NATIONAL LIBRARY OF MEDICINE
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ARMY MEDICAL LIBRARY
     WASHINGTON
        Founded 1836
Section.
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THE
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KEY  NOTES  V
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?
IEDICAL  PRACTICE
7
        CH. GATCHELL, M.D.

tmerly professor of the theory and practice of
University of Michigan, and Physician to Lkivk
  Hospital; Attending Physician and Clinical Lb
    turf.r to Cook County Hospital, Chicago ;
      Author of "How to Feed the Sick."
I
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- ''illust'ra
21 n 9.
     CHICAGO
GROSS & DELBRIDGE
        1884 
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>k
W3,
G258k
1314-
fi $.<**•
Mt
     lf(,l/t>y  ^"'-
        TO
RICHARD HUGHES,
                WHO
              HAS DONE
            SO MUCH TO LEND
          VALUE AND CHARACTER
       TO THE SCIENCE OF MEDICINE, ■
TS okATEFUL ACKNOWLEDGMENT OF MANY FAVORS,
    AND IN MEMORY OF A PLEASANT DAY AT
          BRIGHTON BY THE SEA,
              THIS BOOK IS
               INSCRIBED
                BY HIS
f'''-'.    SINCERE ADMIRER AND FRIEND,
.  '■■          THE AUTHOR.
*i
Copyright, Gross & Delbridge, !"<*•'='. 
PKEFACE.
   This book is intended to be a pocket companion for the busy prac-
 »tioner.  The  effort has  been to include in its  pages that  part of   >
                                                                  f
   1i"'ne which makes up the bulk of the physician's daily practice,  v
                                               *
     !.n addition, I have endeavored  to  introduce much which forms \^
   t of a practical medical education, and yet is not  taught in the   ;
   lege lecturo-room;  what older physicians have learned only after  S.<
   rs of experience, and gradually accumulated.
    )irections for the management of  tho most pressing emergencies,
 > dical, surgical  and  obstetric,  are carefully given,  while  chronic
 urease- and rare cases, in the treatment of which there  is always time
 and  necessity  for consulting  larger works, receive  no attention.
 A hand-book must treat of rules not of exceptions.
   An effort has been made to give additional weight to many recom-
 mendations by attaching  to them the names of those who are widely
 and  favorably known in our profession.   Thus I have made frequent
 reference to our most eminent systematic writer,  Richard Hughes, of
 England, who enriches and illuminates every subject which he touches.
 Baehr, Joussefc, Dunham, Guernsey, Jahr, Baye«, and numerous others,
 have been called upon for the results of their experience.
   I am much indebted to Dr. Chas. Adams, Attending Surgeon to Cook   y
 County Hospital, for very many contributions to the Part on Surgery,
and the accuracy of the entire subject may be relied upon, since it has
all undergone at his hands  a careful and thorough revision.
   Dr. J. H. Buffum, author of " Dis<?a-es and Injuries  of tho Eye,"
han very kindly prepared for me the article on that subject, thus ren-
dering it worthy of entire confidence.
   Dr. F. R. Day, formerly Resident Physician, Homoeopathic Depart-
ment, Cook County Hospital, has favored me with  the drawings  from
which the illustrations have been prepared.
   I
  I 
4                          FUtLi! AVJU..                             .
   If th<we who have been many years in practice should seek in vain  >
between these covers for remedies which they have at times found to jf
be of signal service, let them reflect that if one thousand physicians, of
our school, should each set about preparing  a work of this  character,  1
there would be produced a thousand different books, with as great a
variety of details as there were authors, and yet there would undoubt-a^
edly be a general agreement upon  the leading remedies for each and
every disease.  It  is this common ground  that I have attempted to
occupy.                                        CH.  GATCHELL.
   Chicago, November,  1883. 
                   PAET  I.

MEDICAL    PRACTICE.
                      FEVERS.



      FEVER  AND  CHILL  TEMPERATURES.

1L2..V'  Fahr.—Highest ever recorded.
107- or over—Death.
10fi° to 107°—Almost always fatal; except in intermittent.
10i53 to 106°—Intense fever; recovery doubtful.
104- to 105°—High fever; dangerous if long-continued.
102° to 104°—Active fever; recovery the rule.
101° to 102°—Moderate fever.
100: to 101°—Slight fever.
    to 100°—Feverishness.
   ft*.C   —Normal.
 97° to 98°—Subnormal; not grave.
 95: to 97°—Collapse; in itself without danger.
 93° to 95°—Algid collapse: great danger, though recovery possible,
 92' to 93°—Fatal collapse.


               CONTINUED FEVERS.


  A Continued Fever is one which is  marked  by a con-.
stantly elevated temperature, without sufficient remission
or exacerbation to alter the course from that of a continu-
ous action.



                 TYPHOID  FEVER.

  SYXOXY3ES:  Enteric Fever: Abdominal Typhus.

  PROGNOSIS.  Favorable:  Pulse  of 110  to  115, with
distinct first sound; temperature not higher than 104  to
105" Fahr. on eighth day; abdominal symptoms  mild, and
ceasing early.
  Unfavorable:  The continuance of abdominal symptoms
 -so long as  these last, patient  not out of danger; pulse
120 to 130, with feeble apex beat, and indistinct first sound; 
6          KEY NOTES OF MEDICAL PRACTICE.

capillary bronchitis; haemorrhage from bowels; severe cysv,
titis; bed-sores; perforation of intestine (almost invariably
fatal).  Prognosis also bad in fat persons, gouty subjects,
and  alcoholists; also if complicated by disease of kidneys,
organic disease or degeneration of  heart, oedema of lunge,
pyaemia, or gastric catarrh.
  COMPLICATIONS.   Pneumonitis;  pleuritis;  perfora-
tion of  bowel  and  peritonitis; intestinal  haemorrhage;
parotitis.
  CAUSES OF  DEATH.   Excessive  haemorrhage;  per-
foration and peritonitis; pneumonitis; asthenia.


               LEAUIXG   RF.3IKDIES.

  Daptisia.   To be given as soon  as typhoid fever  is sus-
pected, " in the period antecedent  to the full development^
of the intestinal affection."—Hughes.   Face dark red, with
a besotted expression; dull, stupefying headache, with con-fl
fusion of ideas; tongue brown and  dry, pulse full and soft,
dull, aching pains.  Also, throughout the course of the di&< j
ease, to reduce the high temperature.                      ]
  Bryonia.   Violent, stupefying headache, restless sleep.
with moaning and groaning, face red and swollen, delirium -
day  and night, with  strange  fancier,  desire to  escape.
Tongue  coated with  a yellowish fur,  with  parched  lips,
great thirst, vomiting,  tenderness  at pit of  the stomach,
and constipation.  Of no use after the diarrhcea has set in.
  Belongs to treatment of mild cases, and '■ those in which the brain is
not altogether deprived of its functional power." Baehr.
  Mcmirius.  Tongue loaded with thick, moist,  crenmy
coating; painful sensibility  of whole abdomen;  diarrhcea,
stools copious, liquid, rlocculent, sometimes a little bloody.
Clammy, foetid perspiration.
  " Indicated by predominance  of abdominal symptoms."   Joutact,
" Must be suspended as soo:i as tongue becomes dry and delirium mani-
fests itself." Lilienthal.
  Rhus tox.  Mind dull  and clouded, incoherent mutte:
ing, or  active delirium; headache, epistaxis, tongue  brow
and dry, with red tip; lips, teeth and tongue covered  with
sordes, skin clammy, general trembling, debility and pros-
tration, pulse weak and slow, abdomen bloated,  frequent.
involuntary, copious, yellowish evacuations.  This remedy
belongs to the treatment of  the intestinal stage of the dis-
ease, after diarrhoea has set in. Also  in pneumo-typhus,
with epistaxis,  severe  bronchial affections, dirty-looking,
sanguinolent expectoration.
  " Rhus corresponds to typhus of intense character, beginning with
chill, followed by burning heat, and a copious diarrhoea, which sets in
early."  Baehr.
  Arsenicum.  Extreme  prostration, and  great emaoia-
ct.j 
                     TYPHOID FEVER.                   7

tion, face pale and shrunken, falling of lower jaw, tongue
dry and cracked, black, with inability to protrude it. mouth
covered with sordes, great thirst, decubitus, sopor, picking
at bed-clothes, distended abdomen,  pulse small, almost
imperceptible, irregular action of the heart, with indis-
tinctness of first sound, violent, almost continuous relaxa-
tion of  bowels, discharge very foetid.   Breathing short and
anxious,  rattling  cough, foetid  breath.   Symptoms of
decomposition of the blood set in early, such as nose-bleed,
bloody diarrhcea, bloody sputa, petechiae on the skin.
  This  remedy should be given early, without waiting for
the disease to  develop its pernicious character.
  " A remedy of priceless value." Ruddock.  " Sometimes restoring
the patient when almost beyond hope."  Laurie.
  Mm*, ae.    Extreme   prostration,  patient stupid  and
unconscious, sliding  down  in  the  bed, low,  muttering
delirium, picking at flocks, inability to protrude the tongue,
depression of lower jaw, turning up  of  the eyes, involun-
tary stools and urine.
               SPECIAL.  REKEUIEK.

  Opium.  Coma, stertorous breathing.
  Hyos.  Coma-vigil, or loquacious delirium.
  Tcrel).   Tympanites, and haemorrhage of bowels.
  " Well-nigh specific for tympanites." Hughes.
  Bell.  Great cerebral congestion and furious delirium.
  Arnica.   Low condition, with involuntary discharges.
  Ant. tart.  Pneumo-typhus, with great rattling in chest.
and dyspnoea.
  Phos. Pneumo-typhus, with  violent bronchitis, hepati-
zation, hypostasis and laryngitis.
  "' Unsurpassed by any other medicine."  Baehr.
              GEXEUAL  JIEAS5RES.

  Sick-room.  Let  it  be a  large,  well-ventilated,  upper
room with open fire-place, if  possible.  Make free  use of
disinfectants, and look well to sewer-pipes, or other sources
of impure air.   Immediately remove all  soiled clothing,
and immerse in chlorine water, and boil within twenty-four
hours; all other  articles should be burned.  Receive all dis-
charges into porcelain bed-pan, and cover immediately with
solution sulphate-of-iron.   As soon as vessel is removed
from  patient, cover with an old  cloth, to  prevent exhala-
tions from escaping into room, and immediately
  Dispose of Discharge*, in the country,  by emptying
bedpan into a freshly-dug holefar-remored from a privy
or well, and  cover with dry earth.  If in  the city,  empty 
 8           KEY NOTES OF MEDICAL PRACTICE.

 into a water-closet, which must be used for no other purpose.
 At frequent intervals flush this closet with large quantities
 of solution  of sulphate-of-iron.
   Bed.  If  possible have two beds, and night and  morn-
 ing change  the patient, airing one  while using the  other.
 Avoid use of feather-beds—too soft a mattress favors bed-
 sores; hair  mattress  best.   Cover  mattress with rubber-
 cloth, place over this  the sheet, and a small "draw-sheet"
 under the hips.  Let the pillows be small, rather hard, and
 so arranged as to support shoulders and expand the chest.
   Nursing.  See to it that the nurse gives the patient suf-
 ficient drink to slake thirst.  Often when  the patient  is
 delirious or comatose, this  is  neglected.  Have the  hordes
 washed from  lips, teeth and tongue  with a soft  cloth,
 moistened  in  lemon-water, as  often  as it accumulates, j
 Examine the back and hips daily  for redness.  If it  occur,
 have the spot washed four times daily in alcohol and  water,
 dry  thoroughly,  dust  with  powder,  and use air-cushions.
 Do not permit the patient to stand up, or in any way exert
 himself.
   Bathing.  Sponge  the entire  body several times daily
 with tepid water.  If the temperature rise to  103  in  axilla,
 put  patient in warm bath, 80  to  90% gradually lower tem-
 perature of bath by cold water  till  desired  effect is pro-
 duced. May have to go to 60  , but not lower.  If tempera-\!
 ture fall rapidly remove patient; if slowly, wait till temper- ;
 ature in axilla reaches 101  .   Do not use bath  later than
 second week.   Cold pack answers same purpose.  Spread a
 comfort on bed, over this, blankets, over  these  a sheet I
 wrung out of cold water.  Lay patient  on the sheet, wrap
 him in it, then fold over him the  free edges of the blankets
 and  comfort, making all snug.  Leave him till sheet becomes
 warm.  This is very efficient method of  reducing tempera-
 ture.
   Diet.   Highly  important.  Exclusive milk  diet best. I
 Regularly ever}' two hours give patient a glass of milk, or I
 its equivalent  at convenient  intervals.   If milk disagree, I
 try it with  lime-water, scalded, iced, or  otherwise vary the I
 method of administration until a  form  is found which the
 patient can take  and digest.  Let the  patient draw the
 milk through a bent glass tube.  If  for any reason patient j
 cannot take milk, give other food, being  careful to have it "
fluid in form, easy of digestion, and highly nutritious.  ^In
 early days  give  beef-broth,  mutton-broth, chicken-br^B
 later, food which is stimulating as well as nourishing—bJe"f
 tea, wine-whey, cafe-au-lait, or egg and  coffee; again come '
 back to broths and gruels after  period of depression ias
 passed.  Vary diet to suit caprice of patient.   But remem-
 ber  that the milk-diet is superior to all others, and need
 not be departed from if it agree with the patient.         I 
TYPHI'S FEVER.                    (J
   Examining Patient.  Notice particularly at each visit-
 pulse, nature of heart-beat;state of abdomen; temperature;
 number and character of discharges; respiration, and state
 of lungs.
   Convalescence.   Especial care  demanded  during  this
 period.  Avoid use of vegetables.   Xo solid food must  be
 taken  until stools are consistent and feral.  The slightest
 emir in diet may ccite a. relapse.

                   TYPHIS  FKVER.

   S V X( > N YM S :  Ship Fever: J a it Fever.

   PROGNOSIS.   Always  grave.   Unfavorable:   High
 temperature;  frequent  pulse;  early furious delirium,  or
 early stupor: previous debility; in alcoholists usually fatal.
   Favorable:  Youth;  moderate temperature  and  pulse,
 and mild nervous symptoms.
   COMPLICATIONS.   Pneumonia and swollen parotid
 glands most common.
   CAUSES  OF DEA.TH.   May  result  from  meningitis;
 pneumonia:  capillary bronchitis;  gangrene; asthenia and
 paralysis of  the heart; nephritis.

               I,EAI>I\<»  R Ell ED IK*.

   Baptisia.   Early stage, with high fever and intense char-
 acter of the onset.
   Phosphoric acid.   Great nervous depression, with but
 sliglit febrile excitement or signs of blood poisoning.  Com-
 plete apathy and indifference; quiet delirium,  with stupe-
 faction,  deafness, dulJ, staring look, epistaxis; distention  of
 abdomen,  with rumbling and gurgling; watery, grayish
 diarrhoea; thick, cloudy urine; profuse perspiration.  Pulse
 weak, small, frequent, intermitting.
   Phosphorus.  For a still lou-er grade of nervous depres-
sion.   Eyes hollow and sunken, frequent and copious epis-
taxis,  dryness of mouth, gums stand off from teeth,  and
bleed easily, vomiting of watery, bilious, or slimy masses;
loud  rumbling  and  meteorism  of  abdomen;  grayish  or
black discharges, from decomposed blood; roseola spots,  or
echymoses.   Also  in pneumonic complication, the chief
remedy.
  ** May save life at the utmost extremity.''  Hughes.
  Arsenicum.  Intense febrile  toxa-mia.  Great  restless-
ness and anxiety, tongue black, dry and hard, speech unin-
telligible, excessive thirst, meteorism, involuntary  ttools
and urine,  discharges  brown, watery, foul; haemorrhage
from  bowels,  cold, clammy perspiration and decubitus.
Also for  kidney complications, with suppression of  urine. 
10
KEY NOTES OF MEDICAL PRACTICE.
  Opium.  Stupor or coma.
  Merc, hiniod.. Rhus.   Parotitis.
  Rhus. Mur. acid.  For milder forms of febrile toxaemia..
  Bell.   Headache, cerebral congestion  and  active deli-
rium.                                                     ,
  Strain.  Delirium so  furious as to  threaten patients
exhaustion.

  GENERAL MEASURES.  Typhus being highly con-
tagious, strictly quarantine the patient, and  observe  all
antiseptic  precautions.   Give abundance  of  fresh  air;;
remove all windows, regardless of  cold, and keep  patient,
well protected with blankets.  Guard against bed-sores.   In
noisy  streets, stuff  ears  with cotton.  If temperature  rise
to over 104% put  patient in bath  ten degrees below tem-
perature of body,  and gradually reduce  temp,  of water to
70% till  bodily temp,  falls  to 101:  or 102 \   If  heart's
action weak,  much prostration and feeble circulation, givd
occasional dose of brandy—not more  than one ounce in 24|
hours.                                             •
   Diet.  Of  greatest importance to aid nutrition.  Begin
early, and give small quantities very nutritious food regu-
larly and persistently.  Milk is the best.   Also  use beef-tea
and broths.  If necessary, support by nutrient enemata. ;^
DIFFERENTIAL  DIACiXOSIS.
         TYPHOID.

          ENDEMIC.

  Advent insidious, with general
malaise, headache, chill rare, sev-
eral days before patient takes to
bed.
  roup: little rise at onset; max-
imum about 7th day. Exacerbates.

  Eruption, lenticular spot *. bright
rose color.  Successive crops.  Ab-
domen.

  Delirium appears late; low mut-
tering.
  Countenance, pale, olive, leaden.

  Emaciation great.
  Botvels: Tympanites, and " pea-
soup " diarrhcea.
  Duration 21 to 40 days.
  Terminates by lysis.
TYPHUS.
EPIDEMIC.
  Advent, sudden,  with into
chill,  steadily  increasing  head-
ache with great prostration.

  Temp.:  2nd day, 104°; 105° to
I073 on the 3d day; remains high
to end.
  Eruption, small,  slightly ele-
vated, called  " mulberry nto."
Remains   throughout  diseaH£
Sides of chest and extremities.
  Delirium active trom first.

  Countenance, dull, heavy—lal
mahogany color.
  Emaciation slight.
  Bowels: Constipated;  no ty»
panites.
  Duration, 14 days.
  Terminates by crisis. 
                 CEREBROSPINAL FEVER.               U

              CEREBRO-SPIXAL  FEVER.

   SYNONYMS:  Spotted Fever; C.-S. Meningitis.

   PROGNOSIS.  Grave.  Unfavorable:  Extensive  haem-
 orrhage into cutis, with marked signs of vital prostration.
 More fatal among infants and young children, than youths
 and  adults.   Continued  rapidity of  pulse  unfavorable.
 Favorable:  cessation of headache; free perspiration.
   COMPLICATIONS:   Pneumonia; nephritis; oedema and
 congestion of lungs.
   CAUSES  OF DEATH.   Asphyxia,  from  lesion in res-
 piratory nerve-centre; asthenia; oedema of lungs ;necraemia.

                LEADIXG REMEDIES.

   Gelsemium.  Early in the attack.   Fever, great languor
 and  drowsiness, obscuration of sight, vertigo, respiration
 slow and  sighing, pulse soft and feeble, complete loss  of
 muscular  power.
    In my hands this has been one of the most efficient remedies.
   Yerat.  vir.   Severe frontal headache, violent vomiting,
 pain  in stomach, convulsions, retraction of head, opistho-
 tonos, rolling of eyes, dilated  pupils, pulse labored, slow
 and irregular.
   " Used with great success in many undoubted cases."  Hale.
   Belladonna.   Violent  headache, drowsiness, delirium,
 cutaneous hyperaesthesia, face red and bloated, boring of
 head into pillow, spasmodic distortion of face, grinding of
 teeth, cold extremities.
   ('icuta.  Dilated pupils, staring look, jerking of eyeballs
 and muscles of face, arms and hands, deafness, pale face,
 head retracted, rigid spine, dysphagia, insensibility.
   l>Is considered by many to be  nearly a specific in this disease."
 Lilienthal.
   Hydrocyanic acid.  Fulminant cases.  Patient stricken
 down suddenly, loss of  consciousness, dyspnoea, gasping,
 small pulse, purple  face, tonic  spasms, low moaning, flut-
 tering pulse.
   Hy»>s.  Delirium and convulsions.
   Opium.  Face  bloated, eyes fixed, half-closed lids, deep,
 slow breathing.
'   Actea.  Spasms  continue after acute symptoms have
 subsided.
   Arsenicum.  Septic symptoms, foul discharges from the
" bowels,  signs of decomposition of blood, petechia?.
   Rhus. Bry.  Typhoid-like state, low fever, etc.

   GENERAL MEASURES.   Most  important to get up
"free diaphoresis early.   Put patient into a hot bath—104 -
 106 —for a short time, then wrap in warm blankets until 
12         KEY NOTES  OF MEDICAL PRACTICE.

free perspiration is induced.  Repeat if skin again becomes
dry and hot.   Ice-bag to head.
  Diet. Give concentrated liquid food freely,—milk, beef-
tea, broths.  Nourish by enemata, if patient cannot  take*'
food by the mouth.
  Look to state of sewage  and drainage, and provide for ,
good  ventilation of  the dwelling.   Observe great  care
during convalescence; relapses generally fatal.

           SIMPLE COXTIM'EIt  FEVER.

  SYNONWM:  Gastric fever.

  PROGNOSIS.  In absence of  complications, always >
favorable.

  Baptisia.  Chilliness, fever, violent headache, great lan-
guor, loss of appetite, great thirst, thick, white coaling on
tongue, nausea, vomiting, epigastrium and abdomen sensi- '
five, constipation, with later diarrhoea.
  "Baptisia is a true specific. Defervc-cence and crisis will follow its
use in a very short time." Hughes.
  Arsenicum.  Later  in disease, the  tongue   dry  and
brownish,  abdomen  distended, great  thirst,  prostration.
restlessness, diarrhcea, burning pains in stomach, pale face, J
cold extremities.
  Bryonia.  Vertigo, nausea  and faintness on sitting  up,
fullness in forehead, as if everything would be pressed out,
splitting headache, lips parched, dry  and cracked, tongue
coated, constipation; great irritability.
  Mercurins.   Pale, yellow,  earthy color of face, tongue
thick, yellow coating, fetid  breath, gums swollen, profuse
secretion of saliva, region of stomach sore  to touch,  dark-
red urine, diarrhoea.                                    A
  Ant. tart.   Empty   or  putrid eructations,  constant j
nausea and inclination to vomit, loss of appetite, loathing
of food, great secretion of mucus, apathetic state, exces-
sive debility and prostration, alternate  mucous  diarrhea^
and constipation.                                      A
  CONSULT—Nux v., Puis., Tris, Ipec.

  GENERAL MEASURES.  Plain and simple food must
be given, as every error in diet is apt to cause a relapse.
              ERUPTIVE  FEVERS.

  The Eruptive  Fevers are  distinguished by  a  high
degree of contagion, a period of incubation, intense feTB?
a characteristic eruption, and immunity after one attaAl 
ERUPTIVE FEVERS.
13
                   SCARLET FEVER.

    S YNON YM:   Scarlatina.
    PROGNOSIS.  Depends upon character  of  prevailing
  epidemic.  In severe cases, always uncertain.  Unfavorable:
  Temperature of 105 -f;  dyspnoea; cold surface; livid hue of
  eruption;  suppurative pharyngitis; persistent  vomiting;
  complete suppression, of urine.  Also bad in the very young,
  in organic disease, and if complicated.
                LEADIXG  REMEDIES*.
    Sc. Simplex.  Ac. Bell.. Rhus.
    Sc. Allginosa.  Apis., Merc. iod.. Amm. Carb.. Ac _!/?<>•.,
  Lach.
    Sc. Maligna.  Ailanth., Ars.. Ac. Mur., Cup. Acet., Rhus.
    Aconite.  Has  a  limited  use  early, to subdue arterial
  excitement.
   Belladonna.  In sthenic form, the eruption smooth and
  shining, with great vascular and nervous excitement.  Con-
  gestion of brain  and delirium, throbbing of carotids, eyes
  injected, face fiery red, tongue white, with red edges, or red.
 with  raised  papilla?;  fauces and  tonsils  inflamed  and
  swollen;  external swelling of  neck.  Of  no benefit  in
 adynamic cases.
   Rhus.   Scarlatina  simplex, when eruption is miliary.
 the rash being interspersed with fine red points, and some-
 times fine vesicles.   Also, in the  adynamic form,  erup-
 tion dark, eyes  swimming, tongue dark brown and dry. lips
 and teeth covered  with sorde-s drowsiness, low, muttering
 delirium, epistaxis, swollen  parotids, and  thin, offensive
 discharges  from bowels.
  I have used Rhus in these cases with great success.
   Apis.  Fever of low type.  Tongue deep-red and covered
 with  blisters, tonsils cedematous, swollen and ulcerated,
 abdomen sore to touch, slimy  and bloody discharges  from
 bowels, urine scanty  and dark-red,  micturition  frequent
 and painful, loss of consciousness,  delirium,  sopor.  Also
 for cedema  and  dropsy.
  Amnion,  carb.   Swelling  of  parotid and  lymphatic
 glands of neck, throat dark-red, with tendency to gangre-
 nous ulceration.
  Merc. iod.   Much glandular swelling, with  stiffness and
 pain, salivation, fetor  of  breath, rapid, and great  prostra-
 tien. commencing ulceration of throat.
  Ailanth us.  Malignant cases, the patient being suddenly
 taken with violent vomiting,  severe  headache, intolerance
of light, hot, dark-red face, rapid, small pulse, high temper-
ature, drowsiness, muttering delirium, dark, livid, miliary-
rash, in patches.
  "Directly specific, ami of eminent value."  Dr. Madden. 
14         KEY NOTES OF MEDICAL  PRACTICE.

  Arsenicum.   The  eruption  grows  suddenly pale,  skin
cold,  small pulse, rapid prostration, putrid sore-throat,
great restlessness, dyspnoea; fetid, involuntary discharges^
from  the bowels.
  Cuprum acet.   Sudden  retrocession  of eruption, fol-
lowed by vomiting, convulsions, rolling of eyes, distortion  *
of face, sopor and delirium, signs of metastasis to brain.
  " Employed with gratifying success."  Dr. Drummond.
  Muriatic acid.   Malignant cases.   Severe ulceration of
throat, fetid breath, acrid discharges from nose,  soreness  \
and  vesicles about nose and mouth, eruption faint and
livid,  flushed cheeks, eyes dull red.
  Lachesis.  Throat swollen,  ulcerated,  livid, great fetor
of breath, the system seeming to be re-inoculated  from the  ,
ulcerated sore-throat, with general prostration, quick, fee-  !
ble pulse, low, muttering  delirium, and jactitation.
  " It has never disappointed me." Hughes.
  Cuprum acet.  Retrocession  of eruption;  quick, small,  '
irregular  pulse, low  temperature, sopor, rolling  of eyes,
facial distortion, spasm of various muscles, cold face, blue
lips, convulsions.
  Retrocession of eruption.—Ars., Cup. acet., Camph.
  When the fever  degenerates into a  low, typhoid-like con-   i
dition.— Rhus,  Ars., Lach.
  Stage of desquamation.—Ars., Sulph.
  Nephritis and dropsy.—Ars., Apis, Tereb.
  Discharges from ears.— Ac.  mur., Hep.-s., Sil., Graph.,  .'
Merc. dulc.
   Discharge from nose.—Ac. mur., Aur., Ars.
   Inflammation of eyes.—Aeon., Sulph.
   Glandular Swellings.—Rhus, Lach., Merc.                I

   GENERAL MEASURES.  Quarantine patient, and re-  |
move other children.  Put patient in an upper room, large,
well-vent Hated, and free  from upholstered  furniture and
drapings.   Use  all antiseptic precautions with  clothing,  J
utensils, and discharges.   Sponging  body frequently with  jj
tepid water moderates fever, allays restlessness and favors  |
sleep.  Promote free action of skin.   Watch state of urine,   ]
and  anticipate kidney complication.  Use caution  until
recovery is fully established.                              j
   Diet.  Light  and  nutritious.   Milk,  broths, gruels,  J
toast, etc.   Drinking large  quantities  of  water favors  J
action of kidneys. Jn low cases feed as in typhoid.        I

                       MEASLES.

   SYNONYMS:  Morbilli; Rubeola.

   PROGNOSIS.  If uncomplicated, favorable.           J
   Unfavorable:—In   tuberculous subjects, and  cachectidl 
MEASLES.
15
 constitutions;  black-measles;  complicated  by  epistaxis,
 diphtheria, capillary bronchitis, or broncho-pneumonia.

                UEADIXG REMEDIES.

   Aconite.  High temperature and other febrile symptoms
 —hot skin, red eyes, intolerance of light, general malaise.
 In simple cases, the only remedy required.
   Pulsatilla.   Eyes red  and  watery,  sensitive to  light,
 thick, yellow discharge from nose, dry mouth,  no thirst,
 loose cough, rumbling in bowels, and diarrhoea.
   "Of hi^h repute for the diarrhcea." Hughes.
   Euphrasia.   Streaming  of  hot, burning tears  from  the
 eyes, with great photophobia: profuse running  from  the
 nose, without burning.
   "Invaluable for the nasal and conjunctival catarrh."  Hughes.
   Bryonia.  Eruption retarded, or retrocession of  erup-
 tion, with oppression  of  chest and  laborious breathing.
 Dry cough, with shooting pains in chest.
   "Remarkably successful in bronchitis." Jousset.
   Ipecac.  Eruption retarded  or suppressed, with  nausea
 or vomiting, and rattling of mucus in the chest.  Will gen-
 erally stop the epistaxis.
   Verat. vir.   Convulsions before the eruption.   Conges-
 tion of lungs during febrile stage.
   Arsenicum.  Adynamic and malignant cases.  Burning
 heat of skin, quick, small pulse, great anxiety, restlessness,
 sudden retrocession of rash, pale, bloated  face, great sink-
 ing of strength.
   Camphor.  Rubeola Fulminans.  Face grows  suddenly
 pale, skin cold and purple,  stiffness of body, utter prostra-
 tion and collapse.  Give drop doses, frequently repeated.

                NPKCIAL REMEDSEW.
   Phos.  Bronchitis or pneumonia.
   Rhus.   Low fever, dry, brown tongue.
   Kali hi.  The hoarse, laryngeal cough.
   Cupr. acet.   Retrocedent, affecting brain.
   Bell.  Cerebral congestion or sore throat.
   Sulph.  To promote recovery;  strumous subjects.
   Merc.  Glandular swelling, ulcerations, dysentery.

   GENERAL MEASURES.   Quarantine patient. Room
 well ventilated, with even  temperature.   Darken room
 while eyes are sensitive.  To relieve itching and burning of
 skin,  cool water  spongings.   Warm  bath to bring out
 delayed eruptions.  If temperature rise to 103 '-104'% reduce
by cool sponge-baths.   Protect patient against cold air and
sudden  changes of temperature, and keep chest well pro-
tected.  Diet of milk and broths. 
KEY  NOTES OF MEDICAL PRACTICE.
                     SMALL-POX.

  SYNONYMS:  Variola;  Varioloid.
  PROGNOSIS.  Depends  on  type of disease.  In  V.
discreta, uncomplicated, favorable   In V. eonflucntes, grave
Unfavorable:—lathe intemperate; syphilitic; extremes of
life (recovery rare after (50); lung complications; inflamma-
tion oi skin between pustules; epistaxis and other hwmor-
rhao-es: scanty  urine  early:   intense  secondary fever,
between ninth and twelfth days.  In  V.  hemorrhagica
recovery rare.
  CAUSES  OF  DEATH. - -(Edema  glottidis;   general
bronchitis;  pneumonia:  acute  fatty  degeneration  of
kidneys; asthenia.
               LEAI>IA(>  REMEDIES.
  Variola Discbeta.  Bell., Ant. tart., Sutyh.
  Variola Confluentks.  Sulph., Ars., F'hos.
  Yabiola Hozmobbhagica.   Phos., Ars., Lach.
  Ant. tart.  One of  the most useful remedies; it reduces
the fever, the  pustules run their normal course.  It is also
especially  useful  in  pulmonary  complications,  and  for
gastric disturbances.  Given early it mitigates the severity
of the disease.
  Belladonna.  High fever, severe local symptoms, throb-
bing  carotids, injected eyes,  photophobia, sore  throat,
severe  pain  in  back, starting  and  jumping  in  sleep,
delirium.
  Mercnrius.   Maturation impending,  and suppurative
fever rising.  Moist, swollen tongue, ulcerated throat, fetid
breath, profuse flow of saliva.   Dysenteric discharges from
bowels.
  Arsenicum.  Ha-morrhagic variola.  Eruption dark, skin
blue  or livid, great sinking of strength,  small,  frequent
pulse, extreme thirst, anguish and restlessness.
   Act fa.  Early stage: severe pain in back and eyes, head-
ache, sore, bruised pain all over, exhaustion, nausea.
  Hydrastis.  Great redness, swelling and itching  of  the
skin' with very  sore  throat.  Intense aching in  small of
back  and legs.  Especially  useful when ulcers occur on
 mucous membrane of mouth and fauces.
   Sulphur.  Disease pursues an  irregular course, pustule
 become purple or black.  Also  for period of dessication.

                SPECIAL REMEDIES.

    Pneumonia.  Ant. tart., Phos.
   Glandular Swellings.   Merc. iod.
    Low. Typhoid State.   Bapt., Ars.
   Congestion of Lungs.   Verat. vir., Aeon., Bry. 
SMALL-POX.                    17
   Hoi Is.  Hep. s., Sulph., Phos.
   Ophthalmia.  Merc, corr., Sulph.
   Delirium.  Bell., Strain., Verat. v.
   Dropsical Swellings.   Apis., Ars.
   Repercussion of Lruption.  Can^h., Ars.. Sulph.

   GENERAL MEASURES.   Complete  isolation.  Vac-
cinate patient, if this had never been done.  Free  ventila-
tion of apartment highly important.  Should be attended
by one who has already suffered from the disease.  Cleanli-
ness and  disinfection  of  strictest  kind.  In  cold weather,
keep patient well covered, fire in room, but windows wide
open.  Guard against  bed-sores.  Give patient frequent
sponge-baths.   Do  not injure pustules.  Let adults wear
loose gloves, and bind the hands of children, to prevent
scratching.   To prevent pitting, keep  patient in dark
room, protect pustules from injury, and keep each one well
anointed  with  Vaseline  and flour, made  into a  paste.
Cold water compresses to face and  hands often allay  the
burning pain.   If ulcers in mouth and throat, let  patient
take bits of ice. and use mild Hydrastis gargle.
   Clothing.  After the  attack, destroy  all  clothing, and
fumigate  room.
   Diet.  From beginning, give sustaining diet of  milk,
eggs,  animal broths, oysters, and  beef-tea  every  three
hours.  Fresh, ripe fruits allowable if bowels not affected.
For drink, give iced milk, or if this does not agree, lemon-
ade, or raspberry-vinegar water.

                    vaccination.

   Caution.  Be sure to use  only a  pure article  of  bovine
virus.  Keep in cool place in a tightly-corked vial.
   Scrape the skin in three places  till true skin is reached
and  ready  to  bleed, but  without  any flow  of   blood.
Moisten  the virus, and rub  it  well over the raw surfaces.
Or.  make several  slight horizontal and  transverse cuts.
crossing each other, and rub the virus over these.   Let it
thoroughly dry, or, put piece of plaster over.  If the vac-
cination '' takes "—
Hr<l day.—Papule appears.          loth day.—Areola begins  to fade.
Gfli day,.—Vesicle,  with  central    lift day.—A  brown,  mahogany
        depression.                     crust has formed.
8th day.—Vesicle  distended with    2:inl day.—Crust  becomes  de-
        lymph,  and  has wide,             tached.
        red areola.
  The fever which sometimes accompanies may be met by
Belladonna.
  Vaccination  should be performed at least twice — in
infancy and at the age of puberty.  Also, whenever expos-
ure is liable to occur. 
DIFFERENTIAL   1>I Y<« "VOSIS.
             MEASLES.
Incubation 7-14 days.
           SCARLET FEYER.
  Incubation 1 day to seven weeks -average
4-7 days.
  iYitf/i'.s'.--Incubation, invasion,  eruption, |   Stages.—Premonitory,  eruijtion,  desqua-
dcsquamation.                             , mation.
  Innisitiii:  Headache, vomitiug, malaise, \   Invasion.--Chill, coryza, headache, lassl-
sore-throat.                               ] tude, cough, fever.
  Fever. — Temperature  may  reach 105°- ;   Fever.—Temperature may reach  105° —
107', with great heat of  skin and frequent ] falls after eruption.
pulse; fever higher during eruption.
  Cerebral symptoms frequent and grave.

  Eruption appears first on neck and chest,
 24  hours after invasion;  spreads rapidly.
 Color, bright rose, or deep red.   Finger nail
 drawn over makes while streak lasting sev-
 9ral minutes.
  De.-qiiaiiKition, — Largo  patches- espec-
 ially from hands and feet; itching.
  Tongue.—" Strawberry."
  Fade flushed, dry, red.
  Emaciation slight.
  Duration 21-28 days.
  Crisis about 14th day.,
  Sequela'.--Nephritis; dropsy;  otitis; oph-
thalmia; glandular enlargements.
   Cerebral Symptoms usually absent.

1   Eruption.- On 4th  day appears  first  on
 face;  sp"eads gradually; color,  rose-red  or
 rwihogany;  is  rough; may  be  confluent,
 crescentic and  papular.  Line made by fm-
| gernail disappears quickly.
   Desquamation.--Bran-like, mealy odor.

   Tongue coated, witli red edges.
   Face.—Suffused  and watery eyes.
   Emaciation, not marked.
   Duration 14-21 days. ■
   Crisis—none.
   Sequela-.—Chronic  bronchitis;  otorrlnea;
 ophthalmia; phthisis.
              SMALL-POX.
  Incubation  5-20 days—average,  10 days.

  Stages.—Incubation,  eruption,  suppura-
tion, desiccation.'
  Invasion.—Chilliness, Severe pain in back
and head.
  Fever. -Temperature of 106°, with bound-
ing pulse,  pain in head  and  back -relief
fr< im eruption.  Secondary fever—very high
on 8th day—and falls slowly.
  Cerebral  Symptom*—frequent—delirium
about 3rd day.  Convulsions in children.
  Eruption.—On 3rd or 4th day appears first
at- edge  of hair, lips, palate  or fauces.
First  macule, then reside,  pustule, which
may slough,  and  leave  cicatrix,  or  form
scab.
  Desquamation. — Scabs, crusts and thick
scale.-; violent itching.
  Tongue coated,  swollen, with red edges.
  Face flushed, anxious; photophobia.
  Emaciation great.
  Duration 4-5 weeks.
  Crisis about 21st day.
  Sequela:.- ■Chronic diarrhiea; abscesses;
glandular  enlargements; various  diseases
of eyeball and eyelids. 
                 INTERMITTENT FEVER.              19

                      DENCCE.

  SYNONYM:   "Break-bone Fever."

  PROGNOSIS.   Favorable, except  in  the  aged,  and
in feeble infants.

  LEADING REMEDIES.  Gels.,  Bry.,  Eup.,  Rhus,
Actea, Ars.
            PERIODICAL  FEVERS.

  Periodical  Fevers  are  marked by  intervals in the
course of the disease  during which the patient  is almost
or quite free from fever.

             INTERMITTENT  FEVER.

  SYNONY3I:  kgue.

               LEAI)I\(;  REMEDIES.

  Cinchona. Recent  cases. Paroxysm- preceded  by  head-
ache, hunger, palpitation.   Each stage well-marked—first
the chill, which is severe, and the principal feature of the
attack, with violent shivering  and aching pains; then the
fever, followed  by violent thirst  and sweat which is some-
times profuse and exhausting.  Apyrexia:—Patient suffers
but little—feels almost in ordinary health.
  Dose.—First  decimal, or centesimal, trituration, two or
three grains every three or  four hours in  apyrexia.—
Hughes, Baehr,  Panel/i, Jousset.
  "Undoubtedly the most important remedy." Baehr.
  Arsenicum.  Attack preceded  by weariness, approaching
prostration.   Paroxysm  imperfectly developed.   Before
chill, vertigo, headache, yawning,  stretching, and general
sense of  discomfort.    Chill  and  heat  intermingled;
oppressed breathing,  nausea, sometimes  vomiting; small,
feeble pulse, even during hot stage.  One of  the stages
often absent—sometimes  the sweat, but  usually the  chill.
Tendency to increase in the severity  of  the  paroxysms,
and rapid and excessive prostration.  Urgent thirst through-
out.  Apyrexia:—Prostration, nausea, pains  in  stomach
and bowels,  dropsical swellings.
  Ipecacuanha.  Backache, short chill, long fever.  Nau-
sea, vomiting,  and other gastric  disturbances, occurring
before and during chill and heat;  tongue thickly coated
with  yellowish, moist  fur;  great oppression of   chest.
Nausea and vomiting predominate. Apyrexia:—More or less
gastric disturbance.
  '• Useful in mild forms of tertian."  Baehr. 
 20         KEY NOTES OF MEDICAL PRACTICE.

  Nux v.  Chill, long-lasting and hard, fever severe, sweat
 profuse; both chill and fever accompanied by nmch gastric
 and bilious disturbance.   Distressing  pains in  head, back,  -
 and legs.  During chill  external warmth  aggravates  and
 causes shivering.
  " Nux, in alternation with Ipec, for impure  intermittents in  non-
 aguish districts."  Hughes.
  Natr. mur.30  Chill beginning  in feet or small of back;
 blue nails, thirst, bursting headache, relieved by sweating.
 Bilious chill.  Bilious vomiting before and during chill.
 For severe cases   Dose:—" I am compelled to declare my-
 self for the higher  dilutions."  Dr.  Watzke.
  " One of the most powerful remedies."  Mitchell.
  Eupator. pert'.   Thirst several  hours before chill,  con-
 tinuing during chill and  heat.  Chill short, hot stage  pro-
 tracted, and sweat slight.  Vomiting of bile at end of chill.
 During chill  and heat back aches violently, as if it woxdd  1
 break.                                                    J
  Veratrum  all).   Predominance  of external coldness; m
 cold, clammy  perspiration; great thirst, especially during
 chill and sweating.   Great  exhaustion  and  sinking of
 strength. Vomiting and  diarrhcea, with griping, and pain
 in back and loins.
  "Indicated in the most pernicious kinds."  Raue.
  Phos. ac.  Profuse sweat.
  Gels.  Severe nervous symptoms.
  Aeon.  Recent cases in plethoric  subjects.
  Cedron.   Chills recur with marked regularity.
  !;rn.   Chill  relieved by external  warmth.  Thirst only
 after paroxysm.
  (zaps.  The sweat  coincides  with  the  heat instead of
 following it.
  Pnls.  Gastric symptoms  and  resulting chlorosis  and
hydraemia.
  Hydrastis.   Cachectic  subjects  with hepatic and gastric
symptoms.
  Ars.. Ipec. Ccdr.. Sulph.. for dumb-ague.
  Chinoidine will often cure when Quin. sulph. fails.

  GENERAL  MEASURES.   During  paroxysm, give
Aeon,  to mitigate severity.  Apply artificial heat daring
chills, cooling drinks during hot stage, and warm, dry linen 1
after sweat.                                              . |
  In malarial  districts, avoid  out-door air  after  sundown:
sleep in upper room.

                REMITTENT  FEVER.

  SYNONYM:  Bilious Fever;  Typho-malarial Fever.     \
  PROGNOSIS.   Favorable.
i 
PERNICIOUS AGUE.
L'l
                LEADIX4* REMEDIES.

   Belladonna.  For initiatory fever.  Severe  chill,  with
 vomiting and retching, violent fever, which is  especially
 high at night.
   Gelseminm.   Congestion of head, flushed face, chilliness.
 languor,  great muscular  weakness, pulse full, quick and
 soft; dull pain in head, back and limbs.
   China.  Great prostration, fluctuating pulse,  humming
 in the ears: marked remission.
   Ipecacuanha.  Gastric disturbance, headache, yellow or
 white coated  tongue,  bitter taste, vomiting and  continued
 nausea.
   Mercnrius.  Thick, yellow, pasty coating  on  tongue,
 earthy color of face, bitter taste, soreness in liver.
   " Applicable during greater part of disease." Baehr.
   Bryonia.   Pressive or tearing  pains  in chest, better
 When at rest.   Thin coating on tongue, bitter taste, consti
 pation.   Distinctly marked febrile motion,
   Pulsatilla.  Whitish  coating on  tongue,  bitter  eructa-
 tions, bitter vomiting; chilliness:  thirstlessness.
   Rhus.  Fever degenerates into a low, typhoid state, with
 adynamia, diarrhcea. tongue brown and dry, sordes on lips,
 teeth and tongue.
   Arsenicum.   Great emaciation, prostration and  restless-
 ness, with intense thirst; dark, fetid discharges from the
 bowels.

   GENERAL 3IKASLRES. Sometimes degenerates into
 low  " typhoid " condition, when nursing and diet should be
 similar to that recommended for Enteric Fever.

                 PERNICIOUS   AGl'E.

   SYNC )NV.M:  " < 'ongestive Chili:'

  VARIETIES :-Cerebral { Hto{£ Gastroenteric  } j^

   PROGNOSIS.  Grave.   Recovery  rare  if  more  than
 two  paroxysms occur.
  " I have never lost a patient except where there has been an evident
 heart affection — a fatty condition or dilatation—or where an organic
 brain lesion has  occurred during the first chill." J. P. Dake.
   TREATMENT.  Must be prompt and vigorous.  Bring
 about re-action as soon as possible.  In cold stage, heat to
 surface, with  stimulants.  When cerebral congestion, cold
 affusions to head.

               LEADIXG  REMEDIES.
   Arsenicum.  Cold, clammy sweat, breath cold, eyes sunk
in sockets, Hippocratic countenance, great prostration, with
great anguish, thirst and restlessness. 
22          KEY NOTES OF MEDICAL PRACTICE.

  Veratrnm vir.  Intense cerebral congestion; delirium:
face  purple; violent throbbing of  carotids;  pulse full,
hard, and bounding.
  '• Especially when the congestion involves the brain, and the chill has
been severe and profound.*' J. F. Dake.
  Gclsemium.  Burning  heat of the surface, great sensi-
tiveness to light  and  sound;  delirium; predominance  of
nervous symptoms, with great muscular weakness.
  " When brain and spinal cord  are botli pressed, and heart's action
irregular."  J. P. Dake.
  Quia, sulph.   Must be   freely  given  to  bring  about
reaction.   Give grs. v. every  two hours, or grs. iij every
hour, till signs of reaction appear, then grs. ij every three
hours till the time for another paroxysm is past.  Capsicum
ann.,  one-fourth  part, may  be  advantageously combined
with the Quinia.
  If dose cannot be given by stomach, administer subcu-
taneous ly                                                *
                     Lente's Solution
  IJ1.   Bisulphate of quinine...............50 grains,
       Dilute sulphuric acid,...............  1 drachm,
       Carbolic acid, liq.,..................  5 minims,
       Water, to make,....................  1 ounce.
  Dissolve the bi-sulphate in  the sulphuric acid and water,
by the  aid of heat; filter, and add the carbolic acid.   Ten
drops contain one grain of  the bi-sulphate.
  " Subcutaneous injection is the quickest and most powerful means of
bringing the patient under the influence of quinine."  Bartholow.

              Solution of  Sulphate of Quinine.
  R1.   Sulphate of quinine.............. .30 grains,
       Sulphuric acid, dilute,.............   sufficient,
       Water,...........................  2 ounces.  Mix.
  Give  in syrup of  licorice.
  " Quinine is called for in some cases—perhaps at some stage in all
cases—and no other remedy can take its place." J. P. Dake.
  " The prompt and energetic administration of Quinine is impera-
tively demanded."  L. A. Fallijant.
  " My treatment is Quinine, Quinine, Quinine."  IP. H. Holcombe.
  "Quinine is the remedy par excellence.'1''  A. Charge.

  GENERAL MEAKCRES. During the congestive chill,
use  free,  hot  foot-baths and  mustard draughts to the
extremities, to  divert  the circulation.   If intense conges-
tion of  the head, use cold affusions—but do not use them
if face  be pale.  If  there  be great prostration, profuse,  cold
perspiration, cold breath, give stimulants—feed the patient
with brandy or whisky, mixed  with finely-pounded ice  if
there be great thirst.
  " Remissions grently promoted by free and frequent use of hot mus-
tard foot-bath.  Prostration and exhausting sweat demand stimulant* "
—Falligant. 
YELLOW FEVER.
23
                   YELLOW FEVER.

   SYNONV3I:  Febris Icterodes.
   PROGNOSIS.  Favorable:  Free,  copious urine,  how-
 ever dark or bilious it may be, most favorable of any single
 sign.
   Unfavorable:  Blood in the.early vomit;  black vomit;
 faltering articulation; suppression of urine.

                LEADIXG REMEDIES.
                      FIRST  STAGE.
   Camphor.  Initiatory chill, severe and long-lasting, with
 great coldness of skin and prostration.  Dose:  Drop doses
 of tincture every ten minutes.
   Aconite.  First  stage,  after reaction from chill; fever,
 burning heat, dry skin, full, hard and  rapid pulse,  violent
 thirst,  red face, headache,  restlessness,  prostration and
 vomiting.
   Belladonna.  Cerebral congestion, headache, throbbing
 of carotids, face scarlet-red, shining and swollen, eyes red
 and sparkling,  active delirium, pain in  stomach,  with
 nausea and vomiting.
   " Aeon, and Bell, are complements of each other in stage of fever and
 cerebrospinal irritation, and I therefore use them in alternation,  every
 half hour at first."  Holcombe.
                     SECOND  STAGE.
   Bryonia.  After cerebro-spinal symptoms have  subsided,
 and  the gastric symptoms  are  prominent.   Splitting
 headache, eyes red, sparkling, tongue yellow-coated, lips
 parched, dry and cracked, great irritability and vomiting.
   Argentina  nit.   Vomiting of  brownish  mass, mixed
 with coffee-ground-like flakes.
  "]f the patient sinks', if  the vomiting becomes worse, or with any of
 those various signs which indicate hemorrhage  from the gastric
 mucous membrane, Arg. nit. is the remedy."  Holcombe.
                      THIRD STAGE.
   Arsenicum.   Face  yellowish  and livid, eyes dull  and
 sunken, nose  pointed,  lips and tongue brown or black,
 burning or stitching  pain in epigastrium and region of
 liver,  suppression  of  urine,  oppression  of  chest, short
 anxious breathing, pulse small and tremulous, skin  cold,
 cold clammy perspiration, rapid prostration, and vomiting
 of a brown, turbid matter, mixed  with mucus, and some-
 times stained with blood.
  Lachesis.  Delirium,  slow, difficult  speech, red face,
tongue  heavy, trembling, dry  and brown; nausea, vomiting,
irregular, weak pulse,  urine almost black.
  " When Bell, and Aeon, produce no further amelioration, a change to
Ars. and Lach. brings about the desired amendment."  Holcombe. 
    24         KEY NOTES OF MEDICAL PRACTICE.

      Crotalus.  Hemorrhages from eyes, nose, mouth, stom-
    ach, and intestines—from all the orifices of the body, even
    to bloody sweat.
      " Has proved of excellent service."  Xeidhord.

                   SPECIAL REMEDIES.

      Sal).. Sec.  Threatened abortion.
      Hyos.. Coff.  Nervous  sleeplessness at night.
      Ant. tart.   Prolonged and incessant nausea.
'      Verat. all).   Vomiting and abdominal pains.
      Phos.. Merc.  Resulting diarrhoea or dysentery.
      Ipec.  Continued nausea; vomiting of glairy mucus.   '
      Canth.   Cramps  in  abdominal  muscles and  legs, with
    frequent urging to urinate, or, suppression of urine.
i  -    " Scarcely  ever fails to  remove strangury and restore the renal
    secretion."  Holcombe.

      GENERAL  MEASURES.  Quarantine  patient;  use
I    disinfectants; keep  patient  quiet,  in horizontal  posture;
I    keep air fresh and pure; cool sponging of body when fever
    high.
II      Diet.  Requires strict  attention.  First stage, milk and
    water, with lime-water  added, black tea, with cream; ice-
I    cream; bits of ice, to slake thirst, and allay vomiting.
,    Later, give rice,  milk, and  arrowroot.  During  stage of
,    prostration, beef-tea, wine-whey, cafe-au-lait.   Great cau-
\    tion necessary, lest an error in diet excite a relapse.
    DISEASES  OF  RESPIRATORY   ORGAXS.

I,                           CORVZA.

ij      SYNONYM:  Xasal catarrh.
      Camphor.   Incipient stage, chill.   Drop  doses, fre-
"    quently repeated, often  cut it short.
;      Aconite.  Chilliness,  followed by feverishness,  as pre-
|"    cursor of catarrhal fever.
      Euphrasia.  Acrid, fluent coryza, with  scalding tears
    and aversion to light.
,,      Arson, iod.  Abundant discharge  of  thin, hot,  excoria-
    ting mucus from nose, with burning  sensation: lassitude
    and prostration.
      Merc. iod.  Frequent sneezing,  soreness  of nose, dis-
    charge of  thick mucus; great accumulation  in posterior  ;
;'■    nares; salivation; sore throat; profuse perspiration.        i
      Hydrastis.  Thick,  tenacious secretion from  posterior


\!i___________________________________________________________________________________________________________________________________     ____________________ 
          OZlENA-CEDEMA GLOTTIDIS— EPISTAXIS.       -j,;

 nares,  constantly  dropping into  throat.   Also, a spray.
 locally, of Muriate of Hydrastis.
   Kali  Inch.  Chronic coryza, with tough, stringy mucus,
 hoarseness, cough;  yellow-coated tongue  and gastric dis-
 turbance.

                        OZiKXA.

   Aurui!).  Discharge offensive; bones of nose sore: ruelan
 cholia; mercurialization; syphilitic subjects.
   Nitric acid.  Syphilitic ozaena; also after drugging with
 large doses of Mercury.
   Kali hich.  Thick, tenacious, sometimes bloody discharge.
 and "plugs"  of thick mucus.
   Pulsatilla.  Soreness  of  nostrils,  with  greenish dis-
 charge.
   GENERAL MEASURES.  Local applications, admin-
 istered by means of atomizer, should be made to  affected
 part.  If discharge  very offensive,  use solution Kali per-
 mang.. grs. v. to oz. warm water;  or Carb. acid  gtts. v.,
 Iodine gtts. vi., to oz. water.  In severe cases of  oz<ena.
 ointment of red-precipitate  (Iiydr.-pra»cip.-rub.)  may lx-
 applied directly to the sores, whenever they can be  reached
 in the nasal cavity.

                 (EDEMA  GLOTTIDIS.

   Apis incl.  Sudden cedema of glottis.
  " Trust to Apis-it has cured it in its most fatal form." Hughes.
   CONSULT—Ars.. Sang., Strom.

   GENERAL MEASURES.  Scarify glottis with  point
 of guarded  bistoury; or, with finger-nail sharpened to  a
 point.  Inhalations  of steam.  Tracheotomy, if suffocation
 imminent.

                      El'ISTAXIS.

   Aconite.   Prolonged  or  violent bleeding in  plethoric
 subjects, with fullness of cerebral vessels.
  Belladonna.   Congestion  of   head, blood bright  and
 flowing freely.  From being over-heated.
  Arnica.   From injury.  Nose  feels hot,  blood red and
 liquid,  haemorrhage  preceded by itching  or  tingling of
 nose.
  Carho. veg'.  Severe nose-bleed, beveral times daily for
weeks, face pale  before and after each attack.   Aged per-
sons, bleeding profuse and persistent.
  Nitric ac.  Disposition to nose-bleed; severe and fre-
quent attacks. 
26         KEY NOTES OF MEDICAL PRACTICE.
   China.  Weakly persons  who have lost much  blood—
 ringing in ears, pale face.
   Bryonia.   Bleeding of nose when menses should appear.
   Hamamelis.   Passive flow, blood dark and liquid; haem-
 ophilia.
   Ferrum. phos.  Epistaxis in old people.

   GENERAL MEASURES.  Raise the arms above the
 head.   Apply cold water  or ice to root of nose, or back of
 neck.   Insert into the nostril plug of lint saturated with
 Hamamelis.   Inject  into nostril solution of  alum.  (See
 Part III.)

                     HAY-FEVEE.

   SYNONY3IS:  Hay Asthma; Rose Cold.

   Arsenicum.  The  leading  remedy.   Its persistent  use
 has cured some cases.
  Stifta pulm.   "I have used it considerably,  and with the very
 be.-t results."  Dr. B. F. Bailey.
   1 pecaeuanha.   In conjunction with Ars., especially when
 asthmatic symptoms prevail.
   Sabadilla.  Hay fever with violent sneezing and running
 of eyes and nose.
  "I have cured a number of severe cases."  Bayes.
   Quinine.   Use solution locally.
  " With Binz's solution quinine as local application I have had very
 good results."  Hughes.

   GENERAL .MEASURES.  Change  of climate assures
 immunity.  Mackinac, and the shores of Lake Superior,
 the White Mountains, favorite  resorts.  Sea voyage-also
 effectual.  To stop violent paroxysms of  sneezing, plug
 nostrils with cotton—not tight, but so that the air. in breath-
ing, will filter through.
                     INFLUENZA.

  Arson, iod.  Chills, with flushes of  heat; severe,  fluent
coryza, discharge irritating and corrosive; sneezino-- puffi-
nessofface; prostration.                        °'
  " The specific remedy."  Hughes.
  Aconite.  High fever,  hot,  dry skin, restlessness, dry,
violent, racking cough, with stitches in chest.
  Meremias.  Rheumatic pains in  head, face, ears, teeth
and extremities; fluent coryza, with  catarrh of  throat and
lungs, with violent, racking, unceasing cough; chill and
heat, with profuse, non-alleviating sweat.
  Eupatorium pert'.  Distressing backache  and "bone-
pains." 
crotp.
27
   Kali hi.  Troublesome cough, with coated tongue  and
loss of appetite.

  GENERAL MEASURES.   In severe cases,  confine-
ment to bed, with warm drinks,  and a hot-bottle sweat will
greatly aid.   If cough severe,  keep  atmosphere of room
moist.

               CRi >UP—CATARRH AL.

  SYNONYM:  Acute Laryngitis.

  Aconite.   Early in attack,  short, dry,  hard,  metallic
cough;  hurried, labored breathing; hot,  dry  skin; thirst;
restlessness.
  This is the principal remedy for catarrhal croup.
  Spongia.   Rough, crowing, barking cough; loud, wheez-
ing,  saicing  respiration;  suffocative   fits;  inability to
breathe, except with head thrown back.
  With Aconite, sufficient in most cases.
  Hepar s.   Loose, rattling, choking cough.   Air-passages
seem to be clogged with mucus.   After resolution has been
initiated by Aconite and Spongia, so that the breathing has
a rattling rather than a sawing sound.
   Kali hi.  The throat becomes  filled with tough, tenacious
mucus.
  Phosphorus.  Hoarseness after croup, with tendency to
relapses.
  Ant  tart.  Loose  cough, much mucus on the  lungs,
with difficult expectoration.

  GENERAL 3IEASURES.   Hot  fomentations to the
throat, and  hot  foot-bath, up  to the knees, often benefit
Give patient plenty of fresh air.  Give frequent doses of
indicated  remedy.


         CROUP—PSE EDO-MEM BRAXOES.

  PROGNOSIS.   Grave.   Unfavorable:   Signs of  car-
bonization of the blood—face  becomes  blue, hands  cold
and fingers  blue under nails, with drowsiness and stupor.
Pulse  weak,  small, irregular  and   frequent.   Cold ex-
tremities.
               LEAIUXG REMEDIES.

  Iodine.   Dry, short, barking  cough, with wheezing, saw-
ing respiration, imminent suffocation and extreme  dysp-
noea.   Dose.  Teste uses  a one per cent, solution, three
drops every fifteen minutes.
 " As soon as I am satisfied of  the existence of tvue croup, I give
Iodine, second dilution."  Dr. Elb. 
 28         KEY NOTES OF .MEDICAL PRACTICE.

   Bromine.  Child gasping for  air,  rattling of mucus in
 windpipe  when  coughing,  false membrane  extending to
 lungs, great prostration.
  " Constitutional prostration i* the characteristic indication for the
 preference of Bromine—Iodine suits the more sthenic form."—Hughes.
   Kali  hi.  Gradual  onset, hoarse,  dry,  barking  cough;
 tonsils and larynx red and swollen, with patches of pseudo-
 membrane; violent wheezing and rattling in trachea, mem-
 brane thick and tenacious.
  " Has frequently cured membranous croup." Hughes.

               SPECIAL  REMEDIES.

   Bell.  Early, as anti-pyretic, and to reduce the local ca-
 pillary congestion.  Mitchell.
   Arsen.  Great puffy swelling of throat and neck, putrid
 breath, rapid and extreme prostration.
   Phos.   Increased  dyspnoea,  agony  and restlessness,
 hollow cough,  the  croupous  process  extended to bronchi,
 the lungs hypenemic.
   Ant. tart.  Danger of  asphyxia occasioned by movable
 patches of membrane, cough feeble and without resonance,
 mucous rale in trachea.
   Hep. s.   After the attack, a rattling cough remains.
   Phos.   Dry cough remaining after  recovery.

   GENERAL MEASURES.   Give  the patient an abun-
 dance of pure  air.  Keep temperature of  room  at  70° 1\.
 and atmosphere moist.  Early in attack  bits of ice are
 grateful to the patient.  Give inhalations of the indicated
 remedy,  Iod.,  Brom.,  Kali bi.,  by means of  the  steam
 atomizer, in addition to its internal administration.
   Tracheotomy.   The percentage of  recoveries  following
 tracheotomy is such as to demand its trial  in every critical
 case.  The operation is called for when there is considerable
false membrane in the larynx, when respiration is so difficult \
 that you see falling in of the sternum each  time the patient.  ]
 breathes,  and  each supra-clavicular  space  deepens  with
 every inspiration.   (For method of operating see Part III.J
   Diet.  Give  nourishing  food,  liquid  in  form—broths,
 beef-tea, milk,  eggs stirred in milk, wine-whey, egg-coffee; .1
 or, nutrient enemata.                                      M

                        COUGH.                         "

  Nitric ac. Chronic, laryngeal cough, without expectora-
 tion, with stinging  and  smarting as of  small  ulcer  in
 larynx—generally on left side.
  "I have long used it with  benefit in dry and  violent larvneaid'fl
 coughs."  Hughes.                                   "ijuswiij
   Hepar s.  Irritating cough, with hoarseness, excited by 
WHOOPING COUGH.
exposure to cold.  Rattling of mucus in, throat.  Sensation
as of a clot of mucus, or internal swelling, when swallowing.
  Phosphorus.    Dry cough, excited  by  tickling in the
throat, with hoarseness.   Phthisical cough, in those with
weak lungs.
  Spongia.  Dry. hoarse cough, with pain in larynx, worse
at night.
  Sulphur.  Dry  cough, with  hoarseness  and dryness in
throat, and tightness of chest.  Or, loose  cough, with ex-
pectoration of whitish or yellowish mucus.
  Kali bieli.   Cough with tough, stringy expectoration,
preceded  by  much wheezing,  accompanied  by difficult
breathing, and followed by dizziness.
  Mercnrius.  Chronic, moist cough, worse at night.
  Hyoscyamus.   Nervous, dry, spasmodic cough, worse at
night, especially on lying down.
  Belladonna.  Short, dry, hollow, convulsive  cough, worse
at night, with tickling in throat, flushed face, headache and
cerebral congestion.
  Bryonia.  Hard, dry, shaking cough, with  pain in side,
chest and head.

  GENERA L MEASURES.  Is a symptom, and the cause
must  be  ascertained  and removed.  In simple cough, a
cold compress about throat at night often relieves.  Drink
small quantities of cold water at frequent intervals.  Gum-
water,  and demulcent  drinks, when from simple irritation.


                WHOOPING   COUGH.

  S YNON YM:  Pertussis.

              LEAI)I\G REMEDIES.

  Aconite.  Initiatory fever,  with dry,  hard,  wheezing
cough, burning pains, or dry itching in larynx.
  " Indispensable for the /erer."  Bcenningliausen.
  Ipecac.  Violent, suffocative cough, the child becoming
stiff and blue in the face, gagging and vomiting of mucus.
  " One of our best remedies."  Baehr.
  Drosera.  Spasmodic  stage,  with  frequent and  exces-
sively severe paroxysms of hoarse, loud cough, sometimes
with bleeding from nose and mouth.   Fever may be absent,
or, fever intermixed with chills,  accompanied  by  perspira-
tion, and after  the  cough, vomiting  of food or  mucus.
Dose: lx or tincture.   Bayes.
  "Holds  a prominent  place  among whooping-cough  remedies."
Bannin ghn usen.
  Hydrocy. acid.  Spasmodic stage, convulsions  and suf-
focative attacks.
  •' Exerts almost magical influence."  West. 
30         KEY NOTES OF MEDICAL PRACTICE.

  Belladonna.  Sudden, violent paroxysms of cough, with-
out expectoration, worse at night, with sore-throat, cerebral
congestion, redness of eyes, epistaxis.
  "Very useful remedy.  Suitable only at the beginning, or, later,
when there is cerebral congestion or fever."  Boenninghausen.
  Carbolic acid.  Second stage.  Cough  dry,  hard,  spas-
modic.
  I have used the 2x with excellent effect.
  Corallium rub.  " A remedy of exceeding value in vio-
lent cases."  Carroll Dunham.
  Cuprum. Convulsions.  "Has always succeeded with
me."   Jousset.
  Phosphorus.   Supervening broncho-pneumonia.
  Hepar s.   Croup  prevailing  at  time  of epidemic of
whooping cough.

  GENERAL MEASURES.   In case of  infants, watch
them closely, and take them up if paroxysm of cough sets
in.   Wear warm clothing, and guard against  chill.  If
attack severe, give plenty of nourishing food, to keep up
strength.

                     BRONCHITIS.

  Aconite.  Early in attack; chill and fever, dry, hot skin,
restlessness and thirst, short hard tickling cough, with con-
stant laryngeal irritation.  To be of  service  Aconite must
be given early; later  it is of no  use  except as intercurrent
if there be continuous fever.                              I
  " Should the inflammation have thoroughly established itself, we
cannot expect Aconite alone  to cure it." Hughes.                 <
  Antimonium tart.  Great  oppression and suffocative*
breathing, extensive  mucous rales, great rattling  of  mucus
with the cough, but nothing is raised.   Also,  symptoms of
incipient carbonic-acid poisoning—sopor, delirium, pallor,
bloated  countenance; also, profuse  sweat  without relief,
disposition to vomiting  and  diarrhoea, paroxysms of rat-
tling cough, ending in vomiting.  For capillary  bi'onchitis
of  children, and pneumonia notha of the aged.
  " Enjoys the largest sphere of action, and is pre-eminently character-
ized by a profuse e.n-retion of mucus ivhich it is  difficult to raise, with or
without fever."  Baehr.
  "The grand remedy for this dangerous disorder (suffocative catarrh
of the aged).  I have almost invariably relied upon It alone, and have
seen desperate cases recover under its use."  Hughes.
  Belladonna.   Dry,  distressing,  spasmodic  cough, in
short paroxysms, but very violent, especially towards even-
ing;  no  expectoration,  or yellowish,  tenacious,  scanty,
blood-streaked.   Respiration oppressed, irregular and hur-
ried.  Sensation of fullness in chest, with  determination of
blood to lungs.   Useful only in  first three or four days.   '*
  " Bronchitis setting in with violent fever; moderates the latter much
more certainly than Aconite."  Baehr. 
CHRONIC BRONCHITIS.
31
  Mercurius.   Violent  fever, temperature high;  great
perspiration, without relief; alternation of chills and heat,
with  great  sensitiveness  to  changes  of  temperature.
Tongue with thick, yellowish coating; diarrhcea.  Feeling
of dryness, roughness, and soreness down middle of chest.
violent, wearing  cough, especially  in evening  and  until
midnight, with tenacious, yellowish, sometimes blood-tinged
expectoration, every paroxysm of cough preceded by anxious
oppression and dyspnoea.   Unquenchable longing for ice-
cold drinks.  Particularly adapted to  children  and robust
adults—not so  much for old  people.   Mucous membranes
extensively involved—lungs, stomach, bowels.
   Bryonia.  Trachea  and large  bronchi affected.   Dry
cough, with stitches in the chest, short, labored respiration.
"With cough, determination of blood to head, turgescence of
face.  Ordinary " cold on the  lungs."
  " Too extensive claims are  made  for Bryonia.  Good where the
catarrh invades the trachea and large bronchi—it is  of little use
beyond."  Hughes.
   Kali hi.  Burning pain in trachea, cough with expecto-
ration of tough mucus,  which can be  drawn out in strings;
tongue thickly  coated, with loathing of food.
  " Bronchorrheea, with copious, purulent expectoration, give Kali bi.,
by inhalation, two grains to four ounces of water."  Meyhoffer.
   Ipec.  Asthmatic breathing;  much  nausea and vomiting
of mucus, rattling of mucus in  bronchial tubes, face livid
during cough.  Loud  mucus  rales, with wheezing respira-
tion. Severe gastric ailments and intestinal catarrh, pallid
or bluish or  bloated countenance.   Principally  adapted to
bronchial catarrh of children.
   Hepar s.  Cough, with  wheezing  over whole jchest. in
severe paroxyms, with danger  of suffocation.   Expectora-
tion of a yellowish, tenacious  mucus.  Croupous bronchitis.
   Verat. alb.  Failing  strength, increased frequency and
irregularity  of  pulse,  coarse rales, secretion  of copious
quantities  of mucus, which cannot  be coughed up.  Skin
cold, with cold sweat.
  Arsenicum.    For  aged people,  with  great  debility:.
oedema of lungs.
  Phosphorus.   Complications—oedema of lungs or pneu-
monia.
  Rhus.  Typhoid symptoms and violent fever.

              CHRONIC  BRONCHITIS.

  With mucus expectoration.—Ant. tart.. Kali bi.
  With  purulent  expectoration.—Merc,  Sil., Lye, Calc.
Sulph., Iod.
  "No bronchial disease of long standing can be successfully treated
without Sulphur or Lycopodium.'1  Meyhoffer.
  Sulphur.  Rheumatic or  gouty subjects, or  those of 
;;o         KEY NOTES OF  .MEDICAL PRACTICE.

scrofulous diathesis.   Bronchorrhua. with putrid expecto-
ration.
  "Curative in the most inveterate forms."  Meyhoffer.

  GENERAL MEASURES.  If patient suffering from
extreme dyspiuea, hot fomentations  to  the chest afford
prompt relief.  Do not leave fomentation  on  to  become
cold—renew at frequent intervals.                        .j
  Diet.   In   acute, with fever, diet  as  in other  fevers.'
When profuse expectoration, nourishing, albuminous food.
Demulcent drinks good—milk, gruel, barley-water.


                       ASTHMA.

  Arsenicum.  Asthma with  burning heat in chest, cold
sweats, complicating heart disease, or following bronchitis.
The more the  patient  seems on the point of suffocating, the
more  painful  and distressing his  restlessness, the more
wheezing  and louder  their  respiration, the more Arsenicum
u-ill be found appropriate.   This is  accompanied by livid
countenance, cold sweat, frequent, small pulse, palpitation.
distended abdomen.
  " Arsenic sometimes exerts a magical effect."  Baehr.            1
  Nux vom.  Tongue coated  with thick, yellow fur, slight^
nausea, flatulence, constipation, disorders of digestion.     fl
  " The best curative medicine we have for simple spasmodic asthma,
where there is no bronchial lesion."  Hughes.
  Ipecac.  Attacks of suffocation, feeling  of  constriction \
in throat and chest, coldness, paleness, anxiety and sickness,
rattling of mucus in  bronchial tubes.  Bronchitic asthma.
Give frequent doses during paroxysm.
  Lobelia.  Purely nervous asthma; constrictive, suffoca-
tive sensation, vertigo, nausea, vomiting,  sense of great
emptiness in stomach.
  Aconite.  Dyspnoea, labored breathing,  great fear and
anxiety of mind, suffocative cough at night.  Often relieves
during  paroxysm  of  spasmodic  asthma,  and  bronchitic
asthma from cold.
  Sambucus.    Violent dyspnoea, nightly suffocative at-
tacks,  with profuse  perspiration.  Especially  useful  in
asthma of children.
  Grindelia.   Mucus asthma, tenacious sputa, nervous and
cardiac asthma.
  Sulphur.   Gouty  subjects,  or those  subject to skin-
diseases.

  GENERAL MEASURES.  Let patient seek most com-
fortable position for  himself, to favor respiratory effort.
Keep atmosphere of room  moist.  To relieve paroxysm:—
A cup of  very strong coffee; drop doses tincture Ipec; inha- 
                      PNEUMONITIS.                    33

lation of  Nitrite of A my I, of Chloroform or Ether; inhala-
tions of the smoke of burning Stramonium, leaves, made
up into cigarette, or in a pipe—twenty grains of the leaves,
or ten grains of the dried root.  Soak blotting-paper in a
strong solution of  I'otassic  Nitrate (saltpetre), and dry it
thoroughly.   Burn this,  and  let the patient  inhale  the
fumes.
   Diet.   Important.   Asthmatics are generally dyspeptic,
and much can be  accomplished by attention  to stomach.
Never overload stomach.  Do  not eat hearty meal late in
the day.-  Let the diet be nourishing, but plain, wholesome,
and easy  of digestion.  Use  no  coffee.


                   PNEUMONITIS.

   SYNONYM: Lung-fever.

   PROGNOSIS.  Favorable:   Acute;uncomplicated; pre-
viously healthy subjects;  one  lung.  Unfavorable:   Ex-
tremes of life complication  with Blight's, heart, pregnancy,
etc.; pulse over 150;  delirium  after first  week; collateral
oedema; gangrene; both lungs.
   CAUSES OF DEATH.  Collateral oedema; heart-failure
and heart-clot; asphyxia; asthenia.

                LEADIXt;  R EM ED I ES.

   Aconite.  Initiatory chill and fever.   Stage of conges-
tion.  Of no use after hepatization, and Verat. v. is often
superior  to it in first stage.
   Yeratrum vir.  Stage of  congestion; fu 11, hard, bounding
-pulse, rusty expectoration,  great oppression of chest;  de-
lirium.
  " I have  seen the happiest effects when the attack came with a severe,
long-lasting chill." J. P. Dake.
   Bryonia.    Moderate  fever; severe,   shooting, cutting
pains in chest; painful cough, with scanty expectoration of
tough,  rust-colored  mucus.   Stage  of  restlessness  has
passed, patient quiet and exhausted; tongue  covered  with
thick, white  fur, stomach  inactive,  liver  engorged.  Rheu-
matic pains  in chest muscles.
  " The most essential remedy in second stage."   Baehr.
  Phosphorus.  Stage of   hepatization.   Pain not  very
severe — vaguely localized  stitches.  Great  weight  and
oppression   of  chest, marked  embarrassment  of  respira-
tion, cough,  with bloody, muco-sanguinolent, or sanguino-
purulent, difficult  expectoration.  Very useful in severe
cases, asthenic  pneumonia, and "typhoid  pneumonia."
.Collateral iedema.
  " Our sheet-anchor in pneumonia." Hirschel.
     2 
34         KEY NOTES OF MEDICAL PRACTICE.

  Antimoniuin tart.  Commencing resolution.  Increased.
frequency of pulse, great anxiety and restlessness, copion«,'|
cool perspiration,  pallid  countenance,  suffocative spells, ]
great drjspnwa, loose,  rattling cough, as if much would be
expectorated, but nothing comes.  Impending paralysis of ;,
lungs.   Collateral oedema.
  " One of the most important remedies when pneumonia deviates from
its normal course." Baehr.
  Sulphur.  After defervescence, to promote  resolution; (
tedious course.
  " A deficiency of reaction, and a simultaneous absence of such symp-
toms as point to a destruction of the organic powers, constitute the
best indications for this remedy."  Baehr.

                SPECIAL  REMEDIES.

   Chel.  Liver complication.
   Sang.  Suppuration; hectic fever.
   Lye.  Chronic pneumonia, with hectic.                 <
   Ac.  nit.  In aged, or of feeble constitution.
   Merc.  Broncho-pneumonia;  profuse sweats.
   Hep. s., Sil.  Purulent infiltration.   Abscess.           fl
   Bell.  Cerebral congestion, delirium, convulsions.
   Rhus.  Typhoid character; "prune-juice"  sputum.

   GENERAL MEASURES.   Keep patient  in large, well-
ventilated   room.   Abundance   of pure  air  important./-
Patient should be propped  up in bed, in a raised posture.
Large, thin  poultice  to chest.  Give mucilaginous drinks, ■<
and nourishing food.

           CONGESTION  OE  THE  LUNGS.

   Aconite.  In plethoric  subjects, with  short,  anxious
breathing, pulse quick and  hard,  burning, pressing pains.
 in chest.
   " The main remedy." Baehr.
   "All-sufficient when case taken early." Hughes.
   Verat. vir.  Great arterial excitement,  faint feeling in
 stomach, nausea, heart's  beat loud and strong, pulse full
 and hard.
   " Has often cured." Hem pel.                                {
   Cactus. Congestion of lungs dependent on cardiac affec-1
 tion,  with  oppression  of respiration,  acute  pains, feeble
 voice, feeling  of coustriction.
   I have used this remedy with excellent effect.
   Phosphorus. Feeling of great weight on chest.
   " When turgescence so great as to allow oedema to occur."  H-tghen.

               (EDEMA OF  THE  LUNGS.

    Phosphorus. Acute pulmonary  oedema  in  connectior 
HEMOPTYSIS.                    35
with pneumonia, or other  diseases  of  the  respiratory or-
gans.
  " This remedy sometimes has a brilliant  effect." Kafka.
  " It is possessed of extraordinary powers against cedema."  Baehr.
  Antimonium  tart. Cyanosis,  audible  rattling, great
dyspnoea, coarse  rales, the bronchial  tubes containing a
great quantity of mucus, the patient in constant danger of
suffocation.  (Edema of lungs occurring in  course  of gen-
eral dropsy.
  "I have more than once seen the  cedema subside entirely under the
use of this medicine." Hughes.
  Arsenicum. Supervening on  anasarca;  great  debility
and prostration.
  Amnion, carb. Give on first  signs of drowsiness, and
carbonic-acid poisoning.

                     HAEMOPTYSIS.

           DIFFEKEXTIAL DIAGNOSIS.

                  HEMOPTYSIS.     H.EMATEMESIS.
Blood    -     -    Bright red    -     Dark.
Blood  -     -      Coughed up    -   Vomited.
Blood    -     -    Frothy  -     -      Fluid.
Mixed with  -      Sputum    -    -   Food.
Preceded by    -  Dyspnoea    -      Stomach distress.
Stools contain     No blood   -    -   Blood.
Respiration  -     Rales in lungs       Lungs clear.

               I,EADIX<.i REMEDIES.

   Aconite. Blood red. frothy: incessant cough, hot chest,
anguish, red face.  Dose:  " Low  dilutions,  repeated very
often." Jousset.
  " Indispensable in sthenic ca-o-O'  Hughes.
  Ilamumelis.   Profuse  haemorrhage  of   venous blood,
coming into mouth without effort, like  a warm  current.
  " When blood is black, a precious remedy." Jousset.
  "When flow is passive, from venous haemorrhage, a reliable remedy."
Hughes.
  Arnica.  Abundant, blackish blood, with  clots, after in-
jury or bodily  exertion.
  "Especially useful when with heart-disease or traumatism." Jousset.
  Ipec. Copious  bleeding, precede I  by sensation  of  bub-
bling in  chest. Cough, with spitting of blood,  occasioned
by least effort.  With cough, tickling behind sternum.
  " Holds high rank." Hughes.
  Millefolium.  Blood red, frothy,  ejected without muoh
coughing.
  "Almost always justifies the indications." Hughes.
  Verat. vir.  From  congestion of lungs, with  full, hard,
bounding pulse. 
36         KEY NOTES OF MEDICAL PRACTK'K.

  Cactus.  Marked arterial excitement; haemorrhages, from
over-action of the heart.
  " Haemoptysis with heart-disease." Raue.
  Digitalis.  From obstruction of pulmonary circulation in
consequence of heart-disease and tuberculosis.
  Phos. Tight feeling in chest, ivith dry, tight cough, fol-
lowed by haemorrhage.
  "Inflammatory symptoms supervening on an attack of haemoptysis."
Hughes.
  "The principal remedy when  haemoptysis with dangerous cases of
fever."  Jousset.

  GENERAL .MEASURES.   Recumbent  posture, head
and shoulders elevated—airy room. Bits of ice in mouth.
                      PLEERITIS.

  PROGNOSIS. Favorable: In young and healthy; effu-
sion scanty; early absorption.  Unfavorable:  In cachectic; i
double-sided;   persistent  high  fever;  rapid  increase of
effusion, or return after having once subsided; complica-
tion with phthisis.
  CAUSES OF  DEATH.   Collateral cedema  of  lungs;
perforation of diaphragm, and peritonitis; perforation of
lung, with pneumo-thorax;  hectic;  pneumonia;  syncope
from dislocation of heart.                                ;


                leadixj:  remedies.

  Aconite.  Chill and initiatory fever. Great thirst, quick
and rapid pulse, hot, dry skin, red face, shortness of breath,
great nervous excitability, piercing, stitching pains in chest
with dry cough.
  "In simple, acute pleurisy, the sufficient medicine." Hughes.
   Bryonia.  Acute, stitching pains in side, greatly aggra-  '
vated by breathing or  movement; labored, short,  anxious
and  rapid breathing,  performed  almost  altogether by
abdominal muscles.
  " The sovereign remedy when the inflamm-ition ha- advanced  to the
stage of serous effusion."  Trinks.
   Arsenicum.  Great dyspnoea, with but little pain.  Sec-
ond stage, patient much prostrated, weak and cachectic.
  " It will accomplish  more than any other remedy in the stage of
effusion."  Mitchell.

                 SPKt'IAL  REM EDI KM.

   Apis.  Resorption of effusion.
   Ant. t., Phos.  Pleuro-pneumonia.
   Arn.  From over-exertion or a blow. 
               [ IVDROTHORAX—PLEURODYNIA.          37

  Iod.  In scrofulous subjects, replaces Bry.
  Sulph.   Plastic exudation, slow to disappear.
  3Ierc.   Exudation inclines to become purulent.

  GENERAL  MEASURES.  Absolute  rest important.
Poultices large, hot, and frequently renewed.  Thoracentesis
called for if amount of effusion great, great dyspnoea, and
imminent danger from  suffocation: effusion liable  to  re-
turn if done before fever subsides.  Use aspirator, needle
anointed with oil—no preliminary incision; introduce near
axilliary line, fifth intercostal space on  left side, fourth on
right,near upper edge of  rib; patient recumbent; evacuate
slowly; admit no  air.
  Diet.   As in fevers generally.  Sustaining diet if much
suppuration.


        EFFUSION IN PLEURAL CAVITY.

  Apis.   Oppression very  great, inability to lie down, ab-
sence of  thirst,  dark and  scanty  urine.  From  recent
inflammation, and after scarlet-fever.
  "Absence of thirst and suddenness of  cedema reliable indications."
Hempel.
  Sulphur.  " Unabsorbed  pleuritic effusion,  and  that
which comes on insidiously.  I have frequently cured with
the continued use of  the  tincture of Sulphur, three or four
doses a day at first, but, as improvement continues, one or
two doses a day."  Dr. C'ate.


                  HVDROTHORAX.

  Arsenicum.   Severe  dyspnoea.   Suffocative  attacks.
especially at night.  Patient cachectic, face bloated, small
pulse. Idiopathic cases.
  Digitalis.  Secondary to  cardiac affection.  Face pale
Or bluish, pulse slow and intermittent, urine scanty.
  "Digitalis the remedy in cardiac dropsy." Hale.
  Apocynum.  When amount of effusion very great.  Main
treatment to be directed to primary disease, on  which  the
dropsy depends.

                   PLEURODYNIA.

  Aconite.  Rheumatic  pleurodynia, recent  attack, with
fever.
  Bryonia.  Sharp,  stitching pains, with rheumatic ten-
dency.
  Arnica.  Myalgic pleurodynia, with  stitching  pains;
" spurious pleurisy."  Hughes. 
38         KEY  NOTES OF MEDICAL PRACTICE.

  Aetea rac. Neuralgic pleurodynia, with deranged uterine  ,
function.  " Is specific."  Hughes.
  Ranunculus.  Idiopathic intercostal neuralgia in ansemio
or debilitated subjects.
  Nux  vom.  Hemorrhoidal subjects; patient cannot lie ,
on affected side.  Jousset.
  DISEASES OF CIRCULATORY  SYSTEM.


                        HEART.

  PERICARDITIS-ENDOCARDITIS—MYOCARDITIS.

  DIA(« NOSIS.—Pericarditis.  Friction-sound synchron-
ous with heart-beat, until effusion, when there is increased
area of cardiac dulness  and displacement of apex-beat.
Rarely  idiopathic; generally occurs  as  complication  of
rheumatic fever, pleurisy, pneumonia, albuminuria or sep-
ticaemia.                                                ,
  Endocarditis.   Systolic, ventricular, valvular murmur, ';
of recent origin, associated with a condition which would be j
apt to excite this affection.  Seldom  idiopathic—generally ]
associated with acute rheumatism.                        '
  Myocarditis.   No  characteristic signs—always accom- ,
panied by peri- or endo-carditis.

  CAUSE  OF  DEATH.  Cardiac  palsy—the  pulse be-
comes small and irregular, pulmonary veins engorged, and
death from asphyxia consequent upon ondema of lungs.

                LI.VI>1\<; REMEDIES.

  Aconite.  Acute, stitching pain in  prascordium;  difficult
breathing,  with suffocative  feeling;  feeling of tightness J
about heart; intermission of beats, or tumultuous palpita*
tion felt over large area, with irregular action and volume
of pulse.   Great anxiety and tossing  about.
  Aconite finds its true sphere in cardiac inflammation, whether or not
there lie  high fever. Useful not only at beginning, but  sometimes
throughout entire course of the disease.
  Spigelia.  Severe shooting or stabbing pains, distressing
oppression  of  chest, the  least  motion  almost producing
suffocation; violent palpitation, so severe that  the  walls of
the chest are raised.
  An important remedy in rheumatic endocarditis   Pain and violent
action of  heart highly characteristic.
  Digitalis. Pericarditis coming on  insidiously; friction-
sound of short duration; serous effusion, distressed breath- 
         DISEASES OF THE CIRCULATORY SYSTEM.      39

ing, syncope, palpitation, intermittent, feeble pulse, not
synchronous with  heart-beats; livid,  turgescent face, with
blue lips.   Hyperemia of liver; great anxiety, without any
continual restlessness.
  " An excellent remedy in acute affections of heart, more particularly
pericarditis. If more frequently used in acute heart-affections, would
be less frequently called upon to use it in chronic  heart-disease."
Baehr.
  Bryonia.  Pericarditis as complication of rheumatism,
pleurisy  or  pneumonia.   Commencing   effusion,  sharp.
stitching pains in prsecordium.
  "For  idiojiathic  pericarditis, we have much  better remedies."
Baehr.
  Arsenicum.    Pericardial effusion, violent  palpitation,
rapid pulse,  intense  thirst, burning pain, anxiety,  faint-
ness, extreme restlessness, suffocative attacks, coldness  of
surface, great anguish and apprehension of death.
   Cactus.  Sharp, pricking  pain in  heart,  or sense  of
constriction; oppressed breathing, dry cough; pulse quick,
throbbing, tense and hard.  Great palpitation.
   Lachesis.   Cramp-like  pain, anxiety  about the  heart,
suffocation on lying down, oppression on lying down, hands
and feet  cold, pulse intermittent.
  " A good remedy in endocarditis." Baehr.
   Verat. vir.  Strong, loud beat of heart, with quick pulse?
and difficult breathing.
   Yerat. alb.  Cold sweat. Hippocratic countenance, signs
of  collapse.
   Naja, Aconite. Iodine.   After an attack of endocarditis,
to complete a cure and prevent valvular disease.

   Valvular Disease.  Arsenicum, Plumbum.
   Dilatation.   Digitalis, Physostigma,  Tabacum.
   Cardiac Dropsy.   Digitalis, Spigelia, Arsenicum.
   Fatty  Defeneration.  Phosphorus, Arsenicum, Arnica
I  to relieve dyspnoea in fatty heart).
   Hypertrophy.  Aconite, Cactus, Naja.  Spigelia. Arnica
(after training, rowing, and violent muscular  exercise).

  I'ALl'ITATIOX:
     Cactus.  When due to plethora.
     Cofi'.. Nux.   Nervous palpitation.
     China.  Due to  excessive tea-drinking.
     Tabacum.   Palpitation with fainting attacks.
     Moschus.   To be given at the time of an acute attack.

   GENERAL M E ASURES.   In acute inflammatory, rest,
and hot poultices over region  of heart.  In chronic organic
disease, avoid  running, climbing,  all over-exertion  and
mental excitement, and hearty meals. 
•^«*l
40         KEY NOTES OF  MEDICAL PRACTICE.

                 ANGINA   PECTORIS.

               [,I,AI)1X(.  REMEDIES.

  Arsenicum.  Extreme dyspnoea, increased  by slightest
motion; debility, pale and haggard face, feeble and irregu-
lar pulse, fear of immediate death.
  This remedy is chiefly useful given in the intervals of the
attacks, as a  curative, or preventive,  if the  case is one of
pure neurosis.  Dose:—Higher attenuations recommended.
  " No remedy can be more certainly relied upon than Arsenic.'1''  Hart-
man n.
  Spigelia.  Severe stabbing stitches in heart at every
beat; violent palpitation, tendency  to syncope.   Dose:—
Begin with third, give higher or  lower according to sus-
ceptibility of patient.
  " This is the principal medicine for angina pectin is; it corresponds to
the anguishing, sub-sternal pain, radiating to the neck and arms, irreg- •
ularity of pulse: tendency to syncope;  palpitation; aggravation by the '<
least movement." Jousset.
  Digitalis.  Cases in an  advanced stage,  recurring fre- ;
quently and suddenly. Dose:—Baehr recommends Digitalin,
2d and 3d triturations.                                    i
  Hydrocyanic  acid.   Violent palpitation,  long fainting- J
spells, feeling of suffocation, with torturing pains  in chest,
irregular, feeble beating of heart.  Recent cases.

               SPECIAL REMEDIES.

  Glonoin.  Pale face in paroxysm.
  Cuprum.  Muscular, of  long  standing.
  Aeon.   Recent cases, plethoric subjects.
  Cactus.  Constrictive pain; rheumatism.
  Nux:  V.  Gouty or hsemorrhoidal subjects.
  Verat. alb.  Cold extremities, cramps, cold  sweat.

  CENKRAL MEASURES.  At the time of  an attack,
place patient in  comfortable position, with plenty of fresh ■
air;  loosen clothing,  apply  large, hot fomentations over
region of  heart, and warmth to  extremities.   Give inhala-
tions of Nitrite of Amyl.   Put ten drops on a bit of cotton
in a drachm vial—keep corked  when not in use.  Give fre-
quent teaspoonful doses of brandy.
  Those  who  are  subject  to attacks  of angina, pectoris .
should observe a  regular,  quiet  mode of  life, avoiding all
excitement or over-exertion, errors of diet, overloading  the
stomach,  or anything which  may excite the  heart's action.
The use of tobacco must  be strictly prohibited. 
DISEASES OF THE DIGESTIVE TRACT.        41
 DISEASES  OF  THE  DIGESTIVE  TRACT.

                    STOMATITIS.

   Mercurius.  Swollen glands and abundant salivation.
   Hydrastis.   Yellow-coated tongue, viscid secretions.
   Acid nit.  When accompanied by derangement  of liver
 and portal congestion.  Also, when of mercurial origin.
   Kali chlor.   Mercurial stomatitis.   Breath fetid, with
 ulcers on mucous surfaces.

   GENERAL  MEASURES.  Use gargle of Kali chlor..
 grs. viii. to 3 water.

                     PAROTITIS.

   SYNONYM: Mumps.

   Aconite.  Fever, hot, dry skin, furred tongue.
   Merc. iod.  The gland swollen, red and painful; jaws
 stiff.
   Rhus.  Swelling becomes  dark-red and erysipelatous.
   Pulsatilla.   Metastasis to breasts, or to testicles.
   Belladonna.   Sudden disappearance of swelling, with
 loss of consciousness or delirium.

   GENERAL  MEASURES.  Keep child in warm room.
 In metastasis to mamime or testicles, use  Belladonna oint-
 ment, one  grain to the ounce.

                  CAN( RIM ORIS.

   SYNONYM: Noma.

   Arsenicum.  Extensive disorganization, and great pros-
 tration.
  "Has no rival."  Hughes.
   CONSULT—Merc, Lach.

  GENERAL  3IEASURES.  Apply  locally Sub nitrate of
Bismuth, sufficient to cover  well the diseased parts.  This
has been used with great success.

                    TONS I LITIS.

  SYNONYM: Quinsy.

  Aconite.  High fever, headache, restlessness; stinging,
pricking fullness, or feeling of  choking; throat looks as if
scorched. 
42         KEY  NOTES  OF MEDICAL PRACTICE.

  Belladonna.  Bright redness  and  rawness  of  throat;
flushed face, glistening eyes, headache, pain on swallowing.
  Merc. bin.  Throat swollen; copious secretion of saliva,
swelling of gums and tongue, fetid breath, ulcers in mouth,
profuse perspiration and nightly exacerbation.
  Will often avert suppuration.
  Gelsemium.  Initiatory  fever; aching in  all the limbs;
great muscular weakness.
  Kali bi.   Secretion of much viscid mucus.
  I  have cured several cases of recurrent quinsy with Kali M. and
Oelsemium.                                               .1
  Baryta  carb.   Sensation  as of a plug  in  the throatjs
raw, scraping, or shooting pain on swallowing.
  " If you begin the treatment early with this remedy, suppuration'
need hardly ever occur."  Hughes.
  Hepar s.  Tonsils much swollen,  with throbbing  pain.
This remedy should be  given  as soon as there are signs of
commencing  suppuration.
  Apis.   Dryness of mouth and throat;  much cedematous
swelling.
  Amm.  mur.   Putrid discharge and  tendency to gangre-
nous ulceration.
  Sil.   Abscess slow to heal;  scrofulous subjects.
   Each.  Left side, with hyperaesthesia of throat.
  Ars.  Great prostration; throat  putrid  and gangrenous.

  GENERAL  MEASURES.  Early, bits of ice in mouth.
Later, inhalations of steam  give great relief.  Lance as
soon as pus has formed, with guarded bistoury.
GASTRIC  CATARRH—ACUTE  AND  SUB-ACUTE.

  Arsenicum.   Burning distress in stomach, intense thirst,
violent vomiting, with excessive pain, anguish and restless-
ness,—vomiting immediately after drinking, great prostra-
tion, quick, small pulse.   Also in late stage,  extremities ■
cold,  pulse small,  features  sunken,  hiccough,  extreme
debility  Dose:—Do not give too low—(ith to 12th.
  " The principal remedy—hardly any other needed."  Hughes.
  Cantharis.   Violent pains in stomach,  the patient toss-,
ing about in agony.   Severe burning  in stomach, vomiting,'
with violent  retching and burning thirst.  Urine  scanty,
burning—constant desire, passing few drops at a time.
  Phosphorus.   Vomiting of blood, mingled with bile or
mucus; great fullness of stomach, with painfulness to pres-
sure and cutting pains.  Vomiting of  water  as soon as it
becomes warm  in the stomach.
  Mercurius.  Pasty coating on tongue,  extremely violent
thirst, much saliva collects in  mouth, bitter, sour vomiting. 
               uyio j. ±vj.^ oAiAitun-UHKUNIC.            43

  Iris.   Great burning and distress in epigastrium, vomit-
ing, with great prostration, burning in mouth, fauces  and
oesophagus, headache.
  " Eminently adapted to many forms of  mucous gastritis."  Hughes.
   Aconite.  Simple gastritis, from cold; distention, with
burning, throbbing pains.   Attack preceded  by chill when
muscular coat of stomach  involved.  Dose:—"Tincture."—
Hempel.
  Verat. alb.  Hippocratic countenance, eyes sunken  and
glazed, lips blue, extremities cold and covered with clammy
sweat, almost imperceptible pulse.  Intense thirst for cold
drinks.
  Ant. cr.  Great nausea, paroxysms of  clawing, pressing
pain, loathing  of  food,  tormenting  thirst,  tongue with
thick, white coating.
  "One  of the chief remedies for gastric catarrh without  fever."
Baehr.
  Ipec.  Feeling of  emptiness, with pinching pains  and
bloating, insipid, bitter, rancid taste, vomiting of ingesta,
bile and mucus, and persistent nausea.   Brought on  by
eating sour or  fat food.
  Bryonia.  Stomach bloated, exceedingly sensitive: nau-
sea, with feeling of  coldness  and  chills, and  faintness on
sitting  up.
  Puis. Brought on by  eating  fats,  fruits, ices or acid
food; chilly creepings, sensation as of a mass of undigested
food in stomach, greasy, rancid, bitter taste, tongue thickly
coated, absence of thirst.
  Nux  v.  After abuse of  drugs, stimulants or condiments.
Bitter or sour taste, sour  belching, fullness  and pressure
in  stomach, continued  frontal  headache,  especially  in
morning.  Not much pain.


         GASTRIC CATARRH- CHRONIC.

  REMEDIES:—Sulph..  Lye, Nux v..  China,  Bismuth,
Puis.
  Vomiting.   Ipec, Kreas.
  Heartburn.   Puis., Caps.
  Waterbrash.  Lye, Nux v.
  Acidity.   Calc. c, Phos., Sulph. ac.
  Flatulence.   Carbo v.. Lye, Arg. nitr.
  Gastralgia.   Nux  v., Bismuth, Cocc, Hydr. ac, Ars.

  GENERAL MEASURES.  Acute.   During height of
attack, no food whatever.    Give bits of  ice to slake  thirst.
If attack protracted, and  it  become necessary to nourish
patient, use nutrient enemata.  As improvement progresses,
feed  cautiously.   First, ice-cream, iced-milk  with  lime-
water.  Then, starchy foods only—arrow-root, rice, barley- 
44         KEY  NOTES  OF MEDICAL PRACTICE.

water, gruels. Later, broths.   No solid food until recovery
is complete.  Chronic. Care in  diet, as in dyspepsia.  Avoid
tea and  coffee,  puddings, sauces, stimulants, fresh bread.
Eat slowly and masticate thoroughly.   Butter-milk is excel-
lent.  A  milk diet often curative.
  Wear warm clothing,  and  take salt-water sponge-baths to
excite activity of skin.
  Drinking water as hot as can be taken, often relieves dis-
tress, and stops nausea  and  vomiting.


                  GASTRIC   ULCER.

  DANGERS.   Perforation of wall of stomach.   Hemor-
rhage from rupture of vessel.

               L.EADIX4; REMEDIES.

  Arsenicum.   Constant thirst.   Distention, pressure or
cutting  in epigastrium.    Nausea, fainting,  waterbrash,
vomiting thick, glairy mucus, or a brownish, blackish fluid.
Burning  in stomach, with great pain on pressure.
 " When ulcer at pyloric end."  Hughes.
 " Deserves to be classed in foremost rank."  Baehr.
  Argentum nit.  Violent gnawing, griping and burning;
painful swelling of stomach, with violent belchings.
  Kreasote.  Vomiting, with heat and burning in stomach
and bowels; foul and sanious matter vomited, indicative of  <
disorganization  of mucous membrane.
  Cantharis. Severe burning pains  in  stomach, burning
thirst, vomiting, with violent retching.
  Kali bi.  Yellow-coated tongue, nausea, foul taste  and
faintness.  Giddiness,   followed by  violent  vomiting of a
white, mucous,  acid fluid,  with  pressure and  burning in
stomach.   Vomiting of  sour, undigested food,  of glairy
fluid, of  blood.                                           I
 " Ulceration near cardiac  end." Hughes.
  Hydrastis.  Sour eructations; dull aching,  causing a
weak, faint,  gone feeling;  cutting pains, with oppression
and  sense of weight; acute, distressing pain, with  nausea,
acidity and loss of appetite.


                SPECIAL REMEDIES.

  Atropine.  " No medicine better to  subdue  the frightful
cardialgic  pain of ulcer of the stomach."   Baehr.
  Ipec.,  Ham.. Kreas.   For haemorrhage.
  Opium.   Perforation.    "The  only favorable  recorded
terminations to  this event  are those  in  which  the opiate
treatment  was pursued."  Dr.  Wilson Fox. 
H3EMATEMESIS.                   45
   GENERAL MEASURES.  Complete cure possible  in
 all recent cases.  During severity of disease, absolute  rest,
 confinement to bed, maintain warmth of body.
   Diet.  In severe cases, give stomach absolute rest— nourish
 by nutrient  enemata—beef-tea and milk, or nutrient  sup-
 positories.  This treatment continued thirty days will  cure
 the most obstinate case.  Return to solid diet gradually—
 milk only  at first— then broths and gruels, and soft food.
 No sugar allowed.
   In other  cases,  milk-diet will accomplish desired result.
 Add lime-water, and a little boiled arrow-root to the milk.
 During the course of treatment let patient drink  occasion-
 ally a tea-cup of weak dilution of Calendula.
   Perforation.  Usually follows  a  hearty  meal.  Order
 absolute repose.   Give Opium, to  prevent  movements  of
 stomach.  Continue opium  treatment many days.
   Ha'inorrhage.   Rest, ice, and the indicated medicine.


                    IUEMATEMESIS.

           DIFFERENTIAL DIAGNOSIS.

                     Hjematemesis.    Hemoptysis.
 Blood   -    -    Dark    -    -    Bright red.
 Blood      -    -  Vomited    -    -   Coughed up.
 Blood      -    -  Fluid       -    -  Frothy.
 Blood mixed with  Food    -    -     Sputum.
 Preceded by  -    Nausea        -     Chest-pain.
 Preceded by    -  Stomach distress   Dyspnoea.
 Stools contain     Blood    -    -    No blood.
 Respiration     -   Clear       -    -   Rales in lungs.
   Ipec.  Sudden attack, with  great paleness of face  and
 nausea.  Vomiting of blood, or pitch-like substance. Inde-
 scribable sick feeling in stomach.  Pulse scarcely percepti-
 ble.   Fainting.
  •• Has  long-established reputation and  deserves  the preference."
 Hughes.                                                  f
  " There is no more efficacious remedy."  Baehr.
   Hamamelis.  Thin, dark  blood.  Fullness and gurgling
 in abdomen.  Blood in vomit and stools.
  "A number of excellent cures have been  reported." ■ Heinpel.
   Arnica.    From  mechanical injury or  over-exertion.
 Vomiting of dark coagula.   Soreness as if from bruise.
   Aconite.  Excruciating pains in stomach, gagging, retch-
ing,  gasping  for  breath; distressed  face, anguish,  cold
sweat on forehead.   With great vascular excitement, pulse
 full, bounding and rapid.
  Arsenicum.   Extreme   palpitation,  anguish,  violent
thirst, small, quick pulse, chilliness.
  Belladonna.  Congestion of head and stomach, singing 
46         KEY NOTES OF MEDICAL PRACTICE.

in ears, flickering before eyes, red cheeks, feeling of fullness
and warmth in stomach.
  China.   For secondary symptoms, after all bleeding has
ceased.

  GEXERALMEASURES.   Command  absolute rest in
horizontal position; loosen clothing, and keep patient quiet
and free   from  excitement.  Room  cool  and  airy.  Let
patient swallow small bits of ice, or,  in its  absence,  take
frequent sips of cold water.  Cold applications  over stom-
ach harmful; mustard-plaster  better.   Following the at-
tack, keep stomach at rest, nourish  by enemata.  The first
food must be cool,  and liquid.   No solid food  until  every
trace of pidsation  in epigastrium  has ceased.  Fainting
need  not   alarm—bleeding  stops, if patient faint.  Give
medicine  at frequent intervals.
                  SICK-HEADACHE.

  SYNONYM:   Gastric Headache;  Bilious Headache.

  Iris.   Sick-headache, beginning with  blur before  the
eyes, followed by  nausea and vomiting.   Dull,  heavy,
frontal headache, with continuous  nausea, and vomiting of
mucus and bile.
  In  " sick-headache"  this is a  most reliable  remedy.  Give  the
mother-tincture, ten  drops in a half-glass of water, a teaspoonful at
frequent intervals—every ten minutes. Your patient should experience
relief in twenty or thirty minutes.
  Ipec.  Headache as if brain and skull were bruised, even
to root  of tongue.  Intense and constant nausea.
  Nux  v.  Sick-headache brought on by wine, coffee, close
mental  application, sedentary  habits; begins  in morning,
increases through the day. with dimness of  vision, sour,
bitter vomiting, constipation, worse from noise,  light, after
eating.
•  Podoph. Bilious headache, beginning with blur before the
eyes, darting  pains in  forehead,  or, stunning headache
through temples, giddiness, flushed face, heartburn, nausea,
bilious vomiting, and diarrhcea.
  Chelidonium.  In bilious temperaments, darting, tearing,
throbbing pains in forehead and temples, with heaviness
and  coldness in occiput, accompanied by vertigo, anxiety,
melancholia, nausea, and bilious vomiting.
  " When clearly of hepatic origin."  Hughes.
  Bryonia.  Head aches as if it would split, made worse by
stooping or  motion.  Gets sick and faint on sitting  up.
Sour, bitter vomiting.
  Verat. alb.  Severe bilious  vomiting,  distressing  head-
ache, faiutness from violence of attack. 
HEADACHES OF FEMALES.
47
  Hep. s.  " A valuable remedy in chronic cases."   Laurie.
  Naja.  Temporo-frontal; dull pain.
  " A very valuable remedy." Holcombe.

             HEADACHES OF FEMALES.
  Sepia.   Disorders of sexual function; irregular,  scanty
menses, leucorrhcea. dark rings under eyes.
  Platina.  Plethoric,  animated  and  sensitive subjects;
dark hair, rigid  fibre;  menses profuse, accompanied by
colicky pains.
  Ignatia.  Hysterical  subjects, with disposition  to  con-
vulsions.  Headache periodical—passes off with flow of pale,
limpid urine.  Feeling  as  if nail were  being driven into
head.
  Cocculus. Reflex uterine headache. Menstrual colic, dull
headache, with vertigo and nausea.
  Actea.  Hysterical and menstrual headache; pain extends
to eye-balls, attended by faintness, and "sinking" at pit of
stomach.
                 DIARRIKEA-ACUTE.

               LEADING  REMEDIES.
  Aconite.  After checked perspiration, after cold or damp.
Frequent, scanty, loose, green stools, with tenesmus, fever,
and restlessness.
  Aloes.  Pain and rumbling in  the bowels before  stool.
E<c,ipe of great quantities of flatus with stool.  Constant
urging to stool.  Stool involuntary, with escape of flatus—
stool seems to pass without exertion—after stool sensation
as if more in rectum.
  Antimonium.  Stools watery and profuse, with disor-
dered stomach and white-coated tongue.  Alternate constipa-
tion and diarrhcea.
  " The gastric symptoms predominate."  Bell.
  Arsenicum.  Watery, mucous, or bloody discharge. Great
weakness,  faintness and rapid exhaustion, thirst and  rest-
lessness.   Burning in  rectum,  emaciation, pallor, sunken,
cheeks.  Stools watery,  fetid, painless.
  Apis inel.  Stools greenish, yellowish, slimy mucus, or
yellow watery.   Tongue dry  and slimy, little or no thirst.
Hands blue and cold.
  " The absence of thirst, existing with a dry tongue, and dry. hot skin,
are characteristic."  Bell.
  Bryonia.  Diarrh<jea  in hot weather,  stools brown, thin,
fecal,  or  containing undigested matter.  Aggravation  in
morning as soon as  he moves.
  Calc. carb.  Scrofulous subjects.   Distended abdomen,
with emaciation,  whitish or  watery  stools.  Chronic diar-
rhoea, with chalk-like stools.
  " The stools are of less importance than the person."  Bell. 
48         KEY NOTES  OF MEDICAL PRACTICE.

  China.  Frequent, watery stools, containing undigested
matter, with pinching  colic, occurring especially at night.
  Croton.  Yellow,  watery,  or  greenish-yellow  stools,
expelled with great force.
  "The three highly characteristic symptoms of yellow, watery stool,  ,
sudden expulsion and aggravation from food and drink, form a trio . «,
whose presence will make success certain and brilliant." Bell.
  Dulcamara. Stools  yellowish, greenish,  watery,  with
colic.   From " taking cold " in cold, damp weather.
  Gumm. gutt.   Yellow or green stools, mixed ivith mucus,
preceded by excessive cutting about  umbilicus.
  "One of the most important remedies in  the treatment of diarrhcea,
acute and chronic."  Bell.
   Ipec.  Stools as if  fermented,  green, with nausea and
colic.   Frequent stools of greenish mucus.
  " The continuous nausea is the most constant distinctive symptom of
Ipec."  Bell.
   Iris.   Bilious stools and  bilious vomiting, in hot weather,  j
with much exhaustion and debility.
   Merc.  Stools  slimy, brownish, whitish-gray, acrid and
burning.  Cutting, pinching pain in abdomen, with chilli-
 ness.  Bilious stool, preceded by  colic, followed by tenesmus.
   Phos. ac.   Diarrhcea  not debilitating, though of  long
 continuance.   Involuntary,  with   emission of   flatus.
 Stool thin, whitish-gray.
  " One of the most prominent  remedies for white, watery diarrhcea,
 acute or chronic." Bell.
   Podoph.    Early   morning   diarrhoea,  stool  frequent,
 painless, yellow liquid, with meal-like sediment.
   Sulphur.   Diarrhoea  some  hours  after   midnight,  or
 driving  patient out of bed early  in the  morning.  Stools
 pappy, greenish-yellow, fetid, slimy.
   " Very wide range of action.  Early morning diarrhcea very charac-
 teristic."  Bell.
   Verat. alb.  Diarrhcea, violent, painful,  copious, with
 profuse perspiration.   Stools watery, sudden, involuntary.
   " A remedy of great value and very often required.  It is useless in
 painless cases."  Bell.
   CHRONIC DIARRHCEA.  Ars., Calc. c, China. Ferr.,
 Gum. g., Hep. s., Lye, Phos., Phos. ac. Podo.,  Sulph.

   GENERAL .MEASURES.  Those who are subject  to
 diarrhoea  should  wear flannel  bandage  about abdomen,
 wear warm clothing, avoid exposure to wet and cold, keep
 feet dry.  Look to drainage and see that there is no sewer-gas
 in dwelling.  During acute attacks, absolute rest in bed.
   Diet.  In acute attack, the less food the better. Avoid the
 use of solid food, liquors, coffee, strong tea, fruits  or vege-
 tables.   No potatoes.   Let diet consist of milk and lime-
 water, broths, gruel, rice (well-cooked), barley-water, whey,
 panada, beef-tea, with teaspoonful isinglass to the half-
 pint.   In chronic, nourishing, but  simple  and  easily- 
DYSENTERY.
49
digested food—fresh meat, mutton, beef, soft eggs.  Milk-
diet good.  Avoid salt and cured meat, pork, veal, and fresh
vegetables.

                     DYSENTERY.

                LEADING  REMEDIES.

  Merc. corr.  Distressing,  persistent  tenesmus, and cut-
ting,  colicky pains.  After stool burning and tenesmus of
rectum and bladder.  Urine scanty, hot. bloody, or sup-
pressed.  Stools—frequent,  mucus  mixed with blood,  or
almost pure blood.
  " May safely be regarded as specific remedy for whole process."
Baehr.   " Applicable when occurring in great intensity, and accompa-
nied by the characteristic urinary  symptom V  Bell.
  Aconite.   Early in  attack, with  fever, dry  heat,  great
restlessness.  Stool,—bloody, slimy,  scanty, frequent, with
tenesmus.  Dose:—"The lower attenuations are to be pre-
ferred."  Hempel.
  " In very beginning often able to cut short dysentery." Bell.
  Belladonna.   Violent fever, retention  of urine,  severe
gastric derangement, nausea and vomiting. Violent urging,
scanty  discharge  of slimy,  bloody  stool, with tenesmus;
abdomen distended, hot  and  painful; spasmodic, clutching
pains.
  " Often the only remedy required for severe cases of infantile dysen-
tery."   Bell.  "Next to Mercurins the most  important remedy in
dysentery." Baehr.
  Aloes.  Loud gurgling in abdomen.   Before stool, sen-
sation of fullness and weight  in pelvis: after stool, faintness.
Stool,—bloody, jelly-like mucus.  Tenesmus very severe.
  " One of our mo-t valuable remedies in dysentery." Bell.
  Cantharis.  Stool of  blood and  mucus,  like scrapings
from  intestines.  With  stool, cutting  in abdomen; after
stool, shiverings.   Scanty urine and  tenesmus  of bladder.
  " A] ipearance like scrapings of the intestines is the most character-
istic symptom of Cantharis.'1'' Bell.
  Capsicum.   Stools of mucus, streaked with black blood.
Cutting colic, tenesmus, drawing pains in back.  Drinking
causes shuddering.  Tenesmus of bladder, strangury.
  "Oneof the royal remedies for dysentery."  Bell.
  Arsenicum.  Stools dark,  bloody, acrid and excoriating,
with tenesmus and burning in anus  and  rectum, and great
prostration.  Called  for when case is  far  advanced, dis-
charges dark and fetid, prostration extreme.

               SPECIAL   REMEDIES.

  Color.  Very severe colicky pains.
  Dnlc.  Autumnal,  from cold and wet.
  China.  Intermits; returns periodically. 
50         KEY NOTES OF MEDICAL PRACTICE.

  Colch.  Jelly-like, skinny stools; autumnal.
  Podo.   Prolapse of bowel with every  stool.
  Sulph.   After violence of attack has passed.
  Rhus.  Low fever, involuntary, thin, at night.
  Arn.  Tormina, tenesmus, much haemorrhage.
  Ipec.  Much nausea and vomiting; bloody stools.

  CHRONIC DYSENTERY.   Nitr. ac, Phos. ac, Sulph.,
China, Calc.-carb.

  GENERAL MEASURES.  Absolute rest in bed.  Keep
disinfectants, sulphate-of-iron  and carbolic acid, in bed-
pan.   Dispose of discharges with antiseptic  precautions.
Preserve free ventilation. Change sheets and clothing daily.
If distressing tenesmus,  enema consisting  of two ounces
boiled starch containing thirty drops  Laudanum, or five
grains  chloral-hydrate.   Suppository containing one-half
grain  alcoholic  extract  Belladonna,  also  excellent.  Hot
fomentations to abdomen often relieve pain.  Free  injec-  i
tions of hot water will relieve the distress accompanying a  *
severe attack of dysentery, and help cut short the disease.
Chronic.—Keep abdomen warm by flannel  binder.   Avoid  J
cold and wet.  Warm  clothing.  Remove  from  malarial
district.
   Diet.   Cold drinks  often  aggravate  the  colic.  Simple
diet—scraped meat, milk,  gruel, barley-water, rice-flour
gruel.  Avoid solid foods, fruits, vegetables, and stimulants.


                     PERITONITIS.


                  ACUTE IDIOPATHIC.

   Aconite.   From cold, with predominance of  febrile
 symptoms.  Burning, cutting, darting pain in bowels.
  " Indispensable."  Hughes.    " The principal remedy." Jousset.
   Belladonna.  Severe congestions of head and chest; with
 anguish, dyspnoea, restlessness, dark-red and  bloated face;
 continual distressing  vomiting  of  bile, alternating with
 retching.  Intestines distended, so that  convolutions can be
 felt.   Also, for  the vomiting, in later stages.
   " Suitable only at the commencement." Baehr.
   Bryonia.  Stage of  exudation; stitching, lancinating
 pains in bowels, worse from slightest motion; tongue white
 and dry; great thirst; bowels constipated.
   " When primary fever relaxes, and effusion threatens."  Hughes.
   Mercurius corr.  Frequently exacerbating  fever, with
 oreeping chills, and copious  perspiration  after the heat.
 Peritonitis secondary to wounds and operations  on abdo-
 men.   Tendency to purulent effusion.   Abscesses.
   " Has high curative power."  Hughes. 
                   PERITONITIS—COLIC.                51

   Voratrnm alb.  Copious and  frequent vomiting,  face
 pale and sunken, skin cold, pulse  small; anguish, restless-
 ness and distressing thirst.
   Coloeyntll.   Diarrhoea, with rectal and vescical tenesmus,
 with or without colicky pains.
  " Circumscribed peritonitis, from extension from abdominal organs."
 Jousset.
   Opium.  Great  distention of  abdomen; retention of
 stool and urine; complete  inactivity  of bowels; paralytic
 weakness of intestinal canal, remaining after disappear-
 ance of  the exudation.
   Arsenicum.  Sudden sinking of strength; cold, clammy
 perspiration; restlessness, thirst, constant vomiting; burn-
 ing in abdomen.  Also, later, when copious and persistent
 exudation.
   Sulphur.   To excite and promote absorption of the ex-
 udation.

   GENERAL  MEASURES.  Warm fomentations; or, in
 some cases, cold compresses do more good than hot.  Keep
 patient at perfect rest, and avoid all mental or  emotional
 excitement.   Keep room well ventilated and at even tem-
 perature.  Sometimes necessary to  remove  even weight of
 bed-clothes from  abdomen, by  barrel  hoops, or  suitable
 contrivance.  Turpentine stupes over  abdomen.
   Diet.   For intense thirst of early stage, give bits of ice.
 Ice swallowed sometimes relieves vomiting.   As appetite re-
 turns, give food which will leave but little fecal residue. If
 much exhaustion, broths and nourishing food.   Return to
 diet of  solid food, very gradually and cautiously.


                         COLIC.

  Color.  Extremely severe, cutting, griping, intermittent,
 abdominal cramps, causing patient to  bend double, with
 much moaning and complaining.
  Chamomilla.  Flatulent colic, the  abdomen much  dis-
 tended.   Flatulence  passes in  small  quantities,  without
 much relief.   Pinching, twisting pain.  Great impatience.
 Children want to be carried.
  Nux  vom.  Flatulent  colic from indigestion.  Cramps
 in stomach, with upward pressure.   Cutting, pinching pains.
 Frequent urgings to stool without effect.
  Iris vers.   Severe flatulent colic, with sickness of stom-
 ach, and headache.  This remedy will often help when others
 fail.
  Plumb.  Violent, constrictive, pinching pain in region of
navel.   Retraction and hardness of abdomen.  Flatulence
and obstinate constipation.  Face and skin pale, bluish or
yellow.   Chronic enteralgia. 
 52         Kfc.1 NOTES OF MEDICAL PRACTICE.

   Opium.   Great accumulation of gas in intestines,  with
 great  distention of abdomen, and catting,  pressive and
 twisting pains.  Complete inactivity of intestines.
   Dioscorea.   Sudden attacks, with vomiting of food. Pain
 changes from one part of abdomen to another, with much :
 rumbling.
   COLIC:—
     Indigestion.   Xu.r v., Puis., Ipec. Ars.
     Infants.   Cham., Bell., Cina, Ipec, Iris.
     Bilious.   Merc, Ipec, Podoph., Dios., Iris.
     Flatulent.  Nux v.. Cham., Lye. Dros., Iris.
     Nervous.   Coloe, Bell., Ign., Opium, Plumbum.
     Rheumatic.  Verat. alb., Dulc, Bry., Puis., Rhus.

   GENERAL MEASURES.  If stomach contain a mass
 of indigestible food, give warm water  and salt, tickle back
 of throat, and produce emesis.  Drinking large quantity of
 warm water often relieves.  Place patient on left side,  with
 hips raised, and  give  copious  injection of  warm water.
 Retain  as  long as possible.  Apply  hot fomentations to
 abdomen.

                    LEAD-COLIC.

  REMEDIES:— -Opium, Platina, Alupiina. Belladonna, '
 Arsen icum, Stra mon i um.
  Opium.   Retraction of abdominal muscles, slow pulse,
 obstinate constipation.
  "A most valuable specific."  Baehr.  "Soon gives relief." Hughes.

  AFTER-EFFECTS.  Strain.   Paralysis.   Bell.   Am-
 aurosis.

  GENERAL MEASURES.  In  acute attack,  give  free -
 milk-diet,  and let patient drink large quantities  of  soft
 water.   Use copious warm injections.  Warm baths.
  Workers in  lead should  bathe  and wash carefully,  and
 change linen frequently.  Do not eat in workshop. Keep
 up free ventilation.  After  one  attack change of occupa-
 tion only will exempt from repetition.

                   CONSTIPATION.

  Sulphur.  Hard, knotty stools, accompanied by haemor-
 hoids, followed by burning pain in anus and rectum. Flushes
 of heat, frequent weak, faint spells.   Good  with  which to
 begin treatment.  The improvement begun under Sulph.
 must be followed by some other remedy.
  Nux voni.  For those of sedentary habit, high livers, and
 after abuse of drugs.  Frequent, ineffectual urging to stool,
which is large, hard, and passed with great difficulty.  Dys-
pepsia and haemorrhoids.  Often acts well after Sulphur.
V 
53
   Opium.   Complete torpor of bowels.  Stools  hard and
 lumpy.   Headache, drowsiness, dizziness, congested  face.
 Abdomen much distended, with almost complete paresis of
 intestines.
   Plumbum.   Stools of  small,   hard  balls.    Frequent
 attacks of violent colic.  Retraction of abdomen.   Sense of
 constriction of sphincter ani.
  " The chief indication for the use of Plumbum, in constipation is the
 constant presence of a spasmodic or colic-like pain."  .1 C". l\>pe.
   Hydrastis.   Headache and  haemorrhoids.  Severe  pain
 in  rectum  after stool for hours.   Especially useful  after
 abuse of purgative medicines.  Dose:—Drop  of mother-
 tincture, once  daily, before breakfast, for a week.
  "Hasbeen curative of constipation more frequently than any other
 remedy."  Hughes.
   Platina.  Difficult expulsion of soft stool.   Frequent
 urging, great straining, passing but small quantities; putty-
 like stool, sticking to the  anus.  Constipation  while  trav-
 eling.
   ^-Esculus.  Dryness of rectum, feeling as if full of small
 sticks.  Painful hasmorrhoids, with severe backache.
   Lycopodium.  Stools hard, scant, and passed with great
 difficulty.   Ineffectual  urging.   Acidity and heartburn,
 loud rumbling and gurgling in bowels.
   Graphites*   Stools large, hard  and knotty.  Tendency
 to cutaneous disorders.
   Nitric acid.  Stools  hard,  dry  and scant,  and  passed
 without pain.  Headache; sour or bitter taste after eating;
 sour eructations, excessive  flatulence.
  " In the front rank of remedies for constipation."  Dyce Brown.
   Ignatia.   Constipation  with prolapsus  of  rectum on
 slight effort to evacuate;  creeping, itching sensation in
 abdomen.
  Bryonia.  Hard, large, dry stools; chilliness;  pain about
 the liver; rheumatic  tendency, accompanied by symptoms
 of indigestion; frequent eructations after meals; headache.

  GENERAL  .MEASURES.  Drink a goblet  of oatmeal-
 water every morning on rising.  Avoid tea and  coffee.  Let
 the diet  consist largely of  coarse  meals, succulent vegeta-
 bles and  juicy fruits.   Eat brown bread rather  than white.
  Diet.   Avoid:—Tea. coffee, wine, beer, pork, veal,  salt-
 meats, cheese,  beans, cakes, pastry, pickles, biscuit, fresh
bread, muffins, griddle-cakes.
  Eat: —Mush, hominy, oatmeal, wheaten-grits,  corn-bread,
greens, cresses, squash, turnips, spinach, cabbage, tomatoes,
asparagus, cauliflower, figs, pears, prunes, peaches,  apples,
oranges, melons, grapes, cherries, berries. 
54         KEY
                   HEMORRHOIDS.

   %           LKA1HX<; REMEDIES.

  -Esculus hip.  Haemorrhoids like ground-nuts, of a pur-
ple color, very painful,  with  burning sensation.   Itching,
burning  pains, with sensation of fullness and dryness of
rectum.  Slight haemorrhage.   Severe aching pains in back.
Constant and severe backache, extending  to sacrum and
hips.  Stool  hard and dry, passed with  difficulty, followed
by sensations of  constriction, fullness, dryness, and prick-
ing pains in  rectum.
   Almost specific." Hughes.
  Hamamelis.  Profusely bleeding hemorrhoids.  Burning,
itching and rawness of anus.   Weakness of  back—feels as
if it would break.   Discharge of large  quantities of dark
blood.
  " Never fails  in true varicosis."  Hughes.
  " In excessive haemorrhage a certnin remedy." Jousset.
  Aloes.  Haemorrhoids, with  flow of hot, blackish blood.
Haemorrhoids protrude, like bunch of grapes, with constant
bearing down in rectum.  Great heat and tenderness of the
tumors, relieved  by cold water.  Heat in bowels, and heat
and painful pressure in liver.   Painful inflammation of the
tumors.
  Collinsonia.   Blind  or  bleeding piles,  with  sticking
pains  in rectum.   Obstinate  and  habitual  constipation,
stools  lumpy and light-colored.  Uterine disorders.  Con-
gestive inertia of lower bowel.
  "In constipation and haemorrhoids I prefer it to Aloes." Hughes.
   Nux voin.  For blind or bleeding piles.   From abuse of
spirituous liquors, or sedentary habits.  Bleeding, burning.
and frequent protrusion of the piles.  Abdominal plethora.
Tearing, pressing, bruised pain in small of back.  Habitual
constipation.
  Sulphur.   Bleeding, burning,  and frequent protrusion
of the piles.   Stinging, burning and soreness, in and about
anus.  Itching^and  tenesmus after a  soft or  bloody stool.
Alternate  constipation  and discharge  of  blood-streaked
mucus.
                SPECIAL REMEDIES.

  Caps.   Burning and itching.
   Ferr.   Cachectic constitutions.
  Aeon.  Inflammation of tumors.
  He]), s.  Chronic hepatic affection.
  Pod.  Portal congestion, bilious subjects.
  Ars.  Emaciated subjects.   Burning pain.

  GENERAL  MEASURES.  Avoid soft cushions, and
feather-beds. Sedentary habits bad.  Correct uterine elisor- 
ENTOZOA.
55
ders.  Make a habit of going to stool shortly before bedtime.
Injections  of cold water beneficial.  If piles inflamed and
tender, anoint with Aconite cerate, and sit over steam of
hot water.
  Ointment of Boracic acid and Vaseline has magic effect
in relieving itching piles.
  Make cerate, or suppository, containing  mother-tincture
of JEse, Ham., Aloes, Collin.,  or other indicated  remedy,
and use locally.
  Diet.  Avoid  coffee,  peppers,  spices,  stimulating or
highly-seasoned  food, beer, wine, spirits, and  do not  over-
eat.   During attack, no meats. Vegetables and fruits best.
EXTOZOA.
                   TyENIA  SOLIUM.

                    (TAPE-WORM.)

  Pepo semen.  Take one  ounce of pumpkin  seed,  the
shells having been removed, mash it up and make an emul-
sion with milk.  Take  this dose at bedtime, after  having
fasted from breakfast.  In the morning take a tablespoon-
ful of castor-oil, abstaining from breakfast.  Use one-half
this dose for children under twelve.

  Filix mas.   I?. 01. Filic. maris        3j.
                  Mucilag.
                  Glycer.  aa           3ij.
                  Aqua. dest.            §j.  Mix.
  Dose:-—Give in four doses, fasting, and follow by castor-
oil.
  Or, give  drop doses Male  Fern, every four hours, and a
dose of Merc, con: night  and morning.   Continue  several
days.
  Puniea granatum.   Take of Pomegranate root (Granat.
rod. cort.) two ounces, put into one quart of water, macerate,
and boil down to one-half the quantity.  Dose:—two fluid-
ounces every half hour, after having fasted.
  Rottlera tinctoria.   Give two or three teaspoonfuls of
tincture, after twelve hours'  fasting.  A dose of  Castor oil
may be given if no purgative action follow the  taking of
the medicine.
  " This is the pleasantest, safest  and surest remedy with which I am
acquainted."  Lewis Sherman. 
   r,(5         KEY NOTES OF MEDICAL PRACTICE.

                ASCARIS  UMBRICOIDES.

                      (ROUND-WORM.)

     Santonine.  Give two-grain doses of -*x trit. every three
   hours.   This is a genuine specific for the round worm. For
   young children use Cina.
     The symptoms indicating  the  presence  of  worms, and
   calling for this remedy, are-  Boring at the nose, livid cir-
   cles about the eyes, slight fever, fretfulness and  ill-temper,
   short, hacking cough, coated tongue, bad breath,  tossing
   and uneasiness, or crying out in sleep, nausea and Vomiting,
   capricious appetite, itching  of nose and anus,  the urine
   white and thick; sometimes convulsions.
     Merc.  corr..  Ant.  crud..  Stannum.  The  existence of
   worms is usually accompanied by an unhealthy state of the
   mucous  membranes of the intestines, which secrete a large
   quantity of tenacious, slimy mucus.  To correct this  con-
   dition Mere corr.,  Ant.  crwl. or  Stannum, the  principal
   remedies, must be given, when the worm-symptoms will all
   disappear.

               OXYURIS VERMK CLARIS.

                       (PIN-WORMS.)

     Tenormin.  Thread-worms, with much itching and irrita-
ticttion about the anus, especially troublesome in the evening;
deddepraved or capricious appetite,  pains in the  epigastrium,
pijpicking at the nose, offensive breath, straining at stool, dis-
tutturbed sleep and general restlessness.
     L'U'd  should be applied locally — it relieves the irritation,
deddestroys the worms and stops their breeding.
             DISEASES  OF  THE  LIVER.


             CONGESTION  OF THE  LIVER.

     Podophyllin.  Feeling of  fullness  in right side, with
accacute pain in one spot. Active congestion, with  pronounced
bi I bilious symptoms.   Diarrhcea, prolapsus  ani, bitter taste,
sae sallow complexion.
     "When ' bilious' symptoms predominate, be-t remedyi"  Hughes.
     Leptandrin.  Aching pains  in  liver,  yellow-coated
to t tongue, profuse, papescent,  tar-like, very fetid  stools, con-
st t stant dull pain in region of  gall-bladder.  Much soreness in
htlhead and eyeballs. 
HEPATITIS.
57
   Iris.   Pain over liver, crampy pain in back, flatulence in
 bowels, griping pains, headache, vomiting, lassitude, pros-
 tration.  Excites the biliary secretion.
   "A specific remedy."  Hughes.
   Sulphur.  Chronic cases, hepatic cases from portal en-
 gorgement.   Constipation, or,  early morning diarrhcea.
 Frequent weak faint spells, with flashes of heat.
   " A remedy of great value." Hughes.
   " In chronic, holds the first rank."  Baehr.
   Sepia.   Replaces Sulphur in women at climacteric.
   Chrlidoniuin.   Chronic congestion. Constant pain under
 inner angle of right shoulder-blade,  sallow skin,  yellow-
 coated tongue, dull headache, constipation, fullness in region
 of liver.
   " Has high  value as a hepatic remedy."  Hughes.
   Nux V.  Enlargement and induration, shooting, pulsative
 pains, excessive tenderness in region of liver, pressure in epi-
 gastrium and hypochondria, with shortness  of  breath and
 constipation.  Active congestion from excess of stimulat-
 ing food or alcohol.
   Lachesis.  Acute pain in liver, extending towards stom-
 ach.  Cannot  bear  any  pressure  about  hypochondria.
 Suitable in obstinate cases of drunkards.
   " Cured a very severe case of chronic congestion, with jaundice and
 pain." Jousset.

   GENERAL MEASURES.  Often caused by atoo-abun-
 dant, highly-seasoned, and stimulating diet, and alcoholic
 drinks. Hence these must be avoided.  Observe regularity in
 hours of meals, eat  light,  avoid  tea, coffee, and " hearty "'
 food, and stimulants.

                      HEPATITIS.

   PROGNOSIS.   Grave.   Unfavorable:—Abscess: emaci-
 ation; hectic:  hepatitis following dysentery.  Most recov-
 eries follow discharge of abscess through lung; next, intes-
 tine, intercostal space, cavity of pleura, abdominal wall,  in
 order given, the latter being almost invariably fatal.  When
 air obtains  free access to cavity  of hepatic abscess, favor-
 able result seldom  follows.  Multiple  abscess unfavorable.

               LEAD1XG REMEDIES.

   Aconite.   Beginning  of  attack—violent  inflammatory
fever, with insupportable, shooting pains in region of  liver,
 tossing and great restlessness.
   Belladonna.   Oppressive pain in  region  of liver, ex-
 tending to chest and shoulders; distension  of epigastrium,
 with difficult and anxious breathing,  congestion of head.
 obscuration of sight, sensation of fainting, violent thirst.
 sleepless tossing about, nausea, retching, distressing vom- 
5K         KEY NOTES OF MEDICAL PRACTICE.

iting.  continued fever,  with high  temperature.   No  use
after local pains abate.
  " Better adapted to this diseuse than Aconite." Baehr.
  Mercurius.  Fullness  and swelling in region  of liver,
with pricking, burning, oppressive pain, preventing pa-
tient's lying on right side, worse on movement of the body;
pain  in shoulders,  anorexia,  agonizing  thirst,  jaundice,
shivering,  sometimes followed  by sweating, but  without
relief.   Acute parenchymatous inflammation.
  " Mo>t important remedy in worst forma of acute  parenchymatous
hepatitis." Baehr.
  Bryonia.  The pains  in region of liver  are  sharp  and
shooting, with tension  and burning, increased  by touch,
coughing or respiration, especially  during inspiration,  and
much  increased  by motion.  Violent,  spasmodic oppres-
sion of  chest, rapid  and anxious  breathing, bitter taste,
yellow-coated tongue, constipation, severe headache.  Sub-
inflammatory cases.
  Hepar s.  For threatened abscess, or, after suppuration
has begun.

  GENERAL MEASURES.   When  abscess has  been
made  out, evacuate with aspirator.


                      JAUNDICE.

  Aconite.  Fever, stitches  in liver, yellow skin,  scanty,
dark  urine,  clay-colored stools, local pain,  inflammatory
symptoms.  Or, prostration, vomiting, oppression of chest,
blue nails, cadaverous countenance, cold extremities, feeble
pulse, collapse.
  " Has cured some malignant cases." Jousset.
   Mercurius.  Duodenal catarrh, with extension of the in-
flammation to bile  ducts.   Complete jaundice.   Skin very
yellow, thickly-coated,  flabby  tongue, nausea,  vomiting,
loathing of food, grayish-white feces, diarrhoea, tenesmus,
urine scanty and dark-red.  Pain in region  of liver. Icterus
 neonatorum.
  " One of the most frequently indicated remedies, with  or without
 fever."  Raue.
   Chelidonium.   Yellowness  of  eyes and  skin,  pain in
 liver and right shoulder, bitter taste, tongue clean, of deep-
 red color, stool white, urine dark  red, region of  liver dis-
 tended and painful.
  " No better remedy."   Hale.
   China.  Gastro-duodenal catarrh, particularly after great
 loss of animal fluids,  or in malarial jaundice.  Oppressive
 headache, perverse  appetite, with  canine  hunger, dingy-
 yellow  complexion;  liver swollen, hard  and tender,  with
 spasmodic, stitching  pains.
  " Recurrent form."  Lilienthal. 
CALCULI—BILIARY.
."")!J
    Hydrastis.   Gastro-dnodenal catarrh,  sense of  sinking
  and prostration at epigastrium, with violent and continued
  palpitation of heart.
    Podoph.   Enlargement of liver, with severe pain, urine
  scanty and  dark-yellow, stools  clay-colored,  nausea and
  vertigo.   In  complication  with gall-stones.   Duodenal
  catarrh.
    Arsenicum.  Malignant jaundice, the bile decomposed,
  poisoning the tissues; black or bluish patches on the skin
   " E-pecially  valuable when from disorganization of  the liver"
  Hempel.
    Phosphorus.  Malignant cases, nausea,  epigastric ten-
  derness, numbness of extremities, liver swollen and very
  sensitive  to  pressure; chills, pulse weak  and low;  drowsy,
  comatose condition.  Acute hepatic atrophy.
    Nitric ac.  Chronic jaundice, enlargement and  indura-
  tion of  liver,  obstinate constipation,  fetid, dark-colored
  urine,  sharp  pain in pit of stomach.
    Sulphur.  Chronic, organic disease of liver.
    N tix vom.   Chronic constipation,  sedentary and intem-
  perate habits.
    Chamoniilla.  Acute, from fright or anger.
    Crotalus.   Malignant.  Typhus icterodes.
    Iodine.  Chronic, and after abuse of Mercury.

    GENERAL MEASURES.   Hot fomentations to relieve
  pain.  Warm clothing.   Light diet,  broths, roast-apples,
  vegetables.   Plenty of water.

                 CALCULI—BILIARY.

   Berberis.   Pain, soreness and burning  in the  biliary
 tracts,  with tendency to gall-stone.  Also to be given at the
 time of the attack, for pain attendant  on the passage of
 gall-stone.
   Arsenicum.   Severe attacks, the patient  pallid and ex-
 hausted, covered with cold  sweat, the syncope interrupted
 only  by  efforts to vomit.   Give this  remedy  to excite
 reaction.
   (ale. carb.:!u   Give frequent doses every fifteen minutes,
 during  paroxysm, to relieve pain.
  "Dr. Drury's recommendation led me to try it.  The effect of this
 remedy in the next case I had was something marvellous, and it has
 never  failed me since.  Drs. Bayes and Dudgeon have also borne testi-
 mony to  its efficacy."  Hughes.
   China.  To correct  tendency  to formation.   "I  give
 usually  China 6x, six pills twice a day, till ten doses are
 taken;  then six pills every other day,  till ten  doses  are
 taken, then every third day, till ten doses are taken,  and so
on, till  at  length the dose  is taken only once a month.   I
have  not failed to cure, in a single instance,  permanently 
60         KEY NOTES OF MEDICAL  PRACTICE.

and radically, every patient  with  gall-stone colic, who has
taken the remedy as directed.'"  Dr. David Thayer.
  Chel.  " Has cured numerous cases."  Hale.

  TO PREVENT RETURN.  China, Berb., Chel., Nux v.,
Pod., Mere, Sulph.

  GENERAL  MEASURES.  At time of attack  direct
efforts to moderate  the  pain and set free the impacted
calculus.  Apply hot fomentations, or chloroform-liniment.
A full, warm bath helps.  Olive oil, taken in large quanti-
ties, sometimes promotes easy passage of  the  stone.   In  J
severe  cases failure to relieve excruciating pain may neces-
sitate'  resort  to inhalations of Chloroform, or Morphine •■
hypodermically.    .                                     1
  Diet.  Eat sparingly of animal foods; abstain from use
of fatty and saccharine  substances.  Do not have meals at
too great intervals, as the gall-bladder should be frequently ;
emptied. Carlsbad  and  Vichy waters have proved curative, i
DISEASES  OF THE KIDNEYS.
                NEPHRITIS—ACUTE.

  Aconite.  Acute idiopathic, from cold. . High fever, rest-
lessness, dark, scanty urine, stitches in region of kidney.
  Cantharis.   High fever;  urine scanty,  high-colored,
bloody, passed drop by drop, with scalding, burning pain,
with tearing pains in loins.  Very useful in post-scarlatinal
and post-diphtheritic nephritis.
  Apis.  Renal pains, urine  scanty, albuminous.  Sudden
cedema.   Especially  useful  in  post-scarlatinal nephritis,
and the congestion of kidneys of pregnancy, with oedema.
  Terebinth.    Passage  of  scanty, dark   and  bloody
urine.  " Coffee-ground " sediment in urine.
  " Almost infallible in renal congestion."  Hughes.                1
  Belladonna.  Shooting pains from kidneys to bladder;  •
renal region very tender to pressure; urine orange-yellow,  ,
or bright-red, depositing a  thick  sediment.   Important
remedy for congestion of kidneys.
  Arsenicum. Urine scanty, dark-brown and albuminous.
Great thirst and  restlessness, pale, waxy  skin, cedema of
parts, or anasarca.
  " The best remedy in most cases of  post-scarlatinal nephritis.'"
Hughes.
  Hepars.   Threatened  suppuration.   Cessation of  the
acute pain, sensation of throbbing and  feeling of weicht 
                   BRIGHT'S DISEASE.                gj

in renal region; alternate chills and flushes of heat, followed
by perspiration.

  GENERAL MEASURES.  Absolute rest in bed.  Hot
fomentations to small of back.   Drink large quantities of
soft water.
  Diet.   Milk  and  vegetables, avoiding  meats and all
stimulants.

                 BRIGHTS DISEASE.

          PARENCHYMATOUS NEPHRITIS.

  PROGNOSIS.  Acute, often followed by recovery:  if it
reach second stage (Degeneration), recovery very rare; third
stage (Atrophy), invariably fatal.
  CAUSES  OF  DEATH.  Uraemia; meningitis;  peri-and
endo-carditis; pneumonia.

               LEADIXti  REMEDIES.

  Cantharis.  Early  stage.   Urine   scanty, albuminous,
high-colored, scalding;  aching  pains  across  the  loins.
Urine contains a large quantity of epithelial cells.  Head-
ache, delirium,  convulsions, coma.   Most useful  where
desquamation is considerable, and uraemia threatens.
  Terebinth.    Idiopathic   parenchymatous   nephritis.
Urine scanty, dark, smoky,  bloody.  Much albumen,  and
many blood-casts.  Anasarca. Of no use in unemia.  There
must be blood in the urine in order for this remedy to be
indicated.
  Arsenicum.   Large white  kidney.   Skin pale and waxy,
partial or general dropsy, puffy appearance  and debility.
1 line scanty, albuminous, containing fat-globules, renal
epithelium,  fibrin casts, and  a few blood-corpuscles.  In-
flammation  of serous membranes.                        r.„
  " Ca-t*s? of cure by this remedy are numerous and brilliant." Hughes.
  Phosphorus.   Chronic tubular nephritis.   Urine high-
colored,  high specific  gravity,  containing  albumen,  oil-
globules, and exudation cells.
  " The be-1 remedy in fatty degeneration."  Hughes.


             RED GRANULAR KIDNEY.

  PROGNOSIS.   A  cure may be effected in early  stage;
later,  patient may live for years, but finally fatal.

  CAUSES  OF DEATH.  Generally uraemia; may be from
complications—pneunomia, etc.
  Plumbum.  Cirrhotic kidney.  Headache,  dyspepsia,
cedema  of face  and ankles.   Urine -low specific gravity, 
 62         KEY NOTES OF MEDICAL PRACTICE.

 small percentage of albumen, hyaline and granular  casts,
 and a few blood-corpuscles.
  In 1876 I made a cure  in an undoubted case of incipient renal
 cirrhosis, using Plumbum met. 6x trit. alone.  The former patient is in
 good health at the present writing (1H83), and has remained so all these  ,
 years.   In numerous other cases, which,  however, were  already  j
 chronic when  coming under treatment, by  the same remedy the dis-  '
 ease has invariably been arrested in its rapid course, with improve-
 ment  of all symptoms, although the final result has, of course, been
 that to which the extensive and far-advanced defeneration must inev-  '
 itably lead.  In a case at present in my wards in Cook County Hospital,
 an apparent cure has been effected.*

                SPECIAL. REMEDIES.

   Ars.  Serous inflammations.
   Nux v.   Dyspeptic vomiting.
   Cactus.  Over-action of heart.
   Apocy.   For excessive dropsy.
   Merc. c.   Bronchitis in complication.
   Phos., Chel.   Intercurrent pneumonia.

   GENERAL  3IEASURES.   Adopt  measures  to  keep
 the  skin active, and  promote  free  diaphoresis.   Give  i
 vapor baths, or Turkish  baths, being careful not to  carry
 it to the extent of weakening  the  patient.  Use, also, salt-
 water and alcohol sponge-baths.  Let the patient be warmly
 clad, and avoid cold air, or  sudden lowering of  the bodily  '
 temperature.  Take plenty of open-air exercise.
   Diet.  Milk-diet best.  Let  patient gradually leave off
 all his ordinary food, until he reaches an exclusive  »u7ft-
 diet.   Begin by drinking a quart of milk a day, and  grad-
 ually increase the quantity  from  day to day until finally
 five or six  quarts are taken  daily.   Divide  the day into
 equal  periods,  and take  a  half-pint,  or pint  at a  time.
 Keep it up for at least  a month.

                 AMYLOID   KIDNEY.

  Amyloid degeneration of the kidneys belongs  to  a ca-
 chexia depending on tertiary syphilis or prolonged suppu-
 ration, and should be treated in accordance with the nature
 of the primary affection.
  RE3IEDIES.  Phos. ac, Nitr. ac, Merc, Kali iod..  Sars.,  ,
Sil.

                  CALCULI—RENAL.

  LITHIC ACID CALCULI.   Lye,  Nux v., Puis., Sars.,  '
Eup., Colch.
  Lycop.  Disorders of digestion  and  derangement of
liver.   Lithic acid crystals (red sand) in the urine.
  •Since discharged cured.                                   ~
J 
UR.EMIA.                     63
  Nux  v.   Disorders  of digestion from high living; con-
stipation.
  Diet  must be  carefully regulated.  It must be  simple,
digestible and moderate  in  amount.   Eat  sparingly of
meats—let the diet consist chiefly of vegetable food. If meats
be eaten, take  but very small quantity at any one meal.
Avoid rich and highly seasoned dishes, and take no cham-
pagne, spirituous or malt liquors.
  Regimen.  An abundance of out-door  exercise  highly
important,  to  supply system  with  oxygen.   Keep up
healthy action of skin by Turkish baths,  and daily  fric-
tions with flesh-gloves.  Drink large quantities of pure, soft
water.  Filtered  rain-water is superior to all others.
  PHOSPHATIC  CALCULI. Phos. ac, Aletris, Helonias,
Ignatia, China.
  Diet.  The diet should be  nutritious and simple.  Drink
freely of pure water.
  Regimen.  Exercise,  change of scene, and mental rest
important.   Attention to bladder important—do not let
urine be long retained, and  treat first  indications of  vesi-
C8.1 Cfvtfivrh.
  OXALATE OF LIME CALCULI.   Nitro-muriatic  acid,
 Uranium Nitrate.
   Diet.  Avoid the use of rhubarb, asparagus,  sugar, oils
and fats, and spirituous or malt liquors.  Drink no " hard"
water— i. e, water containing lime.
   Regimen as in previous form.
   Berberis  tinct.  Give during the attack of renal colic,
 to promote passage of stone.

   GENERAL MEASURES.  During passage of stone,
 the  intense suffering  of patient must  be relieved.  Apply
 hot  fomentations  over loins and lower   abdomen.   Put
 patient in hot hip-bath.  Give enema of starch  and Laud-
 anum', gtt. xxx. to  xl., and  let  patient  get effects of the
 opiate.  Inhalations  of Chloroform, if urgency demands.
 Subcutaneous  injections  of Morph. sulph.  Drink  large
 quantities of bland liquids  during the attack.  If it be an
uric-acid stone,  give liquor potassii citratis, f^ss, every
 three hours.

                       UR.EMIA.

   PROGNOSIS.  Unfavorable:  Setting in with great vio-
 lence; convulsions and coma; if kidney degeneration far
 advanced. Favorable: Those cases in which the impediment
 to the excretion  of the urine can be speedily removed.
   Cantharis.  Uraemia secondary to congestion or inflam-
 mation of the  kidneys.  Give  frequent  doses.  Tereb. if
 Canth. fail.
   Digitalis.  If heart's action weak. 
64         KEY NOTES OF MEDICAL PRACTICE.

  Apocynum.   Uraemia following  dropsy.  Administer
remedies subcutaneously if patient unconscious.

  GENERAL  MEASURES.   Resort  to every  possible
means to restore action of kidneys.  Hot compresses or hot
poultices over loins: hot pack, to promote diaphoresis.  If
there be any urine in bladder, use catheter.  If  it occur in
puerperal state, terminate labor  as soon as  possible.  For
convulsions, Morphine, gr. %—}.{ hypodermically, or I'otasii
bromid. per rectum. Free purgation  may  be procured by
Oleum tiglii, one drop on the finger, touched to back of the
tongue.
  Diet.   After attack give nourishing diet, especially a free
milk-diet.
DISEASES OF THE  BLADDER.
                CYSTITIS   ACUTE.

  Aconite.  Only when there is much  erethism  or  fever.
Dry, hot skin, thirst and restlessness; frequent and violent
urging to urinate, with burning in bladder.  Painfulness in
region of bladder.
  Cantharis.  Violent pains and burning heat in bladder.
Very frequent micturition, with tenesmus vesica:.  Burning
and cutting pains, so severe  patient screams  aloud.  Con-
stant  desire to urinate, with scanty emission of dark or
bloody urine.
  Belladonna.   Region of  bladder very sensitive.   Urine
hot and red.  Involuntary dribbling of  urine.  Great ner-
vous irritability.
  Camphor.  The best remedy for strangury, especially
useful if the attack was brought on by toxic doses of Cmi-
tharides.
  Cannabis.  Especially gonorrheal cystitis. Its  symp-
toms are similar to those of  Cantharis, but less intense.  It
may be given  in acute cystitis if improvement  does  not
follow the use of the former in twenty-four hours.


                CYSTITIS- CHRONIC.

  Chimaphilla.  Dysuria, with mucous  sediment in urine.
  " The best remedy in the chronic form."   Ruddock.   "I  have often
used it with advantage.  From one to live drops of the mother-tincture
seems to be the most suitable dose."  Hughes. 
ENURESIS—HEMATURIA.
65
  Mercurius.  Fever, with chilly creepings and great sen-
sitiveness in region  of bladder.  Urine turbid, fetid, con-
taining pus.  Also in gonorrhceal cystitis.
  Sulphur.  Obstinate chronic cases, urine very fetid.
  CONSULT—Dulc, Senecin, Apis, Puis.

  GENERAL MEASURES.   Acute.—Hot hip-bath,  or
hot fomentations, with absolute rest in horizontal position.
Chronic.—Great benefit often  follows washing  out the
bladder.  Use small quantity of water at blood-heat, lightly
colored with Hydrastis tinct.   Force it in gently and slowly.
The best, method is to use a fountain syringe, with a flexible
soft-rubber catheter.  This can be usedj for either male or
female patients.
  Diet.  Prescribe a diet which shall keep the urine as free
from solids as possible.   In  acute cases eat but little meat,
and avoid the use of all  slimula?its, wine, spirits, beer, tea,
coffee, spices.  Drink large  quantities  of pure soft water,
such as Poland or Waukesha water.  Filtered rain-water is
best.

                      ENURESIS.

  Sulphur.  Nocturnal enuresis, copious discharge.
  " Should begin the treatment of every case." Jahr.
  Belladonna.  Paresis of sphincter vesicas; may be neces-
sary to give several drops of mother-tincture as a dose, for
children.
   Causticum.  Involuntary  passage  of  urine  at night
when sleeping.  Passage of  urine when coughing or sneez-
ing.
   Equist»tuin.   Has proved  curative in many cases of noc-
turnal enuresis.
  Cina.  When  traceable to  worms.

  GENERAL MEASURES.   Child should sleep on hard
mattress, with light covering.  Avoid  hot drinks and highly-
seasoned food, late in the day.


                     HEMATURIA.

  Terebinth.  The blood intimately mixed with the urine,
which  has  a  dirty,  brown-red, or  even  blackish color.
Burning and drawing pains  in kindeys, spasmodic urging
and pressing in region of bladder.
  " Occupies the first place."  Hughes.
  Cantharis.   Violent, cutting, pressing and crampy pains
in the  bladder,  extending into  the  urethra and  kidneys;
strano-ury and burning.   Blood discharged drop by drop.
  "One of the chief remedies."  Hartmann.
     3 
1
66         KEY NOTES OF MEDICAL  PRACTICE.

  Millefolium.  Pain in renal region, chilliness; the blood
forms a sediment in bottom of vessel, like a bloody cake;
pressive pain in urethra during flow of blood.
  " Has been used successfully."  Hering.
  Hamamelis.  Haemorrhage  from passive congestion of
kidneys, with dull pain in renal region.
  Belladonna.  Renal hyperaemia from cold.
  Nitric ac.  Active haemorrhage after Mercury; tenesmus
vesica?- after micturition.  Dissolution of blood corpuscles.
  Arsenicum.  Urine scanty, very  dark,  mixed with  pus
and blood, and rapid decomposition  of  it in the vessel.1
Wide-spread burning  pains in  urinary organs.
  " Efficient in both acute and chronic." Baehr.
  Camphora.  Hcematuria after excessive use  of canthar-
ides.

  GENERAL  MEASURES.  Absolute  rest;  promote ,
action of skin by vapor  baths; let patient  drink large j
quantities of soft water; copious injections of  warm water'
often afford great relief.   When bladder is filled with thick
clots  of blood, which cannot be passed, or drawn through a
catheter, force into bladder two ounces of warm water, con-
taining in solution, five drops of  Hydrochloric acid  and
sixteen grains of  Pepsin;  in  a few  hours the contents of
bladder will readily pass through the catheter.
  DISEASES  OF  THE NERVOUS SYSTEM.

          HYPEREMIA  OF  THE BRAIN.

  Belladonna.  Face red and congested, injection of con-
junctivae, photophobia, extreme sensitiveness to the slight-
est noise,  sudden starts and jerks, general hyperaesthesia.
Tendency to delirium.                                  \
  Veratrum  vir.   Cerebral hyperaemia  accompanying
febrile conditions.   Headache, violent throbbing  of  the
carotids, sensitiveness to sound and light, flushed face, ting-
ling and prickling in the lower limbs, full,  hard, bounding
pulse.
  "One of  the  most powerful remedies for cerebral hypersemia."
Baehr.
  Aconite.  The result of cold, or violent emotion, with
hot, dry skin and great excitement of the circulation.
  Gelsemium.  Passive hyperaemia, and hyperaemia occur-
ring during dentition.
  Glonoin.  Sudden and  intense  congestion, with violent
headache; absence of fever.
  Arnica.  When from injury. 
                   CEREBRAL MENINGITIS.               67

                CEREBRAL  MENINGITIS.

    PROGXOSIS.  Grave-   Unfavorable:—Tonic spasms;
  difficult deglutition;  incontinence of faeces and urine; ster-
  torous respiration; stupor and coma.

                 LKADIXG ltRUCDIF.s.

    Aconite.   In the initial stage;  fever, dry, hot skin, great
  arterial tension,  face red and  bloated, burning in brain,
  with sensation as if it were moved by boiling water.  Great
  restlessness and anxiety.
   " As soon as pulse becomes slower, and symptoms of exudation set in
  Aconite no longer indicated."  Baehr.
    Belladonna.  Face red and bloated, with red, sparkling
  eyes, boring of head into  the pillow, great sensitiveness to
  light and noise, with general hyperesthesia; violent  throb-
  bing of the carotids, loss of consciousness, violent delirium.
  convulsive movements of  the limbs; vomiting; involuntary
  stools and urine.
   " A disposition to perspire constitutes a valuable indication in favor
  of Belladonna as compared to Aconite.'1''  Baehr.
   Bryonia.   After  effusion has  set in.  Mild delirium;
  severe,  shooting and tearing pains in the  head, with  sharp
  screams; livid face, chewing motion of  the jaws; stupor.
   " When the stage of excitement is merging into that of depression
  and stupor."  Hughes.
   Helleborus.  Eyes  rolled up, lids half closed;  face pale,
  breathing slow and deep; sighing; soporous sleep, with
  screaming and starting; automatic motions of one arm and
  one leg; jerking and convulsive movements.   Follows Bel-
  ladonna.
   " The proper period for its application has arrived  if reaction  has
 almost entirely ceased and the symptoms of paralysis  are more or less
 completely developed."  Baehr.
   Apis niel.   Convulsions; sopor, interrupted by piercing
 shrieks; bending back, and rolling of the  head; grating of
 teeth.  Follows well  after  Bryonia.
   Sulphur.  " Appropriate as a means  of assisting the de-
 laying resorption of the exuded fluid; hence in the stage of
 paralysis,  after it has continued  for a time without any
 perceptible change."   Baehr.
   Arnica.  Especially when of traumatic origin.  Also, to
 promote resorption of serous effusion,  after inflammation.
  "Absence  of all signs of reaction contra-indicates this  agent  de-
 cidedly."  Baehr
   Zincum.  Patient unconscious; eyes  half-closed; dilated,
insensible  pupils; extremities, or whole body, cold: blueness
of hands and feet;  impeded respiration;  small, weak pulse.
Inflammation has ceased, and effusion, with cerebral torpor,
remains.
  "Even in  advanced paralysis with general  coldness, it has been
nown  to excite salutary reaction."  Hughes. 
68         KEY NOTES OF  MEDICAL PRACTICE

               SPECIAL,  REMEDIES.

  Opium.   Deep coma.
  Merc., Kali  hyd.  Syphilitic cachexia.
  Rhus.  With erysipelas and low fever.
  Hyos.  Severe  cerebral  pains, delirium, aberration of
sight.
  GENERAL 3IEASFRES.   Keep  sick-room  darkened.
well ventilated  and very quiet.  Raise head on a thin pillow.
In severe attack, cut the hair.  Apply cold to head.  To be
of service cold applications must be continuous—not warm
at intervals.  Use bladder,  or small rubber bag, half full of
pounded ice; or, cover head with soft cloth and conduct to
it a constant,  small stream from vessel of cold  water, by
syphon  of small rubber-tube  or cotton  wicking.  Great
caution  necessary.   Apply  only in  stage of  excitement,
never  after  stage of depression has set in.    Throughout
attack, keep extremities warm.  During convalescence  pa-
tient must be kept free from all excitement or disturbance;
do not talk to  children.
   Diet.   During fever give liberally  of cold  water to slake
thirst.  Barley-water, milk and  water, and broths should be
given as soon  as  depression sets  in.   In convalescence re-
turn to solid diet cautiously.

                       APOPLEXY.
                IiEAI>IX<>}  KKlIKnil.S.
   Aeon.   Full, strong pulse, plethoric subjects, great arter-
ial excitement.
  " You will be astonished at the rapidity with which the beneficial
results will manifest themselves under this potent drug."  Hughes.
   Bell.   Great cerebral congestion, red, swollen face, throb-
bing of cerebral vessels, dilatation  of pupils,  conjunctiva
red and  injected,  convulsive movements  of  face or limbs,
involuntary discharge of urine.   To be of service, must be
given early, when  the  effusion is  still  attended  by violent
symptoms  of  congestion.
  " Sometimes has a magic effect."  Baehr.
   Opium.  Profound stupor, bloated, dusky-red face, stertor
 and irregular breathing, stupid, besotted countenance, con-
vulsive motion of  extremities, patient moans  and groans,
 is hard to arouse,  face covered with profuse, cold sweat.
  "Thisdrug is of great value."  Hartmann.
   Arnica.   No arterial excitement  or cerebral congestion.
 Sudden attack, with stupefaction, sighing and muttering.
 involuntary discharges.  Also, to  promote resorption of
 effusion, to be given after the attack, with Bell.,  if signs (rf
 cerebri tis.
  " As remedy to promote resorption,  Arnica occupies  first rank."
 Baehr. 
APOPLEXY—ALCOHOLISM.
69
                SPECIAL. REMEDIES.

   Nux v.  Congestive  condition  of brain favoring  apo-
 plexy.  For those of sedentary habit, who have indulged in
 rich diet  and alcoholic stimulants.
   Sulph.  To promote  resorption, "comes  in where  the
 fiction of Arnica terminates."
   Phos.  Retards degeneration of  arteries.
   FOR PREDISPOSITION.  Nux v., Phos.. Baryta, Lach.,
 Gels., Hyos.
   FOR AFTER-EFFECTS.   Caust., Zinc, Cup,:,  Plumb.,
 < 'occulus.
   Faradization, to restore paralyzed muscles.

   0 EN ERA L MEASURES.  Loosen all tight clothing,
 especially about  neck; remove patient to  quiet, cool place,
 let him lie with head and  body raised, and give plenty of
 fresh air.  Rub extremities with heated flannels, and apply
 hot bottles.   Apply warm cloths to head—cold applications
 do harm,  especially if face pale and surface cool. Venesec-
 tion worse than useless.
   Diet.   Of  great importance.  Avoid  over-eating,  rich
 food, and stimulants  of  all kinds.   At no time should full
 animal diet be indulged in.
   Avoid all  excitement, fits of passion, over-exertion, sud-
 den changes  of  temperature,  exposure to  hot sun,  over-
 heated rooms, hot baths, wet feet, and excesses of whatever
 kind.


               ALCOHOLISM   ACUTE.

   SYNONYM:   Delirium Tremens.

   Hyoseyamus  1 x.  Delirium mixed—loquacious, furious,
 muttering and  incoherent; pulse small  and quick,  very
 compressible; skin cold and clammy.
  "Hyos. most commonly useful: rare that the delirium is inflamma-
 tory enough for Bell., or sufficiently maniacal for Strain."  Hughes.
   Opium.  Comatose condition;  loud,  stertorous  breath-
 ing; loss  of consciousness and sensation.
   Ant.  tart.  Much mucous  gastric disturbance  with the
 attack, and  profuse cold sweat.
   Arsenicum.  Great irritability  of the  stomach, great
 prostration, and muscular tremors.
   Ammonia.  To "sober up"  one who is "pretty tight,"
give a dose consisting of  one drachm Spts.  Amm.,  diluted
in a little water.
   GENERAL MEASURES.  A cup of strong  coffee is
often of  great  benefit.   It is  highly important  that the
strength be maintained by a nutritious diet, as the danger is 
7()         KEY  NOTES OF MEDICAL PRAOTICK.

from  exhaustion.  Give soups, beef-tea, warm milk, coffee,
egg beaten up in coffee or milk.  A plentiful sprinkling of
red-pepper may  be used in seasoning  the food.
  Use as little violence as  possible;  employ only  gentle
compulsion, trying to soothe and quiet the patient by kind
words, keeping him  as quiet as possible, and, if you can
manage it, in a darkened room.  Have the windows, securely
fastened, and help at hand to summon in case of necessity,!

                                                      I
              ALCOHOLISM   CHRONIC.            '"

  Nux vom.  Often indicated.  A few drops  of the lx  in
frequently-repeated  doses  for  bad   effects  following a
"spree."   Very  good for  morning-vomiting, trembling
hands, and other nervo-muscular affections of drunkards.
  Phos. zinc.  In chronic alcoholism, for nutrition of ner-]
vons centres.
  Capsicum.  Ten drops  of  the tincture in a little  water
for atonic dyspepsia of drunkards.                       i
  Arsenic.   For the  morning-vomiting, gastritis, prostra-
tion, muscular tremors.                                  (
  Moschus.  The best remedy to allay the craving.

  GENERAL .MEASURES.  To correct the habit, the
use of alcoholic stimulants must first be entirely  given up.
As substitute, Tr. Cinchona rubra, may be given, ateaspoon-
ful dose, two or three times  daily; or,
             R1  Lupuliuae, fl. ext.
                Tr.  Capsici, equal parts.
  Dose.  1 or 2 tsp. p. r. n.
  This, also, is  an  excellent substitute  for the  alcoholic
stimulant.
  Diet.   A most important part of  the treatment.  Have
patient eat freely of fruits and  vegetables, and drink milk,,
lemonade, fruit-flavored syrups, and water.


                    OPIUM-HABIT.

  Diminish dose by insensible degrees, without the  knowl-
edge of the patient.   Get  control of patient and deal out to
him   his daily  allowance.    If  patient has  hypodermic
syringe, its use and custody must be given up to some one
else.  If  daily quantity is not more than four grains, the
use of syringe must be given up at once,  and a proportion-'
ate quantity—/.  e. three limes as much—given by the stom-
ach.   When per diem  quantity is from one scruple to one
drachm, considerable reduction  must  be made before the
syringe can be abandoned, but it must be dropped at the
earliest  possible moment.  The rate of reduction  should 
HEADACHE.
71
not be greater than 1-16 gr.hypodermically, or 1-5 gr. by
stomach,  each three to eight  days.   The  necessary  time
must be given, even though it take a year.
  " Never stop opiate suddenly."  Bartholow.
  Mix the dose of Morphine with a quantity of the lx or 2x
trituration of Nux v., or  Quin. sulph., gradually lessening
the proportion  of the  former and increasing that of the
latter, until the one comes to be  substituted for  the other.
If Laudanum be taken, pursue same plan, substituting Tr.
Coca Erythoxylon.
  Diet.  Success promoted by correcting abnormal condi-
tion of digestive functions by appropriate remedies.   Im-
portant to keep patient well-nourished.  If digestion good.
and food can be taken and assimilated, difficulties of treat-
ment reduced one-half.  Give milk, eggs,  animal broths,
steaks, chops and other substantial  food.   Important to
have occupation for mind  and body.
  Absolute control of patient is necessary by any method, and easier
to obtain by the one here given than by any other.
             HEADACHE--CONGESTIVE.

  Aconite.   Fullness  and heavy  feeling, as  if everything
would push out of forehead.   Burning headache, as if brain
agitated by boiling water.   Vertigo, with nausea and van-
ishing of sight.   Arterial tension and excited circulation
throughout the body.
  Bell.  Intense  headache,  aggravated by noise,  motion,
moving the eyes, contact, and even coughing.  Great con-
gestion of head, with throbbing of carotids.  Jerking head-
ache, extremely violent on walking—pain increased at every
step.  Stabbing as if with a  knife, from temple to  temple.
Burning of eyes, and pain as if eyeballs would start from
their sockets.
  Verat. vir.  Intense cerebral congestion,  feeling as if
head would burst open, accompanied  by nausea and vomit-
ing.   Headache proceeding  from nape  of neck.  Heart
 eats loud and strong, with great arterial excitement.
  Glon.  Active  cerebral congestion.   Violent throbbing,
 ulsating headache, with  fulness and  pressure  in head.
Pain so severe as  to drive to frenzy.  Patient  grasps  his
liead, and rolls and cries with agony.  Headache from ex-
posure to heat of sun.
  China.  Deafness, noises in ears.
  Cart.  Heavy pressing on vertex.
  Opi.  Passive congestion—sleepiness.
  Gels.  Passive congestion—giddiness.
  Bry.  Frontal; dyspepsia—constipation.
  Nux V.  Occipital, with dyspepsia and constipation. 
72         KEY NOTES OF MEDICAL PRACTICE.

               HEADACHE—NERVOUS.

                    (HEMICRANIA.)

  Bell.  Red face, great sensitiveness to noise and light.
Right-sided, aggravated by slight jar.
  " The best medicine if of recent origin." Hughes.
  Sepia.  Chronic cases.  Skin  yellowish under the eyes;
women with disordered sexual function, leucorrhcea, irregu-
lar  menstruation,  scanty,  preceded by  pain.   Headache
generally occurs about time of menses.
  " Sepia has largest and most unanimous testimony in its favor as a
radical remedy for this disease."  Hughes.
  Ignatia. Headache as if a nail were driven in side of head.
Periodical.   Pain usually semilateral.  Persons  of highly
nervous temperament, or in those whose nervous system
has given way to anxiety, grief, or mental work.
  Nux v.  Sedentary  habits, habitual constipation, sensa-
tion as if skull would split, worse in open  air, during motion
and stooping.   Irritability of senses.
  "A leading remedy in hemicrania."   Baehr.
  Cotfea.  Great nervousness, exaltation of senses and in-
somnia.  One-sided headache, as from a nail driven into
parietal bone.  Useless in case of coffee-drinkers.
  Arsenicum.  Neuralgic and periodic headache, migraine,
and headache  from abuse of quinine and from miasmatic
influences.   Great weight in head, particularly in forehead
  Gelsemium.  Appears  suddenly, with dimness  of sight,
or double vision; vertigo, great heaviness of head, bright-
red face, dull, heavy expression  of countenance, full pulse.
general malaise.
  " Neuralgic headache after cerebro-spinal meningitis."  King.
   Amyl nit.  Pallor of face.  Headache which increases i
severity, and then abates, again  and again.

   GENERAL MEASLTRES.   All victims  of  hemicrania
must give up the use of coffee.


                      NEURALGIA.

   Aconite.—Acute idiopathic, from cold. Face red and hot;
 pains very severe, lancinating, pulsating—almost  intolen
 ble at night, with great restlessness.  Must be acute conge
 tion or actirc inflammation.
  "Invaluable in recent cases."  Hughes.
   Belladonna.  Violent  cutting pain, red shining swelling
 congestion of face, eyes injected, lachrymation, great nerv
 ousness and restlessness, palpitation of heart.  Motion and
 contact exceedingly  painful.   Pains appear in  evenis
 most violent towards midnight. 
NEURALGIA—SCIATICA.
73
  Colocynth.  Tearing,  tensive pain, greatly  aggravated
by every motion of the facial muscles, better from warmth.
attended by inflammatory heat and swelling. Acute neural-
gia, from cold.
  Spigelia.   Neuralgia of trigeminus.  Pain jerking, tear-
ing, sometimes periodical, always  attended by feeling of
anxiety at heart, and great restlessness.   Aggravated by
slightest contact, by motion  or  stooping.   Face pale.  Of
no use in chronic cases.
  " Deserves the first mace."  Baehr.
  Arsenicum.  Idiopathic neuralgia.  Burning, agonizing
pain, accompanied by great restlessness and anguish. Inter-
mittent, with tendency to periodic return. Worse from cold.
easier during exercise.  As a  consequence of malaria, or in
those of debilitated condition.  Dose:—Acts best in high
attenuations.
  " Quiets nervous pain better than any other medicine." Baehr.
  Iris vers.   Neuralgia of head, temples and eyes, begin-
ning in the morning  and lasting for hours, causing burning
distress  in epigastrium, and  vomiting.  The entire scalp
and face are involved, with sharp, shooting, cutting pains.
  Gels.   Malarial origin.
   Rhus.  After getting wet.
  Cedron.  Marked  periodicity.
  Verat. a.   Icy coldness of part.                   ,
  Hep. s.  After abuse of Mercury.
  Bry.  Intercostal, worse on motion.
  Puis.   In lymphatic subjects; jerking pain.
  Phos.  Tic-douloureux from nervous debility.
  Kali bi.  Supra-orbital, with gastric disorder.
  Chel.   Right supra-orbital, with liver disorder.
  China.   Pain, aggravated by the slightest touch.
  Kalmia.   Neuralgia affecting  one-half of the face.
  GENERAL  .MEASURES.   Hot applications some-
times  relieve.  Paint the  course of  nerve with  mother-
tincture  of Aeon,  or Bell.   Chloroform-liniment  locally.
Dip a needle in  oil-o'f-peppermint, or  oil-of-cloves, draw
it along course of affected nerve; sometimes has a magic
effect.  Protect the part  from exposure to cold or damp—
wear warm clothing.   Rest important for those  who  are
over-worked.  Galvanism often cures.
  Diet.  In  chronic   cases, and debilitated subjects,  an
abundance of nutritious food.  Cod-liver oil, and other ani-
mal  fats,  very important—butter, cream, etc., should enter
largely into the diet.
                      SCIATICA.
  Chamomilla.  Pains intolerable,  drawing and tearing in
character, with paralytic sensation.
 " Will often cure in young persons of  nervous temperament."
Hughes. 
74         KEY NOTES OF MEDICAI* PRACTICE.

  Rhus.  Brought on by  exposure  to wet, straining and
lifting.  Pains worse when lying quietly, relieved by motion.
Numbness, formication and stiffness.
  " In chronic cases rarely fails."  Ruddock.
  Colocynth.  Shooting, tearing pains, worse from  motion
and pressure.  Pain sets in suddenly, is constant, becoming
at times intolerable, felt most in daytime.
  " Has always enjoyed high repute."  Hughes.
  Arsenicum.  Burning pains,  attended by anguish and
restlessness, worse at night.  Chronic cases.
  Actea.  Hysterical subjects;  ovarian or uterine compli- i
cations.
  Lycopodiuin.  Coxalgia, with violent jerks of the limbs,
stiffness, weakness and  formication.  Obstinate, chronic
cases.
  GENERAL  MEASURES.   Apply  heat;  cover part ;
with flannel, and  run over  it  with a hot sad-iron. The
battery should be tried  in obstinate cases.  Acupuncture i
often relieves.

                      TETANTS.                      j

  PROGNOSIS.  If access slow, spasms mild, paroxysms!
short,  recurring at long intervals, patient can sleep, and |
temp, not over  101   F., favorable.  Temp, over 101° F., I
unfavorable; 103  F. or over, dangerous.                  \

               LEADIXU  KI.MRIMES.
  Strychnia.  Intermittent fits  of  spasm, with  bending
body  backwards, and disturbed respiration.  Extreme stiij™
ness of  limbs,  hardness  of muscles, full consciousnesH
during the spasm.  The spasm excited by  the slightest touchT\
Dose:—lx or 2x trit.                                     J
  Aconite.  Idiopathic tetanus, excited by exposure to cold •
or wet.  Frequent alternation of redness and  paleness of
face,  distortion of eyes, body bent backwards, face covered
with cold sweat, rigidity of muscles of jaws and neck.
  " Its spasms are more continuous than those of Strych., and less de-
pendent on reflex excitement."  Hughes.
  Hydrocyanic acid.    Lockjaw;  bloating  of face and
neck;  protruded,  glistening eyes;  body bent  forward or
backward; irregular pulse.
  Belladonna.  Constriction of throat; tightness of chest;
grinding of  teeth; clenching of jaws; distortion of  face.1
mouth, foaming; obstructed swallowing;  renewal of spasm
on attempting to drink.
  Cicuta.  Trismus from injuries to head.                .
  Rhus.  From wounds  of joints or tendons.
  Ignatia.   Extreme opisthotonos; from fright.
  "We should  give tolerably large doses  of the remedy employed.
Repeat frequently."  Hughes. 
              EPILEPSY—CHOREA-HYSTERIA.            -r,

  GENERAL MEASURES.  Keep room at comfortable
temperature, the patient very quiet, and allow no draft or
cold air to strike him.
  Diet.  Give  abundant nourishment.  Give four ounces
of milk  every two hours;  one e<jg, with milk, morning,
noon and night; if pulse indicates great exhaustion, give
nutrient enemata in addition.  If jaws locked, pour liquid
food between jaws and cheek.


                      EPILEPSY.

  Belladonna.   Recent cases. Cerebral congestion during  ■
and between the paroxysms.   Young and sanguine subjects,
and for petit mal.
  " Will often be found efficient."  Baehr.
  " In cases of some standing, Calcarea needed to complete the recov-
ery."  Hughes.
  Cuprum.  Violent convulsions, occurring at night.
  •• Occupies the first place among our remedies." Jousset.
  CONSULT—Ignatia. Cicuta, Coeculus. Strychnine. Opiunii
Argentum nit., Nux  vomica.
  GENERAL MEASURES.  Inhalations of Amyl Nitrite
to  ward off a threatened attack.   During attack loosen
clothing, and keep patient from injuring himself.  Pressure
on both carotids, which makes pressure on cervical sympa-
thetic and par vagum nerves, will often shorten attack.  In
female  patients, pressure  on  ovarian  regions has  like
effect.   When convulsions cease, draw tongue forward  and
turn head to one side, that the half-paralyzed tongue may
not fall on larynx.   Let patient rest.


                       CHOREA.

  SYNONYM:  St.  Vitus' Dance.

  LEADING  REMEDIES.  Ignatia. Actea,  Arsenicum.
Ferrum, Cuprum. Agaricus, Aconite.
  Galvanism, the constant current, has cured many cases.


                      HYSTERIA.

               liKAUlXG  REMEDIES.

  Ignatia.   Attack   preceded by  sensation of  lump in
throat, followed by sense of  suffocation, spasmodic eructa-
tion convulsive movements of arms and legs, clenching ot
hands.  Alternate flushing and pallor, yawning"nd,f ^g-
  "IN continued use modifies the morbid impressionability." Hughes. 
78         KEY  NOTES  OF MEDICAL  PRACTICE.

  Mosehus.  Great anxiety, palpitation of the heart, ten-
dency to fainting, headache, feeling of constriction of chest,
and general chilliness, and copious flow of colorless urine.
  " In low  dilutions, will sometimes arrest and always shorten par-
oxysms."  Hughes.
  Asaftetida.  Sensation as of a ball rising in the throat.  1
Nervous palpitation.  The throat symptoms  predominate.
  Pulsatilla.  Patients of mild, sensitive, tearful  disposi-  ,
tion, frequent derangement of menstruation,  the  attacks
being characterized by tearfulness, or fits of crying, without
assignable cause.
  Auruin.  Melancholia.
  Sepia.  Chlorosis;  leucorrhoea.
  Actea.   Depending on menstrual suppression.
  Platina.   Uterine derangements.  Nymphomania.
  GENERAL MEASURES.  In attack—Loosen clothing,
give air;  sprinkle face with cold  water; give  Mosehus.
  Regimen.  Avoid tight clothing, excitement or emotion;
take open-air exercise;  observe regular habits, early hours.  1
eat plain food; avoid  stimulating diet.  Correct  uterine
and sexual disorders.


                    CONVULSIONS.                    (

  Belladonna.   Great  cerebral  congestion,  hot,  flushed
face, violent throbbing  of carotids, drowsy after the spasm,
starting and jerking in sleep.  Great vascular erethism.
  " Seldom happens that a second attack will occur after administer-
ing Bell."  Baehr.
  Ignatia.   Tonic spasms, very violent; during dentition,
in those of  highly nervous organization, from  fright or
grief.   Of spinal rather than cerebral origin.
  Chamomilla.  Extreme sensitiveness, with  great irrita-
bility; one cheek red and hot; bloated bowels; restlessness,  •
with moaning and groaning.
  Cuprum.   Antpmic condition.  Shrill cries during attack,
drowsy and stupid in intervals; bloated abdomen, involun-
tary, thin discharge from bowels.

COW I IiSIO\S FROM
  Passion.   Chamomilla.
  Injury.  Arsen., Cie, Bell.
  Worms.   Ciim, Mere, Cicuta.
  Fright.  Op., Hyos., Aeon., Bell.
  Stomach disturbance.  Ip., Nux v.
  Incipient Brain-allection.  Bell.,  Gels., Ver. v.

  GENERAL .MEASURES.  Lose no time—have child ,
stripped  and put in warm  bath (90°  F.); apply to head
large sponge wrung out of cold water.  Remain in bath ten
or fifteen minutes.
k._____
V 
LARYNGISMUS STRIDULUS—HYDROCEPHALUS.
   In emergency, if no other remedy is at hand, give Cam-
phor, by inhalation, or a  drop in a little sweetened gum-
water.   Lance  gums  if  swollen and inflamed.   During
spasm, administer Amyl Nitrite, by inhalation.
   If child is robust and apparently healthy, the attack
is probably  reflex;  if weakly, wasted, or cachectic, it  is
probably from the brain.
   If patient is  an infant reduced by exhausting diarrhaia,
remain in bath but two or three minutes, and do not put
cold water to head; give  stimulants of brandy and milk,
freely.


            LARYNGISMUS STRIDULUS.

   Aconite.  Attack excited by  cold, dry air.  Spasm of
larynx, severe dyspnoea, febrile symptoms.
  "Eminently specific."  Hempel.  "Of pricele-s value." Ruddock.
   Chlorine.   Spasm of glottis,  a succession of  crowing
inspirations, each followed by an ineffectual  effort at expi-
ration, the chest inflated,  with turgescence of face, more or
less complete coma, followed  by relaxation of the spasm.
Dose:—Prepare weak solution in water, so that the odor of
the  Chlorine can  just be  detected.  Teaspoonful at a dose.
Prepare  fresh frequently.
  " I have used it with great advantage."  Dunham.
   Iodine.   Child  rachitic,  with swelling  of bronchial
glands.
  " To be preferred to all other remedies, as long as general organism
has not become too much reduced."  Bathr.
   Belladonna.   Red face,  arterial  excitement,  cerebral
congestion.
   Sambucus.  Burning, red, hot  face, hot body, cold hands
and feet, profuse perspiration on face and body.
   Mosehus.  Give by inhalation at time of attack, to cut
short paroxysm.

   GENERAL  MEASURES.  Apply hot  compress  to
throat—renew frequently.   Sponge chest with cold water.
Give Mosehus.   Two or three times  a day give neck and
chest cold 6ponging.


             HYDROCEPHALUS- ACUTE.

   PROGNOSIS.   About seven-eighths  of  all cases are
fatal.  Unfavorable:— Deepening stupor; eyes dim, glazed,
and  turned  upwards; convulsions.   Patient may die  in
coma or  convulsion. Favorable:—A  copious outbreak of
perspiration, diminished oppression of breathing, increased
flow of urine. 
78         KEY NOTES OF MEDICAL  PRACTICE.

               LKADI\(; REMEOIES.

  Belladonna.  Heat of head, throbbing carotids, pain in '
head, buries head in pillow, extreme sensibility to light and
noise, eyes red, sparkling and protruding, violent delirium,
drowsiness, stupor, with occasional frantic screams, convul-
sions, vomiting, and occasional  involuntary  evacuations.
The medicine until effusion sets in.
  " The sheet-anchor, after vomiting sets in."  Hughes.
  Bryonia.  Impending  effusion.   Face dark "crimson-
red,"  dry  lips,  dry,  brownish tongue, hasty, impetuous
drinking  and  swallowing, constipation, suppression  of
urine, dry heat,  especially of head, drowsiness, chewing
motion of jaw.
  Hellehorns.   After exudation.  Rolling the head, auto-
matic motions of one arm and one leg, soporous  sleep,
with screaming and  starting, lower jaw sinks  down, chew-
ing motion of  mouth, squinting, pupils dilated, forehead
wrinkled, and covered with cold sweat.
  "One of the most important remedies." Laurie.
  Digitalis.  Sometimes called for in second stage, after
effusion.  Pulse sloiv, weak and irregular.  Sopor, slow, ',
heavy breathing; sleep with frequent startings, convulsions.
  " Has high repute."  Hughes.
  Cuprum.  Hydrocephalus following catarrhal fever, or, ,
metastasis  during exanthematic fever.   Stage of effusion. '
Hot  head, deep sopor, with twitching  and jerking of the
limbs, coldness  of the hands, and  bluish  appearance of
fingers.
  Sulph.  " If others fail."  Hughes.
  Iodine.  " Incipient stage."  Jousset.
  Calc.  c.  "Scrofulous subjects."  Jahr.
  Dose:—"Our best observers unite  in  affirming that frequently-
repeated  doses  of low attenuations are preferable in this  disease."
Baehr.


           HYDROCEPHALUS—CHRONIC.

  Calc.  e.  Scrofulous diathesis.
  Ars. iod.  Tubercular cachexia.
  Sulph., " with Calc. e, accomplishes almost  incredible
results."  Jousset.

  GENERAL  .MEASURES.  Cod-liver oil,  nourishing
diet, fresh air and  sunlight.
L 
DISEASES OF THE SKIN.
7!)
          DISEASES  OF  THE  SKIN.

               L,EAI>IX<-  REMEDIES.

  Arsenicum.   The cutaneous affections to the treatment
of which  Arsenicum  belongs are those which involve the
more superficial structures of the skin; hence, in  branny,
scurfy  eruptions,  and  those marked by  the  presence  of
papules, or minute vesicles, on inflamed bases.  It should
be used for dry. scaly eruptions, accompanied by intense
burning of the surface.
  Varieties.   Pityriasis; Psoriasis; Herpes  zoster;  Pru-
rigo;  Eczema  {chronic);  Lichen; Pemphigus;  Urticaria:
Impetigo; Ecthyma; Lupus.
  Antimonium tart.   In toxic doses this drug excites a
dermatitis, first papular, then vesicular, and lastly pustular.
and its therapeutic sphere lies in the treatment of pustular
eruptions, the  pustules being large,  round, full, with red
areola?.
  Vabieties.   Ecthyma;  Impetigo   erysipelatodes;  Syco-
sis; Acne.
  Apis mel.   Indicated in skin affections not  going on
to  destruction  of tissue,  but accompanied  by excessive
itching, especially of a burning, stinging  character.  Also,
if there be cedema of the part.
  Vabieties.    Urticaria;  Lichen;  Erythema  nodosum;
Lupus.
  Croton tig.   Adapted to the treatment  of  eruptions
chararterized by the  appearance of minute, closely-set, red
papules,  which gradually become vesicles  and  pustules,
which break, become confluent, and form scabs, the process
being accompanied by intense  burning  and  itching.  In
relieving  the itching of eczema it often has a magic effect.
  Vabieties.   Eczema rub rum, faciei et genitale.
  Graphites.  Skin  affections .characterized by rhagades,
fissures, excoriations in folds of the skin, and the exudation
of a sticky,  glutinous, transparent fluid from raw places or
sores.   Itching eruptions, secreting  a corrosive serum.
  Vabieties.   Eczema impetiginodes; Mentagra;  Impet-
igo; Psoriasis pabnaris; Crusta lactea.
  Lycopodium.  Eczematous,  suppurating  eruptions on
the head.  Eruptions  which bleed easily, and form thick
crusts.  Unhealthy skin, with indolent, suppurating inflam-
mations, and swollen cervical glands.
  Vabieties.   Impetigo;  Porrigo capitis  (dry); Intertrigo;
Plica Polonica; Eczema.   „ 
80         KEY NOTES  OF MEDICAL PRACTICE.

  Hepar sulph.  Adapted to scrofulous  subjects, in whom
the slightest injury suppurates.  Eruptions moist, inclined
to ulcerate, exceedingly  sensitive  to the touch; bleed easily.
Eruptions spreading by new pimples beyond the main ex-
coriation.  Vesicular  or pustular  eruptions  in  flexures of
joints, elbows, knees, and  between  scrotum  and  thighs.
Abscesses, whitlows, boils.
  Vabieties.   Eczema impetiginodes;  Crusta  lactea;  In-
tertrigo; Impetigo; Herpes labialis.
  Mercurius.  Eruption of innumerable, minute, transpa-
rent vesicles, on a light,  rose-colored efflorescence, occupy-
ing a large portion of the skin, with pricking and  itching.
Itching eruptions, with  excoriating discharges.  Excessive
perspiration,  viscid,  of  strong odor,  occurring chiefly at
night.
  Vabieties.   Intertrigo; Eczema; Rupia; Ecthyma; Lepra;  •
Impetigo; Psoriasis.
  Mezereum.   Eruptions  characterized by papulation,
vesiculation,  pustulation, and the formation of thick crusts,
with intolerable itching.  Itching occurring  in the evening
when in bed,  aggravated or  changed to burning by touch or
by scratching;'sensitiveness to  touch.   Ulcers, with red
areola, sensitive and easily bleeding, painful at  night; the
secretions tend to form an adherent scab, under  which pus
collects.
  Varieties.    Eczema;  Impetigo;  Herpes  zoster;  Pity-
riasis versicolor; Pruritus;  Prurigo  senilis;  Mentagra;
Erythema.
  Rhus.  Vesicular  eruptions on any  part of  the body;
burning and  redness  over large cutaneous surfaces, which
soon swell and become  covered with  vesicles, accompanied
by almost intolerable itching and burning.   Has a tendency
to invade large surfaces rather than penetrate deeply into
tissues.
   Vabieties.   Eczema;  Herpes  zoster  et labialis; Pem-
phigus; Erythema nodosum; Urticaria;  Prurigo.
   Sepia.   Vesiculo-pustular eruptions, with  itching,  and
cracking of the skin, chiefly affecting the joints, with a yel-
low, earthy color of the skin, and  " liver-spots "'  in various
parts.  Women with  disease of the uterus.
   Vabieties.  Chloasma; Tinea circinata; Psoriasis; Crusta
lactea.
   Sulphur.   Scrofulous  subjects, and  those  with  "un-
healthy " skin—every injury suppurates.  Papular, vesicu-
lar and pustular eruptions, with voluptuous itching,  in-
creased by scratching, and by the warmth  of the bed.   Has
a wide range of application.
   Vabieties.   Prurigo; Favus; Impetigo; Acne; Eczema;
Porrigo capitis; Lichen; Scabies. 
SKIN DISEASES.
81
                   SK IX-1>IKEASES.
   Acne.  Ant. tart., Bell., Hep. s.,  Kali brom., Kali iod.,
 Merc, Puis., Sulph.
   Local.   Puncture each pimple with fine point of a lancet,
 encourage bleeding by warm water,  then apply hot, water
 several times daily, ten minutes at a time.  Press  out all
 comedos.  If indolent, apply stimulating lotion -$  Sulph.
 subl, lij; Camphor, 3j; Aqua. =iv. Mix.       To prevent, at-
 tend to diet (avoid fats) and hygiene (wash parts well every
 night with castile-soap and soft water, making friction with
 flannel).
   Alopecia.   Ars., Fluor ac. Phos., Phos. ac, Sulph.
   Local.   R)   Tr. Canth., ?j; Acid acet.. ;jss.; Glycer., §ss;
 Spts.  Rosemary, =jss.; Aqua  Rosce, ad fviij.   Mix.  Apply
 to scalp, and rub in  well night and morning.
   Barber's Itch.  (Tinea Trycophytina).   Shave  carefully
 and apply Oint. Merc, precip. rubr.
   Chloasma.  Sepia, Sulph., Lye, Guar.
   Comedo.  Baryta e, Bell., Nit. ac, Sulph.
   Local.   Press out " grub;"  shampoo  face, follow by fric-
 tion with flannel.  Apply lotion of Borax and water.   Treat
 dyspepsia, amenorrhoea, leucorrhcea, or other attendant dis-
 order.
   Ecthyma.   Ant. tart., Ars.,  Lach.. Merc, Juglans.
   Local.  Remove scabs and  treat local sores with Calen-
 dula  lotion.  Correct cachexia by diet, air and baths.
   Eczema.  Crot. tig., Rhus, Canth., Graph.,  Ars., Mere.
 Hep. s., Lye'., Mez., Sulph.
   Local.  Early stages, soothing lotions.  Itching may be
 allayed by lotion  of  Croton  or Rhus.  To  protect surface
 from  air,  use—R1.  Oxide of Zinc, "Ay,  Calamine  powder.,
 ;ss.;  Glycerine,  lij;  Rose-water, rviij.   Mix.  In chronic,
 wash  with mild soap, to remove scabs, then anoint with
 Cosmoline, twice  daily.  In eczema of hands, with acute
 inflammation, soak every night  in weak solution Sodai bi-
 carb.,  in  water  hot  as can be  borne,  10 or 20  minutes.
 Then  anoint with 01. Oliver. Aqua calcis, part, aeq., Bism.
 Subnit., 3j.  Mix.  If itching severe, add Acid mur., dil., 3j.
 Apply on soft muslin and cover with oil-silk.  Eczema Im-
petiginodes:—Use ointment powdered Graphites and Vase-
 line.
  Erythema.  Aeon., Apis, Bell., Mez., Rhus.
  Erythema nodosum.   Am., Apis, Rhus.
  Herpes.  H. Labialis:—Rhus, Nat. mur., Mere, Hep. s.
H. Circinatus:—Tell.  H. Zoster (Shingles):—Ars., Rhus,
Mezereum.
  Local.   H.  Zoster.  Protect  from irritation.  Anoint
with Vaseline,  dredge freely with  flour and cover with a
layer of cotton-wool. 
82         KEY NOTES OT MEDICAL PRACTICE

  Intertrigo.  Cham., Calc. e, Hep. s., Merc, Sulph.
  Local.  Keep parts clean and dry.  Anoint with Hydras-
tis and Vaseline.  Dust with equal parts Oxide of Zinc and
Lycopodium seeds.  Bo rac ic ac id and Vaseline, very effica-
cious to allay itching.
  Lichen.  Sulph., Ant. e, A-jris, Ledum.
  Local.  Frequent alkaline baths.  Soothing applications
to allay itching.   Improve general health.
  Pemphigus.  Mi us, Ars.
  Pityriasis.  Ars., Canth., Graph., Mez.
  Local.  Frequent baths, with hard rubbing.  Apply—r$.
Borax, 3j; Glycerine, rj; Rose-water, to 3 v ii j.   Mix.
  Prurigo.   ^4/\s'., Mez., Rhus. Sulph.
  Local.  Use daily  cold bathing.  Avoid stimulants, in
drink or diet.  Avoid scratching.   Apply cold compress of
Mezereum lotion.
  Pruritus.   Calad., Acid nit., Collins., Lycop., Mez.
  Local.  Treat  primary condition  on which it depends.
Relief may sometimes be  obtained  from  use of  grain
doses  of Chloral  Hydrate.    Hamamelis lotion to  part,
or anodyne lotions.  Rj. Opium, grs. viij; Kreasote, gtt. x;
Vaseline, fij.  Mix.       Camphor, 3j; Borax, 3ij; Alcohol,
3jss; Rose-water,  to ~viij.   Mix.
  Psoriasis.  Ars., Graph., Merc, Sepia, Sulph.
  Local.  Soften scales by applying wet compress, covered
with oiled silk; when sufficiently macerated, remove patches
and apply 1$. Red precipitate,  finely powdered-, white pre-
cipitate, aa, grs.  v.; Vaseline, §j. Mix.
  Tinea  Versicolor.   First wash well with  soap, then
apply Hyposulphite of  soda  3v j;  Rose-water,  ;vj.   Mix.
Lilienthal.
   Urticaria.  Ant. c/\, Apis, Ars., Dulc, Rhus, Urt.  urens.
  "Of late I have found Chloral, in gruin doses, sufficient."  Hughes.
  Local.  Warm bath  often  rapidly curative.  To  allay
itching—Grindelia  lotion.  Or, warm water acidulated with
Acetic Acid.
          DISEASES  OF   THE   EYE.

                    HORDEOLUM.

  REMEDIES.   Puis., Merc, Hep. s., Staph., Sulph.
  Local.  Hot compresses.  Open abscess when it points.
Local application of Iodine, early, will sometimes abort. 
GONORRHCEAL OPHTHALMIA.
88
           BLEPHARITIS  MARGIXALls.

  REMEDIES.  Merc.  Ars.. Graph.. Calc  c.  He par  s
Puis.. Sil., Sulph.                              nepa,.,..
  Local.  Remove exciting cause.  Soak crusts  with solu-
tion Socloy bicarb., grs. x to =j water.  Rest eyes.  Avoid
irritating atmosphere. Observe strict cleanliness. Unguents:
R.  White precipitate (Hydrarg.-Ammon.-Chlor.)  gr. ss to
Vaseline 3j.   R.  Red precipitate  (Hydrarg.-Oxid.-rubr.)
grs. ij, to Vaseline 3j. for severe cases.
             CATARRHAL  OPHTHALMIA.

              (CONJUNCTIVITIS SIMPLEX.)

   REMEDIES.  Aeon..  Bell.. Euphr., Puis., Sulph.. Ars..
 Graph.
   Local.  Cold compresses.  Borax solution (grs.  viii to
 f ;j water); or. Boracic acid (grs. v. to f ;j water), a few drops
 in eye three times a day.


            PURULENT  CONJUNCTIVITIS.

   REMEDIES.  Aeon.. Arg. nit., Puis.. Apis m., Calc. e,
 Calc. phos.. He par s., Mere, Sulph.
   Local.  Cold compresses.  Keep eye clear of discharge.


            OPHTHALMIA  NEONATORUM.

   REMEDIES.  Arg. nit. Puis., Hepar s., Mere, Apis m.
   Local.  Cleanliness. Constant removal of the discharge
 every 5,  10, or 15 minutes day and  night, until discharge
 lessens,  then  not so frequently.  Brush everted lids with
 Arg. nit. solution (gr. j to  f fj).  If cornea becomes affected.
 Atropine solution (gr. % to f ~j water),  a drop in eye every
 three hours.


           GONORRHEAL  OPHTHALMIA.

  RE3IEDIES.  Arg. nit.. Puis., Apis  m., Calc  phos..
 Hepar s., Mere, Sulph.
  Local. Cold  compresses.  Ice-bags.   Constant removal
of discharge.  Apply Arg.  nit. solution (grs. v to x to f f j,
aqua) once daily. Use Chlorine water (dil. %), or Boracic
acid (4 per cent.), in cleansing eye.  Corneal implication
requires  Atropine or Eserine solution (grs. iv to f 3j aqua). 
84         KEY NOTES OF  MEDICAL PRACTICE.

         PHLYCTENULAR OPHTHALMIA.

  REMEDIES.   Mere corr.,Aurum. Calc. e, Sulph., Rhus,
Graph., Arsen.
  Local.  Shade eyes.  Bandage rarely necessary.  Severe
pain may require solution Atropine once or twice daily.

                 GRANULAR  LIDS.
  RE3IEDIES.   .4con., Euphr., Arsen., Mere  iod., Bell.
  Local.  Cold applications.  Ice bags. Sulphate-of-Copper
or Alum to granulations.  Tannic acid, grs. x. to Glyc. 3J,
applied by camel's-hair brush to thickened conjunctiva; or,
solution Arg.  nit. (grs. v. to  f?j aqua).  Where cornea in-
volved and pain. Atropine solution m.iy be  useful.

                     KERATITIS.

  Diffuse.   Apis, Ars., Aurum, Baryta iod., Hep. s., Merc,
Sulph.
  Local.   Atropine solution  (grs. ij to f zj aqua) if much
pain.
  Phlyctenular.   Ars.,  Graph.,  Calc. e, Mere, Euphr.,
Hep. sulph.
  Local.   Smoke-colored glasses.  Cleanliness.   Yellow-
oxide-of-Mercury, grs. ij to 3j Vaseline, a piece the size of a
millet-seed between the  lids, once a day.
  Suppurative.  Merc, Sulph., Hep. s., Calc. phos.
  Local.   Hot applications,  applied 15 minutes, then  off
half an hour, then again applied.   Atropine solution; some-
times Eserine solution.
  Ulcerative. Hep. s., Calc. phos., Mere,  Ars., Sulph.
  Local.    Bandage.  Atropine solution if  ulcer central;
Eserine when ulcer is peripheral.

                        IRITIS.
  Serous.   Gels., Bry., Kali  hyd., Phos.
   Plastic.  Merc, sol., Mere  corr., Hepar s., Bell.
  Suppurative.  Hepar s., Merc, sol., Silica, Sulph.
  Syphilitic. Kali   hyd., Merc,  corr.,  Asafoet., Aurum,
Nit. acid.
  Local.  Hot, dry  applications.  Atropine  solution (grs.
iv to ?j aqua) gtt. j. every 3 or 4  hours.  Keep the eye
and that side  of head warm.

                     GLAUCOMA.
  REMEDIES.  Coloe, Ars., Gels., Bell., Bry., Phos.      '
  Local.   Iridectomy. Eserine sulphate (grs. i j to f ? j aqua),
a drop every  2 to 3  hours, to contraot  pupil.   Complete ,
rest of eyes during attacks.
 
                OTALGIA—ERYSIPELAS.              gfi




           DISEASES  OF THE  EAR.

                     OTALGIA.

  REMEDIES.  Aeon., Bell., Puis., Ars.. Merc
  Local.  Hot. dry  applications.  Aconite tincture in hot
water, instilled into ear. Morphine or Atropine (gr. j to f ?j)
in hot water, and three or  four drops in ear.  (All these
solutions are very dangerous if there is any perforation of
the drumhead.)

   ACUTE INFLAMMATION  OF MIDDLE  EAR.

  REMEDIES.  Aeon., Puis., Bell., Mere. Hepar s.
  Local.  Warm applications.  Warm Olive oil and Laud-
anum, equal parts.   Hot water (110  F.) introduced by a
medicine-dropper, or from a small sponge.   Open Eusta-
chian tube with air-big.  Puncture drumhead if bulging.
Avoid poulticing.

SUPPURATIVE INFLAMMATION OF MIDDLE EAR.

                   (OTORRHCEA.)

  REMEDIES.  Silica, Sulph., Cale-c. Arsen.
  Local.  Cleanse ear with absorbent cotton  on  wooden
tooth-pick, and  apply  Boracic acid pulv.   If  necessary
syringe ear with warm water  and Carbolic acid  (gtt. x to
f *"ij aqua) or Boracic acid solution (grs. x to f 5j aqua),
and dry ear with absorbent-cotton  afterwards.   Mastoid
complication—Incision over mastoid process, one inch long
and about % inch from, and parallel to, auricle.
        CONSTITUTIONAL  DISEASES.

                   ERYSIPELAS.

  Prognosis.  Generally favorable.  Unfavorable  in the
aged; in drunkards; if gangrenous; if thrombosis occurs;
extension to larynx; high degree of blood-poisoning; phleg-
monous variety; metastasis to brain.
              LEAIUXG  REMEDIES.
  Belladonna.  Smooth, bright, shining red skin; conges-
tion of head, with throbbing carotids.  Intense fever; tend-
ency to attack brain; delirium.              ,..,.„,.
  " The remedy so long as color is bright^red, and fever high."  Hughes. 
p—
86         KEY NOTES OF MEDICAL PRACTICE.

  Apis.  Burning,  stinging  pain in affected  part; skin
pale;   oedematous  swelling,   dryness of  throat.  CEdema
glottidis.
  Rhus t.   Vesicular erysipelas; dark, bluish  redness of
affected part, with burning and itching.

               SPECIAL. REMEDIES.
  Graph.  Wandering erysipelas.
  Canth.   Vesicular.   From  Arnica.
  Lye. Hep. s.  Local, without fever.
  Strain., Rhus.   Secondary meningitis.
  Aeon.  Fever.   Phlegmonous erysipelas.
  Lach.  Dark purple, threatened gangrene.
  Hep. s.  Phlegmonous, to promote suppuration.
  Arsen.   Typhoid condition; disorganization  of blood.
  Graph., Sulph.  To complete cure, and remove swelling,

  GENERAL  .MEASURES.  The best local treatment is
application of cloths moistened in tepid water, containing
Verat. vir., tinct., a drachm to two ounces of water.  As soon
as evidence of suppuration in subcutaneous cellular tissue,
make long and  free  incisions  through  the skin.   After
incising^ apply poultice, and  provide for thorough drainage
and escape of pus.  Do  not  expose skin to variations of
temperature.  Do  not  paint with collodion, unless  inflam-
mation of very  limited  extent.   Dry flour  or powdered
starch dusted over will allay suffering from heat and pain.
Give plenty of pure air.
  Diet.  Keep  up  strength  by  nourishing  food,  milk,
broths, beef-essence.  Cool drinks to slake thirst.


        ACUTE  ARTICULAR   RHEUMATISM.

  SYNONYM:   Rheumatic Fever.
  Prognosis.  Seldom fatal.   Unfavorable:—Delirium and
coma; scanty excretion of solids in urine; previously-exist-
ing heart-disease.

              LEADIXG REMEDIES.

  Aconite.  Intense  febrile movement, pulse full and
strong, great thirst, anxiety and restlessness; especially for
inflammation of large joints, which  are  red, swollen, and
exceedingly sensitive  to contact.
  "No remedy more adapted to rheumatism."  Hempel.
  Bryonia.  Fever of  adynamic  form:  the articular  swell-
ing pale, or dark red, and exceedingly painful,  aggravated
by contact or the slightest   motion.  Follows   well  after
Aconite.
  " A leading remedy for aoute and chronic." Baehr. 
RHEUMATISM.
87
  Rhus.  Adynamic fever,  great  restlessness,  parts  red
and swollen, pains drawing, tearing,  burning; feels worse
when at rest, better on continued motion. Especially lower
extremities, and when brought on by getting wet.
  "Occupies a high place among the remedies for rheumatism." Hughes.
  Mercurius.  High fever, quick, hard pulse; obstinate in-
flammation of a single joint; puffy swelling, pale or light
red; tearing, burning  pains, deep-seated, as if  periosteum
affected, much worse at night; sour perspiration,  without
relief.  Breath foul, tongue with thick, yellow coating,  ap-
petite gone.   Very sensitive to cold.
  Pulsatilla.  Sub-acute cases, with little fever,  the pains
shifting frequently from part to part;  pains violent, draw-
ing and jerking.  Not much redness or swelling.  Chilliness.
  " In subacute rheumatism, extremely useful."  Hughes.
                SPECIAL REMEDIES.
  Sulphur.  Chronic  rheumatism.
  " Invaluable to prevent the lingering of convalescence, or the pass-
ing of the disease into a chronic form."  Hughes.
  Caulophylluni.  Rheumatism of wrists and finger-joints,
and of  small joints.
  Actea.  Articular  rheumatism  of  lower  extremities;
severe attack; sudden onset.
   Yiola odorata.  Rheumatism of  wrists  in  persons of
highly nervous organization.
   Belladonna.  Red, shining swelling.   Frequent doses at
night for insomnia.
  Chin.. Sulph.   Acute articular; fever of remittent type.
  Spigelia.   Carditis of rheumatic fever.
  CHRONIC  RHEUMATISM. -Bry.. Rhus,  Rhod., Led..
Puis.. Dule. Sulph.. Merc, Kali hyd.. Kali bi.
  GENERAL MEASURES.  Rest  and warmth are  the
cardinal principles in the  treatment of rheumatism.  Keep
the patient quiet, in a  warm  bed  and  covered  with  soft
blankets.   Do not let a draft of air strike him, or let him
get the slightest chill.   Cover affected joints with raw cot-
ton, keeping it  on for  days.  Use  no  baths  if skin  acts
freely; if, however, skin hot and dry, give patient hot pack.
Examine the heart at every visit.   If pain  excessive, great
relief will follow use of
       R.  Carbonate of potash,    -         ?  ji
           Tr. Opium,       -    -    -      5 vi;
           Warm water,   -     -     -    -    0 j.
      Mix.
  Apply locally by a soft  cloth, and cover with dry cotton.
  " I have seen so much relief follow its use that I should  be sorry to
deprive a sufferer of it."  Hughes.
  Diet.  The use of beer, ale, wine, brandy,  and all malt
or spirituous liquors,  must be strictly prohibited.  Use no
sweets.  Lemonade is harmless. 
88         KEY NOTES OF MEDICAL PRACTICE.
                        DROPSY.
   Arsenicum.   Great  debility and prostration, anxiety.
 restlessness, emaciation, dyspnoea, burning thirst, oedema
 of face, hands and feet, and anasarca from disease of heart.
   " Suitable in all forms of dropsy, more particularly that depending
 on heart-disease, and cedema of the lungs."  Baehr.
   Apis.  Acute  febrile dropsy;  dropsy  complicated with
 strangury, suppression, or other  urinary disorder.  Unab-
 sorbed effusions after  serous inflammation.  Post-scarla-
 tinal dropsy.  Absence of thirst and suddenness of cedema
 indicate this remedy.
   Apoe. can.  Restores urinary  secretion.  Urine scanty,
 thick, yellow and turbid.  Has cured hydrocephalus super-
 vening on typhoid, and anasarca, hydrothorax and ascites.
 (Of  no use in  hydrocephalus from  tubercular  meningitis,
 or ascites  from  cirrhosis of  liver.)   Dose:—one to  five
 drops of mother-tincture, or drachm doses  of  infusion of
fresh root, an ounce to a quart of  water.
  " Has made many brilliant cures." Hale.
   Digitalis.  Small, feeble, irregular pulse,  pale face, livid
 lips, distressing dyspnoea.
  " Especially for cardiac dropsy.  Must give large doses."  Hughes.
  " Valuable in almost every variety; often succeeds in most desperate
 cases."  Ruddock.
   Bryonia.  (Edematous swelling of joints.  Hydrothorax.
Dropsy associated with chest symptoms—cough, dyspnoea.
stitching pains in region of  heart; disease of liver.
   Helleborus.  Urine scanty, dark-colored, depositing sedi-
ment like coffee-grounds.  Useful in hydrocephalus, hydro-
thorax, anasarca, and dropsies following  scarlet and inter-
mittent fevers.
   Senecio.   Abdomen  very tense, feet  and legs swollen.
urine  scanty and  high-colored,  or, profuse and watery.
With liver symptoms, from peritonitis, or abdominal tumors.
   China.   Dropsy from exhausting  discharges.   General
debility, countenance pale or  sallow; organic affections of
liver or spleen.
   Aconite.   Recent febrile dropsies.
   Ferruin.   Anaemic or chlorotic females.
   Sulph.   (Edematous  swellings following skin affections
or suppressed eruptions.
  General Dropsy.  Dig., Apis, Ars.. Bry., Apoc, Senega.
DROPSV OP
  Heart.   Dig., Spig., Ars.
  Chest.  Bry., Dig., Ars., Hell.
  Joints.  Aeon., Pids., Bry., Iod.
  Ankles.  Ferr., Bry., Chi., Ars.  ■
  Brain.  Hell.,  Apis., Mere, Bry.
  Abdomen.  Apoc, Ars., Chin.,  Crot.
  Scrotum.  Iod., Rhod., Puis., Graph.
 Dose:—" Dropsy requires to be treated with larger doses than almost
any other disease."  Baehr. 
DIPHTHERIA.                    89
  GENERAL MEASURES.   If abdomen be so distended
as to seriously embarrass respiration and  heart's action,
evacuate with trocar  and canula, or  aspirator.  Introduce
in mesian line, midway between navel and pubes.  Draw a
sheet around abdomen, and tighten it as fluid is gradually
withdrawn.   If legs are much swollen, the skin tense, make
incision three-quarters of an inch long over each malleolus.
Keep warm sponge, moistened  in weak Carbolic acid solu-
tion, to each incision.
  Diet.  Give all the water that patient wants—large quan-
tities of soft water beneficial.  In renal dropsy a systematic
course of skim-milk diet has proved beneficial.   The pa-
tient should be well nourished, receiving  a liberal quantity
of nutritious, digestible food.
  Hygiene.   Warm  baths  and vapor-baths useful in pro-
moting perspiration.   The clothing should be warm, and
the abode high and dry.

                    DIPHTHERIA.

  PROGNOSIS.  Grave.   Unfavorable:—Exudation dark,
thick,  extensive; extension to  larynx or posterior  nares;
great fetor of breath; early pharyngeal paralysis; slow and
intermittent  pulse;  persistent  vomiting; epistaxis; great
glandular swelling.  The younger the child, the more unfa-
vorable.   Favorable:—Affected surface  small.   So long
as exudation confines  itself to fauces and anterior  pillars
of pharynx, and is not thick or putrid, prognosis favorable.

               LI'.VD[\«  K EM EDIES.
  Belladonna.  Mild cases.  Great dryness and redness of
throat, with high fever.
  " Suitable only in the beginning."  Raue.
  Phytolacca. Throat dry and swollen, difficult deglutition,
exudation grayish-white, great prostration, high fever, vio-
lent aching in back and limbs.
  "Acts in truly specific manner."   Hughes.   "My experience has
been very favorable, giving it in one or two drops of the tincture." Bayes.
  Apis mel.  Great  prostration  from   beginning, great
oedema of Ihroat and  tonsils, surface glossy, and of purp-
lish color, burning pain and dryness of throat, extending
into  ears, dirty-gray  exudation, high   fever, oedematous
swelling of face and neck.
  "I have seen striking results from  it, and can commend it highly."
Hughes.
  Kali hi.  Croupy cough, preceded by wheezing and pant-
ing, pain  in chest, uneasiness  in stomach,  nausea,  fauces
covered with dirty-yellow exudation, which is tough, stringy
and tenacious; discharge from nostrils of yellow, corrosive
mucus.
  " In nasal diphtheria I find it specific; in  laryngeal, it does  all that
medicine can do."  Hughes. 
90         KEY  NOTES  OF MEDICAL  PRACTICE.
  Bromine.   Laryngeal diphtheria, the exudation  begin-
ning in  larynx, or beginning in fauces and extending to
larynx.  Suffocating  cough, with hoarse, whistling, croupy
sound.
  Merc.  iod.  Great swelling of parotid and submaxillary
glands, tonsils  much swollen,  putrid  sore throat.   Cases
marked by great  putridity, with dirty coating on  tongue,
and foetid breath.
  Lachesis.   Small amount of exudation, throat purple, or
livid, prostration very great, with weak pulse, cold, clammy
perspiration.
  Merc.  cyan.  Malignant  diphtheria; the disease comes
on suddenly, develops quickly, and patient is rapidly pros-
trated.   Putrid  sore  throat, the exudation  dark-gray, thick
and putrid,  occupying whole  throat, and extending  to
nasal fossae.
  Muriat.  ac.   Exudation  gray, breath   foul,  lips dry,
blackish and cracked, tongue dry. the membrane begins to
invade the larynx and nose,  from which there is a darkish,
fetid discharge; extremities cold, pulse weak and compres-
sible, general prostration.
  "It has some efficacy when  symptoms of  blood-poisoning  are
present."  Hughes.
  Kali pcrinan.  Breath very  foul, general and excessive
prostration, foul exudation over fauces, with extension into
nasal fossa1, with thin, excoriating discharge from the, nose.
Septic forms.
  Cantharis.   Excessive pain on swallowing; throat  looks
as if blistered, expectoration of blood, extreme prostration;
sinking turns.   Cold  extremities. Scanty urine, with albu-
minuria.
  "It has served me well."  Hughes.

             GARGLES  .VXD SPRAYS.

  Alcohol.    Diluted  with  three  parts  water.   Use   as
gargle;
  Kali perman. Grs. iv. to aqua rviij.  Use as gargle when
exudation is putrid, breath  foul, or thin discharge from nose.
  Liquor calc. chlor.  Use in atomizer as  spray to throat.
  " Of virtue in the most malignant cases."  Xiidharil.

  GENERAL MEASURES.  Quarantine patient, if pos-
sible, in  a light,  airy, upper room.  Send other  children
from the house. Keep sick-room well rent Hated. Tempera-
ture 70°.  Throw all  soiled rags into the fire; disinfect all
soiled linen.   Do not inhale patient's breath, or let a piece
of the membrane come in contact with a mucous or abraded
surface.
  Absolute rest  in recumbent posture  necessary.  Early in
disease let patient take bits of ice  in mouth.  Later use
steam atomizer, and at frequent and regular intervals let 
                    ASTATIC CHOLERA.                 91

patient inhale the vapor.  If secretions are putrid, the anti-
septic gargles and sprays must be used at frequent intervals
in order to be of benefit.  Keep nasal cavities clean.   Put
Chlorine-water into the spray-cup  of  atomizer.  In con-
valescence, danger of  paralysis of heart on over-exertion.
Patient should not attempt to swallow solid food till muscles
of pharynx fully restored.  In adynamic cases do not  use
cold drinks or cold applications.
  Diet.  Highly important to keep patient well nourished.
Begin early.   Give to patient all the milk that he can be
induced to take—iced, boiled, warm from cow, or in  any
way to suit  his  fancy.  Occasionally give a glass of milk
with a beaten-egg in it.  Beef-tea and coffee better as stimu-
lants than alcohol.   Make a cup  of  strong  coffee,  add
scalded  milk one-half: sweeten to taste; beat yolk  and
white of an egg together, pour the hot coffee and milk over
them, and serve.  This is very nourishing and stimulating.
If patient cannot swallow food, must be nourished by ene-
mata.   Give  plenty of water to slake thirst.  Ice-cream
and  water-ices may be given freely, only taking care  not to
chill the stomach.


                 ASIATIC  CHOLERA.

  SYNONYMS:  Serous Cholera; Malignant Cholera.
  PROGNOSIS.   Always grave. Varies,  however, accord-
ing  to the period of the epidemic, as  it is most deadly at
the commencement of  an epidemic, whereas those occurring
later in its course  are more apt to be followed by recovery.
  COMPLICATIONS.  Suppression of urine; gastritis  and
enteritis; pulmonary congestion; meningitis; sloughing of
the  cornea:  abscesses over  the body;  coagula  in right
heart or pulmonary arteries; haemorrhage of bowels.

                LEADIXG REMEDIES.
  Camphor.   Early in the attack.  Patient suddenly loses
strength, and looks pinched and blue; the skin  becomes
very cold,  the  voice  deep  and  husky;  the skin  shrivels.
Intense distress and anguish at pit of stomach and burning
in the bowels, the patient  tossing in agony;  sometimes
nausea  and vomiting, but generally the evacuations both
up and down are moderate and infrequent.  Dohk:—"Give
the patient three  to five drops of the tincture, on a little
sugar, every five minutes, and  in the intervals assiduously
rub  him on  the neck, chest, and abdomen with the same
medicine, until the icy coldness of the body gives place to
a return of vital warmth."  Hahnemann.
  " It is our firm belief that Camphor is an almost infallible remedy If
given from the very onset." Dr. Russell. " Very few of the cases went
into collapse when Camphor was given in the first stage." Dr. Proctor. 
92         KEY NOTES OF MEDICAL PRACTICE.

  Verat. all).  Cases  marked  by -excessive vomiting  and
purging, with violent abdom inal pains. Especially indicated
when attack commences with vomiting and purging.  Pale
and sunken countenance;  hollow eyes, with  blue  margins:
repeated  and  violent  vomiting,  with  frequent,  copious,
watery, rice-water evacuations.   Violent colic, especially
about the umbilicus.  Dose:—"Almost  all observers agree
in recommending the lower preparations, even the strong
tinctures,  frequently repeated."   Baehr.
  Arsenicum.   Sudden and extreme prostration, vanishing
of the pulse, great  dyspnoea, inexpressible anguish, con-
stant tossing about,  violent thirst, yet the least quantity of
liquid is thrown up immediately; burning distress in region
of stomach, complete suppression of urine.
  " The medicine most trusted in collapse."  Hughes.
  Cuprum acet.   Loss of consciousness, spasmodic cramps
of fingers  and toes, audible gurgling of liquids down the
oesophagus, ineffectual  efforts to vomit, the diarrhoea has
ceased,  but loud gurgling in bowels, indicating  paralysis
of intestines.   Symptoms indicating general  paralysis of
organism.  Also recommended as prophylactic. Give doses
of the remedies at frequent intervals.

               SPECIAL REMEDIES.

  Hydroc. acid.   Pulselessness,  respiration   slow, deep.
gasping, taking place at long intervals.
  "It would seem at times to restore animation to a  corpse." Dr.
Russell.
  Secale.  Phos.  Profuse, watery stools, after violence of
attack is past.
  Phos. ac. Rhus.  Supervening typhoid condition.
  Tereh.. Canth. For continued suppression of urine, if
A?-s. fail.

  GENERAL MEASURES.   Place patient  immediately
in warm bed.   Keep him at perfect rest  on his back, and
surround him with hot bottles.   Make  friction with warm
flannels.  The  room should be warm, but well-ventilated.
No food can be taken.   Enemata of warm milk, even though
rejected, are beneficial.
  Use  antiseptic precautions  in  disposing of discharges
and of soiled linen,  as directed in Typhoid Fever, p. 7.
  CONVALESCENCE.  A return  to ordinary diet must be
gradual, as an attack  of  indigestion  may  excite  relapse.
Give no solid food till stools are consistent and fecal.  Be-
gin with  milk, thin gruels, chicken-broth, and digestible,
liquid food.
  PRECAUTIONS.   Close all  surface-wells and  those in
vicinity of drains and cesspools.  Remove all filth, and use
disinfectants freely.   Corpses should be  immediately placed 
CHOLERA  INFANTUM.
93
in coffin containing mixture of lime, charcoal and carbolic
acid, and  at once disposed of by burial  or cremation.  In
cholera season  direct  your  patients  to observe  regular
habits in  all things.   All drinking-water must  be boiled
and filtered.  Give strict attention to the first appearance
of a diarrhcea.

                CHOLERA INFANTUM.
  PROGNOSIS.  Uncertain.   Favorable:—Cessation of
vomiting;  diminution  in frequency and quantity of dis-
charges; quiet,  natural sleep; even temperature of body
and limbs; diminution  of thirst;  returning appetite.
   Unfavorable:—Extreme restlessness and jactitation, or,
early apathy, stupor, or convulsions; incessant and obsti-
nate  vomiting;  excessive  frequency and  copiousness of
stools; Hippocratic countenance; extremities cold.blue and
shrunken.   To detect earliest loss of flesh, examine inside
the thighs.
               LEADING REMEDIES.
  Yerat. all).  Vomiting and purging, the latter predom-
inating.  After vomiting or purging, great exhaustion, cold
sweat  on  forehead.   Severe colic.   Stools  profuse and
watery.
  "A  remedy of great value, and one very  often required."  Bell.
" The chief remedy."  Jousset.
   Ipec.  Vomiting, and  almost  constant, nausea.  Stools
grass-green, or  white, with  fermented appearance,  like
yeast.   Colic and sick stomach before and during stool.
  " Verat alb. and Ipec. are undoubtedly the most important of all rem-
edies."  Raue.
  Arsen.    Great prostration, extreme  restlessness and un-
quenchable  thirst.  Cold extremities, face  pale and cada-
veric, skin dry and shrivelled.  Stools thick, dark-green, or
dark, iratery, offensive.
  " The symptoms which most clearly distinguish it are  the character-
istic thirst and restless-ness."  Bell.
  Croton tig. Yellow, watery stool. Aggravation from food
and drink.   Stools expelled suddenly and with  great force.
  "Its proper application  will render success certain and brilliant."
Bell.
  Podoph.   Gagging and empty retching, without vomit-
ing.  Moaning,  with half-closed eyes and rolling  head from
side to side.   Stools profuse, painless, watery,  with meal-
like sediment.
  " Ranks among the first to be referred to."  Bell.
  Merc.  Dark-green stools, slimy or bloody, frequent, ex-
coriating  and scanty,  with tenesmus, and  colicky pains.
Tongue coated,  swollen, soft and flabby.
  Camphor.  Attack very sudden.  Great and rapid sink-
ing.  Child  in stupor,  utter  prostration, face pale, livid,
purple, icy cold.  Vomiting and purging sometimes absent. 
94          KEY NOTES OF MEDICAL PRACTICE.

  /Ethusa.  Child  lies in an unconscious state.  Grave
symptoms—thumbs clenched, eyes fixed and staring, pupils
dilated,  great  prostration, continual  gagging, great  fre-
quency of stools.  Symptoms of hydrocephaloid.
  "Suitable to a severe form of cholera infantum."  Bell.
  Aconite.  Early in  attack, with  hot skin,  quick pulse,
thirst, restlessness, high  fever.  Stools green, watery, with
cutting pain and tenesmus.
  " Only useful in very beginning." Bell.
  Belladonna.  Hot head, flushed face, cold feet, great dry-
ness of mouth and lips, great, drowsiness, with sudden start-
ing during sleep.  Stools green.
  Calc. carb.  Sour vomiting, open fontanelles, old-look-
ing, wrinkled face.  Profuse  sweat  on  head during sleep,
cold  extremities,  emaciation, bloated  abdomen.   Stools
whitish, watery.
  " The stools of  less importance than the person and concomitant
symptoms." Bell.
  Apis mel.   Tongue dry and  shining.  No thirst.  Skin
hot and dry.  Stools greenish, yellowish, slimy mucus.   Ab-
domen tender to pressure. Symptoms of hydrocephaloid:—
Stupor, interrupted by shrill cries, head hot, eyes red, hands
cold and blue, abdomen tender, sunken, urine  suppressed.
  " One of our most precious remedies, corresponding to a low and
dangerous condition." Bell.
  GENERAL .MEASURES.  Keep the child in  a  cool .
shaded place, and let it have an abundance of fresh  air.
Avoid close, ill-ventilated apartments.   No matter how sick
it may be, take it riding, or, if  possible, boating on the
water.  Cool, fresh, pure, air necessary to recovery.  Give
it frequent, cool sponge-baths,  or full baths,  putting it
into water at 85°, and gradually  cooling it down to 75° F.
  Diet.  Of highest importance.  If child cannot nurse at
the breast, its food should consist of fresh, pure, milk, di-
luted with barley-water  and lime-water.   (Vide Article
" Infant Diet.")  If there be great debility and prostration,
give beef-tea,  or  wine-whey.  Use  no starchy foods what-
ever.  If sufficient food cannot be  taken by stomach, use
inunctions of oil to abdomen and extremities.  If water be
rejected from  stomach,  baths  will supply fluid  for the
blood, and bits of ice slake thirst.  Absolute cleanliness of
bottle, and absolute purity  of milk and other food,  will
accomplish all  that can be in this direction.

               DIABETES  MELLITUS.
  Phosphoric  acid.   Frequent urging to urinate, pain in
the  loins, emaciation and  prostration.   Particularly valua-
ble  in cases of  nervous origin.  Dose:-  lx diluted, several
times a day.
  "Stands in the  highest place among the remedies for diabetes."
Hughes. 
LITILEMIA.
95
  Uranium nitrate.  "Cases originating in dyspepsia or
assimilative derangements.  Excessive thirst." Dose:—"The
practitioners who have employed it,  have generally  given
strong  and increasing doses of the first-decimal  tritura-
tion.''1   Hughes.
  Arsenicum.   Insatiable  hunger,  unquenchable thirst,
pale skin, loss of strength,  dryness of mouth and throat.
excessive urination; watery  diarrhcea.
  CONSULT—Helonin. Kreasofe. Plumbum. Argentum nit.
  Diet.  Must be free from starch and  sugar.  Exclusive
milk-diet often benefits. Gluten bread must be substituted
for that made of white flour.
  Avoid.   Vegetables.— Arrow-root, asparagus, bread,  bis-
cuit, beans, beets,  crackers, carrots, maccaroni, oat-meal,
pastry, potatoes, peas, rice,  sago, sugar, turnips,  tapioca.
vermicelli.
  Fruit.—Apples, grapes, pears, bananas, peaches, plums,
pineapples, raspberries, and other sweet fruits.
  Beverages.—Wine, beer, brandy, ale, cider, and  all alco-
holic and sweet drinks.
  Allowable.   Vegetables.  — Artichokes, cabbage, celery,
cresses, cucumbers, olives, greens, lettuce, pickles,  spinach,
mushrooms.
  Fruits.—Lemons, cherries (sour), currants,  gooseberries.
strawberries, and acid fruits generally.
  Meats.—Beef, mutton, poultry, game, fish, oysters, cheese,
eggs, etc.
  Gratify the thirst by an abundance of soft water.
  GENERAL 3IEASURES.  Th'e  diabetic  should  be
warmly clad in flannels, and avoid cold  winds, and expos-
ure of all kinds.

                      LITILEMIA.

  SYNONY3IS:   Lithiasis; Uric-acid Diathesis.
  CAUSES.  Over-indulgence in stimulants, or rich, nitro-
genized food, with sedentary life.
  REMEDIES.  Plumbum. Nux  v.. Lycopodium, Sepia,
Sulphur. Hepar s.,  Calcarea e, Podophyllum.  Hydrastis,
Arsenicum, Nitro-muriatic acid.
  Regimen.  Active out-door exercise!  Daily  salt-water
sponge-bath.  Keep warmly clad, and avoid chill.
  Diet.  Highly important.  Avoid  meats,  oysters,  eggs.
Adopt mixed vegetable diet.   Celery  said to  be  especially
beneficial.   Use no stimulants—wines, brandy, ale or beer.
Use no pastries, sweets, or anything  which will cause indi-
gestion.  Avoid late dinners and late suppers.  Eat slowly,
and masticate thoroughly.   Drink an abundance  of pure,
soft water.  Vichy water has cured. 
96
KEY NOTES OF MEDICAL PRACTICE.
PART II.
OBSTETRICS.
                     ABORTION.

               LEADIXG REMEDIES.

  Sabina.  Threatened  abortion in  the  early months of
pregnancy.  Sensation of  heat and soreness in the womb,
with drawing pain from the back through to the pubes.
Sometimes succeeds  even  if pains and  a red  discharge
have set in.
  " One of the best remedies we have to prevent abortion."  Guernsey.
  Secale.  Threatened abortion in the later months.  Even
when decided haemorrhage is  present, ten-drop doses of
tincture  every  three or four hours  check it, pregnancy
going on to full term.  Copious flow of black, liquid blood,
worse from slightest motion.
  " Secale and Sabina most  in repute for correction of the habit of
abortion."  Hughes.
  Actea.  Rheumatic  subjects.   Irritable  uterus.  Com-
plains much with even slight pains.
  "Has been successfully used to prevent habitual abortion." Hale.  '
  Caulophylluin.  Severe pains in back and loins; uterine
contractions  feeble, slight flow.
  Viburnum.  Given before membranes are injured, when
pains are spasmodic, often succeeds.                     '
  Arnica.  When from fall, blow, or other injury.
  Ipec.  Nausea, discharge of bright-red blood, faintness.
  Morph. sulph., by hypodermic  injection,  when symp-1
toms are urgent, will sometimes succeed when it is too late
to accomplish anything by other drugs.  Dose: One-eighth
to one-quarter grain.  Repeat if necessary.   Deodorized
Tr. Opium, by rectal injection, keeping woman quiet on her
back for days, sometimes  tides over.
  Predisposition to abortion may often  be corrected by
administering the appropriate remedy.  Dose, twice daily,
from cessation of  menses until  after the period  at which
the  accident has  before  occurred.   Apis.,  Caul., Actea,
Helonias, Sepia, Sulph,, will be found particularly  useful. 
                         ABORTION.                    97

    GENERAL  MEASURES.  In  subjects  of habitual
  abortion, build up general health and strength by generous
  diet, systematic exercise,  an abundance of fresh air, and
  regular  bathing.    All  tendency  to  cough,  indigestion,
  diarrhcea or constipation, rheumatism, irritable bladder,
  ovarian  disease, or  other  malady, should be  corrected by
  appropriate medication.
    Should miscarriage  threaten, direct patient  to lie down
'  at once, on a bed having a hard mattress, with light cover-
  ing over her.  In this  position  she must remain at perfect
  rest, avoiding all  motion, and mental  excitement.  Keep
  the apartment cool and quiet.  Whatever food is taken must
  be plain and unstimulating.  such as  tapioca, rice, toast or
  milk; beverages should be old.

    311 S(' AR RI AGE.  If the womb lose the fruit of concep-
  tion prior to seventh month, it is called miscarriage- -after
  that -period, premature labor.  The latter is to be treated as
  labor at  full term.  If sac rupture in early months, liquor
  amnii escapes, and, of course, repair cannot take place, so
  that there will be constant leakage, and  abortion is hard to
  prevent; but the threatened catastrophe may be averted by
  long-continued rest.
    Signs.  Increasing  frequency and  severity  of  pains,
 continued flow, and,  especially, protrusion of ovum.
    TREATMENT.   Tampon immediately.  Never tampon
 vagina after the seventh month.
    The best tampon  consists  of  pledgets, or small balls, of
  raw cotton, each one tied with a string, one end of which
  should protrude, to  facilitate removal.  Or, a soft silk or
  cambric handkerchief may be employed, inserting first one
  corner, and gradually stuffing in the  entire kerchief.   All
  tampons  should  be well oiled before insertion, using car-
  bolized oil.
    Do not leave tampon in longer than twelve hours.  When
 it is removed, the  entire  contents of the womb will prob-
 ably be expelled.  If not. repeat, first washing  out vagina
 with carbolized water.   Examine carefully all  clots which
 come away, to see if  they contain the entire ovum.
   Profuse hemorrhage is to be treated by the tampon, cold,
 and the  appropriate  drug,  or injections of  hot water
 (120  F.).
   If a portion of the  ovum or placenta  remain  in  the
 uterus, take measures to bring it away without,  delay.  De-
 press the uterus, with one hand placed above the pubes, and
 attempt its withdrawal with the finger of the  other, using
 gentle, yet persistent effort.  Failing in this, use the pla-
 cental forceps, or blunt-hook.   If the mass be allowed to
 remain, there is  danger of secondary haemorrhage, or  of
 septicaemia.  After-treatment, as after labor.
       4 
DURATION  OF  PREGNANCY.
     Dibections:—Find  in  upper  horizontal  line  date  on  which  last menstruation  ceased ;  the  figure

                               beneath gives date of expected confinement (280 days).


         12  3  4  5  6   7   8   9  10  11  12  13  14  15  16  17  18   19  20  21  22  23  24  25~~26  27  28" 29  30  31 I
         8 9 10 11 12 13  14  15  16  17  18  19  20  21  22  23  24  25_26  27  28  29  30  31   1  2__3   4  5   6   7) Nov.
         12  3  4  5~~6   7   8   9  10  11  12  13  14  15  16  17  18~~19  20  21  22  23  24  25 26  27-28           ,
 ...-<.    | 8 9 10 11 12 13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30   1   2  3   4   5            Dec.__
 March  112  3  4  5  6   7   8   9  10  11  12  13  14  15  10  17  18  1'F 20  21  22  23  24'  25 26  27" 28 29  30  31 I
 Dec.    [67  8  9 10 11  12  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30 31   1   2  3   4__5 | Jan.__
 April   112  3  4  5~~6   7   8   9~ 10 ~lYT2~T3~ 14~~15^16-17~~i8~uT~20  21  22  23  24~ 25 26  27  28 " 29  30    j
 Jan.    | 6 7  8  9 10 11  12  13  14  15  16  17  18  19  20  21  22  23   24  25  26  27  28  29  30 31   1   2  3   4    | Feb.
 Alny    |12  3  4  5~6~"~7   8   9  10  11  12  13  14  15  16  17" ~ 18~  19  ~20"~ 21  22~2iT~24  25 26  27  28 29  30 " 31 I
>Feb^____; 5 (i  7_ 8  9 10  11  12  13  14  15  16  17  18  19  20  21  22   23  24  25  26  27  28   1  2   3   4  5   6   7 I March.
June   I 1  2  3  4  5 " 6   7   8   9  10  11  12  13" 14  15  16  17  18  19  20  21  22  23  24  25  26 27  28  29 30
,Mareh  \ 8  9 10 11 12 13  14  15  16  17  18  19  20 21  22  23  24  25  26  27  28  29  30  31___1_ 2  3_ 4   5  0     | April.
July    112  3  4  5  6  7   8~  9  10  11  12  13 14  15  16  17 "l8~ 19"" 20 ~21 ~22~23~24~25  26 27  28  29 30  311
April   | 7 8  9 10 11 12  13  14  15  16  17  18  19 20  21  22  23  24  25  26  27  28  29  30   1   2  3   4   5  6   7 | May.

        I 1  2"" 3~4  5  6   7   8"   V  10 "U  12  13 14  15  16  17  18  19  20  21~22  23  24  25^i6~~27  28  29  30  31 I
         8  9HI1112 13  14  15  16  17  18  19  20 21 _22_ 23  2t  25  26  27  28  29  30  31   12   3   4   5   6   7 | June.

         12  3  4  b  6"_7~  8 "V  10  11  12  13~14 ~15~ 16  17 ~ 18  19  29  21" 22~  23  24  25  26 27  28  29 30     j
         8  9 10 1112 13  14  15  16  17  18  19  20 21  22  23  24_ 25  26  27_ 28  29  30   1   2   3  4   5   6  7     | July.
       "| 1  2  S' 4  5"  6 '~1   8~  9  W ll~i~2~ 13 14~ 15 ~i6~17~ 1H~ 19  20~ 21  22  23  24  25  26 27  28  29 30  31 \~
        i 8  9 10 11 12 13  14  15  16  17  18  19  20 21  22  23  24  25  26  27  28  29  30  31   1   2  3   4_ 3_ 6___7 I Aug.
       ', 1  2  3  4  5  6   7   8   9  "lO  11  12  13 14  15  16  17  18  19  2(1  21  22  23  24  25  26 27" 28  29 30     I
        | 8  9 10 11 12 13  14  15  16  17  18  19  20 21  22  23  24  25  26  27  28  29 _ 30_ 31   1   2_ 3_ 4   5_6     | Sept.
Deo.    112  3  4  5  6  _7   8   9~10~ll"~12  13 14'""l5_ 16 "  17 "~18~ 19  20 ~21  22  23  24  25  26 27  28  29  30  31
Stpt.    | 7  8  9 10 11 12  13  14  15  16  17  18  19 20  21  22  23  '24  25  26  27  28  29  30   1   2   3   4   5   6   7_
Oct. 
            PARTURITION—PROLAPSE OF COHD.          99

                   PARTURITION.

  TAKE TO  CASE OF  LABOR   Forceps,  soft-rubber
catheter,  Ergot,  Chloroform,  Ammonia.   For  perineor-
rhaphy—curved needles, silver-wire  or  silk sutures, blunt-
pointed scissors.  For craniotomy—rTpevforator, craniotomy -
forceps; decapitating hook.

  EXAMINATION.   Observe—condition of  bladder  and
rectum; vagina, and os and cervix uteri; condition of mem-
branes;  pelvic  capacity;  determine  presentation   and
position.  Make out presentation before  membranes rup-
ture.  Do not press on membranes during a pain.
  RIGID  OS  UTERI.   Aconite.  Os hot,  dry and  sensi-
tive, patient feverish and restless.
  Belladonna.  Spasmodic rigidity of  the muscular fibres
of the cervix.
  Gelsemium.  Give five  to ten drops of Gels,  in a cup of
hot water, in divided doses.
  " It often acts like magic in producing dilatation and promoting
labor."  J. S. Douglas.
  Local.  Apply Belladonna cerate.  Warm vaginal injec-
tions.  Digital dilatation.
  TOUGH  MEMBRANES.  Notch the finger-nail like a
saw, and rub it to and fro on the bag until  it gives way.
  TUMEFACTION OF ANTERIOR LIP.   In  interval of
pains press  tumor up above crown of the head, and keep it
there during two or three pains, until  it is fully  retracted.
   CYSTOCELE.   Evacuate bladder by means of soft-rub-
ber, or  silver (male) catheter, or, failing in this, use aspi-
rator to draw off contents.
   HYMEN.   Make crucial incision, if spontaneous rupture
does not occur.
   RIGID  PERINEUM.  Apply  hot fomentations.
   Ergot.    Use of, in  labor:—Ergot should  be given  to
facilitate labor only if the parts are fully dilated, position
normal, and head presenting at outlet.


                PROLAPSE  OF  CORD.

               (Frequency.—I in 300 or  400.)

   If there he no pulsation in cord, do not interfere.   Other-
wise, place  patient in knee-chest position,  and, if possible,
reposit  cord well into uterus with the hand, or by means of
a  loop  of tape attached  to the end   of  a  gum-catheter.
Failing in this, terminate labor quickly as possible  by the
forceps. 
]00        KEY NOTES OF MEDICAL PRACTICE.

               PLACENTA   PR.EVIA.

                (Frequency,—1 in 500.)

  Place woman on back, hips elevated, shoulders low, and
pack the vagina well with the tampon.  Do not leave tam-
pon in longer than ten hours.  Attend to bladder.  If parts
dilated or dilatable, and  presentation of placenta is com-
plete, perform podalic version, and terminate labor soon
as possible.   Oil the hand, and pass it between the placenta
and uterine walls, search for feet, rupture membranes, turn
and deliver.


          POST-PARTI M  HEMORRHAGE.

  As soon as it is discovered that the woman is '* flooding,"
quickly but carefully pass hand into uterus, and turn out ,
all clots, fragments of placenta, etc., clearing the uterus of
all  contents—grasp fundus  with other  hand (previously
dipped in cold water, if  this can be done without  delay),
and have nurse pour  a small quantity of cold water onto
abdomen from a height of  several feet.   As quickly as
possible follow this by passing nozzle of  a  syringe  into
cavity of uterus, and inject a stream of hot water-110° to
115° F.  If  delay would  be too great in providing for hot-
water injection, use cold water, or, pass a piece of ice into
uterus.
  As soon as hemorrhage has been sufficiently controlled,
to guard against recurrence.--lower shoulders and  elevat*
hips;  tie bands about the extremities, as near to body as
■possible (let them be snug, but  not too tight); put on snug
binder, with compress over uterus; give indicated remedy—
Ipec, China. Secale, Sabina, etc., according to indications on
p. 110.
  If  alarming flow 2>ersisf, compress abdominal aorta to
left of spine, on line with  umbilicus,  or, as last  resort,
inject into uterus solution perchloride of iron—two ounces
to one pint  of  water.  This—preferably  by means of a
fountain, syringe   should be slowly  and  gently injected'!
through the uterus, previously seeing  that it is clear of
clots.    Transfusion  often  successful  in  restoring  the
woman, when exsanguine.


                      VERSION'.

  PODALIC.  Best  performed  before  rupture  of mem-
branes.  Os must be dilated or dilatable.  Evacuate bladder .
and rectum.  Anesthetize patient.  Bring hips to edge of
bed.  Bare the arm, and anoint arm and hand, except the , 
VERSION—FORCEPS DELIVERY.
101
palm.  Use the hand whose palmar surface corresponds to
face of child.  Work between the pains.  With one hand on
abdomen, introduce other into  vagina, pass it on between
membranes and uterine walls, carefully search for  feet,
rupture membranes, grasp one  foot and bring it down, at
the same time pressing head upward with other hand, to
aid the turning process.  After breech has become engaged.
labor  may be at once terminated, or  left to the efforts of
nature.
  COMBINED  .METHOD.  To be employed when  os is
but slightly dilated.  Introduce one or two fingers of one
hand  into  os,  with other hand on abdomen.  Determine
location of head and breech, and, by combined action of the
two hands, gradually " work " the head downward and the
breech upward, until head is brought to present at the os,
when  membranes should be ruptured.
  When  Required.   Version  is  called for in placenta-
prasvia. prolapse of cord, transverse presentation, presenta-
tion of arm, death of mother, rupture of uterus, convulsions,
or any state in which speedy delivery is  demanded.


                FORCEPS  DELIVERY.

  Parts must be dilated or dilatable.  Evacuate bowels and
bladder.   Anaesthetize  patient,  unless the child's head is at
outlet, when it may not be necessary.   Immerse blades in
warm water.  Have woman lying  across bed, with  hips at
edge, thighs separated, and  held by assistants.  Rupture
membranes, if  still intact.   Anoint convex   surfaces of
blades with lard or oil.  Take  position  between separated
limbs of  patient.  Take male blade into left  hand;  hold it
almost upright;  pass two fingers of the right  hand  short
distance within cervix, on the woman's  right side, between
fpetal head and uterine wall, then  introduce point of blade
along inside of fingers, and pass it, gradually lowering the
handle, until the  convexity of the  child's  head is  well
grasped by the fenestrated  portion of the blade;  depress
handle near to perineum.  Now take female blade in right
hand, and, beginning with blade upright, in similar man-
ner, but by reversed movements, pass blade in right side of
vagina and cervix, bring handle down, and  lock the two.
Proceed gently, and use no force.
  Traction.   As  a rule, make traction  only during  a
pain.   The direction, if head is high, should be first down-
wards;  but, as  head gradually descends, more and  more
upwards, until just before the head escapes from the vulva,
when  traction  is almost at right angles with the long axis
of the woman's body.  Generally, the  direction in which
the blades point determines the line of  traction. 
102        KEY NOTES OF  MEDICAL PRACTICE.

                   CRANIOTOMY.

  Place patient  in  position as for application of forceps.
Evacuate bladder and rectum.  Pass  fingers of  left hand
up  to  foetal head, and  carefully pass perforator along
palmar surface until it reaches head, taking care that none
of the  maternal soft parts be injured.  Perforate cranium,
break  up and evacuate  its contents.  Expulsion of child
may sometimes be effected by the forces of nature.   If not,
apply craniotomy forceps and deliver much the same as in
ordinary forceps case.


                       TWINS.

  As soon as first child is born and separated from mother,
apply  binder about abdomen, and  wait for expulsion of
other.  Do not attempt removal of placenta of  first until
after birth  of second.   If the two  placentae remain in
vagina, twist  cords  together and   deliver   in ordinary
manner.
         ASPHYXIA OF THE  NEW-BORN.

  Clear air-passages of  mucus, etc., with finger wrapped
with handkerchief, the child being inverted.   Provide  for
supply of fresh air.   Make upward friction on lower limbs.
Sprinkle face  and  chest alternately with hot  and cold
water,  or, slap buttocks.  If  not very soon  successful,
resort  to  artificial respiration.   Infant on  back — draw
tongue  forward—carry arms well above the head, then
bring them down  to the sides, with elbows flexed, and press
against sides of chest.  Repeat about twenty-five times per
minute.   As soon as  respiration  restored, apply heat to
body and extremities, and give five drops of brandy in half
a teaspoonful of milk and water.
               RETAINED  PLACENTA.

  If due to uterine inertia, grasp fundus through abdominal
walls, and manipulate  to excite contractions.  If placenta
adherent, pass hand into uterus  and gently and  carefully!
detach.  Leave no fragments.   See to  it that  uterus is
firmly contracted afterwards.  Follow by antiseptic injec- j
tions.  If  from hour-glass  contraction, insinuate hand, in J
conical  shape, into ring, and gradually and steadily over-"|
come resistance of circular  uterine fibres.  Inhalations of
Amyl nitrite will aid. 
PUERPERAL MANIA.                103
               PUERPERAL  ECLAMPSIA.

                    (Frequency, 1 in 500.)

                LKAI>1X<; KEMKIMKS.

    Belladonna.   Convulsive movement  of  limbs  and mus-
  cles of  the  face; dilated pupils, red or livid countenance,
  fixed or convulsive eyes, foam at the mouth, involuntary
  escape  of urine  and faeces;  renewal of the fits at every
  pain;  more or less tossing between the spasms, or deep
  sleep,  with  grimaces,  or  starts  and  cries, with  fearful
  visions.
   " If the patient is actunlly in a convulsion, or the fits are recurring
  rapidly, Bell, is the classical remedy."  Hughes.
    Gelsemium.  In those cases  in which the  spasms occur
  with a rigid os uteri.  Dose:—Five drops of tincture.
    Veratrum \ir.   Great arterial tension, with  full, hard
  bounding pulse.  Dose:—Three drops of tincture.
    Hyoscyamus.  Bluish color of face; twitching and jacti-
'  tation of almost every muscle in the body—of face, eyelids,
  and all.  Almost constant delirium.
   " A valuable remedy when due to reflex excitability." Hughes.
   Aconite.   Hot,  dry skin, thirst,  restlessness,  cerebral
 congestion;  general plethora.
   " Acts like a charm." Guernsey.
', Opium.   Sopor,  with stertorous breathing;  incoherent
 wanderings, with redness, swelling and heat of the face.
   Chamomilla.  From mental emotion,  excited by a fit of
 anger.   Great excitability.
   GENERAL 3IEASURES.   Remove all sources of irri-
 tation; empty bladder and rectum. Place piece of rubber,
. or similar substance, between the teeth.  If  all other means
fail, give Chloroform to control  paroxysms, and terminate
labor as soon as  possible.   If urine  albuminous,  and con-
vulsions are urcemic, then too the pressure on the ureters
must be relieved  by emptying  the uterus.  If convulsions
persist, and cervix unyielding, incise it.

          PUERPERAL  MANIA—ACUTE.

  Stramonium.   Furious  rage.   Loquacious  delirium,
throwing off  the bedclothes,  nymphomania, lascivious talk.
  "In puerperal mania, it stands  highest among remedies." Hughes.
  Belladonna.   Paroxysms of rage; insomnia;  marked
congestion of the brain, with eyes bright and shining.
  Hyoscyamus.  Delirium of  mild type.  Incessant, inco-
herent talking.
  " Simple mania, characterized more by agitation  than excitement,
iue to the existence of obscure illusions and hallucinations." Lawson.
  Cannabis ind. Mental delusions of  an exalted character. 
104        KEY NOTES OF  MEDICAL PRACTICE.

  GENERAL MEASURES.  If woman  suffer from in-
somnia, and mania threatens, or has already set  in, it is
important  that she should have  sleep.  If  other  methods
fail, give Chloral, grs. xx, at bed-time.  If  blood impover-^
ished, give abundance of easily-digested, highly nutritious <
food, fluid in form.


                    AFTER-PAINS.

               lkvdixg kkmedikm.

  Arnica.   Violent  pains, with bruised, sore feeling, pres-
sure on the bladder, and retention of urine; after difficult
labor.
  Gelsemium.   Numbness of  extremities, uterine cramps
extending upward and backward.  Use drop doses of  tinct.
  " The medicine on which I am accustomed to rely."  Hughes.
  Actea.   Rheumatic subjects; excessive irritability, and
over-sensitiveness.   Macrotin acts very promptly.
  Cauloph.  After protracted and exhausting  labor.  Spas-i
modie pains across lower part of abdomen, extending into
groin.                                                 ,■
  Belladonna.   Severe bearing-down,  as if everything
would protrude; pains appear and disappear suddenly; the
least jar hurts her.
  Chamomilla.   Great nervous excitability, pains very dis-
tressing, rendering patient irritable and ill-natured.      *
  Coll'ea.  Great  sensitiveness, with nervous excitability,'
pains driving to despair; wakefulness.
  Secale.  Pains long and severe.
  Ignatia.   Cramplike, with sadness and sighing.

  GENERAL MEASURES.   Hot fomentations over ab-
domen, or  warm vaginal injections, sometimes relieve.  If
due to clois retained in uterus, make pressure  on fundus,
and evacuate contents.
  As a rule, do not attempt to check after-pains for at least
six hours after delivery, as they are often merely caused by
efforts of  the uterus to expel clots  or portions of  mem-
brane.

           LACERATION OF  PERINEUM.

  Prevention.   Freely  lubricate perineum,  with cosmo-
line, oil or  lard, internally and externally. With two fingers-
in dilated anal orifice, and the  thumb on crown of child's
head, make pressure upwards and forwards, towards pubes.
■—.Frequency:—Average  of six observers,  27  per cent,  ofi
all  cases; more frequent in primipara* than in multipara.
Examine for it after every labor. 
LACERATION OF CERVIX.
105
  OPERATION.  Immediate.  As soon as placenta deliv-
ered, cleanse vagina, and, if  laceration slight, tie  knees
together.  If considerable, cleanse thoroughly, bring wound
together by  interrupted silver-wire  sutures, 3 or 4 to the
inch.   Enter suture about an inch from cutaneous margin
of wound, bringing it out on mucous membrane of vagina,
very near raw surface, carry to other side, bring together
and twist ends.
  Secondary.  Patient  should be  in  good  health,  child
weaned; time, few days after monthly period.  Instruments:
Scalpel; scissors, curved on flat; long, rat-toothed forceps;
blunt-edged perineum needle; surgeon's  needles, curved;
silver-wire; needle-holder; flexible catheter.
  Patient etherized: lithotomy position;  labia? held apart
by  hands of two assistants;  shave  hair  from  part;  two
fingers in rectum, draw surface tense, begin in angle of fis-
sure, next to rectum, and freshen surface in triangular shape,
by snipping with scissors and deunding with knife; torsion
bleeding arteries; be sure that entire area of surfaces to be
brought into apposition, is freshened.  Success depends on
care with which  sutures are applied. Pass perineum needle
from cutaneous surface, deeply through tissues, and bring
point out on vaginal surface, close to edge of  wound—
charge the eye of needle with end of suture, and withdraw
needle,  unthread it, pass it through fold on opposite side,
thread it with vaginal end  of  wire, withdraw needle, carry-
ing the  suture in its  track.  Beginning at  angle, pass su-
tures at regular intervals, 2 or 3 to  the  inch; coapt  parts,
and secure ends  by twisting, leaving  long ends, which are
to be brought together and secured  in a short  piece of rub-
ber-tube.

  AFTER-TREATMENT.  Draw the urine, put pad between
knees, and bind them together. Pass catheter three or four
times daily, and  keep vagina clean  by mild Carbolic injec-
tions.  Draw urine with care, and  hold piece of lint to
catch any drip.  Protect parts by  free use of Calendula
ointment, prepared with Vaseline.  Regulate  diet so as to
restrain action of bowels for 5 or 6  days.  Remove sutures,
with great care, on seventh day,and  let knees remain bound
together for  week following;  after that,  only  at  night.
Patient should not assume  upright position for two weeks.
             LACERATION  OF CERVIX.

  Prevention.   "With  adequate  dilatation  there  can
be no laceration.  The indications are,  to procure early,
prompt and thorough dilatation, by means of fingers and
forceps.   If expulsive efforts set in  before cervix  is suffi- 
 106        KEY NOTES OF MEDICAL PRACTICE.

 ciently dilated, urge patient to restrain voluntary efforts;
 oppose rapid expulsion by pressure  against  presenting
 part, and divert its movements in  proper channel."  R. N,
 Foster.                                                  \

   TREATMENT.   Indicated.—When it is the  cause of
 sub-involution, neuralgia or other  serious ill-health.  Do
 not operate if pelvic  peritonitis or  cellulitis  present, as
 indicated by  tenderness in neighboring connective tissue,
 on pressure with  finger.                                  t
   Preliminaries.—Large hot-water vaginal injections, once  I
 or twice daily, for several weeks; scarification of cervix if J
 mucus follicles enlarged and cystic.
   Instruments.—Vaginal douche; Sims' speculum; volsella;
 double tenaculum; bistoury and scissors; dissecting forceps;
 short needles, straight  and curved; needle-holder; medium
 Bilver-wire  sutures.
   Time.—The week following the menstrual flow.

   OPERATION.  Patient  anaesthetized;       lithotomy
 position;    large, carbolized,  hot-water vaginal  injection
 just before operation;    dilate vagina,  with speculum;
 draw down cervix with volsella or tenaculum;     approxi-
 mate edges of cleft  to see  how  much tissue  must be
 removed;     now open cleft  with  double tenaculum, in
 hands of assistant;      with long-handled, curved scissors,
 freshen edges  of  cleft, in V-snape, broad end in angle of
 cleft, narrow towards external  os;     hook up  portion to
 be removed with small tenaculum, and keep  it  on  stretch
 while it is being separated, and, if possible, remove it in
 single piece from side  to side;    get rid of all cicatricial
 tissue, particularly in  angle  of cleft, using bistoury,  but
 looking out for circular artery, near vaginal junction, where
 tissues must be removed very superficially.  If much bleed-
 ing during operation,  hot-water injections,  from time to
 time, will check.  Let undentided portion, which  will form
 walls of future cervical  canal, be broad, and  of uniform
 size and shape.         Sutures. — If tissues  soft, round
 needle; if  dense,  lance-pointed; sutures eight inches long;
 introduce  upper  one  first,- -three or  four  for  each side;
 pass  beneath  one( denuded portion,  across fissure, then
 beneath other.  In double laceration,  pass sutures of both
 sides before tying any.     Tie  sutures from above down- \
 wards.   Make  accurate approximation of  vaginal  edges.
 Remove sutures, carefully, on seventh  day—uppermost one
first.

  AFTER-TREATMENT.  Confine patient to bed for two
 weeks; empty  bladder by catheter for 48  hours; after that,
 water  injection after  every act of  micturition.   If much
 discharge,  warm,  carbolized  injection once or twice daily,  j 
fVh.a.fe.nAL. e£.\ca,.                107
                 PHLEGMASIA DOLEXS.

                 LEADING ICEMKDIIX

    Aconite.  Fever, high temperature, rapid pulse, restless-
  ness, thirst.
    Belladonna.   Skin moist, sharp pains in leg,  cerebral
  congestion.
    Bryonia.  Sharp, shooting  pains, aggravated  by least
  motion.
    Pulsatilla.  Thirstlessness, and in the characteristic sub-
  ject.  If patient not doing well under other remedies.
    Hamamelis.  When symptoms depend on phlebitis ex-
  tending from uterine into crural veins.

    GENERAL  3IEASURES.   Leg more  elevated  than
  thigh; straight or bent, as is more  comfortable  to patient,
  supported on cushions.  Apply Hamamelis fomentations,
  wrap with cotton-wool, and  cover with oil-silk. After acute
  stage past, bandage from toes to hip with roller, as long as
  oedema lasts.  Watch for collections of pus,  and, if found,
  evacuate at once.  As recovery approaches, use friction and
  faradization.  Do not use leg until all disease  has disap-
  peared.


                 PUERPERAL  FEVER.

                LEAIUXG  REMEDIES.

   Aconite.  If there be chill, followed  by high  inflamma-
  tory fever, with hot, dry skin, quick, hard pulse, mouth and
 tongue dry, great thirst, vomiting, urine scanty, red and
 hot, cutting, burning, lancinating pains in uterus and abdo-
 men, which is hot to touch, and excessively sensitive  to
 slightest pressure.
  "I believe it to be a most valuable remedy." Dr.  W. S. Playfair.
   Verat  vir.  Early  stage  only.  Nausea and  violent
 vomiting,  empty retching, much  congestion  of  the head,
 full, hard pulse.  By some preferred to Aconite for the first
 signs of congestion, inflammation,  and fever.
  Belladonna.   Intense congestion, painful retching and
 vomiting.  Abdomen excessively sore  and painful, cannot
 bear the slightest jar, violent clutching pains in  abdomen,
 with great heat, meteorism, painful bearing down in pelvis,
 suppressed lochia;  congestion of head, with flushed face
 and red eyes, throbbing headache and delirium.
  " When the inflammation attacks  the peritoneum. Bell, most fre-
 quently required."  Hughes.  "An excellent remedy for the vomit-
 ing. "  Baehr.
  Bryonia.  If  peritoneum  involved,  and exudation has
begun.   Stitching,  lancinating pains in abdomen, worse 
108        KEY    _..  ..........------............

from slightest motion, lochia suppressed.   Digestive or-  .
gans much involved, though without vomiting or diarrhoea.
Fever not very violent.
  Colocynth.  Severe, cutting,  colicky pains  in bowels,
excessive tympanites, thin watery diarrhoea.   During  par-
oxysms of violent pain, complexion pallid, skin alternately
cold and hot. pulse quick, distressing vomiting.
  "Quite well indicated when  tympanites  is  excessive."  Hughes.
"An important remedy."  Baehr.
  Arsenicum.  Sudden sinking of  strength, cold,  clammy
perspiration, insatiable thirst, constant vomiting, burning
pain in abdomen, great anguish, extreme restlessness, rapid -
prostration.   Symptoms  of decomposition of blood.
  Veratruin  alb.  Violent vomiting and  diarrhcea, sup-
pressed lochia, icy-cold  extremities, Hippocratic counten-
ance, cold perspiration, cold breath, threatened collapse.
  " Deserves preference if disease sots in suddenly, with  great vio-
lence."  Baehr.                                             i
  Nux. vom.  When the uterus itself  is inflamed—puer- "
peral metritis.
  " I have been astonished at the rapidity of it< action."  Hughes.

  GENERAL 3IEASURES.   Washout vagina and uterus
twice daily with weak solution  Kali per man., or Carbolic
acid.  Introduce nozzle of syringe  well through the cervix, \
wash cavity of uterus thoroughly  until  the water issuing ™
from vagina is  no longer  colored.  Unsafe to trust this  s
important treatment  to  the  nurse.  Apply  over abdomen
thin poultice containing  an ounce  of Turpentine.   If tym-^
panites very distressing, enema of  Turpentine very service-
able.  Use every antiseptic precaution in management of
case.
   Diet.  Bits of ice in  mouth  to slake thirst and  allay
vomiting. Important to sustain vital strength by abundant
nourishment.  Give hot milk, strong beef-tea, meat-broths,
and, if prostration great, cafe-au-luit.  If food distasteful,
give albumen-water.  Give small quantities of food at fre-
quent intervals.

                      AGALACTIA.

                LE.VI>I\<>  REMEDIES*.

   Asafietida.   Excessive  sensibility   of  vital organism;
veins of  breast much distended.
   "In high repute."  Hughes.
   Bell.  Breasts large and  heavy, headache, flushed face,
 cerebral congestion.
  " May afford great aid."  Hem pel.
   Puis.  Often called for—promotes the secretion in many
cases.
Sv 
109
  China.   Debility from loss of animal fluids, particularly
of blood.
  Calc. c.  Leucophlegmatic constitution; extremities cold
and damp; inclined to too frequent and too profuse menses.
  "Sometimes  a single dose will effect the  desired improvement."
Hughes.
  Urtica urens.  Entire lack of milk after parturition.

  GENERAL 3IEASURES.  Warm  applications to the
breast will, favor secretion.  A strong  decoction of  the
castor-oil plant  (Ricinus Communis) applied hot  by means
of soft cloths, has been often successfully used.
  Diet.  The use of porter, ale, and other liquors, founded
on false principles.  The patient should  have an abund-
ance  of nutritious,  easily-diijestible food, such as  milk,
cocoa, fresh  meats,  eggs, broths,  and whatever  harmless
food the appetite may crave. Milk-diet is the best.

                       MASTITIS.
                LE.\DI\(;  REMEDIES.
  Bryonia.  Breasts heavy, hot. hard  and painful, but not
very red; breasts gorged with milk, severe stitching pains
in breast; feels sick on first sittingup.  Dose:—6th or 12th
dilution.  Hughes.
  " The great medicine for mastities.  Specific  for mastitis neonato-
rum."  Hughes.
  Belladonna.   Breasts   swollen, hard, glossy,  with  red
streaks running in radii; throbbing, stitching pain, accom-
panied by headache and fever.
   Phytolacca.   Chill, fever, painful  engorgement,  and
swelling; the drawing of milk impossible; the gland full of
hard, painful nodosities.
  " In ordinary caked breasts it is considered to be specific." Raue.
  Hepar s.  Threatening suppuration, or  after suppura-
tion has begun; the discharge is scanty, and there is still
great hardness  of  the inflamed parts.
  Phosphorus.   Phlegmonous  inflammation; breast swol-
len, red in  spots or  streaks, hard nodosities.  Fistulous
openings, with watery, discolored,  offensive,  ichorous dis-
charge.
  "Has cured fistulous conditions  of breast  left behind  after  milk-
abscess." Hughes.
  Apis. Burning, stinging pains, with oedema.
  Coninm.   When  from  contusion.   "Specific."—Hughes.
  Silica.  Chronic fistulous  openings.  Profuse secretion
of pus.
  Graphites.  When then are so many old cicatrices from
former abscesses, that the milk  can scarcely flow.
  " It has never failed me." Guernsey.
  GENERAL 3IEASUIJKS. As soon as.hardn ess appears, 
HO         KEY JNU'l'JSS UD' JW.JSUHJAlj FttAUTlUt.

rub with  olive oil,  from circumference towards center.
Support breast with  sling of broad handkerchief.  Apply
warm fomentations, by a basin lined with flannel saturated
with hot water and Phytolacca  tinct.   If  pus has begun to
form, poultice.  In opening abscess, make incision to cor
respond with radius, and at most dependent part.


                   SORE NIPPLES.

   Arnica.   Nipples  feel sore after nursing.
   Silica.   Much ulceration and suppuration.
   Phytolacca.  Nipples sore and excoriated.
   Graphites. Minute vesicles, exuding glutinous fluid.

   GENERAL 31 EASE K KS.   Nipples should be carefully
 washed after each nursing, and child's mouth thoroughly
 cleansed before and after being put to breast.  When sore,  '
 Hydrastis  and Glycerine, equal parts, applied, will often
 cure.  If there are suppurating sores, apply lotion of  Cal-
 endula tinct., a drachm to an ounce, on soft cloths. If there
 are deep fissures or cracks, touch the raw surfaces with scale
 of Argent, nit.  Lotion  of Phytolacca exceedingly useful;,
 apply in cracked or excoriated nipples, or fissures of syph-'
 ilitic origin.  Until  nipple is  entirely well, cover it  with
 rubber-shield while child nurses.  In those who are subject  ■
 to sore nipples, bathe daily with Arnica lotion.

                    METRORRHAGIA.

                 liEADIXti REMEDIES.

    Ipecacuanha.  After  labor or  miscarriage;  continuous
 flow of bright-red blood; the patient is cold and pale, gasps
 for breath; chilliness and nausea.
   "The first remedy I make use of is always Ipecac.'" Jahr.  "Very fre-
 quently used."  Guernsey.
    Sabina.   After miscarriage or parturition.   Plethoric
 subjects.  Haemorrhage  profuse,  painful;  blood  fluid and
 mixed with clots; drawing pains from back to pubes,  pre-
 cedes the flow.
   " Will help in many cases."  Baehr.  " Used in frequency next to
 Ipecac.^  Guernsey.
   China.  Heaviness of head, ringing in ears, obscuration
 of sight, fainting; face and extremities cold and pale; drow- ■
 siness; weak pulse; twitching and  jerking of  muscles.
 After loss of much blood.
   " Will be found of very great service."  Guernsey.
   Secale.   Haemorrhage from atony  of uterus,  after pro-
 tracted  labor, or in feeble, cachectic  subjects.  Uninter-
 rupted, painless flow of dark,  fluid-blood.  Great prostra-
 tion, faintness, palpitation of heart, convulsive movements,
 cold skin.
   "Floodingin feeble, cachectic women." Lilienthal.

_____________________________lJ 
                      MENORRHAGIA.                   HI

   Belladonna.  Profuse discharge of bright-red, hot blood,
with downward pressure.   Severe pain in  the back.   Great
vascular excitement; throbbing of carotids, flushed face, red
eyes, full, bounding pulse.
  " Very frequently indicated in uterine hemorrhage, particularly in
that after labor."  iluernsey.
   Crocus.  Pressure and feeling of weight in pelvis, with
feeling of something rolling in abdomen,  and discharge of
dark, stringy, viscid, tenacious blood.
  " Frequently called for in post-partum hemorrhage."  Guernsey.
   TAMPON.   Put  patient  in Sims'  position.  With  left
forefinger,  or Sims'  speculum,  retract posterior  vaginal
wall.   With pledgets of cotton, or free end of roller-band-
age, pack vagina posteriorly to cervix, then anteriorly, then
centrally, until firmly filled by plug, taking  care not to ob-
struct urethra.   After  sufficient  time  has elapsed, removo
piecemeal,  patient in same  position.


                    MENORRHAGIA.

               LEAD1XU It Ell EDI ES.

   Crocus.  Discharge black, viscid, stringy and tenacious.
Earthy-yellow face, debility and palpitation.
  " Invaluable in functional form." Hughes.
   Sabina.  Plethoric subjects, uterine hyperaemia, drawing
pain from back to pubes,  blood  bright red.
  " Will cure  large number of cases."   Matheson.
   Ipecac.   Very profuse; constant nausea.
   Secale.   Blood dark, without pain, increased by slightest
motion.
  "Often proves  curative."  Hughes.
   Hamamelis.  Profuse;  dark, thin blood.
   Chamomilla.   Black,  clotted  discharge,  with  severe
pains in back.   Excessive sensibility, local and general.
  " Has undoubted control."  Hughes.
   Nux v.   Menses  too early and too profuse; stops  for  a
day  or two,  and  then returns.   Irritability.   Sedentary
habits.
  Trillium.  Menses every  fourteen days, lasting seven or
eight days; in  interval profuse, yellowish leucorrhoea; blood
at first bright red, but later is pale.
  " For active flow we possess no better remedy."  Hale.
  Calc. c.   Menses too early and too profuse and long-last-
ing; anaemic condition; mal-nutrition;  congestion of head.
  " Sulph. and < ale. c. successively admini>tered during interval be-
tween periods, required in majority of  cases to ensure a radical cure."
Laurie.

  GENERAL  MEASURES.   Hot-water bag to  lower
dorsal and lumbar regions. 
 112         KEY NOTES OF MEDICAL  PRACTICE.

                  DYSMENORRHEA.

               LEAD1 X<;  R Ell EDI ES.
   Actea.  Severe pains in back, down thighs  and through
 the hips.  Hysteric spasms, cramps and tenderness of  hy-
 pogastrium.  Between  menses, debility, neuralgic pains,
 tendency to prolapsus.  Rheumatic, irritable uterus.
   Ciinlophylluni.  Spasmodic  dysmenorrhoea.   Bearing-
 down pains, scanty flow.  Sympathetic spasms of adjacent
 organs, as bladder, rectum, bowels.  Hysterical spasms of
 chest and larynx.
  I have had great success with Mac rot in and Caulophillin, 2x trit.    i
   Viburnum.  Spasmodic  dysmenorrhoea.  Excruciating,
 colicky pains  in  lower part of abdomen, coming on sud-
 denly  preceding  menstrual flow, lasting for  hours.  Should
 be given for a week previous to flow, in tinct. or lx.
   Cocculus.  Sharp, cramp-like pains, with  scanty menses,
 distention of abdomen.                                _ j
   Chamomilla.  Pressure in uterus resembling labor-pains. I
 Discharge  dark and clotted, with tearing pains, frequentfl
 desire to urinate.   Uterine neuralgia.   Excessive irritability!
 and impatience.                                         I
   Pulsatilla.  Menses delayed and  scanty; pains  so vio- I
 lent, she tosses about with cries and tears; blood dark and 1
 clotted, flows  at intervals.  Great chilliness.   Uterine con-
 gestion.
   Belladonna.  Menses too early  and too  profuse; bloodi
 bright red.  Great downward  pressure  in genitals. Face.
 red and bloated, cerebral congestion.  Congestive dysmen-t
 orrhcea.

               SPECIAL  REMEDIES.
   Hiunainelis.  Of ovarian origin.
   Collins.   Much pelvic congestion.
   Borax.   Dysmenorrhoea with sterility.
   Coffea.  Excessive nervous excitability.
   Sepia. Chronic, with leucorrhoea and debility.
   Gelsemilini.  Spasmodic,  to palliate during attack.

   GENERAL  3IEASURES.  Hot fomentations across
 hypogastrium, or hot sitz-bath  at time of attack if freeflow.
 If flow scanty, spinal ice-bag to lumbar  and  sacral regions.
 Warm drinks.  In spasmodic form. Gelsemium at time of
 attack gives great relief.  Dose:—Three to ten drops first-
 decimal, frequently repeated.


                   AMENORRHEA.
               LEADIX4.  RE1IEDIES.
   Pulsatilla.   Delayed, suppressed  or  scanty  menstrua- ;

____________________________________________________________j 
AMENOIiKHCEA.
113
tion; pains  in abdomen or  loins,  hysterical symptoms.
nausea and vomiting, palpitation of the heart, loss of appe-
tite, deranged digestion, pale face, lassitude, chilliness and
headache.  If patient have light complexion, fair hair, and
a timid, easily-vexed, yet uncomplaining disposition, this
remedy is more especially indicated.
  " For the great majority of cases." Hughes.
  Actea.  Pain in left breast and side, rheumatic tendency,
headache,  nervous  excitement, peevishness; when  from
uterine derangement. Hysterical subjects.
  Sepia.   Delayed menses.   Sallow complexion, fair, sen-
sitive skin, feeble,  delicate subjects, leucorrhaa, haemor-
roids, and evidence of portal and pelvic congestion.
  Conium.  General torpor of  the  organs.  The breasts
become enlarged  and painful at every period.   Compli-
cated with ovarian or uterine disease, or chlorosis.
                SPECIAL REMEDIES.

   Aeon.  Sudden suppression  from  cold;  congestion of
 head or chest; young, plethoric girls.
   Bry.   Bleeding from nose in  place of menstrual  dis-
 charge; dry, shaking cough; oppression of chest; heaviness
 or pressure in head.
   Calc. c.  Scrofulous subjects,  and those inclined to incip-
 ient tuberculosis.  Cold, damp feet.
   Phos.   Delicate constitution,   weak,  sensitive   lungs,
 cough, expectoration of blood, and pain in the chest.
   Ferrum.   Delay  of first menses.   Debility,  languor,
 palpitation,  indigestion,  leucorrhoea,   sickly  complexion,
 puffiness of face or ankles.
   Nux V. Patient of  dark complexion, vehement disposi-
 tion, sedentary habits; acute indigestion; constipation.
   Graphites.  Menses  delayed, scanty and  painful, con-
 stipation, tendency to eczematous cutaneous eruptions.
  " Next to Puis, in frequency of usefulness."   Hughes.
   Sulph.  Scrofulous eruptions; temporary flushes of heat.

   GENERAL 3IEASURES.   Keep  the  feet warm, and
 the abdomen covered with flannel.  Warm foot-baths are
 useful, or, the cold sitz-bath.   Sit  in a bath, with water at
 58  or GO % five to ten  minutes,  at bed-time, keeping legs
 and feet warm, and shoulders well  covered.  After the bath,
 the patient should be well rubbed, and  retire to bed.  This
 is  to be used only in  the functional,  variety.  When  due to
 constitutional derangement, apply the  special remedy, and
 prescribe nourishing  diet, out-door exercise, and   every
means to restore the general  health.  In atony of uterus,
electricity, with Conium. 
      114        KEY  NOTES  OF MEDICAL PRACTICE.           1

                         LECCORRH(EA.

                     LEADIX^ REMEDIES.

        Alumina.  Profuse,  yellow, acrid,  corroding discharge,
      with burning in genital organs, the parts  being corroded *
      and inflamed.  Worse before and  after the  menses.  Con-
      stipation, inactivity of the rectum.                        <
        Amnion,  carl).   Watery, burning discharge  from the
      uterus;  profuse,  acrid, milky leucorrhoea; menses every
      fortnight, black, coagulated, profuse.  Weak, delicate sub- j
      jects.                                                     I
        Calc.  carl).   Profuse, milk-like, or yellowish discharge, ij
      with soreness and swelling of  the vulva; too early and too  i
      profuse  menses.  Scrofulous  subjects,  very sensitive to i
      cold, with constant cold, damp feet.
        Pulsatilla.   Discharge thick, like cream, or, milky, some- '<
      times  giving rise to a burning sensation.  Indigestion,
      chilliness, nausea and trembling.   Especially  for those of
      relaxed  fibre and  lymphatic temperament, in whom the
      menses are irregular, delayed and scanty.
i       " Vaginal leucorrhoea, in chlorotic  subjects."  Hempel.
       " Specific for morbid activity of cervical glands."  Hughes.
        Sepia.  Pressure and bearing-down in pelvis, stinging
      pain in ovarian region.  Discharge variable—thick, creamy, i
      yellowish, bland or excoriating, offensive.  Leucorrhoea at
      puberty, during pregnancy, or  at climacteric.
       "Debility and passive uterine congestion, in those who have  borne
      many children." Hughes.
        Helonias.  Uterine leucorrhoea, from atony or conges-
      tion.  General debility  from over-lactation, or other drain
      on the system.
        Hydrastis.   Yellow discharge, of an extremely tenacious
      character, often offensive,  frequently with long shreds in
      it.   Often  accompanied  by   derangement of  liver  and
.'      stomach.

$        GENERAL  MEASURES.   Attention to state of gen-
      eral health, of which  this is usually but local  expression,
      necessary.  Irrigation of vagina with cold water beneficial.
      Calendula-ivater or Hydrastis-water, better  than astringent
      solutions, as injections.


                           OVARITIS.

                    LEADING REMEDIES.

       Apis.   Inflammation of right ovary.  Numbness in right
      side, extending down the thighs.  Sharp, lancinating, sting-
      ing pains in ovary.  This is one of our most reliable reme-
      dies in ovarian affections. 
                 OVAK1T1S—CLlMAfrKllUJ.              115

   Pulsatilla.  Sub-acute ovaritis, with menstrual suppres-
 sion, nausea, chilliness, pressure on bladder and  rectum;
 pains so violent she tosses about in all directions, with cries
 and tears.
  "I believe it to be far superior to most of the remedies ordinarily
 recommended."  Hughes.
   Belladonna.   Hard swelling  of ovary, with  stitching,
 throbbing pains; constant  bearing down  in  pelvis.  Per-
 spiration, glistening eyes, cerebral congestion.
   Lachesis.  Inflammation  of  left ovary, with  swelling
 tensive, pressing pains and stitches; cannot bear slightest
 pressure on ovarian region.
   Hainainelis.  An excellent remedy in more intense form,
 when peritoneal covering not involved.

               SPECIAL  REMEDIES.

   Aconite.  Much fever.
   3Icrc. s.  Threatened abscess.
   Hep. s.  To check suppuration.
   Thuja.  Chronic, of left side;  much pain.
   Coniuin.  Chronic ovaritis, with induration.

   GENERAL 3IEASURES.  Hot fomentations, contain-
 ing Hamamelis, over affected part.   Rest.


                    CLIMACTERIC.

   Actea.  Pain in left side.  Pain at vertex and irritability
 of disposition.  Faintness at epigastrium.
  " It rarely fails to relieve."  Hughes.
   Lach.  Hot "'flushes,''burning in the vertex, and faint-
 ness.
  "Of great service."  Bayes.
   Gels.  Flushes of heat, burning pain in top of head.
   Glonoin.  Rush of blood to  head, great giddiness, throb-
 bing, beating, roaring in ears.
  " A most efficient remedy."  Hughes.
   Platina.   Vertigo,   palpitation, headache,  roaring  in
 ears.  For those in whom  menstruation has  been profuse
 and  prolonged.
  Amyl nit.  Flushes of heat.   Give by inhalation.

  GENERAL 3IEASURES.  Frequent warm baths help-
ful in tiding patient over critical period. 
lit;
Kl'A  NOTES OF  MEDICAL 1'KACTICl'..
I
PAUT III.
SURGERY.
                       TRACHEOTOMY.

       INDICATIONS.  1.  Foreign bodies in trachea, bronchi
     or pharynx.  2. Scald of glottis in children.  3. Prelimi-
     nary to extensive operations about jaws and throat (admin
     ister anaesthetic through  tracheal  tube).   4. Croup and
     laryngeal  diphtheria, with laryngeal  dyspna>a,  indicated \
     by  presence  of  considerable  exudation  in larynx, and
     respiration so difficult that there is sinking  in of sternum
     and of supra-clavicular spaces with each inspiration.   Con-A
     tra-indicated:—Auscultate posterior  chest—if  one  lung (
     seriously obstructed, tracheotomy contra-indicated.
       Instruments.  Scalpel; curved bistoury; tenaculum; two  |
     strabismus  hooks;  two or  three catch-artery  forceps; ■
     sponges; tube with tapes.
       Chloroform  may be given if  time permit. Local anaes-
     thesia by ether spray.   If no anaesthetic used, wrap  child™
     in shawl to secure limbs.

       OPERATION.  Place patient on firm table in front of
     good light; put small, firm pillow (quart-bottle  rolled up
     in a  towel will  answer)  under neck to make trachea prom-
     inent. The operator standing on right side of patient seizes
     trachea  between thumb and finger of left hand  and fixes it
     until exposed by the incision.  The incision should be free,
     extending from cricoid cartilage, from one  and one-half to
     two or more inches downward,  including integument and
     cellular  tissue.  It is to be deepened by successive cuts, or
     by hooking of tissues aside until the trachea is reached, the
     operator keeping  strictly in the median line.
       The trachea reached, four or five rings should be cleared
     by blunt hooks or handle of scalpel.   The  operator then
     hooks the tenaculum into the trachea at the highest point
     exposed, and making traction  upward (now for the first "'
     time releasing trachea from grasp of left hand)  cuts  from
     below upward, with the sharp bistoury, a sufficient extent of
     trachea  to admit the canula.  The wound may be held open ,


t

k_____________________________I 
Tit AC IIEOTOMY—HERNIA.
117
with the blunt hooks until, by suction, the trachea is cleared
of blood, mucus or other foreign  matters.  The outer tube
may then be inserted, and secured by tying tapes about the
neck.  The inner tube, slightly moistened  with glycerine,
may be put in place, the  opening covered  with  several
thicknesses of gauze, to  filter air, and the patient placed in
bed.  The tube should be  large enough to  permit quiet
breathing.
  During operation  bleeding vessels may be  seized with
catch-forceps, which are allowed to fall toward  the sides of
the neck,  making lateral traction. Free haemorrhage should
be checked by forcipressure, if time be limited, or torsion,
if not, before  trachea is  opened.  General  oozing, from
congestion, is best checked by opening of trachea relieving
congestion, and by  pressure of canula.   Should  thyroid
isthmus appear in track of incision, hook upward or down-
ward, or incise.
  After operation the inner tube must be  removed often,
and thoroughly cleansed, the small bristle brushes  used for
feeding-bottles, answering well; or, a stiff feather, properly
trimmed.
  If operation  be made for foreign body, the trachea  may
be held open and body extracted by suitable forceps; if this
not feasible, insert  tube  and wait.

                        HERNIA.

   REDUCTION.  Taxis.   Anaesthetize  patient;  place  in
supine position, legs drawn up.  Resisting forces: tightness
of constricting ring,  and swelling of  strangulated  viscus.
Manipulate hernia as nearly as possible in line of axis  of
ring—compress gently, but steadily, for long time.  While
keeping up pressure  with one hand, with finger and thumb
of other manipulate neck of tumor back into abdomen. In-
sinuate finger-end or  nail beneath edge of constricting ring,
and pull outward.   When reduction occurs, bowel goes back
suddenly, with a gurgle. Aspiration by No. 1 needle occa-
sionally* facilitates  reduction after  failure of gentle taxis.
Or, give patient 20  minims Laudanum, place him in warm
bath for 20 minutes, then between warm blankets, and try
taxis.
  " Taxis should be gentle and thorough, and tried only once before
resorting to operation."  Adams.
  " Unskilful taxis is a more frequent cause of death than the knife."
Hamilton.
  Indications   for Operation.  Symptoms of intestinal
obstruction with an irreducible hernial protrusion.

  HERNIOT03IY.  Instruments:— Scalpel, forceps, direc-
tor,  artery-forceps, ligatures,  retractors,  hernia-director,
hernia-knife, sponges and accessories.
  Shave parts and  empty bladder.  Patient  anaesthetized, 
118        KEY NOTES OF MEDICAL  PRACTICE.

supine, thigh slightly  abducted and rotated outward.  Xote
positions of  spine of pubes,  Poupart's ligament, femoral
artery.  Make incision free  enough to  give access to stric-  i
ture.  Divide coverings of sac layer by layer, on director.  .
Tie and cut superficial epigastric artery, if exposed.  When  I
sac is exposed reduce  hernia without  opening, if possible.
If hernia still  irreducible, raise small fold  of sac at  most
dependent point, make small  opening, from  which a  little
fluid will escape;  introduce director, and on this enlarge  '
incision.      Division of stricture:—If point of stricture
is at external ring, make incision  upward and outward; if
at internal ring, insinuate left index finger,  and pass the
finger-nail under the stricture; pass hernia-knife  flat, along
palmar  surface  of finger, through stricture,  turn edge of
knife directly  upward, and cut a mere notch—}& or }£ inch  *
—by  pressure of  the  knife, not by  sawing  motion.  The  j
hernia may now be returned by gentle manipulation.       '
  If gut gangrenous or ulcerated, artificial  anus m ust be
formed.  If omentum inflamed, tie with stout ligature and  ;
cut off inflamed portion.                                 l
   After reduction of  hernia, dress wound aseptically, apply!
compress and bandage.  Provide for  drainage.      ^t/ter-H
treatment:—Rest in bed; liquid food  till bowels act; enema  J
if bowels do not act in ten days.   Peritonitis, treat as fromjl
other causes.                                            ■


             TREATMENT  OF   WOUNDS.

              (Antiseptic Method—Listerism.)

   1. Check haemorrhage by torsion, acupressure, forcipres-
sure,  or cat-gut ligature, cut short.
   2. Cleanse wound of all foreign bodies.
   3. Irrigate with antiseptic solution—CarooJic acid (1:40),
Prince's Lotion.
   4. Provide drainage by  carbolized horse-hair, glass-silk,
cat-gut or perforated rubber tube.
   5. Bring edges into exact apposition by carbolized silk
or gut sutures.
   G. Apply antiseptic dressing.
   The principles of wound  dressing  are—(a) make wound
aseptic, and (b) preserve it so.
   The first principle may  be carried  out, in  operation  ,
wounds, by allowing nothing' (fingers, instruments, etc.,)
to touch parts unless previously  disinfected by  thorough
washing in antiseptic solution; the second, by use of  some
form of  dressing which shall  prevent access  of  unpurified
air to wound.   Taking an amputation wound for illustra-
tion, the dressing may be efficiently made as  follows:—The
wound surfaces having been thoroughly disinfected, drain- 
             TREATMENT OF WOUNDS—ABSCESS.        119

 age provided, and sutures adjusted, the line  of the  wound,
 and half an inch or more of the surface on each side, are
 covered  with Iodoform  dusted on  thickly;  over  this  is
 placed a strip of aseptic oiled silk, perforated; directly on
 oiled silk is placed Lister's antiseptic gauze,  eight layers
 wrung out  of 1:40 carbolic lotion, a layer of  mackintosh, a
 top layer of dry gauze, and a bandage evenly and firmly
 applied.  Drainage tubes are  to be cut  off  flush with the
 skin, and secured, if in danger of slipping,  by transfixing
 end with safety-pin. at right angles to wound.
   In a large percentage of  cases there will be no necessity
 for changing first  dressing  for four  or five  days, when
 drainage-tubes may  be removed, and dressings repeated.
   In cases where wounds are not inflicted by surgeon, the
 same method of dressing is  to be followed, after thoroughly
 disinfecting wound by irrigation with carbolic lotion (1:20
 or 1:40).  Always provide free drainage. Where there  is
 tension on wound edges, relieve by deep sutures adjusted
 at some distance.  Deep sutures, preferably of silver-wire,
 fastened by means of buttons at each end.
   If, after removal of a tumor (e. g., mammary gland) deep
 cavities exist under flaps, apply pressure by pads of gauze,
 so adjusted as to keep deep portions in exact apposition.
 Complete immobilization of wound necessary.   Other anti-
 septics may be used—Boracic, or Salicylic, Acid; Boro-glyc-
 eride; Naphthaline;  Corrosive  sublimate (1:1000) or Tere-
 bene.
   " Under this, or any efficient antiseptic method—wounds heal by first
 intention, patients are free from  fever, and cases pursue  an aseptic
 course."  Adams.


                       ABSCESS.

                LEADIXU REMEDIES.

   Hep. s.   To avert threatened  suppuration; or, when sup-
 puration is  inevitable, tumor hard, hot, swollen, with throb-
 bing pains.
   3Ierc.  To avert suppuration.  Glandular abscess, with
 nocturnal pain;   tumor  hard,  shining  red,  beating  and
 stinging.
   Bell.  Bright redness of affected part, burning, throbbing
 pain, erysipelatous appearance.
   Silica.  Fistulous openings, hard to heal, discharge thin
 and watery.  Abscess of bone.   Chronic abscess.
  Calc. c.   After suppuration completed,  to  promote heal-
ing.  Strumous abscess.
  Sulph.  Profuse discharge; tendency  to  recur, emacia-
tion, hectic.  Strumous abscesses. 
120         KEY NOTES OF MEDICAL PRACTICE.

               SPECIAL REMEDIES.

  China.   During excessive discharge.
  Ledum.  From injuries or splinters.
  Arsen.    Foetid,  sanious discharge; or threatened gan-
grene.
  Mezereum.  Abscess in fibrous or tendinous structure, or
from abuse of mercury.
  Rhus tox.   Abscess of axillary or parotid glands, dis- '
charge thin and sanious.

  GENERAL MEASURES.   Remove splinter or other
foreign body which  irritates.   Cover with  poultice until
"ripe" for lancing.  Open abscess at most dependent point,
as soon as pus has formed.   All abscesses of size require
drainage after incision.  Deep-seated abscess, in  proximity j
to, or underlying,  important structures, blood-vessels, etc.,
may be opened by Hilton's method,  i.e., incise  skin, push !
grooved director through tissues toward purulent collection;
as soon as pus issues along groove of instrument,  pass dress-
ing  or  polypus forceps, open  them and  withdraw,  thus,
making free  opening  for discharge  without endangering
vessels.
  Chronic  abscesses should never be opened  except under
strict antiseptic precautions.
  In whitlow, or abscess beneath periosteum, lance clear to
the bone, early.  In thecal abscess, lance in the middle line,
to avoid digital arteries, which run  along the sides  of  the j
finger.
  " Occasionally cure of extensive abscess has followed repeated aspi-
ration."  Adams.

         LOCAL  TREATMENT OF ULCERS.

  HEALTHY.  Cleanliness; dress  with  Calendula lotion
(3j to fij warm waiter).  Protect from external  irritation.

  UNHEALTHY.  Indolent.   Remove source  of  irrita-
tion. Remove fungous granulations by knife  or caustic
Arg. nit.   Stimulate surface of ulcer with Carbolic oint. (j
to Zj  Vaseline), or powdered Iodoform.  For  cedema of
edges, scarify or  use  poultices.   Apply  rubber  bandage.
Method—After ulcer has been thoroughly cleansed (prefer-
ably by an antiseptic solution), if upon leg, apply bandage
from toes up with just sufficient  tightness for each turn to
hold the one preceding without reverses; dress twice a day. \
Healthy action being established, treat as healthy ulcer, or,
if extent be large,  hasten cicatrization by skin-grafting.
  Irritable.  Keep part at rest.  Apply hot-water, by com-
press or irrigation.  Dress with anodyne pQultices—hops or
laudanum.  Apply caustic thoroughly once.   Do not strap
or bind. 
TREATMENT OF GANGRENE.            121
   Inflamed.  Keep part  at rest, and elevated.  Dress with
 antiseptic poultices—Carbolic, Charcoal. Sodium and Zinc.
 chlorides.  Avoid compression and caustics.
   Sloughing.  Occurs in  debilitated  and starved  cases.
 Treat constitutional  condition; build up general health by
 good, nourishing  food  and  tonics.  Local—same  as for
 inflamed, unless  very active, when Bromine (pure Bromine
 one drachm to water eight ounces) may be employed.

                     REMEDIES.

   Arsenicum.  Ulcer inflamed, raw-looking surface, which
 is red and hot, and bleeds on slightest touch; thin discharge,
 mixed with blood; edges of sore hard and irregular; intense
 burning pain.
   Lachesis.   '• Irritable" ulcer; phagedenic  and sloughing
 ulcer; threatened varicose ulcer.  Large ulcers, tending to
 extend rapidly, surrounded by small ulcerations or pustules;
 surrounding  skin presenting  mottled, dark-blue or  purple
 appearance.
   Sulphur.   Excessive itching, burning, gnawing  pains;
 bleeds easily; secretion thick yellow, or thin fetid; margins
 elevated and surrounded by pimples; considerable adjacent
 swelling and discoloration of skin.
  "To begin the treatment of all chronic ulcers."  Jahr.
   3Iercurius.   Deep ulcer, tendency to spread, discharge
 thin and offensive.
   Belladonna.   The surrounding skin is the seat of chronic
 inflammation, of erysipelatous appearance.
   Kali hich.  Deep ulcer of leg, with hard base and over-
 hanging edge.
   3Iezereum.   " Mercuric>-syphilitic ulcer of lower ex-
 tremity." Dunham.
   Sanguinaria.  Old, indolent ulcers,  with   callous edges
 and ichorous discharge.
   Hamamelis.  Varicose ulcers.
   Scrofulous Ulcers—Calc. c. Sil., Sulph.
   Phytolacca.  Ulcerations of mucous membranes.


           TREATMENT  OF  GANGRENE.

  Traumatic.  In  lacerated and contused wounds  of ex-
tremities, bones  badly crushed, large  vessels  torn, limb
generally disorganized,  if  gangrene  feared, amputation
should at once be practiced.
  In case of gangrene of an extremity, after attempt being
made to save it, amputate at  once, and  in all varieties of
traumatic where limits of disease can be well-defined and
whole extremity involved.  Superficial sloughs  are not to be
taken for entire destruction of limb. The extent of destruc- 
 122        KEY  NOTES  OF MEDICAL PRACTICE.

 tion of tissue being small,  bring about speedy separation
 of slough by poultices, and hot dressings.  Remove  dead
 pieces, as they loosen, with scissors and forceps.
   During sloughing,  use locally  antiseptic poultices, and
 carbolized hot-water dressings.
   During local reaction, no pressure is to be used on injured
 part.
   Gangrene from extreme heat, cold or escharotic, treat on
 expectant plan till line of demarcation formed, then ampu-
 tate if entire thickness of limb involved.
   Gangrene from infiltration  of urine in perineo, immedi-
 ately make free incisions to relieve tension and give free
 ve,nt to collections.
   Gangrene from arrested circulation  after  ligation  of
 arterial trunk, apply warmth  by cotton, etc., and keep up
 patient's strength until  collateral circulation is established.


                     CARBUNCLE.

   Iodine,  locally,  has  dispersed.   Also   lime-water  and
 camphor.  Early strapping beneficial;  encircle with tightly
 applied broad adhesive  straps, which will draw  the edges
 together.  Remove straps daily after discharge has begun,
 and cleanse  surface.   Keep  well poulticed.  Not  neces-
 sary to incise unless  tension  is extreme.   After suppura-
 tion established, dress  with Carbolic acid and Glycerine.
 If  gangrene threaten, dress with powdered charcoal, fre-
 quently renewed—every 3 to 6 hours.
   A commencing carbuncle may be successfully aborted by
 injecting into its center several drops of pure Carbolic acid.
   Never use knife, in carbuncle complicating Diabetes.

               LEAD IXC} REMEDIES.

   Arsenicum.   Malignant carbuncle.  Great prostration
 and restlessness, small, irregular pulse, cold sweats, diar-
 rhoea and fever.
   Bryonia.  "Hastens the process  of suppuration, reducing
 the period many  days."   Jahr.
   Belladonna.   Smooth, bright-red swelling, tense skin.
   Apis.  For extension of erysipelatous swelling.
   Lachesis.  Parts look purplish; low inflammatory condi-
 tion; blood-poisoning.
   Arnica.  In repeated doses, early, sometimes  disperses.
   Silica.   After suppuration, to check excessive ulceration,
 and promote healthy granulation.


  Dissection Wounds.  Suck  the wound immediately, and
apply Carbolic acid, or cauterize with nitrate of silver.  If
the wound becomes inflamed, dress with hot poultices.  In- 
HYDROPHOBIA.
123
ternally, Arsenicum.   If great prostration, give carbonate
of ammonium.

  Insect-Stings.  For stings of bee, mosquito, wasp, etc.,
apply Aqua  ammonia, or tincture  of Ledum pal.  Moist
clay poultice, if nothing else at hand.  Remove sting when
visible.

  Snake-Bites.  Tie  broad  ligature  tightly about  limb,
above wound, so as to check circulation.  Suck the wound,
and cauterize with nitrate of silver, strong Carbolic acid or
a nail heated red-hot.
  Apply ligature, and,  as soon as  possible, inject  with
hypodermic syringe a solution Permanganate of Potash (1
to 100), as nearly in line of penetration of serpent's tooth
as possible.
  The Emperor of Brazil has recently bestowed on Dr. Lacerdo $20,000,
for his discovery of this antidote.
  Stimulate by injecting Ammonia  into the veins,  or by its
internal administration.  Keep patient  quiet, and conserve
the strength.  Artificial respiration  if breathing fall to ten
per minute.
  The ligature must be occasionally  slackened, that the
poison may but slowly enter the system, and the  limb not
suffer from complete stoppage of circulation for too long a
time.

  Sprain.   Give part absolute rest; immerse immediately
in hot water, until  pain and  swelling  are reduced.  After-
wards dress with cloth wrung out of lotion of Rhus, Aeon.,
Am., or Hypericum, and covered with oil-silk.
   After pain has been lessened by immersion in hot water,
envelop part in absorbent cotton and apply bandage firmly,
exerting through cotton uniform  elastic compression of
parts.
  Arnica.  Contused appearance.
  Rhus.   When tendons involved.
  Aconite.  Heat, redness and swelling.
  Hypericum.  Nerves involved, or lacerated.

                   HYDROPHOBIA.

  Belladonna.   As soon as a person has been bitten, ad-
minister Bell,  in a  low dilution, and keep  him under its
influence  for at least  six weeks.  Also administer it if the
characteristic Convulsions set in at  any time, with great
burning and accumulation of frothy mucus in the throat,
constricting  sensation when attempting to swallow, redness
and bloatedness of  the face, foaming at the mouth  and
tetanic convulsions.
  " It is only in the largest quantities that its remedial power has been
most frequently observed."  Hughes. 
124        KEY NOTES OF MEDICAL PRACTICE.

  Stramonium.  Convulsions attended by frightful dreams,
agitated sleep, sudden shrieks, insensible and dilated pupils,
disposition to bite and tear things with the teeth.
  " Reputed a specific for the disease in China."  Hughes.
  Scutellaria.  Nightly restlessness, frightful dreams, rapid
and unequal action of the heart, with pain, tremulousness,
and twitching of the muscles.
  " Has been found very successful in many cases, both as preventive
and curative.,"  Laurie.
  GENERAL 3IEASURES. Immediately suck the wound
(do not let it come in contact with an  abraded surface of
the mouth), wash it out with a  stream of warm water, and
apply  freely pure  Carbolic  acid.  Or, actual cautery may
be applied.   Give Belladonna treatment.
  In Attack.  Vapor bath, or Turkish bath, temp. 107° F.,
said to have been successfully  used.   Give patient bits
of ice.


                 BURNS  AND SCALDS.

                 CLASSIFICATION

  First Degree:  Hyperaemia; erythema; irritation or in-
flammation of the  skin, without vesicles.
  Second Degree:  Vesication; inflammation of  the skin;
formation of vesicles and bullae.
  Third  Degree:  Eschars; gangrene, superficial or deep,-
involving the skin or any other subcutaneous tissues; car-
bonization of a part, or of the entire body.

  PROGNOSIS.   If one-half, or even one-third, of  the
surface is burned or scalded, death is inevitable.  In other
cases,  result  depends  on location, intensity of heat, nature
of medium, age, temperament and constitution of patient

                     TREATMENT.

  LOCAL.  Apply immediately one of the following:
  Carbolized Vaseline [carb. ac. cryst. five per cent.).
  Carbolized Olive  Oil (11 parts oil to 1 part liquid carb. ac.).
  Flour and lard, equal parts, worked together.
   White lead paint. Equal parts linseed oil and lime-water.
  Bi-carbonate of soda.  Fine wood charcoal.
  Dress to exclude  air and keep up warmth of part.
  Probably no dressing equals the carbolized  Vaseline.
Use that which can be most quickly obtained.  Spread on
a  thick layer, cover with gauze and cotton-wadding,  and
bind lightly.  Leave first dressing  on as long as possible—
until offensive nature of discharge or discomfort demand its
removal.   Dress in such a  way as to facilitate future  dress-
ings bit by bit.   Do not expose  too large a surface at once. 
HEMORRHAGE.                  125
Blisters should be  pricked, and contents evacuated, leaving
the skin as protective covering.  In dressing, irrigate with
carbolized water, drachm to pint.
   Iodoform, sprinkled on, relieves pain; put other dressing
over it.
   In  extensive burns or scalds, use continuous tepid  bath,
90 to 100  F.
   During cicatrization,  prevent deformity by position, at-
tained by splints  and  mechanical appliances.   Employ
skin-graftiug to promote healing of ulcers.
   GENERAL.   Treat shock by artificial warmth, rest, and
repeated doses of  Camphor.  For depression, Ammonia as
stimulant.   In exhaustion from profuse suppuration, give
nourishing food.
   Rhus.  Burns of first and second degree.
   Kali Inch.   Indications of  ulceration ot duodenum.
   Cantharis.  Vesication;  scanty and high-colored urine.


                    HAEMORRHAGE.

   Ligature.   Cut  down  upon  bleeding point,  and  tie
above and below the wound.    In case this would involve
large and deep incision, tie  "in  continuity."   Materials:
silk,  hemp, catgut.    Instruments:   forceps,  retractors,
directors, artery-forceps, tenaculum (sometimes, aneurism-
needle).   Secure vessel,  tie with reef-knot, and, unless cat-
gut used, one end of ligature must be left hanging out of
wound.  The ligature must be  smooth, round, strong, and
well waxed.
   Torsion.  Draw out vessel  and  make three or four sharp
rotations  of forceps.   In  large arteries  continue rotation
till sense of resistance has ceased, but do not twist off  ends.
In small  arteries the  number of  rotations of  no import-
ance, and ends may be twisted off or not.
   Acupressure.  Compress vessel between needle  and loop
of  wire,  like  common   hare-lip  suture.   In  arteries of
medium   size,  needle may be  removed  in  four hours.
Adapted to scalp wounds, and when varicose veins burst.
   Cautery.   For  haemorrhage from neck of womb  after
operation.
  Compression. By tourniquet, Spanish-windlass, or digital.
  Cahotid.—Press  along  inner edge  and  lower half of
sterno-mastoid muscle.
  Subclavian.—Push firmly with thumb  in  subclavian tri-
angle behind sterno-mastoid.
  Bbachial.—Inner border of coraco-brachialis and biceps.
  Femoh.yl.- -Under Poupart's ligament,  midway  between
anterior superior spinous process of ileum, and the pubes.
  Abdominal, Aorta.—Short distance above and to left of
umbilicus. 
126        KEY NOTES OF MEDICAI- PRACTICE.

  In wounds of palm, or  where many inosculating  vessels
injured, pack wound tightly with picked lint or other avail-
able substance,  and apply firm bandage.   Put limb upon'
splint to insure perfect rest.
  Flexion.   In wounds below shoulder, put arm-pad or roll
high up  in  axilla,  and bind arm to side.  In wound of.
palmar arch, put compress in bend of  elbow, flex forearm|
on arm, and pronate hand.   In  haemorrhage from plantar
vessels, put  pad in popliteal space, flex leg on thigh and
thigh on abdomen.  Or, hang leg, in bend of knee, over
sharp chair-back.
  Styptics.   Ice, applied directly to bleeding surface.  Per-
sulphate of  iron (Monsel's  solution).   Tannic acid, Gallic
acid, Matico, Alum.  Water 120c F.

  GENERAL 3IEASURES.   For faintness and weakness
caused by loss of blood—horizontal posture; absolute rest;d
ammonia; ether; wine. Esmarch's bandage, to drive blood
from limbs to vital centers.   Transfusion.
                     EPISTAXIS.

  When slight, apply pressure to cheeks, at junction with
alae nasi; use nasal douche of hot water, 110  F.; ice  to the
nape of neck; use Tannin as snuff; use styptics in solution
—alum, iron-persulphate.  Enjoin quiet  on patient; keep,
neck straight.
  Plug nostril  if  severe; pass loop of double thread, bj
means of catheter or Bellocq's canula, along floor of nose
to pharynx, seize loop  and fasten it to a plug of lint or
cotton already attached  to a string, which "is  brought out of
mouth and retained for  withdrawal.  By  means  of the
double thread in  nose draw plug  into posterior nares and
tie ends of thread over  plug inserted  into nostril in front
Remove by string through mouth when no longer needed.


            URETHRAL HEMORRHAGE.

  Locally, use cold applications, hot injections, Hamamelis,
or, introduce catheter and  apply  compression  by means of
bandage.  If from external, longitudinal wound, make closfe
coaptation  by  fine  sutures  and  draw water  with  smaM
catheter four or five times a day.  In transverse wound, afteM
haemorrhage is checked, introduce sound at intervals during"
healing process, to prevent stricture.   In haemorrhage intoj
tissues about deep urethra, make free incisions to  relieve
tension, use antiseptic irrigation and keep urethra patent
by use of catheter or sound. 
        RECTAL HEMORRHAGE  VENESECTION-SHOCK.   127

               RECTAL  HEMORRHAGE.

    When beyond  control  by use of ordinary remedies,  if
  from vessel within  reach, apply  ligature; if general, and
  styptics and hot water fail, use tampon.  To plug properly, '
  take cup-shaped sponge or wad of cotton, pass stout double
  ligature through middle, and pass into bowel beyond source
  of haemorrhage.  Pack rectum below with pledgets of cot-
  ton, and then  draw threads  tight,  and  fasten them  over
  compress of  cotton placed externally, thus making even
  pressure in all  directions.  A  stiff catheter or tube  may be
  placed before plugging, to allow escape of flatus.


              UTERINE   HEMORRHAGE.

   Method of plugging vagina.—Put patient  in Sims' posi-
  tion; with left  forefinger, or Sims' speculum, retract poste-
  rior vaginal wall; with pledgets of cotton, or free end of
  roller bandage, pack vagina posteriorly to cervix, then ante-
  riorly, then centrally, until firmly filled by plug, taking care
  not to  obstruct urethra.   After sufficient time has elapsed,
  remove piecemeal, patient in same position.

                    VENESECTION.

   Instruments.  Bleeding-tape, or bandage; bowl; lancet;
  pad; sponge and water.
   Patient recumbent.  Apply tape to middle of upper arm,
  tight enough to congest veins, but not to affect pulse. Hang
  arm down a little while; then choose spot, usually median
  basilic vein  (look out for  brachial artery); pass lancet
 gently  and obliquely into vein, and enlarge opening without
 deepening incision.   If necessary, make patient work hand,
 opening  and  shutting it; or, grasp some  small  object.
 When sufficient blood withdrawn,  remove  bandage from
 arm, apply pad to wound,  bandage it, by figure-of-8.  Wear
 arm in sling for several days.

                        SHOCK.

   Loosen everything about neck and chest that can impede
 respiration; body recumbent, head low.   Maintain tempera-
 ture of body—warm room, warm blankets,  hot bottles  to
 extremities, between thighs, in axillae.  Hot  compress  over
 cardiac region.  Warm affusion to head.  Frictions. If much
 blood lost, and vaso-motor mechanism not paralyzed, trans-
fusion.   Stimulants,  not   too freely.   Brandy, Ammonia,
 Ether.   Do not pour fluids  down a patient who cannot swal-
 low. Ether has been used with  great success.   Inject, hypo-
 dermically, thirty  minims  every five or ten minutes until 
12H        KEY NOTES  OF MEDICAL PRACTICE.

patient is able to swallow, then substitute brandy and Am-
monia, by the mouth.  In absence  of  Ether, employ intra-
venous injection  of Ammonia, ten minims of  liquid Amm.
fort.—degree of dilution not material.
   Digitalis,  ten  minims,  hypodermically,  as   cardiac
stimulant—very  beneficial.   When reaction  sets  in, give
warm, nourishing, liquid food, small quantities, frequently
repeated—coffee and  scalded milk, equal parts; milk; beef-
tea; soup.
   If there is a mangled limb to come off, and shock is slight,
give Ether, and operate.  If  shock so grave that reaction
doubtful,  wait several  hours  till  pulse  begins to regain
strength.  If temperature below 96  F., do not operate.

       ADMINISTRATION  OF ANESTHETICS.

   Chloroform.   Commence gently; limit  dose to smallest
quantity  capable of producing  insensibility —gtt. xv.  onJ
towel to begin with; permit free access of air.  Ether: —Two*
drachms  to begin; no  air; push vigorously, especially
stage of excitement.  Mixture:—Alcohol, one part; Chloro
form,  two parts; Ether, three parts;  (favorite  at Guy's]
give as Chloroform.
   Precautions.  Do not push too much  at  first.   Watch
quantity used.   Allow plenty of air with Chloroform.  Have
provision for admitting free supply of fresh air.   Carefully
watch  pulse  and  respiration, — especially latter.  Have
dressing-forceps ready to grasp tongue.  Do not let aflame
come near Ether vapor.

    TREATMENT  OF  DANGEROUS  SYMPTOMS.

   Give fresh air.  Pull tongue well forward.   If any diffi-
culty, tongue may  be drawn  from  off  glottis  by placing
thumbs alongside of nose, and the index fingers behind
ascending ramus of lower jaw, and  drawing  it  forward.
Clear throat of  blood or vomited matter.   Hot  affusion to
head.  Invert patient.  Artificial respiration.   Inhalations
Nitrite Amyl.   Galvanism—one pole on throat near phrenic
nerve,  other at pit of  stomach; or, through skin at sides of
nose.
  Local Anaesthesia.  Two parts crushed ice to one part
salt, in gauze bag.  Ether spray.  Do not freeze part.


                     TREPANNING.

  If there be already a scalp wound, enlarge it; if not, shave
scalp and  make U-shaped incision  down to bone, and peel
back periosteum with the flap of  the scalp.  Avoid regions 
                   HARE-LIP—N.3EVUS.                129

of longitudinal and transverse sinuses, and middle menin-
geal artery.   Adjust trephine so  that  pin  shall project
beyond teeth.  If there  be fracture, place teeth on firm
edge of bone.  In working, press evenly on all sides.  After
penetrating short distance, withdraw pin into crown of tre-
phine.   As dura mater approached,  proceed gently,  and
frequently probe with piece of quill, obliquely sharpened to
a point.  As soon as  dura mater detected, tilt trephine to
other side.  When loose enough, remove  disc of  bone with
elevator.
  Dangers.   Wounding dura mater; haemorrhage.
  Htemorrhage,  from abnormally large veins in diploe, can
be arrested by pressure of ball of carbolized  wax, softened
in hot water; from wounded artery, pressure with ball of
wax; from sinuses, light compress.


                       HARE-LIP.

  Best time to  operate, third  to fifth month of infancy.
Contra-indicated—during  dentition or ill-health.  Chloro-
form unnecessary.  Apply  small bag of pounded ice and
salt, till local anaesthesia induced.  Child  held in assistant's
lap. Secure limbs by rolling  him lightly but firmly in a
Bhawl. Assistant to check haemorrhage by holding each side
of the upper Up between finger and thumb. Begin by sepa-
rating, with knife, the  two sides of the  lip from the jaw
subjacent, unless former structures be already  very free.
Then pare edges of cleft.  Remove enough, especially from
apex of cleft, and junction of cleft with edge of lips.   Coapt
edges, insert two "hare-lip" pins; enter and exit l4 inch
from fissure;  pass deeply,  nearly  reaching mucous  mem-
brane.  Lower one  secures coronary  artery.  Secure with
hare-lip suture.   Interrupted wire  suture at  red border of
lip.  Sharp ends of pins nipped  off.  Pieces of  lint placed
beneath ends  of pins.  Strapping, broad at  ends and nar-
row in middle, brought across lips.  All  pins must be re-
moved on  third  day, very  gently, lips  being well supported
at time, and  strapped immediately afterward.   Instead of
pins, the interrupted suture of wire, aseptic silk or gut may
be used.

                        NEVUS.

  Capillary naevi may be successfully treated by successive
paintings with liquid carbolic acid, nitric acid, lunar caustic,
or by puncture  at various points  with hot needle.   More
extensive forms may  be  treated by  (1) compression; (2)
ligature, which should  be subcutaneous, to avoid scar; (3)
excision;  (4) by ligature of vessel of supply.
  Injections info nawi should never be employed.
       5 
130        KEY NOTES OF  MEDICAL PRACTICE.

                 INTUSSUSCEPTION.

  Plumbum.  Colic and fecal vomiting.
  Aeon., Bell.   To obviate inflammation.
  Opium.  Meteorism, and stercoraceous vomiting.
  Nux vom.  To correct irregular and excessive peristalsis.

  GENERAL  TREATMENT.  Early  in  attack—place
patient  on back, hips elevated,  shoulders  low; introduce
long tube into rectum, passing it as high up as possible, and '
slowly inject large quantities of warm water or olive oil.  As
the fluid is coming away, manipulate abdomen with hands,
so as to move coils  of  intestines.   Repeat entire process
several times, if necessary.  Sometimes well to anaesthetize
patient  preparatory to  operation.   Also  try  inverting ,
patient.  In children, inflate bowel with air until abdomen I
is much distended.   Keep stimulants at hand, as syncopal
sometimes occurs.                                      H
  In cases where above measures  fail, and  diagnosis of J
obstruction clearly made, perform laparotomy with antisep- '■
tic  precautions.   Operation,  preferably in  median line,.
consists in exposing  peritoneum by incision of three to five^
inches,  checking  all haemorrhage,  opening  peritoneum,
searching for obstruction and relieving it according to its
nature.

                  THORACENTESIS.

  Indications.   Amount of effusion great, with dyspnoea;.
old effusion, which remains stationary.

  OPERATION.  Use  aspirator;  needle moistened with
oil; slight preliminary incision.  Introduce  near  axillary
line, fifth  intercostal space on left side, fourth on right, or |
seventh,  near angle of  scapula,  posteriorly.   Insinuate
needle with twisting motion, near upper border of lower-
most  rib.  Then piunge needle smartly through pleura,
turn cock of aspirator and collect fluid.
  Dangers.   Wounding  intercostal vessels,  lung or dia-
phragm; rupture  of pleura or capillaries by excessive suc-
tion with aspirator; admission of air.


           PARACENTECIS  ABDOMINIS.

  Indications.   Called for if amount of effusion so great
as to seriously embarrass respiration or heart's action.
  Operation.   Make ink-mark exactly in median line, mid- i.
way between umbilicus and pubes.  Turn patient on side,
near edge of bed.  Bladder must be empty.  Ascertain by
percussion presence of fluid at spot to be pierced.  Apply ,
A 
         PNEUMATIC ASPIRATION -HAEMORRHOIDS.      131

 broad flannel belt,  or  a  sheet, around  abdomen, the ends
 crossed behind, and held  by assistant, who gradually draws
 it tight as fluid is withdrawn.  Tap through hole cut in cloth
 at proper point.  Incise  skin  at point selected, and intro-
 duce trocar.  Draw  off  fluid  slowly.  When  all out,  seal
 wound with plaster,  and  pin the band  tightly around  ab-
 domen.
   Dangers.  (1) Haemorrhage, from not keeping to middle
Tine.  (2)   Wound of bladder, from not emptying it.   (3)
 Wound of bowel, from not tapping in thoroughly dull spot,
 or from plunging trocar too deeply.  (4) Fainting.

              PNEUMATIC  ASPIRATION

 May be practiced in any part of the body—and is  a  safe
 procedure as long as only the  fine needle (No. 1.) be used.
 Aspiration with the larger  needles is to be practiced with
 the same  caution as tapping with trocar, the risk of aspira-
 tion equaling that of tapping  when  the larger needles  are
 used.
                   HEMORRHOIDS.

   Internal. Of capillary variety—viz., elevated thickenings
 of mucous membrane—best treated by application through
 speculum, with wooden spatula or glass rod, of pure nitric
 acid.  Forcible dilatation of sphincter, occasionally cures by
 relief  to  circulation during partial  paralysis of sphincter
 following dilatation.  Internal haemorrhoids, more or less
 pendulous, best treated by (a) Injection of mixture of equal
 parts  of  Glycerine  and  Carbolic acid.  To do this safely,
 clamp base of pile with forceps, so as to interrupt circulation;
 with hypodermic syringe,  charged with mixture, insert needle
 into substance of haemorrhoid and inject M. v ad x.  Repeat
 injection  at intervals of three or four days  until tumors
 shrivel and slough  away.  (6) Ligature.—Patient under
 ether; dilate sphincter, forcibly seize haemorrhoid with for-
 ceps; with curved scissors dissect haemorrhoid slightly from
 mucous membrane from below  upward, thus avoiding vessels
 which always  enter pile from  above;—transfix pile with
 threaded needle and tie firmly  on each side; repeat process
 on all internal piles.  Confine  patient strictly  to bed for  a
 week.   Ligatures come away generally in four to five days.
 Patient should take no exercise of amount  for ten to four-
 teen days.
   External haemorrhoids, when seen early,  i.e., during first
 forty-eight hours, should  be incised and the clot of extrava-
 sated blood, which gives  pain by causing tension of tissues,
 turned out.   Always incise  in line radiating from anal  cen-
 tre.   If ancient, and source of annoyance,  remove by scis-
 sors, clipping away tab  of thickened  integument in line
 radiating from anal  centre. 
\      132       KEY NOTES OF MEDICAL PRACTICE.

                        ANAL  FISSURE.

        When productive of slight degree of  suffering, may he
      treated by application  of Iodoform, in powder or supposi-
      tory.  A single application of Nitrate of silver to fissure will
      sometimes suffice.  Severe forms only amenable to treat-
      ment by incision or forcible dilatation.
        To incise, expose part thoroughly and cut through base of
      fissure deeply enough to divide the superficial fibres of  the
      sphincter  directly under it,  then apply Iodoform, cotton
      pad and T bandage.
        To dilate, put patient under ether, insert thumbs into rec-
      tum back to back, and stretch sphincter until  the thumbs
      touch tuber  ischii,  or  sphincter is thoroughly  relaxed.
      Dress as above.

                     RECTAL  STRICTURE.

        Gradual dilatation with bougies at intervals  of  three or |
      four days, safest but slowest method.   If stricture be thin,
      and bridle-like, nick edge of  constriction at three or four!
      points in circumference, and pass bougie.
        Posterior recfotomy to be employed  if stricture irritable _
      and of small  calibre.  Patient under  ether; with straight, J
      probe-pointed knife,  cut through  stricture and sphincter
      towards coccyx, keeping incision strictly in median line.
      Keep patient recumbent, pack wound with antiseptic cotton,
      and,  as it heals, pass bougie to preserve calibre  of rectum.


                       RECTAL  FISTULA.

        Three varieties—result of abscess  in submucous tissue
      of rectum—internal, external, and complete.
        Internal  should be made  complete by passing a probe,
    .  bent into hook-shape, into rectal opening  and making it
      project integument, cut down on end of  probe  and operate
      as for complete.
        External should be made complete by passing director
      into external opening to thinnest portion of rectal wall, deter-
      mined by finger in rectum, and  forcing director through
      into rectum.
        Complete fistula may be treated by  incision  on director,
      or, in  timid  patients, by  elastic ligature.  To incise,  put
      patient  under ether, pass grooved director through fistule.
      bring point out at anus and cut all overlying tissue; slit up
      sinuses leading into fistule, pack wound with oakum for first
      forty-eight hours,  and then dress with Iodoform, keeping
      patient recumbent until wound is fairly  filled by  granula-
      tions.
        To ligature, take solid rubber cord Y& inch in diameter,
i 
          RETENTION OF URINE—CIRCUMCISION.       133

 pass silk cord through fistule by means of eyed probe, draw
 rubber cord through double, pull tense, and tie tightly, over-
 tying rubber knot with silk to prevent slipping.  Under this
 method patient may move about.


                   COCCYGODINIA.

   If obstinate,  divide subcutaneously all muscular and liga-
 mentous structures  from  borders  and tip of  coccyx.  If
 coccyx luxated and displaced, or carious, remove it.


              RETENTION OF  URINE.

   From Stricture.  Put patient in warm  bath  to  relax
 spasm; pass small catheter, or filiform bougie, which use as
 a guide for tunnelled catheter.   If filiform bougie or small
 catheter  passes, tie in for continuous dilatation, replacing it
 by larger size in twenty-four hours.  If stricture is impassa-
 ble, relieve bladder two or three times in twenty-four hours
 by aspiration, supra-pubic.  After two or three days, attempt
 passage  of  instrument  again.  If  instrument cannot  be
 passed, and fistulous opening exist, perineal section should
 be performed.
   From  Enlarged Prostate.   Pass soft-rubber  catheter,
 Mercier"s elbowed  catheter, or  over-curved  gum-elastic
 catheter.  If  retention has  existed for some  time,  do not
 empty bladder at once, but at third or fourth catheterization,
 after which keep bladder clear of residual urine.       When
 bladder is completely closed by hypertrophy of prostate
plus inflammation, supra-pubic aspiration may be practiced
twice or thrice daily, until catheter may be passed.
  " If catheterism impossible, supra-pubic puncture arid introduction
of permanent tube relieves retention, and, when done early enough is
followed by subsidence of prostatic overgrowth."  Adams.


                   CIRCUMCISION.

  Draw foreskin well forward and hold by compression be-
tween  blades of  forceps applied where section is deemed
best; cut off portion included in forceps, split up  mucous
membrane to corona, turn back, trim edges,  and unite to
skin by numerous fine sutures of cat-gut.  In infants sutures
are unnecessary.  Dress by enveloping part iii strip of sheet
lint which should be kept moist with 1 to 40 carbolic lotion.
Treat haemorrhage by torsion if not spontaneously checked.


  Ganglion. Rupture it by placing patient's wrist on your
knee, steady  it with your  fingers,  while you squeeze the
ganglion, with  ends of both your thumbs, against ridge of 
bone beneath.  Other methods failing, employ subcutaneous
puncture, and  follow either method by  pressure with pad
and bandage.

  Bunion. Remove pressure of boot, which is always cause;
restore toe to natural position by mechanical contrivance.
Use  corn plaster; soap  plaster; arnica plaster.  If it dis-
charge, stimulating dressing.   When  inflamed,  poultices,
fomentations.

  Corns.   Soak foot in warm bath half an hour or an hour,
extract  hard head with  finger-nail,  or blunt  instrument,
dress with Arnica lotion, wear  during day  Arnica plaster.
and felt, with hole in centre.  Repeat this several days, and
wear easy shoes, and there will be no more return.

  In-growing toe-nail.  With  point  of  pen-knife insinu-
ate a bit of cotton beneath  side of  nail, and between edge i
of flesh and over-lapping nail.  Poultice and rest  if  much
inflammation.
  If scrapipg nail in middle fails to relieve, pare away over-
lapping flesh—remove underlying portion of nail; or, these «E
measures failing, remove  entire  nail by  avulsion under ';
anaesthetic.

                  THE  VENEREAL.

                      SYPHILIiS.
  Period of Incubation.  A chancre (if not modified by
treatment) will usually be followed by secondary symptoms
within fifty days, and always within six months.  It may be
as short as ten  days.

TABLE GIVING USUAL PERIOD OF  DEVELOPMENT
                     OF LESIONS.
Lesion.
                          Usual               Mat Delay
                         No. Days.              as long as
 1. Roseola.....................25 to 45.....................12 months.
 2. Lichen.....................28 to 65.....................12   "
 3. Mucous patches........... 30 to 70....................IS   "
 4. Sec'd aff. fauces............50 to 70.....................18   "
 5. Vesic. erup................55 to 90........•............. 6   "
 6. Pustular....................45 to 80..................... 4   "
 7. Rupia...................... 7 m. to 2 yrs............... 4   "
 8. Iritis.......................2 to 6 ms.................. 1 year.
 9. Sarcocele................... 6 to 12 "................3 years.
10. Periostitis.................. 4 to 6 " ................. 2   "
11. Tuberc. erup............... 3 to 5 yrs................. 2   "
12. Serpig. erup................ 3 to 5  " .................20   "
13. Gummy tumors............. 4 to 6  " .................15   "
14. Onychia.................... 3 to 6  " .................22   "
16. Exostosis................... 2 to 6  " ...........     20   "
16. Ostitis......................2 to 4 " .................41   "
17. Destruct. vel. pal........... 2 to 4 " .................20   " 
SYPHILIS.
135
  No one who has  had syphilis should marry until  he has
been free from all symptoms for a period of at least three
years.
          Chancre.        -            Chancroid.
1.	A general blood disease.	1.	A local tissue disease.
2.	From inoculation with syphil-	2.	From inoculation with chan-
	itic riri/s.		croidal virus.
3.	Incubation, ten to sixty days or more.	3.	Incubation, none.
4.	Auto-inoculation impossible.	4.	Auto-inoculation always pos-sible.
5.	Lesion, usually an excoriation	5.	Lesion, a rapidly-spreading,
	or indurated shallow ulcer.		soft ulcer.
6.	Number, usually single.	6.	Number, often multiple.
7.	Secretion scanty, serous, san-guinoleut.	7.	Secretion, creamy, free.
8.	Edges slanting, adherent.	8.	Edges, perpendicular or un-dermined.
9.	Generally painless.	9.	Often painful.
10.	Phagedena very rare.	10.	Phagedena not uncommon.
11.	Bubo invariable; seldom sup-	11.	Bubo in about one-third the
	purates.		cases; often suppurates.
12.	Second attack very rare.	12.	Second attack possible.
13.	Local treatment unimportant.	13.	Local treatment highly im-
portant.
                       SYPHILIS.

  Definition.  A  specific, infectious  disease,  having   a
period of incubation, and characterized by the appearance
of a chancre, then by eruptions on  the  skin and  mucous
membranes, subsequently  by chronic inflammations of the
cellulo-vascular tissues and the bones,  and finally by small
tumors, or gummata.
  One attack  affords  protection  against a  second.   The
initial lesion is  always a chancre, whether  the  source  of
infection be  a chancre, or a secondary  lesion.   A  perfect
recovery from syphilis is possible (Keyes).
  Initial  lesion.    Varies.   May  be  hard,  desquamating
papule, a raw erosion, or a  superficial  ulcer.   Indurated
chancre—generally solitary, shallow,  borders adherent and
sloping,  base indurated, floor grayish, the  secretion  thin,
scanty, non-purulent.  It is indolent and  generally painless.

                     TREATMEXT.

                     PRIMARY STAGE.
  3Ierc. sol.   This is the only remedy worthy of confidence
in the treatment of  recent, uncomplicated chancre.  Chan-
cre with red  edges, lardaceous bottom, painful and readily
bleeding: indurated  base and margin.  Dose, lx  to 6x trit.,
a grain night and morning.
  "Stands in the front rank."  Franklin. " Only remedy for the un-
complicated forms."  Baehr. " Enjoys universal confidence."  Hughes.
  Merc. corr.  For phagedaenic chancre; ulcer secreting 
136        KEY NOTES  OF MEDICAL PRACTICE.

thin,  ichorous  pus.   Secondary  symptoms  make  early
appearance.
  Merc. iod.  Painless chancres; glandular system largely
involved; inguinal glands large, swollen, but not inclined to
suppurate.
  Arsenicum.   Gangrenous chancre.   Ulcers  with  florid,
unhealthy granulations; or, secreting a watery, corrosive,
offensive fluid.
  "In gangrenous, never fails."  Jahr.  "Only  efficient remedy."
Baehr.
  Nitric acid.   For chancre of some weeks'  standing that .
has been treated with large doses of Mercury.   Ulcer bleeds \
easily and profusely; pale, flabby, prominent granulations;
fungous growths; corrosive discharge.
  Arsen. iod.  For swelling of inguinal and axillary glands, ,
threatening suppuration.
  " Excels all other remedies in the rapid  cure of venereal bubo."
H. Noah Martin.                                            1
  Bubo.  Requires same treatment as chancre from which 1
it proceeds.   For acute bubo, Merc, sol.; for indolent bubo, 1
Merc. iod.
  Local.  Observe strict cleanliness of the parts.  To pri- J
mary sore, apply simple lint, soaked in cold or tepid Calen- <
dula lotion, renewed every three or four hours.   Chloral
Hydrate, solution, grs. xx. to "j aqua, hastens healing pro-
cess.  If discharge fetid, sprinkle with powdered  Chlorate ',
of Potash, and  cover with wet compress;  renew frequently.i
  For sloughy  ulcers, apply slightly caustic solution Nitric
Acid, or Carbolic Acid.
  General.  Avoid stimulants, excitement, over-exertion,
and excesses of all kinds.   Let  the  surroundings be the
most favorable, hygienically. that can be procured.  Have '
fresh air, moderate  out-door  exercise,  and  a plain diet.
Encourage in  the patient  hopes  of ultimate  recovery.
Frequent bathing of  the skin very beneficial.


          SECONDARY  AND  TERTIARY.

  Mercurius.  Feverishness, rash, sore throat; rheumatoid
pains, aggravated  by rest  and the warmth  of  the bed.
Erythematous,  papular and squamous eruptions.  Superfi-
cial ulcers in the throat.  Iritis.  Fauces and tonsils swollen,
inflamed  and  ulcerated.    Emaciation, with  slow,  hectic
fever.
  Kali  hyd.  For  secondary and tertiary  forms, partiou- '■
larly  in those  who have been over-dosed with  Mercury.
Nodes,  gummata,  erythema,  tubercular   skin  eruptions, '
ulcers on  tonsils, periostitis, coryza.  Iritis.  Ulceration of
nose, mouth or throat, with corrosive, burning discharge. <
Pain in nodes quickly relieved, and the nodes soon  disap- 
                        CHANCROID.                    I37

 pear.  Dose:—Give grs. j. to v. of the crude drug ter die;
 in obstinate cases, grs. xv. to xx., ter die.
   " No remedy surpasses this as an antidote to the syphilitic poison in
 the secondary, and especially in the tertiary form of the disease."
 Franklin.  " We have nothing to take the place of the Iodide of Potash,
 in tertiary syphilis."  Hughes.
   Aurum.   Syphilophobia.   Ozaena,  with caries of nasal
 and  facial bones.   Ulcers of nose and mouth,  with  fetid
 discharge.    Nodes of  cranial bones.   Sarcocele.  Lupus.
 Syphilitic rheumatism.  Suicidal melancholia.
   " Covers nearly the whole field of the tertiary, with its cachexia."
 Hughes.
   Nitric acid.  Ulceration of the mouth, and cracks about
 the commissures of the lips.
   Kali  Inch.  Indolent  ulceration of the tonsils. Affec-
 tions of  the throat, eyes, skin and periosteum.
   Rupia.  Thuja.
   Sarcocele.  Aurum.
   Iritis.  Merc, Kali hyd.
   Gummata.  Mere, Kali hyd.
   Ozfena.   Aur., Kali bi., Kali chlor..  Kali hyd.
   Condylomata.   Ac nit., Thuja., Merc, Ant. tart, Ac.
 phos.
   Caries of Bone.   Aur., Mez., Phos.,  Kali hyd.. Mere,
 Ac. fluor.
   Throat,  ulceration of.  Merc.  Kali bi., Ac.  nit, Iod.,
 Kali iod., Hydr., Ac. fluor.

                       CHANCROID.

   SYNONYM:  Soft Chancre.

   Definition.  A  virulent,  local, contagious  ulcer, never
 giving rise  to  constitutional  symptoms,  its effects being
 limited to  the  vicinity of the  sore, and the  neighboring
 lymphatic glands.
   It  is never transmitted  by inheritance.  It is auto-inocu-
 lable. A person may have repeated attacks.  The prognosis
 is always favorable.
   Lesion.  A round or oval ulcer, surrounded by a faint,
 pink  areola, with abrupt edges, sharply cut at right angles
 to surface,  often slightly undermined, the bottom being
 irregular, soft, and covered with pultaceous, dirty-yellow pus.

                     TREATMENT.

  REMEDIES.  Merc, Ars., Acid nit.  Kali bi., Hep. s.,
 Phos. ac, Silica.
  Local.  Touch with  strong Nitric acid.  Before cauteriz-
ing, cleanse surrounding parts with Carbolic lotion.   Do not
cauterize  unless the whole of diseased  surface can  be acted
on.  Chancres beneath phimosed  prepuce, treat by frequent 
138        KEY  NOTES OF MEDICAL PRACTICE.

injections Carbolic lotion (1 to 40), using syringe with long
nozzle.
  When caustic not used, best application is Iodoform; dust
on powdered crystals, cover with dry lint, and use retaining
dressings.
  Dressings of all  kinds must be  changed frequently, and
opposing surfaces be kept apart.   Destroy old dressings.
Use no greasy applications.


                   PARAPHIMOSIS.

  If strangulation  occur, effect reduction.  In phimosis, if
swelling so great as to prevent use  of syringe, or if slough-
ing threaten, slit up prepuce, by double incision, or remove
altogether, and treat as phagedaena.   Otherwise, hot, local,
baths to reduce cedema.                                   '

                     PHAGEDENA.

  Immerse entire diseased part in bath at 98  F., and main-
tain this heat for nine or ten  hours per day.  Use hip-bath.
Continue for several days after sore puts on healthy appear-
ance.  Let patient go  to bed at night, dressing sore with
Iodoform.  If disease not arrested, make bath continuous.!
Full bath, in which patient can lie down, will  accomplish
this.  If milder  measures fail, cauterize.   Check all  haem-
orrhage  at once; apply to bleeding point pledget of lint
soaked  in solution persulphate of iron, retained by firm
bandage.
  General.  Rest; good food;  good ventilation. In phage-
dasna, tonics and cod-liver oil.

                         BUBO.

  To favor resolution, use pressure and dry  heat.  If sup-
puration be found to be inevitable, promote  with poultices,
open by free incision across line of  Poupart's ligament, us
soon as presence of pus is manifest, and treat same as local
sore.  Aspiration of no service.


                     GONORRHOEA.                    '
               L.EAJDIXCJ  KEHEDIES.
                      ACUTE STAGE.
  Gelseminm.  Recent cases.  Discharge moderate. Much
irritation, considerable heat,  little pain, smarting and red-
ness at meatus.   Dose:—gtt. j to ij every three hours.
  "Has a striking effect on the acute stage o'f  gonorrhoea,  UBJinUT
bringing relief in twenty-four to forty-eight hours.  Fully ninety per
cent, of cases report speedy relief." Adams. 
GONORRHOEA.
139
   Cannabis, sat. tinct.  Smarting, burning, stinging, dur-
 ing micturition; constant urging; copious, thin discharge;
 prepuce swollen and painful.  Strangury, pains extending
 into scrotum, with dragging in testicles.
   "A characteristic indication for this remedy is priapism."  Adams.
   Cantharis. 2x.  When urinary symptoms indicate that
 inflammation is extending toward bladder.  Ardor urince.
 cutting, stinging  pain during and after micturition.
   "Particularly called for when blood occurs, either free or mixed with
 discharge."  Adams.
   Mercurius. 2x.   "When inflammatory process is accom-
 panied by free exudation into submucous tissue and thick-
 ening of the urethral walls, producing great  diminution in
 the size of the stream of urine, and chordee."   Adams.
   Local.  Astringent  and irritative injections  of  doubtful
 utility.   Observe  strict cleanliness of part.  To absorb and
 remove discharge, keep  piece of lint over meatus, retained
 by drawing  prepuce over it.  or a piece of soft  linen, with
 hole in center, drawn,  like a collar,  just back of corona
 glandis, and corners then brought forward,  with prepuce
 over it.   Avoid use  of  warm and  cumbersome dressings;
 tissue-paper  is  best.    Renew  dressings frequently, and
 destroy old ones.   Wear light suspensory for scrotum.
   If, after  well-conducted course  of treatment, a "drop  or
 two" still appear,  suspect incipient stricture  and  use me-
 chanical  dilatation.
   Diet.  Avoid all greasy, fried, or highly-seasoned articles,
 pepper,  vinegar,  salt,  coffee  or  tea.   Salad-dressings,
 asparagus, acid fruits,  tomatoes, strawberries, pastries, and
 particulary all malt, vinous and  spirituous liquors should
 be strictly prohibited.   Let the  diet be light.   Plain milk-
 diet best.  Drink large quantities of soft water.
   General.   Rest in recumbent posture will greatly pro-
 mote recovery.   In  any event,  to as great  an extent  as
 possible, avoid physical exertion, and all sexual excitement.
   Chordee.  Empty  rectum  by  enema  before retiring.
 Sleep on hard mattress, with light bed-clothes; room cool
 and well ventilated.  When erection occurs, evacuate blad-
 der;  stand  on cold  oil-cloth.  Medicinal treatment as for
 original  disease.   External application  of  Camphor-ice
 along urethra, at night, has prevented chordee.
   Injections.  Useful in but small number of cases.  Hot
 mucilaginous infusions best—gum-water, linseed-water, with
 a  little Hydrastis.   Any injection  which  causes  greater
 pain than very slight smarting, will do  more  harm  than
good.  In any case, must be employed very early—later, of
no use.
   Retention of Urine.  Avoid passage of catheter if pos-
sible!  Quiet mental  anxiety; inject in  perineum Morphia
gr. ]4 and Atropia gr. 1-120; repeat in  an hour; place pa- 
]40        KEY NOTES OF MEDICAL PRACTICE.

tient in hot bath, submerged to the chin, until flow of urine
begins; if signs of syncope, remove him from bath, put hot
mush poultice over hypogastrium,  and give enema of hot
water and soapsuds,   All  other means failing, aspirate the
bladder.

                STAGE  OF  DECLINE.

  Merc. iod.  Discharge free and mucoid; patches of indu-
ration found along urethra.
  Sepia.  Chronic mucoid discharges, without pain.  Espe-
cially gonorrhoea of females.
  Hepar  s.   Muco-purulent discharge  in those who have
had several attacks.
  Thuja.  Thin, whitish, painless discharge.   Sub-acute
and chronic cases, especially when there is inflammation of
prostate.
  Sulph.  Much thickening along urethra.
  Silica.  Cases of long standing, with slight, shreddy dis-
charge.
  Injections.  May be used in this stage.  Half a grain or
grain of Arg-nit., Zinc sulph. or Plumb, acet, to ounce of
water.  Powdered Hydrastis 3ss. to 5j  water, excellent  in
cases of long standing.
  Short-nosed, hard  rubber  syringe holding  3ij.  First
clear urethra by urination, or  warm water.  Insert  nozzle
just within meatus; compress  sides of  urethra with thumb
and finger above syringe  tip;  inject slowly.  Retain injec-
tion for minute or two, manipulating urethra.
  If discharge persist, pass slowly full-sized, smooth, steel
sound, at  intervals of three or four days.


                        GLEET.

  Treat by slightly astringent injections, and remedies as
indicated  above.  But  permanent  cure demands  treat-
ment of the accompanying


              URETHRAL STRICTURE.

  Chronic urethral discharge always indicates siricture, and
latter must be treated.  Pass  olive-pointed bougie, not be-
yond prostate, using no force.   If meatus contracted, with
keen-edged bistoury cut downward and backward in median
line, and insert piece of oiled lint to prevent primary adhe-
sion.  Make gradual dilatation at  point of stricture with
olive-pointed bougies  up to No. 8, then steel sounds.  Never
use steel sound smaller than No. 9.
  Leave bougie in situ only few moments, and introduoa!
^ 
HYDROCELE.
141
 larger sizes at intervals of two days, more or less,  accord-
 ing to patient's urethral sensibility.  Use no force.  Make
 haste  slowly.   Gradual dilatation should be  carried up  to
 normal size of urethra, as  ascertained by  bulbous  bougie,
 or urethrometer.  Traumatic and resilient strictures, and
 those  of  the  penile urethra, should be treated by over-dis-
 tention and urethrotomy combined.

          EPIDIDY3IITIS  AND  ORCHITIS.
               LEADIXG KEHEIXEM.
   Pulsatilla.  Sub-acute  inflammation,  the glands alone
 being affected; pain shooting down the back or into the
 thigh, and changing suddenly.
   Hamamelis.   Dull, heavy pain in testicle, at times excru-
 ciating.   Scrotum  hot, congested  and  swollen; the skin
 tense, smooth and shining.
   Aconite.  Fever, hot dry skin, full pulse, great vascular
 excitement.
   Belladonna.   Great sensitiveness of  nervous system,
 with intolerance of pain, which is of neuralgic character.
   Clematis.  Orchitis following chronic urethritis.
   Arnica.  Conium.  From contusion.
   GENERAL 3IEASURES.  Absolute  rest in bed—do
 not let patient rise even to relieve bladder or bowels.  Sup-
 port testicle so as not to drag on cord.  Apply hot Hama-
 melis fomentations.  After inflammation has subsided, strap
 with adhesive plaster so as  to  make pressure.   Relief of
 tension of tunica vaginalis promptly afforded by puncture.
 a straight,  three-cornered surgical  needle  being  passed
 through scrotum, and six or ten punctures being made in
 envelope of testis.

                    HYDROCELE.
  REMEDIES.  Iod.,  Calc e, Sit.  Aurum, Puis., Rhod.,
 Graph., Kali-hyd.
  Operative Treatment.  In infants, acupuncture, causing
the fluid to escape into areolar tissue of scrotum, often cures.
  Palliative treatment, for adults, evacuate contents of
sac with aspirator or trocar.  Method:—Make out position
of testicle; grasp tumor firmly in left hand, with testicle
occupying middle of  palm.   Plunge needle or trocar ob-
liquely upwards and backwards into juncture of middle and
lower thirds of hydrocele.
  Radical Cure.   Tap  hydrocede  with small trocar, empty
sac of  all  fluid and  inject liquid  Carbolic  acid,  twenty to
thirty minims, manipulating sac so as to bring  acid into
contact with entire surface, allowing acid  to remain.  Con-
tine patient to room for forty-eight hours.
  " This method is followed by a radical cure in most cases, and is un-
attended by fever or other complications."  Adams. 
142        KEY NOTES OF MEDICAL PRACTICE.
PAHT  IV.
MISCELLANEA.
                 LEGAL MEDICINE.

  Expert Testimony.    A physician is in law an expert
as  to  all matters  embraced  within  the  range of  his
profession.  It is not necessary that he  be at the time in
actual  practice.  It  is not necessary  that he should have
made the particular disease involved  in any  inquiry, a
specialty.  But if he has devoted himself exclusively to one
branch, and has had no experience in  that subject to which
he  is called  to  testify,  his  testimony is  inadmissible.   A
practicing physician  whose  knowledge of the particular
subject of inquiry (e. g.. insanity) was derived from study
alone, has been held competent to express an opinion as an
expert.   Medical books are not admissible in evidence.
  An expert cannot be compelled to attend during  the  en-
tire trial for  the purpose of  hearing all the testimony.
  The  law is extremely  conflicting us  to whether profes-
sional men can be compelled to testify  as experts without
extra compensation.  In England it is settled that addi-
tional compensation is required.  In the United States  the
question is open, with the weight  of authority in favor of
the English rule.
  In the absence of  any statutory provision to the contrary,
it is well settled that a physician or surgeon  may be com-
pelled to disclose any communications made to him in pro-
fessional  confidence.  This  rule   has been  abrogated  in
several of the states by express statutes.                    .
  " Physicians  and surgeons shall b.e incompetent to testify as to infor- -t
mation obtained in a professional capacity from a patient.'1  Missouri.  '■
  " No person duly authorized to  practice physic or surgery shall be
allowed or compelled to disclose any information which he may have
acquired in attending any pulient in his professional character, and  j
which information was necessary to enable him to prescribe for such  '
patient as a physician, or to do any act for him  as a surgeon."  Sew
York.

  Skill demanded.  A  physician's charge is more on ac-
count of his  skill and knowledge than of  the time given to
his patient's  case.  He is held to exercise ordinary care  and  ']
^
J 
LEGAL MEDICINE.
143
 skill, but is not held to produce any benefit to the patient.
 The only defence against a suit for physician's service ren-
 dered on employment, is, first, as  to the unreasonableness
 of the charges, or. second, actual malpractice.  But a physi-
 cian must adhere to the system and the custom of the branch
 of the profession he has avowed.

   Collections.   A physician has a right to demand and sue
 for reasonable charges for professional services rendered
 upon employment, either in advice or aid.
   Books of original entry only are received as evidence.  A
 bill of items may be demanded by the debtor.
   When a patient receives,  without objection,  the services
 of an assistant, or a student, he is bound to the principal
 for the same.  But where partners both attend a patient,
 they must recover in the firm's name.
   A bill for services rendered to a servant must be collected
 from him, unless the master expressly agrees to pay for the
 same.   A  minor may be  held responsible for medical aid
 rendered him.
   Either the husband or wife, or both jointly,  may be held
 for services  rendered  to one of  the family.  A city must
 pay for services rendered by a physician  called by a police
 officer, if  the  case is urgent  and  the regular  City Physi-
 cian and Surgeon is absent.

   Good-will.  A physician may  sell the "good-will" of
 his practice, or his business, and may contract that he will
 not, within certain places  and times, practice  his profes-
 sion; but an agreement not to practice his profession at all
 is unlawful and cannot be enforced, because it is against
 public policy.

 .  Jurors.  Practicing physicians are exempt from duty as
 jurors.

   Liability of Physician.  A  physician  is  liable  for  any
 damage caused by  malpractice.  He is also liable for  all
 acts of  an assistant or student done in the regular course
 of business.

  Malpractice.  A physician  or surgeon  must bring to the
 performance of  his duties as a professional man at least
 ordinary skill and knowledge, and must apply without mis-
 take what is settled  in his  profession;  and must have the
 knowledge of the best and leading authorities in his science,
 down to the time the act is performed,  or he is liable for
 damages that may accrue from his practice.

Law Regulating the Pkactice or  Medicine in the  State
                      of Illinois.
  Every person practicing  medicine, if  a graduate in med- 
144        KEY NOTES OF MEDICAL PRACTICE.

icine, shall present his Diploma to the State Board of Health,
for verification; if found to be genuine, the State Board of
Health shall issue its Certificate to that effect, and such Di-
ploma and such Certificate shall be  conclusive as  to the
right of the lawful holder of the same  to practice medicine
in this State.  If not a graduate, the person practicing med-
icine in this State shall present himself  before  said Board
and submit himself to such examinations as the  said Board
shall require, and if the examination be satisfactory to the
Examiners, the said Board shall issue its Certificate in ac-
cordance with the facts, and the lawful holder of such  Cer-
tificate  shall be  entitled to all the rights and privileges
herein mentioned.
  Every person holding a Certificate shall have  it recorded  \
in the office of the Clerk of the County in which he resides.  |
Any person removing to another County  to practice,  shall
record the Certificate, in like manner, in the County to
which he removes.
  The State Board of Health may refuse Certificates to
individuals guilty of  unprofessional or  dishonorable  con-
duct, and they may revoke Certificates for like causes.
  Any person  shall be regarded as practicing medicine,—
within the meaning of this Act. who shall profess publicly J
to be a  physician, and to prescribe for the sick, or who shall i
append to his name the letters of u M. D."

               THE  TEMPERAMENTS.

   SANGUINE TE3IPERAMENT.  The form is full and
round, neither very gross nor very spare, and the m uscles firm
and elastic.  The complexion  is florid  and ruddy, from the
rich capillary circulation.  Arterial blood abounds, the veins
being small, the  circulation active, and  the pulse full and
quick.  The bodily functions are quickly and  easily per-
formed.  Mind and body are quickly stimulated into action,
and there is great endursince.
   There is an  intense animation and buoyancy of  spirits.
and in the mental sphere rapid thought, vivid imagination
and quick perception.
   Subjects of this  temperament are prone to congestions.
inflammations and fevers, and all  diseases are  inclined to
take on inflammatory action.
   Remedies.  Aconite. Belladonna.  Bryonia.  Gelsemium,
Veratrum vir.

   NERVOUS TEMPERAMENT.  The habit is spare, the
frame somewhat angular, the muscles spare, and  not well de-
fined.  The skin is dark, dull, earthy, or sallow, and hot and
pungent to the touch.  The cranium is large.  The ct'rcM/an'oH
is languid, with a preponderance of the venous  system, the 
THE TEMPERAMENTS—INFANT  DIET.
 pulse variable and easily  excited.   The face has the linea-
 ments of energy, and movements are hasty and abrupt.
   The mental powers are large, and  capable of  persistent
 exercise. The affections are violent, and the sexual passions
 usually very  strong.  Sensations have an  intensity far in
 excess of the exciting cause.
   The individual is subject to neuralgia, nervous diseases.
 spasmodic affections, and mental disorders.
   Remedies.  Atropia.  Ignatia,  Coffea,  Valerian,  Jfos-
 chus, Phosphorus, Zincum.

   LYMPHATIC TEMPERAMENT.  The body;is heavy,
 inclined to corpulence, the flesh full, but soft: the joints and
 hands large, and the feet broad and flat.  Complexion sallow
 or pasty, the hair light or reddish.  The pulse  is slow and
 easily  compressed.  The  bodily  functions are  slow  and
 languid.  The chest  and heart are  inadequate in bulk to
 the rest of the body.
   The  mental processes are slow,  though there is great
 firmness and constancy, and usually good judgment.
   These subjects are inclined to glandular enlargements.
 catarrhal affections, abscesses and dropsies.  There is slight
 power of resistance  to  acute diseases, with a tendency to
 take on the chronic  form, especially  of the  strumous and
 asthenic kinds.
   Remedies.  Arsenicum.  Iodine,   Calcarea,   Hepar  s.,
 Mercurius, Sepia, Silica, Sulphur.

   BILIOUS  TEMPERAMENT.   Habit  spare; muscles
 hard-knit; tendons wiry, complexion swarthy, with a yellow-
 ish tinge; sharp features; dark and deep-set eyes.  They are
 characterized by violence of reaction to  irritation, particu-
 larly of the  biiiary apparatus, with  disturbances of  the
 digestive  functions, dark-colored urine, and constipation.
 The bilious derangement engenders melancholy,  ill-humor
 and acrimony of temper.
   Remedies.  Nux  vom.,  Chamomilla,  Bryonia, Sulphur,
 Podophyllum, Aloes.
                    INFANT  DIET.
   In order to  prepare cow's-milk so as  to  adapt it to the
 wants of the infant organism, it must  be diluted by the ad-
 dition of a mucilaginous liquid, such as gum-Arabic-water,
 barley-water, gelatine, or oat-meal-water, some lime-water,
 sugar,  and a little salt, in about the  following proportions:
      Oatmeal-water,    -    -     2 tablespoonfuls;
      Lime-water,    -    -    -   1 tablespoonful;
      Fresh milk,   -    -    -     3 tablespoonfuls;
      Sugar-of-milk,  -    -    -   1 teaspoonful;  .
      Salt,     .    -    -    -     a  pinch.
  This is sufficient for one feeding.  Prepare it fresh as
wanted. 
146        KEY NOTES OF MEDICAL PRACTICE.

  Oatmeal-water.   Soak a teacupful  of  oatmeal in  a
pint of water, with a little salt added, over night.   Strain •
thoroughly, through a napkin, next morning.

  Barley-water.  Take  a teacupful  of  pearl-barley, and
soak it for half an hour in a little luke-warm water, previ-
ously salted.  Drain off  the water, pour  the  barley  into a
pint of boiling water, and let it simmer one-half hour; when
done, strain into a pitcher.

  Gum-Arabic-water.   Dissolve  pure  gum-Arabic  in
water, one part to ten, by bulk.
  For very young babes, use the  gum-Arabic water, in the
proportion above given; for older children, barley-water if
the bowels  are loose, oatmeal-water  if there be constipa-
tion.  A little gelatine added to  the  mixture of milk and
water, may be substituted for any of the above.


          DIET IN  CHOLERA-INFANTUM.

  Keep the child cool, let it have plenty of fresh air, and
let it have no food in which the process of fermentation has
begun.  Avoid starchy foods.
  The milk-and-barley-water, prepared as above, may be
all-sufficient.  Keep  litmus paper  on hand,  and test the
milk frequently; if it show any acidity, reject it.

  Albumen-water.   Gently stir the whites  of two eggs
into  a half-pint  of cold water, and  sweeten with a little
sugar-of-milk.
  This is the most simple food that it is possible to obtain,
and may be resorted to when all others fail.

   Wine-whey.   Heat a pint of fresh milk to the  boiling
point; add slowly a wineglassful of sherry wine, and  let it
gently  simmer until the curd  forms.  Strain  the whey
through a cloth, and sweeten.  This is nourishing and stim-
ulating."

                 DIET  IN FEYERS.

  Give  no solid food, to a fever-patient.  Let  all  food be
simple but nutritious.  Give food at frequent intervals and
in small quantities.  Food for fever-patients should be fluid
in form, easy of  digestion, and highly nutritious.  Those •:
who  have been properly  nourished make the  best recov-
eries.  In typhoid, and  diseases in  which the bowels have
been affected, no solid food must  be given until the stools
are again consistent and fecal.
  Milk is the best food that can be given.   So long as  the
patient can take it, none other need be sought for. 
DIET IN FEVERS—RECTAL ALIMENTATION.
   Beef-tea. in the stage of  depression, is useful as a stim-
 ulant.
   Recipe.  Take one pound of fresh  meat, cut very fine,
 soak in one-third of a quart of cold water over night.   In
 the morning remove the meat, saving the water in which it
 has soaked.  Put the meat in two-thirds of a quart of water,
 and let it simmer for two  hours, keeping the  water up to
 its original level by replacing what is  lost by  evaporation.
 Now pour the beef-broth into the cold  liquor  in which the
 meat was soaked,  squeezing the meat as dry as possible.
 The meat  which remains should be spread on a tin plate,
 and dried in  an  oven.  When perfectly dry it can be easily
 reduced to a  powder in a mortar.  Mix this  meat-powder
 in the liquor, and you have all the elements of the meat in
 a fluid form.  Salt  to taste, and add twenty drops of Muri
 a tie acid and three  grains of Pepsin.
   This is the only preparation  of beaf-tea which contains
 all the elements of  the meat.

   Rules for making Beef-tea.  Never let beef-tea boil.
 Always begin with cold  water.  Cut  the meat very fine, and
 remove all fat, gristle and bones.  The proper proportion
 is  a pound to a pint.  After making, carefully remove  all
 traces of fat.  To warm up  beef-tea, put it in  a bowl, and
 set the bowl in a vessel of hot water.

   Egjg-nog.   One  egg;  one glass  of  milk; one  dessert-
 spoonful of brandy; one dessertspoonful of sugar.
   Carefully scald the  milk,  and let  it  afterwards become
 cold.  Beat the sugar and egg up together to  a froth, put
 into a glass, add the brandy and fill up with  the milk.  If
 wanted  in a hurry, the milk may be used without scalding.

   3Intton-l>roth.   Take  a  pound  of  fresh mutton, free
 from  fat: cut into thin slices with a  sharp knife; put into a
 suitable dish, salt, pour over it a quart of cold water and
 let it simmer over a slow fire for an hour—then let it boil
 for an hour longer.  Strain off the broth, refusing the meat
 fibre.   Season with salt.


              RECTAL ALIMENTATION.

   Preparatory to giving an  enema, empty and wash  the
 rectum  by giving an injection of clean, warm water.
  Force the enema in slowly.
  Throw it as high up as possible.
  Inject at intervals of two hours.
  Inject no more than half a teacupful at a time.
  Let the enema have a temperature of  about  that of the
body—98  or 100' F. 
 148         KEY NOTES OF MEDICAL PRACTICE.

   Warm-milk, with a little salt in it, makes a simple and
 readily-absorbed enema. Heat the milk to the proper tem-
 perature, inject every two hours, and the patient is getting
 considerable nourishment.

   Beef-tea, made  according to  the recipe given, makes a j
 very nutritious enema. The pepsin and  muriatic  acid are
 necessary to fit it for absorption.

   Cod-liver-oil.  Chop fine a half-pound of beef-pancreas,
 cover this with water and allow it to stand for an hour in a
 warm place.  Strain through a cloth.  Mix an ounce of this
 pancreas solution in a half-ounce of  Cod-liver-oil, and use
 as an injection in those cases in which it is desired to sup-
 ply the system with fat.

            NUTRIENT SUPPOSITORIES.

   Take a quantity of the whole-beef-tea,  set the basin con-
 taining it in another vessel of hot water,  and evaporate the
 water from the beef-tea until it  becomes of a creamy con-
 sistence.  Now add an equal  quantity of Cacao-butter, melt
 both together, pour into  a dish and allow the mixture to
 cool and solidify.   With a warm knife cut into  bits, and ,
 shape like  a pigeon's egg.  These nutrient suppositories *
 introduced into the rectum at frequent intervals, will afford
 nourishment to the system in the neatest and cleanest way
 in which artificial alimentation can be practiced.


                     MILK  DIET.

   Diabetes, Bright's disease, Dyspepsia,  and some other
 diseases, undergo great improvement on  an exclusive milk
 diet. The following rules will aid in carrying out this treat-
 ment.
   Use fresh milk.   The milk may be taken cold or warm,
 but it must not be boiled in the warming.
  The first day take from four to six pints.  This would be
from two to three glasstfuls taken every two  hours during
the day.
  It is better to divide the day into equal  periods and take
frequent draughts—even though  a  glassful be taken every ;
hour—than to take a large quantity on the stomach at once.
  The quantity of milk should be increased from day to day
until five or six quarts are taken daily.  This quantity, six
quarts, need not be exceeded.
  In Diabetes, nothing else must be  taken while the  milk
diet is used.  If at the end of a week there is no improve- J
ment, the treatment may be abandoned.   If the treatment
be of benefit it will be denoted by a diminished amount of
4 
POULTICES.
149
 urine, less sugar,  and improvement  in  the general health.
 It should be continued from three to six weeks  after all
 sugar has disappeared from the urine.


                       POULTICES.

   Cataplasms are local baths—they supply heat and mois-
 ture to a part, soften the  cuticle, relax the skin, dilate the
 vessels, lessen tension and relieve pain.
   Use in—Pneumonia, Pleurisy,  Bronchitis. Pericarditis,
 Peritonitis,  other  internal  inflammations,  Rheumatism,
 Lumbago, and to mature Abscesses.
   Rules.  Do not  remove one poultice till next is ready to
 replace it.  A poultice should be applied as hot as it can be
 borne.  Change a poultice every two or three hours by day,
 every four hours at night.  To  make a poultice retain  heat
 longer, cover  with  oil-silk  or cotton-wool.  Peritonitis
 requires a thin poultice; cover  with cotton-wool.   In  sup-
 purations, do not let poultice be larger than the abcess it is
 intended to cover.

   Linseed-meal.   Put sufficient hot water into a hot bowl,
 sprinkle the meal into the water, stirring  vigorously  until
 the required consistency is attained, and lastly stir  in a
 small quantity of olive oil.  Spread smoothly and evenly
 on a piece of muslin, and cover with piece of cheese-cloth.
 Oatmeal poultices may be prepared in a similar manner.

   Starch.   Add a little cold water to the starch,  and blend
 the two into a pap; then  add  sufficient boiling  water to
 bring it to  the required consistence, and spread  on cloth.
 This is neat, bland  and unirritating.

   Disinfecting  poultice.   Anoint the part with Carbolic
 oil (1 to 10) and apply a pad of carded oakum, wrung out
 of hot water.

   Fly-blister.  Spread a thin layer of Cantharides Cerate
 on piece  of brown  paper, soft leather, or,  preferably, a
 piece of adhesive plaster.  Leave fjee  margin around the
 salve.  Moisten skin with vinegar, cover surface of  plaster
 with tissue-paper moistened with vinegar, apply and secure
 by adhesive straps.   From two  to twelve hours minimum
 and maximum time to leave plaster on.

  Cantharidal  collodion.   Dissolve  gun-cotton  in  an
 ethereal solution of   Cantharides.   Apply by means of
 camel's-hair pencil.  This makes a very effectual and easily-
 regulated vesicant

  3Iustard-poultice.   Mix  some linseed-meal in a quan-
tity of boiling water,  to creamy  consistence, then add same 
150        KEY NOTES OF MEDICAL PRACTICE.

quantity of mustard as of meal used, stirring constantly.  ;
Spread on a cloth, cover with gauze, and apply.
  A mustard poultice should  remain from ten minutes to
half an hour, according to strength.  Indicated when  mild
and rapid counter-irritation is required.


              MOIST  FOMENTATIONS.               I

  Used to relax spasm, as intestinal, renal  and biliary colic.
  Directions.   Place a fold of flannel cloth in the middle
of a towel,  twist the ends  of the towel, and dip the portion
containing  the flannel into  boiling water, take  out  and
wring it until  as  much water  as possible  is pressed away.
Take out the  flannel and apply to the painful  part.   Or,
sprinkle a fold of flannel with warm water, and  run a  very
hot flat-iron over  it.   Compresses  lose  their  heat rapidly,
and must be frequently renewed.

  Turpentine stupe.  If slight counter-irritation be de-
sired, sprinkle the fomentation with turpentine.

  Poppy-fomentation.   Sprinkle  the  fomentation  with
Laudanum, if sedative action be desired.
               DRY  FOMENTATIONS.

  When dry heat, is required, put into a flannel or muslin
bag, of suitable size, a quantity of hot sand, hot  suit, hot
bran or hot corn-meat  A hot plate, wrapped  in  a cloth,
answers well.   A rubber-bag filled with hot water is the
most perfect.  Put Acetate of Soda into a tin can, tightly-
closed, of suitable shape; set this in boiling water for thirty
minutes; remove, wrap in flannel and apply to painful part.
It will give off heat for many hours.


               COLD  APPLICATIONS.

  Ice-bags.  Put pounded ice, with a  little water, into a
bladder or rubber bag,  filling it only  half full.  Use for
refrigeration and to contract  the  vessels and reduce con-
gestion, especially in inflammation of the brain.

  Cold cloth.   Cloths may  be simply wrung out of cold
water, or, put some salt and pounded ice into a tin  basin,
set this on  a wet cloth, stir, and the cloth beneath may be
quickly frozen to any  required degree.

  Cold  drip.   Stand  a  vessel of  cold water  on  a  table
higher than the patient's bed,  put  one end of a  long strip 
BATHS.
151
of lamp-wick into the water, and lay the other across a cold
cloth which is applied to the inflamed part.   A continuous
stream of cold water is  thus conveyed to the part, and the
water which passes  from it  must be caught in a basin on
the other side.

  Cold cap.  Stitch onto  a muslin
cap, made to fit the head, a  coil of .^gLi
rubber tubing, arranged spirally, v^
with the two ends  free.  Wet the
cap, and put it on  the  head, then
place  one free end in a bucket of
cold water, suspended at a height.
and the other in another bucket on
the  floor.  Let the water syphon
from the upper to the lower bucket.
When  the  upper  one  becomes
empty, reverse their relative po-
sitions.
  This is a very efficient method of  Stl^.;
refrigerating the head in cerebro-
spinal meningitis, and in " brain-fever," when it is desired
to apply continuous cold.
BATHS.
	Temperature of Baths.
Cold -	50°— 60 Fahrenheit
Temperate Tepid -Warm Hot	_ 75 — 85: "■ 853— 95° - 95 — 98; " 98°—110 "
  Bran bath.  Boil four pounds of bran in one gallon of
water, strain, and add the liquor to sufficient water for a
bath.   Use to allay irritability of skin, and to soften  it in
squamous diseases.
  Salt  bath.   Add  rock-salt in  the proportion of  one
pound to four gallons of water.  Used as an invigorating
bath,  and to lessen susceptibility to cold.

  Alcohol  bath.  An ounce  of Alcohol to  the quart of
water.  Use for same purpose as salt-bath.

  Sulphur  bath.  Twenty grains  of Sulphuret  of Potas-
sium  to a  gallon  of water.  For  skin-diseases and rheu-
matism.
  Mustard  bath.  Add  a handful of mustard  to the ordi-
nary  hot bath, or a smaller quantity to  a foot-bath.   Use
when  stimulating action is required. 
152        KEY NOTES OF MEDICAL PRACTICE.

  Cold  douche.  Lower patient's head, place rubber-cloth
under, and pour cold water from  a pitcher over crown of
head, the pitcher  being slowly and gradually raised higher
and  higher, so that  the  water  may fall with more force.
Used in sun-stroke, and intense cerebral congestion.

  Wet  pack.  Spread a  comfort and several blankets on
the bed, and over these  a sheet wrung  out of cold water.
Remove all of the patient's clothing, lay him in middle of -
sheet, draw  the edges of sheet  over, and wrap the patient
in it snugly, then draw over  one  side after  another of
blankets and  comfort, and  make  all snug.  Put cold wet
compress on forehead.
  Used  to reduce  temperature  in typhoid, and  to develop
delayed eruption in scarlet, and other specific fevers.
  " It develops the rash, greatly reduces the fever, quiets the pulse,
renders the skin moist  and comfortable, and  abates the restlessness
and wandering." Ringer.
  Vapor  bath.   Improvised.  Place patient, with clothing
removed, in  large, cane-seated  chair, and surround both
completely with blankets, letting them  extend to the floor,
and  be secured about patient's neck.  Under the  chair place
basin of hot water, with alcohol-lamp beneath it; bring water
to a boil, and patient will soon be brought into state of per-
spiration which may be carried to any desired extent.  Use
in Uraemia, Bright's disease, and whenever diaphoresis iaf
required.

  3Iercurial bath.  Given as  above, by adding a metal
plate, with lamp beneath, on which is put  60 to 180 grains
bi-sulphurct of Mercury.   Used sometimes in treatment of
secondary syphilis.
                  DISINFECTANTS.

  To purify the atmosphere of a sick-room, nothing equals
an abundance of pure, fresh air.
  To ventilate a room, and  at same  time avoid a  draft,
raise the lower sash, and shut it down onto a folded blanket
placed beneath it,  leaving an aperture  of several  inches
between  lower edge  of upper, and upper edge of  lower
sash.
  For Air of sick-room.   R.  Polassii permanganatis,Z\\
Acid Oxalici,  Ij, mix, and  moisten with twice the quantity
(by bulk) of water; in two hours add a small quantity more
of water.   This will emit ozone freely enough for a  large
room, and it is an active disinfectant.
  For drinking-water.   Add sufficient permanganate nf
potassium to  render it slightly pinkish in  a  strong  light,
then filter. 
                     DISINFECTANTS.                 I53

      For Water-closets. Vessels and Drain-pipes.

     Hot water,     -     -                 2*.; gallons;
     Copperas.  -----     4" pounds;
     Carbolic acid,                     -   4  pounds.

   In typhoid  fever, dysentery, etc., keep it in  vessels, and
 pour it down water-closet freely.

   For  Drains, Ditches  and  Sewers.    Disinfect with
 Chloride-of-lime:—one pound is sufficient for one thousand
 gallons of running sewage.

   For heaps  of tilth.   Cover with  Charcoal, two or three
 inches deep, or with dry earth.


                For Washing Clothing.

     Sulphate of Zinc,       -    -    -    2H ounces;
     Carbolic acid,  -    -    -   -    -  1  ounce;
     Hot water,   -----    1  gallon.
   Soak the  clothes twelve hours, then wash.  Use in cases
 of Erysipelas, Small-pox, etc.

   Fumigation after Contagious Diseases. With Sulphur,
 only practical method.  Heavy clothing,  blankets, etc., to
 be disinfected, should  be opened and exposed.  Close the
 room as tightly as possible;  stuff all cracks and paste paper
 over key-holes.  Place the Sulphur in iron pans set  on
 bricks,  in wash-tubs  containing  a  little water.   Ignite
 it by aid of hot coals,  or,  a spoonful of alcohol poured
 over it and  ignited with a match.  Hasten from the room
 and  keep it closed for twenty-four  hours, then  open win-
 dows wide  and  air it  thoroughly.   For a room ten feet
 square, use two pounds of Sulphur, and for larger ones a
 proportionate quantity.
  Airy, well-ventilated  sleeping  apartments  are of the
utmost importance for the sick. The sick-room should also
have such an exposure  that  it may receive, several hours of
each day, the direct sun-light.
  To prepare  chromicised  cat-gut:—One  part  of chromic
acid  is first added to five of water.   One part of the solu-
tion  thus made is then  mixed with five of glycerine.  Steep
the gut in this for a week and it will be capable of resisting
the action of the tissues for a fortnight. 
154        KE\ NOTES OF MEDICAL PRACTICE.

    MICROSCOPICAL  EXAMINATION  OF   THE

                        URINE.

                 (a:\HRAL  RILES.

  1. Sediment in the urine has no significance unless de-
posited within twenty-four hours.

  2. Albumen in the urine does not indicate kidney-disease
unless accompanied by tube-casts.  The most fatal form of
Bright's disease (contracted kidney)  has little or no albu-
men.

  3. Every white crystal in urine, regardless  of shape, is a
X>hosphate, (except the oxalate of lime, which  has its own
peculiar form) when the urine is  alkaline.

  4. Every yellow crystal is uric acid if the urine is acid, or
a urate if the urine is alkaline.

  5.  Mucous casts, pus and epithelium signify disease of
the bladder (cystitis), or of other parts of the urinary tract,
as determined by the variety of epithelium.

  6. The urine of females can often be differentiated, from
that of males, by finding in it the tessellated epithelium of
the vagina.

  7. Hyaline casts (narrow), blood and epithelial  casts, sig-
nify acute catarrhal nephritis.   Much albumen.

  8. Broad hyaline casts, and epithelial, dark granular, and
oil casts, signify chronic catarrhal nephritis. At first, much
albumen; later, less.

  9. Hyaline and pale granular casts and little or no albu-
men signify interstitial nephritis.

  10. Broader casts are worse than narrow casts,  as  far M
diagnosis is concerned, for the  former signify  a chronic
disease.

  11. The urine should he fresh'fov microscopical examina-
tion, as the micrococci will change hyaline casts into gran-
ular casts, or devour them entirely, in a short time.

  12. Trommer's-test should never be trusted to alone, if the
amount of sugar is small.
  " The microscope gives better ideas of the exact condition of affairs
in the examination of urine than the various chemical  tests."  Dr.
Formad. 
MICROSCOPICAL APPEARANCES.
155
 
156
KEY NOTES OF MEDICAL PRACTICE.
URINALYSIS.
Albumen.
  Render urine slightly acid—if
not already so—by  Acetic  or
Nitric acid; boil, and add  one-
tenth bulk Nitric acid.
  A  whito,  cloudy
deposit on boiling,
which remains after
addition of the acid
:  Albumen.
Blood.
Pus.
  Heat  the  urine,  then  add
caustic potash nnd-heat it again.
1   Let urine stand till sediment
 deposits—pour off super-natant
 fluid—add  to remaining sedi-
 ment  equal  volume   liquor
 potassoe.
  A dirty, yellowish\
red sediment, bloo&y.
red color by train-
mitted \ight=Blood. .


  Mix well, and  n
viscid,    gelatinous
mass, which pours
like white of egg=
Pus.
Mucus.
  Add  to freshly-voided  urine,
some Acetic acid; if considerable
turbidity  appear,  add  Hydro-
chloric acid.
  If turbidity disap-l
pear,  the urine be<
coming clear on ad-.
dit ion of the Hcl,=
Mucus.
Bile.
  Place small quanity urine and
a few drops of red, " fuming "
Nitric acid side by side  on por-
celain dish,  and allow them to
gradually intermingle.
  A play of colors-
green, blue, violet,
red,  and yellow  or
brown -Bile.
Sugar.
  Add to urine  few drops solu-
tion Cupric sulphate,  then its    A  precipitate of
own volume liquor potasscr, and  brick-dust-like aedi-
boil. (Albumen must be absent). , ment-Sugar.
               I   Take two  specimens—to one I
                add a bit of yeast; set  side by j   If specimen whiefcj
Su°'ar         side  for  twenty-four hours in ! contained the  yeoir^
   °   *        temp, of  750 to 80° F., then take I has  ,0<rer SP- Si-
               ; specific gravity of each.         | than  other =Sugur.
Urea.
  Take  equal parts  urine and | 0/^£,$SC2

and"eta«We    " *     ~*  * i «aked eye-indicate
anu set asiao.                 _ | excess of r,.eo>
T, .   .  .,    ;   Take urine q. s.. add Hydro- '   A  precipitate  of
L 1'IC ACUl.    chloric acid one-eighth part: set  square    crystals=,
                aside  for twenty-four hours.    , Uric Acid.
D,     ,  ,        Boil the urine; if there is a    If the urine clears
.FUOSpnates.  cloudy deposit,  add one-tenth  up on addition of the
                part Nitric acid.                 acid  - Phosphates.
Chlorides.
   Slightly acidulate urine with
j Nitric acid, and add  few drops
i solution Nitrate of Silver.
  Clumpy white pre-
cipitate - Chloride*.
X 
                    VITAL CAPACITY.                  157

                 VITAL CAPACITY.

  Definition.  The capacity of the lungs, in  cubic  inches
 of air, as measured by the spirometer.
  The vital capacity varies according to sex, height, freight,
 age, and disease.
  Sex.   The vital capacity of man exceeds that of woman.
 of same height, by about 38 inches.
  Height.   There is an increase of 8 cubic inches in vital
 capacity for every inch in height between 5  feet and 6 feet.
  Weight.  Excess  in  body-weight  is associated  with
 diminished capacity in the proportion  of about one  cubic
 inch per pound excess.
  Age.   From thirty  to sixty years  the  vital capacity-
 decreases nearly l1^ cubic inches per year.
  Disease.  In lung-diseases the vital  capacity  is always
 diminished,  and bears a  certain relation to the  extent of
 the lesion.

                        TABLE

GIVING VITAL CAPACITY OF MALES AND FEMALES,  AT DIFFERENT
                        HEIGHTS.
EET	. INCHES.	M.	F.	FEET.	INCHES.	M.	F.
4 -	. . 7 . .	- 126 -	- 88	:j -	- - i - .	- 198 -	- 160
4	- - 8 -	- 134	- 96	5 -	- 5 -	- 206	- 168
4 -	- - 9 - -	- 142 -	- 104	5 -	- - 6 - -	- 214 -	- 176
4	- - 10 -	- 150	- 112	5 -	- 7 -	222	- 184
4 -	- 11 - -	- 138 -	- 120	3 -	- - 8 - -	- 230 -	- 192
3	- - 0 -	- 166	- 128	5 -	- 9 -	- 238	- 200
3 -	. . 1 - .	- 174 -	- 136	a -	- 10 - -	- 246 -	- 208
5	- - 2 -	- 182	- 144	5 -	- 11 -	- 254	- 216
5 -	- - 3 - -	- 190 -	- 152	6 -	- - 0 - -	- 262 -	- 224
   Of twelve phthisical patients examined, those who  had
 lost over three-tenths of their vital  capacity, only  three
 lived longer than four months, as  shown  by the following
 table:
 PATIENT.    LOST.    SUBVIVED.   PATIENT.    LOST.   SURVIVED.
 No. 1 -  -  - 4-10 - - - 12 ds.     No.  7 - - - 4-10 - - - 4 ins,
 "2  -  -  5-10  -  -  - 8 ms.     "  8   -  -  3-10  - - - 8  "
 ••  3 -  -  - 4-10 - - -  2 "      "  9 - - - 3-10 - - -  4  "
 "  4  -  -  2-10  -  -  - 6 "      " 10   -  -  3-10  - - - 3  ''
 "  5 -  -  - 4-10 - - -  2wks.    " 11 - - - 3-10 - - -  2  "
 "  6  -  -  6-10  -  -  - 2 "      " 12   -  -  3-10  - - - 3  "

  Phthisis.  To examine sputum for elastic fibres, mix it
with soda solution  (Ij! Liquor Soda;, Ij, Aqua, ;ij. M.) and
boil five minutes.   Then dilute with equal quantity distilled
water, and pour into a flat porcelain  vessel.   The particles
suspended in the water may  be taken  out  and examined
under a microscope.  The fibres are brown, slightly reticu-
lated, and a fraction of a millimetre in length. 
158        KEY NOTES OF MEDICAL PRACTICE.

         ARRANGEMENT OF THE TEETH.
                                 g   Q   M   o  S
                     (Upper Jaw  2   14   1  2=10^
Temporary Teeth. - -  •]                          o~ :20
(Lower Jaw  2   14   1    2=10)
                         g   a   o   £   o   =i  S
              f Upper Jaw 3   2   14   12  3-^16/
Permanent Teeth. ■{          -—   —------------------------,-32
              (Lower Jaw 3   2   14   12  3=16)

      PERIODS OF ERUPTION OF  THE TEETH.


                  Temporary Teeth.

  6th or 7th month, two middle incisors.
         9th   "   two lateral incisors.
        12th   "   first molars.
        18th   "   canines.
        24th   "   two last molars.


                   Permanent Teeth.

   6th or  7th year, the four anterior or first molars.   *
           7th  "   two middle incisors.
           8th  "   two lateral incisors.
           9th  "   first bicuspids.
          10th  "    second bicuspids.
  11th to 12th  "   canines.
  12th to 14th  "   second molars.
  17th to 21st  "   last molars or "wisdom teeth."
  Early closing of the f ontanelles indicates early dentition,
 and vice versa.
  The teeth of rachitic children are about one month late.
  The "wisdom teeth"  are the last to come  and the first
 to go.
  Children have been born with teeth  (N. Y. Med. Jour., V.
 xxii., p. 444).   Richard III. is said to have been born with
 teeth.  Cases are  recorded  where adults never cut teeth
 (Boston Med. Jour., Mar. 6, 1879, p. 183).  A  man  said to
 be over one hundred years old, cut a complete front set of
 teeth (German " Ephemerides^ dec. ij. ann. 3, p. 57). Com-
 plete third sets have been cut. 
TEMPERATURE—HYPODERMIC MEDICATION.     159
                   TEMPERATURE.

             1  Centigrade  =1.8° Fahrenheit.
  Rule.  To convert Centigrade into Fahrenheit, multiply
by 1.8 and add 32.
  Example:  37°C. X1.8-f-32=98.6 F.
  Rule.  To  convert  Fahrenheit into Centigrade,  deduct
32 and divide by 1.8.
  Example:  104°F.—32h-1.8=40°C.

                    EQVIVALKXTS.

        F.     C.         F.    C.        F.    C.
       97.0 =36.1;      100"=37.73      104r=40.0°
       98.0 =36.6=      101  =38.3       105=40.5°
       98.6 =37.0°      102:=38.83      106=41.1°
       99.0 =37.2C      103  =39.4°      107 =41.6°
  An increase of one  degree Fah.  above 98°  corresponds
with an increase of ten beats of the pulse per minute.
  If, in the  first week of a supposed case of  typhoid, the
temperature fall to normal, for however short a space of
time, it is not typhoid.
  Average temperature in health, 98.6° F. ^37'C.).   In rec-
tum and vagina it is 0.9   to 1.3°F. higher.  The daily range
rarely exceeds 1.8 F. (1"C.) above  or below the average.
The axillary temperature may fall to 97CF.  without col-
lapse, or rise to 100 F. without fever.
 . " In an instance of injury to the spine after a fall, reported by Mr.
Tealeto the Clinical Society (London Lancet, March, 1875), the young
lady lived, though the temperature reached  above 122°, and ranged
for days between 112° and 114° F.'' Da Costa.


            HYPODERMIC MEDICATION.

  Select for injection, flexor side  of arm,  over  biceps
muscle, or  abdomen,  near  umbilicus.   Pinch  up fold of
integument between thumb  and forefinger, insert point of
needle well  beneath integument, inject slowly, withdraw
carefully.  As rule, not more  than one-half usual dose, as
given by the mouth, should be injected.

                     TABLE OF DOSES.
Muriate of Morphine,    -   -    -   -  H to '-j of a grain.
Sulphate of Morphine,     -    -   -    % to'2 of a grain.
Sulphate of Atropine,    -             1-120 to 1 30  of a grain.
Strychnine,......1-120 to 1-30  of a grain.
Sulphate of Soda,.....2 grains.-
Sulphate of Quinine,    -   -    -   -   2 to 4 grains.
Squibb's liquor of Opium,      -    -   -  5 to 40 drops.
Magendie's solution,   -    -   -       3 to 20   "
Tincture Hyoscyamus,    -    -    -   -10 to 20   "
Tincture Cannabis,    -   -   -   -   10 to 20   "
Ergot, Fl. Ext.,......15 to 30   " 
160        KEY NOTES OF MEDICAL PRACTICE.

  Test for Chloroform.   When equal  parts of Purified
Chloroform and colorless, concentrated Sulphuric Acid are
shaken together in  a  glass-stoppered vial, there should be
no color imparted to either liquid, or but a faint tinge of
color imparted to  the acid  after twelve hours' standing;
neither should  there be any sensible heat developed at the
time of mixing.
  Chloroform, as it evaporates from bibulous paper, should
give but little  foreign odor, and the paper should be left
odorless  after  evaporation.   Chloroform should not  be
used for inhalation without  having been subjected to these
tests.

  Iodoform.   To destroy the dflor of, add three grains of
Cumarin  to  a drachm of  Iodoform.   Mixing  Iodoform
with peppermint-oil also masks its odor.

  Rubini's Camphor.  Equal parts by weight of Camphor
and  spirits of wine, 60 degrees over proof.   The  spirits ■
will dissolve and hold in solution its own weight of camphor.

                            lee.   To keep  in sick-room, j
                          tie  a piece  of  flannel loosely ■
                          over the mouth  of a bowl, put |
                          the  pounded  ice  in the  nest 1
                          formed by the depression as the j
                          cloth hangs down  in the bowl,
                          and  cover  with another  piece 1
                          of same  material.   In this way j
                          it will last throughout a warm
                       _. _ night.  Break bits off, as want-
                       - ~~ ed, with a pin.

              HARDENING BANDAGES.

  Starch Paste.  Starch is stirred in cold water to a uni- j
form, cream-like consistence, and then, constantly stirring.
boiling water added to produce a clear, thickish mucilage.   ]

  Starch Bandages are  made by  drawing  through this
paste ordinary  roller-bandages, of strips  of muslin.

  Starch  Splints.   Draw  strips  of  paste-board once
quickly through hot water, then thickly smear both sides
with the paste.
  Application.  Pad recesses  about  joints  with cotton-
wool, apply moist flannel roller, lay starch splints over this,
and  then bandage with starch roller.   Envelop whole with
dry roller bandage.

  Plaster-of-Paris.  Mix   in porcelain  dish,  constantly
stirring, pouring on sufficient water to make paste consist-
 
WiSlUHTS AND MEASURES—SIGNS OF DEATH.    161
ence of thick cream.  It stiffens in five to ten minutes.  To
delay setting, add  more  water,  or powdered  borax;  to
hasten, use hot water, or add common salt.
  Application.  Cover limb with  dry roller bandage, then
apply plaster bandage over this.
            WEIGHTS AND MEASURES.

  To learn to write prescriptions, in terms of Grammes, is
really a very easy matter indeed, it being only necessary to
bear in mind the following approximate

                  EQHVALEXTS:

      1 Grain   (gr.) equals    .06 Gramme  (6m.);
      1 Drachm (3)  equals  4.   Grammes (Gm.);
      1 Ounce   (5)  equals 30.   Grammes (Gm.); hence,
To convert Grains  (or MA into Grammes, multiply by .06;
To convert  Drachms (or fl) into Grammes, multiply by 4;
To convert Ounces (or f;) into Grammes, multiply by  30.*
  N. B.  Use an upright line in the decimal place.
    EXA3IPLKS:

IODOFORM  POWDER.
«.	Thymol, - - - (mj)
	Iodoform, - - (grs. xxx.)
	Calamine, - - (3j) Starch, - - (Ij) -
	
Mix	
	BROMIDIA.
«•	Ext. Cannabis Ind.,
	Ext. Hyosciami, - aa (grs. iij.)
	Brom. Potass., -
	Chloral Hyd., - aa (3vj)
	Syrup simpl., - - i'?j) -
	Aqua pura., - - - (;ij)
 Gm.
   [ 06
 1 I 80
 4 I
30
Gm.
Misce.
24
30
60
18
SIGXS   OF  DEATH.
  1.  The entire  and continuous cessation  of the  hearVs
action.   This must be tested by a practiced ear, using the
stethoscope.  Or, tie a ligature tightly about a finger: the
part beyond the  constriction will, if there be  circulation,
become bluish-red, while,  where  the  ligature is  applied

 *More accurately,  .065 (.06); 3.9 (4); 31.1 (30).
    6 
162        KEY NOTES OF MEDICAL PRACTICE.
there will appear a narrow white band.   If, during life, a
little Ammonia solution be injected subcutaneously, a port-
wine congestion is set up in the surrounding parts: no such
redness results when the operation is  performed on a dead
body.                                                  ■
  2.   The entire and continuous cessation of  respiration..
Test  by the surface of a cold mirror held over the mouth: if
moisture condense, breathing has not ceased.  Hold a light
feather over the lips, to see if there be a current of air pass-
ing.   Set a glass of water on the  chest—motion, if present,
will  be indicated by  the images of surrounding objects ■
reflected from the surface of the water.
  Six hours after cessation  of signs of life, if  the muscles
do not respond to a strong electrical current, life is cer-
tainly extinct.


           ARTIFICIAL   RESPIRATION.

  To be resorted to in all cases of suspended animation if
the respirations fall below ten to  the minute.              i
  Remove all clothing from chest and arms.  Clear mouthj
of mucus.   Patient on back, with small, firm cushion, or
roll  of clothing, under shoulders.   Pull tongue  forward
and  secure it by string tied over tongue and under chin.'
  Stand or kneel behind and at head of patient.  Grasp the!
arms just above the elbows,  and draw them  gently and
steadily outwards, upwards and backwards, till they meet
above the  head,  keeping  them in that position  for two 1
seconds.
  Then,  flex the  arms  at the  elbows and return  them •
slowly to the sides of the chest, and press  the arms firmly
A 
TRANSFUSION.
163
 against  the  chest, holding  them  there  for  two seconds.
 Repeat this process at the rate of fifteen or eighteen times a
 minute.   When spontaneous respiration  has become re-
 established, cease further effort, and proceed to induce cir-
 culation and warmth.
  In changing operators do not miss a single movement.
 Occasionally blow a little of the vapor of Ammonia, or  a
 little  snuff, into nostrils.  Persevere in this treatment for
 hours.
  After  breathing has been  restored, promote warmth by
 rubbing limbs upwards, with firm, grasping pressure, and
 energy,  using flannels, handkerchiefs,  etc.  Continue the
 friction  under the blankets, or  over  dry clothing.  Pro-
 mote  warmth  by  application of hot bottles,  hot bricks,
 bladders of  warm water, etc.. to  pit of stomach,  armpits,
 between the thighs, to soles of feet.  Provide at all times
 for free supply of fresh air.
  As  soon as patient can swallow, give hot water, by tea-
 spoonful, and follow  it by wine, diluted brandy, or coffee.
 Put him  in a warm  bed, and encourage a disposition to
 sleep.

                   TRANSFiSIOX.

  To  support patient  until transfusion can be  performed—
 Keep  head low; raise  the limbs; make friction from distal
 end towards the body, and then apply snug bandage about
 the limbs, near to body,  Maintain warmth.
  The object to be attained is to fill the blood-vessels,  and
 get up vascular tension, so that the heart will have something
 to contract upon.  For this purpose use the

                Solution of Schwartz:
  R1.   Distilled water, 100° F.,  -   2   pints;
       Common Salt,    -     -     \x/z drachms;
       Liquor Sodae,       -    -  20   drops.  Mix.

  Select median basilic vein at elbow, or internal saphenous,
in front of internal malleolus.  The collapsed vein is some-
 times hard to find—cut down onto it, expose it freely, and
 pass two ligatures  under  it.  With one ligature, tie the
 vein at the exposed portion  which is  nearest the hand or
foot;  push  the other ligature to  the  other end of the
wound.
  Open the vein by raising the upper wall with  a fine pair
 of toothed forceps, beneath  which  an oblique slit is to be
 made with scissors, so as to make a small,  flap-like opening.
 Raise the flap, and pass in the bulbous point of  a canule
 (glass, vulcanite or silver I,  directed towards  the  centre of
 circulation.   Tie this in the vein with the second ligature. 
164
KEY NOTES OF MEDICAL PKAUTlCli.
                       Have  ready a  glass funnel, to
                     which is attached a  foot of rubber-
                     tubing, with the canule at the other
                     end.  Have the tube guarded by a
                     clip.  Pour the Solution into the fun-
                     nel; open  the clip, and let the Solu-
                     tion start from mouth of the canule,
                     when the clip must be shut, and the
                     point  immediately introduced into
                     the vein.  Now open the clip, raise
                     the funnel and the  patient's  arm,
                     and the  Solution will be forced into
                     the vein by hydrostatic pressure.
                       Admit no air.   A few small bub-
                 ;*-& bles of air do no harm—the quantity
                     to cause death must be considerable.
                     Inject no clots or foreign  particles,
                     which may act as  emboli.   Keep the
                     Solution  in  a  clean,  warm, glass
                     vessel.
                       Inject slowly.   Quantity—a  half-
                     pint to a pint.  If signs of dyspnoea
appear, stop  the  injection  by lowering the funnel,  and
wait for it to subside.  During process keep Solxdion warm
by wrapping funnel with hot flannels.
  As soon as funnel  nearly empty,  withdraw  canule from
vein, apply compress and treat as simple wound.
                     POISONING.

                      EMETICS.

  Apomorphia.  Solution in water, 1  to 50; inject 5-10
drops hypodermically. This is the most prompt and efficient
emetic known.

  Ipecacuanha, powdered, 30 grains, in water.

  Sulphate-of-zinc, 30 grains in water; repeat if necessary.
Prompt and safe.

  Sulphate-of-copper, 5 to 10 grains dissolved in water.

  Mustard, a tablespoonful in a half-pint of warm water.

  Common salt,  two tablespoonfuls in a half-pint of tepid
water.
                    ANTIDOTES.

  For  Opium.  Atropia  sulph., gr. one-fortieth, or, Tr.
Belladonna, 15 drops, repeated in 15 minutes if necessary.
Strong coffee,  ad  libitum. 
           POISONING—GENERAL DIRECTIONS.          165

   For Arsenic.   Dialyzed Iron, ounce  doses frequently
 repeated.  Hydrated Peroxide of Iron, give ad lib.  Iron-
 rust.

   For Strychnine.  Chloral, 30  grains, repeated if neces-
 sary; Bromide-of potassium, ~ss.; Animal Charcoal, ad lib.;
 Tannic acid, ad lib.; Chloroform; Ether; Nitrite of Amyl,
 by inhalation.

   For Acids.  Lime-water, ad lib.; chalk-and-water; Mag-
 nesia, mixed in water; Ammonia and water, ?j to ;viij; Ashes;
 Plaster from the wall; Tooth-powder, in  water; Soap and
 water.

   For Alkalies.  Vinegar, freely; Acetic acid and water;
 Lemon-juice; Muriatic acid, freely diluted with water; any
 dilute acid.

   For Narcotics.   Coffee, strong, given freely; Nitrite of
 Amyl by inhalation;  Ammonia; Galvanism;  Stimulants.

   Multiple Antidote.  R\   Saturated Solution Sulphate
 of Iron, ^ijss;  Water fxx;  Calcined Magnesia, f ij; Animal
 Charcoal, f j.
   Keep Iron solution separately,  and the Magnesia  and
 Charcoal  mixed' in  a  bottle of water.  When required  for
 use. pour  all into bottle  together, and shake.  Give ad lib.,
 a wineglassful at a time.
   This is a perfect antidote to Arsenic, Zinc and Digitalis;
 it delays  the  action  of Salts  of Copper,  Morphine  and
 Strychnine, and slightly influences Salts of Mercury.

   Stimulants.   Wine, Whisky. Brandy. Ammonia, Tea,
 Coffee, Ether.

   Instruments.   Stomach-pump,  Hypodermic  syringe,
 soft-rubber catheter, enema-syringe.

  Demulcent Drinks.  Milk;  white of an egg  and water;
 oil;  linseed-tea;  gruel;  flour  and water;  boiled starch.
 Give in large quantities.

               GENERAL DIRECTIONS.

  Emetic.  Give that emetic which can  be most speedily
 obtained.   If it be a corrosive poison, give copious draughts
of demulcent drinks, followed by an emetic and the appro-
 priate antidote. If the emergency be great, and no emetic
 at hand, give copious draughts of tepid water, even though
 it be dirty or greasy;  then run the finger down the throat,
to excite vomiting.   The action of an emetic is facilitated
 if  large quantities of  fluid be swallowed. 
 166         KEY NOTES OF MEDICAL PRACTICE.

   Depression, if present, must be combated by stimulants,
 warm applications to the extremities, friction, galvanism,
 and, if the respirations fall below ten per minute, artificial
 respiration must be employed.  Catheterize bladder in pro-
 longed cases.

   Battery.   One  pole at the side of the neck, the other
 over pit of stomach, or muscles of the chest.  Or, touch the
 two  poles to different attachments  of  the muscles of the
 chest, using  strong current, sufficient to excite  pain, and
 produce efforts at crying.

   Flagellation.  In  poisoning with narcotics, to combat
 the depression, and keep  patient  from  sinking into fatal
 stupor, slap the skin with wet towels, spat the skin sharply,
 rub the soles of the feet with a stiff hair-brush; make every
 effort to rouse him.   Walking the patient only adds ex-
 haustion to  stupor—better lay him  on  a lounge and use
flagellation.

   Douches.  To  aid  in  rousing when there is stupor and
 depression, dash cold  and warm water, alternately,  onto the
 head and chest. In apparently hopeless cases, two or three
 sharp blows on  the  chest, delivered in quick succession,
 will sometimes restore the heart's action.  .

   Stimulation.  Alcoholic  stimulants may be used if  the
 poison is not  a  narcotic.  Coffee may  be employed  as a
 stimulant in Belladonna, Opium and other narcotic poison-
 ing; give an enema  of a pint  of hot, strong coffee.  -4m-
 monia may  be given by inhalation, or  by  injection into
 veins.  Strong tea is an excellent  stimulant, and it also
 antidotes many poisons; give by the stomach, if possible.
 Whiffs of  Ether, by  inhalation, will stimulate the heart's
 action.

   Demulcents.  In  cases of  poisoning by corrosive sub-
 stances, give, after the administration of the antidote and
 emetic, large quantities of mucilaginous drinks; preferably,
 white-of-egg and water.

   Stomach-pump.   If it become necessary to wash out the
 stomach, and no pump is at hand, pass down the oesophagus
 and  into the stomach,  the  end  of  a  long rubber tube.
 Raise the free end above the patient's head, attach a small
 funnel to it, and pour  down  sufficient  water to fill  the
 stomach.  Now carry  the free  end below the  level of the
 stomach, and its contents will flow out, when, by repeating
 the process,  fresh water may be syphoned back, and this
 process repeated indefinitely. 
POISONS.
167
HIM) OF POISON.
TREATMENT.
Unknown.
Opium.
Morphine,
Laudanum.
Chloral.
Arsenic.         )
  Paris green,    [■
  Scheele's green.  )
Strychnine,  )
Pierotoxine. )
Acids —
  Sulphuric,
  Nitric,
  Muriatic,
  Oxalic.
  Carbolic.

Alkalies—
  Ammonia.
  Soda,
  Potash,
  Lye.
Corrosive sublimate.
Tartar emetic.
Phosphorus.
Nitrate-of-.silver. )
 (Lunar caustic)  )
  Provoke repeated vomiting;
  Give demulcent drinks;
  Multiple antidote;
  Stimulate, if necessary.

' Provoke repeated vomiting;
  Give strong coffee, etc.;
  Inject Belladonna;
  Rouse  by flagellation;
  Artificial respiration.

  Provoke repeated vomiting;
  Give dialyzed iron, etc.;
  Give dose castor-oil;
  Secure rest;
  Stimulate, 'if necessary.

  Provoke vomiting once or twice;
  Give purgative;
  Give Chloral, etc.;
  Secure absolute quiet
f Give an alkali;
J  Provoke vomiting;
]  Demulcent drinks;
(_ Stimulate, if necessary.
Give an acid (vinegar);
Provoke vomiting;
Demulcent drinks;
Stimulate, if  necessary.

Provoke repeated vomiting;
Give strong tea, freely;
Give raw eggs and milk;
Give dose castor-oil;
Stimulate, if  necessary.

Provoke vomiting;
Sulphate of copper, sol. grs. iij,
  every 5 ms., till emesis;
Epsom salts, 5ss.;
No oils or fats.

Strong solution salt and water,
  very freely;
Provoke repeated vomiting. 
168
KEY NOTES OF MEDICAL PRACTICE.
Sugar-of-lead.
Aconite.
Digitalis.
Belladonna,  ""
Stramonium,
Hemlock.
Toadstools.
Tobacco.
Chloroform.        )
Carbonic-acid-gas.  \
Alcohol.
Decayed Meats  )
and Vegetables.)
Glass.
  Give Epsom salts repeatedly;
  Provoke repeated, vomiting;
  Give demulcent drinks;
  Give dose castor-oil.

 \ Provoke vomiting;
 j Stimulants, freely;
■{ Digitalis tinct.  gtt. xx, hypo-
    derm.; mustard over heart;
 [ Artificial respiration.

 f Provoke vomiting;
J Give strong tea;
 | Give stimulants;
 \ Recumbent posture.

  Provoke vomiting;
  Stimulants, freely;
  Hot, strong coffee;
  Opium,  tinct., gtt. iij—v,  or
    more;
  Cold  to head, galvanism, flag- J
    ellation;
  Artificial respiration.
 Abundance of fresh air;
 Pull   tongue  forward,  clear
   mouth;
 Loosen clothing,—head low;
 Alternate  cold   and  ivarm
   douche;
 Inhalations Amyl Nitrite—Am-
   monia;
 Aetifioial eespibation !—Bat-
   tery.

 Stomach-pump, or emetic;
 Ammonia-and-water;
 Battery and flagellations;
 Cold douche to head;
 Artificial respiration.

 Provoke vomiting;
 Give purgative;
 Powdered charcoal, freely,

  If  particles  of  glass  have
been swallowed, let the patient,
eat large  quantities of bread-
crumbs, to envelope it—then
give emetic.   Do not let it pass
into the bowels.
I 
INDEX.
 ABORTION, 90
 Abscess, Hit
 Acne, 81
 Acupressure. 125
 After-pains, 104
 Agalactia, 108
 Ague, 19
 Ague, pernicious, 21
 Albumen-water,  146
 Alcohol-bath, 151
 Alcoholism, 69
 Alopecia, 81
 Amenorrhcea, 112
 Anesthetics, 128
 Anal fissure, 132
 Angina pectoris, 40
 Antidotes, 164,  165
 Antiseptic surgery, 118
 Apoplexy. 68
 Apomorphia, 164
 Artificial  respiration, 162
 Asiatic cholera, 91
 Aspiration, 131
 Asphyxia of new-born, 102

 BANDAGES, 160
 Barber's itch, 81
 Barley-water, 146
 Bathing, 8
 Baths, 151
 Beef-tea, 147
 Bed. 8
 Biliary calculi, 59
 Bilious fever, 20
 Bilious temperament, 145
 Bladder, diseases of, 64
 Blepharitis, 83
 Brain, congestion of, 66
 Bran-bath. 151
 Break-bone fever, 19
 Bright's disease, 6T
 Bromidia, 161
 Bronchitis,  30
 Bubo, 138
 Bunion. 134
 Burns, 124

 CALCULI, biliary, 59
     "     renal, 62
 Camphor, Rubini's, 169
Cancrum oris, 41
Cantharidal collodion, 149
Carbuncles 122
Cautery, 125
Catarrh, nasal, 24
Cerebral meningitis, 67
   Cerebro-spinal fever, 11
   Cervix, lacerated, 105
   Chancre, 135
   Chancroid, 135, 137
   Cholera, Asiatic, 91
   Cholera-infantum, 93
   Chorea, 75
   Chloasma, 81
   Chloroform, 128
        "     test for, 150
   Circumcision, 133
   Climacteric, 115
   Coccygodinia, 133
   Cold cap, 151
    "  cloth, 150
    "  douche, 152
    "  drip, 150
    "  pack. 8
   Collapse,  temperature, 5
   Collections, 143
   Colic. 51
   Comedo, 81
   Condylomata, 137
   Congestion of liver, 56
   Congestion of lungs, 34
   Congestive chill, 21
   Constipation, 51
   Convalescence, 9
   Convulsions, 76
j   Conjunctivitis, 83
   Cord, prolapsus of, 99
I   Coryza, 24
   Corns, 134
   Cough, 28
     "    whooping, 29
   Craniotomy, 102
   Croup, 27
   Cystitis. 64
|   Cystocele, 99

I   DEATH, signs of, 161
   Demulcents, 166
   Dengue, 19
   Diabetes niellitus, 94
   Diagnosis, 18
   Diarrhoea, 47
   Diet, infant, 145
    '■'  in fevers, 146
    "  in typhoid,  8
   Diphtheria, 89
   Disinfectants, 152
   Dissection wound, 122
   Dropsy, 88
   Douche, 166
   Duration pregnancy, 98
I   Dysentery, 49 
170
INDEX.
Dysmenorrhoea, 112

EAR, diseases of, 85
Eclampsia, 103
Ecthyma, 81
Eczema, 81
Egg-nog, 147
Emetics, 164
Endocarditis, 38
Entozoa, 55
Enuresis, 65
Epididimytis, 141
Epilepsy, 75
Epistaxis, 25, 126
Eruptive fevers, 18
Erysipelas, 85
Erythema, 81
     "     nodosum, 81
Ether, 128
Eye, diseases of, 82

FEBRIS ICTERODES, 23
Fever, enteric, 5
   "   intermittent, 10
   "   jail, 9
   "   puerperal, 107
   "   remittent, 20
   "   ship,  9
   "   scarlet, 13
   "   typhoid, 5
   "   typhus, 9
Fevers, continued, 5
   "   eruptive, 12
   "   periodical, 19
Fissure in ano, 130
Fistula, rectal, 132
Flagellation. 166
Flexion, 126
Fly blister, 149
Fomentations, 150
Fumigation,  153

GANGLION, 133
Gangrene, 121
Gastralgia, 43
Gastric catarrh, 42
   "    fever, 12
   "    ulcer, 44
Glaucoma, 84
Gleet, 140
Good-will. 143
Gonorrhoea,  138
Gonorrheal ophthalmia, 83
Granular lids, 84
Gummata, 137
Gum-water, 146

H.EMATEMESIS, 45
Haematuria, 65
Haemoptysis, 35 .
Haemorrhage, 125
      "      post-partum, 100
      "      rectal, 127
      "      urethral, 126
      "      uterine, 127
Hsemorrhoids, 54, 131
  Hare-lip,  129
  Hay-asthma, 26
  Headaches, 46, 47
[  Headache, nervous, 72
      "      congestive, 71
  Heartburn, 43
  Heart, diseases of, 38, 39
  Hemicrania, 72
  Hives, 82
  Hepatitis, 57
  Hernia, 117
  Herniotomy, 117
  Herpes, 81
;  Hordeolum, 82
  Hour-glass contraction, 102
  Hydrocele, 141
  Hydrophobia, 122
  Hydrocephalus, acute. 77
                  chronic, 78
  Hydrothorax, 37
I  Hymen, imperforate, 9!)
  Hyperseinia of brain, 66
  Hypodermic medication, 159
  Hysteria, 75

  ICE-BAG, 150
  Iodoform, 160
      "      powder, 161
  Imperforate hymen, 99
  Infant-diet, 145
  Influenza, 26
  Ingrowing nail, 134
|  Intertrigo, 82
  Intussusception, 130
  Itch, barber's, 81
[  Iritis, 84
     "  syphilitic, 137

!  JAUNDICE, 58
|  Jail fever, 9
  Jurors, 143

i  KERATITIS, 84
I  Kidney, amyloid, 62
      "   red granular. 61
  Kidneys,  diseases of, 60.  62
  Keratitis, 84


I  LACERATION of cervix, 105
|                 of perineum, 104
[  Laryngitis, 27
  Laryngisums stridulus, 77
  Lead-colic, 52
!  Legal medicine, 142
  Lente's solution, 22
  Leucorrhoea, 114
  Lichen, 82
  Ligature,  125
  Liver, congestion of, 56
  Lithsemia, 95
  Lithiasis,  95
  Listerism, 118
  Lung-fever, 33
  Lungs, congestion of, 34
     "   oedema of, 34
  Lymphatic temperament, 144 
	INDEX. 17j	
MALPRACTICE, 143	Poppy fomentation, 150	
Mania, 103	; Poultices, 149	
Mastitis, 109 Meas es, 14	Post-partum hsemorrhage, 100 Premature labor, 97	
- Meningitis, cerebral, 67	Prolapse of cord, 99	
" cerebro-spinal, 11	Pruritus, 82	
Monorrhagia, 111	, Psoriasis, 82	
Mercurial bath, 152	1 Puerperal eclampsia, 103	
Metrorrhagia, 110	Puerperal fever, 107	
Milk diet, 148	" mania, 103	
Milk-leg, 107		
Miscarriage, 97	RECTAL ALIMENTATION, 147	
Morbilli, 14	fistula, 132	
Morphine-habit, 70	" hemorrhage, 127	
Mutton-broth, 147	" stricture, 132	
Mustard bath, 151	Remittent fever, 20	
Mustard poultice, 149	Renal calculi, 62	
Myocarditis, 38	Respiration, artificial. 162 Retained placenta, 102	
NEVUS, 129	| Retention of urine, 133	
Nervous temperament, 144	Rheumatism, 86	
Nephritis, 60-61	Rigid os, 99	
Neuralgia, 72	" perineum, 99	
Nipples, sore, 110	Rose cold, 26	
Nursing, 8	j Rubeola, 14 1 Rubini's camphor, 16 I	
OATMEAL WATER, 146	Rupia, 137	
' Obstetrics, 96		
OZdeina glottidis. 25	SALT BATH, 151	
(Edema of lungs, 34	' Sanguine temperament, 144	
Opium habit, 70	1 Sarcocele, 137	
Ophthalmia, 83	Scalds, 124	
" catarrhal, 83	Scarlet fever, 13	*-""
gonorrhceal, 83	Schwartz, solution of, 163	
neonatorum, 83	Sciatica, 73	
phlyctenular, 84	Shingles, 81	
Orchitis, 141	i Ship-fever, 9	
Otalgia, 8"i	Shock, 127	
Otorrhaea, 85	Sick-room, 7	
Ovaritis, 114	Sick-headache, 46	
Oza?na, 25	Signs of death, 161	
Ozsena, syphilitic, 137	Simple fever, 12 Skin-diseases. 79-82	
PARACENTESIS ABDOMINIS	Small-pox, 16	
130	Snake-bites, 122	
Paraphimosis. 138	Solution of quinine, 22	
Palpitation, cardiac, 39	Spotted fever, 11	
Parotitis, 41	Sprain, 122	
Parturition, 99	Starch poultice, 149	
Pemphigus, 82	Stimulation, 166	
Pericarditis, 38	Stings, 122	
Perineum, lacerated, 104	l Stomatitis, 41	
Pernicious ague, 21	1 Stricture of rectum, 132	
Peritonitis. 50	" of urethra, 140	
Pertussis, 29	Stye, 82	
Phagedena, 138	Styptics, 126	
Phlegmasia dolens, 107	Sulphur-bath, 151	
Pin-worms, 56	Suppositories, nutrient, 148	
Pityriasis, 82	Surgery. 116	
Placenta prrevia, 100	Syphilis. 134	
" retained, 102	" secondary, 136	
Pleuritis, 36	" tertiary, 136	
' Pleurodynia, 37	treatment of, 135	
' Pneumonitis, 33		
Podulic version, 100	TAMPON, 111	
Poisoning, 164-167	Tape-worm, 55	
 
1TJ		INDEX.	
Teeth, 158			Urinalysis, 154-156
Temperaments, 144			Urine, retention of, 133
Temperature, 5, 159			Urticaria, 82
Tetanus, 74			Uterine haemorrhage, 127
Thoracentesis, 130			
Tinea versicolor, 82			VACCINATION, 17
Tonsilitis, 41			Vapor-bath. 152
Torsion, 125			Variola, 16
Tough membranes, 99			Varioloid, 16
Tracheotomy, 28			Venereal, the, 134
Transfusion, 163			Venesection, 127
Trepanning, 128			Version, 100
Turpentine stupe, 150			1 Virus, 17
Twins, 102			j Vital capacity, 157
Typho-malarial fever,	20		
Typhus fever, 9			i WATERBRASH, 43
Typhus, abdominal, 5			j Wet pack, 152 Weights and measures, 161
ULCERS, 120			White leg, 107
" indolent, 120			Whooping, cough, 29
irritable, 120			Wine-whey, 146
Urteinia, 63			Wounds, treatment of, 118
Uric-acid diathesis, 95			
Urethral haemorrhage	126		YELLOW FEVER, 23
		ERRATA.	
P. 25,	for Ozcena, read Ozrena.		
P. 25.	for	gtts.,	read gtt.
P. 52,	1.11, for Dros., read Dios.		
 
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by the most eminent and liberal teachers of both branches of the pro-
fession.  By a simple arrangement of the type used, there are shown
at a glance the remedies used by both schools, as well as the remedies
peculiar to each, for any given morbid condition.  Over -forty promi-
nent teachers are referred to, besides occasional references to more
than thirty others.  In the first class are Bartholow, Ringer, Phillips,
Piffard, Trousseau, and Waring of the old school; Hempel, Hughes,
Hale, Ruddock and  Jousset among modern Homoeopathic authorities.
The Physician's Condensed Account  Book.  An Epito-
    mized System of Book-Keeping, avoiding the necessity
    of separate Journal, Day-Book and Ledger, combining
    system, accuracy, and easy reference, with a minimum
    of labor.  272 pages.  Price S3.50.
The Physician's Day-Book and Ledger.   Arranged  by
    T. D. Williams. M.D.  220 pp.   Price $2.00.   Sample
    pages sent on application.
Lahel Book, for the use of Physicians and Pharmacists.
    Containing more  than thirty-five hundred gummed  la-
    bels in  large clear type, and bound in a neat and sub-
    stantial manner.   Price  50 cts.   Sent  postpaid  on
    receipt of  price.
The Soul and the Body.  A Sermon  to Medical  Students.
    By Rev. L. P. Mercer.  12mo.  Cloth.  31 pp.  25 cts.

  This discourse is simple, logical, scientific, eloquent.  It elaborates
and enforces the doctrine of the reality of the spiritual man, consider-
ing the relation of the soul to the body as presented by old opinion, by
science, and by revelation.
"Bless  Thee,  Bully Doctor:''  By M.  E. Dicus,  M.D.
    Illustrated  by  100 finely  executed wood-cuts.  Cloth.
    50 cts.

  This is certainly the most  extraordinary book of  the year.  The
Author has gathered and put into book form the cream of the medical
wit of the world, and the whole thing is profusely illustrated. 
Key Notes of Medical  Practice.   By CnAs. Gatohf.ll,
    M.D., formerly Professor of The Theory and Practice
    of Medicine, University of Michigan; Attending Phy-
    sician to Cook County Hospital.   Pocket book.  Flexi-
    ble leather.  172 pp.   $2.00.

 This is a complete hand-book of Medicine, Surgery and  Obstetrics,
and is in such form as to actually go into the pocket, making it a verita-
ble vade-mecum.
Ruddock's Family Doctor.  Being  a reprint of  Dr. Rud-
    dock's "Vade Mecum," "Diseases of Women," "Dis-
    eases  of  Infants  and Children,"  and ''Essentials of
    Diet."   With  Notes  and  Additional  Chapters, by
    James E. Gross, M.D.  750 pp.  Crown octavo.  Cloth,
    $3.00.  Ready March 1st, 1884.
The American  Homeopathic Dispensatory.  Designed
    as a Text Book for the Physician, Student and Drug-
    gist.   By T. D. Williams,  M.D.,  Member  Illinois
    State  Pharmaceutical  Association,  Active  Member
    American Public Health  Association, late Attending
    Gynaecologist Cook County Hospital, etc.  About 700
    pp.  Octavo. Ready April 1, 1884.

  The above work will be to the Homoeopathic school what the United
States  and National Dispensatories are to the Allopathic school—a
desideratum.
n
Clinical Papers on Ophthalmology and Otology.  By
    J. H. Buffum,  M.D., Professor of  Ophthalmology and
    Otology in the Chicago Homoeopathic Medical College,
    and Author  of '* Diseases  and Injuries of the Eye."
    22 pp.   Octavo.  20 cts.
The Medical Era.   A Monthly Journal of Medicine.  Each
    number contains  32 double-column  quarto  pages.
    Volume commences in July.   Terms, X2.00  a year in
    advance.
  For Sale at all Homoeopathic Pharmacies or £
sent free by the Publishers on receipt of price.
A discount of 20 per cent, to physicians.

                 CROSS &  DELBRIDGE.
                            48 Madison St., Chicago. 
 
 
 
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NATIONAL LIBRARY OF MEDICINE
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