Lippincott's Medical Dictionary. A Complete Vocabular.r of I lie Term* used in Medicine and the Allied Sciences, with their Pronuiit'iation, Elj niolog.i - and Signification, including much Collateral Information of a Descriptive and Knc.vclopjctlic Character. PREPARED ON THE BASIS OF "THOMAS'S COMPLETE MEDICAL DICTIONARY." By RYLAND W. GREENE, B.A., WITH THE EDITORIAL COLLABORATION OF JOHN ASHHTJRST, JR., M.D., LL.D., Barton Professor of Surgery and Professor of Clinical Surgery in the University of Pennsylvania; GEORGE A. PIERSOL, M.D., SURGEON GENERAL'S OFFICE LIBRARY. 4NNBX Section,. jvo. iM&Mj, reliable. The latest terms are given, so that we may truthfully say that it is the most complete dictionary issued up to date. It certainly deserves a large sale, and will meet with it, if superior ex- cellence is any criterion. The publishers are cer- tainly to be congratulated on the issuance of this really meritorious work."—»SV. Louis Medical and Surgical Journal. J. B. LIPPINCOTTT COMPANY, Publishers, PHILADELPHIA. VADE MECUM OF OPHTHALMOLOGICAI THERAPEUTICS BY DR. LANDOLT and DR. GYGAX PHILADELPHIA J. B. LIPPINCOTT COMPANY 1898 LIBRARY EON GENERAL'S OFFICf JLC-21-1897 /Si % Copyright, 1897, by J. B. Lippincott Company. INTRODUCTORY. Our object in publishing this little work is to put into the hands of the profession a vade mecum containing in a concise form the indispensable facts of special therapeutics. This work is not a treatise of ophthalmologic^ therapy, nor is it a dictionary, either of which would have made up a volume far larger than the small, easily portable guide, which we desired to produce. It is our aim to give a constant companion, a true friend to the busy practitioner and to the student preparing for examination. To facilitate the handli ng of our vade mecum we have arranged the headings in alphabetical order, thus saving the reader the trouble of looking up the index. As the pharmaceutical part—the dosage of cer- tain remedies and the most appropriate form of administering them—escapes the mind more easily than the general therapy, we have taken particular pains with our formulas. It is clear that we could not enumerate all rem- iii INTRODUCTORY edies and formulas. We have limited ourselves to giving the most important, in order not to embar- rass by the amount of matter those hurriedly look- ing up a subject. Different type is used : for the general text ; for titles at the top of the page f for the title of each ar- ticle ; for formulas, and fdr fhe method of their use. Where method of application is not quoted under recipes it appears in the corresponding place of the text. We have purposely omitted in our little work those modern forms of treatment, the therapeutic value of which is not yet established. Nor did we describe tlie' different operative methods, which would require a- lengthy explana- tion or drawings or photographs/ Our guide would in this manner have become* miM too voluminous to accompany the busy practitioner. Our thanks are due to Professor Fournier, to whom we are indebted for the important chapter on the treatment of syphilis. Mr. C. F. Haussmann, of St. Gall, the eminent chemist and pharmacologist, has had the kindness to review the chemical and pharmaceutical part of our little work. Without his help we would have committed only too many of those chemical heresies so frequently met with in medical literature. iv INTRODUCTORY The translation of the vade mecum into the Eng- lish language has been made with the kind assist- ance of Dr. E. H. Key man, of Milwaukee. We wish to express our thanks for the interest he has taken in the subject, and particularly for the considerable part of his time devoted to the work in question. We must also not forget our publishers, who have acquitted themselves with as much good-will as success of their at no time easy task of giving this little volume the convenient form, which we hope will contribute to win for it a place, if not in the libraries, at least in the pockets of our col- leagues. v OPHTHALMOLOGICAL THERAPEUTICS. 1. ACCOMMODATION, PARALYSIS AND PARESIS OF THE. Search for and treat the systemic disease, cause of the paralysis [anaemia, disease of the brain or of the general nervous system, syphilis, diabetes, systemic poisoning]. Faradization : Positive pole upon the centre of the closed eye. Negative pole is passed along the orbital border, an even pressure being used. Myotics [Eserine (111) or pilocarpine (251 a)]. —Paralysis of the accommodation being, as a rule, of long duration, limit the use of myotics to the time of eye work, and use strictly but the dose necessary to get effect wanted. Should the patient not stand the drug well, or should drug show itself inefficacious, add to the accommodation by convex lenses, adapting the eye to the necessary distance. In cases of paralysis of diphtheritic origin: Strengthening food, open air, quinine (259), iron (164), hot baths.—Injections of strychnine (300 a). In rheumatic paralysis : Ergot (109), salicylate of sodium (275), ointment of veratrine (318), of strychnine (300 ft), or periocular massage. 1 ACCOMMODATION—ALCOHOL 2. ACCOMMODATION, SPASM OF THE. Mydriatics [Atropine (23 a) or scopolamine (284)].—Eest; smoked glasses. Where there is hypereesthesia of the retina, stay in darkened room. As soon as the spasm seems fully overcome, lessen the dose of the mydriatic ; work to be resumed gradually and carefully, beginning with convex lenses to entirely free the accommodation. Slowly the strength of these glasses can be diminished. Acetanilid. See Antifebrin (14). Achromatopsis. See Daltonism (94). 3. ^SORCIN. Same use as Fluorescin (117). A 10 to 20 per cent, solution will stain the corneal erosion red immediately upon instilling. The red stands out better than the green of fluorescin on the colored background of the iris and the black of the pupil. 4. ALBINISM. Smoked glasses. Where the nystagmus which frequently accompanies it is not very pronounced, stenopeic glasses. Albugo. See Leucoma of the Cornea (87). 5. ALCOHOL, ABSOLUTE (TEST FOR PURITY OF). Add a small crystal of sulphate of copper to the alcohol; pure alcohol will remain colorless. Alkali, volatile. See Ammonia (10). Aldehyde, formic. Sec Foumaltn (119). 2 ALUM—AMBLYOPIA 6. ALUM. a. Alum................. 2 50 38 gr. Rose water..............50 00 13^ Distilled water.............150 00 5| b. Pencil of alum, crystal of pure alum, for cauterizations of the conjunctiva. Amaurosis, cerebral. See Amblyopia and Cerebral Amaurosis. 7. AMBLYOPIA AND AMAUROSIS, CER- EBRAL. Treat the systemic disease [uraemia, typhoid fever, scarlatina, epilepsy, loss of blood, intense pain, hysteria.] In cases where the cause is unknown : Absolute rest, darkened room, injections of strychnine (300 a).—Suggestion. —Eye-douches (99). 8. AMBLYOPIA, CONGENITAL. —AM- BLYOPIA FROM LACK OF USE. Where there is congenital cataract : Operate. —Iridectomy in case of corneal opacities.—Correct strabismus. Methodical visual exercise of the amblyopic eye by itself several times daily five to ten minutes at a time. Correct astigmatism and aid accommoda- tion according to needs with convex lenses. Exercise eccentric vision. Where possible: Stereoscopic exercise to achieve binocular vision. 9. AMBLYOPIA, TOXIC. Treat according to cause. —Stop tobacco and alco- hol.—Milk diet.—Treat inflammation of stomach, AMMONIA — ANISOMETKOPIA digestive troubles, and insomnia (140). Carlsbad salts, tonics, hygienic diet.—Hydrotherapy (98j, Turkish baths. 10. AMMONIA. a. Ammonia............ 0 3* 0 8* 0 ^ ...........Vaa 10 0 2\t. Sulphuric ether or chloroform .... J I For insect-bites. b. Carbonate of ammonia—" vola-"I „|,n, 0U „ , V 0 50 to 2 0 8 err. to Iv. tile salt" ......... • I I s 2a As a draught. For instance : Carbonate of ammonia......'. . . 12 Distilled water..............250 Syrup of althaea.............50 Tablespoonful every half-hour, In case of poisoning. 11. AMYL NITRITE. Three to eight drops inhaled. Anaesthesia. See Chloroform Anaesthesia (42) and Ethyl Bromide (113). 12. ANISOMETROPIA. It is impossible to give absolute rules for the cor- rection of anisometropia. One patient will be comfortable, refraction of both eyes having been completely equalized ; another will stand only a partial correction ; still another will refuse all glasses capable of lessening the difference in re- fraction between his two eyes. Let yourself be led by the habit of the patient, and give preference to lenses that ease the effort at 4 ANKYLOBLEPHARON—ANTISEPSIS accommodation most if patient will not accept a full correction of his anisometropia. 13. ANKYLOBLEPHARON. Surgical treatment. Antidotes. See poisoning by Atropine (23), Morphine (231), Pilocarpine (251). 14. ANTIFEBRIN, ACETANILID. Antifebrin..........0125 to Oi 40 4 gr. to 7 gr. White sugar.........0J30 | 5 gr. One powder. Take 3 to 5 powders a day. 15. ANTIPYRIN. a. Antipyrin........0|50tol|0 7£ gr. to 15 gr. Powder every two hours. Not more than 5 to 6powders a day. b. Antipyrin...............10 00 2fe Muriate of cocaine............0 15 2\ gr. Distilled water.............10 00 2\^ For hypodermic injections : One Pravaz syringe contains 0 \ 50 (7 1-2 gr ) antipyrin. 16. ANTISEPSIS AND ASEPSIS. a. Ope rating-room is aired and cleaned with greatest care. b. Patient takes a complete bath on the evening before the operation. The whole head is washed with particular care. For cataract operation: Cut off lashes and eyebrows and brush the palpebral margin with sublimate solution 1 : 2000, or with biniodide of mercury (4 parts to 1000 parts of sterilized olive oil).—During the night, antiseptic dressing (101) of the eye to be operated. On day ANTISEPSIS—ASEPSIS of operation, early, purgative; for instance, suffi cient quantity Hunyadi Janos water (2 to 4 wine- glasses). After movement: Opium (242 <■), in order to prevent stools for several days.—An hour before soap, and sublimate solution 1 :1000. Clean with operation the ocular region is cleansed with brush, the greatest care all the folds of the conjunctival sac with 1 : 5000 sublimate solution ; thereupon aseptic dressing (sterilized cotton and bandage), which patient will wear up to the moment of operation.—During operation the field is washed when necessary with a physiological salt solution (6 to 7 : 1000) which has been previously boiled. c. To disinfect the hands of operator and assistants: Wash with (1) Hot water, brush, potassium soap. (2) Alcohol. (3) Sublimate 1 : 500 ; dry with ster- ilized towel, or wear sterilized cotton gloves, which have to be removed when instruments are picked up. d. Instruments are boiled in a physiological salt solution ; they are not to be put into the solution before it has reached boiling point.—Less reliable proceeding : Instruments remain for 30 to 40 min- utes in carbolic acid solution 5 : 100 ; oxycyanide of mercury 1 : 100, or solution of formaldehyde 1 : 500. Just before operation instruments are placed in sterilized water.—Keep disinfected needles in absolute alcohol (5). e. Collyna are sterilized by boiling before each operation. /. All materials for dressings < cotton, bandages, gauze, etc.) are subjected to the action of over- 6 AQU.E AROMATIC^— ARNICA heated steam (110° to 120° Centigrade) in a steril- izer during 30 minutes. Antisyphilitic Treatment. See Specific Treatment (291). Aphakia. See under the heading of Hyperme- tropia (137). 17. AQUJE AROMATIC^. \_Do not confound with aromatic s})irits.~\ Rose water, lavender water, fennel water, cherry-laurel water, aniseed water, balm mint water, thyme water. In the treatment of conjunctivitis one can add these waters indiscriminately to the different col- lyria in the proportion of one-fifth. In case of pain or itching, cherry-laurel water is to be preferred. 18. ARISTOL. a. As a powder. b. Aristol...........3|0tol0|0 45 gr. to 21^ Vaseline.........30|0 I 1% Burns (of the lids); cover with gutta-percha. c. Aristol................ 3 Olive oil................20 Lanolin................100 Burns. 19. ARNICA. a. Pure tincture of arnica. Rub into diseased parts. b. Tincture of arnica.............20|0 5^ Distilled water..............150|0 5J As compresses. 0 45 gr. 0 &3 0 n 23 ARSENIC—ASTIGMATISM 20. ARSENIC. a. Fowler's Solution. (1 part arsenic acid, 1 part pure car- bonate of potassium to 100 parts solution.) Begin with 2 drops a day, gradually increase to 14, and decrease the dose again to 2 drops before ceasing. b. Arsenate of sodium............0 003 ^ gr. Extract of gentian............0 10 1J gr. Powder of gentian q. s. To make 1 pill; 3 pills a day. Asepsis. See Antisepsis and Asepsis (16). 21. ASTHENOPIA, ACCOMMODATIVE. Correct hypermetropia and astigmatism. Stop overwork and sexual excesses. Gymnastics. So- journ in the country. Strengthening food, tonics. Hydrotherapy (98). Faradization. Compare also Paresis of Accommodation (1). For muscular asthe- nopia, see Insufficiency of Convergence (142). 22. ASTIGMATISM. a. Regular Astigmatism: After examination with ophthalmoscope or by skiascopy and with keratometer and repeated tests with glasses [if need be under atropine], correct the whole astig- matism with the corresponding cylindrical glass, adding, where necessary, a spherical lens accord- ing to rules mentioned. See Myopia (234) and Hypermetropia (137). b. Irregular Astigmatism : Correct as much as possible by spherical and cylindrical lenses that part of the ametropia which can be corrected, Stenopaeic glasses. 8 atropine Atrophy of the Eyeball. See Phthisis of the Eyeball (250). Atrophy of the Optic Nerve. See Optic Nerve (243). 23. ATROPINE. a. Neutral sulphate of atropine.......0|05 | gr. Distilled water.............10|00 2Jj Instil several times daily; 1 drop each time. b Neutral sulphate of atropine........0 03 \ gr. Muriate of cocaine............0 20 3 gr. Distilled water..............5 00 IJ3 Instil several times a day. c. Neutral sulphate of atropine . . . ."!-. n m -- 11 r \ > aa 0 lOaaljgr. Neutral sulphate of duboisine . ... J Muriate of cocaine........... 0 50 8 gr. Distilled water............ 1500 45 Instil several tunes a day. d. Neutral sulphate of atropine . 0|03 to 0110 £ gr. to 1£ gr. AVhite vaseline.......15|00 I 4sj Put into conjunctival sac. To get the greatest possible effect: Introduce the pure salt into the conjunctival sac. taking care to close the lachrymal ducts by pressure. As a rule, let patient keep eyes closed for 5 minutes after having instilled the mydriatic. In case of poisoning by Atropine: a. Absorption per os. Stomach-pump or hypodermic injections of a solution of hydrochlorate of apomorphine 2 : 1000 up to 30 centigrammes (5 grains). b. Absorption through the tissues (injections). Hypodermic injections of a solution of hydro- 9 BALSAMUM TRANQUILLANS—BATHS chlorate of pilocarpine 5 : 100, repeated as often as necessary up to 60 centigrammes. In both cases internally : Brandy, strong coffee, carbonate of ammonia (10 b). 24. BALSAMUM TRANQUILLANS. Oleum Hyoscyami Compositum. Rub into skin of forehead and temples or on painful parts. Cover with cotton or oiled silk to prevent grease spots. Basedow's Disease. See Exophthalmic Goitre (129 A). 25. BATHS, MEDICINAL. A bath should be from 200 to 300 quarts for an adult; less for children. There should be an interval of at least 3 hours after a meal before taking a bath. Temperature of bath : Cold bath.........10-22 Centigrade. (50- 71 F.) Tepid bath........23-32 " (73- 89 F.) Hot bath.........33-40 " (91-104 F.) a. Bran bath : Add to the bath a decoction of 2-4 pounds of wheat bran. b. Jfflftbath: Pour 6 pounds of boiled malt through a sieve and add slowly to bath. c. Salt bath: Chloride of sodium, 8 pounds. 10 BATHS d. Sea Salt bath : Sea salt................. Chloride of magnesium..........I aa 4 pounds. Sulphate of sodium............J Chloride of lime...... ....... 6 pounds. c. Ferruginous bath : e''. Sulphate of iron.........."| .. rn,n , _ _ „,.,.. >aa 50 0 12 5z Terra sihcica............i a ° Mi.r and dilute in water. e"'. Iron and potassium tartrate erra silicic; As before. ■ ■ ■ ■ Ual00|0 3} 5 Terra sihcica............/ ' 4 ° 0 63 0 13 53 0 m f. Iodine bath : Iodine..................10 0 2\% Iodide of.potassium............20 0 5^ Distilled water............. 250 0 85, Dissolve before adding to bath. Wooden bath-tub. g. Sublimate bath : Bichloride of mercury...........25 Chloride of sodium............50 Distilled water..............200 Dissolve before adding to bath. Wooden bath-tub. For the new-born reduce the close of sublimate to 0150; in- crease it to 1, 2, 3 grammes, etc., for older children. Medicinal Foot-baths. See Foot-baths (118). Belladonna. See Atropine (23) and Poul- tices (255). Biborate of Soda. See Borax (29). Blennorrhcea. See Blennorrhceal Conjunc- tivitis (69). 11 BLEPHARITIS 26. BLEPHARITIS, CILIARY, SQUA- MOUS.—INFLAMMATION OF CIL- IARY MARGIN OF LID. Minute cleanliness. Wash with soap and hot water. Pluck out diseased lashes (black roots).—Clean every morning from scales and pellicles with an ointment and a piece of soft linen [cold or tepid potato-starch poultices (255«)]. Do not let the salve remain on lids too long; wipe off with care. Never apply ointment just before retiring at night. Pay attention at the same time to any existing conjunctivitis. Watch the normal flow of tears through the natural passages, but avoid slitting the lachrymal ducts unnecessarily. In case of scrofula and ancemia : Systemic treat- ment. Cod-liver oil (54), iron (164), sea bathing with certain restrictions (a well-protected beach without fine sand). Mornings apply on the margin of the lids one of the following ointments, and let it remain there for one hour: Yellow oxide of mercury (229 a), red oxide of mercury (229 c), iodoform (148), oxide of zinc (325 b), or, according to the case : Salicylic acid...............] Oxide of zinc ..............10 Powdered starch..............15 Vaseline..................20 0 aa lg 0 15 gr. 12 15 gr. 0 43 0 5z Simple lead plaster..........) nn t • a -i V aa 30 Linseed oil............i Balsam of Peru..............1 BLEPHARITIS > aa 0|15aa2£gr. lied precipitate of mercury .... Camphor............ White vaseline ..............2!00 Lanolin..................II00 Flowers of sulphur.............3 0 Hydrochlorate of ammonia.........10 Rose water.................50 0 Spirits of camphor.............10|0 15 gr. 45 gr. 15 gr. 1^3 2*3 Camphor.................0 Precipitated sulphur............1 Lime water............."» aa 10 10 1J gr. 00 15 gr. 00 aa 2£3 20 3 gr. Rose water........... Gum arabic................0 For unyielding cases, apply this ointment exceptionally every evening to the border of the closed lids and let it remain until morning. White precipitate of mercury........0 Neutral acetate of lead...........0 Oil of sweet almond............0 Vaseline.................5 03 £gr 10 Ugr- 50 8 gtt 00 1*3 0 15 gr. 0 45 gr. m Red lead oxide...............1 Neutral acetate of lead...........3 Lard.........'..........45 0 or : White wax............") .. 0„|A .. _ „., „ , V aa 20 0 aa 5z Oil 01 sweet almond........> \ Oil of roses..............3 drops. 3 gtt. Against itching: Inunction, repeated several times a day, with resorcin ointment (260 a), or carbolic acid ointment (249 a), or brushing with : Neutral acetate of lead............0 Hydrochlorate of cocaine . ..........0 White vaseline...............3 13 10 Ugr 15 2*gr. 00 45 gr BLEPHARITIS Blepharitis, Simple. See Ciliary Blephari- tis (26). 27. BLEPHARITIS, ULCEROUS. In the beginning always try the treatment of simple blepharitis (26). If there is no improvement: Compresses, with carbolic acid solution (1 :100) to detach the crusts. Applications with a thin, pointed pencil of pure nitrate of silver, or with the mitigated pencil (287 b, d), or with a camel's-hair brush dipped in a 2 per cent, nitrate of silver solution. Wash the ciliary border of lids with glycerin soap, and make careful applications of 75 per cent, acetic acid to the ulcers; thereupon abundant bathing with hot water. Careful applications with oil of juniper (166 b), pure or with the addition of alcohol. Where ulcers are torpid : Stimulate with tincture of iodine or with : Crystallized acetate of zinc.........0 Glycerin.................. 5 Cherry-laurel water....... •......20 In unyielding cases: Brush ulcers with a subli- mated glycerin solution 1 : 30. Repeat every other day. Patient brushes border of lids himself with a solu- tion of sublimate in glycerin 1 : 100, taking care that the solution does not get into the conjunctival sac. After the application: Calomel ointment (33 b) or: Vaseline..............."I . Lanolin...............J 40 6gr. 00 U3 00 53 0 1*3 14 BLEPHAROPHIMOSIS—BORIC ACID Should none of these treatments lead to a cure: Cauterization with the galvano-cautery, or: Re- moval of the ulcerous part of the ciliary border. 28. BLEPHAROPHIMOSIS. Canthoplasty. Blepharospasm. See Spasm of the Orbicu- lar Muscle (289). Blue Stone, Blue Stick. See Copper, Sul- phate of (80 c). Borate of Soda. See Borax (29). 29. BORAX.—BORATE OF SODA.—BI- BORATE OF SODA. 0 to 115 15 gr. to 2:1 gr 0 1 = o 43 0 *3 Biborate of soda...... 1 Lavender water......30 Distilled water.......120 0 1553 b. Borate of cocaine............ 2 Lavender water............50 Distilled water.............150 0 5J 30. BORIC ACID. a. Boric acid..............2010 5£ Distilled water.............500| 0 1 pt. Calcined magnesia increases solubility of boric acid. b. Boric acid..............60 Calcined magnesia.......... 6 Distilled water ... .........500 Boric acid solution, 12 per cent, (will not crystallize in the cold). c. Boric acid, finely pulverized.......25|0 63 In a large box; bring to each consultation for massage of the conjunctiva. 15 0 2.1 0 1*3 0 1 pt BROMIDES 0 2*3 0 n 0 43 d. Boric acid................0125 4 gr. White vaseline..............5100 \\z Bran. See Medicinal Baths (25) and Poul- tices (255). 31. BROMIDES. a. Bromide of potassium..........10 Syrup of bitter orange-peel.......30 Distilled water.............120 Tablespoonfid 2 to 4 times a day. The bromide of potassium can be replaced by a little larger dose of bromide of sodium or a some- what smaller dose of bromide of ammonium, or it can be combined with the two mentioned salts of bromine: b. Bromide of potassium.......... 3 Bromide of sodium........... 4 Bromide of ammonium......... 2 Distilled cherry-laurel water.......15 Simple syrup..............25 Distilled water.............110 Tablespoonful 2 to 3 times daily. (One tablespoonfid con- tains 1\0 of the combined bromine salts.) Where the patient does not stand the bromine well or where prolonged use is necessary, give after each dose a glass of carbonated water, or replace the above prescription by the following : Bromide of potassium........... 1 Bromide of sodium............ 2 Bromide of ammonium.......... 1 Carbonated water............1000 1 wineglassful 2 to 3 times a day. Avoid calomel applications while patient takes bromides internally! 16 50 55 gr. 50 70 gr 00 30 gr 00 4.3 00 6*3 00 3? 57 50 24 gr. 00 30 gr. 00 15 gr. 00 2pts. BUPHTHALMOS—CATARACT Bromine. See Bromides (31). Burns. See Conjunctiva (57) and Lids (192). 32. BUPHTHALMOS. Try: Myotics, sclerotomy.—Befrain from iridec- tomy.—When troublesome : Enucleation. Calcareous Infarcts and Concretions. See Conjunctiva (61) and Cornea (82). 33. CALOMEL. — MERCUROUS CHLO- RIDE.—MILD CHLORIDE OF MER- CURY. a. Calomel (by vaporization)........00150 7J gr. White vaseline.............lo|oO 2%$ In trod nee into conjunctival sac and make a massage of the cornea through the lid. b. Calomel (by vaporization)........110 15 gr. White vaseline.............10|0 2\% Apply to border of lids. c. Calomel (by vaporization).........610 1$% In wide-mouthed bottle. Throw on conjunctiva and cor- nea with, camels-hair brush ; massage during one minute, wash with boric acid solution after 15 minutes to remove powder. Once or twice daily. d. Internally as a diuretic.....0[05 to 011 1 gr. to 2 gr. A powder. Avoid applying calomel while patient takes iodine or bro- mine internally! Carbolic Acid. See Phenol (249). Castor Oil. See Oleum Ricini (274). 34. CATARACT. Surgical treatment [see Antisepsis and Asepsis (16)].—Where not completely ripe or in case of 2 17 CHALAZION—CHERRY-LAUREL WATER zonular or punctated cataract, try to better vision by the use of mydriatics (233) ; instil scopolamin (284) in preference, as it can be used a long time without danger. 35. CHALAZION. Always operate from the conjunctival side. Squeeze out the chalazion or excise on the finger-nail, using pressure of the fingers. [Desmarres' forceps is troublesome, painful, and not necessary.] Cavity should be scraped out with sharp spoon even where simple squeezing seems sufficient. 36. CHARCOAL, POWDERED. Is added to irritating salves. The best is the char- coal prepared from the poplar-tree, as it releases the salts added to the ointment but slowly. It is sufficient to add 1 part of charcoal to 100 parts of the salve. Preparation: Pound the charcoal in an iron mor- tar and pass through a silk sieve after having heated it to red heat during several minutes. 37. CHEMOSIS. — SUBCONJUNCTIVAL (EDEMA. Etiological treatment.—Ice-cold compresses.— Canthotomy.—Scarifications. 38. CHERRY-LAUREL WATER. Is added to different collyria, particularly where there is pain and itching. 18 ( IILORAL HYDRATE—CHLOROFORM 39. CHLORAL HYDRATE. a. As a sedafit-e......0|10to0|50 1^ gr. to 8 gr. b. As a narcotic......2100 to 3100 30 gr. to 45 gr. 75 gr. 13 25 120 23 0 aa 1^3 c. Chloral hydrate...........5 Syrup of orange peel.........30 Distilled water............60 1 to 2 tablespoonfuls before going to bed. To heighten the narcotic effect: d. Chloral hydrate..........1 Bromide of sodium.........|aa Syrup of codeine.........^ Cherry-laurel water......../ aa Distilled water........... 1 to 2 tablespoonfuls before retiring. Hypodermic injection : e Chloral hydrate.......... Muriate of morphine....... Distilled water.............10 1 syringeful contains 0102 (J gr.) of chloral hydrate and 0\01 (k gr.) of morphine. aa 63 43 3 gr. l*gr. 2*3 40. CHLORATE OF POTASSIUM. Chlorate of potassium........... 10|0 2\^ Distilled water........•.....300[0 10| Mouth toash; also brush teeth with solution during mercurial treatment. 41. CHLOROFORM. a. Chloroform...............40 0 1.? 2\^ White wax..............10 0 2\% Lard................90 0 3g Inunctions against superficial extra-ocular pains. b. Chloroform...........20|0to30|0 53 to 1| Olive oil................40|0 l'| 2\% Inunctions. 19 CHLOROFORM ANAESTHESIA 42. CHLOROFORM ANESTHESIA. Pure chloroform poured on a sheet of white paper will produce the same sweet odor until totally evap- orated, and leaves the paper absolutely dry, white, and odorless. 20 minutes before narcosis: Injection of 1 or 1* syringefuls of: Muriate of morphine............00120 3 gr. Neutral sulphate of atropine........00 02 J gr. Distilled water............. 2oloO 5^ 1 syringeful contains 0\01 (^ gr.) of morphine and 0\001 (zU 9r-) o-iropine. 5 minutes before narcosis: Apply a 5 per cent. cocaine solution to the mucous membrane of nose and pharynx. For very anaemic individuals add several drops of amyl nitrate to the chloroform. [10 drops to 5010 (1| bxj) of chloroform.] For patients with heart trouble, where narcosis is indispensable, replace chloroform by ether; give large doses of digitalis (96) several days before the operation, and let an injection of 0|001 (-^ gr.) 0f strophanthin take the place of the morphine and atropine injection. After narcosis cover face of patient for about 3 hours with a compress soaked in vinegar; renew it frequently. Choroid, Detachment of the. See Detach- ment OF THE Eetina (265). Choroid, Hemorrhage of the. See Hemor- rhage of the Eetina (266). 20 CHOROID—CHOROIDITIS 13. CHOROID, LESION OF THE. Minute antisepsis ; rest; ice.—Eemove foreign bodies where indicated by means of the electro- magnet forceps, hook, or by aspiration. Compare also Penetrating Wounds of the Sclera (282). 44. CHOROID, RUPTURE OF THE. In fresh cases absolute rest.—Antiphlogistic measures. 45. CHOROID, TUBERCULI OF THE. Enucleation in case diagnosis is absolutely posi- tive. 4(5. CHOROID, TUMORS OF THE. Tumors of the choroid are all malignant. Enu- cleation or exenteration of the orbit, according to extent of the tumor. 47. CHOROIDITIS, Plastic, Exudative, Dis- seminate, Areolar.—CHORIO- RETINI- TIS. —SCLERO-CHOROIDITIS. In the acute stage: Leeches (186) to the temple and to the mastoid process, or Heurteloup's artifi- cial leech (3010 to 6010 [1.5 to 23] of blood), or dry leeches, according to the patient's strength.—Abso- lute rest and darkness for 36 hours after blood- letting.—Derivation to skin and digestive tract.— Poultices (255) ; repeated hot compresses.—Mydri- a( ics (233) as long as patient remains in darkened room ; later, smoked glasses. 21 CHOROIDITIS—CILIARY BODY Methodical sweating (305) ; medicinal foot-baths (118).—Massage of the eyeball.—Eepeated para- centesis of the anterior chamber. When patient is ancemic: Strengthening diet. In case of syphilis: Specific treatment (291). 48. CHOROIDITIS, Suppurative, Metastatic, Purulent. In the beginning: Compresses with iced water ; mydriatics (233) ; antiphlogosis. Where suppuration has begun : Hot compresses or poultices (255). Narcotics, and where the pain is great: Hypodermic injections of morphine (231 c) at temples. No indigestible food.—Extraction of the swollen or dislocated lens.—Lengthy incision of the cornea or sclera to give vent to pus.—Exenteration (after- wards disinfection with sublimate solution 1 :1000). Enucleation during remission of pain. When suppurative choroiditis runs its course ivithout acute inflammatory symptoms, as in young children, special treatment is not required. Simple hygienic rules generally suffice to hinder the sup- puration from invading the whole eyeball. 49. CILIARY BODY, FOREIGN BODY OF THE. Where extraction is impossible : Antiseptic (101) and antiphlogistic dressing and treatment. Should inflammation and symptoms of irritation of uveal tract increase : Enucleation or evisceration of the globe of the eye. 22 CILIARY BODY—CODEINE 50. CILIARY BODY, MELANOSARCOMA OF THE. Enucleation. 51. CITRIC ACID. Citric acid................1010 2\^ Distilled water..............150|0 5| 52. COCAINE. a. Muriate of cocaine...........00120 3 gr. Distilled water.............10| 00 2\% Instillations. b. Muriate of cocaine...........00120 3 gr. White vaseline.............10|00 2J^ Introduce into conjunctival sac. Hypodermic injections of cocaine may be used in lid operations, tenotomy, even in advancement of the muscles and enucleation. c. Muriate of cocaine...........001 40 6^ gr. Distilled water.............20| 00 5^ 2 per cent, cocaine solution; 1 syringeful contains 0102 (i 9r-) °f cocaine. d. Muriate of cocaine...........0180 12 gr. Distilled water.............20|00 5^ 4 per cent, cocaine solution; 1 syringeful contains 0\04 (§ 9r-) °f cocaine. 0\05 (^ gr.) of cocaine =. maximal dose for injections in the periocular tissues. 53. CODEINE. Phosphate of codeine......0|01to0 Subnitrate of bismuth ..... \ aa 0 Sugar of milk......... > 1 powder every 3 hours. 23 2 I gr. to 3 gr. 50 aa 8 gr. COD-LIVER OIL 54. COD-LIVER OIL. In spoonfuls, large or small, according to age. Where there is fever and gastric trouble, cod-liver oil is not indicated. The light-yellow oil is the best, extracted by an almost cold process, heat not having altered the active principles of the livers (iodine, chlorine, bromine, etc.), which are very volatile.—The light- brown oil is less active than the light-yellow, but is preferable to the dark-brown oil. Should stomach revolt: Take often in small quan- tities, as: a. Light-yellow cod-liver oil.........1|0 15 gr. In capsules—up to 15 daily. For children, use can be made of the aromatized cod-liver oil. b. Cod-liver oil.............500|0 1 pt. Oil of cinnamon...........15 drops 15 gtt. For scrofula : Combine the cod-liver oil with ex tract of malt and iodide of iron. c. Extract of malt............1000 Cod-liver oil............500 Gum arabic............100 Powdered tragacanth......... 5 Glycerin............... 50 Vanillin............... 00 Iodide of iron............ 15 1 to 2 teaspoonfuls a day. 24 00 2 pts. 00 lpt. 00 3^3 00 U3 00 1.? 53 50 8gr. 00 4.3 COLLYRIUM—CONJUNCTIVA 55. COLLYRIUM, YELLOW ASTRIN- GENT. Chlorate of ammonium..........00 50 8 gr. Sulphate of zinc ............ 1 25 19 gr. Distilled water..............200 00 6£g Camphor................00 40 6 gr. 70 per cent, alcohol............20 00 5^ Crocus.................00 10 1J gr. Macerate 24 hour s and filter. Compresses of Subacetate of Lead. See Lead (185 c). 56. CONIUM. Powdered conium leaves..........2010 53 Lard...................50|0 13 53 Heat on v:ater-bath for at least half an hour; rub on skin of forehead and temples; acute pains of iritis. See also Poultices (255 e, /). 57. CONJUNCTIVA, BURNS OF THE. Quick elimination of the caustic agents. In case of burns with chemicals, wash with a. Oil or milk (quicklime). ( b. Acidulated water (caustic bases). Teaspoonful of vinegar to a glass of water. c. Lime water, or bicarbonate of sodium or of potassium (acids). Teaspoon ful. in a glass of water. Remove scabs. Apply lukewarm 3 per cent, boric acid compresses. To avoid formation of adhesions: Instil 2 to 4 drops of sterilized oil into the conjunctival sac until com- plete; cure is effected, and pass a probe between the 25 CONJUNCTIVA lids and the globe of the eye every day.—Later: Calomel ointment (33 a) or boric acid ointment (30 d). 58. CONJUNCTIVA, CYSTICERCUS OF THE. Extraction after incision of the mucous mem- brane covering the parasite. 59. CONJUNCTIVA, HEMORRHAGE OF THE. —SUBCONJUNCTIVAL EC- CHYMOSIS. Compression.—Compresses with subacetate of lead solution. Avoid straining, coughing, vomiting, etc. In old people, inform family of a possible cere- bral apoplexy. 60. CONJUNCTIVA, HYPEREMIA OF THE. Treat as chronic conjunctivitis (70). 61. CONJUNCTIVA, LITHIASIS OF THE. —CALCAREOUS INFARCTION OF MEIBOM'S GLANDS. Incision of the mucous membrane following the course of the gland; remove the concretions with a small curette or knife. 62. CONJUNCTIVA, LUPUS OF THE. General tonic treatment [iron (164), arsenic (20)]. Applications of tincture of iodine with a camel's- 26 CONJUNCTIVA hair brush or small pledget of cotton.—Excision of diseased parts. Scrape with sharp spoon.— Thermo-cautery. 63. CONJUNCTIVA, TRAUMATISM OF THE. Eemove foreign bodies.—Sew very carefully.— Antiseptic bandage (101) to be worn several days. 64. CONJUNCTIVA, TUBERCULOSIS OF THE. According to extent: Excision or cauterization. Symptomatic treatment. 65. CONJUNCTIVA, BENIGNANT TU- MORS OF THE. [Fibromata, Lipomata, Cysts, Dermoid Tu- mors, Erectile Tumors.] Excision ; sew, having care to sacrifice the mu- cous membrane only as far as is strictly necessary. 66. CONJUNCTIVA, MALIGNANT TU- MORS OF THE. [Epithelioma, Sarcoma, Lepra.] Where tumor is not too large and where conjunc- tiva alone is involved : Eemove it. As a rule, a plastic operation will be necessary to avoid sym- blepharon. Where the eyeball is involved, enucleation or exenteration may be indicated. 27 CONJUNCTIVA—CONJUNCTIVITIS 67. CONJUNCTIVA, XEROSIS OF THE. Better the state of the general health. Wash frequently with biborate of soda (29). Instil milk or fresh oil. 68. CONJUNCTIVITIS. General rules: Use lukeicarm collyria. Do not content yourself with simple instillations, but turn the lids and brush them.—Between treatments pa- tient is told to wash out and bathe his eyes, using absorbent cotton and an eye-cup.—Dry eyes after applications, and avoid going out immediately after- wards. One can add to the collyria diverse aqueous (never alcoholic) aromatic solutions. Cherry- laurel water seems to be slightly soothing. 69. CONJUNCTIVITIS, BLENNOR- RHCEAL.—OPHTHALMIA OF THE NEW-BORN. Prophylaxis: Where we find a suspicious white flow : Antiseptic vaginal injections before confine- ment.—In all children (mother having white flow), without exception, immediately after birth and be- fore bath : Abundant washing of the lids and the surroundings of the eye with a 1: 2000 sublimate solution and instillation of one drop of a nitrate of silver solution (2 per cent.). Where one eye alone is infected protect the other by a watch-glass hermetically laid on, or, better, by an antiseptic dressing, covered by a layer of collo- 28 CONJUNCTIVITIS dion adhering to the skin.—Tie the hands of the new-born. Inform the mother, nurses, and all persons that come near the child of the danger of contagion.— Have the linen of the child carefully laid aside, as well as all dressings. Burn cotton used for wash- ing the eyes. Wash your hands after each dress- ing with soap, brush, and sublimate 1 :1000. As long as the swelling lasts: Iced sublimate com- presses (1 : 5000) ; remove every trace of pus care- fully and regularly. To avoid borders of lids get- ting glued together, put between them a little vaseline ointment, with peroxide of hydrogen (135 6), or some of the following ointment: White wax................ 3 0 45 gr. Spermaceti................ 2 0 30 gr. Oil of sweet almond............15 0 4^ If necessary: Scarifications, followed by ener- getic sublimate washes (1 : 500).—Blepharorrha- phy.—Leeches (186) at the external angle of the eye and at the root of the nose.—Where the swell- ing is very tenacious: Continual irrigation with permanganate of potassium (1 : 2000).—Wash the everted lids twice a day abundantly with a solution of «-naphtol (0.4 : 1000). As soon as swelling and false membranes have disap- peared: Cauterize with formaldehyde (1:500 to 1 : 300) or with nitrate of silver (2 :100). Eepeat daily. [Before using nitrate of silver or formalde- hyde solution, clean the whole conjunctival surface very carefully with sublimate (1:5000), or, better, with an alumnol solution (4:100), which forms 29 CONJUNCTIVITIS with the pus a white precipitate that is very easily removed.]—Linear cauterization of the conjunct ival sac with the mitigated pencil (287 b, d). immedi- ately afterwards neutralize with a salt solution. Do not cauterize again before the scab has fallen off.— Large granulations should be removed with scissors or cauterized with the unmitigated pencil (287 6). In unyielding cases: Eeplace the nitrate of silver by pure perchloride of hydrogen, or by the iodide of silver in statu nascendi, which is obtained by in- stilling two drops of the following solution : I. Iodide of potassium...........2 30 35 gr. Distilled water.............3 50 53 gr. Pure glycerin.............6 50 100 gr and immediately afterwards two drops of the fol- lowing solution : II. Crystallized nitrate of silver.......3 Distilled water.............3 Pure glycerin..............6 50 53 gr. 50 53 gr. 50 100 gr. or try : Daily energetic massage of the whole con- junctiva with calomel. Should there be any complication from the cornea: Avoid extra- as well as intra-ocular pressure: Eserine (111) or pilocarpine (251 a). [Atropine (23) only in case of central ulcer.] Besides these therapeutic means, which the physi- cian uses himself, continual care should be given to the child by nurses remaining with it day and night. The nurse will wash the eyes whenever there is the slightest trace of secretion. [Washes with sub- limate (1:10,000), or salicylate of mercury (1:5000), or hydrochinone (2 :100).] 30 CONJUNCTIVITIS All suppuration having ceased, physician uses boric acid (4:100), or a 1:200 solution of ammoniated sulphichthyol.—At home an astringent collyrium is used.—Strengthening diet. Act lightly on stools.—Pure air.—High pillow. 70. CONJUNCTIVITIS, CHRONIC- CHRONIC CATARRH OF THE CONJUNCTIVA. Keep bowels loose.—Pure fresh air.—Exercise. —Footbaths (118).—Change of climate.—Cold (98 «) or Scotch douches (98 6). Avoid: Constipation, liquor, coffee, strong wine, heavy meals, smoke and dust, tiring of eyes, late hours, insomnia (140), but also sleeping too long. Protection from dust, wind, and strong light by : Coquille lenses, blue or smoked, or veil. Prohibit caustics and irritating collyria. Brush or douche with any of the following solutions : Borate of soda (29), boric acid (30 a), yellow astringent collyrium (55), sulphate of zinc (325 a), sulphate of copper (80 a) [for physician to use], tannic acid (310 a), or with : Salicylic acid.............. 3 0 45 gr. Biborate of sodium........... 10 15 gr. Distilled water.............500 0 1 pt. or: Sulphate of copper. . . | .. tQ Q Crystallized alum ... J Distilled water....... 12 Tincture of opium...... 0 Glycerin.......... 2 31 04 I gr. to f gr. 00 33 20 3 gr. 00 30 gr. CONJUNCTIVITIS Eye-douches (99) with thymol (1: 2000) or benzo- ate of sodium (3 :100). For itching: Instillations of cocaine (£ per cent.) and frequent eye-douches with cherry-laurel water. In case of beginning excoriations: oxide of zinc (325 b) or white precipitate (229 d) ointment. To obviate an ectropium: Patient should dry lids. wiping from below upward. Pull out diseased lashes. Squeeze out Meibo- mian glands. See that lachrymal ducts are per- meable. Nasal douches (100) or more energetic treatment of coexisting rhinitis (273). Should the conjunctivitis resist all above means of treatment: Eepeated abrasions of the epithelial layer of the palpebral conjunctiva with a Des- marres scarificator or any convex scalpel. 71. CONJUNCTIVITIS, CROUPOUS.— PSEUDO-MEMBRANOUS CON- JUNCTIVITIS. Bacteriologic examinations of the false membranes. For ordinary cases: No caustics. Alternating hot and cold compresses moistened with boric acid (3 :100), carbolic acid (3 :1000), or permanganate of potassium (1: 4000). Eye-douches with benzo- ate of sodium (2 to 4 :100). In tenacious cases: Eemove false membranes and touch up conjunctiva with sublimate (1:300) or with nitrate of silver (2 :100). At the same time vaporize lime water near bed of patient. 32 CONJUNCTIVITIS In severe forms with fibrinous exudation: Local treatment of true diphtheritic conjunctivitis (72). 72. CONJUNCTIVITIS, TRUE DIPHTHE- RITIC. Vigorous prophylaxis. Take all children out of patient's room.—Avoid contact of diphtheritic membranes with mucous membranes. Antitoxin injection.-— Strengthening food. Ton- ics.—Where necessary, light purgative.—Inter- nally, chloride of iron, 6 drops daily, in milk, or: Benzoate of sodium........... 1010 2\^ Syrup of turpentine...........39010 12lJ Tablespoonfid every three hours. Where one eye alone is attacked: Protect the other [see blennorrhceal conjunctivitis (69)]. Never cauterize in stage of fibrinous infiltration. Where we find considerable swelling and sharp pains : Energetic antiphlogistic treatment [leeches (186) at root of nose and external angle of eye.] No scarification of the conjunctiva ! [Hardly any blood would flow and the deep tissue would be ex- posed to the danger of diphtheritic infiltration.]— Carefully apply iced congresses [circulation being poor there is always danger of necrosis setting in]. As soon as the swelling subsides: Eeplace ice by hot compresses to loosen the fibrinous exudation and to hasten absorption. Moisten these compresses with a non-irritating disinfectant: Sublimate 1: 10,000, permanganate of potassium 1 :4000, ben- 3 33 CONJUNCTIVITIS zoate of sodium 2 :100. Clean eye frequently and carefully.—Vaporize lime water or the following solution near bed of patient: Recti lied oil of turpentine......1 -. ^ Tincture of eucalyptus........i Alcohol................ 300 Distilled water.............1000 Eub parts covered with false membranes twice daily with a solution of sublimate in glycerin (1:100) [wash afterwards with salt water], with lemon-juice, with boric acid (30 b), with a solution of chloral 1: 30 [remove one minute after applica- tion with hot water], or with trypsin 10 :100. Suppurative stage: Treatment analogous to that of blennorrhceal conjunctivitis (69).—Watch cor- neal complications (175, 176). Cicatricial stage: Do not use caustics, and ward off adhesions of the conjunctiva of the lids and the ball of the eye by inserting a probe between the eyeball and the lids daily, and instilling milk, glycerin, or oil into the conjunctival sac. 73. CONJUNCTIVITIS, FOLLICULAR. Systemic treatment.—Change of climate.—Diet analogous to that of simple conjunctivitis (78). Subacetate of lead (1 to 2 :100), boric acid (4 :100), nitrate of silver (1:100) [applied only by the phy- sician].—Alum pencil (6 b).—Massage with pulver- ized boric acid (30 c).—Smoked glasses.—Nasal douches (100). 34 0 aa 13 103 2 nts CONJUNCTIVITIS 74. CONJUNCTIVITIS, GONORRHOEAL, OF ADULTS. Treatment analogous to that of ophthalmia of the new-born (69;, but more vigorous. 75. CONJUNCTIVITIS, GRANULAR.— TRACHOMATOUS CONJUNCTIVI- TIS.—TRACHOMA. Bub conjunctiva in its full extent with small pledgets of cotton soaked in the following solu- tion : Bichloride of mercury........ 0 50 8 gr. Chloride of soda............ 7 00 l£45gr. Distilled water........ . . 1000 00 2 pts. Repeat rubbing once or twice a day. Massage of the conjunctiva with boric acid in im- palpable powder (30 c) or with powdered calomel (33 c). Afterwards wash with sublimate (1: 500). —Squeeze out granulations with roller forceps.— Scarifications parallel with border of lid.—Cauteriza- tions with sulphate of copper pencil (80 c) or with alum pencil (6 b).—Brush with a saturated solution of acetate of lead in glycerin.—Cauterize con- junctiva 3 to 4 times a day with chloride of zinc (1 to 2 : 100), not neutralizing afterwards.—Anoint the palpebral conjunctiva with the following gly- cerole : Sulphate of copper.............0 j 20 3 gr. Glycerin ointment.............5(00 75gr. Where the secretion is great: Cauterize with ni- trate of silver (2 : 100). 35 CONJUNCTIVITIS In unyielding cases, laceration of the mucous mem- brane with a metallic brush.—Eemove excrescences. Excision of the fold of transmission.—Cauterize re- peatedly with the galvano-cautery. [In the in- tervals : Massage with iodol vaseline 10 : 100.]— Electrolysis [30 m. a. until quite a little foam has formed ; previous to this, incisions into the palpe-" bral conjunctiva]. In desperate cases: Transplantation of conjunctiva or of mucous membrane of the oral cavity. Abundant washes at home with sublimate 1: 5000 or sulphate of copper (80 a). Vary the treatments, combine them, adapt to each special case. Have these two important rides in your mind always: I. Turn the upper lid well, using, when neces- sary, torsion forceps, and treat the upper conjunc- tival sac in its whole extent, the corners included, the internal and external angles being the princi- pal seat of the granulations. II. Never cause a loss of conjunctival or sub- conjunctival tissue. Limit yourself to achieve a modification of tissue. Treatment of trachomatous pannus: Direct massage of the cornea with boric acid finely pulverized (30 c) or with aristol.—Peritomy or careful gal- vano-cauterization of the limbus.—Eepeated abra sion of the epithelial layer of palpebral conjunctiva with a Desmarres scarificator or a lance with blunt point. —Where pannus does not yield : Try care- ful application of a maceration of old jequirity 36 CONJUNCTIVITIS seeds (165) three times a day until considerable secretion and swelling have been produced. Treatment of complications : Ulcers of the cornea (176) [do not scrape], complications from lachry- mal apparatus (91,180, 181), ectropion (103), or en- tropion (106), distichiasis (97), symblepharon (306). Systemic treatment: Change of air, country life. —Good nourishment.—Avoid congestions.—Ton- ics [iron (164), iodine (147 b), arsenic (20)].— Medicinal baths (25 c, d, e). Conjunctivitis, Phlyctenular. See Phlycten- ular Keratitis (173). 76. CONJUNCTIVITIS PRODUCED BY ATROPINE. Examine collyrium as to its being sterilized.— Where necessary replace atropine by duboisine (102) or scopolamin (284).—Eye-douche with non- irritating collyria [see simple conjunctivitis (78)]. 77. CONJUNCTIVITIS, PURULENT (not blennorrhceal). Sublimate (1 : 500), formalin (119), or pure per- oxide of hydrogen (135). Applications to be made by the physician. At home: Sublimate (1 : 5000). Where swelling is great: Iced compresses. As soon as suppuration has ceased: Treat as simple conjunctivitis (78). 37 conjunctivitis 78. CONJUNCTIVITIS, SIMPLE, Catarrhal. —CATARRH OF CONJUNCTIVA. Keep bowels loose.—Avoid bad air, smoke (above all, tobacco smoke), radiating heat, congestions to the head, all work tiring the eyes. Smoked glasses.—Examine conjunctiva for for- eign bodies ; remove them. Brush conjunctiva, douche the eye and wash with one of the following collyria : Boric acid (30 a), biborate of sodium (29), yellow astringent colly- rium (55), sulphate of zinc (325 a), subacetate of lead (185 a). For pain: Add to the collyrium some drops of tincture of opium or try a combination of boric acid and cocaine, as follows : Boric acid................ 5 0 75 gr. Muriate of cocaine............ 10 15 gr. Distilled water..............125 0 4| Cherry-laurel water........ ... 25 0 6£ 3 Should there be considerable swelling of the lids : Compresses with subacetate of lead solution (185 d) or iced water. In unyielding cases: Brush the palpebral con- junctiva every other day with a solution of nitrate of silver (0|5 to 1: 100), provided there is much secretion. Where, however, there is no or hardly any secretion but swelling of the follicles : Careful cauterization with the blue pencil (80 c'") [in sensitive patients pulverized calomel stops pain promptly]. As a general rule, repeated use of a weak remedy is to be preferred to the application of a strong one. 38 CONJUN* TIVITIS—COPPER Watch the border of the lids. See Blepharitis (26). Where necessary : Eeopen lachrymal passages by simple probing. 79. CONJUNCTIVITIS, VERNAL.—VER- NAL CATARRH. As a rule: No irritants, no astringents. Washes and compresses of carbolized water (1:500), or salicylic acid (1:200), or boric acid (2 :100).—Mas- sage with calomel ointment (33 a) or cocaine oint- ment (52 b). Exceptionally, where there is no improvement by above treatment: Instillations of acetic acid (1:100) four t imes a day. Where there is considerable pro- liferation of conjunctival tissue: Excision of the hypertrophied parts on the level of the conjunctiva and the corneal limbus. Galvano-cautery. Glasses to protect the eyes.—Hygienic diet.— Change of climate. 80. COPPER, SULPHATE OF. a. Sulphate of copper........... 0 50 8 gr. Rose water..............50 00 1 % 03 Distilled water.............150 00 5J ' Dissolre and filter. b. Sulphate of copper........... 110 15 gr. Glycerin............... 1010 2^ c. Crystallized sulphate of copper. cf. Pure crystal = unmitigated blue stick. c//. Sulphate of copper .... "1 Equal parts = mitigated Nitrate of potassium ... J blue stick. 39 CORNEA c'". Crystallized sulphate of copper -, Equa] parts = divine Nitrate of potassium ... . I . Alum ...........J 81. CORNEA, ABSCESS OF THE. Treat as infected ulcer (176).—Prevent sponta- neous perforation by puncture with cautery. Cornea, Burns of the. See Burns of the Conjunctiva (57). 82. CORNEA, CALCAREOUS CONCRE- TIONS OF THE. Eemove with sharp spoon or small gouge. An- tiseptic bandage. 83. CORNEA, FISTULA OF THE. Freshen up edges. Eserine (111) or atropine (23 a), according to seat of fistula (peripheral or central). Antiseptic pressure bandage (101). 84. CORNEA, FOREIGN BODY OF THE. On anterior surface of cornea : Try in all cases to remove icith brush. Where unsuccessful with brush try Daviel's spoon. Exceptionally : Cauterize care- fully with galvano-cautery, and try several days later to remove the foreign body with the scab. Where foreign body penetrates deeply into the corneal tissue: Introduce cataract-needle behind it and remove. Where foreign body has penetrated into anterior chamber: Paracentesis and extraction with iridec- tomy forceps or with the magnet. 40 CORNEA Where foreign body has penetrated into the tissue of the iris: Iridectomy. 85. CORNEA, HERPES OF THE.—HER- PETIC KERATITIS. Dry aseptic bandage. Boric acid ointment 130 d). In unyielding cases: Destroy the vesicles by massage, with a sufficient quantity of powdered calomel. Thereupon treatment analogous to that of ulcerous keratitis (176). For pain : Instillations of cocaine (52 a) and in- jections of morphine (231 c) into the preauricular region. 86. CORNEA, LESIONS OF THE. Eemove foreign body. In perforating wounds : Eserine (111) where perforation is peripheral; atropine (23 a) where it is central. Iris having prolapsed : Ablation with scissors or destruction with galvano-cautery of the herniated part. Strict antisepsis, sublimate (1:5000) dressing. 87. CORNEA, LEUCOMA OF THE.—FILM OF THE CORNEA.—NEPHELION. According to time of subsistence and age of indi- vidual : Calomel ointment (33 a), red precipitate ointment (229 c), yellow oxide ointment (229 b), or blue ointment: Blue ointment...............10 15 gr. Yellow vaseline..............2 0 30 gr Lanolin................10 15 gr. [Blite ointment alone is too great an irritant.] 41 CORNEA Direct steaming of the anaesthetized cornea. In- sufflation of calomel (33 c) or boric acid (30 c), fol- lowed by massage. Try: Electrolysis, 3 to 4 m. a., until foam forms upon the surface of the cornea. Duration of appli- cation, \ to 2 minutes once a week. Or direct gal- vanization for several weeks daily 1 to 3 minutes ; \ to W m. a., just as patient tolerates it. Or yet (but only in fresh cases) : Subconjunctival injections of tepid salt water [salt, 110 to 310 (15 gr. to 45 gr.) ; sterilized water, 3010 (1.5)] near the corneal border; whereupon massage and pressure bandage. Or use: Sulphate of cadmium............0 05 § gr. Distilled water...............4 00 I3 Gum arabic................2 00 30 gr. Extract of opium..............0 10 1J gr. Apply with a brush to centre of the leucoma. Where vision is bettered by mydriasis : Iridec- tomy. The place of this iridectomy and its size will vary with the situation and extent of the leucoma. Tattooing with india-ink in antiseptic solution. Abrasion where there are calcareous incrusta- tions or deposits of metallic salts (acetate of lead, nitrate of silver). For fresh corneal opacities produced by slaked lime : Instillation of a sugar solution, which changes the lime into a soluble saccharate. Vision in irregular astigmatism is bettered with stenopeic glasses. See, furthermore, Nos. 22 b and 177. 42 CORNEA —DACRYOCYSTITIS 88. CORNEA, ADHERENT LEUCOMA OF THE. Iridectomy, to better vision and to combat in- flammation. Careful tattooing. Si). CORNEA, TUMORS OF THE. Eemove them. Antiseptic bandage. Larger malignant tumors : Enucleation. Cornea, Ulcer of the. See Ulcerous Kera- titis (176). 90. CYCLITIS.—IRIDOCYCLITIS. Eest, atropine (23 a), poultices (255), diaphoresis (305), purgatives, smoked glasses.—For the pain : Morphine (231 c), strengthening treatment, iron (164) and iodine (147) preparations.—In case of synechise : Iridectomy as soon as inflammation has subsided. Cysticercus. See Cysticercus of Conjunc- tiva (58) and C. of Vitreous (319). Dacryocystitis, Acute. See Purulent Dac- ryocystitis (92). 91. DACRYOCYSTITIS, CHRONIC. Squeeze out contents of lachrymal sac, make an injection and see whether the liciuid escapes through the nose. If not, dilate lachrymal canaliculi with a conical probe, and introduce into the nasal canal an olive button probe.—Where there is a stricture : Split one of the canaliculi (the upper one in prefer- ence?). 43 DACRYOCYSTITIS Methodical probing.—Where there is total ob- struction of the nasal canal open a passage by force with Weber's knife. Each probing is to be followed by an injection of boric acid (4 :100), or sublimate (1: 3000), or per- manganate of potassium (1:1000), or with one of the following solutions : Boric acid...............10 00 2Jg Salicylic acid.............. 2 50 38 gr. Distilled water.............500 00 1 pt. | aa 40 0 2\Z to 6J3 0 aa lg 2^3 Triturated iodoform..... 10|0 to 25 Glycerin .... Distilled water . . . Shake solution before each injection. In unyielding cases give probes a coating of Triturated iodoform or iodol........510 75 gr. Cocoa butter...............30|0 13; Where dacryocystitis resists all these forms of treatment, or where patient has but a few days to spare for treatment: Perform a curettage of the lachrymal sac and naso-lachrymal canal with a small curved sharp fenestrated spoon. Where the lachrymal sac is much dilated : Par- tial resection of the anterior wall of the sac. Where coexisting fistula of the lachrymal sac does not disappear with the re-establishment of the lachrymal passages : Use of galvano-cautery or ex- cision of the membrane lining the fistulous duct and careful suture of the margins of the wound. Coexisting conjunctivitis (70, 75, 78), rhinitis (273), syphilis (291), or tuberculosis requires special treatment. 44 DACRYOCYSTITIS—DACRYOPS 92. DACRYOCYSTITIS, PURULENT.— PHLEGMON OF THE LACHRYMAL SAC. Slit both canaliculi up to the lachrymal sac. Cut through the internal ligament with scissors to unite both wounds, and thus open the superior part of the sac completely.—Squeeze out contents.—Instil several drops of tincture of iodine or cauterize with mitigated pencil (287 b, d) [prevent injected liquid getting into eye]. Inject lachrymal sac with sublimate (3 :1000), chloride of zinc (£ to 1:100), creolin (2 to 4 :100), thymol (0.05 to 1:1000) (312), sulphocarbolate of zinc (1 to 3 :100), or phenosalyl (4 :1000). Where inflammation is very great: Perman- ganate of potassium (2 :1000). Injections should be very carefully made, on ac- count of danger from periorbital'phlegmon. In the interval patient should empty lachrymal sac frequently by squeezing. Sublimate compresses (1:5000), or boric acid (4 :100;, or subacetate of lead solution (185 d). Acute symptoms having disappeared: Probe nasal canal and treat as in chronic dacryocystitis (91). 93. DACRYOPS. Excision of a part of the wall of the cyst and closure of the wound by sutures. 45 DALTONISM—DISTICH IASIS 94. DALTONISM.—PARTIAL ACHROMA- TOPSIS. In slight degrees of partial achromatopsis: Try glasses colored with fuchsin that increases the dif- ference between red and green. A color-blind person should never take up a call- ing which necessitates his being perfectly able to distinguish between colors, as : Coast-guard, sailor, switchman, dyer, dealer in or manufacturer of colored cloth. 95. DERMATOL.—BASIC GALLATE OF BISMUTH. Can sometimes take the place of iodoform. Has no odor and does not irritate. Dermatol................. 1 Oxide of zinc.............1 Starch................}aa 6 Vaseline.................12 Mix and make a paste. For eczema of the lids. Diastase. See Extract of Malt (115). 96. DIGITALIS. Powdered digitalis leaves........ . 0110 1J gr. White sugar................0(40 6£ gr. 3 to 5 powders a day. 97. DISTICHIASIS. Transplantation of ciliary margin. Electrolysis : A fine platin-iridium needle, made 46 0 15 gr 0 1*3 0 ^3 douches expressly for this purpose, is attached to the nega- tive pole, while the positive electrode rests upon the arm. Strength of current can be increased to 8 in. a. Duration : .V few seconds. Decrease slowly to zero. The lashes may be pulled out or left to fall out by themselves.—Eemove but a few lashes at one time, and protect the cocainized eye by a plate of horn. 98. DOUCHES. a. Cold douche: 8° to 10° C. [47° to 50° F.] ; short. Begin with douche of 3 seconds, and do not apply longer than 25 or 30 seconds. b. Scottish douche: Begin with hot douche of 30° C. [86° F.], increase temperature to 35°, 40°, and 45° C. [95°, 104°, and 113° F.], and end with a cold stream of 8° C. [47° F.]. c. Alternating douche: Alternating hot and cold stream, for an equal number of seconds (10 to 15); not longer than 2 minutes altogether. All douches can be thrown as a spray or a stream. On the whole, the stream is to be preferred. Direct it principally along the vertebral column, on feet, calves, and legs. Whichever form of douche is used patient should observe the following rules: Take a short walk before the douche. Protect head and contract muscles during douche. Dress quickly, and take vigorous exercise after douche (horseback-riding, gymnastics, fencing, etc.). 47 DOUCHES—DRESSING 99. DOUCHES, EYE-DOUCHES. a. Steam-douche to clear up fresh corneal opacities. The cornea is steamed directly, and where neces- sary, protected by a thin muslin bandage. Time : 15 to 30 minutes. b. Simple spray: Patient opens and closes eye, exposing conjunctiva as much as possible. Dry the eye carefully after spray. Any appropriate collyrium can be used as a spray. Time : 30 to 40 seconds. c. As a quite strong stream in cases of astheno- pia of neurasthenic origin. Apply to ocular and frontal region, the eyes remaining closed ; dry, and use massage afterwards. 100. DOUCHE, NASAL. Place vessel containing liquid about 50 centi- metres (? yard) above the head.—Insert olive of canula horizontally, so that one nostril is com- pletely closed by it.—Hold the head erect, having care to breathe with open mouth to hinder liquid from penetrating into pharynx, and let it run out of the other nostril. —Douche through one nostril after the other.—After douche wait at least 20 minutes before blowing nose. 101. DRESSING, ANTISEPTIC. Solutions for eye-baths: Corrosive sublimate........... 0|20 3 gr. Distilled water............100o|oO 2 pts. Patient washes, brushes, and disinfects his hands, soaks small pieces of hygroscopic cotton in the solu- 48 DUBOISINE —EMBOLISM tion and places them upon the eye, which has been previously covered with a bit of muslin cut round, moistened with sublimate.—A strip of oiled silk, or gutta-percha tissue-paper, overlapping the cot- ton on all sides, hinders evaporation.—Dressing is held in place by a muslin or fine linen bandage. Where patient cannot tolerate the sublimate, re- place it by boric acid (30 a or 30 b). Drooping of the Upper Lid. See Ptosis (258;. 102. DUBOISINE. Neutral sulphate of duboisine........00|05 f gr. Distilled water..............10|00 2$3 Instil one drop several times a day. Duboisine combined with atropine. See Atro- pine (23 c). Ecchymosis. See Conjunctiva (59) and Lids (196). 103. ECTROPION. Cauterize with galvano-cautery.—Surgical treat- ment. Eczema of the Cornea. See Phlyctenular Keratitis (173). Effusion of Blood into Anterior Chamber. See Hypilema (138). 104. EMBOLISM OF CENTRAL ARTERY. Careful massage of the eyeball. Eepeated para- centesis of the anterior chamber.—Atropine (23 a). Keep bowels loose.—Avoid every excess (on ac- count of the other eye). 49 EMPHYSEMA—ERGOTIN 105. EMPHYSEMA, SUBCONJUNCTIVAL. Etiological treatment.—Pressure bandage. 106. ENTROPION. Cauterize with galvano-cautery.—Surgical treat- ment. 107. EPICANTHUS. Surgical treatment not before the eighth or the tenth year. The development of the nasal bone makes this anomaly either disappear or modifies it in all cases. 108. EPISCLERITIS. Protect the eye : Dark glasses, or, better, a dry bandage.—Apply dry heat: Aromatic leaves (255 f) or conium leaves (255 g) in linen bags heated and applied to the eye for hours.—Massage with co- caine ointment (52 b), calomel ointment or powder (33 a, c). For acute pain and pericorneal injection : Instil combined atropine and cocaine collyrium (23 b). For coexisting conjunctivitis : Hot eye-baths with boric acid (30 a) or borate of sodium (29). After- wards dry the eye thoroughly. Watch the general health. 109. ERGOTIN. As the different preparations of ergotin are of very variable strength, it is better to prescribe ergotinin, the alkaloid itself. 50 EROSIONS—ETHYL BROMIDE Krgotinin.................0 Sugar of milk................0 Liquorice powder q. s. To make 50 pills; 3 pills daily. 02 J gr. 50 8 gr. 110. EROSIONS (OR FISSURES) AT THE OUTER ANGLE OF THE EYE. Ichthyol..................410 I3 Lanolin................"1 .. ,L ns. \ aa 5 0 75 gr. Glycerin................> Olive oil..................1 [0 15 gr. Eepeated application with the pure or mitigated pencil of nitrate of silver (287 b). 111. ESERINE OR PHYSOSTIGMINE. Neutral sulphate of eserine . . 0 Distilled water ....... 03 to 00 10 10 £ gr. to 1£ gr. 00 2*3 Instil one drop several times a day. 112. ETHER. a. Pure ether. Sulphuric ether. Hypodermic injections in case of collapse produced by chloroform. Pracaz syringeful several times. b. Hypodermic injection of camphorated, ether : Camphor................1 part, Ether.................4 to 5 parts, has a stronger effect than sulphuric ether alone. Ether as a narcotic. See Chloroform Anaes- thesia (42). 113. ETHYL BROMIDE. Aiuesthetie for a short narcosis. — Inhalation of 10|0 to 15|0 (2]3 to 4") ; maximal dose l>() |0 (53). 51 EXALGIN—FIOR A VENTI It is dangerous to narcotize an individual twice on same day with this anaesthetic. Pure ethyl bromide is colorless, completely trans- parent ; odor and taste is similar to ether. 114. EXALGIN (METHYLACETANILID). Exalgin................. 2 Spirits of peppermint........... 10 Aqua tiliae..............120 Syrup of orange flowers.......... 15 00 43 Tablespoonful several times a day. 50 38 gr. 00 2}3 00 45 Exophthalmic Goitre. See Goitre (129-4). 115. EXTRACT OF MALT. 2 teaspoonfuls twice a day.—Give preference to diastase, a powder of which 015 to 110 (7 gr. to 15 gr.) should be taken three times a day. Eyelashes, Loss of the. See Loss of the Eye- lashes (226). 116. FIORAVENTI, BALSAM OF. Cinnamon oil; clove oil; juniper oil; mace 1 .. , oil; turpentine oil; thyme oil......' Peru balsam................ gtt. 4 Alcohol .... .............100)0 33j 23 Rub on forehead and temples. Fissures. See Erosions (110). Fistula of the Lachrymal Sac. See under the heading of Chronic Dacryocystitis (91). 52 FLUORESCIN—FOOT-BATHS 117. FLUORESCIN. Fluorescin................00 40 6J gr. Carbonate of sodium............00 70 11 gr. Distilled water..............20 00 53 Instil 1 drop, close the eye for several seconds, and wash with any collyrium. Stains the parts of the cornea bare of epithelium green and those of the conjunctiva yellow.—Where epithelium is only altered the stain will be less marked. 118. FOOT-BATHS, MEDICATED. Take foot-baths of an evening before supper or 2 or 3 hours after supper. 5 to 7 quarts of water. —Time, 20 seconds to 2 minutes.—Wipe feet, and dry them thoroughly by rubbing afterwards. Temperature, 35° to 40° C. [95° to 104° F.]. a. Mustard foot-bath. Foot-bath with mustard flour : Mix 1251 0 (4 J) of mustard flour with cold or barely luke- warm water. Add later a sufficient quantity of water.—Be careful not to put in any vinegar. b. Hydrochlorate of Ammonium foot-bath : Hydrochlorate of ammonium........250 0 8J Water q. s. for a foot-bath. c. Acid foot-bath : Muriatic acid..........12010 to 150 0 4J to 53, Water q. s. for a foot-bath. | d. Alkaline foot-bath : Carbonate of sodium...........125 0 4^ Water q. s. for a foot-bath. 53 FORMALIN—GLAND e. Sea-Salt foot-bath : Sea-salt.................125 Water q. s. for a foot-bath. Formaldehyde. See Formalin (119). 43 119. FORMALIN.-FORMIC ALDEHYDE. —FORMOL. a. For disinfecting instruments : solution 1 : 500. b For the conjunctiva : solution 1 : 2000. c. In blenorrhcea increase strength of solution up to 1 : 300. Fowler's Solution. See Arsenic (20 a). 120. GALLANOL.—GALLIC ACID ANI- LIDE. Gallanol............l|0to 410 15 gr. to I3 Vaseline............ 2o|o 5 3 Cover with traumaticin (10 per cent, solution of gutta-percha in chloroform). Eczema of the eyelids. 121. GELSEMIUM. Tincture of gelsemium sempervirens. 15 to 30 drops several times a day on a piece of sugar. Neuralgia of the fifth nerve and spasm of the orbicular muscle. 122. GLAND, LACHRYMAL, FISTULA OF THE. Freshen up edges and close fistula by sutures. Cauterization. 54 G LAN D—GLASSES 123. GLAND, LACHRYMAL, INFLAMMA- TION OF THE. Poultices (255).-—Where there is fluctuation: Incision through conjunctiva. 124. GLAND, LACHRYMAL, TUMORS OF THE. Extirpation. 125. GLASSES FOR WORK, RULES FOR PRESCRIBING. 1. Establish necessary refraction for distinct vision at working distance (t). It is in inverse ratio to this distance. Example : For 25 cm., or---—' : / = 4D. 2. Establish the amplitude of accommodation or dynamic refraction (a), of which only two-thirds ( ~\ should be used for work, while one-third re- mains as a reserve. (The following table shows the normal amplitude of accommodation for different ages.) Example : For the age of 40 : a = 4.5 D; therefore L^ = 3D. O 3. Establish the maximum of refraction which can be used for work (u) by adding the two-thirds of the dynamic; refraction to the static refraction (r) ; u = ~— -\- r. In myopia r is plus; in hyper- metropia it is minus. 55 GLASSES 4. The glass for work (w) is found by subtracting the maximum of usable refraction for working distance (u) from the necessary refraction (t) : W=t— u. In our example (age 40, working distance 25 cm.) : W =4 — 3 = 1 for the emmetropic eye (where r = o). W= 4 — (3 — 2.5) = 3.5 for the hypermetropic eje of 2.5 D. (r negative). W= 4 — (3 4- 0.75) = 0.25 for the myopic eye of 0.75 D. (r positive). We should remark that the myopic eye but rarely needs the help of concave glasses for work this side of its far point. Amplitude of ac- Usable accommo- commodation d dation in round Yeaks. according to 3" numbers. Bonders. 2a a. 3 " 10 14 4.7 9 15 12 4 8 20 10 3.3 6.5 25 8.5 2.8 5.5 30 7 2.3 4.5 35 5.5 1.83 35 40 4.5 1.5 3 45 3.5 1.17 2.5 50 2.5 0.83 1.75 55 1.75 0.58 1.25 60 1 0 33 0.75 65 0.75 0.25 0.5 70 0.25 0.08 0 See also Presbyopia (256). 56 GLAUCOMA 126. GLAUCOMA, ABSOLUTE. Where there are violent attacks with irritation of the other eye : Enucleation. 127. GLAUCOMA, ACUTE. Forbid mydriatics and poultices. Escrinc. (Ill), pilocarpine (251 a). Drastic cathar- tics, diuresis, and diaphoresis (305). Complete rest of body and mind. Bloodletting (186). Nar- cotics, hypodermic injections of morphine (231 c). Repeated paracentesis. Iridectomy from above. Large and peripheral incision. [Where the tension is great iridectomy can be facilitated by making a puncture of the sclera first.] Anterior sclerotomy: Puncture and counter-puncture as much in the pe- riphery as possible [should about correspond with the horizontal meridian] ; push the knife up as high as possible on both sides, but Jeave a bridge of sclera separating cuts to prevent prolapse of the iris. Sclerotomy with the lance, repeated at di- verse points of the limbus. Posterior sclerotomy: Incision at region of the equator of the eye between rectus externus and rectus superior ; let a little of the vitreous escape. Always regulate the outflow of aqueous humor or vitreous carefully in order to prevent intra-ocular hem- orrhages. After the operation : Instil myotics (235) repeat- edly. 128. GLAUCOMA, CHRONIC. Myotics (235).—Avoid congestions to the head and excitement.—Iridectomy.—Incision of the an- 57 GLAUCOMA —HEBRA'S OINTMENT gle of the iris.—Anterior or posterior sclerotomy. For pain : Narcotics. 129. GLAUCOMA, HEMORRHAGIC. Rest.—Myotics (235).—Ice.—For pain : Narcot- ics, exceptionally lukewarm poultices with conium leaves (255 g), hypodermic injections of morphine (231 c).—Punctures through the sclera, do not try any other operations.—Where pain persists : Enuclea- tion. 129.1. GOITRE, EXOPHTHALMIC- GRAVES' DISEASE. —BASEDOW'S DISEASE. Phosphate of sodium in doses of 1510 (£3) pro die. Preparations of thyroidal (daily dose should represent 2|0 to 4|0 [z3 to 13] of the fresh gland.) Cease giving thyroidin as soon as diarrhtea sets in or where there is no amelioration of symptoms after three weeks of this treatment. Galvanization of the cervical sympathetic nerve. Hydrotherapy (98). Light diet. Avoid mental emotions as much as possible. In severe and unyielding cases extir- pation of the cervical sympathetic. Granulations. See Granular Conjunctivitis (75). Graves' Disease. See Exophthalmic Goitre (1294). 130. HEBRA'S OINTMENT. Simple lead plaster...........1 1 Olive oil...............}aal0]° 2*3 Spread on piece of linen; renew application every 24 hours at least. 58 HEM ERALOP1A—HYDROGEN 131. HEMERALOPIA RESULTING FROM TORPOR OF THE RETINA. Systemic treatment.—Treat gastric and intestinal troubles. Strengthening food, open air, gymnastic exercises.—Quinine (259), iron (164), cod-liver oil (54).—Keep patient away from noxious influences [excess of work, strong light].—Prescribe smoked glasses and instil myotics (235) in a weak solution for a long time.—Correct with glasses anomalies of refraction. 132. HEMIANOPSIA.—HEMIOPIA. Etiologic treatment. —In case of apoplexy: De- rivative treatment; absolute rest; elevated position of head ; ice bag ; later electricity. 133. HOMATROPINE. llydrobromate or sulphate of homatropine........0 [ 1 to 013 Distilled water........ lo|o Instil from 2 to 4 drops, at 5 minutes drops. To determine refraction. Hordeolum. See Stye (301). 134. HYDRASTIS CANADENSIS. Fluid extract of hydrary symptoms have disappeared. Should synechias capable of bringing on relapses remain, iridectomy may be indicated. 162. IRITIS, SEROUS. Treatment similar to that of interstitial keratitis (170). (hneral treatment: Tonics.—Diaphoresis (305), species sudorificae (290), moist pack. Local treatment: Atropine (23) (stop when tonus is -f-).—Hot compresses.—Poultices (255). Should deposits form on the posterior surface of the cornea: Paracentesis. Withdraw the needle slowly; thereupon open the wound by light pressure upon its edge with a sparula, so as to let the aque- ous humor escape drop by drop. Repeat this on following days without renewing puncture. In case of relapse: Change of climate, sojourn in the country. 69 IRITIS—JUNIPER OIL 163. IRITIS, TRAUMATIC. The only form of iritis in which iced compresses are indicated. Otherwise about the same treatment as in ordinary iritis (161). 164. IRON. a. Sulphate of iron.......l|0to 210 15 gr. to $3 Distilled water........ 160 |o 5J Collyrium. b. Blaud's Pills: Sulphate of iron...........\ aa 1610 aa A? Carbonate of potassium.......J ^agaCanth.............Vs. for 100 pills. Glycerin..............J ^ r 3 to 5 pills a day. c. Tincture of iron malate. Immediately after or during meals 5 to 10 drops in water. d. Ammonium citrate with iron pyrophosphate . "> Sugar of milk..............i Twice daily according to age of child 1\0 to 3\0 of the mix- ture in milk or soup. Wine of Iron and Quinine Citrate. Sec Qui- nine (259 a). Syrup, Iodide of Iron. Sec Iodine (147 6). Iron Baths. See Medicinal Baths (25 c). 165. JEQUIRITY, MACERATION OF. Macerate in one pint of water 1010 (2] 3) of old shelled jequirity seeds for 24 hours. 166. JUNIPER OIL. a. Pure juniper oil 70 KEFIR—KERATITIS Or better: b. Juniper oil.............. 210 £2 Olive oil................3[0 45*gr. Apply to border of lids in blepharitis. The oil penetrates into the eye easily and causes great irritation. 167. KEFIR. a Weak kefir (has fermented 24 hours). b. Medium strong kefir (has fermented 48 hours). c. Strong kefir (has fermented 72 hours). Take in small quantities at a time. Maximum: 3 quarts daily. Keratitis of Stellwag. See Deep Punctated Keratitis (174). 168. KERATITIS THROUGH LAGOPH- THALMUS. Close litis by sutures, leaving an opening which permits cleaning of the eye with aseptic solutions. Where surgical interference is not permitted : Dry aseptic dressing during the night; repeated instil- lations of milk, glycerin, or mucilaginous fluids dur- ing the day. Pilocarpine (251 a) or eserine (111). Keratitis, Eczematous. See Phlyctenular Keratitis (173). Keratitis, Fascicular. See Phlyctenular Keratitis (173). 169. KERATITIS, FILAMENTOUS. Hasten and facilitate the abnormal exfoliation of the epithelial layer by instillations of an aqueous solution of hydrochlorate of ammonia 2 :100. 6 to 10 times a day. 71 KERATITIS 170. KERATITIS, INTERSTITIAL.—PAR- ENCHYMATOUS KERATITIS. In the beginning: Atropine (23 a). Stop as soon as pupil is dilated.—Poultices (255), 4 to 10 liours a day.—Steam-douches (99 a). For intense pain : Hot fomentations with Extract of belladonna........... 3|0 45 gr. Distilled water..............20010 (',5 53 One tablespoonfid in one-half pint of hot water (35° to 40° C). Later (when inflammatory symptoms are less pronounced) lessen hot applications slowly and add massage of the cornea, at first once, then twice, to three times daily for 2 to 5 minutes. Use for massage calomel ointment (33 a) or : Lanolin................^ Blue ointment.............}aal 0 aa!5gr. Yellow vaseline..............2 0 £3 After massage bathe the open eyes with a boric acid solution (4 :100) or a solution of biborate of soda (1:150). To hasten resorption by vascularization : Instil rancid oil or touch up corneal limbus or conjuncti- val sac with the galvano-cautery. General tonic treatment.—Rational and strength- ening food.—Hygienic diet: Open air, exercise. medicated baths (25), iron (164), quinine (259), arsenic (20).—Sojourn in the country or at the sea-shore. Where heredity is proved and child is not too weak : Energetic antisyphilitic treatment (291), in- terrupted every 2 to 3 weeks by 5 days of rest. 72 KERATITIS 171. KERATITIS, NEUROPARALYTIC— INDOLENT ULCER OF THE COR- NEA. Aseptic protective bandage.—Antiseptic washes. —Eserine (111) or pilocarpine (251 a). Galvanic current; positive pole held at neck, negative pole on closed lids. 172. KERATITIS, PANNOUS.—CORNEAL PANNUS. SUPERFICIAL VASCU- LAR KERATITIS. Treat the cause [foreign bodies, chalky deposits, trichiasis (314) and disticliiasis (97), entropion (106), granular conjunctivitis (75), etc.]. Eserine (111) or pilocarpine (251 a) if there are no symptoms of iritis.—Direct massage with finely powdered boric acid (30 c) (after cocainizing). —Yel- low oxide ointment (10:100!).—Insufflations of antipyrin powder and gentle massage [intense react hit]. Or : Red oxide of mercury .... 0 Camphor.......... 0 Vaseline Lanolin . aft 110 to 3 15 2\ gr. 10 1J gr. 00 aa 15 a:v. to 45 c;r. In unyielding cases: Abrasion of the region of the corneal limbus down to the sclera, followed by scarification of the sclera. Peritomy. Peridec- toniy, followed by scarification of the episcleral tissue. Keratitis, Parenchymatous. Sec Intersti- tial Keratitis (170). 73 KERATITIS 173. KERATITIS, PHLYCTENULAR, EC- ZEMATOUS.—ECZEMA OF THE CORNEA.—FASCICULAR KERATI- TIS. Forbid bandage.—Smoked glasses.—Myotics (235) [atropine (23 a) only in cases of threatening iritis; combine it with cocaine (23 6) where there is blepharospasm].—Massage with calomel (33 c) [forbid internal use of iodine preparations]. Several times daily compresses with sublimate (iy to \ in 1000) or with boric acid (4 :100). In case of small superficial ulcerations: Replace calomel powder by iodol (149), aristol (18 a), cal- omel (33 c), or yellow oxide (229 a) ointment. Where ulcers are deep and large : Treatment of ulcerous keratitis (176). Should the phlyctenular not yield to calomel: Cauterize either with point of a mitigated nitrate of silver pencil (287 6, /5) or with galvano-cautery, followed by a well-fitting bandage moistened with sublimate (1:3000) or with the following solution : Neutral sulphate of eserine.........0 Boric acid................2 Glycerin.................40 Distilled water..............10 20 3gr. 00 30 gr. 00 13 2J3 00 2 J 3 For photophobia and blepharospasm: Dip the face in fresh water, whereupon rub vigorously with a rough towel; let the child walk or run in a room in which obstacles have been placed so as to force it to open its eyes.—In unyielding cases : Open the lids by force and keep them open during from 5 to 15 minutes. —Blepharorrhaphy. KERATITIS 0 53 0 1.3 0 m Attend to the eczema and acne of the face and head : Soap the head vigorously with tar soap and make appropriate applications with ointments. See Eczema of the Lids (197). Attend to the scrofulous rhinitis: Clean nasal cavities frequently. Nasal douches (100). Insuf- flations of: Subnitrate of bismuth...........20 Tannin..................4 Powdered benzoin.............10 General a uti scrofulous treatment: Baths with bran (25 a) or sea-salt (25 d) ; cod-liver oil (54); iron preparations (164), arsenic (20), syrupus armoraciae (308) ; kola (179). Sojourn in country or at sea- shore [avoid sandy beaches]. Combat swelling of the conjunctiva by cauteriza- tion with the pure (287 6) or mitigated (287 6, a) nitrate of silver pencil. For pain: Collyrium (52 a) or ointment (52 6) with cocaine or morphine (231). Cauterize fissures brought on by tears with the nitrate of silver pencil (287 6) and apply the fol- lowing ointment: Acetate of lead..............2 Extract of opium.............0 Balsam of Peru..............5 Fresh lard................30 < 174. KERATITIS, DEEP PUNCTATED. —KERATITIS OF STELLWAG. [Do not confound with the deposits on posterior sur- face of cornea through serous iritis.'] 00 is 10 H sr 00 H3 00 i* keratitis In the beginning: Atropine (23 a) and energetic antiphlogistic treatment. Later: Eserine (111) or pilocarpine (251 a). Yel- low oxide ointment (229 6). Poultices (255) ; hot fomentations with an infusion of chamomile flowers or belladonna leaves. Hypodermic injections of pilocarpine (305 6). Systemic treatment of arthri- tis and gout: Lithium salicylate (225 a). 175. KERATITIS, SUPERFICIAL NON- VASCULAR. Atropine (23 a), where there are symptoms of impending iritis ; otherwise, eserine (111) or pilo- carpine (251 a).—Poultices or hot compresses with boric acid (4 : 100).—Calomel (33 a), boric acid (30 d), or yellow oxide (229 6) ointments. Keratitis, Superficial Vascular. #eePANNOUS Keratitis (172). 176. KERATITIS, ULCEROUS.—ULCER OF THE CORNEA. Strict antisepsis.—Avoid cold applications. Etiologic treatment: Foreign bodies, purulent con- junctivitis (69, 77), trachoma (75), dacryocystitis (91, 92) [in this last case the radical operation with scraping or cauterization of the lachrymal sac is the safest], ozaena : Repeated douches with sub- limate (1 : 2000) and inhalations of: Carbolic acid............... 5 0 75 gr. Absolute alcohol..............150 J^ Aqua ammonia.............. 5 0 75 gr. Distilled water...............10 0 2\% Bismuth, finely pulverized, to be used as a snuff every three hours. 76 KERATITIS Antiseptic dressing (101) and hot compresses with sublimate (1 : 5000).—Apply chlorine water or chloride of zinc (325 c) with a brush.—Fomenta- tions with salicylic acid (1 to 2 per 100). Where fundus and sides of ulcer are infiltrated: Galvano-cauterization followed by free and pro- longed irrigation with strong antiseptic solutions, or : scraping with sharp spoon followed by the ap- plication of a strong sublimate solution (1 : 500), or : subconjunctival injection of a sublimate solu- tion (1 : 2000) [daily amount one syringe of Pravaz]. Instillations of atropine (23 a) where perforation is not to be feared. Where perforation is to be feared from lack of resistance of the ulcerated cornea : Myotics (235). As soon as perforation seems inevitable: Perform it carefully with the galvano-cautery. Previously instil atropine (23 a) where ulcer is central, or a myotic (235) where ulcer is peripheral. In case of ulcus rodens with hypopyon: Keratotomy, passing through the centre of the ulcer, or para- centesis from below parallel to corneal margin, fol- lowed by washing of the anterior chamber with : Salicylate of eserine ,...........0 Boric acid ................ 1 Distilled water..............25 Thereupon instil : Neutral sulphate of atropine........0 Neutral sulphate of quinine........20 Sterilized distilled water..........30 Then : Antiseptic dressing (101). Should pain caused by the ulcer be very great 12 2gr 00 15 gr. 00 6*3 50 8gr. 00 53 00 13 KERATOCONUS—KERATOGLOBUS Morphine injections (231 c) at temple, instillations of cocaine (52 a), or fomentations and compresses with: Chlorine water............1 .- onn n .. ~z ,,_ >aa zOO U aa 65 62 Lime water.............J « «j Hydrochlorate of cocaine......... 4 0 I3 and three times a day an instillation of 3 drops of: Extract of Calabar bean..........0130 4J gr. Pure glycerin...............10j00 2J3 For deep indolent ulcer of the cornea, the treat- ment is the same as that of neuroparalytic keratitis (171). 177. KERATOCONUS. Stenopaeic glasses.—Spherical, conical, or torical glasses placed before the cornea or in contact with it. Where necessary : Galvano-cautery applied to apex of keratoconus, followed by aseptic pressure bandage.—Ablation of the apex or a segment of the cornea. 178. KERATOGLOBUS. In the beginning: Pressure bandage.—Myotics (235).—Peripheral iridectomy.—Section through the ciliary muscle.—Sclerotomy.—Repeated para- centesis. Where the prominence of the keratoglobus hin- ders the movements of the lids: Ablation of the prominent part or enucleation. 78 KOLA—LACHRYMAL PASSAGES 179. KOLA. a. Kola wine. 5010 to 100|0(ljg to 3|) a day. b. Fluid extract of kola. 10 drops several times a day. Lachrymal Sac, Blennorrhoea of the. See Purulent Dacryocystitis (92). Lachrymal Sac, Fistula of the. See under the heading of Chronic Dacryocystitis (91). 180. LACHRYMAL PASSAGES, OB- STRUCTION OF THE. Methodical use of probes without slitting lachry- mal canals except where absolutely necessary. The ends of the probes should be olive-shaped.—At each dilatation leave them in place for about 15 min- utes.—Do not probe more often than necessary, just often enough to keep passages open for tears and injections.—Medicines should be injected with a syringe, the point of which is also olive-shaped. In unyielding cases : Ablation of the palpebral or orbital lachrymal gland [operating from conjunc- tival side] or: Electrolysis of the lachrymal passages : A Bowman probe (insulated with the exception of the end) is introduced into the duct [avoid splitting canalicu- lus, if possible ; where this is unavoidable it must be done some time before this process is tried]. Connect probe with the negative pole. The posi- tive pole wrapped in a little moist cotton is placed in the nostril of the same side.—Increase intensity of current by the aid of the rheostat slowly up to a 7'J LACHRYMAL POINTS—LACTOPHENIN maximum of 5 milliamperes. If a strong current is used, we have to fear the formation of scars.— The application should last no longer than five minutes in all.—Decrease the strength of the cur- rent to zero very gradually.—The operation can be repeated several times at an interval of a few days. —The batteries are the same as those used for the continuous current. They should give a 40-milli- ampere current at least.—Milliamperemeter and rheostat are indispensable.—The procedure is used particularly in cases of inflammatory origin. Where there is suppuration: Slit the upper lach- rymal canal and treat as chronic dacryocystitis (91). 181. LACHRYMAL POINTS, EVERSION OF THE. Where palpebral tissue has undergone no change bring the points back into their normal position by making a channel, the posterior wall of which is excised or cauterized. Special treatment is necessary where the eversion is caused by conjunctival or palpebral trouble. 182. LACTIC ACID. Lactic acid..........l|0to 3 0 15 gr. to 45 gr. Distilled water........ 100 0 3£ 33 183. LACTOPHENIN. 0[ 50 to 110 (8 gr. to 15 gr.) before retiring. Lagophthalmus. See Paralysis of the Or- bicular Muscle (244), and Keratitis through Lagophthalmus (168). 80 LANOLIN—LEAD 184. LANOLIN Excellent excipient for ointments ; active of itself in light forms of blepharitis. Its consistence is but little modified by temperature. It is well to add a more oily body to it, for instance: Vaseline (3010 to 40 ( 0 to 10010 of lanolin). Use also : Pure lanolin . ..............65 Liquid paraffin..............30 Ceresin..................5 0 2,? 0 13 0 U3 185. LEAD. a. Subacetate of lead...........00 Rose water.............. 30 Distilled water............120 b. Subacetate of lead........01 50 to 2 Distilled water......... 8 White vaseline......... 10 Pure lanolin.......... 10 Apply on closed lids Subacetate of lead............00 Distilled water.............8 White vaseline.............10 Pure lanolin..............10 Apply to conjunctiva of lids. 50 8gr 00 !3 00 4.1 0 *3 0 23 0 2*3 0 2*3 25 4gr. 00 23 00 2*3 00 2*3 d. Compresses of subacetate of lead solution. 20 drops of liquor plumbi subacetici in a bowl containing about 400\0 (13^) of lukewarm water; steep pledgets of hygro- scopic cotton into this solution and apply twice or more times daily on the eyes during from a half to one hour; renew pledgets every 3 minutes. 6 81 LEECHES—LIDS 186. LEECHES, APPLICATION OF. According to the disease and state of general health of patients : Apply 2, 3, or 4 leeches, and let the blood flow as long as desirable, according to the case.—Take a tube or vial narrow enough to permit of placing the leech just at the spot you wish. Clean this spot beforehand.—Should leeches refuse to suck : Pour 2 or 3 drops of white wine or some drops of diluted vinegar into the glass which holds them.—Usually leeches are left until they drop off. To keep up the bleeding: Apply a linseed poultice. To stop bleeding: Apply a piece of tinder or haem- ostatic cotton upon the incision made by the leech and dust with powdered alum. Where necessary : Tight pressure bandage. 187. LETTUCE, DISTILLED WATER OF LEAVES OF. For soothing compresses. Can be added to the different collyria. 188. LIDS, ABSCESS OF THE. Etiologic treatment.—Poultices (255).—Incision parallel to the free margin.—Drainage.—Com- presses with sublimate (1 : from 2000 to 5000). Lids, Angioma of the. See Erectile Tumops of the Lids (217). 189. LIDS, ANTHRAX OF THE. Incision in the shape of a cross, thereupon alter- nately poultices (255) and sublimate compresses' (1: 500).—Strengthening food.—Tonics. 82 LIDS 190. LIDS, BITES OF INSECTS ON. Iced compresses.—Repeated applications of am- monia mixed with ether or chloroform (10 a). 191. LIDS, BLACK HEADS OF THE. Expression. 192. LIDS, BURNS OF THE. a. Slight burns (burns of first degree, causing ru- bel'action only). Finely powdered bismuth.—Linimentum calcis (223). or : 0 45 gr. Hydrochlorate of cocaine..........3 Vaseline............ Distilled water.......... Lanolin ............ | aa 20 0 aa 53 0 75 gr. 6. More severe burns (burns of second degree, causing vesiculation). Hydrochlorate of cocaine..........1 50 23 gr. Salol..................3 00 45 gr. Vaseline..................25 00 6^3 or : Aristol ointment (18 b, c). or : Iodoform.................4 Extract of conium leaves..........2 Carbolic acid................0 Unn'uentum rosatum............30 Before applying any of these three ointments open the vesicles and wash carefidly. 83 00 13 00 *3 05 lgr 00 11 LIDS 0 45 gr 0 2,3 0 2? 0 13 c. Severe burns (burns of the third degree with destruction of tissue). Europhen................3 Olive oil .................1 Vaseline..................60 Lanolin..................30 Renew this application but every third or fourth day. 193. LIDS, CHROMIDROSIS OF THE. Oleaginous inunctions.—Etiologic treatment (dy smenorrhcea). 194. LIDS, COLOBOMA OF THE. Freshen up the edges and unite carefully by numerous sutures. Lids, Cyst of the. See Hydatid of the Lids (205). 195. LIDS, CYSTICERCUS OF THE. Excision. 196. LIDS, ECCHYMOSIS OF THE. Pressure bandage.—Compresses with subacetate of lead solution (185 d).—Fomentations with : Tincture of arnica.............210 £3 Water..................80|0 2g 53 197. LIDS, ECZEMA AND ACNE OF THE LIDS AND NEIGHBORING PARTS. Systemic treatment of the scrofulous diathesis: Arsenic (20), iron (164), cod-liver oil (54), baths with bran (25 a), and sea-salt (25 d). 84 LIDS Forbid taking of too much food, abuse of meat and spices. Total abstinence from wine and alcohol.— Keep bowels loose. Minute Cleanliness.—Wash head with tar soap, pluck out lashes and hairs which are about to fall out; acne pustules or pimples to be incised and squeezed out. Prophylaxis. —Wash repeatedly with 50 per cent. alcohol, to dissolve sebaceous masses obstructing the canaliculi of the glands, having care that the alcohol does not penetrate into conjunctival sac. Antiseptic Treatment.—Repeated compresses with sublimate (from 1:800 to 1:500). Ointments with boric acid (30 d), ichthyol (139), naphtol (236 6), tannin (310 6), calomel (33 6), sul- phur (304), gallanol (120), ointment of Hebra (130) or Pagenstecher (229). Let the ointment remain on the lid several hours, then wipe off carefully and dust with an inert pow- der : Rice powder, talc, or brush the lid with : Oxide of zinc.............. 50 Salicylic acid...............5 Starch.............. Glycerin.............. Water..................75 aa 2 1J53 75 gr. 0 aa £3 In unyielding cases use one of the following oint- ments : Naphtol .................10 Precipitated sulphur............50 TarsoaP..............1 Aa20 \ aseline...............> Application to remain on lids from 30 minutes to 1 hour, whereupon wash with hot water. 85 0 2^3 1^53 0 aa 53 LIDS | aa 0|50to 0 aa 8 gr. to 15 gr. Resorcin..... Salicylic acid . . . Oxide of zinc....... 2 Vaseline.......... 18 This ointment will not decompose; it may therefore be applied at night and replaced in the morning by cold cream or rice pow- der. *3 4*3 Subnitrate of bismuth...........10 Oxide of zinc...............2 Glycerin.................8 Carbolic acid............20 drops. White vaseline...............30 3 times daily during one-half hour. 0 2*3 0 *3 0 23 0 20 gtt 0 13 0 2*3 0 15 gr. 0 3.^ Naphtol.................10 Camphor.................1 White vaseline..............90 During 15 minutes. Soothe any stronger irritation following by an oil or an emollient paste. Between each application of any of these oint- ments, dust diseased parts with an inert powder. Lotions : Tincture of male fern...........30 Absolute alcohol..............15 Tincture of myrrh.............4 Crude powdered opium...........4 Shake before using Brush the diseased parts carefully twice a day with this solution and wash vigorously with an alkaline soap afterwards. 0 is 0 \l 0 13 0 13 Precipitated sulphur............1 Spirits of camphor.............5 Lime water........ .......80 86 0 15 gr. 0 75 gr. 0 23 53 LIDS Tumenol.................50 75gr Sulphuric ether..........) I .,,.,,, > aa 15 0 aa £5 Absolute alcohol...........J 2,1> Glycerin or distilled water..........30,0 15 Finely powdered iodoform.........10i00 2Jz Pure cocaine ...............0| 30 5 gr. Mix' with care and add : Menthol.................0150 8 gr. Spirits of lavender.............20|00 53, The use of these numerous therapeutic means must vary and adapt itself to the different forms of eczema. Should the disease persist: Carefully cauterize with galvano-cautery or apply a mixture of equal parts of: Tincture of iodine, Pure carbolic acid, Chloral. In both cases use a non-irritating ointment after the applications. 198. LIDS, EMPHYSEMA OF THE. Eti(>1 ogic treatment. —Pressure. —Massage. Lids, Epithelioma of the. See Malignant TUMOKS OF THE LlDS (218). 199. LIDS, ERYSIPELAS OF THE. Systemic treatment. —Purgatives. —Antipyretics. Energetic local treatment. [Danger of infiltration of the orbit on account of the laxity of tissue, and if progressive, of meningitis by immigration of streptococci passing through the veins of Santo- rini.]—Try to limit the erysipelas to the face by: S7 LIDS Injections of sublimate (i : 1000, several syringefuls), compresses with carbolic acid (3 :100) or sublimate (1: 1000) ; repeated energetic washes with alcohol (90 :100).— Brush with tincture of iodine (147 a). From the beginning lids should be closed by adhesive plaster and any fatty substance. According to extent, seat, and intensity : Ice, in- unctions with double mercurial ointment (2916).— Friction with ichthyol (10 :100) or with : Traumatacin............... 120100 4£ Resorcin................. 1150 23 gr. or with : Carbolic acid........... 0 aa £3 0 I3 0 1353 y aa 15 Alcohol...............i Spirits of turpentine............30 Glycerin.................50 Shake this mixture before using. or apply : Flexible collodion.............2010 . 53 Iodoform.................1|0 15 gr. or : Flexible collodion.............3010 12; Sublimate.................11 0 15 gr. During intervals dust with an inert powder, such as : Talc, starch, rice. Where there is great pain: Linimentum calcis (223). 200. LIDS, FAVUS OF THE. Pluck out all the eyelashes and even the hairs of the eyebrows.—Vigorous washes with tar soap, followed by friction with sublimate (1 : 400). LIDS 201. LIDS, FIBROMA OF THE. Excision, followed where necessary by a plastic operation. Lids, Furuncle of the. See Stye (301). 202. LIDS, FURUNCULOSIS OF THE. Open air.—Bodily exercise.—Regulate stools.— Local treatment similar to that of blepharitis (26, 27). Wash regularly with : Salicylic acid............... 5 Biborate of soda............. 3 Distilled water..............500 or with : Precipitated sulphur............3 Hydrochlorate of ammonium........1 Rose water................50 Spirits of camphor.............10 Shake solution before using. Iii unyielding cases apply every evening on lids and between lashes : 0 75 gr. 0 46 gr. 0 1 pt. 0 45 gr. 0 15 gr. 0 13 53 0 2*3 Spirits of camphor............. 1 Precipitated sulphur............ 1 Lime water ............1 aa 10 ltose water............ 1 Gum arabic ... ...........0 S/iakc solution before using. 00 15 gr. 00 15 gr. 00 aa 2*3 20 3 gr. 203. LIDS, HERPES FEBRILIS OF THE. Inert powder : Talc, rice powder.—Where itch- ing is great : Ointment with cocaine (52 6). 89 LIDS 204. LIDS, HERPES ZOSTER OF THE. Starch, talc, ointment with cocaine (52 6) or morphine (2316).—Liniment with chloroform (416), having care that liniment does not penetrate into cul-de- sac. Galvanic current for periorbital neuralgia.— Compresses with : Corrosive sublimate............ 0 15 2\ gr. Hydrochlorate of cocaine......... 2 50 40 gr. Distilled water..............100 00 3^ 23 Systemic treatment: Antifebrin (14), antipyrin (15 a), salicylate of soda (275). In cases in which cornea and conjunctiva ar,e af- fected : Treat according to rules set down under the heading of Herpes of the Cornea (85) and Zona Ophthalmica (326). 205. LIDS, HYDATID OF THE. Excision of part of the wall of the cyst. 206. LIDS, HYPEREMIA OF. Hygienic treatment.—Open air.—Compresses with subacetate of lead solution (185 d) or with non-irritant collyrium (29, 30 a, 185 a).—Regulate stools. 207. LIDS, IMPETIGO OF. Systemic treatment: Cod-liver oil (54), iodides (147 6), iron preparations (164), alkalies, arsenic (20). 90 LIDS During inflammatory stage apply the following ointment as a plaster on a thin piece of linen : Boric acid ................ 1 Emplastrum hydrargyri compos.......5 Vaseline.................30 As soon as every trace of inflammation has dis- appeared : Simple lead plaster............20 Oxide of red lead.............2 Red sulphide of mercury.......... 1 Renew every day, washing with a solution of spirits of cam- phor before each dressing. 0 15 gr. 0 75 gr. 0 12 00 53 50 38 gr. 00 15 gr. 208. LIDS, LIPOMA OF THE. Excision, followed where necessary by a plastic operation. 209. LIDS, LUPUS OF THE. Energetic scraping with the sharp spoon.—Ex- cision.—Cauterize wound with thermo cautery.— Plastic operation when lupus is cured. Lids, Melanosarcoma of the. See Malig- nant Tumors of the Lids (218). 210. LIDS, MILIUM OF THE. Incision.—Expression.—Cauterization. 211. LIDS, MOLLUSCUM CONTAGIOSUM OF THE. Total extraction or ablation where tumor is pe- diculated. Lids, Molluscum Lipomatoides of the. See Xanthelasma of the Lids (222). 91 lids 212. LIDS, (EDEMA OF THE. Treat the cause.—Locally : Compresses with sub- acetate of lead solution (185 d). In unyielding cases: Apply flexible collodion, or brush with : Spirits of lavender..........\ aa 20 0 aa 63 Spirits of rosemary..........> Oil of lemon...............2 0 £3 Scarifications where other measures fail. 213. LIDS, PAPILLOMA OF THE. Ligature.—Ablation.—Cauterization with chem- icals or the thermo-cautery. Lids, Phlegmon of the. See Abscess of the Lids (188). 214. LIDS, PHTHIRIASIS OF THE. Energetic washes with tar soap.— Careful applica- tion of mercurial ointment. Lids, Sarcoma of the. See Malignant Tu- mors of the Lids (218). 215. LIDS, SEBORRHCEA OF THE. 1. Seborrhea sicca. Remove the pellicles and scales hindering the regular drainage of the product of the sebaceous glands several times a day. Facilitate this clean- ing by a previous application of some non-irritant ointment.— See Blepharitis (26). 2. Seborrhea oleosa. Systemic treatment. [Often Dysmenorrhcea.]— Minute cleanliness. 92 LIDS Dry the lids several times a day with tissue- paper and brush with : Precipitated sulphur . ..........110 15 gr. Linseed oil ................5|0 75 gr. Cold (98 a,) or Scottish (98 6) douches upon the nape of the neck and the vertebral column.—Wash the lids with water to which some alcohol has been added, or with cologne water. Careful applications with juniper oil mixed with some alcohol or mitigated by olive oil (166 6), or with spirits of alkaline soap. 216. LIDS, TELANGIECTASIS OF THE. Repeated punctures with the galvano-cautery.— Excision, followed where necessary by a plastic operation. 217. LIDS, ERECTILE TUMORS OF THE. Ablation. 218. LIDS, MALIGNANT TUMORS OF THE. [Epithelioma, Sarcoma, Melanosarcoina.] Radical ablation, followed by a plastic operation. —Save the smallest pieces of healthy palpebral tissue, on account of its vitality and the difficulty found to replace it. 219. LIDS, TYLOSIS OF THE. Energetic massage upon a shell or horn plate during * to 1 hour with : 93 LIDS—LINIMENTUM CALCIS White precipitate of mercury . . 0|05 to 0 Cold cream.......... 5 1 1 gr. to 2 gr. 0 75 gr. 220. LIDS, ULCERS OF THE, through Syphilis or Smallpox. According to case: Antisyphilitic treatment (291) or cauterization.—lodol (149 6) or aristol ointment (18 6, c). Lids, Warts of the. See Papilloma of the Lids (213). 221. LIDS, WOUNDS OF THE. Unite the edges of wound by suture as exactly as possible.—Antiseptic pressure bandage (101). 222. LIDS, XANTHELASMA OF THE.— XANTHOMA. Where tumor is small: Cauterization with nitric or hydrochloric acid. Where it is large: Multiple ligatures.—Coagu- lating injection [insulate diseased part by pressure]. —Excision followed by a plastic operation. Lids, Xanthoma of the. See Xanthelasma of the Lids (222). | aa 100 223. LINIMENTUM CALCIS. Lime water........ Linseed oil or olive oil . . . Thymol ... ........... 0 Apply to parts affected. Linseed oil should have the preference in spite of its disagree- able odor. 94 00 aa 3g 23 20 3 gr. LINIMENTS—MEMBRANE 224. LINIMENTS, SOOTHING. a. Oil of sweet almond .... 6010 2^ Chloroform........30|0to40|0 l'| to 1| 2^3 0 3,? 23 0 \l 0 2*3 b. Oil of hyoscvamus...........100 Fluid extract belladonna........15 Tincture of opium........... 10 Linseed Meal. See Poultices (255). 225. LITHIUM. a. Salicylate of lithium........"» .,„ a f •„ aS 10 aa 15 gr. Sugar or milk...........J One powder. To be taken in a half wineglassful of car- bonated water. Four powders a day. b. Lithia water. Carbonate of lithium......... 1|0 15 gr. Carbonated water...........1000|o 2 pts. To be taken in two days. Gallic acid.............. 0 Oil of lavender............4 drops. Castor oil.............. 2 Vaseline............... . 5 Lunar Caustic. See Nitrate of Silver (287 6). Malt. See Extract of Malt (115). 227. MEMBRANE, PERSISTING PUPIL- LARY. Where membrane is very thick : Iridectomy.— Otherwise refrain from any interference. 95 50 8gr. 4 gtt 00 *3 00 1*3 MENTHOL—MERCURY 75 12 gr. 25 4gr. 15 2*gr 00 U3 228. MENTHOL. a. Menthol................0 Hydrochlorate of cocaine.........0 Chloral hydrate............0 Vaseline................5 It is also used in the form of: b. Pencils. For local applications. 229. MERCURY. Pagenstecher' s Ointment = Yellow Oxide Ointment. a. Yellow oxide of mercury . . 0120 to 0] 50 3 gr. to 8 gr. White vaseline...... lo|oO 2fa Apply to border of lids in the morning; wipe off carefully after one hour. b. Yellow oxide of mercury . . 0|10to 0120 1* gr. to 3 gr. White vaseline...... lo|oO 2*3 Triturate thoroughly before mixing and add vaseline grad- ually. Introduce into cul-de-sac.— Where ointment irritates: Add 0\1 to 0\2 of poplar-tree charcoal (36) to it. Red Oxide Ointment. Red oxide of mercury . . . . 0|10to 0 White vaseline...... 10 To be used as above. 20 1 £ gr. to 3 gr. 00 2*3 White Precipitate Ointment. d. White precipitate of mercury......0150 8 gr. White vaseline.............10|00 2J3 Apply to border of lids. 20 drops of the tincture of benzoin can be added to these ointments, or the simple vaseline can be replaced by benzoinated vaseline [made with gum, not with tincture]. 96 MERCURY e. Salicylate of mercury....... 0|40 6 gr. Tincture of opium........10 drops. lOgtt. Extract <>f gentian, q. s. For 20 pills; 2 to 3 pills a day. f. Protiodide of mercury..........1 Powdered opium ............0 Extract of liquorice and liquorice powder, q. s. For 50 pills ; 2 pills three times a day. 00 15 gr. 30 5 gr. g. Tannate of mercury........... 310 45 gr. Extract of liquorice and liquorice powder, q. s. | For 60 pills ; 1 to 2 pills three times a day. All these pills are taken with or after meals. h. Oxicyanide of mercury......... 110 15gr. Distilled water ............10010 3J§ Sot at ion for sterilizing instruments. i. Biniodide of mercury......... 410 I3 Sterilized olive oil...........1000|0 2 pts. 10 l*gr. 00 1]3 00 ljg 00 85 k. Biniodide of mercury..... ... 0 Iodide of potassium.......... 5 Distilled water............. 5 Simple syrup.............240 2 tablespoonfuls a day for adults. For children/rom 4 to 6 years: a teaspoonful three times a day; for the new-born: half a teaspoonful twice daily. I. Cyanide of mercury........... 0120 3 gr. Distilled water.............20100 63 One syringe = 0 \01 (\ gr.) cyanide of mercury.—Begin by injecting half a syringeful, and only in exceptional cases inject the maximum of 2 syringefuls (0|02 = £ gr.).—Every other day. 7 * 97 20 3gr. 20 3gr. 05 lgr. 00 &3 30 aa 5 gr. 20 3gr. 00 43 00 \l METHYL—MORPHINE The cyanide of mercury does not coagulate albumen and remains soluble in the tissues. m. Benzoate of mercury..........0 Chloride of sodium...........0 Hydrochlorate of cocaine........0 Distilled water.............20 Daily dose: one (Pravaz) syringeful. n. Peptone............."I .. n y V aa 0 Pure chloride of ammonia.....J Corrosive sublimate...........0 Glycerin................ 5 Distilled water.............15 Daily dose: one (Pravaz) syringeful. Bichloride of Mercury and Peptonate of Mercury. See Sublimate (302). Mild Chloride of Mercury. See Calomel (33). Simple Mercurial Ointment. See Mercurial Inunctions (143).—Double Mercurial Ointment. See Specific Treatment (291 6). Methylacetanilid. See Exalgin (114). 230. METHYL, IODIDE OF. Local application as a vesicant in neuralgia. 231. MORPHINE. a. Hydrochlorate of morphine........0 30 5gr. White vaseline.............6 00 1*3 Introduce under the lids in cases of corneal ulcerations with violent pains. b. Hydrochlorate of morphine.......210 *3 Benzoinated lard............3010 lj Soothing ointment. 98 MUSCLE VOLITANTES c. Hydrochlorate of morphine.......0110 1* gr. Spirits of peppermint . ,....... 1 00 15 gr. Di>tilled peppermint water.......lo'oO 2*3 One syringe = 0\01 of morphine. This solution is less subject to changes than those generally in use, still it is better to dissolve 0 [01 (h gr.) of the hydrochlorate of morphine in one cubic centimetre of sterilized water immediately before injection. In case of morphine poisoning: Hypodermic in- jection of 0|001 (gL gr.) of the neutral sulphate of atropine [T\ of a (Pravaz) syringeful of the ordinary collyrium (23 a) ]•—Where necessary, a second injection can be made at the end of 15 min- utes, and even a third one after 30 minutes. Inhalations of amyl nitrite (11). Internally: Strong coffee, brandy, volatile salt (10 6). Artificial respiration, massage, and friction of the body. Muriatic Acid. See Foot-baths (118). 232. MUSCJE VOLITANTES. Are often without signification ; often due to overwork or some change of the deeper structures of the eye. Rest. —Glasses correcting astigmatism and re- lieving accommodation.—In the bright light: Blue or smoked glasses.—In case of exudations in the vitreous, see Choroiditis (47), Retinitis (271). Muscarin. Sec Myotics (235). 99 MYDRIATICS Mustard. See Medicated Foot-baths (118) and Sinapisms (288). Mustard Paper. See Sinapisms (2S8). Mustard Plaster. See Sinapisms (288). 233. MYDRIATICS. [Dose and directions for use, see Atropine (23), HOMATROPINE (133), DUBOISINE (102), SCOPO- lamin (284), Cocaine (52), and Instillations of Collyria (141) ]. They are poisonous.—Dilate the pupil.—Increase intraocular tension [scopolamin is perhaps the only exception].—Paralyze the accommodation. For aseptic or antiseptic purposes 110 to 210 (15 gr. to *3) of a 1 : 1000 sublimate solution can be added to 1010 of collyrium. To obtain the greatest possible effect, the pure salt can be introduced, care being taken to compress the lachrymal passages so as to avoid poisonous effects. In small children it is best to prescribe mydriatics in the form of an ointment. a. Atropine (23). Mydriatic the most in use.— Very powerful.—Very poisonous.—Mydriasis lasts long.—Sometimes not tolerated by conjunctiva. 6. Homatropine (133). Action is more prompt but weaker.—Less poisonous.—Shorter mydriasis. c. Duboisine (102). Is used where conjunctiva will not tolerate atropine, alone or also in combina- tion with atropine and cocaine. d. Scopolamin (284). Prompt and energetic ac- tion.—Limited duration of the paralysis of accom- 100 MYOPIA modation.—Very little poisonous.—Hardly in- creases intraocular tension. It is indicated particularly where a tendency to an increased tension exists in cases of short dura- tion and for determining refraction. e. Cocaine (52). Very weak mydriatic action.— Adds to the effect when given in combination with other mydriatics. /. Hyoscine and hyoscyamine have been abandoned on account of their uncertain action. 234. MYOPIA. Patient hardly ever tolerates permanently the glass completeJy correcting his myopia; that is, the glass which gives him the best vision in the distance. A weaker glass giving him sufficient vision for dis- tance is therefore to be preferred. It is nearly always better for a myope to use no concave glasses for near vision. Myopia of a slight degree can even require convex glasses, particularly in myopes of mature age.—Where work demands a distance beyond that of the far point of the myope he should use the glass representing the difference between his myopia and the denominator of the working distance. For instance, let working dis- 1 7)Z tance be 50 cm. = -—, the denominator, that is, A the corresponding refraction, is equal to 2 D. A myope of 5 D will receive No. 5—2 = 3 D to see at this distance; a myope of 7 D, the concave glass 7—2 = 5 D. Myopes of a very high degree generally prefer to 101 MYOTICS use one eye alone for near work, renouncing binocular vision, whereby they have the advantage of larger retinal images.—The physician should recommend that patient does not get nearer to his work than the distance corresponding to the glass prescribed. Prophylaxis and hygiene of myopes: From early childhood avoid fatiguing the eyes, even in the choice of playthings.—Moderate reading, good light, daylight by preference.—Good print, large letters, black on a white background, short lines.— Keep as far away as possible from object at which you look.—Avoid bending head forward too far. —Lean against back of chair in reading, write upon an inclined plane.—Light in reading should come from behind ; from the left side and from above in writing.—Interrupt work frequently.—Avoid con- gestions to the head [constipation, excesses at meals, cold feet, tight clothing, sitting close to the lamp, etc.].—Room should be well ventilated, and work never be taken up immediately after a meal. Strengthen the general health, exercise in the open air, gymnastic exercises.—Rest for the eyes, sojourn in the country. Compare also Spasm of the Accommodation (2) and Sclero-choroiditis (47). 235. MYOTICS. [Dose and directions for use, see Eserine (111), Pilocarpine (251), and Instillation of Col- lyria (141).] Contract the pupil.—Lessen intraocular tension,— Are poisonous. 102 NAPHTOL—NEURALGIA OF THE FIFTH NERVE Collyrium is kept aseptic and its action is not modilied by adding 1 cc. of a 1 : 1000 sublimate solution to 1010 of the collyrium. To get the greatest effect possible the pure salt can be introduced, care being taken to compress lach- rymal passages. a. Eserine (physostigmine) (111). Active my- otic, somewhat irritating to conjunctiva. 6. Pilocarpine (251). Less active but better tol- erated by conjunctiva.—Particularly indicated in cases lasting some length of time. c. Muscarine has been abandoned on account of its uncertain action. 230. NAPHTOL. Naphtol a is more irritating than, but has twice the antiseptic strength of, naphtol /?. a. Naphtol a.............. 0120 3 gr. Distilled water............1000|00 2 pts. b Naphtol a...............0|50 8 gr. Lanolin................10|00 2^3 237. NEURALGIA OF THE FIFTH NERVE. Laxatives.—Foot baths (118).—Galvanic current [positive electrode applied upon the painful part.] Locally: Heat.—Massage and friction with: Spirits of camphor, soothing liniments (224\ men- thol pencil (228 b) or ointment (228 a), iodide of 103 NEURITIS methyl (230).—Mustard plaster (288) or a vesicant applied at nape of the neck. Internally: Antipyrin (15 a), antifebrin (14), gelsemium (121), phenacetin (248). In severe cases: Hypodermic injection of mor- phine (231 c), of antipyrin (15 6), or of osmic acid (245).—Alternating hot and cold applications fol- lowed by energetic massage.—Neurectomy. 238. NEURITIS, OPTIC—PAPILLITIS.— INTRABULBAR NEURITIS.—PAP- ILLARY STASIS.—NEURO-RETI- NITIS.—PERINEURITIS. Treat the cause (meningitis, tumors, abscesses, etc.). —Combat circulatory troubles (dysmenor- rhcea, etc.). In fresh cases: Derivatives.—Dark room.—Press- ure bandage.—Mydriatics (233).—Bloodletting (186) at the mastoid process. —Sweating (305).— Drastic cathartics. Later: Dry leeches.—Preparations containing iodine (147 6).—Foot-baths (118). In the regressive stage: Strengthening treatment. —Eye-douches (99).—Galvanic current.—Sojourn in the country. Avoid: Sudden changes from a mild light into a bright light, congestions to the head, and excite- ment. For those suffering from rheumatism: Alkalies (lithium (225), etc.) ; for scrofulous and anwmic patients : Iron (164), arsenic (20) ; for syphilitic patients : Specific treatment (291). 104 NEURITIS — OPHTHALMIA 239. NEURITIS, RETRO-BULBAR. Rest, light diet.—Energetic inunctions with mer- cury (143) during three weeks; where cases then remain unimproved, cease.—Bloodletting (186), foot- baths (118), derivative treatment.—Iodide of po- tassium (146 6, c), strychnine (300).—Diuretics, diaphoretics (305). Nitrate of Silver. See Silver (287). 240. OCCLUSIO PUPILLiE. Iridectomy or iridorrhexis. Oil, Castor. See Oleum Ricini (274). Ointment, Blue = Simple Mercurial Oint- ment. See Mercurial Inunctions (143). Ointment, Calomel. Sec Calomel (33 a, 6). Ointment, Neapolitan = Double Mercurial Ointment. See Specter; Treatment (291 6). Ointment, Red. See Mercury (229 c). Ointment of Unna. See Peroxide of Hydro- gen (135). Ointment, Yellow. See Mercury (229 a, 6). Ophthalmia of the New-Born. See Blen- norrhea l Conjunctivitis (69). 241. OPHTHALMIA, SYMPATHETIC. Enucleation of the eye first affected and excision of part of the optic nerve, followed by an irrigation with a sublimate solution (1 to 2 per 1000) during live minutes. Should the eye first affected not be amaurotic and the other eye already much diseased: Symptomatic treatment: Narcotics.—Atropine (23 a).—Dark 10 •> OPIUM—OPTIC nerve room ; absolute rest.—Iced compresses or hot poul- tices (255), according to the state in which the eye is.—Diuresis and diaphoresis (305 .—Mercurial treatment (143, 291 6). 242. OPIUM. a. Extract of opium........... 0|20 3 gr. Distilled water ............100|00 3Jg Several instillations a day, 1 drop at each instillation. b. Tincture of opium...........1010 2I3 10 to 20 drops at a time in brandy or upon apiece of sugar. A little water to be swallowed afterwards. c. Extract of opium......0102 to 0 06 \ gr. to 1 gr. Subnitrate of bismuth . . 1 .. n c - - o > aa 0 5 aa 8 gr. Sugar of milk.....i A powder; take two powders like this, the first one 11-2 hours, the second 1 hour before cataract operation. 243. OPTIC NERVE, ATROPHY OF THE. Careful anamnesis and appropriate general treat- ment. In the beginning of the atrophy : Injections of strychnine (300 a) ; iodide of potassium internally (146 c) and in inunctions (146 a, 6).—Should there be no improvement after several weeks: Cease this form of treatment so as not to harm the general health, as the resulting benefit to vision is very problematical. Preparations containing iodine (147 6) or iron (164).—Hydrotherapy. Douches in a stream along the spinal column.—Prolonged applications of heat or cold upon the vertebral column.—Sojourn in a 106 ORBICULAR muscle—PARALYSIS warm climate.—Sweating (305).—Massage of the eyeball.—Gal van i c current. In case of syphilis: Specific treatment (291). 244. ORBICULAR MUSCLE, PARALYSIS OF THE.—LAGOPHTHALMUS. Etiologic treatment. —Electricity. —Surgical treatment.—Compare also Keratitis through Lag- ophthalmus (168). 245. OSMIC ACID. Osmic acid................0|05 1 gr. Distilled water..............10|00 2^3 For hypodermic injections: One syringeful contains 0 \ 005 (tV 9r-) osnlic acid. Keep from light. Ozsena. Sec Rhinitis (273). Pagenstecher's Ointment. See Mercury (229 a, 6). Pannus. Sec Pannous Keratitis (172). Panophthalmitis. Sec Suppurative Cho- roiditis (48). 246. PARALYSIS AND PARESIS OF THE OCULAR MUSCLES. Etiologic treatment. In case of I'heumatism : Large doses of salicylate of soda (275).—Sudorifics (305). In case of syphilis: Energetic specific treatment (291). Electricity: a. In paralysis of peripheral origin : Galvanization. The positive pole is a broad plate, 107 PERMANGANATE OF POTASSIUM which is placed upon the neck or the arm. The negative pole has an ovoid form well adapted to the shape of the closed eye. A more circumscript effect is achieved by the use of lentiform electrodes. These should be well insulated with varnish and caoutchouc with the exception of one surface. The eye having been cocainized, the electrode is placed upon the globe directly as far as possible along the position of the diseased muscle. Duration of ap- plication one minute for each single muscle.— 6. In paralysis of central origin: Faradization of the brain may be tried. The electrodes are to be ap- plied upon opposite sides of the head. Should diplopia trouble the patient: Prisms, if the images are near enough to each other to be united by this means, which is rarely the case; opaque glass, where distance between images is too great to unite them. Where above-named treatments give little or no result: Surgical intervention. Give patient binocular vision, at least in a part of the visual field, by a comprehensive advancement of the muscle com- bined with a tenotomy of its antagonist. Paralysis of the Orbicular Muscle. See Or- bicular Muscle (244). 247. PERMANGANATE OF POTASSIUM. Permanganate of potassium . . 0| 05 to 0150 1 gr. to 8 gr. Distilled water........ 200100 6J 43 This solution should not be used after it changes in color. Peroxide of Hydrogen. See Hydrogen (135). 108 PHENACETIN—PHTHISIS OF THE EYEBALL 248. PHENACETIN. L'henacetin......... Sugar of milk.......... From 1 to 3 powders a day in milk 249. PHENOL.—CARBOLIC ACID. a. Phenol ................ 0120 3 gr. White vaseline.............lOJOO 2J3 b. Phenol................ 410 I3 Distilled water.............10o|o 3*23 Instruments should remain in this solution for 45 minutes at least. c. Phrnosalyl. Mixture of carbolic acid, salicylic acid, lactic acid, menthol, and oil of eucalyptus. Takes the place of carbolic acid ; is of greater antiseptic strength. It is used in the following proportions : c/. 1 : 100/o?' instruments. c//. 4 : 1000 for the conjunctiva. Phlyctaena of the Conjunctiva and of the Cornea. Sec Phlyctenular Keratitis (173). 2)0. PHTHISIS OF THE EYEBALL. Prothesis.—In case of persisting inflammatory symptoms: Enucleation. As the phthisical eye is an organ which has kept its vitality, one must never forget telling patients that such an eye is & permanent danger for the other eye (ossification, cicatricial enclosure of the ciliary nerves, etc.). Physostigmine. Sec Eserine (111). 109 laa 0]50 8gr. PILOCARPINE—poultices 251. PILOCARPINE. H}Tdrochlorate of pilocarpine........0| 10 l*gr. Distilled water..............10|00 2J3 Instil 1 drop several times a day. Pilocarpine internally and in hypodermic injec- tions, see Methodical Sweating (305). Poisoning by pilocarpine, see Methodical Sweat- ing (305). 252. PINGUECULA. The Pinguecula may be left without any treat- ment, or can be removed for cosmetic purposes. 253. PLANTAIN.—AQUA PLANTAGINIS. Soothing compresses ; can be added to the differ- ent collyria. Plaster of Mustard. See Sinapism (288). Poisoning by Atropine. See Atropine (23); by Morphine, see Morphine (231) ; by Pilocar- pine, see Methodical Sweating (305). 254. POTASSIUM ACETATE. Acetate of potassium.......... 4 Oxymel of squill............ 50 Distilled water.............1000 Drink in one day; a wineglassful at a time. 255. POULTICES. a. Potato starch poultices. Dissolve starch in a quantity of water just suffi- cient to make a paste ; upon this paste pour boil- 110 0 1* 0 1553 0 2pts. PRESBYOPIA ing water, stirring briskly, until the mixture is transparent and homogeneous. This mass is kept over the fire for 30 seconds, then wrapped in two squares of muslin which have been steeped in water previously in order to remove stiffness.— Heat the reserve poultice constantly in the water- bath while the other remains on the eye ; change as soon as it begins to get cool.—Cover the poultice with a piece of flannel and a piece of oiled silk overlapping the poultice on all sides. For antiseptic purposes boric acid (4 : 100) or sublimate (1 : 5000) can be used to dissolve the starch. Proceed in a similar manner for : b. Linseed poultices. c. Bread or bread and bran poultices. Where pains are very severe : d. Powdered hyoscyamus leaves......3010 1^ Linsrcd-meal.............100|0 3g 23 or : e. Powdered conium leaves........ 40 0 1^ 2^3 Powdered belladonna leaves...... 20 0 53 Water...............1000 0 2 pts. Reduce, one-fourth by boiling. Add linseed-meal q. s. For dry poultices : /. Aromatic leaves, or: g. Conium leaves............. 5010 I3 53 Species emollientes...........150|0 5^ 256. PRESBYOPIA. Where by presbyopia is understood an incapacity of prolonged eye-work, due to age on account of 111 PTERYGIUM— QUININE the diminution of the amplitude of accommodation, the following table will show approximately the convex glass necessary to an emmet rope for reading at a dis- tance of SO cm.: ears. Diopters. 40 0.25 45 1.0 50 1.5 55 2.0 60 2.5 65 3.0 70 3.5 These numbers obtain for the emmetropic eye. The hypermetrope should add to the number cor- responding to his age the lens correcting his hyper- metropia, while the myope should subtract the glass correcting his myopia. Work nearer by necessarily requires a stronger glass ; farther off, a weaker one. Compare : Rules for prescribing glasses for work (125). 257. PTERYGIUM. Ablation by any method permitting the bringing in contact of the margin of the cornea with healthy conjunctiva.—Cauterize the corneal wound. 258. PTOSIS. Systemic treatment. — Electricity. — Surgical treatment. 259. QUININE. a/. Wine of Calisaya bark. Small glassful with meals. 112 RESORCIN—RETINA a". Wine of Calisaya bark and iron ... 1000 2.I3 Citric acid.............. 2 50 40 gr. Malaga wine.............2000 00 4 pts. Sugar................200 00 7g Tablespoonfid 2 or 3 times a day. b. Decoction of Calisaya bark.......20 0 53 Wat.-r................200 0 7:§ Syrup of bitter orange peel.......30 0 I3" While boiling add : Diluted sulphuric acid...........0|50 8 gr. (In order to keep draught clear.) Tablespoonfid 3 times a day. c. Sulphate of quinine........... 0|50 8gr. A poivder. Take one powder every 2 or every 4 hours. Antipyretic. 260 RESORCIN. a. Resorcin................ 10 15 gr. Vaseline................10 0 2Jg Resorcin spray : b. Resorcin............... 510 IJ3 Distilled water............1000|0 2 pts. 261. RETINA, ANEMIA OF THE. Systemic treatment [chlorosis, amentia (164, 259), leuca'iida, diseases of the heart].—Massage of the body and gymnastic exercises.—Hydrotherapy (98). 262. RETINA, ANESTHESIA OF THE. Dark room ; after the sixth day increase light gradually.—Later, smoked or blue glasses.—Abso- lute rest of the eyes for a long time—Tonics.— s H3 RETINA Bromides (31), lactate of zinc (325 d).— Hydro- therapy (98), salt and iron baths (25 c, d, e).—In- halations of amyl nitrite (11).—Galvanic and fa- radic current. Treat the cause [hysteria].—Suggestion. 263. RETINA, ASTHENOPIA OF THE. Treatment for neurasthenia: Scottish douches (98 b), river baths, sojourn in the mountains or at sea-shore. Stop sexual excesses (onanism) and excesses at table. — Smoked glasses. Where photophobia is great, blow anaesthetic vapor into the external auditory canal. 264. RETINA.—"COMMOTIO RETINA." Rest.—Dark room. —Cold compresses. 265. RETINA, DETACHMENT OF THE. Darkroom.—Atropine (23 a).—Remain in bed, lying upon the back, if possible (get up every other day for an hour or two, but during this time lie down on a lounge).—Avoid sudden movements. Pressure bandage; change the bandage once or twice a day. According to the general health of the patient: Every 5 days bloodletting (186) or dry leeches he- hind the ear. Food that is easily digested, particularly milk. —No hard food requiring mastication.—Watch the stools.—Derivative and diaphoretic treatment (305). Follow out this treatment for several weeks.— 114 RETINA Patient will slowly take up his habitual life, and should wear smoked or blue glasses for a long time. Where there is no notable improvement: Try one of the following operative procedures: Puncture or incision at the meridian of the sclera on a level with the detachment.—12 to 15 small cauterizations over the whole surface of the sclera corresponding to the detachment (avoid the ciliary zone) ; or electrolysis: A platin-iridium needle is attached to the positive pole. The negative elec- trode is placed upon the arm. The needle is intro- duced at the place of the detachment.—Current of 3 to 5 milliamperes.—Duration of application : One minute. — Aseptic bandage. In all of these methods of treatment a chance for improvement lies only in fresh cases and where the detachment is not too great in extent. Prophylaxis: Individuals predisposed to a detach- ment of the retina, as myopes of a high degree, or those having already lost one eye through retinal detachment, should avoid sudden movements, con- gestions, constipation, strains, coughing, vomiting, overwork for the eyes, etc. 260. RETINA, HEMORRHAGES OF THE. Systemic treatment [pernicious aneemia, diseases of the heart, nephritis], and treatment of the direct cause [congestions, indigestion, excitement, over- work, menstrual troubles]. Pressure bandage.—Absolute rest.—Cold com- presses. -Bloodletting (186).-Foot-baths (118).— 115 RETINA Diuresis, cathartics, diaphoretics (305).—Iodide of potassium (146 c). In diabetes: Strict diet: no sugar, no starch, sac- charine, specially prepared bread.—Exercise of the body.—Arsenic (20).—Vichy water. In case of frequent relapses: Ergot (109), to in- crease the tonus of the blood-vessels. 267. RETINA, HYPEREMIA OF THE. Treat the systemic trouble (anomalies of circu- lation, emphysema, etc.).—Rest the eyes [iio mydri- atics increasing hypersemia of the fundus but rather myotics (235)]. —Smoked glasses or dark room for some length of time. Purgatives.--Bleeding (186) behind the ear.— Periodical and prolonged cold applications (com- presses or ice-bag). 268. RETINA, HYPERESTHESIA OF THE. Rest.—Dark room, later smoked glasses, the tint of which should be diminished gradually.— Where there is astigmatism correct it. Systemic treatment for anaemia, chlorosis (164, 259), and the neuroses, which are often the cause of this affection. 269. RETINA, ISCHEMIA OF THE. Combat spasmodic interruption of the circula- tion by eye-douches (99) or alternate hot and cold compresses.—Absolute rest, dark room.—Digitalis (96), amyl nitrite (11).—Tonics, stimulants. no RETINA—RETINITIS PIGMENTOSA 270. RETINA, TUMORS OF THE. [Glioma, gliosarcoma, etc.] Enucleation. 271. RETINITIS, DIFFUSE, Exudative, Punctated, Specific, Albuminuric, Dia- betic, Leucsemic. Treat the systemic disease. In the beginning: Absolute rest in a dark room. —Heurteloup or leeches behind the ear (186), where general health of patient permits.—Accord- ing to the constitution of patient: Iodide of potas- sium (146), mercury (229) or iron (164), quinine (259).—Mild purgatives. Later: Smoked glasses; avoid sudden change from darkness to bright light. —Strengthening food, tonics, sojourn in the country or at the sea-shore.— In unyielding cases: Try repeated paracentesis.— When cured: Correct anomalies of refraction before permitting return to work.— Continue treatment, and long after re-establishment of vision take great care of the eyes. 272. RETINITIS PIGMENTOSA. — PIG- MENTARY DEGENERATION OF THE RETINA. No form of treatment is effective.—To retard devel- opment : Strengthening food.—Cod-liver oil (54). —Hydrotherapy (98).— Where the eyes are very sensitive to light: Dark glasses. Retinitis, Purulent. See Purulent Choroi- ditis (48). 117 RHINITIS 273. RHINITIS, CHRONIC. Treat the cause [syphilis (291), scrofula, polyps]. Minute cleanliness.—Open air.—Good ventilation, particularly in the bedroom. Spray the nose with a solution consisting of: o 332^3 0 6153 0 13 0 45 gr. Peppermint water............100 Distilled water..............200 Glycerin.................30 Biborate of soda............. 3 Nasal douches (100) with boric acid (4 : 100), permanganate of potassium (£ to 1 : 1000), or salt water (physiological solution 6 to 7 : 1000). In case of ozcena : Thymol (z : 1000) or : Salicylic acid............... 2 0 £3 Biborate of soda............. 3 0 45 gr. Distilled water..............200 0 63" 4s; Where there is little secretion : Prolonged inhala- tion of the steam of a saturated salt water solution. After each steaming use one of the following oint- ments : White precipitate of mercury........0150 8gr. Cold cream................25|00 63 or: Sulphate of zinc.............. 0120 3 gr. Vaseline................. 20|00 53 Every other day physician should apply : Pure iodine........•'.......0 20 3 gr. Iodide of potassium............ 0 30 5 gr. Glycerin.................30 00 1 if to the nasal mucous membrane. Where secretion is copious use one of the following powders as a snuff : 118 RICINI SALOL Finely powdered betol . . .......2 Menthol..................0 Pure cocaine...............0 Ground roasted coffee............1 50 38 gr. 25 4gr. 10 ijgr. 50 23 gr. 00 n 00 75 gr. 05 \ gr- Salicylate of bismuth...........15 Camphor................. 5 Pure cocaine...............0 At ropie forms of ozcena require special treatment. 274. RICINI, OLEUM.—CASTOR OIL. 1 to 2 tablesjwonfuls. [Lemon juice may be added.] 275. SALICYLATE OF SODA. Salicylate of soda..............6 Distilled orange flower water.....) -. nn. ^. •„ t . r aa 60 Distilled peppermint water......J Simple syrup.............. 30 Table spoonful every two hours. U3 aa 2% 13 276. SALICYLIC ACID. Salicylic acid............ Tincture of benzoin........ Lanolin..................15 aa 0 50 aa 8 gr. oo \l 277. SALIPYRIN. Combination of salicylic acid and antipyrin.—In powders of 0|5(8gr.). From 1 to 4 pow^ders a day. 278. SALOL. Salol............... Sugar of milk............ One powder ; 4 t° 10 powders a day. Salt, Volatile = Carbonate Sec Ammonia (10 b). 119 aa 10 15gr. of Ammonia. SCLERA — SC LERITIS 279. SCLERA, SUBCONJUNCTIVAL RUP- TURE OF THE. Absolute rest.—Pressure bandage.—Ice. 280. SCLERA, BENIGNANT TUMORS OF THE. Expectant treatment. 281. SCLERA, MALIGNANT TUMORS OF THE. Enucleation. 282. SCLERA, PENETRATING WOUNDS OF THE. Suture the conjunctiva over the scleral wound.— Stitch at some distance from edge of wound so as to form a tampon of conjunctival tissue. Where there is prolapse of the choroid coat: Replace it or cut it off (the latter measure is the safer).—Pressure bandage.—Strict antisej)sis.—Ab- solute rest. 283. SCLERITIS. Local treatment as in episcleritis (108), more or less energetic according to time of subsistence and intensity of inflammation. Should this treatment not suffice: Leeches (186) at the temples.—Galvano-cautery or deep scarifica- tions, followed by the instillation of a weak solu- tion of eserine (111) or cocaine (52 a), and a dry bandage kept upon the eye night and day.—Gal- vanic current through a solution of salicylate of 120 SCOPOLAMIN—SCOTOMA lithium [1 to 2 : 100], in which the eye is bathed for 5 minutes every other day.—During intervals : Dry heat or hot fomentations.—Foot-baths (118). Treatment for gout and rheumatism : Salicylate of soda (275, antipyrin (15 a), antifebrin (14), tinc- ture of aconite \20 to SO drops a day as a draught], salicylate of lithium (225 a). All inflammatory symptoms having disappeared, assist resorption by : Hydrotherapy (98). Methodical sweating (305).—Compresses with : Oil of turpentine..............2510 73 Yolk of one egg. Emulsify with a Chamomile infusion.......15|0to300|0 £3" to 10^ Add Spirits of camphor............2510 73 Shake the mixture before using. 284. SCOPOLAMIN. Hydrobromate (or hydrochlorate) of scopolamin........0101 to 0 02 £ gr. to $ gr. Distilled water........ 10 00 2J3 Instil 1 drop several times a day. Scotoma, Scintillant, with Objective Symp- toms. See Synchisis (307). 285. SCOTOMA, SCINTILLANT, WITH- OUT OBJECTIVE SYMPTOMS. Tonics, good nourishment.—Avoid overwork.— Stop use of tobacco and of anything which can hinder digestion.—Antipyrin (15 a), quinine (259), caffeine [up to 110 a day].—Galvanic and faradic 121 SECLUSIO PUPILLtE—SINAPISM current.—Pressure on the suborbital nerves.—Re- peated massage of the eyeball.—Suggestion. Correct anomalies of refraction (particularly astig- matism) and of the accommodation. Treat hemicrania, anamiia, dyspepsia, and other troubles, which generally accompany scintillant scotoma. 286. SECLUSIO PUPILL^E. Iridectomy. —Iridorrhexis. 287. SILVER, NITRATE OF. a. Nitrate of silver............0|05 £ gr. Distilled water.............10|00 213 After instilling the collyrium neutralize with salt water. Keep solution from, the light. b. Nitrate of silver pencil. Pure nitrate of silver pencil (lunar caustic). Mitigated nitrate of silver pencil. Either : a. Nitrate of silver...........\&a 1I5 aa 23 gr. Nitrate of potassium.........> or : p. Nitrate of silver.............1|0 15 gr. Nitrate of potassium...........2|0 £3 After each, application neutralize with salt water. 288. SINAPISM. Dissolve mustard meal in barely lukewarm water and apply directly upon the skin.—Xever use boiling water, vinegar, or acids.—Where imme- diate effect is desired use mustard paper. Soothing Liniment. See Liniments (224). 122 SPASM OF THE ORBICULAR MUSCLE 289. SPASM OF THE ORBICULAR MUS- CLE, Tonic and Clonic. Correct anomalies of refraction.—Treat existing conjunctivitis (70, 73, 78). Smoked glasses, or dark room.—Leeches QW) at temple.—Injections of morphine (231 c).—Vapors inducing amesthesia in the external auditory canal. —Keep from any irritation.—Bromides (31).— Tincture of aconite root [20 to 30 drops daily as a draught.']—Gelsemium (121). In persisting spasm: Neurotomy or extirpation of the external nasal nerve. 290. SPECIES SUDORIFIC^. Adjuvant to diaphoretics and diuretics. 291. SPECIFIC TREATMENT. — ANTI- SYPHILITIC TREATMENT. There are three methods of administering mercury, which should be applied according to the indica- tion to be met. a. Internal medication.—This is the most practical and the most simple method of administering mer- cury, but it naturally depends upon the gastro-intes- tinal tolerance of the patient.—It is not indicated in dyspepsia or any digestive troubles, tendency to diarrhoea, etc.—a'. Protiodide pills (5 centigr. for each pill with 1 centigr. of extract of opiums /, later 2, of these pills a day just before meals.—Or a". Sublimate pills (302 e). From 2 to 3 or even 4 of these pills a day where the stomach tolerates them. They should be taken immediately before or with meals. 123 SPECIFIC TREATMENT —Or a'". Van Swieten's solution (302 d) (1 or 2 tablespoonfuls a day in milk). b. Method of administering mercury by inunctions. —This method, while very efficacious, is often repel- lent to the patient on account of the difficulties en- countered in applying it. Above all, there are dan- gers from irritation of the buccal cavity in it, which it is well to avert in time. The method is not indi- cated for patients with poor teeth or chronic gingi- vitis.—Daily inunctions (lasting at least 10 minutes) with 4J0 (I3) of the double mercurial ointment (equal parts mercury and excipient). These inunc- tions should be made alternately on one and on the other side of the body below the armpits. — Use ointment in the evening and leave it in contact with the skin over night. — Wipe off the ointment in the morning, wash with soap and powder with starch-meal. Watch the oral cavity during this treatment. Strict hygiene of the mouth.—Brush the teeth morning, night, and after meals.—Gargles of chlorate of potassium (J/.\0 to one large glass of water).—At the slightest trace of gingivitis suspend inunctions. c. Method of administering mercury by injec- tions. This is a very active method and in particular acts quickly. It is therefore to be preferred to the other methods where an imminent danger is to be averted or rapid action is indicated. However, it has its inconveniences, as it is painful and produces nodules or sometimes even abscesses at the seat of the injection.—It can be administered : (1) By daily injections of Delpech's solution (229 n) (1 Pravaz syringeful); or with the solution of the biniodide of 124 SPECIFIC TREATMENT mercury in oil (229 /) in the same dose; or (2) the more active method with calomel injections at greater intervals can be employed : Powdered calomel.............110 15 gr. Hydrocarbon oil..............lo|o 2^3 1 Pravaz syringe contains about 0\1 (1 1-2 gr.) of calomel. —Dose : 1-2 Pravaz syringeful every week. Observe the usual rules of strict antisepsis while making these injections : Wash seat of injection previously with a sublimate or carbolic acid solu- tion.—Use a syringe that can be sterilized ; wash syringe with alcohol or carbolic acid solution ; dis- infect needle by heating. Injection should always be a deep one. Deep in- jections are, as a rule, well borne by patients, while superficial injections are painful and dan- gerous at the same time. These hypodermic injections can be made either in the retro-trochanteric fovea, the lumbar, or the gluteal region. d. Combined treatment. Where indications demand the reenforcement of the action of mercury by that of iodide of potassium, prescribe this drug and use in conjunction with mercurials : d'. Distilled water............50010 1 pt. Iodide of potassium..........30|0 1^ 2 to 4 tablespoonfuls before meeds in 1-2 glass of milk, beer, or sugar water. Or: d.". Syrup of bitter orange peel......50010 1 pt. Iodide of potassium..........25|0 6^3 2 to 4 tablespoonfids before meals in 1-2 glass of water. 125 STAPHYLOMA—STR A11ISMUS One of the best methods of administering the combined treatment is the following : Immediately before each meal one (Dupuytren) sublimate pill (229 e) taken with a spoonful of the iodide solution or syrup. Or : One injection or one daily inunction together with 2 to 3 to 4 tablespoonfuls of the iodide of po- tassium solution or syrup. 292. STAPHYLOMA, PARTIAL CORNEAL. In a recent staphyloma: Repeated paracentesis followed by an aseptic pressure bandage. Iridectomy.—Tattooing.—Excision of the cica- tricial tissue. Staphyloma, Pellucid Corneal. See Kerato- conus (177). 293. STAPHYLOMA, TOTAL CORNEAL. According to the degree of prominence : Tattoo- ing or ablation with strict antiseptic precautions. 294. STAPHYLOMA, ANTERIOR SCLE- RAL. Watch the case.—Where patient insists upon an operation : Ablation with strict antiseptic precau- tions.—Where staphyloma is very large and hin- ders the movements of the lids : Enucleation. 295. STRABISMUS, CONVERGENT NON- PARALYTIC. In children under one year : Do not interfere.— Later, atropine (23 a) (0102 in 101 0 [} gr. in 2J3] ) ; carefully instil one drop into each eye once or 126 STRABISMUS twice daily. For older patients use a stronger so- lution.—For children under three years give atro- pine in form of an ointment (23 d).—Convex tinted glasses correcting the whole hypermetropia.—Avoid looking near by as much as possible.—At an age where study is indispensable give for near vision convex glasses 3 D stronger than glasses used for dis- tance, so as to be able to continue using mydriatic. To develop binocular vision: Stereoscopic exercises repeated several times a day, even if only for a few minutes at a time. This pacific treatment is continued as long as strabismus diminishes.—Should strabismus remain stationary: Surgical intervention. Where one eye has very poor vision, this should take place im- mediately. Where vision in both eyes is good : Operation can be postponed for months and years. The surgical treatment which can be most recom- mended for convergent strabismus is the advancement of the external recti of both eyes without tenotomy of the internal recti. Advancement of the rectus ex- ternus of the strabotic eye alone will but rarely be sufficient. After operation bandage both eyes and order pa- tient to remain in bed until healing has taken place (6 days, as a rule).—When use of bandage is dis- continued : Atropine, convex glasses, stereoscopic exercises until any tendency to strabismus has dis- appeared. This treatment should not be suddenly interrupted. Begiu by decreasing the dose of the mydriatic, later decrease strength of convex lenses. The glass 127 STRABISMUS correcting the manifest hypermetropia is retained as long as eye covered with the hand shows any tendency to convergence.—Watch and strengthen the general health. Where strabismus is of long standing, of high de- gree, and where motility towards temples is limited, increase the effect of an advancement by resection of the tendinous ends of the external recti.—In the highest degrees only tenotomy of the internal rectus of the deviated eye may be added. But this tenot- omy should be made very cautiously and not before several weeks or months have passed since the principal operation : Horizontal conjunctival in- cision, detachment of the tendinous end without lengthening the cut into Tenon's capsule. In over-correction: Stop use of atropine, remove the binocular bandage as soon as possible, practise convergence.—Where necessary, reattachment of the retracted internal rectus by a suture. In case of insufficient correction: At first energetic exercise without further surgical intervention.— Where insufficiency is due to the fact that the ex- ternal rectus is attached too far away from the cornea, perform operation for the advancement of this muscle again.—It will hardly ever be necessary to perform tenotomy of both interni. We would caution against the forced tenotomy as well as the " thread operation.'"—Prominence of the eyeball, retraction of the caruncula, restriction of the movement of the eye inward, and insufficiency of convergence may result, followed in most cases by a divergent strabismus. 128 STRABISMUS 296. STRABISMUS DEORSUM VER GENS. If due to a systemic disease: Treat this disease. Should this not promise much : Surgical treatment. Slight degree of strabismus deorsum vergens : Ad- vancement of the superior rectus. Medium degree: Extensive advancement of supe- rior rectus with slight tenotomy of the inferior rectus. High degree: Perform advancement of inferior rectus or tenotomy of superior rectus or both on the healthy eye in addition to the treatment mentioned above. General rule : When a difference in the level of both eyes exists, it is better to place the eye which has the higher level on to a lower level (increasing the power of the inferior rectus by advancement), than to raise the other by a tenotomy of this mus- cle. As a matter of fact, the eyes are used more in lowering the glance than in looking up. 297. STRABISMUS, DIVERGENT NON- PARALYTIC. Advancement of both internal recti will nearly always be necessary. Stereoscopic exercises greatly assist in this treatment. In divergent strabismus of long standing and of high degree generally affecting an amblyopic eye, tenotomy of the external rectus must be added to a comprehensive advancement of the internus. Often even a combination of the advancement of both internal recti with a tenotomy of both external 9 129 STRABISMUS—STRYCHNINE recti is necessary to achieve a sufficient correction. —Exercising convergence is useful to heighten the effect of the operation. In over-correction: Reattach by advancement one of the muscles upon which tenotomy has been per- formed without touching those upon which ad- vancement has already been practised. Slight degrees of divergent strabismus are treated as Insufficiency of Convergence (142). Strabismus, Paralytic. See Paralysis of the Ocular Muscles (246). 298. STRABISMUS SURSUM VERGENS. Where surgical treatment is indispensable : Slight degree: Advancement of inferior rectus. Medium degree: Advancement of inferior rectus with tenotomy of superior rectus, even detachment at its origin of the inferior oblique muscle. Where the degree is very high: Assist these opera- tions by a tenotomy of the inferior rectus of the other eye. Compare also Strabismus Deorsum Vergens (296). 299. STROPHANTHIN. Strophanthin.........0|01to 0j02 £ gr. to £ gr. Distilled water....... 20|00 53 1 syringe = 0\0005 to 0\001 (1-125 gr. to 1-60 gr.) of strophanthin; injection 20 minutes before narcosis in case of disease of the heart. 300. STRYCHNINE. a. Sulphate or nitrate of strychnine.....0110 1J gr. Distilled water............ lo|oO 2$3 1 syringe — 0\01 strychnine ; begin with 1-4 syringeful. 130 STYE—SUBLIMATE b. Sulphate or nitrate of strychnine.....0|40 6 gr. Lard .................20|00 53 Periocular inunctions, once or twice daily. 301. STYE. — HORDEOLUM. — FURUN- CLE OF THE LIDS. Poultices (255).—Incision. followed by an anti- septic bandage (101). As a prophylactic : Frequent sublimate washes (302 b) ; watch coexisting conjunctivitis (70) and blepharitis (26); derivative treatment. 302. SUBLIMATE, CORROSIVE = BI- CHLORIDE OF MERCURY. a. Solution 1 : 500: For disinfection of hands.— Treatment of purulent conjunctivitis and of granu- lations [friction of everted lids after massage with powdered boric acid], b. Solution 1: 5000 : The usual solution for wash- ing and eye bandages.—For cataract operation add half the quantity of sterilized water. These solutions [a and b] are more efficacious and will keep better if a quantity of chloride of sodium equal to that of sublimate is added. c. Peptone................ 110 15 gr. Distilled water.............50|0 1^ 53 Filter and add,: Corrosive sublimate solution 5: 100 .... 20 0 53 Chloride of sodium solution 20 : 100 ... . 160 %% Distilled water, q. s. to make........100 0 3% 23 1 syringe — 0\01 (1-6gr ) of sublimate. 131 SULFONAL—SWEATING d. Van Swieten's Solution : Corrosive sublimate.......... 10 15 gr. 80 per cent, alcohol.........100 0 3 2 2? Distilled water...........900 0 305 Not to be recommended for local applications; the alcohol contained in it is irritating to the eye. e. Dupuytren s Pills: Corrosive sublimate...... ... 0 50 8 gr. Extract of opium...........1 00 15 gr. Extract of liquorice, q. s. for 50 pills. 4 pills daily, to be taken immediately before or with meals. Sublimate Baths. See Medicated Baths (25). 303. SULFONAL. 210 to 410 (I-23 to I3) as a powder.—Before retiring. 304. SULPHUR. Precipitated sulphur............ 1|0 15 gr. White vaseline..............20|0 5z Application to remain on parts for several hours. 305. SWEATING, METHODICAL.—DIA- PHORESIS. In nearly all eye troubles steam baths are contra- indicated, as they cause congestion to the head. Only when every trace of inflammation is gone can they be used. Sweating and salivation through pilocarpine: a. As a draught [where stomach tolerates it] : Hydrochlorate of pilocarpine..... 0 Brandy............... 20 Distilled water...........250 2 to 4 tablespoonfuls daily, at intervals of 1-2 hour. 132 20 3gr. 00 53 00 8.1 SYMBLEPHARON—SYNCHISIS b. Hypodermic injections : Hydrochlorate of pilocarpine......0| 10 1^ gr. Distilled water............10|00 2^3 Dissolve and filter; 1 syringe = 0\01 (1-6 gr.) of pilo- carpine ; 1 to 2 syringefuls a day. To assist sweating and as a diuretic prescribe : Tea of species sudorificse (290), of linden flowers, of sambucus, of quassia or the acetate of potassium (254). In case of pilocarpine poisoning: a. Absorption by gastro-intestinal tract: Stomach-pump or hypodermic injections of a solution of hydrochlorate of apomorphine (2:100), up to 0\03 (1-2 9r-)- (3. Absorption through the tissues (injections) : Hypodermic injection of one milligramme of neutral sul- phate of atropine [2-10 of a Pravaz syringeful of the ordinary collyrium (23 a)]. In both cases internally : Black coffee, brandy, carbonate of ammonia (10 b). 306. SYMBLEPHARON. Surgical treatment. 307. SYNCHISIS, SCINTILLANT.—SCIN- TILLANT SCOTOMA, WITH OB- JECTIVE SYMPTOMS. [Crystals of cholesterin and tyrosine in the vitreous.] Combat biliary lithiasis depending on alcohol- ism or arthritis.—Repeated paracentesis where there is also cholesterin or tyrosine in the aqueous humor. Syphilis. See Specific Treatment (291). 133 SYRUPUS ARMORACLE—THYMOL 308. SYRUPUS ARMORACIiE. Simple or with iodine. A small glassful at meals. 309. TALC. Dust upon integuments [moist and excoriated parts]. 310. TANNIN.—TANNIC ACID. a. Pure tannin.............. 0 Fennel water.............20 Distilled water.............100 b. Tannin..............1 .. in V aa 10 Glycerin.............J Glycerole of starch............50 Apply to excoriated parts. 25 4 gr. 00 53 00 33 23 0 aa 2^3 0 13 53 311. TARSITIS. Antisyphilitic (291) or antiscrofulous treatment [iron (164), arsenic (20), cod-liver oil (54)]. Massage on a plate lid holder with an anodyne ointment or simple mercurial ointment. — Hot fomentations. —Scarifications. 312. THYMOL = THYMIC ACID. Can replace phenol ; as a spray (\ to 1 : 1000) upon the closed lids. To make a 1 :1000 solution : Dissolve the thymol in 4|0 (13) of 90 per cent, alcohol before adding water. 134 TILI.E -VASELINE 313. TILIiE, AQUA. Soothing compresses.—Can also be added to the different collyria. Trachoma. Sec Granular Conjunctivitis(75). 314. TRICHIASIS. Destroy root of lashes by electrolysis. [See Dis- tich iasis (97).] 315. TRIONAL. 110 to 1150 (15 gr. to 23 gr.) in a cup of hot milk before retiring. 316. TRYPSIN. 10 : 100 solution; dissolves diphtheritic mem- branes. Tylosis. See Lids (219). Ulcer, Indolent. See Neuroparalytic Ker- atitis (171). Ulcer of the Cornea. See Ulcerous Kera- titis (176). Unna's Ointment. See Peroxide of Hydro- gen (135). 317. VASELINE. Good excipient for eye salves; does not irritate ; does not change when exposed to air.—In summer add a little ceresin or simple wax to keep it from getting too liquid. White vaseline is the best as long as it is pure ; when not sure of its quality take the yellow by preference. —Vaseline must be tasteless, odorless, and neutral. 135 VERATRINE—VITREOUS 318. VERATRINE. Veratrine................. 0150 7$ gr. Lard................ . . 20|00 63 Periocular inunctions; once or twice daily. 319. VITREOUS, CYSTICERCUS OF THE. Sufficiently long incision [not less than 8 mm.] in the direction of the cysticercus, following as much as possible a meridian of the eyeball.—Ex- traction with a hook, forceps, or by aspiration.— Sutures, antiseptic bandage (101). Possibility of the presence of a second cysticercus! 320. VITREOUS, DETACHMENT OF THE. Absolute rest.—Atropine (23 a).—Pressure band- age.—Diaphoresis (305), diuresis, laxatives.—See Detachment of the Retina (265). 321. VITREOUS, FOREIGN BODY OF THE. Extraction with the electro-magnet, or, accord- ing to the case, with a hook or the forceps. In- cision of the sclera in the region of the foreign body; sutures; antiseptic bandage (101).—This operation can be performed even when suppura- tion has begun around a piece of metal.—In case of extensive suppuration : Enucleation or evisceration. 322. VITREOUS, HEMORRHAGES INTO THE. Treat the systemic disease : Xephritis, diabetes, pernicious anaemia.—Special treatment of the cho- roiditis (47) and chorio-retinitis (271). 136 VITREOUS—ZINC' Hemorrhage from circulatory troubles or trauma : Absolute rest, darkened room.—Atropine (23 a).— Pressure bandage.—Cupping at the temple.—Iced compresses upon the eye. Later diaphoresis, diuresis, laxatives [pilocar- pine (305), salicylate of soda (275), calomel (33 d) ]. —Iodide of potassium (146 c).—Hot compresses.— Local douches alternately hot and cold.—Repeated paracentesis. 323. VITREOUS, LIQUEFACTION OF THE.—SYNCHISIS. Treat the systemic disease.—See Choroiditis (47) and Retinitis (271). 324. VITREOUS, OPACITIES OF THE. Special treatment of the choroiditis (47) and retinitis (271). Derivative treatment, pilocarpine (305), iodide of potassium (146 c).—Galvanic current.—Pro- longed poultices (255) upon the eye.—Where thick central membranes are found a discission should be made and the membranes can be displaced. [Scle- ronyxis.] White Precipitate. See Mercury (229). Xerosis. See Conjunctiva (67). 325. ZINC. a. Sulphate or sulphophenate 10] 10 to 0 20 1$ gr. to 3 gr. of zinc........> Distilled rose water ... 50 00 lg 63 Distilled water..... 150 00 63" Mix and filter. 137 ZONA OPHTHALMICA b. Oxide of zinc.......... 0150 7^ gr. Vaseline............15|0to 25100 43 to 63 20 3 gr. 00 13 10 gtt. c. Chloride of zinc......... 0 Distilled water.......... 30 Tincture of opium.........10 drops. Filter. d. Lactate of zinc.............0|30 4£gr. 1 powder every 3 hours. 326. ZONA OPHTHALMICA. Cupping (6010 to 8010 [23 to 23 53] ) near orifice of external nasal nerve.—Atropine (23 a).—Anti- septic bandage (101).—Washes and hot compresses, with: Neutral acetate of lead.......... 3 0 45 gr. Powdered alum............. 2 0 $3 Distilled sterilized water..........150 0 5^ For pain: Instillations of cocaine (52 a), injec- tions of morphine (231 c) at the temple. Internally: Quinine (259), antipyrin (15 a), anti- febrin (14), or : Fluid extract of gelsemium........ 110 15 gr. Sulphophenate of sodium......... 7 0 If 3 Distilled water..............15o|o 5g Mix ; teaspoonful every 2 hours. Where vesicles having burst become ulcers: Apply antiseptic washes (sublimate 1 :2000), boric acid 4 :100, etc., and later on ointments with calomel (33 a, b) or yellow oxide of mercury (229 a, b). THE END. 138 Therapeutics: ITS PRINCIPLES AND PRACTICE. A work on Medical Agencies. Drngs and Poison*, with Especial Reference to Relation* between Physiology and Clinical .Medicine. By H. O. WOOD, M.D., LL.D., Professor of Materia Medica and Therapeutics, aud Clinical Professor of Diseases of the Nervous System in the University of Pennsylvania NEW TENTH EDITION. Thoroughly Revised. 1 vol. Octavo. Over 1000 pages. (loth. $6.00: Sheep. $6.50. NOTICE OF NINTH EDITION. " To review this standard work is a real pleasure : it discovers so much original investigation, sound learning, and practical worth, and so little sub- servience to mere authority, that it engages atten- tion, commands respect, and inspires confidence, —the chief desiderata in all teaching. 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LIPPINCOTT COMPANY, Publishers, PHILADELPHIA. The Practice of Medicine. By HORATIO O. WOOD, M.D., LL.D. (Yale), Professor of Therapeutics and Cluneal Professor of Nervous Diseases m the University of Pennsylvania; Member of the National Academy of Science, AND REGINALD H. PITZ, A.M., M.D., Hersey Professor of the Theory and Practice of Physic in Harvard University ; Visiting Physician to the Massachusetts General Hospital; formerly Shattuck Professor of Pathological Anatomy in Harvard University. Complete in one handsome octavo volume of about one thousand one hundred pages. Cloth, $6.00; Sheep, $7.00: Half Russia, 87.50. Sold only by subscription. "The work before us is a good one in every respect, and is in addition a splendid example of collaboration in writing."—St. Louis Medical and Surgical Journal. " It is a delight to pick up a work devoted to the practice of medicine which, instead of being a mere collation, is wholly original. 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