  niUfli  rcHtrictod.  To  relieve  tliitvt  he  rocommotds 
the  alkdliic  water?.  Those  who  habitually  partake  of  stimulaoti 
flliould  not  be  wholly  dei)rive(!  of  tlioin.  In  the  rare  csiBm  char^ 
oclerizcfl  by  hyporfjyrexia.  he  uses  cold  baths,  affiieions.  op  laigt 
doMs  of  quinine ;  preferably  tlie  aniorphoutt  hydioc-hlorate.  Col- 
lapse cnlU  for  powerful  stimulants,  such  as  cunphor,  iuuhI:, 
Rtroiig  wines  and  bruiuly. 

In  less  urgent  cnwa  with  an  evening  temperature  of  um 
lOS",  quinine  in  doses  of  fiftuen  to  tliirty  grains,  given  towaids 
evening,  iH  nione  siifticient  to  moderate  the  violence  of  the  diseaie. 

In  vigorous  persons,  when  the  heart's  action  is  so  oxcit«da« 
to  indiait^*  threatened  cndoc-arditiit,  digitalis  may  ha  pvea  is 
lai^  dosca. 

As  to  tho  local  pain,  some  relief  may  bo  obtained  by  oleT■^ 
ing  the  alleetod  limb.  He  objeetB  to  the  local  u^e  of  heat,  bot 
affirms  that  the  H]ipli«ttion  of  icc-bags  i"  not  only  harmleiw.  but 
legend  the  dumtion  of  the  joint  iitl'wiinn.  Kven  the  energetic  use 
of  hydropathy  has  been  followed  by  good  results.  Kunzr  i-ecoro- 
mended  injections  of  carbolic  acid  ("  fivringoful  of  &  one  per 
cent,  solution)  under  tin.'  .-ikiii  c)ver  tin- altW-tod  jnints.  Srkatoh 
employed  it  in  iwo  cases,  and  was  struck  witli  the  rapid  relief 
from  piiin  whi<'b  followed.  This  was  far  more  f'ertiiiii  than  that 
of  cliloride  of  ethylene,  recommended  by  Wukdurlicii,  or 
ether,  subsiituiefl  by  NiEMEYKR.  Painting  the  Joint  witU  oarbol* 
ized  oil  is  lew*  effifncions.  Fixing  the  limb  by  plaster  I>and«g« 
ha«  proved  very  u»etiil,  but  the  method  is  hard  to  carry  out. 

11"  the  treatment  fails  to  relieve  wakefulness,  he  givee: — 

it-     MarpliiniF  lijdrochlor. p.  j 

ChloraJ.  lijdnL, QjOI 

M"", 

Synipt,.... ....si    /S M 

M.    S.— On*  or  two  uttlMpoeafuls  to  W  Ukta  mt  bti  Itiac. 


KUBCMATISM:    ACCTK 


417 


For  the  txfwsive  ttwcnling.  he  dirccta  sptwigiiig  with  Tinegar 
and  %^'at4?r,  »nd  giveit  mie-flixtieth  to  ono-thirtietl)  of  a  grain  of 
atnpine  daily. 

The  local  nae  nf  ice  is  roMrvod  by  him  for  ca^«3  which  are 
not  benefited  by  the  other  remedies  employed.  When  the  inters 
vertebntt  jointA  are  fttfcetcd,  the  severity  of  the  pain  lony  eompel 
OB  to  apply  leeches,  and  give  morphizw  hyivodemiically. 

I^aroxysms  of  dyspnea  and  palpitxition  commonly  yield  to 
moBtard  applied  to  the  epigaetrium,  and  the  um  of  valerian  in- 
ternally. 

If  the  inflammation  he  slow  to  leave  a  joint,  absorption  may 
be  promoted  by  leeches,  merciirifll  innm-tions,  Mir^ti>ri,  iodine, 
wanu  iwnltieea,  and  the  internal  use  of  iodide  of  potassium. 

LoHOSTRKTH  truya  that  tho  appliculimi  of  dry  cupa  over  Che 
lower  vertvbree  modify  the  seventy  of  the  affection  in  the  lega. 
He  find!=  moist  hc»t  ai>pHcnblc  to  <!a*es  where  the  intra-erticolar 
infinmmation  is  marked,  and  the  capsular  ligament  resists  the  ex- 
pansion of  the  exudation.  He  speaks  of  a  strong  solution  of  car- 
bonate of  Roda,  with  liiudanttm,  aa  useful. 

Quinine  he  finds  of  value  only  as  an  antipyretic.  The  treat- 
ment by  salioin  and  iU  derivatives  meets  bis  api)ro\'aI;  as  well 
as  that  introduced  by  Da  Costa. 

Maclaoait  introdut-cd  into  use  t\te  salirin  group,  which,  iir 
the  form  of  salicylate  of  soda,  cna'^titittes  the  most  popular 
remedy  now  in  vogue.  A  Miuple  of  thin  suit  may  be  given  ovory 
two  houn  until  the  fever  Iihk  iMseii  i^ubdued. 


Fdi.lbb*8  remedy  was  the  bicaxbooate  of  potaah.  He  di- 
rected one  ounce  of  this  Halt  to  be  taken  during  each  twenty.four 
houK  until  the  fever  ih  broken.  Thcda-te  Li  Ihen  tes.<ened  totiti 
drachms,  m  one  <ir  two  days  to  half  nn  ounce,  and  finally  to  two 
drachms.  An  excess  of  fever  must  be  met  by  un  incrcaf«  of  tho 
alkali. 

Da  Costa  recommended  tlie  bromide  of  ammonium,  gr.  xx. 
every  three  hoiirx.  He  claims  that  no  coAes  developed  cardiac 
complications  while  uuder  this  treatment 

SB 


4^B  MAKUAL   or  TaUTHSHX. 

Garbod  used  the  fullowtng  combination: — 

n    PotH.bkul>, gr.sxs 

Qoinlnamilphat, gr.r 

TineL  cudanooiL, , f  Jj 

HudLaoMue^ /|j 

Aiiuw f  5  Uj 

DiK>lv«  tbe  poUMft  In  tli«  vM«r,  mb  in  Ui«  luleliw  wd  add  Lb*  atbn 

This  doac  18  given  ovory  four  lionra,  UDtil  the  joint  affection 
and  fever  hnve  abated. 

He  alM>  n:t.-uiiiiituiided  the  lithia  Kalta. 

Trlmethylamine  waa  brought  into  use  by  the  Ruaaians,  bul 
it  in  doubtful  if  it  be  i\silly  a  remedy  of  value. 

No  remedy  has  as  yet  given  such  good  results  in  prcvcotinj 
heart  complications  »»  tbo  alkalios  rocoraTucndcd  by  Kuu.nL 
But  to  obtain  this  physician's  success,  it  is  neceMory  to  adopt  bia 
method.  Moat  phygicians  give  the  alkaliee  in  inefficient  doeee. 
"We  have  substituted  the  carbonate  of  soda  for  the  potash  ealt,  ta 
we  find  that  the  former  is  more  easily  bomo  by  the  etomaofa,  and 
that  the  urine  is  more  readily  rendered  alkaliue  than  by  the  uae 
of  the  bicarbonates.  The  daily  dose  may  be  di»)oIvcd  iu  a  email 
pitcher  of  water,  and  flavored  with  a  little  sugar  and  Icraon-ped. 

This  may  be  used  as  a  beverage,  the  patient  taking  the  whole 
amount  in  the  day  and  night.  Some  prefer  to  take  Vichy  or  Ap- 
pollinariB  water  as  a  vehicle. 

Salicylate  of  soda  is  the  remedy  to  he  given  in  very  severe 
cases,  where  the  pain  ia  bo  great  that  the  most  speedy  relief  is  de- 
manded. A  scrtiple  of  the  salt  ii  to  be  given  every  two  hours 
nntil  the  severity  of  the  fever  has  abated.  It  is  then  to  be  given 
leaa  froquently.  The  objection  to  this  method  in  that  tlie  heart 
Boon  begins  to  ebow  signs  of  wonkncss.  This  may  be  prevented 
to  Bome  extent  by  the  co^^^ioint  ndministnition  of  digitalis,  (syra- 
meneed  as  soon  as  the  fever  b€>gins  to  abate.  I'hoiigh  we  have 
□ever  bad  luiy  unpluHMant  von<«quence8  from  this  drug,  we  alwaya 
watoh  the  condition  of  tbo  heart  when  the  patient  is  taking  thea* 
lai^  doMw.  Altliough  no  other  renietly  produces  as  speerly  reliar 
as  this,  yet  the  disease  is  never  so  apt  to  recur.  Ilenoe,  in  per- 
manency of  effect,  thcNiHcylateti  cannot  compare  with  the  alkalies. 

We  have  never  obtained  any  but  antipyretic  effects  from  the 


khbdmatism:    ACUTB. 


419 


administration  of  \nTge  dtwes  of  quinine  in  this  diacasfl.    It  has 
no  special  virtues  in  the  treatment  of  rhuurautiam. 

Bromide  of  ammonium  certninly  HhowH  u  decidedly  bcDe- 
ficitil  (.•fttK-t  upon  aoute  oases,  but  not  bo  quickly  as  the  SEdicylates ; 
while  the  same  weaknetw  of  the  heart  Hupervones,  even  mora 
quickly. 

Tincture  of  iron,  in  d(»((«  of  thiiiy  droj«  to  a  dmchm,  every 
foar  hours,  was  introiluoed  by  ItKYKOLiMt,  who  reported  good  re- 
salts  fmm  itji  u!w.  We  have  tried  it  in  several  ca««et,  but  have 
never  obtained  auy  benefit  from  its  lu^  eveu  in  cases  whore  the 
iron  wait  oiherwiiie  uidlcated  by  the  anemic  condition  of  the 
patients. 

Tlicro  is  recently  n  tendency  to  return  to  the  use  of  oil  of 
Vlntei^reen  (from  which  salioylic  acid  was  originally  obtained), 
and  it  in  givun  in  da9<»  of  Ave  to  twenty  drops  every  two  to  four 
hour*.  The  remedy  i»  efficient;  but  the  piBlient  soon  acquires 
such  an  une4iu<|uerable  repugiuiiice  to  t}ie  oil,  thai  it  la  with  difii' 
culty  he  can  bo  induced  to  take  it  in  sufficient  quantities  to  b« 
of  use. 

Very  many  fihyficiaiis  Hpeak  of  cases  in  which  iodide  of 
potASSitim  ULx-omptiBhud  a  cure  when  other  romcdius  failed.  This 
iodicateo  tlio  value  of  the  drug  and  ita  true  place  in  the  treattneat 
of  rheunmtism.  Wc  limit  it«  lire  to  ucutc  cui**s3  which  have  lasted 
longer  than  usual,  and  tlireaten  to  become  rhrcmiv.  In  this  emer- 
gency the  iodide  will  rarely  fail  to  accomplish  a  cnre. 

A  method  undeservedly  neglected  is  the  administration  of 
cathartics.  While  we  do  not  give  draatiea,  or  such  doses  as  will 
weaken  the  |>Htient,  we  find  that  ho  is  invariably  better  after  an 
evacuation  of  the  bowels.  In  spite  of  Senator's  condemnation* 
and  the  ti-ouble  caused  by  moving  the  patient,  wc  ftitd 
that  the  relief  experienced  more  tbau  reconciled  the  patient  to  the 
trouble.     We  prefer  the  nsc  of  RochcUc  wilta  for  tliis  purpose. 

For  Uio  rare  ca«es  of  hyperpyrexia  we  have  heretofore  roliod 
upon  the  use  of  cold  buths,  and  ice  to  the  scalp.  But  the  intro- 
duction of  antipyrin  has  given  us  another  and  moat  efficient 
agent  Twenty  graitis  may  ho  administered  every  twenty  min- 
utea  ODtil  throe  doees  have  been  taken. 


420 


HAKCII.  or  TREATX«HT. 


RHEUMATISM.— CHRONIC. 

Bkcck  reeoinmendu  for  Ihe  relief  of  pain,  the  locnl  aac 
iodine, blistere,  opium,  l)«lla«Umiia  and  chloroform,  or  friction  witb 
stiniiilating  liiiiment£  coiitaiaiiig  camphor,  ^^Pt  turpcntino  or 
a(^«tic  acid.  Warm  fomentations  ni^ht  and  morning,  with  hot 
wut«r,  followed  by  rubbing,  aiid  stimulating  linimenbt  under  worm 
rollers,  is  n  most  efficneious  method  of  local  trcatmeut. 

Wliun  the  ]tatiunt'«  meuiiK  will  |«nnit,  he  Kliould  be  sont  to 
ft  warm,  equable,  8ub>tropIcal  climate.  A  hi^^hly  nourishing  diet 
fthoiild  1)0  |ire^nbL-d,  a^  well  un  freedom  from  muscular  exertion. 
Iron  and  cod<liver  oil  are  the  beet  drugs  to  improve  the  general 
healtli.    Tlie  Turkiii}i  bath  often  gives  tem|}omry  relief. 

RoBBKTS  Hpenkit  of  the  lieneBt  derived  from  a  great  i-ariety 
of  baths,  hot,  cold,  vajwr,  and  variouslj,'  medinited.  Goo<.I  results 
follow  Btrapping  the  joint,  with  ammoniac  or  pitch  phister.  Tho 
local  use  of  galyanism  hoa  often  bLvii  of  service. 

Intermdly  tlie  iodide  of  potassium  ifi  very  nsefnl ;  and  thia 
may  be  comhlucd  with  quinine.    Tonics  yield  the  best  results 

Davis  reoommeuds: 

8    PoU5B.tC«UL, ^It 

KxUpbjrtoUeaea.. f  J  I] 

TiucL  lira  roan  il, fj  ir 

l-^lix.  iiitn|) , '5  jw 

it.    B. — A  tcupounrul  «TU7  «U  liuuni. 

Cimicifuga  or  senecio  may  be  Hubstitntod  for  the  phyloliicca. 
Tlie  latter  ia  best  when  diuretics  are  needed.  IIk'.-w;  romcdiea 
must  be  continued  for  weeks.  For  subacnic  exacerbations  he 
ordera  ten  grains  of  Dover's  powder  and  three  graioA  of  calomel 
at  night,  followed  by  a  ealino  laxative  in  the  morning.  For  per- 
manout  relief  we  must  maintain  the  limlthy  action  of  the  eliminft- 
tive  orgnn!4.  Flannel  must  ho  worn  next  tho  akin;  damp  and 
cold  rooms  must  be  avoided;  vtuleutexoreisoand  sedentary  habits 
muNt  be  alike  shuimed;  the  diet  slioukl  be  plain,  nutritious,  suf. 
&icnt,  and  taken  with  regularity.  Akotiol  in  alt  foniu  Hhould 
be  forbidden,  an  hindering  the  ellminatton  of  the  products  of 
tiasue-metamoi-phosis. 


RHBUMATISM:     ACUTE.  421 

"Warm  alkaline  baths  may  bo  taken  twice  a  week.  When 
the  boweU  are  coHtive  and  the  dige<ttion  impaired,  he  prescribes: 

B     Ferri  nilph^ gr.  xIt 

Eit.  oolchiol  BQft,. sr-^uy 

Kxt-  iTMtakbiM  Ind, Kr>xt 

Ext.  biraniwnii, gr.x 

Eit.  alon, gr.  X 

U.  fU  mm-  cl  In  pil.  no.  zW  Hr. 

S. — OnvpUl  to  b«  given  bt-fort  each  iue*l  until  th«  Vowels  u«  regular,  thca 
ITvtitaUT  dboontinued. 

If,  in  addition,  the  blood  be  impovcriahod  and  the  feet  cold, 
he  adda  two  graiue  of  goaiac  to  each  pill  and  emits  the 
oolchicnm. 


Drlapield  givee  Iodide  of  potassium,  beginniug  with  thirty 
grain? 'loily.  and  increasing  gnuliially.  Witli  this  he  use*  mas* 
sage  t>f  the  uft'ected  joints.  "KTien  a  skilled  manipulator  (annot 
he  scciiivd,  he  subtititules  the  appliuution  of  iodine  or  blisten, 
long  LHintiimed. 

IIi.RTSiioRi>E  recommends  a  liniment  containinj;  tarpentiiie, 
oil  of  itawuLt'raH,  Hiniiionla  and  latidaniitii,  dUuted  with  Hoap  lioi- 
ment.  If  the  pain  ho  con.siilemhle,  chloroform  or  aconite  lininieut 
is  better.  Blislera  may  In;  appHwl  in  had  ca.se*.  For  rigidity  of 
the]  joints,  great  relief  \s  obtained  from  pouring  hot  water 
continuously  over  the  i>art8. 

AlTKBN  recommuudB: — 

a 


r 


M. 


I'lilv.  guaiad,. ■ |  j 

PulT.rhel, 5U 

Polos,  biurt.,. 

Kiilpliur  miblim U    5  J 

Piilv.  mTrisliae. J  y 

HellU,.' Ilk  J 

B. — ^TVo  laraic  spooufuila  to  bo  tokeo  night  and  morning. 


TuiLLiPa  speakH  liighly  of  rhus  toxicodendxon,  especially 
in  cases  charautorlzcd  by  mieturnul  jtuin.  A  liuuturu  may  be 
made  by  macerating  one  part  of  fn»h  leaves  in  two  parta  of 
alcohol.    Of  this,  \  h  ^  k  >aay  )>&  given. 


422 


MAyiTAL  0?  TBFiTMBNT. 


Other  rcmodies  which  have  been  proposed  are  oil  of  cajepot, 
iodoform,  |)etroIeum,  sassafras,  and  xnnthoxytum. 

Wc  bavo  already  spoken  of  the  speciljc  value  of  iodide  of 
potaaHium.  No  single  drug  equals  it  in  utility.  When  the  dis- 
ense  seems  disposed  to  rcmnin  permaBontly  in  a  single  joint  (gen- 
erallv  the  knee),  tlie  most  nwfiil  eourse  is  to  sew  amnnd  the  joint 
a.  cap  of  red  flannel,  and  soak  the  flannel  iii  cod-Uver  oiL  Thia 
may  be  covered  with  oiled  ^ilk;  and  the  supply  of  oil  renewed 
daily.  Hassage  is  particularly  useful  in  breaking  ap  the  adhe- 
sions whii-'h  are  HUre  to  be  found  anmnd  a  joint  long  rbcuinatic. 
For  the  »ime  caum  faradisation  i»  ef«ential,  to  restore  the  disused 
muscles  to  their  nurumt  <--(mditlon.  Many  u  joint  la  supposted  to 
be  disabled  by  rheumatism,  which  is  simply  iu  a  statti  of  false 
anchylosis.  Among  the  American  springs  which  have  been  found 
useful,  the  Oettysbui^  Kat*lysine  is  especially  valuable.  The 
Hot  Springs  of  Arkanaa**,  are  also  popular.  But  wc  bare  more 
faith  in  the  use  of  tonics  when  needed,  the  iodides,  massage, 
the  prompt  treatment  of  every  acute  cxaeerlMtioii,  and  proper 
hygienic^  management  The  climate  of  Southern  California  is  the 
beet  as  yot  found  on  thin  continent  for  rheumatic caaefl.  Contrary 
to  the  usual  belief,  very  dry  climates  are  uosuited  to  this  dlscaAe. 


RHEUMATISM:    GONORRHEAL. 

BftODncRST  recoraraenda  vigorous  treatment  iulhecommence- 
ment  of  the  attack.  If  the  fever  be  high,  piu^tiveB  may  be 
ttdniitiiHtered,uiid  a  email  veneseiition  made;  while  local  finuen- 
tations  are  employed,  and  the  joint  kept,  at  re-it  by  a  gulla-porcba 
BpUiit.  Ho  then  gives  a  full  dose  of  Dover's  powder,  and  a  Turk- 
ish bath.  The  nrthritic  pain  sometimes  ceases  while  tin;  ixitient 
18  in  the  bath.  In  acute  attacks,  abstinence  from  meat,  and  from 
fermented  and  distilled  liquors  is  ftbHt)lulely  net««<ary.  These 
measures  will  usually  cut  tlie  attack  short,  [f  the  iufiammatioo 
tend  to  become  cbn)nic,  the  iodide  of  potassium  should  be  given, 
up  to  forty  grains  daily.  Leeches  aggravate  the  symptoms,  and 
induce  suppuration  in  the  cellular  tissue.  In  repeated  attacks,  or 
in  weakly  persons,  the  treatment  should  be  tonic. 

When  the  pain  and  swelling   have  subsided,  considerable 


RICSSTg. 


423 


difficulty  may  lieexporicnccd  in  reHtorin^  mobility  to  thd  affocted 
joints.  Frictions,  shampooing,  and  forcible  flexion  under  chloro- 
form laay  be  necessary. 

Brdck  nays  the  treatment  in  not  very  itatiafactnry.  He  favors 
persistence  in  the  eflbrte  to  check  the  nretfaml  discharge.  A. 
lininiciit  cora[>osod  ofcqiial  jmrta  of  glycerine  and  extract  of  bella- 
donna may  be  applied  to  the  jolut. 

In  acute  cases,  free  purgation  ttliould  be  (tbtuinud,  Ibllowed 
by  wiine^,  alone  or  with  quinine.  Iodide  of  potasaium  niuy  be 
given,  with  iron  or  with  alkalici*.  Mcrcuriutrt  Moinotimcs  uffect  a 
care,  especially  as  there  is  not  uncommonly  a  syphilitic  taint. 


RICKETS. 


Senator  calls  attention  to  the  importance  of  providing  suit- 
ablo  food  for  the  child.  Nothing  takes  the  plat*  of  tlic  mother's 
milk.  Cow's  milk  is  the  bei^t  aubetitute.  When  the  first  teeth 
corao  through,  the  mother's  milk  ehouM  be  supplemented  by  some 
digeetible  food,  euch  as  broth  with  iaiiigla?fl,  or  nieat-sha^nngs. 
"When  milk  proves  indigestible  ho  gives  the  yolk  of  an  egg  beat- 
en up  with  water,  milk-sugar  and  a  trace  of  salt.  Next  to  milk, 
he  places  Ncatlc's  milk-food,  condensed  milk,  rcvalcnta  Arabica, 
Liebig's  eoup,  Loefluud't*  iiilimU'  food,  and  boiled  arrow-root. 
All  infant  will  Bometiraes  do  well  on  n  less  popular  food  wlien  the 
famous  onea  dlaagroc.  "Warm  or  tepid  baths,  with  «alt,  aromat- 
ic8  or  malt,  are  servitieable.  If  the  dyspnea  prevent  bathing,  we 
can  8|>ongc  the  body  with  warm  brine,  and  rub  the  limba  with 
spirituous  lotions.  '\^nien  there  in  nnu-li  sweating  about  the  head, 
it  may  be  bathed  with  eoM  water.  The  child  should  be  kept  out 
of  dooni  and  in  the  kuii  m  niiii-h  a.*)  possible.  It  should  be  tdiield- 
ed  against  cold  by  warm  t^lothing,  and  the  immediate  change  of 
wet  linen. 

To  prevent  deformities,  the  child  should  tie  on  a  barrl  mat- 
treaa;  its  head  on  an  annular  ])illow,  with  a  central  o|)euiiig  for 
the  ooriput.  The  child  should  not  be  allowed  toRtand  or  to  walk. 
When  not  asleep  it  should  He  on  a  blanket  on  the  floor^in  the  sun. 

The  remedies  suitable  to  the  digestive  derangement  should  be 


424 


HAKUAU   OF   THKATUKKT. 


preftcKhn).  Iiimo  meets  most  of  the  indications  at  once.  From 
a  tenepoonful  tu  a  tiLble^jiooiiful  of  liiue-water  may  be  ^veo  sev- 
eral tinioK  a  day  in  tbc  milk  or  broth.  The  nilldor  preparBUooi 
of  iron  are  to  he  given,  wiih  eiin-'hona  or  goiitian.  If  the  (li| 
tion  Ihj  in  good  order  the  clialybeate  waters  may  be  preacril 
aJoneor  with  milk. 

Cod-liver  oil  cannot  be  given  when  tlie  digestive  oi^iu  i 
disordoifil,  nor  in  lioi  weather.  During  the  colder  months  it  may 
be  given  to  the  amount  of  a  drachm  to  an  ouncti  daily,  with  the 
best  efl'ect. 

Slight  afi'ecticns  of  the  respiratoij  organx  must  be  uureAiDy 
watched. 

IlKNOcncoincideH  with  Skkator, almost  precisely,  in  Iiis  meth- 
ods  of  treatment  Ue  rooommend*  hydrochloric  acid,  followed 
by  tinct.  rbei  atpiosa  or  vinorm,  ten  drojw  thrice  ii  "liiy,  it'uni)nrx!&, 
coateil  tongue,  coustij>ation  or  diarrhea  be  pre^^nt.  Ife  ha.*  never 
seen  any  good  from  the  lime  Halts.  Th<-  pneumatic  cabmet,  in 
whieb  children  arc  placed  to  breathe  rarefied  air  has  been  recom- 
mtindcd  to  diminLsli  the  cheat  delbmiity. 

Ei;sTAc-K  Smith  calls  attention  to  the  fact  that  food  whieh  ii 
digcfltible  to  one  ehilil  is  not  digostiblo  to  another;  hence  in  overy 
case  the  diet  muKt  he  suited  to  tlic  peculiarities  of  the  individual. 
Rickety  children  should  at  once  Ix-  wcanod.  and  placed  uj«on  tb« 
use  of  milk,  with  liquor  calcis  saccharatus;  fifteen  droiis  to 
each  bottle  of  milk.  Farinaceous  food  must  be  given  with  cau- 
tion; not  more  than  a  teiwitooiifnl  in  one  day  to  a  child  under 
twelve  months.  Over  this  age,  strong  beef  gravy,  mutton  pound- 
ed in  a  mortar,  or  a  meiily  boileil  pottito  taay  bo  allowed.  Castor 
oil  or  rhubarb  and  soda  should  be  given  to  clear  away  undigested 
fond,  and  a  little  soda  with  a  dro]>  of  laudanum  and  an  aromatic 
water  nflerwanls  to  remove  the  ofi'ensiveness  of  the  motlooa. 
Citrate  of  iron  may  then  be  added,  and  the  chiM  placed  cm  the 
Qf^  of  cod-livor  oil.  The  doee  of  thin  shoultl  at  first  be  small; 
fifteen  niiiiinif,  nr  less  if  the  oil  uiJjiC'ar  in  the  stools.  As  oCMk- 
Talcacence  advan<%ti,  wino  of  iron,  quinine,  and  Parrish's  food 
Arc  all  u^fnt.  So  l<>ng  as  the  previous  directions  arc  followed, 
the  exact  tonic  is  iif  littlii  conKct^uunce ;  but  tlic  c<>d-livur  oil  m^ 


ROTHBLH. — SCARLET   FBVBR. 


426 


not  be  omitted.  Lime  ia  of  little  value.  A  flannel  buiidage  di- 
minishei!  the  tendency-  to  diarrhcfl,  and  to  chcttt  dL'i'onnit^-. 

Pepsin  **hoiild  Ije  given  with  every  meal ;  and  no  more  effl- 
uent remedy  can  be  ibtutd  for  the  gaetric  and  hituitinal  distur- 
bances which  pi-ev-ede  and  accompany  ncketi«.  In  some  case^  the 
sztract  of  malt  will  aUo  prove  bcnctioial.  Vco*  otton  it  will  be 
fouud  preferable  to  rub  the  body  with  coddivor  oil,  instead  of  giv- 
ing it  by  thf  stomach.  Raw  beef  will  sometime*  be  found  an 
ext-elleiit  addition  to  the  diet  The  yolk  of  eggs  may  be  given,  if 
boiled  hard  and  reduced  to  a  powder,  or  a  pulp  with  milk.  Of 
the  iron  prt>  pa  rations,  the  best  ix  iho  elixir  ciiiehomo  forrata.  whieh 
combines  pliospliate  of  iron,  cinchona,  aromatics  and,  when  prop- 
erly made,  Freiifli  brandy. 

But  were  wo  <:(mtined  to  a.  single  remedy  in  the  treatment  at 
rickets,  we  would  ehooso  the  hot,  salt  bath.  Wo  must  except 
liie  Incto-phnisphateof  linie  I'roin  thegenvfal  condenitmtlonuttju-hed 
to  the  lime  salt« ;  aa  thiH  hne  appeared  to  u«  of  nuqucut  ionahle  utility. 
tt  sliiitild  be  given  in  daily  doties  of  three  grains,  divided  into 
many  portions. 


rCtheln. 

SqvIRR  »ay»  that  re!<t  in  bed  for  three  diiyn,  and  eonHnement 
to  the  house  for  a  week,  is  almost  all  that  18  roqiiireil.  The  fevor 
demands  no  H[)eeial  treatment.  Dilute  iicids  may  be  given  for 
relaxed  tliroat,  and  eluchoua  and   iron  during  convalest-enco. 

A  few  grains  of  citrate  of  potaniia,  or  a  little  aeonite,  may  be 
given  if  the  fever  be  higher  than  usual.  If  the  eoiigh  prove 
troublesome,  ipecacaanha  givea  the  xame  relief  aa  in  meaalea. 


SCARLET  FEVER. 

Thomas  advices  that  all  useless  articles,  carpets,  Ac.,  which 
can  collect  and  retain  dust,  sliall  be  n-niuvwl  iViim  the  room. 
Thorough  ventilation  must  be  obtained  in  some  way.  The  pa- 
tient tthonld  be  kept  periectly  clean,  and  all  i-xi-retioim  should  be 
ftt  oDce  disinfected  and  promptly  removed.    The  linen  should  bo 


49B 


iJtKDAL  OP  TRKATUBHT. 


placed  in  a  solution  of  chlorinated  soda  a»  mod  as  removed  ;  and 
should  b«  thoronghly  waithcd  in  liibH  u»ei\  for  nothing  elm.  Ar- 
tides  of  slight  value  should  be  burnt.  The  sweepings  of  tbe 
roODi  should  also  be  burnt.  All  clothing  and  other  aiiiclea  used 
by  tlie  attcmlBTits  abonlcl  be  treated  in  the  same  way.  Tlie  nanw 
should  ti-equeiitly  wash  their  hands  lu  some  disinfix-ting  liquid. 
Artielex  whii^h  cannot  be  washed  should  be  ezpoeed  to  a  higb 
degree  of  heat,  and  thoroughly  aired.  It  is  of  the  utmost  impop 
tancc  to  prevent  the  wcape  into  tbe  room  of  tbe  deBquamating 
acaleB;  which  may  be  done  by  keeping  the  hK>dy  clean,  or  rubbing 
twnco  daily  with,  oil. 

Convalescents  ahould  not  be  allowed  to  mingle  "with  tbe  w«U 
nntit  desquamation  ia  completed,  until  the  body  has  boon  waahcd 
and  clothed  in  fre^h  garmenta,  and  tbe  sick-room  with  its  contents 
thoroughly  elcansod  and  disiinfectod. 

It  i»  desirable  that  patients  should  not  be  congregated  in  tlie 
Batnc  room,  aa  the  ecveritj  of  the  cases  ia  increased  by  mi  doing. 
The  young  members  of  the  family  should  1»  exclmled,  aa  the  dis- 
poiition  to  flcurlct  fever  materially  leaeeua  with  each  year.  AK 
display  and  uscleea  attendance  at  funerals  should  be  prohibited. 

There  are  no  prnphylavticfi  except  iiMlution  and  dLMnfectirai. 
Nor  are  there  any  specifics  in  the  treatment  of  scarlet  fever,  tha 
only  rational  method  being  baied  uimmi  the  Bymptoma, 

In  normal  and  uDoomplicated  cases,  He  keeps  the  patient  i& 
bed  until  desquamation  has  ceased.  The  room  must  bo  thoroughly 
ventilated  but  draughts  avoided.  The  tempcmtnro  should  b« 
about  .59°  F.,  and  the  patient  must  not  be  overloaded  with  bed- 
ding. Tbe  liody  t^hould  be  a]>onged  several  time>  a  day,  and  thd 
linen  frequently  changed.  Slightly  SBtringcnt  gargles  should  bft 
nsed  for  the  sore  throat.  The  patic-nt  nbonld  be  allowed  to  drink 
freeh  water  or  lemonade-  Tliu  diet  should  be  I'v.-ilricttid  to  milk 
and  thin  soups  at  first ;  but  during  the  dcolino  of  the  disease  more 
nourialiitig  food  wliould  ,he  allowwi.  The  bowels  may  be  kept 
open  by  laxative  food  or  by  mild  a[»eriont«,  but  not  calomel.  Tha 
urine  should  Ik*  examinwl  daily,  l»oth  nnt'mBco](indIy  and  (dicmi- 
cally.  Very  high  fever  necessitates  the  use  of  cold  baths.  He 
believes  tliat  since  he  orders  u  daily  bath,  the  nephritis  occurs  lev 
Irequently  and  is  of  a  lighter  character. 


eCARLST  FSVBR. 


427 


ZlSHSeKH^S  botli»,  in  which  Die  water  is  ^radiiatly  cooled 
down,  fihould  be  uaed.  As  thefwerginkd.thetemperaturei^hould 
be  gradually  raiftcd  -,  during  convateHcence  the  batbt)  aliould  be 
wamt.  Ill  mild  ca^^ce,  and  when  the  parents  are  apprehensive,  it 
IB  best  to  use  oiily  wann  hatha. 

Intense  fever  demands,  in  addition  to  cold  hatha,  quinine, 
in  eight  grain  doses,  two  or  three  tiniM  daily ;  or  digitalis,  in 
doeeo  of  wven  to  thirty  grains  daily,  according  to  age. 

TbeAo  raea8urt«  itbnuld  uImo  be  employed  whenever  the  fever, 
although  not  excessive,  l»  unduly  prolonged.  The  increased  waste 
due  lo  high  or  prolonged  fovcr  nv<v!isitiites  freqncntand  nutritious 
feeding.     IIakk  recommends  frozeu  beef-tea. 

An  endeavor  should  be  made  to  meet  the  toxic  etfectA  of  tlie 
fever-poison  by  the  use  of  antizymotics ;  such  as  quinine ;  oai^ 
bolic  acid*  intenmlly  and  ttuhcutuncouitly ;  ttulphocurlmlate  of 
soda,  fifteen  grains  to  a  drachm  daily;  the  hyposulphites,  and 
osone, 

Collattse  calls  for  powerful  etimulanta;  such  as  camphor,  ben- 
zoin, musk,  ammonia,  rum,  cognac,  strong  winoit,  and  cold  affu- 
uon  while  in  an  empty  tub  or  a  batli.  In  desperate  ca«cs  it  may 
be  worth  while  to  practice  transfusion  of  blood.  BE>fNBTT  report* 
that  by  the  use  of  fresh  yeast,  one  to  two  tiibl««pooMfuls  several 
timoA  A  dsy,  ho  haa  never  lost  a  cose  of  malignant  scarlet  fever. 

\Snicii  the  eruption  is  slow  in  developing,  it  mHv  be  hastened 
by  niUKtard  [toultioe^,  or  by  anointing  the  iikin  with  lard.  Tlte 
bath  frequently  brings  out  the  rush.  If  the  fever  be  moderml«, 
diaphorutics  may  also  W  tried.  The  tuune  mca.tiin:»  tDay  bo  em- 
ployed when  the  eruption  threatens  to  fade  too  soon.  But  if 
dangcixiux  symptoms  aupcr^'ciic,  warm  batliA,  hot  douches,  mus- 
tard poultices,  cold  jiacks,  cold  aifusions  followed  by  wann  wrap- 
pings, and  diaphorcticit,  ammonia  and  musk,  may  he  employed. 
Lanoeniikck  «peak«  tn  the  higlicttt  terms  of  the  unc  of  a  hot  Hab- 
iron,  with  a  mustard  bath,  followed  by  sweating  cauned  by  worm 
wrappings. 

Severe  brnin  symptoms  are  due  to  fever  and  yield  to  active 
antipyretic  mcatiures.  Congestion  or  meiiingitie  demand  IcechoB, 
ioe-bflg8,  and  perhaps  venesection. 

Narcotics  are  useful   in   iicrvouM   delirium  and  excitement 


498 


MANUAL  07  TBEATHBN7. 


withoat  hyperemia  nf  the  bruin,  where  improvement  doea  oot 
follow  the  use  of  coM. 

Fur  moilerato  sore  tliruat,  ho  utw»  cold  droseingB,  ice  in  Um 
mouth,  and  the  use  of  cleansing  mouth  va«hea  and  gargles.  Tba 
use  of  leecbet}  to  t.lie  nock  or  nitrate  of  eilver,  thirty  jErnlnato 
the  ounce  of  wftt«r,  to  the  tonciU,  is  only  iieceeaary  when  then 
organs  arc  rapidly  Dwelling  and  threaten  suiTm^tion.  In  oldw 
patients  the  tonsils  may  be  freely  scarified. 

Gangrene  nf  the  throat  rnay  \te  treated  by  peimanganate  of 
potassium,  fincen  grains  to  tlie  ounce  of  wat«r,ehlonitL'  of  pnUi.«n, 
chlorine  wafer,  carl>olic  acid,  one  i»art  to  two  bnndred  of  water, 
and  with  cauterization  of  the  ulcerated  surface*.  Complitating 
diphtheria  xhoiild  be  trvatetl  like  ttlniple  diphtheria.  If  It  extencl 
to  the  larynx,  tracheotomy  otTers  little  hope.  In  the  usual  dijib- 
theri;},  th«  iiieinbnine  should  btt  removed  meclianicjilly  or  by  bm^ 
water,  and  a-stringent  and  cleansing  iiyections.  The  nan;!!  should 
be  oiled  or  greiutcd.  Stomatitis!  demands  thorough  cleansing  rf 
the  mouth,  and  timely  cauterization  of  utcer». 

The  ear  denmiuls  cjire  wbieh  cuiinot  be  jioatpoiicd  till  conva- 
lowence  wt»  in.  Tlie  tiocretion  obould  be  oarefuliy  removed  from 
the  nose  and  throat  by  means  of  doncbc?  and  c^argles;  and  from 
the  oxlerunt  meatu»  by  injection.  The  iullatinn  of  the  m 
ear  is  of  great  importance.  For  the  j^iain,  leeches  may  be 
and  Inter.  ponlticB& 

Severe  conjunctivitis  necessitnto*  the  ntw  of  cold-water  d 
ings.  Rupture  of  the  cunieu  may  bi?  ]ireveDte<l  by  the  local  uaa 
of  intense  cold,  by  the  use  of  atropine,  or  by  puncture  of  the 
cornea.  The  »eoretion  should  l)e  removed  if  it  <an  lie  done  with- 
out much  wtiTigglijig. 

Intense  cervical  infiltration  dcmnuds  ioo,  or  cold  water  drea^ 
ings,  but  leecbee  only  in  case  of  nece«sitj.  Aa  eoon  as  ptut  has 
formed,  hot  applications  should  be  substttutcd,  and  the  abscess 
speedily  opcnwi.  Chronic  iutiltration  of  glands  requires  the  ex- 
ternal use  of  iodine.  The  moment  gangrene  show-s  iteolf,  power- 
ful caufiticti  should  be  used,  and  carbolic  dreseings  applied.  Inter- 
nally, (quinine,  ncids,  stimulants,  strong  food  and  wine,  are  ur- 
gently indicated. 

Pulmonary    complicationa    render    the    freest    ventilation 


8CARLHT   PEVRR. 


429 


Othcrwiite,  and  with  llieavaiJmiueof  bloodOetling,  the 
treatnient  \»  that  ordtaarily  used  in  the  eame  nfToctions  occamng 
indepemicntly. 

Rlieuiuatic  (laiusof  tbeJoiDte  require  anodyne  luiimente  and 
a  supporting  bandage. 

Hemorrhagitf  scarlet  fever  roquires  the  early  oee  of  antifebrile 
iui(l  antimiflitniiitic  ntcnns,  abundant  Vi^ntlbtiou  and  quinine.  For 
severe  heinnrrbagiM,  he  usos  mid,  et|^t,  t&nnic  acid,  and  iron. 
"Wine,  etimulnntA  and  nonrisbment-s  are  all  importjint.  "WT^icn 
nephntiti  huK  set  in,  it«  aggmvalioii  may  be  preveiilvd  by  the  con- 
tinued 1186  of  warm  batli)«,  and  by  d]aphoretic)<.  Jtut  a  rapid  de- 
velopnwnl  of  the  synj]it»ni!*  call*  for  hlood  letting,  gL'in>nil  or 
local.  If  diarrhea  be  not  prewiit,  poi^atlves  may  be  employed 
to  relievi*  the  kiilneyo,  but  diuretii-!!  Klinuld  boavoiilvd.  If  ini- 
provemeut  be  not  »oon  manifested,  the  bleeding  should  be  rejieat- 
ed,  or  dry  cnp«  appliinl  over  tin-  kidni-yii. 

If  the  symptoms  increa;^,  hot  bnths  followed  by  two  hours 
of  sweating,  will  not  unfnsiueiilly  succx-ed.  Thi-wo  measures  are 
contra-iudicatL'd  in  capillary  bronchitis,  oedema  of  the  lungx,  and 
eclani]Uiia.  Vapnr  or  lint  air  liatliH  may  be  9ub-stitnt«tt  if  the 
patient  he  very  weak.  MiM  diuretics  may  be  given  in  addition. 
If  these  nieasurOB  do  not  carry  oil'  the  dropy,  largo  doses  of  ipoD. 
DU^  be  given. 

Uremic  convulsions  sliould  be  treated  by  venesection,  or  local 
bleeding  from  the  forehcail,  whcucver  the  pn'drmnnl  hcaihu-he, 
vomiting,  mild  delirium  or  slight  coma,  have  not  been  relieved 
bj  Btimulnut  baths,  diuretics,  dmatics,  cold  affusioiut,  and  cold  to 
the  head  and  stomach.  If  tJic  coiivulflions  continue,  resort  should 
be  had  to  the  inhalation  of  chloroform,  to  tlie  hypwlcrmic  uaoof 
morphine,  and  to  the  cumpresiiion  of  the  carotids. 

DojARDm-BEAtJMRTi:  says  iliat  inoculations  for  scarlatina  were 

made  by  Minuitt,  who  iimkI  blood  taken  from   the  scarlatinoua 

patclns,     A  nid  circle  was  pnHhuvd  around  the  puiictun**!,  which 

dieappearcil  the  aevcnth  day.     These  subjectn  were  pioof  against 

'  soarlatiiia. 

LoouiB  recommeDds  washing  the  body  with  cjirboliKcd  soap. 
His  advice  is  uot  to  um  cold  to  the  akin  or  outipyretic  doaes  of 


480  HAinrAi  of  tkbatment. 

quinine,  unless  the  fever  rise  above  lOfi'  F.    In  nil  caaei  du 

patient  is  to  be  spongwl  frequently  with  topid  wator,  to  which  k 
valine  i«  to  be  uddod  if  lUeiv  he  intense  buniiug  of  tbt?  »kia. 

For  the  tbront  complications,  he  prefers  oold  carbonic  acid 
water,  and  pieces  of  ice  held  m  the  uiooth. 

In  the  ailvunced  Htages,  with  great  cervical  Infiltration,  he 
prefers  hot  applications  rather  than  cold.  Ulcera  may  be  itpnyed 
with  carbolic  acid,  tincture  of  iron,  or  chlorate  of  potash. 

In  some  foebtc  and  uervoQs  cases,  stimulants  -will  I>e  demaod- 
ed  early ;  even  from  the  otart.  This  w  in  some  cases  our  only 
reliance. 

In  the  kidney  complications,  besides  cnps  over  the  Iddnofs, 
hot  fomentations,  haths  and  flannels,  he  givoi  digitalis.  If  tlie 
anasarca  do  not  diiwppear,  he  adds  calomel  to  this.  The  jMtleaC 
should  Inj  cncoumgeil  to  drink  freely  of  water.  If  convaUloas  do 
not  occur,  he  gives  morphine  hypodermics. 

Bartholow  givi»  tincture  of  aconite,  a  drop  every  hoar,  b 
tlie  initial  fever;  or,  profci-ably,  tincture  of  digitaliB,  one  to  ten 
drops  every  two  hours.  If  the  stomach  be  irritable,  and  tbew 
remejdies  rejected,  he  i-ecommGnds  :— 

Q     Tinrt.  iodU 51} 

Acid,  ctu-bolici .•••...•Si 

M.    B.^-One  drop  evcr^  two  to  fbnr  hour*,  Id  irgUt. 

For  conatipatiou,  he  gives  onc-«ixth  to  one  grain  of  calomel ; 
l>nt  Thomas  repeatedly  warns  againet  giving  mercurials  in  any 
etago  of  this  disease. 

If  the  eruption  be  pale  and  tardy,  with  feeble  circulation, 
Bartholow  gives  belladonna,  two  to  ten  drops  of  the  tincture 
every  two  hours;  and  if  tliia  fail,  tuxpentine.  Ue  approvM  of 
cold  Bponging  and  inunction  with  fat ;  the  latter  every  four  houza. 
Should  diarrhea  be  present  with  vomiting,  he  proscribes : — 

B     Biamiilli.aubniU. Sj 

AcE<J.  carbolidv gr,  tr 

Mud  I.  Bcnci)^ 

Aq.  lucntbs  pip^....^ U    fj  j 

M.    8,— A  leaajMonful  eyery  two  to  four  boan. 

For  severe  throat  symptoms  he  uses  wet  eompreaMft| 


BOAKLBT   FEVER. 


4S1 


cold.  The  throat  nhould  bo  frequently  garglod  with  milk  and 
water,  or  piec»  of  ice  maj  be  allowed  to  melt  in  the  back  of  the 
mouth. 

In  coses  showing  profound  alterations  of  the  blood,  he  prefers 
the  c»>nibination  of  iodine  and  t-jirbolic  acid. 

Davis  Kayn  that  when  judicioualy  used,  the  cold  water  treat- 
ment will  do  more  to  allay  exeitjibility,  lessen  fever,  and  favor 
natunJ  molecular  changed  than  can  be  dune  hy  all  other  remedies. 
For  further  correcting  secretory  derangemeota  in  severe  anginoee 
cases,  he  givcH  three  or  four  alterative  doisc^  of  calomel  during 
the  first  day,  and  subsequently  the  aqueous  i^oliition  of  iodine. 
He  cartrfuUy  avoida  nil  active  evacuants.  To  lessen  the  severe 
throat  att'ection,  he  makas  nse  of  hlnddere  fnll  of  pounded  ice,  or 
clothb  wet  witli  au  iitfuKiun  of  aconite  leaved  and  chloride  of  am- 
monium ;  made  by  pouring  a  quart  of  boiling  water  on  an  oimoe 
of  aconite  leaves,  and  half  an  ounce  of  the  salt.  Locally,  he 
oaes  on  the  throat  a  solution  of  chlorate  of  potassa  with  a  little 
hydrochloric  acid  ajid  belladonna. 

When  the  glands  remain  swollen  after  the  disease  has  com- 
menced to  decline, he  KulMtitute»  for  the  ico  a  liniment  of  one  part 
of  tinctnre  of  iodine  and  three  parts  of  camphorated  soap  liniment; 
while  internally  tincture  of  iron  and  (jninlite  are  administered. 
In  cases  showing  luiiif^ual  weakness^  a  mixture  of  Hqnor  ammoniss 
aeetatis,  tincture  of  digitalis  and  carbonate  of  ammonia  may  be 
given  alternately  with  the  above. 

Throughout  the  whole  course  of  the  disease,  o  good  nourish- 
ing diet  should  be  given;  consisting  of  milk,  gruel  of  milk  and 
flour,  and  bcof-tea.  It  may  be  naeeasary  to  rub  the  ekiu  with  cod- 
liver  oil,  containing  u  little  quinine  in  suspension. 

In  malignant  anginouH  caees,  or  incipient  gangrene,  he  orders 
an  infusion  of  one  drachm  of  eaiieicum  in  four  fluid  ounces  of 
boiling  milk;  and  to  a  child  five  years  of  age  he  gives  a  tvaMpoon- 
ful  every  hour  or  two  until  the  sloughs  separate. 

In  case»  chamcterixed  by  very  high  fever,  he  sponges  the 
body,  and  anoints  it  with  cod-liver  oil  containing  a  little  iodine. 

He  thinks  Utat  if  patients  take,  not  later  than  the  second  day 
after  exposure^a  solutionof  hyposulphite  uf  soda  with  belladonna, 


4t2 


HAHUAL  or  TKBATJIBKT. 


the  disease  wili  be  prcrontcd  or  ronderal  miMer.  To  a  child  fiw 
ycftre  of  age  he  gives  eight  grains  of  the  bypowulphitc,  and  two 
miiiims  of  tincture  of  belladoima,  three  or  four  iiraea  a  day. 

Many  phyaicians  bare  great  faith  iii  digttaUs,  given  in  Urg« 
doses,  when  nyniptoms  of  blood-polsoDiu^  ure  luaaifest. 

We  are  disposed  to  credit  special  virtuw  to  a  lotion  for  the 
mouth  and  throat,  mtule  by  diattolvlng  two  drachiiis  each  of  borax 
and  salicylic  acid  in  eight  ouneen  of  water.  When  the  ill-om€4ied 
eoryKa  i)rvi4C'nt*  itself,  tliu  btwt  rumilt»  will  be  obtained  by  syring- 
ing the  nostrils  with  a  solution  of  nitrate  of  silver,  five  grains 
to  one  ounce  of  diMtillpd  water.  This  sihniild  \te  repe-ated  oveiy 
four  lioiiix.  Besides  llio  u^  of  ice  oxlenmlly  in  severe  anginose 
cases,  great  benefit  will  result  from  giving  small  portions  of  loe 
cream  fjnito  fiwinently  to  the  jHiticnt.  This  will  relieve  the 
tbrout,  and  give  the  child  a  large  amount  of  niitrini(-at  in  a  Bmalt 
bulk.  Fistid  rtcci'clloii.s  sliould  be  removed  from  the  throat  as 
quickly  and  thoroughly  as  possible;  and  this  will  be  found  far 
more  beneficial  to  thu  enlarged  cervical  glands  than  any  treotment 
applie»l  directly  to  them. 

We  have  tried  many  x|iecifics  for  scarlet  fever,  and  found 
none  which  arc  trustworthy.  We  have  long  siiicre  thrown  off  the 
fenr  of  driuigliLM,  and  have  Iwimed  to  a.-i8ociate  (he  freest  poasib^e 
ventilation  with  mild  casefl  and  no  sequels;  while  thcovor-anxictj 
which  clortCB  all  pitssiblc  Himrcos  of  fresh  air,  and  shuta  in  the 
poison  exhaled  by  the  patient  so  that  he  re-absorbs  it  with  cvtay 
brootli,  goes  hand  in  hand  with  severity  of  all  the  eymptoms,  and 
probable  ncpbt-itis  afterwards. 


SCIATICA. 

Dujardin-Bkaumetz  says  that  the  revulsive  medication, 
carried  ont  inall  Its  rigor,  succeeds  bent.  When  sciatica  isohstinate^ 
and  not  due  to  compi-easion  of  blood  vessels,  viscera,  etc.,  it  ht  doe 
to  neuritis.  Ob:ttinute  si:iattcAa  arc  uUo  often  dependent  on  disease 
of  the  t^piual  coixl;  e-ipecially  when  bilateral.  He  recommends  a 
blister  uti  inch  wide  to  be  applied  along  the  whole  length  of  the 
afi'ected  nerve.  LicuRotix  dippeil  a  stick  in  snlphurio  acid,  and 
with  it  marked  out  the  branches  of  the  nerve  on  the  leg.    This 


8CIATIUA. 


4^ 


18  too  )«i'i?i'e;  mid  imt«]i«l  he  uees  Um  Piu(ii«liii  cautery,  itiurklng 
point!*  ailing  the  course  of  the  iiervo.  These  point*  nn?  hnlf  a 
centimetre  in  tlepth.  Scbkkihrr  hu-s  l»t(!lv  rn^mi mended  massage 
in  neiirutgiaa  genenilly. 

Hv7AAitv  arlvJ8*s  that  in  severe  eaeeB  the  jmticnt  bo  kept  in 
bwi.  Hot  |umltiL-i.ti  sonii^tinu'«  givp  ii'lief,  if  rapidly  i'et>eated. 
The  liypodpiTwic  iiije»>tioji  of  moTphine  givea  of  all  romcdioe  the 
most  sfieu(]y  relief.  Oiie-tttntti  of  nf  n  gniiii,  twice  n  day,  in  enough 
to  l»gin  with.  The  do^o  should  Im"  diminished  as  relief  ie  obtninod. 
He  nt-imiiiu-iids  galvanlsui,  lining  fruiii  twenty  Lr»  forty  eellrt;  one 
polo  being  npplied  to  the  snci-o-iliae  artjfulation,  and  the  other  in 
a  tnb  of  salt  water  in  whieh  the  foot  of  the  affected  lindt  is  placed. 
The  application  should  be  continued  ten  minutea. 

COMEoy*  reports  that  be  has  sueceoded  with  a  plan  proposed 
by  Maloaioxk,  of  touching  witJi  a  red  hot  needle  the  anterior 
part  of  the  helix,  at  its  entrance  into  the  concha,  on  the  aftected 
aide.  It  seeina  wingniar  tliat  euch  a  connection  should  exist  be- 
tween the  ear  and  the  sciatic  nerve.  Another  very  painful  bat 
efficient  remedy  is  the  injection  of  twenty  droits  of  ether  jusl 
tmder  the  skin,  behind  tlie  great  trochnnter. 

Da  Costa  rertimmends  aa  giving  certain  relief,  the  hyi»odermic 
injection  of  one-eighth  of  h  grain  of  morphine  and  one-eightieth 
of  a  grain  of  atropine. 

Labordk  gives  the  following  as  a  aBcfnl  liniment:— 

R      01.  t«Kl.inlh, t%  tIU 

Chlorofonnl. 

Tin^-(.  «pii. U     rs  y 

M.    S.— To  be  nibbed  iaio  li*  «kb  atrtal  time*  k  day,  with  k  piece  of  fl«(in«l. 

VooT  rwommenda  etrctcldng  the  nttectt^l  nerve  i  without 
cutting  down  to  it),  by  extending  the  leg  at  the  knee  and  forcibly 
flexing  it  at  the  hip,  while  the  other  leg,  the  pelvis  and  the  body, 
are  fired.     RoMBKaa  apeaks  favorably  of  this  mt-lliod. 

TaotrasBAi',  Nirmbvkr,  and  many  other  authonttti  Mjieak  of 

the  Value  of  turpentine  jw  an  internal  remedy  in  sciatica,  but 
ac 


484 


BfAKVAIi  or  TBBAtWBflT. 


DujARDis-BBAiTMKTr.  nbjocts  to  U  oti  occount  of  caudug  gastric 

dietiirbaiioe: — 

B       ULterebintb^ f|  J 

M«Jli% fj  j 

M.    S.— A  Ublo^Mxmrul  twice  ^17. 

Akstie  spoke  very  tavombly  of  turi>ciitinc,  given  10  t^ 
mipim  doees.     Rohbero  8&y&  ii  is  almoet  a  specific    JjUUbsos 
recommended  it  in  the  following  fonnula:— 

n     tM.  terebititli^ f 5  y 

01.  ricini, f5  iv 

TiiktL  canlamoiiii  cutnp^ f  5  j 

Murilnginii, .,.,.,..... 

A^iiuc,.... ii    q.a,Ml    f  J  u 

M.    ii^-Al  one  do«e. 

Ite  ilurid  that  tho^e  who  derive  the  moat  Iwnefit  from  tK! 
remedy  are  middle  aged  persons.  looking  prematurely  old,  with 
hair  prematurely  aud  permanently  gray ;  the  complexion  having 
ft  atiude  of  ashy-gniy  or  stone-color. 

Taocssbau  stated  that  sometimes  when  Misters  and  morpbine 
endermicaU^'  failod,  a  cure  waa  obtained  by  covering  the  vhcAe 
thigh  with  H  pitch  pljwt^ir. 

(For  further  information  see  article  on  Nem-algia). 


SCROFULA. 

BiRcn-Hiii.sc a PRLD  adviHett  that  great  attention  be  paid  to  the 
feeding  of  scrofaloua  childrew.  No  universal  rule  can  be  given, 
BS  the  itamc  articlett  di>  not  agree  with  all  children.  He  oltjecta  to 
children  being  allowed  to  eat  food  intended  only  for  adults.  Qood 
milk,  easily  digested  meat  und  wcll-lmked  bread,  forma  the  bulk 
of  the  diet.  Lentil  soup  agrees  with  many.  The  beet  drink  is 
water;  but  well-fermiuitcd  light  beer  is  not  to  he  rejected.  Chil- 
dren must  not  eat  too  much  or  too  often;  white  as  to  the  habit  of 
friends  presenting  children  with  candica,  he  exclaims ;  **Thc  Lord 
protect  them  from  their  friends!"  I'ure  air,  muscular  training 
and  the  culture  of  the  skin,  should  receive  due  att^tion. 

Cod-livcT  oil  i^  especially  suited  to  poorly-nouriahed  patients, 


SCROFUUl. 


4SS 


and  thorn  with  scrofulous  bone  ()iAea«es  and  ulcon.  On  glandular 
tumors  it  Iium  iio  tiffect.  It  sbould  bo  given  iu  daws  of  two 
drachnis  at  first,  half  an  hour  after  mcaln. 

The  Iciwt  dangoroiia  form  of  iodine  is  the  water  of  the  Adol- 
huid  spring,  of  lleilbronn.  Ni'ssbaum  report*  numeroua  casca  of 
bone-ecrofiila  sent  to  him  for  operation,  which  recovered  under  its 
use.  Of  tho  other  iodine  proparalione,  the  best  ia  the  iodide  of 
iron.  It  may  bo  useful  in  chronic  and  grave  affections  of  t^ie 
bones  or  of  the  brain. 

Iron  i»  indicated  m  anemic  cases,  and  tlien  Uic  mildoat 
pre[)iarationB  shonld  bo  preferred,  such  as  the  lactate,  pyropho»> 
phatv,  etc- 

The  muriatic  saline  waters  are  recoiii mended  for  glandular 
tnmorx,  connective  tissue  inflammations,  chronic  calarrhs  and 
skin  atfections.  The  water  i«  uce^l  inf«niiiMy  and  oxtemally. 
But  tlio  most  important  point  in  the  selection  of  a  spring,  is  the 
hygiene,  purity  of  air,  and  pnitection  fnuu  winds,  which  it 
affords.      Wherever    tho    patient  is  sent,  a  long   residence    ii 

^K|«aaential. 

^^r         At  the  seaside,  serofulnus  aflbi-tions  of  tho  eye  bocomo  wonM, 

r       while  bone  diseases  and   large  solid    glandular  ttiraoni   remain 

I        stationary. 

^^m  Hydropathy  is  beneficial  if  rationally  applied ;  but  a  fanatic 

^^pmay  do  hurni  with  it.     Wet  ]MickHaiul  cold  douches  are  to  Ims 
*       commended. 

Local  scrofulous  uticctionH  rw«)ivc  the  nrdinuiy  local  treat- 
ment. Hkin  <)isea«es  ilemand  simple  cleanlinesii.  Ophthalmia  is 
not  benefited  by  astringents,  and  is  made  wome  by  cold  water. 
Tying  up  the  eyes  with  hea^-y  materials  must  be  forbidden.  For 
photophobia,  immersion  uf  the  fuoo  in  cold  water  is  a  giMxl 
remedy.  Catarrlm  »hoiild  he  carefully  and  thomughly  treated,  on 
general  priiiciplee;  the  digestion  being  sedulimsly  improved. 

A»  to  glandular  tumors,  ho  do«  not  take  as  docidod  grouiuls 
in  favor  of  their  removal  as  doe*  Bi'btrk,  whoAe  prcseriptloii  is 
"iron  in  the  form  of  the  scalpel."  His  objections  are  as  follows: 
(1)  Lonnl  tuberculosis  of^n  exists  in  the  l»Mly  for  years  without 
producing  general  tuberculosis.  (2)  The  lung  disease  almost 
always  b^ios  simultaneously  with   the  cbe«sy  deposit  In  the 


4S6  MAItUAb   or  TRBATMEHT. 

glouds,  und  anvh  pntionte  die  of  phtliisM  in  Bpitc  of  tlu>  exliquitian 
of  thi>  glnmU.  (S)  In  the  duiiger  of  genera]  miliary  tuben'oloeu 
greater  than  iht*  diiiigi?i*  for  tbe  niieration?  (4)  In  niany  aww  it 
\»  imiKKviihlo  tn  remove  all  \he  di(ie«i«ed  glandular  matter;  win 
the  csniif  of  the  iiic<Ua8tiiia1  glands. 

To  tiiew  objectlntiis  w«  will  aiuiwer  a  few  word:8,  tui  w<j  an* 
hteitattiigly  owt  in  oar  vote  in  this  tuntter  -with  Ht'KTKB.  (1) 
Nobody  <;IairoH  tiiat  local  tuborciilosw  always  produrea  getieiml 
tubercular  tliwiu<e,  but  that  it  often  doe»  m>,  and  thiit  there  is 
always  danger  th«t  it  will  do  so.  Hence,  wf  advise  the  removal 
of  en1ai^>:Kl  glands,  just  nn  we  advie«  a  person  who  has  a  Iteniia 
to  wear  a  trtiFts.  (2)  In  na.ie.t  where  the  lung  dineu:^-  really  exi«t« 
already,  the  removal  of  diitcuaed  glands  is  not  so  iD)j)eralive;  al- 
though even  then  it  is  in  auoordance  with  rwison  and  obMin'ntioai 
that  the  systiini  can  better  reaiitt  the  attack  of  the  di^cat^e  if  ite 
extent  he  UniUoil.  Hut  is  it  really  tnte  timt  pulnutiiury  tutwrca- 
losis  ttluiiwt  always  nccompanies  Bt-rofulous  cidargemetit  of  the 
lymphatic  glandn?  If  this  Iw  true,  thu  rwnlts  «f  our  oj>emti<»n« 
in  removing  such  glands  arc  simply  astounding — if  each  time  we 
unwittingly  cured  a  pulmonary-  tuberculoHts.  (8)  This  is  a  ques- 
tion to  Uo  decided  in  nwh  piirtiinitar  tiMj;  ami  us  not  a  proper 
objection  to  be  brought  agaiui^t  the  method.  (4)  This  is  aim 
irrelevant;  m  there  is  no  qiiettion  of  operation  ujion  glands  which 
are  out  of  the  surgeon's  reach. 

Hbsocu  calls  attention  to  the  iroportanoo  of  avoiding  tht 
disea»;es  which  miiy  awaken  the  dispoaition  to  Hcrofulft;8uch  a» 
whwi ping-cough,  luoaslc^,  small-pox  and  vaccinia. 

I'urc  air,  in  light  and  airy  apartments,  the  removal  of  cold 
and  moiwturr,  nutntioiis  diet,  country  air,  g^'mnastiecxereiaeeaniil 
carefid  attention  to  the  functions  of  the  skin,  are  the  most  impor- 
tant anti-ML*n>fulonK  remedies. 

.Among  drugs  he  placet;  iodine  IJnst;  giving  it  in  the  form  ol 
iodide  of  iron,  or  in  Lugol'^  solution.  If  no  diaturbaiice  of  di- 
gestion occur,  the  remedy  muHt  l>e  oontinuod  for  months;  but  it  is 
conlra-indicalwl  by  even  the  suspinion  of  jmliuonary  tuberenlosis. 

His  catimato  of  the  l>athing  resorts  agrees  mainly  with  that 
G^  Bmcii-HinscuFELD. 


scRonti^ 


Cod-liver  oil  )iu  i-oiiniil«rH  fiir  infmnrlo  'loduie.    Il'tljo  \aceA 
[>plH-jiliii[i  of  ioiliiio  pi\>ve  uii3m-coa--*riil  iit  causing  renolutioii  of 
enlnt^t'i)  <_'^!iinili;,  the  tniinctioii  of  [KitAsli  map  ^should  be  Iricd  Im- 
fore  |iroce«<Iing  to  exiirjMite  the  glaud^. 


h 


Davu  adds  his  voice  in  favor  of  the  long  rcmtiniied  uw  uf 
IbdW  ill  ^tiiull  iIuMtw. 

When  thn  gbmU  have  ftiippuratitl,  the  pUK  Hhould  Li«  iUa- 
cburgtMi  by  uii  var\y  uwhUni.  WUoti  Ihere  h  ext«iiaive  i)U|tpur- 
fttion,  with  open  iiU-ors  which  hnvc  excavated  edgett.he  prescribett: 

B     H^ilnrgrrt  chlof.  corraK....... ••-Br.j 

Tioct.  dnchonir  mmm f|  l|i 

E^tconUlL, f3W 

Synipl, - rSU 

v.    R-~A  tOHpooaful  (to  wi  adult)  befon  each  mad. 

Bartiiolciw  recoiiiiiieiid!!  the  emulftion  of  co(]-liv(>r  nil  with 
losphate  of  lime.  The  «ynip  of  indidc  of  iron  mid  tnou- 
is  an  elBcieiiL  remedy.  The  \iwl  locul  rvmudy  U  the  oint- 
ment of  the  red  iodide  of  mervury.  Wlien  absceasa*  form,  the 
pu«  Fiiioiild  be  drawn  oR'  with  an  aspirator,  and  the  cavity  iigect- 
od  with  tincture  of  iodine.  Open  ulcere  may  be  duated  with 
iodoform  iind  tiutnic  ucid. 

RlXiiBK  reooiuuiendH  the  Sulphide  Of  calcium  wtiea  pus  14 
forming. 

Loouis  eayi^  that  brine  baths  arc  frequently  of  tlie  greatcHt 
benefit. 

We  have  frequently  obtained  more  benefit  from  hotflaltbotha, 
with  nibhiujr.  than  from  any  internal  medicine,  llie  laotophoiH 
phate  of  lime  has  proved  very  serviceable  in  our  hmida;  more 
thftn  iodine  or  cod-liver  oil.  It  must  be  given  to  the  amount  of 
ten  graiiia  daily,  divided  into  many  doeea.  It  should  be  continued 
for  from  six  month)*  to  two  years.  But  tittle  benefit  will  be 
obtained  if  it  be  given  for  a  few  weeks  mily.  Whenever 
suppuration  U  threatened,  one  grain  of  sulphide  of  caldmn 
per  day  may  be  added.  Of  local  ineaAun^,  the  only  one  worth 
employing  is  rest;  xceured  by  an  apporatus  og  euggeeled  by 
Hilton.    Thia  author  claimed    tliat    the    constant    movements 


4^8 


HAKVAL   OP  TRBATUSST. 


of  the  cervical  raneoles  prevented  the  subsidence  of  the  inlUtuin&- 
tion.  Be  this  as  it  nuiy,  Uic  fixatini)  nf  tlic  head  in  a  tu«ful 
atiziUary  in  Iho  treatment  of  such  a-fibctioii8.  The  injectiou  of 
iocHtic  IB  a  DBcleee  and  cruel  procetluni,  when  one  conuden  tliat  it 
ie  generally  children  who  are  the  eubject«  of  treatment.  Tlie 
meet  satisfactory  coms  vc  van  recall  to  mind  are  thom  in  which 
we  extirpated  the  ^landa. 

Rc7<idcncc  in  dump,  elevated  ngions,  such  aa  Bradford,  Pa., 
and  many  Alpine  valley's,  increuee  the  tendency  to  enlargement 
and  nupptiration  of  the  gland?. 


SCURVY. 


V  LsAoii  states  that  the  treatment  is  almoet  purelydietary :  and 

I  consists  in  replacing  the  green  vegetables  whoso  deprivation  cauwifi 

I  acurvy.     Solid  atiimul  food  (frei^h)  ctliould  be  given  once  a  day,  m 

I  soon  n8  it  can  be  masticated.    Kggs,  broths,  minced  meat  awl  ti«h 

I  may  be  given  at  onoe,  a^i  well  as  vegetable  food.      If  iharv  be 

^^  great  prostration,  brandy  niU8t  be  given  in  smnll  and  tm^n^'^nTly 
^^p  repeated  doReA,  but  thii*  is  only  exceptionally  neoe^ifuirT.  Malt 
liquors  are  antiat^trbutic.  So,  also,  is  milk.  All  active  niodiciiial 
trcolnicnt  is  to  W  avoided ;  aa  well  aA  all  forma  of  (.■ounler-irrila- 
tioD.  It  is  said  that  lime-juice  is  an  efficient  agent  when  iismI 
loc»11y  to  promote  the  faeaJing  of  ulcent  and  wounds. 

Merchant  vessels  of  most  nations  are  now  compelled  by  law 
to  diHtribute  to  tlie  tailors  re^ilar  rationa  of  pure  and  genuine 
lime>jaiC6.  But  the  greal  dimiimtion  in  the  number  of  av*es  of 
scurvy  in  modem  limes,  depends  low  on  thia  than  on  the  generally 
diffWd  knowlcilgc  of  the  causes  of  this  disease.  Ship  owneni 
are  too  careful  of  their  own  interests  to  allow  the  crews  of  their 
vesscU  to  become  disabled  by  scurvy ;  now  that  improvoil  methods 
in  preeerving  vegetable  foodn  allow  the  latter  to  be  used  even 
on  long  voyi^;c8.  The  knowledge  that  fresh  vegetable  focNl 
of  any  deecription  will  cure  scurvy  has  saved  many  Uvea. 

Old  sea-captains  will  almost  always  be  found  to  entertain  a 
firm  conviction  that  scurvy  may  be  prevented  by  keeping  their 
meu  fiiUy  occupied;  and  a  similar  belief  is  prevalent  in  regard  to 
the  jjrevetitioTi  of  yell<iw  fever. 


t 


SEA-eTCKNKftS. 


489 


Ooawionally  we  »ee  iimtances  of  scurvy  on  land;  mostly  in 
children  wlio  are  loo  carefully  fed,  by  Hmitiog  tlic  diet  too  closely. 
Wc  httvv  noticed  in  the  c«rly  days  fit*  spring,  little  children  eating 
huge  t'ucumber  pickles;  and  aacprtaiuod  on  inquiry  that  thoy  had 
bought  theiH;  with  the  pennies  given  tliem  to  purchane  candy. 
Wbeo  one  re6ect«  upon  the  fondueea  of  children  for  sweetmeata, 
the  purchase  of  suc-h  articles  w  picklctt,  at  a  waflon  when  fresh 
truck  has  long  been  scarce,  is  very  signilicant. 


SEA-SICKNESS. 

Ds  ZoucBB  iwy^  that  there  are  no  known  nicaD>):  of  preventing 
8ea-«iekneee.  Mo«t  casee  got  well  efiontaiicously,  but  nmny  re<)uire 
treatniimt.  Tlie  diet  alionid  He  light  hefore  cmlwirkiiig.  Fre»h 
air  is  a  powerful  remedy,  and  the  iwtient  nhnnld  reni:iiii  on  dwk 
whenever  the  weather  permits.  In  the  early  stages,  alkalies  aro 
indicated.  Ton  to  twentj'  grains  of  bi^earbonate  of  eodu,  fifteen 
minims  of  aniinoniate<l  tincture*  of  viilerian,  five  luinims  of  chlo- 
roform, half  a  drachm  of  rectified  spirit,  a  drachm  and  u  half  of 
muciliigc  of  acacia,  and  sufficient  camphor  water  to  make  one 
oun«?:  this  may  ho  given  every  two  hoiirs.  Chloroform  is  a 
Tatiiiibli'  sedative  to  the  stfliiiach.  Other  uwiful  drugs  are  iloff- 
mann'it  anodyne,  hydrocyauie  acid,  and  bismuth  in  prolonged 
caw*.  Ii-ed  champagne  is  often  valuable.  Ice,  8ucke<l  nlowly, 
relieve*  thii-»t  niiJ  Mii\h  vomiting.  A  hypodermic  of  motpMne 
Bometimei)  actx  like  a  charm.  Chloral,  nitrite  of  amy]  and  nitro- 
glycerine have  been  auccessfully  employed  in  aonic  autca. 

Belladonna,  chloroform  and  camphor  liniments  applied  to  the 
epiga'^trium,  and  a  fimi  alidnminnl  Imndage  are  useful.  When  in 
the  t)Crth,  lIic  patient  ;th<iidil  lie  im  hi^  back,  witii  the  head  low, 
and  a**  quiet  ae  iKwsible.  Light,  semi-fluid  fiK)d  should  be  given 
fr(X|Ucntly.  Aft«rw«nl»,  toaitt,  Iwet-tea,  chicken  hrotli,  hnilod 
fowl,  or  pickled  meat<<  may  be  tried.  At  this  stage,  aoids  aid 
digestion;  and  now,  aUo.  clan;t,  champagne,  hrandy  or  stout  may 
be  allowed.  Diarrhea  iind  other  symptoms  are  to  be  treatajd  ii-< 
usual. 

Cu^pM.iN  rocommenda  ieo  to  bo  applied  to  thespinc;  and  l'>i« 
is  sometimes  suct^^Aful. 


440 


SAMUAL   OF   TREATUKNT. 


LooMis  divided  the  treatment  int<>  two  groonil  plana;  tbo 
Milative  Riid  the  stimulant. 

Of  till'  tipst,  t)io  Hpinal  ice  bago  ure  of  decidctl  \*nlac,  but  are 
itiiCetiitcd  Ui  many  cwc4,  Tlic- bromides  a  re  often  nwfiiMtttt  most 
Ijo  oouirtiuni'wi  aomc  (inie  iKJtbre  tJie  voynfff  and  omtintiod  until 
Uk*  pnlk-iit  hn^  booitne  aucmtomc«)  to  the  motion  uf  the  rc«eL 
Amyl-nitrito,  fmni  tlie  rapidity  and  the  certainty  of  ita  actino, 
sL-eiii'i  Hi  lif  the  iu<»Bt  dwirabte  remedy  yet  pi-oposwl.  It  aliould 
bw  given  in  full  drttios  upon  the  first  appi-anin'Mt  n(  epiff».«trir 
dittlroKS,  aiul  re|ieat*xl  ha  iuk-vubhi-^. 

The  eflwti*  n(  stitniilaDtfc  are  gwn\  sometinn.'s,  hut  not  UMiiiliy. 

In  i«»me  slight  wwes,  t«imple  devices  prove  mioccflsful.  A  pr»- 
lunged,  I'Vt-n  iiiitpimtioii  UD  the  viivcl  risite,  folIi>wt-iI  hy  a  nimikr 
expiration  during  de<ic«nt,  in  anvmg  the  moBt  pni^cemfiil. 


Itt  Honie  iMsei  ih>  renM?«li«)t  will  be  nftiny  nw,  and  the  patient 
niiut  be  fed  per  rectnm  with  artilicially  digested  foods.  Two 
cUttOi  of  cases  are  to  he  dictinjrnisheil;  thcr  plethoric  anil  the 
anemic.  lu  fUll-blooded  i>eraoii»,  with  pulaatin^  aipotids  aod 
headache,  the  romedies  are  total  nbittinenro  from  food  and  drink  ; 
bromide  of  sodium  in  duse^  of  twenty  grninA  every  two  to  fonr 
faouDi :  a  ht^ltle  of  cilmte  of  mn^rne^ia.  an  aloelic  pill  or  an  encina, 
the  day  iK-fon.'  wtiling,  and  twenty  grains  of  chloral  at  be«ltinie, 
the  first  night  nn  board.  No  stimulants Hhould  lie  allowed;  bnt 
the  next  inuraing  a  smalt  rup  of  very  liol  coffoo  without  (nvam 
or  sugar,  or  of  bcef-u-a.  should  he  given  iuinie'liately  upon  awaJc* 
ing,  uiiil  before  nny  attempt  t*»  line.  U  miwle  A  cold  Hponging 
may  follow,  and  usually  t]io  patient  will  take  a  light  brcokfaat 
witli  nllsh. 

In  anemic  i-naos  the  jtatient  should  be  ted  up  larefuUy  fort 
week  hfforo  setting  >iail.  The  bowels  should  l*e  open,  but  not 
with  purgation.  Instead  of  sedativoe.  hot  water  may  be  given 
before  each  meal,  and  if  the  water  lie  vomited,  a  small  quantity 
of  the  most  quickly  absorbable  food  should  be  swallowed  immedi- 
ately the  vomiting  ^top^.  Of  finoh  food,  rennet  and  milk,  limo- 
Water  ainl  milk,  the  white  ot  egg  beaten  up  ui  water,  and  bori- 
nine,  arc  the  bi»t  examples.  Small  dowvi  of  atryclmine  {gr.  1-60) 
arti  u.tcful  in  theeo  cases.    The  strength  should  be  supported  fruQ 


«KA-StCKS»MS — SBPTICKMIA. 


441 


► 


tbc  first  l>j  quinine  ^U|)|HMiLoi'ieH,  live  giiiiriri  uvorj  i\x  lioiira; 
and,  if  the  ea-*  bo  iirotmctcd,  by  oiiomate  of  j>o|«fiinixixl  milk  and 

li"  the  Btfiniavh  be  exciterl  and  irritiiblo,  rojoi-ting  overj-tbiog 
wbicli  U  nrtrrwl,  ii  i-lmifc-  tuny  liC!  niiiilc  jirmmtr  tin-  Inllowing 
articles, eai'li  of  wbicli  iitcflictciil  at  times:  Bisiniitb  liubcarb.,  gr.  v, 
and  Kodii  bitnirb,  gr.  ij,  tuki>ii  tiigi<ttier,  evm*  batt'  to  two  h»urs; 
chlorofono,  gtt,  v.  every  hour;  cocain.  bydniclitor.,  gr..  1-10, 
«very  two  to  lour  lioiira;  firgtiiit.  uxiil.,  gr.  j,  or  y.'ituL  oxid.,  gr.  j, 
everj' four  bouiit;  sinnpiBms  to  the  e]>iga>»triunt.  After  the  tirat 
two  dayti,  ruiiof  will  oftt^ii  h«  cxjHTtviK^ed  by  taking  &  miiiill  glam 
of  bitter  ale,  or  of  champagne ;  especially  if  stimulants  have  ])een 
herotofon.'  withheld.  In  miiiic  fuw.«  lec  will  l>e  found  UH'fiil,  hut 
much  more  frequently  hot  drinkft  will  give  relief.  I'lain  ftoda 
water  in  Mmall  dowit,  »ometinu;a  acts  like  u  oliarm.  Salty  drinka 
like  Viuhyor  Appollinarisagrecbetterwith  plethoric i>ei-ftoiti>.  Some 
pationtA  tiiid  relief  in  ouckitig  Icmutis,  or  eating  oUvcs;  white  wiUi 
many  othei^  banltack.  dried  U^f.  "wilt  borne."  or  old  and  tough 
ship's  beef",  arc  tlie  firat  thiug&  which  ^vUl  remain  iu  the  stomach 
long  enough  io  be  digested.  In  thin  case,  the  action  of  chewing 
prohuhly  sct^i  up  u  .^cnitioii  of  hcaltliy  ga«trii;  juice  an  well  aa  of 
aaliva.  A  bimilar  action  would  probably  follow  the  n»e  of  ttmatl 
doBffi  of  i[)ccacuanlia  and  rhubarb. 

I'crsona  who  are  unusually  sea-iticlc  should  aeloct  a  stateroom 
W  fur  as  t>o3BihIe  Ixom  the  propeller,  where  the  Jarring  motion  will 
be  least  annoying.  Tboy  ehouW  keep  in  the  oi>en  air,  and  away 
&0U  the  engines,  where  the  smell  of  the  machinery  is  bo  trying. 
Generally,  the  forward  port  of  the  vessel  is  most  endurable,  or 
some  p]H<;e  near  the  center  of  gravity.  Of  the  very  first  ini|.ior- 
tanco  iit  the  finditig  of  some  otlicr  owupniion  than  that  of  watch- 
ing the  development  of  Htumaclial  Miiittatioibt.  If  one  atn  he 
induwd  to  forgot  their  tiualms,  the  battle  is  won.  Finally  much 
oan  be  done  if  the  patient  can  be  itiduued  to  exercitie  hiH  will,  and 
resolutely  eut  his  mealii,  even  if  they  1>o  rejected,  until  the  rebclt- 
iona  organ  is  quelled. 


SEPTICEMIA.     (See  Pyemia). 


442 


^ 


MAHDAL  OP   TRBATM 


SMALLPOX. 


CraaCBaiAini  stfttee  tliat  vaccinAtion  during  the  incnbaticm  of 
enmlTpox  n'tll  not  pravcnt  the  outbreak  nf  the  lutter,  and  it  U 
doiibtrul  whether  it  renders  the  attack  any  lighter.  The 
aseertion  tliat  lurgc  doiwx  of  quinine  given  during  the  «tiige  of 
inviitsion  renders  the  subsequent  covirse  shorter  or  modified,  ii 
contrary  to  ]ii«  lur^  cjctxirience. 

During  the  stage  of  invssiou  tlio  patient  ehould  be  kept  in  a 
luge,  well-ventilated  mom,  at  a  coiidtant  temperature  of  G0''-67^ 
F.  The  patient  should  be  kept  in  bed,  and  given  eaeily  digested 
food.  Purv  water  !»  the  l*eHl  drink.  1  Tigh  lever  may  necewitata 
the  nm  of  quinine,  digitalis,  cool  baths  or  sponpng.  If  the 
beadac'he  be  severe  and  the  faee  flushed,  ii-e  compreHHen  and  ice- 
biigg  usually  give  relief.  Ice  and  Seidlitz  (wwders  may  relieve 
vomiting.  When  the.<te  are  incflcctual,  lie  uhcm  hydrocyanic  acid 
and  hypodermics  of  morphine. 

[n  the  eruptive  Htnge,  the  tuea&urcti  to  be  adopted  varv  with 
the  fonu  of  ita  aiipcnranoe.  Mild  varioloid  neodR  no  interferunec 
In  severe  variola,  the  Arabs  opened  the  pustules  and  evacuated 
the  contents.  This  merely  renders  the  ]«itient  more  comfortable. 
Oftul*rixation  is  impossible  in  confluent  at«s,  and  unneccsaary  in 
discrete  forms.  The  best  plan  is  the  use  of  cold  compresses  on 
tby  face  and  hands,  and  wherever  the  oniptlon  is  abundant.  By 
this  the  severe  [lain  is  diminished,  the  swelling  and  redno»»  of  the 
ekin  arc  lc»»PDcd',  but  no  modification  of  the  eruption  is  obtained. 

The  intense  pain  in  tJie  hands  and  feet  may  be  relieved  by 
wrapping  tlicm  in  cold  clotha.  If  tlie  odor  be  bad,  carbolic  acid 
or  other  autiseptica  may  be  added  to  the  water. 

BalliH  are  not  go  useful  as  in  typhoid  fever.  CompreeseH  and 
ipongiug  of  the  baly  are  more  easily  used. 

Astringent  gargles  are  indicated  for  the  mouth  and  pharynx ; 
the  best  being  a  weak  i«olution  nf  tincture  of  iron. 

The  diet  should  correspond  to  the  d^p-ee  of  fever,  and  the 
eondition  of  the  paticiifg  stomach.  Bouillon  with  egg/t,  Liobig'B 
beef  extract  and  even  wine  may  lie  given  if  the  patient  be  weak. 
In  delirium,  chloral  >4liould  bo  given,  by  the  rectum  (to  avoid  irri- 
tating the  thi'oat),  in  doses  of  ninety  to  one  hundred  and  twenty 


SMALLPOX. 


44S 


U. 


graiiid,  in  eight  ounces  nf  thin  mucilage.  Hypodennics  of  mor- 
phine, or  bromide  of  potasdium  may  be  used  itietead  of  chloral. 
Delirioii.t  patient*  shoiiUl  he  closely  watched. 

If  patientfi  be  weak  or  threatened  with  collnpee,  quinine, 
camphor,  wlno  or  alcohol  should  be  f^ivcn.  A  very  good  prepara- 
tion is  this:  Brandy,  difltilled  water,  each  two  fluid  ounces;  the 
yolk  of  one  egg;  syrup,  one  fluid  ounce.  A  tahlcspoonful  every 
two  to  throe  hours. 

In  the  declining  atagc,  warm  bathft  ^ve  great  comfbrt,  and 
lUt  iu  the  removal  of  the  erucita.  Lnunctiona  of  t«t  alleviate 
the  itching. 

Abscess  must  be  opened  early  and  freely.  Nothing  will  pre- 
vent the  fonnation  of  cicatrices,  but  in  variola  vciTueosa  he  has 
painted  the  nodulea  with  iodine,  with  greot  benefit. 

Againiit  the  licmorrhagic  form  we  are  almoiit  jxnverless. 
Styptics,  ice  and  tampons  may  bo  used,  but  have  little  eBect. 
Transfiisinn  hiw  pnivcil  disiip pointing,  but  should  be  tried  further. 
In  prophylaxis,  it  is  to  be  remembered  that  contagion  cling8  to 
clothes,  etc.,  for  a  long  time.  All  such  artifles  are  to  be  de-ttroyed 
or  disiiifw-'ti'd  by  heat,  chlorine,  sulpliur  or  cxiMwurt?  to  the  o|Kjn 
air  for  a  long  time. 

Ruth  clalme  to  have  prevented  »mnll-pox  in  over  one  hundred 
caseei  by  giving  for  Bf^een  days  an  ounce  of  vinegar,  four  times 
a  day.  and  using  also  aromntic  vinognr,  which  contains  camphor, 
garlic,  lavender  Rod  nutmeg. 

DnjAftDiK'BsimfBTZ  reconunende  for  the  back-ache: 

%    Chlororoniii, ...••.C5ij 

OL  tent^th.^ fSU 

Lin.  mpania, f}  y 

M.    8. — Linimtmt. 

For  constipation  he  gives  mild  ptirgativce. 

Mcrcutial  oiiitmeuta  have  the  curious  property  of  preventing^ 
the  development  of  the  pustuIcM.  He  appUci*  over  tlic  whole  face 
the  eroplastrum  dc  vigo  t^am  mercurio,  and  over  this  duatA  starch 
powder.  All  fiwinre.t  which  appear  in  lhi.t  iiiuak  are  lilted  up 
with  new  applications  of   plaster  and  starch.    This  shfuild  be 


444  MAKDAt.  or  TBKATMUNT. 

a^1ie<l  at  ihit  very  begiouuig  of  die  eruptiou.  The  pustuliB 
aroand  the  luoutli  will  not  be  aUtrtod,  l>oruu:»o  the  constant 
mntionA  btt-tilc  tluMiuiMk. 

Tbo  meihoii  of  Serkks  trnraiMtA  in  ojiening  ouch  vesicle  biuI 
[»pltl \  iiiji:  nitrate  of  Bilver.     Thiftt*bouM  l»e  reserved  lor  pnstnles 
■  developiug  oii    the  ixmiea.     For  the  nimilh,  gargles  of   Vichy 
and  chlorute  of  jtntaxMt  often  give  rcliet 

In  the  period  of  pe«>nclar.v  fever,  he  earnestly  rc<;<->[niuciids 
baths  nt  a  itiniiierafure  of  95*,  to  which  may  be  added  chh^nil, 
thymol  or  antiseptir  vinegar.  Th«  duration  ^hould  he  half  U) 
throe  qtmrtvrs  of  an  hour,  and  some  rum  punch  lihould  he  giTca 
during  the  hath.  Tlie  antiseptic  vinegar  of  Pcnni*  is  made  ai 
followit: 

B     Aeiil.  Mlit^lid, imrt  m 

AluauDi  McUL, "    i^j 

Conrant.  linct.  eucalrpt.  gMx, *    x 

CoawnL  lind.  YCrbM*. **    Tt 

CanceaLllact.  UvwuIuIk,.........!...    "    x 

Coocmit.  lincL  bMuain.^ "  J 

Acid.  McCid,  8*. *  z 

U.    8.— Tliree  oiinceB  ire  to  he  added  lo  a  fall  ImUi. 

To  these  local  measures  may  be  added  the  use  of  disiofcctaiit 
powders,  of  salicylic  acid,  nix  purtj*.  and  starch  or  talc,  one  hiin- 
dreil  i»rt«;  or  paiutiug  with  iodine.  PiocB  uses  one  jMrt  of 
tincture  of  iodine  t-o  rhr«;  juirt*  <if  glywrine,  and  applies  it  witli  a 
camel's-hair  pencil  every  four  hourei. 

When  heart  Aymptomit  develop,  with  a  wft  bruit,  a  double 
second  sound  of  the  heart,  delirium  and  great  wcj^knc^us,  ether 
may  be  given  in  deeply  inserted  hyi>odcnni(M,  and  opium  to  Lbe 
amount  of  two  to  four  grains  of  the  extract  daily,  in  divided 
doeoe.     AVith  thcM),  alcohol,  cafTcinc  and  ciucbona  eliould  be  uaed. 

Do  Castbl  give*  a  byi>odermic  nyringeful  of  ether  twioa 
daily,  and  one  to  two  grains  of  opium  moniing  and  evening. 
Tlic  more  intense  tin-  delirium  the  larger  the  dow  of  opium. 
Finally,  tincture  of  iron  if*  given  in  twenty-drop  dtitiea. 

HoBRKTs  (ipealcH  of  the  impoitaneo  of  tow  diet  in  the  begio- 
ning,  with  plenty  ut  ctMiling  driiikii,  iee,  f^uit,  ruueit  apples,  and 
no  Htimulajits.     loiter,  the  diet  xlmuld  lie  irnuhmlly  altered  to  beef 


3 


BlIAXLPOX.  446 

tea,  soups,  jellies  and  alcohol.  Iii  cases  of  a  low  type  and  with 
much  (nippiiration.  fiup[JOrl.iiig  niaiAurt*  must  bo  employed  from 
the  first. 

The  eruptive  Htage  retpiipefl  tfool  drinks  and  B|)«nging  with 
uitiseptic  lotiou^  8.tN^oat  touchc.-*  each  pucitdlc  with  carholic  acid, 
and  then  applies  a  mixture  of  that  sub^^tanre  and  oil  of  tbyme. 
The  fever  can  Im-  kc]it  in  ch&ik  by  sponging,  or  by  the  adminia- 
tration  of  quinizie,  three  to  five  grains  every  four  hours.  Dur- 
ing suppuration  tunica  are  iicodeil,  such  as  iron,  quinine,  miueral 
acidd,  and  stimulants  if  adynamia  be  present.  For  the  eye«,  com- 
preeeee  of  cold  water,  or  of  a  solution  of  corrosive  i<ubliroate,  one 
grain  to  six  ouncef>,  may  be  uMd. 

Davis  givea  ton  Ut  fifteen  groins  of  hyposulphite  of  sodft 
every  four  hours,  to  destroy  the  spocifie  virus,  and  in  eonflueut 
cases  this  is  continued  thnjiigh  the  eruptive  stages.  If  there  he 
much  gastrit;  distrosti  and  vomiting,  he  gives  a  grain  of  calomel, 
every  two  hours,  ulternnted  with  a  teuH[HK>uful  of  the  following: 

B     Add.  cariwUd, p.  vj^ 

Uljxcriai, 

Tinct.  gelKnii!, ki     t^JT 

Tiart-opii  nBptu, , 

AquKv ii    fl  i) 

Tf  the  hyposulphite  be  rejected,  it  ia  given  by  the  rectum. 
Dnring  the  secondary  fever  he  fiubwtitutea  the  tinetnre  of  iron 
and  quinine ;  and  If  gi-cut  wcakucsa  be  present,  the  ciLrbonate  ol 
ammonia  in  camphor  water. 

Ill  hemorrhagic  casee  he  givce  etrychnine  and  nitric  acid 
inatead  of  the  quinine.  For  free  intestimil  hemorrhage  he  givee 
one  or  two  grains  of  jwrsulphate  of  iron,  every  hour. 

In  malignant  caitoR  he  recommends  the  following: — 

B     Sodii  hypOHilphiL, 5  TJ 

Acid,  <«i'bDUd > gr.  z 

Aq.  menilw. ....fS  Jr 

M.    &— A  leaqMonful  evary  hoar  or  two, 

Bot  they  generally  die. 


m 


UXltVid.  OF  TREATMBNT. 


SPERMATORRHEA. 

8.  W.  Qrobs  recommeiidd  that  the  diet  be  natritious  nni] 
•digeetible,  the  evening  mt^l  in  i^iarticular  being  li^ht  and  drrtUid 
BtimaUting  food  m  well  as  alcohol  being  avoided.  iSefore  rctir- 
iog,  tbe  bladder  eboiUd  bo  emptied.  The  patient  shouid  learn  to 
sleep  on  the  side,  on  a  hair  mattress,  without  much  covcrii^.  A* 
fiilnees  of  the  bladder  induced  erections  and  nioniing  emiadoos,  _ 
the  patient  should  ect  uu  ulann  t-lock  to  etrikc  one  hour  before  the  m 
time  at  which  the  pallutionB  ni^nally  occur,  in  order  that  he  maj 
be  awakened  to  rit;e  and  empty  hid  bladder. 

HoPBobock  riding  and  driving  over  rough  roads  should  be 
interdictetl.     Kfasturbation,  i^exnal  intercourse,  and  all  which  tends 
to  excite  erotic  einotion«  sliould  be  avoided.    The  mind  and  the  m 
body  tthoiild  be  plea«ant1y  employed ;  and  if  the  (utimil  bavi^  no  I 
manual  labor  to  perfonu,  he  should  be  encouraged  to  devote  him- 
Relf  to  gyninastlL*  exercises.      But  if  there  be  »\gn»  of  .tpinal 
exhaustion,  bi^  mental  and  physical  exertion  ehould  be  very  modei^ 
ate.     Any  abnormal  condition  found  about  the  extenial  genitals 
should  be  remedied  ;  such  as  phimosis,  for  which  eircumeision  itfl 
ciyoined.  Her|»e«yieldH  toa  regulardiet,  relief  of  constipation,  dort-" 
ing  with  bismuth  and  calomel,  or  touching  with  a  five^rain  boIu- 
tion  of  nitrate  of  silver.     Contraction  of  the  meatns   should  bsJ 
divided;  a  short  i'renum  should  be  clipped ;  piles,  rectal  tit^ure^I 
pruritus  ani,  varicocele,  and  constipation,  should   reo^ve   thcii 
appi'opriate  treatment 

Of  tlic  exciting  causes,  the  most  frequent  is  inflamiuatic 
and  hyperesthesia  of  the  prostatic  ui-ethra,  jierlia]*  associat 
with  stricture.  For  this  condition  the  same  remedies  are  to  be 
UBcd  as  recommended  under  the  head  of  jmimtencp  fpnnje  "251 ). 
Under  all  circumatanoes  ho  giviw  half  a  drachm  of  bromide  of 
potasaium,  with  ten  drops  of  fluid  extract  of  g^UeuLiam,  every 
eight  hours,  and  oiie-»ixtictli  of  a  grain  of  atropine  at  bediime. 
In  anemic  subjects  the  bromide  may  bo  givi-u  at  bedtime,  and 
quinine  and  iron  during  the  day.  If  the  bromide  be  badly  borne, 
it  may  be  replaisd  by  a  scruple  of  ohloraL  Of  loral  remedies, 
the  steel  bougie  owupica  the  first  rank,  but  whai  the  infiamma^ 
tion  18  reduced  to  a  limited  area,  around  the  opening  of  tbe  qaca- 
latory  ducts,  he  applies  nitrate  of  silver.    The  hot  sits-bath  ia 


SPEKllATOBIlHEt. 


447 


invalnablo;  and  HA»Bii=iON  ailvm<s  doiiching  the  lownr  upme  with 
^water  at  1S0°  F.  If,  as  rarely  liappenn,  a  case  roavit  fchcoe 
[ineaBures,  he  roa^inmcnilFi  galvanization,  with  the  nnodc  to  th« 
nnmbar  region  and  the  oathtwlL'  to  tliv  pfriiiyuii). 

■When  atony  of  the  moiitlis  of  the  ejaciilatory  ducta  remains, 
the  galvaiik*  cm-rout,  ^vith  the  anodo  on  the  pemieuni  and  tli« 
cathode  in  the  rectum,  affords  tho  most  striking  results.  If  gal- 
vaiiizatiou  prove  iuadequate,  the  faradic  current  may  he  parsed 
through  a  negative  electrode  in  the  prastjitic  urotlira,  to  the  positive 
on  the  perineum  or  epine.  This  reijuii-es  caution;  beginning  with 
a  feelile  current.  Some  ca«ee  of  atony  are  hene^t«d  by  the 
administration  of  ergot,  lialf  a  Hiitd  drachm  of  the  fluid  extract 
after  eadi  meal.  Twt-lvi:  drojw  of  tincture  of  iron,  with  three  of 
tincture  of  cantharides,  also  provts  iwrvicejibte. 

TnoosssAP  suggeBtt-d  t}ie  ubc  of  an  ivorj'  or  hard  rubber  plug 
to  he  worn  in  the  rectum.  Eicuards  obtained  good  results  fi-om 
forcible  dilatation  of  the  arms.  Tf  there  he  spasm  of  the  sphincter 
ani,  this  procedure  should  afford  benotit. 

The  use  of  the  steel  sound  is  undoubtedly  the  most  efBcaeioiu 
agent  known  in  the  treatment  of  this  affection.  It  should  be 
passed  every  other  day,  and  allowed  to  remain  at  first  but  a 
minutu,  but  left,  longer  at  each  inrtwtioii,  until  half  an  hour  is 
reached.  As  large  an  instrument  should  be  used  as  nHlI  readily 
'pawi  into  the  bladder.  The  treatment  should  ha  continued  until 
there  is  no  longer  any  1«ndemefts  in  any  part  of  the  urethra.  In 
many  caaoB  it  will  be  found  lulvic^ablo  to  supplement  the  nee  of 
the  8t«el  fwund  by  that  of  the  boII  French  olive-pointed  bougie. 
This  may  be  used  by  the  patient,  if  ho  be  unable  to  sec  the  physi- 
cian often  enouprh.  Tonica  will  bo  frequently  required,  especially 
iron  and  Btrychnine.  Phosphorus  is  a  noxious  drug  In  these 
can&s.  Coca  ia  sometimes  singularly  bcnoiiclal.  A  little  sympa- 
thy is  not  misplaced  in  those  cases,  as  it  will  generally  he  found 
that  the  victims  of  spermatorrhea  were  a^  children  given  to  wet- 
ting the  bed,  even  perhaps  until  the  age  of  puberty.  Masturbation 
is  the  next  atep,  then  spermatorrhea,  and  lastly  hj*pochondrift. 
In  apite  of  the  alleged  obstinacy  of  these  cases  we  have  never 
met  with  one  whic^  resisted   a   rational   system   of  trcatmcot, 


448 


MAKITAL  OP  TRKATMBKT. 


bai^i)  oil  u  etudy  uf  llie  symptoms  ]ir(Ku>tit,  aiid  tempered  with  the 
kindly  intprwt  in  his  sufferings,  whirh  at  onoe  wina  the  confidence 
and  ctilUu  ihei-tMtpui-ution  of  llm  patieut. 


SPINAL  CORD:  DISEASES  OF 

1.  MENIN'GKAL  IIKMOKRIIAGE. 

Ekb  prescribes,  tirst,  absolute  reet  on  the  side  or  face.     To< 
prevent   further   Llevdiiig   hv.  giveH   repuatcd    {jowerful    puigea,' 
applies  ice  to  the  spine  energetically,  and  fireely  leeches  the  Bpine 
or  jiorineinn.    The  effect  of  these  renii'ilitet  iimy  be  aided  by  hot: 
applications  to  the  feet,  and  by  the  Dse  nf  ergotin  in  large  doses. 

If  infliimmatory  Bympt^iiiis  ari«e,  th«  le«;lictt  inay  W  repeated, 
and  merciuy  used  locally  and  by  the  mouth. 

I{(.-snr])tion  may  \w  huKtencd  by  the  local  and  gt-neml  use  of 
iodine,  by  lukewarm  baths,  by  cold  water  treatment  and  by 
galTanism.  I<ator,  the  strength  will  require  quinine  and  niuc 
Yomira. 

ruin  jiiid  s|<tiHm  ill  the  beginning  will  rcquiru  itarcutlca;  at\ot- 
tliosia  oud  |:iaralyaiA  in  the  later  atageei  demand  faradiration,  and 
other  symptoms  call  for  thoir  usual  treatment 

2.  MEXTNOEAL  TUMORS. 

Eru  given  little  emroumgement  to  the  therat>eutiiit.  Some 
iiiiprovemeiit  has  followed  the  ti-eatment  at  the  warm  epringa 
aud  the  n.se  of  brine  batli;).  Iodine  and  mercury  tdiould  be  tried, 
even  in  nou-syphilitic  cases.  The  queetion  of  operatire  interfet^ 
ence  belongs  to  the  surgeon. 

Qenerally  the  treatment  will  consist  in  |ralllating  the  symp- 
toms and  attending  to  tlie  patient's  needfk 

3.  ANEMIA  OF  THE  CORD. 
Erb  wiys  tJiat  the  firet  indication  i»  to  remove  th«  cauw; 

BBQWK-BlcqtURD  rec>inmcnd.4  that  tJie  jniliont  lie  on  tfaehaekf 
with  Uie  extremities  raised,  during  the  night,  and  »cv(^ra]  hoois 
during  tb(>  day.     He  »![>eHkH  wannly  of  the  value  of  Btryohninc, 


tnSXt.  CORD:    PISKAflRg  OF 


449 


and  Haumonh  ngi-crs  with  )itm,  giving  this  drug  in  doiicsofgr. 
^  to  ly  thret;  umm  a  day,  porbaps  adding  phosphide  of  Eino, 
gr.  c-  I1as«moxi>  also  reconimends  galvaiiizaiion  of  tliQ  djiiiio, 
to  dilate  the  vessels  of  the  cord  mid  improvo  Its  ntitrition.  Tie 
prefers  the  ascending  titiiliile  current 

Erb  also  makes  asc  of  hot  eAnd-bogs  to  tho  epinc,  or  ultematD 
hot  aiid  cold  douche*. 

4.    SPINAL  APOPLEXY. 

Krb  says  that  eiieb  «iusea  as  cau  be  reached  must  he  ohviatod 
to  prevent  the  attack.  Siipj»refwed  in<.'n«c«,  eosRation  of  henior- 
ihoidAl  hieedliig,  h^vt  disease  and  spinal  oongaatiou,  should 
roceivc  attention. 

If  the  symptoms  be  due  to  central  myelitis,  large  bleedings, 
ice  to  the  spine,  powerful  purgatives,  mereurj-  and  iodid«  of 
potaaeiuni  should  be  ui^cd. 

For  the  hemorrhiigp  itself,  little  can  he  done,  aA  it  in  over 
hefore  the  physician  arrives.  But  if  a  recurreiiee  be  threatonedf 
the  measures  just  mentioned  should  be  eniployetl  to  prevent  it; 
hcaides  the  maintenance  of  a  position  on  the  side  or  on  the  abdo- 
men, the  suhcntaiicoiiM  injcr^tion  of  ergotln,  or  the  adminis- 
tration of  digituli.i,  and  plunging  the  fc-et  into  hot  water.  The 
chief  ohjwTL  later  will  Iw  the  previ-ution  of  (-jstitis  and  of  bcd-soree. 
Nothing  but  the  niof»t  careful  and  self-sacrificing  attention  can 
accomplish  thiw.  TIjc  nriue  niii!'!,  nut  be  alhmvd  to  «tjigiiate  in  tho 
bladder.  Mechanical  nianipulntion^  ma.y  be  used  to  facilitate 
craciuition,  and  if  ntH;i'i«ary  tlie  («tbctcr  eliould  be  uwcrl  twice  a 
day,  with  the  utm<Mt  care  and  rlennliness.  Plenty  of  water  should 
bo  drank,  witli  salicylic  or  bcDZolo  acid,  Ut  prevent  dccompo- 
aition  of  the  urine. 

If  cystitis  bare  dcvclo]>cd,  he  ui^ca  aali(^lic  acid  by  the  month 
(tbirt}'  to  eixty  grains  daily),  and  by  ii^ection  into  the  blflddiir,in 
the  Btrengtli  of  one  grain  to  the  ounce.    Benzoic  acid  is  said  by 

L      QossBU.*!  to  be  boat  for  amnioniacal  Qrine.    The  dose  is  thirty  to 

I      ninety  grains  a  day. 

[  Bed-sores  arc  to  be  prevented  by  avoiding  continuoaH'pres- 

I      snre  on  the  «kiti.     All  tilth  muttl  be  removed  from  the  skin  m 

1  8I> 

P 


460 


UANDAL  or  TBBATKSXT. 


(luickly  as  powible.  The  circulation  of  the  skin  sboald  bo  ■lightl}' 
8timul]Lt«(l  bj'spirUuoufl  lotions,  cold  waUir.poultioeBpJor  moder- 
ate foradiBatioD.  Air  and  water  pillows  are  of  use.  If  a  bed  xm 
form,  it  mav  often  lie  healed  hy  great  cleanlineBB,  Iretiacot  wasli- 
lug,  zinc  ointment,  mildly  irritant  salves,  chamomile  water  or 
aromatic  wine. 

For  the  great  gaDgrenous  Bores,  Browk-Sequari>  rooonunenla 
ilio  altuniation  of  ice  (ten  miniitee)  with  |ioultic«a  (one  or  two 
hoora).  The  dead  tit^uee  should  be  quicktj*  removed,  and  anti- 
Beptic  drcwingfl  applied.  Carbolic  acid  ia  the  beat,  and  skouM 
be  applied  on  wadding,  in  wat^r  or  oil.  Water  or  air  pillows 
xaust  be  u^.  In  biul  cones  swing  tlic  leg  od  a  pillow  and  lift  the 
sacrum  up^ 

If  the  first  week  p&ss  without  fterioaa  runlta,  give  iodides 
to  promote  resorption,  with  luke-wai-m  baths,  warm  brine  batlii, 
moderate  cold  water  cure,  and  the  scientific  uee  of  galTaimm 
above  all.  The  latter  Is  the  chief  remedy  for  sequent  pal«iea, 
atropbiee  and  anesthesias. 

6.    SPINAL  CONCUSSION. 

£)nD  ttay«  tliat  tlio  treatment  U  primuritr  tbat  of  shock. 
Quiet,  warmth  and  rubbing  the  body  are  the  tirst  things  to  attend 
to.  Then,  stimulants  must  be  given  in  full  doMw ;  such  as  wine, 
cotFcG,  tfia,  hot  grog  and  cognac,  or  ammonia,  ether,  mu»k  and 
camphor.  In  severe  and  tliroatenuig  «l*l^s,  lai-ge  blistora  or  eiua- 
pisms  and  the  faradic  bruah  are  to  be  used. 

Lkyden  recommended  the  hypodermic  use  of  stiychninfi. 

Blood  letting  is  i-arely  needed ;  leeching  aomewliat  more 
frequently. 

The  reaction  requires  absolute  reflt.  ERicnsE:?  put  the  patient 
on  bis  back  on  a  couch  with  the  foot  tilted  down.  The  other 
meoHurcs  indicated  are  those  used  for  hyperemia  of  the  conL 

During  convalescence  the  pntient  must  carefully  avoid  ezceB- 
nve  bodily  or  mental  work,  sexual  excitement,  and  jarring  tbo 
body ;  and  be  must  have  raiough  sleep.  Recovery  can  bo  favored 
by  careful  rubbing  with  cold  water,  by  ascending  stabile  galvazuc 
currents   through    the   spme,   by   faradisation  of  the  skin,  by 


I 

I 

I 


spiKAL  cord:  msbaobop. 


451 


carbonated  chalybeate  waters,  and  by  the  use  of  tonics.  Strychnine 
mtiet  not  be  given  as  long  a«  any  iiyini>tonn(  of  irritation  remain. 
Patience  la  a  first  requisite.  The  Bcqiielte  often  reqaire  the  treats, 
ment  of  chronic  mcningo-niyclitin.  Quiet  and  a  wcll-onlered  life 
arc  of  the  first  moment.  The  chief  remedies  are  the  galvanic 
current,  derivatives  to  the  nkiii  and  the  iodides.  Ehichsen 
praises  hia  combination  of  oorrosiTe  sublimate  and  quinine 
Strychnine  and  iron  come  in  later,  when  a  goiHl  tiim  ha^  been 
taken.  Hot  hatha  are  mjurioos,  but  judicious  cold-water  cures 
are  nitefiil.  SoHOLZ  flayn  that  tlie  Cudowa  springs  are  indicated 
in  pure  cases  of  coucusBtou,  and  in  later  periods  when  tliere  ts 
little  inflammation. 

6.    SPINAL  miUTATION. 


£rb  eaya  that  the  treatment  U  difficult ;  the  patioDt  U  also 
trritiihle,  ehaugeahle  and  weak  of  ]iurji08G. 

The  chief  object  is  to  improve  the  nutrition  of  the  nervous 
8y«t«m.  Good  fcHid  in  abundance  should  be  preacribeil,  with  a  free 
use  of  alcohol.  IIjimmond  orders  brandy  and  rum.  Quiaino  and 
iron,  xine  and  cod-liver  oil  may  be  used.  Fresh  air  is  indifiponsa- 
ble;  judicious  active  and  piaasivo  oxorciae  is  always  indicatiid,  as 
well  aA  fnxjuent  repose.  Mountain  and  forest  air  is  to  he  sought, 
^(oderaie  hydrotherapy  aids  this  treatment,  especially  when 
ajiplietl  in  a  high  moiitilain  climate. 

Strychnine  cnjoye  a  sjtocial  roputation  among  maay  phyai- 
cians  in  this  affection.  U^muonh  givea  it  with  phosphide  of  zinc 
He  aUo  ascribes  great  value  to  the  g^Tanlc  current  Erb  alao 
tcstities  to  ita  value,  lie  pasaea  au  aacending  stabile  current 
through  the  spine,  including  the  painful  jjorlion  between  the 
poltiii.  Tlie  currant  idiould  not  be  strong  uor  the  sitting  pro- 
longed. The  negative  polo  may  often  bo  applied  directly  to  the 
painful  s|)ot.  General  laratliaation  and  ceiitrtd  galvauizatiou  are 
freqaontly  beneficial. 

Blisters,  tartar  emetic,  turpentine,  veratrine,  dry  cups,  moxst* 
or  the  actual  cautery,  can  be  usetl  directly  over  the  paiuful  spota 
on  the  Hpine;  the  severity  of  the  application  being  regulated  by 
the  grade  of  the  diaeaitc. 


4S2  MAVUAL  OP   TR'^ATMEST. 

IJAMUoyD  rccomnicutb  opiates  for  the  pains.  Hot  sands  bags 
Ai-c  pi-cfcrablc,  also  the  bromidos. 

BROWN-S£<itiARD  nays  that  he  employs  the  fol  lowing  eabstances 
together  with  innru  bcntiiit  thuii  any  one  of  thtiu  aloiio  in  suck  caeea : 
morphine,  from  J  to  i  a  grwn,  strychnine,  from  A  to  i  of  a  grain, 
auid  atropine,  from  ^  to  ^  of  a  grain,  Wgtnnmg  with  Uiu  minimum 
doee,  and  reaching  f|uickly  the  niaxinmm  one,  if  the  iocrea*:*  can 
be  borne.  A\1ien  the  pain  or  tcndenicsn  ib  localiwd  in  a  fiinall 
part  of  the  epine,  he  has  obtained  great  relief  from  the  use  of  an 
oiutmeut  of  aoonite,  two  grains;  vcratrinc,  four  groins;  and 
lanl,  two  draL-hmi*.  Every  counter-irritant,  including  galvanism, 
has  been  uao<l  with  hetio^t  in  Konm  ca«c>i.  Applications  of  ice 
and  of  the  actual  cautery  will  l>e  found  to  be  the  bast  Ice  may 
be  employed,  finely  poumksl,  a«  a  kind  of  poultice,  applied  on  a 
large  surface  and  on  tlie  hare  skin,  or  in  frictions  ou  the  two  sides 
of  the  spine;  and  by  eitlior  process  only  for  throe  to  six  minutes, 
■  twice  a  day.  If  there  be  no  success  by  these  moans,  the  applica- 
tion of  a  very  hot  piece  of  tiannol  over  the  principal  scat  of  pain  is 
adTisablc,  followed  after  five  minutes  by  the  application  of  ice 
according  to  one  or  other  of  the  two  above  metho<i3.  When  the 
whole  spino  is  tender  or  painful,  each  of  its  throe  regions  should 
be  treated,  one  after  the  other.  Next,  if  not  firet  in  iniportaoce, 
IB  the  use  of  the  actual  cautery,  at^er  the  following  rules: — FirBt, 
the  instrumcDt  must  bo  at  wMte  heat;  seoondly,  it  must  have  a 
very  email  aurfat-o;  thirdly,  it  muat  be  applied  quit-kly  iilthough 
finnly;  fourthly,  it  must  make,  on  each  day  of  application,  three 
or  four  cauterisations  on  each  aide  of  the  Bpine,  and  tbcie  irrita- 
tions must  extend  over  two  or  three  inches  in  length;  fifthly,  the 
operation  ie  to  be  repeated  every  day  for  eight  or  ten  dayn,  caro 
being  falcon  that  the  instrument  i^  pa«t;od  each  time  on  unaltered 
skin.  The  outer  layer  of  the  skin  dries  up  and  becomes  brown, 
but  there  is  no  blister,  ulcer  or  purulent  discharge.  Thin  ia  a 
most  valuable  moans  of  treatment,  especitiHy  when  the  pain  and 
tendcniess  of  tlie  Hpine  are  intent.  If  all  the  means  already 
mentiojied  have  failed,  or  oven  when  they  have  not  been  tried, 
and  when  the  patient  i»  attacketl  in  a  great  extent  of  the  xpine, 
and  is  quite  submissive  and  willing  to  do  as  she  is  told,  absolute 
reet  of  the  tender  and  |)ainfiil  {arts  is  tobe  employed.  In  Hilton's 


3 


BPIKAL  OOKD:   DlfiEASES  OF. 


work  on  Rest  and  Pain,  the  rules  arc  given  which  must  be  followed 
in  such  coBoa. 

The  words  absolute  rest  express  exactly  wh«t  is  neodetl. 
It  would  be  wor^  thati  useless  to  make  a  patient  witJi  spinal 
irritation  lie  down,  and  stay  in  bod  for  two,  three,  or  four  weeks, 
if  lie  or  she  were  allon-ed  to  turn  in  bed,  or  to  move  tlie  fi]»ine  at 
all  at  the  afibetod  part.  If  the  reat  of  the  part  is  really  absohite 
and  constant,  a  cure  ih  almost  aUvayfi  obtained  alter  a  few  weeks. 
Bo  long  as  the  difficult  treatment  lasts,  every  attention  must  bo 
paid  to  the  nourishment,  to  the  etate  of  the  Wwels,  and  to  the 
occupation  of  the  mind  of  the  patient.  It  need  not  be  said  that 
otiier  means  of  treatment  I'esiieeially  t(ut>(--ulaneous  injecttona 
against  pain),  are  to  be  used  during  the  period  of  rest.  Fresh 
air  must  be  admitted  to  the  room  om  far  ha  the  fteatton  allows.  The 
muscles  of  the  limbs  (which  are  to  be  left  without  voluntary 
movement)  arc  to  be  gently  galvani^tJ  nevcral  timen  a  day,  mo  as 
not  only  to  improve  their  nutrition,  but  to  act  also  ou  the  general 
cirt-ulttlion  of  the  blood.  On  getting  out  of  bed,  when  it  U 
ascertained  that  both  pain  and  tenderness  have  disappeared  from 
the  spine,  the  patient  must  for  a  time  (a  week  or  more)  be  most 
I  to  avoid  moving  much  the  parts  which  have  been  affected. 

SPINAL  NEUKASTllEXIA. 

Ebb  [mys  special  ati».'niion  to  the  diet  atnl  regimen  of  tho 
patient.  He  must  live  a  regular  and  healthy  life,  mu^t  work 
little,  with  fretjuent  rest*,  must  go  t«  Ih,i1  early  and  sleep  as  rauch 
as  he  can,  must  eat  plenty  of  strong  but  digestible  food,  at 
moderate  intervaU.  Ue  may  drink  wine  in  m(Mieration,and  take 
plenty  of  easy  open-air  exercise,  but  never  to  exhaustion.  If  he 
be  eaaily  exbauitted  be  must  t^it  nmcti  in  the  open  air.  Sexual 
intercourse  must  he  closely  restricted,  but  not  forbidden,  unless 
for  a  short  time  only. 

Moderate  cold-water  cure  is  especially  beneficial.  Rubbing 
with  Inkc-warm  water,  gradually  made  colder,  wa.shing  the  back 
and  feet,  and  eitz-bathe,  are  the  most  suitable  meat^ures,  and  soon 
iuoreaae  the  vigor.  Douches  and  cold  applications  should  be 
avoided.  Mountain  air  is  no  less  efficacious;  a  long  time  passed 
among  high  mountains,  gradually  ascending  higher,  docs  much 
good;  eapcciully  when  combined  with  a  walor-curc. 


I. 


MAITOAL  OP   TREATWE.VT. 


GalvanlBm  U  best  applied  attccniling,  ntabile,  clianging  the 
electrodee,  and  not  too  strong.  It  may  also  be  applied  to  the  legs 
aiid  genitalB.  Of  drugn,  the  only  ones  of  am  arc  iron,  quinine 
and  Btrychuine;  the  latter  should  be  used  cautiously. 

For  anemic  persons,  chalyl>eate  baths  are  indicated.    The 
who  are  sensitive  t«  oold  sliould  try  the  hot  brine  baths, 
hatha  arc  an  dxoellent  after-lreatniL-nt  for  ijotientts  who  are  used 
the  water,  and  hare  a  good  digedtioo. 

These  cures  must  be  follow-ed  up  steadily  for  a  long  time,  far' 
the  afiection  ia  obstuiate. 


8.    ACUTE  MYELITIS. 

Ekb  speaks  of  the  causal  treatment  as  necewary  in  many 
case«.  If  tlio  signti  of  coming  myelitis  appear  after  exposure  to 
oold,  the  diseaee  may  be  arrested  by  energetic  diaphoresb,  by  hot 
drinks,  by  tlic  warm  bath,  by  the  (tack,  and  by  derivativea  to  the 
back.  When  there  has  been  excessive  bodily  exertion,  the  same 
eud  may  bo  obtained  by  alN>oIuto  n»t  in  bed,  a  warm  Imlli,  ct<x 
Suppressed  secretions  or  dischargee  should  bo  excited  afresh*] 
Syphilis  demands  an  energetic  courec  of  mercury  and  the  iodidea 

But  usually  ]>atienta  are  not  seen  until  the  diacoao  u  devcl- 
C^ped.  In  severe  and  threatening  owes  an  energetic  antiphlogistic 
tnMitznent  is  indtrati^d.  Leeches  or  wet  cups  may  be  spj-licd 
repeatedly.  Ice-bags  iuhj  ^>^  i^'niployeii.  Compresses  should  be 
applied  to  tlic  Imck  and  changed  every  few  honra.  Mercurial 
inunctions  may  be  added  to  this.  Calomel  may  be  given  in 
smikU  doses,  and  later  iodide  of  potassium.  Bbowx-Seijcakd 
recommends  the  xie,e  of  ergot  and  belladoiina. 

In  most  cases  moderate  catliartics  and  diuretics  are  luoro 
important  and  more  useful.  Blisters,  when  properly  uised,  will 
do  DO  harm  and  often  do  good.  In  serious  cases  the  actual  cau- 
tery should  be  used.  Neither  should  ever  be  applied  to  anesthetio 
skin  or  to  parts  exposed  to  continuous  preesorc.  In  dangerous 
cases  a  bold  Btreak  or  punctate  cauterizations  should  be  dratvtt 
along  vuL'h  side  of  the  spine,  and  repeated  every  day  or  two. 

Tliis  treatment  must  be  modified  to  suit  the  case  and  the 
patient's  strength.  The  strength  must  be  kept  up  by  careful 
feeding.    The  patient  sliould  lie  absolutely  quiet,  and  on  the  side 


SPIlTALCORIi:   DUSASIS  OP.  4d5 

or  abdomen  mtlicr  tlmn  on  the  iMick.  Easily  digested,  nourish- 
ing foodf  no  alcohol^  no  tea  nor  coffee,  absolute  mental  quiet,  regular 
wanhing  of  the  skin,  mid  everj*  prcaiution  against  cystitis  nnd 
l>ed  sores;  these  are  the  j^eiieral  rules.  If  we  tide  over  the  firet 
few  weeks,  the  c»sq  may  for  a  time  be  left  Ut  nature;  tlie  careful 
DUreiiip  atid  dieting  being  still  continued.  After  thia  the  treat- 
ment is  tliat  (if  chronic  myelitis. 

Spitzka  doubts  the  efficacy  of  all  the  above  regimen;  all 
the  more  becauAe  Jewell  claims  improvcniGni  to  have  followed 
the  tiae  of  abychnine,  in  very  large  doses.  In  relnpees,  he 
(SpiTZKi)  liiw  obtained  good  results  from  derivation  to  the  feet; 
and  as  people  contract  myelitis  from  exposure  of  the  feet,  but  not 
of  the  Irnck,  he  oonaiders  it  bettor  practice  to  apply  rem«lic»  to  the 
same  extremities.  Reel  is  im[)crative.  The  earlier  the  {natienfc 
takes  to  his  bed,  and  the  more  thoroughly  he  obcya  the  injunction 
to  keep  »till,  the  better  will  be  the  result.  In  convaleecence, 
gradually  increasing  exercise  is  pi-oper,  invariably  stopping  short 
of  fatigtie.  In  all  caeca  in  which  bc<l  aorcfi  are  feared,  the  water 
1k.-«1  t^bould  be  ufied.  The  wann  bath  is  probably  the  most  use- 
ful single  mciwure  which  can  be  employed  in  acute  myelitis.  In 
cases  due  to  ezpoenre  it  cannot  be  employed  too  soon.  Tlic  tom- 
peratore  at  fint  should  be  88°  F.  and  the  duration  seven  miuutea. 
If  the  effect  permit,  it  can  be  extended  to  half  an  hour  or  longer. 
It  should  bo  used  once  daily,  or  oftcncr  if  the  patient  be  not  dis- 
tnrbcd  by  it.  Retention  of  urine  is  the  mmt  frequent  eaasc  of 
death.  Complete  retention  demands  continuous  catheterization. 
In  other  cases  the  bladder  hIiouKI  be  emptied  everj*  eight  hours. 
The  catheter  is  to  be  thoroughly  disinfected,  and  it  the  slighteat 
sign  of  ej-stitis  appear,  the  Madder  shonlii  be  irrigal^l  with  a 
solution  of  corrosive  Bublimate,  one  part  to  two  thouaaud. 

"WHit-u  the  bladder  and  rectum  ane  paralytic,  they  should  hare 
galTanism  applic«l  by  ineatm  of  properly  iuaututed  soundij. 

9.    CHRONIC  MTELITIB. 

Ebb  says  that  it  is  only  in  isolated  cases  that  anything  can  he 
done  in  respect  to  the  causal  indication.  Acute  myelitis  must  be 
carefully  treated,  compression  removed,  syphilis  attacked,  aii'l 


u 


456 


MASL'AL   OF  TREATJIKNT. 


diseases  of  the  periphery,  of  tho  inUMtiiics.  or  of  the  uriaan*  iinc 
sexual  orgnns,  must  be  jiroperly  nmtuige<L  llemorphoiUa,  consti- 
pation and  (lygpcpsia  should  he  trcntcd.  In  any  «u!«^  ttie  enrlier 
the  treatment  ia  Itcgun,  tlic  mon.'  likely  it  is  to  prove  ancoewfiiL 
Antiph logistics  are  only  to  bo  employed  for  acato  or  gubacuto 
exiu-t'rlialimis.  IX'rivativea  are  of  i-ery  little  iiiMJ.  A  faartnlcM 
and  sometimes  useful  measure  h  the  application  of  dry  cupe  to  the 
fipine,  evtjry  few  days. 

BRowK-SfiQUARD  pnttsee  the  daily  lue  of  hot  douc-hea  to  the 
liack,  for  two  to  three  minutes  at  a  time;  the  Htream  fthould  be 
nearly  an  inch  in  djanieler. 

The  I'hief  reliance  ia  now  on  three  remedies;  batlia,  hydro- 
pathy and  galvanism.  Tho  baths  «hoald  never  Iw  above  9^  F. 
They  lOiould  only  l>u  u^d  aHvr  other  meano  fail,  and  ewn  tlieo 
with  every  preeaiition.  Brine-barliB  at  7D*  to  86^  arc  preforahla. 
lliey  should  no)  l>e  ]>rolnnged ;  mid  luiy  inereaae  iu  the  activity  of 
the  treatment  must  he  made  with  great  caution.  Qreat  irritability, 
violent  jKiiiiK,  and  utlier  Kymplnms  of  irritation,  Hituiild  make  oh 
hcflitato  to  OBC  these  baths.  Of  twenty-one  ca^os,  twelve  were 
iniprnvvd  Ijy  this  treatment,  and  none  were  made  wiir«e. 

Still  better  are  the  reanlts  of  the  Cold-water  tnire.  In 
twenty-niue  caaes,  twenty-one  gave  favorable  reaalts,  five  were 
Quebanged,  and  three  bocame  worse.  Forced  curc«,  and  aevera  aad 
excituig  procedures,  euch  as  very  cold  water,  douches  and  ahaip 
slapping,  arc  very  dangerous.  Even  entire  wet  pocks  prove  iqjari- 
ouB.  Simple  rubbings  with  wet  eloths,  half  baths  with  afftuioos 
to  the  back,  hip  baths,  foot  baths  and  sponging  the  back,  and 
local  compresses  to  the  back  left  on.  nntil  warm,  are  the  mo«t 
applicable  measures.  The  treatment  should  begin  with  a  temiwr- 
ature  of  6fi''-77"'  F.;  and  never  go  Wlow  61''-54'>.  Excessive  pro- 
longation of  the  iroatmout  is  injurious.  This  method  is  af^li- 
cable  to  nearly  all  coses,  but  is  uiisuiied  to  tlicMe  in  which  reaction 
is  insufficient 

In  one  hundred  caaes  treated  by  galvanism,  Erb  obtained 
fikvorable  results  in  fifty-two.  Complete  recovery  wa«  rara  In 
the  minority  the  improvement  was  but  moderate.  In  one  only, 
the  result  was  decidedly  bad.    The  chief  method  employed  u 


SPHTALCORD:    DI9BA8IC3  OF. 


457 


dipeet  galvani^Atioii  of  the  ooril.  It  is  licst  lo  l«l  lioth  poles  net 
BUccesaivcly,  with  &  stabile  or  slowly  Ubitp  ourroiit.  Tho  furrent 
should  be  woiik  imtl  the  d^iiiictM  short.  Tliu  treatment  nmiil  be 
continued  for  montlis,  with  brief  pousoa.  It  may  be  alternated  or 
ootnbineil  with  otlu'r  iiictliodH.  If  it  bo  not.  well  borne,  it  must 
be  atopjiod.  Nitrate  of  Bilver,  prait^cd  by  Whnuerlicu,  is  snid 
by  l-RB  to  Iw  cKcwioually  m<et'ul,  and  by  Lkyden  is  pronounced 
a  hftmiless  placebo.  HRows-Sfeyi'AKli  urgently  reconimentis  ergot 
and  beUadonna,  to  le^eti  conge«it)oi)  Hiid  i-eflex  irritability.  He 
gives  from  iive  to  sever;  grain.s  of  ergot  twice  a  dny,  and  applies  a 
large  belliulonim  plaster  to  the  back,  or  givca  tli«  extract  oi'  bella- 
donna internally  in  doses  of  gr.  -J,  twice  a  day.  Iodide  of 
potassiam  bu.-*  pi-o^-cd  useless,  and  even  in  sy]>hiIiti<:.H  its  value 
is  limited.  Arsenic  is  alHo  us«les--v  Strychnine  i)« almost  alwayn 
objectionable. 

The  genenU  niniiagcment,  the  diet,  and  the  loodo  of  life,  are 
of  essential  iraportanec.  Rest  and  a  regular  life  are  needful, 
over-work  of  cverj-  kind  niuBt  be  iivoido<J,  Hoxtuil  intercourse  raiust 
be  atrietly  limited  or  stopped,  and  violent  emotion  prevented. 
Plenty  of  nourishment  should  be  given,  together  with  cod-liver 
oil.  Spirituous  drinka  can  only  be  allowed  in  small  quantities, 
and  strong  coffee,  tea  and  cigars  niufit  l)e  avoided.  The  bowels 
mu.'»t  be  kept  open  by  laxatives  and  c-nemata.  Tlie  patients  should 
be  kept  in  the  open  air  aft  much  as  pouible.  A  prolonged  sojourn 
in  the  lower  mountain  rongce  or  at  tho  ecft-oooat  is  ueeful.  Oare 
must  be  taken  not  to  unduly  prolong  the  exercise,  as  a  too  long 
walk  has  caused  a  relupee.  Woakneiis  and  stillness  cannot  be 
removed  by  forced  exertion. 

I'atientii  who  aru  beil-ridden  must  not  lie  always  on  tlio  baek. 
,A  wheel-chair  will  give  fresh  air  and  some  cxerciBO  to  thcfto  cases. 
The  >=Lame  care  aa  in  acute  myelitis  w  needfUl  to  prevent  cystitis 
and  bed-sores. 

For  the  pain  we  may  use  hypo^lermics  oi  morphine,  if  the 
bromicU-s,  quinine,  zine  and  valerian  fail.  Countcr-irrilanlj;,  tho 
faradic  brush,  compresses,  ehloroforni  and  veratrine  loea.lly,  often 
do  good.  For  the  other  symptoms  and  the  scqueW,  electiidty 
is  the  sovereign  remedy. 

SpiTSKA  speaks  favorably  of  wann  hatha  and  warm  climatee. 


45S  MAXUAL  07  TREATMENT. 

SPLEEN.  ENLARGEMENT  OF;    or  Ague  Cake. 
lIiLL  rccominemU  th«  fonowing:— 

9     Qiiibiiuruilph, •■>p.  Ix 

8<M)ii  h.vponilpliit., gr.  xrj 

Arid,  mlphurid  aroiB, git.  «j 

Aqu". '5  j 

M.    H. — A  wwponnrul  «-nrf  two  hour*  to  a  cbild. 

Da  Costa  prefers  tho  liy^odormlc  injitction  nf  ergotme* 
gt.  iy  to  V,  daily. 

Gazio  injecla  the  ethereal  fluid  extract  of  ergot,  mixed  with 
half  iiA  bulk  of  glyoerinc,  directly  into  tlio  si>Ieen  ibielf.  Two 
Bjringefiils  are  used  at  one  time,  and  the  operation  repeated  daily. 
The  more  deeply  the  eyrioge  enters,  the  leas  is  tlin  fmio. 

M08LEK  suhetitutes  the  ii^jectlon  of  carbolio  aeid,  in  two 
per  cent  Bolution,  and  Fowler's  rtoUilion  of  arsenic,  *>ne  \tirt  to  ten 
of  distilled  water.  The  acid,  however,  caused  eo  much  [laln  that 
ho  discontinued  it ;  but  the  artteuie  was  rcpeatod  a  number  of 
timee  mid  vauaed  a  diminution  in  the  size  of  the  organ. 

TViLLiAMii  believes  that  the  bromide  of  potaasitun,  given 
in  full  dmaa,  n-duL-es  splenic  hypcrtr,'piiy  rciaarkably. 

BAKTOOLOir  attributes  the  same  power  to  tbe  following:— 

a     AmmoDii  [odidl, 5  J 

Lii].  [touui.  anwnitw, fj  ■ 

Tinct-  atlumbo;^ f|  m 

Aqu», fjjii 

M.    8.— A  WMpoonfuI  three  tim«B  «  day. 

McQuiRB  rcportei!  good  results  from  the  use  of  strychnino 
in  doecs  of  gr.  i,  three  times  a  day,  with  iron  and  tiuinine. 

KvERs  obtained  tho  boat  results  from  the  juice  of  unripe 
papaws,  (carica  papaya.)  A  tenspoonful  wn«  given  each  day,  mixwi 
with  sugar  and  divider!  into  three  doeea.  Twenty  to  twenty-five 
days  siifliced  for  a  cure  in  nearly  all  cases. 

SK0BB2BW3KY  employed  faradieation  with  benefit. 


SP1.EEN:    ESIAROMEKT  OP. — STERrUTY. 


4^ 


Acupuncture  in  «ut;cc«»fully  emjiloj-etl  iit  India. 
Ga-dbtrt  Rpoke  highly  of  the  oxy-sulphide  of  iron : — 

&       Terri  aulphftt. $  j 

Arid-oUrici, fj  J 

U. — Btir  uDtU  tBcTvoBoeticc  ccMca  and  then  wM: 

Aqnw, ti  iv 

fi. — liq.  fcni  oxy-«ulph, 

tt     Liq.  fcrri  oxj-sulpli, f3  Ml 

A(|.  cinnamomi, fj  rWj 

Qtiininte  aniph., J  m 

Pota*.  oitrnt., 5  Uo 

IS.    &/— A  UlilespoonAil  four  lime*  a  dtj. 

PnABGS  recommended  the  root  of  oeanothus  Amcncftnu«; 
giviugaQ  ounce  of  a  saturated  thicture  three  tinice  a  day.  The 
same  tincture  was  also  used  locally. 

Maclkah  found  that  of  all  remedies  tried  hy  him,  none  were 
as  effectual  a»  inunctions  of  the  ointment  of  biniodlde  of  mercury. 
A  piece  the  size  of  a  walnut  is  to  be  well  rulil)©<l  into  the  skin, 
and  the  patient  ia  to  keep  the  part  exposed  before  a  warm,  opea 
fire  for  some  time  after. 

Oold  dniichefl  ujion  the  enlnrge4l  organ  are  also  useful.  TVTiat- 
ever  treatment  is  adopted,  it  will  i^eneriilly  be  found  ftdvisahle  for 
the  patient  t<i  remnvi?  from  u  iiiidiirial  dlwtriet,  and  lotakequininaf 
iron  and  araenic,  in  efficient  doses,  long  continued. 

B     Quininir  niilpli., |j 

F«rri  aalph.  enic, p*.  Hx 

Add.  UMntari, fr.  riij 

01.  [ilperis  aigr.. niz  sx 

M.    Vt.  mfts.  H  in  [lil.  no.  iJx  dtv. 

ft. — One  inll  ihne  titnca  a  dny. 


STERILITY. 

SIMPSON  snya  that  in  commencing  the  treatment  of  any  case 
we  must  hear  in  mind  that  morbid  couditioiiB  may  bo  present  in 
more  than  one  of  the  planes  of  the  sexual  system,  and  tliat  we 


MAmTAt  or  TRKATXinrT. 


erofl 


must  begin  with  the  rcmovnl  of  the  olistacle  that  lice  ooBroet  Uia 
Bnrlace.     Urethral  fiirunclun  and  otlior  sonsitivo  ("tniciun.-*  in  the 
vulvft  must  he  cut  ofl"  or  caiiteriswl.     Coutnii-tioiu*  uf  the  vagiiud 
orifice  or  canal  must  be  stretched ;  awl  where  tliore  is  compteta 
atresia  an  aperture  munt  be  tiirtn(><l  iirxl  kept  pntulou?.    Btetiona 
of  the  ateritio  orifices  may  be  oveixK>nie  by  temponu*}'  dibitAtiot 
witli  a  tangle  tent,  which  the  writer  ban  more  tbau  onoe  eeen  fol- 
lowed by  impregnation.    Where  such  dilalalifm  fiiiU,  tlie  o»  may 
he  dilated  more  |ieniianently,'hy  tlie  uterine  dilator,  or  by  dirt 
ing  the  oervix  at  both  sides,  or  in  one  or  other  lip,  with  a  hynt 
tome.     Tlie  deviations  of  the  iiteriiH  must  lie  rectitied ;  t'craioiM, 
after  iieplacement,  being  usually  retained  by  some  niodilicatioa  of 
Hodge'e  [M»8ary;  ncxiontt  demanding  in  addition  the  luw  of  an 
intrauterine  stem.    The  stem  jie!*sikry  of  xinc  and  copi>cr  IntRV 
duced  into  the  interior,  \*  the  best  meno^  nf  stitnuhitlng  to  ita  Inl^^ 
function  the  imperfc<-t1y  developed  uterus,  and  the  uti-ruA  whidfl 
baa  withci-cd  from  supcrtnvotution.      Morbid  eonditiona  in  the 
interior  of  tlie  uterus  require  direct  applit-ntinns  to  ita  cavity. 
And,  ae  in  a  large  pro])ortiou  of  tJie  cases,  Bome  inflammatDfj, 
mittchief  complicates  the  other  morbid  condition,  it  ia  oftea  bel; 
fit]  to  the  cure  to  make  the  {ukticnt  uac  hot  douo h(.«  and  baths, 
the  Internal  remedies  which  tend  to  remove  the  cU'ects  of  inflam* 
matory  action.    It  ia  to  the  beneficial  influence  which  the  vraler* 
of  Ems,  Aix,  Kiseiugeu,  and  other  spad  exert  on  chronic  meliiliB, 
that  their  reputation  for  ctuing  sterility  is  mainly  due.    Iji  caaw 
whore  the  natural  method  of  getting  spermatozoa  brought  iato 
relation  with  the  ova  luui  failed,  sucocsa  is  said  to  have  followed 
the  introduction  of  seminal  fluid  by  means  of  a  fine  syringe  and 
tube  into  the  cavity  of  the  uteru.4 — a  line  of  treatment  legitimate, 
it   may   be,  bat   only   to   be   followed    in   quite   exceptional 
ctrcumBtanece. 

The  first  point  ie  to  ascertain  whether  the  etorility  in  doe  U> 
the  huabaud  or  tx>  the  wife.  In  the  former  caec,  stricturea  mi»t  b« 
dilated,  morbid  states  of  the  urethra  removed,  and  if  the  somen  be 
too  thick,  a  few  drops  of  warm  water  injected  into  the  vagiuA 
immediately  before  or  after  coition-  Any  other  alteration  from 
the  normal  condition  in  the  male  muftt  receive  ite  apptopriaM 
treatment.    The  same  general  rule  holds  good  in  case  tb«  dUHovlty 


'V 


STERILITY. — stomach:    DISKABES  OF. 


461 


b*  dependent  ou  the  wife.  Acy  affection  found  must  be  treated. 
Perhaps  the  most  common  cause  is  endometritis,  cervical  or  oop- 
popca.1,  dnc  to  the  improper  tise  of  the  syringe  and  other  preven- 
tives of  conception.  Stouosie  of  the  uterus  is  now  treated  almost 
ojtclusively  by  the  dilator;  the  use  of  the  hyuterotomo  having 
become  obsolete.  Intra-uteriuo  BtomA  are  best  let  alone,  unless  the 
phyaician  hi  welt  vcj^ctl  in  their  «i»e«  and  diingen*.  The  galvanic 
stem  is  of  little  value,  as  it  causoa  such  a  uterine  catarrh  an  soon 
no«>ssitates  the  ronmval  of  the  inHiruinent;  and  then  the  ™tnrrh 
must  be  cured.  The  wearing  of  auy  ordinary  pessary  for  a  long 
period  induces  growth  and  development  of  tlic  infantile  utome ; 
but  the  most  certain  remedy  is  marriage,  with  consequent  ttexuai 
intercourse.  In  the  ver^*  rare  caseH  in  which  Bcnieii  ih  to  b« 
injected  into  the  utoms,  groat  care  is  to  be  taken ;  as  this  sub- 
gtODoe  lit  exceedingly  irritating  to  the  womb,  and  apt  tn  induce 
very  aevero  uterine  c'olic.  Half  a  drop  is  usually  S8  much  as  can 
be  used  at  one  time. 

Patients  who  are  anxious  to  have  children  iihould  be  cau- 
tioned againRt  excessive  sexual  indulgence,  a^  thin  is  sure  to  defeat 
the  object.  The  period  immediately  tbllowing  menstruation  is 
almost  univerwilly  looked  upon  as  the  time  when  pregnancy  is 
most  likely  to  follow  cohabitation;  but  this  rule  has  niauy  excep- 
tions. We  have  IwfCii  assurt-d  by  sonn;  of  the;  best  of  observori, 
phyaicians,  that  maternity  was  only  possible  to  their  wives  when 
intercourse  took  \Atux  during  menstruation.  But  the  diffituilty 
of  securing  accurate  information  on  these  subjects,  nud  of 
eliminating  all  sources  of  error  is  ao  groat,  and  the  tendency  to 
deduce  general  laws  from  iwolated  phenomena  i.^  so  prevalenti 
that  wc  must  put  all  auuh  Uioories  in  the  same  category  tut  (hat 
of  Ovid.  

STOMACH.— DISEASES  OR 

1.    ATROPUY. 

Fbnwick  says  that  the  most  important  [K)int  in  treatment  is 
tiio  T^ulation  of  the  diet.  As  there  is  usually  a.  groat  distaste 
for  animal  food,  tlio  ingenuity  of  the  practitioner  U  oft.eu  wjvcrely 
taxed  to  discover  some  form  of  food  likely  to  funiish  albumen  to 
Una  system,  wltich  the  patient  can  be  prevailed  upon  to  take.    The 


462 


BUIfTAIi   OP  IBEATHE5T. 


[ttuJ 
witP 


articles  of  diet  that  asoally  apreo  best  are  mnttoo,  fowls, 
soles,  wliiting,  haddock,  and  ovKtem.  It  U  odea  neccaaary  U>~ 
order  that  the  meat  should  be  beaten  up,  or  mincad,  so  that  ii 
may  be  swallowed  quickly.  Milk  aiid  t>gg3,  wliere  tbej*  agrw, 
arc  invaluable,  and  in  the  later  stages  soups  and  auimal  broths 
may  be  auhatituted  for  solid  food.  In  some  amni  gluten  bread 
and  gluten  cliocolate  answer  well.  Other  articles  of  diet,  com- 
posed of  starch  and  sugar,  are  UMially  more  readily  talcea^  and 
more  easily  digested. 

As  regards  medicines,  iion  in  all  shapes  is  bcncficiiil.    It ' 
be  combined  wiUi  strychnine,  quinine,  or  utherbittere,  accor 
to  the  circumstauces  of  the  case.    Anexiio  may  be  ui«cd 
ad\'autage,  but  it  will  Ihj  found  a  good  plan  to  alternate  it  with 
other  tonics.    Pepsin  ia  often  preecribed,  but  it  does  not  produce 
much  benefit.    Acids  arc  often  valuable,  the  moet  tiaeftil  being 
the  hydrochloric  and  phodphoric.    They  are  beat  giveti,  it  ia  i 
ahortly  after  a  meal. 

Change  of  air,  traveling,  and   freedom   from   the 
busmoAs,  are  gcnorally  of  more  use  in  retarding  the  progicM 
the  diecftM  thau  any  drugs  we  can  prescribe. 

Where  the  avonsion  to  animal  food  haa  become  tmoonqaen-' 
ble,  the  patient  may  be  fed  by  the  fltomach-tabc. 

2.    CANCER. 

Fribdreich  gave  twenty  to  thirty  grains  of  cundi 
three  times  a  day  in  one  case,  and  found  Ibe  epigastric  tumor  aod 
the  glandular  enlargements  disappear  in  a  striking  manner;  and 
the  improvement  continued  at  leitst  »\x  months.     Leubb  tried  it 
once  with  no  benefit.     Riboel  gave  it  in  six  caaca,  but  (bund  nd 
other  virtue  in  it  than  that  of  a  powerful  stomachic  tonic. 

By  way  of  prophylaxis  Lkube  rocommeiids  energetic  treat- 
ment of  all  gastj-ic  cafjirrtiis  occurring  in  old  people.  The  diet 
should  bo  regulated  so  as  to  control  the  vomiting,  to  alloviata 
the  pain,  and  to  clieck  the  cachexia.  Oproi-zER  eaya  that  in  many^ 
cases  cold  food  will  be  retained  wheu  warm  food  will  cxcit 
vomiting.  Tbc  incliuatioiu  of  the  patient  should  in  all  caaee 
consulted,  and  any  food  he  desires  ehould  be  given.  If  vomit 
continue,  let  the  stomach  rest,  and  give  n^ctal  ii^jectioos  of  meat 
and  paacrea«.    for  obstinate  vomiting  he  recommeuda : 


I 
luiangtfl 


nany 

xcit^ 

iti^ 


BtOHACH:  DI&EAaBS  OF. 


463 


B     Mor[ihiaa!  unriaL, .....gr.jw 

Aqnie  Uuroc«ran 0.  5  t 

it.    S.— FiftMR  drop*  to  thirty  in  Ihe  UHaA. 

Cold  ill  bcHt  employed  lo  tlic  form  of  compreee««  to  the 
Abdomen  or  epigastrium.  Pellets  of  ice,  carbonic  acid  drinks, 
Seltzer  water,  or  champagiie  may  be  tried. 

The  relief  of  pain  demande  tbe  bold  use  of  narcotics.  Mor- 
phine m&y  bo  given  hypodermically  or  by  the  mouth,  in  dosoa 
sufficient  to  relieve  pain  and  give  sleep.  For  the  relief  of  pyrosis, 
antacids  may  be  given,  and  for  fGrmentntion  cither  creosote,  half 
ft  drop,  or  benzine,  seven  minims  at  &  dow. 

If  the  stomach  bo  dilated,  the  Btomacli  pump  may  Iw  usod 
once  dally.  This  measure  relievos  the  acidity,  fulness,  and  dis- 
trees,  reducos  the  dilatation,  and  prevcnte  hemorrbngcB  by  remov, 
ing  the  acid  [:orroaiv8&ubBtancaii,aiid  thus  lessening  tlie  doitructiou 
going  on  at  the  site  of  the  cancer.  The  same  measure  relieves  tho 
coiistiiiation.  "Wlien  tlie  Htoniacli  pump  cunnol  be  used,  oonbtijia- 
tion  can  be  relieved  by  enemnta.  Flatulence  may  be  ari-efite<l  by 
purgative  enemata  or  by  oil  of  cajeput  in  one  to  three-dro]> 
doaee,  on  sugar  or  in  pill.  Dropsy  is  beet  treated  by  diuretics, 
such  aa  the  acetate  of  pK^tanta  lifVecot  gniins  ever^'  two  hours. 

Dt>jABDlK-BBAt;ustz  calU  special  attention  to  the  &ct  that 
oven  in  the  most  prolonged  caaea  of  cancer  we  can  preserve  the 
functions  of  tlie  digestive  organs  almost  intact.  He  citos  a  caae 
in  which  a  patient  was  kept  alive  for  a  month  upon  hard-boiled 
oggB  alone.  In  another  cnec,  under  the  induenco  of  lavage  (wash- 
ing out  tho  stomach  with  the  stomach-pump),  the  patient  so  far 
recovered  that  she  was  able  to  take  her  nourislunent  b}*  tbe  nioutli 
for  a  year  before  she  finally  euccumbed.  Uo  urges  that  the  phy- 
sician should  be  guided  by  iliu  desires  of  the  patient,  taking  care 
that  tbe  aliments  an.'  pure,  and  insisting  that  vogctahlos  and 
starches  are  given,  rutlier  tlian  ulluimen  and  fats.  Ue  excludes 
the  latter  because  tho  gastric  Juice,  in  losing  its  hydn>ehlaric 
acid,  loses  tho  ]>ower  of  digesting  tlietti!  aliments.  Thuy  may, 
however,  be  U8e<l  if  hydrochloric  acid  be  given  at  the  mime  lime. 

8.    DILATATION  OF  THE  STOMACH. 
IiBOBB  says  that  occasionally  tonics  are  indicated.    As  glutony 
is  often  the  cause  of  the  disease,  food  should  be  given  in  small 


464 


WAWTAfc   OP  TBKATMEST. 


qnantitieR,  anil  each  as  is  cnsily  digested,  wlnle  the  nae  of  fluids 
should  be  ro6ti-ict«d.  By  the  j^yKleiiiatic  wa«faing  oat  of  tli« 
stomach  hy  the  pump,  the  ti-eatment  of  this  diaca«e  has  becom« 
a  rational  one,  atid  all  other  remedies  sink  to  the  seooad  or  third 
rank.  As  the  romplete  rumoval  of  all  the  contents  of  the  stomach 
is  the  object  to  bo  obtained,  tliat  iiutrument  iti  to  be  preferred 
whidi  mo»t  certainly  attains  thU  retiutt.  The  pump  should  be 
used  for  ordinary  purposes  (by  the  physidaii  only),  and  the  aiphoa 
when  the  coiitentA  of  the  viiuriiK  an:  tliitd  only. 

Tbis  operation  preveata  further  distention  of  the  titomach 
wallK,  it  nOtevf^  the  mucous  mumbmne  of  a  source  of  irritatioo 
and  it  prevents  decomposition  of  the  contents  of  the  atomacb. 
The  Htomadi  bceoincM  again  uhlo  to  ah^rb  the  jiruductA  of  diges- 
tion, and  the  nutrition  improves.  The  vomiting  and  constipation 
arc  relieved,  und  ae  the  nausea,  hcartbuni,  vomiting  and  fulnoas 
rapidly  disap[icai',  there  U  a  striking  improvement  in  t^ 
subjoetivc  condition. 

It  murtt  not  be  forgotten  that  in  canoeroiLs  or  cicatric 
gteooeifi  of  the  pylorua,  or  in  ii're]tamblo  degeneration  of  the 
stomach  walls,  some  relief  will  be  obtained  but  no  cnre  ean  be 
expected. 

The  existence  of  recent  ulcere,  orao  unconquemble  repugiumoo 
to  the  operation  on  the  purt  of  the  patient,  or  intense  alarm  aitd 
Bponi)  excited  by  llie  eflbrt  to  introduce  the  tube,  eontraimlioate 
its  use.  Cftthartics  are  the  best  substitutes,  as  i^nietics  never 
thoroughly  empty  the  «tomach.  Surprising  results  are  obtained 
from  the  TirM?  of  colocynth  or  Carlsbad  water.  The  latter  ako 
relieve«  the  «itarrb. 

If  nneniia  be  prosent,  he  prespribeK  hydrochloric  acidf  to 
be  taken  a  few  hours  after  eating.  Boeides  limiting  the  qtiaiitity 
of  the  food  and  drink,  the  diet  must  be  diy  anc]  enitily  ilIgeKtiblc. 
The  patient  should  also  wear  au  abdominal  bandage,  and  should 
lie  upon  Iuh  right  side.  The  constant  current  ahould  be  applied 
over  the  atoranch.  Huplay  recommeuded  nux  vomica  to  restore 
the  tone  of  tlit>  nmMcleti.  Bitter  tonics  may  be  used  to  promote 
the  secretions,  or  cracked  ice  with  milk  may  be  given. 

Loouis  considers  the  diet,  as  above  laid  down,  the  most 
important  part  of  the  treatment.    Whilo  wlvising  the   twe  of 


I 


STOiiAcn:  DiKiASis  or. 


lavage,  he  has  not  found  it  as  iidetui  aa  Kv'ssmai'l  clairaeil. 
Strychnine  should  b*  used  to  overcome  the  popeeUoi"  the  muscu- 
lar ixiit.  To  ]ii'eveiii  Icnrieutatiou,  tlie  suliiliitos  or  carbolic  acid 
may  bo  uncil.    Sugar  ami  stan-h  must  bo  forbidileii. 

Bouchard  limited  the  {mtierit  to  ten  ounces  of  liquid  at 
breakfast,  and  at  dinner.  N*<)  drinks  which  have  any  twndem-y  to 
ferment  should  bo  taken:  i-O"!  ivirie  U  torbidden,  and  the  patient 
JO  allowed  only  a  table  minend  water,  ordinary  water  xvith  one- 
thinl  [tart  of  beer,  a  glass  of  whito  wine,  or  a  little  coffee  with 
brandy,  lie  should  not  drink  between  niualrt.  Fnta  «hotdd  bo 
given  uj>;  only  crusts  or  toasted  hreail  should  be  cat«n :  the 
ro[iaM(((  sliould  lie  an  far  ajiart  u.s  {uiMiihlL-,  nine  lionrs  butween 
breakfast  and  dinner,  niiil  five  between  dinner  and  HUpper. 


Dcjahdix-Bravmetz  diviilw  thcw  uucm  into  two  classes;  thoM 
who  have  diarrhea  an<l  thow  who  ai-e  const ipateii.  For  the  for- 
mer he  onU-rB  a  pure  vegetable  re<rinie,  coniixwKid  of  starches, 
of  leguminous  article-s  arwl  of  friiili'.  The  starcliw  should  he  taken 
in  a  state  of  purity,  the  Icji^umeu  U'clt  cookifl,  and  the  fruits  etcwcd. 
Meat  aud  e^iifs  are  abe^olutely  forbidden;  for  drink  he  ordera 
Bavarian  or  PJlwjn  beer,  or  rnalt-bwr  (malt-cxtraci'!').  He  regu- 
lates the  time  for  the  mcalt;,  au<l  allows  ten  ovmcxiA  of  drink  at  each. 

To  this  regime  he  add?  the  employment  of  sulpho-carbonate<l 
water  as  an  antb>eptic: 

B    CnHMn.  wiljiliid.  piir., gna.  xst 

En.  mtrnthiv, Ittt  I 

Aqatt, ....grm-oewi 

This  ii»  put  in  a  bnttlo  of  a  capacity  of  five  hundred  grammea, 
shaken  and  nllnwi-d  to  mettle.  The  water  should  be  renewed  as 
it  is  used.  lie  givea  during  the  day  from  four  to  eight  spoonfuls 
of  thit*  water  with  or  nwny  from  each  meal,  mixed  in  half  a  glass 
of  milk  or  beer.  For  the  cases  attended  with  eonstipatinn  he 
adopt*  the  treatment  of  BotrcDAaD;  that  ia,hc  ordei-s  ronst  meats, 
toasted  hrcail,  an»l  fniitw;  especially  pea^rhes  and  graj**.  He 
olso  gives  mild  inline  pnr^ntivce,  espctially  the  purgative  \vatere. 

In  all  cattoi  hydrotherapy  renders  great  eervice.    Lavage  in 

indicated  iu  all  oi^?  where  the  dilatation  ia  very  great. 

2E 


UAKI'AL   OF  TREATMENT. 


KcsTBH  ilisapproves  of  lavage,  and  recomuienda  tlie  tiw  of 
muriatic  acid,  CarUbad  salts  aiid  silver. 

Baatbolow  advocateft  the  am  of  tiux  vouiioa  aiid  phywv 
stigioa. 

Despite  the  enthusiastic  ottcranccd  of  Lecbc.  lavage  Ii»«  not 
proved  as  valuable  aa  bo  supjioaed.  Many  |)aticiit«  can  not  allow 
its  iHe;  and  in  others,  no  benefit  accrued  from  even  tlie  can-ful  and 
intelligent  application  of  the  method. 

In  one  such  case,  after  lavage  had  been  thoroughly  t.rie<l  and 
dropped  aa  ufteles?,  marked  and  luating  benefit  foltowiH]  tlic  u&e  of 
rhubarb  and  9oda,  oxide  of  zinc,  and  later  hydrastis.  The 
latter  dnig  appeare  to  have  a  distinct  oflect  for  good  ujKin  relaxed 
tnucDiiH  iiiembntnc,  wherever  found. 

Tlie  importaiu*  of  ii  dry  diet,  restricted  iw  auggeatod  by 
DiMARDix-GKArMETZ,  18  Very  great  The  great  ditficulty  i*  to  get 
the  patient  to  ndiivru  to  it,  im  the  cnlATged  stoinach  cravun  dixt^ju- 
tioii^  and  demands  to  be  tilled.  Dilatation  occura  also  for  the 
nitwt  part  in  drinkem  of  alcoholic  liquora,  and  it  in  exiH-txlingly 
diflit^ult  to  induce  thew.  men  to  forego  their ac-cimtomol  lihiitiinw. 
For  both  these  purposes,  i.  e.,  to  remove  the  ponae  of  cnipiiucAS 
whit-h  leads  to  gomuuidbiing,  and  to  remove  the  d^ire  for  liquor, 
we  have  recommended  the  chewing  of  coca,  with  the  be^t  e^'ect. 
Tlie  drug  is  made  into  bolxises,  with  gum  and  licorice, and  ^-hewed 
whenever  the  uneasy  scit-atlonfl  arc  felt  Phytolacca  api-eura  to 
have  some  power  in  causing  ucmtraction  of  tbk;  dilated  tifiautM. 

4.    ACUTE  CATARRH. 

Lbubs  considors  a  well-reguliited  diet  .lulliLrKmt  treatment  iu 
most  caftCtt.  If  the  eiute  he  more  eeriouii,  the  patient  »hoitld  fast 
for  a  few  days,  or  take  food  only  by  the  roctuin.  If  this  be  not 
recjuirifd,  the  diet  should  conaiat  of  barley  water,  soft  boiled  eggs, 
beef  tea,  and  the  like. 

The  casual  indication  requires  the  removal  of  irritating  mat- 
ters by  emetics  and  cathartics;  magaejsiii  being  preferable  for  the 
Utter.  Kmetics  have  the  advantage  of  not  allowing  the  noxa  to 
irritato  the  bowel)!.    Apomorphia  ie  the  best  emetic,  and  may  be 


btuuack:  mseasbs  op. 


467 


given  by  tht  mouth  or  hjiiodcrmically,  in  dosea  of  i  to  J  grain 
The  iLse  of  the  stomach  ]>ump  is  still  l>etter,  because  it  coni|ilet«1y 
cmptie!^  i\\0-  stomach.  Thu  organ  may  thoti  Ii«  ivunhel  out  with 
a  weak  eolation  of  9o^la.  C«utioQ  ihould  then  be  ehowu  in  resum- 
ing the  ordinary  diet. 

If  the  catarrh  be  due  to  catching  cohl,  xw<!ating  should  1m 
indiicetl  by  t.hti  use  of  hot  bivth»  and  wrapping  in  warm  lilunlceta. 

For  tlic  treatment  of  aevorc  aksca,  sec  article  on  Cholera 
Morbne. 

In  general,  uothliig  more  ib  needed  in  acute  ga-^tric  catarrh 
\     than  total  abstinence  from  fooil  for  twenty-four  honrs,  and  tho  use 

r 


M. 


9     Exkrhci  a ..r3iU 

V)n.Ipe<--&ni&iih«k.. ..i........rs  ij 

Fetus. orb.,... • 5  >j 

Aqu^  q.«.wt, f5iij 

K.— A  Uupocnhtl  every  foor  lioan,  is  a  cap  ftf  v^rr  h«l  miLcr. 


5.    CHROlflCCATAUUH. 


LruiiB  callfl  attention  to  the  fact  that  the  cause  of  gaatric 
catarrh  U  fretiuently  to  be  found  in  disease  of  the  lungs,  heart, 
and  liver,  tubercle,  cancer,  old  age,  Rright'e  diae«r»c.  and  the  use 
of  alcohol,  which  require  their  own  treatment,  and  arc  often  incur- 
able. Stilt,  thiH  docH  not  preclude  a  direct  treatnicnt  of  the  gastric 
ttfieetion,  with  benefit  wbicJi  U  more  or  leaa  cuduruig  as  the  rase 
may  be. 

Tlio  finit  fttep  is  to  stop  fermentation  in  the  •'turiiai-b. 
Creosote  may  be  given,  in  doees  of  half  a  grain,  or  bflDzine  in 
twenty-drop  doses. 

liTacuants  are  more  certain  nnd  more  correct  in  principle. 
Catlumie  is  best  obtained  by  the  sulpliate  of  soda  waters,  such 
as  those  of  Carlabad.  If  there  bo  cxiwasive  flatulcnec,  the  Taraep 
wftterR  are  ppeferabk',  on  account  of  the  largo  amount  of  earbon- 
ato  of  lime  it  contains.  Knough  must  be  given  to  produce  aov- 
erat  watery  stools  <Ltily. 

IJo  prefere,  however,  to  empty  the  stomach  by  mejins  of  tho 
Btomaeh-piimp,  or,  if  this  be  nnavailable,  by  an  emetic  of  ipecac- 
uanha or  a[X)mor[>hine.    This  should  be  repeatedly  practised. 


468 


UANCAL  OF  TREATUBNT. 


TTie  nexi  indU-ation  is  tojireeervetlienmcousmeinbniiwfrotn 
fill  irritation  wliicli  may  iiiterfyrt-  with  »  cure.  If  the  gT»\itj*  of 
the  ciiw  wamiiii  «iieh  a  jirooedure.  all  eti'orta  at  fe*cling  by  the 
«toiii]u-h  ftliould  Ik:  fnrbiildeti  uuil  tliv  ]Hitifut  tHiiiri^hud  5<ilel,v  by 
the  rectimu  Of  iiuiritiou^  eticmata  the  paticrcniic  meat  (.■muUloo 
in  to  be  proi'erreil.  (V.erny  n.-oDmnit'ndwl  rlic  w!iite  of  hu  egg, 
beaten  nil  witb  one  himI  ono-Iialf  tinier  it«  voliimo  of  water. 

Ill  miWort'«*M*  it  is  raffieient  to  onU'P  aii  oifily  diguKtible 
did.  tliin  !«lioiil()  be  tbt?  otic  whit'b  fia««i«  inoHt  ([uifkly  fnim 
tiis  tlt^sMOfi  ^toninvli.  which  ih  of  tbo  blatidu»t  cnnHigtc'iiLV,  and, 
in  a  word,  wliifh  Ivant  aroiiM:^  llic>  netivity  of  ihc  diseased  oi^gan. 

Slan-hcrt  ?«]iould  be  but  ^jwringly  admitted,  or  not  at  all. 
Wlivn  urted,  the  follmvinfj  list  should  be  nelcctod  from:  "WTiite 
brea<l,  IiiKint,  nwk,  a«i>tiragus,  j.eiis,  young  carrote  and  i>"tttto 
Hottp.  Fntit  shouhl  bo  forbidden.  Egge  may  be  eaten  wbuii  soft 
boiled.  Meat  fhoiild  not  he  too  fresh.  Amony:tVie  most  dipt*tible 
are  tbe  white  meat  of  fowlH,  the  glands  of  young  uniniaU,  youni; 
pige'»ii8  and  swcctbreadi*.  Boiled  fi(>h  is  also  eiwy  of  digestion. 
Boiled  veal  U  pcraiisaible.  If  the  ]jntient  be  unable  to  do  >titboQt 
beef,  it  nhould  only  be  taken  when  n.nt^tod  rare.  Milk  i^  useful 
except  ill  the  ijascA  tu  which  it  ditiagreeis  The  solution  of  meat 
devised  by  Kosesthai.  ntid  biniAelf  la  partieubirly  eommoiided  by 
LKVbB. 

In  a  few  «»5(w  eauily  iligeKted  fo*id  does  not  (igr««.  \Vhan 
the  tttoiiiacb  biu  been  weakened  by  the  imjjroper  nse  of  aiiicc«, 
these  niiiy  Ik*  rcpluix^  by  Iiartnleas  sut»tancei<,  such  an  icOf  alkalies 
or  bitter  tonics. 

Btimitlantd  had  better  be  avoided;  but  if  n«cd, diluted  red 
irine  ia  the  be^t.  If  i^tiTniibints  be  needed,  they  inity  he  admln- 
iatere*!  in  (■rii-iimta.     T<-e  may  be  iir'tfd  to  relievo  thirst. 

Tbi'  alkaline  mineral  waters  are  (uetid,  tlie  Tarioas  aprii^ 
being  Hiiitable  to  the  variety  of  phasei<  prettentud  by  this  dbwaao. 

Muriatic  acid  and  popdn  are  indicated  when  digwtion  U  too 
elow,  or  the  Beerotion  of  ga«trie  juice  is  doti^tetit.  Uismutb  and 
silver  may  be  used  when  c««es  resist  the  foregoing  treatment, 

yiBMEYBR  recoinniends  that  the  diet  be  pnaseribed  aa  part 
of  the  treatment,  as  it  is  tbcn  more  ciirelully  observed.    Soioeget 


I 


\ 


STOHACK:    DISIJISES  OK.  469 

aloni;  well  oq  coucentrate^l,  iinttkiiuiuod  nicut  broth,  others  do  well 
ou  cold  meat.  Somctim^'S  only  meat  which  is  salt  or  smoked  is 
well  borne,  m  the  latter  will  remain  long  in  the  stomach  before 
d6com[iOdiiig,  and  thtu  allow  time  for  digestion.  All  food  (thould 
be  c-arefully  chewed,  and  only  small  portions  taken  at  a  time. 
The  exclusive  uae  of  milk,  or  l«jtt**r,  of  buttermilk,  agrees  won- 
derfully with  some  ]>atierit*.  The  twc  of  the  Carlsbad  water, 
with  the  regimen  observeit  at  thetie  8pring»,  t\irnia)ieti  the  most 
brilliant  reaultd  ever  attained  in  mcdieiuo.  [f  there  be  no  consti- 
pation, soda  wat<;r  will  otten  suoceed  as  well. 

If  atony  of  the  raucous  membrane  oxi«t,  thi?  mild  chalybeate 
watcn*  are  to  ho  u.-«ed,  with  i^lightly  HuuBOned  and  ^alty  food. 

Dcjabdin-Braumetz  rceoturaends  the  excluitive  miiy  diat, 
aa  the  motit  active  curattvo  agent  in  the  i^hronic  catarrli  duv^el- 
oped  under  the  influence  of  alcoholic  exeeaa.  In  the  first  stage 
there  iii  exofssive  i*eerotiou  of  auidi*,  with  waterbrash  niid  heart- 
burn, in  the  sei-'inul  the  gastric  Juice  is  replaced  liy  the  proihictioo 
of  mucU8.  Id  both  periods  he  employs  the  milk  diet,  aUvayx 
adding  to  the  milk  the  alkaline  water  or  bicarbonate  of  soda. 

In  the  tn^atnient  i>f  tJiix,  tlit)  mont  cnmnion  disease  to  which 
huraauity  is  liable,  the  universal  fault  is  to  treat  it  oe  dyspepitta ; 
a  rarer  uftw^tiou,  and  one  vrliiw!  appropriufe  n.-mcdies,  the  tonics, 
do  infiTiite  harm  in  gastric  catarrh.  Tbe  mental  and  IwKllly 
depn-iwion  chaniftcrizing  gastric  t-atarrh  .seem  to  point  ti»  the 
use  of  iron,  mineral  acids,  qninine.  alcohol  and  end  liver  oil,  all  of 
whitJi  are  liannful.  Kven  in  thoM  cuao^  which  hare  commenced 
aa  atonic  dy-^pepi«ia,  im<l  in  which  the  catarrh  is  added  HubM> 
qiicritly,  it  is  bu*t  to  treat  the  latfcr  atret-tioii  iH-fnn'att-empting  to 
relieve  the  dyfij^psia. 

For  fairly  wtU  nourished  patients,  the  Carlsbad  wiitor  or  9alt 
may  be  oiKlere^l  at  once.  Tbe  following  formula,  taken  from  tlie 
German  Phannm;o]xcia,  gives  an  artificial  ^It  which  ib  for  all 
practical  pur|>OE(eii  equal  to  the  genuine: — 

a     ScNlii  ffiihihat.  «xric pKit.  ilir 

Potfua])  uiliihaL, poM.  jj 

i:V><lii  clili>rid patC  xvi^ 

Sodii  liicoirb^ psrt.  xxzrj 

Reduce  to  tine  powder,  ind  nux. 


470 


MAXUAL  or  TRKATMENT. 


Of  tins'  salt,  a  wiiall  tonwj'oonful  may  be  taken  in  a  c 
hot  water  one  hour  before  e«ch  meal  If  the  bowtla  should  be 
moved  too  firecly,  lee*eii  the  dose.  If  tliu  [wiiieni  bv  feeble  or 
ftnemie,  the  prescription  of  rhubarb,  ipecncuauba  and  carb«>nate 
of  potaswi,  given  in  the  article  on  tu;ute  gwrtric  I'atarrh,  mny  be 
8u)Htltuted. 

Thciie  prc[ 01111  ttoni*,  given  in  hot  MWur,  aceompliiUi  aex*enl 
objects.  They  eloonvio  the  ^tomneh  and  diiuudve  the  imhenlUij 
mtieuK  which  ha^  m\\<*v\etl  Uierc ,  und  leave  a  elean  surface  for  the 
food.  They  also  atiinulato  the  accretion  of  healthy  gastric  jniec— 
Epartieiiliirly  the  rhiibiirh  niixhiro.  But  it  iiiiwt  ni»t.  he  fnryotteo 
'that  thf  long  TOiitinucd  nsc  of  nlkelie^  is  t'xeeedingly  ii^arioua, 
e«[ief.-ially  iu  causing  deatruetion  of  the  red  blood  corjiUftule^.  "We 
fear  our  Gei-miin  friends  foritet  this.  At  any  mle  they  fail  to 
einiihuFiizi-  the  fuct  that  the  oflic-e  of  the  alkalioH  in  but  to  prepare 
the  way  for  otlier  and  more  curative  remedies. 

A*  eoon  H«t  the  cutarrlial  symptoms  have  somewhat  Kuliitided, 
the  tongue  cleaned,  the  breath  become  pure,  the  enii:-tati<KM  of 
gan  and  sour  liquid  .stopped,  and  the  heartburn  pa*sc<l  away, 
the  patient  should  begin  to  take  one  of  the  following: — 

B      Ar|[anli  ot'tA^ ^,  v 

Zinoi  oxid gr.  xl 

M.    cl  in  cb&n.  no.  ii  div. 

8. — Onn  |xiw(ltir  juKt  befofo  laich  tatxl. 

B     ISnet.  liTdrnatii^ (J  iij 

S. — ^Tliirty  drops  jort  before  twcli  mnl. 

The  alkaline  mixture  in  tititl  to  be  continued,  aci  it  cleanses 
the  stomach,  and  by  this  enables  the  other  remedies  to  come  into 
direct  contact  with  the  discuHcd  mucous  mcmhmne.  When  it  in 
not  deemed  advisable  to  give  the  alkalies  any  longer,  the  hot 
water  Eiuy  be  eontitiucd  alone. 

In  flimplc  catii.rrhii>  the  silver  and  nine  ix>wders  are  to  be 
preferred;  but  if  tlic  stomach  be  dilated,  or  if  the  catarrh  be 
due  to  alcohol,  or  if  tlie  atony  be  very  great,  hydrastls  will  do 
better. 

Ah  a  rule  theBlkaHes  should  not  becoutinued  more  than  two 
to  four  weeks,  except  in  plethoric  persoue,  where  their  depletory 
«lfcct  is  dudi ruble.    The  hydrastis  can  he  continued  with  benefit 


STOHACn:    DISEASES  OP. 


471 


longer  than  any  trtiiic  with  whieh  we  are  actjuainted ;  in  some 
csfies  for  iniiiiy  nmntlis.  When  it  is  ileeme<i  rwjnisiti!  to  administer 
iroo,  bittei-s.  or  iniiiernl  ntids.  after  the  catarrhal  symptonis  have 
Bubttidcil,  mild  pre|>itniti<in!<  nliould  Im-  preferred  ;  ttiich  as  the 
citrate  or  tartrateof  iron,aiiil  iiifiiaion  of  rulumbo.  Hydrochloric 
acid  mid  [iciwiii  iiiiiy  then  Ite  jriveii  al'ti-r  iiiealFt. 

The  vot^ea  in  which  cured  meutt^  ngree  beet  with  the  stomach 
are  more  mimenms  thftn  any  otlier  L-la^s.  Lean  ham  and  amoked 
dried  boet"  are  lietter  than  cured  iinh.  Other  persoiifi  digest  the 
pickled  meata  with  more  eomfort  than  any  other  articlea.  As 
catarrh  in  t'rocjnently  due  to  hurrie<]  swailriwing  of  the  mcaU,  it  is 
ftometimes*  advautojreous  to  preecribe  such  foods  as  cftunot  be 
swallowcil  without  thorough  mastication  and  insalivatiou. 

"SuMic3,"  made  of  oatmeal  and  water,  and  baked  on  the 

hearth  until  they  are  the  coiiaiatoiicy  of  jrranitc,  aro  exceedingly 

usefbl.     Hurd-taek,  (ig^  hi^iiit,  bailed  wliole  wheiit,  and   tough 

anlt  beef,  are  nuitablo  in  thoBC  owes.     Wc  havo  often  loDged  to 

,prc6cril>e   Kriar  Tut-k's  pai-chod    i)ea3  as  a  suitable  diet.    The 

f^iatient  must  be  wunied  not  to  drink  while  eating     lee  water  and 

ice  cream  are   reHponnihle   for   many  <»tiirrh8   in    this  eountry. 

Well-drittl  and  toostud  stale  bread  can  be  oaten  by  mottt  per- 

Milk  U  by  no  meuiiH   nni\'en(ally  applieahle.     In  many 

it  cannot  be  taken  at  all;  and  it  will  often  be  found  to  fer- 

'ment  (iniekly  in  the  stoniai-h.     It  rIioiiM  nevurbe  Uiken  iee-cold, 

or  drank  qiiicrkly.    Buttermilk  is  the  nioet  generally  useful  form, 

if  taken  slowly,  when  i»erfeetly  sweet  and  fresh. 

If  there  be  iimch  heartburn,  snbnitrate  of  blBmuth  is  an 
excellent  palliative.  It  may  he  taken  in  do*es  of  ilve  grains, 
whenever  the  jiain  or  fiilneMS  is  felt. 


ti.    GASTRIC  ULCER. 

I.RvnK's  treatment  is  as  fol]ow»:  The  patient  is  confined  to 
be«l,  and  active  motion  is  avoided  m  mnoli  a&  poiwible.  At  night, 
a  cold  compress  is  applied  to  the  epigastrium,  oi-  an  ice  bag  if 
hemorrhage  be  thiviiteiied.  During  the  fin*t  few  days  a  table- 
spoonful  of  CaxUbad  salt,  in  a  pint  of  luke-wann  water,  is  given 
every  moming  before  breakfast.  If  this  fail  to  properly  evacuate 
the  stomach,  it  is  washed  out  with  luko-wami  water,  by  means  of 


UANOAL  OF   TBB&TMKKT. 


tba  Btoraach  imni[».  The  diet  at  first  conaiats  of  one  pot  of 
•olution  daily,  ropreseiiting  Imlf  a  [K>und  of  buef.  To  thin  liu  addi, 
at  breakfast  and  dinner,  some  milk  and  a  few  pieces  of  nuk, 
which  niiiHt  be  thoroughly  iiutHticated.  Tlie  \iee(  itolution  in  taken 
pure,  or  in  soup,  with  a  little  Liebig'*  extract  and  rait  to  the 
taeit4*.  A]l  food  flhould  be  taken  luki>-warai.  In  two  or  three 
weeks  he  gives  the  patient  pigeon,  potato  pur^  thick  eoupe  and 
wheat  bread;  and  in  one  week  more  he  retunw  to  cottrser  food. 
With  ihiit  treatment  he  finds  morphine,  silver  and  bismuth 
sujterflnoue. 

Gbbiiabdt  coiisidorod  the  tmcture  of  iron  the  t>eat  remedy 
for  reltoviiig  pain.  He  gave  three  dropa,  in  a  win<^la»aful  of 
water,  eeveral  times  a  day. 

When  the  pnin  and  tendernetw  ntv  <i>nfined  Htrictlj  to  one 
spot,  the  coQtiimous  use  of  a  small  ioe  bag  is  to  he  commended. 
FUttilentx*  niny  be  relieveil  by  charcoal  <>r  by  the  utomach  pump. 

Nothiiis;  i-elitvoa  the  vomitintj  ^o  well  as  the  strict  observance 
of  a  Buitublc  diet.  I'yrosis  cull^  for  untavi'ld.  In  chJoroeia,  \3^, 
beet  chalybeate  in  the  lactate  of  iron.  ^^H 

Wlieii  pi'rforfttioTi  oceiin*,  the  only  treatment  is  to  prodaoe 
euthannsia.  The  energetic  use  of  opium,  ice  and  the  Other 
nuffl«iuri;s  of  treating  jjcritonitia  are  iiuliuatctl. 

Dujariiin-Beacmmz  approvew  of  tlio  plan  dovii»cd  by  Csr- 
VEiLUiEh,  the  "tuilk-iliet  in  all  its  rigor,  for  if  the  patient  depart 
from  this  regime,  mortal  hemorrhage  may  be  produced."  He 
'inotfs  Debovk's  proposition  t/>  neutralize  the  gastric  jtiice  and 
prevent  etomaeh  digostVoii  by  ndrainistoring  each  day  aeven  and 
oue^half  to  ten  drachms  of  bicarbonate  of  soda;  but  prefers  the 
method  of  Lucca,  who  mixes  the  milk  with  lim(^-water. 

The  ordinary  diet  should  be  but  gradually  resumed;  giving 
fint  the  ntsrchets  and  then  meat  in  the  form  of  powder. 

NiBMKTBR  spoke  very  decidedly  of  the  benefit  derived  from 
the  use  of  morphine.  He  said  that  the  administration  of  the 
eighth  of  a  grain  is  tbltowed  by  the  mo«t  marked  relief;  and  that 
thi«  is  Bometimas  permanent. 


BTtWAOH:    DtSBAeBS  i>P. 


478 


It  U  only  iu  a  eoruiii  clas*  of  casos  that  the  alkaline  treat 
ment  is  aJvlKuhle ;  an  nmn^-  [mrsoiis  with  gfixtriu  ulcer  are  Uio  weak 
to  endure  any  lowering  ineaj^ures.  fii  fact,  it  may  be  oonaidered 
certain  that  -eery  often  the  ulcer  \n  i>reveiited  from  healing  by  the 
condition  of  Innutrition  into  which  the  hemorrhages  and  enforced 
starvation  have  reduced  the  jiatieut^.  In  all  audi  cad»s,  if  it  be 
necesaary  to  relieve  the  stomach  from  the  labor  of  digestion  we 
may  uac  the  |ianctvatixed  nitat  per  rectum,  and  have  the  body 
rubbed  with  warm  cod-liveroil  twicedaily.  Baths  of  %vann  milk, 
or  s]iongiiig  with  the  same  fluid,  arc  uaeful.  The  akin  \ms  far 
greater  powers  of  absorption  than  is  ummlly  mijiposetl ;  ami  a  large 
amount  of  nutritioua  material  can  be  Introduced  through  this 
chanuel ;  especially  if  the  material  be  applied  wanri  and  he  well 
rubbed  in.  In  females  also,  the  vagina  baa  heen  recently  ehown 
to  poesens  absorptive  powers  cxceoditig  thoxo  of  the  rectiuu.  [ii 
some  CAoea  where  patienta  hare  l)een  unable  to  retain  food  in  the 
stomach,  it  will  be  found  tliat  after  the  admin iatra lion  of  luor* 
pMne,  gr.  ^,  iodoform,  gr.  j-ij,  or  cocaine,  gr.  i,  bland  articlea 
may  be  taken  without  exciting  vomiting.  With  each  of  thceo 
three  drugs  we  have  succeeded  in  rapidly  ctiring  gastric  ulcers: 
but  each  bos  tailed  in  other  ca«<^$.  Bismuth  in  tcn-gmin  dosc:*  \s 
an  exoelleut  palliative,  but  hot  water  i^  better.  A  pint  of  liot 
wattr  taken  on  an  empty  stomach,  before  each  meal,  U  aometiwea 
the  only  remedy  to  relieve  pain.  The  drugft  usually  gi\-en  for 
vomiting,  croawtc,  hydrocyanic  acid,  chloroform,  and  cauiiabia 
Indies,  are  only  additional  dourcen  of  suftering.  We  have  given 
Fowlor's  solution  in  linlf-<liMp  to  fivo-drti]*  dnses,  in  n  number  of 
cases,  and  Imve  never  obtained  any  benefit  from  its  uw. 

The  endcnuic  use  of  morphine,  uniting  the  ettect  ol'a  blistur 
to  that  of  the  narc^itici  is  sometimes  of  it[iecial  value. 

The  pain  is  generally  amoUomteil  when  the  bowold  are  fraely 
opened  ;  whit-h  may  Iw  done  by  giving  an  enciiui  of  »;oUl  milt  water. 

Although  we  are  unable  to  account  satisfactorily  for  ita  action, 
there  is  no  doubt  that  the  silver  saltn  somet-imes  give  marked 
relief.  Le-i*  froqiiciitly,  the  same  I>ciiefit  is  obtained  from  tho 
ealta  of  copper,  xinc*,  or  lead.  The^e  remedies  are  ba^t  Huited  to 
chrouic  cases. 


474  MAKVAL  OP   TRKATURVT. 

STOMATITIS. 

Clabkk  recommends  that  the  <Iiel  ami  the  li^'gK'iw  lie  first' 
regululed.    Small  ilojie*  of  grej  ]»owd*r,  or  ni'  rhubarb  and  mag- 
nesia, elioiiUl  be  ijiven  to  regulate  tlie  Ik>wv!s  ;  wliile  at  tixe  mudc  ■ 
time  chlorate  of  potassa  and  eiiH-hona  should  be  u^ed.     Later, 
a  cfnirse  of  cod-Uver  oil,  ioclide  nf  iron  or  Parrmh**  chemical  food  m 
should  be  given.  fl 

The  iiuiiitli  nhoiild  Im>  washoil  witli  borax  solution,  or  if  the 
breath  be  t'etid,  with  m_vrrb  or  chlorinated  soda.  M 

For  ^'Hngn-tie,  or  noma,  h<i  advLwjK  tlie  Ktroiigisi  supiHirtiug  I 
mesaaurcs,  washing  the  mouth  with  disinfectant  lotioiis,  |H^ultic(4  M 
to  the  cheek  nlitil  the  slough  rte|»amte8,  and  then  dn-iwiiig  the  n*w 
surface  with  lotions  of  carbolic  or  nitric  ac-id,  or  of  sulphate  of 
Eioc    If  the  gangrene  thrcAtcn  to  itpivad,  the  cdgc^   niudt  b«| 
touch&I  with  strong  nitric  acid. 

Stahb  diii-cts  for  ea-turrhul  stonrntiti!*,  ihat  the  uiuutli  sliall 
he  washed  every  hoar  wliile  tlic  child  ia  awake,  with  a  solution 
of  borax,  ftr  dilorate  of  potassa,  ten  gniins  to  one  ounce  of  1 
nise-water.    A  leaajioonfiil  of  iiu-ut  ml  mixture  majf  be  given  e^'wyj 
two  hours  if  there  be  fever.     When  Ihe  tongue  iis  heavily 
aiid  the  stomach  di»ordei-ed,  he  gives: — 

B     Sodii  bicarb^ gr.  xzir 

P«pi)IiMs gr-xU 

Pulv.  aromat gr.  itj 

M.  ct  in  I'-hurL  no.  x  ij  (tiv. 

6i--~0iic  powder  four  tin)n>  dailjr,  in  milk. 

For  aphthous  stomatiti*,  he  reeommends  can-fnl  attention  to 
the  apparatue  used  in  feeding  the  child,  and  regularity  iii  feetiing. 
A  do«?  of  ipeoaouanha  may  be  needed  to  relieve  an  overIond«l 
Btomfteh  ;  or  a  half-grain  of  calomel  for  constipation.    If  diarrh«K 
be  preiM^>nt  he  glveH  a  teaH[Hioui'ul  of  OftStor  oU  witb  live  drop^  n(  ■ 
jiaregorie,  aud  follows  with  the  alkaline  !?ynip  of  rhubarb.     Th«  f 
fever  re<[uii'eK  a  hot  muKturd  hah-bath,  with  neutral  mixture  and 
perliaps  a  lit  lie  aconite.     LoenHy,  he  oblnins  the  Wt  rc«ultM  by  m 
toufhiiig  each  uN-er  lightly  witli  a  jioini  of  lunar  cauatie.     OiM  1 
a[iplioatiou  is  often  enough,  or  it  may  be  rep«ateil  even'  day. 
The  mouth  is  waslied  out  with : — 


ITATITI^. 


475 


B     PMaibii  dilomtq gr.  zx 

Vin.  opii, tH  t 

(ilvoerini, f3  j 

A(3.roBK,q.ft  ad fjj 

tit 

When  the  fever  has  subsided  he  gives  wine  of  pepsin. 
For  uleerntive  stomutitU,  he  recoiimietids: — 

B     PotubLl  clilorat. gr.  xItU] 

Arid.  h]ri]nM'hIori<-i  dil^ f5  j 

Sjrujiv tim 

Aqiur.  q. «.  ad f|  i^ 

M.    S. — A  t«M|Wonfii],  dilulAd,  every  two  lioafs. 

It'  needed,  half  a  grtiui  of  quinine  may  be  added  !->  oicb  do*c. 

Locally,  he  uses: — 

B.     PfrlMsIi  cblorat, gr.  Uxz 

Acid,  curbolict, gr.  ij 

Cilycenoi, r|J 

Aquv,  1).  a.  ad > {%  rifj 

31.    8y— A])plT  to  Lh«  tiltvn  thoromgblj  at  ImA  OW*  ffrory  hour. 

^Iron  and  Mtiiitiiliiutiit  will  lie  required  inBtvcrciind  pn>tnicled 
The  tiucturc  w  the  K-st,  ftirm  of  iron,  and  may  W  added 
to  the  acid  mixture.    LooHoned  teeth  nniet  be  allowed  to  remain. 

For  gangrene,  he  uonsident  it  of  tlie  first  imijortanoc  to  niairi- 
tain  the  strength  by  t-onetintrated  liquid  fcxwl,  tonics  anil  Btimu- 
lants.  If  swallowing  be  difficult,  encuiata,  Buppositoriea  of  qui- 
nine, and  stimulation  by  the  rectum  are  necewary.  The  air  of  the 
room  nmat  be  kept  in  a  state  of  pm-ity. 

Early  cauterixatlcm  is  reeommended.  Slouglw  should  be 
removed  by  M-issora.  The  si>ot  should  be  hatlied  with  eti-ong 
solutions  of  chlorate  or  f permanganate  of  pntusiiiiim.  carbolic  acid 
or  chlorinated  linie. 


Ubkocu  «]>cak6  highly  of  the  chlorate  of  potassa  in  caeee 
ftS*ociateti  witli  fi'iur.  If  mi  ob-Jtinate  cine  i^'HiHt  tliis  remedy  ho 
apftlies  a  solution  of  sulphate  of  zinc,  one  part  to  twenty  of 
diHtiUed  water;  or  sulphate  of  copper,  one  jiart  to  forty  of 
distilled  water. 

In  ulcerative  vsmh  he  uxes  decoction  of  einchona,  with 
chlorate  of  potassa,  and  lotions  of  carbolic  or  salicylic  acid,  or 


476 


MAVDAL  OF  TBEATMBNT. 


permanganate  of  {wtasga.    The  extraccioa  of  looeo  teeth  hagtansi 
recovery. 

Ill  gangrene^  be  adviue  the  use  of  the  hot  iron  alone,  bs 
aooti  as  noma  has  developed.  All  tlie  gsngrenoug  t'lwae  mast 
hi'  c&TotaWy  rwinoved,  Tho  use  of  autiseptic  ilreeeiu^,  aud  Hut 
dipped  in  camphorated  wine  should  not  be  neglected. 

VoasL  cftlU  attention  to  the  importaDce  of  removing  thi 
caneee  of  catarrh  of  the  mouth  in  adutte;  such  as  d«cajed  teeth, 
or  toUacoa  In  acute  catarrh  the  mouth  ahonld  be  freqoeoUy 
ringed  with  water  or  solution  of  chlorate  of  potasaa,  t«ii  grains 
to  the  ounre  of  water.  In  the  catarrh  of  dnuiluinL-t,  Xikmetbr 
recommended  chewing  a  piece  of  rhubarb  root  before  going 
to  bed. 

In  some*  eases  of  aphthse  PraupBB's  method  of  riuaing 
wiih  corrosive  sublimate,  one  grain  to  ten  otmcea  of  diotilled 
witter,  18  of  •lci;idoLi  benefit.  The  chlorate  of  potaasa  haa  no 
decided  action  ii]  tlirse  ca->«e».  For  niercurial  stomatitiK,  VooBL 
recomraeiids  the  chlorate  as  a  prophir lactic.  If  sj^hilis  be  treated 
hy  mcrcnriftl  inunctions,  niid  at  the  same  time  the  patient  take 
every  hour  fivL'  p-Hiru^  of  L-hlonite  of  [rfita^jta.  months  may  elapse 
without  stomatitis  being  [imdiK-O"!,  unless  them  an.'  carious  toetli. 

For  noma  he  profer»  the  hot  iron.  Lasob  employwl  oil  of 
turpentine  in  a  severe  case,  in  which  a  jart  of  the  cheek  vm 
ticsiroyfd,  as  well  as  half  tlie  tongue.  Ho  laid  saturated  cluirpie 
ujcn  the  parts,  and  renewed  the  application  every  two  lioiin. 
The  n-i^ult  wao  surprising;  the  gangrene  became  limited,  and 
cicatrization  set  in. 


i 


i 


The  introduction  of  cocaine  nnd  of  iodoform  hns  given  ns 
two  valuable  ngeuta  in  the  treatment  of  all  the  ulcerative  nffeo- 
tions  of  the  moutli. 

In  chronic  dry  catarrh  of  the  mouth,  great  benefit  will  en»tu ; 
from  chewing  tlie  root  of  hydrastis. 


hCNSTROKE.  ^^^^V  4TT 

SUNSTROKE. 

Maclsan  sajs  that  undur  the  old  treatment  bjr  veDe&ectioa 
ihe  mortality  was  very  great.  At  the  earliest  jioaitible  momoit 
tlie  sufierer  Hlioviltl  )hi  cnrritil  to  tliu  nearest  shade,  stri]i[>(Ml,  uiid 
atwidmmslj-  iloiiohed  witli  wld  w«ter  over  head,  neck  «ml  chest. 
If  this  be  cfi'ectnally  and  fpitc-kly  done,  nvpiration  will  aooii  be 
ro-c«tahHi-bed,  and  the  beat  <tf  the  skin  redneed.  Tlie  douching 
inoy  require  to  hv  repealed  eevural  tinieB.  lu  hospitals  it  may  W 
necfsfiftry  to  wrap  the  patient  in  a  wet  ^heet  and  fan  him  vigor- 
ously. 

The  patient  should  druik  freel}'.  The  douche  niay  be  abused 
if  otHsl  loo  long  on  a  8ha^*etl  scalp.  Nor  eliould  tt  be  used  Umi  long 
when  the  «kin  is  cold  and  claDinij,  and  the  rcapiraliou  nighing. 
He  then  restricts  the  douching  to  the  lac«  and  cheat. 

When  the  heat  of  the  skin  is  excc^ive,  Parkes  auggesta 
giving  an  euemn  of  ice-wat«r.  Ammonia  itbould  be  cnutiously 
applied  to  the  nostrils.  The  sooner  the  bowel*  are  relieved  the 
better.  If  the  ekiu  i-einaiu  dry,  \Vai-bui*g"s  tincture  may  bft 
tried.  Support,  and  the  judicious  nm  of  Btiinulants,  must  uot  bo 
neglected.  If  seuRibiliiy  be  not  r\«topet|  by  the  douche,  o  blister 
ehoald  be  applied  Uy  the  nc<*k,  or  |>crhaps  to  the  beitd.  In  cou- 
mlsivo  cmon  be  wuruily  advoculai  the  inhalation  of  chlorofomL 

LooMis  8]tonk?  of  the  neiHMwity  of  abrolute  i-oat  aud  plenty  of 
cool,  fretili  air.  Stimulants  uru  ot>en  neeeiwarj';  It'  tboy  excite 
vomiting,  they  t>hould  be  <»iven  hypo<lermi«illy,  or  by  euenui. 
Ether,  muffk,  animoiiiii  and  tiir|<cnrine  an*  recumniended- 

Ii)  nio«t  ca-seH  the  coId-water  tre-atmcm  u  the  best.  Between 
the  bathw  dry  cupn  tuny  1>e  applied,  and  ((ttmulant»  may  h« 
given  during  the  bulb  if  the  pul^e  demand  it.  The  patient  should 
alwuvft  be  nrmov'cd  from  the  bath  bi-fore  the  teiiipci-atua>  fiilU  to 
normal.  Purgative  enemata  and  t^tiinulantft,  with  the  cold  water, 
arc  all  that  is  ii-ijuinxi  wheru  the  tenn'ci-aturc  U  Iwlow  105^. 

Thermic  fever  tlemami^  ice-water  to  the  flkin.  a  brisk  aalujo, 
and  raorpbino  with  <[uiniiic  hrpodermically.     BliBttirtt  arc  often 
beiielicial.      Severe    bniin  symptoms  are  often   relieved   by  the 
inhalation  of  ether  or  of  chlornfonu.    These  comm  should  resort 
I   to  a  cool  climate  and  refrain  from  active  bntin  work. 


478 


MAKOAX.  07  TRBATMEITT. 


Wood  remnrks  that  when  cxi^xisure  to  beat  U  imperative,  all 
■leoboUc.  sexuat  and  other  excesses  must  be  aTOidcd,  as  well  as 
great  fatigue.  Thtr  iliet  .Hhoiilil  l>e  farinaceous  wnd  all  the  secretory 
orgHiiN  kejit  ill  full  ojieratlon.  Large  draugbt^i  of  iiitciiM.-lv  cold 
water  m&y  \^m»ih\y  ilo  harm,  but  »inall  ([iiuntitioi),  taken  at  abort 
intervals,  reduce  the  temperoturc  and  keep  n]t  t'rcc  jierapi ration. 
The  addition  of  claret  is  of  f*or%'it«  if  stimulants  be  nettled. 

In  mild  oa^e^  the  basis  of  treatment  in  the  oold  batlL 
GuiTEKAS  wrapjied  tbo  [latient  in  a  dry  sheet,  lifted  bim  inio  a 
tub  uf  water  at  85°.  and  rapidly  eooloil  tbi-t  \>y  nuans  nf  ine.  The 
immereioa  lasted  fifty  to  fifty-live  minutes,  being  regulated  by 
the  thermometer  in  his  month.  The  ]jatient  wa»  th^n  lifted  not 
npon  a  blanket,  the  skin  partially  dried  and  the  botly  i-ovcrwL 
A  little  whiskey  and  half  a  drachm  of  tincture  of  digitalis  wu 
given  twenty  minutes  before  the  batb.  Draughts  are  tn  bi;  avoided, 
and  the  bath  must  be  given  in  a  small,  warm  room.  The  rpsalt 
was  alwayn  a  fall  of  the  fever,  nf  the  pulse,  and  of  the  respiration, 
with  refreshing  sleep.  Al\er  the  second  bath  the  temperature  did 
not  return  to  its  former  height.  It  was  never  necessanr  to  give 
more  tbiui  two  l>atbs  in  one  day,  but  sometimeD  they  bad  to  be 
continued  for  many  days. 

In  the  severe  auute  form,  no  time  should  be  tost  The  clothea 
should  bo  removed  and  cold  allusions  over  the  ehest  and  body 
praeliRi-d.  The  teritimony  in  favor  of  antlpyrin  i^  ^t*  strong  ihac 
it  should  always  bo  employed  as  an  aid  Co  the  eold  water.  Kifreen 
to  thirty  grains  fjlinuld  lie  gi\-en  al  onei?,  hypoilGnnicallv.  In 
convulsive  caso.^,  morphine  has  been  treqneutly  given  at  th« 
Pennsylvania  hcxpltiil,  witii  ex«-ellent  re«uit*i.  One-fourth  of  a 
gmin  may  be  administered  hypodemiieftlly. 

The  direction-t  issued  to  rogimcntal  ^tKrei-s  for  the  trratment 
of  cftsca  of  sunstroke  in  the  British  army  in  India,  are  as  follows: 
The  patient  should  be  carried  at  once  to  a  shady  spot,  stripped, 
wrapped  in  a  wet  sheet,  and  fanned,  or  the  skin  itpoQged  with  ice- 
water  or  alcohol  and  water,  and  famiod.  A  Btpeam  of  cold  water 
should  be  poured  upon  the  head,  aud  the  patient  should  be  giveo 
iced  water  freely.  If  the  skin  become  hot  and  burning,  when 
these  applications  are  suspended,  pieecs  of  ice  may  bo  applied  to 
the  scalp,  aud  rubbed  over  t}ie  body.    On  no  aooount  adrointfiter 


STNOOPE.  ^^^^V         479 

aI<^ohol  or  any  ottior  etinmlaitt ;  but  anitnoiiia  may  b«  belil  to  the 
no8triis 

The  coUl'Watci*  treatment  U  now  tb«  standard  metJiod  «m- 
{ilo^'ed  IP  sunstroke.  But  tliu  great  luiijorily  of  the  ea.'HM  r«]>orted 
aa  suiiatroke  are  dimply  ca-^em  of  heat  exhaustion.  Most  of  these 
are  due  In  die  imiiiodvrutc  usv  of  bcvcragot.  When  il  miui  Itegiiu 
to  diiok  ice-water  before  breakfast  on  a  hot  summer  day,  he  is 
apt  to  keep  it  up  all  day  long.  Immoderate  drinking  eaumai  free 
pci¥i|>imtiou ;  ami  thia  m  turn,  tnrreni^es  the  thirst-  By  this  means 
an  eiioniious  amount  of  the  tttliiic  elements  of  the  hlcMid  unc  tont, 
aud  a  t-onditiini  of  great  weaknem  reeultA  Nothing  but  absolute 
ignonuiCf  could  mistake  these  cases,  with  ati  abBcnec  of  fevcr» 
with  a  soR,  coinprewfiilile  pulw,  <x>oI  «kiu  and  ntt«r  proatratiou,  for 
aunatroke.  Tlie  Iroatmeiit  consists  in  l-est,  with  the  head  lowered, 
and  the  admitiistrntioii  of  small  and  frequently  repeated  dosee  of 
hot  beef-tea,  well  salted.  Cofliee,  coca,  tea,  or  ammonia  may  be 
given  in  the  iv\ine  mamicr.  If  the  dcprceeion  be  extreme,  digi- 
talis is  better  than  alcohol,  though  the  latter  may  be  more  readily 
obtaiiiwl  In  avoi<iiug  all  forma  of  sunstroke,  it  is  our  conviction, 
that  the  mon  who  i^  exceedingly  moderate  iu  the  u«j  of  Hqaidi 
will  he  for  lUifer,  ait  well  sn  infinitely  more  corafjrtjibte,  than  the 
one  who  i*  constantly  at  the  ice-water  cooler.  l'er*onii  who  have 
Brigbt'8  dieeaso  ahould  beware  of  exixwnrc  to  the  direct  rays  of 
the  tropical  enn  of  our  suntmefB. 


SYNCOPE. 

Brucb  oaya  that  two  indications  are  eiiually  urgent;  removal 
of  the  cause  of  faintnc»»  and  rcBtoration  of  tlic  heart's  action. 
The  patient  should  he  laitl  llat  <m  tlie  back,  the  free  access  of  air 
gbould  be  insured^  and  the  dress  looeencd  at  the  neck,  chest  and 
waiHt.  Ilemorrliage  must  l>e  utopjieil,  if  it  Im*  pretent.  Cardiac 
Btimulnnts  should  then  bo  employed.  Alcohol  is  the  most  genar- 
ally  available  and  tlie  most  [wwerful,  and  may  ho  given  in  any 
form  which  is  hiom  quickly  to  be  had,  and  in  quantitios  to  «uit 
the  case.  Anunonlar  ether,  and  cologne  are  equally  ureful.  If 
the  patient  be  unable  to  swallow,  these  drugs  as  well  as  warm 


48Q 


MANUAL  OP  TREATMENT. 


Hquidn  sftouW  be  givoii  by  cticiiia,  or  etiicr  may  be  iiyectwl  hypo* 
dennifally  over  tlie  heart.  Snielliug  m\tn,  ptrfumcit.  fumiiug-.  culd 
dotiulius,  liriil  8{iiritiiouK  loliori^  U>  Uiu  teinploe  iiik)  hstidRareotfaar 
ineatis  of  exititing  tho  hetirt  reflexly.  If  theac  UL-tJiod^  fail,  frii> 
UonK  to  ihc  limb^  Ht>i{  trunk  iihould  be  usctl^  with  giilvatiLcatioB 
of  the  heart,  ami  wvwii  IranHt'usion  of  bl™xl. 

In  4.-Asc»  cmliiig  favomhly,  the  {xiticiit  must  not  bu  too  <ttiick 
to  re»uiii«  the  standing  petition  too  hastily,  until  rest  and  uoa^ 
tthmciit  hftvc  been  obtnincd. 

Roberts  sstatea  tliat  faiutiug  may  generally  be  avoidud  by 
bending  forward  and  hanging  the  head  down  lietween  tho  knees. 
Besides  the  means  recommended  in  the  preceding  extract,  he  «ig- 
gestA  tliHt  the  blood  may  be  confined  to  the  central  organs 
oompreBsine:  the  artene«  of  the  limbs.  This  apricars  to  ua  a  ver 
unsafe  nu-tliod,  as  the  dtmgcr  of  cougiilatiun  ot  the  hlutnl  in  iiro-' 
ducetl,  if  the  coinpretsiiiou  be  really  efficient,  ^luuh  better  is  it  to 
lower  the  head  and  niii^e  the  lcg«  and  arma  as  high  a^s  [NM<.ili1i*,^ 
while  etininlants  ai-e  jjivon  by  the  mouth,  by  the  reetum  or  hi-j«v^ 
dennicully,  and  warmth  U  applied  externally. 

Artificial  rct^piratioii  niny  lie  necessary  occai»ioiuilly.  Tb«X 
inhalation  of  nitrite  of  amyl  \s  a  mo^t  ]<ovs-erfuI  remedy  when  it^ 
can  be  procured  in  time.  Care  should  be  taken  not  to  allov 
ammoniii  to  Ite  inbak-d  in  too  concentrated  a  form,  as  «-riou*  IrritA-i 
tion  of  the  bronchial  lubots  may  ensue. 


SYPHILIS. 

ItArMLER  quotes  a  number  of  authorities  who  favor  csoi-Km 
or  cauti'rUation  of  the  primary  sart^,  and  oiherw  who  cmiyider  it 
useless.  Still,  be  coii^idciv  that  positive  evideuco  outweighs  liiU- 
ure»;  and  where  the  elianere  is  tiitualed  u|ion  a  oonveniont  ^[KPt. 
it  ehoald  be  excised,  if  a  papnlc;  or  cnntcrisi'd  with  fuming, 
nltiio  acid  if  sn  ulcer. 

If  tho  prinmry  IcHion  l>e  too  far  lulvanced  when  first 
the  ]>arte  nflwted  should  bo  sinijily  kept  elvau  and  drt***-!!  with! 
moist  lint,  which  must  he  fn^pivntly  changwl.     If  there  lie  muchj 
Kuppuration,  a  solution  of  lead  or  copper  should  be  need.    F« 


STpnais. 


ulcerating  indurations,  uicrc-unal  lotioiiii  are  advieabU*: 
ouch  as  "bliick-wa.'^h,"  mmle  by  a<hling  three  to  eight  graios  of 
calomel  to  an  ounce  of  liniO'Watci'. 

Plin'^leiia  is  beat  treated  by  permanent  baths,  witb  irrigii- 
tioiis  of  pcimanganate  of  potaasa  st>lutione.  Opium  U  only  of 
eervioe  in  set-uring  rest.  Iodoform  is  miirh  used,  dusted  upon 
tho  sores.  Coniplirntions  aix-  In  be  treated  uixin  aurgit-al  priiw 
ciplcfl. 

Wliile  admitting'  that  certniii  forms  of  pyphilitic  disea^i' 
wmctinies  undergo  RpontnneoiiH  cure,  he  fwyfi  t hot  the  rrsidta  do 
Dot  coiTi[iare  with  tiio«c  obtained  from  the  proper  use  of  mercary. 
1^18  remedy  has  a  Uu-al  action  a»  well  as  a  onnstitntional  efli«t. 
and  a  number  of  obscrvei*  have  noted  the  mi>id  etlecta  of  its 
local  application  to  sypbiliden,  ami  amdylomata,  vrbilo  other 
leeions  not  directly  treated  remained  unaffected,  flven  IIutchik- 
eoN  (who  formerly  denied  it)  now  admit**  that  if  mercury  be 
iriveu  at  the  start,  tlie  di&cni<e  may  be  cored  iu  the  primary  stage. 
Salivation  interferes  with  the  action  of  mcRrury.  and  is  to  bo 
eedulously  avoided. 

The  claims  of  guaiae,  earsajMirilUi  and  emiitar  drugs,  he  con- 
sider lo  be  Ikiihx]  oil  the  fact  tliat  the  ntiniulant  eflccto  th*^y  exert 
on  the  secretory  organ",  with  tlic  aceomi'aiiyirg  low  diet,  caTises 
tho  (tymptomx  of  xyjvhiliH  to  dit<a]>iH-ar  for  the  time,  in  (be  i*anio 
way  an  an  attack  of  cholera  produce*  the  same  result.  But  no 
permanent  lulvaiiluge  i«  derivetl  from  thi«  method  of  treatment. 
The  iodides  exert  their  force  mainly  ou  tertiary  lesions,  gum- 
niata,  tubeivular  i-ypliiliden,  NT]>iginnnH  ulccin,  diBcawK  of  the 
boneo  and  |>eriaflteum,  and  ditwrders  of  the  nervous  system ;  while 
eecondary  eyphiUdes  arc  not  aflcctinj  by  thcni  at  all.  Zeissi. 
elainut  that  iodine,  in  doses  of  two  minims  of  the  compound 
^cture,  twice  daily,  cauj^-s  a  more  rapid  di^uppcaninceof  miicoua 
aflfoctioiiH  than  nieix-urj'  doer*.  Moreover,  at>er  the  use  of  iodine, 
frZDore  pronounced  effect  Ih  obtiiincd  frtmi  a  itnlwHfjucnt  course  of 
mercury.  Bausilbr  urgo^  that  mercury  be  vomnienceU  aa  foon  ob 
th«  diagnosis  of  syphilis  is  made. 

If  tho  sypbilift  he  de-itroyed  iu  tho  prinmij'  lesion,  a  treat- 
ment of  four  month*  may  miflice;  but  if  wH-iHukry  symptonw 
appear  it  Hliould  be  pnilongcd  to  six  or  eight  months.    If  due 

2K 


482 


xal  op  trratmbkt. 


litre  be  sltnwn,  tho  course  nood  not  be  iutcrniptcd.  Kotbing  bat 
i.he  ellghtest  j^rade  of  mereurial  etmiial  itis  sliuiiUl  Ik;  alloxvc'd  to 
urLie.  Tin:  (reatnient  mnst  lie  conririued  i'nr  manlb»  afler  all 
niaoifeetations  of  the  disease  have  i]i!ttiii[iear(!d. 

FoDBXTRH  gives  mercury  for  llircc  tnontbs  and  thcii  RORpmda 
t  for  one  iDoiitli ;  rv^mavs  tJiu  dru^  for  two  motitbs,  tliuii  Ktops-it 
f(ir  thrvG  months ;  w)  that  diinnjr  iwo  yenrs  tho  jiaHcnt  ha*  tokcti 
the  morcnry  for  loa  monlha.  Bacmler  adJs  Ibal  soroetiinai  in 
nlhilinate  cii&es,  twpivially  6Ui;b  n«  arc  iint  brought  iinilor  Uvatmcnt 
until  a  lato  jjeriad^  if  the  jntiont  lake  a  two-wevka  |iluiuiura  trip 
without  any  treatniont,  in«rrurjr  displa  v«  an  increased  power  wfaco 
resumed. 

In  the  eruptive  Bti^,  patients  should  be  conAiicd  to  their 
bed  for  a  few  weeks.  Quiet  should  be  maintained  duriuff  ihe 
reuiainder  of  the  treatment,  but  patients  should  be  allowed  to  go 
about  in  good  wwithcr.  They  should  go  to  bc<i  early,  wear  ilajiiiel, 
and,  in  general,  olwerve  the  rule,-*  of  |>cru')n»l  hygiene  varpfull?. 
Beor  anil  wine  may  be  taken  niniierntely,  but  s]>irit«  avoidcl.  Milk 
nppearH  tn  have  a  tavorabie  influence  on  thi>  voiii^ie  of  tbc  diwua 
Acid  fruits  which  would  vaiiee  gastric  catarrh  are  to  be  avoided. 
The  mniilli  should  be  rin[ie<l  with  t<>pid  wal«r  morning  luid  even- 
iiig,aftcr  meals  and  twice  at  night.  Tho  (coth  should  be  airefully 
brUKhcd  twiec>  daily.  Myrrh  may  lie  um>«]  with  advantage  in  the 
wat^r  for  cleaning  the  tcoth.  Chlorate  of  potaBsa  nmy  bo  ined 
UK  a  month  wniih  and  Tnlcen  intcniiiliy. 

T))c  patient  nitmt  give  up  iinioking»  to  avoid  tvlivatioo; 
especially  if  the  mouth  he  afl'ectal  with  Hypbiii^  Warm  baths 
liave  a  tavorabie  influence. 

He  prefers  the  ii>«  of  mercury  by  inunction.  Fifteen  to 
thirty  grain.^  of  nmrcuriul  ointment  are  rubbed  into  the  nkln,  the 
tiret  day  on  the  legs,  the  second  on  the  thishn.  the  third  on  the 
abdomen  and  uhuat,  the  fourth  on  the  back,  and  the  fifth  ud  the 
arms;  then  begin  ni  the  legs  and  repeat  the  wirae  round*  Thd 
nibbing  ahmild  continue  for  ttn  minulea.  Tlie  hand  should  bo 
smeared  with  soap  before  rubbing,  though  tboni  is  little  riitk  of 
mercurialixing  the  person  who  does  tlic  nibhtog.  A  warm  bath 
should   precede  each  inunction.      This  mar   bo  continued  for 


BYPIItLIS. 


4ft8 


moiitlis.  If  Btotnstitis  occur,  the  incmctiotiK  ithoiiltl  Iw  dimmn* 
tiniunl,  the  uhloi-nte  of  potaiua  Utted  locally  atid  intentally,  and 
tlie  glims  bruehed  with  a  etronger  astringent  solution,  or  toticlied 
with  nitrate  of  tdU-er;  the  teu'lh  buiii^  avouWd  and  the  moath 
washed  afterwartls  with  salt  water. 

The  inunction  method  is  preferred  wherever  tbp  state  of  the 
intestinal  canal  forbidd  the  internal  ase  of  mercury,  and  whoD 
the  efleet  is  deair«d  as  quickly  lu  poivible;  ae  when  thu  bratii,  the 
oyc,  op  the  larynx,  is  threatened.  It  13  contra-indicatofl  when 
there  ia  a  tendency  i^  eczema  or  acne,  in  hairy  per»f>nB,  or  thom 
who  have  mueh  eruption,  or  pustuleit.  I,kk  praised  the  dm  of 
calomel  by  fumigatioiL  Kight  gt-uiiis  are  UMed  at  one  time,  the 
patient  1>eing  8tripf*ed  to  the  skin,  and  eurroundeil  with  a  tent  of 
llaniie].  Ilie  calumel  id  de|HHit«d  on  tlie  ekin  and  itt  not  to  be 
rubbed  off. 

Baths  of  corrosive  sublimate  are  of  use  for  Finall  children, 
with  pumtuliM,  Ci4iK.'ciully.  Haifa  dnwhm  may  be  dissolved  in  the 
hath,  which  should  be  continued  half  an  hour.  Zbissl  adds  two- 
fifUiH  tliiii  rjuantity  of  tuil  ammoniac 

Iiitornatly  the  b&<«t  i«modie«  are  mtircuri&l  pill  and  mercury 
with  rliallc.  Five  gntiriH  may  be  given  thtlly,  alone  or  with 
opium.  Lkbert  gives  mercurial  ointment  in  suppository.  liKwiM 
uses  mercury  hypodermicjilly ;  but  the  stivero  KulTering  more 
than  counter-balances  the  advantages  of  this  method. 

BiBTT  and  0A7.K.KAVB  ofc  the  following: — 

R     Ilydrugyri  |>rt<dodld., P- tUI 

J^arliJMrii,    gr.  xztT 

M.    ct  in  pil.  no.  xx  rfiv. 

&— Od>  fatt,  twir*  or  thrin  dailjr. 

SEDitLOT's  pillfl,  used  in  France  u  tlie  standard  prei>aratioti 
of  mercury  for  i^yphilifl.aro  oompoeod  of  mercurial  ointment,  soap 
and  marBbmallow  powder. 

Van  Swibtes's  liquor  ia  made  by  dissolving  ono  grain  and 
a-))alf  of  «»rro«ive  ftublimato  in  three  tliiid  ouncoa  of  com 
whiskey.    The  dose  for  internal  use  is  one  drnuhm. 


Tlie  icxiulea  of  meivury  arc  Rpecially  useful  in  rvlajK^ei  of  the 
cutaneous  initiiilWtiitifmA,  csixiinallir  of  the  W|uiiiiiaus  variety,  and 
palmar  papules;  nbo  in  tubenTutnr  eru|)ti<iii.t  atid  in  tertiary 
manifestaticiiLs,  n-ilh  the  imlidb  of  iintaKsiiiui.  Mvix-ury  ts  ornLn* 
iudicateil  in  but  few  i-n.<<e3  of  syptiili?..  Clironir  lung  diseoees  <lo 
not  abMolutviy  tbrbiit  (liiti  treatment.  OtM!itof  chroiitculburiiiiiuria, 
unlcHA  flue  to  syphilis,  are  uiiduitod  to  merL-iirial  treatment,  u 
ealivation  i«  very  qiiii;kly  imluucil.  Pn^fereiM-e  t^btiulil  Ur  jfiveo 
to  iodine  and  the  vegetable  a{teL-i6ce. 

Auuniia  i«  very  i)fteii  duo  to  the  syiihiltH,  and  inipro%'c*  vory 
rapidly  under  the  intlueuee  of  mcix'ury,  while  iron  haa  no  eSect. 
Thin  is  not  the  ohm  when  nypliilia  attacks  a  clilorotic  person.  In 
•uch  aises  imn  ahould  be  ailtuiniatcrwl  until  Ui:*tinct  evidence  o( 
flyphiUfl  ap]u'ar;  and  in  Home  ca^ea,  quinine  and  cod-liver  oil 
should  Ih;  ii»cd  together  with  nicn-iiry.  Prcguant-y  docit  not 
oontra-indk-ate  niertury;  least  of  all  in  the  early  months, for  then 
thid  drug  may  jtivvent  abi>rlion,  or  even  eontnminutioti  of  the 
fotufl  or  of  the  mother.  Vos  Siomckp  reooioincnd*  it  only  up  to 
the  (Kveiith  montli. 

The  iodides  are  be^t  >^iiited  to  cases  showing  atfectiotuof  the 
bonca,  rhcunifttio  symptom^,  pnat'dar  eruptions,  and  wrpiginom 
ulcer?,  or  dry  tubercular  pyphilidec.  Kven  if  such  flymptunui 
Occur  early,  or  in  uloeratlvc  atoniatitii*  with  nipid  breaking  down 
of  tissue,  this  remedy  has  a  very  sinking  inllnciiee.  tK-genvntiivo 
gumniatu  and  d(.«truetivo  ulccratini)  of  ihe  llimst  and  larynx 
•Iflo  call  for  \U  admiiH^tration. 


Paokt  and  IIutchisbos  recommend  that  tliia  rumcdy  should 
always  be  given  with  arnmnnia.  Patlwits  u.^nidly  imifaso  in 
weight  while  taking  the  iodide.  A  good  and  rich  diet  shoulil 
given  to  cachectic  patieuta. 


STPIIILU. 


485 


Throe  to  five  grnins  of  iodide  of  potoasiuin  may  be  given  to 
patients  who  have  not  previously  takoii  it;  to  othera,  or  where  it 
ia  desired  to  ehock  an  ulecrntive  proceos  as  quickly  as  posiible, 
the  doee  may  be  Increased  to  tiftecii  graiDs.  It  ^bould  always  be 
given  well-diluted,  after  meaU.  It  may  be  given  in  very  large 
dosee  for  a  very  Icng  time  without  (fusing  any  ill  efl'ccta  The 
effeeta  are, however,  not  laating;  andn  speeily  at*urrenco  will  take 
place  if  the  remedy  be  diwoiitiiiuod  too  aoon. 

In  ooovulrtivf  cL'ix'bml  aflVflion*  the  bromide  of  ])otaa8ium 
wae  joined  to  the  iodide  by  1!iti:iilt?jijs  .Jackson. 

The  iodide  4>f  rhodium  or  of  uiitmonium  ntay  bo  Kiibittituted 
for  the  [lot-wih  »ilt,  if  the  latterdiflagrct-. 

If  aiiotiilu  cull  for  fL-rruginoud  pi-c|)anLtioiiH,  BAtiMLRa  prcfeni 
a  inixtDre  of  the  irxtide  nf  pota»^iuni  with  the  ammonio-citrate  of 
iron,  rather  than  the  iodide  of  iron. 

When  torliary  Qa.f^»  resist  the  action  of  the  iodides,  a  cnw 
may  be  ohlai]iud  by  the  nse  of  mercury  or  of  the  vugelnble 
deeoetiona 

During  the  secondar}'  stage,  tfaeae  decoctiotw  may  be  luted  as 
adjuvantd  to  tho  mercurial  treatment,  and  in  the  tertiary  stage,  if 
the  disejuie  be  wlvjineitig  nipiilly,  their  u«c  with  tht  i<idide5  ii 
often  attendfil  with  hajipy  reaults.  In  the  morning  the  patient 
aliould  tAkv  fnmt  eight  to  Nixbeitn  finid  nuncea  of  Xittmann'* 
Btrong  decoction,*  and  in  the  evening  a  quart  of  the  weaker 
prepanition.  The  jiuticrit  should  {jtuis  the  grmter  part  nf  the  day 
in  l^.     The  diet  must  be  nutritioufl. 

Condylomata  may  be  treated  by  the  appHentinn  of  oulonicl, 
one  part  to  uigiit  of  lard,  or  ducted  over  the  mirfaeo  of  tlie  warts, 
which  afaould  lintt  be  nioiiilt'rieil  with  niU  wator.    ClcanlineM  and 


'Krvk*^  flmlinf;  thi'ririKin'vl  rormiilnfDrZilimFinii'ailn.-octiontnaclains*'  r<ir{imc- 
itcal  ii»c,  prepared  th«  fultoninK  niotliticution,  wbiiLli  kc  fmOa  lo  UHircr  cvcrj  purpoae 
of  tli«  orlgioal : 

B     HvdnrEjri  cli lurid,  corra., Sr>  j 

Aliiiaiius, 3  m 

BzLnrBsfl., fj  )J 

Gljrcrini f  3  j 

l>yr.  iccuuc^- , ■•.....>,..(...f^  jM 

§>.  aniai,. r5j 
Kl.  gltejrrhiiie, J  J 

Aq,  fcmiciili.  q.  «.  md -•-... fJ  Tifj 

U.  8.    f3  n  Bl  oacl)  dr-M. 


486 


KANOAti  OP  TBBATMBKT. 


the  UBu  of  cliarpie  nKJit^teiied  with  CHrbolle  attid  eulutiou  or  fat&pk- 
wosh,  promotes  the  absorption  of  moist  papuW  Tf  they  caoM 
much  paiti,  u  solution  of  nitrate  of  silver,  one  gram  to 
ounce  of  distilletl  water,  is  of  use. 

Severe  ulcerations  of  the  mouth  may  be  repeatedly  touchl 
with  the  mitigated  nitruto  of  silver,  with  an  alcoholic  solution  of 
carbolic  acid,  or  with  tincture  of  iodine. 

AfTections  of  the  nAMil  pfuutnges  require  thorough  clconring 
with  soluticmc  of  carlwlic  acid  or  permanji^natc  of  potaasa.  It  is 
not  ftlwaya  easy  to  tell  whether  imtisyphilitif  trcaitmcnt  ie  nevdad 
in  thc»i«  casee.  In  early  eyphilis  mercury  will  imually  be  of  ase; 
but  if  the  bonen  be  iifiiK-ted,  the  iodides  are  prvferable.  Calomel 
mny  also  be  used  ns  n  snuff.  If  syphilidcs  he  entirely  isolated, 
they  may  be  retiioved  by  locul  treatment  alone.  Mercurial  plaster, 
or  inuTictioiiJ^  of  aiiimonia,te<l  morcurj*  or  of  oleato  of  mon'ury,  or 
hypridi^nnicfl  of  (stiouiel  into  the  centre  of  tlie  utlWrted  fmtch 
Bomctimes  suffice. 

Serpiginous  ulcers  are  ofttii  treutwl  with  difficulty.  If  the 
cniBts  be  thin  and  siipcrlioial,  with  little  swjcretion,  they  should 
not  be  disturbed.  If  they  be  ex|iO!«'d  to  friction,  they  may  be 
protected  with  plaster.  Small,  round  uli«r8,  are  host  treated  with 
black-wanh  or  wiih  ointmeritit  of  red  or  white  prec-i]>itjtte.  Zatsst 
recornmeiide  iodoform  for  torpid  ulcere,  and  Lancekkaux  found 
the  Minu!  remedy  uwl'ul  in  Kerjiigiiious  utccnitiona. 

Painful  periostitis  may  he  relieved  by  'be  loe«l  n«o  of  iodine, 
or  of  oleiilo  of  mercury  and  morpliiiio.  This  is  uUoiitiC'ful  when 
rubbed  over  swollen  joints  Kicoan  odviKeA  %i»g  bttstcre  over 
painful  nodc».  Sy[ihiliti(;  te«t.idee  ehoulil  be  onvehiiie4l  in  mer- 
curial pla-iter  or  olcate  of  merenry.  In  all  rases  of  iritis  u  «oltl- 
tion  of  atropine  should  he  dropfied  into  the  eye,  and  nien-urial 
treatment  instituted.  tf  the  inHummution  Iw  severo,  leoclm 
should  he  applied  to  the  temples,  and  the  mon^ury  pushed  to 
slight  iinlivallon.  OioroiditiK  and  retinitin  alM>  indicate  prompt 
and  vigorous  mercurial  treatment. 

Mercury  is  the  leading  agctit  in  the  treatment  of  hercdituy 
Byphilia.  Be^idcA  the  ordinary  methods  of  exhibiting  the  remedy, 
a  flanr.el  compress  smeared  with  mercurial  ointment  may  be 
applied  to  the  child's  breast  or  back. 


STPHILIS. 


487 


No  benefit  in  to  b©  obtained  from  oiirainiatoriii^  the  mercury 
to  the  mother  or  to  the  aninm]  which  tiimishes  milk  for  tha  obild ; 
as  the  uinount  of  the  uiotol  which  passes  iiito  the  tnilk  i^  too 
slight 

Iti  most  vasch;  the  proper  trcutracnt  will  lie  aultii  by  removing  the 
patient  fntin  hiR  uhub]  mode  of  MUt.  Fur  ilehilitattxl  [uitients,  a 
wiuter  in  the  South,  or  a  suinincr  in  the  country,  will  be  found 
extraiucly  boiiefiuinl. 

Some  phyKieianfi  believe  that  the  int'Criml  aii<l  uxtenuil  u^-  of 
sulphur  waters  {irevent^  too  iietive  e&eutd  of  a  mennirinl  course. 
The  rosultx  obtained  nt  Aix-la-Chapc-llo  render  it  likely  that  thUiaof 
advantage,  hut  the  fineation  i^  not  settled.  The  idea  that  the  aae  of 
fiulphur  constitutes  n  test  of  the  completoneM  of  the  cure,  by 
caosiiig  an  outbreak  of  Fjphilis  if  it  be  atill  pre^wt,  has  been 
practi^-ally  abandoned, 

S3rphilization  i^  now  but  a  themi>eutic  c-urio»ity. 

IUlxkr  has  very  recently  proposed  the  subeutnneoua  injection 
of  C&lomel  mixed  with  vaaeline,  in  the  proportion  of  one  |)art  to 
twenty.  From  three-oightlia  to  thi-oe-fourth-iof  a  jjniin  of  calomel 
were  injected  »t  oiu-h  opunitiim ;  which  watt  prw.ttioi><t  mire  a  week. 
These  ii\)eclious  wore  almost  painlo;)'.  and  were  not  followed  by 
irritation  or  by  ab.-4ce>M.  ('iimm  which  had  resisted  the  iiUunial 
and  external  ui^e  of  mercury  were  promptly  cured  hy  these  injec- 
tion!!. 

Davis  recomniendu  the  following  combination  very  highly 
for  all  furioH  of  cun.4titutional  syphilis: — 


H. 


A     HvdKricyTi  dtluritl.  rarro*., '  sr-  j" 

?<)diiI««iMl Sir 

Ell.  mnii  9.^ , f  J  [t 

Clis.  »iui|i.i. f}  ini 

8> — A  loupooafut  IB  w«t«r  four  timet  «  inj. 


I  Tho  late  Mahiom  Stus  recommended  the  use  of  HcDade's 

I  Elixir,  a  compound  of  stillingia  and  other  plants.  The  efiectaol' 
thin  j»ri?]iarHtion  do  not  differ  fnmi  those  of  ZittTnann's  decoction, 
and  are  due  to  the  stimulation  of  the  Bccretioiw  which  ia  caused 
by  its  UKC. 


488 


KAHUAL   OK  TKRATMK.NT. 


Orobs  prefcrTCd  the  iibc  of  oorroBive  sublimate,  with 
iodide  of  potassium  and  t^ymp  of  ^aisaimrillu;  aiul  his  I'onuula 
U  [mthnbly  matx}  goiioriilly  usal  in  AniurivA  than  any  other.** 

Keves,  id^er  reviewing  the  later  writings  on  sj-pbili^^  cnmet 
to  OxB  cnnclugiou  that  the  testimony  farora  i  rfducUon  tn  the 
amount  of  mercury  used. 

Tin;  Hot  Spring!*  of  Arkanias  liave  become  very  popular  of 
late;  hiU  Kkve^  tlnnkn  the  itpiN^lfic  virtues  reside  in  the  mercurial 
innuutions  pnu;tis4?d  there,  as  the  waten*  areptwr  in  mineral  ingre- 
dients. He  favoni  tliu  a/te  of  mercury  In  moderate  dooes,  a&d 
extcndd  the  treatment  into  the  foiirtli  year.  He  gives  the  protio- 
dide  an  prcpiired  by  Gamier  and  Ijiunonrcux,  in  granules  contain- 
ing oiio-aixlh  of  a  grain  each.  Of  these  he  give«  one  after  caeh 
snoal,  adding  one  every  fuur  da^'s  until  the  poisonous  eflectaof 
the  drug  are  iiianifested.  This  "full  d<»e"  i«  only  to  be  mwd  ia 
cases  of  necessity.  It  mu^'  l>e  taken  fur  some  time  withoal 
injury,  with  the  aid  of  n  little  opium,  drinking  uiilk  and  eating 
rioo.  One-half  of  the  full  dose  U  a  "  tonic  doee,"  and  thin  may  be 
ooQtiaucd  for  yean;  apparently  to  the  patient'^  advantage,  oa  bii 
blood  becomes  richer  in  rwl  corpustilcs.  Of  late  years  he  has  pre- 
ferred to  give  but  one-thinl  of  the  full  dose. 

If  the  symptom!*  he  prossiug,  the  patient  ia  to  be  rapidly 
brought  under  the  influence  of  mercury. 

Tt  is  not  deemed  advisable  to  quote  furtlier  opinitma  on  this 
subject,  ad  thei-e  is  practltally  but  little  ditference.  Each  autltor 
|irat*ers  the  preparation  of  moreury  with  which  he  is  most  fatniliar. 
Those  who  have  ^cn  an  unusual  number  of  «)«e«  in  whieh  this 
firug  has  been  abused  favor  the  substitution  of  the  ioilidcs,  or  of 
the  vegetable  deeoctttmii.  Tlie  latter  are  of  uao  in  chance  cases, 
but  are  not  to  bo  depended  upon. 

Some  prefer  to  give  mercury  by  Fouhnier's  method,  coup  stir 
eovp,  and  others  give  it  persistently  ftxim  the  beginning  of  the 
treutnieut  t^i  the  end.  The  rpM^MtiDu  il4  to  which  of  these  methods 
ia  preferable  will  he  decided  by  tlie  view  Uiken  nf  llie  nat 
of  the  action  whieh  mei'cury  exerts  upon  syphilis. 

*  Although   thb  formolft  U  reiy  frMuenll;  preavibeJ,  the  mercurul  b  inCMB- 
|i«tiblc  irUh  compaiind  ii^rupof  latMpulllK. 


I 


SYPUILIg. 


489 


The  oiilj'  ratioiml  cxiiliiimtioii  wc  huvc  over  met  is  the 
ftillovring:  The  siieoitir  viniit  (if  i^yphilw  resides  in  tlic  tissues 
formeil  undpr  tin*  influuiicc  of  tliU  dW'aHu;  t>ut')i  oa  tlic  ciilurgo- 
nients  of  the  lymphatic  glands,  mndvloinata  and  pmuniata. 
Now,  if.  is  wi'II  kmiwri  thitt  llitwi;  HViiIiilitii.'  tisdues  lmv«  u  lower 
gnule  of  vitality  tlmti  the  naniial  tii^iie:ri.  Syphilitic  neopUianu 
very  olteii  hreak  down  »]iOntaiioouely. 

Mercury  ha«teii8  the  breaking  dnwn,ab'<oriition  and  excretion 
of  tiieiw  !iy|>hi1ici<-  tis^iieH.  The  xame  dnig  |io<uest«it  a  like 
powur  over  the  iinminl  (itteues  of  the  body,  hut  on  account  of  the 
greater  rcHititiiTieb  of  tlie  iionnul  tissues  a  lurjfor  doac  of  mercurj 
i^  roquiretl  to  destroy  them  than  to  t«iniiliir)y  afl'cct  the  eyphilitio 
ti«wm>s.  lli'iu-p,  Mf  aim  is  to  girt  tm  Uirye  u  ttost-  of  Oic  mercurial  a$ 
possiblr,  icbick  iriU  yrt  be  too  small  to  ajfo-t  the.  hraUhff  lisjuwes.  This 
trmy  be  done  by  keeping  just  within  the  point  of  salivatiim.  For 
inslance,  we  give  tlic  incix  iiriiil  in  grathially  increasing  diws  until 
alight  signs  nf  aalivntion  apiiear.  The  dose  is  then  lest^neii  a  little, 
but  continned  steadily  (or  the  rcqnisiU'  period. 

Vfe  prufer  the  blu«  pill,  bcliovin^  it  to  be  the  moat 
maDiigmblo  and  len»t  irritsiing  of  nil  the  mercturinK  %Vc  give  it 
in  daies  varying  iVoni  ten  to  tliirty  gniinsevt?ry  day,  divideil  into 
many  do[K«:  conihining  with  it  the  extract  of  cinchona,  Tallet't 
maiw,  or  a  cnialt  amoimt  *i(  tijiiuni  If  thure  be  a  Ivndenuy  for 
the  medicine  to  run  ofi*  by  the  bowels.  It  w  not  enough  to 
continue  thi^  trvatnient  niitil  all  visible  ^igiu  of  the  discAAe  have 
dteapi>cnre^.  Tliero  will  tx?  still  remaining  enough  of  the  diseaM 
to  Kproduce  the  ny mptoniH ;  and  the  mercurial  muxt  be  continued 
natil  there  is  not  a  t-nlitary  cell  in  the  body  which  can  be  possibly 
contamiiiittcd  with  .syphili.-*. 

Abundant  experience  has  convinced  us  that  a  well-nrrHugod 
and  proi)erly  sui»erviitud  coitrwe  of  this  kind  is  devoid  of  danger 
to  the  health.  I'aticnis  nsiially  impmvc  in  every  way  while 
taking  the  medicine.  The  ap|)etite  becomes  enormous,  the  skin 
becomes  clear  and  hc-althy,  amt  all  the  bodily  and  uioutal  facultica 
apficiir  to  he  in  a  stiitc  of  the  hcnlthicgt  activity. 

The  vaJtui  of  the  indides  is  most  dearly  shown  in  cajtes  of 
threatened  cerehmt  syphilis.  It  must  not  be  forgotten  that  when 
damage  is  once  done  to  the  ner\'0i]s  tiwue,  it  caimut  be  repaired 


490 


MANUAI,  OF  TRKATMBST. 


by  aiiy  niedieiiMs.  Tlic  dcslruction  of  cerebral  tisane  tniiat  be 
prevetitiHl,  and  for  tlii»  pnrjifwc  enormous  tlnses  nf  the  iodiilcs  are 
iDtiiciileil.  From  one  to  four  timchnM  of  t]ie  iodide  of  potaseium 
muv  lie  givuii  ihii'itij^  twunty-four  hoiirH^  and  mercury  ut\\il  at 
the  Bame  time  by  inunction,  by  fumigation,  aiid  liypodennically; 
the  latter  lu:  near  llie  uoat  oi^  tlic  local  Itstionit  as  piMsiblu. 

The  loeal  use  of  mcri'urial  prejiaration*  for  the  cure  of 
coiidyltimata  and  the  Kyjdiilideo  itlinuld  alwayit  aix^onijwny  the 
general  treatment. 

rpfilihylaxis.  BaDmlkr  urges  that  jiroi^tltiites  should  be  od- 
der  governnieiit  Hti]icrviHion,  and  slionld  be  eom|K>IU>d  to  enter  ft 
hospital  whenever  they  become  nyphJIitio,  and  to  stay  there  until 
cured.  Tliit;  wouhl  render  lliein  powerle^ut  for  evil  until  the  danger 
hnjs  piiK^'d  nwny.  Wen  who  work  in  glasa-blnwing  establish monta 
have  demanded  an  examination  of  their  own  ae<!ord,  a^  tlie  danger 
of  contatniiiatinn  m  givjit,  when  the  tubc»  nsol  are  passed  from 
mouth  to  raouth.  Sailoi-s  should  bo  subjected  to  the  same  prec!ai> 
tions  before  being  alloweil  to  go  on  Rhore,  as  they  very  frequently 
tnuiKmit  thiK  d  iseane.  I^urgical  appliances,  towelx.  eupet,  and  other 
Qtensili^  ii8ed  by  syphilitic  persons  should  not  be  touched  by  otlieni; 
at  least,  not  uidesw  perfectly  cleansed. 

In  the  choice  of  wct-nurscs  the  grcot*st  care  should  be  exei^ 
cieed,  as  well  as  in  the  selection  of  infants  from  whom  vaocine 
virus  i«  taken.  Tlie  question  of  nmrriage  for  ^lyphilities,  nnd  the 
dangei-s  of  matrimony  to  the  conimunily  as  well  as  to  Ihe  wife 
and  totheprrapcctivc  family,  have  been  taken  up  and  mnet  vividly 
portrayeil  by  Foursikr.  His  iidvieo  is  that  no  syphilitio  should 
marry  until  thorough  treatment  hait  recultett  in  a  cure,  whieh  has 
poivistod  at  least  three  yeare  after  the  last  manifestation  of  syphilis 
has  been  evident. 

If,  despite  the  advice  of  the  physician,  aneil.  pnsons  persist 
in  entering  into  wedlock,  the  wife  must  l>e  watched  Carefully,  and 
whenever  pregnancy  occure,  be  placed  upon  an  efficient  mercurial 
course. 


I 


TAPS   W<mM. 


iffi 


TAPE  WORM. 

TRor6i>EAtJ  recomnu^inloil  that  tbe  eflbrt  to  ox]*!  the  worm  l« 
made  at  the  period  when  jninU  am  being  ex|>«1Io<l  nitturnlly. 

Tliv  patient  alioiitd  lie  juit  u]K)ii  a  milk  diet  the  |>reviivu(i 
evening,  with  thin  eotip  and  fruit.  The  next  mondnfr  an  enema  U 
to  be  given.  Then  the  patient  U  sfiven  capeulca  ontaininjj  wven 
and  a  Iialf  grains  of  extract  of  male  fern  and  thix^-IV'urrhs  of  n 
grain  of  calomel,  rej^eated  every  ten  nnnntO'i  until  eijjhl  dtww 
hftve  been  taken.  Two  hour*  later  the  pHticnt  beptt:*  to  pui^e, 
and  at  the  w>-ond  or  thin)  hIooI  the  wurm  i^  |i9U!e;ed.  The  preouu- 
tion  should  bo  taken  to  have  the  ffltieiit  evnenal*  his  liowels  in  a 
bucket  of  water,  that  th<!  wonn  may  be  floated  up  an<l  pn»ervt?d 
from  breaking. 


I Btn 

^H»l 
^^^Tfwni  ft 


BtrRuNi#.Re3  HtatM  that  the  Abyssiniaiui  use  kouBBO  •iuipl^ 
nlliati^'e.  Thej-  take  a  d«K*e  every  month  t«  prevent  the 
from  reaching  a  hirgo  size.  When  thej  wiiih  to  rid  them- 
selves of  t!ie  wruTti  entirely,  they  lake  three  or  fmir  i>iiiit-eii  of 
mouceona  biirk,  well  [•owdared  and  mixed  with  himey,  having 
bated  the  previntis  day.  The  |xm-der  fomit  a  woft  magma  with 
honey,  wbirh  ia  ditDeulito  swallow,  eatiHUM  diitgu^t  aud  ollcn  voiii- 
iting;  this  in  the  only  annnyam*  eaused  by  the  raoucfnnH. 


* 


CoBHoiin  fiudci  no  other  remedy  equal  to  male  fern. 


Hkllbh  recommend*  that  the  inte^tinc^  be  cleanil  ont  for  two 
days  before  the  p|>c<.'itif  remwlicp  are  given.  Ordy  the  milde«i 
laxatives  and  onenmta  tihmdd  be  n>)ed  for  tbi«  pur|>o«e.  During 
these  two  rlaya  the  food  ehouhl  be  only  of  uuch  artielc)  a^  fuminh 
very  littlo  ri'sidua;  gueh  a«  mestt,  white  bread,  milk,  wdfee, 
wine,  beer  and  tea. 

On  (he  evening  pnxt-ding  the  cure,  the  juitient  (inglit  to  eat 
a  plate  of  herring-^tnlail,  eompoAcd  of  tinely-eiit  »alt  herring,  not 
previouftly  Htee|>ed  in  water,  with  plenty  of  onionii  atid  garlie. 

Ttie  next  mundng  the  ]>atient  may  take  a  eujt  of  extHae 
with  a  Hide  white  bread,  whieli  Ie(»en8  the  teudetiov  (o  vnnnt  the 
medicine.  One  hour  Inter  ho  take*  a  dnse  nf  kotisso,  tive 
drachma  for  a  taenia  eolium,  wven  and  a  half  for  a  wgiitata. 


± 


492 


MANUAL    OP   TKRATMEXT. 


Tlie  il()c<c  in  t»  he  taken  wttliiti  an  liuur.  It  may  be  encUteed  in 
gelatine  diwij.  Any  hicUnation  to  vtimit  must  be  represBed,  siul 
BTIU1II  pulletH  nf  ux  or  HUjis  of  conuu  aiil  in  ateiulying  the  etomach. 
Two  Uoura  after  the  last  of  this  dowj  has  been  swallowal,  s  mull 
dome  of  cnator  oil  may  1m.»  taken. 

When  the  w«rm  has  been  juissed,  the  patient  may  take  aom* 
niueilaginouit  Koiip,  with  a  Tew  c]ro])i<  of  laudanum. 

Fkiedrek'u  recommeinied  the  pit;rouitrate  of  potasaa,  in  dwM 
of  Hve  grains  three  times  a  da}'. 

MosLRit  giveti  benzine,  twenty  (1ro|Mi  in  vapitulc  CTcry  boar 
until  the  worm  in  expelled. 

He  aim)  nfvs  large  ctieniatu  o{  warm  water,  after  tlio  adminia- 
tration  of  an  anthelmintic.  A  laxative  having  emptied  the 
bowcU,  a  doMJ  (if  extract  of  pomegranate  hark  is  given,  prepared 
from  the  fi'esh  bnrk. 

Dick  ui^i^es  that  the  dose  of  extract  of  male  fern  should  be 
two  dnifhma.  He  gives  it  at  U  P.  M.,  and  follows  it  the  next 
morning  with  half  an  ounce  of  tarp«utin& 

BoiTRDiER  propo^  ether  as  a  t«nifuge.  lie  gives  a  taa- 
Bpootiful  iu  u  glutM  of  Htrong  decoction  of  male  fern;  followed  bj 
two  ounces  of  castor  oil. 

"Watson  prcfen-ed  the  oil  of  turpentine. 

The    m-tion   of   glycerine   in  destroying    the  embryos  of 

trichina  has  led  to  the  reconiniondation  of  the  same  sulwtanee  sf 
a  ri'iiicdy  for  all  varieties  of  inttetlinal  parasites.  We  have  not 
yet  8ceii  any  reliable  account  of  ita  use  in  taenia.  Fririikeich 
administered  glycerine  in  dnM«  of  a  tuhlospoonful  every  hour  for 
trichina,  and  found  tlmt  dose  well  home. 

We  have  curt^l  tape-worm  by  the  u«o  of  oil  of  itirpetitine, 
of  oleoresin  of  male  fern,  of  pumpkin-sccd,  and  of  kuiuaia 
PclletWrine  is  too  entitly  and  the  (ms\i  |H)mcgranate  bark  too 
difficult  to  obtain,  for  ordinary  use. 

A  moat  nerions  (jne-ttion  ift,  in  what  do»c  Bltonld  those  drugs 
be  given  to  little  children.    Undoubtedly  it  require*  oa  umch  to 


TBTASB8. 


498 


kill  a  taenia  in  a  babe'e  intestines  a»  it)  an  adult'ii.  But  altlioiigb 
Stask  pponks  of  two  dra(-hin  do»e»  of  nlcorosin  of  male  fern  for 
children,  we  would  not  give  such  a  quuntit}*  to  a  four  ycur  oM 
child.  Half  tbnt  amount  protluccd  ainrming  syTDjitonis  in  one  of 
our  ciiKex,  the  i-Iiikl  fuiniinjt^,  and  being  itwtored  with  ditlic-ulty. 
In  tbo3o  tflsen  we  now  jjive  only  the  piunpkin-seed.  Two  to 
four  ounces  of  the  dry  M"ed«  may  bo  stripivd  (if  tlic  husks,  and 
tho  kemela,  with  th«  greenish  membrane  lining  the  inner  aurface 
of  the  hiwk  (In  wliieh  the  taenlafuge  pmjxTty  reside*),  given  to 
the  child  to  ent.  In  one  ca»e  when  tho  fcm  failed  to  bring  the 
head  of  the  worm,  tho  seeds  were  given  afl  above,  and  smaller 
amounts  given  daily  for  a  number  of  days.  The  result  was 
natis  factory. 


TETANUS. 

Bai:er  oppowfl  amputation  in  traumatic  tetauuB.  Diviaion 
of  tho  aH'c-cted  nerve  otfora  a  le^  objectionable  resource,  and  one 
which  has  been  followed  hy  ^od  reauUa.  But  if  there  be  ascend- 
ing neurltiti  the  sourue  of  the  UlHeuKu  is  not  reached. 

Surgical  treatment  is  of  the  greatest  importance,  and  for  this 
the  reader  is  referred  to  works  on  surgery.  We  should  hardly 
attempt  to  gi^t  along  without  the  local  use  of  morphiiie. 

To  check  nervous  inntability  the  bydiiitc  of  chloral  is 
iiU]kcrior  to  all  other  meann.  Tobacco  oxorciieB  a  favorable 
influence  upon  tho  apaam*  by  its  ptiwcrfnl  paralyzing  action  on 
the  cerebrum  and  cord.  ft*  depressing  aflor-ctfiJtit  la  a  die- 
advantage.     Hence,  ho  prefera  the  bromides,  <'r  phyHostigma. 

T<i  iliniiitiKli  the  irrilability  of  the  motor  nerve«wo  may  give 
prosaic  acid,  lielladonna,  and  especially  curara.  Bnt  from  the 
efl'etl  of  tlieso  rcniediiw  upon  ihr  heart,  be  concUidoa  that  the 
opaanis  are  beat  controlled  by  the  chloral  and  hi-oniide  of 
potawiiim.  Tito  cold  batb  and  coM  douche  are  anticjuated  and 
heroic  mcaaure-s. 

When  the  tempcmlurc  is  cx<««»ivoly  elevated,  the  cooled 
hath  will  prove  valuable.  The  warm  bath  Is  pleasant  to  the 
patient,  bnt  not  of  any  other  value.     All  Imtatioii  should  be 


avoided. 


4H 


MAHUAL  OP  TRKATMEjrT. 


The  Btrciiglh  should  be  carefully  8uiii>ort«c].  If  the  jaw  be 
Iftcketl  the  fooil  iii»>'  Iw  intrijdiicei]  through  the  atotnaL-b-tube  or 
by  Ihu  retluin.  Tlie  ln^wc-U  filioiilil  be  kejit  u|)i;ti,:ind  any  other 
B^DiptoiiiB  nrinng  nboiild  ■'cceivc  neeJeil  treatment. 

Conner  thinks  that  if  the  mycotic  ori^ii  of  tho  diiwaM  ta 
establifihed,  there  will  b«  goofl  rtaeoii  to  a<iminiBter  the  clilnrides 
of  mercory.  The  local  oppfication  of  ico  to  th«  npine  ha*  boon 
orediieii  with  nmJiy  cures,  e^itecinlly  of  non-trrttimatic  vasc-t.  Free 
pcrril'initioi),  iiidiicttd  by  hot  Itathft  or  by  Jaborondii  haftw*iiafr-< 
timert  seemed  to  ho  of  aervice. 

Conium  was  ti»ed  nucctawfully  in  two  case*  by  Jouxsos,  i 
apiximtl  to  give  relief  in  othen*  which  proved  finally  fata!. 
39  fU9C3  ill  Yandell's  tabic,  treated  by  physostigma,  89  per 
(■en),  repovered.  Of  25  cases  treated  by  cannabis  Indica,  64  per 
cent,  recovered,  If  cannabis  be  given,  il  should  be  in  doees  of 
oiie-liBlflofoiirgriunHof  tlierxlniftevery  two  hours,  In  ISiV  raMB 
ireut«d  by  opium,  57  jier  cent>  recovered.  In  all  the  pnx-cding 
caoeH,  it  in  tdnioe't  wholly  Ihe  milder  and  more  chronic  fomis 
which  recovered. 

Chloral  is  the  most  valuable  drug  yet  discovered.  It  ig 
given  in  iloae*  varying  fmm  seventy  graina  a  day  (Mackahara)  Io 
foi3r  dnirbnis  in  the  wjme  pcrifHl  (Vernkcil). 

Tlie  bromide  of  potassium  has  been  givcu  in  doaes  reacbitig 
to  nn  ouiK-e  n  day.  Knucut  obtained  nine  euros  out  of  ten  coeei, 
by  the  u^  of  the  bromldo  and  t^htoral.  Kakb  obtained  sixieea 
earea  out  of  twcnt.v>4ine  ea«C9  treated  with  the  HUQe  reincdie'^. 

VoisiN  reiMiried  a  ease  in  which  chloral  had  been  iiA«ii  with 
little  etfcet  tor  eleven  dayi^,  when  do<:ided  impn>vemcnt  eiiHned  in 
three  day;*  when  ihe  bromide  wait  given  in  two-drachm  dosea,  and 
half  a  grain  of  mnrphinc  injected  hy]Midcrmical]y  three  timus  a,; 
day. 

The  lue  of  alcohol  nppeared  of  benefit  in  «orae  caws,  as 
eighty  per  cent,  of  re-^overie?  Ibllowed  its  use  in  Y\NM:Li.'fi  easce; 
bat  in  I'olakd's  lUt  the  death  rate  wb«  swveiity-five  per  cent. 

The  coiiehwion  of  Cokser  is  that  no  remedy  for  tetanus  haa 
yet  been  found.    Piieriterat  <«;taiiu»  domanda  Uie  aatnc  trvatm<^t 


TCTANUH. 


495 


as  the  orJinnry  form  of  the  iliiteHse;  the  iitenin  being  cniptiod, 
ani]  antiwptic  irripitioiu  emplovKd. 

In  tetanuA  neonatorunij  Mariom  Rims  called  attention  tn  the 
fact  tlmt  the  occipilnl  l>uiic  of  tLi>  Infant  ia  often  duplat'C*!  inwardit 
b>  the  t-liild  ht'in^  laid  t-xchbiivel^-  on  Ihe  biick.  This  h  enaWj 
rec()iniized,  and  simply  nece**itatC9  h  i^'hange  in  the  [losition  of  the 
chiU),  after  the  bniic  haft  hucii  rc[ilai-ud  bv  inunipulalion,  or  even 
by  lU)  operation.  The  ftnct.'ess  attending  Ibis  metbuil  haA  becii 
sinai-kabte. 

In  Brazil  tins  form  of  tctanui^  is  ko  prevalent  that  it  is  esti* 
mated  tliat  one-tbird  of  tbc  infanta  die  of  it.  The  Eiiro[K«u 
plivrtirianH  in  that  cniintry  attribute  the  pn'valetice  of  tetanus  to 
the  manner  iu  whit-h  the  native  phydicians  diesj  tbc  umbilical 
conl.  The  fnniH  U  severed  cliwe  to  the  jil'caitay  and  coiled  up  in 
a  nia»9  on  the  infant's  abdomen;  a  liberal  amount  of  ointment 
beiii^  added.  The  Atemrh  of  thifi  putrefying  ma^  fioon  becomes 
very  great. 

Reaoan  reported  a  case  of  traumatic  tetanus  in  which  by 
mintake  two  hnndi-ed  and  sixty  grains  of  quinine  were  admini»- 
teiMsd  at  one  dose.  Tbc  next  morning  the  patient  was  found  resting 
well,  fiweating  profusely,  luid  with  no  Hyin]itonis  of  tetanun 
remaining.  Two  other  cases  were  subsequently  treated  sucwas- 
fully  by  giving  one  bnndri^rl  grain»  of  <piinine  every  hour  nntil 
the  symptoms  gave  way.  No  bad  results  followed  this  lieroic 
dosiige. 

Macnauara  emphai4)Ke:s  the  importance  of  nounHhing  the 
patient  well,  lie  gives  four  ounces  of  milk  every  four  honi-s;  an 
egit,  or  half  an  ounce  of  raw  meat  juice  being  added  three  times 
daily.  If  the  puUe  Indicate  great  exhaustion,  l)oef-tea  and  brandy 
may  also  be  given  iu  enema.  If  the  teeth  be  firmly  locked,  the 
fingem  may  he  inwrteii  between  the  cheekn  and  the  jaws,  and  the 
fluid  poured  into  the  cavity  thua  formed,  when  it  will  be  dniwn 
hito  Ihe  mouth  and  swiilloweil.  lie  givtw  only  cliloral,  thirty 
grains  at  noon  and  forty  at  bed  time.  Tliis  plan  must  be  rigidljr 
I       odhirrcd  t(>,  however  iterious  tbc  ease  may  be. 


496 


MANHAI,  or  TREATMBXT. 


TETANY. 

Bastiak  says  thnt  the  tr^Atmcnt  ehouM  in  ttio  main  be  dlreot^ 
ed  towards  the  general  health,  aud  the  diminution  of  al)  debilitat- 
ing oonditions  or  canws  of  irritation.  At  tho  sfliite  time  lie 
gfniiral  nnil)ilir_v  ot"  the  nervous  nysteni  may  !« Iiwec-ufrU.  by  ■'Ct'ing 
that  tlio  pitticnt  ohtainit  rcgulnr  nnd  itound  i>loop,  iind  by  the 
fld  minimi  nit  ioi)  of  the  bromides  ill  ituitable  do«4Qs,  with  vAlcrifta, 
tnui«k,or  cotiium. 

It  will  i>early  alwuys  be  found,  that  there  hk  in  Iboite  i-aaw 
canfct)  of  reflex  irritiitian,  winch  must  bo  removt-d  before  a  cure  w 
efleeted.  Tape-wonu,  ascaridos,  i-elmvoi-sion  or  other  di«pliict>ni«nt 
of  tho  womb,  Htriutore  of  tlic  urethra  and  phjmoHifl,  may  ho  men- 
tioned anioii<t  oau«e«  oajiable  of  giving  rise  to  tetany. 


TORTICOLLIS. 

IlAMtLTON  con^siders  hyoscyamine  the  most  Borv-icenblp 
remedy.    Electricity  haa  done  good  in  either  form,  nnd  vigowua 

farudii^tiGn  wilh  the  electric  briii<b  is  carnt»tly  recomniendM  in 
hystpriciil,  rheumatic  or  runctioiial  case,*.  lie  prefers  tho  com- 
bined nnd  eitnultancous  use  of  the  galvanic  and  faradte  en rrent*. 
The  galvmiix-  unode  and  the  fBrudic  cathoilt;  are  np|)lied  to  the 
back  of  the  neck,  the  gidvnnic  cathode  'is  placed  over  the  origin 
of  the  aflV'Ctcd  muscle,  and  the  iiiradic  anode  over  the  other  muacle, 
which  18  not  in  HfMvsm. 

In  old  Cdfics  cxsDctiou  of  the  Kjiinal  acceasory  nerve  has  been 
practiced  with  nuiweiw.  Symptoms  of  or|;anic  cerebral  diseOiW,  or 
the  exialciice  of  unilaterally  inci-ensol  tendon  relies  or  tremor  are 
contraindicuiionri.     Braves  and  apparatuH  are  worse  than  luieleM. 

Sesatob  eaya  that  when  the  diseaM  is  one-aided  it  may  gen- 
erally bo  cured  by  keopin.u  the  nock  warm  with  flannel,  or  by  hot 
poultices  or  the  wet  pack.  Tim  symptoms  may  he  relicvwl  and 
often  romox-ed  by  nibbing  tho  rigid  muscle  with  the  hnnd,  or  wilh 
opiate  enibrocationn.  Careful  and  gradual  extension  of  the  musel« 
by  jMuwive  traction  of  the  head  to  tho  h*\illhy  Ride  U  pometii 
of  nerviee. 


TILAKCB. 


497 


If  the  cervical  muaclea  be  symmetrically  and  largely  iuvolved, 
the  disorder  may  be  curwl  by  wet  or  dry  cupping;,  sinnpism^  or 
stimulating  linttnonti^.  A  liypodcrmic  Injectioii  of  morplune  may 
prove  indiapcnsiblc 

VTry  no4*k  in  the  moat  eoiiimoii  form  tiniially  getn  welt  in  a 
few  days  under  any  metliod  of  treatment.  Patients  experionce 
definitu  relief  by  applying  an  anodyne  liiiiineiit,  and  then  going' 
over  the  neck  with  a  hot  iron,  firat  rovering  the  gkin  with  flaiuieL 

Tlie  iiw  of  electricity  i«  not  alwayw  pleasant.  Tn  one  «i»e  in 
which  we  made  use  of  a  very  weak  faradic  current,  the  patient 
fainted;  and  c-outd  never  be  induced  to  use  the  remedy  anern-ards. 

The  internal  adniini^tratiou  of  clmicifoga  in  bolieTed  by 
some  to  be  useful. 


TRANCE. 

GowBRs  says  that  the  treatment  has  to  be  directed  to  two 
end.-t:  the  niatntennuee  of  life,  and  the  arreat  of  the  trance  Ad- 
vantage must  1)0  taken  of  any  intervaU  of  wmi-conwioasneaa,  to 
give  nuurt»<linicnt  in  a  concentrated  fonn.  If  swallowiDg  bo  con- 
tinuously imposwiblo,  food  most  be  given  by  the  nasal  tube,  or  by 
eiiemata.  Warmth  should  be  applied  to  the  extremities,  and  car« 
taken  to  prevent  bed-ROPC"*.  In  wjvere  cosos  every  attempt  at  ar- 
rest is  often  fruitless.  Errhinett,  suc-has  KnuflT,  liave  unnally  no  influ- 
ent-e,  and  itisonty  iiisliglit  case.-*  that  ihinmcans,  or  stimulation  of 
the  skin  by  ainapismi^  isefFeetive.  Tlio  most  [Hiwerful  cutaueouB 
excitant  is  Ktrong  faradisation.  In  a  case  under  Gowebs'  notice, 
which  had  la-tted  for  thirty-six  hours,  strong  faiudlsatloil  to  the 
arm  quickly  roused  the  patient.  In  another  case  which  lasted  for 
several  months,  this  treatment  had  for  a  long  time  no  influonee^ 
aftcnvarda  the  patient  could  be  ]mrtial!y  rouwd  for  a  short  time 
by  fanidisation,  and  by  repeating  the  application  at  the  itamc  hour 
every  day  a  tendency  to  periodicul  waking  waa  established,  the 
renilmionn  became  longer  and  more  complete,  and  the  attack  was 
ultimately  brought  to  an  end.  Nervine  stimolants,  such  as  ether 
and  valerian,  may  Iki  given  by  Uie  bowel,  or  sulphuric  ether  may 
b«  iiuected  eubc-utaneously.  Alcohol  must  be  given  with  caution 
and  in  small  qnantitiea;  onomata  of  strong  coffee  arc  often  mora 


498 


KAKUAL   OP   TEEATHEXT. 


* 


iwcful.  A  remedy  which,  from  its  effect  on  the  vascular  syetero, 
would  certainly  deserve  trial  in  trance,  is  the  inhalation  of  nitrite 
of  amyL  Transfusion  of  blood  haa  been  proposed,  and  would  be 
jostitied  in  cases  following  exhausting  disease.  The  recurrence 
of  attacks  ronst  be  prevented  by  the  Improvemeut  of  health, 
phyeieal  and  moral.    (See  Hysteria.) 


k 


TRICHINA. 

Hblleb  has  nothing  to  say  of  the  troslnient  of  this  disease, 
deeming  all  the  proposed  remedies  inefficient  lie  spoaka  of  tlie 
importauc;e  of  prophylaxis.  The  meuna  by  which  we  prevent 
the  occurrence  of  trichinosis  are,  Ist  Prevention  of  the  sale  of 
trichinatoua  pork ;  2ud.  Thorough  cooking  of  all  pork  prepara- 
tions;   8d^  Prevention  of  the  acquisition  of  trichina  by  tbo  hog. 

Trichinatoua  hogs  should  be  boiled  under  government  super- 
vision, and  the  refuse  buried  deeply  or  burnt  Ilog  butchers 
should  be  prohibited  from  keeping  or  feeding  hogs;  as  the  princi- 
pal cause  of  the  tiprcad  oi  trichina  is  the  feeding  of  healthy 
animals  with  the  offal  of  those  already  infected. 

FiBDLBR  instituted  a  scries  of  experimeats  with  the  varioDi 
drugs  which  have  been  p^iposed  for  the  cure  of  trichinoeis, 
including  oil  of  turpentine,  castor  oil,  croton  oil,  calomel, 
jalap,  coloc-ynth,  pyroHgneous  acid,  kameela,  male  fern,  benzine, 
picronitrate  of  potosaa  and  of  soda,  and  glycerine.  llTegative 
results  were  obtained  from  all,  with  the  jiossible  exception  of  the 
last  named.  Ills  attention  was  directed  to  this  by  noticing  that 
when  glycerine  was  applied  to  trichiufe  in  prcfiaring  microscopic 
specimens,  the  animals  immediately  die  and  become  shriveled  by 
the  rapid  absorption  of  water  from  tlieir  tiasuta  by  the  glycerine. 
In  one  case  of  trichinosis  the  patient  was  given  a  brisk  purgative, 
followed  by  pure  glycerine  in  doses  of  a  tablespoonful  every  hour. 
The  man  escaped  infection,  and  no  bad  effects  were  noticed  from, 
the  glycerine.  Fibolbb  concludes  that  if  wc  succeed  in  conveying 
the  glycerine  unchanged  past  the  stomach  into  the  small  intea* 
tine,  we  will  have  an  efficient  remedy  against  trichina.  But 
un   the  thirst  of  the  glycerine  for  water  is  apt  to  be  sated  by 


TBICUINA. — TlfPULITIB. 


499 


extracting  that  fluid  from  the  walls  of  tho  stomach,  this  will 
detract  greatly  from  the  value  of  the  remedy. 

Had  U.VNA  3iic<;c«<Ied  in  finding  in  keratin  a  euhstancc  of 
which  capsuled  could  bo  made,  wli  ich  would  rediut  the  sol  vent  actioD 
of  the  acid  gnstrio  juice,  and  be  di.ssolved  by  the  alkaline  inte*- 
tiiial  fluids,  the  problem  would  have  been  solved.  But  keratin 
has  proved  n  failure;  and  Himjile  oi^  this  question  appears,  it  still 
remains  for  future  elucidation. 

Meanwhile,  Fiedler  recommendu  tliat  glycerine  be  given  by 
the  mouth  and  by  tho  rectum,  as  tho  most  promiaing  remedy  yet 
proposed. 

As  alcohol  possesaes  the  same  property  of  absorbing  water 
from  aninuil  ti(i.tii&t,  itx  am  may  be  conjoined  to  that  of  g1  ycerina 

Otherwise,  the  treatment  should  be  that  of  fevers  ordinarily. 

If  the  patient  be  seen  early,  an  emetic,  tollowed  by  a  catliartic, 
may  rid  the  intestinal  tract  of  the  tricliinatoue  pork,  before  the 
panwitet  liave  effected  a  lodgment  in  the  tissues. 

BABTUOLO>fr  proposes  the  administration  of  carbolic  acid  and 
iodine. 

Quinine  seemed  to  exercise  the  most  iavorable  influ- 
ence of  any  drug  uscil  in  fiDTTON'.t  cjisea.  When  tlic  puraaitea 
have  migrated,  the  treatment  is  purely  symptomatic.  Obstinate 
wakcfulnesH  and  pain  ref^uire  morphine  and  clilorol.  Quinine 
and  stimulanta  will  be  needed  to  support  the  powers  of  life. 
Milk,  beef-juice,  egg-nog  and  other  alimente  must  be  given  from 
the  beginning. 

RuoDK  reported  a  case  in  which  rapid  improvement  in  the 
general  aymptonu  ^I'otlowed  when  ergot  liad  been  accidentally 
given  for  another  purpose. 

Fbrrkr  also  reports  a  cure  elfected  by  the  use  of  alcohol,  aix 
to  nine  ounces  being  given  daily.  The  case  recovered  in  eighteen 
days. 

TYPHLITIS. 

Outer  states  aa  the  6rst  indication  the  relief  of  conatipation; 
for  which  purpose  ho  administers  calomel,  oolocyiith,  seima  or 
■aline  aperients,  combined   with  opium  and  the  uu  of  warm 


«00 


HXRCAL   OF   TBBATHBKT. 


enemata.    The  latter  aro  especially  iodicated  vrhen  the  vomitbg 
U  trcKibteaomew 

The  second  object  U  to  eubdue  iufinmmatioQ;  bjr  rest,  poaU 
ticcs,  blUtors  and  opiates.  Tito  diet  throughout  iihould  bo  fluid, 
consisting  of  lieef-tea  and  luilk.  Strong  a[)crient8  are  to  be  oon- 
demned,  as  they  incrca^  the  iuflniQmii.tton  and  the  ri»k  of  per- 
foration ;  Bn<I  while  aggravating  the  vomiting,  may  fail  to  inove 
the  bowels.  If  the  local  inSammation  be  nev«re,  with  groAt  paia 
and  tendemestn,  a[)ertetiU  hy  the  mouth  are  to  be  avolde<l,  enemata 
used,  and  opium  given  freely,  while  leeches  are  applied  over  the 
tnmor. 


Lbubb  rocoTDnicnds  an  active  an tiph legist iu  regimen,  includ- 
ing the  continuous  application  of  ice-bags  or  of  cold  comprewei, 
leeching  in  robust  peiwons.and  injecHrig  iee-watorinto  tho  rectum. 
The  latter  also  servc«  to  keep  the  bowels  open,  which  is  tlie  first 
indication  so  long  as  there  is  no  nymptoro  of  peritonitis.  If  the 
ico-wator  iiijectioiia  prove  iuaufflciont  for  this  purpose,  eatt  or 
honey  may  bo  added  to  them,  and  a  dose  of  castor  oil  or  even 
a  Btronger  laxative  may  be  given,  if  peritoneal  irritation  can 
bo  certainly  excluded  from  the  diagnoaU. 

If  these  meoHurett  do  not  succeed,  or  if  ]ieritonitifi  be  iodt- 
cated,  opiiun  should  be  used;  or  am  a  last  report,  eutcrotomy  per- 
formed above  the  obstruction.  Tho  induration  remaining  aher 
the  typhlitis  ]im  subsided  u«  to  be  treated  by  poultices  and  warm  or 
ealt  bathn;  while  [lerityphUtic  absoessea  arc  to  be  opened  u 
a«  fluctatiou  is  detected. 


Tannea  recommends  anodyne  fomentations  to  be  appliedf 
while  opium  ia  given  internally  in  Rufficient  doses  to  relieve  pain. 
Prolonged  hot  hitvliaths  often  give  great  relief.  Kfiervescing 
drinkn,  lemonade  and  ice,  will  bo  u<tcful  in  relieving  Che  nausea; 
white  if  it  be  neceatiar}'  to  relieve  the  bowels,  castor  oil  enemata 
may  be  employed.  Great  care  must  lie  taken  to  keep  the  patient 
qulot  in  bed,  as  well  as  to  enforce  the  exclusive  use  of  liquid 
nourishment,  until  all  aymptoma  of  disease  have  passed  away. 
If  suppuration  occur,  milk,  cream,  raw  ^gs,  caaence  of  beef,  and 
cinchona  with  brandy  or  port  wine,  will  be  needed. 


i 


TTPnUTIS. 


In  chronic  caees  he  has  seen  most  good  result  from  niinplo 
noaiishiii^  food,  warm  bathing,  sedattva  applioitiona,  cod  llvor 
oil  and  oUicr  tonics. 

Davis  begins  the  trentment  with  the  use  of  Inrgs  orioiimta, 
with  iinoilj-ncs  by  the  stomach  and  local  appllcatious  ot*  clotha 
wet  with  wanu  narootic  infusions. 

He  has  found  gmtifj-ing  relief  follow  fbe  iitM>  of  un  enema 
containinjr  chloTal,  ffr.  isv,  and  tincture  of  beUadomui,  i  rxv, 
in  four  ounces  of  hikcwivrm  water.  Within  liulf  iin  hour  it  will 
be  followed  by  decided  relief,  and  the  patient  wilt  be  enabled  to 
eloep.  This  relief  will  continue  for  two  to  three  hours,  when, 
if  the  distress  recur,  the  enema  may  bo  repented. 

The  choice  of  a  laxative  in  typhlitis  is  by  no  mcann  a  nmtter 
of  indifference.  There  is  on  the  whole  nothing  to  equal 
Bulphate  of  magnesia;  because  M'hen  given  in  Hinall  down 
it  renders  the  contents  of  the  bowclo  fluid,  without  notably 
increasing  the  peristaltic  movements.  Half  u  drachm  nliould  bo 
given  evory  four  houm,  in  h.ttf  a  glana  of  cold  water.  Larfi^o 
injections  of  hot  water  nhould  be  given  at  the  numo  intcrvalii. 
These  assist  materially  in  removing  the  fecul  aocuaulattoius  enpo 
cially  if  the  oi>erator  be  skilful  enough  to  inflate  tho  colon  with 
tlie  liquid  ii^ected.  Ue:sidcs  this,  they  assist  in  relieving  tlio 
inflammatory  symptoms,  in  rocch  tho  samo  nuuinor  fti  pnolticon, 
bat  with  much  more  effect  Kxtcnially,  hot  fomcntationa  an 
preferable  to  poultices,  becaiuc  tho  latter  aro  in  moit  cum  too 
heavy  to  be  bom. 

The  use  of  opinm  must  be  regulated  by  the  dtgno  of  pain; 
enough  being  given  to  afford  relief,  after  iho  priinarjr  tmpaetini 
has  been  removed.  If  the  («tient  can  f^along  without anodyiMi 
during  the  day,  a  full  4o«o  may  be  given  at  bed-tiriuh 

Ttie  diet  oeed  not  be  limited  to  fluida  unloM  fover  be  preeent, 
bat  should  never  contain  mbatanoei  which  lncn>a«t  (Im)  feesl 
maes.  The  white  of  egg  beaten  ap  In  rnittc  or  walaff  Hnlislrnry 
steak,  and  soft  boiled  eggs,  may  be  given  \f  iIm  aunt  Ihi  proUmtf/ad^ 
and  the  sticngth  of  the  patient  impaired.  In  othar  mam  riM- 
water,  barley-water,  and  skimmed  milk  are  MiflaUnL 

(See  Fieri-T^pUUiM.} 


602  HAHUAL  OF  TABATUBKT. 

TYPHOID  FEVER. 

LiRBBRVETSTEB  tAVB  that  among  all  the  rcmcdic«  for  thu  Ju 
MBe  tti«re  are  but  two  wlios«  epecitic  inHuoncc  he  would  not  poei-j 
tively  deny,  and  thone  are  iodine  and  calomel.    He  givei  tbc] 

following; 

B    lodl^ 5  J 

PotMtit  iodicL, 5y 

Aqatt, rs  s 

H.    SL^Four  drapa  la  &  glau  of  vat«r  ever?  tvo  bonra. 

In  two  hundred  casee  the  iodine  produced  no  roarked  effect 
on  the  coiirBC  of  the  fever,  nor  on  the  diarrhea  and  the  iatestioal 
syraptoms,  nor  on  the  tem[>enituro.  In  fact,  the  only  difference 
noticed  I>etween  these  caseu  and  those  treated  without  iodine  wat 
that  in  the  foroier  the  mortality  was  lees.  jM 

Kearly  all  ohserv(?iN  who  have  treated  great  numhera  of  cawM 
with  large  doses  of  calomel  claim   favorahlo  results.     Liebkr-V 
HEISTEK  gives  from  Hevcn  and  a  half  to  ten  grains,  three  or  four 
times  a  day.     The  cases  thus  treated  appeared  to  nm  a  milder 
courae  than  usual  in  many  ca.ws,  but  mit  in  all.     The  drug  wm 
usually  given  for  but  one  day.  ■ 

The  danger  in  typhoid  fever  consists  in  the  effccft  of  coo-fl 
tinued  high  temperature  upon  the  tinaues.     Antipyretics  are  therfr^ 
foro  of   the   first  importance.     For  adult«  the  full-length  coU 
bath,    at  68°  or   lower,  is   to  be    preferred.      The    duration 
should  bo  ten  minutes,  or  \cm  for  feeble  pcreons  who  do  not 
well.    Af^er  Hie  bath  the  patient  is  wrapped  lu  a  dry  sheet  and] 
put  to  bed,  lightly  covered,  and  given  a  gloea  of  wine. 

With  very  fccblo  patient?,  baths  at  75"  ehoald  bo  oaed  at  first  j 
For  these  caees  Ziemssen's  method  ia  to  be  recommended,  of  bathaj 
at  95°  cooled  down  gradually  by  adding  cold  water,  until  tho 
temperature  ia  reduced  to  72**  or  below.    The  duration  of  thc» 
baths  should  be  lougor.      Whenever  the  axillary   t«mpor»tare 
teaches  102^.2  a  cold  bath  is  given.    In  children  the  bath  ia  notfl 
used  until  the  tcmpemturo  reaches  103°.  H 

Too  much  must  not  be  expeeted  from  one  or  from  a  fcnr^ 
faaths.    In  very  severe  coses  they  mast  bo  repeated  every  two 
hours.    Tho  rapidity  of  the   repi-oductiou  of  heat  constitutes  a 
valuable  prognostic  sign.    The  baths  must  he  continued  dnriog. 


TYPHOID  FBVBR. 


fiOS 


I 


the  sight  as  well  as  the  day.  With  &1  pcnone  the  baths  muBt 
be  long  and  colder. 

In  later  Btnges  the  paticnta  often  roqaert  the  baths,  but  if  the 
roctal  temperature  be  under  I0l.5°,co1d  Bpongingshnuld  beaubsti< 
tuted.  Cold  affusions  have  much  less  effect.  C^]i\  piu'k«  nro 
well  borne  if  the  legs  below  tlie  knee  be  left  free.  They  may  lake 
the  place  of  the  baths  in  children.  Cold  sponging  has  but  slight 
cooling  power.  Cold  eompreseee  and  ioe  bags  havo  no  effect  on 
the  general  heat,  but  may  be  of  uhg  by  long-continued  application 
over  the  heart,  or  head,  in  protecting  those  organs. 

While  cold  drinks,  ice,  anil  cold  eneniata,  have  hut  little 
effect,  the  little  reduction  of  heat  obtained  by  their  use  is  not  fol- 
lowed by  a  snlweqiient  increased  ]iroduction  of  hejit.. 

Hemorrhage  from  the  bowels  contra-indicates  the  use  of  cold 
bath«.  So,  alHO,  doc»  j}erfbration.  Menstruation,  pncuinonia,  and 
hypostasis  do  not  contra-indicate  them. 

Weiikncfts  of  tlie  heart  c-ontm-indicatca  the  cold  bath ;  though, 
if  the  weakness  be  slight,  Zi  kmsskn's  bath  may  still  be  employed. 

Besides  tlie  bathf),  Likbermbister  hardly  over  treats  a  severe 
case  without  aiilipyrctie  doses  of  quinine.  From  twonty-two  to 
forty-five  grains  rauat  be  taken  wilbin  half  an  h«)ur,  or  at  least 
within  an  hour.*  This  is  never  repeated  witbio  twenty-four 
bourt,  and  usually  not  within  two  dayn.  The  decline  of  tem- 
perature begins  in  a  few  hours,  and  in  from  six  to  twolvo  hoars 
It  may  go  to  the  normal  .standard;  then  it  begins  to  rise,  but 
even  on  the  second  day  has  not  reached  the  previous  height. — 
If  the  iirst  do<ia  reduce  the  temperature  to  9^.5**  or  lower,  the 
next  dn«e  is  diminished. 

When  the  fever  strongly  remita  Hpontaneously,  quinine  is 
much  Ie5M  indicated.  It  may  be  used  when  the  liaths  are  contra- 
indicated  by  heniorrhagc. 

The  same  may  be  said  of  its  use  in  cardiac  wcaknots.  tf  the 
quinine  cannot  be  given  by  the  mouth,  the  IwMt  Hubiilitule  l»  to 
inject  it  into  the  rectnm,  in  solution,  with  a  little  laudanum. 

In  the  unooramon  aut»  in  wliich  tltc  fovcr  rcfuwtt  to  bow 
liefore  the  bath  aofl  •quinine, digitalis  "K  ''         m  ftirtti'T  weapon. 


SMilijrctie  tBtet  and  tb«  nuiuaJ  isoraiBg  mniauua  will  oeruf  U  lh«  mrm  tiaia. 


UAaOAl.  OF  TBBATUKXT. 


The  dofto  w  eloveu  to  twenty-two  grains,  in  powder,  given  durit^ 
thirty-eix  hours.  This  should  be  followed  by  a  full  dose  of  qui- 
nine. If  this  produco  a  complete  intcrmisdioii,  the  ^mc  oud  tnxy 
afterwarda  be  obtained  by  the  use  of  quinine  atone.  IH^talis  can 
only  be  ug«d  when  thoro  is  not  much  weakness  of  the  heart,  and 
where  the  pulse  is  not  yet  extremely  frequent. 

Voratria  will  tcinponirily  break  the  fever  when  quinine  fiiila. 
One-twelfth  of  a  grain  may  be  taken  in  pill  every  two  hours  until 
nauBea  cnftucs.  Four  to  »\x  dosctt  cinlRcc  The  ensuing  colta])6e 
is  not  dangerous,  and  can  soon  be  overcome  by  tho  u»c  of  wine. 

Ko  further  trcnlment  apart  from  the  dietetiu  regulations  will 
bo  required  in  t-asos  whieli  pursue  a  regular  course.  Failure  of 
the  heart  i-hIIb  for  the  treatment  of  itji  cause,  which  ishigU  fever. 
To  stimulate  the  heart,  the  first  agent  is  alcohoL  All  fmtienta 
who  have  been  in  the  Imbit  of  u/uig  ak-oho!  shouKl  be  iienuitted 
to  continue  ita  moderate  use.  "Wine  is  also  to  be  given  after,  and 
sometimes  also  before,  a  hath.  Cardiae  weakness  e»IU  for  more 
stJnuilant,  in  stronger  forms. 

In  tiudden  i^otlapKe,  strong,  hot  punch  and  strong  tea  aud 
coffee  may  be  of  great  value.  The  stimulants  should  not  be 
pushe<l  btiyond  what  is  nc^L-^wwary,  or  so  that  a  further  failure  finds 
us  devoid  of  fiirthei-  resources.  The  only  other  re8torati%'es  used 
by  htm  ai-c  camphor  and  mUBk :  tlio  latter  for  sudden  cmergcu- 
ciee,  and  the  camphor  where  a  more  prolonged  action  is  required. 

Cerebnil  [laralysia  i-an  be  most  surely  prevented  by  tho 
antipyretic  treatment.  In  the  rare  coses  in  which  it  oc-eura,  the 
tisual  cold-water  treatment,  with  ice-bags  to  the  sptnc,  nsaally 
sutTiwir.  Kxtrcme  irritability  and  insomnia  indicate  the  need  of 
morphine. 

\roderate  diarrhea  requires  no  treatment.  If  more  than  four 
full  passages  occur,  opium  may  be  given  in  small  and  repeated 
doaes,  with  ipecac,  nux  vomica,  tannic  acid,  or  alum.  Soraettniea 
prolonged  constipation  calls  for  calomel  or  castor  oil.  Tympanites^ 
whicli  rarely  hecomes  great  under  the  antipyretic  regirocu,  may 
require  cold  compresses  to  the  abdomen,  changed  every  half  hour. 
Cold  rectal  injections  may  aUo  be  used,  pcrlui{.«  with  turpentine, 
or  an  inteatiiml  tube  or  (esophageal  sound  may  be  recpired. 

Dryness  of  the  tongue  may  be  relieved  by  holding  ice  in  the 


TTPnOID  FBVEX. 


S05 


inoath,  by  drinking  frcqucnll/,  or  hy  rinsing  tlic  raoulh  with  red 
iviitc,  BO(ia-n'at«r  or  chloride  of  lime  »oIiilir>n.  The  bladder  should 
be  frequently  examined,  and  emptied  if  ueees.tary. 

In  intcfltinal  hcmorriia^e  the  bowels  should  bo  restrained  by 
Bmall  doses  of  opium ;  two  grains  being  given  during  twenty-four 
hour».  Pcrfoct  (|uict  mu»t  be  enjoined,  and  the  abdomen  kept 
covered  with  an  ice-bag.  TaoQic  acid  or  alum  niuy  be  given  with 
the  opium. 

Perforation  or  peritonitis  calls  for  the  persistent  two  of 
opium,  one-tliinl  to  onc-lia!f  a  grain,  at  first  every  half  hour. 
Kouri?<bment  mast  be  kept  down  to  the  smallest  bulk,  and  that 
of  liquids  alone.  Never  allow  younielf  to  be  persuaded  into 
ordering  n  cathartic  or  an  enema. 

To  avoid  hypoetaais,  keep  up  the  heart's  action,  change  tho 
patient's  position  frequently  and  compel  hira  to  take  full,  deep 
in»]iimtionB  from  time  lo  time.  Scnipulous  clconlinisw  prevent* 
bed-sopcs.  "Water-cDBbions  aid  in  their  prevention  or  cure.  Tho 
ekin  should  bo  frcqiiently  Iwithed  in  alcohol ;  when  erosions  appear 
diluted  alcohol  and  lead-water  should  be  substituted,  preosure 
should  be  removed,  imd  the  position  ehnngetl.  Doop  sores  roquire 
oiutments  of  lead  or  tannic  aeid,  or  carbulic  acid  lotloiu.  T)ry 
gangrene  should  not  1>e  disturbed.  Moist  gangrene  demands  tlint 
the  patient  be  placi^d  in  such  a  |>ofiition  as  to  leave  l}ie  [larts  froo, 
and  aromatic  |x}ultices  applied. 

If  new  sores  develop  whenever  the  position  is  changwl,  tba 
permanent  bath  sometimes  does  goo<l  service;  tho  jjotiunt  remain* 
ing  in  the  hath  fmm  sixteen  to  twenty  lioum.oreven  continuously 
for  several  days.     Oak  bark  may  be  added  to  the  water. 

£zi)erience  proves  conclusirely  tjiat  paticoudo  Itcttor  who  go 
to  bed  early  in  the  diftease,  «vcn  if  tbo  attack  bo  light.  'Diej 
should  not  be  allowed  to  sit  Dp,  tintil  tbo  ave&itig  t«ai)«raturo  hs« 
been  normal  from  three  to  six  days. 

The  boweU  aud  hhulder  must  be  evacoatod  whila  tho  jsitient 
is  lying  down. 

All  mental  and  j^ysinal  nnnojtMvm  sliouhl  b«  kept  caralVilly 
away.     But  one  ptnoa  should  bvtllnwt'^l  in  Of  sl'ik-rooiu,  and 

tation  should  not  be  punriitt«d.     T)m  tAiniwraturo  of  the 


fioa 


M&XVAh  OF  TItKATHBKT. 


room  should  be  kept  between  56^  and  64°  Fahrenheit     Pn^ier 
vcntilatiou  ehoulcl  he  maintauied. 

Water  is  the  nutritive  most  needed.  This  xnay  be  ftavorcd 
to  euit  tiie  paticiit'e  taste.  Decoction  of  parched  rice  ia  a  naefiil 
diink,  if  there  be  much  diarrhea.  Proteins  and  fats  are  not 
absorbed,  and  will  cau*c  catarrh.  Thu*,  the  Uippocratic  diet, 
barley-wotor,  thin  gruel  and  vreak  raeat-brothf,  constitutes  the 
most  deairable  diet.  STBOMEtEa  prefers  oaten  grita,  conked  three 
hours,  without  sugar.  Milk  mu&t  only  be  iriven  when  boiled  and 
diluted  with  water,  wjltwr,  tea  or  coffee.  Later,  the  yolk  of  ao 
egg  may  be  beaten  up  in  the  broth.  Thoac  who  arc  very  low 
may  bo  given  beef-ten,  with  elnrot,  or^LEUDE's  meat  and  pancrcaa 
ii^ectiona.  Solid  food  should  be  reserved,  for  advanced  con- 
valescenoe. 


I 


J.  CWlLSOK  states  that  the  one  efficient  prophylactic  measure 
that  includes  all  others  is  the  prompt  and  thorough  dii«iNft>ctioii 
of  the  dcjcctiona.    For  this  purpose  he  rccomnionds  soliitioDS  of  ■ 
carbolic  acid,  one  part  to  twenty  of  water;  or  of  &ulpliate  of    i 
iron  or  chloride  of  zinu.     Soiled  clothing  or  ItcJding  must  be  im- 
mediately  removed,  disinfected  and  boiled  thoroughly.  ■ 

Sucuesa  in  the  treatment  Is  largely  dcj:>cndcDt  on  the  general 
management  and  nursing.  The  original  source  of  the  infection 
ahnuld  bo  fK>ught  and  removed.  The  diet  should  eoMiAt  of  milk, 
buttermilk,  m«a^broths,  with  barley,  claret,  port,  nicat-juice, 
oyster  or  clam  &oup,  and  coficc  or  tea  twice  a  day.  A  moderate 
quantity  of  thickened  gruel,  arrowroot  or  bread  and  milk,  may  be 
given  once  a  day,  but  generally  starches  ore  objectionable. 

The  food  should  be  given  every  two  hours  during  the  day, 
and  every  three  hours  at  night  Tf  tlie  quantity  taken  bo  but 
small,  and  the  weakne^  extreme,  tlie  intervaU  may  be  shortened. 

Alcohol  is  injurious  during  the  primarj*  fever,  unless  it  b« 
given  to  meet  Bpecial  needs. 

In  the  secondary  fever,  stimulants  are  indicated  by  cardiac 
Treakness  and  by  the  occurrence  of  serious  nervous  ]>henomena.  The 
proceaa  of  gangrene  going  on  in  the  intci^tiues  also  culls  for  the 
use  of  alcohol,  as  external  gangrene  aliw  does.  Bat  many  caaea 
require  no  stimulants;  many  others  only  during  the  last  days  of 
eonvalesoence. 


TTPQOID  rSVBK. 


607 


Peppbb  advocates  the  use  of  nitrate  of  Bilver,  in  the  doM 
of  gr.  J  to  gr.  J,  three  or  four  times  daily,  al'tvr  eating.  Bellft- 
doons  or  opium  u  to  bo  added,  according  to  the  state  of  the 
bowek. 

Flikt  suggested  that  the  mineral  acids  ehould  alwKTS  eater 
into  the  tTeatmeat.  They  are  given,  well  diluted,  as  agreeablo 
driaki. 

Bartholow  uBca  the  combination  of  tincture  of  iodine,  one 
part,  to  carbolic  acid,  tn-o  parts,  and  gives  from  one  to  three 
drape,  thrice  daily. 

"Wttsoji  considem  that  in  the  greater  number  of  ivxs  occur- 
ring  in  America,  the  antipyretic  system  is  unnecessary,  on  account 
of  the  mildnees  of  the  fever.  In  other  cnset)  it  is  iimdmiasible, 
and  in  fact  can  but  rarely  be  institiitcd  outside  of  hoepitaU.  lie 
give«  quinine  in  acconlance  with  Liebermeistrr's  directions,  in 
all  cases  where  the  temperature  goea  above  104*  P.  He  prefera 
the  ex[>cctfint  treatment.  Absolute  rest  in  bed,  careful  nursing, 
a  restricted  diet,  cleanliness  of  the  person  and  bedding,  and  venti- 
lation, form  the  batiia  of  this  treatment.  Jejinkr  Ba^*a  that  if 
niedicine  be  rcjuired,  it  is  because  of  special  unfavorable  symp- 
toms. The  physician  will  be  moat  succeaaful  who  watches  the  pro- 
gress of  the  fever,  with  skilled,  intelligent  and  conxlant  care,  and 
gives  unceasing  attention  to  little  things;  and  who,  when  pre- 
scribing an  active  rcmcily,  carefully  weighii  tlie  intended  good 
against  the  poaeible  evil;  and  if  the  evil  be  death,  and  the  good 
short  of  saving  life,  holds  hk  hand. 

Early  headache  simply  requires  absolato  qniot,dftrtE(ming  the 
room,  and  heat  or  cold  to  the  head. 

I'crsistcnt  sIccplcsuieM  rcqain^  chloral  and  bromide  of 
potaasiiun,  alone  or  combined.  Opitun  is  rarely  required  until 
the  eet-'-'ndar}'  fever,  when  il  ehtjuld  replace  the  chloral. 

Somnolence,  stupor  and  delirium  are  to  bo  treated  by  stimu- 
lants and  antipyretics.  Aloohol  slsmda  first  and  almost  atone 
among  stimulants.  Cold  douches  or  ioo  caps  may  bo  applied  to 
the  heed.  Light  brain  symptom*  are  nCUau  relieved  by  coffee. 
Desperate  cases  may  re^iuire  shaving  the  hood  and  the  application 
of  a  blister.     Tremor  calls  f<ir  full  do»cs  of  alcohol  and  ooium. 


I 
I 

I 


508  HAHVATi  or  TRRATHBNT. 

Diarrbcft  in  best  trcntod  by  bismuth.,  in  scruple  doaea,  four 
to  six  times  daily,  with  ojiiura  if  iiGcessary. 

If  the  Btoola  be  fetid  or  ammoniacal,  Jekkbr  gives  an  occs^ 
siotial  t«adpooiiful  of  animal  charcoal,  in  impalpable  powder. 
Creosote  and  curbolic  acid  arc  also  of  service. 

Tympanites  require  alcohol,  tiupentino,  camphor  and  mi- 
nute doses  of  opium,  cliarcoal  to  prevent  decomposition,  and  pepsin 
witli  the  mineral  acids  to  insure  perfect  digestion. 

For  hemorrhage  he  sfieaks  favorably  of  gallic  acid,  turpentine 
and  ergot.    Murciiison  places  his  trust  in  the  following: 

f)    Add.  tanoicti t^.  x 

Tincl.  ojiii, ^  X 

01.  IcrcbintliisB^ "^  xt 

Miidlaeiitli, f  5  ij 

Tinct.  clilororoRni,  "K  i^x 

Aq.  tnentlw,  pip.,  ad f^J 

M.    S. — A  t  one  d  ose. 

Ergotine  may  bo  injected  hypodermically,  in  doses  of  ten 
grains  every  half-hour  or  every  hour,  until  the  evidences  of  hem- 
orrhage ceaw). 

An  ice  bag  may  be  applied  to  the  abdomen. 

During  convalescence  the  temperature  is  apt  to  rise  on  very 
slight  provocation.  The  diet  must  be  carefully  watched,  and 
vlaitH  of  friends  must  be  few  and  short  Undue  exertion  must  be 
avoided.  At  the  end  of  a  week  solid  food  and  meat  may  he 
resumed. 

Tonics,  sea-air  and  change,  are  useful  in  this  stag& 

Davib  speaks  of  the  benefit  derived  in  the  early  stogee  from 
the  use  of  cblomto  of  potassa,  chloride  of  sodium,  bichloride  of 
mercury,  uiid  to  u  less  extent,  from  iodine  He  objects  U)  the  nse 
of  ealomel ;  having  witnessed  a  number  of  cases  where  salivation 
had  resulted  from  its  administration. 

He  recommends  frequent  sponging,  with  water  at  the  temper- 
ature most  agreeable  to  the  patient.  To  further  promote  the 
action  of  the  skin  and  kidneys  he  gives  nitrous  ether,  liquor 
ammonite  acctatla  and  digitalis,  separately  or  oomblncd. 

When  the  first  stage  has  parsed,  and  the  symptoms  point  to 


TVPQOID  FSVBR.  509 

failure  of  tbe  nervous  functioDs,  he  administers  etiychnine  and 
nitric  add.    It'  the  bowcia  be  too  loose,  opium  ia  added. 

Moat  authors  advise  the  ufieofetimulont^  in  bypostasia.  But 
DO  laet  ill  thcmpcutica  bos  been  beCt«r  estabtiahed  than  tbat 
alcohol  diniitn^licti  the  interchange  of  carbonic  acid  and  oxygen 
in  the  longs,  and  les^ns  the  nervous  acuiiibUity  generally.  As  the 
blood  to  these  coeee  is  already  darker  and  l<ss  coaj^lable  than 
natural,  and  the  coi«»city  of  the  lungs  is  dinjinish«d  by  the  hypo- 
stasis, while  the  eoti$ibility  generally  is  bluntctl,  it  \a  difficult  to 
8C0  rational  groumls  for  the  iu>e  of  alcohol. 

AiYer  fairly  etudyiiij*  the  (juoation  for  thirty-five  yeam,  he  lias 
been  unable  to  find  an  im!rease  of  the  hearfs  force  follow  the  use 
of  alcohol  in  a  single  case;  aa  shown  by  cai<diac  auscultation,  by 
the  sense  of  touch,  or  by  the  »phyymogni|ib. 

The  use  of  some  anodyne,  with  email  doges  of  mercuriaU  or 
of  iodine  in  the  fimt  (stage,  then  with  a  mineral  m>id,  nitnilc  of 
ulver  or  oil  of  turpentine,  and  in  the  later  stages  the  lost  named 
remedy  and  strychnine,  fulfils  the  rational  indieatioiut  hotter  than 
any  other  means. 

In  the  matter  of  diet,  he  reeommendtt  that  milk  should  bo 
boiled,  and  while  boiling  a  little  wheat  flour  added,  wiih  brink 
stirring  to  prevent  the  formation  of  lumpj,  and  given  in  the  form 
of  thin  gruel.  Of  this,  one  to  two  ounces  may  be  given  every  one 
or  two  hours.  Wlien  there  is  much  muttering  delirium  with 
Bubsultus  or  unQsual  drowsineiM,  he  gives  tea  and  coil'ee. 

^Vith  thia  treatment  in  operation  he  finds  no  oc-casion  to  em- 
ploy the  antipyretic  nystem. 

The  formulic  used  by  thia  eminent  clinician  are  as  follows: 

B    01.  Wrebinihiiut^ f3  iij 

Ol. SKultberln, fS  n 

Tinct.  opii, f  3  )* 

PnlT.  acads, 

e»i«h.  »IW, U    3  yj 

U.    ctaiUc 

Aqttt, 1 1  ir 

S,    A  tMapoonful  tvety  UirM  to  kuE  hcan. 

This  in  given  when  there  is  increased  fulness  of  the  abdomen, 
drynesH  of  the  tongue,  and  increased  diarrhea. 

If  the  turpentine  cause  uriiuiry  irritation,  he  substitute: 


610 


MANUAL  or  TBEATMBHT. 


1}    Arscatlalmt,. gr.  z 

Kit.  hfOR^ftmi, gr.  zsc 

Pulr.  apii, ,.gt.  ZKX 

it.    ct  10  pil.  no.  Kxx  dir, 

6.    Om  CVAT7  UiFM  lo  hU  bwin. 

g     Sti7chniiue, gr,  J 

Acid,  nilrtei, f  3  j 

Tioct.opil, f  5  It 

Aqua, >..,.. f  5  iiji* 

U.  8.    A  tcupoonriil  vv%rj  Ihm  lo  ax  boun. 

Looms  doclares  that  there  is  not  the  sUghtost  proof  that  the 
poison  of  typlioul  has  ever  boeu  removed  from  the  8jBt«ra  and  the 
disenw  tlnis  aborted,  hy  any  agents.  Like  most  American 
physiciane,  he  attaches  great  importance  to  the  proper  regulation 
of  tlie  eick-room.  A  propci-ly  qualified  nurso  should  be  seleclad, 
theroomshoiildbeUrgeand  well- vent ilate(l,and  u-seloes articles  and 
carj^iete  should  be  removed.  The  bed  should  be  placed  iu  the 
center  of  the  room.  Free  ventilation,  day  and  night,  is  of  tb« 
utmost  importance.  The  tempemtureof  the  room  should,  be  kept 
below  60**  Fuhr.  The  bed  and  body-lincn  «hoiild  be  changed  daily, 
and  at  once  removed  from  the  room  and  placed  in  a  weak  solation 
of  chlorinated  soda;  especially  if  the  diiwharge.?  be  pajwed  in  the 
bed.  The  apartment  should  be  perfectly  quiet,  the  light  etubdued, 
and  the  neceswary  attendanbt  alone  allowed  in  the  room. 

Iu  mild  cases  tlic  treatment  reaolvea  iteclf  into  the  above 
arrangements  and  proper  dieting.  Milk  is  the  most  suitable  food, 
and  fruits  are  not  to  be  allowed  in  any  case.  Even  in  the  mildest 
cases  tills  care  in  diet  ia  noccsaaiy,  and  the  patient  should  be  kept 
in  bed  until  coovaleecence  is  established. 

He  bclicvee  that  the  »iiccific  poison  of  the  disease  has  more  to 
do  with  parenchymatous  degenerations  than  the  high  tomperatnre 
has.  Still,  the  judicioua  cm]>toyment  of  antipyretics  has  much 
to  do  with  the  safety  of  the  patient  Of  these  he  utilizes  the  oold 
bath  and  qulBine.  He  finds  that  if  five  bathe  do  not  naffice  to 
maintain  a  continuous  low  temperature,  verj'  little  is  gained  by 
their  continuance.  Nor  docs  he  employ  the  baths  after  the  eocood 
week,  on  account  of  the  danger  of  collapse,  or  of  pulmonary  com- 
plications. 

In  some  caece  the  temperature  can  be  rapidly  lowered  by  th« 


* 


TTPBOID  rKVKR. 


Sll 


application  of  ice-bags  to  the  nbdomen.     Tliey  also  exert  a  lavop- 
able  influence  on  the  intestinal  lesioiiii. 

Knemata  of  ioe  water  alM  will  ffomctimce  lower  the  tomp«n- 
tore  rapidly. 

The  antipyretic  power  of  quinine  i»  well  cttabliahed.  It 
must  be  f!;\vtm  iu  doees  of  thirty  to  forty  grains  within  two  hoare. 
His  rale  is,  after  reducing  tlie  tem]>eniCure  to  101°  or  102°  by  a 
cold  bath,  to  give  a  full  dose  of  quinine  to  delay  the  snbaequeot 
rise  of  tempeniture. 

His  rules  concerning  the  u?e  of  stimulants  are  m  follows: 

They  shonld  not  be  indiacrimiDately  given  in  all  cuaos  of 
typhoid  fever. 

"When  there  ia  reasonable  doubt  about  their  use,  thoy  should 
be  withheld  until  the  indication  is  clearer. 

The  effect  of  the  first  few  dosea  should  be  carefully  marked. 

If  the  tongue  become  dry,  the  patient  restless  and  the  pulsd 
&8ter,  the  une  of  stimulanttt  !»  not  iiidlcuted. 

But  if  the  pulfio  become  fuller  and  more  r«gular,  if  the  first 
heart  eound  be  heard  more  distinctly,  if  the  rcatlcsauQui  and  deli- 
rium be  lesd  marked,  the  tongue  moiater  and  the  patient  inor« 
intelligent,  the  indication  for  the  uao  of  stimulants  in  clear. 

Ouce  begun,  they  must  be  given  regularly;  e^pocially  at 
night 

The  only  suitable  diet  is  milk.  It  may  be  given  eurdledt 
boiled,  frozen,  ferraontod  sltglitly,  or  mixed  with  lime  water, 
seltr.er,  pepsin  or  paucreatin.  BLttermilk  may  bo  Mubittituted  for 
atimc.  Thequnntity  ncod  not  be  limited,  [uilionUt  umually  taking 
from  four  to  six  quarts  daily.  After  the  fourth  wook,  croum  and 
the  yolk  of  egg»  may  be  given  with  the  milk. 

Early  diarrhea  he  lets  alone;  but  for  thiit  which  occurs  during 
the  third  weiJc  or  later,  he  gives  opium  in  very  amall  and  froquont 
doaes.    In  coaimleeceDoe,  astringents  may  be  umiiloyMl. 

For  distresaing  tjrapanites  he  umm  Uirpontine  stupop. 

Hemorrhage  occoring  early  reqniraa  no  treatnient  AfUr 
the  second  week,  it  should  b«  promptly  chocked.  Tho  mrMt 
remedy  is  opium  in  small  and  frequent  dnwH.  AlMolote  rest  In 
bed  must  be  insisted  upon,  and  an  ico-bof  must  Ito  appltsd  ov«r 


513 


UAXUAL  OP  TRUTHENT. 


^ 


the  aMoiiicn.  In  prolonged  ai«c«,  keep  the  piiticiit  under  the 
influence  of  opium,  and  give  turpentine  internally. 

Purrorutioti  in  to  l>o  treatcil  as  Im'alizctl  [H^-ritonitis. 

Bronchitia  demands  no  treatment  unless  it  become  capillary^ 
whmt  dry  cuiM  an<l  the  nmiof  carbonate  of  ammonia  will  give  greftt 
relief.    Vapor  inhalations  will  also  be  of  serrice  in  severe  caaoft. 

The  occuiTOiice  of  pnoumooU  is  always  an  indication  for 
etimulants,  ami  change  of  posture. 

Ijiryngilis  may  be  relieved  by  a  blister  below  the  angle  of 
the  jaw,  and  by  enveloping  the  neok  in  a  poaltico.  Tnu-hootomy 
may  be  necessary  to  prevent  suif<icntion.  For  IkxI  sores,  he  rocom- 
mends  washing  withawcak  solution  of  varbolic  aeid^or  bnishiog 
with  balsam.4  of  Peru  an:1  copaiba,  and  dreeing  with  lint  covered 
with  va«oiinc. 

Hendndie  in  uBtislly  to  Iw  relieved  by  warm  applications.  If 
atimlyne^  be  aeces»try,  opium  is  the  best.  \Vlicn  ancnlyncs  fail  to 
give  reliei,  t;timu1uuts  often  succeed ;  efipcciailj  when  the  con> 
dition  La  that  of  cerebral  anemia. 

All  gastro-intestirial  syraptom-i  occurring  iii  eonvalc*coiice 
Rhoiild  bo  regarded  as  dangorouii.  While  the  intestinal  ulcers  are 
Btill  iinhr>id(-(),  the  diet  mutit  Wcttrietly  limited,  and  tlio  paliont's 
cravings  disregarded.  SJid  food  must  be  strictly  forbidden, 
6uch  piitient«  should  keep  the  recumbent  or  eerai-recumbent  ]k«l< 
tiou  until  tho  ulcers  have  ctcatrlzetl ;  which  may  be  some  weeks 
after  the  convalescence  ia  well  establi^ied. 

Li  the  Boston  City  Hospital,  excessive  diarrhea  ia  quickly 
cbeiTlcGd  by  a  pill  containing  one  grain  of  opium  aud  one-foarth  of 
a  grain  of  sulphate  of  copper.  The  frequent  use  of  a  mouth- 
wash of  equal  parts  of  glycerine  and  roae-water  ia  very  pleasant 
to  the  patient 

pKPrsH  reported  thirty.nine  cures  out  of  forty  cases  in  which 
the  nitrate  of  silver  was  given  in  Iht^  wcoml  week  of  the  disease. 
Quinims  cold  hatha  and  other  remedial  moaaurea  were  employed 
at  the  Bume  time,  in  such  cases  as  required  them. 

BujAKDiN-BnAUMKTz,  in  a  recent  paper  published  in  the 
BuUeiin  Ocneralile  T^erapcMh'jHc  (Jan.  15, 1887),  calls  attention  to 
the  tact  that  the  state  of  tlie  intestinal  lymphatics  in  typhoid  fever 


TYPnOID  TEVKR. 


51 S 


is  such  that  neither  fats  nor  peptonon  c«n  possibly  be  absorbed. 
The  !yTO|ihatic  network  is  blocked  up  luid  the  mesenteric  glanila 
inflamed,  in  fueh  a  manner  that  the  chylifcroua  function  id  pro- 
foundly f«erturbed.  Ib  the  mciintime,  nothing  but  liquids  cati  be 
absorbed  by  the  vcnoue  rootlets  of  the  portal  syatem.  Conse- 
quently, the  only  nutritious  elements  which  can  ]:>eDetrate  the 
eyatcm  by  the  dig^wtive  canal  are  water  and  the  salt*;*  while  the 
albuminoiiH  and  fatty  |irinuip]e6  co{ii«ume<l  in  the  vital  processes 
an-  ."iiniishcd  solely  by  the  tia*nei<  of  tlie  jmlient. 

Only  precise  experiments  by  weighing  patienta  uonrished  on 
bouillon  oxclu»ivc)y,  and  tbo«c  submitted  to  the  milk  diet,  will 
allow  ue  to  jnrlge  accurately  the  value  of  the  latter.  For  himself, 
he  bcliev€»  that  milk  skU  otdy  through  the  water  and  the  wiline 
substances  it  containa. 

He  t-jieaks  highly  of  the  effect  of  lemonade. 

Tlte  great  indit^tionfi  for  the  emploj-ment  of  alcohol  are  the 
adynamic  forma  of  fever,  the  habitual  uae  of  alcohol  previously, 
and  the  cxtrcmc-s  of  life. 

Th'u  rigorous  regime  should  terminate  the  moment  con^'oles- 
cence  begins. 

Thi^  i9  the  latest  teaching  of  this  distinguished  clinician,  aa 
In  his  earlier  writings  he  recomm6nd<'d  the  milk  diet,  milk  punch 
and  meat  jvowdcr.  For  a  mouth-wosh  he  prefers  Vichy  water. 
DiBinfccttou  of  the  fecal  dleeliarges  is  promoted  by  euemota  of 
charcoal,  two  or  three  sjioonfulti  to  the  pint  of  water. 

Rpeukingof  typhoid  delirium,  he  urges  that  in  young  women 
the  hair  shall  be  cut  short.  This  is  but  little  of  &  6a«;rifiuo,  as  the 
hair  fullff  out  during  eonvahticence. 

Spoaklng  of  the  use  of  bathe,  he  enters  hie  decided  protest 
agaiiiKt  the  niimiiw  of  MtaListicM.  So  tunny  elements  may  modify 
the  severity  of  this  fever,  that  the  same  system  gives  very  different 
results  in  dilfervnt  pl«c<«i,  Hefwonx,  agvx,  and  in  the  Mkme  place  in 
ditierent  years.  There  is  no  doubt  that  pulmonaiy  congestions 
arise  from  the  nse  of  the  cold  bath,  ami  that  tii  some  eiiMes  intes- 
tinal hemorrhage**  result. 

*  Ka»pbriiolo«,Ti«M'li«fl,oiilrlh«  Tkibiik  sW>rb««l  bj  lli«  Uct«nl*,  utd  lli«pro- 
dada  ef  iliji^ailoa  of  HigarL,  tiarcb't«  and  iiitra|^efi«a*  fooda  rm  atMorbtd  bj  ihe  n^- 
Im>  a{  i)i«  iMftHl  svMni,  ilis  Dodur'n  caltiiliujon*  mnnot  b«  tcmnte.         C.  F.  T. 
8U 


L 


514 


UAWAL  or  TRBATUBNT. 


The  UM  of  tepid  hatha,  at  OS"  to  98^,  U  much  Ic^e  objoclion- 
able;  allaying  nervoim  exciteinciit,  ]ci«Acmt)g  the  ^en«tion  of 
buriiiiig  boat,  aud  niaiutaiuliig  perfect  cleoDlioeefe,  Tliis  mav  be 
repeated  once  or  twice  a  day,  the  patient  buing  well-sustained  by 
wiiiu  and  nu-nt-bi-otli6  given  during  the  bath. 

lie  advi^^ce  \i»  to  give  ()uininc  only  in  dmei  of  thirty 
grains  or  less,  and  uot  cootinaously ;  but  prefera  to  this  drug 
aalieylic  acid.  Tin*  should  be  administered  in  ofliviulc*,  in 
doM?.- nof  excvt^Ung  one  drachm.  In  severe  diarrhea  lie  reoom- 
nien'bi  the  salicylate  of  bisnmth,  in  doees  of  forty  to  sixty  graioa 
n  day. 

IIi'cnABii  reported  very  favimibly  uiM>n  the  one  of  anti- 
Pyrine  in  high  tcmiicratuita  in  typhoid  fever.  He  gave  fpom 
one  to  lliivc  dofie-,  of  liftecn  gruind  ttwh,  at  least  an  hour  apart. 

Fkiwicsok,  in  i-ln'  Indiana  Metllcal  Jourmtl,  jjiive  a  less  favor- 
able account  of  t.hi*  remedy,  finding  that  it  increased  the  dryness 
of  the  tongue  and  tlie  other  symptoms  which  are  hmkol  ujioa  ai 
bad  pnignnstiiw. 

liVi-  ogi-ee  most  heartily  wtlb  Ddjardis-Beaomktx  in  hi* 
ohjectiou  to  treating  all  cases  of  tj-phoid  fever  upon  one  plan.  We 
could  not  look  upon  imy  uiuii  uh  a  skilful  ph>-dician  who  would 
put  n!l  his  patients  upon  a  Procnistwun  method.  In  fact,  we 
cuiinot  now  recall  any  two  cases  within  the  loitt  fire  yean  in 
which  we  have  UBod  i)roci»ely  the  wimc  couree. 

The  m^ority  of  casei*  require  but  little  medicine.  The 
beneficial  effectw  of  reat,  quiet  and  a  subdued  light,  with  a  per^ 
fvutly  arranged  system  of  nursing,  are  more  highly  valued  by 
every  physician  as  years  bring  him  experience.  The  valno  of  free 
Tentilation  can  hardly  be  over-estimated.  In  our  opinion,  one 
of  the  most  valuable  lci8on»  over  given  to  the  profession  on  tbt* 
diseaae  is  the  celebrated  case  detailed  by  Flho',  where  an  emigrant 
vesaci  landed  a  lai^e  number  of  typhoid  caaes  at  tbe  Xew  York 
quaruntuie  station.  Aeeommodationa  being  wanting,  a  rough 
wowlen  shed  wa*!  put  up,  with  a  canvas  roof, and  one  side  remain- 
ing uneuelosed.  In  this  tbe  sick  wore  placed.  So  eligbt  was  the 
shelter  afforded,  that  the  following  night  the  inmates  were 
drenched  to  the  skin  by  a  fall  of  rain.    AU.  recovtrtdy  while  of 


TYPHOID  KEVKR. 


515 


* 


four  officers  tak«n  into  r  fnrm-honRc  for  treatment,  two  died. 
Actiuf^  upon  thU  hint,  we  have  always  envoumged  the  nurses  to 
provide  the  freest  possible  (Uft'usinn  of  air  through  the  eiek-roorn. 
Ill  epiteof  the  great  respect  due  to  the  opinionaof  Dujakdik- 
Bbadubtz  we  cuiniot  la^*  aside  our  belief  iu  the  auatAining  ()ualitioA 
of  miik;  which  we  Iiavo  long  iwcil  aa  an  almost  exchwive  diet  in 
^rphoid  fever.  Ther«  are  several  poiut*  which  are  not  positivclj 
determined  by  h\t  investigations. 

1.  Is  it  always  the  case  that  alt  of  the  iiiteatinal  lymphatic 
ftyxtetn  Is  dipuibletl  frtim  jjerfonning  itA  fanctionft  in  typhoid  lever, 
at  the  same  time?  Or  i^  not  the  disease  somewhat  progressive, 
so  that  (Wimc  of  the  lyuipimticti  are  able  to  abtuirb  nutritious 
materialn  for  a  time,  while  othent  are  disabled  ? 

2.  Kven  if  this  be  not  the  ea^e,  is  it  not  pa<Hibl(>  that  absorp- 
tion may  take  plaeo  through  another  channel?  Nature  sdows 
herself  fertile  of  resources.  She  provides  for  aet^identit,  and 
maken  allowanoes  for  cnrolessness.  She  opens  up  collateral  circu- 
lation when  a  main  arteiy  is  occluded.  She  elimatos  bile  by  the 
kidneys.  She  provides  the  pancreas  for  the  traditional  Amoricna 
who  it*  in  to«i  gri-at  a  hurry  to  inaKtieate  his  bread.  It  dous  not 
seem  likely  lliat  she. 'iljiiiild  have  no  resource  left:  in  the  present  case. 

We  trust  that  the  great  importance  of  this  subject  will 
excnw  the  digression. 

Alcohol  must  not  be  given  too  soon.  Many  cases  do  not 
rw^nire  it  at  all;  few  demand  it  before  the  thini  week,  unless  in 
the  case  of  those  who  have  been  previously  accustomed  to  its 
daily  use. 

Acting  upon  a  suggestion  of  Xlkbs,  we  are  in  the  habit  of 
prmcribing  twenty  grains  of  benzoato  of  ammonium  every 
four  hours,  as  a  routine  treatment.  W'hile  we  think  the  caaes 
thus  treated  have  been,  orb  the  vrliole,  milder  tliaii  usual,  wo  are 
not  prepared  to  affirm  m<^  than  a  possible  good  effect  from  this 
remedy.  We  have  hari  no  deaths  tn  nearly  one  hundred  casce, 
but  the  number  is  too  few  for  deductioa^of  much  value.  Nitrate 
of  silver  has  pi-ovcd  too  irritating  to  the  stomach  for  ordinaiy 
nse-.  and  aa  it  cannot  poasibiy  reach  the  diseased  portion  of  the 
intestinal  eaiul  without  being  converted  into  the  chloride,  its 
effect  cannot  be  very  beneficial. 


516 


HAmJAL  or   TBBATMBn. 


While  aotipyretic  dw^efl  nf  quinine  t-ertainly  reduoe  the 
t6iii|xjmttirfi,  tlit^ir  use  i*  followed  by  itii  iiicreajtt!  of  the  Rtnp»ir, 
diarrla'u,  dryness  of  the  totigue,  tytnittciteH  and  delirium; 
wbilo  intcstinul  hetiion-hage  ham  nti  several  occu^iotu  npp(<ftre<l  for 
the  fiixt  tiuie  the  dny  fnllnwing  the  exhibitioa  of  this  drug.  "We 
have  boon  enabled  u>  do  without  it. 

Sponging  with  luko-warm  water,  or  with  vinegar  and  water, 
is  very  agi-ecablc  to  the  patient  and  allayti  the  fever.  In  some 
caaea  we  have  applied  cold  compressw  to  the  abdomen,  in  the 
xoaniier  described  under  tlie  beading  of  Acute  Tnl>ci'ciil<>^U,  and 
have  found  the  ai>plication  useful  and  agreeable.  For  diarrhea 
we  have  obtaino*!  the  best  rcsnltK  from  the  fret»  uw  of  snbnitraie 
of  blBmUtb,  gr.  X,  every  hour.  Voh  t^inpanttea  and  tlirealcucd 
perforation,  we  have  never  had  n«flon  t«  regret  our  roliamH!  on 
"Wooiv's  remedy,  the  oil  of  turpentine,  .ijtt.  x,  every  two  to  four 
horn's.  The  remarkable  elluft*  wniietinies  exlubilcd  when  this 
rciiieily  i-<a]t|)Hed  to  external  gnngi-Due  »huuld  lead  us  to  infer 
that  its  ettocts  in  typhoid  fever  are  not "  mcndy  n  slight  «tim- 
ulfttioti," 

IiileHtina!  hemorrhage  is  not  common  when  the  diet  isslrictly 
enforcetl,  but  wlien  it  doe&  m^cur  we  treat  it  with  aeetale  of  lead, 
gr.  ij,  and  opiuro,  gr.  J,  every  two  honiii.  Ice  comproHtoe  10  the 
abdomisi  ai-e  hImi  ellicatMoiut. 

In  failure  of  the  heart,  alcohol  is  the  remedy,  with  utiych- 
nine,  gr.  ^,.  hypodemiicnlly  repeated  every  four  honw  if  nwsossary. 

Delirium  is  not,  aKvayn  due  to  ilebility.  In  one  ca^e  the 
attack  bugan  with  fiiriou*  delirium,  total  absence  of  sleep,  and  a 
hai-d,  full  pulse.  Tiathor  than  make  nue  of  a  utmit-jacket,  as  the 
FrerK'b  anggest,  we  gave  the  jiatient  tartar-emetic,  in  tlivea 
sufficient  to  calm  him.  A  i>r«tty  fi-ci^  in(f>tiiiid  hcniurrha^e  fol- 
lowed, and  the  case  jmrsued  a  more  serious  courae  than  uitual, 
lint  rccnved  in  fcmr  wii-lo*.  This  wiw  one  of  the  worst  i.aaes  we 
have  ever  witnessed,  and  the  only  one  to  which  we  have  ever  given 
ariiiniony.  In  the  prcKciit  dny  it  sounda  itingubir  to  hoar  of  anti* 
monybeingufted  in  typhnidfevcr.  but  the  physician  whodi'*'*:*tx;iat<'8 
hiH  mind  fmm  ra^liiund,  and  truutit  ciwrh  vase  a»  it  precuut.i  il<«)f, 
and  not  simply  afi  one  of  a  serie?,  will  aomctimea  meet  with  a  caae 
wliicli  requires  the  obooluto  mctliodji  of  our  father*.    VTc  believe  fad 


TTFatrS  FBVXK. 


517 


will  likewise  obtain  mor«  thau  average  rcAulte.  Eveu  were Diue out 
of  ten  raaea  (saved  by  Uio  method  of  L1BBERHBI8TBR,  wd  ftliouUl 
hope  that  a  diHercot  treatment  applied  to  the  tenth  case  would 
&av«  that  one  also. 

In  other  cased,  a  moderate  doee  of  morphine,  one-eighth 
to  ORC-eixth  of  a  grain,  has  not  onlj  diuipatcd  the  delirium,  but 
has  bauUbed  the  wearying  coma-vigil,  the  waking  dreams  and 
miMcalar  aching,  which  are  often  verj*  annoying  during  the  first 
two  weeks.  It  ia  often  only  by  close  attention  that  we  can 
Bscertuin  that  onr  patient  is  not  getting  sleep. 

If  milk  bo  unpleasant  to  ibe  patient,  we  may  enatitute  rice- 
water,  the  white  of  an  egg  beaten  up  in  wafer,  perfectly  fresh 
buttermilk,  koumiss,  or  bett«r  thau  all,  coffee.  This  maj  be 
ina<le  in  the  (mlinary  manner,  or  by  utting  rfkitiiniiH]  niilk  instead 
of  water  in  its  preparation.  If  the  French  I'hyfiieiaiis  he  ri^t 
in  regan)  to  lIih  impos8ibility  of  introducing  aliment,  there  is 
Btill  greater  reason  for  the  free  ueo  of  the  subatauees  that  enable  per- 
sons to  do  without  fooil,  i.  e,  wiftW,  tea  and  coca. 


TYPHUS  FEVER. 

Beveriime  calls  attention  to  the  iraportani*  of  preventing  the 
spread  of  the  <li9eai4c,  by  idolation  and  other  sanitary  precautions. 

All  efforts  to  cut  the  disease  ehort  have  tailed.  The  principle 
of  treatment  is  to  keep  up  the  strength  by  every  means,  until  the 
disease  has  run  it8  counw.  Constant  and  careful  nursing  is  reqai- 
Bite.  Tlic  patient  should  be  kept  in  be<l  absolutely,  and  not 
ftlktweil  to  rise  even  in  the  early  days  of  the  attack.  Ho  should 
be  fed  at  abort  intervals  with  liquid  food,  efl{>ecially  milk  and 
atrong  !iou[)ei,  and  thate  should  l>e  given  to  as  groat  an  extent  as 
the  patient  can  be  induced  to  take  thom. 

The  thirst  should  be  relieved  by  drinks  of  any  kind.  Thoy, 
as  well  a.s  nourisliment,  should  be  pressed  upon  the  patient,  aa  he 
will  not  ask  for  anything  in  serious  eaAes.  Const  iitittion  may 
require  an  occasional  dose  of  castor  oil.  The  patient  should  be 
made  to  empty  his  bla<lder  at  proper  intervals.  Sometimes  it  is 
neoeaaary  to  use  the  catheter.  Ab(iolut«  quiet  should  be  secured, 
and  efforts  to  converse  with  the  patient  should  he  forbidden.    For 


ftl8 


MAKVAL  OP  TRKATMKNT. 


ileq>laMnaflB  and  (luUrium  tlio  be«t  remoiJiee  are  quiet,  darkcnin; 
the  room,  and  applying  cold  wet  clotha  to  the  head  ateadilj. 
Opiam  aud  aodative^  arc  ill-borao.  Th«  judicious  um  of  stiin- 
nlants  in  moderate  qoantity  is  oAcn  very  advantageooa.  Tfaej 
should  be  kept  in  reserve  to  push  through  an  cmcrgoncT.  The 
best  guides  to  their  admialjtratiou  are  tbe  rapidity  and  th« 
strength  of  the  pulse,  the  dogreo  of  mosculiir  prostration,  and  the 
quantity  of  nouriuhment  taken.  Recoutve  Mhoultl  not  be  had  to 
alcohol  until  it  is  nWohitoly  nocessary,  and  not  during  the  ttret 
week  if  it  can  be  avoided,  Ae  soon  as  the  appetite  bogiiu  to 
rctnm,  reliance  should  ba  pliuMxl  upon  feeding,  and  stjmulaats 
should  be  laid  aside.  The  quantity  need  not  be  lai^;  four  to 
eight  ounce!*  of  wine  in  the  twent^'^four  bouni,  and  a  little  more, 
with  a  little  brandy  added  in  bad  cases,  will  procure  alt  the 
advantage  obtainable;  wlille  larger  AoMi  increaiie  the  heai)-«ymp- 
toms.  The  bei^t  indication  of  their  good  efTeet  is  the  falling  of 
the  pulae. 

The  position  should  be  changed  o^en,  to  avoid  the  occurrence 
of  pneumonia  or  of  bed-«oret<. 

If  pneumonia  occur,  ipecacuanha  or  sunilar  remedies  tn  small 
dones  tnhould  Ix^  given,  with  Htimulant^  Ckild  sponging  w  ex- 
tremely agi'eeable  and  soothing  to  tbe  patient. 

Lbbbbt  adnses  nearly  the  same  system  of  nursing  and  feed- 
ing. Cold  sponging  in  uecfiil  >ind  plctusuiit.  Cold  baths  at  66*^  F. 
may  be  repeated  day  and  night,  as  ofUa  as  the  temperature  risea 
above  102.2«. 

He  admits  that  drugs  are  unnecessary  and  givM  only  a  little 
diUitu  phosphoric  acid  to  satisfy  the  friends.  \Vhere  there  ia 
extreme  restledsueas,  a  warm  bath  often  proves  efficacious,  aloue  or 
followed  by  a  oold  douche.  ■ 

Large  doses  of  quinine  are  only  to  bo  used  when  the  fever  is 
intense,  and  when  cold  baths  cannot  he  u^ed  at  all.  Fifteen  to 
thirty  graiiiB  of  quinine  are  suitable  dosos.*  Where  the  thomcio 
symptoms  are  niarkod,  ipecactianlia  may  be  given  with  ammo- 
nia, alcohol  and  oil  of  anUo.  Small  doses  of  niorplliiu  may  be 
prescribed  for  the  exhausting  wakefulnu^  duriug  convaIeeceuc«. 

*  Whenever  qulolno  b  glren  as  an  antipyretic  io  whiitcrei  <)iM«ae.  it  ■hooU  b»  j 
pTra  in  ihe  c««ninK,  to  ihHt  tti«  ilocline  of  troipcnuire  ouned  kj  tbe  t|uiiiijw  vlU 
coincidr  with  the  natiinii  decline  during  the  Mrl/  monung  boun^  ukI  lli«  /ull  oSl 
of  both  will  bo  rdl  in  ibe  moniiag.  (C  F.  T.J 


mrrao. 


519 


VERTIGO. 

1.  OCULAR  VKRTIGO. 

The  trcatmont  u  that  of  the  ocular  disease  which  causes  Uie 
Tertigo- 

S.  ACRAL  ■VTHtTIGO,  or  Meniere's  DiBoaae. 

Mackesv.ib  (lir&:ta  the  [lattcnt  to  maintain  th«  rccun)l>oi)t 
posture  during;  the  attack  and  for  some  time  afterwards.  Bromide 
of  potassium  may  bcjjiven  in  ten  to  twenty-grain  doBw,  and  small 
pievcB  of  ic-e  may  be  ewallowed.  Any  fiastric  derangement  should 
be  corrected,  to  i«revent  thatsoiirroof  the  excitation  of  pnroxyBnis. 
Any  abnormut  local  condition  mu»;t  be  treflt«d.  Subsequent  to 
theattiu'k,  theuwofquiiiineiii  full d<>i4«-i,  three  ti> ten grainit  three 
tiiiwsaday.uswl  persovoringly,  is  sonietinioa  attended  with  the  beat 
resulb.  Hdwer)}  fimnd  gelsemium  and  tJie  salicylate  of  soda 
useful.  CnantcNirritanti,  including  the  actual  eauttfry,  applied  to 
the  miutoid  prot«t)«,  Iiuvc  pmvHd  stirvia>ahle  in  ttonie  casos. 

S.  Wbir  Mitchkix  reoomincnda  points  of  cautery  behind 
and  in  fnnit  of  tlitt  ear  alternately.  All  auditory  diMume  in  Uy  re- 
ceive approi>riate  trentnient.  While  acuta,  morphine  \»  very 
■ervicttible,  wirU  full  doses  of  the  broinidcji.  When  thi«e  niuiwlica 
oeane  t*)  1«;  of  value,  Ciuhcot'h  plan  of  the  heroic  use  of  quinine 
does  good,  but  hydrobromic  acid  in  full  dosc^  ithould  be  given 
at  the  BBino  time.  It  is  well  t^  wani  the  relatives  that  while 
remote  relief  ia  probable,  it  will  be  bought  at  the  cost  of  incrciwing 
deafncMft,  and  that  wb  «in  rarely  do  more  than  help  the  patient  to 
endure  his  state  until  time  comee  to  our  aid. 

3.  GASTRIC  VERTIGO,  or  vertigo  S  stomacho  laao. 

Maitn  recommends  a  cold  bath  on  arising,  followoel  by  free 
friction  witli  a  Turkirtb  towel  or  a  flesh-brush.  No  malt  liquor 
phould  be  taken.  The  diet  must  lie  plain  and  regular.  Vlchy 
water,  with  perhapM  u  little  brandy,  may  l>e  nsetl  aaadrink.  The 
patient  must  retire  early  and  sleep  in  a  well-aired  room.  Tlie 
following  may  be  taken  before  moals: 


£20 


HAKUAL  OV  TRKATMEKT. 


ft     PulT.rlid, 3j 

ijodii  bicvtx, S  ij 

PuIt.  gtntuu^ sy 

Aq.  mcntiui  pip^ 

Aq. dau^.... U    '!  iij 

il.    8.— A  UblOTpoourul  tbrioe  dail;. 

Inst«ad  of  this,  &ve  drops  of  tincture  of  nuz  vomica  may  be 
giren  before  meals,  ^lony  caM»  arc  duo  to  alcohol  or  to  montftl 
anxiety,  aud  will  not  improve  until  th&se  cauaee  are  removed. 

In  others,  oxaluria  will  be  found  to  b«  present,  and  will 
roquira  fif^t^drop  doses  of  nitro-moriatic  acid  in  water,  thrioe 
daily,  before  medls.  In  others,  the  prwwicc  of  an  excoas  of  nrlc 
acid  or  of  urates  will  necessitate  a  strict  diet,  rent,  free  exerciae, 
and  pui^tivc  alkaline  waters,  euch  as  the  Saratoga  Vichy  and 
the  Poland,  or  small  doses  of  the  citrate  of  lithia. 

Flikt  considereil  quinine  Ihe  most  useful  drug,  when  gii 
in  full  doaee. 

Ba  Costa  aay-i  tliat  it  is  often  necessary  for  tlie  patient  to 
change  his  habit*,  and  perhaps  to  Uike  a 'sea-voyaj^e.  After  the 
diet  ix  rogiiluttid,  he  gives  the  bitten  bufore  niualH  and  alkaUet 
after  eating.  Lat«r  on,  he  gives  iron  with  strychnine,  gr.  1-30, 
thric*^  daily.  Aiiot}ier  plan  eoudists  in  the  adiuiiilst ration  of 
corroBive  sublimate. 


4.    NERVOUS  VERTIGO. 

Mackexzib  stated  that  this  is  to  be  treated  bv  remoTOl  of 
caiitie  (overwork,  sexual  indulgence,  ttic  abuse  of  aluohol,  tid 
or  t«a),  by  correction  of  dyspeptic  troubles,  and  by  the  admiu  isti»- 
tion  of  iron,  quinine  or  strychnine.  The  bromides  are  to  be 
avoided. 

In  the  vertigo  of  old  age,  .Jonrs  reeoinniend!i  the  intlowing: 

it     Ilydnrgjri  chlor.  comM, ■ ^.  j 

Ol^uarini, f  j  j 

Tinct.  cinchonw  comp^ fJV 

Ol.  meniliR  pip.,, Tfl(  ijt 

U.    B. — A  l«Mpcunfu]  it)  wAtor  thr*«  lime*  ■  imj. 

8.  Weik  Mitobell  sjteaks  &vorably  of  the  use  of  the  bromides 


VOHITINO. 


521 


Or  bydrobromic  acid  in  ac-uto  attacks,  however  caused.  If 
the  tmiible  be  grave,  he  givcd  hyiKKlermtcs  of  morphine;  and 
if  there  be  marked  poUor  of  the  fnoe,  inhalotions  of  amyl-nitrite, 
or  the  intemnl  use  of  nitro-glycerine  or  of  alcohol.  Lying  down 
and  taking  an  ounce  of  brandy  will  otlccn  avert  an  attack. 

Vertigo  from  abdoiuitial  pk'thom  is  best  treated  by  laxatives 
and  the  limitiitg  of  animal  fooil.  This  will  often  be  found  uifieful 
in  vertigo  of  uld  age  with  cxeeas  of  blood.  TUo  change  brought 
aboat  by  a  milk  and  vegoUnble  diet  ih  sometimes  remarkable. 

AVheu  the  vertigo  eensos  to  depend  on  the  original  cause,  and 
becomes  c^iecntinl,  lie  i>raKunbe»  the  »)»mu  limited  diet,  after  cor- 
recting tbe  ocular  dufoe(s.  These  patient*  must  rest  supine  for 
an  hour  after  each  meal,  Kpeiid  much  time  out  of  dimix,  and  take 
eyet^matic  exorcise  or  massage.  Near  u^  of  the  eyci«  is  to  be 
avoided  at  find,  and  wliun  tliwir  n.ie  is  resumed,  it  «hoii1d  Iw  by 
gystem,  adding  a  mtnute  a  diiy,  until  the  limit  of  easy  \\s»  of  the 
eyes  \*  readied.  Practice  oftoij  enables  patieiilit  to  oven^onie  the 
tendency  to  vertigo  by  increasing  the  control  of  the  will. 


VOMITING. 

LArDBR  Bhpntos  says  that  the  treatment  of  vomttinj;  is  to 
be  direvt«d  to  two  ends :  (1)  io  rwiore  the  eaitac  if  possible ;  and  (2) 
to  lu^fn  ike  irritability  of  Me  vomiting  eenler.  Tbe  chief  drags 
which  lessen  the  irritability  of  the  vomiting  water  are  morphine, 
bromide  of  potaesmrii,  fblor.it,  and  probably  also  hyUrofyanic 
acid  and  lietladonnn.  Strychnine  nnd  xmnll  do^^  of  ipecneuanha 
are  also  useful  in  vomiting,  iirid  thoy  probably  owe  their  power 
to  their  action  on  the  vomiting  center.  Most  o{  these  drugs  have 
a  local  sedative  action  on  the  stomach,  and  therefore  it  is  advan- 
tageous to  give  them  by  the  moutli  when  |xiasib]e.  Even  when 
the  Btomaeh  is  very  irritable,  they  may  be  retained  by  giving 
tbem  in  a  contwntrate*!  form.  Wlien  the  stomm-h  wilt  not  retain 
them,  they  miut  be  given  by  the  rectiim  or  by  aubc-utaneouB  in- 
jection. In  wa-HickneKs  the  eflWt  of  tlie  {lOHition  of  the  head  is 
Bometimes  very  marktxl,  and  the  vomiting  may  sometimoa  be 
arretted  compktttdy  by  removing  all  pillowH  and  putting  the  bead 
on  a  level  with,  or  mtber  lower  than,  the  body. 


ftS2 


TiMm 


W  TRRATMFNT. 


In  eatim  of  diseafle  of  the  brain  or  its  merabmneci,  where  it  U 
difficult  or  impoiMiible  to  remove  the  cause,  we  must  tr^  to  leAten 
the  congMtion  hy  mfnnnof  ]eex-he«  and  cold  upplk-ationB  to  tin; 
head;  and  al^o  to  soothe  the  Tomiting  center  by  hydmcyanic  ■ 
Bcid.  or  by  bromide  of  potassium.  At  Oil'  same  time  howuver, 
M»n«ideralj!c  heuetit  is  obtainod  iwm  the  use  of  remedie*  which 
act  locally  on  the  atomuch,  thcwe  Bccroiiig  to  ha\x  some  reflex 
cfl'fcl  upon  the  %'omiting  center.  One  of  the  mcwt  iiwfiil  irt  tee, 
■which  may  be  constantly  eiicked,  and  also  swallowed,  iu  anall 
lumpa.  Where  tlie  vomiting  is  dejxindent  on  the  action  of 
poisons  circulating  in  the  blood,  as  in  the  later  stages  ofoon-. 
tnwting  kidney,  we  must  endeavor  to  ellintnate  thc*e  by  in- 
creiiAing  the  uotioii  of  the  kidneys  and  the  skin.  In  vomiting 
dependent  on  inflammation  of  the  mouth  and  fauooe.  wo  le^scQ 
the  irritjibility  by  soothing  or  astringent  gargles,  confeotiotM,  or 
glyccrinca.  A  eoiiicction  or  glycerine  is  often  better  tJiao  a 
gargle,  iuasmuch  as  it  remains  longer  attached  to  the  paits,  and 
thus  exercises  a  more  pi-olongcd  effect  upon  them.  TiVhcn  vomit- 
iug  is  due  iv  irritant  substuucw  in  the  cavity  of  the  :»tomach, 
such  oi  indigestible  fowl,  and  acrid  fluids  or  poisons,  it  is  beat 
troat«d  by  evncuiiting  them.  A  large  drangbt  of  lukewarm 
■water,  alone  or  mixed  with  a  tca«ix)onful  of  mustard,  is  one  of, 
the  best  means.  J..arge  draiighUt  of  trami  water  alone,  eveii  if  J 
they  are  not  ejootod,  may  give  relief  by  diluting  the  acrid  aob-j 
Btancea  in  the  Htomacb  ho  much  as  to  prevent  (heir  inilating  the' 
mucouB  membrane.  In  thi8  way  they  sometimes  relieve  sick- 
headaclios.  It  is  of  gn.>at  ini|>fjrtane«>  sometimes,. not  otdy  to 
prevent  the  formation  of  acrid  ftuhstjuiceH  by  slow  and  impwrfect 
digcetion,  but  to  jn-eveiit  the  mechanical  irritation  of  the  mucuos 
membrane  by  undigested  food.  "For  examjde,  we  not  unfrequently 
notice  that  sicknesa  and  vomiting  will  occur  iu  suseeptible  indi- 
viduals aH^r  uuuiIh  containing  kucIi  KiilMtaut;*^'.^  aA  are  not  only 
slowly  digcated,  but  are  swallowed  in  lumps.  Examples  of  these 
are  untmoked  apples  and  chcwe,  or  even  ]H)tatn(xt,  esiH^'ially 
when  imjierfectly  hoiletl  or  new.  Tbeee  articlee^  instead  of  Wing 
oruslicd  to  a  powder  by  the  tect}i,  are  swallowed  in  loiops  of  con- 
siderable Mze,  and  apparently,  in>ttead  of  pHneing  the  pylorus,  are 
retained  iu  the  stomach,  and,  partly  by  the  mcvluuticul  irritation. 


VOKITTsa. 


528 


tion,  and  portly  by  their  pivinjj  riso  to  acrid  product*,  cnnMj  sick- 
aeae.  Milk,  when  ewallowed  in  lar^e  draiiplitB,  or  when  there  is 
too  much  acidity  iu  the  tttomnch,  instead  of  tailing  in  tine  tl&keci 
will  coagulat«  in  lar^  tamps,  which  liave  a  similar  «ttcct  to  the 
cheese.  To  relievo  thin  it  i.s  advisable  to  mix  the  milk  with  soda- 
water  or  lime-water,  or  to  take  it,  at)  iu  the  whey  cure,  by  sipptng. 

When  vomiting  i*  dnc  to  alow  or  imperfect  digestion,  which 
allows  decomposition  or  fermentation  of  food  to  take  place  In  the 
stomach,  it  mny  bo  nrrosted  by  improving  the  dige«tion.  Thus 
fire  grains  of  calomel*  by  acting  on  the  stomach  through  the 
liver,  may  arrest  vomiting;  and  tinctore  of  walnot  (the  active 
principle  of  whioh.  jtiglandin,  i«  b  hepatic  Mimulant)  has  also 
been  recommended.  Fepsine  »Iso,  by  tUcilitntingdigestion,  may 
prevent  vomiting;  and  bitters,  euch  a^  caliuaba,  may  do  also,  by 
preventing  pntrefaction  or  fern lenfAt ion. 

"When  decnmposilion  nr  fermentation  of  food,  with  formation 
of  acrid  or  irritating  prodiietB,  has  once  set  in,  it  may  continue  a 
long  time,  act  the  orgiiniitmA  which  canse  it  remain  constantly  in 
the  stomach,  and  renew  the  process  in  every  fresh  supply  of  food. 
It  may  be  stoppcii  by  antisepticH.  Where  the  vomited  mattcre  are 
frothy  and  yeasty-lnoking.  sulphurous  acid,  in  doscTt  of  one  fluid 
dmchni,  diliit*^!  with  half  a  wine-jjliifwfnl  of  water,  otlen  8rr<«t» 
Huch  vomiting  like  a  charm.  CieoBOte  hat*  a  ttimilar  action,  but 
poMibly  has  Aomc  a^lditinnal  action  on  the  nervous  system,  as  it  is 
useful  even  in  cases  where  the  vomiting  doce  not  appear  to  be  due 
to  decomposition  of  food. 

Wlicnthe  mucous  membrane  of  the  atoraach  itaelf  is  inflamed 
or  irritated,  we  mu«t  try  to  lesnen  the  irritation.  The  best  drugs 
for  this  purpose  are  ice.  hydrocyanic  acid,  opium  and  bismuth. 
The  inmiluble  salta  of  bistiiuth,  and  eflj^iecially  the  suti-nitrat^,  are 
to  be  preferred  to  the  eolutlons;  and  it  is  advisable  to  combine 
them  with  inugnoMia,  potiu^h,  mh^h,  or  iyirlw>njitt'  of  lime,  according 
to  the  condition  of  the  intestines,  preferring  the  magnesia  when 
tlie  bowels  are  confinetl,  and  carbonate  of  lime  when  they  are  too 
loopc.  Sonietimeo  the  tendency  to  vomit  is  increased  by  lying  on 
the  right  side.  Tliis  is  probably  due  to  the  drag  of  the  ittomach 
upon  its  canliac  extremity,  and  partly  to  the  difficulty  with 
which  gaseous  eructations  escape  from  the  itomach  in  this  position. 


<S4 


MAKD&L   or  TBEATMEHT. 


Wlicii  thoro  h  a  Uiiidimcy  to  vomit,  therefore,  tlic  patient  ehould 
lie  dovm  on  the  left  side  ai^r  a  meal.  In  the  vomiting  of  bepA- 
titis,  in  addition  to  opium  and  hydrocyanic  acid,  we  may  aeo  io*- 
water,  or  ice  swallowed,  and  leeches  over  the  liver.  In  biliary 
calcnlu3,  we  mny  give,  along  with  opium,  a  full  do»o  of  ether 
intenmlly,  and  in  addition  may  employ  other  or  chloroform  by 
inliulfition;  Himilnr  treatment  may  he  adopted  in  caM»  of  renal 
caleuluB. 

Tn  iiitu.'«niia(vptii)u  or  hornia  we  muiit  remove  the  cause,  if 
possible.  In  peritouilU  full  doBos  of  opium  are  best.  For  the 
vomiting  in  t'y.ttitiK  and  ovariiin  [liseaseH,  we  mutit  lessen  the  scn- 
Bihility  of  the  vomiting  ceutcre  by  tlic  drugs  already  mentioned, 
and  treat  tlieloeal  oonditlons. 

In  tho  vomiting  of  pregnancy  we  trust  partly  to  the  drugs 
already  mentioned  to  act  ou  the  vomiting  center,  and  portly  to 
local  a]:)plicationB.  It  le  sometimes  arretted  by  the  application  of 
a  10  per  cent,  solution  of  nitrate  of  silver  to  the  (m  uteri,  or  hy 
slight  detachment  of  the  membrane-i  around  the  margin  of  the 
internal  os.  AVliere  all  other  methods  fail,  the  induction  of 
premature  labor  rauHt  be  resorted  to. 

A  iiioi-c  efBcicnt  remedy  than  any  mentioned  by  Briintoit  is 
xeet.  We  have  seen  every  remedy  fail,  and  the  vomitiug  promptly 
cured  hy  forbidding  all  drinking  of  water  or  of  anything  «l«e  for 
tlie  space  of  twn  linnni. 

For  the  vomiting  of  pregnancy  the  moat  efficient  remedy  in 
the  oxalate  of  cerium.  Hut  the  nervous  character  of  tbis  di> 
eaao  ia  well  exemplified  by  the  fact  that  the  netc  remedy  will  be 
inbllible  until  it  faib<  Of'<'(^,  and  after  that  it  will  be  oselees;  the 
patient  reading  the  doubt  in  the  phyaician's  foce. 


I 


WHOOPING  COUGH. 

Squire  sayu  tJiat  we  have  nosjwcifie  for  whooping  cough;  no 
drug  to  check  ita  onset  or  atop  its  progreas.  The  diseaae  is  of 
long  duration,  the  patient  a  eliild.  Hygienic  conditions  muat.  be 
ob«ierved,  and  means  used  to  prevent  distre^,  re^rving  the  more 
active  remedies  for  special  occaaions.  Kent  auid  warmth,  with 
much  individual  care,  and  the  utmost  attention  to  a  sufficiency 


4 


WHOOPIXO  COUGH.  63& 

of  pore  air,  are  rwiniait*  from  the  first,  and  indeed  throughout  the 
illnced.  It  19  not  merely  exposure  to  cold,  but  fatigue  and  inju- 
dicious food,  that  detorraines  the  acceeaioQe  of  fever  so  frequent  in 
the  course  of  whooping  octugh.  These  accessions  hare  always 
with  them  aji  iiicreaae  of  tlie  germe  of  the  disease,  more  oa  a 
reeult  than  as  a  cause;  they  are  Iwtter  letwened  or  prevented  by 
whatever  aids  the  resisting  j>oweK  of  the  child,  than  by  close 
cosseting  indoon^  or  thp  use  of  .ipeciat  gt?nnlcidc8,  exL'ept  as  * 
means  of  freabening  the  air  of  the  room;  an  aggravHtion  of  all 
tlio  symptoms  follows  the  ctrnfinement  of  one  or  two  eufl'erens  to 
a  single  chamber.  The  diet  is  to  Lie  light  and  nutritions,  millc 
forming  an  important  element  in  ihe  meal,  anfl  some  addition  to 
tlie  urdinary  food  has  often  to  be  sought,  whilet  all  things  hard 
of  (ligCKtion  or  irritating  are  to  be  arruded.  Broth  should  be 
made  wltli  vegetables  and  without  condiments;  «tew«l  fruit, 
orange  or  lemon  juice,  and  gra]K.-it  «it  grait-ful ;  gome  extra  dilu- 
i  ent  U  always  requisite.  Each  child  wants  a  good  deal  of  help 
I  and  iv;uh"  iuwUIuhl'O  ;  itome  one  should  be  near  to  calm  fr«"»m  fright 
when  the  cough  begins,  and  to  raise  und  hold  the  child  till  the  fit 
18  over. 

In  the  cotnrrhnl  stage,  if  the  ingress  bo  febrile,  a  day  in  bod 
may  1m  right;  the  child  is  butter  indoors  till  tlm  stage  is  over; 
the  room  must  he  changed  two  or  three  times  a  ilay,  s^t  llutt  one  is 
thrown  open  and  freRhonod  while  the  other  ia  occupied,  and  then 
cloBed  and  wannc«l,  in  its  turn,  tu  be  ready  fnr  use.  Some  siniplo 
saline,  u;*  acetate  of  ammonia,  may  bo  required,  or  ammonia  in 
any  dilute  fi Tin.  Ahipdf  culd  wiiter  ot^en  relieve*  cough,  but 
at  night  itomo  ipecacuanha  will  be  needed;  a  tciutprM>nful  of  the 
wine,  mixfti  with  uti  ouui-e  or  two  of  nweetencd  water  foe  the 
night,  can  be  given  by  s|x.>oufuls  till  the  cough  i-llln'r  hills  or 
mds  in  sickness.  The  bromide  of  potassium  or  ammonium  in 
rejKjjitOil  doses,  gr.  i(j-v,  to  tlic  sjHiunl'ul  of  water,  gives  relief  at 
uigbt  in  this  stage,  though  more  suitable  to  the  next,  when  aiiti- 
B|)aiimodics,  of  which  chloral  is  the  chief,  are  most  wanted.  Xo 
form  of  opium  or  of  belladonna  is  to  be  um.hI  till  the  first  stage 
ia  over,  and  secretion  i«  (m^;  nor  while  there  is  any  loail  (--onges- 
tion  nr  other  source  of  irritation  to  he  removetl.  A  wann  poul- 
tice of  crushed  linseed  acrwd  tJic  back  of  the  chest  is  often  of  tlio 


5S6 


MAMTAL  or  TKVATHSNT. 


greatest  use  when  Uie  cough  is  teaaing.  and  shnnM  alm/i  be 
applied  if  Btie  rfiltet  be  henrd,  nr  if  thcrv  hm  deficient  expansioo 
over  any  jiapt  of  the  Inng.  The  first  extensioii  of  hroiichitis  to 
tlie  lliiiT  tiilxw  oxcitw  si^asni,  for  which  u  fvw  Mimll  d<j««  of 
aiir  antimonial  may  be  proper,  if  the  child  be  robust  atid  pie- 
thorit;.  Jii  most  t.-aaca  ii>ecaciuinha  can  bo  contiuuM  in  tttnall 
doses  f'f  some  time;  the  emetic  dose  at  night  often  sMwthos  by 
emptying  the  storaaeli ;  thiB  relief  mnat  not  be  sought  too  fre- 
quently, thoTigh  ohikiron's  atomnchs  sf>on  rwwver  fVom  this  effect 
of  ipecaeiianhn  al'ler  u  nkn-p.  The  hntmidos  of  potiijwiiim  and  of 
animoiiiuni  can  be  contiuiiod  througbont  all  the  first  nnd  Aecond 
stageft  with  ttdvajitage.  A  nohition  of  carboUo  acid,  two  or 
thro*  grain3  to  the  lluid  oiuioe  of  waliT,  ni;»v-  ]«.:  l)onufiL-idily  given 
to  children  for  se\'emt  daya  together  at  the  end  of  the  catnrrhal 
stage,  in  diMCH  of  a  tenfipoonfnl  to  en  infnnt,  nnd  a  tnhle>t[)oonfal 
toachildoight  yeiirrt  of  iigo,  every  six  houn*.  The  mode  of  action 
of  carbolic  acid  i»  probably  very  moeh  like  that  of  hydrocy&nto 
acid,  once  BO  much  i-ccomiuoitdcd  in  xim  complaint;  it  not  only 
Icssenit  spanm,  hut  exerts  liome  influence  on  the  white  corpasctes. 
Some  of  tlie  mmthing  efl'uct  of  i^praying  this  ttolution  of  earbolio 
acid  with  a  small  steam  vaporizer  in  a  room  may  be  from  a  part 
being  ahuorbed.  In  many  aks&t  no  medicinal  treatment  i.i  needed. 
hut  there  are  others  in  which  the  child  is  obviously  ill,  with  more 
than  the  usual  fever;  or,  just  when  amendment  is  cxpccti/d,  and  a 
freer  secretion  should  come  on,  there  is  an  increase  of  fever,  with 
no  marked  complication.  In  these  cases  qoiiime  should  be  given ; 
one  grain  i»er  iliem  in  powder  tor  each  year  of  age,  continued  for 
two  or  three  dovs,  answers  best;  double  this  quantity  at  n  ningle 
da-sc,  and  tJiat  repeated,  haa  been  given  with  good  ertcct  during 
the  first  four  or  five  days  of  the  spasmodic  stage.  The  power  of 
quinine  in  opiHwing  the  pyrogeiiic  force  of  infci-tion  nmy  l)e  exer- 
cised through  the  white  corpuscledf  ad  explained  by  13iNz;  it  has 
been  proved  to  control  rotlex  excitability.  The  usual  dose  of 
chloral  required  by  children  is  one  grain  for  each  year,  given 
two,  three  or  four  timo»  in  the  twenty-four  houra,  in  proportion 
to  the  frequency  and  severity  of  the  apasm.  One  great  advan- 
tage in  the  use  of  both  these  remedies  is  that  they  can  be  giveo 
in  euemata,  either  uutrient  or  stimulant. 


irvoopiHO  cocoH.  &27 

Rtilicf  of  spatim  ia  tlie  main  object  of  treatment  in  the  ■^'<K>nd 
or  spasmodic  sta^e,  the  cffioacy  of  th«  meiuiB  employed  being 
mewurwl  by  tlie  (liiuttiution  in  the  number  ol'  daily  nttaukft. 
By  this  t(»t  belladonna  comes  next  to  chloral,  if  given  in  targe 
nud  continued  deceit;  with  a  child  three  yearn  old,  |th  to  jth  a 
giuiii  of  tlieext-ruotfOr  ten  to  fiftoeii  minims  of  the  tincture,  is 
reachetl  before  the  pupil  la  dilated  ;  atropine  divided  uito  dosee 
of  ,\th  or  lintli  of  a  grain  witli  sugar  of  milk,  in  a  more  certain 
way  of  getting  the  etl'ect  rtxjuired,  aud  regulating  tl»?  nuauti- 
ty  neceM^ary  to  produce  it.  Minute  i\oM»  i>f  morphine.  ,\th 
of  a  grain,  given  wilh  the  atropine,  or  small  dosea  of  any 
opiate  with  belladouita,  auswcr  butt4:r  than  if  given  uncom* 
hiitcd;  but  tliis  aiiditiou  i»  only  pcrmii^ible  when  the  seem- 
tions  are  free,  and  the  meaoB  of  relief  do  not  require  rrctjuent 
repetition ;  it  in  siwioially  useful  near  im^ds,  when  food  ia 
ejected  with  tlic  cough.  Oxalate  of  cerium,  two  or  three  graiiui 
for  children,  ten  graiua  night  mid  momiiig  for  older  persons,  is  of 
at>ehvre;  or  strong  coffee  given  at^r  mealti.  Tlie  rK)uid  extract 
of  erg^t)  one  drachm  a  day,  given  in  divided  do.>os  to  children  for 
two  or  three  daya,  13  »iid  to  control  spa^m.  Conium  reduces  spi- 
nal irritability ;  a  loscnge  made  with  one  grain  of  the  extract,  I 
of  a  grain  of  ipecacuanha,  and  ,^nth  of  a  grain  of  morphine,  mixed 
with  powdered  sugar  or  treacle,  can  be  given  in  the  earlier  spas- 
modic  attacks  of  cough  with  advantaga  A  diild  three  years  old  can 
take  three  or  four  of  tlie^te  in  one  day  without  nausea.  Ten  minima 
of  the  fiuccud  conii  are  equal  to  one  grain  of  the  extract.  The  tinc- 
ture is  equally  active.  I[ydn)bromatc  of  conia,  ^  gmin  for  a 
child,  Imn  been  given.  The  inhalation  of  ether,  othyl-bromide,  or 
of  chlomforni  is  not  ttuitable  for  children.  Croton*obloral,  in 
doees  half  those  of  chloral,  one  or  two  grains  iu  weak  golutiou,  or 
disguised  in  {)Owder,  given  to  children  three  or  four  tiino-t  n.  day 
lesoena  the  force  an<L  t'rtM|uency  of  the  spa»m.  Bromide  of  am* 
monium  \»  often  alt  that  i^  required,  but  nothing  U  ho  efficacious 
as  chloral  hydrate.  Mo«t  of  the  remedie*  vaunted  for  cure  of 
wliooping-cougb  owe  their  repute  to  tmviug  been  adniini.sterod  in 
the  fiitk  or  sixth  week  of  illness,  wbon  other  agents  are  said  to 
have  failed,  and  the  (iineaee  i?  nearly  over.  Frictiona  acroiw  the 
tiock  and  choitt  with  oji  oily  liniment,  to  which  oil  of  amlier  is 


L 


6S8 


UAKTTAL  OP  TaiATMB>-T. 


often  added,  or  with  belladonna  and  opium  liniments  comlnned, 
are  iiwcIhI.  S[iinal  inctioti,  or  ro[)fatctl  use  nf  a  iiarr(tw  poiiltioe 
with  a  little  mustai-d  along  the  spine  every  nii^ht  to  caiuo  tem]>0- 
rary  redness,  hM  seemed  to  be  of  service.  All  the  more  |>ot«it 
means  of  eoHnt*r-irritation,  eroton  oil,  blister*,  and  mnntard  i*h1- 
ticee,  are  to  be  avoided,  m  well  oa  leeches  to  the  head. 

Id  tho  tMrd  sta^e  of  whooping-cough  some  astriugeiitA  aro 
often  of  great  use;  and  restorative  meaus  are  tiiuvh  wanted.  Altim 
Ib  of  decided  benefit  when  cxcf^^ivc  secretion  is  troiiblot'ome.  So 
ift  to!u  or  aniiiiODiuciiin.  Tftnnin,  und  altio  oil  uf  tur]>eiitiiie  are 
mod.  Zinc  in  small  diK<e«  U  useful.  One  or  two  grairu  of  tho  ox- 
ide may  be  given  three  or  four  timos  a  day  iti  powder,  or  half  a 
grnin  of  the  sulphate  ill  Molntioii.  An  emetio  niiiy  bo  required, 
to  remove  excess  of  mucus ;  zinc  can  at  thin  time  he  added  to  the 
ipecncimnhu,  whivh  alone  if  Ixwt  for  the  airlier  dtapi's,  when  eme- 
818  ie  more  often  refjnired.  Purgiiti^-es  are  at  no  time  advb«alile. 
A  drop  of  lumlanum  before  fo^id  atay*  sickneiis.  The  minsml 
acids  make  an  ngn-eable  «id  to  diirestion.  Bafk  or  iron  nmy  l»e 
recjiiire*!,  and  cfKl-liver  oil.  Miiiiit**  dciMM  of  araenic  with  uicals, 
and  iodine  extemidly  over  small  spaces,  ou  alteniaie  days  to  back 
and  front  on  eitlicr  side,  wmnterafl  obstinate  ndi'nnpathy.  Cliange 
of  air  has  a  remarkable  eft'ect  in  restoring  ttp[)etite  and  removing' 
spasm,  aller  the  di.Hviwe  is  <piite  over;  it  should  not  l»  sought  b»- 
fbre  six  weeks,  and  is  often  better  deferred  till  two  ramtha 
fix>m  the  comnieuoement  of  illneoM.  If  the  tiiberviilar  dtathaaia 
have  been  set  up  or  evoked,  the  greatest  care  in  nursing  and  the 
most  perfect  quietude  arc  essential.  Qrcat  riske,  without  benefit* 
have  been  run  by  taking  children  tn  cTisworks  during  thi'  courw 
of  the  complaint.  Attempts  to  cut  nlioi-t  ibu  diswiRi-  by  iii  liuUttion 
or  insuHlations  of  germicideA  fiul.  A  vraak  spray  of  carbolic-  Add 
in  the  room,  or  o  solution  of  it,  or  of  peroxide  of  hydrogen,  on 
clotlis  or  near  the  child'A  couch,  or  sprinkled  about,  do  go^xi  by 
purifying  the  air. 

I-oosita  8[)ealu  favorably  of  the  carbolic  acid  spray  aiwl  <rf 
qainine.    Locul  applications  do  more  hann  than  good. 

Henoch  says  that  ho  has  come  to  re\y  on  one  drug  alone,  %'i^, ' 
morphine,  which  at  leoat  moderates  tlto  violent  |>aroxytiuu. 


nally  OiR  iioHiirnal  ones,  aiid  diiiiiiii^oii  llieir  fn*<|iieiicy. 
Sot  the-  raotlier  luiutt  Ije  named  to  8iupeii<l  the  medicine  it'  iiiiusuieI 
drowsinesR  develcpp.  He  prefent  tliiM  drug  ki  at  ixtpiiWT  t'ut  givM  it 
ooly  in  i-ases  wlioru  nwro  than  twenty  paroxynnisot-cur  in  iwenty- 
t'oiir  horns.  Ill  tnitder  cwiet!  ho  recommends  inlialalions  of  OftT- 
bolic  acid,  one  to  two  per  cent.  If  the  aproy  a])paratu8  bo  difficult 
to  work,  the  iiir  of  the  room  may  lie  impregnated  wit  h  the  vajwr, 
a  ^Iionge  dipi^d  in  the  Holutioii  hung  at  the  head  of  the  bed,  and 
oct-asionaUy  hel<l  in  fivint  of  the  rhildV  nose. 

Iti  fine  u'eatber  the  fresh  air  should  be  er^oyed  m  much  ob  poesi- 
ble,  but  in  windy  weather,  or  wliere  bi^nrhitis  ii"  prcwnt,  tbi» 
should  be  Btndly  prtihibittH). 

KimiBR  coiH)dcr»  lobeliA  QaefUl  in  the  firat  stage. 

Bartiiolow  pronoimce«  codeine  the  mo«i  efficient  antiftpas- 
modii;.  A  idiglit  hypnotic  elU-c't  »lionld  tie  tnainlained  fontttaotty. 
The  blOlllides  moilenite  the  \'iolence  of  the  ttpasmodie  attacks. 
Of  these  the  monobromide  of  <iimphor  seems  tlie  best.  Two  to 
ten  grains  may  Ije  given  every  four  lioiirs.  The  ven'  hewt  renulta 
and  often  an  anvst  of  tlic  dieoase  niay  be  procured  by  fnll  dotted 
of  quiniiie.  Xiti-ic  acid  ban  given  excellent  reKultM.  Tie  thinkn 
the  Niipitosed  efliitncy  of  iidiRliiii^  the  atmos]>bere  of  tho  gatt  workit 
depends  on  tlie  mental  Inipi-etMion  on  tlie  infants 

<)j:itiiAHti  rtHoiiniit'iidrt  the  fluid  extract  of  tbc  leaves  of  OftS- 
tanea  vOBOa  IChestuutt  a*  an  efficient  remoiiy  in  many  ea««»i. 

The  itijectiou  of  a  solution  of  quiuizie  into  the  pharynx  haJ 
been  lately  oommendod. 

Thero  is  tio  remedy  witli  which  we  are  acquainted  whieh  will 
certjiiuly  relieve  every  attack  of  whooping-cough.  Bromide  of 
auimoiiiuni  hel|M  in  tuonie  easiest,  failts  in  (ither».  The  monobrouiide 
uf  camphor  in  more  efiicient,  but  can  t^'^rcely  be  put  up  in  a  form 
wbich  patiente  can  be  induceil  to  take.  Nirmkyeh  mentioned  the 
relief  obtained  by  drinking  a  tittle  solution  of  baking  aoda  when- 
ever the  paroxysm  is  telt  wiming  on.  The  alkali  diiwolvefl  tlie 
mucim  an<I  it  ii4  then  readily  coughed  up.  We  do  not  uee  bow  the 
solutiou  can  be  of  much  um,  aa  the  Hpoani  come;*  on  tom  quickly 
for  any  Huch  solvent  action. 

21 


L 


6S0 


MASDAL  OF  TBBATHBST. 


We  hiive  witnesseil  the  gooil  eflects  of  the  inhalation  of 
illuiaiiiutinj^  gon  tno  rnxjuciitly  to  doitlit  ite  utilit,v.  The  [patient 
iieecl  not  be  sent  to  the  ga»-w(irk>),  as  nil  that  in  needed  is  to  plaui* 
tliL*  chiM  in  a  rtniiill  n>fiiii  and  turn  on  Hie  gatt  until  it  in  unpleo^ 
antly  atrang  in  the  air  oC  the  room.  Great  relief"  usually  follows. 
We  know  of  no  ttiiigle  ronicdy  which  roliovft*  a«  large  a  ]>rf)|iortiou 
of  caftjflL 

III  cttMce  of  cougli  jiruloiigod  by  habit.,  n  roniovnl  to  the  scuaido, 
vACL-inatiou,  aud  a  libeml  tiw  of  the  n>d,  have  caolt  had  their 
ndvoi^atw  niid  their  succoA>t^.  Tho  om  of  I'lill  doMM  of  quinine 
13  I'lvquently  cH'eotnal. 


YELLOW  FEVER. 

HAHSif>c)i  advi^vt  the  nkoet  thorough  diainfection  of  veaaels 
from  sickly  i^orts,  and  of  their  {losseiigeni  and  crew.  tjtric*t  iieclu- 
sion  for  two  week?  will  bo  requisite  if  reeent  cn^t*  have  occurred 
on  board  the  veescl. 

rcrsone  in  an  infot-tod  |)ort  fthoutd  betake  themaelvee  to  the 
hilla,  or  inland  beyond  the  rench  of  aalt-wuter. 

Il'  c-onii>eHod  to  roninin  in  danj^rou^  fjuarterf:,  men  should 
avoid  all  oeaksional  causes,  withoiin>o(*oining  too  anxioTis.  The 
ctHeacy  of  prophylm^tiv*  is  very  <loubtfid, 

In  the  treatiiKviit  of  this  diMiMc  there  haa  as  yet  been  no 
specific  diecovorcd.  At  the  Ijcijiiniing  a  dose  of  castor  oil  or  of 
ralomel  in  given.  Severe  hnckiwlio  may  call  for  dry  cti]*  or  a 
blister  to  the  lumbiir  region.  Hy]>oderuiic  iniectionn  of  quinine 
arc  the  Iwwt  remedies  for  tlie  i'cvnr.  If  the  vomiting  of  bloml  Iw 
cwpious,  ice  and  Btyptie*!  niay  l>e  given  internally,  and  icetl  onni- 
presww  spplicd  to  the  opigantrium. 

Davis  a4lviiH:i*  tJiat  from  «ix  to  twelve  leeches  be  applied  to 
tiie  e|iigastriiim,  or  otit«  to  the  epine,  with  Rinapiams  over  the 
stoinnch,  it  hot  mustard  bath  to  the  feet,  mid  cold  clotlw  to  tJie 
head.  The  whole  Ixxly  may  be  f)^>onged  with  cold  water,  and  tbo 
fidlowing  mistnrc  given  iiitcnmlly: 

B     Acid,  itirbolici, gr.  vi^ 

UVwlni, 3  iv 


TVT,1.0W    PEVBR. 


531 


TSnrt.  Kdneiaii, TS'^ 

■Hnct.  vcralri  vir'uli^ 5  J"* 

Tiiwt,  iipit  odinph.,, ...■.••■.•■.■•.>>■>>$  Ij 

Aquop, fj  ij 

V.    S. — A  tetwpiMnftil  «*crT  Iwrt  to  four  honm, 

AIw.>,  two  j^miiitt  *if  calomel  nUonuilely  with  tlio  mixtiiiv. 

Tl'tlio  case  he  located  in  n  iiiakrial  dietrict  lie  gives  quiuiue 
111  Cult  (Uiece.  If  tlio  liowi'ttt  tin  not  move  aflei-  uix  jiowdiTs  of 
ilomet  have  Inwn  takfu,  ho  admiiiistore  a  snlioe  laxative.  Then 
llie  ctiUiiiicI  is  repti],(!eiJ  by  a  iHaplioretic  niixture,  and  this  u  coii- 
i)iuiG(i  until  tlie  enJ  of  tho  soeond  day. 

Tr  the  teni]ieratiiru  l)i!  Hiun  lovveivtl,  the  itiHtlcKuiiicws  luid  imiiin 
atiatod,  tho  urino  more  free  and  not  very  album iiiouft,  the  nkiii 
moist,  mid  the  piilieiiL  Iitij^eful,  Iiu  oniiui  tliu  venilrtiin,  but  con- 
linues  tlie  remainder  of  the  treat  mout  until  convalesfonoe  is  eslab- 
ILtliwl  or  the  yellowneot  Ix-giiis  to  apjtear.  The  juitient  luiiKt 
then  lie  kept  entirely  at  i«^t,  and  only  the  mo^t  bland  articluit  of 
fiHKl  he  tiiken.  Hinall  nnd  fn.*(|iicnt.  Josun  of  tinctun>  of  iron,  thv 
ttiqieritine  emulsion,  quinine  or  strychnine,  appear  lo  he  tho  best 
iviiiwlie*  in  this  uoudition.  The  lii«t  two  can  Ije  given  liypoder* 
niiealiy,  nnd  the  food  by  enematn.  Suluoquciitly  ihc  fecdiug 
iihotiht  l>c  done  witJi  the  grenteAt  care. 

It  h  wfll_known  in  cities  where  yellow-fever  is  prevalent,  tluil  the 
hillrt  lire  wile  l'n«n  it*t  attacks.  The  poison  is  active  only  after 
sunset,  mitil  sunrise,  and  hence  prudent  people  do  ntit  venture 
down  intti  ihc  low  jiorliims  of  tho  city  during  (he  night 

All  sort«  of  exccanes  predispose  to  yellow  fever;  particularly 
veiiei-ml  exttsBs.  It  iw  best  to  koop  the  st<>nuu-h  full,  as  a  hungry 
iiiiui  will  more  readily  be  attacked. 

There  la  maircely  a  h<»pi3  for  tlie  habitual  consumer  of  alcohol 
if  he  bo  oiicc  aeizotl.  Our  own  ex|)crieiiee  Iium  luHiu  Uiat  the 
drinker  was  more  liable  to  bo  attacked  than  the  teistotaler. 

Ships  anclioN^l  some  distance  from  the  ehi'i-c  arc  eafr. 

The  (ilthiost  ]>Iaci»  in  a  city  arc  the  moKt  dangerous;  cs|)e- 
eiully  the  i>oint«  where  newors  diachat^e  their <'ontciitji. 

A  very  Buet-oiwfu]  method  of  treatnichi  in  tli©  liospitub  of 
Rio  do  Janeiro  eoriatdtod  in  putting  tlie  {loticnt  tu  IkhI,  covering 
him  with  a  blanket,  iiiid  giving  nothing,  excupt  a  sup  of  wat«r 
ocuasloually.    The  pby^-iciann  argued  that  it  is  useler^s  to  put  into 


hSi 


UAHDAL  or  TBEATUSm. 


the  Rtomach  rood  which  caiinot  be  tligeeted,  and  wbicli  will  bej 
sure  to  bring  on  vomiting  ;  while  this  whole  course  of  the  Jiaes 
is  too  short  to  c%\i^  any  risk  from  the' deprivation  of  fcMxI. 

A  jiriori.  we  would  my  tliat  if  then;  be  a  diflca^-  in  which  the 
use  of  cold  hatha  i^  imlicated,  it  is  this  ;  for  a  temperature  above 
'iOt>°  18  almost  Murcly  fatal,  while  if  the  fever  <lo  not  reucli  that 
jKiint  the  case  is  almost  sure  to  rarover.  Beeides  this,  the  intense 
renal  hyperouiia  (in  which  lies  the  elnef  (longer)  deniandx  tlie 
(([►eedioHt  relief;  niich  iw  can  only  Iw  obtainetl  from  the  local  use  of 
cold. 

But  in  the  New  Orleans  epidemic  of  1879,  the  antipyretic  eys- 
tem  wae  fjnithfully  tried  with  but  meagre  ret^ult^. 

Unsatisfactory  as  are  the  tlieraiMJuties  of  yellow  fever,  we 
have  learned  oriu  Icaaoii  in  mudeni  tiroea :  tliat  thorough  cleanli- 
UWB  U  a  certain  preventive. 


-*^>^-^ 


VS:5<-^ 


LANE  MEDICAL  LIBRARY 


To  avoid  fine,  this  book  should  be  returned  on 
or  before  the  date  last  stamped  below. 


UlOl     Taylor,    C.F.          65777 
T£4           Manual  of  treatraent. 

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