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Full text of "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"

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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. 



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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 landan nm 
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* 
i nm 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— 

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 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 

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 re gnlation 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 
awit liow, 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 opi um, 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 l td 



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 a dheres 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 

[ th e 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 ca refully washed wit^ yoan am i 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; ti ncture of io dine \$ 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 tl i 

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*, 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 heroorrb aga 
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 a dvancing 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 a rr e ie. 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] 

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 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, ^' ^ry jtl^"" ' 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 m odera tion, 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 o f 
t)ie alini eiimry^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. 

. t fiT'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 
t h e se 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, be