BRYCE'S 
POCKET PRACTICE. 
A. COMPLETE AND CONDENSED WORK ON THE: 
PRACTICE OF MEDICINE FOR PHYSICIANS 
AND STUDENTS. 
BY 
CLARENCE A. BRYCE, M. D„ 
kuthox of Bryce's Visiting List ; Author of The Physician's-- 
Companion ; Editor of The Southern Clinic, and Editor 
of The American Doctor; Member of the Amer- 
ican Medical Press Association. 
Copyrighted, 1892. AH RiWits Reserved. 
RICHMOND, VA. 
THE SOUTHERN CLINIC. 
1892. PREFACE, 
In the preparation of this little volume it has been our endeavour 
to give, in the most condensed form, a modern work on the Practice 
of Medicine, which will at the same time be full enough for all prac- 
tical purposes and yet be of such size as to enable one to carry it in 
the coat pocket easily. 
We have availed ourselves freely of the latest standard literature 
by the recognized authorities in the profession and have added our 
own personal experience thereto in the pages following. That the 
little book may prove of real service to the "rank and file" of the 
profession is the sincere wish of 
THE AUTHOR. BRYCE'S POCKET PRACTICE. 
GENERAL INTRODUCTORY REMARKS. 
In a condensed work on the Practice of Medicine, it is 
both impossible and unnecessary to go into lengthy 
details of the many theories of diseasesand the supposed 
correct methods of treatment appropriate for the same. 
A work on practice should really be free from conflicting 
theories or uncertain advice of any kind. In the present 
book we propose to give our readers the results of our 
experience and observation in the best and surest 
methods of curing sick people, whether this observation 
agrees or not with the various popular theories of the 
day. 
With this statement, which we trust will relieve us of 
any appearance of egotism, we shall give a brief outline 
of some of the general principles applicable in the treat- 
ment of the majority of diseases. Just where sickness 
begins and where health is departed from in slight cases 
is often a difficult matter to decide, but one of the most 
constant and unfailing signs of a departure from the nor- 
mal standard of health is fever. 
FEVER. 
There is probably no actual departure from the normal 
standard of health which is not accompanied or even pre- 
ceded by fever of more or less intensity. Therefore fever 
should be looked upon both as a valuable aid in detecting 6 
bryce's pocket practice. 
the presence and advance of disease, and, in many in- 
stances, as a salutary effort of nature to rid the system of 
morbid products. It is therefore important for the prac- 
titioner to study the general characteristics of fever as 
they appear in common in all complaints. With this 
general knowledge a case need not go along untreated 
while waiting to make out a diagnosis, which, after all 
may never be reached. Fever indicates at all times some 
departure from the normal equilibrium and can be rec- 
ognized by certain well marked symptoms in all cases. 
The most prominent symptoms of fever are abnormal 
heat, acceleration of circulation and respiration, dimi- 
nution of secretion, and a feeling of general uneasiness or 
malaise, as the French people call it. Now while we 
should regard all fevers as salutary efforts, we should not 
lose sight of the fact that, beyond certain limits, these 
febrile disturbances are the most serious and dangerous 
conditions that could possibly surround a patient. It 
will be seen, therefore, that there are certain indications 
for treatment in these fevers, whether they be specific or 
symptomatic, and oftentimes we can, by a prompt treat- 
ment of these symptoms in themselves, cut short further 
pathological developments. We mention this for the 
sake of those who have been taught not to treat symp- 
toms. While a correct diagnosis is a most important 
matter yet we have been compelled to treat many cases 
of sickness from time to time during quite an extended 
period in which we could not make a satisfactory diagnosis, 
and indeed we had no need of a diagnosis. The careful 
and observing physician cares but little what name he 
gives his case provided he can abate and regulate the 
various disturbing symptoms as they arise. 
As we have said, therefore, there are general lines of 
treatment to be adopted in all fevers and applicable to INTRODUCTORY REMARKS. 
7 
all fevers. For example, we endeavor to reduce the 
temperature to the normal, to regulate the secretions, 
restore the circulation to its equilibrium, and favor the 
action of the skin and secretory organs. We reduce the 
temperature by refrigerant drinks, diaphoretics, the va- 
rious antipyretics, cold sponging, baths, quinine, salicin, 
etc. We find the circulation brought nearer the normal 
standard by alcohol, ammonia, prussic acid, digitalis, 
veratrum viride, antimony, venesection, etc. When the 
temperature reaches the normal grade by these measures, 
the secretions will be found to have been properly re- 
established. Most fevers are due to special causes or 
special poisons, though, we undoubtedly have many forms 
of fever which are purely irritative and dependent upon 
other disturbances within the system. Other special 
general fevers will be considered further on in this work 
under the appropriate headings, though, at this point, 
we will mention the various malarial fevers, typhoid and 
special eruptive fevers, all of them, nevertheless, re- 
quiring the general essential treatment we have outlined. 
Inflammation.-Of equal importance with fever, will 
be found the general different inflammations which affect 
in a similar manner, more or less, all of the organs and 
tissues of the body, constituting, according to anatomical 
relations and cellular structure the different diseases in 
the different organs, resulting in various pathological 
changes and local destruction of parts. Inflammation 
may result as a sequel of local or general disturbances, 
direct mechanical injuries, irritating poisons, or depressed 
or impoverished conditions of the blood itself. 
Inflammation again is generally recognized by some of 
the more prominent symptoms of fever. For example, 
the old description of heat, pain, redness and swelling, 
apply very well indeed at the present time to what may 8 
bryce's pocket practice. 
be observed in ordinary inflammatory conditions. We 
have at first dilatation of the blood vessels and commenc- 
ing congestion, followed by stasis or stopping of the cir- 
culation, with a loss of the special functions of the blood 
globules extravasation and exudation in the surrounding 
cellular tissues, thus giving us swelling-pressure upon 
the sensitive nerves, causing pain-and death of the part 
from rapid disintegration. Such phenomena as these 
going on at any local point in the system will certainly be 
announced by general or symptomatic fever. 
We do not propose to give a full treatise on the subject 
-of inflammation, but a few leading points, which will 
serve the practitioner or student in the general treatment 
of all cases. We will say, for the general treatment of 
inflammation, the effort should be to do as we have done 
in fevers ; reduce the temperature, calm the turbulent cir- 
culation, and restore the secretions. Wherever we can 
find the local point giving this trouble, we should adopt 
in addition to the regular treatment also local treatment 
to the parts on the same general principles that we have 
■outlined, namely, local depletion by means of cups, 
leeches, scarification, hot or cooling lotions, etc., etc. 
All special inflammations will be treated of further on, as 
they will occur in the various individual diseases, and we 
will reserve only this to be said in reference to them, that 
the practitioner may not be surprised at peculiar results 
in special inflammatory conditions of certain tissues. For 
example, in parenchymatous or glandular structures, the 
tendency is for inflammation to be intense and rapidly 
run on into the formation of pus and death of the parts. 
In serous tissues, we have of course a greater tendency 
to the production of plastic lymph and serum which 
quickly become organized, forming dangerous bands 
here and there, limiting action and usefulness of the parts INTRODUCTORY REMARKS. 
9 
or forming pus, and when we take into consideration 
each special tissue, we may expect some peculiar ten- 
dency under inflammatory conditions according to its 
own anatomical structure and functions. 
Bacteriological Pathogenesis.-Before going into 
the consideration of the various diseases, we will call 
attention to the subject of bacterial influence in the pro- 
duction of disease. For some years past this has been 
one of the most severely ridden hobbies that has been be- 
fore the profession for a long time. We have been in- 
formed ever and anon of the discovery of this or that 
microbe, until now we have the claim made by enthusi- 
astic workers that the specific microbe or germ of nearly 
every disease has been discovered. The outcome of all 
this agitation has been to divert much thought from the 
actual causes of disease and their correct management. 
Proceeding upon the presumption that the principal line 
of treatment was to annihilate the various bacilli by means 
of antiseptics and germicides, other and more important 
measures have been neglected or overlooked by the en- 
thusiast. Indeed, it is highly probable that much harm 
has been done both in surgery and midwifery as well as 
in general practice by the reckless use of the so-called 
germicides. 
But we will not trespass upomour space in simple con- 
jecture. We will introduce the conclusions of one of the 
ablest observers and experimenters in this or any other 
section of our country, on the subject of the bacterial 
cause of disease. Dr. L. B. Anderson, of Norfolk, Vir- 
ginia, in the Southern Clinic for August, 1886, after detail- 
ing the results of a long series of laboratory and micro- 
scopic investigations, and after a very ample study of 
various cultures of these germs reaches the following con- 
clusions : 10 
bryce's pocket practice. 
" If then they cannot live in healthy tissue, (and this he 
proves) they can only have a name and a being in dis- 
eased tissues. If they only find a nidus and a home and 
nutriment in diseased tissue, how can they produce dis- 
ease in a locality in which they cannot live ? If, therefore, 
bacteria are only in diseased tissue, their presence, with 
reference to the disease can only be said to be post hoc ; 
while the disease by no logical deduction whatever, with 
reference to them, can be said to be propter hoc." 
As far as we know at the present time there is not the 
slightest proof of the capability of these bacilli to gen- 
erate disease in the system, and their presence in certain 
diseased tissues only argues their ability to live in suitable 
soil. . If the ground taken by the advocates of the germ 
theory of disease was true, according to their own claims, 
there should not be a single living human being upon the 
face of the earth today. We do not pretend to say that 
the system may not be impressed and that disease may 
not be induced by morbific agents of all kinds, including 
micro-organisms occasionally ; but the statement that the 
majority of diseases are induced by the action of certain 
specific micro-organisms capable of generating certain 
specific diseases, is both absurd and untrue, and calcu- 
lated to do violence to far more rational and better estab- 
lished laws of pathology. • 
GENERAL TERMS IN SYMPTOMATOLOGY. 
The Incubation Period is the time between exposure 
to a disease and the manifestation of the first symptoms. 
The Prodromic Period is the time of early develop- 
ment of a disease. 
Objective Symptoms are such as are apparent to the 
observer. INTRODUCTORY REMARKS. 
11 
Subjective Symptoms are those complained of by the 
patient. 
Aetiology is a study of the causes producing diseases. 
An Infectious Disease is supposed to be due to the 
introduction of a disease germ into the system from with- 
out. but not capable of reproduction in the body and not 
communicable to another individual. 
A Contagious Disease is due to a specific cause and 
capable of being transmitted to others. 
A Sporadic Disease is one occurring in isolated 
cases. 
An Endemic is where many cases occur in a limited 
locality. 
An Epidemic is where a disease spreads over a wide 
territory. 
The Pulse in an adult should normally average 65° to 
750 per minute, in infants it should be from 1 io° to 130°, 
in old age about 6o°. The pulse may be very rapid in 
low fevers, anaemia, great debility, etc., or very slow in 
brain injuries, effusion, and cardiac muscular failure. It 
may be small, hard and wiry in inflammations of the peri- 
toneum and other serous membranes. 
The Tongue in health is small, smooth, slightly 
coated in the morning at times and pleasantly moist. It 
is denuded of epithelium in scarlet fever, dysentery, some 
gastric conditions, occasionally in pneumonia, and a few 
other conditions. It is dry in various acute diseases,, 
coma, and in diabetes. It is extremely red in gastro- 
enteric irritation, and this is especially noticeable at the 
tip. When it is glazed, smooth, and glossy with promi- 
nent papillae, it indicates great prostration. 
Tem perature.-The normal temperature of the human 12 
bryce's pocket practice. 
body is 98° F. Children have normally a higher temper- 
ature than adults (about one or two degrees). A tem- 
perature continued above 98.5° indicates prostration and 
illness; ioi° to 105° severe fever ; 105° to 1080, great 
danger ; 108° to 1090, impending death. A temperature 
of 1050 or 1060 on first day of illness indicates ephemeral 
or .malarious fever; certainly not typhoid. In typhoid 
fever, an evening temperature of 103.5° indicates a mild 
■course ; 105° in the evening or 104° in the morning, in 
the third week indicates danger. An uniform tempera- 
ture from morning until evening is favorable. A high 
temperature from evening until morning is unfavorable. 
A falling temperature from evening until morning is fa- 
vorable. A rising temperature from evening until 
morning is dangerous. 
Fever Diet consists in giving the patient light, cooling 
and easily digested food every two or three hours, day 
and night. The best food of this character is milk, soups, 
broths, arrowroot, buttermilk, etc. 
Fever Treatment consists in giving refrigerant 
drinks, cold sponging, the various antipyretics, sedatives, 
diaphoretics, etc. The patient should be kept in a quiet, 
darkened and well ventilated apartment and guarded 
against all noises and other disturbing causes. 
SIMPLE CONTINVEI) FEVER Fehricula. 
'I'he simplest form of continued fever may be seen in 
the ephemeral fever of over fatigue, exposure, mental 
worry, and want of food sometimes. It may last from 
one to six or seven days and can be traced to no special 
pathological lesion. 
Symptoms.-Chill, followed by sudden rise of tempera- 
ture, which may reach 104° in a few hours. This high TYPHOID FEVER. 
13 
temperature subsides speedily in from a few hours to a 
few days at most. There is usually headache, disordered 
digestion, some pains in limbs, thirst, coated tongue, and 
constipation. 
Prognosis.-Always ends in recovery, usually by crisis. 
We have a copious perspiration, abundant flow of urine, 
and a general restoration of secretions. 
Treatment.-Quiet rest in bed, light unstimulating diet 
of milk, broths, cooling acidulated drinks, and some 
gentle aperient, usually some of the mild salines. Spirits 
nitre, or liq. ammon. acet., may be given in iced water. 
As the fever leaves the patient tonic doses of quinine and 
dilute muriatic acid may be given for a while. 
TY PHOID FEVER-Enteric Fever, Abdominal 
Typhus. 
This is the typical and most serious form of the contin- 
ued fevers, excepting true typhus, which is seldom seen 
in this country. 
Symptoms and General Characteristics.-This 
disease is peculiar in its slow onset, its marked debility, 
diarrhceal tendency, and temperature record. The pro- 
dromal period lasts from three or four days to as many 
weeks ; is characterized by chilliness, general malaise, 
feverishness towards night, loss of appetite, great debility, 
probably some diarrhoea, and occasionally epistaxis. In 
the first week of actual development of fever, we have 
the fever continuous, with a gradual ascent from 990 up 
about one degree every evening until within six or seven 
days the temperature will have reached its height, 1030- 
1050. During this continued rise we find a morning de- 
cline of about one degree less than it was the previous 
evening. After the maximum temperature has been 14 
BRYCE'S POCKET PRACTICE. 
reached it remains almost stationary with a slight morn- 
ing remission and evening exacerbation until the thir- 
teenth or fourteenth day, when it, in favorable cases, be- 
gins to decline behaving vice versa in its descent as it did 
in its ascent until from the twenty-first to the twenty-fifth 
day the evening temperature reaches the normal. Dur- 
ing this first week we have usually diarrhoea, if not pres- 
ent before ; anorexia, lassitude, headache, soft compress- 
ible pulse, and frequently delirium at night. In the second 
week from the above temperature record we may look 
for increase of all of the symptoms, higher fever, stupor, 
hallucinations, dry tongue, the diarrhoea of thin pea-soup 
offensive stools continues, with tympanitic distention. 
About this time we may look for a slight eruption of rose 
colored spots about on the thighs, abdomen or chest; 
they are seldom seen on the face. These spots quickly 
disappear under pressure, but return again. They are 
scattered, seldom showing over twenty or thirty on 
the whole body. They are by no means constant and 
should not be considered necessary diagnostic points. In 
the third week in favorable cases all of the symptoms be- 
gin to subside and the patient commences to improve. 
In unfavorable cases we have a deepening of the stupor, 
excessive diarrhoea, rapid exhaustion and death from this 
cause or some complication. 
About the middle of the fourth week the temperature 
should be normal and the patient convalescing. 
The immediate cause of this disease is not fully under- 
stood, but it is reasonable to suppose from all of the evi- 
dence that it may be due to several methods of introduc- 
tion of poisonous material into the general circulation. 
The use of drinking water contaminated with dejecta 
from typhoid patients, diseased milk and similar circum- 
stances have all been considered causative of the disease. TYPHOID FEVER. 
15 
We believe many cases originate from pure debility and 
over work, and that the general system becomes poisoned 
from slow absorption of morbific matters in the intestinal 
tract. 
The chief pathological or anatomical lesions found are 
in the glands of the small intestines. Peyer's patches and 
the solitary glands seem to swell and become elevated 
several lines during the first ten days, then they inflame, 
ulceration occurs, and sometimes perforation of one or 
all of the coats of the bowel may follow, causing fatal 
hemorrhage or peritonitis. This ulceration continues 
from this time on to the twentieth or twenty-fifth day, 
after which cicatrization takes place. The mesenteric 
glands are always involved and the spleen is found soft 
and enlarged in typhoid fever. Associated with these 
symptoms we may have bronchial cough, hypostatic 
pneumonia, nervous troubles and kindred affections re- 
sulting from this condition of profound systemic poison- 
ing. 
The Diagnosis is plain from the detailed symptoms 
given, and possibly the only confusing diseases would 
be prolonged febricula, mild typhus, or some malarial 
complications. The rapid rise of temperature, period- 
icity, sudden onset, intermission, etc., will settle 
the matter in favor of malarial trouble ; while previous 
history, apparent cause, and temperature will help out in 
favor of febricula. The average mortality is from twenty 
to twenty-five per cent. 
Recent writers, advocates of the forcible reduction of 
temperature by the cold bath, claim a still further reduc- 
tion of the mortality rate. The disease is most prevalent 
from the ages of fifteen to thirty years. It seldom ap- 
pears in children under ten or in persons over fifty. 16 
bryce's pocket practice. 
Prognosis will depend upon the age, severity of symp- 
toms, previous condition and general surroundings of the 
patient, and may be made out from the outlines given 
above. We have to take into consideration, however, 
possible complications in shape of pneumonia, brain dis- 
ease, heart failure, and perforation of the bowel. 
Treatment.-It will be apparent to our readers that 
this disease must run a definite course uninfluenced by 
any remedies intended to jugulate or abbreviate it. Let 
us therefore impress you that here, of all other cases, you 
must not give a single dose of medicine unless it is indi- 
cated. The greatest possible good can only come to the 
patient by placing him in the most favorable circum- 
stances to conserve his vital powers and enable him to 
hold up and let the disease run its course. Of course 
drugs and food are necessary, and, properly used, will be 
of great avail in the prolonged struggle with which all 
typhoid fever patients must contend ; but here good, 
judgment must prevail. The system must be aided in 
eliminating the morbific agents, and not obstructed with 
unnecessary drugs or food. 
The patient should be placed on a moderately firm cool 
mattress, and in a cool, quiet, well ventilated room. The 
skin should be gently sponged and cleansed with tepid 
water or cold water containing some bread soda, whisky 
and vinegar. Remember, a patient in favorable cases 
may go through an entire attack without one single dose 
of physic; and now with this final injunction we will out- 
line the special indications for drugs. 
First in importance is food. This should be an easily 
digested liquid or semi-liquid usually. Good pure milk 
is the best throughout; then in addition, beef tea, essence, 
and juice, thickened with arrowroot or burnt flour, milk 
custards, milk and eggs, milk toast, etc. Liquids such as TYPHOID FEVER. 
17 
coffee, tea, toast water, apple water, etc., may be given 
freely. If the condition of the bowels will permit it, 
grapes without skin or seeds, orange juice, raspberry vin- 
egar, etc., may be given with no sugar, or very little. 
The inside of well baked acid apples, cold, are very much 
relished and are serviceable. A patient must be fed reg- 
ularly by day and night, and if they are listless and make 
no call for their food they should be aroused and made to 
take milk, soup, or stimulants every three hours. As 
long as the pulse and heart hold up well, stimulants may 
be withheld, but usually they will be demanded in the 
second week. If prostration is marked, the pulse weak 
and compressible, skin moist and cool, respiration fatigued, 
the time has come for immediate and continued systematic 
stimulation, whether it be the first day or the third week 
of the disease. Good pure whisky or brandy are to be 
relied upon chiefly, and they may be given as juleps, or 
with plain water and ice, or in milk punches, egg-nogs, etc. 
Port wine and pure blackberry wine come in as auxiliaries 
between the stronger stimulants. They both stimulate, 
feed and check haemorrhagic tendencies. The mineral 
acids well diluted are valuable as refrigerants and styptics. 
Quinine is positively harmful. Carthartics must be 
avoided. If the bowels are constipated a gentle laxative 
of calomel and ipecac guarded with Dover's powder 
should be administered in the early stages of the disease. 
Moderate diarrhcea should not be checked, but if it be- 
comes profuse, over four or five stools a day, it should be 
held in check with Dover's powder, opium, bismuth, 
acetate of lead, used singly or in combination. 
For excessive tympanites, as well as for the dry, glazed 
tongue, turpentine emulsion internally and turpentine 
stupes are invaluable. This will be found a most admir- 
able stimulant and anti-ferment also. For epistaxis or 18 
bryce's pocket practice. 
other haemorrhages turpentine is most excellent, and we 
would especially recommend in these haemorrhages the 
free use of ergotole in doses of twenty drops every two 
hours. Lime water with milk and ice, drop doses of laud- 
anum, or champagne will often relieve the gastric dis- 
order. Frozen cream without egg or sugar is of great 
service also in the stomach disorder of typhoid. 
■ For restlessness and sleeplessness we have opium, 
chloral, morphia, potass, bromid., hyoscyamus, chloral- 
amide 30 to 45 grains. The weak heart must be sustained 
with brandy, strychnine, strophanthus, nitroglycerine. 
To disinfect the stools use copperas water, lime water or 
solution of corros. sublimate. 
About the latest agitation in the way of new treatment 
is the plan of giving the patient a cold bath as advocated 
by Brand and practised extensively in Germany. They 
immerse the patient in a cold bath of 68° F. for fifteen 
minutes every three hours, day and night, as long as the 
rectal temperature shows over 1020. An immense reduc- 
tion in the death rate is claimed by the advocates of this 
plan of treatment. We prefer cold sponging. 
TYPHUS FEVERShip Fever, Jail Fever. 
In general practice this is a rare disease, and considered 
somewhat allied to typhoid, though it is generally re- 
garded as a distinct disease by the best authorities. It is 
evidently a blood disease, very contagious, and due to a 
special poison, the result of overcrowding, bad air and 
poor food. 
Symptoms.-After a period of twelve hours to as many 
days of incubation the disease is ushered in with chill, 
high fever and rapidly rising temperature. The ther- 
mometer will register 1040 to 1060 within the first three or TYPHUS FEVER. 
19 
four days and may do so within the first twenty-four 
hours. There is no morning remission until the fifth or 
sixth day which continues until a very decided remission 
occurs about the tenth day, but the temperature again 
rises and continues high until about the fourteenth day 
when it falls rapidly to, or below, the normal. There is 
constipation. On the fifth day an eruption of measly 
blotches occurs all over the body, but does not appear on 
the face. This eruption gradually deepens to a dull, 
dusky, purplish hue, and becomes petechial frequently. 
All of the grave nervous symptoms seen in typhoid are 
observed in this disease, intensified in the form of fierce 
delirium, headache, stupor, etc. 
Diagnosis.-By contrasting the sudden onset, erup- 
tion, rapidly reached high temperature, and absence of 
tendency to diarrhoea, we can distinguish typhus from 
typhoid which it somewhat resembles. 
Mortality is about twenty-five per cent, and the prog- 
nosis is unfavorable when the pulse exceeds 120, the patient 
is of an advanced age, or where there is overcrowding or 
the system has become profoundly poisoned. There are 
no distinct anatomical morbid lesions, and this may be 
truly designated essentially a blood disease. 
Treatment.-The patient should be placed in a well 
ventilated apartment, isolated, and all of his dejecta, cloth- 
ing, etc., disinfected. The bowels should be regulated 
with calomel, colocynth, podophyllin, citrate of magnesia, 
salines, etc. The skin should be acted upon with nitre, 
ipecac, jaborandi, etc. The mineral acids have been found 
very useful. Quinine in small doses is of service, and its 
efficiency is increased by the addition of pulv. capsici. 
The system must be sustained with an abundance of 
liquid diet, broths, milk, and stimulants. For stupor, 20 
BRYCE'S POCKET PRACTICE. 
weak heart and sleeplessness we must use leeches or 
blisters to back of neck, stimulants, opium, caffeine, digi- 
talis, cocaine, etc. Complications must be looked for as 
in typhoid and treated as they arise. 
CEREBRO-SI'INAL FEVER-Cerebro-Spinal 
Meningitis, Spotted Fever. 
This disease occurs as an epidemic usually during and 
following wars and along the routes of armies, caravans, 
etc. It is non-contagious, due to a specific poison and 
is quite malignant under certain circumstances. It affects 
primarily the meninges of the brain and spinal cord, has a 
period of incubation of from two days to one week. It 
is usually characterized by violent head symptoms, ver- 
tigo, photophobia, intense headache and eruption of a 
petechial character, stiffness and contraction of the mus- 
cles of back of neck and back, fever, delirium and gen- 
eral cerebral disturbances. 
Symptoms.-Commences with chill, followed by high 
fever, temperature 1020 to 1050, violent headache, nausea, 
great rigidity of all post-cervical and dorsal muscles. 
In the fulminating form all of these symptoms burst 
upon the pa'tient with startling rapidity and leave him 
with delirium or stupor ; high fever, very high tempera- 
ture 1030 to io5°-6°-7°, rigid contraction of muscular 
system, etc. Milder cases are evidenced by slower ap- 
proach and less pronounced symptoms. 
Complications.-If the patient does not succumb to 
the immediate force of the disease, we have to run the 
chances of insanity, general or partial paralysis, deafness, 
blindless, epilepsy and other disturbances of the central 
nervous system. The mortality is very high in this form 
of trouble, ranging as high as sixty or seventy per cent, in 
certain epidemics. RELAPSING FEVER. 
21 
Treatment.-Prompt purgation with calomel and sub- 
sequent small doses of same. Jaborandi for skin action, 
opium, potassium bromide, ergotole for brain conges- 
tion, cups, leeches and blisters to back of neck, shave 
head and blister or apply ice cap if necessary. Keep up 
patient's strength and attend to general conditions which 
favor quiet and freedom from excitement. As the inten- 
sity of the disease wears off support the patient's 
powers with tonics, good food, and quiet restful sur- 
roundings. 
RELAPSING FEVER-Febris Recurrent, 
Seven Days Fever, Etc. 
The peculiarity of this disease is in its definable febrile 
paroxysms lasting about six days, then remissions for as 
many days followed by relapse which have a tendency to 
pursue this typical course of fever and relapse for quite a 
time. The disease is a specific infectious trouble sup- 
posed to be caused by a micro-organism which is always 
found present in the blood of these patients, and known 
as the spirochaete of Obermeier. There are no special 
anatomical lesions found in this disease, though as in most 
fevers the spleen will be found enlarged and soft, and as 
in the malarial fevers the white blood corpuscles will be 
found in greater numbers than normal. 
Symptoms, Course, Diagnosis.-Beginning with chill, 
fever and severe pain in back, head and limbs, the tem- 
perature rises usually rapidly, often reaching 1040 on the 
evening of the first day. The pulse reaches 120 to 130. 
We may have severe gastric disturbances, delirium, 
jaundice, sweating is common. This fever holds up for 
about six days increasing in severity of all symptoms un- 
til the crisis approaches, when a critical sweat sets in, or 
diarrhoea occurs and all of the symptoms subside and 22 
BRYCE'S POCKET PRACTICE. 
the temperature falls to the normal or even below. The 
crisis may come sooner than the seventh day or it may 
be delayed until the ninth or tenth day, but we have 
described the usual course. Convalescence is rapid, the 
patient feeling entirely well in three or four days, but 
about the fourteenth day he has a rigor and goes through 
the same course again. The diagnosis is plain ; micro- 
scopic examination will show the micro-organism which 
is characteristic. The mortality is not great, being about 
four per cent. 
Treatment.-It is not possible to cut this fever short 
or to prevent its recurrence. Quinine has been found of 
no service. It is best to treat the fever as any other con- 
tinued fever by rest, diet, careful attention to nursing, 
and the treatment of individual symptoms and complica- 
tions as they arise. The refrigerants and mild mercu- 
rials, with diuretics are indicated. In the stage of apyrexia 
tonic doses of mineral acids, iron, and quinine should be 
pushed. 
PERIODICAL OR MALARIAL FEVERS. 
General Considerations.-These fevers are all pro- 
duced by the same poison, have many points in common, 
are easily convertible from one form to another and are 
influenced by the same line of treatment, especially by 
the more marked antiperiodic remedies. They are pro- 
duced by malaria ; and by this term we mean a condi- 
tion of atmosphere poisoned by the presence of micro- 
scopic germs generated under the influence of heat 
and moisture upon vegetable or animal matter. 
This peculiar poison is found along sluggish streams or 
low marshes where there is abundant decaying vegetable 
matter and after we have had a prolonged degree of INTERMITTENT EEVER. 
23 
summer heat. It seems to be a heavy poison often being 
prevented in spreading by dense trees, settlements of 
houses as in villages, etc. It may arise from newly 
ploughed earth which has been unworked fora longtime 
and suddenly exposed to high sun heat. Thickly settled 
portions of cities are protected from this poison, and the 
sea coast is free from it, unless near marshes, salt water 
probably destroying it. The eucalyptus tree seems to 
absorb and destroy this poison. A continued tempera- 
ture of at least 6o° for two months seems necessary to 
develop it; and a decided frost or two will generally put 
a check to its further advance or activity. The poison 
enters our bodies through the air, and possibly also with 
our food and drink. Persons going about in malarial 
districts in the early morning hours with empty stomachs 
seem much more liable to be poisoned than persons for- 
tified with a full meal. The principal forms of malarial 
fever are intermittent, remittent, congestive and a few 
bastard or complicated forms wrongly designated typho- 
malarial, haemorrhagic-malarial, etc. ; all of these latter 
being only aggravations of the original forms of malarial 
fever. 
INTERMITTENT FEVER. 
This is one of the most typical forms of malarial fever, 
and is known as ague and, /ever, chills and fever, etc. In 
the early fall it is most prevalent, and next in frequency is 
the springtime. The most common form is the tertian or 
every other day, though we may have the quotidian 
every day ; the quartan every fourth day, and so on for 
any peculiar freak it may assume. 
Symptoms, Course, Etc.-The chief features of inter- 
mittent fever are the three stages of chill, fever and 
sweating, followed by complete intermission or ab- 24 
bryce's pocket practice. 
sence of all symptoms of disease to be followed by a repe- 
tition of the same symptoms in longer or shorter time as 
the type of disease manifests itself. These stages are 
called the cold, hot and sweating stages. The attack 
commences with a feeling of malaise, pain in back 
and limbs, yawning, weariness and lassitude; a 
sensation of coldness comes on with a creeping, 
shivering feeling, tremors, rigors and a feeling of utter 
miserableness. Headache, sometimes nausea, blueness 
and pinched appearance of skin. The chill lasts from a 
half hour to two or three hours, when reaction sets in 
violently. The pulse bounds with a full hard stroke, the 
face becomes flushed, headache increased, skin hot and 
dry, urine scant and high colored, mouth dry and parched. 
The thermometer shows an increase in surface heat of 
1050 to no0 ; and we should have mentioned that in the 
cold stage there is actual fever as will be shown by the 
thermometer. This hot stage may last from one to twelve 
hours when we have the sweating stage. This comes 
on gradually, the face first becoming moist and then the 
whole body becomes bathed in perspiration. With this 
fortunate condition all of the symptoms are generally re- 
lieved and the patient gradually reaches a condition of 
comfort. The headache, pain in back and limbs, nausea 
and general distress are all relieved and a pleasant sleep 
causes the patient to believe that he has gotten away 
from a most terrible enemy. The secretions are all re- 
stored and the thermometer indicates no actual fever. 
During the intermission or apyrexia, treatment should 
be commenced, or we will have within certain space of 
time a return of this condition which may last for weeks 
or months, until the disease runs on into some graver 
form, or leaves the patient in a state of chronic anaemia. 
In this disease the nervous system becomes most pro- INTERMITTENT FEVER. 
25 
foundly impressed so that after we have antidoted the 
poison we often find it very hard to break up these par- 
oxysms, and this is the reason that many obscure drugs 
are credited with curing this disease after a failure with 
the more prominent antiperiodics. In all of these fevers 
we find hepatic and splenic engorgement with degenera- 
tion of the blood corpuscles. 
Treatment.-During the cold stage, keep the patient 
as comfortable as possible with blankets, hot drinks and 
hot applications. In the hot stage the reverse obtains, 
giving cracked ice, refrigerant drinks, aconite if necessary 
and cold sponging. The sweating stage requires nothing 
as it brings relief. The main treatment is to prevent a 
return of the paroxysms, and is conducted in the inter- 
mission. Three things are to be accomplished to effect a 
cure. The liver and portal engorgement must be un- 
loaded ; the specific poison must be eliminated, and the 
resulting anaemia and nervous disturbances must be 
overcome with appropriate tonic remedies. As soon as 
the patient is free of fever give calomel, blue mass, colo- 
cynth, singly or combined in such doses as will act thor- 
oughly and promptly upon the liver and clean out the 
alimentary canal. I think here ten grains of calomel re- 
inforced with soda, colocynth, aloes or rhubarb is only a 
fair dose. From six to ten hours before the expected 
return of the chill, which may be looked for from one to 
two hours earlier each day of the paroxysms, the system 
must be impressed with the best possible antiperiodic 
obtainable. The salts of cinchona are considered almost 
a specific for malaria in most forms, and the sulphate of 
quinia is the salt relied upon in almost all cases. 
The old idea, with which we commenced practice, of 
giving large doses at once, seems to us not to be the best. 26 
bryce's pocket practice. 
We seldom give any patient over ten grains of quinia to 
prevent any ordinary paroxysm, and this we administer 
in two grain doses every hour or two so as to give the 
last dose a few hours before the expected chill. We find 
the greatest good to be derived from the quinia when we 
have acted well upon the liver, emptied the alimentary 
canal, and prepared the system for its reception and 
proper appropriation. The salts of quinia are useless un- 
less administered under these circumstances. Thus given, 
small doses are required and they are thoroughly 
effective. We advise the continuance of this line of 
treatment with quinia for four or five days, and a return 
to it on the seventh and fourteenth days as precautionary 
measures. A good tonic of tr. chloride of iron, with a 
grain of quinine to the dose is of service after the discon- 
tinuance of the full quinia treatment. When the stomach 
does not readily manage the sulphate, we have great 
faith in the bisulphate of quinine. It is much more solu- 
ble and easily appropriated and thus acts quickly when 
we are in a hurry. After a failure with the various salts 
of cinchona, we may try many other much vaunted reme- 
dies, such as arsenic, (Fowler's solution) salicin, sulphate 
of copper in one-fourth grain doses, dogwood, eucalyptus 
and many other agents. Hyposulphite of soda has been 
used very successfully, and, on theoretical grounds, its 
use is to be commended as a germicide. After a very ex- 
tended experience in malarial diseases, we would say to 
our readers that the great success lies in getting the liver 
and digestive system in good order, then intelligently us- 
ing some salt of cinchona, and finally toning up the sys- 
tem to resist the effects of the malarial poison. When 
this is done we will not seek such a multitude of rem- 
edies. When, however, anaemia is well established and 
the disease becomes almost neurotic in character, we will REMITTENT FEVER. 
27 
be compelled to avail ourselves of all manner of nervines, 
antispasmodics, tonics, mineral acids, reconstructives, 
change of locality, scenery, etc. 
REMITTENT FEVER-Bilious Fever. 
Due to the same cause as intermittent, it is ushered in 
with a chill, sudden high fever and all of its accompany- 
ing symptoms ; headache, full pulse, great gastric distur- 
bance, and coated tongue. Temperature 1050 to 1070, 
delirium, often jaundice, bowels usually constipated. 
This is followed in ten to eighteen hours by sweating 
stage. For a few days we have these paroxysms of chill, 
fever and sweat, but unlike intermittent, the fever re- 
mits but never leaves the patient entirely. In a few days 
we have an absence of the chill with more continuous 
high fever, morning remissions and evening exacerba- 
tions. Uninfluenced by treatment this disease might go 
on into intermittent or into some low continued semi- 
typhoid condition or the popular " typho-malarial " form, 
or haemorrhagic form. The duration of the disease is 
from three to six weeks. 
Diagnosis.-We have more often been perplexed to 
distinguish bilious fever from typhoid than any other pos- 
sible condition, but when we note the sudden onset and 
rapid gain of temperature, nausea and vomiting, consti- 
pation, decided remissions, black tarry stools, jaundice 
and full bounding pulse we can leave out typhoid fever 
pretty safely. 
Treatment.-From what has been written on the 
general management of malarial fever in a previous chap- 
ter, we can easily arrive at the best method for managing 
this form of malarial disease. Relieve the distressing 
nausea and bilious vomiting with cracked ice, lime water. 28 
BRYCE'S POCKET PRACTICE. 
mint water, champagne and ice, granular effervescing 
bicarbonate of potassium, citrate of magnesia, etc. A 
mustard plaster, bruised mint, or spice poultice over the 
epigastrium, will all be found valuable auxiliaries. Act 
well on the liver and intestinal canal. If the stomach is 
very irritable give three grains calomel with a little 
morphia, or cocaine on crushed ice every hour until 
twelve grains are taken. If this is not sufficient to move 
the bowels thoroughly follow with some saline purge : 
epsom salts, Rochelle salts, citrate of magnesia, Seidlitz 
powders or something similar. As soon as the fever 
lowers a little, and after a good purge, in the remission 
commence and give quinine in solution, pill, or capsule, 
either ten grains at one dose, or two to three grains every 
two hours until twelve or fifteen grains have been taken. 
Come in between these remissions and follow this line of 
treatment until the fever is checked. Should this fail and 
the disease assume a decided typhoid form, lessen the 
•daily quantity of quinine, and look out for symptoms and 
complications. If there is no decided remission or favor- 
able moment for giving quinine do not wait, but crowd it 
into the system. Observe the usual rules as to fever diet, 
attention to the general comfort and hygienic surround- 
ings of patient. Aconite, veratrum viride, antipyrine, pot. 
bromid. and other similar agents may be needed for head 
symptoms and arterial tension. Cups, leeches and blis- 
ters are occasionally of great service applied to back of 
neck for severe head symptoms. Treat stage of conva- 
lescence as in intermittents. 
HAEMORRHAGIC MALARIAL FEVER. 
This aggravated form of remittent has been honored 
with the above special name. It is merely an intense re- 
mittent however, which is apt to be accompanied within CONGESTIVE MALARIAL FEVERS. 
29 
the first few days by sudden jaundice, haemorrhage from 
gums, nose, bowels, kidneys or elsewhere as the sweating 
stage commences, and is absent or less intense during the 
remission. After a while this haemorrhagic condition be- 
comes persistent and lasts through the remission. Where 
the kidneys are the source of haemorrhage this condition 
is called malarial haematuria. 
Treatment.-The essential treatment for this condi- 
tion is that of remittent fever, only requiring a more vig- 
orous use of quinine administered at the earliest possible 
moment without waiting for subsidence of fever or remis- 
sion. These conditions are merely to be considered as 
complications and increased saturation of the system with 
malarial poison, and demand treatment based on the 
known cause. In haematuria dry cups over the kidneys, 
and the internal administration of twenty drops of 
ergotole every four hours will be found very efficacious. 
CONGf^TIVE MAI.ARIAI, FEVER-Conges- 
tive Cliills, Pernicious Malarial Fever. 
This is the most dangerous form in which malarial 
poisoning can manifest itself. It usually commences as 
an ordinary intermittent or remittent but within a few 
paroxysms we will find the patient having a prolonged 
chill, with cold surface and extremities ; the skin is blue 
and pinched, the circulation is slow and the respiration 
labored and sighing, the pupils (in brain congestion) are 
dilated usually and have a fixed stare. In short the 
patient may be in profound coma, or if other organs than 
the brain are the seat of congestion, we may have great 
difficulty of respiration with bloody froth from the lungs, 
or intense vomiting when the stomach is the seat of con- 
gestion. The whole nervous system is profoundly im- 
pressed by the poison. 30 
bryce's pocket practice. 
Treatment.-Must be prompt and active to bring on 
reaction, and equally as important will it be to prevent a 
recurrence of this dangerous condition. Frequently pa- 
tients die with the first chill, more so in the second, and 
the third chill is almost certainly fatal. When the patient 
is seen in the chill, every possible means must be used to 
bring on reaction. Brisk frictions with brandy and cay- 
enne pepper ; blankets wrung out of hot water, hot water 
bottles, and sinapisms should be applied to the surface. 
Where the brain is severely congested local depletion and 
cold applications will be of service. Faradism to the 
spine, frictions with hot turpentine and rectal 'injections of 
hot brandy and milk have all aided us in bringing on re- 
action. 
If the patient has had a severe chill and we see him 
when another one is impending we must endeavor to pre- 
vent its advent or mitigate its force. An hypodermic ad- 
ministration of morphia, followed by one of pilocarpine 
will either arrest it or lessen its force. The sheet-anchor 
here is cinchonism. As soon as it is possible to get it into 
the system, regardless of all other conditions, from thirty 
to sixty grains of sulphate or bisulphate of quinine should 
be given the patient, either by mouth, rectum or subcu- 
taneously, of course if we have to resort to the hypoder- 
mic method smaller doses must be used. The only plan 
of safety is to bring the patient thoroughly under the in- 
fluence of the salts of quinia and keep him impressed for 
a week or ten days, increasing the quinia every seventh 
day for some weeks. These patients require good cloth- 
ing, food, and tonic after-treatment. 
Other Malarial Diseases.-The multitude of dis- 
eases with which malaria associates itself, influencing 
and modifying each one can hardly be enumerated. YELLOW FEVER. 
31 
The late lamented Prof. Otjs F. Manson, M. D., of Rich- 
mond, both in his lectures, as an author, and in practice 
demonstrated the effects of malaria upon all diseases 
occurring in persons subjected to the malarial poison; 
and some of the most brilliant results we have ever achie- 
ved in practice have been due to the detection of this 
enemy incases ofdysehtery, pneumonia, hysteria, haemor- 
rhagic troubles, neuroses, etc., and the timely administra- 
tion of impressive doses of quinine. For all of which we 
have to thank our honored instructor whom we have 
mentioned above. 
VEEEOW FEVER. 
This fever found only under certain conditions of high 
temperature, low moist conditions and in certain geo- 
graphical limits, seems to be due to a specific germ, pos- 
sibly vegetable, consists of one paroxysm and three 
stages. It is feebly contagious and seems to be propa- 
gated only where soil and surroundings are ready for its 
development. It seems necessary to bring a quantity of 
the material and air of the infected locality into any suit- 
able locality for its further development before it can be 
spread as an epidemic among the people. There is 
almost absolute certainty that in a healthy locality a sick 
person with yellow fever cannot communicate it to those 
around him. It is therefore essentially a disease of cer- 
tain localities or developed on ship-board or at other ports 
by bringing infected merchandise, air, etc., into such lo- 
calities as are susceptible of infection. It is only to be 
found on the sea-coast or near a large river emptying into 
the sea. 
Symptoms, Course, Etc.-Commencing with an in- 
distinct or very decided chill, after an incubation from 32 
bryce's pocket practice. 
a day or two to twenty-four days, the patient is taken 
with fever, pains in back and limbs, intense thirst, nausea 
and vomiting, hot dry skin, flushed face, epigastric ten- 
derness, fiery look of the eyes, supraorbital pain and 
violent headache. Bowels are usually costive, and deli- 
rium often present. This fever lasts from one to three days 
and constitutes the first stage. The second stage is a 
period of intermission or remission-lull-in which the 
symptoms all abate, the flush of face giving place to a 
yellow or jaundiced hue of skin. The pulse, respiration, 
diminished heat of skin, all indicate that the patient is 
better, he feels better and frequently sits up. Sometimes 
convalescence commences in this period of remission and 
the patient recovers ; otherwise the third stage, that of 
collapse, ensues after a remission of twelve to fourteen 
hours. This is evidenced by profound debility, rapid 
feeble pulse, circulation slow and impeded, deep yellow 
or bronzed appearance of skin, brown dry tongue, great 
gastric irritability, black vomit, (altered blood), haemor- 
rhages from nose, throat or elsewhere, low muttering 
delirium, cold clammy sweats, hiccough, convulsions, 
death occurring on the fourth to sixth day. The diagno- 
sis of this disease when mild must be from the aggra- 
vated forms of malarial; when intense it is plain. Locality 
and prevailing epidemics will clear up the case. The 
mortality is very high, from 15 to 80 per cent, according 
to intensity of poison and local conditions. 
Treatment.-We have no specific or satisfactory 
treatment for this disease and a plain expectant plan is 
about as satisfactory as any yet adopted. The patient 
should be kept cool and comfortable as possible, strict 
quiet in the recumbent posture with refrigerant drinks 
should be observed. Granular condition of the heart ERUPTIVE FEVERS. 
33 
muscle with threatening failure should make us guard 
against all undue exertion. The diet should be small in 
quantity and liquid in the first stages. In collapse stim- 
ulants may be needed, heart tonics, digitalis, strychnine, 
cocaine, strophanthus, cracked ice, champagne; small 
doses of calomel in early stages. For fever, nausea, thirst, 
etc., give carbonated waters, neutral mixture, Vichy, etc. 
The latest line of specific treatment suggested is the ad- 
ministration of small doses of corrosive sublimate with bi- 
carbonate of sodium in large quantities of water every 
two or three hours. A very successful line of treatment 
has been in giving a pill of calomel, quinine and rhubarb 
every two or three hours, along with iced acid drinks 
and little or no food for three days; sinapisms or 
dry cups to the epigastrium, and cocaine to relieve nausea 
stop black vomit, and hold up a weak heart. 
ERUPTIVE FEVERS. 
General Considerations-The eruptive fevers are 
characterized by an eruption, definite course, contagious- 
ness, self-limited nature, and by being protective 
against other attacks in the same individual. The prin- 
cipal fevers of this class are, scarlet fever, measles, rotheln, 
small-pox, chicken-pox, and varioloid. 
SM AVE-FOX-Variola. 
An acute highly contagious eruptive fever depending up- 
on a specific poison communicated from patient to patient 
or by infected articles of clothing, furniture, etc. The pe- 
riod of incubation is about fourteen days. 
Symptoms.-The disease commences with a fever and 
intense headache and terrible pains in back and limbs ; 
on the third day of fever a peculiar papular eruption ap- 34 
brvce's pocket practice. 
pears, at first on the forehead, face and lips and finally 
over the whole body. On the next day, second of the 
eruption, these papules become vesicles. On the third, 
fourth and fifth days these vesicles become pustules. 
From fifth to eighth day the pustules increase in size, fill 
with pus and are surrounded with a distinct areola. At this 
time these pustules become indented in the centre, forming 
the peculiar umbilicated pustule known in this disease. 
About the eighth day of eruption (eleventh from com- 
mencement of fever) the pustules are generally at their 
height, pus oozes from them and scabs begin to form over 
them. From the fourteenth to the twenty-eighth day 
these scabs form, dry, and fall off. From the eighth to 
the fourteenth day when the scabs are forming it is known 
as the period of maturation. By the twenty-eighth day 
most of the scabs have formed and fallen off, leaving little 
red or livid spots which become white pits in the skin. 
The fever is peculiar in small-pox. It subsides when the 
eruption appears, and the patient is much easier, and it 
reappears and is known as secondary fever when the pus- 
tules maturate about the eighth or ninth day. 
Variola is said to be discreet when the pustules are 
scattered ; confluent when they coalesce, and malignant 
when there is extravasation of blood in the pustules. 
The grade of eruption usually determines the severity of 
the disease ; the mortality ranging from four per cent, 
in the discreet to fifty in the confluent, and ninety-eight 
in the malignant form. One attack generally protects 
the patient from this disease for life, though it has occurred 
a second and third time in the same patient. 
Diagnosis.-Is easily made out by the three days fever, 
and accompanying pains in small of back and limbs ; with 
the eruption on third day and its becoming vesicular and 
pustular in the time mentioned under symptoms. SMALL-POX. 
35 
Treatment.-The patient should be isolated for the 
safety of others, and should be kept in a comfortable well 
ventilated room with little furniture or bedding to become 
charged with morbific germs. A general fever treatment 
should be adopted as regards diet, etc. It is positively 
harmful to stifle these patients in close, hot apartments 
and drench them with hot teas under the idea that the 
eruption will be hastened. Cracked ice, cooling drinks, 
and light nutritious diet should be the line of general 
treatment, with concentrated food and stimulants later on 
as the system will demand about the period of maturation. 
For violent pain in back and limbs opium and potass, 
bromide. Nausea and vomiting will be helped by using 
the refrigerant diaphoretics, neutral mixture, liqr. am- 
monia acet., and similar preparations. Granular efferves- 
cing citrate, or bicarbonate of potash are very grateful to the 
patient.. In conjunctivitis, pharyngitis, and rhinitis, es- 
pecial care must be taken to cleanse and disinfect these 
surfaces with antiseptic solutions of carbolic acid, bi- 
chloride of mercury or similar agents. The care of the 
eyes in confluent cases is of the utmost importance. 
Most authors insist that there is no specific for this terrible 
disease and < consequently the treatment must be con- 
ducted upon the general plan applicable to these symp- 
toms as they arise. We wish, however, to state very 
frankly to our readers that we have found a certain line 
of specific treatment so valuable that we regard it as well 
nigh a specific. We have given it faithful trial in a large 
number of cases of small-pox, and we have succeeded so 
well in cutting short and reducing the formation of pus- 
tules that we have very little concern when we can see 
a patient just as the papules are appearing. 
We refer to the peculiar action of salicylic acid in this 
disease. It unquestionably has the power to abort the 36 
BRYCE'S POCKET PRACTICE. 
disease to such an extent as to render it almost a specific. 
It will reduce temperature, relieve pain, and prevent the 
appearance of pustules. 
Some eight or nine years ago we had a most excellent 
opportunity to test the value of this agent when Rich- 
mond, Virginia, was suffering severely with an epidemic 
of small-pox. A few instances will suffice to show how 
we treated these cases and how they behaved. We 
were called to see a poor negro man one morning, living 
in a small kitchen room about io x 12. His wife had fled 
and we found him covered with the small-pox eruption 
in the vesicular stage. In this room were four children, 
the oldest not over eight years of age. None of these 
children had ever been vaccinated, and the oldest one 
had a fever upon it at the time and papules were be- 
ginning to appear upon the face and forehead. We or- 
dered a quart mixture containing twenty grains salicylic 
acid, two drachms liqr. ammon. acet., and one drachm 
spirits nitre dulce to the ounce. Of this we gave the 
man a half ounce every three hours, and to every one of 
the children, sick and well, proportionate doses at the 
same interval. In addition we gave the adult one grain 
calcium sulphide three times a day, and smaller doses of 
the same drug to the children. 
The father's case ran a very mild course ; the pustula- 
tion being very much abridged, and in ten days he was 
well. The child escaped with less than three or four small 
pustules, and the other children escaped entirely. Some- 
time afterwards, I related this* experience to Dr. R. H. 
Cowan, then one of the small-pox physicians of this city, 
and he was so much interested that in a few days he 
called upon me to go with him down on Seventeenth 
street, in a squalid portion of the town, to see an entire 
family just blooming out with the fever and papules. VARIOLOID. 
37 
We placed everything in the crowded hut on the line of 
treatment suggested ; and the developed cases soon 
ended in a most favorable manner, while it prevented 
the appearance of the disease in all who had not reached 
the papular stage. 
We believe fully that the salicylic acid alone is the 
effective agent, but on scientific principles we have com- 
bined the other ingredients and have no doubt that they 
aid still further the action of the acid. Many suggestions 
have been offered to prevent pitting of the face, but 
most of them may be summed up in one general direc- 
tion to keep the face covered with some bland oil or 
ointment with glycerine occasionally added, and the 
room kept darkened. If the case is seen early enough, 
the use of the remedies suggested for general treatment 
will so abate the symptoms that there will be no fear of 
disfigurement. 
VARIOI.OID Modified Small-Pox. 
Varioloid or modified small-pox occurs occasionally 
in persons who have been protected by vaccination. 
All of the symptoms are those of true small-pox except 
in their very mild character. The fever, eruption and 
duration of the disease are all much modified. The 
same care should be used to prevent these patients 
spreading the disease, as they can communicate genuine 
small-pox to any unprotected persons. 
Vaccination.-The great prophylactic against small- 
pox is vaccination. This is performed by introducing 
the virus or lymph from the eruption of cow-pox appear- 
ing on the udder of the heifer, or from lymph or virus 
which has passed through the human system into an 
abraded surface. The ordinary crust from the arm or 
the quills charged from the heifer may be either used, 38 
BRYCE'S POCKET PRACTICE. 
though the bovine virus direct is a little more apt to be 
followed by a higher grade of inflammation and insilres- 
no special advantage as to safety against small-pox over 
the humanized variety. We would say by way of paren- 
thesis, that even though a person may have been ex- 
posed to small-pox, if he is immediately vaccinated, the 
chances are that by the quick action of the vaccination the 
disease will be anticipated and in many cases either 
aborted or greatly mitigated. The method of perform- 
ing vaccination needs no description here. It is simply 
necessary to abrade, puncture or scarify the skin and in- 
troduce a little of the moistened virus when the capil- 
laries will take it into the circulation-hence the only 
caution would be not to draw blood, but simply produce 
a blush with exudation of serum and you have the best 
possible condition for insuring a successful vaccination. 
If successful, a vaccination pursues about this course : 
On the fourth day a red papule appears ; between the 
fifth and seventh days this papule becomes a decided 
vesicle. By the eighth day the vesicle reaches its height 
and is surrounded by an immense angry red areola; and 
by the tenth or eleventh day it becomes a matured pus- 
tule with a proportionate areola. From the thirteenth to 
the fifteenth day the local inflammation fades and the crust 
or scab forms, which finally falls off about the twentieth 
day. 
SCARLETjFEVKR*-Scarlatina. 
There are three varieties-Simplex, Anginosa and 
Maligna, which are only terms used to signify the 
intensity of the peculiar attack which may be of the sim- 
ple or mild variety, or with its chief force spent upon the 
throat, or finally of a very rapid and malignant type. 
Period of Incubation from one to twenty-one days. SCARLET FEVER. 
39 
Symptoms, Course, Etc.-This highly contagious, 
acute, eruptive fever commences with an abrupt onset 
of vomiting, chill, or convulsion, with sudden high fever 
and pulse ranging from 130 to 180. After twenty-four 
hours of fever the eruption appears as a bright scarlet 
rash about face and neck. This is at first in form of 
minute dots, but in twenty-four hours more it is con- 
fluent and over the entire surface. The appearance of 
the patient may be likened to a boiled lobster. This 
eruption remains at its height for four or five days and 
gradually fades away. Desquamation sets in with the 
subsidence of the eruption and may be going on for two 
or three weeks. The fever continues high during the 
eruption, but does not leave the patient entirely until 
very late in the desquamation stage. In the anginose 
variety the throat symptoms are more marked and severe 
than in the simple variety, and the tonsils are enlarged 
and covered with a dirty membrane. In the malignant 
form the symptoms are all aggravated by delirium, con- 
vulsions, petechial spots, grave kidney symptoms, etc. 
The Sequelae of this disease are both numerous 
and grave. The chief being acute albuminuria, with 
the attendant consequences of structural kidney disease, 
then heart trouble, dropsies, deafness, blindness, chorea, 
chronic anaemia, chronic diarrhoea, etc., etc. 
Prognosis.'-Must always be guarded, and the mor- 
tality in all types of cases would be about fifteen 
per cent. 
Treatment.-The patient should be placed on the 
usual fever diet and general treatment. Attention to 
the action of skin and kidneys is of the utmost impor- 
tance in the management of these cases. The skin 40 
brvce's pocket practice. 
should be freely anointed with some oleaginous sub- 
stance such as perfumed lard, oil or vaseline. It greatly 
allays the annoying itching and is advantageous in re- 
ducing temperature. The usual gentle diuretics and 
diluents are indicated for the kidneys. If there is ten- 
dency to heart failure, quinine, brandy and digitalis are 
all indicated. For the throat symptoms an abundance 
of ice in the mouth is grateful and beneficial, while 
pleasant antiseptic and disinfectant washes and gargles 
are to be used. It is yery necessary to guard the patient 
against exposure to cold or dampness about the time of 
desquamation, as the disposition to albuminuria and 
general kidney troubles is very great. 
For some weeks after the patient is convalescent he 
should be carefully guarded against exposure and be 
given a general tonic of iron, bark, etc. 
MEASLES Morbilli, Rubeola. 
This acute contagious disease is confined mostly to 
the period of childhood, though adults are by no means 
exempt from it when exposed to it and when they have 
not been the subjects of the disease in childhood. 
Symptoms, Course, Etc.-After a period of incuba- 
tion ranging from one to three weeks from time of ex- 
posure, the patient experiences chilly sensations, ca- 
tarrhal symptoms and fever. There is some decline of 
fever on the second day, but the other symptoms persist 
and on the fourth day the characteristic eruption appears 
and fever and catarrhal symptoms all become increased 
in severity. After the eruption has lasted for three or 
four days it begins to decline and all of the symptoms 
are speedily dissipated. 
The special symptoms for diagnostic purposes are the 
peculiar behavior of the fever, which declines on the MEASLES. 
41 
second day, and rises again on the fourth with the 
eruption; the period of eruption, and the intense ca- 
tarrhal symptoms attacking eyes, throat and nose 
violently. The temperature is peculiar also as it rises 
abruptly to 1020 or 1030 on the first day, falls almost to 
the normal on the second day and again reaches its 
former high grade on the fourth with the advent of the 
eruption. With these symptoms a mistake need not be 
made in diagnosing the disease. 
Treatment.-This is simple and satisfactory and 
consists in giving a light laxative, gentle diuretics, 
diaphoretics, and acidulated drinks, warm or cold, 
as the patient may prefer. The old fashion remedy 
of flax-seed lemonade with a little spirits nitre is a most 
excellent one and will in the majority of cases be all 
that is required throughout the attack. Of course there 
will be met with now and then, cases which will require 
most careful attention to save life. We will have in- 
tense fever with cerebral symptoms, delayed eruption, 
lung troubles, coma, etc. Such cases require intelligent 
management on general lines. High fever may call for 
aconite, hydrocyanic acid, jaborandi, or the lancet. We 
may have to give more attention to preventing pneu- 
monia by local measures, quinine and similar agents. 
Patients may require the warm bath in threatened coma 
from arrest of eruption. We failed to state in our de- 
scription of the disease that the eruption first appeared 
on the face and neck and presented the appearance of 
patches of irregular crescentic rings of flea bites. 
GERMAN MEASLES Rubella, Rotlielu. 
This is a hybrid measles characterized by an eruption 
on the first or second day of an irregular kind and with 42 
bryce's pocket practice. 
less fever and catarrhal symptoms. The throat and 
glands of the neck are more often affected and the erup- 
tion may appear and reappear several times during the 
course of the disease which usually lasts about eight or 
ten days. 
Treatment.-A modified line of measles treatment 
will be all that will be necessary, and most cases do well 
on the least medication. 
CHICKEN TOX Varicella. 
The special features of this disease of childhood are 
the presence of mild fever after a slight chill with a 
peculiar scattering vesicular eruption on the second day 
of fever. The eruption is always vesicular and sparsely 
scattered over the trunk. It never becomes pustular 
and after three or four days forms large scabs, some- 
times leaving pits. The period of incubation is about a 
week and the duration of the disease about as long. 
Treatment.-The child should be kept in a room of 
an equable temperature and treated as if he had a mild 
case of measles. Generally a mild laxative and slight 
febrifuge drinks are all that will be required in these 
cases. Spirits nitre, spirits of mindererus or lemonade 
will be beneficial and refreshing to the patient. 
ERYSIPELAS. 
Sometimes called Rose or St. Anthony's Fire may be 
classified as one of the eruptive diseases, though there is 
no definite course which it pursues or has it a period of 
incubation. The question of its contagiousness is one 
of doubt, and while some practitioners consider that 
there is a contagious element in it, most physicians do 
not look upon it as such. ESYSIPELAS. 
43 
Symptoms.-It commences with the usual chill of most 
eruptive fevers and is followed with moderate febrile dis- 
turbance, then an eruption or rather a bright red spot 
makes its appearance usually on the face or about the 
head or neck. This spot is accompanied with greatly 
increased fever and rapidly increases in size, spreading 
over the face or up towards the head. The skin 
assumes a bright, swollen and glistening appearance and 
a sensation of itching and burning is complained of by 
the patient. The rapid advance of the eruption, with 
high fever and the oedematous and red glistening color 
will make out the diagnosis. 
Treatment.-A gentle antifebrile course should be 
pursued. A dose of Rochelle salts, citrate of magnesia 
or a seidlitz powder will be of service in the beginning. 
Diaphoretics act well and the kidneys should not be al- 
lowed to neglect their duty. We have found much ben- 
efit in reducing the determination of blood to the skin by 
the use of a preparation of ergotole, a most valuable 
agent mentioned elsewhere in this book. We cannot 
expect to cut the advance of the disease short by local 
measures, although many practitioners rely very much 
upon the efficacy of iodine or nitrate of silver to 
the sound skin about an inch ahead of the inflamed sur- 
face, with the hope that its further advance may be 
checked. It is undoubtedly true that this is sometimes 
effectual and we advise its trial to a reasonable extent 
along with other measures. We have found a mild and 
cooling application which reduces the temperature and 
protects the parts, of far more service generally than any 
abortive attempts. The patient should have a light diet 
of milk and stale bread, fruits and light broths, and should 
be kept quiet and free from excitement. The constant 44 
bryce's pocket practice. 
application of cloths wet with a solution of sugar of lead 
and glycerine and with the addition of cocaine to the solu- 
tion if the skin is very painful, or itching is much complained 
of, will prove to be a valuable line to pursue. The admin- 
istration of small doses of quinine and tincture of chloride 
of iron every two or three hours is a popular practice and 
one which seems to be highly beneficial. Where the di- 
sease rapidly extends to the scalp and affects the brain, we 
must resort to vigorous purgation and use prompt cere- 
bral sedatives such as potass, bromide, aconite, jaborandi 
and ergotole. Many cases of this disease will be charac- 
terized by extreme prostration from the beginning and 
will require careful supportive treatment both in the way 
of drugs proper and in concentrated foods. Brandy, eggs, 
cream and liquid beef will all be needed. Where phleg- 
monous abscesses form they should be opened and 
treated antiseptically. 
DENGUE Breakbone Fever, Dandy Fever. 
Dengue or breakbone fever as it is commonly called, is 
a disease which is seldom seen in this country except in 
the southern portion of the United States. It is ushered 
in with the milder symptoms of rheumatism, such as pain, 
swelling and stiffness of the smaller joints and aching of 
the muscles in various parts. The muscles of the neck 
are especially affected, and the stiffness of the muscles 
generally give the patient that appearance in walking 
which causes it to be called " Dandy " fever. There is 
fever and headache lasting for three or four days when 
the fever declines and the symptoms are lessened in 
severity. After a few days interval the symptoms all re- 
turn and headache and gastric irritation are more pro- 
nounced. The tongue is heavily coated, and anorexia is 
marked. About the sixth day of the disease an eruption DISEASES OF THE DIGESTIVE ORGANS. 
45 
appears resembling scarlet fever, nettle rash or measles. 
This eruption cannot be relied upon as a distinctive sign 
as it may present itself under many very different forms, 
though it is more likely to favor that of scarlatina. This 
rash lasts for two or three days usually and all of the 
symptoms rapidly decline after it has made its appear- 
ance. The disease is contagious. 
Treatment.-Patient must be placed on the usual 
general line of treatment appropriate for all fevers and 
kept in bed until the disease is at an end. We know of 
no special line of treatment which can be called specific 
for this trouble. Quinine has been given in moderate 
doses all through the disease with fair results. Recently 
salicylic acid, antipyrine, and phenacetine have been re- 
commended as affording great relief. We would prefer 
a good mercurial purge in the commencement, and then 
the administration of repeated doses of quinine, capsi- 
cum and Dover's powder in combination. Later on in 
the disease the patient may require supportive and stim- 
ulating treatment, and certainly when the fever subsides 
and convalescence commences it will be necessary to put 
the patient upon a good tonic for some time. The min- 
eral acids, quinine, strychnia, and tr. ferri chlor, are all 
valuable agents in the convalescing period. 
DISEASES OE THE DIGESTIVE ORGANS. 
There are many things in common in all diseases of 
the alimentary canal. The entire route is lined with 
mucous membrane and an affection of one portion of the 
tract often produces a corresponding disturbance in the 
whole canal. Very often an attack of disease in one part 46 
bryce's pocket practice. 
of the canal will be extended entirely through the tract. 
With some allowances for a variation in the secretions 
and physiological reactions of the same in different por- 
tions of the canal, treatment applicable for inflammation 
or catarrh in one portion of the tract is equally applicable 
for all parts. We have in advance pages of this book 
given an outline of the peculiar behavior of mucous 
membranes under the influence of inflammation. We 
find the membrane red, congested and secretion at first 
checked. Fever is invariably present and then we find a 
supersecretion of thick mucous with a rapid tendency to 
the production of pus. To relieve congestion, remove 
all sources of irritation, quiet the circulation and protect 
the organs from local irritating secretions are important 
measures in all inflammatory conditions of the mucous 
membrane of the alimentary canal. 
STOMATITIS-Inflammation of the mucous 
membrane of the mouth. 
This disorder is mostly confined to children, though 
•we have seen it in a most aggravated and painful form in 
the adult. It may appear as an ulcerative, follicular or 
catarrhal condition, and is due to altered or vitiated se- 
cretions of the mouth or stomach, to want of cleanliness 
of teeth and gums, or to the introduction of irritating 
substances in the mouth. It frequently follow'S acute 
fevers, gastritis, or the exanthemata. 
Symptoms.-There is a red fiery condition of the mu- 
cous membrane, and the patient experiences a sharp, 
burning pain in the mouth upon taking food of any 
kind and especially when taking sweets or acids. Often 
small ulcers will be seen dotted here and there over the 
tongue, lips and buccal membrane. Generally this con- STOMATITIS. 
47 
dition will be associated with disturbed digestion in 
stomach and bowels. The diagnosis from this descrip- 
tion is perfectly plain. 
Treatment.-Cleanse, disinfect and soothe the in- 
flamed surfaces with lime water, boracic acid, borax and 
tr. myrrh, or any similar agent. Correct the secretions 
and the undue acidity of stomach by a gentle purge of 
calomel and soda. Follow with lime water and milk and 
the blandest diet until all congestion and irritation has 
subsided. In the ulcerative, follicular, or catarrhal con- 
ditions of this trouble we have an agent in the peroxide 
of hydrogen that is of the greatest possible value, and as 
it has a very wide range of usefulness in a multitude of 
other affections we will be pardoned for noticing the 
remedy somewhat in detail. Peroxide of hydrogen as 
made by Mr. Chas. Marchand of New York, (and by the 
way this is the only preparation of it that we have ever 
found of uniform purity and strength) is a colorless, 
odorless and tasteless liquid yielding over fifteen times its 
own volume of oxygen. This preparation has no inju- 
rious effect upon the living animal cell; has no toxic prop- 
erties and may be taken internally or used freely exter- 
nally without the least fear. It has a destructive and im- 
mediate action on vegetable cells, microbes, germs, pus 
and other morbid products. When brought in contact 
with diseased surfaces-either skin or mucous membrane 
-it is immediately decomposed, giving off fifteen times 
its own volume of nascent oxygen which at once destroys 
all pus, bacteria and other products of disease, leaving 
the parts sweet, clean, and thoroughly disinfected. It 
can be readily seen from this how valuable this remedy 
will prove in the hands of the practitioner in thousands 
of cases. For ordinary gargles, washes, or internal use 48 
brvce's pocket practice. 
it may be diluted with from four to ten parts of water. 
In stomatitis it will disinfect the mouth and hasten the 
healing processes after all other agents have failed, and 
in gastric and intestinal indigestion it will arrest the de- 
velopment of germs and fermentation. Indeed, where- 
ever we need the ideal pus and germ destroyer it is the 
remedy par excellence. 
TONSILLITIS-Inflammation of the tonsils. 
This affection, when severe, is also called quinsy and 
consists in the extension of inflammation from the mu- 
cous membrane to the glandular structure of the tonsil 
beneath. The disease is ushered in with malaise, chill and 
some irritative fever. There is soreness of the throat, 
swelling of the tonsillar glands, difficulty of swallowing 
and often pain in the limbs as if the patient had taken a 
general cold. The diagnosis is plain. 
Treatment.-The tendency of this affection is to run 
a rapid course towards suppuration and the suffering in 
the case of full blooded and plethoric patients, where the 
trouble is not promptly jugulated, is out of all propor- 
tion to the simple character of the malady. A good 
sharp purgative of epsom salts, Rochelle salts or citrate 
of magnesia should be given as soon as the patient is 
seen. Warm or hot gargles may be used every half hour 
with warm poultices of flaxseed or corn meal mush exter- 
nally. Stimulating and anodyne liniments are often in- 
dicated. Spts. turpentine, camphor and laudanum with 
sweet oil make a very good liniment. The skin should 
be kept active with small doses of ipecac or jaborandi, 
and we should endeavor to prevent and forestall suppura- 
tion by the prompt and continuous administration of grain 
doses of sulphide of calcium every two or three hours. PHARYNGITIS. 
49 
We have the greatest confidence in this remedy and be- 
lieve that when used early and faithfully it will almost al- 
ways prevent the formation of pus in any inflammation 
of the glandular system. 
PHARYNGITIS-General Sore Throat. 
This may be due to a thousand causes, and requires in 
some cases for simple acute conditions, only a little as- 
tringent gargle or wash, and on the other hand it may 
become one of the most annoying, chronic and intract- 
able of affections. In the chronic form we find a thick- 
ened condition of the membrane with altered secretions 
and constant tendency to a return of the trouble under 
the slightest provocation from dust, diet or cold. 
Treatment.-Depends upon the cause. If the case 
is one from ordinary cold, a gargle of alum, salt, or vin- 
egar will often afford relief. In the commencement of an 
attack from cold or exposure it may frequently be aborted 
by the immediate use of guaiacum, which may be ad- 
ministered in the form of lozenges made of fruit paste, 
to be dissolved slowly in the mouth. The use of a 
foot bath, a Dover's powder and a cup of sage tea to- 
gether with a brief sojourn in bed will also prove a very 
certain means of cutting short the development of an 
acute attack. The chronic variety will require more care 
to find and remove the cause, which very often will be 
found to be in the stomach, or in the nasal organs. 
Again it may be due to general impoverishment of the 
blood, or to some fault in the nervous system. Here we 
have to resort to the most approved course of systemic 
building up by iron, cod liver oil, the hypophosphites of 
lime and soda, arsenic, phosphorus and drugs of this, 
class. The diet should be full and assimilable and rich 
in blood-making material. Locally the throat will re- 50 
brvce's'pocket practice. 
quire the application of nitrate of silver, blue stone, car- 
bolic acid, and undiluted tincture of iron. Sometimes 
much good is accomplished in the intractable cases by 
continued counter-irritation with croton oil, oleate of 
mercury, etc. 
GASTRITIS-Inflammation of the Stomach. 
This condition is variously termed acute and chronic gas- 
tric catarrh, simple inflammation, and by some, chronic 
dyspepsia. The acute form is generally the result of 
some violent irritant, either in the form of corrosive 
poisons or of acrid and disordered secretions. 
The symptoms are severe burning pains, increased by 
taking food, incessant nausea, vomiting of mucus, fetor 
of breath, and in some cases often followed by attacks of 
diarrhoea, with fever of more or less severity. 
Treatment.-If due to some poison, the same should 
be antidoted and evacuated from the stomach. The 
stomach should be kept absolutely at rest and counter- 
irritation in the shape of blisters, cups and stimulating 
fomentations should be used. The intense pain and ner- 
vous irritation should be abated with morphine, cocaine, 
caffeine and similar drugs or agents. Where the stomach 
fails to retain these agents, they should be used hypoder- 
mically. Hydrocyanic acid, for extreme irritability, is a 
most excellent remedy. The diet should consist simply 
of liquid nourishment in the shape of lime water and milk, 
frozen cream, and after a time, the blandest possible 
broths. 
In the form known as acute gastric catarrh, which is 
often known as a bilious attack, we have a loathing of 
food, heavily coated tongue, constipation and bilious 
vomiting and epigastric pain. CHRONIC GASTRITIS. 
51 
A prompt purgative of calomel and soda or podo- 
phyllin followed by some of the salines, will be found 
a most effective early treatment. For the irritation of 
the stomach, we may use lime water, hydrocyanic acid, 
soda-mint, a little champagne and ice, bismuth, etc. 
CHRONIC GASTRITIS. 
This is more properly called chronic gastric catarrh. 
It occurs about middle life, or after, and is more prone to 
attack hard drinkers, or persons who have been subjected 
to repeated attacks of gastritis. 
Symptoms.-We have early morning vomiting, con- 
sisting especially of glairy mucus, thirst, delayed and 
painful digestion, flatulency, acid eructations due to the 
fermentative processes going on in the stomach. There 
is usually thirst, fictitious appetite, with some tenderness 
over the stomach. 
Treatment.-It is important that the patient should 
change his whole manner of life. He should take nothing 
but good nutritious and easily digested food, and none 
but that of the very best quality should be given him. 
Starches and sugars should be avoided and the stomach 
should be washed out occasionally with warm water ren- 
dered alkaline in inveterate cases. An excellent substitute 
for this stomach washing is the drinking of hot water about 
twenty minutes before taking food. A half pint of hot 
water quickly swallowed washes out the accumulated 
mucus and prepares the stomach for the reception of 
food. The diet should consist mostly of animal food, 
and free from all unnecessary condiments. Steaks should 
be rare, and wild game is always preferable to all other 
kinds of meat. In the way of drugs we would suggest 
pepsin, mineral acids, and the vegetable pepsin 52 
brvce's pocket practice. 
known as papoid ; and in painful conditions, cocaine, 
bismuth, belladonna, etc. Where the liver is sluggish, 
the milder mineral waters may be used to advantage, es- 
pecially those of an alkaline reaction. 
I I.CI'.R OF THE STOMACH. 
This condition usually follows a chronic disease of the 
stomach. It may be found at any portion of the stomach, 
though its favorite seat is either at the cardiac or pyloric 
orifice. The symptoms are usually those of aggravated 
and painful dyspepsia, with anorexia. The pain is fixed 
and not general, as in dyspepsia. It is increased imme- 
diately after taking food and there is generally vomiting 
after food. We may find induration and hardness over 
the seat of the ulcer ; occasionally, though, the diagnosis 
would be completed by the history of the case and char- 
acter of the pain. It is always increased by taking food. 
Finally, haemorrhages occur from the stomach, either 
as an admixture of blood with the ejected food, or as in- 
dependent haemorrhages later on. In simple cases the 
prognosis is fairly favorable in good subjects. 
Treatment.-This is essentially a question of rest to 
the organ ; protection to the ulcer and improvement of 
the patient's condition. We rest the organ by giving it 
nothing to do ; we protect the ulcer by neutralizing all 
irritating secretions by bland and soothing diet, always 
liquid, and aided by such drugs as will allay pain and 
form a protective coating for the surface of the ulcer. 
For this purpose we find cocaine, morphine and bismuth 
exceedingly valuable. Patients have been kept for 
weeks upon nothing but lime water and milk ; and quite 
recently a case has been reported in which the patient 
with an enormous gastric ulcer, lived entirely upon ice- GASTRIC CANCER. 
53 
cream for a period of from six to eight weeks, and even- 
tually recovered. For the haemorrhages we would re- 
commend turpentine, opium, ergotole, etc. 
GASTRIC CANCER. 
This disease occurs usually after middle life and may 
consist of any form of cancer. The scirrhus is the form 
usually seen and it generally affects the pyloric orifice, 
though any portion of the organ may be involved. Many 
of the symptoms of acute gastric catarrh are common to 
those of cancer of the stomach. 
Its most common seat is at the pyloric orifice, though 
it may appear in any portion of the organ. We find 
great flatulency, acid eructations and fermentations. 
Among the special symptoms which would lead us to 
make a positive diagnosis we would find pain, vomiting, 
haemorrhages and the presence of a tumor. The pain is 
independent of food and may be felt at all times or at odd 
times. It radiates rapidly and is of a sudden, shooting 
charactei. 
If the cancer is at the cardiac end of the stomach, vom- 
iting occurs almost immediately after taking food ; if at 
the pyloric orifice, it occurs several hours after eating, 
though sometimes it comes on sooner. 
Treatment.-Our treatment can only be palliative; 
we do not expect to cure the disease. The remedies 
suggested for the treatment of gastric ulcer, as well 
as the diet, are nearly all indicated in this trouble, with 
the addition of such constitutional agents as are supposed 
to affect the general system. For this purpose arsenic, 
the hypophosphites, corrosive sublimate, and simple, 
general alteratives are indicated. For the fermentation, 
pain and acidity, the same remedies mentioned under 
the head of Gastric Ulcer are applicable here. 54 
BRYCE'S POCKET PRACTICE. 
DYSPEPSIA. 
This has truly been termed the American disease and 
may be traced in great measure to the manners and cus- 
toms of our country. It is undoubtedly true that this di- 
sease is produced by the gross disregard of all the com- 
mon laws of health in this country. In America the rush 
and struggle of the business man causes him to take his 
food hastily at odd hours, and with his mind the roughly 
concentrated on his business affairs, he gives little thought 
to the proper care of his health. The constant desire to 
bring out new dishes and to add to the luxuries of the 
table, and the wide departure from our primitive methods 
of living, late suppers and irregular hours for meals, have 
all contributed to bring about an unnatural condition of 
affairs in our digestive organs. The result is dyspepsia, 
with all of its attendant evils and consequences. It 
would be impossible to classify all of the symptoms of 
this disease. We have nervous dyspepsia, flatulent dys- 
pepsia, acid dyspepsia, water-brash and hysteria. The 
symptoms may vary from simple heart-burn to the most 
aggravated forms of nervous disturbance. We may have 
flatulence, heart-burn, nausea, pain, headache, vomiting, 
heart palpitation and, indeed, almost any symptom. 
Treatment.-The most important measure of treat- 
ment consists in improving the patient's general condition, 
avoiding improper food, insisting upon sufficient physical 
exercise and in the use of such medicine as will correct 
urgent and pressing symptoms. All foods that favor fer- 
mentation and the formation of flatus should be prohib- 
ited most strictly ; white fish, boiled game and rare meats 
are more likely to agree with the patient. Sugars and 
starches and the quantity of food should be limited, 
while the quality should be of the most nutritious char- DYSPEPSIA. 
55 
acter. In this, as in other diseases, the patient must be- 
come a law unto himself, as no positive rule in dietetics 
can be given for general application. It is equally harm- 
ful to place the patient upon too strict a diet, as many 
dyspeptics have their troubles aggravated by withholding 
the proper food from them. Acidity may be corrected by 
the use of charcoal, magnesia, lime water, etc. 
In all cases where the stomach is primarily at fault in 
furnishing a sufficient quantity of gastric juice, it has been 
the practice to try to supplement this deficiency by the 
administration of the artificial pepsins. A very fair sub- 
stitute is prepared by making an acid solution of any of 
the good grades of animal pepsin, using dilute hydro- 
chloric acid and sufficient water to make a properly diluted 
mixture. This may be administered before each meal, 
and in many cases proves a very valuable aid. Where 
the trouble is partly intestinal we endeavour to supply the 
lacking elements here also by the use of soda, pancreatin 
and bile. Where we need a true digestive agent, how- 
ever, for all portions of the alimentary canal we have it 
in the vegetable pepsin called papoid. This article is 
derived from the Carica Papaya and is free from the ob- 
jections found in the animal product and possesses many 
advantages over the latter. It has been truly said that it 
is the only agent that acts upon all kinds of food, under 
all conditions, and throughout the entire digestive tract. 
Dr. Frank Woodbury, Professor of Clinical Medicine 
in the Medico-Chirurgical College of Philadelphia, gives 
an interesting article on this new remedy in the Neur 
York Medical Journal, from which we take the following : 
Dr. Woodbury says that the action of papoid as a di- 
gestive agent has been thoroughly established. It acts 
upon albuminoids, converting them ultimately into pep- 
tones. It converts starch with great promptness, the 56 
bryce's pocket practice. 
ultimate product being maltose. It emulsifies fats. It has 
a direct tonic action upon the stomach, stimulating the 
secretion of the gastric juice. It is distinctly antiseptic in 
its action, preventing abnormal fermentative processes in 
the stomach and intestines. It acts at all temperatures, and 
in either an acid, alkaline or neutral solution. It is freely 
soluble and is most active when in concentrated form. 
It has no action on living tissues and is positively inno- 
cuous when swallowed in any quantity likely to be ad- 
ministered. 
Dr. Woodbury placed portions of bread, meat, potatoes 
peas, mince pie, " and other substantial," in a large test- 
tube and added some papoid and bicarbonate of sodium, 
with a small amount of water. " The meat rapidly soft- 
ened, and the other ingredients gradually disintegrated, 
forming a pultaceous mass." 
Active out-door exercise should be insisted upon; the 
bowels should be kept regulated by simple doses of aloes 
cascara, colocynth, etc., either singly or in proper combi- 
nations, while the general system should be strengthened 
with iron, bitter tonicsand strychnia. 
Cardialgia, Gastrodynia and Pyrosis are simply va- 
riations of dyspepsia in its multitude of forms. The same 
general line of treatment is applicable and we need only- 
say for gastralgia that cocaine, essence of peppermint, 
soda-mint, or any of the carminatives would afford relief 
in any usual and ordinary pain. The water-brash would 
require the use of a mild astringent, such as kramaria, 
ammonia, ferric alum, red-oak bark or sumac. 
cholera MORBUS. 
This condition is induced by errors of diet, sudden at- 
mospheric changes, or depressing causes acting upon the 
patient. CHOLERA MORBUS. 
57 
Symptoms.-It commences with sudden vomiting or 
purging. At first the contents of the stomach are ejected ; 
then we have mucus ; later, bilious matter, and lastly, a 
frothy serous matter is with difficulty ejected. The purg- 
ing is usually very copious and the later discharges from 
the bowels are altogether serous. There are violent 
cramps in the stomach, intense nausea and colliquative 
sweating. The skin becomes cold, clammy and pinched, 
and the patient very often gets into a state of complete 
collapse, resembling Asiatic cholera. We would recog- 
nize this disease by the vomiting, cramps and purging. 
Treatment.-The offending matters should be 
speedily cleared out of the stomach by a prompt emetic, 
and especially out of the alimentary tract. It would be 
well, also, to use a cathartic of calomel or soda and cap- 
sicum. The pain should be relieved by morphine, hy- 
podermically injected, or small doses of laudanum or 
cocaine. The incessant vomiting and nausea will be 
controlled by morphine, hydrocyanic acid, cocaine, soda- 
mint or lime water. Pieces of cracked ice dissolved in 
the mouth will often allay this intense nausea. Both for 
the relief of the pain and nausea, warm stimulating 
applications in the shape of poultices or plasters of mus- 
tard, cloves, pounded mint, etc., can be used to great 
advantage, and they should be kept over the entire chest, 
stomach and abdomen. Where there is a tendency to 
collapse we may administer brandy, digitalis, strychnia 
or strophanthus. Where the vomiting is intractable, one- 
half grain doses of calomel with bismuth administered 
every half hour have been very effectual. Drop doses 
of laudanum, repeated every fifteen minutes, may be 
mentioned as an old, but quite an effectual remedy, also, 
for this distressing complication. 58 
BRYCE'S POCKET PRACTICE. 
CHOLERA INFANTUM. 
This trouble is mainly confined to children between 
one and two years of age, and is dependent upon certain 
disturbances of digestion and rise of atmospheric tem- 
perature. It has been observed that the trouble comes 
on with the advent of sudden and severe hot weather 
and its subjects are children mostly in the transition stage 
between the mother's breast and the shift for other food 
upon which they are trying to subsist in the absence of 
enough good quality breast-milk. At this time with the 
depression from intense heat, and usually a moist vapor- 
ous condition of the atmosphere added thereto, these 
children are seized with this dangerous and alarming 
disease. 
Symptomatology.-The disease may commence 
gradually as an ordinary summer diarrhoea with some 
gastric disturbance, nausea, and anorexia, and finally 
increase in severity until we have a condition of absolute 
rebellion of the stomach for all articles of food, frequent 
and copious colorless evacuations, great thirst, fever, 
head symptoms and death. On the other hand we have 
seen its onset resembling the cyclone in suddenness and 
fatality. A child apparently well and playful may in a 
few moments turn deathly pale, vomit a little half digested 
milk in a pint of fluid, at the same time one immense 
evacuation of colorless non-fecal water from the bowel 
may occur. There will be no pain, no fever or other 
special symptoms, and a little color may return to the 
cheeks of the little one ; it may even attempt to play for 
a moment or two, but in less than five or ten minutes 
this same vomiting and purging will again occur and will 
increase in frequency and severity until death closes the 
scene. Very often the disease shades off from an acute CHOLERA INFANTUM. 
59 
condition into a very chronic and obstinate form of infan- 
tile gastro-enteritis in which these little sufferers linger 
for months. 
Causes.-While we know very little of the exact 
nature or definite pathology of this trouble, we can easily 
see that the whole nutritive apparatus is affected, and 
while we can trace its onset to undigested or partially 
poisonous remnants of digestion which have either dis- 
turbed the system by absorption or reflex irritation, it is. 
apparent to the observer that the whole ganglionic ner- 
vous system is profoundly impressed. Under this local 
and general disturbance we find nutrition arrested and 
the contents of the alimentary canal producing reflex 
effects ; the circulation becomes interfered with in a most 
serious manner, and we have intense internal congestion, 
with later on, cardiac failure and cerebral disturbances 
and impairment of action from deficiency in quality and 
quantity of blood supplied. 
Treatment.-The indications immediately urgent are 
to restore the circulation at once, correct and eliminate 
the offending materials in the alimentary canal, regulate 
the secretions of liver and digestive tract, and sustain the 
system during the trying ordeal. 
An immediate use of the hot bath will often help the 
circulation greatly. Correctives come in well. Calomel 
and magnesia or soda-one-half to one grain-on a little 
crushed ice every half hour until the stools change con- 
sistency and color, indicating action from liver. We 
give calomel here both for its effect upon the liver and 
for its antiseptic properties. Where it can be obtained 
fresh, I have great faith in the use of medicinal peroxide 
of hydrogen (Marchand's) in these cases until the fermen- 
tative and poisonous products of digestion can be over- 60 
bryce's pocket practice. 
come and the canal rendered aseptic. A large spice 
poultice or mint poultice should be placed over the 
child's abdomen to favor a better circulation and to aid 
in allaying nausea and vomiting. Lime water and iced 
milk, cracked ice, brandy and water, mint tea cold, and 
similar articles may be used as the symptoms demand. 
Later on, as the immediate danger passes off", if diarrhoea 
continues, we should resort to the general measures for 
improving digestion, restoring tone to the nervous sys- 
tem, and checking the wasting discharges from the bowel. 
It will be proper to select a good grade of milk, or easily 
digested foods with but little sugar and starch. The 
milk may be peptonized before giving it, or mixed with 
lime water. Some excellent prepared foods are upon 
the market in which a very near approach to mother's 
milk is reached. We would recommend some of these 
where it is difficult to get a first-class article of cow's 
milk and when the mother's supply is deficient in quan- 
tity and quality. The various astringents, opiates, etc., 
may be used with these little patients; but the great re- 
liance after the acute attack has passed, is in proper feed- 
ing with the purest articles of food suitable to their ages 
and needs, the careful protection from changes of tem- 
perature, and good pure country air. Here the dietary' 
and hygienic conditions count far above all other consid- 
erations. 
DIARRHOEA. 
The acute forms of this disease are induced by various 
errors of diet, dampness or irritating causes. 
Symptoms.-Griping pains in the abdomen, tender- 
ness, frequent watery stools, coated tongue and occa- 
sional fever. It may pass off in a few hours or days, or 
it may run into a chronic condition. DUODENITIS. 
61 
Treatment.-It is well usually to give a gentle lax- 
ative or mild cathartic, which will unload the liver, cor- 
rect the secretions and carry off offending material. If 
the case is seen early, we may give simple doses of castor 
oil, with some carminative, or preferably, fair doses of 
calomel, soda and Dover's powders. Later on we should 
give opiates or astringents in moderate degree and place 
the patient upon a diet of boiled milk, rice, toast, etc. 
Where the disease does not yield to this treatment,, 
preparations of mineral acids with paregoric, bismuth 
with opium, rhatany, tannin, etc., may be used. It is 
very necessary to render the contents of the bowels un- 
irritating to the mucous membrane, and for this purpose, 
the food should be of the blandest character, and all 
acidity should be corrected by the use of lime water and 
other antacids. The application of a good flannel band- 
age around the abdomen will be found very often a val- 
uable adjuvant. 
In the chronic form of this disease, in addition to the 
remedies mentioned above, we would oft-times find ben- 
efit in the use of astringent enemas, su< h as acetate of 
lead with tannin, sesqui-chloride of iror, sulphate of cop- 
per or nitrate of silver. A most efficient combination is 
a chalk mixture with tincture of catechu and opium,, 
and also a decoction of logwood with lime water, or aro- 
matic sulphuric acid with laudanum. The same care in 
diet and in protecting the patient from changes of tem- 
perature should be observed even more rigidly in the 
chronic form of the disease. 
DVODENITIS. 
This is a catarrhal inflammation of the duodenum. It 
is dependent upon exposure to cold, errors in diet and 
other depressing agencies. There is usually a great dis- 62 
bryce's pocket practice. 
tention of the stomach and intestines by gases resulting 
from fermentative processes. There is pain which comes 
on a few hours after eating and is intense and horribly 
depressing, inducing, oft-times, a spasm at the pylorus, 
ending in the vomiting of the entire contents of the 
stomach and regurgitation of the bile into the stomach, 
thereby greatly increasing the nausea and pain. There 
is usually continued tenderness over the entire region of 
the stomach, constipation, loathing of food, coated 
tongue and frequently jaundice. 
Treatment.-It is absolutely important to withhold 
all sugars and starches here. At first, there should be 
only such food allowed as skimmed milk or lime water, 
with a little pepsin or papoid. In an acute attack, the 
intense pain may be relieved by the use of cocaine, 
given internally, or morphia, hypodermically injected. 
Alkaline draughts should be administered to relieve 
acidity, to wash out the accumulated mucus and to re- 
store the liver to its proper action. If the pain is not 
very intense, belladonna or hyoscyamus would be pre- 
ferable to opium. The various alkaline waters are 
valuable and especially those containing phosphate of 
sodium. The practitioner will derive immense benefit 
from the use of repeated blisters over the duodenum in 
this condition. By restricting the diet, as we have men- 
tioned above, absolutely to milk at first, and then grad- 
ually allowing only oysters, white fish or game,, with 
absolutely no white bread, potatoes or other starchy 
.compounds, we may expect the best results. 
ENTERITIS. 
This is an inflammation of the mucous membrane of 
the bowel, extending to all of the other coats. It is gen- ENTERITIS. 
63 
erally caused by exposure, mechanical irritation, indiges- 
tible foods, etc. This condition is known as intestinal 
catarrh, and may, like the other forms of mucous 
trouble, be either acute or chronic. The acute stage is 
ushered in with violent cramps in the abdomen ; intense 
pain, especially around the umbilicus ; nausea, vomiting, 
high fever and quick, tense pulse. The bowels are us- 
ually constipated at first; this is followed by diarrhoea, 
and finally with muco-serous discharges, scant in quantity 
and painful upon movement. We will find the tongue 
red, furred and a tendency to become dry ; the appetite 
poor and thirst considerable. The inflammation may 
involve only a portion of the bowel, or it may extend 
through the entire tract. In the more chronic forms we 
have symptoms similar to that of chronic diarrhoea, with 
liquid, pale stools and sometimes with considerable 
mucus, tinged with blood, giving the appearance of 
chronic dysentery. 
The diagnosis is made by recognizing the marked 
fever, local tenderness and griping pains in the bowel, 
throbbing of the abdominal vessels and constipation, fol- 
lowed by diarrhoea. 
Treatment.-The diet must be of the simplest char- 
acter. The patient made to keep in a recumbent posture 
and the bowel put in splints, as it were, by commanding 
doses of opium, warm counter-irritation externally, tur- 
pentine stupes, occasionally leeches, dry cups, blisters, 
etc. Hot spice poultices are very grateful later on, un- 
less their weight is objectionable to the patient. If there 
is a known irritating cause for this condition, it is proper 
to remove it by gentle aperient measures as early as pos- 
sible. For this purpose, a dose of castor oil, guarded 
with a little laudanum, will be found valuable. It may 64 
BRYCE'S POCKET PRACTICE. 
be necessary in the acute form to make use of minute 
doses of mercurials at first, following with castor oil. 
As soon as the offending matters have been removed 
from the bowel, we should rely upon limiting the diet to 
the smallest quantity and the simplest character. Bis- 
muth, soda and Dover's powders make an excellent 
combination for protecting the bowel and allaying the 
pain. When the inflammation comes from positive 
obstruction to the bowel, we should avoid giving purga- 
tives in any shape, controlling the pain and relaxing the 
spasms with opiates and supporting the patient by nutri- 
tive enemas. 
The chronic form will require the same care in dieting 
the patient; a milder form of constant counter-irritation 
over the abdomen and more decided astringent remedies. 
Bismuth and Dover's powders in good size doses will be 
required ; lime water and laudanum, emulsions of tur- 
pentine and lime water, nitrate of silver and a number 
of the more common vegetable astringents may be used 
to advantage. 
DVSl'.Vl'ERV Inflammation of tlie I„arj»e 
Intestine. 
This is an inflammation of the descending portion of 
the large intestine, usually catarrhal in character, though 
it may be ulcerative and gangrenous. It is often epi- 
demic and seems to be due to atmospheric changes, cold 
or damp surroundings and sometimes to errors in diet. 
It has been observed as a sequel to malarial trouble. 
The pathological condition in dysentery exists in a 
swollen, red and thickened mucous membrane, in which 
the secretion is at first arrested, and then increased, and 
finally becomes muco-purulent. The engorgement of DYSENTERY. 
65 
the vessels is intense and they often rupture, leaving, 
ecchymosed, ulcerous spots. 
Symptoms.-There is usually a reasonable amount of 
fever present, pain, tenesmus with a constant desire to go 
to stool. The passages are mucous, purulent and bloody. 
There is very little fecal matter, though there is a con- 
stant effort to move on the part of the bowel, and very 
often marked constipation exists. Later on we have 
diarrhoea. We also have a good deal of disturbance of 
the stomach and bladder from sympathetic or reflex irri- 
tation. During the acute stage, the temperature is high, 
running from 1020 to 1030 or 1040 and corresponding 
fever exists. There is great thirst and tenderness over 
the bowel on pressure. The patient is greatly disturbed 
by the accumulation of gases in the bowel, which in- 
creases the desire for movement. The disease ordinarily' 
lasts from three to six or eight days for the acute form.. 
* 
Treatment.-The diet in this, as in other affections 
of the stomach and bowels, should always consist of 
bland and unirritating substances, such as boiled milk, 
grated toast, rice and light broths. Moderate counter- 
irritation should be applied. If this trouble results from 
constipation, or the liver is at fault, we should administer 
mild doses of mercurials, with opium and belladonna. 
A very favorite prescription is the administration of table- 
spoonful doses of epsom salts, with about the same 
quantity of paregoric every two or three hours. The 
main object of the physician will be to clear out offend- 
ing matters, regulate the secretions, allay the pain and 
make use of astringents and anodynes. The condition, 
of the skin should not be neglected, and a combination 
of ipecac, quinine and opium will often prove of great 
service. Among other remedies may be mentioned tan- 66 
bryce's pocket practice. 
nin, rhatany, catechu, salol, bismuth and acetate of lead. 
In typhoid conditions the patient's strength must be kept 
up by the use of brandy, milk punches and a good con- 
centrated diet. After the failure of the various remedies 
usually prescribed we have seen inveterate cases relieved 
by the use of simple enemas of cold water ; washing out 
the bowels several times a day with ice water relieves 
tenesmus and gets rid of irritating mucus. 
In the chronic form the line of treatment laid down 
above will apply fully. We will have to use also the 
more decided astringents and a long continued course of 
dietetics will be necessary, consisting mainly of milk, 
rice, soft boiled eggs, corn starch or arrow-root. Very 
little bread should be allowed, and this should be sub- 
jected to great heat. The mineral acids, sulphate of 
copper, sulphate of zinc, nitrate of silver combined with 
opium and ergotole are indicated. Where we suspect 
ulcerations, iron, ergotole and turpentine are*valuable. 
Suppositories of opium, hyoscyamus and cocaine are all 
indicated, as well as the various injections of silver, tan- 
nin. etc. Small blisters frequently applied over the 
region of tenderness are also of unquestioned value in 
this trouble. 
TYPHLITIS. 
This is an acute or chronic inflammation of the caecum 
■or ascending colon and frequently of the vermiform ap- 
pendix. This latter inflammation is known as Appen- 
dicitis. 
Peri-typhlitis is an acute inflammation external to the 
caecum and in the surrounding connecting tissue, usually 
ending in the formation of pus and giving all the symp- 
toms of an ordinary abscess of large size. Both forms 
present the appearance and symptoms of localized peri- TYPHLITIS. 
67 
tonitis, with fever and evidence of intestinal obstruction. 
Symptoms.-We have in typhlitis local pain, with ex- 
treme tenderness over the right iliac fossa, with swelling 
and distention from gases. The patient lies in an atti- 
tude to relax the muscles ; there may be constipation or 
diarrh<ea, or the two conditions may alternate. The 
stools are generally watery and small, consisting of se- 
rous discharges finding their way through hardened 
masses of fecal matter. The fever is generally high, and 
constitutional disturbance is considerable. There will be 
found vomiting in the majority of cases and if the obstruc- 
tion to the bowel is complete the vomiting will become 
stercoraceous. Where the obstruction is not relieved, or 
continues for a long time, we are likely to have ulcera- 
tions and perforations, giving rise to general peritonitis, 
which usually ends fatally. 
In the external form or peri-typhlitis we have the pain 
developed slowly, with an enlarged mass in the right 
iliac fossa, usually ending in early suppuration, when the 
tumor becomes soft and fluctuant. With the suppurative 
process, we have fever, chills and hectic sweating. 
Causes.-Both of these conditions are due in many 
instances to the lodgment of foreign substances at the 
vermiform appendix, or at other points in the caecum or 
ascending colon. Very often large quantities of fruit 
seeds, bundles of worms, or chalk stones are responsible 
for this condition. More often the condition results from 
the lodgment of hardened and impacted faeces-and 
lastly from traumatisms or exposure to cold. 
Diagnosis.-This trouble should be diagnosed from 
the symptoms we have just given, though we should be 
guarded, as we have to decide frequently between aneur- 68 
bryce's pocket practice. 
isms, tumors and malignant growths. Usually, however, 
the history of the case and the prominent symptoms of 
fever, pain, tenderness and enlargement in the right iliac 
fossa, with the alternating diarrhoea and constipation, 
should enable us to arrive at the proper diagnosis. 
Treatment.-The diet should be restricted to liquids 
given in small and repeated quantities ; the patient should 
be placed absolutely at rest in bed, and if in the earlier 
stages of inflammation, leeches and ice bags should be 
used over the spot. The bowels should be kept abso- 
lutely quiet, and paroxysms of pain relieved by the free 
use of opium, hyoscyamus and belladonna. Gentle pur- 
gatives, to favor the softening or removal of these masses 
from the bowel, should be cautiously administered. We 
have excellent results from the use of the mild salines, 
with the addition of small quantities of belladonna to 
relax spasm and favor peristalsis. Where the patient 
does not object to it, or can be induced to take it without 
great difficulty, there is no remedy equal to castor oil, 
turpentine and paregoric. Where the obstruction con- 
tinues unrelieved, or where we have ulceration of the 
bowel, with perforation, the surgical precedure of laparo- 
tomy is demanded and should be promptly undertaken. 
In the external form or peri-typhlitis we may try the 
use of a blister and later on, poultices. When it is posi- 
tive that pus has formed, the patient should be placed 
upon a supportive diet, with quinine, brandy and other 
stimulants, and the abscess freely opened and drained. 
INTV8SVSCEPTION-Invagination, or Ob- 
struction of tlie Bowel. 
This condition may result from a number of causes, 
such as impaction, products of inflammation, presence of foreign bodies and twisting or invagination of the 
bowel. 
Symptoms.-From whatever cause it may proceed, we 
have a constant set of symptoms which may be men- 
tioned in the following order : 
Complete constipation, continued vomiting, finally 
reaching stercoraceous matter; great prostration, fre- 
quent, small pulse, coldness of the skin and collapse. 
Upon local examination we are apt to find hardness and 
swelling at certain portions of the intestinal tract, with 
pain and gaseous distention. 
Treatment.-As soon as we find that the case is one 
of intussusception, we should by all means avoid purga- 
tives of every kind. We are compelled to rely entirely 
upon the efforts of nature with the relaxing effects of 
opium. In this condition we find belladonna of especial 
value, though we have been gratified in using a combina- 
tion of belladonna and hyoscyamus in fair doses fre- 
quently repeated. Large, warm water enemas used with 
care, are often of great value, though force should not be 
used. Aspiration has been practised with fair success, 
both for removing large, gaseous accumulations and for 
inflating the bowel in the hope of removing the constric- 
tion or the invagination. 
Where all other remedies fail, the abdomen should be 
opened promptly and without fear, and the patient be 
given a chance for his life before he is allowed to get into 
a state of collapse and die on account of timidity or in- 
decision on the part of the medical man. In such cases 
as this, surgery becomes a sheet-anchor and offers the 
most tempting results. 
INTUSSUSCEPTION. 
69 70 
BRYCE'S POCKET PRACTICE. 
HAEMATEHESIS Haeinorrhage from the 
Stomach. 
Symptoms.-Of course the prominent symptom is the 
vomiting of blood, which may. on the contrary, be passed 
by way of the bowel. Usually the haemorrhage in the 
stomach takes place slowly, and the blood is thrown up 
in the shape of blackened coffee grounds, as it were ; 
sometimes as good sized clots. When the blood is thrown 
up in large quantities of bright red color, it indicates that 
one or more blood vessels have given away suddenly. 
Haemorrhage from the stomach is indicated usually by 
nausea, which is one of the first symptoms. There is a 
faintness and a feeling of weight and oppression in the 
stomach, with cold, clammy skin and symptoms of shock. 
These symptoms are usually relieved when the contents 
of the stomach are vomited. We find the food mixed 
with blood when vomited up in this condition. 
Diagnosis.-The fact that the blood is usually mixed 
with food, is vomited, is generally black, and presenting 
the appearance of coffee grounds, and frequently 
black tarry stools, would fully complete the diagnosis. 
We need not confound this condition with haemorrhage 
from the lungs, for in the latter case, the blood is usually 
coughed up as a bright red, and frothy substance, un- 
mixed with food. 
Treatment.-Absolute rest, cold water, cracked ice, 
tannic or gallic acid, sulphuric acid, turpentine, ergotole, 
etc, are the remedies. To quiet the tumultuous circu- 
lation of the heart and the excitement of the patient, 
prussic acid, morphine or bromide of potassium may be 
given. If the bleeding continues after the usual remedies 
are tried, ergotole, hypodermically injected is highly 
recommended. COLIC. 
71 
COUC. 
Symptoms.-The general symptoms of this trouble are 
twisting and griping pains around the umbilicus, unac- 
companied by any fever, and occurring in paroxysms of 
varying severity. 
It is frequently due to flatulence, irritating secretions 
within the bowel, errors in diet, poison, and lastly to con- 
stipation. It passes away for a time, leaving the patient 
with a feeling of soreness and depression, but is apt to 
recur again and again, until the conditions producing it 
are removed. The immediate symptoms are vomiting, 
which is very frequent, and always violent, spasmodic 
pain of a peculiar twisting character. There is a marked 
depression, in which the extremeties become cold, with 
a clammy sweat, and great anxiety on the part of the 
patient to be relieved. Other symptoms vary with the dif- 
ferent character of the colic which may present itself; for 
example, where it results from constipation, we have the 
history of this condition sometime ahead, with disordered 
digestion, gradually culminating in an attack. 
In other forms from poisonous metals we may have 
what is commonly known as copper colic, lead colic, 
etc. We would distinguish these latter affections by the 
peculiar symptoms of poisoning from the above metals^ 
Treatment.-Warmth, externally applied, anodynes 
and carminatives, at first. For the simpler conditions ; 
hot water, hot soda water used internally ; hot poultices, 
ginger tea, fennel seed tea, weak mint juleps, Hoffman's 
anodyne, compound spirits of lavender, etc. In severer 
cases we may administer laudanum, morphine or chloro- 
form to relieve the pain and relax the spasm. As soon 
as possible the alimentary canal should be relieved of all 
offending matters, and for this purpose calomel and soda. 72 
brvce's pocket practice. 
or turpentine and castor oil, with a little laudanum and 
large warm water enemas may be used. For the general 
relief of spasm, pain, etc, belladonna is especially indi- 
cated, and not only for simple colic, but for that of 
metallic origin. 
In copper colic we generally find violent inflammation 
of the intestinal canal and our treatment should be based 
upon this knowledge. Regulation of the diet, with the 
use of bismuth, opium, and an occasional light mercurial 
would cover the ground. 
In lead colic we have violent constipation to overcome 
and small doses of opium will be found of great advan- 
tage. This may be aided by the use of calomel and large 
injections of warm water, while diluted sulphuric acid, for 
its antidotal purposes, may be used continuously. In 
■obstinate constipation croton oil in minute doses is re- 
commended, as well as strychnia, iodide of potassium and 
atropine. 
CONSTIPATION. 
This annoying and general trouble is due to a variety of 
causes. Especially do we find it in dyspeptic persons of 
feeble nervous and muscular powers and those leading 
sedentary lives. 
Symptoms.-It is hardly necessary to give symptoms 
of constipation ; still, besides the knowledge that it does 
•exist, we have certain very disagreeable symptoms de- 
pendent entirely upon this condition, such as general 
lassitude, headache, vertigo, disturbed sleep and a dis- 
tended or weighty feeling in the abdomen. 
Treatment.-In general terms-by exercise, diet 
and lastly, drugs. The diet should be nutritious and 
consist of articles not likely to form gases, and sufficiently MUGUET OR THRUSH. 
73 
stimulating to the coats of the stomach or bowel to favor 
the formation of mucus and peristaltic action. Cooked 
fruits, graham bread, corn bread, warm drinks and soups 
are of service. Great quantities of sweet milk should be 
avoided. Where there is atony of the bowel from over- 
distention from gases or from want of nervous power, 
the diet should be regulated accordingly, and belladonna 
strychnia and the phosphates should be administered. 
Where there is want of secretion, colocynth, rhubarb, 
aloes and belladonna are all indicated. 
Alkaline mineral waters frequently have their value, 
and massage and electricity often do much good as well 
as the various gymnastic exercises. 
Probably one of the most important measures for over- 
coming this condition, as an adjuvant to what we have 
already mentioned, will be the formation of a regular 
daily habit by the patient, and for this purpose the patient 
should try to educate the bowel to make an effort at 
about the same hour every day. 
Of course, in the beginning of the treatment the use of 
calomel, enemas and mercurials may be all called for to 
clear out the offending matter and to restore the secre- 
tions before commencing a uniform course of treatment. 
MIGUET OR THRUSH, 
This is an affection almost entirely associated with in- 
fancy. There are a number of small, white patches 
which form within the mouth, soon coalescing, and form- 
ing patches of white, curdlike exudation. The mouth 
is found to be hot, and there is frequently a slight fever and 
a disordered stomach, or diarrhoea associated with this 
condition. The attack usually lasts from one to several 
weeks. It is supposed that this trouble is due to some 
parasite. 74 
BRYCE'S POCKET PRACTICE. 
Treatment.-Mouth washes of flax-seed tea and gum 
arabic, borax and glycerine, ooracic acid, solutions of 
alum water, weak muriatic acid with honey and water 
are all recommended for local use. Much faith has been 
placed in the use of chlorate of potassa, and this may be 
given in solutions with glycerine for a child of from two 
to three years of age in doses of from three to five grains 
several times a day. The general health of the child 
must be kept up as far as possible and carefully consid- 
ered in the treatment of this trouble, as in all others, and 
where exercise and an improved dietary is indicated, it 
should be attended to carefully. 
GLOSSITIS. 
This is an inflammation of the tongue proper, charac- 
terized by pain and enlargement of the organ, with much 
difficulty in articulating, chewing, or swallowing food, etc. 
The cause of the trouble is usually of an irritant or me- 
chanical nature. 
Symptoms.-The prominent symptoms are fever, great 
congestion or redness of the organ with swelling, and 
rapid pulse ; the mouth then becomes hot, the pain is 
considerable and the secretions of the mouth are greatly 
increased. 
In the chronic form the inflammation is usually con- 
fined to the end or edges of the tongue. 
Treatment.-If from vitiated secretions or mechan- 
ical irritants such as broken teeth, the cause should be 
removed, when a cure usually follows. In the acute form 
the patient should be placed upon a fever diet, with febri- 
fuge drinks. Aconite, veratrum viride or prussic acid 
may be used to control the circulation. Incision into the 
tongue should be freely made if the swelling is very STRICTURE OF THE OESOPHAGUS. 
75 
great. Cracked ice will be found grateful, and frequent 
use of very hot water later on. In the event of threatened 
suffocation, laryngo-tracheotomy should be performed 
promptly. 
STRICTVRE OK THEOESOPHAGUS. 
Th s consists essentially in a narrowing or constriction 
of the oesophagus at some point. It may be either spas- 
modic or organic. In the spasmodic form we find it oc- 
curring mostly in hysterical women or nervous men. 
Symptoms.-There is difficulty in swallowing food of 
any kind, especially solids. The spasm is not constant, 
but should swallowing be attempted during the spasm, 
the face becomes livid and the patient presents symptoms 
of imminent suffocation. 
Diagnosis.-An oesophageal bougie will readily pass 
into the stomach, where the trouble is of the spasmodic 
variety, and should it be arrested, the spasm can easily 
be overcome. 
Treatment.-The patient should be reassured and an 
effort made to let him understand that the condition is 
only temporary. The bougie should be passed every 
day ; bromide of potassium and other nerve sedatives 
should be administered and the general system improved 
by the use of tonics, exercise and electric treatment. 
In the organic variety, which may be the result of in- 
juries or acrid poisons, or the results of inflammation 
from other causes, the bougie will be arrested at the site 
of constriction, and it may be with great difficulty that 
the smallest one can be passed. It will be almost im- 
possible for the patient to swallow solids of any kind. 
We should diagnose this form from cancer and aneurism. 76 
bryce's pocket practice. 
In cancer we have severe pain, haemorrhages, and the 
general cancerous cachexia with a continued increase in 
the stricture in spite of treatment. In aneurism we may 
detect the bruit and other conditions. 
Treatment.-When the stricture follows inflamma- 
tion. we must gradually dilate with bougies up to a con- 
siderable size. The electrical treatment by electrolysis 
is worthy of trial in every instance where this severe 
trouble occurs. 
DILATATION OF THE STOMACH. 
This may be due to cancer, to organic obstruction at 
the pylorus, or to atony of the muscular coats, with defi- 
cient nerve power. 
Symptoms.-The patient presents general dyspeptic 
symptoms. There is great distention of the stomach, 
and percussion causes a general tympanitic sound. 
There are frequent eructations and vomitings of partly 
digested food, some of which may have remained in the 
stomach for days. The patient suffers very much from 
many sympathetic disturbances due to pressure on the 
surrounding tissues and organs by the greatly distended 
stomach. 
Treatment.-The patient should live on small quan- 
tities of solid, nutritious food, and should be given mix 
vomica or strychnia, massage and electricity over the 
stomach, and some anti-ferment after each meal. Change 
of habits and abundant exercise will be of service. 
INFLAMMATION OFSEROVS MEMBRANES. 
There are some common symptoms in all inflamma- 
tions of the serous membranes wherever found in the MENINGITIS. 
77 
body. The inflammation is usually of high grade, 
accompanied with severe pain, quick, tense pulse, high 
fever and a tendency on the part of the membrane itself 
to serous effusions, becoming rapidly organizable in the 
form of fibrinous bands and attachments, rapid pouring- 
out of serum, causing local dropsies, and the speedy for- 
mation of pus in great quantities. 
MENINGITIS. 
This is, properly speaking, an inflammation of the 
meninges of the brain. The usual form seen, when not 
dependent upon traumatisms, is that of the pia mater and 
arachnoid, and this condition is almost always associated 
with a limited cerebritis, so that in speaking of menin- 
gitis, we really mean meningo-cerebritis. The conse- 
quent symptoms are always those of both troubles. 
Symptoms.-We have great excitement, often culmi- 
nating in maniacal or furious delirium, severe headache,, 
intense intolerance of noise or light, flushed and injected 
countenance, the carotid arteries pulsating with great 
force and frequency. We also find fever, vomiting and 
other symptoms of cerebral disturbances. The patient 
generally passes from these symptoms into a state of 
drowsiness, general hebetude, rapid and feeble pulse, 
spasmodic twitching of the muscles, hemiplegia and coma. 
Treatment.-Cold applications to the head, such as 
iced cloths, the ice bag, evaporating lotions, stimulating- 
mustard foot baths, local abstraction of blood by way of 
leeches or cups, general counter-irritation, active purga- 
tion with saline cathartics ; subsequently minute doses of 
mercurials, bromide of potassium, ergotole and arterial 
sedatives, such as aconite and prussic acid. The head 78 
bryce's pocket practice. 
may be shaved and a fly blister used to great advantage 
in many instances. 
PLEURITIS-Inflamniation of the Pleura. 
Symptoms.-This disease is ushered in with a chill, 
sharp lancinating pain in the chest, which increases in 
severity greatly during inspiration, cutting short the 
patient's breath and making respiration both painful and 
superficial. Usually there is a dry, short cough, with 
high fever. The ear applied to the chest at this time will 
detect, in addition to these symptoms, a dry friction 
sound. With the subsidence of these acute symptoms to 
a certain extent a change occurs very often in a few 
hours. We have the usual effusion to occur, which by 
its pressure compresses and limits the action of the lung 
and oft-times bulges the inter-costal spaces. When this 
fluid has been absorbed, the lung gradually resumes its 
functions, though, there may be dutness for some time. 
Treatment.-Our object is to cut short the disease at 
the earliest possible moment, so as to prevent serious 
after-consequences. At first we should give a prompt 
cathartic, with opium and bromide of potassium for re- 
lief of pain, and to quiet the circulation, aconite or 
veratrum viride. In plethoric subjects, the prompt use 
of the lancet is of inestimable value. Locally we may 
make use of fomentations, turpentine stupes, cups, 
leeches and general counter-irritation. If the stage of 
effusion has occurred the hydrogogue cathartics such as 
elaterium, scammony, etc., must be used, and the diu- 
retics such as potassa, digitalis, and squills ; and in addi- 
tion thereto, diaphoretics such as jaborandi, etc. Should 
the disease become chronic, it will be necessary to place 
the patient upon a generous diet with alcoholic stimulants. PERICARDITIS. 
79 
In cases of suppurative pleuritis or severe hydrothorax, 
it is proper to evacuate the matter to prevent compres- 
sion of the lung in the first instance and severe and pro- 
longed hectic in the other. 
PNKI MO THORAX. 
This is a condition in which there is movement of at- 
mospheric air in the pleural cavity, and is the result of 
injury to the lung, or sometimes a perforation from 
tubercular disease into the pleura. 
Symptoms.-In this condition we, of course, find 
liquids and air in the pleural cavity. The most promi- 
nent symptom of this condition would be the amphoric 
breathing and voice, and a tinkling, splashing sound upon 
palpation. 
Treatment.-We must resort to opiates and warm, 
soothing applications to the chest, with a generous diet, 
tonics, alcoholics and readily assimilated foods. To re- 
lieve impending dypsnoea we should resort promptly to 
aspiration or puncture. 
PERICARDITIS. 
This is an inflammation of the serous covering of the 
heart, sometimes due to injuries ; more frequently found 
in subjects affected with pleurisy, rheumatism and Bright's 
disease. 
Symptoms.-Increased action of the heart, quick, vi- 
brating pulse, want of appetite, debilitated condition, 
some fever, usually more or less pain in the region of the 
heart, with a dry, fretful cough. A very valuable diag- 
nostic sign would be the cardiac friction sound or mur- 
mur. This is caused by friction of the pericardial sur- 80 
BRYCE'S POCKET PRACTICE. 
faces before effusion occurs and is only obtained in the 
earlier stages of the disease. 
Treatment.-We should quiet the action of the heart 
with aconite or prussic acid ; relieve the pain with opiates, 
local counter-irritation in the shape of blisters, cups, 
leeches ; acting upon the skin and kidneys with mild 
mercurials, squills and digitalis ; and support the patient 
when necessary with a generous diet. 
PERITONITIS. 
This is an inflammation of the serous membrane lining 
the abdominal cavity and is due to a number of causes 
such as external injuries, perforation of the intestines, or 
the discharge of pus into the peritoneal cavity. When this 
condition follows the accidents of child-birth, it is known 
as puerperal or child-bed fever. In the acute stage there 
is severe pain, high fever, great tenderness over the ab- 
domen, with tympanitic distention. The pulse is corded 
rapid and hard ; the facial expression is peculiar, being 
haggard, pinched and anxious. The position of the 
patient is also characteristic : the limbs are flexed upon 
the abdomen, and every effort is made even to prevent 
the weight of the bed clothing upon the abdomen. 
Treatment.-Prompt counter-irritation, and local or 
general abstraction of blood if necessary ; control of the 
circulation with arterial sedatives, and an absolute con- 
trol of pain with full doses of opiates. 
DISEASES OF THE EIVER. 
CONGESTION OF THE EIVER. 
This is usually a transient affection, the result of expo- 
sure to cold, the improper use of alcoholics, or other 
errors in diet. CATARRH OF THE BILE DUCTS. 
81 
Symptoms.-There is a sense of weight in the right 
hypochondrium, loss of appetite, a bitter taste in the 
mouth, headache and occasional nausea and vomiting. 
Treatment.-Usually a brisk, saline cathartic followed 
if necessary, by a light mercurial, and proper regulation 
of the diet, will effect a cure. We have a frequent and 
chronic form of congestion, due very often to heart 
trouble or obstruction to the circulation. This condition 
must be treated on general principles; the cause, as far as 
possible, must be removed, and the general circulation, 
improved by proper diet, clothing and drugs. 
HEPATITIS-Inflammation of tlie Elver. 
Symptoms.-There is great pain and tenderness in the 
region of the liver, high fever, with evening exa- 
cerbations and morning remissions. We have constipa- 
tion, clay colored stools, which are sometimes black. 
There is occasional icterus, and frequent and irregular 
perspirations. This may end in resolution and recovery, 
or in the formation of abscesses. 
Treatment.-We may resort to local abstraction of 
blood, counter-irritation, aided by the internal adminis- 
tration of mercurial or saline purges. The diet should be 
-light and plain and restricted in quantity. Alkaline diu- 
retics and mineral waters may be given. If the trouble 
is due to malarial origin, quinine will be found advanta- 
geous. In the chronic form of this disease, the treatment 
required will be about the same as that of chronic conges- 
tion of the liver. 
CATARRH OF THE BIEE IH CTS. 
This is an inflammation of the common duct, extending 
to the smaller ones, and to the substance of the liver. It 82 
BRYCE'S POCKET PRACTICE. 
is frequently known as catarrhal jaundice, and is due more 
generally to an extension of inflammation from the 
<iuodenum. 
Symptoms.-It occurs suddenly after a few days of 
trouble about the stomach and bowel. There is a decided 
jaundice, with great tenderness and swelling over the liver 
and stomach, clay colored stools, nausea, vomiting, 
sluggish pulse and great itching of the surface. 
Diagnosis.-We would recognize this condition by the 
preceding gastric troubles, with swelling of liver, and 
jaundice. 
Treatment.-Act on the skin and kidneys with the 
usual diuretics and diaphoretics. Locally, leeches, dry 
cups and especially blisters, do much good. The diet 
should be restricted to the simplest liquids. The portal 
circulation should be relieved by the use of very mild 
mercurials, though the salines are better. The remedy of 
all others in this condition is the phosphate of sodium. 
The patient may be given sixty grain doses of this several 
times a day. . Where the disease is persistent and shows 
a tendency to chronicity, chloride of ammonium, iodide of 
potassium or corrosive sublimate should be used. 
ICTBRVS-Jaundice. 
This is simple jaundice and is in itself a symptom, 
rather than a disease. It is often due to some obstruc- 
tion of the bile ducts, galls-tones, plugs of mucus, or to 
catarrhal inflammation. It may be due also to disordered 
conditions of the blood, as in malarial or yellow fever ; or 
to a disordered liver, as in atrophy or fatty degeneration. 
We have known violent anger or great mental emotion 
to produce intense jaundice. GALL-STONES. 
83 
Symptoms.-Almost anyone should detect jaundice by 
the yellow skin, conjunctiva, clay colored stools, and urine 
almost like porter. In addition to these symptoms, the 
patient almost always complains of being absolutely mis- 
erable and utterly worthless. After a few days the itching 
of the skin becomes intense and intolerable. 
Treatment.-The skin should be acted upon by di- 
aphoretics, the kidney should also be acted upon and the 
circulation through the liver regulated as far as possible 
by purgatives. The salines, and especially the phosphate 
of sodium are of great service. The mercurials come in 
well and are absolutely necessary in some conditions. The 
diet should consist bf plain and digestible food, with butter- 
milk, acid fruits, etc. For the intense itching of the skin, 
a warm water bath, rendered thoroughly alkaline with bi- 
carbonate of sodium, is of much service. 
GAI.I.-STONES. 
This painful and distressing condition is characterized 
by an intense pain in the epigastric or right hypochondriac 
region, and it occurs from time to time in violent par- 
oxysms. The vomiting and retching in this trouble are 
severe and we usually find the patient deeply jaundiced in 
a few hours. These stones are usually passed into the 
bowel within a few hours, or as many days, though their 
passage may be prolonged for as many months. 
Treatment.-Hot hipbaths, warm applications in the 
shape of poultices or fomentations, morphia hypodermic- 
ally injected with atropia or belladonna, if necessary, and 
the inhalation of chloroform to relieve pain and relax the 
spasm. Large draughts of hot alkaline waters are com- 
monly supposed to facilitate the passage of the stone. 
Phosphate of sodium is highly efficacious here. Many prac- 84 
bryce's pocket practice. 
titioners rely upon giving large doses of sweet oil, and 
look upon it as being a panacea in these terrible attacks. 
To prevent the recurrence of gall-stones and to favor their 
disintegration when formed, much reliance has been 
placed upon the use of turpentine, upon the various alka- 
line waters and sweet oil. From ten to twenty drops of 
chloroform well diluted, three times a day may be given 
for this purpose. Durand's remedy consists of three parts 
of ether to one part of turpentine, and may be given in 
doses of from ten to twenty drops, three times a day on 
an empty stomach. The diet and exercise of the patient 
are of the utmost importance ; he should avoid much 
sweet or fatty food, and the skin and kidneys should be 
kept active, with an abundance of out-door exercise. 
ABSCESS OF THE EIVER. 
Symptoms.-The symptoms of this disease are usually 
not well marked and are generally of a very diverse char- 
acter at first, consisting of a slight discoloration of the 
skin, with some lassitude, disturbed digestion and marked 
melancholy or depression of the spirits. As the abscess 
develops more or increases in size, we have chills and 
fever, nausea and vomiting, clay colored stools, poor ap- 
petite, high colored urine, tenderness and swelling over 
the region of the liver and finally a fluctuation. 
Treatment.-As soon as pus is discovered, it should 
be evacuated promptly, either by aspiration or incision. 
The patient's general health must be strictly looked after. 
Good food, tonics and stimulants should be made use of, 
with the mineral acids, and especially quinine. 
YEEEOW ATROPHY OF THE EIVER. 
This is a diffuse inflammation of the parenchyma of the FATTV DEGENERATION. 
85 
whole organ which rapidly diminishes in size. It is usually 
accompanied with enlargement of the spleen and attended 
by haemorrhage and symptoms of uraemic poison. This 
disease generally develops quickly and unfortunately ends, 
in the majority of cases, in convulsions or death. It is very 
often seen in pregnant women, and sometimes follows 
grave surgical operations. It begins with gastric distur- 
bances, jaundice or more or less fever. This jaundice 
deepens with sluggish pulse and intense headache, fol- 
lowed by convulsions, coma and death. 
Treatment.-All our efforts are usually without avail. 
Active purgation may be tried and the mineral waters and 
phosphorus have been recommended. 
FATTY DEGENERATION. 
This is a condition in which there is gradual degenera- 
tion of structure by fatty infiltration throughout its tissue. 
It is caused by improper eating, especially of rich foods 
and by systemic diseases, such as cancer, consumption, 
etc. 
Symptoms.-The patient has a pale, sallow complexion ; 
the fats and starches seem to disagree and the stools are 
usually discolored, owing to the presence of altered bile. 
The area of percussion dulness is greatly increased over 
the liver. 
Treatment.-The patient's diet should be limited, fats 
and starches entirely excluded, and proper exercise en- 
joined. The various salines, such as sulphate of magnesia, 
phosphate of sodium, or Vichy water will be found of ser- 
vice. The action of the skin should not be neglected in 
this condition. 86 
bryce's pocket practice. 
CIRRHOSIS-Interstitial Fibral Hepatitis. 
This is a diffuse form of chronic, interstitial inflammation 
leading to a contraction of the organ and an interference 
in the portal circulation, producing passive congestion. 
In this condition we will find ascites, jaundice and splenic 
enlargement. 
Symptoms.-Probably the first symptoms noticed will 
be those of ascites, which will be strengthened by the dis- 
covery of the diminished size of the organ, with the high 
colored appearance of the urine which is usually loaded 
with an abundance of blood pigment. This is usually due 
to over-indulgence in alcoholic liquors and is commonly 
known as gin liver. 
Treatment.-If we could see the patient before con- 
traction took place, we would make use of the usual 
treatment for congestion or inflammation. After the con- 
traction has set in, corrosive sublimate, alternating with 
iodide of potassium, may be tried. Throughout we should 
act upon the portal circulation, and upon the skin and 
kidneys with diaphoretics, quinine, digitalis, etc. The 
diet should be regulated and all alcoholic liquors avoided. 
Where the dropsy is troublesome, paracentisis should be 
praqtised. 
CANCER OK THE EIVER. 
This is a very common affection, and may be either pri- 
mary or secondary to other cancerous troubles. It is more 
common in women than in men and is not usually seen 
until after middle life. It is very often the seat of metas- 
tatic cancer. 
Symptoms.-Disturbance of digestion from interference 
with the portal circulation, more or less jaundice when HYDATID CYST. 
87 
there is pressure upon the ducts. Dropsy is usually slight 
unless the vena cava or portal vein is obstructed by pres- 
sure. The urine is high colored, containing leucin and 
tyrosin. There is pain and tenderness at various points 
over the region of the liver and nodosities may be detected 
here and there. There is a little fever, but as the disease 
progresses the patient presents the peculiar cachectic, 
cancerous appearance. 
Diagnosis.-This will depend upon the local pain and 
tenderness, enlarged liver, irregular, nodulated surface, 
the usual absence of fever and marked cachexia. 
Treatment.-The treatment is usually unsatisfactory 
and of course, is only palliative. The hypophosphites; 
have been much lauded, while arsenic and corrosive sub- 
limate are still popular remedies for retarding the progress; 
of the disease. Externally plasters ofbelladonna, coniurn, 
or hyoscyamus may be worn to relieve tenderness and re- 
tard growth. Whenever the pain is intense, it may be 
relieved with morphia, cocaine, or other opiates. 
HVDATID CYST. 
This is rather a rare affection in this country. There is 
very little pain, fever or other constitutional disturbances- 
As the cyst grows, it gradually projects forward from, 
under the ribs and gives rise to a jelly-like vibration upon 
percussion. The morbid anatomy consists in the simple 
cyst of the liver due to the egg of the tape-worm from dogs, 
which are supposed to enter the body with our food, 
travelling through the portal vein to the liver and there 
becoming encysted. The booklets of these eggs are 
found in the cyst, which contains, besides, a large quan- 
tity of gelatinous fluid. 88 
bryce's pocket practice. 
Prognosis-Fairly good, recovery frequently occurring. 
The bile very often kills these eggs and the cysts may be 
shriveled up or be discharged into the intestines, or ex- 
ternally. 
Treatment.-Glycerine is often administered, under 
the belief that it abstracts fluid from the cyst and thus 
-causes it to disappear. The sodium salts are also recom- 
mended. The most radical treatment is by the surgical 
method which consists in aspirating these cysts and in- 
jecting iodine into them. There is some risk of inducing 
hepatitis by this method, but the remedy, nevertheless, is 
one to be heartily commended. The electrolytic current 
is also an agent likely to accomplish much good in this 
trouble. 
DISEASES OE THE HEART AND AORTA. 
PERICARDITIS. 
This being an affection of the serous membranes, is 
treated of elsewhere in this book. See " Inflammation of 
the Serous Membranes." 
ENDOCARDITIS, 
This is an inflammation of the membrane lining the cavi- 
ties of the heart, and is very often associated with Bright's 
disease and rheumatism. 
Symptoms.-Palpitation, in which the action of the heart 
is greatly out of proportion to the force of the pulse beat. 
The pain over the heart is dull, not sharp and lancinating 
like that in pericarditis. 
Treatment.-We must use prompt counter-irritation 
over the region of the heart, light mercurials, salicylate of 
soda, with digitalis if necessary. If there is much ner- VALVULAR DISEASE OF THE HEART. 
89 
vous excitability, bromide of potassium or chloral may 
be given. 
VAI.VU.AR IIISEASE OF THE HEART. 
Usually the mitral and aortic orifices are the seats of 
the trouble in valvular diseases. These conditions are 
generally due to endocarditis, in which there is contrac- 
tion of the orifices or regurgitation due to valvular insuf- 
ficiency. In time, this condition leads to hypertrophy 
and dilatation, and this is followed ultimately by general 
dropsy, beginning with anasarca of the lower limbs. In 
mitral lesions, with hypertrophy, there is difficulty of 
breathing on exercise. This increases in proportion as 
the pulmonary, circulation becomes obstructed, until 
finally the difficulty of breathing becomes habitual and 
the patient cannot lie down. Aortic lesions are mani- 
fested more by palpitation upon excitement or exercise, 
with the usual pain over the neighborhood of the heart. 
In mitral lesions we observe the systolic, or presystolic, 
murmur, which is heard best near the apex beat; while 
the systolic murmur from aortic lesions is most distinct at 
the base of the heart. We have other murmurs due to 
anaemia, which must not be confounded with these con- 
ditions. 
Treatment.-Our effort will be to relieve pulmonary 
congestions, quiet and regulate the action of the heart, 
the beating of which is tumultuous, and strengthen the 
muscular action of the organ, thus preventing further 
hypertrophy. The patient should be well nourished, and 
digitalis should be given where the heart's action is very 
irregular and feeble ; strophanthus is also highly lauded. 
If the heart's action is rapid, but not weakened by dila- 
tation, aconite comes in well. For general dropsical ef- 90 
BRYCE'S POCKET PRACTICE. 
fusions, hydrogogue cathartics are indicated. There 
should be counter-irritation to the chest, belladonna 
plasters over the praecordium, nux vomica should be given, 
also caffeine. General anaemia should be treated also, 
as some of this trouble may be functional. 
HYPERTROPHY AMiO DILATATION. 
Both of these conditions are so nearly allied or inter- 
dependent that we cannot discuss one without consider- 
ing both. In hypertrophy we have an abnormal increase 
of the muscular tissue of the organ itself, and where the 
cavities of the heart are not enlarged it is known as sim- 
ple hypertrophy. If the cavities are enlarged, it is then 
known as eccentric hypertrophy. In dilatation we have 
enlargement of the cavities and at the same time the 
muscular walls may be thickened or thinned, constituting 
hypertrophic or atrophic conditions. These conditions 
of hypertrophy and dilatation may be due to violent mus- 
cular exercise, excitement or other strains upon the heart 
itself. Various obstructions to the flow of blood through 
the organ would give rise to it. 
Treatment.-We must control the excessive action 
of the heart with prussic acid, aconite, veratrum viride. 
According to the weakness of the muscular action, we 
will be called upon to use digitalis, strychnia or strophan- 
thus, as may be required. When this condition arises 
from other obstructive causes, we should endeavor to 
remove them or compensate for the same as far as possi- 
ble. The diet should be plain and unstimulating, and 
yet, nutritious ; the exercise moderate and reasonable. 
FATTY DEGENERATION. 
As in other tissues, we have here a loss of muscular 
tissues and the substitution of fat cells. PALPITATION. 
91 
Symptoms.-The patient is generally exhausted upon 
slight exercise, the heart is weak and the circulation is 
sluggish and wavering. There is shortness of breath 
from slight exertion, sighing, panting respiration, with 
intermittent pulse at times. The brain suffers from want 
of blood supply as the heart runs down. We may have 
vertigo and even slight epileptiform seizures. 
Treatment.-The first thing is to rest the organ. 
Fats should be avoided, but a sufficient amount of ani- 
mal food should be given. Undue exercise and mental 
worry must beprevented and the patient should be given 
tonics, a reasonable amount of wine or whiskey, strychnia, 
convallaria and caffeine or other heart tonics. 
CARDIAC EXHAUSTION. 
What we have said of the treatment for fatty heart will 
well apply to conditions of cardiac exhaustion, with the 
exception that our active agents may be more freely 
used and, in addition to the remedies mentioned, we 
would suggest brandy, digitalis, strophanthus, and strych- 
nia in large doses. 
PALPITATION. 
This is a very distressing condition, due very often to 
sympathetic disturbances, such as dyspeptic troubles, 
mental emotions or other nervous affections, but more 
generally due to anaemia. 
Treatment.-Where it is from plethora or errors of 
diet, and the habit is full, we would relieve the porta) 
circulation as well as the general circulation by purges of 
aloes, mercurials, colocynth, or some of the saline group. 
Where it is due to menstrual disturbance, this condition 
should be corrected ; and especially do we need the min- 92 
bryce's pocket practice. 
eral acids, iron tonics and dioviburnia, brandy, strophan- 
thus, etc. When due to general nervous disturbances, 
we would find the various anti-spasmodics such as musk, 
valerian, assafoetidae, Hoffman's anodyne, cocaine, etc., 
of much service. 
ANEURISMS OF AORTA. 
The majority of the aneurisms of the thoracic aorta oc- 
cur usually somewhere in the arch. We can always find 
physical signs in abundance when the cardiac two-thirds 
of the arch is the seat of the trouble. A local bulging 
will be seen, in which one rib, or an inter-costal space, 
seems to be pushed forward. We get a distinct pulsa- 
tion from this enlargement, which is different from that 
of the heart. Upon auscultation, we get a very percep- 
tible whirr or thrill, or even a musical sound sometimes. 
Diagnosis.-The diagnosis of this trouble is easily 
made when the disease is advanced. In aneurism of the 
abdominal portion we may have deep-seated and severe 
pain in the back and abdomen, and resistance to all 
treatment; later on muscular spasm of the lower limbs, 
frequent displacement of the liver or other viscera. We 
may be apt to confound this condition with aortic pulsa- 
tion, or with neuralgia or rheumatism of the bowels. 
Diagnosis.-The true diagnostic points would be the 
discovery of a pulsating tumor, which would be 
strengthened by the additional localized bruit heard 
along the course of the spine. 
Treatment.-The treatment of both forms of these 
aneurisms is practically no treatment at all. The patient 
must be made to assume the recumbent posture as much 
as possible and remain so for a long time, trusting to a CONGESTION OF THE BRAIN. 
93 
narrowing of the sac and the filling up of its cavity with 
fibrinous material, by thus reducing the force of the cur- 
rent of blood. The recumbent posture for many months, 
and years even, with large doses of iodide of potassium, 
seems to have given very favorable results; and now and 
then, a cure. The amount of fluid taken should be 
limited, and everything done to lessen arterial volume 
and pressure. 
DISEASES OF THE D'RAIN ANiU SPINAL 
CORD. 
CONGESTION OF THE DRAIN. 
This may be active or passive, due in the first instance, 
to the excess of arterial blood from increased action of 
the heart, paralysis of the vasomotor nerves, etc. 
In the passive form, there is an excess of venous 
blood produced by impediments to return, such as 
tumors, aneurisms, etc. 
Symptoms.-We have headache, fullness and weight, 
flushed face, great heat of head and face, photophobia, 
vertigo, ringing in the ears, sleeplessness, etc. Where 
this hyperaemia is intense, we may have violent throb- 
bing of the carotids, mental confusion, delirium and 
convulsions. The symptoms of the passive form would 
be turgid veins of the head and face, intellectual dulness 
and hebetude, with more or less cyanosis. 
Treatment.-Cold applications to the head should 
be used. In the acute form, cardiac sedatives, aconite, 
prussic acid and veratrum viride are indicated. If ne- 
cessary the blood must be abstracted with the lancet; 
locally, cups and leeches to the nucha and temples, hot 
pediluvia, and active saline purgation aided by enemas 
are all recommended. For immediate reduction of cir- 94 
bryce's pocket practice. 
culation in the brain, bromide of potassium, chloral and 
ergotole are all of value. In the passive form, the 
remedy would be the removal of the cause. 
ANAEMIA. 
This means, of course, a deficiency of blood to the 
brain, and is due to congestions in remote organs, vaso- 
motor disturbances, heart failure, excessive debility and 
sudden loss of blood. 
Symptoms.-The sensation of faintness or actual 
fainting, vertigo, ringing in the ears, blindness, weak, 
feeble pulse, sighing respiration, together with sleepless- 
ness, etc. 
Treatment.-When the trouble comes from sudden 
loss of blood, the recumbent posture must be assumed 
and alcoholic stimulants administered, aided by digitalis, 
strophanthus, strychnia and caffeine. Where it is of the 
chronic character, the condition must be remedied by 
the use of stimulating and nutritious diet, with alcoholic 
stimulants, tonics and reconstructives. 
CEREBRITIS. 
(See Meningitis.) 
EMBOLISM. 
This is an occlusion of some of the cerebral vessels by 
the lodging of an embolus or clot. Such a condition 
may result from the whipping off of fibrinous shreds 
from the valves of the heart, or from clots found else- 
where in the circulation and carried along, these clots 
finally reaching a vessel through which they cannot 
pass. 
Symptoms.-Due very much to the location of the clot APOPLEXY. 
95 
or embolus and to the amount of brain tissue deprived of 
blood. Usually, these symptoms are sudden vertigo and 
headache, mental confusion, the speech mumbling and 
imperfect, frequent vomiting, with hemiplegia or some 
other form of paralysis. The patient frequently presents 
all the symptoms of apoplexy, falling suddenly with un- 
consciousness. 
Prognosis.-The prognosis should be guarded, as 
patients are frequently restored to perfect health, though 
there are many chances for hemiplegia to become per- 
manent, chronic enfeeblement of mind, or cerebral soft- 
ening to a limited extent. 
Treatment.-If we find the heart failing, as we us- 
ually will, it must be sustained by hypodermic injections 
of strychnia, digitalis or ammonia. We may often need 
alcoholic stimulants, and we should by no means use de- 
pressing treatment in any such case. The patient should 
be placed on a light, nutritious diet and kept in a state 
of perfect rest, with the bowels moderately open but not 
actively purged ; and after a few days we may resort to 
the use of iodide of potassium to favor the absorption of 
the clot. 
APOPLEXY. 
This is due to sudden haemorrhage of the blood vessel 
within the brain. There is of course, extravasation, 
producing pressure and causing sudden unconsciousness, 
stertorous breathing, with a complete relaxation of the 
muscular system, reduction of temperature and a slow, 
uncertain pulse. It seems to be somewhat hereditary, 
occurring usually after middle life and seems to be pro- 
duced by mental worry, full feeding, or sudden arterial 96 
bryce's pocket practice. 
excitement. Its immediate cause is due to arterial de- 
generation. 
Symptoms.-Occasionally we have prodromic symp- 
toms, such as headache, vertigo, a tingling sensation in 
the extremities, numbness, mental confusion and a feel- 
ing of impending danger some days before the actual 
haemorrhage occurs. Usually, however, these prodro- 
mic symptoms are lacking, and the patient is taken en- 
tirely unawares. In the sudden attack we have symp- 
toms which we have described before, and in addition, 
the face is usually flushed and turgid with blood, the 
pupils are sluggish, and they may be contracted or di- 
lated with entire muscular relaxation. Unless the patient 
dies in a state of coma, we have then about twenty- 
four hours as a period in which reaction may take place, 
during which there is a rapid rise in the temperature, 
with returning evidences of consciousness and a condi- 
tion of hemiplegia which is very apparent. With this 
rise of temperature, due to an inflammatory condition 
around the clot, there may be tonic contraction of the 
paralyzed muscles and severe neuralgic pains. 
Prognosis-If the temperature begins to rise very early 
and there are signs of returning consciousness, the prog- 
nosis is favorable so far as the present attack may be con- 
cerned. It is unfavorable where the heart shows failure 
and irregular action, or where there is great contraction 
of the pupils, and convulsions. Where sensation returns 
to the paralyzed parts and within the first week there be- 
gins to be some motion, the case is favorable. If no im- 
provement takes place in the paralyzed parts for two or 
three weeks, we will have a tedious case, with the proba- 
bility of no recovery. CEREBRAL SOFTENING. 
97 
Treatment.-If we have prodromic symptoms and 
they are noticed by the practitioner, and if the patient is 
plethoric he should be bled and purged promptly. If we 
fear to take so much blood, we may cup and leech locally, 
and administer large doses of bromide of potassium, 
ergotole or chloral. If seen after the attack has occurred 
or during the attack, and the face is turgid, with good 
strong pulse, the propriety of bleeding should then be 
considered, especially local depletion by cups and leeches. 
The patient should be freely purged at this stage and for 
this purpose we may use croton oil if we have difficulty in 
administering other remedies. A drop or two of croton 
oil rubbed on the back of the tongue will answer, if the 
patient has even lost the power to swallow. Turpentine 
enemas and hot mustard foot baths are valuable ad- 
juvants. If reaction has been established, it will be our 
duty to control the circulation with aconite, prussic acid,, 
veratrum viride, bromide of potassium, chloral or ergotole. 
Leeches may also be used if necessary, behind the ears, 
in case the temperature continues very high. After the 
reactionary stage has subsided to some extent and the 
temperature has become somewhat normal, the patient 
should be kept at perfect rest in every way and free from 
noise, excitement or mental activity. His diet should be 
plain and simple, the bowels should simply act reason- 
ably, and full doses of iodide of potassium should be given 
to hasten the absorption of the clot. . For the paralysis, 
after the inflammatory symptoms have passed, we may 
institute massage, electricity, and passive motion ; 
strychnia may be administered internally. 
CEREBRAL SOFTENING. 
This trouble may be either acute or chronic in character. 
It usually results from embolism or thrombosis, the exten- 98 
bryce's pocket practice. 
sion of inflammation from contiguous parts, from syphilis, 
from great exhaustion or other excesses. 
Symptoms.-In the acute form we have headache 
usually accompanied by fever, vomiting and convulsions. 
There is also delirium, some forms of paralysis limited to 
certain muscles, impairment of the mental faculties and 
difficulties of speech. In the chronic form there is gradual 
mental decay, impaired memory', headache, vertigo, 
debility and disordered nervous sensations, together with 
symptoms of hyperaesthesia and anaesthesia, aphasia and 
slight paralysis or palsy. 
Treatment.-We can do practically very little in the 
line of treatment for these people. In the acute form, we 
must treat the hemiplegia, aphasia and other symptoms 
purely on general principles ; while in the chronic form, 
chloride of gold, phosphorus and other tonics are sup- 
posed to retard the progress of the disease. Really, our 
chief care will be to prolong life and to make our patients 
as comfortable as possible, and this may be done by' 
strict attention to the ordinary' hygienic and dietetic rules 
of life. 
ABSCESS OF THE BRAIN. 
This condition results from injuries, the extension of 
inflammation from disease of the middle ear, from disease 
of the cranial bones or from apoplexy, embolism and 
other similar troubles. 
Symptoms.-We have violent headache, vomiting and 
mental hebetude. We even find coma, stupor, irregular 
rise in the temperature, chills and palsies. The diagnosis 
of this trouble is difficult, though it may be made out by 
taking in all the symptoms and noticing what area of the CEREBRAL SYPHILIS. 
99 
brain would govern the paralyzed muscles. In this way 
we can sometimes locate the seat of the trouble. 
Prognosis.-Very unfavorable. 
Treatment.-Where the condition is due to trauma- 
tisms, or to diseased conditions of the bone, the pus 
should be evacuated by the use of the trephine, other- 
wise we must relieve the pain with morphia, cocaine and 
other anodynes. The strength of the patient should be 
sustained and he should be kept perfectly quiet while 
waiting for nature to help us out. 
CEREBRAL SYPHILIS. 
This may be due to gummatous deposits, giving rise to 
symptoms of meningitis or encephalitis. These syphilitic 
tumors may occlude blood vessels, thus cutting off nutri- 
tion and function, or they may press down upon the brain 
substance here and there, giving us all the symptoms of 
abscess or tumors. 
Diagnosis.-Diagnosing from the history of the 
patient as regards his having been the subject of syphilitic 
trouble ; and especially should this condition supervene 
within twelve or eighteen months after the appearance of 
chancre we might strongly suspect the presence of a 
syphilitic tumor. The diagnosis would be materially 
aided by the result of a few weeks of tentative treatment. 
Treatment.-Essentially that for syphilis. The pa- 
tient should be saturated with iodide of potassium and 
this method of-treatment should be alternated with mer- 
cury from time to time, also arsenic and the vegetable 
alteratives. Nutritious diet, general tonics and comfort- 
able clothing should always be considered in our special 
treatment. 100 
BRYCE'S POCKET PRACTICE. 
SPIINAE CONGESTION. 
This congestion of the spinal cord may be either active 
or passive, and is due very' often to exposure to cold, in- 
juries, malaria, excessive sexual indulgence and alco- 
holism. . 
Symptoms.-A dull, tired pain in the back, which is 
usually increased by pressure, disturbed sensation in the 
limbs, numbness, tingling and sometimes weakness in 
the legs. This condition is often increased upon lying 
down. 
Prognosis.-Usually favorable. 
Treatment.-Counter-irritation along the spine, local 
depletion, sometimes by cups or leeches, and complete 
rest for the patient. Where there is active hyperaemia of 
the cord, chloral, bromide of potassium, ergotole and 
belladonna will aid in relieving this condition. The 
bowels should be kept moderately active with saline 
purgatives or an occasional aloetic purge, if necessary. 
SPINAL ANAEMIA. 
This, of course, is the reverse of spinal congestion, 
though in many forms the symptoms and effects are 
quite similar. We should diagnose the anaemia from the 
history of the patient, the general want of tone about 
the system-pallor and weakness-and the fact that the 
erect posture aggravates the trouble. 
Treatment.-We should treat this condition very 
much as we should that of passive hyperaemia, a subject 
which we have reserved in order to describe it along 
with this treatment. Here we must give the patient rest, 
we should avoid active depletion, and wre should admin- 
ister digitalis, tonics, and just enough mild counter-irrita- SPINAL MENINGITIS. 
101 
tion to improve the circulation. Frictions up and down 
the spine morning and evening, general massage, electri- 
city, warm clothing, nutritious diet and moderate exer- 
cise are the best remedies for this trouble. 
SPINAI. MENINGITIS. 
This is a common inflammation of the arachnoid and 
pia mater, which is sometimes called lepto-meningitis. 
This is a true inflammation caused by exposure, trauma- 
tism, rheumatism, phlebitis, extension of inflammation 
and other causes. It follows the course of other inflam- 
mations, having at first intense hyperaemia or congestion 
followed by exudation of lymph and the formation of fib- 
rinous bands here and there. 
Symptoms.-There is pain and tenderness along the 
spine, which is increased by motion or pressure. The 
patient lies absolutely still to avoid any undue pain from 
motion. We have the various symptoms of disturbed 
spinal functions, such as girdle pain around the waist or 
abdomen, hyperaesthesia, muscular spasms, etc. There 
is a moderate amount of fever present in the earlier 
stages of the disease, and if the trouble continues and 
progresses, we have disturbance of function in organs 
supplied by spinal nerves from the parts affected. 
Treatment.-Very, much that which we have de- 
scribed for congestion. The patient should be confined 
absolutely to bed ; cups, leeches and counter-irritation 
down the spine, and the spinal depletants must be admin- 
istered internally. All these remedies we have men- 
tioned heretofore. After the acute stage has subsided 
we may resort to light mercurials, or rather mercury, in 
minute quantities for its constitutional effect and for the 
purpose of hastening absorption and preventing the 102 
brvce's pocket practice. 
organization of lymph. Iodide of potassium is also 
highly recommended to hasten absorption, while in the 
more aggravated or chronic forms, the galvanic cautery, 
blisters and iodine are suggested. 
PACHYMENINGITIS. 
This is an inflammation of the dura mater of the spinal 
cord. It is due very much to the same causes that pro- 
duce the other forms of meningitis. 
Symptoms.-The symptoms advance gradually, among 
which we may have chills, fever and severe pain. We 
may also have anaesthesia or hyperaesthesia, with shoot- 
ing pains along the nerves coming from the diseased 
parts. The muscles supplied by these nerves undergo 
frequent contractions which are spastic in character. 
There are various other reflex conditions noticed, such 
as wandering pains in the chest, abdomen and limbs, with 
gastralgia, vomiting and other reflex disturbances. 
Diagnosis.-We should diagnose this condition from 
that of ordinary inflammation of the meninges by the 
character of the pains, which are severe ; by the muscu- 
lar contractions and the marked fever. 
Treatment.-On general principles we should place 
the patient at perfect rest in the recumbent posture, 
which should be changed from time to time. Counter- 
irritation along the spine and especially dry cupping 
should be tried. As the disease advances a little and 
with the subsidence of acute symptoms, we may resort 
to blisters here and there ; also, iodine, iodide of potas- 
sium, mercury and electricity. 
MYELITIS. 
This is an inflammation of the cord itself, and is pro- POLIOMYELITIS. 
103 
duced by the same causes which induce meningitis. The 
symptoms are the same as those of meningitis, only 
more intense in character. Of course, as the disease ad- 
vances and the integrity of the cord is destroyed, besides 
the muscular contraction and anaesthesia mentioned be- 
fore, we have paralysis and complete anaesthesia. The 
reflexes are all lost, the rectum and bladder being be- 
yond the control of the patient, and bed sores and 
sloughs occurring on various parts of the body below the 
diseased portion of the cord. 
Treatment.-In the earlier stages, we should proceed 
just as we would treat meningitis, with local abstraction 
of blood, counter-irritants, purgatives, depletants for the 
cord, and later on we should depend especially upon the 
most improved diet, iodide of potassium, tonic doses of 
corrosive sublimate, iodide of iron, cod-liver oil, etc. 
POI.IOMYEUTIS. 
The acute form of this affection, known as infantile 
paralysis, is an inflammation in the ganglion cells of the 
anterior horns of the gray matter of the cord, which pre- 
side over the nutrition and motion of the parts to which 
their nerves are distributed. This affection is almost en- 
tirely confined to children of from three to six years of 
age and may be due to many causes, especially to cold, 
exposure, metastasis of exenthematous diseases, denti- 
tion and other less frequent causes. 
Symptoms.-It usually begins with a mild attack of 
fever, which lasts three or four days. The child com- 
plains of headache, vertigo and spmptoms of nausea, 
and there may be a slight convulsion or two. Within a 
week or ten days there will be found paralysis of one or 
both sides of the upper or lower extremity. We have 104 
bryce's pocket practice. 
usually found it to be one of the lower limbs, which in a 
very short time becomes utterly useless. The peculiarity 
about this form of paralysis is the rapid wasting of the 
muscles of the limbs which quickly shrink away and feel 
soft and flabby. There is very little reaction to the stim- 
ulus of electricity, nor is there any pain in the limb. 
Prognosis-The prognosis is rather favorable, though 
the disease is usually very tedious. 
Treatment.-We should use in the earlier stages, as 
we should in most of the other spinal affections of an in- 
flammatory character, leeches, counter-irritation, cups, 
bromide of potassium, ergotole ; and later on, the iodides 
with tonics. The bowels must not be allowed to remain 
constipated during the course of the disease. The hard 
light and real treatment is the subsequent management 
or relief of the deformities and paralysis. Treatment 
will sometimes be required for years, and the child should 
be placed in the very best possible hygienic condition. 
He should be comfortably clad, well fed, and be given 
sufficient sunshine and moderate exercise, to assure 
assimilation. Cod-liver oil, phosphorus and iron are all 
indicated. Passive motion should be practised, massage 
and electricity should be made use of; and this line of 
treatment should be faithfully persevered in until an ab- 
solute cure has been effected. 
CHRONIC POLIOMVEUTI8-Progressive 
Muscular Atrophy. 
This disease comes on between twenty-five and forty 
years of age, and is due to exposure, injury, mental and 
physical depressing causes, and sometimes to syphilis. 
The muscles under the microscope, are seen to have de- 
generated, as well as the peripheral nerve fibres. This SCLEROSIS. 
105 
degeneration extends to the spinal cord to a certain de- 
gree. 
Symptoms.-The attack commences frequently in the 
arm, with an aching pain, and we soon afterwards notice 
a wasting of the muscular tissue, with loss of power. This 
spreads to other muscles of the arm and shoulder and 
often to the other arm. This condition may continue 
until it affects the muscles of the back, the muscles of res- 
piration, and indeed, the entire muscular system. The 
reflex responses are weakened and there are very poor 
responses to the electric current. A peculiar feature is 
muscular irritability or fibrillation, occurring over these 
fibres when they are lightly struck. 
In addition to these symptoms, we have a reasonable 
amount of pain, rheumatic in character, in the beginning 
of this trouble, which may be accompanied by numbness, 
tingling, etc. The disease progresses steadily, though it 
may seem to be temporarily arrested from time to time, 
the patient finally dying from pulmonary trouble or from 
paralysis of the muscles of deglutition or respiration. 
Treatment.-We should rest the body and mind. 
The patient must be placed in the best hygienic conditions 
possible, and the general alteratives or reconstructive 
remedies used. Massage, electricity, arsenic, and 
strychnia are all recommended, though none have ever 
proved of any special service. 
SCLEROSIS, 
This is an interstitial inflammation of the cord in which 
there is a deposit of connective tissue, producing atrophy 
of the nerve structure itself. It may attack the anterior 
or anterolateral columns or the posterior columns. It may 
disseminate throughout the entire cord and so reach the 106 
bryce's pocket practice. 
brain. It comes on usually after middle age, and is said 
to be due to syphilis, exposure, cold, excessive venery, 
traumatisms, etc., though we really know nothing about 
the cause of it. The disease spreads in the longitudinal 
direction, and the cord becomes atrophied and indurated. 
Symptoms.-In the anterolateral variety, we have 
jerking and twitching of the muscles, with spasms or stiff- 
ness, followed by entire loss of motion of the lower ex- 
tremeties. The patient's gait is peculiar-he seems to 
walk on his toes, bending his body forward, and has a 
tendency to lose his equilibrium. Sensation and reflexes 
are preserved. In the posterior form known as loco- 
motor ataxia, we have a gradual advance of the disease, 
in which there are lightning like pains down the limbs. 
The sensation is very much impaired, especially that of 
contact, the patient often feeling as if he were stepping on 
pillows, or that he cannot feel the floor properly with his 
feet. As the disease progresses there is entire abolition of 
the sensation of the feet and lower limbs. An essential 
symptom is want of coordination in muscular movements, 
the patient cannot walk in a straight line ; he cannot close 
his eyes, and walk or stand erect. Often there are girdle 
pains, which are very distressing, around the whole body. 
We have also what is known as multiple sclerosis, w hich 
gives all the symptoms of both of the forms already de- 
scribed, as well as of brain trouble. 
Prognosis-In all cases unfavorable, the disease 
having a constant tendency to gradual progression and 
death. 
Treatment.-Of late years much good has been done 
by treatment. Now and then cures are reported and it 
is well worthy the attention of the physician to study these 
closely and to give them careful thought, as we will fre- PARALYSIS AGITANS. 
107 
quently be very much surprised at the results of per- 
sistent. scientific treatment. The patient should be 
placed absolutely at rest, so far as undue exercise or 
mental worry are concerned. The diet should always be 
nutritious and easily digestible. We should use very 
gentle counter-irritation (we prefer iodine) up and down 
the spine. The internal administration of corrosive sub- 
limate in tonic doses has proven of great service. The 
chloride of gold and sodium has also been favorably 
mentioned. Of late years much has been claimed for a 
species of mechanical treatment, which consists in 
stretching the spine by swinging the patient by an appa- 
ratus somewhat like Sayre's jury mast. It is claimed that 
very satisfactory results have been obtained temporarily 
by this method and it would be well to give it a trial. 
The moderate application of electricity, especially in the 
form of the faradic current to the muscles and the gal- 
vanic current to the spinal column itself, has at times af- 
forded relief to these agonizing pains. The lightning like 
pains must be relieved by the use of appropriate anodynes, 
opium being reserved for the last. 
Hyoscyamus, for muscular tremor in the disseminated 
form, is one of the best agents we know of. 
PARALYSIS AGITAMS. 
This is known as palsy and is a disease of the nervous 
system, seen oftener among women than men. There is 
constant trembling of the body which may be confined to 
the limbs generally, or to the head and certain limbs, 
though universal trembling is the rule. The pathology 
of this trouble is but poorly understood. 
Symptoms.-As we have stated, the general muscular 
trembling is the prominent symptom, and this condition 108 
bryce's pocket practice. 
obtains though the patient may be lying quietly in bed. 
It affects the entire body, and in this respect differs from 
spinal sclerosis. 
The speech is free and without scanning. As in ante- 
rolateral sclerosis, the patient walks somewhat on tiptoe, 
with the head and body usually bent forward and a 
slight push would throw him off his equilibrium. The 
disease seems to be progressive and there is finally loss 
of power and entire paralysis. 
Treatment. - Here, as in other forms of nervous di- 
seases, the patient must have rest, and such food and hy- 
giene as will be favorable to the building up of the nervous 
system. Phosphorus, arsenic, cod-liver oil and the va- 
rious hypophosphites are all indicated. A special prep- 
aration spoken of elsewhere in this work as "neurosine," 
has been very highly recommended. The nutrition of 
the muscles must be kept up by massage ; the application 
of the faradic current and the use of friction must also be 
borne in mind. To relieve and control the trembling, 
strychnia, electricity and hyoscyamine are especially 
useful. 
GENl.RAI. NERVOUS DISORDERS. 
Apart from well marked and special diseases of certain 
portions of the nervous system proper, we have our most 
frequent, distressing, and unmanageable cases in the 
form of general affections of the entire system. The 
more prominent forms thus encountered are Neuras- 
thenia, Epilepsy, Hysteria, Chorea and General Neu- 
ralgia. They all seem to be dependent to some extent 
upon certain general conditions in which the system is 
depressed and below the standard of health. At the 
same time we may often find a local cause which is NEURASTHENIA. 
109 
operating to further depress and keep up this systemic 
condition. Besides these general symtoms each affection 
has its own peculiar symptoms sufficiently well marked 
to allow us to arrive at a diagnosis and institute special 
treatment along with the general course indicated for 
them all. 
NEVRASTHEMA. 
This is another trouble which has been, by some of 
our very observing writers, appropriately termed the 
" American Nervous Disease " and is, in our experience, 
the outcome of the worry of business and rush after 
wealth in this fast age of ours. Of course, poverty, 
want, trouble and other depressing causes, as sexual ex- 
cesses, inebriety and the like are prolific causes of this 
trouble. The literal name of this disease would be 
Nerve Exhaustion, and indeed the condition is one of 
prostration of the whole nervous system with attendant 
disturbances of the digestive organs, and general irrita- 
bility of mind and body. 
Symptoms.-The symptoms of neurasthenia are of the 
most widely divergent character, showing a profound 
depression of the mental and physical powers. The 
patient is irritable, fretful, unhappy and dissatisfied with 
himself generally. It is a labor for him to tax his mind 
or body with any kind of task which must be performed. 
While the mind and intellectual faculties are perfect, yet 
they speedily become tired and refuse to respond to the 
demands made upon them. There is forgetfulness, 
sleeplessness, indigestion and restlessness. Great inde- 
cision of character marks the individual in the smallest 
affairs of ordinary business. The patient is weak, 
anaemic, low spirited, always tired and the subject of all 110 
BRYCE'S POCKET PRACTICE. 
manner of aches, pains and morbid fears. The limbs 
are weak, tremulous and easily benumbed by slight pres- 
sure on the nerves. There are palpitations of the heart, 
sudden perspirations and other evidences of general de- 
pression. In the female many of the symptoms are aug- 
mented by the additional reflexes from the uterus. In a 
number of cases we find neurasthenia as a sequel of im- 
moderate use of alcohol, opium, chloral, cocaine and 
other remedies of this class. 
Treatment.-If any local or special cause can be 
found for this condition it should be attended to at once. 
The next important step is to secure absolute freedom 
for the patient from all business worry, care and bother. 
He will need rest in the true sense of the word and he 
should have all the possible advantages of recreation, 
change of scene and surroundings and pleasant associa- 
tions. His diet should be simple and nutritious from the 
first and gradually brought up to a full and highly concen- 
trated course, rich in material for building up the blood and 
the nervous structures. At first we should give rich milk 
and plain bread, following on after the usual general 
irritability of the system has subsided, with rice, soft boiled 
eggs, white fish, oysters and finally reaching the full meal 
of beef, mutton, game, and vegetables. As soon as the 
system is in a condition to use them advantageously, the 
wines, ales or porters may be freely allowed when indi- 
cated. Much harm is done by the effort of the physician 
to build up the patient too fast and before the system is 
prepared for this forced feeding. It is therefore of equal 
importance with full feeding that the patient be carefully 
prepared beforehand, or else there is danger of serious 
consequences to the patient from this sudden over- 
charging of the system with irritating ingesta. NEURASTHENIA. 
111 
Massage, electricity, exercise of the entire muscular sys- 
tem, either actively or in shape of passive motion is of great 
value. Tonics of all kinds are indicated, especially iron, 
arsenic, strychnia, the phosphates and the usual vege- 
table bitters. The various tonic and sedative narcotics 
are very often called for to relieve the melancholia, in- 
somnia or extreme nervous excitability of these cases. 
Often it is absolutely necessary to thus control the highly 
irritable condition of the nervous system by an appropri- 
ate special line of these drugs before we can put the pa- 
tient upon any improved course of alimentary article or 
more direct tonics. Where such conditions exist we have 
in a preparation called Neurosine, one of the most valua- 
ble and effective neurotics within the reach of the physi- 
cian. This preparation is put up by a St. Louis firm of 
chemists and presented to the profession in an open 
handed, scientific and strictly professional manner. It af- 
fords us pleasure to introduce such an excellent remedy 
as we have found in neurosine and at the same time to 
know that we can do so without helping on a secret propri- 
etary compound. The formula of this valuable prepar- 
ation is freely given to the professoin and is as follows : 
Each fluid-drachm contains five grains each of the C. P. 
bromides of potassium, sodium and ammonium; one- 
eighth grain of bromide of zinc, one sixty-fourth grain 
each pure extracts belladonna and cannabis indica, four 
grains extract lupuli, and five minims fluid extract cas- 
cara sagrada. This preparation is simply invaluable in 
the condition mentioned above and as it is of even more 
service in some of the affections yet to be described we 
have introduced its formula in this connection. In the en- 
tire treatment of a case of neurasthenia we must not lose 
sight of the fact that the tendency will be towards con- 
tinual relapses and we must be ever on the lookout to en- 112 
bryce's pocket practice. 
courage and cheer the patient until he has gained sufficient 
physical and mental strength to go on to a complete cure 
as time and faithful treatment will insure, remembering al- 
so that he needs all of his forces in this long fight and hence 
it will be hardly necessary for us to urge the physician to 
be careful not to give too much physic. 
EPILEPSY. 
This disease is marked by sudden loss of consciousness 
and convulsive seizures which pass off in a deep sleep. 
The trouble is a chronic one and the attacks recur at 
longer or shorter intervals. There are three varieties of 
the disease, known as grand mat, petit mat and Jack- 
sonian epilepsy. In the first the attacks are complete 
and profound, the loss of consciousness being complete 
and the convulsions being general and severe. In the 
second variety there may be little or no loss of conscious- 
ness and the convulsive movements may be of the slight- 
est kind, the patient simply appearing slightly confused 
for a few moments. In the Jacksonian variety there is 
no loss of consciousness and the convulsive seizure is 
confined to certain muscles or groups of muscles. This 
latter form is usually the result of disease of the cortical 
substance of the brain. 
Symptoms.-The prominent symptoms of epilepsy 
have been given with the above description, but there 
are a few special features which are associated with it 
and which further aid us in making out a diagnosis be- 
tween it and some hysterical affections now and then 
simulating epilepsy. Besides the loss of consciousness 
and the convulsions in the major variety, there is usually 
a distinct aura or warning symptom just before the 
attack. This may be manifested in any kind of distur- EPILEPSY. 
113 
bance of sensation such as a feeling of distress about the 
stomach, simple heartburn, flashes of light before the 
eyes, noises in the ears, numbness in the limbs or some 
similar symptom. Very often the patient will describe 
this warning symptom as something that gradually rises 
up from the stomach to his head when he no longer re- 
tains consciousness. The patient will frequently give a 
sudden cry as of terror and fall over with a convulsion. 
The tongue is frequently bitten and the convulsions as- 
sume the tonic and subsequently the clonic form before 
the attack subsides. An attack may last for only a few 
minutes or it may be prolonged for hours. It usually 
passes off in a profound sleep and the patient emerges 
from it in a dazed and semi-confused state. 
Prognosis.-In all forms of epilepsy this is unfavora- 
ble, and much will depend upon the age and exciting 
cause producing the trouble. Where it occurs in chil- 
dren from errors of diet, teething or remediable diseases 
we may hope to cure it in a certain number of cases, but 
where no cause can be found and when it continues to 
recur at more frequent intervals the prospects of cure 
are very bad. The worst feature of this trouble is its 
tendency to produce mental impairment as it advances, 
though many epileptics are very intelligent people. The 
duration of the disease cannot be predicted as it is essen- 
tially one of extreme chronicity. It may not shorten life 
at all except through accidents occurring when the 
patient falls from loss of consciousness, when he may 
kill himself by blows on the head, or from falling into 
the fire or water. 
Treatment.-Remove all exciting causes if such are 
to be found, and if it is impossible to assign a cause, 
then we should pay attention to every peculiar habit or 114 
brvce's pocket practice. 
act of the patient, regulating the quantity and quality of 
food, seeing that all of the functions of the body are 
properly performed. If it proceeds from an irritated 
prepuce, an injury, tumors, or injuries to the brain, the 
surgeon will be able to do much for the case and should 
not hesitate to operate, as these cases are hopeless if left 
alone. The majority of these cases, however, are de- 
pendent upon some obscure general condition and re- 
quire treatment from this point. Long experience has 
proven that the most uniformly successful remedies for 
improving and mitigating these epileptic seizures and in- 
suring the longest possible intervals between attacks are 
the bromides of potassium, ammonium or sodium, 
either singly or better, combined. They should be 
pushed vigorously and continued in full doses until the 
reflex sensibility of the palate is abolished, as may be 
ascertained by tickling the palate with a feather without 
provoking any attempt at vomiting. They should still 
be continued after this but in smaller doses. All treat- 
ments should be continued for many months after all 
symptoms have been subdued. The dose of these 
bromides for an adult should range from a half drachm 
to a drachm at a time and may be required from one to 
three times a day. Thousands of other remedies are 
mentioned both by the profession and the laity for this 
distressing condition, but this multitude of drugs only 
shows how unsuccessful the general treatment has been 
with all of them. Among others specially mentioned 
are cannabis indica, chloral, nitro-glycerine, and zinc. 
The combination referred to elsewhere in this book as 
Neurosine is one of the best preparations that can be 
given in this condition as it combines all of the bromides 
and the zinc together with mild narcotic sedatives. HYSTERIA. 
115 
HYSTERIA. 
This is more generally looked upon as a reflex from 
the uterus rather than as a pure nervous disorder. In 
many cases the trouble can be traced directly to the 
uterus, but this is by no means the only source of the 
trouble as we have frequently seen unmistakable cases 
of hysteria in males. The majority of cases are seen in 
females and for this reason the cause is saddled upon the 
unfortunate uterus. 
Symptoms.-^The attack may vary in severity from a 
simple fit of uncontrollable laughter or weeping to one 
resembling the most severe epileptic convulsion. It 
often comes on with a sensation of a ball rising in the 
throat {globus hystericus}, a sense of constriction about 
the body, or other similar symptoms. A further pecu- 
liarity of the disease is in the simulation of so many 
other and grave diseases. We have seen it assume the 
role of aphonia, paralysis, brain diseases, amaurosis 
and all imaginable troubles. The phantom tumor is the 
most remarkable of these hysterical manifestations. It 
looks and feels like an abdominal tumor and may remain 
for a long time and then in an instant disappear. Gen- 
erally in an attack the abdomen will become suddenly 
and enormously distended with gas but this is not the 
phantom tumor, which lasts and sometimes deceives the 
surgeon to the extent of making a fool of him. We 
have known of more than one instance where the sur- 
geon has made all of his arrangements to remove a 
tumor, when it would remove itself much to the chagrin 
of the operator. These attacks consist of much weep- 
ing as a general rule, though we have seen patients in a 
most hilarious and happy mood ; frequently they get into 
a state of catelepsy, or simulated coma. The attack us- 116 
bryce's pocket practice. 
ually passes off with a good cry, an immense discharge 
of liquid urine, an emptying of the stomach or bowels or 
some other physiological act. 
Treatment.-Functional disorders should be cor- 
rected and the general health improved by tonics, fresh 
air and good wholesome plain food. Abundance of ex- 
ercise in the open air and sunshine is an excellent adju- 
vant to the treatment with drugs. The various antispas- 
modics and sedatives are indicated, such as musk, vale- 
rian, assafoetida, castor, the bromides, neurosine, shower 
bath, iron, cod-liver oil and electricity. 
CHOREA St. Vitus' Dance. 
Symptoms.-Incessant movements of the voluntary 
muscles in an irregular manner. There is no control 
over this condition of muscular movement or if so it is 
very little. The affection may be confined to certain 
muscles or groups of muscles or to the entire muscular 
system. Usually it is confined to certain groups. In bad 
cases patients cannot walk, or use the hands well enough 
to feed themselves ; frequently speech is interfered with 
to a considerable extent and the constant movements of 
many muscles actually brings on positive fatigue and de- 
pression in severe cases. During sleep all of these move- 
ments are arrested and the patient is for the time relieved 
of the annoying and fatiguing affection. A certain de- 
gree of palpitation of the heart with cardiac murmur is 
frequently observed, probably due to the same irregular 
muscular action of the heart or its valves. 
Causes.-Chorea is mostly seen in young people and 
children and in very nervous and weak adults. It is 
traceable to debility, fright, overwork, mental excitement, 
injuries, rheumatism and exposure. NEURALGIA. 
117 
Prognosis.-This is always favorable in young people 
and also in all well managed and ordinary cases in adults. 
The duration of the disease is from four weeks to as many 
months. 
Treatment.-Tonics, good diet, and healthy exercise 
with mild antispasmodic and sedative remedies. In mild 
cases light doses of the bromides, change of occupation 
or suspension of studies, improved nutrition and salt 
bathing will be all necessary. In more severe conditions 
iron, arsenic, strychnia, cod-liver oil and the hypophos- 
phites of lime and soda may be tried, and in place of the 
bromides we can find a still more powerful combination 
in neurosine. 
NErRALGIA. 
The general form of neuralgia may invade any portion 
of the body supplied with nerves, hence we cannot ex- 
empt any muscle or organ from this painful and in- 
tractable neurosis. 
Symptoms.-Pain is the essential symptom of this af- 
fection. It is a pure nerve pain without heat, swelling or 
other symptom of inflammation. As far as we can ascer- 
tain this is a purely non-inflammatory trouble confined 
to the nerve itself. The pain is very acute, sudden and 
shooting and there may or may not be tenderness over 
the parts on pressure, except when there is a coexisting 
inflammation present. The affection may arise from an- 
aemic and disordered conditions of the blood itself, from 
a diseased condition of the nerve centres, or from local 
affections of the nerve, as tumors, injuries and inflamma- 
tion. Various forms of neuralgia are named from the spe- 
cial nerve affected or from the site of the pain ; thus we 
have tic douloureux for facial neuralgia, sciatica for neu- 118 
bryce's pocket practice. 
ralgia of the hip, gastrodynia for the pain when it affects 
the stomach, hemicrania for unilateral neuralgia of the 
head, pleurodynia for the side, and angina pectoris when 
the heart is affected with the sudden painful neuralgic 
seizures. 
Treatment.-While the manifestations of neuralgia 
are local, it is evident that the general system is greatly 
at fault in a large number of cases, and it is important, 
therefore to attend to building up the system with gen- 
erous diet, tonics, and placing the patient in a favorable 
general hygienic condition. Where the trouble can be 
traced to malarial influence, as it is very often found de- 
pendent upon this condition, the administration of qui- 
nine in full doses until the system is thoroughly impressed 
will afford the most satisfactory results. In these mala- 
rial cases it will always be found that the ferruginous prep- 
arations as well as the various bitter tonics, and the prep- 
arations of zinc, copper, and arsenic are valuable 
adjuncts. After paying attention to these general points 
in the treatment, we must then treat the special forms of 
the trouble as they arise. Pain must be combated with 
aconite, belladonna, conium, morphia, cocaine, chloro- 
form, hyoscyamus, chloral and opium. Locally we must 
resort to liniments, blisters and counter-irritation. Hy- 
podermics over the course of the nerve, acupuncture, 
electricity and the actual cautery are all to be relied upon 
in extreme cases. Where the trouble is found to be de- 
pendent upon some morbid growth or pressure upon the 
nerve it will be necessary to resort to surgery for relief. 
It should be borne in mind that the general system in 
all cases of persistent neuralgia is apt to be greatly at 
fault and the prevention and cure of this terrible affliction 
will depend upon measures addressed to such condition. LARYNGITIS. 
119 
For this purpose, in addition to the remedies named, we 
would speak further of cod-liver oil, phosphorus, the 
hypophosphites, and neurosine as being of inestimable 
value. 
DISEASES OFTHE RESPIR ATORV SYSTEM. 
EAR VtNOITIS-Inflammation of the Earynx. 
Symptoms.-Some difficulty or oppression in breathing, 
tickling in the throat, altered or abolished speech, hoarse- 
ness, dry cough, difficulty of swallowing and some fever. 
The condition is simply that of a common cold and lasts 
from a day or two to a week or longer for the acute va- 
riety. This dry and hoarse condition passes into that of 
free secretion and expectoration and the symptoms all 
abate and pass away in favorable cases. The inflamma- 
tion sometimes passes down and ends in bronchitis, or 
the trouble may terminate in oedema of the glottis. 
Treatment.-Place the patient upon a mild liquid diet 
and keep him in a room of equable temperature of about 
68° with a certain amount of warm moisture in the atmos- 
phere of the room. Cracked ice will be very comforting 
and beneficial to the patient, and a gentle purge if there 
is plethora, will be indicated. Inhalations of warm and 
soothing vapors are grateful, and especially those com- 
bining an astringent. Dover's powder and ipecac act 
very well in some cases. In severe cases where suffoca- 
tion threatens from oedema of the glottis or continued 
spasm, tracheotomy must be performed. In the chronic 
form we will find syphilis or consumption usually present 
as the cause, and our treatment must be directed to the 
general condition of the patient as well as the local trouble. 
In addition to the symptoms of the acute variety, we will 
have pain, soreness and difficult deglutition. The 120 
bryce's pocket practice. 
opiates and nervous sedatives must be used freely with in- 
halations of carbolic acid, turpentine, etc. 
BRONCHITIS. 
The various forms of bronchitis may be classified as 
acute, chronic, plastic and capillary. In the acute form 
there is catarrhal inflammation of the larger bronchial 
tubes. This is due to exposure to cold, certain general 
disorders of the system and metastasis from the exan- 
themata. In the plastic form there seems to be a fri- 
brinous exudation in which there are actual casts of false 
membrane. Capillary bronchitis may be really termed 
a suffocative catarrh, in which the smaller bronchial tubes 
are affected with catarrhal inflammation, completely 
blocking them up and interfering with inspiration to such 
an extent, that we have collapse of certain portions of 
the lung. In children, or in very debilitated people, this 
is a very dangerous condition. The chronic form is also 
a catarrhal inflammation of the larger bronchial tubes, 
following an acute attack, which develops slowly and 
lasts nearly all the winter with a tendency to return with 
each advent of cold weather. The pathology is simple 
and is that of the acute disease, the difference being its 
excessively chronic character, and the fact that it does not 
seem to shorten life or impair the health very much. 
Symptoms.-The acute form begins with chill, and 
sometimes with a slight fever, with a harsh, dry cough, 
somewhat paroxysmal in character. The expectoration 
is mucous in character and slight in quantity and some- 
times streaked with blood. There is some shortness of 
breath, occasional nausea, with headache, aching in the 
limbs and a general feeling of malaise. Later on, as the 
inflammatory symptoms somewhat abate, the cough be- BRONCHITIS. 
121 
comes easier and the expectoration freer, in which the 
patient brings up pus or muco-pus ; the fever gradually 
subsides and the cough lessens in the same way. Acute 
bronchitis usually lasts from ten to fifteen days. Upon 
auscultation, we find an almost natural vesicular murmur, 
the respiration is harsh from both lungs, and dry, sonor- 
ous rales may be heard throughout the chest. These 
rales in the second or full stage, give way to moist, bub- 
bling rales. 
Prognosis.-Usually favorable, unless the disease 
should run into capillary bronchitis or become compli- 
cated with pneumonia. 
Treatment.-The patient should be placed upon 
fever diet and treatment. The temperature of the room 
should be uniformly at about 68°, and it would be well to 
have a sufficiency of moist vapor always present, this 
being easily produced from boiling water. If the patient 
is full and plethoric, and the pulse bounding, we should 
control the same with a sedative, probably veratrum 
viride being the best; also make moderate use of wet 
or dry cups over the chest. Frequently, a little counter- 
irritation in the way of sinapisms to the chest will be 
found serviceable, or a warm mush poultice with red pep- 
per in it, may be applied over the entire chest. The 
skin should be acted upon with small doses of tartar 
emetic or ipecac, and if necessary, with jaborandi. If 
the cough is very troublesome, inhalations of vapor, 
with turpentine and hot water, tincture of benzoine, or 
broken doses of Dover's powders may be given with 
much benefit. If the disease still shows a tendency to 
advance further down and to attack the capillaries, the 
circulation should be more thoroughly guarded with 
veratrum viride, counter-irritation should be more vigor- 122 
BRYCE'S POCKET PRACTICE. 
ously pushed, and quinine and jaborandi should be ad- 
ministered freely. When the second stage is reached, 
the patient should be sustained by appropriate and nutri- 
tious diet, with such stimulants as milk toddy, egg-nog, 
essence of beef, porter, etc. To facilitate expectoration 
and dissolve tenacious secretions, the muriate or car- 
bonate of ammonia, in combination with senega, squills 
and ipecac should be administered. 
In the Plastic form the treatment should be almost the 
same as for that of the acute form. It should be deci- 
dedly more active, and freer use be made of the chlorid 
of ammonium, while the necessity for stimulation and full 
nutrition will become even more important. 
In the Capillary form the symptoms are the same as 
those of acute bronchitis, with the exception that there is 
more fever. There is also more general depression and 
more evidence of want of aeration of blood, showing 
feeble circulation, great difficulty in breathing, a blue- 
ness of the lips and finger extremities, and great promi- 
nence of the veins. The patient exhibits a dull, delir- 
ious and stupid appearance and the extremities are cold, 
the pulse irregular, the sweating profuse, and collapse 
follows. Percussion gives a clear note, except over the 
collapsed portion of the lung, where it will be found 
dull. This dulness is changeable, as the secretion is 
moved and the collapsed lung becomes filled with air 
once more. The prognosis is always unfavorable in this 
disease. 
Treatment.-If the case is seen early, there should 
be counter-irritation, wet or dry cupping, leeching, etc. 
In the case of elderly persons, we should prefer the dry 
cups. The arterial tension should be controlled to a cer- 
tain degree with such agents as veratrum viride, digitalis CROUP. 
123 
or prussic acid, though we must be careful not to depress 
the heart too much in this condition. Very full doses of 
quinine and jaborandi will be of especial service. As 
the disease threatens suffocation, it will be necessary to 
resort to emetics and nauseants as far as the patient can 
stand them, in order to mechanically unload these 
blocked tubes. Chloride of ammonium is also of es- 
pecial value in this condition. Alcoholic stimulants must 
also be freely used as occasion requires. 
In the Chronic form, the patient may be treated upon 
general principles. Mild counter-irritation, careful cloth- 
ing to protect against the vicissitudes of temperature and 
moisture, and the avoidance of great diversity of temper- 
ature in the sleeping apartments must be well consid- 
ered. It is also very important that the patient should 
inhale no dust or other irritating matter. He should be 
kept upon highly nutritious diet, and whenever necessary,, 
cod-liver oil, egg-nog and a reasonable amount of alco- 
holic stimulants should be administered. Among the 
medicinal agents proper, the iodides, and especially the 
iodide of iron, are of general utility. Where the secre- 
tion is scanty, muriate of ammonia is a most valuable 
ally. Inhalations of the vapor of tar, or iodine and car- 
bolic acid will materially aid us. Where the secretion is 
too profuse, we may sometimes find it necessary to check 
it by the administration of preparations of zinc or tannic 
acid, krameria, cubebs, etc. A preparation of wild 
cherry and diluted sulphuric acid is a remedy of consid- 
erable popularity. 
CROUP. 
This condition, known as laryngismus stridulus or 
spasm of the glottis, or spasmodic croup, is quite a 
common complaint among young children. It is evi- 124 
bryce's pocket practice. 
dently due to some spasmodic action involving muscles 
which close the glottis, and may be due to a number of 
causes, both local and centric. We think we very often 
trace it to cold and exposure. 
Symptoms.-It usually comes on very suddenly and at 
night. The leading symptom is dyspnoea, or difficulty 
of breathing, which is accompanied with a stridulus, 
crowing inspiration. The appearance of the child strug- 
gling violently for breath, with anxiety depicted upon its 
countenance, and with blueness of the face showing want 
of aeration, makes a very prominent picture, which one 
may easily diagnose. Frequently the attack ends quite 
suddenly, and respiration is complete without alteration 
in the voice and without any cough. This condition may 
pass off, or may recur from time to time with increasing 
severity. It may last from a few minutes to an hour or 
so, perhaps longer. 
Treatment.-This must be prompt, and will consist 
at first in every thing which will engage the child's atten- 
tion and break in upon the nervous spasm that threatens 
to suffocate the sufferer. Shaking the child, dashing cold 
water in its face, slapping or rubbing the back and some- 
times placing it in a warm bath, holding stimulating mix- 
tures to the nostrils for inhalation, etc., are all not only 
household, but professional remedies. A prompt emetic 
is the most reliable agent, however, and this may be in- 
duced either by making the patient take full doses of 
ipecac, tartar emetic, sulphate of zinc or turpeth mineral. 
If there is difficulty about getting the child to swallow an 
emetic, we should resort to apomorphia hypodermically 
injected, while the powerful diaphoretic effect of jabo- 
randi, aided by a hot bath, will almost surely break up 
the spasm. After the immediate attack is over, we ASTHMA. 
125 
should look around for whatever causes may be produ- 
cing this condition, and as far as possible remove them. 
Should there be nasal trouble, dentition or errors of di- 
gestion in addition to other supposed causes, the diet 
and general hygiene are entitled to more than a passing 
notice. The internal administration of kerosine oil in 
doses of from one to two teaspoonfuls will often produce 
the most satisfactory results. Melted mutton suet, and 
flannels saturated with turpentine and wound around the 
neck and throat very often afford prompt relief. 
ASTHMA. 
This disease is characterized as a spasm of the bron- 
chial mucous membranes. In pure asthma of nervous 
origin the disease is often induced by local irritants and 
digestive disturbances. 
Symptoms.-The attack is usually ushered in by very 
difficult respiration, which ofttimes comes on very sud- 
denly. There are loud, wheezing rales, which are more 
forceful and decided upon expiration. The oppression 
of the chest is very well marked and all of the muscles 
are brought into play in the endeavor to expand the chest 
and thus aid inspiration. After a certain lapse of time, 
from a few hours to a day or twro, there is profuse secre- 
tion and expectoration, the bronchial tubes are relieved 
and the attack gradually subsides with a tendency to re- 
cur again under the provocation of dust, dampness, or 
digestive disturbance. 
Treatment.-In considering the treatment we must 
exclude all cases of asthma which may be dependent 
upon cardiac trouble, aneurisms, or other organic causes. 
For the nervous, or spasmodic variety-the only form 
which we shall consider as pure asthma-we should re- 126 
BRYCE'S POCKET PRACTICE. 
sort to such agents as will be likely to favor immediate 
secretion from the membrane and relax the nervous 
spasm. For that purpose, the atmosphere of the room 
should be kept moist and warm, counter-irritation should 
be kept over the chest, the skin should be encouraged to 
act promptly by positive diaphoretics, and we have found 
none better than jaborandi. The nervous system should 
be brought under immediate control by such agents as 
bromide of potassium, hydrate of chloral, or Hoffman's 
anodyne. Many patients have derived great benefit from 
the inhalation of burning stramonium leaves. Other 
agents of essential service are musk, assafoetida, caffeine, 
cocaine, grindelia robusta, and even the hypodermic in- 
jection of morphia. For the prevention of the recur- 
rence of these attacks, the causes must be sought for as 
far as is possible, and every attention must be paid to 
building up the nervous system and improving the gen- 
eral tone of the patient by diet, exercise, clothing, diver- 
sion, and a change of climate, if necessary. The altera- 
tive course of treatment with iodide of potassium, iodide 
of iron or arsenic, has sometimes produced very wonder- 
ful results. 
PNEUMONIA. 
This disease may attack any age, but, is most prevalent 
between the ages of twenty and forty. It usually affects 
the lower lobe of the right lung. If the upper lobe is 
affected, usually the whole lung is affected. Double 
pneumonia is rare. The disease is divided into three 
stages : the first stage is that of simple congestion, the 
second stage known as red hepatization, is that in which 
there is exudation and consolidation, in which the air 
vesicles are occluded or nearly so, and the lung tissue 
has the appearance of a piece of liver. The third stage PNEUMONIA. 
127 
is known as resolution or gray hepatization, in which the 
disease recedes or ends in fatty degeneration. 
The Immediate Symptoms.-More or less severe chill, 
flushed face, headache, fever, and temperature running 
up to about 1050. Breathing is oppressed, respiration 
hurried, running all the way from 30 to 60 or 80 per 
minute, usually some cough present, but not severe. 
Expectoration is usually tinged with blood, having a 
frothy brick-dust appearance. The older writers speak 
of it as prune juice expectoration. We sometimes have 
jaundice connected with this trouble. 
Physical Signs.-Percussion affords diminished res- 
onance. Inspection shows a diminished respiration on 
the affected side. Auscultation gives feeble inspiration, 
prolonged expiration and crepitant rales heard only on 
inspiration. In the second stage these symptoms are all 
increased in intensity with marked bronchial breathing, 
vesicular murmur absent, and both vocal fremitus and 
resonance increased. 
Diagnosis.-With these symptoms carefully outlined, 
it will be only necessary to guard against mistaking this 
disease for acute bronchitis, the first stage of pleurisy 
or pleurisy with effusion. 
Treatment.-The patient should be confined to bed, 
and in the early or congestive stages, we might resort to 
gentle action on the liver with minute doses of calomel 
and ipecac, a fair dose of sulphate of quinia from eight 
to ten grains, and repeated doses of digitalis, veratrum 
viride or aconite ; warm poultices over the chest will be 
found serviceable here. If the congestion goes on into 
consolidation, we would then administer muriate or car- 
bonate of ammonia in one to five grain closes, along with 128 
bryce's pocket practice. 
syrup of senega, syrup of tolu and syrup of wild cherry. 
In this stage, our judgment has always been, that it is the 
best time known to apply the blister, and though others 
recommend that we wait later, we have found that this 
was the golden moment. In the event of not using 
blisters, if for any reason it should not be desired, dry 
cups, wet cups or poultices would be found valuable. 
Later on as the disease progresses, we should favor and 
encourage diaphoresis, lessen the amount of quinia, cease 
to give heart sedatives, but give digitalis, muriate of am- 
monia, beef broth, brandy, milk punch, etc., etc. 
HAEMOPTYSIS Haeinorrliajre from the 
I^Ull^S. 
This is usually not a disease within itself but a symp- 
tom of other complications. It often follows violent ex- 
ercise, severe congestion, ulceration from tuberculous 
deposits, etc. It occurs in pneumonia, and is frequently 
vicarious and has been known to occur where there are 
peculiar idiosyncrasies from the use of certain articles of 
food. 
Symptoms.-The trouble usually comes on suddenly 
with a slight cough or spitting of blood, a mouthful at a 
time, the patient becoming thoroughly demoralized and 
frightened. The respiration and pulse are rapidly in- 
creased, while the color may be changed to that of pal- 
lor. The character of the blood brought up is red and 
frothy, and at first, uncoagulated. Later on there may 
be coagulated clots brought up from the larger bronchi. 
Diagnosis.-We would diagnose the haemorrhage in 
this case from haematemesis by the usual absence of 
nausea and vomiting and from the fact that the blood 
from the stomach would not be mixed with atmospheric HYPERAEMIA OF THE LUNG. 
129 
air and be frothy as it would if it came from the lungs. 
There should not be the hurried respiration, with cough- 
ing in haemorrhage from the stomach, and we would ex- 
pect in the latter case to find the blood admixed with the 
food. It would be quite easy to diagnose this disease, 
also, from epistaxis or haemorrhage from the gums, by 
the symptoms which are very plain in both cases. 
Treatment.-The patient should be kept perfectly 
quiet and his condition of fear and anxiety should be 
overcome by the assurance that there is no immediate 
danger to be apprehended. He must be prevented from 
even talking. To the chest we may apply dry cups, 
mustard plasters or turpentine stupes. Internally, we 
may administer turpentine, ergotole, tannic or gallic acid, 
and cracked ice, small pieces of which may be held in 
the mouth for some time. If the heart is bounding and 
the pulse is full, the circulation must be controlled by the 
administration of aconite, veratrum viride or prussic acid. 
The preparations of acetate of lead and opium or of tur- 
pentine and laudanum in repeated doses are all consid- 
ered valuable remedies. A professional friend of ours, 
of wide experience, and who has been a personal sufferer 
himself for many years, always succeeds in promptly 
arresting these haemorrhages in his own case by satura- 
ting a large handkerchief with turpentine and holding it 
before his face, inhaling freely the vapors which would 
thus be carried into the chest. For a few days the diet 
should be plain and unstimulating, and great quantities 
of liquids should be avoided. 
HYPI.RAEMIA OF THE I.l NG I'ulnionary 
Congestion. 
This trouble may be either active or passive, though it 
is often the result of some other intercurrent affection. 130 
BRYCE'S POCKET PRACTICE. 
The active form may be brought on by violent and un- 
due exercise, from over-exertion in singing, walking or 
jumping, or the rapid ascent of mountains and hills. 
More often it is the beginning of inflammation and is the 
result of exposure to cold, or arrest of cutaneous circu- 
lation. The passive form is the result, ofttimes, of adyna- 
mic disease, heart diseases, and anaemic conditions. 
Symptoms.-In both of the varieties we have similar 
symptoms. There is shortness of breath which is very 
decided, a short hacking cough, very little expectoration, 
accelerated circulation and general disquietude. 
Treatment.-In the active form, we should treat this 
very much as we would the "beginning stage" of in- 
flammation or that of haemoptysis, by using counter- 
irritation, local application of cups, either wet or dry, 
and even the general abstraction of blood by venesec- 
tion. The force of the heart should be regulated by 
proper arterial sedatives, and the patient's diet and ex- 
ercise should be so ordered as to keep the circulation 
within proper bounds, and the nervous system should be 
so controlled as to keep it free from all excitement. In 
the passive form, where the heart is essentially at fault, 
we should have recourse to digitalis, caffeine, strychnia 
and strophanthus. Where the condition is due to Bright's 
disease, the kidneys should be carefully looked after, and 
where it is from anaemia, due to prolonged depressing 
disease, hydrostatic congestion must be guarded against 
by changing the position of the patient's body frequently, 
and by the administration of such tonics and stimulants 
as may be required. 
EMPHYSEMA. 
Emphysema is a dilatation of the air vesicles of the OEDEMA OF THE LUNG. 
131 
lung. Sometimes there is rupture of the vesicles and the 
inspired air travels along between the connective tissue 
of the lung. This disease may be produced by violent 
expiratory efforts, such as may be seen in the perfor- 
mance on wind instruments. It is a sequence of chronic 
bronchitis very often. 
Symptoms.-There is a shortness of breath upon slight 
exertion, even, and there are very frequent attacks of 
asthmatic catarrh. Where the disease has progressed 
for some time, we may have symptoms of heart disease, 
in which there are palpitation and interference with the 
action of the liver and kidneys, due to disturbance of cir- 
culation on account of dilated heart. 
Treatment.-A dry climate is of great value to patients 
suffering with this affection, as this sort of atmosphere, 
coupled with attention to clothing, will aid in preventing 
the bronchial catarrh. The use of iodide of potassium 
is highly recommended, as it is of great service in re- 
lieving this chronic bronchial trouble, and the frequent 
use of small blisters to the chest will also be found of 
much value. Where there is heart failure or dilatation, 
digitalis, strophanthus and strychnia are of great service. 
The skin and kidneys should receive due attention, and 
the circulation through the liver should be kept as near 
as possible at the normal late by the use of gentle salines 
or mercurials. Where there is rupture of the air vesicles, 
and considerable infiltration, such a condition should be 
promptly relieved by puncture. 
oedema of the eing. 
This serious trouble may follow congestions of the 
lung or alcoholic excesses, and consists* of an effusion 
of serum into the air vesicles, and pulmonary tissues. 132 
bryce's pocket practice. 
Symptoms.-The symptoms are very much those of 
the congestive stage of pneumonia. There is much 
difficulty in breathing, in which the patient complains of 
an oppression over the chest. He presents a face of de- 
cided anxiety, and there is a short, constant cough, with 
frothing or bloody expectoration. Upon auscultation, we 
get a feeble, vesicular murmur with loud rales and very 
much serous effusion into the bronchial tubes. 
Treatment.-Very much on the same line as that for 
congestion of the lungs, though it must be prompt and 
decided. We should make use of digitalis, jaborandi, 
counter-irritation and full doses of the carbonate or 
muriate of ammonia, with senega, squills or ipecac, as 
may be indicated. 
CONSUMPTION-Phthisis Pulinonalis-Tuber- 
culosis. 
Consumption, as it attacks the lung, is essentially a 
chronic, catarrhal or interstitial pneumonia, resulting 
from the deposit of tuberculous matter here and there in 
ihe substance of the lung, which undergoes all of the 
various stages of inciting inflammation and suppuration, 
finally breaking down as pus and debris. This tuber- 
culous condition is evidently due to systemic faults and 
may be either hereditary or induced. During the various 
stages of deposit, maturation and breaking down of 
these tuberculous masses, we have varying symptoms of 
local or general character, covering a period of time 
longer or shorter with the severity of the disease and the 
patient's surroundings, which may greatly prolong his 
life wherever they are favorable. While we find the di- 
sease going on in the lung, we are apt to find evidences 
of tubercular 'disease in other portions of the body, 
which will give rise to general symptoms of fever, head- CONSUMPTION. 
133 
ache, etc. The duration of pulmonary trouble may 
cover a period of a few months, as in the galloping form 
in which the patient is rapidly carried off, to many years 
where every possible advantage being taken in the in- 
terest of the sufferer, his life is greatly prolonged. 
Symptoms.-Among the earlier symptoms, we would 
notice the slight hacking cough, which though dry at 
first, after a while becomes mucous in character and 
slightly streaked with blood. Under the irritation of the 
presence of tubercles, the lungs becoming more con- 
gested, we may expect haemorrhages to occur. Follow- 
ing this, we may expect more abundant secretion from 
the lung, which becomes muco-purulent or purulent. 
Early in the disease, about the time of the deposit of tu- 
berculous matter, we shall be able to detect some fever, 
especially in the afternoons and evenings. Indeed, we 
can almost always find fever in the earliest manifestations 
of this disease. As these tuberculous masses increase in 
quantity and begin to break down, we have fever of a 
more decided and permanent type. The patient has- 
frequent chills, and as pus cavities are formed in the 
lungs, we have well marked hectic fever and exhaustion, 
night-sweats and great debility. With this advance of 
the disease from its inception to the breaking down of 
the tuberculous masses, we have rapid and progressive 
emaciation. Topical examination will give to the edu- 
cated physician what he might expect under these cir- 
cumstances : dulness on percussion where the tubercles 
are thickly studded in the lungs, bronchial respiration, 
cavernous respiration through the cavities, and amphoric 
respiration. Of course, all manner of murmur and rales 
may be heard through these inflammatory and breaking- 
down tissues ; and there should be no need for the prac- 134 
BRYCE'S POCKET PRACTICE. 
titioner to confuse this condition with that of any other. 
There are other varying symptoms, not all especially 
valuable, such as pains in the chest, reflex dyspeptic 
symptoms and cough. Some importance is attached to 
the form of sputum, especially the nummular form, 
which is brought out in roundish masses like coins and 
does not float on water perfectly. This is regarded by 
some as being pathognomonic of the disease. 
Diagnosis.-The diagnosis of this trouble in the ad- 
vanced stages is sufficiently easy. It may be readily 
made from the great emaciation, high temperature, 
cough, and the physical signs given us upon auscultation 
and percussion. The important time, however, to diag- 
nose this trouble is in the first stages, for then our treat- 
ment will be of the most avail. A slight cough, slight 
elevation of temperature every afternoon, disturbance of 
digestion, increased respiration or pulse, with any degree 
of emaciation, should cause us to examine very carefully 
the apexes of both lungs, the points at which we would 
suspect the first tuberculous deposit. Should we find 
the lungs clear, even with these symptoms present, we 
should strongly suspicion that condition of the system 
favoring tuberculous deposit and should treat our patient 
accordingly. If we had but one symptom to go by in 
the earlier stage of the disease, we should attach much 
importance to the slight and daily rise in temperature in 
the afternoon and should regard that as a matter of grave 
suspicion, and look forward to the deposit of tubercle as 
one of the most probable consequences we can think 
of. 
Treatment.-We have unquestionably of late years 
gained a considerable knowledge in the treatment of this 
disease. Many cases of consumption are undoubtedly CONSUMPTION. 
135 
cured and many more incurable cases have been greatly 
benefited and life has been prolonged by proper and in- 
telligent treatment. Regarding the disease as one of 
general disturbance of assimilation and nutrition, local- 
izing itself in the lungs and dependent upon hereditary 
and local causes, our effort should be to place the patient 
in the best possible condition for preserving all of his 
vital forces, building up the system and retarding the ad- 
vance of the disease. We have been able to find no spe- 
cific for the treatment of this trouble, and our methods 
now, as in former years, consist in giving the patient the 
power to eliminate this morbid element from his system 
and to resist the tendency to new deposits of tubercle. 
In the earlier stages of the disease we must reduce the 
rapidity of the action of the heart, equalize the circulation 
and as far as possible, prevent the local deposit of 
tubercles and the subsequent inflammatory processes. 
Therefore, for evening fever, we will find veratrum viride 
and especially prussic acid, of much value in controlling 
the accelerated circulation. Gentle counter-irritation 
over the lungs should be resorted to, and all depressing 
causes should be removed. If the patient is overworked 
he must be given rest ; if he is the subject of mental 
worry or depression the surroundings must be changed 
at once. If he is the occupant of unhealthy apartments, 
where the sunlight and pure air are not obtainable, the 
condition should be immediately reversed. In a word, 
the treatment of the pre-tubercular stage, or the first 
stage, consists essentially in the removal of all depressing 
causes, giving improved nutrition to the fullest extent 
and placing the patient in the most cheerful and comfort- 
able surroundings possible. We know of no other ap- 
proved treatment of consumption, and the rational treat- 
ment of this disease, from beginning to end, consists in 136 
BRYCE'S POCKET PRACTICE. 
building up the system with an abundance of material for 
restoring the drain made upon it by maturation and the 
breaking down of tubercular masses. What we have 
said of the treatment in the earlier stages in general terms 
will apply as well for that throughout the entire disease. 
We will of course, have other symptoms to treat ; the in- 
tense fever, the violent and distressing cough, night- 
sweats and shooting pains through the chest all require 
special treatment, though the main success will depend 
upon the general outline which we have given above. 
For the severe cough we may make use of preparations of 
opium, codeine or hyoscyamus. We have a most ex- 
cellent cough remedy in a combination of syrup of wild 
cherry, syrup of senega and diluted hydrocyanic acid. 
Where we need something for the cough and fever also, 
and a general tonic, we have found nothing better than a 
cold infusion made from wild cherry bark, of which we 
should give a wineglass full with a half ounce of whiskey 
and five drops of diluted muriatic acid, three times a day. 
For the very high temperature, we may give small doses 
of aconite or digitalis. We think very poorly of quinine 
in this disease and have never noted any benefit from its 
use. Where it has been especially hard to reduce the 
high temperature, we have resorted to antipyrine for a 
few days with very good results. We may give from five 
to ten grains of this every hour or two until the tempera- 
ture has been reduced. For the distressing night-su'eats 
the elixir of vitriol, ten drops three times a day, properly 
diluted, will often be of much service. Sponging the 
skin with solutions of alum and w hiskey, or strong red- 
oak bark tea may be tried and very frequently with 
success. Belladonna or the alkaloid, atropine, may be 
given at night and it is a very valuable remedy. Going 
back to the general treatment, we desire to say that we CONSUMPTION. 
137 
know of no special course applicable to all cases, or to 
any one case. Despite all that may have been said or 
written up to the present day regarding a microbic origin 
of consumption, nothing has been accomplished by the 
application of any remedy based upon such a theory, conse- 
quently all specific treatment may be ignored. Jn this con- 
nection we would say that " Koch's tuberculin craze," 
which seized our country, was well tried in this disease 
and died of its own weight along with many of its vic- 
tims, should be remembered. Cod-liver oil, which has 
been a sheet anchor for years and years, has in our expe- 
rience no real practical value whatever. Wherever it is 
well borne by the digestive organs, it is a most excellent 
remedy in the same sense that good mutton and butter or 
pure cream would be. After years of experience in the 
treatment of this disease, we desire most earnestly to im- 
press upon our readers the relative value of this popular 
agent. We know that much harm has been done with it 
and that many patients have been hastened on to their 
end by having their digestive organs thoroughly des- 
troyed by this popular remedy, when other and more pal- 
atable foods might have been assimilated. We urge its 
use wherever it is of service, but only as a food. Much 
good may be gained by causing the patient to take out- 
door exercise whenever the weather will permit, and this 
exercise should be accompanied with interesting occu- 
pation, so that it may not be a forced task, but an enter- 
taining business. In short, the patient should have out- 
door employment as far as possible, such as will induce 
greater lung expansion, give better air and promote 
better digestion. We do not care to consume our space 
with a list of the specially prepared foods now upon the 
market for the different grades of the disease. There is 
absolutely nothing prepared which will compare with the 138 
diet that a good and careful cook might furnish the in- 
valid, catering to his appetite and tastes at all times. So 
far we have made no mention of alcoholic food. A^hen 
we consider the peculiarities of the action of alcohol upon 
the human system, upon animal tissue, and upon albu- 
minoids, it.naturally suggests itself as one of the most 
important remedies and foods that we can give the con- 
sumptive. From our knowledge of the pathology and 
tendency of this disease we desire to stop destructive 
changes, and alcohol undoubtedly exerts this sort of in- 
fluence upon tissue. As a fuel we can have no better, as 
a fat producer it is without a rival and as an antipyretic 
it is most valuable. In other words we advise the free 
and constant use of alcohol, wherever it can be borne by 
the patient and in whatever form he may select. Among 
the various preparations that are offered, we now think of 
one in which we get a fair amount of alcohol, and also 
nitrogenous food, which has proved of great service to 
us in the treatment of advanced phthisis ; we refer to a prep- 
aration known as " Ale and Beef Peptonized." We have 
been enabled with this compound to add greatly to the 
effort of the patient to sustain his failing powers, and to 
give comfortable sleep frequently when all other things 
had failed us. We have made no mention of the advan- 
tages that may be derived from travel or residence in 
localities claimed to be specially favorable for the cure of 
pulmonary troubles. All of these matters have their 
value, and it is presumed that where the pecuniary con- 
dition of the patient will admit of it, his physician will 
take into consideration the advantages of residence in 
these more favored localities. Sea voyages or other di- 
version, employment, hygienic conditions, etc., should all 
be thoroughly considered, and other such measures of a 
bryce's pocket practice. bright's disease. 
139 
like nature must be resorted to whenever it is thought 
proper and desirable. 
DISEASES of the KIDNEYS AND BLADDER. 
CONGESTION OF THE KIDNEYS. 
This condition is induced by injury, exposure to cold 
and dampness, or by irritants passing through the kid- 
neys. 
Symptoms.-Urine passed in small quantities, at fre- 
quent intervals, is high colored with traces of blood and 
albumen. There is a dull pain in the small of the back 
and usually some slight constitutional disturbance. The 
chronic form of this trouble is usually dependent upon 
disease of the heart, and the symptoms are those of the 
acute stage in more intense form, with greater deposits 
of urates and dragging pains in hips and loins. 
Treatment.-Counter-irritation with iodine, dry cups, 
hot baths, infusion of digitalis, jaborandi, mild alkaline 
waters. Attention must be paid to the proper action of 
the skin, and warm clothing for the patient to prevent 
sudden congestions of the kidneys. No active diuretics 
should be employed. 
BRIGHT'S DISEASE-Acute and Chronic Par- 
enchymatous Nephritis. 
This is a disease of the secreting structure of the kid- 
ney. It is an inflammation of the tubules and is often 
the result of exposure to cold, or of traumatism ; it some- 
times follows ordinary neglected congestion of the kid- 
neys, and is very often the direct sequel of the acute 
exanthematous affections. It is very frequent as a con- 
comitant of scarlet fever. 
Symptoms.-The urine is scanty, dark and of high 140 
bryce's pocket practice. 
specific gravity, containing blood corpuscles and epithe- 
lial casts from the tubules of the kidney. Albumen is 
present in considerable quantity in the urine. Symptoms 
of arsenic poisoning are frequently present and should be 
guarded against in all cases, however mild they may 
appear. These symptoms as seen are stupor, headache, 
and listlessness and occasionally convulsions. With the 
subsidence of the active inflammation dropsy frequently 
follows. The outlook is favorable for most cases receiv- 
ing prompt attention. 
Treatment.-Our aim will be to relieve the kidney of 
all extra work, to favor the action of the skin and bowels 
and thus prevent dropsy and uraemic poisoning by get- 
ting rid of waste products in the blood. We must also 
sustain the action of the heart which is always a constant 
source of anxiety in these affections. The patient should 
be made to take absolute rest in bed for the sake of the 
heart and also for the advantages of uniform temperature 
favoring cutaneous action. The diet should consist of 
nothing but milk and the lightest gruels or broths. No 
stimulating articles of food or medicine should be em- 
ployed. Counter-irritation, dry cups, iodine and small 
blisters are to be used. Digitalis in some form will be of 
service to the heart and will help to clear up the effusion. 
Cream tartar and jalap, croton oil or elaterium may be 
needed where the patient is disposed to become poisoned 
from retention of urea. Pilocarpine in small doses of one- 
twelfth or one-eighth of a grain hypodermically, or fluid 
extract jaborandi internally are very prompt to act where 
symptoms of uraemic coma are urgent. 
Where the patient is strong and plethoric it will be ad- 
vantageous to resort to vigorous purging with the drastics 
or salines. In anaemic or weakened conditions this bright's disease. 
141 
would not be advisable however and milder remedies for 
acting upon the intestinal tract would be indicated. 
The Chronic form of this trouble is what is known as 
true Bright's Disease or fatty kidney. It is an aggrava- 
tion of all of the symptoms of the acute form with many 
more complications. In advanced cases we find the en- 
tire system affected by this disorder. The nervous, cir- 
culatory, and digestive systems all are seriously dis- 
turbed by the retention of urea and waste products in 
the blood. The more prominent symptoms of this dis- 
ease are scanty urine of high specific gravity, much albu- 
men and granular casts of the tubules. Along with this 
condition of the urine there will be found dropsy and 
serous effusions in the cavities, progressive anaemja, 
marked and intractable digestive disturbances, headache, 
drowsiness, impaired vision from a low form of retinitis, 
and heart trouble. The prognosis in many of these 
cases, if the patients will submit to a rigid course of diet- 
ing and treatment, is very hopeful. In the chronic form 
as in the active we have the same indications to fulfil in 
the treatment; the kidneys must be relieved of all unneces- 
sary work and irritation ; the skin must be made to do 
double duty, and the bowels must also be called upon to 
eliminate an extra portion of effete matter formerly 
carried off by the healthy kidney. The patient must live 
upon skimmed milk if possible or where he cannot do 
this, his diet should consist largely of it with the addition 
of eggs and plain broths. He should be well clad in 
woolen underwear and protected from all sudden changes 
in the weather. Where there is need for a stimulant, 
port-wine may be allowed with the meals, though unless 
this is positively necessary it is best to avoid all alcoholic 
drinks. The anaemia in this trouble is always a promi- 
nent symptom and calls for special treatment. I have 142 
bryce's pocket practice. 
found no agent to act so well as the ordinary tincture of 
chloride of iron in the anaemia of Bright's Disease. I 
am fond of giving ten to fifteen drops of the iron several 
times a day with as much ergotole in an ounce of good 
port-wine. This has been very beneficial in my hands 
and as a general prescription it will fill the bill very fre- 
quently. Digitalis, strophanthus, and strychnia may be 
used for the heart; Dover's powder, jaborandi, quinia, 
potass, nitrat., and ipecac for the skin ; the salines, elate- 
rium, compound-jalap powder, squills and similar reme- 
dies will be needed for clearing up the dropsical effusions. 
Where uraemia threatens we must resort to active purga- 
tion, hot baths and pilocarpine. 
cYikoinic interstitial nephritis- 
Granular Kidney-Gouty Kidney. 
This disease is slow in its development and very 
chronic in character. It seems to be the result of long 
continued depressing causes acting upon the general sys- 
tem, for we find it following syphilis, overwork, exposure, 
mental worry, gout and other depressing causes. It is a 
disease of later life, coming on usually after fifty years. 
The kidney is small and shrunken, there is atrophy of 
the Malpighian bodies and tubules from interstitial pres- 
sure. 
Symptoms.-In this affection we find a variety of ill 
defined symptoms which are referable to all other organs 
of the body. We will find dyspepsia, nervous and circu- 
latory troubles as in Bright's disease, but dropsy is us- 
ually absent except very late in the disease and then due 
to heart trouble. Urine is passed in large quantities and 
albumen is rarely present except in minute quantities. 
Late in the disease the hyaline casts will be found un- 
der the misroscope. PYELITIS. 
143 
The prognosis is unfavorable in this complaint though 
the patient may live a great while with it, going down all 
the time until the end is finally reached from exhaustion, 
cardiac failure or uraemic poisoning. 
Treatment.-Not much can be expected from any 
drug in this affection and our chief reliance will be upon 
the regulation of the patient's diet and attention to his 
clothing, exercise and general hygienic surroundings. 
Nutritious and easily digested foods should be selected ; 
milk, eggs and fresh meats are the best of this class. 
Arsenic, corrosive sublimate, and the iodide of iron have 
been suggested as likely to favor the absorption of the 
connective tissue between the tubules, but we have failed- 
to find any special benefit from them. We would rely 
more upon the hypophosphites with some constant coun- 
ter-irritant as the oleate of mercury over the loins. Long 
continued use of the interrupted current is of service in 
certain cases as favoring better nutrition of the kidney and 
dispersion of adventitious tissue. Whatever may be tried 
for the relief of this condition should be with a view to 
holding up the general health of the patient rather than 
expecting to effect a radical cure by any special drug 
action. 
I'VEI.ITIS Surgical Kidney. 
Suppurative disease of the kidney may be confined to 
the pelvis or to the substance of the body of the kidney 
itself. It may arise from a number of causes, chief of 
which are calculi, cold, irritants, debilitating diseases, 
extension of inflammation from bladder or from gonor- 
rhoea. 
Symptoms.-Frequent micturition, but little pain, 
abundance of pus in the urine, columnar epithelial cells 144 
ijryce's pocket practice. 
will be found indicating that the pus comes from the 
pelvis of the kidney. The urine will be found to have an 
acid reaction unless the bladder is also diseased. Where 
the disease is limited to the pelvis of the kidney there 
will be found little or no albumen or tube casts, and very 
slight, if any, fever. Where the structure of the kidney 
is involved both albumen and tube casts will be found 
and hectic fever and grave constitutional disturbances 
will be present. 
Diagnosis.-There is a likelihood of confounding this 
trouble with inflammation of the bladder but in this latter 
affection the urine is almost invariably alkaline, the epi- 
thelial cells are of the squamous variety instead of the 
columnar as in pelvic affections, and there is pain over the 
region of the bladder upon or after urinating. 
Treatment.-General attention to rest, mild unstimu- 
lating but nutritious and digestible diet of milk, eggs, 
white fish, mutton and only the best dry and sweet bread 
with a few well cooked vegetables or thoroughly ripe 
cooked fruits. Dry cupping or iodine over the loins with 
comfortable housing and clothing will be of general value. 
For internal administration a great number of remedies 
are mentioned but we have little faith in the majority of 
them. We have obtained the best results from the use 
of lime water abundantly taken with milk or simply with 
the water drank for thirst, then with sulphide of calcium, 
eucalyptus, and carbolic acid. Among other agents that 
may be mentioned are copaiba, cubebs, oil of sandalwood, 
tar, turpentine, and many similar drugs. In very debili- 
tated conditions tincture of chloride of iron with or with- 
out cod-liver oil may be given with advantage where the 
stomach will bear it. Where the bladder is involved and RENAL CALCULI. 
145 
cystitis is a complication, benzoic acid or the benzoate 
of sodium will be of service. 
REMI. CAI.CIT.I. 
The pelvis of the kidney is frequently the seat of calcu- 
lous formations, and many of the subsequent diseases of 
the kidney can be traced to damage done by these calculi 
either in producing hydronephrosis from obstruction or 
by inducing abscesses in the tubular structure of the 
organ. 
Symptoms.-An attack of kidney colic, as the passage 
of a calculus through the ureter is usually called, is an- 
nounced by most unmistakable symptoms. Pain is very 
intense and commences in the loins extending down the 
ureters and into the head of the penis. There are fre- 
quent efforts to urinate with but a small quantity passed 
at a time and this is high colored and often tinged with 
blood. The patient has nausea and often actual vomiting 
with cold clammy skin and much depression. The par- 
oxysms last from half an hour to an hour and are fol- 
lowed by a temporary lull, which is in turn followed by 
other paroxysms until the stone finally reaches the blad- 
der. An attack will usually last from four to eight or ten 
hours and leaves the patient very sore and exhausted. 
Treatment.-The main thing to be done in the im- 
mediate attack is to produce relaxation and favor the 
speedy transit of the stone to the bladder. Warm or hot 
baths, hypodermics of morphia, or the same by the mouth 
chloroform, belladonna, and nauseants will all be likely 
to come in for use before the patient is relieved. The 
most important measure of treatment after the relief of 
the immediate attack is to prevent the future tendency to 
the formation of other calculi. This is best done by 146 
hryce's pocket practice. 
examining the nature of the calculi and finding what dia- 
thesis we have to contend with. If it is the uric acid, we 
must limit the amount of nitrogenous foods, keeping the 
patient mostly upon milk and vegetables with very little 
acid as drink or in fruits. Alkaline diuretics as citrate or 
bicarbonate of potassium, citrate of lithium, etc., are of 
especial service here. If it is the phosphatic calculi that 
are forming we should give the mineral acids well-diluted 
with water. Benzoic acid is a good remedy in this condi- 
tion. Where the calculus is of the oxalic variety nitro- 
muriatic acid is said to be the best remedy. In conditions 
of lithiasis of whatever variety, it is important to keep the 
kidneys active and well flushed out, and for this purpose 
the gentle diuretic mineral waters should be freely used, as 
well as milk, buttermilk, fruits, etc. 
AMYLOID KIDNEY-Waxy or Albuminoid 
Kidney. 
The disease is brought on by long continued depress- 
ing causes. The urine is passed in large quantities, con- 
tains considerable albumen, large waxy casts devoid of 
epithelium, are found, and there is similar enlarged 
and altered condition of liver and spleen. Anaemia is a 
marked feature of this condition. 
Treatment.-Knowing the pathology as we do, it is 
apparent that a general line of treatment directed to pre- 
venting undue destruction of structure of the kidney, 
supplying waste of tissue, and a general alterative, sup- 
portive and constitutional course will be the most appro- 
priate. Clothe the patient comfortably, give him an 
abundance of albuminous food in shape of milk, eggs, 
etc. The iodide of ammonium, syr. of iodide of iron, and 
cod-liver oil are all recommended. HAEMATURIA. 
147 
CANCER OI THE KIDNEY. 
This trouble as well as tubercular disease occasionally 
attacks this organ. Both of these conditions would be 
recognized by the altered urinary secretion, which would 
be variable in quantity, frequently tinged with blood and 
containing pus or debris from destructive processes in 
the kidney. There would be pain, some febrile distur- 
bances and the general anaemia and cachexiae peculiar 
to the cancerous or tubercular conditions. 
Treatment.-This should be conducted purely on 
general constitutional lines, our aim being to allay pain 
and support the strength of the patient. 
HAEMATVRI A. 
Technically speaking this is a condition of bloody urine 
though usually we are led to regard it as a haemorrhage 
from the kidney. We may have this haemorrhage from 
kidney, bladder or urethra, however, and in consequence 
we adopt the term as meaning the presence of blood in 
the urine. 
The Causes are inflammatory conditions of kidney, 
calculi, parasites, scurvy, purpura and malignant condi- 
tions. 
Symptoms.-The presence of blood is the only neces- 
sary symptom to establish the diagnosis. 
Treatment.-It is of the first importance to determine 
from whence comes the blood, and for this reason we 
present the special symptoms of haemorrhage from the 
different portions of the urinary tract. When the kidney 
is the source of the haemorrhage the blood is thoroughly 
mixed with the urine and gives it a smoky appearance ; 
the urine is also likely to contain a certain proportion of 148 
bryce's pocket practice. 
albumen and the blood corpuscles are full and well de- 
veloped. When the blood is from the bladder it is not 
intimately mixed with the urine, but comes either in ad- 
vance of the urine or with the passage of the last of it. 
There is more often bladder tenesmus, and frequent 
urination ; while under the microscope the blood corpus- 
cles appear broken up and shrivelled. When it is from 
the urethra there is scalding and burning as the urine is 
being passed and frequently a few drops of blood precede 
the passage of the urine. It is therefore upon this knowl- 
edge that we can treat the condition in the most satis- 
factory manner. Where purpura, scurvy and constitu- 
tional causes are operating they should be remedied and 
the general condition of the patient improved. If mala- 
rial influences are causing this trouble in the kidney, 
quinine, and bitter tonics will help to cure the patient. 
The general line of treatment for all conditions of haema- 
turia will consist in moderate counter-irritation over the 
region of the kidney, the internal administration of gallic 
acid, the mineral acids, ergotole, tr. of iron and mild di- 
uretic mineral waters. 
HYDRONEPHROSIS. 
We find in this affection a dilatation of the pelvis and 
calyces of the kidney with non-purulent fluid. This is due 
to obstruction usually or to twisting of the ureter. Some- 
times malignant disease is the cause of the obstruction. 
Symptoms.-The prominent symptom is the presence 
of a tumor in the renal region which must be distin- 
guished between ovarian disease and an overdistended 
colon. Floating kidney also complicates the diagnosis. 
Treatment.-The treatment for this condition as well 
as that for floating kidney to which we have alluded is CYSTITIS. 
149 
purely mechanical or surgical, and especially for the 
latter. Tonics and constitutional treatment are indicated. 
Where the distention is great in hydronephrosis we may 
resort to aspiration and finally excision if the case is an 
extreme one. In floating kidney we must replace the 
organ, apply a suitable bandage and put the patient upon 
a bracing tonic course. 
CYSTITIS. 
This condition known as vesical catarrh, inflammation 
of bladder or chronic vesical gleet is characterized by un- 
easiness and a sense of pain and tenderness over the 
bladder and hypogastrium, with a constant desire to mic- 
turate, while the urine is passed in small quantities, with 
pain and a sensation of burning. There is generally a 
considerable amount of mucus mixed with the urine, 
and in chronic cases, we find pus, blood or an ammonia- 
cal thick gelatinous ropy mucus or muco-pus. 
Treatment.-The all important thing to do is to find 
out and remove the cause as far as possible. If there is 
any local irritant or special degree of acidity or alkalinity 
excessive enough to give rise to injurious irritation, it 
should be removed at once. In acute cases it will be of 
great service to give warm hip-baths, use fomentations 
and poultices over the hypogastrium, apply leeches to 
the perineum and over the bladder. A hop poultice is an 
excellent application for the hypogastric region in acute 
cases. The urine should be rendered bland and unirri- 
tating by the administration of demulcent drinks, lime 
water and alkaline salts. Bi-carbonate of potassium, 
either plain or effervescing will usually prove of great 
service. Sometimes where the bladder is filled with 
highly ammoniacal urine it will be found necessary to 150 
bryce's pocket practice. 
render the urine somewhat acid and antiseptic by the 
administration of acids in the shape of benzoic or boracic 
acid and in washing out the bladder with warm antisep- 
tic astringent or acid fluids. Other popular remedies are 
teas, decoctions, or fluid extracts made from buchu, uva 
ursi, pareira brava, triticum repens, golden rod, etc. 
Balsam copaibae with liquor potass, has long enjoyed a 
good reputation in chronic cystitis. In all cases of cysti- 
tis of any standing, however, there will be found a con- 
dition of intense congestion and thickening of the mucous 
membrane with lowered vitality of the parts. It is al- 
most impossible in many of these cases to effect a cure 
with the use of ordinary internal remedies and we are 
compelled to resort to local treatment. For a long time 
we have been so uniformly successful with one agent in 
particular in the local treatment of this troublesome com- 
plaint, we trust our readers will pardon us if we go a 
little freely into details in describing it. We have refer- 
ence to a preparation known as ergotole and which is 
manufactured by the reliable and professional house of 
Messrs. Sharp & Dohme, of Baltimore. This agent re- 
presents all of the valuable constituents of ergot without 
any of its impurities or inert properties. It is quickly 
absorbed, prompt in action, useful for internal, local or 
hypodermic administration and requires the minimum 
dose to give characteristic results. As we have said, we 
would not give it for all of the drugs in the materia 
medica in the treatment of sub-acute urethritis, chronic 
cystitis, or gleet. As soon as we have regulated the con- 
dition of the patient's urine and somewhat abated the 
extreme irritability of the bladder, we proceed at once to 
wash out the bladder, in very bad cases, with an alka- 
line bath of borax or some simple agent ; frequently we 
only use hot water as a wash, followed with a smaller LEVCORRHOEA. 
151 
quantity of ergotole, either of full strength and alone or 
diluted and combined with some alkaline or astringent 
mixture. As a general thing, however, our main reliance 
is upon this preparation, and we are confident of its 
ability to re-establish a healthy condition of the mucous 
membrane in all states of chronic or passive congestion 
of the membrane in cases of cystitis, gleet, urethral 
relaxation, etc. So well convinced are we of its positive 
value in chronic urethritis, we often make use of no 
other agent in long standing and intractable cases. We 
simply commence and continue with ergotole alone until 
the cure is complete. We should state that in these cases 
our plan is to open up the canal of the urethra with the 
sound to its limit or normal calibre and with a deep 
urethral syringe carry the ergotole in its full strength to 
the congested parts. This application gives no pain, 
lessens irritation, and speedily restores the diseased 
urethra to its former condition of health. 
DISEASES OF WOMEN. 
In a work on practice which is destined to be a con- 
densed companion, we cannot depart very far from a 
consideration of general diseases as they confront the 
medical man in his daily work. But there is a certain 
class of non-surgical female disorders which must be 
met with in practice and demand the most serious atten- 
tion of the practitioner. It is of these prominent troubles 
that we will speak in this section. 
EEUCORR HOE A-"Whites. 
This very common and disagreeable affection may 
arise from a number of causes, chief of which are pro- 
lapsed conditions of the uterus, general debility and 
want of tone, and often severe constipation. 152 
bryce's pocket practice. 
Symptoms.-The discharge itself is the most direct 
symptom. It may consist of simply an over-abundant 
mucous secretion, or it may be so severe as to consist of 
a very great discharge of muco-purulent matter, giving 
rise to much excoriation of the parts and inducing reflex 
aches and pains in the limbs and back. 
Treatment.-If the uterus is displaced it should be 
restored to a normal position ; tonics should be em- 
ployed, constipation relieved and suitable astringents 
and antiseptic washes used. The free douching of the 
entire vagina with large quantities of hot water does 
great good by cleansing out the vitiated secretions, and 
also by toning up the relaxed parts. The various astrin- 
gents such as alum, tannin, zinc, acetate of lead, sumac, 
and red-oak bark all make excellent injections for this 
trouble. 
VAGINITIS. 
Inflammation of the vagina may be produced by any 
irritating agent, excessive indulgences, or from specific 
causes. 
Symptoms.-Swelling of the labia and vagina, throb- 
bing heat and tenderness, excoriations and frequent de- 
sire to pass the water with violent pain and profuse puru- 
lent leucorrhoea. 
Treatment.-At first a mild cathartic will be of ser- 
vice if there is much inflammation. Copious hot water 
injections either simple or medicated with glycerine, 
laudanum or cocaine are very soothing. For the ardor 
urinae, nitre, buchu, or alkaline drinks are indicated. 
Later on we may resort to the more decided astringent 
washes and specific remedies where the case is depen- 
dent upon specific causes. AMENORRHOEA. 
153 
AMBMORRHOBA. 
Where menstruation is and always has been absent 
there is imperfect or tardy development of ovaries and 
uterus. Treatment consists in everything that will favor 
physical development. Where menstruation is scanty or 
irregular, if the general health is good and no pain, no 
special treatment is required ; but if there is disordered 
health and the most common condition (anaemia and 
constipation), give iron (Blaud's pills), deutoxide of man- 
ganese, aloes, and salines; hot hip baths several 
nights in succession before expected period ; good diet, 
fresh air, and plenty of exercise in open air. Some 
patients flow more if they remain in bed during the 
period. Galvanism will sometimes succeed when every- 
thing else fails. 
Probably one of the most valuable remedies now be- 
fore the profession for amenorrhoea is Dioviburnia, a 
preparation which fully meets more of the indications 
than any other drug or combination, with which we are 
acquainted ; and as we shall make further allusion to it 
in connection with other female complaints, we will in- 
troduce it here : Dioviburnia is composed of viburnum 
prunifolium, viburnum opulus, dioscorea villosa, aletris 
farinosa, helonias dioica, mitchella repens, caulophyllum 
thalictroides and Scutellaria laterifolia. It is the ideal 
uterine tonic and anti-spasmodic. It is put up by the 
Dios Chemical Company of St. Louis, Missouri, who 
handle it in a purely ethical and scientific manner, pub- 
lishing their formula and introducing the preparation 
solely to the profession. A very excellent formula in 
anaemia or chlorotic amenorrhoea is the following com- 
bination : 
R Ferri et quin, citrat z i. 
Dioviburnia £xvi. 154 
brvce's pocket practice. 
M. Sig. Tablespoonful after meals. 
ACUTE OOPHORITIS. 
Symptoms.-Severe pain and great sensitiveness to 
touch in region of ovary, which is usually enlarged. 
Fever and chill. Resolution occurs within a week or 
proceeds to abscess-rare. 
Causes.-External violence, gonorrhoea, suppression 
of menses, or extension from pelvic peritonitis. 
Treatment.-Chloral enemata, morphia hypodermi- 
cally, bromide of potassium, dioviburnia, ice-bag, leeches. 
CHRONIC OOPHORITIS. 
Symptoms.-Fixed pain over ovary, dysmenorrhoea 
and hysteria, pain in rectum and down thighs-exagge- 
rated after defecation, leucorrhoea, and sometimes dys- 
pareunia. 
Course.-Chronic and common, usually due to uterine 
displacement. 
Treatment.-Bromide of potassium, dioviburnia, can- 
nabis indica; locally, tincture iodine, blisters, oleate of 
mercury, correct displacement of uterus. 
dysmenorrhoea 
Varieties.-Neuralgic, congestive or inflammatory, 
obstructive, membranous, and ovarian. Remedies: Liq. 
ammoniae acet., belladonna, chloral hydrate (preferably 
by enema), iron, deutoxide of manganese, guaiacum, 
opium, potass, bromide, galvanism, dilation of cervix (in 
obstructive form), and correction of displacement when 
present. MENORRHAGIA AND METRORRHAGIA. 
155 
MENORRHAGIA AND METKORRHAJilA 
Are symptoms of several uterine affections, and an ex- 
amination is essential to diagnosis. It is sometimes due 
to debility from protracted nursing, local causes, tumors, 
polypi, etc., affections of the os and cervix, congestion of 
the womb or ovaries, subinvolution or inversion of the 
womb. The nervous system primarily or secondarily is 
often responsible for aggravated menorrhagia. Reme- 
dies : Arsenic, Rockbridge alum water, cannabis indica, 
ergotole, gallic acid, bromide of potassium, quinine in ma- 
larial districts, hot vaginal injection, with or without as- 
tringents, such as alum and tannin ; tampon the cervical 
canal. A valuable formula in this trouble is : 
R. Ergotole a ss. 
Dioviburnia 5 xvss. 
M. Sig. Tablespoonful three times a day in hot water. 
Inflammation of the endometrium may be confined to 
the cervix, or the body may be also implicated. The 
salient points of diagnosis are leucorrhcea, pain in back, 
loins, and pelvis ; menses too scanty or severe, too fre- 
quent or reverse ; nervous disorders. Bimanual examin- 
ation elicits pain in fundus or cervix ; in cervical form, os 
enlarged, lips puffy or eroded, and sound encounters ob- 
struction at internal os. Where the fundus is involved 
the os interum is usually patulous, uterine cavity pro- 
longed, and there is tenderness when touched by the 
probe. 
Treatment.-There is a tendency on the part of gynae- 
cologists to greater conservatism in the management of 
these cases. The heroic intra-uterine medication is losing 
favor as a consequence of the untoward results which 
sometimes followed. Some of the cases will recover 156 
BRYCE'S POCKET PRACTICE. 
without local treatment under a judicious constitutional 
treatment, such as sexual hygiene, the avoidance of con- 
stipation and everything which tends to produce engorge- 
ment of the pelvic vessels. An occasional blue pill, 
saline purgatives, heart tonics, such as digitalis and stro- 
phanthus ; nerve tonics, as strychnine and quinine. Iron 
is positively hurtful. If anaemia exists, subnitrate of bis- 
muth and arsenic are preferred. Local treatment: Hot 
vaginal douche, tampons of glycerine in vagina, correc- 
tion of displacements. The erosions and so-called ulcers 
of the os are best treated by solution of nitrate of silver 
applied by means of absorbent cotton on probe, and car- 
ried up into the cervical canal short of the os interum. 
GENERAL AND UNCLASSIFIED DISEASES. 
DIPHTHERIA. 
This epidemic and highly contagious trouble is mostly 
confined to children. 
Symptoms.-More or less fever with a spreading inflam- 
mation of the mucous membrane of the fauces and tonsils 
attended with the formation of greenish white, slightly 
elevated false membrane in patches here and there over 
the inflamed area. Besides these symptoms there is 
always a swelling of the submaxillary and post-cervical 
glands. 
Prognosis.-Should be guarded in all cases, as this is 
a most dangerous and deceptive disease. 
Treatment.-Sustain the child from the start with 
quinine, iron and alcohol, as well as with the most con- 
centrated foods. Do not fret or worry it by cauterizing 
the false membrane ; it does no good to forcibly remove PAROTITIS. 
157 
it and only endangers the safety of the child by pro- 
moting a struggle and giving a larger exposed surface for 
absorption of poisonous material. A simple wash, spray 
or gargle of diluted tr. of iron, papoid, or peroxide of 
hydrogen will answer all purposes for local medication. 
The lime steam bath, made by allowing lime to slack in 
the room is of much service. The heart should be 
watched and held up when it shows a disposition to fail. 
After convalescence the child should be well clad and 
kept up for a long time on tonics and reconstructive^ as 
there may be paralysis or sudden heart failure long after 
all danger seems past. 
PERTV88I8-Whooping-Cough. 
Symptoms.-This contagious disease of childhood com- 
mences as an inflammation of the naso-bronchial tract 
with an acute catarrh and some dyspnoea at night. In 
about ten days it reaches the stage of whoop. The child 
has from time to time prolonged attacks of spasmodic 
coughing which seem to threaten strangulation until he 
brings up a little mucus and for the time is relieved. In 
these spells the food is frequently brought up during the 
spasmodic coughing. The disease may last from a month 
to six months and gradually passes away. 
Treatment.-For the catarrh, ipecac, squills, ammo- 
niae muriate, and similar agents. For the nervous symp- 
toms, potass, bromide, valerian, assafoetida, cocaine 
spray locally, and nerve tonics. Comfortable clothing, 
generous diet, mild counter-irritation, stimulants, and sun 
shine are the leading measures for general treatment. 
PAROTITIS Mumps. 
Symptoms.-This contagious trouble commences with 158 
bryce's pocket practice. 
chill, fever, headache, and malaise, and in from twenty- 
four to forty-eight hours there is a swelling of the parotid 
gland with stiffness and pain in the tempero-maxillary 
articulation. Pain is especially severe upon motion of the 
jaws or upon exciting the secretions of the gland with 
vinegar or any condiment of the kind. There may be a 
metastasis to the testicle or breast. 
Treatment.-Fever diet and mixture, light purgative 
and warm anodyne applications over the gland. Guard 
against taking cold from too early exposure. When 
metastasis occurs the parts affected must be treated on 
general principles. 
ASIATIC CHOLERA. 
This is a disease due to some specific germ and seems 
to be carried rapidly over vast areas in the atmosphere. 
Symptoms.-Usually a premonitory diarrhoea, then 
violent purging, copious watery discharges, and the 
peculiar rice-water stools following. Along with these 
symptoms are vomiting, cramps of the muscles, great 
thirst, prostration, coldness of skin and collapse. 
Treatment.-Arrest if possible the premonitory diar- 
rhoea in all cases when cholera is prevailing. For this 
purpose use morphine or any of the opiates, camphor, 
brandy, capsicum, or other agents. Ice, brandy, cocaine, 
morphia hypodermically and sinapisms can be used for 
the vomiting. An enema of warm salt water has proven 
useful both for arresting the vomiting and for restoring 
circulation in the algid stage. Warmth must be applied 
to the surface in shape of hot cloths, heated stones, 
bottles of hot water, and in addition, stupes, sinapisms 
and frictions. In the stages of prostration and collapse 
we must use brandy, ammonia, and other rapid and ANAEMIA. 
159 
diffusible stimulants. The acids have been very strongly 
recommended, and we would advise their use. Diluted 
sulphuric, muriatic, or nitro-muriatic acid may be given 
every now and then when the patient complains of thirst. 
Enormous doses of calomel are very strongly advocated 
by some practitioners. We favor minute and frequently 
repeated doses of calomel, as it may exert an antiseptic 
influence and aid in quieting the great nausea. 
ANAEMIA. 
This is a condition of the system in which there is defi- 
ciency of the red corpuscles and albumen in the blood. 
Causes.-Any and all depressing agencies, especially 
bad hygiene, poor food, wasting drains on the system, 
certain poisons, and mental worry. 
Symptoms.-Extreme pallor, great muscular weak- 
ness, rapid, weak and irregular heart action with a ve- 
nous hum in the jugular veins. The respiration is hurried 
and sighing, and there is faintness and dizziness on exer- 
tion. The most striking symptom is the deadly pallor 
that the patient presents, which is especially noticeable 
in the tongue, gums, cartilages of the ear and in the con- 
junctiva. 
Treatment.-In these cases sunlight, good feeding, 
fresh air and cheerful surroundings are of immense ser- 
vice. All drains upon the system, depressing causes and 
unhygienic conditions should be remedied. Iron is the 
leading drug to be used, and there is no better form in 
which to give it than that of the ordinary tr. of the chlor- 
ide where the digestive organs will tolerate its use. If it 
disagrees, we can try the citrate or lactate. We have 
been very much pleased with the use of dyalised iron in 160 
bryce's pocket practice. 
these cases, as it neither constipates nor offends the 
stomach. Whatever form of iron that we may select 
must be continued for a considerable time and pushed in 
increasing doses until the improvement is satisfactory. 
In addition to the ferruginous preparations, we must 
avail ourselves of the other adjuvants in building up the 
system, such as the hypophosphites, cod-liver oil, malt 
extracts, and the various bitter tonics, mineral acids, etc. 
In women we find this condition frequently associated 
with menorrhagia and other disordered conditions of the 
uterine functions, and we should pay attention to this 
condition which may be either the cause or the result of 
the anaemia. In these cases we would find benefit from 
the use of mineral waters containing alum, iron, etc., as 
well as the tonic antispasmodics dioviburnia, neurosine, 
and other agents of this class. In the form known as 
progressive or pernicious anaemia the disease is not well 
understood as to its exact pathology. It has a tendency 
to pursue a rapidly progressive course and is almost al- 
ways fatal. It is supposed to be due to disease of the 
spleen or lymphatic glands in some instances, though the 
pathology, as we have said, is not clear. The symptoms 
are those of aggravated anaemia, and the treatment 
should be conducted on the same general lines. 
I.EL'COCYTHAEMIA. 
This condition resembles pernicious anaemia in many 
respects and the pathology seems to be about the same 
as far as can be seen. It is essentially a state of super- 
abundance of the white globules in the blood. It seems 
that this is due to the formation of the same in the lym- 
phatic glands, spleen or marrow of the bones. 
Symptoms.-These are essentially those of severe an- ADDISON'S DISEASE. 
161 
aemia with enlargement of the lymphatic glands, and a 
haemorrhagic condition. As the disease progresses the 
patient has very great depression with alteration of the 
special senses, haemorrhages from gums, stomach and 
bowels, and finally he dies from exhaustion. 
Diagnosis.-With these symptoms the diagnosis may 
be fully confirmed by examining the blood under the 
microscope. 
Treatment.-This should be conducted much as we 
would in cases of pernicious anaemia. Good food, com- 
fortable clothing, ferruginous and bitter tonic prepara- 
tions are all indicated. In lymphatic enlargements, syr. 
ferri iodidi, potass, iodide, cod-liver oil, sea bathing and 
traveling are recommended. Where the spleen seems to 
be primarily at fault much good is said to be derived 
from the use of ergotole hypodermically. Nutrition 
and assimilation should be improved and sustained by 
every possible means. 
ADDISON'S DISEASE. 
This is another grave form of anaemia which usually 
ends in death within eighteen months or two years. 
Symptoms.-Marked anaemia with a peculiar bronzing 
of the skin and accompanied with gastric and intestinal 
irritation. The discoloration of skin begins about on the 
face and in the folds of the body in patches at first, but 
gradually increases until the entire surface is deeply 
bronzed. There is a tendency to dropsy as the disease 
advances and later on the cerebro-spinal and sympathetic 
nervous systems suffer and the patient finally dies from ex- 
haustion. In this trouble in addition to the deficiency of 
red globules and albumen in the blood, we find upon 
post-mortem examination, a strumous degeneration of the 
supra-renal capsules. 162 
bryce's pocket practice. 
Treatment.-Here, as in other forms of anaemia, 
proper diet and hygiene are of the first importance. 
Moderate use of alcoholic stimulants may be advanta- 
geously allowed. The hypophosphites, chloride of gold 
and sodium, tr. ferri chloridi, arsenic, strychnia and 
phosphorus are all recommended in this trouble, though 
we cannot expect to do more than prolong life reasonably 
by any course of treatment. 
SCO RDUTUS-Scurvy. 
This is a disease due to a deficiency of certain food 
elements for a prolonged time. It is pretty well proven 
that the lacking ingredients are contained in the usual 
vegetables and fruits. 
Symptoms.-General anaemia, lassitude, mental de- 
pression, palpitation and breathlessness upon the slightest 
exertion. There is a spongy protruding condition of the 
gums in which they bleed freely upon the slightest touch, 
the teeth become loosened and there is foetor of breath. 
Here and there we will find ecchymoses or petechiae 
under the surface of the skin, and haemorrhages fre- 
quently occur from stomach or bowels. 
Treatment.-An immediate change of diet from the 
salt meat or other former deficient food, to one in which 
an abundance of vegetables, fruits, potatoes, cabbage, 
and lemon or fruit acids is supplied. Sweet milk is 
also of great service in this affection and should be freely 
prescribed. The free use of lemon juice, tr. of iron, 
mineral acids and bitter tonics will give the best results. 
For the spongy and bleeding gums we may use a mouth- 
wash of myrrh and capsicum, or an infusion of sumac ber- 
ries with a little alum. Red oak bark tea makes a most 
excellent wash, while for thoroughly disinfecting the PURPURA. 
163 
mouth and hastening a cure the peroxide of hydrogen 
is of the greatest value. 
I'I'Rl'I RA Simplex and Haemorrliaxica. 
In this affection we find an extravasation of blood in 
spots under the skin in form of petechiae or ecchymoses 
in the simple varieties of the disease, and in the haemor- 
rhagic forms there is additional haemorrhage from the 
mucous membranes, stomach, bowels or elsewhere. 
Symptoms.-The haemorrhagic conditions constitute 
the prominent symptomatology of the affection. 
Pathology.-The pathology is but poorly understood 
and while the symptoms are very much like those of 
scurvy, the two diseases are different and dependent up- 
on different causes. Purpura is entirely independent of 
the diet and may appear at all periods of the year and 
while the patient has access to all kinds of food, vegeta- 
bles and fruits. The blood is altered in its composition 
and its fibrin forming properties are diminished. The 
capillaries are frequently diseased and we have haemor- 
rhage by reason of these two conditions of watery blood 
and weakened vessels. 
Treatment.-The patient should be sustained with 
stimulants and tonics and his food should be selected so 
as to give him the greatest blood making pabulum. Er- 
gotole has been found very valuable in this trouble for 
checking haemorrhage and toning the capillaries. Tr. of 
iron, elixir of vitriol, Huxham's tincture, the mineral 
acids and bitter tonics are all to be used. Turpentine in 
doses of ten to twenty drops every two or three hours is 
highly recommended. 164 
bryce's pocket practice. 
RHEVMATISM. 
Causes.-Diathesis has much to do with the produc- 
tion of this trouble, as well as improper diet, continued 
overwork, and exposure to cold and dampness. The 
blood will be found excessively acid in this disease, due 
to the presence of uric and lactic acids. 
Symptoms, Course, Complications, Etc.-Fever, 
which follows severe chill, stiffness and severe pain in one 
or several joints. The joints become red, swollen, hot 
and painful upon any attempt at motion or if they are 
touched. The fever ranges from 1020 to 1040. The urine 
is usually scant, high colored, and loaded with urates. 
The course of this disease runs from ten days to six 
weeks. In the acute form we may have such complica- 
tions as valvular heart troubles, due to morbid deposits 
upon the valves, bronchitis, cerebral metastitis, liver 
troubles, etc. 
Treatment.-Wrapping the inflamed joints in flannel 
or rubber bandages has proved beneficial without other 
local medication. Hot and moist applications, liniments 
of laudanum, sweet oil, and camphor are serviceable. 
Cocaine, gr. xx to lard, 1 oz. makes an excellent oint- 
ment. The effort should be made to render the blood 
free from acidity as soon as possible by the administra- 
tion of the potash or soda salts. Bi-carbonate or acetate 
of potass, in 30 to 40 grain doses every few hours for sev- 
eral days will speedily change the characteristic acidity 
of the blood. Bromide of potassium is a most excellent 
agent for the relief of pain and restlessness, as well as 
for its power to render the blood alkaline. Salicylic acid 
or the salicylates have played an important part in the 
treatment of rheumatism of late years, though in weak 
heart or threatening heart complications, their adminis- DIABETES MELLITES. 
165 
tration should be undertaken with caution. The dose of 
sodium salicylate should be from 15 to 20 grains every 
two or three hours in any simple menstruum until the 
amount reaches a drachm or two in twenty-four hours. 
Salicylate of lithia in 5 gr. doses three or four times a 
day is a very valuable agent. The old fashion remedy of 
colchicum may be mentioned. Sulphate of quinia, tinc- 
ture chloride of iron and other similar agents are of value 
in various conditions. Antipyrin, phenacetine, and re- 
cent new remedies are before the profession, but their 
merits are not yet well established. As a local applica- 
tion "salol collodion'' is highly recommended as reliev- 
ing pain rapidly. This is made by dissolving 4 parts of 
salol in 4 parts of ether and adding 30 parts of collodion; 
of course, applied to the joints as a simple collodion. 
Oil of wintergreen, locally and internally, has received 
much favor too. Careful attention to diet, avoiding 
such agents as produce internal congestion and favor the 
formation of uric acid is to be enjoined. The occasional 
use of alkaline waters, such as Vichy, Carlsbad, etc., will 
favor a continuance in health. 
DIABETES MEIJ.ITU8-Su>;ar in the Urine. 
The pathology of this trouble is most obscure, as the 
abnormal excretion of sugar by the kidney may depend 
upon so many very widely divergent causes. Pancreatic, 
hepatic, cerebral, or nervous disturbances are all capable 
of inducing diabetes. Even an undue proportion of cer- 
tain foods may bring about this pathological condition. 
Treatment.-The diet should consist as far as possi- 
ble of such articles of food as are free from sugary or 
starchy ingredients. For this reason we interdict the use 
of white bread, potatoes, beans, peas, rice, etc., all 166 
bryce's pocket practice. 
sugars and sweets, as well as fermented drinks. We allow 
animal food, milk (in the majority of cases), gluten 
bread, or where it is impossible to get this latter article, 
have the bread sliced thin and baked until it is a crust 
through and through, thus transforming the starch to 
some extent. Glycerine or saccharine may be used for 
sweetening purposes. The patient should be comfort- 
ably clad and the skin encouraged to act by the use of 
warm baths when necessary. It is important to build up 
and maintain the system at the best possible standard, 
and therefore we would not advise a strict adherence to 
any line of practice which seemed to depress or disagree 
with a patient, however sound it might appear theoreti- 
cally. We remember having heard a case detailed by an 
old physician, now dead, in which a man far advanced in 
emaciation and several local complications, the sequelae 
of chronic diabetes, finally abandoned hope of recovery, 
and commenced to eat greedily of brown sugar, sweet 
meats, etc., daily for a considerable time-indeed until 
all craving for such things had been appeased. The re- 
sult was that a cure of his diabetes ensued without 
further attention to special treatment. We throw this out 
incidentally to say that in the practice of medicine cures 
sometimes follow very peculiar practice! Of drugs 
proper, we have quite a fair number which have been 
found useful, and in a few cases cures have been claimed 
from their use. 
Opium, codeine, ergotole, salicylate of sodium and a 
few other agents are generally recommended. 
Among the most recent remedies mentioned in the 
International Medical Annual, for 1892, may be mentioned: 
Jambul, salicylate of sodium, creasote in doses of four to 
ten drops daily, arsenic, and basic hippurate of chalk. 
Professor Dujardin Beaumetz has pointed out the value SUNSTROKE. 
167 
of fatty foods, and recommends a bread made from the 
soja meal. He further recommends one potato at each 
meal as a substitute for bread, and very wisely condemns 
the use of skimmed milk as being most disastrous. 
SUNSTROKE-Heatstroke, Insolatio. 
There are two varieties of this trouble. One is due to 
the direct rays of the sun, which produces cerebral con- 
gestion. The other is due to prolonged and excessive 
heat and may occur independent of the immediate rays 
of the sun upon the patient. The first form is sunstroke, 
and the second is heatstroke. 
Symptoms.-Sunstroke comes on suddenly, the patient 
usually falling in an unconscious state, with hot head, 
throbbing temporal arteries, stertorous breathing and 
slow full pulse. There may be convulsions and speedy 
death. Heatstroke occurs also quite suddenly, but there 
is no unusual or excessive heat of head, the pulse is weak, 
there is no stertorous breathing and less unconsciousness 
and the patient's condition resembles an attack of syn- 
cope. The depression is very profound and the prostra- 
tion following an attack of heatstroke lasts for quite a 
long time. 
Treatment.-In sunstroke the patient should have 
ice or iced water freely applied to the head, and imme- 
diately following this we should resort to local abstrac- 
tion of blood by cupping or leeching about the temples 
or back of head. The head and shoulders should be 
elevated and kept so until the patient is better. An 
active enema, sinapisms to the extremities and hot foot 
baths are all to be used promptly. Heatstroke requires 
altogether different treatment from sunstroke at first. 
There will be no need for the abstraction of blood, but 168 
bkvce's pocket practice. 
rather for the administration of stimulants. Mustard 
plasters may be applied to the extremities, spine and epi- 
gastrium. Cool or iced drinks may be given if the 
patient complains of heat or thirst. Iced mint juleps are 
of immediate benefit if prostration is marked, and if it is 
extreme we must resort to digitalis, brandy, nitrite of 
amyl, nitro-glycerine and ammonia to keep up the failing 
heart action. The hypodermic use of nitro-glycerine in 
severe cases is of great avail. For the speedy reduction 
of great heat of the body in either form antipyrine, anti- 
febrine and similar agents are much used. Both forms 
of this trouble are followed by considerable weakness 
and prostration, and the patient should avoid overwork, 
mental worry or exposure to the sun for some weeks 
after an attack. 
DEEIRIUM TREMENS-Mania a Potu, Alco- 
liolism. 
Delirium tremens occurs as a consequence of either the 
direct action of alcohol for a long period on the brain, or 
from the sudden withdrawal of alcoholic stimulants in an 
habitual user of it. 
Symptoms.-The prominent symptoms are sleepless- 
ness, tremors, hallucinations or horrors, debility, and loss 
of appetite and digestive power. 
Treatment.-The main points in the treatment are to 
produce sleep, sustain the action of the heart, and substi- 
tute good nutritious food for the alcoholic stimulants 
which have been improperly used. The first important 
question would be whether to promptly withhold all al- 
coholic drinks or to gradually withdraw them. We think 
where it is clear that the system is not depressed and 
where the pulse is full, with flushed face and heat of head CHRONIC ALCOHOLISM. 
169 
that we can interdict at once the further use of alcoholics. 
On the contrary, where the circulation is feeble, and the 
skin is cool with irregular perspirations and evidences of 
poor blood supply to the brain, the withdrawal of alco- 
holicstimulants would be positively dangerous. To pro- 
duce sleep we may have recourse to opium, hyoscyamus, 
morphia, chloral, chloroform, antikamnia, neurosine, 
bromidia and similar agents. The patient will require 
relatively larger doses of opiates than are usually admin- 
istered, and for the purpose of securing sleep, we may 
give a grain of opium every three or four hours, and if 
sleep should be delayed, we may carry the opium up to 
a grain every two hours or even more. Where opium is 
thus demanded we will usually find a need for stimulants 
of an alcoholic character, and we may give ale, porter or 
whiskey. The use ofinfusion of hops, capsicum and agents 
of this character has been of great service in certain cases 
of this affection. Capsicum in thirty grain doses has 
heen highly praised. Much good will be derived from 
the mercurials, especially where there is much cerebral 
excitement. Digitalis in very large doses is a most ex- 
cellent remedy where the heart is irregular in its action. 
It may be given in doses of one drachm to half an ounce. 
The careful feeding of the patient on nutritious food is of 
the utmost importance, as we cannot expect to relieve 
him of the terrible craving for alcohol until we have sub- 
stituted its place with the proper food products. 
CHRONIC AUOHOI.ISM-Inebriety. 
This condition, induced by the long-continued indul- 
gence in alcoholic liquors, so affects the brain and viscera 
that the patient has impaired functions of various kinds, 
such as thickening of the membranes of the brain with 
hyperplasiae of the connective tissue. There is loss of 170 
bryce's pocket practice. 
memory, and want of self respect and an inordinate 
craving for alcoholic drinks, which is irresistible and 
drives the victim to any extremity to procure them. 
Lungs, heart, liver, spleen and stomach are all more or 
less affected, sometimes with fatty degeneration or 
oftener with induration. 
Treatment.-Much good has been done by treating 
these intractable cases in the private asylums here and 
there over our land, and the general practitioner has 
gained much information of value from these specialists 
in their successful management of thesecases. The value 
of systematic feeding and of certain therapeutic agents 
which do undoubtedly relieve the craving for drink and 
restore tone to the system has been well proven. In all 
cases where there are no organic diseases of the brain or 
tubercular trouble and where there is a sincere desire on 
the part of the inebriate to reform, the practitioner may 
safely treat the patient at his home with every hope of 
curing him. 
In the first place it will be necessary to get the co-op- 
eration of the patient to aid us in effecting a cure. He 
must be willing to try to break the habit and overcome 
the appetite while we aid him with remedies. We must 
make him abstain from the use of alcoholics either by 
the abrupt cutting off all imbibition or by gradual taper- 
ing down. We think that except in very rare cases the 
immediate cessation of the use of alcohol in every form 
should be the rule. The next step is to regulate the di- 
gestive functions, improve the action of the liver, and 
feed the patient on the best and most assimilable food ob- 
tainable. He should be requested to remain in bed for 
a few days at first, until his secretions are restored and 
his appetite and digestion have become in proper shape to favor an improved nutrition. We think that after all, 
the chief reliance should be given to the nitrate of 
strychnia, for it has been pretty well demonstrated both 
in regular practice and in the hands of successful charla- 
tans that strychnia will certainly abate the craving for 
drink. We are satisfied that the so-called chloride of 
gold and sodium is an utterly worthless compound and 
that its therapeutic value is a myth. 
One of the best preparations that we know of for abso- 
lutely destroying the appetite for alcohol and at the same 
time restoring the natural desire for food and aiding in im- 
proving digestion is known as Cincho-Lupli. This prep- 
aration contains in each ounce 1-32 of a grain of nitrate of 
strychnia, 2 drachms of Jamaica dogwood, 2 1-2 drachms 
each of fluid extract red cinchona and humulus, 1-4 
drachm each of fluid extract jalap and cannabis Indica, 
and 5 minims of fluid extract digitalis. This compound 
is dispensed in our drugstores under the convenient name 
of cincho-lupli ^and should be given in doses of a tea- 
spoonful to a dessertspoonful every two to four or five 
hours and be continued for a good long time, certainly 
until the patient is fully restored to a fair state of general 
health and with the desire for alcohol totally abolished. 
In inveterate cases the hypodermic injection of strychnia 
nitrate in doses of i-6oth to i-4oth of a grain with r-2ooth 
to x-iooth of a grain of atropia sulph. may be practised 
twice a day for a while. As soon as the patient improves 
the atropia must be discontinued, but the strychnia may 
be used with advantage for many weeks. Many cases 
will get along very well with the cincho-lupli alone and 
only occasional ones will require the additional help of 
the hypodermics of strychnia. 
CHRONIC ALCOHOLISM. 
171 172 
bryce's pocket practice. 
CENERAI. DROPSY. 
All dropsies, whether local or general, are but symp- 
toms of other disordered conditions. This transudation of 
the watery portions of the blood into the serous sacs and 
into the cellular tissues is due to disease of the heart, 
kidneys, liver, and frequently to impoverished conditions 
of the blood itself. 
Treatment.-By diuretics, diaphoretics, and hydro- 
gogue cathartics to reduce the general oedema. The 
skin and absorbents must be encouraged to take up and 
carry off the effusion, and squills, the various potass., 
salts, jaborandi and nitre will be found useful. In anae- 
mia, the iron tonics and generous diet should be given. 
In dropsies from liver troubles we should relieve that organ 
of its congestion and favor venous return. The salines 
and mercurials with counter-irritation are all indicated. 
Where the heart is at fault, we must try to regulate its 
action and compensate for its deficiency in disposing of 
the volume of blood, by using digitalis, strychnia, stro- 
phanthus, cocaine and other agents. 
HAEMORRHOIDS-Piles. 
These are small, indolent or inflamed tumors near or 
within the anus, and consist of enlarged and knotted 
veins covered with mucous membrane in various stages 
of congestion and inflammation. They are generally 
associated with congestion or torpor of the liver and 
bowels, and give rise to much pain, burning, and discom- 
fort in defecation,or when they become unusually inflamed. 
Sometimes considerable haemorrhage takes place from 
them, and they occasion frequent prolapses of the bowel. 
Treatment.-Relieve portal engoregment. Hot fo- ENTOZOA. 
173 
mentations or very cold applications, scarifications or 
leeching are all valuable procedures in this affection. 
Soothing astringent applications in the form of opium, 
tannin and glycerine are often needed, and suppositories 
of tannin and hyoscyamus are much used. Haemorrhoids 
may be radically treated by injecting the individual tumors 
with ergot, or carbolic acid, or removed by the ligature, 
ecraseur or the galvano-cautery. 
ENTOZOA-Worms. 
Symptoms.-The symptoms of both the common round 
worm and the tapeworm are obscure and uncertain, 
though they may vary from slight colic or constipation to 
the more serious reflexes, such as vertigo, amaurosis, 
epilepsy, etc. The seat worms are easily recognized by 
the amount of irritation they set up and by being occa- 
sionally discharged in large masses. 
Treatment.-For the lumbricoid worm calomel, tur- 
pentine, pink root, cowhage, chenopodium, powdered 
tin, and dozens of other remedies are mentioned. A 
popular form of spigelia is an infusion of half ounce with 
as much senna to the pint; dose for an adult, a wineglass- 
ful every morning before breakfast. The fluid extract of 
these agents may be given in teaspoonful doses. San- 
tonin is the most reliable remedy of any that we know of 
in killing and clearing out these offenders. It may be 
given in doses of one-fourth to one-half grain to a child, 
once or twice a day, either with small doses of calomel 
and white sugar, or alone and afterwards followed with 
some cathartic, such as castor oil and turpentine or cal- 
omel and soda. An adult may take as much as two or 
three grains at a dose, though the drug should be admin- 
istered with care to both adults and children as it pro- 174 
bryce's pocket practice. 
duces serious prostration, vomiting and other nervous 
symptoms when administered in too large doses. 
For tapeform, spts. turpentine in large doses (half 
ounce) will usually bring away the worm, though this 
size dose of turpentine will frequently produce intoxica- 
tion or other unpleasant symptoms of a cerebral charac- 
ter, and this should be borne in mind. Extract of male 
fern in one or two drachm doses will often act very 
promptly. A mixture of male fern and kameela or 
pumpkin seeds largely taken on an empty stomach are 
quite effective in removing the parasite, as well as the 
milk from a large cocoanut taken before breakfast. 
For thread or seat worms a suppository of santonin and 
cacao butter will generally answer. Injections of lime 
water, quassia, or infusions of aloes are all very excellent 
for removing these little pests. INDEX. 
Page. 
General Introductory Re- 
marks ------- - 5 
Fever - - - - 5 
General Terms in Symp- 
tomatology ----- JO 
Febricula ------ 12 
Typhoid 13 
Typhus ------- 18 
Cerebro-Spinal - - - - 20 
Relapsing ------ 21 
Periodical 22 
Intermittent ----- 23 
Remittent 27 
Haemorrhagic Malarial - 28 
Congestive Malarial - - 29 
Yellow - -- -- --31 
Eruptive Fevers. 
Small-pox 33 
Varioloid ------ 37 
Scarlet -------38 
Measles ------- 40 
Rothehi - -- -- --41 
Chicken-pox ----- 42 
Erysipelas ------ 42 
Dengue -------44 
Diseases of the Digestive 
Organs. 
Stomatitis ------ 46 
Tonsillitis ------ 48 
Pharyngitis ----- 49 
' Gastritis ------ 50 
Chronic Gastritis - - - 51 
Ulcer of Stomach - - - 52 
Gastric Cancer - - - - 53 
Dyspepsia ----- * 54 
Cholera Morbus - - - - 56 
Cholera Infantum - - - 58 
Diarrhoea ------ 60 
Duodenitis - - - - - - 61 
Enteritis ------ 62 
Dysentery ------ 64 
Typhlitis ------ 66 
Intussusception - - - - 68 
Page. 
Diseases of the Digestive 
Organs. 
Haematemesis - - - - 76 
Colic ------- - 71 
Constipation 72 
Muguet - -- -- --73 
Glossitis ------ 74 
Stricture of the Oesopha- 
gus 75 
Dilatation of the Stomach 76 
Inflammation of Serous 
Membranes. 
Meningitis ------ 77 
Pleuritis- ------ 78 
Pneumothorax - - - - 79 
Pericarditis - - - - - 79 
Peritonitis ------ 80 
Diseases of the Liver. 
Congestion ----- 80 
Hepatitis - 81 
Catarrh of the Bile ducts 81 
Icterus - -- -- --82 
Gall-Stones ----- 83 
Abscess ------- 84 
Yellow Atrophy - - - - 84 
Fatty Degeneration - - 85 
Cirrhosis ------ 86 
Cancer - -- -- --86 
Hydatid Cyst - - - - 87 
Diseases of the Heart and 
Aorta. 
Pericarditis ----- 88 
Endocarditis ----- 88 
Valvular Disease - - - 89 
Hypertrophy and Dilata- 
tion -------90 
Fatty Degeneration - - 90 
Cardiac Exhaustion - - 91 
Palpitation ------ 91 
Aneurisms of Aorta - - 92 176 
INDEX. 
• Page. 
Diseases of the Brain and 
Spinal Cord. 
Congestion of Brain - - 93 
Anaemia ------ 94 
Cerebritis ------ 94 
Embolism ------ 94 
Apoplexj' ------ 95 
Cerebral Softening - - - 97 
Abscess 98 
Syphilis - -- -- -- 99 
Congestion of Spine - - 100 
Anaemia ------ 100 
Meningitis 101 
Pachymeningitis - - ■ 102 
Myelitis - 102 
Poliomyelitis 103 
Poliomyelitis-Chronic - 104 
Sclerosis - 105 
Paralysis Agitans - - • 107 
General Nervous Disor- 
ders. 
Neurasthenia ----- 109 
Epilepsy - - - - - - 112 
Hysteria ------ 115 
Chorea - -- -- --116 
Neuralgia ------ 117 
Diseases of the Respira- 
tory System 
Laryngitis - -.---119 
Bronchitis ------ 120 
Croup ------- 123 
Asthma ------- 125 
Pneumonia ------ 126 
Haemoptysis ----- 128 
Hyperaemia of Lung - - 129 
Emphysema ----- 130 
Oedema ------- 131 
Consumption ----- 132 
Page. 
Diseases of the Kidneys 
and Bladder. 
Congestion- - - - - - 139 
Bright's Disease - - - - 139 
Chronic Interstitial Neph- 
ritis 142 
Pyelitis ------- 143 
Renal Calculi ----- 145 
Amyloid Kidney - - - 146 
Cancer of Kidney - - - 147 
Haematuria 147 
Hydronephrosis - - - - 14s 
Cystitis - - - - - - - 149 
Diseases of Women. 
Leucorrhoea ----- 151 
Vaginitis 152 
Amenorrhoea ----- 153 
Acute Oophoritis - - - 154 
Chronic Oophoritis - - 154 
Dysmenorrhoea - - - - 154 
Menorrhagia ----- 155 
Metrorrhagia ----- 155 
General and Unclassified 
Diseases. 
Diphtheria ------ 156 
Pertussis ------ 157 
Parotitis ------ 157 
Asiatic Cholera - - - - 158 
Anaemia ------ 15g 
Leucocythaemia - - - 160 
Addison's Disease - - - 161 
Scurvy ------- 162 
Purpyra ------- 163 
Rheumatism ----- 164 
Diabetes Mellitus - - - 165 
Sunstroke ------ 167 
Delirium Tremens - - - 168 
Chronic Alcoholism - - 169 
Dropsical Affections - - 172 
Haemorrhoids - - - - 172 
Entozoa ------- 173 1S67 TELEPHONE 385. 
WW 8 9 
Manufacturer of and Dealer in 
FURNITURE AND MATTRESSES. 
Orders by Mail promptly attended to. 
Nos. 1420, 1436, 143S, Main St., and 22 Governor St. 
FACTORY and UPHOLSTERING rooms, NOS. 16, 18 
AND 20 N. 15th ST., 
RICHMOND, VIRGINIA. 
itT FIRST PRIZE FOR FURNITURE AT STATE FAIR, 1891. The Physician's Companion. 
BY C. A. BRYCE, D 
This handy and compact little vade mecum is now ready 
for delivery. It contains 160 pages, is nicely printed on 
fine paper and is a suitable size for the coat pocket. It con- 
tains very complete information on the following subjects : 
AN EPITOME OF PRACTICE. 
SURGERY-Emergencies, Hivmorrhages from Accidents, Fractures. 
Dislocations, Ligation of Arteries in their Continuity, &c., &c. 
DISEASES OF WOMEN-Symptomatology, Diagnosis, Method of 
Examination and Treatment. 
OBSTETRICS-Hivmorrhage before, during and after labor. Puerpe- 
ral Convulsions, Management of Difficult cases of labor, After- 
Treatment of mother's Breast, Lochial troubles, Puerperal, 
Ephemeral and other Fevers. First care of Infant, &c. 
INFANT FEEDING-The principles involved and the best articles 
for the Child. 
HYPODERMIC MEDICATION-The method, peculiarities, dangers 
advantages, and doses of drugs. 
ELECTRICITY IN MEDICINE AND SURGERY-A concise and 
plainly written chapter, valuable and practical. 
TREATMENT OF STRICTURE OF THE URETHRA BY ELEC- 
TROLYSIS. The rationale, and details fully presented. 
HOW TO CONDUCT POST MORTEMS. 
EXAMINATION OF URINE. 
ARTIFICIAL RESPIRATION. 
POISONS AND ANTIDOTES. 
DISINFECTANTS. 
TABLE OF ERUPTIVE FEVERS. 
TABLE OF DIGESTIBILITY OF FOODS. 
FULL, COMPLETE, AND REVISED DOSE LIST OF ALL MEDI- 
CINES. 
THERMOMETRY IN DISEASE. 
MEDICAL "ODDS & ENDS "-A valuable chapter of over 35 pages 
of useful formulae, favorite prescriptions, list of States having 
Medical Examining Boards, and the full law governing the Va. 
Med. Examining Board. 
This book in cloth, pout paid, • . - - • $1 00 
The same in handsome leather, for carrying in pocket, • " 1 25 FOURQUREAN, PRICE & CO., 
B Magnificent New Store, 
Corner 4th and Broad Streets, 
RICHMOND, VA. 
Hw -:o:- 
Headquarters for the Finest and Best of every- 
thing in Staple and Fancy Dry Goods. 
Elegant Novelties 
In Silks, Velvets, and Colored Dress Goods, while 
the Stock of Staple Dress Fabrics is complete in 
SPLENDID BARGAINS from 25 to 50c. per 
Cloaks and Wraps of the Newest Styles and 
0 Lowest Prices. 
p Rugs, Druggets, Lace Curtains, and Curtain 
traces in Full Assortment. Best Stock of Linens 
Band White Goods to be found, and special attrac- 
tions in Black Goods. 
Ladies' Clothes and Gents' Furnishing Goods 
in choice assortment. 
Agents for the celebrated Butterick Patterns. 
K^°Samples Cheerfully Sent. 
FOURQUREAN, PRICE $ CO. RnHi 
I the empire 
the empire Elastic Bandage. 
ABDOMINAL SIPPORTEK t , , 
, .. - . . . Specially adapted for vari- 
Is the best, cleanest, coolest. r ' 
. , . .. , cose veins, and superior to 
most comfortable and effi . ' 
_ .1 elastic stockings. 'Die most 
cient supporter in the world. 
elastic and absorbent band- 
it 'j SJ!>tlnrei Try it. 
age made. 
Net Price: 
The Empire Umbilical Truss 8 inches wide $2 50 ^»d $1 for sample 3-inch 
Is an 11-inch supporter with button inserted at the .. ., .. $ qq by 5-yard bandage for appro- 
navel. Can be worn day and night. - 11 val. 
Net Price, $4 00. I 
f^"The above are net prices to Physicians. 
We send all our Goods Free by Mail upon Receipt of Price, and Refund Money if not Satisfactory. 
THE EMPIRE MANUFACTURING COMPANY, Lockport, N. Y.,U. S. A. is the only digestive agent 
which acts upon all kinds of 
food, under all conditions, and 
throughout the entire diges- 
tive tract. 
CVvmvsXs VkM. Bryce's Visiting List and Pocket Record. 
This beautiful list is without an equal either for value of 
contents or elegance of finish. Handy for the pocket 
weighing about four ounces only, will allow an entry of 
210 visits per week for one year. Has valuable dose 
tables of every known remedy and printed matter for 
emergencies generally. Is splendidly bound in rich hand- 
some leather with kid lining, pocket, pencil loop and deep 
flap. Price #1.00, post paid.