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A  TEXTrBOOK
Practical  Therapeutics,

           WITH ESPECIAL REFERENCE TO THE

  APPLICATION OF REMEDIAL MEASURES TO DISEASE
                    AND THEIR

      EMPLOYMENT UPON A RATIONAL BASIS.
                    BY

       HOBART AMORY  HARE, M.D., B.Sc,
PROFESSOR OF THERAPEUTICS AND MATERIA MEDICA IN THE JEFFERSON MEDICAL COLLEGE OF
  PHILADELPHIA ; PHYSICIAN TO ST. AGNES'S HOSPITAL AND TO THE JEFFERSON MEDICAL
   COLLEGE HOSPITAL ; CONSULTING PHYSICIAN TO THE FRANKLIN REFORMATORY
     HOME J LAUREATE OF THE ROYAL ACADEMY OF MEDICINE IN BELGIUM,
       OF THE MEDICAL SOCIETY OF LONDON, ETC. ; PRESIDENT OF THE
          SECTION OF THERAPEUTICS IN THE PAN-AMERICAN
                 MEDICAL CONGRESS.


    THIRD EDITION, ENLARGED AND THOROUGHLY REVISED.
     PHILADELPHIA :
LEA BROTHERS  & CO.
         1892. 
i-* X(4H=
Entered according to the Act of Congress, in the year 1892, by
             LEA BROTHERS  &  CO.,
in the office of the Librarian of Congress.  All rights reserved.
DOKNAN, PRINTER. 
THIS VOLUME
                IS  DEDICATED  TO


         Dr.  J. WILLIAM WHITE,
PROFESSOR OF CLINICAL SURGERY IN THE UNIVERSITY OF PENNSYLVANIA,

                       AS AN

        EVIDENCE OF FRIENDSHIP AND ESTEEM,

                          BY
THE  AUTHOR. 
 
PREFACE  TO  THE  THIRD  EDITION.
  Ix presenting the third edition of this Text-book of Practical
Therapeutics to the profession  the author may be allowed to ex-
press his  gratification at the favorable reception accorded its  prede-
cessors.  Just two years ago the book made its first appearance, and
the rapid exhaustion  of  the editions  has  forced  the author to be
constantly engaged  in  revising the work and preparing it  for  the
publisher.   By this constant attention to the smallest detail connected
with the book the author has  been able to present not only accurate
information, but  also  the very latest  reliable  results  obtained in the
treatment of disease by those who have employed the newer remedies.
In  this edition directions are  given for the  use  of  drugs  of such
recent introduction as Salophen, Guaiacol, Diuretin, Europhen, Thiol,
Phenocoll   hydrochloride,  Piperazine,  Dermatol,  Pental,  Terpine
hydrate, Terpiuol, and the  salts of Strontium.   Much  information
has also been added to the articles on such drugs as Salol, Phenacetine,
Menthol,  and similar comparatively recent remedies.  Another  im-
portant addition is a list of drugs arranged as far as possible accord-
ing to  their physiological  action  and  a  list of  definitions of  the
terras used to designate classes of drugs.
  In making  the necessary  additions the  author  has  been careful to
preserve that conciseness of statement and facility  for ready reference
which has  done  so  much   toward rendering the previous editions
useful to  the  active  practitioner and  student, whose needs consist
in having at hand a work which will not confuse the reader by the
statement  of many different views, but gives  that which experience
ha!s shown  will prove  most useful in practice.

    Philadelphia, 222 South  Fifteenth Street. 
 
PREFACE  TO  THE  SECOND  EDITION.
  The fact that the first edition of this book was exhausted within
six months of its publication, and adopted as a text-book in a number
of medical schools during that time, has encouraged the author in
his  efforts to  make the work  more  serviceable than  before.  A
number of new drugs are discussed  which have been tried with suf-
ficiently good  results to  warrant their introduction into a text-book
and work of reference, and the latest information  regarding the more
familiar  medicaments has been added.  The method of employing
the  rest-cure,  and the use of suspension in the treatment of  loco-
motor  ataxia  and  allied  affections are given, and a large number of
new  prescriptions  have been  iuserted to illustrate still  further the
best  means of applying remedies for the cure of  disease.

   Philadelphia, 222 South Fifteenth Street.
                   May,  1891. 
 
PREFACE  TO  THE   FIRST   EDITION.
   The object of this book is  to provide the physician or under-
graduate student of medicine with a reliable guide in the study of
Therapeutics, or the application of remedial measures for the cure of
disease.  It  has been written  because,  in the belief of  the author,
most of the  text-books on this  subject  treat  of it as if  the student
were already a skilled physician or experimental pharmacologist.  As
a consequence, two classes of undergraduate readers exist.   One finds
that the mixture of science and empiricism is  too difficult for him to
fathom, and is hopelessly confused; the other  simply learns the reme-
dies and doses by heart and gives drugs with  little  idea as to what
they are to do.  Further than  this, the physician is often  at a loss to
decide when a remedy is indicated, even though his theoretical knowl-
edge of the subject be very  thorough.   Thus, he is told that ammo-
nium chloride is a remedy in bronchitis,  but the exact stage at  which
it  is to be employed is often not stated  ; or he knows that  digitalis
does good  in cases of cardiac  disease, but fails to recognize  the  fact
that it is only when  compensation is lacking that the drug is needed.
For this reason Part IV. has been  written,  not  with the  object of
providing a rigid system for treating disease, but rather for the pur-
pose of bringing together the best remedies, and of showing  how and
why they are given.
   Rational  therapeutics at  the  present day  does not consist in  a
knowledge of doses and the materia  medica,  but exists as a complex
art in which knowledge and its proper application, based on common-
sense principles, go haud-in-hand.  The  treatment of "symptoms as
they arise" by the employment  of remedies  recommended  by some
eminent authority is a variety  of empiricism  whose  existence has
depended largely on the fact that many  physicians of the past have 
 xii           PREFACE TO THE FIRST EDITION.
 either been so ignorant as to be led where a writer willed, or so sloth-
 ful as to be willing to let others  think for them.   Scientific research
 has so largely opened up to everyone the possibility of using drugs
 with a distinct idea of  the  reason  for  their  employment, that the
 writer  has  endeavored to bring  together in a readable form the com-
 bined results of laboratory and bedside experience, thinking the time
 ripe  for such a task.   It is  true that several other books  give, in a
 more or less  thorough manner, a resume, of the  physiological action
 of the  drugs  of which they treat, but in even the best of them only
 the most trained student of pharmacology can discover the  close rela-
 tionships which exist between the results  reached  by the physiologist
 on the one hand and the clinician on the other.   The two parts of the
 study are usually so divorced  by the  prolonged mental effort neces-
 sitated by the arrangement of the text, that the student either ignores
 the physiological  action for the sections on therapeutics, or crams the
 former to pass an examination  required  by the teacher whose  course
 he must  follow.   As  a consequence, too many physicians  regard
 pharmacology simply as a species of mental training, or believe it to
 be a waste of  time and energy.   No one  can think that the  writer of
 this book will ever deny the value  of original research  or bedside
 experience, but he does desire to weave science and practice into so
 close a network that the foundations  of experience may be  cemented
 by the mortar  of exact knowledge.  In  some instances,  however,
 science  and practice seem to  be  absolutely opposed, and only  future
 research can explain the apparent contradiction.
   Throughout this book, in every part where drugs or diseases are
 considered, the writer has arranged the  titles in alphabetical  order,
 according to their  English names.  This  has been done because it is
 desired  to  afford  the reader a ready-reference  book to which he may
 turn at short notice for desired  information, for at present  the state
 of pharmacology is so unsettled that a true classification  is  impossible.
 Thus, morphine may be classed  by one writer as a nervous  sedative
by another as a sleep-producer, by a third as a bitter substance and
by a fourth  as a respiratory depressant.   Bromide  of potassium can
 with equal propriety, be called a spinal sedative or a cerebral sedative 
             PREFACE  TO  THE FIRST EDITION.           xiii
or caffeine be classed  as a cerebral  stimulant, a circulatory stimulant,
or a diuretic.
  In order to make the book  more complete, the preparations of the
British  Pharmacopoeia have  been introduced;  and  with  the same
object in view, a dose-list of drugs,  both official and unofficial, has
been appended for ready reference.  The subject of medical electricity
has heretofore  commonly found a place in most text-books on thera-
peutics, but has been advisedly omitted in this  instance, since  elec-
trical therapeutics  has  outgrown any work save one  devoted to that
subject alone.
  For many of the articles on treatment the author wishes to thank
friends who have earned  prominence in connection with their special-
ties.  Thus Dr. Gr. E. de Schweinitz  has  contributed the articles on
the treatment  of diseases of the eye;  Dr. Edward Martiu those on
the treatment  of venereal diseases and on antisepsis; Dr. Barton C.
Hirst those on the treatment of diseases of the puerperal state; and
Dr. J. Howard Reeves, the articles on the treatment of diseases of the
upper  air-passages.   All of these  articles enhance the value of the
book  to so great an extent  that the  author feels sure they will be
sought out and read with interest.
  In addition  to the general index, a copious and explanatory index
of diseases and remedies has  been appended, which will prove sug-
gestive  and valuable to  practitioners, and  for which the  author is
indebted to his friend and student, Mr. J. G. Clark.

    Philadelphia, 222 South Fifteenth Street.
                September, 1890. 
 
o3/.^
CONTENTS.
                           PART  I.
                                                          PAGES
General Therapeutical Considerations.....17-38

                           PART II
Drugs............39-335

                          PART III.

Remedial Measures other than Drugs.....337-371
Foods for the Sick    .     .   .......372-378

                          PART IV.
Diseases............379-629
Table of Doses and Remedies.......631-638
Tables of Relative Weights and Measures  in the Metric
    and Apothecaries' Systems.......639,640
Index of Drugs and Remedial Measures     ....  641-657
Index of Diseases and Remedies......659-698 
 
                   PART   I.

GENERAL  THERAPEUTICAL CONSIDERATIONS.
   Before entering into a study of the action of drugs upon a living
 body, it is necessary that the student should possess a clear idea of
 what the word  " therapeutics" means, the  reason why we  resort to
 drugs, and more important than all, that he should grasp  the limi-
 tations  which govern the administration of remedies.
   Two very  foolish and  unfounded  ideas  have recently  been  put
 forward by certain physicians—one being, that medical  therapeutics
 is useless; and the other, that this branch of medical knowledge is not
 advancing  with so great  a stride as is pathology or  surgery.   The
 individuals who laugh at the general use of drugs in  disease  belong to
 one of two classes: either  they have never tried  them, or if so have
 used the drugs  ignorantly or wrongly, or else they  believe  that they
 are promulgating a new theory, and  do not know that the eras of ex-
 cessive  dosage and of nihilism are alike relics of the past.   No reform
 has ever attacked a crying evil without becoming excessive and absurd
 itself, and  if successful in accomplishing its  object  has generally re-
 sulted  not  in the mere remedy of the faults  it antagonized,  but in so
 complete a reversal  of popular opinion  as  to force its converts  into
 ways as reprehensible  as their former habits.   Thus,  in exactly the
 same manner that the excesses of Catholicism resulted  in  fanatical
 Puritanism, so did the careless methods of physicians during the  past
 century lay the foundation for the growth of homoeopathy or thera-
 peutic  nihilism.  At the present  time, although we have  much to
 learn, it can be said that we have benefited by both of these errors,
 and  are in consequence taking a  path which may be considered  the
 happy medium.
   To the majority of the readers of this book, however, the  harm ful-
 ness of  over-dosing is  sufficiently evident, and the cry  of " no drugs
 at all" so absurd that no rebuttal need be offered.
   The  statement that therapeutics is to-day more backward than are
pathology and surgery  is readily answered by a denial; for the thera-
peutist  is  able  to  treat successfully many diseases  of  which   the
pathologist knows nothing, and is obliged  to rest his treatment on
empiricism  simply because he  cannot  tell how his drugs act if  the
pathologist cannot tell him what  the disease is.  Rheumatism  is a
good example of this very  point. 
18     GENERAL  THERAPEUTICAL  CONSIDERATIONS.

  In  regard to surgery, everyone  must recognize the extraordinary
advances made in this branch of medical science, yet  comparatively
few realize  that it  is solely by- the introduction of drugs that all its
triumphs are possible.   The definition of the word "therapeutics" in
Billings's Dictionary is :  " that branch of medical science which treats
of the application of remedies to the cure or alleviation of disease," aud,
practically, the term is almost universally used to signify the employ-
ment  of drugs for such purposes.   The credit for the introduction of
new instruments may or may not be accorded to surgery, but the dis-
covery of new drugs must be accorded to therapeutics.  We find, then,
that ether and chloroform began to revolutionize surgery fifty years
ago, and that corrosive sublimate, carbolic acid,  and other drugs have
revolutionized it once more within the lifetime of everyone who reads
this book.   Cocaine has changed the entire aspect of eye surgery and
other  minor operations, and  has immediately averted an enormous
amount of pain and  suffering which the surgeon  could  not  relieve,
and certainly could  not remove, in the absence of its influence.   To
the  accusation of backwardness,  the  therapeutist can  well reply by
asking the champion of any other  branch of medical science to  put
forward  one  discovery  which  equals  antipyrine or  acetanilide in
power to relieve disease or pain, or which can be applied as specifics
to so wide a scope of ailments.
  In the language of one of the most progressive medical  men of to-
day in the United States, the  man who does not believe in the proper
use  of drugs for the cure of disease must lack the very keystone of the
arch upon which all medical knowledge rests.
  The ultimate aim and object of all medical thought and effort is the
cure or alleviation of disease, and therapeutics is the refined  product
culled from  every department  of medical learning.   Like every other
thing  requiring a thorough knowledge of its component parts, it is
often  much  abused  by the careless  and ignorant, but is a power for
good in the  trained  hand of the properly educated physician.
  Further than this, therapeutics is the only universally used branch
of medicine, for each and every branch must resort to it, and the most
skilful operator who fails to treat his cases medicinally with equal skill
will have worse results than he who, though  bungling in his surgery,
yet  uses drugs intelligently after his slashing is finished.
  Homoeopathy depends upon more than one reason for its existence.
If infinitesimal doses  are given, the patient is satisfied  that  he is
receiving medicine,  and Nature often produces  her most rapid cures
when  left alone.  Again, the entire basis of homoeopathic therapeutics
rests not upon the study of the causes of diseases, but upon the symp-
toms  which constantly present themselves.   As a  result  of this, so
many  minor  symptoms are  relieved that the  patient's  comfort is
insured, and doubtless in many  instances serious  disorders are dis-
covered which might otherwise be cast aside or go unseen.  No detail
should be too small to attract the  attention of the physician  aud he
who exercises  care in detail must  reap reward in larger measure. 
MODES OF ADMINISTERING DRUGS.
19
             MODES OP ACTION OF DRUGS.

  ^ Drugs act in two ways, which are sometimes called near and remote,
direct and indirect.  The near, or direct, action of a drug is that influ-
ence which is felt by the exercise of its effects directly upon the tissues
with which  it  comes in contact;  the indirect, or remote, influence is
that result which comes as  a sequence of its primary effect.   As an
illustration  of  this we  may  take the local  use  of cantharides.  The
local, pear, or direct effect of this is a blister ; the remote or  indirect
effect is the absorption of exudations or the influencing of inflammatory
processes.  If pilocarpine is used, its direct effect is the sweating which
ensues,  while its  indirect  effect is the  relief of dropsy through  the
removal of exudation by  the increased action  of the  skin, salivary
glands,  and kidneys.


          MODES  OP ADMINISTERING  DRUGS.

   Drugs may be administered for the purpose of affecting the general
system in many ways, but practically we employ only six methods, as
follows  :
       1. By the mouth or stomach.
       2. By hypodermic injection.
       3. By inhalation.
       4. By the rectum.
       5. By inunction.
       6. By the endermic method.
   By far the most usual manner of administering drugs is by way of
the mouth, which is the most natural means  of entrance into the body
for foreign substances.  Whenever medicines are  used in this way,  the
physician should clearly bear in mind what the medicine is to do after
it is swallowed.  Thus,  if the drug  is  intended to  act directly upon  the
stomach it should not be given after meals, but some time before, since
the food and gastric juice may afterward so  cover the gastric  mucous
membrane that the  medicament cannot act.   Thus, in  the  case of
chronic  gastric catarrh or gastric  ulcer the nitrate of silver which is
used should  always  be given  half an  hour or an hour before meals.
On the  other hand, if an ulcer or other trouble exist in the small intes-
tine, the pill should be given some time after meals, and if a heavy
meal is taken, three or four hours after, since under these circumstances
the medicine is swept out  into the intestine almost at once, without
remaining any time in the stomach,  where it may be chemically altered.
Very often it is necessary to  give a medicine soon after food  is  taken,
in order that it may not act in too  powerful or concentrated a manner
upon the viscus which receives it.
   The general rule, however, may be laid down, that all medicines are
to be taken after rather  than before meals, unless a local gastric effect
or very  rapid absorption is desired. 
 20    GENERAL THERAPEUTICAL  CONSIDERATIONS.

   Next to the use of drugs by the mouth, by far the most popular
 method is their administration by means of the hypodermic needle and
 syringe.   The logic of this  method  rests upon the absorption  of all
 soluble substances from  the subcutaneous tissues with great rapidity.
 Any substance soluble enough or suspendable enough  to pass through
 a hypodermic  needle without forming an obstruction may be employed,
 provided it is not too irritating and that it is " clean."
   The proper places  to  give  such  injections  are the  forearm, on the
 extensor surface,1 the calf of the leg, the buttock, or the broad of the
 back—in other words, any spot where  the tissues are not dense and
 unyielding.  The skin of the part is to be grasped or pinched up with
 the thumb and forefinger of the left hand and the needle sent well into
 this raised fold, preferably above the finger and thumb—so that the
 pressure of the fingers may prevent pain aud the too rapid entrance of
 the  medicine into the system.   The  needle should always penetrate
 well into the loose connective tissue, so that the  liquid injected may
 find lodgment  in the  loose and spongy subcutaneous  tissues without
 separating the  skin from its rather close adhesion to the tissues  below
 or from the bloodvessels supplying it, for if suppuration occurs abscess
 and a slough may result.
   The dangers from  hypodermic injections are  chiefly two.  First:
 The medicine  may enter a vein, owing to the  penetration of its wall
 by the needle, and the entire dose be carried at once, en masse, to the
 vital centres.  Second :  The  solution used may  not be sterile, or the
 needle may be  dirty, and an abscess  may result.   The first danger is
 to be avoided by injecting into spots not well supplied with veins, and
 the second by thoroughly washing both syringe and needle with  water
 the instant before they  are used, pushing a fine wire through the needle,
 and in some cases by soaking the latter in carbolized oil.   The liquid
 injected may be rendered sterile by using freshly boiled water and
 adding thereto  carbolic acid in such proportion that one-half to one
 drop  of carbolic acid  is  present in each  injection.  It is claimed by
 some that this use of carbolic acid seriously hinders absorption, and in
cases  of urgency it should not be used.   Most hypodermic  syringes
 hold from twenty to thirty minims.

   When drugs are  given by the rectum,  we employ them for  three
 purposes.   First, to influence the general system by their absorption;
 secondly, to act locally upon any disease which may be present in this
 particular locality or in the colon ; and, finally, to dislodge substances
 or parasites which it is desired to bring away.  The word " enema " is
 loosely used to  denote  all these  injections, be their purpose what they
 may, and  is synonymous with  " rectal injection"  or  the  more old-
 fashioned word " clyster."  If nourishment is being given the  injection
 is called a " nutrient enema."  Sometimes these injections are called
 " lavements."

  1 Hypodermic injections into the anterior aspect of the forearm often cause much
pain  in the  hand by irritating temporarily the branches of the radial or ulnar
nerves. 
             MODES  OF  ADMINISTERING  DRUGS.          21

  In this  mode  of administration it is very necessary that the physi-
cian should use his medicaments in proper bulk ;  and it may be laid
down as a rule that no more liquid should be injected than is necessary
to convey the medicine or food, unless the  injection is for the purpose
of emptying the bowel of fsecal matter or other  materials, or it be
desired to distend the bowel  in order to overcome  obstruction or to
influence the colon by drugs.
  The reason for this lies in the  fact that any large bulk of liquid sent
into the rectum  so stimulates its walls by distention as to cause spas-
modic contraction,  with expulsion of  all the  rectal contents, which is
just what is  needed when  faecal  matter  is  to be removed,  but  the
opposite of what is desired when  retention  of a  remedy or food is
necessary for absorption or  local action.  In rectal  catarrh  or ulcer,
two to four ounces of liquid are usually sufficient in an adult to accom-
plish any medicinal  influence locally or by absorption, while as a
laxative enema one to two pints  may be employed.
  In the use of injections we frequently find  that the rectum becomes
irritable, and promptly resists all efforts to force the entrance of liquids
or solids.   This is to be avoided by giving the injection so gently that
the bowel fails to recognize,  as it Mere, the entrance of liquid, and by
introducing a few drops of oil aud laudanum in each injection.
  A large amount of distress often follows the gradual accumulation
of faecal masses in the colon which are not passed with the daily move-
ment of the lower bowel.   These can  readily  be removed  by large
injections of warm water or by the use of medicated liquids.
  A very important use of injections by the rectum is in the treatment
of  the  various  causes of intestinal obstruction.   Here  the  greatest
caution should   be exercised  that the injection  be made  with  all
possible gentleness, and slowly,  the liquid being  allowed to dribble
into the bowel rather than to force its way.  It is dangerous to use a
greater pressure than is given by a fountain syringe at the height of two
or three feet, as  rupture of the peritoneal coat of the bowel may occur.
Where a large quantity of water is used it should be carefully warmed
to 100° or a little more, and it is well to add salt  to it, so that it will
represent  the normal  saline strength  of blood  serum, namely, seven-
tenths of  one per cent.  (For  use of injections  in  special diseases see
Part IV.)
   Suppositories  are  another means by which we introduce medicines
into the bowel, either for local effect, or to act after absorption of their
contents upon the general system.

  When  drugs  are given  by inhalation they are  generally employed
with the object of  affecting the respiratory tract alone, although there
are notable exceptions to this in ether, chloroform, nitrous oxide gas,
and other volatile substances.   Aside from anaesthetics, we find such
remedial measures  adopted as  the inhaling of  steam laden with  the
drugs  employed, the  respiring of air loaded with the fumes of  the
medicament, or the inhalation of gases ; and last, and most commonly
resorted to of all,  the use of the atomizing spray, whicli, if properly 
22     GENERAL  THERAPEUTICAL  CONSIDERATIONS.

made and employed, so minutely divides the liquid containing the medi-
cine  that the inspired air carries it to the  furthest bronchiole and
pulmonary vesicle.
  As examples of the rules governing the administration of drugs  in
this manner we find that compound tincture of benzoin may be taken
by  inhaling the steam arising from hot water containing it, but cannot
be used in a spray because it occludes the fine points of the atomizing
tubes.  In a similar manner we may inhale the smoke of belladonna
or tobacco leaves to relieve asthma, or the fumes of chloride of ammo-
nium for bronchitis in its later stages.  Finally, we find that oxygen
is exceedingly useful, the gas being readily inhaled with good  results
in proper cases.
  The " spray " or atomizer is made in twro forms ; one form of appa-
ratus being worked through  the agency of compressed air, the other
through the  escape of steam from  a small boiler.  Very few of the
compressed-air atomizers throw a spray fine enough to reach the deeper
parts of the lung, particularly if the air is compressed by the hand.
  The inhalation of moist air is very useful in bronchitis, and greatly
aids other remedial measures.   Steam  may be disengaged in  a room
by  means of a kettle of boiling  water, or by placing pieces of unslaked
lime in a pan of water.

  Inunctions consist in the rubbing into the skin of medicines gener-
ally of an oily or fatty nature, or which assume this character through
embodiment with oil  or fat.    The three substances most  commonly
used in this way are cod-liver oil, mercurial ointment, and iodine oint-
ment.   They should always be applied on some part where the derm
is thin and well supplied with  subcutaneous lymphatics, as  in the
axilla?, the groins, or the insides of the thighs.  Other substances have
been and may be used  by inunction ; but as this method is necessarily
a disagreeable and dirty one, it is rarely resorted to unless the stomach
is disordered, or it is necessary  to push the drug into  the system by
every possible avenue of entrance.

  The endermic method consists in  the use of a blister by means  of
which the epiderm is raised, when a little morphine or other  alkaloid
may be slipped under it and so  absorbed through the true skin.  It is
a painful method, almost never to  be  resorted  to, which  has been
entirely supplanted  by the hypodermic method of medication.

  Remedies are administered  in a number of forms, but chiefly  as
follows:
  Abstracts are dry powdered extracts mixed with sugar  of milk
until they are twice as  strong as the crude drug;  only eleven of them
are  official.
  Aceta,  or vinegars, are solutions  of drugs  in  vinegar or acetic
acid.   There are four in the  United States Pharmacopoeia aud three
in the British. 
MODES  OF  ADMINISTERING DRUGS.
23
  Alkaloids are organic bases,  generally occurring in  crystalline
form and abstracted from crude drugs.  They nearly always represent
the active principle of the drug.
  Aquje, or waters,  are  used  as vehicles either for the dilution  of
strong medicines, or for  the purpose  of carrying minute amounts  of
flavoring materials.
  Cataplasms are not  official in  the United  States Pharmacopoeia,
but are in the British Pharmacopoeia.  They are virtually poultices
made of linseed-meal or  of bread-crumbs.
  Cerates are ointments containing wax to render them harder than
would ordinary fats.
  Chart.e, or papers, consist of bibulous paper soaked in a solution
of the drug which they are meant to carry.
  Confections are sometimes called electuaries or conserves, and are
soft pastes which contain the drug mixed with sugar or honey.
  Decoctions are solutions  of  drugs made by boiling  and then
straining while hot.
   Elixirs are diluted tinctures rendered pleasant to the taste  by the
addition of aromatic substances and sugar.
   Emplastra, or plasters,  are   made  up of  adhesive  substances
placed upon a backing of cloth or leather and designed to adhere to
the skin :  being so applied  for the  purpose of  holding a medicinal
substance in  contact  with the body, of acting as a protective, or  of
aiding in  the  approximation of the edges of a wound.
   Extracts  consist of the soluble parts  of plants  reduced to  a
semi-solid or  solid condition by evaporation ; the soluble constituents
being taken from the plant by water  or alcohol.
   Fluid Extracts  are made in the  same way as  solid extracts,
except that they are not  so completely evaporated.
   Glycerita, or glycerins, are  solutions of various  substances  in
glycerin—the glycerin being used as a vehicle.
   Infusions are made by pouring  boiling water on  the  crude drug-
and allowing it to  stand  for a  short  time until the water  cools, after
which the liquid is strained.   Sometimes cold water is employed.
   Pills  are  small round masses which, as a general rule,  should  not
weigh  more  than three grains,  in  order to  avoid  their  being  too
bulky.  If the material is a heavy  one, as much as five grains may
be  placed  in each pill.  Pills may  be  uncovered or coated with
sugar or  gelatin.   If the pill  is  fresh and the sugar  pure they are
useful.  Many pills  are  fraudulently coated  with varnish and are
insoluble.
   Suppositories  are  small  masses  made into a cone  shape and
having for  their basis cacao butter.   They are designed to carry into
the rectum certain  medicines for absorption into the system or for local
action.
   Tablets.   Under  this name manufacturing pharmacists and others
prepare small compressed pills or lozenges, generally of small size, the
mass being  made to adhere  by means of its being subjected to great
pressure by special machinery.  Smaller tablets  are used for carrying 
24     GENERAL THERAPEUTICAL  CONSIDERATIONS.

powerful drugs for hypodermic use.  These, however, are often only
lightly pressed so as to render them easily soluble.
  Tinctures are  solutions  of  the  active  principles of  drugs  m
alcohol.
  Triturates are made by adding ten per cent, of the  active medi-
cine to ninety  per cent, of milk-sugar.   These are  then  carefully
rubbed  together until the  two are intimately mixed, and  are very
valuable in the administration of  medicines to adults or to children.
  Troches, or lozenges, are flat,  hardened masses designed for hold-
ing medicines in the mouth so that  they may be slowly dissolved,
thereby affecting the local mucous membrane.
  Ointments, or  unguents, consist of the mixture  of some kind  of
fatty substance with the medicine which they are designed to carry.
  Wines are made in the  same  way as tinctures—strong white wine
being used in the United States,  and  sherry or orange wine in  Great
Britain, in place of ordinary alcohol.


                           DOSAGE.

  There is,  unfortunately,  no absolutely fixed  rule  which can be
applied to dosage, for several reasons.   In the first place,  the indi-
vidual may  not  be readily  affected by drugs,  or the  disease-process
which is present  may  so antagonize them as to render very large doses
necessary.  Further than this, the age and sex of a patient have much
to do with the regulation of the  proper amount of  a  drug which we
may give.  Finally,  that curious but common condition of suscep-
tibility to various remedies, that we call  idiosyncrasy,  creeps in as an
important factor in the decision as to  the dose which should be given
in each case.  By far the  nearest approach which  we can make  to
absolute accuracy in dosage, is to use drugs according  to the weight of
the patient, but this method  possesses the disadvantages  that we cannot
always weigh our patients, and that the presence of a large amount of
fat or of dropsy will make an unknown quantity in our calculation as
to the true weight of  the active part of the individual.
  At  present we are  accustomed to be governed by  a list of doses
to be given to all adults within certain  limitations,  and whicli  are
varied sufficiently to permit  of great differences in the effects  obtained.
It is in this  very point that the success of many a  physician chiefly
rests ; for the use of a dose by " rule of thumb "  is as empirical  and
lacking in thought as  is use of a  remedy, not  because we have a defi-
nite action for it to carry out, but because it  did someone else good
who was suffering from Avhat appears to have been  a  similar attack.
The dose must be varied to fit the case in the same  manner that the
cut  of a coat must be  varied to fit each individual.
  There are a number of  approximate  rules in regard to  the doses
which are to be  given in treating the diseases of children, the best of
which is Young's rule.  This is as follows :
  Add 12 to the age and divide by the age.   Thus, if a child  is two 
IDIOSYNCRASY.
25
years old,  we have  the following  formula:  2-f-12=14-f-2 = 7;
or, one-seventh of the dose for an adult is  the dose for a child of two
years.   This rule is not a law, however, for of  narcotics children
receive  less than this (one-half), and of purgatives or laxatives more
than this (two to three times).
  When drugs are given hypodermically the dose should be generally
one-half to one-quarter of that given by the mouth, and if any thought
of idiosyncrasy exist the dose should be  smaller still at the start if
powerful remedies are to be used.
  By the rectum the  dose should be twice  the  amount given by the
mouth, unless  the drug be  very  powerful or capable of very rapid
absorption.

                        IDIOSYNCRASY.

   This is one of the most interesting features of the study of the action
of drugs.  It is a frequent cause of disappointment to both patient and
doctor^ and an equally frequent cause of excessive action  from what
the  phvsician  has thought to be  a  moderate dose.   No rule can be
laid down for the discovery of idiosyncrasy in a given case, except that
females, particularly of the hysterical type, are more subject to it than
are  males,  although certain  men  often present  marked evidences of
this tendency.   No better illustration of idiosyncrasy can be adduced
than the case  which  here follows, nor than that  of a  friend  of the
author, who cannot eat a strawberry without suffering from a violent
 attack  of hives.                                          .
   The first case is that of a woman of thirty years, suffering irom
 severe  headache, who received an eighth of  a grain of  the hydro-
 chlorate  of pilocarpine, hypodermically,  every twenty minutes, until
 nearly three-fourths of a grain was taken, without any evidence of its
 action  either in salivary flow or  sweat.  But the tolerance of drugs
 did not stop here.   Twenty drops of tincture of cannabis indica every
 four hours  failing  to relieve the pain, half-gram pills of the solid
 extract were ordered, two of which commonly affect a grown man
 most  markedly.  The extract had been  proved to be active to other
 patients.  In  order to avoid any failure in absorption the pills were
 each cut  in half before they were given, and  forthwith administered,
 one every three hours, without any effect after ten had been taken.
 Twentv more  of the pills, from  the same  manufacturers  but  from a
 different retailer, were now given, one every hour with the exception
 of a few irregularities in  administration during the night, the  entire
 twenty being  swallowed  between four o'clock one afternoon and two
 o'clock in the next  afternoon.   The thirty pills  (15  grains) were
 taken in less than forty-eight hours without producing a single physio-
 Wical sign of the slightest character.   That  the  doses were  really
 swallowed would seem to be undoubted  for their administration was
 cTrried out by a trained attendant, and their black color forbade their
 expulsion  from the mouth  on the  bed without attracting attention.
 The hypodermic injections were given by the author, and  as the solu- 
GENERAL  THERAPEUTICAL  CONSIDERATIONS.
 tion was made as fast as it was used, the  patient must certainly have
 received all of the pilocarpine.
    As there was  daily an afternoon rise of temperature amounting to
 several degrees, quinine bisulphate was  ordered in the dose of fifteen
 grains, to be given after six powders of one-sixth of a grain of calomel
 had been taken; this  not  only failed to  control the fever, but  also
 produced no buzzing in  the ears.   The writer was  now inclined to
 consider  all the symptoms as  hysterical,  even including  the evening
 rise of temperature.
   Twenty-four hours after the last dose of cannabis indica, the attendant
 gave the patient, without orders, no  less than sixty grains of antipyrine
 in sixteen hours without any physiological symptoms, and, under orders,
 she took from forty to fifty  grains of bisulphate of quinine every  day
 for three days without any signs of cinchonism.

  ^Wide experience has taught us, however, that several conditions act
 fairly constantly in regard  to some idiosyncrasies.  Certain diseased
 conditions—such as peritonitis or pain—allow large doses of opium to
 be  given, and  in lead-poisoning and  paralysis patients may require
 enormous doses of active purgatives to move the  bowels.
   The climate in which the patient lives, or has been accustomed to
 live, renders him more  or less susceptible to  certain remedies.   Thus
 the East Indian runs amuck after eating hasheesh or cannabis  indica,
 or  the Chiuaman goes into a delightful  dreamland  from  smoking
 opium, whereas the Anglo-Saxon experiences no such agreeable sensa-
 tions, as a general rule.  Southerners generally require larger doses
 of  purgatives than Northerners, often because  their livers are  not as
 active.
  The temperament of an individual is also a  highly important matter
 to be considered.  It is a notorious  fact that phlegmatic dark-skinned
 persons usually yield to drugs less  readily than blondes and nervous
 persons,  more especially  in respect to the drugs which  act on  the
 nervous system.   Nervous light-haired women  stand belladonna very
 badly as a general rule,  while  children will take  large  doses  often
 without discomfort.  Opium is usually badly borne by children.
  Habit is another important factor governing  idiosyncrasy.   We all
 know how rapidly one becomes accustomed to tobacco; and how mor-
 phine habitues take enormous amounts of their  favorite druo- without
 effect.                                                   fe

                 ABSORPTION OP DRUGS.

  The knowledge of the rapidity with which certain drugs are absorbed
 from the various  surfaces with which they  come in contact is of im-
portance  m  order that  we may know when  to repeat  the dose if  the
first amount does not  produce the  desired effect.   The rapidity of
absorption  depends upon  a  number of factors.   If the circulation is
active  absorption is active but if it be depressed absorption is slow
 lhus, in a person apparently drowned, absorption may not  occur at 
         STRENGTH AND  RELIABILITY  OF  DRUGS.       27

all until the vital functions are restored, and repeated doses given to
the^patient while unconscious, acting together, in the end poison him.
This is often the case in delirium tremens where hypodermic injections
of morphine are given, or when the drug is administered by the mouth.
In  dropsy absorption is peculiarly slow, and the drug may  remain
in the tissues for days, only to be absorbed with the exudation after
severe purgation or profuse diuresis, or tapping.  In general dropsies
hypodermic medication is nearly always worse than useless.
  When the stomach or bowel is empty absorption from either is rapid,
but when  they are full it is very slow.  In this fact we find the reason
for  the popular idea  that a glass of whiskey when a man  is hungry
makes  him drunk, whereas twice the quantity after dinner does not
do so.
  Drugs  in the stomach or bowel have no influence over the general
system unless they are irritants.   They  only act when taken into the
blood or lymphatics.
  Recent  studies  show  that  alcoholic solutions of drugs are  more
rapidly absorbed than are watery solutions or those made with glycerin
or milk.

          DURATION  OP ACTION OF DRUGS.

  The duration of  the  action of drugs depends partly  upon  their
rapidity of absorption, but chiefly  upon the rapidity  or slowness of
their destruction in the  body, or their  elimination from  it.   Thus,
volatile substances such as ether,  chloroform, aud nitrite of amy!,
act  only for a short time and are quickly eliminated, whereas bromide
of potassium and digitalis continue active during many hours, and are
slowly eliminated, as in the case of the former, or oxidized, as in that
of the  latter.  Again, if curare is given hypodermically it will  cause
paralysis,  but if taken by the stomach in moderate  amount it will be
eliminated by the kidneys as  rapidly as it is absorbed, and produce no
effects if these organs are active.
  From studying the rapidity of the elimination of a drug we  learn
how often to order a dose.  Thus, digitalis may be given once, twice,
or thrice  a day, but carbonate  of ammonium every two or  three
hours.
  When the physician is  not careful in the use of a drug which  is
eliminated slowly, it  may suddenly develop so severe an  effect as to
cause  alarm, owing to the accumulation of the poison in the body.
This is called " cumulative action."
      STRENGTH AND  RELIABILITY OP DRUGS.

  If a census could be made of those who die annually from the use
of drugs  which  are  impure or useless from weakness, the writer
believes that a most  alarming array of figures would  be presented.
For many vears this was unavoidable to a great degree, either because 
28     GENERAL  THERAPEUTICAL  CONSIDERATIONS.

our knowledge of the active principles of drugs aud the methods of
isolating them was  deficient, or because  the  time  consumed in their
transportation  by sailing vessels or on the  backs of natives from  the
countries  in which  the natural products yielding the  drugs were
obtained,  permitted  deterioration to take place.    At present these
difficulties have been largely  overcome.   The trained pharmacist is
taught how to make an  assay for  active principles in most of  the
valuable alkaloidal drugs, and every physician should make careful
investigation into the quality of all preparations  which he employs.
That these remarks are not out of place will be seen by the fact that
very recently an intimate friend of the writer bought from five of  the
leading druggists of Philadelphia six ounces of tincture of nux vomica
which were stated to have  been made according  to the directions of
the United States Pharmacopoeia.  That  made by perhaps the leading
druggist of the five contained  twice  as much strychnine and  brucine
as it should, and had twice as  much  solid residue;  or, in other words,
a physician prescribing this tincture in full dose would probably have
poisoned his patient and reported the case as one of unusual suscepti-
bility to drugs !  On the other hand, the author has  recently seen a
tincture of nux vomica which contained  only a  trace of alkaloid,  but
had  much inert solid residue.  In  neither instance was the druggist
a dishonest one intentionally,  but one  had used a crude drug which
was unusually rich in alkaloids, while the other had  purchased nux
vomica beans which, by reason  of immaturity, bad surroundings, or
exposure to weather, were very poor in  active principles.   All these
disadvantages  may  be  avoided if physicians  will insist that  the
druggists who dispense  the drugs they order shall  either themselves
prepare assayed products, or purchase such products from any one of
the large manufacturing chemists who put assayed goods on the  market.
When this is impossible the  physician should employ the alkaloids,
in pill form, or, if solutions are desirable, the alkaloid may be added
to alcohol  and water and  given by drops, as is  the  case with any
ordinary tincture.   Digitalis and veratrum viride are practically  the
only drugs with which this  cannot be done;  in  the first the action of
the drug does  not depend  upon a single active principle,  but upon a
large  number, and in the second the relative proportions of jervine
and veratroidine caunot be well  estimated by the physician.   H. C.
Wood records  a  case in which opium poisoning occurred  in  a child
who had taken a  Dover's  powder; the reasou being that the  amount
of opium  intended  for many  doses was  in the powder that was dis-
pensed, the other constituents not having been properly mixed with
the opiate in compounding  the prescription.   Constant uncertainty is
a dangerous element when we are dealing with  patients who  are
desperately ill; and  in  many  cases  failure and discouragement may
both  be avoided  if the physician will  see to it that the tools with
which he  works  are in good order and capable  of doing what he
requires of them.  A poor drug  to the physician is worse  than a
rusty knife to the surgeon; for the injury in the one case is unknown
whilst in the other it can be carefully watched and guarded. 
   INDICATIONS, CONTRA-IND1CATIONS, DEFINITIONS.   29


       INDICATIONS  AND  CONTRA-INDICATIONS
                     AND  DEFINITIONS.

   The indication  for a drug is  any symptom or series of symptoms
 which we  know the drug will relieve without  causing  at  the  same
 time  an evil effect to be felt by other parts of the body.  A contra-
 indication  is any coexisting  state or tendency which will be made so
 much worse by the drug as to forbid its use.   Thus, one  might be
 tempted to give quinine in meningitis for the  fever, yet this would
 be bad therapeutics, since quinine  is contra-indicated  because it will
 intensify the meningitis.
   Abortifacients form a class of drugs which, as such, ought never to
 be employed.   If pregnancy is to be interrupted the  interruption
 should be  produced  by instrumental means,  and  then only  after
 consultation.
   Alteratives are indicated where cell-growth is active to excess, but
 contra-indicated where  tissue break-down is present, or there exists  a
 tendency thereto.
   Anaesthetics are drugs used to produce lack of  sensation.   They are
 either local or general.   Many of the  local anaesthetics produce loss of
 sensation through  benumbing the  parts by the cold  they produce.
 Cocaine is  an example of a local anaesthetic which  causes anaesthesia
 by a  direct paralyzant action on the peripheral sensory nerves.
   Anaphrodisiacs are remedies used to diminish  sexual desire.
   Antacids are  employed in cases of gastric fermentation when, as  a
 result of the morbid processes, lactic and butyric  acids, or even  hydro-
 chloric acid, are found in abnormal quantities.
   Anthelmintics are those remedies which are used for the purpose of
 removing intestinal worms.
   Antiarthritics is the name given those  drugs which are employed
 for the purpose of relieving inflammations occurring in joints, whether
 these  be in an acute or chronic condition of disease.  Colchicum, which
 is one of this class, is contra-indicated, as a rule, in cases  of gouty in-
 flammations of the joints if the bowels are already moving too freely,
 as, under these circumstances, retrocedent gout is apt to occur.
   Antihidrotics  are used  to  prevent excessive sweating,  either when
 it is  local  or general.  Camphoric acid  is  probably the  best general
 antihidrotic.
   Antiperiodics is  a term applied to drugs or remedies employed for
 the prevention or  cure of malarial poisoning.   They  are so  named
 because they tend  to break  up the  periodicity of the attacks, which
 periodicity is a characteristic of such diseases.
   Antiphlogistics are remedies employed to prevent the progress of
 inflammatory processes.   They are nearly all contra-indicated  in the
presence of tissues possessing an  impaired  vitality through  previous
conditions of disease.
   Aphrodisiacs are remedies used to increase sexual desire and  power.
   Astringents  are  employed for  the purpose of contracting or  con- 
30     GENERAL  THERAPEUTICAL CONSIDERATIONS.

stringing  tissues.   They  act not  by coagulation of albumin, but  by
their influence over the vital processes of the tissues with which they
come  in contact.   Theoretically,  all astringents should be  non-irri-
tating, but practically they possess irritant properties, and are, in con-
sequence,  contra-indicated in the presence of very acute inflammations,
as a rule.   Three of the mineral astringents, however, possess marked
sedative properties  in  addition to  their astringent power,  and  can
therefore  be used freely in acute inflammations  when locally applied.
They are nitrate of silver, subacetate or acetate of lead, and the subcar-
bonate or  subnitrate of bismuth.
  Bitters  are remedies designed to increase the activity of the mucous
membrane of the gastrointestinal canal by increasing its tone.   They
may be divided into simple bitters and complex bitters.   The first
depend upon their bitterness  solely for their activity;  the  second
class is well  represented  by quinine or strychnine, both of which are
exceedingly bitter, but, in addition  to their local effect on the gastro-
intestinal  mucous  membrane, act as stimulants  to other portions of
the organism.   A good example of a simple bitter is columbo.  Many
bitters contain so much tannic acid that they are  not generally useful,
and for this  reason very few can  be used with  preparations of iron,
since a tannate of iron would be formed.
   Cardiac sedatives are drugs which decrease the force of the heart,
and, as a class, the amount of blood expelled at  each beat of the ven-
tricles.  They are indicated in arterial excitement, contra-indicated in
arterial depression.
  Cardiac stimulants are  drugs which increase the force of the heart,
thereby increasing the quantity of blood expelled from  the ventricles.
This may be accomplished by an increase in the  rapidity of the beats,
or by a greater output of blood at each contraction, the diastole being
sufficiently prolonged to admit of the ventricles  being well filled.
They are  contra-indicated in the presence of arterial excitement, and
indicated in arterial depression.
   Carminatives are remedies given for the purpose of expelling flatus,
particularly if there is reason  to believe that the ''wind" has accu-
mulated because of intestinal  torpidity.  Many of the carminatives
are necessarily possessed of irritant properties, and  are  therefore
contra-indicated in the presence of flatulence due to intestinal atony
arising from inflammation.   The  best carminative is spiritus setheris
compositus, or Hoffmann's anodyne.
   Cathartics.   These are drugs employed when a positive  and decided
action  of  the bowels is desired.   They occupy a position  between the
purges  and the drastics.   (See Purges  and Drastics.)  The best ex-
ample  of  a cathartic is  probably jalap.
   Cholagogues are  used when it is  desired  to exert a stimulant influ-
ence over  the  flow of  bile, without necessarily  increasing intestinal
peristalsis.  Nitro-hydrochloric acid is, perhaps, the best type  of a
pure cholagogue, while podophyllum represents the class  of chola-
gogues which increase intestinal peristalsis in addition.   Cholagogues 
  INDICATIONS, CONTRA-INDICATIONS,  DEFINITIONS.   31

are contra-indicated in the presence of acute inflammation of the gall-
bladder or liver.
  Counter-irritants are remedies used  to produce  irritation at a spot
distant from a painful or inflamed area, in order to relieve the diseased
parts by reflex action exerted  through the nervous system  upon the
painful nerve or disordered capillary network.
  Demulcents  are  substances used to protect any exposed parts of the
body from irritation.
  Diaphoretics produce an increased secretion from the  sweat glands.
They may be considered as internal and external.  The internal are
represented by pilocarpine, which stimulates  the sweat-glands them-
selves ; the external are represented by the Turkish and Russian baths,
which,  by increasing bodily  heat,  cause  a profuse sweat by reflex
action.
  Diuretics are used  to increase the flow of  urine from the kidneys.
They act  by  stimulating the renal  epithelium  to greater  activity,
thereby increasing the excretion of  both  the watery  and solid con-
stituents of the urine; or they simply increase the watery constituents
by increased blood pressure in the kidney.
  It is  to be  remembered  that the vegetable salts of potassium and
the  lithium salts  increase the solids in the urine, not by stimulating
the secreting epithelium of the kidney, but by  uniting with insoluble
material in the system, forming soluble  compounds  which are then
readily  eliminated.   (See Eliminators.)  They are indicated  in con-
ditions of  renal inactivity due either to functional or organic causes.
Irritating diuretics, such as cantharides, for example,  are contra-indi-
dicated  in acute nephritis.  Such a diuretic is  only to be used where
the  kidneys are inactive through atony or prolonged  chronic or sub-
acute disease.
  Eliminators are drugs which, by forming  soluble compounds with
insoluble substances  in the body, render  them  capable of being ex-
creted by the excretory organs, such as the skin, kidneys, and  bowels.
  Emetics are  drugs  used  to  produce vomiting.  They act centrally
when, as  is the case with apomorphine, they stimulate the vomiting
centre, peripherally when they irritate the walls  of the  stomach. They
are indicated when we wish to  unload the stomach of undesirable mate-
rials, or when we  desire to cause an increased  flow of  bile  from the
gall-bladder, which is accomplished by the pressure exerted upon this
viscus when the abdominal walls and diaphragm contract  in retching.
When the ducts are mechanically obstructed with a gall-stone  emetics
are dangerous, as they may cause rupture of the gall-bladder.
  Sometimes we  are  able by the use of emetics to rid the lungs and
stomach of mucus in bronchitis or gastric  catarrh.
  The contra-indications to emetics are cerebral congestion or menin-
gitis, gastritis, gastric ulcer, advanced pregnancy, and hernia.
  Emmenagogues  are remedies used to produce or increase  the  men-
strual flow.  They are of two classes—direct aud indirect.  The direct
are all of them irritants, and  are seldom of much value; the  indirect
are used to overcome the morbid condition underlying the menstrual 
32    GENERAL THERAPEUTICAL  CONSIDERATIONS.

disorder, and are therefore more rational.   Thus iron and arsenic may
be used in amenorrhcea due to anaemia with beneficial result.
  Expectorants are employed  when it is desirable to promote secretion
or to get rid of secretion in the bronchial tubes.  Thus, in the^ early
stages of an acute bronchitis, the mucous membrane is hyperaemic and
swollen, but dry and  irritable.  Ipecac and citrate of potassium form
at this time a sedative expectorant mixture, which, while allaying irri-
tation, promotes secretion, and so relieves the engorged area.  On the
other hand, after the acute  stage  is passed, there  may  be so much
atony of the mucous glands  that the secretion is either too scantyor
too viscid to be coughed up.   Stimulant expectorants, such as chloride
of  ammonium,  eucalyptus, and terebene  are now to be  employed.
These latter drugs  are contra-indicated  in  the acute inflammatory
stage of the disease,  as  they would simply stimulate the irritated
mucous membrane to greater  irritation.
  Hypnotics are drugs  used to produce sleep.  They may  be divided
into those which produce sleep and relieve  pain, and those which have
no analgesic power.   The latter are therefore not to be employed  in
sleeplessness due to  pain, and the former are contra-indicated when
pain is absent.   Thus  chloral produces sleep if it  be ordinary func-
tional insomnia; but if the sleeplessness is due to pain, opium is  the
drug to be employed.   Chloral,  in  ordinary  doses, is the  purest
hypnotic that we have.
  Mydriatics are drugs which produce dilatation  of the  pupil  or
mydriasis.   Conditions of the eye associated  with increased intra-
ocular tension, are contra-indications to mydriatics, as a rule.
  Myotics are drugs  which cause contraction of the pupil or myosis.
They are best represented by eserine.
  Nervous sedatives  are indicated  and contra-indicated in  a  reverse
manner to nervous stimulants.
  Nervous  stimulants  are contra-indicated  in  nervous  excitement,
indicated in nervous depression.
  Oxytoxics are drugs which increase the  expulsive power of  the
uterine muscular tissues.
  Revulsives are remedies used to  produce  increased  activity of the
general system  or parts  thereof  through reflex influences—that  is,
they cause a determination of blood to one part, thereby relieving  an
engorged  area.    Thus,  in cerebral  congestion or effusion,  a vigorous
purgative or cathartic may give relief by exercising a derivative effect.
Revulsives are closely allied to counter-irritants.
  Boborants are drugs or measures devoted to the repair and building
up of tissues in the body, and  comprise both foods and drugs.   Robo-
rant treatment also includes hygienic surroundings, fresh air, light and
healthful employment.
  Tonics are used to  increase vital activity.  They are  indicated  in
instances of local or  general  systemic depression, contra-indicated  in
cases  of inflammation or excitation with excessive functional activity.
(See Bitters.)
   Vasomotor depressants are drugs which decrease arterial pressure  by 
INCOMPATIBILITY.
33
an  action on the vasomotor nervous system rather than by an action
on  the heart.   They act indirectly by relaxing the bloodvessels.
    Vasomotor stimulants are drugs which increase arterial pressure by
an  action on the vasomotor system, thereby producing contraction of
the bloodvessels.


   COMBINATION  OP DRUGS  FOR JOINT EFFECT.

   The study of the physiological action of drugs has aided us very
greatly in improving our therapeutic measures.   Thus, we now know
that chloral is a heart-depressant and cannot be used in very full doses,
or  pushed to  produce  sleep in persistent insomnia,  without grave
danger;  whereas morphine, which also produces sleep, but does not
depress the heart, but does depress the respiration, can be combined
with  it,  and the two acting together, each in small dose, produce a
heavy sleep, although so little chloral is present that the heart  is safe,
and so small an amount of morphine is used that the respiration does
not suffer.
   Another example of  this is  found in certain purgative pills where
the purgative agent is assisted by belladonna and nux vomica, the first
of  which relaxes muscular spasm, while the second acts as a tonic to
the alimentary tract, the drugs combining to accomplish one result.
   Skill  in the combination of drugs,  not  only for increased physio-
logical effect, but also for the purpose of making their administration
pleasant to the taste, has  much more  to do with professional  success
than  is  generally supposed.   This is  particularly so  in  regard to
children, for parents dislike forcing their children to take doses which
they themselves regard as horrible, and they are ever ready to  believe
that as long as a medicine tastes good it is better than one which tastes
otherwise.
  The medical practitioner who prescribes  ever so wisely and  appro-
priately for a patient, but who is utterly regardless as  to his combina-
tions  of  drugs  so far as taste is concerned, will sooner or later see a
more  ignorant man take  from him  that practice which his  greater
wisdom  entitles him to, but which is driven from him by his  own
errors in this matter.
  While  in some cases there is  no alternative but to give a bad  dose,
in others a little thought and care will  often avoid offending the taste
of  the patient.

                     INCOMPATIBILITY.

  The chief value of a knowledge of chemistry or pharmacy to  a prac-
titioner of medicine is the avoidance of what is known as an "incom-
patibility," or the placing in one prescription of two or more substances
which will undergo chemical interchanges, decompositions, precipita-
tions, or  cause the formation of explosive mixtures.   It is impossible
to detail  all the  incompatibilities, and  only the most dangerous and
common  possibilities of error can be considered.
                                 3 
34     GENERAL  THERAPEUTICAL CONSIDERATIONS.
   1st. An acid should never be combined with an alkali.
   2d. An acid should  not be added  in any quantity to a tincture.
 The following prescription is an illustration of this :

          R •—Potassii iodidi
             Acidi nitro-muriatici
             Tr cinchonse comp.
    S—Use as directed: a teaspoonful

   In this ridiculous mixture the acid  is incompatible with the iodide
 of potassium, forming a chloride and  setting  free iodine, and would
 also change part of the alcohol in the tincture  into an ether.
   3d. Alkalies should not be combined with the  alkaloids.   Thus :
          rx.—Strychnine sulph.
             Potassii iodidi
             Syr. sarsaparillse comp
    S.—Teaspoonful t. d.

   In this prescription the strychnine would  be  precipitated  by the
 potassium salt, and  the patient would get nearly  all the strychnine in
 the last dose.
   4th.  Potassium chlorate should  not be  ordered  to  be  rubbed up
 with  tannic acid or any  other organic substance capable of oxidation,
 as it will explode.   Permanganate of potassium is subject to the same
 rule.
   5th. Chlorate of  potassium and  ammonium chloride when  mixed
 together may take fire.
   6th. Iron is incompatible with tannic acid, as it forms a tannate of
 iron,  or ink. As all the vegetable astringents contain tannic acid they
 should none of them be used with iron  except chiretta and columbo.
   7th. Tannic acid should never be added to solutions of alkaloids.
   8th. Gum arabic  is not  to  be added to solutions of iron, lead, or
 the mineral acids.
   9th. Alcoholic solutions of camphor and similar resinous substances
 are incompatible with  water.
   10th.  Fluid extracts are incompatible with  water, as the addition
 of water  will precipitate them.
   11th.  All salts not acid but alkaline in reaction are decomposed by
 acids.
   12th. All salts which are acid are decomposed by alkalies.
   13th.  All vegetable acid salts are altered  by mineral acids and are
 decomposed by alkalies.
   14th. Iodine and the iodides should  not be given with alkaloids.
   15th. Corrosive sublimate, the salts of lead, iodide of potassium,
and nitrate of silver should always be prescribed  alone, except in the
 following instances :
   (a) Corrosive sublimate may be given with  potassium iodide, since
it will throw down a precipitate which  redissolves and forms a double
salt.
   (6)  Nitrate of silver may be used with extract of opium or hyoscy-
amus.
 3U-
f3J-
M.
 gr-J-

f 3 "j-
M. 
CLASSIFICATION  OF DRUGS.
35
   16th.  Syrup of squill  should not  be given with the carbonate of
ammonium, as it contains acetic acid.   Chloride of ammonium is not
incompatible with it.
   17th.  Cherry-laurel water should not be prescribed with morphine,
as it may form the poisonous cyanide of morphine.
   18th.  Chloral and cyanide of potassium should never be placed in
the same prescription, as  they will decompose each other, setting free
hydrocyanic acid.
   19th.  Cocaine and borax when added together  form an  insoluble
borate of cocaine.  Boric acid and cocaine do not result in this formation.
   20th.  Calomel  and antipyrine are said to be  incompatible, as are
also sweet spirit of nitre  and antipyrine.
   21st.  AVaters cannot  be used  in  preparing  saturated  solutions of
drugs, as they are already loaded with a volatile substance.
                CLASSIFICATION OF DRUGS.

  In order that the student may gain a definite idea as to the various
actions of different remedies  the following list of drugs is appended,
which is of necessity somewhat arbitrary.   The  endeavor has been
made to  place the best or most powerful drug of each class first in the
list.   It is to be  remembered that a strict physiological classification
is impossible.
I. Alteratives.

     1. Mercury.
     2. The Iodides of potassium and so-
         dium.
     3. Iodine.
     4. Iodoform.
     5. Iodol.
     6. Arsenic.
     7. Cod-liver oil.
     8. Colchicum.
     9. Ichthyol.
    10. Taraxacum.
    11. Mezereum.

II. Anesthetics.
     1. Ether.
     2- Nitrous oxide gas.
     3. Chloroform.
     4. Cocaine.
     5. Bromide of ethyl.
     6. Chloride of ethyl.
     7. Pental.
     8. Bromoform.

III. Antacids.
     1. Ammonia.
     2. Sodium and its salts.
     3. Liquor potassa.
     4. Calcium and its salts.
IV. Anthelmintics.
  Those that are used against the round-
         worm are :
     1. Santonica.
     2. Spigelia.
     3. Chenopodium.
     4. Azedarach.
     5. Santoninate of Sodium.

  Those used against the tape-worm are:
     1. Pelletierine.
     2. Aspidium.
     3. Pepo.
     4. Pomegranate.
     5. Bray era.
     6. Kamala.
     7. Turpentine.
     8. Chloroform.

  Those used against the  seat-worm, or
         oxyuris vermicularis, are:
     1. Quassia.
     2. Turpentine.
     3. Tannic  acid.
     4. Chloride of sodium.
     5. Vinegar.

V. Antiseptics.   (See also  Disinfect-
         ants.)
     1. Corrosive sublimate in weak so-
         lutions. 
36      GENERAL  THERAPEUTICAL CONSIDERATIONS.
     2. Carbolic acid in weak solutions.
     3. Peroxide of hydrogen.
     4. Boric acid.
     5. Sulphate of iron.
     6. Permanganate of potassium.

VI. Antiperiodics or Antimalarials.
     1. Cinchona.
     2. Eucalyptus.
     3. Aval-burg's tincture.

VII. Antipyretics.
     1. Antipyrine.
     2. Acetanilide or antifebrin.
     3. Phenacetine.
     4. Phenocoll.
     5. Salicylic acid.
     6. Thallin.
     7. Carbolic acid.
     8. Kairin.

VIII. Antispasmodics.

     1. Chloral.
     2. Bromides.
     3. Hoffmann's anodyne.
     4. Camphor.
     5. Opium.
     6. Belladonna.
     7. Asafoetida.
     8. Musk.
     9  Valerian.
    10. Monobromate of camphor.
    11. Amber.
    12. Cimicifuga.
    13. Hops.

IX. Astringents.
   Vegetable :
     1. Tannic acid.
     2. Hsematoxylon.
     3. Kino.
     4. Catechu.
     5. Rhatany or krameria.
     6. Rhus glabra.
     7. Geranium.
     8. White oak.
     9. Black oak.
    10. Gallic acid.
    11. Rosa centifolia.
    12. Rosa gallica.
  All of these depend chiefly upon tannic
acid for their active principle

  Mineral:
     1. Sulphuric acid.
     2. Alum.
     3  Lead.
     4. Nitrate of silver.
     5. Nitric acid
     6. Sulphate of copper.
     7. Bismuth.
     8. Sulphate of zinc.
 X. Cardiac Skdatives.
      1.  Aconite;
      2.  Veratrum viride and album.
      3.  Antimony.
      4.  Hydrocyanic acid.
      5.  Veratrum sabadilla

 XL  Cardiac Stimulants.
      1.  Digitalis.
      2.  Ammonia.
      3  Ether.
      4.  Alcohol.
      5.  Caffeine.
      6.  Nux vomica.
      7.  Ignatia.
      8.  Strophanthus.
      9.  Adonis vernalis
     10.  Convallaria majalis.
     11.  Sparteine
     12.  Amyl nitrite (momentarily).
     13. Opium.

 XII. Counter-irritants.
  Those  counter-irritants that blister are
       called epispastics They are:
      1. Cantharides.
      2. Thapsia.
      3. Ammonia when under  a watch
          glass.

  Those  that  redden or  produce local
       hyperemia of the skin are:
      1. Mustard.
      2. Capsicum.
      3. Turpentine.
      4. Ammonia
      5. Chloroform.
      6. Burgundy pitch.
      7. Canada pitch.
      8. Most of the spices.

 Under the  name  of Escharotics  are
  grouped a number of  substances capa-
  ble of acting as destructive agents upon
  the soft tissues of the body.  They are:
      1. Chromic acid.
      2. Nitric acid.
      3. Sulphuric acid.
      4. Nitrate of mercury (solution).
      5. Bromine.
      6. Caustic potash.
      7. Caustic soda
      8  Arsenious acid
      9. Chloride of  zinc.
     10  Vienna paste
     11. Canquoin's paste

XIII.  Diaphoretics

  The only  ones that we know as direct
      stimulants* to the glands are:
      1. Pilocarpus or jaborandi.
      2. Warburg's tincture. 
CLASSIFICATION  OF  DRUGS.
37
  The others are:
     3.  Hot dry and hot moist baths.
     4.  Dover's powder.
     5.  Alcohol (particularly when hot).
     6.  Nitrous ether.

XIV. Digestants.
     1.  Pancreatin
     2  Pepsin.
     3.  Hydrochloric acid.
     4  Papain.
     5.  Diastase.

XV. Disinfectants.
     1.  Corrosive sublimate.
     2.  Chlorine or chlorinated lime
     3  Carbolic acid
     4.  Chloride of zinc.

XVI. Diuretics.
  Those that increase both the solids  and
      liquid constituents are probably:
    10. Pennyroyal.
    11. Guaiac

  The indirect are:
     1. Iron.
     2. Copper.
     3. Arsenic.
     4  Tonics in general.

XIX. Emetics.
  The direct are represented by:
     1. Apomorphine.
     2. Ipecac (which is both centric and
          peripheral).

  The peripheral are:
Sulphate of zinc.
Mustard.
Alum.
Sulphate of copper.
Turpeth mineral.
1.	Caffeine.
2 3	Squill. Cantharides.
4	Buchu.
5.	Blatta
6. 7. 8.	Juniper. Turpentine. Uva ursi.
9. 10	Chimaphila. Cubebs.
11.	Pareira brava
  Those which increase the watery con-
      stituents of the urine without  in-
      creasing the solids proportionately
      are:
     1. Digitalis.
     2  Vegetable salts of potassium.
     3. Nitrous ether.
     4. Lithium.

XVII. Eliminatives.
     1.  The iodides.
     2. The salicylates.
     3. The vegetable salts of potassium.
     4.  The lithium salts.
     5.  Jaborandi
     6.  Colchicum (probably).

XVIII. JEmmenagogues.
  The direct emmenagogues  are:
     1.  Apiol
     2  Binoxide of  manganese.
     3.  Permanganate of potassium.
     4.  Cantharides.
     5.  Aloes
     6.  Myrrh.
     7.  Rue
     8.  Savine.
     9.  Tansy.
XX. Expectorants.
  Sedative :
     1. Citrate or acetate of potassium.
     2. Ipecac.
     3. Antimony.

  Those which act as stimulating expec-
       torants are:
     1. Ammonium chloride.
     2 Apomorphine.
     3 Creasote.
     4 Eucalyptus.
     5. Tar.
     6 Terebene.
     7. Oil of sandal wood.
     8 Lobelia
     9. Sulphur.
    10 Grindelia robusta.
    11. Garlic.
    12. Squill.
  Besides these we  have  nux vomica
which  increases expectoration by stimu-
lating  the  nervous system to coughing,
and thus expels the mucus.   Opium and
the bromides depress the nervous system
and allay cough, and so decrease expecto-
ration.

XXI. Hypnotics.
     1. Chloral.
     2. Bromides of potassium,  sodium,
         etc.
     3. Opium.
     4. Sulphonal.
     5. Paraldehyde.
     6. Urethan
     7. Somnal.
     8. Amylene hydrate.
     9. Methylal.
    10. Hypnone.
    11. Hyoscine, in mania.
    12. Cannabis indica (in large dose). 
38
GENERAL  THERAPEUTK
XXII. Nervous Sedatives.

     1.  Chloral.
     2.  Opium (in full doses).
     3.  The bromides  and hydrobromic
          acid.
     4.  Chloroform.
     5.  Amyl  nitrite.
     6.  Nitrites of potassium, sodium,
          and nitroglycerin.
     7.  Ether.
     8.  Bromide of ethyl.
     9.  Nitrous oxide.
    10.  Bromoform.
    11.  Cannabis indica.
    12.  Belladonna.
    13.  Antipyrine.
    14  Acetanilide.
    15.  Phenacetine.
    16.  Calabar bean.
    17.  Hydrocyanic acid.
    18.  Lobelia.
    19.  Conium
    20.  Tobacco.
    21.  Sulphonal.
    22.  Croton chloral.
    23.  Paraldehyde.
    24.  Camphor.
    25.  Monobromated camphor.
    26.  Asafcvtida.
    27.  Amber.
    28.  Hoffmann's anodyne.
    29.  Cimicifuga.
    30.  Musk.
    31.  Valerian.
    32.  Humulus.
    33.  Castor.
    34.  Hypnal.
    35.  Somnal.
    36.  Amylene hydrate.
    37.  Urethan.

XXIII. Nervous Stimulants.

    1. Nux vomica.
    2. Ignatia.
CAL CONSIDERATIONS.


    3. Coffee.
    4. Coca.

XXIV.  Oxytocics.
      1.  Ergot.
      2.  Cotton root.
      3.  Ustilago maydis.

  And indirect when in labor:
      1.  Quinine.

XXV. Tonics.
      1.  Cinchona.
      2.  Nux vomica.
      3.  Calumba.
      4.  Arsenic.
      5.  Phosphorus.
      6.  Mercury (in minute doses).
      7.  Copper.
      8.  Iron.
      9.  Hydrochloric acid.
     10.  Nitro-hydrochloric acid.
     11.  Nitric acid.
     12.  Phosphoric acid.
     13.  The  vegetable bitters in general.

XXVI.  Vasomotor Depressants.
      1.  Veratrum viride.
      2.  Antimony.
      3. Aconite.
      4.  Veratrum album.
      5.  Veratrum sabadilla.
      6.  Alcohol (in excessive doses).
      7.  Jaborandi.

XXVII. Vasomotor Stimulants.
      1.  Belladonna.
      2.  Hyoscyamus
      3  Digitalis.
      4.  Nux vomica.
      5  Ergot.
      6  Stramonium.
      7. Caffeine.
      S. Convallaria. 
PART   II.

     DRUGS.
                           ACACIA.

  Acacia, U. 8., Acacias Cummi, B. P., Gum Arabic, or Gum Acacia,
is a gummy exudate from the stems and branches of small trees known
as Acacia  VereJc,  Acacia  Senegal,  and  other acacias  growing in
northern Africa and in Australia.  As sold in the stores it consists of
irregular semi-transparent lumps, which are either smooth or angular,
according to whether the substance has been preserved in the original
beads or broken  by handling.   Its color is slightly yellow or almost
white, both color and  transparency depending largely on the amount
of the impurities  by which it is contaminated.
  It is devoid of physiological action.
  Therapeutics.—Acacia is employed in medicine as a local applica-
tion  to  inflamed  and irritated mucous membranes, particularly of the
upper air-passages, and also in the form of a drink in the same condi-
tions.  In  instances where genito-urinary irritation exists it is useful
as a vehicle for more powerful remedies.   Made into a mucilage with
flaxseed, to which liquorice may be added, it is largely employed to
loosen a hacking  cough in children or in adults.  The flaxseed should
not be boiled, but allowed to staud on a moderately warm part of the
" range," and the gum  arabic solution added with a little lemon-juice
for flavoring purposes.   Acacia is chiefly used in pharmacy for making
pills, emulsions, and similar preparations, and is official  in  the form
of the  mucilage of acacia  (Mucilago Acacice,  U.  8. and B. P.);  and
the syrup of acacia (Syrupus Acacice,  U. 8.), the  first  containing 34
parts of acacia  aud 66  parts of water,  aud  the second 25 parts of the
mucilage to 75  parts of simple syrup.


             ACETANILIDE, or  ANTIFEBRIN.

  This substance, first employed in medicine by Cahn and Hepp, is  a
white crystalline material only  slightly soluble  in  water, but com-
pletely soluble  in alcohol  and ether.   Applied to  the tongue it causes
a burning sensation which is not very severe.   It  has been known to
chemists for many years, and is made by the action of glacial  acetic
acid upon aniline, forming in this way acetanilide or phenyl-acetamide. 
40
DRUGS.
The word  antifebrin  is a trade-mark, and  should be avoided  by the
profession,  since its employment obliges the druggist to use the acetan-
ilide made by one firm instead of the compound made by other chemists,
who are able to make the drug as an  ordinary chemical compound,
and do not charge  so high a price as do those holding control over the
trade-mark name.
  Physiological Action.—Acetanilide  has  been studied experiment-
ally and chemically to a very great extent,  and fairly definite outlines
of its action have been mapped out.
  Nervous  System.—On the nervous system acetanilide has  been
found to act as  a sedative, the sensory portion of the nerves and spinal
cord particularly being quieted.  After a poisonous dose general anaes-
thesia comes on, with total loss of reflex action and with motor and
sensory paralysis.   The portions of the nervous system  involved  in
these changes are, primarily, the sensory side  of the spinal cord and
the sensory nerves, the motor apparatus  being least affected.  The
muscles are not influenced by the poison, except indirectly.
  Circulation.—On  the  circulation acetanilide has but little direct
influence except when used in poisonous doses.  Applied to the frog's
heart it at  first  accelerates its  beat and increases its force, but  soon
causes a weakening, ending with  arrest in  wide diastole.  Upon the
higher animals  it  causes, in toxic dose, an immediate fall of arterial
pressure with a  diminution in the size of the pulse-waves and all the
evidences of cardiac and circulatory  depression, notwithstanding the
fact  that death  ensues  from respiratory failure.  The cause of this
fall of blood-pressure is a direct depressing action on the heart asso-
ciated with failure of the vasomotor system,  as asphyxia  causes no
rise in pressure.
  In medicinal dose acetanilide causes no circulatory changes of any
moment.  Sometimes the pulse-rate is increased, sometimes diminished.
The tendency is, however, toward  depression  rather than stimulation
of the circulation.
  Blood.—The action of this drug  upon  the blood, when used  in
large doses, is more pronounced than its influence  upon  any part  of
the body, causing  this tissue to become brownish-red, decreasing its
ozonizing   and   oxygen-carrying  power, and, finally,  reducing  the
haemoglobin to  methaemoglobin to a  very  considerable extent.   The
question as to the influence  of acetanilide upon the  corpuscles is still
somewhat  undecided,  some  observers  declaring that these bodies are
disorganized, while others  assert that they  remain intact.   In moder-
ately large  poisonous  doses it may not affect the corpuscles, but if its
use in large amount  be maintained  for some  days, or a very large
amount be used at one time, corpuscular destruction certainly occurs,
free  haemoglobin appearing in the urine in its characteristic forms.
The normal alkalinity of the blood is decreased, and the urine becomes
dark and brownish in color, so  that the blood-crystals of Teichmann
may be  found in it.   In ordinary medicinal doses the blood shows no
change  except in cases where idiosyncrasy is present or the doses are 
                ACETANILIDE, OR ANTIFEBRIN.            41

 unusually large.  Under these circumstances the blood in the arterial
 system becomes more blue than normal.
   Respiration —Xo effect is produced upon this function by acetan-
 ilide when given in moderate doses.  A\rhen poisonous doses are used
 the breathing  at once becomes rapid and then  impaired and labored.
 Large doses produce death by  paralysis of the respiratory  centres.
 The causes of these  changes are,  primarily, the alterations in the
 blood, which  so influence  oxygenation of the tissues as to lead the
 respiratory centres to greater effort, while at the same time they are
 beginning to be directly depressed  by the drug  itself, so that impair-
 ment of their  function is soon manifest,   Bokai asserts that the drug
 paralyzes the  peripheral motor nerves, which, if true, brings forward
 a third factor  in the respiratory  failure.
   Temperature.— \Yhen  given in full medicinal  doses, acetanilide
 lowers the normal  bodily  temperature  or  else  fails to produce any
 change.   In poisonous  doses  it produces  a decrease in  temperature
 depending on  the  amount  employed, and  may produce collapse and
 rigors.   On a  fevered temperature  it acts  as a powerful and fairly
 constant antipyretic, lowering  the fever by  decreasing heat-production
 and  increasing heat-dissipation, heat-production being  the function
 most affected.1  \Vhether the decrease in heat-production is  due  to an
 action ou the heat-centres in the  nervous  system, or upon other causes,
 is not positively known.   Some investigators have  claimed that the
 fall  depends upon the  partial  reduction of the haemoglobin of the
 blood, whereby less oxygen is carried to the tissues  and less combus-
 tion  ensues.   This  seems doubtful, in view of the fact that the most
 careful spectroscopic examination of the blood fails to show any such
 change.   That the fall of temperature is not dependent on  the sweat
 produced is proved by the fact that the  temperature falls  even  if
 enough atropine be given to stop all perspiration.
   Kidneys,   Tissue-waste, and  Urine. — Much  contradictory
 evidence exists in regard to the  changes which occur in these organs
 and their excretory products under the influence of acetanilide, but
 most observers agree that the excretion of urea is increased, and it is a
 fact that the more  laborious researches  which have  been undertaken
 have reached a similar result. (Lepine, Chittenden, and  Taylor.) Less
 uncertainty exists as to its influence on uric acid, which is  increased
 rather than diminished by the drug.  After excessiyely large  doses
 the  urine  becomes dark from the  presence of  broken-down blood-
 coloring matter.
   Elimination.—The  drug is eliminated by the kidneys in the form
 of para-amido-phenol-sulphate.
   Antiseptic  Action.—The  drug  possesses some   slight  antiseptic
 powers, but they are only exercised  when the amount present is  quite
 large.
   Toxic Changes from Prolonged Use. —Although it  has been claimed

  1 The conclusions of Evans and of the writer have been  severely criticised  by H.
C- Wood  My reasons for holding to the opinions stated can be found in my Boyl-
ston Prize Essay on Antipyretics   Philadelphia, 1891. 
42
DRUGS.
that no untoward effects result from the prolonged use of acetanilide
in large  doses, there can be no doubt that this  is untrue.   Under
these  circumstances  congestions of the liver,  kidneys,  and  spleen
occur, and if the doses be poisonous, clots may be found in the cardiac
cavity.
  There  may be also a progressive decrease in the number of the red
blood-corpuscles.
  Poisoning.—In  man  this  drug  in  toxic quantity causes the  lips
to become  blue, the  face livid, cvanosed, expressionless,  or anxious.
The forehead  aud  cheeks become  covered  by beads of sweat, which
gradually extend over the rest of the body.  The pulse is  soft and
compressible, but slow and fiually very weak.   The  respirations are
slow and shallow.
  The treatment of a case of poisoning by acetanilide  should consist
iu supporting measures, the  use  of stimulants, external  heat, bella-
donna to maintain blood-pressure, strychnine to aid  the  respiration,
and oxygen inhalations if they are necessary to overcome  cyanosis.
  Therapeutics.—The  employment of  acetanilide  in fevers  must
depend very much upon the exact condition of the patient and the
form of his disease.   The mere existence  of a  malady, or of  a  high
temperature,  cannot,  correctly speaking, be an  indication for  any
particular remedy.   The phase of  the disease must be recoguized, and
the question as to whether the fever which  is present is harmful  must
be duly weighed.   (See  Fever, Part IV.)
  In  typhoid fever the studies of most clinicians show that though
the drug possesses very decided antipyretic power, it often  causes great
depression  and collapse, and in  no way influences the  duration or
general course of the disease.
  For the same reasons  the value of acetanilide in phthisis is doubtful,
since, although it  greatly affects  the  temperature, it  is  very  apt to
cause collapse, profuse  sweating,  and depression.   Thus the  writer
has seen cases of phthisis  where the  attempt  to control the fever
resulted  in the manner just  stated, and Riese  points  out, what the
author has also noted, namely, that in this disease cyanosis is very apt
to come on after the use  of the drug.
   In regard to the employment of acetanilide in  sthenic fevers, it at
once becomes  evident to the  most  careless  student of medicine that a
drug  absolutely unsuited to  a case of asthenic disease may, on the
other hand, agree with a sthenic fever  patient very well.   In  conse-
quence of this, we find  that  the sweating  produced by acetanilide  is
not so marked or troublesome in diseases of a dynamic type, and  that,
in consequence, it more  rarely causes collapse.
   In much the same manner that antipyrine was found, some time
after  its  introduction, to be possessed  of pain-relieving  power, so
acetanilide  has been discovered to possess similar properties—a dis-
covery the  credit of which must be given to the French  investigator
Lepine, who has written upon this subject, at various times, very ex-
tensively.  Almost every form of nerve pain  seems  to indicate its
employment, aud it has  been  successfully used in the crises of ataxia, 
ACETATE OF POTASSIUM.                 43
the agonizing dartings  of gastralgia, and even  in  chorea, with good
results.  In a corresponding manner Secretan has obtained brilliaut
effects in cases of sciatica, aud Silva has  seen the most obstinate head-
ache yield to its influence.   A large amount of experience  has proved
it to be of  value in epilepsy.
  The employment of acetanilide  in  rheumatism may be separated, if
desired, iuto  that devoted to the cure of  the disease, with the relief of
pain and the reduction of pyrexia.  There can  be no doubt whatever
of the ability of the drug to control the fever of this disease, aud the
question as  to  whether it favorably influences the progress  of the
malady is to be answered very forcibly  in the  affirmative (see Rheu-
matism, Part IV.).   The dose for cases  of rheumatism should be 4 to
6 grains three times a day.
  Acetanilide has even  been recommended as a haemostatic  iu epistaxis
and hcemoptysis.
  Untoward Effects are not very common if acetanilide be used with
care.   The writer has  collected  a number of cases  (thirty-eight) in
whicli unfavorable signs appeared after  its  use, but untoward action
was never seen unless the dose given was excessive for the case which
received it.   The dose most commonly producing such symptoms was
from  3 to 10 grains.  In only three instances of the series did death
occur, one  from heart-clot and two from excessive dosage.  No deaths
were  reported  from  moderate amounts, although  some of the cases
were  very alarming.
  Administration.—Acetanilide may be  given in doses varying from
2 to 10 grains,  the last-named amount  being usually far too much.
As  it is virtually insoluble iu water, it should always be administered
in wine or spirit/in  which  it will  dissolve, or in capsules or pills.
The antipyretic effect begins to be felt about one hour after the drug
is taken.   When neuralgias are to be treated, or similar forms of pain
are present, monobromated camphor, in the dose of \ a grain, may be
combined with acetanilide with advantage.
         R.—Acetanilidi......gr. xx.
             Camphor, monobromati  .    .    .    .  gr. v.   M.
    Ft. in pil. no. x.  S.—One every two hours.


                 ACETATE OF  POTASSIUM.

  Potassii  Acetas, U. 8. and B. P., is a neutral white salt of saline
taste,  readily deliquescent and  soluble in water.  It was at one time
very  largely used  in the treatment of rheumatism  in  the " alkaline
method/'* as when it enters the blood  it is  changed into the alkaline
carbonate.  It has, however, been supplanted by the salicylates in the
treatment of most cases.  The  dose should be  from 1 to  2 ounces a
day.   A combination of 10 grains of the iodide of potassium and 30
of the acetate is useful iu  rheumatism in  some instances.
  In  hepatic torpor acetate  of potassium  is exceedingly  useful, and
aids in  promoting the  flow of bile  as well  as that of the urine.  It 
44
DRUGS.
has been used in the treatment of the uric acid diathesis, and acts pow-
erfully in rendering alkaline an acid urine.   At one  time it was sup-
posed to purify the blood by aiding in the oxidation of effete material.
The dose of potassii acetas  is from 20 grains to 2 ounces, but the
latter dose is only employed when a purgative effect is desired.


                     ACETATE OF ZINC.

  Zinci Acetas,  U. 8. aud B. P., occurs in the form of  white mica-
ceous crystals, which are efflorescent and quite soluble in water.  It
acts as a decided astringent  to the skin  and  mucous  membraues, but
is less astringent than the sulphate of zinc.   It is used as a collyrium
in eye diseases, such as conjunctivitis, iu  the strength  of 1 to 2 grains
to the ounce.  In  gonorrhoea it is often  employed instead of the ace-
tate of  lead in  injections of the strength of 1 to 20 grains to the
ounce of rose-water.
  The treatment  of poisoning by acetate of zinc is that adapted to
gastro-enteritis.   (See Gastro-Enteritis,  Part  IV.)


                        ACETIC ACID.

  Acidum Aceticum, U. 8. and  B. P., as  used  in  medicine, is a clear
liquid made up of 30  per  cent,  of acetic acid and  64  per  cent, of
water, and has a sweetish odor.  It is obtained  from wood by destruc-
tive distillation.
  Acetum, or Vinegar, is a  dilute acetic acid.
  Therapeutics.—Acetic acid is seldom used internally, except in com-
bination with potassium or sodium.  As  a  powerful escharotic, the
glacial or absolute acetic acid (A cidum Aceticum Glaciate, U. 8. and
B. P.) is used.   It can be applied to warts and other growths, and to
old sores where the  granulations are profuse and slow to heal.  The
dilute acid (Acidum Aceticum DUutum, U. 8.  and B. P.) is used as a
lotion iu night-sweats, and to arrest epistaxis and other small haemor-
rhages.   As a lotion to be widely employed it  should be diluted one-
half  AMiiegar,  or dilute acetic acid, has been  used internally for the
decrease of obesity, but  is a  harmful and  useless remedy, disordering
digestion and reducing the patient's  strength.
  In the following mixture acetic acid has been used with success for
the removal of vegetations about the external genitals :
         R.—Acid, salicylic     .    .        .       gr. xxx.
            Acid  acetic.......f^j.      M.
    S.—Apply with a camel's-hair brush.

Very little pain is caused by this application.
  Poisoning.—When over-doses of acetic acid are  taken the treat-
ment consists in the use of large  doses of  milk, alkaline liquids, such
as lime-water, soap-water, etc., and the general measures  adopted for
the treatment of gastro-enteritis.  (Sec  Gastro-enteritis, Part IV.) 
ACONITE,  OR  MONKSHOOD.
45
  Contra-indications.—Xursing mothers should not take freely of
vinegar, as it may produce a troublesome diarrhoea in the nursling.
                 ACONITE, or MONKSHOOD.

   The Aconite of the  U. 8. P. is derived entirely from the tuberous
 root of Aeonitum Napellus.   At  one time the leaves were  official,
 but are so no longer, and for this  reason  the  term " radix" is not to
 be employed, as it is a useless distinction.
   Aconite is indigenous in Germany, France, and  Switzerland, and
 is cultivated as a garden plant  all over  Europe and  America.   The
 root is so strikingly like that of horseradish as to be readily confused
 with that article of food, but does not emit the puugent fumes of the
 latter  when it is scraped or broken.  It is to be remembered, however,
 that it produces a distinct  feeling of heat in the mouth when chewed.
 The active principle upon  which the therapeutical value of  aconite
 would appear to  depend is aconitine, but there is reasonable doubt
 whether this  can be relied  upon as  completely as the fluid prepara-
 tions of the crude drug; the aconitine of commerce, moreover, varies
 very much in strength, because some of it is  amorphous and impure,
 while  other samples are very pure and crystalline.  Further than this,
 even the crystalline form  is  exceedingly variable.  Iu addition to
 aconitine Dunstan asserts that there  are  two amorphous alkaloids—
 namely, acouine and napelline, and this investigator believes that there
 is a fourth alkaloid closely allied to napelline.
   Physiological Action.   Nervous  System.—Aconite in  full medi-
 cinal dose depresses the functional activity of the perceptive centres in
 the brain, the sensory side of the spinal cord, and, finally, the peripheral
 ends of the sensory nerves.   Applied  to a mucous membrane, it  acts
 as a local anaesthetic, but is too  irritating for  use in the eye.   On the
 motor  portion of the body  it exerts  little influence, unless given in
 poisonous doses, when it paralyzes the motor tract of the spinal  cord
 and the peripheral motor nerves.
   Circulatory System.—On the heart  aconite acts,  when given in
 moderate doses, as a quieter of its  movements  and  force, and  lowers
 blood-pressure and pulse-rate by a direct action on the heart  muscle.
 There  is no good experimental evidence of its possessing  any direct
 influence on the vasomotor  system, but clinically it seems  to possess
 this power.   In poisonous dose it causes first a very marked  fall in
 pulse-rate,  preceded  sometimes  by a quickening due to a condition of
 weakness and abortive  cardiac action; this condition gradually passes
 into diastolic arrest of  the heart-beat, the viscus becoming  paralyzed
and  refusing to  respond to stimuli.
  Respiration.—In moderate doses aconite quiets the respiratory
movements  slightly,  particularly if the breathing is hurried  before
its use.  In poisonous doses it paralyzes the respiratory centres, and
so causes death.
  Temperature.—Aconite acts as a distinct reducer of fever, prob- 
40
DRUGS.
ably because of increased heat-radiation arising from relaxation of the
capillaries and impaired circulation.
  Kidneys.—In fever aconite usually increases the urinary flow.
  Poisoning.—When aconite is taken internally in excessive amount
it  causes  tingling  of  the mucous membranes wherever  it  touches
them, which sensation  finally amounts to severe burning.  This soon
passes away, and is followed by a sense of tingling about the lips and
finger-tips," or all over the skin.  At the same time the patient feels
relaxed, the pulse  becomes slow and  weaker, but later on rapid and
running so that  it  seems a mere trickle under the finger; sweating
more or  less  severe is present, aud fainting  may ensue.  Vomiting
may occur, but  is rare.   The respirations  now  become  slow aud
shallow, seeming to expand the lung iu the smallest possible degree.
The face is pallid  and anxious.   There may be exophthalmus,  or
the  eyes may  be  sunken  and  dull.   There is  excessive pallor.
Epileptiform  convulsions may be present, due  to  disorder of the
circulation  at the  base of the brain.   Previous to this there may be
marked anaesthesia of  the  skin.   The  pupils  may be  normal,  or
dilated to a wide degree.  The sclerotic  coat  of the eye is pale and
pearly-looking.  The temperature is very low.   Death may be gradual
or sudden, the slightest movement  of the body which can throw any
strain on the heart stopping that organ in diastole.
  Treatment  op Poisoning.—The patient is  to be placed  in a
prone position or  on a board, with the  feet higher than the head, in
order to confine the circulation as far as possible to the vital centres at
the base of the brain.   Hot bottles or bricks are to  be placed about the
body for the  purpose of maintaining the  bodily heat.  Emetics are
not to  be given if the  symptoms  are severe, as vomiting may  cause
cardiac arrest, owing to  the muscular  effort  involved, or the stomach
may be so depressed that the emetics will not act.  If vomiting comes
on, let  it be into a  towel without the patient being allowed to raise the
head.  The stomach is to be washed out by means  of a stomach-pump
or a siphon made of rubber tubing.   Ether may  be given hypoder-
mically, and followed by alcohol, and this  again  by  digitalis.   The
ether acts at once and lasts while the alcohol is being absorbed, and
the alcohol  supports the heart until  the digitalis, which is the physio-
logical antagonist  of aconite, but  slow and prolonged in  its effects,
asserts itself.  If  the  breathing fails, artificial respiration  is  to  be
employed, or if the heart seems about to cease its action, a whiff of the
nitrite  of amyl may start it going again, but only a few drops of the
nitrite  should be  used, as large amounts depress  this organ.   Full
hypodermic doses of strychnine, such as -^V to TVj-  of a grain, may be
given to stimulate  the respiration and heart.
  Therapeutics.—The employment of aconite in disease is one of the
most universally recognized  procedures in  medicine.   It fulfils  indi-
cations which nothing else  can, and  lends  itself to the control  of a
large number of morbid processes, its  effect  being  uniformly explain-
able by its known physiological action.   It is used  chiefly for its  influ-
ence as a cardiac and circulatory quieter, for its effects on the periph- 
ADONIS  VERNALIS.
47
eral sensory nervous  system, as in the vomiting of pregnancy, and in
those states in which, through inflammation  elsewhere, the  nervous
system needs a sedative which  will simultaneously reduce arterial ten-
sion.  In the early stages of all acute inflammations aconite is of service.
It may be  applied  locally over superficial  nerves in  neuralgia in the
form of an ointment (2 grains to 1 drachm, or as the oleate of acoui-
tine, 2 grains  of the oleate to 100 of sweet oil).  In the earliest stages
of gonorrhoea  aconite in small  doses frequently  repeated is a most
valuable remedy, and later in  the disease tends to prevent chordee by
its influence  on  the nervous  centres.   It  is useful in  croup, quinsy,
sore-throat, severe colds, bronchitis and asthma due to exposure, in their
early stages.   When suppression of menstruation  follows an  exposure
to cold, this drug will often restore the  normal flow.   In pericarditis
it is  valuable to allay the inflammation  and  quiet the  excited heart,
and it is also of great value in the earliest stages of pneumonia.   It
ought not to be used in adynamic, asthenic  affections.   Aconite is use-
less  and harmful in  prolonged acute diseases, such as scarlet fever, if
constantly employed.
   In persons  who  suffer from asthma  which is preceded  by coryza,
aconite does good in the earliest stages.
   In nervous palpitation of the heart, and  in the palpitation  of exces-
sive cardiac hypei-trophy, it is very valuable.   In the epistaxis of full-
blooded people it often affords  great relief.   Aconite is by far the best
circulatory and nervous  depressant for children suffering from sthenic
fevers, particularly of the irritative type.
   Administration.—As  a  general rule, small divided doses of the
drug in  the  form  of the tincture, | to |  a drop given every fifteen
minutes, will act better than a full dose  given at once, unless the con-
dition of the patient requires very active treatment,
   Preparations.—Tincture of aconite  (Tinctura  Aconiti,  U. 8. and
B. P.) is  used in  the  dose of 1 to 5 drops  in water, repeated every
hour if needed so often.  A very useful way of employing it  is in the
form of  tablet triturates.   The extract of aconite (Extractum Aconiti,
 U. 8.) is given in the dose of  J to f of a grain, while of the  abstract
(Abstractum Aconiti, U. 8.) 1 grain is used.   The fluid extract (Ex-
tractum Aconiti Fluidum, U. 8.)  is given in the dose of 1 to 2 minims.
Fleming's  tincture  ought  never to be used.   The  active  principle
aconitine is not  official  in the U. 8. P.  Its  dose is ^T to  y^- of a
grain, but it ought never to be  used internally.   The B. P. prepara-
tions that are not official  in the  U. S. P. are : aconite leaves  {Aconiti
Folia), aconitine (Aconitina), aconite ointment ( Unguentum Aconitince),
and aconite liniment (Linimentum Aconiti). The dose of the extract of
aconite (Extractum Aconiti, B. P.), is J to  1 grain.
                     ADONIS VERNALIS.

  From Adonis vernalis, a plant indigenous in  Europe  and Asia, is
derived a  glucosidc, Adonidin.   When given to one of the mammalia 
48
DRUGS.
—the dog, for instance—it causes an increase in heart force and a rise
of arterial pressure.  In the frog, poisonous amounts arrest the heart
in diastole.
  The indications  for the use of adonis are all conditions  of cardiac
failure, particularly the presence of cardiac dropsy.  It is much infe-
rior to digitalis and caffeine, but may be employed when  these fail, as
it sometimes succeeds under such circumstances.  The dose of adonidin
is i to £ of a grain three times a  day ;  or, 4 to 8 parts of the plant—all
portions of which are employed—may be added to 180 parts of water,
and of this infusion a tablespoonful may be given every four hours.
                          AGARICIN.

  Agaric, or  Touchwood, or Punk, has been  used in the southern
United  States very largely in the dose of 5 grains every few  hours
in the treatment of the  night-sweats of phthisis;  and  agaricin, the
alcoholic extract of the drug, has been used with very extraordinary
results,  under these circumstances,  by certain  German and  English
physicians, in  the dose of from  1 to 2 grains every five hours.  Its
physiological action  is unknown, but it is  supposed to act upon the
nerve filaments in the sweat-glands.   The writer has employed  it fre-
quently in varying dose, and  has never seen any  decrease whatever
produced by it in the  sweats  of phthisis, although he has watched it
most closely, expecting to see great relief follow its use.
                          ALCOHOL.

   Ethyl alcohol  (Alcohol Ethylicum, B. P.) is the only alcohol used
in medicine.   Some of the other alcohols  are exceedingly poisonous.
Amylic alcohol is fusel oil.
   Alcohol is a liquid derived from  the fermentation of starches or
sugars in  the presence of heat.  It is official  in two forms—namely,
as Alcohol, U. S., containing 91 per cent, of the spirit and !* per cent.
water, and Alcohol Dilutum,  U. 8., or  dilute alcohol, 45.5 per  cent.
spirit and the remainder water.  The drug is generally given in the
form of whiskey  or brandy, and when the  word alcohol is used in the
saying, " Give the patient alcohol/' one of  these two liquids is always
meant unless it is otherwise stated.
   Physiological Action.  Nervous System.—Alcohol  acts first as a
powerful  excitant and  afterward  as a most  active depressant and
paralyzant of the nervous system.  Locally applied in small amounts
to the peripheral  nerves it .excites them at first  and paralyzes them
afterward.  By the primary stimulation of the brain it  increases the
rapidity, but not  the depth, of thought, while it  increases  the reflex
activity of the spinal cord,  the muscles, and the nerves.   In  larye
doses  it produces  lack of coordination by depression of the  brain and
lower  nervous  system, the loss of  coordination being due  largely to 
ALCOHOL.
49
sensory paralysis, so that the power of touch is interfered with.  This
makes a drunken man fail to recognize  the  angles  and surfaces of
obstructions, and the impaired mental power and disordered judgment,
combined with the badly acting motor and sensory pathways, cause
him to stumble and fall.
  Circulatory System.—When alcohol is  ingested, either  by man
or the lower animals, it stimulates the heart muscle and increases the
rapidity as  well as  the force of its beat,  According to Dogiel, the
increase in rate is partly due to stimulation of the accelerator nerves,
but Castillo denies any such influence.  Wood teaches that the effect
of alcohol is not through any action upon these nerves, and is proba-
bly correct  in his belief.   Along with the stimulation  of the heart a
rise of arterial pressure ensues,  largely due  to increased heart action
and partly to vasomotor stimulation.   In very large toxic doses alcohol
depresses and finally paralyzes the heart and vasomotor system as well
as the nervous system.
  Respiration.—Respiration is stimulated by small doses of alcohol
and decreased by large ones.
  Temperature.—Alcohol  at  no  time  increases to any extent the
actual number of heat units in  the body.  It produces a sensation of
warmth and warms the extremities by causing the heart to  pump hot
blood from  the centre of  the body to the  cold parts.  If it be used iu
excess the temperature  rapidly falls,  owing  primarily to the  increase
of heat-radiation produced by the excessive distribution of heat just
named, and secondarily by  the  depression of vital  power which  is
caused  by a too rapid  destruction of the tissues  of  the body in the
effort induced by the drug.   Calorimetrical studies show that, while
more heat may be created under its influence, so much heat is dissi-
pated that the temperature nevertheless falls.
  Bodily Metabolism.—The quantity of carbonic acid given off by
the body, under the  use of alcohol, is in most instances increased; but
it may  be decreased.  The  effect on the absorption of oxygen is not
known.  Some observers have  noted an  increase, some a  decrease of
such  absorption, and some  no change at all,  when  alcohol is taken.
Upon the giving  off of nitrogenous substances it acts as  a  decided
depressant,  which seems to prove that it inhibits rapid tissue changes,
and is a conservator of vital power.   It  adds force, but not tissue, to
the body.
  Elimination.—Alcohol is largely " burnt up"  in the  body, but
when taken in excess of the  latter's  oxidizing power, it is eliminated
by the breath, and by the skin, kidneys, and intestines.
  Digestion.—Alcohol added  in any amount to food in a test-tube
containing digestive  ferments retards or inhibits digestion, but in the
stomach, on the other hand,-it assists  the process; for, by reason of its
irritant and  stimulating properties, it induces the secretion of an excess
of the digestive juice.
  Therapeutics.—The employment  of alcohol in  disease can here be
only briefly alluded  to, special mention of its indications being named
where the diseases in which  it is used are  discussed.  Its chief uses
                                4 
50
drugs.
are as a rapidly acting stimulant in all forms of cardiac failure due to
shock or to  poisons, and as a systemic support and stimulant in low
fevers and prolonged wasting diseases, in old age, and in convalescence
from acute disease.
  Some of the conditions, to state them specifically, in which alcohol
is indicated, are fainting, snake-bite, surgical shock, acute, subacute and
chronic pneumonia  in  its later stages,  and excessive wasting, due to
prolonged suppuration.
  Alcohol should never  be given in sthenic fevers unless some  com-
plication,  such as  syncope  or pneumonia, comes on.   The  reason
it is contra-indicated is that in sthenic fevers the circulation is already
sufficiently excited, and  is generally in excess of the needs of the
system.   In  exhausting fevers, such as typhoid or typhus, alcohol  finds
its true usefulness.  While it  is well to give alcohol iu many  cases
from the beginning to the end of the attack, for the double purpose of
aiding digestion and of supporting the system, its administration should
not be a mere matter of routine, but should be based upon clear  ideas
of the indications it is calculated to fulfil.  If the pulse is weak and the
patient seems to  be sinking, or the appetite is failing and  adynamia
is a pressing  symptom, alcohol is indicated; but if the pulse is good,
and the passage of the patient through his  illness is not a stormy one,
alcohol should be excluded from the sick-room.  In phthisis, in neu-
ralgia, aud in similar states dependent upon depression of the system,
care must be taken  to prevent the setting up of a " habit."
  Alcohol is very useful  as a local  application to  ulcers and wounds,
as it acts as an antiseptic and stimulant, and when combined with salt
forms a useful liniment in cases of debility and atony of the skin and
subcutaneous tissues.
  Acute Poisoning.—In advanced poisoning by alcohol, with coma and
total relaxation, external heat and  hypodermic injections of digitalis
and strychnine are indicated, if the heart or respiration seems failing.
Belladonna should  be administered to stimulate the vasomotor system
if the skin is relaxed  and clammy, and counter-irritation to the  back
of the neck is to be employed if any brain symptoms  seem  pressing.
The after-treatment consists in the use of substances stimulating to the
stomach, such as ammonia, spirit  of  Mindererus, and spices, unless
there is gastric inflammation, when emollient substances should be used
to quiet the  irritation.   If persistent vomiting comes on it must be
quieted by the patient swallowing pieces of ice, by aconite, cocaine, or
minute doses of ipecac.  Counter-irritation should be applied over the
belly.  If the emunctories are  not acting freely, thorough  purgation
by jalap or  elaterium (40 grains of jalap powder or | of a grain of
elaterium) should be employed; or calomel followed by a saline may
be given, if  milder  effects are sought.
  In view of the frequency with which alcoholic and opium poisoning
are confused,  the following  table  is appended, which will  be found
of value in making a differential diagnosis as  to the condition  of the
patient: 
ALCOHOL.
51
Alcoholism and Opium Poisoning.
            Alcoholism.
  1. Pupils normal or dilated.
  2. Respiration nearly normal
rapid, and finally feeble.
  3. Face may be pallid.
  4. Skin cool, perhaps moist.
                                           Opium Poisoning.
                                      1. Pupils contracted.
                            Pulse      2. Respiration and pulse slow and full.
                                      3. Face suffused and cyanosed.
                                      4. Skin  warmer than  in alcoholic
                                    poisoning
                                      Note.—The urine is always to be saved
                                    for medico-legal examination.
There is scarcely any difference as to consciousness in the two conditions.
Acute Alcoholism and Apoplexy.
            Apoplexy.
  1. Pulse apt to be strong and slow.

  2. Skin hot or dry.
  3. Bodily temperature raised.
  4. Pupils unequal.

  5. Hemiplegia;  one  side  tossed, the
other remaining motionless.
  6. Respiration  stertorous; the  lips
being inflated on one side on expiration.
  7. Facial palsy.
  8. Unconsciousness complete.
            Alcoholism.
  1. Pulse  rapid,  compressible,  and
 weak.
  2. Skin moist, or relaxed and cool.
  3. Bodily temperature lower.
  4. Pupils equally  contracted  or  di-
 lated ; generally dilated.
  5. No hemiplegia

  6. Breathing not so stertorous, nor so
 one-sided in lips.
  7. No facial palsy.
  8. Unconsciousness  may not be com-
 plete.
  The smell of alcohol in the breath is no guide, as acute alcoholism may have caused
 the rupture of a cerebral bloodvessel.
   Chronic  Poisoning.—The treatment of this  condition may be  car-
 ried out in two ways : First, by the isolation of the  patient and  the
 complete withdrawal of the drug at once ; secondly, by what is better,
 a gradual tapering-off in the daily amount  of the spirit.   In either
 instance isolation must be absolute, and all smuggling of alcohol to or
 by  the patient prevented.   The attendants must be absolutely trust-
 worthy.  Careful scrutiny of bed-clothes and closets will often be re-
 warded by finding hidden bottles.  The depression of the patient when
 recovering from alcoholism must be met by the use of nutritious broths
 highly seasoned, in  order to stimulate the stomach, by easily digested
 or  predigested foods, and, by small doses  of morphine or coca if  the
 patient be very weak and need such a stimulus.   Koumyss  is an  ex-
 ceedingly valuable preparation under these circumstances.
  In the treatment of the  atonic stomach of drunkards  nothing does
 so well as the following pill:
         R.—Oleoresin. capsici......Tltx.
             Olei caryophylli......TTLx.
             Hydrarg chlor. mit......gr. xx.
             Aloe Socotrinae......gr. xl.    M.
  Ft. in pil. no. xx.  S.—One three times a day after or before meals.
  If this pill  fails to move the  bowels after  thirty-six hours, a saline
purgative should be used to avoid  any danger of mercurialism.
  (See  Capsicum.) 
52                            DRUGS.
    Chronic  alcoholism  may produce cirrhosis  of the  liver, with the
 resulting symptoms, notably ascites.
    The following are the principal points in the differential diagnosis of

          Alcoholism and the Q-eneral Paralysis of the Insane.
            Alcoholism.                      Paretic Dementia.
   1. Attacks shorter, and  more widely     1. Attacks more prolonged.
 separated by intervals of sanity.
   2. Delirium may be of any character.     2. Delirium of grandeur more marked
                                    and defined.
   3. Visions more characteristic, and are     3. Visions often not evil, but pleasant.
 evil.
   4. Tremors confined to head and arms.     4.  Tremors more diffused.
   5. Tremors removed by dose of alco-     5. Tremors made worse by alcohol.
 hoi.
   6. Mental  symptoms temporarily re-     6.  Mental state made worse by alcohol.
 moved, or at any rate improved, by
 alcohol.
   7. Tremors occur chiefly in the morn-     7.  Tremors not confined to the morn-
 ing,                                ing.
   There is danger of pneumonia from failure of the right side of the
 heart  in  subacute and  chronic  alcoholism, and the physician should
 always be on the lookout for this complication.
   Administration.—Brandy and  whiskey are generally used as rapidly
 acting stimulants.   They should be exhibited in the form best adapted
 to the work they are intended to perform.  If the action  must  be in-
 stantaneous, as in a case of fainting, they should be employed hot and
 concentrated, so that the stomach has not to warm the liquid before
 absorption.  They are to  be used hypodermically if still  more rapid
 action is required.  If  administered to aid digestion and  support the
 system, then they should always  be given with the food—never alone,
 and never concentrated. They may be given as milk-punch or as egg-
 nog, the latter being the " heavier " of the two so far as digestion5 is
 concerned.   Wine-whey is very light and useful.  Mulled wine  and
 champagne are particularly useful in the treatment of irritable stomach.
 (For recipes for mulled wine and wine-whey see Foods for the Sick.)
 The champagne should always be as devoid of sugar as possible—that
 is, what is known as " extra dry."   Gin is rarely employed as a stim-
 ulant,  except when  given  to young children, or to adults, when the
 kidneys are torpid.  Stout and porter are of value in wasting diseases,
 in convalescence  from acute diseases, and for nursing women.  Lager
 beer contains too little alcohol to be used as a distinct stimulant, but
 may be used in moderation to aid digestion, or ale may be employed
 instead.   Clarets are useful aids to digestion, and  port is also of value
 in these cases.
   Contra-indications.—All states of cerebral excitement, unless due to
 exhaustion, acute inflammations, the alcoholic habit, apoplexy menin-
 gitis, acute nephritis, aneurism, and advanced atheroma contra-indicate
the use of alcohol.
The official preparations of alcohol are as follows : 
ALLIUM.
53
  Whiskey (Spiritus Frumenti, U. 8.) should be at least three years
old, and be made, in America, from rye for medicinal purposes.
  Brandy (Spiritus Vini Gallici, U. 8. and B. P.) is obtained by the dis-
tillation of fermented grapes or fruits, and should be from three to five
years old before use.
  Cologne Water (Spiritus Odoratus, U. 8.) is used solely as a lotion and
perfume.
  Red Wine (Vinum Bubrum, U. S.) is made from grapes not deprived
of their skins.   White Wine (Vinum Album, U. 8.) is the fermented
juice of grapes the skins of whicli have been removed.
  Dilute (Alcohol Dilutum, U. S.), and pure alcohol (Alcohol, U. 8.), are
also official.
  The unofficial preparations are :
  Rum, whicli is made from the fermentation of molasses, and  con-
tains about 40 to 45 per cent, of alcohol.                     -WW
  Gin is made from rye or barley, with the addition of juniper  berries
and  hops.   (Good  gin and  the Spiritus Juniperi  Compositus  of the
 IT. S. Pharmacopoeia are virtually identical therapeutically).  When
diuresis is required and atony of the kidneys is present, without in-
flammation, gin is a useful  medicament, provided that a stimulant is
indicated.  Gin is  one of the  alcoholic drinks most apt to produce
cirrhosis of the liver.
  Port Wine  ( Vinum Portense, B. P.) is a  fermented wine  to which
pure spirit is added to increase its strength.  It is one of the strongest
table wines, and is useful as a stimulant in convalescence.
  Sherry  (Vinum Xericum,  B. P.) has about 30 per cent, of alcohol in
it.  It is not official in the  IT. 8. P.
  Beer is  made by a slow fermentation, while Ale is made by a more
rapid fermentation at a higher heat.
  Porter resembles the other malt  liquors closely, except that  it con-
tains more solids, due to a scorching of the grain by a high heat.
  The B. P. preparations that are not official in the IT. S. P. are rec-
tified spirit (Spiritus Bectificatus), proof spirit (Spiritus Tenuior), sherry
(Vinum Xericum), amylic alcohol (Alcohol Amylicum), and Mistura
Spiritus Vini  Gallici, which is a useful, pleasant  and nutritive stimu-
lant made by beating up the yolks of two eggs with half an ounce of
sugar, and then adding four ounces each of brandy and cinnamon-
water.   This is sometimes called " egg-flip."
                            ALLIUM.

  Garlic is  a stimulant to digestion, owing to the volatile oil it con-
tains, which, by its somewhat irritating qualities, excites the gastric
mucous membrane  to increased secretion.   In persistent  colds,  where
the bronchial tubes are particularly affected, a garlic poultice, made by
pounding the bulbs in a mortar, is a very efficient, though disagree-
able, remedy.   In the treatment of children with colds, garlic may be
used boiled in milk, and the liquid given as a drink, warm or cold, or 
54
DRUGS.
the oil of garlic may be given in emulsion in the dose of 1 or 2 drops.
It ought not to be given during the febrile stage, as it is stimulating.
If the skin in any case is too delicate to permit of the use of pounded
garlic alone, it may be mixed with equal parts of bran, and a regular
poultice or plaster made thereof.  Employed in this form, allium is
useful if applied over the spine  or feet in the treatment of the cerebral
and  spinal convulsions of infants; placed over the belly in cases  of
gastro-intestinal  catarrh, it  acts almost as well  as a spice  poultice.
Allium-juice has also been used, in the dose of 2 to 5 drops, to relieve
nervous vomiting.  The dose of the syrup (Syrupus Alii, IT. S.) for a
child is 1 drachm, but 4 drachms may be given to an adult.
                          ALMONDS.

   Almonds are official in the form of the bitter  almonds (Amygdala
Amara, IT. 8. and B. P.), and the sweet almonds (Amygdala Dulcis,
 IT. 8. and B. P.).  Bitter almonds develop hydrocyanic acid  in  the
presence of water, by the reaction between the amygdalin and water
in the presence of the emulsin contained in them; this is not the case
with sweet almonds.
   Sweet almonds, when  rubbed up  in a mortar  with water, form a
pleasant-tasting emulsion of au agreeable odor, that is very  useful as a
vehicle for remedies having a disagreeable taste.   Almond  bread  has
been proposed as  a food for diabetics, owing to its containing virtually
no starch ; but it is requisite that the oils and saccharine constituents
of the almond shall first  be removed.   (See Foods for the Sick.)
   When half au ounce of sweet almonds are rubbed up with thirty
grains of gum arabic  and two drachms of sugar, to which is added
gradually a half-pint of distilled water, the mixture being then strained,
an emollient and soothing drink is  formed  which is very useful in
irritations of the  stomach and intestines, and  of the air-passages and
pharynx.  The  expressed or essential oil of almonds is a useful demul-
cent, and has been recommended in the cough of phthisis, given in  the
dose of  a few drops in  emulsion.
   Bitter almonds  give off an oil ( Oleum Amygdalae Amarce, IT. S.), which
is exceedingly poisonous, owing to the  prussic acid which it contains,
and it is said that one drop will kill a cat, while seventeen drops have
killed a man.
   Bitter almonds are used to allay irritable coughs and similar states,
but are not frequently employed, because other drugs are less danger-
ous, more stable,  and more active as remedial  agents.  The emulsion
of bitter almonds is made as is that of sweet almonds, and may be used
in teaspoonful doses for the same purposes, and as a vehicle in cough
mixtures.   Both  emulsions are useful as vehicles in the treatment of
gonorrhoea, to diminish the burning on urination.   Almond  emulsions,
when locally applied, are supposed to  be of value for the removal of
freckles and sunburn.
   The preparations of sweet almonds are: a mixture (Mistura Amyg- 
ALOES,
55
dalce, IT. 8. and B. P.), dose 1 to 2 ounces; a syrup (Syrupus Amyg-
dalce, IT. S.), dose 2 drachms to 2 ounces ;  a compound powder (Pulvis
Amygdalce Compositus, B. P.), given in the dose of 1 to 2 drachms ■
aud  the oil (Oleum Amygdalce Expressum, IT. 8. and B. P.), the dose
of whicli is 1 to 4 drachms.  Aqua Amygdalce Amarce(U. 8.) is pre-
pared from the oil of bitter almonds.  The dose is 30 to 60 drops.
                           ALLSPICE.

   Allspice, or Pimenta (IT. S. and B. P.), is  the  nearly ripe fruit of
 Eugenia Pimenta, a tree of the West Indies.   It contains an official
 volatile oil (Oleum Pimentce, IT. 8. and B. P.), used for flavoring pur-
 poses, as a constituent of spice plasters, in diarrhoea mixtures, or as a
 carminative.   It will also prevent the griping of purgative medicines.
 The dose of the oil is 1 to 5 drops.   Aqua Pimentce (B. P.) is given in
 the dose of 1 to 2 ounces.

                             ALOES.

   Aloes, or  Aloe of the IT. S. P., is derived  solely  from  the  Aloe
 Socotrina, while that of the B. P. is obtained not  only from  Socotrine
 aloes, but also from Barbadoes aloes (Aloe Barbadensis, B. P.).  It is
 the inspissated or dried juice  of the leaves of the plant.   The actual
 species from which the drug is derived is uncertain.   It  is probably
 derived from several species.  Aloes contains an active principle known
 as alo'in, which is a crystalline substance.   As alo'in is generally  sold,
 it is,  however, an amorphous  powder of extremely bitter taste.
   Physiological Action.—Locally  applied  to  the tongue, aloes is a
 bitter of rather a persistent taste.  According to the studies of Ruther-
 ford,  the drug increases very considerably the flow of bile  in the dog,
 but in man  it cannot in any sense be regarded as a medicament for the
 production of an increased biliary flow.   Rutherford's doses given to
 the dog amounted to as  much as sixty grains, equal to three or four
 drachms in man.  In  the lower animals and in  man aloes  acts very
 slowly, requiring many  hours for its influence to be distinctly felt,
 unless the dose  be  toxic  in amount.   As  much  as four drachms of
 aloes  have been  injected into the veins of a horse without inducing
 purgation, probably because four  drachms were not enough to affect
 the bowels.  Aloes has been used endermically, and when so  employed
 is said to act  thoroughly.  It is eliminated  by the milk  of nursing
 women, and will cause purgation in an iufant put to the  breast of a
 patient taking  it.   If  the doses be quite  large  (10 to 20 grains), the
 passages will  be watery;  but  if the dose  be  more moderate (2 to 3
 grains), the stools will  be thick aud pultaceous.
  Therapeutics.—Aloes  should be used  only when a somewhat  slow
 stimulant  to peristaltic movement  is desired,  and never where the
 object of the physician is to relieve congestions by depletion through
the intestine.   It is a favorite remedy in cases of  subacute or chronic 
56
DRUGS.
constipation, but is distinctly harmful if continued constantly  for any
length of time, as it  seems to produce atony of the bowel.  Owing
to its bitter properties it acts as a tonic to the stomach, aud is often
given with iron to promote the absorption of this  metal ^ by stimulat-
ing the  liver and  by preventing  any constipation which  might  be
produced by  the chalybeate.
   When taken in a large enough dose to produce a copious passage,
aloes nearly always produces a feeling of weight  and fulness  in  the
region of the rectum after the  evacuation,  and the writer^ has  seen
severe rectal catarrh produced in this way.  If given  alone  it is very
apt to produce griping, and it ought always to be combined with
other drugs whose tendency is to  prevent intestinal spasm.
   In cases of haemorrhoids occurring in persons suffering from general
muscular relaxation and atony, aloes  is said  to do great good, but  its
use under these circumstances is  by no means universal or  generally
accepted as correct.   For weak, anaemic  persons, leading  sedentary
lives, it  may be combined with  tonics  to  relieve  the constipation  so
often a pressing symptom in these cases.  In amenorrhoea dependent
upon atony  of the sexual  system,  or  anaemia,  or constipation, it is
thought to have a specific emmenagogue influence.  Locally applied in
the form of the glycerole of aloes, it  has been employed in the heal-
ing of old or new fissures of mucous membranes, and even in bedsores.
The glycerole of aloes is  to be  made  by evaporating  four to eight
quarts of tincture of aloes and gradually adding thirty parts of glycerin.
   Contra-indications.—Constipation  occurring  in plethoric  persons
should not be treated by aloes, and it should not be used if any irri-
tation or catarrh of the intestine  is present.   Pregnant womeu should
use aloes most carefully lest abortion  be produced,  and if hepatic con-
gestion or inflammation is present it  ought not to be used.  Fever is
said to contra-indicate the use of aloes, as does rectal catarrh.
   Administration.—Aloes is generally given  in a pill, combined with
spices and belladonna (see Constipation, Part IV.).  The dose should
be about 1 to 5 grains as a laxative, and  10  grains as a purge.   The
Aloe Purificata, IT. S. P., should always be used.  The  official prepa-
rations most commonly employed  are the pill of aloes (Pilulce Aloes,
 IT. S. and B. P.), two grains each of aloes and soap; the pill of aloes
and myrrh (Pilulce Aloes et Myrrhce,  IT. S. and B. P.), two  grains of
each constituent; the pill of aloes and mastisch (Pilulce  Aloes et Mas-
tiches, IT. S., two grains of aloes), or the " Lady Webster dinner pill;"
the pill  of aloes and iron (Pilulce Aloes et Ferri, IT. S. and  B. P.),
one grain of  aloes aud one of dried sulphate of iron ; and the pill of
aloes and  asafoetida  (Pilulce Aloes et  Asafatidce, IT. S. and  B. P.),
containing four grains of  aloes, asafoetida, and soap.  The dose of  all
these is 1 to 2 pills.   The liquid  preparations are the tincture (Tinc-
tura  Aloes, IT. S. and B. P.), dose 1 to  3 fluidrachms; the tincture
of aloes  and myrrh  (Tinctura Aloes et Myrrhce, IT. S.), dose  1 to 2
fluidrachms;! and the wine  of aloes (Vinum Aloes, IT. S. and B. P.),
1 Sometimes called Elixir Proprietatis. 
ALUM.
57
containing cardamoms and ginger, the dose of which is \ to 1 drachm
or even 2 drachms.  The B. P. preparations,  besides those given, are
Alo'in, dose ^ to 2 grains; the Decoctum Aloes Compositum, dose \ to
2 ounces; and the extract, Extractum Aloes Socotrince and the Extrac-
tum Aloes Barbadensis, the  dose  of  each  of which is 2 to 6 grains.
Enema Aloes, given in the dose of 10 ounces,  is composed of aloes 40
grains, carbonate of potassium  15 grains, and  mucilage of starch 10
fluidounces.

                             ALUM.

   Alum (Alumen, IT. S. and B. P.) is the sulphate of aluminium and
potassium, or  of  aluminium and ammonium,  crystallized  from a
watery solution.   At present all the alum of commerce is made in
the manufacture of coal gas for illuminating purposes, and it is there-
fore very cheap.   It occurs in the form of octahedral crystals, and has
an astringent teste and acid reaction.   After the crystals are exposed
to the air for some time they become covered with a white coating.
   Physiological Action.—When alum is brought in contact with a
mucous  membrane it produces whitening, constriction, and puckering
of the part, and applied to the skin thickens and toughens it by means
of its astringent  action.   In either case it decreases  secretion and
causes contraction of  the local bloodvessels  and capillaries.  Large
amounts giveu  for any length of time seem to increase secretion.  Very
large amounts are necessary to produce death.  As much as two ounces
will not kill a  sickly dog.   This is largely due to the  fact that the
vomiting and purging rids the animal of the  drug, for if vomiting is
prevented death rapidly ensues from gastro-enteritis.  Injected into
the blood, alum produces embolism and thrombosis.
   Therapeutics.—Alum is used at present in a number of diseases,
chiefly as a local application.  In cases of ordinary sore-throat appli-
cations of a  strong solution (20 grains to  the ounce of water) on a
swab will be found very useful.  It is a valuable gargle in this con-
dition, but ought not to be  used because of its  destructive action on
the  teeth.  In hemorrhage, when the leaking  bloodvessels can be
directly  reached,  alum is a remarkable  haemostatic, aiding in  the
arrest of the  bleeding in three ways, namely,  by coagulating  the
albumin, by constringing the parts,  and by crystallizing when applied
in large amounts on lint, and  thereby affording a  surface  which is
rough and aids coagulation.   In hemorrhage after tooth-extraction
its application  is a very useful treatment.   Dissolved in water, or
alcohol,  it makes an exceedingly efficient  application for sponging in
night-sweats or  localized sweating of the feet or hands.   In conjuncti-
vitis as a lotion  alum may be employed in a solution of 1  to 3 grains
to the ounce of water  for a child, or in the form of alum  curd, made
by adding powdered alum to milk or white  of  egg until a curd is
formed,  which  is  then applied to the eye every few hours or oftener.
This  is  often useful in ecchymosis  of the eyelid, or " black-eye," to
prevent  much exudation aud discoloration.  In cases where  granular 
58
DRUGS.
conjunctivitis occurs, the use of the alum crystal or stick is sometimes
very useful, the lid being lifted and the alum passed lightly over it.
In hcemoptysis a fine spray of a strong solution of alum, 20 grains to
the ounce, may be employed, the necessity of the spray being made
very fine being constantly borne in mind.  This method may also be
resorted to in bronchorrhcea or chronic bronchitis with excessive secre-
tion, and in chronic catarrh of the pharynx and larynx.  In mercurial
ptyalism the drug may be used on a swab.   Bathing the parts affected
with an alum  solution is said to  be an efficient remedy in chilblains,
and even for pruritus vulvae.   As a vaginal wash for excessive leucor-
rhoea, in the strength of from 10 to 20 grains to the ounce of water
alum is of value.   Some  observers claim good results from its use in
diphtheria  and  tonsillitis.  In follicular tonsillitis the alum-stick may
be deeply inserted  into the depressed follicles or applied to the swollen
surface of the gland.   In ingrowing toe-nail with granulations, a piece
of twisted absorbent cotton  soaked in strong alum solution and  in-
serted  under the  edge of the nail, will in most instances do a great
deal toward a cure.   Burnt Alum (Alum Exsiccatum, IT. 8. and B. P.)
is useful  as a dressing for old ulcers and  sores, and has been highly
recommended as an application for swollen gums where they press upon
and override a tooth, particularly at the  back of the jaw.   The possi-
bility of its exercising an evil effect on the teeth should not be forgotten
when this treatment is resorted to.
   Internally, alum has been  used in diabetes, gastralgia, and dysentery
of an acute and chronic type.   In lead-colic it seems  to  be of value
in conjunction with morphine to allay the pain.   In some forms of
constipation it is said to be quite  valuable if given in large dose.   At
one  time  alum was largely employed in membranous croup in emetic
dose for the dislodging of the membrane and for the astringent effect
exercised as it was swallowed and expelled.
   Alum may be used as an antidote in acute lead-poisoning, as it is a
soluble sulphate and also an emetic.
   The emetic  dose of powdered alum  is a heaping teaspoonful for a
child or a tablespoonful for an adult.
   Glycerinum  Aluminis (1 to 5) is official in  the B. P., and  is used
as a local astringent application.
                            AMBER.

  Succinum is derived from a fossil resin found in Prussia and Bohe-
mia, and is official in the form of the oil (Oleum Succini, IT. 8.), which
is volatile, quite irritant, and obtained by destructive distillation from
the deposits named.
  Therapeutics.—Oil of Amber is one of the best remedies  for per-
sistent hiccough  that we have.   It is very useful  as a counter-irritant
over  rheumatic joints, and has been used in asthma, whooping-cough,
and hysteria with good results.   In the  bronchitis  of infants, with
nervous  disturbance, oil of amber in  the proportion of one to three 
AMMONIA.
59
parts of olive oil applied to the back and front of  the  chest is of
service.  In adults suffering from acute laryngitis with an extension
of the  inflammation into the  bronchial tubes  full  doses  of sodium
bromide with this proportion of amber oil rubbed into the neck and
chest are very useful.  The dose internally is 2 to 6 minims  given in
emulsion.

                           AMMONIA.

   Ammonia is a gas of a very acrid, burning taste and sensation,
capable of producing death very rapidly, when inhaled,  by inflam-
mation of  the air-passages and the spasm of the glottis which ensues.
It is made in large amounts in the manufacture  of coal gas.
   Physiological  Action.—When ammonia comes in contact with the
tissues  of the body it acts as a most powerful irritant, causing a red-
dening of the parts,  followed, if the exposure  be  long enough, by
local  death and  sloughing.  If it be inhaled as a gas  it may produce
instant death by spasm  or oedema of the  glottis, or if a strong solu-
tion of it  is  swallowed the same accident will occur.  After  more
moderate inhalations severe bronchitis or pulmonary oedema may take
place.
   Nervous  System.—If ammonia  be injected into the blood  of
animals violent convulsions at once ensue which are largely tetanic in
type and depend upon a spinal action of the drug, since  they are  not
stopped by division of the spinal cord, as they would be if  the convul-
sive movements had their origin  in the brain.  The drug in moderate
amounts acts as a spinal excitant, increasing reflex action and all  the
evidences of spinal activity.   If applied  directly  to  a  nerve, either
motor or sensory, it paralyzes it, or if the drug be in very  weak solu-
tion it seems to increase its functional activity.
   Circulation.—Upon the circulation ammonia acts as a very power-
ful but fleeting stimulant, increasing to a very great extent the pulse-
rate, pulse force, and arterial pressure.  The cause of the increased
pulse-rate depends upon  stimulation of the accelerator nerves  of the
heart, and of the heart itself, while the increase  in force is due to  the
same cause, for Ringer and  Sainsbury found the strength of the ven-
tricles much increased.  The rise of arterial pressure is  due to  the
increased amount of blood pumped into the arteries by the stimulated
heart, and  probably by an action on the vasomotor centre, although
it is  stated by some authorities that this is not so.   As the drug acts
as a stimulant on the respiratory centre, which is very near the  vaso-
motor centre, it probably increases the functional activity of both.   If
by means of intravenous  injection the ammonia reaches  the  heart  in
large amount, this organ ceases its beat at once, owing to paralysis  of
its muscular walls.
  The Blood.—In moderate amounts the drug has no effect on  the
blood,  but when injected in  poisonous quantities it causes the blood to
fail to take up the oxygen, according to Feltz and Ritter.
  Respiration.—The injection of ammonia in moderate quantities 
60
DRUGS.
into the blood causes an acceleration of the rate of respiration due to
a stimulation of the respiratory centre, so that the respiratory move-
ments  not only become  more full, but more rapid.   If the drug is
inhaled in small amounts the same action is seen in a less degree, and
the changes both in breathing and circulation are partly due under
such circumstances to a reflex irritation transmitted along the sensory
nerves.
   Elimination.—Ammonia when taken into the body is so extremely
fleeting in its action that the question as to its escape from the system
is of iuterest.  If large amounts are taken,  it is partly given off by the
breath, but  more of it  is burnt up in the system, and, according to
Bence  Jones, eliminated as nitric acid by reason of its being oxidized
in the  body.   Some think that it is in part excreted as urea.
   Therapeutics.—Ammonia is employed for four distinct purposes in
medicine,  namely:  as a circulatory and respiratory  stimulant, as a
counter-irritant, and as an antacid.
   The indications for the use of ammonia in the first class of cases are
all forms of sudden cardiac failure, where  there is no time or oppor-
tunity  to use the more  stable and slowly-acting drugs.   These emer-
gencies occur in snake poisoning, in syncope, from fright or other shock,
or indigestion, in sudden cardiac failure during  the  course of fevers
and in pneumonia, and in all cases where rapid cardiac stimulation is
needed.  In the most pressing cases it should be injected directly into
the vein of the leg so as to act more quickly.   If put into the subcu-
taneous tissues it is almost certain to make a slough, and if injected
into a vein of the arm it may reach the heart in too concentrated form
and cause cardiac depression.  Ringer has found that the drug  has
the extraordinary power of causing a heart stopped  or depressed by
chloroform to return to its beating.
   In  gastric acidity  due to fermentation, with  the  development of
abnormal  acids, ammonia is  the most active remedy we can employ,
but is not to be given if acute irritation of the stomach exists.
   In prolonged diseases the employment of ammonia is  not particu-
larly advisable, owing to its fugacious action, although  it is largely
used ; for the frequent administration necessarily required is apt to pro-
duce gastric disorder.   Some persons claim that ammonia is useful as
a sedative in drunkenness, but this is doubtful.
   Locally applied, strong ammonia water  may be used to produce a
blister  by placing a few drops on the skin  under an inverted watch-
glass.  Ammonia water  may also be  applied, often with great relief,
to the spot^ stung by insecte.  The waters of ammonia  are  used exter-
nally in stimulating liniments, and hypodermically when the drug is so
given.   The stronger water ought  not to be employed for the latter
purpose.   The aromatic spirit is generally  used internally in the dose
of J drachm to 1 drachm, well diluted.   This is also the dose of  the
ordinary spirit.
   Administration.—Ammonia is never employed in medicine as pure
ammonia, but in the form of the stronger water (Aqua Ammonice For-
tior, IT. S.; Liquor Ammonice Fortior, B.  P.) and the weaker water 
bromide of  ammonium.
61
  (Aqua Ammonice, IT. S.; Liquor Ammonice, B. P.).   The spirits of
  ammonia (Spiritus Ammonice, IT. S.), are given in the dose of 30 to 60
  minims in water ; and the aromatic spirit of ammonia (Spiritus Ammo-
  nice Aromaticus, IT. 8. and B. P.), in the dose  of 25 to 60 minims in
  water. The latter preparation is composed of carbonate of ammonium,
  the oils of pimenta, lemon and  lavender, with alcohol and ammonia
  water.  Spiritus Ammonice Fcetidus and Linimentum Ammonice  are
  both official in the B. P.

                          AMMONIUM.

    The following salts of ammonium are official, and are used for vari-
  ous purposes:

                     Acetate of Ammonium.

    Acetate of Ammonium is used in medicine in the form of the Spirit
  of Mindererus (Liquor Ammonice Acetatis, IT. S. and B. P.), dose 1 to
  2 fluidrachms, for the purpose  of acting as an antacid in gastric in-
■ digestion, and also  as a mild diaphoretic, which is inferior to sweet
  spirit of  nitre.

                     Benzoate  of Ammonium.

    Benzoate of Ammonium (Ammonii Benzoas, IT. 8. and B. P.) is  em-
  ployed chiefly for its diuretic influences, which depend entirely upon
  the benzoic acid present in the  compound.  As  benzoic acid  is elimi-
  nated as hippuric acid, and ammonia as nitric acid, this drug may be
  employed in cases where the physician desires to make the urine de-
  cidedly acid ; as, for example, in patients suffering from catarrh of the
  bladder,  when the  urine is  loaded with  phosphates,  which  may be
  dissolved by this acidulation.   The dose is 10 to 30 grains, which
  should be dissolved in water.
                   Bromide of  Ammonium.

  Bromide of Ammonium (Ammonii Bromidum, IT. S. and B. P.) is
really a crystalline salt, but is generally found in commerce as a white,
granular powder which, when exposed to the atmosphere, becomes
slightly yellowish.  It is readily dissolved in water.
  Physiological Action.—Applied to the mucous membrane of the
mouth the bromide of ammonium  produces a salty taste, is markedly
pungent, and dissolves readily in the oral secretions.  If large amounts
are swallowed it  causes burning pain in the belly and evidences of
gastro-enteritis.
  Nervous  System.—The action of this drug upon this part of the
body is its most important effect.   Given to the loWer animals it pro-
duces in frogs total loss of reflex activity, preceded, it is said, in some
cases by tetanic convulsions, although no such motor disturbances may 
62
DRUGS.
take place.  In a series of studies undertaken by the writer to deter-
mine the exact effect of the drug, it was found that the spinal cord was
depressed, both on its motor and  sensory sides, while the nerves and
muscles escaped.  These results are in accord with those of other  in-
vestigators who also found that the nerves are unaffected.  On  the
cerebral cortex it acts as a very distinct sedative.
  Circulation.—Upon the circulation bromide of  ammonium acts
as a stimulant in  small doses, but as a cardiac paralyzant  if a large
amount comes in contact  with the heart.   In  medicinal dose it is
distinctly stimulant to the circulation, but not sufficiently so to render
it valuable as a circulatory stimulant.
  Therapeutics.—The bromide of ammonium may be used in nearly
every instance where bromide of potassium may be employed, and
possesses the distinct advantage of being less depressant to the general
system than the latter drug.  It is, however, no less  apt to disorder
the  stomach even  if given in moderate doses.   In epilepsy it would
seem to be  of as much value as the potassium salt, and may be  com-
bined with it in some cases with success.  (See article on  Epilepsy,
Part IV.)  According to Da Costa, the drug is of very distinct value
in rheumatism in  the dose of 60 to 80 grains a day, well diluted, al-
though its manner of action in this disease is not known.  The usual
dose is 10 to 30 grains.  It is incompatible with spirit of nitrous ether.
                 Carbonate of Ammonium.

  Carbonate of Ammonium (Ammonii Carbonas, IT. 8. and B. P.) un-
doubtedly has an action exactly like that of the liquid preparations of
ammonia, and is used either alone or with the chloride in the treat-
ment of bronchitis, particularly when this disease occurs in babies and
young children.  It is also largely employed by surgeons in the treat-
ment of children after surgical operations.  The dose is 2 to 10 grains
in syrup of acacia.   It is a rapidly-acting  cardiac and respiratory
stimulant.

                   Chloride of Ammonium.

  The Chloride or Muriate of Ammonium (Ammonii Chloridum, IT. S.
and B. P.) has an entirely different action and  therapeutic use from
the rest of this group.   It possesses almost no influence over the heart
and  respiration, but does exercise a very stimulant effect on mucous
membranes, increasing  the secretion of mucus.   The consideration of
its use in diseases of the lungs can be found  in the articles on Pneu-
monia and Bronchitis.   Chloride of ammonium fumes can be obtained
from a few grains of the drug heated in an iron spoon over a gas jet,
or by means of a set of three wash bottles.  In one of these is placed
stronger water of ammonia, in the other muriatic acid.   Each of these
is connected with a third bottle by means of glass tubing, this bottle being
partly filled with water, through which the fumes in passing  become 
valerianate of ammonium.
63
purified, and form the fumes of chloride of ammonium.  The drug may
also  be used  in  a  spray from  an atomizer.  It has been  employed
in intermittent fever, but has gone out of use, and has also  been used
in neuralgias of the ovarian type, by Goodell and others.  In the treat-
ment of chronic  torpor of the liver and subacute hepatitis, and even in
cirrhosis and hepatic abscess, it has been thought  of value.   Many
clinicians have found it useful in the treatment of the gastric  and in-
testinal catarrhs  of children  of a very subacute type, and it  is  the rou-
tine  treatment for  all such cases which come under observation at the
hospitals and elsewhere where the author has charge.  The dose is  2
to 15 grains, preferably given with liquorice and water  to  mask the
taste.   The chloride of ammonium may, however, be given in com-
pressed pills provided a large draught of water or milk is  taken
simultaneously to protect  the  stomach.  (See article on Bronchitis for
prescriptions.)
                    Iodide  of Ammonium.

   Iodide  of Ammonium  (Ammonii Iodidum, IT.  S.) may be employed
in the dose of 2 to 3 grains  in all cases where the iodide of  potassium
in indicated, and seems to possess alterative influences equal  to  those
of that salt.   It has been recommended as a local application in cases
of enlarged tonsils in the  form of a solution of 30  grains of the salt
to the  ounce  of glycerin, particularly if struma is the cause of the
enlargement.  The application is  to  be made once a day with a swab
or camel's-hair brush.  It is necessary that this solution be not exposed
to the air or it will undergo decomposition.

                  Valerianate of Ammonium.

   A'alerianate of  Ammonium (Ammonii Valerianas, IT. 8.) is the salt
of ammonium commonly used in the nervous unrest of pregnant or
hysterical women, or at the menopause in  the peculiar nervous dis-
orders apt to occur at that period.  In poisonous doses it paralyzes the
spinal cord in the lower animals.   It is usually given  in the form of
the  elixir of valerianate  of ammonium, the dose of which is  a tea-
spoonful to a dessertpoonful, or it is combined with the  bromides, un-
der  which circumstances it is much more efficacious.   The  dose of the
salt itself is 10  to 15 grains.

   The sulphate of ammonium (Ammonii Sulphas,  IT. S.)  is  never
used in medicine.   The phosphate of ammonium (Ammonii Phosphas,
 IT. 8. and B. P.)  is employed in  rheumatism in the dose of  10 to 20
grains.
   The B. P. preparations besides those already given are : Sulphide  of
Ammonium, Oxalate of Ammonium, Liquor Ammonii Citratis, dose 2 to 6
fluidrachms, Liquor Ammonii Citratis Fortior, dose 30 minims to 2
fluidrachms, Liquor Ammonii Acetatis Fortior, dose 25  to 75 minims. 
64
DRUGS.
                         AMMONIAC.

  Ammoniac  (Ammoniacum,  IT. S. and B. P.)  is a  resinous gum
obtained from Dorema Ammoniacum and is used very little in medi-
cine at the present time.   Internally and externally it  produces some
irritation when brought in contact with  the tissues, and may be used
internally in the dose of  10 to 30 grains in pills in cases of chronic
bronchitis devoid of any  active inflammatory process.   It is  official
in the  form of the plaster of ammoniac (Emplastrum  Ammoniaei,
 IT. S. and B. P.), which  is used as a stimulant over enlarged  glands
and joints, and as the plaster of ammoniac and mercury (Emplastrum
Ammoniaei cum Hydrargyro,  IT. 8. and B. P.) whicli is used for the
same  purpose.   Finally there is the mixture of ammoniac (Mistura
Ammoniaei, IT. 8. and B. P.) used in chronic  bronchitis,  in the dose
of a tablespoonful.

                       AMYL NITRITE.

  Amyl Nitrite (Amyl Nitris, IT. 8. and B. P.)  is a  very  volatile,
somewhat oily, liquid possessing a peculiar penetrating  pear-like odor.
It is made by  the action of nitric and nitrous acids upon amylic alco-
hol, and is not to  be confounded with nitrate of amyl, which has a
different physiological action and is never used medicinally.
  Physiological Action.—When swallowed or inhaled the drug pro-
duces staggering, fulness in the head,  roaring in the ears, duskiness
of the face, and finally utter muscular relaxation, so that the animal
or man falls to the ground. The heart beats very rapidly and forcibly,
and the respiration becomes gasping.
  Nervous System.—Nitrite of amyl acts as  the most rapid of all
the nervous depressants  and  sedatives  known  except prussic acid.
Experiments show that its dominant action is on the  motor side of
the spinal cord.  The motor cortex of the brain  and the motor nerves
are only affected by  large amounts.   Upon the nervous apparatus of
sensation nitrite of amyl has no effect in medicinal amounts and can
never be used  to relieve pain unless it be due to spasm or to angina
pectoris.  The muscles are depressed by toxic amounts.
  Circulation.—When nitrite of  amyl is  used the pulse becomes
exceedingly rapid, while the arterial  tension  progressively falls.   The
increase in  pulse-rate is  due  to depression of  the centric inhibitory
apparatus of the heart  and to  the  sudden  relaxation  of the  blood-
vessels, by reason of which, the resistance being taken away, the heart
beats  faster.  The fall of arterial pressure is due to a depression of
the vasomotor centres and the muscular coats of the bloodvessels.   In
very small amounts  the drug stimulates  the heart muscle (Reichert),
but its dominant action is that of a depressant,
  The Blood.—In medicinal  dose this drug  produces a chocolate
color of the arterial  blood, due to the change of oxyhaemoglobin  into
meth semoglobin. 
anthrarobin.
65
  Urine and Elimination.—The urine sometimes contains sugar
after the use of the nitrite of amyl, and there is increased diuresis.
The drug is eliminated very rapidly from the body by the lungs  and
kidneys.
  Temperature.—If the nitrite of amyl be employed for any length
of time a most remarkable fall in bodily temperature  ensues, whicli is
probably due to diminished oxidation, but possibly to some effect on
the heat centres governing heat production and dissipation.  The vas-
cular dilatation also greatly tends  to aid in the fall of bodily heat
produced by the drug.
  Therapeutics.—Nitrite  of amyl  is used to  relax general  or local
muscular spasms, for the  relaxation of the spasm of epilepsy  and for
aborting an on-coming fit,  for the prevention and subjugation of strych-
nine convulsions  and tetanus, and  for  the relief of  angina pectoris,
provided  the  attack  is accompanied  by high arterial  tension.  It
may be used in  puerperal eclampsia, but it is a dangerous  remedy
because of its  relaxation  of the uterus and the consequent danger of
post-partum  hemorrhage.   In dysmenorrhea with uterine spasm it
often gives great relief. Nitrite of amyl has been used in cases of sea-
sickness as a prophylactic, and cure with considerable  success.   In
cardiac failure from fright or anaesthetics amyl nitrite is often of great
value in single whiffs.   If it does not act at  once under these circum-
stances it is worse than useless to push it.   It has also been found of
value  in whooping-cough, laryngismus stridulus, asthma, spasmodic
croup  and infantile convulsions.  In migraine with  local vasomotor
spasm and true hemianopsia it is very useful. In strychnine poisoning
and tetanus it must be  used  between the spasms  or else  given hypo-
dermically, as the respiratory cramp prevents its inhalation.
   Administration.—The  drug may be  given by  placing three to five
drops on a handkerchief and inhaling the fumes, or it may be dropped
on  sugar and taken by the mouth in the same quantity.
   It is important to remember the  fact that the effects of the drug are
more severe for a moment after its use than during its inhalation.
   The physician should warn the patient that the effect of the drug is
sudden and alarming, and in nervous cases  should direct that the in-
halations be made gently, as a very full inhalation may produce  un-
pleasant sensations of  cardiac failure.
   The best way for patients to use  the drug is to have it in pearls of
glass, each holding 3 minims.  One or more of these may be  crushed
in  the  handkerchief  and  the fumes  inhaled.   Some of the pearls
made by careless manufacturers are of such thick, strong glass  that
they are difficult to break, and if broken are apt to  cut the  fingers.
These are, of  course, to be avoided.


                       ANTHRAROBIN.

   Anthrarobin,  which was  originally discovered  by  Liebermann,
seems to possess  equal  value  with  its relative chrysarobin, and to be
                                  5 
66
DRUGS.
capable of acting as efficaciously as this substance in the treatmeut of
skin diseases.  It is  a yellowish  powder, tolerably stable  in  a dry
atmosphere,  not  soluble  in  acids  or water, but readily soluble  in
dilute  alkaline solution  or alcohol, at first making a  solution of a
brown color, which, as  oxygen is taken up, passes to a green and
finally to a violet,
   Therapeutically, anthrarobin has  been employed  by Rosenthal and
by Behrend, and  more recently Kobner has recorded  his experience
with it, employing it with good  results in  a 10 to 20 per cent, solu-
tion  in the various  forms of  tonsurans as  a  wash.   Rosenthal has
used it in psoriasis and pityriasis  versicolor  and herpes, and Behrend
asserts that it is often  better in its effects upon  the  skin than  chrys-
arobin, as it produces  less inflammation and only discolors the skin
slightly.   It also possesses the additional value  of making so slight
a stain on the linen that it can be removed by washing.
   According to most  authorities, it is best  to keep  the drug in alco-
holic  solution,  and, if the  bottle is well   corked,  such a mixture
remains good for a  week.

                          ANTIMONY.

   Antimony itself, or  its oxide, is rarely used  in medicine, owing to
its insolubility, but is generally employed as  the tartrate of antimony
and potassium, or Tartar Emetic (Antimonii et Potassii Tartras,  U. 8. ;
Antimonium  Tartaratum,  B. P.), or in the form of the sulphide (Anti-
monii  Sulphidum, IT.  S.);  purified sulphide (Antimonii  Sidphidum
Purificatum,  IT. 8.;  Antimonium  Nigrum Purificatum, B. P.); and
sulphurated antimony (Antimonium Sulphuralum, IT. 8. and B. P.).
The last three  drugs  are  so  rarely employed and are such unreliable
and useless preparations  that they will probably be dropped  in the
present revision of the Pharmacopoeia.

                        Tartar Emetic.

  Tartar  Emetic (Antimonii et Potassii Tartras, IT. 8.; Antimonium
Tartaratum, B. P.) is made by boiling the  oxide of antimony with
bitartrate  of potassium and water.   Although  it  is  really crystalline
it  is generally  sold  as a fine powder, owing to these  crystals  being
easily pulverized.  It is insoluble  in  absolute alcohol,  but is soluble
in ordinary water,  and  still more so  in  boiling water.   In  dilute
alcohol it is partly soluble.
  Owing  to  its chemical constitution tartar emetic  should never  be
given with either acids or alkalies, and all  drugs containing tannic
acid are also  incompatible with it, owing to  the  fact  that an insoluble
tannate is  rapidly formed which  is  absorbed  very  slowly if at all.
So complete is the insolubility of the  compound so formed that tannic
acid is  the best antidote to the drug that we  possess.
  Physiological Action.—Tartar  emetic, when applied to  mucous
membranes, produces a burning sensation, and  upon the skin it may 
antimony.
67
readily cause a large amount of irritation if the part be delicate.  If
kept in contact with a mucous membrane very distinct inflammatory
changes occur, and if it be applied to the skin for any length of time,
redness,  followed by acne  of a pustular  character, appears,  which
finally ends  in  ulceration and sloughing  if the use of the drug is
persisted in.  Under these  circumstances the vitality of  the  parts
seems interfered  with, and, as a result, healing takes place very slowly
indeed.
  Nervous System.—Antimony is a depressant to the sensory side
of the spinal cord  and a paralyzant  to all  the spinal centres, motor
and sensory, in poisonous dose.
  It  is  stated that sensation  to heat  and  acids is lost  before  the
ordinary sense of touch is destroyed.  The  convulsions which some-
times ensue  after poisonous doses  in the  lower animals are due to
anaemia of the brain brought on by the circulatory depression.  Ringer
and  Murrell have proved antimony to be a  motor-nerve and muscle
poison.
  Circulation.—The chief influence of antimony is exerted upon
the circulation.   In small doses it  lowers the pulse-rate  by a direct
depression of the heart-muscle, and simultaneously  decreases arterial
tension by an action  upon  the peripheral portions of the vasomotor
system in the walls of the bloodvessels, but the vasomotor  influences
may be in part  centric, and  this question  must be  considered as sub
judice.   The  fall of arterial pressure is also  due to failure of heart
force.   With the lowering of the pulse-rate there is nearly always a
corresponding decrease in cardiac power.
  When poisonous  doses are employed death ensues after great circu-
latory and respiratory depression, as will be seen below.   The heart
is found relaxed and flabby and utterly dead to all  stimuli, although
if the dose has not been very excessive and digitalis is freely employed
the heart may be made to beat again ; this is at least true in the frog.
The drug in poisonous doses is thought to depress the peripheral ends
of the vagus nerves.
  Respiration—The drug has little or no  effect upon  respiration
except when given in lethal doses.   Under  these circumstances death
is produced  in three ways, all of them  acting together.  Primarily,
the respiratory centre in the medulla is  depressed, and the governing
nerves  of breathing, the  pneumogastrics, are also rendered  inactive;
secondarily, the cardiac  failure readily causes  pulmonary congestion;
and, thirdly, the drug causes such an outpouring of  liquid and mucus
into the bronchial  tubes  that the  patient  is drowned  in his own
secretion, which he is too weak to expel.
  Stomach and Intestines.—Antimony in toxic doses is a powerful
irritant to these portions of the body.  In full medicinal  amounts it
acts as a slow  but powerful  emetic, producing much nausea.  The
vomiting is due  to an action on the vomiting-centre in the medulla and
to a  direct  action on the stomach  itself.   The  drug is, therefore, a
centric and  peripheral emetic. 
68
DRUGS.
  Very full doses produce watery purging attended with some griping
and tenesmus.
  Elimination.—Antimony escapes from the  body in all the secre-
tions, but largely  by the bowels.  The latter method  of elimination
seems chiefly to follow poisonous doses, and Wood believes with others
that purging is an effort at elimination.
  Poisoning.—When  toxic doses of tartar emetic are' taken the pulse
at first becomes slightly weaker and slower, the skin becomes moist aud
relaxed, a general sense of relaxation comes on, and simultaneously a
sensation of severe nausea and gastric distress appears.
  Following this condition violent vomiting asserts itself.  The ejected
mass consists of the contents  of the stomach, mucus, bile, and watery
fluids, and perhaps  blood.   Purging appears almost  as early as  the
vomiting, and consists first of the normal contents of the intestines, then
mucus, then bile, and, very rarely, blood.  These signs may rapidly pass
away and  the characteristic  peculiar  " rice-water"  stools1  appear.
The general condition of the patient is now most serious.  The face is
pinched, livid, and covered  with a cold sweat.  The pulse is rapid and
shuttle-like—to and fro—or  lost at the wrist;  the arterial tension is
almost nil.  The respirations are faint and fluttering, and so shallow
as hardly to be seen or heard.  Cramps in the calves of the legs attack
the patient, due to  the abstraction of water from the  tissues by the
violent  purging, and the temperature  falls lower and  lower  as death
approaches.   The general condition is  such that all the signs point to
Asiatic  cholera, and  antimonial poisoning cannot be separated from
this disease without a history of the case or a chemical  analysis of the
secretions, which ought always to be preserved.2
  The treatment of antimonial  poisoning consists in the internal  ad-
ministration of large amounts of tannic acid, in the use  of the stomach-
pump, and in the maintenance of an absolutely prone  position.   The
patient should vomit into towels and not raise the head from the ground;
the head,  indeed, should generally be placed lower  than the heels.
External heat, alcohol, and digitalis should  be thoroughly used, and
opium should be employed  hypodermically to allay pain and irritation,
unless the respirations are too feeble.
   Fatty degeneration of the  tissues  may occur  after acute antimonial
poisoning.
   Therapeutics.—Tartar emetic is employed for at  least five  separate
purposes, the most usual of which is as a circulatory quieter and seda-
tive.  The indications for antimony as a circulatory depressant are not
so generally recognized at present as they were at one time, on account
of  the introduction of other drugs.   Suffice it to state that all states of

  1 A " rice-water " stool is one which, on standing in a glass, separates into two lay-
ers, the lower white and flocculent, the upper watery and almost clear.
  2 This is probably as good a place as will occur to state that the secretions and ex-
cretions of a person dying of any poison should  be placed in a chemically-clean jar
capable of being sealed tight. The same rule of cleanliness applies to the jars hold-
ing organs at the post-mortem. The jars should be ready, and no intermediate vessel
used.  They should be sealed at once, and kept so until claimed by the authorities. 
antimony.                        69
sthenic inflammation with a bounding pulse, high fever, aud symptoms
showing the patient to be possessed of robust constitution, permit of its
use,  while all asthenic conditions most emphatically coutra-indicate
its employment.  In the treatment of colds, to break forming diseases,
and to aliay inflammation, it  is given in moderate dose.   It is useful
iu sthenic bronchitis as an  expectorant.  Under these circumstances
it may be given in emetic dose;  or, if eniesis is not desirable, minute
amounts given hourly are of value,  such as -fa of a grain every hour,
or a teaspoonful of a solution of 1 grain to a half-pint every hour may
be used.  This is a particularly useful method in children, as the solu-
tion is tasteless, and it does not produce nausea and vomiting.
   In the  acute catarrh of children, which affects the stomach and entire
alimentary canal and is associated with  little fever, the use of the drug
is extremely valuable, aud often aborts an  attack in the same dose as
just described.
   As as emetic antimony is slow but forcible, and  it ought not to be
used in poisoning owing to its slowness.
   Before the introduction of anaesthetics, emetic doses were employed
to relax the muscles in reducing dislocations and fractures.
   Tartar emetic is  harmful if irritation of the stomach is present or if
kidney lesions are active, and if one good-sized emetic dose is not suffi-
cient to produce vomiting, it should not be repeated, but some other
 emetic or the stomach-pump be used, lest  antimonial poisoning com-
 plicate the case.  This dose  must be large enough to be effective, or
 none at all should be given.  If this rule is  disobeyed systemic changes
 come on  with undesirable severity in those cases where eniesis fails to

   Asa counter-irritant antimony is employed in the form of an oint-
 ment whenever a verv slowly acting and  prolonged counter-irritation
 is  to be  maintained, as on  the  back of the neck in epilepsy or similar
 chronic states, and in  old enlargements  of the joints.
   Antimony acts well as a diaphoretic, but  its use is unnecessary owing
 to its  disagreeable effects, such as  nausea  aud intestinal disturbance,
 and because other, more pleasant, drugs act equally well.
   Administration.—The dose of tartar emetic, when there is an excited
 circulation, is 2V to ^ of a grain every three hours  until an effect is
 obtained  As an emetic the dose is J to 1 grain. The wine of antimony
 ( Vinum  Antimonii, U. S. ;   Vinum  Antimoniale, B. P.) contains  only
 two trains of tartar emetic to each  ounce, and may be used m the dose
 of | to 1 teaspoonful, or, as an emetic, in the dose of 1 to 2 tablespoon-
 fuls.   The compound pill of  antimony (Pilulce Antimonii  Lompositce,
  IT.  8) is used as an alterative, and contains sulphurated antimony |
 a grain, calomel \ a grain, guaiac  1 grain, and tragacanth; the  dose
 is 1 to 3 pills.                               .    ..        r  t> t>\
   The ointment of antimony (Unguentum Antimonii  lartarati, -B.f.)
  is used externally  as a counter-irritant  spread on a rag or piece  of lint.
  Antimonial powder (Pubis Antimonialis,  IT. S. and B. P.) or .lamess
  powder, contains oxide of antimony and phosphate of calcium, and is 
70                           DRUGS.
given occasionally as an antipyretic in the treatment of rheumatism
and fever in the dose of 3 to 10 grains;  it is best given in a pill.
  The compound syrup of squill (Syrupus Scilla.' Compositus, IT. S.),
otherwise known as " Coxe's Hive Syrup," contains three-fourths of
a grain of tartar emetic to the ounce/  The dose is  20 to 30 drops for
an adult as a sedative,  or from this amount to 1 drachm to a child as
an emetic.  Liquor Antimonii  Chloridi, B. P., is not official in  this
country, and in  England is rarely used, as an escharotic.


                         ANTIPYRINE.

  Antipyrine is a  derivative of coal tar, its  chemical  name being
dimethyioxyquinizine.  In appearance it is a white  powder  of a some-
what bitter taste and is very  soluble in water, less so iu ether, alcohol,
and chloroform.
  When  antipyrine is given to a  man in full  medicinal  amount  it
causes a  buzzing and tightness of the head not unlike that produced
by quinine.   The bodily temperature, if normal, is depressed a frac-
tion  of a degree, but no other symptoms are manifested.  If  the dose
be quite  large some blueness of  the  lips  and  finger-nails  appears,
chilly sensations are experienced, and finally a profuse sweat breaks
out over the entire  body, which is  more severe if fever has  previously
existed.   Large doses sometimes cause nausea and vomiting.
  Physiological  Action.   Nervous System.—When a  poisonous
dose  of  antipyrine  is given to one  of the lower animals, relaxation,
utter loss of reflex action, and total inability to move come  on at once
and  death ensues.    Somewhat smaller  doses  produce  exceedingly
severe tetanic and  epileptiform convulsions, but consciousness seems
to be preserved.   It  has  been proved that the chief cause of the
convulsion is  an action of the drug; on the brain.1   Very large toxic
doses, therefore, decrease reflex action  and smaller ones  increase it,
though  medicinal amounts certainly lessen reflex activity to a notable
degree.   The cause of this  failure of reflexes  is   depression of the
sensory nerves and the receptive centres of the spinal cord.  Medici-
nal  amounts  must, therefore, be  regarded as  very distinct  nervous
sedatives, acting much more actively on the nerves of sensation than
on those of motion.
   Circulation.—The studies  of a very  large number of  pharma-
cologists  prove most conclusively that antipyrine has no effect on the
circulation of the lower animals in moderate doses, unless these be so
frequently repeated that cumulative  effects  ensue.  Many  reliable
clinical  observers have asserted that the drug depresses the  circula-
tion in  man  in  some cases, and antipyrine is certainly not a cardiac
stimulant. The writer is confident, however, that antipyrine  is not so
distinctly a cardiac depressant as some think.   Large, poisonous doses
lower blood-pressure, unless convulsions are present, when the pressure

     1 See author's Boylston Prize Essay on Antipyretics.  Philadelphia, 1891. 
antipyrine.
71
 is raised.  The action of the drug on the circulation is nevertheless a
 very unimportant part of  its power, and in most cases  is not to be
 considered in the treatment of disease.  In many of the cases where
 vascular depression  and collapse have  followed  its use it  has been
 employed in excessive amounts, or the  fall in bodily temperature has
 caused the untoward symptoms.  (See Fever and its Treatment.)
   Blood.—No spectroscopic changes in the blood follow the use of
 medicinal doses  of  antipyrine  in  the  ordinary individual,  but  in
 poisonous amounts it produces methaemoglobin.  If the doses be toxic,
 or idiosyncrasy exists, cyanosis may come on.  That the blood is not
 destroyed by small amounts is proved  by the absence of haematin in
 the  urine  of persons taking the  drug.   The corpuscles suffer  no
 changes  except in very pronounced poisoning, when they are said to
 become crenated and shrivelled.
   Respiration.— When  antipyrine is given  in  lethal doses death
 results from failure  of the respiratory centre.  Ordinary doses  have
 no  effect on  this function, but large  ones  make the breathino- more
 rapid.
  Temperature.—In normal men and animals antipyrine in medici-
 nal dose may be considered as without effect so far as bodily tempera-
 ture  is concerned.  In fevered  animals it  has been found to lower
 temperature  by decreasing heat production  and increasing heat dissi-
 pation.   That  it does not do this  by an action on  the  blood seems
 proved by the fact that the blood is  not affected by medicinal amounts.
 The  sweating  does  not  cause the  fall, since it takes place when  no
 sweating occurs.  It  may, therefore,  be  considered  that the drug
 directly affects  the nervous heat-mechanism of the body.
  Kidneys, Tissue-waste,  and   Urine.—A   large  number  of
 studies made upon man and the lower animals by competent investi-
 gators have brought about very considerable advances  in our knowl-
 edge  of  the influence of antipyrine upon tissue-waste. ' It is useless
 to burden this volume with a discussion of their methods and results,
 which may be found in the author's Essay on Antipyretics. Suffice it
 to say that while all observers are not agreed as to the effects produced,
 the deductions  apparently  to be drawn  are that the drug diminishes
 the quantity of  the urine excreted, and also decreases the elimination of
 the results of nitrogenous  tissue metamorphosis—or, in other words,
 is a conservator of the tissues of the body.
  Elimination.—The elimination  of antipyrine goes on  very rapidly
 indeed, and begins  almost at once after its ingestion.  Maragliano
 states that it appears in the urine in  three hours  after it is taken,
 so that at  the  fourth hour elimination is  at its height, although it
 continues for twenty-four or perhaps thirty-six hours.  According to
 Pavlinow, part  of the antipyrine ingested is eliminated by the  sali van-
 glands.
  Toxic  Effects from  Prolonged Use.—After chronic  poisoning by
antipyrine a post-mortem examination shows intense engorgement of
the  brain and  meninges, with a serous  exudate into the  cerebral
ventricles.  The lungs are highly congested, the spleen is small and 
72
DRUGS.
shrivelled, and the kidneys are filled with blood and slightly inflamed.
The liver is  not much affected, but the blood-corpuscles  are  greatly
decreased in number.
  Poisoning.—The treatment of poisoning by antipyrine consists  in
the administration of stimulants, the maintenance of bodily heat, the
use of atropine to restore the  tone of the  vascular  system,  and  if
cyanosis  is alarming the employment of oxygen inhalations.
  Antiseptic  Power.—Antipyrine  exerts  a  very distinct antiseptic
action  in  small  amounts,  delays   all  forms  of  fermentation,  and
destroys  germs when it is present iu large quantity.
  Therapeutics.—Antipyrine is employed  in medicine for two great
purposes—namely, for the reduction of fever and the relief of pain,
but its employment as an antipyretic is now entirely surpassed by its
use as an analgesic.
  As an  antipyretic, autipyriue  should be given  in a few large doses
rather  than frequent small ones, as a general rule, since if the fever
is  of any severity  the  latter  method  of administering it will  have
no effect.   On the other hand, too large doses may depress the  tem-
perature  to a point below normal, and induce collapse.   In the article
on Fevers  the conditions are indicated in which the drug is best em-
ployed, these  being the  sthenic fevers, as a  rule, or instances where
excessive outbursts of fever necessitate prompt reduction of tempera-
ture.   Under these conditions, antipyrine is the best adjunct to the
cold pack.   In excessively high temperature  in  pneumonia  it  is  of
great value, and in scarlet fever and smallpox antipyrine is of service
in some  instances.   In pneumonia, as a  rule, the condition  of the
patient indicates at first cardiac depressants  rather than antipyretics.
In  phthisis  antipyrine  generally  increases  the  sweating, produces
oppression, and either  fails  to act at  all or  produces collapse  by
producing  too great  an effect   In sunstroke  it  frequently fails  to
influence the temperature
  Be the fever what it  may, provided it be associated with any dis-
eased process, antipyrine  is absolutely  useless  so  far as any influence
over the course of the disease itself is concerned.  It is a remedy  to
be  used  in  the  treatment of symptoms, not in  the  removal of the
cause of  the fever.
  As an analgesic antipyrine is the peer of opium.   Although the
latter drug will  relieve  all forms of pain if it be pushed, it possesses
many disadvantages not  found in  antipyrine.  In deep-seated pains
due to  disease of the organs of the body, in inflammations and similar
disturbances,  antipyrine  is useless.  In  neuralgic  affections of  all
kinds it  finds its sphere, particularly if the disorder be rheumatic,
gouty,  or  due to nervous depression  a disease.  Under  the latter
circumstances it is best combined with caffeine and a little bromide of
potassium (see Neuralgia).  In rheumatism it will give relief in a fairly
large number of cases, not only relieving  the pain and  fever, if they
be present, but also actually modifying the disease.  It seems, however,
to increase  sweating  in  acute  articular  rheumatism.   In gout it is
stated  to have a specific curative  effect upon  the  disease, over and 
ANTIPYRINE.
73
above the relief of the pain, but this is doubtful.  Its use in dysmenor-
rhea has been recommended, but  its beneficial influence in such cases
is doubtful.  At one time it was thought  that its use would relieve
the pains of labor entirely, but this has, unfortunately, proved untrue.
It may, however, be tried when the suffering is very severe, in the dose
of 15 grains.   In the severe lancinating or darting pains of locomotor
ataxia, and in the laryngeal and gastric crises complicating this disease,
antipyrine is an invaluable and reliable remedy.  Curiously enough it
seems to subdue acute attacks of pain in posterior sclerosis, but fails to
control  the slighter pains and muscular twitchings sometimes seen in
this disease and in myelitis.
   Some clinicians have  used antipyrine with asserted great success in
diabetes mellitus.  Antipyrine  may  be used hypodermically in  the
case of a hypersensitive  nerve  as a local anaesthetic.   The anaesthesia
produced  by it lasts  for several days, but the pain immediately after
the injection is excruciating.
   Antipyrine is a very useful remedy in epilepsy.
   In whooping-cough antipyrine  has given relief  more frequently in
the writer's experience than any other remedy.  It should be given
to a child of  five years in the dose of  2 grains every four or five
hours, the patient being watched for cyanosis and the drug stopped as
soon as this symptom appears.  Antipyrine  frequently decreases  the
frequency rather than the force of the attacks of cough.
   In malarial  diseases antipyrine certainly exercises no antiperiodic
influence, although it controls the febrile paroxysms to a great extent.
Yet, while this is the opinion of the majority of those who have used
it, it cannot be said that every observer has reached similar conclusions.
Potter reports cases where the results obtained from its use were most
satisfactory, particularly in the intermittent form of malarial  poison-
ing.  One cannot help thinking that frequently where antipyrine  has
been reported as acting as an-antiperiodic, it has simply lowered  the
fever and so seemed to affect the disease.
   Untoward Effects.—Aside from  the results  of poisonous doses, a
large number of cases present slight cyanosis or duskiness of the hands
and of the face about the nose and  lips ; the fingers may be cold and
clammy, and the feet are often  very cold ;  sweating is a very common
symptom of the untoward influence of antipyrine, and pricking  or
tingling of the skin is  not uncommonly  seen.   By  far the largest
number of these cases, however, suffer from disorders  associated with
the skin, and  erythematous patches may  be seen everywhere, more
particularly on the hands and feet, and about the  face, arms, and chest.
Occasionally pemphigus-like spots appear, and often large bullae have
been noted as present. Elsewhere  are published the statistics, collected
from medical literature, of 121 cases of untoward effects exercised by
antipyrine.1  An  analysis of  these  shows that females were much
more frequently affected than males, and that the most susceptible  age
was  decidedly that of full  adult  life—namely, from  thirty to  forty

          1 See author's Essay on Antipyretics.  Philadelphia, 1891. 
74
DRUGS.
years in both sexes.  The dose causing these effects was most com-
monly a moderate one—from 10 to 15 grains, or even from 4 to 10
grains.   This fact holds good with regard to both sexes.   The time
of onset of  the  symptoms varied somewhat, according to whether
the drug was given in  one excessive dose or in  frequently repeated
medicinal doses.   In many instances the appearance of the symptoms
was  sudden  rather than  gradual.   As  a rule  the duration of the
symptoms did not exceed one to three hours, three days being the
longest time  mentioned.  It is  interesting to note, however, that  of
all these cases only six proved fatal, and in these there was ample
cause for death aside from  any effect of the  drug.  We  can rest
assured, therefore, in ordinary cases of disease, that patients exhibiting
untoward effects of antipyrine are not in any acute danger, although
the symptoms may be  temporarily most alarming.   Typhoid  fever
seems, according  to  the' statistics collected by the writer, to be the
disease in which  this unexpected influence manifests itself most fre-
quently, but  this  may  be due to the fact that  it  is so common a
malady, and is so frequently treated by means of  antipyretics.
  Administration—Owing to the solubility of antipyrine, it is most
readily given in a little  water in a wineglass or spoon.   If its slight
taste is disliked, it may be dissolved in any one of the aromatic waters,
or in syrup of bitter orange peel, or some similar vehicle.  Most per-
sons prefer to take it with water.   The  amount whicli may be given
at a  dose is 5 to  20 grains, 5 grains being perhaps the  best dose in
most cases.
  Incompatibles.—When  added to sweet spirit of nitre, antipyrine in
the course  of a  few moments produces a  blue, changing to a dark-
green, color, owing to the  formation of iso-nitroso-antipyrine, which is
not poisonous, but when in the form of a dry powder is readily oxi-
dized on exposure to slight heat.   If this  color is not formed the
spirit of nitre lacks its nitrous ether and is worthless, so that we have
not only another  incompatibility to remember, but a new means of
testing the therapeutic value of all  samples  of sweet spirit of nitre
which may be dispensed by druggists.   Calomel and antipyrine have
also been found to be incompatible.


                            APIOL.

  Apiol is a yellowish,  oily liquid with a specific  gravity greater than
water, an acid taste, and curious odor.   It is derived from  common
parsley, or Petroselinum.  So far as is known to the author, no careful
study of its physiological  action has ever been made, but two French
observers, Joret  and Homolle, state that in overdose it causes ringing
in the ears, intoxication, and severe frontal headache.
  Therapeutics.—Originally introduced to combat  malarial  fevers,
because of a  fancied resemblance in its  toxic action to quinine, apiol
has at last found its true  level as a remedy in amenorrhcea, given in
the dose of 2 to  8 minims three times a day for a week  before the 
APOMORPHINE.
75
proper date for menstruation.  It should  be  given,  if possible, in
capsules owing to its bad taste.  It is said not to possess any abortive
influences, although it is often taken with this object in view.
  Apiol is  imported from France  in  capsules containing a little less
than 3 minims.

                       APOMORPHINE.

  Apomorphine is an  artificial alkaloid obtained by the  action of
hydrochloric acid upon  morphine in a sealed tube to which  is applied
a high heat.  It is a whitish or gray powder, made up of minute crys-
tals, which rapidly undergo decomposition when  exposed to the air.
The drug should  be kept in dark bottles  well  stoppered.  A very
important point to remember is that old  solutions  rapidly decompose,
and, if employed, may produce poisonous symptoms. The drug ought
to be freshly dissolved each time it is  used.
  Physiological Action.—One of the best studies of this drug is that
of Reichert, who found that in poisonous doses  it produces convul-
sions, and finally paralysis which is chiefly spinal in origin.
  Nervous System.—On the nervous centres in the brain apomor-
phine acts as a stimulant, but the convulsions produced by poisonous
doses are probably spinal.  The motor and  sensory nerves  are finally
paralyzed, and even the muscles become poisoned and incapable of
contraction.
  Circulation.—Apomorphine increases the  rapidity and force of
the pulse and raises arterial pressure, when given in moderate amounts,
by  stimulation of the  accelerator nerves and the  vasomotor  centre.
In large doses it acts as a circulatory  depressant.
  Respiration.—After ordinary amounts  no changes in respiration
occur,  but  after poisonous doses  the breathing  becomes  rapid and
irregular.
  Vomiting.—Vomiting is produced by a direct action of the drug
upon the vomiting centre in the medulla, and not by an action on the
stomach.  Apomorphine is, therefore, a typical centric emetic.
  Therapeutics.—Apomorphine is useful in  nearly all cases  where  an
emetic  may be employed.  In poisoning from other drugs, particu-
larly depressants and narcotics, we have little knowledge of its safety,
but, unless  the stupor  or  circulatory change is  very profound, the
drug may be used with  care.   In subacute and chronic catarrh of the
stomach and air-passages it may be useful in getting rid of  the mucus
by emesis, and it is a  useful remedy in acute  bronchitis when it is
necessary to quiet  irritation, or when the secretion which  has been
poured out is very scanty.
  Administration.—The drug when used as an emetic should  always
be given hypodermically and the  solution be freshly  prepared.  The
emetic  dose is about fa of a grain, but as much as |  may be used in
strong  patients.  The expectorant dose is fa to fa of a grain  by the
mouth.  No nausea is  usually  felt.  The  drug  nearly always acts
badly in children, and it is better not to use it in this class of patients. 
76
DRUGS.
The salt used is Apomorphincc Hydrochloras, IT. 8. and B. P.  An
injection (Injectio Apomorphincc Hypodermica—2 grains dissolved  in
100 minims of camphor-water) is official in the B. P.


                           ARISTOL.

                     (See Thymol  Iodide.)


                           ARNICA.

  Arnica is a medicine derived from  Arnica montana, a native plant
of the Western United States and Europe.  It holds a very high posi-
tion in  domestic medicine as a local  and internal remedy in sprains
and bruises, and in the  treatment  of passive haemorrhages, amenor-
rhea, and  similar states.   Two  parts  of  the plant  are official, the
arnica flowers  (Arnicce Flores, IT. 8.) and the root (Arnicce Badix,
IT.  8., Arnicce Bhizoma,  B.  P.)
  Physiological Action.—When arnica is applied to a delicate skin it
produces burning and irritation, and even extensive skin lesions.   Ac-
cording  to  the studies of the  author it slows the pulse,  raises the
blood-pressure slightly, and stimulates the vagus nerves.  Toxic doses
produce a rapid pulse from paralysis of these nerves.
  Administration.—Arnica is rarely given internally.   If it  is so used
the  dose of the tincture  (Tinctura Arnicce Badicis,  IT. 8.) is 15 to 30
drops, and  the same  amount of the tincture of the flowers  (Tinctura
Arnicce  Florum, IT. S.)  may be employed.   The  solid  (Extractum
Arnicce  Badicis,  IT. 8.) and the fluid extract of the root (Extractum
Arnicce Badicis Fluidum) are also official.  The dose of these prepara-
tions is  3 to 5 grains and 5 to 10 minims respectively.   The plaster
(Emplastrum Arnicce, IT. 8.)  is very useful for external applications.
  The tincture  is the preparation  usually applied  to  sprains  and
bruises,  and the alcohol  contained therein  accomplishes a large part
of the good achieved.
  The only British preparation  is the tincture (Tinctura Arnicce),
which is given in the dose of 30 minims to 1  drachm.
                           ARSENIC.

  Arsenic (Arsenicum)  itself is never employed in medicine, but it is
used in the form of arsenious acid or the arseniates  of sodium, potas-
sium, or copper.
  Arsenious acid is derived from arsenic-bearing ores by roasting them
in a reverberatory  furnace, when it rises in the form of a  vapor which
adheres  to  the  walls  of the furnace, requiring a second sublimation
owing to the first deposit being  quite impure.   It is soluble in water,
is without odor, and when heated gives off the smell of garlic. 
arsenic.
77
   Physiological Action.—The changes produced in man by poisonous
 doses will  be found considered under the heading of Poisoning, and
 the writer  will now confine himself to a study of the effects  of ^niedi-
 cinal amounts.
   Applied to the normal skin arsenious acid produces no change of
 any moment whatever, but if the surface be broken  or a wound or
 sore exist  its action is very powerful, and it destroys  the tissues to a
 considerable extent.   For this reason it has been employed as a caustic
 by "quacks" and to  some extent  by regular  physicians, the latter
 using it to remove warts, condylomata, and similar growths, while the
 former  have  employed it chiefly as a " cancer cure," asserting  that it
 would take the disease  " out by the roots."
   Nervous  System.—When small amounts of arsenic are  given to
 animals, particularly those of the lower  types, as represented by the
 frog, reflex action is lost long before, or more rarely at the same time
 that voluntary movement is put aside, and, finally, all sensation  to
 pain produced by heat and pinching  totally ceases.   It is, therefore,
 quite evident that the sensory nervous apparatus is affected, and  ex-
 periments  have proved that the sensory tract of the spinal cord is at
 fault.   Ultimately, however, the motor system also fails and  complete
 motor palsy ensues.  Arsenic in poisonous amount acts as a depressant
 poison to all protoplasm with which it may come in  contact,  (Ringer
 aud Murrell.)  In medicinal  amounts the drug  acts as a nervous ex-
 citant and  as a stimulant to the  trophic nervous  apparatus.
   Circulation.—In moderate  amounts arsenic has  little or  no in-
 fluence  upon  the circulation.  Large doses cause  marked decrease  in
 the force and frequency of the pulse, accompanied by a decided fall in
 arterial pressure, and in these amounts it is to be regarded as a distinct
 cardiac depressant which depresses all the heart's  component parts, such
 as the ganglia, muscle, and nerves.  The fall  of the arterial pressure is
 due to vasomotor depression with relaxation of  the general bloodves-
 sels, more especially those of the abdominal cavity.   According  to
 Lesser,  small  doses cause  it to act as a cardiac  stimulant, increasing
 the pulse-rate.  Arsenic is absorbed by the bloodvessels.
   Respiration.—In  small amounts arsenic very distinctly stimulates
 the respiratory centre, aud Lesser asserts that small doses stimulate the
 peripheral ends of the  vagi in the lungs, but that in toxic quantities
 arsenic acts as a powerful respiratory depressant.
   Elimination.—Arsenic escapes from the body chiefly by the kid-
 neys and bowels.  In poisoning, the purging which is produced carries
 off much of the drug,  but after medicinal amounts  some traces of it
 may be  found in the saliva and  in the milk of nursing women.  The
 writer has seen colic produced in infants taking  milk at the breasts of
 women who were receiving large doses  of Fowler's solution.
   Tissue-waste.—According to Chittenden and Cummins, arsenic in
 medicinal amount distinctly decreases tissue-changes.   Large  doses,
 however, greatly increase nitrogenous metamorphosis.
   Therapeutics.—Arsenic is used in chorea, in  which  it is almost a
specific, acting iu an unknown manner.  Small doses should be given 
78
DRUGS.
at first, and  later on the dose should  be rapidly increased, as patients
soon get accustomed to the drug.   As a tonic combined with iron it is
invaluable in malarial ancemia and cachexia.   In atony of the mucous
membrane  of the stomach and intestines it is exceedingly useful, and
in ordinary ancemia and debility, combined with a simple bitter tonic,
it is invaluable.  In malaria it acts as a prophylactic, as a cure, and
as an aid to convalescence.   Next to quinine it is the best antiperiodic
that we  have.   When  the attacks of intermittent fever are  far apart,
arsenic is useful between the paroxysms as an  antiperiodic, quinine
being withheld for use during the attack itself.  In ordinary neuralgia,
due to eye-strain or debility, it is very useful, and in gastralgia  it is of
great service.  The author desires to speak particularly of the employ-
ment of arsenic for  the improvement of depraved mucous  membranes
of the respiratory tract, particularly in those persons  who have not
true tuberculosis  but phthisical tendencies—that is, individuals who
continually have colds in the head, chest, or elsewhere. The prolonged
use of arsenic for months at a time will often cure these cases.
  No drug is so universally abused as is arsenic in  the treatment  of
skin disease; it should never be employed  in  " wet" skin diseases—
that is,  those associated with much  proliferation of new cells and the
exudation of serum and other liquids.   Its field of usefulness is  in
the dry, scaly skin affections.
  Where the skin is affected in its lower layers arsenic is useless and
should be used only where the epiderm is diseased (Duhring).
  In psoriasis  arsenic at first makes the skin more red and seemingly
worse, but this passes off and the disease gets well.  This is important
to remember, as otherwise the drug may be stopped just at the  wrong
time.   Pemphigus, lichen, and lepra all yield to its influence in most
instances.
  In  the treatment of diabetes and pruritus vulvce the drug is said  to
be of value when given internally.  In gouty diabetes  the use  of the
carbonate of lithium and the arseniate of sodium is  often of great
service.
  In  asthma, particularly where the mucous membranes are at fault,
arsenic is one of the best remedies that we have, either given internally
or smoked in arsenic cigarettes, which are to be made as follows •}
         R.—Belladonna? foliorum
             Hyoscyam. foliorum
             Stramonii foliorum
             Extract, opii
             Tabaci
             Aquae .
    Ft. sol. et adde
             Potassii nitratis......gr. clx.
             Potassii arsenitis......gr. cccxx.  -M.
  Bibulous paper is to be wetted with this compound, and after drying is to be rolled
up and smoked in a cigarette.

  A more  simple  procedure is to wet bibulous paper in a solution  of
arsenite of potassium of the strength  of  fifteen grains to the ounce.
gr. xcvj.
gr. xlv.
gr. xlv.
gr. iv.
gr. lxxx.
Oj.       M.
1 See Philadelphia Hospital Pharmacopoeia. 
ARSENIC.
79
  In chronic rheumatism arsenic is very valuable in certain cases, but
often  fails to be of service.  In coryza, iu cancrum oris, severe sore-
throat, and chronic nasal catarrh it is  to be employed internally, and
in some  cases of hay-fever undoubtedly affords relief.   The use of
arsenic in all stages of phthisis often gives the most surprising results.
In gastric cancer and ulcer, given in small amounts frequently repeated,
arsenic will  often do  good by  relieving the pain and checking the
vomiting.  It may be tried in  the  vomiting of pregnancy with  some
chance of success.  In atonic dyspepsia associated with chronic diarrhoea,
and with evidences of dysentery, arsenic is of service, and in small
amounts it is very valuable in frequently repeated doses (j^-q of a grain
every hour),  in all forms of serous diarrhea.
  For gastric atony or  torpidity the following  prescription is useful;
but if irritation of the stomach is present it should not be employed  :
         R .—Liq. potas. arsenit......f^ss.
             Tr. nucis vomicae .    .    .   .    .      f 3 j.
             Aqua;......q. s. ad  f^iij.   M.
   S.—Teaspoonful t. d. in water after meals.
  In  old persons whose feet  become swollen and hot after prolonged
standing  and who have  shortness of breath on exertion, arsenic does
good.
  Locally applied to warts and other growths of the skin for several
days in the form of Liquor Arsenicalis (B. P.), or Liquor Acidi Ar-
seniosi, or of Fowler's solution, it  causes the growth to drop off or
to become very much loosened.   Where the growth is very hard and
horny its  surface should  be softened  by  the application of  liquor
potassa before the arsenical liquor is applied.  The same plan may be
used for  corns, and salicylic acid is employed in  a similar manner, but
is not so efficient.   Where large growths with wide surfaces are to be
attacked the physician must  use arsenic  most  boldly  or not  at all.
The danger  of  absorption is  only escaped when the drug is used so
generously as  to  destroy  the tissues before they can  carry on any
absorption of the poison.  Marsden recommended the use of one ounce
each of arsenious  acid  and powdered gum acacia to five drachms of
water as an application to epitheliomatous growths.
  Administration—Children generally  bear more arsenic than adults,
proportionately, and Ringer states that boys bear less than girls.   The
drug  should  generally be administered after meals, as it is apt to irritate
the stomach  if given when this viscus is empty.  Whenever a patient
is given  arsenic he should be cautioned  to watch  for  any  puffiness
about the eyes,  particularly in the  morning on arising, and for  slight
laxity of the bowels  and  griping.  These are signs that  the drug
should be stopped for a day  or  more.   The  swelling under the eyes
may spread if the  use of the drug is  persisted in, and finally amount
to general anasarca.  This is  due at first to a cellulitis, aud afterward
to a true effusion.
  The official preparations are: arsenious acid (Acidum Arseniosum,
 IT. 8. and B. P.), the dose of which is -fa to fa of a grain, the solution
of the arsenite of potassium (Liquor Potassii Arsenitis,  IT. 8.; Liquor 
80
DRUGS.
Arsenicalis, B. P.), or Fowler's solution, the dose of which at first is
from 1 to 5  drops in water; the  solution of  arseniate of sodium
(Liquor Sodii Arseniatis,  IT. S. aud  B. P.), or Pearson's solution, the
dose of which is  1  to 5 drops, and the solution of  arseuious acid
(Liquor Acidi Arseniosi,  IT. S.;  Liquor  Arsenici Hydrochloricus, B.
P.), the dose of whicli is 1 to 5 drops.  This is more irritating to the
stomach  than the other preparations.  The iodide of arsenic enters
into Donovan's solution (Liquor Arsenii  et Hydrargyri Iodidi, IT. 8.
aud B. P.), the dose of which is 1 to 3 drops well diluted.   Iodide of
arsenic (Arsenii Iodidum, IT. S. and  B. P.) is given in fa grain doses,
and arseniate of sodium (Sodii Arsenias, IT. S. and B. P.), in the dose
of fa to ^ of a grain.
  Acute Poisoning.—Arsenic is a gastro-intestinal irritant, producing,
when taken in  poisonous  dose, violent vomiting and  purging,  with
great pain in the oesophagus, stomach, and entire belly.  The passages
are  finally watery and resemble " rice-water"  stools,  but  are to  be
separated  from  those  of cholera and antimonial poisioning by the
presence of blood and,  if necessary, by chemical analysis.  The mucous
membrane  is  stripped off the bowel and in the passages appears in
shreds.  Very commonly about the third day, if the patient  survive so
long, an intermission in the attack appears, which will only be followed
by a return of all the symptoms, so that the physician must not give a
favorable prognosis.   In this symptom (remission) arsenical poisoning
resembles  phosphorus  poisoning  and yellow fever.  Death  generally
occurs  about the fourth or sixth  day, aud  on or about the third day a
peculiar skin  eruption appears which may be of any character.   In
rare cases sudden  pain, collapse, and death may take place after the
ingestion of the poison. Widespread  multiple neuritis may be brought
on.  A typical change always present in acute poisoning when it lasts
for any length of time is fatty degeneration of all the tissues.
  Treatment  of  Acute  Poisoning.—Besides washing  out the
stomach by the stomach-pump, applying external heat and stimulants,
the proper antidotes should be at once employed, and the only ones of
any value are the freshly-precipitated hydrated sesquioxide of iron and
magnesia.  (See below.)  The first is to be prepared by the precipita-
tion of iron from one of its fluid preparations by the use of an alkali.
Ammonia added to the tincture  of the chloride of iron is efficacious,
but the precipitate has  to be repeatedly washed to rid  it of an excess
of this irritant.  Magnesia is a better precipitant because it not  only
precipitates the iron  but is an antidote itself.   MonsePs solution and
the so-called dialyzed iron  may be employed in place of the tincture,
but the Monsel's salt is too irritating and the dialyzed iron is so readily
precipitated that it needs no alkali, but may be given pure.  Magnesia
is a useful antidote when used alone.
  Under the name Ferri Oxidum Hydratum cum Magnesia the IT. S.
P. recognizes  an antidote for arsenic; this  is often called the " anti-
dotum  arsenide   The V. S. P. directs that this antidote  should  be
kept on hand  for immediate use in the following manner: Mix \Z\
fluidrachms of the official solution of the  tersulphate of iron (Liquor 
ASAFOETIDA.
81
 Ferri Tersulphatis) with 4| ounces  of water aud keep the mixture in
 a well-stoppered bottle.  Rub 150 grains of magnesia with a  little
 water to a smooth and thin mixture;  transfer it to a bottle capable of
 holding 32 ounces and fill the  bottle with water.   When the antidote
 is to be used add the magnesia  solution  slowly to the iron solution
 and shake together until a homogeneous mass results.
   After the use of the autidote opium should be used to allay irritatiou
 and pain, and large draughts of water be given to flush the kidneys
 and dilute the poison.  In the later stages the  danger from arsenical
 poisoning arises from the changes produced in vital organs.
   Chronic Poisoning  by arsenic shows itself in great irritation of the
 air-passages, in  diseases of the kidneys, in pigmentation of the  skin,
 and in nervous symptoms due to inflammations of the nervous tissues
 in different parts of the system, such as patches of anaesthesia and local-
 ized loss of motor power.  These anaesthetic areas are generally con-
 fined  to  the  extremities,  and extend  only to the first or the second
 joint above.  Arsenic often produces asthma in those exposed to  it by
 reason of the irritation it causes  in  the  bronchial tubes.  Chronic
 poisoning is to be treated by withdrawal from the exposure, and the
 use of iodide  of potassium to aid in the elimination  of the arsenic.
 The other symptoms  are to be treated by the application of electricity,
 tonics, out-of-door life, and such measures  as will improve the general
 condition of the patient.


                          ASAFCETIDA.

   Asafetida, IT. S. and B. P., is a gum obtained by making au  inci-
 sion  into the root  of the Ferula  Narthex.  It occurs  in irregular
 masses of  a dark yellow or reddish  color  which become still  more
 red if exposed  to the light  and air.   Asafoetida in tears is a  term
 applied  to  the  drug when it appears in the shape of drops or pearls,
 and is a form seldom  seen.  Its odor  is penetrating  and strong, and
 resembles that of garlic.  When taken internally it causes a sensation
 of warmth and acts as a stimulant  and carminative in the alimentary
 canal.
   Therapeutics.—Asafoetida is  used  in medicine as  a carminative
 which will particularly affect the lower bowel, and  is useful  in the
 intestinal indigestion of old persons when  associated with flatulence,
 and in the flatulent colic  of children.  By way of rectal injections it
 is of value in the tympanites of children and in that of adults during
 typhoid fever.   It is also used as a stimulating expectorant in the  later
 stages of bronchitis.   In the nervous irritability of children it is often
 of service.
   Administration.—Asafoetida  is given in pills of asafoetida (Pilule
 Asafetide, IT. 8.),  of which two  or  three may be taken, each one
 containing 3 grains; the mixture or milk of asafoetida (Mistura Asa-
fetide, IT. S.), the dose of which is \ to 1  ounce; and  the tincture
 (Tinctura Asafetide,!!. 8. and B. P.), J to 1 fluidrachm.  The  sup-
                                 6 
82
DRUGS.
positories contain what is equal to 40 drops of the tincture;  and the
plaster of asafoetida (Emplastrum Asafetide, IT. S.) is  used where a
faint counter-irritant and antispasmodic is needed.  When intestinal
indigestion and flatulence occurs iu old people the following pill is of
service :
        R.—Extracti nucis vomica?.....gr. y.
            Extracti physostigmatis    .    .    •    •  gr. iij.
            Asafcetidse.......gr- xl.    M.
   Ft. in pil. no. xx.  S.—One night and morning.
  The B. P. preparations not official in the IT.  8. P. are Enema
Asafetide and Pilula Asafetide  Composita,  composed of asafoetida,
galbanum, and myrrh, dose 5 to 15 grains.
                           ASPIDIUM.

   Aspidium, IT. 8., Filix Mas, B. P., or Male Fern, is employed in
medicine as a taeniacide or remedy against the tape-worm, and is a very
efficient and valuable drug under such circumstances, being, perhaps,
the most reliable of all the vermifuges except pelletierin.   When em-
ployed the directions and precautions given in the  article  on Worms
must be strictly followed.
   Administration.—Male fern is rarely, if  ever, used at present in its
crude form, being  employed most commonly in this country in the
form of the oleoresin (Oleoresina Aspidii, IT. 8.), dose J to 1 fluidrachm
in capsules, or as follows :
        R.—Oleoresin. aspidii \                      ^y.  7
             Tinct. vanilla?    j-.--.aa   H|xlv.
             Pulv. acacise .    .   .    .    .   .    .    g ss.
             Aq. destillat.......f 3J.     M.
    S.—Take entire amount after fasting, and follow in two hours by a full dose of
castor oil or sulphate of magnesium.

   The dose of the liquid extract (Extractum Filicis Liquidum) of the
B. P. is 15 minims to 1 fluidrachm.
                         AZEDARACH.

  Azedarach, IT. 8., is the bark of the Melia Azedarach, or Pride of
China, as it  is sometimes called.    It  is found in Syria, Persia, the
north of India,  and in the southern United States.
  The drug has  little toxic power, and children may eat of it largely
without  ill effect.  If very large  amounts are used  gastro-intestinal
inflammation occurs.   It is employed as a remedy against the round-
worm, and should be given in decoction made by boiling 2 ounces of
the drug in a pint and a half of water until there only remains a pint
of liquid.  Of this from 1 to 2 tablespoonfuls are to be given a  child,
and  repeated  every two hours until the bowels are opened.  It  has
also been used as a fluid extract prepared by the ordinary means with 
BARIUM CHLORIDE.
83
alcohol, to which some white sugar should be added.   The dose of this
extract is a teaspoonful, and is not to be repeated.   The decoction is
the best form in which  to use the drug.


                    BARIUM CHLORIDE.

   One of the most recent and  one of the best evidences of the value
of the study of the action of drugs upon the lower animals is given
us  by this  substance.   It will be remembered that Brunton and
Ringer, of London ; Kobert and Bary, of Dorpat;  and Bartholow
and the writer in America, have at various times published, during
the last few years, studies concerning the effect of barium on the cir-
culatory apparatus of the frog, dog, and man, and all of them are  in
accord in the statement that it slows the heart very greatly, steadies
its  rhythm, aud,  at the  same  time, increases  the volume  of blood
thrown  out of the ventricle.   They have also found  that barium in-
creases  blood-pressure, and  Kobert has, by a series of careful experi-
ments, concluded that it brings about this change  by  an action on the
muscular coats of the bloodvessels.
   If large doses are used in the lower animals, the heart suffers sys-
tolic arrest from over-stimulation, and the  strongest  irritation of the
vagus nerves  fails to relax the systolic contraction.   Still more inter-
esting is the statement that this failure of the vagi to  inhibit  the heart
is not the result of paralysis of these nerves, but is simply due to the
excess of cardiac  contractile power.   The slowing of  the pulse is not
due to inhibitory influence, but depends solely  upon  the stimulation
of the heart muscle, although  it would  seem  probable that  the vaso-
motor stimulation, by increasing the arterial resistance, may be at least
a factor in the reduction of the pulse-rate.  At one time, in the dog,
after  large doses,  there is a period of increase  of pulse-rate which is
asserted to be due to stimulation of the accelerator nerves.
   In most  works on chemistry barium is stated to be.an irritant
poison, but to produce such evidences of its presence the dose given
must be extremely  large, and  many times  greater than  any amount
useful for medicinal purposes.
   Therapeutics.—Barium chloride may be used in all forms of cardiac
disease in which failure of the heart muscle is present.  In the treat-
ment of varicose  veins  it is said to  be of value, both  when given
internally and applied locally over the distended vessels.
   A point worthy of remark is the character  of the  pulse-wave pro-
duced.   While its volume is increased it does not give that  sensation
of tenseness to  the finger that does digitalis, and the pulse-wave seems
to be very considerably prolonged; a fact that the sphygmograph also
records.
  Administration.—The solution of barium chloride to be used inter-
nally should have the strength  of 5 grains to the ounce of water, and
of this 1 or 2 teaspoonfuls is to be given three times a day. 
84
DRUGS.
                        BELLADONNA.

  Belladonna is botanicallv known  as Atropa Belladonna,  and  is
official  in the form of the root (Belladonne Badix, IT. 8. and  B. P.),
and leaves (Belladonne Folia,  IT. 8. and B. P.).  It belongs to a very
large  class  of plants which all  have a  similar physiological  action.
Belladonna  contains  an active principle in the form of an alkaloid,
known  as atropine (Atropina,  IT. 8. and B. P.), which is insoluble in
water.  The sulphate of atropine (Atropine Sulphas, IT. S. and B.P.)
is soluble.
  Physiological Effects.—In man, full medicinal doses produce flush-
ing of the face, redness and dryness of the fauces, dilated pupils, some-
times an erythematous rash over the skin, rarely diplopia and delirium.
If the dose  be still larger the  delirium  becomes very marked  and is
wild  and talkative.   The pulse  is rapid and wiry.   The rash which
appears resembles that  of   scarlet  fever, but  lacks  the punctations.
The skin may desquamate after several days if the rash is severe.
  In  children belladonna is  usually borne very  well indeed, and
opium very badly.  When  belladonna  asserts itself in children the
respiration is quickened, the  eyes become bright and the cheeks red,
but lines of pallor reach  from the malar bones to the corners  of the
mouth,  giving the face a curious expression.
  Nervous System.—Belladonna acts as a powerful excitant of the
brain  and spinal cord.
  When very large doses are given, paralysis of the spinal cord comes
on,  which is followed by  tetanic  spasms  and finally  by recovery.
The primary loss of power is due to paralysis of the entire cord, and
the second state, of convulsions, to the escape of the motor and sensory
pathways from  the  paralysis  before the  inhibitory  centres recover.
As  a result any peripheral irritation  causes  violent explosions  of
motor power.1  Even in large  medicinal dose belladonna may be con-
sidered  as a depressant to the motor nerves and as a quieter to sensory
nerve-filaments.   On voluntary muscles the drug  has no effect, but
upon  unstriped muscles it acts as a depressant and antispasmodic.  It
distinctly lessens reflex action.
  Circulation.—Belladonna quickens the  pulse  by depression  of
the peripheral vagi  and by  stimulating the cardiac  muscle.  It  pro-
duces a rise of arterial  pressure  by stimulating the vasomotor centre
and by  the increased heart action which it causes.   In poisonous doses
it causes  a  fall of arterial pressure due to  centric vasomotor palsv,
and depression of the muscular  coats of the bloodvessels, but not ito
cardiac  depression, as has  been generally taught, for Reichert has

  1 If  a homely simile, found useful by the writer in teaching, may be used, the in-
hibitory centres may be represented by  a schoolmaster, and the  motor and  sensory
centres by two boys.  The escape of chloroform in the room paralyzes them all, but,
finally, the boys recover before their master and go off as truants (convulsions); at
last the master (inhibitory centres) recovers, and order, or health, is restored. 
BELLADONN a.
85
proved that the drug is not a heart depressant unless the dose is simply
overwhelming.  Sometimes when  belladonna  is given  the pulse be-
comes slow, but in these cases the slowing is due to temporary stimu-
lation of the peripheral vagi or to momentary depression of the cardiac
motor ganglia.
   Respiration.—Atropine is a  stimulant to the respiratory centre
in ordinary amounts,  but recent  careful studies show that its  high
reputation as a respiratory stimulant is not based either on clinical  or
experimental  experience.  In  many  cases it fails  to increase  the
respiration at  all, and it is certainly inferior to coffee and strychnine
in the treatment of opium poisoning.  In large doses it is a depressant
and  paralyzant to respiration, and  produces  death from  respiratory
failure due  to paralysis of the motor nerves supplying the respiratory
muscles, and probably by depressing the respiratory centres.
   Abdominal  Contents.—Belladonna increases peristalsis by de-
pressing the peripheral ends of the inhibitory fibres of the splanchnic
nerves and  by diminishing any tendency to spasm  on the  part of the
muscular coats of the intestine.
   Action on Secretion.—The drug decreases all the secretions of the
body except the urine, which is sometimes increased in amount under
its use.  The decrease of secretion is due to paralysis of the peripheral
nerve-filaments supplying the secretory cells of the glands.
   Bodily  Heat.—When belladonna is used in large amounts there
is nearly always a rise of temperature, which in children may amount to
one or two degrees.  In advanced poisoning  the temperature rapidly
falls.
   Elimination.—Atropine is eliminated by the kidneys and bowels
and  is partly destroyed in the liver.   In a suspected case of poisoning
the urine of the patient may be dropped in the eye of an animal,  and,
if atropine  or belladonna has been taken, mydriasis will result.
   Eye.—On  the eye  belladonna produces dilatation of the pupil by
stimulating peripherally the  sympathetic  nerve fibres of  the  iris and
paralyzing the ocular motor fibres, but the dominant action of the drug
is undoubtedly exercised upon the  muscular fibres of the iris.  It  gen-
erally increases intra-ocular tension
   Treatment  of Poisoning.—Poisoning by belladonna is to  be
treated by the application of external  heat if the patient goes  into
collapse aud the use of strychnine if respiration fails.   Opium may be
employed in carefully graded doses as the physiological antagonist, but
large doses are of doubtful service, particularly if the respirations are
not in a satisfactory state.
   Therapeutics.—Belladonna is used to allay excessive secretion, to act
as an antispasmodic, and to influence the circulatory apparatus when
local inflammations are beginning, particularly in secretory glands. In
cardiac palpitation small doses of  belladonna internally, or  its ex-
ternal use over the praecordium in the form of a belladonna plaster or
ointment, is very useful.   It is also our most useful vasomotor stimu-
lant  in shock.   Belladonna is of value in neuralgias and  in the pains
due to irritated peripheral nerves. 
86
DRUGS.
  To check secretion in night-sweats it is one of the best remedies we
have, and it is useful in excessive idiopathic ptyalism, as seen in chil-
dren, or in that due to mercurialization.  In bromidrosis of the feet and
other localized sweatings it is useful, and may be employed locally or
taken internally for their cure.   It is the best drug we have for check-
ing the secretion of milk in an inflamed breast, and under these circum-
stances it is  best to smear it over the gland in an ointment.   Bella-
donna may be used  in serous diarrhea, as it checks the disorder by
stimulation of the splanchnic vasomotor  filaments of  the intestinal
bloodvessels,  which being inactive permit a transudation of liquid into
the bowel.
  Trousseau  recommended as a  local remedy 1 to 2 grains of the ex-
tract  of belladonna with 6  to 8 grains  of tannic acid  in leucorrhea
dependent upon  disease of the uterine cervix.  This should be placed
on a  pledget of cotton and applied  to  the  affected part daily, being
allowed to  remain all day.  Ringer states that  if  pain  is also present
in these cases the following  injection is of  value :

       H.—Sodii bicarbonatis   .......  3J-
           Tr. belladonna?........f^ij-
           Aquae dest........q. s. ad  Oj.   M.

This is to be  injected into the vagina, the woman first being placed on
her back with  her buttocks raised, so  that  the drug may bathe the
uterine cervix for some minutes.
  As an antispasmodic, atropine is to  be used in torticollis, injected
directly into  the muscle itself, so as to act on its motor nerve fibres,
and it may be given  in spasm of the intestine  with  cramps and griping,
while in cramps in the legs and  body, either as a local  application by
means of  liniments, or when  employed internally,  it  is of service.
In asthma  of the spasmodic type, belladonna  is a sovereign  remedy,
particularly if it be combined with morphine.  It may be used both as
a prophylactic and as a cure during the attack.   The belladonua leaves
may be smoked  by rolling them into a cigarette or putting them into
a pipe.
   This drug is  used in whooping-cough  at all  ages and in all stages,
but it has generally  to be given in large amounts in this disease  to do
any  good.
   In spasm of the sphincter ani, either that which is idiopathic or due to
fissure, belladonna in the form of an ointment or suppository is of value.
In spasm of  the  urethra and bladder the drug may be used internally
and  externally, and in the former state the ointment should be smeared
along the under surface of the  penis every night.  This treatment is
also useful in chordee. In the colic resulting from the passage of hepatic
and renal calculi belladonna in full dose will nearly always give relief.
Where urinary  incontinence depends upon spasm of the bladder bella-
donna should be used (see Urinary Incontinence).  In dysmenorrhea in
nervous women  with spasm of the cervix uteri  it is of very great value
applied as an ointment or in a  vaginal suppository, or when given by
the  mouth.  For the nervous cough of  children and adults belladonna 
BELLADONNA.
87
is one of the best remedies we have.  In constipation it does good  by
depressing the inhibitory nerves of the intestine.  It is also of value in
laryngismus stridulus aud in hiccough.  In spasms from peripheral irri-
tations belladonna is of value.   In iritis atropine is used to dilate the
pupil and prevent adhesions.  The solution to be dropped into the eye
should contain 1 to 4 grains of atropine sulphate to the ounce of water.
Atropine sulphate is also used for the purpose of producing mydriasis
before ophthalmoscopic examination  in solutions of the strength just
given.  It increases intra-ocular  tension aud is contra-indicated in
glaucoma.   When employed to act on the circulation it is  to be used
in shock and collapse  from injury, or iu the course of severe disease
(see Shock).   During  the  progress of a case of pneumonia, typhoid
fever, or other  severe disease, belladonna should  be kept in the house
and administered freely if collapse or vasomotor relaxation suddenly
asserts itself.  In mastitis, or inflammation of the breast, even where pus
is beginning to be formed, belladonna, if pushed, will give surprisingly
good  results if given  internally and  applied  locally.   In sore-throat,
when the  pharynx is hot and  dry and has  a sensation of  rawness,
while the local capillaries appear injected and red, belladonna is often
of the greatest service if given  in  full dose, aborting the "cold."
Iu exophthalmic goitre belladonna is thought to act by stimulating the
sympathetic nerves, and certainly gives relief in  some cases.   For the
relief of local nerve pains it is of value, and probably acts by quieting the
irritated nerve.  It should be applied in these cases in the form of an
ointment or plaster and be well rubbed into the  part affected.
   In headache occurring in young persons,  often due to over-work,
with paiu in the eyeballs and forehead and  a  sensation as if the orbits
were too small for the eyeballs,  belladonna is  of service.  In intercostal
neuralgia or pleurodynia  belladonna plasters may be  applied to the
spot where  the pain is felt,  with relief.
   Use  of Atropine in Poisoning.—Atropine acts as  an antidote in
cases where  poisonous mushrooms have  been eaten, and is a physio-
logical antidote to opium, Calabar bean or physostigma, and jaborandi.
In opium poisoning it acts as an antidote in all parts of the body except
the eye, and in jaborandi poisoning the  same fact holds true.  In opium
poisoning the drug should not be given after the respirations rise to ten
from three or four per minute, as too much of the drug may be given
and atropine poisoning may come on and  complicate  the case.   The
condition of the pupil is not a guide as to the effect of atropine in opium
poisoning, because opium acts centrically and atropine acts peripherally
on the nerves governing the iris.  Atropine should be used in aconite,
antimony, and hydrocyanic acid poisoning,  for its influence on  the
vasomotor  system, the respiratory centre, and the  heart, and for  the
purpose of maintaining the bodily heat, the dissipation  of which it
retards by preventing vasomotor palsy and  consequent dilatation of
the peripheral  bloodvessels.  It should  be borne  in mind that atropine
is not  the very best single  antagonist to opium, and  that it  always
should be largely replaced by caffeine and strychnine. 
88
DRUGS.
  Administration.—The dose of the sulphate of atropine (Atropine
Sulphas, U. S. and B. P.), is  ^ to -fa of a grain.  The alcoholic
extract (Extractum Belladonne Alcoholicum, IT. S. and B. P.) is given
iu i to I grain doses, and the tincture (Tinctura Belladonne, IT. S.
and  B. P.) in the dose of 5  to 15 minims.   The fluid  extract (Ex-
tractum Belladonne Fluidum,  IT. S.) is given in 1 to 2 minim  doses,
while the  extract of the B. P. is  given in  | to 1 minim doses.   Ab-
stractum Belladonne,  IT. S., is given in the dose of 1 grain, and Succus
Belladonne, B. P., is  given in 5 to 15 minim doses.  The preparations
of the B. P. not official  in the IT. S. P. are Liquor Atropine Sulphatis,
given in the dose of 1 to 6  minims, Lamelle Atropine, each of which
contains n]M of  a  grain  of atropine, and Unguentum  Atropine.
Belladonna  liniment  (Linimentum Belladonne, IT.  8.  and  B. P.),
Belladonna plaster  (Emplastrum Belladonne, IT. 8.  and B.  P), and
the  ointment  (Unguentum  Belladonne, IT. 8.  and B.  P.) are for
external application.
  Recent experiments show that belladonna decreases gastric secretion
very considerably  in some persons.  It is better, therefore, not to
administer it just before or  immediately after a meal.
                 BENZOATE OF BISMUTH.

  This  is  a preparation which has been highly  recommended  in
Germany, and  to some  extent in this country within the last few
years, in the treatment of chancroid.  Under  its influence the sore
heals up with great rapidity and leaves a comparatively small cicatrix.
It may also be used in the treatment of all specific sores and for the
dressing of indolent or sloughing ulcers.   Benzoate of bismuth, when
properly applied,  should be  preceded by a  careful washing  of the
diseased surface with a very weak bichloride solution, after which the
bismuth is to be  sprinkled over the wound and the entire  surface
covered with cotton, which should be held in  place  by an adhesive
strip.   The only disadvantage in this dressing  lies in the fact that it
has to  be changed once  or twice in every twenty-four hours.  Im-
mediately after it is applied it may produce some tingling or burning,
but this is never very severe.
              BENZOIN AND BENZOIC ACID.

  Benzoin (Benzoinum,  IT. 8. and B. P.) is a resinous balsam derived
from the Styrax Benzoin, which is a native of Sumatra, Borneo, and
Java.  Benzoic acid is  obtained by the  sublimation of gum benzoin,
and it is benzoic acid which is generally used in medicine.
  Physiological Action.—Locally applied in concentrated form ben-
zoic acid  is an irritant, and taken  internally in excessive  amount it
causes a sensation  of warmth and burning.  It is eliminated as hip- 
BICARBONATE OF SODIUM.
89
 puric acid, and increases the acidity of the urine.  On the lower forms
 of life  it acts as an antiseptic and germicide.
   Therapeutics.—Benzoic  acid  is useful in the treatment of chronic
 cystitis with alkaline urine which is loaded with phosphates, and, com-
 bined with cannabis indica, acts  well in the later stages of gonorrhoea.
 Senator states that in the dose of 2 or 3 drachms a day it is a specific
 in acute rheumatism, and thinks  it equal to salicylic acid.   When these
 doses are to  be used the benzoate of sodium should be employed, owing
 to its solubility.  In acute laryngitis accompanied by great hoarseness
 the inhalation of steam laden with compound tincture of benzoin is of
 the greatest  service.  A tablespoonful of this tincture should be placed
 in a pitcher of boiling  water, the face  held  over  the liquid, and a
 towel thrown over the head of the patient to retain the  steam.   The
 drug caunot be used  in an atomizer, as  it clogs  the  " tips."   Taken
 internally it is useful in chronic  bronchitis.
   Administration.—The dose of  benzoic acid  (Acidum Benzoicum,
 IT. S. and B. P.) is  usually 10 to 40 grains, but a drachm  may be
 given in capsule.  The gum itself is never used as such.  The tincture
 (Tinctura Benzoini,  IT. S.) is given in 30 minim to 1 drachm doses,
 and the compound tincture (Tinctura Benzoini Composite, IT. S. and
 B. P.) is composed  of benzoin, aloes, storax, balsam of Tolu, and
 alcohol, the  dose  of it  being  1 to 2  fluidrachms.  The  preparations
 official  in the B. P. but  not in the IT. 8. P. are the troches (Trochisci
 Acidi Benzoici and Unguentum Cetacei).
   Adeps Benzoinatus  (U. 8. and B. P.), or benzoated lard, is simply
 a  non-rancid basis for many ointments, notably that of zinc.


              BICARBONATE  OP POTASSIUM.

   This salt  (Potassii Bicarbonas,  U. 8. and B.  P.)  is used  for  the
 same purposes  as the  citrate and  acetate of potassium, and  as it is
 much less agreeable in taste should not be employed when they can be
 obtained.  From the bicarbonate of potassium are made several very
 useful preparations :  the liquor potassii citratis, by adding 960 grains
 to 720 grains of citric acid and 24 ounces of water;  the neutral mix-
 ture,  by adding to 1 pint of lemon-juice enough of the potassium salt
 to neutralize it.  The dose of potassii bicarbonas  is 5 to 40 grains, or
 even  as much as 2 drachms may be given if well  diluted  with water.


                BICARBONATE  OP  SODIUM.

   Bicarbonate of Sodium (Sodii Bicarbonas, U. 8. and  B. P.) is a
salt largely used as an antacid in gastric fermentation, and in sick head-
aches arising from this condition.  Combined with calomel in powder
it  certainly adds to  its  efficiency  in  increasing  biliary  flow,  as  all
alkalies of this class  liquefy and thin the bile.   The  drug has been
widely employed in the treatment  of rheumatism, and  is found to be 
90
DRUGS.
of great service in allaying pain and soreness in the joints when used
in a lotion  made  by dissolving it in water and applying it to the part
on lint or rags.   In acidity of the  stomach the following effervescing
powder is useful: Bicarbonate of sodium (Sodii Bicarbonas), 30 grains
in one paper, and, in  the  other, 20 grains of tartaric acid (Acidum
Tartaricum).  These are each dissolved in half a tumbler of water,
added to one another, and swallowed during effervescence.


                          BISMUTH.

   Bismuth  (Bismuthum, B. P.)  is  official  as the subcarbonate (Bis-
muthi Subcarbonas, U. 8.), the subnitrate (Bismuthi Subnitras U. 8.,
and  B. P.), the citrate (Bismuthi  Citras, U. 8.  and B.  P), and  the
bismuth  and ammonium citrate (Bismuthi et Ammonii  Citras, U. 8.
and B. P.).  The first and second are identical in their dose (5 to 20
grains)  and action, and may  be employed interchangeably.  The
third and  fourth  are  more astringent and more irritating than  the
other two, and must  be given in a smaller dose, which  is 2 to 4
grains.   Many years  ago  the drug  was  supposed to be capable  of
producing  gastro-enteritis in  large doses, but this was due to a con-
tamination by arsenic.   Bismuth may produce chronic poisoning after
prolonged  use on wounds or when internally  administered.  The
changes under these circumstances are the formation of black sloughs
in the mouth and gastro-intestinal  tract, desquamative nephritis, and
albuminuria.   The preparations  of the B. P.  not  official  in  the
 U. S. P. are the Liquor Bismuthi et Ammonii  Citratis, dose J to 1
fluidrachm, and the troches  (Trochisci  Bismuthi), 2 grains in each.
Bismuthi  Carbonas, B. P., is the same as the subcarbonate  of  the
 U S. P.
   Therapeutics.—Bismuth is used as an astringent in large doses to
cover the surface  of inflamed  mucous membranes and so to allay irrita-
tion.  It is useful in irritative  vomiting for this reason, and in diarrhea
of a similar type in which  the stools are serous.   If the  passages  are
mucous, castor oil should  precede bismuth in order to  rid the ali-
mentary canal of the secretion already poured out.  It is very useful
when combined with  carbolic acid in serous  diarrhea, given in cap-
sules containing 5 grains of bismuth subnitrate and 1 drop of carbolic
acid (Wood).  It is also to be used as a slow aud feeble antacid. The
Bismuthi et Ammonii Citras is very astringent, and should be used iu
chronic serous diarrheas in the dose of 5 grains  every  two or three
hours.  The other preparations of bismuth  are insoluble, and they
should not be given in water, but this preparation is soluble, aud may
be given in solution.   Bismuth is of service  in dyspepsia when lactic
and butyric acid fermentation is present with excessive belching, and
may be  employed in gastralgia and gastric ulcer and gastritis as a
sedative and astringent.  Bismuth and ammonium citrate must never
be employed if acute inflammation exists.
   When the  salts of  bismuth are used for  any length  of time they 
BITARTRATE OF  POTASSIUM.
91
cause the odor of garlic to appear  in the breath, which is due to the
presence of an exceedingly slight trace of tellurium  in the  bismuth.
The stools  are apt  to become black, and the tongue, if furred, may
also be black about the centre when bismuth is used.
   Where there is chapping of the hands or cheeks  from  exposure to
cold or wet, the following prescription is useful :
         R.—Bismuthi subnitratis.....^iij.
             Zinci oleatis.......giij.
             Lycopodii.......3 ij.    M.
    S.—Apply to the parts t. d.


                  BISMUTH  SALICYLATE.

                 (See Salicylate of Bismuth.)


                 BISMUTH SUB-GALLATE.

   Dermatol or the  sub-gallate of  bismuth was first used by Heinz
and Liebrecht.   It  is a  fine yellow powder which  is unaffected by
long exposure to light and air, and is entirely odorless.   Its uses are
identical with the external uses of iodoform, and it probably acts in
much the same manner as does the  latter drug, namely, by so drying
the wound  that it becomes an  unfavorable soil for the  growth of germs.
As dermatol is an astringent it cannot be employed  in the treatment
of  indolent ulcers  which need stimulation  rather than an astringent
influence, and it would seem  probable on theoretical grounds, that it
is not to be compared to iodoform  in the treatment of cases in which
tubercular  processes are going on.
   There is no doubt that dermatol is  less poisonous than iodoform,
but it must be capable  of producing some  untoward effects if used
profusely for  any length of time,  since  poisoning  follows the pro-
longed employment of bismuth preparations, as has been determined
by Balzer,  Dalche, and A7illejean, for the symptoms of which see the
article on Bismuth.
   Dermatol may be tried in  cases  of skin disease in which there is
much secretion, as in weeping eczemas and similar states, either in the
form of a dusting powder or  in an ointment with vaseline or lanolin
in the proportion of J to 1 drachm  to  the  ounce.  Sometimes its
efficiency can  be  much  increased by the  addition of equal parts of
oxide of zinc to the prescription just given.
   Dermatol has been used in cases  of purulent  otitis media and many
states requiring similar effects with marked success.


              BITARTRATE OP POTASSIUM.

  Potassii  Bitartras, U. S., Potassii Tartras Adda, B.  P., is some-
times called "  cream of tartar," or acid tartrate of potassium.  It is a 
92
DRUGS.
white gritty powder which may occur in rhombic crystals.  Owing to
its stability it has been thought that it escaped from the body without
oxidation, and so to differ from the other potassium salts formed from
vegetable acids.   This is probably incorrect.
  Therapeutics.—The bitartrate of potassium is the most diuretic of
the potassium salts, and  is used in chronic nephritis with gin or com-
pound infusion of juniper, when  it is very useful in removing dropsy.
One ounce of the salt is  added to a pint of the infusion of juniper
berries, and the entire quantity taken in divided doses  in twenty-four
hours.  In acute renal disease the drug should be used without the
juniper.   In large doses  (half an ounce) it  acts as a  watery purge, but
is rarely so used.  Where the urine is  thick and alkaline bitartrate of
potassium is  a useful remedy to  neutralize it and  make  it clear and
normal in hue.

                BORAX AND  BORIC  ACID.

  Borax, or Sodii Boras ( U. S. and B. P.), may be made by the action
of boracic  or boric  acid upon soda, but  the drug as it appears in
commerce in America is derived entirely from natural deposits found
on the shores of lakes in California and Nevada.  The natural product
is, of course, very impure, and has to be purified before it is market-
able.  Borax  is soluble  in twelve times  its weight of water.   Both
borax and boric acid have been supposed to  act as efficient germicides in
strong solutions, but this has been  proved incorrect.   They are anti-
septics, however, even when in weak solutions.  In the form of a lotion
boric acid  has been  used as a remedy for  erysipelas with a good deal
of success, and  it may  be similarly employed in  burns  and scalds.
Borax may also be used as a wash in diphtheria and in aphthous stoma-
titis, cancrum oris, and gangrenous stomatitis.  Internally borax has
been used  in epilepsy, and  may be tried with  some slight hope of a
good result.  In the treatment of pruritus ani  and vulve, and in
bromidrosis and fetid sweating it  is of great value wdien used as a wash.
Strong solutions locally applied are useful  in tinea tonsurans and tinea
cireinata.  Boric acid may be given internally in cystitis to render the
urine acid, and is useful  in the removal of freckles when applied as a
wash to the skin.
   Borax should not  be  used with glycerin,  as au acid  reaction is  apt
to occur.
   Boric acid  is one  of  the most commonly used  substances in eye-
washes, either alone or with cocaine. When used with cocaine or other
drugs it is employed to prevent the  destruction of the alkaloid or
glucoside, as the case may be, by the growth of mould.
   The following formula may be employed :

         R.—Cocain. hydrochlor.    ....  gr. iv vel viij.
             Acid, boric.......gr. x vel xx.
             Aquse destillat......f g ij.        M.
S.—To be used in conjunctivitis and similar states. 
BRAYERA.
93
   Boroglycerin is a liquid made by mixing 62 parts of boric acid with
92 parts of glycerin in a tarred porcelain capsule, at a temperature of
not more than 302° F.   The acid is added to the glycerin gradually,
with constant  stirring.   When the mixture has  been  reduced to the
weight of 100 parts it is poured on a flat surface, wet slightly with
petroleum, and on hardening is cut into blocks, which should be placed
at once in a well-stoppered bottle.  When used for medicinal purposes
the glycerite of boroglycerin should be employed, whicli may be made
by adding 1 ounce of the boroglycerin  in solid  form to 1 ounce of
glycerin and heating in a dish while stirring.  It is soluble in water.
Locally the glycerite of boroglycerin is used as an antiseptic, and as a
vehicle for carbolic acid, chrysarobin, and the vegetable alkaloids in
the treatment of skin diseases and  in  diseases  of  the eye,  such as
purulent ophthalmia.
   The following makes a very elegant application for the skin of the
face and bauds :

         R.—Acid, boric........zj.
             Cerae albse.......tj.
             Paraffini          .    .        .    .       zjj,
        t    01. amygdalae dulc.......f3ij.   M.
    S—To be thoroughly mixed and applied night and morning.

   Potter  recommends the following in uric acid  diathesis when there
is a tendency to the formation of stone :
         R.—Magnesii carbonatis
             Acid, citrici
             Sodii borat.
             Aquae bullientis
    S.—A tablespoonful t. d.

   Or,
         R .—Acid, boric........£ j.
             Potassi bitartrat.    .    .    .    .    .       z iv.
             Aquae......q. s. ad  fjfx.   M.
    S.—Heat together to dryness, and give 20 grains in water, well diluted, t. d

   Borated lint is  made by dipping lint into a boiling,  saturated solu-
tion  of boric acid or borax.   It makes  a simple, inexpensive anti-
septic  surgical dressing, and contains nearly one-half  its weight  of
the drug.   Glycerinum Boracis, B. P., and  Mel Boracis, B. P., are
not official in the  U. 8. P., but  are used as local applications for
chapped hands and small sores.
                           BRAYERA.

  Brayera, U. 8., Cusso, B. P., sometimes called Kousso, is derived
from Brayera Anthelmintica, a plant of Abyssinia.  It contains a vola-
tile oil, tannic acid, and  koosin  or taeniin.  The drug is used against
the tape-worm, and is  most valuable  as  a vermifuge, also possessing
the advantage of safety.   It should be used  iu an infusion (Infusum
•   3J-
•   3ij-
. fjviij.  M. 
94
DRUGS.
 Brayere, U. S. P.) in the dose of J au ounce of the powdered flowers
 to a pint of water, and be taken in the morning on an empty stomach.
 (See Worms.)  Koosin may be used in the dose of  20 to 40 grains in
 capsule.   The fluid extract (Extractum Brayere Fluidum) is given in
 the dose of \ au ounce.   It has been said that the drug is apt to cause
 abortion in pregnant women, but this is not known to be a fact.   In-
 fusum Cusso, B. P., is given in the dose of 4 to 8 fluidounces.


                          BROMIDES.

   Bromides of potassium, sodium, lithium, calcium, gold, nickel and
 ammonium, and hydrohromic  acid.

                    Bromide of Potassium.

   Bromide of potassium (Potassii Bromidum, U. 8. and B. P.) is the
 most commonly used  and  important  member of the group  above
 named, and will, therefore, be spoken of before the others.
   It is prepared by precipitating  freshly-made bromide  of iron with
 pure carbonate of potassium, or by a process  more readily carried out
 and recommended by the B. P.   It occurs  in colorless transparent
 crystals which are stable in dry air, but absorb moisture in a damp
 atmosphere.   It is very soluble  in water,  but  less  so in alcohol.
 This bromide has a salty taste, and is distinctly irritant to mucous
 membranes if locally applied in concentrated  form.
   Physiological Action.—Bromide of potassium has an action  upon
 the animal economy which is clearly defined  and closely followed by
 all the other bromide salts, so that what is said in this place concerning
 its effects may be taken as representing the whole class of bromides,
 except in the instances  where slight differences exist, which will be
 pointed out under the various  names of the respective salts.
   Nervous  System.—The  bromide of potassium acts  as a distinct
 depressant to the motor and intellectual portions of the cortex cerebri.
 It slows the development of thought and decreases the excitability
 and  power of the  motor cells  of the brain.   (Albertoni.)  Upon  the
 spinal cord it acts as a marked sedative, affecting chiefly the sensory
 tracts, and causing thereby loss  of  reflex action  and a decrease in
 the ability of the animal to  recognize  pain.   It  also  depresses to a
 less  extent the motor  pathways in  the cord.   Motion is maintained
 after sensations  to pain and reflexes are  lost.   The drug  depresses
 the peripheral parts of the  sensory nerves, and, in very large doses,
 the motor nerves aud muscles are similarly involved.
   Circulation.—If the drug be injected in ordinary dose into  the
jugular vein it causes at once a fall of arterial pressure and pulse-rate.
 These  changes are due  to a  direct action of  the  bromine  and the
 potassium upon the heart.   When given to man in therapeutic doses
 by the mouth its circulatory effect is so slight as not to be worthy of
 consideration. 
bromide of  potassium.
95
   Respiration.—Bromide of potassium is a depressant to the respir-
 atory centre in  toxic  dose.  In  medicinal dose  it does not affect the
 breathing  except  when  the amounts given are large and  the drug
 persistently administered, when the breathing becomes slower.
   Temperature.—No effect upon this function is noted, unless the
 dose be enormous;  wheu such a dose is given the bodily heat  is pro-
 gressively  diminished, the fall of temperature being probably due to
 the circulatory and nervous depression produced, associated with the
 general failure in vital power.
   Elimination.—The  drug escapes unchanged very slowly with all
 the secretions, and  is found in  the  sweat, urine, tears, semen, milk,
 and faeces'.
   Tissue-waste is decreased.
   Therapeutics.—From what has  been already said it is evident that
 bromide of potassium  is  a remedy to be devoted almost entirely to the
 treatment of diseases of the nervous system, and its uses are, therefore,
 as various as the  manifestations of perversion of nervous action  can
 be various.  In a word, it may be said that bromide of potassium is
 to be  used wherever over-excitement of  nervous protoplasm is present,
 but never  where nervous symptoms are due to depression.
   In epilepsy, which, to the best  of our knowledge, is due to  explosive
 impulses arising in the  cerebral  cortex, it is the best drug  we have,
 and in all  forms of minor spasm, due to heightened reflex activity, it
 is of service.  In spasmodic contractions, in the treatment of hysterical
 females, in nervous  startings and alarm  at sudden noises in adults and
 children, and in the nervous symptoms accompanying pregnancy and
 the menopause, it will  be found  of great value.  The following pre-
 scription is recommended very highly by Goodell, and will  be found
 of service  in these  states :

         R.—Ammonii bromidi     .   .   .    .      g ij.
             Potassii bromidi......z, iv.
             Spts. ammon. aromat.   .....  f.^vj.
             Aquae eamphorse  .    .   .    .   q. s. ad  f^yj.    M.
    S.— A dessertspoonful  to a tablespoonful every four hours.

   In headaches due to uterine trouble the pain is often  felt at the  top
 of the skull or at the  back of the  neck near the occiput.  The cause
 of this trouble will  sometimes  be  found to be in the cervix uteri, and
 relief under these circumstances can only be obtained when the uterus
 is treated aud the bromides administered.
   In convulsions in children and adults, combined with chloral, bro-
 mides are most efficient,  and are sometimes of service in incontinence
 of urine due to vesical spasm.   Iu seminal emissions due  to a morbid
excitability of the centres in the  spinal cord, bromide of potassium is
 one of the best remedies  we have, and in satyriasis and nymphomania
 it is of great service.
   In cases where undue irritability of the pharynx and larynx prevents
examination of these parts, one or two full doses will render an  exami-
nation  easy of performance by  decreasing the  local  reflex activity. 
96
DRUGS.
This is a useful point to be  remembered in relation to the treatment
of pharyngeal and laryngeal disease.
  In  cases of acute laryngitis full doses of the bromides (60 to 120
grains a day) are very useful.
  The bromides  are  found to be of service in the laryngeal crises of
locomotor ataxia, the explanation of this fact being  as follows: The
adductor centre of the larynx is situated in the brain, and the abductor
centre  in  the spinal  cord.   The first closes the  larynx, the second
opens  it, and  in health they maintain a patulous tube by their oppo-
sition.   In disease  the spinal centre (the abductor or opener)  fails,
and the adductor in the brain being unopposed, produces closure of
the tube with disastrous results.   The bromide, by quieting reflex
action, as well as depressing the adductor centre in the cerebral cortex,
prevents this accident.
  In whooping-cough with  much mucous exudation the drug is rarely
of benefit and  had better  not be used.   In laryngismus stridulus or
any form of spasm depending upon  local irritation,  the local trouble
must, of course, be removed if possible.   In teething the drug may be
used to decrease reflex irritation and prevent convulsions, and it will
decrease the  night-screaming of children—which is often due  to bad
dreams—to  a very  extraordinary degree, even if the dose be quite
small.   As a soporific for the insane, and in the insomnia of the over-
worked and  that of nervous women, the bromide of potassium  is of
great service.  It may also be employed  with good results in chronic
alcoholism and morphiomania.  In migraine and neuralgia due to eye-
strain  or  other  nerve strain, combined with caffeine  the  bromide is
almost a specific.   The caffeine seems to stimulate the depressed nerve
up to the normal level, and the bromide to deaden the perception  of
the pain.  The following is  a most valuable remedy in migraine and
even in sick headache.  It ought not to be used in bilious headache,
which  will often be made worse by it:

        R.—Antipyrini......gr. xxv.
             Caffeinae citratis    .   .    .    .    . gr. x.
             Potassii bromidi.....gr. xxv.    M.
   Ft. in chart no. v.  S.—One powder as needed.

  In the treatment of dysmenorrhea  and menorrhagia, particularly in
young subjects, the  bromides are also of service (see Dr. Goodell's
prescription just given.)  When the flow is too great at such a period the
drug should be begun a week before the expected epoch, and kept up
in the  dose of 5 to 10 grains night and morning.  In%cases where the
epochs follow one another too closely the drug should be used con-
tinuously.  After an apparent cure ensues the bromide should be used
for a few periods to avoid a relapse.  For sea-sickness the bromides
are the best prophylactics we possess, and should be  used in the dose
of 5 to 10 grains three times a day for several days before the patient
sails in order to quiet the vomiting centre.   After sea-sickness begins
they should  not be  given  in ordinary solution, but in an effervescing
draught made as follows : 
BROMIDE  OF  AMMONIUM.
97
         R —Acid, citric.......zij.
             Aquae dest........f § iv.    M.
   Ft. sol.
         R.—Potassii bromidi......zj.
             Potassii bicarbonatis.....Zj.
             Aquae dest........f ^ iv.    M.
   Ft. sol.  S.—A tablespoonful of each of these solutions should be added to one
another and taken during effervescence.

  This prescription will also be found of value in the persistent vom-
iting  of pregnancy  and  in that  following  prolouged etherization, or
other states.   If the vomiting is excessive the dose ought to  be re-
duced to 2 teaspoonfuls of each solution and be given every half-hour
until  half of each  mixture  is taken or the patient is  relieved.  In
cases where this will not act, rectal injections of the following will be
found of value :
         R.—Potassii bromidi  ......  gr. xxx.
             Tinct. opii deodorat.  .....  gtt. xxx.
             Aquae amyli    .    .    .    .    .    .  f^yj.   M.
    S.—To be injected gently into the empty rectum and retained as long as possible.
  This method is the most reliable plan that can be followed.
  Bromide of potassium may be used to  prevent the symptoms of
cinchonism after quinine and salicylic acid, and it is said to prevent the
nausea and depression so apt to follow the use  of opium.
  Administration.—The dose of bromide of potassium is from 5 to 120
grains a day.
  Use of  Bromides in  Poisoning.—Bromides  are useful in  all  con-
vulsive attacks consequent upon the ingestion of poisons, except those
due to cardiac sedatives which depress the circulation at the base of the
brain; aud they may be used to allay any nervous  symptoms which
are of an  excited  nature, to prevent excessive vomiting, to  produce
sleep, aud to quiet  delirium,  and even to allay  paiu.
  Effects of Prolonged Use.—After the drug has been used  for some
time  acue appears  about the face and  extends over the entire body,
the breath becomes foetid, the patient dull, expressionless, and  heavy,
remaining buried  in  sleep  during nearly  every  hour  of the  day.
During this time he can be  aroused, but at once falls to sleep again.
The walk  becomes weak and feeble, the movements slow aud pain-
fully prolonged   Taste is  lost and hearing is benumbed, while the
intellectual faculties of the brain  are almost blank.  Loss of sexual
power is an early symptom.   The acue  may be put aside by the use
of arsenic, and where bromides  are used to any extent in women this
drug should always be given simultaneously to prevent  the eruption.
As Fowler's  solution is compatible with the bromide in solution, it is
the best form of arsenic to employ.

                    Bromide of Ammonium.

  Bromide of Ammonium  (Ammonii  Bromidum, U. 8. and B. P.).
This  salt is far more stimulating  than  the bromide of potassium, and
                                 7 
98
DRUGS.
 it is certainly much more irritating.  The dose is about the same as the
 potassium  salt—5 to 60 grains a day.   Combined with  antipyrine it
 is useful in epilepsy.   Da Costa has recommended it highly in rheu-
 matism in large doses well diluted, but the author  has  never seen it
 do any good  in such cases.


                     Bromide of Calcium.

   Calcium Bromide (Calcii Bromidum, U. 8.) was introduced  into
 medicine as a nervous sedative and hypnotic, and was thought at one
 time  to be an efficient  substitute for the bromide of potassium.   Its
 action on the nervous  system is  virtually identical with that of  the
 potassium salt, and it has been found to be far less  irritant and depres-
 sant than the latter.  For some unknown reason it has never won  the
 confidence of the profession, but it may be given with very good results
 in the dose of from 30 to 90 grains a day, or even more in cases which
 are not readily  affected by bromides.   It  is employed  especially in
 hysteria and  epilepsy, and in  all  the  conditions  in which the other
 bromide salts are indicated.   It is sometimes of value combined with
 the potassium salt, since under  such circumstances better results are
 often gained  than if a single salt is employed.


                       Bromide of Gold.

   The bromide of gold has been employed in  epilepsy by a number
 of clinicians with great  success in the dose of from £ to J grain three
 times a day in pills.   Physiological studies  have proved that the drug
 is a direct sedative to the motor cells in the cortex cerebri.

                     Bromide of Lithium.

  Bromide of Lithium  (Lithii Bromidum, U. 8.).  This  salt is much
 weaker than the other salts, and may be given in larger dose.  Dr. S.
 Weir Mitchell states that it is  of value in epilepsy after the potassium
 salt fails.   The dose is 30 to 90 grains a day.


                      Bromide of Nickel.

  This is a green salt quite irritant to the stomach.  The author  has
 made an experimental study of the bromide of nickel and found it prac-
tically identical with the bromide of potassium in physiological action.
It should be given well diluted, or in an effervescing draught, as it is apt
to disorder  the stomach if used in concentrated solution. The efferves-
cing form of the drug is made  by mixing the salt with bicarbonate of
sodium and tartaric  acid, moistening with alcohol, passing the moist
powder through a sieve, and then drying it  in a warm closet. 
BRYONIA, OR BRYONY.
99
                     Bromide of Sodium.

  Bromide of Sodium (Sodii Bromidum, U. S. and B. P.).   This salt
is to be used in every instance where  bromide of potassium can be
employed.  Its dose is the same, although it is  asserted to be a  little
weaker physiologically, grain for grain, than the potassium salt.  It is
far less apt to disorder the stomach, and is not so generally depressant
as is the bromide of potassium.

                     Hydrobromic Acid.

  Hydrobromic Acid is  an extremely  irritant preparation, but is
thought to be less  apt to cause acne and other untoward effects than
the other bromides.  It  is only to be used in the form  of the official
dilute acid (Acidum Hydrobromicum Dilutum, U. 8. and B. P.) and to
be given in the dose of from one  drachm to  half an ounce well diluted
with sweetened water.   It is highly recommended by De Schweinitz
and others for headaches due to eye-strain in nervous women.


                   BROMIDE OP ETHYL.

                     (See Ethyl Bromide.)


                BROMIDE OP STRONTIUM.

                        (See Strontium.)


                          BROMINE.

  Bromine (U. 8. and B. P.) is  a  dark-red liquid of an excessively
pungent  odor like that of chlorine,  possessing very  extraordinary
power as a caustic  when applied  to the tissues of the body.   It is the
most severe caustic we possess, and penetrates very deeply.   It may
be applied in  hospital gangrene and other large sloughs, by means of
a glass-rod.


                  BRYONIA, or BRYONY.

  This  is a  remedy very  largely used by irregular  physicians but
which nevertheless possesses very great power and often relieves con-
ditions which are obstinately persistent under other treatment.  It is
the root of Bryonia Alba or Bryonia Dioica (U. S.). The only official
preparation is the tincture (Tinctura Bryonice,  U.S.).  The  dose of
the powdered root  as a drastic is  10 to 40 grains.
  Physiological Action.—In overdoses bryonia acts as a hydragogue
cathartic and gastro-intestinal  irritant.  On  serous   membranes it 
100
DRUGS.
exercises an irritant influence and may produce symptoms of meningitis
when given  in  poisonous doses.   In  moderate  doses  bryonia may
cause some flushing of the face and neck aud headache in susceptible
persons.  The drug needs studying from a physiological point of view.
  Therapeutics.—Although one of the oldest of remedies, bryonia has
been given a new impetus  by the homoeopaths,  who  employ it in a
number of affections.   In the  treatment of dyspepsia depending upon
gastric and intestinal  atony or the abuse of alcohol or other similar
causes, bryonia often gives relief.   Its  influence is exerted  through
the irritaut effects it produces, for by this means it stimulates or spurs
the atonic digestive glands to  increased activity.  For this reason  it
has been found to be  particularly useful in children who  suffer from
constipation  resulting from  insufficient secretion  on  the  part  of
the intestinal glands.   When the  passages are  dry and friable and
resemble  those of  a dog  in   character, bryonia is of great  value.
The drug has been praised as a  remedy  in the treatment of rheu-
matism and  in  pleurisy, but  little  is  recorded  as  to  its real value
in these diseases.   It is  probably always  more effective  when  the
febrile stages of these affections have  passed  by.  Thus in pleurisy
it is useless during the acute, forming stage, but prevents the pouring
out of  effusions, and if  they be already  poured  out aids  in their
absorption.
  Administration.—The dose  of the  tincture of bryonia is from 1 to
2 fluidrachms as a laxative, but the so-called mother tincture of the
homoeopaths  is perhaps  the best preparation for ordinary  use.  The
proper amount to be  used in the treatment of a case of dyspepsia is
from  5 to 40 drops  unless  the mucous  membranes are very torpid,
when this quantity  may  be  increased.  In pleurisy with  effusion
drastic doses  may be  needed, but the saline purgatives are safer and
more efficacious.

                            BUCHU.

  Buchu (U. S.) is derived from Barosma Betulina,  a plant of Africa.
It contains a  volatile oil, which is probably the active principle, and
a bitter extractive.   It is official, under the name of Buchu Folia, in
the B. P.
  Therapeutics.—Buchu  is used as a diuretic when it is  desired to
affect the mucous  membranes of the genito-urinary tract  which are
chronically diseased,  and  particularly  when these  parts  are  below
their  normal tone.  It does  not  increase  the  urinary flow to any
great extent,  but acts  on the  genito-urinary passages as a stimulant.
It is useful in pyelitis,  cystitis, and vesical irritation of a chronic type.
The following prescription is useful :
     R.—Potassii citratis .
         Spt. chloroformi
         Tinct. digitalis  .
         Infusi buchu
S.—Two taJblespoonfuls three times a day.
 zjv.


f I viii.   M. 
CAFFEA.                          101
  If the urine is continually  highly acid, muddy, laden with salts,
and productive of incontinence by  reason  of the vesical  irritation
which it produces, buchu iu the form of the fluid extract, in the dose
of a teaspoonful  three times a day, combined with an equal amount
of sweet spirit of  nitre, will  be of great  service.   For a  child  the
dose of the fluid extract should be about ten  to thirty minims.   If
the vesical irritation is acute buchu is contra-indicated.
  Administration.—The fluid  extract (Extractum Buchu  Fluidum,
 U. S.) is  the only official preparation, and it should  be always well
diluted  before it  is given, in the dose, to an adult, of 1 drachm three
times a day.   The infusion is not official, but is made  by adding  one
ounce of the leaves to a pint of water.   The dose of this is a table-
spoonful to two tablespoonfuls.  The official B. P. preparations  are
the infusion (Infusum Buchu), dose 1 to 4 fluidouuces, and the tincture
(Tinctura Buchu), dose 1 to 2  fluidrachms.


                 CACTUS  GRANDIFLORUS.

  This is a plant of Mexico and the West Indies.   There  are other
species possessing medicinal power, but  the Cactus  grandiflorus is the
most active.
  The drug is best given in the form of the tincture or the fluid extract.
  Physiological Action.—This has been  studied by  Myers, and  Boinet
and Teissier, who have  found that the drug causes a distinct increase
of arterial pressure, but does not slow the pulse, sometimes increasing
its rapidity.   Myers has also shown that the drug is a stimulant to
the vasomotor centres aud to the motor  ganglia of the heart muscle.
Cactus grandiflora also acts as a stimulaut rather thau a depressant to
the spinal cord.
  Therapeutics.—Cactus grandiflorus bids fair to prove itself  a good
substitute for digitalis in certain diseases of the circulatory  apparatus
such  as cardiac  palpitation and weakness.   It  has also been   found
very serviceable as a remedy in cardiac  failure  the  result of valvular
disease.   Cactus  also acts well in some cases of angina pectoris.
  Administration.—The dose of the tincture of cactus is 2 to 8 minims
and of the fluid extract  2 to 4 minims.
  Untoward Effects.—It is claimed that these do not occur, and that
the drug never produces a cumulative effect.


                            CAFFEA.

  Caffeine (Cafeina,  U. 8. aud B. P.)  is  an alkaloid derived from
the berries of Caffea Arabica, which also  contain, upon roasting, an
empyreumatic  oil.   Caffeine  is  usually employed in medicine as the
citrate, and is soluble  in 75 parts of water.1

  1 Theine, derived  from tea, caffeine, the active principle of coffee, and the  alkaloid
of guarana from South America, are chemically identical. Much of the caffeine of
commerce is really theine, although it is claimed that pure theine has a very different
physiological action. 
102                          DRUGS.
   Physiological Action.—On the nervous system caffeine acts as a
rapidly acting stimulant, exerting its chief influence on the brain
aud spinal cord.  By its cerebral effect  it causes increased  rapidity
of  thought,  and  by its  influence on the  spinal  cord  it  increases
reflex activity, and for  this reason is said to make people " nervous."
It is important to remember that it has no effect on brain  protoplasm
except to stimulate it,  and that ultimately a brain  driven along  by
caffeine breaks down by the concentration of its energy for  the time
being in one effort.  In the frog in poisonous doses it causes tetanic
convulsions by an action  on the spinal cord, and if applied  directly
to a muscle, causes it to contract spastically.   It does not affect the
motor nerves.
   Circulation.—Caffeine has been supposed to increase the pulse-
rate and blood-pressure by stimulating the heart muscle, but from
recent studies in this country and abroad it would seem probable that
these changes are indirectly produced and  due solely to its stimulating
action on the nervous system.  Clinically, it certainly seems  to raise
the blood-pressure in almost every instance where it  is used.
   Kidneys, Tissue-waste, and Elimination.—Caffeine  increases
diuresis  by a  direct  stimulation of the  secretory epithelium of the
kidney, and therefore increases the amount of solids as well as of the
liquids in the urine.  Upon tissue-waste the drug acts as a depressant,
and is therefore a conservator  of  the  tissues.   It is burnt up in the
body.
   The empyreumatic oil, of which there is about  one-half to one tea-
spoonful in each well-made breakfast cup of coffee, has no physiological
effects.   It is probably the cause of the "biliousness" sometimes pro-
duced by the habitual use of coffee, due to the faulty digestion of this
oil, which is also apt to disorder the digestion if taken alone.
   Therapeutics.—Caffeine is a valuable cardiac stimulant and tonic
as well as a renal stimulant.   It acts equally well in cardiac aud renal
dropsies for this reason, and is au invaluable remedy in such cases.   In
acute renal inflammation it is contra-indicated, because all stimulants
are contra-indicated in  acute inflammations.   In opium  poisoning,
owing to its  stimulant effect on  the  respiratory centre,  it  is very
valuable.  Under  these  circumstances  it may be given in the form of
strong black  coffee, which will aid in  keeping the patient awake and
also add heat to the body, which is often very cold.   A cup of strong
black coffee is often useful in the treatment of a paroxysm of asthma.
In  headache  due to nerve-strain, caffeine  combined  with  antipyrine
and one of the bromides is of the greatest service (see Neuralgia).'   So
useful is caffeine  in cases of cardiac disease that it has largely sup-
planted'digitalis in the hands of some practitioners.
   Caffeine, U. S.  and B. P., cannot be used hypodermically, owing
to its decomposition in the presence of  water.   The following  solution
may, however, be used hypodermically : Salicylate of sodium, 30 parts;
caffeine, 40 parts ; and distilled water, 60 parts ; or, in  other instances,
the following preparation, recommended  by  Huchard,  may be em-
ployed : Benzoate  of sodium, 45 grains; caffeine,  30 grains •  distilled 
CALCIUM.
103
water, H drachms.  This mixture is to be heated and 10 drops given
at a dose.

                        CAJUPUT  OIL.

   Oil of Cajuput (Oleum Cajuputi, U. S. and B. P.) is a volatile oil
distilled from Melaleuca Cajuputi, a tree of the Molucca Islands.  It
is a  stimulant, and in  large amounts an irritant, to mucous mem-
branes,  but acts  as  an  efficient  carminative  and  parasiticide  in
moderate amounts.  As a remedy for  tinea tonsurans and pediculi it
should be applied pure to the part affected.   Cajuput oil is capable of
irritating the skin.  In diarrhea of a serous type it is of value in
the  dose of 10  to 20 drops (see  Diarrhoea).  Spiritus Cajuputi  is
official in the B. P.; dose, ^ to  1 fluidrachm.


                           CALCIUM.

   Calcium  is official  in  a number of  forms, and  is to be distinctly
separated in the mind of  the student from calx or lime, which is  an
oxide of calcium.  It is never employed as calcium, but as one of its
salts.   These are as follows : Bromide of calcium (Calcii Bromidum,
 U. 8.), precipitated carbonate of calcium (Calcii Carbonas Precipitatus,
 U. 8., Calcii Carbonas Precipitata, B. P.), chloride of calcium (Calcii
Chloridum,  U. S. and  B. P.), hypophosphite of calcium (Calcii Hypo-
phosphis, U S. and B. P.), and as  precipitated phosphate of calcium
(Calcii Phosphas  Precipitatus,   U.  S., Calcii Phosphas Precipitata,
B. P.).   Calcium sulphate is  not official.
   All salts  of calcium are incompatible with  acids.
   The precipitated carbonate of calcium is  used in the treatment of
serous diarrhea, as an antacid and as a local protective in  cases of
chapped skin or intertrigo, particularly in  young children.  When
given internally the dose is from 10 to 30 grains,  but by far the best
method for  its  administration is in  the employment of chalk mixture
(Mistura  Crete,  U. 8. and B. P.), which contains  about 30 grains of
the chalk to each ounce of liquid.   The dose of this mixture is  from
a teaspoonful for a young child  to an ounce for an adult.   In the
treatment of cases of diarrhea  chalk  mixture is  best given in  com-
bination with tincture of  kino  or the  compound tincture of catechu
and paregoric, in some such form as follows:
         R.—Tr. kino.......fgj.
             Tr. catechu comp......f.^ij.
             Mistura; cretae   .    .   .    .   q.s. ad  f^vj.    M.
   S.—A dessertspoonful every three  hours till diarrhoea ceases.

   It is to be remembered that the chalk mixture acts very slightly as
an astringent, and chiefly as  an antacid and  mechanical agent in the
alimentary canal.
   Precipitated  carbonate of calcium is the  slowest antacid which we
possess, and for this reason is the remedy to be employed in acidity of 
104                          DRUGS.
the intestines, as it passes through the stomach to a very great extent
unchanged.   (For the varieties of diarrhoea in which it is to be used
see article on Diarrhoea.)   As au  external application it  is used  in
sweating of the feet and hands, and sometimes as a dry  dressing  to
ulcers.  It may also be used over burns.
   Calcium chloride, when taken internally in any amount,  acts as an
intense gastro-intestinal irritant, and may produce death by this means.
It is to be distinctly separated from the chlorinate or chloride of lime,
with which  it is sometimes confused,  for the latter is nothing more
than hydrate of lime  or slacked lime, containing 25 per cent, of chlo-
rine, while chloride of calcium is a hard, vitreous, friable  substance,
giving off no odor  of chlorine  and utterly different in  its  use, action,
and appearance.
   Chloride of calcium is used in medicine by some physicians  in the
treatment of scrofulous enlargements of glands in the neck and else-
where, aud  is even said to cause calcification and encysting of tuber-
cular nodules.  In cases where deficient bone-formation is evident it
often  does good, but  the  other salts of  lime, such as  the  lactophos-
phates, are better.   In cases where boils mature slowly, a poultice made
by adding a solution  of chloride of calcium to the  mass may be used
to hasten suppuration.  The dose  internally is 5  to  30 grains, best
given  in  a  solution  made by adding water in the proportion of a
drachm to each 5 grains of the drug.
   The hypophosphite of calcium and  the precipitated phosphate of
calcium are  used  for the  treatment of scrofulosis or strumous states
and allied conditions  such as rachitis, generally in the form  of the
Syrupus Hypophosphitum,  U. S., and  the  Syrupus Calcii Lactophos-
phatis,  U. 8.
   The large amount of phosphate of calcium in the bones and tissues
renders it a useful drug  when  the  body  is  starved  of  its proper
proportions of salts, and its use  has been found, in animals, to cause
a great increase in bony growth, not only in the earthy  but also in the
animal constituents of the  osseous tissues.  The hypophosphite has a
similar effect.
   In rickets and in fractures where the  bone  is slow in uniting, and
in some cases of phthisis and scrofula, the lactophosphates and hypo-
phosphites are of service.    In dental caries, particularly that  occur-
ring in  nursing women, and in the anemia  of this class of patients,
they are useful.   In general debility and nervous prostration  they are
often of great value, and may be even used with benefit in chronic and
atonic diseases of the skin and mucous  membranes.  In cases of hepatic
torpor they may be employed with  advantage.
   The lactophosphates are better than the hypophosphites, as the latter
are probably changed  into phosphates in the stomach as soon as they
enter the  viscus.   The only advantage which they possess  over phos-
phorus in certain diseases, particularly of the  bony system, is that they
afford an easy method of administration, and  also that they contain
calcium.  The dose of either  of these  two  drugs is 10 to 30 grains
three times a day,  or, of the  syrups just named, a teaspoonful to a 
CALUMBA.
105
tablespoonful.  The difference between these salts and phosphorus,
both in therapeutical effect and  physiological  action, is to be clearly
borne in mind.  The lactophosphates and hypophosphites are simply
convenient modes of administering  calcium, potassium, or other sub-
stances, while phosphorus acts as a stimulant to bone growth and not
by its deposition in the bone.  Phosphoric acid does not act any more
like phosphorus than does sulphuric acid act like sulphur.
  Sulphate of calcium is not to be confounded with sulphide of cal-
cium, or, to speak more correctly, calx sulphurata.  Very often failure
attends the  use of this  remedy, because  the  calx  sulphurata has
undergone oxidation and is calx sulphate.  (See Boils and Calx.)
  Chalk is a native calcium carbonate chiefly obtained  from shells.
  Prepared chalk  (Creta Preparata, U. 8. and B. P.) is given in the
dose of 20 to  60 grains.   Other preparations are compound chalk
powder (Pulvis Crete Compositus, IT. S.), dose 10  to  60  grains, and
troches of chalk (Trochisci Crete, U. S.).   Preparations official in the
B. P., but not in the U. 8. P., are  aromatic powder of chalk (Pulvis
Crete Aromaticus), dose 10 to 60 grains, and Pulvis Crete Aromaticus
cum  Opio, dose 10 to 60 grains.


                          CALUMBA.

   Calumba, Columbo, or Columba, is the root of the  Cocculus Palmatus,
a climbing plant of Mozambique.   Its taste is bitter,  and its odor  is
slightly aromatic.  Two alkaloids are found in it, berberine and colum-
bine, and a third substance known as columbic acid.   Calumba is one
of the purest bitters known
  Therapeutics.—Calumba is one of the best simple tonics which can
be used, owing to its lack of astringent effect and to  its favorable action
on mucous membranes.
  In cases of gastro-intestinal atony, particularly that following fevers
and similar states, calumba will be found of service, and  it is a valu-
able remedy in the convalescent stages of summer complaint and serous
diarrheas.   The  following  prescription of Dr. George B. Wood  is
very useful in these states when they are associated with flatulence:

         R.—Calumbae pulv.........J ss.
             Zingiberis pulv.......3 ss.
             Sennae fol........3"j.
             Aquae bullientis......Oj.     M.
   Ft. in infusum.  S.—A wineglassful t. d.

  Administration.—The  fluid extract (Extractum  Calumbe Fluidum,
U. S) is given in the dose of 15 to  60 minims ;  the tincture (Tinctura
Calumbe, U  8.), dose  1  to  4 fluidrachms.  The dose of the extract
(Extractum Calumbe, B. P.) is  2 to 10 grains; the  infusion  (Infu-
sum  Calumbe, B. P.) 1 to 2  fluidounces,  and the tincture (Tinctura
Calumbe, B. P.) ^ to 2 fluidrachms. 
106
DRUGS.
                             CALX.

   Calx, or Lime, or Oxide of Calcium, is an alkaline earth whicli is
incompatible with acids, ammouiacal and metallic bases, borates, alka-
line carbonates, and astringent vegetable infusions.
   Therapeutics.—Lime is used for the purpose of acting as an escha-
rotic, particularly on  old  ulcers and on hairy growths.   It is  never
given internally, except in  the  form of the hydrate or slaked lime.
As an escharotic application lime is used in the official caustic Potassa
cum  Calce. When given internally it should always be used as Liquor
Calcis, U.  8. and B. P., or lime-water, and under these circumstances
it acts as an antacid, as an aid to the digestion of milk by  preventing
too rapid  and solid  coagulation of the casein,  aud by exciting an
increased  gastric secretion.   It is also feebly astringent.   Given to
infants and nursing women it is probably utilized in the body in the
formation of bone.   It is also of value in diabetes, in  the uric acid
diathesis, and in the excessive nausea and vomiting very often  seen in
adults and children.   Teaspoonful doses of milk and lime-water, equal
parts, will often  be  retained  when  nothing else will remain in the
stomach.
   The dose of lime-water is a teaspoonful to 1 ounce or even 2 ounces.
Externally applied, lime-water is of  value in tinea capitis and similar
states, and it is the best application in burns, when  it is  to be mixed
with  equal  parts of  linseed  or olive oil, forming the Linimentum
Calcis, U.  S. and B. P., or carron oil.  As a  local application  in mem-
branous croup aud diphtheria, lime-water has a high reputation and is
believed to dissolve the membrane.   It may be used as a spray or by
means of  a swab.
   Liquor  Calcis,  or lime-water, is to be made by adding a piece of
unslaked lime as large as a walnut to 2 quarts of boiled and filtered
water in an earthen jar; after stirring it thoroughly allow  it to settle,
and pour off the clear liquid into a bottle.   More water  may  then be
added to the  lime until it is all used.
  Sulphurated  lime (Calx Sulphurata,  U. S. and B. P.) is useful to
check inflammation and hasten suppuration; the dose is fa of a grain.
It is of value in acne pustulosa aud  all forms  of suppuration in the
skin.  Where sulphurate of lime is not obtainable and successive crops
of boils constantly appear, it is often possible to relieve the patient by
baking egg-shells iu  an oven, powdering them, and then  letting the
patient eat 1  drachm  or more of the powder each day.   The prepa-
rations of the B. P. that are not official in the U.  S. are the  saccha-
rated solution  of lime (Liquor Calcis Saccharatus),  dose 15 to 60
minims, and slaked lime (Calcii Hydras) used in different prepara-
tions.

                          CAMPHOR.

   Camphor (Camphora,  IT.  S.  and B. P.) is derived  from the  Cin-
namomum  or Taurus Camphora, which grows chiefly in  China and 
CAMPHOR.
107
 Japan.   The camphor used  in the drug stores is in reality refined
 camphor, and is so obtained by repeated sublimation.  It is a volatile,
 irritant gum or resin, producing a burning  taste aud  possessing a
 peculiar odor, soluble in one thousand parts of cold water and in one
 part of  strong alcohol.   Camphor is so volatile  that if allowed to
 remain exposed to the air for any length of time it rapidly loses its
 bulk  and eventually disappears.  It  is an exceedingly  combustible
 substance, burning with a flame and much smoke.  It may be white
 or pinkish in color.
   Physiological Action.—If taken in large amount camphor produces
 epileptiform convulsions  preceded by vertigo, roaring  in the ears, and
 delirium.  The  pulse soon becomes rapid, feeble, and running, and the
 skin livid, cold, aud covered with  sweat.  Great heat and burning may
 be felt in the belly, and if the poisoning be slow, evidences of gastro-
 intestinal and  renal  inflammation ensue.  In small doses it acts as a
 stimulant and adds a sensation of warmth to the  stomach, while the
 pulse may become more  rapid and stronger under its influence.  At
 the same time there is a sedation of the nervous system aud a general
 feeling of contentment.   In large medicinal dose camphor is thought
 by some to act as a sexual stimulant and by others as a sexual sedative.
 The stimulant effect is probably only produced by doses large enough to
 produce irritation of the  genito-urinary tract.  The convulsions fol-
 lowing poisonous doses are cerebral in origin, and the drug, although
 largely destroyed iu the body, is eliminated by the kidneys as campho-
 glycuric acid and escapes by the breath and perspiration.
   Therapeutics. Internal Use.—Camphor is employed for the pur-
 pose of acting as a nervous sedative and antispasmodic in the treatment of
 nervous women and children, and as a carminative in persons who suffer
 from intestinal flatulence.  It is of value in nervous dysmenorrhea and
 headache, and is best  combined with one of the new analgesics, such as
 antipyrine and  acetanilide given  in  pill form.  As it is virtually a
 volatile oil, so far as its  physiological  action is concerned, it will be
 found useful in  cholera morbus and all forms of serous diarrhea, but
 rarely in  mucous diarrhoea (see Diarrhoea).  In chordee, combined with
 bromides  and similar depressants to  the  spinal cord, camphor is  of
 great service in some cases, particularly late in the disease. In adynamic
fevers it has been used as a diffusible stimulant by Graves and others
 with great success.  Camphor is a very useful remedy in cases of sud-
 den  nervous depression.   It  may be given by the mouth or, if the
 emergency is a pressing  one, by hypodermic injection.  Under these
 circumstances it is  best given  in  the  form of  camphorated oil in the
 strength of  1 part of camphor to  9 of sweet oil, which last should be
 perfectly  sterile.  The dose of this  solution is 15 minims.  When
 used in the nervous depression of phthisis Alexander asserts  that its
 continuous injection may result iu cumulative action and  develop the
 symptoms of mild camphor poisoning.  In hiccough it is of great ser-
 vice, and  in cardiac  palpitation  due  to  functional irritability it  is
 found to be  of value.   In capillary bronchitis and  catarrh of  the air-
passages  it will  be  found useful in old or atonic  cases.    In  chronic 
108
DRUGS.
nasal  catarrh spirits  of camphor when inhaled from the neck  of a
vial gives off enough of the drug  to  start up  secretion and tone  up
the parts.  It is also of  value as a mouth-wash iu  persons who  have
foetid  breath.
  External Use.—Externally camphor may  be used as a stimulant
to indolent sores, and  as a useful addition in small amount to the pre-
cipitated  carbonate of calcium as a dusting powder in intertrigo.   In
the form of a liniment camphor is used over inflamed joints from sprains
or rheumatism, and in myalgia and neuralgia to relieve the  pain and
stiffness.
  Camphor may be inhaled or taken internally  in cases of cold in the
head with great relief and a decided influence in aborting the  attack.
After the attack is  in full force it is  useless, but  used early it will
decrease the frontal headache and the sneezing and running at the nose.
In coryza from unknown causes with much lachrymation and  incessant
sneezing, camphor will be found of benefit.  It  may be snuffed up the
nostril in a fine powder, or powdered camphor  may be put in boiling
water and the fumes inhaled.   The spirit may also be inhaled  from a
handkerchief.
  Camphorated alcohol, spirit of camphor, is a  useful application for
abortive  purposes when  used over  boils, in their formative stage, if
repeated two or three times a day, for a few moments at a time.  Fol-
lowing these applications  the skin should  be dried,  and comphorated
oil applied.   Ringer  and Tilt both recommend that Eau de  Cologne,
saturated with camphor, be rubbed into the head in the drowsiness and
headache of the menopause, and a lotion of equal parts of aqua am-
monia and spirit of camphor dabbed on the painful or hypersesthesic
spots at the top of the head, so commonly  felt at the change of life  or
during menstruation,  will be found to give relief.
  Administration.—Camphor is used  internally in the form of the
camphor  water (Aqua Camphore, U. 8. and B.  P.),  dose J to 2 fluid-
ounces ; the spirit of  camphor (Spiritus Camphore,  U. S. and B. P.),
dose \ a fluidrachm, or in the form of the camphor itself, in pill,  in
the dose of 1 to 3 grains iu each pill. The best preparation for internal
use is the spirit, or the camphor itself may be given in pill form.
  For external use we have, official, the  Camphor Liniment (Lini-
mentum Camphore, U. 8. and B. P.), and the Soap Liniment, or Lini-
mentum Saponis, U.  S. and B. P., which  is  the mildest of the  two.
Ceratum  Camphore is also official.  A  compound tincture of  camphor
(Tinctura Camphore Composita), composed  of opium, benzoic  acid,
camphor, aud oil of  anise, is official in the B. P., dose 15 minims  to
1 fluidrachm.  Linimentum  Camphore Compositum, B. P., is  com-
posed of  camphor, rectified spirit, and  stronger  ammonia.


              CAMPHOR MONOBROMATE.

  Monobromate  of Camphor (Camphora Monobromata  U. 8.).   This
drug  is  made by  heating together in a  sealed tube camphor and 
CAMPHORIC  ACID.
109
bromine.  It occurs iu colorless crystals or scales, and has a mild taste
resembling camphor.   It is  almost entirely insoluble  in  water, but
freely soluble in alcohol, ether, and chloroform.
  Physiological Action.—Monobromate of camphor possesses powers
partaking of the bromides and of camphor.  In the frog it causes loss
of reflex action, motor  palsy and death by respiratory failure, and  in
warm-blooded  animals  violent  convulsions, Cheyne-Stokes respira-
tions, muscular  tremblings and weakness.   The pulse is at first more
rapid than  normal, then slow and weak, death  coming  in coma  or
during the convulsions.
  Therapeutics.—Monobromated  camphor will  generally be  found
most  useful in combination  with  other drugs in pain due to disease,
such  as lumbago, or  that due to  nervous  disturbances.   If used  in
hysterical females it will  often produce sleep, and  is of value to those
who are addicted to  the camphor-habit, as it acts as a hypnotic and
warms the stomach.   Like camphor itself, it is a gastric irritant, and
should not  be  employed where gastritis exists.   It has been used  iu
spermatorrhea  with  great success,  and in delirium tremens has been
found of  benefit in cases where the gastric mucous membrane is de-
pressed and the  nervous twitchings  are troublesome.  In whooping-
cough it may be tried,  and it has even been used in chorea, epilepsy, and
petit mal.   In the nervous depression and pains of epidemic influenza
monobromated camphor has been largely used.   (See Acetanilide.)
  Administration.—It  should never be used hypodermically, as it is
too irritating, but administered in the dose of 5 grains three times a
day in pill or in an emulsion made  by dissolving it in six times  its
weight of expressed oil of almonds and then forming an emulsion with
gum arabic and water in the usual  manner.


                     CAMPHORIC ACID.

  Camphoric  Acid is made  by the oxidation of camphor through the
influence of acids, and  has been  used in the night-sweats of phthisis
with  great success.   In a large number of cases suffering from night-
sweats the author has  found this  drug to act very favorably indeed
where other remedies  failed.
  It may be resorted  to iu the dose of from 20 to 30 grains taken  an
hour  or two before the  sweat is expected.   In  very obstinate cases  as
much as  60 grains should be given, but under these circumstances it
should be used in  two  separate doses of 30 grains each, two hours
apart, in  order  to avoid  irritating the stomach.   It  is best given  in
capsule, as it is insoluble in water.   In other instances camphoric acid
may be given in the following formula :

         R.—Acid, camphoric.......|jiv.
             Alcohol........f.fjj-.
             Mucilag. acaciae......f<f"j-
             Syr. aurantii corticis  .    .    .   q. s. ad  f^vj.    M.
  S.—Dessertspoonful to a tablespoonful one hour before sweat is expected. 
110
DRUGS.
  It is worthy of note that camphoric acid is possessed of little power,
in the writer's experience, in cases of bromidrosis.
                      CANNABIS INDICA.

   Indian Hemp (Cannabis Indica, U. S. and B. P.) is the flowering
tops  of Cannabis Sativa   It is  to be distinctly separated from the
so-called American,  American-Indian or Canada hemp,  or  Apocynum
 Cannabinum, which is an intense irritant and drastic.
   Physiological Action.—Given in full  dose to man this drug causes
exhilaration, and periods of constant laughter arising from the slightest
cause, the person seeming convulsed with  merriment;  in  other cases
the sensations are disagreeable, and even death may seem imminent to
the deranged mind.   Often the sensation of very full breathing comes
on, and the  patient thinks he  is about to burst with the inflation of
his lungs.   After this deep  sleep  appears, lasting  for many  hours,
even  as much as fourteen  or fifteen, without any intervals of wake-
fulness.  If  the  dose  be  very large the  respirations are slowed very
considerably, but no death from the use of cannabis indica by man is
on record, and enormous  amounts  have been given to the lower ani-
mals without causing a lethal effect.1   Applied to mucous membrane it
acts  as  a very severe irritant and  then as a local anaesthetic, but the
primary effect is  so  powerful as to prevent its local use for the relief
of pain.
   One  of the most  constant  and pressing symptoms in poisoning in
man is the marked sensation of prolongation of time, so that minutes
seem  like hours, and, in addition to this, a peculiar separation  of the
mental  powers occurs during which both  hemispheres of the  brain
seem to think differently on the same subject.
   Therapeutics.—Cannabis indica  is one  of the  best adjuncts to
cough mixtures that we possess, as it quiets the tickling in the throat
and  yet does not constipate or depress the system as does morphine.
In advanced phthisis it is justifiable to constantly keep the patient in
a state  of euthanasia  by its use.  For the relief of pain, particularly
that depending on nerve disturbance, it is very valuable.  Before the
introduction  of antipyrine  and its  congeners, tincture of  gelsemium
and  the tincture  or extract  of cannabis indica were our best remedies
in migraine.   The gelsemium  under such circumstances  should be
given in full dose, 20 drops of the tincture, and be followed  by 10
to 20 drops  of the  fluid extract of cannabis indica—it being known
that the sample about to be  used is active.   After  this dose of gel-
semium the patient should be carefully watched  least he suffer from
an excessive  influence of the drug, as such an  amount may produce
great depression  in  susceptible persons.   In  true migraine with

  1 The author has  injected as much as 5 drachms of a fluid extract, active in the
dose of 10 minims to man, into the jugular vein of a small dog without producing
death for many hours. 
CANNABIS  INDICA.
Ill
hemianopsia  this  treatment is  often  most effectual in aborting the
attack.   The  prevention of further attacks  is to be attained by the
use of smaller amounts of  the  cannabis indica  during the intervals;
the gelsemium only  being used at the onset of the symptoms.   In
paralysis agitans  cannabis  indica may  be used  to quiet the tremors,
aud in spasm of the bladder, due  to cystitis or nervousness, it often
gives great relief.  In sexual impotence, not dependent upon organic
disease, it  is  said to  be of value combined with strychnine, or nux
vomica, and ergot.  When  a patient  suffers from sleeplessness  which
is due in part to pain and iu part  to nervousness, the following pre-
scription may be given:
           R.-Chloralis    1                            .
               Sodii bromidi /                          dJ"
               Ext. belladonna? fl.......f zj.
               Ext. cannabis indicae fl.  .    .   .    .     . f zj.
               Syr. acaciae   .    .    .    .   .    .     . f^vj.  M.
    S.—Tablespoonful at a dose.

   In headaches at the menopause  cannabis indica  is  useful, and,  if
the headaches are  associated with constipation, iron  and  aloes should
be given simultaneously, particularly if anaemia is  present.  Where
headaches are due to retinal asthenopia  a very useful  prescription,
according to De Schweinitz, is as follows:
           R.—Tr. nucis vomicae   .    .    .   .   .    .  fzjj.
               Tr. cannabis indicae     .    .   .   .    .  f zjj.  M.
    S.—Fifteen drops in  water twice or thrice a day.

   In whooping-cough aud asthma cannabis indica sometimes proves  of
service.
   In uterine  subinvolution, chronic inflammation  and  irritation  can-
nabis indica is of great value,  and it has been  found of service  in
metrorrhagia  aud nervous  and spasmodic  dysmenorrhea.   Not  only
does it relieve the pain, but it seems to act favorably upon the muscu-
lar fibres of the uterus.
   In acute and chronic Bright's disease cannabis  indica often  allays
the painful  sensations  over the renal  region, and  has been recom-
mended by some writers in the  cases in which bloody urine is present.
In gonorrhea it is said to decrease the discharge and prevent chordee,
and it has supplanted the use of copaiba and cubebs in some  practi-
tioners' hands.  It should  not  be used in the early stages of  gonor-
rhoea, but in the later or subacute stages.
   There is some foundation for the belief that in  small  doses  it acts
as a sexual stimulant.  The advantages  possessed by it are its lack  of
constipative power, and the fact that it does not cause after-depression
and nausea, its happy effect in most cases, and an increase rather than
a decrease of  the appetite under its  influence.
   Administration.—The employment of this most valuable remedy is
handicapped by its frequent lack of power—a fault which is largely
dependent upon its preparation.   The drug  as  prepared by Parke,
Davis & Co. and the solid extract of McKesson  &  Robbins  have 
112
DRUGS.
proved efficacious in the author's  hands for a number of years.   The
physician should always employ some preparation known by hini to
be active by personal trial before  condemning  the drug as a failure in
a given case.
  The dose of the solid extract (Extractum  Cannabis Indice, U. 8.
and B. P.) is from  ±- to £ grain, that of the fluid extract (Extractum
Cannabis Indice Fluidum, U. S.) from 4 to  20  minims, and that of
the tincture (Tinctura Cannabis  Indice,  U. 8. and B. P.)  from 15
minims to 1 drachm.

                         CANTHARIS.

   Cantharis (IT. 8. and B. P.), or "Spanish Fly," is  really a beetle
known as the Cantharis vesicatoria,  and as  such appears with  iri-
descent coverings or wing-sheaths of a bluish or greenish hue.  They
come  chiefly  from  Spain,  Italy,  and  Sicily,  and from the  southern
parts  of  Russia.   Those from Russia are  supposed to be the best.
According to Leidy, the vesicating substance is in the blood, the eggs,
and the secretions of the generative apparatus.   The  blistering sub-
stance contains cantharidin as an active principle,  but cantharidin is
not medicinally employed.
  Physiological  Action.—The ingestion of a  moderate dose  of can-
tharides produces only slight stimulation of the genito-urinary system,
particularly the kidneys aud urinary tracts.  Large amounts produce
great  pain in the lumbar region,  burning in the bladder and entire
urethra,  priapism, agonizing vesical tenesmus, widespread acute  ne-
phritis, bloody urine, which is scanty at first  and finally suppressed,
with  great irritation of  the  external openings of the genito-urinary
apparatus.  The inflammatory changes which  are produced may cause
sloughing of the penis or of the labia in the female.
  Violent gastro-enteritis is  nearly always a  pressing condition.  A
diagnostic sign of cantharidal poisoning, where the beetles have been
swallowed, is the appearance of pieces of the iridescent wings and coats
in the vomit.   Thirst is always a prominent symptom of poisoning by
cantharides.
  Therapeutics.—Cantharides are employed internally aud externally.
When given by  the mouth  the tincture is used as a uterine stimulant,
to affect  the uterine mucous  membrane and  relieve amenorrhea in
cases  where atony and  depression  are the cause of the suppression.
Some persons teach that the tincture of cantharides is a  valuable
remedy in  small doses  in the  second stage of acute desquamative
nephritis, but in  the instances where the writer has seen it used it has
made matters much  worse, although  it is supposed to decrease the quan-
tity of the albumin and blood.  In  the later stages, where the kidneys
are relaxed and torpid or where albuminuria comes on on the slightest
exertion,  cantharides in  the  dose of one  drop of the tincture three
times a day are of great service.
  In  cases of chronic nephritis, particularly where alcoholism is  the
cause  of  the disease and the kidneys are inactive,  cantharidal tincture 
CANTHARIS.
113
is very useful.   In pyelitis and in chronic cystitis it is of service, and
it has been  recommended very highly in drop doses in irritability of
the bladder  iu women and children.   In these cases the bladder  must
not be inflamed, but irritable  from depression.  The use of cantharides
is of value  in  incontinence of urine of a minor degree,  as that occur-
ring in some elderly or nervous females when coughing, sneezing, or
laughing, and will  often prove of service after many years of suffer-
ing.  In chordee in the dose  of one  drop twice or thrice daily it is of
service.   For impotence depending  upon  sexual excess  Ringer asserts
that the use of 10 to 15 drops of the tincture of cantharides with full
doses of the tincture  of the chloride of iron and nux vomica will
often relieve the patient and  enable him to beget children.  The drug
has no true  aphrodisiac influence except  in  toxic dose.   In. gleet of a
very chronic type  and in prostatorrhea it is of service.  Dermatolo-
gists have used cantharides internally as a remedy in psoriasis, eczema,
lichen, and prurigo, with asserted great success.   The dose should be
so small as  not to irritate the stomach.
   The unofficial plasters of  cantharides made by several firms are the
best preparations to use for the production of a blister.   In  order to
obtain a  perfect effect the  skin should  be washed thoroughly with
soap and water and dried with a towel, whicli should be rough enough
to produce  reddening  of the  cuticle.   After this wet  the skin with
vinegar, and while wet apply the blister.
   Externally cantharides are used in the  production of vesication for
the purpose of withdrawing  water  from a small area, or as a counter-
irritant of some severity in  cases  of deep-seated  inflammations (see
Counter-irritation).  Care should be taken that a sufficient amount of
the  drug is not absorbed  to  cause strangury  and renal irritation.
In renal  congestions and inflammations the use  of cantharides as a
counter-irritant is often contra-indicated  for this reason.  In the pro-
portion of one drop of the tincture of cantharides to forty  of water it
is  said to be a very good application for  burns, but how it acts is not
known.
   Administration.—The dose of the  tincture (Tinctura Cantharidis,
 U. 8. and B. P.) is from 1 to 10 drops, and it is the only preparation
used  internally.   The cerate (Ceratum  Cantharidis, U. S.)  is  used,
spread upon a rag, to produce a blister, and the cerate  of  the extract
(Ceratum Extracti  Cantharidis, U.  S.), is used for the same  purposes
and in the  same manner.   The cantharidal collodion (Collodium cum
Cantharide,  U. 8.) is a method of applying the blister^ which is most
cleanly, but there is more danger of absorption of the  irritant if it is
used.  The collodion  acts as a protective to the part.  The papers of
cantharides  (Charta Cantharidis, U. S. and B. P.) are used  as  blis-
ters, but are weak in action.   The liniment of cantharides (Linimentum
Cantharidis,  U. S., Liquor  Epispasticus, B. P.) is employed as a
counter-irritant.                                       #           .
   "Warming  plaster" (Emplastrum Picis cum Cantharide,  U. 8.)  is
a mild counter-irritant to  be employed where a blister  is thought to
be too severe.   The preparations of the B. P., other than those named,
                                 8 
114
DRUGS.
are Acetum Cantharidis, Charta Epispastica, Emplastrum Calefaciens,
Emplastrum Cantharidis, aud Unguentum Cantharidis.


                          CAPSICUM.

   Capsicum, U 8.,  Capsici  Fructus,  B. P., or Cayenne  Pepper, is
the fruit of Capsicum Fastigiatum, a native of tropical Africa and of
Central America.  It occurs in long ovoid pods which, when ripe, are
scarlet red and possess a very hot, burning taste.  The active principle
is  capsicin, which is a dark reddish  liquid, or,  in  other words, is  a
volatile alkaloid.
   Physiological Action.—Locally applied to the  skin or mucous mem-
branes capsicum causes great redness, and, finally, in the case of mucous
membranes, vesication.   The alkaloid will also produce these changes
in the skin.   When used internally for any length of time in excess
capicum will cause a chronic or subacute gastritis with pain and dis-
comfort over the liver and  stomach.   If single  large  doses are used
renal irritation  and  inflammation ensue, with  strangury and high-
colored urine.   Taken  internally, capsicum  is said to act as a circu-
latory stimulant.
   Therapeutics.—In cases of  atony  of  the  stomach  due to  general
debility, errors  in diet,  and  alcoholism of the chronic  type, capsicum
is  one of the best remedies we have.   In cases of acute alcoholism the
gastric  mucous  membrane is often too much irritated to permit of its
use, but after the lapse of some days it may be found of benefit to
increase the appetite.  As a  remedy for subacute alcoholism it is quite
useful, since by its stimulating effect and hot sensation it often satisfies,
at least to some degree, the craving for  liquor.  Under these circum-
stances it should be used in the dose of  5 to 10 drops of the  tincture
every four or five hours, or as the oleoresin in pill in the dose  of J to
1  grain.  The following prescription  has been found of great service
in the wards under the writer's charge at St. Agnes's Hospital in
these cases :
          R —Tr. capsici.......fgijss.
             Tr. opii deodorat......f 3 ij.
             Spt. aether, nitrosi.....f z. iv.
             Spt. lavandulae   .   .   .    .   q. s. ad  f sjiv.    M.
    S.—Dessertspoonful every four or five hours.

   In the flatulent colic of old  persons and young adults capsicum will be
found not only to act as a carminative but also to prevent the develop-
ment of the gas.  In low fevers it has been used as a diffusible stimulant,
but it is of doubtful value.   It is rather in the anorexia of convalescence
that capsicum acts most favorably. In chronic nephritis it is of consid-
erable service and it tends to check albuminuria, but it is only to be used
in the chronic forms and stages of renal  disease or in the treatment of
functional torpidity of the kidney.  The tincture is to be given under
these circumstances in the dose of 20 drops or less,  but  in some cases
whicli are very chronic, as much as 40 drops may be  used.   In sore- 
CARBOLIC ACID.
115
throat and simple tonsillitis the tincture of capsicum and glycerin, half
and half, are Arery useful as a local application applied by means of a
swab.   The same preparation may be used as a gargle for relaxed uvula
and sore-throat.   Applied externally capsicum acts  as a  counter-irri-
tant, producing  redness of the skin, but not a blister in the ordinary
individual.   It is one of the best moderate counter-irritants which can
be used, and it  may be  employed by saturating blotting-paper, time
and time again, in the tincture of capsicum, allowing it to  dry between
each dip.  This  paper should finally be placed when warm  and wet
over the part and held closely to the skin by a compress.  Capsicum
plaster (Emplastrum Capsici,  U.  8.) is useful iu lumbago, rheumatism,
and  in headache  when applied  to the nape of the neck.   The tincture
is sometimes painted over chilblains which are unbroken.   The fol-
lowing  method  given  by Ringer, from Rheims, is very efficacious in
this annoying affection :
   " Make  a strong tincture of capsicum  pods by steeping them for
several days in a warm place, in  twice their weight of rectified spirits
of wine.  Dissolve  gum arabic  in water to  about the consistence of
treacle.   Add to this an equal quantity of the tincture, stirring together
with a small brush,  or a large camel's-hair pencil, until they are well
incorporated.  The mixture will be cloudy and opaque.   Take sheets
of silk or tissue-paper;  give them, with the  brush, a coat of the mix-
ture ; let them dry,  and  then give another.  Let that dry, and if the
surface is shining, there  is enough of the peppered gum ;  if not, give
a third coat.  This paper should be applied in the same way as court-
plaster, to chilblains that are not broken and burns that  are not blis-
tered, and it will speedily relieve the itching and pain.  It acts like a
charm and  effects a rapid cure.  The same is true of discolored bruises.
It likewise allays rheumatic pains in the joints."
   The dose of capsicum  is 1 to 2 grains in powder, on food or in pill.
The dose of the  tincture of capsicum  (Tinctura  Capsici,  U. S. and
B. P.) is 10 to 30 drops,  and  of  the  oleoresin (Oleoresina Capsici,
 U. 8.), £ to  \ grain.   The dose of the fluid extract (Extractum Capsici
Fluidum, U. S.)  is 1 to 3 minims.   The plaster (Emplastrum Capsici,
 U. S.) is useful for external applications.


                      CARBOLIC ACID.

   Carbolic Acid (Acidum Carbolicum,U.  8. and B. P.) is also known
as Phenol, Phenylic Alcohol, and Phenic Acid.  Not only  is it an
acid, but in addition it is an alcohol of the peculiar group  known as
the phenols, which are derived from coal  tar by a process of distilla-
tion.
  It has a peculiar characteristic odor, aud varies  in color according
to its method of preparation and purity.  It is soluble in  20 per cent.
of water, but is  liquefied by the addition of 6 per cent, of water.
  If the crystals be exposed to the air they undergo liquefaction, and
in consequence the purest carbolic acid is usually prescribed in drop 
116
DRUGS.
doses rather than in grains.   It is  soluble in alcohol, ether, chloro-
form, glycerin, and most oils.  It unites with alkaline bases  to form
salts, earbolates, but these are very readily decomposed by the feeblest
acids, such as carbonic acid.
  Physiological Action.—Locally applied,  carbolic acid  produces at
first a burning  over the skin, accompanied  by a diffuse reddening of
the surface.  If the  solution be very strong the part at once becomes
temporarily painful, then  bleached  aud numb, so  that tactile sensi-
bility is destroyed.   Applied to mucous membranes it causes similar
changes, but to a more marked degree, and may even act as a mode-
rately  severe  caustic  of a  superficial type.   Owing to  the local
coagulation of  albumin  produced  by it it  cannot  penetrate very
deeply.
  Nervous System.—Carbolic  acid  acts as a depressant and para-
lyzant to the  peripheral sensory nerves when  locally applied.  Upon
the higher centres  in the brain the acid produces a condition of de-
pression and stupor.
  The convulsions which  sometimes occur after toxic doses  are spinal
in origin, as they occur after section of the  spinal  cord.  The motor
nerves escape almost untouched, as do  also the muscles.
  Circulation.—Upon  the circulation  in the  higher animals  the
drug exercises  a  distinct  depressant  influence,  stopping  the heart
in diastole in  lethal dose and paralyzing the vasomotor  centre even
before the cardiac muscle is affected.  These changes follow only lethal
doses.  Small  medicinal doses have no effect of any moment upon the
circulation.
  Respiration.—After large doses the breathing becomes more rapid
and  full.   These chauges, according to Salkowski and  others, are due
to stimulation  of the respiratory centres and  the peripheral vagi.
Lethal doses almost invariably kill by failure of  respiration due to
depression of the centres.
  Temperature.—Carbolic  acid  acts  as  a depressant  to  normal
bodily temperature even  in  medicinal close,  and  also decreases  the
bodily heat in fever.   It lowers fever by diminishing heat production
and  increasing  heat  dissipation.   This antipyretic power  is hardly
sufficient to permit of its use in disease.  (Hare.)
  Kidneys and  Elimination. — When carbolic acid is given  in
overdose the  kidneys may become so irritated that total urinary sup-
pression may occur.  When taken in large quantity it causes the urine
to become  brownish-black.  This discoloration is  due to  an oxidized
educt of carbolic which is not yet isolated.   The drug  is eliminated as
a sulpho-carbolate of sodium and potassium and as glyco-uronic acid
and hydrochinon.   Part of the carbolic acid is burnt up in the body.
  It is to be distinctly understood that the dark urine  of carbolic-acid
poisoning is not due to the presence of blood or any of its educts.
  Poisoning, Prolonged and  Acute.—As the changes produced in the
tissues of  the body by acute aud chronic poisoning by carbolic  acid
are identical, they may be considered together.
  Carbolic acid is one of the most rapidly  acting poisons  known,. 
CARBOLIC acid.
117
notwithstanding the fact that few people  seem to  recognize it as
such.    If  a large  lethal dose  be  swallowed  by a  man  he may
drop dead  from its  effects within  a few feet of the spot where he
stood when  drinking it, or may perhaps live a few hours.   In cases
where  death has  occurred  suddenly from the  acid, the cause has
been failure of respiration.   If the  patient does not die at  once all
the evidences of  gastro-enteritis come on.   Violent vomiting  and
purging may ensue, and burning pain in  the entire abdomen  is a
prominent symptom.   The skin is wet with  sweat, the face pinched
and  anxious.   Collapse,  with a  thready,  imperceptible pulse  and
extreme dyspnoea  may be present.  The mouth  and  lips   may not
smell  of the drug,  but the  mucous membrane will  be seen to be
corrugated and stained black if impure acid  has been taken, or be
whitish if the pure drug has been used.   The eschar on the mucous
membrane  is a peculiar  one, and is pathognomonic of  the poison,
having a white  centre surrounded  by a  reddened  and   inflamed
zone,  the  centre  sometimes  becoming  dark-brown or  black.   The
post-mortem will  show  these spots  in the  oesophagus and   stomach,
and even  in the intestines.   All  the internal  organs, as the brain,
kidneys, liver,  and  spleen,  will be  found filled with dark  grumous
blood, aud on opening the  body the strong odor  of the acid will be
perceived.   A peculiar croupous exudate  is sometimes found  in the
bronchial  tubes, and fatty degeneration of a more or less widespread
type often follows carbolic-acid poisoning.
   A large number of cases are  on record  in which carbolic-acid poi-
soning has  been  produced by its absorption from surgical dressings.
One of the  earliest signs of such au accident is a darkened,  smoky
urine and a slight  nervous unrest or cerebral disturbance.  Very often
pain in the lumbar region indicates kidney strain aud irritation.  The
dressings should, of course, at once be removed.
   Treatment of Poisoning.—The chemical antidote to carbolic acid
is any soluble  sulphate, such as Epsom or Glauber salts, which form
insoluble sulpho-carbolates.  As these  salts follow the acid  into the
bloodvessels and tissues to unite with it, the mere fact that hours have
elapsed since the  poison has been taken does not invalidate the pro-
priety of using these sulphates.  The further treatment consists in the
administration of  warm mucilaginous drinks, hot applications to the
extremities, the ingestion of cardiac and  respiratory stimulants, such
as digitalis  and strychnine, and counter-irritation over the abdomen.
Emetics and the  stomach-pump should be used if possible, but  the  *
former are generally useless because of the state of the stomach.
   Therapeutics.—Internally carbolic acid is  little used, but,  never-
theless, has a very  favorable  effect  in  certain states.  In nervous
vomiting, or in that due to gastric irritation, the drug does good in J
to 2 drop doses by depressing the sensory nerves in the stomach.
   In diarrhea depending upon fermentation, from 2 to 4 drops of the
acid do great good, particularly if combined  with  10 to 20 grains of
bismuth administered in powder or capsule.
   In  gangrene and  tuberculosis of the  lung a  spray  of the acid in 
118
DRUGS.
water in the strength of 5 to 15  drops to the ounce may do  some
good and at least stop the cough and relieve the irritation and tickling
in the throat}   Creasote is, however, generally preferred in these con-
ditions at the present time.
   Externally the acid is very largely employed as an antiseptic lotion,
and in solutions in which to place instruments while operating.   The
solutions for this purpose should be in the proportion of 1 of acid to
20 of water (see Antiseptics).
   Carbolic acid is  rarely used directly over  wounds in dressings at
present, unless the dressing be one of carbolized oil.   Other drugs have
supplanted it.   The use of the carbolized spray over wounds has been
found to do more harm than good, and it ought never to be employed.
   In diphtheria, ulcerated sore-throat, and even in ordinary stomatitis,
carbolic acid will be found of value  when used in a spray or mouth-
wash, and  in ordinary sore-throat, in the strength of 1 part to 100 of
water, it will be found, when  applied on a swab or  by a gargle, to
relieve the pain and inflammation.   In the  treatment of burns car-
bolized sweet-oil in the proportion of 1 drachm of  the acid to each 6
ounces makes one of the best dressings that can be  used.   By means
of the local anaesthesia produced by the acid, minor operations, such as
eversion of  the toe-nail or opening a felon, may be performed by  soak-
ing the part for  ten minutes  in a solution of 30  parts  to 100 and
applying the pure acid by means of a brush  to the line of the incision.
Carbolic  acid may be used as a lotion in the itching of jaundice in the
proportion  of 10  grains of the  acid  to  2 drachms  of glycerin and 2
drachms  of water.   In enlarged glands which have not yet gone on
to suppuration, intra-glandular injections with a hypodermic needle
are of value in a  large number of cases, the  solution  used being  no
weaker or stronger than 2 per  cent.; 5 to 10 minims of this solution is
sufficient for each gland.   In  the treatment of buboes 10 minims of
a solution of 8 grains to the ounce may be injected  into the swelling,
the skin being first benumbed by au ether spray.  This  is a  most
successful treatment.   The same treatment may be applied in chronic
synovitis  and repeated every three days, and boils and carbuncles may
also be so  treated with great success if  the  measure be  used  early
enough to abort the trouble.
   In  the form of  an ointment carbolic acid may be  used in the
strength of 10  minims to  the  ounce  of simple cerate, particularly in
cases of subacute eczema where there is a great  amount of weeping and
itching.
   As a disinfectant  carbolic acid ranks among the poorest;  1 to  2 per
cent, solutions, however, kill most spores aud  germs.
   Administration.—Carbolic acid ointment (Unguentum Acidi   Car-
bolici, U. S.  and B. P.) is the only official preparation of carbolic acid
in the U S. P.   In the B. P. the following preparations are official:
Acidum Carbolicum Liquefactum, given in the dose of 1 to 2 minims ;

  1 The spray must be a very fine one, or it will not carry the drug far enough down
into the lungs to do any good. 
CARBON:  CHARCOAL.
119
Glycerinum Acidi  Carbolici,  and Suppositoria Acidi  Carbolici cum
Sapone, each suppository containing 1 grain of carbolic acid.


                   CARBON:  CHARCOAL.

   Carbo Ligni, U. S. and B. P., or Charcoal, is prepared  by the ex-
posure of soft wood to a red  heat, air being  prevented from coming
in contact with the wood during the process.  Charcoal when used for
medicinal purposes should be a black, brittle, somewhat shiny, porous
substance, devoid of taste and odor, and completely insoluble in water.
Owing to its power of absorbing a very large  amount of certain  gases,
it is of  value in medicine in states where these gases abound.
   Therapeutics.—Charcoal is used externally as an application  to old
sores or sloughs  to act as a deodorant  and antiseptic.   This is accom-
plished  by the absorption of any liquids which maybe present, thereby
depriving germs of  a nidus, and by its distinct oxidizing power.  It
may be applied in the form of a dry powder or in a poultice, which is,
however, so uncleanly that other antiseptic dressings are better.
   The poultice (Cataplasma  Carbonis,B. P.), if used, should be made
in the following manner : Take of powdered wood-charcoal ^ ounce,
bread-crumbs 2 ounces,  linseed meal 1J ounces, and add boiling water
10 fluidounces.  Macerate the bread-crumbs and meal for ten minutes
over the fire,  and then  stir  in the charcoal to the extent of half the
amount just named.  Spread  out the poultice and sprinkle the remain-
ing half of the charcoal over its surface, and apply to the part affected
while hot.
   Internally,  charcoal is used in  powder in many conditions, and acts
very well  indeed  in cases of so-called " sour  stomach," from  which
eructations of gas or sour liquids take place.
   The following prescription will also be  found useful in the atonic or
subacute gastric catarrh of persons who are careless in eating and who
have much belching:

         R.—Oleoresin. capsici.....gtt. x vel xx.
            Pancreatin.......gr. xx.
            Pulv. zingiberis.....gr. xl.
            Pulv. carbon, ligni.....gr- xl-      M.
    Ft. in pil. no. xx.   S.—One or two t. d.

   As ordinary charcoal  is not always obtainable, it may be substituted
by pieces of very thin toast burnt to a state of charcoal, through and
through.  A few  of these pieces will, when  eaten, often stop all the
symptoms  mentioned.   If the  attack is very severe and vomiting
eventually ensues, the ejecta will commonly be found  to be^ odorless
and not sour, and the stools will also be almost odorless, though  black.
In fermentative and acid diarrheas in children and adults this method
of treatment is often of  value.  When charcoal is used in any  condi-
tion associated with irritation of the mucous membranes of the gastro-
intestinal tract it should always be very finely pulverized. 
120
DRUGS.
  As a filter for impure water, charcoal, in mass or in powder, is one
of the most satisfactory substances we have.


                   CARBON BISULPHIDE.

  Carbonei Bisulphidum,  U. 8., is a clear, colorless, highly refractive
liquid, having a strong characteristic odor, a sharp aromatic taste, aud
a neutral reaction.
  Poisoning.—The symptoms  of poisoning by bisulphide of carbon
consist in headache and nervous excitement resembling in many respects
the  symptoms of belladonna poisoning, particularly in the volubility of
the  patient and the evidences of hysterical tendencies.
  Prolonged exposure to the fumes of this drug causes great cachexia
and pallor, accompanied by muscular weakness and failure of intel-
lectual power.   Sometimes convulsions of an epileptiform character
come on.
  The treatment of poisoning by bisulphide of carbon consists in quiet-
ing  the nervous system,  if convulsive  disorders are present, by the use
of bromide of potassium and chloral, and in supporting the circulatory
system if any evidences of  its failure manifest themselves.  Circulatory
depression is not, however, a common condition except in very advanced
poisoning.
  Therapeutics.—Bisulphide of carbon  has been used in medicine ex-
ternally over enlarged lymphatic glands.  The application is made by
placing the liquid in a bottle of such a size that the mouth of the vessel
is large enough to cover the diseased area.   In the bottle should be placed
a sponge large enough to contain a fluidrachm of the drug, and the
skin over the gland should be well moistened with water.
  The vapor derived from the drug under these circumstances is an
active agent in promoting  a cure.  Bisulphide of carbon has also been
used in a similar manner in the treatment of neuralgia.


              CARBONATE OP  POTASSIUM.

  Carbonate of Potassium (Potassii Carbonas, U 8. and B. P.).  This
salt is never used in medicine, except to prepare  other salts, as it is
disagreeable to the taste and is an irritant (see  Potassium Citrate).


                   CARBONATE  OP ZINC.

  Precipitated Carbonate  of Zinc (Zinci Carbonas Precipitatus, U. 8
Zinci Carbonas, B. P.) is used as a protective, rather astringent powder
over surfaces covered by weeping eczema and similar moist discharges.
It may be employed to fulfil all  the indications commonly treated by
the oxide of zinc.  It is very largely  used, not as the precipitated car- 
                      CASCARA  SAGRADA.                 121

bonate, but as the impure or native carbonate, under the name of cal-
amine.
  The following prescription is useful for eczema :

         R.—Calamines......gj.
             Ung. zinci oxidi.....Hvij.    M.
    S.—Apply to the eczematous spot.

  Iii cases of infantile intertrigo or redness of the buttocks and geni-
tals  from maceration  due  to diarrhoea or urination,  the  following
lotion is very useful indeed :

         R.—Pulv. calamine)
             Pulv. zinci     }   •    •    •    '  aa    3y-
             Glycerini.......f^iv.
             Alcoholis.......  fzij.
             Aquae.....q.s. ad    Oj.    M.
    S.—Apply after each removal of the diaper.
                     CASCARA SAGRADA.

   Cascara Sagrada is the bark of the  Bhamnus Purshiana, a plant
growing in California.   It  is sometimes called California buckthorn,
to distinguish  it from  ordinary buckthorn,  or  Bhamnus  Frangula,
which it closely resembles in many ways, and which may be used as a
substitute for cascara sagrada in some cases.
   Therapeutics.—Cascara sagrada  ought never to be used as a purge,
but  only as  a  laxative.   It is by  far the best remedy we have when
employed simply to empty the bowel of faecal matter  in cases of con-
stipation, since it  not only performs this function without intestinal
disturbance,  but simultaneously acts as a tonic to the intestine, and so
prevents the constipation which usually follows the use of all other
drugs of its class.
   Though unofficial it is most commonly employed  in this country in
the form of the fluid extract (Extractum  Cascare Sagrade Liquidum,
B. P.) in the dose of from  10 to 20 drops at night, or morning and
night.  If 20  drops fail to act, 30 drops may be used, but  if larger
doses are required other drugs should be employed, as fluidrachm doses
have been known  to produce  irritation of the bowel, with enteritis
or intestinal catarrh.   The  objection to cascara  sagrada is its bitter
taste, which  may  be partially overcome by the additional use of the
Syrupus Aurantii, in the proportion of 1 part of the cascara extract to
2 parts of the syrup of orange peel.
   Some  of the preparations of this drug are now made in an  almost
tasteless  form, such as " Cascara Cordial," or the non-bitter fluid ex-
tract, made by  a prominent  firm in this country.  The solid extract
(Extractum Cascare Sagrade) is official in the B.  P., and given in
the dose of 2 to 8 grains in  pill. 
122
DRUGS.
                        CARDAMOM.

  Cardamom (Cardamomum,  U  S.) is the fruit of Elettaria  Carda-
momum, and is a bitter tonic possessing some aromatic properties.  It
is useful in cases of atony of the stomach and small intestine, particularly
if combined with some other bitter, such as gentian, and a mineral acid.
Cardamom is official in  the B. P. as Cardamomi Semina.
  If  the  intestine  is atonic and secretion is deficient, the following
prescription will be found of value :
         R .—Acid, nitric  dil......f.^j-.
             Tr. cardamomi comp.  .    .    .   q. s. ad  f:fyj-   M-
    S.—Dessertspoonful after each meal.1

  Administration.—The official  preparations of cardamoms  are the
tincture of cardamoms (Tinctura Cardamomi,  U. 8.), dose  1  to 3
drachms ; and the compound tincture (Tinctura Cardamomi Composita,
 U.  S. and B. P.), which is to be given in the same dose as the tincture.
This tincture also contains cochineal, cinnamon, caraway, and glycerin.
Cardamom is also a constituent of the official aromatic powder  (Pulvis
Aromaticus, U S.).


                      CASSIA FISTULA.

  Cassia  Fistula,   U. 8., is the fruit  of Cassia Fistula, or Purging
Cassia, as it is sometimes called, and occurs in long, dark-brown pods
containing a dark pulp in each segment.  This pulp is the useful part
of  the drug, and is official in the B.  P.  as  Cassie Pulpa.   Cassia
Fistula ought never to be used alone, as it is too apt to cause pain and
griping, but it is  officially present in the  Confection of Senna (Con-
fectio Senne, U. 8. and B. P.),  and  may be given  in  the dose of J
drachm to 1  drachm as a laxative, or as much as \ ounce  may be
used if a purgative  effect is desired.


                         CASTOR  OIL.

  Castor Oil (Oleum Bicini, IT. S. and B.  P.) is a fixed oil, derived by
expression from the beans of Bicinus Communis, a plant of the United
States and elsewhere, but originally derived from India.   It  contains
an  acrid  substance,  ricinoleic acid.
  Physiological Action.—The manner in  which castor oil purges is
somewhat in doubt, but its activity probably depends upon the presence
of the acid just named, and the fact that it is an oil.
   As is well known, oils, such as olive oil, for example, if given in any

  1 While the rule that an acid is incompatible with a tincture is not  recognized in
this mixture, the quantities  of acid and alcohol are so  disproportionate that ether
in any amount is not developed. 
CASTOR  OIL.
123
quantity tend to move  the  bowels, and the ricinoleic acid, which is
somewhat  acrid, stimulates the small and  large gut, and so develops
peristaltic movement.  According to some writers, this acid is not set
free until the oil is attacked by the pancreatic  juice.   That this acid
possesses purgative properties  of itself seems proved  by the fact that
the oil will purge when  it is rubbed in by the skin, and that nursing
mothers on taking the oil eliminate  the acid in the milk to such an
extent  that the  suckling is  purged.   According to  the studies  of
Rutherford and Vignal, the oil has  no effect over biliary  secretion
other than that violent purgation indirectly increases the flow, and
the researches of Hess have  shown that the oil acts more rapidly  in
the small  than in the  large  gut, and  only produces peristalsis by
coming iu  contact with the mucous membrane.
   Therapeutics.—Castor oil is the blandest and most nnirritating purge
we have with  the  exception  of the  sulphate of magnesium, which  is
depletant and much more rapid iu its effects.   While the Epsom salt
will act in  one-half to one hour  if the stomach  is empty, castor oil
will generally act  in  four hours, or  perhaps five.  Its action is  so
regular that it can  almost be used as a timepiece.
   Castor oil is used whenever irritant materials, such  as bad food,
putrid flesh, or decaying or  green vegetables have been eaten, even if
the inflammation  set up after them is  very active.   If hard bodies,
such as broken  cherry-stones, have been swallowed, castor oil is a far
better purge than  sulphate of magnesium,  as  it  is more  gentle and
lubricates the  gut, thereby preventing scraping and irritation.  Where
mucus has accumulated  in the bowel in children, and  must be gotten
rid of before other treatment is resorted to,  castor oil should be used.
Previous to parturition  it has been largely used to  relieve the bowels
of faecal matter, and is  said  by old  practitioners to  make the  labor
easier than if any other purge is used.   It is also employed  in the
constipation following  acute  diseases, and in that occurring in infants
and children.
   The  disadvantages of castor oil lie in its taste, the fact that it  is
oily, that  it tends to  produce haemorrhoids if used  constantly, and
finally  that its  frequent use, or even a single dose, is generally fol-
lowed  by more  obstinate  constipation than before, so that  the  dose
must be rapidly increased in size to be effective.  This is  one of the
reasons why it is useful  in irritative  diarrhoeas.  The effect of castor
oil is very  much increased if a little bicarbonate  of sodium is given
with it.
   Administration.—Castor oil is very  much  more agreeable to the
taste if pure than  if poorly prepared.  It is also true that too  great
purity,  so far as taste is  concerned, renders it less active.
   The  methods directed for taking castor oil  are  as various as the
tastes of individuals.  Its odor  may be covered by  a drop  or two
of the oil of bitter almonds, but emulsions  of the oil are not of any
service, save to interfere  with its efficiency.  Some take the oil in the
foam  of beer  or porter, others  in  syrup of  sarsaparilla  and  soda-
water, and  still others in  milk or cream.   A  good way to take  it  is 
124
DRUGS.
to eat one or two strong so-called cream peppermint drops, or even the
crystalline peppermint drops, swallow the oil from a spoon which  is
to be placed well back in the mouth, and immediately eat several other
peppermints.  This  plan is improved by using  the oil  in milk or
water, so that the liquid carries the oil down into the oesophagus without
its touching the  mucous membranes.   It may also be taken in highly
seasoned beef-tea.  Ringer recommends the following:   \  ounce of
oil, fresh  syrup  of acacia 3 drachms, and distilled water  5  drachms,
flavored with a little oil of lemon or peppermint.  Wood advises that
it be mixed with glycerin, equal parts, to which is  added a drop or two
of oil of gaultheria or oil of cinnamon.   By far the  best way of ad-
ministering it is in soft capsules  containing from  \  to 1 drachm.
Very few people are unable to swallow such a mass, and several of the
capsules may be given  at once  to complete the  necessary dose.  The
capsules should  be lightly dipped  in water in order  to render them
slipping and so easily swallowed.
   The dose for an infant is 1 to 2 teaspoonfuls,  and for an adult \
ounce to 1 ounce.
   Owing to the fact  that the oil will very frequently  produce griping,
a few drops of laudanum should be added to it, or tincture of bella-
donna may be used.    If these cannot  be employed, a drop of the oil
of cinnamon is equally useful for this  purpose.


                           CATECHU.

   Catechu (U.  8.) is  derived as  an  extract from  Acacia Catechu.
The catechu of  the U. 8. P. is true catechu; that of the B. P. is in
reality an extract of gambier, being derived from the leaves and shoots
of  Lncaria Gambier.   Catechu  depends for its medicinal use upon
the astringent properties which  it possesses.  Beyond this  power  it
has no particular value.
   It is  of a dark-red color, has a somewhat sweetish taste, and is in-
soluble, like most extracts, in water.
   Therapeutics.—Like all the vegetable astringents catechu is used as
a remedy for diarrhea, particularly that of the serous type, or that in
which the  stools are of too fluid a consistency.   If  large amounts of
mucus in the passages  show a catarrhal state of the bowel, the mucus
should be  displaced by a purge of castor oil or sulphate of magesium
before the astrigent is used.
   Catechu may  or may not be  combined with opium  in cases of diar-
rhoea, but the following prescription will be found of service in many
instances :
    For an adult:
         R.—Tinct. catechu composit.....f.^ij-
             Tinct. opii camphoratae    .    .   .    . f ?ij.
             Misturae cretae......f^ij-    M.
    S.—Dessertspoonful every four hours till relieved. To be shaken before using. 
CERIUM  OXALATE.
125
  Iii cases of sore-throat, where the  secretion is excessive and the in-
flammation subacute, catechu may be used as a gargle.
  In cases of spongy gums catechu is  sometimes useful  as a mouth-
wash.   If the powdered catechu is used internally the dose is 2 to 30
grains.  The dose of the Compound Tincture of Catechu (Tinctura
Catechu Composita,  U. 8.) is 1 to 2 fluidrachms.  Its only constituent
besides the catechu is cinnamon.   The Troches of Catechu (Trochisci
Catechu, U. 8. and B. P.) are to be  employed in sore-throat and are
to be held in the mouth.  They are not generally used.
  The official preparations of the B. P. besides the ones given are :
Infusum Catechu, given in the dose of 1 to  1J fluidounces ;  the  tinc-
ture (Tinctura Catechu), dose 1 to  2  fluidrachms,  and  a compound
powder (Pulvis Catechu Compositus), composed  of catechu, kino, and
rhatany, the dose of which is 20 to 40 grains.


                     CAUSTIC  POTASH.

  Caustic  Potash (Potassa, U. S.,  Potassa Caustica, B. P.)  is a  very
deliquescent hard white solid, possessing great caustic power, and used
in medicine for  the  purpose of burning away growths  or  exuberant
ulcers.  A piece of the drug should be placed on the skin by means
of a pair of forceps, when  it will at once soften down and  burn the
tissues until  it can reach  no further.  The surrounding  skin should
be protected by wax, suet or oils, and a piece of adhesive plaster with
a hole for the growth should first be applied to prevent any  action on
the surrounding healthy tissues.  The  burn produced  by caustic pot-
ash is very painful, and cauterization through its influence should not
be practised if it can be avoided.   When  the caustic has acted  suffi-
ciently  it  is  to  be washed off with  vinegar  or other  dilute  acid.
Vienna paste (Potassa cum Calce,  U. 8.) is used for the same purpose
as is caustic potash.

                       CAUSTIC SODA.

  Caustic Soda (Soda, U. 8., Soda Caustica, B. P.) is milder thau caus-
tic potash, and its action is more readily controlled.  It should be used
in the same way and for the same purposes as is  caustic potash, and the
surrounding skin ought to be protected by adhesive plaster and oil or
ointment.
  The soda must be kept in well-stoppered bottles made of hard strong
glass.   The only official preparation  of caustic soda  in the U. S.  P.  is
Liquor Sode, or solution of soda.


                     CERIUM OXALATE.

  Cerium oxalate (Cerii Oxalas,U S. and B. P.) is a white granular
powder, permanent when exposed to the air, odorless and  tasteless, and
insoluble in water and alcohol, but freely so  in hydrochloric acid. 
126
DRUGS.
   Therapeutics.—It is used instead of bismuth iu the treatment of the
vomiting of pregnancy or that due to uterine disorders  and displace-
ments, and in some cases of gastric acidity.   The dose is from  2 to 5
grains given  in pill form every 4 or 5 hours.


                        CHENOPODIUM.

   Chenopodium (U. 8.)  is the fruit of the Chenopodium Ambrosioides
or American wormseed.   The seeds contain a volatile  oil and have a
distinct and rather disagreeable aromatic odor.  These seeds rubbed up
into a powder form with a syrup an electuary which is a most efficient
remedy against the ascaris lumbricoides or round-worm  as it  occurs in
children.   The dose  of  the powdered seeds is  from 10 to 30 grains.
The better way of using chenopodium is in the form of the oil (Oleum
Chenopodii, U. 8.) in the dose of 10 drops to a child of five years, either
on sugar or in an  emulsion made of gum acacia.  If the patient is old
enough capsules may  be  used.   The general dietetic measures adopted
for the removal of worms  should  be  insisted upon before the drug is
given.  (See article on Worms.)


                         CHIMAPHILA.

   Chimaphila (U 8.), or Pipsissewa,  is the leaves of Chimaphila Um-
bellata, an  evergreen found in  America, Europe and Asia.
  Therapeutics.—Pipsissewa  is a drug employed in atonic renal con-
ditions, particularly of the functional type, as a stimulating diuretic
which will bring into activity the secreting structure of the kidney and
the mucous membranes of  the genito-urinary tract.  It is also a tonic
to the stomach.   For this reason it is often placed in mixtures  given
to dropsical patients if debility and anorexia are present.  Iu  the treat-
ment of ulcers of the skin due to struma it is said to be of service, and
it probably has some slight alterative power.  The drug may be used
in the form of a decoction, which  is not official, in the dose of 1 to 3
fluidounces, and as the fluid extract (Extractum Chimaphile Fluidum,
U S.) in the dose of J to 1 drachm.


                          CHIRETTA.

  Chiretta (Chirata, U.  S. and B. P.)  is the plant Ophelia  Chirata,
which is a native of India.   It is a bitter tonic, possessing a  very
distinct influence  over the liver,  and,  unlike many bitter tonics, is
devoid of tannic acid.   For this reason it may be used with  prepara-
tions of iron.   Chiretta may be given in all  cases of indigestion and
loss of appetite, particularly where the liver is torpid or if any tend-
ency to  constipation is present,  although it  is not  directly  laxative.
When given  in  powder  the  dose  is 20 grains; the dose of  the fluid 
CHLORAL.                        127
extract (Extractum Chirate Fluidum, U. S.) is 30 drops  to 1 drachm,
while  that of the tincture (Tinctura Chirate,  U. S. and B. P.) is 1 to
4 drachms.   The unofficial solid extract may be giveu iu pill in the
dose of 2 to 4 grains.  The dose of the  infusion (Infusum Chirate,
B.  P.) is a wineglassful.

                           CHLORAL.

  Although the name Chloral is applied to the substance  used in medi-
cine, chloral proper is never so employed,  hydrate of chloral (Chloral
Hydras, B. P., Chloral, U. 8.) being the  real preparation.   Chloral
hydrate is a white, crystalline body, but is  often  sold in irregular
broken masses, which are generally impure.
  Physiological  Action.—When chloral is applied to a mucous mem-
brane  it causes distinct reddening and buruing pain, and finally acute
inflammation.  It is, therefore, a local  irritant.   Chloral acts  in  the
body as chloral, and  is not broken up into formic  acid and  chloro-
form, as was taught at one time.
  Nervous  System.—In medicinal and toxic dose chloral produces
sleep  by quieting the intellectual centres  in  the brain, at  the same
time depressing the motor  tract  of the  spinal  cord  and the motor
nerves.  In medicinal amounts it does not decrease sensation, but in
toxic dose it does do so.  Arery often hyperaesthesia results from small
doses.   Reflex action is decreased by its influence on the motor por-
tions of the spinal cord.
  Circulation.—A dose of  10 to  20 grains,  in the  adult, rarely
causes  any circulatory changes, but larger amounts  produce a fall  of
arterial pressure  and a slow,  feeble,  or sometimes a rapid running
pulse  due to a direct  depression of the heart  muscle,  for chloral is a
cardiac paralyzant.
  After death from chloral the blood may be found dark and grumous-
looking, with the corpuscles broken  down, but  these changes occur
only after very large doses.
  Respiration.—In moderate amounts  no respiratory effect is felt,
but in  toxic doses the breathing becomes slower and slower,  and more
and more shallow, until it stops in death.  When death  is caused  by
chloral it  is due to respiratory failure, with au  almost  simultaneous
arrest of the heart.
  Temperature.—Chloral tends to lower bodily heat,  and in large
doses produces a very marked fall of temperature, which does much
toward causing death.  Brunton has  fouud that  rabbits  will survive
very large doses  of  the drug  if external  heat  is supplied to them.
The fall of temperature is, at least in part, due to the failure  of the
circulation and vascular dilatation.
  Kidneys,  Tissue-waste,  and  Elimination.—Chloral is elimi-
nated by the kidneys in the form of uro-chloralic acid, and, if given  in
excess,  as chloral.  Large amounts irritate these organs and  may pro-
duce bloody urine, owing to the nephritis which is set up as the drug 
128
DRUGS.
passes through  the  renal 'structures.   After chloral is  ingested the
urine of a patient will often give Fehling's test  for sugar.
   Poisoning.—When a poisonous dose of chloral is taken by man the
person soon falls asleep and sinks into a deep coma.   The respirations
become at first slow and labored, then shallow and feeble.  The pulse,
at first perhaps a little slowed, soon becomes rapid, thready, and shuttle-
like, and is finally lost at the wrist.  The face is white and  livid, the
forehead and the hands  covered with  a  cold sweat, and the pupils,
which are at first contracted, soon  become widely dilated.   Absolute
muscular  relaxation is present,  and it is impossible  to arouse the
patient.
   Treatment  of Poisoning.—The physician  should apply external
heat, and use emetics in the early stages, or if the case is  seen too late
for emetics to act because of systemic  depression he  should use the
stomach-pump.   This latter means of removing the drug  from the
stomach is more reliable and safer, because the production of vomiting
may result in efforts which will strain  the heart.  Strychnine should
be given in full  dose, fa to fa of a grain, to stimulate respiration, or
atropine may be used for the same purpose.   The heart  is to be sup-
ported by 10-drop doses of tincture of digitalis  given hypodermically
every twenty minutes until some effect is noted; and as the digitalis
is rather slow in its action, it may be preceded by ether and  ammonia
or brandy or whiskey.   The patient must not raise the head to vomit,
and the head should be placed on a lower  level than the heels to keep
the blood in the brain.
   In chronic poisoning  the patient suffers from weakness, mental and
physical, with sudden flushings  due to vasomotor disorder, from pal-
pitation  of the heart, and finally from petechial  eruptions, ulcerations
and sloughs.
   Therapeutics.—Chloral is the purest hypnotic that we have, and
may therefore be used where simple nervous insomnia is  present, but
not when sleeplessness is due to pain.  Under such circumstances it is
to be employed in the combination of 10 grains  of chloral with ^ of a
grain  of morphine, as a much  more powerful hypnotic effect is pro-
duced by the combined action of the two drugs than by the use of
either one of them alone.
   In tetanus  and strychnine poisoning chloral is the  best remedy we
have, as it depresses the  motor  tract of the  spinal cord.  In such a
case it should  be given  in 20-grain doses combined with  60  grains of
bromide of potassium.   If the convulsion prevents deglutition, or is
brought on by swallowing, the remedy should be used by the rectum,
and if the spasm expels  it from the  rectum the patient should be chlo-
roformed long enough to allow the injection to be given and absorbed.
The same remedies in small doses are  to  be  used in infantile convul-
sions and in infantile colic in the dose of J grain to 1 grain of chloral
to 2 grains of bromide  of potassium or sodium in a teaspoonful of
peppermint-water.   In chorea, paralysis agitans, and delirium tremens
chloral is of great service, but must be given cautiously  in the  latter
condition for fear it may depress the heart, which is already diseased 
chloralamide.
129
by alcoholic excess.   Cases are on record where chloral has  caused
sudden death  from cardiac failure in  the  persons  of alcoholics  who
were suffering  from fatty heart.
   Chloral has  been used for the relief  of labor pains, but is rarely so
employed, and is not a good remedy.   If much rigidity of the os uteri
exists  chloral may  be used with advantage to relax the spasm.   The
dose giveu should be  15 grains.   In uremic convulsions it has been
highly extolled, but if any acute renal trouble is present it  must  not
be used.   In puerperal  convulsions not dependent upon nephritis, 20
to 30 grains of the drug may be given, and  repeated  in  one  or two
hours.
   Hiccough, nocturnal epilepsy and whooping-cough are all indications
for its use, but in asthma it rarely does good, and if pushed is danger-
ous to the heart.
   As an antiseptic, chloral possesses a good deal of power, but is sel-
dom used except to prevent the decomposition of urine and to assure
the maintenance  of purity in urinals  used by  paralytics, as  in these
cases the urine is generally heavy and ill-smelling.
   Untoward Effects.—Chloral sometimes causes nausea, purging and
vomiting, by reason of its irritant action, aud sudden cardiac failure
in heart  disease has resulted from 20 grains or less.
   Administration.—Chloral is best  given in syrup of acacia, simple
syrup, or water.   It should be always well diluted.   The syrup of
chloral (Syrupus Chloral, B. P.) is given iu the dose of 1 fluidrachm.
The following  prescription is useful in insomnia :
       R.—Chloralis  ......    zj vel  zij.
           Potassii  bromidi .......zij.
           Syr. pruni virginianae .     ..... f*j-
           Aquae  .    .   .   .     .   .   .   . q. s. f 3 iij.  M.
    S.—Dessertspoonful at night.


                       CHLORALAMIDE.

   Chloralamide is a compound very recently introduced into medicine,
formed by the  addition of formamide to anhydrate of chloral, and is a
colorless crystalline substance, soluble in 9 parts of water and 1J parts
of alcohol.   Its taste is slightly bitter, but not biting, and it keeps well
in watery solution without  decomposition.  Its physiological action is
closely allied to that of chloral, except that it is not quite so depressing
to the  circulation.   Upon the nervous system it acts chiefly  upon  the
brain and spinal cord,  and produces sleep, a result  to  be  expected,
since both chloral  and formamide are hypnotics.   It is  said  not to
irritate the stomach and kidneys, but it probably is only less irritant
than chloral.
   Therapeutics.—Chloralamide may be employed in  medicine when-
ever chloral may be used.   It  is decidedly a  nervous sedative,  and in
the wakefulness of nervous insomnia is very  useful.   Sleep  generally
ensues  about thirty to forty-five minutes after it is taken.  According
                                  9 
130
DRUGS.
to most of the reports published so far, the drug relieves pain as well
as produces sleep, and is, therefore, distinct in its actions from chloral.
In neuralgia it is  very useful, and it has  been found of  value in the
pains of tabes dorsalis.   The dose is 10 to 30 grains, which may be
repeated in three  or four hours,  although the sleep generally  lasts
five  to eight  hours.  The following formula  may  be  used for its
administration :
         R.—Chloralamide
             Acid, hydrochlorici dil.
             Syrupi  ....
             Aquae dest.
   S.—Take in two doses in a little water

   Very recently Charteris has obtained very extraordinary resultsin
the treatment of sea-sickness by the use of chloralamide and bromide
of potassium.   He gives it in the dose of thirty grains with an  equal
amount of the bromide.   It  is necessary for the patient to take  a
cholagogue for two days before starting on his voyage, and as soon as
he gets on board to take the dose  named on an empty stomach and at
once to go to bed and to sleep.   If this is done Charteris claims that
the patient will awake feeling bright and well, and remain so for the
rest of the voyage.


               CHLORATE  OF POTASSIUM.

   Chlorate of Potassium (Potassii  Chloras, U S. and B. P.) is  a salt
of potassium  differing entirely  in  physiological  action from all the
other potassium salts, and, with the exception of  the  cyanide of potas-
sium, is certainly the most poisonous.  Not only  is  it, when locally
applied, an irritant to mucous membranes, but when it is absorbed into
the blood it causes changes of a serious character in this fluid, aud pro-
duces acute nephritis if given in overdose.
   Physiological Action.—It has been thought by some that chlorate of
potassium gives up a large amount of oxygen to the body, and for this
reason that it would be of value in cases of slow asphyxia, such as result
from pneumonia or phthisis.  It has even been recommended to persons
crossing high mountains where the  rarity of the air produced dis-
agreeable effects; but nothing is more absurd than  the belief that it
gives up  oxygen  to the body.  Chlorate of potassium does give off
oxygen when treated with very high  heat, but not at the temperature
of the body.   Nearly all of it escapes from the body unchanged.
   When overdoses of the chlorate are taken, it produces  sickness of
the stomach, headache, pain iu the loins and belly, dyspnoea, cyanosis,
heart failure, and  great  weakness.  The blood is dark and chocolate-
looking, this  change being due to the production of methaemoglobin.
The blood-corpuscles are crenated and broken down, and  the  liver,
kidneys,  spleen,  and intestines  are found  softened  and  filled with
broken-down  and disorganized blood.
gr. xl.
gtt. v.
M. 
CHLORIDE  OF  SODIUM.
131
  Therapeutics.—Chlorate of  potassium is  useful in  stomatitis,  and
in mercurial sore-mouth,  as a mouth-wash, or, given  internally,  in
the following mixture:
         R.—Potassii chlorat.    ......  gr. xlviij.
             Tr. myrrh.    .    .    .    .    .    .    .  f Zss.
             Elixir calisayie    .    .    .    .   q. s. ad  f^iij-    M.
    S.—Teaspoonful every rive hours; or use as a mouth-wash.

  Owing to the  fact that the drug is  eliminated by the saliva  to a
great extent, the  mucous membranes affected by stomatitis are con-
stantly bathed  by a solution of the  chlorate  when it  is taken by the
stomach.   If  any irritation of  the stomach or  kidneys  exist, the
medicament must  be used on a swab and none of it swallowed.
  In diphtheria chlorate of potassium is very commonly employed, but
its use is exceedingly dangerous.  Death in  .many cases of diphtheria
is due to the renal irritation present, or,  in other words, to an acute
nephritis, and  this drug simply increases the inflammatory process.
If the chlorate of potassium is employed in  diphtheria it should  be
used in solution and applied  by means of a swab.   (See Diphtheria.)
  In anginose sore-throat chlorate of potassium is a useful gargle, and
Wood  recommends the  use of a solution  made by adding 1 ounce  of
sumach berries, J ounce of chlorate of potassium, and 1 pint of boil-
ing water to each other and allowing them to simmer  for a few hours,
when the mixture should be strained,  cooled, and used as a gargle.
  The following is equally serviceable :
         I£.—Potassii chlorat.......Zj.
             Ext. rhois glabrae fl......f % ss.
             Aquae dest......q. s. ad  f^iij.   M.
    S.—To be added to an equal quantity of water in a glass and used as a gargle
every two hours.
  This prescription  makes  an  abominable-looking  pharmaceutical
preparation, but an exceedingly useful one.
  In acute rectal catarrh with mucous diarrhea and tenesmus, a solu-
tion of chlorate of potassium in water, 20 grains to the ounce, injected
into the bowel, will often  produce a cure  after one or two injections.
Not more  than 4 ounces should  be used, and it ought  to be retained
for  twenty minutes.   In the treatment of  hemorrhoids a few drops  of
laudanum added to this solution will be found of great  service.  The
troches (Trochisci Potassii Chloratis, U. S.  and B. P.) are given  in
the  dose of 1 to 6, each  lozenge containing  5 grains.  They  are in-
tended to affect the oral  mucous membrane.
                  CHLORIDE  OF  SODIUM.

  Chloride of Sodium (Sodii Chloridum, U. 8. and B. P.), or common
Salt, is a useful drug and food, aiding  in  maintaining the alkalinity
of the blood and  tissues, and in the formation of gastric juice, being
changed  by the lactic acid of  the stomach  into lactate  of sodium, 
132
DRUGS.
thereby setting free hydrochloric acid, which acts not only by aiding
digestion but in the production of pepsin from  the pepsinogen of the
gastric tubules.  The dose is 10 to 20 grains.


                    CHLORIDE  OF  ZINC.

  Chloride of  Zinc (Zinci Chloridum, U. S. and B. P.) is a white,
crystalline, deliquescent powder,  of caustic taste and acid reaction,
possessing considerable disinfectant power.   It has  been used as an
eye-wash in the strength of 1 to 2 grains to the  ounce, but is rarely
so employed at present.  The same  solution may be used as an injec-
tion in the  second stage of gonorrhoea.  Under the name of Liquor
Zinci Chloridi,  U. 8. and B. P., is prepared a strong solution of the
salt for disinfectant purposes of the strength of  about 50  per cent.
  Numerous experiments with the proprietary " chlorides " show them
to be possessed of  very slight disinfectant power but to be strongly
antiseptic.

                   CHLORINATED  LIME.

  Chlorinated  Lime (Calx Chlorata, U. S., Calx Chlorinata,  B. P.),
is the hydrate of lime  containing 25 per cent, of chlorine, provided it
is of official strength.   It is an exceedingly irritant substance,  because
of the chlorine which it contains, and is never used internally.
   Much of the chlorinated lime sold is  useless, containing too little
or no free chlorine.  Good  chlorinated lime should  be so laden with
the gas that the face cannot  be held near  it without the eye being
severely irritated.   Unless the chlorine is present the substance is of
no value, for its employment as a disinfectant depends upon the action
of this gas, the lime being used, merely as a vehicle  and  oxidizer, the
gas by itself being difficult of application.
  Uses.—As a disinfectant for privies, drains, and sinks, chlorinated
lime is  one of the best, if not the  best, we possess.   A few pounds of
it may be added every week to the contents  of a  privy vault  with
great advantage, and a solution of it may be used in  all bed-pans and
urinals.  When the passages of a patient having typhoid fever are to
be received in a bed-pan, a chlorinated  lime solution  should be placed
in the  receptacle beforehand, so that the faecal  matter or urine will
fall at ouce  into a disinfecting fluid.  The solution  should be of the
strength of  1 pound to 2 gallons.   As  it is one of the most powerful
deodorizers, chlorinated  lime  should be placed  liberally  about decay-
ing animals, and, in exhuming corpses, sheets wrung out  in a solution
made as above will be found of service to destroy the stench, if wrapped
about the body.
   Water which has become foetid by stagnation may be rendered drink-
able by adding 1 to 2 ounces of the chlorinated lime to every 65 gal-
lons, and standing the solution aside for some hours until  precipitation
and exposure to the air have gone on for some time. 
CHLOROFORM.
133
  It should be remembered that the chlorine fumes will bleach many
dyed goods.
  Chlorine gas, in a diluted form, has  been used for the treatment of
aphonia  due to cold, in  cases where the aphonia  persists for some
months.   It can be obtained by allowing a few drops of hydrochloric
acid to fall upon chloride of lime or sodium.
  The placing of chlorinated lime in saucers about sinks  and closets
is useless, as the amount of chlorine liberated is very slight as com-
pared to the volume of air in the room.   Where the chlorine is present
in a sufficiently concentrated form to kill germs it will also kill  the
occupant of the chamber.  A deodorant  effect may be obtained, but a
bad smell, if it  exists, even when  overcome  by a greater one, is  not
really gotten rid of.   The official preparations of the B. P. are Liquor
Calcis  Chlorinate and Vapor Chlori.
                        CHLORODYNE.

  Chlorodyne is a preparation used to a very large extent by the Eng-
lish for the treatmeut of serous diarrheas or cramps in the stomach.
Even iu England its constitution varies considerably, but the formula
most commonly used is as follows :

        R.—Morphinae hydrochlor.  .    .    .    .    .  gr. viij.
            Aquae dest.......•.  f 3 ss.
   Heat together, and as soon as the morphine is dissolved and the liquid cooled,
add
            Acid, hydrochlor. dil......f zss.
 yhloroformi
Tr. cannab. indicae  .
Acid, hydrocyanic, dil.
Alcoholis
01. menth. piperit. .
Oleoresinae capsici  .
fzjss-
f.=5J-
mxij.
f.^ss.
Tu>y-
mj.   m.
■5 to 15 drops for an adult, in water.  More than this quantity is dangerous.
                        CHLOROFORM.

  Chloroform was originally discovered by Guthrie, of Sackett's Har-
bor, New York, but first brought into medicinal use by Simpson, of
Edinburgh.  It is a  clear liquid of  an exceedingly  hot,  burning,
sweetish taste, of a rather agreeable odor, and is very volatile in the
presence of ordinary air.
  There are two  kinds of  chloroform, the purified  (Chloroformum
Purificatum, U. 8.) and the  commercial chloroform  (Chloroformum
Venale, U. 8., Chloroformum, B. P.)
  If exposed to the light for any length of time chloroform develops
hydrochloric acid and certain gases which render it unfit for use.  If im-
pure because of improper methods of manufacture, an oily odor will be left
on the hand after evaporation takes place. Under these circumstances
the methods of purification directed by the U 8. P. should be followed in 
134
DRUGS.
order to avoid untoward effects.  Even these methods, however, do not
give us of necessity a  perfectly pure chloroform.   The  methods and
researches now carried out by Pictet probably give us the safest and
purest article.
  According to a number of recent studies chloroform vapor in the
presence of gas  flame  undergoes  certain changes which result in the
development  of  noxious and  irritating fumes consisting principally of
hydrochloric  acid.
  Physiological Action.—Locally applied to the skin, chloroform may
produce some tingling  and  burning, even if evaporation be not inter-
fered with.   If  it be confined under a watch-glass on the skin it will
cause a blister and act  as a counter-irritant.
  When inhaled, chloroform produces a sensation of warmth in the
mouth and throat, a feeling of relaxation, and finally unconsciousness.
The respirations are at first full and deep, but soon become more rapid
and shallow.  The pulse may be somewhat stronger and fuller for a
short interval, but soon fails in  strength  and becomes more rapid.
The irritation produced in the air-passages by its inhalation is very
slight, and no primary arrest of respiration ensues, as is generally seen
after ether is first given.   The pupils are at first slightly dilated, but
are contracted during anaesthesia.   If the pupils dilate during the use of
chloroform, after the contraction  just named, danger is imminent, and
death may suddenly occur.  In some persons the first effects of chloro-
form are violent struggles, and there is danger in trying to overcome
these struggles by pushing the drug very rapidly.   This is particularly
apt to be the case in athletes  and drunkards.   Total  muscular relaxa-
tion should never be caused by the drug.
  Nervous  System.—Chloroform  first affects the brain,  then the
sensory part  of the spinal cord, then the motor tract of the cord, then
the  sensory  paths of  the medulla oblongata,  and finally the motor
portion of the medulla, thereby producing death from failure  of res-
piration unless the  heart has already succumbed to the drug.   On the
sensory and motor  nerves, when  locally applied, it acts  as an  irritant
and anaesthetic.   Upon these trunks, when taken by  inhalation, it has
little effect.
  Circulation.—Chloroform may, during the first few moments of
its  inhalation, have a slight stimulant effect on the circulation, but  its
dominant effect is depressant, and  it is iu overdose a  powerful  cardiac
poison, first  dilating the ventricles and then absolutely paralyzing the
contractility of the heart muscle.   It either kills by heart or respiratory
paralysis, or  both functions  cease  simultaneously.   McWilliams has
found that dilatation of the heart occurs to an appreciable extent, even if
the chloroform is gently administered and mixed with an abundance of
air.  Both sides of the heart are equally affected and the dilatation of
the  heart causes failure of the  circulation before the  cardiac move-
ments entirely cease.
  Blood.—Upon  the blood  in the body chloroform has little or no
effect when it is inhaled.  ShaKen with chloroform  in a bowl  outside
the body the blood becomes scarlet in hue. 
chloroform.
135
   Respiration.—Iu  small amount chloroform may not be a respir-
atory depressant, but in full dose it  certainly acts'as such.   Death
from chloroform may be from either respiratory or cardiac failure,
often from both.1
   Temperature.—Chloroform when taken by inhalation distinctly
lowers the bodily temperature, probably by aiding in the dissipation of
heat and by its action on the nervous mechanism of  heat production.
   Elimination takes  place by the lungs  and by  the kidueys, and
goes ou very rapidly owing to the great volatility of the drug.
   If large  amounts are eliminated  by the  kidueys, these  organs are
apt to become  irritated and  inflamed.
   Antiseptic  Power. — Salkowski  has   investigated,  after  Koch's
methods, the degree to which chloroform-water acts upon microorgan-
isms.  He has also used chloroform for some years  to  prevent urine
from decomposing  before he had time to examine  it.    Chloroform
prevents all fermentations which depend  upon the  growth of micro-
organisms—e. g., alcoholic  fermentation, ammoniacal fermentation of
urine, conversion of hippuric acid by fermentation into benzoic acid
and glycocol, lactic acid fermentation, and  the putrefaction of albu-
mins—but it has no action  on  those processes caused by unorganized
ferments, as ptvalin, pepsin, etc.
   Chloroform-water may be used to prepare solutions for subcuta-
neous injections and  be given internally in diseases of the digestive
organs depending on the presence of microorganisms—among others,
cholera.   Possibly the benefit that many patients derive from stomachic
mixtures  which contain chloroform-water is due  to  its  destructive
action on various  microorganisms.  Salkowski gave a dog 200 cubic
centimetres (about 6J  ounces) of chloroform-water with its food for
four  days without producing any ill  effect, so  that  in  the treatmeut
of a  disease like cholera large  quantities of chloroform-water  might
be given.   It may also be employed as a mouth-wash.2
   Untoward Effects.—Sometimes during the administration of chloro-
form the heart or respiration suddenly cease to act, and  m  some cases
this change is preceded by a peculiar shade or cloud which passes over
the face of the  patient.   Death often comes suddenly aud without
any warning.   If untoward effects appear the  anaesthetic  must be at
once withdrawn and artificial respiration  resorted to.3   Injections of

  1 For a complete study and series of experiments concerning the effect of chloroform
see the reports of the Hyderabad Chloroform Commission, and also a paper by Wood
and Hare, Medical News, Feb.  22,  1890; one  by McWilliams, British Medical
Journal, Oct. 25, 1890, and one by J. C- Reeve, Medical News, vol lvii, 1890.
  2 Chloroform-water is to be made by adding 1 fluidrachm of chloroform to 25
ounces of distilled water. The mixture is then put in a well-stoppered bottle and
shaken thoroughly until the chloroform is dissolved in the water. The dose is gener-
ally j to 2 ounces
  3 While few text-books give any specific directions concerning the practical applica-
tion of the methods which are to  be employed in such emergencies, those that do so
force the physician to a procedure at once dangerous and impractical; for the direc-
tions usually given are, to place the positive pole of the battery on the phrenic nerve
as  it crosses  the  anterior scalene muscle at the root of the neck, the negative pole
being pressed against the lower margin of the ribs.  A rapidly interrupted current is 
136
drugs.
ether and hot brandy should be given beneath the skin, and the  poles
of a  battery with a rapidly interrupted  current swept over  the  body,
but  not held over the phrenic nerve and diaphragm.   The  patient
must be held  head downward, so that  the  blood will flow to  the
brain, and external heat should be applied.   Atropine,  strychnine,
and  digitalis may be used to stimulate the heart and  respiration.  Of
these  strychnine is  the most  valuable.   (See directions  under  the
article on Ether.)
   The measures adopted  for resuscitation should not be stopped for at
least one hour, as persons have recovered as long as this after an acci-
dent from chloroform.
   Ostertag has  found that very prolonged  inhalations of chloroform
in the lower animals produce widespread fatty degeneration.
   Therapeutics.—The first and most important use of chloroform is as
an anaesthetic, and at this point we come to a question which has been
for many years a matter of contention between different sections of the
medical profession, namely, as to whether its  use is very dangerous.
In the southern and western parts  of the United  States chloroform is
nearly always used, but in the eastern and northern portions it is rarely
employed.   Southerners  certainly seem to take chloroform better than
northerners or those living on the Atlantic coast.  It is impossible to
go into a general discussion  of the  question here ; suffice it  to state
that  even the most enthusiastic supporters of the use of chloroform
confess that  it is a more dangerous drug than ether, if carelessly  used,
and while the advantages of chloroform are many, this one  great dis-
advantage  overshadows  them  all.   The advantages are—its  more
agreeable odor and the fact that it does uot irritate the  air-passages,
owing to the small amount necessary to  cause anaesthesia, the fact that
it is  less apt to  be followed by nausea  and  vomiting, the rapidity of
its action, and the small  bulk which has to be carried by the surgeon.
Its disadvantages are—the possibility of its killing the patient  by sud-
den cardiac or respiratory  paralysis from which there  is no relief, and
the powerfully depressing influence which it exercises over the  respira-
tory centres.  Owing  to these facts these rules may be followed in
regard to chloroform and ether :
   1. Chloroform may be used whenever a large number of  persons
are  to be rapidly anaesthetized so that the surgeon  may  pass  on to
others aud save a majority of lives, even if the drug endangers a few,
as on the battle-field, where only a small bulk of anaesthetics can be
carried.
   2. Its employment is indicated in cases of Bright's disease requir-

now to be used with the purpose of causing contraction of the diaphragm by the
direct action of the electricity upon the nerve.  Even theoretically this is a possible
source of danger, and practically the writer has proved danger to be ever present under
such treatment.  The cardiac inhibitory nerves run so closely to the phrenic fibres,
and respond so readily to electrical stimulation, that it is hard to imagine how they can
escape stimulation  if a current be used of sufficient strength to excite the phrenic
nerves near by.  By practical experiment the writer has proved that inhibition of
the heart may not only be possibly brought about by this method, but that it is nearly
impossible to avoid such an effect if the phrenics are to be reached at all. 
chloroform.                      137
ing the surgeon's attention, owing to the fact that anaesthesia may be
obtained with so little chloroform that the kidneys are not irritated,
whereas  ether, because of the large  quantity necessarily used, would
irritate these organs.   Quantity for  quantity, ether is, of course, the
less irritant of the two.
  3. In  cases of  aneurism,  or great atheroma of the bloodvessels,
where the shock of an operation without anaesthesia would be a greater
danger than the use of an anaesthetic, chloroform is to be employed,
since the greater struggles caused by ether and the stimulating effect
which it has on the circulation and blood-pressure might cause vascular
rupture.
  4. In  children or adults who already have bronchitis, or who are
known to bear  ether badly, or, in other words, have an  idiosyncrasy
to that drug, chloroform may be employed.
  5. Persons who struggle violently and who  are robust and strong
are in greater danger from the use of chloroform than  the sickly and
weak, probably because the  struggles  strain the heart and  tend to
dilate its walls.
  Above all things it is necessary to remember  the fact that a person
having taken chloroform twenty times before does not show he is not
in danger on taking it the twenty-first  time, and it is also to be borne
in mind that many of the sudden deaths from chloroform have occurred
during the first inhalation of the drug, before consciousness has been
lost, and, therefore, when an accident was least  expected.
  When chloroform is given it should  be poured drop by drop upon
a folded napkin  or towel, and  the  cloth  should then be held about
three to six inches from the  mouth and  nose, so that  the vapor may
be  thoroughly mixed with air in the  proportion of  95 per cent, of
air to 5 of vapor.  The administration  must be  gradual,  as " push-
ing"  the anaesthetic is dangerous.  The quantity of  chloroform ad-
ministered  can  only be  imperfectly determined by  measuring the
amount  thrown on the  " inhaler," for during ordinary breathing one
quantity is taken, and in exaggerated breathing  much more is respired.
Increased respiration should be a signal to withdraw  the drug rather
than to push it.
  Chloroform inhalations have been recommended in excessive chorea
and in  puerperal  convulsions, and are, of course, of great service in
the reduction of hernia, owing to the  muscular relaxation produced.
Sometimes a few whiffs will put a nervous patient to sleep.  For some
unknown reason parturient women seem able to take chloroform with
more safety than men or women under other circumstances.
  Chloroform, when taken internally by  the mouth, causes a sensation
of warmth in the stomach and a hot, burning taste about the lips and
buccal mucous membrane.  In overdose it can and has produced death
when taken in this manner.  Although rarely used in internal medicine,
chloroform  in the form of the spirit of chloroform (Spiritus Chloro-
formi) is useful in cough mixtures, which are given to persons having
an irritative cough, and in cases where, through  nervousness or other 
138
DRUGS.
cause, tickling in the throat or bronchial tubes keeps the patient con-
tinually in a state of unrest.   (See Bronchitis)
   In severe whooping-cough a few drops of chloroform may be poured
on the hand of the attendant and held before the child's face.   While
the child may at first dislike the odor of the drug the relief given soon
teaches the patient its  value, and he will ask for it when he feels the
attacks coming on.   If the attack  is  prolonged and violent this is a
dangerous  treatment, owing to the strained condition of the  heart
muscle.
   In gastric  or intestinal flatulence  1 or 2 drops of pure chloroform,
or 10 to 20 drops of the spirit of chloroform, will  often give  relief.
In the treatment  of serous  diarrhea when  combined with astringents
and  opium the spirit of chloroform is most  useful,  provided that the
irritating  cause is first  removed.  In renal or  hepatic  colic a few in-
halations, not sufficient to disturb  consciousness, will  not only give
temporary but sometimes permanent relief.   Hypodermic injections of
10 to 15 drops, reaching down to a painful sciatic nerve, have been re-
commended by Bartholow.  Rubbed on the chest in the form of chloro-
form liniment this drug will sometimes prevent asthmatic attacks, but
it  ought to be most carefully  inhaled in this disease, because of the
strained condition of the right side of the heart.   In drachm  doses
chloroform has been used as a remedy for  tapeworm, but ought  never
to be so employed.
   When placed in liniments of a stimulating character chloroform is
a very useful application over  muscles affected by soreness and stiff-
ness, as in lumbago and  gout, and these liniments may also be used in
neuralgias for their local anaesthetic effect.
   Administration.—The official  preparations  of  chloroform   are  a
liniment (Linimentum Chloroformi, U. 8. and B. P.), a spirit (Spiritus
Chloroformi,  U. S. and B. P.), the  dose of which is 20  minims to 1
fluidrachm ; and  a mixture (Mistura Chloroformi, U. S.), composed of
chloroform, camphor, yolk of egg, and water, given in the dose of 2
to 4 fluidrachms.  The  B. P. recognizes, besides those  given, the fol-
lowing preparations: Aqua Chloroformi, given in the  dose of J to 2
fluidounces;  Tinctura  Chloroformi  Composita, composed of rectified
spirit, chloroform, and cardamoms, dose  20 to 00 minims; and  Tinc-
tura Chloroformi  et Morphine, dose 5 to 10 minims.


                       CHROMIC  ACID.

   Chromic Acid (Acidum Chromicum,  U. 8. and B. P.) is not a true
acid, but an anhydride, aud occurs in the form of brilliant red crystals
which are deliquescent and  possess a sour,  metallic  taste.   It should
never be mixed with sweet spirit of nitre, strong alcohol, or glycerin,
as under those  circumstances it may explode.
   Therapeutics.—Chromic  acid  is used solely as  a caustic for the
removal and destruction of growths on the skin or mucous membranes.
The liquid, resulting from its deliquescence on exposure to the air 
cimicifuga.
139
may be employed by means of a glass rod, if a very severe action is
needed.
  Dr.  J. Wm. White  has recorded a death from  the  application of
this  acid to a large number of condylomata about the buttocks  and
vulva.  Where the drug has been  swallowed the patient  should be
treated for gastro-euteritis, and dilute alkalies and lime-water be used,
as well as emetics and demulcent drinks.
  If a superficial action is desired, a solution containing 100 grains to
the ounce of water is sufficient, and for small warts and similar growths
this will be found strong; enough.
  Liquor Acidi Chromici, B. P., is composed of 1 part of acid to 3 of
water.

                       CHRYSAROBIN.

  Chrysarobin (Chrysarobinum, U. 8. and B. P.) is a mixture of the
proximate principles derived from a powder found in the  wood of the
tree  Andira Araroba, which was  originally  used  for  medicinal pur-
poses in Brazil.  In  the East  Indies  it is called  " Goa powder."
Chrysarobin is misnamed chrysophanic acid, and is a yellow, tasteless
powder, soluble in solutions of alkalies, iu acids, and in ether.
  Therapeutics.—Chrysarobin is given internally in the  dose of |- of
a grain in psoriasis and parasitic diseases of the skin, but more com-
monly is employed  externally in the  form of the official ointment
(Unguentum Chrysarobini, U. 8.  and B. P.), which is too strong for
direct use, and should be mixed with 4 or 5 parts of benzoated lard
before  application to the skin.  As the drug stains the skin a dark-
brown it ought not to be used on the face, although the discoloration
may be removed by a weak  solution of chlorinated  lime.  In psoriasis
the following may be employed :
        R.—Chrysarobini     .    .    .    .    .   •    3J-
            ^Etheris 1                          -, c.   ,
            Alcoholis}.....aa q. s. ad ft. sol.
            Collodii.......fgij.     M.
   S.—Apply to the part affected, with a brush, after a bath.
                         CIMICIFUGA.

   Cimicifuga (U.S.).  This  drug is derived from  Cimifuga Bace-
mosa, otherwise known as black cohosh or black  snake-root.  It con-
tains a resin and  a volatile  oil, upon which its medicinal  powers are
supposed to depend.  The fluid extract and tincture should always be
freshly  prepared  from  the fresh crude drug.   It is official in the B.
P. as Cimicifuge Bhizoma.
  Physiological Action.—In large doses cimicifuga paralyzes the sen-
sory side of the spinal cord, and in consequence lowers reflex activity.
It has no  effect on the nerves and  muscles.  On the circulation the
drug acts  by depressing the heart and vasomotor system.  Death is 
140                          DRUGS.
due to respiratory arrest.  In small dose it is a cardiac stimulant.   In
overdose it nearly always produces frontal headache.
  Therapeutics.—Cimicifuga is, after arsenic, the best remedy we have
for chorea, particularly if the patient is otherwise in good health, but
it should be used with careful attention to the bowels and often be
accompanied by iron.   In  chronic bronchitis it  is asserted to be of
value, and in rheumatism of  a subacute or chronic type  cimicifuga
sometimes gives relief.
  Cimicifuga has been highly praised in the treatment of neuralgia,
particularly  of the ovarian type, and  in  amenorrhea, subinvolution,
and  tenderness of the womb.   To women who  state that they cannot
step  off a step without paining or hurting the uterus or ovaries, cimici-
fuga often gives relief.  Some writers assert that it is an  efficient  and
active heart tonic in cases  of fatty and  irritable heart when digitalis
fails.   There can be no doubt that it is a powerful uterine stimulant,
and it ought not to be used  during pregnancy for fear  of abortion.
By reason of this power it may be employed instead of  ergot during
labor, and is better in some  cases, because  it produces  normal,  not
tonic contractions.  In the treatment of headache, arising from over-
straining of  the eyes in study, cimicifuga is said to do good.
  The drug is official  in the form  of  the  fluid extract (Extractum
Cimicifuge Fluidum,  U. S.  and B. P.), the dose of whicli is 10 to 30
drops, or even 1  drachm, and the tincture (Tinctura Cimicifuge, U. S.
aud  B. P.), the dose of which is 1  to 2 drachms.


                          CINCHONA.

   Cinchona, U. S., is a name  applied to the bark of all the trees be-
longing to the  genus Cinchona, provided they contain as much  as 2
per cent, of the alkaloid quinine.  The same barks are included under
the  name of Cinchona Cortex, in the B. P.  There  are thirty-one
species of this genus, but only a  comparatively small number can be
included in the list of 2 per cent,  of obtainable  alkaloid.  These are
the Cinchona Calisaya, or Cinchona Flava, U. 8., whicli  contains the
most quinine, the Cinchona Condominea, Cinchona  Micrantha, Cin-
chona Succiruba, or Cinchona Rubra, U. 8.,  Cinchona  Bubra Cortex,
B. P., and Cinchona Pitayensis.  The first is called yellow bark, the
second pale bark, the fourth red bark.   The alkaloids  of the  quinine
series derived from these barks are  quinine or quinina,  quinidine or
quinidiua, and quinicine, which is an artificial alkaloid.   Of  the cin-
chonine series we  have cinchonine (Cinchonina, U.  S.), cinchonidine
(Cinchonidine Sulphas, U. S. and B. P.), and cinchonicine, which last
is also an artificial alkaloid.   Besides these alkaloids we have present
kinic and kinovic acids and other inert and useless substances.
   As quinina is  the most important of the group, and as its  physio-
logical  action is virtually  identical with the rest, whatever is  said
hereafter  in this  article  refers  to quinine  unless it  is  otherwise
stated. 
CINCHONA.                        141
  Physiological Action.—When quinine is taken in overdose it causes
ringing in the ears, dizziness, disorders of taste and smell, disturbance
of vision in some cases, and  fulness in the head.   Deafness often
comes  on, and is  generally, with the roaring in  the ears, the most
pressing symntom.   Headache is not uncommon.
  Nervous  System.—Upon the cerebrum  quinine  acts as a stimu-
lant, and, finally,  as a  congestant, if given in excessive  dose.   If
poisonous doses  are used  intense  cerebral  congestion  ensues, and,
finally, unconsciousness comes on.  On the spinal cord the drug first
causes  a decrease in reflex action by stimulating Setschenow's reflex
inhibitory centre,  and,  finally,  by depressing  the spinal  cord and
nerves.  The latter changes occur only after poisonous doses.
  Circulation.—If quinine, even in small amount, be injected into
the jugular vein of a dog,  so that it goes in concentrated form to the
heart,  cardiac paralysis will result.   If this  does  not occur the drug
decreases pulse-force, rate, and arterial pressure.   In minute doses the
drug acts as  a general stimulaut to the  entire body and  so supports
the circulation.
  Blood.—The blood  after poisouous doses  is more coagulable than
normal, but in medicinal amounts no such effect is  produced.  The
movement of the white  blood-cells through the walls of the  capillaries
in inflamed areas is checked by large doses of quinine, aud  medicinal
amounts increase the number of the  red  blood-corpuscles very mate-
rially.    It is said that  quinine prevents the oxygen-bearing powers
of the corpuscles, but this probably does not occur  from  medicinal
doses.
  Respiration.—Upon respiration quinine acts as  a slight stimu-
lant in small doses, but as  a marked depressant in poisonous amounts,
death being most commonly due to failure of respiration if it be taken
by the stomach in lethal dose.
  Temperature.—Quinine lowers bodily temperature in health very
little if at all,  and in fevered states its influence is governed by the
cause of the fever.   Thus  in malarial fevers quinine is a  very power-
ful antipyretic.
  In fever before  crisis quinine  is of little service, but in  that after
crisis it causes  a rapid fall.
  As an antiseptic quinine has considerable power.
  Quinine is absorbed from the  stomach, not from the intestine, and
it is precipitated by the alkaline juices of the  bowel.
  Kidneys, Elimination, and  Tissue-waste.—Quinine escapes
from  the body chiefly through the kidneys,  although much of it is
destroyed by oxidation iu  the liver and tissues.   The process of  ex-
cretion of quinine  is by no means rapid  so far as the entire quantity
to be  eliminated is concerned.   While  it may in rare  instances  be
found  in the urine in fifteen minutes from the time-it is given, it does
not disappear from this secretion  for about  twenty-four hours.  In
the urine it  is found as quinine and as dihydroxyl quinine.
  Upon tissue-waste quinine acts as a depressant and decreases the
elimination of  nitrogenous materials. 
142                         DRUGS.
  Poisoning and Untoward Effects.—Severe poisoning so seldom occurs
as the result of the ingestion of overdoses of quinine that untoward effects
is the best term with which to qualify the disagreeable symptoms which
sometimes come on in persons having an idiosyncrasy to the drug, and
who are  in reality poisoned by small doses.   In these cases  sudden,
complete, but temporary blindness is often met with.   De  Schwcinitz
has  shown that in  dogs quinine produces in toxic doses  permanent
optic atrophy and thrombosis of the central vein of  the retina.   He
believes that the drug produces local changes in the vessels of the eye
(endo-vasculitis.)  In other instances complete deafness asserts itself,
due to congestion of the middle ear, while  skin eruptions, generally of
the nature  of  erythema,  are not rarely  seen.   After lethal doses
haemorrhage  into the  middle ear may be  found, and  severe  epistaxis
may ensue after so small a dose as 4 grains.  The buzzing in  the ears
can generally be put aside  by 10 grains of bromide of sodium with a
little ergot.   Karamitsas has proved that quinine may produce haema-
globinuria in persons suffering from malarial  poisoning, and may  even
develop bilious remittent fever.
  Therapeutics.—This  drug is  employed in medicine to  fulfil  four
great offices,  although its  influence in other  directions is  hardly less
powerful.  These are as an anti-periodic or anti-malarial,  as  an anti-
pyretic, as a tonic possessing peculiar  virtues, and as a stimulant to the
parturient uterus.
  For many years physicians were forced to  employ this drug empiri-
cally,  not knowing the cause of the disease process  called  malaria.
We now know that the theory of Binz, offered as long ago  as  1867, is
correct, and that malaria is due to the presence of a germ, the  plasmo-
dium malariae, which  was first  accurately studied by Laveran, and
named by Marchiafava and Celli.  These and other investigators  have
found  that quinine acts as  an active poison to these germs,  even in  so
weak a solution as 1 to 20,000.
  For the reasons given  in the preceding paragraph, quinine is the
best remedy  we have for malarial fever, as a prophylactic and cure,
and it should be given in  doses which are indicated by the  state of the
patient.   (See Malarial Fever.)   It should always be preceded  by a
purge  having an hepatic action, if this is  possible.   This  fact is par-
ticularly important in bilious or  remittent fever.   The drug should  be
given in hourly doses or iu one or two large  doses  in such a way that
its influence is fully felt, not at the time of the expected paroxysm, but
about an  hour or thirty minutes  before that time.   If the paroxysm is
near at hand, the drug should be given in solution, bitter though it be,
in acidulated water.
  Asa prophylactic against malaria the dose of quinine should  be 2
to 4 grains, or more, three times a day.
  In malarial cachexia or  haemorrhagic malarial  fever, quinine gener-
ally does  more  harm  than good.   Under  such circumstances the
danger in using quinine consists in irritating the engorged  kidneys
after the chill has passed  by.   The quinine is not a haemostatic, and 
CINCHONA.
143
only does good in malarial haematuria by preventing  the paroxysm
which will produce  the bloody  urine.  To give  quinine after  this
symptom appears is  to "lock the door after the horse is stolen."   In
haematuria occurring from chronic malarial poisoning without a chill
quinine is of no value.1
  In pernicious malarial fever quinine should be given by the mouth,
by the rectum and hypodermically, as much as 60  to 70 grains being
used at a dose.   In brow ague or malarial neuralgia quinine often acts
most usefully, and this is also true in some cases of ordinary nerve-
pain not dependent upon a specific disease.
  For the reduction  of the pyrexia of typhus or typhoid fever, quinine
will be found inferior to the  new antipyretics, even when given in very
large  dose, and ought to be used very rarely.   It will seldom cause a
fall of temperature  before crisis or lysis, but will aid in the  fall very
actively after these changes have occurred.
  As a  tonic quinine  is not only a simple bitter, but also  seems to
have a direct effect in increasing the number of the red  blood-corpus-
cles.  The tonic dose should be 1 to 2 grains three times a day.
  In  parturient women the  drug  undoubtedly aids in the expulsion
of the child by stimulating the uterine contractions, either by a direct
influence  over  the uterus, or by supporting the system.   Its use  is
particularly indicated  in  cases where  the  pains have ceased because
of exhaustion from prolonged labor.   The dose should be 10  to 20
grains dissolved  in  water iu order that  immediate absorption  may
occur.   Quinine  will not of  itself  cause abortion.
  In the lobar pneumonia of children quinine should be used in  sup-
positories in the dose of 2 grains three times a day.
  In cases where prolonged mental or physical strain is to be undergone,
quinine in the dose of 2 to 4 grains will often prevent exhaustion and
support the system.
  Used in solution in the form of  a spray by the atomizer, quinine is
of undoubted service in whooping-cough, and  will  often  prevent the
spread of the disease to other children if  they be subjected to its use.
The solution should  contain  from  1 to 2  grains to the ounce and be
employed every few  hours.   It  is  well to remember that quinine  is
not tasted by the tip of the tongue, but is tasted by the back portion.
The tip  of the atomizer should therefore be carried well back of the
root of this organ and a 1 per cent, solution of cocaine painted  over
the dorsum of the tongue in cases  where  the disagreeable  taste of the
quinine  is objected  to very strongly.   The same solution of quinine
used, by means of an atomizer, in colds in the head and in fetid sore-
throat is often of service.
  A very much more agreeable method of pursuing this treatment in
whooping-cough is to give the patient the so-called quinine chocolates,
which are made of 1 grain of tanuate of quinine and chocolate.  They
do not taste of quinine at all, if  well made.   Several prominent drug

  1 See collective investigation of this subject by the author in Therapeutic Gazette,,
for July, 1892. 
144
DRUGS.
firms manufacture these chocolates.   One  or two may  be allowed  to
dissolve in the child's mouth three times a day.
  Administration.—Quinine  ought never to be given in solution if
it can  be avoided, because of its  disagreeable taste.   In adults and
children  it  should be used preferably in small  capsules  and in pills,
which may be gelatin- or  sugar-coated.  Care should  be taken  that
the gelatin is thin aud  the sugar not hardened by age, for if the pill
escapes into the intestine the quinine is precipitated and not absorbed.
If the case is that of a child too young to take a pill, the drug may  be
given in the following manner without tasting very disagreeably :
         B.—Quininse sulph.......grxvj.
             Ext. glycyrrhiz......       3J-
             Syrupi aurantii cort. vel syrupi zingiberis vel
               yerba santi......f^ij-    M.
    S.—A teaspoonful t. d. for a child of three years.

  In some  cases quinine chocolates may be used, but  unless they are '
well made the after-taste  of quinine is well  marked.   When they are
used the  tannate of quinine should always be placed in them.  In
other cases quinine may be used  in the suppository iu the dose of 2 to
3 grains,  care being taken that irritation of the rectum does not  ensue.
  For hypodermic use the bisulphate of quinine (Quinine Bisulphas,
 U.  8. and B. P.) should be used  most commonly, as it is soluble  in
about 8 parts of water.   To its solution should be added a little tartaric
or sulphuric acid to prevent precipitation of the drug in the alkaline
juices of the connective tissues before it can be absorbed.  The tartaric
acid should be present in  the proportion  of about 1 grain to each 5
grains of the quinine.   If sulphuric acid is employed  10  grains  of
the sulphate of quinine should be added to a drachm of water aud the
acid added, drop by drop, until the salt is dissolved.  The hydro-
bromate of quinine (Quinine Hydrobromas, U. 8.), the solubility of
which is about  1 to 16 of water, may also be used hypodermically, as
may also the  bimuriate of quinine  and urea  (Quinine  Bimuriatica
 Carbamas), which, however, is  scarcely more than  half  as  strong in
quinine as the other salts.  The hydrochlorate of quinine is also a use-
ful salt for hypodermic use, and is the strongest in alkaloid.  It may
be employed in the following manner :
          R.—Quininse hydrochlorat. .....   gr. vij.
             Glycerini   \                           ,       Af
             Aquae dest. /.....aa  t^ss.    At.
    S—Warm solution before using it and do not add acid.
           R.—Quininse hydrochlorat.....gr  xv.
               Alcoholis    ......   Tflxv.
               Aquae dest.......f 3Jss.    M.
    S.—Add a few drops of hydrochloric acid to complete the solution before using.

  The best place to give the hypodermic  injection is  in the buttock
between the trochanter aud the tuberosity of the ischium.  Injections
into the calf of the leg are very painful. 
CINCHONA.
145
   In Italy Baccelli has resorted to the intravenous injection of quinine
 in pressing cases.  He employs the following solutiou for this purpose:

          R -—Quininae hydrochlorat.....gr. xv.
              Sodii chloridi......gr. xij.
              Aquae dest.......f^yss.    M.
    S —This should be injected, after distilled water is added to it, into a vein of
 the leg rather than into a vein of the arm, to avoid too great an effect on the heart,
 and the solution should be boiled and filtered before using, and used while warm.

   As quinine in concentrated form is a powerful heart  depressant, the
 injection should be given very slowly indeed when intravenous methods
 are employed.
   Valerianate  of quinine  (Quinine Valerianae, U. 8.) is given in  1
 to 2 grain doses,  and the hydrochlorate (Quinine Hydrochloras, U. 8.
 and B. P.) in the dose of  1 to 10 grains.  The alkaloids of cinchona
 other than quinine which are commonly used in medicine are cinchoni-
 dine, cinchonine,  quinidiue, and  chinoidium.  Cullen, Sinkler, and
 De Brun have  all found the sulphate of  cinchonidine very useful in
 malaria, and  it is less bitter and more soluble than is quinine.   Sinkler
 states that it does not produce the severe  head symptoms caused by
 quinine.
   The dose of quinidine  sulphate (Quinidine Sulphas,  U. S.) is about
 twice that  of quinine, as is also that of cinchonine sulphate (Cincho-
 nine Sulphas, U. S. and B. P.) and  cinchonidine  sulphate (Cinchoni-
 dina Sulphas, U. S. and  B. P.).   The tannate of quinine is a salt not
 so bitter as the other salts and is weaker in relative alkaloidal  strength.
 One grain of the  tannate equals about  one-fourth  of a grain of pure
 alkaloid.  The bisulphate  equals  about two-thirds and the sulphate
 three-cpiarters of a grain  of the pure alkaloid.
   Chinoidinum is a resinous mass obtained  in the preparation of the
 alkaloids of cinchona, and contains amorphous alkaloids.  It possesses
 distinct  anti-periodic power and may be used freely where cost  is a
 matter of importance.   Its  dose is  3 or 4 times that of quinine.
   The liquid  preparations of cinchona are  the infusion  (Infusum Cin-
 chone,  U.S.), dose a wineglassful; the  tincture (Tinctura Cinchone,
 U S. and B.  P.), one to two teaspoonfuls; and the compound tinc-
 ture (Tinctura Cinchone  Composita, U 8.  and B. P.),  a teaspoonful
 to a tablespoonful.  Under the name of elixir roborans or Whytt's
 tincture, a similar mixture is employed for precisely the same purposes.
 Huxham's tincture is a  most efficient and elegant bitter tonic in debility
 aud  convalescence from  low  fevers.   It  is  too weak to be used in
 malarial poisoning.  The other liquid preparation  is the fluid extract
 (Extractum Cinchone Iluidum, U. S. and B. P.),  dose  5 to 15 drops.
 A solid extract  (Extractum  Cinchone, U 8.) is also official in the dose
 of 5 to 10 grains.  The B.  P. preparations not official in the U. 8. P.
are as follows  : Decoctum Cinchone, dose 1  to 2 fluidounces ;  Infusum
 Cinchone Acidum, dose 1  to 2  fluidounces;  Tinctura  Quinine Am-
moniata, dose  \  to 2 fluidrachms ;  Vinum Quinine, dose \ to 1 fluid-
ounce.
                                10 
146
DRUGS.
  Contra-indications.—Quinine is contra-indicated in gastritis, cyst-
itis, meningitis,  epilepsy,  cerebritis, middle-ear disease, and in those
cases which have an idiosyncrasy to its action.


                         CINNAMON.

  Cinnamon  (Cinnamomum,  U 8., Cinnamomum Cortex, B. P.) is the
inner bark of the Cinnamomum Zeylanicum, a native of Ceylon, or of
the species indigenous to China.   It contains a volatile oil and tannic
acid.   In overdose the oil acts as a soporific,  and kills by failure of
respiration.
  Therapeutics.—Cinnamon  is used, as are all the drugs of its class,
for flavoring, as a carminative, and as an intestinal stimulant in serous
diarrheas.   It has the peculiar  power of acting as a haemostatic in
uterine hemorrhage where the flow is oozing and not active, thereby
differing from  the  other volatile  oils, with the exception of that of
erigeron.
  Administration.—The dose of the oil (Oleum Cinnamomi, U. 8. and
B. P.) is 1  to 5 drops; of  the  water (Aqua  Cinnamomi,  U. 8. and
B. P.) a wineglassful or less ; of the spirit (Spiritus Cinnamomi, IT. S.
and B. P.) 5 to 30 drops; of the tincture (Tinctura Cinnamomi, U. S.
and B. P.) J to 1 drachm.  Under the name  of Pulvis Aromaticus,
 U.  S.  (Pulvis Cinnamomi Compositus, B. P.),  a carminative powder,
consisting  of cinnamon 35 parts, nutmegs 15  parts, cardamoms 15
parts, and ginger  35  parts, is official.   It  is useful in the  treatment
of the  flatulence of adults and children.   The latter should take about
10 grains at  a dose, an adult 30 grains.


                 CITRATE OF POTASSIUM.

  Citrate of  Potassium (Potassii Citras, U. 8. and B.  P.) is a white,
granular, deliquescent salt, almost  neutral in reaction and very soluble
in water.   It is by far the most agreeable of all the salts of potassium
to the taste.   In  the early stages of bronchitis it is  of the  greatest
value when combined with ipecac  (see Bronchitis), and it is also use-
ful as an alkaline diuretic.  In bronchitis the dose should be 20 grains
every four hours, and in urinary incontinence due to acid and concen-
trated  urine the dose  should be equally large.
  Under the name of neutral  mixture (Mistura Potassii  Citratis,
 U.  8.), made by adding to 1 pint of lemon-juice enough bicarbonate
of potassium to neutralize it, we have a useful febrifuge drink in fevers,
particularly those of childhood.   The dose is J to 1 ounce every few
hours.
  Liquor Potassii Citratis, U. S., is made in the same manner as is the
neutral mixture, except that  citric acid is substituted for the lemon-
juice (citric acid 720  grains, potassium bicarbonate  960 grains, and
water 24  ounces). 
CLOVES.
147
  Neutral mixture is the better preparation of the two, but more ex-
pensive.  A  very refreshing and agreeable way of  prescribing this
drug  is iu  the form of " effervescing draught," made by mixing two
solutions which are  prepared as  follows :  1. Lemon-juice and water,
equal parts, enough  to make 4 ounces.  2. Bicarbonate of potassium
1 drachm, aud water 3 ounces.  These solutions  are  to be mixed in
the quantities desired and taken while effervescing.   If lemon-juice is
not at hand, a solution of citric acid of the strength of 2 drachms to
4 ounces of water should be employed in its stead.


                        CITRIC  ACID.

  Citric  Acid (Acidum  Citricum,  U. S. and  B.  P.)  is  chemically
identical  with the acid of the  lemon, but has not identical influences
over the  body with lemon-juice.
  Not only does the lemon owe its acidity to this acid, but most of
the other edible  fruits, such as  strawberries and raspberries, depend
upon its  presence for their acidity.
  Therapeutics.—Citric  acid is  used in scurvy or scorbutus as a pro-
phylactic and cure.   For  some  unknown reason pure  lemon-juice
seems to  benefit these cases more  thau citric acid itself, and it is, there-
fore, to be preferred  to the latter whenever it  can be had.  In order
to keep lemon-juice from decomposition on long voyages, it should be
boiled, and poured while hot into bottles until it nearly reaches to the
cork; the remaining space is then filled with a thin layer of sweet oil
and the bottle corked and stood upright.  Under these circumstances
the juice  may be kept iudefinitely.
  In some cases lemon-juice or lemonade will cause indigestion and a
sensation of weight in the  stomach ; particularly is this the case with
the sick.   This is due to the presence of soluble irritant albuminoids,
which should be precipitated by boiling the lemonade, decanting the
solution  on cooling, and leaving the precipitate to be thrown away.
If the supernatant liquid is cooled and properly sweetened  it is almost
as agreeable as the fresh juice and devoid of irritant power.
  In rheumatism, either  acute or  chronic, lemon-juice  may be em-
ployed in the dose of 1 to 2 ounces  four times a day, well diluted, or
2 drachms of citric  acid may be given.  The acid is also of value in
hepatic inactivity and catarrhal jaundice.  (See Citrate of Potassium.)
  The preparations  containing  citric acid are Syrupus Acidi Citrici,
U  S., Succus Limonis, B. P., and Syrupus Limonis,  B. P.


                            CLOVES.

  Cloves (Caryophyllus,  U.  S., Caryophyllum, B. P.) are  the unex-
panded flowers of the Eugenia Caryophyllata, a plant of the East and
West Indies.   They possess an aromatic odor and  the  pungent  taste
of a  typical  spice.   They  contain  a volatile oil (Oleum Caryophylli, 
148
DRUGS.
 U. 8. and B. P.), which is yellow when fresh, but very dark colored
 when old.
   Therapeutics.—Cloves,  or their oil, are used  in  medicine for the
 purpose of acting as a carminative.   They are  also employed  as  a
 stimulant and tonic to the  stomach to prevent griping during an attack
 of diarrhea or that caused by purgatives, to  act as a flavoring agent,
 as a counter-irritant, and, finally, as a parasiticide  and local anesthetic.
   Like all volatile oils, this oil  is an  efficient local application for
 pediculis pubis and similar parasites, and it may be used in toothache
 because of its anaesthetic powers if placed on a pledget of cotton in the
 cavity of a tooth.   In the treatment of myalgia or muscular rheu-
 matism oil of cloves  is often  placed in  the liniment for  its counter-
 irritant effect.  In overdose it acts as a  soporific and kills by failure
 of respiration and the production of marked gastro-enteritis.   Minute
 doses of J to 1 drop of the oil  in a little water will sometimes control
 excessive  vomitiug.   In addition to the oil the B. P. has an official
 infusion, Infusum Caryophylli,  the dose of which is 1 to 2 fluidounces.


                    COCA AND COCAINE.

   Cocaine is the alkaloid derived from Erythroxylon  Coca,  a shrub of
 Peru and  Bolivia.  A secoud alkaloid, known as Ecgonine, has en-
 tirely different powers.  It is  to  be distinctly understood  that Ery-
 throxylon  Coca is  not the same as chocolate, or Theobroma Cacao.
 Erythroxylon Coca is official in the B. P. as Coca and in the U. 8. P.
 as Erythroxylon.
   Physiological Action.—Coca and its  alkaloid cocaine, when taken
 internally, produce a sense of exhilaration and pleasure.   Often the
 amount of muscular and mental power is temporarily increased under
 their influence.  When locally applied to a mucous membrane cocaine
 causes a blanching followed by marked congestion.
   Nervous System.—The dominant action  of cocaine, when locally
 applied, is to  paralyze the  peripheral sensory nerves.   When  taken
 internally it stimulates the brain to an extraordinary degree, but ex-
 ercises no  effect upon the sensory  nerves.  Sometimes  its internal use
 produces a decrease of sensation which Mosso believes to be due to an
 influence on the spinal cord.  This effect is, however, very feeble.  If the
dose be a poisonous one, convulsions of cerebral origin ensue, and are
clonic in type.
   The sensory nerves are paralyzed by enormous doses, both when the
drug is directly applied or  when it is taken internally.
   Upon the muscles, when taken  internally, Mosso has proved  the
drug to be a direct stimulant, and it is particularly active after starva-
tion or fatigue.
   Circulation.—Cocaine acts as  a stimulant  to the heart and  cir-
culation in moderate amounts, but its effects are not marked except in
poisonous dose. 
COCA  AND  COCAINE.
149
  Respiration.—The drug acts as a powerful respiratory stimulant,
producing in large dose a great increase in the rapidity of the respira-
tory movements.
  Temperature.—Cocaine raises  bodily temperature to a very ex-
traordinary degree  if given in overdose, this rise being due  to an
increase of heat-production.  (Reichert.)  In moderate amounts it has
no effect.
  Kidneys, Elimination, and Tissue-waste.—The drug is elimi-
nated by  the kidneys, but is  chiefly destroyed by oxidation in the
body.  The quantity of urine  passed is increased under its influence,
and the  nitrogenous  elements eliminated  in  this fluid are a  little
diminished.
  Eye.—Owing to its powerful action as a local  anaesthetic, cocaine
has  been used  largely in diseases  of the eye.   The anaesthesia comes
on in from one to five minutes after the use of  the drug, according to
the strength of the solution used, and is accompanied by very marked
dilatation of the pupil.  It is important to remember that this dilata-
tion, unlike that produced by mydriatics such as atropine, does not
paralyze accommodation.   The dilatation of the  pupil is due to  a
peripheral stimulation of the sympathetic nerve.   The drug does not
cause a forcible mydriasis, and is never used for the prevention of adhe-
sions in iritis.
  Therapeutics.—Cocaine hydrochlorate (Cocaince Hydrochloras, B.P.)
is used as an anaesthetic in the eye in the dose of from 3 to 5 or more
drops of from a 1 to a 4 per cent, solution.   The  strength of 2 and 3
per cent, is perhaps most commonly employed.
  The conditions indicating its use are all operations upon the eye of
a painful character, be they what they may, and it is also to be used
for the relief of pain when an acute inflammation or foreign body  is
causing suffering.
  The following formula will be found useful in these states:

        R.—Cocain. hydrochlor.......gr. viij.
             Acid, boric........gr. vij-
             Aquae dest.   .   .   .   .   .    .    .  f%')■   M.
    S.—Use with a dropper in the eye every hour until relieved.

  Cases are recorded in which  cocaine has caused  permanent corneal
opacities.
  Where enucleation of the eyeball is to be  practised the drug should
be replaced by general anaesthetics, but cocaine may be used if it  is
injected deeply around the eyeball.
  Owing to the density of the mucous membranes of the vagina and
rectum, cocaine has little effect upon them unless used in 10 per cent.
solution and profusely applied.  In the  mouth cocaine may be used
in cases  of stomatitis where a spot is to be cauterized, in pharyngitis
and in soreness and tenderness of  the gums.   While it gives much
temporary relief in  pharyngitis the subsequent effects are often ex-
ceedingly disagreeable, the  congestion looking more angry and being
more painful than before,  and the experience of  the writer indicates 
150
DRUGS.
that it will only act in a curative manner if applied before the capil-
laries  become relaxed  or paralyzed  by the  severity of the inflamma-
tory process.  In coryza and hay fever a powder consisting of cocaine,
morphine, and bismuth in the proportion of one part each of the two
alkaloids  and five  parts of  the bismuth will often be of service  if
snuffed up into  the nostrils.   If cocaine  be applied to a large nerve-
trunk, amputation  of  the tributary  limb may be performed  without
pain, but  so large an amount of the  drug must be used that  there  is
great danger of  poisoning the patient.
   Cocaine is  generally used at present in the place of ether in cases
requiring amputation of the fingers, or in cases of minor surgery  where
the drug can be  confined to the part  injured.  A tight cord should be
bound around the  base of the  finger aud a 4 to 8 per cent, solution
injected into the part, a ligature about the base of the digit  being
used to prevent  haemorrhage aud the systemic absorption of the drug.
After the  operatiou is concluded slight haemorrhage should be allowed
to occur  to  sweep out the  drug, and  thereby avoid  systemic  medi-
cation.
   Internally, cocaine  or the  fluid extract of coca  may be used as  a
supportive and  stimulant  in  low  fevers,  and in  cases  where great
physical  and  mental  strain is to be borne.  Thorington has  found
cocaine of very  great value  as a stimulant  and anti-emetic in  yellow
fever.
   Cocaine is undoubtedly of service  in the opium habit, but if largely
used soon changes the patient from a case of morphiomauia to a  "coca
fiend."  In  the vomiting of pregnancy and other  forms of excessive
emesis it is of great service by depressing the gastric sensory nerves and
thereby decreasing  the irritability of the stomach.  The dose of the
fluid extract (Extractum Erythroxyli  Fluidum, U.  8. and B. P.)  is
from | to 2 drachms.  That of cocaine from % to h grain. The other
B. P. preparation is Lamelle  Cocaine, each disc containing y^- grain
of cocaine hydrochlorate.
   A new preparation of cocaine which  is said to possess very distinct
advantages over those commonly employed is the phenate of  cocaine.
As is well known,  carbolic acid exercises, even when used alone, very
marked anaesthetic  powers aud simultaneously coagulates the albumiu
in the tissues with  whicli it comes in contact.   One of the dangers in
the employment of the hydrochlorate of cocaine is  its absorption and
the production of  poisoning.   The phenate of cocaine  is insoluble in
water and is therefore  very slowly absorbed, and in  addition coagulates
the albumin, thereby imprisoning itself.  By this means  not only are
the dangers  named avoided, but the period of auaesthesia is greatly
prolonged.  As the phenate of cocaine is soluble in  alcohol there  is
generally much  pain  when it is used hypodermically.  The  manu-
facturers  state that this may be largely avoided  by  the use  of the
following :
          R.—Cocain. phenat.......gr. 1J.
             Alcoholis.......f.^jss.
             Aquae dest........f ^jss.    M.
    S.—20 minims to be given at each injection. 
COD-LIVER oil.
151
  Whether  phenate of cocaine will  prove of much value remains to
be seen.
  Untoward Effects.—Sometimes loss of speech, blindness, nausea and
vomiting, syncope and unconsciousness, have followed the internal use
or local  application of cocaine.  Epileptiform convulsions have  also
been noted,  while the circulation and respiration have been disordered
in every posible manner.  Iu many of these cases the urine passed after
the poisoning is very limpid and contains albumen.  Curiously enough
a large number of cases of severe poisoning have followed the injection
of cocaine into the urethra  previous to some operation for the relief
of chronic gonorrhoea or stricture.


                           CODEINE.

   Codeina,  U. 8. and B. P., is an alkaloid prepared from opium, and
is often contaminated  by morphine.  Its physiological  action is very
closely allied to that  of its sister alkaloid—morphine—but it is very
much less powerful.
  Physiological Action.—Codeine resembles morphine very decidedly
in its physiological action, the  chief difference being that it  possesses
less  narcotizing power, but in large amount  more readily  produces
tetanus aud  final paralysis of the peripheral motor nerves in the lower
animals.  (Dott and Stockman.)
  Therapeutics.—Codeine has been- highly recommended in France
as a  nervous quietant, and in this country  in nervous  cough, or in
cases where the cough is  excessive  in bronchitis and phthisis.   In
diabetes mellitus some clinicians have found  it of the  greatest value,
while others have  been disappointed  in  its use.   It should, however,
always  be tried in this disease,  in the hope  that it may exercise a
favorable effect.    When given for  cough it  should  be used in the
dose of  from Ho 2  grains, generally placed iu  the  syrup of wild-
cherry bark.  Much so-called codeine consists largely of morphine.


                       COD-LIVER  OIL.

   Oleum Morrhue, U 8. and B. P., is a fixed oil obtained from the
fresh livers  of the Gadus Morrhue, or  cod fish.   There are several
species  of  cod from which the oil  is obtained other than the  one
named, but  this is the chief source of supply.  The  oil  is  pale or
dark, according to its degree of freedom from foreign materials.   Al-
though the  paler  oils are generally prescribed, there can  be   little
doubt that  the darker ones are more medicinally active. The  most
prominent inorganic  constituents of  the oil are  iodine, bromine, sul-
phuric aud  phosphoric acids.  It  also  contains more  or less of the
biliary salts.
  Physiological Action.—Cod-liver oil depends on a number of sub-
stances  for  its peculiar effect.   The iodine certainly exerts certain 
152
DRUGS.
 alterative powers aud the oil seems peculiarly adapted to digestion and
 absorption, for  cod-liver oil passes through  animal membraues very
 readily, probably owing to the biliary salts contained in it.
   It aids in the maintenance of bodily temperature by its oxidation
 and causes a deposit of fat in the tissues.  The oil also seems to influ-
 ence the  blood directly, for clinical observation shows  that  anaemic
 persons become healthy-looking  under  its use, and Cutler and Brad-
 ford have found that  this is a physiological fact  by the use of Malas-
 sez's blood-cell  counting apparatus, the red  corpuscles being always
 increased.   It  has  been  proved by experiment that this  oil is more
 readily oxidized than any other.
   The belief among physicians  that the effects of cod-liver oil are
 dependent upon some peculiar combination of substances has shown
 itself in the attempts of physiological chemists to isolate the combina-
 tion.  One of  the best results reached is the so-called " Morrhuol" of
 Chapoteau, who seems  to  have isolated  a crystalline  substance  con-
 taining phosphorus, iodine, and bromine.  Three to five grains of this
 preparation are said to represent one drachm of the pure oil, and it is
 certainly of value as a medicament in most of the  states  in which we
 use  the oil itself.  In "colds" which u hang  on" and are not  readily
 gotten rid of, morrhuol is  best given  in capsule or pill.  This sub-
 stance is put on the market in gelatin-coated pills or capsules.
   Therapeutics.—Cod-liver oil is useful in persons who have no tuber-
 cular lesion in the  lungs or other tissues, but have mucous membraues
 which are readily susceptible to disease.  This  state has  been called
 the pre-tubercular stage of phthisis.  Cod-liver oil possesses no curative
 power in cases  of well-developed  phthisis, and its administration in
 many cases only serves  to nauseate and distress the patient or  to  pro-
 duce an oily diarrhoea through failure of digestion.  It may be used
 in the early part of the disease as a food but not as a cure.   In chronic
 rheumatism the drug is often of great service, particularly if the disease
 is largely muscular.   Strumous skin lesions depending for their exist-
 ence not only upon scrofulosis but also upon anemia often yield to its
 use.  In enlargement of the lymphatic glands, where they are not under-
 going acute active suppuration, cod-liver oil does good.   This  is a
 statement requiring explanation.  By acute active suppuration is meant
 the early formation  of pus or the molecular death  of  the  parts—not
 the slow formation characterized by no active change but represented
 by cold abscess or old sores.  If the discharge is chronic the oil does
 good.  In strumous  ophthalmia cod-liver oil is of great service.  In
 advanced  syphilis cod-liver oil is most useful, and in the early stages
 of rickets  it ought always to be employed.  In marasmus, when used
 by inunction or taken  internally, if the stomach will stand it, it is one
of the best drugs we have.   If a few grains of bile-salts, consisting of
glycocholate and taurocholate of sodium, be added  to each drachm of
 oil it will  be very readily absorbed  from the skin.1

  1 These salts may be bought, or made as follows: To about 300 c.c. of ox-gall is
added nearly thrice that quantity of ordinary alcohol, and the flask shaken thoroughly.
All the mucus is now precipitated and the  supernatant  fluid is filtered. To  the fil- 
cod-liver  oil.
153
   In sciatica and lumbago and in neuralgia cod-liver oil is of service.
In emphysema of the lungs it is said to be of great value,  and certain
writers commend its use in gout, although others have asserted that it
is of no value.  Sometimes old persons, whose  digestion is not dis-
ordered and who have no  organic brain disease, complain of giddiness.
The best treatment for this condition, in many instances, is cod-liver
oil with doses of quinine; or, if these fail, wine of ergot and one of
the bromides may be used.
   Administration.—Owing to its disagreeable taste and  smell  most
patients rebel against taking cod-liver oil;  but this can, with a little
persistence, be readily overcome, so that finally the patient may not
only not object to its use but  actually like  it.  This  is particularly
true of young children.  The secret of reaching this much-to-be-desired
state lies in the use at first of doses which may be dropped into a tea-
spoon and the spoon then gently submerged in a glass  of  milk.   The
oil floats off into the  milk in a globule in the centre of the tumbler,
and if the milk  be rapidly gulped down without the oil touching the
sides of  the glass it will not be tasted.  The first gulps must be large
enough to include the  oil.  The oil  may be taken on a full stomach,
but as a general rule  it is best digested  if taken about two or  three
hours after meals, when the gastric contents are about to be passed into
the small bowel, where the oil is digested, and if it be followed in five
or ten minutes by a little pancreatin its disgestibility will be much in-
creased.   Other modes of ingestion consist in the placing of the oil in
whiskey or brandy, in the  manner which has  been described with milk,
and this method possesses the advantage that the alcohol aids very dis-
tinctly in the absorption of the oil.   Sometimes a pinch of salt placed
in the mouth before and after the oil is taken aids in covering  its taste
and in its digestion.  (See Indigestion.)   Oil of eucalyptus in  the pro-
portion of 1 to 100  of the cod-liver oil will cover the latter's taste, but
many dislike the eucalyptus more than the cod-liver oil. The addition
of an equal quantity of glycerin, with \ to 1 drop of the oil of bitter
almonds to each dose, is often  of service.  Syrup of bitter orange-peel
is one of the best covers to its  taste.   Tomato ketchup has also been
used with good results.   Chewing- a piece of smoked  herring before
and after taking the oil is of value to disguise the taste in some cases.
The oil is readily taken in soft capsules, holding from  \ to 1 drachm.
Very few people are  unable to swallow them if they are first  made
slippery by dipping them  in water.
   Cod-liver oil is most readily digested when  given in single uightly
doses after supper, or after a light meal just before going to bed. After
a few days it may be  given after dinner,  and in the course of a week
after breakfast.  If the patient is once nauseated by  overdoses it is

trate is added a large excess of sulphuric ether, and after a time a plaster-like mass
forms at the bottom of the vessel, which slowly becomes crystalline.  These crystals
are now placed on a filter paper and washed with a mixture made up of ether and
alcohol, equal parts.  The filter paper is dried and the substances  then seen are the
taurocholate and glycocholate of sodium.  Having carefully removed these salts from
the paper they are ready for use. 
154                          DRUGS.
almost impossible to make the stomach retain the oil.  If it cannot be
digested a drachm of ether aids in its absorption, or a drink of whiskey
or brandy may be used instead.
  A large number of preparations of cod-liver oil are on the  market
in emulsion, pancreatized and purified  till they are  nearly tasteless.
Many of the permanent  or  perfect emulsions contain  more Iceland
moss or  acacia  thau oil.   One of the emulsions widely advertised in
the street  cars  of  Philadelphia  as  "tasteless,"  has  been shown to
contain no  oil  at all.   The pancreatized emulsions  are the best  if
the oil is really present in sufficient quantity to do good, as the very
fact  of its being artificially  digested adds to  its value and the possi-
bility of putting more oil into the emulsion.   Oil devoid of smell  is
probably devoid of medicinal value, as all the peculiar properties have
been " purified " out of it.


                            COFFEE.

                         (See Caffeine.)
                         COLCHICUM.

   Colchicum is the corm  (Colchici Cormus, B. P.;  Colchici Badix,
 U. S.)  and  seed  (Colchici Semen,  U.S.;  Colchici  Semina,  B. P.)
of the Colchicum  Autumnale, a plant of  Europe, containing au alka-
loid, colchicine, which may be  still further changed into colchiceine.
While the drug is official in the form of the seeds and root, the former
are rarely employed.
   Physiological Action.—Colchicum is a very powerful drug,  and
when locally  applied is an  irritant to the  gastro-intestinal  mucous
membrane.
   According to the studies of one of the writer's students—Dr. Ferrer
Y. Leon—the  drug has little  or  no effect when given in moderate
dose on  the nervous system, circulation, respiration  or temperature,
only producing changes in  these parts when given in poisonous doses.
Jacobi asserts that death is produced by respiratory failure, the heart
continuing to  beat for many minutes  after respiration ceases.   The
violent  gastro-enteritis which is present  in  colchicum poisoning cer-
tainly has much to do with the fatal result in man.
   Therapeutics.—The employment of  colchicum in medicine centres
around its use in gout and similar states,  such as  chronic rheumatism
or rheumatoid arthritis.  Indeed it is almost a specific in acute  gout,
provided that it be pushed until it causes slight griping or laxity of
the bowels.   Care must  be exercised under these circumstances  that
" retrocedent gout" does not occur, owing to the manifestations of the
disease leaving the toe and going to the  internal viscera.   In  some
cases iodide of potassium should be used  in  conjunction with the col-
chicum.  This is particulary the case in subacute or chronic cases. 
COLLODION.
155
   The use of colchicum in such doses as to cause severe purgation or
 emesis is dangerous, and ought not to be resorted to.  Colchicine can
 be used successfully against gout in the dose of T-^¥ to fa of a grain.
   Poisoning.—The symptoms of poisoning by colchicum are nausea,
 griping, agony in the belly, purging followed by the passing of thick
 mucus with great aud increasing tenesmus, profuse salivation, collapse,
 and death from  exhaustion  and gastro-enteritis.   Bloody purging is
 almost never seen.  The poisoning is one  of  the most  painful, slow,
 and hopeless poisonings known, and  a  man  taking as much as an
 ounce of the wine of the root  or the seed is almost inevitably doomed
 to a terrible death.  Tannic acid may be used as a partial chemical
 antidote, and the stomach washed  out with  emetics and the stomach-
 pump.  Opium  is to be used to  relieve the pain and irritation, and
 oils are to be given  to soothe the  inflamed mucous membrane.  If
 collapse comes on, external heat and  stimulants are to be used, and
 atropine may prove of service under these circumstances.
   Administration.—Colchicum ought  never to be used  in  substance,
 but sliould be employed in the form of wine of the root (Vinum Col-
 chici Badicis, U S.)  in the dose of 10 to 20 drops, although if a
 marked effect is  required 30 drops  may be used.  The extract (Ex-
 tractum Colchici Badicis, U 8.) is given in the dose of 2 to 3 grains,
 and the fluid  extract (Extractum Colchici  Radicis  Fluidum, U. S.) in
 the dose of 2 to 4 minims.
   Of  the seeds  the tincture (Tinctura Colchici Seminis,  U.  S. and
 B. P.) is  given in 30 to 90 minim  doses ; the wine  (Vinum  Colchici
 Seminis,  U. 8.)  in the  same  amounts,  and  the  fluid extract (Ex-
 tractum Colchici  Seminis Fluidum, U. S.)in the dose of 2 to 5 drops.
 The B. P. preparations besides those given are  Vinum  Colchici, dose
 10 to 30  minims ; Extractum  Colchici, dose \ to 2  grains ; and Ex-
 tractum Colchici  Aceticum, dose J to 2 grains.


                         COLLODION.

   Collodium,  U.  8. and B. P., is a solution of gun-cotton in  alcohol
 and ether, and is a clear, syrup-like fluid, smelling strongly of ether.
   Therapeutics.—Collodion is  used as an  air-tight dressing for small
 wounds and abrasions, and  for rendering small dressings waterproof.
 A difficulty in its use consists in the  contraction which takes place as
 it dries, drawing  and puckering the part sufficiently to cause not only
 discomfort but acute pain.   It should be applied with a camel's-hair
 brush over the part affected.
   In boils when  they are beginning in a small  pustule or papule with
 an inflamed zone, collodion painted over the spot will generally abort
the disease.  If the boil  has burst,  this treatment is useless, but if it
has not  the pus  should not be liberated, but  allowed to become in-
spissated.  By this treatment and by the frequent application of a coat
or two, the trouble eventually disappears.   Of course, this  rule only
applies to certain  cases, and  if  pain is caused by the  retention  of the 
156
DRUGS.
pus it must  be evacuated with antiseptic precautions.   In smallpox
the flexible collodion may be used to prevent pitting.
  In  gouty inflammations of the joints an application of collodion
mixed with iodine, equal parts, will'  often  remove  the  pain, although
at first the suffering may be increased by this treatment.

                      Flexible Collodion.

  Flexible Collodion (Collodium Flexile, U S. and B. P.) is made by
adding turpentine 5 parts and castor oil 3 parts to ordinary collodion.
It does not contract  or  become hard, and is generally to be preferred
to ordinary collodion in the dressing of wounds.

                       Styptic Collodion.

  Styptic Collodion (Collodium Stypticum, U. S.) contains tannic acid,
and is employed to control small hemorrhages.   It is seldom used, and
its employment is a dirty way of controlling bleeding.

                    Cantharidal  Collodion.

  Cantharidal  Collodion (Collodium cum Cantharide, IT. 8.) has been
referred to under the head of Cantharides.  Collodium Vesicans, B. P.,
is identical with this preparation, and is used for the same purpose.


                         COLOCYNTH.

   Colocynthis,  U. S., is the fruit of the Citrullus Colocynlhis, a plant
at present largely  grown in all parts of the world.   It contains an
alkaloid, colocynthine, and a resin.  ^Neither of these are ever used in
medicine.  Colocynth causes large  watery evacuations, and may,  in
very  large  dose, produce  fatal  gastro-enteritis.  It is  official in  the
B. P. as  Colocynthidis Pulpa.
   Therapeutics.—Colocynth is never used alone, but always in com-
bination with other drugs of its class as a hydragogue cathartic.
   In cases of chronic dropsy or for serous effusions it is generally given
in the form of the compound extract of colocynth  (Extractum Colo-
cynthidis Compositum,  U. 8. and B. P.), which contains 16 parts of
colocynth, 50 parts  of purified aloes, 14 parts of the resin  of scam-
mony, 6 parts  of cardamom, and 4 parts of soap.   In the dose of 5 to
20 grains this acts as a powerful watery purge.  The extract (Extrac-
tum Colocynthidis, U S.) is given with other drugs in the dose of 2 to
5 grains as a purge.  The following is a useful form in which to ad-
minister it:
          R.—Extract, colocynth. comp.....gr. xxx.
             Extract, belladonnae.....gr. ij.
             Extract, nucis vomicae.....gr. ij.    M.
    Ft. in pil. no. x.  S.—One in the morning. 
CONIUM.
157
   Colocynth is one of the principal ingredients in compound cathartic
pills (Pilule Cathartice Composite, U 8.).  Each pill contains : com-
pound extract of colocynth, li grains ; abstract of jalap and calomel,
of each 1 grain ; gamboge, \ grain.
   The  preparations  of the  B. P. not official in the U. 8. P.  are :
Pilula Colocynthidis  Composita,  composed of colocynth pulp, aloes,
scammony,  sulphate  of potassium, and oil of cloves, dose 5 to  10
grains, and Pilula  Colocynthidis et Hyoscyami, dose 5 to 10 grains.


                            CONIUM.

   Conium (U. 8.) is  the leaves and fruit of the Conium Maculatum.
The plant grows  in Europe and the United States, and contains a resin
known  as coniine.   This drug is official in the B. P. as hemlock
leaves (Conii Folia) and hemlock fruit (Conii Fructus).
   Physiological  Action.—When conium is taken in very full dose  it
causes weakness  and  a sense of relaxation, giddiness, staggering, aud
disordered vision, with failure of the circulation.
   Nervous System.—Conium causes paralysis of the motor nerves,
and, if the  dose  be extraordinarily large, depression of the sensory
nerves.  Upon the spinal cord it exerts a feeble, depressing influence,
but has no positive effect, while the fact that consciousness continues
almost up to death shows that the intellectual portion of the cerebrum
escapes its influence.
   Circulation.—The action  of the drug  upon the circulation is
depressant.   It causes at first  a fall  of arterial pressure, then a rise,
due to the asphyxia caused by nervo-muscular failure of the respira-
tory apparatus.   Finally a constant fall of pressure takes place.
   Respiration  is depressed because of the influence of the drug on
the nerve-trunks supplying the respiratory muscles.
   Therapeutics.—Couium holds an unimportant place in the drug-list
of to-day.
   It  has little value except in  spasms due to irritation of  a  nerve-
trunk, when it may be of service.   In spasms of cortical or spinal
origin other drugs should be used, as  it is evident  that conium has
really no effect in quieting the central nervous protoplasm, but only
prevents the impulses which  are sent out from manifesting themselves
in movements of the muscles.  The powdered leaves or other prepara-
tions  may be smeared over poultices to relieve the pain of ulcers and
cancers, and it certainly does good in such  instances.
   Administration.—The dose of the abstract (Abstractum Conii, U. S.)
is from ^ to 3 grains, that of the alcoholic extract (Extractum Conii
Alcoholicum, IJ. 8.) is from \ to 1 grain,  and of fluid  extract (Ex-
tractum Conii Fluidum, U. 8.) 2 to 6 drops.   The dose of the tincture
(Tinctura Conii,  IT. 8. and  B. P.) is  10 to  30  drops.   Coniin  is  a
liquid alkaloid which should  never be used.  The dose would be about
-fa of a grain.   The  dose of the hvdrobromide of coniin  is said by
Helbing  to  be ^  to ^ a grain.   The preparations in  the  B. P. made 
158
DRUGS.
 from the leaves are :  Cataplasma Conii, for external use ;  Extractum
 Conii, dose 2 to 6 grains or more ; Succus Conii, dose 30 minims to 2
 fluidrachms or more;  Vapor  Conii, for inhalations; and Pilula Conii
 Composita, composed of extract  of hemlock and ipecac, dose 5 to  10
 grains.  Vapor Conii consists of the juice of hemlock (succus conii) J
 ounce, liquor potassa 1 drachm, and distilled water  1 ounce.   Twenty
 drops of this mixture are placed  in  hot water in  an inhaler and so
 employed for the relief of irritative coughs or spasmodic asthma.
   It is to be  remembered that the  variability of the drug, so far as
 power is concerned, is very great—so great as to make it  unreliable.
 For this reason a small dose should be given at first and the amount
 gradually increased.
   Poisoning.—A  prominent  symptom  of  poisoning by  conium is
 dropping of the  eyelids  (ptosis), due to paralysis  of the oculo-motor
 nerves, and staggering and inability to walk.   Its  treatment consists
 in  the use  of strychnine as a respiratory and nervous stimulant,  the
 employment of external heat,  and the use of cardiac stimulants if the
 circulation  fails.   The stomach  is to be emptied  by emetics  or  the
 stomach-pump before the antidotes are used.


                           COPAIBA.

   The Copaiba of the  U. S. P. and  B. P. is really the  balsam or
 the oleoresin  of Copaifera Langsdorfifii, and is  a  clear, transparent
 liquid of oily consistency, of  a pale yellow color and a peculiar odor.
 From it is distilled an oil (Oleum Copaibe,  U. S. and B. P.) which is
 of little value.
   As copaiba  is an oleoresin, the  term "oleoresin of copaiba" is often
 used to distinguish it from the oil.
   Therapeutics.—Copaiba is used for  the purpose of stimulating the
 mucous membranes of the genito-urinary tract, particularly  when they
 are depressed  after a period of inflammation, as in  the later stages of
 gonorrhea.   In cases suffering from  chronic  urethritis  with anaemia
 and debility the following pill is  useful:
         R.—Oleoresinae copaibae
             Oleoresinae cubebas
             Ferri et ammonii citratis  .
    S.—Ft. in capsule no. x.  One t. d. after meals

  Copaiba is employed in subacute and chronic bronchitis as an expec-
 torant.  In the treatment of subacute pyelitis, cystitis, and dysentery it is
 of value.  In dropsy due to slow renal changes it will often be of service.
  Administration.—Copaiba  itself is given in the dose of 5 to 20
 minims in capsule or in emulsion.  The oil of copaiba (Oleum Copaibe,
 U. 8. and B.  P.) is given in capsule or emulsion, preferably in  the
 former, in the  dose of 10 to 20 minims two to four times a day.  Some-
times it  is dropped  on sugar  and so administered.   Massa Copaibe,
 U. 8., is  made by  rubbing  up  copaiba with  magnesium,  but this is
a useless  and clumsy way of using it in the pill form.
3J-
gtt. iv.
gr. xx.    M. 
COPPER.
159
  The drug is eliminated  in the urine, and gives the test for albumin
with nitric acid.
  In  some cases it causes urticaria, which soon ceases on  the with-
drawal of the drug.

                           COPPER.

  Cuprum is never used in the form of the metal itself, but chiefly as
the sulphate, which appears in commerce as a blue, clear, somewhat
efflorescent salt.   It is soluble in four parts of cold water, two of boil-
ing water, but is not soluble in alcohol.
  Physiological Action.—Copper sulphate, when locally applied  to a
mucous membrane, acts as a  powerful astringent, or,  on  the surface
of an ulcer,  as  a  mild and superficial  caustic.   Upon the nervous
system in cats it  acts at a depressant poison  when given  hypoder-
mically, finally causing death  from respiratory failure.  When given
in overdose by the stomach it causes death by violent  gastro-enteritis
and exhaustion.   The symptoms do  not generally come on for an
hour, and consist in burning pain  in the stomach, a copperish or  me-
tallic  taste  in the  mouth, followed by vomiting of bluish liquids and
glairy mucus.  With  the vomiting  purging  comes on,  the passages at
first containing  the contents of the intestine, and finally mucus  and
blood.  Convulsions of an epileptiform character are present, and con-
stant  and  profuse salivation  is not infrequent.    After  death fatty
degeneration of  the liver aud kidneys has been noticed, and it  is  not
at all  uncommon  for  jaundice to appear after the first twenty-four
hours, if the patient  survives  so  long.  This  jaundice is dependent
upon  changes in the  blood.   The treatment of the poisoning consists
in the primary use of the chemical antidote, which is the yellow prus-
siate of potassium, and the administration of emollient or demulcent
substances, such as sweet oil and white of eggs, followed instantly by
emetics, or the stomach-pump.  If emesis and  purgation  are already
active, emetics are of course contra-indicated and counter-irritation
is to  be employed over the stomach and intestines in  the shape of a
mustard plaster of moderate strength, with opium to  allay irritation
and relieve pain.
  Chronic copper-poisoning is almost never seen, and although  the
metal is largely used for coloring canned green vegetables, it seems to
be harmless in such small amounts.
  Therapeutics.—Sulphate of copper (Cupri Sulphas, U S. and B. P.),
in the dose  of 5 to 7  grains, may be used as a rapidly acting emetic
which only acts upon the stomach, not the vomiting  centre.  As it
is irritant  the emetic  dose ought  not  to be  repeated, but if  emesis
does not occur, the sulphate of zinc or mustard should be used iu its
stead.   Indeed,  it may be said of sulphate  of copper  that  it should
never be given as an emetic, except in phosphorus poisoning, when it
acts as the chemical antidote.   Even here its use  must be most cau-
tious, for Thornton has proved that an antidotal dose  of copper  sul-
phate  given to  a dog poisoned with phosphorus  may produce death 
160                          DRUGS.
 before the phosphorus can do so.  In pill form it is sometimes given iu
 diarrheas depending upon ulceration of the bowels.   The dose should
 be \ to 1 grain combined with opium.
   In some states  of the body, particularly in skin diseases  of the dry
 type and in persons with  tubercular tendencies, copper seems  to  act
 like arsenic and may  be used in minute doses of fa of a grain or less
 three times a day where arsenic is  not well  borne.  In small doses it
 is said to be a  direct stimulant to the tissues and to increase the firm-
 ness of the flesh and strength of the normal man.  Very recently strong
 claims for copper as a remedy for anemia have been put forward, par-
 ticularly if it is employed as the arsenite of copper, when the action of
 the arsenic and copper together produce a good effect.
   Injected  into the rectum in the strength of 5 to 20 grains to the
 ounce  the drug will be found of service  in those cases of diarrhea
 which arise in  the lower bowel and are dependent upon ulceration.
   Locally applied, sulphate of copper  is  useful,  in the solid form or
 in powder, in the treatment  of indolent ulcers.   In chronic conjunc-
 tivitis or in cases of tinea tarsi—that is,  tinea on the  margin of the
 eyelids—a crystal of  the  sulphate may be drawn  over the diseased
 spot; or a weak solution of  1 to 3 grains to the  ounce of water may
 be dropped into the eye in subacute conjunctivitis.
   In relaxed sore-throat, as a gargle, in the strength of 4 grains to the
 ounce, it is often of service.  Nitrate of copper (Oupri Nitras, B. P.)
 and acetate of copper (Oupri  Acetas,  U. 8.) serve the same purpose as
 the sulphate.

                          CREASOTE.

   Creasote  (Creasotum, U. 8. and  B. P.), as  employed  in  medicine,
 should always be derived from  the destructive distillation of beech-
 wood and be designated " beechwood creasote."  Much of that sold is
 derived from coal-tar and is far less useful.  Chemically, creasote is
 almost identical with  carbolic acid.  Clinically  it  is  very different.
 It is a powerful antiseptic.   Beechwood  creasote should be of a red-
 dish amber hue and  about  as  thick as olive oil.   Its physiological
 action is almost identical with that  of carbolic acid, and in  poisoning
 by creasote the same antidotes as are employed in carbolic-acid poison-
 ing, namely, soluble  sulphates, should  be used.1  Creasote contains
 60per cent, of guaiacol  and 40 of cresol, not creosol.  Guaiacol is
 sometimes used in place of creasote in the dose of 1  to  2 minims.
 (See Guaiacol.)
   Therapeutics.—During the past  few years creasote has been largely
prescribed in phthisis  and chronic bronchitis, and some of the results
reached by its use have undoubtedly been of value.   It has  also been
inhaled from sponges  with great relief, and even has  been injected
into the lungs  by  the trachea or through  the chest-wall.  (See article
on  Tuberculosis.)   In the treatment of chronic bronchitis, creasote
1 See University Medical Magazine, 1889. 
CRE0LIN.
161
may be placed in boiling water and inhaled in the  steam.   Under
these circumstances it at least relieves the foetor of the breath, and this
method often gives more rapid relief than any other measure in  ordi-
nary subacute inflammation of the bronchi.  The beginning dose when
the drug is given internally is 2 to 5 drops.  Applied on a pledget of
cotton to the cavity of a tooth creasote often  relieves toothache.
   When given in phthisis the following prescription may be  used,
or the drug may be placed upon a Yeo's inhaler and  inhaled in that
way:
         R.—Creasoti (beechwood).....^3UJ.
             Tinct. gentian, comp. .     .   .     .    .  f ?j.
             Spt. vini rectificati.....f3viij.
             Vini Xerici     .    .    .   .   q. s. ad   Oij.    M.
    S.—A tablespoonful in a wineglassful of water three times a day.

   Creasote is useless so far as producing a cure is concerned if tuber-
culosis is more than incipient, and ought not to be employed if it dis-
orders the stomach.  The drug is contra-indicated in phthisis if  fever
or  haemoptysis  are present, and those patients who have little  fever
and a  chronic phthisis  are the most  favorable subjects for its employ-
ment,  as are those in which the bronchial tubes seem to be much affected.
Inhalations of the drug often  give  relief in the advanced stages of
phthisis and  decrease the cough, allay the laryngeal dryness, and aid
expectoration.  When creasote is given hypodermically in phthisis  it
should be given in the following formula :
         R.—Creasoti.......f ^ij.
              Olei amygdal. dulcis.....f ^ij.   M.
    S.—Ten minims to be injected deeply into tissues below the scapula.

   Unless the  patient is fastidious  the creasote may be dropped into
half a glass  of milk and taken in this three times a  day.   Often as
much as a drachm can be  given  by gradually producing tolerance
through ascending doses, and  it is  worthy of note that in  most in-
stances large doses are required if satisfactory results are expected.
   The preparations of creasote are Aqua Creasoti,  B.  P., given in the
dose of 1 to 3 fluidrachms; Mistura  Creasoti, B. P., dose 1 to 2  fluid-
ounces ; Unguentum Creasoti, B. P., for local application, and Vapor
 Creasoti, B. P., used by inhalation.


                            CREOLIN.

   Creolin is a liquid cresol, a coal-tar product possessing marked anti-
septic but comparatively slight poisonous  properties.    In appearance
it is a dark-brown fluid and is derived from soft coal.  It is of the
consistency of syrup.  When added to water it forms a white cloud and
mixes thoroughly, forming an emulsion up to 12 per cent, of the drug.
   Therapeutics.—Creolin  is  used  as an  antiseptic  in the lying-in
state,  as a wash for the  hands and   for vaginal irrigation.  It cannot
be used as a solution  in which  to  place instruments, as it makes  so
opaque a mixture with  water as to prevent their being seen at the
                                 11 
162
DRUGS.
bottom  of the  dish.   When used as  a vaginal douche it  should be
employed in the strength of 2 per cent.  One property of value is
that it forms a  slippery coating over the maternal parts during partu-
rition.  In the treatment of cystitis in the female, Parvin highly recom-
mends it as a vesical wash in  the strength of a 1 per cent, solution,
or, after the bladder becomes  accustomed to its use, in a 2 per cent.
solution.   According to Kretzschmar and others, a solution  of  1 to
500,  used  with a syringe, is useful  in  otorrhea,  1  to 100  in nasal
ulcers, and 1 to 1000 as a nasal douche in rhinitis, when there is much
discharge with the formation of crusts.   Creolin has also been used as
an injection in  the proportion of 5  parts in  1000 of  water  for  dys-
entery and entero-colitis  with success.
  In the eye, Alt has used a 1  to 2 per cent, solution in the treatment
of blepharitis, keratitis, and phlyctenular  ophthalmia.


                    CROTON CHLORAL.

  Croton Chloral, or Butyl Chloral Hydras, B. P., has a physiological
action closely allied to  chloral itself, but possesses  more  analgesic
power and is very much less  depressant to the heart and  circulation.
The dose for the production  of sleep is the same as  chloral,  5 to 20
grains in syrup.
  Therapeutics.—Croton chloral is infinitely preferable to chloral in
sleeplessness due to pain.
  In facial neuralgia  and migraine it is exceedingly efficacious,  par-
ticularly if the  fifth nerve be involved.  In headaches due  to  eye-
strain, and in those associated with sick stomach, but not due to gastric
indigestion or nervous debility, croton chloral is of service.   Curiously
enough it is valueless in  toothache, but does good iu the neuralgia due
to decayed teeth.
  Administration.—Croton chloral should be used in pill form in the
dose of 3 to 5 grains every two hours till the pain is relieved or sleep
comes on, or it may  be given  in solution  or syrup of acacia  and
water, or water and glycerin.   It has been used in as  large a dose as
60 grains, but 20 to 30  grains ought  to  be the  maximum dose  as a
general rule.

                         CROTON  OIL.

  Croton oil (Oleum Tiglii,  U. 8., Oleum  Crotonis, B. P.) is au ex-
ceedingly irritant oil derived  from Croton Tiglium, a small tree of
India.  The oil is pale yellow and of a  complex character.   Applied
to the skin  for any length of time it is an intense  irritant, producing
blisters or pustules.  One  drop placed on the tongue with 5  drops of
sweet oil acts as a violent watery purge, and, owing to the smallness
of its dose, it is frequently employed to revulse the unconscious, as in
cerebral  congestion.   In delirium it is  used for the same purpose,  and
may be given to maniacs who are suffering from an attack of cerebral 
CYANIDE OF POTASSIUM.
163
congestion  or obstinate constipation,  owing to  the  smallness of its
dose and rapidity of action.   The dose is 1 drop placed on the tongue
with sweet oil or given in emulsion or in pill.   It ought never to be
used when  there is any irritation of the stomach or bowels.  As a
counter-irritant it is sometimes  applied over a tender nerve, or to the
chest in  the  treatment of bronchitis, in  the  proportion of half-and-
half with  sweet oil.   Thus applied  it may be absorbed and  cause
purging.  The treatment  of poisoning by croton oil is identical with
that of gastro-enteritis.  (See Gastro-enteritis.)   Linimentum  Crotonis
is a preparation  of the B. P., whicli  is employed as a counter-irritant
liniment for sprains and in muscular rheumatism.


                           CUBEBS.

  Cubebs (Cubeba, U. 8. and B. P.)  are the unripe fruit of Cubeba
Officinalis,  a  plant of Java.   They consist in wrinkled or rough black
bodies, about the size  of small peas, and have an aromatic  pungent
taste.  They contain a volatile oil, cubebic acid, and cubebin.   The
drug should not be kept in powdered form, as it loses its powers,  but
should be  powdered as needed.  Overdoses  of cubebs  cause gastro-
intestinal and genito-urinary inflammation.
  Therapeutics.—Cubebs are used in the advanced stages of gonor-
rhea where a tendency to a chronic discharge is present.  Some sur-
geons have used them in the early stages as an abortive treatment, but
this is a bad practice.   In cold in the head the powdered berries may
be snuffed up the nostril, provided that the stage of secretion is well
established.   They ought not to be used before this stage.  In  the
treatment of chronic  or subacute bronchitis the oleoresin of cubebs
is very useful in some cases (see Bronchitis), and in the form of cubeb
cigarettes the drug is  much used as a remedy for  hoarseness due to
subacute laryngitis.
  Administration.—Cubebs may be  given in powder in  the dose of
10  to 60 grains, in the  fluid  extract (Extractum  Cubebe Fluidum,
 U.  8.) 10  to 30 drops, and in the  form of the  tincture (Tinctura
Cubebe,  U. 8. and B. P.) in the dose of  10 drops to J an ounce.
  The dose of the oleoresin (Oleoresina Cubebe, U 8. and B. P.)  is
2 to 20 drops three times a day, and  it may be  given in  capsules or
emulsion.  The troches of cubebs (Trochisci Cubebe, U S.) are used for
the relief of pharyngitis of a chronic type.  The dose of the oil (Oleum
Cubebe,  U. S. and B. P.) is 5 to 20 minims.


                CYANIDE OF POTASSIUM.

  Cyanide  of potassium (Potassii Cyanidum,  U. S. and B. P.) is used
in the same way and for the same purpose  as hydrocyanic acid.   (See
Hydrocyanic Acid.)   The dose is fa  to fa of a grain. 
164                          DRUGS.

   The  following  prescriptions may be  used in cases suffering  from
bronchitis or phthisis accompanied with excessive cough :
         R.—Potassii cyanid.......gr- JJ.
            Morphinae sulph.......§r-..J"
            Acid, sulph. arom.    .    .    •    •    •  ^5}3\
            Syr. pruni virginianse .    .    .   q. s. ad  f^iij-    M.
   S.—Teaspoonful three times  a day.

Or as follows:
         R.—Potassii cyanid.......Sr;}i-
            Ammon. chloridi .    .    .    •    •    •   SVJ-
            Acid.  hydrochlor. dil......fj?J-
            Elix. calisayae    .    .    .    .   q. s. ad  f|iij.    M.
   S.—Teaspoonful three or four times a day.


                         DERMATOL.

                   (See Bismuth Subgallate.)


                           DIGITALIS.

   Digitalis, U S., is obtaiued from the  leaves of Digitalis Purpurea,
or foxglove of the second  year's growth.   The leaves are official in
the B. P. as Digitalis  Folia.   It contains a number  of  substances,
none of which act as does the  crude drug.   In other words, all  these
compounds must  act  together to be  therapeutically active.   Among
the  substances  so far  isolated from digitalis  by  chemists may be
named digitalin, digitalein, digitoxin, digitin, and digitonin.  Several
of these are  simply compounds of the others.   Digitalin,  so-called,
occurs in two forms, amorphous and crystalline. The crystalline digi-
talin (French) is  largely digitoxin, while the amorphous is  composed
of digitonin,  digitalein, and digitalin.   A  pure digitalin has been iso-
lated, but it is not on the market.  Digitoxin and pure digitalin are
the two most active principles yet found.   None  of these substances
should be used in medicine to  take the place of digitalis.
   Physiological Action.—Digitalis  is  apt to  irritate mucous mem-
branes which  are already  slightly out  of order, and for  this reason
should not be given by the mouth in cases of gastritis and allied states.
   Nervous  System.—The action of digitalis upon the nervous sys-
tem is  only manifested when  poisonous doses are used.  Small toxic
doses decrease reflex action by stimulating Setschenow's reflex inhibi-
tory centres in the medulla, and finally by depressing the spinal cord.
Convulsions are sometimes seen as a result of the disorder of the cir-
culation at the base of the  brain, owing to the disturbed and abortive
action of the heart.   Finally, the motor nerve-trunks themselves are
 depressed.
   Circulation.—Upon the circulatory  system  digitalis   exerts its
chief influence.   In moderate amounts it increases the pulse force and 
digitalis.
165
arterial pressure, slows the pulse, and increases the size of the pulse
wave.   The increase of pulse force is due to a stimulating influence
exercised  upon the  cardiac ganglia and the muscular  fibres  of the
heart, the rise of arterial  pressure is caused by this  increased pulse
force and  pulse volume, and by a stimulation of the vasomotor centre
and the muscular coats of the  bloodvessels, whereby  a  contraction
occurs in the walls of the  arteries and arterioles.   The  slow pulse  is
produced  by stimulation of the pneumogastric  centre and the periph-
eral ends  of the vagus nerves.   The increase in the volume of the pulse
is due to this influence on the vagi, for, the pneumogastric nerves being
stimulated,  the diastole of  the heart is more full and complete and oc-
cupies a greater length  of  time.   The result of this delay is that the
ventricles become thoroughly distended, and on contracting drive out
a much larger wave of  blood  through the aorta than  is normally sent
out.  This  is important to remember when usiug the drug in heart
disease and  other states. While we do not know that the vagi  are the
trophic nerves of the heart, we have a  large amount of evidence in
favor of such a view, and  it has long been thought that digitalis was
not only a heart stimulant  but a heart tonic.   If the trophic nerves of
the heart  are stimulated by digitalis it at once becomes evident that it
is a doubly  useful remedy.
  The action of digitalis  upon the heart is a double one, in  that  it
creates  two  opposing forces.   By the action on the heart muscle  it
steadily strives to cause contraction  or  systole of the ventricles;  by
the action on the vagi it equally steadily struggles to produce diastole
or dilatation  of  these  cavities.  In  medicinal dose neither of these
tendencies gets the upper  hand, for both are equally excited, so that
now increased systole occurs, now increased diastole.
  In poisoning, on  the other hand, or  in instances where  overdoses
have been given, so much stimulation is caused that  the  heart beats
now slow,  now fast, now strong, now  weak :  slow when the vagi
overcome systole, fast when systole  overcomes the vagi; strong when
systole escapes from  the inhibitory nerves, weak when  the  ventricles
can scarcely contract because the vagi are holding the ventricles open.
In man we  frequently see this  irregular pulse replaced by an exceed-
ingly rapid  pulse, which is shuttle-like in character.   This is probably
due  to  a  depression of the peripheral ends of the vagus nerves.   In
the  frog digitalis nearly always causes, when given in  full doses, an
•arrest  of  the heart in  systole, while in  man and the  higher animals
the arrest is in diastole.
  If the patient, who has taken a poisonous dose, be raised up  he may
drop dead, owing to the still more active disturbance of the balance of
power caused by the calls for blood due to the erect position, and under
these circumstances  the heart  beats so fast that it has not time to get
enough blood into it to  pump anything out, or so feebly that the dilated
ventricles are never emptied.   Finally, a fall of arterial pressure en-
sues, not  because  the vasomotor system  is depressed, but because the
heart cannot pump out  enough blood to fill the bloodvessels. 
166
DRUGS.
   Respiration —Digitalis has almost no effect on this function, un-
less the amount be poisonous, when respiration is slowed.
   Temperature.—Upon the normal bodily temperature digitalis has
little or no effect in medicinal dose.  In poisonous dose it lowers tem-
perature.   In fever the drug seems to cause a fall of a  small amount
with some constancy, but  it can rarely  be used for any antipyretic
influence.  High temperatures prevent digitalis from acting.  This  is
an important point to be remembered in its therapeutic  use.
   Kidneys,  Tissue-waste,  and  Elimination.—Digitalis has
almost no effect over the kidney structure itself, and does not to any
extent stimulate the renal epithelium.   The  cause  of the  increased
urinary flow produced in cardiac dropsy depends upon the removal  of
congestion of the kidneys and  the increased arterial pressure and im-
proved circulation brought about by the drug.
   Upon tissue-waste digitalis seems  to have little effect, and there is
still  some  discrepancy in the reports as to the amount of urea cast
off under its use, some investigators saying it  is increased, others that
it is diminished.
   We do  not  know how  the  drug is eliminated, as chemists have
never been able to find it in the urine.  It is probably oxidized in the
body.
  Poisoning.—The slow, full pulse, followed by the hobbling, dicrotic,
shuttle-like pulse-beats, and the  angry, tumultuous cardiac beat against
the chest-wall,  affords a combination of symptoms characteristic of the
over-action of  digitalis.  The pulse may be full  and slow when the
patient is lying down, but at once becomes irregular on his sitting up.
  Often when the patient has by error received too much of the drug
the finger can scarcely note any pulse at the wrist, while  the ear placed
over the heart shows it to be beating wildly, as though it would break
out of the chest.  It is important that the weak pulse at the wrist be
not taken as the only guide as to the state of the patient, for this very
reason.   The physician  should  always consult the prsecordium  before
reaching an opinion as to the action of digitalis.
  As the poisoning progresses vomiting may come on,  exophthalmos
occurs, and a peculiar blue pearliness  of the sclerotic coat of the eye
is seen.   Consciousness  is generally preserved  nearly to the  last.
Death  may be put off for days, or  occur in two hours, or even less.
Headache is often a severe symptom.
  Treatment op Poisoning.—Tannic acid is to be given as a chemi-
cal antidote; emetics and the stomach-pump are to be used, the former
only when  the drug has not yet  been absorbed, for if the heart is much
affected emetics are dangerous.   External heat is to be applied, partic-
ularly about the abdomen ; the maintenance of a horizontal position
must be insisted upon, and the use of tincture of aconite, as the physio-
logical antidote, resorted  to.
  Therapeutics.—Much  unfortunate misunderstanding concerning the
action  of digitalis has  arisen,  and while some call  it a circulatory
stimulant, others think it a circulatory depressant.   The first class base
their belief on the signs of increased arterial pressure and cardiac power, 
DIGITALIS.
167
the others on the fact that it slows and steadies  an irritable, rapidly-
acting heart, and they overlook the other signs.   Digitalis is a cardiac
stimulant, and not  a depressant.  The quieting of irritability by it is
the quietness  produced by the drink of whiskey or coffee taken by  the
speaker before mounting the platform, or the pugilist before he enters
the ring, to steady  his nerves and make him firm.  If digitalis is used
to decrease arterial tension  its dose must be  dangerously large.  (See
Physiological Action.)1
   Digitalis is of value in all cases of cardiac disease where the condi-
tion is one in which the heart fails to do its proper amount of work.
If simple hypertrophy or excessive compensatory hypertrophy exists
it is harmful.  It is of less value  in  aortic regurgitation than in  any
other lesion, because the prolongation  of diastole allows  greater oppor-
tunity for the blood to fall back into the ventricle.   In some instances
the drug does harm by over-distending the auricle through ventricular
stimulation, and we can never tell before trying it which cases will be
so affected.   In cases where the heart  is irritable, palpitation present,
and indigestion not  the cause  of the trouble, digitalis is of service.
(See Heart  Disease.)
   In the second stage of pneumonia digitalis  is invaluable  (see Pneu-
monia), and in  exhausting fevers, in small doses, is  of great service.
In congestion of the lungs in the typhoid state,  it will drive out  the
blood from the part congested aud relieve stasis.
   In cardiac weakness from collapse, injury, poisoning or shock digi-
talis  is of  service, particularly in aconite poisoning, where it is  the
physiological antidote.   Owing to the slowness of its action it should,
however,  be  preceded  by ammonia and alcohol where  the  need  is
pressing.   In muscarine poisoning digitalis is the antidote.
   As a diuretic, digitalis may be used where the kidneys are congested
and the circulation  is sluggish.  Where the renal  structure is  dis-
eased, other drugs should take its place, or it  should be  combined with
more active renal remedies, such as squill or caffeine, or  in very chronic
cases with compound spirit of juniper.
   In some cases  a cumulative  action  occurs which consists in  the
failure of the drug to appreciably influence  the circulation for some
days, only to exert all its  power suddenly and produce symptoms of
poisoning.  This is particularly apt  to occur where the removal of
ascites or  dropsy takes  place by tapping after the drug  has been taken
for a long period.   It is thought that the sudden withdrawal of press-
ure  upon the great vascular  trunks  of the body-cavities  causes  the
absorption  of the  drug with  the juices of  the  tissues where  it  has
remained in inactivity.
   The contra-indications to the use of digitalis are marked atheroma
of the bloodvessels, aneurism, apoplexy, and any state of arterial  ex-
citement.
   Administration.—The official preparations of digitalis are the tinc-
ture (Tinctura Digitalis, U S. and B.  P.), dose 10 to  20 drops;   the

  1 It is absolutely necessaiy for  the student  to turn to the article on heart disease
and to read it carefully in order to understand the action of digitalis in disease. 
168
DRUGS.
infusion (Infusum Digitalis, U. S. and B. P.), 1 teaspoonful to 4 tea-
spoonfuls ; the fluid extract (Extractum Digitalis Fluidum, U. S.), dose
1 to 2 drops;  the abstract (Abstractum Digitalis, U. S.), J to 1 grain;
the extract (Extractum Digitalis, U. S.), £ of a grain ; and the powdered
digitalis  leaves (Digitalis Folia, B. P.),  dose  1  to 4  grains, generally
given in a pill.  The tincture is the preparation most commonly used,
and is most  satisfactory, although the  infusion has been thought  of
greater value,  without any good reason.
  The dose of digitalin, which ought not to be used, is fa of a grain.
                DIURETIN.

(See Sodio-salicylate of Theobromine.)
                         ELATERIUM.

  Elaterium, B. P., is a sediment obtained from the juice of the Ecballium
Elaterium, or squirting cucumber.  It appears in small, easily broken,
thin, grayish-green flakes, and has a bitter  taste.   Elaterium is not
official in the U. 8. P., but its active principle, elaterin (Elaterinum,
U. 8. and B. P.), is official.   Notwithstanding this fact, the  crude
preparation  is largely used.
  Physiological Action.—Elaterium  is a very decided irritant  to all
mucous membranes, and even to the hands of those who handle it.
Its chief effect in man is to cause profuse watery stools, but for  some
unknown reason it rarely acts upon animals in this manner.
  Therapeutics.—This drug is the best  hydragogue purge which we
have, causing very large watery passages, but  not producing much pain
when used in proper dose. For this reason it is useful in the treatment
of local serous effusions, as in pericarditis and pleurisy and in dropsy
and ascites.   It ought never to be used in cases  of marked exhaustion,
and  may be advantageously followed, soon after it acts, by alcoholic
stimulants.  In uremia, with dropsy, it is thought to aid  in the elim-
ination of the poison by the bowel.   In cerebral congestions or effusions
the drug will often be of service.
  In poisoning  by elaterium the symptoms  are those of violent
gastro-enteritis, and must be treated accordingly.  (See Gastro-enteritis.)
  Administration.—The dose of  elaterium is ^  of a grain, given in a
freshly made pill.   Elaterin  is best given in  the dose of* from -£ to
fa of a grain, as follows :

         R •—Elaterini   .......   gr. iv.
             Alcoholis.......13 iv.   M.
   Dissolve by gentle heat.  S.—Half  a drachm contains T\ grain, or one full dose.

  The official preparations of elaterin, the active principle of elaterium,
are Trituratio Elaterini, U. 8. (elaterin 1, sugar of milk 9), given in the 
ergot.                         169
dose of \ to £ graiu, and Pulvis Elaterini Compositus, B. P. (elaterin
1, sugar of milk 39), dose 1 to 5 grains.


                            ERGOT.

   Ergota, U. S. and B. P., is derived from the spawn or mycelium of
the fungus known as  Claviceps Purpura, which growns in the flower
and replaces the grain in common rye or Secale Cereale.
   Many so-called active principles have been isolated by chemists, and
named ecbolic acid, ergotic acid, sclerotinic acid, and ergotin. None of
them represent the entire drug, the nearest in its approach being ergotin,
and ergotin is not an isolated principle, but a combination of principles.
Kobert teaches that there are three principles, namely, ergotinic acid,
cornutine and sphacelinic acid, and  that cornutine is a  true alkaloid.
Tanret on the other hand denies the  existence of cornutine as an alka-
loid.
   Physiological Action.  Nervous System.—Upon the nervous sys-
tem ergot  exercises  little, if any, effect.  In  chronic poisoning, due
to eating rye-bread contaminated by ergot, we sometimes see what is
known as spasmodic ergotism due to disturbances of nervous system.
   Circulation.—Ergot when injected into the circulation causes a
primary fall  of arterial pressure, followed by a  rise.  The dominant
action is represented in the rise.  This rise is due to a stimulation of the
vasomotor centres, but the primary fall is caused  by its  direct depres-
sant effect upon the heart muscle, resulting from contact  on the part of
the drug en masse with the heart.
   If the dose be  very large the fall of pressure is never recovered
from, and progressive paralysis of the vasomotor apparatus and heart
occurs.
   Uterus and  Unstriped  Muscular Fibre.—It  is commonly
taught that ergot  acts as a stimulant  to the uterine muscle, and causes
contraction of unstriped  muscular fibres everywhere, but the careful
studies of Hemmeter during  the  past few months  have proved that
the drug also causes uterine contractions by stimulating  the centres in
the lumbar portion of the spinal cord.
   On the  uterus ergot in full  medicinal dose exerts its influence—not
increasing the normal pains of labor, but causing a tetanic, tonic, un-
yielding uterine spasm which drives all before it.  In very small doses
it may assist the normal contractions without causing them to become
tetanic.
   Chronic  Poisoning.—Two forms of poisoning, from the prolonged
use of ergotized rye-bread, sometimes occur.  One is characterized  by
spasmodic muscular contractions, the  other consists in the formation of
gangrenous sloughs.
  Therapeutics.—Ergot is given to parturient women for the preven-
tion or cure of post-partum hemorrhages.  For the prevention it should
be given to the woman by the mouth just as the head of the  child is
about to slip over the perineum, and not before.   When administered 
170                         drugs.
to stop a haemorrhage already flowing the doses  should be large, as
much as 1 to 2 drachms of the  fluid extract or 2 wineglassfuls of the
wine of ergot.  Ergot  should never  be  given in the early stages of
labor, but this  rule may, under  certain  conditions, be modified.  If
uterine inertia comes on in the course of  a normal labor and quinine
cannot be used for any reason, small doses of ergot may be employed.
These small doses do not cause a constant tetanic uterine contraction,
but simply bring on the " to-and-fro " movements. By small doses the
writer means from 5 to 20 drops of the fluid extract.
   If  the  canal is  obstructed ergot should never lie employed,  and
unless the os uteri is well dilated should not be given  in any dose.
   In post-partum haemorrhage it may be well to give a solution of the
aqueous  extract  of ergot  hypodermically.  The extract  should be
rubbed with the  proper  amount  of water (parts  1 to 5), and  filtered
through a fine aseptic handkerchief to get rid of foreign bodies before
it is injected.
   When ergot is given care should be taken that  the uterine cavity be
clear of all clots or placental fragments, lest the closure of the os uteri,
under the influence of the drug, imprison these harmful materials.
   In hemorrhages from  the lungs and kidneys, or other unapproach-
able parts, ergot is  thought by some to be very useful when given by
the mouth, but  it is probable that it rarely achieves any real good.
Particularly is this the case in pulmonary haemorrhage, since the vaso-
motor system practically does not exist in the pulmonary vessels, and
the increased pressure caused by the ergot in the  general systemic cir-
culation may increase the pulmonary leakage.  The truth is  that in
pulmonary haemorrhage very little real good can be obtained by internal
medication.
   In epistaxis, menorrhagia, and metrorrhagia, and in some cases of
night-sweats, it is of service.  In hypostatic, pulmonary, and other  con-
gestions it is useful, particularly if employed with digitalis.
   In dysenteries with bloody stools and in serous diarrhea ergot some-
times does good.
   Some persons suffer from vertigo associated with hypereesthesia of
the scalp and headache.  Relief can often  be  obtained by the use of
20 drops of the fluid extract of ergot and 5 to 10  grains of bromide of
potassium three times a day.
   Ergot has been used very largely in the treatment of uterine fibroids
as an expulsive remedy and cure.   It is  only of value in those cases
where the growths are just beneath the  mucous  membrane.  By the
contractions of the uterine muscular fibres the  blood-supply of the
growth is decreased, the recurring haemorrhages  cease, and the tumor
is finally expelled, having really sloughed  out of its bed.  This method
is inferior  to the  knife, and  very painful  and prolonged.   Large
growths cannot be so treated.   Ergot is sometimes useful in the treat-
ment of bleeding  hemorrhoids, and it has  been given with success in
diabetes insipidus.
   Administration.—Ergot is official in the U. S. P. as the fluid extract
(Extractum  Ergote Fluidum), dose \ to  1 drachm;  the solid extract 
ETHER.
171
(Extractum Ergote), dose 5 to 20 grains ; and the wine ( Vinum Ergote),
dose 2 to 4 drachms.  Bonjean's ergotin is made by a special process,
and it or the solid extract can be given hypodermically in the manner
already described.   The  B. P.  preparations are Extractum Ergote
Liquidum, dose 10 to 30 minims; Infusum Ergote, 1 to 2 fluidounces ;
Tinctura Ergote, 10 minims  to 1 fluidrachm.   Ergotin (Ergotinum,
B. P.) is given in the dose of 2 to 5 grains.  Injectio Ergotina Hypo-
dermica, B. P. (ergotin 1, camphor water 2 parts) is  given, in the dose
of 3 to 10 minims, by subcutaneous injection.


                 ERIGERON, or FLEABANE.

   Oil  of Erigeron (Oleum Er*igerontis, U. 8.) is a yellowish, volatile oil
of a peculiar, not bad, taste, closely resembling turpentine.  It is by
far the best remedy which we have for the  treatment of passive uterine
oozing, or a " show," as it is sometimes called.
   In epistaxis and other haemorrhages of a subacute type it is quite
useful.   In some instances it is  used in place of copaiba and  cubebs in
the later stages of gonorrhea. It is best given in capsule or on sugar,
in the  dose of 10 to  30 drops after meals, or oftener  if needed.


                            ETHER.

   Sulphuric  Ether  is official as JEther, U. 8.  and B. P., aud JEther
Fortior,  U. 8.  Pure Ether (^Ether Purus, B. P.) is free from alcohol
and water.   Ordinary ether is not generally used as an anaesthetic, but
for the abstraction of oils and for other pharmaceutical purposes.   It
is made by  the  action of sulphuric acid on ethylic alcohol, and is
sometimes called in consequence ethyl oxide.  Ordinary ether contains
about 74 per cent, of ethyl oxide and 16  per cent, of alcohol, with a
little water.  On the other hand, the stronger ether contains  about 94
per cent, of ether oxide  and only  6 per cent, of alcohol, with water.
Both preparations boil when held  in a test-tube, if a piece of broken
glass  is  added to the liquid.  The stronger ether  boils much more
vigorously than the weaker under these circumstances.
   Ether possesses a peculiar penetrating odor, a hot burning taste, and
is a colorless, volatile, and very inflammable liquid.   For this reason it
should never he held near a fire or light, and, as its  vapor is heavier
than air, any light in the room should be above the patient, not below
him.   No light should be held nearer than five feet.
   Physiological Action.—The action of ether on the animal organism
is very rapid and powerful, but  temporary.  Except for the rapidity
of its effects it is  very much like that of alcohol.  When applied to
the skin  it causes  intense cold by its evaporation,  and may be used by
means  of a spray to  benumb or locally freeze a part.
   Upon  mucous membranes ether acts as an irritant, and causes, when
first inhaled, great irritation  of the fauces and  respiratory  tract, so 
172
DRUGS.
that temporary arrest of respiration  is not uncommon.  The face be-
comes  suffused and red and the conjunctiva injected, but a  stage of
quiet succeeds the primary stage  of struggling which arises  from the
choking  sensations.   During this period the breathing is  generally
full and deep and  the pulse rapid but strong, while the ocular reflexes
are at  its beginning intact.   Following this stage a second period of
struggling comes on, in which the patient may become absolutely un-
controllable except  by  brute  force.  Yelling, shouting, screaming,
cursing or laughing and crying may be prominent symptoms, and the
individual is pugilistic, caressing  or ill-tempered, as  the case may be.
If the drug is now pushed a condition of total anaesthesia is attained,
and quietude takes the places of the struggles.   This is the time for
the operation  to be  carried  on, for if it is attempted in the earlier
stages  the struggles  of the second stage prevent any operative pro-
cedures (see  Therapeutics below).  It is  not  proper  to  push  the
muscular  relaxation  to  complete  flaccidity, as this endangers  the
respiration.
  Nervous System.—Ether acts  first  on  the brain, then on the
sensory centres of the spinal cord, then on the motor centres, then on
the sensory centres of the medulla oblongata, and, finally, upon the
motor  centres of the medulla, thereby producing death from respira-
tory failure.  Upon  the nerve-trunks it exerts no effect unless it is
directly applied to them.  Ether does not act by influencing the blood,
coagulating  the protagon  of the nervous  system, or by any  other de-
structive influence.  It simply puts aside, for the time being, the vital
functions of the parts affected by it.
  Circulation.—Ether  is one of the  most  diffusible and  rapid
cardiac stimulants which  we possess, and is correspondingly fleeting
in its effects.  It increases the pulse-rate  and force by stimulating the
heart and by  increasing the activity of the vasomotor centres.   In
overdoses it acts as a cardiac depressant, but only when the amount is
very large.
  Respiration.—When ether is first inhaled it often causes an arrest
of respiration.  According to Kretzschmar,  this  is due to an  irritation
of the  trifacial nerve, which causes a reflex  spasm of the glottis, and
not to irritation of the peripheral  vagi  in  the  lungs.   This is only
partly  true,  for the author has proved that section of the vagus nerve
prevents  this occurrence, so that both the vagal  and trigeminal irrita-
tion are responsible for the arrest.
  Upon  the respiratory centre ether acts as a powerful stimulant in
ordinary  amounts ; in  overdose it  paralyzes this part of the nervous
system.
  Temperature.—Prolonged  etherization lowers  the  bodily heat
very greatly.  That  of the dog may be lowered  some 9°  F.  in an
hour if the  drug be pushed, and as great a fall has been known  as
4° F. in man (Hare).   The fall is partly due to the  depression of the
nervous system and the chilling of the body and  lungs by the evapora-
tion of the drug. 
ETHER.                         173
   Elimination.—Ether  escapes from the body by the lungs  and
 kidneys.
   Untoward Effects —Ether, while safer than chloroform, is not ab-
 solutely devoid  of all dangerous effects.  Sometimes when  the  drug
 is pushed  too  strongly deep cyanosis  with pulsation of the jugular
 veins shows deficient oxidation and  cardiac distention.   In other and
 very rare instances sudden cardiac failure has occurred, or total arrest
 of respiration ensued.  In nearly all cases of sudden death from ether
 grave kidney or other lesions have been present, and have been found
 at the autopsy.
   One  of the earliest signs of the over-action of ether is the  failure of
 the diaphragmatic movement, followed by that of the lower part of the
 chest, then of the upper part and then  of the cervical muscles.
   In patients under ether the movement of the diaphragm is an ex-
 ceedingly interesting study, for before the condition known as surgical
 anaesthesia is developed, while  there is still some  rigidity, and the
 throat reflex  is  not completely abolished, the contractions  of the dia-
 phragm are frequently so violent that unless  the laryngeal opening
 be absolutely free, the intercostal spaces are depressed  and  the  ab-
 dominal contents thrust violently downward and outward.   Just so
 soon, however, as the chin is pulled forward and a free access of air
 is allowed, the abdominal  displacement, though  it is  still  present,
 is not so great, and  the chest movement is no longer reversed.   As
 the  ether is pushed, the respiration becomes purely thoracic, the dia-
 phragm no longer  taking part  in the  respiratory cycle, or  becoming
 so relaxed that  it allows the  chest on expansion to  aspirate  the
 abdominal viscera upward, as is shown  by the  retraction of  the belly
 wralls at a time when they should  normally expand with the thorax
 in inspiration.   This observation would seem to point to the fact that
 the primary stimulant action of ether upon the respiratory apparatus
 is particularly felt by those  centres which govern the movements of
 the diaphragm,  and  that, as  this is the case,  these centres later on
 are the first to  feel the paralyzing  effect of still larger amounts of
 the drug.
   These facts give us, therefore, yet another danger-signal during the
 administration of the ether, and the integrity of the diaphragmatic
 function, as represented by the movement  of the belly  walls, should
 be as carefully observed as are the thoracic excursions, the character of
 the pulse, or  the coudition of the pupil.   The rule may therefore be
 laid  down that when the diaphragm  ceases to  act, anaesthesia  has
 been carried  to its extreme  legitimate  limit, aud that the use of an
 anaesthetic after this time must be carried  on with the greatest care
 and watchfulness.
  The  diaphragm  is the first part of the  respiratory mechanism to
 yield to respiratory paralysis.  In death from any cause, the progress
 of failure of respiration will, in the  vast majority  of cases, be denoted
 by a failure on the  part of the diaphragm primarily, with compensa-
 tory excursions  of the chest; and  it is also to be  noted that as the
chest movements fail, the accessory muscles of the neck come into 
174
DRUGS.
play.  These muscles in time cease to act, the hyoidean group  lose
their point d'appui,  the chest remains motionless,  the lower jaw  is
dropped, and the scene  is closed by a few gasps in which the muscles
of the neck may be the  chief factors.
   The treatment of accidents during etherization consists in the with-
drawal of  the ether,  the use of artificial respiration, and the placing
of the body, if the face  is pale, head downward.   On the other hand,
if the face is flushed  and cyanotic it indicates respiratory, not cardiac,
failure, and  this  position is not to be resorted to.   The physician
should also employ hypodermic injections of strychnine, atropine,  and
digitalis, or more rarely  an intravenous injection of ammonia, which  is
more dangerous but  better than the others in  a pressing  emergency,
because it is  more rapid  in its action.   Ether is often given hypoder-
mically under such circumstances, and seems to do good, but its use  is
a bad practice, as, if the heart or respiration is already depressed by
ether, the use of still more  of the drug simply makes matters worse.
The cases in which such  a line of treatment is followed by good results
are those in which the failure of respiration is not due to a saturation
of the body with  ether, but to asphyxia produced by mechanical inter-
ference with  free  breathing, as, for example, the presence of mucus in
the air-passages or a too  close application of the towel to the face.  In
such cases  the hypodermic injection of ether causes so much local pain
and  irritation as reflexly to call up respiratory movements as well as
to directly stimulate the  respiratory centre to greater effort.1  Alcohol
ought not to be used if the other drugs named can be  obtained, because
alcohol is so nearly allied physiologically and chemically to ether.  Fric-
tions, hot  applications, and  artificial respiration should be practised
(see article on Asphyxia).
   As ether is at hand it  may be dashed  on  the chest  and abdomen to
cause reflex  inspiration  in lieu of cold water, which wets the clothes
and does not evaporate.
   In some cases  great nausea and vomiting follow the use  of ether.
This can generally be prevented  by the proper  use of food before the
operation  (see Therapeutics), and by the use of cracked ice and small
doses of aconite after the operation.   (See  Vomiting.)   Severe bron-
chitis may occur in invalids and children after the inhalation of ether.
   Therapeutics.—Ether is used chiefly as an anaesthetic by means of
inhalation.   The method  consists  in forming a cone out of a towel
aud a piece of paper and placing a small sponge  in  its end.  Upon
this sponge the ether  is poured and the large open mouth of  the cone
is placed over the  face.   If this  be  done  suddenly  the sensation of
suffocation is generally  so great  as to  cause  fright and struggling,
which is inadvisable.   The better way is to hold the cone at some dis-
tance from the face and  gradually bring it nearer as the effects  of the
ether are felt.  After partial anaesthesia is attained the cone should be
placed closely over the face and the vapor be pushed in as concentrated

  1 As consciousness is not necessary to the carrying out of a reflex action, this  is
perfectly possible and probable. 
ethyl  bromide.
175
a form as possible, whereas when chloroform is used it should be well
mixed with a  great amount  of air.   Care should be  taken  that the
ether  does not get  into the  eyes of the patient, either  in vapor or
liquid form, owing to the irritation which it will set up.   To prevent
this a thin piece of muslin wet with water will be found  of service if
placed over the eyes.  A large number of ether inhalers are employed
in preference to the towel, of which the best is probably that known
as the "Allis Inhaler."
   When ether is to be given, no food ought to be allowed the patient
for twelve hours preceding its use, except a little milk or tea an hour
or two  before the operation, in order to avoid vomiting during and
after this procedure.   The patient should not be allowed  to retain any
tobacco or false  teeth in the mouth, as they may slip into the larynx
and cause death while the anaesthetic is being given.
   Locally ether may be used in  an atomizer spray as an anaesthetic
owing to the cold produced by its evaporation.  Thus it is particularly
useful in cases where thoracentesis or paracentesis abdominis is to be
performed, and  also in  cases of superficial neuralgia, where the be-
numbing of the nerve often  effects a permanent cure.
   Internally,  by the stomach, ether is  very useful  in colic,  although
for flatulence  of adults  and  children Hoffmann's Anodyne is a more
agreeable remedy.  In cases of collapse the hypodermic and gastric
use of ether make it of great  service when cardiac action is very feeble,
and it will give relief by inhalation in some  of these cases  more rapidly
than  the nitrite of amyl.
   In hiccough a few inhalations of ether will often stop the spasmodic
movements, and local muscular spasms can be relieved in this way.
   Ether may  be used to  produce muscular  relaxation when the sur-
geon  attempts to reduce a strangulated hernia by taxis.
   In cases where cod-liver oil cannot be digested, ether may be given
in 20-drop doses in ice-water or capsule, either with, or some minutes
after, the oil  is taken, to aid  in its digestion and  absorption.   The
time of its use should be that at which discomfort is apt to come on,
and not at any stated moment.
   Administration.—Ether should be given, when used  internally, in
ice-cold water, or, better still, in capsules, in the dose  of 30  drops to
| ounce.  If cold water is not used to dilute it, so great  is the irrita-
tion of  the fauces produced  by the fumes of the ether  that deglutition
is impossible.
   Contra-indications.—Ether  should not  be  used  by  inhalation in
bronchitis, acute nephritis, peritonitis or gastritis, in aneurism, or in
the presence of marked vascular atheroma.


                     ETHYL BROMIDE.

   Bromide of Ethyl is  obtained by distilling a mixture  of alcohol,
sulphuric acid, and bromide  of potassium, and  is a colorless fluid of
neutral  reaction, having a pleasant odor resembling chloroform.  It 
176
DRUGS.
evaporates with great rapidity, and any sample which does not do this
is to be discarded.  Poured on the hand it should leave no fatty feel-
ing.  It should be remembered  that  the drug is decomposed by sun-
light  and when in contact with  pure air.  In  the presence of lamp-
light  the fumes form bromal hydrate and bromine.   The drug should
be kept in dark-glass bottles.  The physician should distinctly separate
in his mind bromide of ethyl from bromide of ethylene.  The latter is
a chemical product possessing very  dangerous properties, and should
never be used in medicine.   There is reason to believe that  unfavor-
able symptoms follow the use of bromide of ethyl only when tfye drug
is impure or is improperly  used.
  Therapeutics.—Bromide  of ethyl is a useful anaesthetic for  short
operations,  such  as  opening boils  or abscesses,  or  for the  relief of
the pain in other brief surgical procedures.  Originally introduced into
general use in this country by Levis, it has been found  unsuited to
major surgical cases because  if continued for a long time it seriously  de-
presses the respiration.  Bromide of ethyl has been found of the great-
est  value by Montgomery,  of Philadelphia, as  au anaesthetic in labor
and for minor gynecological operations in office practice.  He finds that
the patient may be allowed to inhale the drug from a Hawley inhaler,
for as soon as she has  had  enough to produce anaesthesia the inhaler
drops from her hand.  The patient is also more obedient to the physi-
cian's directions,  because of the fleeting influence of the  drug, than
when chloroform or ether are taken, and it is not  so apt to  cause post-
partum hemorrhage through uteriue  relaxation.
  A  very  great  advantage possessed by  bromide of ethyl  is  the
rapidity of its action.   A few whiffs  are generally all that is needed to
cause anaesthesia.  It rarely produces disagreeable effects.   Cases of
sudden death under  its use are, however, on record, and in some  in-
stances nervous twitchings and even  tetanic spasms have been known
to follow its employment.   These symptoms are, however, fleeting, and
generally of little importance.  Nausea and vomiting rarely follow its
employment, but  it is apt  to leave  an unpleasant garlic-like taste in
the mouth, and a similar odor of the  breath is  frequently noted  for
several days after its use.
  Administration.—Bromide of  Ethyl should be  administered but for
a brief period, but when taken should be inhaled freely.  It cannot
be given carelessly with good effect.   If a  good  sample is employed
45 minims to 3 drachms is  a sufficient amount.  This quantity should
be used at once instead of added  to the inhaler drop  by drop, as in the
case of chloroform, and the cloth or inhaler should be held close to  the
mouth and nose instead of  at a little distance, as is often necessary
with  other anaesthetics.

                       ETHYL IODIDE.

  This is a colorless, non-inflammable liquid, which really should be
called hydriodic ethyl.   Ethyl  iodide must  be kept in dark-colored
bottles in a dark  place to prevent it from undergoing decomposition. 
eucalyptus.
177
It is very volatile and the fumes arising from it are slightly pungent,
but not irritating in ordinary amounts.   Unfortunately the odor is
disagreeable to most persons.
   Physiological  Action.—Very little is known of the general physio-
logical action  of iodide of ethyl, and  the drug would be a good  one
for laboratory investigation.   It does not  produce anaesthesia except
in very large amounts.
   Therapeutics.—Iodide  of ethyl is used in medicine entirely by in-
halation for the treatment  of  subacute or  chronic catarrh  of the  air-
passages  and  for the purpose of rapidly impressing the system with
iodine for alterative purposes, as it  is the iodine in the remedy which
produces the curative effects desired.  In catarrhal states of the bron-
chial  tubes  the  stimulating effect  of the  iodine causes free  secretion
and prevents abnormal thickening of the mucus and dilatation of the
air-passages.  For  this reason iodide of  ethyl is supposed  to be of
service in asthma and its  resulting emphysema.   Very recently Bar-
tholow has recommended this drug in the treatment of pneumonia.  It
is said by that writer to be particularly useful in the later stages of this
disease, as it aids in producing resolution, but the author  has never
seen it produce much effect.
   Administration.—Ten to twenty drops may be placed upon a hand-
kerchief and inhaled, or a small vial filled with the drug may be held
in the hand under the nostrils.  Under these circumstances the heat
of the hand sets free the necessary amount of vapor.


                        EUCALYPTUS.

   Eucalyptus, U. 8., is the leaves of the Eucalyptus Globulus or Blue
Gum tree, a native of Australia, but  grown at  present all over  the
world.   Their  chief medical constituent is the Oil of  Eucalyptus
(Oleum Eucalypti, U:8.), from which is derived eucalyptol, which  is a
camphorous body obtained by  redistillation  with caustic potash or
chloride of calcium.  The oil of eucalyptus and eucalyptol are used
for the same  purposes, but the latter is the refined product of  the
former.
   Physiological Action.—Locally applied the oil is a decided irritant.
Ten  to twenty  drops taken internally cause slight stimulation,  fol-
lowed by  a sense of calm, while larger doses produce disturbed diges-
tion and loose, oily-odored stools.  The pulse is increased in frequency
and force, and intense headache may  come on.  After very large doses
there  is a fall in pulse force, bodily temperature, and strength of limb,
and the respirations are decreased.   A peculiar loss of sensation in  the
lower limbs may occur.  If death takes place it is due to respiratory
failure.  The  drug is eliminated by the skin,  kidneys, bowels and
lungs. The urine may  have the odor of violets,  as it sometimes does
after the use of oil of turpentine.
   The oil of eucalyptus has considerable antiseptic power.
                                12 
178
DRUGS.
  Therapeutics.—Eucalyptus is used in malarial fever where quinine
cannot be  had or be borne by the patient owing to idiosyncrasy.   In
bronchitis in an emulsion or in capsule  it is of great  value iu the later
stages (see Bronchitis), and it may be used in the subacute forms of
gonorrhea  in the same manner, since  in its elimination by the lungs
it acts locally upon  the  inflamed mucous membrane.  The following
prescription will answer:
         R.—Olei eucalypti......f 3J-
             Olei amygdalae dulc......f 3J-   M-
    Ft. in capsule no. x.  S.—One t. d. after meals.
  Oil of eucalyptus is very useful in some forms of rheumatic head-
ache or in  headache dependent  upon malarial fever.
  Eucalyptol is largely employed by rhinologists and others in lotions
and other nasal applications.  It may be used in solutions of fatty oils,
but is insoluble in water, although it is soluble in alcohol and ether.
  Administration.—The extract (Extractum Eucalypti Fluidum, U. 8.)
is given in  the  dose  of 10 drops  to 2 drachms.   The oil (Oleum
Eucalypti, U. 8. and B. P.) in the dose of 5 drops.  The dose  of euca-
lyptol is 5  grains in  capsule.
   Unguentum Eucalypti is official in the B. P., but is seldom used.


                         EUONYMUS.

  Euonymus, U. S., or Wahoo, is the bark oiEuonymus Atropurpureus,
a native plant  of the United States.   It contains an active principle,
euonymin.    As a laxative its action is very slow and moderate, but it
is thought  to act particularly on the liver, and may be used when mild
 hepatic torpor is  present.
  Administration.—The dose of the solid extract (Extractum Euonymi,
 U 8.) is 3 to 10 grains.

                        EUPATORIUM.

   Eupatorium, U S.,  Thoroughwort or Boneset, is  the  leaves  of the
 Eupatorium Perfoliatum, an American plant which is used as a simple
 bitter tonic and diaphoretic very largely in household medicine.  The
 drug is generally given in hot infusion in cases of arrested menstrua-
 tion due to cold, or in the chill of a remittent or intermittent fever, and
 also for anorexia and debility.   Its  taste is very disagreeable, and in
 the dose of a pint of the cold  infusion it has been used as an emetic.
 The fluid extract (Extractum Eupatorii Fluidum, U. 8.) is given in the
 dose of 30 drops to 1 drachm.


                 EUPHORBIA PILULIFERA.

   This herb is  sometimes called  Snake-weed  or Cat's-hair, and is a
 native  of  Australia and the West Indies, where, like stramonium, it
 grows profusely  as a weed by the wayside. 
europhen.
179
  Physiological Action.—In toxic doses the drug  kills  small animals
by failure of the respiration and circulation, these  two vital functions
being greatly affected by doses which exert no great influence  on the
rest of the body.   In full dose it may cause some  gastric irritation.
  Therapeutics.—Euphorbia pilulifera is one of the latest remedies in-
troduced into medicine for the relief and cure of asthma, in which disease
the results obtained, after other remedies fail,  are very extraordinary
if the reports of  those who have given it a thorough trial can be ac-
cepted without reserve.   As yet we do not know the form of asthma
which is most relieved by its use, and its employment  is  purely em-
pirical.   It has also been highly praised in the treatment of chronic
bronchitis and emphysema.
  Administration.—Euphorbia pilulifera is best given in the form of
the fluid extract in the dose of 30 drops to a drachm.   The decoction
is made by adding a " handful of stalks with the leaves on them to two
quarts of boiling  water and  boiling down to a  quart and a half."  Of
this decoction the dose is a small wineglassful three times a day.  (See
Asthma.)

                         EUROPHEN.

   Europhen is the  result of the action of iodine on isobutylorthocresol
in the presence of an .alkali, and appears as a fine yellow powder, sol-
uble  in  alcohol, ether, chloroform  and oils, but  insoluble in water.
Introduced because it was hoped that it might prove a useful substitute
for iodoform,  its usefulness is still  undecided,  owing to the short time
that it has  been  before the  profession.  One advantage claimed for it
is that it parts with its iodine very slowly, and  so is not  apt to prod in e
toxic symptoms  as rapidly as does iodoform.   For this very reason,
however, it lacks the remedial power of the older drug, except in those
iustances in which a drying powder is needed which will  keep the
wound  pure by making  it  too dry to be favorable  to  the growth of
germs.   When such an  action is desired europhen possesses the addi-
tional advantage of being five times as bulky as iodoform.   In the
treatment of tuberculous growths europhen has already proved itself
very inferior to iodoform.   Owing to  its stability  it  fails to part with
its iodine except in the presence of moisture, and is useless  in dry-skin
diseases.  It has been found useful in scrofuloderm, ulcer of the legs, and
lupus.  Europhen may be employed externally in a  salve of the strength
of from 5 to 10 per cent., or with olive oil or lanolin.   It can also be
added to flexile collodion.  The drug does not possess the odor of iodo-
form, but experience will probably prove it to  be more  irritating  than
the latter drug.  The internal dose is 1 to 3 grains in cases  of syphilis.
Europhen is incompatible with metallic oxides  and the preparations of
mercury, and  also with the starch and zinc paste largely used by der-
matologists. 
180
DRUGS.
                          EXALGINE.

  This  substance is  really methyl-acetanilide and closely resembles
acetanilide or antifebrin  in its effects.   It is given for the  same pur-
poses as is acetanilide and antipyrine, namely, for the relief of pain
in locomotor ataxia and other nervous affections, but never as an anti-
pyretic.  When used, exalgine should  be given night  and morning as
a rule, so that the doses  shall not be  near  together.  The beginning
dose should be from 2 to 4 grains, and not more than 12 grains should
be given in 24 hours. It is stated  by those who have used the drug
that fever contra-indicates its employment.
  The following prescriptions will be found applicable :

         R.—Exalgini    .    .    .
            Tincturae aurant. dulcis
    Ft. in sol. et adde
            Syr. aurantii
            Aquse menth. piperit.  .
    S.—A tablespoonful night and morning.

Or,
         R.—Exalgini    ....
            Spt. frumenti
    Ft. in sol. et adde
            Syr. simplicis
            Aquae, dest.  ...
    S.—Tablespoonful night and morning.
                          FLAXSEED.

  Flaxseed or Linseed (Linum, U 8.), is the seed of Linum Usitatissi-
mum, or flax from which linen is made  ; it  is official  in the B. P. as
Lini Semina.   It contains an oil and a mucilage, the first of which is
largely used in the arts, and the second is sometimes employed in medi-
cine.  The oil (Oleum Lini, U. S. and B. P.) is also used by physicians
and pharmacists for various purposes.
  Therapeutics.—Flaxseed acts  as a demulcent  to inflamed  mucous
membranes, and is used largely in the treatment of acute cystitis, bron-
chitis, gastritis, nephritis and similar states in the form of flaxseed-tea.
This is  prepared by mixing together 3 drachms of flaxseed, not ground,
30  grains of extract of liquorice, 10 ounces of boiling water, and allow-
ing the  mixture to  stand one to four  hours in a warm place.   If the
mixture is boiled  the oil  is set free and makes the dose  disagreeable.
This infusion may  now be made  more tasteful and useful by the addi-
tion of  a little lemon-juice aud sugar and by the placing of from 1 to
2 drachms of gum-arabic  in the pitcher containing it.   If the cough
is excessive, a little paregoric may be added. Linseed  oil is used some-
times as a laxative in the dose of 2 ounces,  and  is said to be of service
when so given in the treatment of hemorrhoids.
     .  gr. xxx.



q. s. ad  f^iv.     M.
 gr. xxx.
flss.    M.
•    •    •  flJ-
   q. s. ad  f3iv.    M. 
GALLIC ACID;   NUT-GALL.              181
  Flaxseed meal (Lini Farina, B. P.) is  employed  universally when
moistened as a useful poultice,
  Under the name of Carron oil, an emulsion of lime-water and linseed
oil, equal parts, is  the standard application for  limited or extensive
burns.
  An infusion of linseed (Infusum Lini) and a poultice (Cataplasma
Lini) are official in the B. P.
                        GALLIC ACID.

  Acidum Gallicum (U. 8. and B. P.) is prepared from  powdered
nut-galls  by a somewhat  complicated  and  prolonged process.   It
occurs in nearly colorless, long, needle-like crystals, which are soluble
in 100 parts of cold water, 4 J parts of alcohol, and 3 parts of boiling
water.
  Physiological Action.—Gallic acid is an astringent but not a coagu-
lator  of blood.  Locally applied in bleeding it is useless, but given
internally in haemorrhages which cannot be  acted upon by the direct
local application of tannic acid it is  useful as a haemostatic.   It is
eliminated from the body by the kidneys, as  gallic acid.
  Therapeutics.—Gallic acid may be used with much success in hemat-
uria, hemoptysis, colliquative sweats, and in bronchorrhea with profuse
expectoration.
  Combined with  opium it is  one  of the best  remedies in diabetes
insipidus, and is even useful in diabetes mellitus.
  In albuminuria dependent upon a relaxed, atonic state of the kidneys
and in night-sweats  and acute or chronic diarrhea, gallic acid may be
used with advantage.  In the form of the ointment it is useful in the
treatment of psoriasis, and in  the cure of ulcers and sores which are
actively discharging.
  Administration.—Gallic acid is given in the dose of  2 to 40  grains
in pill or solution.   It  ought  never to be used with any salt of iron,
as it is incompatible.  The official preparations are Unguentum Acidi
Gallici, U. 8., used  locally, and  Glycerinum Acidi Gallici, B. P., given
in the dose of 10 to 60 minims.

                            Nut-gall.

  Nut-galls (Galla,  U. 8. and B. P.) are the small excrescences found
upon  the oak  (Quercus Infectoria) formed by  the ova of the fly Cynips
Galle Tinctorie.    Their  sole  value  depends upon  the  tannic  acid
contained in them, and they are official in  the form  of the tincture
(Tinctura Galle, IT. 8. and B.  P.), dose J to 2 fluidrachms ; and the
ointment (Unguentum Galle,  U. 8. and B.  P.).   Unguentum  Galle
cum Opio is official in  the  B.  P., and is used as  an astringent and
sedative ointment. 
182                          DRUGS.
                        GAULTHERIA.

   Wintergreen, or Gaultheria Procumbens,  is an American evergreen
containing a volatile oil.  The oil possesses a peculiar, exceedingly
penetrating odor and a warm aromatic taste.  It is about 90 per cent.
salicylate of methyl.
   Physiological Action.—Owing to the large amount of salicylate of
methyl contained  in  the oil, its  physiological action is almost identical
with that of salicylic acid.  (Wood and Hare.)
   Therapeutics.—Aside  from  its use as a  flavoring substance,  oil of
gaultheria is largely  used in all forms  of rheumatism, and in place of
the ordinary salicylates.  It does not  so commonly disturb the  diges-
tion of patients as do the salts of salicylic acid or the acid itself.   The
oil (Oleum Gaultherie, U. 8.)  is  best  given in capsules or emulsion,
or dropped on a teaspoonful of sugar,  three times a day after  meals.
The dose may be  as  high as 100 drops  a day ; if 60 drops three times
a day do no good, pushing it further is practically useless.
  The spirit of gaultheria (Spiritus Gaultherie,  U. S.) is  given in
the dose of 10 to  20  minims.
                         GELSEMIUM.

   Gelsemium, U 8. and B.  P., or yellow jasmine, as used in medicine,
is  the rhizome of the  Gelsemium  Sempervirens, a climbing  plant of
the southern United  States.   It contains an alkaloid, gelsemiue,  and
gelseminic acid.
   Physiological Action.   Nervous System.—Gelsemium paralyzes
the spinal cord, particularly on its sensory side (?), although the motor
side is certainly ultimately  depressed.   It  does not  influence  the
nerves or muscles except those of the  head, on which  it acts as a
paralyzant particularly affecting the motor fibres.
   Circulation.—Gelsemium is a depressant to the circulation, acting
particularly on the heart.
   Respiration.—Gelsemium kills by paralyzing the respiratory cen-
tres.  (Sanderson, Ringer, and  Murrell.)
   Temperature.—In overdose  the  drug lowers bodily heat very
markedly.
   Eye.—Gelsemium is a  mydriatic of considerable power, causing,
when dropped into the eye, wide dilatation of the pupil, a result  due
to paralysis of the oculo-motor nerve.
   Therapeutics.—Gelsemium is used  in headache and  migraine  de-
pending  on  nervous troubles or upon eye-strain.  It is  particularly
useful in combination  with cannabis indica.  (See  Cannabis Indica
aud Migraine)
   In malarial fever it is said to be of great service, but this is doubt-
ful.  In  the early stages of pneumonia &n& pleurisy it has been highly
spoken of by Bartholow. 
gentian.
183
  Gelsemium has also been found of value in asthma, whooping-cough,
laryngismus stridulus, and nervous cough.   In localized muscular spasm,
such as is seen in torticollis or wry-neck, and in spasmodic dysmenorrhea,
it is of considerable service.   It ought not  to be  used  if the system
is already depressed, but only in sthenic cases.
  When used as a mydriatic Tweedy recommends  it as equal to atro-
pine in effect, but  much more transient in  its influence.   He uses a
solution of 8 grains of gelsemine to the ounce of water,  instilled, drop
by  drop, into the  eye every fifteen minutes for one hour, and then
every half-hour for two hours.
  Poisoning.—The most prominent symptoms of gelsemium poisoning
are ptosis and dropping of the jaw. " These are preceded by a sensa-
tion of languor, a  desire to  lie down, relaxation and  muscular weak-
ness.   Gelsemium  is apt to cause temporary internal squint owing to
its  paralyzant action on the sixth pair of  cranial nerves.   The pulse
becomes rapid and  feeble, the skin wet and cold, the face pinched and
anxious, the  voice  is lost in aphonia, and death ensues from centric
respiratory failure  and an almost simultaneous cardiac arrest.  Sensa-
tion in man is impaired  very late in the poisoning.
  The treatment of the poisoning consists in the use of cardiac stimu-
lants,  such as ammonia, digitalis, and atropine,  the application of ex-
ternal  heat, and the employment of atropine and strychnine for the
purpose  of stimulating  the respiratory centre.   Emetics  and  the
stomach-pump  are, of course, to be employed.
  Administration.—The fluid extract, Extractum Gelsemii  Fluidum,
U 8.) is given  in the dose of 5 to 10 minims, and the tincture ( Tinc-
tura Gelsemii,  U. S. and  B. P.) 10 to 20 drops.  Gelsemine  may be
used in the dose of fa of a  grain.  Extractum Gelsemii Alcoholicum,
B. P., is given  in the dose of J to \ grain.
                           GENTIAN.

   Gentiana, U. 8., is the root of the Gentiana Lutea, or yellow gen-
 tian, a European plant.  It contains gentianine and gentisic acid and
 has a  bitter taste.    This  drug is  official in the B. P. as Gentiane
 Badix.
   Therapeutics.—Gentian is one of the most efficacious bitter tonics
 that we possess, as well as one of the most  elegant.   In the anorexia
 following acute diseases and in gout and malarial poisoning with dys-
pepsia it is of service.  Combined with bicarbonate of sodium it is of
great service in the treatment of the gastric and intestinal catarrh of
children.
   Administration—The compound tincture (Tinctura Gentiane Com-
posita, U. 8. and B. P.) is given in the dose of a drachm to a wine-
glassful, the fluid extract (Extractum Gentiane Fluidum, U. 8.) in the
dose of 30 drops to  a  drachm, and in the solid extract (Extractum
 Gentiane, U. S. and  B. P.) in the dose of 1 to 8 grains.   Infusum
 Gentiane Compositum, B. P., is  given  in the dose  of 1 to 2  fluid- 
184
DRUGS.
ounces, and the compound tincture (Tinctura Gentiane Compositus) in
the dose of J to 1 fluidrachm.   The compound  tincture and infusion
are composed of gentian, bitter orange peel, and  cardamoms.  The fol-
lowing prescription is an excellent  one for use in convalescence from
prolonged fevers :
        R.—Acid, nitro-hydrochlor.dil.  .    •   f 3J vel f3y-
            Tr. nucis vomicae......f.^j;
            Tr. cardamomi comp......faij-
            Tr. gentianae comp.    .    .    .   q. s.  ad  f Jiv.   M.
     S.—Teaspoonful in water after meals.


                          GERANIUM.

   Geranium, U S., is the rhizome of Geranium Maculatum.  It con-
tains tannic and gallic acid and  is useful in diarrhoea as an astringent.
It is not the common red geranium seen in flower gardens.
   In infantile diarrhea geranium root boiled  in milk in the propor-
tion of one or two roots to the pint will be found of great service, and
is lacking in  taste.   The dose  of the  drug itself is 20 to 60 grains,
and that of the fluid  extract (Extractum Geranii Fluidum, U. S.) J to
1 fluidrachm.

                            GINGER.

   Zingiber, U. S. and B. P., is the rhizome  of Zingiber Officinale, a
plant of Hindoostan, Jamaica, and  other  tropical countries.   Black
ginger is the dried rhizome with its bark, while  white ginger has this
covering removed.   It  contains a hot volatile  oil and  an  aromatic
resin and  is very largely used  in domestic  medicine as a carminative
and stomachic.  In the treatment of menstrual cramps it is often given,
and is particularly useful in those due to suppression from exposure
to cold.   With purgative medicines ginger is employed for  its flavor
and the prevention of griping.   Of itself it is decidedly constipating,
and when used in diarrhea mixtures is of value other than as a flavoring
addition to the prescription.
   Administration.—The fluid extract (Extractum Zingiberis  Fluidum,
 U. S.) is given in the dose of 10 to 30 drops, well diluted.  The tinc-
ture (Tinctura Zingiberis, U. 8. and B. P.), 20 drops to 2 drachms ; the
syrup (Syrupus Zingiberis, U. 8. and B. P.), dose 30 drops to 2 drachms ;
the oleroesin  (Oleoresina Zingiberis, U. 8.), dose J to 1 drop, well
diluted, or in pill, and the troches (Trochisci Zingiberis, U. S.) used as
stimulants to salivary secretion.   In  the B. P. a  stronger tincture,
Tinctura Zingiberis Fortior, is official, dose 5 to 20 minims.


                           GLYCERIN.

   Glycerinum, U S. and B. P., is a liquid obtained by the decompo-
sition aud distillation of fats.   It possesses great power of absorbing 
glycerin.
185
water and of dissolving many substances.   Even if pure  it irritates
the skin of susceptible persons  by its absorption of water, and often
causes a slight rash.
  Physiological  Action.—Injected into  the  circulation  in  large
amounts,  glycerin causes convulsions, which are due  to  its hydro-
scopic power.
  According to the clinical researches of Pavy,  glycerin increases the
polyuria of diabetes almost  one-half, and for this reason he thinks
it is  not to be employed in this  class of cases as a  substitute  for
sugar.  Again, the experiments of Luchsinger and Weiss have shown
that the administration of  this substance increases  the  amount of
glycogen  iu the  liver  to  a very considerable extent;  while, on  the
other hand, the  researches  of  Eckhard and Luchsinger have also
proved  that glycerin  very frequently tends to prevent  glycosuria
which has been  brought about by puncture of the so-called diabetic
centre in the floor of the fourth ventricle, if the drug be given hypo-
dermically.   Luchsinger, therefore,  believed  that  while  glycerin
might increase the amount  of glycogen, it also prevented its trans-
formation  into  sugar  by inhibiting  the  amylolytic  action of  the
hepatic ferment.   Eckhard believes that the hypodermic injection of
glycerin  produces  such   radical changes  in  the blood and general
system  that no  conclusion  can be  made  of  the  proper  influence
exerted by  it.   In a paper  exceedingly useful and interesting, both
from  a physiological and clinical standpoint,  Ransom, of London,  has
recently gone over this work in a satisfactory manner, and has  tried,
with considerable success, to unravel the somewhat complex pathology
of the disease, as well as the equally complex and opposing statements
of investigators as to  the influence of glycerin.  He points out that
one element of fallacy in all these experiments is the fact that  glycerin,
when given hypodermically, must  reach the liver so slowly and in
such  a  diffused state as  to be almost powerless, and, in consequence,
Ransom  introduced the  glycerin into the alimentary canal.   All the
experiments  seem to have  been made  in a most  painstaking  and
careful manner, but as we have no space for  their detail,  we must
pass them by in  order to reach the  results attained.  These are as
follows :   1. Certain forms of glycosuria may be checked by  glycerin.
2. Glycerin acts  more efficiently when introduced into the alimentary
canal than when injected subcutaneously.   3.  Glycerin  checks glycos-
uria by inhibiting the formation  of sugar in the liver.   4. By  this
means glycerin increases  the quantity of glycogen found in the liver.
While these conclusions are not final in proving the value of glycerin
under such circumstances, it would seem probable that they are of great
value in pointing toward a solution of one of the most complex subjects
with  which physicians are called upon to deal, and it  is to be hoped
that Ransom will publish other researches  at  a future time which
will further elucidate this difficult subject.  The quantity of glycerin
which the writer would recommend to be given clinically by the mouth
is 1 drachm diluted at least one-half with water.
  Therapeutics.—Glycerin may be employed as a sweetening agent in 
186
DRUGS.
the food of diabetics and  in cases where sugar  cannot be used.  It
has also been given as a  laxative,  in  1 or 2 drachm doses  by the
mouth,  and in enema—1 to 4 drachms  with or  without equal  parts
of water.   In some cases  it may be used in  suppository.  This latter
method is very successful  in  chronic constipation.  Its continued use
by suppository may, however, result in rectal irritation.
  As an antiseptic it is used for preserving specimens, and for keeping
alkaloids in solutions for hypodermic use.
  In  acute  coryza, applied by a spray or brush  to the nostrils, it is
sometimes of service ; for this purpose it should  be diluted  four or
five times  with water.  If used on the skin it should be diluted one-half
with  water.   In cases of impacted  cerumen in the external auditory
canal glycerin is often of service in softening the  mass.
  The uses of glycerin, other than those  mentioned, are many.  In
the proportion of 1 part of glycerin and 1 of water  it makes a very
useful mouth-wash in the sore and dry mouth of typhoid fever and for
the removal of sordes.  The same wash  with lemon-juice added to it
is very agreeable and will relieve the dry, glazed tongue of advanced
phthisis.
  Owing  to the fact that  glycerin is hydroscopic, it may be used as a
depletant  on a pledget of cotton in congestion of the uterine cervix, the
tampon being renewed daily.  (See Boric Acid and Boroglyceride.)
  For  the  prevention of  bed-sores Ringer recommends  the  daily
washing and rubbing of the part likely to  be affected, followed by the
application of glycerin, and a draw-sheet placed  smoothly against the
patient to protect the bedding.
  Glycerin  and whiskey  is a favorite household remedy for colds and
coughs, but  is  not very useful.   Glycerite of starch (Glyceritum
Amyli,  U. 8. and B. P.) is used as a protective.   Glycerite of yolk of
egg (Glyceritum Vitelli, U. 8.) is used in making  emulsions.
  A very useful ointment for the application of  medicinal substances
to the skin may be made by mixing constantly in the presence of heat
1 part of potato starch and 15 parts of pure glycerin.   The result is a
clear, transparent, jelly-like substance which does not  decompose and
has the advantage of holding the medicament which it carries in solu-
tion rather than by mechanical suspension.
  The B. P. preparations of glycerin are as follows : Glycerinum
Acidi Carbolici; Glycerinum Acidi  Gallici ;  Glycerinum Acidi  Tan-
nici;  Glycerinum Aluminis;  Glycerinum Boracis ; Glycerinum Plumbi
Subacetatis, and Glycerinum Tragacanthe.


                             GOLD.

  Gold is  not  official in the U.  S.  Pharmacopeia, but has  been
recommended very highly by Bartholow in chronic Bright's disease in
the form of the chloride of gold and sodium (Auri et Sodii Chloridum,
U. S.).  The dose of this substance is fa to fa of a grain once, twice,
or thrice a day.   The author has not found it of much value.   Gold 
GUAIAC.
187
has also been strongly  recommended for indigestion with  epigastric
pain after eating when looseness of the bowels is present, and is said
to act as a powerful sexual stimulant and to be of service in impotence
dependent upon inability to obtain an erection or when there is  de-
ficient glandular action.  In overdoses the drug causes gastro-enteritis.
Magruder has recommended chloride of gold and sodium in the treat-
ment of pertussis.

                   GRINDELIA ROBUSTA.

   Grindelia, U. S., is  an American plant (Grindelia Bobusta)  con-
taining  a resin, a volatile oil, and au alkaloid.
   Physiological Action.—Upon the lower animals and man this drug
is not  very powerful in its action,  but may cause,  in large doses,
paralysis of the peripheral sensory nerves, the  sensory centres in  the
spinal cord, and finally the motor centres and nerve-trunks.  It slows
the heart by stimulating  the vagi,  and raises  blood-pressure by stimu-
lating the vasomotor centre.
   Therapeutics.—Grindelia robusta is an exceedingly useful remedy in
some cases  of asthma, and  in bronchitis in  its later stages.  It may
be given in  the dose of 20 to 60 drops of the fluid extract (Extractum
Grindelie  Fluidum), or  by inhaling the fumes of burning grindelia
leaves which are previously soaked  in a solution of nitre, dried, and
burned  on a plate, or rolled into a cigarette and smoked.   In chronic
cystitis it stimulates the bladder, and is of great service.  By diluting
it 1 to 10 with water it forms one  of the best lotions that we have for
the relief of the  dermatitis produced by poison ivy or Bhus Toxico-
dendron.
   Administration.—The only preparation which is official  is the fluid'
extract  (Extractum Grindelie Fluidum, U. 8.), dose 20 to  60  drops.


                            GUAIAC.

   Lignum Vitae, or Guaiacum Officinale, a  West Indian tree, is used
in medicine in two forms—namely, as Guaiac wood (Guaiaci Lignum,
U. S. aud B. P.), which is in raspings and  enters into the compound
syrup of sarsaparilla, and Guaiac resin (Guaiac Besina, U. S. and B.
P.) or Guaiac, which is soluble in alcohol, ether, and chloroform,  but
insoluble in water.
   Therapeutics.—Guaiac has been largely used in syphilis, but is now
rarely, if ever, so employed.  Given  in acute tonsillitis in  the dose of
30 grains in an emulsiou made by the use of white of egg, it will often
abort the disease. . In  rheumatism it has been largely used.  The am-
moniated tincture of guaiac is sometimes employed in the treatment of
sore-^Aroa^, particularly if it be rheumatic in  type, but is a disagreeable
preparation  to take into the mouth.
   Aministration.—The tincture (Tinctura Guaiaci,  U. S.)  is given in
the dose of 5  to 60 drops, and the ammoniated  tincture (Tinctura 
188
DRUGS.
Guaiaci Ammoniata, U. 8. and B. P.) is used in the same dose, prefer-
ably in milk.  Mistura  Guaiaci, B. P., is given in the dose of 1 to
1^ fluidounces.

                          G¥AIACOL.

  Guaiacol is a liquid constituting from 60 to 90 per cent, of creasote.
It is obtained by the distillation of beechwood creasote, followed by a
complicated process which  it is not necessary to  describe.   In other
cases  guaiacol is  obtained  from  beechwood  creasote by precipitation
with barium  hydrate.  Much of the " absolute guaiacol" of commerce
is impure.   Chemically  pure  guaiacol  obtained by the  process  last
named  is a  light-colored fluid of an agreeable odor  and  soluble in
water in the  proportion of 1 to 85 (Helbing).   It is easily  soluble in
alcohol and ether.
  Therapeutics.—Guaiacol has been largely used by some practitioners,
chiefly in Europe,  for the treatmeut of tuberculosis, as a substitute for
creasote, because  it  is the  principal ingredient of that  drug.   (See
Creasote.)  It was thought by  Guttmann, Sommerbrodt, and others
that the good effect of creasote was due to its  destructive  action  on
the bacillus,  or that it so improved digestion as to increase the resist-
ance of the patient to the spread of the disease.  Recently  Hoelscher
and Seifert have asserted that guaiacol and creasote produce their good
effects by forming compounds with the toxines or poisonous albumin-
oids formed  by the  bacilli,  which are then eliminated  from the body.
The same rules govern the use of guaiacol as govern the  employment
of creasote.  It is  best  given with brandy, wine, or  other alcoholic
drink, or in capsules with cod-liver or  sweet oil.   Five  or ten drops
of guaiacol may be  added to a pitcher of hot  water  and  the  vapor
inhaled 3 or  4 times a day in cases of subacute and chronic bronchitis.
The dose by  the stomach is 5 to 20 minims.


                         GURJUN OIL.

   Gurjun Oil, or,  as it is sometimes called, Gurjun Balsam, or  Wood
Oil, is the exudation obtained, by incision and the application of heat,
from the bark of an  East Indian tree.   It is a transparent liquid pos-
sessing the consistency of olive oil, of a  greenish-gray color  when held
up to the light.   It  has an  aromatic odor resembling  to  some  extent
that of copaiba.   It is not, however, so disagreeable to the taste.
   Therapeutics.—Gurjun oil has been found of value in cases of chronic
bronchitis where a stimulating expectorant of considerable power was
desired, and  this is particularly the case if the mucus in the bronchial
tubes  is very tenacious.   The oil has also  been  found of value in
gonorrhea and gleet  as a substitute for copaiba and cubebs.
   Administration.—Gurjun oil is best  given in the dose  of from 1 to
2 drachms three  times a day, combined with spirit of nitrous ether,
mucilage of acacia and cinnamon water, or mixed with extract of malt 
HAMAMELIS.
189
ill the proportion of 2 drachms of the oil to an ounce of the extract.
Persons having irritable stomachs may not be able to take this drug.


                      HEMATOXYLON.

   Hematoxylon,  U. 8., Hematoxyli Lignum, B. P.,  or Log-wood, is
the heart-wood of Hematoxylon Campechianum, a tree of the Ameri-
can tropics.   It contains an alkaloid, haematoxylin.
   Therapeutics.—Haematoxylon is a mild  astringent, very useful in
serous diarrheas and in the diarrhoeas of young children, as "children do
not dislike it, owing to its agreeable taste.  (See article on Diarrhoea.)
As it colors  the stools and urine red, the nurse should be warned,  lest
she be alarmed  at  the sight of what looks like  blood on the diaper
after the drug is given to infants.   In leucorrhea its internal use is
of service.  The extract (Extractum Hematoxyli,  U. 8. and B. P.) is
given in the dose of 8 to  30  grains, and Decoctum Hematoxyli, B.  P.,
in the dose of 1 to 2 fluidounces.  An unofficial fluid extract is often
to be found  in the shops.  The dose of this is J to 2 fluidrachms.


                        HAMAMELIS.

   Hamamelis, U. S., Witch-hazel,  or Hamamelis  Virginica, is a plant
of the United States, devoid of any true active principle, but possess-
ing extraordinary remedial power.
   According to  the studies of Wood and Marshall it has absolutely
no physiological action, yet practically we know it to be a most useful
remedy.
   Therapeutics.—Hamamelis is wonderfully successful in the treat-
ment of uterine oozing from  small bloodvessels, seems to do good even
in hematemesis and hemoptysis, and will sometimes  arrest hematuria
when all other remedies fail.   Applied by means of cloths to leg ulcers
it acts very thoroughly  and relieves the surrounding angry-looking
skin at  once.  In bleeding from the  bladder it  may be injected into
this  viscus  daily in the form  of  the  distilled  fluid  extract,   Taken
internally and applied locally it is of value in the treatment  of bleed-
ing and the  so-called blind piles.  (See Haemorrhoids.)
   Injected into  the part affected, or taken internally, hamamelis is of
value in persons suffering from varicose veins.
   Administration.—The one  official  preparation is  the fluid extract
(Extractum  Hamamelidis Fluidum, U. 8.), dose 5  to 20 drops.   The
dose of the  distilled extract, which is uot  official, and is a  perfectly
clear liquid, is from 30 drops to 1  drachm, and this  is  much the best
preparation  for internal and external use.   Unfortunately, the prepa-
rations of the drug vary very much both in odor and efficacy.   Some
of the  proprietary  preparations of witch-hazel are  more active than
those ordinarily  dispensed in the drug store.  This  is due to greater
care in their preparation and to the fact that they are sold in original
packages without exposure to the air. 
190
DRUGS.
                 HOFFMANN'S ANODYNE.

  Spiritus Mheris  Compositus,  U. S. and B. P.,  consists of alcohol,
ether,  and  the heavy oil  of wine.  The writer has experimentally
studied very thoroughly the action of the last-named ingredient, and
finds :
  First.  That the belief in heavy  oil of wine being the quieting agent
in Hoffmann's anodyne is fallacious.
  Second. The calmative effects of this mixture depend largely on the
ether, rather than on the oil.
  Third.  It would seem  probable that  in  Hoffmann's  anodyne we
possess an agent in which there  are linked together three drugs of
undoubted power, each one of which successively substitutes the other,
stimulating  the system in  the order here named, viz., ether, alcohol,
and the heavy oil of wine.
  On  animal  temperature, as ascertained by the thermometer in the
rectum, the  heavy oil of wine exercises  no influence, even when the
arterial pressure  is very low.  That large doses  of  the  heavy oil of
wine are in  no way possessed of toxic effects is proved by the fact that
30 c.c. of the drug given by the mouth to a small dog, weighing twelve
pounds, failed to produce any apparent  symptoms, except, perhaps, to
stimulate him slightly.  While the odor of the oil is penetrating it  is
by no means disagreeable, and it possesses but  little  taste other than
that of the presence of an oily substance.
  Therapeutics.—Hoffmann's anodyne is the best carminative that we
possess for  general  use, and is one of the best remedies  for singultus
or hiccough.  These effects are  accomplished probably in two ways :
The alcohol and ether act as irritants or stimulants to the intestine, and
free peristalsis results,  while the heavy oil of wine acts, perhaps, as a
nervous sedative.  In angina, pectoris this drug is often the best remedy
we have, and in the cardiac palpitation of tobacco-heart or that arising
from indigestion it is very useful.
  In  the nausea and depression seen after excessive smoking, Hoff-
mann's anodyne should always be given in capsules  or in cold water,
preferably ice-cold, in order  to prevent too  rapid volatization of the
ether aud consequent difficulty in swallowing the liquid.
  The dose  is 1 to 2 drachms to an adult.
                       HOMATROPINE.

  Homatropine  is an  artificial alkaloid obtained by  prolonged  and
gentle  heating of a  solution of equivalent quautities of tropine1  and
toluic acid  in hydrochloric acid.   The hydrobromate  of homatropine
is a crystallizable salt of homatropine soluble in 10  parts  of distilled
water.

  1 Tropine is a product obtained by splitting up atropine into tropine and tropic acid- 
HOPS.
191
  Hydrobromate of homatropine, properly applied by frequent instil-
lations, is a reliable mydriatic for the correction of anomalies of refrac-
tion in healthy eves.  Experience is not at hand to determine its value
for  this purpose in eves  affected with retino-choroidal  disturbance.
Atropine and hyoscyamine are preferred under such circumstances,
for  the obvious  reason that their prolonged action is desirable  as a
method of treatment.  The danger of systemic disturbance from homa-
tropine  is far removed,  even when  repeated instillations have  been
made, and its temporary action upon the pulse causes no inconvenience
to the patient.  Slight hyperemia of the conjunctiva almost invari-
ably follows its use, but true conjunctivitis, if it occurs at all, must be
excessively rare.   According to the studies  of Dr. de Schweinitz and
the writer, the drug has a physiological action closely allied to that of
atropine, from which it is derived.  Homatropine mydriasis generally
lasts from 36 to 48 hours, that of hyoscyamine 8 to 9 days, and that
of atropine 10 to 12 days.  For the production of ordinary mydriasis
the drug should be used in solution of the strength of 4 grains to the
ounce of distilled water, which is to  be  dropped into the eye every 5
or 10 minutes.  As the drug is expensive only a few drachms of the
solution of the strength named should be ordered for a patient.
                            HONEY.

  Honey, or Mel,  U. 8. and B. P., is the saccharine fluid deposited in
combs by the  honey bee, or Apis Mellifica.   It  is used to cover  the
taste of disagreeable medicines.   When it is abstracted from a peculiar
variety of flowers it  frequently has the odor of the flower, and when
taken internally may even produce the  physiological effects of  the
plant from which  it is gathered.   This accident occurs commonly in
those parts of the country where the bees have had access to mountain
laurel and similar plants.
  Therapeutics.—Honey  is used as an emollient  in  gargles and to
relieve cough and dryness of  the mouth and fauces.   When used as a
gargle it very distinctly increases the secretion of the mucous mem-
brane, and so relieves the congestion.
  Under the name of Oxymel the B. P. recognizes a mixture of 8 parts
of honey, 1 of acetic acid, and 1 of water.  This is generally  used as
a vehicle for more active remedies in gargles, or even for expectorant
mixtures.  Melted and strained honey is known as  Mel Despumatum,
 U 8., and Mel Depuratum,  B. P.  There are also a honey of roses
(3Iel Bose, U. 8.) and  a confection (Confectio Bose, U. S.)  used as
vehicles for other drugs.

                              HOPS.

  Humulus,  U. S., is the strobiles of ordinary hops,  or Humulus
Lupulus.   They contain a liquid  volatile alkaloid,  lupuline, and a
bitter principle, lupulinic acid.  Hops are known under the name of 
192
DRUGS.
Lupulus in the B. P.  Much confusion has arisen in regard to the
preparations of this drug partly because Humulus  is the official name
in the U. S. P. and Lupulus in the B. P.  This has been increased
by the fact that the alkaloid of hops  is called lupuline, while the
powder which is  found on  the strobiles is called lupulin.   Those
preparations in the U. 8. P. having the word  " humulus" in  their
name  are made  from the hops  themselves.  Those with "lupulin"
in their name from the powder of the strobiles.
   Therapeutics.—Hops are used as antispasmodics and nervous seda-
tives in cases of hysteria and nervousness.  In priapism, vesical irri-
tability, and renal  irritation they are of service.  Even  in delirium
tremens they seem to be of value.   For local application a hop poul-
tice may be made by placing the powdered strobiles in the mass, and
employed in this way they are a favorite home remedy for local pain-
ful inflammations.   Hops have been used in the  form of a hop pillow
in nervous insomnia, but the soporific influence  is  largely imaginary,
or depends  on the fumes  of the  alcohol with  which the pillow is
moistened.
   Administration.—The tincture (Tinctura Humuli, U. 8.) is given in
the dose of J  to  3 ounces.   Lupulin (Lupulinum, U. 8. and B. P.),
which is  the  powder fouud on the strobiles of hops, is given in the
dose of 2 to 5 grains or more; the oleoresin of lupuline  (Oleoresina
Lupulini, U. $.)  is given in dose 10  to 40 drops in capsules, and the
fluid extract (Extractum Lmpuline Fluidum, U.  S.), in the dose of 30
to 120 drops.  The preparations  of the B. P. are the extract of
hops  (Extractum Lupuli), dose 5 to 10 grains; the infusion (Infusum
Lupuli), dose  1 to 2 fluidounces, and the tincture  (Tinctura Lupuli),
dose J to 2 fluidrachms.


               HOPE'S CAMPHOR MIXTURE.

   This is a mixture originally made with  nitrous acid,  but largely
used at present with nitric  acid, owing to the  fact that nitrous acid
is changed into nitric acid when water  is added to it.  The nitrous
acid is, however,  more efficacious  than nitric acid in the serous  or
choleraic diarrheas which it is used to combat.  The formula is as
follows:
         R.—Acidi nitrosi......fzj.
             Aquae camphorae......f^viij.
       et adde
             Tinct. opii.......gtt. xl.
   S.—One-fourth of this in water every three or four hours.


                         HYDRASTIS.

  Hydrastis, IT. S., is the rhizome of the Hydrastis Canadensis, contain-
ing two alkaloids, known as hydrastine and berberine, and, perhaps,
xanthopuccin. 
HYDROCHLORIC  ACID.
193
  Physiological Action.—In poisonous doses hydrastis may cause con-
vulsions followed by paralysis, according to the quantity of berberine
or hydrastine present,   The  latter  is more convulsive in its effects
than the former.  Upon the circulation hydrastine, when injected into
the jugular vein, causes a primary fall of arterial pressure succeeded
by a decided rise, aud  the studies of Cerna have proved that it is an
active poison producing spinal convulsions followed by paralysis.
  Therapeutics.—Hydrastis is of service in chronic gastro-intestinal
catarrh, particularly that following the abuse of alcohol, and may be
used as a stomachic and tonic after malarial fever and similar depress-
ing diseases.   Wherever membranes exist in a  condition  of lowered
tone, this drug is indicated.   Thus, in catarrhal jaundice of a subacute
type, in uterine catarrh, in leucorrhea dependent  upon a relaxed state
of the vagina, and in chronic nasal inflammations  and irritations it will
be found useful.
  Tincture of hydrastis is  said to possess a distinct anti-malarial in-
fluence.
  One of the best remedial measures that we have in the later stages
of gonorrhea, when the acute period has passed, is the local and in-
ternal use of hydrastis.   If it is used as an injection  5 grains of the
commercial  hydrastine to each ounce of water  should be employed
twice a day.   If this is not used the following infusion will  be found
of service :  Take 1 drachm  of  the  powdered root and add it  to  8
ounces of boiling water.  Half  to  one drachm  of  the fluid extract
may also be added  to  a pint  of  water and used  as a wash in vaginal
gonorrhea and  leucorrhea.  In chronic dyspepsia hydrastis seems to
act as  an antiseptic and as a curative agent upon the mucous mem-
branes of the stomach.
   Administration.—The fluid extract (Extractum Hydrastis Fluidum,
 U. S.) may be given in the dose of 5 to 30 drops, while the dose of the
tincture (Tinctura Hydrastis, U. S.)  is from 30 drops to  2 drachms.
   Much doubt exists as to the dose of hydrastine.   This arises from
the fact that two forms of it are  sold.  That most commonly seen  is
a dark-brown mass which is very impure, and contains berberine  and
other substances.  Its  dose is  3 to 10 grains.  The pure hydrastine, as
made by Merck, is given in the dose of f; to J grain.


                   HYDROCHLORIC  ACID.

   Acidum Hydrochloricum (U.  8.  and B.  P.)  is  a  clear, colorless
liquid, possessing an acid odor and taste, devoid of astringency, but
in concentrated  form decidedly caustic.   Iu the strength of two-tenths
of 1 per cent, it is  present normally in the gastric juice and aids the
pepsin in the conversion of proteids into peptones, aud in the formation
of pepsin from  pepsinogen.
   Therapeutics.—In dyspepsia due to faulty gastric  secretion, as  in
typhoid fever and in gastric indigestion, accompanied  with fermenta-
tion, this acid is of service.   Iu combination with compound tincture
                                13 
194
DRUGS.
of cardamoms it is of value in intestinal indigestion.  (See Indiges-
tion.)  The acid is best used in the form  of the  official dilute  acid
(Acidum Hydrochloricum Dilutum,  U. 8. and B. P.), dose  10 to 30
drops in water.
  In the sick stomach  aud  gastric  distress  following  an  alcoholic
debauch, 20 drops of the dilute acid in water are often of service.
  This acid is combined with nitric acid to form  dilute nitro-hydro-
chloric acid (Acidum Nitro-hydrochloncum Dilutum, U. 8. and B. P.),
the dose of which is 10 to 30 minims; also the pure acid (Acidum
Nitro-hydrochloricum, U. 8), dose 1 to 5 minims.
  Hydrochloric acid  causes, when  taken in poisonous  doses, violent
gastro-enteritis and corrosion of the gastric walls, and its  action should
be combated by  alkalies, soap, oils, and white of egg.


                   HYDROCYANIC ACID.

  Hydrocyanic or Prussic  Acid is a transparent, colorless, very vola-
tile liquid, giving rise to vertigo when inhaled in minute amounts and
producing  death  if  the fumes be concentrated.   If the bottle con-
taining the pure drug  be opened it should be done where there  is
sufficient draught between windows to prevent any contamination of
the atmosphere of the room by the acid.
  Pure hydrocyanic acid is never used in medicine ;  the form employed
is  that of the dilute  acid  (Acidum Hydrocyanicum Dilutum, U. S.
and B. P.), which contains about 2 per cent, of the drug.  It must be
kept in dark, tightly-stoppered bottles.
  Physiological Action.—This is one of the most rapid, if not the
most rapid, lethal  poison  known, only being approached by carbolic
acid and nitrobenzole in  the violence  of its  effects.  Owing to its
volatility it is absorbed with great rapidity, and acts upon the respir-
atory centre and the heart, being eliminated almost immediately after-
ward.   As a consequence, the survival  of a patient twenty or thirty
minutes after the ingestion of a poisonous dose is a favorable sign.
  The drug is an active paralyzant  and exerts a lethal influence over
every part of  the body.    The  nervous  system,  heart, respiration,
brain, and all parts are  killed at once if much of it is present.
  Poisoning.—Death either comes at once, so that the person drops dead
to the floor with a gasp, is for a moment convulsed, the  face cyanotic,
the eyes wide open, with the teeth  tightly shut, and the lips covered
by a bloody froth, or, three stages of poisoning may ensue if the dose
has not been very large.   In the first of these there is difficult respi-
ration, slow cardiac action, and disturbed cerebration.  In the second
stage, which is convulsive, we find  wild cries, dilated pupils, uncon-
sciousness,  vomiting, spasmodic urination and  defaecation, erections of
the penis and ejaculations of semen.   In  the third stage  there  is
asphyxia, collapse  and paralysis, ending  in  death.    The blood  is
found to be dark and venous-looking, but does  not give the spectrum 
hydrocyanic  acid.
195
bands  of cyano-haemoglobin.    These bands  only appear  when the
drug is shaken with the blood outside the body.
  The diagnostic signs of  death from  prussic acid are the odor on
the body, the wide-staring eye, the clinched teeth covered with froth,
and the  livid,  cyanosed face.   If the  body be  opened the odor of
hydrocyanic acid is marked, but rapidly passes away.
  The only poisoning producing symptoms  resembling those  which
have just  been described is that  produced by nitrobenzole or essence
of mirbane, which has a somewhat  similar odor, but which is, how-
ever,  more permanent, the odor remaining  in the opened body  for
hours.
  Therapeutics.—Hydrocyanic  acid  is useful in cases of gastralgia
of purely nervous  origin, and  in some cases  of nervous vomiting, and
in irritable stomach where,  owing to a  hyperaesthesia of the mucous
membranes, the taking of food  produces discomfort.
  Iu irritable coughs, due to tickling in the throat  and  bronchi, it is
very extensively  used and has received  high praise by those  best
qualified  to judge.  On the other  hand, it  has been claimed  that
owing  to the extreme volatility  of the drug it only acts for the mo-
ment, and that a dose every ten or fifteen  minutes is necessary to
produce  any real effect.   However this may be in  theory, practically
the acid certainly does relieve  cough.   In these  states  the following
prescription will be found of service  :

         R.—Acid, hydrocyan. dil......^3J-„
             Morphinae sulph. .    .   .   .    .   .  gr. ij.
             Syrup, pruni virg.    .   .   •    .   . f 3 iij.   M.
    S.—Teaspoonful every four or five hours to an  adult.

   In  enteralgia  or neuralgia  of the intestines,  prussic acid is very
useful.
   Externally the drug is useful in pruritus and other forms of  itching
skin diseases, and the following  formula  will be found of  service in
pruritus vulve :
          R.—Hydrarg. chlor. corros.     .   .     .    .  gr. J.
             Acid, hydrocyanic, dil.     ....  f 3j.
             Aquae amygdal. amarae     .   .     .    .  f§vj.    M.
    S.—Apply to the itching surface with a small rag.

   The same  prescription  may also be employed  in pruritus without
the bichloride, if so desired.  The dose of dilute hydrocyanic  acid is
1 to 5 drops.   In certain forms of irritable cough  inhalations  of the
vapor  (Vapor Acidi  Hydrocyanici, B. P.) are  recommended;  it is
prepared  by adding 10 to 15 minims of  the  diluted acid to 1 fluid-
drachm of water, which  is then placed in a suitable apparatus from
which  is inhaled the vapor  that arises. 
196
DRUGS.
HYDROGEN  PEROXIDE.

        (See Oxygen.)
                       HYOSCYAMUS.

  Hyoscyamus, U. 8., or Henbane, is a plant of the northern  United
States  and Europe.  The leaves (Hyoscyami Folia, B. P.) only are
used, and from them are obtained two alkaloids, one known as hyos-
cyamine, the other as  hyoscine.  The first has the same physiological
action as atropine (see Belladonna).   The  second is quite different in
its influence over the body.  The only marked difference in the action
of hyoscyamine and atropine  is in the mydriasis produced by each.
While  that of atropine  lasts, in man, from  twelve  to fourteen days,
hyoscyamine  generally remains for only seven to nine days.   Owing
to the  presence of hyoscine in hyoscyamus it  is more quieting and
depressing to the nervous  system than is belladonna.
  Therapeutics.—Hyoscyamus is used in every condition indicating
the employment of belladonna; or, in other words, wherever  local
spasm, or arterial  relaxation exists or where pain  is due to  spasm.
It has  been particularly recommended in nervous cough, in whooping-
cough,  aud in colic, and probably is better in its influences in these
states than is  belladonna.  In  combination  with nitrate of silver the
extract may be used with advantage  in chronic gastric catarrh.  In
urinary incontinence due to irritable bladder it is very serviceable, and
particularly is this true of this affection in children and old persons.
  Administration.—The drug itself is  official in four forms,  and as
hyoscyamine  sulphate.   The dose  of the tincture  (Tinctura Hyos-
cyami, U. 8.  and B. P.) is 30 drops to 1  drachm;  the alcoholic ex-
tract (Extractum Hyoscyami Alcoholicum,  U. 8.), dose 1 to 3 grains;
the alkaloid (Hyoscyamine Sulphas,  U. 8.), dose -^j- to fa of a grain;
the abstract (Abstractum Hyoscyami, U. S.), dose 2 to 3 grains; and
the fluid extract (Extractum Hyoscyami Fluidum, U. S.), dose 5 to 30
drops.   The  B. P. preparations besides those given  are  the  extract
(Extractum Hyoscyami), dose  2 to  5 grains, or more,  and the  juice
(Succus Hyoscyami), dose  30 minims to  1 fluidrachm.

                           Hyoscine.

  This is one  of  the alkaloids derived from  hyoscyamus  and is a
powerful nervous depressant.
  Physiological Action.—Hyoscine quiets the cerebrum and produces
deep sleep in a certain class of patients.  In the lower animals,  or in
man, it may cause sleep or wild  delirium.  It  causes loss  of reflex
action in overdose, which  is due to paralysis of the spinal cord and
not of  the nerve-trunks.   Upon the circulation it has little effect, but
it is worthy of note  that  it does influence the vagus nerves, as does 
HYPNAL.
197
atropine,  stimulating  them  at first,  and  finally paralyzing  them;
although the contrary has been asserted.   In any event the circulatory
effect is a minor one.
   Therapeutics.—Hyoscine is of value as a hypnotic in a very limited
class of cases, but in this class generally acts most favorably.   These
cases  consist of  those  who, from  acute  mania,  alcoholic  mania,
hysteria,  or similar cause,  suffer from insomnia, and  perhaps use
violent struggles against proper control  or refuse  to swallow or retain
food.
   The drug may  be  given  to such  persons  hypodermically, in the
dose of jfa to -fa of a grain, or  by the  mouth in the dose of fa to
fa of a  grain.   The  fact that it possesses no taste, and is small in
bulk, renders it ready of employment.  In some persons it utterly fails,
even  in this particular type  of cases.1   In delirium tremens it may
cause evidences of cerebral  congestion and Cheyne-Stokes breathing.
Some cases are not quieted  by the drug, but pace up and down in a
semi-sane condition until its  action wears off.  In the opinion of the
writer the applicability  of the drug  is  very limited indeed, and un-
toward effects are common.
   Hyoscine is said to be of great value in spermatorrhea and nocturnal
emissions.
   The drug is contra-indicated in the sore-throat of scarlet fever, as
it may cause glottic spasm.    In  the  insomnia of heart  disease with
nervousness it will  cause sleep, but may also produce death by respi-
ratory failure or cardiac arrest, and it is to be remembered  that the
drug will produce  asthma rather than relieve it.  The breathing, in
some  persons, may become under its influence croupy or rasping.
   Hyoscine  is an  uncertain  remedy in nervous affections,  sometimes
acting very well, at others  producing  very alarming symptoms  in
cerebration, circulation, and respiration.


                            HYPNAL.

   The chemical  name of this substance  is monochloralantipyrine, or
monotrichloracetyledimethylphenylpyrazalon, and it is, as its  name
indicates,  a  compound of chloral  and antipyrine.   There is  also a
dichloralantipyrine, which  contains more chloral.   The compound
is employed in  treating those patients who suffer from pain and  in-
somnia combined, the antipyrine  relieving the pain and the chloral
producing sleep.   Opium is the only drug known which can be relied
upon  to  act in  this double  manner,  and the disadvantages of that
medicament are often  so prominent as to prevent its use.   Iu cough
arising from bronchitis or phthisis, and  causing by its constancy loss
of sleep, and in neuralgic insomnia, hypnal will be  found of service.

  1 The writer has given one-tenth of a grain of Merck's  hyoscine  in twenty-four
hours, obtained from two different and  reliable stores, without  producing sleep,
although the respirations were much quickened. 
198
DRUGS.
The dose is  from 5 to 20 grains, best given  with simple syrup and
water or with syrup of orange peel, or it may be used as follows :

           Hypnal........gr xv.
           Chartreuse.......f .;?.]•
           Distilled water......f 3ss-    M-
    S.—The entire amount to be taken in one dose.

                          ICHTHYOL.

   Ichthyol is a substance obtained  by distillation  from a  peculiar
resinous accumulation found chiefly in the Tyrol, and supposed to be
the result of a deposit of extinct fish.   Ichthyol occurs as the  ichthyo-
sulphate of sodium  or ammonium.   Both of these contain about 10
per cent, of sulphur, and it is largely upon this that their therapeutic
activity depends.  The disagreeable odor  of ichthyol  depends  upon
the presence of an inseparable volatile oil.
   Therapeutics.—Ichthyol is without doubt one of the  most  remark-
able substances used for medicinal purposes which has appeared in the
last decade.  In skin diseases it  has  been  most  highly  recommended
on both sides of the Atlantic, and is employed in the form of ichthyol
ointment in  chronic eczema,  acne, urticaria, and even  on lupus and
keloids.   In  almost all chronic  skin affections it is  of the  greatest
value, and the writer has seen it exert a most favorable influence upon
erysipelas both in hospitals and in his private  practice.   Under these
circumstances the ointment  should  contain  about  20  per  cent, of
ichthyol,  or  less.   Some practitioners  recommend that ichthyol be
applied  iu a watery solution  of the strength of 1 drachm to the
ounce, by means of a camel's-hair brush.   Under these circumstances
it is  necessary  to  wash  the  parts  with  oil  and water every  day,
using the greatest gentleness.   It has also been found  by the writer
very efficacious in the pain and swelling accompanying  acute  rheuma-
tism of the joints, both during and after the acute stage of the disease.
The strength for this use should be  about 30 parts of ichthyol to
70 of benzoinated lard.   In frost-bites, chilblains, aud in burns it is of
service, and  Agnew has  recommended it highly  when rubbed  into
lymphatic enlargements.  Ichthyol has proved remarkably efficacious
in removing peri-uterine and other  pelvic  exudations when used as a
salve or in a vaginal suppository.
   For acute sprains, and for the removal of the swelling following
such  injuries, its influence is extraordinary if it be well rubbed into
the part affected.
   Owing to the disagreeable odor of ichthyol, oil of citronella ought
to be added to it, as follows :
          R.—Ichthyol........^ij.
             01. citronellae     .... gtt. xv vel. xxx.
             Adepis........3"j.   M.

   The dose  of ichthyol  internally  is 1 to 10 minims,  given in pill.
When used in this  way the sodium salt should be used. 
IODIDE OF POTASSIUM.
199
                            IGNATIA.

   Ignatia,  U. S., or  Ignatia  beau, is the  seed  of the Strychnos
 Ignatia.  It contains two alkaloids, strychnine  and brucine, as does
 nux vomica.
   Physiological  Action.—Its physiological action is identical with
 that of strychnine or mix vomica.
   Therapeutics.—(See Nux Vomica.)   The abstract  of ignatia (Ab-
 stractum Ignatie, U. S.) is given in the  dose of  1 grain; the tincture
 (Tinctura Ignatie, U. 8.) in the dose of 10 to 15 minims.


                  IODIDE  OF AMMONIUM.

   Ammonii Iodidum, U.  8., is used in smaller doses, but for the same
 purposes as the iodide of potassium.  It is preferred by some  practi-
 tioners to the latter salt when the respiratory or digestive tracts are
 involved, but  is  much more irritant.  The  dose is  from 2  to  10
 grains.

                     IODIDE OF ETHYL.

                       (See Ethyl Iodide.)


                  IODIDE  OF  POTASSIUM.

   The physiological effects of iodide of  potassium  (Potassii Iodidum,
 U. 8. and B. P.) are entirely  comparable to those of iodine itself, but
 it is employed  for somewhat  different purposes, is less irritant, more
 readily given, and perhaps more readily absorbed.
   Physiological  Action.   Circulation.—Upon  this part of the
 system iodide of potassium produces effects differing very slightly, if
 at all, from those caused by potassium itself.  Small amounts raise the
 blood-pressure, and large  quantities  lower it.   (Prevost and Binet.)
   Elimination.—Iodide of potassium is very rapidly eliminated,
 appearing, according to Doux, in thirteen  minutes after it is ingested
 in the urine, aud  the daily amount excreted equals about 90 per cent.
 of the dose taken.  All traces of the iodide in the urine cease 4 or 5
 days after the last dose is  administered.  (Ehlers.)
   Therapeutics.—The use of iodide  of potassium may  be divided into
 three great divisions, each of which is important.   It is also employed
 for many conditions not included in  these classes.
   1. Syphilis.—The use of iodide of potassium in syphilis is recog-
nized as a part of  all  treatment  for its relief.   Elsewhere Dr. Martin
has, in his excellent article (see Syphilis), treated  of this question, and
it is only necessary to call attentiou to the  fact that the drug is generally
well borne in large amounts by  advanced syphilitics, although this is 
200
DRUGS.
not  always the case.  The term u therapeutic test" is applied by one
eminent teacher to signify a state of the system produced by syphilis
in which a diagnosis  may be made by the fact that large doses of the
iodide are borne without inconvenience.  As already intimated, this
resistance does not always  prove the presence of syphilis,  nor does
its absence prove the absence of this disease.  Persons having heredi-
tary asthma, gout, rheumatism, or some similar diathetic malady, often
resist the iodide, and some syphilitics are affected with " iodism "  after
very small doses.  In treating syphilis the drug should be used in the
dose of 10  grains three times a day, aud this amount gradually in-
creased a grain a day until symptoms of " iodism " occur.
  The quantity borne often amounts to from 100 to 200 grains a day.
The best way to use the iodide of potassium is to order for the patient
a saturated solution of the drug, which contains in each drop about  1
grain, and at the same time  a bottle of the compound syrup  of sarsa-
parilla.   To a tablespoouful of the latter the patient is to  add the
iodide  solution, beginning with 10 drops three times a  day and in-
creasing a drop every twenty-four hours.
  The iodide acts more slowly as an anti-syphilitic than does  mercury.
  In tertiary syphilis the iodide is invaluble.
  In nervous syphilis, be its manifestations what they may, iodide  of
potassium is the standard remedy,  only being supplanted by mercury
when it is necessary to break down a growth whose existence  is a daily
menance to the patient's life.
  2. Metallic Poisoning.—Owing to the fact that iodide  of potas-
sium forms double soluble salts with  all the metals  in the tissues  in
chronic poisoning, thereby aiding in their elimination, it should always
be employed in chronic lead, zinc, arsenic, or mercurial poisoning.
  3. Anti-rheumatic—Iodide of potassium  is best  suited, not  to
the acute  sthenic stages  of  rheumatism when the joints are very hot
and  painful, but to the secondary or subacute periods when the joints
are large and the case " hangs on "—now better, now worse.   It acts
best, under  these circumstances, if combined with wine of colchicum-
root (see Rheumatism).  It  is also to be tried in sciatica, lumbago, and
rheumatic neuralgia,  and should be  employed in chronic pleurisy, peri-
carditis, and hydrocephalus, to cause absorption of the fluids.
  In aneurism, particularly that of the aorta, the drug does good,
but its value rests largely upon the cause of the disease.   If  it is due
to syphilis the aneurism  yields very rapidly to the drug.  The pain,
swelling, and pulsation generally decrease.
  In asthma iodide of potassium  is valuable if the  disease  is of the
bronchial type, but  it ought not to be employed if it is  gastric.  In
bronchitis  and  intestinal  catarrh where the  condition of the mucous
membranes  is semi-chronic, and not  relieved by  chloride of ammo-
nium, iodide of potassium should be used.  If the bronchitis is chronic
and  the secretion profuse (bronchorrhoea) iodide  of potassium will
make it worse.  The dose for an adult in all these instances should be
about 3 to 5  grains three times a day.  In pulmonary emphysema
iodide of potassium is often  of great value. 
IODIDE OF POTASSIUM.
201
  In chronic nephritis small doses (5 grains t. d.) are thought by some
to check the disease, but it is to be remembered that the drug  may
produce poisoning if the kidneys do not  eliminate it, so that, if  used
at all, it must be with great care.  If the drug is  well borne  it will
cause an extraordinary increase  in the urinary flow, and will relieve
any dropsy which may be present very rapidly indeed.
  In bronchocele the employment of iodide  of potassium internally,
and tincture of iodine externally, is the best treatment we can use, and
in acute coryza, or " cold in the  head," 10 grains of the iodide taken
at the beginning of the trouble will often  abort the attack.
  In hepatic cirrhosis, in its  early stages,  the  iodide often  does good,
and in arteriosclerosis, or atheroma of the bloodvessels, it  is of great
service, according to many English, French,  and American writers.
  A very important use of iodide  of potassium is for the removal of
enlargements of the cervical glands and those occurring in other parts of
the body.  In enlargements of  the spleen, malarial or otherwise, exter-
nal paintings with iodine  and the internal use of the iodide in small
doses are of service.  In  the  later stages of pneumonia  the  iodides
are useful  to  aid in the absorption of any exudates, but  they are
contra-indicated in phthisis, except in the fibroid form and  in many
of these cases  when dependent  upon syphilis, as they aid in the break-
ing down of the lung.
  Untoward Effects. —In  some  persons,  after the  use of the iodide,
coryza with a  tearful condition of the eyes comes on, so that  the edges
of the lids become reddened  and the nose runs  constantly.   This is
followed, if the drug is pushed, by the more positive signs of "iodism"
spoken  of under Iodine.
  In other cases acne breaks out on the face  and disorders of digestion
and gastric irritability come  on.  The acne can nearly always  be pre-
vented by giving arsenic at the same time with the iodide.  In some
cases petechial rashes break out on the legs,  while in others great
mental  and physical depression  appear, so that  listlessness or melan-
cholia may develop.
  In persons susceptible to iodide  of potassium care should be exer-
cised when it is first administered lest sudden and dangerous  oedema of
the glottis occur.
  Sometimes  the  iodide of ammonium or iodide  of sodium will  be
borne when the iodide of potassium will not.
  If bullae  or blebs follow  the use  of the  iodides, or other rashes
appear, it is said that atropine will afford  relief.
  Administration.—The iodide of potassium, owing to its exceedingly
disagreeable taste, should be given with the compound syrup of sarsa-
parilla, extract of liquorice, or in milk.  Large amounts of these vehicles
are to be used.  The dose varies from 5 to 60 grains, according to the
condition of the patient.
  One of the best ways to take the drug  is in capsule, but  if this  is
done a  drink  of milk or water or other fluid should precede or follow
it, in order to prevent  the  drug  from  coming in contact with the
stomach in  concentrated form.   The  preparations of  the  iodide of 
202
DRUGS.
potassium are : Unguentum Potassii Iodidi, U. 8. and B. P., and the
linimeut (Linimentum Potassii Iodidi cum Sapone, B. P.).


                   IODIDE OF SODIUM.

  Sodii Iodidum, U. S. and B. P., is used in the same doses and for
the same purposes as the iodide of potassium.


                            IODINE.

  Iodum, U. S. and B. P., is a non-metallic element found largely in
seaweed and in mineral iodates arid iodides.   It is soluble in ether
and alcohol, but slightly so  in water, aud possesses an acrid burning
taste and a neutral reaction.
  Physiological Action.—The physiological action of iodine, so far as
its alterative powers are concerned, is absolutely unknown.  Applied
to the skin it stains it yellow, brown, or black, according  to  the free-
dom of its application, and  it acts without pain  if the skin is intact.
If very large amounts are used it produces vesication.  Upon mucous
membranes  iodine acts as a powerful  irritant.   Germain-See believes
it to be a stimulant  to the nutritive processes of the  body and to  the
circulatory system, and he is certainly correct in regard  to the influ-
ence it exercises over nutrition.
  Elimination.—The drug escapes chiefly through the   kidneys, the
skin, the salivary glands,  and it even appears  in the milk of nursing
women.
  Poisoning.—The  symptoms of acute poisoning  by iodine are those
of acute gastro-enteritis with severe pain in the oesophagus,  stomach,
and abdomen, accompanied  by violent vomiting  and purging.   An
early symptom is the  persistent strong metallic  taste in the mouth,
with markedly increased  salivation.  The  pulse  becomes rapid,  run-
ning and feeble, the face deathly pale, total arrest of  urinary secretion
takes place  through renal irritation,  and death occurs by failure of
respiration, which is accompauied by loss of all vital power.
  If the  poisoning  is not severe enough  to  cause  death at once, a
fatal result  is, nevertheless,  often  reached after a few days, by reason
of a widespread fatty degeneration of the tissues.
  The treatment of  the poisoning consists in the use of large amounts
of  starch in any of  its forms  as the antidote, the employment of
emetics and the stomach-pump, the application of heat  to the body
and extremities, aud, finally, the employment of hypodermic injections
of alcohol, digitalis, ammonia, and atropine or strychnine, for the pur-
pose of maintaining the strength  of the circulatory and respiratory
system.
  Chronic Poisoning.—Under the name of " iodism " the profession
recognizes a state  of the body brought on  by the  prolonged and  ex-
cessive use of iodine in any of its forms.   The earliest signs of this 
IODINE.
203
state are shown by a peculiar  metallic taste in the mouth, particularly
before breakfast, slight tenderness of the teeth and gums, increase of
salivary secretion, a  little morning nausea and  lack of appetite for
breakfast, and  perhaps some  coryza or evidence  of gastric irritation.
Acne rosacea often comes on very early.   If the drug is continued
all these symptoms become  more marked aud the coryza becomes in-
tense.   Headache under the frontal bone and sore-throat often appear,
and the pustular aud bleb-like changes in the skin go  on to active
suppuration.  Sometimes large boils appear, or purpura haemorrhagica
comes on.
   In other cases the  nervous system chiefly suffers.  Twitchiugs of
muscles, neuralgic pains in the trunk and extremities, and  wasting
of the testicles, mammae, and all  other tissues occur, as the result of
trophic disturbances.    Anaemia amounting to au  actual cachexia is
commonly produced.   Loss of vision and  paralysis may ensue in ex-
treme cases.
   Therapeutics.—In all cases where the system is in a state of chronic
perverted  functional   activity, as  in  those diseases associated with
disorder of the processes of nutrition and often included under the
single name of scrofulosis, iodine is of service.   In enlargement of the
lymph-glands it is, in  its various forms, one of the best remedies we
possess, but  it ought not to be employed in those cases where rapid
changes are going on in the gland, such as the formation of pus, since
under these circumstances it will increase the  size of the slough.
The drug ought  never to be used  in phthisis because it tends to disin-
tegrate the tissues, and this is precisely what the  disease is doing.  In
the exceedingly chronic form of  pulmonary disease known as fibroid
phthisis iodine may be used.   When  inhaled  in  fumes it may be of
service as a stimulant to the mucous membranes,  but is never of value
in phthisis otherwise.   In countries where  exophthalmic goitre is
very  prevalent iodine ranks as a most efficient remedy.   In cystic
enlargement of the thyroid gland it is valueless, but  in simple hyper-
trophy of the gland is of great value.
   In chronic bone disease iodine applied about the affected joint  in the
form  of the ointment diluted one-half with lard,  or in the  pure tinc-
ture, will be found of service, and if  anemia exists  the syrup of the
iodide of iron should be given internally.
   The other uses of iodine externally are many  and important.  As
a slow counter-irritant which does  not produce  pain if properly em-
ployed, it is particularly useful in children, and may be employed in
one to three coats, and no more.
   The proper way of using the tincture is to give one good black coat
at one sitting, and not to repeat it until the skin has desquamated and
become well renewed.   If iodine is applied soon after one good effec-
tive coat it will  cause agonizing  burning pain, which nothing will
relieve except the removal of the iodine by the use  of cologne-water,
alcohol, whiskey, or gin.  The application of any of the latter liquids
causes such au  increase in  the pain as to  be almost useless after the
skin is  broken.  The best solution for its  removal is one of iodide of 
204
DRUGS.
potassium, which should be followed by a poultice.   A good  rule to
follow is never  to  cause  pain by the use of iodine, as  the drug acts
equally well if applied in such a way as to avoid suffering.
   Iodine in the form of the  tincture is applied as a counter-irritant
paint in pleurisy, both to abort an attack and to aid in absorption of
the fluid after it is thrown out into the chest.  Iu harassing irritative
cough it may be painted over  the supra-clavicular  spaces, and it will
lessen  the  secretion in chronic  bronchitis  if  used  in this  way.    In
chronic rheumatism affecting the joints and muscles it does good when
locally  applied.  Often in  synovitis  the local application of iodine
causes increased  swelling  for some  days.   This should  not cause
alarm, for ultimately the swelling decreases very greatly, and the cases
in which this occurs are generally the best from a prognostic point of
view.
   In the course of phthisis every now and then a " spot" in the chest
will become " sore," probably due to a limited area of pleurisy, and,
under these circumstances, tincture of iodine locally applied will give
relief.   In lupus the tincture  may be painted around the edges of the
growth, and even  over its  surface,  with the object of retarding its
spread.  In  chilblains  an application  of  iodine ointment gives the
greatest relief if diluted  one-half with lard, and its use is probably
the most efficacious measure at our disposal.  In  certain individuals
who have " pains in the chest" iodine ointment may do good if applied
over the spot.   As has been pointed out by others,  iodine does good if
muscular tenderness is present, while  it fails if pleurodynia or inter-
costal neuralgia is the  cause of the suffering.   The latter troubles
should be removed by the use of belladonna. In certain forms  of skin
diseases, such as tinea tonsurans and circinata, tincture of iodine may
be applied with a camel's-hair brush, and even the entire scalp  may be
painted.  A better way  is to apply it to different spots  each  day.
When erysipelas is present the tincture may be painted around the
edges of the inflammation, in  order to prevent its spread.
   In old persons, or those in  middle life, retraction of the gums  from
the teeth sometimes comes on, and Stille recommends for this disorder
the use, by means  of a camel's-hair brush, of a watery solution of
iodine of the strength of 1 grain to the ounce, to be followed at  once
by a thorough rinsing of the mouth with pure water.  In hydrocele
iodine in the form of the tincture is the best remedy for effecting a
permanent cure that we have.   The sac should first be emptied by the
use of a trocar and canula, aud  the iodine alone, or with glycerin, in-
jected with a syringe, and then allowed to escape.  As the paiu is most
atrocious, the patient should first be put partly or entirely under the
influence of ether or other anaesthetic.
   In white swellings and ovarian tumors as  much as 10  ounces of the
tincture may be injected, but it is to be remembered that certain  dan-
gerous symptoms  may arise.  • After  its use in this way in the  chest
violeut symptoms  of poisoning  have come on, in some cases the most
common complication being convulsions.  These are epileptiform in
character and are followed by  coma or collapse. 
IODINE.
205
  In empyema a solution  of iodine 6 grains, iodide of potassium  6
grains, and water 1 pint, may be used daily as an irrigating fluid with
good results.
  The tincture  of  iodine  may be used,  according to  Ringer, as an
inhalation with signal benefit in the following four instances :
  1. In the chronic forms of phthisis (fibroid lung).  When the expec-
toration is abundant, and when  the cough is troublesome, its inhalation
used both night and  morning  will generally lessen the expectoration
and  allay the cough.
  2. In  children six to ten years of age, who after meals, or, inde-
pendently of them, on exposure to cold, are seized with hoarseness, a
hoarse, hollow cough, and some wheezing at the chest.   This affection,
involving the larynx, trachea, and larger bronchial tubes, and often
proving very obstinate, is apt to return, and to persist  a considerable
time.
  3. In  some epidemics of diphtheria the inhalation recommended by
Dr.  Wariug-Curran is of value, and consists of 4 grains of iodine and
4 ounces of water.  A teaspoonful of this should be added to boiling
water, and kept hot by a spirit lamp, whilst the steam is inhaled.  As
the patient becomes accustomed to the iodine the quantity of the solu-
tion may be increased till half an ounce of it is used at each inhalation.
It should be repeated many times a day, and each inhalation continued
from 8 to 12 minutes.
  4. Some persons suffer with  itching of the nose, of the inner canthus
of one or  both eyes, sneezing,  running at  the  nose of a watery fluid,
weeping  of the  eyes,  and severe frontal headaches, and these  patients
of various  ages are greatly troubled, often for many years, with daily
attacks  of this  character lasting, it may  be, several  hours.   Iodine
inhaled often removes this  affection at once, lessening the headache and
discharge from the  nostrils.  Its effect is most marked in respect to the
itching.
  Ringer generally adopts the following  simple, handy, cleanly, and
effectual  plan  of inhalation :  Heat well a jug capable of holding about
two  pints, by  rinsing with boiling water, then partly fill with boiling
wrater, into which pour 20 to 30 drops of  the tincture of iodine, then
direct the patient to put his face over the mouth of the jug and breathe
the iodized steam, covering the  head to prevent the escape of the vapor.
This inhalation should  be used night and morning for five minutes,
or a little longer.   Occasionally an excess of iodine will  temporarily
produce a sensation of soreness in the chest and throat, accompanied
with redness of the conjunctiva, running  from the nose, and pain in
the head.
  In some cases of acute coryza much relief may be obtained by sniff-
ing the  iodine from a bottle, as in the use of " smelling salts."  The
heat of the hand is sufficient to disengage the vapor in proper quantity.
  Administration.—Iodine is  never  used in solid form,  and it has
been taught that the  tincture (Tinctura lodi,  U 8. and B. P.) should
not be given internally, on the ground that it is  precipitated  in the
stomach.   Whether this be  true  or false,  it is a fact that  the tincture 
206
DRUGS.
 has recently been  largely used  in  the  vomiting  of pregnancy with
 very good results.   The dose is 5 to 10 drops, well diluted.   Under
 the name of Lugol's  Solution (Liquor lodi Compositus,  U. S.) iodine
 is  frequently used internally; the dose  is 5 to 10  drops, in  water.
 The B. P. preparations  not official in the U. 8. P. are  the liniment
 (Linimentum lodi), the solution (Liquor lodi), and Vapor lodi, which
 is prepared by adding 1  fluidrachm of iodine to 1 fluidounce of water,
 which is gently heated, and the rising vapor inhaled.
   Within recent years a so-called colorless tincture of iodine has been
 sold  which has  obvious advantages and is  made by the following
 process, according to Curtmann  and Aiken,  of St. Louis:  Take of
 iodine IJ ounces, alcohol 13 fluidounces, of stronger water of ammonia
 3 fluidounces.  Dissolve  the iodine in the alcohol and add the ammonia.
 Allow to stand for four weeks with repeated shaking.  Or the prepara-
 tion may be made hastily by using an excess of ammonia and afterward
 cautiously adding enough  hydrochloric acid to render the liquid only
 feebly alkaline.  Iodide of nitrogen  may be precipitated,  which is
 explosive.
    Unguentum  lodi, U.  8. and B. P., is used  locally over enlarged
 glands.  In the case of children  or adults who have delicate skins the
 ointment should be diluted one-half with lard.
   Contra-indications.—Iodine  is  contra-indicated  in renal diseases,
 except in  small doses, during the progress of acute inflammation, and
 whenever tissues are rapidly undergoing degenerative changes.

                        Hydriodic Acid.

   Hydriodic Acid is  employed  for precisely the  same  purposes  as
 iodine itself.   It is used  almost entirely in the  form of the  official
 syrup (Syrupus Acidi Hydriodici, U. 8.), which is a syrupy clear liquid
 containing 1 per cent, of absolute hydriodic acid.  Sometimes the
 syrup has a light straw  color.   Syrup of hydriodic acid should  be
 kept in a  dark place and not exposed to the air.   The  dose is J to 2
 drachms  well  diluted with  water.   The advantages  claimed  for
 hydriodic acid  are activity, its agreeable  taste as compared to iodide
 of  potassium, and the rarity with which it disorders the stomach.


                          IODOFORM.

  Iodoform (Iodoformum,  U. 8.  and B. P.) occurs in  small saffron-
 colored crystals which possess a powerful characteristic penetrating
 odor, aud strong taste.  It is soluble in alcohol,  ether,  chloroform,
 benzol, and in fixed and  volatile oils, but  is insoluble in water.
  Physiological  Action.—When  iodoform  is   absorbed from the
stomach, or from the  skiu  from  surgical dressings, it induces a train
of  serious and  curious  symptoms.   Within half  an hour  iodine
appears in the urine, and the evidences of its action assert themselves
in one of  two ways.  One  set  of  symptoms resembles meningitis. 
IODOFORM.
207
The face is suffused, the pupils contracted, the respiration stertorous,
and the pulse  slow and full, or  rapid.  Delirium  of the wildest
character may ensue so  that the patient tears everything within reach.
In  another class of cases the symptoms resemble those of cerebral
congestion  in the flushed face, contracted  pupils, slow breathing, and
low muttering delirium  or  perfect vocal  quiet.  Widespread  fatty
degeneration is found at the autopsy.
  The resemblance of the symptoms to cerebral  congestion or menin-
gitis should  not mislead  the physician into the belief that any head
injury is present when a limb has been dressed with iodoform after an
accident.
  Locally applied to mucous  membranes the drug possesses very dis-
tinct anaesthetic power.
  Therapeutics.—Iodoform is used chiefly as a surgical dressing.  It
is antiseptic, but not germicidal.   Germs may be  found  in powdered
iodoform, and will even grow in it.   The drug does good by absorb-
ing  the liquids  of the  wound, and thereby removing the nidus for
germ growth;  and when  applied to large moist surfaces gives off free
iodine and  acts as well as a protective.
  In syphilitic sores the  following  dressing will be  found of  great
service :  Iodoform, 20 grains; oil  of eucalyptus, \ fluidounce;  or, a
powder of—Iodoform \ an ounce, camphor 75 grains, and  essence of
roses 2 drops, may be employed.  In eczema, with  tingliug and  itch-
ing, the following application will give relief (Ringer):

         R.—Iodoformi.......gr. iv.
             Olei eucalypti......f gj.
             Petrolati.......gj.    M.
    S.—Apply locally.

  Internally, iodoform is used in tertiary syphilis in all its forms,
in the dose of  from 1  to 5  grains.   Bartholow recommends it  most
highly in  catarrhal jaundice and  in  the early stages of hepatic cir-
rhosis ; indeed, he thinks  its  persistent use in small dose will cure this
affection.
  Used  by  means  of  a  powder-blower it will  often  relieve the
hoarseness  and  discomfort of laryngeal phthisis.   Sometimes a spray
may be used, which should consist of  spirits of turpentine  and sweet
oil, half and half,  and  contain  2  grains of iodoform to each ounce.
This mixture may also be used in bronchial catarrh  to lessen the cough
and foetid discharge.  In  the early stages of phthisis several clinicians
claim to  have reached very good  results by the daily  hypodermic in-
jection into the back of 30 minims  of a 1 to 100 solution of iodoform
iu oil of sweet almonds.
  In fissure of the  anus  5 grains of iodoform in a suppository may
be placed in  the rectum, and after it has remained there a  few minutes,
defaecation  may be had without pain.   The pain following operations
on the female perineum may  also be much relieved  in this manner.
  Administration.—The ointment  (Unguentum Iodoformi, U. S. and
B. P.) is useful when applied over foetid sores.  The drug  itself may 
208
DRUGS.
be given in 1 to 5-grain  doses  three times a day.  The suppositories
(Suppositoria Iodoformi) are official in the B. P. ; each one contains 3
grains of iodoform.

                            IODOL.

  This is a dark, dirty-yellowish-looking powder, soluble in alcohol,
ether, and oils, but only slightly so  in water.   Its  uses  in medicine
are identical with those of iodoform, and it possesses the advantage of
being not so penetrating in odor as the latter drug.
  In tubercular laryngitis the  powder may be blown into the larynx
without disagreeable results and with a favorable effect on the diseased
process.  Cerna has found iodol of very great service in diabetes when
given internally, in the dose of from 2 to 6 grains three  times a day,
aud it is said to be of value in  tertiary syphilis in the same quantity.
  A very useful antiseptic dressing for small wounds and abrasions is
made by adding 1 part of iodol to 10 parts of ether and  5 of gun-
cotton, thereby preparing an iodol collodion.


                       IPECACUANHA.

  Ipecacuanha, U 8.  and B. P., or Ipecac, is the  root of Cephaelis
Ipecacuanha, a small shrub of Brazil.  It contains an alkaloid, eme-
tine, and ipecacuanhic  acid.
  Physiological Action.—Locally applied to mucous membranes ipecac
acts as an irritant, and if applied for a long period to the skin produces
vesicles and irritation.  Very minute doses have little noticeable effect,
but large ones produce  nausea,  relaxation,  vomiting, free secretion
into the bronchial tubes, and a  profuse flow of saliva.  The emesis is
due both to the  irritation of the stomach  and to an effect upon the
vomiting centre in the medulla.
  If emetine is given in lethal dose death is due to  failure of respi-
ration.
  Therapeutics.—Ipecac  is used as  an emetic where a  fairly rapid
action is required.   It is particularly useful in cases where the stomach
of a child is overloaded with  food.   In cases of poisoning it is hardly
active or rapid enough as an  emetic  and is not as good as mustard or
sulphate of zinc.  In  babies and young children an attack of bron-
chitis often causes digestive disorders, by reason of the mucus coughed
up from  the lungs being at once swallowed instead of spit  out of the
mouth.  In these  cases the stomach may be relieved and the state of
the  luugs improved  by the use of an emetic dose of syrup of ipecac.
(Dose, 2  to 3 drachms.)   Often if the dose  be not large enough to
produce emesis it will  purge  the child and remove the mucus by the
bowel.
  In obstinate  vomiting small  doses of ipecac will  act as a most suc-
cessful cure, provided that the vomiting is due not to  inflammation and
excitement,  but  to  depression.   The  irritant effect of the ipecac 
IPECACUANHA.
209
 stimulates the depressed organ up to a normal tone.  The proper dose
 of ipecac for this  purpose is J to J a grain or less, every half-hour'
 until five or six doses are taken.
   In some cases of  the vomiting of pregnancy it is very useful, in
 others it utterly fails.  One drop of the wine or one or two grains of
 the powdered  ipecac is all that should be  used.   In vomiting with
 ■flatulence, either  ipecac or nux vomica is of service.  In the morning
 vomiting  of drunkards, ipecac is  of service, but it is  not  so  good a
 remedy as small amounts of arsenic or hydrochloric acid.
   In true  acute  dysentery, ipecac is  the best  remedy we possess.
 When the passages are large and bloody and the disease is malignant,
 as it occurs in the  tropics, ipecac  should be given in the following
 manner:  The powdered ipecac is to be administered in the dose of 60
 grains at once to produce vomiting.  After vomiting has taken place,
 small doses of 3 grains are to be given every hour  and  continued
 until a profuse black stool is  passed.  The passage of this stool  is a
 most favorable prognostic sign,  and its  non-appearance is equally
 significant of danger.  Vomiting is to be controlled with opium  and
 stimulants are to be freely used to avoid great depression.
   In choleraic diarrheas and  cholera morbus ipecac is often of great
 service  in the  dose of 3 grains  every two hours.   No less a person
 than the great Trousseau  asserted that ipecac was a hemostatic,  and
 it is said  to be  the  most  effective remedy in hemoptysis  in  small
 doses.
   As an expectorant,  ipecac is to be used in the early stages of bron-
 chitis, to act as a sedative to the  inflamed mucous  membrane and to
 promote secretion.    Under these circumstances  it is  best combined
 with citrate of potassium (see Bronchitis).
   Ringer and Murrell  have found that inhaling ipecac spray is very
 useful in chronic winter cough or bronchitis, particularly when there is
 present shortness of  breath.  The pure wine may  be used in a spray
 apparatus, or be diluted one-half with water.  While the throat  may
 seem temporarily worse, the shortness of breath rapidly decreases, and
 a great  improvement takes place in the cough.  In order to prevent
 the  wine  which collects  in  the mouth  from being swallowed,  the
 patient  should be  directed to rinse his  mouth thoroughly every  few
 minutes lest nausea and vomiting be produced.  The inhalation should
 not last at first over three or four minutes, and, until it is known how
 well the patient will bear the application, the wine should be diluted
 twice or thrice.
   Administration.—The syrup (Syrupus Ipecacuanhe,  U. 8.) is given
 in the dose of \ to  1  drachm as an expectorant, or in the same dose
as an emetic to an infant.  The wine (Vinum Ipecacuanhe, U. 8. and
 B. P.) is given in the same dose  as the syrup, the fluid extract (Ex-
tractum Ipecacuanhe  Fluidum, U. S.)  in the  dose  of 30 drops as au
emetic to an adult, and the troches  (Trochisci Ipecacuanhe,  IT. 8. and
B. P.), 4; of a grain each.   Trochisci Morphine et Ipecacuanhe, U. 8.
and  B. P., containing fa of a grain of morphine and fa of a grain of
ipecac, are used in sore-throat, dissolved in the mouth.  Dover's powder
                                14 
210
DRUGS.
(Pubis Ipecacuanhe et Opii, U. 8., Pulvis Ipecacuanhe Compositus,
B. P.) is given in the dose of 5 to 15  grains.  It contains 1 grain of
opium, 1 grain of ipecac, aud 8 grains of sugar of milk.   (See Opium.)
  Emetine may be given in the dose of -fa to £ grain as an  emetic.
  The pill of ipecac  and squill (Pilida Ipecacuanhe cum Scilla, B. P.)
is given in the dose of 5 to 10 grains.


                             IRON.

  Iron (Ferrum, U. S.  and  B. P.)  is  a  metal and a  food.   A food
because it forms part of the body when taken into the organism and
is  used by the system  in  the making of blood.   The number of its
official salts  and compounds  is absurd, and half  the  list is rarely, if
ever, used.
  Physiological Action.—Iron has little or no effect upon the system
when given in a single dose, but repeated  doses cause  an  increase in
the number of red blood-corpuscles, and plethora, or an increase in the
quantity and quality of the blood.   Iron is eliminated from the system
by the liver,  aud perhaps by the kidneys.   If given in excessive doses
it  is changed into the  sulphide in the bowels, and escapes with the
faeces.   It has been  asserted  that it is never released from  the body,
but this is untrue.   Whether it acts as  a stimulant to blood manu-
facture, or simply supplies  the  glands with  blood-making  material,
we do  not  know.  Iron probably increases the activity of  the body
to some extent, and thereby causes oxidation  to go on  more  rapidly
by reason of its  peculiar power of converting oxygen into ozone.  The
studies of Skvortzoff are interesting in connection with this subject.
He found : 1. That  iron has no  marked influence on nitrogenous meta-
morphosis iu the healthy body.  2. The ingestion of iron in daily
doses of 0.02 to 0.03 gramme  (0.3 to 0.5 grain)  causes a very slight
decrease in the assimilation  of the nitrogenous portions of  the food.
3. After bleeding, the assimilation of nitrogenous  substances increases
a little, whether iron is used or not; but  if iron is used at this time
the haemoglobin is rapidly reproduced, and the drug would seem to be
of value in restoring the bodily  weight.
   The preparations  of iron consist in the soluble and insoluble salts
or forms.  Of these the insoluble are better than the soluble,  because
nearly all the soluble salts of  iron are  precipitated by the gastric juice
and have to be slowly redissolved.
   Therapeutics.—The  chief indications  for iron  is anemia  (see
Anaemia), and its chief contra-iudication  is plethora.   When used in
small dose (J to 1 grain), it is quite as efficacious as in large amounts,
and less apt  to disorder the stomach.   In some cases  of anaemia of a
semi-pernicious  type large  doses of iron are really needed, probably
because the system is deranged in such a manner that an excessive loss
or destruction of iron is constantly present.   Large doses compensate
for this leakage  and  afford the quantity needed for  physiological pur-
poses.   It should not be used as a tonic unless some direct indication 
IRON.
211
for its employment  is present, and  no drug is more abused  in this
respect  than iron.   As each of its preparations possesses some pecu-
liarity, the use of each will be considered separately.

                    Ammonio-ferric Alum.

   Ammonio-ferric Alum (Ferri  et Ammonii Sulphas, U. 8.)  is often
given in cases of atonic leucorrhea in the dose of 2 to 5 grains.   It is
quite astringent.
                 Aromatic Mixture of Iron.

   The Aromatic Mixture  of Iron (Mistura Ferri Aromatica, B. P.)
contains so little iron that it should not be administered in cases where
a chalybeate influence is desired ; it  is, however, a useful tonic, given
in the dose of 1 to 2 fluidounces.   Aromatic mixture of iron  contains
cinchona bark, calumba, cloves, iron, compound tincture of cardamoms,
tincture of orange peel, and peppermint water.

                       Arseniate of Iron.

   Arseniate of Iron (Ferri Arsenias, B. P.) is used in the dose of
fa to -fa grain in anaemic subjects who are suffering from skin  diseases.

                      Basham's  Mixture.

   Under  the name  of  Basham's Mixture (Mistura Ferri et Ammonii
Acetatis, U.  8.), a very useful and elegant preparation of iron is em-
ployed.  It is made  up  as follows :
             Tincture  of chloride of iron    ...  2 parts.
             Dilute acetic acid.....3
             Spirit of Mindererus.....20
             Elixir of orange     .    .    .   .    .10
             Syrup........15
             Water........50
   The dose is from  1  to  8 drachms well diluted, and  it acts  as a
diuretic, diaphoretic, aud chalybeate.

                       Bromide of Iron.

   Bromide of Iron (Ferri Bromidum) is said by Da Costa to be useful
in ancemia, when this state is associated with chorea, in the dose of 5 to
20 grains given in syrup.   In other nervous diseases accompanied by
anaemia and insomnia the syrup of the bromide  of iron (Syrupus Ferri
Bromidi,  U. 8.) is useful in the dose of J to 1 fluidrachm.

                      Carbonate  of Iron.

   The Carbonate of Iron (Ferri Carbonas Saccharatus, U. S. and
B. P.), is very slightly astringent, and may be used in pill form under
the name of Pilule Ferri Composite,  U. 8., or in Griffith's pills, which 
212
DRUGS.
also contain myrrh.   The dose is 3 grains, and this preparation of iron
may be largely used for the treatment of amenorrhea dependent upon
anaemia.  Under the name of Mistura  Ferri  Composita, U.  S.  and
B. P., we have a liquid preparation used for the same purposes as the
pills,  in the dose of 1 to 2 tablespoonfuls.   Pilula  Ferri Carbonatis,
B. P., are given in doses amounting to 5 to 20 grains.

                        Chloride  of Iron.

  Tincture  of the Chloride of Iron (Tinctura  Ferri Chloridi, U. 8.),
often  called tincture of the muriate of iron, is one of the best and most
useful preparations of iron that we have.  It  is the most  diuretic
preparation of iron.   This diuretic effect  does  not  depend upon
the presence of a muriatic ether, as has heretofore  been taught, since
hydrochloric ether  is not present, and is hard to prepare except there
is an  excess of chlorine present.   According to some researches of Dr.
S. Weir Mitchell, the only ether present  is  nitrous ether, and this is
devoid of power aud in small quantity.  As chloride of iron  itself is
diuretic, it  is probably  upon this that  the  diuresis produced by it
depends.  The dose of the chloride of iron (Ferri Chloridum, U. 8.)
is  1  to 3 grains.   Tincture of the  chloride of iron is considered a
specific in  erysipelas, and should  be  given in very  full  dose and
frequently repeated if it is to be of any service.  Ten  drops every
hour  is not  too much.  In chronic Bright's disease  it is of value and
decreases the albuminuria.   In anemia it is useful, and owing to its
acid  is a doubly effective tonic.  In cases of slight anaemia iu which
very  great  arterial pressure exists  Dr. Mitchell uses a purely milk
diet, and an ounce of an old tincture of iron in the twenty-four hours.
While he recognizes the fact that iron preparations are generally sup-
posed to raise blood-pressure, he asserts that in this iustance the blood-
pressure is  lowered.   The dose of Liquor Ferri Chloridi is 4 to 10
drops.  It  is  rarely  used  internally, but chiefly as an  astringent of
great  power.   Liquor Ferri Chloridi is  identical with Liquor Ferri
Perchloridi, B. P.   Tinctura Ferri Perchloridi, B. P., is used inter-
nally in the dose of 10 to 20 minims.
  As a local  application tincture of  the  chloride of iron is useful in
diphtheria and membranous croup, and even in  tonsillitis.  Iu each of
these  maladies large doses of the tincture internally with counter-irri-
tation over  the neck are most useful.  When used internally it should
be well diluted and taken through a glass  tube to protect the teeth.
The strong solution of perchloride of iron (Liquor Ferri Perchloridi
Fortior, B. P.) is a powerful styptic.

                Citrates and Tartrates of Iron.

  The  four citrates of iron are soluble  in water and very useful for
this  reason.   Ferri  Citras,  U. S., aud Ferri et Ammonii Citras, U. 8.
and B. P.,  occur in garnet-red scales and are given in the dose  of 5
grains.   The solution of the citrate of iron (Liquor Ferri  Citratis, 
IRON.                          213
U. 8.) is given in the dose of 10 minims.  The Ferri et Quinine Citras,
U. S. and B. P., and the Fori et Strychnine Citras, U. S. and B. P.,
are given in the dose of 5 to 15  grains and 1 to 3 grains respectively.
The  solution of iron and quinine (Liquor Ferri et  Quinine Citratis,
U S.) is given in the dose of 8 to 15 minims.
  Besides these citrates there are two tartrates—Ferri et Ammonii
Tartras, U. 8.,  and Ferri et Potassii Tartras, U. 8.;  and Ferrum  Tar-
taratum, B. P., all given in the dose of 5  grains.

                         Dialyzed  Iron.

  Dialyzed Iron (Ferrum Dialyzatum) is a very feeble preparation of
iron, lacking in astringency, easily precipitated from the solution  in
which  it occurs, but  largely used in anemia  by some practitioners.
The  dose  is 10 to 20 drops in  water three times a day.   Sometimes
river water, if  it contains much inorganic or organic matter, will  pre-
cipitate it.   Owing to the instability of dialyzed  iron it may be  used
without any preparation as an  antidote  to arsenic.   Liquor Ferri
Dialyzatus, B.  P., is given in the dose of  10 to 30 minims.

               Hydrated Sesquioxide  of Iron.

   Hydrated  Sesquioxide  of Iron (Ferri Oxidum Hydratum, U. S.) is
the antidote to arsenic, but to be efficacious it must be freshly prepared.
It is to be made by precipitating any liquid  preparation of iron by
the addition of an alkali such as ammonia, or by the addition of mag-
nesia.  If ammonia  is used, the precipitate has to be washed  with
water several times to get rid  of the alkali, which will render the
antidote too irritant to be swallowed  if it is allowed  to remain  with
the precipitate.  Magnesia is an antidote  in itself and  should  be
preferred  under all circumstances.   The antidote should be  given in
excess and as much as a  pint of  the  iron  solution should be precipi-
tated.   The magnesia  should  be freely added, as too much of it
cannot be given.   The official  antidote  to  arsenic is Ferri Oxidum
Hydratum cum Magnesia, U. 8.  In the Prussian  Pharmacopoeia
this is known as the Antidotum Arsenici.   (See Arsenic.)

                         Iodide of Iron.

  The Syrup of the  Iodide of Iron (Syrupus Ferri Iodidi, U 8. and
B. P.) is a transparent liquid of a sweet, iron-like  taste.  It  should
contain no free iodine, and if it strikes a blue color with starch should
be discarded.   It is largely used  in anaemia associated with scrofulosis
and  struma,  and is useful  in the eczema of young children when this
is dependent upon lack of vitality or  anaemia.  The  dose  to a child
of two years is 2 to 3 drops well diluted, and  to an adult  30 to 40
drops in water, to be taken through a glass tube to protect the teeth.
  The saccharatcd iodide of iron (Ferri Iodidum Saccharatum, U. S.)
is used in place of the syrup in the dose of 2 to 5  grains.   The 
214
DRUGS.
official pills (Pilula Ferri Iodidi,  U. 8. aud B. P.) each contain  £ of
a grain of reduced iron and \ of a grain of iodine, and are given in
the dose of 1 to 3 pills.

                        Lactate of Iron.

   The Lactate of Iron (Ferri Lactas, U. 8.) is soluble in forty-eight
parts of water, and is given in  the  dose of 5 grains.   It is used for
the same purposes as the other preparations of iron.  Lactate of iron
is one of the ingredients of Syrupus Hypophosphitum cum Ferro, U. 8.,
the dose of which is J to 1 fluidrachm.

             Ferri  Subsulphas, or  Monsel's  Salt.

   Monsel's  Solution (Liquor Ferri  Subsulphatis,  U. 8.), sometimes
wrongly called the solution of the persulphate of iron, is one of the most
powerful styptics or haemostatics that we have.  It is never to be em-
ployed where a haemorrhage is to be attacked through  the circulation,
but only when the solution can come in direct contact with the bleeding
spot.   The objection to its use is  the heavy, black, and dirty clot which
it forms on coming in contact with the blood.  In hemoptysis Monsel's
Solution should be used in fine spray consisting of from 10 to 60 drops
to the ounce of distilled water.   In uterine hemorrhage from any cause
the dilution may be  half-and-half, or  if the hemorrhage be from a
polypus or the cervix uteri the pure solutiou should be used, locally
applied.   In nose-bleed Monsel's Solution may be employed diluted
one-half or pure, but it is disagreeable because of the hard, black clot
which is formed and the uncomfortable sensations and  pain produced
in the nasal chambers.  Plugging the nostrils with  pledgets of cotton
is generally sufficiently efficacious.
   In the intestinal hemorrhage occurring during or after typhoid fever
Monsel's Solution has been given, but ought not to be, as it is decom-
posed in the  stomach before it  reaches  the intestine.   Monsel's Salt
(Ferri Subsulphatis)  should be  given in  pills of  3 grains each, the
pills  being made hard enough to escape into the intestine before the
stomach  breaks them down.  One, two, or three  pills may be given
aud  repeated  in an hour.   Hematemesis due  to bleeding  in  the
stomach should  be  treated by 3-drop doses of the  solution in a  little
water.
   In tonsillitis and pharyngitis  a most efficient application is  pure
Monsel's Solution applied by means of a pledget of cotton or camel's-
hair brush ; or equal parts of  the solution and glycerin may be used.
This application is ofteu as painful as it  is efficient.   In diphtheria
this method of treatment is often of great service.  The antidote to
Monsel's Solution is common soap.

                        Oxalate of  Iron.
   Oxalate of Iron (Ferri  Oxalas, U. 8.) is given in the dose of 2 to 3
grains. 
IRON.
215
                     Phosphates of Iron.

  There are two phosphates of iron, Ferri Phosphas, U. S. and B. P.,
aud  Ferri Pyrophosphas, U. 8.   The  first of these  is insoluble and
is rarely used.  The second is quite soluble and  useful in the dose  ot
2 to  5 grains.   Syrupus Ferri Phosphatus, B. P., is given in the dose
of 1  fluidrachm.  Phosphate of iron is one of the ingredients of the
syrup of iron,  quinine,  and  strychnine (Syrupus  Ferri, Quinine  et
Strychnine Phosphatum,  U. S.), and is  given  in  the  dose  of 1 fluid-
drachm.
                         Reduced Iron.

  Quevenne's Iron (Ferrum Beductum, U. 8. and B. P.) is an iron-
gray or reddish powder which is frequently adulterated  with lamp-
black.   If it is pure it should burn in sparks when dropped into a
flame, but if lampblack is present this will not occur.   It should also
yield no sulphuretted hydrogen on adding sulphuric  acid to it.  It is
tasteless, and may  be given to  children for  this  reason  in  pills or
gum-drops, or placed inside of small chocolate creams,  or in the form
of troches (Trochisci Ferri Bedacti, B. P.), each lozenge containing
1 grain of the reduced iron.  It is used solely in anaemia and is one
of the least astringent of the iron preparations.

                       Sulphate of Iron.
  Sulphate  of  Iron (Ferri 8ulphas, U. 8. aud  B. P.) is used  inter-
nally in the  dose of  5 grains in pill form  in chronic diarrhea.  Ex-
ternally, in a solution of the strength  of  5 to 25 grains to the ounce,
it is  used as  an  astringent lotion.  Two other forms of the sulphate
are also employed, namely, the dried (Ferri Sulphas Exsiccatus, U. S.
and  B.  P.) and the precipitated (Ferri  Sulphas Precipitatis,  U. 8.)  or
(Ferri Sulphas  Granulata, B. P.), each of which is given in the dose
of 3 grains.
                     Valerianate of Iron.

  Valerianate  of Iron (Ferri Valerianas,  U.  8.) is sometimes useful
in hysteria with anaemia, given in the dose of 1 grain or more.

                        Wines  of Iron.

  The Bitter Wine of Iron  ( Vinum Ferri Amarum, B. P.) is useful
in anemia, both in  children and  adults, and may be advantageously
accompanied with cod-liver oil.  It is given in a dose of 1 to 2 fluid-
drachms or  more.  This wine is composed of soluble  citrate of iron
and  quinine, tincture of sweet orange-peel, syrup, and stronger white
wine.
  Wine of the Citrate of Iron, or Vinum Ferri Citratis, U 8., is com-
posed of the citrate of iron and ammonium, tincture of sweet orange-
peel, syrup, and stronger white wine.   The dose  is identical with that
of the bitter wine, and it is used for the same purposes. 
216
DRUGS.
   Hydrated  Peroxide of Iron (Ferri Per oxidum  Hydratum, B. P.)
is used in the dose of 5 to 30  grains.   From the last preparation
iron plaster (Emplastrum Ferri, B. P.) is made.  The plaster of iron
official in the U. 8. is prepared from the hydrated oxide of iron.
   The following preparations of iron  are  also official:  Liquor Ferri
Acetatis,  U. 8., dose 15  minims to  1  fluidrachm;  Liquor  Ferri
Acetatis Fortior, B. P., dose 1 to 8 minims;  and  Basham's Mixture
(see page 211).

   Untoward Effects of Iron:—Iron is apt to cause gastric distress and
frontal  headache in persons who  are susceptible to its use.   Even one
dose will cause this trouble in some persons.   In many instances  the
frontal headache will be found to be due to the constipation which has
been brought on by the iron, and will be relieved if mild laxatives  or
purges are used.   The state of the bowels should  always be watched
and laxatives given whenever constipation  is present and iron is being
administered.  In rheumatic and gouty persons frontal headaches are
a common symptom when iron is given, and purgatives will not gen-
erally give relief.   Garrod and Haig have shown that iron decreases
the elimination of uric acid, whicli  may account for the production of
headache in the case of rheumatic patients  under its influence.  Some-
times salts of iron produce vesical  irritation and a  constant desire  to
urinate, causing mucus to  form in abnormal  amount in the bladder.
In children its use may result in  nocturnal incontinence of urine.


                           JALAP.

   Jalap (Jalapa, U. 8. and B. P.)  is the root  of Exogonium  Purga,
a native of Mexico.   It contains two resins, jalapin and convolvulin,
neither  of which  is used in medicine by itself, though both of them
enter into the Resin of Jalap of the U. 8. P.   In overdose jalap or its
resin causes vomiting  and purging,  with gastro-enteritis.
   Therapeutics.—Jalap is used in medicine as a hydragogue purge  to
relieve dropsy of any  origin.  It  may be  used to deplete in cases  of
general plethora with cerebral congestion, and owing to its tastelessness
is  a useful cathartic in children if given in the proper dose, namely,
1 to 2 grains in half an ounce of syrup of rhubarb.  Combined with
calomel it is preferred to all other  purges  by some practitioners, par-
ticularly if the liver is torpid.
   Administration.—Jalap may be given in the form of the compound
powder  (Pulvis Jalape Compositus, U. S. and B.  P.), dose 15 to 40
grains; as the abstract (Abstractum Jalape, U. 8), dose 5 to 15 grains ;
and the resin (Besina  Jalape, U. 8. and B. P.), dose for an adult, 2  to
4 grains.   Owing to the  small  size of the dose of the resin and its
lack of taste,  this preparation  is  to be  preferred for children in the
dose of \ to  \ a grain.  The  tincture (Tinctura Jalape, B.  P.)  is
given in the dose of J  to  1  fluidrachm; the extract (Extractum
Jalape, B. P.) is used in the dose of 5 to 15 grains. 
JUNIPER.
217
                          JEQUIRITY.

  This is a plant known as Abrus Precatorius, the seeds of which are
poisonous.    Jequirity  is never  used internally in medicine in this
country.   In the proportion of 8 grains of the powdered seeds to an
ounce of distilled water, jequirity  is sometimes dropped into the eye in
cases of chronic granular conjunctivitis, in order to produce an acute
diphtheritic  inflammation which  will  so  change the chronic process
present as to permit of a cure.  The solution undergoes decomposition
with great rapidity, and should  be prepared freshly each  time  it is
used, or 4 to 8 grains of boric acid should be added to preserve  it.
The drug is a  powerful cardiac depressant poison.
                            JUNIPER.

   Juniperus,  U. 8., is the fruit  or  berry of Juniperus Communis, an
evergreen of Northern Europe and America.   It contains a volatile
oil and au amorphous principle, juniperin.
   Physiological Action.—Juniper  acts as  a  gastric stimulant  and
touic, as a mild diaphoretic if combined with alcohol, and as a marked
stimulating,  exciting  diuretic.   It escapes from the  body by the
kidneys.
   Therapeutics.—Juniper  is  valuable as a stimulant to the genito-
urinary system whenever it is depressed or chronically diseased, as in
chronic pyelitis, nephritis, and chronic catarrh of the bladder.  In con-
gestion  of the kidneys, if not accompanied by active tissue changes, it
relieves these  organs and does  away with  albuminuria.   Used after
an attack of acute Bright's disease, when reaction  has  set in and the
secreting  epithelium of the kidney  is atonic, it is of value, but  care
should be taken that  all inflammation has passed  by, or it will  make
the patient worse.  In the later stages of scarlet  fever, in which the
renal condition corresponds to  that just described, juniper is useful.
In old persons a sensation of weight across  the lumbar region is often
readily removed by the use of juniper if the kidneys are inactive.
   Administration.—Juniper is  used in the form  of the compound
spirit (Spiritus Juniperi Compositus,  U S.), composed of the oils of
juniper, caraway, and fennel, combined with alcohol and water,  in the
dose of 1  to 4 drachms.  Gin is virtually identical with the compound
spirit.   The infusion  of juniper is  made by adding an  ounce  of the
berries to a pint of boiling water and allowing it  to stand in a  warm
place for an hour.  The entire  quantity is to be taken in twenty-four
hours, and the infusion is often combined with acetate of potassium or
an ounce of the bitartrate of potassium in the treatment of dropsy.
The spirit (Spiritus Juniperi, U. S. and B. P.) is given in the dose of
30 minims to  1 drachm.  The  oil (Oleum Juniperi, U. 8. and B. P.)
is used in the dose of 1 to 4 minims. 
218
DRUGS.
                          KAMALA.

  Kamala, U S. and B. P., or Rottlera, as it is sometimes called, is
the hairs and bristles from the capsules of Bottlera Tinctoria, a plant
of Abyssinia, India,  and China.  It  contains  au active principle,
rottlerin, which is not official.   Given in the dose  of 1 to 2 drachms
kamala acts as  a drastic and as a remedy for tapeworm.  It should
be administered in syrup, and repeated in eight hours if no  effect  is
produced.  (See Worms.)

                           KAOLIN.

  Kaolin is a soft white powder and is a decomposition product of
mineral deposits containing feldspar.   It is used externally as a dust-
ing powder in eczema.

                            KINO.

  Kino is the inspissated juice of the Pterocarpus  Marsupium, a tall
tree of India.   It contains kino-tannic acid and is  used as an astrin-
gent in serous  diarrhea.  It is official in the form of the  tincture
(Tinctura Kino, U. 8. and B. P.) and is given in the dose of 1 fluid-
drachm.   Kino may  be used as a gargle in sore-throat and for relax-
ation of the uvula.  Under the name of compound powder of kino (Pul-
vis Kino Compositus,  B.  P.) an efficient and  pleasant anti-diarrhea
powder is used.  This  powder is not official in the U. 8. P.  The
formula for each powder is 15 grains of powdered kino, 4 of powdered
cinnamon, and 1 of powdered opium.


                         KRAMERIA.

  Krameria,  U. S., Krameria Badix, B. P., sometimes called Rha-
tany, is the root of  Krameria  Triandra and Krameria Tomentosa,
shrubs of Peru and New Granada, and is employed iu  serous diar-
rheas with good effect.  The tincture (Tinctura Kramerie, U. 8. and
B. P.) is given in the dose of 1 drachm, the  solid extract (Extractum
Kramerie, U. 8. and B. P.)  5  to  10 grains,  the  fluid  extract (Ex-
tractum Kramerie Fluidum, U. 8.), dose 10 to 20 drops, and the syrup
(Syrupus Kramerie,   IT. S.), dose 1  ounce.   The  troches (Trochisci
Kramerie, U 8.) are held in the mouth for the purpose of producing
a local astringent effect.   An infusion (Infusum Kramerie) is official
in the B. P., dose 1 to 2 ounces.
     LACTOSE.

(See  Sugar of Milk.) 
LEAD.
219
                           LANOLIN.

  Lanolin is a fat derived from the wool of the common sheep, aud is
a whitish substance  of peculiar stability, very difficult of saponifica-
tion and incapable of  becoming rancid.  Unna states that ointments
of acids, hydrogen peroxide, aud other substances may be made by it.
One great  objection  to lanolin is its  stickiness, which is avoided  by
adding  one-third  of vaseline.   Lanolin is supposed to possess very
remarkable penetrating powers when applied to the skin in cases where
much infiltration is present, particularly if it is combined with resorcin
or some similar medicament.   In itself it has little curative power, and
is but little better than lard, oil, or any common fat as a basis for oint-
ments.   In some cases, which are  rare, it  will cause irritation of the
skin.

                              LEAD.

  Plumbum,  or Lead,  is a metal  possessing  more or less power over
the organism according to the salts  which are employed.  It is not
official as lead itself.
  Physiological  Action.—Lead in one of  its soluble salts, if applied
to a mucous  membrane, produces  a  bleaching  which is particularly
noticeable  where the redness of inflammation has previously existed.
It has little effect iu single dose except by an indirect influence over
the circulation, nervous  system, or respiration.   For a description of
the effects of lead in overdoses see  " Poisoning," below.
  The most irritant and poisonous salt is the nitrate, the next the sub-
acetate,  and the least poisonous of the soluble salts is the acetate.
  Acute Poisoning.—When the acetate of lead is taken in poisonous
amounts it produces a  sweet  metallic taste  in the mouth, followed by
pain in  the  epigastrium and  the  vomitiug of white,  milky-looking
liquids  or white curds mixed with  food.   The white color is due to
the presence of chloride of lead formed by the action  of the gastric
juice.
  The pain continually increases, and diarrhoea due to gastro-enteritis
may be set up, or, in  other cases, obstinate constipation  is  present.
The passages are generally black, this being due to the presence of the
sulphide of lead.  At the same time the pulse becomes rapid, tense,
and cord-like, but after a time weak and relapsed.  The face is anxious
and pale, or livid.  The thirst is excessive  and cramps iu the calves of
the legs or muscular twitchings may ensue.   It is said that the char-
acteristic  blue  line on the gums may appear in acute poisoning, but
this is not based on fact.   If coma comes on, death  is assured.
  The treatment consists in the use of the chemical antidote, a soluble
sulphate, in large quantity, in the administration of emetics and the
use of the stomach-pump if the  vomiting  produced by the drug  is
not sufficient to rid the stomach of all the poison.  The best  soluble
sulphates to  employ are Epsom  and  Glauber salts, because they are 
220
DRUGS.
always  at hand,  are readily soluble, and,  in  excess, act as purges,
which will wash out the intestinal canal.  Hot applications should be
applied  to the  belly and feet, and the  pain aud  irritation  which is
present  relieved by opium.
  Chronic Poisoning.—Chronic  lead-poisoning is  rarely produced by
the soluble salts of lead, nearly always being due to the insoluble salts.
The symptoms of chronic  lead-poisoning or plumbism are as various
as it is possible to find variety in the signs  of disease of every kind.
There is no train  of  symptoms which may not occur, and the occur-
rence of rare, anomalous symptoms  in  a given case should  at once
bring to the mind the thought of lead-poisoning or syphilis.  Chronic
poisoning occurs in painters, manufacturers of lead salts, and everyone
who is largely thrown in contact  with the metal in the arts.  It occurs
from the use of hair-dyes containing the acetate of lead, from drink-
ing water which has passed through  new lead pipe, and even  from  the
biting of silk threads loaded with lead to increase their weight.  Chro-
mate of lead  has been  used to color  sponge-cake, when eggs were
thought too dear, and has  killed  many persons.  Millers, who have
filled the holes in grindstones  with  lead,  have  caused widespread
epidemics of what has been  called " dry cholera," and many persons
have suffered  from  lead-poisoning from eating apple-butter  kept iu
jars glazed with lead.
  The most prominent, but by no means the most constant symptom
of  chronic  plumbism, is bilateral wrist-drop,  due to palsy of  the
extensor muscles  of  the forearm.  The short extensor of the  thumb
generally  escapes  the  drug's  influence.   Sometimes iuternal  squint
arises from paralysis of  the  external rectus  muscles.   Another very
common symptom is  colic  centering around the umbilicus and  ra-
diating  through  the belly and  loins.  Obstinate constipation often
accompanies these symptoms, and the faeces, when  passed, are white
and clay-colored.
  During an attack of lead-colic the arterial  tension is increased very
markedly, the tongue is coated a*nd whitish, and the bowels are obsti-
nately confined.
  If these early  warnings are disregarded  aud the exposure to  the
lead is continued, cerebral symptoms come on, the result of encepha-
lopathia saturnina or saturnine  cerebritis.   Saturnine epilepsy is not
very rare.  If convulsions come on death generally ensues.  The con-
vulsions in some  cases are not due to a cerebral effect of the lead, but
to uraemia from the renal changes which it has caused.
  Renal disease  is very commonly  produced by  lead, and  it is  not
uncommon for chronic contracted kidney to be found at the autopsy
of a sufferer from lead-poisoning.   If a patient  with chronic lead-
poisoning have a urine  with a persistent low specific gravity,  the
prognosis is grave as evidencing advanced kidney involvement.
  Asthma, due to the  inhalation of  lead-dust, is sometimes met with.
   The most  important confirmatory evidence of chronic lead-poisoning
is a blue line on the gums just where they join the teeth.   Its absence is
not a negative sign, however, as poisoned persons cleanly in respect to 
LEAD.
221
their mouths often do  not have it.  Marked cachexia or anaemia is
commonly seen in chronic lead-poisoning."
  After prolonged lead-poisoning the nerve-trunks are found atrophied
and finally  changed into  fibrous  cords.  Polio-myelitis, anterior  or
posterior, may be present, and locomotor ataxia is commonly caused.
It is said that the locomotor  ataxia produced by lead may be dis-
tinguished  from the idiopathic form by the fact  that in lead-poison-
ing the sphincters are  affected, while in the non-toxic variety they
escape.
  In some cases trophic  changes in the joints  ensue, and plumbic
gout is not rarely  seen,  or even lead arthralgia with deposits of urates
in the joints.  This condition is due to the fact pointed out by Garrod
and Haig, that lead forms  insoluble salts with uric acid.
  Lead escapes from the  body in the urine, the faeces,  and all  the
secretions.   It is chiefly eliminated by the liver and the bile.
  Treatment  of Chronic Poisoning.—The  treatment consists in
three classes of remedial measures :  1st, the removal of the  cause;
2d, the removal of the  poison in the body; and, 3d,  the treatment of
the lesions produced by the poison.
  In lead-colic hepatic  purges, such as jalap and calomel, combined
with opium to prevent pain, are  indicated, and  alum and opium, or
morphine, are said to be almost specifics, the alum in  two-grain doses,
the others in full amounts.  After all,  purges fail to move the bowels
of a person suffering from  chronic lead poisoning and succeed only
when morphine is given to overcome the intestinal inhibition produced
by the irritation caused by the  lead.
  In the cerebral inflammation  of lead-poisoning  a blister  to  the
back of the neck, revulsives,  aud  a  pilocarpine  sweat  may  be re-
sorted  to.
  To aid in the elimination of the lead, iodide  of potassium, which
forms double soluble  salts in the tissues with the metal, is to be used,
10 to 20 grains three times a day.
  If progressive paralysis is present*, Wood insists on the use of large
doses of strychnine at  the same time that the iodide is given.   The
strychnine should  not,  of course, be  given with the iodide, as it is
incompatible.
  Electricity should  be used as' a remedy to restore  lost function.
If the  faradic current  makes the muscles  contract it should be em-
ployed,  and, if not, the galvanic should be used.   Curiously enough,
voluntary power sometimes returns before  the muscles will react at
all to electricity.
  It is  said  that  baths of sulphuret of  potassium should be  used;
5 or 6  ounces of the salt  to each bath, which  is to be given in a
wooden tub.   The patient  should afterward be well  soaped, then
thoroughly rinsed off, and rubbed down with a rough towel.

  As the salts of lead are used  for different purposes, the therapeutics
of each  one will be taken  up separately. 
222
DRUGS.
                       Acetate of  Lead.

   Acetate  of Lead (Plumbi Acetas, U  S.  and B.  P.),  or sugar of
lead, has a sweet, astringent taste, and is soluble in water, although
the solution formed is slightly milky in appearance.
   Therapeutics.—Acetate of lead may  be  used, and is  largely em-
ployed, in the following pill in  the treatment of serous diarrhea:
         R.—Plumbi acetat.......gr. xl.
             Pulv- opii.......gr. x.
             Camphorse.......gr. xl.    M.
    Ft. in pil. no. xx.  S.—One every four hours.

   This pill may also be given in dysentery.
   Administration.—The B. P,  recognizes the following preparations
of lead acetate (Pilula Plumbi cum Opio), dose 3 to 5 grains; Sup-
positoria Plumbi Composita, each  suppository containing 1  grain  of
opium  to  3  grains  of lead acetate;  and  an  ointment (Ungentum
Plumbi Acetatis).
                      Carbonate of Lead.

   Carbonate of Lead (Plumbi Carbonas,  U. S. and B. P.) is insoluble
and is used as a coating or dressing for  burns, scalds, or ulcers, when
rubbed up with linseed  or other oil, or  in the form of the ointment
(Unguentum Plumbi Carbonatis, U. 8.  and B. P.).   If a wide surface
is  covered with this  ointment  it  may cause lead-poisoning by ab-
sorption.
   Carbonate of lead may  be used in the  treatment of sunburn in the
following prescription :
         R.—Plumbi carbonat.......gj.
             Pulv. amyli  .......  gj.
             Unguent, aquae rosse.....^j.
             Olei olivse.......f g ij.    M.
    S.—Apply to the inflamed skin.

                        Iodide of Lead.

   Iodide  of  Lead (Plumbi Iodidum, U.  8. and B. P.) is  occasionally
employed in  medicine; the dose is J to 2 grains. Emplastrum Plumbi
Iodidi, P. B.,  and  Unguentum  Plumbi Iodidi,  U. 8. and B. P., are
useful  as external astringent and alterative applications.

                 Liquor Plumbi Subacetatis.

   Liquor Plumbi Subacetatis, U. S. and  B. P., or Goulard's Extract,
is  a colorless liquid, much used  externally, when diluted, with lauda-
num, for sprains, bruises, and local inflammations, under the name of
" lead-water  and laudanum."  The  proportion  should be 4 parts  of
the pure lead-water, diluted  with 16 parts of water, to 1 of laudanum,
but this is varied as the inflammation  or  pain is  the more severe.
The official liquor is also official in a  dilute solution (Liquor Plumbi 
LEPTANDRA.
223
Subacetatis Dilutus, U. 8. and B. P.), and, as such, is too weak for
ordinary use, although it is commonly employed.   The strong solu-
tion should  be  used in the strength of from 1 to 4 ounces to the pint
of water.  This  solution should never  be  employed  if the skin is
broken, as  absorption  may occur, and what is more important still,
the drug prevents  healing by constringing  and whitening the edges
of the wound.  If some bread-crumbs be saturated with this solution
and applied to  an inflamed finger, a felon can often  be aborted in the
early stages.  The official dilute solution is useful as a lotion in eczema
which  itches and  tingles, and is not dry iu  character.   It should  be
applied once or twice a day, and  it is  well  to  follow the  applica-
tion  of the lead  with  a weak sulphur  bath or alkaline wash.  (See
Eczema.)
   Lead-water is  also useful  in pruritus pudendi, and the acetate of
lead  may be used as an injection in  the dose of 1  to 8 grains  to the
ounce  of water in  cases of gonorrhea.   The cerate (Ceratum Plumbi
Subacetatis, U. 8.), the liniment (Linimentum Plumbi Subacetatis, U. 8.),
and the glycerin  (Glycerinum Plumbi Subacetatis,  U. 8. and B. P.),
may be used for the same purposes as the Goulard's extract.

                            Litharge.

   Litharge (Plumbi Oxidum, U. S. and B. P.) is used for the prepa-
ration  of lead-plaster (Emplastrum Plumbi, IT. S. and B. P.),  some-
times called " Diachylon," and this  is in turn employed for the manu-
ture  of resin-plaster (Emplastrum  Besine,  U. 8. and  B. P.).  It is
also used in the preparation of the solution of subacetate of lead.
   Hebra recommends  for  sweating of the feet an application  of equal
parts of lead-plaster and linseed oil, applied  on linen, and  wrapped
around the feet every third day.

                        Nitrate of Lead.

   Nitrate of Lead (Plumbi Nitras,  U. 8. and B. P.) is never used in-
ternally but as  a powder in the treatment of cases of onychia maligna,
and in the  formation  of Ledoyen's  Disinfecting Solution.   The latter
discolors the paint in water-closets, dissolves the solder in drain-pipes,
and is not a good preparation for general use.


                         LEPTANDRA.

   The medicinal  portion of Leptandra  Virginica is the rhizome and
rootlet from which are made the official extract (Extractum Leptandre,
U. S.) and the fluid extract (Extractum Leptandre Fluidum, U. S).
The dose of the former is from 1 to 8 grains and of the fluid extract 5
to 40 minims.
   Physiological Action.—Very  few experiments have been  made as
to the action of this remedy, and the only ones of importance are those 
224
DRUGS.
of Rutherford  and Vignal, who found  that  it possessed  a moderate
influence in increasing the flow of bile.   In overdose it causes violent
purging.
  Therapeutics.—In the official preparations of leptandra, which are
not as active as  is the  fresh drug,  we have  excellent substitutes for
calomel according to many clinicians.  Those who have used leptandra
also believe it to be of the greatest value in the indigestion of the intes-
tinal type sometimes called " duodenal atony."  The following pill  is
a good method of using  the drug in  these cases :
         R.—Ext. chirettse......gr. xx.
             Ext. leptandrse......gr. xx.    M.
    Ft. in pil. no. x.  S.—One pill after each meal.

  Under the name leptandrin we have an impure resin which is given
in the dose of 2  to 5 grains.  An  alkaloid of doubtful existence  is
called leptandrine.

                            LIPANIN.

  Lipanin is au artificially prepared mixture devised by Von Mering
as a substitute for cod-liver oil, and  consists  in 6 parts of oleic acid
added to 100 parts of olive oil.   The advantages  possessed by it are
its  lack of disagreeable  odor and taste, and  its  ready emulsification
and digestibility.   The commencing  dose is 1 drachm, which may be
increased  to 4 drachms.   This mixture  has been found of value in
most of the diseases  in which cold-liver oil' is employed,  and in the
opinion of the author its efficacy is greatly increased if the hypophos-
phites of lime and sodium are used at the same time  in  the dose of
10 grains three times a  day.  Iodine, or one of its compounds, may
also be given if it is desired to exert  an alterative influence.
                          LIQUORICE.

   Liquorice  (Glycyrrhiza, U. 8., Glycyrrhize Radix, B.  P.) is the
root of Glycyrrhiza Glabra, a plant of Southern  Europe  and Asia.
It is used to increase secretion in the mouth in the form of a solid
extract, and when dissolved in water to form a vehicle for other drugs,
particularly if they have a disagreeable taste.   The powdered  solid
extract is a very  mild and useful laxative.
   Administration.—The  solid extract (Extractum  Glycyrrhize, U. S.
and B. P.) is used in a dose anywhere from 5 to 120 grains.  The pure
extract (Extractum Glycyrrhize  Purum, U. 8.) is used in  the same
quantities as  the ordinary extract,  The fluid extract (Extractum Gly-
cyrrhize Fluidum, U. 8.) or the liquid extract (Extractum Glycyrrhize
Liquidum, B. P.) is used in 1 to 2-drachm doses.   Under the name of
Brown Mixture or  " compound liquorice mixture," a very efficient ex-
pectorant solution  is official (Mistura Glycyrrhize Composita, U. S.)
which contains as its most important ingredients 12 parts of paregoric, 
LITHIUM.
225
6 parts of wine of antimony, and 3 parts of sweet spirits of nitre.
The dose is 1 to 4 drachms.  Pulvis Glycyrrhiza Composita, U. 8.  and
B. P.), or compound liquorice powder, contains, according to the U. S. P.,
18 parts of senna, 16 of liquorice, 8 of fennel,  8 of washed sulphur,
and 50 parts of sugar.   According to the B. P. it should contain  2
parts  of senna, 2 of liquorice  root, 1 of  fennel  fruit, 1  of sublimed
sulphur, and of sugar  6 parts.   The dose is 1 to 4 drachms.   It  is
largely used as  an efficient laxative after childbirth and in cases which
suffer from constipation chiefly from the inactivity consequent upon
being in bed.   The Troches  (Trochisci Glycyrrhize et Opii, U. S.  and
B. P.) contain  -fa grain of opium and 2 grains of extract of liquorice.
Finally we have Glycyrrhizinum Ammoniatum, U. 8., which is the sweet
principle of liquorice rendered  soluble and easily tasted by the addition
of ammonia.   The dose of this preparation is 5 to 15 grains.


                            LITHIUM.

   Lithium is used in several forms, but its salts may be divided  into
two classes—those which act  as  lithium and those which act  as the
acids forming them.  In the  first class we have the carbonate  (Lithii
 Carbonas, U. 8. and 5. P.) dose 2 to 10 grains, and the citrate (Lithii
 Citras, U. 8. and B. P), dose  5 to 20 grains.   In the second class we
 find the benzoate (Lithii Benzoas, U. S.) dose 5 to 30  grains; Lithii
 Bromidum, U. S., dose 10 to  40 grains, and Lithii Salicylas,  U. 8.,
 dose 10 to 30 grains.
   Haig has pointed out that although lithia forms salts with uric acid
 in the test-tube, in the body it  has a greater affinity for the acid sodium
 phosphate in the blood and  practically leaves the uric acid to itself.
 This is an important point,  since it proves that the large  amount  of
 water generally taken with  lithia has more to do with relieving gout
 than has the lithia.
   The carbonate and citrate are used in gout and  rheumatoid arthritis
 for the purpose of entering into combination with the uric acid in the
 body to form soluble urates  and prevent  deposits in the joints.  They
 have  been said to dissolve  calculi, but  this is untrue,  though  they
 are used  when  it  is  desired to render the  urine  alkaline.   The
 carbonate is not soluble in water, and should be given in capsule  or
 freshly-made pill, but  the citrate is  soluble.    The  latter may  be
 made from the former by taking  50 grains of the carbonate, 90 grains
 of crystallized citric  acid, and warm distilled water 1  fluidounce.
 The  acid  should  be dissolved first and the carbonate added  to the
 solution.   The solution should then be kept hot until effervescence ceases.
   In cases of diabetes depending upon a gouty taint remarkable results
 are often obtained  from the use of the citrate or carbonate of lithium
 and arsenic.  The dose should be -fa of a grain of arsenite of sodium
 and 10 grains  of the lithium salt three times a  day.
   For the use of  the  other salts of lithium, see  the  articles  on the
 Bromides, Salicylic Acid, and Benzoic Acid.
                                  15 
226
DRUGS.
   It is worthy of note that in some cases citrate of lithium will dis-
order the stomach and produce vomiting.   Lithia water, or the prepa-
ration of the British  Pharmacopoeia, Liquor Lithie  Effervescens, is
useful in gout iu quantities of 5 to 10 ounces at a time.


                     LIQUOR POTASS^.

   Liquor Potasse, U. S. and B. P., is a solution of potassa contain-
ing about 5 per cent, of potassium hydrate, and is a clear, odorless
liquid of caustic taste  and strongly alkaline  reaction.   It is used  in
medicine as an antacid and for the purpose of decreasing the acidity
of the urine.
   In ingrowing toe-nail it  is often used  to  soften the nail, prior to
packing with cotton or partial evulsion.   Its dose is  5 to 30 drops
well diluted with water.

                           LOBELIA.

   Lobelia, U 8. and B. P., is the leaves and tops of Lobelia Inflata, a
common weed of the United States.  It contains an alkaloid, lobeline,
aud lobelic acid.
   Physiological  Action.—When  taken  in  overdose   lobelia  causes
emesis, intense prostration, a  feeble pulse,  pale skin, livid face, mus-
cular relaxation and a cold sweat.   Violent purging may be present.
It is said to paralyze the motor nerve-trunks, and it causes a fall  of
arterial pressure, followed by a rise due to the asphyxia  which it finally
produces.   Ultimately  it paralyzes the respiratory  centre  and the
peripheral vagi.  The treatment of the poisoning is to administer opium
to stop irritation and vomiting, to give alcohol aud  ammonia to sup-
port the heart, and in  the use of external heat.
   Therapeutics.—Lobelia is used chiefly as an anti-asthmatic and has
been  equally greatly praised and condemned by eminent authorities.
The reason for this lies in the fact that it is generally useless in asthma
unless given in almost poisonous dose.   Wood teaches that  it should
rarely if ever be used, because of its poisonous effects  even in  doses
medicinally active, while Sidney Ringer says  that the drug is  erro-
neously thought to be dangerous.   In asthma both of  the gastric and
bronchial form lobelia is undoubtedly of  service.    In some cases it
fails as signally as  it succeeds in others.   If the asthma is  due to or
associated with cardiac disease lobelia should never be employed.  The
drug  should be taken  in the dose of J a drachm to 1 drachm of the
tincture at the first sign  of an attack, or in 10-drop doses every fifteen
minutes until distinct nausea occurs, or relief is obtained.
  In atonic constipation, 10 drops of the tincture at bed-time are often
of service.
  Administration.—Lobelia  is  given in  the form of the tincture
(Tinctura Lobelie,  U. 8.), in the dose of  10 to  30 drops, or 1  to 2
drachms, as an emetic.   The vinegar (Acetum Lobelice,  U. 8.) is given 
MAGNESIA.
227
in the dose of 20 to 30 drops, and the fluid extract (Extractum Lobelie
Fluidum, U. S.), in the dose of 1 to 5 drops, or, as an emetic, in the
dose of 15 drops.
   In the form of the infusion, lobelia is useful as a lotion in the treat-
ment of the dermatitis produced by poison-ivy.   The proportion  used
should be an ounce to the pint of water.
   The preparations of the B. P.  are the Tinctura Lobelie, dose 10
minims to J drachm, and Tinctura Lobelie JEtherea, dose 10 to 30
minims.

                        LYCOPODIUM.

   Lycopodium, U. 8.,  is a pale yellow powder derived from Lyco-
podium Clavatum,  a species of moss.  It is used by pharmacists as a
powder in which to roll pills  and by physicians and nurses to prevent
the intertrigo or chapping of the skin of infants and adults.
                            LYSOL.

   This is a preparation made  by dissolving in fat and saponifying
with alcohol that part of tar oil which boils  between  190° and 200°
C, and is a brownish, clear, oily fluid, smelling somewhat like crea-
sote.   It is used for  the same purposes as  creolin, but possesses  the
advantage of forming a clear, soapy fluid, when mixed with water, in
which  instruments can be  seen.  If small instruments are used  the
solution is too soapy, and  renders  them slippery.  Those who have
used lysol claim that  it does not affect the operator's hands, except to
render them soft and  flexible.   Experiment  shows it to be possessed
of marked antiseptic power, and  it is far less poisonous than carbolic
acid.   Used upon mucous membranes the  solution  should not  be
stronger than 2 per cent.


                          MAGNESIA.

   Magnesia is the oxide of magnesium made by exposing the carbonate
of magnesium to a red  heat.  It is used  in the  form  of the light
magnesia  (magnesia levis) as a dusting powder.  The troches (Trochisci
Magnesie, U. S.) each contain 3 grains.
   Magnesia is an antidote to arsenic, and  when employed to precipi-
tate a soluble preparation of iron it forms the antidotum arsenici (Fer-
rum Oxidum Hydratum cum Magnesia, U. S.)
   It is important that the student  should not  confuse magnesia and
magnesium.  The  first is the oxide of the second, and is sometimes
called calcined magnesia, or " Husband's Magnesia."  Magnesia is of
little value except as a feeble antacid.   Magnesia and the carbonate of
magnesium may be used  interchangeably. 
228
DRUGS.
                         MAGNESIUM.
   Magnesium is a metal never used as such, but always in the form of
one of its salts, which are the sulphate, citrate, carbonate, and sulphite.
The sulphite is a natural salt found in sea-water and iu caves or in the
water coming from the latter.   The  citrate  and carbonate are derived
from the sulphate.   The carbonate is insoluble  in water and alcohol.
The others are soluble.

                    Magnesium Carbonate.
   The Carbonate of Magnesium is  official  in the form  of the heavy
and light powder (Magnesii Carbonas Ponderosa, U. S. and B. P., and
Magnesii Carbonas, V. 8., Magnesii Carbonas Levis, B. P.).  These two
substances do not differ in respect to their effects.  The light magnesium
is never given internally, because of its bulk, but it is used as a dusting
powder in intertrigo, and in the form  of white cubes rubbed on the skin
to prevent excessive perspiration and as a cosmetic.  The heavy mag-
nesium is used as an antacid, and is not, as has been thought by some,
in any sense a laxative, as  it possesses  no  such  power.  When the
stomach or intestines contain much acid from fermatative changes, these
acids may, however, unite with  the  magnesium and form a slightly
laxative salt.
   In sick-headaches  due to great gastric acidity, carbonate  of magne-
sium is often of service.  The dose of the carbonate  is  from  5 to  60
grains.   It  should  not be used constantly, as there is danger that it
will accumulate in the intestines.
   Liquor Magnesii  Carbonatis,  B. P., is given in the dose of 1 to
2  ounces  as  a  laxative.

                      Magnesium Citrate.
   The Citrate of Magnesium (3Iagnesii Citras) is  a  much  more irri-
tating purge than the sulphate, but it is more agreeable to the taste. It
is official in two forms,  one  of which is the solution  (Liquor Mag-
nesii Citratis,  IT. 8. and B. P.), which is effervescent and should never
be used unless freshly prepared.   It  is made  by adding bicarbonate
of potassium to a syrupy solution of the citrate of  magnesium, con-
taining an excess of acid, and  corking  the bottle tightly, the cork
being tied down with a strong cord.   Care should be  taken that the
bottle is a strong one.   The dose is half to one bottle.   It  is too irri-
tating to be  used where inflammation of the alimentary canal  exists,
but is useful in the treatment of sick  and bilious headache.
   The Granulated Citrate (Magnesii  Citras  Granulatus, U. 8.) is less
agreeable  to take.   It should be dissolved in water, about  1 to  3
drachms of the salt being used in each dose, and swallowed while
the solution  is effervescing.   It  must  be kept in  bottles tightly
corked.
                    Magnesium  Sulphate.
  Sulphate of Magnesium (Magnesii Sulphas, U. 8. and B. P.) is  a
white granular powder  of neutral reaction, salty taste, and  is  soluble 
MANNA.
229
in water.  It is the form  generally known by the laity as " salts,"
although in some parts of  the country this also includes the sulphate
of sodium.   According to  the studies of Hay and others, sulphate of
magnesium is a purge  by reason of its abstraction  of water from the
intestinal bloodvessels.  All strong saline solutions above the strength
of 7  per 1000 abstract liquids  from  the tissues when brought in
contact with  them.   On the other hand, if a saline  solution be  less
strong than  7 per 1000, it  will abstract salts  from the tissues and
replace them with water.   The recollection of these facts readily makes
clear  the use of magnesium  sulphate.   Whenever a thorough purga-
tive action is required,  that is, where depletion of  the intestine or
absorption of exudations is to  be attained, the magnesium should  be
given in concentrated form, so as to make its solution of as high a
percentage as possible.   Magnesium sulphate may be given by enema
with the double purpose of unloading the bowels and acting as a deple-
tant.   The best mixture for this purpose seems to be that proposed by
Watkins, namely,  2 ounces of magnesium, 1 ounce of glycerin, and 4
ounces of water.
   In cases of dropsy this  is particularly necessary, and from one to
two ounces should be given before breakfast, or on an empty stomach,
in as  little water as will dissolve the salt.  (See Dropsy.)
   In enteritis and peritonitis this  use  of magnesium is widely recog-
nized as a proper measure.   The sulphate is not irritating and may be
given freely when inflammation  exists.   (See Peritonitis.)   It forms
a  large part of most  of the natural  purgative waters.  The B. P.
recognizes an enema, Enema Magnesii Sulphatis, composed of sulphate
of magnesium 1 part,  olive oil 1 part, starch mucilage 15 parts.


                        MANGANESE.

   Manganum, or  Manganese, is  official in  the  form  of the black
oxide (Mangani Oxidum Nigrum, U. 8.  and B. P.), and the sulphate
(Mangani Sulphas,  U. 8.).  The first of these, under the  name  bin-
oxide of manganese,  has  been  highly  praised in amenorrhea  de-
pendent upon functional disturbance and anaemia.   The dose is 3 to
5 grains three times a  day, in pill form, and the drug should be taken
for a  few days before  the  expected or proper date for menstruation.
The sulphate is rarely  if ever employed,  but may be tried in malarial
jaundice.   The dose is 1 to 2 grains.


                            MANNA.

  Manna, U. 8. and B. P.,  is the concrete juice of the  exudation of
Fraxinus Ornus, a tree of Europe.   It occurs in small or large round-
ish masses, looking somewhat like a gray-colored gum arabic.  It has
a sweet taste  and odor.   Sometimes the taste is a little bitter.
  Therapeutics.—Manna is the  most feeble of the laxatives,  and 
230
DRUGS.
causes a slight flatulence in some persons.   In children fed  by the
bottle one of the  most frequent disorders is obstinate constipation, and
for its  relief 1 to 2 drachms of the sweet variety of manna  may be
dissolved in the  milk of each bottle.   When given to older children
or adults manna is always combined with other more powerful drugs,
chiefly to cover their taste.   It may be combined with advantage with
rhubarb and senna, and it enters into the official Infusum Senne Com-
positum, U. S., the dose of which is from 1 to 4 fluidounces.


                        MATRICARIA.

   Matricaria,  U. 8., German Chamomile, consists in the flower-heads
of Matricaria Chamomilla, a European plant, possessing mild tonic
properties in moderate dose.   In larger  amounts it acts  as  au emetic
and anthelmintic.   In the form of an infusion, of the strength of 1 to
2 ounces to the pint, it has been  largely used as a diaphoretic,  and, in
small doses, to prevent colic in teething children.


                           MENTHOL.

                        (See Peppermint.)


                          MERCURY.

   Hydrargyrum,  U.  S. and B. P.,  Mercury, or Quicksilver, is a
heavy fluid metal of a peculiar color  and appearance.   As mercury
it  is  used  in medicine in the form  of  the ointment, the plaster, gray
powder, and blue mass.
   Physiological Action.—When mercury is taken into  the body in
one of its insoluble and mild preparations, it may cause no evidence of
its presence until  by frequent dosage the system in general  begins to
feel its  influence.   The first evidences  of this are to be found in the
mouth,  and consist in tenderness of the teeth when  the jaws are firmly
and quickly closed, foetid breath, sponginess of the gums, which finally
may  bleed at the slightest  touch, swelling of the tongue, and, most
prominent  of all, excessive  salivation, a condition  sometimes called
ptyalism.  If the use  of the drug is persisted in,  all these symptoms
grow  worse.  Eczema, and finally sloughs of the chin and chest de-
velop as the result of  the constant dribbling of saliva and  the direct
depressing  effect of the drug on the tissues.  The teeth drop out, the
maxillary bones undergo necrosis, and amid a general melting-down
and decomposition of the tissues the patient dies.  The blood  is affected
and becomes very thin, fluid, and  poor  in its corpuscular  elements.
These symptoms ensue ou the use of mercury in continued doses, and
rarely follow exposure to the drug in the processes of the arts.  Iu the
arts, as, for instance, in the  making of looking-glasses, workmen are 
MERCURY.
231
often affected by various trains of symptoms varying very widely in
their course.  In some cases the nervous system becomes chiefly affected.
Tremors  of  all sorts  arise, paralysis agitans is developed  with  its
typical characteristics,  and widely different  changes and degenerations
in the spinal cord ensue.   Chorea often comes on in chronic mercurial
poisoning, and its occurrence in an adult should cause inquiry as to any
possible exposure to mercury.  In other cases brownish discoloration
of the skin,  resembling Addison's disease, appears.  Blindness, deaf-
ness, sensory disturbances, such as hyperaesthesia and auaesthesia, are
developed, and localized wasting  of muscles or groups of muscles may
assert themselves.   In still other cases the blood becomes impoverished
and mercurial cachexia is developed.
   It is worthy of note that children under three years are rarely
salivated  by the use of mercury, but this is no reason  for using this
drug carelessly in this  class of cases, since  the  other  changes in the
organism nevertheless occur.
   The question as to the form in which mercury finds  entrance into
the system is one of interest and importance.  According to certain
writers, it is changed into an albuminate and so circulates in the blood,
but while this is probably true it is not known to be a fact.
   It is generally supposed that  the  bichloride is held in  solution as
an albuminate  of the oxide of mercury united with sodium  chloride,
but  others have asserted that metallic mercury in a state of minute
subdivision circulates  in  the  blood; this  point, however, cannot  be
considered settled, and the drug  undoubtedly accumulates in all the
tissues, more especially in the liver and kidneys.
   Mercury in all its forms is absorbed, and eliminated by the kidneys,
liver, skin and salivary glands.   No secretion of the body, even to the
semen, fails to carry it out of the system, but it  is to be remembered
that, although  all these parts are actively engaged in its elimination,
the drug nevertheless  rapidly accumulates  in the body.  Winternitz
asserts that the drug is excreted with equal  rapidity whether given in
its  soluble or insoluble forms, or, in  other words, that  calomel is
absorbed  and eliminated as rapidly as is corrosive sublimate.
  Balzer  and Klumpke have made a  long series of observations at the
Lourcine  Hospital,  in  Paris, on the  rapidity of  the  elimination of
mercury by the kidneys during a treatment  of long standing.   While
there are many methods for the estimation of mercury in organic fluids,
these investigators  throughout adopted that of Witz, as modified  by
Souchow  and Michaelowsky, which permits of  the easy detection of
the yoVo" of a grain  in an ounce.   After a single dose of mercury the
elimination of the drug is rapid  aud sometimes complete in twenty-
four hours, but if a continuous treatment is interrupted its excretion
continues  for some  time, and  Kussmaul  and  Gorup-Besanez have
found it in the liver as much as a year after its administration has
been stopped.  The amount of mercury that caii be readily eliminated
for many  weeks from the  kidneys when the body is saturated  is about
fa of a grain daily. 
232
DRUGS.
  Therapeutics.—The employment of mercury in medicine centres
around  four great points, viz.:  1st, its value in syphilis and kindred
states;  2d, its use as a purge;  3d, its power as an  antiseptic and
germicide ; and 4th, its action as an antiphlogistic ; the first and fourth
points are fulfilled by all the mercury salts more or less perfectly, the
second only by blue mass and calomel, the third by the  bichloride and
biniodide of mercury.
  In syphilis mercury is to be given, not  because  the  patient shows
symptoms of the secondary or tertiary type of the disease, but because
the conditions present do or do  uot call for  its employment.  Many
writers  have insisted  that it ought only to be employed in the second-
ary  stages, and while this is, as a general rule, correct, certain con-
ditions may call for it at any time.   (See Syphilis.)
  Mercury is  often administered by means of fumigations or inhala-
tions both for the removal of local and general syphilitic disorders.
The best apparatus for either  purpose is  one devised by Bumstead,
and it is both  simple and^ inexpensive.   It consists of a sheet-iron cup
so bent that the bottom of the vessel instead of being flat projects into
the  centre of the cup,  thereby forming a raised centre with a little
ditch about it. The top of this projection is flattened, and on its apex
is placed the calomel  which is to be sublimed.  The surrounding ditch
is then  filled with hot water, and the cup placed over an alcohol flame
which disengages the  vapor of the calomel and water.
  When inhalations are used the face  should be held some six or eight
inches away from the cup to permit the fumes to pass through the air.
Under  these  circumstances the quantity of calomel used should not
exceed 4 or 5  grains at  each sitting.
  If general  fumigations are to be practised the  patient places  the
lamp and cup with 30 grains of calomel on it under a chair on which
he sits wrapped in a heavy blanket.
  When inhalations are used the mouth should be rinsed out to pre-
vent mercurial stomatitis, unless a local action on the buccal mucous
membrane is desired.   Not more than eight or ten inspirations should
be takeu at one sitting.
   The employment of mercury as a purge or laxative having a special
action on the liver is  constantly resorted to.  The two preparations
used are blue  mass and calomel, but the latter is more active.   They
both cause soft and watery stools, according to the dose in which they
are  given, but the blue mass is rarely, if ever, used, except  for the
production of a laxative effect.
   Much discussion has arisen  as to  whether mercury does affect the
liver, and whether the  peculiar greenish or brownish-yellow stools
produced by it are due  to the presence of bile or mercury.
   The  experiments   of  Rutherford,  Prevost  and Binet,  and others
upou the lower animals seem to prove that in these instances, at least,
mercury does  not increase the biliary flow; but, on  the other hand, it
is undoubtedly a fact that  in man, even so small  a dose  as -^j- of a
grain of calomel may produce a  bilious-looking passage, and yet it is
evident  that  there cannot  be enough mercury present to color a large 
MERCURY.
233
passage green or yellow.  Again, analysis of the stools often fails te>
find any mercury unless large doses are given.   Further than this,
we know clinically that when the  stools are clay-like and lacking in
biliary coloring-matter  mercury will restore  the  normal state.  The
conclusion must be reached  that, be the results in  animals what they
may, in man, at least, the  drug does  increase biliary  secretion  and
flow.
   Calomel and blue mass are largely used in the condition known as
biliousness, and undoubtedly give  relief.  (See Biliousness.)   If the
tongue is heavily coated, the breath foul, the  conjunctiva a little icte-
roid, and headache is present, either of them should be employed.   In
remittent malarial fever the  use of small repeated doses of calomel will
often bring relief from the  vomiting, and it should always be given in
the treatment of malarial disease before quinine is used, if a thorough
action of the antiperiodic is required.
   The disinfectant and germicidal power of bichloride of mercury and
of the biniodide are very well established by clinical experience and
experimental investigation.   The strength of the bichloride in solu-
tion  for antiseptic purposes  may vary from  1 to 2000 to 1 to 20,000
of water, and  for disinfectant use  from 1 to 500 to 1 to 1000.   (See
Antiseptics.)
    In using the bichloride of mercury as an antiseptic it is necessary to
 add a few grains of tartaric acid to the solution  to prevent its uniting
 with the albumin of  the  tissues to form  au insoluble  and  useless
 albuminate.   The same is true of the mercury biniodide.
    The antiphlogistic or  anti-inflammatory action of  mercury is very
 marked indeed,  but  its employment is absolutely limited under these
 circumstances to  one variety of inflammation, namely, the sthenic  or
 dynamic form.   In  inflammation  arising during the course of  some
 exhausting disease mercury is not only contra-indicated, but harmful.
 Thus, if a man  in health is stricken with  pleurisy or peritonitis or
 meningitis, or any acute  inflammation of a  serous membrane, be the
 cause what it may, the exudate poured out will probably be fibrinous,
 and capable of undergoing  organization, thereby causing  adhesions of
 the pleural surfaces,  of the intestines, or of the meninges of the brain.
 On  the other hand, if a man be taken  with pleurisy or meningitis
 during the  course of  phthisis or typhoid fever, the exudate will be
 serous and  large in quantity.  It is in the first case that mercury
 should be used, to prevent the fibrinous exudate or to make it serous.
 In the second instance it will do harm by increasing the exudation.
    When  given as an antiphlogistic the drug is often combined with
 opium to  relieve the pain and irritation  and to prevent purging.  In
 meningitis arising from head injuries this is  the routine treatment and
 may be carried out by the use of powders containing ^ grain of calomel
 and i grain of powdered opium every hour  till 1 or 1| grains of each
 are taken.   The simultaneous use of the ice-bag to the head and perfect
 quiet will often bring relief very rapidly.
    Mercury is also the best remedy in  sthenic endocarditis, aud should
 be given in full dose.  The bichloride may be used  in small doses in 
234
DRUGS.
place of the calomel, and  does  not, of course, produce the same ten-
dency to laxity of the  bowels.   At the same time it often seems to be
less efficacious.
  Mercury  iu myocarditis  and pericarditis is also of service, and
certainly exerts distinct prophylactic  power in  the early  stages  of
diphtheria and membranous croup.  (See Diphtheria.)
  Leaving the general subject of mercury, we may now consider each
individual preparation.

                    Ammoniated Mercury.

  White Precipitate or Ammoniated Mercury (Hydrargyrum Ammonia-
turn, U. 8. and B. P.) is used in an ointment (Unguentum Hydrargyri
Ammoniati, U 8. and B. P.) in various skin  affections.  It should
generally be diluted with lard.
  In ozena,  whether syphilitic or not, Trousseau has recommended
the employment of the following powder as a snuff:

         R.—Hydrargyri ammoniati .....  gr. iv.
             Pulv. sacchar. alb......3ss.    M.
    S.—To be used as a snuff, after thoroughly blowing the nose.

  The Red Precipitate may be used instead of the white.  This treat-
ment removes the stench and may cure the complaint.  It may, however,
irritate the mucous membrane, in which case it should be used in the
strength of 2 grains to the J ounce.  It is never used internally.


                   Bichloride of Mercury.

  The Bichloride of Mercury, or Corrosive Sublimate (Hydrargyrum
Chloridum Corrosivum, U 8., Hydrargyri Perchloridum, B. P.) as it is
called, is an exceedingly poisonous and irritating substance when taken
in concentrated form.
  Taken internally, it  causes violent pain in the stomach, vomiting,
purging of mucus,  blood,  and the conteuts of the intestine, collapse,
syncope, and  death.  If taken in poisonous amount the patient should
be made to swallow large amounts of the  antidote, white of egg, the
stomach should be washed out with the stomach-pump, heat should be
applied about the  body, and the proper stimulants be given  if the
pulse or respiration fail.   If death does  not  occur at once the patient
generally has a protracted convalescence or else  dies from the organic
changes produced in  the  gastro-intestinal tract,  such as strictures,
sloughs, destruction of the peptic glands and ulcerations.
  The bichloride of mercury is an exceedingly useful preparation of
mercury for hypodermic  injection  in  syphilis  and is  better than
calomel for this purpose.  About -fa grain may be injected deeply and
gently into the  cellular tissues  every two  or three days.  When the
injections are made the greatest possible cleanliness should be obtained.
The needle should be aseptic and the hands  of the operator well dis- 
MERCURY.
235
infected.  The best place for the injection is in the gluteal region or
between the shoulder-blades.
   Mercury bichloride, aside from its antiseptic use (see Antiseptics),
is of great value  when given internally, not only in syphilis, but in
other states  not associated with any  such depraved  condition.  In
diphtheria it may be used to prevent fibrinous exudation as readily as
calomel (see Diphtheria), and  in tonsillitis, where the inflammation is
severe, it  is often used with great service.
   When  using a solution of bichloride of mercury as au antiseptic,
tartaric acid should be added to the solution  to prevent the precipita-
tion of the mercury in the form of an albuminate.
   In  small amouuts, that is in fa to T7 of a grain three times a day,
the bichloride is one of the best remedies  which we  possess  for  the
treatment of anemia, be its cause what it may.
   Bichloride of mercury is of value in minute doses of -fa^ to fa of
a grain in the ill-smelling green stools of summer diarrheas in adults
and children, and  it has been  recommended that a solution be made
of \ a grain in 5 ounces of water and a teaspoonful given every hour
until  relief  is obtained.  The water used in  making  the  solution
should be distilled, and it may be well to add  to it a little tartaric acid
to prevent  precipitation of the  bichloride by organic  matter which
may have gotten into the water.   This  treatment is particularly useful
in mucous diarrhea, in which blood and mucus are thoroughly  mixed.
Patients in the dispensaries often speak of these passages as contain-
ing " corruption," and others  think they consist of  " lumps of flesh,"
owing to the  masses  of blood and mucus.  Whether the disease be
acute or chronic, the bichloride, used in the way just described, will be
found of  service.   In dysentery and the diarrhea of adults the same
treatment may be resorted to,  using two teaspoonfuls  of the solution
instead of one.  It is hardly  necessary to  add that the greatest care
must be bestowed upon the diet and clothing.   The author has treated
a child  suffering from  persistent diarrhoea for months  with varying
success, only to succeed when, it being found that  the  abdomen was
exposed to the air, the  mother  was forced to apply aud keep on  the
child a flannel binder.
   In some cases in which an obstinate syphiloderm  is present, half an
ounce of corrosive sublimate and one ounce of chloride of ammonium
may be added to a warm bath which should be taken every few days.
   Half a grain of the bichloride of mercury in  six ounces of water
is said to  be most efficient as an  injection in gleet, if used every three
or four hours.   (See Gonorrhoea.)
   In  all  parasitic affections  of the skin a  solution of 2 grains  of
bichloride to the ounce of water may be sopped on the part three times
a  day.  A  solution of perchloride of  mercury  (Liquor Hydrargyri
Perchloridi) is official in the B. P.; it is prepared   by adding \ grain
of the perchloride of mercury to 1 ounce of water, with \ grain  of
ammonium chloride to hold it in solution.   (For the antiseptic uses of
the bichloride of mercury, see Antiseptics  and Disinfectants.) 
236
DRUGS.
                    Biniodide  of Mercury.

  Mercury Biniodide (Hydrargyri Iodidum Rubrum, U. 8. and B. P.)
is a bright-red powder, possessing irritating powers  equal to or above
those of the  bichloride, and causing symptoms when taken in over-
dose closely resembling those produced by the latter drug.   Owing to
the formation of the salt it is thought to be particularly useful in the
later stages of syphilis.  The dose is fa to fa of a grain.  (See Syphilis.)
Au ointment ( Unguentum Hydrargyi Iodidi Rubri, B. P.) is useful as
an application in goitre and obstinate skin diseases.
  At one time it was thought that  biniodide of mercury was a better
antiseptic than the bichloride, but recent researches  have proved that
this is not a fact.
                         Black Wash.

  Black Wash (Lotio Hydrargyri Nigra, B. P.) is  made  by adding
1 drachm of  calomel to a pint  of lime-water.  It is used  for  wash-
ing syphilitic sores and wounds, and in various forms of eczema.

                          Blue Mass.

  Blue  Mass (Massa Hydrargyri,  U. S., Pilula Hydrargyri, B.  P.)
is made  by rubbing up  metallic  mercury  with liquorice  and other
excipients, and is often called  Blue Pill.   Each grain of the mass
contains ^  grain  of mercury,  and it may  be given in the  dose of
from J to 20 grains, for the same laxative purposes  for  which we use
calomel. Blue Mass is rarely used to produce systemic effects.

                            Calomel.

  Calomel Hydrargyri Chloridum Mite,  U.  S., Hydrargyri Subchlor-
idum, B. P.), or the Mild Chloride  of Mercury, is  an  insoluble  salt
which is nevertheless freely absorbed.  Some have taught that it enters
into the body as a bichloride, being  changed into this salt by  the acid
of the stomach, but practically this does  not occur.   Calomel on pass-
ing into the intestines is changed by the  alkaline juices there present
into the black or gray oxide of  mercury.
  Calomel when used as a laxative  purge should be given  in the dose
of ^ to  J grain every half-hour  or every fifteen minutes until 1 or  2
grains are taken, as it will act as efficiently in this way as if 10 grains
are given at one dose, and there is no danger of producing ptyalism.
The reason that small doses  are  as efficient as large ones lies in the
fact, that only the calomel which is changed into the gray oxide is
active, and as the amount of alkaline juice  in  the intestine is  small,
only a minor part of a  large dose of calomel acts, the major portion
escaping unchanged.  This is the reason that  bicarbonate of sodium
is added to calomel'powders, to  aid  the  intestinal juice  in the reduc-
tion of  the salt.   If purgation  does not  occur after a dose of  calomel,
a saline purge may  be given at  the end of twenty-four hours,  and  this 
MERCURY.                        237
 must always be used if large doses of the mercurial are employed, to
 avoid possible mecurialization.
   Mercury in the form of calomel is very largely used hypodermically,
 being held in solution by a mucilage, or better still by fluid cosmoline.
 Best of all, however, is the employment of chloride of sodium in water
 with the calomel in the proportion of 5 parts each to 50 parts of water.
 Itshould be injected deeply into the tissues, not immediately underneath
 the skin, the greatest cleanliness  being  necessary to avoid abscesses.
 The best place for these injections is in the fold of  the buttocks, but
 sloughing, tetanus,  and even  gangrene, has followed its employment
 in this way.   (See Salicylate of Mercury.)
   In dysentery of the acute form calomel and ipecac are the two best ■
 remedies.  (See Dysentery and Ipecac.)   The calomel should be given
 in small doses repeated every hour or half-hour until a favorable change
 in the number and character of the stools appears.   Calomel is not to
 be used if great asthenia complicates the disease.
   In children who  seem constantly " under the weather " and  never
 quite  well, who have flatulence, fetid breath and ill-smelling,  pasty
 stools, calomel often gives great relief in the dose of fa of a grain every
 half-hour  until four doses  are taken, this treatment being pursued
 every fourth or fifth morning.
   In jaundice due to exposure to cold and to slight hepatic congestion
 i of a grain  of calomel  every half-hour until J grain is taken will
 often bring relief.
   Calomel is  generally prescribed in conjunction with sugar of milk,
 white sugar, or bicarbonate  of sodium, which are added to increase
 the bulk and  wieldiness of the powder, and, in  the case  of the latter
 ingredient, to  increase its activity.   Owing to its  lack of  taste, calo-
 mel is often  placed on  the  tongue in children, but in this instance
 white sugar is to be used, iu small quantity, as the other vehicles  are
 less agreeable.   The most agreeable form of administration  is in tritu-
 rates.
   It  is important to remember that calomel, when used as  an anti-
 syphilitic, produces salivation very much earlier than the  other mer-
 curials.
   A very important use of calomel, and  one which has been brought
 forward very  recently as new, but  which  is really many years old, is
 its employment in dropsy as a diuretic, either alone or combined with
 squills  or  digitalis, or with  opium to  prevent purging.  The dose is
 small, about 1 grain thrice a day, and if a  diuretic influence does  not
assert  itself in twenty-four hours it should uot  be continued.  Still
 another use of calomel is in typhoid fever, in which disease it has been
 highly recommended in small repeated doses, particularly if constipa-
tion is present.  In the opinion of the author this is disadvantageous
as a routine measure aud entirely uncalled-for.
   Sydney Ringer has called  attention to the fact that in  constipation
or in " biliousness "  podophyllin does more good  than calomel pro-
vided that the stools are dark in color, whereas if the same signs  are
present but the stools light and clayey in color  calomel is  more effi- 
238
DRUGS.
cient.  The  author has  proved the correctness of this  assertion so
frequently that he is convinced of its truth.
   Calomel has been  recommeuded in the condition  of anorexia and
depression following  acute diseases, and, when  the tongue is covered
by a thick yellow coat, it is the remedy for the gastro-intestinal torpor
always present.  While  purgative doses of calomel  certainly are of
value, the use of freshly prepared nitro-muriatic acid is, however,
highly preferable to the mercurial salt in many such instances.
   Calomel is often given in small  doses  to "settle  the  stomach."
Sometimes it will  act in  this way, but in other cases it will  seem to
increase  the  nausea and  bring on vomiting.  This  is true  of  both
adults and children, and it is impossible  to tell beforehand which will
occur.  In a peculiar form of vomiting occurring in very young chil-
dren, which  comes  on immediately after the food is swallowed, the
rejection of milk being forcible and perhaps so sudden that it is not
even curdled, and which is not accompanied by much straining, calomel
will often give relief when all other remedies fail.  It should not be
resorted to until some evidences of wasting occur, as this action of the
stomach in many children only rids that organ of that part of the milk
which is in excess,  and  is a purely physiological regurgitation.   The
calomel may be  given in the dose of -fa of a grain every hour, or, if
preferred, gray powder  in the dose of ^  of  a  grain every hour for 3
doses is equally efficient in these cases.
   Calomel will often remove syphilitic  condylomata if dusted over them
for some time, and an ointment made  of one drachm of calomel to one
ounce of lard is very useful in pruritus.
   Calomel ointment  (Unguentum Hydrargyri Subchloridi, B. P.) is
often  useful in the treatment of small patches of eczema, or the follow-
ing prescription may be given for its use :
         R.—Hydrarg. chlor. mit. .    .     .   .    .  gr. xl.
             Magnesise carbonatis .....  gr. xl.
             Unguent, aquae rosae  .....  Jj.     M.

                     Mercury with Chalk.

   Mercury with Chalk  (Hydrargyrum cum Creta, U. 8. and B. P.), or
Gray  Powder, is slightly purgative,  but is chiefly employed  in the
treatment of infantile syphilis, as it will not freely purge.   It  is com-
posed of 38 parts of mercury, 12 parts of sugar of milk and 50 parts
of prepared  chalk.  The dose is 1  to 10 grains.  Children suffering
from syphilitic marasmus seem fairly to  fatten on it.   This prepara-
tion is also of service in adults, and  may be employed whenever the
laxative effect of mercury is not desired.
   In the treatment of infantile diarrhoea with watery, colorless stools
containing undigested food, gray powder in small doses is often very
useful.
                      Mercury Ointment.

  The Ointment of Mercury, Mercurial Ointment (Unguentum Hy-
drargyri,  U  S. and B. P.), sometimes called Blue Ointment, is  made 
MERCURY.
239
by rubbing up mercury with suet aud  lard until it is extinguished—
or, in other words, until the globules of mercury cannot be seen with
a magnifying power of 10 diameters.
  The ointment of  mercury is used externally in certain skin affec-
tions, and for the purpose of influencing the general system iu cases
where the drug cannot well  be taken by the mouth. In syphilis where
a mercurial  effect  is to be  reached, the ointment in small amounts
should be thoroughly rubbed into the skin in various parts of the body,
one evening in the  left groin, the next  in the  right groin, the next
evening in the left axilla aud the  fourth evening in the right  axilla,
beginning on the fifth evening in the left groin once more.  This avoids
local irritation of the skin by means of too frequent applications, places
the drug on spots where  it  is  readily absorbed, and very rapidly in-
fluences the system of the patient.  Iu infantile syphilis this  method
may be employed, or a flannel  binder covered with the ointment may
be placed about the belly.   The clothes should not be changed  too fre-
quently, as their saturation with the drug aids in producing the im-
pression upon the  system, and  the wearing of an undershirt saturated
with the ointment  after a few  days' wear, is a very valuable, though
somewhat dirty, method of producing  mercurialization.  The ointment
of mercury is sometimes  rubbed into the skin over enlarged  glands.
Under the name of oleate of mercury (Oleatum Hydrargyri, U. S. and
B. P.) a very efficient and more agreeable application  than the oiut-
ment, is used  in the same  manner, or still further diluted with lard.
It is made from the yellow oxide of mercury.  (See Oxides of Mercury.)
   For pediculus pubis, or in any case where parasites, such as the flea or
louse, infest the region of the genitals, or any spot covered by a hairy
growth, mercurial ointment  may be used as a remedy owing to its lethal
influence over these troublesome pests.   Care should be taken that it
does not cause salivation of the patient, and it must not be allowed to
remain on the parts, but be wiped off in the course of an hour or two,
or less.  The following words from the  pen  of  Dr. Joseph Leidy are
sufficiently interesting to  demand a place at this juncture : " We may
here say that  if it is once understood  that all  insects, including lice,
are destroyed .quickly by the application of any fixed  or volatile  oil,
physicians will see there  is  no necessity of employing remedies of a
noxious character  to the  patient.   The  fat of mercurial ointment is
probably more active than the  mercurial oxide."
   Mercurial  suppositories (Suppositoria, Hydrargyri, B. P.) are used
when a  mercurial  effect is  desired without the danger of interfering
with  the digestion.
   Linimentum  Hydrargyri, B.  P.,  and  Emplastrum Hydrargyri,
 U. S. and B. P., are used for the same  purposes as  is  the ointment
of mercury.   The plaster is made with olive oil, resin and  lead plas-
ter instead of ordinary suet or  lard.

                      Nitrate of Mercury.

   The Solution of Mercuric Nitrate (Liquor Hydrargyri Nitratis, U 8.
and B. P.), acid nitrate of mercury, is an exceedingly active, pene- 
240
DRUGS.
tratiug caustic, so rapid in its effects that it seems to drop through the
tissues.  It may be employed for the removal of epitheliomata and large
warts, and should be applied by means of a glass rod.  This treatment
may also be  resorted to with advantage in lupus until  the surface of
the growth is level with the skin.  The surrounding parts should be
protected by lard or oil.
   As  this treatment is  very painful, the  spot should afterward  be
covered with flexible collodion.
   Citrine Ointment (Unguentum Hydrargyri Nitratis, U. 8. and B. P.)
is used in chronic skin  diseases of the  scalp and  trunk.  It is  too
strong for ordinary use  and should  be  diluted one-half or less with
lard according  to the  stimulating effect required; the  dilute oint-
ment  is  official in  the B. P. as  Unguentum Hydrargyri Nitratis
Dilutum.

                      Oxides of Mercury.

   The yellow and red Oxide of Mercury (Hydrargyri Oxidum Flavum,
 U. S. and B. P., and Hydrargyri  Oxidum Bubrum, U. 8. and B. P.),
red precipitate, are used largely as a dressing for syphilitic sores when
diluted about one-half with chalk or other powder.   If used pure
they are somewhat caustic.   From the yellow oxide is made the Oleate
of Mercury (Oleatum Hydrargyri, U. S. and B. P.), which is used for
the same purpose as ordinary mercurial ointment.
   In intestinal and gastric indigestion, with foul belching and very ill-
smelling stools which are due to intestinal sepsis, the yellow oxide is
sometimes given in the dose of fa to fa of  a grain in trituration.
   Red Precipitate Ointment (Unguentum  Hydrargyri Oxidi Bubri,
 IT. 8. and B. P.) and the Ointment of the Yellow Oxide (Unguentum
Hydrargyri Oxidi Flavi, U. S.) are largely used, diluted one-half with
lard in chronic, scaly skin affections, in obstinate conjunctivitis and in
granular lids.  (See Styes.)


                    Protiodide of Mercury.

   Mercury Protiodide (Hydrargyri  Iodidum Viride, U. 8.)  is much
more mild than the biniodide and is given  for exactly the same pur-
poses.  The dose is \ to \ of a grain three times a day.  (See Syphilis
for method of administration.)


                Yellow Sulphate of Mercury.

  Hydrargyri Subsulphas  Clavus,  U. S.,  has been used under the
name of Turpeth Mineral as an errhine in chronic ophthalmia, and
also  as a prompt emetic  in croup.   It is a quick  and  certain emetic,
and, it is claimed, does not  produce  depression, but the writer would
recommend great care in its use.   The dose for a two-year-old  child
is 2 to 5  grains repeated in fifteen minutes if necessary. 
METHYLENE CHLORIDE.                241
                         Yellow Wash.

  Yellow Wash (Lotio Hydrargyri Flava, B. P.) is made  by adding
30 grains of corrosive sublimate to a pint of lime-water.  It is used
for  the same purposes as the black wash, but is much  more stimu-
lating.

  Incompatibles.—Bichloride of mercury should never be given with
any other substance  except  iodide of potassium and  chloride of am-
monium, as it  is incompatible with  almost  every other drug.   With
the iodide of potassium it may be used because the precipitate formed
is at once re-dissolved, and the resulting mixture is highly alterative.
  Calomel should never  be given with iodides or bromides, aud hy-
drochloric acid  may convert it into the bichloride if the acid is present
in any amount.

  One of the best ways to employ any of the various forms of mercury
is in the form of triturates which may be prepared by triturating  10
parts of the drug with 90 parts of milk sugar.   The minute subdi-
vision  of the medicament aids  in its efficiency  because of its  more
ready absorption.

                    METHYL CHLORIDE.

  Methyl Chloride is a colorless gas, easily liquefied under pressure,
with an odor resembling that of ether and chloroform, used to produce
local anaesthesia, which it does  by absorbing a large amount of heat
on passing from the liquid to the volatile state.  It is usually kept in
a siphon or in  an ordinary bottle and applied to the skin in a spray,
or better still,  by means of a cotton  tampon which  is laid upon the
skin and then saturated by the spray.
  Under these  circumstances the skin becomes pale in a few seconds,
and  afterward   perfectly  white   aud  parchment-like in appearance.
Local anaesthesia is now complete, and minor surgical operations, such
as opening  boils or abscesses, can be performed without pain.  The
spray should not be continued  more than  2 to 4 minutes, as  local
death of the tissues  may  result   A  great advantage of methyl over
the spray of ether is its slight inflammability and rapidity of action.
Methyl chloride is to be distinctly separated  from methylene chloride.
The first is monochlormethane, the second dichlormethane.


                 METHYLENE CHLORIDE.

  Methylene chloride  is  made  from chloroform  or by the action of
chlorine on marsh gas, and is a colorless liquid resembling chloroform
in odor.  It is  readily decomposed  by light, which process may  be
hindered by the addition of a little absolute alcohol.
                                16 
242                          DRUGS.
  Therapeutics.—It is  employed  as  an anaesthetic in a manner like
chloroform and was introduced as a safe substitute for that drug, but it
is of doubtful safety and is little used.  It has been used as a spray for
the production, of local anicsthesia.  As stated under Methyl  Chloride,
it is not to be  confounded with that  drug.   In England under the
name of methylene chloride or methylene, a mixture of ethyl ether and
and methylene chloride has  been widely  employed.   This prepara-
tion is, of course, to be distinguished from  true methylene chloride.
The amount of this mixture used to  produce anaesthesia  is  1  to  2
drachms  for minor and 3 to 6  drachms for  major operations.  The
term methylene chloride has also been applied to a  mixture of  chloro-
form and methyl chloride.


                         MEZEREUM.

  Mezereum,  U.  S., Mezerei  Cortex, B. P., is the bark of Daphne
Mezereum,  a plant of Asia,  Europe, and Great Britain.  It  is sup-
posed by some to be possessed of  extraordinary alterative  power, but
this is certainly a mistake, as its  influence in this  line is very feeble.
It is never used  internally except in compound  decoction  of sarsa-
parilla.   It is distinctly irritant, and in overdose causes all the symp-
toms  of gastro-enteritis.  Mezereum is so  irritant as to have  been
used externally as  a  counter-irritant  in  the  form of the  ointment
(Unguentum Mezerei).  It enters into  the compound syrup,  fluid ex-
tract, and decoction of sarsaparilla.   The official preparations of meze-
reum are  the  extract (Extractum  Mezerei,  U.  8.), the fluid  extract
(Extractum  Mezerei Fluidum,  U. 8.), and the  ethereal extract (Ex-
tractum Mezerei JEthereum, B. P.), all of which are  used as external
irritants.

                             MUSK.

  Musk  (Moschus, U. S. and B. P.)  is obtained  from the  preputial
follicles of the musk deer of Thibet,  and  is  a substance possessing
the most remarkable  penetrating  powers, so far as odor is concerned.
Very little of the  musk for sale  in  the shops is pure, aud most of it
is not musk at all.  Its price varies very greatly, but  if sold for less
than twenty-five cents a grain it is probably worthless or impure.
  Therapeutics.—For some unknown reason musk acts as a  diffusible
stimulant and supports the system.   It is also an anti-spasmodic and
nervous sedative.   In all low fevers where the strength of  the  patient
is fast ebbing away, and the nervous symptoms are those of  the most
advanced depression, rectal injections of musk in starch-water should
be employed.   The dose should be 5 to 10 grains.   This  drug is  of
value, either where nervous excitement  or nervous collapse  is present,
but is not to be employed until  it is absolutely needed to  carry the
patient past a crisis.  If frequently employed it loses its power and
the expense is a needless one. 
MYRRH.
243
  Musk is one  of the best remedies in obstinate hiccough.   The dose
of the tincture (Tinctura Moschi, U S.) is 30 drops to 1 drachm, ajid of
musk itself 5 to  10 grains.

                          MUSTARD.

  Mustard is official  in  the form of Sinapis Alba, U. S., Sinapis
Albce Semina, B. P., or white mustard, and Sinapis Nigra,  U. S., and
Sinapis Nigre Semina, B. P., or black mustard.  Both of these con-
tain an irritant  oil (Oleum Sinapis  Volatile,  U. S.,  Oleum Sinapis,
B. P.) as their chief active constituent.
  Therapeutics.—Mustard is  often used in the form of mustard flour
as an emetic, when stirred up in  water iu the proportion of a table-
spoonful to a glass of water.  It is also employed as a counter-irritant
and as a condiment.  If given in excessive dose it will cause  violent
gastritis, and chronic gastritis is often set  up by its constant use.  It
is contra-indicated internally during the  existence of acute gastritis
and all similar states.
  When used as a counter-irritant it  is applied to relieve the  pain of
colic due to flatulence and acute inflammation, in muscular  rheumatism
and inflamed joints, and for neuralgia, and it may be applied at the nape
of the neck in cases of headache and cerebral congestion.  When applied
to the skin of an ordinary individual it will produce a bad burn if left
on  more than a  few minutes, and  it should be mixed with wheat flour
in the proportion of half-and-half for tender skins. 'Children generally
will not stand more than  one-fourth mustard.   The plaster should be
made with warm water or vinegar, or  a  little brandy may be  used.
Mustard plaster (Cataplasma Sinapis) is official in the B. P.
   The  scald or  burn produced by mustard is peculiar in its slowness
to heal, and  in  the fact that it is tender and reddened for days.  If
the burning of the mustard becomes excessive it should be treated by
a piece  of lint soaked in  lime-water  and olive oil, half-and-half, or
olive oil alone may be used.
   The oil of mustard is very irritant, and almost epispastic in its effects.
It is given in the treatment of the atonic stomach of drunkards in the
close of I to ^ a drop.   Charta Sinapis, U. S. and B. P., or mustard
papers, are sometimes called sinapisma, and these afford a ready means
of applying this counter-irritant.   They are generally  very strong, and
should  be covered by one or two layers of old and moistened linen to
prevent too  great an action.  (See Counter-irritation.)  The compound
liniment (Linimentum Sinajns Compositum, U. 8. and B.  P.)  is com-
posed of the  oil  of mustard, castor  oil,  extract  of mezereum, and
alcohol.

                            MYRRH.

   Myrrha,  U. 8. and  B. P.,  is a gum  resin obtained from Balsamo-
dendron Myrrha, a tree of Arabia.  It occurs in dark-colored tears,
aud contains an active principle, myrrhin. 
244
DRUGS.
   Therapeutics.—Myrrh, in medicinal amount, is a stimulaut to the
circulation, and to the uterine and the bronchial mucous membranes.
   In amenorrhea due to functional inactivity, or  ancemia, " iron and
myrrh " is a standard remedy.
   The tincture of myrrh, diluted one-half, is  useful in ulcerated sore-
throat as a gargle, and  the  pure tincture is sometimes applied with a
small brush or by the end of the finger, to spongy or tender gums.
   In leucorrhea  depending  upon uterine  trouble,  and  in  chronic
crystitis, myrrh is often of service.   Sometimes it enters into expecto-
rant mixtures given in the later stages of bronchitis.   The dose of the
tincture (Tinctura Myrrhe,  U. S. and B. P.) is  10 to 30 drops.  It
also enters into the  composition of Pilule Aloes et Myrrhe, U S. and
B. P., dose 2 to 5 pills, and Tinctura Aloes et Myrrhe, U. 8. and
B. P., the dose of which is 1 to 2 fluidrachms.


             NAPHTHALAN, or NAPHTALENE.

   Naphthaliu is a coal-tar derivative occurring in colorless mica-like
crystals,  possessing  a  peculiar smell, and soluble  in  alcohol to some
slight extent.  Helbing states that naphthalin when pure is colorless
and without action on moist litmus paper.  It should also dissolve in
concentrated sulphuric acid without color when gently warmed. After
it  is taken for some time, or even after the first dose, the patient will
state that when he belches, the gas has the smell and taste of burning
rubber.
   The drug  possesses distinct antiseptic power,  and  for this  reason
has been employed  in certain gastric and intestinal diseases, associated
with fermentative changes or dependent upon ulceration and organic
lesions.   In fetid diarrhea  it may be given as a deodorant and cure.
   When given to children, as in summer diarrhea, the dose should be
^ to \ grain every 2 or 4 hours, but  adults may take as much as 5 to
10 grains.   More than  this will  disorder the stomach.  The drug
should be given  in powder, in  capsules, or with  sugar.  It has  not
been as widely employed as was expected when it  first came before the
profession, and certainly often fails to do good.
   In cats and rabbits naphthalin when administered continuously for
a considerable period of time may produce cataract.


                NITRATE OF  POTASSIUM.

   Nitre  (Potassii Nitras, U. S. and B. P.), or  Saltpetre, occurs in
long needle-like crystals, and  has a sharp, saline  taste.  Sal Prunella
is  saltpetre melted and run into moulds.
   Next to the chlorate of potassium  this is the most poisonous of the
potassium salts, and produces when taken in  overdose violent  symp-
toms of gastro-enteritis.  While it does not affect  the blood, it is more
irritant than  the chlorate. 
NITRATE OF SILVER.                  245
  Nitrate of potassium is  rarely employed at present, and  has been
very properly put aside  as inferior to the harmless vegetable potas-
sium salts (the citrate,  acetate, and bitartrate).  If used in rheumatism
the dose should be 1 ounce in a pint of barley-water or syrup of acacia
and water, to be taken in divided doses of a tablespoonful every three
hours.   Nitrate of potassium papers (Charta  Potassii Nitratis, U. S.)
are made by dipping  unsized  paper in a solution of the drug of the
strength of 20 parts of the salt to 80  parts of distilled water. * They
are rolled into cigarettes and smoked by asthmatics or burned in a pan
and the fumes arising from them inhaled.
  J. Solis-Cohen thinks that asthmatics are more benefited by smoking
nitrate of  potassium papers than by  any other remedy.   The paper
should be medium thin bibulous paper.  If too thick it gives off too
much heat and gas, if  too thin it does  not hold enough of the  drug.


                    NITRATE OP  SILVER.

  Nitrate of Silver (Argenti Nitras,  U 8. and B. P.) is a heavy, crys-
talline salt of silver, readily soluble  in its own weight of  water.
  It is official as the pure nitrate (Argenti Nitras, U. 8. and B. P.)
and as the sticks or fused rolls (Argenti Nitras Fusus, IT. 8.) or lunar
caustic.  The latter are never used in medicine internally, only the
crystals being employed.   Applied to  the tissues of the body or other
substances it causes a brown and finally a black stain, which is due to
the formation of an oxide  of silver.
  Physiological Action.—Nitrate of silver is one of the few astringent
substances which are applicable to inflamed mucous  membranes, as  it
is, with lead, bismuth, and zinc, the only drug  of the  class which is not
irritant as  well as astringent.   Locally applied it acts in pure form as
a powerful caustic, which  is, however, very superficial  indeed, as the
drug coagulates the albumin with which it comes in contact and thereby
forms a coat which protects the tissues beneath.
  The action of the drug upon the circulation, respiration, and  similar
vital functions is  only partly known  and has no relation to its employ-
ment iu medicine.
  Nitrate of silver is eliminated from  the system very slowly indeed.
  Poisoning.—Almost immediately after the  ingestion of a poisonous
dose of nitrate of silver, violent pain  iu the belly, with vomiting and
purging, conies on.   At the same time  evidences of widespread  gastro-
enteritis develop.  The  abdominal  walls  are knotted aud hard, and
perhaps scaphoid.  The face is anxious and livid and covered with a
sweat.   When the vomiting occurs, the ejecta are seen to be  brown or
blackish or even white and curdy.  The lips are stained white, then
brown, then black.  In  some cases  the nervous symptoms are severe
and convulsions with delirium may occur.  The convulsions are epi-
leptiform.  Death ensues either from  gastro-enteritis or from  centric
respiratory failure accompanied by a profuse exudation of liquid mucus
into the bronchial tubes. 
246
DRUGS.
  The treatment consists in the use  of common salt, which is the
chemical antidote, the employment of opium and oils to allay irrita-
tion, and  in  the ingestion of large draughts of milk and of soap and
water for the purpose of diluting the poison aud protecting the  mucous
membranes of the  oesophagus and stomach from the action of the
irritant.   The bodily heat must be maintained.
  Chronic Poisoning.—This is a form of poisoning quite  frequently
seen.   The most prominent symptom  is the  pale slate-blue color of
the skin which causes  the  individual to be most  livid and death-like
in appearance.
  Argyria, as chronic silver poisoning is called, is caused  by the con-
tinued employment  of the  drug until  it is deposited in the  tissues.
It is  then found in every part of the body.   The first signs  of dis-
coloration can generally be seen in a darkening of the conjunctiva over
the sclerotic coat of the eye, or in  a dark  line on  the inner  part of
the lips.
  The treatment of  argyria is  not hopeful so far as  the color of the
skin is concerned, but it may be improved by the  use of iodide of
potassium to  aid in'the elimination of the poison.
  Therapeutics.—Internally this salt  is  used as a  cure  for gastric
ulcer, and it is certainly the best remedy we possess  if combined with
extract of hyoscyamus or  opium in pill  form.   In  chronic gastric
catarrh and gastritis nitrate of silver is very useful,  when the  patient
is troubled with sour eructations  or  when vomiting occurs after meals.
When used in these states it should  be given in ^ to \ grain doses, half
to one hour before each meal, in  order  that  the  stomach may be ex-
posed to its effects and not be protected  by food.
  In intestinal ulceration the drug has  been highly recommended by
Dr. Pepper, and under these circumstances should be given in  hard or
keratin-coated pills in order that it may escape through the stomach
without being chemically changed.   In ulceration of the cecum and
rectum and in acute and chronic dysentery the disease should be attacked
by injections of nitrate of silver.  If the caecum is involved the solu-
tion must be in large quantity in order to reach the part affected, but
if the rectum is diseased the amount of  liquid injected should not ex-
ceed four ounces, the bowel in  either case being; washed out before-
hand by warm water to rid it of faeces.  Soap and water and  salt and
water must not be used for this purpose, as the soap  which remains iu
the bowel will prevent the silver salt from acting. The strength of the
solution employed shouid be 1 drachm to three pints of water in caecal
trouble, and  3 grains  to each  four  ounces in rectal trouble.   If the
latter  condition is very obstinate  and  chronic, the  strength  may be
raised to 5 grains to each four ounces.
   Whenever nitrate of silver injections are used in this way a  solution
of  salt and water should be made,  ready for use, and injected if the
action is too  severe, or as soon as it is thought that the drug has acted
with sufficient thoroughness.
   Nitrate of silver is the only remedy of any value in idiopathic ante-
rior and posterior spinal sclerosis, but often fails. 
NITRATE OF SILVER.
247
  Nitrate of silver has been largely used iu epilepsy and chorea, but is
now seldom so employed, aud does little good in most cases.
  Dr. William Pepper speaks highly of the continual  administration
of nitrate of silver iu pill form in the dose of \ to \ grain through the
entire attack of typhoid fever, and believes it greatly modifies the severity
of the disease.
  Externally nitrate of silver is used for many purposes, and will often
prevent the pitting of smallpox,  if on the fourth or fifth day the vesi-
cles are punctured by a needle dipped in a solution of nitrate of silver
in the  strength of 20 grains to the ounce of water.   Others simply
paint the skin over the eruption with a solution  of 5 to 10  grains to
the ounce, claiming that  this method is equally effective and prevents
inflammation and suppuration.
  Higginbottom has highly recommended the use of nitrate of silver
over erysipelatous inflammations, but the practice is not often resorted
to, and  is now supplanted by better measures.   (See Erysipelas.)   In
other inflammations of a  superficial character nitrate of silver is of great
value.   Paiuted in strong solution over the scrotum iu the early stages
of orchitis or  epididymitis it will often relieve the pain and swelling,
and felons can sometimes be aborted  by its early application over the
surface  of the finger.
  In all inflammations of the pharynx, larynx, fauces, and mouth, solu-
tions of silver nitrate are to be used in varying strength.  Sometimes
after slight exposure to cold or dampness the posterior wall of the
pharynx suddenly becomes sore and raw, feeling as if the mucous mem-
brane had  been scarified.  A solution of nitrate of silver will relieve
this, and if it is employed in the strength of 60 grains to the ounce of
water the application will be more efficacious and less painful than if
weaker  solutions are employed.
  In laryngeal phthisis a spray used from an atomizer in the strength
of h to  2 grains to the ounce of water may do good service.
  In whooping-cough Ringer recommends the use of a  spray in  the
strength given above for the purpose of relieving the  cough  in its vio-
lence aud frequency and  of obtaining a good night's rest.  The appli-
cations should be made when the stomach is empty, as they  are apt to
bring on retching. The end of the atomizer must be within  the mouth
or the skin of the face will be stained.
  In the later subacute stages of gonorrhea an injection of nitrate of
silver of the strength of  2 to 4 grains to the ounce is very useful.
  In uterine ulceration and  in leucorrhea, when the cervix is boggy
and teuder, the application of the solid nitrate of silver  stick is of ser-
vice.  Its use is often followed by headache about the vertex, and this
in turn  is to be relieved by 10-grain doses of the bromides.
  In pruritus pudendi, ani, and vulve a solution of 4 to  6 grains to the
ounce should be  painted with a camel's-hair  brush over the parts to
relieve the itching.  The application is to be made from  two to four
times a  day.
  Bed-sores may be aborted  if, as soon as the skin reddens,  a solution 
248
DRUGS.
of nitrate of silver of the strength of 20 grains to the ounce is applied
with a brush to the part.   This measure fails in paralytics.
   Boils which begin in a small limited papule with a  surrounding
area of inflammation may be aborted  by the use of a strong solution
of this salt.
   In granular lids, conjunctivitis, and  similar affections about the eye
the use of the nitrate of silver  in stick form or in solution is largely
and successfully  employed.   (See Conjunctivitis.)
   When it is desired to remove nitrate of silver stains they should be
washed with  a solution made  of cyanide of potassium  2J drachms,
iodine 15 grains, and water 3 ounces.
   Administration.—The dose of nitrate of silver is ^ to ^ of a grain
in pill form.  Mitigated  caustic, or diluted  nitrate of silver (Argenti
Nitras Dilutus, U. 8., Argenti et Potassii Nitras, B. P.), is composed of
equal parts of nitrate of silver and  potassium nitrate, and is used as a
mild caustic.
   The drug when given  continuously for a long time should bedis-
continued for four or fiye days  at the end of the second week, as  it is
so slowly eliminated as to accumulate in the body and cause argyria.
                        NITRIC ACID.

  Nitric acid (Acidum Nitricum, U 8. and B. P.), the strongest and
most corrosive of the mineral acids, is  a clear  liquid, becoming slightly
yellow with age, which acts, when  in pure form, upon the tissues of
the body as a powerful caustic.  Applied  to  the  mucous  membranes,
well diluted, it acts as an irritant or astringent, and when taken inter-
nally exerts a stimulating  influence over the secretory glands of the
stomach and small intestines.
  It does not tend to relax the bowels as does nitro-hydrochloric acid.
  Poisoning.—When nitric acid is taken  in concentrated  form it pro-
duces a widespread gastro-enteritis, great pain in the mouth, oesophagus
and abdomen, and  finally  death, from  the inflammation induced, or
from collapse.   If the patient survives the  acute stages  he may die
from secondary changes in the stomach and bowels, such as stricture
or destruction  of the peptic tubules.  The  stain made by the acid about
the mouth and clothes is deep  lemon yellow.   Renal irritation is often
a severe symptom, and the passages  from the bowels and the urine
may be bloody.
  The antidotes are  any alkali of a  mild type, as magnesium, chalk,
or whitewash from the walls  of the room  ; the use of oils and opium
to relieve irritation, and the proper maintenance of bodily heat.
  Therapeutics.—Nitric acid is used externally in medicine as a caustic
for chancres and chancroids, the surrounding tissues being  protected by
oils or ointments.
  It may also be used on warts, in cases of gangrene to destroy the tis-
sues, and on phagedenic ulcers.   Whenever the acid is to be applied for
such purposes  a solution of soap and  water should be at hand to neu- 
NITRITE  OF  POTASSIUM.
249
tralize its effects as soon as it has acted  deeply enough.  Nitric acid is
also used externally in a dilute form, 5 to 30 drops to the ounce, as a
stimulant and astringent  to indolent ulcers.   Internally, nitric acid is
used as a tonic and astringent   In the oxalic acid diathesis when
oxaluria is present, nitric acid will give relief when nitro-muriatic acid
cannot be obtained, although the latter is far preferable.   When small
ulcers exist in the mouth, or stomatitis is present, 3 drops of nitric acid
at a dose, in water, will often be of service,  but it should  be taken
through a tube to protect  the teeth.  In gastric indigestion,  in which,
soon after a meal,  sour food regurgitates into the mouth, a few drops
of nitric acid will often give relief.  In intestinal dyspepsia coming on
some  hours after  meals, and  in  which  not  only discomfort but pain
may be felt in the hypochondrium, nitric acid with some simple bitter
tonic  is most efficient, and it  will often cure the green  diarrhea of
children, particularly in the  summer,  bringing about these changes
not only by its astringent power, but also by its stimulating effect on
the intestinal glands.   Combined with some good pepsin it will give
relief in the chronic diarrhea of children associated with lientery, and
in which the stools may be pasty or watery and at the same time
ill-smelling.
   Ringer recommends the employment of nitric acid in the treatment
of piles.  The strong acid should be used and simply touched to one or
two points, not swept over the whole surface.  The pain is very slight,
or none at all may be felt.   A slough results, and finally comes away
leaving a cicatrix which as  it contracts diminishes the size of the pile.
   The same author also states that a lotion of dilute nitric acid in the
proportion of  \ to 1 drachm to a pint of water  is  of service in
bleeding hemorrhoids, arresting the bleeding, constringing the parts,
and relieving the sensation of weight and fulness so often a pressing
symptom.
   The  dose of dilute  nitric acid (Acidum Nitricum Dilutum,  U.  S.
and B. P.) is 3 to 15 drops well diluted and taken through a  tube,
to protect the teeth.


                  NITRITE  OF POTASSIUM.

   Nitrite of Potassium is  a salt  used  largely in modern  medicine to
take the place of nitrite of amyl, but it possesses greater stability, and
is, therefore, more permanent in its effects.  It is used for the relief of
angina pectoris or heart-pang, in the treatment of gastralgia and even
in epilepsy.   The  dose  is  from  3 to 5 grains, although  much larger
doses have been employed.  These larger  doses are,  however,-not
devoid  of danger.   Nitrite of potassium is eliminated  by  the  lungs
and by the kidneys as a nitrate.

                Cobalto-nitrite of  Potassium.

   This preparation has been suggested and tried successfully as a sub-
stitute for the nitrite of potassium.  As it is a more stable compound 
250
DRUGS.
it is less rapidly broken up iu the system, and so exercises a more pro-
longed  influence.   For this  reason it does not act so vigorously or
suddenly, which is a great advantage in some cases. Its use is identical
with that of the rest of the nitrite group.  The dose of cobalto-nitrite
of potassium is \ grain every three hours.


                      NITRO-GLYCERIN.

  Nitro-glycerin is a compound which, in its pure  state, is used largely
as au  explosive, but it is employed in medicine in a dilute form, as a
useful  drug in those instances where a somewhat rapid and  powerful
effect is to be exercised over the vascular system.  Its physiological
action  is  identical  with that of the other nitrites, such as the amyl
nitrite, except that  it is not so fugacious as the latter, nor so persistent
in its effects as the nitrites of sodium and potassium.  The dose is 1 to
2 drops of a 1  per  cent, solution in a little water or in a pill, and no
more than this  may be employed at one dose unless the patient  takes
the  remedy for  a considerable period of time,  when  as  much as 10
drops may be administered.   The drug is largely  employed in angina
pectoris,  and sometimes in  epilepsy and  chorea  and in gastralgia.
Da Costa and others have highly recommended  this drug in the treat-
ment of chronic parenchymatous nephritis,  as  it very distinctly de-
creases  the escajie  of albumin from the  kidneys.   Iu interstitial
nephritis, with  cardiac disturbance resulting from the renal changes, in
which there is a marked increase in arterial pressure, so that  ausculta-
tion reveals at the second right costal cartilage an accentuated second
sound due to  the forcible closure of the aortic leaflets, nitro-glycerin
often produces  a good effect by reducing the pressure aud relieving the
heart of strain.   When attacks of angina pectoris seem to be accom-
panied or preceded by  marked  vascular  spasm nitro-glycerin is also
indicated.   In  cases of asthma  dependent upon  engorgement of the
mucous membranes of the bronchial tubes it is very serviceable.  The
solution  used in medicine is too weak  to be explosive.  Tablets of
nitro-glycerin (Tabelle Nitro-glycerini, B. P.) each contain  Tfa of a
grain.   Nitro-glycerin is sometimes called trinitriue or glonoin.


              NITRO-HYDROCHLORIC ACID.

  Nitro-hydrochloric Acid (Acidum Nitro-hydrochloricum, U.  S.) is a
liquid giving off a distinct odor, and possessed of a very caustic power,
staining the tissues of the body a light yellow.   It is official in the
form of the dilute acid (Acidum  Nitro-hydrochloricum Dilutum,  U. 8.
and B. P.) which is often lemon-yellow, in which case it is useless ex-
cept as an ordinary acid. According to the U. 8. P. it  must be orange-
yellow.  When we wish to use the acid for its own peculiar effects, the
official dilute acid ought always to be supplanted by the freshly mixed
strong acid and be  of an orange color.   If this cannot be obtained the 
NITR0-HYDR0CHL0RIC  ACID.
251
physician should prepare the compound for himself by adding 4 parts
of medicinally pure nitric acid to 16 parts of hydrochloric acid, and
allowing the mixture to stand in an open bottle  until the  fumes are
no longer given off in  excess, when it must be tightly corked and
kept in a dark place.  This acid ought to be freshly prenared every
few days.
  Poisoning.—The symptoms  caused  by poisonous doses are those of
violent gastro-enteritis with vomiting and purging of bloody matters.
Death may  occur from  perforation of  the  alimentary canal, from in-
flammation  of the abdominal  viscera, and from destruction of  the
peptic  tubules  or  constrictions of the  oesophagus  or  bowel.  The
treatment consists  in the use of alkalies  such  as magnesium, lime,
whitewash,  soap, and oils, with opium  to allay irritation.   The use of
external heat to prevent collapse is also to be resorted to.
  Therapeutics.—Nitro-hydrochloric acid is  an invaluable remedy in
many cases  of indigestion  arising either in the stomach or bowels, as
it acts as a tonic and stimulant to secretion   Upon  the  biliary flow
its action is quite marked, and  it may even  cause bilious purging if
pushed to any extent.  It is therefore largely used in hepatic torpor,
either  acute or chrome, and  in the early stages of hepatic cirrhosis
should always be resorted  to.   In the chronic hep>atitis of hot climates
it is exceedingly useful, but  it  is not to be employed in acute sthenic
hepatitis, as it is a stimulant to the liver, which, under these conditions,
needs quieting.   When  used in chronic hepatitis,  it should be given in
full  dose and  pushed to its physiological limit, as  evidenced  by the
bilious  purging produced, or by signs of gastro-intestinal irritation.
   A useful additional means for obtaining the beneficial effects of this
acid is to use it by means of the foot-bath or general bath.   As used
by Johnson in India, the acid for this  bath is prepared by slowly and
carefully adding together 2 parts of nitric acid, 3  parts of hydrochloric
acid, and after twenty minutes mix carefully with these distilled water
5 parts.   For the general bath  (in a wooden tub) take 5  pailfuls of
water, 64 fluidounces of the acid mixture, and enough boiling water to
raise the temperature to  98°.   Keep the patient  in  the bath twenty
minutes.  Then rub him thoroughly with warm towels and place him
in a dry, warm bed.  For the foot-bath add 6 ounces of the acid to 2
gallons of water at  98°  and bathe the thighs and calves of the legs for
twenty  minutes with a sponge  wet with the mixture.  This is a very
useful treatment according to Stillefor cases of alcoholic hepatic torpor.
If in either  case the skin becomes irritated less acid is to  be used.
  In ordinary  so called biliousness, which  is not biliousness, but in-
testinal indigestion, this acid is often of great service.  (See Indiges-
tion  aud Biliousness.)    It  is  also of value in  dysenteric  diarrhea
where the dyseutery rests  upon defective  secretory action ou the part
of the glands  which pour out the proper fluids for digestion.  In
chronic diarrhea its persistent  use for a week or two should be tried.
  Administration.—The strong freshly mixed acid should be given to
the adult in the dose  of 1 to 3 drops  three times  a day, well diluted,
and taken through a tube after meals.   If the patient is intelligent he 
252
DRUGS.
should be ordered \ ounce of the pure  acid and told how to drop it.
If he is not, the physiciau must order it partly or entirely diluted in
the prescription, and in so small au  amount  that  it may be renewed
before it loses any  of its power.  Warning should  be given of its
effects on any clothes with which it may come in contact, and care
should be taken  that  the bottle is held some distance away from the
face when  the cork is withdrawn, as the acid, if it  is fresh, may fly
out aud burn the eyes  and face.


                      NITROUS  OXIDE.

  This gas  is  obtained by a complicated process  which requires the
use of such cumbersome apparatus that  its manufacture is out of the
question for the ordinary  practitioner of medicine, and the fact that
several  large firms prepare the gas  and sell it in cylinders ready for
use renders its preparation on a small scale unnecessary.  The gas is
devoid of odor but possesses a slightly sweet taste.
  Physiological Action.—Owing to the symptoms sometimes produced
in patients  inhaling this gas,  it  has received the popular name of
" laughing gas,"  but a condition of hilarity  is rarely seen  when the
inhalations are full  and deep, and only comes on in  the  majority of
cases where the gas is taken in small amounts or very slowly.  When
used properly, the patient is directed to take long deep inspirations
from the tube placed in  the mouth,  the  nose being  held so that the
nostrils are closed.   Under these circumstances the face becomes for a
moment  flushed, then  of a deadly pallor, aud finally  the jaw drops if
the effect is very great.  At this time anaesthesia is complete and the
operation is to be rapidly performed.
  According  to  the most recent studies upon this  gas (Wood and
Cerna) it causes at first a rise  of arterial pressure, followed by a fall
if the asphyxia  caused  by  its  inhalation  is  very severe.   The
anaesthesia  is  probably chiefly due  to  the  non-oxygenatiou of the
blood during the time  the gas is in this fluid,  or, in other words, it is
largely due to  asphyxiation.  It has  been thought  that  the use  of
this drug produced  temporary glycosuria, but recent studies render
this doubtful, to say the least.  Where permanent glycosuria has been
produced, some injury to the  vascular  system in the region of the
diabetic centre in the floor of the fourth  ventricle  has in all proba-
bility occurred.   The gas ought  not to be given to those who are
advanced in years or have atheromatous  bloodvessels, since the rise of
arterial pressure consequent upon the asphyxia may rupture a cerebral
bloodvessel and thereby cause an apoplexy.   Nitrous oxide gas when
inhaled very rarely produces any disagreeable after-effects, save a little
light-headed sensation  or dizziness for a few hours.
  Therapeutics.—Nitrous oxide is a useful anaesthetic  in all minor
operations, such as opening an abscess, boil or  felon, or even ampu-
tating a thumb.   It possesses two disadvantages, the  first of which is
its brevity of action, since its continued administration is dangerous; 
NUX VOMICA.
253
the other, the difficulty in carrying it about from  place to place.  It
possesses a great advantage in almost absolute safety, very few deaths
having been caused  by it directly.   It  is  the  safest of all anes-
thetics, not even  excepting cocaine, which latter drug  has  largely
supplanted the gas for many minor  surgical operations.  When teeth
are to  be extracted a plug  or  cork is placed between the jaws before
the gas is given, to keep them apart.  Under these circumstances the
cork should  always be attached to a string, so that if it slips into the
back part of the  mouth  it may be withdrawn before it chokes the
patient to death.

                           NUTMEG.

   3Iyristica, U. 8. and B. P., or Nutmeg, is the kernel of the seed of
Myristica Fragrans, an East  and West Indian Plant, Mace being the
outside covering of the same.  Nutmeg is a soporific and nervous  seda-
tive exercising a peculiar influence over the cerebrum.   It is also used
as a flavoring substance in somnifacient mixtures, and is  of value in
prescriptions for serous diarrhea.    The oil  (Oleum Myristice,  U. S.
and B. P.) is given in the dose of 1 to 3 drops.  The spirit or essence
(Spiritus  Myristice,  U. S. and  B.  P.) is used  in the dose of 1 to 2
fluidrachms.
   Several cases of poisoning by nutmeg are reported—the most recent
by Dr. Reading, of Woodbury, X. J.  The symptoms closely resemble
those produced by excessive doses of cannabis indica.


                        NUX VOMICA.

   Nux Vomica  (U.  S.  and B. P.) is the seeds or beans  of the
Strychnos Nux Vomica, an East Indian tree.  It contains two alka-
loids, strychnine  and  brucine, and  depends largely for its medicinal
power  on the former.  For this reason the statements  made in regard
to the  physiological action  of strychnine may practically be considered
as applicable to the entire drug.
   Physiological Action.—When strychnine is  given  to  man  or the
lower animals in full medicinal dose it increases reflex activity, respi-
ratory  rate, pulse-force, arterial pressure, acuity of vision and hearing,
and causes general systemic irritation or excitement.
   Nervous System.—On the nervous system strychnine exerts its
chief  influence.  It excites the spinal cord in its  motor tracts and
probably  increases the receptive activity of the sensory  centres.  It
also has some slight  influence in increasing the conductive power of
the motor and sensory nerves.
   In overdose strychnine produces spinal or tetanic convulsions by an
action  exerted on the spinal cord.   When enormous doses are given
intravenously total paralysis,  resembling that caused  by curare, pre-
cedes  the convulsions, and if artificial  respiration is not used  the
animal dies from  failure  of respiration.   If  death  takes  place from 
254
DRUGS.
the effects of the drug the motor nerves  are  found to be depressed,
partly  as  the result of the poisonous action  of the strychnine and
partly  as  the  result of the  exhaustion  of the nerve-trunks by  the
convulsing impulses which they have carried.
   Circulation.—Nux vomica increases  the  force of the pulse-beat
and the pulse-rate by a stimulation of the heart muscle and its ganglia,
while the rise of arterial pressure which it causes is  due to stimulation
of the  vasomotor centre.   If very poisonous doses are injected intra-
venously a fall  of arterial pressure occurs  instead of a rise, which is
due to  vasomotor depression and paralysis.
   Respiration.—Strychnine is one  of the most constant and pow-
erful stimulants to the respiratory centre that we  have, aud it  not
only increases the rate  but the respiratory capacity.
   Temperature.—Ordinary doses have no effect  upon temperature,
but poisonous doses may raise it by reason of the convulsions.
   Elimination.—Strychnine  is eliminated from  the  body by  the
kidneys as strychnine and strychnic acid.   Most of it is  oxidized and
destroyed by the liver.
   Poisoning.—Wheu a poisonous  dose of strychnine is taken it acts
either  suddenly or gradually.  If suddenly, the man or animal may
be, without any premonition, thrown  several  feet, and become  rigid,
by contraction  of his muscles.
   If the onset  is gradual, some stiffness at the back of  the neck and
uneasy startings may  precede the general nerve-storm.   The con-
vulsions are tetanic, or in other words tonic, and the body is thrown
into opisthotonos, that  is, resting on  the head  and  heels at each con-
vulsion.
   Sometimes the trunk is twisted sideways, or with the back in the
air.  (Emprosthotonos.)  The  eyes are open and fixed, the corners of
the mouth drawn back into risus sardonicus, and respiration, during a
severe  convulsion, is impossible owing to the respiratory muscles being
in a state of tetanic rigidity.
   The slightest noise, draught of air,  or touch, may  cause a convulsion,
or convulsion  after convulsion, because the sensory impulse, reaching
the spinal cord, causes a  spasmodic motor impulse to be sent out to
the muscles.
   The convulsions are not absolutely continuous, but periods  of utter
or partial relaxation occur, during which the  patient breathes- easily.
The cramp-like contractions of the  muscles are exceedingly painful,
and the patient either dies of cramp asphyxia—that is, through failure
of respiration, because  his chest muscles are locked  in spasm, or much
more rarely, from exhaustion.   Reichert has  shown that it  requires
five hundred  times the  fatal  dose of strychnine  to cause death if
artificial respiration is  properly maintained.
   Treatment of  Poisoning.—The attendant should give at  once, if
no symptoms  have yet appeared, inhalations of nitrite  of amy],  and
meanwhile  employ the stomach-pump, using the  nitrite to prevent
any convulsive tendencies during the operation.   Draughts of water
containing tannic acid, as the chemical antidote,  are to be adminis- 
NUX VOMICA.
255
tered, and  after the stomach  is washed out 60 grains of bromide of
potassium  and 20  grains of chloral in solution are  to  be given.
These  are  the  physiological antidotes, for the bromide of potassium
depresses the sensory side of the spinal cord, and the chloral depresses
the motor tracts.   If the convulsions prevent swallowing, the patient
must be chloroformed with care, and the physiological antidotes given
in star%h-water by the rectum, muscular relaxation being maintained
by the anaesthetic until the drugs are absorbed.  Ether cannot be used
as a relaxant, as it is too  irritant and too slow.  Nitrite of amyl is also
a physiological antidote, but it is useless if a complete convulsive attack
is present,  as it cannot be inhaled if the  chest is immovable.  Neither
can any other relaxant, such as chloroform, be used under those circum-
stances.  These drugs should  be gently given between the paroxy-ms.
If relaxation  does  not occur, the nitrite of amyl should be injected
hypodermically.
  While a light touch may produce a  spasm, a  firm, hard grasp of
the limb often relieves  the pain  of the cramp.   Sensation,and con-
sciousness  is preserved  in strychnine-poisoning  unless the asphyxia
destroys  it.
  Differential Diagnosis.—The convulsions  of  strychnine-poisoning
do  not resemble  epilepsy, because they are so distinctly  tonic, and
never clonic.  From tetanus strychnine-poisoning is to be separated
by the fact that in tetanus the locking of the jaws comes first, while
in strychnine-poisoning  it comes  last.  The convulsions  of  tetanus
rarely, if ever, completely  relax,  while  those of strychnine  do have
periods of relaxation.   There is a different history in each case.   In
one, perhaps, of an  injury, as of a nail run into the foot;  in the other,
of a dose of poison  having been swallowed.
  The differential diagnosis of strychnine-poisoning  from hysterical
convulsions is more difficult.  The convulsions are rarely so persist-
ently tonic  in hysteria, and the peculiar expression of the hysterical
face is often seen  in  such cases.  The history of the patient, if obtain-
able, will throw much light on the case,  and aid very materially in the
separation  of the two conditions.
  As the treatment of all  these states  is virtually identical, the em-
ployment of the measures just suggested  may be resorted to in each
instance,  and the diagnosis made afterward.
  Therapeutics.—Nux  vomica, or its chief  alkaloid, strychnine,  is
used for several purposes in medicine.  Owing to its  bitter character-
istics it may be employed as a simple bitter tonic or as one especially
influencing the nervous system.   It may also be used as a respiratory,
cardiac, and ocular stimulant.
  In cases of functional  nervous atony, or depression,  strychnine does
good, but in organic disease,  if used during  the  period of acute in-
flammation, as after an apoplexy or in acute infantile  palsy,  it is dis-
tinctly harmful.  Some  cases of apoplexy can never  take the drug
without a spasm coming  on in the paralyzed part or parts.   In acute
or subacute neuritis strychnine ought never to be used  in  any way
whatever, as the  nerves  are already  inflamed, and are not to be still 
256
DRUGS.
further irritated  by the  employment of nervous excitants.  In pro-
gressive lead palsy large doses of strychnine should be constantly used
to stop the progress of the disease, iodide of potassium  also  being
employed to cause the elimination of the lead.
   In amaurosis dependent upon the excessive use of tobacco or alcohol
strychnine is  almost a specific, and in eye-strain  resulting from in-
sufficiency of  the ocular muscles it does great good, curing the insuf-
ficiency and improving the general condition of the muscles.  Accord-
ing  to  De Schweinitz, the patient should use ascending doses of the
tincture of nux vomica, beginning with 3 drops three times a day,
and  increase  the  amount  2 drops a day until distinct physiological
effects  are produced.  Sometimes  60 drops may be used  in twenty-
four hours after tolerance is reached.
   There is no drug known which is so antidotal to the effects of over-
doses of chloroform  as  is strychnine.   In cases of sudden accident
during the use of this anaesthetic, the physician should give hypodermic
or even intravenous injections of -fa grain of strychnine as a power-
ful,  rapidly acting cardiac and respiratory stimulant.
   In dyspnea, from any cause, such as  that  of old persons  with
winter cough  or  bronchorrhea, in emphysema, phthisis, and in  idio-
pathic shortness of breath, strychnine is of service,  and it is a valuable
drug for the treatment of opium-poisoning, preserving the reflexes and
stimulating the respiratory centre.
   Strychnine is  a very valuable remedy in  surgical shock, and is a
better  antidote to opium than is belladonna.
   In atony of the bowels strychnine is of service, and it is to be added
to purgative  pills  to avoid  their depressing  after-effect on the  intes-
tines.   Where a  lesion exists in the brain, strychnine may be  used to
keep up the nutrition of a limb which is  paralyzed, but if the  palsy
be due to disease of the trophic cells in the spinal  cord, it does  little
good except to stimulate the remaining cells to greater effort.
   The following prescription is  a useful one in gastric and intestinal
atony and in chronic bronchitis :

         R.—Tr. nucis vomicae ......  f^j.
              Liq. potassii arsenitis  .....   f^ss.
             Aquse......q. s. ad  f 3 iij.    M.
    S.—Teaspoonful t. d. after meals.

   According to Ringer, sick headaches, due to errors in diet and with-
out much nausea, can be put aside for the day by the use of a drop of
the tincture of nux vomica iu a teaspoonful of water every five or ten
minutes until 10 drops are taken.
   Administration. — Abstract  of  nux  vomica  (Abstractum  Nucis
 Vomice, U. 8.)  is given  in  the dose of J  to  1  grain;  the extract
(Extractum Nucis Vomicce, U. 8. and B. P.), in the dose of \ to \ of
a grain ; the fluid extract  (Extractum Nucis Vomice Fluidum,  U S.),
in the dose of 1  to  5 drops; the tincture (Tinctura  Nucis Vomice,
 U. S. aud B.  P.), in  the dose of 5 to 30 drops.  Strychnine Sulphas, 
OPIUM.
257
U. 8. and B. P., is given hypodermically in the dose of fa to -fa of
a grain, and by the mouth in the same amounts.


                            OPIUM.

  Opium (U S. and B. P.) is the juice or milky exudation appearing
on the surface of the unripe capsules of White Poppy or Papaver
Somniferum, a native plant of Asia, now grown in many other parts
of the world.
  Good opium, according to the  U. S. P., should contain at least 9 per
cent, of morphine.
  The chemical composition of this drug is very complex, no less than
seventeen alkaloids having been obtained from  it, the most important
of which are Morphine,  Codeine,  Narcotiue, Thebaine, Narceine,
Papaverine,  Pseudomorphine,  and  Laudanine.    It  also  contains
Meconic Acid and Meconine.
  Physiological Action.—Opium, when given  iu full dose, produces
in the lower animals, such as the frog, violent spinal convulsions; in
the dog, great increase in reflex  activity, and in man deep sleep, the
spinal symptoms being in abeyance.
  Nervous  System.—Opium  has  a double action on the nervous
system.  It quiets the brain but excites the spinal cord  if given in
very large doses.  In the frog, which has no brain of any size, the spinal
action predominates; in man, whose brain  is  proportionately larger
than his spinal cord, the cerebral effect is the dominant influence.  In
the animals between the frog and man opium either produces convul-
sions and sleep, or sleep alone.   If the dose is  large, the spinal cord
becomes depressed  in all animals and the reflexes  fail.   The motor
nerve-endings are also somewhat depressed under these circumstances,
but the sensory nerves generally escape.
  Circulation.—Small therapeutic doses  of  opium have no effect
upon the circulation, but large ones slow the pulse, increase its force,
raise arterial  pressure and cause the  respirations to become deepened
and more full and  at the same time a little slower.
  The slowing of  the pulse depends upon stimulation of the pneumo-
gastric nerves peripherally and centrically; the  increase in pulse-force
rests upon the stimulation of the heart muscle and its ganglia; the rise
of pressure is due  to the increased heart action and vasomotor stimu-
lation.
  After  poisonous doses all these changes become more marked, aud
finally go on  into a rapid running pulse and great depression, due to a
reversal of all the influences named;  the vasomotor centre is depressed,
as are also the pneumogastric nerves.
  Respiration.—In very minute doses opium is a feeble stimulant,
or at least not a depressant, to the function of respiration.  In overdose
it is one of the most powerful paralyzants  of  the respiratory centres
in the medulla oblongata, causing death in this  way.
                                17 
258
DRUGS.
   Temperature.—The bodily temperature is  raised slightly by full
 doses and lowered by poisonous amounts of opium.
   Tissue-waste. — Opium  acts  as a preventive to  tissue-waste,
 decreasing the elimination  of urea and  other  results of nitrogenous
 breakdown.
   Elimination.—The drug escapes, if given in excess as morphine,
 chiefly by way of the intestines and kidneys, but most of it is destroyed
 in the  body.  Experiments  made by  Alt and Tauber show that
 morphine is chiefly eliminated by the stomach, and that if this viscus
 is frequently washed out during a case of poisoniug, recovery is much
 aided, as by this means reabsorption is prevented.
   Pupil.—Opium contracts the pupils by a centric stimulation of the
 oculo-motor  nerves, and perhaps by  depression  of the  sympathetic
 fibres.                                                       i
   Stomach,  Intestines,  and  Secretion.—Opium depresses  the
 motor activity of the stomach aud intestines and produces constipa-
 tion.
   It does this by stimulating the  splanchnic  inhibitory fibres of the
 intestine  and thereby preventing  peristalsis.   In very large  doses it
 increases peristalsis by paralyzing these fibres.
   Opium checks every secretion in the body except that of the skin.
   Acute  Poisoning.—When opium is taken  by man in  overdose it
 causes drowsiness, deep sleep, full breathing, a slow, full pulse, a warm,
 dry skin, contracted pupils, and pleasant, or, more commonly, in the
 Anglo-Saxon  race, disagreeable dreams or no dreams at all.
   Preceding  this  period there may be a brief one during which the
 person feels self-satisfied and contented.  The duration of this agreeable
 sensation only lasts a short time, and if the dose is large does not occur
 or at once passes off.   It has been called the first stage,  while the
 more marked  symptoms  just described have been grouped into a so-
 called second  stage.
   During the sleep of the second stage the patient can be roused  by
 shouting in his ear or by violent shaking, but sinks back into slumber
 at once on being left alone.
   The face is suffused and reddened, and may be finally distinctly
 cyanotic.   Many of the symptoms resemble those of congestion of the
 brain.  The  breathing may be puffing  and  stertorous.  When the
 patient is awakened  he breathes more rapidly, and for this reason the
 duskiness of the face disappears and the  normal hue returns.   Death
 never occurs in the second stage of opium poisoning from the poison
 alone, but if a complicating disease is present death may take  place at
 this time.
   The third or fatal  stage emerges  from  the second  by a process so
 gradual that no abrupt line  of separation can be noted.  The face be-
comes at first more cyanotic, then pale and livid, the respirations, which
have been 8 to 10 to the minute, are now only 4  or 5, and finally, such
prolonged pauses occur that all hope of another respiration is  lost  by
the attendant.  While the slow breathing is at first deep it now rapidly
becomes shallow, and muscular relaxation is present to the  greates 
OPIUM.
259
degree.   The skin, previously dry, is wet with the sweat of death, and
the patient is so deeply narcotized that nothing can arouse him and he
dies from respiratory failure, although the heart ceases almost simul-
taneously from the asphyxia.  The pupils do not dilate in  the  third
stage, except in the relaxation of death.
  Treatment of Acute  Poisoning.—After employing the  usual
methods  resorted to for the purpose of unloading the stomach, and
after giving tannic acid as the chemical antidote, the patient should
receive one or two cups of strong  black coffee, hot  and concentrated.
The heat iu  the  liquid is ■ useful  in  maintaiuing bodily temperature
and the caffeine stimulates the  respiratory centre and  keeps the man
awake.   Coffee should be used even before any symptoms come  on in
order to  put them off if possible.  If atropine  be at hand and the
respirations are becoming very slow, fa-^  to fa of a grain should be
given hypodermically, but this dose should not be repeated after the
respirations increase  to  10 or  12.   Strychnine is, however,  much
better than atropine  as  an antidote  to opium, and should be  given
hypodermically in full dose, repeated frequently enough  to keep the
nervous  system of the  patient active and  respiration intact.   The
pupil is  no guide as  to the action of atropine, as the action of  these
two drugs on the eye  is not  antagonistic.
  Alcoholic stimulants may be called for, and ammonia as a cardiac
and respiratory stimulant may be resorted to.
  In the third stage heat  should be applied to the trunk and ex-
tremities.
  Much  emphasis has been  placed on keeping the patient  awake, and
it has been thought that the cause  of death was the deep sleep.  This
is not so.   The man must be kept awake in order that he will supple-
ment the efforts  of  his  depressed respiratory centres by voluntary
breathing.   If he sleeps he  forgets to breathe, and sleep means  death
for this reason, and not because sleep in itself produces death.
  Besides  the  use of the hot strong coffee, the patient may be kept
awake by lashing him with  switches  or by keeping him walking up
and down between two attendants.  Both of these measures are repre-
hensible  if anything  better can be  done, the first method because it
covers the patient with cuts and  bruises, the  second because it may
aid in the production of death by exhaustion.   If an ordinary medical
electric battery is at hand the full force of the current may be allowed
to come in contact with the skin  from two  small poles wet with salt
water, or better still, the dry or wire  electric brush should be swept
over the body while  the negative pole is  held  in the hand of the
patient or pressed against his  skin.   This causes the most exquisite
pain in the normal individual, but if the  brush is  kept  moving will
not cause any bruises or discoloration.  (See Asphyxia.)   Artificial
respiration may be resorted  to.
  Chronic  Poisoning.—Morphine  or  opium  when taken  constantly
generates  a habit.  The person, or  morphine-habitue as  he is some-
times called, depends for a comfortable existence on  the drug, and day
by day increases  his dose until  the most extraordinary amounts are 
260
DRUGS.
taken by the stomach, or by  means  of the  hypodermic  needle.  If
the drug is withheld a  train of symptoms  typifying depression or
exhaustion  ensues.   The pulse is  scarcely to be felt, horrible mental
depression  and melancholia come  on, the  miserable man  or woman
wrings his  or her hands, and begs, screams, howls, or yells for mor-
phine, only to break down aud  cry at its withdrawal.   Diarrhoea, of
a serous type and most  violent in character, with cramps in the mus-
cles, may assert itself, and must be controlled by astringents and an
active line of treatment, as far as possible free from opium.
  A characteristic symptom of chronic opium-eating is the develop-
ment of the most remarkable and clever lying, in previously truthful
persons.  In the breath  that  the patient begs the physician to cure
him and not give him another dose of morphine, he will lie to obtain
the drug iu a surreptitious mauner  and may even have  the drug in
his mouth  at the moment he speaks.  It will often be found hidden
in the seams of the clothing in small packages, and the nurse should
be  absolutely  reliable and forever  on  the watch  lest  the drug  be
obtained  by smuggling.   Any sudden  improvement on the part of
the patient should  be placed  to the  credit of more morphine, not to
professional skill.
  Treatment.—The best way to treat such cases is to " taper off" the
daily dose,  and to decrease a sixth  or  fourth of the total customary
amount in each twenty-four hours.   The complete withdrawal of the
drug is an unnecessarily severe measure, and its withdrawal in a slower
manner than that named is simply prolonging the treatment beyond
reasonable limits.  Cocaine has  been  used  to tide over the crisis after
the withdrawal  of  morphine, but  too  frequently the  patient passes
from opium to the cocaiue and finally to the alcohol habit, all of which
are equally bad.   If the circulatiou flags, digitalis and strychniue may
be given  and the remaining  symptoms treated as common  sense in-
dicates.
  Sometimes paregoric is taken in excess, aud the writer has seen and
treated a case under the  care  of Dr. H. C. Wood which took over a
pint of paregoric every day.
  When a  mother is  an opium-eater the newborn child  ofteu suffers
from collapse on the second or third day after its birth, owing to the
lack of its  customary dose of opium.
  Therapeutics.—Opium is used for relief of five  great conditions
which will  be spoken of seriatim, the  minor uses of the drug  being
considered afterward.
  Pain.—Opium, as is known to every one, is the best  remedy that
we  possess  for the relief of all forms of pain, except in those iustances
where neuralgia  exists, when antipyrine  and its fellow-compounds
exceed it in medicinal value.   In one form of pain the drug is not to
be employed, namely, that arising from cerebral congestion or  cerebritis,
for it is  distinctly  contra-indicated iu these affections, as  it makes
them worse.  In acute or traumatic meningitis, however, opium is of
great service, either alone or combined with mercury in sthenic  cases.
In  the treatment of cases of renal and hepatic colic associated with 
opium.                         261
spasm, and in dysmenorrhea, belladonna and opium given  together
will relieve the spasm and pain, and yet so counteract each other else-
where in the body as to be devoid of effect upon other organs.   Per-
sons suffering  from pain will always bear very much larger  amounts
of opium than painless individuals.
  Insomnia.—Opium, while capable of producing sleep in almost
every case to which  it is given, save in those  persons who by reason of
idiosyncrasy are  made  wakeful  by  it,  is only to be used  in those
instances where  the sleeplessness is due to pain.   If constantly used
in insomnia or in pain, the opium habit is rapidly contracted, and for
this  reason the use of  the  drug should be alternated  with  chloral,
cannabis indica, and other soporific drugs.
  In some cases  chloral and morphine when given in small doses in
combination will  so act  upon the brain as to produce sleep.
  In the insomnia  of typhoid fever, opium may be used, particularly
during convalescence, but it must be employed most  carefully.
  Inflammation  and Irritation.—Opium seems to possess some
influence over inflammation which we cannot explain, and both small
and large doses  are particularly valuable in inflammations of serous
membranes, such  as peritonitis, meningitis, and pericarditis.   It allays
the nervous excitement and anxiety  following  hemoptysis,  and the
intense unrest caused by itching skin diseases, as, for example,  the irri-
tation of smallpox.  Sometimes intense irritation or inflammation pro-
duces so great an effect upon unstriped muscular  fibres as  to cause
spasm  or paralysis, as in retention  of  urine, cystitis, or the consti-
pation  following  inflammation of the bowels from irritating foods;
under these circumstances the employment of opium is indicated, and
is usually very successful.   In irritative couglis morphine does good,
given in syrup of wild-cherry bark, in the dose of fa to fa of a grain.
  In some cases of irritable cough due to tickling in the larynx, a
drachm or two of paregoric  added  to hot water and the steam inhaled
gives great relief.
  Whenever the cough is in excess of the expectoration, that is, greater
than is necessary  to free the lung from mucus, morphine may  be given
in small doses.  If the lungs contain more rales after than before its
use it must be stopped,  as the increase  in the number  of rales  indi-
cates an increase in the  accumulation of mucus.
  Iu the treatment of strangury and  rectal  inflammation, provided
they are not acute, after operation on the pelvic organs, and in cystitis,
suppositories, in the strength of \ or i- of a grain of the watery extract
of opium, are very useful.   In excessive vomiting from any cause, ex-
cept it be from a  previous dose of opium, injections of laudanum and
starch-water, with 20 grains of bromide of sodium, will be found  of
value.   (See Vomiting.)
  For sprains and  bruises lead-water and laudanum is one of the best
applications.   If the  skin  is broken laudanum may be used alone to
relieve pain, and, by its alcohol, to act  as  an antiseptic.  Opium is
also a useful drug in the treatment of internal and  external burns, to
relieve the pain and irritation. 
262
DRUGS.
   Over-secretion.—In serous diarrhea, diabetes insipidus and mel-
litus, and in the treatment of over-secretion on the part of all secreting
surfaces except the skin,  opium may be used.
   It is said  to decrease the amouut of urine before decreasing the
amount of the sugar in diabetes.
   Opium should not be used in mucous  diarrhea  until after the
mucus already present is swept out of the intestinal canal by castor
oil or  magnesium sulphate.   Minute doses of fa to fa of a grain of
morphine will sometimes check summer diarrhea in children  at once
when given hypodermically.
   Systemic Strain.—In prolonged  strain upon the system, as in
great physical effort, or more frequently in old age, to smooth  out the
cares of the remaining  years of life,  and decrease worry, opium is
useful.   In asthenic fevers it is thought to be supportive, but its use is
apt to cause so many other conditions, such as constipation, anorexia,
or mental depression, that alcohol is much better for this purpose.  In
very advanced phthisis it is often justifiable  to give enough opium to
keep  the patient free from  pain and  discomfort for the remaining
hours of his life,  but care must be taken that the dose does not inter-
fere with his breathing, and so hasten death.
   In muscular rheumatism and  similar states, where a "cold" has
been taken, opium in the form of Dover's powder will  often produce
a cure, particularly if employed in combination with hot drinks and a
hot foot-bath.
   In heart disease, particularly of the  mitral valves, the patient can
often breathe easily only when awake, starting up when he falls asleep,
and gasping for breath.   It is stated by some writers that morphine
will relieve this state and permit sleep, but that  it will not be of ser-
vice in aortic disease.  While this may be partly true, the drug will
often give great  relief in all  forms of cardiac dyspnea, and ought
always to be tried.   Care should  be taken  that the first dose is small,
as in some instances it  increases  the discomfort.   The relief obtained
is supposed to be due to cardiac stimulation by the drug, and while
this is, no doubt, correct, other cardiac stimulants, such as  digitalis,
will fail when morphine succeeds.    The presence of  cyanosis aud
lividity is said to be no contra-indication to the hypodermic use of
morphine uuder these circumstances, provided the dose is  not unrea-
sonably large.
   Administration.—Recent studies upon the action  of opium  and its
alkaloids show that it acts in an inhibitory manner upon gastric diges-
tion and absorption, decreasing the amount of hydrochloric acid in
the gastric juice.  Unless there is an excess of acid present it is always
well not to give opium  or morphine at meal times, but some hours
after.
   Opium itself is used in the form of the powder (Pulvis Opii,  U. S.)
in the dose of from % to 1 grain.  The solid preparations  are  the de-
narcotized  opium (Opium Denarcotisatum, U. S.), which is  deprived
of its narcotine, dose ^  to 1  grain, the  pills of opium (Pilule Opii,
U. S.), each containing  1 grain,  and the watery extract  (Extractum 
OPIUM.
263
 Opii,  U. 8. aud B. P.), dose £ to J a grain.   Of the liquid prepara-
 tions we have paregoric (Tinctura Opii Camphorata, U. 8., Tinctura
 Camphore Composita,  P. P.), dose 1  drachm to 2  tablespoonsfuls;
 laudanum (Tinctura Opii, U. S. and B. P.), dose 10 to 30 drops;  the
 deodorized tincture, (Tinctura Opii Deodorata, U. S.), dose  10 to 30
 drops; the Vinum  Opii,  U. S. and  B. P., or, as  it is  sometimes
 called, Sydenham's Laudanum, dose 5 to 10 drops; and Acetum Opii,
 U. S., or Black Drop, dose 5 to 10 drops.
   Under the name  of Dover's Powder (Pulvis Ipecacuanhe et Opii,
 U. S.), a powder containing one grain of powdered opium,  one grain
 of powdered  ipecac,  and  eight grains of  sugar  of  milk, is largely
 used.   This  is more efficacious if separated into fifths, and taken in
 divided doses.   The tiucture of ipecac aud opium (Tinctura Ipecacu-
 anhe et Opii, IT. S.) is given in the dose of 4 to  15 minims.
   All the liquid preparations of opium are 10 per cent, strong except
 paregoric, whicli is much weaker.
   The  preparations  of opium  official  iu the B. P., other than those
 named, are: Confectio  Opii, dose  5  to 20 grains; Extractum Opii
 Liquidum, dose 4 to  20 minims; Pulvis  Opii Compositus,  composed
 of opium, pepper, ginger, caraway fruit, and  tragacanth, dose 2 to 5
 grains; Tinctura Opii Ammoniata, dose J to 1 drachm; and Trochisci
 Opii (fa grain of  opium in each), dose 1 to 4.
   Pilula Saponis Composita, B. P., is purely a preparation of opium.
 It is sometimes necessary to give this  drug to patients  without  their
 knowledge, and it may be prescribed  in  this way,  the  patient  not
 learning from the  prescription the nature of the medicine.
   The  B.  P. also recognizes a  liniment (Linimentum Opii), and a
 plaster (Emplastrum Opii), for local application, and an enema (Enema
 Opii), composed of J a drachm of the tincture of opium and 2 ounces
 of starch mucilage.
   Ordinary opium is apt to produce nausea and depression, as already
 stated, while the denarcotized opium is deprived of its narcotine, this
 being one of the chief causes  of these disagreeable symptoms.  The
 deodorized  laudanum is substituted for the ordinary laudanum  for
 the same reasons.   Morjihine is used to relieve pain rather than opium,
 because it does not cause so much constipation, but opium is better to
 check diarrhoea.  Paregoric is particularly useful  in diarrhoea  because
 it contains a volatile oil and camphor.
   Untoward  Effects.—Opium  in  many persons  produces  after  its
 primary influence  great nausea, and sometimes vomiting.   The men-
 tal depression may be  simply overwhelming,  and the very fact of
 having to drag out existence is a curse.  These symptoms are said to
 be  largely done away with by the use of 20 grains of bromide of
 potassium, which must  be taken at the same time as the opiate, and
 by employing  the  preparations of opium largely devoid of narcotine,
 such as the deodorized  tiucture.   Haig is responsible for the assertion
 that as opium frees the blood of uric acid by causing  its  retention in
 the tissues of the body,  the pleasant effects are so produced, and that
the retention being cumulative,  no sooner does the effect of the opiate 
264
DRUGS.
pass off than the uric acid is set free in the blood, and as a result de-
pression ensues.   He states that if salicylates are given with the opium
the retention does  not  occur, and the  unpleasant sequelae are much
modified or prevented.   After the untoward symptoms come on, coffee
and stimulants may be used.
   Children bear opium badly, aud some children are very much more
susceptible than  others to its influence.
   One-eighth grain of morphine has caused death in an adult when
given hypodermically.   If the drug enters a vein the patient may give
one gasp and fall back apparently dead.  Sometimes  the drug causes
collapse, or in other cases an eruption over  the body.

                            Codeine.

                          (See p. 151.)

                           Morphine.

   Sulphate of Morphine (Morphine Sulphas, U. S. and B. P.) is given
in the dose of ^ to \ grain, either by the mouth or  hypodermically.
Besides the sulphate of morphine we have the acetate (Morphine
Acetas, U. S. and B. P.), and the muriate (Morphine Hydrochloras,
 U. S.  and B. P.), both  given in the  dose of J to J grain.   In the
U. S. Pharmacopoeia of 1870 a solution, Liquor Morphine Sulphatis,
was official, dose 1 to 2 drachms, but it is no longer official, and should
not be called for.  Magendie's solution is  sixteen times as strong as
this liquor (16  grains to the ounce) and is not official.  The words
" Liquor Morphiuae Sulphatis " will generally  cause Magendie's solu-
tion to be dispensed in New York State, and care should be  taken that
poisoning does not  result.  Pulvis Morphine Compositus, U. 8., is
given in the dose of 10  grains; troches of  morphine and ipecac (Tro-
chisci Morphine et Ipecacuanhce, U. S.) are given 1 or 2 at  a  time.
   The following additional preparations of morphine are  official in
the B. P.: Liquor Morphine Hydrochloratis,  dose 10 to 40 minims;
 Tinctura Chloroformi et  Morphine, dose 5 to 10 minims;  Suppositoria
Morphine aud Suppositoria Morphine  cum Sapone, each suppository
containing J grain of morphine; Trochisci Morphine and Trochisci
Morphine et Ipecacuanhe, each lozenge containing -fa of a  grain of
morphine, dose 1 to  4.   Liquor Morphine  Acetatis is given  in 20 to
40-minim doses.  Injectio Morphine Hypodermica, B. P.,  contains 1
grain of the acetate of morphine in each 10 minims of water.
   It is said by Alt that morphine when given hypodermically is elimi-
nated by the stomach and so causes nausea, but if the stomach be well
washed out this  is avoided.

   Incompatibles.—Morphine is incompatible with tannic or gallic acid
or astringent solutions  coutaining them, with  alkalies such as potas-
sium, sodium, and ammonium, but with the chloride of ammonium it
is not incompatible.  With  tincture  of chloride of iron it  forms a
deep red color.   (Meconic acid.) 
oxide of zinc.                     265
                           OX-GALL.

  Iuspissated Ox-gall (Fel Bovis Inspissatum, U. 8.) is, as its  name
implies, dried ox-bile.   It is  used in medicine for the purpose of re-
lieving certain forms of indigestion  whicli  depend upon deficient se-
cretion of bile or whicli occur in persons who digest fats with difficulty.
In full doses it is apt to cause some looseness of the bowels and it may
be given with this object.  When it is used the fact should be remem-
bered that bile prevents the gastric juice from acting upon proteid or
albuminous  substances, shrivelling them up, and in addition so altering
the gastric  liquids as to  decrease their digestive power.  We learn,
therefore, that this drug must be administered some hours after meals, as
a rule, or in other words when gastric digestion is ended and intestinal
activity is beginning.  The dose of inspissated ox-gall, which is dried
by evaporation from 100 to 15 parts, is 5 to 15 grains.   Purified  ox-
gall  (Fel Bovis Purificatum,  U. 8., Fel Bovinum Purificatum, B.  P.)
is given in  the same  dose as the inspissated bile.   It is made by
evaporating 3 parts of pure ox-gall to 1 part, and then  adding to this
part an  equal amount of alcohol, which constituents are mixed  thor-
oughly,  and after standing  twenty-four  hours  the  clear liquid is
decanted and the residue is  evaporated  to a consistency  capable of
forming a pill.

                       OXIDE OP ZINC.

  Commercial  Oxide  of Zinc (Zinci Oxidum Venale) is not used in
medicine, but in the purified form is largely employed in the shape of
Zinci Oxidum, U.  S. and B. P., which is  insoluble in water.  In  the
form of the  oxide of zinc ointment (Unguentum Zinci Oxidi, U 8. and
B. P.) this drug affords one of the most generally used applications in
the treatment of skin diseases, burns, and sores.
  In all states where the surface of the skin is dry it is contra-indi-
cated, but where the eruption  is moist  it  is useful.   In the treatment
of the chloasma of pregnancy the following prescription is  of service  :
         R.—Zinci oxidi.......gr. iij.
             Hydrarg. ammoniat......gr. j.
             Olei theobromse......Sijss.
             Olei ricini.......3^3SS-
             Essent. rosae.......gtt.  x.  M.
   S.—Apply to the face night and morning.

In eczema with many vesicles  use
         R.—Pulv. camphorse......^ss.
             Pulv. zinc oxidi......S^j-
             Glycerini   •......gtt. xl.
             Adepis benzoinati.....^j-    M.
   S.—Apply to the part without other treatment or precede it by powdered bismuth.

  In powdered form  zinc oxide is useful in the treatment of intertrigo,
and in conjunctivitis.  With bismuth subnitrate and pepsin it is largely 
266
DRUGS.
used by some practitioners in the treatment of the summer diarrhea of
infants or adults.
  In the night-sweats of debility or phthisis oxide of zinc  in  the  fol-
lowing formula has been highly recommended, but probably  depends
largely for its action on the second ingredient:

         $.—Zinci oxidi......gr. xxx.
             Extract, belladonna?.....gr. iij.    M.
    Ft. in pil. no. x.  S.—One at night before going to bed.
  Bartholow recommends the oxide of zinc  for cases of asthma  and
whooping-cough, given to an adult in the manner just indicated.


OXYGEN, OXYGEN  WATER, HYDROGEN PEROXIDE.

  The gas Oxygen is now widely used in medical and surgical prac-
tice  in  three  forms, as  follows:  By  the inhalation  of  the  gas
itself from a cylinder in  which  it  is compressed until  40 gallons
occupy  a very small  space ;  by  drinking  oxygen  water, which is
distilled  water saturated with the gas; and finally, by the use of the
dioxide or peroxide of hydrogen,  which is applied locally to  diseased
surfaces.
  Inhalations of oxygen are useful in the second and third stages of
pneumonia where the patient  is about  to die from deficient  aeration
of the blood with resulting heart-distention.   They are also of value
in advanced bronchitis, particularly that of old persons, and for the
resuscitation of persons asphyxiated  by coal-gas (Hare and Martin).
Iu  phthisis and other exhausting  diseases oxygen will  allay dyspnoea
and oppression.
  In the preparation of the solution of oxygen gas the water must be
distilled so that it may be  as free as  possible from other gases.   The
bottling should be done under a pressure of  150 to 200 pounds  and
the contents drawn off by means  of a tap such as  is used  in siphons
or for champagne bottles.  Birch, of England, has found that the addi-
tion of a little nitrous-oxide  gas  to  this water adds  piquancy to its
taste and increases its stimulating effects. The value of this preparation
is undoubted, aud when taken into  the body it has proved of the greatest
service  in chronic  dyspepsia, persistent vomiting, and  headaches  both
digestive and neuralgic.
  In constipation depending upou  intestinal atony, oxygen gas is  said
to give relief if it is  taken in solution just before going to bed.   It is
hardly necessary to state that the  water should be swallowed as  soon
as possible after it is taken out of the bottle which  has contained it.
In some eases where  general systemic torpor is present, oxygen water
taken  after each meal, or  even more  frequently,  may be  used  with
advantage.   One or two tumblerfuls  may be taken each time.   As a
substitute for this water the physician may employ peroxide of hydro-
gen (15-volume) in the proportion of  1 ounce to 2 pints of water.
  The peroxide or dioxide of  hydrogen is  a colorless, transparent, 
         pancreatin and. pancreatic  extracts.     267

 odorless syrupy fluid, of  a specific  gravity  of  1.452, with a harsh,
 bitter taste, and is readily soluble in water.  It is rarely used in its
 pure form, but should be employed in the strength of what is known
 as  the 15-volume solution, or 3 per cent., which strength is the pro-
 portion  generally sold as the pure article.  As many of the solutions
 are worthless, the following test for its purity has  been recommended
 by Walliau :
   Place a few crystals of  permanganate  of potassium  in a test-tube
 and add to it 1 or 2 drachms of the solution. The violence of the result-
 ing effervescence is in direct ratio to  its value as  a  remedial agent and
 to  its purity.
   Peroxide of hydrogen is used as an effective application to ulcers of
 the acute aud chronic form and upon burns and scalds.  When applied
 to  surfaces  of this character the  strength of the solution  should be
 varied according to the condition of the part.   If the diseased  surface
 is very sluggish, the pure 15-volume (3 per cent.)liquid may be used;
 but if the lesion is a recent one, one-half this strength should  be em-
 ployed.  In pharyngitis aud diphtheria a solution  of the strength of
 1 part to 7 of water of the 15-volume liquid is  useful as a gargle, or
 the undiluted 15-volume liquid may  be used on a swab.  In the treat-
 ment of sinuses the liquid should  be used undiluted, as  in ordinary
 irrigation, aud the wound dressed autiseptically immediately afterward
 in  the ordinary  manner, or  as desired by the surgeon.   Tubercular
 abscesses are said to heal under the  influence of peroxide of hydrogen
 with extraordinary rapidity.
   In laryngeal phthisis, ulcerative  tonsillitis, ordinary fetid sore-throat,
 and even in pulmonary phthisis,  a 2 per cent, solution  of the  pure
 hydrogen peroxide is of service when used in an atomizer which will
 throw a fine spray.


     PANCREATIN AND PANCREATIC  EXTRACTS.

  Under these names a number of firms now  sell an extract from the
 pancreatic gland or juice.  It contains, or should contain, the four pan-
 creatic ferments : trypsin,  which digests  proteids (meats, eggs, etc.);
 steapsin, which  splits  up and emulsifies  the fats ;  amylopsin, which
 has diastatic power—that is, converts starch into sugar ; and finally,
 a milk-curdling ferment.
  A preparation equally useful  with the commercial pancreatin may
 be made by the physician in the following manner;
  Take the pancreas of a  pig which  has been killed about six hours
 after a full meal, the organ being therefore active, and, after chopping it
 up finely, add to it four times its weight of dilute alcohol and allow it
 to stand for twelve hours.  Decant or  filter off the  alcohol, and give the
 filtrate in the dose of 1 to  2 drachms.   Or, better still, as follows :
 Wash and chop up  finely a fresh pancreas and allow the gland to
soak in alcohol  (absolute)  twenty-four  to forty-eight hours.  After
this squeeze  out the alcohol and add  to the gland ten times its weight 
268
DRUGS.
of glycerin.  This must stand forty-eight hours and then be filtered
and be  used in  doses of 30 drops to each glass  of  milk.   (See Pep-
tonized  Foods.)
  Some doubt has been cast upon the usefulness of the employment of
pancreatin in food, unless  this ferment  was allowed to act upon the
aliment before it was swallowed by the patient, on the ground that
pancreatin is destroyed and rendered inert in the presence of  an acid.
This objection is not a valid one, because food remains in the  stomach
for from fifteen minutes  to half an hour before enough gastric juice is
secreted to  interfere with  the pancreatic action.    It is during this
preliminary period that the work of the pancreatin is accomplished.


                             PAPAIN.

  Papain or Papayotin, or as it is sometimes called Papoid,  is a fer-
ment derived from  the  juice of Carica Papaya.  This ferment pos-
sesses the power of changing  proteids into peptones in the presence of
an acid or an alkali, or even in a neutral mixture, thereby differing
from pepsin and pancreatin.  This power, if it exists, is of very great
value, since the drug would then be useful in all forms of dyspepsia.
Careful experimentation, however, renders it doubtful as to  whether
papain really can supplant either of the animal ferments named above.
The dose  of papain is from 1 to 8 grains in solution, or better in pill.
It has the reputation of  being capable of causing abortion.


                       PARALDEHYDE.

  Paraldehyde is a form of aldehyde used as a soporific and  nervous
sedative, and is a clear, colorless  liquid, with an  ethereal  odor and a
burning, followed by a cool, taste.   It  is readily soluble  in  alcohol,
moderately  so in water, less so in hot water.  It possesses the great
disadvantages of being necessarily given in  large dose, aud having a
disagreeable taste and odor. It is also very apt to disorder the stomach.
Paraldehyde kills when  taken in overdose by respiratory failure, but
is not so  depressant  to  the heart as is  chloral.   It  requires frequent
repetition and soon loses its power.   The dose is 20 drops to 1  drachm,
in capsules; or, better still, it may be used, after the formula of Yvon,
as follows :
         R.—Paraldehyde......gijss.
             Alcoholis (90 per cent.)   .... f 3Jss.
             Tincturse vanillse......f^ss.
             Aquse^........f^j.
             Syrupi pimplicis .     .   .   .  q. s. ad f§iv.    M.
   S.—A dessertspoonful every half-hour until sleep is obtained.
Paraldehyde is uot official. 
PEP0.
269
                          PAREIRA.

  Pareira, U. 8., Pareire Badix, B. P., is the root of Chondoden-
dron Tomentosum, a plant of Peru and Brazil, and is used as a diuretic
of an alterative or stimulaut character, and for the relief  of chronic
inflammations of the  genito-urinary type in general, such  as pyelitis,
cystitis of a  subacute type, and similar pathological states.   The dose
of the unofficial  infusion  is  a wineglassful, and the fluid extract
(Extractum Pareire Fluidum, U. 8.) is given in the dose of a teaspoon-
ful three times a day.   The B.  P. preparations of this drug are the
decoction (Decoctum Pareire), dose 1 to  2  ounces, the extract  (Ex-
tractum Pareire), dose  10  to 20 grains,  and Extractum Pareire
Liquidum, dose 1 to 2 drachms.
                           PENTAL.

  Pental is an impure amylene  first described in 1844 and  used in
1856.  It at once dropped out of notice until a year or two ago, when
it was  brought forward  as  an anaesthetic  for use in  minor or brief
operations.  Pental is a colorless liquid, insoluble in water, but readily
mixed  with ether, chloroform, or  alcohol.   It is  very inflammable,
but not affected by exposure to light and air.
  Physiological Action.—Our knowdedge of the physiological  action
of pental  is exceedingly limited.  Wood and Cerna,  from a very in-
complete and  imperfect  study, conclude that it is a powerful cardiac
and respiratory poison.
  Therapeutics.—Pental is  to be employed by means of a  Junker
inhaler if its use is continued for auy  length'  of time.  If it is to be
taken  for a few minutes, an ordinary chloroform mask or towel may
be used.   The quantity to be used for the production of anaesthesia is
about 2 to 3 drachms.  Pental is an anaesthetic which so far promises
very little and which will probably be used by a very limited number
of practitioners, as  it possesses no  particular  advantages over older
and safer anaesthetics.

                             PEPO.

  Pepo,  U 8., Pumpkin Seed, the seed  of the  ordinary  domestic
pumpkin, is a  useful and efficient vermifuge against  the tape-worm.
The  seeds are  not  only  efficient,  but  harmless to  the  host of the
worm.   The outer coverings of the seeds should be removed, and the
remaining part rubbed up into  an emulsion  with water, or into an
electuary with sugar, the dose  of the seed being 2 ounces.  This mass
should be taken  on an empty stomach aud followed in from  one to
two hours by an active purge. 
270                          DRUGS.
                            PEPPER.

   Piper,  U. 8., or Black Pepper (Piper Nigrum, B. P.), is the unripe
fruit  of Piper Nigrum, a vine of India, Java, Borneo and Siam.   It
contains an alkaloid, piperine,  which is official.
   Therapeutics.—Black pepper may be used as  a counter-irritant  or
internally as a carminative and stimulant to the alimentary canal.
   It may also be used in all cases of atony of the mucous membranes
of the genito-urinary system, but is contra-indicated whenever acute
inflammation  is present, as in  acute gonorrhea.  It may be used  in
the treatment of great flatulence with marked relief.
   Piperine has been used as an antiperiodic with varying success, and
is given  in the dose  of 1  to 5  grains.   The  oleoresin (Oleoresina
Piperis,  U 8.) is given in the dose of \ to 2 drops in laxative pills, to
prevent griping.  A confection (Confectio  Piperis) is official  in the
B. P., given in the dose of 1 to 2 drachms.


                         PEPPERMINT.

   Mentha Piperita,  U. S., is official in  the form of the leaves and
tops.   It has  an  aromatic odor and taste.  Locally applied, the oil
acts  as an irritant and  local anaesthetic.   From this oil  is  obtained
menthol, a camphoraceous substance of a hot burning taste, possessing
marked power as a local anaesthetic.  (See next page.)
   Therapeutics.—Peppermint  is  used  very largely as  a  domestic
remedy for flatulence and infantile colic.   Sometimes the oil  is added
to purgative pills to prevent griping, and it may  be employed to cover
the taste of many  medicines wdiich are disagreeable to take.   In this
respect it is used as  are  all the volatile oils.  In the colic of children
of six months to  a year, when it is unusually severe  and associated
with nervous symptoms, the following will  be found of value:
         R.—Chloralis    ......   gr. xvj.
            Potassii bromidi.....gr. xxxij.
            Aq. menth. piperit.    .    .    .    .   f gij.       M.
    S.—Teaspoonful in a little warm water every four hours.

   When used in the treatment of  neuralgia, oil of peppermint should
be placed on  a piece  of linen or muslin rag and applied  over the
affected spot.   Care must be taken that it does  not  blister the skin.
If, after  its removal, the burning is too severe  to be borne, a little
cosmoline or olive oil should be applied.   Oil of peppermint is some-
times placed on cotton and inserted into  dental cavities for toothache.
   It is to be  remembered that the more menthol is present in the oil
the more  active will it be as an anaesthetic, and that the Chinese oil
contains more menthol than the American oil.
   Administration.—Peppermint is used  in the form of the oil (Oleum
Menthe  Piperite, U. 8. and B. P.), dose  1 to   4 drops; the spirit
(Spiritus  Menthe  Piperite,  U. 8. aud B. P.), dose 10  to  30 drops; 
PEPSIN.
271
the water  (Aqua Menthe  Piperite,  U. 8. and  B. P.), dose 1  to
2  drachms, and finally as  the  Troches (Trochisci  Menthe Piperite
U.  S.)  to  be held  in  the  mouth in  indefinite number.   Essentia
Menthe Piperite, B. P., is given in the dose of 10 to 20 minims.

                            Menthol.

  Menthol, or mint stearopten, or as it is sometimes called, Mint Cam-
phor, is derived chiefly from  the essential oil of peppermint.  It occurs
in colorless prismatic crystals,  with a strong  odor of peppermint.
Upon it rests  much, if  not all, of the therapeutic  activity of pepper-
mint.  Menthol is slightly soluble in water; very soluble  in alcohol
and ether.
  Menthol has been  used in the  vomiting of pregnancy with  great
advantage in hourly dose of a teaspoonful of the following:
-Menthol.   ........   gr. xv.
 Spt. frumenti.....|At     f^vj.
 s^p1.......^   •  f|j.'
   Menthol has also been used as a carminative and in gastralgia, in the
dose of from 1  to  2 grains three times a day in pill  or in  alcoholic
solution.  It is contra-indicated in acute inflammation of the  gastric
mucous membrane.
   As menthol exercises a local anaesthetic effect on the skin as well as on
mucous membranes, it is used externally over the course of neuralgic
nerves and in migraine.
   When menthol is used as a depletant on the mucous membrane of
the throat or nose, it causes a contraction of the local bloodvessels,
which is not followed by the excessive dilatation produced by cocaine
when used for similar purposes.   In acute coryza its local  application
to the mucous  membrane  by a  spray or dropper is often a source of
great relief in the saturated solution of about 1  grain to the ounce.
   Another very useful method of applying menthol is by means of a
simple inhaler  consisting of a  small glass  tube of about 4; inch  in
diameter and 2 J inches in length.   Both ends are closed by a piece of
gauze and two perforated corks,  the menthol being placed in between.
The air  is now drawn through this  tube, and  being  heavily  loaded
with the fumes, clears the nostril and  relieves  the  stuffiness.   It is
not to be simply smelled, but inhaled.  Care should be takeu that the
crystals are not allowed to enter the nostril as they are almost cauter-
aut in power.   Sometimes where great excoriation of the  alae  of  the
nose exists, the too persistent use of the menthol may produce small
herpetic spots about the nostrils.
PEPSIN.
  Pepsin, B. P., is the digestive ferment of the gastric juice.   That
sold  in the shops is generally derived from the pig, and is prepared 
272
DRUGS.
by many persons in many ways.  Much of the pepsin of the market
contains  more peptone than pepsin, and much mucus and albumin.
Used with hydrochloric acid in weak solution, it replaces  the diges-
tive action of the stomach.  Pepsin containing peptone has the pecu-
liar musty smell of peptone, and if the peptone is in excess will absorb
moisture and become sticky on  exposure to the air.
  Therapeutics.—Pepsin is a much over-rated remedy for indigestion.
Pancreatin will always be found  more serviceable, and  should be
given either immediately  after or  one or two hours  after  meals.
Pepsin should  be  used after the food or with it.  Hydrochloric  acid
should always  be  giveu, as its presence converts any pepsinogen in
the gastric tubules into pepsin.  Pepsin is official  in the U 8. P. as
Pepsinum Saccharatum, dose 20 to 30 grains, to be of any  service.
It is a weak and almost useless preparation, made up chiefly of milk
sugar.  Liquor Pepsini,  U. S., is given in  the dose of  2 drachms.
Pure pepsin should be given in 5 to 15-grain doses.


            PERMANGANATE   OF POTASSIUM.

   Potassii Permanganas,  U 8. and B. P., is a salt of a  dark pur-
plish-red color, appearing  in  small crystals and readily  soluble in
water.  In  the  presence of moisture it rapidly gives up the  oxygen
whicli it contains and becomes the binoxide of manganese.
   By reason of this oxidizing  power the  permanganate  of potassium
is largely used as an antiseptic aud  deodorant.   It  should not be
employed as a disinfectant, because  its action is too fleeting.
   Permanganate  of  Potassium (Potassii Permanganas,  U.  S.  and
B. P.)  is given in  the  same  dose for the same  conditions as the
binoxide of manganese, but is  much less  efficacious.  It is also very
apt to irritate the  stomach.
   It is  thought to  be useful  in  dyspepsia, flatulence, lithemia, and
obesity, and in the  former states  is  certainly  of service, being a
destroyer of the abnormal products by oxidation.   Owing to this or
other reasons, it has been asserted  by Weir Mitchell and Reichert to
be the  most efficient antidote to snake venom, if placed in the wound
before the  poison is absorbed.   It should be injected hypodermically
about the bite.   Owing to its rapid absorption of oxygeu it acts as an
antiseptic, and may be used in the washing of wounds, ulcers, and
sores, and as a  lotion in  the form  of a gargle, or on a swab in diph-
theria and  scarlet fever.   The  solution used should be from 20 to 60
graius to the pint; the former if used on mucous membranes, the latter
for sores and wounds.  In fetid rhinitis and otitis media permanganate
solution is useful  as a wash.   When given in solution  permanganate
of potassium should be dissolved in distilled water, and it should never
be mixed in a mortar with any organic matter, as it will explode.
The drug has  been used  for  the  relief of amenorrhoea in the same
manner as the binoxide of manganese.  A solution (Liquor  Potassii
Permanganas) is official in the B. P. 
PHENACETINE OR  ACETPHE NETIDINE.        273
                       PETROLATUM.

  Under the name of Petrolatum, U. 8., or Unguentum  Petrolei,  is
sold a semi-solid substance derived from coal-tar and sometimes called
Cosmoline or Vaseline.
  Owing to its  soothing powers and  non-rancidity, it is  used as an
emollient dressing in sores and skin affections.  It has no value ex-
cept as a protective, and may be given in capsules in cases of gastro-
intestinal irritation in any quantity as a soothing treatment.  It does
not affect  the passages from the bowels and is not absorbed, although
assertions to the contrary have been made.
  Cosmoline is a useful vehicle  for medicines for the  skin.  Under
the name of fluid or liquid cosmoline a fluid  form is sold, and is used
in the form of a spray in the treatment of rhinitis and after  irritant
applications  to the nasal cavities.


        PHENACETINE, or ACETPHENETIDINE.

   This  is another of the coal-tar products introduced several years
ago as an antipyretic of the same  character as antipyrine, and while
more apt to  disintegrate the blood than the latter drug when given  in
large amounts, is not very dangerous, because its influence upon other
vital parts is not severe.
  When this drug is carelessly made an impure product is the result,
which produces  irritation of the kidueys and, in consequence, causes
grave complications.  Reuter states  that the impurity may be dis-
covered by placing a small amount of chloral hydrate in a test-tube,
melting it at the temperature just sufficient to liquefy it, and then adding
the suspected sample of phenacetine in the proportion of one-fifth.   If
the phenacetine is impure it will become purple, then red, and finally
blue.
  Physiological  Action.—Unfortunately our knowledge of the phy-
siological action of phenacetine upon the nervous system is not  as
thorough as is  desirable.   We know, however,  that it is  a  distinct
nervous sedative, and that it acts particularly on the spinal cord in its
sensory paths.
  Upon the  circulatiou the drug has  little or no effect, unless given
in doses far above those generally employed, or continued in over-
dose for some time.  The blood after the ingestion of these  doses be-
comes dark  and blackish from the formation of rnethaemoglobin, and
the urine  becomes dark yellow  and reacts with Fehling's solution.
Upon normal bodily  heat  and the heat of  fever the drug exerts a
depressing effect, decreasing the production and dissipation of  heat.
  Therapeutics.—Our knowledge  concerning the influence of phen-
acetine upon the human body  in  disease may be divided  iuto two
separate parts, in much the same manner that we divided antipyrine—
namely, its uses as an antipyretic and as an analgesic.
                               18 
274
DRUGS.
  Like the other members of the antipyretic group which are blessed
with this double action, its antipyretic influences were first observed,
and shall therefore first be spoken of.
  The employment of this drug  in  medicine  was first attempted by
Hiusberg and Kast, who from the very first spoke of it in the highest
terms  of praise.  They found that  it seldom, if ever, caused serious
untoward effects, and  that its power over fever, in the dose of from 3
to 8 grains, was quite extraordinary.   Very shortly after the paper of
these writers appeared, Kohler published the report of its use in some
fifty cases in the clinic of Bamberger of Vienna,  the febrile affections
being  tuberculosis, pneumonia,  typhoid fever, pleurisy, and several
other  diseases of like character.   He found, as have most of his suc-
cessors, that the fall of fever does not occur for  nearly half an hour
after the  dose is taken, aud that the stage  of apyrexia continues  for
from four to eight hours afterward.
  As a general rule, sweating  was not noted as being present to any
great extent, but in phthisis and  advanced typhoid fever there can be
no doubt that  chilliness and an abnormal fall of temperature may
come on.   Cyanosis and vomiting did not occur in a  single  one of
Kohler's  cases.   In a  very instructive case  of pneumonia due to septic
infection  in a patient  of twenty years, phenacetine not  only lowered
the fever, but in  addition decreased, to a  large extent,  the blood in
the urine, and did  not in the slightest degree influence the kidneys
unfavorably.  That the drug has  power is evidenced by the fact that
Kohler used it only when the temperature reached as high as 103°,
104°, or  105° F., and in these cases the temperature fell not less than
from three  to five degrees.
  It is a very important fact to  be remembered  that morning  doses
of phenacetine seldom  have as powerful an influence as evening doses.
Two morning doses are only equal to one evening dose in most cases,
and it would seem better in phthisis to give the drug about noon to
prevent the evening exacerbation of temperature than to resort to it at
a time nearer the pyrexial period.
  The conclusions  of Kohler have been  confirmed  by Hoppe in a
long series  of studies,  and this  writer also  points out the deleterious
excess  of apyrexia  which  sometimes  comes on in debilitated cases of
phthisis.
  One of the advantages of having  several drugs belonging to one
class is the benefit often  derived from the use of one where another
has failed.   Thus Hueber found that in several instances phenacetine
was successful  where antipyrine had not  acted,  and believes it to be
the more powerful drug of  the two—a conclusion  also reached  by
Heusner, who thinks that 15 grains of phenacetine are  equal to half
as much  antifebrin and to 30 grains of antipyrine.  Lepine, who  has
studied with so much care  the  other antipyretics, also  believes it to
be superior to them all, and in this Guttman  is  largely of the same
opinion.
  These  conclusions are, in the author's belief, far too favorable, for
while he  has found  the drug to possess  powerful antipyretic activity 
PHENOCOLL.
275
and to be useful in nearly all the fevers where antipyrine  can be em-
ployed, he does  not  look upon  it with the same degree of confidence
that he does the latter drug, when  anxious to reduce a fever which
seems dangerous and worthy of rapid and certain  reduction ; neither
does he believe it to be as safe as antipyrine.
  Upon the nervous  system  phenacetine acts as an anti-neuralgic, is
of service in migraine and  ordinary headache from  eye-strain, in tabes
dorsalis, in  intercostal  neuralgia, and in rheumatism.   Sometimes it
cures these  troubles when  antipyrine fails.   Altogether we may con-
sider phenacetine a rival of antipyrine in the power to relieve pain.
  For neuralgia the following prescription may be ordered :

         R.—Phenacetine......gr. x.
             Caffeinse citratis  .   .   .    .    .    .   gr. v.
             Sacchar. lactis   ......   gr. xx.    M.
    Ft. in chart, no. v.  S.—One powder every two hours while pain lasts.

  In rheumatism and iu the lumbar  or muscular pains of influenza a
powder or pill  of 4  grains of phenacetine and 5 grains of salol given
three or four times a day is most efficient.


                         PHENOCOLL.

  Phenocoll is a compound closely allied to phenacetine.  It is always
used in the form of the hydrochloride of  phenocoll, which occurs  in a
fine, white powder, quite soluble iu water and forming a neutral solu-
tion   It is incompatible with alkalies.   It is used  as an antipyretic.
  Physiological Action.—A number  of studies of the action of pheno-
coll  hydrochloride  upon  the  animal organism have  been  made by
Kobert and Von Mering, in Europe, and by Wood and Cerna, and Ott,
in America.  These investigators have found  that it separates itself
from most of the coal-tar antipyretics in  that it has little effect  on the
red blood-corpuscles.   It does not cause as great  a sweat when  the
fever falls as do its near antipyretic relations.   Von Mering has  shown
that phenocoll  has little lethal  power, but Ott asserts  that it kills by
failure of respiration and causes paraplegia, cyanosis, and  depression
of the heart in poisonous dose.
  Therapeutics.—Whatever advantages further clinical  experience will
show this drug  to possess over its older fellows iu the antipyretic field,
it cau never be widely used as a  remedy for fever, since no drug is now
widely  employed for this effect except in a limited  class of cases   As
pointed out in the treatment of Fever, antipyretic drugs are of little
value as compared to bathing.  Phenocoll may be  given for the same
purposes and under the same circumstances in the presence of fever as
can antipyrine or acetanilide, but like these drugs is contra-indicated
in advanced exhausting diseases  such as consumption.   A number of
clinicians have tried  phenocoll  hydrochloride for  the relief of rheu-
matism and to remove neuralgic pain, with asserted success.   As yet
it has not  been used  largely enough to insure its continuance as a 
276
DRUGS.
remedy of positive value.  The dose of phenocoll hydrochloride is 5
to 8 grains two to five times a day.  It is best given in capsule.


                 PHOSPHATE  OF SODIUM.

   Sodii Phosphas, U S. and B. P.,  is a preparation whicli is rarely, if
ever, used to supplant phosphorus, as it has an entirely different effect.
It is particularly useful in bottle-fed children, who continually alternate
between diarrhea and  constipation, and is also useful in rickets.   It
should be added  to  each bottle  of  milk in  the dose of 2 to 4 grains.
Phosphate of sodium is slightly laxative.   Bartholow believes phos-
phate of sodium  to be the  best  remedy that we have  in  hepatic cir-
rhosis and jaundice.

                    PHOSPHIDE OF  ZINC.

   Zinci Phosphidum, U. S., is often  used  in  place of  phosphorus,
owing to  its greater stability and readiness of administration.  The
dose is fa to y1 of a grain three times a day.    It is used in  gelatin-
coated pills.

                     PHOSPHORIC ACID.

   The pure acid  is very rarely employed in medicine, but when given
is used in 2 to 8-drop doses.  In the form  of dilute phosphoric  acid
(Acidum Phosphoricum  Dilutum, U. S. and B. P.) it is widely em-
ployed in the dose of 20 drops to 1 drachm as a tonic and gastric stim-
ulant.  It is not a food to the nervous system, does not resemble phos-
phorus in  its physiological action, and  is not to be employed in its
place.  It does good in nervous exhaustion simply by stimulating the
stomach and thereby aiding the organ in the digestion  of food.
   Many cases of wretchedness  or  headache due to an excess of uric
acid in the blood are relieved by this drug if the phosphate  of sodium
or calcium be used,  since these substances cause the disappearance of
the acid from the blood, not by causing its elimination, but by causing
its deposit in the tissues in the form of urates.  The use of these so-
called acid phosphates is harmful in gouty or rheumatic persons.


                        PHOSPHORUS.

   Phosphorus, U. 8. and B. P., is a  non-metallic element, generally
obtained from bones, and is very soluble iu oils, less so  in  ether aud
alcohol.   Its odor is very characteristic and peculiar.  When placed
in a dark room  after exposure to light it is luminous, and  if exposed
to the air will ignite.   It  should be kept in  tightly stoppered bottles
under water.  Very commonly it is contaminated by arsenic  and sul-
phur. 
PHOSPHORUS.                      277
  Physiological Action.—Phosphorus is found iu large amount, com-
paratively speaking, in the bones and in the nervous system, and is a
stimulant to the growth of both.  It acts, therefore, as a direct tonic
to nervous tissue aud is a producer of bone.  Upon tissue-waste the
drug acts as a depressant, thereby preserving the body, as it decreases
the elimination  of urea and diminishes the quantity of carbonic oxide
exhaled.
  Upon  the growth of bones phosphorus has a most remarkable in-
fluence, causing, when  it is given to young animals, great increase in
the size  of  these parts.  The first  change noted is  an  enlargement
which consists  in a jelly-like mass containing little or no bone salts,
and this  is  finally converted into a very hard material which may fill
the entire canal in the centre of the bone.   Kissel has stated that this
does not  occur, but his results must be doubted iu view of the thorough
studies of Wagner.
  Acute  and Chronic Poisoning.—When  phosphorus is taken in poi-
sonous dose, often from the ends of matches,  no  symptoms may come
on for  eight or ten hours.   At the end of  that time the peculiar taste
of  phosphorus may be noted in the mouth, the  breath  is heavily
laden with its color, and burning pain iu the oesophagus, stomach, and
abdomen ensues.  Vomiting and purging  now assert themselves, and
both the  matters which are vomited  and  those which are passed from
the bowels  may be luminous in the dark owing to  the  presence of
phosphorus.  The vomit at first consists of food, then mucus, then bile,
and then perhaps blood.   All the symptoms of a mild gastro-enteritis
may develop, but it is to be noted  that constipation of an obstinate
type may replace the purging.  Very soon the liver  increases in size
and gives rise  to general  hypochondriac pain and  tenderness as well
as local  swelling.   At the end of twenty-four hours, or, perhaps,
after the second day, a cessation in the symptoms occurs, and, if the
physician be not on his guard, this will lead him to a hopeful prog-
nosis, but in the course of a few hours jaundice begins in the con-
junctiva  and then extends  over the entire body.   With the onset of
jaundice  the vomiting and   pain return with renewed vigor.    The
matters vomited  are  often   the color of  "coffee  grounds,"  due to
exuded and altered blood.   The bowels  are absolutely  confined, or
the few  hard masses  passed are white and  clay-like because of the
absence of biliary coloring matter.  There is no bile in the vomit in
this stage because  the  hepatic ducts have  been closed  by the inflam-
mation which has been produced in the liver.  Later, nervous symp-
toms ensue.  Muscular twitchings, headache, vertigo, wild  delirium,
erotic  convulsions, and finally unconsciousness  aud  death  occur.
Sometimes the convulsions occur just before dissolution.  Even if the
patient survives the acute stage of the poisoning he generally dies of
the changes produced  in his  organism, which consist in widespread
fatty degeneration.  These fatty changes occur even in the acute period
of the  poisoning.   Atrophy of the liver, destruction of the gastric
tubules, pancreatic involvement and  kidney degenerations aid in pro-
ducing the ultimately fatal results. 
278
DRUGS.
  During the poisoning by phosphorus the urine is scanty and per-
haps albumiuous, and is  peculiar because  of  the  unusual substances
which are found iu  it.   The most unusual of these is sarco-lactic acid,
which results from the breaking down of the muscular tissues.  Leucin
and tyrosin are also found, and tube-casts with fatty globules in  them,
are seeu.   Free fat  globules may also occur.   Bile acids aud bile col-
oring matter  are found iu large amount, and  the urine is generally
dark-colored for this  reason.  As phosphorus  is eliminated as  hypo-
phosphoric acid, this substance is also present.
  The symptoms of phosphorus poisoning may so closely resemble
those of acute yellow atrophy of the liver as  to make a  differential
diagnosis  impossible unless some evidence of the presence of phos-
phorus is  obtainable.
  In chronic poisoning by phosphorus, when,  by the inhalation of its
fumes systemic changes occur, the most  common lesion  is  necrosis  of
the lower  jaw, which may be widespread or limited.   It never occurs
in those who have  no  solution of continuity  iu the teeth or  gums,
and for  this reasou  it is necessary that  the employes in match  facto-
ries should have  their  teeth constantly attended to.  It  is said that
pans containing turpentine when  set around the room will  protect the
workmen, but this is the merest fetich.
  Treatment of  Acute Poisoning.—The antidote to  phosphorus
is generally taught  to be the sulphate of copper, which  will act as an
emetic if given in excess, but recent studies made by Thornton  in the
laboratory of Jefferson Medical College prove that it is as dangerous a
poison as  the phosphorus.  Peroxide of hydrogen and permanganate
of potassium are probably the best antidotes.  Oil of turpentine, in
America,  is not only valueless as an antidote, but  harmful, for only
old,  ozonized, French oil  of turpentine  is antidotal in its influence.
As phosphorus is soluble in oils, we simply aid  in its absorption  if any
such substances are given.
   Therapeutics.—Owing to its influence on the development of bone,
phosphorus is very useful in rhachitis and osteomalacia.   It  is also
useful in the sweats of general or nervous  debility and in nervous ex-
haustion,  aud in some cases of melancholia  depending upon overwork.
In the  course of prolonged exhausting  diseases, as typhoid fever  or
typhoid pneumonia, the drug is of service if the nervous system seems
to be particularly affected,  aud in convalescence it is of great  service
to aid in building up the shattered forces of a patient.
   In the  sequelae of acute and chronic alcoholism and in morphiomania
it is often of service.   Phosphorus is also  employed in sexual exhaus-
tion  or abuse.   In  boils  and carbuncles and  similar disorders phos-
phorus  is very useful, particulary so in acne indurata.  In pneumonia
some physiciaus use minute doses with  the belief that  it  aids  in the
production of resolution, one of  the most  enthusiastic  of these being
Dr.  Board man Reed.
   In the  neuralgia from  nerve-depression, and in  cerebral softening
and meningitis of a chronic type, phosphorus often does good.
   The  dose  of phosphorus is  Tfa  to fa  of  a grain  iu  pill  form 
PHYSOSTIGMA.
279
(Pilula Phosphori,  U. 8. aud B. P.), but it may be gradually pushed
to fa of a grain  if urgently  needed.   Phosphorated  oil  (Oleum
Phosphoratum,  U.  8. and B.  P.) is  given  in the dose of 1 to 5
minims.
   The  beginning dose  of phosphorus should not  be above fa-§ of a
grain for fear  of some idiosyncrasy.


                       PHYSOSTIGMA.

   Physostigma,  U.  8., Physostigmatis Semen, B. P., is a seed derived
from Physostigma  Venenosum,  a  tree of West Africa, often called
Calabar Bean.  It contains two alkaloids, eserine  or physostigmine,
and  calabarine.  The former is  the most important  from a medical
point of view.
   Physiological Action.—Calabar bean is a general paralyzant, but if
the alkaloid calabariue be in excess it may be a  convulsant.
   Nervous  System—On the  spinal cord in poisonous dose,  this
drug acts as a  direct depressant poison,  particularly affecting  the
motor tracts.  On the motor nerve it exerts no  influence at  all unless
given in large toxic doses, when it depresses  their peripheral ends.
The sensory nerves  generally escape, but  sometimes even they  are
involved.   On the  voluntary muscles the drug  in  these doses  causes
twitchings, due to a direct  influence over their  fibres.  In  all medi-
cinal doses the drug is a stimulant to unstriped muscular fibre.
   Circulation.—Calabar bean  causes  comparatively little  circu-
latory change, but it produces a rise of arterial pressure, based largely
upon a direct  stimulation of the heart, and slows  the pulse by peri-
pheral stimulation of the cardiac inhibitory nerves.
   Respiration.—In moderate amount Calabar bean causes no  in-
terference with the respiration, but  in poisonous dose produces death
by paralysis of the respiratory centre.
   Pupil.—Physostigma  causes  myosis or contraction of the pupil
by stimulation of  the oculo-raotor nerves peripherally, and  by  de-
pression of the sympathetic fibres.   It decreases  intra-ocular tension.
   Alimentary Tract.—Physostigma  is a stimulant to  intestinal
peristalsis,  increasing the  muscular activity in  the walls of the gut,
and acting as a tonic to these fibres.
   Poisoning.—Calabar  bean is  used by the African as an " ordeal
bean," to determine whether a person is or is  not guilty of a crime.
If an individual eats it and survives he is guiltless,  but if he  dies he
is  guilty, according  to this rather fatalist belief.  If he does survive
it  is generally  by  reason  of the  calabarine producing vomiting aud
purging, and so ridding  the patient's stomach  of the poison before it
is absorbed.
   Poisonous  doses  cause  muscular tremors,  followed  by  complete
muscular relaxation.  The  pupils  contract, the respirations become
slow and irregular, and all  reflex action fails.  Vomiting  or purging
may or  may not occur. 
280
DRUGS.
  Treatment of Poisoning.—This consists in the use of atropine,
which is the physiological antidote, iu the application of heat to the
body, and the use of respiratory and cardiac stimulants, such as digi-
talis,  alcohol or ammonia.
  Therapeutics.—Calabar bean  is employed in many affections, such
as trismus neonatorum, tetanus, and other spasms, with only moderately
good  results.  It  is, however, of value  in atony of the bladder and
intestines, and in catarrh of the bowels.  The author has used it with
great  success in cases of gastric and intestinal dilatation.
  In  bronchial asthma and emphysema it will aid iu the expulsion  of
the  mucus by its influence over the muscular fibres in the walls of the
air-tubes.  It is also useful in purgative pills.  (See Constipation.)
  Administration.—Physostigma is used in the  form of  the  extract
(Extractum  Physostigmatis, U. S. and B. P.) in the dose of J of a grain,
which may  be readily increased to \ of a grain.
  The tincture (Tinctura Physostigmatis, U. S.) is given in the dose of
10  to 40 drops.
  Eserine (Physostigmina, B. P.) may be used in the dose of -g1^ of a
grain three times a day.   In the eye, the strength of 1 to  2 grains  to
the ounce of water, eserine is used in the treatment of corneal ulcera-
tions, and for the relief of glaucomatous states with high intra-ocular
tension.   If, for any reason, atropine mydriasis is to be rapidly over-
come, eserine is to be used, but it is  not so powerful as atropine, and
it will require larger amounts of the  solution to  produce  contraction
than it took of atropine to cause mydriasis.  Lamelle  Physostigmine,
B. P., each  contain  -ffa-^ of a grain of physostigmine.   Two salts of
eserine or physostigmine are now on the  market,  namely, the sulphate
and the salicylate.   The former is much  more soluble and is generally
to be  employed.   The salicylate is  largely used nevertheless by oph-
thalmologists.  The  dose of both salts is -j-jU^- to -j-^ of a grain.


                        PILOCARPUS.

  Pilocarpus, U. S., Jaborandi,  B. P., is derived from  the South
American tree, Pilocarpus Pennatifolius.  It contains two alkaloids
known  as pilocarpine aud jaborine, a volatile oil,  and other minor
constituents.  The alkaloid pilocarpine is non-crystallizable and occurs
as a soft mass.   The salts of pilocarpine are, however,  crystallizable.
  Physiological  Action.—When jaborandi is taken in  medicinal dose
by  a  healthy man it causes a deep  flushing of  the face and  neck,
followed by the  outbreak  of a  profuse  sweat, which,  though begin-
ning in  these regions, rapidly spreads over the entire body.  Accom-
panying the sweat the salivation is  often exceedingly profuse,  so that
saliva dribbles from the mouth.  Nausea frequently  comes on, and
severe vomiting  may appear in  susceptible persons either during  or
after  the sweating.   On  the contrary, some individuals are singularly
insusceptible to the influence of pilocarpus, and this is particularly so
with  children, according to Ringer, who will often  take  as  much  as 
pilocarpus.
281
60 grains of the crude drug before they perspire.  Some adults also
refuse to yield to its influence.1   The  sweat lasts from  three to five
hours.
  Nervous  System.—Moderate doses have no effect on this part of
the body, but poisonous amounts cause in  the frog tetanic reflex con-
vulsions, and finally paralysis, the latter being due to depression of the
muscles and spinal centres.   The nerves escape.   Medicinal doses in
man exercise no effect over the nerves.
  Circulation.—In large  doses there is no doubt  that  jaborandi
acts as a cardiac depressant rather thau as a stimulant, and while there
may be no evidence of an experimental character pointing  to  such a
conclusion, the fact exists  in  practical medicine.   The drug causes,
in the lower animals, a slow pulse and increased  arterial pressure,
in  moderate  quantities, the first  change  being due to an  action on
the inhibitory centres in the heart or the  peripheral vagi.  Ringer, on
the other hand, has proved that it slows the beat of the ventricles in
the frog, when they are separated  from these centres, and believes that
the drug acts directly on the motor centres of the heart-muscle and the
muscle  itself.   In man the drug does not slow the pulse but quickens
it very markedly, often as much as forty to fifty beats per minute. The
rise of arterial pressure seen iu the animal is often replaced by a fall of
pressure in man, and though the pulse in animals is generally made
stronger from its use, in man it is generally weaker.
  Temperature.—Jaborandi lowers bodily temperature to a consid-
erable degree, probably by the dilatation  of the peripheral capillaries
and the profuse sweat which it produces.   This fall is sometimes pre-
ceded by a brief rise.
  Kidney  and Tissue-waste.—Upon the kidneys jaborandi acts
very slightly or  very strongly,  according to  the  dose  that is  given.
Large  doses, which produce  a profuse sweat, naturally decrease the
urinary secretion, and small ones undoubtedly increase it.  Upon the
tissue-changes in the body under pilocarpine no researches have  been
made, but it is an undoubted fact that the excretion of urea  is largely
increased in disease under the influence of this drug.
  Eye.—Jaborandi contracts the  pupil by acting peripherally on the
nerves of the iris.
  Skin.—The amount  of sweat caused by the drug in  man may equal
as much as a pint, and  it  is, generally, first acid, from the  secretions
of  the  sebaceous glands ;  then neutral;  and finally, alkaline.  The
sweating is  not  due to vasomotor palsy,  but to stimulation of the
ends of the nerves supplying the glands and of the sweat-glands them-
selves.   Sometimes excessive salivary  secretion  supplants that of the
skin.
  Pilocarpine increases the gastric, salivary, and lachrymal secretions
as well  as that of the skin and kidneys.   It also seems to have con-
siderable influence over  the secretion of milk.

  1 The writer has reported a case (see Idiosyncrasy, page 25) where a woman of
thirty received three-quarters of a grain of the muriate of pilocarpine  hypodermi-
cally in half an hour without any effect. 
282
DRUGS.
   Therapeutics.—Jaborandi or, better still,  its alkaloid, pilocarpine,
is of great value for the relief of dropsy of the renal  type.   In that
due to cardiac disease it  is generally too depressing, and  the author
knows of a case in which a fatal result  followed its use under these
circumstances.   It  may be  used to abort an attack or paroxysm of
malarial fever, but because of its depressant  influence should never be
employed in asthenic fevers, such as typhoid  fever.   In pleurisy with
effusion it may be used, but more efficient remedies are elaterium or
salines given in concentrated form and at the proper time of the day.
(See Magnesium Sulphate and Dropsy.)  Mitkowski has tried pilocar-
pine iu catarrhal jaundice of a persistent type with great benefit, in the
hypodermic dose of i; grain every other day for three weeks.  In uremic
poisoning pilocarpine is the  most efficient and rapidly acting remedy
that we have, and when used in BrigMs disease it is of value in several
ways : first, by removing the straiu on the kidneys  ; second, by elimi-
nating the uraemic poison  ; and  third, by decreasing the inflammatory
action in the kidueys, if  they are  acutely inflamed, by lowering the
blood-pressure which, it will be remembered, is the more constant effect
of the drug  in man.   The drug iu small  doses certainly increases renal
activity.  The hypodermic dose as a renal stimulant should be about
fa t° fa of a grain.  In some forms of profuse sweating, such as come
on at night in  general debility, pilocarpine, if given  hypodermically
or by the mouth about two hours before the sweat in the dose  of fa of
a grain, is often useful, even where atropine fails.   Pilocarpine cer-
tainly has a decided effect in encouraging the growth of hair,  and ap-
plied locally will often do good  in partial baldness.   If too much
pilocarpine is used it is apt to cause the development of small  pustules
about the hair follicles.   Bartholow recommends the following appli-
cation for baldness:

         R.—Extract, pilocarpi fluid.    ....  f 5j.
             Tincturse cantharidis  .    .    .    .   .  f 3SS.
             Liniment, saponis.....f ^jss.   M.

   Antagonisms of  Jaborandi.—Jaborandi is a physiological  antidote
to atropine and to agariciu.  Four times the dose of pilocarpine must
be used to equal a dose  of atropine.
   Administration.—The  dose of jaborandi  is 40 grains, used iu the
form of the powdered  leaves  in  infusion.    The  fluid extract  (Ex-
tractum Pilocarpi Fluidum, U. 8.) should  be used in the dose of 30
drops to 1 drachm.   Pilocarpine is far superior to jaborandi, in that
it does not so often  produce nausea and  vomiting.   It  is used in the
form of the hydrochlorate (Pilocarpine Hydrochloras,  U. S.) in the
dose of from \ to J of a grain hypodermically or \ to J of a grain by
the mouth.
   The preparations of the B. P. are, the extract (Extractum Jabo-
randi) dose 2 to 10 grains; the infusion (Infusum  Jaborandi), dose 1
to 2 fluidouuces; the tincture (Tinctura  Jaborandi), dose \ to J fluid-
ounce ;  and the nitrate of pilocarpine (Pilocarpine  Nitras), dose ^V to
I grain. 
PISCIDIA ERYTHRINA.
283
  Clinical reports show that pilocarpine in small doses is a very good
remedy in tobacco and alcoholic amblyopia, and Da Costa has recently
highly recommended the hypodermic injection of pilocarpine around
the border-line of erysipelatous inflammation as a preventive and cura-
tive measure iu the early stages of this disease.
                         PIPERAZINE.

  This  is a  substance the  chemical formula  of which is  CJELJSL
  1*111          i
which has been recently introduced into medicine for the treating of
the uric acid diathesis.  It is not stable, and when exposed to the air
attracts  water and carbonic acid.   Aqueous solutions are decidedly
alkaline, but do not have any distinct taste.
  Piperazine is peculiar  in its power to dissolve uric acid, dissolving
twelve times as much as will carbonate of  lithium, while it  is also
entirely soluble in water, which lithium is not.   When taken into the
body the drug  is  partly oxidized  and  partly eliminated unchanged.
Theoretically piperazine, when taken into the body, forms with uric
acid a urate of piperazine, which  is soluble and readily eliminated.
As yet  no competent experiments have been made to determine this
point, but repeated clinical observation  has  shown  that the adminis-
tration of the drug causes an increase  in the amount of urea in the
urine with a decrease in the uric acid, iudicating that under  its influ-
ence oxidation is more complete.
  Therapeutics.—Piperazine is used for the purpose of preventing the
formation of renal and vesical calculi  in  the uric acid diathesis, and
also iu cases where  the excess of uric acid in the urine tends to produce
irritation of the bladder.   Similarly its action has been found of value
in treating vesical  irritation  due to this  cause  by washing out the
bladder with a solution of piperazine of the strength of one per cent.
Piperazine may  also be injected into uric acid deposits about the body
or applied to the broken-down surfaces  of these deposits in 1 per cent.
solution.
   The dose of piperazine is 15 grains in twenty-four hours.   It is best
given by dissolving this amount of the drug  in one pint of water, and
directing the patient to take a  wineglassful of  the solution frequently
through the day.  Owing to  the effect  upon the drug of exposure to
air it cannot be given in  pill  or powders, and should be freshly mixed
each day.  The  writer has failed  to obtain any results from the use of
this drug in his practice.


                   PISCIDIA ERYTHRINA.

  Piscidia Erythrina is a drug which is stated to possess  marked nar-
cotic and pain-relieving properties.  It is sometimes called Jamaica
dogwood.  Its powers as a soporific aud analgesic do not compare with
those of opium, but  it is stated to be devoid of the unpleasant after-effects 
284
DRUGS.
of the latter drug.  Further studies concerning its effects on the animal
economy are needed.  According to Dr. Isaac Ott and  Dr. Nagle the
drug has little or no effect on  the motor and sensory nerves, and its
dominant effect on the circulation is to increase arterial pressure through
stimulation of the vasomotor system.   The  indications  which have
been met best  by piscidia are dysmenorrhea due  to irregular flow and
spasm of the uterine cervix and fundus, to allay nervous irritability,
and to relieve pain or insomnia due to pain.
  Administration.—The dose of the fluid extract of piscidia erythrina
is J to 2 drachms; of the solid extract 2 to 10 grains.   The alkaloid
piscidine is not known to represent all the properties of the drug and
is not used in  medicine.

                             PITCH.

  Pix is a resinous exudation derived from  several species of pines,
firs, and spruces, and is, in one of its forms, obtained by  the evapora-
tion of  wood-tar.  It is used for various purposes, according to its
derivation.  Burgundy Pitch (Pix  Burgundica, U. 8. and B. P.) is
derived from Norway spruce, or Abies Excelsa, a plant  of Europe and
Asia.  It softens and melts at the temperature of the body, and is
useful in plasters.   In muscular  rheumatism and in chronic bronchitis
pitch is a mild  and fairly useful  local remedy.  In the form of the
plaster  (Emplastrum Picis Burgundice,  U. S. and B. P.) and in the
form of warming plaster (Emplastrum Picis cum  Cantharide, U. S.) it
is employed for the relief of deep-seated sprains and bruises, aud acts
as a mild counter-irritant, which may blister a tender  skin.  Canada
Pitch (Pix Canadensis,  U.  8. and B. P.) is obtained from the hemlock
spruce of Canada and the United States, and is used for the same pur-
poses as Burgundy  pitch.   The Canada-pitch  plaster  (Emplastrum
Picis Canadensis, U. S.) is employed for the same conditions as the
plaster of Burgundy pitch.
                               Tar.

   Under the name of Pix  Liquida,  U. 8. and B. P., or Tar, we have
an empyreumatic oleoresin obtained by destructive distillation from
Pinus Palustrus and other varieties of pine.  It is a thick, dark oil,
slightly soluble in water, and soluble in alcohol,  oils, and solutions of
potassa and  soda.   By distillation of tar we obtain oil of tar (Oleum
Picis Liquide,  U. 8.), which is sometimes  used by inhalations from
an atomizer in bronchitis, but is  not a particularly useful application.
It should be diluted with some other oil or with  fluid cosmoline.  Tar
itself is used  in subacute and chronic bronchitis in 2-grain pills, and as
a remedy for gasiro-intestinal catarrh.   Externally,  it is  used in
psoriasis and other skin  diseases  needing stimulation.  In obstinate
diarrhea Wood has highly recommended a  mixture of tar made as
follows : Add a pint of tar to a gallon  of lime-water,  aud allow this
solution to stand one week, stirring it every few hours.   Decant the
clear liquid   and percolate  it through powdered wild-cherry  bark, 
                        podophyllum.                     285

allowing one ounce of the bark to  be present for each pint passed
through it.  The dose is a wineglassful.
  In chronic bronchitis tar-water is largely used, as a popular remedy,
in Europe and England.  Tar-water is made by shaking 1 part of tar
with 4 parts of water several times during twenty-four hours, decant-
ing and filtering.   The dose is from 1 to 2 pints a day as a drink.  It
at first increases the expectoration, but finally decreases it.
  Syrup of Tar (Syrupus Picis Liquide, IT. S.)  is simply sweetened
tar-water.
  In skin  diseases of the dry, scaly sort, tar ointment (Unguentum
Picis Liquide, U. S.  and B. P.), equal parts of tar and suet, is very
useful if frequently applied.  It should not  be used on  the face, as it
will stain the skin..
  Wine of Tar ( Vinum Picis) is made  by adding together tar 1 pint,
glycerin, white wine, and honey, of each half a pint, dilute acetic acid
1 ounce, and 3 quarts of boiling water, and  shaking  constantly at a
temperature of 160° Fahr. for several hours.  It is then set aside to
stand for some days and repeatedly filtered or strained through  mus-
lin.  The dose is 1 to 4 ounces.   It may be  used  instead of tar-water
or tar-syrup.

                       PODOPHYLLUM.

  Podophyllum, U. 8., Podophylli Bhizoma, B. P., May Apple or
Mandrake, is the rhizome and small  roots of Podophyllum Peltatum,
a plant of the United States  and Canada.   Podophyllum contains a
resin, podophyllin.
  Therapeutics.—Podophyllum  is  the  slowest-acting  purge in the
Pharmacopoeia.   In small doses it is laxative, but is purgative and
almost drastic in larger amounts.  In overdose it may produce gastro-
enteritis.  The drug particularly excites the  flow of  bile, and is used
as a cholagogue.   It is  best given when the stools are  dark in color,
calomel  being indicated when they are light.   In  children one or
two months old who have hard, stony stools, podophyllin  is  the  best
remedy.   The dose  should  be  given by dissolving  a grain of the
resin in a  drachm of alcohol and using 2  drops of this  on sugar
once or twice a day.   In children who suffer from diarrhea in which
the passages consist almost  entirely.of water, which  have  a peculiar
musty smell or a mouse-odor, podophyllin in the dose of  fa to fa of
a grain is of service, seeming to control the  passages and make them
normal.  This treatment will often succeed when all  else fails.   This
statement is also  true in regard to the chronic diarrheas of adults,
though the drug should be given in somewhat larger amounts in such
cases.  Podophyllin will also check vomiting in  these doses in some
instances, provided that the  stomach is depressed  and the liver is
torpid.   It should not be employed if the vomiting is  due to irritation
or inflammation.
  Administration.—Podophyllum is  used in the form of the extract
(Extractum  Podophylli,  IT. 8.), dose  1  to 5 grains,   as the  abstract 
286
DRUGS.
(Abstractum Podophylli, U 8.), dose J to  1  grain, the fluid extract
(Extractum Podophylli Fluidum,  U. S.), dose 2 to 20 drops, and more
commonly  than all, as  the Besina  Podophylli, U. S. and B. P.), or
Podophyllin, which is  the  best preparation.   The dose of this prepa-
ration  is from fa to fa of a grain as a laxative and from fa to J a
grain as a purge.   The tincture of the resin (Tinctura Podophylli,
B. P.) is given in the dose  of 15  minims to 1  drachm.
                          POMEGRANATE.

      Although Granatum (U. S.) is official, it is almost never used in
    America in its crude form.   It contains an alkaloid known as pelle-
    tierine, this alkaloid being a colorless liquid,  soluble in 20  parts of
    water,  and  readily  miscible  with ether,  chloroform,  and  alcohol.
    When  acids are added to it, it forms crystalline salts, of which four
    are used, namely, the tannate, the  sulphate, the hydrobromate, and the
    hydrochloride.   The first is most commonly employed, and is a yel-
    lowish powder possessing an astringent taste.  It is  soluble in 700
    parts  of water aud 80 of alcohol.   Its  physiological  action  needs
    further investigation but it seems probable that  the drug in poisonous
    amounts paralyzes  the peripheral ends  of the  motor  nerves in  a
    manner closely resembling the action of curare.
      Therapeutics.—Originally  pomegranate  was  largely  used  in  the
    form of the rind of the fruit iu  decoction as  a vegetable astringent,
    but this practice  has ceased  because of its disagreeable taste and effect
    upon the stomach.   The ailments  which were supposed to indicate its
    employment were  serous  diarrhoea and  profuse  sweats.  In some
    tropical countries the bark of the  root is used  as a vermifuge and is
    very efficient in removing the tapeworm.   It is said that the  bark  of
    the root of the wild shrub is  much more efficacious than that of the
    cultivated and more handsome plant.   To be efficacious the dose  of
    the decoction  of  the bark  must be large.   The drug is prepared by
    soaking two ounces of the bark in two pints of  water for twenty-four
    hours and then boiling down to a  pint.   A wineglassful of this is the
    dose which  is generally given, and it  may be repeated every hour
    until the whole amount is taken.   The  objectiou to this line of treat-
    ment is that  it is  unnecessarily, severe, often purging  and vomiting
    the patient excessively.  The nausea produced is often great.  Should
    purging fail to appear it is necessary to give castor oil or other purge
    to dislodge the worm aud it is always necessary to starve the patient
    for twelve hours  before the remedy is tried.
      The dose  of pelletierine is 3 to 5 grains, and the tannate is the salt
    always  employed.  Practically the only  pelletierine used is  that of
    Tanret, and  his  preparation  is a  syrupy  solution, in each bottle of
    which  is one dose of the drug.
      As large doses as 20 grains of pelletierine have been used, but as
.   very serious paralytic symptoms have ensued after the ingestion of 5
   grains  by a susceptible woman, not more than this amount should be 
QUASSIA.
287
given.   When pelletierine is used it should always be followed in two
hours by a purge.   Those who have used it most  place great reliance
on it.
  The B. P. contains one official preparation of pomegranate, namely,
the Decoctum Granati Badicis,  the dose  of whicli is  1 to 2 fluid-
ounces.

                   PRUNUS  VIRGINIANA.

  Prunus  Virginiana, U. S.,  Wild Cherry as it is incorrectly called,
is the bark of Prunus Serotina, a large tree of the United States aud
Canada. It contains two substances known as emulsin and amygdalin,
which  when they come together in water form hydrocyanic acid.
  Therapeutics.—Wild-cherry bark  is  largely  used as a domestic
tonic, and in the form of a syrup as a vehicle for cough mixtures.
  It has been supposed that the  hydrocyanic acid  present allays the
cough, but this is doubtful, as the acid is  very fleeting in its effect and
present in very small quantity.
  Administration —As a tonic it is used in  the form of the infusion
(Infusum Pruni Virginiane,  U.  8.), dose J to 1  ounce, and the fluid
extract (Extractum Pruni Virginiane Fluidum,  U S.), dose 30 drops
to 1 drachm.  The syrup (Syrupus Pruni Virginiane, U. S.) is given
in the  dose of 1 to 4 drachms.
                         PYOKTANIN.

  This is really a methyl-violet, or aniline dye of any color, deprived
of arsenic and any other impurities in order  that it may not be irri-
tating to wounds or mucous membranes to which it may be applied.
Pyoktanin was introduced to professional notice under this  name  by
Stilling as an antiseptic, but careful study has proved it to be of very
feeble power over the growth of germs.  Iu all  conditions of the eye
in which antiseptic lotions are indicated pyoktanin has been stated to
be of value, but elsewhere in surgery it  is practically useless.   Even
in the eye it  possesses,  according to  De Schweinitz, a very limited
range of usefulness, being no better than the older antiseptics except
in diseases of  the  lachrymal apparatus.  The  fact that pyoktanin
stains everything it touches is a great disadvantage in its use  It may
be tried  in blepharitis, eczema of  the  eyelids, conjunctivitis, both sim-
ple and  phlyctenular, and  in  the treatment of corneal ulcer.  When
employed it should be applied in the strength of 1 to 1000 of water.


                           QUASSIA.

   Quassia, U. S., Quassie Lignum, B. P., is the wood of Picrena
Excelsa, a large tree of Jamaica and other islands of the West Indian
group.  It contains an  active  principle named quassin, which is 
288
DRUGS.
intensely bitter and an irritant to mucous membranes.   Quassia is a
simple  bitter tonic, which has been  used very  largely in domestic
medicine and by the medical profession.  It is very efficient, is sup-
posed  to be particularly useful  in  the anorexia  following  malarial
fevers, and has even been thought to possess antiperiodic power.   In
simple dyspepsia with eructations after meals, not due to gastritis, it is
very serviceable.
   In the treatment of seat-worms (Oxyuris vermicularis) or  thread-
worms, as  they are often called, injections of the infusion  of quassia
are the most efficacious and useful  remedial measures we possess, and
are  also very harmless  to the  patient.  The bowel should be well
washed out by soap and water, and a half-pint to a pint of an infusion,
made by adding 1 or 2 ounces of quassia chips to a pint of water, should
be injected and retained for some minutes.  A few such injections will
invariably kill the parasites, provided  the bowel  is  first well washed
out with soap and water and enough fluid be injected to reach high up
into the  rectum.
   Administration.—The tincture (Tinctura Quassie, U. 8. and B. P.)
is given in the dose of  \ a drachm  to 1 drachm,  the fluid  extract
(Extractum Quassie Fluidum,  U. S.)  | a drachm,  and  the  extract
(Extractum Quassie, U. 8. and  B. P.) 1 to  3 grains.   The  infusion
(Infusum Quassie, B. P.) is given in the dose of J to 2 ounces, and is
made by macerating 1 drachm of quassia with 10 ounces of water, and
allowing it to stand twenty-four hours or more.


            QUERCUS ALBA AND TINCTORIA.

   Quercus Alba, U. S., or White Oak, in infusion is used as an astrin-
gent injection in gonorrhea and vaginitis in the female, where a large
amount  of fluid  is  necessarily employed.  It  is  also used as a wash
in the treatment  of prolapse of the  rectum, for hemorrhoids, for  leu-
corrhea  and  as a gargle in sore-throat.   It stains the clothing very
slightly.
   Quercus Tinctoria is equally efficient, but is seldom used because it
stains  the clothes very badly.  Either may be used  in  infusion in the
strength of 1 ounce to the pint of water.   In the form of the pow-
dered bark it is often used as an astringent poultice to freely running
sores to check the discharge.  Decoctum Quercus is official in the B. P.


                      RESIN, or ROSIN.

   Besina,  U S. and B.  P., is Resin, or Rosin, the mass left after the
distillation of turpentine, and enters largely into plasters, cerates,  and
similar preparations.  Its burning  fumes when  inhaled are said to
be of value in cases of chronic bronchitis.   Ceratum Besine, U. 8., is
used in the treatment of chilblains and superficial scalds, and  Em-
plastrum Besine, U. S. aud  B. P., is adhesive plaster.   Unguentum 
RHUBARB.
289
Resine is  a B. P.  preparation  used for the same  purposes as the
plaster or cerate.

                          RESORCIN.

  Resorcin is the meta compound of the group of which hydrochinone
is the para and pvrocatechin the ortho, aud occurs in clear crystals of
a slightly reddish hue.  It is quite soluble in water, alcohol, and ether.
  Physiological Action.—Resorcin is an irritant to mucous membranes,
and when  taken internally in  poisonous doses causes deafness, giddi-
ness, salivation, profuse sweat, unconsciousness, and clonic convulsions.
The heart of the dog uuder  its influence is  at first  slowed by vagal
stimulation, and then becomes very rapid from vagal palsy.
  Therapeutics.—Resorcin has  been fouud of service as a remedy for
whooping-cough, given in the dose of 10 drops of a 2 per cent, solution,
or used  in a spray of the same strength, the latter  being the better
method of using; the drug-.
  Resorcin has also been employed in a spray in 2 per cent, solution
in hay-fever with remarkably good  effects.  It has  been used as an
antipyretic, but is not serviceable, and has  little power over strong
fevers.
  The chief use of resorcin is in skin affections of a subacute or chronic
character, such as eczema, with much induration, and in psoriasis.  In
these states  an ointment of the following character, well  applied, is
of service:
         H.— Eesorcin........3j.
             Zinci oxidi........3j.
             Ung. aquae rosea.......gx.  M.
    S.—Apply to the part affected twice a day.

   After mixing the ointment,  heat it until the resorcin crystals  melt,
to prevent any irritation of the skin.


                         RHIGOLENE.

   This is  a product of petroleum  obtained  by repeated redistillation
until the liquid resulting from this  process  boils at 64.4°  F.   It
evaporates more rapidly than any other known liquid, except cymo-
gene, which boils at 32° F., and is used in a spray for the  production
of localized  numbness  or freezing  before minor painful  operations,
such as the use of the actual, cautery.


                           RHUBARB.

   Rheum,  U. 8., Rheum Badix, B. P., is the root of Rheum Officinale,
a plant of Thibet, but which is cultivated in America aud elsewhere.
It is also  derived  from China, aud this variety is known as Chinese
                                 19 
290
DRUGS.
Rhubarb.  Several alkaloids are contained in it, all  of _ whicli are
unimportaut aud never used alone, except chrysophanic acid.
  Physiological Action.—According  to  the  studies of Prevost  and
Binet,  rhubarb  acts inconstantly upon  the  flow  of bile,  sometimes
increasing it,  sometimes   having no effect, but, on the  other hand,
according to those  of Rutherford and Vignal, it never fails to stimu-
late biliary secretion.  Owing to the astringent  properties possessed
by rhubarb it  does uot purge excessively, and improves the appetite,
digestion and intestinal tone.
  Therapeutics.—Whenever  it is desired simply to unload the bowels
without affecting the general system, rhubarb  may be employed.  In
other words, it is useful  in simple  constipation.   In children a state
is very commonly seen in which  constipation  is replaced  by diarrhoea
if any  ordinary laxative  is employed, and in these instances rhubarb
is the  best remedy, as it is astringent and prevents any after-effects
beyond those  produced by the dose.   In the summer diarrhea of
children, where the stools are green, rhubarb is often used to empty
the  bowels of fermentative products before direct  treatment is in-
stituted.
  Administration.—The   preparations  of rhubarb are unnecessarily
numerous.  Rhubarb itself may be given in the dose of 20  grains in
powder, and small pieces of the root are habitually chewed by some
persons for the relief of constipation.  Extractum Rhei, U.  8.  and
B. P., is given in the dose of 5 to 10 grains in pills.  Pilule Rhei,
U. S., of which each pill  contains 3 grains of rhubarb, is  given in the
dose of 1 to 3 pills; and Pilule Bhei Compositus, U. S. and B. P.,
which contain  2 grains of rhubarb and IJ of aloes, are given in the
same  dose.  Pulvis  Bhei Compositus,   U. S. and  B. P., contains
magnesia, and is  given  in  the dose  of 20  to 40 grains;   Ex-
tractum Bhei Fluidum, U. S., is given in the dose of 20 to 30 minims.
Syrupus Bhei, U. 8. and B. P., is given in the dose of 1 drachm to
a babe, and 4 drachms  to an adult, although rarely used for  such
persons.   Syrupus Bhei  Aromaticus,  U  S., is given in the same  dose
and to  the same class of cases.   Tinctura Bhei,  U. S. and B. P., is
used in the dose of 1 to 2  drachms, and Vinum Bhei, U. S. and B. P.,
in  the  dose of 1 to 4 drachms.   Tinctura Bhei Aromatica, U. S., is
used in the dose of J to  1 drachm, aud  Tinctura Bhei Dulcis, U. S.,
2 to 3 drachms.
  The aromatic syrup is commonly employed for children and the
compound pills for adults.   Infusum Bhei,  B. P., is given in the
dose of 1 to 2 ounces, and Mistura Rhei et Sode, IT. 8., in the dose
of 2 drachms  to 3  ounces.
                    RHUS  AROMATICA.

  Sweet Sumac is unofficial,  but  has  been so  largely used of  late
that it  deserves notice.   In  hematuria, menorrhagia, diabetes, in-
sipidus, and  in urinary incontinence  in  children, depending  upon 
ROSA  GALLICA.
291
vesical atony, it has been  highly praised.   In the latter affection a
sufficient amount  of experience has been acquired to show that it
really is of benefit.  Rhus Aromatica should be used in the form  of
the fluid extract derived from  the  bark of the roots according to the
general directions  in the Pharmacopoeia for making  fluid  extracts.
The dose  as a remedy for urinary incontinence  is 15 drops of this
preparation.   Adults may take 15  to  60  drops.  The drug is  best
given with glycerin and water.
                       RHUS  GLABRA.

  Rhus Glabra,  U.  8., Smooth Sumac, is the  fruit of Rhus Glabra,
and contains tannic and malic acids as its chief constituents of medi-
cinal value.  In the fluid extract (Extractum Bhois Glabre Fluidum,
 U S.), we have  an  official preparation  which is very efficient as a
gargle for sore-throat when diluted with glycerin and water or prepared
according to the formula given under Chlorate  of Potassium.


                      ROCHELLE  SALT.

  Sodii et Potassii  Tartras, U. S., Soda Tartarata, B. P., has been
used as a  saline  cathartic in the dose of \ an ounce, and is preferred
by many patients to Epsom salt, because its taste is not so disagreeable.
It is,  however, more irritating.   Rochelle salt is the purgative con-
stituent of Seidlitz powder.


                    ROSA CENTIFOLIA.

  Bosa  Centifolia,  U. S, Bose Centifolie Petala, B. P., Pale Rose,
possesses  almost no medicinal  value, but is mentioned  because  its
official preparations are largely used in practice.
  Aqua  Rose,  U. 8.  and B. P., is  used a  diluent  or solvent  for
preparations, such as astringents, which are to be employed locally, as
in injections for gonorrhea.  It may also be  used  internally for these
purposes.   Unguentum Aque Rose, U.S., is  "cold cream," and is
largely used as an  emollient application to small burns, sores, cuts,
scratches,  and  chapped hands and  lips.   It  is much improved if a
little  glycerin  and  benzoic acid  are added to  keep it sweet in warm
weather.

                       ROSA GALLICA.

  Rosa Gallica,  U. 8., Rose Gallice  Petala, B. P., Red  Rose, con-
tains  more gallic and  tannic acids than  pale  rose, and is astringent.
From  it  are prepared the Extractum Bose Fluidum,  U. S., dose 5
drops to  2 drachms, used to flavor other extracts, and the Confectio 
292
DRUGS.
Bose,  U. 8. and B. P., which is used as a basis for pills.  Mel Bose,
U. 8., or  honey of rose, is  employed  as a  local application or as a
vehicle for gargles, and the Syrupus Rose,  U. 8. and B. P.,  dose 1 to
2 drachms,  as a flavoring  substance.  The acid infusion  (Infusum
Bose Acidum, B. P.) is given in the dose of 1 to 2 ounces.


             RUBUS HXglUS,  or RASPBERRY.

  Bubus  Ideus,  IT. S., or Raspberry,  is used for the preparation of
a syrup (Syrupus Bubi Idei,  IT.  8.) whicli  is employed very largely
as an elegant vehicle  or  flavoring mixture.   The leaves  are  often
used in domestic medicine in a decoction or infusion for the  cure of
diarrhea when an astringent is neeeded.


                              RUE.

  Buta Graveolens is the  source from which we derive the Oil  of Rue
(Oleum Buta, U. S. and B. P.).
  Physiological Action.—Locally applied, rue  is au  irritant, produc-
ing vesication, and if taken internally in large amount gastro-enteritis,
whicli may be most severe.   It is eliminated by the lungs, kidneys,
and skin, and its odor is easily noticed in all these secretions.  If the
dose be poisonous, vomiting, great pain in the belly, aud epileptiform
convulsions come on,  but  death has rarely occurred.
  Therapeutics.—Rue has  been  used  as an abortifacient,  but with
great danger to the mother.   Its action is most uncertain even  when
poisonous doses are employed.  It has been given in colic  as a car-
minative, and seems  to be  really valuable in atonic menorrhagia aud
metrorrhagia.
  Given  in capsule, oil of  rue has been employed for  the  removal
of  lumbricoid  or  round-worms, but ought  not  to  be so used.  The
dose of the oil is 3 to 6 drops.


                         SACCHARIN.

  Saccharin is a compound first  prepared  by Fahlberg under the
direction  of Professor Eemsen, of Johns Hopkins University.  It is
a  remarkably sweet substance,  220  times  stronger  than  sugar in
sweetening  power,  and  is  used  largely to sweeten  glucose  and in
confections.   It escapes  from  the body unchauged, and  has been
used in the treatment of cases of diabetes and gout to sweeten coffee,
food or medicine.
  The dose  is indefinite, but it is to be noted that a very few grains will
sweeten a very large bulk of material.
  Physiological  Action.—Upon   the  circulation  and  similar vital
functions saccharin has no  effect, but  Pliigge has proved it to retard 
SALICYLIC  ACID.
293
the action  of all the digestive ferments and  to  be in consequence
harmful to diabetics whose digestion is impaired.


                SALICYLATE OF BISMUTH.

   Salicylate  of  Bismuth  is a white, soft powder, insoluble in water,
alcohol, ether, and chloroform, but soluble in acids.   It is largely used
by some practitioners, particularly on the European continent, as an
intestinal antiseptic in cases where, in the presence of gastro-intestinal
catarrh, fermentation  or putrefaction is thought to be present in the
bowel.  It is to be given  in powder, or better still, in capsules, in the
dose of 3 to 15 grains.


                SALICYLATE  OF MERCURY.

   Salicylate  of  Mercury is a drug which has come into  quite general
use since  the introduction of the hypodermic method of administer-
ing mercury  in syphilis.   It is  to be suspended in paraffin oil in  the
proportion of 22 grains  of the  salicylate of mercury to  3 drachms of
the oil, and before it  is used the bottle must be well shaken in  order
that the insoluble mercury may not remain at the bottom.  It is of
great  importance that  the needle  and  syringe shall  be thoroughly
cleansed after each injectiou, as the insoluble  drug readily clogs  the
opening of the instrument.  At first one minim of the mixture just
named should be injected  deeply into the gluteal  region every fourth
day, and this may be increased to  every  second day if no systemic
evidences of  the action of the drug appear.


                      SALICYLIC ACID.

   Salicylic Acid (Acidum Salicylicum,  U.  8.  and B. P.)  is derived
from carbolic acid by treating it with  caustic  soda and  carbonic acid
at a moderate heat.   It is soluble in 300 parts of water aud 4 parts
of alcohol.
   Physiological Action.—On mucous membranes salicylic acid acts as
an irritant.   (See Poisoning.)
   Nervous  System.—Upon the nervous system salicylic acid exerts
comparatively slight effects in medicinal doses, causing buzzing in the
ears, decrease of the reflexes, and finally producing, in overdose,
epileptiform  convulsions by an action on the brain.
   Circulation.—Upon the circulation the effects of salicylic acid
are  not very marked in  medicinal  dose.   It  undoubtedly has  a
depressant rather than a stimulant effect,  but the depression is very
slight.  It is sufficient, however, to  make the use of the drug in cases
of feeble circulation worthy of thought and care. 
294
DRUGS.
   Respiration.—Salicylic  acid stimulates the pulmonary vagi aud
respiratory  centre, but  if the  dose be  poisonous death  is  due  to
respiratory failure.
   Temperature.—The effect  of salicylic acid on temperature has
been  studied  by the author with  a good  deal  of care.   The drug
acts as a  distinct antipyretic upon fevered states, and is  a slight
depressant of normal  bodily  heat.   The  studies of Gedl,  Fiir-
bringer and See also show this, and those  of Danewsky point to it.
In the experiments of North  upon  man, after  and during exercise,
the antipyretic effects were  marked.    According to  the  author's
studies, the drug  lowers fever  by  diminishing heat-production  and
increasing  heat-dissipation, but this is by no means positively de-
cided as a fact.
   Absorption and Elimination.—Salicylic acid is absorbed from
the stomach as a salicylate of sodium and  so circulates in  the  blood.
It is  eliminated  by the  kidneys, and by all the secretions.   In the
urine it appears as salicyluric acid.  The  urine after large  doses  is
dark olive-green, aud the change  in color  is due to the presence of
indican and  pyrocatechin, which are  formed by the  action of the
pancreatic  juices upon the drug  in the  intestine.  The presence of
salicylic acid  in the urine is to be discovered by the addition of a
solution of the chloride of iron to that fluid, which causes the appear-
ance of a violet color.
   Poisoning.—Salicylic  acid when  taken  in excessive dose  causes
profuse sweating, roaring in the ears, dimness of vision, headache,
partial  or  total deafness, and a decided  fall in  temperature.  The
pulse becomes weak and relaxed, and  finally ptosis, strabismus, and
general paralysis  ensue.  The urine aud  faeces are passed involun-
tarily, and the urine is olive-green in color.    The respirations at first
are quickened and deepened, but  finally become shallow and feeble,
death ensuing from respiratory failure.
   If the dose is  sufficiently  large the blood is involved and the cor-
puscles rapidly break down.
   Therapeutics.—Salicylic acid, owing to  its  close  resemblance  to
quinine, was  first introduced as an  antiperiodic and antipyretic, but
soon was found to be of  an inferior value in these states and of super-
lative value in rheumatism.   At present, it is rarely if ever used for
either of the  former purposes, but is largely employed as a standard
remedy for the latter trouble.
   The  value  of  salicylic acid in  rheumatism limits  itself solely to
the relief of pain and the cure of the malady without  preventing the
complications  incident to its course.  That is to  say, the changes in
the joints or heart in rheumatism are only of less  frequency after the
use of salicylic acid, because the drug  shortens  the disease, and not
because it prevents these changes by a direct influence; this  is also
seen in rheumatic  hyperpyrexia, where salicylic acid  is of  service,
though it often fails to control  the  temperature to any great extent.
In acute rheumatism 10 to 15 grains should be given hourly or every
two hours, until  marked physiological  symptoms occur.   It is to be 
SALICYLIC ACID.
295
 remembered, however, that in many cases the salicylates are of no
 value whatever, merely producing sweats aud headaches, and it is also
 worthy of note that nothing else does these cases  much good, as they
 seem bound to run a given course before the patient recovers.  If a
 cure does take place relapses are very common indeed, and the drug
 should always be continued for several days after  all symptoms cease.
 In gonorrheal rheumatism the salicylic acid is of  little value until  the
 gonorrhoea is cured, when the rheumatism  also ceases whether  we
 give salicylates  or not.  In  rheumatoid arthritis  it is  entirely value-
 less, and the same  statement is true  in  regard to gout.   In chronic
 rheumatism citrate of potassium and sodium  may be used in place of
 the salicylic acid, in the dose of 30 to 60 grains, aud  these salts  are
 to be taken just before going to bed.   In lumbago, sciatica, and similar
 states, salicylic acid is  a very useful remedy.   While it is not as good
 as  antipyrine in neuralgia, it is of great service  in the migraine of
 rheumatic persons, often entirely curing the disease. Haig has proved
 that the salicylic compounds  all aid in the excretion of uric acid, and
 thinks they relieve rheumatism in this manner.
   In quinsy or true tonsillitis the drug is  a specific, particularly when
 rheumatism  is  the  cause.   It  will generally prevent suppuration,
 shorten the  attack,  and relieve  the pain and swelling.   The doses
 should be small, and  given hourly, say  3 grains at  each  dose.   In
 stomatitis, after  the  blisters have  broken, the burning and pain  are
 often intense, and a mouth-wash of salicylic acid  in the proportion of
 1 to 250  of water is useful.
   Ringer recommends  the use of the  following salve  in pruritus of
 the  anus  and vulva :
          R.—Acid, salicylic.  .    .    .   .    .       gij.
              01. theobromse  .    .    .    .    .       gv.
              Cetacese.......^ iij.
              01. myristicse   ......   f^iss.    M.

   In the treatment of corns  there is  probably no better application
 than lint soaked in a  solution of salicylic  acid, or  the  use of the
 following formula:
          R.—Acid, salicylic.......gr.  xxx.
             Ext. cannab. indicae  .   .   .    .       gr v.
             Collodii.......f|ss.    M.
    S.—Apply with a brush until a good coat is formed.

  A solution of salicylate of sodium or  of  bicarbonate of sodium,
applied on lint to inflamed rheumatic joints, often gives  great relief.
  In gastric  dilatation  or  catarrh, where  vomiting occurs, and  the
matters vomited  contain  sarcine, salicylic acid will be found of ser-
vice, and  Bartholow thinks it of value in paroxysmal gastralgia.   In
adults  suffering from ascaris  lumbricoides, or  round-worms, salicylic
acid may be  used in the dose of  8  grains every hour till  40 graius
are  taken. For thread- or  seat-worms the following injection will  be
found of service : 
296
DRUGS.
         R.—Acid, salicylic........3SS-
             Sodii borat........3SS-
             Aquse........Oj.    M.
    S.—Warm, and inject into the bowels.  For a child reduce this one-half in all
its parts.
  In bromidrosis of the  feet (excessive sweating with fcetor) salicylic
acid may be dusted over  the parts, or the following powder used :
         R.-Acidi salicylic.  |.....aa  5ss.    M.
             Pulv. amyl.     J                         °
    S.—Apply to the feet.
  In eczema of the face and hands, where the eczema is of the wet or
weeping variety, salicylic acid, locally applied, is often of great service.
  Antiseptic Use.—Salicylic acid  is employed as  an antiseptic in the
treatment  of wounds, as a local remedy and as a dressing, but should
not be applied over too large an area,  as it may be absorbed, aud pro-
duce constitutional symptoms.   As an application to small  burns, a
mixture of 1 drachm of salicylic acid to  8  ounces of olive oil is of
service.
  In the treatment  of soft chancres and venereal sores salicylic acid
has been largely used by some practitioners either as a salve or as a
dusting-powder, as follows:
Or,
I£.—Acid, salicylic.......gr. xx.
    Alcohol........gtt. xlv.
    Adipis benzoinat.......  §ij.    M.

Efc.—Acid, salicylic.......gr. xv.
    Pulv. amyli vel cretae.....^ij.    M.
  Salicylic acid may be added to urine to keep it sweet, but will some-
times cause the tests for  sugar to appear.   Patients taking salicylic
acid often notice that  the  urine  is odorless after standing, and that it
will remain fresh for many days.
  Untoward Effects.—Salicylic  acid, as  already stated, may produce
headache and roaring sounds in  the ears.   In persons with middle-ear
disease  it is contra-indicated unless urgently  called for, as  it often
makes the deafness  permanently worse.  Sometimes erythema or acne
follows its employment, and  blindness and retinal haemorrhages have
been found to occur.  It  would be impossible to enumerate all the
untoward effects which  have been noted, but it is worthy of remark
that very few deaths have taken place.1
  Administration.—Salicylic acid has a nauseous, disagreeable  taste
and is irritant to  the stomach.   It  should be given in a solution of
glycerin and  water, or its taste  may be covered by the use of syrup
of bitter orange peel or  syrup  of  ginger.   The  following  formula?
may be used :
         R.—Acid, salicylic.......^ij.
             Tinct. lavandulae comp.    .    .    .    .  f.^iv.
             Glycerini.......f5Ess.
             Aquae......q. s. ad  f^viij.   M.
    S.—A tablespoonful every two hours.
1 See author's essay on Antipyretics. 
SALOL.
297
Or,
         R.—Acid, salicylic.
             Glycerini
             Syrup, aurantii  .
             Aquae ....
    S—A tablespoonful every two hours

   Salicylic acid may be used in  pill or capsule, but is irritant to the
stomach in so concentrated a form ; it must be taken with much water,
and should follow rather than precede meals.  Salicylic acid ointment
(Unguentum^ Acidi Salicylici, B. P.) is a useful preparation for external
application in chronic deep-seated skin diseases.
   If buzzing in the ears is annoying, bromide of sodium in the dose
of 20 grains will generally give relief.

                      Salicylate of Sodium.

   Salicylate of Sodium (Sodii  Salicylas,  U. 8. and B.  P.) is  a  less
irritant and somewhat less disagreeable preparation than  salicylic acid.
Its action,  use,  aud doses are the same as the acid.

   Other salicylates are largely used  by some persons.   Salicylate of
Lithium is supposed by some physicians to be of more value than the
other salts.

                             SALOL.

   In appearance, Salol is a white crystalline powder, faintly aromatic
and almost without taste.  It is not soluble in water, but  is so in alco-
hol, and an alcoholic solution forms an imperfect emulsion when mixed
with water.  Salol is also slightly soluble in copaiba, in the oils of
sandalwood and of turpentine, and in mineral oils.   This solubility is
very useful in prescribing it  with  these remedies  in certain diseases of
the genito-urinary apparatus.  (See Gonorrhoea.)
   Salol is a compound of 60  parts of salicylic acid and 40 of carbolic
acid, and is decomposed by the pancreatic juice  into these two sub-
stances.  For this reason overdoses will produce symptoms of carbolic
acid poisoning.   Thus twenty grains taken five times a day will cause
a man to take 40 grains of carbolic acid, which is almost a poisonous
dose.
   Hesselbach  has proved that salol is very apt  to affect the kidneys
unfavorably, and rightly believes  it to be contra-indicated in all cases
of renal inflammation of an acute type.
   It is worthy of note that the drug rarely produces untoward effects,
although at one time a number of observers accused it of doing so
frequently.
   Salol is used for the same purposes as salicylic acid, when the stom-
ach  is irritated and cannot bear the  latter drug, as it is dissolved in
the small intestine.  A dose often used is  10 grains an hour, but this
is too much, as a rule, and may produce dangerous  symptoms.   Salol
      •   3ij-
      .  f ^ ss.
      .  f.^iv.
q. s. ad  fjjviij.   M. 
298
DRUGS.
may be given in wafers, capsules, or pills.   It is of the greatest value
in duodenal catarrh and catarrhal jaundice.
   In the treatment of gonorrhoea, in all its  stages, salol may be em-
ployed by the mouth, as  it  sterilizes the urine and tends to disinfect
or sterilize the urethra at each act of micturition.   (See Gonorrhoea.)
   Salol is of very great value in functional disorder of the intestines.
Indeed, there is no other remedy which can exert the same power for
good in cases of intestinal indigestion and fermentation.   In diarrhoea,
dependent upon such causes, salol is one of the best remedies we have,
since it renders the canal antiseptic and so  removes the cause of the
disorder instead of locking the putrid material in the bowel as does
opium.   In the writer's practice salol has come to be one of the most
valued  drugs in  the treatment of the affections just  named, and  also
in muscular rheumatism and neuralgia, due to exposure.  In cholera
morbus the writer's friend, Dr.  Fussell,  of  Philadelphia, has found the
following very useful:
         R.—Salol   ........3J:
             Bismuth, subnitrat.     .....   sjij.
             Misturae cretse     .    .    .    .  q. s. ad  f^iij.    M.
    S.—Two teaspoonfuls every two hours.


                          SALOPHEN.

   Salophen has  been introduced into  medicine within the last few
months as a substitute for salol, and it is said to possess the advantage
of being far less  poisonous  than salol, because in this case the phenol
of the salol is replaced by a compound of phenol which is innocuous.
Experiments on animals seem to indicate that these theoretical advan-
tages are present  in fact.   Like salol, salophen is broken up in the in-
testine by the juices  there present, and the result is salicylic acid and
acetylparamidophenol.   Salophen  contains about  10 per ceut.  more
salicylic acid than does salol (51 per cent.) and appears in the form of
thin, white  laminae, nearly insoluble iu  water.   It is  tasteless.
   Therapeutics.—For the  therapeutics of salophen  the  reader is re-
ferred to the article  on Salol, as the indications  for  both drugs are
identical save that salopheu  can probably be used when salol cannot be
employed.   The  dose  of salophen  is from 5 to 20 grains three times
a day.  It  can be very effectually combined  with phenacetine in the
treatment of neuralgia.


                       SANDALWOOD.

   Sandalwood (Santalum Bubrum, U. 8.),  or Red  Saunders, is the
wood of the Pterocarpus Santalinus, a tree of India and the Sandwich
and Feejee Islands.  It is known under  the name of Pterocarpi
Lignum iu the B. P.  From it is derived an oil (Oleum Santali, U. S.
and B. P.)  which has a hot, burning taste.   The odor is very pleasant 
SANTONIN.
299
and it has  been used as a perfume.  In overdose the oil is capable of
producing great irritation of the genito-urinary passages.
   Therapeutics.—The oil of sandalwood,  often called erroneously the
" oil of yellow sandalwood," is much used by genito-urinary surgeons
in chronic gonorrhea and gleet for the purpose of stimulating depraved
mucous membranes to proper action, and  in chronic cystitis to act as a
tonic to the bladder.
   In the subacute or later stages of bronchitis, when the expectoration
is  thick and ropy and  the cold is not readily " thrown off," the oil of
sandalwood is  efficacious.   In all cases it should  be given in capsules
in the dose of 5 to 20  drops, 5 drops being generally sufficient.  Oil
of sandalwood may irritate the stomach,  but it is not so apt to do so
as are cubebs or copaiba.


                        SANGUINARIA.

   Sanguinaria, U. 8., or Blood Root,  is the rhizome of Sanguinaria
Canadensis, and has been largely used in medicine, but is a dangerous
remedy, possessing more power for harm than  good.  Its chief alkaloid
is  sanguinarine.
   Poisoning.—Sanguinarine in poisonous  dose causes vomiting, purg-
ing, profuse salivation, and  finally tonic convulsions which are  spinal
in origin.   Death is due to respiratory failure, but the circulation is
much decreased in force and frequency.
   Therapeutics.—The employment of sanguinaria in chronic bronchitis
is about the only purpose for which it is now employed to any extent.
As an emetic iu croup it has  been largely  used, but is too irritant  and
depressant and  ought not to be so employed.  According to Bartholow,
the drug acts as an hepatic.stimulant and is of service in gastro-intestinal
catarrh with jaundice.
   Administration.—The  dose of the fluid  extract (Extractum San-
guinarie Fluidum, U. S.) is 1 to 5 drops as an expectorant, or 10 to 30
drops  as an emetic.   If the drug  does not cause vomiting after an
emetic dose it  must not be  allowed to remain in the stomach.    The
tincture (Tinctura Sanguinarie,  U.  8.)  is the best  preparation to  use,
and may be given iu 20 to 30-drop doses as an expectorant, and  1  to 3
drachms as an emetic.  The vinegar (Acetum Sanguinarie, U S.) is
given in the dose of  10 to 30 drops, and  as an emetic in the dose of
2 to 4 drachms.

                          SANTONIN.

  Santoninum,  U. 8. and B. P., is  a neutral principle derived from
Levant Worm-seed or Santonica, which is  the uuexpanded flower-
heads of Artemisia Maritima, a  plant of Asia Minor and Turkestan.
Santonin is soluble in alcohol  and chloroform, but  less so in water.
Santoninic  acid is formed  by  warming santonin with alkalies,  and 
300
DRUGS.
Hesse  has found that santonin is an  anhydride of santoninic acid.
Santoninic acid is more soluble than santonin.
  Poisoning.—Santonin causes muscular tremors, convulsive  move-
ments, unconsciousness, and sometimes epileptiform convulsions.
  One of the most common symptoms of the poisoning is chromat-
opsia or xanthopsia, during  the  existence of which  all  objects look
yellow.  This is due to the staining of the humors of the eye by the
drug.  This may go on to total blindness, or pass away in a few days.
If the  color is  not yellow,  it may be  green.   The urine  is also
stained—first yellow,  then  saffron, and  finally  purple-red,  or  is
bloody-looking.   This  is  not due  to  the  presence of blood, but  to
the drug.  Poisonous doses of the  drug do not cause gastro-enteritis.
  Therapeutics.—Santonin is used for the removal of round-worm,
and  is very efficacious.   It has no influence on the tape-worm.   It
should  be  given  in the  manner of  all  vermifuges  (see Worms),
namely, at a time when  the alimentary canal  is  empty.   Santonin
is  said  to have  a distinct  influence  over vision, increasing,   in
medicinal amount, its  acuity whenever the optic nerve is at fault.
In  urinary incontinence santonin  will often produce  cure after  all
other remedies fail.
  Santoninate of Sodium (Sodii Santoninas, U. 8.) is a useless, harm-
ful  preparation, never  to be  employed except for the benefit  of the
eye when vision fails through disease of the optic nerve.  Introduced
into medicine because of its solubility, it is absorbed  into the system,
which  is just what is least desired  in an anthelmintic, which  should
seek the worm in the bowel,  not by entering the blood.   In eye affec-
tions the dose may be from 2 to 8 grains, according to the  age  of the
adult.
  Santonin may also be given in the dose of 1 to 2 grains to an adult
in capsules or wafers.  The crystals should be used, not the powdered
santonin.  If the  bowels are not  opened within teu hours after the
drug is used, a saline purge should  be given, preceded preferably by a
2 or 3-grain dose of calomel, taken half an hour before, as the flow
of bile caused by the mercurial is particularly useful in making the
worm  let go its hold.
  Administration.—Santonin is  best given in the form of a  troche
or lozenge (Trochisci Santonini B. P.), but it is to be distinctly borne
in mind, and written on the prescription, that the Trochisci  Sodii San-
toninatis, U 8., are  not  to be sold to the patient.  The  troches  of
santonin itself are not official in the U S. P., and it is better for the
physician to write for troches to be made as follows :

         R.—Santonini.......gr. v.
             Pulv. sacchari alb......3iij-
             Pulv. acacia* .......  gr. viij.
    Misce bene, et adde
             Acaciae mucilag.......gtt. xvj.
             Aquae........q. s.
   Ft.  in troches no. x. S.—One or two  lozenges, as directed. 
SAVINE.
301
                       SARSAPARILLA.

   Sarsaparilla,  U. S., is the root of Smilax Officinalis, Smilax Medica,
and other species of smilax growing chiefly in Central America.   It is
known in the B. P. as Sarse Badix.   The drug  is largely devoid of
any physiological  action, yet seems to possess  some power  over the
general condition of the  system.   Thus while  sarsaparilla  seems
utterly without  effect in the hands of most physicians  when  given
alone, it often seems to do good and to increase the effects of other
drugs when combined with them, so that some cases of syphilis whicli
are of an obstinate character, will  yield to iodide of potassium and
sarsaparilla when the iodide alone  fails.  Sarsaparilla is largely used
in domestic medicine as a " blood purifier," and is a prominent con-
stituent of many patent medicines.
   Administration.—Sarsaparilla is most commonly given in  the form
of the compound  syrup (Syrupus  Sarsaparille Compositum, U S.),
composed  of sarsaparilla,  sassafras, guaiacum  wood, liquorice, pale
rose,  gaultheria, anise, and senna, dose 1 to 4 fluidrachms.  The other
official preparations of the  U S.  P. are the compound decoction (De-
coctum Sarsaparille Compositum),  composed of  the same  principal
ingredients as the compound syrup, except that anise, senna, pale rose,
and mezereum are omitted, dose 4 to 6 fluidrachms; the compound
fluid  extract (Extractum Sarsaparille Compositum Fluidum), similar
to the syrup  in composition, dose \ to 1 fluidrachm; and  the fluid
extract (Extractum Sarsaparille Fluidum), dose J to 1 fluidrachm.
The  B. P. preparations are a decoction (Decoctum Sarse), dose  2  to
10 fluidounces;  a compound decoction (Decoctum Sarse  Compositum),
which is identical with the decoction  of  the U. 8. P.; and a liquid
extract (Extractum Sarse Liquidum), dose \ to  4 fluidrachms.


                           SAVINE.

   Sabina,  U. S., Savine Cacumina, B. P., is the tops of the Juniperus
Sabina, an evergreen shrub of northern Europe, Asia, and America.
It contains an official volatile  oil (Oleum Sabine, U. 8. and B. P.).
Locally applied,  it is more of a counter-irritant than is turpentine, and
if swallowed  in poisonous amount causes nausea, vomiting, gastro-
enteritis,  unconsciousness, suppression  of  uriue, and death.  If the
individual  be a  pregnant female abortion takes  place as death ap-
proaches, but  very rarely before this time.  Profuse flooding nearly
always accompanies the act.
   Therapeutics.—The oil, taken in the dose of 5 to 10 drops, repeated
every three  or four hours,  acts as a powerful stimulant to the uterus
and ovaries, causing hyperaemia and aiding in the production of men-
struation in cases of amenorrhea.   It may also be employed to give
tone to the uterus in menorrhagia.  The drug is  best given in emulsion
or capsule.   The fluid extract (Extractum Sabine Fluidum,  IT.  S.) is 
302
DRUGS.
given in the dose of 5 to 15 minims; the tincture (Tinctura Sabine,
B. P.), in  the dose of 20 minims to 1 drachm.  The ointment (Un-
guentum Sabine, B. P.) is used as an external application to irritate
the skin.

                         SCAMMONY.

  Scammonium, U. 8. and B. P., is a resinous exudate from the root
of Convolvulus Scammonia, growing  in  Asia Minor  and Syria.   Its
active principle is sometimes called jalapin.  .
  Therapeutics.—Scammony is an irritant, drastic, hydragogue purge,
which causes a good deal  of griping, and exerts  a  cholagogue  effect.
If any inflammatory action of the  bowels is present its use is contra-
indicated.
  The ingestion of poisonous doses is to be followed by treatment
suitable to  gastro-enteritis.   Scammony is given in the dose of  2 to 5
grains, always in combination with some other similar  drug, as, for
example, colocynth.   Scammony forms part of the compound extract
of colocynth (Extractum Colocynthidis Compositum,  U. S,), the dose of
which is 1  to 3 grains as a laxative  or 5 to 20 grains as a purge.   The
resin (Besina Scammonii, U S. and B. P.)  is given  in the dose of 3
to 8  grains.  The B. P. preparations of scammony are Mistura Scam-
monii, dose % to 2 ounces; Confeclio Scammonii, dose 10 to  30 grains;
Pilula Scammonii  Composita, dose 5 grains;  and Pulvis Scammonii
Compositus, dose 10 to 20 grains.  The last two preparations are com-
posed of scammony, ginger, and jalap.


              SCOPARIUS  AND SPARTEINE.

  Scoparius,  U. 8., Scopari Cacumina, B. P., or Broom, is the tops
of the Sarothamnus Scoparius.   It contains scoparin and sparteine,
the first being a crystalline principle and  the second a liquid alkaloid.
The  second (sparteine) is the alkaloid  used in medicine in the form of
a sulphate,  which is a crystalline salt readily soluble in water.
  Physiological Action.—As scoparius depends for its medicinal value
almost entirely upon sparteine, what is here said applies to both the
crude drug and the  alkaloid.
  Nervous  System.—Sparteine acts on the nervous  system very
decidedly if given in large dose, depressing the brain  and spinal cord,
chiefly in its  motor tracts, thereby causing a decrease  of reflex action
and motor  power, ending in complete paralysis.  These changes occur
both in man and in the lower animals. The  heart is said to be stopped
in systole.
  Circulation.—Upon the circulation  sparteine acts as a stimulant.
It quickens the pulse-rate in  moderate doses, and also raises arterial
pressure.   The force  of the contraction  of the ventricles is  also in-
creased.  In very large poisonous doses the  drug acts as a circulatory
depressant. 
SEIDL1TZ POWDER.
303
   Respiration.—Upon this function in small amounts sparteine has
no effect, but poisonous doses kill by paralysis of the respiratory centre.
   Poisoning.—The symptoms of poisoning consist in trembling and
incoordination of movement, and clonic and tonic convulsions, followed
by a second stage of depression of the nervous system and general en-
feeblement.
   Therapeutics.—Sparteine has been recommended in all states of the
heart in which digitalis is of service, aud it is sometimes useful in  those
fairly frequent cases where digitalis fails.  In cardiac arhythmia or pal-
pitation, it is thought to be of great service by those who have used it
most.  Clark found it of value in Graves's disease and in nearly  every
circulatory abnormality,  but in the judgment  of the  author of this
book sparteine is generally a useless drug, only  to be turned to as a
last  resource after  more generally known remedies fail, or in  other
words, it is not a remedy to be used as a " stand-by " in the manner in
which digitalis is employed.
   While some clinicians  have found sparteine of value, many of them
have not.   In the few cases in which it has been  used by the writer it
entirely failed to be of service.  The dose is as variable as its action.
Some state it to be ^V of a grain, while still others recommend 2 to 4
grains.  A small dose should be used at first, and rapidly increased
until some effects ensue.  The drug should be given in watery solution.
   Scoparius itself is used in decoction, made  by adding half an ounce
of the broom tops to a pint of water, and boiling them down to a half-
pint.   Of this, an  ounce should be taken every three hours.  This
decoction  is one of the most efficient diuretics in cardiac dropsy.   An
unofficial  fluid extract is given in the dose of 30 drops.  The official
preparations of the B. P. are a decoction (Decoctum Scoparii), dose 1
to 3 ounces, and the juice (Succus Scoparii), dose 1 to 2  drachms,


                     SEIDLITZ  POWDER.

   Under the official name of Pulvis Effervescens Compositus, the U  S. P.
recognizes a purgative powder made  by taking the bitartrate of sodium
and potassium, or Rochelle salt, 120 grains, and bicarbonate of sodium
40 grains, which are wrapped in blue paper, and 35 grains of tartaric
acid placed in a white paper. The contents of each paper are dissolved
in a little  water—half a  tumblerful—and the two solutions added to
one another and  swallowed during  effervescence.  As  much as two
powders may be used, but this is generally too large an amount unless
full purgation is needed.   In sick stomach associated with constipation
when  a whole powder cannot be retained, the two powders should be
divided in fourths and a  fourth added to a fourth in a half-wineglass-
ful of water  and taken  every 15 minutes until the entire powder is
ingested.   This will often settle the  stomach  and  produce purgation. 
304
DRUGS.
                            SENEGA.

   Senega, U. 8., Senege Badix, B. P., is the root of Poly gala Senega,
a  small  plant of the United States, containing a principle known as
polygalic acid and senegin.
   Therapeutics.—Senega is used in medicine as  a stimulating expec-
torant in the subacute and chronic forms of bronchitis.  It has also
been employed as a diuretic in cardiac dropsy or that due to renal dis-
ease.   In cardiac disease it should not be used, aud indeed it is rarely
employed at present  except in combination with other drugs in expec-
torant mixtures.
   Administration.—Senega is  used in the form  of an abstract (Ab-
stractum Senege,  U.  8.), dose 5  to  10  grains, the  fluid  extract
(Extractum  Senege  Fluidum,  U.  S.), dose 10 to 20 drops, and the
syrup (Syrupus Senege, U. S.), dose 1 to 2 drachms.   It is also used
in Coxe's Hive Syrup.  The official preparations  of the B. P. are
a  tincture (Tinctura Senege), dose  1 to 2 drachms,  and an infusion
(Infusum Senege), dose 1 to 2 ounces.


                            SENNA.

   Senna, U. S., is the most drastic of the laxative purges used for the
relief of constipation.  It is the leaflets of Cassia Acutifolia and Cassia
Elongata and contains a very acrid  irritant purgative principle known
as cathartic acid.   Senna is official in the B. P.  as Senna Indica and
Alexandrina.
   Physiological Action.—Senna acts as a purge, producing  copious
stools, often with a great deal of griping if it is used alone.  Accord-
ing to Rutherford and Vignal, it acts very materially in increasing
the flow  of bile, but it is seldom, if ever, used in medicine as a chola-
gogue, although, according to Prevost and Binet, cathartic acid has an
influence over biliary secretion.   Hess has  found that the drug acts
directly as a stimulant upon the mucous membranes and so produces
a local peristalsis as it is moved  along.   It is also known that the
drug acts as a purge when absorbed from the skin, and for this reason
nursing mothers should not take senna, as it will purge the nursling.
   Administration.—Senna is generally combined  with offeer drugs for
the relief of constipation, but may be used alone.   If this is done the
fluid extract (Extractum Senne Fluidum,  U. S.) may be employed in
the dose  of 1 to 2 drachms to a child or  4 drachms to an adult.   It
is, however, always  better to give children the more agreeable confec-
tion (Confectio Senne, U. 8. and B. P.) in the dose of J drachm to a
child, or 1 to  2 drachms to  an adult.  As  the confection is apt to
cause gastric disorder if used continuously, because of the sugar con-
tained in it, its use is limited to  a certain class of cases.
   In  the treatment of the constipation of pregnancy senna is thought
to be  very useful.  Under the name of Black Draught a mixture of 
           silicate  of  potassium  or  sodium.       305

senna,  manna,  and  sulphate of  magnesium has been  largely  used
(Infusum Senne  Compositum, U. 8.), in  the dose of 4 ounces.   It is
an active hydragogue purge.  The syrup (Syrupus Senne, U. S. and
B. P.) is given in the dose of 1 to 4 drachms.
  One of the best ways to  use  senna is in the compound liquorice
powder (Pulvis Glycyrrhize  Compositus, U. S. and B. P.), which is
a good laxative in the dose of 20 to 30 grains.  Compound liquorice
powder is composed of senna, liquorice, fennel, washed sulphur, and
sugar.
  Infusum Senne, B. P., is given in the dose of 1 to 2 ounces;  Mis-
tura Senne  Composita,  B. P.,  in the  dose of 1  to  2 ounces, and
Tinctura Senne, B. P., in the dose of 1  to 4 drachms.
  Senna may stain the urine  red, and no alarm should  be felt if this
color appears in  this secretion.   Often  it  is necessary to warn the
parents of a child of the possibility of such an occurrence, in order to
prevent any fright on the part of the mother, who otherwise might
think that haematuria was present.


                        SERPENTARIA.

  Serpentaria, U 8., Serpentaria Bhizoma, B. P., or Virginia Snake-
root, is the rhizome and rootlets of Aristolochia Serpentaria and Aris-
tolochia Reticulata, plants of  the southern United States.   It contains
an active principle, aristolochin, which is never used in  medicine.
  Therapeutics.—Owing  to  the rather pleasant, warm taste of ser-
pentaria, and the  fact that it  stimulates secretiou, it is used largely as
a vehicle for other more potent remedies.   It has tonic properties, and
in consequence has been largely used in the treatment of atonic  dys-
pepsia  and indigestion.   It is even said to be a sexual stimulant, but
this  is  doubtful, to say the least.  In  overdose it is an irritant and
will  cause vomiting and purging if large amounts are taken.
  Administration.—Serpentaria is given in the  form  of the extract
(Extractum Serpentaria Fluidum,  U. S.) in the dose of 10 to 40 drops,
and  the tincture  (Tinctura Serpentaria,  U. S. and B. P.) in  the dose
of \  to 2 drachms.   It also enters into Huxham's Tincture of Cinchona
(Tinctura Cinchone Composita,  U. S. and B. P.).  Infusum Serpen-
tarie, B. P, is given in the dose  of 1  to 2 ounces.


        SILICATE OF  POTASSIUM OR SODIUM.

  Soluble Glass, or Silicate of Potassium or Sodium, occurs as a clear
syrupy fluid, and  is not official.   It is used  as a  splint in the
dressing of fractures and sprains, as  it rapidly becomes hard and
immovable  when  painted over the bandages.   Silicate  of potassium
or sodium may be universally substituted for plaster-of-Paris.
20 
306
DRUGS.
                             SOAP.

  Sapo,  U. S., Sapo Duris, B. P., is prepared  from any  alkali and
fixed oil, although soda and olive oil  are most frequently employed
in the manufacture of the soaps which are used medicinally.  Castile
soap, if good, is the best representative of a pure soap that we have.
  Soap may  be  cut  into  the  form of  a suppository and used  to
provoke movements of the bowel in young children who are suffering
from constipation, by placing it just inside the anus, having previously
dipped it into water one instant to make it slippery.   It may also be
used as an enema, dissolved in warm  water, or a mixture known in
Philadelphia as the " House Mixture " may be employed in the case of
an adult.  This consists of a mixture of water, soft-soap, and molasses
in varying proportions, and if flatulence is present, turpentine and olive
oil are added to it.  This preparation is as efficient as it is cheap and
dirty.  Soap  is  also used as an  antidote to many poisons and as an
aid  to emetics.
  Green  Soap (Sapo Viridis, U S., Sapo Mollis, B. P.) is not generally
green, but brown.  It is a  soft soap made by the use of potash and
olive oil, and  is largely  used by dermatologists in the  treatment of
eczema and similar skin diseases where a detergent, stimulating appli-
cation  is  needed.  It  is sometimes  called "German soft-soap" to
separate it from the ordinary soft-soap, or sapo mollis, of this country,
which is  an impure substance often made of rancid fats, containing a
large  excess  of alkali and never used except for scouring purposes.
Green  soap is not commonly employed as green soap, but in the tinc-
ture (Tinctura Saponis  Viridis,  U. 8.),  which  is to  be thoroughly
rubbed into  the  part when used  medicinally, well washed off, and
afterward simple cerate or some other soothing salve applied.
  Soap Liniment (Linimentum Saponis,   U S. and  B. P.), or Opo-
deldoc as it is called in domestic medicine, is largely used for rubbing
stiff muscles and sprains.   It is  generally employed to carry more
active external remedies,  such as opium  or aconite.
  Soap Plaster (Emplastrum Saponis, U S.) is used as a  thick, heavy
protective in bed-sores or where bed-sores are feared.   It  is also used
as a support about sprained  joints.
        SODIO-SALICYLATE  OF THEOBROMINE.

  This compound, known as diuretin or  sodio-theobromine-salicylate,
derives  its name from  the  extraordinary  power which  it is  said to
possess of producing  a  great increase in the urinary flow from the
kidneys.  This power depends entirely upon the theobromine, which
is a crystallizable, bitter, and volatile alkaloid, closely allied  to caf-
feine and xanthine, and derived from the seeds  of theobroma cacao, or
the  source of ordinary chocolate.   Owing  to the insolubility of theo- 
SODIUM.
307
 bromine it has been found necessary to combine it with sodium salicy-
 late, as under these conditions it is readily absorbed.
   The diuretic properties of this alkaloid were first discovered during
 a series of experiments made by Schroder in  Strasburg iu 1889, who
 found that  the diuresis  produced in man and the lower animals was
 very marked.    A  large  number of  clinical trials  in  Europe and
 America  have confirmed his observations, but there are a uumber of
 cases in which it signally fails, particularly in chronic Bright's disease.
   Theobromine does not have so stimulatiug an effect on the heart as
 does its relative  caffeine, so that the circulatory effect, while showing
 a stimulant rather than a  depressing tendency, is very slight.   It
 slightly iucreases muscular power, but its peculiar affinity for the renal
 structures surpasses all its other activities.
   As the action of the drug depends upon  its ability to stimulate the
■ secreting epithelium of the kidney, the physician should remember
 that in cases of advanced renal  disease where the secreting structures
 are almost entirely destroyed no result can be expected from its admin-
 istration ; but it is probable that the drug is useful in almost all con-
 ditions of dropsy—whether due to  renal inactivity or cardiac disease,
 and is harmless to the patient even if the diuretic effect does not ensue.
 The  only contra-indication to the use of  theobromine  or  diuretin
 is the presence of acute nephritis,  when, of course,  sedatives rather
 than stimulants are needed.   So far as the writer is aware no study as
 to the proportion of solids aud liquids in the urine under the  influence
 of this drug have been made, but the fact that  it  stimulates the epithe-
 lium or secreting structures of the kidney indicates that the solids are
 increased.
   As diuretin only contains from 30  to 50 per cent, of theobromine
 it has to be given  in very large amounts, as much as 1 to 2 drachms
 in twenty-four  hours, preferably in divided doses  of from 10 to 20
 grains in capsule or in warm water.  The former method is the better,
 as the taste of the drug  is disagreeable and soapy.
   It must not be exposed to the air, as it undergoes decomposition.
   In all the cases in which the writer has tried sodio-salicylate of theo-
 bromine he has failed to see any effect produced, and while he has no
 confidence  in  the  drug mentions  it because  others claim  to have
 obtained good results from its use.
                            SODIUM.

   Sodium  is a  non-metallic element, the salts of which are usually
white and colorless.   It is not  used in medicine, but many of its salts
are employed.  Unlike the potassium  salts, the salts  of sodium seem
to exert  comparatively little effect  upon  the  animal economy.   The
salts vary in  their power with the acid forming them.
   Acetate of Sodium (Sodii Acetas, U. S. and B. P.) is rarely if ever
used iu medicine as a substitute for acetate of potassium.  Its dose is
20 to 40  grains three times a day. 
308
DRUGS.
                    SODIUM ETHYLATE.

  Sodium Ethylate is  a whitish powder decomposed  in the presence
of water into alcohol and caustic soda, but soluble in absolute alcohol
without decomposition.
  Sodium ethylate is employed in  medicine as a depilatory—that is,
for the purpose of removing hairy growths.  To accomplish this pur-
pose it is necessary that the growth be clipped close to the skin, and
that the drug be dissolved in absolute alcohol and applied over the
roots of the hair with a glass rod.
  Soon after this application a crust forms, which should  not  be de-
tached for two or three weeks, but  which, on  its removal  at the end
of this time, generally  shows that all the roots of the hair have been
destroyed.   If not, the operation may be repeated as soon as the skin'
is in a  condition to bear it.   To  prevent pain, a  5 per cent,  solu-
tion of cocaine  may be applied.  It is worthy of remembrance that
moles and  small birth-marks, or naevi, may be  relieved by a similar
application.

                    SODIUM SULPHATE.

  Sodii Sulphas, U. 8. and B. P., or Glauber's Salt, is one of the most
irritant of the saline purges, rarely used in human medicine, but largely
employed by veterinarians.   The purgative dose for  man  is half an
ounce to an  ounce.  If any intestinal  inflammation is present it is
contra-indicated.  It produces large watery stools, with a good deal of
griping.  Sulphate of sodium is a prominent  constituent of Carlsbad
water, Hunyadi Janos, Hunyadi Arpad, and similar waters.


                           SOMNAL.

  Somnal is stated  to  be ethylated chloral-urethan,  and seems to
possess  marked hypnotic  power.  It is a clear, colorless  liquid of a
hot, burning taste, resembling  sweet spirit of  nitre.   The dose is 20
to 40 drops in  liquorice-water or  syrup of raspberry, and the sleep
produced by it is said  to last seven to eight hours.   The  remedy has
been so recently introduced  that no very  definite reports have yet
been made concerning it, but in a number of cases in which the  writer
has used it it has acted very well, although drowsiness is usually present
on the next day.

                         SOZOIODOL.

  Sozoiodol differs in one respect from  other antiseptics, so far  as our
patriotism is concerned, in that it  was first made  and employed by
one  of our own countrymen in San Francisco,  but at that time the
preparation  of it was so imperfectly carried out that foreign matters 
SPIGELIA.
309
made it too irritating for general use, and it was discarded, only to be
better prepared and more widely used in Germany some years later.
  Therapeutics.—Sozoiodol has been found of value as an antiseptic
and  disinfectant in the treatment  of wounds whicli are in a diseased
state, and for acute stomatitis and  pharyngeal catarrh it may be em-
ployed locally in the form  of a 5  per cent, watery solution.  It has
also  been found useful  in acute purulent conjunctivitis, and in ophthal-
mia neonatorum, in the proportion of two parts of sozoiodol to thirty
parts of water.  In urethritis, of a specific  type, we may employ the
preparation  known as zinc-sozoiodol in a  2 per cent, solution with
advantage, and this compound is also of value in mild and malignant
vaginitis if preceded by pyroligneous acetic acid or nitrate of  silver,
applied by means of a speculum.
  In the  treatment of gynecological  cases, particularly in  catarrh of
the  cervix uteri, Nitschman uses sozoiodol iu the form of a powder
applied by means of a tampon with good results, and it would seem
to be worthy of trial in many  other states of the mucous membranes
than those just named.

                           SPIGELIA.

  Spigelia, U. S., Pinkroot, is the root and rhizome of Spigelia Mari-
landica, or Carolina Pink,  a plant  of the southern United States.
  Poisoning.—Almost immediately after the ingestion of a poisonous
dose of spigelia the animal  has short and quick expiratory movements,
amounting almost to a cough.1   Soon after, the pupils become widely
dilated, the eyeball is turned inward, and at the same time the orbit
becomes very fixed in  this position, so that the eye cannot follow any
object,  such as a pencil, when it is moved from side to side.  Constant
retching, with no result, now comes on, the animal standing and appa-
rently  suffering  from no sensory or motor palsy.   There is no change
in gait.  Soon after this,  marked exophthalmia is  developed.   The
retching, having  lasted about five  minutes, now passes off, and at this
time signs of muscular weakness  and lack of coordination appear,
the walk  becoming staggering  both in the fore and hind legs.   The
respirations now become very rapid, resembling those of a dog after a
long run on a hot day.   The tongue hangs  from the mouth and  is
dry  and red, and the nose is  hot aud no longer moist.   Muscular
power  is  progressively lost, so that  the  dog frequently  falls   when
endeavoring  to walk,  but  sensation does  not seem to  be affected.
About this period the animal lies  down and passes  into a deep sleep,
which, in turn,  soon  changes  into coma,  and  death  follows without
any  movement  being  made, evidently from  a general failure of vital
force.  The respirations, as death  approaches, become  slow, and are
finally  extinguished simultaneously with cardiac arrest.   The palsy is
spinal  in origin, the motor  and  sensory nerve-trunks and  the muscles
escaping the paralysis.

       1 See investigation by author in The Medical News, March 12,1887. 
310
DRUGS.
   Therapeutics.—Spigelia is one of the most efficient remedies in the
 treatment of round-worms, and is not dangerous when given with care.
 When employed for the removal of worms the usual precaution should
 be taken  in regard to the ingestion of food (see Worms), and it should
 be followed by a purge to sweep out the worm while it is narcotized by
 the drug.  The purge should be one which is rapid in its action,  such
 as the sulphate of magnesium.
   Administration.—The dose of spigelia, in the form of the fluid ex-
 tract (Extractum Spigelie Fluidum, IT. S.) is 2 drachms; that of the
 unofficial fluid extract of spigelia  and senna  (Extractum Spigelie  et
 Senne Fluidum)  is  \ to 1 drachm for a child of two years of age;  \ an
 ounce is the dose for au adult.   The addition of fluid extract of senna
 makes the drug more efficient, and the mixture is generally not disliked
 by children.   It is to be remembered that this  latter mixture is no
 longer official.


                            SQUILL.

   Scilla,  U. 8. and B. P., is the sliced bulb of  Urginea Scilla or Scilla
 Maritima, a  plant  of the countries bordering  on the Mediterranean.
 It contains  scillin, scillipikrin, and  scillitoxin,  all of which possess
 poisonous properties and  none of which  are  used  in medicine alone,
 except by a few persons.
   Poisoning.—In poisonous  doses  squill  produces vomiting, purging,
 dulness,  stupor,  intermittent palsy, convulsions, and deathin  ten to
 twenty hours.   These symptoms are preceded by a great fall in tem-
 perature.   The  urine is suppressed or bloody, and acute nephritis is
 produced.  Gastro-enteritis may be marked.
   Therapeutics.—Squill  is  largely used as a stimulant or  irritant
 diuretic, not to affect the renal epithelium directly and promote secre-
 tion,  but rather to  tone up and excite to  normal  effort a kidney
 depressed by disease, as in very chronic Brighfs disease  or renal con-
 gestion from cardiac trouble.  In cardiac dropsy, combined with digi-
 talis  squill is a  standard and much-used remedy, and is  undoubtedly
 of value in aiding in the absorption of  effusions in the pericardium,
pleura, aud abdomen.  Squill is usually given  in dropsy,  in pill form,
 as follows :

         $•—Pulv. scillae.......gr. x.
             Pulv. digital, fol......."  gj.    ]yr.
   Ft. in pil. no. x. S —One t. d. after meals.

   The employment of squill in bronchitis, although  largely resorted
 to, is not a very good practice, since its irritant action on the kidneys
 and stomach may cause trouble.  The period for its administration is
 in the second stage, when secretion  is scanty or so excessive as to need
 proper stimulation  of the mucous membranes to bring  on a healthy
 action.  Sometimes  Coxe's Hive Syrup is used, either as an emetic in
drachm doses every ten minutes  until it acts, or as an expectorant in 
STILLINGIA.
311
the dose of 30 drops to 1 drachm for an adult.   As it contains  anti-
mony it should be given with care.
  Administration.—The fluid  extract (Extractum Scille Fluidum, U.
8.) is given in the dose of 1 to 5 drops ;  the tincture (Tinctura Scille,
 U. 8. and  B. P.), in the dose of 5 to 30 drops; the vinegar of squill
(Acetum Scille, IT. S. and B. P.), in the dose of 10 drops to J drachm.
The compound syrup  (Syrupus Scille Compositus,  U S.), or Coxe's
Hive Syrup, is composed of squill, tartrate of antimony and potassium,
precipitated phosphate of calcium, alcohol, sugar, and water,  aud is
given in the dose of  20 drops to 1 drachm.
  The following prescription will be found  useful in bronchitis in its
subacute stages:
         R.—Vini ipecac........f ^j.
             Tincturae scillae......f gij.
             Syr. tolutan........f £v.
             Aquae........fgj.    M.
    S.—Teaspoonful every three or four hours.

  The  plain syrup  (Syrupus Scille,  U. S. and B. P.)  is given in the
dose of ^ to 1 drachm; the honey (Oxymel Scille, B.  P.), in the dose
of J to 1 drachm, aud the  compound pill (Pilula Scille  Composita,
B. P.), in  the dose of 5 to  10 grains.


                          STILLINGIA.

  Stillingia,  U. S., Queen's  Root, is the root of Stillingia Sylvatica, a
plant of the United States,  the active principle of whicli is stillingin.
  Physiological Action.—There can  be no doubt that this drug acts in
two ways: first, by  its immediate effects on the system, and second,
by its more slowly shown alterative influences.  In overdose it causes
bilious purging, increased heart-action, and active secretion  from the
bronchial mucous membrane.
  Therapeutics.—Stillingia is highly recommended in habitual consti-
pation, as it increases intestinal secretion, aud it is even said to act as a
specific in  haemorrhoids dependent largely  for  their  existence upon
hepatic eugorgement and intestinal atony.
  Bartholow recommends the following  prescription under these  cir-
cumstances :
         R.—Extract, stillingiae fluid. .
             Tincturae belladonnae    ^
             Tincturae nucis vomicae  j-
             Tincturae physostigmatis J
   S.—Twenty drops in water t. d. before meals.

  Tincture of aloes  may also be added to this prescription if consti-
pation  is present.  In syphilis of an obstinate and rapid type, stillingia
should be used as an aid to other drugs.
  In pasty-looking, white,  " putty-faced " children,  who  are anaemic
or strumous, and who never have any appetite, or are subject to middle-
.   aa  f^j.    M. 
312
DRUGS.
ear trouble and general debility, stillingia is of value.  It should be
used, under these circumstances, for some time.
   The only official  preparation is the fluid extract (Extractum Stillin-
gie Fluidum, U. 8.), which should always be made of the fresh root,
the dose of  which is 10 to 60 drops.


                        STRAMONIUM.

   Jamestown Weed, or Datura  Stramonium, is official in the form of
the  leaves (Stramonii I^olia,  U S.) and the seeds (Stramonii Semen,
U S. and B. P.).   It contains an alkaloid known as daturine, which
is physiologically identical with atropine.
   Physiological Action.—(See Belladonna.)
   Therapeutics.—The uses of stramonium are  identical with those of
belladonna.
   Administration.—The extract (Extractum Stramonii, U. S. aud B. P.)
is used in the dose of ^ to J grain, the fluid extract (Extractum Stra-
monii Fluidum, U S.) in the dose of  1 to 5 drops, and the tincture
(Tinctura Stramonii,  U 8. and B. P.) in the dose  of 5 to 30 drops.
The ointment (Unguentum Stramonii, U. 8.) is used for the same pur-
poses as is belladonna ointment.   The dose of daturine is Tfa to -g1^ of
a grain.

                         STRONTIUM.

   This substance has lately been introduced into medicine in the form
of the bromide, lactate, iodide, and  phosphate,  largely through  the
studies of Laborde, See, Paul, and others.  The bromide of strontium
is used for precisely the same effects  as are the other bromides, but it
is claimed that as the strontium  has  a distinct nutritive influence over
the  system, the well-known disadvantages of the potassium salt  are
avoided.   The dose of bromide of strontium is from 30 to 60 grains.
In addition to the ordinary effect of  bromides  See found  the bromide
of strontium to be very useful in overcoming attacks of gastric indiges-
tion  associated with pain in the stomach  and hyperacidity, and  the
author has confirmed this statement.   The lactate of strontium seems
to be indicated chiefly in cases of albuminuria due to renal atony.  It
does not increase urinary flow, and is contra-indicated in the presence
of the uraemia and high fever of acute parenchymatous nephritis.  In
chronic parenchymatous nephritis, such as is due to rheumatism or gout,
it is of value.  Unfortunately, as soon as  the lactate of strontium is
withdrawn, the albuminuria is apt to recur if the  disease is not entirely
cured.  The dose of the lactate of strontium is 60 to 100 grains a day.
Fortunately, strontium possesses no toxic  power whatever, and over-
doses are not followed by any bad consequences.  If the strontium is
contaminated by barium serious effects are produced. 
SUGAR  OF  MILK.
313
                      STROPHANTHUS.

  Strophanthus Hispidus is an African plant from the seed  of which
the natives make Kombe arrow poison.  There are many varieties of
strophanthus.   The active principle is strophanthin, from  which is
derived strophanthidin.  It has been claimed that strophanthus con-
tains  a local  anaesthetic principle,  but Dr.  de Schweinitz  and the
author found it to be possessed of this power only in dogs and  not iu
man.
  Therapeutics.—Strophanthin may be used in  all forms of cardiac
disease to supplant digitalis, but it is not its equal.
  From the cases of  cardiac disease seen frequently by the  writer he
has reached the conclusion that digitalis gives relief to patients under
the age of twelve years in a much smaller proportion of cases  than it
does  in  adults, and that though the stomach is no more frequently
disordered, increased dyspnoea, nervous irritability, and cyanosis often
follow its use.
  As everyone knows, there are a certain number of cases where digi-
talis seems to do harm in adults, the explanation being that under such
circumstances the ventricle is so overstimulated that the auricle cannot
empty itself thoroughly, and becomes congested in consequence.
   Strophanthus acts exceedingly well in these instances where digitalis
fails,  and this is  particularly true in adults.  It will relieve cardiac
dropsy by its action on the heart, but is not diuretic in itself.
   Administration.—Strophanthus is given in the form of the tincture
in the dose of 3 to 6 drops three times a day.   Strophanthin  may be
given hypodermically  in the dose of j-4^ to -^ of a grain. Its effects,
when so used, are said to last a week, but this statement can scarcely
be correct.

                             SUGAR.

   Saccharum, U  S., Saccharum Purificatum, B. P., is the refined juice
of Saccharum Ofificinarum, or Sugar Cane,  or the juice obtained from
the sugar beet.  It is an  anti-putrefactive but not an anti-fermentative.
Mixed with iron preparations  it prevents oxidation.   As it is a  hydro-
carbon it  is a nutrient and a developer of  adipose tissue, or, in other
words, is a food.  Its use is  contra-indicated  in obesity, during the
existence of fermentative changes in the stomach and intestine,  and in
diabetes mellitus.

                       SUGAR  OF MILK.

   Saccharum Lactis, U. S. and B.  P., is  derived from the whey of
cow's milk by evaporation, in the proportion  of about 5 per cent., and
is then purified by re-crystallization.   It has little sweetening power
compared to cane sugar, and possesses a peculiar flat taste.  It is, how-
ever, less apt to ferment and is better for infants than is cane sugar. 
314
DRUGS.
   Milk sugar is largely used  in triturations because by its hardness it
 aids in the subdivision of the medicament.  It is also used to increase
 the bulk of small powders, where such drugs as podophyllin and calomel
 are prescribed.
   Recent studies,  both scientific aud clinical, have shown lactose to be
 possessed of very  great diuretic power when given in full doses.  The
 advantages claimed for lactose as a diuretic is its direct action  on the
 kidney and the slight effect exercised upou the rest of the organism. It
 is, therefore, in renal dropsy or renal  inactivity that  this substance is
 particularly indicated.  The dose of lactose in cases of dropsy should
 be as  great as  from  2 to 4 drachms, given daily, dissolved  in a quart
 of water.  It  has been found that the lactose acts best in those cases
 in which there  is no albuminuria.   These recent studies are of interest
 in view of the well-known clinical fact that the addition  of lactose to
 the milk of bottle-fed babies always causes profuse diuresis.


                    SULPHATE  OF ZINC.

  Zinci Sulphas,  U 8. and B. P., is a white, somewhat efflorescent
 salt, of a  sharp acid taste, and is soluble in water.   In large amounts
 it acts as an irritant, and is  employed as an irritant peripheral emetic
 in the dose of 10 to 30 grains.   It is not so severe as sulphate of copper
 in its emetic and poisonous properties and may be repeated if the first
 dose  does not  produce vomiting.   In weak solutions it may be used
 as an astringent application in gonorrhea and  other  affections of the
 urethral mucous membrane.   In 2-grain pills it is sometimes given in
 serous diarrheas, particularly if it be combined with opium or minute
 doses of podophyllin (fa of a grain  at a dose).   Iu conjunctivitis and
 other eye affections  the drug  is used in the form  of a wash.   (See
 Conjunctivitis.)

                          SULPHIDES.

  Baths of the various sulphides,  such as those to be obtained at
 sulphur springs, are very useful in many cases of skin disease  of an
 obstinate  type, such  as psoriasis, lichen, and  eczema.   They are  also
 employed  in chronic rheumatism and gout.
  In laryngeal hoarseness  and pharyngeal affections, such as follow
 public speaking aud exposure to cold, sulphides or sulphur  waters are
 very useful, and little doubt exists  but that their persistent employ-
 ment is one of the best means to cure the obstinately atonic state of
 the throat sometimes seen in public speakers.
  As was first  noted by Dr. Ringer, the sulphides, particularly  in the
 form of calx sulphurata, are very  useful  in all cases where" pus is
 about to form.
  They may be employed in cases where successive crops of boils occur
 and  in adenitis of the neck and elsewhere.   If they do  not stop the
formation  of  pus they aid in  its inspissation  and absorption.   Chil- 
SULPHONAL.
315
dren should take a teaspoonful every hour of a solution  containing a
grain of calx  sulphurata  to  the  half-pint of water.   Adults may be
given sulphide of calcium in gelatin-coated  pill, dose £ to J a grain
three times a day.   The solution must  be  freshly prepared,  as  it
undergoes oxidation, changing the drug into a sulphate.
                         SULPHONAL.

  Sulphonal is a synthetically prepared substance first manufactured
in Germany by Baumann, and possesses the chemical name of diethyl-
sulphon-dimethyl-methane.   It is a colorless, odorless, solid substance,
soluble in 100 parts of cold and 18 to 20 parts of hot water, and is
readily soluble in alcohol and ether.   The drug is not affected by any
of the ordinary acids, and is very stable.
  Physiological Action.—Several quite interesting researches  upon
this  comparatively new hypnotic  have been  carried out  recently.
Smith, of Londou, has studied its action on the  activity of tissue-
change,  and  also  attempted to  determine  the  changes in *the  drug
during its passage  through the body.   In regard to the first question
he found, by experimenting  upon  a powerful, healthy dog, weighing
thirty-five pounds, which  was fed upon one pound of dog-biscuit and
one  quart of water  daily, that the amount of urea during the ad-
ministration  of sulphonai  is a little greater  than that eliminated
during the period when no  drug is giveu.   He also found the  urine
slightly increased  in amount under the influence of the drug.  The
changes were, however,  so very slight that he reaches  the conclusion
that moderate doses of sulphonal do not affect nitrogenous metabol-
ism.  In regard to the second  question Smith quotes the results of
Kast, namely, that sulphonal does not pass into the urine as such, but
in the form of a sulphuretted  organic  compound.   Smith, therefore,
endeavored to find out whether the entire amount  of the drug ingested
is changed  or not.  Without taking  up space with a full considera-
tion  of his method of experimentation, we find  that his conclusions
may be summed up  as  follows : In moderate doses the drug is  com-
pletely changed during  its passage  through the body into a sulphur-
etted organic  substance, and the elimination of sulphuric acid is not
increased by taking sulphonal.   Dr. Smith does not give us the  exact
nature of the substance  derived  from sulphonal,  but promises to in-
form us further concerning it in a later contribution.  Another paper
upon the physiological action of sulphonal has been published by Dr.
William  F.  Shick, of  Easton,  Pa., who has found,  by a series of
experiments,  first,  that  sulphonal  when given by the stomach acts
very slowly on account of its insolubility; but that subcutaneously in
warm solution it is much more active.   The  drug was also found to
produce a general  relaxation of the  muscles, and a staggering gait
after its hypnotic  power  had passed by.  The spectroscope failed to
show any changes  in the blood.  The motor  nerves were not  affected.
Shick believes  that the  action of the drug is exerted upon the higher 
316
DRUGS.
nerve-ceutres.  He also found a decreased reflex activity, and believes
this lessening to be due to stimulation of Setschenow's reflex inhibi-
tory centre.  On the circulation the drug was found to have but little
power.  When sent directly into the blood there was produced a slight
decrease in arterial pressure, followed very soon after by an  increase.
Upon the respiration  the  drug was found to act as a depressant when
given in full doses.
   Therapeutics.—Sulphonal finds its  place  in medicine as a somni-
facient  or  hypnotic, valuable when functional nervous  insomnia is
present,  useless where advanced disease, such as  cardiac trouble, is
responsible for the wakefulness.   In insanity it often produces sleep,
and is of  great service in  the  various  mental disturbances charac-
terized by lack of sleep and often affecting persons of unsound  mind.
Sulphonal  may be defined  very briefly  by  anyone who has largely
used it or watched the reports made of its  progress.  This definition
is that  the drug does possess  sleep-producing power  of  moderate
amount—not equal to chloral or potassium bromide, but greater than
that of paraldehyde,  and that it will sometimes  succeed where  the
other hypnotics fail.
   Administration.—Sulphonal being virtually insoluble in cold water,
it may  be  given  in large capsules or  in mucilage of acacia, so as to
be held in suspension until swallowed.  The insolubility and bulki-
ness of the drug render its use difficult.  It is best given in hot water
(about 6 ounces), as suggested by Stewart.   This  makes a solution,
and as soon as the liquid is cool  enough to be swallowed, it should be
taken before precipitation occurs as the  result  of cooling.  The dose
is 20 to 40 grains.

                           SULPHUR.

   Sulphur is a non-metallic  element official  in three forms in  the
U. 8. P., namely, as Sulphur Sublimatum, or sublimed or flowers of
sulphur, Sulphur Precipitatum,  U. 8. and B. P., or precipitated  sul-
phur, and Sulphur Latum, or washed sulphur.
   Much confusion exists among students as to the  differences between
these various forms of sulphur.   Sulphur itself is  an element which
is prepared for medicinal uses by being heated and sublimed (Sxdphur
Sublimatum), or flowers of sulphur.   Sulphur  lotum, or washed  sul-
phur, is prepared in order to get rid of sulphuric acid and other con-
taminating substances, and is made from  sublimed  sulphur.   Sulphur
precipitatum is also made from  sublimed sulphur, and is more bland
and minutely subdivided.   Some suppose it to differ from sublimed
sulphur in its therapeutic  properties, by  reason of  a small amount of
water supposed to be present.  It is sometimes called milk of sulphur.
When sulphur is prescribed for  internal  use the sublimed sulphur is
generally designated.
  Physiological Action.—Sulphur has little physiological influence over
the general system.   When taken internally it causes a soft, mushy
stool of a yellow color, with a strong odor of hydrogen sulphide.  The 
SULPHUR.
317
drug acts particularly on the skin and mucous membranes.  The juices
of the intestines break up some of it into sulphuretted hydrogen and
sulphides.
  Therapeutics.—Sulphur is used as a mild laxative, never as a purge.
In stricture of the bowels the soft stools produced by it will often slip
by the obstruction, and it is worthy of note that  sulphur  will some-
times overcome constipation when nothing else will give relief.   It  is
particularly valuable  in  the treatment of constipation where there are
hemorrhoids, and in chronic rheumatism and sciatica it is thought by
some to effect a cure.
  Sulphur is of great service in the treatment of chronic bronchial
affections, but for some curious reason its use has become almost obso-
lete.  The  so-called Bergeon's  method of treating phthisis by rectal
injections of carbonic  acid gas loaded with sulphuretted hydrogen was
simply a revival of a  custom of our great-graudfathers who often used
sulphur waters  by the mouth in the treatment of catarrhs or other dis-
orders of mucous membranes.   Bergeon took  the trouble to go to the
back door to accomplish what was done  200  years ago by the  front
door, aud the only novel part of his method was his filthy way of using
the drug. Graves recommended 5 to 10 grains of sulphur three times
a day wherever  bronchial secretion was excessive, and found that  it
rid the lungs of mucus and relieved the cough.
  The external use of sulphur is very much  more important than its
internal use, in so far as regards affections of the skin.  Of itself the
drug exercises little effect over the cuticle when used in  powdered form,
but combination with an ointment makes it at once active.  Even irrita-
tions of the  skin may ensue from its constant use in concentrated form.
  In scabies, or itch, sulphur ointment (Unguentum Sulphuris,  U. 8.
and B. P.) is the best remedy we have.   The female parasite burrows
under the epiderm and deposits the ova as she moves about, while the
male does not burrow but stays on the surface.    The ointment  will
kill him, as he  is readily attacked, but the female is protected by her
burrowing propensities.  To get at her and the ova the burrows must
be opened, and this may be accomplished  by a  thorough  soaking of
the body with soap and water, thereby softening  the epiderm covering
the parasite, which can then readily be removed by rubbing the patient
with a rough towel.   The towel should be boiled at once  to prevent
its conveying the parasite to others.   The ointment,  if now applied,
relieves the  patient almost at once.   It is important that the skin be
well softened and rubbed, in order to keep open every burrow.   The
ointment should be allowed to remain on the part all night and be used
for three or  four nights consecutively.
  Young women often suffer from acne,  particularly  about the  men-
strual epoch, the skin also becoming at this time sallow and muddy.
Ringer recommends the following lotion as one which is very successful
in promoting a cure :
         R.—Sulphuris sublimati  .
             Glycerini  ....
             Aquae rosae ....
    S.—Apply as a wash once or twice daily
'3.1-
f3J-..
fgviy.
M. 
318
DRUGS.
   Administration.—Sulphur is given in the dose of 10 to 20 grains
three times a day as an alterative, and from  1 to 2 drachms at night
as a laxative with a little molasses to form a paste.
   A  confection  (Confectio Sulphuris)  is official  in the B.  P.,  dose
10 grains to 2 drachms.

                     Sulphide  of Calcium.

              (See Calcium, Calx, and Sulphides.)


                      SULPHURIC ACID.

   Acidum Sulphuricum, U 8.  and B. P., Sulphuric Acid, or Oil  of
Vitriol, is a powerful irritant and escharotic, rapidly dehydrating and
carbonizing the tissues,  causing  them to  become  black.   It  is the
most astringent of the mineral  acids, and when absorbed is converted
into sulphates and so eliminated by the kidneys, the lower bowel, and
the skin.
   Poisoning.—The  symptoms produced  by poisonous doses are those
of a  gastro-intestinal inflammation  of the most severe type,  or the
patient may drop to the floor almost at once owing to collapse, depend-
ent upon perforation of the walls of the oesophagus or stomach  by the
acid  and  its consequent  escape  into the peritoneal cavity.  If the
patient lives to the  fourth day the parotid glands may become swollen,
as the result of stenosis of the  salivary ducts of  Steno, and violent
inflammation of  the kidneys may appear from the passage  of the
drug through these  organs in the process of elimination.  If partial
recovery takes place the patient  often dies from inanition due to the
formation  of strictures  in the  alimentary  canal  or to destruction
of the peptic tubules.  The stain about the mouth is black, and  if
any  of the acid is  spilt  on the clothes, the  characteristic  burn is  to
be seen.
   The treatment consists in the  use of alkalies, such as chalk, mag-
nesium, whitewash  off the walls, and  soap.  Opium aud  oils  are  to
be given to allay irritation, and external  heat is to be applied.
   Therapeutics.—Sulphuric acid  is sometimes  employed as a caustic
to venereal sores, warts, and slowly healing ulcers, but is most commonly
used internally, as it fulfils several pressing indications.  As a remedy
for serous diarrhea, particularly if combined with some vegetable
astringent, it is unsurpassed, and  its use in cholera  deserves  great
attention. ^ (See Diarrhoea.)  In  the  Philadelphia  Hospital  during
an epidemic  of cholera some years since, every case which received
it  improved  or failed  to  be attacked, whereas  those who did not
receive it were  either very ill or  died.
  The proper way  to use the drug as a prophylactic during cholera
epidemics is in the form of  " sulphuric-acid lemonade," made so that
each wineglassful of water contains 5 drops of  the aromatic sulphuric
acid.  The same solution may be  used in acute lead-poisoning in order 
SWEET  SPIRIT  OF  NITRE.
319
to form an insoluble sulphate of lead, and may be taken by artisans
exposed  to chronic  lead-poisoning  as  a  prophylactic for the same
reason.
  As sulphuric acid is eliminated by the skin it is  often useful  in the
night-sweats of phthisis combined with belladonna or morphine.
  Administration.—The dose of the dilute acid (Acidum Sulphuricum
Dilutum, U. 8. and B. P.) is 10 to 20 drops, and of the aromatic acid
(Acidum Sulphuricum Aromaticum, U. S.  and B. P.) 5 to 20 drops.
The latter is  the best preparation for general use.  Both  should  be
thoroughly diluted before they are administered.
                           SUMBUL.

   Sumbul. U 8., is the  root  of Ferula  Sumbul,  a large plant  of
 Northern Asia,   The dose of the root (Sumbul Badix, B. P.) is 10 to
 40 grains.  On the nervous  system sumbul acts as  an efficient nerve
 tonic, and is very largely employed by Goodell in  cases of nervous
 exhaustion and  in the unrest of nervous females.   It is official  in the
 tincture (linctura  Sumbid, U. S. aud  B.  P.), dose 1 to  4 drachms.
 Goodell uses the following formula :
          R.—Extract, sumbul......gr xx.
             Ferri sulph. exsiccat.    .    .    .    .  gr. xx.
             Asafcetidae.......gr x.
             Acid, arseniosi .    .    .    .    .    .  gr. \   M.
    Ft. in pil. no. xx.   S.—One t. d. after meals.

   To be of any value the drug must be fresh and care must be taken
 that the crude drug from which it is made is a good sample.


                SWEET SPIRIT  OF  NITRE.

   Sweet Spirit  of  Nitre  (Spiritus ^Etheris Nitrosi, U. S., and B. P.),
 or Spirit of Nitrous Ether, is a mixture of alcohol, water, and  ethyl
 nitrite.   It is upon this  last constituent  that most of its value as a
 remedial  ageut  depends.  The  drug when sold  by pharmacists or
 others who are not very careful to keep fresh preparations is no better
 than alcohol and water alone, since the ethyl nitrite readily escapes,
 and  deterioration at once takes place.   Until recently the profession
 have  had no ready means of protecting themselves from  such poor
 preparations, but at present we know that all that is necessary is to add
 a grain  or two of antipyrine to a half-ounce or less of the spirit.  If
 the ethyl nitrite be  present a purple color followed  by a green precipi-
tate will be found.   This green precipitate is iso-nitroso-antipyrine,
which is not in the  least poisonous.
  Physiological  Action.—Sweet spirit  of nitre is a  sedative to the cir-
culatory and nervous system and a diaphoretic and diuretic according
to the manner in which it is administered.
  If given in very full doses it rapidly produces  the cyanosis char- 
320
DRUGS.
acteristic  of the full effects  of any one  of the nitrites.   (See Amyl
Nitrite.)
   Therapeutics.—There  is probably no drug so widely employed  by
the laity as a household remedy which is so potent for good and yet so
harmless, if wrongly used, as is this oue.
   Physicians often place less reliance  upon it than it deserves, and
in nearly every instance where it fails  it is  either not indicated or the
nitrite has escaped and left it powerless.
   In incontinence of urine in children the combination which follows
is very useful in certain cases.   (See Incontinence of Urine.)  In these
instances  the urine will  be found high-colored and concentrated, and
therefore  capable of  irritating the bladder and genito-urinary tract.
          R .—Potassii citratis  .    .    .    .   . 3J to  £ij.
             Spt. aetheris nitrosi.....f.^ss.
             Aquae......q. s. ad  fjiv.    M.
    S.—Dessertspoonful every five hours until the urine becomes clear.
   As soon as the urine is clear  belladonna may be  used; the citrate
of potassium and  spirit of nitre being continued, or not, as the case
demands.
   Where the spinal centres  are depressed and there is general atony
of the system it may be well to substitute the  following  pill for the
belladonna:
          R.—Acid, arseniosi......gr- i-
             Extract, nucis vomicae    .    .    .    .  gr. ij.
             Quininae sulphatis.....gr. xx.     M.
    Ft. in  pil. no. xx.  S.—One pill t. d. after meals.
   The diuretic action of sweet spirit of nitre is best obtained by using
the drug  in ice-cold water and keeping the patient  lightly covered and
cool.  On the other hand, if a diaphoretic influence is desired it may
be given  simultaneously  with warm lemonade, and the patient should
be well blanketed.   This last action of sweet spirit of nitre has made
it  a  remedy  of common use  in treating acute  colds in adults and
children, and  in setting aside the fever of these conditions in  the
latter class as well.
   Sweet  spirit of nitre is a distinct antispasmodic, and can be well em-
ployed where slight nervous excitement  accompanies fevers or in other
states associated with irritation in infancy.
   The  dose for an  adult is from 20 drops to 1  drachm, and for a
child of one year  5  to 10 drops.  It should always be given  in cool
water to  this class of patients.
                          TAMARINDS.

   Tamarindus, U. S. and B. P., is the preserved pulp of Tamarindus
Indica, a tree of the West Indies.
   The taste is a peculiar mixture of bitter and sweet.   As a laxative
it exerts little power over that of any ordinary fruits, such as apples, 
TANNIC  ACID.
321
but it enters into the confection of  senna (Confectio Senne,  U.S. and
B. P.).   Patients often find tarmarinds a very agreeable laxative when
they are taken before going to bed or eaten as a confection after meals.


                        TANNIC ACID.

  This acid when pure is au uncrystallizable, white or yellowish-white
powder without bitter taste and very soluble iu water or glycerin.  It
is not so  soluble in  alcohol and ether.   It is the chief active principle
of vegetable astringents, and occupies  the relative position of an  alka-
loid to a crude drug, so  far as the  active portion of these  vegetable
astringents is concerned.
  Physiological Action.—Tannic acid when brought in contact with
any of the tissues of the  body constringes them and decreases  their
vascularity  for a time, by causing contraction of their bloodvessels.
For these reasons it stops secretion and condenses parts of the  body
which are relaxed and feeble.   Mixed with blood it forms a  clot with
great rapidity through coagulation  of the  albumin.  Tannic  acid is
absorbed as  gallic acid and eliminated as such, only acting as tannic
acid before  absorption.   This  is  important to  remember,  since we
learn from this that tannic acid is to be used to check haemorrhage only
where  the drug can be  brought in direct contact with the  bleeding
point.  If a haemorrhage is to be reached through the circulation, as
in renal bleeding, gallic acid is to be given, as it  is absorbed at  once
without change.
  Therapeutics.—Tannic acid  is used in medicine to control hemor-
rhage, and to act as an astringent to relaxed tissues as in diarrhea of
the atonic or  serous type, or in localized or general sweating.   It is
also of service  for the purposes of toughening mucous  membraues or
parts of the skin which  are exposed to much rubbing, as in the case
of the  nipples  of a primipara, or where the feet become macerated
aud sore, or sweat  profusely on exercise being taken.   In  the treat-
ment of  hemoptysis, tannic acid may be dissolved in water in the
proportion of 5 to 10 grains to the ounce and used as a fine spray.
Glycerite  of tannin is made by adding 2 troy ounces  of tannic acid
to a | pint of glycerin and mixing  at a gentle heat until solution
occurs.  It is  useful as  an application to slow ulcers  and depressed
mucous membranes, as after an attack  of stomatitis.   In haemorrhoids
of the bleeding type tannic acid suppositories are often very useful, and
cotton saturated with tannic acid solution is often used as a packing in
vaginal leucorrhcea.
  Administration.—The dose of tannic acid is 2 to 10 grains, best given
in pill.   The  official preparations  are: the  troches (Trochisci Acidi
Tannici,  U  8.), each containing 1 grain of tannin, and an  ointment
(Unguentum Acidi Tannici).  The B. P. preparations are Glycerinum
Acidi Tannici;  Suppositoria Acidi Tannici, each containing 3 grains,
and Trochisci Acidi  Tannici, of which each contains \ grain of the acid.
                                21 
322
DRUGS.
                            TANSY.

  Tansy (Tanacetum, U. S.).  The leaves and tops of Tanacetum Vulgare
yield a volatile oil (Oleum Tanacetum) which possesses emmenagogue
powers and  has been largely used as a uterine stimulant.   It  is  also
used as an anthelmintic.
  In poisonous dose it causes epileptiform convulsions in  some cases,
and deep coma, with death from respiratory failure.
  The dose of the oil as an emmenagogue is 1 to 3 drops.
  In  domestic medicine tansy  tea, made by adding 1 ounce of the
leaves or tops  to 1  pint of water, and given iu the dose of 1  to 2
ounces, is largely employed as a remedy for amenorrhea.


                              TAR.

                         (See page 284.)


                        TARAXACUM.

  Taraxacum,  U. 8.,  Dandelion,  is a very  old  remedy  for hepatic
torpor and  the dyspepsia  resulting therefrom.   It  should  be  pre-
pared from  the fresh  leaves  or roots, as the dried stale plant is inert.
From disregard of this fact much disappointment has arisen.   Owing
to its being  bitter it acts as a tonic.  The  extract (Extractum Tarax-
aci, U. 8. and B. P.), dose 5 to 30 grains,  and  the fluid extract (Ex-
tractum Taraxaci Fluidum, U.  8.), dose 1 to 3 drachms, are the only
official preparations.   Succus Taraxaci, B.  P., is given in the dose of
1 to 2 drachms; Decoctum Taraxaci, B. P., is  administered in the
dose of  2 to 4 ounces.

                      TARTARIC ACID.

  Acidum Tartaricum,  U. S.  and B. P., is  a vegetable acid much less
powerful than acetic acid, but capable of producing very severe gastro-
enteritis if taken  in  overdose and in .concentrated form.   It is rarely
used alone and is most commonly employed to act upon  sodium or
potassium bicarbonate  to  form  effervescent drinks.   (See  Seidlitz
Powder and Effervescing Draught.)   The dose is 5 to 20 grains.
  When tartaric acid is taken in poisonous dose, lime-water, alkalies,
and magnesium are  the antidotes, and opium is to  be given to allay
irritation.   If necessary, emetics are to be used.


                         TEREBENE.

  Terebene  is  a  liquid substance, clear, colorless, insoluble in water,
having a peculiar odor like that of new pine sawdust, and is made by 
TERPINOL.
323
the action of sulphuric acid upon oil of turpentine, which is then dis-
tilled at about 160° F.
   Therapeutics.—Terebene is a very useful  stimulating expectorant,
to be used iu the late stages of acute or in chronic bronchitis to liquefy
and get rid of the mucus which is clogging the bronchial tubes.   The
drug may be given by way of the  stomach or  by inhalation.   A useful
mixture in the later stages of bronchitis when the mucus is very thick
and tenacious is one composed  of equal parts of terebene, iodide of
ethyl, and  chloroform, placed on  a sponge and held some two or three
inches from  the face.   It has also been employed in genito-urinary
inflammations of a subacute or chronic form  in place of oil of sandal-
wood or copaiba as a stimulant.  In fermentative dyspepsia it is of
service as an antiseptic.  The drug should always be given in capsules
in the dose of 5 to 10 minims, or by dropping it ou sugar in the same
amount.   This dose may be repeated every three hours.   Unfortunately
terebene is very apt  to  irritate the stomach  or  to produce diarrhoea,
and it sometimes irritates the kidneys.


                    TERPINE HYDRATE.

   Terpine hydrate is prepared by a  certain  process, unnecessary to
explain, from a mixture of pure  oil of turpentine, alcohol,  and  nitric
acid.   In this manner large, colorless crystals, without odor, and with
a faint taste, are formed, aud in  this form the drug appears on  the
market.   Terpine hydrate is soluble in 250  parts of cold, 32 parts of
boiling water, and in ten parts of alcohol.   In ether it requires  100
parts for its solution and in chloroform 200  parts.
   Therapeutics.—Terpine hydrate is used for the purpose of increas-
ing secretion from the bronchial  mucous membrane, and is a useful
remedy in subacute or chronic bronchitis to  rid the tubes  of mucus.
The drug  has also been satisfactorily employed in the treatment of
hay fever when  given in  full doses.   The remedy, while only useful
in a  limited number of conditions, certainly seems to  be very useful
iu  the varieties  of disease named.  The dose as generally given is 2
to 3 grains, but it may  be given in the dose of 15 to  20 grains three
times a day in hay fever.  Terpine hydrate may be prescribed in pills,
capsules, and in alcoholic solution, flavored with some of the aromatic
waters, and with the addition of  a little syrup.


                           TERPINOL.

   Terpinol is derived from terpine hydrate by boiliug  the latter with
dilute mineral acids.  Terpinol  occurs as an oily substance, smelling
like hyacinths.   It is almost insoluble in water, but dissolves readily
in ether and alcohol.   It  is  used for  precisely the same purposes as
terpine hydrate, in the dose of 8 to 20  grains, in capsules or pills.
This dose may be given twice or  thrice a day.   The drug may irritate
the stomach and kidneys when given in overdose. 
324
DRUGS.
                           THALLIN.

   Thallin is a synthetically prepared chemical compound otherwise
known  as Parachinanisol.   There are  three salts  of thallin:  the
sulphate,  the tartrate,  and the hydrochlorate.    All are  alike  in
appearance and  taste, but the sulphate is generally employed.  Given
to man in a healthy state  they produce au unpleasant taste  in  the
mouth, but no other symptoms unless the dose be quite large.  Buzzing
in the ears, labored respiration, deep cyanosis and coma come on after
excessive amounts are taken.
   Physiological Action.  Nervous System.—So far as  is known,
the influence of this drug over the nerves amounts to almost nothing.
No studies are on record which show any such  direct influence.
   Circulation—Upon the circulation  thallin has little influence, in
moderate dose, although its  tendency is toward  depression rather than
stimulation.  In very large doses it lowers blood-pressure by depressing
the heart and peripheral vasomotor  system.
   Temperature.—Thallin reduces normal bodily temperature very
slightly, and lowers febrile temperature by increasing the dissipation
of heat.
   Tissue-waste and Urine.—It increases the  urinary flow,  but its
action on tissue-waste is uncertain.
   Antiseptic Action.—It  possesses  more antiseptic power  than other
antipyretics, and 1 per cent, solutions prevent fermentation in organic
liquids for some time.
   Prolonged Poisoning.—In prolonged poisoning the drug  causes
degenerative changes in the kidneys and a decrease in the number of
the red  blood-corpuscles.
   Therapeutics.—Thallin has never  obtained  much  hold upon pro-
fessional favor for reasons  not very easy to perceive.   The studies of
Minot seem  worthy of  special  mention as in reality outlining  the
general  opinion  and thought of the practitioners  on  this side  of  the
Atlantic in regard to this drug.   Minot found that thallin acted more
satisfactorily and with the most lasting effect when it was given at or
just before the acme of a febrile process.  The  effects of the drug
were always most favorable, sweating and  vomiting  occurring but a
few times, while in many instances the patient,  previously restless and
delirious,  became tranquil and quiet.   It was also found by  Minot
that the drug exercises no appreciable influence upon  the  duration of
the disease in typhoid fever, and he concludes that it is  sufficiently
harmless to be given to very young children.
   The writer's  experience with thallin is too limited to permit  of his
speaking authoritatively concerning it, and he can therefore  merely
state that it  has always seemed to him far less useful in fevers than
many of the other drugs of its class.  The fact that its influence is so
transient,  lasting only from  two  to three hours  as a rule, the necessity
of its frequent dosage in consequeuce, and its liability to nauseate the
patieut by reason of its taste and action on the stomach, are all against 
THIOL.
325
 its use.  Of the fact that it acts quite as rapidly, if not more so, than
 antipyrine and acetanilide, there can be no doubt.   It has been found,
 too, that the sweat is  often very excessive, although there  are  some
 observers who assert that, in  children particularly, this  symptom  is
 often absent.  Jaccoud  thinks that so many people have an idiosyn-
 crasy to its use that small doses should always be used at first.
   Owing to the transitory effects of the drug frequent administration
 of the  remedy is  necessary, and as  this fact was first pointed out by
 Ehrlich, the term  " thallinization  of  Ehrlich" is  frequently  heard
 when the use of the drug is spoken  of.  The dose under these circum-
 stances should be  given hourly in the amount of J to 1 grain, or even
 2 grains in adults.

                            THAPSIA.

   Thapsia  Garganica is an umbelliferous plant of Southeastern Europe
 employed for the purpose of producing a blister.  It is generally used
 under these circumstances iu the form of a plaster.  The resin, obtained
 from the bark of the root, is the form in which it appears in medicine.
 When  applied continuously it produces  great  irritation  and finally
 sloughs appear.

                              THIOL.

   Thiol is a  substance  introduced  into medicine as a substitute for
 ichthyol, which possesses the  disadvantage  of having a disagreeable
 odor.   It is derived from brown-colored paraffin or gas oils by a com-
 plicated process.   The product obtained is evaporated in vacuo  to  a
 thin extract called  thiolum liquidum, or still  further to dryness, or thi-
 olum sicca.   The liquid thiol  occurs as a thin brownish-black neutral
 fluid, smelling slightly like birch oil.  It is slightly soluble in alcohol and
 ether, but quite soluble in water, forming a clear mixture,  which is
 rendered more perfect  by the  addition of glycerin.  Thiol sicca may
 appear  in lustrous scales.
   Therapeutics.—The question which arises  at once in regard to thiol
 is,  whether  the fact that thiol is  practically an artificial  ichthyol
 necessarily indicates that it can be used as a substitute for that  sub-
 stance.  While it is true that they are  both  sulphur compounds, it is
 also true that ichthyol  possesses  very extraordinary powers not met
 with in any other form of sulphur previously known.  Thiol has  been
 used largely by skilful observers in diseases of the skin in moist eczema,
 scrofulosis of the skin, and in syphilides with asserted good results.  In
 cases of moist eczema the thiol  is used, after first washing the part with
 an antiseptic solution, by dusting it over in powder form.   Bidder has
 treated  the disease by using compresses wet with thiol in 10  per cent.
 solution.
   While it is claimed that thiol will relieve exudations  about joints
and elsewhere in as effective a manner as ichthyol, sufficient evidence as
to this point is not yet before us.  Thiol is much cheaper than ichthyol. 
326
DRUGS.
                           THYMOL.

   Thymol, IT. S. and  B. P.,  is derived  from the oil  of thyme  aud
other volatile oils, and occurs in large crystals.  It is almost insoluble
in water, but is freely so in fats  aud oils.   Thymol is irritant, but
antiseptic aud  disinfectant, and has been employed in typhoid fever
as an intestinal antiseptic by Heury aud  others.   In the treatment of
stomatitis or tenderness of the gums after mercurialization the follow-
ing mouth-wash may be used  :
         R.—Thymol.......gr. x.
             Sodii boratis......gr. xv.
             Aquae........f^ij.    M.
    S.—Place a teaspoonful of this in half a tumblerful of water and use as a gargle.

   It has  been  used for dressing wounds, but is too costly.   In sum-
mer weather it cannot be employed, because  of its attraction to flies,
which make the patient's life miserable. The dose is J to 2 grains,
in capsule or in wafer, aud it  is better to follow its use by a glass of
milk to prevent  the drug  from  irritating the stomach.  In  typhoid
fever as much as 30 grains in twenty-four hours may be given.
   If very large amounts (100 grains) are taken in a day, poisoning
may result, but as much  as this must be used before danger is present.


                      THYMOL  IODIDE.

   This compound of iodine and thymol, sometimes called aristol, but
more correctly dithymol  diodide,  has  been introduced into medicine
for  the purpose of substituting iodoform.   It does not possess the
unpleasant odor of iodoform,  and it is stated to be less apt to produce
poisoning by absorption.  A  great deal of contradictory  experience
has  accumulated as to its exact value, but the result of a careful ex-
amination of clinical reports is that in some respects it is abetter drug
than iodoform  aud in others not so good.  Tichhoff and Neisser state
that when  taken internally thymol iodide   is incapable of  causing
toxaemia, but this can only be true when moderately large  doses are
given.  Upon  cocci  and bacilli thymol  iodide  has less power than
iodoform.   In regard to the  power of this   drug in  healing wounds
or sores, the decision has been reached that whenever secretion is free
it is contra-indicated, as the  thymol seems to increase  moisture.  On
the  other hand, in  those instances where in disease of the skin or
mucous membrane an undue  dryness is present the effect produced  is
often favorable.   Upon  lupus littls effect is produced  unless  the  sur-
face is first curetted.   Finely powdered thymol iodide has been found
of very unusual value iu the treatment of interstitial keratitis by De
Schweinitz  aud Wallace when dusted into the eye each day.  In an
ointment of J  to  1 drachm to the ounce of lard, thymol iodide  may
be used in psoriasis, but it is not as useful  as is chrysarobin in this
affection. 
TURPENTINE.
327
                           TOBACCO.

   Tabacum,  U. S. (Tabacum  Folia,  B. P.), is the dried leaves  of
Nicotiana Tabacum, a native of tropical  America, but cultivated all
over the temperate zone.   It contains a liquid alkaloid, nicotine, but
dose not  contain  nicotianin,  as no  such principle exists.1   When
smoked it yields pyridine, which is sometimes  used in  medicine by
itself.
   Physiological Action.—Tobacco,  in overdose, is a nauseating emetic,
very depressant in its influence on respiration and the circulation.
The pupils are contracted by its influence, the  bodily temperature  is
lowered, and the skin becomes cold  and clammy.
   Upon the motor nerves tobacco acts as a depressant poison.
   Nicotine is one of the most  violent poisons  known, and is almost
as fatal as hydrocyanic acid, death having taken  place iu three minutes
after the ingestion of a poisonous amount.
   The drug, when smoked or chewed to any extent by young persons,
stunts  the growth of all parts  of  the body,  aud is very apt to cause,
in all  persons, granular  sore-throat, pharyngitis, laryngitis, and fau-
citis.  Sometimes angina  pectoris is  developed.   "Tobacco heart" is a
term applied to a  condition of this viscus characterized by disorders
in its rhythm or power;  palpitation, arhythmia, and dyspnoea being
often present.
   The  treatment  of poisoning by tobacco  consists in  the  use  of
strychnine to stimulate the nervous system and the respiratory centre,
and  in the employment of cardiac  stimulants, external heat,  and
atropine.
   In  the  mild form of  poisoning, following excessive smoking,  in
which  slight nausea  is felt, the author has  found 1 to 2 drachms  of
Hoffmann's Anodyne taken in ice-water most effective.
   Therapeutics.—Tobacco  is  used to  relieve  constipation by  some
practitioners, and for this purpose the wiue ( Vinum Tabaci) is usually
employed  in the dose of 10 minims every night on retiring to bed.
The drug  has been employed in  many affections, such as asthma, intes-
tinal obstruction, and dropsy, but has passed into disuse  because the
symptoms produced were often excessively severe and very serious  to
the patient.   Applied iu  solution to pruritus ani and vulrce tobacco  is
frequently of service, but absorption may occur aud produce untoward
effects.  It ought not to  be used on piles for  this reason.


                         TURPENTINE.

   Terebinthina,  U. S., occurs  iu two forms, namely,  as  turpentine
derived from the  ordinary yellow  pine (Pinus Austral is) and  other
varieties of pine, and as  turpentine derived from Abies Balsamea,  or

          1 See author's Prize Essay on Tobacco.  Philadelphia, 1885. 
328
DRUGS.
silver fir, or species of cone-bearing  trees other than Pinus Australis.
The turpentine  derived  from  the latter sources is sometimes  called
" Balm of Gilead."
  Much confusion often  exists  in students' minds as to the difference
between oil of turpentine (Oleum Terebinthine, U. 8. and B. P.) and
spirit of turpentine, both of which  are  the same substance  under a
different name.  This oil is not, however, the same thing as  " turpen-
tine," for the oil is distilled from turpentine.  The distilled oil is a
thin, clear fluid, having a peculiar odor  and taste, and is irritant  to
the  skin and mucous membranes.   It is  exceedingly inflammable,
should  never  be placed near a  light, and if added to any strong min-
eral acid takes fire.
  When turpentine is spoken of in this book, or in medicine generally,
the oil of turpentine is what is  meant unless the contrary  is stated.
  Physiological Action.—Turpentine, when taken internally, produces
a sense of warmth  in  the stomach, a quickened pulse, a warm skin,
and slightly accelerated breathing. In overdose it  may cause  intoxica-
tion.   Upon the circulation it  produces a very slight rise of arterial
pressure, increased pulse-rate, and increased heart-force.   On the ner-
vous system the drug, in large amounts, causes loss of sensation before
voluntary motion.
  The  drug  is eliminated by the "kidneys  and lungs, and gives the
odor of violets to the urine.
  Poisonous doses cause  strangury, bloody urine, renal  inflammation,
and cyanosis, with dilated pupils and gastro-enteritis.
  Therapeutics.   External  Use.—Turpentine is used as a local
application for the  purpose of  producing counter-irritation over any
area where deep-seated inflammation exists.   Under these circumstances
it is almost always used in the form of a stupe, made as follows :  Place
a tin cup containing the turpentine in a vessel containing hot water  so
that the turpentine may be  warmed without  coming near  a flame.
Dip a piece of flannel into very hot  water and  wring  it  out in  a
twisted towel, and,  when it is so  dry that no water drips from it, dip
it into the hot turpentine and wring  it out again to free  it from any
excess  of the  drug.    The cloth, while  hot, should  be applied, and
allowed to remain  until discomfort  ensues, when  it  should  be with-
drawn,  as it will blister the skin if left on too long.   In children and
adults turpentine may be rubbed  on the chest in bronchitis with much
relief, but in the former class it should be diluted  with  sweet oil, half
and half, or even two-thirds of oil.
 ^ Internal  Use.—Turpentine is used internally as a stimulant of a
diffusible  type in the course of the exhausting fevers, particularly  if
any flatulence exists or if any ulceration of the  bowels is present.  In
typhoid fever turpentine stupes, turpentine enemata, and the  adminis-
tration of the drug  by the mouth, are the best ways to overcome tym-
panites.   At the end of the second week, when the tongue is  red, dry,
cracked, and brown, the teeth  covered with sordes, aud  tympany is
well marked, turpentine should be used in emulsion in  the dose of 5
in 10 drops three times a day.  Again, in convalescence from typhoid 
turpentine.
329
fever, when diarrhoea  is persistent and relapses are constant and due
to an unhealed state of Peyer's patches, turpentine is the remedy par
excellence.
   In intestinal and other passive  hemorrhages, such as menorrhagia,
the drug is often of service.
   Used against the tape-worm, turpentine is given in the dose of half
an ounce to an ounce mixed with an equal amouut of castor oil.  This
is a somewhat dangerous practice, but is efficient.   In chronic and
well-advanced kidney disease very large doses of powerful diuretics
are often required to stimulate the kidneys sufficiently to cause urinary
flow, and turpentine may be used under these circumstances.
   Turpentine is contra-indicated  in any  acute  inflammation of the
gastro-intestinal tract and in acute nephritis.
   In lumbago the dose of 20 drops is said to be very useful, and many
have found it of value when inhaled from boiling water in  bronchitis
of a subacute or chronic form.  In  gleet  it is given by the mouth to
stimulate the genito-urinary tract.   Turpentine should  be tried in the
treatment of purpura hemorrhagica, as it has been found of value.
   Administration.—Turpentine may be given for the  relief of flatu-
lence by placing 5 drops on a piece of sugar or iu emulsion made by
using acacia and a  flavoring substance, as follows :

         R.—01. cinnamomi......gtt. xx.
             01. terebinthinae......f.^iv.
             Mucil. acaciae    .    .    .    .   q. s. ad  f^iv.   M.
    S.—A teaspoonful every four hours in typhoid fever.

   A more agreeable preparation, not to be used in  typhoid fever, is
that recommended  by Bartholow, as follows :

         R.—Olei terebinthinae.....fzj.
             Olei amygdal-expres. •       .   .    .  fgss.
             Tincturae opii    .    .    .       .    .  f^ij.
             Mucil- acaciae    .    .    .   •   .    .  fgv.
             Aquae lauro-cerasi     .    .   .   .    .  f^ss.    M.
    S.—A teaspoonful every four hours for tympanites.

When used as an enema, the following is useful:

         R.—Olei terebinthinae......f.^j.
             Olei olivae  .   .   .   .   .    .    . f^jss.
             Camphorae.......gr.  xx.
             Mucil. acaciae......f ^ss.
             Aquae....... fgx     M.
    S.—To be injected as an enema for the relief of tympanites and to aid in the
removal of hardened faeces.

   The Liniment of Turpentine (Linimentum  Terebinthine,  U. S. and
B. P.) is largely used as a stimulating  application  to sprains and en-
larged joints.
   Turpentine is of service in ring-worm, applied with  a brush to the
part  affected.  The following preparations  are official in the B. P. :
Confectio  Terebinthine, dose  1 to  2  drachms; Enema Terebinthine,
Unguentum Terebinthine, and Linimentum Terebinthine Aceticum. 
330
DRUGS.
  The ointment is used as a counter-irritant and stimulant to the part
to which  it is applied.   The  liniment acts  in  the same way when
applied to sprains and bruises.


                          UVA  URSI.

   Uva Ursi,  U S., Bearberry, is  the  leaves of Arctostaphylos Uva
 Ursi a widely distributed evergreen shrub.  The drug  is known in
the B. P. as Uve  Ursi Folia.   Its active  principle is arbutin, some-
times called ursin.
   Therapeutics.—Uva ursi is employed in medicine as a weak, astrin-
gent  diuretic, possessing alterative power  over the genito-urinary ap-
paratus.  It is used in pyelitis, cystitis, aud in chronic gonorrhea or
gleet.   When taken in overdose it escapes from the body as hydro-
chinone, making the urine dark-colored or black.
   Administration.—Arbutin itself is often used  in the dose of 3 to 5
grains.  The dose of the fluid extract (Extractum Uve Ursi  Fluidum,
 U. 8.) is 2 to 4 drachms three times  a day.  An infusion (Infusum
 Uvce  Ursi) is official in the B. P., dose  1 to 2 ounces.


                          VALERIAN.

   Valerian (Valeriana, U. S.) is the rhizome and rootlet  of Valeriana
 Officinalis,  a  plant of Europe, but cultivated  in  America.   It  is
official in the B. P.   as  Valeriana Bhizoma.   Its active principle  is
apparently a volatile  oil (Oleum Valeriane, U. 8.).   It  also contains
valerianic acid.
   Physiological  Action.—Valerian is  a very feeble depressant to the
nervous system,  tending  to produce nervous rest, but in cats it ex-
cites  sexual activity to a great degree, probably from its odor.   When
very  large doses  are given to man  it causes a sense of warmth in the
 stomach, a slightly quickened pulse, and perhaps nausea and vomiting.
 Still  larger amounts produce purging and mental hebetude.
   Therapeutics.—Valerian is used alone or in combination with other
drugs to quiet nervous females and  to relieve nervousness and insomnia.
 In hysteria it is often very serviceable, and combined with morphine
 is much used in  the treatment of delirium tremens.
   Administration.—The  fluid extract (Extractum Valeriane Fluidum,
 U. S.), dose  1  fluidrachm, and the ammoniated tincture (Tinctura
 Valeriane  Ammoniata,  U S. and B.  P.), dose 1 to 3  drachms, are
 the best preparations for ordinary use.   The infusion,  which is not
 official,  is given in the  dose  of a  wineglassful, while that  of  the
 simple tincture  (Tinctura  Valeriane,   IT. S. and  B. P.) is  1 to  3
 drachms.  The  dose  of the  oil (Oleum  Valeriane,   U.  S.) is 2 to 4
 drops.  An infusion  (Infusum Valeriane) is official  in  the B. P., in
 the dose of 1 to  2 ounces. 
VERATRINA.
331
                     VALERIANIC ACID.

   Acidum Valerianicum is au oily, colorless liquid of a strong odor
and burning taste, but is not employed in medicine except in the form
of its salts, such as the valerianate of zinc, iron, quinine, or ammo-
nium, all of which are employed partly for  their sedative effects aud
partly for their influence as tonics.
   The dose of Zinci Valerianas  is J  to  3  grains, that of  Quinine
 Valerianae, U. 8.,  1 to 3  grains, of Ferri  Valerianas  2 to 10 grains,
and of Ammonii  Valerianas 2 to 10 grains.  Under the name of " the
pill of the  three valerianates "  Goodell recommends the following in
nervousness and hysteria:
         R.—Quininae valerianat. ^
             Ferri valerianat    I      .    .      aa 9j.   M.
             Ammon valerianat. )
    Ft. in pil. no. xx.  S.—One or two three times a day.


                         VERATRINA.

   Veratrina, U. 8. and B. P., is an alkaloid derived from Veratrum
Sabadilla, and occurs in a grayish  powder, which, if it enters the nose,
produces violent sneezing which lasts for hours.
   Physiological  Action.   Nervous System.—Veratrine  has little
effect on the cerebrum, but it does excite the spinal cord and the vol-
untary muscles, thereby giving rise to tetanic  or tonic convulsions,
which  are never clonic or epileptoid.  The dominant action  of the
drug  is paralytic and the nervous symptoms just named soon give
place to paralysis.  The muscles lose their contractile  power and the
nervous centres are depressed.
   Circulation.—In poisonous dose the heart is slowed by the drug,
greatly weakened, and finally stopped in diastole, and  is found  after
death to be soft and flabby.  In smaller doses it at first slows the pulse
by stimulating the peripheral  inhibitory nerves and the centres in the
medulla, but later  these parts are  paralyzed.  It first stimulates the
vasomotor centre, then paralyzes it.
   Respiration.—The drug kills by failure of respiration due  to
paralysis of the respiratory centres.
   Temperature.—Veratrine always causes a fall of bodily heat.
   Poisoning.—The symptoms of  poisoning  iu  man  are collapse,  a
pale,  cold,  wet  skin, pinched features, and a  rapid, thready pulse,
accompanied by  violent vomiting  and muscular tremors.   Tetauic
convulsions may come  on and  resemble those of strychnine in that
they arise from the slightest touch or draught of air ;  after death the
muscles will be found to have lost  their irritability.
   Therapeutics.—Veratrine is never used internally.    It is employed
chiefly in the form of an ointment  rubbed into the skin over  muscular
rheumatism  and  rheumatic joints,  and over neuralgic nerves.   The 
332
DRUGS.
official ointment  (Unguentum  Veratrince,  U. S.  and  B.  P.), or the
oleate (Oleatum Veratrine, U. S.),  should be used, the  latter  most
carefully,  as absorption of the drug may  take place in  sufficient
quantity to  poison  the  patient.


                    VERATRUM VIRIDE.

   Veratrum  Viride,  U.  S.,  Indian  Poke, Poke-root,  or Swamp
Hellebore, is  an American  plant largely used  for  the  purpose of
allaying inflammation; it is  official in the B.  P. under the name
of Veratri Viridis Bhizoma.
  It probably contains a number of principles, the chief of which are,
however, jervine and veratroidine.
  Veratrum viride is the  safest and best  circulatory  depressant that
we have for use in adults.
  Physiological Action.—The physiological action of this drug is to
be considered under the effects of its two alkaloids before the complete
effect is studied.
                             Jervine.

  When Jervine is given in full toxic dose it causes great  slowness of
movement, relaxation of the muscles, through which  thrills continu-
ally run, and finally the animal falls to the ground. Violent epilepti-
form  convulsions may  now  ensue,  but  no tetanus is present.  The
convulsions soon give  place  to paralysis, and are characterized  by
their  lack of force.  Sensation is  not affected until the near approach
of death  brings on anaesthesia.    There  is no evidence of  gastro-
enteritis and no vomiting or purging.  The  saliva is always increased
and pours from the mouth.  Death results by failure of the respiratory
centres  and an almost simultaneous  failure  of the heart.  The heart
and circulation are  greatly depressed and the pulse-rate and force are
far below their normal rate and strength.
  The  blood  pressure  is very low except when  the convulsion pro-
duces a temporary rise, but  the condition of the vagi is apparently
normal.  Jervine acts as  a direct  depressant to the vasomoter centres.
The convulsions are due to the disturbance of the circulation at the base
of the  brain (Wood), and the spiual cord is  directly depressed by the
action of  the jervine on its motor  tracts.


                          Veratroidine.

  This  alkaloid is much more irritating  than jervine,  and  in overdose
causes vomiting and purging.  The muscular twitchings and convul-
sions caused by  jervine  are  also produced by veratroidine, but are
generally  not so severe.   It also depresses the spinal cord in its motor
tracts.
  On the circulation veratroidine  slows  the pulse by  stimulating the 
veratrum  viride.                   333
pneumogastric  centres, but  finally quickeus it if given  in very large
doses, by paralyzing the peripheral vagi.

   The following summary given by Wood of the circulatory effect of
veratrum viride, from a study of its alkaloids, is so brief and terse as
to be worthy of insertion here :  " Veratrum viride slows the pulse by
a direct depressant action  on the heart muscle (jervine), aud by stimu-
lating the pneumogastric  nerves (veratroidine); it lowers blood pres-
sure by an  action on the  heart  muscle (jervine) and by depression of
the vasomotor centre (jervine)."
   Poisoning.—Veratrum viride,  while  one  of the  most  powerful
drugs we  have, is one of  the least dangerous, since  it almost invaria-
bly causes vomiting before enough of the drug is absorbed to produce
serious consequences.  The  vomiting is partly due to the veratroidine
and partly to the presence of an irritant resin.   In poisoning, cardiac
stimulants, atropine, external heat, the placing of the  head  below the
feet on an inclined plane,  and the use of strychnine as  a respiratory
and nervous stimulant are to be resorted to.
   Therapeutics.—The chief use of veratrum viride  is as a circulatory
sedative in acute, sthenic,  or dynamic inflammations.
   In pneumonia, pleurisy, acute hepatitis, peritonitis, and cerebritis it
is of the greatest value if given at the  proper stage when only con-
gestion or hyperaemia is  present.  After the  onset of the lesions  fol-
lowing this  period, its use is not only valueless, but malpractice.   The
only objection  to the  employment of veratrum  viride  in peritonitis
lies in its  tendency to produce vomiting, which is, of course, harmful
when the peritoneum is inflamed.  For this reason aconite is  preferred
to veratrum viride in peritonitis.  Owing to its physiological influence
veratrum  viride bleeds a man into his own bloodvessels,  and the indi-
cations for its use  are the same in inflammation as they would be for
bleeding.   In puerperal fever it has  been highly recommended, but
must be most  carefully employed.  It is  also of value in  excessive
cardiac hypertrophy and  in  the irritable heart of strong  healthy men.
In aneurism where the circulatory disturbance  is great aud the arterial
pressure high,  the drug may be used, with great care, to decrease the
pressure and prevent rupture of the diseased vessel.
   Contra-indications.—Veratrum viride is contra-indicated  in all
conditions  of depression  or exhaustion,  and if vomiting  is feared,
must not  be given in peritonitis or gastritis, as  it  may cause emesis
and in this way disturb and irritate the abdominal contents.
   Administration.—The drug in inflammation should be given  every
half-hour or hour, aud at least 1 drop of the tincture should be used
each time in a healthy adult.  In the course of two or three hours,
or less, the skin becomes  moist or relaxed, the pulse slower and  less
angry,  and  slight nausea may be  present.   These symptoms show
that the drug is exerting its influence and it should now be withdrawn,
or in very sthenic cases pushed a little farther.  If vomiting  comes on
before the drug has acted on the circulation,  5 to 10 drops of lauda-
num should be given 15 minutes before each dose of veratrum viride. 
334
DRUGS.
The best preparation to employ is the tincture (Tinctura Veratri Viri-
dis, U. 8. and B. P.), dose 1 to 3 drops.   The fluid extract (Extractum
Veratri Viridis Fluidum, U. 8.)  is given in the dose  of 1 to 3 drops.
Under the name of Norwood's Tincture, a saturated tincture has been
sold.   It is not official and ought never to be used.
                       VIENNA PASTE.

  Potassa cum Ccdcc, U. S., is a milder and more manageable escharotic
than is caustic potash, and is used for the same purposes.  (See Caustic
Potash.)

                  WARBURG'S TINCTURE.

  Warburg's  Tincture  is a complex liquid formed by  the mixing
together of no less than thirteen ingredients.  Its inventor, Dr. War-
burg, held  its composition as a secret for a time, but finally made  it
public.  Since he published the original formula  it has  been consider-
ably altered, and some of the preparations now sold as Warburg's tinc-
ture contain none of the original ingredients.  Further than this, some
of these ingredients are now not  obtainable.  It  ought  to be made as
follows, if possible:
         Aqueous extract of aloes
         Rhubarb
         Angelica seed
         Elecampane
         Saffron
         Fennel
         Gentian
         Zedoary root
         Cubeb
         Myrrh
         White agaric
         Camphor  .
         Sulphate of quinine
         Dilute alcohol enough to make 8 pints.

  The  coarse vegetable portions of this list are to be  ground into a
coarse powder, and the  myrrh and camphor,  which have been pre-
viously pulverized, added to them.  The entire mass, less the quinine,
is then digested for 12  hours in a well-covered vessel,  on a water-
bath, the alcohol being prevented from evaporating as much as pos-
sible. The liquid is now to be strained under pressure and  the sulphate
of quinine added and dissolved.
  Therapeutics.—Warburg's tiucture, next to pilocarpine, is the most
powerful sweat-producer that we have, and possesses in addition very
remarkable anti-malarial power.   In this last respect  it far exceeds
quinine as a remedy in pernicious  malarial regions  for acute attacks
and as a prophylactic.   Its advantages over quinine rest  in its favor-
able action where congestions accompany the paroxysm.
28	grains
448	"
448	"
224	It
224	It
224	a
112	u
112	it
112	it
112	a
112	it
112	it
1280	it
 
ZINC.
335
  Administration.—To be of any value, Warburg's tincture should be
given according to the following rules :  The  bowels of the  patient
should be  first opened thoroughly by a saline purge, and a | ounce
of the tincture  should be given in one dose undiluted, no drink being
taken. After the lapse of two or three hours a second J ounce is given
in the same way, and very shortly a profuse sweat appears, which gen-
erally marks the crisis of  the disease, and recovery soon takes  place.
                             ZINC.

  Zincum is not employed in medicine in its metallic form but in the
form of several of its salts, of which there are a large number, each of
which will be found under the names of the acids forming them. (See
Sulphate of Zinc.)
  Physiological Action.—Nearly all the salts of zinc are somewhat
astringent, and when taken internally act as depressants to the nervous
system.   Some  of them are more irritating than others, such as the
chloride and sulphate, whereas the  valerianate has  almost no power
except so far as the  valerian is concerned.
  All of the salts when taken for a long time in excess produce organic
changes in the nervous system, generally represented by a myelitis, which
differs from that caused by lead, which is ascending, while that of zinc
is transverse.
  Zinc is eliminated by the liver  and  kidneys.   Chronic poisoning
among workers in  zinc  is rare,  but has  occurred.   The  symptoms
closely resemble those of chronic lead-poisoning. 
 
PART  III.
REMEDIAL  MEASURES  OTHER  THAN  DRUGS.
              FOODS  FOR THE  SICK.
                      ACUPUNCTURE.

  This is  a term applied  to the insertion of a small pointed instru-
ment into  the tissues of any part of the body for the purpose of re-
lieving pain, swelling, or dropsies.  When used in painful  affections
it accomplishes its best results in lumbago and sciatica, particularly in
the former.   When treating lumbago in this manner the writer takes
two darning-needles, places them in boiling water to render them
aseptic, inserts them one to  one and a half inches and allows them to
remain in  place  for several  minutes.  They are then slowly with-
drawn, care being taken to prevent them from breaking off.  Often
after  this treatment  the  patient can at once move more freely, to his
great delight.  Ringer  has, with his usual clear clinical insight, noted
that this treatment is  more successful in those who have bilateral
pain than  in those cases who have  one side affected, and the writer
has found this statement invariably true.
  In  sciatica acupuncture is less successful than it is in lumbago, but
is always to be tried.   The needle should be carried  down until it
reaches the nerve, and, perhaps, pierces its sheath; and  it must  be
absolutely aseptic.  Bartholow has recommended the use of a hypo-
dermic needle for the simultaneous  injection of a few minims  of
chloroform  or morphine.   Sometimes the  best  results are reached
from  inserting the needle immediately below where the  nerve finds
exit from the pelvis.   In other  cases it is asserted that the insertion
of a needle  over  a corresponding spot to that which  is sore, on the
sound side, may do good.  Acupuncture is useless in acute rheumatism
and for the lumbar pain produced by fevers.
  Sometimes a rhigolene  spray may be used  to  freeze  the skin  over
the parts with advantage in lumbago or sciatica
  Acupuncture is occasionally resorted to for the relief of dropsy, but
it is not commonly employed, although it is  often a useful  measure.
When the skin of the limbs becomes  so tense with an effusion as to
endanger its life, the tension  should be removed by  incisions,  not
punctures; but saline purges are better for the removal of dropsy, if
they can be  used.  Punctures rapidly close and  make  hard spots,
                               ■» 
338    REMEDIAL  MEASURES  OTHER  THAN DRUGS.

while incisions remain open aud permit free drainage.  Immediately
after  the incisions are made the parts are to be dressed with cotton
previously saturated  with boric acid solution and dried, or  by ab-
sorbent cotton sterilized by baking it iu an oven.  It is hardly necessary
to point out that the incision must be made under autiseptic precau-
tions.  (See Antiseptics.)


                         ANTISEPTICS.

   The  term " Antiseptic," as generally  used,  does  not  necessarily
imply the power to destroy pathogenic germs.   Any substance which
inhibits the growth of microorganisms, which destroys or renders in-
nocuous the poisonous products of their action upon the tissues of the
body, or which retards or prevents the absorption of such products, is
properly termed antiseptic.  Since germicides necessarily possess anti-
septic attributes,  they should, strictly speaking, be  classed with anti-
septics ; in this portion of the work, however, only such drugs as are
sufficiently innocuous to allow of their  use in  the human body or upon
its surface will be considered.   Some of these, as, for instance, carbolic
acid and bichloride of mercury, are efficacious solely from their  germi-
cidal properties   Others, and of this  class iodoform  is the most im-
portant and typical example, exert their influence, not upon the micro-
organisms, but upon the toxic substances formed by these organisms.
   Of the long list of antiseptics  which have within  recent years re-
ceived warm  commendation at the hands of individual writers, there
are comparatively few which have retained the confidence of the pro-
fession after prolonged trial.   Only these few well-proven  drugs will
be discussed in this article.
   Heading  the list, and  in its germicidal  power  far surpassing all
others, is Bichloride of Mercury.   Long since, the researches of Koch
have shown that this salt is efficacious  as a germicide in a watery solu-
tion of 1 to 50,000.   He stated, however,  that where albumin was
present the bichloride was decomposed and rendered  inert.  The same
change was  observed when solutions  were allowed  to stand for some
length of time, even when distilled water was used as a solvent.   By
the addition of either sodium chloride or a weak acid such decomposi-
tion was prevented.
   From this  it  follows that under ordinary circumstances solutions
of bichloride  should  be freshly prepared, or, if it is desirable to keep
them  for a long time, a sufficient amount of sodium chloride should be
added to prevent precipitation of the mercury salt.   Koch advised
that as  much salt should be  added as would equal the weight of the
sublimate.   Other observers,  however, have advised  ten times this
weight of sodium chloride.
   Since whenever bichloride solutions are used in wounds or in cavities
of the body they are  brought in contact with blood-serum  or other
albumin-bearing substances,  care must be taken  that the antiseptic
powers of the mercury lotion are not destroyed  by the decomposition 
ANTISEPTICS.
339
of its active principle.   The power of the solution  may be preserved
by using  it in such large excess  that the small  amount of chemical
change has practically no effect, or by combining  with it,  as stated
above, an acid which will not in itself  be  unduly irritating to raw
surfaces.   This end is accomplished by tartaric acid.   In making up
a solution, one part of bichloride  and five parts  of tartaric  acid are
added to as much water as is needed.  Thus, in making up a solution
of 1 to 1000, for surgical purposes, the following prescription may be
employed :

         R.—Hydrarg. chlorid. corros.....gr. xv.
             Acid, tartaric   .... gr. xv. vel  sjj.
             Aquae dest........Oij.     M.

  Bichloride solutions are used in the strengths of 1  to 500, 1 to 1000,
and  1  to 2000, in the treatment of ordinary wounds.  For the irriga-
tion of large cavities solutions of a strength greater than  1 to 10,000
should rarely be employed, and even these dilute lotions  have, when
used in the peritoneal cavity, given rise to toxic symptoms.  The 1 to
2000 solution is the one generally employed for sterilizing wounds and
irrigating during operations.  The stronger solutions of 1  to 500 or 1
to 1000 are used  in cleaning the surface of the body.
  The ordinary method of preparing a surface of the body for opera-
tion  is as follows : The part is first thoroughly scrubbed with soap and
warm  water, is  shaved, aud is washed again as  before.  It  is then
cleansed with alcohol or ether, after which a scrubbing with bichloride
solution of 1 to 500 should follow, and  be continued for at least two
minutes.   If no surgical interference  is immediately indicated, the
whole  operative region should  be enveloped  in towels wrung out in a
solution of 1 to 500 or 1 to 1000, and  kept thus protected  until the
surgeon is prepared to operate.   The moment the skin is incised no
lotion  stronger than 1 to  2000 should be  employed, or if the more
powerful  solutions are used they should  immediately be flushed out
with one of less strength.  The dressings, unless some particular form
is used, may consist of boiled, bleached, and sun-dried gauze, soaked
in a  1  to 500 bichloride solution and subsequently washed aud wrung
out in  a 1  to 3000 dilution of the same antiseptic.
  Next in order of importance and in efficacy among the antiseptic
preparations is Carbolic Acid and its solutions.  The particular value
of this drug lies in the fact that  its potency is equally developed in
both albuminous and  non-albuminous solutions.  Like the  mercury
salts, its great disadvantage lies in its toxic properties.  It is usually
used in solutions of 1 to 20 and 1 to 40.  The carbolic acid of com-
merce is found in a liquid form, dissolved in  alcohol, and represents  a
strength of about 95  per cent.   In  making the solution for  surgical
purposes, an ounce of this liquid is added  to 20 or  40 ounces of water,
according  to the strength of the solution  desired.   Although carbolic
acid  is soluble in fifteen parts of water, this solution does  not take
place immediately, aud  in making solutions  of  a  strength of 1 to 20
either the  water must be hot or a certain amount of  time and consid- 
   340    REMEDIAL  MEASURES OTHER THAN  DRUGS.

•   erable agitation  of the mixture  are  required, otherwise globules of
   almost pure carbolic acid are deposited in  the  bottom of the tray or
   vessel into which the solution is poured, and these, by coming in con-
   tact with  instruments  or with the hands of the operator, exert an
   undesirable cauteraut effect..
      The 1 to 20 solution is used for the disinfection of instruments and
   the cleansing of  surfaces.  For half an hour before an operation  it is
   customary to  submerge all instruments which  will  be required in a
   solution of this strength, and when the surgeon  is ready to use these in-
   struments  the solution is diluted to 1 to 40 by the addition of an equal
   volume of water which has  been  boiled.   If a carbolic  lotion is em-
   ployed for irrigation, or for cleansing sponges  during an operation, it
   should not be stronger than  1 to 40.
      A property possessed by carbolic acid, which renders it  an unsafe
   medium for the impregnation of gauze, is its volatility.  After an ex-
   posure of a few hours to the atmosphere it entirely evaporates, leaving
   not an antiseptic, but simply a sterile, dressing.  This fact is utilized
   by the surgeon iu the preparation of the deeper layers of the dressing,
   which come in immediate contact  with the lips of the wound.  Since
   all antiseptics are more or less  irritating to raw surfaces, healing will
   be promoted by  a sterile rather than by an antiseptic application.  By
   moistening a piece of boiled and  sun-dried gauze, sufficiently large to
   cover the wound-edges, in a carbolic solution of 1 to 20 the antisepticity
   of this dressing is assured, and in a very few hours the heat of the body
   causes the entire evaporation of all the carbolic acid, leaving a sterile,
   non-irritating surface  in contact  with the wound.    If protective is
   used, or oiled  silk is applied beneath the dressing, these materials
   should be treated with carbolic acid in the same way.
      In addition to its toxic effect upon  the patient, carbolic acid greatly
   irritates the hands of  the surgeon, and if used in a strength of  more
   than 1  to 40  causes  so much benumbing of tactile sensibility that
    manipulative skill is seriously interfered with.   The  cracked and fis-
   sured fingers resulting from the use of carbolic lotions are familiar to
    all, and at times produce results of far more serious import than tem-
    porary pain and discomfort;  many recesses are provided in the depths of
    which septic germs may successfully resist the action of antiseptic washes.
    There can be no question that septic poisoning has been frequently due
    to this fact.
      Iodoform occupies a unique place among antiseptics in having been
    almost universally accepted  and  used by surgeons  and clinicians in
    spite of the fact that  its germicidal  action has  been well  proved by
    laboratory research to  be practically nil.   It is found that nearly all
    forms  of  pathogenic  germs  grow abundantly  upon culture materials,
    the greater part of which is made up of iodoform, and  that injections
    of such germs, mingled with  large  quantities of iodoform, produce
    the characteristic effect upon living  tissues with almost as great cer-
    tainty as  though this  drug had  not  been used; furthermore, it has
    been shown that iodoform is not even sterile, and  that as employed 
ANTISEPTICS.
341
by surgeons it was  frequently a cause of infecting previously aseptic
wounds.
  Iu spite of this overwhelming evidence against it, the drug steadily
grows  in  favor.  Recent  researches have explained, in  part at least,
the reason for this contradiction between experimental  and practical
results.  It has been well said that the human body is not a test-tube,
and that  bacteriological research  cannot  supplant the evidence of
clinical observation.  Elaborate investigation showed that this drug
acted  as a powerful antiseptic, not  by destroying  the germs,  but by
undergoing a decomposition in their presence, the products of which
render the ptomaines, the result of germ growth, inert.   In this  way
suppuration is, to a certain extent, inhibited, or, if present, its disas-
trous  effects upon the system  at  large are prevented, since these are
due to ptomaine absorption rather than to  a direct effect of the micro-
organisms themselves.  It has been apparently proved that ptomaines,
in themselves and without the presence of microorganisms, can gene-
rate pus,  but  that  where  such ptomaines are  mixed with iodoform
before infection no pus is formed.   If these septic chemical compounds
are rendered inert, a powerful adjuvant to  the destructive action of
the germ  upon living cells is removed, and thus the system  is often
enabled to overcome one enemy where two  would have prevailed.  The
fact that  iodoform is in  itself not  sterile is, from a practical stand-
point,  most important.   Fortunately, sterilization is readily  accom-
plished.   A thorough  washing in  a 1  to  1000 bichloride  solution
destroys all microorganisms, and the powder may then  be used with-
out fear of producing infection.
   It will  be readily understood from the  foregoing that iodoform is
of little service in aseptic wounds ; that it  becomes of utility in direct
proportion to the foulness of discharge, and that to exert its influence
it must be  applied directly to the part.   It  is  liable, in suppurating
wounds, to form a  hard crust with the discharges, thus frustrating
one of the most important indications  in  antiseptic  surgery, i. e.,
draiuage.   Particular care should  be exerted to see that  the exudation
from the surfaces of the wound has a free  exit.
   As employed in surgery, iodoform, after  having been sterilized, is
placed in small pill-boxes or wide-mouthed  jars, over the opeuing of
which is tied a single layer of antiseptic gauze; through this the iodo-
form is spriukled, as desired, over wouud surfaces.
   Kreolin, or  Creolin, a preparation obtained from English coal by
dry distillation, has  been steadily and  rapidly growing  in  popular
favor,  and bids fair to rival carbolic acid.  In addition to its powerful
germicidal effect it  is non-irritant and  practically non-toxic.   The
claim first advanced that this  preparation was absolutely  non-poison-
ous can no  longer be supported, since cases have been reported where
toxic  symptoms have followed its use; these were probably  due to
individual idiosyncrasy, a factor which we can never hope to entirely
overcome.  It  is certainly true that kreolin  is the least poisonous of
all  the powerful antiseptics heretofore used.  As au additional  advan-
tage, in place of the harsh, irritating effect produced upon surfaces by 
342     REMEDIAL  MEASURES  OTHER  THAN DRUGS.

carbolic acid solutions, kreolin exerts an influence very like that of an
oily or mucilaginous preparation.
  The extravagant  claims advanced for kreolin  in  regard  to  its
germicidal property have not been confirmed by bacteriological inves-
tigation.  In solutions containing albumin it is not efficient as a germi-
cide  in strengths  of  less than 1 to  100, its power being somewhat
below  that of carbolic  acid;  since, however, its toxic properties are
much less marked than those  of  the  latter drug, it can be safely used
in stronger mixtures,  and therefore, for practical purposes, its strength
is greater.
  Kreolin, though insoluble in water, readily forms au emulsion quite
as efficacious in its antiseptic properties as a  true solution.  Since this
emulsion is opaque it is scarcely applicable for  immersing and steril-
izing instruments, the latter not being readily found.   It is admirably
suited, however, for cleansing the hands, a 5 per cent, solution neither
cracking the skin nor benumbing  the  sensory  nerves.   In irrigating
large  wounds, cavities  of the body,  and particularly as a means of
preventing sepsis or aborting it in gynaecological work, kreolin can be
warmly commended.  It may be employed in a strength of from 0.2
to 5 per cent.
  Barring the opacity of its emulsion in  water, it would be the medium
par excellence  for rendering instruments sterile and maintaining them
in this condition during an operation.
  Among  the many antiseptic agents of less importance may be men-
tioned Peroxide of Hydrogen.  This  drug comes  in what is termed a
fifteen-volume solution.  By this it  is  meant  that fifteen volumes of
feebly combined oxygen are  contained in each volume of the liquid.
The few who have used it report  remarkable results.  It is applicable,
not to sterile surfaces, but to suppurating wounds and  sinuses.  It is
alleged that peroxide of hydrogen immediately destroys the micro-
organisms  of  pus, converting, in  one or two applications, a septic
wound into one which is sterile and which will promptly heal.  It is
used in the strength of  from 5 per  cent, up to full concentration.  Its
disadvantages  lie  in  the fact  that  it is expensive and that it readily
undergoes  decomposition.  In this latter circumstance, possibly, lies
the explanation of its want of popularity, since the preparations vary
so greatly iu   strength that  it  is  impossible  to determine  to  what
extent they should be  diluted or what may be  their potency  when
applied. (See Oxygen.)   When this drug is poured into a suppurating
sinus or cavity an ebullition takes  place, which ceases only when the
drug is exhausted or  the infected surfaces are rendered sterile.   With
more extended trial the true value of this  preparation will be deter-
mined.
   Chloride of  Zinc has  been  extensively employed in some clinics as
an antiseptic  application.  It is used in 10 per cent, solutions, and is
applied when the field of operation  is probably infected  by pre-
existing pus-formation.  Although bacteriological research has shown
that this  agent possesses feeble  antiseptic  power, clinical experience
demonstrates its great value when applied to infected surfaces.  Lately 
ANTISEPTICS.
343
the Sulpho-carbolate of Zinc has to a great extent replaced the chloride,
as it is less toxic and irritating, and far more potent.
   For the sterilization of mucous surfaces a saturated aqueous solution
of boric acid is commonly employed.

                  Double Cyanide  Dressing.

   The increasing popularity of the latest dressing prepared by Lister,
and its possession  of  qualities  apparently superior to those  of any
other dressing yet described, make it desirable to give a  brief  de-
scription of  the  method of  preparation  described in  Lister's  latest
writing on this subject.  " Cyanide of potassium, cyanide of mercury,
and sulphate of zinc are  mixed together in  solution,  in quantities
proportioned  to  the  atomic weights  of  2KCy, HgCy2, and ZnSo4
-}-7H20 ;  the cyanide  of  potassium and cyanide  of  mercury  being
dissolved  together  in IJ ounces of water  for every  100  grains of
potassium  cyanide, and added  to the sulphate of zinc dissolved in
three times that  amount of water.   The precipitate is collected in a
strainer, and when  well drained  is washed with two successive por-
tions of water equal iu quantity to that used for the solutions, namely,
6  ounces  for every 100 grains of potassium  cyanide;  at  least this
amount of washing  being essential  in order ,to free the precipitate
sufficiently from the highly irritating soluble salts which are associated
with it in its formation.  The precipitate having  thus been  washed
and drained, but not dried,  it is thoroughly diffused with pestle and
mortar in distilled water (6 ounces for every 100 grains of potassium
cyanide), containing in  solution  1 part of hsematoxylin for every 100
parts of the cyanide salt,  the amount of which is known  from  the
circumstance that the dry product of cyanide salt is almost  exactly
equal in weight  to  the potassium cyanide employed.   Hsematoxylin
is readily  soluble in a small quantity of hot  water, and remains in
solution when added to a large quantity of cold water.  The  cyanide
salt, while it precipitates the hsematoxylin, changes  its color to a pale
bluish tint.  This  is advantageously enhanced by the addition of a
little ammonia to the mixture, in the proportion of one  atom  of am-
monia  (NH3=17) to each atom of hsematoxylin (C16H14063H20
= 356).   More than this amount proves prejudicial.   The ammonia
is added in a dilute form,  and  it is  convenient to have the dilution
such that  1 fluidrachm of the  ammoniacal liquid shall correspond
with 1  grain of hsematoxylin.   The dye is further  economized by
allowing the ammoniated  mixture to stand for three or four hours,
and stirring it occasionally, so  that  the  ingredients may react thor-
oughly  upon each other.  If the mixture is filtered  immediately, there
is considerable loss of coloring  matter.  The dyed salt, having been
drained and dried  at a moderate heat, is levigated, and may  then be
kept for any length of time fit for use.   When employed for charg-
ing a dressing it is  diffused by means of pestle and mortar in solution
of bichloride of mercury (1 to 4000) in sufficient abundance to drench
the fabric thoroughly,  for which 4 imperial pints to 100 grains of the 
344     REMEDIAL  MEASURES  OTHER  THAN  DRUGS.

salt will be found  adequate.  This will give a percentage of between
2 and 3 of the cyanide to the dry gauze.   The gauze should always
be used  moist;  and if it be  prepared for immediate  use, as by the
dispenser of a hospital, the process  of drying may be omitted, and the
gauze, after being hung up for a  while to drain, is further deprived of
superfluous moisture by placing  it for a while iu a folded sheet.  It
may afterward be conveniently kept  moist by wrapping it in a piece
of mackintosh cloth.  When obtained dry from the manufacturer, it
should be  moistened again with  a weak corrosive  sublimate  solution
before it is used."
  The advantages claimed for this  dressing are that it is not irritating
to the skin, and that the antiseptic  substance is not  soluble, hence  is
not washed out by  discharges.

  An omission  of  the details of cleansing the hands of the  surgeon
aud  assistants in preparing  for  an  antiseptic operation is  scarcely
permissible in writing upon the  subject  of antisepsis.  The most
approved method is as follows :
  The hands and  forearms are  thoroughly brushed in hot soap-suds
for several minutes, after which  the  nails are carefully cleaned by a
knife and brush, and the washing again  repeated;  the  hands are then
washed in  alcohol for one minute,  special attention being paid to the
nails; finally they  are soaked for  three minutes in a solution  of bi-
chloride (1 to 1000), and during  the course of the  operation are occa-
sionally washed in a  solution of the same  strength.  If it is neces-
sary to lift a chair, to  turn the patient, or to touch any object which
has not  been previously sterilized, the hands should be enveloped in
towels wrung out in 1 to 1000 solution, or immediately washed again.


                   COLD AS  A  REMEDY.

  Cold, or the rapid  abstraction of  heat, is a remedial measure that
can nearly always be obtained aud is  possessed of very great power for
good iu properly selected  cases.   At the very first, we may divide its
use into its local  application, for  a  superficial, limited,  deep-seated, or
distant influence, aud its general  application  for the purpose of affect-
ing the entire body.
  When cold is applied for its limited and local action, it is always used
with two objects in view, namely,  to cause localized contraction of blood-
vessels, which, through inflammation, are engorged so that the parts
are reddened and swollen, or temporarily to anaesthetize or benumb a
nerve-fibre for the immediate relief of pain and with the hope that the
temporary paralysis may ultimately result in such nerve changes as  to
produce a  cure.
  For these reasons cold, in some form, is a popular remedy for a
burn or sprain, or  any injury likely  to be followed  by inflammatory
processes.  Iu some cases, it is true,  hot water or  dry heat is equally
efficacious, and this fact will  be referred  to again when speaking  of 
COLD  AS  A  REMEDY.
345
heat.   (See Heat.)   It may, however, be stated, as an almost invariable
rule, that the choice of heat or cold is to be governed by the sensations
of the patient, who  will generally assert that one of  the  two is  the
more agreeable.
   Cold or  heat cause relief of pain iu inflammation by producing con-
traction  of the local bloodvessel walls.   As a  result, inflammatory
exudates do  not occur, congestion is relieved, and as the pressure on
the nerve filaments ceases, the pulsating pain  of inflammation passes
away.
   A very useful remedy for the sprain of au aukle, when it is a recent
accident, is to let  the patient sit  with the  foot  elevated, with a cloth
wrung out in ice-water, or an ice-bag applied over the part affected.
   In the treatment  of localized  pain, cold  is used in a  number of
ways, largely depending in their  choice on the  will of the physician
and the wealth of the patient.   The simplest, cheapest, and perhaps
the most efficient method of  using  cold is to place  cracked ice in  a
pig's or sheep's  bladder, and  after tying the  opening to prevent leak-
age, to  lay it directly on the skin, surrounding it with a towel so as to
prevent the moisture which appears on the surface, from condensation,
from wetting; the clothing;.
   Where a very limited and  comparatively transient effect is needed,
it is customary  in hospital and private practice  to use a  piece  of ice
sprinkled with a little fine  salt, and held against the  skin by means
of a towel  in the hands of a physician.  Actual  freezing can often be
produced in this manuer very rapidly.
   Where a more rapid and elegant method is desired, sprays of various
very volatile liquids  may be driven  against the  part by an atomizer.
Probably the most  readily employed of these liquids is ether,  which
is fairly effective if it is used in a fine spray and driven against  the
skin in such a way as to favor rapid evaporation.  Another of these
agents  is rhigolene, which is one  of the lightest  and most volatile of
the liquid  products of coal-tar, and is used in a spray from an atomizer
in the same  manner as is ether.  Chloride of methyl is a gas, whicli  is
very inflammable, of a sweetish smell and taste, used  as  a substitute
for  rhigolene as a local ansesthetic through the intense cold produced
by its application.   The gas is to  be directed against the skin over the
involved area by means of a tap attached to the cylinder containing it.
   It is hardly necessary  for the writer  to  repeat that, as the  last
three applications are very inflammable, they should not be used near
a light or  fire.
   Aside from the local effects of  cold on inflammatory processes,  it  is
largely resorted to for the relief of neuralgia of a superficial type,  and
has often been used for the cure of  deep-seated neuralgias,  as over the
course  of  the sciatic  nerve in sciatica.   Generally, however, it is em-
ployed in neuralgia of the supra-orbital nerve, where, owing to the
superficial position  of these fibres, the  cold can  readily penetrate.
The skin should be distinctly whitened  and blanchefl, and even hard-
ened, by the cold before its application is stopped, and if one applica-
tion  does  not cause a cure it may be repeated  every day for several 
346    REMEDIAL  MEASURES  OTHER  THAN DRUGS".

weeks in obstinate cases.  Sometimes cold is used to benumb the skin
or subcutaneous tissues in cases where a minor surgical operation is to
be performed, and  it is  undoubtedly superior to cocaine where  one
wishes to open boils or small abscesses.   It is also valuable when the
physician is using  the  actual cautery, and in  all these cases may be
employed as is indicated above.
   The local employment of cold for the influencing of deeply-seated
organs is not only a well-recognized therapeutic measure, but of great
practical and physiological  interest, and is  so  closely associated with
the subject of counter-irritation as to be worthy of comparison by the
reader with the article on that subject  before considering the subject
as sufficiently studied to render its use clear.  According to Winter-
uitz, cold applied to the feet affects the cerebral circulation, cold to the
thighs the  circulation in the  lungs, and cold to the back the circula-
tion around about the pituitary region.  That these assertions are true
we do not positively know, but the fact that Winternitz  has  reached
them by  a series of experimental studies indicates their correctness to
a great extent, and they also  find additional support in  the  popular
and medical confidence  in the use of cold to the head and heat to the
feet in cerebral diseases.
   Practically cold has been  employed with no small degree of success
in the treatment of pneumonia and pleurisy in the form of the ice-
poultice or ice-jacket.   The  only thing needful  for  such treatment is
a condition of strength on the part of  the  patient,  for it should not
be used in adynamic  cases.   When the ice-poultice is used it  is made
by taking a mass of finely-chopped ice, draining it  of all water,  and
mixing it  thoroughly with dry  sawdust,  in  sufficient  quantity to
absorb all the water derived from the ice as it melts.   This  is  then
basted into a quilt,  so arranged that all of  the  contents will  not sag
to the lower border, and wrapped around  the  chest, the mass being
thoroughly covered by a layer of well-oiled silk.  Cold  has also  been
highly recommended  when used in  pneumonia in another manner, and
by no less  prominent an  authority than Niemeyer, who  speaks of it
as follows :
   " I have made extensive employment  of cold in the treatment of
pneumonia, and  relying upon a  large  number of very favorable
results, can recommend this procedure.  In all cases I cover the chest
of the patient, and the affected side in  particular, with  cloths whicli
have been  dipped  in cold  water and  wrung  out.   The  compresses
must be  reapplied every five minutes.  Unpleasant as this procedure
is in almost all cases, yet even  after a few hours the patients assure
me that they feel a  material  relief.  The pain, the dyspnoea, and often
the frequency of the  pulse are reduced.  Sometimes the temperature
goes down an entire degree.   My patients often retain this surprising
condition of improvement  throughout the entire duration  of the
attack, so that their  outward  symptoms would hardly  lead  one to
imagine  the grave  internal  disorder.   The relatives  of the  patient,
too, who do not fail to perceive the  improvement, now readily assist
in the treatment to  which at first they were opposed.  In a few cases, 
COLD  AS  A  REMEDY.
347
and only in a few, the use of cold  affords no relief, and  the trouble-
some  manipulation for its  application increases  the  distress  of the
sufferers so much that they refuse to keep it  up.   In  such  cases I
have not insisted upon the further application of cold.
   " In the hospital at Prague every case of pneumonia is treated with
cold compresses, and, according to the statements of Smoler, it is ex-
ceptional for a patient not to feel material relief from this treatment.
I should only ascribe a palliative influence to their use,  had  not the
duration of the disease  in  many instances been  decidedly shortened
aud  the convalescence  hastened  by  means  of their energetic and
methodical employment.  In fact, iu but few cases  have we seen the
disease  delay its departure until  the  seventh  day.   Many have im-
proved  on the  fifth, and a very large number as early  as the third
day ;  nay, I have repeatedly found  it impossible  to keep  patients
with  recent  pneumonia  in  the hospital  for a  longer  period  than a
week.   Cold is rightly regarded  as one  of the  most efficient  anti-
phlogistics in inflammation of external organs.   Its action is directly
tonic  upon the  relaxed tissues aud dilated capillaries."
   The use of a cold bath, for  the purpose of increasing the tone of the
system, is as old a custom as any which  we have, but, like all other
things in medicine, cannot be used without distinct indications for its
employment, or to speak more correctly, the absence of certain  contra-
indications.  The most universal exception to  its use which  we find
is that class of persons with whom  bathing of  any  kind, particularly
when it is  frequently repeated, does not agree.  The writer  is sure
that a  much larger number of persons belong to this class than  is
generally recognized, and he has seen cases of nervous exhaustion and
general loss of  vivacity  and vitality occur as a result of too frequent
bathing.   This  is  the  case  more especially with daily bathers who
use cold or  warm fresh  water, particularly if the  bath be taken in
the morning.
   Before passing on to a consideration of the  physiological action of
a bath,  and why and when  we should use it, it is  proper  to call atten-
tion to  the  fact  that a very large proportion of  children who are
bathed  daily are allowed to lie and soak in the  tub, and as a result
become debilitated and fretful, only to recover  when the bath is used
once or twice a week, and replaced in the interval by a nightly spong-
ing off with salt and whiskey or salt and water.
   Through practical experience and  much experimental research of
a  more or less reliable  character, we  now know that the following
phenomena accompany the use of a cold bath  in a  healthy person
with whom such a bath agrees.
   On entering the water he shivers, thinks it almost unbearably cold,
his teeth chatter, and he  gasps if the cold suddenly touches the belly
wall,  or an equally sensitive surface.  In a moment, however, reaction
sets in, and  the extremities  heretofore blue, trembling, and  covered
with  cutis anserina, become warmer and  flushed.  The pulse is  in-
creased in force and frequency, and the respirations are deeper and
more thoroughly performed.  As a result of this, each portion of the 
348     REMEDIAL  MEASURES  OTHER  THAN DRUGS.

body receives  a more perfect supply of blood  and  feels  rejuvenated.
Following this  stage of exhilaration a third  comes on in which the
blueness and  depression of the  first stage  recur  in  an exaggerated
degree,  but this condition does not ensue  unless the  person remains
too long in the water.   If he leaves the bath while in  the acme of his
exhilaration, the stimulus may remain with him throughout the rest
of the day.
  The reason for the occurrence of this train of symptoms  is not far
to seek.   The chilliness of the first stage shows that the great abstrac-
tion of heat is lowering the bodily temperature, the centres for calori-
fication in the  body not manufacturing all the heat that is needed for
the preservation of the normal temperature.   At first the cold drives
the  blood hurrying into  the warm recesses  of the  body,  leaving the
surface of the body cold;  but in  a few moments the system is aroused
to the recognition of the fact that it must increase  its  exertions in the
propulsion of blood and manufacture of heat, and  so with an  effort it
puts forth all its  power, picks up each corpuscle that is  hiding from
the  cold  in the internal  organs, and, after  imbuing  it with warmth
obtained by increased heat-production  in the  sources of heat-manu-
facture,  forces it out to the surface of the body along with its  fellows,
which are driven to all  parts of the system.   This is  not a mere
figurative way of  putting  the  matter,  for  cold always  contracts
bloodvessels and reflexly stimulates  the vital  centres  to  increased
activity.
   When the bath  is too prolonged  the result  of over-stimulation
ensues,  and the depression  of the  nervous system  and  circulation
may be  sufficiently severe to  interfere greatly with normal functional
activity.
   Just at this  point  it becomes clear why persons " catch cold," or,
more technically  speaking, are attacked  by local  or  general conges-
tions.   One person who is weak may never reach the stage of stimu-
lation of which we have just been speaking,  because  his  system has
not  enough units of force in it to unite them and  expend them upon
the  functional  activities  named, and,  as a consequence,  the blood,
which at the  first shock has hurried into the internal viscera, is not
driven back to its  duty, but sulking in  its retreat,  like a deserting
soldier, allows disaster aud disease to ensue because its superior officer,
the  central nervous system, cannot  gather together  enough  force  or
authority to make it do its duty.  These cases present evidences, there-
fore, of circulatory and systemic depression, or have congestion of the
lungs, liver, or other parts.   In the strong person exactly the same
state of affairs obtains in the third stage of depression, but  only after
the  strength of the system  has  been expended in the activity of the
stage of exhilaration.
   Cold salt baths, particularly if they are sea baths, are more stimu-
lating and not so relaxing as is fresh-water bathing.
   Cold effusions to the  head, or, better still, the use of an  ice-bag,
have long held a high position in the treatment of meningitis and head
injuries, and a hot bottle to the feet  aud cold to the head will often 
COLD  AS  A REMEDY.
349
cause sleep in persons who habitually suffer from  insomnia.   This is
particularly the case with those persons who  have wakefulness from
mental over-work.   On the other hand, cases with insomnia from
cerebral ansemia do well if a cold pluuge bath is taken  before going
to bed, although in still  other cases a hot bath  is more efficacious.  (See
Heat)  The latter instances  are not due to ansemia but to nervous
irritability, which the  heat quiets, whereas  the insomnia of cerebral
anaemia is relieved by a cold plunge by reason of the increased circu-
latory activity produced by the bath.
   When cold is to be applied to the head continuously it is often  con-
venient to employ a coil made of rubber tubing, aud so shaped as  to
fit the vertex.  One end of the tubing should  reach to a tub of cold
water on one side of the bed and the other to  an  empty tub on the
other side.  By sucking on one tube siphonage is  established, and  as
soon as the  liquid has  been transferred  from  one tub the stream  may
be reversed and the water passed back again to its former receptacle.
   The use of a cold bath after a person becomes heated  is popularly
supposed to be dangerous.  On the contrary, every  athlete knows that
nothing is so refreshing and so  preventive of muscular stiffness after
severe exercise and sweating as a cold plunge  or shower bath, but  he
also recognizes the fact that a plunge  is all that is permissible, aud it
is only the person who possesses  the  healthy circulatory power which
will enable him to  rebound from momentary depression to increased
activity that  should resort to such procedures.
   Cold water dashed or sopped  against the perineum  or the scrotum
and the  lumbar  region, is a favorable remedy for  nocturnal seminal
emissions with some practitioners, and the scrotum may be submerged
in a tumbler of cold water for a few minutes at  night for a similar
purpose.
   A* very useful treatment of dysentery is to gently inject into the
rectum about oue or two quarts of cold water—if necessary it may  be
icy cold;  and a similar application for piles is a useful adjunct to all
forms of treatment for these troublesome formations.
   So highly do  some  physicians praise this  method, that the writer
has thought it proper to quote from a paper of Dr. J. William White
upon this subject.  He says :
   "I desire  ito call the attention of the profession to  a  method  of
treatment which, although not  altogether new, is yet not appreciated
as, in my judgment, it  should be.  I refer to  a moderately  forcible
stream of water of varying temperature  in the treatment of a number
of affections  of the rectum, anus, and genito-urinary apparatus.   The
tonic and astringent effect of such a stream of water upon  any living
tissue is, of course, a well-understood fact, and  has been employed  in
the arrest of haemorrhage, in the treatment ot inflammation, aud  in
various conditions.  But it has only been in exceptional cases, aud
usually by the aid of more or  less troublesome apparatus that it has
been used in  the class of cases to which I now refer.
   " The bidet, as I have now for a few years  prescribed  it, should  be
of the variety which can be attached to the water-closet seat habitu- 
 350    REMEDIAL MEASURES OTHER THAN  DRUGS.

 ally used by the patieut.   It  should  have a nozzle capable of throw-
 ing a stream of about the calibre of an ordinary lead-pencil, or a little
 less.   The head  of water should be  sufficient to make it  impinge
 upon the parts exposed  to it with enough force to excite  there a little
 sensatiou of smarting or tingling.  That degree of force  will, for ex-
 ample, be sufficient  to enable the patient to take an enema, or, if a
 female, to take a vaginal injection.  The bidet pipe should be movable
 by means of a handle, so that the stream can  be directed against any
 portion of the external  genitals, the perineum, the anus, or  the sur-
 rounding parts.   It should  also have  connection with  the  hot and
 cold water supply of the house, so  that the water may be used of any
 temperature which the physician may prescribe, or which  the sensa-
 tions of  the patient  may make desirable.  Stop-cocks should  regulate
 the  size  and  force of the stream, and should  be  so placed as to be
 easily reached by the hand of the individual sitting  upon the water-
 closet seat.  Such  an apparatus can be put in place by any experienced
 plumber, in any ordinary water-closet, at an expense of  from fifteen
 to twenty dollars; and, in Philadelphia at least, the usual  head of
 water obtainable  even in  third-story rooms is quite  sufficient for all
 therapeutic purposes.
   " The cases in  which it may  be desirable to use this method of
 treatment may be divided into two classes :  First, those affecting the
 lower end of the  bowel  and  its outlet;  second, those involving the
 genito-urinary  system.    Among the first the most important are
 haemorrhoids, internal and external, prolapsus ani, and slight cases of
 prolapsus recti; pruritus ani and  eczema of the  margin of the  anus
 should also be included in this group of cases, in which it has  now for
 some time been  my habit to prescribe the systematic  employment,
 twice daily, of the bidet, once immediately after the daily stool, and
 for the second time, by preference, just before going to bed.  As a  rule,
 in all the mid-winter months, the ordinary temperature of the  Schuyl-
 kill water is that to be preferred, although I am largely governed by
 the feelings of the patient in this respect.  An enema should be taken
 at each of these times, the  lower portion of the  rectum being  thus
 thoroughly washed out at least twice daily, after which the stream of
 water is allowed to play  upon the affected region for a period of from
 five to fifteen minutes.   The ordinary and useful effect of cool spon-
 ging or washing immediately after stool in cases of haemorrhoids is by
 this means enormously increased.   Internal  haemorrhoids will, under
 this  treatment, in many cases almost entirely disappear, unless  they
 are exceedingly large and have  been  frequently inflamed  or strangu-
 lated  and badly neglected; external haemorrhoids, even when fleshy,
 will shrivel and become scarcely noticeable.
   " I could detail  a number of cases of this character taken from my
practice of the last two years.  In some iustances iu which I had  been
habitually called  in, at intervals of a few months, in the case of old
people, the result has been practically their disappearance from my list
of patients; and they speak in the warmest manner of the great com-
fort derived from this simple method of treatment. 
COLD  AS  A  REMEDY.                 351
  " Perhaps nothing is more distressing among minor affections than
the trouble described as pruritus ani, and variously attributed to liver
disease, constipation, gastric troubles, latent gout, uterine disease, para-
sites, neuroses, and a number  of other causes, varying from eating of
shell-fish, or excessive smoking, to  alleged  hereditary predisposition.
There are very few practitioners of any experience who  have not dis-
covered how difficult it is in any particular case of pruritus to assign
distinctly the annoj'ing symptoms to any one of these causes.   Often
the whole list may be carefully gone through and eliminated, or the
proper remedies may be applied successively, as different theories are
adopted, without the slightest benefit resulting.  Ointments, lotions,
and ordinary cool bathing will be tried in great variety, but without
avail;  and  such patients  will often go from one physician to another,
or fall  into the hands of quacks while seeking proper professional re-
lief.   My list of cases of  this character, whicli I have now treated by
means  of the ' bidet,' comprises eight.
   " Nearly all my cases  have resulted in cure; requiring, to  attain
that  end, simply different lengths of time of the application  of the
douche, with variations of the temperature of the water,  and occasion-
ally the use of some emollient salve.   I have been particularly struck
by the fact that these cases include among  their supposed  causes
widely distinct conditions, and the  uniformity with which they have
yielded to this simple treatment has  led me to regard with suspicion
the orthodox etiology of the disease.   Iu procidentia ani, aud iu slight
cases of prolapsus recti, I have had very satisfactory, though, of course,
less striking results.  In a few instances the trouble almost eutirely
disappeared, and in all of them it was distinctly relieved.  These cases
require for their successful treatmeut a much longer application  of the
douche, and the water should, in my judgment,  be at one or the other
extreme of temperature—either quite cool, or as hot as  can be comfort-
ably borne.
   " I am quite aware that the use of cold water in these affections is
not in  the least a novel plan of treatment; but the method under con-
sideration combines the effects of temperature with a sufficient force of
the stream, and  admits  of the  prolonged application of the remedy
without effort on the part of the patient, who is in the  most suitable
position for this treatment—practical points which induced me to make
this mention of my results in rectal aud anal cases.
   " Agnew says  of pruritus, that  among the local remedies frequent
ablutions with cold water should be mentioned ; aud of  prolapsus ani
et recti, that ' In all cases where remedies have proved unavailing, or
where patients have declined an operation, much good  may be doue by
douching the parts with cold water  and applying an oiled compress;'
and Alliugham says of the same class of cases, that ' The frequent and
bountiful application of cold water is to be most strongly recommended ;'
but few authors, so far as I know, have especially alluded  to the method
of application by means of a bidet.
   " My second class of cases includes, chiefly, certain prostatic troubles,
varicocele, atonic impotence in the male,  aud pruritus  of the vulva or 
352    REMEDIAL  MEASURES  OTHER  THAN DRUGS.

vaginitis  in the  female.  In  case  of variocele, although  I have not
succeeded in effecting a cure in any instance  by this method, I  have
certainly  seen  advancing enlargements  of the  spermatic veins be-
coming stationary;  long relaxed and  pendulous scrotums become firm
and much smaller;  aud the mental condition  of the patient, which is
so important an element in many of these cases, shares in the improve-
ment.   In chronic  prostatitis, a most  intractable and  distressing ail-
ment in  many instances, it  has come to be  a part  of  my routine
treatment to order  the  use of cold perineal douches by means of the
bidet, associated with frequent cool enemata  given in  the same man-
ner ; and I believe to-day that  if I  had to discard  all  therapeutic
measures  but  one in these cases, I would retain this one.   In a cer-
tain number of cases of impotence, associated with general muscular
weakness, loss  of tone, lack of general strength and vitality, accom-
panied  by imperfect or rapidly subsiding erections,  I have found
that the cold  douche applied with some force  and for considerable
lengths of time to the perineum and testicles  has been productive of
marked benefit.
   " In  two  cases  of pruritus vulvse my results have been good,
though less striking  than in similar disease affecting the region of
the anus.   In vaginitis, where the woman has  sufficient intelligence
to learn how to take  an injection  by means of the bidet,  it offers an
admirable method  of cleansing the  vagina, of carrying away thor-
oughly all  accumulated  secretions, of  reducing heat and swelling,
and at the same time of avoiding the frequent introduction into the
inflamed  canal of  a  foreign body in the shape  of the nozzle  of a
syringe.   My opportunities for observation in this class of cases have
been limited, owing to the disinclination of these patients  to procure
the bidet, and owing to  their irregular habits of life and their frequent
changes of residence; but  I have  seen enough of its good  results to
make me  feel  confident that it  is valuable addition to  our therapeutic
agencies.
   "After all,  in  every  one of the cases which I have mentioned, its
use is  simply the application of the  most elementary and common-
sense  principles to  every-day practice, but I am satisfied that this
particular method of applying  these  principles  has not received the
attention which it merits."

                        Cold in  Fevers.

   The proper manner to employ cold water in fever should be  thor-
oughly understood.   It may be  used at a number of temperatures,
according to the effect desired, such  as cool, moderately cold, and  very
cold."
   Very commonly in the course of a  fever the patient is restless, un-
comfortable, and sleepless, yet has not a temperature fraught with any
harm.   Such a case may be sponged off with  tepid water or with a
little alcohol and  water, or salt and whiskey, with great benefit in the
production of sleep, the reduction of fever, and the advantage of ner- 
COLD  AS  A  REMEDY.
353
vous quiet.   Sometimes the sponging is successful when used only
over the arms aud legs, but more frequently it should be extended  at
least to the spinal column.
  If tepid sponging  does  not lower the fever in a given case, then
ordinary cool tap-water should be employed ; and it is well to remem-
ber that the secret of successful sponging lies in the use  of a sponge
not saturated  to overflowing, but only sufficiently wet to  leave a thin
film of moisture on  the skin  which cools  the patient by its  rapid
evaporation and does not wet the clothes and the bed.
  There are many cases where sponging, even  with ice-water, fails  to
reduce the fever, aud in these the fever  must be lowered by the " cold
pack," as it has been called.   The name  is unfortunate, as it is indica-
tive of a very severe exposure,  which  really does not occur.   The
application is  carried  out as follows :
  A small canvas  cot should be placed  by the side of the bed of the
patient and covered  by a  large rubber  cloth,  which, by being raised
at the  head  and depressed at the foot, forms a channel for the water.
Over this, again, is placed an ordinary sheet.  The  patient, after being
stripped,  is laid upon this  sheet, which is then folded over him, and a
fine spray from an ordinary  watering-pot for flowers allowed to play
upon his body from  end to end.   The temperature of the water de-
pends  upon the effect required.  The bed should be so arranged that
the water will not remain in puddles under the patient, but drain  off
constantly into  a  bucket at the foot.   The sheet  being wet allows
evaporation to go  on, and a rapid fall in the fever results.
   It is of the greatest importance that the attendant lightly but
briskly rub the patient all  over with the  hands,  so as to bring the
blood  to the surface and prevent internal congestions.
   During this procedure  the thermometer  should be placed in the
mouth or pushed deeply into the rectum, and  the fall in the tempera-
ture watched.  As soon as it reaches 101° or 100° F. the bath must
cease,  lest the fall continue and collapse  ensue.
   On  the removal of the  patient  the  surface  should  be  gently dried
 with towels, and  the bed-clothing consist  of only a sheet, or a sheet
and one  blanket  in  cold weather.   Above all things, it  must be  re-
membered that the patient is not to be  wrapped up in a  blanket, and
not only  this, but that he must not  be  placed  in a  blanket while still
in  a wet sheet.   The wet  sheet, if surrounded by a blanket, soon
places the patient in  a typical Russian or warm moist bath, calculated
to raise instead of lower the fever.
   Where sunstroke  (thermic  fever) is  present the patient may have
chopped  ice applied  or be put directly into  a bath-tub  of ice-water,
but iu any event the attendants must rub the  patient's skin to bring
the hot blood to the  surface and prevent congestions.
   The treatment of  rheumatic hyperpyrexia by cold is quite as suit-
able as is this treatment of other  fevers, whenever the hyperpyrexia
 is so excessive as to endanger life.
   The presence of pneumonia and bronchitis does  not seem to contra-
 indicate  the use of cold in fevers, and no fear of "cold" being taken
                                 23 
354    REMEDIAL  MEASURES OTHER  THAN  DRUGS.

need  exist unless the bodily temperature is lowered below the normal
point or to one degree above it.  According to Liebermeister, intes-
tinal haemorrhages contra-indicate the use of cold,  but  this statement
has been contradicted by no less a writer than Wunderlich.
   (For Brand's cold treatment of typhoid fever, see Typhoid Fever.)


                   COUNTER-IRRITATION.

   Counter-irritation  is a term applied to  the use of substances irri-
tating to the surface with which they come in contact, and employed
for the  purpose of influencing morbid  processes in more or less distant
parts, or of affecting  the  general system.  It  has been thought that
this method savors of the doctrine of  "like cures like," but in reality
it is based on souud physiological laws, and  is  so  logical  as  to have
been described by the founder of homoeopathy as useless.
   The eutire basis for the employment of counter-irritation rests upon
reflex actiou, or the conduction of a nervous impulse to a centre, which,
when so stimulated,  sends out an impulse to the part of the body
which is diseased.
   The use of counter-irritation may be divided into four parts or pur-
poses. The first is for affecting inflammations or congestions, the second
for causing the absorption or removal of  inflammatory deposits after
true inflammation has ceased ; while the third purpose is for the relief
of paiu, and the fourth for the effect which can be exercised upon the
general system by blisters in systemic disease.
   In the same manner that we can divide the indications for counter-
irritation into  four parts, so can we also  divide its forms into three
varieties, according to their severity.   The most severe are the caus-
tics or escharotics, the next the  epispastics or blisters,  and finally the
rubefacients or reddeners.
   The proper manner of employing a  counter-irritant to affect inflam-
mations is not to apply it directly to an inflamed  area, but a little to
one side of it or at a  spot known to be connected intimately with the
diseased area by nerve fibres.
   Thus, it is well known that in diseases of the eye the blister should
be applied back of the ear, and that in  abdominal neuralgia or in
pleurodynia  the best  results  are reached, not from the application of
a blister to the spot where the pain is  felt,  but to the point upon the
vertebral column where the nerve at fault  takes its exit.   The reason
for this is that pain is always referred to the  peripheral end of an irri-
tated  nerve, and pleurodynia or abdominal pain often arises from ver-
tebral disease or inflammation about the spinal  ligaments  or the fora-
mina of exit for the nerves.   In a similar manner we sometimes apply
a blister, in the early stages of hip-disease, not to the  knee  or ankle,
where the pain is felt, but at the seat of the trouble, namely, the hip.
Counter-irritation is  contra-indicated by  the  presence of any acute
inflammation  directly uuder the spot where it is proposed to place a
blister—that is, if any reddening of the skin is present the  blister or 
COUNTER-IRRITATION.
355
other form  of irritation must not be applied there.  If used at all, it
must be some little distance away, or a series  of small flying blisters
should be  placed  around  the inflamed  zone.   A  flying blister is one
which is  small in area—say as large as a Lima bean—and of compara-
tively slight action, healing rapidly after its effects have passed by.
  Among the inflammatory affections in which we find counter-irrita-
tion most serviceable may be mentioned  pleurisy, pneumonia, iritis,
synovitis (rheumatic or traumatic), cerebritis and peritonitis (acute or
chronic).   A  host of more subacute or chronic inflammations  are also
benefited by this  measure, some  of which are gleet, chronically en-
larged  joints, and inflamed glands   In all these states the blister, or
more rarely, the rubefacient,  is to be resorted to;  and while it is true
that nearly  all of these conditions are accompanied by fever, and  that
fever is generally held to be a contra-indication to the use of counter-
irritation, blisters undoubtedly do good at  such times.  In pneumonia
or pleurisy, along  with the use of veratrum viride, a cantharidal blister
of the size of a silver dollar should be applied  near the spot where the
most pain is  felt  or on the  back near the spine.  Where joints are
inflamed, the  blisters  should  be at some distance from the seat of the
swelling, although  it  is often useful to place the counter-irritant on
the inner or outer aspect of the knee-joint, if the skin is not reddened.
In  peritonitis the  blisters are  best applied  directly over the seat of
tenderness,  and, in cerebritis, at  the nape of the neck.   In  gleet a
little cantharidal collodion may  be painted along the under surface of
the penis or  upon the perineum with  great advantage in obstinate
cases.
  Where inflammation is chronic and  resists cantharidal blistering,
then resort is often had to more severe forms of counter-irritation by
means  of the red-hot, not white-hot, iron, or the use of escharotics,
such as caustic potash or soda, or arsenic.  The reason for using these
is that they all cause so much tissue-change in the  part that the coun-
ter-irritation is  very prolonged.  Sometimes antimonial ointment  is
applied constantly, until a slough  forms, to accomplish the same pur-
poses.
  For the removal of the products  of inflammation we resort to can-
tharidal  blisters or drugs possessing powers as local irritants and at
the same time as alteratives.   Thus,  in  pleurisy  with effusiou it  is
very proper to employ a good-sized  cantharidal  blister if the effusion
has a tendency  to remain unabsorbed.  Some have thought that the
absorption which  follows  is due  to the abstraction of serum which
takes place in the bleb formed, but this is a mistaken idea, as one often
sees an effusion absorbed which far exceeds in quantity the amount of
liquid  in the  blister.  Under these  circumstances, the spot for apply-
ing the blister is,  as a rule, immediately under the arm, about two or
three inches below the axilla.  The blister,  while  it is useful in caus-
ing absorption in chronic effusions and deposits about joints, is not so
good as  are alterative irritants—for example, as iodine, which in the
form of a thorough application at  one sitting until  the skin is black—
not yellow or  red—is often of  service.   In  other cases, particularly 
356     REMEDIAL  MEASURES  OTHER  THAN DRUGS.

in very chronic states, iodine ointment, alone or with lard, may be
rubbed into the parts with advantage, care being taken to stop its use
for a day or two as soon as the skin gets red.  This same treatment is
also useful in treating enlarged glands in the neck and elsewhere.
   One of the best treatments for epididymitis is to paint  the scrotum
black with  many coatings of a  strong  solution of silver  nitrate or
iodine, to  insist on total rest in bed, and to resort  to  the local use of
cold.   The  testicles should  also be  supported  by a  suspensory or
adhesive strips during  this treatment,  and aconite given if fever is
present.
   For the relief of pain we very commonly resort to the rubefacients
rather than epispastics, since the more moderate applications are equally
effective in most instances and do not leave evil effects behind to remind
the patient of his attack.
   Everyone who has  had stomach-ache and remembers  the relief
obtained by the use of a mustard plaster or spice plaster,  recognizes
the value  of this means of obtaining  relief, and it only remains for
the writer to state that headaches are often  amenable to similar treat-
ment.  These headaches may be neuralgic  or due  to  dyspepsia or to
cerebral anaemia or congestion, but counter-irritation will  nevertheless
do good.  If neuralgic, a little menthol or oil of peppermint may be
applied over the course of the nerve—which application, if the pain
be supra-orbital, will require care lest the oil gain access to the eye.
   For the treatment of pain in the belly or chest or elsewhere we
have  four methods  of applying counter-irritation in  the shape of
rubefacients.  The first is mustard ;  the second, capsicum ;  the third,
the spice poultice; and the fourth, the turpentine stupe.
   The mustard plaster should be made by mixing mustard flour  with
warm vinegar or water, and  adding  varying proportions of ordinary
flour  to modify  its action.  If  the skin is tender, half mustard and
half wheat-flour may be employed, or, if a child is to be treated, the
proportion may have to be one-fourth mustard.  The plaster is made
by placing  a  newspaper  on a table and  putting over it  a piece of
heavy muslin or linen.   On  this is smeared the mustard,  and  over
the mustard mass is placed a more or less thin piece of linen, which
prevents the poultice  from  adhering  to the skin and modifies  the
burning according to its density.   By  folding the edges of  the news-
paper so that it  resembles a picture-frame we have at hand a cheap,
effective and strong plaster, the  back of which is supported by the
newspaper.
   The spice plaster is made by mixing equal parts  of  allspice, cloves,
cinnamon, and nutmegs, and adding thereto ^ part of black pepper.
These constituents are made into a homogeneous  mass by using a knife-
blade to mix them, and are then sewed up in a bag which is quilted
to prevent sagging of the  contents.   One side of the  poultice is now
wetted with warm brandy, whiskey, or vinegar, and  applied to the
part desired.
   If the skin is tender, the proportions of pepper and cloves should
be decreased. 
DISINFECTION.
357
  This  plaster may be allowed to remain over the affected parts for
hours or even days, aud it is very useful  in  the  treatment of gastric
catarrh  and indigestion, particularly that occurring in children.
  The  turpentine  stupe (see Turpentine)  is  not to  be allowed  to
remain  very long on the skin, as it  may blister a tender cuticle, and
the pepper  plaster  may be so  active as to produce unbearable pain
if it is not watched.
  The proper way of treating all such burns  from  counter-irritation
is to  apply simple cerate, cosmoline,  or  sweet oil, to which may be
added carbolic acid iu the proportion of 1 to 100.  The carbolic acid
not only acts as an antiseptic  but as a local ausesthetic, while the oil
acts as a protective from contact with the air.
  Much difference  of opinion exists as to the proper treatment of the
blister formed by cantharides.   Where the blisters are small—that is,
the size of the end of a finger—they may be allowed to break of them-
selves, and  then  be dressed with dry cotton;  if they are large, the
blebs should be punctured at their most dependent part with a needle
and dressed with dry absorbent cotton, as  by so doing the new skin
rapidly forms underneath and  is soon able to  carry on its normal
functions.
  The  proper treatment  of the blister while it is forming is to apply
a poultice, which will decrease  the  pain  and  aid in the formation of
the bleb.

                        DISINFECTION.

  Before  discussing  the subject  of disinfection we  must turn  our
attention to what we mean by the terms employed when speaking of
this subject iu general.   At present we recognize universally that the
word germicide is a term applicable solely to agents capable of kill-
ing the lower forms of life, whereas antiseptics are substances  which
simply  render the material with  which  they  come in  contact  so
antagonistic or  unsuited to germ development  as to  render  their
presence for any length of time impossible, at least in an active state.
To use  a simile : the killing of the inhabitants of a district by  shoot-
ing  them would stop  all  growth and  be  germicidal,  whereas  the
destruction of crops in these same parts would  only be antiseptic ;  or,
in other words, the people might remain, but would either have to go
elsewhere or starve to death.  (See article on Antiseptics.)
  We now speak  of germicides as disinfectants, but never of anti-
septics as disiufectauts, if we use these terms correctly.  Germicide
and disinfectant are therefore synonymous words.
  From what  has  just  been said it is evident that we should always
resort to disinfectants rather than antiseptics, for although the latter
are good the former are better.
  We have three ways of destroying germs  which are particularly
useful.   The first is the total destruction  not only of the germs, but
also  of their resting-place,  by means of fire, which may be  used in
the case of old furniture, mattresses and similar materials, and  which 
358     REMEDIAL  MEASURES  OTHER  THAN DRUGS.

may be extended to  everything about the patient, if it  is necessary
to stamp out a brisk epidemic before it can get well under way.  The
second is the use  of moist heat in the form of superheated  steam, or,
better  still, for  common purposes,  the  use of boiling water;  aud,
thirdly, by means of disinfectant materials which have  a proved
reliability.
   Moist heat in the form of superheated steam  is infinitely prefer-
able to dry heat,  but as superheated steam cannot be readily obtained,
physicians  usually direct the  clothes to be  boiled for at least two
hours.
   Very  often the bed-clothes  are taken from a sick-room,  trailed
through the house, and finally deposited at any spot until a convenient
time for boiling  them occurs.   This is  radically wrong and capable
of causing a widespread distribution of the disease.  In all  such cases
the bed-clothes  should be rolled off the  bed in a bundle  and com-
pletely submerged in a bucket or tub of boiling water, or, better still,
in a corrosive sublimate solution of the strength of 1 to 1000, before
they are taken from the room.   This tub is now to be carried at once
to the fire and the clothes lifted out dripping wet and plunged into a
clothes-boiler in which the water is actively boiliug.  The  lid  of the
boiler  is at once to be put on  to increase  the heat and prevent the
escape of any germs in the steam or in the hot air which arises from
the surface of the water.   The active boiling should be continued for
one or two hours, and water be continually added to prevent scorching
of the  contents of the boiler.
   It is important that food be not cooked on the stove at the time
the clothes are being boiled, aud no food should be in the room.
   If boiling cannot be resorted to for any reason,  the clothes may  be
soaked in a 1 to 500 solution of corrosive sublimate or a 1 to 20 solu-
tion  of carbolic acid,  although  neither of these is  so sure a  method of
disinfection.
   The proper care of a room after it has  been occupied by a case  of
infectious disease is of great importance and  is generally  sadly mis-
managed.   Very commonly sulphur is burnt, and  this, as  commonly
employed, is perfectly useless,  owing to leaking windows  and doors
which  permit most of the generated gas to escape.
   To  be of any  value, the  burning of sulphur must be preceded by
packing  the  window- and  door-cracks with  cotton  or soft  paper.
Broken rolled-sulphur is  moistened with  alcohol,  which is then
lighted.
   By far the best method of disinfection is to take all movable objects
out of doors into the fresh  air and  then to wash  the floor, sills, aud
casings, using a scrubbing-brush, hot water, and soap.   The  water
remaining in the  bucket should afterward be boiled to kill the germs
which  may be  in it.   This scrubbing being accomplished, the same
surfaces should be scrubbed a second time with a solution of corrosive
sublimate (1  to 500 or 1  to 1000), and left wet so that the salt of mer-
cury may remain on them.  Cracks and  crannies are to receive par- 
DISINFECTION.                      359
ticular attention.   If corrosive sublimate cannot be used then carbolic
acid (1 to 10 or 1 to 20) may be resorted to.
  By far the best disinfectant for all diseases is good ventilation.  Not
only should as much air as possible be allowed to enter the sick room,
but after the case has vacated the premises the windows should remain
open  for weeks, if possible.   Fresh air dilutes germs  as fresh water
dissolves or dilutes dirt.
  Disinfection of the discharges of the patient is  an important  duty
to be remembered.  The urine and faeces  should always be received
in a vessel containing enough corrosive sublimate  solution (1 to 500)
to kill all germs  and to prevent their escape into the air or into water
or food when the discharges are thrown away.  The disinfectant should
be placed in the bed-pan before, not after, it is used.
  The  bed-pan or chamber should not be allowed to stand in the
room, but  be removed  and  emptied at once in such a manner that it
cannot contaminate any water or food.   It should not be thrown upon
the ground, as the air will  dry it and cause the germs to  fly in the
form of dust anywhere and everywhere.  In very  contagious diseases
bathing or swabbing-off the patient  with weak antiseptics may be
tried.   Thus 1 to 10,000 of bichloride of mercury may be  used aud
the patient afterward wiped off with a wet towel.
  The  question as to which are  the  best  disinfectant substances  is
one which has  attracted the attention of physicians  and original in-
vestigators  for years.  The result  of a  vast amount of study and
experience shows that corrosive sublimate is the  best of all  disinfect-
ants in the proportion  of 1 to 250 to 1 to  500, or even weaker, and
that for cheapness, activity, and general  usefulness  chlorinated  lime
is better still.  The disadvantages in the  use of corrosive  sublimate
lie  in  its ready decomposition, its formation of  an albuminate when
albumin is present, its  uselessness where lead pipes  are present, aud
above  all  its expense.   Chlorinated lime depends entirely upon  its
chlorine for  any disinfectant power which  it may  possess.   Chlorine
gas itself is  not  readily handled,  but  the  lime enables us  to put  it
where we will.  It cannot be employed to disinfect colored fabrics, as
it bleaches them.
  Whenever chlorinated lime is bought the  physician should see that
all its chlorine has not departed from it, as most of the material  kept
in the stores is so old as to be worthless.
  For scrubbing  floors, chlorinated lime may be made into a solution
by adding a cupful to  a bucket of water, and in privies  it may be
spread thickly  over the surface of the  mass of filth.
  It  is useless to place  chlorinated lime around  the room for the
purpose of disinfecting the air, as the amount of chlorine to the
volume of air to be disinfected is as nothing.
  Copperas,  or sulphate of iron, while largely used as a disinfectant
by some persons, is in reality only an  antiseptic. 
360    REMEDIAL  MEA.SURES OTHER THAN  DRUGS.
                             HEAT.

  Heat is used locally for a number of purposes in the same manner
as is cold, aud, as was stated in the article on Cold, the choice of heat
or cold, in the  treatment of any acute form of inflammation, depends
almost entirely upon  the wish of the patient, who generally can  tell
at once which will give him the greatest comfort.
  In sprains of the ankle nothing compares  to a hot  foot-bath pro-
longed for hours, the object being to decrease the pain and swelling, in
order thereby to rapidly regain the use of the limb.  To carry this out
effectively a piece of rubber tubing of small size should be led from
a wooden bucket, which being a bad conductor of heat prevents  the
water from being rapidly chilled, to a sink or large tub  near by, when
by starting  the water by suction a continuous but very small stream
can  be  made to flow from the  bucket; while  by means of another
similar arrangement running either from another tub, or, better still,
from a hot-water spigot, a small stream  of hot water continually enters
to take the place of that withdrawn by the first siphon.   Under these
circumstances a very constant temperature of the water can readily be
maintained.   The high degree of heat which can be borne, by gradu-
ally increasing the temperature of the water in  the supply  tube, is very
extraordinary, the favorable results obtained  being in direct ratio to
the height of the temperature.  Between these soakings the part should
be dressed with lead-water and  laudanum, and  rubbed now and then
with camphor liniment containing laudanum.
  In spasmodic affections  involving  either striped or unstriped mus-
cular fibre the local  application of  heat  is a very useful means of
relief.   Sometimes  in lumbago or muscular  stiffness in  other parts of
the body the use of an ordinary laundry iron over the affected part
will prove of great service, the skin being covered by  several layers
of newspaper to afford a smooth surface over which to pass the iron
and to protect the parts from too great heat.
  In chordee the best means  for rapid relief, other than the use of
drugs or general relaxants, such as amyl nitrite, is to steep the  penis
in hot water.   A hot sitz bath before going to bed is a good prophy-
lactic against this painful complication of gonorrhoea.
  In croup of the spasmodic type the local  application  of a hot com-
press, made by wetting spongiopiline with   hot  water, is  very useful,
or,  if spongiopiline cannot be  had, several layers of flannel should be
wetted, placed on the neck, and covered with cotton and oil-silk so as
to prevent the roll from becoming chilled.
   Where attacks of dysmenorrhoea depend upon spasmodic closure of
the cervix, with simultaneous  spasm  of the fundus uteri, a hot  sitz-
bath or vaginal injection is useful, and this treatment is also of value
where uterine congestion results iu leucorrhcea or a sensation of weight
in the pelvis.  Sometimes attacks of torticollis may be  subdued  by
applying hot com presses to the sterno-mastoid muscles.
  In universal or partial spasm of the body,  as well as that represented 
HEAT.
361
by chorea, a  hot pack is of great service, and it is to be used in the
following manner :  The child having first been stripped of all clothing
is placed upon a bed which is covered by a rubber blanket and imme-
diately wrapped in  a woollen  blanket which has been dipped in hot
water aud the excess of water wrung out of it   Over this wet  blanket
is  immediately wrapped a dry one, to retain  the heat, and very soon
the patient begins to perspire freely.  Care should of course be taken
that the temperature of the  patient  does  not  rise  too high before
sweating comes on.  This hot pack will sometimes quiet  a  case  of
chorea  which has resisted all  forms of treatment so  far as  drugs  are
concerned.   Cases  of insomnia  are often benefited by a similar expe-
dient, and mild cases of sleeplessness will  occasionally rest quietly alter
an ordinary  hot bath.                              .        .
   A wet pack which speedily becomes a warm one  is used  in cases
where  during the course of an  eruptive  fever, the eruption fades and
it is desired  to bring it out on the surface.   It  is also useful  m those
cases of severe chorea iu which the child can stand the first shock ot
 the cold.  It consists in wrapping the child  in a cold wet sheet and
 over this wrapping one or two  blankets.  In a few minutes the sheet
 becomes heated from the body and the sweating which results is pro-

  U Cold may be applied to the head to relieve cerebral hypersemia and
 to prevent overheating during this treatment.
    The use of heat in two forms has been and is largely used at present
 for medicinal purposes, when the kidneys or skin are torpid  to aid in
 the elimination of impure and  effete  materials from the  blood  and
 tissues   These two forms of heat, the dry and the moist, are commonly
 called the Turkish and Russian baths respectively and may  be taken
 under  home arrangements or in one of the establishments found in all

    The first of these is in the form of dry heat, the second is moist
 heat   The Turkish bath consists of a series of rooms ranging in tem-
 perature from 100°  F. to 150° F. or more, into which  the individual
 passes successively until the hottest room is reached.   In each chamber
 he lingers until the system becomes accustomed to the high temperature,
 and perspiration is well established before he enters the hottest room,
 where he remains for a varying length of time, according to the advice
 of his  physician or his  own whim or comfort.  The rule governing
  his stay is,  that he must leave it at once if any sense of oppression is
  experienced or if perspiration does not flow freely.   Sometimes a glass
  of cold water taken at this  time causes a sudden profuse sweat, and
  also relieves any overheating by abstracting many units of heat   lhe
  cold  water in the centre of the  body causes contraction of the blood-
  vessels in these parts, and the blood  rushing to the surface causes the
  sweat-glands to pour out their secretion.       .,..,,         in.n
     Following the stay  in the warm room the  individual  passes  into
  still another chamber, where he is shampooed from head to  foot,  well
  rubbed, and the  blood  made  to circulate  through  the skin,    lhe
  shower-bath is then used, at first hot or  warm and finally changed to a 
362     REMEDIAL  MEASURES  OTHER THAN DRUGS.

dash of cold, or, better still, the patient plunges into a long tank, swims
to the other end, and is  there met by an attendent who rapidly dries
his skin, wraps a cover round him, and shows him to a lounge, where
he is supposed  to  recline and sleep for  an hour or less.   The air of
this sleeping-room is at the ordinary temperature of a living-room.
   Reviewing for a moment the  effects of this bath, we find that  the
first two-thirds are  devoted to  the opening and stimulation of  the
pores of the skin, while the last third is devoted to the contraction of
these pores  and their supplying bloodvessels.  In other words, it is
necessary to use the cold to prevent gradual chilling of limited areas,
which  would result in internal  congestion.  If the patient receives  a
cold douche the natural rebound prevents congestion of a permanent
nature, whereas if he is  exposed to cold a long time  these stagnated
areas become permanently diseased.   The physician must  always re-
member that this cold douche or plunge is a sine qua non, and that a
rest after the bath before dressing is almost equally important.  If
the patient is too weak to bear the cold he  must not use the bath.
   The indication  for the Turkish bath, as a medicinal measure, is any
condition of the emuuctories of the  body, whereby effete matters are
not properly eliminated, as in Bright's  disease in its various forms.
The increased action of the skin  not  only casts  off impurities for  the
time being, but frequeut  repetition  of the bath  causes  functional
hypertrophy of the  sweat-glands, and eventually enables them to do
more work, or, in other words,  to  cast  off an  increased quantity of
effete material.   As  a consequence of this the patient is able to avoid
uraemia or other evidences of Bright's  disease,  and,  employing  the
normal epithelium still left in the kidney for constant  use, uses  the
the bath once, twice, or  thrice, a week, with the  object of abstracting
the excess  of impurities which  the impaired  activity of his  kidneys
cannot  remove.  The frequency of the bath depends, therefore, upon
the rapidity with  which  the effete materials accumulate.   In  cases of
Bright's disease the patient should not attempt to use the room con-
taining high heat at first, and  should be  accompanied  by a medical
attendant to watch for untoward effects, particularly if the  heart is
diseased or uraemia  is already shown  by headache  or  other signs.
If sweating does  not come on  at  once, danger is at hand from acute
uraemia, renal and cerebral congestion, or heat-stroke.
   Not  only is  the Turkish bath useful  for kidney disease, but it is
often of great service in  rheumatism.   The acute form of rheumatism
is rarely so treated,  because  cardiac  complications often forbid  ex-
posure to heat, and fever is generally present. In subacute and chronic
rheumatism the case  is different, aud the enlarged joints or iuflamed
muscles yield like magic  in  some instances to such treatment.  Fur-
ther than  this, the  muscular stiffness following prolonged or severe
effort can be so avoided, and neuralgia depending upon  rheumatic or
gouty taint may be relieved by the hot-air bath.
   Acute colds  affecting  the head or elsewhere, if taken at an early
formative stage, can  often be aborted by  a good Turkish bath,  and
when  further  developed, greatly relieved  by the same  means.  If, 
HEAT.
363
however, congestion of the lung,  pneumonia, or chronic bronchitis,
with emphysema  or a dilated weak heart, are present, the  bath may
be dangerous.   In acute pharyngitis, in which the pharynx  feels like
a raw surface,  or "as  if it were filed or scraped," the  bath  will give
relief in many instances.
  Sometimes in suppression of menstruation from cold the flow may
be restored by a Turkish bath.
  Some persons complain that they are  always catching cold upon
the slightest provocation, and  apparently without  cause.  One class
seem  to have delicate mucous membranes readily susceptible to irri-
tation and inflammation, the other have dilated  or  relaxed peripheral
capillaries, which readily allow  the blood  in  them  to become chilled,
and, consequently, suffer from internal local  congestions.  Two sepa-
rate means of  treating such  cases exist.  The first set will do well on
minute doses  of arsenious acid (grain  fa-$ to fa) three times a day,
used for weeks; the second will be cured  of  their habit by the use of
a Turkish bath twice or thrice a week, since by this means the periph-
eral capillaries are toned up and made  more active.
  The Turkish bath, as thoroughly carried out  in large cities, is not
obtainable for those living elsewhere, so it is well to describe a home
modification which, with attention to detail and care, may prove almost,
if not quite, as effective a remedy.
  The patient is  placed  upon a wicker chair, naked, and under the
chair a small alcohol lamp is put,  which is  lighted.  The individual
is now wrapped thoroughly, chair and all, with  one or  two large
blankets, and the  heat  of the lamp  soon  causes  profuse  sweating.
Many cases  are, however, on record where the  lamp has been upset
and the patient badly burned.  The eminent physiologist, Dr. Car-
penter, so met  his death.   The best way is to have the lamp a little
to one side and its flame immediately under the mouth  of an  inverted
funnel attached to a piece of tin tubing, the  free end of which is
placed under the blanket so that the  hot air and vapor may surround
the body.   If the tube be covered  with cloth the loss of heat is slight
and the danger of burning the patient is  removed.  If this  is not
practicable several very hot bricks or stones, thoroughly heated in an
oven, may  be placed under the chair,  or small heated  logs may be
substituted.
  The Russian  bath  differs from  the  Turkish in that the  heat used
is moist, not dry.   As a  consequence  the danger of heat-stroke and
similar states  is much increased, because  evaporation  from  the skin
does not go  on so rapidly and the  body is not cooled so well in con-
sequence.   In its place the patient may be given a warm pack,  which
consists in wrapping him in a sheet and surrounding  him with large
blankets wrung out of water as hot as  can be borne, which  is in turn
covered with a dry blanket to prevent cooliug.
  This  method of treatment  is useful in the  same  states  as  is the
Turkish bath, but is more rarely used.  The warm pack just named
is also employed  to develop the  rash  of any  of the  exanthematous
fevers when it is suppressed by cold or is not " well out" on the skin. 
364    REMEDIAL MEASURES OTHER  THAN DRUGS.

The temperature of the patient must be watched lest he fails to have
sweating aud develops heat-stroke  in  consequence.  A thermometer
should be kept constantly under the tongue during the use of the pack.
   The  hot moist bath can also be  obtained by placing a patient  on
a wicker chair, under which  is  placed a bucket of hot water.  The
patient  is surrounded by a blanket, and a hot iron or stone is put into
the water, causing the development  of  a great amount of steam.
   Whenever the Russian bath is used, except  in  the exanthematous
fevers, it should be followed by a cold douche.
   Although these baths  have been  used in  the treatment of  cases of
heart disease to relieve dropsy aud renal engorgement they are not
safe and should  uot be  generally employed.   All acute or chronic
diseases of the  lung, except acute bronchitis of a mild form, contra-
indicate their use.
   Kalashnikoff has made a series of observations on the therapeutic
effects of heat on syphilis, and especially on syphilitic eruptions, his
patients  being  inmates of the St.  Petersburg Lock  Hospital  for
Women and Children.    The  heat  was applied  where possible  by
means of partial hot-air baths applied to the affected part for  half an
hour twice a day, the part being enveloped in hot flannel immediately
afterward, and remaining so  protected until the  next hot-air bath.
The temperature never exceeded 116° F.  (46.6° C).    When  the
eruption was  ou  the  back or neck or on  some part which it was
impossible to insert into a hot-air  chamber, India-rubber hot-water
bottles or tubes, through whicli the hot water was kept flowing, were
employed.   When both arms or legs  were  affected in a symmetrical
manner the treatment  was confined to one  side, the other being left
untreated for the purpose  of  comparison.   The results showed that
the heat treatment acted  very energetically and beneficially on syphi-
lids, both  when  employed alone instead  of mercurials and  iodides,
and also when used in conjunction with these remedies.   Often heat
proved  beneficial  when  the ordinary  specifics had failed.   Among
other observations it was noted that hard chancres healed and the
induration disappeared in from 8 to 16 days;  roseola and papular
erythema disappeared in from 4 to 8 days;  various forms of  papular
and impetiginous syphilides,  with marked pigmentation,  disappeared
in from 8 to 21 days; non-ulcerated tubercles  and gummata disap-
peared iu from 7 to 24 days,  but those which  had already begun to
ulcerate required from  1 to 6 weeks; periostitis was cured in from 10
to 24 days;  ostoses were not affected ; syphilitic ulcers,  consequent on
the breaking down of gummatous  periostitis, required treatment  of
from  6 weeks to 3 months or more,  while necrosis of bone frequently
required many months' treatment before the sequestra could be got
away.

               INTRAVENOUS INJECTION.

   Intravenous injection is a  method which is to be employed only
under extraordinary circumstances and  with  only a few  drugs.   Thus 
LEECHING.
365
in the case of snake-bite it may be  advisable to resort to such an
injection of diluted aqua  ammonia or ether, or even warm brandy or
whiskey.   Under  these circumstances the  injection should  be  made
into a vein in the leg rather than one in the arm, as the drug under
these circumstances does not reach the heart in so concentrated a form
and cardiac depression is thereby avoided.
  The objections to intravenous injections  are  several.  In the first
place the veins  are apt to be collapsed and hard to find, and it is still
more difficult to puncture one without wounding the opposite wall of
the vessel.   Again, phlebitis is a very probable sequel and thrombosis
and embolism are by no means impossible.
  It is needless to say that the solution which is injected into a vein
should always be of a neutral or alkaline reaction in  order to avoid
coagulation of the blood.   (See Transfusion.)
                       KATAPHORESIS.

  By the term kataphoresis we mean a method resorted  to  by physi-
cians having  for its  purpose the introduction into the body of drugs
through  the influence of electricity.   Correctly speaking, kataphoresis
is an osmosis of medicaments through the tissues, the osmosis being
carried on by the electrical current and the drug being carried through
the tissues between the two poles.  Quinine, iodide of potassium, the
various soluble salts of mercury, and chloroform and ether may be so
used.  The ordinary sponges or absorbent cotton  tips of the electrodes
may be saturated with  the  medicament  to be  used, and the constant
current employed, the current being reversed every few minutes.   The
positive pole of the battery is  placed over the affected part,  and the
negative  at a little distance away.
  In cases of  neuralgia, chloroform  and alcohol, of each one-half, or
even pure chloroform,  may be employed, and in syphilitic nodules,
when the patient's stomach cannot bear drugs, kataphoresis over the
part affected, with iodides, may be resorted to.   The iodide of  lithium
is commonly employed  in  the  strength  of 5 per cent, in these cases.
The strength of the  current depends upon  the size of the electrodes
and the sensations of the patient.  It is not necessary to use a stronger
current than the patient can bear with comfort.
                          LEECHING.

  Leeching is a method of abstracting blood for the purpose of re-
lieving  local  inflammations  or  acute  congestions.  There are two
forms of leech commonly employed  in  medicine, both of  which are
imported.   A small leech is found in many streams in the United
States.  Leeches, after  attaching themselves to the skin by means of
their  sucking apparatus  and teeth, secrete a liquid which prevents 
366     REMEDIAL  MEASURES  OTHER  THAN DRUGS.

coagulation of blood, and this accounts for the persistent haemorrhage
sometimes seen after a leech-bite.
   Therapeutics.—The reasons for using venesection or depletion have
already been considered, and we can therefore  pass  directly to the
uses to which leeches are put.   In cases  of meuingitis they may be
applied to the temples or to the nape of the neck, and in  the treatment
of swollen joints such as occur after sprains they are useful.  In orchitis
they should not be  placed  upon the scrotum but on the perineum ; in
conjunctivitis or inflammation of the eye, upon the temple or back of
the ears, not upon the lid itself.
   Employment.—Leeches if singly applied may be placed  on the skin
under an inverted  wineglass or under a large pill-box.  If they will
not take hold, a little sweetened milk  may be placed on the skin or a
drop  of blood extracted from the finger  may be placed there.   Iu all
cases  the skin  should be carefully washed before the leech  is used.
When they have taken enough blood they can be made to let go their
hold  by sprinkling them  with  salt.  Each  leech will  take  about  1
drachm of blood.   Leech-bites should be watched lest prolonged con-
secutive bleeding exhaust the patient.   In  case of such an  accident
styptics are to be employed.  As leech-bites make permanent scars, the
animal  should not be applied on the face or other exposed surface.


                          REST CURE.

   The rest cure, so called, is a method devised and elaborated by Dr.
S. Weir Mitchell, of Philadelphia,  for the  relief of a large  class of
patients who, for various reasons, are generally ailing from apparently
no organic disease, and yet whose condition is often so alarming  as to
lead  to the belief that some hidden cause of a severe train of symp-
toms  must  be  present.  In many such instances  a careful  study of
the case will show that there is a cause, near or remote, which has ex-
hausted the patient's  vital forces without producing anything else than
functional  disturbances  of the body.  Thus a prolonged nerve-strain
in nursing a sick  relative may so exhaust the strength of a hitherto
healthy woman as to produce hysteria, anaemia, and great disturbances
of nutrition, or, in another instance, cause neuralgia, disordered  men-
struation, and uterine or ovarian pain.   In males, mental, sexual, or
physical vigor may be impaired owing to prolonged anxiety in business.
Be the  symptoms what they may, as long as they are dependent  upon
nerve-strain  this "cure"  is to be resorted to, and if properly carried
out is  often blessed with surprising results.  Before describing the
method in detail it  is proper  to state that the entire rationale rests
upon the remembrance  that every movement is an expenditure of
force, and that a system  which has already overdrawn  its  reserve
fund  of strength  must be no  more  prodigal with the  funds  that
remain than a bank should be under the same circumstances.
   It  having been  decided that the rest cure is  to be employed, the
directions are given as follows : 
REST  CURE.                       367
   A bright, airy, easily-cleaned aud comfortable room is to be selected,
and adjoining it, if possible, should be a smaller one for an attendant
or nurse.   The patient is put to bed and kept there for from three to
six weeks as may be necessary, and during this time is allowed to see
no one except the nurse and the doctor, since the preseuce of  friends
requires conversation and mental effort.  The patient, in severe cases,
must be fed by the nurse in order to avoid the expenditure of the force
required in the movements  of the arms.  No sitting up  in  bed is
allowed, and if any reading is done it must be done by the nurse,
who can read aloud for an hour a day.
   In the case of women the hair should be  dressed  by the  nurse to
avoid any physical effort on the part of the patient.
   To take the place of ordinary exercise two measures are employed,
the first of which  is massage or  rubbing of the body, the  second,
electricity.   By the  kneading and rubbing of the muscles and skin
the liquids in  the  tissues are absorbed and poured into the  lymph
spaces aud a healthy blush is brought to the skin.   This passive ex-
ercise is performed in the morning  or  afternoon, and  should last for
from a half to one hour, every part of the body being kneaded, even
to the face and scalp.   In the afternoon or morning the various mus-
cles should be passively  exercised by electricity, each muscle being
made to contract by the application of the poles of the  battery to its
motor points.   Both these forms of exercise do not call for any ex-
penditure of nerve force, though they keep up the general  nutrition.
The following  programme,  for a  day's existence, is an example of
what the physician should order :
   7.30 a.m.  Glass  of hot or cold milk predigested, boiled or raw,
as the case requires.
   8 a.m.  The nurse is to sponge the patient with tepid  water, or
with  cold  and hot water alternately, to stimulate the skin and circu-
lation, the  body being well  wrapped in a blanket, except the  leg or
portion which is being bathed.  After this  the nurse should dry the
part last wetted with a  rough towel, using some friction to stimulate
the skin.
   8.30 a.m. Breakfast.  Boiled, poached, or  scrambled eggs, milk
toast, water toast, or a finely-cut piece of a mutton-chop or chicken.
   10 a.m.  Massage.
   11 A.M.  A glass of milk, or a milk-punch, or egg-nog,
   12 m. Reading for an hour.
   1 p.m. Dinner.  Small piece of steak, rare roast  beef, consomme
soup, mutton broth,  and any one of the easily digested vegetables
well cooked.
   3 p.m. Electricity.
  4.30 p.m. A glass of milk, or milk-punch, or egg-nog.
   6.30 p.m. Supper.  This should be very plain, no tea or coffee, but
toast and butter, milk, curds aud whey, or a plain custard.
  9.30 p.m. A glass of milk or milk-punch.
  In this way the day is well filled, and the time  does not drag so
heavily as would be thought.  If the stomach rebels at over-feeding, 
36S     REMEDIAL  MEASURES  OTHER THAN DRUGS.

the amounts of food must be cut down, but when all the effort of the
body  is concentrated on respiration, circulation, and digestion, a large
amount of nourishment can be  assimilated by  the exhausted body
which  before this treatment is undertaken may have its resources so
scattered as to be unable to carry out any physiological act perfectly.
   For the treatment to be successful the rules laid down should  be
rigidly followed and never remitted for a single hour.


                         SUSPENSION.

   The treatment of locomotor ataxia and allied affections by means of
suspending the  patieut has, during the last few years, been found  so
valuable as  to have  taken  a permanent place  in therapeutics.   The
method is uot confined to cases  depending upon diseases of the verte-
brae producing  lesions  in the  spinal cord,  but is  equally useful  in
instances where the lesion is primarily situated in the nervous centres.
The pain, nervous shootings, aud  tiuglings, as well as  the muscular
contractions, which often trouble the patient very greatly, are all re-
lieved, and in some cases walking is possible, where, before the treat-
ment, crutches were entirely relied upon.  The knee-jerk, when absent
or excessive, tends to return to  the normal state, and the bladder and
rectum become more regular in their functions.
   The patient should use one of the apparatuses  made  by most large
surgical instrument  makers, which consists in a cushioned head-strap
and a  cushioned leather loop  for each axilla.   The traction on  the
head should not be sufficient to cause discomfort; in other words, the
weight of the patient should be equally  distributed between the sboul-
ders and the head.   A rope is run from the harness to a pulley in the
ceiling, and by this means the patient may be slightly raised  from his
chair—say, two inches—once a day, for thirty seconds at first, which
may gradually be increased to ten minutes.  The swinging should  be
resorted to at first every second and third and  finally every day.   If
several pulleys are put in the circuit of rope, the patient can soon learn
to lift himself, making  the rope fast  to a cleat  in a heavy  chair  or
table or even holding it in the hands.  It is important that  the patient
after each swinging should rest for thirty minutes to  an hour, and
when  let down to his chair the  movement should be most gentle and
not jerky or sudden.   The same rule as to gentleness applies to raising
the patient.

                        TRANSFUSION.

   Very closely allied to the intravenous injection of medicines is the
transfusion of saline liquids, blood, or defibrinated blood, for the pur-
pose of replacing the vital fluid which may have been lost  by haemor-
rhage.   It must be distinctly understood that transfusion is not to be
resorted to in the presence of heart  failure  arising from other causes
than haemorrhage, nor for the  purpose of improving the state  of the 
TRANSFUSION.                      369
blood in the vessels.  Its effect is only temporary, and it is used solely
for the purpose of  bridging the chasm until the system can manufac-
ture normal blood after a sudden  loss.   It has been found  that  the
transfusion  of pure blood even iu the " direct method," which will be
presently described, is no better than the  employment of a properly
made saline fluid,  because the corpuscles are killed  by the change of
abode, even from man to man, and their destruction gives the kidney
the work of eliminating the free haemoglobin.
   Direct transfusion may be performed by  the employment of a large
number  of complicated pieces of apparatus, but the simplest manner
of procedure is as follows, provided a good-sized vein is used, and the
blood-donor is full-blooded, as he ought to be: An incision is  made
in the arm of the donor over the longitudinal axis of the vein, gener-
ally a prominent one on the flexor surface of the forearm or arm.  As
soon  as  the vessel  has been cleanly dissected  from the surrounding
tissues,  a bull-dog  clip should  be  placed above and below the point
where it is  intended to make the incision in the vessel.  At the same
time  a  silk ligature  is  passed  under the vessel.   The vessel is now
longitudinally incised, and a small glass  or metal  canula  furnished
with a shoulder is  slipped into the opening, with its point toward the
wrist, after which the ligature is tied so as to hold the canula in place.
The opposite end of the  canula should be  attached  to a short rubber
tube of about eight inches in length, and the  moment this is in place
the canula  and  tube should  be filled with.a normal saline  solution.
(See below.)  The same process is then repeated with  the vein of the
recipient, except that the canula is  not armed with a rubber tube, and
is pointed toward  the  body of the patient, or, in other words, in the
direction of the blood stream.
   The only point where  great care  is to be exercised is in the filling
up of the tubes with saline solution to displace the air.1  The  tubes
being completely filled, the ends are joined  by slipping the tube of the
recipient into the rubber tube of the donor.  The bull-dog clip next
the shoulder of the recipient is  now removed, and  the  one  next the
hand of the donor  is taken.off, thus allowing the blood to flow from
one person  to the other.   It is  necessary that  the other clips should
remain  to prevent  haemorrhage by anastomosis back of the canulas.
If the pressure is  low in the vein of the  donor, the  passage of  the
blood from  the  one to  the  other must be aided by stroking the tube
in the direction of  the flow, using enough compression to displace the
fluid.  If the tubing is  elastic and strong, this method is fully as good
as that of Aveling,  where it is necessary to use a ball  syringe to propel
the blood and fill the tubes.   The normal saline liquid, already named,
consists in a solution of common salt of the strength  of nearly 6  parts
to the thousand, or, in other words, six-tenths of  1 per cent, or, in

  1 Whether or not small amounts of air finding entrance into  the veins do  any
harm is not decided. A number of deaths in man from this cause are reported, but
the experiments of Senn and of the author show that large amounts have to  be in-
troduced before death occurs.  As the dread of such an accident is part of the medical
teaching of the past, it is at least well to respect it.
                                24 
370     REMEDIAL  MEASURES  OTHER THAN DRUGS.

other words,  1| drachms of pure common salt to a quart of distilled
water.  It is called a normal solution because its percentage of saline
is exactly that of the blood.
  The amount of blood transfused may be from 2 ounces up to the
point at whicli its withdrawal  causes the  donor to feel faint, but 8
ounces is  generally the maximum amount used.   It is to  be  remem-
bered that the passage of the liquid must be gradual, not sudden, and
that  an  excessive amount may cause cardiac distress.
  The use of defibrinated blood ought  never to be resorted  to when
direct transfusion or a proper saline is  to  be had, as the difficulty in
separating all the minute coaguli is very great, and it is also difficult
to maintain the temperature.   If direct  transfusion is not wished for,
the saline solution named may be gently forced into the vein by means
of a good hydrostatic syringe raised very  slightly above the level of
the  patient.  The water used should always  be boiled to render it
aseptic.   The solution used should, of  course, be  warm, at a temper-
ature of about 100° or 101° F., and the  presence of any foreign or
insoluble  substance must be strenuously guarded  against.   Indeed, it
is always best to pass the liquid through a  fine sieve before it is used.
The  quantity of saline used should not exceed one pint, and this is
usually  more than should  be giveu unless  the haemorrhage has  been
exceedingly severe and the  patient really  improved by the additiou
of each ounce of liquid.
  In a  large number of cases warm fresh  milk, just as it is drawn
from the cow, has been used as an injection into a vein with success,
but it always causes albuminuria, and is not as good as directly trans-
fused blood, nor better than saline  solutions unless it is taken directly
from the  udder of the cow as it  is milked.   The possibility of the
cow  being tuberculous is also to be remembered.
  Abdominal transfusion of both saline solutions and milk have been
successfully carried out, the  reasou being that  the peritoneal cavity is
a vast absorbent surface which rapidly takes up liquids  if the systemic
vessels  are not as full as they normally  should be.  The method con-
sists in  puncturing the abdominal wall as if for aspiration for dropsy.
The  tube from a hydrostatic  syringe is now attached to the  canula,
and  the liquid, having been warmed, is allowed  to slowly flow into
the belly.   This method is not to be relied on  where death seems very
imminent, as it is not rapid enough in its effects.
                       VENESECTION.

  Bleeding, or Phlebotomy, is so rarely practised to-day that very
many of the profession have never abstracted blood for therapeutic pur-
poses or have even seen it done by someone else.  Furthermore, it is
to be feared that many of  the younger physicians would hardly know
how to bleed  if called  upon to do so at a  crisis.  All this is wrong,
for  bleeding is a measure undoubtedly  of  the greatest value and one
which everyone may be called upon to resort to.  Like many medical 
VENESECTION.
371
measures, it was sadly abused in the early part of this century, and
people were bled with the same regularity that they were put to bed.
  The indications for venesection are as clear and well defined  as are
the indications for any remedy.  Briefly stated, we may  say  that all
states of the circulatory apparatus denoting high arterial tension and
excitement are indications, and that weakness, low arterial tension, and
systemic or circulatory depression are contra-indications.  Since the
use of veratrum viride has become more common the conditions indi-
cating venesection have been lost sight of, because this drug so dilates
the blood-paths  that a man is bled into his own vessels.
   Having made clear the general indications for the use of  venesec-
tion, we may pass on to state some of the diseases in which it mayr be
well resorted to.   Of these, pneumonia, pleurisy, meningitis, and peri-
tonitis,  if they are sthenic, are typical examples, since all of them are
accompanied by arterial excitement and  characterized by  local conges-
tions affecting the lung,  pleura, cerebral membranes, or peritoneum.
(See Pneumonia.)  By the abstraction of blood the vascular tension
is lowered and the engorged area relieved.   In the first place, the con-
gested area is  made up of relaxed bloodvessels, whereas the remaining
bloodvessels of the body are tense, and,  as a consequence, the blood is
urged to the spot already engorged.   In the second place, the abstrac-
tion of blood from the tense bloodvessels renders the general  pressure
lower than that iu the diseased area,  and the congestion is relieved.
   In apoplexy  the extravasation of blood  into the brain causes great
arterial excitement, as a  general rule, and  this in turn  results in in-
creased  intracranial  haemorrhage.   Bleeding  is,  therefore,  strongly
indicated, not only to  prevent inflammation, but also to prevent further
leakage into the brain substance.
   The method by which venesection is practised is yet to  be described.
It  is a  very  simple operation  if  au  assistant  is  present to make
pressure on the  vein or entire arm.    Often this pressure is best exer-
cised by means of a  handkerchief or bandage tightly twisted about
the arm above the spot where the incision is to  be made.   Under these
circumstances, the veins of the arm become prominent and distended,
and one of them may  be readily bared by a  short longitudinal incision
of half an inch, the  fascia being separated until  the glistening blue
surface of the vessel appears, free from fat or connective  tissue.  Into
this vessel, with the  edge of the knife turned upward, a small longi-
tudinal incision  is made, care being taken that the point of the blade
is not driven in far  enough to  injure the posterior wall of the vein.
If a  clot forms and  stops the flow it must be removed  by an  aseptic
cloth, while if the flow is to be  stopped we may remove the  bandage
above and apply a compress over  the  incised vein, which compress
may be held in position by a bandage. 
FOODS   FOR   THE  SICK.
                     PEPTONIZED MILK.

  Take a perfectly clean, clear  glass quart bottle and place iu it the
contents of one of Fairchild Bros.' peptonizing tubes or Parke, Davis
& Co.'s peptonizing tablets, both that containing the sodium and that
containing the pancreatin, and a teacupful  of cold water, and after
shaking pour  into the bottle a pint of perfectly fresh, cool milk and
stir the mixture  thoroughly.  Next place the bottle  containing the
milk in a can  of  water at such a temperature that the whole hand of
the nurse may be  indefinitely submerged in it without pain.   If com-
plete digestion of the  milk is desired, this application of heat may be
continued as long as twenty  minutes, but in most cases five  minutes
is sufficient.   If carried on longer than twenty minutes, the milk will
become bitter and disagreeable to the taste  through the development
of peptone iu  excess.
  Immediately after taking  the  bottle from the  hot water it should
be placed on ice, in order to check  further peptonizing and to keep
the milk  from spoiling ;  or if  ice is  not available  the  water  bath
should be quickly brought to a boil, in order to prevent further action
of the ferment, and the bottle then be placed in a  cool place.   This
recipe may be used where it is thought  necessary to digest the milk
before it  is swallowed.  Where we  desire  simply to  aid digestion it
is best  to follow the  directions already given, except that the bottle
is not  heated but at once  placed upon ice and allowed to  remain
there, being slightly warmed when  it is desired to give it to  a child,
or it may be  given as a cool and  refreshing drink to an adult, the
heat of the body rapidly causiug the ferment to do its work  as soon
as the food enters the  stomach.  When irritability  of the  stomach
exists in adults this peptonized milk may be made  more agreeable to
the taste  by following  the directions given in the first recipe, except
that it must remain in the hot water  for no less than two hours, when
it is  poured out  into a tin cup or  pan and  rapidly brought to the
boiling-point.   After this it is strained through  a piece of coarse
muslin  and placed upon ice.  Before giving it to a patient this mix-
ture may be flavored  with lemon or orange juice or any form of acid
that is desired, without  the milk becoming curdled.   Peptonized milk
punch is  made from  milk prepared in the way  already described in
the  first  recipe,  by adding  St. Croix  or  Jamaica rum  or  brandy,
and is a pleasant nutrient, particularly if the surface  of the  liquid is
sprinkled with a  little grated nutmeg. 
PEPTONIZED GRUEL.
373
  A very refreshing and  agreeable drink  may be  made be  diluting
peptonized milk one-half with highly charged carbonic acid water and
swallowing it while effervescing.


                    PEPTONIZED BEEF.

  The following method of preparing Peptonized Beef is recommended
by the Fairchilds, and  is very useful, as is also peptonized oyster stew
as first introduced by my friend, the late Dr. N. A. Randolph.
  Take J pound of finely minced raw lean beef; cold  water, J pint.
Mix in a saucepan.   Cook over a gentle fire, stirring  constantly until
it has boiled a few minutes.  Then pour off the liquor for  future use,
beat or rub the meat to a paste, and put it into a clean  fruit jar with
\ pint of cold water aud the liquor poured from the meat, and add

          Extracti pancreatis (Fairchild)   .    .    .20 grains.
          Sodii bicarb. .   .    .   .    .    .    .  15  "

  Shake well  together, and set aside in a warm place, at about 110°
to 115°, for three hours,  stirring or shaking occasionally ; then boil
quickly.  The liquid may then be strained, or clarified  with white of
egg in the usual manner, and seasoned  to taste with salt and pepper.
  In the great majority  of cases  it  is not necessary  to  strain the
peptonized liquor, for the portion of meat remaining undissolved will
have been so softened  and acted upon by the pancreatic extract  that
it will be in very fine particles and diffused  in an almost impalpable
condition, and  is, therefore, in a  form ready for asssimilation in the
body.
  Peptonized. Oysters.—Peptonized Oysters are prepared by mincing 6
to 12 large oysters,  and adding to them, when mixed with a moderate
amount of their own  liquid, 5 grains of pancreatin or peptonizing
powder and  20 grains of sodium bicarbonate.  The cup containing
this mixture  is now placed  in warm water at 100° F. and allowed to
remain there from ten to twenty minutes, according  to the degree of
digestion desired.  After this the liquid mass is quickly brought  to a
boil to cook the oysters  and stop digestion, and  served with pepper
and salt as required.  Any condiment or flavoring substance  may be
used.

                    PEPTONIZED  GRUEL.

  Peptonized  Gruel may be  made by taking thoroughly boiled hot
gruel made  from oatmeal, barley, wheat,  or from arrow-root, to the
amount of \ pint, and adding thereto while it is hot, \  pint of fresh,
cold milk; to this may now be added the contents of  one peptonizing
tube and the mixture allowed to stand in moderately hot water or in
a warm place for twenty minutes  before it is placed upon ice. 
374
FOODS FOR  THE  SICK.
                           KOUMYSS.

   This is a preparation of milk which is very useful for children aud
adults during convalescence from  acute  or subacute  exhausting dis-
eases.   Even young children of three or  four years will take a fancy
to it if it is not  made too sour by continuing the fermentation process
too long.   The liquid  is prepared as follows :  Add to 1 pint of cool,
perfectly fresh milk 2 teaspoonfuls of sugar, and place it, after shak-
ing thoroughly, in a beer or claret bottle.  Then add ^ of a cake of
Fleischman's compressed Vienna yeast and tightly cork the bottle,
standing it in a warm place or in a water-bath at 99° to 100° F. for
eight to ten hours.   Then  place in a cool place or on ice  and use as
needed.  It must be remembered that the development of carbonic gas
is very great in this liquid, and that if an ordinary cork is inserted it
must be tied in before  the heat is applied.   Further than this, the
cork must be pulled very gently or the  liquid will  squirt all over the
room.   The best thing to use when about to drink  the koumyss is
a " champagne tap," by means of which the liquid may be drawn off
as needed.

                           DIET LIST.

   The following bills of fare are used in  the Children's  Hospital in
this city, with  good results, are  easily prepared, and the directions
readily carried out  by the inexperienced :

    Diet in Gastro-intestinal Catarrh for a Child of Seven Years.

   Breakfast, 7.30  a.m. :   Milk,  with lime-water;  4  teaspoonfuls of
lime-water to each tumblerful of  milk.   The  lightly-boiled yelks of
two eggs, thin slices of well-toasted bread, or  stale bread.
   Dinner, 12 m. :  A mutton  chop without fat, broiled, or a slice of
roast beef or mutton, occasionally  a bowl of meat broth.   Stale bread
or toast.
   Supper, 7 p.m. :  Milk  and lime-water.  Stale  bread  or toast, or
milk-toast.
   For drink : Filtered or boiled water.
   Starch foods to be avoided as much as possible.

                 Diet for a Child Two  Years Old.

   Breakfast, 7.30 a.m. :  Milk.  The lightly boiled yelk  of an egg.
Thin bread and butter (the bread to be one day old).
   Lunch, 11 a.m.  :  Milk.  A thin slice of bread and butter.
   Dinner,  1.30 p.m. : Beef-tea or  small piece of minced roast beef or
mutton devoid of gristle.   One well-mashed  potato, moistened  with
gravy.   Rice and milk.
   Supper, 6 p.m. :  Milk.  Bread  and butter.
   For drink : Boiled or filtered water. 
RESTORATIVE  BEEF  ESSENCE.
375
         Diet for a Child One Year Old.  (5 meals a day.)

  First meal, 7 a.m. :  Two teaspoonfuls of grated flour-ball (prepared
as directed below) in half a pint of milk.
  Second meal, 10.30 a.m.  :  Half a pint of milk with  4 tablespoon-
fuls of lime-water.
  Third meal, 2 p.m. : The yelk of 1 egg beaten up in  1 teacupful of
milk.
  Fourth meal, 5.30 p.m. :  Same as the first.
  Fifth meal,  11  p.m. : Same as the second.
  Flour-ball is to  be  made by taking one pound of good flour—un-
bolted, if possible—tie  it up very tightly in a pudding bag;  put it in a
pot of boiling water early in the  morning, aud let it boil until  bed-
time, then  take it out and let it  dry.   In the morning peel  off the
surface, and throw  away the  thin  rind of dough, aud with a grater
grate down the hard, dry mass into a powder.  To use this, take from
1 to 2  teaspoonfuls of the powder, rub it down  until smooth with a
tablespoonful of cold milk,  and add 1 tumblerful of hot  milk,  stirring
it wrell all the time.

  Diet for a Child from Six to Twelve Months Old.  (5 meals a day.)

  First  meal, 7  a.m.  : Mellin's  food,  1  tablespoonful, or flour-ball
grated, 1  or 2 teaspoonfuls (prepared as directed  above), hot water, 4
tablespoonfuls; warm  milk, enough to make half a pint.  Dissolve
the Mellin's food  or rub down the grated flour-ball  in  the hot water
by stirring, then add the milk; mix thoroughly.
  Second meal,  10.30 a.m.,  and third meal, 2 p.m. :  A breakfast-
cupful of milk with 4 tablespoonfuls of lime-water.
  Fourth meal, 5.30 p.m. :  Same as first.
  Fifth meal,  10.30 p.m. :  Same as second.


                          BEEF  TEA.

  Take 1 pound  of lean beef, and mince it.  Put it, with its juice,
into  an earthen vessel  containing a pint of  tepid water,  and  let the
whole stand for  one hour; strain well, squeezing all the juice from
the meat.  Place  on the fire, aud slowly raise just to the boiling-point,
stirring it briskly all the time.  Season with salt and pepper to taste.
In administering  this, always be careful to stir up  the sediment.
  Or, take 2  pounds  of beef, without  fat or bone, half a breakfast-
cupful of cold water;  place it in ajar in a saucepan of  water.  Sim-
mer four hours.


        RESTORATIVE BEEF ESSENCE.   (Ringer.)

  Take  1  pound of fresh  beef, free from fat, chop it up fine, and
pour over it 8 ouuces of  soft water,  add  5 or  6 drops of hydro- 
376
FOODS FOR  THE  SICK.
chloric acid, and 50 or  60 grains of common salt, stir  it well, and
leave it for three hours in a cool place.   Then pass the fluid through
a hair sieve, pressing the meat slightly, and adding gradually toward
the end of the straining about two ounces more of water.   The liquid
thus  obtaiued is of a red color, possessing the  taste of  soup.   It
should be taken cold, a  teacupful at  a time.  If preferred warm, it
must not be put on the fire, but  heated in a covered vessel placed in
hot water.
  Should it  be  undesirable for the patient to take the acid, this soup
may be made by merely soaking the minced beef in  distilled water;
or, take 1 pound of gravy beef, free from  fat and skin, chop it up
very fine, add a little salt, and put it  into an earthen jar with a lid,
such  as  is used  for  roasting venison, fasten up the  edges with a
thick paste,  and place the jar in the oven for  three  or  four hours.
Strain through  a  coarse  sieve,  and  give the patient  two or three
teaspoonfuls  at a time;  or, cut up in  small pieces 1  pound of  lean
beef from the sirloin or rump,  and place it in a covered  saucepan,
with ^ pint of cold  water,  by the side of the  fire  for four or  five
hours, then  allow it to  simmer  gently for two  hours,  skim it well,
and serve.

                     BARLEY WATER.

  To prepare barley water, put two good-sized teaspoonfuls of washed
pearl barley with 1  pint of cold  water  in a saucepan, and  boil slowly
down to two-thirds.   Strain.
                        RICE WATER.

  Rice water  is made by boiling  2 ounces of clean rice in 2 quarts
of water for an hour and a half.
                        WINE  WHEY.

  Boil 1 pint of fresh milk; while boiling, pour in 1 small tumbler-
ful  of sherry wine (8 tablespoonfuls), bring  it to the  boil a second
time, being  careful not to stir  it; as soon as it boils set it aside until
the curd settles, and pour off the clear whey.


           ALMOND  BREAD  FOR  DIABETICS.

  Take of blanched sweet almonds £ pound, beat them as fine as pos-
sible in a stoue mortar; remove the  sugar contained in  this meal by
putting it into a linen bag and steeping it for a quarter of an hour in
boiling water acidulated with  vinegar;  mix this paste thoroughly
with 3 ounces of butter aud 2 eggs.   Next add the yelks of 3 eggs 
MULLED WINE.
377
and a little salt, and stir well for some time.  Whip up the whites of
3 eggs and stir in.   Put the dough thus obtained into greased moulds,
and dry by a slow fire.
             BRAN BREAD  FOR DIABETICS.

  Take a sufficient  quantity (say 1 quart) of wheat bran; boil  it in
two successive waters for a quarter of an hour, each  time straining it
through  a sieve; then  wash it well  with cold water (on the sieve)
until  the water runs off perfectly clear; squeeze the bran in a cloth
as dry as you can, then spread  it  thinly on a dish and place it in a
slow oven ; if put in at night,  let it  remain until morning, when, if
perfectly dry and crisp, it  will be fit for grinding.   The bran thus
prepared  must be ground  in a fine mill and sifted through a wire
sieve  of  such fineness  as  to require the use of a  brush  to pass it
through; that which remains in the sieve must be ground again until
it becomes quite soft and  fine.   Take of this bran  powder 3 ounces
(some  patients use  4 ounces).   The  other  ingredients  as follows: 3
new-laid eggs, IJ ounces (or 2 ounces, if desired) of butter, and about
| pint of milk; mix the eggs with a little of  the milk, and  warm  the
butter with the other portion; then stir the whole well together, add-
ing a  little nutmeg  and  ginger, or any other agreeable  spice.   Bake
in small tins  (patty-pans), which must be  well buttered, in a rather
quick oven for about half an hour.   The cakes, when baked, should
be a little thicker than a ship's  biscuit; they may be eaten with meat
or cheese, at breakfast, dinner, and supper;  at tea they require rather
a free allowance of  butter or they may be eaten with curd  or any of
the soft cheeses.
  u It is important that the above directions as to washing and drying
the bran should be exactly followed, in order that it may be freed from
starch and rendered more friable.  The bran in its common state is
soft, and  not easily  reduced to  fine powder.   In some seasons of  the
year, or if the cake has  not  been  well prepared,  it changes  more
rapidly than is convenient, owing to moisture.   This  may be prevented
by placing the cake  before the fire for five or ten minutes every day."
                       MULLED  WINE.

  Boil some spices,  cloves, nutmeg,  cinnamon, or  mace,  in  a little
water, and add as much  of this decoction as is necessary to flavor a
wineglassful of sherry, or any other wine.  Add sugar to taste, and
bring the mixture to the boiling-point.   If claret  is used, it will require
more sugar than  if  a less sour wine is  employed.   The vessel  for
heating the wine should be scrupulously clean. 
378
FOODS FOR  THE SICK.
                     WATERED  TOAST.

  Brown several  pieces of bread and carefully butter the toast so that
the butter is equally distributed.  Place enough salt over the toast to
flavor  it and add pepper to taste.   Finally pour as much  boiling
water on the edges  of the crust as is necessary to thoroughly soak
them, and serve to the patient.   This is  a more agreeable dish than
would be imagined, and is useful where milk toast is distasteful. 
PART   IV.

  DISEASES.
                          ABORTION.

   The treatment of abortion divides itself into three parts : the first
for its prevention, the second for its arrest when threatened, the third
for its proper care when inevitable.
   In the preventive means we find, as in nearly every branch  of
medicine, that the use  of hygienic  measures is more important  than
the employment of drugs.  If the previous abortions are known to  be
due to syphilis, endometritis, or uterine displacements these conditions
must be relieved  by the proper remedies.   If there exists no apparent
cause for the interruption of normal gestation, the patient should use
a simple diet, lead a quiet life,  avoid all sexual intercourse, sleep on a
hard  bed, and resort only to gentle  exercise.  Fresh air is, however, a
necessity and should be  plentifully supplied.   The  food should  be
light, but nutritious and palatable, and a sufficient variety supplied  to
avoid any repugnance to a given dish.   In many cases abortion  rests
upon deficient nutrition of the foetus, either  by reason of faulty assim-
ilation  on  the part of  the mother or because of poor food, so that if
ansemia, debility, or other impoverished states of the maternal  system
be present, these  should be  treated at once.  The clothing should  be
loose, the night's sleep  undisturbed and of full length, and the mind
be  set at rest as far as possible in respect to household and other
worries, and particularly diverted from the thought of possible uterine
disturbance.
   The use of drugs is to be limited strictly  to the fulfilment of a dis-
tinct indication, and the employment of cathartics is to be avoided, the
bowels being kept in order by fresh  fruits in moderate quantity, or  by
mild laxatives, such as cascara sagrada in small doses  and compound
liquorice powder.  If these fail rhubarb may be resorted to and castor
oil  in capsule may be used.   Podophyllin, senna in full doses, saline
purges in active  amounts, aud aloes, are not to be used if they can  be
avoided.  If the woman be exceedingly stout and  plethoric  saline
purges  are indicated to  act as depletants.  It is hardly necessary to
add that elaterium and scammony, or jalap,  are not safe, and can only
be used if dropsy and  ascites are present and where we must  choose
the least of two evils.   Strychnine,  which stimulates  the spinal cord,
should  never be employed, and  cautharides, oil of erigeron, and 
380
DISEASES.
manganese ought not to be used  unless they are for some reason very
necessary.  Although quinine is not of itself abortifacient, it is unsafe
if an abortive tendency is present, and can only be used in cases in
which the  abortion is brought on by malarial poisoning, when it will
act as a preventive.
  The only drug whicli seems to be of any service as a prophylactic
to be taken all  through pregnancy is the  fluid extract of viburnum
prunifolium, the close of which is \ to 1 drachm. This drug is said to
be a uterine sedative and to have no injurious  effects upon the mother
or child.
  Cimicifuga racemosa is probably equally valuable as a prophylactic
against abortion in the dose of 10 to 20 drops  of a good sample of the
fluid extract,  given night and morning.
  The arrest  of  threatened abortion  is one of the most difficult duties
which come to the physician,  and there is no doubt that  large doses of
morphine or opium are the best means  of quieting the uterus that we
have.  While viburnum prunifolium may be  resorted  to, we do not
know enough of it to rest assured of its  value, but it should be tried
if opium is not at hand or fails.  The patient should be at once quietly
placed in bed in the most comfortable position, be so covered as to
prevent over-heating aud taking cold, and receive  by the hypodermic
needle \ grain of morphine, or better still, a rectal injection of warm
starch-water  containing 30 drops  of laudanum.  The bulk  of the
injection should  be small in order not to disturb the bowels, and must
be at the bodily temperature.   If this is  not done, a suppository of
the aqueous extract of opium, containing \ to \ grain, should be used.
Ice-cold  drinks  should  be given and no tea or coffee allowed.  This
treatment quiets the uterus, allays nervousness and restlessness, and at
least  puts  off the abortion for a few  hours.   Venesection has been
practised iu very plethoric women with advantage.
  When an abortion is inevitable it is to be treated by measures directed
to the avoidance of haemorrhages, the thorough delivery  of the ovum
and  its appendages,  and the prevention of inflammation  and septi-
caemia.   For the prevention of haemorrhage a number of balls of
absorbent cotton tightly wound with thread to the  size of a small egg
should be packed into the vagina back of and around the cervix until
the bleeding is controlled, and while a small amount of iodoform may
be dusted over them before they are inserted, no astringents are to be
applied,  unless it be tannic acid to coagulate the blood in the cotton,
as astringents cannot reach the bleeding-spot.  Sponges ought never to
be used,  as they often fail to  control  the bleeding and rapidly  become
septic.   By means of this  packing the blood  in the uterus cannot
escape, and, as the uterine walls contract, they urge the liquid between
the membranes, thereby causing complete  separation.   Ergot should
be used  after the tampons are applied in the dose of a fluidrachm of
the extract or a tablespoonful or two of the wine.   Generally after
twenty-four hours the removal of the tampons will show the ovum to
be in the vagina, but if part  of  it remains  in the uterus the following
measures should be  resorted to.   The administration of ergot should 
ABSCESS.
381
be stopped unless the haemorrhages are severe, and the uterine cavity
is to be cleared by the use of the fingers of the attendant, who grasps
the membranes and draws them away.  If the  cervical canal is too
small it must  be dilated by dilators  or by packing it with sponge
tents.   After  the membranes are removed  the  tincture of iodine
should  be  applied to the inner surface  of the uterus as a haemostatic,
antiseptic, and alterative.
  The  after-treatment consists in the use of small doses of ergot and
quinine, of vaginal antiseptic irrigation or even of  uterine irrigation
if  it is needed, and the maintenance of perfect  rest for one or two
weeks, or longer if possible.   Ergot  ought not to be given if there is
reason to believe that portions of the membranes  or  blood-clots are in
the uterus, as by contraction  of the os uteri it may imprison materials
which may become septic.  (See Puerperal Diseases.)
                           ABSCESS.

  The  medical  treatment of abscess  resolves itself into the  use  of
drugs to prevent the formation of pus, to cause  its fatty degeneration
and absorption,  to quiet the systemic disturbance if the inflammation
be severe, and to support  the body if the suppuration be prolonged,
or in large amount, or if  debility exists.  The treatment may also be
divided into that suited to acute and to chronic abscess.
  As acute abscess in its early stages is simply  a localized inflamma-
tion  with  hypersemia and an  outpouring of leucocytes, it may often
be aborted by the use of aconite or veratrum  viride in full dose  to
quiet the circulatory excitement and relieve  the congestion.   This is
particularly true where the  pain  is pulsating.   At the same time, if
the swelling is  superficial,  a poultice,  made by moistening  bread-
crumbs with lead-water, should be placed over it, or lead-water may
be placed  on  lint and applied in this  way.   Belladonna  ointment
smeared  over  the  same area may be of  service, and the tincture may
be used  internally if aconite cannot be had.  If a gland be involved
the needle of a  hypodermic syringe may be inserted obliquely into
its centre and 5  to 10 minims  of  a 2  per cent, solution of carbolic
acid  injected  into the swelling.  This  method has been  found  of
singular efficacy in bubo where  pus seemed  just about to form.    It is
almost always curative., but should not be used in a stronger or weaker
solution than that  named.   Another useful  abortive method for the
treatment of the early stages of abscess is the application, externally,
of a strong solution  of nitrate of silver, 20  to 40 grains to 1 ounce
of water, by means of a  camel's-hair brush, all over the skin,  cover-
ing the area involved, or byT the  use of the  tincture of iodine  in a
similar manner.
  Internally, calx sulphurata  in  the dose of fa  grain  given  every
hour or two, may be used as an abortive, or at least to promote arrest
and cause absorption.  If it becomes  evident  that pus is going  to
form, then resort  must be had to poultices whicli by their heat and 
382
DISEASES.
moisture will aid in the formation  of pus by favoring the escape  of
leucocytes aud by softening the tissues.   If pus forms and fluctuation
ensues the abscess should be freely opened, drained, washed out by a
solution of carbolic acid, in the strength of 1  to 20, or  of bichloride
solution 1 to 5000, and dressed with antiseptic gauze.  If it is tuber-
cular the abscess may  be opened in the ordinary manner, all diseased
tissues removed  by  scraping and the cavity packed with  iodoform
gauze, or it  should  be drained by aspiration  and an ethereal solution
of iodoform  injected and allowed to remain in the abscess cavity if it
is a small one.   The opening is  now closed  by a  pledget  of cotton
wet with tincture of benzoin and an antiseptic  dressing applied  over  it.
Not more than  20 grains of iodoform should be so  used in  the treat-
ment of tubercular abscess.
  A  very  good  treatment  for  slow abscess is to wash out the cavity
with  a 10 per cent, solution of  peroxide of hydrogen.
  If  the abscess  is chronic (cold abscess) and  associated with great
weakness, resort must be had to the internal use of iron in the form  of
the tincture of the chloride, cod liver oil, with  hypophosphites,  quinine
as a tonic to prevent hectic fever, and the use of nutritious, easily di-
gested food.  Alcohol may be used and should be given with the milk.
  The following tonic pill and  solution are of service:

         R..—Strychninse sulph .        .    .     .   .  gr. j.
             Ferri redact.  ...                 .  gr. xv.
             Quininse sulph.   ......  gr. xx.  M.
    Ft. in pil. no. xx. S.—One t. d. after meals.

Or,
         R..—Tr. cinchona? comp   ~)
             Tr. gentian, comp.   y .
             Tr. cardamom, comp. J
    S.—Dessertspoonful t. d. after meals

   Having described the means  of treatment, it is to be explained how
these measures act.  The aconite quiets the  circulation aud  thereby
relieves the inflammation, the lead-water acts locally as an astringent
and sedative, while  the belladonna by  its action on the bloodvessels
contracts the dilated capillaries and allays  pain.  When carbolic  acid
is injected into an enlarged  gland it acts as  an  anaesthetic, as  an
antiseptic to the germs always present, such  as staphylococci, and  as
an  astringent and stimulant.   The  nitrate of silver applications  act
by constringing the bloodvessels, as  local  sedatives and  as counter-
irritants.   The  iodine  applications do  likewise, and also exercise  an
alterative influence.
   The physiological action  of calx sulphurata is unknown.   The
object in using  the antiseptic  irrigations  is  self-evident and the em-
ployment  of iodoform in tubercular abscess rests upon the  studies  of
Bruns, of Tubingen, and  many others,  who  have found  by  experi-
ment that iodoform is fatal to the bacillus  tuberculosis.
   As large  numbers  of corpuscles are  destroyed in the formation  of
pus,  and other sources  of vitality are sapped  by its  formation, the use
aa f^iij-
          M. 
ADENITIS.                        383
of hypophosphites and iron to replace the  loss is necessary, and  of
cod-liver oil and tonics to increase the blood-corpuscles and the assimi-
lation of food.

                              ACNE.

   This affection occurs in so many forms and arises from such differ-
ent causes  that a thorough consideration  of its treatment cannot  be
here given; suffice it to state that arsenic is a remedy which will often
cause a cure  and prevent a  relapse if used  in small doses for a long
period—that is : 1  to 3 drops of Fowler's Solution three times a day
for a month or two.   This is particularly useful if debility and ansemia
underlie the disease.   If the ansemia be marked, the proper treatment
is that directed to the cure of this condition (see Ansemia); if obstinate
constipation is present, relief must be obtained by saline  purges and
the bowels kept in order by cascara sagrada  or some similar drug.   If
scrofulosis exists cod-liver oil is of great  service, or, if much pustula-
tion is present, calx  sulphurata, in the dose of -j^- to £ of a grain, may
be used in pill form three times a day.   In menstrual acne  sulphur
may be used  internally to open the bowels,  and applied as a wash  to
the face in the following form :
         ^.—Sulphuris.......3J.
              Glycerini  .......   f 5j.
              Aquae rosse.....q. s. ad   f.^viij.    M.
    S.—Apply twice or thrice a day.
Or the following may be used in cases of severe inflamed  acne:
         $.—Sulphuris iodidi.....gr. xxx.
             Cerati simplicis......% j.       M.
    S.—Apply to the parts night and morning.
   If the skin is very atonic, muddy, and torpid, it  should be bathed
night and  morning with hot water and castile  soap, or even with the
tincture of green soap, and well rubbed with a rough towel.
   If the green soap causes  irritation, some  bland  application should
 follow it, such as simple  cerate or the emulsion  of the oil of  bitter
almonds.  If the pustules be large they may be incised and vent given
to their contents, the sac  being  touched with a drop of carbolic acid.
 If induration is great, ichthyol ointment  of the strength of 20 parts of
 ichthyol to 100 of lard should be well rubbed in, or resorcin, 10 to 20
grains to the ounce  of lard, be applied.   Mercurial ointment may also
 be used to relieve induration, but several days must elapse between its
 use and that of sulphur, as  a  black sulphuret  of mercury may be
 formed and stain the face.

                            ADENITIS.

   Adenitis is an  inflammation  of the  lymphatic glands, generally
 arising from  scrofulosis, unless there be  some specific trouble, such as
 syphilis, present.  Less commonly it occurs in the neck from the irri- 
384
DISEASES.
tation produced by the eruption of milk-teeth, sometimes from blows
or exposure to cold.
   If the condition consists in a simple enlargement it should be treated
by inunctions of iodine ointment and lard, half and half, night and
morning, care being  taken that the ointment is stopped as soon as any
reddening of the skin appears, or if fluctuation develops.   If the oint-
ment  cannot be used, the tincture of  iodine should be thoroughly
painted over the swelling with a brush, but is less efficacious.  The
following prescription makes a useful application :

         R—Ichthyol........3]J-
             Adipis benzoinat.......]§ij.   M.
   S.—Hub a small piece of the ointment into the swelling, t. d.

   Syrup of the iodide of iron, in the dose  of 5 to 10 drops,  is to be
given if the patient is a child, and tonics must be used to improve the
systemic condition.  As soon as  fluctuation  or reddening shows the
formation of pus all  this treatment should  be  stopped, and a  poultice
be applied  for twenty-four or forty-eight hours till the  swelling goes
down or is ready for lancing.   Lancing is better than  allowing the
abscess to break, as the scar  left in after years  is a mere line instead of
a large cicatrix.
   If the enlargement  be scrofulous, the following treatment, recom-
mended  by Treves and Griinfeld, is of  value, and should  be carried
out if the patient will submit to it:
   The entire removal of the glands  should be effected  by dissection
alone ; directors, handles of scalpels, or fingers should be used to sepa-
rate the glands from the surrounding cellular tissue as closely from the
capsule as a nerve is cleaned in the dissecting-room.  When sufficient
of the anterior surface is exposed, a thick thread is passed through the
gland, and drawn  gently, when by continuing  the dissection the opera-
tor may gradually get to the back of the gland, removing portions of
the mass at a time.  The cavity should be packed with iodoform gauze,
and the walls scraped if an  abscess has existed.


                        ALCOHOLISM.

                         (See Alcohol.)


                          ALOPECIA.

   This disease, when due to  a  parasite, is best treated, according to
Crocker, by first pulling out all the loose hairs around the bald  spot
and then painting the affected surface  with  linimentum  cantharidis
(liquor epispasticus).  Three coats of this liquid should  be  employed,
and  each coat allowed to dry before the next  is  applied.  In other
cases an ointment of chrysarobin, J to 1  drachm to the ounce of lano-
lin, may be used, but care must be exercised that too much  staining of
the skin and clothes  does not result.  Another equally good applica- 
AMBLYOPIA  AND  AMAUROSIS.            385
tion is 2 grains of mercury bichloride to 1 drachm of rectified spirit
and 7 drachms of oil of turpentine.   This  mixture may be rubbed in
with the finger over and around the patch.   If the patient's skin will
stand it, 5 grains of the corrosive sublimate may be used in place  of 2
grains.

              AMBLYOPIA  AND AMAUROSIS.

   Amblyopia, or dull vision,  and amaurosis, or blindness,  usually
refer to defective  sight or its total loss, the result of  functional  dis-
turbance  of the retina, optic nerve, or visual centres, and  unaccom-
panied by changes in the eye-grounds in the beginning of the disease.
These terms, however, also include cases of partial or complete blind-
ness, in which optic atrophy subsequently develops, and are often  used
to  describe ocular disorders not limited by the definitions  here  em-
ployed.
   These cases may be gathered  into certain groups :
   I.  Congenital amblyopias and  amblyopias  from non-use of the
eyes.
   In the former there is  often a  high degree of error of refraction,
usually far-sightedness; the latter  is seen when an eye  is debarred
from binocular vision by a squint.   In both the treatment consists in
as perfect a correction of the optical error as possible, and, in case one
eye alone is  involved, the  separate exercise of its functions. Con-
genital  amblyopias  may include incurable  defects in the  structure of
an eye.
   II. Amblyopias  the result  of (a) general  diseases or conditions—
typhoid fever, the exanthemata, syphilis, scurvy, malaria, colds,  etc.;
(6) local diseases or conditions—haemorrhoids, haemorrhage, pregnancy,
disordered menstruation, kidney disease, diabetes, migraine, disorders
of the nervous system, etc.
   The  remedies  indicated by the  special cause  are to  be employed ;
the medicinal agents most usually needed  being mercury, iodide of
potassium, pilocarpine,  particularly in ursemic amaurosis,  emmena-
gogues, and tonics, especially hypodermics of strychnine.  As  local
measures  repeated fly-blisters to the temples, wet and dry cups, and
the constant electric current are used.  The nape of the neck may be
cauterized or a seton introduced.   In hysterical cases  metallotherapy
may be tried.
   III.  Amblyopias the result of the action of certain medicinal and
toxic agents.
   The  abuse of alcohol, and particularly of tobacco, produces a  form
of amblyopia characterized by the development of a  scotoma or an
area in the centre of the, field of vision, in which the  appreciation of
red and green is  lost or greatly diminished.   Quinine in excess  has,
in  a number of  instances, been  followed  by  temporary blindness,
which is usually  denominated  quinine amaurosis.  Of less frequent
occurrence are the cases of amblyopia produced by the toxic action of
salicylic acid, lead,  silver, mercury, osmic acid,  nitro-beuzol,  and the
                                 2-5 
386
DISEASES.
vapor  of  sulphide of carbon.   In all instances the patient  must be
withdrawn from the  influence of the poison;  in  tobacco amblyopia, in
its early stages, this  is  usually sufficient to effect a cure.   The reme-
dies which have proven of the greatest utility are digitalis, inhalations
of nitrite  of amyl, nitro-glycerin, and strychnine.   Iodide of potas-
sium should  be exhibited iu chronic cases, and always  in amblyopias
the result  of lead-posoning.  The constant current has also been em-
ployed.
  IV. Amblyopias the result of direct or indirect injury, or from re-
flex irritations.
  Traumatic amblyopias may follow a blow upon the eye itself, or an
injury to the skull or spinal cord.  To carious teeth, intestinal irrita-
tions, the  presence of parasites, and the like,  a certain number of am-
blyopias have been attributed, but, while  it is not possible to disprove
the association, such cases must be received with doubt.  After  the
removal of the cause, strychnine should be exhibited.
  Optic neuritis  most frequently depends upon coarse diseases of the
brain (tumor, abscess) or inflammation of its membranes (meningitis).
It is also a  symptom of numerous disorders—suppression of  the
menses, exposure to  cold, rheumatism, anaemia, syphilis, uraemia, lead-
poisoning, etc.   The remedies  are those  naturally suggested by  the
disease  or condition which has  called it  into existence.   The prog-
nosis depends upon the  cause.  Mercury,  iodide and  bromide  of
potassium, the  salicylates,  pilocarpine,  local  blood-letting   and  fly
blisters, are the remedies commonly employed.
  Optic-nerve atrophy is either primary, or secondary to disease of the
brain or spinal cord, or consecutive to an antecedent neuritis.  After
all irritation has subsided the greatest improvement may be expected
from hypodermic injections of strychnine, which should be pushed to
the point  of tolerance.  Temporary improvement follows the inhala-
tion  of nitrite of amyl, and, in the hope of improving the circulation
in the optic nerve,  digitalis  and  similar cardiac tonics may be em-
ployed.  The constant electric current has been employed with benefit.


                       AMENORRHEA.

  This condition depends upon so many  causes for its  existence  that
it must be treated in many different ways.   If ansemia  or  chlorosis
show that a deficient supply of blood is  present, measures adapted to
the relief of such states are required (see Ansemia), while if plethora is
a cause depletants in the shape of saline  purges are needed,  but aloes
are harmful.   In a similar manner, in amenorrhoea due  to constipa-
tion  saline and  other purges may be used,  but the best of  these is
aloes;  aud as constipation and anaemia often exist hand in hand, a
combination  of  aloes and iron  in  a pill is commonly resorted to.
The  iron  improves the blood, and the aloes stimulates and  congests
the pelvic viscera by  bringing blood to the sexual organs.  Aloes
also increases the assimilation of iron in some unknown  manner.  The 
ANAEMIA.
387
following pill is often of service and  is especially recommended by
Goodell:
         R.—Extract, aloes aqueosi.....3J.
             Ferri sulphat. exsiccat......^ij.
             Asafcetidae.......giv.    M.
    Ft. in pil. no. c.  S.—From 1 to 3 pills three times a day.

  Cimicifuga has been highly recommended in chronic and apparently
causeless amenorrhoea, in the dose of 30 drops of the fluid extract at
the time for a proper flow to  occur.   Within the last few years  the
binoxide of manganese in  the dose of 1 to 3  grains has come promi-
nently forward as a remedy in simple  idiopathic amenorrhoea and is
undoubtedly of service,  but it should be taken for at  least two weeks
before the date  upon which each menstruation is expected to  occur.
Potassium permanganate  is also useful during  the  same period  in
similar states, but  it is  inferior  to  the binoxide of manganese in the
author's experience.
  Apiol, the active principle of parsley, may be given in  capsules in
the dose of  3 to  10 grains for  the same condition,  and oil of rue,
savine, and tansy have also been employed in capsule in the dose of
5 drops three times a day.
  In all forms  of amenorrhoea  a hot   sitz-bath  at the time for  the
expected " period " is  of service, more  particularly if the  patient  has
" caught cold."   The bath should be persevered in for several  nights
and care should be taken  to avoid  exposure.  Often  a little  mustard
added to the water will increase  the efficacy of this treatment.
  Under the name of" Dewees's Emmenagogue Mixture," first devised
by  Professor Dewees, of Philadelphia,  the following formula  has been
largely used  in functional  and organic amenorrhoea :
     R.—Tinct. ferri. chloridi
         Tinct. cantharidis
         Tinct. guaiac. ammon.
         Tinct. aloes
         Syrupi ....
S.—Tablespoonful three times a day.
 •  f.^iij-
 ■  f3J-

 .  f.^ss.
ad  fgvj.    M.
                           ANEMIA.

  The theory of Bunge that  the  presence of sulphur in excess iu the
body prevents the assimilation of  iron, and its indorsement by Clark,
is not generally received as correct;  for they claim that in chlorosis
sulphides are formed in excess, and that this causes chlorosis by non-
assimilation of iron, so that the question at once arises, How did  the
chlorosis come on in the first place, before the sulphides were formed ?
Sulphides may aid in its continuance, but it is  not proved that they
produce  it, and it is proved  that they are often present in enormous
quantities where no chlorosis occurs.   Again, we have no  proof that
the  manufacture of haemoglobin depends  upon the absorption  of iron
alone.   Clark thinks  that when we give iron  to such a case the sul- 
388
DISEASES.
 phides unite with it and  the  iron  in  the food escapes into the blood-
 making organs.  Either  the  doses of iron  must be  very accurately
 fitted to the amount of sulphides, or excessive amounts must be used,
 so that no sulphide may be companionless.  As nearly all persons have
 sulphides  present in  sufficient amount to make a characteristic black
 stool  on  taking iron,  we should, according to this theory, all have
 anaemia unless we protected the iron in our  food by a constaut use of
 the free metal.
   Practical experience does not support the use of  enormous doses of
 iron in ansemia and chlorosis, but rather the contrary.   The celebrated
 teachers of the Dublin school years ago put forward  the theory that
 small doses of iron were more useful than large ones in direct ratio to
 the severity of the disease, and the writer decidedly  agrees with them.
 There is quite  as much likelihood of failure of assimilation of iron
 by diseased organs  as of its destruction by wolf-like sulphides.  The
 use of large doses of iron is,  however, necessary in obstinate cases of
 anaemia.
   We learn  from practical experience several  things which  science
 does not  tell us, namely :  Iron will not cure all cases of chlorosis or
 anaemia, even if they belong to a functional  type, but  other methods
 must  be resorted to at the same time, or separately, for their cure. The
 insoluble salts  of iron are better remedies  for absorption  thau   the
 soluble salts, because they are  not precipitated in the stomach, and  for
 this reason reduced iron is the best chalybeate for uncomplicated cases.
 Beside using iron in this form,  we should  employ laxatives  if  the
 bowels are  confined,  mineral  acids, particularly  nitric and  nitro-
 muriatic, for their effect on the  function of the small intestine and
 liver,  and, in addition, bitter tonics of a more or less simple form  ac-
 cording to the exigencies of the case;  using quinine if malaria seems
 lurking in the body, simple bitters if the stomach lacks tone, aromatic
 bitters if, from atony of the muscular  coats,  the digestive tract seems
 sluggish,  with a resulting formation and accumulation of flatus and
 digestive  juices.
   The preparations of iron best employed in  anaemia are the  insoluble
 salts just named, such as Quevennes' iron and the carbonate, but there
 are indications which must be  regarded as to the salt to be used.   In
 many  anaemic persons, particularly females, the  tongue- is  broad and
 white, not  from  coating but  pallor,  is flabby and  torpid-looking.
 Under these circumstances the bowels should be kept moving by mild
 purges, and the sulphate or  some other astringent preparation of iron
■be taken by the patient.  In the ansemia caused  by rapid childbearing
 and lactation, cod-liver oil, the hypophosphites and phosphates of lime
 should be used, while  the iron and quinine  in  tonic dose may be of
 service in all forms of the disease.   With some practitioners Bland's
 pill is very much used, made as follows:

          R.—Ferri. sulph. exsiccat. \
              Potassii carbonatis   J    '   "  a<l  3VJ-
              Syrupi.......q. s.     M.
    Ft. in pil. no. xlviii. S.—One to three pills three times a day, after meals. 
ANAEMIA.
389
  Although it  is perfectly true that we have  almost  no knowledge
of the manner  in which alteratives act in instances of disease where,
through morbid functional  activity, enlarged glands or  growths ap-
pear, it is evident that they must act upon the trophic nerves or directly
upon  the nourishment of the affected parts.  If they are  used in large
quantities they act as depressants to the normal nutrition of the body,
producing  primarily a decrease in the  vitality of morbid growths, so
that they melt down and disappear, and they may finally  so reduce the
condition of the healthy tissues as to  cause sloughs and  ulcerations.
Whether these  changes are due to over-stimulation of nutrition—that
is, to  an  excessive  trophic change—or whether they depend  upon
actual lowering of the tone of the parts, we do not know.  One thing
we do know, however, and that is, that small doses of most of the so-
called alterative drugs act as very distinct stimulants to  the develop-
ment  of normal structures, and in  no  instance do we find this more
typically represented than in the effect which they exert upon the blood.
Quite a number of years ago  Keyes,  of New York, emphasized the
value  of minute doses of mercury bichloride  in  syphilitic and other
anaemias, and abundant clinical observation has certainly confirmed his
views.  The dose of bichloride of mercury in ansemia should be about
fa of  a grain.   Not only will minute doses  of the bichloride of mer-
cury act  in this way, but small amounts of calomel or mercury itself
will have such  au effect.
  Inunctions of very small amounts of mercurial ointment once a day,
or every other day, in adults aud in children, will increase the fulness
and redness of the cheeks and  lips, and the number of the corpuscles  ;
the piece of ointment used  being no larger than the half of a very
small pea.   This treatment will be found of service in cases not neces-
sarily  dependent upon specific taint or scrofula.  The marked increase
in the nutrition of children of a syphilitic taint  who are suffering from
marasmus, under the use of gray powder and inunctions, gives further
evidence of this fact.
  Arsenic, also, is  of value in anaemic conditions, and  may be  em-
ployed in  relatively larger  doses  than  mercury,  but,  nevertheless,
smaller amounts than are usually given in chorea and similar states.
Osier has shown the value of  the drug in anaemia, and so has Barton
in England.  Any one of the preparations of arsenic may be employed,
but not more  than fa grain of arsenious  acid  should be taken in  a
day, although more has been used with no less benefit to the patient.
Most  of the drug,  under these circumstances, is in excess, and is cast
off in the urine and faeces unused and wasted, straining and irritating
the emunctories of the body during its passage through them.
  Arsenite of copper is also  a remedy of very considerable value under
these circumstances iu the dose of from -j-fa to fa of a grain three times
a day.
  Bullock's blood, fresh, or dried and re-dissolved, may be used by the
rectum in the treatmeut of ansemia in those cases where iron fails, and
a change of air and diet may often produce a cure which no drug can
bring about. 
390
DISEASES.
  Diet is an important part of the treatment of anaemia.   The  food
should be good, well flavored, and varied, as well as easy of digestion.
It should contain, as far as  possible, the remedies needed by the sys-
tem, such as bone salts, iron, and alkalies, and should be accompanied
by some  red wine, such as port.
  At present we may conclude that  pathology has not found out the
real cause of these troublesome cases, and that until physiology can
put its finger  upon the  most intricate mechanism of blood-making
with a positive, clear  statement of its function  and the  physiological
chemistry of the manufacture  of haemoglobin, we must remain  satis-
fied to resort to the remedies which experience or common sense  tells
us will be of value to our patients.


                       ANAL FISSURE.

  This is one of the most painful  affections to which man is  subject,
and requires intelligent treatment, generally by surgical  means if the
result is to be curative, although great relief can be obtained by the use
of drugs.
  The most painful and annoying feature of the lesion is the violence
of the pain on defaecation, which is so severe that any emptying of the
bowel is  impossible except on rare occasions, when the pain is concen-
trated in one effort.
  To relieve this  pain and enable the patient to have a fairly com-
fortable stool, nothiug is so good as an iodoform suppository contain-
ing 2 to 5 grains of the drug.   Iodoform being a local anaesthetic the
passage takes place almost without the patient's knowledge.   If much
spasm of the sphincter is present, extract of belladonna, J grain, may
be added to each  suppository.  For the cure of the fissure a drop of
strong carbolic acid may  be applied to the spot, and a lotion of tannic
acid, glycerin, and water  used if  haemorrhoids are  also  present.
Ringer highly recommends the application to the fissure, by means of
a brush, .of a solution of bromide of potassium, IJ drachms to 1 ounce
of glycerin.   In order  that  the  passages may be soft and  yet  the
patient not be purged, sulphur should be given in the dose of one tea-
spoonful every night; or, if this cannot  be  used, castor-oil may be
given.
  The best way to give the sulphur is by combining it with powdered
cinnamon or aromatic  powder.  Sometimes relief is obtained by the
use of flexile collodion painted over the fissure.


                          ANEURISM.

  The treatment of aueurism by drugs is, unfortunately,  not very suc-
cessful, but is at least worthy of trial in all cases.  Vascular disease
resulting in such a lesion depends upon so many causes which may
modify the treatment  that the history of the case should be well borne 
ANGINA PECTORIS.
391
in mind.   The most common causes are syphilis, rheumatic taint, and
traumatism, and very often injury is  superimposed upon one of the
systemic taints named.   Whatever the cause of the disease may be,
iodide of potassium is par excellence the remedy most apt to do good,
and it will nearly always give relief, even if it does not cure.
   The doses should be large,  10 to 20 grains three  times a day, if the
patient will bear  them, and the prognosis under this treatment is far
more favorable if the cause  be syphilis than if the disease be idio-
pathic or traumatic.   For its successful use the  recumbent position
must be insisted  upon and the patient  kept quietly in bed, changing
his position as little as possible  aud confining himself  to  the  most
simple  and easily digested diet, with entire avoidance of all stimu-
lating substances, either in the way of food or drink.  If  the heart is
excitable and irregular  and the vascular system irritable with a high
arterial  tension,  the circulation  must  be  quieted  by small doses of
veratrum viride, say 1  or 2 drops twice or  thrice a day, but digitalis
is not to be employed, since it increases the strain upon the aneurismal
sac, although it  does quiet the irregular  heart-beat.  Aconite  may
also be used with care,  but it is inferior to veratrum viride.   If the
pain be very great, and it often is severe, particularly at night, opium
is indicated and  sleeplessness should be allayed, not by full doses of
morphine, but of morphine and chloral; or, better still, croton-chloral
should be so ordered that the  patient receives §■ grain of morphine and
10 grains of croton-chloral in pill at bed-time.  All attempts to cure
aneurism by the use of  other  drugs, unless syphilis indicates mercury,
are useless  when the lesion  is thoracic or  abdominal,  and when it
occurs in the extremities, as  in popliteal aneurism, surgical measures
are to be  resorted to  as the chief means  of cure.   If dyspnoea in
thoracic aneurism is marked, slight inhalations or "whiffs" of chloro-
form are useful.
   As we do not know how alteratives act, other than that they govern
nutrition, we cannot explain the value of iodides in aneurism.


                    ANGINA  PECTORIS.

   As the condition which exists in angina pectoris, so far as pathology
and morbid anatomy .are concerned, is unknown, it is impossible for
us to establish any scientific basis  for the employment of drugs in the
cure of this disease.  The nearest approach to any such attempt is
that first proposed by  Lauder Brunton, and is but another evidence
of the value of studies of the action of drugs upon animals, since he
argued that as he found nearly all attacks of angina pectoris  were
associated  with  vascular spasm, that vascular spasm might be the
cause of the paroxysm,  and that a drug decreasing  this spasm would
in consequence be  of service.   From his researches upon animals with
the nitrites he  knew that this class of compounds would fulfil the
indications.   Whether the vasomotor excitement is "cause or effect"
we do not know, but we do know  that drugs which decrease arterial 
392
DISEASES.
pressure often give relief in the attack if it be associated with high
arterial pressure, and  may even eventually produce a cure.   Further
thau this, we know that nitrite of amyl, nitrite of sodium  or  potas-
sium, and nitroglycerin, are of this  class.   All of these  drugs lower
blood-pressure at  once and powerfully, but the nitrite of amyl  aud
nitroglycerin are the best remedies for the attack itself, and the  nitrite
of potassium  or sodium for  the  intervening periods, or  where the
paroxysm is prolonged.  The reason for this lies in the  fact that the
sodium and potassium salts are more stable than the other two com-
pounds, are more  slowly broken up in  the body, and therefore more
prolonged in  their effects.  In an attack, a  few drops of the  nitrite
should  be given  by inhalation from  a handkerchief, or  the  nitro-
glycerin can be used in  the dose of 1 drop of a 1 per cent, solution
by  the mouth.  The  dose  of the  sodium  and  potassium nitrites  is
3 grains three times a day, but all these drugs are useless  unless the
arterial tension is  high aud  the heart throbbing  or irregular in its
exercise of power.   If vascular relaxation is present, they should be
supplanted  by stimulants,  such as alcohol, in full  dose,  in  warm
water.
  Digitalis may be given during the attack to stimulate the heart, if
it is weak, and  between the attacks to improve its condition.   The
writer has found 20-grain doses of antipyrine of  great service in some
cases.   Ether  given hypodermically  is often of  service,  but  Hoff-
mann's Anodyne may  be used by the mouth  instead of ether.
  If the  nitrite does  not relieve the  pain, or if it cannot be used,
morphine must be given hypodermically in the dose of 4; to J  grain,
but it should never be given by the mouth under these circumstances,
as its absorption will be too slow and its effects will come on after the
pain has ceased.
  In that form of angina pectoris occurring in nervous females, 1
drachm of ether in ice-water or capsule will often  abort  the attack,
or if the paroxysm is  caused by dyspepsia and  if the stomach be
overloaded, the sufferer may be relieved by the stomach-pump.   The
cure of the patient rests upon  the elimination of all causes which can
possibly produce a nerve-storm  from cardiac irritability, and in  the
administration of arsenic in full dose for long periods of time.   Phos-
phorus  is another remedy which is of undoubted  value, and should
always  be tried in the dose  of Tfa  grain three  times  a  day after
meals.
  The  diet should  be moderate and easy of digestion, and salads,
lobster  and similar articles of food abandoned.   If  the patient  is
inclined to take exercise of a  violent character he must be restrained,
but some exercise must be insisted on if it is possible.
  Tonics, fresh air, freedom from  mental worry aud avoidance of ex-
posure and cold are also necessary.
  Cocaine has been  highly recommended for  the cure  of angina
pectoris, but is as yet untried, except in a few cases. 
                            APOPLEXY.                        393


                           ANOREXIA.

   Anorexia is  only a symptom of disease, generally associated with
 debility or  other systemic disorder, such as fever or mauy exhausting
 diseases.
   It is best treated by a careful diet, the use of the bitter tonics, such
 as gentian,  cardamoms, and  the mineral acids, or by the use of one of
 the following prescriptions :
          R—Acid arseniosi......gr. i.
             Extract nucis vomicae    .            .  gr iv.
             Quininae sulph.......gr. xx.    M.
    Ft. in pil. no  xx.  S.—One t. d  after meals.
 Or,
          R.—Acid, hydrochlorici dil.....f 5 ss
             Tinct. cinchonas comp.....13 vj.     M.
    S.—Dessertspoonful three times a day, after meals, well diluted with water.

   For  the  use  of other  bitter tonics  see Calumba, Quassia,  Chamo-
 mile, Cardamom, and Strychnine.
   None of these drugs are  suitable if there is any acute irritation or
 inflammation of the stomach or intestines.   (See Indigestion.)


                          APOPLEXY.

   When a person suffers from a stroke of apoplexy the chief aim of
 the physician must be to lower the blood-pressure, and so to  decrease
 haemorrhage, and as the  blood-pressure is  nearly  always excessive
 under these circumstances its reduction may be  considered as a routine
 treatment.  If the person be at all full-blooded copious venesection is
 to be employed, any one of the  veins in the arm on its anterior surface
 being most  convenient.  (See Venesection.)  xVt least one pint should
 be  withdrawn and the condition of the pulse carefully  noted.   If
 bleeding  is impossible, veratrum  viride or  aconite  must  be  used to
 lower blood-pressure, the latter in full dose, 5 drops of the tincture.
 Hot  mustard plasters must  be  applied to the feet or a warm mustard
 foot-bath be used, if this is practicable.   Ice in an ice-bag or wrapped
 in a towel may  be applied to the head,  and if vomiting  comes on care
 must be taken  that the stertorous breathing does not draw  into the
 lungs particles  of the  ejected food.  Sometimes croton oil,  1  drop,
 placed on the  tongue  with  five drops of  sweet oil,  may cause a
 depletaut catharsis, or ^ grain  of elaterium  may be used.   The head
 must be  kept high aud  the feet low down.   These are the methods to
 be used immediately after the rupture of the bloodvessel.
  The object  to be sought,  after  the "stroke" has occurred and the
 haemorrhage has ceased, is the removal of the extravasated blood, the
 restoration of function  in  the paralyzed parts, and the prevention of
secondary lesions consequent upon inflammation of the brain as a
result of the  injury to its  substance.  If the patient survives  the
/ 
394
DISEASES.
 attack no drugs should be used, save arterial sedatives, for one or two
 days, until  the  clot in the ruptured vessel has become firmly fixed,
 unless symptoms of meningitis arise,  when these drugs  must  be
 pushed, and opium and calomel  administered in  small  antiphlogistic
 doses, 4; grain of each every four hours.  Meningitis  and cerebritis
 rarely occur if the veratrum viride or aconite is properly used.  After
 the  clot is  firmly formed and has plugged the bloodvessel  we may
 proceed to  take measures for the absorption of the exudate, the chief
 measure consisting in the use of  iodide of potassium in as large doses
 as the patient will  bear without the production of iodism.   This drug
 should not  be resorted  to until  several  days, or even  two or three
 weeks, have elapsed since the attack.
   Mercury in small doses may also be given.
   In order  that the muscles of the extremities  may not waste  and
 become powerless from disuse, passive exercise, rubbing, and, if possi-
 ble,  massage must be resorted to.   Electricity may be applied to them
 in the form of the slowly interrupted current,  and strychnine may
 be  used  hypodermically or  by the mouth, as a  stimulant  to  the
 trophic centres in the spinal cord.  None of these measures are to be
 employed if any inflammation exists  in  the brain, as they will in-
 crease the cerebral disorder, and  at least three weeks  should elapse
 after the attack  before they are resorted to.
   Electricity applied to the head  to remove the lesion is useless, as the
 current does not go through the brain, but around the skull by means
 of the scalp.
   A very careful diet is to be maintained.   Meats are to be used very
 sparingly, the bowels maintained in perfect regularity, aud  no wines
 are  to be  taken nor any stimulants used, lest they cause  a second
 rupture of the weakened vessel in the brain.
   Apoplexy must  be  carefully differentiated from  acute alcoholism
 and  opium poisoning, which it much resembles.  (See Alcohol.)
   If respiration fails,  nothing can be done with much advantage, but
 belladonna or strychnine may be  given  hypodermically.   The use of
 electricity to stimulate the phrenic nerve and diaphragm when respira-
 tion  fails is  a remnant of senseless medical practice and  is particularly
 useless in apoplexy.  (See Asphyxia.)
   Above  all things stimulants are contra-indicated, even though the
 pulse fails, as they  increase the haemorrhage into the brain.


                          ASPHYXIA.

  With the advent of the production of artificial anaesthesia by the
 use of certain chemical compounds the  importance of this subject
 necessarily became enormously increased, and  no one can  doubt that
 the majority of  cases of arrested respiration depend for their exciting
 cause upon such agency, or to the inhalation of noxious gases.  It is
 of the greatest importance that a clear idea of the necessities of the
case  be grasped by the physician under such circumstances, and that his 
ASPHYXIA.
395
action be one of rapidity and clearness so  far as the ultimate  result
which  he seeks is concerned.  By some curious fallacy of teaching
the greater  part of the profession have been taught  to  faradize the
diaphragm into  contraction  with the  rapidly interrupted electrical
current, by the application of one pole over the phrenic  nerve iu the
neck and the other over the abdomen.   It requires but little thought
to show that such a  method  is ludicrous in the extreme, for by  using
such a current on  any muscle, we produce  a condition of spasmodic
contraction  or tetanus.   Everyone knows that the diaphragm relaxed
by paralysis  or contracted by spasm,  so  long as it is immovable, is
equally harmful to the patient.   If any current  is to be employed, it
should be that which is slowly interrupted and which  will alternately
contract and relax this important respiratory muscle.   There can be
little doubt  that the  rapidly interrupted current has  caused  persons
to renew  their respiratory movements, but' in these cases the result
has been dependent  almost certainly on the reflex excitability of the
cells in the spinal cord  and medulla rather than on an action upon
the phrenic  nerve.   If such an  action is required, the poles of the
battery may  be  swept   over the  body  so as  to  cause peripheral
irritation.
   The absurdity of the applicatiou of the rapidly interrupted current
to the phrenic nerve is not alone dependent upon the  points we have
named.   It has  recently  been proved by careful observation on the
part of  Dr. Martin  aud the  author that  the application  of the
electrode over the pheuic  nerve  in  the neck may cause cardiac arrest
through diffusion  of the  current to the vagus  nerve, and Griswold
reached conclusions of au identical character in the year 1885.
   If electricity is used, it should be employed  solely as  a peripheral
irritant, with the object of arousing the patient, as would a  dash  of
cold water.
   The question at once arises as to the best thing to do when  such an
accident occurs.  If the arrest has occurred when the patient is under
chloroform, his head should be lowered and the feet raised almost
perpendicularly.  The neck  should not be extended  but held in the
normal position, so that the chin is somewhat shot  forward and at a
right angle to the body line.   If the neck be extended the glottis does
not open as well as when the position named is assumed.   While one
assistant supports  the head in this position, another should use artifi-
cial respiration by Sylvester's method, and it will then be readily seen
that there is an increased volume of air passing in and  out of the chest.
The drawing forward of the tongue is  not so important as is imagined,
unless  it is pulled upward  and toward the teeth in  the upper jaw.
The use of ammonia, when  given  intravenously into the leg,  as a
rapidly acting respiratory and cardiac stimulant, may be resorted to,
and dashes of cold and hot water should be employed, not only for
their excitation of the peripheral nerves, but also for the purpose  of
keeping the bodily temperature from rising above or falling below the
normal  line, the  latter danger being,  of course, the  most pressing.
The hypodermic injection of ether  during asphyxia from ether anses- 
396
DISEASES.
thesia  is  a ridiculous  therapeutic attempt, for if the  system and
respiratory centres are so depressed by the ether already taken into
the blood through the lungs as to have  their functions in abeyance,
why should we add still  greater depression by injecting more of the
same drug?  Let everything that is done  be born  of sense and
thoughtfulness of the exact action and result desired, and let nothing
be done simply because some other person has  done it, great though
he may be in the  practice of the healing art.  Measures for the relief
of persons  suffering from  any  malady depend not upon empirical
laws, but upon the good  common  sense of the physician in charge,
even if the measure is a most revolutionary one in character.
  When  practising  artificial respiration in cases of asphyxia, Syl-
vester's method should always be employed.  This  consists  of laying
the patient on some hard, flat  surface, kneeling above  his  head, and
then, after grasping  the arms at the elbows, to bring them upward
and outward, so that they follow the plane on which the body is ex-
tended.  This movement causes expansion of the chest or inspiration.
After a moment's pause the arms are  lifted  up and brought toward
one  another, and then, while  still  approximated, pushed  down  to
their  original  position  upon the floating ribs upon  which  they are
pressed.   This  last movement  drives out  the  air  from the chest,  or
causes  expiration.   These  movements should be at the rate of from
sixteen to twenty per minute, about that  of normal  respiration, and
be persisted in for at least forty-five  minutes even though the case
seems hopeless, as cases have recovered after as long a period of appa-
rent death as an  hour.  While they are being  carried  on,  the patu-
lousness of the upper air-passages is  to be maintained.   In some
researches  made  by Dr. Martin  and the writer, the following rules
regarding the position of the head, neck,  epiglottis, and tongue were
formulated :
  The fingers are passed behind the angles  of the lower jaw, and the
latter is pressed forward;  this elevates  the epiglottis and the base  of
the tongue about  a quarter of an inch  from the  post-pharyngeal wall.
Extending the head and pushing  it forward  so  that the  neck makes
an angle  of forty-five degrees with the plane of the table, draws the
base of the tongue and the hyoid bone far forward, this motion being
at the same time imparted to the epiglottis, so that the latter  stands
upright and is separated  from the posterior wall of the pharynx by
an interval of about an  inch.  By tightly closing the jaw the antero-
posterior space is  still further increased.
  The epiglottis  may prevent  free entrance of  air to the lungs even
though the tongue is  pulled forward.   Any  means which  accom-
plishes  the anterior projection  of  the hyoid  bone immediately and
infallibly raises the  epiglottis and  the base of the tongue, and the
hyoid  boue may  be made to  project  anteriorly by direct pressure
upon its cornua,  by direct pressure or traction  applied to the tongue
far  back  behind  the anterior half arches  of the palate and by the
action  of  gravity  iu  the abdominal decubitus, or by extension of the
head upon the neck, although  flexion  of the neck with extension of 
ASTHMA.
397
the head upon the neck does away with the epiglottis as an obstructing
factor as completely as any other posture.


                         ASTHENOPIA.

  Asthenopia, or weak sight, depends upon exhaustion of the power
of accommodation in cases of refractive error, usually hypermetropia,
or upon insufficiency of the external ocular muscles.   The former is
sometimes  called accommodative  asthenopia, and  the  latter muscular
asthenopia.   The treatment  of these conditions requires the prescrib-
ing of the proper pair of glasses, combined, if necessary, with prisms,
and with systematic exercise of the ocular  muscles.  Locally, a weak
solution of the sulphate of eserine or pilocarpine acts as a stimulant to
the ciliary muscle, and  internally good results follow the use of large
doses of the tincture of nux vomica or of strychnia.

         R.—Eserinse sulph.......gr. -£%.
             Aq. destill.......f gj.     M.
    S.—2 drops night and morning.
Or,
         R.—Pilocarpin. nitrat......gr. -£$.
             Aq. destill........f gj.     M.
    S.—2 drops night and morning.

  Another form of asthenopia  is termed neurasthenic asthenopia, or
retinal anesthesia, and presents a number of eye symptoms in connec-
tion with a  general depression or debilitated state  of  the nervous
system,  the eye itself,  however, being  a healthy organ.   The chief
symptoms  are  fluctuation in visual acuity, rapid disappearance  of
objects  looked  at, contraction of the field of vision, imperfect  retinal
images, often associated with dread of  light.   The mere  prescription
of glasses in these cases  to  correct any refractive error  is  not suffi-
cient.   Much relief will often be obtained if hot  compresses at 110°
F. be made  to  the closed eyelids for five minutes at a  time.  The
patient  requires the same general  treatment that would be  applied
to any neurasthenic case.   All the functions of the body must be care-
fully examined into and  placed  in  as uormal a condition as circum-
stances  will allow.   Especially valuable  are rest,  massage, salt baths,
and full doses of strychnia, together with iron if  there be ansemia.


                            ASTHMA.

  Asthma is one of the most difficult diseases to successfully treat that
the physician has to deal with.
  The disease in all its forms depends upon interference with the free
entrance and exit of the air to and from the lungs,  and this is geu-
erally if not  always dependent  upon a spasm of tbe  muscular fibres
in the walls of the  bronchial  tubes, although it  has been asserted to 
398
DISEASES.
be due to a sudden  swelling or hyperaemia  of the  bronchial mucous
membrane.  Both of these states  are  probably present in varying
degree in all cases.
  The spasm has been  proved by Longet, Williams, Romberg, Paul
Bert, Bierner, and very recently by Sandmann, to be due to'a neurosis
of the pneumogastric or vagus nerve, while the swelling of the mucous
membrane  has been seen by  Stoerk  and  others.  This has formed
two schools of teaching concerning the pathology of this disease, when
a little attention to the physiology of the subject would  at least show
that  no difference need exist, the vagus nerves governing not only the
muscular fibres, but  also  the bloodvessels  of  the bronchial  tubes.
The  discovery of Michaelson  that injury of the recurrent laryngeal
nerves causes  catarrhal inflammation of the bronchial tubes, particu-
larly those of  the upper  lobes,  renders  the analogy between acute
asthma and laryngeal spasm  which has  been spoken  of  by many
writers still more interesting.
  One other step remains for a thorough understanding of the manner
iu which the  disease  is  produced.  Gastric, dyspeptic,  or  intestinal
asthma arises  from indigestion, as its name implies, and is caused by
the irritation  of the afferent  filaments of the vagus in  the  walls of
the stomach and intestine, thereby  causing reflexly a contraction and
hyperaemia of the bronchial tubes.   In a similar reflex  manner hyper-
trophies of portions of the nasal chambers or abnormal conditions of
the nasal mucous  membranes in general  may result in au asthmatic
attack.
  Having obtained some idea  of the cause of an attack, let us turn to
the treatment of the affection.
  By far the most serviceable  remedy in asthma is belladonna, which,
as has been pointed out when that drug was studied (see Belladonna),
exercises in medicinal dose a  decided sedative and  depressing influ-
ence  on  the peripheral  filaments of the vagus nerves,  not only so far
as the heart is concerned, but also upon  bronchial secretion, which is
always diminished by the drug, probably by its vagal influence.
  It  is evident, therefore,  that  the use of  belladonna or  atropine
although originally employed  in an empirical manner, is really based
upon rational  ideas, and as the physiological action of stramonium,
hyoscyamus, and similar members of this group is nearly identical with
belladonna, their influence for good is also explained.  The experiments
of Ott proved  that lobelia is  a peripheral pneumogastric depressant,
aud those of Rosenthal  and the author likewise showed that tobacco
has a similar effect.   The same is also true of nitrite of amyl and the
other nitrites which also relax unstriped muscular  fibre.   We have
before us, therefore, a list of the most  efficacious and  best anti-asth-
matics, all of them being depressant to the peripheral vagi.
  The other remedies commonly employed are chloroform  by inhala-
tion, which relaxes the spasm  of muscular fibre by  its  local influence,
and morphine  which acts as a  nervous sedative, prevents reflex irrita-
tion and  quiets the  patient, acting at the same time as a heart stimu-
lant and  unloading the engorged cardiac cavities.  The relief obtained 
ASTHMA.
399
by the inhalation  of the fumes of nitrate  of potassium, See asserts,
depends upon the formation of the protoxide of nitrogen and carbonic
acid gas, which act as local anaesthetics.
  The practical treatment of an attack of asthma consists in the use
of morphine hypodermically in the  dose of ^ to 4; grain, alone or in
combination  with  atropine.    Cigarettes made of paper  soaked in a
solution  of nitrate of potassium  and  belladonna  may  be used  (see
formula under Belladonna),  or they may be made in the following
manner :
-Foliorum belladonna
 Foliorum hyoscyami
 Foliorum stramonii
 Extracti opii
 Aquae lauro-cerasi
gr. nj.
gr- nj.
gr. ]•
q. s.
M.
  These various  leaves are broken up like  commercial tobacco, and
moistened by adding the cherry-laurel water, which should contain the
opium.   Finally  a whole  leaf soaked  in  the same fluid is used  as  a
cover,  or a piece of cigarette paper may be employed in  the same
manuer.
  A remedy very recently brought forward in this  country for the
relief and cure of asthma is euphorbia pilulifera, the fluid extract of
which may be given in the dose of | to 1 drachm, once, twice, or thrice
a day.   (See Euphorbia Pilulifera.)
  The author finds the following formula very useful in asthma :
M.
ft-	—Sodii iodidi . . .	• gf- ij-
	Potas. bromidi ....	• gr- 'J-
	Ext- euphorbiae pilulifera? fl.	. . Ttluj.
	Nitroglycerin! ....	• g1'- ?fa
	Tr. lobeliae.....	• • my-
Ft in pil. vel capsul. no. i.  S.—From 1 to 4 three times a day.
  It will be seen that each ingredient of this pill has a different action.
The action of iodides in asthma is well known, as is also that of the
bromides.  The euphorbia pilulifera has been found useful  in asthma
empirically.  The nitroglycerin depresses the peripheral ends of the
vagus nerves and acts as a stimulant to the heart when engorged with
blood by relieving the inhibitory action of the vagus and relieving the
bloodvessels elsewhere.  The tincture of lobelia acts as a depressant
to the vagus also.
  The use of amyl nitrite by inhalation, 3 to 6 drops  on a handker-
chief, is invaluable in many cases, and it rarely fails  to relieve the
spasm.  Owing to the engorgement of the heart consequent upon the
embarrassment of respiration, the nitrite must  be used  with care, and
in one or  two instances it has proved dangerous by causing cardiac
failure.
  Sometimes tobacco may be smoked, and it is particularly  efficacious
in those who are not accustomed to its constant use.
  Lobelia when employed should be used in full emetic dose (1 drachm)
in the form of the  tincture if an attack is  present.   If an attack is 
400
DISEASES.
feared, 10 drops of the tincture every four hours may be given if the
heart is in good condition.
   A treatment of asthma, which is very successful when it arises from
nasal disorders, consists in the application to the nasal cavities, at the
onset of the attack, of the following solution by means of a brush or
spray:
         R.—Cocain. hydrochlorat.....gr. xv.
             Aquae destillat  .     -       .   q. s. ad  f 3 iv.    M.
    S.—Apply as directed.
   If this solution is thoroughly applied and the other directions given
are carried out, very rapid relief will often  be obtained.  Unfortunately
we cannot readily separate those cases which are due to nasal  disease
and those produced by other causes, and in consequence this treatment
when tried for the first time in a given case is purely experimental.
   The curative treatment of asthma,  to a very large extent, rests upon
the use of iodide of potassium, and in the  careful regulation of the diet
and bowels, particularly if the  trouble seems to be dependent  upon
indigestion.   As the attacks are generally nocturnal the evening meal
should be taken early, be light and easily digested, and tea and coffee
should be avoided at this time.  The patient should avoid dusty streets
and live in the open air as much  as possible, and a damp atmosphere
is usually preferable to a dry one,  provided it is not too cold.   This
rule is subject to many variations, and each case will be fouud to be a
law unto itself, and must try different climates until the proper one is
found.   Arsenic  may  be used, particularly if the mucous membranes
are below par, and a dose of bromide of potassium or sodium, 30 grains,
half an hour before retiring to bed, may be of service.   Grindelia ro-
busta is largely used as a prophylactic in the dose of 10 to 30 minims
of the fluid extract three times a day.
   Lobelia may also be used in  the  form of the tincture,  10 drops  three
times daily.
   Compressed and rarefied air are of service, and inhalations of oxygen
are valuable if the cyanosis is extreme.
   In some cases the presence of nasal polypi or other irritations of the
air-passages causes asthma to appear, and they must be removed before
a cure can be attained.   In other instances  arsenical wall-papers are the
cause of the trouble.
                         BED-SORES.

  Bed-sores  depend  upon disturbances of nutrition resulting  from
pressure exercised in such a manner that the local circulation is inter-
fered with at a time when the vitality of all the tissues is depressed
by disease or injury.   In most instances the part involved  becomes
chafed by creases in the sheets, by crumbs of food, or by moisture
from the discharges of the rectum and bladder.
  The chief  thing to be done is to prevent the trouble  by careful
nursing and  cleanliness, which must  be supplemented by measures 
BILIOTJSN ESS.
401
devoted to the hardening and improving of the skin covering the parts
where the sores are apt to appear, as over the buttocks and sacrum.
To permit of a good  supply of blood, the patient should be turned
on one side  or  the other every few hours  and the skin rubbed  thor-
oughly with a dry towel to cause a healthy transudation and absorp-
tion of the nutritive  juices.   Salt and whiskey,  2  drachms to  the
pint, may be rubbed over the skin, or tincture of catechu  and  the
dilute solution of the snbacetate of lead applied to harden it.   If this
is not used,  a mixture of alum and spirit of camphor is useful,  made
by  adding 1 ounce  of powdered alum to the whites of 4 eggs and
mixing  this with 2  ounces of the camphorated  spirit.  Where  the
skin is  very red and  angry-looking, but still  intact, a solution of
nitrate of silver of the strength of  20 grains to  1 ounce is to be thor-
oughly painted over  the spot.  All these remedies act in hardening
the skin through their  astringency, or by acting as sedative astringents
to the inflamed capillaries of the part.
   When a  bed-sore is  developed,  measures must be  taken  for  its
cure and  the prevention of its  spread.  With this  object  in  view
the body  must not  rest on the  part  affected if  it can  possibly  be
avoided, and in order that the sore may be protected and the pressure
equalized, a large piece of soap-plaster, with its edges  deeply incised
to make them pliable, should be applied after the  sore has been thor-
oughly washed out by means of a  swab or  syringe filled with a 1 to
5000 solution of bichloride  of mercury,  and afterward dusted with
iodoform.   Sometimes  large squares of lint heavily covered with zinc
ointment  are serviceable  in  lieu of  the  soap-plaster.  If the  sores
spread and  burrow  through the parts the sinuses should be freely
opened and  irrigated, all dead tissues being cut away to avoid sepsis.
  Nitrate of silver  in  the strength of 20 grains to 1 ounce may also
be  used as  the patient recovers, if the ulcers seem  sluggish, and a
smooth slip-sheet  should always  be placed under  the  buttocks.   If
possible, supportive measures and an increased amount of predigested
food should be given  if the sloughs  are large.  The internal use of
iron is particularly valuable in the form of the tincture of the chloride.
                        BILIOUSNESS.

   This  is a term used to designate  a state which presents different
symptoms in  different  cases, but always  includes languor, headache,
or dizziness, perhaps some yellowing of the  skin  and conjunctiva,
and a general  sense of atony, mental depression, and discomfort.   It
depends  not upon an  excessive secretion  of  bile,  but  upon  some
perversion  of its  function or secretion, or its retention  in the bile-
ducts.   Further  than  this, most  of  the  symptoms do  not depend
directly  upon the changes in the  bile, but upon failure  of proper
digestion in the  stomach and intestine, coupled with the development
of irritative decomposition-products of various kinds.   The stomach,
intestine, liver, pancreas, and their  juices all form a complex inter-
                                26 
402                         DISEASES.
woven chain of function in which if one link -breaks the eutire chain
becomes disturbed.  The entrance into the stomach of certain food-
stuffs which are cither ill-prepared or improper for gastric digestion
rapidly causes  the  development of active  fermentation  and a split-
ting-up of  these bodies, with the formation of lactic and  butyric
acids, which irritate the gastric mucous  membrane and thereby bring
about a faulty gastric  secretion of mucus, which aids in makiug still
further trouble.  By the same means the circulation of the stomach
is  disturbed aud  becomes  abnormal,  and the intestine,  liver, and
pancreas receive reflex irritation to which they are not normally ex-
posed.  Further than this, the irritated stomach fails to convert its
contents into peptones and  the general features of chyme, and too
early or too late drives out into the duodenum a mass of semi-digested
aud  fermenting material,  utterly unfit for  intestinal digestion and
absorption,  thereby disordering  the  functions of these  parts  still
further at a time when they are not  prepared  for the reception of any
food.  The secretion poured  out by the different glands varies from
the normal, the alkaline juices are  not  able to overcome the  normal
acid of the gastric juice plus  the lactic  and butyric acids, and  finally
the reaction of the intestine becomes acid instead of alkaline, with re-
sulting irritation and  secretion of  morbid juices and mucus.   The
trouble when existing in the  stomach gives rise to headache and dis-
comfort, a bad  taste in the  mouth,  and  perhaps pain, and is followed
by  fever,  languor,  jaundice,  and  flatulence  when the intestine  is
affected.  The cause of these symptoms rests  upon the fact that while
gastric juice and bile are antiseptic,  pancreatic juice mixed with food
undergoes  rapid decomposition with the development  of products of
decomposition such as  skatol and indol and a  large number of poison-
ous  alkaloids.   Normally these are  not allowed to form,  owing to the
presence of antiseptic  bile,  which also  hurries on  the absorption of
the food, but if the bile is retained in its  ducts its secretion is impaired
and  its constitution  altered  by the disorder of the liver which  results
reflexly from the gastric and intestinal irritation.  Unfortunately the
complication does not  cease  at this  point, for the liver in  health has
other functions to  fulfil,  one of the most  important of which is the
arrest  and destruction of all poisons  of an  organic  character which
come to it from the stomach  and bowel.   Not only are decomposition-
products destroyed  by it, but all the vegetable alkaloids are rendered
innocuous  if present in ordinary amounts.1   The disorder  of hepatic
function, therefore, permits the entrance into  the general  circulation
of these substances, which are very various  as regards their powers
and  effects.  Thus  Bruuton  has  pointed  out that one of these com-
pounds closely resembles curare, in  that it poisons the peripheral ends
of the motor nerves, and thereby is at least partly responsible for the
muscular relaxation and languor often seen in patients suffering from
so-called " biliousness."  Other substances act as  do digitalis, atro-

  1 See studies of Schiff,  Lautenbach,  and many others, including  Ludwig and
Schmidt-Mulheim. 
BILIOUSNESS.
403
pine,  muscarine,  and  picrotoxin,  and the number  of these  various
compounds is infinite.1
  It  is impossible to  give space  to  a  further consideration of these
poisons,  but  what has been  said  shows  clearly that "biliousness"
only expresses a state in which absorption of the bile is not the  sole
cause of the symptoms, but  that  other  poisons are at work.   The
methods of treating biliousness are therefore not to be considered as
depending upon  some regular routine, but upon a  study of the  case
and its symptoms.
  Very frequently after several days of  minor discomfort, the attack
culminates in a severe sick-headache, after which vomiting comes on
and relief is  obtained almost at once.  Such patients can generally be
relieved  in the very first part of their discomfort by emetic doses of
ipecac or apomorphine,  30 to 60 grains of the former, or fa grain of
the latter hypodermically.   The manner  in which this treatment does
good is very evident.   It  compresses the  liver and  expels inspissated
bile by the  compression exercised by the  abdominal walls and  dia-
phragm  in the effort of vomiting and thoroughly  excites  to  normal
secretion the torpid glands of the  stomach and intestine.
  The vomitiug  also rids  the stomach of the fermenting  masses and
bacteria  contained in  them, and  renders  the alimentary canal pure.
This purity may be increased  between the paroxysms by draughts of
warm water, or  water  containing a few grains of bicarbonate of
sodium or salicylic acid.
  When it  becomes evident that  an  attack is about to begin, that is,
when  constipation, slight drowsiness or languor  after meals show the
tendencies present, one of two drugs should be used, either podophyllin
if the stools be dark, or calomel if they be light-colored.   One-sixth
grain of the former to au adult is generally enough, or 1 grain of calo-
mel divided into six powders, one of whicli is to be taken every fifteen
minutes, is a good dose,  to be followed  in four hours by a saline.  If
the attack is sudden in  its onset  no  time is allowed for these hepatic
stimulants, and a saline  should be used iu a good-sized dose at  once,
not because it causes a flow of bile but because it sweeps the poisonous
matters out of the gut before complete absorption  can occur aud aids in
restoring the normal intestinal alkalinity.
   The prevention  of " biliousness " depends upon the maintenance of
a normal, easily  digested diet, upon  the  formation  and excretion of
normal bile,  and  the prevention of fermentation  and decomposition in
the alimentary tract.
   The term " normal diet" is a very elastic one, and varies with each
case.  While certain  forms of food are generally considered good or
bad,  easy of digestion  or difficult  of assimilation,  it nevertheless
remaius a fact that many of the simplest foods  are capable of acting
as  poisons.    A  large number of persons cannot take milk  or  eggs
because their digestion of  these substances is faulty, and the writer is

  1  See the researches of Schweringer, Zuelzer and Sonnerscheim,  Bence  Jones,
Dupre, Korch and Fasbender, Brieger, Schmiedeberg and Harnach. 
404                        DISEASES.
 cognizant of one case where lobster salad can be eaten at bed-time with-
 out discomfort while an egg at breakfast will  cause a severe headache
 or pain in  the  belly.   Rules as to diet must  not  be " iron-clad," but
 based on observation.
   By far the best means of maintaining hepatic activity in cases where
 this organ is torpid is horseback exercise, particularly if the exercise
 is taken on a trotting horse, as the jolting of the liver  keeps the chain
 of digestive functious active and  prevents the secretions from becoming
 clogged.  Along with this exercise massage of the hypochondrium and
 belly walls is useful, and the movement of stooping over, bending from
 side to side,  and bending backward with the feet close together, is of
 value.   Coffee is often the cause of biliousness because of its oil.
   The use of pure,  dark orange-colored undiluted nitro-muriatic acid
 in  these cases in the dose of three drops three times  a day in half a
 tumblerful of water is invaluable, and the fluid extract of stillingia in
 the dose of 20 drops is of service, as is also the solid  extract of euony-
 mus in the dose of 3 grains.   Five-grain doses of extract of chirata in
 pill are also  useful in hepatic atony of a mild type.
   The  knowledge of the action of many of the  poisonous materials
 formed in the alimentary canal renders it possible for us to relieve the
 patient by other means than those which may be generally resorted to
 when the attack is  present.   Thus, if  the pupils are dilated, the skin
 hot and dry, the eyesight dim, and the pulse rapid, the alkaloid pro-
 ducing these signs of atropine poisoning may be antagonized by opium
 in small dose, or if the pulse be slow and full, the arterial tension
 high, and there is throbbing in the head with frontal headache, the
 alkaloid representing digitalis may be antidoted by the use of aconite.
 If nervousness and irritation  are present, the bromides and chloral may
be used.
   For  some unknown  reason, the use of caffeine in the headaches of
biliousness nearly always makes  them worse, particularly if the head-
ache is  due to over-indulgence in coffee.
   If  the face is flushed, a mustard plaster or  cup to the nape  of the
neck may be used, and a hot foot-bath is often of service.
   In  cases where the bilious  attacks are associated with catarrh of the
stomach, intestines, and bile-ducts, chloride of ammonium, in 5-grain
doses  three  times a  day, is very useful, as  is also the protiodide  of
mercury, when triturated with sugar of milk, in the dose of fa to fa
of a grain three  times a day.   Frequently the use of salol  or salophen
 in 10-grain doses, three times a day, does much good  in  these  cases,
acting as an intestinal antiseptic.  (See Salol.)
                        BLEPHARITIS.

  Blepharitis is divided clinically into an  ulcerative and non-ulcera-
tive  variety.  The indication of  prime importance  in the treatment
of this affection  is the removal  of  the scars  and crusts before the
application of the local remedies.  This may be accomplished by the 
BOILS.
405
use of alkaline solutions, bicarbonate of sodium, or biborate of sodium
(8 grains to the ounce), or a 5 per cent, solution of chloral, as recom-
mended by Gradle.   The salves  that have met with the greatest suc-
cess are Pagenstecher's ointment (yellow oxide  of mercury  1 grain,
vaseline 1 drachm), dilute  citrine ointment, pyrogallic acid ointment,
or a 3 per cent, milk of sulphur ointment, to which resorcin  may be
added.  The latter application is  useful in the squamous variety alone.
In the ulcerated form, if the crusts are tenacious, these, as well as the
stunted cilia, must be removed with forceps, and yellow oxide of mer-
cury  salve,  or some  similar application, applied.   Excellent results
follow touching the crater-like abscesses, whicli exist in  edges of the
lid, with nitrate of silver.   If there is an accompanying conjunctivitis
a  boric acid  solution  is  suitable, while,  under any  circumstances,
obstruction of the lachrymal  duct—a frequent accompaniment of the
disease—must be removed, and  the nasal passages explored for any
chronic inflammatory condition.    The relation between  this disease
and  the presence of refractive errors  demands the correction of the
latter, should this exist, before a  hope for cure may be entertained.
                             BOILS.

   Boils are dependent upon an impoverished state of the system, due
to several causes, or, more rarely, to some local trouble situated in the
skin, as in the persons of oil or paraffine workers.
   Their constitutional treatment rests upon the use of fresh air, cod-
liver oil,  iron, arsenic,  phosphate of sodium, and,  if any boils are
present at the time, the  use of the sulphurate of calcium in the dose
of fa grain every five hours.   The sulphurate of calcium hastens the
maturation  of boils and prevents the formation of new ones, but  is
useless, according to its  original  user, Dr. Ringer, in the boils which
appear during the course of some cases of diabetes.
   The local treatment of boils  may  be divided into the abortive and
curative methods.  The abortive method consists in painting the in-
flamed spot, when the  trouble first  begins, with a solution  of gun-
cotton (collodion) and renewing the coat hour after hour until a heavy
contractile covering is  formed.    If pus  forms under this it may be
absorbed,  but if  this does not occur, then the boil  must  be  opened
under antiseptic precautions and  properly dressed.  A strong solution
of nitrate of silver is also very  useful at the very beginning of the
formation of a boil, if painted  over the part in the strength of 20
grains to the ounce.   The  other local applications consist in the use
of the extract of opium or belladonna over the part to  relieve pain
and decrease the inflammation.
   Poultices may also be  used to relieve the  sensation  of tenseness and
mature  the  boil,  and they should contain  sweet oil  and laudanum.
Ringer recommends the  application of alcohol and camphor over the
skin in the early stages.  After the skin  is  wiped  dry,  it is to  be
smeared with camphorated oil.   Stelwagon  uses the following: 
406
DISEASES.
         R.—Ichthyol........5J.
             Emplast. plumbi......3y-
             Emplast. resinae......3J-    ^-
    S.—Apply to the part.
  He  also approves of the injection of a few minims of a 5 per cent.
solution of carbolic acid into the  apex of the boil, if its formation is
assured.

                   BREASTS,  INFLAMED.

  Mastitis is, from  a medical point of view, readily treated.   Lacta-
tion should at once cease,  and  the breast  be  dressed  by the  use of a
sponge compress, underneath which belladonna ointment is to be copi-
ously  smeared.  Belladonna is a  useful remedy both before aud after
very acute inflammation has begun, and its use should be persisted in
for twenty-four hours.
  At the same time that these measures are resorted to, the circulation
should be thoroughly  impressed  by aconite  or veratrum viride, and
mild saline purges  should  be given.   If the milk persists in forming
it must be removed  by the breast-pump.  For the surgical treatment
of mastitis the reader should refer to the books on surgery.


                BRIGHT'S DISEASE, ACUTE.

  The treatment of acute nephritis, accompanied by  any active in-
flammatory chauge,  requires care  aud  intelligence.  The  pain iu the
loins,  and,  perhaps, the bloody  urine, which is scanty and high-
colored,  febrile disturbance, and the  history  of  exposure or other
exciting  cause, all form a clinical  history typical  in its major points.
Here,  as  elsewhere, for the reduction of inflammation, circulatory de-
pressants are to be resorted to, and  aconite is generally most service-
able.  The patient should  be kept quietly  in bed and supplied with a
milk diet, cups  or  leeches  being  used over the loins if  the  urine  is
scanty.  Blisters are  not  advisable, as the irritant substances pro-
ducing them  may be  absorbed and  cause increased renal irritation.
The restlessness will generally  be  quieted by the aconite; but if  this
fails, resort must be had to bromides, or small doses of opium, which
must  be given cautiously, as these  drugs are not readily  eliminated
when the kidneys are diseased.   Cannabis indica  is thought to be of
great  service  if bloody urine is present, but chloral  is generally too
irritating to  the kidney to justify its  employment.  The appearance
of  large amounts of blood in  the urine at about the fifth day of the
illness is an  indication, according to Sydney Ringer, for  the use of
drop doses of tincture of cantharides given every  few hours.
   If dropsy comes  on and is excessive it must  be  relieved  by the use
of  hydragogue purges, such as elaterium, which is particularly useful
in that it is  supposed to aid  in the elimiuation of the urea by the
bowel.  Jaborandi or pilocarpine  may be  used to sweat the patient at 
                bright's disease,  CHRONIC.            407

this time or in the earlier stages with advantage; | grain of the hydro-
chlorate  should  be given hypodermically  and repeated in fifteen min-
utes if no sweat appears.  Hot-air baths are often useful to  provoke
a sweat.   Warm mucilaginous drinks, as flaxseed tea, are of service,
and the use of the citrate of potassium and the sweet spirit of nitre
should be resorted to to iucrease urinary flow.  Generally these cases
go  on to recovery,  although convalescence  is often  somewhat  pro-
longed.  The treatment of  the  later stages  consists in the use of
stimulants to the kidneys to arouse  them from the atony consequent
upon  the excitement of inflammation.   To this end  digitalis  and
squill, or digitalis  and calomel or caffeine citrate may be used  in small
amounts gradually increased and followed by the compound  spirit of
juniper or gin as the case progresses.  If the renal structure is  per-
sistently atonic,  f  to 1 drop of the tincture of cantharides  at each dose
may be used, and  as ansemia is often a prominent symptom, tincture
of the chloride of iron, which is both diuretic and  a  tonic, should be
resorted to.  If renal haemorrhage is excessive, gallic acid and ergot are
indicated to control the bleeding.  A milk  diet should be rigidly en-
forced.

              BRIGHT'S  DISEASE,  CHRONIC.

  The treatment of chronic nephritis is a very different matter, so far
as prognosis is concerned, from that  of the acute form.   It is almost,
if not quite, impossible to cure the condition present,  and  we can only
improve  the state of the kidneys and other organs by  care and the use
of proper drugs.   As Tyson has aptly put it, we must try to arrest the
development of the renal lesions and improve the general  health, treat
the symptoms which  are not  dependent upon the  nephritis, except
indirectly, and last, treat those signs  which are due  to the nephritis
itself.  To arrest the disease all alcoholic drinks should be avoided as
far as possible, and business cares and worries be cast aside.  Great
care should  be taken to avoid cold, and a  warm climate is generally to
be recommended to the patient, since  sudden changes of  temperature
tend to produce congestion of the kidneys by the chilling  of the skin.
  The diet and drink are  important considerations,  and should con-
sist largely  of milk.  Beyond this  we can  do little toward a cure.
To allay symptoms we  can do much, and  the albuminuria can be
greatly decreased by the  use of digitalis, squill, the acetate and bitar-
trate  of potassium,  and  the iodides; nor  should  the bichloride of
mercury  be  forgotten.   These remedies are  also of  value to relieve
the dropsy,  and  the most efficacious  treatment of all  is a combination
of the bitartrate of potassium aud jumper berries, so that 1 ounce of
the former is dissolved in 1 pint of an infusion of the  latter and taken
in twenty-four hours.  If dropsy ensues,  hydragogue purges  are use-
ful, such as jalap  and elaterium, and hot baths, Turkish or Russian,
are to be given, not  only to relieve the dropsy, but to so hypertrophy
the excretory glands of the skin that  they  will be able through greater
activity to relieve the kidneys.   (See Heat.)   Sugar  of milk  may be 
408
DISEASES.
given in the dose of 40 to 80 grains a day as a diuretic, and butter-
milk is a useful form of food.  (See Sugar of Milk.)
  Ascites or thoracic effusions should be treated by tapping.
  In the interstitial  forms of this disease Bartholow has highly recom-
mended the use of the chloride  of gold and sodium  in the  dose  of
^U" t° fa grain.  The ansemia is to be combated  by the use of the
tincture of the chloride of iron and oxygen inhalations.
  The arsenite of sodium aud the  carbonate or citrate of lithium are
also said to be of value in  this form of Bright's disease, particularly
if it is dependent upon a gouty taint.   The dose of the former should
be fa grain, and of the latter 5 grains three times  a day.
                   BRONCHITIS,  ACUTE.

  In the early  stages of bronchitis there is  always present a very
distinct hyperaemia, followed by a true inflammation of the mucous
membrane lining the bronchial tubes.  When these changes are con-
fined to the larger bronchi the term bronchitis is employed, but when
the minute bronchioles are invaded  the disease is  known as capillary
bronchitis.  In the article on pneumonia and  elsewhere  in this book,
the writer has  spoken of  the various  stages  of inflammation, the
measures  indicated  under such circumstances,  and has  described the
action of the various  drugs.  In  many cases the  physician only sees
the patient when the  second stage of his disease is present, but if the
individual presents himself at once, the following history and physical
signs will indicate  the treatment  to  be employed :  After  exposure,
more or less  severe,  to wet, dampness, or dry cold,  a sensation of
oppression comes on, associated  with a feeling of " tightness  across
the chest," or a sensation as if a bolus of food was  under the sternum.
Aching and pain may then be traced over the lines of the bronchial
tubes, while the dry hacking cough increases the discomfort and seems
to strain the tubes till each one can be outlined on the chest wall by
the patient.  The cough,  when it occurs,  is virtually unproductive,
and  often hurts the larynx and throat.   On making a physical ex-
amination  by auscultation there  will  be found  over  the  posterior
aspect of the chest, between the shoulder blades, sounds  of bronchial
breathing, which are rougher than normal, and  due to the air passing
over an inflamed, swollen, and  roughened  mucous membrane.   This
bronchial  roughening may be sufficient to  cause a harsh respiratory
sound over the entire chest, and the  expiratory sounds may be heard
a little  louder than  usual.  No other changes  from the normal can
be noted, but isolated  spots of discomfort may be pointed out by the
patient where  aches, "catches," or "kinks" seem  to be  present in a
previously normal tube.   Percussion, palpation, and inspection  show
nothing more of note.
  Some fever may be present.
  If possible, the patient  is to be put to  bed, and ordered, if  he be
strong aud hearty and if the signs of inflammation are severe enough 
BRONCHITIS,
ACUTE.
409
 to  cause  alarm,  a full dose of  pilocarpine for the production of a
 sweat, particularly if there is a great necessity for rapid cure without
 regard  to the  nausea  which may be produced  by the drug.   If this
 is done no other medicine need be used,  but the  employment of a
 mustard  foot-bath and a drink of hot brandy or whiskey and water
 should  be ordered.
   If, for any  reason, this treatment is  not called for, and  in many
 cases it will be fouud unnecessarily severe, the pilocarpine may be re-
 placed by full doses (2 to 4 drops) of the tincture of veratrum  viride
 or a teaspoonful  of the wine of antimony in adults, or J to 1 drop of
 the tincture of aconite in children, the employment of hot drinks and
 a foot-bath being also insisted upon.
   The  use of  antimony as a remedy in the early stages of bronchitis
 should  only be  resorted to when a very powerful action  is required
 and the individual is very strong and  sthenic.   Under these  circum-
 stances  it may  be  given in full  enough  dose to produce  marked
 nausea  and even vomiting, with a profuse sweat.   Along  with the
 depressiou a profuse outpouring  of liquid takes place in the bronchial
 tubes, which  speedily relieves their congestion, and in consequence
 brings  on the  second  stage of the  disease  iu an hour or two instead
 of in two or three days.   Unless some pressing need requires it, most
 persons will regard this remedy as worse than the disease.
   Counter-irritation may be applied to the chest in the  shape of a
 mustard  or spice plaster, or  dry cups may be employed, several on
 each side of the vertebral column, at about the  sixth rib.  If the sore-
 ness of the bronchial tubes is not relieved by this means, inhalations
 of steam  arising from boiling water placed before the patient may be
 practised, either  through a cone covering the top of a pitcher and the
 mouth  and nose of the  patient,  or by covering the head and pitcher
 with a towel.   The usefulness of this method may be much increased
 by the addition of one tablespoonful of compound tincture of benzoin
 to each  pint of water.  In children, both in the first stage of bronchitis
 and in the later stages, the use of the so-called  " bronchitis tent" is of
 great value.  It  consists  of a canopy raised over the bed a sufficient
 distance to allow of the circulation of plenty of air.   Through one side
 of this canopy passes a tube leading from a tin pail or kettle of boiling
 water, under which is an alcohol  lamp to keep the temperature of the
 water sufficiently high.   By this means  the air breathed by the child
 is so saturated  with moisture  that the  mucous membraue lining the
air-passages is soothed  and quieted.   In order that the full benefit of
this measure be  understood, it must  be remembered that a mucous
membrane in  the early stages of inflammation is always dry and red,
lacking its normal moisture, and that the  upper air-passages fail to
catch upon their surfaces, by reason of their dryness, particles of dust,
and do not moisten the air before it reaches  the lungs.   Again, it will
be remembered  that the bronchial mucous membrane is covered with
ciliated epithelium which, by the  constant upward wavy  motion of its
cilia, urges out  of the lung all impurities.   Dryness of the surface at
once stops this ciliated movement with unfavorable results.   The em- 
410
DISEASES.
ployment of the "bronchitis" tent is equally useful in adults, but less
readily employed owing to the size of the bed.
  Poultices may be applied to the chest, and while the cardiac sedatives
are acting, resort should be  had to ipecac and to citrate or acetate of
potassium, which act as sedatives to the inflamed mucous  membranes
and aid in the formation of secretion, moistening the inflamed surfaces
and thereby overcoming the dryness  and irritation.   The potassium
salts also act as febrifuges aud  should be used in full doses, as much
as 40 grains to 1 drachm in a day, in addition  to the aconite already
recommended.  The  following  prescription illustrates  their employ-
ment :
         R .—Syrupi ipecaa    ....    f^jvelf^iij.
             Potassii citratis   ....           £iv.
             Aquae destillat.....q. s. ad  f gyj.    M.
   S—Dessertspoonful every four hours for a child of five years.

         R.—Syrupi ipecac.......fgij.   _
             Succi limonis......f g.j.
             Potassii carbonatis.....g iv.  .
             Spirit, aether, nitrosi   .....  f gj.
             Aquae destillat.....q. s. ad  fgyj.    M.
   S.—Dessertspoonful every four hours for an adult.  This mixture should not be
corked for some time after it is made.
  For a  child this prescription  should be  reduced just  one half in
each part with the exception of the water.
  In some cases, particularly if the patient  be a  child,  large doses of
the citrate, or other salt of potassium,  exert a depressing influence and
have to be decreased.
  When fever is persistent, quinine should be used, in addition  to the
aconite already recommended, aud if the cough is excessive aud annoy-
*ng> "2T to fa grain of  morphine may be given  in each  dose of the
solution  just named, or a few drops of the  spirit of chloroform may
be added to the prescription.
  Having considered the treatment of the first stage of bronchitis,
we  pass to that of the second.  The condition of the  mucous  mem-
branes is now quite  different  from  that which Ave  have just been
speaking of.  In the place of an  absolute lack  of secretion we have
a profusion of cast-off  epithelial cells, a  large  amount  of  mucus, and
more or less liquid poured out  upon the walls  of the bronchial  tubes,
forming  obstructions everywhere to the ready passage of air.    The
secretion is apt to be  more or less viscid,  ropy, and when it is coughed
up, after considerable effort, appears in lumps.  This  state is one in
which the excitement of inflammation is  followed by local  depression
and an effort on the part of  the  tissues to rid themselves of the con-
gestion and of the  useless epithelial formations.  The physical signs
on listening to the chest are now found  to  consist in a large number
of loose rales which are distinctly wet and moist.  Later they become
markedly liquid and bubbling, and so  large as to cause  gurgling on
inspiration  and expiration.   Sometimes  they are musical or squeak-
ing.   Generally the latter signs do not come on until  the case is far 
BRONCHITIS, ACUTE.
411
advanced, and, if a cure  is soon  to  be reached, they only last a few
days or hours, as the mucus is so loose as to  be  easily coughed up
and the lung readily  cleared.
  The object of the physician is to use remedies which will, as they
are eliminated by the parts, stimulate the bronchial tubes and increase
the volume of liquid poured out.   For this purpose  the bronchitis
tent  may of course be employed,  but the drugs to be used internally
are ammonium, chiefly the chloride,  and the pitches and turpentines,
such as terebene, pyridine,1 or even turpentine itself.   Allium or garlic
is often of great  service at this time, or a  little later in the course of
the ailment.  It  may be  used by boiling  garlic in  milk, or  by the
application of an onion or garlic poultice.
  In the majority of instances an ammonium mixture will be the best
and most serviceable  prescription, in one of the following forms :
         R.—Ammonii chloridi.....zjj.
             Ext. glycyrrhiz. fluid......^ij.
             Aquae destillat.....q. s. ad  fgiij.    M.
   S.—Teaspoonful every four hours.
Or,
         R—Ammonii chloridi......zij.
             Mist, glycyrrhiz. comp.     .    .   .    .fgiij.    M.
   S.—The same dose.

  The disadvantage  of the  latter prescription is the presence of anti-
mony in the compound liquorice mixture.
  If the cough is troublesome a little morphine  or belladonna  may be
added, or the following be used, particularly if  any  signs of  cardiac
failure appear:
     R.—Ammonii chloridi
         Ammonii carbonatis
         Ammonii bromidi.
         Extract, glycyrrhiz fluid.
         Aquae destillat.
S.—Desertspoonful every few hours.
 33-
 5J-
 ziv.
fgvj.    M.
   In this prescription the first constituent  acts particularly on  the
air-passages, the second stimulates the heart and  respiration, and  the
third allays the cough, while the liquorice covers the salty taste of the
ammonium.   Ammonium chloride may be also used by means of the
steam atomizer or by inhalation of its fumes by the use of some of the
apparatus used for this purpose.  In obstinate cases the inhalations of
the funics from chloride of ammonium may be very  necessary.  These
may be obtained by attaching a long  piece of rubber tubing to one
end  of a glass  tube about  one and a  half  inches  in diameter and
placing in the centre of this tube a drachm or two of sal ammoniac,
the tube being placed in a  horizontal position, each end resting on a
thick book or other support.  The open end of the glass tube is lightly
packed Avith cotton and a small alcohol lamp passed backward and

  1 Pyridine, not pyrodine, is used by placing 1 fluidrachm on a hot shovel or sauce-
pan in a small room, the patient breathing the fumes which  are carried to him by
the air of the apartment. 
412
DISEASES.
forward under the tube where  the  ammonium salt  is lying.    The
patient may now gently inhale through the rubber tubing, and  take
the fumes which are set free directly into the air-passages.
  A very simple and ready Avay of using this salt Avithout apparatus
is to place a few grains of it in an iron spoon and heat the drug over
a gas jet, the fumes being inhaled when the spoon becomes well heated.
(See article on Ammonium Chloride.)
  The use of  au oro-nasal respirator, with the sponge saturated  with
equal parts of terebene, iodide of ethyl and chloroform may be worn
in order to allay cough and loosen the mucus.
  Counter-irritation may do good at this stage, particularly if applied
over some aching bronchus, and  a blister or plaster may be employed,
or even a dry cup resorted to.   If the administration of the chloride
of ammonium does not aid in the  expulsion and liquefaction of the
secretion, and  rid the  lungs rapidly of the mucus, the use of terebene
in 5 or 10-minim capsules may be resorted to  with great success.  If
capsules cannot be supplied, terebene  may be made into an emulsion
with acacia or  tragacanth and given in this way.  Sometimes terebene
will irritate the  kidneys  and produce a  sense  of weight across the
loins;  if this occurs its use should be stopped.  In other cases  it
Avill disorder the stomach or cause  diarrhoea.   These effects are not,
however, commonly seen.   Terpine hydrate in  10-grain doses  may
be  used three  times a day, or terpinol in  the  dose of 8  to  10 grains
in capsules or pills.   Certain of the volatile oils and resins are also
of value at  this  time, notably the oleoresin of cubebs and copaiba,
which, however, possess the disadvantages of disordering the stomach.
The oil  of  eucalyptus is also of great value, and  may be given in
capsule or emulsion in the dose of from 1  to 5 drops every five hours.
The oil of sandalwood in the dose of 5 to 10 minims  is very valuable
and is not so apt to disorder the stomach, bowels, and kidneys as are
some of the  other remedies named.  The balsam of Peru and  Tolu
may be used, but ought always to be combined with other more active
drugs.  Apomorphine has been highly recommended in the subacute
stage of bronchitis  as an expectorant for the purpose  of loosening the
phlegm and increasing secretion.  The dose should be from fa  to £
grain by the*mouth to an adult, three times a day, under such circum-
stances.   Squill has  had  a very  good  reputation  in this stage of
bronchitis, but is a very poor remedy as  compared to most  of  those
now in use, irritating the.stomach and kidneys  and  acting  compara-
tively slightly on the  diseased area.
   While the proper use  of these remedies usually brings about the
results desired, in others a stage of profuse secretion  comes on, which
in its treatment is identical with that seen in chronic bronchitis, chronic
"winter  cough," and emphysema,  and  these diseases will therefore
be considered  together.
   In old persons suffering from dilated bronchial tubes, from emphy-
sema, and from chronic bronchitis, there is constantly poured into the,
air-passages so free a  secretion that persistent coughing is necessary to
rid the lung of enough of the mucus and liquid to enable the man to 
BRONCHITIS,  ACUTE.
413
breathe.    Any excess of  this  exudation drowns him in his  own
secretions,  and the constant obstruction to the ready flow of air and
blood in the lung soon produces dilatation and Aveakness of the right
side of the heart.  The same condition in a more acute form some-
times asserts itself in young children and in adults.   In children it
sometimes  comes on  so suddenly as  to be known  as  "acute suffo-
cative  catarrh,"  while in  older persons  it appears with  sufficient
severity to make the  condition of the patient most serious.  Of the
treatment of this state the writer will  speak at once.
  The objects desired are to rid the lung of the liquid secretions, to pre-
vent the outpouring of more exudations, and to support the patient until
the crisis is past.  Where the exudations rapidly fill the lung, nothing
is better in the strong child  or adult  than an  active emetic, such as
apomorphine, hypodermically, in the dose of fa grain to an adult, or
fa  to a child, which is not to be repeated ; if this dose fails to act in
ten minutes, ipecac may be used iustead in the form of the powder,
a small teaspooful for a  man or 5 to 10 grains for a child, or, if the
powder be  not at hand, a wineglassful of the Avine or syrup  of ipecac
to an adult  or  two teaspoonfuls to a child may be given.   Digitalis
should be  administered to support the heart, and strychnine be em-
ployed in  full  dose to stimulate the respiratory centre  and  excite the
nervous system, which is generally depressed by the increasing carbonic
acid in the blood.   For the same purpose caffeine or strong coffee may
be used.   Oxygen may be inhaled  and astringent sprays drawn  into
the air-passages, containing  tannic  acid, Monsel's solution,  or other
astringents  such  as  shall  be mentioned  below.   If  death seems
at hand, hot and  cold dashes  of water may revive the patient suffi-
ciently to  keep up respiratory movements until voluntary efforts are
made once more by the patient.  The alternate  use of hot and cold
water is  necessary for the exaggeration of peripheral sensation,  and
the hot water aids in  preserving the bodily temperature.  Sometimes
letting the patient hang his head over the bed when he coughs may
aid in the expulsion of the liquid.
  The treatment of the more moderate condition of excessiA^e secre-
tion in the bronchitis of old persons, which is  more slow in its pro-
gress, but which may end as fatally as similar  attacks in the young,
is somewhat similar to that just given.  Injurious results are often
produced by the physician  failing to recognize that the secretion is
sufficiently liquid, and that  ammonium and such expectorants are  not
only useless, but harmful, because they increase  the quantity of these
liquids.  Under  these circumstances  a fine spray  of  a solution  of
tannic acid of the strength of from 2 to 30 grains to the ounce may
be used, or of alum  solution from a few grains to saturation.  Mon-
sel's solution should be employed in the dose of  10 to 15 drops to  the
ounce of water, or acetate of lead may  be used in the strength of from
1 to 15 grains to the ounce.   Lobelia induces a too free secretion, and
is contra-indicated  under such circumstances.   The use of  opium to
check the  excessive excretion  is a measure of doubtful value, as it
checks the cough  and thus  causes  the lung to become more rapidly 
414
DISEASES.
filled with mucus.  Belladonna, which checks  secretion even  more
than opium, stimulates the respiratory centre, and is for this reason a
doubly  useful remedy.   Counter-irritation may do  good, and if the
patient be strong free purgation should be resorted to.  Strychnine is,
hoAvever, the best of all  remedies to help the patient to get rid of the
sputum.   It  should  be  given  in the  dose of 2V grain or more three
times a day.
  In those cases where dilatation of the tubes is  present in old per-
sons, Calabar bean, in  the form of the tincture or extract of phy-
sostigma, is of service, owing to its action, as a tonic, on the muscular
fibres of the walls of the tubes, preventing further bronchial dilata-
tion  and aiding  in the  expulsion of the secretion as rapidly as it is
formed.
  The use of remedies designed to allay the cough in these cases is
absolutely unjustifiable.   The question as to whether the cough is ex-
cessive or not must depend on the ability of the  lung to  rid itself of
the secretions in its bronchial tubes.
                   BURNS AND SCALDS.

  The treatment of burns and scalds  is both  internal and external,
the first being devoted to the quieting of the nervous system after the
injury, the relief of pain and the treatment of  shock, and the second
to the care of the injured surfaces.   Immediately upon being called
to a case  of burn, it is the duty  of the physician to determine hoAV
badly shocked the patient is, what  the condition of the  pulse may be
and  whether or not  the lungs and air-passages are involved.   After
these mental notes, he should give a hypodermic  injection of  4; to J
grain of morphine and -g1^ of atropine, and then roll the entire body
in a large quilt to maintain the bodily heat Avhile the sufferer is being
transferred to the hospital, or the house to which he belongs.
  In some cases the  shock is so great that the pulse flags at once, the
temperature fails, and collapse  ensues.  Stimulants hypodermically,
external heat, and warm drinks of  Avater  and whiskey are indicated,
folloAved by digitalis  if the circulation does  not  respond to the  less
powerful stimulants.
  If time  and cirumstances  permit,  the dressings should be applied
before  moving the patient, but this is rarely  possible.  By far the
best dressing is lint, wrung out  of  a  mixture of linseed oil and lime-
water, equal parts, or, if desired, the oil  may  be  rendered antiseptic
by the addition thereto of 1 part of carbolic acid  to  20.   This mixture
is also of service in  that it  acts  as a feeble local anaesthetic.   The
cloths should  be renewed every tAvelve or twenty-four hours, as may
be needed, or they may be substituted by lint wrung out of a saturated
watery solution of boric acid.
  If the burn is not very diffuse  a  solution  of the  tincture of can-
tharides, 1 part  to  40, upon  a rag, is said to relieve pain and  aid in
healing, but if the burned surface  be extensive this treatment cannot 
CHANCROID.                       415
be resorted to, OAving to possible irritation of the kidneys, Avhich are
already overtaxed by the interference with  the function of the skin.
In  comparatively  small burns  a saturated solution of carbonate  of
sodium gashing soda) often does great good  in relieving the pain.
This relief may  depend on the  solvent power of this salt over  albu-
minous deposits, formed by the heat, which  irritate the  peripheral
nerves.
  A large number of other remedies have been and can be used, but
are no better than those named, and less generally employed.
  A very important point in the subsequent treatment of burns is the
remembrance  of the  close relationship existing between the internal
organs, particularly the  duodenum and the  kidneys, and the cuticle.
When we recollect that Ave try to influence internal  congestions, such
as pulmonary congestion for example, by the application of irritation
to the  skin  of the  chest, we see  at once that a widespread and  severe
burn is practically a huge counter-irritant and must affect the viscera.
  Again, the  skin, being prevented  from exhaling impurities, forces
the kidneys to do the Avork, aud, if the  kidneys fail  under the  strain,
death  results.  Whenever the urine is  high colored and cloudy, the
citrate of potassium should  be freely given, 20 grains in water three
times a day, combined with 30 drops of sweet spirit of nitre.


                          CHANCROID.

  The chancroid  is a contagious, non-specific ulcer, which has no
period of incubation,  is distinctly inflammatory in type, and is usually
multiple.   It is further distinguished from the  primary sore of syph-
ilis by the fact that it is auto-inoculable, is not followed by secondary
eruptions, and, if it involves the lymphatics at all, produces a  mono-
ganglionic unilateral swelling, which frequently attains a considerable
size and suppurates.
   Chancroid,  being a purely local affection, Avould  seem  to require
nothing beyond local  treatment;  this  is true of the uncomplicated sore,
but where phagedena or serpiginous ulceration sets in, the question  of
constitutional treatment is of paramount importance.
  The treatment of uncomplicated chancroid is as simple as  it  is effi-
cient.   One thorough cauterization converts the sore into a healthy
ulcer, the cicatrization of which is quickly and surely accomplished.
  As the most efficient means of thoroughly destroying the chancroidal
ulcerations, the actual cautery is chiefly commended.  This is, how-
ever, objectionable to patients.  Sulphuric or nitric acid will be found
equally serviceable.  The pain of their application may be greatly less-
ened by the previous  employment of a 20 per cent, solution of cocaine.
When  the surface involved is large the patient should be etherized.
The cardinal  point in  the cauterization of chancroids is  to reach and
destroy all the diseased area.  Every pocket and sinus must be thor-
oughly acted  upon, otherwise it remains as a  focus for re-infection.
A convenient way of both destroying the chancroid and providing for 
416
DISEASES.
the after-dressing is offered in the application of Ricord's paste.  This
is made by adding to finely powdered charcoal enough strong sulphuric
acid to form a paste of about the consistency of castor oil.   This is
then applied to every portion of the ulcer.   The acid shortly dries
out, leaving a dressing of charcoal which in a few days drops off, ex-
posing a  healthy, nearly healed, granulating surface.   Where nitric
acid is applied  the subsequent  dressing consists, preferably, in the
application of dusting poAvders, iodoform being the best.
  There has been a tendency of late years to substitute for this treat-
ment  one less radical, more acceptable  to the  patient, and in many
cases  almost equally satisfactory in results.  It is certainly true that
many of the chancroids as found in  persons of robust health show little
tendency  to spread  beyond  comparatively narrow limits, and are
amenable to mild treatment.   It must be remembered, however, that,
as long as the smallest portion of such an ulcer remains unhealed, it
may, at any time, take on all the features of  a  virulent  ulceration.
Moreover, the patient  is constantly exposed to the risks of a chan-
croidal bubo—a complication so troublesome that  the possibility of its
development constitutes the  strongest  argument against  palliative
treatment.
  Where  the ulceration is entirely superficial, constituting the erosiAre
form of chancroid, iodoform, dusted over the surface of the carefully
cleansed granulations, offers the best form of palliative treatment.  As
a cleansing and stimulating wash, to  precede  the application of the
iodoform, 1 drachm of nitric acid to the pint of water is most satisfac-
tory.   The objection to iodoform lies in its disagreeable and penetrating
odor.   To prevent this, great care should be exercised in applying the
powder to see that none  is distributed  elsewhere than  upon the sore.
The odor cau also  be disguised to  some exteut by thoroughly mixing
Avith the iodoform a small quantity of one of the essential oils,  such as
oil of peppermint or attar of roses, using not over 5 minims to 1 drachm
of the powder.   There is no dusting powder which can entirely take
the place  of iodoform, yet when the objections to the use of the latter
are insuperable aristol  or iodol may be substituted, or a mixture of 1
drachm of zinc oxide and 3 drachms of subnitrate  of bismuth, or equal
parts  of calomel and bismuth.  Where the discharge is profuse,  pow-
dered tannin may be combined with the dusting powder in the propor-
tion of one part to four.
  In  the ordinary uncomplicated  chancroid these dry  dressings are
greatly to be preferred to wet applications;  when, however, the sore
is attacked by a high grade  of inflammation, and  becomes  indurated,
prolonged immersion  of the part involved, or of the whole body, in
hot water may be followed by the application of dressings kept con-
stantly Avet with the dilute nitric-acid lotion, as given above, or with
weak  carbolic solution, 5 grains to the ounce of  water, or with lead-
water and laudanum.  Where the chancroid assumes  the phagedenic
type, extending with great rapidity and causing  extensive sloughing
and destruction  of tissue, free cauterization,  either with the hot iron
or by  means of nitric acid,  should be instituted immediately, every 
CHOLERA, ASIATIC.
417
portion of the ulcerating surface being thoroughly destroyed.   This
should be followed by prolonged hot sitz-baths or general Avarm baths,
the patient remaining in the water for days at a time,  if necessary,
and, if practicable, eating and sleeping with the  body still  immersed.
If this is not possible, baths of from two to four hours' duration should
be given two or three times daily.  After cauterization, powdered iodo-
form  is the best local application in  phagedenic cases.  In addition
the patient may be given full doses of opium, and should receive a
tonic and supporting treatment.
   Should the chancroid assume the serpiginous type, slowly extending
in spite of treatment, till, in the course of months or years,  large areas
are destroyed by the process, the warm  bath, continued night and day
for Aveeks at a time, together with thorough cauterization of the eutire
diseased surface Avith the hot iron, represents  the most satisfactory
methods of treatment.
   The  chancroidal bubo is best avoided by prompt and thorough
cauterization of the sore; Avhen  it occurs, however, it should  be first
treated by  rest, pressure, and  counter-irritation, since it  may be a
simple  inflammatory adenitis,  and, Avith  care,  may  not  run  on to
suppuration.   Iodine may  be painted  around the SAVollen area, the
patient should be put to bed, and  a  compress, together  Avith a spica
bandage of the groin, should be applied, or this may be  substituted
by a hot  bag placed upon the inflamed gland.  At the  first sign of
suppuration the bubo should be opened freely, should be  washed out
with bichloride solution,  1  to  1000, peroxide  of  hydrogen,  half
strength, or chloride  of  zinc, 40 grains to the ounce of  Avater, and
should be packed  with iodoform gauze.  If the bubo  takes on phag-
edenic action it should be treated precisely as the phagedenic chancroid.
                    CHOLERA,  ASIATIC.

  The treatment of this exceedingly dangerous disease is prophylactic,
curative, and convalescent.
  The first measures  consist of strict quarantine, both public and
private, the aA^oidance of all water  for culinary purposes which  has
not been  boiled at least an hour and  cooled in  a place devoid  of
germs, and the employment of those foods which, while preserving
the normal bodily health, in  no Avay predispose to  intestinal dis-
turbances, as do some  of the fruits, as melons and  grapes.  If these
things are attended to, little remains to be done; but it is worthy of
remark that sulphuric acid, perhaps by  its auti-diarrhoeic influence,
is a drug which is harmless in itself, yet apparently one which is pos-
sessed of distinct prophylactic power in this disease.
  The treatment of the attack itself  is  supportive, and  directed to
the curtailment and modification of  the symptoms shown.   Above
all things the diarrhoea  must be controlled, if this is  possible, since
it saps the strength and induces the collapse  Avhich ends in death.
To this end 10 drops of aromatic sulphuric acid may be given every
                                27 
418
DISEASES.
tAVO hours and it may be accompanied by 5 or 10 drops of the strong
spirit of camphor  and 20  drops of laudanum  until  constitutional
symptoms prohibit the further  use  of the  opiate.   If the vomiting
is  too  severe to permit of the use  of the laudanum  by the mouth,
morphine should be given  hypodermically, and it is to be remem-
bered that this  treatment  may  be  resorted to even in the stage  of
collapse.  Sometimes  the spirit  of chloroform in 5 to 10-drop doses
every hour is of great service.  The fact that the purging must  be
constantly  decreasing the liquids  in the tissues,  thereby altering the
constitution of the blood, renders it evident that  some means must
be taken to replace the salts and water lost.  For  this purpose large
draughts of water are to be employed, and, if possible, the  following
salts should be placed in it, the proportions being 100 parts  of a satu-
rated solution of tribasic phosphate  of lime  and 5 parts of a 1 per
cent, solution of potassium  chloride.  This fluid is very nearly iden-
tical with  the  blood  physiologically, and  may  also  be used  intra-
venously with great success in place of defibrinated blood, to which
it should always be preferred.  No food must be  given by the  mouth
during an attack if it can be avoided, but nourishment is to be adminis-
tered chiefly by way of the rectum, using predigested  milk or beef-broth.
Friction of the arms aud legs as well  as of the trunk is often a comfort,
and the use of hot broths tends to put  off the algid stage.  The preserva-
tion of the bodily heat by every means in our poAver is a more important
point as the disease progresses. To control the vomiting small doses  of
cocaine may be employed and a turpentine  stupe  applied to  the belly.
   Very extraordinary results  are  said by Italian observers to  follow
the rectal injection of a solution of common salt in the proportion  of
1 drachm to the pint of Avarm water.  In other instances the use  of
tannic acid in  the strength of from 1 to  8  drachms to the pint  of
water  has proved very satisfactory.   The amount  used at each injec-
tion should be about  2  quarts  and  the injection  made as  gently  as
possible in order to urge the fluid  high into  the  bowel.   The  inflow
tube should  be a soft female catheter and  the  overflow tube twice
as large as the  inflow tube.   The tubes are to be  inserted side by side
after  thorough oiling.  The injection may be used every two hours
and  continued  till  the  outflow is  clear.  This is done to  wash out
poisonous materials and to supply liquid to the  system.  A solution
much stronger or weaker than  that  named is dangerous for similar
reasons to those given under the head  of Dropsy and  Saline Purgatives.
   Another useful measure  is hypodermoklysis,  or the passage of a
solution similar  to  that just named  into  the subcutaneous tissues  of
the thigh or belly wall.  If done slowly these injections are absorbed
readily and supply liquid to the  depleted bloodvessels.
  Very recently Harkin has written in high praise of the so-called
" vagus treatment" of cholera, and has recorded cases  in his OAvn and
others' practice which reached brilliant cures by the  use of a  fly-blister
over the course of the  vagus nerve  on both sides of the neck, just
beneath the angle of the lower jaw.   The explanation of this treatment
rests in the belief that cholera is dependent upon  some impairment  of
the functions of this nerve in the abdomen. 
CHOLERA  INFANTUM.
419
                   CHOLERA  INFANTUM.

  Cholera Infantum is a term often applied to all the forms of active
serous diarrhoea afflicting children in the summer months, whether its
cause be exposure to high heat, the use of bad food, or both.   In reality
the term should be applied to that form of serous diarrhoea in which heat
is the most common cause, and in which symptoms of lowered vitality
and collapse rapidly come on Avith coldness of the extremities, pinched
face, and Avrinkled skin.  The treatment by the use of drugs is iden-
tical in all forms of serous diarrhoea in children so far as the purging
is  concerned, but the removal of the cause requires greater care in its
discovery and more skill in its cure.
  In cities where  the heat is often great, the air damp and impure,
and  the food not  ahvays fresh, cholera infantum often appears as a
form  of thermic fever or heat-exhaustion, or, in other words, as sun-
stroke.   In these  cases  the temperature in the rectum Avill be found
febrile, Avhile that  of  the axilla is  below normal, and as pyrexia does
harm to the internal organs the internal temperature  must be loAvered
by cool  drinks, pieces of ice, and the careful use of antipyretics.
The diarrhoea  in  this case is dependent upon a relaxation of the
bloodvessel Avails  iu  the intestine  by  reason  of the  influence of the
high heat upon the splanchnic nerA7es, and may also be  partly due to
irritant matters derived from food, or result from  defective secretion
of the digestive juices.  If the thermometer placed high  up in the
rectum shoAvs a subnormal  temperature,  heat-exhaustion  is  present,
not thermic fever, and the  treatment is reversed : Hot drinks are to
be used,  external  heat  applied,  and friction of the limbs resorted
to, or the child may be put in a  hot bath at a  temperature of 105°
F., its temperature being  carefully Avatched lest it rise suddenly to
above the normal.   Vomiting is nearly always a prominent symptom
in cases of cholera infantum, and it is  best under all  circumstances to
use predigested milk in teaspoonful doses every fifteen or twenty min-
utes.  If vomiting is active and collapse is threatened, a few drops of
good  brandy should be used in each teaspoonful of nourishment.
  There is another form of cholera infantum Avhich is not due to a high
atmospheric temperature alone, but more commonly to the ingestion of
irritant foods or foods unsuited to a child, obtained by the patient sur-
reptitiously or through the ignorance of the parents.  If there is  such
a history, and some of the masses of undigested food have been passed,
a purgative dose of castor oil (1 to 2 teaspoonfuls  to a  child of two
years), with 20  drops of paregoric, should be used to SAveep out the
offending  materials and  allay irritation, and be  followed at once by
the treatment Avhich will be spoken of in a moment.  Care, of course,
should be taken to maintain the bodily heat, or  lower it if it is above
the normal, and a  watch must be  kept  upon the pulse and breathing
to note any changes requiring stimulants.
  Clinically, there is still another class of cases.   The physician will be
called to see a child with a history much like that just described.  There 
420
DISEASES.
Avill be the same history of indigestible food or of curds in the move-
ments of the boAvels.   Careful examination will show that there is much
bearing down, or in other cases a simple running off of the liquid from
the bowel almost Avithout effort.  Very soon indeed the passages become
entirely colorless, except for a speck or two of green, Avhich shows the
presence of the peculiar  microorganism Avhich  produces  this  color.
The diapers have a peculiar mousy odor, aud are characteristic—that
is, they seem to be only wet and odoriferous, and  to  contain no solid
matter.   If close attention is paid  to them they will  be  seen  to  be
soiled by a small amount  of a Avhite pasty-looking substance, looking
like a paste made of water aud fine chalk.   Such a passage bodes  ill
for the child, unless treatment is instituted at once.   The physician
should order at once \ grain of podophyllin for a child of six mouths,
to be taken in 2 doses half an hour apart.   Two hours after this the
dose should be repeated, and again  in  tAvo hours more, if necessary.
By the  end of the fourth hour  there  Avill  be  generally seen in the
movements of the bowels a trace of color,  and this will gradually be-
come more marked if the case is to have a  favorable termination.
   As soon as  the movements  have changed from  the pasty-white
motions named to those having a bilious color, then, and not till then,
are astringents to  be employed.   If they are  used  before this the
diarrhoea may  become less for  a few hours, but the child  absorbs
poisons from its alimentary canal, and rapidly goes into collapse.
   The rationale of this treatment  rests upon the fact  that owing to
the disease process, every gland connected Avith the alimentary canal
has become inactive  through the influence of the micro5rganisms of
the  disease.   It is absolutely  necessary  to bring about glandular
activity, and podophyllin, in the experience of the author, is the best
remedy for this  state.  During the period that the  podophyllin is
acting it is well to apply a spice plaster to  the belly or to immerse the
child in a hot bath to  preserA7e its bodily temperature.
   It is of  the utmost importance to stop all milk feeding at this time.
Nothing in  the way  of food may be given except Valentine's  or
Wyeth's beef-juice, 10 drops every two hours in a little cold Avater.
   A remedial  measure carried  out with great success in cities in the
treatment  of cholera infantum is  the use of irrigation  of  the bowels,
or rather Avashing out the colon.   This is  accomplished by the use of
the solution named in the article on Cholera.  The inflow tube should
be of soft  rubber,  like a female catheter.   The outflow tube should be
larger  in order to carry off flakes of food or mucus.   They may be
inserted side by side after being oiled.  The pressure  used should  be
by a fountain syringe raised  not  more than three feet above the but-
tocks, and the  outfloAv should be clear and unobstructed.   The irriga-
tion may be resorted to every hour or two and  continued  until the
fluid flows away clear.   The solution should, of course, not be too
cold or too hot, say 100° F.
   After these measures have been resorted to, aud the chief  object—
namely, a  colored  stool, not green—obtained, the diarrhoea  must be
stopped at once to prevent the depletion of the tissues.  The medicinal 
CHOLERA INFANTUM.
421
treatment should consist in the use of a mixture such as the following,
for a child of a year or eighteen months :
         R.—Acid, sulph  aromat......gtt. xxiv.
             Tr. opii camphorat......f 3 iij.
             Elixir, curagoae......f.^ij-
             Aquae cinnamomi     .    .    .   q. s. ad fgiij.    M.
    S.—Teaspoonful every two hours in water.
Or,
         R.—Acid, sulph. aromat.
             01 caryophylli
          Tr. opii camphorat.
          Spirit, chloroformi
          Syr. zingiberis
S.—Teaspoonful every two hours.
      gtt. xxiv.
   •   Hlviij.

      gtt. xlviij.
s. ad   fgiij.    M.
   If preferred, the tincture of kino, or compound tincture of catechu,
may be substituted for the  oil of cloves or the spirit  of chloroform^
or again, the fluid extract of haematoxylon may be taken in the place
of either of these.
   Where  the vomiting is very severe  and  incessant,  the purging
profuse, ill-smelling and mouse-like  in  odor,  a  rectal  injection  of
starch-Avater, 3 ounces,  containing 10  drops of laudanum,  is to  be
employed, and at the same time ^ of a grain of  gray powder (hydrar-
gyrum  cum  creta)  given  every  hour.  The gray powder  may  be
substituted by fa of a grain  doses of calomel.   Very minute doses
of arsenic giveu  by means of the following solution are  ofteu of ser-
vice in  checking the  vomiting and purging, and  should be resorted to
if necessary :

          R.—Liq.  potas. arsenitis   ....  gtt. j  vel ij.
              Aqua? cinnamomi    .    .    .    .        gj.     M.
    S.—Teaspoonful every fifteen minutes until four teaspoonfuls are taken.

   Iii still other cases the remedies named above only stop  the diarrhoea
for the  time being, and it returns as soon as they are withdrawn.    In
such a case the  following is of value to restore the lost  tone of the
parts involved :
          R.—Resinae podophylli.....gr.  -J-.
              Liq.  potas. arsenit.    .    .    .    gtt. iij vel vj.
              Liquor calcis......fvfiij-    M.
    S.—Teaspoonful  every five hours.  Shake well before using.

Or a powder may be used :
          R.—Resinae podophylli.....gr.  \.
              Pulv. ipecac.......gr. j.
              Sacchar. lact.......gr. xx.   M.
    Ft. in chart, no.  x.  S.—One powder every five hours.
   A very important, never-to-be-forgotten measure in  cholera infan-
tum is the use of  counter-irritation over the belly by means of a mus-
tard plaster (1 part  mustard flour to  4 of wheat  flour) or by a spice
plaster.   The plaster should be renewed as often as it cools, and kept
on continuously if the skin will stand it. 
422
DISEASES.
                    CHOLERA MORBUS.

  This acute, painful, rapidly exhausting disease arises from exposure
to cold, the  ingestion  of poisonous  or irritating foods, exposure to
excessive heat, and to a number of similar causes.
  In reality  it may be regarded in one instance as a  gastro-enteritis,
and in another as an acute serous diarrhoea associated  with much pain
of a griping, rending character.  Nothing compares to counter-irrita-
tion  for the purpose of affording relief.  A large mustard or capsicum
draft should be placed over  the abdomen and allowed to remain as
long as it can be borne.   If the patient knows that he has taken irri-
tant foods, castor oil with 15 to 20 drops of laudanum added to it, to
prevent griping,  should  be  employed  to sweep out  the  offending
masses before any other  remedies  are used,  and be  followed by  an
anti-diarrhoea mixture such  as here follows :
         R.—Acid, sulph. aromat.  .   .        f gij vel f^iv.
             Extract, haematoxylon.   ....   J^ij.
             Spt. chloroformi......f gss.
             Syr. zingiberis   .    .   .    .   q. s. ad fjiij.    M.
    S.—Teaspoonful every two hours.

(See article on Diarrhoea.)

                          CHLOROSIS.

                          (See Anemia.)


                           CHOREA.

  St. Vitus's Dance is a nervous affection, generally occurring in chil-
dren, yielding to treatment quite readily in some cases and  in others
remaining persistently severe, and even becoming worse under the
physician's care.
  The disease is always to be  treated by the removal of all  sources
of reflex irritation, such as worms, a  long prepuce if it is irritated  by
retained  urine  or smegma, or other  trouble  of this character, and iu
the avoidance of punishment or severe rebuke on the part of the attend-
ants.  Except  in  that  form of the disease closely associated with or
dependent upon rheumatism, the profession universally employ arsenic
in oue of its forms as a specific remedy.   Generally Fowler's solution
is used, and unless the parents are intelligent enough to drop medicine
carefully from a bottle or dropper, the physician should order a three-
ounce  mixture, with 48 drops of FoAvler's solution, so that each tea-
spoonful Avill contain two drops of the drug.  Very frequently, to be
effective, arsenic must be used in ascending doses, increased one drop a
day, aud, in consequence the dilution just spoken of has to be avoided
and the importance of care in measurement urged upon the patient's
relatives. 
CHOROIDITIS.
423
  AVhenever arsenic is used, the physician should instruct the attend-
ants to stop administering the drug if any puffiuess under the eyes  is
seen in the morning on arising from bed, or if any pain in the boAvels
ensues, as these  symptoms show that the full  medicinal action of the
drug is being felt.
  When arsenic fails, cimicifuga  in  the dose of 20 to 30 drops of a
fresh fluid extract to a child of ten years, may be used as the next best
remedy.
  Where  the disease is associated Avith  rheumatism, near or remote,
the salicylates or iodides may be of value, aud should  be  thoroughly
tried.
  In some cases of chorea  the muscular jerkings  are  so  severe that
sleep is impossible and the  patient has to be held iu bed and the bed-
covers tied down.   These cases will often obtain a quiet night by the
use of the  hot pack at bed-time.  (See Heat.)   The child should be
placed in a blanket previously  dipped iu  Avater as hot as can be borne
by the patient and  thoroughly Avrapped  up in another dry blanket, to
retain the heat, and then be  allowed to SAveat.   Care must be taken that
a heat-stroke does not result, and, if sweating does not come on and
oppression ensues, the blanket must be removed.   The sheets should
be ironed to have them warm for the patient when he  is  returned to
bed, and  it  is  often better to let him  sleep between  dry  blankets.
The efficacy of this treatment is largely increased by the use of a dose
of bromide of sodium or potassium and  a little chloral, as follows :

         R.—Chloralis.......Z. ij.
             Sodii bromid.......gss.
             Aquae dest......q. s. ad  fgiij.   M.
    S.—A teaspoonful in water every five hours for three doses.

  The nitrate  and  oxide of silver have been largely used in chorea,
but  are not  reliable remedies  iu  this disease.   The dose of the first
should be | to ^ grain, and of  the second | to 4; grain in pill form.
                         CHOROIDITIS.

  Choroiditis, or  inflammation of the choroid, is  revealed  only by
ophthalmoscopic examination,  and may consist merely  of increased
vascularity, of cloudiness due to serous effusion, or of yellowish-Avhite
patches surrounded by masses of dark pigment, indicating an  atrophy
of the choroid as well as the retina.  Numerous groups and clinical
varieties of choroiditis  are described by systematic  writers, but it is
not easy in each instance  to determine the cause, which may be local
in the eye or comprise  a constitutional origin like syphilis  or gout.
In  the  early or hyperaemic  stages,  bleeding from the temple  is ad-
visable, and later  mercury, especially in the form of the bichloride,
or iodide of potassium may be  given.  The  constitutional state  which
is present will indicate the suitable  general  medication.  All  use of
the  eyes should be forbidden. 
424
DISEASES.
                       COLIC, HEPATIC.

   This exceedingly painful condition, due to the passage of a gall-stone
through the bile-ducts, is always associated with faintness, nausea, and
great agony.
   The object of the physician  must be to relieve this pain, not only
by the use of anodynes, but also by aiding in the escape  of the stone
into  the bowel.  To relieve the pain a hypodermic  injection  of mor-
phine 4; to J grain, accompanied by -g1^- grain of atropine,  is indicated.
The  opium not only decreases the pain but allays  spasm, and the bella-
donna relaxes the spasm of the muscular coats of the ducts and allows
the stone  to pass through the relaxed passage-way.   Hot  applications,
such as a  turpentine stupe, may be used over the liver, but relaxation
is not to be obtained by the use of nauseating emetics, as  the retching
or vomiting may rupture the distended gall-bladder.   Severe rubbing
should not be used for the same reason.
   Very recently the use of olive or cotton-seed  oil  has come largely
into  use in this affection, and Avhile we are not sure of the means by
which it acts, the studies of Rosenberg and others point to the chang-
ing of the oil into  glycerin and fatty acids, the  first of  Avhich  lique-
fies and increases the flow  of bile.  The  oil  is used  during the attack
of pain, and must  be swallowed  in the dose of  half a pint at  least;
smaller quantities do not suffice.  Its action may be aided and its  reten-
tion  in the stomach promoted, by the addition of a drachm of ether to
each dose.
   Shortly after the  oil is  swallowed,  sudden relief often occurs,  due
to the escape of the stone into the bowel.   The stools should then be
carefully watched for gall-stones, but care should be taken that the
lumps of  soap which are passed, made from  the oil by  the alkaline
juices in the intestines, are not  mistaken  for  true biliary calculi.   If
the pain does  not yield to morphine,  chloroform or ether may be in-
haled for  the relaxation of the spasm and  the relief of pain.
   The treatment of  the state predisposing to the  formation of hepatic
calculi consists largely in the use of a moderate, regular diet devoid
of much fats, wines or beers, and in the following of an out-door life.


                      CONJUNCTIVITIS.

   Simple  Conjunctivitis, sometimes called catarrhal, acute, or muco-
purulent ophthalmia, is characterized by congestion of the  conjunctiva,
loss  of transparency of the  palpebral portion, and  some dread of
light, with a discharge,  sufficient only to  glue the lids in the morning
or free and muco-purulent.  In the milder  stages the use of  a  boric
acid  lotion (10 grains to the ounce) is  suitable, and the lids should be
frequently Avashed with neutral soap and Avater; if there be much muco-
purulent discharge the lid should be everted  and an application made
of a  solution of nitrate of silver (from 2 to 5 grains to  the ounce). 
CONJUNCTIVITIS.
425
If the discharge becomes great, bichloride of mercury, 1 to  10,000,
may be employed with advantage, and the nitrate of sil\Ter solution
increased  to 10 grains to  the  ounce, the excess being  neutralized
with a  solution of salt or  washed aAvay Avith tepid  water.   Much
inflammatory reaction  in  this disease may be alleviated by cold com-
presses.  These are rendered more efficacious if dipped in equal parts
of water and  the  extract  of hamamelis.   Patients  suffering from
catarrhal conjunctivitis should be protected from tobacco smoke, bright
light, dust, or any mechanical irritant.   Atropine usually is unneces-
sary unless a corneal ulcer complicates the affection.  The patient may
wear smoked  glasses,  but  under no circumstances must  the  eyes be
bandaged or have poultices applied to  them.   Domestic medication of
this sort may  change a simple ophthalmia into a serious and purulent
inflammation.   Topical medications other than those meutioned are
alum (4 to 8 grains to the  ouuce), sulphate of zinc (1 to 2 grains to
the ounce), which may be suitably combined with  boric acid,  creolin,
1 per cent,  solution, and pyoktanin, 1 to 1000 ; the latter remedy,
however, has  not justified the claims which ha\Te been made for it.
During the subsidence of  the  inflammation,  and if  it  shows any
tendency to become chronic, the application of an alum crystal, or a
solution of tannin,  and glycerin  (10 grains to the ounce), is suitable.
It should be remembered  that muco-purulent ophthalmia may become
epidemic in crowded institutions, and great care  should be taken to
isolate  cases.   One soiled towel may be the source of infection  to a
great number  of children.   Constitutional treatment ordinarily is not
required, but  proper hygiene, fresh air, good food, the intelligent use
of laxatives, tonic doses of quinine, and whatever treatment  is indi-
cated by any associated condition, are useful.  The associated condi-
tions most commonly are nasal catarrh, bronchitis, a  general cold,
eczema of the  face, and the exanthemata.
   Burns of the Conjunctiva.—Immediately  after  the  accident  all
foreign particles should be removed or neutralized with a Aveak acid
or alkaline solution if a  liquid caustic or acid solution has  entered
the eye ; then a feAV drops of cod-liver oil may be instilled and atro-
pine employed (suitably incorporated with liquid  vaseline) to  prevent
iritis.   The chief danger lies in  the formation of severe corneal in-
flammation aud symblepharon ;   the  latter may  sometimes  be pre-
vented by daily breaking up the granulation tissue or by the insertion
of a piece of gold-beater's skin betAveen  the inner surface  of the  lids
and the eyeball.  The  associated conjunctivitis and keratitis require
treatment differing  in no  way from  that  described in the  idiopathic
forms of these affections.
   Purulent  Conjunctivitis, which is commonly seen in the adult in
the form of gonorrhceal ophthalmia, and  in  the infant as ophthalmia
neonatorum, is produced in  both  varieties by the introduction  into the
eye of a specific virus from either the urethra or the vagina. The chief
danger  of the disorder  is destruction of the vitality of the cornea  and
loss of sight.   The  most important indication is to prevent this danger
by reducing the amount of  swelling of  the lids and conjunctiva  and 
426
DISEASES.
the profuse discharge, which  are  the  characteristics of  the disease.
These  indications are  met best in the  following  manner :   Hourly
cleansing of the eyes with an antiseptic solution,  preferably bichloride
of mercury (1 to  8000), or a saturated solution of boric acid.   During
the acute  inflammatory stage,  and  before  the  discharge  is profuse,
astringents and cauterants must uot be applied.   When this stage has
arrived,  and the  conjunctiva  is profusely coA^ered with discharge, the
lids should be carefully everted once  a day,  Aviped clean of every par-
ticle of pus, aud carefully touched with a solution  of nitrate  of  silver
(10 to 20 grains  to the ouuce), and the excess neutralized with  a few
drops of a solution of common table salt.   In the early stages, iced
compresses Avrung out of carbolized  water  and frequently chauged,
Avill help to reduce the reaction, or these compresses may be  made by
placing squares of lint upon a block  of ice  and thus securing intense
cold.  If  the vitality of the  cornea is  threatened it is  advisable, in
many  instances, to substitute  for the cold applications hot compresses
of a temperature of 110° F.  These may be applied for from ten to  ,
twenty minutes every tAvo or  four  hours, according  to the exigencies
of the case.   The appearance of ulceration in the cornea calls for the
use of atropine or eserine.  Atropine was formerly  employed almost
exclusively ; in recent times great success has followed the adoption of
eserine.   This is especially applicable if the ulceration should form in
the periphery of the  cornea.   In  adults, high  reaction and violent
inflammation may be alleviated by the use  of leeches to the temple.
Bleeding of any  sort is not applicable to newborn infants.  Other ap-
plications Avhich have  met with favor at the  hands  of various  surgeons
are solutions of  sulpho-carbolic acid, sulphate of alum, sulphate of
zinc, nitrate of silver, creolin (1 per  cent.), and iodoform ointment.
Both blue and yellow pyoktanin have been  recommended, but do not
yield satisfactory results.   Peroxide of hydrogen is  a good cleansing
agent, but healing does not progress as favorably under its influence as
with bichloride of mercury and nitrate of  silver.   Solutions of per-
manganate of potassium, aud aqua  chlorini have  many advocates.
Mules has recommended a treatment with alcohol and corrosive  subli-
mate.  The preventive method of treating ophthalmia neonatorum that
has obtained  the happiest results is that instituted by Cred6, namely,
the dropping of a 2 per cent, solution of nitrate of silver into the eyes of
the newborn infant.  If one eye alone is attacked in gonorrhoeal ophthal-
mia the other should  be protected  by covering it with Buller's shield,
Avhich consists of a watch-glass fixed in a square  of plaster, which is
carefully applied so that the crystal comes directly in front of the eye,
and the plaster covers the surrounding area.
   Chronic Conjunctivitis may result from an antecedent acute inflam-
mation of the conjunctiva, or exist as an idiopathic affection, especially
in elderly  people, in whom it  sometimes becomes a troublesome symp-
tom, especially if complicating cataract.   The characteristic lesions are
roughness of the papillae of the conjunctiva, swelling of the caruncle,
and soreness of the angles of the eyelids.   There are no granulations,
although the disease  is  sometimes inaccurately spoken of as granular 
CONJUNCTIVITIS.
427
lids.  A soothing  wash  is indicated (10 grains  of boric  acid  to the
ouuce of Avater) to whicli  may be added  2 grains of cocaine, provided
the cornea is not ulcerated, and for Avhich a similar boric  acid  lotion
Avith 4 grains of salt to the ounce may be substituted.   A very suitable
local application is lapis divinus (sulphate of copper one part, alum one
part, nitrate of potassium one part, fused together, aud camphor equal
to one-fiftieth of the Avhole added.  The mass is run into sticks  and
the application made to the everted lids, or 1 grain of the same prep-
aration to the ounce of Avater may be droppod into the  eye).   Other
useful applications are taunin and glycerin (10 grains to the ounce),
yelloAV oxide of mercury salve, and alum crystal.   If refractive error
exist  this  should  be corrected.   It is to be remembered that chronic
coujunctivitis distinctly contra-indicates  any operative interference in
the eve, as, for instance, cataract extraction.
   Lachrymal Conjunctivitis  is a name giAren to a chronic  form of
inflammation  of the conjunctiva, associated with obstruction in the
lachrymal duct, aud characterized by a tear-soaked appearance of the
eye, small pustules at the roots of the lashes, and a gummy discharge
along the palpebral margin.  This can be cured only by relief of the
stricture of the nasal duct which causes it, but may be alleviated with
the same remedies  recommended  in the treatment of chronic conjunc-
tivitis.  Good results are reported from the use of pyoktanin.
   Follicular Conjunctivitis, a disease sometimes  mistaken for granular
lids, but having a distinct clinical difference, inasmuch as  the swollen
follicles are absorbed without the production of cicatricial changes in the
conjunctiva, requires for its local treatmeut weak astringents and anti-
septic lotions, and the application to the swollen follicles of an oint-
ment of  sulphate  of- copper  (gr. J to the drachm), dusting in calomel
either alone or Avith equal parts of subnitrate of bismuth, or iodoform
or aristol  used in the same way.  If the disease is stubborn the swollen
follicles should be  crushed with forceps.
   This  disease, or one analogous to it, is sometimes produced by the
prolonged instillation  of atropine, and  less frequently by eserine and
cocaine.   If this  is its  cause, the drug must be suspended  and the
surface painted Avith an alum crystal.
   Granular Conjunctivitis.—This disease may be divided  into acute
and chronic granulations.   In the former, astringeuts and  caustics are
inadATisable, the eyes  requiring weak antiseptic solutions like boric
acid or salicylic acid, and the instillation of atropine.  Leeches  to the
temple Avill aid in reducing the inflammatory reaction.  In the chronic
disease  the object  of treatment is to bring about absorption of the
granulations Avhich are  its characteristic lesion, not by au application
so caustic as  to destroy  the  mucous membrane around them,  but of
sufficient vigor to produce  healthy reaction.   The  following  applica-
tions  comprise those  which  have been employed  Avith  the greatest
success : 10-grain  solution of nitrate of silver, if there is discharge,
applied once  a day Avith neutralization of the excess;   sulphate of
copper  in  the form of a crystal  carefully applied to the  everted lids
and the retrotarsal folds; pure  carbolic  acid applied Avith a camel's- 
428
DISEASES.
hair pencil and the excess Avashed away Avith  Avater; glycerole  of
tannin (tannic acid grs.  30, glycerin 1 oz.) best applied Avith  a  cotton
applicator;  boro-glycericle from  20  to 50 per cent, according  to the
vigor of the granulations.   Strong solutious of  corrosive sublimate
are employed  in the following manner:  solutions of the strength  of
1 to 300 or 1 to 500 are painted on the everted lids every second day,
the pain of the application being alleviated by the previous instillation
of cocaine, Avhile three times daily the eyes are  irrigated thoroughly
with a solution  of the  mercury salt 1  to  7000.  Among the many
other applications Avhich may be used  in  this disease  the following
may be mentioned :  liquor potassa, beta-naphthol, iodoform or aristol
in powder or salve, an  ointment of the  yelloAV oxide of mercury;
calomel and hydrastin.   The surgical means  which  are employed  to
destroy the granulatious are  scarification of the conjunctiva,  an inad-
visable method;  excision of  the granulations, useful  if these exist  in
isolated  groups; crushing  the granulations with  specially devised
forceps, a method often followed  by satisfactory results;  scarification,
folloAved by a vigorous  brushing of the affected tissue with  a brush
containing short bristles, previously dipped  in  a strong (1 to 500)
solution  of corrosive sublimate (Grattage); and excision of the fornix
conjunctiva.  In long-standing cases associated with inveterate pannus,
De Wecker has  proposed the use  of an infusion of jequirity  (3 per
cent.).   This produces  an intense  membranous conjuuctivitis, which
must be treated  by iced compresses or  similar measures  to reduce  its
reaction, but when it has subsided the pannus is often relieved.   This
method has not  been employed in recent times to the extent that it was
practised Avhen first introduced.
   Diphtheritic Conjunctivitis is rare in this country, but on the con-
tinent  of Europe occasionally occurs as an  epidemic.  It may  appear
alone or in association  with  diphtheria of the throat and nose.  The
initial  subjective symptoms  are  those  of purulent  ophthalmia; the
characteristic objective symptoms, a board-like infiltration  of the lids
with a deposit  of  gray  membrane upon the palpebral conjunctiva.
More  than in any other eye disease destructive inflammation of the
cornea is threatened.    In   the early stages  the eye should  be fre-
quently  cleansed Avith  boric  acid or bichloride of mercury solutions,
and atropine instilled, while hot compresses help to maintain the nutri-
tion of the cornea more perfectly than the cold compresses which were
formerly recommended for antiphlogistic purposes.  Tweedie has highly
recommended a solution of quinine (3 grains to the ounce); Burgomaster
insufflation of floAvers of sulphur; Avhile in France the local application
of lemon juice or citric acid  ointment has been endorsed ; Galezowski
uses oil  of cade (1 to 10).  In the early stages all caustics  are contra-
indicated ; after absorption of the  membrane and reestablishment of
the discharge the cautious use of nitrate of silver in the manner de-
scribed under Purulent Ophthalmia may be employed.   The constitu-
tional  measures for diphtheria are necessary.
   Chemosis of the Conjunctiva, in  which this membrane is infiltrated
with serum, is usually  a symptom of other ocular disorders, and sub- 
CONSTIPATION.
429
sides Avith the general treatment directed to their relief.  Good results
may follow nicking the swollen tissue Avith a pair of scissors;  the
application of a warm,  moist compress,  and the use of astringents,
especially alum.
  Haemorrhage Beneath the Conjunctiva (subconjunctival ecchymosis)
may follow an injury, occur during a paroxysm of Avhooping-cough,
and  occasionally, in elderly people, may appear spontaneously.   No
treatment materially hastens  the absorption of  the blood unless it be
massage of the globe through the closed lid ; auy associated conjunc-
tival irritation may call for a boric acid and cocaine wash.
  Xerosis of the Conjunctiva, depending upon  a cicatricial metamor-
phosis and the absence of normal moisture, is seen after long-standing
inflammations (granular lids, diphtheria, pemphigus), and is incurable.
The affection may be relieved by the local  use of glycerin, almond oil,
emulsion of cod-liver oil, or the use of weak alkaline solutions.   Trans-
plantation of  the rabbit's conjunctiva has been tried without success.
                       CONSTIPATION.

  This  troublesome state depends on a number of causes, the most
common of Avhich is the following of a sedentary life totally devoid of
the exercise intended to keep the intestinal and hepatic secretions in an
active state.  Another frequeut cause is simple laziness, which causes
the patient to resist the call of the bowel for evacuation  until this part
of the body becomes indolent aud atonic, Avhile modesty often causes
constipation in females, because a woman prefers to suffer rather than
go  to a closet Avhich may be somewhat publicly situated.   In other
instances constipation seems to  be hereditary and to depend upon
deficient nerve-supply, or muscular weakness and lack of secretion in
the lower bowel, or to hepatic torpor.
  Whatever the causes are, they should be sought for, and, if possible,
removed, the physician not being content to order purgatives, which,
while they may give temporary relief, soon lose their power.
  Further than  this, it  must be remembered that hygienic measures
always  take first place in  the method  of treatment, and, if possible,
drugs  should occupy a very secondary role.  Particular attention
should be paid to diet, and the physiology of peristalsis must be well
borne in mind.
  It has been proved by a large number of studies, both in the normal
intestine, and by the use of purgatives, that peristalsis is almost entirely
a reflex action depending for its  existence  upou the integrity of the
nervous plexuses in the intestinal walls, namely those of Auerbach
and Meissner, the first of which are situated between the longitudinal
and circular  muscular fibres which they supply, the latter  existing
in the submucosa and supplying the walls  of the villi, the glands of
Lieberkiihn, and  the small arteries and venules.
  It has also been found that the vagus nerve, when stimulated re-
flexly or directly, increases peristalsis, and  that moderate stimulation 
430
DISEASES.
of the splanchnic nerves decreases it.1   It at once becomes evident that
any decrease in the normal activity of these nerves and nerve-centres
must  speedily result in  constipation, and  the costive condition conse-
quent upon hepatic torpor is due  to the fact that the intestinal walls
do not receive the proper stimulation from the bile to set in motion a
reflex wave the result of which will be evacuation.  This fact rests
upon the results of direct experiments which prove the  bile to be pri-
marily an intestinal stimulant, antiseptic, aud promoter  of  secretion.
   Other series of experiments have shown  that  the circulation of the
blood through the intestines greatly influences peristalsis, and disorders
in the blood-supply readily bring  on intestinal disorder.
   The deductions  to be drawn from  these  facts are many.  In  the
first place, it is evident that the maintenance of  an active, normal cir-
culation of blood in the abdomen  and a free pouring-out of bile from
the liver  and gall-bladder are necessary to a healthy peristalsis, and
Ave find that, aside  from drugs, we have a number of remedial meas-
ures which are to be resorted to according to the means  of the patient.
By far the best of these is  horseback exercise for at least an hour a
day, or every other day, which, by the  motion,  actively stirs up and
excites the abdominal viscera as no other measure can do.   If for any
reason horseback exercise is  impossible, then abdominal massage car-
ried out by a capable  masseuse  is to  be tried, the hands following
more particularly the course of the ascending, transverse, aud descend-
ing colon, the kneading moA^ements being also  applied to the hypo-
chondriac regions.  If neither of these measures  can  be  used, then the
patient must resort to those gymnastic movements which involve  the
abdominal muscles, either by the  use of dumb-bells or pulleys, such
as are sold under the  name of "home gymnasiums,"  or by beuding
the body forward, backward, and  laterally, Avith the fists pressed  into
the hypogastrium.
   At the same time that these measures are  directed, the  diet of the
patient must be so  regulated that the food shall contain a large amount
of residue—that is, after digestion enough of the husk of the grain or
enough vegetable  fibre  must  be  left free  in the intestines to form a
stimulus to the  intestinal Avail as  it slips over the mucous  membrane.
If a meat diet is largely used, so  little  residue  is left after digestion
that constipation ensues, but if vegetables are largely eaten  the reverse
is the case.  No better evidence of this can be adduced than the hard,
clay-like passages  of the dog, and  the soft passages of the cow.  Very
often  a plateful of cracked Avheat (wheaten grits) eaten at breakfast
each morning, or the use of bran bread, will relieve a chronic tendency
to constipation.   In these cases milk is to be avoided above all things,
since it is almost eutirely assimilated and  leaves no residue, though it
supplants  other  foods.   Green or canned corn is  of  great service.
Fruits do  good in constipation in one of two Avays—they either con-

  1 Some persons believe that Meissner's plexus receives impulses from the walls of
the intestine and transmits them to the motor plexus of Auerbach, which then sets in
motion peristalsis. 
CONSTIPATION.                     431
tain residuous materials or sufficient vegetable-acid salts to be laxative.
Figs, by reason of their many small  seeds, Avhich scrape the mucous
membrane during  peristalsis, are  particularly valuable, and  apples,
prunes, dates, and tamarinds  are all useful.  It must be remembered
that straAvberries, raspberries, and  blackberries are generally consti-
pating rather than purgative.   Iu regard to drink, nothing is so good
as a glass of cold Avater taken  on arising in the morning or just before
breakfast, or, if the cold cannot be borne, then a glass of as hot water
as can be swallowed with comfort may be substituted.   Coffee is con-
stipating to most persons, largely because of its empyreumatic oil, and
tea has  the same  tendency because  of its tannic acid.  Brandy, as
everyone  knoAvs, is distinctly constipating, and Avhiskey possesses so
little  poAver to the  contrary as to be  devoid of influence in either
direction.   Beers differ  in their properties, some of them  increasing
and some of them decreasing  intestinal activity.
   The patient suffering from  constipation should go to stool regularly
after breakfast every day, eAren if the attempt is abortive, and so train
the bowel to expect  a movement at this time.
   The use of drugs  for the relief of constipation is capable of division
into two parts :  first the employment of remedies to unload the bowel,
which has become filled; second, the use of drugs which will so influ-
ence the intestines as to cause  evacuation aud produce normal activity,
or, in other words, drugs which  will cure  the tendency instead of
giving  temporary relief.   Of the first  class Ave find the various pur-
gative  salts, jalap,  colocynth, senna, mercury,  castor  oil,  and rhu-
barb;  of the second class, aloes, cascara  sagrada,  manna, tamarinds,
rhamnus frangula (buckthorn), phosphate of sodium and small  doses
of podophyllin.  The physician should bear in mind that defaecation
is a normal physiological  act, which must be continued all through
life, and it is almost as foolish to stimulate the bowel continuously to
peristalsis  as to  perpetually  employ heart stimulants or respiratory
excitants.
   Although they are habitually employed by many persons in  daily
doses, the  purgative salts  are exceedingly harmful in such instances,
rapidly losing their  power and decreasing the patient's strength by the
abstraction  of liquids  and salts from the  blood.  They often produce
anaemia Avhen constantly  used.  These salines are to be  employed
simply to unload the bowel when an excess of faecal  matter has  accu-
mulated, or when irritant materials  are to be swept out of the alimen-
tary canal.   In some  cases of pelvic congestion associated with con-
stipation, magnesium sulphate may be  given by enema in the propor-
tion of 2 ounces  of the salt, 1 ounce of glycerin and 4  ounces of
Avater.  In  some rare instances, where great plethora exists, a course
of Hunyadi Avater,  Friedrichshall  or Carlsbad Avaters  is of service,
but these  instances are rare  indeed in America.  Jalap, colocynth,
and senna  are not to be used  constantly, as they are too active, and
the reaction from their effects  causes constipation.   Rhubarb is com-
monly used, but is of its class  peculiarly unfitted to its task.  Although 
432
DISEASES.
it purges it is  distiuctly  astringent, and  is, therefore, more consti-
pating in the end than if no drug had been used.
   Mercury is exceedingly harmful if used continuously as a purge,
and is the cause of much ill-health, bad  teeth, and digestive troubles.
Castor oil is notorious for its tendency to cause ultimate constipation.
   Of the curative class of laxatives none compare to cascara sagrada,
particularly in the form of the tasteless fluid extract or cascara cor-
dial.   Originally this drug as prepared was very  bitter, but it is now
made almost tasteless by certain manufacturers.  This is the only
drug which alone moves the bowels and  at the  same  time tends to
make  future passages more easy and regular; the' dose  is  10 to 20
drops of  the fluid extract, or 1 drachm to 6 of the cordial.   There is
almost no griping produced by it.   For the regulation  of  the bowels
of young children, particularly if the case be somewhat " rickety " in
tendency, phosphate of sodium in the dose of 5 to 10 grains in milk
is the best laxative, and the same salt may be used in 30 to  60-grain
doses in adults.   Manna is to be  classed  as a laxative fruit, but even
it sometimes  make the intestinal  torpidity  ultimately much worse.
The tAVO remaining drugs of this class, aloes and  podophyllin, should
ahvays be used in combination with  other  non-purgative drugs, as is
seen in the following formulae:
          R.—Aloes socotrinae  .    .    .    .   .   .   gr. xx vel xl.
             Extract, nucis vomicae     .    .   .   .   gr. iv.
             Extract, physostig.   .    .    .   .   .   gr iij.
             Extract, belladonnas  .    ,    .   .   .   gr. iv.    M.
    Ft. in pil. no. xx. S.—One pill at night or night and morning.
Or,
          R.—Resinae podophylli.....gr- ij vel iv.
             Extract, nucis vomicae     .    .   .   .   gr. iv.
             Extract, physostig.   .    .    .   .   .   gr. iij.
             Extract, belladonna?  .    .    .   .   .   gr. iv.    M.
    Ft. in pil. no. xx. S.—One as above.

   The object of using several of  these drugs is seen at a glance.   We
have already learned  that  nearly  all  purgatives tend  to  produce
griping.   The nux vomica acts as a bitter  tonic and  stimulant and
prevents  subsequent  atony of the mucous membrane, as well  as  in-
creases reflex action, and consequently improves peristalsis.  The physo-
stigma is  a tonic to the unstriped  muscular fibre and gives it strength;
the belladonna  aids peristalsis  by depressing the  inhibitory fibres of
the splanchnic  nerves, by allaying spasm and by decreasing griping.
In using these  drugs, aloes and podophyllin, Ave should  remember
that aloes is sIoav and acts  particularly on the lower bowel, and that
podophyllin acts  chiefly on the upper bowel and  is the  slowest purge
in the list of purges.
   In the  flatulence of old persons associated with constipation a little
asafoetida or capsicum  should  be added  to  the pill   of  aloes  just
named.
   In some instances constipation  arises from reflex irritation, or from
ovarian or bladder trouble or from chronic  lead poisoning.   This form 
CORYZA.
433
of constipation may resist all  purgatives  and yield to opium or to
tobacco, Avhich quiet reflex action.  Tobacco depresses  the inhibitory
nerves of the gut, and devotees of the " Aveed " often use it as a laxative.
  The employment of enemata as a routine practice is to be discour-
aged.  In cases where it is necessary to use them for temporary relief,
and to get rid of flatulence, a little soap, common salt, or a few drops
of turpentine may be added to the water.   Recently the injection of
glycerin  (1 to 2 ounces) has been largely  resorted to,  either  pure or
diluted one-half, and this method has been  improved upon  by the
use of glycerin  suppositories containing several drops of the drug.
Glycerin acts in  these cases as an irritant to the mucous membrane
and  causes secretion by this means and by its  abstraction of water
from the tissues by reason of its hydroscopic powers.


                            CORNS.

   These troublesome  formations are  best  treated by the use of sali-
cylic acid, the following formula being applied night and morning for
several days, after which the part should be well soaked iu hot water,
when the entire corn will readily come away—or in some cases several
attempts Avill be necessary.
         I£.—Acid, salicylic.......gr xxx.
             Extract cannab. indicae   .    .    .       gr. x.
             Collodii.......fgss.   M.
    S.—Apply with a camel's-hair brush.

   The same  acid may be used in alcohol, and lactic acid in  the same
proportion is ofteu of service.
   In the so-called  "soft corns" Avith much  inflammation  the  foot
should be  washed and  dried,  and a  saturated solution  of nitrate of
silver, 60 grains  to  the drachm, applied  to  the part every four or
five days.

                            CORYZA.

   Coryza, or ordinary cold  in  the head, is an acute inflammation of
the  mucous  membrane  of the  nose—a disease of so frequent occur-
rence during the changeable weather of the spring and winter months
that it rarely receives the attention that it deserves.   As it is in most
cases the point of departure from health toward chronic nasal catarrh,
its complete  cure, in each instance, is a matter of importance.
   Among the causes of coryza are exposure to cold or dampness, Avet
feet, the checking of secretions, and lowering the tone of the mucous
membranes by  inhaling close  or impure  air.  It is also caused by
inhaling dust, acrid  vapors or gases, as bromine, chromic acid, and
pyrethrum, or Persian insect powder.
   Permanent changes  occur in the nasal  mucous  membranes Avhen
the exposure to irritation is long continued.
   Hay-fever subjects are liable to attacks of coryza from very slight
                                 28 
434
DISEASES.
causes during any part of the year, the susceptibility increasing, how-
ever, as the season approaches  for  their  periodic outbreaks.  The
exciting agent is  usually in the form of dust of some kind, though
all  are  not equally sensitive to the same irritant.   The rose, the
peach, the golden-rod, the rag-weed, each has its victims.  The Avriter
once treated a Avoman who  could work in Avheat flour with impunity,
while  the same exposure to rye flour at any season of the year pro-
duced  a violent  attack of coryza Avith uncontrollable fits of sneezing
and running from the eyes and nose.  By removing  the  cause and
retiring to a quiet, cool room these  attacks would  pass off in a short
time without  any  other treatment.  It is  possible  to multiply the
description  of cases  of  this  nature,  but their  consideration  comes
more appropriately under the head of  vasomotor  disturbances and
hay-fever.
  Coryza usually  commences  with a  creeping  sensation, Avith  or
Avithout  a distinct chill, followed by constitutional  disturbance,  as
fever,  dry,  parched skin, pain  and aching in the back and limbs.
The urine is  high-colored  and scanty.   Frontal headache varies in
intensity from an acute  lancinating pain to a dull ache or throb over
the brow, increased by  leaning  forward.   The  nose and  throat  at
first are dry and parched,  the tongue literally " cleaving to the roof
of the  mouth."
  Sneezing, which may be a prominent symptom from  the first, is fol-
lowed  by a profuse Avatery discharge from the nose and eyes.  The
erectile tissues on  the turbinated bones become engorged with blood,
producing complete obstruction to breathing.   When the swelling causes
excessive pressure, the intra-nasal tissues may become oedematous.
  Pressure  to this degree,  stretching  the  turbinated tissues and im-
pinging  upon the delicate sensory nerves of the septum, causes acute
headache centring over the  frontal sinuses or the cheek-bones, having
a neuralgic  tendency  to shift its  position.   The eyes are injected and
become suffused  on the  least exposure to light.   Mild delirium may
supervene upon  pressure in  the upper turbinated  region, the  roof of
which, we must remember, is only separated above from the  base of
the brain by the cribriform  plate of the ethmoid bone.
  The filaments of the  olfactory nerve, piercing the cribriform plate
of the ethmoid  bone, are distributed to the upper turbinated and the
upper  half  of the middle  turbinated bones, and  on the  septum  to
about the same level.   This region, called from its function, olfactory,
appears  in health slightly lighter in hue than the region below, whicli
is mainly respiratory in function.
  A few of the  reflex disturbances, resulting from changes in intra-
nasal pressure, will be considered elsewhere.
  An  intense itching of the end of the nose is, with some people, the
first indication  of an approaching cold in  the head.   Such persous
usually have an abundance of stiff hairs in  the orifice of the nostrils,
aud, stimulated  by the extra blood-supply to their roots, these hairs
gradually become erect, and, in  doing so, tickle the already  hyper-
sensitive membrane of the vestibule of the nose. 
CORYZA.
435
  During this stage of hypersecretion the  amount  of Avatery fluid
discharged from  the nose is ATery great, containing in addition to the
secretion from the mucous glands, exfoliated epithelial cells, leucocytes,
and saline constituents from the blood.  The free discharge  and con-
staut  use of the handkerchief  may excoriate  the  upper lip and the
alae of the nostrils, adding to the general discomfort.
  The rapid  draining of serum produces a degree of weakness and
vital  depression, apparently  disproportionate to the  severity of the
disease, the exhaustion being indicated by loss of weight and  strength,
and by pallor.
  After a Arariable period the discharge becomes thicker, less copious,
and more muco-purulent  in  appearance, and, under  favorable  con-
ditions, completely  disappears  in a  week  or  ten  days, gradually
drying up,  so that  the swollen  mucous  membranes regain their
natural tone.
  Under less favorable conditions, as in strumous subjects, resolution
takes  place  more sloAvly, and  the discharge remains muco-purulent or
purulent for an indefinite period.
  The tissues remain more or less  thickened, leaving a permanent
contraction  of the  calibre of  the nostrils, with slight difficulty  in
breathing through the nose.   A renewal of  the cold at this  time and
increased infiltration or relaxation of the submucous connective tissue
leave  still greater obstruction.   The tendency to recovery is  lost, and
the condition has  become one  of hypertrophic nasal catarrh.   In-
spection of the interior  of the nose shows the tissues at first dry and
red.   The ends of  the turbinated bones appear as puffy, red  cushions.
This  congested  state may extend to the vault of the pharynx and
involve the  orifices of the Eustachian tubes, and so lead to a train of
ear symptoms.
  During the stage  of  secretion  the membraues become very much
SAVolleu.   The erected turbinated  tissues completely close the lumen
of the nostrils aud  press firmly against the septum.   The same state
exists at the back of the nose, and the tissues on the loAver or middle
turbinated bones may even project into the  naso-pharynx, the whole
interior surface  being bathed Avith secretion, either  serous  or muco-
purulent,  according to the stage  of the  disease.   The intense swelling
makes an examination  rather  unsatisfactory  at this period.  The
mucous membrane remains slightly  reddened  for  some  time after
apparent recovery takes place.
  The usual method of treating cold in the head is with u contempt."
The patient, as a rule, takes the law into his  own hands, only seeking
medical advice when an attack of unusual  severity arouses his fear of
catarrh.
  Prompt treatment will often abort an attack of coryza, and, failing
in this, will cause it to run a shorter and milder course.  (See Iodine,
Menthol, and Camphor.)
  When it is the result of chilling the surface of the body, a Turkish
bath  may  be taken  at  once.   Should this  be  inconvenient,  or  too
active, a hot mustard foot-bath, Avitha hot draught or Dover's powder 
436                         DISEASES.
may be sufficient, with rest in bed, to bring on perspiration and a com-
plete relief.
   Whiskey, by its  power of increasing the capillary circulation of the
skin, is a useful remedy, especially where the heart is weak.
   It has been well  proved that whiskey is not equally efficient in pre-
venting an attack, as the first glow which it produces is followed by a
stage of depression, during which the resistance to exposure is lessened.
   The inhalation of steam  charged with such volatile substances as
camphor, cubebs or benzoin, may give relief to  the congested mucous
membranes.   Quinine by its action on  the nervous system often gives
good results, and is universally employed by the laity.
   As congestions of the mucous membranes  frequently result from a
torpid  liver or overloaded bowel, good  results often follow from small
doses  of calomel or a blue  pill, followed by a saline laxative.   The
saline purge alone,  by its revulsive  action, is often of benefit.  Meas-
ures to restore any  suppressed secretion should be instituted at once.
   Atropine in small closes  has given  me excellent results, employed
during the stage of free Avatery secretion.  It may be combined with
small doses of morphine, employing quinine at the same time.
   Locally, the use  of a mild alkaline or antiseptic wash gives relief,
by reducing the inflammation and  cleansing the parts from  secretiou.
The following, which is a modification  of the well-known " Dobell's "
solution, meets the  requirements :
         R.—Acid, carbol.  (cryst.)  .   .    .  gr. x. vel xv.
             Sodii bicarb. \                            .
             Sodii borat. /.....aa  3J-
             Glycerini.......f^j.
             Aquae......q. s. ad  Oij.   M.

   This solution  may be used by gently drawing it up the nose, or as
a spray from a hand atomizer.  When  the odor of carbolic acid is ob-
jectionable, it  may  be substituted  by  menthol, thymol, or eucalyptol
in very small  quantity.   When the membrane is too  much swollen to
admit  such a spray, the local application of a  2 or 4 per cent, solution
of cocaine will contract the tissues  long enough  to allow the employ-
ment of other measures.   Cocaine gives great temporary relief, but its
too frequent use appears to increase the congestion  aftenvard.
   The alkaline wash  may with advantage be followed by the insuf-
flation of the  following anodyne powder, known as Ferrier's  snuff:
         R.—Morphinae sulphatis.....gr. v.
             Bismuthi subnitratis.....gij.
             Acaciae........gss.

   Fluid cosmoline  sprayed into  the  nose, after  cleansing  it from
secretions, has a soothing effect.  The use of severe remedies, such as
irritating snuffs, while they deplete the tissues by increasing  the flow,
only intensify the inflammation afterward.
   The nasal  douche should be avoided in all conditions of obstruc-
tion in the nostrils, especially in obstruction to the outflow of liquids.
As a rule, solutions  are  carried into the nose more readily than from 
CROUP, SPASMODIC.
437
it, and in such a case the hydraulic pressure may force the fluid into
the Eustachian tube.   This accident  is  fortunately rare.   The Avriter
has the record of only one  such instance, in which a physician using
the douche for the first time, suddenly felt the water rush into one ear;
the hearing was instantly  lost and  never recovered.   The accident
occurred some years ago, and the exact condition was not ascertained
at the time.
   After recovery from coryza, tonics, and especially iron, should  be
employed to fortify the system against a repetition of the attack.
   Important prophylactic measures consist in exercise in the fresh air,
cheerfulness,  attention to the state of the skin,  the  use of Avoollen
underwear, and the avoidance of dissipation, late hours, reading Avith
the head  near a hot lamp, dust, draughts, or anything which lowers
the vital forces.


                             CROUP.

                        (See  Diphtheria.)


                    CROUP,  SPASMODIC.

   As this  is a spasm of the glottis depending  for  its  causation upon
catarrh of the mucous membrane of  the larynx, aud as it is due most
commonly to some reflex  irritation, such as dentition,  indigestible
food,  or sudden atmospheric changes, the  treatment is both prophy-
lactic aud curative.   Prophylaxis consists in the  avoidance of cold,
the use of a simple diet, particularly  at the evening meal, the render-
ing of the air of the bedroom moist by means of steam, or at least by
the avoidance of dust-laden, furnace-heated air, aud by the removal of
dental irritation and  nasal hypertrophies, which  make  the child a
" mouth-breather."  Small  doses of the bromides, chloral, belladonna,
or opium may be resorted to at bedtime.   A very useful  prescription
for this purpose is the one that follows :

         I£.—Sodii bromidi......3j.
            Syrupi lactucarii......f ^ ij.    M.
    S.—Teaspoonful to a dessertspoonful on  going to bed, and once or twice during
the night.

   When the attack is present, a cold  cloth should  be wrapped about
the neck and the child placed at once  in a hot bath, the air of the room
being moistened by the steam escaping from a kettle of boiling water
or by pouring water upon  unslaked  lime.  If the paroxysm is very
severe a few Avhiffs  of amyl nitrite may be employed, or antimonial
wine in the dose of 1 drachm  may be used to cause vomiting.  It is
also useful to  disseminate  the  fumes of menthol  through the air of
the room by heating some  crystals in an iron  spoon.  If the fumes
are strong enough to produce a distinct odor they are present in suffi-
cient amount. 
438
DISEASES.
  The drugs  first  named do good by decreasing reflex excitability,
while  the  emetics  indirectly relax  the spasm  by the nausea and
depression which they produce.


                      CYSTITIS,  ACUTE.

  If, by reason of exposure to cold, iujury, the introduction of foreign
bodies, such as dirty catheters, or the presence of gonorrhoea or other
disease due to a septic poison, an acute  inflammation of the bladder
ensues, it is accompanied by a sensation of weight and vesical fulness,
by pain, tenesmus, and inability to retain the urine.  Sometimes the
last-named condition may be reversed, and retention of the urine be
present.
  If the general system responds  to the local inflammation, as  evi-
denced  by increased arterial excitement and  fever, aconite, in full
doses of the tincture, should be used, and it should be combined Avith
small  amounts of sweet spirit of  nitre  and citrate of potassium, as
follows:
         R.—Tinct. aconiti......f gj.
             Spirit, aether, nitrosi .   .    .   .    .  f ,^j-
             Liquor, potassii citratis   .    .  q. s. ad  f ^vj.    M.
   S.—Dessertspoonful every four  hours until all fever ceases and the pulse is quiet.

  At the same time a hot compress should be applied over the blad-
der,  but it should  not contain  turpentine  or  any  irritant substance
which  may be absorbed  from the  skin  and when eliminated by the
kidneys irritate the  bladder walls.  Leeches may be placed upon the
perineum or cups applied to the region of the sacrum.  In  some cases
belladonna may be used with  or  without aconite in the dose of 5 to
10 drops of the  tincture three times a day, and it is worthy of note
that this drug is particularly  serviceable  in the cystitis due  to cold; 5
drops of liquor potassa every four  hours may be substituted for the
citrate of potassium, or the  acetate  of  potassium may be used.  If
there is much pain and bearing-down, an enema of 30 drops of laud-
anum  in 2  ounces  of starch-Avater may be employed, or  the opium
may be giA^en in suppository.
  Sometimes  a  belladonna  suppository is of  more service, and an
iodoform suppository will often relieve the pain by its local  anaes-
thetic effects.  Hot  enemata, without any  drugs,  are often valuable
as a means of relief, aud  a  hot sitz-bath  is very  efficacious.   Can-
nabis indica,  if an active preparation can be had, is  better than opium
to relieve  the pain,  since it seems  to  affect the bladder  favorably.
The other curative measures  are hygienic, and consist in the mainte-
nance  of the  recumbent posture, absolute  physical and  mental rest,
the avoidance of  all foods which  are stimulating, as rare  meats and
highly-seasoned dishes, and abstinence from all  varieties of alcoholic
beverages.
  Should the inflammation be severe enough to become purulent the
physician should order  salol in  the  dose  of  10 grains three times a 
CYSTITIS, CHRONIC.
439
day.  This drug being broken up in the bowel into carbolic acid and
salicylic acid is so eliminated and renders the urine antiseptic.
  Laxatives are to  be  employed  with persistence if the bowels are
confined,  and salines in  the  early  stages  are  generally  better than
vegetable purges
  Quinine should not be used against the fever, as it is contra-indicated
owing to its irritant effects upon the bladder.


                     CYSTITIS, CHRONIC.

  The treatment of  chronic cystitis  is entirely different  from that of
the acute  form, and  consists iu  the use of remedies which will stimu-
late the diseased mucous membrane, cause a normal secretion of mucus,
and so  influence the urine that  the  mucus  already  formed will  be
passed out and the fluid rendered alkaline or acid, as may be desired.
When the secretion  of mucus in large amount is persistent, the  urine
should be rendered alkaline  by  the  use of liquor  potassa,  or the
citrate, acetate, or bicarbonate of potassium.  The bitartrate of potas-
sium is eliminated  as the bitartrate of potassium, and, as it is acid,
cannot be employed.
  We acidify  the  urine  because of the necessity  of dissolving the
phosphates  and preventing deposits  in the bladder and elsewhere.
The two best drugs  for this purpose are boric acid, in the dose of 5 to
10  grains, or benzoic acid, in the same amount.  Both of these may
be  given in pill form, made by  adding a little glycerin.  The rule
may be laid  doAvn  that, if the  urine  is high-colored and is strongly
acid, alkalies are  useful; Avhereas  if it is light in color, but loaded
with phosphates, the acids named should be employed.  Salol may be
given to prevent decomposition of the urine.
  One of the best measures for the relief of chronic cystitis is to wash
out the bladder daily, by irrigation  with warm  water, or Avater con-
taining bichloride of mercury  in the  proportion of 1 to 10,000, as
this washes aAvay all mucus and uric acid deposits, and prevents irri-
tation.   Solutions of nitrate of silver have been used with great suc-
cess Avhere the discharge is muco-purulent, and Thompson recommends
the use of a solution of the strength of 1 grain  to 4 ounces of water,
gradually increased  to 2  grains to the ounce.   Others, such as Gard-
ner, Richardson, and Potter, recommend the use of stronger solutions,
5 grains to the ounce of water, claiming that while these amounts may
produce serious effects in some instances, they are \7ery efficacious in
obstinate  cases.  The physician should have at hand a solution of
common salt, which he should inject into the bladder at  once if the
action of the silver solution is too painful, or seems  excessive.   This
treatment is only suited to the most chronic cases.
  The remaining remedies Avhich  are  employed  internally in chronic
cystitis are those which are directed to the improvement of the mucous
membrane of the bladder, and consist in buchu in  the  form of the
fluid extract in the dose of \ to 1  drachm, well diluted, arbutin or 
440
DISEASES.
ursin, 3 to 5 grains, or the fluid extract of uva ursi, dose 30 drops to
1 drachm.   All of these are better fitted for the treatment of subacute
than chronic cystitis, as they are not sufficiently active for the chronic
forms.
  In cystitis of an advanced type, with great vesical atony, strych-
nine is of service, and drop doses of tincture of cantharides  do great
good.  Turpentine may also be used with advantage in 5 to 20-drop
doses, as may also the oils of eucalyptus,  sandalwood,  cubebs,  and
copaiba.
  All these measures are suitable for the treatment  of cystitis in the
male and female, but it is to be noted that injections into the female
bladder are made much more readily than  into that of the male, be-
cause of the  shortness of  the  female   urethra.   In either case the
operation  is best  performed  by attaching a small  funnel to a soft
rubber catheter and filling the  bladder by raisiug  the funnel above
the patient's belly.   Creolin has beeu highly recommended by Parvin
in the strength of from 1 to 2 per cent, with water.  The irrigation
is to be performed every twenty-four hours.
                   DIABETES INSIPIDUS.

   In diabetes insipidus the disorder  exists simply as a profuse  urin-
ary  flow dependent upon  some disorder of the innervation of the
kidney, or upon atony  or  relaxation of this organ.  The treatment
consists in the use of astringents and  tonics, and in some cases iu the
employment of opium or belladonna, particularly if the over-secretion
rests upon nervous irritability.   Gallic  acid may be used in 20-grain
powders three  times a day, and the fluid  extract or  wine of ergot  is
often of service given in the dose of 30 drops to a drachm of the
former  or  a wineglassful  of the latter.  As tonics, the  sulphate  of
iron and strychnine are indicated.


                   DIABETES  MELLITUS.

   In the treatment of this  affection it should be remembered that it is
the result of disordered function and is not a disease in itself, but a
symptom of several disease  processes.  For this  reason a remedy which
succeeds in one case may fail in another.
   The treatment of diabetes mellitus is dietetic and medicinal.  The
diet  list should consist largely of meat, particularly  of meat  Avith
some fat attached to it, as the fat takes the place  of starch in the
nutrition of the body.   The avoidance  of starches of all kinds, and
the use of dry wines, or those containing little or no sugar, is to  be
insisted upon.  Beers and malt liquors  must be forbidden.   Accord-
ing to some authorities, the patient should be placed in bed and put on
a purely milk diet, generally of skimmed milk,  although buttermilk is
better than any other  form, owing to  its lactic acid and  lack of sugar. 
DIABETES MELLITUS.
441
Koumyss for the same reason is very valuable.  The chief aim of the
patient must be to avoid all substances Avhich can be readily converted
into sugar by the organism.
   The folloAving list of foods and drinks may be taken, and the second
list forbidden.1
   Meats of all kinds (except li\Ter), eggs, fish, cheese, butter and cream.
Oyster-plant, asparagus (?), tomatoes, almonds, pecan nuts, butternuts,
walnuts, and cocoanuts.   String-beans, beet tops, radishes, mushrooms,
lettuce  and water-cress, cauliflower, spinach and onions.  Celery and
cucumbers may also be permitted.
   Of the foods and drinks to be avoided we have all forms  of sugar,
all forms of starch, such as ordinary flour, cornmeal, arrowroot, sago,
tapioca, oat-meal, barley, carrots, beets, parsnips, pie-plant, peas and
beans, chestnuts and most of the fresh fruits, cider, beers, champagne,
sweet Avines and honey.
   The treatment of diabetes  by drugs is varied by the condition of
the patient, the cause  of  his disease, and the quantity of sugar in  the
urine.   While the drugs most commonly employed are used in many
instances  without  any knowledge of how they act, and have  each of
them a set of warm supporters among prominent authorities, much of
the treatment must depend upon whether or not a rheumatic or gouty
taint is the cause of the trouble, or Avhether it  is due  to high living,
little exercise, and a plethoric, congested, overloaded system.  In  the
first class of cases iodide of  potassium and the salicylates will be most
serviceable;  in  the  second class, a restricted diet, moderate exercise,
and  purgation to relieve engorgement of the hepatic artery  and veins
may be needed.  In the cases of gouty diabetes where relief does  not
follow the use  of the  iodides and  colchicum, resort must  be had  to
arsenic and  lithium  citrate or  carbonate, a combination  peculiarly
adapted to such a condition according to several authorities.   Indeed,
arsenic is a  sheet-anchor  Avith many practitioners  in all forms  of
diabetes, and should be given in fairly large, constantly repeated doses
for a long time.  A very much larger body of medical men rely on
opium,  or one  of its  alkalies, codeine.   The   former  is used in  the
dose of \ to J grain three times a day; the latter 1 to 5 grains three
times a day, and I have found it very useful.   The chloride  of gold
and sodium (fa grain) has  been highly recommended by Bartholow,
and ergot by Wood and DaCosta.  In cases depending upon rheuma-
tism, the use of salicylic acid is often  of great value, the dose being
10 to 15 grains three times  a day.
   In  cases of  diabetes in which diet will control the disease, the best
clinicians  insist that  drugs should be avoided, for when opium or any
of its alkaloids are used it is necessary to give rapidly increasing doses
which finally become enormous, as much  as  7 grains  of morphine a
day being  taken  by some persons.  Once having begun the use  of

  1 It is worthy of note that certain persons  may have a slight glycosuria without
serious injury, who waste under a limited  diet, requiring ordinary fare to support
the body plus the diabetic drain. 
442
DISEASES.
drugs in severe cases it is very dangerous to stop them, for clinical
experience has shown that many of these patients waste rapidly and
generally break down when this is done.  In regard to the time of
day at which to give the morphine or codeine, it  is generally consid-
ered  best about  one hour after meals.   Under the circumstances  the
drugs seem  to decrease  diuresis more  than if the  dose  precedes  the
meal;  further than  this, the stomach  is  not disordered.  In  some
cases results will be obtained from opium when its individual alkaloids
fail.  Careful observation of  the patient should be carried out to de-
termine the proper beginning and subsequent doses, and if at first the
opiates  fail to give relief discouragement should not be felt.
   Jambul is a remedy Avhich has  been  Avidely used by clinicians  for
the  relief of diabetes with  such varying results  that its position  in
therapeutics  is uncertain.   This is probably  because it is effective in
one form of diabetes and not in another, and we are unable to make
the clinical distinction.   Jambul is used in powder or the poAvdcr is
placed in capsules or pills.  The dose is  5  to 30 grains once to thrice
daily aud gradually increased.  As much as an ounce has been given
in twenty-four hours. This medicament is said to be advantageously
combined with a pure meat diet iu  diabetic cases.
   The  excessive thirst  of  diabetes can be best allayed by the use
of acidulated Avater or alkaline Avaters containing  non-purgative  salts.
It  is useless to cut  off  the water-supply, to the  productiou  of  great
suffering, but the patient should use moderation in drinking so far as
possible.
   The Avasting coming on in  diabetes is to be treated by careful diet,
rest, and the supply of all the food which the patient can digest.   In
many instances, the amount  of aliment ingested is extraordinarily large,
while in others digestion is  so impaired that food  cannot  be taken.
   If cachexia comes  on,  iron, strychnine, bitter tonics, the lacto-phos-
phates of lime and sodium, and astringents, are to be used to support
the circulatory and nervous systems.  Tea and coffee and all forms
of  food needing sweetening, may be rendered  palatable by the use of
saccharin or of glycerin.   The former  passes through the  body un-
changed, the latter increases the  glycogen in the  liver but checks the
formation of sugar (Ransom).
   Unfortunately we have no positive knowledge as to the minute and
innermost causes of  diabetes, nor the manner in which the glycosuria
is brought about, and in consequence cannot explain the manner  in
which opium, codeine, or other drugs produce relief.


             DIARRHOEA AND  DYSENTERY.1

  Diarrhoea  is a term loosely applied, with perfect correctness, to  all
*brms of intestinal disturbance accompanied by the passage of liquid

  1 The articles on Cholera, Cholera Morbus, and Cholera Infantum  should be care-
fully read in connection with this article. 
DIARRHGEA AND DYSENTERY.
443
stools, and its meaning, " to run through," expresses the state it repre-
sents.
  The treatment  of each form of diarrhoea depends upon its  cause,
and no case can be intelligently treated in which the physician fails to
recognize this aspect  of the  case.   Diarrhoea is but a symptom, not a
disease, and must  be regarded solely as au evidence of intestinal dis-
order.
  While the same drugs are prescribed in many forms of the trouble,
we may divide cases of diarrhoea into  four classes as follows : (a)  Those
in which the  laxity is due to a catarrh, acute or chronic, of the intes-
tinal  mucous  membranes, causing  the  passages  to contain mucus.
(b)  Those Avhere,  owing to disordered innervation,  a profuse outpour-
ing of liquid takes  place from the bloodvessels  into the intestinal
lumen,  (c)  Those in which, owing  to disease, the glands fail  to pre-
pare juices  to digest the food properly; and  finally  (d)  those cases
where ulceration causes irritation and bloody purging.
  The treatment of the catarrhal form first  named consists primarily
in the regulation of the diet, which should be made up chiefly of milk,
boiled or predigested, or of milk whey, and  in the administration of
castor oil or other mild  purge, such as sulphate of maguesium, to
sweep out fermenting food  and mucus.    Enough laudanum  should
accompany this oil to prevent griping, and it is well to add bicarbonate
of sodium, grains 20 to 30,  to the dose, both to aid the  action of the
oil and to render  the bowel alkaline in  reaction (normal)  instead of
acid, as caused by the fermentation  abnormally present.   A mustard
plaster or  other counter-irritant should  be  applied to the abdomen.
Often in the milder forms of mucous  diarrhoea this is all that is needed,
but more frequently it must  be  followed by  the  use of tonics  and
astringents, such as nitrate of silver  and  hyoscyamus in  the following
pill:
         R.—Argenti nitratis......gr. ij-
             Extract hyoscyami.....gr. v.     M.
    Ft. in pil. no. x.  S.—One 3 times a day.
Or,
         fy.—Plumbi acetatis......gr. ij.
             Extract, opii......gr. ij-    M.
    Ft. in pil. no. x.  S.—One three times a day.
  If these stop the diarrhoea and there still seems to be a tendency for
it to  return, or atony is present, we should use a pill containing the
extract of chiretta, or employ nitro-muriatic acid, or, better still, nitric
acid and  cardamoms, because the constant tendency to  relapse indi-
cates a deficient secretive action on  the part of the intestinal glands,
which these remedies are prone to improve :
         ty.—Acid, nitric, dil.......f.^j-
             Tr. cardamomi comp......^%}):
             Tr. gentian, comp......f 3 ij.     M.
    S.—Dessertspoonful every four hours.
  If the catarrhal state is persistent, no remedy compares to the chlo-
ride of ammonium, dose 5 grains every  four hours in liquorice  and 
444
DISEASES.
water.  Where the catarrhal state is exceedingly chronic and obstinate
it is well to employ 3 to 5-grain doses of potassium iodide.
  If the pills already named do not control the diarrhoea, the follow-
ing may be used:
         R.—Acid, sulph aromat......f^jss.
             Spt. chloroformi......^{5$'
             Tr. opii camphorat......f % ij.
             Syr. zingiberis   .   .    .    .   q. s. ad  f.^iv.    M.
    S.—Dessertspoonful every two hours.

Or,
         R.—Tr. kino.......
             Tr. catechu comp.    ....
             Misturae cretae   ......
             Aquae cinnamomi    .    .    .  q. s. ad  fjvj.     M.
    S—Shake well before using.  Tablespoonful every three hours.

  In the second form of diarrhoea named—that in which serous or
watery purging is  present—the treatment is radically different.   In
these cases the bloodvessels of the gut are relaxed and leaking, and
must be  contracted and made water-tight.   This dilatation may  result
from fear (" nervous diarrhoea "), from exposure to cold,  or from ex-
haustion, extreme heat, and irritant food.   If from irritant foods, they
are generally swept out in the first flush  of liquid.
  The measures to be adopted consist in those directed to  the contrac-
tion of the dilated and relaxed bloodvessels, and the restoration of the
proper nerve-supply to the parts.
  As the splanchnic nerves are the  vasomotor nerves  of the intestine
as well as  the inhibitory  nerves  of peristalsis, it is evident that  we
must use drugs which Avill cause stimulation of these  fibres, and the
chief of  these is found to be opium, which diminishes intestinal  peri-
stalsis and  secretion by just such  an influence.    In the same way
small doses of volatile oils are of service, and camphor and spirit of
chloroform may be used.   As there is relaxation, astringents are indi-
cated ; and as sulphuric acid is not only astringent, but eliminated by
the lower bowel, it is peculiarly serviceable.   We find, therefore, that
the following prescription  fulfils every indication :
      R—Acid, sulph. aromat.
         Olei cajuputi
         Ext. haematoxyli fi.
         Spt. chloroformi .
         Syr. zingiberis
S.—Teaspoonful in water every two or three hour
 .  fgss.
 .  gtt. xl.


ad  fgiij.    M.
  If desired, kino or catechu may be used in lieu of the haematoxylon,
or the oil of cloves substituted for that of cajuput.   Camphor or pare-
goric may also supplant these drugs.
  In some instances  these attacks appear to depend upon hepatic dis-
order, and the only cure, aside from partial relief, is to be obtained  by
the use of 2  to 6  grains of mercury with chalk (hydrargyrum  cum
creta) or calomel given in \ to J grain doses.  What is said of intes-
tinal  disorder from lack of secretion under the  heading of Cholera 
DIARRHCEA  AND  DYSENTERY.
445
Infantum applies very forcibly to these cases, and diarrhoea may per-
sist for weeks, or only temporarily be held in check by the most pow-
erful drugs, until the physician thoroughly flushes the intestine with
bile  by the use of prodophyllin and calomel.
  Wood  has highly recommended the use of a bismuth powder con-
taining a  drop or two of carbolic acid.
  The third class  of cases seems, in  many instances, to lie between
those just spoken of and those  in which the writer has placed them;
they occur chiefly  in children  and consist  in the foetid, " mousy "-
smelling  stools  of summer diarrhoea, with green, spinach-like masses
of semi-digested food, or distinct lientery.   They may be due to defi-
cient glandular action  in  any part of the alimentary canal, and are
often cured by  the use of pepsin and  hydrochloric acid  to perfect the
gastric processes.   In  other instances the duodenum is at fault, and
should be excited  by small doses of nitro-muriatic acid, or  by podo-
phyllin in the dose of fa to fa of a grain, with a little milk-sugar, or
given in alcoholic solution.  Similarly, ipecac in powdered form may
be used in the dose of 4; to 4; a grain three times  a day.   In the case
of children, avIio are often sufferers from rickets, phosphate of sodium,
lime salts, and  common salt should be freely given.
   For the purpose of establishing intestinal  antisepsis, carbolic acid
may be used, and naphthalin, thymol, and other  drugs  of this  class
have been employed, particularly salicylic acid.  None of them com-
pare with carbolic acid, however, which should be used in 1-drop doses
on bismuth or  in Avater.  When the carbolic acid is  given to a child
it is best prescribed in such a way that in each teaspoonful a half-drop
is present.  This teaspoonful of liquid should be placed  in a table-
spoonful  of Avater.
   Sometimes a good-sized, brisk purgative dose of calomel  followed
by a saline does good in these cases, if  they are strong  enough to
permit of its use.
   The regulation of the diet, which should consist iu sterilized  milk
or koumyss, the  former being  predigested, is  of  the  greatest impor-
tance, and the proportions of the milk, water, and cream placed in the
bottle for the baby should be varied until  a  mixture  is  formed which
is exactly fitted  to  the digestion  of  the  case.   The after-treatment
consists  in the  use of  tonics  and  a  carefully regulated diet, which
should be largely composed of milk and milk  foods.
   The fourth  type, generally known  as dysentery,  is  due in  some
cases to hepatic trouble, in others  to  the drinking of impure water,
and in the  third place to exposure to heat and bad food.   It  is in
most cases a very obstinate form  of diarrhoea, requiring much skill
and patience for its cure.   In the chronic forms deep ulcers may
exist; in the milder cases a high inflammation is present.
   In  those cases which are due to exposure to heat  and  hepatic
trouble there are two remedies which  are far above all others in value
and should always be  resorted to.  The  first  of these  is  ipecac,  the
second is calomel.
   The ipecac should be used  in a special manner to be effective (see 
446                        DISEASES.
Ipecac), and  the  calomel  should be used in full purgative  amounts,
but is contra-indicated if much weakness is present.
  If the passages are slimy and bloody T4^ of a grain of bichloride of
mercury every hour or two is of service, and if much blood is present •
injections of the distilled extract of hamamelis are of value.   In some
forms  of dysentery due  to acute inflammation large enemata of iced
water are of  the greatest value.   The water should  be ice-cold and at
least a quart  injected by hydrostatic pressure.   This  method can only
be used in  strong persons.   The  following mixture may be injected
into the bowel in place of cold water in  feeble cases:

         R.—Sodii boratis
             Tinct benzoin.
             Spt.  camphorae
             Aquae bullientis

  If the ulcers are very old and chronic, nitrate of silver injections of
the strength of 10 to 20 grains to the pint of water may be employed
in large bulk, a salt solution  being at hand for the destruction of the
silver salt if  the action which ensues is too  severe.
  For the manner in which to use  these intestinal irrigations see
Cholera and  Cholera Infantum.
  Recently the injection of water or medicaments into the bowel for
the purpose  of influencing the  intestinal wall has  given way in the
hands  of prominent physicians to irrigation by means of an  inlet and
outlet tube.  The inlet tube should be attached to a  fountain syringe,
and the outlet tube be long enough to  reach to a  vessel by the side of
the bed and  of sufficient  calibre to carry off flaky mucus.  In many
cases of dysentery of a mild form  rectal irrigation will  suffice, but if
the entire  colon  is involved larger injections are  necessary.   The
irrigation  should  be  continued until  the returning  fluid  becomes
perfectly clean  and  free from foreign particles.   If the bowel move-
ments  are  very  frequent, the injections may be made every three
hours.   Probably the best solution to  employ  for  irrigation,  where
much  mucus and pus  is  present, is one  composed of bichloride of
mercury 1  : 5000.   When this is  used, a pure water injection or one
of  1 :  30,000 should  follow it  in  order to prevent absorption of the
mercury into the  system.   If for any reason the effect of the bichloride
is feared, boric acid may be used in the proportion of 1 drachm to the
pint.
  Tannic acid is  an intestinal antiseptic, and  can be employed  in the
strength of 1 drachm to the pint for irrigation purposes.
      DIPHTHERIA AND MEMBRANOUS CROUP.

  Diphtheria is at first a distinctly local disease, the membrane in the
throat forming a nidus from which the entire body ultimately becomes
filled by the poison  manufactured by the microorganism peculiar to
the malady.   The author does not believe that membranous croup
3J-

Oij.
M. 
DIPHTHERIA  AND  MEMBRANOUS CROUP.      447
and  diphtheria are distinct diseases, but regards one as the mild or
undeveloped  form of the other.  As the treatment is identical, be the
belief of the physician Avhat it may, the case should always be consid-
ered as true diphtheria until it  is proved to be some other disease.
  The treatment of the  throat-changes before the membrane appears
should consist  in  the use  of sufficiently large doses of belladonna to
impress the system,  accompanied  by painting  the pharyngeal wall
with a solution of chlorate of potassium of the strength of 15  grains
to the ounce, or, if this  seems  too  strong, only  5  grains to the ounce
may be employed.   After the membrane is formed, its dissolution may
be carried on  by the use  of the atomizer spray with lime-water, or
with lactic acid solution of the  strength of 30 grains to the ounce,
every hour.  In other instances a solution of trypsin, one of the fer-
ments of the pancreatic  juice, may be used on a swab or by means of
a spray  to digest the membrane.  Other cases do well when a solution
of boric acid  is applied dissolved  in glycerin in a water-bath in the
strength of 1 to 30.   Still another solution, which may  be used by
means of  a spray from an atomizer  with great advantage, is made as
follows :
         R .—Sodii bicarbonatis")                   aa    xx
             Sodii boratis     I                '       ° X  '
             Aquae........f § ij.   M.
    S.—Use in atomizer.

  After the  use  of  this solution there is often an expectoration of
creamy  mucus mixed with  particles of false membrane.
  Of all  the  treatments which  are directed against the  membrane,
laden as it  is Avith the  microorganisms of the disease, none compare,
in the opinion  of the author, to the peroxide of hydrogen.  A cotton
swab should be soaked with the stroug undiluted  15-volume prepara-
tion and  pressed against the mucous  membrane which  is  diseased.
The effect is often extraordinary.  After a few applications the false
membrane appears to exist only in  disorganized  shreds.  If the nasal
chambers become  affected, a solution of the strength of from 1 to
4 to 2 to 4 parts of peroxide of hydrogen (15-volume) should be used
in a spray or with a syringe, the child breathing through  its mouth.
The applications should be  made  as rapidly as the membrane forms.
Another very useful application, which is more readily obtained than
the peroxide of hydrogen, is tincture of the chloride of iron undiluted.
A cotton applicator is used as with  the peroxide  of hydrogen, but care
must be taken that the  cotton is not so fully soaked in the iron solu-
tion as to permit of drops falling into the larynx or on the teeth.
  Cohen states that  in diphtheria the disengaging of sulphurous acid
fumes by the method usually carried out in  the disinfection of rooms
is a useful prophylactic measure against the contraction of the disease.
  By far the best thing for the physician to do to prevent  or limit  the
formation of membrane, consists in the judicious use of mercury.  This
is  to be done by employing fa to  \ grain of corrosive sublimate in
divided  doses in twenty-four hours, or in other words, by the adminis- 
448                         DISEASES.
tration of fa grain every hour, or by using calomel 4; to J grain every
hour, until the evidences of the action  of the mercury are shown by the
loose stools.   It is said the stools following this use of corrosive  sub-
limate in diphtheria sometimes resemble " frog spavra "—that is, are
frothy-looking.  The object  in using the  mercury is to cause a lack of
plasticity in the blood,  so decreasing the exudation  of fibrin.   Having
made this attempt, which is only to be tried  in  sthenic cases,  sup-
portive measures are to be resorted to, and for this purpose tonics and
stimulants with nourishing food are to be employed.  Tincture of the
chloride of iron, quinine, and strychnine are of service to keep  the
kidneys active, to stimulate the heart  and respiration, and to  support
the vital forces.
   The tincture of iron is  given internally by some physicians from the
beginning to the end of the attack, but it  certainly does the most good
after the disease is thoroughly under way, and should be used in large
quantity if great exhaustion and anaemia appear.  The dose may be
as much as 2 drops every hour to a child of four years, or even more
than this may be given.
   The food of a child during an attack of diphtheria should consist in
pancreatized and sterilized milk.  The object is to keep the  bacillus
limited  to the  throat, yet with every drink of ordinary milk they are
taken into the  stomach  in a culture medium.  It is  always best to use
an antiseptic spray or swab before giving the sterilized milk, to render
the mouth as far as possible antiseptic, and to avoid the gagging, which
may result in vomiting, if the swab is used after taking food.
   Another treatment which  is often of great value in the treatment of
diphtheria is  the use  of turpentine,  either by inhalation or by the
stomach. Its use should follow the employment of the mercury should
this drug fail to abort the formation of the exudate.  All those who
have given turpentine internally in  diphtheria agree that the dose
should be very much above that recommended  in other states.  Thus
it is stated that from \  to 1 drachm^Kild be given three times a day.
The following  prescription may be mrployed :

         E.—Spt. terebinthinae......f ^ ij.
            iEtheris fortior......f^j.
            Alcohol......  q. s. ad  f %\n%  M.
    S.—Teaspoonful three times a day in cold water.

  If the patient is old enough  the turpentine  may be given  in cap-
sules, and followed at  once  by a drink of milk or water to prevent
irritation of the stomach by  the concentrated stimulant.
  Turpentine acts in these cases as a  respiratory, cardiac and general
systemic stimulant and  at the same time as an antiseptic in the mouth,
alimentary canal aud kidneys.   It also acts as a diuretic and prevents
renal torpidity.
  The other method of  using  turpentine is  by  inhalation, and  is
highly recommended by J. Lewis Smith.   The following prescription
is placed in Avater  in  the proportion of 2 tablespoonfuls  to a quart,
and  this mixture is then placed  on a gas or oil  stove in a broad open 
DROPSY.
449
vessel  aud allowed to boil constantly.  The air  of the sick-room is
soon laden with the vapor, Avhich is  not offensive.  The prescription
is as follows :

         R.—Acid, carbolici \                    -- e-z-
             Olei eucalypti  J.....aa to3-
             Spt. terebinthinae......f^viij.  M.
    S.—Use as directed.  Label:  Poison if taken internally.

  Hundreds of other measures have  been recommended and em-
ployed until almost every physician has his favorite  method, but the
treatments here given  Avill  be found advantageous  iu the majority
of cases.   Where the glands of the  neck  threaten to suppurate, ice-
bags should be applied to the throat and pieces of ice held constantly
in the  mouth Avhile the tincture of  iron  is pushed in as full amounts
as possible.
   If suffocation is imminent, inhalations of oxygen are to be used and
atropine or strychnine employed, although tracheotomy or intubation
may be necessary.
   Chlorate of potassium must never be given internally, as  the kid-
neys are already severely iuflamed, and  this drug is  not only useless
when so given, but is in addition a renal irritant.
   Although the author has  been criticised for this last statement, he
is convinced of  its truth ;  aud that he is not in error is proved by the
fact that no less eminent authorities  than H.  C. Wood and J. Lewis
Smith agree with  him.

                            DROPSY.

   Dropsy  is to be regarded  as a symptom, not as a disease in itself,
which may arise  from many causes, such as cardiac, pulmonary, or
renal diseases, or depend upon obstruction, from various causes, to the
normal flow of the blood and  lymph through the vessels and tissues.  Its
existence is dependent upon so many causes of a still more indirect nature
that it is  almost  impossible to  notice all of them, but the following
consideration of the subject will at least make clear some of the reasons
for its occurrence  and  indicate the means Avhich are to be taken for its
relief.
   At  the  very  start Ave are confronted by facts which  seem  para-
doxical, but which are  in  reality quite  reconcilable.   These are, that
low arterial pressure  predisposes  to  dropsy and that high  venous
pressure does likewise, or,  in other  words, that the cause of exudation
on one side of the circulation is its  prevention on  the other.
  The explanation of  these statements lies  in a thorough understand-
ing of the physics of the circulatory system and  its anatomical struc-
ture.   It Avill be  remembered that dropsical  exudation takes  place
from the capillaries, and that the integrity of the walls of the blood-
vessels  and lymphatics depends upon  normal nutrition, or, in other
words, upon a  proper blood-supply.   As a consequence, dropsy may
be due to poorly  nourished vessels as much as to any other cause.
                                29 
450
DISEASES.
Further than  this,  a watery state of the blood  permits abnormal
exudation.
  The force exercised  upon  the column of blood  as it is driven out
by the heart into the aorta may be considered as the chief support of
the capillary circulation, so that  if the  heart  be Aveak the pressure
falls in  the arteries, and  in  consequence the  rapidity of flow is de-
creased in  the  capillaries,  while, on  the other hand,  an increased
cardiac activity hastens the  capillary circulation.    As the  arterial
pressure and force depend not only upon  the heart force, but also upon
the tonicity of the arteries which carry the blood  stream, it becomes
evident that dilated  arteries  must  lower blood-pressure even if the
heart be  strong, although practically the heart  and  A^asomotor  system
generally fail or increase in tone together.  We find,  therefore, that
a weak heart or a relaxed artery both  tend to cause stagnation of the
blood  in  the capillaries,  and  having  found that such  stagnation is
productive of exudation it  is  not hard  to  discover Avhy low arterial
pressure is a cause of dropsy.
  Having shown this to be true, let us turn to an explanation of the fact
that a  high  pressure in the veins is productive of the same changes.
  Here  the normal pressure is almost nothing, being much less than
in the  arteries, and considerably less than in the capillaries.  The
result of  this is, that in health the blood flows  rapidly  from the high
pressure of the artery  to  the low  pressure of the ATein,  and passes
through the small veins  under a gradually decreasing  pressure until
it reaches the heart.  Any obstruction  to this venous  flow must in-
crease  the venous pressure, and the venous pressure being increased
the rapidity of  flow through  the capillaries must be decreased.  The
whole  subject may be made more clear  by the following example :
  Supposing that two  iron tubes are connected at  one end by  several
lines of rubber tubes (the capillaries), and that water is flowing into
the first tube, or the artery, under a pressure which is represented by
the  figure  100, while  the resistance to  the flow in the second tube,
the vein, is represented  by the figure  0.   It at once becomes evident
that the rapidity of the  Aoav through  the connecting rubber tubes
will be  very great, whereas,  if the pressure in the first or arterial
tube is decreased  to 50 the rapidity is decreased to one-half, or if the
pressure  in the second tube  be increased  to 50 instead of remaining
at 0 the same  changes will occur;  in  either instance capillary flow is
lessened, and exudation is  caused.  This is the pathology of dropsy,
and having understood it, let us proceed to  discover  the causes of
dropsy in various diseases.
   In cardiac disease it is due to a weak heart being unable to supply
the arteries with enough blood to maintain the normal  pressure, or to
a damming-up of blood in  the venous system as the result of the
imperfect emptying of the cardiac cavities.  In the first instance low
arterial pressure produces dropsy ; in the second, high venous pressure
has a similar effect.1

  1  For an explanation of the changes in the action of the muscle, valves, and cardiac
action in heart disease, see Heart Disease. 
DROPSY.
451
  In renal troubles the dropsy depends more upon the lack of proper
nutritive  processes in the capillary walls  and upon changes in the
blood-pressure  than upon other causes.  If the kidney is diseased it
may not be able to eliminate  the proper quantity of liquids, which
accumulate and finally escape  into  the tissues, while the same failure
iu reual function causes disease of the  blood-paths  themselves, and
often produces cardiac complications.
  Hepatic troubles cause dropsy by producing pressure upon the large
bloodvessels going to the liver, and, in consequence, the exudation is
generally  confined to the lower  limbs aud abdomen.  If  the hepatic
trouble be severe, some failure  in the nutrition of the bloodvessels and
changes in the quality of the blood  may ensue.
  Pulmonary disease rarely causes dropsy unless the venous pressure
is greatly increased and productive of cardiac  dilatation, or,  as in
phthisis, Avhere  the changes  in the nutrition of the body involve the
bloodvessel AA^alls and the blood.
  Haviug spoken of these causes of dropsy, it remains for us to con-
sider its treatment, Avhich may  be divided into two parts, namely, that
directed to its removal Avhen ouce the liquid is poured out, and its relief
or cure by direct attention to its causes.   The means for the removal of
the fluid are suitable in all cases, be the cause Avhat it may, unless the
dropsy be of renal origin.  Whenever an accumulation of liquid  takes
place in the tissues, drugs or measures must be resorted to which will
cause  the emuuctories  of the  body to get rid of  it.  In ascites, in
particular, we may employ elaterium in the dose  of -1- of a grain, or
elaterin in the  dose  of 2V 0I* a grahb  placed  in the mouth and
washed down by a little water,  or, if this is not  used, the compound
jalap powder  may be resorted  to,  in  the dose  of 20 to 30 grains,
and to it may  be added, to increase its efficiency, 10 grains more of
bitartrate of potassium than the official powder contains.  These two
remedies are particularly serviceable in renal dropsies, since the ela-
terium is supposed  to aid  in  the elimination of urea by the bowel,
Avhile the cream of tartar in the jalap  powder increases the action of
the kidneys.
  The cream of tartar is not to be used in cases of acute nephritis.
  Compound extract of colocynth may be  employed in the dose of
2 to 6  grains, according to the  state  and idiosyncrasy of the patient.
  All  these remedies relieve dropsy by causing so great an outpouring
of liquid  from  the bloodvessels of  the body that the liquids in the
tissues are takeu  up by the depleted bloodvessels  to replace the loss
through the action of the purgative.
  In other words, these purgatives render the alkalinity of the blood
greater by concentration, and absorption of fluid  occurs by reason of
the following physiological and physical facts:
  As  is well knoAvn  to every physiologist,  the passage through a
bloodvessel of a salt  solution of less than fa of one per cent, causes
an abstraction of salts from the surrounding tissues by the circulating
fluid, in order that the amount of salts  in the vessels and tissues may
be  identical.   At the  same time  the tissues  become infiltrated Avith 
452
DISEASES.
liquid.  On  the other hand,  if  the  solution  be stronger than  the
normal, the liquid leaves the tissues  to  enter the vessels, and  the
tissues in consequence shrink.
  When salines are given to relieve dropsy they must be administered
in concentrated or saturated  solution and  on an empty stomach, total
abstinence from the drinking of  Avater being insisted upon until they
have  fully acted, for the  reasons  given in the last paragraph.   For
this  reason they should be given an hour or so before breakfast.   If
these directions are not followed this treatmeut is useless.
  The other means which we possess  for  the removal of dropsy are
by Avay of the kidneys and skin.   If  the  kidneys are hopelessly dis-
eased that pathway is  almost useless, but if they are only passive, or
partly inactive,  diuretics  may be used to stimulate their secreting
structure  and to  increase the leakage  of liquid through them by
increasing blood-pressure.   Such patients should  be placed almost
entirely on a milk diet, and many of them Avill greatly improve under
the use of buttermilk to the  exclusion of other nourishment.  If this
cannot be taken, sugar of milk may be employed as an active diuretic.
(See Sugar of Milk.)
  Often the kidney will be found inactive, because, owing to conges-
tion  from cardiac  trouble, it cannot act.   Under these circumstances,
digitalis, in 5 or 10-drop doses  of the tincture, given three  times a
day, will  be of  value, and its efficacy will be increased  by the addi-
tion  of 1  drop of  the tiucture of cantharides, if the renal lesion is ex-
ceedingly chronic or mere torpidity exists.   Digitalis and squill, in pill
form, as follows, may be  used :
         R.—Pulv. digital, fol......gr. xx.
             Pulv. scillae......gr. xx.     M.
   Ft. in pil. no. xx. S.—One every five hours.

Or digitalis and calomel  may  be  employed in pill form  in renal  aud
cardiac dropsies.
  Caffeine is also a useful  diuretic, particularly in torpidity of  the
kiduey,as it stimulates the secretory epithelium, thus eliminating urea
and other effete  matters, and increases the passage of liquids by  the
increased  blood-pressure Avhich it  produces.
  That a large  amount of liquid may be  gotten rid of through  the
skin under the influence of heat is  well known.  (See Heat.)   In
addition to external heat we  may use  pilocarpine by the  mouth  or
hypodermically  in localized dropsies, to produce absorption and con-
sequent elimination of liquid by  sweating.  No drug should  ever be
given hypodermically iu dropsy of a general character, as it will  not
be absorbed  from  the  water-soaked tissues with any rapidity, if at
all.
  The hydrochlorate of pilocarpine may be given in the dose of \ to \
grain by the  mouth, or J to 1 by the  needle.  This  method of re-
lieving dropsy is often very  exhausting, and should be most carefully
used if cardiac depression or weakness is present.
   If dropsy  depends upon deficient cardiac action digitalis will nearly 
DYSMENORRHEA.
453
always do good.  (See Digitalis.)  If this is not used, citrate of caffeine
Avill be found of service.
  Remembering that this  form of dropsy is the result of failure on
the part of the  heart  to do its work, Ave must use  proper exercise,
food, stimulants, and rest,  combined with  fresh air and  avoidance of
mental Avorry.
  An infusion  of scoparius, 1  ounce of the tops to a pint of  water,
taken in  twenty-four  hours, may be of service, and strophanthus,
sparteine, and adonidin may all be used if any one of the drugs fails
which are commonly employed.
  In hepatic cirrhosis, and in localized effusions of a chronic type,
the best treatment  for the  removal  of the liquid  is the  iodide of
potassium, or tapping with a  trocar and canula  attached  to  an
aspirating  flask.
  Where the tenseness of the skin  in the lower extremities  causes
danger of local sloughs, some authors recommend small punctures  for
the escape of the liquid, the limbs being incased in sterilized absorbent
cotton to absorb the liquid.   (See Acupuncture.)
 DYSENTERY.

(See DlARRHCEA.)
                     DYSMENORRHCEA.

   The existence of dysmenorrhoea depends  upon so many conditions
that the treatment employed in one  case  is seldom  productive  of
success in  the next.  This is not the place for a consideration of the
surgical measures adopted for the cure of this symptom, and only the
medical treatment will be spoken of.
   When dysmeuorrhoea results  from  the taking  of a cold, and  is
accompanied by  uterine  congestion and irritability,   the  following
measures are particularly valuable, and  may do  good in many cases
depending  upon other causes.  The patient should take a hot sitz-bath
and  immediately  get into bed as soon as  the buttocks are dried, being
well covered while  in  the tub, and afterward, by a blanket.  A tur-
pentine stupe is  now to be  used (see  Turpentine), and 10 grains  of
Dover's powder to be administered, unless some  idiosyncrasy toward
opium is known to exist, Avhen half or  one-fourth of this amount  may
be employed.   Often Avhen the attack is  accompanied by constipation,
a purgative dose of Epsom salts or aloes  is of service in  the congestive
forms of the disorder.
   If the pain is  persistently severe,  a  belladonna suppository, of J
grain of the extract, may be inserted  into  the rectum, or, in other
cases, belladonna  ointment smeared over the os uteri will be found  of
service.   The latter method  is generally impracticable  and is rarely
resorted to.  Very commonly belladonna tincture, by  the  mouth, is 
454
DISEASES.
of service  in  relaxing the spasm of the cervix and of the uterine
fundus.
  Some practitioners resort to the use of opium at  each  epoch, and
keep  the  patient partially narcotized until menstruation is passed.
This is unjustifiable and born of ignorance and bad practice,  since the
physician  is simply dodging the trouble and predisposing the patient
to future  attacks, by reason  of the constipation and the  resulting
habit which is sure to appear after the employment of opiates.
  When the dysmenorrhoea is due to obstruction of the cervical canal
by  organic  changes  or flexions, these conditions must, of course, be
relieved before a cure can be expected, and the medical treatment can
be directed only to the alleviation of the pain.  Divulsions or sIoav
or rapid cervical dilatation should be carried out by the use of instru-
ments or tents.
  In neuralgic dysmenorrhoea dependent rather upon  nervous disorder
accompanying menstruation than  upon menstruation itself,  measures
directed to the improvement of the nervous  system and the  nutrition
of the patient are necessary.   These cases generally occur in nervous,
anaemic women, run down by excessive dancing or other gaiety, or  by
the bearing aud care of a large family of children.
  A course of strychnine or quinine and iron in small doses is often
beneficial  in these cases,  aud  horseback exercise, between the men-
strual periods, out-of-door life  and aAToidance of excessive dancing and
exhausting exercise is to be ordered.
  Sometimes bathing the loius with alternate dashes of hot  and cold
water may do good in atonic patieuts.
  Cannabis indica and gelsemium  are often of great service, both as
cures and  alleviators  of  the  pain,  and antipyrine,  acetanilide, and
similar drugs may  be  resorted to  while  the attack lasts,  if it  be
neuralgic.
  When the pain seems to be greater than the patient can bear, enough
ether may be given by the physician by means of inhalation to produce
the primary stages of anaesthesia, but chloroform is not advisable, as
the patient,  if taught its value by the doctor, may resort to it without
advice and die from  an overdose.


                         DYSPEPSIA.

                        (See Indigestion.)


                          DYSPNCEA.

  Shortness of breath, or dyspnoea, arises from cardiac  Aveakness, abnor-
mal innervation resulting  in cardiac palpitation, from the accumulation
of fluids in  the  chest, from the involvement of the lungs by any dis-
eased process in such a way that respiration becomes impaired, or it is
produced by indigestion, or, finally, by the encroachment ou the lungs
or chest-walls of tumors and growths. 
EARACHE.
455
   Each of these states must be removed to effect a cure, but it is only
of the relief of the symptoms  that we will speak.
   In old persons who  suffer from dyspnoea, the result of bronchor-
rhoea, where a large amount of liquid fills the bronchial tubes, and
shortness of breath follows exertion, strychnine is the best remedy
that we  have.   Its  value depends  upon its powerful iufluence OATer
the  respiratory centres, on Avhich it acts as a stimulant, and  as these
cases very  commonly also have dilatation of  the right side of the
heart, Avith consequent cardiac enfeeblement, strychnine is of additional
service through its influence upon the circulation.   These persons are
not to be given  opium or its alkaloids, or any sedative drugs, as such
medicines, Avhile giving temporary relief  from cough, only  serve to
depress the  respiratory apparatus and cause an accumulation of liquid
mucus in the chest, as a result of the prevention of  cough  and  lack
of expectoration.  The cases in Avhich opium  or morphine  do good
are those in which through nervousness or  fuuctional neiwous disorder
the  respiratory  cycle is imperfect, and, above  all, in those  instances
Avhere dyspnoea occurs as the result of cardiac disease.   In these cases
the  attacks  of  oppression and  suffocation  can  often  be  entirely set
aside by the use of |- to  J grain of morphine  given  every night, or
night aud morniug.  If these doses fail, larger ones may be cautiously
used.  Hyoscine, instead of causing sleep, nearly always  makes these
cases Avorse.
   Sometimes a little carbonate of ammonium is  useful  as a respiratory
and cardiac  stimulant in cases of dyspnoea.
   Dry cupping applied  over the back of the chest may also be service-
able Avhen shortness of breath from  cardiac or pulmonary trouble is
present.
   In cases of dyspnoea due to emphysema and pulmonary inflammation
of a chronic type, or in those  persons who take cold  on the slightest
exposure, particularly after attacks of asthma, arsenic is useful if con-
tinuously employed.
   If pleural effusion be present, relief of a positive and lasting nature
can  only be obtained through aspiration, or, in other words, by the
operation known as thoracentesis.


                           EARACHE.

  Earache is generally due to an acute inflammation of the middle ear,
which has  arisen  either from exposure or by the extension of an in-
flammation  from the nasal cavities along the Eustachian tube. • In
any case, unless the patient  already be a sufferer from chronic catarrh
of the middle ear, the pathological process consists simply in an in-
flammation of the mucous membrane lining these parts without  the
formation of pus, except in those instances in which the changes  are
very severe.
  The buzzing in the ears, followed by more or less severe pain, is to
be relieved by measures which  are known to allay inflammation.   A 
456
DISEASES.
leech  may be placed in front or behind  the ear, and heat is to be
applied to the head on the side affected in a dry form, as in a bottle
or water-bag.  Poultices, oil and laudanum, and similar applications
are not to be resorted to, as they may ultimately cause trouble and do
not always produce temporary relief.
   Sometimes  dropping a little Avater, as hot as can be borne, into the
external  auditory canal gives great  relief if repeated  as fast as the
water cools.
   Cardiac sedatives are indicated, but  quinine is  distinctly  contra-
indicated, as it tends to cause aural inflammation.
   If a cold in the  head is present,  the patient must not  use nasal
douches  of any kind, but the physician may employ with advantage
a  fine  spray from an atomizer of a solution such as the  following
(Dobell's solution):
         R.—Acid, carbolic, (cryst.)     .    .       gr. x vel xv.
             Sodii bicarb. 1                        aa  _•
             Sodii borat. /......aa    .'
             Glycerini........f.^j.
             Aquae......q. s. ad  Oij.   M.

   Syringing the nostrils is a dangerous procedure except when  per-
formed by a specialist in ear or  throat and nose diseases.
   Relief is often obtained by a spontaneous rupture of the  tympanic
membrane so that the secretion escapes, or, in  other words,  the ear
" runs."   If pus is discharged it is often A7ery foetid.  This  accidental
relief is  no more to be waited for by  the physician than  is the  rupture
of an  abscess, but when the drum is seen to be bulging it should be
punctured and the fluid allowed to escape.   The mucus or  pus must
not be alloAved to accumulate  in the external  auditory canal, but be
frequently removed by swabbiug it out with pieces of absorbent cotton
on a probe or match-stick.  If  the discharge becomes adhesive it may
be dissolved by the use of a drop or  two of warm water or carbolized
oil, 1 to  100.  Sometimes the canal  may  be washed out by means of
a very gentle syringing with salt and warm Avater, a teaspoonful to
6  ounces.  After each  washing or  cleansing  finely powdered boric
acid is to be  blown into the  ear through a goose-quill or powder-
blower.

                            ECZEMA.

   This is probably the most common form of  skin disease  which the
physician is called upon to treat, with the exception of acne.
   Dermatologists divide it into many forms and stages, but in this
book a consideration of its forms is  out of place, and only the treat-
ment for its stages is proper.
   In the first place it may be stated  that the  treatment is a  quadruple
one, namely, dietetic, hygienic,  external and internal.
   In regard to diet, the patient  should be told to avoid salt foods,
such as salt fish or pork, and corned  beef; greasy foods, such as bacon
aud fried dishes, pastry and cheese.   Only moderate amounts  of  Avine 
ECZEMA.                        457
and beer can be taken, aud foods difficult of digestion are to be stricken
off the bill of fare.
   In the way of hygienic measures, fresh air, the avoidance of seden-
tary habits,  horseback exercise,  or walking  is  to be  recommended.
External  treatment is  the  most important of the two measures in
which  drugs are employed, and  its course is  perhaps  best described
by taking a  case of ordinary eczema as an example, and treating it
through its entire course.
   In the early stages of an acute  eczema, when the process is  very
active  and  the  erythematous reddening  of  the beginning of  the
disease is merging into the formation of vesicles or  pustules,  with
the formation  of large scabs, no application  is  better  than oxide of
zinc ointment thoroughly applied night and morning.   If  the eczema
be situated upon the scalp the hair must be invariably clipped short
or shaved  off  in such a  way as to preveut  the gluing of the hair
into a mat by reason of the discharge.   The ointment may be smeared
over the part or applied on a piece of lint in a thick layer.  Nearly
always the  ointment should  be  used in conjunction  with  black Avash
(calomel  1 drachm, lime-water 1 pint), whicli should be applied  twice
a day just before the zinc  ointment is resorted to, by means of a swab
or a sop  and allowed to dry.   In other cases  the powdered oxide of
zinc is dusted over the part  if the discharge is very watery and pro-
fuse ; or the  following ointment, recommended by McCall Anderson,
is very efficacious :
         R.—Bismuth, oxidi......%j.
             Acid oleic, pur.    ......  ^ viij.
             Cerae albae   .......  ,^iij-
             Petrolati    .    .   .    .    .   .   .  ,^ix
             Oleirosae.......ITlv.   M.
    Ft. in unguent.  S.—Apply to the part affected.

   As the quantities of this prescription are large they may be reduced
one-half for use in limited eczema.
   Where the proliferation of cells and the secretion are very profuse it
may become  necessary to remove the crusts before the  local remedies
can reach the skin, and for this purpose poultices may be used; or, if
the disease be on the face, the parts should be anointed  with olive oil,
containing 1  or 2 drops of carbolic acid  to the ounce, to  soften the
crusts, which are readily removed in a half-hour by the use of a little
castile soap and water.  The soap is not to be used if the inflammatory
action is  very angry-looking.   Whenever itching is an aunoyiug fac-
tor, the parts  should be protected  by lint smeared Avith some  simple
ointment, which may be carbolized both  for  its antiseptic and  local
anaesthetic effect.   English  and American dermatologists use what is
known as liquor carbonis detergens very largely in the acute stages of
eczema as well as in other skin diseases.  It should not be used pure,
but diluted  in  such a way that for  each 4 ounces of water 2 drachms
of the pure liquor are present.  Liquor carbonis detergens is made by
taking 9  ounces of  tincture of soap bark  (quillaia bark) and 4 ounces 
458
DISEASES.
of coal tar, mixing and allowing them to digest for eight days, after
which the mixture is filtered and used.
   When  the disease has passed from the acute, active inflammation of
the first stage to the subacute form of the second stage of its  existence,
applications of a mildly stimulant character are necessary. Before this
the physician has endeavored to soothe the parts ; now they must  be
excited to normal activity.   For this  purpose resorcin in the propor-
tion of 2  to 30  grains  to the ounce of  lard, according to the severity
and  induration  of the lesion in the skin, should  be used.  Stelwagon
recommends the following:
          R.—Unguent, picis liq......3J-
             Unguent, zinci oxidi.....gvij.   M.
    S.—Apply to the parts.
   Where  the disease is chronic and very persistent, but sluggish  or
atonic in  its course, still  more powerful remedies are necessary, such
as salicylic acid, tar, or tincture of green soap used  Avith hot water
until the  skin beneath  is bared, dressing this by means of zinc oint-
ment or resorcin  ointment, 2 to 10 grains to the ounce, spread on a
cloth.   The salicylic acid should be used in the proportion of 30 to  60
grains to the ounce of  lard, while the tar is used  in the form of the
pure official tar ointment.
   In seborrhoeic eczema where the secretion is greasy and dry, and fol-
lowed, if wrongly treated, by oozing and the pouring out of serum and
the formation of cells which form crusts, the following prescription  is
of value:
          R.—Resorcin.     .....   gr. x vel xx.
             Pulv. amyli       \                 a&    ..
             Unguent zinci oxidi J                     «* J°
             Petrolati.......^ss.   M.
    S —To be applied after removing the scabs by  the use of  a lotion composed of
one part of bay rum and three parts of water.

   The  internal  treatment is directed  to the  cure of any disordered
function which  is present, such as dyspepsia (see Indigestion), hepatic
torpor, general  debility,  anaemia,  scrofulosis, inanition, constipation,
gouty diathesis, or renal insufficiency.   The gastric disorder is to  be
relieved by the use of hydrochloric acid and pepsin ;  the hepatic torpor
by mercury,  podophyllin, or, better still, nitro-hydrochloric acid, of a
deep orange color ; the debility by tonics, such as cinchona, cod-liver
oil, strychnine, and bitters ; the anaemia by iron, and,  if scrofulosis
exists, by the syrup of the iodide of iron.   Constipation is to be cured
by the use of proper foods and laxatives, and the gouty tendency counter-
acted by the employment of lithium citrate and colchicum, or potassium
iodide.  If the kidneys are at fault because of torpidity, the diuretic po-
tassium salts, such as the citrate, are indicated.  Arsenic is never to  be
used, except in those instances where the skin is very dry, and where,
by improving digestion and through its alterative power, it does good.
In the chronic forms of  dry eczema or those depending upon some atonic
state of the trophic nerves of the skin, arsenic is of great value in the
form of Fowler's solution, or arsenious acid may be given. 
EMISSIONS.
459
                          EMISSIONS.

  Seminal emissions occur as the result of sexual abuse, whereby a con-
dition of hyper-excitation of the nervous cells in the spinal cord and
the nerves of the genitalia is developed, or they are due  to peripheral
or centric irritations, which reflexly irritate the genitalia or the nerves,
and to a number of other similar causes.   These emissions also occur
Avith some periodicity in normal  males who are continent and chaste,
and, under these circumstances, are not to be interfered with by treat-
ment, unless the emissions become excessiAre.
  The former types are, however, proper for medical treatment, and
their cure consists in the avoidance of unchaste literature and  lascivi-
ous thoughts during the Avaking hours, and the use of such spinal and
cerebral sedatives that the centres governing the ejaculations of semen
may be calmed, and so quiet a  sleep produced  that erotic dreams are
aAroided.  The patient should sleep on a hard hair mattress, not be too
heavily covered, and should aA'oid sleeping on his back, as this causes
an undue blood-supply to the spinal centres, and consequent stimula-
tion and ejaculations.   Sometimes hard bodies, such as spools,  are tied
around the loins so that lying on the back will cause so much  discom-
fort that the patient awakes and turns on his side.   The drugs to  be
used are bromide of potassium or sodium in 20-grain doses, at bedtime,
or chloral may be taken in the same amount.  Hyoscine has been most
enthusiastically recommended by Wood  in the dose of fa-Q grain-
Sometimes a warm sitz-bath or general bath, before going to bed, is of
service.  In other  cases, where atony is the cause of the trouble, the
physician should  recommend cold sponging of the perineum and loins
night and morning.
   In the cases in which emissions come on as the result of continence,
and become excessive, the remedies just named are to be tried, but
really do not effect any permanent cure unless used until sexual power
is seriously depressed,  so that it has been the custom  of many physi-
cians to recommend u marriage," which the patient  may interpret  in
its legitimate light or not as he pleases.
   It is Avorthy of note that all irritations of the urinary bladder and
other parts of the genito-urinary system should be removed, and it is
often of value  to  administer citrate of potassium in 20-grain doses,
in water, three times  a day, to  render the urine non-irritating and
alkaline.  Stimulating foods aud drinks are  to be interdicted, and
condiments, such  as pepper and mustard, avoided.
  Sometimes, when the emissions are caused by genital atony, strych-
nine and arsenic are of very great service if given in full dose.
  In many of  these cases it is the duty of the physician  to treat the
moral state of his patient as well as to give medicines.   Many per-
sons, believing that emissions are always  an evidence of disease, read
books on such  subjects which are sold by quacks, and soon find their
way to the hands of these persons or sensibly consult a regular physi-
cian.   Half the treatment in these  instances consists in assuring the 
460
DISEASES.
patient  that he  has nothing to worry about and in making him feel
that the physician is his friend and worthy of all confidence and com-
plete belief.

                       ENDOCARDITIS.

   Endocarditis  occurs sometimes as a single manifestation of disease;
sometimes as a symptom, with  many others, of some general  tendency,
produced  by  a  diathesis, such as gout and  rheumatism, or syphilis.
Further than  this, it may be acute, subacute,  or chronic, and each one
of its forms must be differently treated.
   It is hardly  necessary to state that any  diathetic taint should be
treated  by anti-rheumatic  or anti-lithic remedies, such as the iodides.
The iodides are  not, hoAvever, indicated if  any rapid changes of a de-
generative type  are at work.  In acute sthenic endocarditis, associated
with great vascular disturbance and much cardiac embarrassment, or
irregularity, there is no remedy half so good in the early stages as
full doses of tincture of aconite, 2 to 3 drops, given every hour until
the  physiological symptoms of its influence  are felt, or, in its place,
with equal efficacy, may be employed the tincture of veratrum  viride
(2 to 3  drops).  At the  same  time  calomel  aud opium may be used;
the  calomel for its  antiphlogistic influence, and the opium to control
the purgative  tendencies of the mercurial.   Thus we may use £ grain
of calomel every two hours and  fa of morphine.  Leeches should be
placed over the  praecordium in a goodly number, and if these are not
obtainable wet  cups are to  be employed.  This depletion  is only of
service  when  the disease  is seen  early enough to make its abortion
possible.   As the disease progresses, if the physician fails  to stop it,
it will be found that the heart  becomes someAvhat labored in its  action,
irregular, and weak, and that its rhythm  is seriously interfered with.
At  this time  digitalis is of use in  stimulating the depressed cardiac
muscle  and increasing its reflex activity, also  steadying it through the
pneumogastric  irritation  Avhich  it produces.  Aconite  and other de-
pressants are  contra-indicated  at this time.   Absolute  rest upon the
back is to be  insisted upon,  aud it is recommended, in those cases
where deposits  of a calcareous nature are likely to occur in the valve,
that the  citrate or acetate of potassium  be given, or that citrate of
lithium be employed.   If the  disease  becomes ulcerative, supporting
treatment, consisting chiefly in the use of  good food, and the tincture
of the chloride of iron is  of great  value if the dose which is given is
large.

                           EPILEPSY.

   The  disease known as  epilepsy is probably the most disheartening
condition as to treatment that  the  physician  has to deal with, since it
often resists the influences of all  the standard remedies, and drives the
practitioner from drug to drug iu the hope of finding one which  will be
at least alleviating in its effects.   For this reason the author has in this 
                           EPILEPSY.                        461

instance  included the drugs  which are rarely used, as well as those
generally recognized as useful in its  treatment,  in  order that the
physician may try every remedy of any possible value.
  It should be borne  in  mind that the treatmeut of epilepsy  is as
various  as the disease is variable in its forms and phases, and should,
in nearly all cases, resolve itself into two or perhaps three divisions,
consisting  in  the removal of any exciting  cause, in the checking of
the convulsive tendency already set up, and iu the prevention of any
further attacks by suitable drugs or other measures of relief.
  The treatment is governed largely by the cause, and is medicinal or
operatiA'e, according to the etiological  factors  at  work.  In simple
idiopathic epilepsy medicinal means must be followed, while in a case
resulting from traumatism, the depressed bone, abscess, or tumor  must
be removed, and in those due to reflex irritation, the peripheral source
of trouble must be sought out and relieved.
  So far as drugs are concerned, the  most valuable remedy iu use for
the relief of epilepsy is bromide of potassium, although other  forms of
bromide salts are to be mentioned later on.
  This drug, however, is  not a " cure-all," even  in epilepsy, and re-
ports are constantly made of cases Avhere it has failed; but many  cases
prove that the remedy is undoubtedly responsible for a cure Avhen it is
pushed in a suitable manner, and, in  the A'ast majority of instances,
the seizures are  so decreased, both in violence and frequency, that its
use may be said to be indicated in every case of the disease.
   Iu a  very  small minority, however, it signally fails; and in a still
smaller number of cases, it is  useless unless combined with some  other
drug Avhose power alone  is very slight.  Nevertheless it is to be laid
doAvn as a rule, that the bromide treatment of epilepsy is,par excellence,
the treatment to be employed on every occasion.   There is  no  other
drug known  which can  be relied upon so  absolutely, or which is so
powerful in its action and devoid of marked  toxic effect, unless given
in enormous doses.
   The doses to be  used vary Avith the salt employed  to a considerable
extent, and depend upon  the  character of the disease  and the  tem-
perament and physique of the patient.  The greater the duration of
the disease the greater is the  difficulty in  effecting a cure;  and the
length of time which the man has been epileptic should therefore be
most carefully reckoned before the treatment begins.   Further  than
this, the frequency and severity of the  attacks are to be looked into,
and these points are really more important than the actual  duration
of the ailment;  since,  if a man has only one  fit every six months for
twenty years, his condition is far less serious than if he has a history
of three or four fits a day for one year.  Again, the character of the
attack, as  to its violence, may  be  the most important fact to be
regarded; for if it is violent  enough to endanger life, remedies must
be pushed even beyond the point of tolerance.   The writer has heard
a very celebrated physician cause much amusement among his auditors
by detailing an instance of an epileptic who was getting well, and Avould
have recovered if he had not died.   His explanation Avas, that the man 
462
DISEASES.
Avas syphilitic, and was receiving moderate doses of iodide and bromide
of potassium, which were slowly benefiting him, and Avould have cured
him  had  not a single  severe  fit  produced death in  the meanwhile.
Another point to be considered  is  the  condition  of the  digestion,
Avhich  the  bromide of potassium  is peculiarly liable to disorder, and
Avhich is sometimes so disturbed as to necessitate the administration of
the drug by the rectum in serious cases.  Females generally require
smaller doses than males, and children of both sexes do not require as
large quantities as adults.  The dose to be used  in the beginning of
the treatment, in moderate cases, is about 10 grains thrice a day; and
while this may seem a ATery small quantity, it avi'11  be found that it can
be rapidly increased  in  amount  Avithout causing the gastric distress
produced by the sudden use of larger doses.   Each day an  additional
ten grains  may be added, until, at  the end of a  week,  the patient is
taking 80 grains in each twenty-four hours.  There are very few cases
which Avill  not become completely saturated with the drug if this is
done, and there are very few in whicli a more rapid arrival at bromism
is needed.   If, howeA^er, the  patient has  become  able to stand large
amounts, by the prolonged use of the  drug, the amount given is not
to be governed  by grains  but  by physiological effects, and it may be
pushed  to any amount which is borne without distress.
  In chronic epilepsy, too, with regularly recurring fits, the greatest
good is obtained by pushing the drug in ascending doses for one week,
and then, for the  succeeding Aveek, only enough is  given to preserve
the general effects of the medicament.   By doing this the stomach
gets a rest and the appetite is not greatly interfered with.  Where the
attacks occur only every  tAvo weeks,  this is  a  particularly  useful
method for obvious reasons.   As regards the  time of day when the
drug  is to  be taken, there  can  be  no doubt.   Some  writers have
directed that it shall  always be  taken before meals; but this is entirely
lacking in  advantage and decidedly  fruitful  of harm.   Medicines
Avhich  are given with the object of affecting the general system  should
be taken  after meals, not before, and  it is only when a local  gastric
effect is desired that we use them on an empty stomach, particularly
when the substance  is  as irritant and depressing as potassium.   If
taken after meals the appetite is not decreased,  but there are few who
can take a dose of  10 or 20 grains of bromide of potassium  before
breakfast without  suffering from  indigestion.   It has been held by
some that the drug should be taken in minute doses, frequently repeated,
in order to keep the patient constantly under its influence.  This is an
example of therapeutic ignorance, because bromides are slowly elimin-
ated, and this frequent administration  possesses the disadvantages of
being inconvenient, annoying, and apt to disorder the stomach.
   If the attacks have a distinct periodicity, or can be foretold  for as
much  as two hours beforehand, the remedy may be taken in a large
doseonly  at  this time, and  but  a  few grams given in the intervals,
and if the attacks are severe,  no one should hesitate to  use large doses,
by the mouth, and by the rectum on the day of the attack.
  A very important  point to be borne in mind, is that the drug often 
EPILEPSY.
463
seems to  have produced a complete cure; and this results in careless-
ness  in the regularity of administration.   The patient should be im-
pressed by the fact that every day passed without a fit is a  step for-
ward, and  that  every  fit carries  him  many steps  backward.   He
should also be made to use the drug, in moderation, for at least three
years  after  all fits have ceased, and to watch, after that time, for the
slightest sign of their return.   The quantity taken each day should be
gradually decreased, not suddenly stopped short.
   It  is true, also, that if a recurrence of the fits takes place they yield
to treatment very much  more slowly than before.
   Before passing on to the discussion of the other bromides, and the
conditions produced  by the  excessive use  of all of them,  we may
place  our use  of these  compounds  in epilepsy on a scientific footing.
It  is  noAV  generally recognized that the seizures known as epilepsy
arise  from the cells in the cerebral cortex, and  there can be no doubt
that  the bromides act very  powerfully upon  the cerebrum in the
higher animals,  decreasing the  irritability  of  the motor  centres in
these regions to a veiy great extent.   Not only is this pointed  to by
clinical facts,  but the well-known researches of Albertoni prove that
such  is their  action beyond  all doubt.  This investigator found that
the administration of a single dose of  the  bromide of potassium so
lessened the excitability of the motor cells  in the cortex cerebri that
much stronger stimulation was necessary, in order to cause  response
in  the limbs, than  was normal, and that it Avas difficult to produce
epileptic attacks  by means of  the electrical  stimulation of the motor
areas, even Avhen currents very much stronger than those which  com-
monly  produce such a  result Avere  used.  He also found  that this
lessened irritability was  increased still further  if the drug Avas given
for several days beforehand in  such  doses as thoroughly to impress the
organism.   It is, therefore, evident that the bromides act directly on
the cortical areas, calming the tendency to explosions of nerve force.
   The results of Seppilli have also  confirmed  those of Albertoni in
every way.
   An enormous  amount of research has also  proved that the drug
may be doubly useful in reflex epilepsies, not  only by its action on
the motor portion of the  cortex, but by its influence on the afferent
portion of the nervous system.
   The  experiments of  Eulenberg   and Gutmann  prove  that the
sensory paths  in  the spinal cord feel more  powerfully than any other
portion of the body the effects of the drug; for  these investigators
found that  if they tied the bloodvessels supplying one limb  of an
animal, reflex  action was  abolished equally on  both sides,  proving
that the loss of reflex action does not depend upon the action of the
drug  on the sensory nerve trunks.   That the loss of reflex  activity is
not due to an  action on  the  motor  portion  of the cord is proved by
the fact that voluntary motion is completely preserved.  As these ex-
periments have been  confirmed by  LeAvisky, Bartholow, Purser, the
author, and  Laborde, there can be  no doubt of their truth; and we
can rest assured  that not  only does the drug prevent  nervous dis- 
464
DISEASES.
turbance in the cerebrum, but  also that it prevents the peripheral
irritation  from travelling  up to the  brain, there to produce morbid
excitement.
  Apropos of the theory that epilepsy is due to vasomotor disturbance,
which is unfounded, it may also be added that the bromide of potas-
sium  Avas, and is, believed by some to effect a cure by producing a vaso-
motor spasm at  the  base  of the brain, but there is no basis for this
idea, even if the disease were due to vasomotor  changes.   Hammond
and Amory have seen the circulation in the  brain slowed by the drug,
and it has been claimed by Lewisky that if the toes of a frog be cut
off, the blood flows more sloAvly from  them in the poisoned animal
than in the normal frog.  None of these facts prove vasomotor action,
but rather that there is  a lessened circulation by reason of the cardiac
depression produced by  the potassium,  for this element  is known  to
have this influence.
  An important therapeutic point is  to  know  hoAV  rapidly bromide
of  potassium is eliminated, so that Ave may know how frequently to
give the drug.
  That it passes out of the body Avith  only moderate speed is certain,
for Rabuteau has  noted its presence in the  urine one month after the
last dose, and Bill has fouud it in the same  secretion tAvo Aveeks after
the use of the drug had ceased.
  Amory recovered, on the other hand, one-half the amount  ingested
in the first succeeding twenty-four hours, and one-third in the second
twenty-four hours.  It is  evident, hoAvever, that  it  is eliminated  so
slowly  that doses  giAren three times a day make  the patient ingest
more than he eliminates.  That bromide of  potassium remains a long
time  in the system  is proved by the  fact  that after repeated  doses'
given to a healthy man  marked' somnolence  persists for some days.
  There is one more point to Avhich attention must  be called, and that
is the fact that when the bromides are taken for any leugth of time they
produce bromism, which, in  its moderate or severe forms, produces a
mental  condition very closely allied to  that seen in  old, chronic epi-
leptics.   This condition of the mind should  never be overlooked; and
the ordinary mental  changes  of epilepsy are  greatly increased by its
constant and careless administration.
  The  bromide salts of gold, iron, sodium, lithium, nickel, and am-
monium have all been used in epilepsy Avith good results;  but, except
in certain instances, they fail to act as well as that of potassium, unless
given in  larger  doses.  There are several circumstances, however,
under which each one possesses marked advantages, and may succeed
where potassium has failed.  In all cases of epilepsy complicated Avith
anaemia  the bromide of iron should be employed; but  Avhere  there
is plethora it will generally increase the disease or do no good.  When
it acts  after potassium  fails, the iron is of  value, because of its tonic
and nutritive effect.  Bromide of sodium, while somewhat less powerful
than  potassium, is  not  by any means  so apt to disorder the stomach,
and is preferable in some cases on this  account.  It possesses no other
advantages. 
EPILEPSY.
465
   The bromide of lithium has been highly recommended in intractable
 cases, by Weir Mitchell, avIio even states that it may be given in one-
 half the dose of  the potassium salt with equally good effects.
   The bromide of nickel cures some cases where all other remedies fail,
 but this  occurrence is rare.   In a series of physiological  experiments
 made by the Avriter some years  since, he  found it virtually identical
 Avith the potassium salt  in its action, and it is useful in about the same
 doses and cases as is bromide of potassium.
   The bromide of  ammonium  is  very  irritant  aud  disorders  the
 stomach  quite readily.   It ought always to be used, Avhen used at
 all, Avith some other  drugs, the ammonium  salt  only  acting  as  an
 adjuvant.
   Several clinicians  have tried hydrobromic acid, but it  is very much
 more apt to derange digestion and to produce vomiting  than  any of
 the salts.   The dose of the dilute acid is \ to 3 drachms in a tumblerful
 of sweetened water.
   The bromate of potassium  has  been used  by Mitchell in doses of
 not more than 5 to 10 grains  Avith good results, but is more dangerous
 aud scarcely of greater  value.
   There can  be no  doubt that in some  instances what is known as
 the mixed treatment is successful when  all else fails.   This consists
 most commonly of a prescription in which the bromides  of potassium,
 sodium, and ammouium take part.  Why this combination acts  better
 than any one of the  salts alone no  one  knoAvs, but it  is certainly a
 clinical fact.
    In other cases  still, digitalis Avhen used  along with  one of the
 bromides seems to produce favorable results.   Indeed, digitalis has for
 years been used alone in epilepsy with fairly good results, and should
 always  be used  in obstinate  cases.   In petit mal, where bromide of
 potassium  Avhen  used alone so often fails,  it is  useful, and several
 English  Avriters, notably GoAvers, assert that its  best  effects are in
 cases of nocturnal epilepsy.  Why this  should be the  case no one
 knows, and it would seem doubtful whether it does any more good in
 nocturnal attacks than in others.  Indeed, it is difficult to understand
 how digitalis can influence epilepsy at all, for its action on the nervous
 system  is slight, save in toxic amounts, when it lessens  reflex  action
 very markedly, first by stimulation of Setschenow's reflex inhibitory
 centre, and later by paralysis of the spinal  cord.   This latter  action
 never occurs,  of course, from a medicinal use ; but in medicinal doses
. it may, by acting  on the inhibitory  centre, allay convulsive tenden-
 cies.  Probably its chief action is through  its circulatory influence,
 and further study may  shoAV  it to be efficacious  only  in those cases
 where a heart tonic is required.
    Another combination very  much employed and lauded is bromide of
 potassium Avith belladonna, the mydriatic being almost useless aloue, but
 of great antiquity in its use in epilepsy.  Like the mixture of digitalis
 and bromide, it succeeds very frequently in petit mal, and,  indeed, seems
 to be much more successful than the digitalis, but its mode  of  action
 is exceedingly doubtful.  As the drug acts even more powerfully upon
                                  30 
466
DISEASES.
the nervous system than the circulatory apparatus, it has been thought
that its influence for good depended  upon this effect, but  the experi-
ments of Seppilli contradict this belief, for he found that if atropine
Avas given  to an animal  the  surface of the cortex cerebri responded
more readily than is normal to electrical stimulation.
  At one time it  was held that belladonna acted on the spinal cord
and peripheral nerves under such circumstances,  but  it should be re-
membered that Ave noAV know  that atropine is only of value  in relax-
ing spasm Avhen given in full dose, oftentimes  hypodermically, and
that Albertoni has made a series of experiments to determine whether
it irritates  the motor centres  of the  cortex.   In  his hands  repeated
small doses or one large dose  in  no Avay retarded  the convulsions
commonly produced by stimulation of the brain.   Both these investi-
gators are, therefore, in accord.  Under these circumstances,  it  affects
rather the motor nerve-endings than the central nervous apparatus.
  At the present time those who believe epilepsy to be dependent on
cerebral vasomotor  spasm rest  the occasional  good results  obtained
by the use of belladonna on  its vasomotor  influence;  but there is a
good reason  for throAving this idea aside, even if the morbid process
named Avas really present, namely, that the drug in ordinary medicinal
doses raises  arterial tension by  stimulation  of the vasomotor centre,
while it loAvers blood-pressure  only when given in toxic amounts, and
then by an action on the bloodvessel Avails.
  As long ago as the early part of this century cannabis indica came
into notice in the treatment of epilepsy, and it  is probably of greater
value alone than Avhen combined with  any other drug, unless it be
Avith the bromides.   Although it is at  present rarely so used, the author
believes, from his own studies, that it is of A-alue, for he  found that
it distinctly lessens reflex action and  acts powerfully upon the higher
nervous centres  in  the  brain.    Its use and value in migraine are un-
deniably of the greatest  importance, and epilepsy and migraine are
often very closely allied.
  Gelsemium sempervirens is  an American plant  whose praises have
been widely  heard  in almost every  disease.   Its influence alone  is
Avorthless, for it possesses no power over the cerebral centres whatever;
but in combination with cannabis indica it makes a very useful remedy,
and depresses the conducting power of the spinal cord, while the can-
nabis indica in its turn quiets  the cerebrum.  The dose of the tincture
is 20 drops, but it should be remembered that it is as poisonous as the
cannabis indica is innocuous.
  Owing to the  soporific influences exercised  by  opium  it has been
very frequently tried, Avith both success aud failure as a result.  It
certainly has not taken any rank in  the list of  remedies, and  is de-
servedly lacking in professional favor.  It  increases reflex activity
very commonly, and seems to  affect the intellectual centres of the cere-
brum rather than the motor portions, although Seppilli's experiments
show it to exercise a decided depressant influence over these areas.
Combined  with gelsemium  it  may be employed,  but only  when
nothing else is at  hand  or all other remedies have failed.   If it is so 
EPILEPSY.
467
employed great care is to be used, and it should not be forgotten that
both  drugs kill by respiratory failure.  When used in the  " status
epilepticns " it often does good in relieving the spasm, but  it must be
employed in large doses, and  if the succeeding coma of epilepsy has
added to it that of large doses of opium death may ensue.
  The employment of zinc, in its various salts, has  been greatly recom-
mended for many years, but has found little favor of late among the
profession.  It has been stated that it quiets the cerebral cortex, the
medulla  oblongata, and the spinal cord,  and in this Avay cures the
attacks.   This is, hoAvever, merely clinical  evidence, and  has no ex-
perimental  proof to  support it.  Even its most sanguine supporters
confess that the range of usefulness of zinc is generally in those cases
Avhere the bromides succeed, and  agree that its powers are much  infe-
rior to these compounds.   The dose of the oxide is 3 to 7 grains tAvice
or thrice  a day,  and even in this amount it may cause nausea and
vomiting.   The citrate of  zinc is more soluble, and is better borne by
the digestive apparatus.  Its  influence over the disease is probably
the same as that of the oxide, and this  is also true of the lactate,
whicli was so largely used  by Herpin, and which  is probably the best
salt of zinc to employ.
  Nitrate of silver Avas  brought into use long before the value of more
recent drugs Avas known.   Everyone is agreed that it  is  without
power for good,  save Avhen it was used  constantly for  a  long  time.
As the drug  is eliminated very slowly it rapidly  accumulates in the
body, and argyria soon  comes on.   It  may be used, after all else fails,
in  doses  of ^  to 4; grain thrice a day after meals, the mucous mem-
brane of the inside of the  lips, and the conjunctiva, being carefully
watched  for the early signs of chronic  silver poisoning.  We certainly
have no  knowledge as to its influence  on the nervous system; and, if
it acts at  all, it  must be by some alterative influences rather than by
any other means.
  Nitroglycerin is to be employed in the treatment of petit mal rather
than  haul mal, in  the  dose of 1 drop of a 1 per cent, solution, once,
tAvice, or three times a day.   Our knowledge of its effects, so far as its
curative  influences are concerned, is very slight, but it seems to benefit
some cases.  Its action is very fleeting, and it influences the brain very
little, except it be taken just before au  attack is expected, or Avhen the
cardiac action is  defective.   Its  great  lethal power should never be
forgotten.
  The use of the nitrite of amyl is not for the purpose  of  directly
curing the disease, but of warding off impending attacks, the warning
of which is given  by an aura of slow progression.   It  increases the
severity of petit mal, but in epileptics who have a prolonged aura we
may use nitrite of amyl pearls,  Avhich consist in small glass beads
containing a few drops of the drug.   As  the aura comes  on, the
patient should break one of" these in his handkerchief and inhale the
drug, thereby putting aside the attack.   The influence which the drug
exerts upon the brain is secondary rather than primary, and is proba-
bly dependent on its action on the blood or circulation.   Its influence 
468
DISEASES.
on  the  spinal cord and nerves is much more marked aud direct, and
it is most certainly a very poAverful  spinal depressant.   As  its influ-
ence over unstriated muscular  fibre is very great it  affects  the Araso-
motor system very powerfully; and those Avho think epilepsy is due
to a vasomotor spasm at the base of the brain point to the effects of
this drug as a proof of their hypothesis.   Such reasoning is not, how-
ever, necessarily correct.  Nitrite of amyl puts aside au attack  by a
sudden  shock to the  nerve  centres, which diverts them, so  to speak,
from their intended discharge, very much as a ligature* around the
arm stops an aura.   When Ave remember that the drug acts  instantly
and converts nearly all the oxygenating blood of the body into a non-
oxygen-carrying  fluid, by reason of the  methaemoglobin produced,
the sudden change in the cerebral nutrition and state is easily uuder-
stood.
  In the  treatment of the "status epilepticus" nitrite of amyl is  of
great value in stopping the seizures, and may be used under these cir-
cumstances in heroic  amounts,  applied  to the nostrils at  intervals.
During the presence of the tonic spasm, if it be severe enough to stop
respiration, it should be remembered that if the drug is not inhaled it
is absolutely Avorthless.  It is only when respiration is being carried
on that it can enter the lungs and do its Avork.
  As a general rule, the nitrite  of ammonium or of sodium, both of
which are prolonged   in their effects, should  be used  internally  to
supplement the nitrite of amyl.
  Gowers states that nitrite of amyl does good in epilepsy by flooding
the brain with arterial blood.  How such a statement can be  made by
anyone  is amazing.  Of all the  drugs  in the Avorld, nitrite  of amyl
produces exactly the opposite change.
  The  use of anaesthetics during an attack  of epilepsy  is virtually
useless,  and,  in  some  cases,  dangerous,  for ether is  too sIoav in its
effects and may, by its irritant vapors, increase the tendency to laryn-
geal spasm or cause lung complications.   Further than this, if uraemia
is the cause  of  the fit—aud this fact is unknown in every case until
the individual is carefully examined—the ether may increase the in-
flammation of the kidneys very seriously.
  Chloroform, though it acts much more rapidly, may cause sudden
cardiac  failure, and both drugs may increase the post-convulsive coma
very greatly.
  In "status epilepticus" they may be used, as iii such cases  the con-
vulsions must be stopped at all hazards, but the preference should be
always  for amyl nitrite.
  ^ The iodide of potassium  is entirely useless  in epilepsy unless the
disease is due to syphilis, Avhen it is  of the greatest service.  Indeed,
the bromide  and all  other drugs should be set aside while this one is
pushed  to the utmost.   As is well known, syphilitics  usually bear the
drug extremely well;  and the author knows of one instance where no
less  than  800 grains were taken every twenty-four hours Avith rapid
improvement as a result. This point is strongly insisted upon by all 
EPILEPSY.
469
therapeutists and syphilographers, notable among whom stands Four-
nier.
   Where the convulsions are due to the presence of a gumma the
iodide of potassium is, however, too slow in its action and  should be
associated Avith mercury in order to break down the growth without
delay, lest a seizure cause death by glottic closure producing asphyxia
or some similar accident.
   Some  difference  of opinion exists as to  the usefulness of iron in
epilepsy.  Several very eminent clinicians have asserted that it always
makes the attack worse, and therefore does more harm than good.
Like everything else, iron is no more  to be given in every case than
is a dose of oil; when there is plethora it is harmful, and when there
is malnutrition and  anaemia  it does good.   Over the disease itself
iron has  really no effect at all, except through its action on the general
system.
   Chloral hydrate is a remedy which has  been  only partly tried in
epilepsy, and its usefulness  is not  as yet determined.   It possesses the
marked disadvantages, as compared Avith the bromides, of being  a very
fatal  poison, Avhich is an important fact to be borne in mind  by the
physician when giving it to a patient whose mind, already Aveakened
by the disease or naturally stupid, may forget and take too  much. Its
physiological action indicates much more fully that it may be of value
than  does that of  many other  much more lauded remedies, since  it
exerts its chief influence on the motor pathways of the spinal cord
and quiets the motor portion of the  cerebral cortex and  also produces
sleep.  Seppilli has proved this, by direct experimentation after the
method employed by Albertoni.  Its use, combined with  one  of the
bromides, is often  accompanied by the most desirable results,  and  it
should be tried at all times  unless some  cardiac complication  forbids
it.   It may disorder  the  stomach, and should,  like the  bromides,
ahvays be giA'en A\rell diluted and after meals.
   Of the more recent remedies, acetanilide certainly stands in the fore-
most rank, and  bids fair  in some  instances  to  rival the  bromides.
Professor Germain-See, the author, aud some others have reported
cases which  obtained very marked  relief  from it, and  more  recent
investigators have  done likewise.   The drug will be found to exert
its chief  benefits in chronic  epilepsy. At least, if a child Avas brought
to the author with a beginning  epilepsy, he would use the  bromides,
but if the disease Avas cbronic, acetanilide.
   Antipyrine has  also  been  pushed forward as  a  remedy, and  its
physiological action on the nervous  system  is virtually identical with
acetanilide.
   Antipyrine has been recommended by Lemoine in certain forms of
epilepsy, but condemned in most cases.   In  those Avho suffer from
menstrual epilepsy, so called, or  in those  in  whom the attack is pro-
duced  reflexly by the presence  of intestinal parasites, the  drug does
good.
   Lemoine  also found  it very useful in those cases Avhich are asso-
ciated  with  migraine.   In  these  cases  the  results were better than 
470
DISEASES.
Avith the bromides, but in the idiopathic simple varieties it was useless.
Mairet and Combemale have used the drug in the epileptiform mania
with satisfactory results.
  In children suffering from frequently recurring  epileptic attacks the
presence of Avorms should always be looked for,  and Avhen they are
found they should be expelled as rapidly as possible.   If they are the
oxyuris vermicularis (seat-worms) the  best remedy  by  far is the  injec-
tion  of  a strong infusion of quassia of such a strength that there are
2 ounces of quassia to each pint of Avater.
  In girls, where the removal of the worms from the rectum is not
followed by relief, a careful examination of the vagina should be made
and quassia employed in somewhat Aveaker solution, as very commonly
intense  inflammation is there present, produced by  migratory move-
ments of rectal parasites.  If the quassia is unobtainable in any case,
a saturated solution of chloride of sodium  may be employed.
  The treatment of epilepsy by  borax has not received very wide re-
cognition.   Perhaps the most thorough studies of its  effects have been
those of Gowers in  England, and  Folsom in America.   It  would
seem that some cases  Avhich are obstinate under ordinary treatment, are
benefited by borax, but  it is certainly not  to be commonly employed.
The  dose generally given is about 15  grains.
  Having  spoken of the drugs Avhich  may be  given  to epileptics,
attention may be draAvn to those Avhich  may not be used.   There is  a
very large amount of reliable evidence, both experimental and clinical,
that  quinine should never be employed in these cases Avhen it can be
avoided.  Thus Seppilli, in his researches, found that it increased the
irritability of  the cerebral cortex, and Briquet has asserted that it is a
direct cerebral stimulant.  That toxic doses of quinine may provoke
epileptiform convulsions has been proved  by Jakowbowick, who has
seen  them  occur  in  cinchonized dogs and  other animals, and Brown-
Sequard and  Albertoni have noted  that  cinchonidine  and quinine
always increase the number of attacks in epileptics.
  Salicylic acid, too, has  an  effect  upon the brain very closely allied
to that of quinine, and should always be used with  care  in cases of
epilepsy. Professor Germain-See has also pointed out that  large doses
of this  drug produce  violent epileptiform  convulsions  in the  lower
animals.
  Strychnine, Avhile  its chief effect is to heighten the activity of the
spinal cord, also, according to Seppilli, increases the irritability of the
cortex, and  should be employed only in  peculiar cases.   The  same
writer also found that absinthe and picrotoxin predispose  to epileptic
seizure by increasing the excitability of the motor zone of the cerebral
cortex.
  Bleeding the patient in epilepsy, unless there is marked  eATidence of
cerebral congestion, which is exceedingly rare, is harmful rather  than
of value.   Orschansky found that removal of one-seventh of all the
blood in the body by the femoral vein did  not lessen the  irritability
of the cortex, and Minskowsky  ligatured all the bloodvessels going to 
EPISTAXIS.
471
the brain without  decreasing its excitability.  We  know  also  that
cerebral anaemia produces epileptic attacks.
  A very important point,  which is constantly brought before the
physician who is treating epilepsy,  is that of diet.  Nearly every
patient who suffers from this disease inquires Avhat he shall eat. Very
few  researches of a thorough  character have ever been carried out
on a large  scale to determine the things Avhich may or may not be
ingested.  Of course, nearly every one of us knows from our personal
experience  that  red  meats  are hurtful,  particularly in  children.
Curiously enough,  the influence of diet  in one  research covering a
number of cases of chronic epilepsy, seemed to be of little moment.
Thus,  Mersou examined twenty-four such cases,  putting  twelve of
them on a purely vegetable, and  twelve  on  a purely nitrogenous  diet.
The result, after this study had been continued for two months, was that
the vegetarians had had a few less fits than the others, but the difference
Avas so slight as to be of almost no Aveight in determining the question.
Some authors at the present day believe this opinion as to the harm-
fulness of meats  to be erroneous, and Gowers is one of them.
                          EPISTAXIS.

  Nose-bleed depends upon many causes, the chief of which are trau-
matisms, plethora, and the preseuce of ulcerations in the nasal cham-
bers.   It also occurs as one of the prodromata of typhoid fever.
  Probably plethora is the most frequent cause of nose-bleed, and in
most instances the latter is an attempt on the part of the system to rid
itself of an excess of blood.  Under  these circumstances epistaxis is
not dangerous, nor is it proper to arrest it unless it becomes excessive.
Where it is excessive, or must be controlled for any reasou, the meas-
ures to be adopted are both medicinal and non-medicinal. If the person
is full-blooded and strong, full doses of tincture of aconite or veratrum
viride are useful, say 2 to 4 drops of one of them, followed in a half-
hour by a smaller dose, if necessary.   The  value of these drugs de-
pet ds upon their power of loAvering blood-pressure, and iu consequence
decreasing  the leakage from the solution of  continuity in the  blood-
vessel.  Some physicians  have recommended ipecac in full nauseating
doses to relax the arterial  system.  Powdered alum, pure, or half and
half with starch, or  in solution, may be snuffed up the nostril,  and
tannic acid, in powder or  in solution, may be  used Avith advantage.
If this does not  control the haemorrhage an atomized spray of Mon-
sel's solution, in the strength of 30 drops to 4 ounces of water, may
be of service.  Ergot in the form of the fluid extract iu the dose of 1
drachm may be  given, or its Avine in the dose of a wineglassful  em-
ployed. Sometimes, when the oozing is sIoav, doses of turpentine taken
internally,  oil of erigeron, or hamamelis, do good.  As  a household
remedy, vinegar may be injected into the nostrils, or lemon-juice may
be employed in the same way.                    ,
  All these remedies act as styptics when  locally applied, by causing 
472
DISEASES.
coagulation of the fibrin and the formation of a clot, while the internal
remedies produce local contraction of the bloodvessels in the congested
area, this area being more susceptible to  the influence of these drugs
than the rest of  the vascular system.
  The non-medicinal measures to be employed, if the bleeding is severe,
consist iu plugging the anterior nares with pledgets of cotton or pieces
of lint soaked in vinegar.  If this  does not control the haemorrhage,
the posterior nares may also be closed by plugs, and compression of the
facial artery, of  the same side as  the bleeding nostril, be made upon
the superior maxilla near the nose, thus decreasing the blood-supply.
The head must be kept raised aud the patient  must not  bend over a
basin or wear a tight collar.
  A piece of bacon fat cut to fit and  placed in the nostril may stop
epistaxis Avhich has resisted all other measures.
  Sometimes, if the patient raises one or both  hands high  above the
head, the haemorrhage  ceases.  This is due to the fact that  the easiest
pathway for  most of the  blood is  straight  up the brachial arteries
rather than through  the tortuous vessels of the face.   A hot  foot-
bath,  by dilating the veins  of the lower  extremities, draws aAvay the
blood from the face and is a useful  measure.   In other  cases, a hot-
water bag applied over the dorsal vertebrae  is efficacious, and  some-
times cold when so used'is of service.   A piece of ice pressed against
the nose may  prevent further haemorrhage, by causing localized
anaemia.
  Where the nasal haemorrhage results from traumatism, with fracture
of the bones, and great loss of blood ensues, ligation of  the bleeding
vessel or its supplying vessel should be, if possible, resorted to.


                         ERYSIPELAS.

  This disease is now being studied  very widely, because of the gen-
eral recognition  that  it is dependent for its existence upon  a  germ.
The streptococcus of erysipelas is practically identical with that of pus,
and the disease is at  first a distinctly local one.   The changes Avhich
have  come forward  in its  treatment  are chiefly  the  local measures,
Avhile those  methods Avhich have been used internally for many  years
have suffered no alteration.
  Whether  or not erysipelas is a local or systemic disease has  little
to do Avith the proper  treatment.  In any case it is an inflammation,
and as such  it must be treated.  In  its early manifestations and Avhere
some uncertainty may exist as to  its true character, aconite  or  vera-
trum  viride  may be used in  sthenic cases in Avhich the  nervous and
circulatory systems give evidence of reflex irritation, and the pulse is
hard and full.  Those remedies are contra-indicated if any teudency to
weakness exists.   Da Costa has recommended, and others have carried
out with success, the practice of using pilocarpine in sweating dose (J
to I grain hypodermically), in these  early stages, and in some instances
the injection may be made at the  margin of  the  inflammation with 
ERYSIPELAS.
473
advantage, as this method seems to control the development and spread
of the disease.   The objection to the use of these injections about the
inflamed area rests  in  the  possibility of the formation  of  a  slough,
whicli when infected A\xrald speedily chauge a superficial lesion  into the
phlegmonous form  of the  disease.  As with  aconite and  veratrum
viride, it is to be remembered that this use of pilocarpine is  not to be
resorted to if debility exists.  When asthma is present, or the disease
is too far  advanced  to be aborted, belladonna  in the dose  of 3  to 5
minims of the tincture every four hours should  be used.  It may also
be locally applied on lint with benefit, or belladonna ointment may be
smeared on the skin.
  The internal treatment of erysipelas  par excellence is the plentiful
use of the  tincture of the chloride of  iron—20 to 30 drops, or even
40 drops, four times a day.  The diet  should  be regulated and the
bowels kept  in good order, Avhile any excessive  febrile movements are
to be treated by the use of antipyretic drugs  such  as antipyrine—
better still  by  cold bathing.   Where the  patient passes into the
typhoid state, supportive measures must be used and alcoholic stimu-
lants added to the food, which should be predigested or prepared so as
to be readily absorbed.
  During  convalescence the use  of tonics, both in the form  of  iron
and  bitters,  is particularly indicated, if the  recox-ery  of strength  is
slow.  The  local treatment of erysipelas is very varied, but in the
majority of cases resort need be had to  but one  or two methods.
  By far the best dressing for the general run of cases of erysipelas is
a modification of that of Von Nussbaum, which the author has tried
in a  number of cases with great success.  The skin of the part in-
volved is carefully cleansed with castile soap of the purest form, Avhich
is washed off by a 1 to 1000 solution of bichloride of mercury.   The
skin  is dried with a soft towel and  a thick coating of ichthyol  and
vaseline or lanolin applied,  the strength of this ointment being  half
and  half.   OATer this is placed antiseptic gauze  or sterilized  absorbent
cotton and adhesive strips, or a bandage is used to keep the dressing
in place.   Sometimes  the ointment alone may be applied if the  area
is small.   Under this  treatment  the results are  often extraordinary,
in all stages of the malady.   Where  ichthyol is not obtainable, a
thick coat  of white-lead paint, as it is sold  in cans before it is mixed
Avith any  thinning  substance, will be  found of service  in  an emer-
gency.
  The plan  recommended by Higginbottom, of applying  nitrate of
silver, is often successful.   It consists  in the use of a solution of the
strength of 80 grains to 4 drachms of distilled water,  which is thor-
oughly applied  Avith a camel's-hair  brush over  the entire inflamed
area, and  for a little space beyond.   The application must be made
twice or thrice to secure a good coating.   This treatment will often
arrest  the  inflammation  and  prevent  its   spread,  but has  caused
sloughing. 
474
DISEASES.
            EXHAUSTION  AND DEPRESSION.

   While the treatment of both these conditions is almost identical in
some respects, it is, nevertheless,  important that a clear idea of the
difference between  the two  be clearly  understood,  if  for no other
reason  than that the  physician may recognize that exhaustion is  a
far more serious state than depression.   It also requires  more  careful
treatment.   The man  who  is  depressed  retains in his  body all  the
vital forces necessary  for the maintenance  of  life, but they are tem-
porarily in  abeyance from  some  cause.   As soon as the incubus is
taken aAvay, the system at once asserts itself and recovery takes place.
This is not the Case Avith a man suffering from  exhaustion.  In this
patient  every particle of his  strength is  sapped and lost.   The mau
depressed is the giant lying unconscious from a blow  on  the head;
the man exhausted  is the same giant after a long attack of typhoid or
other fever of  a similar nature.   The treatment  of  depression is
stimulation; of exhaustion, not  only stimulation, but feeding and
protection from  exposure.


     FEET—SWOLLEN,  TENDER,  OR  SWEATING.

   These comparatively  simple,  yet  annoying, conditions  are often
brought before  the  physician for relief, and patients suffering from
them will frequently be more grateful for skilful treatment than in
the event of recovery from a severe illness.
   Swelling  of the feet occurs chiefly in two classes of cases,  excepting,
of course, iu dropsy, which  makes a  third  class.   These are old per-
sons taking too  little or  too much exercise,  and who may have gouty
or rheumatic tendencies, aud those avIio, by constant standing or walk-
ing, cause congestion of the lower extremities, chiefly by fatigue, or
by Avearing  bad  shoes, or by running over uneven ground, causing
bruising.  Where the  swelling takes  place in the first class, small
doses of arsenic, in the dose  of -g1^ to fa grain, often do  good, and
careful  examination should  be made of the  circulatory,  renal, and
respiratory apparatus to discover any weak points, such as vascular
relaxation or tendencies  to varicosities.   The distilled or fluid extract
of hamamelis is often of service in the dose of ^ to 1 drachm of the
former  and 10  to 20 drops of the latter preparation.  In some cases
absolute rest of the feet will be necessary before cure is reached.
   Where the feet are tender the most common cause is bruising from
too thin soles on the shoes, too tight shoes, and  from abrasions or skin
disease.   More commonly than all, they become sore from excessive
sweating and resulting maceration.
  The treatment of sweating and tender  feet is, of course, the removal
of the cause and the use of  remedies designed to tougheu and harden
the skin of  the parts  Probably the best application for this purpose
is  a  solution of salicylic acid  and borax, half and half, in  Avater and 
FEVER  AND  ITS  TREATMENT.
475
glycerin, rubbed over the feet night and morning.   If the sweating is
very severe, the  stockings Avorn should be clean  each day, and pre-
viously soaked in a strong solution of borax and dried.   The follow-
ing prescription affords a useful powder :

         R •—Pulv. acidi salicylici    .   .    .  gr. xx vel xl.
             Pulv. acidi borici  .   .   .    .    .      -jij.
             Pulv. amyli.....q. s. ad   |j.   M.
   _ S —To be dusted over the feet night and morning, after washing and thoroughly
drying them.

   Sometimes  the use of cotton  instead  of Avoollen stockings  may
aid in the cure.
              FEVER AND ITS  TREATMENT.

           (For the Treatment of each Fever, see its  Title.)

   At the present time  the  medical  profession are almost universally
of the opinion that fever is a disorder of calorification dependent upon
nervous action,  said nervous action being the result of various causes,
such as the presence of poisonous materials in the blood, or of per-
verted fuuctional activity.   The first  may be represented by the fever
of any infectious disease; the second  by the so-called hysterical hyper-
pyrexia.   Turning from the  general question of fever to those drugs
which combat it, Ave are met at once by an array of synthetically pre-
pared  substances Avhich are almost  Avithout number, and which are
derived chiefly from the tar found always in close proximity to deposits
of coal.
   The value of a  drug which  can decrease high  temperature  by in-
fluencing heat-production alone cannot  be  over-estimated, and while
several drugs seem to influence  this part of the heat apparatus more
than that portion connected Avith the dissipation of  heat,  we have no
substance Avhich is distinctly and solely capable of  exercising  an in-
hibitory power over the development of heat in the body.  Frequently
one of the substances  put forward  by its discoverer as a  useful anti-
pyretic remedy  has been found so to depress the  heart or respiration
that it cannot be used, while others  produce secondary lesions in the
tissues of the  body by more  slowly  acting influences.  For  both ex-
perimental and  practical  purposes  we may, therefore, divide anti-
pyretics into three  great classes:  First, the  substances Avhich allay or
prevent fever  by inhibiting its productio'i;  second, the drugs Avhich
possess the poAver of  decreasing  bodily temperature  by increasing the
dissipation and  decreasing  the productiou of  heat; and third, the
compounds  Avhich  allay fever,  not  by stopping the manufacture of
heat units, but  by  so increasing the exhalation of heat that the loss
is  greater than  the manufacture.  The first and  last of these three
classes are directly opposed  to one another.   The second class is half-
way betAveen, and  it is to this class that most of our  antipyretic  drugs
belong.  The  first  is the ideal, the second is the  one Ave  have  to be 
476                         DISEASES.

content Avith ; the third  is the one used by our forefathers, and is the
most dangerous and unreliable, since  the  tissues are quite as rapidly
destroyed as before the drug was given ;  the centre of the body re-
maining in pyrexia, while the cool skin  and extremities are apt to
lead the physician into  the  belief that the fever  no longer exists.
The tissiie-Avaste of the fever goes  on unchanged, and the patient, if
the disease be prolonged or asthenic in character, is in almost as bad
a condition as when no  such antipyretic attempt has  been made.
Almost as badly off, because it should never be forgotten that hyper-
pyrexia, or  even ordinary fever, is dangerous in  two ways, namely,
by destroying tissue and reducing vital  power, and by acting simply
as too great bodily heat, and  thereby producing nervous or cardiac
symptoms, such as are  seen in cases of sunstroke and heat-exhaustion,
where the condition of the patient is the result  of coagulation of the
cerebral  or  cardiac protoplasm, or is  one of depression  of all  vital
function.
  Closely allied to this question  is that which asks us to define what
we  mean by hyperpyrexia.  As  given by most Avorkers upon fever
this  term is applied to  any state in  which the temperature reaches
106° or 107° F.;  but  in reality this has nothing to do, except in an
indirect way, with what the student or  physician Avishes to know.
This is but  another example of the fact that the presence of a  high
temperature  alone does not  constitute  the sole indication  for  the
treatment of the disease, the physician  being governed by  the  state
of the  patient who is laboring under the malady.   A temperature of
106° F. in  a young healthy man, suffering  from an  attack  of some
short-lived disease, does  not  mean very great danger; but a tempera-
ture of  103° day in and day out in typhoid fever does mean danger,
and  must be  carefully  attended to.    In a  simple continued fever
106° F. is a hyperpyrexia.   The question  is one not of actual degrees
Fahrenheit, but rather  as to Avhether the temperature present is doing
any harm.
  Turning to  the drugs, Avhich are divided into classes, named from
their physiological effects, we may, in view of our present knowledge,
place them  as  follows  :  First, those Avhich decrease heat-production
alone are not known.   Second, those  Avhich act both on  dissipation
and production are antipyrine, acetanilide,  carbolic acid, salicylic acid,
similar substances, and quinine.  In this class, also, should be placed
cold bathing, which probably decreases heat-production as well as in-
creases heat-dissipation.  Third, those  drugs Avhich only dissipate heat,
as far as Ave  know, namely, the great  group of cardiac sedatives and
their allies.
  No one is more sensible of  the fact than  the  Avriter  that   this
arrangement  of the subject is partly artificial, but  in the present  state
of our knowledge it is  probably the best Ave cau do.
  Though a number of writers have claimed that  certain  antipyretic
remedies of equal power act with different  results iu different diseases,
the  writer has never been able to see any such  distinction, aud we
must be guided rather by experience as to the value of some particular 
                 FEVER  AND  ITS TREATMENT.            477

antipyretic  in  all diseases than by any other rule.  All  observers are
not  in accord, however,  as  to the best one of this class.   While
phenacetine has  been spoken of very highly by some authorities, the
writer has heard it equally condemned by others,  and although Ringer
prefers antipyrine, Mitchell Bruce  relies chiefly on  acetanilide, Avhile
in America almost  everyone  prefers the former drug, the  general
diffusion of this  prefereuce apparently resting  upon wide experience.
Though the number of cases of ill-effects recorded are small  Avith acet-
anilide as  compared Avith those of antipyrine, the  idea  prevails, and
perhaps justly too, that the former is much  more capable of harmful
effects than the latter, and it  cannot be denied  that  scientific  basis of
great Aveight exists for this belief.
   It may be said that we ha\re only three measures for the relief of
fever which are reliable and  have stood the test of time.   These are
antipyrine, acetanilide, and the use of cold.   (For the mode of using
antipyrine and acetanilide see pages 42 and 72,  and  for the use of cold
see page 353).
   For many years the profession of medicine has been in the habit of
feeling the pulse with the perfectly proper object of determining what
the state of the system is as it appears on this sign-board of the body,
but it has only been of late, when our  knoAvledge has increased, that
we haAre come to consider the pulse rate and  force as something more
than a simple aid to diagnosis.  At present many seem to forget that
the very value of the pulse, as a sigu-board,  depends upon  its readi-
ness to obey the beck  and call of the variations in the  body, and  to
consider that, in fever, for example, the pulse is rapid, not  because
the  fever makes a rapid pulse, but  that a rapid  pulse and fever are
equally dangerous conditions, both of them  of primary importance;
in other words, these persons  regard the rapid pulse, not as  the result
of a high temperature, but as a symptom in itself.
   While  in our present  state of knowledge concerning the  poisons
which produce fever Ave cannot  assert that none of them act on the
heart in the same manner as do certain drugs, thus altering  the  pulse
rate and force, Ave are able by experiments  to prove that  high tem-
perature of itself does seriously alter the heart-beat, aud, in addition,
that antipyretics, as a general rule, in lowering  the  fever  lower  the
pulse,  not  directly,  but indirectly.   Such results are to be gleaned
from the  studies of  Lauder  Bruuton,  Newell Martin, aud  several
other workers in this field, Avho have found that  febrile  temperatures
stimulate the accelerator cardiac nerves.
   Closely associated with this question is that of  the relationship be-
tween arterial pressure and fever.   It at once  becomes evident that,
if heat stimulates the  accelerator nerves, an increased  rapidity of car-
diac action must ensue, and, in consequence, an increase in the amount
of blood thrown into the arteries must result.   As a consequence of
this the arterial pressure must rise, even if the vasomotor system gives
response in no Avay to the heart.   In nearly  all cases of high fever,
however, unless the system be greatly exhausted, the vasomotor appa-
ratus certainly  is excited to increased activity. 
478
DISEASES.
   As the writer has spoken of the dangers of high fever, it is not right
that the impression be given that everyone belieA'es Avith Liebermeis-
ter in the absolute harmfulness of such states. While the profession in
general accept such vIcavs, the  opponents to them, though not  great
in number, have been so prominent, as individuals, that  their studies
cannot be passed by.  In 1883  Unverreicht tried  to  rebut the  testi-
mony then so rapidly accumulating in favor of antipyretic measures,
and, still later, Naunyn, in a very carefully Avritten and logical paper,
positively denied their value and usefulness.   While he grants  that
high temperatures are most important in prognosis and diagnosis, and
that certain  antipyretic measures do good, he,  nevertheless, insists
that, though the cold bath does good primarily, its effect upon the
nervous system nullifies its direct action upon the fever.   He acknoAvl-
edges, of course, that such temperatures  as 108°  or  110° F. are  of
dangerous  import  in themselves.  To prove that  his assertions are
correct, Naunyn  gives results reached in a series of studies made by
him on animals.  He found that healthy  rabbits will  bear a tempera-
ture, artificially induced, of 106° to 107° F., rising at times to  108°
to 109° F. for days together, Avithout any injury.   He further states
that in  many autopsies  he has failed to find any lesion present as the
result of exposure,  except a slight cloudiness of the renal epithelium.
The author  cannot  help calling attention to tAvo facts Avhich Naunyn
apparently overlooked, in  common Avith  many of the  readers of his
paper, namely, that 106° to 107°  F. is only a few  degrees above the
rabbit's normal heat, Avhich is about 103° F., so that the pyrexial  tem-
perature of these animals corresponded to but 101° or 102° in man, a
temperature easily borne in many fevers.   Second, it should be remem-
bered that this heat Avas applied constantly in  these studies to the
animal, which did not ha\Te to manufacture the heat itself. Although, at
first, this seems unimportant, it should not be overlooked, as the tissue-
changes in the two instances are entirely different; to use a homely
simile, in one case the stove is kept warm  by heat applied to it exter-
nally without  the  combustion of its tissues, the  coal; in the other
case, the stove is kept hot by the use of the coal itself.   Very different
changes are naturally found in the tAvo cases in the coal.  The author
cannot  go further  into these questions;  suffice it to state that while
high temperatures are borne in some instances Avith no evil results, the
majority of cases do not turn out so favorably.
   The various opinions expressed by well-knoAvn  German clinicians
concerning this question have been collected by Ziemssen.  Speaking
of the worth of antipyresis in any form, he divides the writers of the
last twenty years into groups, as folloAvs  : First, the extreme hydri-
atricists who only use cold bathing and object to internal antipyretics
—such  as  Vogel,  Winternitz,  and  others.  Second, the  moderate
hydriatricists, Avho  resort to lukewarm baths, but reject internal  anti-
pyretics, among Avhom may be named Naunyn and others.   Third,
those who, according to indication, resort to moderate hydropathy  and
to antipyretics,  such as Jiirgensen  and  Reiss.  Fourth, those  Avho
consider fever  as a salutary and necessary regulator, and only resort 
FEVER  AND  ITS TREATMENT.
479
to antipyretics when dangerous symptoms arise—as Heubner, Cursch-
mann, and others.   Fifth, those who  claim that fever  is a necessary
phenomenon,  and  therefore  reject all  attention to antipyresis  and
attend to diet (Glaser).  Finally, those Avho absolutely deny the in-
fluence of treatment on the mortality of fever (Port).
 ^ Truly, it would be  hard to find a set of more diverse and contra-
dictory opinions on so limited a basis, but  the practice  of  Jiirgeusen
and Reiss has virtually proved the value of antipyretic measures, and
they are resorted to by most of us.  Those av!io have tried them rely
on this method very  largely, and they are certainly an advance in
therapeutics.
   A very important question arises as to the value of the cold bathing
in private practice.  There  can be no doubt of its acting well under
these circumstances if carefully carried out, and it is certainly much
the best remedy for fever where trained nurses are on hand to admin-
ister it, but Avhere only members of the family are in care of the sick
man, and where the doctor can  only be on hand once in twenty-four
hours, it is manifestly impossible to resort to it.   Even if the bath be
properly  given, the exhaustion  produced   by clumsy handling may
more than counterbalance all the good achieved.   It has been claimed
that  the cold  pack never results  in cardiac failure, as does the use of
antipyretics.   We are quite confident of the fallacy of this  statement.
Indeed, the Avriter has  recently  seen  such a case.   The  cold  pack
cannot be used more carelessly thau antipyretic drugs, and  it is prob-
able  that when  this measure is  more Avidely employed  more reports
will  appear in the medical magazines  of  accidents  occurring as the
result of its abuse.   (See Cold iu  Fevers, p. 352.)
                         Sthenic Fevers.

   The application of antipyretics to the febrile temperatures occur-
ring  in  sthenic cases has  an entirely different purpose from  their
employment in a prolonged low fever of the adynamic type.   There
can  be  little  doubt that in the sudden excessive outbursts of febrile
temperature in a child  from  functional disorder  but Avith no  acute
disease underlying it, antipyretics are of great  value, and there are
also  reasons for their employment in the treatment of children and
adults in order to favor popular  prejudice.  Iu America, at least, a
physician visiting a case  of  croupous pneumonia  for the first time and
finding  the patient  with a high  fever would not  be allowed to give
the patient a cold  bath if the friends could prevent  it, and he must, in
consequence, fall back upon antipyretics.  Again, the fever of such
cases cannot be prolonged enough to necessitate the use of  antipyrine
day in and day out for weeks at a time, and  there  is, for this  reason,
less danger of the patient being injured  by its influence.  In scarlet
fever the use of such drugs  should be most carefully Avatched, because
the kidneys are in danger and the disturbances accompanying the fever
may  last a long time. 
480
DISEASES.
  In  pneumonia and erysipelas in strong persons antipyretics find
their true place.  Lasting about a Aveek in their febrile activity, these
diseases are often accompanied by sudden hyperpyrexia Avhich must be
overcome at  once by a drug, and the temperature is  so apt to rise at
any time to a dangerous degree  that some remedy often has to be left
in the hands  of the nurse Avith instructions to use  it if a hyperpyrexia
should assert itself.   Even in these cases the cold is the best remedy,
but the physician must be careful to see that it is  properly applied, or
it will be harmful instead of useful.
  In  thermic fever, or sunstroke, the employment of antipyretics is
often  useless.   The excessively rapid upAvard rush of the temperature
responds in no  way to drugs, and there  are cases  on record in which
the use of antipyrine has utterly failed of good result.  Thus, in one
case reported by Singer, a man suffering from thermic  fever, Avith a
temperature  of 108  degrees, received  50 grains of antipyrine hypo-
dermically at 6 p.m., at 7 p.m. he received 10 grains more under the
skin, at 8 p.m.  20 grains  more,  and at  9.30  another  20 grains were
used without effect.   In  other  Avords, 100 grains in three and a half
hours  proved  useless.   In children  suffering from  excessive  heat
during  summer weather antipyrine seems to be Arery useful, and has
been highly recommended by Demme.   It must be used with caution
lest collapse be induced.

                       Asthenic Fevers.

          (Typhoid Fever and  Fevers  of a Typhoid Type.)

  In  the opinion of the author, antipyretics should play a secondary
role in the  reduction of the pyrexia of the  typhoid  state, our main
reliance  being  upon cold applications, the antipyretics being  used
as an adjunct  to the cold  pack or bath.  Aside from the fact that
he  has found  such an opinion well  founded in a large  number of
typhoid fever  cases, logical reasoning endorses its correctness.  Even
if antipyretics  were  perfectly innocuous, their constaut use  in fever
would  but give  the  already over-strained  kidneys the task of their
excretion, Avhile the stomach, sufficiently disturbed by  necessary medi-
cines  and illness, has enough to do Avithout  the addition of an_addi-
tioual load.  Further  than this, Ave  know that these drugs are not
perfectly harmless, and we also  know that they act on the protoplasm
of  the body, and in  consequence  must  gradually lose their power,
which is  uot the case with the  cold pack.  The Avriter is sure that in
typhoid and  other low fevers of the continued type antipyretics should
be given only when the cold pack cannot be used, or at the end of the
cold application  to  prevent the temperature from bounding upward
after  its  depression.   (For Brand's treatment, see Typhoid Fever.)
Further than this, fever will sometimes resist all doses of antipyretics
Ave  can give, or all  that it is safe to  give, but no fever can resist the
cold bath.   Iu diseases of a  more chronic  type, particularly those
represented by phthisis, antipyretics are of doubtful  value, owing to 
GASTRALGIA.
481
the increased sweating which is so apt to be produced, and unless the
patient seems to be  particularly robust  they should  not be employed
except in the smallest available doses.
               FRECKLES  AND  CHLOASMA.

  The removal of freckles is readily accomplished, but  their return is
inevitable if any exposure to the sun or Avind occurs.  One of the best
applications for their removal is a solution in water of corrosive sub-
limate varying in strength from 1 to 4 grains to the ounce, and applied
night and morning  until the skin shows that it is irritated, Avhen the
lotion  must be stopped  for some days, after Avhich its use may be
begun again.   A very efficient,  and much less  dangerous remedy to
leave about the room in which children are alloAved to play, is a satu-
rated solution of boric acid in water, applied in the same manner as
is the solution of bichloride of mercury.
  Another  remedy  is  lactic acid, 10  grains  to a  drachm  of water,
used in the same manner as the solution of the bichloride of mercury.
The folloAving prescription  is recommended by Unna :
         R.—Bismuth oxidi 1
             T) ,     v  >       .    .    .       aa   gr. xxx.
             Pulv. amyli J                          °
             Kaolini........3j.
             Glycerini   .    .    .    .    .    .    .  fkij-
             Aquae rosse.....q. s. ad  f jjij.   M.
    S.—Paint on spots and allow to  dry, washing the drug off before each new
application.
Or the following may be used :
     R.—Zinci oxidi
         Hydrarg. ammoniati
         01. theobromse
         01. ricini
         Essent. rosae .
S.—Apply night and morning.
 gr- "J-
 gr. jss.
f^ijss.
fjjijss.
 gtt. x. M.
                         GASTRALGIA.1

  The treatment of gastralgia  may be divided into two parts—that
directed  to  the relief  of the  attack Avhen it is  present, aud that de-
voted to  the prevention of other attacks.  During the  acute stage hot
applications and drinks, aromatic and  locally stimulating  warm in-
fusions, a few  drops of chloroform, or brandy, or  whiskey hot  and
concentrated, or 30 or 40 drops of laudanum may be used.  Counter-
irritation often does good, and in some cases, particularly if a suspicion
of an  hysterical element exists,  a vigorous revulsive may act  with
surprising  success.  Emesis and  purgation are sometimes  indicated,

  1 See article written by author in Keating's Cyclopaedia of  Diseases  of Children,
vol. iii.
                                 31 
482
DISEASES.
since in the early attacks the cause of the pain may be suspected to be
the presence of indigestible food.
   The treatment required in the intervals  between the  attacks must
vary with the cause and with the general condition of health.  A care-
ful search must be made for the real cause of the  trouble, and when
found it must be removed or palliated by appropriate measures.
   The diet  should be carefully  regulated, and all the hygienic details
of the patient's life be critically studied and directed.   The avoidance
of improper food, the abandonment of tea,  coffee,  and tobacco,  the
prescription  of proper dress, exercise, or change of residence, may be
followed by marked improvement in general health and by a  cessa-
tion of the attacks of gastralgia.
   In regard to  remedies,  it  may be  premised  that all  depressing
drugs must be avoided, as Avell as all purgatives which would weaken
the digestion.  Any marked disturbance of digestion  should be cor-
rected ; and this may require the use  of  pepsin,  or of some tonic
remedies such as are suggested in the article on Indigestion.   The
chief reliance is,  however, to be  placed  upon the  administration of
arsenic and  iron immediately after  meals,  in proper form and  doses.
Thus, we may direct:
         R.—Liquor, potassii arsenitis    ....  f .^j.
             Vini ferri amari  .    .    .   .  q. s. ad  fjiv.   M.
    S—From 30 to 60 minims in water after meals, three times daily, for a child of
six years, or twice this quantity for an adult.

Or,
         R.—Tinctura? ferri chloridi.....f 3j.
             Acidi hydrochlorici diluti \                f ■?      tit
             Liquor, acidi arseniosi   j                 ^  •
    S.—From 4 to 20 drops in water after meals, three times daily.

   Occasionally even better results are secured by the use of cod-liver
oil in emulsion with hypophosphites.
   The  new preparation of  bromide of stroutium is a \raluable one in
gastralgia in the  dose of 20 grains three times a day.
   It is well, in cases Avhere the pain is very severe, to combine Avith
the above  a powder of bismuth subnitrate and  saccharated pepsin,
given about an  hour or an  hour and a half after meals.   Consti-
pation,  should it exist, must  be overcome by proper diet, massage,
enemata, or by suppositories of gluten or glycerin or soap.  If the use
of bismuth favors the continuance  of constipation too decidedly,  small
doses of cyanide of potassium, dilute hydrocyanic acid, or chloroform
may  be substituted at the same hours.  In  cases where a highly neu-
rotic state exists, it may be necessary to alternate all other  treatment
with  the bromides or with the preparations  of valerian, or the follow-
ing prescription may be used :
         R.—Acid, hydrocyanic, dil......f ijj.
             Ext. cannab. indicae.....f gj.
             Tr. hyoscyam.......f£j.
             Spt. chloroformi......f ^ij.    M.
   S.—30 minims t. d. in water. 
>
                 GASTRIC  CATARRH, ACUTE.              483


               GASTRIC CATARRH, ACUTE.

  By far the most important point in the treatment of acute gastric
catarrh is the regulation of the diet, and the following abstract from
the article  written  by the  author for the third volume of Keatiug's
Cyclopedia of  Diseases of Children, embodies  the ideas which  the
writer desires to express, so thoroughly, that he has inserted it here.
The dietetics may be divided into  two parts—first, the regulation of
the food during  convalescence or during the attack, and second, the
character of the  food to be  used during the interval following  one
attack and preceding the  next.   Total abstinence from  food  in  the
acute stages of  the attack, and absolute bodily and mental quietude,
are advisable.  There are several reasons for this.  In the first place,
the juices of the stomach are in an abnormal state and  unfit to act
properly if the stomach receive more  food.   Secondly,  the  mucous
membrane  of the stomach is already hyperaemic from the inflamma-
tion,  and,  as the normal  viscus becomes  physiologically hyperaemic
on the ingestion of food, we Avould add  to the congestion of the blood-
vessels did we  allow  more nourishment to enter the viscus.  Last of
all, the excess of the  mucus and  lactic and  butyric acids  present ren-
ders any new food impure before  it can  be assimilated, and so prolongs
the trouble.  As the  attack passes off, small amounts  of  food may be
given, which should be readily digested  and not likely to become easily
decomposed or rendered acrid by the mucus in the stomach.   Milk  with
a large percentage of lime-water is to be used, since the alkali not  only
prevents a too firm coagulation, but also decreases the secretion and acid
reaction  of the mucus.  The thirst is often  excessive, although  an-
orexia is complete, and small pieces of ice may be administered for its
relief.  Commonly it  will be found that the patient rapidly improves
up to a certain point, then stops improving, or relapses.  This is
sometimes   due to au  accumulation  of mucus,  which when  mixed
with food  undergoes  fermentation   If  marked evidences  of  the
presence of this secretion  are given, a mild and gently acting emetic
may be employed to dislodge the fermenting-mass.  In other instances
the relapses depend  upon a tendency to a condition of atony which
can  only be overcome by prolonged and careful treatment adapted to
the  improvement of the general health.   Sodium bicarbonate  with
compound  infusion or compound  tincture of gentian may  be  used
during convalescence,  and  small  sips of  effervescing draughts are
useful.   If constipation exists  and vomiting  forbids the use of the
ordinary purgatives, a Seidlitz powder divided into fourths or fifths
and taken  in this Avay every fifteen  minutes or half-hour Avill settle
the stomach, move the bowels, and often carry away mucus.
   If there is  much  epigastric distress, a spice'fioujtice is often of
service.
   SAveets and starches are to be rigidly denied the patient.   If anaemia
exists, iron may  be used ;  but this is rarely needed. 
484
DISEASES.
  The abdomen should be  carefully  protected  with  flannel,  and
draughts and unsanitary surroundings avoided.
  The use of pepsin and of hydrochloric acid is to be much more
thoroughly attended  to  thau  has heretofore  been the custom.  As a
rule, Ave  are  apt to forget that pepsin acts  largely  by catalysis, and
that it is not secreted as pepsin, but as pepsinogen, a substance which
is changed into pepsin  in the  presence of an acid.   For this reason
hydrochloric acid should be freely employed, and pepsin given in large
or small  quantity according as  there is  reason to believe this ferment
to be in normal or abnormal amount.  Common salt (sodium chloride)
is virtually  identical  in  its ultimate influence Avith hydrochloric acid,
and should be always used, in moderation, with the food.


              GASTRIC CATARRH,  CHRONIC.

  Chronic gastric catarrh is a condition of the stomach commonly seen
in this country in a more or less active form.   It is often associated
with much indigestion and the eructation of sour liquids, or even with
active vomiting.  The  secretions of the stomach are  nearly always
abnormal,  and  fermentative  changes  are  constantly present  in  the
gastric contents.
  By far the best treatment for this condition is the use of counter-
irritation over the epigastrium, the close regulation of the diet and the
use, internally, of nitrate of  silver  and extract of hyoscyamus, or, if
any hyperacidity exists, the administration of  the subnitrate  of  bis-
muth.  Constipation is nearly ahvays present, and should be removed
by  appropriate drugs, such  as cascara sagrada,  of Avhich  the best
preparation is the fluid extract rendered free from bitter taste by certain
large manufacturers in this country, or in  the form of cascara sagrada
cordial.
   All fats, rich foods, strong meats, ham, bacon, or fried things are to
be avoided, and only light broths, koumyss, or matzoon resorted to if
the case  be an obstinate  or severe one.   A nitrate of silver pill should
be used half an hour before each meal, and be prescribed as follows :
         R.—Argenti nitratis   .   .    .     .    .    .  gr. iv.
             Extract,  hyoscyami   .    .     .    .    .  gr. x.  M.
  Ft. in pil. no. xx.  S.—One, half to one hour before each meal.


                   GASTRIC  DILATATION.1

  The treatmeut of dilatation of the stomach  may be divided into two
varieties—the first consisting of the methods of cure which are directed
against the diseased state of the gastric walls themselves ; the  second,
of those  methods by which abnormal changes  in the food and the gastric
contents and secretions are  combated, thereby  allowing reparative

  1  See article by author in Keating's Cyclopaedia of Diseases of Children, vol. iii. 
GASTRIC  DILATATION.
485
changes to take place.   As  is Avell knoAvn, dilatation of the stomach
may be dependent upon some constitutional or some local cause.  If the
cause be rickets, it is evident that the malnutrition of the bony system
and of the system in general is to be improved, and that remedies de-
voted to this object are to be given, such as cod-liver oil by inunctions,
or, if the digestive apparatus will bear it, the oil may be given by the
stomach.   Lacto-phosphate of lime, phosphate of sodium, or iron,
often in the form of the  syrup of the iodide, should be  used if any
signs of struma are present.  Good foods possessing large  amounts of
salts, yet easy of digestion, are, under these circumstances, particularly
desirable, and by  far  the larger part of the  treatment  should  be
directed to the dietetics of the case.  Of this the writer will speak
further on.
  There are several means  to be employed for the relief of gastric
dilatation other than those which  can be called medicinal, so far as
drugs are concerned.
  These consist, first, in efforts to evacuate the stomach and to cleanse
it;  secondly, in attempts  by these  and  other  means to  prevent  its
distention by the gases which arise or by  the accumulation of ingesta
Avhich takes place; thirdly, in the regulation of the diet so as to avoid
causes which have a tendency to  increase  the disorder.
  Dilatation of the stomach is  so  difficult to cure that  very satis-
factory results are not to be  looked  forward  to;  nevertheless,  the
nutrition  and the general state  of health are  to be carefully consid-
ered.
  Taking up seriatim the non-medicinal means Avhich we have named,
we come at once to the consideration of lavage, a  method which  has
been resorted to with most thorough trial on the continent  of Europe.
Originally proposed  by Epotius in 1863, it  has  been most  widely
employed in children  by Epstein, Avho in one article alone records its
employment in two hundred  and eighty-six cases of gastric disease in
infancy, the patients being less than one year of age.
  Epstein employs a No. 8 or a No. 10 Nelaton catheter for the tube,
and warm  Avater holding  in solution a little benzoate of magnesium,
the latter being resorted to chiefly Avhen fermentation and  decomposi-
tion products are present.   If none of these conditions are  present,
ordinary water  will usually suffice.  The liquid   employed  should
always  be warmed.   Others—as, for example, Lorez—use the ordi-
nary catheter, of the size known  as No. 13 or No. 15.   The question
as to the variety of tube to be employed is a vital one, since a poorly-
devised apparatus not only  gives  no relief,  but   disgusts both  the
patient  and the physician with  the technique  of  the  method.  The
tube  should  be more  like a hollow bougie than a catheter, in order
that its calibre  may be great  enough  to carry off some of the serai-
solid materials present.   If this  rule  is  not carried out, two evil re-
sults follow.   In the first place, the tube aud its  apertures rapidly,
or even at once, become clogged ;  secondly,  the  liquid  is  drained
away, leaving behind a mass which is semi-solid, to be sure, and  less
bulky, but Avhich  is, nevertheless, the quintessence  of the nastiness of 
486
DISEASES.
fermentation, and quite as well  qualified to leaven any fresh food on
its entrance as the liquid would be.
  The holes in the gastric end of the tube should, therefore, be large
enough to take in fairly large  masses.   In some cases the ordinary
siphon may be used, but where there is any solid food or resistance,
suction by means of a stomach-pump is necessary.
  The tube should be tAventy-four or thirty inches in length for a child,
or forty inches for an adult.  The methods by which lavage is employed,
further than those we have named, are as folloAvs :  The catheter or tube
should be passed backward against the roof of the mouth, so that by
following the curve of the  hard and soft palates it is directed  into the
pharynx and  oesophagus, and then by gentle pressure forced on down
into the stomach.   As  it is introduced the patient  should be told
to  swalloAV.    The  irritability  of the  pharynx rapidly disappears
Avith repeated operations, and it is surprising how quickly the patient
becomes  accustomed to the operation, aud submits to it without any
feeling of discomfort.   After the tube has reached the stomach,  a
small  funnel is to  be fitted in  its external end, Avhich is  then  held
above the head of the patient Avhile water prepared in the  way we
have mentioned is poured into it until the stomach is filled, when the
funnel end is lowered and the stomach is emptied by siphonage.
   The stomach-pump has one very serious  disadvantage,  which  is
present with even more force in the case of a child  than in  the adult,
namely,  the danger of injury to the coats of the organ.  This appa-
ratus is also more costly and cumbersome, aud for children the siphon
is powerful enough in its action  to take away all excuse for the use of
the more complicated apparatus  unless the contents of the stomach are
in bulk.
   It is particularly necessary in  children, on account of the lack of in-
telligent aid and their liability to gulp, that every care should be taken
that the  tube does not slip entirely out of reach into the stomach, and
for the prevention of this  danger  a string  should  be  attached to the
external end of the tube before it  is introduced.
   The treatment of  dilatation, to  be  next considered,  is  dietetic.
There can be no doubt that one of the chief reasons for the emaciation
which comes on is the failure on the part of the stomach to digest and
assimilate nourishment.   In addition to this, the intestine is really the
place for absorption of food to take place, and the delay of the food  in
the stomach virtually makes  the  chyme unfit  for  the function of the
small intestine.
   The foods  to be given are, of course, to be in  the  highest degree
capable  of ready assimilation, and should be confined, especially  in
severe cases, to the materials  which can be readily predigested by the
employment of the digestive ferments now so largely sold.   Carefully-
skimmed milk is valuable, aside from its inherent usefulness, iu that
it lacks  the fats which can be utilized only in the intestines, and Avhich
simply break  down  and decompose if kept in  the stomach.  Oyster
broth, carefully freed from any oily matters in cooking, and thoroughly 
GASTRIC  ULCER.                     487
pancreatized, is to be giA^en.   Ordinary whey obtained from milk by
means of rennet is useful.
  Rectal alimentation to some degree is always useful, and Ewald, of
Berlin, suggests the following nutrient enema :  Beat up two eggs with
a tablespoonful of cold water; to this add a little starch, boiled in half
a cupful of a  20 per cent, solution of grape-sugar  and a  Avineglassful
of red Aviue.   The  solution  is to be Avell  mixed at a  temperature not
high enough to coagulate the albumin, and injected as  high up into the
bowel as possible.   For a child this mixture should be somewhat less
in quantity than that given for the adult, particularly  as to the wine.
  An exceedingly important part of the dietetic treatment of gastric
dilatation consists in the constant bearing in mind of the  fact that the
tendency of food is to accumulate, and the avoidance of the pernicious
habit of adding solids  or  liquids to the quantity of  ingesta still re-
maining from a previous  meal.  If the child  is old  enough, all the
remains  of previous feedings should be  remoA^ed  by lavage before
anything more is given, since otherAvise the sweet food is at once con-
taminated by the liquids Avhich it meets in  the stomach.
  The  medicinal  treatment of gastric  ectasy is, unfortunately, very
limited, so  far as the stomach itself is concerned, and, indeed, Ave doubt
Avhether any direct  medication can ever be of much  value unless in
the form of disinfectant substances, such as Ave have spoken of when
speaking of lavage, aud these only prevent decomposition of the food
aud do  not effect a cure.
  In a case  of marked gastric dilatation we should, nevertheless, al-
Avays resort to the bitter tonics, such as gentian or calumba, and for
the improvement of  the muscular coats of the viscus  should employ
the tincture or extract of physostigma in the dose of 5 to 10 drops or
8 to ^ grain, respectively.   In the case of  a child  under  the author's
care a very extraordinary improvement followed the use  of  this drug
aud the careful fulfilling  of all the directions just given except the
lavage, which Avas not employed.
                      GASTRIC ULCER.

  In the treatment of gastric ulcer three points must be borne in mind
as being essential.  These  are, rest for the stomach as far as possible,
rest for the patient herself, and the maintenance of the general  health.
The  first of these points involves a consideration of diet.  If,  in any
case, the stomach is very irritable it is best to place the patient in bed
and  nourish her for  from  two  to eight days by means of  enemata.
Probably the best form of nourishment for this purpose  is a mixture
recommended  by Dreschfeld and consisting of 2 raw eggs with 2
ounces of beef-tea and a little brandy, which may  amount to 1 ounce
if the patient really needs stimulants.   It may be well to  place  a little
pepsin in this  injection to  peptonize the proteids, but  if  this is done
the alcohol must be left out, as it will interfere Avith the activity of the
pepsin.  Pancreatin may also be  used with advantage in some cases in 
488
DISEASES.
the amount of 5 or 10 grains in each injection.  For the relief of
thirst, which may be excessive if rectal alimentation is resorted to, the
patient should hold in the mouth small pieces of ice or drink moderate
quantities of barley or rice water.  After this treatment has been used
for some days small quantities of food may be given  by the mouth,
such as a little peptonized milk or a little warm milk with lime-water
in the proportion of half aud half, or 1 part lime-water to 2 of milk.
After this thin arrow-root or gruel may be given in moderate quantity.
It is better to give the food in small amount every two hours than in
larger quantity three times a day.   The increase in rations,  both  as to
variety and  amount, should  be most gradual, the physician extending
the dieting over  at least six  weeks, of Avhich the first two had best  be
spent in bed.  It is well to use massage and electricity  under  these
circumstances  to preserve nutrition, as in  the rest cure.  (See Rest
Cure.)  Beef-tea and  soups had  better be avoided during the early
stages of the treatment, as they will  irritate the stomach.   Soft-boiled
eggs, tender chicken or game, and minced lamb may be finally given.
Cheese, coffee, tea, beer, and ale are to be avoided, as are all hot
drinks.  Fresh green vegetables may be used in moderation, but  fresh
bread  and  unripe fruit  must be carefully avoided.  When milk is
taken it should  be warmed   The presence of gastric  pain indicates
that the diet must be cut down in quantity or the nutrition  carried on
by rectal injection.
   The drug treatment of these cases is both palliative as to pain and
curative.  For the pain counter-irritation of a more or less  severe and
constant type  should  be applied to the epigastrium, either as a spice
or mustard  plaster or by means  of a hot-water  bag.  The counter-
irritation should be as continuous as possible.   Sodium bicarbonate
aud the subnitrate and subcarbonate of bismuth are  also of service in
the dose of 20 grains each, and to these may be added from -^ to 4^ of a
grain of morphine hydrochlorate or 1 grain of codeine.  These may be
given thrice daily if necessary.   Only the smallest dose of morphine
necessary to relieve  the  pain should be  employed.  By far the best
treatment for the pain and for the ulcer itself is the following pill:

         Be.—Argenti nitratis   .   .    .    .    .   . gr. iv.
             Extracti hyoscyami   .    .    .    . gr. x vel xx.   M.
    Ft. in pil. no. xx. S.—One pill half to one hour before meals.

   For the  constipation which is frequently present the  patient may
receive a dose of Carlsbad  salts or phosphate of sodium, or even the
sulphate of magnesium.
   For the relief of vomiting and of haematemesis absolute abstinence
from food, so far  as its administration by the mouth is concerned, is
to be insisted  upon.   Nutrition must  be maintained under  such cir-
cumstances by the rectum.   Small doses of \ grain of cocaine may be
given, or cocaine  and bismuth subnitrate together if the vomiting is
persistent.   Sometimes drop doses of creasote are useful, or carbolic
acid may be given in the same dose Avith 20  graius of subnitrate of
bismuth.   One  of the best remedies for haematemesis is oil  of turpen- 
GASTRO-ENTERITIS.
489
tine in the dose  of 5 to 10 drops four times a day.  In  other cases
good  results  will often  follow  the use of the solution  of the  sub-
sulphate of iron (Monsel's solution)  in the  dose of 3 drops every
half-hour or by the employment of 3 grains of the salt itself in pill.
Cold compresses or au ice-bag should be applied to the epigastrium.
  Should perforation of the stomach occur the prognosis is most
gloomy.   The  tendency to peritonitis should be  antagonized by the
application of cold to the belly wall, by the avoidance of food, perfect
physical rest, and supportive treatment in the Avay of heat to the limbs
and the hypodermic use of ether, brandy, or ammonia.  Morphine
should also be pushed actively unless collapse  is too pronounced,  as it
tends to prevent abdominal pain and inflammation.   Operative meas-
ures are to be resorted to in suitable cases.
                     GASTRITIS, ACUTE.

   This is generally due to the ingestion of irritant foods or drinks,
rarely arising in its true acute form from other causes.
   The treatment is  to  be directed entirely to the  prevention of the
spread of the inflammation and to the relief of that already developed.
If the patient is seen soon after the onset of the trouble, the stomach is
to be emptied of all irritant substances by means of vomiting induced
by large draughts of warm  water, or,  better still, by the use of the
stomach-pump,  as the  retching may increase the  irritation.   Muci-
laginous drinks are to be given freely, and albuminous materials  seem
especially useful.  Oils and  similar protective liquids aid in prevent-
ing further damage.   Opium, to allay pain and the local and systemic
irritation, is invaluable.  This drug should always be given in liquid
form, and the deodorized tincture  is the best in this respect, owing to
its freedom from narcotine.   Paregoric contains too little opium to be
of value, and is irritating because of its volatile oil.   If the stomach
will  not  retain drugs, they should be given  by the rectum.  If evi-
dences of collapse appear, hot applications, atropine,  or belladonna
should be exhibited.  It is important that the heat should be applied
over the epigastrium and  chest, and a flaxseed poultice is the best
method of doing this.   Practically the same rules hold good in regard
to diet in both acute gastritis and in gastro-enteritis.


                    GASTRO-ENTERITIS.

   Gastro-enteritis  is a condition of inflammation affecting  the entire
alimentary canal iu some  instances, and commonly produced  by the
ingestion of some irritant  substance, either in the form of bad food,
poisons, or mechanical  irritants, sucb as grape-seeds or cherry-stones.
The  symptoms  accompanying it are exceedingly various, but consist
chiefly in pain of a griping character with watery or mucous stools, or
if the inflammation  be very severe, absolute and unyielding constipa- 
490
DISEASES.
tion may be present.  The nervous symptoms depend upon the degree
of irritation and the general nervous tendency of the patient, and if
the trouble is very severe, he may go on into a condition of shock or
collapse.
   If the irritation is very intense exfoliation of the mucous membrane
may take place, the epithelium coming away in shreds.
   The  treatment  of gastro-enteritis  depends  upon its  severity and
cause.   Almost always we first allay the pain and tendency to inflam-
mation  by the  hypodermic use of  morphine, and immediately follow
this or precede it by an emetic of a non-irritating and rapidly acting
type, such as apomorphine, provided there is reason to belie\Te that the
poison  or food still  remains in Avhole or in part in the  stomach.   If
the irritant has been taken some time before the physician  is  called in
to  see  the case,  emetics  are  contra-indicated, as by  disturbing  the
abdominal contents, they render the inflammation Avorse.  Following
this, or in place of it if emetics are not useful because the poison has
already passed through the pylorus, castor  oil in the dose of 2  to 3
tablespoonfuls  to  an adult may be given to sweep  out the offending
materials and  lubricate the intestinal Avails.  In other cases  sulphate
of  magnesium may be used, but not sulphate of sodium or Rochelle
salt, as  they are both irritant.   The sulphate of magnesium is of value
because in addition to its purgative effect it also  depletes the inflamed
bowel.   Having  gotten  rid  of  all  offending  materials  opium and
sulphuric acid are to  be freely  used to allay irritation and control
diarrhoea (see Diarrhoea),  and hot compresses  are to be applied to the
belly, or a spice or mustard plaster used  instead.  Vomiting when it
is excessive is to be treated in the  manner described under that head.
The after-treatment of acute gastro-enteritis is very important both in
respect  to food and drugs.   The  inflammatory process, if severe, will
have  interfered with or destroyed glandular action to  such an extent
that starvation from the  non-assimilation of food may occur.  Pre-
digested foods  are therefore in many cases  indispeusable, and a care-
fully regulated diet a sine qua non.


                          GLAUCOMA.

   Glaucoma,  or  that disease dependent  upon an increase  of intra-
ocular pressure, appears in an acute or chronic form.  The disease in
general terms is characterized  by halos appearing about the gas-light;
periods of obscuration of sight; shrinking of the  nasal half of the
field of vision ; narrowing of the anterior chamber of the  eye ; anaes-
thesia of the cornea; and increased tension of the eyeball   In  the
" glaucomatous attack," or acute glaucoma, the injection of the eye-
ball is  intense;  the  lids  swell,  there is photophobia, the cornea is
steamy, the pupil dilated and motionless, and the vision  rapidly de-
stroyed.  The case may be mistaken for iritis or acute ophthalmia—
a fatal blunder.
   Iridectomy or an equivalent  measure is  the only treatment for 
GONORRHOEA.
491
glaucoma.   If for  any reason  this  is  delayed, a  solution  of the
sulphate of eserine,  1 to 2 grains to the  ounce, or pilocarpine nitrate
in twice this strength,  should be dropped into the eye every two or
three hours until relief  follows.   Atropine must not be employed.  Hot
compresses, opiates,  and leeches are also  useful to alleviate the pain,
if for any reason operation is delayed.
                        GONORRHOEA.

  The therapeutics of  urethritis varies in accordance  Avith Avhether
the disease  is acute or chronic, and is very greatly modified  by the
seat  of  inflammation—a  posterior  urethritis,  for  anatomical and
mechanical reasons, not being amenable to the same treatment which
will  prove successful when the  disease  invades the  penile portion of
the urethra.
  The membranous and  prostatic portions of the urethra constitute
its posterior part.  They are surrounded by layers of powerful muscles
which keep the canal constantly occluded,  and  which play the part of
vesical sphincters.  Hence, any injection forced into the urethra passes
to but not beyond its membranous part, and is  worse than useless  if
administered AAdth  the  intention  of  combating  inflammation  of the
posterior urethra.
  Since the general acceptance of the gonococcus as a specific cause of
gonorrhoea the treatment of acute anterior urethritis  has been  mainly
antiseptic, those drugs  being chosen  which are found  to  act  most
poAverfully upon the specific germs and at the  same time produce the
least  irritant action upon the  mucous  membrane.    Bichloride of
mercury, as representing the  most poAverful germicide known to
medicine, has been used most extensively.  The main objection to its
action lies in the fact  that Avhen employed in  efficient strength it is
exceedingly irritating.  This effect may, to some  extent, be avoided by
using  a  large quantity in  dilute solution,  and one of the most satis-
factory treatments yet ad\rocated consists in thoroughly and repeatedly
flushing the urethra with bichloride lotion 1  to 20,000 or 1 to 40,000.
This may be accomplished by  means of a bulbous catheter provided
with  numerous  small apertures opening  backward  just behind the
enlarged extremity; immediately after  urination the bulb is carried to
the membranous portion of the  urethra, the tube from an irrigator is
then attached to the extremity of the catheter, and one or two pints of
dilute mercury solution, as hot  as can be borne, are injected.   This
may be repeated once or twice daily.  When the urethra  is so sensitive
that the passage of an  instrument is not practicable, a conical nozzle
carrying  a supply- and  a drainage-pipe, and of a  size to close the
meatus entirely when inserted,  may be employed for irrigation.  The
drainage-pipe should be  of slightly smaller calibre  than that Avhich
carries the solution into the urethra.   This insures the passage of the
iujection back as far as the membranous portion of the urethra, beyond
which it Avill not pass if  the  pressure  does  not exceed that obtained 
492
DISEASES.
by  elevating the irrigator two  feet above the  level of  the  urethra.
When neither of these methods of irrigation can be practised, a syringe
with a conical nozzle and with a capacity of at least one ounce may
be employed; this should be used six or eight times a day, two syringe-
fuls of the  dilute lotion being  injected immediately after urination.
The liquid should be forced in very gently, being allowed to  Aoav out
by slightly lessening the pressure of the nozzle upon the meatus when
the anterior urethra is full.  When large injections are attempted by
the ordinary small urethral  syringe, the frequent  application of the
latter to the meatus occasions much irritation.  As a precaution against
forcing the injection into the posterior urethra the patient may be in-
structed to sit with the weight of the body bearing upon a folded towel
placed beneath  the perineum.  These copious irrigations inaugurated
in the earliest  stage of gonorrhoea  are frequently successful in pro-
ducing a complete cure  in a few  days.
  Much stronger solutions of mercury are  frequently employed, the
concentration depending upon the subjective sensations of the patient
and varying from 1 to 1000 to 1 to 4000.
  The addition of other antiseptic agents  to the mercury  solution
has been found advantageous.   A favorite injection  of Dr. J.  William
White is :
         R.—Hydrarg. chlor. corros.....gr. ij vel iv.
             Zinci sulpho-carbolat......gr- ij vel x.
             Acid, boric......3J.
             Hydrogen, peroxid......f %y
             Aquae......q. s. ad f^viij.   M.
  The strength of this  should be varied to suit the individual.
  While this prescription is an  incompatibility, Dr. White states that
the results obtained are exceedingly good.
  Any of these ingredients may  be  used alone or iu  combination.
Either  individually or  together, they probably represent the  most
efficient topical medication yet discovered.   When  the  gonorrhoea has
already assumed a markedly inflammatory  type,  with swelling  aud
oedema of the  penis, redness  and  eversion of the  meatus, and great
sensitiveness of the  urethra, no  injection should be employed.  The
penis should be  wrapped  in cloths kept wet Avith alcohol and water,
or lead-water and laudanum.   With the subsidence of acute inflam-
matory symptoms and  the appearance of copious discharge, the injec-
tion treatment may be inaugurated.   It  must be remembered that
injections may  in themselves prevent the discharge from entirely dis-
appearing.  Hence,  as the symptoms ameliorate, the injection should
be made less frequently; finally being entirely omitted for some days
if the discharge seems to "continue longer than usual.
   Internal  medication  and constitutional treatment are  most impor-
tant iu all  forms and  stages of  gonorrhoea.  It is almost universally
accepted that certain  drugs, such as copaiba, cubebs, and oil of san-
dalwood, when eliminated through the kidneys, possess  the  power of
inhibiting the growth of the gonococci or of destroying their vitality.
Bacteriological research has shown that  of this   class of  remedies 
GONORRHOEA.                      493
copaiba alone possesses  such  power.   To this drug  must be added
salol, Avhich has  been  proved by laboratory and clinical tests  to exert
a powerful germicidal action upon the gonococcus.  Cubebs is useful
not because it has  any specific action,  but because it exerts a dis-
tinctly  modifying  action  upon the  ardor  urine,  one of the most
distressing symptoms  of urethritis.  A very admirable formula sug-
gested by White  is as  folloAvs :
         R.—Salol.........gr. v vel x.
             Oleoresinae cubeba?   .    •    .    .    .  gr. v.
             Copaibas (Para)......gr. x.
             Pepsinae   .    .    .    .    .    .    .  gr. j.     M.
    Ft. in capsul. j.  S.—Take one of these capsules six times daily.

   Beyond the capsules  there  is  little  need  of medication by the
stomach.   Obstinate chordee may require bromide of potassium and
chloral.   Of these a drachm of the former must be given at bed-time,
and 10 grains of the latter,  Avhich may be repeated in the  night if
painful erections persist.   Lupulin in 30-grain doses is also indorsed.
When practicable, opium or  belladonna suppositories, or hypodermic
injections into or about  the perineum of morphine gr. ^ and  atropine
gr. fa will prove very satisfactory.  In  all cases the patient should be
instructed to rise once during the night  and pass his Avater.
   Ardor  urine  is usually relieved  by the use of cubebs,  as in the
capsule given above, by  demulcent drinks, aud by the employment of
bicarbonate of sodium or citrate of potassium in  sufficient doses to
render  the urine slightly alkaline.  Either of these drugs is conve-
niently administered in  the form  of compressed tablets taken one or
two hours after meals in 10-grain doses, the quantity being increased,
if necessary, until  the desired  effect is  produced on the urine.   The
instillation into  the urethra, by means of an eye-dropper, of a 4 per
cent, solution of cocaine  a feAv minutes  before urination  markedly
diminishes the burning.   Finally, this symptom may often be  relieved
by instructing the patient to pass his Avater Avith the penis submerged
in a vessel containing Avater as hot as can be borne.
   Where the  inflammation is of a high grade and attended by fever
and general malaise, the administration of 2 drops of aconite  repeated
every two or three hours is followed by marked relief.
   In regard to  the general  treatment of a patient  suffering from
gonorrhoeal urethritis, rest in  bed  is  particularly desirable.  This,
however,  is rarely  possible,  and the surgeon must be  content  with
enforcing the  avoidance  of all  active exertion and the observance of
as much  rest of mind aud body as is  compatible Avith a continuance
of the daily routine of business life.   While skimmed  milk  or butter-
milk diet  is theoretically desirable,  the advantages to be gained  by
it are  scarcely sufficient to justify insistance upon such a regimen,
especially as  it would excite  suspicion  as to the  presence of  venereal
disease; hence a  light diet consisting mainly of vegetables and fruits,
and in  quantity about  half that usually taken, with  a  minimum
amount of meat, should be advised.   In addition the patient should
be  induced to drink  liberally of plain  water or any of the sparkling 
494                        DISEASES.
mineral Avaters, as by this means the urine is not only rendered bland
but  greatly increased  in quantity,  thus enabling the urethra to be
fully flushed from behind many times a day. Flooding of the stomach
with such large quantities of liquids  as  to produce dyspepsia is to be
carefully avoided.  It is scarcely necessary to state that copulation or
any  form of venereal excitement must be strictly interdicted.  Finally,
prolonged warm baths lasting  from  half an hour to two hours seem
to exert a favorable influence upon the local inflammation.
   Acute posterior urethritis does not usually develop until  the  dis-
ease of the penile portion of the urethra has run a course of two or
three Aveeks.  During  the very  acute  symptoms  local  treatment
applied to any portion of the urethral canal probably aggravates the
condition, and even  the internal administration  of balsams and anti-
septics must be  employed with  very great  caution, their use  being
suspended at once if the  inflammation seems to be aggravated by their
employment.  Hence, Avhen in  the third  week of gonorrhoea there  is a
violent outbreak of inflammation in the membranous and prostatic
portions  of the urethra, suspension of all active treatment is indicated.
The bowels  are kept open, the diet is carefully regulated, the urine is
rendered bland, unirritating and antiseptic, continued warm baths are
ordered,  the painful symptoms  being controlled by opium and bella-
donna  administered either hypodermically or in the form of a supposi-
tory.  When the acute symptoms subside, the quantity of  antiseptics
taken  by the mouth may be increased, balsams  may be  added,  and
local treatment may be  directed, first to the posterior urethra, after
the cure  of which the anterior urethritis  should  receive attention.   It
has been stated  already  that injections forced into the meatus rarely
penetrate beyond  the bulbous portion of the urethra, hence to influ-
ence the  deeper portions  of this canal some other method of applying
these drugs must  be devised.  This end is best accomplished by means
of Ultzmann's irrigation  catheter,  or  other instrument  similar  in
principle.
   The patient is first instructed to empty the bladder of a portion of
its contents; by this means the urethra  is flushed out.   The  catheter
is then introduced into the membranous portion  of the canal, and, by
means  of a syringe,  1 ounce of the injection  is forced into the  mem-
branous and prostatic portions  of the urethra.  This fluid does  not
regurgitate along  the sides of the catheter, but enters the bladder, and
is passed with the urine at the next act of micturition.  The injection
most employed is the following: Nitrate of silver, grain J  to 1; dis-
tilled water, §j.   Carbolic  acid, 1 grain  to  the  ounce, or any of the
injections used in anterior urethritis, may also be employed.  These
injections should be made twice a Aveek.

                     Chronic Gonorrhoea.

   Chronic gonorrhoea differs from the acute form  in the fact that  the
inflammation is distinctly localized in certain portions of the urethra,
and does not invade the whole canal Avith uniform intensity; hence, 
GONORRHOEA.
495
efficient treatment must be directed not to the whole urethra but to
the  diseased  areas.   Foci  of chronic urethritis are  usually  found
either in the bulbous portion of the  urethra or in the membranous or
prostatic portions.  If the disease is located  in  the  anterior urethra
it will commonly be found to depend upon the existence of a stricture
of large calibre.   The  passage of  sounds of full  size—cutting the
meatus if this is necessary for their  introduction—will be  followed by
prompt relief in such cases.  The sounds  should be used not  more
frequently than tAvice a  week, and should  be most carefully sterilized
before introduction.
   If after free dilatation  the discharge still persists, and a large por-
tion of the anterior urethra is in a catarrhal  condition, as shoAvn  by
examination of the urine, irrigation of the urethra  should be  prac-
tised.   This may be  best effected  by  passing a  soft  rubber catheter
down to the membranous portion of the urethra, and injecting through
it once daily 3 ounces of a half-graiu-to-the-ounce solution of nitrate
of silver.  When the general  catarrhal condition is materially modi-
fied,  by means of an ordinary hard-rubber endoscope and a head-
mirror the focus of inflammation may be exposed, and may be treated
directly by strong astringent solutions carried in by means of a brush
or by absorbent cotton secured to  the extremity  of a long applicator.
Nitrate of silver or sulphate of copper, 20 grains  to the  ounce, may
be employed.   Unna has devised a most successful treatment for ob-
stinate cases of gonorrhoea.  He advises coating the sounds with the
following mixture :
         R.—01. cocae........^iij.
             Cera? flav.........^ss.
             Argent nitratis    ......  gr. xv.
             Balsam. Peruvian.......^ss.    M.

   This is liquefied in a water-bath, the sounds are dipped in  it and
are then  hung  up to dry.   On being passed, the  heat of the  body
melts the coating.  The objection to  their use lies in the fact that the
application is made to the entire urethra.   Practically,  however,  their
employment is often followed by brilliant results.
   Chronic posterior  urethritis must be treated by  remedies applied
directly  to  the  diseased  area.  Nitrate of silver is more commonly
successful than any other medication.  By means  of Ultzmann's appa-
ratus three or four drops of a solution varying  in  strength from 0.1
per cent, to 5 per cent, may be employed.
   Finger recommends the following  ointment:
         R.—Argent, nitratis vel cupri sulph.   .   .    .  gr. xv.
             Lanolin.........3 iij.
             01. olivae........3jss.   M.

   By means of an ordinary catheter—which is first filled,  then intro-
duced  until its  eye reaches the prostatic  portion of the  urethra—a
definite quantity  of the  ointment can  be forced into the  canal by  a
graduated rod.
   In many cases pressure will  exert a curative action, causing prompt 
496
DISEASES.
absorption of inflammatory effusion.  To accomplish this result large
sounds may be passed into the bladder.   Frequently the therapeutic
influences of cold, together with  pressure, are found beneficial.  The
best means of combining  these two remedies is found in  the psychro-
phore, an instrument in the shape of a sound, but so arranged  that a
stream of Avater flows through  its interior.
   It must be borne in mind that chronic gonorrhoea is commonly due
to unskilful or not sufficiently prolonged treatment of the acute stages.
Not only should the treatment  of acute gonorrhoea be continued until
the  gonococci have entirely vanished, but for fully two Aveeks after
the disappearance  of all  symptoms of inflammation.  The same rule
holds  good  in  regard  to the  chronic manifestations  of the disease.
Ouly after careful examinatiou  of the uriue  fails to show any sign of
inflammatory trouble for at least  two weeks should the treatment  be
suspended ;  and this should not take place suddenly, but the intervals
between the applications be gradually increased in length, the patient
being carefully watched in the  meantime.
   Per contra, it must not be  forgotten  that long-continued irritant
treatment may in  itself  indefinitely  prolong a  urethral  discharge.
Hence, it is wise to suspend all injections in certain cases, and to ex-
amine the discharge carefully, as found in the urine,  to  determine
whether or not the continuance of symptoms  is dependent  upon this
cause.
   There is a mucous secretion Avhich quite frequently follows gonor-
rhoea,  but Avhich is iu  no Avay  dependent upon the persistence of this
disease.   Microscopic examinatiou will at once determine its nature.
It is probably most rapidly cured by attention to general hygiene and
by tonic and supporting treatment.

                Complications of  Gonorrhoea.

   Among the many local and  general complications which may occur
in the course of an acute or subacute gonorrhoea are balanitis, balano-
posthitis, prostatitis, and epididymitis.
   Balanitis  and balano-posthitis are  treated by  perfect cleanliness.
The discharge must be  thoroughly Avashed  out, and the surface must
be dried aud  isolated.  The thorough cleansing of the  parts is best
accomplished  by Aveak astringent solutions,  such  as the chloride of
zinc, 4 grains to the ounce, 1 per cent, boric acid, or 1.5  per cent, car-
bolic acid ; nitrate of silver is particularly valuable, and in  the pro-
portion of 1 grain to the ounce  will be found sufficiently strong for use
as a wash or injection.   The  superficial ulcerations may be further
touched Avith the  solid  stick of the nitrate  of  silver.   The  prepuce
having been retracted aud the  parts having been thoroughly  washed,
dusting powder, such as  tannin  or  oxide of zinc,  is distributed over
the surface of the  inflamed parts;  the glans  is then covered with  a
thin layer of absorbent cotton, and the prepuce drawn forward.  This
dressing is to be repeated three times daily.
   If the phimosis is so tight  that  the prepuce cannot  be  retracted, 
GONORRHOEA.
497
cleansing, astringent  injections and Avrapping the penis in one or two
thicknesses  of gauze or other thin fabric, constantly kept Avet with
dilute lead-Avater, will be the treatment indicated.  If, in spite of this
treatment, inflammatory symptoms become more marked, circumcision
is iudicated.
  Prostatitis rarely develops before  the second  or third week  in  the
course of urethritis.  Where the acute symptoms are fairly developed
direct local treatment is of little avail.  Rest in  bed, light diet, careful
regulation  of the  boAvels, medication to  render the  urine bland and
unirritating, elevation of the pelvis, local depletion by means of leeches
applied t<> the perineum, aud the administration of morphine and bella-
donna,  either by  means of suppository or  by hypodermic injection,
represent the general treatment of all inflammatory conditions at or
about the neck of the bladder.  In the  great majority of cases, pros-
tatitis undergoes prompt resolution, and this is more powerfully influ-
enced  by rectal injectious  than  by any other method  of treatment.
For this purpose a two-Avay rectal tube must be employed, the nozzle
of  Avhich is directed against the projection of the  prostate into  the
bowel.   From 2 to 4 quarts of water, either very cold or as hot as  can
be  borne, are allowed to flow into the rectum by gravity, this arrange-
ment of the tubes allowing the injection to flow out as rapidly as it
flows in. This treatment should be repeated three or four times  a day.
When, in spite of careful treatment and the free use of anodynes and
antispasmodics, there is retention of urine, a soft catheter should be
passed  into the bladder and allowed to remain there.
   If general and  local symptoms denote abscess formation, the  pus
should be evacuated by perineal incision as soon  as its presence is posi-
tively determined upon.  It is true that the pus collection usually is
spontaneously discharged into the urethra, but  this  result cannot  cer-
tainly be depended upon, and, at best, is an  unsatisfactory termination
of the trouble.
   When the  inflammation runs into a chronic type,  the treatment
suitable for  chronic posterior urethritis is indicated, namely, the use of
 large cold steel sounds aud local  applications to the prostatic urethra.
 Iu addition rectal  injections, by means of the two-way  tube, are very
efficient in producing a cure.
   Epididymitis requires rest in  bed, cessation  of all local treatment
 directed against the gonorrhoea, the elevation of the pelvis and testi-
 cles, and  the systemic treatment  applicable to acute inflammation.
 The general tendency  of  this complication of gonorrhoea is  toward
spontaneous resolution.  The testicles may be supported by a hand-
 kerchief bandage,  the  base of which is passed beneath  the scrotum
 while the ends and apex are secured in front to a circular baud passing
 about  the Avaist.   To combat the agonizing pain and hasten the cure
 punctures have been advised.  These, by relieving  tension, promptly
alleviate the suffering.  Ice-bags may  also be applied, though it is
 claimed that as a result of  this treatment there remains an obstinate
 induration of the epididymis.   Local applications of the nitrate of
silver and of tincture of iodine are also said to  act beneficially.
                                 32 
498
DISEASES.
   Since it  is usually impossible  for a  patient suffering from gonor-
rhoeal epididymitis  to keep to his bed, a treatment must be devised
Avhich will alloAV him  to  attend to  his business, and at the same time
will  preA'ent the inflammation from becoming aggravated.  The part
must be splinted ; if at the same time uniform pressure can be applied
the cause of the trouble will be still further favorably modified.  These
indications  are  complied with, partially at least, by strapping the in-
jured testicle. For this purpose a number of adhesive resin strips, each
half  an inch wide and long  enough to  pass three-fourths around  the
SAvelled testicle,  are cut.   The first strip eucircles the scrotum between
the affected testicle and the body, tightly imprisoning the former in a
pouch of skin.   The  succeeding  strips  are then placed each overlap-
ping  the other  in  such a manner that the entire pouch is covered in,
and a handkerchief bandage, applied as described  above, may then be
used  to elevate the testicle.   A  better  means of  securing rest and
pressure, and at the same time  exerting the resolvent influences of heat
and moisture, is offered in the  dressing proposed  by Horand-Langle-
bert.   The  entire scrotum is first enveloped in a thick layer of cotton ;
over  this is placed a piece of rubber-dam sufficiently large to cover-in
the cotton, and  the dressing is completed  by an ordinary suspensory,
gored at the sides and provided with tapes to alloAV of close fitting.
Unless there be decided swelling of the spermatic cord this dressing
usually allows the patient to attend to his business, and is followed by
as prompt  resolutiou  as  though confinement to bed had been insisted
upon.  When the  acute  symptoms have disappeared  attention  must
be directed  to the removal of infiltration, which if it persists may be
a cause of sterility.  This is accomplished by the continuance of  heat,
moisture, and pressure; by local applications, such  as iodine gr.  iv in
lanolin Sj, or of equal  parts of mercury ointment and belladonna  oint-
ment, or  by ichthyol, with lard  half and half, and by the internal
administration of iodide  of  potassium,  10 to 20 grains three times
daily.
                 Gonorrhoea in the  Female.

   The symptoms of acute gonorrhoea in  the  female  are usually so
mild  that the attention of the  physician is rarely called to the disease
until  it  has reached its chronic form and has invaded the uterus and
its appendages.  When, however, acute  urethritis is found, the treat-
ment, both  local and  general, is  conducted on the same principles as
when  the disease attacks the  male urethra.  During the most acute
stage  no local treatment  is advisable, but subsequently injections can
be made  with the ordinary  hard-rubber  syringe,  not  more than a
drachm and a half of the liquid being employed at a time.  If the
urethral discharge  persists, the seats of the suppuration are readily
found by the endoscope tubes  and treated  directly  by applications of
strong solutions  of nitrate of silver or sulphate of copper.   The results
of treatment are commonly satisfactory.
  Acute vaginitis is not very  frequently observed.   Iu addition  to
the general  treatment of inflammation,  local  treatment directed  to 
GOUT.
499
cleansing thoroughly  the  inflamed surfaces of discharge and  acting
upon them by a strong antiseptic lotion, Avill be folloAvcd  by a rapid
cure.  The patient is instructed  to  irrigate  the vagina  three times
daily with  two pints of bichloride of mercury solution, 1  to 4000,
throAvn in by means of a fountain syringe.   For this fluid  to reach
every portion of the diseased  mucous membrane, it is necessary  that
the  patient should lie upon her back Avith the hips elevated.  Before
rising,  a pledget of  absorbent  cotton is placed betAveen the labia.
During the most acute stage of vaginitis hot-Avater injections and  pro-
longed  hot sitz-baths are  indicated.   In addition  to the antiseptic
irrigations Avhich the patient is directed to make, the physician should
every second  day insert a  speculum  and paint every portion  of the
diseased mucous membrane Avith nitrate of silver solution, varying in
strength from 4 to 40 grains to the ounce.   The vagina should  then
be packed  with  tampons  of absorbent cotton, which may be dusted
with astringent  medication.
   Vulvitis corresponds to balanitis  in  the  male and is treated in a
similar manner.   Cleanliness  is the most essential point in securing a
cure.  The parts are thoroughly washed with weak  antiseptic lotions,
and the abraded mucous surfaces are kept from coming in contact by
means of a layer of  absorbent  cotton, or a piece  of lint soaked in
dilute lead-water or other mild astringent solution.


                              GOUT.

   Gout is a word  used to signify a series of manifestations occurring
chiefly in those  avIio have  led a lazy, sluggish  life,  and  have lived
on the  fat  of the  land and  partaken more frequently  of alcoholic
beverages than  of water;  or  it occurs in persons who do not live in
this way, but Avhose ancestors  Avill be found  to  have done so, and to
have handed doAvn to them  the gouty  taint or diathesis;  or,  once
more, in those Avho have had  poor food  for  a long time.   In other
words,  it is  a  disorder  of nutrition and  metabolism.  Very  few
Americans  have gout in its  marked and characteristic forms,  owing
to the active  life pursued  and to the fact that the inhabitants of the
Western hemisphere drink large amounts  of water, thereby continually
dissolving effete  matters in the  system  aud Avashing them away.
   The  importance of pure water in this state is  therapeutically
remarkable, and  the  so-called  lithia  waters  depend  for their  value
more upon  their freedom  from  salts than their presence.   When  a
patient  goes to  medicinal springs he simply acts as a sluice-way,  and
by continually drinking water  washes  out the kidneys and prevents
deposits  of calcareous matters throughout the body.   In  a  gouty
individual  the liquids  of the body  may  be said  to be so  overladen
with salts that they deposit them wherever a spot  is found Avhich is
easy of access, just as water laden  with  lime forms a deposit on the
sides of its  bed  when  a drought  comes on, and dissolves aud removes
these formations when  a freshet takes place.  Very  often,  when such 
500
DISEASES.
waters are not attainable, satisfactory results  will be reached by ordi-
nary distilled Avater, the insipid taste of which can be overcome by
charging it with carbonic acid gas.
   When  an acute attack of gout comes on, it is generally situated,
as is well known,  in the joints  of the big  toe or other toes, but may
involve any part  of the  body, even to  the heart aud the contents of
the abdomen.  By far the best remedy for the relief of the pain is
morphine, which should be given  hypodermically, some persons say
as near the spot involved as possible.  At the same  time the best
remedy for gout  that Ave have,  colchicum,  should  be freely  given
until the  patient  shows the full  effect of the drug, as  evidenced  by
gastro-intestinal discomfort or pain and slight laxity of the bowels.
The drug should be used in the form of  the wine of the root, not that
of the seeds, in the dose of 20 drops at first, and increased by one drop
every four hours  until relief is obtained or  symptoms of poisoning
appear as noted above.  In using this drug it is important to remem-
ber  that retrocedent gout is more apt to  occur under its influence than
in an attack where the drug is not used.   That is to say, the inflam-
mation  in the great toe may suddenly disappear, only to break forth
in a violent and frequently fatal entero-colitis,  gastritis, cerebritis, or
heart-failure.   Any intestinal irritation  or  diarrhoea predisposes very
commonly to such a complication under the use  of colchicum.
   The local treatment of gout, Avhen  it is  active,  consists in  the
application of a number of  much Araunted  but frequently useless
remedies.   For hospital practice  a very useful mixture is  made by
adding one part of bicarbonate of sodium to nine parts of linseed oil,
and wrapping the joint involved  in a piece of lint soaked  with this
concoction.   In other cases collodion may be applied in one or two
good coats, not more,  with relief, and in still  others  oil  of pepper-
mint has been recommended.  It  is to be remembered, however, that
the inflamed joints are not to be treated by depletion through leeches
or  bleeding, as by this means  they ultimately become worse;  or, in
other words, the treatment of gouty inflamed joints is  not identical
with that  of  inflamed joints  from other causes.  When the pains of
acute gout are very severe at night, potassium  iodide, in the dose of
15  grains  at  four or five  o'clock in the  afternoon, will sometimes
give relief; this drug  should  always be combined with colchicum if
the disease is subacute  or chronic.
   In chronic gout, except during the acute exacerbations of the dis-
ease, colchicum is almost useless, but  potassium iodide should  be
pushed to  the point of iodism, if the trouble be painful.  Here diet
comes in  for a great part of  the  treatment, and should consist  of
foods which are not fatty nor rich, but  plain and nourishing.   Milk
and  eggs,  the white meat of chicken, and fruits  cooked without  sugar
being added, are allowed, tea and coffee being  used only in modera-
tion.  If  any wiue is taken,  it must be followed by copious  draughts
of pure water, and this last article should be  used ad libitum.   On
the other  hand, pastries, and, more than  all, sweet Avines, are  the 
HAEMORRHAGE.
501
worst  things  that such a  patient can take, and must be absolutely
prohibited.
   The insomnia of chronic or subacute gout is best put aside by potas-
sium bromide and chloral, the former drug being the safest and best.
   The local treatment of chronic gout consists in the application of
flying  blisters at a little distance from  the  suffering joint every few
days.  Where the deposit  around the joints  is  very great  and the
normal movements are  impossible, relief is  often  obtained by the
application  of a solution of citrate or carbonate of  lithium, 5 to 10
grains to the ounce of Avater, on lint wound around the parts.  Where
the  skin  is broken and will not heal, this treatment often permits
healing by dissolving  the crystals in the Avound which prevent the
approximation of the  edges and  so cause  local  irritation.  Iodine
ointment or the tincture of iodine is often placed around chronic gouty
joints with advantageous results.
   A standard remedy in subacute or chronic gout in arsenic, and its
administration in the form of 3 drops of Fowler's solution, either with
perfectly pure or lithiated Avater, is always to  be  resorted to.   If
anaemia is present arsenic is particularly indicated, and cod-liver oil
and  syrup  of  the iodide of iron are also of value in this state.
   We find, therefore, in conclusion, that the use of large amounts of
pure water devoid  of salts,  and the administration of  colchicum,
potassium iodide, and  arsenic are the greater points  about which the
rest  of our treatment should centre.   In those cases where retrocedent
gout comes on, the  heart must  be  supported  by stimulants, particu-
larly by hypodermic injections  of ether until the slower  drugs  can
act,  by heat over  the  belly, by the use of opium to allay irritation,
except Avhen the brain and  kidneys are seriously affected,  by the use
of diuretics and alkaline drinks, and finally by counter-irritation in
the  shape of  a  mustard plaster  placed over the abdomen or chest as
the case may require.

                       HEMORRHAGE.

   (Including Menorrhagia, Metrorrhagia, Hemoptysis, Hematemesis,
Intestinal Hemorrhage, Hematuria, and Postpartum Hemorrhage.)

   Under this  heading the author will consider all forms of haemorrhage
which can be controlled by drugs or  measures  not directly  surgical in
their scope, with the exception  of  epistaxis, Avhich  has already been
spoken of.
   Whenever a haemorrhage can be  arrested by the  application of a
ligature or by compression, as in a cut of the finger  or  some similar
wound, no  styptic should be used.   Styptics are employed for the
double purpose of constringing  the tissues and coagulating  the blood,
and,  in consequence, form coagula which tend to make a nasty septic
mass about the wound.   In their place the physician  should resort to
a compress soaked in some antiseptic liquid,  or filled  with some disin- 
502
DISEASES.
fectant poAvder, and if this fails to control the bleeding then  ligation
of the bleeding vessel becomes necessary.
  Where the bleeding-point cannot be reached by direct compression
or for ligation,  the  use of packing and  of astringents is advisable,
and drugs Avhich are anti-haemorrhagic  should be used by the mouth.
As  these  forms of haemorrhage are generally given  separate names,
they Avill be so considered.
  Menorrhagia is an excessive Aoav of menstrual blood, either excessive
in quantity during two or three days, or prolonging  itself over an
unusual number of days, while metrorrhagia is a state in which bleed-
ing takes place from  the uterus independent of menstruation and at
any period of the month, or even after the menopause has occurred.
  Menorrhagia  or excessive menstruation is not  to be judged by the
amount of the flow, but by whether the loss is  sufficient  to  cause
decrease of health or to indicate disease.   In some cases it is a means
of relieving plethora.
  When  the  physician  decides that something   should  be done  to
improve  the condition  of the patient, either in menorrhagia or me-
trorrhagia, it will  be necessary for him to find out Avhether any polypi
or other form of uterine disease is directly responsible for the trouble,
and  in the meantime  to employ drugs known to act favorably upon
uterine haemorrhage.   The most prominent  of these  drugs  are ergot
and oil of erigeron, the first being the more active and the best remedy
for active bleeding, the second the better for oozing and for cases where
there is a continual " show."
  The fluid extract of ergot may be given in varying  dose, from 10
to 60  drops according to the necessities of the case, and the oil of
erigeron  in capsules iu the dose of from 3 to 5 minims, or if capsules
cannot be had, the physician must employ the oil in an emulsion made
by using syrup of acacia or other similar substance.
  Where menstruation is irregular  and the menorrhagia is almost  a
metrorrhagia, bromide of potassium or sodium in the dose of 10 grains
once or twice a day is  often very serviceable indeed, and  the distilled
extract of hamamelis  in the dose  of  1 drachm three times a day  is
almost as useful.  Cannabis  indica, if an active sample is obtainable,
is also said to be of service, but the writer has  never used it to any
extent.  Oil of cinnamon in the dose of 4; drachm is very efficacious
in the slow oozing of some cases where  erigeron  cannot be  used or
obtained.  Sometimes, Avhere congestion of the pelvic  viscera is the
cause of  the trouble  dry cups over the sacrum give relief.
  Hemoptysis, or haemorrhage from the lung, is nearly always due to
tubercular ulceration of a small or large bloodvessel, and  the life of
the patient depends in  reality more upon  the rapidity with Avhich a
clot naturally forms  than upon the skill of the physician.   Though
text-books order  atomized  solutions to be inhaled and other remedies
to be taken by way of the lung, in most cases  these  measures will be
found impracticable, simply because the nervousness of the  patient
and the constant cough will  not  permit of inhalations to any extent,
and even if a full breath is taken it  generally increases the bleeding 
HEMORRHAGE.
503
and coughing.   The only occasions on which  inhalations of styptics
are of service are those in which the haemorrhage is just beginning, or
so slight as to  streak the  sputum or to be at least thoroughly mixed
Avith it.  The solutions to be so employed must be used iu an atomizer
which Avill throw a fine  spray—sufficiently fine to enter the smallest
air-tubes with  the inspiratory wave of air.  A very good fluid is one
made from Monsel's solution as follows :
         R .—Liquor, ferri subsulphat.    .     .  gtt. xx. to xxx.
             Aquae dest........fgiv.   M-
    S.—Use in an atomizer every few minutes.

Or the following :1
         R.—Acid, tannic
             Glycerin i
             Aquae dest.
    S.—Use in an atomizer.
Or,
         P.—Aluminis
             Aquae dest.
    S.—Use in an atomizer
   Some clinicians advise that the patient should swallow, whether the
haemorrhage be acute or not, not less than 1 to  1| drachms of the fluid
extract of ergot, or a solution made by adding 20 grains of gallic acid
to 1 ounce of water.  Tannic acid given by the stomach is not as good
as gallic acid, because it  must be absorbed and  changed into gallic acid
before it can reach the bleeding-point through the circulation.  On the
other  hand, the tannic  acid if locally used is the better^ for it con-
stringes the tissues  and  forms a clot,  whereas gallic  acid does  not
coagulate the  blood.  There is no doubt that of all the  internal
remedies for haemorrhage from the lungs, aconite is the best.   Careful
studies show that ergot causes primarily au increased Aoav of blood to
the lung, although its dominant and final actiou is  to cause contraction
 of the bloodvessels.  Haemorrhage from the lung  is to be regarded as
 any other haemorrhage.   The object of the physician is not to stimulate
 the heart and vasomotor system, thereby increasing the leakage from
 the bleeding vessel, but to lower the arterial pressure to as Ioav a point
 as is safe.   The rule to  follow is best  stated as follows : If the patient
 is seen early in the attack give full doses of aconite to prevent further
 haemorrhage.   If Avhen seen so late that he is too much exsanguinated
 to use sedatives, place his head loAver than the feet and apply Esmarch
 bandages to the limbs to keep the blood in  the vital parts as far as
 possible.   The use  of stimulants can only increase the haemorrhage by
 increasing the pumping  power of the  heart and by dislodging the clot
 from  the eroded bloodvessel.
   To allay nervous  excitement many writers advise that a hypodermic
 injection of morphine should  be used.   The author is convinced that

   1 If the Monsel does not stop the haemorrhage, the tannic  acid will probably fail,
 but more important still, the two should not be used together, as the tannate ot iron
 will be formed, which is as black as ink.
q.s
ad
f3ij-
M.
gr. vj.
M. 
504
DISEASES.
this treatment is  irrational, for  morphine  is a circulatory stimulant,
and by increasing the power of the heart  increases  the haemorrhage.
Chloral  and the  bromides are much better remedies, and should be
given by the mouth.
   Sometimes  the patient  can point  directly to the spot Avhere  the
haemorrhage exists, and under these circumstances a dry cup or a piece
of ice  placed over this point may prove useful.
   After  an attack of haemoptysis  there is great danger in many cases
of a traumatic pneumonia being  set up by the  presence of the  ex-
travasated  blood.   This should be  combated by the use of a carefully
regulated diet, and the reduction of any arterial excitement by small
doses of  aconite in persons not weakened by advanced  disease or bleed-
ing.   Complete rest in bed is to  be insisted on  and  no stimulants
allowed  in  food  or drink,  unless  the  weakness  of the  patient  re-
quires  it.
   Hematemesis.   This depends either upon  some injury to  the stomach
or, much more commonly, upon gastric ulcer, cancer, or some other
severe  form of gastric trouble, and  is one of the easier of the so-called
"internal haemorrhages" to  treat, because by ordering  the patient to
swallow  drugs we can act directly upon the  bleeding surface.1   In
such a case small pieces of ice should be swalloAved frequently, and
this may be accompanied  by 3 drops of Monsel's solution in a half
tumblerful  of water every fifteen  minutes  till  four doses are taken.
Tannic acid may be given instead in the dose of 20 grains to a drachm,
but the  two should never be given at once to the same  case.  (See
foot-note to page 503.)  Monsel^s salt may be given in pill in the dose
of 2 to 3 grains.   The acetate of lead is also of value in pill form in
the dose  of  2 to 3 grains with  morphine or opium.   Tincture of  the
chloride  of iron, the sulphate  of iron, turpentine,  ipecac, ergot, and
hamamelis may all be used, the last three particularly in slow or passive
haemorrhages.  Sometimes nitrate of silver  in the dose of \ of a grain
in pill  form is of service if the haemorrhage is a slow one.
   Hemorrhage from the bowel is to  be treated according to its point of
origin.  If in the small intestine, as from ulceration of Peyer's patches
or other glands, the medicines must  be used by the mouth, if it be from
the colon or rectum, or from haemorrhoids, medication must be by way
of the  anus.
   Haemorrhage of the  first class is best combated by the taking of
small amounts of ice by the mouth, and by the use of Monsel's salt
(ferri subsulphatis).  Three grains  should be given every half-hour or
oftener, the pill being made hard enough to  reach the intestine without
being dissolved and decomposed in  the stomach.
   Ergot  has been  largely resorted to, but is  of doubtful value, but
tannic  acid may be given with  advantage in large amount in  solution
or pill if the Monsel's salt  is not obtainable.   The  other remedies

  1 Haematemesis also ensues as a result of swallowing blood which has escaped into
the mouth or naso-pharynx, and this symptom is sometimes induced by malingerers
in order to further their ends. These forms of haematemesis should, of course, be sepa-
rated from those dependent upon some lesion in the stomach itself. 
HEMORRHAGE.
505
which are of service are  sulphuric acid in the dose of 5 to 10 drops
in water in acute or passive bleeding, or  turpentine given in capsule,
or, better still, in emulsion Avith acacia in the dose of 10 drops every
half-hour, particularly where the haemorrhage is not active.  Acetate
of lead and  camphor in the following pill may be of service in some
cases:

         R.—Plumbi acetatis......gr- v.
             Camphorae.......gr. x.   M.
    Ft. in pil. no. v.  S.—One pill every hour.

   Where the haemorrhage  is dependent upon ulceration of the colon
or rectum, injections are to be resorted to. These are both styptic and
curative,  the styptic injections  being particularly useful  when the
bleeding is to be stopped at once, the others where it is sought to re-
move the condition producing the trouble.
   To the first class belong alum, sulphate of copper, Monsel's solu-
tion, sulphate of iron, tannic acid, and cold water.  In the second we
find  nitrate  of silver, the  sulphates of copper aud of iron, and the
chlorate of potassium.
   The  alum solution used should be fairly  strong, 10 grains  to the
ounce ; the copper, 5 grains to the ounce; the Monsel's salt, 10  grains
to the ounce; or, \ to 1 drachm of  the  Monsel's solution  to each 2
ounces of water.  The  tannic acid should be used in the strength of
20 grains  to the ounce  of water and glycerin.   When  chlorate of
potassium is  used it should be employed in saturated solution in small
injections (25 grains to  the ounce), or weaker  if the injection be a
large one (10 grains to  the  ounce).
   These injections should be carefully given, and the success or  failure
attending the treatment of these states depends as much upon the tech-
nique of the operatiou as upon the injection of the medicinal substance.
It should never be forgotten that an  injection designed for local medi-
cation should be as small in bulk as circumstances will permit.  Thus,
in inflammation of the rectum the amount of the injected liquid should
not  be  above 4 ounces at the utmost, and preferably 2 ounces  unless
the diseased area is high up.  An enema is given in bulk so as to cause
distention and  excite the  bowel  to movement, Avhereas, from a  medi-
cinal injection no movement is desired.  Again, the apparatus for
sending in the fluid  ought  not to be a "family" or ordinary syringe,
but a fountain  syringe,  the pressure being hydrostatic.  This may be
dispensed with if the injection be small and only intended for  the lower
part of the rectum, but it is indispensable if the  injection be intended
to reach the upper  part of the colon.   The entrance of the  liquid
should  always be gradual  and  easy.  If resistance  is  met Avith, the
pressure must be overcome, not by force, but by Avaiting a moment
until it passes off.  When the  entire colon is to  be flooded, at least a
gallon of warm liquid  may be  needed.   In  these cases those  drugs
which are capable of absorption and the production of poisonous  symp-
toms are not  to be used except in small amounts. 
506
DISEASES.
   Where the injection is to reach high up into the bowel the patient
should be put in the lithotomy position Avith the buttocks elevated.
   Sometimes, in dysentery, the injection of a pint to  a quart of ice-
cold Avater has a most favorable effect upon bloody purging.
   Whenever a medicated injection is to be used  for the cure of ulcers
Avhich cause haemorrhage, the entire tract which is to be  invaded should
be Avashed out with pure water or with a saline  or soapy liquid, in order
to dislodge  mucus and faeces  Avhich prevent the drugs from acting on
the bowel wall.
   Hematuria is a condition in Avhich  blood appears in the urine, and
may  be  divided iuto tAvo classes :  those  in  which the blood comes
from the kidney or bladder and those in Avhich  it comes from the
urethra.   In the first class  the  blood is always well  mixed Avith the
urine, which is changed in color from its  decomposition, and  appears
either through the entire act of urination or just at the end of the act.
In those instances in Avhich the blood  is iu the first part of the stream
it arises  in the urethra, is nearly pure, and not Avell  mixed with the
urine.
   If the blood is due to the presence of an acute nephritis the kidneys
need treatment, and for directions as to this point the article on Acute
Bright's  Disease  should be read; while, if the haemorrhage is due to
the presence of a lesion in the  bladder, the directions governing the
use of turpentine, erigeron, or ergot,  as  given for menorrhagia and
metrorrhagia, should  be followed;  or, if any morbid groAvth be pres-
ent,  it should be removed.  Sometimes 10  to 20 grains of camphor in
divided  doses  are of service, given  in pill form, Avhile in others can-
nabis indica is of  value.
   Gallic acid,  in  20-grain doses, may be  used, and is very valuable.
If the haemorrhage is alarming, injections of  astringent washes,  such
as tAvo or three grains of alum to  the ounce of water, should be in-
jected into the bladder.   It must be  remembered, however, that this
simply fills  the bladder with  clots, which  are  not readily passed and
are liable to become septic.
   A. very useful prescription is :

         R.—Acid, gallic.......•   3.1-
             Acid, sulphuric, dil......f gij.
             Aquae......q. s. ad fgiij.   M.
    S—Teaspoonful in water every four hours.

   If the haematuria  be malarial, quinine  may be employed, but in a
large number  of  cases it makes the haematuria worse; aud in the
southern United States, Avhere severe  malarial poisoning is often seen,
physicians  ought rarely, if ever, to use the drug for malarial  haemat-
uria.   The value  of quinine consists  in its ability to  prevent future
attacks rather than to relieve the  result  of the attack, namely, the
haematuria.   Hyposulphite of sodium is a most useful remedy in the
dose of 5 to 15 grains every five hours.
   Post-partum hemorrhage is to be controlled by the use of  friction
and  kneading or grasping the dilated  uterus through the relaxed ab- 
HEMORRHOIDS.
507
dominal Avail; by the use of drachm doses of the fluid extract of ergot
or a wineglassful  of the wine  of ergot;  and by the irritation of the
uterine Avail by passing the hand up through the vagina into the uter-
ine cavity.  Sometimes ice may be passed up the vagina and into the
uterine cavity Avith success in stopping the bleeding, aud even vinegar
and lemon-juice may be tried if the case is a desperate one.  In  other
cases injections of Avater as hot as can be borne may be resorted  to.
                       HEMORRHOIDS.

  These painful, annoying, and often serious dilatations of the haemor-
rhoidal  veins about  the rectal opening may be internal or external,
bleeding or " blind."   In nearly every instance where they are promi-
nent and troublesome  the only cure  rests in operative measures for
their relief; but, nevertheless, much can be done for the alleviation of
the pain and discomfort produced by them.  In those cases where the
haemorrhoids " come down "—that is, pass out by the sphincter and
become  strangulated and sore, the patient's habits should be so arranged
that his daily act of defaecation is at night before going to bed rather
than in  the morning, as under these circumstances the rest in bed re-
lieves congestion aud   soreness  Avhich  the maintenance  of  the  erect
posture  might make Avorse.  Plethoric persons  should not use uphol-
stered chairs for office  or lounging purposes, as the heat of the  body
relaxes  the rectal tissues.  A cane-seated chair is best, or an air cushion
Avith a holloAV centre.   The liver plays a most important part in  rela-
tion to haemorrhoids, and, if it is congested, congestion of the haemor-
rhoidal  veins is very apt  to ensue.   The  connection between the  liver
and the haemorrhoidal plexus is most intimate, since the plexus is
formed  by the superior haemorrhoidal veins, Avhich are branches of the
inferior mesenteric, and the middle and  inferior haemorrhoidal veins
which terminate in the internal iliac.   The portal  venous system is
composed in part of the inferior mesenteric vein, aud any obstruction
to venous flow  in  the liver  at  once  results in engorgement of the
haemorrhoidal plexus.   Constipation  is  nearly  always  a harmful
and annoying symptom,  and  should  be  relieved by the proper diet
(see Constipation), and by the use of sulphur  or aloes.  The latter
drug has been  highly praised  and severely condemned by equally
eminent observers.   The  author, however, is  not favorable to its use.
In  any event the dose of  the  aloes should  be very small, not  over
fa grain.   (For formulae, see article on Constipation.)
  In some  cases the  injection  of a  pint of cold  water (see Cold)
in the morning will  relieve congestion, and permit an easy evacuation
of the boAvels, or 10 to  20 grains of rhubarb root may be chewed each
night before  retiring.   A very serviceable local  application is hama-
melis, either  in  the  form  of  a  lotion  or injection (1 drachm to the
ounce).   In other cases it is more  convenient to use the fluid  extract
of hamamelis and alcohol, half  and half; or, better still, the distilled
extract  of hamamelis, pure  or diluted  one-half  or one-fourth.  Great 
508
DISEASES.
 relief is often obtained by inserting into the boAvel a pledget of absor-
 bent wool which is wet Avith the distilled extract of hamamelis, leaving
 a small amount of the wool outside the sphincter so as to act as a sup-
 port to that muscle.   Wool is better than cotton, because when wet it
 still retains to some extent its shape and elasticity, Avhereas cotton be-
 comes hard and sodden.  Sometimes either of these preparations  may
 be used internally with advantage in the  dose of 10 to 20 minims of
 the former or  1  to 2 drachms, of the  latter.   An  ointment of gallic
( acid  and opium is of value, made as follows :
          R—Acid, gallic.......gr. x.
             Extract, opii......gr. iv.
             Extract, belladonnae.....gr. iv.
             Ung. simplicis......^ iv.    M.
    S.—Apply night and morning.
   Probably no other service is more apt to provoke everlasting grati-
 tude on  the part of the patient than the cure or alleviation of haemor-
 rhoids.  The physician who does not resort to purely surgical measures
 may use a drop of strong acetic acid  or carbolic  acid  on  each pro-
 truding mass, or strong nitric acid  may be  similarly employed.   The
 injection of a drop  of carbolic  acid  into  a  haemorrhoid often acts
 exceedingly well,  but it  will, once in a great while,  cause  a bad
 slough.
   For the surgical treatment of piles, reference  must  be  made to
  surgical works.

                          HEADACHE.

 (For Neuralgic Headaches, see Neuralgia.   For Bilious Headache,
                         see Biliousness.)

   Probably no  single source of pain compares in its  frequency to
 headache, chiefly because it is essentially a symptom of many diseased
 processes or functional disturbances and nothing more.  It may arise
 from eye-strain,  from brain disease, from anaemia, from uraemia,  from
 plethora, from  nervous breakdown, and from a multitude of causes
 which, if they Avere all recounted, would  cover many pages of this
 book.   The only  forms of headache  which will be considered here
 are those due to congestion or which arise from fatigue.
   Congestive headaches, dependent upon an engorgement of the  cere-
 bral vessels with blood, are to be treated in a number  of ways, and if
 any  direct cause of congestion can be discovered, this must, of course,
 be removed.   So far  as the  direct application of drugs  is concerned
 we find two methods of promoting  a cure.  The first  consists  in the
 use of ergot, whicli will cause contraction of the dilated vessels, the
 second in the employment of vascular sedatives whicli will produce
 arterial depression and so remove congestion.   Sometimes one  of
 these methods  will  succeed  where the other  fails, and  it  is  almost
 impossible to  tell, beforehand, which  case should have one drug and
 which another.   It is to be remembered that  when  the  congestion is 
headache.                        509
due  to vascular  relaxation  aud  Aveakness  the vascular sedatives  are
contra-indicated.
  The use of a hot mustard foot-bath is of great value, and a mus-
tard plaster or cup applied to the nape of the neck is often of service
in congestive headaches, while in severe cases an ice-bag applied to  the
head, or leeching behind  the ears or on  the temples, may  be resorted
to.   Bleeding often gives  relief at once in severe congestive headache.
  Where  headache  depends  upon fatigue,  either  general  or local,
stimulating treatment  is  necessary.   If  eye-strain be the cause, full
doses of strychnine or  nux vomica are  of service.   These cannot be
used if there is much  retinal irritability.  And in many instances a
combination of caffeine, bromide of potassium, and antipyrine is very
successful, as follows:
         rj.—Caffeinae citratis   .    .    .    .    .   .   gr. xl.
              Potassii bromidi   .    .    .    .    .   .   giv.
              Antipyrini.......^ij.    M.
    Ft. in chart, no. xx.  S.—One powder in water as needed

  Sometimes the caffeine makes the headache more acute, and if this
occurs only the antipyrine can be used.
  Sleep is generally a more useful  prescription  than any drug, and if
city life creates so much mental anxiety during the day as  to be wear-
ing upon the nervous system, or make the patient Avakeful  at  night,
business  must be  put aside and health  and recreation sought at a
watering-place.   Horseback exercise is very useful indeed, and should
be resorted to by all who  can afford it if  they are sufferers from ner-
vous  headaches.
  A form  of headache whicli is often ATery  severe, sometimes  fleeting,
sometimes  persistent, is that due to gout, and it is to be treated by
means quite distinct from  those named so far.  Some  practitioners of
wide experience employ salicylic  acid in doses of from 5 to 15 grains,
while  others  rely  on the iodide or acetate  or  potassium.  In  cases
where anaemia is present, Peabody uses the following prescription,
which is compatible, Avhereas most of the preparations  of iron  and
salicylic acid are incompatible :
ft.—Acid, salicylic.
 gr. xx.
 gr. v.
 gr- j-
fSss.   M.
             Ferri pyrophosphat.
             Sodii phosphatis
             Aquae dest.
    S.—This is to be taken every three hours

   Cohen has used the following, which is more pleasant to the taste :

         R.—Sodii salicylatis   .    .    .    . r  .       giv.
             Glycerini    .    .    .    .    .    .    .  f 3 ij.
             01.  gaultheriae......TTlxx.
             Tr.  ferri chloridi......f 3 iv.
             Acid, citrici  .......gr. x.
             Liq. ammonii citratis, B. P.1 .    .   q. s. ad  f^iv.   M.
    S.—Dessertspoonful in water twice, thrice, or four times a day.

  1 Liquor ammonii citratis, B. P., is made by adding five fluidounces (imperial
meas.) of strong  solution of citrate of ammonium to fifteen fluidounces (imperial 
510
diseases.
  Other cases of a gouty headache  require  colchicum, particularly  if
the gout  be  Avidely distributed  in its  manifestations,  and  to  these
Hamilton gives
         R.—Vini colchici seminis.....f^ss.
             Potassii acetatis        ~|
             Potassii iodidi         >   .    •    .   aa f^v.
             Tr. cimicifugae racemosae J
             Aquae......q. s. ad f 3 iv.   M
    S.—Teaspoonful every four hours.


                       HEART  DISEASE.

        (For  Treatment of Angina Pectoris, see page 391.)

  The writer  classifies  all forms  of heart  disease under this heading
advisedly.  In valvular disease the profession are beginning to under-
stand more and more that the mere destruction  or laming of this valve
or that has  little to do Avith the  treatment,  although the ultimate
result of the case is  somewhat dependent upon these conditions.  It
matters not whether the leak in a valve be  minute or huge, provided
the heart can still do its work;  the condition of the cardiac muscle  is
the important factor to  be considered.   If an irreparable  leak exists
in a pump the question is not, Can  we cure  that leak ?  but rather
whether we can work  the pump with  enough  force and  rapidity to
obtain all the water  needed for the maintenance of life.  Some physi-
cians  use heart  tonics, such as digitalis, whenever they find a valve
diseased, as if to mend the broken valve.   Nothing  can be  more
erroneous,  for a valve once injured is never regenerated.
  It should be an invariable rule Avith  every physician in examining
a patient with heart disease to  determine whether or not  the tissues
of the body receive  their normal blood-supply.  If they do not, even
though the leak is so small as to escape notice, digitalis or other tonics
are to be used; but  even if the murmur heard  on auscultation  is as
loud as that of a machine-shop, and the tissues are not  starved, no
remedy is needed.
  Another very  important point in regard to the treatment of cardiac
disease in children, is the remembrance that  the stunting of the body
and the slowness of groAvth are  not merely the result  of heart trouble,
whereby the tissues  do  not increase in size from lack of nourishment,
but occurs for a special purpose.  Supposing that  a child  of eight or
nine years has scarlet fever or rheumatism, which leaves  the  cardiac
valves impaired  iu  function.  For a few days, or hours at least, the
question must arise in the  heart:  " Can I fill all  the bloodvessels
properly ?"  If the  heart can supply the vessels the child  lives, but is

meas.) of distilled water. The stronger solution of citrate of ammonium is made by
taking twelve ounces (avoirdupois) of citric acid, strong solution of  ammonia eleven
fluidounces, and adding enough distilled water to make twenty-four  fluidounces (im-
perial meas.). 
HEART DISEASE.
511
stunted because Nature is Avise enough to understand that the struggling
heart has  all it  can do to supply even  a stunted frame, and realizes
that a  rapidly increasing area of bloodvessel surface in  a growing
child Avould exhaust the cardiac muscle.
   The physician should  not endeavor to make such a child grow by
gymnastics or tonics, but should direct his attention to the care of the
general health, and particularly that of the heart, for  as  soon as this
organ is strong enough to permit of growth, growth will take place.
   Having made  these preliminary remarks, let us turu to the direct
application of drugs to heart disease—the chief drug in the list being,
of course, digitalis.
   The value of the digitalis  may be said to rest upon a number of
influences possessed by it.  In  the first  place, evidence is constantly
accumulating to  sIioav that  digitalis  increases the nutrition  of  the
heart muscle by the stimulating influence Avhich it exerts  over  the
pneumogastric nerve;  this nerve having been partly proved to be a
trophic  nerve  of the heart.   Aside from any such nervous  influence
the heart muscle receives a greater blood-supply under the use of digi-
talis, since both  diastole and systole are influenced by the drug, the
systole  being more complete and the diastole being prolonged and more
extensive.
   Two theories concerning the nutrition of the heart  muscle through
its blood-supply have been promulgated.  One  is, that the coronary
arteries are filled with arterial blood as the heart drives its contents out
of the  left ventricle, or, in  other  words, during  systole.  The other
hypothesis rests  upon the belief that the contracting muscle prevents
a free circulation of blood through the cardiac bloodvessels, and that
the blood is driven into the coronary arteries during diastole by the
pressure in the aorta, the aortic valves being closed.   In the belief of
the author both  of  these theories are partly true.   That is to say, the
coronary arteries are filled during ventricular systole, according to the
'first theory, but  the complete passage of the blood through the smaller
vessels  of the cardiac muscle only takes place as relaxation or diastole
occurs.   The ground for this belief consists iu the observation that a
muscle  when firmly contracted always  presses upon its supplying
bloodvessels, and particularly interferes with capillary flow.  The heart
of one of the lower animals, if carefully watched after the chest-Avail is
removed, will  always  be found to become paler during systole  and
redder during diastole, and if Avounded will  bleed more freely during
the relaxing period than during the contraction of its  fibres.  As  the
blood everywhere in  the body nourishes the tissues, not when in the
arteries, but while passing through the capillaries, it Avould seem self-
evident  that, while the coronary arteries are filled by the systole or
contraction of  the  heart, the nutritive changes and perfect  capillary
circulation go on during diastole.   If these things are true, the increase
in cardiac nutrition  and growth under the action of digitalis is only
what one would expect, for we have learned when studying this drug
that it  prolongs  diastole and increases the force and volume of the
systolic wave of blood.  In  other Avords, digitalis fills the  coronary 
512
DISEASES.
arteries almost to bursting, and so, when diastole occurs, not only floods
the cardiac capillaries with  blood but  prolongs the period  during
which the interchange  between the  blood-stream and  tissues takes
place.
   There is still another way in which digitalis does good in  cardiac
disease by reason of its  peculiar powers.  Normally, the heart beats
fast or slow according to the demands made upon it by the system for
blood, and its action is varied by the calls Avhich  it receives from the
tissues.  In  heart disease, OAving to the  leaky valves, the tissues are
starved, and continually send messages for more nourishmeut to the
cardiac muscle,  which finally becomes exhausted by its  endeavors to
supply their wants, and beats now fast and now slow, uncertain what
to do.  If digitalis is giA7en, the vagi render the cardiac action regular
and effective, acting as regulators and directors of its energies, thereby
supplying the tissues aud using the remaining  poAver of the heart to
the greatest advantage, in additiou  to improving its blood-supply by
the methods  already described.   The  starving tissues of the body hav-
ing been satisfied, as Dr  H. C. Wood has  eloquently expressed it, "the
angry messengers  from the periphery cease their callings, and the heart
is at peace aud in  comfort."
   From what has been said it becomes evident that this drug, digitalis,
does good whenever the heart is Aveak  or unable  to supply the body
with  blood, and we find for this reason that  cardiac dilatation, simple
cardiac failure, or heart failure dependent upon the presence of poisons,
all indicate its use.
   The mechanism of the action  of digitalis  in the different cardiac
lesious still remains to be described.
   Taking up the most common condition, that of mitral regurgitation,
we find that  in  this disease the blood passes, in its normal Aoav, from
the auricle into the ventricle, and, Avhen  the ventricle is filled, that
the cardiac muscle contracts  on  all  sides equally.   Normally,  the
mitral valves close the auriculo-ventricular opening and prevent any'
of the blood from regurgitating back into the auricle, and the greater
the pressure  the tighter they  become.  Abnormally, the  blood is still
pressed upon on all sides as  before,  and, trying to escape, as do all
liquids, from pressure, finds that, owing to disease of these valves, it
can, in part  at  least, slip back into the  auricle from which  it came,
rather than  pass out  into the high pressure  of  the arterial  system.
The ventricle, therefore, propels blood in two directions—in the wrong
Avay and in  the right way.  If the leak is  large  enough to carry off
more  blood  than the aorta, then death occurs.  Digitalis, under these
circumstances, does good, because, by  increasing the force of the ven-
tricle, it increases  the  friction at  both the mitral  leak and  the aortic
opening; but, as the-aortic opening is a large one and  the mitral leak
a small one, the greater quantity of blood passes out into the circula-
tion.   The same fact arises for consideration  as  before,  namely, that
it  is not the amount  of leak, but the amount of supply to take its
place,  which  is the vital question in the case.   Sometimes  relief does 
HEART  DISEASE.
513
not occur, and the patient is made Avorse  by digitalis, because the leak
is increased as much as the  normal flow.
  In mitral obstruction the difficulty is that the blood cannot enter the
ventricle Avith sufficient rapidity, and  this part of the heart contracts
before it is well  filled.  By the prolongation of diastole the blood is
given sufficient time  to enter,  and the ventricle is filled, sendiug out
into the system a large AvaATe  of blood when it contracts.  Further
than this the stimulation of the right ventricle by the digitalis enables
this part of the heart to overcome the tendency to congestion Avhich
arises through the obstruction on the left side of the heart.
  In aortic stenosis there is obstruction  to the normal flow of blood
out of the heart,  and the digitalis is needed to increase the  ventricular
force, so that  it may overcome the difficulty.
  In aortic regurgitation,  digitalis,  by its stimulation of the heart,
may cause a sufficient output of force to clear itself of the  regurgitant
flow, but in many cases the drug fails, because the prolongation of
diastole gives so  much more time for the blood to flow baclnvard into
the dilating ventricle.  The cardiac remedies to be used in  such cases
are strophanthus, in the form of the tincture, dose 3 to 5 drops, adoni-
din, dose £ to \ grain, or  sparteine, \ grain.   These remedies may
also be used in the other forms of cardiac disease where digitalis fails.
It is important to remember, hoAvever, that some cases of aortic regur-
gitation do improve, at least temporarily, under digitalis.
  In cardiac dropsy digitalis and the other heart stimulants do good
by  raising blood-pressure and pulse-force.   (See Dropsy.)
  In cardiac  palpitation dependent  upon  indigestion, this condition
must be relieved by appropriate digestive remedies; but in that form
of palpitation due  to over-exertion or heart-strain digitalis is  useful.
Sometimes aconite or veratrum viride are very  serviceable  in palpita-
tion, if the cardiac condition is good, and iron is to be used if the irri-
tability is due to anaemia.   Tea, coffee, tobacco, and excessive venery
are to be forbidden.  Sometimes nux vomica does good by stimulating
the  heart and nervous system, and  belladonna seems of  great value
where arhythmia is present.   Ringer recommends the use of veratrine
ointment over the praecordium in some of these cases.
  In sudden cardiac failure from Aveakness or poisons the use of ether
and ammonia is to be resorted to at once, aud these are to be followed
by alcohol aud digitalis, if  necessary.   The ammonia is a direct heart
stimulant,  as are also the alcohol and ether.
  Cardiac hypertrophy is rarely seen without some other lesion accom-
panying it, but it may occur from prolonged and excessive exercise or
other cause.   It  is  to be treated by aconite, veratrum viride, perfect
rest, and avoidance of exercise, and by the use of moderate amounts
of food of a non-stimulating character.  Wines and coffee  should  be
forbidden, and veratrine ointment may be placed over the praecordium
if the action of the heart is  very excessive.
  An exceedingly useful treatment of excessive  cardiac hypertrophy is
rest in bed, with  or without  medication.  The results in some cases are
                                 33 
514
DISEASES.
extraordinary, whether the  hypertrophy be due to valvular disease or
other cause.
  Fatty heart occurs in two forms:  that in which true fatty degener-
ation has taken place in the muscular fibre and that in which there is
a deposit of fat  between the fibres.   Nothing  of any importance can
be done for the first state, but much for the second.   The patient suf-
fering from this  latter form of heart trouble is nearly always obese,
and should suffer abstinence from fats and rich foods, from all  SAveet
wines or malt liquors, from sugars  and  milk,  and, at the same time,
take exercise.  At first this treatment may cause dyspnoea, but by
gradually increasing the severity of the exercise great feats can  gen-
erally be effected in the end, with marked improvement in the cardiac
action.  (See Obesity.)


                          HEPATITIS.

        (Acide and Chronic Hepatitis, and Hepatic Abscess.)

  Inflammation of the liver may be produced  by many causes,  such
as injuries, cold, exposure to high heat (as in the tropics), syphilis, and
the presence of any infectious disease  or of parasites.  It may also arise
from  alcoholism.   The acute form  is rarely  directly produced by
syphilis unless by the presence of some other form of the disease,  such
as gumma, or the absorption of septic materials into the circulation
from Avounds or sores.   The same may be said  of the hepatitis of hot
climates, which is generally subacute or chronic.   The pain, swelling,
and general symptoms of the acute form of inflammation of the liver
are described thoroughly in the text-books on the practice of medicine.
The measures commonly adopted for the relief of the symptoms and
the disease itself  are of two kinds:  the first, medicinal; the second,
dietetic.
  The patient, if the  attack be  acute or  severe, will commonly be
found  in  bed owing to the pain and fever, but, if not, he must be
placed in bed and  kept in a recumbent posture.  Over the surface
of the right hypochondrium should  be placed tAvo cantharidal blisters
of the diameter of from 1  to 3 inches,  or, if  this is not possible, a
large  mustard plaster  is to be used.  Sometimes hot cloths applied
over this  area  not  only give relief, but also aid in the formation of
the blister.  At the same time,  if the bowels  are greatly confined, a
saline purgative may be given, and  be preceded by 1 grain of calomel
given in fractional doses.  In regard to internal medication the physi-
cian  should recollect that hepatitis is, like every inflammation, a local
hyperaemia or vascular engorgement, and, in consequence, that aconite,
in full doses, is useful.  Veratrum viride may  be used, but as it may
produce vomiting and disturb the liver it should rarely be employed.
The kidneys may be kept active by spirit of nitrous ether and citrate
of potassium, or  by any one of the diuretic Avaters, such as Vichy in
moderate  quantities.    If  the  inflammation is not  aborted  by this 
HEPATITIS.
515
treatment it will go on to hepatic abscess.1  If hepatic abscess develops
the best thing to be done is to aspirate  and draw off the pus.  Very
frequently the inflamed organ will form so strong au attachment Avith
the peritoneal coat of the abdominal cavity that a bistoury may be
used to free the pus if an aspirator is not at hand.  After pus is once
formed any constitutional evidence of its presence, as by night-sweats,
hectic or rigors, is a sign for immediate  interference with the purulent
collection by the physician.  If dysentery exists it  must  be cured as
rapidly as possible by the measures  generally employed for this pur-
pose.   (See Dysentery.)
   The diet during the  early and later stages  of  acute hepatitis  is
almost identical, and may be resorted to in  the  subacute and even in
the chronic forms of the disease.   It should consist of koumyss  to a
great extent, or matzoon may be employed,  but "strong  foods," such
as meats of all  kinds, particularly beef, pork, and mutton, are to be
sedulously avoided.   All spices in  the  food must  be forbidden, and
alcohol utterly tabooed.   If koumyss cannot be had  the patient may
be fed on peptonized milk or  pancreatized oysters.  (See page 373.)
After the abscess develops, the same  recommendations are  to  be  fol-
lowed, and the  diet is to be as supportive as possible, small doses of
quinine being used.
   In the treatment of the subacute or chronic hepatitis of hot cli-
mates no remedy compares  to  freshly prepared strong nitro-muriatic
acid used both externally and  internally.   The acid should be a deep
orauge color, and be mixed Avith water only when  about to be taken,
in the dose of 3 to 4 drops three times a day.  This remedy is contra-
indicated in acute hepatitis, because it acts in the chronic form of the
disease  by stimulating the organ  up to its normal tone, and would
only increase the severity of the acute form  of the disease if adminis-
tered at this  time.   Externally,  it is  to  be used  by mixing it with
water and applying it  by means of a flannel wrung out in the mixture,
or by  placing it on  spongiopiline in the proportion  of from 1  to 3
fluidrachms to the pint of warm water and applying it over the liver.
If 3 fluidrachms irritates the  skiu too greatly the smaller quantity
should be employed.   This application  causes a tingling  of the skin
and a localized SAveat.
   The hepatitis due to syphilis generally shows itself as a cirrhosis,
and is  to be treated by anti-syphilitic measures.  (See Syphilis.)
   If ascites develops  from cirrhosis the liquid  is  to  be withdrawn,
and  frequent  aspirations, as often as the liquid returns,  have been
known to result in  fiual  cure or arrest of the disease.   In all forms of
chronic hepatitis iodide of potassium is a useful remedy in the dose of
from 5 to 10 grains three times a  day, or larger amounts may be used
if the case be due to syphilis.

  1 Just here it may be well  to recall that many cases of hepatic abscess are now
known to be due to dysentery, and that the diseased  state of the  lower bowel may
infect the liver. 
516                        DISEASES.
                          HICCOUGH.

  This is an affection arising from many causes, depending upon irri-
tability of the nerves supplying the diaphragm as a result of gastric
irritation, nervousness, uraemia, and as a complication  of several ex-
hausting diseases, such, for example, as typhoid fever.
  The mechanism of its  production rests upon  the sudden contrac-
tion or descent of the diaphragm, whereby a vacuum is formed in the
chest  into which the outside  air attempts to rush, but is prevented
from doing  so by a  sudden closure  of the glottis, the peculiar sound
of the hiccough  being thus developed.  Generally the symptom  stops
of itself, but it may  become excessive.
  The remedies to be employed are used according  to the  cause  of
the disorder.  If there be gastric or  intestinal irritation, the irritating
matter must be  removed by emetics or purges, and nervous and local
sedatives used.  A few drops of spirit of chloroform do good in many
cases, and a little tincture  of capsicum may be employed  in  other
instances, say  2 or 3  drops well diluted.   Children  should only have
J to 1 drop  of the tincture, Avell diluted.   Spirit of camphor, or the
tincture of valerian, in the dose of 1 drachm, may be serviceable, and
Hoffmann's anodyne is peculiarly appropriate.   In the hiccough  of
typhoid fever nothing compares to musk, 10 grains by the rectum, and,
if this cannot be used, oil of amber may be given in the dose of 5 to 10
drops in capsule or emulsion.  Nitrite of amyl may also be inhaled.
  Where external remedies are resorted to, ether  thrown  in  a fine
spray on the epigastrium may stop an attack.
  In cases where the affection comes on after meals, and is due to in-
digestion, a course of tonic treatment will often give relief.   Thus
nux vomica in pill  or tincture, accompanied  by some dilute mineral
acid, such as hydrochloric or nitric, may be employed.
  If the symptom be due to uraemia, a hypodermic injection of hydro-
chlorate  of  pilocarpine will be  found  of service unless it is contra-
indicated by advanced depression and systemic weakness.


                INCONTINENCE OF URINE.

  Incontinence of urine may be classified either according to  its forms
or the methods of its treatmeut.
  Four varieties may be recognized as occurring separately,  although
all  of them may occur in one case.   There  are cases where the bladder
fails to  hold  the  urine day or night, those in Avhich the incontinence
is only nocturnal, and those in which it occurs only upon some ner-
vous  start, or in Avhich  the sphincter  becomes relaxed from general
atony.   The first of these occur in children, the last in adult females.
A  fourth form  of incontinence depends upon paralysis arising from
centric nervous disorder or from paralysis due to retention aud conse-
quent paralytic distention. 
INCONTINENCE  OF  URINE.               517
  Taking up the consideration of the first forms, namely, those occur-
ring in children, in which the trouble is generally nocturnal, the com-
plete history and the present condition of the case must be discovered.
Many of the most obstinate cases will yield Avhen the urine is made
clear and  mild by  the use  of alkalies, and others will recover upon
the  removal of worms from the vagina, which have crawled there
from the rectum, or upon circumcision of a  redundant prepuce,  par-
ticularly if this be  tight  and smegma aud urine be found back of it
in large or small quantity.  The cause of the incontinence in  both
these conditions is  reflex  irritation, exercised by the  urine on  the
bladder walls or by irritation at the end of the penis or in the vagina,
and  the reason that alkalies do  good is  that they render the urine,
which is concentrated and irritating, dilute, alkaline, aud mild.   Bella-
donna in these cases is rarely, if ever,  curative, and is  at most  only
palliative,  the  condition returning as soon  as the passing off of the
effects of the drug permits  the irritation to  be felt by the nerves of
the  bladder.   After  alkaline diuretics  have been used, belladonna is,
however, very valuable.
   Where the  urine  is concentrated  and  dark  in color, the following
prescription is always useful:
         R.—Potassii citratis   .    .   .   .    .    .   gss.
             Spt. aetheris nitrosi.....f^vj.
             Aquae......q. s. ad  f gj.     M.
     S.—Dessertspoonful every four hours in equal quantity of water.

   As the urine becomes clear, after several days, a few drops of  tinc-
ture of belladonna may be added to the mixture; but if a little is not
sufficient it must not be  increased,  as belladonna'will  not cure the
condition,  and may make the urine concentrated—a condition directly
opposed to that which is A\anted.
   Sometimes these cases are dependent not  so much upon vesical irri-
tability  as upon Aveakness of the spinal centres  governing the bladder.
If this  be the case  the remedies used should  be directed to the im-
provement of  these parts, and  the following pill  should  be adminis-
tered, or the succeeding solution :
         R.—Acid, arseniosi......gr. ^.
             Extract, nucis vomicae.....gr. ij.    M.
     Ft. in pil. no. xx.   S.—One three times daily after meals for a child of eight or
ten years.
Or,
         R .—Liquor, potassii arsemtis   ....  gtt. xxiv.
             Tinct. nucis vomicae.....gtt. xyj.
              Aquae......q. s. ad  fgiij.    M.
     S.—Teaspoonful three times daily after  meals for a child of eight or ten years.

   This  mixture  is  so bitter as to  be exceedingly  disagreeable, and
 Fowler's solution may often be used alone in the dose of J to 1  drop.
And at the same time strychnine in  gelatin- or sugar-coated pill or
granule.
   It must be  remembered that this  last treatment is only to  be em- 
518
DISEASES.
ployed in chronic cases  devoid of all irritation and  dependent upon
atony.  It will not do good if the urine is not previously made clear.
  Nothing can be more unfortunate in the treatment of these cases
than  punishment by severe scolding and Avhippings, as it never does
good, and the fault being beyoud the child's control the unjust punish-
ment makes him sullen, or through nervousness, augmented by such
treatment, his trouble becomes worse.  In some cases it may be neces-
sary, in order  to  cure  the habit, to let the child drink diuretic Avaters
for years, and  the patient  should always be taken up from bed when
the parents retire for the night and  made to evacuate the bladder.
  In the incontinence of adult  females or males, on laughing or sud-
den  movement, nothing compares,  from a curative point of view, to
drop doses  of tincture of cantharides  three  times a day, the  urine
being kept  flowing freely  from  the kidneys by means of alkaline
diuretics.
  The treatment of the fourth  form of incontinence of urine comes
into  the province of surgery.   The bladder  must be relieved by the
catheter  if the trouble be  from retention.  If the disorder is due to
paralysis nothing can be done except to carry out those general measures
valuable in such cases, to  maintain the urine in as normal a state as
possible, to frequently catheterize Avith an aseptic catheter, and to wash
out the bladder every few days or hours, as the case may be, Avith some
weak antiseptic fluid such as the 1 to 10,000 solution of bichloride of
mercury, or 1  to 100 of carbolic acid, or 1 to 100 of boric acid.


      INDIGESTION, GASTRIC AND INTESTINAL.

  Under  the heading " Biliousness " the writer has already described
many of the conditions arising out  of indigestion, and this being the
case  the consideration of that state known as dyspepsia or indigestion
will  ouly receive attention  at this point  in so  far as its cure is con-
cerned, without the  relief of the symptoms produced.
  Lack of gastric digestion depends for its existence upon  a very great
number of causes, and is always a symptom, not a disease.  It occurs
during the course of short or prolonged fevers, from atony of the gastric
walls and glands, from lack of secretion of the proper character, from
hypersecretion of mucus  by the mucous glands, and  by fermentative
changes iu the food, or as the result of any one or all of these condi-
tions ; and lastly, because the food is unsuitable to the case or is of a
kind difficult of assimilation, or is readily split up into effete products
by the juices of the organ.   Sometimes it is due to organic changes in
the viscus, as carcinoma or ulcer, and sometimes to acute or  chronic
gastritis.  In each of these states the treatment is, of course, different.
  The indigestion  attendaut upon  the  course  of fevers can  nearly
always be avoided  by a proper diet and the use of predigested food,
such as pancreatized beef-tea, milk, or broths.
  The necessity of  this artificial digestion is  the more readily recog-
nized when we recall  the  investigations  of Hoppe-Sevler  upon  the 
         INDIGESTION,  GASTRIC  AND INTESTINAL.      519

quality of the  gastric juice  of a patient suffering from typhus fever,
for he  found that no hydrochloric acid Avas present.   Uffelmann has
also found in a similar study that the peptone-forming secretion of the
stomach ceases  entirely during fever.
   Generally, if the accompanying disease is adynamic in type, alcohol
should  be takeu  with the food, so that the stimulating effect of the
drug Avill cause  gastric and intestinal activity.  A  very important
point to be remembered, is that the exercise of the function known  as
digestion requires force,  and that digestion fails in cases of prolonged
fever because the system lacks the force required to carry out the act.1
As alcohol adds  force to  the system  it aids digestion and should  be
varied  in  the amount given according  to  the  state of the organism,
and particularly  that of the  stomach  itself.   During  convalescence
from fevers or other acute  diseases the digestive functions are to  be
kept up to  their  Avork  by bitter tonics and a gradual decrease in the
amount of alcohol insisted upon, lest the alcoholic habit be set up.
The tonics  may  be given in the formulae to be found below if  so
desired.
   In the gastric atony dependent upon overwork or fatigue of mind,
as well as body, tonics are to take the place of alcohol, as this drug is
peculiarly apt to give rise to the alcohol habit in such cases.  These
tonics ought always  to  be bitter and should chiefly depend for their
activity upon this property.   The most  powerful of them  are  nux
vomica, or its alkaloid strychnine, and quinine, both  of Avhich drugs,
however, exercise  a more powerful effect  ou other parts of the body
than on  the stomach.   The other bitters are gentian, cardamoms,
quassia, chiretta, and calumba, all of which may be  used with great
success iu combination Avith one another or alone.
   The  folloAving formulae are  useful, but  before naming  them it is
proper  to  call attention  to the fact that all tonics are contra-indicated
if any irritatiou of the stomach is present,  because they are stimulants
and irritate the gastric Avails all the more if these are already inflamed.
          ft.—Extract, nucis vomicae    .    .    .   .   .   gr. iv.
              Extract, quassia?......gr. xx.
              Quininae sulphatis......gr. xl.   M.
    Ft. in pil. no.  xx.  S.—One pill three times a day after meals.

0r'
         R.—Tr. nucis vomicae......f.^j.
              Tr. cinchon. comp.....q. s. ad   f Jiv.    M.
      S—Teaspoonful after each meal.
Or,
         R.—Extract, chiratae......gr. xl.
              Extract, gentianae......gr. xl.
              Oleoresinae capsici......Tttv.    M.
    Ft. in pil. no.  xx.  S.—One after each meal.

  1 Very few of us realize the amount of force used up in the body in daily life.  It
is almost impossible to estimate the amount used  in digestion, but we know that
glandular secretion is very powerful, so powerful  in the salivary glands as to  be
twice that of the  blood-pressure  in  the carotid artery, if necessity requires  it.
(Ludwig.) 
520
DISEASES.
   Where the failure of digestion rests upon a deficient secretion and
it is  desired to  increase the rapidity of the  act by purely artificial
means, we may rely upon pepsin and hydrochloric acid, but if this is
done  it should be resorted  to Avith a clear idea  of why such  remedies
are prescribed.
   Very commonly, in the treatment of gastric dyspepsia proper, pepsin
is given in such  absurdly small doses as  to be almost useless, and  yet
the prescription as it is taken is  intended to aid the true gastric juice
which is  not thought strong enough to  be capable of performing its
functions aright.   This is not by any means the result attained, in  the
majority of cases, for the following reasons—indeed, the direct diges-
tive action of the dose administered probably brings about the smallest
part of the good achieved :
   It  is a mistaken  idea to believe that pepsin and hydrochloric acid
are simultaneously  secreted  and  utterly independent  bodies, or, in
other words, that the pepsin  may be formed  even  if the glands  fail
to form the acid.  We  knoAV, from the  experiments of Heidenhain
and of Langley, as well as many others, that pepsin, as such, is  not
secreted  by  the  glands ready formed, but that these tubules secrete a
so-called "mother substance" called pepsinogen, which is  absolutely
impotent  until it is changed into pepsin in the presence of hydro-
chloric acid or sodium chloride.   Consequently, we learn that the two
digestive  elements are very closely associated, and that the absence of
acid means absence of pepsin.
   In  normal life this acid is derived by the splitting-up of the chlor-
ides in  the  blood supplying  the  glands  by the lactic acid which is
present almost constantly in the stomach, owing to the decomposition
of carbo-hydrates.   This assertion, made by Maly, is also confirmed
to some  extent  by Julius  Thomsen, who has shown that very Aveak
acids  may displace stronger  ones from their bases, and even appro-
priate the greater part of the  base.  This is  doubtless the reason why
common  salt is  so  useful a condiment,  since it is broken  up in  the
stomach, thus setting free hydrochloric acid, besides keeping up  the
alkalinity of the juices  of the body which  is so necessary  to health
and the future  secretion of gastric juice.  It also explains in a very
ingenious manner the well-knoAvn fact that salt added to a glass of
milk  increases  its digestibility to a great degree.   Further  than this,
the usefulness of the salt taken  in small amount before  meals does
not depend entirely, as  has been  thought, upon an endeavor on  the
part of the stomach to neutralize the sodium present in a normally acid
medium, whereby an excess of gastric juice is secreted, but upon  the
reasons given above.  We find, therefore, that  in cases where there is
reason to believe that  gastric digestion is imperfect,  common  salt
should be used  in  increased amount  in the food so that the quantity
of hydrochloric acid may be increased.   If, however, there  is reason,
to believe that lactic acid is present in  too small a quantity to split up
this salt, then hydrochloric acid must  itself  be used, and, where it is
employed, given  freely in order  not only to act thoroughly so  far
as its own  functions are concerned, but also to perform an equally 
        INDIGESTION, GASTRIC AND INTESTINAL.     521

important function, namely, the conversion of pepsinogen into the active
ferment pepsin.  In other Avords, deficiency of pepsin in the juice is
to be corrected, not by a prescription containing  much pepsin and a
little acid, but rather the reverse, for the pepsin in the prescription is
after all an extraneous product, while the pepsin brought into  being
by the acid  is a normal secretion.  Of course, the quantity of pepsin
must depend on a normal formation of pepsinogen ; but it should not
be forgotten, on the other hand, that as pepsin acts by catalysis, and is
a most powerful ferment, only very small  quantities  of it, compara-
tively  speaking, are absolutely  necessary, while large amounts  of
hydrochloric acid, comparatively speaking, are essential.
   Bourget has enunciated views  Avhich are so completely in  accord
Avith the views here expressed as to be Avorthy of quotation.   He
believes, as does the writer, that the hydrochloric  acid is generally the
secretion which is  lacking in  amount and recommends its free em-
ployment as the  most  important part  of the treatment  of  gastric
indigestion.   He does not do  this because he believes  it to  increase
the pepsin, but only because he thinks the acid formation is more apt
to be deranged than  is that  of the ferment.   According to practical
experience, and the equally reliable information gained by experimental
research, it  is  to be concluded, therefore, that pepsin is to occupy the
least prominent position in a prescription for gastric indigestion, and
that the acid is to be freely used.
   Where indigestion results from the presence of gastric catarrh the
remedies applicable to such a state must  be resorted to.   (See Gastric
Catarrh.)
   In many cases in Avhich distress comes  on  some time after eating,
the trouble  is due to the development of large amounts of lactic and
butyric acid in  the  stomach,  and the  remedies to  be given, unless
the patient  Avill cause himself to vomit by tickling his pharynx or
swalloAving  an emetic, are sodium bicarbonate or ammonia.   Some-
times  patients go  from  physician to physician Avithout relief, only to
find it when someone  gives them 10 to 20 drops  of the aromatic
spirit of ammonia  for each attack.
   Salol may also be given in the dose of 10  grains three times a day
in many of these cases Avith very extraordinary  results, as may also
fa grain of podophylliu morning and night.
   In other cases the cure of this condition  rests upon the removal of
the  state of atony or dilatation  of  the gastric  walls.   (See  Gastric
Dilatation.)
   Intestinal indigestion depends upon almost the same causes as does
gastric dyspepsia,  and  is to be  treated in  much the  same  manner,
chiefly by a careful study and  regulation of the patient's diet, and by
the  use of a number of remedies  calculated to  supplant to some  ex-
tent the normal juices by some  artificial  ferment.   These ferments
should be given with the meals, or the  food  predigested before it is
taken.                                                   .
   The pancreatin should be given in good dose (5 to  10 grains), with 
522                         DISEASES.
bicarbonate of sodium, and alkaline mineral waters used  if the urine
is conceutrated.  (See Biliousness.)
  Sometimes Avhere intestinal  indigestion is present great flatulence
comes on and is  an annoying symptom.    Very commonly in these
cases it will  be found that the patients think they have heart disease,
because of the pain they suffer under the praecordium.  This paiu is
due to the accumulation of flatus in the small intestine, or more com-
monly to its pressing upward at  the angle where the transverse colon
turns to go  down  to form  the descending colon and sigmoid  flexure.
Under these circumstances the following prescription will  be found of
service :
         R.—Acid, nitric dil.......f.^j.
             Tinct. cardamom, comp.     .    .    .    .  fjvj.   M.
    S.—Dessertspoonful in water four times a day.

  In old persons  flatulence of the  large bowel is  frequently found,
and  is  often associated Avith atony of the muscular coats of th,e gut.
Under these circumstances the following prescriptions will be found
of service:
         R.—Asafoetidae.......gr. xl.
             Extract, nucis vomicae .    .    .    .    .  gr. iv.
             Extract, physostigmatis    .    .    .    .  gr. iij.
             Oleoresin. capsici......TTLx.   M.
    Ft. in pil. no. xx. S.—One pill three times a day, two hours after meals.
Or,
         R—Tinct. belladonna? •    .    .    .    .    .  f^ij.
             Tinct. physostigmatis.....f^j.
             Spt. camphorae    .    .    .    .  q. s. ad  f^iij.   M.
    S.—Teaspoonful two hours after meals, or whenever needed.
  Where intestinal indigestion results in lientery the treatment be-
comes entirely changed, except in regard to the use of a predigested
milk diet, and efforts  must  be made to  increase the secretion of the
glands of the intestinal wall.   Often minute doses of mercury bichlor-
ide or podophyllin may do this, fa to fa grain  of the first or second,
respectively.   More commouly, however, the mixture of  nitric acid,
given above, will  be the proper treatment, or, perhaps, the folloAving,
if the liver is found to be  torpid :

         R.—Acid, nitro-hydrochlor. (not dil.) .   fgssvelf^j.
             Infus. gentianae comp.  .    .    .  q. s. ad  f'^vj.   M.
   S. —Dessertspoonful every four hours, or after meals, in water.
                          INFLUENZA.

  The disease known  as  influenza influences  various individuals  so
differently and presents so many symptoms associated Avith functional
disorder of various organs in the body, that it  is almost impossible to
do more than consider the remedies which  are  to be employed  in  the
treatment of the more frequent or more immediate manifestations or 
INFLUENZA.                      523
complications.   Greater in importance  than the employment of drugs
must be regarded continuous rest, aud stimulants are in many cases
absolutely essential.
   In those cases in which the disease is  ushered in by a severe chill,
accompanied by violent pains in the back,  if the patient is seen early
enough, it may  be  necessary to employ remedies for the relief of the
rigor, Avith the double purpose of improving the patient's general  con-
dition and  preventing internal congestion of vital  organs.   In  the
majority of instances, however, the  patient will  not be seen during
this period of the disease, but during the febrile stage, Avhich succeeds
that just mentioned.   Under these circumstances the author does not
believe that it is Avell for the physician to resort to any of the remedies
which have been so largely used during the last feAv years, and which
are  known as the " antipyretics," or the derivatives of coal-tar.   Al-
though originally introduced for the purpose of reducing febrile tem-
peratures, practical experience has taught us that their sphere of action
is very limited under  these  circumstances, and the author almost
never gives antipyrine, phenacetine, or acetanilide with the  object of
reducing fever.   Although he does not believe that these remedies are
to be used for the reduction of temperature, he has certainly seen very
marked relief follow their employment  with the object of relieving the
severe  pain which occurs in the back, limbs, or head.  Small doses
are  usually sufficient to at least reduce the suffering,  if not to remove
it entirely, but as cardiac complications are  by no means unusual, large
doses are  contra-indicated  in most  persons.  The author prefers to
alloAV the patient to suffer from a moderate  degree of pain rather than
from the dangers incident to the administration of doi-es large enough
to entirely relieve it, because  in his experience these  doses have to be
very large if they are to  be entirely competent as analgesics.
   If any  of the coal-tar products  are used either  for the  relief of
fever  or of pain,  phenacetine and  antipyrine  should  be  chosen.
Experiments made in America and in Germany on animals have
proved that phenacetine  is far less toxic in its relations to the heart
than is  antipyrine or  acetanilide,  and while it  has  in a number of
instances seemed more inclined to produce cyanosis in  man than either
of the  other drugs, this  cyanosis  rarely, if ever, has been associated
Avith any other  dangerous symptoms.  Indeed, it is  quite extraordi-
nary the amount of cyanosis  which  phenacetine may  produce without
the  respiration  becoming greatly disordered, very much less cyauosis,
Avhen caused by acetanilide or antipyrine, being accompanied by much
more alarming  symptoms.  A very favorite combination with practi-
tioners  who have had a large experience is one of salol and phenace-
tine.   The action  of the phenacetine  in  relieving  the pain and in
reducing the fever  seems to point to it as a rational  remedy, but  the
exact influence  of salol  under these  circumstances  is not so clear.
Composed, as it is,  of 60 per cent, of salicylic acid and 40 per cent, of
carbolic acid, it seems to possess a therapeutical  poAver different from
that possessed  by either of these  two  constituents  alone, for neither
carbolic acid nor salicylic acid have much power  in the relief of pain 
524
DISEASES.
when used alone, unless, as in  the  case  of carbolic acid,  they are
applied directly to the part affected.   Perhaps the condition of pain
in the  lumbar and other muscles during the attack of influenza is in
some unknown way associated  Avith the condition  which  we  have
called  " rheumatism," and in which salicylic acid does  good  in  an
unknown  manner.   Salicylic acid alone might be equally useful if it
Avere dissolved in the intestine and did not irritate the stomach.
   On  seeing a  case  of influenza during the first few hours of the
attack, the author resorts to those remedies which have been in use  by
the profession  for many years, and, so far as he can learn, it  is the
custom of other members of the profession to give a mixture composed
of tincture of aconite, spirit of nitrous ether, and a solution of citrate
of potassium in preference to any other medicine at  this  time.   This
mixture possesses the advantage  of increasing the action  of  the skin
and kidneys, and of reducing the temperature, of quieting the circula-
tion, aud of being readily taken by the patient Avithout danger of dis-
ordering the  stomach at this time or  later on, which is important, as
this  organ is apt to become irritable.  As a general rule, citrate of
potassium is given in too small doses, and, unless there are reasons to
the contrary, it should be given  in the dose of 15 to 20 grains three
times a day.
   If the fever becomes excessive, so that there is danger of the patient
suffering  from a true hyperpyrexia, it is better  to resort  to cold
bathing instead of the autipyretics first spoken of.  It  is  true that
the patients themselves and the friends of the patients Avill sometimes
protest  against what they deem an heroic measure, but the  author is
satisfied that if the  cold is used in the proper manner it  is devoid of
danger  to the  patient.   The majority of physicians  do  not  seem to
carry out the treatment of Brand  and Leiberraeister as it  is carried
out by its originators. Most of them forego the very important por-
tion  of the treatment, Avhich consists in frictions designed to bring the
heated blood to the surface, and the author has  again and again seen
physicians apply cold either by means of a wet sheet, by sponging, or
a cold bath without using any measures which are  directed against
internal congestion.   (See Cold.)
   Hyperpyrexia in influenza does not seem to possess the same dangers
that  it does in the course  of some other diseases.  In the first place, as
a general rule, the course of the disease is a brief one, and  although
it  may leave the patient weak and  exhausted,  the  duration of the
malady does not extend beyond a few days.   Clinical experience aud
physiological study have proved that it is not the temperature of 105°
or 106° F. which is  distinctly dangerous, but the continuation of this
temperature for  many hours, which is harmful.  Similarly, a patient
ill from typhoid fever, having a temperature of 103°, for many days
suffers very much  more than  does a patient who is suffering  from
pneumonia, and who may have for forty-eight hours  a temperature of
104.5°  or  105°.  For these very reasons a temperature of 104.5°
or 105° is not  particularly alarming in the condition which we are
considering, unless they are symptoms  pointing to the fact  that the 
INFLUENZA.
525
patient is being injured by an  excessive temperature, as may be indi-
cated by somnolence and an  exceedingly dry skin, as Avell as cerebral
symptoms.  Of course, if renal trouble, associated with cardiac disease,
comes on  at this time, methods for  the reduction of the temperature
must be resorted to.   The point to be strongly emphasized is that the
mere existence of high temperature is not to be regarded as a point to
which great attention must be given by the use of drugs.
   It seems to be the general  consensus of opinion, both in this country
and in England, that any measures of a  depleting character are dis-
tinctly harmful in influenza, even at its earliest stages, and Ave would
naturally expect that this Avould be the couclusion arrived at by physi-
cians who treat  their patients rationally.   Although  influenza is  a
short-lived disease, there is  probably no malady in Avhich the patient
goes  on into  a condition of profound depression, or eveu exhaustion,
as  in this one.  The abstraction of blood from a vein, or by the use
of cups, should not  be resorted to.  It  may increase the danger from
exhaustion before the  system has a chance to recover from the simul-
taneous appearance of the attack aud  the therapeutic measures of the
physician.
   As the  case of influenza progresses, a condition of marked depres-
sion, or even  collapse, very  frequently develops.   The expression of
anxiety on the patient's  face is to a physician, who  is accustomed to
see it in other  diseases, a most alarming symptom, and it is not until
one has  seen  it  repeatedly in  influenza that he  is  able to give it its
exact value.   Associated  with this  condition, the  skin  is frequently
covered Avith  a profuse  perspiration and  the pulse  is very apt to be
very rapid, running, feeble,  and easily  compressed.   At first glance
the  old saying, that " Ave treat the symptoms as  they arise," would
seem to cover to a very large extent the indications whicli are present
at this period; yet the author's experience, which may differ from that
of some  of his readers,  is that the cardiac stimulant which Ave are
most frequently accustomed  to use—namely, digitalis—does  not seem
to take hold of the  circulatory apparatus  and to act upon  it in the
manner which is desired.   It may be that the pressing symptoms have
made us more anxious and impatient as to  the use of my medicament,
and that we have not had the patience to Avait and allow such a slowly-
acting remedy as digitalis to take effect.  Be this as  it may, we have
come to  regard strychnine as  infinitely preferable to foxglove when
these symptoms appear; and  Ave have been able to prevent their appear-
ance, or at any rate to modify them to a very great  extent, by using
strychnine in full doses from the first portion of the stage of depression.
We believe that, as  a  general  rule,  strychnine is given in very much
smaller doses than safety requires, and that in many instances it fails
to act because the doses  are  too small  to struggle with the profound
condition  of exhaustion which  is present.   In an adult we can see no
reason why -^j- of a  grain may not be given tAvice or even  three or
four times in  twenty-four hours, and in some cases we have given it
every four hours without producing  any of the symptoms of an over- 
526
DISEASES.
dose of strychnine.  Divided doses are better than a feAV very large
ones.
  The author knoAvs of no better illustration of the fact that in some
conditions we are to give drugs for effect rather than according to cus-
tomary dose than the employment of strychnine in influenza, and the
physician who is timorous in  the presence of this frequent complica-
tion, depression, certainly increases the patient's  danger.   As Avith
everything else, the drug should be carefully watched, and at the first
sign of muscular twitching, or stiffness at  the back of the neck, its
administration should  be cut down or  discontinued.   In.many in-
stances where the collapse comes  on suddenly, the  strychnine should
be administered hypodermically  and folloAved by full doses by the
mouth,  in order  to keep up the full effect exercised  by the drug  upon
the nervous and  circulatory system.  In some  cases it will  be found
that the blood paths seem to be so relaxed and  atonic that the strych-
nine is  unable  to  produce a  sufficient vascular  effect to bring  the
patient out of his difficulties, aud  under  these circumstances very good
results  follow the combination of  belladonna with strychnine;  the
belladonna being, as we well  know, a powerful vasomotor stimulant
under such circumstances.  It  also  should  be  given in full doses for
effect.   As the  acute  stage  of depression  passes  off  the belladonna
should be stopped and  the strychnine continued alone through conva-
lescence.
  Alcohol  has not seemed  to be of much value  during the  active
period of the disease.   In milk-punches and eggnogs it is, of course,
useful during convalescence.   If  delirium comes on it  has not seemed
to be a  symptom of very serious character  either for immediate re-
sults or in influencing  the  prognosis as to  the ultimate  recovery of
the case, and in cases of pneumonia, complicating grippe, in  Avhich
delirium was the  prominent  symptom, it  appears that  delirium is
not to be regarded iu the same light as similar  manifestations compli-
cating ordinary pneumonia or other diseases.   The delirium may be
either talkative  or  muttering, but  does  not in the majority of cases
require treatment, passing away with the fever and rarely extending
into the stage of exhaustion.
  For the irritative cough, steam inhalations, laden in the first stage
with benzoin or  other innocuous and sedative substances, seem particu-
larly useful.   For the  bronchitis, which is  often present, it  is gener-
ally sufficient to administer the ordinary mixtures containing ipecac,
potassium citrate, in the earliest stages, and to  follow them by chloride
of ammonium and cubebs in  the  later stages.  The author does not
think that the compound licorice  mixture containing antimony should
be given in the second  stage of influeuza. A complication too apt to
occur at this time  is oedema of the lung or a widespread bronchitis
with a profound exudation which bids  fair  to drown the patient in
his own secretions.   Antimony  is  not  only  a substance depressing
to the  circulatory and  respiratory  systems,  but aids  very materially
in causing the  peculiar variety of secretion  which  has just  been
spoken  of. 
INSOMNIA.
527
  It may be necessary to use bromides if the cough is excessive, or to
replace them by codeine, or \Tery small doses of morphine.   In many
cases  still better results will  be obtained by  a  good preparation of
cannabis indica,  which  may  be pushed  until it relieA^es the cough,
without  in  any  Avay endangering the patient's  life,  a  safety Avhich
cannot be obtained by  the employment of any other  of the drugs
named.
  If  sleeplessness is  so  pressing a symptom  as to require attention,
the bromides may be given, but it will  be generally found that the
insomnia comes after the attack rather than during it, or in any event
it will not require attention until the  patient is convalescent.   Under
these  circumstances chloral or chloralamide, or even  sulphonal, may
be administered, care being taken,  of course,  in the case  of chloral
that the  cardiac apparatus is in good condition, and in the case of sul-
phonal that  it is administered  in a  powdered form, .or dissolved in
hot water and given four or five  hours before the time at which sleep
is desired.
  For the vertigo and dizziness which are sometimes bitterly com-
plained of by the patient, either during or after the attack, small doses
of bromide with  ergot  or cannabis indica  have seemed  particularly
valuable, probably because  they  exercise  some effect  upon the blood-
vessels of the brain or its membranes, or perhaps upon the bloodves-
sels of the ear.   Certain it is that in those  cases of tinnitus not asso-
ciated Avith  organic change in the  aural canals, bromides and ergot
do more  toward relieving them than any other  medication.
  In  the constipation which is sometimes present iu the early stages
of influenza it  is generally advisable to administer either castor oil, or
in other cases  half an  ounce of the  sulphate of magnesium, or for
more  fastidious patients the citrate of magnesium.   A full purgative
effect  of  any  of these salines seems to lessen the fever when it unloads
the bowels.   Care should be taken  that the dose of the  purgative is
not excessively large, as it will Aveaken the patient  as much as would
bleeding.  For the constipation  following  the  attack,  probably no
drug  is as efficient as cascara  sagrada, combined perhaps with aloin.
If diarrhoea supplants the constipation, the ordinary astringents, such
as aromatic sulphuric acid or haematoxylon, will  be found sufficiently
active.

                           INSOMNIA.

  Insomnia  is a  condition characteristic of almost every disease in
some  of  its  stages, and  arises  from  such  a host  of causes that the
physician may  not be able to discover any one of them for days after
the patient  is  first seen.  As  a general  rule, a  patient consulting a
physician with this symptom expects a  prescription to  be given at
once  and the cause found  out  afterward, or,  in other instances,  wil-
fully defeats all the efforts of the practitioner for one reason or another,
but desires relief although he may not choose to aid in its attainment.
Under these circumstances  the  physician may safely employ  certain 
528
DISEASES.
drugs  according to the information that he may have coucerning the
patient's state.
  One of the most common remedies is chloral given in the following
manner:
         R.—Chloralis.......3 iij.
             Syr. simplicis......f.^iv-
             Aquae cinnamomi .    .    .   .    q. s. ad  f^iij.    M.
    S.—Dessertspoonful at night.
Or,
         R.—Butyl chloral-hydrat......3J.      M.
    Ft. in pil. no. xii. S.—One, two, or three pills at night, as needed.

  Where, for any reason, as  the  presence  of a Aveak heart, chloral is
contra-indicated, resort may be had to the  bromide of potassium or
sodium,  aud if the  patient is a female, these drugs  should always
be accompanied by a small dose of arsenic, generally iu  the form of
Fowler's  solution, 1  to 3 drops three  times  a day, in  order to avoid
all danger of the production of acne.  The  following prescription is
useful:
         R—Potassii bromid.   .   .    .    .    .       ^ij.
             Liq- potassii arsenit  .....  f ^ss.
             Aquae cinnamomi    .    .    .    q. s. ad  fjvj.    M.
    S.—One to two dessertspoonfuls at night.

  In many cases larger amounts of the bromide Avill be needed.
  Where the sleeplessness is due to pain, chloral is of little  value and
bromides are Avorth  but little more.   Under these circumstances, by
resorting  to Avhat is known as the " crossed  action of drugs," we can
often obtain a very good effect.  Thus morphine and chloral both act
on the brain to produce  sleep, or, in other words, their action is here
crossed, for one relieves pain and  the other does not; one kills by
failure of  the  heart  in overdose,  the other by  respiratory failure:
as a consequence,  large doses of  neither  can be given  alone.  The
following is, therefore, a  useful combination  either where  one  drug
fails, or when dangerously large doses of either one  alone have to  be
used  to obtain the desired result:
         R.—Morphinae sulphatis.....gr. iv.
             Chloralis.......^ij.
             Aquae......q. s. ad  fgiv.    M.
    S.—Dessertspoonful at night.

  In cases where insomnia is due to mania, hyoscine is said to be very
useful, given  in the dose of fa^ to fa grain by the mouth,  or  Tfa to
TFo % ^e  hypodermic needle.   Owing to its tastelessness the powder
may be put on the tongue, and it is best to order a  little sugar of milk
or Avhite sugar (1  grain) to every small dose of hyoscine,  in order to
give it bulk.
  Where insomnia folloAvs  mental  effort, avoidance of  all cerebral
activity should  be insisted upon  during the evening, and if the feet
are cold on  going  to bed, sleep should be induced by a hot foot-bath or
the use of a hot-water bag at the feet and cold to the head. 
INTERMITTENT FEVER.
529
  During the last few years a very large number  of remedies have
been introduced as hypnotics, such  as somnal, paraldehyde, chloral-
amide, sulphonal, amylene hydrate, liypnal, and  others.   None of
them are comparable  in therapeutic activity with the older remedies,
although sulphonal and chloralamide seem to be the best of the  lot.
The dose of sulphonal is 10 to 20 grains  in powder, but as it is large
in bulk and hard to swallow it should be used in a prescription made
up as follows :
         R.—Sulphonal........gr. xxx.
             Syrupi simplicis......f ^ ij.
             Mucilaginis acaciae......f 3 ij.
             Aquae destillat.....q. s. ad  f^j.    M.
    S.—Half to all of this at one dose, as may be needed.

  In other instances sulphonal may be dissolved  in  very hot water
and the  solution  SAvallowed before it cools sufficiently to  permit pre-
cipitation.
  Chloralamide may be used in the dose of 15 to 60 grains  dissolved
in wine or given  in capsule.  Paraldehyde is given in the dose of 20
to 60  minims.  As it  is  disagreeable in odor  and taste, it must be
given iu capsule, and it is  very apt to disorder the stomach.
  The dose of amylene  hydrate is the same as that of paraldehyde.
It is a liquid, and, like the rest of the drugs named with the exception
of liypnal, has no effect in insomnia from pain.
  Somnal is used in the  dose of 10 to 40 minims with liquorice  and
water, and possesses considerable power.
   In the treatmeut of insomnia it should be  remembered that drugs
should be  used which,  if possible, will  quiet the part of the brain
which is most active.   Thus, if the patient tosses  much,  we use bro-
mides  and  chloral  as  motor  depressants.   If sensation  is active
bromides  and the hot-pack are used to act as sensory quietants.   In
other cases  horseback exercise  taken late in the afternoon does good,
particularly if the patient follows a sedentary life.   Many persons
who are usually sleepless will obtain  a refreshing slumber  by taking a
very light and easily digested meal just before retiring for the night
or by eating a cracker or drinking a glass of milk  when  they awake
during the night.

                  INTERMITTENT  FEVER.

   In all forms of intermittent fever, whether the attacks  are diurnal,
quotidian, tertian, or quartan, the best remedy for their prevention is
quinine, which should,  under these circumstances, be given about  two
or  three hours before the  attack is expected, so as to be absorbed  and
physiologically active when the paroxysm is due.   This precaution
is often overlooked, and the dose ordered at the time of the expected
attack, with failure as a result.  Not  only should sufficient time elapse
for absorption, but the  fact should be remembered that the chill often
begins an hour earlier each day, and will be in full sway before the
quinine can stop  it, if the drug be not administered at the proper time.
                                 34 
530
DISEASES.
 Experience has proved that quinine never acts as favorably if consti-
 pation is present as when the bowels  are  lax, and  hepatic activity
 seems particularly necessary  for  its full  effect.  To obtain the full
 influence of the drug it should  be preceded, by some four or five
 hours, by ^ to \ grain of calomel every fifteen minutes  until a grain
 is taken, or by a dose of podophyllin amounting to fa to | grain.  If
 podophyllin is used, a longer  time should be allowed  before the anti-
 periodic is given, because of the slow action of this purgative, and if
 the  patient has  been rendered unusually insensitive to  purgatives,
 larger doses of both the  remedies named must be used ; particularly
 is this true  in the South.
   The dose of quinine varies with the exigencies of the case, which in
 turn generally depend  upon the region  in which the  patient lives or
 has  lived.   Ten to fifteen grains in one dose are generally sufficient in
 the eastern  and northern States, but as  much as  twenty to forty-five
 or even  sixty  grains may  be  required  in the  southern  parts of  the
 United States  and  elsewhere.    When these very large doses are em-
 ployed, the drug should be given partly hypodermically and partly  by
 the rectum in suppository, or in solution, as Avell as by the stomach, as
 this  viscus will rarely withstand 60 grains of quinine without irrita-
 tion.  (For the best salts for hypodermic use, see article on Cinchona,
 page 144.)   If  the stomach is  irritable,  resort to  these  means of
 entrance into  the body are absolutely necessary and must be entirely
 relied on.
   In cases where the attacks are several days apart, small doses of qui-
 nine of from 3 to 6 grains are to be taken daily between the paroxysms,
 or, what is better, arsenic may be given  in moderate dose for its anti-
 periodic influence during the intermission.  In this manner the quinine
 acts  Avith full force when most  needed.
   Having considered the  prophylaxis of a  chill, let  us turn to the
 treatment of  the attack  itself.   It  must be  remembered that  the
 greater part of the harmful effect of the malarial poison is  exerted at
 this  time by the internal congestions and engorgement  of the abdom-
 inal  and thoracic organs.  The physician should, therefore, try to pre-
 vent, as far as possible, too great a rigor, and if stasis results from the
 chill, OA^ercome it, not by depletants, unless  the case  is very sthenic,
 but  by stimulants, such as digitalis, which will drive out  the blood
 from the congested area.
   If a full meal has just been eaten, the stomach should be emptied  by
 an emetic dose  of ipecac, 2 drachms of the powdered drug to an adult,
 or by 20 grains of sulphate of zinc.  It is about useless to give quinine
 at this time, as absorption from the stomach and subcutaneous tissues
 is almost entirely absent.  Alcoholic stimulants are not  to be employed,
 as clinical experience seems to  indicate that they act unfavorably.
   If the chill is severe enough  to endanger the patient's life, measures
must be used to control it.  Chloroform  may be inhaled and imme-
 diately preceded by laudanum by the bowel or mouth.  If  the lauda-
num is given by the mouth, a little ether or chloroform may be added
to the dose of the opiate.   The opium may be used hypodermically in 
IRITIS.
531
the form of morphine, in the dose of ^ of a grain combined with fa of
a grain of atropine.
   In the fevered  stage little can be done, except to give the patient
comfort  by cool drinks and  cool sponging, or if the  fever  becomes
excessive by the use  of antipyrine or the  ice-pack.  The latter has
seldom to be used, as the fever is generally too fugitive to need such
measures.
   The sweating stage needs no particular treatment, unless exhaustion
is caused by it, when stimulants may be cautiously used as needed, and
large draughts of water at ordinary temperatures swallowed.
   Many measures have been resorted  to to put off a malarial attack,
the chief of which is the use of ether or chloroform anaesthetization at
the time of the expected paroxysm, of nitrite of amyl or of the nitrite
of potassium or sodium in 10-grain dose for the same purpose. Where
the " chill habit" exists and depends  largely upon  nervousness it has
been broken by misplaciug the hands of the clock, and so getting the
patient past the time for his attacks without his knowledge.
   It should  be remembered that the use of quinine in malarial fevers
is  no  longer based on empiricism, but upon the fact that  the drug
exerts a peculiarly lethal influence over the cause of the disease, the Plas-
modium malane of Marchiafava and Celli, or, as it is sometimes called,
the malarial germ of  Laveran or the haematozoon of malaria.


                              IRITIS.

    Iritis, or inflammation of the iris, as usually encountered  is caused
 either by syphilis, rheumatism,  or gout.  It  may also  be traumatic;
 less frequent causes are gonorrhoea, diabetes, malaria, and tuberculosis,
 Metastatic iritis occurs in pyaemia, relapsing fever, etc.   The  most
 marked symptoms are severe brow pain; fine  ciliary injection; dis-
 coloration of the iris and immobility of the pupil, due to the forma-
 tion of adhesions  between  the iris and the capsule of the lens.  The
 most  important local  remedy is atropine, to be used every two hours
 according to circumstances.  If for any reason this is not tolerated,
 duboisine or  daturine may be  substituted.    Cocaine increases the
 mydriatic power of atropine.
    Pain may be relieved by leeches to the temple and the use of dry
 heat externally (cotton batting  heated over a register will suffice) or
 hot fomentations—water, chamomile infusion, or laurel-water (1 to 15).
    In  traumatic iritis iced compresses are suitable in the  early stages,
 but not in the later periods, aud not in any other form of iritis.  Great
 care must be taken not to mistake iritis for conjunctivitis, on the one
 hand, and glaucoma  for iritis, on the other;  delayed  use  of atropine
 and the employment of astringents on account of the former error, or
 the instillation of atropine because of the latter, would constitute seri-
 ous therapeutical  blunders.  In serous iritis,  or that variety in which
 there  is a hypersecretion of the aqueous humor, which becomes turbid,
 and a precipitate of dark spots occurs upon the membrane of Descemet, 
532
DISEASES.
 atropine  must  be cautiously instilled,  owing  to  the  tendency to  in-
 creased  tension.  If this occurs,  paracentesis of the cornea  may be
 needed,  and  pilocarpine should be given  internally, if the vitreous
 becomes opaque.
   In  true  syphilitic  iritis mercury must be  pushed to the point of
 tolerance, but it is not necessary to salivate the patient.  Any form of
 mercury usually employed in secondary syphilis may be used—calomel,
 blue mass, or protiodide of mercury—but the most efficacious method
 is by  inunction;  this is preferable even to hypodermic medication, in
 the  opinion of many authors.   After  the  mercurial impression has
 been made,  and  the  pupil is well  dilated,  potassium  iodide, either
 alone or in combination with  bichloride of mercury, is indicated.
   In  plastic  iritis, appearing six to eight months after the disappear-
 ance of the secondary symptoms,  this latter  treatment, AAdthout the
 previous  use of mercury, has  been recommended.  Carmichael's plan,
 consisting in the administration of drachm doses of turpentine, iu addi-
 tion to which the potassium iodide may be given, receives the endorsement
 of some surgeons, and is useful in serous iritis.
   Rheumatic iritis calls for salicylic acid, oil of gaultheria, and, later,
 potassium iodide; in  the chronic  types of  the affection Zollicoffer's
 mixture is an excellent remedy.  Potassium iodide should be admin-
 istered in gonorrhoeal  iritis, and relief  occasionally follows a pilocar-
 pine sweat.  In all  forms of iritis the treatment of the constitutional
 disorder which has occasioned the local iuflammation is necessary, aud
 if the iritis becomes purulent  surgical interference is usually  required.
 In any variety  of iritis the intense pain should  be alleviated  Avith
 morphine or other anodyne sufficiently active to secure sleep.   During
 the  course of the disease saline laxatives may be administered, and
 after the subsidence and cessation of the specific treatment, a  course of
 iron tonics is an excellent routine practice.


                          KERATITIS.

   Keratitis is the name applied to the various types of inflammation
 of the cornea.   If this inflammation is associated Avith a breach in the
 continuity of the  corneal surface it is  termed corneal ulcer,  and four
 characteristic  symptoms supply  the indications for local treatment:
 1, photophobia, or dread of light;  2,  blepharospasm, or spasmodic
 contraction  of the orbicularis muscle; 3, congestion of the bloodves-
 sels ;  4, pain ; while any existing dyscrasia or constitutional coudition
 upon which the  local disease may depend requires general medication.

                     Interstitial  Keratitis.

  Interstitial  keratitis is that form of chronic diffuse inflammation
of the cornea characterized by ciliary congestion and a  ground-glass
appearance of this membrane, most common between the ages of five
and  fifteen  years, and, in the vast majority of cases, the  result  of 
                            KERATITIS.                        533

 inherited syphilis.  No local measure is sufficient, anti-syphilitic treat-
 ment being of paramount importance.  During the height of the ciliary
 congestion Avarm antiseptic lotions and  atropine are indicated, the latter
 especially to prevent the tendency to iritis.   Severe pain may be alle-
 viated by the use of a leech to the temple, if the subject be of sufficient
 age to justify the employment of local bleeding.
   Various  other types of  keratitis are described as the result of con-
 stitutional disturbances,  such as gout (Hutchinson), malaria (Kipp,
 Van Milligen), or any condition of the system  associated  with great
 exhaustion, such as irregularities in the menstrual  functions, certain
 forms of pulmonary  disorders (true  herpes of the cornea, Horner).
 The local management of these cases  does not differ from  that which
 has been described.   The co-existing constitutional disturbances must
 be combated with suitable remedies.

                    Phlyctenular Keratitis.

   Phlyctenular  keratitis appears in  the form  of small,  blister-like
 bodies,  sometimes  single,  sometimes   multiple,  frequently  situated
 directly at the  corneo-scleral margin, whicli  become yellow,  break
 down, and leave an open  ulcer (phlyctenular ulcer), to which runs a
 leash of injected bloodvessels.  The  disease is common in children;
 often follows in the Avake of the exanthemata, and is so frequently
 associated with a strumous diathesis that it Avas formerly called strumous
 ophthalmia.   Congestion may be relieved by frequent irrigation Avith
 a  AA'arm boric acid solution.  Pain  and irritation call for the use of
 atropine drops (4 grains to  the ounce), which should be continued until
 the ulcer is covered with  regenerated  epithelium, Avhen the  process of
 cicatrization may be hastened by the insertion daily into the conjunc-
 tival  sac of a small  quantity of yellow oxide of mercury salve, or
 dusting  it Avith  finely powdered calomel, provided  the patient is  not
 taking, at the same time, any form of iodine.  During the whole treat-
 ment the eyes  should be  protected by dark glasses, and  the subject
 permitted to go out into the open air.   All local treatment will prove
 unsatisfactory unless associated Avith strict hygiene, carefully regulated
 diet, and constitutional measures—tonics and alteratives.
   If the photophobia becomes distressing in spite of the other treat-
 ment, it has been suggested  that this  may  be relieved by the use of
 cocaine, a practice that by no means commends itself in corneal ulcera-
 tion, in spite of the temporary relief from the local anaesthesia.  Relief
 of  this symptom in many instances follows the use of a douche of cold
 water on the closed eyelids.

                    Suppurating  Keratitis.

   Suppurating keratitis,  or that  form  of inflammation characterized
by  the formation of pus in the  cornea, may be either diffuse, as,  for
example, a  complication of purulent  ophthalmia, or circumscribed,
forming  an abscess of the cornea.   If the pus gathers in the bottom of 
534
DISEASES.
the anterior chamber the condition is  called hypopyon aud the dis-
ease hypopyon keratitis.   These conditions require prompt  treatmeut,
namely, frequent application of hot compresses, which may be advan-
tageously  composed  of  slightly  carbolized water, atropine  drops, or,
in the opinion of many, eserine (J to 2 grains to the ounce).  If the
abscess  forms, the pus  should be  evacuated  by a formal  operation,
either by dividing the anterior surface or by performing the operation
after the manner of Saemisch.
   In  addition to the types of disease which have been described we
have  the  examples of  sloughing or infective  ulcers,  Avhich are  seen
under a variety of conditions, aud  often  are directly traceable  to an
injury, being more common in elderly people.  The tendency of all
these  ulcers is to spread,  from whence  one  important variety  has
received the name serpiginous.   The  mild measures  are  antiseptic
lotions, either boric acid or bichloride of mercury, iodoform, hot com-
presses, and instillations of  either atropine or eserine.   Formerly
atropine was almost  exclusively used ; in recent years eserine has been
much employed.   It certainly has  the  power of limiting a sloughing
process in the cornea.   Threatened perforation may  be  aA^erted  by a
pressure bandage.  This is made  by placing upon  the eye a wad of
antiseptic cotton, over which, in figure-of-eight  turus, a flannel roller
is applied.  If, in spite  of  this, the process coutinues, the  following
measures  have met  with the  greatest success:  Touching the margin
of the ulcer Avith a stroug solution of nitrate of silver, 10 to 20 grains
to the ounce, care being taken that the ulcer alone receives the appli-
cation ; scraping the floor  of the ulcer with a small curette or spud ;
finally, and this is  the  best  method, the use  of the actual cautery.
Iu every case of sloughing ulcer the  lachrymal passages must be ex-
plored for obstruction.

               SequelaB of Corneal Ulceration.

   After healing of a corneal  ulcer the cicatrix consists of a more or
less dense Avhite spot in the cornea  (macula).  If these scars are thick
and white they are irremediable by local medication, and require sur-
gical  interference for optical relief.   If, however,  they are  diffuse,
much good  will follow systematic massage of  the cornea, aided by the
introduction of a small particle of yelloAv oxide  of mercury salve.
The massage  is  performed as follows :  A piece of the salve the size
of a split pea is introduced  beneath  the upper lid ;  upon the closed
lid a finger  is placed, and regular motions made through the lid  over
the surface of the cornea, namely, vertical, lateral, and radial motions,
the seance being completed by circular movements.   The whole should
last from one to three minutes.   Alleman claims excellent results in
dissipating corneal opacities by the use of electricity, by connecting a
suitably prepared electrode with a battery, the cathode being placed
directly on the previously anaesthetized cornea and the  auode on the
cheek. 
LARYNGITIS,  ACUTE.
535
                  LACHRYMAL  ABSCESS.

  Lachrymal  abscess results from  suppuration  in a  chronically dis-
tended lachrymal sac, owing to the presence of obstruction in the nasal
duct, and exists  as  a SAvelling  under  the  skin at the inner canthus,
pressure upon the surface causing au escape of pus through  the canal-
iculi.   The treatment is practically confined to surgical interference
—that  is, division  of the canaliculi and  washing out the distended
sac Avith antiseptic fluids,  and restoring  the.patulency of the nasal
duct by the use of probes as soon as the inflammatory symptoms  have
subsided, or if the skin  over the seat of  the abscess  is thinned and
rupture is threatened, by free puncture  downward and outward.   In
purulent discharge from the lachrymo-nasal duct,  solutions of blue
pyoktanin  (1 to  1000) injected through  the passage, favorably modify
the unhealthy secretions.   Much comfort Avill ensue from the use of hot
compresses over the inflamed area.   These may be  made in the  ordi-
nary Avay,  or are still more efficacious if composed of a lead  lotion, the
ordinary lead-Avater and  laudanum answering the purpose very Avell.


                    LARYNGITIS, ACUTE.

  Acute laryngitis is an inflammation involving the mucous mem-
brane  of  the larynx, to which  it is  usually confined, although it
sometimes  assumes a phlegmonous form, in which the  deeper struc-
tures  of the larynx are  involved.  It  may in form be idiopathic or
traumatic.
  The  idiopathic form results from exposure to cold, from extension
of inflammation from above or below, is a local expression of a con-
stitutional  disease, as in scarlet fever,  diphtheria, or syphilis, or is  an
acute exacerbation of chronic laryngitis.
  If traumatic, it may be the result of the presence of foreign bodies,
as fish-bones, pins,  or may be due to operations upon  the larynx.
  The symptoms of acute laryngitis are hoarseness of voice, pain in
the throat, tickling cough, and difficult  or painful deglutition.  The
cough is often annoying aud out of proportion to the amount of ex-
pectoration.  It may be brazen or barking in character, but  should
there be much  swelling is  more  likely to be  smothered.  These
symptoms  may be aggravated by dyspnoea.
  The attack may be ushered in by a chill, followed  by fever, head-
ache,  pain  in the back and limbs.
  Acute laryngitis  may be strictly local, though, as a rule, the inflam-
mation  does not  limit  itself  to the  larynx, but extends into the
pharynx, even reaching the tonsils.
  When the  epiglottis becomes  inflamed the pain is exquisite and is
felt both in swallowing and  in  using  the voice.   Extension to  the
trachea gives  sub-sternal  pain,  while pressure on the breast-bone
excites coughing. 
536
DISEASES.
   Unless aborted, an attack lasts about a Aveek or ten days, and may
continue three weeks or more.
   A laryngoscopic examination gives us the only means of making
a  perfectly accurate diagnosis.  The mucous  membrane varies from
bright red to purple, the  shade depending on the  severity of the
inflammation present.
   If the inflammation is diffuse, all the parts  are  of the same color,
the ventricular bands and  arytenoids usually being the first to swell.
The ventricular bands may overlap the cords.
   The  inflammation  may be circumscribed.   The writer  has seen
instances  in which the vocal  cords  alone escaped and remained per-
fectly white.   Sometimes only one side is affected,  one cord alone
being involved.  Pyriform sAvelling of the same arytenoid  generally
occurs and strongly suggests incipient phthisis.   The trachea when
inflamed may be seen below the glottis, having a diffused red color,
the rings being hidden by the swelling.
   With some, every attack of coryza ends in  laryngitis; or, as it  is
popularly expressed, the cold " goes down."
   Prompt measures Avill often abort an attack.
   During an acute attack the  patient must be  kept quiet, talking as
little as  possible, remembering that whispering  is  more  injurious
than vocalization.  The diet  should be  bland and unirritating, but
nutritious.
   At the outset, a  hot mustard  foot-bath  and   demulcent  drinks
should be administered,  and  small, repeated doses of calomel given
and followed by a saline purge.  Fever is to be combated by aconite
combined Avith a diaphoretic.   An opiate—as a  Dover's powder—
may be required to relieve pain and give rest.   Inhalations  of steam
charged Avith benzoin, camphor, or cubebs may be used.
   Locally, the  best  results   follow the  employment of alkaline or
astringent sprays, followed by the insufflation  of anodyne and astrin-
gent powders into the larynx.
   Gargles are  of  very little  use  in laryngitis, better results being
obtained from  the  use  of lozenges slowly dissohred  in the mouth.
Excessive cough may be  relieved by nervous  sedatives, such as bro-
mide of sodium or potassium combined with small  doses of potassium
cyanide.   Opiates disorder the digestion, and should only  be used
when specially  indicated.  A very useful treatment is full doses of the
bromides  combined with rubbing the  neck and chest with amber oil
and sweet oil, half and half.
   During convalescence, tonics, fresh air, aud  change  of climate are
indicated.  Attention to the state of the skin  and the  use of woollen
underwear are advisable.

                     Subacute Laryngitis.

   This  form of laryngitis often occurs  in debilitated subjects whose
systems are not vigorous enough to carry on an acute inflammation,
or have not sufficient recuperative power to throw off an attack rapidly. 
LARYNGITIS,  SUBACUTE.
537
 It  may also  follow  an acute attack when,  from any cause, conva-
 lescence is retarded.
   Subacute laryngitis produces very little constitutional disturbance,
 and its symptoms are, for the most part, the symptoms of acute laryn-
 gitis, excepting that  they are all of a  milder type.  Pain, soreness,
 and a burning sensation are referred to the region of the larynx.   The
 voice is husky, and efforts at conversation excite  paroxysms of cough-
 ing.  The expectoration, at  first  only glairy mucus, becomes yellow
 and more abundant  as  the disease progresses.  Laryngoscopic exam-
 ination shoAvs that the mucous membranes are redder than normal, but
 not of the liA'id shade seen in the acute  form.  Mouth-breathing, due
 to  occlusion of one  or  both nostrils, should be looked upon, Avhen
 present, as a predisposing cause.
   The  treatment  adopted in the acute  form is  usually sufficient to
 produce a cure.  The inhalation of steam charged Avith  an ethereal oil
 or gum resin relieves the engorged vessels and stimulates the mucous
 membrane to healthier action.   Compound tincture of benzoin,  30 or
 40 drops in a  cupful  of hot Avater, has  done the writer good service.
 An  extemporaneous  inhaler is made by covering a cup with an in-
 verted funnel.   The benzoin will  be volatilized  by the  heat,  and the
 medicated steam is readily inhaled from the small end of the funnel.
 The vapor should be  drawn in through the mouth  gently and firmly,
 the  breath  being  held a second and  then exhaled through the nose,
 and the inhalation continued until the water  cools, this  process  being
 repeated at intervals  during  the day.  If the secretion  is thick and
 tenacious, better results will follow the addition of a few drops of tere-
 bene or oil of eucalyptus to the benzoin.
   As this hot inhalation  often induces  perspiration, it may be well
 to caution the patient against exposure in the open air  immediately
 after using it.  This form  of inhaler  has  the  advantage of  being
 simple  and cheap, as  well as  effective, and  may be constructed at a
 moment's notice in any kitchen.  An inhaler devised by Seiler  meets
 the requirements, and, being made of tin, is not injured  by hot water.
 It consists of  a tin cup having a lid shaped  like  an inA7erted funnel,
 the end of the funnel terminating in a  rubber  mouth-piece.   A tin
 tube runs through the lid and reaches beloAv the  surface of the liquid
 in the cup.  Suction upon the mouth-piece causes the air to be drawn
 down through  the tube  and  bubble up through  the liquid.   By this
 means the vapor is more strongly  charged Avith the preparation used.
   In addition  to benzoin Ave may use camphor,  aud fluid extract of
 cubebs  or tar, as  inhalations Avhich are stimulating  or sedative  to
 the mucous membranes in different degrees.  Astringent sprays  of
 sulphate  of zinc,  ferric alum, tannic  acid, or  a weak solution  of
 bichloride of mercury are useful in the hands of  a physician.
  Even better results are obtained by the insufflation  of astringent
powders into  the larynx, all  adherent secretions having first been
removed by an alkaline or antiseptic spray.
  This  method is more  accurate  than that of astringent sprays, but
the insufflation of powders into the  larynx with any degree  of con- 
538
DISEASES.
fidence presupposes considerable proficiency in the use of the laryngo-
scope, a description of the  methods of Avhich would  carry us beyond
the limits of a work of this nature.
   Among  remedies suitable for insufflation are:  Sulphate  of zinc,
mixed with an equal part of sugar of milk or other inert  substance.
(The powder must be so fine that no grit is felt Avhen rubbed  between
the fingers.)  Tannic  acid  reduced  to  one-fourth  or one-fifth,  com-
bined with iodoform, is useful on abraded or ulcerated surfaces.  To
this mixture  subnitrate or subcarbonate of bismuth may be  added
when indicated, and morphine  also,  for the relief of pain.  Acetate
of lead in proportion of 10  to  20  grains  to J ounce, combined with
a  little acetate  of morphine, gives  us  what  may be called a solid
" lead-Avater and laudanum."
   Nasal catarrh, if present, must be  treated, otherwise the laryngitis
will probably not be permanently cured.
   To prevent a return of  the de\Telopment of chronic laryngitis, the
treatment should consist of tonics, such as  iron, quinine, strychnine,
and cod-liver oil,  together with a generous diet and exercise in the
fresh air.   Owing to the intimate  relationship between the skin aud
the mucous  membranes of the  nose  and throat,  the use of woollen
underwear is important.   Friction to the  skin and Turkish  baths,
especially when  a  gouty or rheumatic ailment exists, may  give good
results.
   Should  any  permanent  laryngeal thickening remain,  potassium
iodide, with  or  without arsenic, continued for a long time  in very
small doses, or one of the lithia waters, may be of service.

                      Chronic Laryngitis.

   This form of laryngitis, like the subacute, is divided into  the simple
catarrhal  or idiopathic, and the traumatic.   The catarrhal  form also
includes those  varieties in which  a constitutional  vice  occurs,  as
phthisical, gouty, or syphilitic laryngitis.
   Chronic laryngitis may develop insidiously, or it may be the  direct
result of an acute  or subacute attack.
   In a state of ordinary health, an attack of acute laryngitis runs a
course of from one to two  Aveeks, terminating in recovery.
   When  from any cause the vitality is  reduced,  convalescence may
be retarded, and we have  what is  known as  subacute  laryngitis, a
loAver grade of inflammation than the acute form, but still  tending to
recover under favorable conditions.   A renewal of the attack at this
stage may carry the patient beyond the line where Nature unaided  is
able to assert herself, and chronic laryngitis results.
   A lowered state of health is a predisposing cause, particularly when
there is a lowered  nervous  tone.
   Overwork, business reverses, or severe mental strain; a sedentary
life, continued exposure to impure air, sewer gas,  fumes from  chem-
icals, or the dust and fibres  floating  in the  air of cotton and Avoollen
mills—all act as predisposing or exciting causes of chronic laryngitis. 
LARNYGITIS,  CHRONIC.
539
Loss of sleep, over-indulgence, and excesses tend to produce the same
result.  In regard to the  use  of tobacco, cigarette smoking is more
injurious than either the  pipe  or cigar, for the reason that the cigar-
ette smoke is inhaled, and the irritating products resulting from the
destructive distillation of  the Avoody fibre are drawn  directly into the
larynx.
   Chronic laryngitis is essentially a disease of civilized life.   One of
its most common sources  is found in mouth-breathing and its conse-
quences.
   The nose is so constructed that a large surface of mucous membrane,
warm and  moist, comes into contact Avith the inspired  air, imparting
to it its warmth and' moisture, while particles floating  in the air adhere
to the moist surface and are discharged with the flow  of mucus which
they excite.
   In mouth-breathing no such preparation of the air occurs, and the
delicate  mucous membrane of the larynx,  being subjected  to this
constant source of irritation, is kept in a congested condition.
   The symptoms of ordinary  chronic laryngitis  are hoarseness, diy-
ness of the throat, tickling sensations, vague  feelings of discomfort, a
sense of constriction about the throat, and a dry, hacking cough.  The
expectoration is usually scanty and raised with difficulty.   A  profuse
discharge from the vault  of the pharynx, removed by hawking, indi-
cates  more or less naso-pharyugeal catarrh.
   The mucous membrane in simple cases, as seen by the laryngoscope,
is redder than normal.  The ventricular bands may be thickened until
they nearly overlap the cords.   The vocal cords vary in color from a
muddy tinge to a deep livid red.  The inflammation sometimes occurs
in livid spots.
   Injection of  the  vocal cords may be marked, showing twigs of
dilated bloodvessels running longitudinally.
   As the result of irritation occasionally a minute white fibrous SAvell-
ing develops on the  free edge of a vocal cord, or two may form directly
opposite each other, interfering with the proper approximation of the
cords.  They are usually mere points, and the writer has only seen
them occur in the throats of singers.   They gradually become smaller
under astringent applications and  attention to hygiene.
   Finally, fissures or abrasions may occur  in the larynx in chronic
laryngitis, the common location being the inter-arytenoid space.  A
small laryngeal fissure is  not always easily recognized.
   The mucous  membrane at that point is usually darker than the
surrounding  tissue, and  may be bathed  in a muco-purulent secretion.
In the morning, after considerable coughing, a  small  pellet, resem-
bling boiled sago, which has formed during the night, may be coughed
from this spot.
   When a fissure of this  nature granulates it may give rise to many
of the symptoms of laryngeal phthisis, a diagnosis which the laryngo-
scope can alone clear up.
   The physician must strike at the root of the trouble by finding the
cause and removing it.  If due to a faulty use of the voice, either in 
540
DISEASES.
speaking or singing, proper training in its management and care will
be productive of decided benefit.
  As far as possible, all  sources of  irritation should  be removed.
Relieve nasal obstruction, enlarged tonsils, or anything that prevents
the free circulation of air through the  nose;  for Ave cannot look for a
cure while mouth-breathing continues.
  Complete rest of the  voice, with  attention to the general  health,
will greatly relieve the throat in most instances;  but, unfortunately,
the trouble  usually returns  on resuming the use of the voice.  In
fact, it is not always advisable for one who must use his" voice again
to prolong  the rest  indefinitely,  for a throat  accustomed  to heavy
demands is  liable to stiffen under prolonged disuse, the voice  never
quite regaining its old poAver and flexibility.
  After the laryngitis has made  decided  improvement, the judicious
use of the voice has  seemed to the writer, in some instances,  to have
favored resolution, and to have kept the muscles from degenerating.
  Very  much depends  on local treatment  in  the  cure of  chronic
laryngitis, and  some of the  directions given  for  treating subacute
laryngitis apply here equally well.
  After  cleansing the mucous membrane  of the larynx from secre-
tions, the use of astringent sprays gives excellent results.
  The insufflation into the larynx of astringent poAvders, as sulphate
of zinc reduced one-half; or tannic acid one-fourth or one-sixth, com-
bined with boric acid, subnitrate of bismuth and sulphate of morphine,
is useful in  painful conditions.
  An excellent  powder for protecting  and covering raw or ulcerated
surfaces is a modification of the formula known as " Ferrier's  snuff: "

         R ■—Morphinae sulph......   .    .  gr. v.
             Bismuthi subnit.  .......  oijss.
             Pulv. acaciae........gr. xxv.

   To this may be added iodoform, AAdien this drug is indicated by the
presence of ulcerations  or abrasions.   Indolent or granulating  inter-
arytenoid fissures  should be touched with a strong solution  of nitrate
of silver applied by a brush attached  to a  bent  probe, or a little of
the  pure  salt or the " mitigated" stick fused on the end of  a  silver
applicator.
   This is by no means an easy operation to perform, as it is important
to avoid touching any other part of the larynx, which would  increase
the spasm whicli is liable to occur.
   Stimulating vapor inhalations, such as compound tincture of benzoin,
tar, or cubebs, used as Avas described under the heading of Subacute
Laryngitis,  gi\re decided  relief.  Pleasant occupation in the open air or
travel in a dry, bracing climate is useful.  As a rule, the air at the
seashore is too moist for chronic  laryngeal troubles.
   Sufferers from chronic laryngitis should always wear Avoollen under-
wear,  and  keep the skin  and the secretions generally  in  a  healthy
condition. 
LEUCORRHCEA.
541
                         LEUCORRHCEA.

   This is a condition—vulgarly knoAvn as the " Avhites "—consisting in
 a hypersecretion from those glands Avhich pour out their contents into
 the vagina or the cervical canal of the uterus, or even into the cavity
 of this organ.
   It is a state dependent upon many causes for its existence, the chief
 of which is a condition of the system Avhen it is " run doAvn " from any
 cause, Avith  perverted fuuctions  of the glands or their surroundings.
 In some persons, Avho seem perfectly strong and well, it would appear
 to be due to an effort of the system to overcome plethora.  The char-
 acter of the discharge Araries with almost every case.  In some instances
 it is thick and tenacious, in others so liquid  as to trickle down the
 limbs in a stream and greatly soil the clothing.   In most of the latter
 cases catarrh of the Fallopian tubes or ovarian  irritation and  tender-
 ness will be present.   Where the secretion is very thick and tenacious
 it generally arises from the cervical canal, while that from disorder  of
 the  vaginal Avail alone, independent of other  morbid conditions, may
 be either thick or thin.
   The treatment of these forms of leucorrhoea  may be  divided into
 two parts : one, that directed to the remedying of the morbid process
 through the use of drugs by the mouth, the other by their employment
 locally.
   It is needless to state that in that form dependent  upon excessive
 lactation, or other exhausting manner of  life, tonics of an active char-
 acter are needed.   As a general rule, anaemia will be present, and the
 following pill will be found of service:
          Be.—Acid, arseniosi......gr- 4.
              Ferri redacti.......gr- v.
              Quininae sulph.......9j.     M.
    Ft. in pil. no. xx.  S.—One pill three times a day, after meals, for an adult.

 Or,
          R.—Tr. ferri chloridi......fgj.
              Tr. cinchonas comp......f.?ij-
              Tr. gentian, comp.....q. s. ad fgiv.  M.
    S.—Dessertspoonful three times a day, after meals.l
   Sometimes small  doses  of the sulphate of  iron are better for this
 purpose, owing to its astringent properties, and when any preparations
 of iron  are  used care must be taken that the bowels are kept active
 and that the stomach  is not disordered.  Associated with the use  of
 these internal remedies  should be a moderate amount of  exercise and
 the avoidance of late hours and rich  foods.
   The local applications which are of value  in these states consist  in

  1 In both these prescriptions the small amount of iron and arsenic given will prob-
ably be noted, but this is done advisedly, as iron aud arsenic do as much good to the
blood in small as in large amounts, under most circumstances. (See Iron.) 
542
DISEASES.
couuter-irritation and vaginal injections or painting the mucous mem-
brane of the parts from which the discharge comes with proper fluids.
In the  leucorrhoea dependent  upon  irritation  of the  ovaries  Avith
catarrh of the Fallopian tubes, the use of small blisters formed by the
employment of cantharidal collodion or a cantharidal  plaster over the
groin on either side is often accompanied by good results.  At the same
time  the vaginal surfaces surrounding the cervix uteri may be painted
with  a mixture of iodine, carbolic acid, and chloral, such as is used by
Dr. Goodell, as follows :
          R.—lodi resublimat.   .   .    .   .   .    .  3 iv.
             Acid, carbol. crystal. \                    s.
             Chloralis           / •    '   •    •  aa  3J-
    Eub the iodine and chloral in a glass mortar into a powder and add the carbolic
acid.  S.—Formula.  To be used by the physician only.

   The following pill may also be employed:
          R.—Hydrarg. chlor. corros......gr. J.
    Ft in pil. no. xx.  S.—One pill three times  a day, after meals; or a tablet
triturate may be used instead of a pill.

   The remaining  treatment of watery leucorrhoea consists in  the use
of astringent injections.   A very cheap astringent injection is made
by adding 1  ounce of powdered white oak bark to each  pint of water,
or tannic acid  and glycerin in the proportion of  1 ounce to 2 quarts
of warm water.  Ringer recommends the following :
          R.—Sodii bicarbonatis......gj.
             Tincturae belladonna?.....f ^ ij.
             Aquae........Oj.   M.
    S.—Use as a vaginal wash.

   Where the discharge is foetid a solution of permanganate of potas-
sium  should be used as an injection in the strength of \ drachm to  1
pint of water.   In purulent vaginitis, specific or otherwise, the  follow-
ing injection is  serviceable:

          R.—Creolin.......fSssvelf^ij.
             Ext. hydrast. canaden. fl.....f ziiss.
             A(luse........' f Jviij!  M.
    S-—Add two tablespoonfuls to a pint of hot water and use as an injection.

   Sometimes a tampon thoroughly saturated with a powder of iodo-
form  and tannic acid, equal parts, and packed around  a discharging
uterine cervix,  is of service.
   When using  vaginal injections in females it is important to remem-
ber that they should  be in large quantities.   Nothing is more antago-
nistic to  true asepsis  than  the  usual  manner in which these applica-
tions  are made.   Generally a pint of the solution  is placed in a basin
over  which the  woman squats and by means of a syringe forces  the
liquid into the vagina as fast as  it runs out, thereby filling the syringe
joints with the dissolved secretions and returning to the vagina as soon
as they flow away the impurities which have left it.  The only proper
way to give  such an injection is to  have the solution in one  basin, to 
                        MANIA,  ACUTE.                    543

the extent of 1 gallon, Avhile the patient squats over a second basin
into which the impure liquid may run.
   A very useful astringent injection may be made by ordering :
         R.—Zinc, sulphat.......f ^j.
             Alumin. sulph.......f ^j.
             Glycerini.......fgvj.    M.
    S.—A tablespoonful to each quart of water.


                       LID ABSCESSES.

   Lid abscesses are seen more  frequently in children than adults, as
the result of injury, the sequel of acute illness (epidemic influenza, pul
monary catarrhs, fever, etc.), or from local infection ; under the latter
circumstance they  may assume a gangrenous type.   The treatment is,
that for any form of abscess—poultices, preferably in the form of hot
compresses, early incisions, autiseptic solutions, and  tonics.


                          LUMBAGO.

   This is a form of myalgia or muscular rheumatism of the muscles
of the loins and small of the  back, and is frequently  the  result of
lifting heavy weights,  or it results from other strains.  In many cases
acupuncture is very useful, particularly if the trouble is  bilateral.
Sometimes after the employment of  this  measure the  patient  can
straighten  the back at once and retain that position.   In  other  in-
stances antipyrine or acetanilide, in 10 to 20-grain doses  of the former
and 4 to 8-grain doses of the latter, are of service, and iodide of potas-
sium  and salicylic acid are not to be forgotten if the condition of the
patient does not rapidly improve.   Phenacetine and  salol are also
useful combined or alone.  A large hot poultice applied to the back is
often  efficacious in obstinate  cases.  Sometimes a hot foot-bath and a
Dover's powder on going to bed will produce a cure, and ironing the
back  with  an ordinary hot laundry iron at a proper heat, a piece of
newspaper or cloth being placed over the skin under the iron, is very
efficient.  Counter-irritation in the  shape of  a blister,  a mustard
plaster or capsicum draft, Avill often give relief.
   Where these measures fail the reverse treatment may be tried, such
as an ice-bag  placed over  the  loins, or an ether  spray turned  on the
part until the skin is greatly blanched.


                     MALARIAL FEVER.

           (See Intermittent and Remittent Fevers.)


                        MANIA, ACUTE.

   Space  is  wanting to consider the thorough and complete treatment
of mania as it comes to the neurologist.   All that can be done here is 
544
DISEASES.
to  denote  temporary measures suitable for cases which are brief in
their course.
   In those cases which occur after confinement and are not supposed
to be based upon permanent trouble, cimicifuga racemosa is said to be
very useful in the dose of 20 to  30 drops of the fluid extract three
times a  day, while for the rapid quieting of the patient we may use
hyoscine hydrobromate in the dose  of fa$  grain.  In  other instances,
if the kidneys and heart are  healthy, full doses of chloral may be
used, and  if au active  preparation  of cannabis indica can be had, at
least 1 grain of the solid extract, or 1 drachm of the tincture, should
be employed.   Cannabis indica will be found particularly serviceable
if 60 grains of one of the bromides can be  combined Avith it.
   Where a patient suffering from mania is so violent that nothing
can be done with him, he should be held,  and an emetic  dose of y1^
grain of apomorphine be given hypodermically, to produce  vomiting
and so relax the muscular system, or he may be tied or anaesthetized
sufficiently  to  enable  the  physician to  administer  proper remedies.
Sometimes full doses of morphine  are needful, and  in others a cold
douche to the head, Avhile the body is in hot Avater, is of service.


                       MELANCHOLIA.

   This is not the place for a discussion of  melancholia of so  severe a
form as to amount to insanity, since the treatment of this  latter state
is very various and largely depends upon the skill of trained physi-
cians who are alienists.
   There is one form of melancholia, however, Avhich may  often be
rapidly relieved by a simple  measure.   It  is that dependent  upon the
condition of the  system in which oxaluria is present.   Whenever an
individual complains of melancholia the urine should be examined,
and if  any oxalate crystals are found, deeply orange-colored,  not
diluted, fresh nitro-muriatic  acid should be given in the dose of 5
drops after each  meal  in  a half-tumblerful or more of  water.  In
order to guard against errors in diagnosis  it is well to remember that
pears, tomatoes, and cabbage, all cause oxalates to appear in the urine
for a short period after their ingestion.
                    MENINGITIS,  ACUTE.

   Meningitis  is to be treated as is  any other form of acute inflamma-
tion occurring in  a sthenic  or dynamic individual, and particularly
does its  treatment  correspond to that  of the other inflammations of
large serous membranes, such as peritonitis or pleurisy.
   In the early stages the patient should receive sufficiently large doses
of aconite  or  veratrum  viride to  strongly impress  the  circulatory
system.  These drugs have the power of producing such dilatation of
the blood-paths throughout  the body  that the congested  or  inflamed 
MENINGITIS,  ACUTE.
545
area is  relieved of its excess of blood, because the pressure being less
elsewhere the blood obeys  the  law that liquids always try to escape
from pressure, and so leaves the meninges of the brain for the vessels
of the limbs and trunk.   A good-sized blister should ahvays be placed
at the nape of the neck as a counter-irritant to prevent effusiou.
   The proper dose of veratrum  viride in the form of the tincture is
3  drops every hour until the  skin becomes  moist or nausea is devel-
oped.1   The  tincture of aconite is also useful in full dose.  If great
arterial excitement is present venesection may be practised (see Bleed-
ing), but A'eratrum viride or aconite are better remedies if they are at
hand.   Associated with these  two drugs Ave should employ  mercury
aud opium, the first for  its antiphlogistic influence, the second for its
power  in allaying irritation.  One-fourth grain of powdered  opium
and A;  grain  of calomel  may be given every hour until the full effect
of the opium  or  mercury  is manifested.  In some instances the de-
odorized tincture of opium  (Tinctura opii deodorata) is better than the
crude drug, in  the dose  of 2  to   5  drops every  one or two hours.
Sometimes belladonna  is of great ser\Tice, and this is particularly the
case Avhere the drugs already named are contra-indicated because of a
condition of Aveakness  or asthenia.  In  both conditions ergot is of
value in allaying the congestion, but  its period for exerting a favor-
able effect is  not at the very first part of the  attack, but a little later
Avhen the stage of exudation is at hand.   During the first acute stage
an  ice-bag should be applied to  the head, both for its local influence
and antipyretic effect, aud leeches may be put at the nape of  the neck
with advantage.   As the disease  advances and the nervous disorders
of  the  affection  become  marked, nervous sedatives  are required to
allay the twitchings, muscular spasms, or convulsions, and  for this
purpose no drugs  are to compared to chloral and the bromides.
   The  doses  to be used vary Avith the violence of the symptoms,  but
it may be stated  that the chloral should rarely, if  ever, be used in
doses above  10 grains, and  the bromides given in the dose of from
5 to 40 grains  If coma conies on, a  large blister should be applied
to the nape of the neck.
   Quinine has been recommended in meningitis, but it  is absolutely
contra-indicated, as it predisposes  to this condition.   It  may be em-
ployed only in convalescence and  then  used most carefully.
   The treatment of the second stage of meningitis must be necessarily
supportive owing to the reaction  consequent upon great nervous and
arterial excitement.  Under these circumstances the use of  opium is
still indicated,  because it  allays  nervous unrest and  supports  the
system, partly by  conserving the  tissues and  partly by  inhibiting the
waste of nervous force  apt to occur at this time.  Alcohol should be
given Avith the food if Aveakness  is present, and a very simple milk
diet insisted upon.

  1  It is to be remembered that veratrum viride often causes nausea and even vomit-
ing in susceptible persons, and  in consequence  it should be  carefully given in
meningitis, lest if vomiting come  on the disease be made worse.
                                 35 
546
DISEASES.
                          MIGRAINE.

                        (See Neuralgia.)


                   MUSCLE VOLITANTES.

   Muscae volitantes is the name applied to the dark  specks Avhich
patients frequently see floating across their fields of vision, especially if
the eyes  are  directed toAvard a bright sky or a Avhite page.   Usually
they indicate no disease of the vitreous humor and the ophthalmoscope
fails to detect abnormal changes.  They are attributed to torpidity of
the liver by the laity.   Muscae volitantes may indicate eye-strain, and
if the refraction is abnormal  this should be corrected;  a mild course
of alteratives is often a useful adjuvant.
                           MYALGIA.

  Soreness of the muscles either on pressure or on movement may be
dependent upon a number of causes, such as strains, bruises, rheumatic
taint, or inflammation due  to cold.   Here, as  in  many other  states,
the treatment  is to be divided  into  the  external and the  internal
methods.   Of  the internal remedies the best are the salicylates or the
iodide of potassium, if rheumatism be at the base of the trouble.  On
the other hand, if a bruise or cold be the cause,  the chloride of ammo-
nium Avill  be of service in 10 or.  20-grain doses given  in a  solution
with  extract  of liquorice (for  prescription see Bronchitis).  Other
remedies Avhich may be tried Avith a good chance  of success are full
doses of a good fluid extract of cimicifuga (20  drops to 1 drachm) or
the citrate or acetate of potassium in 20-grain doses.
   The local medications are numerous, but only a few can be consid-
ered as worthy of routine employment.  The chief one is iodine, in
the form  of the pure ointment, or diluted one-half with lard if the
skin is easily irritated.  Another method is to employ a liniment, Avell
rubbed  in, made up as follows :

         R.—Tr. belladonna?......f 3J.
             Tr. aconiti .   .    .   .     .   .   .  fgij.
             Tr. opii.......f3ij.
             Liniment, saponis    .   .     .  q. s. ad  f^vj.    M.
    S.—Poison.  To be used externally and only as a liniment.

   Sometimes  chloroform  liniment is  singularly successful, and  poul-
tices applied as hot as can be borne and  covered by oil-silk and cotton
to retain the heat, are often of great value.   Massage or good rubbing
is also a sine qua non for successful treatment iu this state. 
NASAL  CATARRH, ATROPHIC.
547
              NASAL CATARRH, ATROPHIC.

                   (Synonym: Atrophic Rhinitis.)

   The atrophic or last stage of nasal catarrh, commonly knoAvn as dry
catarrh, is a natural sequence of the  stage of hypertrophy; although
in exceptional instances the atrophic  type has appeared at once.  In-
creased vascularity and  over-stimulation of the hypertrophic stage lead
to increased fuuctioual activity, and finally to exhaustion and atrophy
of the tissues  involved.
   In atrophic nasal catarrh the nostrils are roomy and  the mucous
membrane red aud shiny.  The formation of connective tissue has,
to a great degree, obliterated the delicate  serous glands,  and the dis-
charge of mucus, no longer diluted,  forms inspissated crusts, which
adhere to the mucous membrane of the septum and turbinated bones.
   Areas of ulcerated or abraded membrane are disclosed upon removal
of these adherent crusts.
   The turbinated bones are  gradually absorbed and the secreting
surface thereby much reduced.  Sometimes the wasting is so great that
the posterior Avail of the pharynx is  clearly visible from the front.  The
inspissated secretion may make a cast of the nostril, and as fresh layers
form underneath, the oldest part is raised  until the Avhole interior of
the nostril  becomes a mass  of decomposition, giving  rise  to an  over-
powering stench.   This form of catarrh causes  loss of the sense  of
smell, and the odor is not recognized  by  the patient himself.  Ulcera-
tion or caries of the bony structure produces an odor even Avorse than
the so-called ozena   The  pharynx  suffers from the general Avasting
and  presents  a  dry,  varnished appearance called pharyngitis  sicca,
which is  rather a symptom of nasal atrophy than a separate disease of
the pharynx.
   The indications are the removal of all accumulations in the nose and
nasopharynx  and the  healing of abraded or ulcerated surfaces.   The
early removal  of dead bone is imperative, and Avhat secreting surface
remains,  as far as possible, must be stimulated to  compensate, in a
measure, for the glands that are hopelessly destroyed.   In other Avords,
our efforts are directed  toAArard producing a compensatory hypertrophy
of the glandular tissue that  remains.  Therefore, with the use of anti-
sepsis we combine alteratives and local stimulation.
   The nose should be thoroughly cleansed Avith an alkaline wash—
Dobell's solution—Avarmed  to increase its solvent poAver.   To relieve
the odor  increase the amount of  carbolic  acid  or  substitute  for  it
eucalyptol and thymol in the Avash.   Listerine contains both of these
and may be added  to the wash.  Its own pungent odor masks some-
what the offensive odor.  Permanganate  of potassium may be used  in
weak solutions, but it is painful except Avhen sensation is entirely lost.
Peroxide of hydrogen is recommended, but the writer has had no ex-
perience in using it over such an extensive  surface.
  The solutions  are  best applied  by means of an atomizer or post- 
548
DISEASES.
nasal syringe in the  hands of the physician, or by snuffing from the
hand or cup.
  The odor,  if due to decomposition, is much decreased as soon as the
passages  are  clear.   The discharge must never be allowed to re-accu-
mulate, or much time will be lost.
  Ulcerations require local stimulation by a strong solution of nitrate
of silver or a superficial application of the flat surface of the galvano-
cautery heated to a dull redness.   Necrosed bone should be removed,
and it is  often found detached in the nostril.
  Local  stimulants should  be judiciously combined with  alteratives.
Powders of nitrate of silver in starch, varying in strength from 1 to
10 grains to  2J drachms of  the latter, may be bloAvn into  the nostrils
by  means of an insufflator.   Cover gently the Avhole surface  with a
thin layer, and use  it  only of sufficient strength to be slightly felt.
Nitrate* of silver in.  solution, 1  to  10  grains to 1 fluidounce, gives
better results at other  times when applied to the mucous membrane.
Avoid over-stimulating and  so  exhausting  the glands which it  is
Avished to strengthen.   The use of alteratives may  alternate  Avith the
silver  salt and  iodide of potassium,  and this may be done by using
solutions  of  iodine and glycerin,  as  recommended for hypertrophic
nasal catarrh.   Internally, the physician should employ iodide of
potassium to  increase  nasal secretion and mucous membrane stimulants
and tonics.   He should also pay attention to the activity of the skin.


               NASAL CATARRH,  CHRONIC.

   Chronic nasal catarrh is essentially a disease of civilization, which
may occur at any  period of life, but more  commonly develops from
youth to early adult life.
   Although  more  prevalent  among  the  upper  classes, it is  iu the
lower ranks that it  most  frequently reaches  its later stages and its
worst forms.  This does not result from lack  of opportunity for treat-
ment, but from the ignorance or indifference which this class shoAV to
diseases Avhile there is no suffering and no interference Avith business.
   Continued exposure to the action of irritants of various characters,
in  the form of dust or particles floating in the air, keeps the mucous
membranes in a state of constant irritation,    A low grade of inflam-
mation is established,   resulting   in  permanent thickening of  the
mucous  membrane, and of the  submucous connective tissue, Avith
dilatation  or actual  hypertrophy  of the  erectile tissue covering  the
turbinated bones.  The swollen  tissues  obstruct the  passage  of  air
through  the nostrils, and  mouth-breathing  results, Avith its train of
symptoms.
   The most common cause of catarrh is found in repeated attacks of
coryza, each attack increasing the thickening of the mucous mem-
branes and narrowing the breathing-space.
   Nasal  catarrh, in  its course, passes through three stages or periods, 
NASAL  CATARRH, CHRONIC.              549
namely,  the  stage  of coryza or acute nasal catarrh, and the chronic
stages knoAvn as hypertrophic and atrophic nasal catarrh.
  Coryza, or cold in the  head, is not strictly a stage of nasal catarrh,
but, as stated elseAvhere, is an acute inflammation of the nasal mucous
membranes,  generally running a definite course and  terminating in
recovery in a week or ten days.   Its chief clinical importance, how-
ever, is derived from its tendency, Avhen  the vitality is reduced or
recovery is retarded, to pass into a chronic stage Avhich, to all  intents,
is identical Avith the hypertrophic stage of nasal- catarrh.  The line of
demarcation  is not  clearly draAvn between these two diseases or stages,
nor can avc locate Avith absolute certainty the point where acute coryza
becomes hypertrophic nasal catarrh.
  Atrophic  nasal catarrh commonly develops from the hypertrophic
stage, although occasionally the disease takes this form  from the begin-
ning.  Its symptoms are essentially  different from the other stages,
being characterized by functional inactivity and derangement in place
of  the over-stimulation of the hypertrophic stage.
  Hypertrophic nasal catarrh commonly has its origin in a neglected
cold in the head, or in a series of colds occurring in rapid succession,
keeping  the nose in a congested state  until the erectile tissue covering
the turbinated bones loses in a measure its poAvcr of contracting, and,
decreasing the calibre of the nostrils, becomes a source of permanent
obstruction to breathing.
  As  the disease  increases there  is  increased susceptibility to cold.
Slight exposure produces a stuffy feeling in the nose.  The nostrils
may become completely occluded; usually,  however,  only  one  side
at  a time is obstructed  at  first—the obstruction showing a tendency
to  change sides.   This change  is most  noticeable in turning in  bed,
the loAver side usually stopping,  and ou changing the position the
obstruction is  reversed, the  clearing being  accompanied by a crack-
ling sensation.   A slight tickling cough  and  tendency to clear the
throat in the  mornings  may result from irritation of the pharynx or
larynx.
  The  nasal obstruction, generally greatest at  night,  causes restless,
troubled sleep, Avhile the mouth-breathing leaves the tongue dry and
coated in the  morning.  A dull, frontal headache, due to reflex  irri-
tation from intra-nasal pressure, is not  uncommon.   Unusual irrita-
bility  of the mucous membranes may  result in  frequent attacks of
sneezing  or  in a free Avatery secretion, Avhich is more active in  cold
weather, appearing as a drop of water, resembling a bead at  the  end
of  the nostril, which may drip from the nose on leaning fonvard.
   In patients of a  neurotic type, attacks resembling acute coryza occur
without a moment's Avarning, and subside as  quickly as  they come.
The nose at  such  times  becomes stopped  up to an oppressive degree,
with free secretion, with or without violent  sneezing.
  Such  attacks are precipitated  by  exposure  to  a close or  impure
atmosphere or to dampness,  especially at  dusk Avhen the dew is falling
or  Avhen the patient is fatigued.   The voice  becomes husky or altered 
550
DISEASES.
in character from loss of nasal resonance.   Catarrh of the  middle ear
is liable to occur.
   During the early stage of hypertrophic rhinitis, on inspection of the
anterior nasal passages, all the tissues appear red and highly vascular.
Along the surface and margin of the lower, aud perhaps  the middle,
turbinated bones the tissues are swollen and puffy,  and in severe cases
these puffy bags adapt themselves  to the  shape of the nostril, com-
pletely closing the passage-Avay.  This does not often completely close
both sides, except during an acute attack of coryza.   One or the other
side, as a rule, remains open,  Avith  a tendency  for  the  obstruction to
reverse sides.  The nervous impression produced by examination may
cause temporary contraction and clearing of both sides, which,  unfor-
tunately, are soon as bad as eATer.
   The swellings, as described elsewhere, consist of cavernous  blood-
A'essel tissue, Avhich has the property of filling Avith blood and erect-
ing, under stimulus.   These  swellings  on the turbinated bones are
knoAvn as hypertrophies,  although  at  this  stage  they contain little
hypertrophied tissue,  but  are, more strictly,  bags of erectile tissue
AAdiich  have lost the poAver of contracting.  They readily disappear
upon pressure by means  of  a probe,  but return at once Avhen the
pressure  is AvithdraAvn.  Applications of cocaine (4 per cent, solutiou)
produce some contraction, benumbing and blanching the tissues at the
same time.
   The poAA^er cocaine possesses, of contracting hypertrophied tissue, is
useful  for purposes  of diagnosis in hypertrophic nasal catarrh.   By
its  use Ave may readily distinguish  tumors, or  bony or cartilaginous
groAvths, from the erectile tissue.
   The long continuation  of a Ioav grade of inflammation favors the
formation of connective tissue and actual hypertrophy of the turbin-
ated tissues, which become  larger and firmer, and  do not completely
disappear uuder pressure  from a probe.   At the same time a progres-
sive increase in the nasal obstruction is observed.
   A rhinoscopic view posteriorly reveals a similar state of affairs, and
a hypertrophy developing on  the  middle or lower turbinated bone—
rarely  on the upper.  At this position the  hypertrophy appears  as a
round, globular  tumor, extending backward toAvard the vault of the
pharynx.  It is sometimes  sessile, but often has a slight constriction
at its attachment to the turbinated bone.  It is occasionally pale and
covered with mucus—indeed,  a collection of mucus may be mistaken
for a hypertrophy.   Cleansing the nose Avith  a solution  sprayed by
means  of an atomizer directed through  the  nose from the front, or by
a post-nasal syringe  from behind, clears the diagnosis.
   At other times a posterior hypertrophy becomes engorged with blood,
and presents a deep purple color, resembling, in size and shape, a red
raspberry.
   Enlarged pharyngeal tonsils produce decided obstruction posteriorly,
and, by  the  secretion  of large quantities of mucus, cause a constant
feeling of fulness, Avith a desire to " haAvk and spit."
   An enlarged pharyngeal tonsil is recognized  as a soft, spongy mass 
NASAL  CATARRH,  CHRONIC.
551
in the vault of the pharynx.   Occasionally it hangs down in festoons
which someAvhat resemble stalactites hanging  from the roof of a cave.
Should one of these  stalactites become  eroded it may cause frequent
and alarming haemorrhages.
   Hypertrophy of the pharyngeal tonsil is more common in children
than in adults, and  frequently  occurs  in  connection  with hypertro-
phied  faucial tonsils  or  in conjunction Avith  adenitis, or results from
diphtheria or scarlet  fever, or as part of a strumous diathesis.
   Hypertrophied tonsil  is a  fruitful  source  of deafness  in  children,
as it may become large enough to interfere Avith the passage of air
through the Eustachian tube, or cause extension  of catarrh  to  the
middle ear.
   When a child is too small to permit a rhinoscopic examination, the
preseuce of an enlarged pharyngeal tonsil may be felt by introducing
the  index-finger through the mouth up behind  the soft palate,  taking
care that the finger is protected from the child's sharp teeth.
   It is well to educate the finger to  recognize the  size and shape of
the naso-pharynx, although its introduction is a disagreeable  perform-
ance, for it  may aid materially in outlining the structure, consistency,
or point of attachment of tumors projecting  from the nose  into this
space,  or eveu  assist in engaging a large groAvth in the loop of wire
from a snare introduced through the nose.   The ear should be educated
to recognize the different effects produced on  the voice by obstructions
in the front or back  of the nose and so  assist the eye in diagnosis.
   Occlusion of  the nostrils, if Avell  in  front, gives  a nasal souud  to
the voice from the pent-up vibrations in the nose and naso-pharynx.
An  obstruction  at the back  of the  nose deadens the voice, interferes
with its carrying power, and  prevents the voice being heard at any
distance from the speaker.  The voice, to use a  technical  term, loses
its  timbre,  and  should  it be  used  to  any  extent chronic laryngitis
results.  The extra pressure injures the  larynx, and tires the throat,
Avithout increasing the carrying poAver.
   The pathological changes  occurring in hypertrophic nasal catarrh
do  not differ materially from similar changes occurring in catarrhal
inflammations elsewhere.   In treating catarrh, find the cause, and, if
possible, remoA'e  it.  Great assistance  in  this direction  may  folloAV
careful inquiry into the occupation and environment of the patient.
   The difference betAveen nasal catarrh and  simple catarrh occurring
in other places is chiefly the  result of  location.   The nasal mucous
membranes  are  surrounded by bony Avails Avhich limit the poAArer  of
SAvelling to one direction, namely, toward the centre.   This affects the
main function of the nose, that of respiration, and obstructed respira-
tion leads at once to  a train of symptoms, not  of catarrh, but  of the
results of catarrh.
  Swelling  of the  turbinated  tissue and nasal obstruction are early
symptoms  of hypertrophic nasal catarrh.  The change in functional
activity which is caused by obstruction to respiration, and the nervous
irritation resulting from pressure, sooner or  later produce permanent
injury, either local or reflex. 
552
DISEASES.
   The first indications for treatment are the reduction of inflammation
and restoration of the breathing 'space.
   As the chief function of the nose is respiratory, the reestablishment
of free nasal respiration, combined with the liberal use of antiseptic
Avashes, will lessen  the  inflammation  and  irritation and produce  a
healthier state of the secretions.
   The  Avriter  places cleanliness  at the head of the list of remedial
measures.   The alkaline Avash recommended on page  547,  sprayed
into the nose by a hand  atomizer, or gently snuffed from the palm of
the hand or from a  small cup, gives good results.  The hand Avarms
the solution slightly, but when snuffed from a cup the solution should
be artificially warmed.   This Avash may be used two or more times  a
day.
   The nasal douche  should never be used Avhere there is nasal obstruc-
tion, on account of the risk of forcing the solution into the Eustachian
tube and causing catarrh of the middle ear.
   In addition to the antiseptic wash, Avhere the mucous membrane is
congested and  irritable, the  treatment  recommended  for coryza may
be instituted for a few days with  good results.   A  solution  composed
of equal parts of distilled extract  of hamamelis and Avater, or a dilute
solution of hydrastis, may be sprayed  into the nose during  the acute
stage.
   A little later a spray  of ferric alum, 5 grains  to  the ounce, may be
applied carefully, in an  atomizer, by the physician.
   It is not advisable to use alum  in any considerable strength  in the
nose, as its continued use is liable to impair the sense of smell.
   The alterative and absorbent action  of iodine makes  it a valuable
remedy  for local application in chronic nasal catarrh.   Combine it
with  glycerin in the strength  of 6 or 8  grains to the ounce,  with
enough  potassium iodide to  make a solution.   Apply this by means
of a piece of absorbent  cotton on the end of au applicator,  along the
floor of the nose, until it reaches  the pharynx.   It is needless to say
that such an application as  this should be  made  with the utmost
gentleness.  The cotton should project beyond  the probe, and care
should be taken to avoid bruising the tissues.
   After the acute stage has subsided, as shoAvn by the disappearance
of the livid color and  lessened sensibility, any  remaining  hypertro-
phied tissue should be removed by a snare or the galvano-cautery.


                         NEURALGIA.

   Like headache, neuralgia gives rise to most of the suffering experi-
enced by active persons  avIio are not sick enough for bed and to those
who are confined to bed by other diseases.  It affects members of every
walk of life, and may be so severe as entirely to incapacitate the most
powerful of men.
   The causes  of  neuralgia  are  very  various, but they may be
briefly stated  to  depend  chiefly  upon  malnutrition, over-AVork, 
NEURALGIA.
553
ner\Tous excitement, with consequent reaction, aud to reflex irritation
from  diseased organs, as in the case of supra-orbital neuralgia from
eye-strain, or ovarian  irritation from uterine inflammation.   Nerves
functionally diseased are ahvays more or less active than normal; that
is, %pe?-excited or %po-excited, aboA'e or beloAV par.  In  both cases
they  must be  brought back to  their  normal  tone by appropriate
remedies,  and these consist  in nervous excitants and nervous seda-
tives.  To give a nerve  already depressed the additional  depression
of a bromide, or a nerve  excited the additional excitement of strych-
nine is absurd.
   From what has just been said  it becomes evident that the physician
must ahvays  determine the coudition of the system of his patient,
and the causes of that coudition, before administering remedies.
   The treatment of this disease, from its curative standpoint may be
divided into the use of touics, nutritives, and palliatives.
   Where neuralgia is associated with anaemia  no hope  of  permanent
relief can  be  looked for, unless  irou and arsenic are used until the
anaemia is cured, and it is often necessary to  combine  with  these
drugs the use of cod-liver  oil and bitter tonics.   These are the cases,
too, in which  nux vomica or strychnine raises  the depressed nerves to
increased  acti\Tity and  so bring relief. How they do this is not knoAvn,
but we knoAv enough to recognize one or two  important facts.   Strych-
nine is certainly a nervous stimulant, and is also a  stimulant to the
anterior columns of the spiual cord.  It probably also acts upon the
trophic centres in the anterior cornua  of  the  spinal  cord,  and by
stimulating these centres increases the nutrition of the tributary nerve
fibres.
   It is needless to state that the  neuralgias of syphilis and scrofulosis
are to be  treated by  the specific remedies directed to the cure of these
affections, while at the same time the various symptoms are carefully
controlled by  appropriate palliatives.
   When  nervous exhaustion causes neuralgia phosphorus is a useful
remedy, particularly in those cases which are convalescing from acute
fevers.
   Sometimes  malarial poisoning produces a violent form  of  supra-
orbital pain  knoAvn as " brow ague," which is to be relieved,  not by
ordinary  remedies, but by large doses of quinine.
   The relief of  the states  producing  neuralgia having been spoken
of, it yet remains for us to consider the measures  to  be adopted for
the cure  of an  attack.  Fortunately, the recent advances  of thera-
peutic study have placed in our hands a large list of drugs  not apt to
produce a habit after prolonged use, comparatively safe though active,
and  not of disagreeable taste or general  effect.   By these  terms  the
writer refers to antipyrine,  acetanilide, and  phenacetine, all of which
possess wonderful .power in  the  alleviation of pain dependent upon
true nervous  involvement.   In  order  to  avoid  failure in the use of
these drugs in the relief of headache we must always remember that
their  field of service is that  of neuralgic pain, not other pains.   Anti-
pyrine is  to be used in the dose of 5 to 20 grains for ordinary neuralgia, 
554
DISEASES.
or the pain arising from the crisis of locomotor ataxia, acetanilide in
the dose of 3 to 8 grains for the same purposes, and phenacetine in
the same amount as acetanilide.
   Upon these  remedies combined  with caffeine  and the  bromides,
according  to circumstances, Ave  noAV depend ;  and the following pre-
scriptions Avill be found of service :

         R—Antipyrini.......3j vel £ij
             Caffeinae citratis......gr. xx    M
    Ft. in chart no. x.  S.—One every thirty minutes till relieved.

   The folloAving may be of  use  also:
         R —Antipyrini.......^j.vel ^ij.
             Potassii bromidi......3 iij      M.
    Ft in chart no. x.  S.—One every thirty minutes till relieved.

Or, Avhen the caffeine  in the first prescription causes nervousness :
         R.—Antipyrini.......3J. vel ^ij.
             Caffeinae citratis   .   .    .    .    .    .  gr. x.
             Potassii bromidi......^iij.      M.
    Ft. in chart no. x.  S.—One as above

   In any one of these prescriptions  acetanilide or phenacetine may be
substituted for the antipyrine.
   A very effective remedy in some cases of neuralgia of the fifth nerve
is croton chloral in from 5 to 20-grain doses in pills of 5  grains each.
   In some cases of anaemic neuralgia of the head nitrite of amyl inha-
lations haveprovTed useful, by reason of the cephalic flushing produced
by this drug.
   A  vrery  large number of  local applications  have  been used Avith
success in obstinate neuralgias and other cases not so difficult of cure.
Cocaine cannot be applied, as it  does not penetrate the skin, but relief
can sometimes be obtained by the local  use of the oleate of aconitine
painted over the spot  if it be limited in area.  Much  of this alkaloid
cannot be applied, lest poisoning by  absorption occur.
   Where the nerve is very superficial it can often be treated by cold
with great  success.  This is  accomplished by freezing the parts Avith
an ether or rhigolene  spray, or by the application of a small package
of finely chopped ice and  salt.   Within the last feAV  years the treat-
ment of neuralgia by kataphoresis (see p. 365) has come into promi-
nence, and consists in  the use of some local anaesthetic, such as chloro-
form, which  is  applied over the part on a small piece of lint, and a
rapidly interrupted current  used through  the  pledget.  Under these
circumstances the anaesthetic passes through the skin and affects  the
nerve.
  A very useful local injection  in  localized  neuralgia is 4; to I of a
grain of morphine, but the  danger of beginning the  morphine  habit
is to  be remembered  when  treating  chronic  cases.   Sometimes acu-
puncture (see p.  337) is of service, and the surgeon may be called
upon to stretch  the nerve or to do a  neurectomy.
  There still remains to be considered a form of neuralgia generally 
OBESITY.
555
knoAvn as migraine.  This affection is very severe in its manifestations,
and is often most obstinate in yielding to treatment.  Commonly it is
associated Avith eye-strain or cerebral  disease or other similar causes,
and  these must be removed before a cure is entirely effected.   The
best treatment of most of these attacks is  the use of 20 drops of the
tincture of cannabis indica every hour, if  a good  preparation can  be
had, or  by the use of \ to J a grain of the solid  extract every two
hours accompanied by 10 to 20 drops of tincture of gelsemium.


                       NIPPLES, SORE.

  Whenever the  nipples become sore, so that it is  impossible for the
mother  to allow  the  child  to nurse, a solution of  cocaine of the
strength  of four  grains to the ounce  should be applied to  the part,
and Avashed off carefully just before the child sucks.  Following the
nursing a solution of boric  acid, of the strength of 20  grains to the
ounce of Avater or mucilage of acacia, may be used  over the part, the
nipple being thoroughly dried  beforehand.   Where the fissures are
deep  and slow to heal,  the  tip of a  stick of  silver  nitrate may  be
applied to them Avith advantage.   Some practitioners employ tincture
of benzoin over the inflamed part, and glycerite of tannin is often of
value.  Cleanliness, dryness, and  care of  the breast previous to par-
turition do much  toAvard preventing the condition.
  Sometimes  it is necessary to  use a breast-pump or  nipple-shield
before a cure can  be effected.
                            OBESITY.

   Whenever an excess  of fat accumulates in  the body as part of its
substance, various  discomforts, both  mental and  physical, arise, and,
in addition, the normal functions of all  the parts are so disturbed or
interfered  Avith that  the  continuance  of health is often impossible.
In many cases the deposition of fat about the heart or between its
fibres results in serious symptoms; and breathlessness on exertion is
produced by the obstruction Avhich  is offered  to  the free movements
of the diaphragm  by masses of omental fat, aided by the  fact that
the great Aveight  aud  bulk of the  body  require severe  muscular
effort.   It is worthy of note, also, that a layer of fat OA'er the body
increases the vascular surface very greatly, and in consequence gives
the heart the labor  of supplying a larger number of bloodvessels.
   The causes of obesity are numerous.   In many families there is an
inherited tendency, while in others only certain individuals are affected.
These  persons  are fat  because their systems  naturally  tend  to the
deposit of  obese materials  in the same way that the  members  of one
family have large bones Avhile another has small bones.  The etiology
of obesity, outside  of the causes just named, are very numerous, but
the chief one is over-indulgence in food. 
556
DISEASES.
  Just at this point it is not out of place to state exactly Avhat over-
indulgence in food  means.   Every  individual  is a  law unto  him-
self in regard to the amount of food  Avhich is consumed and ingested.
One often sees large, powerful, Aviry men, who eat little, sit beside
others, not so powerful or large, who eat excessively and avIio appar-
ently do not suffer from  indigestion in consequence.   Neither of these
tAvo  groups become  excessively fat,  because one represents a grate
which burns its fuel  so that there  is no AA-aste, Avhile  the other resem-
bles  a grate in which there is ahvays a residue of unburnt coal, which
is cast out Avith the ashes as effete matter.  As different engines of the
same build burn varying amounts of coal, so do different men assimi-
late  different amounts of food.   No  stated  amount of food can be set
down as a man's daily portion, until  his case is carefully studied, but
it is important to remember that the quantity of food is generally in
direct ratio to the severity of the toil, and that a man who loafs about
a club,  or " takes  life easy,"  often eats more than a day-laborer, of
far richer foods too,  and  wonders why he gets stout.   In nearly every
case  of  obesity  not dependent upon gross disorder  of the trophic
nerves,  over-indulgence in food is  the cause.   To some this may  seem
absurd, and the patient Avill say that  he eats just enough to keep him
from feeling empty between meals, but this does not alter the case in
the least.  The  proper amount  of food for a  man is not Avhat his
appetite or gastric viscus calls for, but what his system needs.  To this
further  reference will be made when considering the diet for obesity,
found below.
  The very presence of fat aids in the deposition  of it, for, by acting
as a  non-conducting  pad  all over the  body, it prevents the dissipation
of heat, and  so decreases the combustion of those substances which,
when not used for  the  manufacture of  heat, are deposited as  fat.
Again,  we nearly always find that obese persons take  alcohol  Avith
their food, thereby increasing the fat  in their bodies ; for, finding that
they  cannot digest all the substances Avhich greediness  makes  them
swallow, they take alcohol to  stimulate their digestive  apparatus to
increased efforts and assimilation.   Further thau this,  alcohol  adds
force to the body,  and preserves the  tissues by substituting  the oxi-
dizing processes.
  We find, therefore, that three great causes are active  in producing
corpulence in many cases, namely, heredity, over-indulgence  in  food,
and  lack of exercise, which is one of  the means by Avhich over-indul-
gence is produced—i. e., less exercise,  less food needed, but often  more
eaten.
  The treatment of corpuleuce rests solely upon  the conditions named.
In all  instances the diet is the important  point for the bestowal of
care.   Reference  has already  been made to the fact that the needs of
the system are the  criterion  by which we  judge the amount of food
necessary to each case, not  the sensations in the stomach.  The use of
coca by the  natives  of  South  America enables  them  to withstand
hunger  and deprivation,  not because it  gives tissue to  the body, but
because it paralyzes the sensory nerves in  the  stomach, and relieves 
OBESITY.
557
the sensation of hollowness or Aveakness which we  are accustomed to
overcome  in this country, in  the absence of food, by tightening  our
belts.   Everyone who has  undergone severe mental or physical labor
and missed a regular meal, will remember that about the usual hour
for the meal his sensation of emptiness may amount to nausea and
distress, but the hour once passed he feels as strong as before until
by prolonged toil  he so exhausts his poAvers that the  system forces
him to eat, not so much from hunger as from exhaustion.  To under-
stand  this clearly,  Ave must recollect that  the system  keeps its shares
of force in the same Avay as a careful  speculator keeps  his shares of
stock, namely, one part 'iu active use  for speculation, the other half
for reserve in case of need.   In  health the  stomach begins to " feel
hungry " as soon as the speculative  shares of force are nearly used,
in  order  to cause the ingestion  of more food  and  to  preserve  the
"sinking fund" intact.   It becomes evident, therefore, that the mere
presence of hunger is purely a  symptom, not  an indication of  the
absolute necessity  of food, for, if it  Avere, the  consumptive  would
be notorious for  his appetite, instead  of being noteAvorthy for  his
anorexia.
   The food  of the patient suffering from obesity is  to  be cut doAvn
gradually, and the character of it arranged so  that,  though its bulk
be great, its nutritive  properties are small.  Beef and other meats are
concentrated foods containing much  nourishment  in a small space,
while  lettuce, spinach, cabbage, and nearly all vegetables, except roots
or  tubers, contain a large amount of  fibre useless  to the body.   By
the use of a carefully arranged vegetable diet in obesity, we cut down
the actual amount of food absorbed, and, by its bulk, keep the stomach
so  busy at sifting the  nutritious  from the non-nutritious materials
that hunger is not felt, because another meal-time  is reached almost
before the food of the  first is assimilated.  We find, therefore, that
the diet for the reduction of corpulence should consist  chiefly of bulky
vegetables, but not too exclusively of any one article or set of articles.
Heretofore it has been thought that proteids (meats, eggs, etc.) should
be used to take the place of all  hydrocarbons or carbohydrates (fats,
starches, and sugars), but this is not  physiologically  correct, as both
forms  of food are  ahA'ays needed for  health, and it  has been  found
that proteids may be converted into fats in the body.
   The folloAving bill of  fare Avill  be found of sendee in the treatment
of obesity :
   Breakfast: One  or tAvo cups of coffee or tea, Avithout milk or sugar,
but sweetened Avith a fraction of a grain of saccharin.  Three ounces of
toasted or ordinary Avhite bread or six  ounces of bran bread.  Enough
butter may  be  used to  make the bread palatable, not more than one
ounce.  Sliced raw tomatoes Avith vinegar, or  cooked tomatoes Avith-
out any sugar or fats.   This diet may be varied  by the use of salt or
fresh fish either at breakfast or at dinner.
   Noon  meal (dinner): One  soup-plate of bouillon, consomm<e,  St.
Julien, or other thin soup, or Liebig's or Johnston's beef essence, fol-
lowed  by one piece of the  white  meat of any form of bird or fowl. 
558
DISEASES.
Sometimes a small piece, the size of one's hand, of rare beef or mut-
ton, but no fat, may be alloAved, and this should be accompanied by
string-beans, celery,  stewed or raw; spinach, kale,  cabbage,  beans,
asparagus, leeks,  and young  ouious.   Following  this, lettuce Avith
vinegar aud  a little olive  oil (to  make  a French dressing), a cup of
black coffee or one of tea, and a  little acid fruit, such as  some sour
grapes, tamarinds, and sour oranges, or  lemons,  may be taken, and
followed by a cigar or cigarette.
  Supper should  consist of one or  tAvo  soft-boiled eggs, Avhich may
also be poached, but not fried, a feAV ounces of bran bread, some salad
and fruit, and perhaps a glass or  tAvo of light, dry (not sweet)  wine,
if the patient is accustomed to its  use.
  Before going to bed, to avoid discomfort from a sensation of hunger
during  the  night, the patient may take a meal  of ponada  or soak
Graham or bran  crackers or  biscuits in water and flavor the mass
Avith salt and pepper.
  The reduction  of diet is generally best accomplished slowly, and
should be accompanied by measures devoted to the utilization of the
fat present for the support of the body.   Thus the patient should not
be too heavily  clad,  either day or  night,  should  resort to exercise,
daily becoming  more severe, and  should driuk freely of Avater, pro-
vided that sweating  is established  sufficiently freely to prevent the
accumulation of the liquid in the vessels  and tissues.
  Very often a cold bath will, by its dissipation of heat, cause destruc-
tion of fat, which will be burnt up in the body in the manufacture of
heat units to maintain the temperature, and if the  patient  is  not too
anaemic and  stands this exposure to  cold Avell,  the bath should  be re-
peated each day or a Turkish bath used  instead.
  The boAvels should be kept active by laxative fruits or purges, but
if liquids taken  in drink are not eliminated rapidly, saline  purges are
useful, since, if  the bloodATessels are engorged, the circulation in the
capillaries is  slow and a deposit of fat is apt to result.
  Where proper exercise is impossible, the rest cure, with massage,
electricity, passive exertion, aud an absolute skimmed-milk diet, may
be resorted to, particularly in those persons knoAvn  as " fat anaemics,"
who have not enough red corpuscles in their blood  to carry sufficient
oxygeu  to the tissues to complete oxidation.


                        PERICARDITIS.

  Inflammation  of the pericardial  sac is a frequent occurrence, and
requires prompt treatment.   If the  case be sthenic, and is  seen early,
five to ten leeches should be placed over the praecordium, and at the
same  time sufficiently large  doses of veratrum viride resorted  to, to
depress the circulation, and  by the dilatation of the bloodvessels else-
where to draAV off the blood from the inflamed area.  To prevent the
outpouring of a plastic  exudate capable of undergoing organization 
PERITONITIS, ACUTE.
559
and forming adhesions, calomel should be given in ^-grain doses every
hour, combined Avith enough opium to prevent purgation.
  Where the case passes from the acute stage of  inflammation to that
in Avhich effusion takes place, the treatment changes  at once,  and be-
comes supportive if the system shows signs of failure.  The friction-
sounds of the first stage are noAv lost, and the heart-sounds  may be
feeble or muffled  in tone by reason of the effusion present.  Digitalis,
alcohol, or caffeine may be used if the heart shoAvs signs of failure, but
Avhen digitalis is  used its influence should be carefully watched—since
the employment of this drug produces a very full diastole or dilata-
tion of the ventricles, and these are already cramped for space in which
to dilate, by reason of the  exudate Avhich has entered the pericardial
sac.   If the effusion is sufficient to endanger life it should be tapped
and aspirated aAvay very gradually.   In other instances, if the patient
is strong, it is  only necessary to administer hydragogue purges,  such
as jalap—20 grains of the  compound jalap powder, or  elaterium ^
grain, or  a  saline purgative in concentrated  form,  before breakfast.
Often a blister over the praecordium is of service.
                   PERITONITIS, ACUTE.

  An inflammation of the peritoneum, as Avith any serous membrane,
maybe either sthenic and fibrinous or asthenic and serous.  The same
rules  hold, therefore, in  this case as in all forms  of inflammation,
namely, that circulatory  depressants are only to be used iu  the first
type, and followed, if needed, by stimulants;  whereas, in the asthenic
class,  the use of stimulants  is called  for at once and depressants are
contra-indicated.   For  many years  the profession have  recognized
opium and  belladonna—particularly the  former—as the  most  uni-
versally  applicable remedies and best curative  drugs  for  cases  of
peritoneal inflammation,  and while a neAV method of treatment in this
disease has  arisen, it has  only pro\Ted  itself of  value  in a limited
number of cases.
  Remembering  constantly that peritonitis  is an  inflammation,  the
course of treatment to  be pursued by  the physician is  by no means
complicated.   While the use of veratrum viride  may be resorted to,
when the patient is strong and the pulse hard and tense, aconite may,
perhaps,  in such  cases be better, for the double reason that vomiting
is apt to  occur of itself and may be induced by the veratrum viride,
while aconite decidedly preATents any such tendencies.  This is impor-
tant in vieAV of the fact that vomiting is always to be avoided, lest
the retching increase the  peritoneal inflammation.  If vomiting is
present, this  aud the pain  should  be controlled  by the use of large
doses  of opium and  belladonna—say \ grain of the extract  of each
to an  adult,  and these should be accompanied by the application  of
leeches to the abdominal wall in large  numbers—from 10 to 30.^  If
these cannot be had, a mustard plaster may be used.  If the vomiting
is too severe to permit of the administration of drugs by the mouth, 
560
DISEASES.
they must be given by the rectum in |- pint of starch-Avater, laudanum
and  the tincture of belladonna being employed in the proportion of
1 drachm each.
   Opium can ahvays be taken in full dose by  those suffering  severe
pain, and it seems to  be  particularly Avell  borne in peritonitis.   The
use of this drug in peritonitis, as Avith all other drugs in  medicine, is
not  governed by the amount in grains which  has been used, but by
the effects which it produces.  There seems, too,  to be some evidence
that belladonna can  be taken in full amounts without  disagreeable
results;  and the same rule  applies with equal  effect to belladonna, it
being- given for the influence exerted and not according to  the number
of grains used.  Both of these drugs, unlike  depressants  and stimu-
lants, may be used in all forms of peritonitis and in all stages, if called
for,  but the leeches  and counter-irritation  are  limited in their  use to
the early periods of the attack.
   The  use  of calomel in peritonitis is  highly praised by some and
condemned  by others, largely because its proper  sphere is not recog-
nized.  Mercury does good  only in the  severe acute  forms  of peri-
tonitis which arise from  traumatism.or other cause, and is to be used
for the liquefaction or changing of a fibrinous exudate into a serous
exudate incapable of undergoing organization.   If, on the  other hand,
the peritonitis be tubercular, or occurs in  the course of some exhaust-
ing disease Avhich has largely sapped the patient's  strength, the  use of
mercury is exceedingly harmful and tends to increase the danger of a
fatal result.
   The remaining directions which the physician  should give are: abso-
lute rest, Avhich is nearly always adhered to voluntarily by the patient
owing to the pain, and the use of small quantities of predigested—
that is, pancreatized—milk  administered every feAV hours or  every
hour in small quantities.
   Often in peritonitis the  inflammation extends to the boAvels, and
paralysis of their  muscular  fibres occurs.  As  a  result of this, obsti-
nate constipation  ensues  which  is not   to be  overcome  by purges,
which if mild will  not act  and if severe  are  dangerous, but by the
use  of  belladonna and opium already  spoken  of.  The  rationale of
this  treatment  is not  far to seek iu  the light  of our present physi-
ological  knowledge.   Belladonna acts as an  antispasmodic upon all
unstriped muscular fibre, and in the large doses Avhich should be given
in peritonitis  depresses the  peripheral ends of the splanchnic  or in-
hibitory intestinal nerves.   In this Avay the muscular fibres which
are in spasm become relaxed so that peristaltic waves may freely move.
The value of the opium, also, is apparent;  for  it allays irritation and
prevents the reflex  muscular  spasm dependent  upon the pain  and
inflammation.  Obstinate constipation after the  ingestiou of irritant
foods,  such as putrid  meat, will often  be relieved   by  opium  and
belladonna as effectively as if the  patient was purged by an ordinary
purgative.
   Very frequently in  acute  peritonitis  tympanites becomes not only
a very painful, but even a dangerous symptom, the distention of the 
PERITONITIS,  ACUTE.
561
belly being very great.  This may be  much relieved by the employ-
ment of turpentine stupes (see Turpentine), aud in some cases  by the
rectal injection of milk of asafoetida, or better still,  turpentine J to 1
drachm, milk of asafoetida 3 ounces, and warm Avater, 4 ounces.
  Not  content Avith  having made a A^ast  stride forward during  the
past  feAV  years, abdominal surgery brings  with  it  not only  neAv
methods of  treating diseases  in this   region  by the knife,  but  also
has  giveu  us a method of curing  peritonitis  by the  use of saline
purgatives Avhich is  certainly of the  greatest value in those sudden
inflammatory  conditions  which  occasionally spring into  life after
operations upon the  abdominal area.   It Avill be  remembered  that
abdominal surgeons haAre been the chief advocates of this treatment for
several years, and that the wonderful results Avhich they have obtained,
the reputation of the reporters, and  the complete reversal of all  our
ideas concerning the  treatment of the disease,  have called  forth  not
only an enormous number of trials of the method in  this country,  but
have also brought forth two opposing factions in the profession.   The
first of these is  chiefly composed of surgeons, the second  of persons
avIio iu a long experience have reached good results by older methods,
and avIio are generally physicians.  The first class dogmatically assert
that the physician should  turn  over every case of peritonitis to the
surgeon to be opened, searched, and purged; the second  class do  not
deny that saline  purgatives do good in the  hands of the  surgeon,  but
are more conservative in their opinions concerning the general meas-
ures to be employed in all  cases of peritonitis.
   Again, it Avould  seem impossible at  the  present time to assert  that
peritonitis may  be either  idiopathic  or traumatic without  bringing
upon  one's head a storm of criticism; for on the one  side Ave have a
number of physicians Avho believe that peritonitis may arise Avithout
any direct  exciting cause,  and on the other  hand  an equally large
body of observers avIio  assert that it  is essentially a  secondary in-
flammation brought on by direct  contiguity with an already inflamed
tissue, or else that the inflammation is  set up by the escape of foreign
bodies  into the peritoneal  cavity, or by pathological changes occur-
ring  in orgaus normally  situated in  these regions, as for example,
fibroid enlargements of the uterus Avith impaction  in  the pelvis, or
pyosalpinx.
   As it is absolutely impossible for either side at present to prove that
their opponents are Avrong, and as both sides are not to be  doubted in
the  integrity  of their observations, the unbiased judge can but come
to the  conclusion that, as yet, Ave have a  right to believe that idio-
pathic peritouitis may exist.
   If those observers are correct Avho believe that no peritonitis arises
save as the result of some one of these  conditions, then the attempt on
the part of the physician to treat such a case is criminal negligence,
and, as such,  cannot be too severely condemned; but too many cases
of peritonitis are to-day walking examples of the value of the use of
opium to permit of auyone asserting that this  treatment is useless, or
36 
562
DISEASES.
that the knife of the surgeon is to be used in every case : yet some of
the  more radical members of the profession Avould have  us  belieAre
that the  abdomen should be  opened solely for the purpose of making
a diagnosis, aud  that this having been done and no intestinal compli-
cations found, salines should  be given.
  Whether the  inflammation  be idiopathic  or  not  has  little to do,
hoAvever, Avith the methods which Ave are to  resort to in  the medical
treatment of this condition.   It cannot  be  gainsaid that the results
obtained by surgeons in the use of saline purgatives have been start-
lingly brilliant;  neither  can anyone  deny that their  methods may
sometimes  be employed  in medicine as Avell  as in surgery;  but there
are several points to be  recalled by both parties Avhich  Ave think so
seriously modify  the views of each as, after  all, to  unite them in a
bond of unanimity.   No one denies that the surgeon does rightly
when he uses  salines to  prevent peritonitis after an operation;  but
the knoAvledge  of the condition of the patient after he has been oper-
ated upon by the surgeon, and that possessed by the physician Avhen
called to see a case of peritonitis, are radically different:  for the sur-
geon has a right to  believe that  the intestinal canal is patulous aud
devoid of  impactions and intussusceptions, while  the latter knoAvs
not  whether he  has before him  an inflammation of the peritoneum
without intestinal involvement or inflammation dependent upon some
abnormality  in the  prima via.   As  a  consequence it  is  perfectly
proper for surgeons to  administer  salines whicli, to use their own
words, not only deplete  the  abdominal bloodvessels, but  also  by the
increased peristaltic  movements produced, prevent adhesious;  Avhile
the physician in the case of peritonitis from perforation, impaction,
or intussusception may do the patient an immense amount of harm
by such a procedure  long before it is possible to decide Avhat the cause
of the trouble  may  be.   It is  evident, therefore,  that  the  opium
treatment must be adhered to, at least until  the diagnosis is formed,
unless at the very first  sign of pain an exploratory incision is  made
instead of using those remedies generally employed in ordinary attacks
of abdominal discomfort; and it should  not be  forgotten  that pain
and tenderness with  inflammation are the  symptoms of peritonitis, not
only after section, but also of many other states in the  ordinary indi-
vidual.
  It is also evident that other conditions  may exist  which render the
administration  of purges unjustifiable, and in Avhich the use  of the
knife by the surgeon is  not to be thought of.  It is undeniable that
the surgeon should be summoned the moment a suspicion of perfora-
tion  arises, but in the case of a person  in whom an enteritis  has arisen
locally by an old adhesion, increased peristaltic movement is equivalent
to strapping the normal side of the chest in pleurisy with the object of
giving the diseased side more exercise.
  Again, it is of the gravest  importance that both the  physician and
surgeon should distinguish very clearly between an  inflammation  of
the peritoneum iu a strong,  healthy person, and in  one who is in a 
PERNICIOUS  MALARIAL  FEVER.
563
condition  of vital depression, or exhaustion from  prolonged disease
elsewhere.   Depletion by means of purges is, of course, in  the first
class, as much indicated as the application of leeches or bleeding, but
in the second class, quite  as  strongly contra-indicated.  In the dyna-
mic form of inflammation there is  danger of adhesions being formed
by reason of the fibrinous exudate thrown out; in the adynamic con-
dition of inflammation there is already an enormous exudation of serum
into  the abdominal cavity which purges  canuot remove until they have
drained off a large amount of liquid from  the blood.
   Again, there are some cases of peritonitis which are ushered in  by
an acute paroxysm of pain,  but Avhich  do not continue  during their
whole course as  dynamic cases, and in whicli depletion at first results
in exhaustion later on.
   Uutil the profession have employed these two methods side by side,
Avith  an  absolutely unbiased opinion, for  a long period of time, the
only proper conclusion to  be reached  seems to  the Avriter to be this,
namely, that in acute peritonitis, suddenly lighted up in a surgical
case, and Avhich  is  recognized almost at the moment of its birth by the
ever-watchful surgeon, Avho  is on  the  lookout  for it, salines may be
given ; whereas, in the case whicli the physician rarely sees till hours
have elapsed, and in  which grave doubt exists as to the cause of the,
trouble, opium and external methods of depletion must be resorted to.
             PERNICIOUS MALARIAL  FEVER.

  This is one of the most acutely dangerous diseases knoAvn to  man,
if it be fully de\Teloped, and requires the  greatest activity and skill
on the part of the physician, avIio  may be called upon to treat a large
number of Avidely varying symptoms, all of a pressing  nature, at one
and the same time.  The chief indication is for the use  of quinine, in
its  most  soluble forms, in  solution and in large doses,  which may
amount to 60 or 100 grains, by the mouth, by the boAvel, and hypo-
dermically.
  The manner in which  quinine  acts in malarial poisoning is now
generally  conceded to  depend  upon  its influence over  the malarial
germ  of  Laveran, Avhich  has been so well studied in America  by
Osier and Councilman.   All the students  of  the  subject have found
that at least some of these bodies are made  inactive and  disappear
under  the influence of the drug, and we have at last obtained a
knowledge as to the manner in whicli quinine  does good, which  in its
absence Avas a  constaut  opprobrium to  scientific medicine.  The
saying that "As  soon  as the  physiologist  and pathologist tells the
therapeutist Avhat disease is,  the latter  will tell how his remedies  do
good," is very well exemplified by the use of  quinine in malaria and
the  present Avell-founded scientific  reasons for  its employment.  (See
Intermittent and Remittent  Fevers.) 
564
DISEASES.
                 PLEURITIS,  or  PLEURISY.

   Under the  consideration of  Peritonitis,  the writer has  already
given  so full an  account of  the treatment of  acute  inflammations
affecting  serous membranes or surfaces capable of  throAving  out  a
croupous or  fibrinous exudate, that  it  seems  scarcely necessary to
repeat the directions here.   It is to be remembered that an inflamma-
tion of the pleura is identical Avith an inflammation anywhere.   The
treatment of this disease in its early stages is therefore  identical with
other inflammatory diseases, or, in other Avords, the use of venesection,
or, better still,  of tincture of \Teratrum viride or aconite to bleed  the
man into his own bloodvessels, is  to be resorted to.  Along with these
measures, counter-irritation in the Avay of blisters, or depletion by wet
cups is in order; but dry cups are never to be used in pleurisy over the
diseased  area, since they may produce ecchymosis of the pleura by their
suction exercised through the intercostal spaces.   Where dry cups are
used they should be employed at some distant spot, as over the skin of
the back, where the tissues are too dense to permit of  pleural involve-
ment by cupping.  In  cases Avhich are very sthenic it is best to give
calomel  for its aplastic effect, in order to prevent a fibrinous exudate.
By this treatment nearly every case  of pleuritis, if seen early enough,
can be aborted.
   When  the pain from  the pleurisy is excessive and the movements
of respiration greatly increase the discomfort, strapping the chest-wall
may be resorted to.  This is done for  the purpose of immobilizing the
chest.   The  straps should  consist of adhesive plaster, tAvo and a half
inches wide  and long enough to follow the line of the ribs from  the
vertebrae to  the sternum.    They should  be  applied tightly during
expiration, slightly overlapping one  another.
   Both  in pneumonia and pleurisy a poultice is often useful  when
applied to the  chest, but,  while this is efficient, it generally soils  the
clothes and slips down to the Avaist. A cotton jacket is much better.   It
consists of one or two thicknesses  of carded cotton basted inside a thin
undershirt, like a fur-lined coat.   On  the outside of the shirt  oil-silk
should be basted.  By doing this we envelope the  chest in a warm
poultice, because the heat of the body  keeps  the cotton  at  the proper
temperature, while  the  oil-silk,  by preventing  evaporation  of  the
moisture exhaled from the skin, soon causes the cotton to be moist as
well as warm.   Poultices are forever getting cold and  boggy, and if
not changed  make the  patient  Avorse.  If they are changed, there is
danger of the patient  taking  cold;  to avoid  such  an  accident  a
fresh and hot poultice should always be ready by the side of the  nurse
before the old one is taken off, so that as little exposure is suffered as
possible.
   When the second  stage of pleurisy,  or  the stage of effusion, is
reached,  other lines  of treatment  are  needed.  The cardiac sedatives
have been stopped as soon as the quieting of the circulation, the lessen-
ing of pain, aud  the absence of a friction-sound denote the passage of 
PNEUMONIA.
565
the case from the first stage to the second.   If the pulse becomes weak
and the system is depressed, stimulants in the form of alcohol or digi-
talis are needed, and special  care must be devoted to the condition of
the exudation in the pleural space.   If the effusion is sufficiently large
to cause  dyspnoea on exertion, and is not readily removed  by the ad-
ministration of saline purges at the proper time in concentrated form, or
if it is not taken  up by the vessels after jalap or elaterium is used, then
resort must be had to aspiration of the liquid by the proper apparatus.
The physical sigus at this time, it Avill be remembered, consist in flat-
ness on percussion over the loAver portions of the chest, which area of
flatness generally varies Avith the change in the position of  the patient
from the erect to  the recumbent position, unless  the effusion  is saccu-
lated.  BloAving or bronchial breathing at the apex of the  lung Avhen
this organ  is compressed upAvard by the fluid beneath it is often heard.
During this stage of effusiou blisters  are often  very useful in  aiding
in the absorption of the liquid Avhich is present.
                        PLEURODYNIA.

   This condition being one of intercostal neuralgia, should be treated
according to the directions given under the  heading of Neuralgia and
Counter-irritation.

                          PNEUMONIA.

   It  is of the greatest  importance that the physician should employ
drugs in this disease at the proper stage, in  the proper dose, and with
definite ends in view.   In the beginning of a pneumonia of the croup-
ous type the state of the patient is utterly different, as  a rule, from that
of an individual attacked by the catarrhal form of this  disease.   The
first generally attacks a person possessing sufficient vitality  and force
to cause him to  suffer an acute inflammation of the tissues  involved.
In other Avords, the balance of health being destroyed, systemic dis-
turbance is far greater than if less vital force Avas misdirected from its
proper functions, and, as a consequence, high fever, with increased and
excesshre arterial tension, rapidly asserts itself, the changes in'the cir-
culatory system being produced both directly by the diseased processes
aud  indirectly by the heat of the body acting as a stimulant to all its
functions.   In catarrhal pneumonia the systemic changes' are, as a rule,
someAvhat differeut, since the patient is frequently already suffering
from  some  predisposing  disease, such as whooping-cough, bronchitis,
measles, or similar affections.   If the patient is in good condition, the
fever and circulatory excitemeut of catarrhal pneumonia may be  equal
to that occurring in the croupous form; but even if this be so, there will
ahvays  be found  symptoms of lowered vitality Avhich must modify the
treatment in the early stages of the attack.   For a clear and rational
understanding of these  conditions the reader should completely grasp
the difference between them;  and under the title of Exhaustion  and 
566
DISEASES.
 Depression the Avriter has already defined the differences between these
 states.
   It is important to emphasize that many diseases, taking pneumonia
 as an example, may be produced in two entirely different ways, or in
 two states of the system  diametrically opposed to one another.   On
 the one hand, we have a pneumonia attacking the lung of a strong and
 healthy individual who may be exposed to cold; on the other, a pneu-
 monia may attack an  invalid recovering from typhoid fever or other
 exhausting disease,  such as any one  of the  exanthems or phthisis.
 The question of the presence of pneumonia is, of course, to be decided,
 but the state of the system is to be the guide in the treatmeut.   In  the
 perfectly healthy man  avIio has pneumonia, exposure to cold upsets  the
 normal balance, and the full force of his system runs riot and must be
 reduced  to  its  proper  level.   In  the weakly individual the  curve of
 health has fallen beloAV the  normal line and must be raised until it is
 regained.  In a sthenic pneumonia there are three stages of treatment:
 (1) The depressant or  abortive stage, and, if this fails,  (2) the suppor-
 tive,  followed finally by (3) measures for the relief of  the recoA^ering
 lung in  convalescence.  In  asthenic adynamic pneumonia  Ave must
 omit all depressant treatment and resort at once to the second or sup-
 portive measures.  The remarks Avhich  immediately  follow, it is to
 be remembered, have only to do with the so-called first stage in sthenic
 cases.
   If the  patient  shows symptoms  of  Aveakness, as evidenced  by  the
 pulse and  other  sign-boards of disease, the treatment is to be consid-
 ered as that of the second stage.
   It  should be remembered, hoAvever, that the mere fact that either
 stage of the disease is in existence should only lead to a most thorough
 study of the indications present.
   Primary Stage.—The primary stage of pneumonia consists  in  an
 increase in the calibre of a number of the bloodvessels of the lung, so
 that  congestion occurs,  and,  as  a result, the blood stagnates and an
 exudation  finally ensues.   We have, therefore, a state of the  vascular
 system in which all the bloodvessels of the body are tense, except those
 which are relaxed by the inflammation in the lung, and the blood Aoav-
 ing  in the  direction of least resistance still further stagnates in and
 engorges the diseased area.  All this occurs in the first  stage,  and it is
 the object of the physician so to decrease the  over-pressure in  the gen-
 eral  system that the blood will  leave the lung in order to obey the
 law of resistance Avhich has originally  caused it to accumulate in this
 locality.
  In those instances where the diseased process goes on still further
into what is knoAvn as the second stage, or  that of  consolidation, the
indications are at once reversed, and the change from the proper plan
of treatment for the first stage to that necessary for the second may be
required very promptly.   The stagnation of the blood, combined Avith
the pressure exerted by the rapidly forming exudate, not only narroAVS
the patulous vessels by its pressure,  but so prevents the expansile
movements  of  the lung that proper  pulmonary circulation  cannot 
PNEUMONIA.
567
occur.   As a consequence the right side of the  heart  is distended at
first and exhausted finally by the resistance offered to the blood-stream
Avhich it is forced to propel, and is simultaneously fed by blood Avhich,
by reason of the deficient respiration of the patient, is loaded Avith an
excess of carbonic acid.  Under these conditions the circulatory system
must be so stimulated by the physician as to be able to overcome the
obstruction.
  The methods which may be resorted to during the primary stage are
very numerous, but there are only two which can be recognized as of
great value, while the other procedures are but subordinate measures.
These  tAvo measures are bleeding and the use of such drugs as our
clinical  and physiological knowledge  tell us are proper.  The discus-
sion of  bleeding as a therapeutic measure Avill be  fouud on page 370,
and it will readily be seen that the abstraction of blood from the entire
system will rapidly relieve the diseased lung.   The second, and  by far
the best  method, is by the use of veratrum viride, aconite, or antimony,
and perhaps se\Teral other drugs of a similar class.
  In adults  veratrum viride Avill  be  found far more  useful  than
aconite, Avhile in most instances the reverse will hold true in children,
in whom aconite ahvays  exercises  a much more  Avholesome influence
than any other drug of this class.   Supposing that the disease be in
the adult, let us for the moment  consider Avhy veratrum viride in this
first stage is so useful a medicament.   It avi'11 be remembered that the
two  alkaloids, jervine  and  veratroidine, possess  different influences,
and  that between them they  fulfil every object Avhich is sought after.
According to the experiments of Wood, jervine is a most  powerful
vasomotor depressant, relaxing to a remarkable degree the Avails  of the
bloodvessels everyAvhere, and  not only does it do this, but, at the same
time, it so quiets the heart by an action upon its muscle or ganglia as
to reduce its  force, thus preventing engorgement of the luug, while
veratroidine  by stimulating the  inhibitory nerves of the heart slows
its beat,  fills the ATentricles by increasing their scope aud the period of
diastole, and  allays excitemeut.
  Further recollection of physiological faets shoAvs us that the blood-
vessels of the  abdomen are capable of holding  all the blood  in the
body, and into these Avill IIoav the major portion  of the  fluid Avhich
is filling the pulmonary vessels,  at once loAvering  blood-pressure very
greatly  everywhere, so that  the lung is starved of blood  Avithout
dangerous engorgement taking place iu the abdomen.
  The manner of using Areratrum  viride  is a good example of the
necessity of careful physical  diagnosis and a clear  idea of Avhat one
is about  to do.  Used at the  proper time and in the proper amount
it is most useful,  but when abused it is dangerous or  disappoiutiug,
according to the carelessness of the physician.   The folloAviug case,
briefly described, is in point: A. E.,  aged twenty-five,  brakeman,
ahvays strong  aud well, Avas  much  exposed to wind aud snow after
having been thrown into a profuse sweat by coupling a large number
of cars.   He had a severe chill in the evening, ushered  in by a cough
and  followed by  fever  and a sense  of oppression Avith somewhat 
568                         DISEASES.
hurried breathing and pain in the side.   At the time  of admission
into my wards, three hours  after the chill, he had  a temperature of
103° F.,  the  eyes Avere  bright, the  expression  of the face slightly
anxious.  Physical  examination shoAved exaggerated breathing over
the eutire right side, Avhile at the base of the left lung posteriorly there
Avas marked bronchial breathing and dulness on percussion.   Fine
rales could be heard noAV and then, but were not constant.   The pulse
was full and bounding.   This man Avas at once given 3 drops of the
tincture of  veratrum  viride every two hours until  such a time as he
complained  of faint nausea, and his pulse  Avas found to be no longer
rapid and bounding, but soft aud sIoav, while the  skin Avas moist and
relaxed.   The sense  of  oppression  disappeared,  the  expression of
anxiety passed away, no pain Avas felt in the chest, and the attack was
aborted.
   The employment of veratrum viride in this instance took place at a
period in  Avhich it Avas possible to quiet the inflammation by" bleeding
the man into his own vessels," or to reduce the hyperaemia and con-
gestion.   If veratrum viride  had been used later it Avould have done
more harm  than good, as we have already sIioavii when discussing the
state of the inflamed part at the commencement of the second stage,
for the heart would then  be laboring to push blood  past the con-
solidated area and the  disease be  fairly started  or developed,  and
beyond the stage in Avhich its abortion would be possible.
   The advantages of veratrum viride are its completeness and rapidity
of action, the fact that  it preserves in healthy bloodvessels the blood
 Avhich  may be   needed  in  the struggle for life if the disease is not
 aborted,  and lastly, its safety1 is a point largely in its favor.
    The use of aconite in pueumonia  is of particular value in children
 in Avhom the emetic effects of veratrum viride often  prevent its being
 pushed to a sufficient degree to permit of an  effect  on the circulation.
 The indications for its employment  are  identical  with those already
 named when speaking of the use of veratrum  viride, and the only
 question which arises  is  as  to  Avhether  its  physiological action and
 clinical record justify its use.   In reply to such a query the ansAver
 may be that it  does  act favorably in pneumonia, but that it is not as
 thorough in the case of adults as other drugs.  The studies of Ringer,
 AchscharumoAv, Boehm, and Wartmanu all  prove  that the drug is a
 distinct cardiac depressant, but there is no reliable evidence to prove that
 it exerts  any vasomotor influence—the fall of arterial pressure, accord-
 ing  to most Avriters, being produced only by the decreased action  of
 the heart.   On  the other hand, there can  be little doubt that clinically
 the arterial pressure is  decreased by the  drug.   It at  once becomes
 evident, however, that while  its influence  is  for  good in  pneumonia,
 it does' not  possess  the scope  of action  which makes  it desirable in
 every case, and  yet its powers of producing nervous  quiet, allaying

   1 Both veratroidine and a resin contained in veratrum viride are powerful emetics,
so that uoon the ingestion of a poisonous dose of the drug so much is generally vom-
ited that recovery spontaneously occurs   The symptoms produced  are said to yield
to treatment with remarkable readiness. 
PNEUMONIA.
569
vomiting, or meeting some idiosyncrasy make it a drug  always to be
thought of in this disease.  Antimony, although at one  time used
very largely in the treatment of pneumonia, has very properly ceased
to be so commonly employed, chiefly for the reasons that it is a poison
capable of producing decided morbid changes  in the tissues, seeming
to deprive  them  of  their vital power for long periods  of  time,  and
that it often  induces nausea  of a distressing type, or even vomiting,
before it can be pushed to a  sufficient degree to cause the desired cir-
culatory depression.  Next to veratrum  viride  it holds a more useful
position in  extremely sthenic cases than any  other  drug,  and may
be used if  the  patient be  unusually robust.   Uniike aconite, Avhich
expends its chief action on the heart, this drug  not only quiets  and
slows  the pulse by an  action exerted directly upon  the heart muscle
and  its motor ganglia, but in addition markedly affects the  vasomotor
system, thereby aiding in causing the desired  fall of arterial pressure.
The proper dose of tartar emetic is -j1^ grain repeated every two hours
until the skin shows moisture, nausea asserts itself, or the pulse gives
evidence of sufficient relaxation.
   Gelsemium has been highly recommended  by BartholoAv  in the
treatment of the early  stages of pneumonia, but  is certainly of very
inferior influence, and  is at the same time a dangerous drug.  The
use  of  chloral has been attempted, but  its other powers so dominate
its action on the circulation as to make it  useless for the purpose
before  us.   There can be little doubt of the  value of pilocarpine in
the  very  earliest  stages of the malady.   Given in  full dose hypo-
dermically it  will produce so profuse a sweat and so great a lower-
ing  of arterial pressure as  to relieve materially the congested lung.
Its value, hoAve\Ter, depends upon  its very early employment, and it
should not be used if any tendency to true consolidation has already
asserted itself, as  it  is then useless  and capable of depressing to  a
serious extent the heart, which is about  to undergo a severe struggle
with the engorged lung.
   The  application of cold  to the chest  in the early stages of pneu-
monia  has been resorted to very largely in Germany by Liebermeister,
Niemeyer, and others.  It is said that  the  dyspnoea is  decreased at
once, and the  pain lessened.   Bartol and  Ziemssen speak  of it  highly
in the croupous pneumonia  of children,  but the Avriter Avould  fear to
use  it  in  any case, unless  the patient was above puberty  aud very
strong.   (See Cold.)
   If cold is used it  should be employed as an ice-poultice made of
cracked ice  and  sawdust, mixed and seAved up tight in an  oil-silk
bag in  such  a Avay as to prevent  the  bed and clothes from becoming
wet.   (See page 344.)   At this period, too, very distinct effects  can
be exercised over the bloodvessels  of  the lung by  irritatiou of the
skin, Avhich  results in  the  reflex influence already spoken  of under
Counter-i rri tation.
  The  most  active  means  of producing this  counter-irritation is
by the  use of the dry cup.   The Avet cup may be used to deplete or
bleed the patient at  the same time that  it acts as a counter-irritant, 
570
DISEASES.
but in many instances the dry cup will suffice.   If the counter-irri-
tation  is to be thorough the cups  should be applied to the number of
five or six, scattered over the area involved  and a little to the sides
of the diseased patch.
   Mustard may be employed and a turpentine stupe (see Turpentiue)
or Cayenne pepper can be used as  counter-irritants.  The latter is at
once one of the most efficient and least dangerous irritants, as it pro-
duces much reddening  and irritation, but  does  not destroy  or burn
the skin.  In the beginning of a pneumonia a blister should be applied
not immediately over the congestion,  but a little  to one side, as it
may increase the congestion if placed over the diseased spot.   When
resolution  begins, the blister  may be placed  0A7er the exact spot iu-
volved, to aid reparative changes.
   The treatment of the second stage of pneumonia,  Avhen of a sthenic
type,  is much more difficult and hazardous  than  the treatment  of the
first stage.  The question as to the line separating the first from the
second stage must be clearly answered in  the physician's mind, and
distinct indications must exist for the employment of measures suited
to the disease  at  this period of its development.  The physical signs
in the chest are only of value as evidencing the progress of the local
disease process, and only indirectly indicate  the use of a  given  line
of treatment, Avhile the state of the pulse, the color  of the skin, more
particularly of the face, the  duskiness  of  the  nails  along Avith the
rhythm of the  respirations,  tell  the physician  Iioav the patient  is
standing the  strain.   This is not  the place to  discuss the possible
causes of death  under these conditions, but to indicate clearly Avhat
is to  be  done Avhen the flagging,  to-and-fro  pulse  indicates  arterial
starvation, and the dusky skin and pulsating jugulars show venous
engorgement and  distention of the right  side  of  the heart.  The
employment of digitalis is here of the  greatest service.   It  should
be given  in 5-drop doses  of the tincture  every  four hours,  and be
accompanied by  fa of a grain of  strychnine three times a  day, or
oftener, as the case may  require.   If the  digitalis is carelessly giveu,
and its effects are not  watched, it  may be found to produce so rapid
aud irregular a pulse at the Avrist  as to  give one the impression that
the heart needs  still further  doses of the drug, but if the  ear be
placed over the  praecordium   under such  circumstances  the  violent
apex beat, diffused thrill, aud accentuated heart-sounds will sIioav that
this viscus is over-stimulated, and that the  drug  should be AvithdraAvn
until some hours have elapsed, and  its need  is eAddenced by a condition
of real cardiac enfeeblement folloAving a stage of marked improvement
due to the temporary AvithdraAval of the drug.
   Having recommended these drugs iu these  states, let  us study Avhy
they do good aud  the reasons  for their use.  According to a mass of
experimental  evidence, Avhich by  its very volume is  iucontestable,
digitalis  acts upon the heart  muscle as  a  most poAverful  stimulant,
increasing  the force of contraction in  the  cardiac Avails and  driving
the contents of the ventricles out into the pulmonary artery and aorta
Avith an unmistakable increase in  arterial tension.  The experiments 
PNEUMONIA.
571
of  Boehm  shoAv  that  the  heart  actually does  more  Avork  under
digitalis, and these studies have been confirmed by Williams.   Fran-
cois Frank  agrees Avith  Williams  in the belief that this increased
force is due to improved tone of the cardiac  muscle.   These facts
indicate the  raison d'etre  of  the use of digitalis in the second stage of
pneumonia, since  it enables the right side of the heart to send  the
venous blood to the general arterial system, thus preventing the over-
distention  of the  right ventricle.   When Ave remember, on the one
hand, that all  muscular  fibres  rapidly become paralyzed by over-dis-
tention, and, on the other, that digitalis produces a systolic contraction
of extreme completeness,  AA'e can readily see how, by the entire empty-
ing  of  the ventricle at each contraction, distention from gradual  ac-
cumulation  is impossible.   It  seems probable, too,  that  the pneu-
mogastric  nerves  are the trophic nerves of  the heart, and  that  in
consequence its nourishment is impiwed by their stimulation  by  the
digitalis.   (See articles on Heart Disease and Digitalis.)
   There are other reasons, however,  Avhy digitalis should be used  at
this time, A\diich are only second to those just named.  The heart-beat
under  its influence  is greatly slowed, and by means  of this sloAving
becomes a cool-headed man instead  of a flurried, nervous,  irritable
invalid.  By its very slowing it finds time to carry  out all its func-
tions regularly, and with " all its might," it  does not  exhaust itself
by fruitless effort, and accomplishes far more than Avhen it is irregular,
and uncertain as to Avhether it is to contract or  expand.  That digitalis
slows  the  pulse   by  a stimulation of the  pneumogastric nerves has
been pro\red beyond all doubt, and the  remembrance  of the fact that
these nerves are respiratory in function  as well as cardiac, clearly in-
dicates  the value of this  influence.   They supply motor  fibres  to  the
muscular coats of  the entire bronchial system,  the  tonicity of Avhich is
most important for the Avell-being of the  lung, since by this  means
the quantity of air admitted  to the  vesicles is equalized and the ex-
cessi\re  use of the  healthy vesicles preArented.   Longet asserts that the
" lung  tonus" during increased tension (which  is  present   during
pneumonia) depends solely upon these muscles and their proper nerve
supply.  These assertions are once more supported by the experiments
of Graham Brown and Roy, Avhich prove that the vagal  filaments  are
to the lung and its air streams what  the Arasomotor nerves are  to  the
circulatory system, dilating or contracting the  bronchial tubes as may
be necessary.   Digitalis by stimulating them  increases their tone and
supports them when  strained.  The assertion  of  Schiff, that  the
vagus is the vasomotor nerve of the  lungs, is  ouly partly true, and is'
so doubtful as to prevent any value  being  derived from this  fact, so
far as the blood-supply is concerned.   Another Avay in Avhich digitalis
does good  is often overlooked.  The respiratory centre is governed
solely by the condition of the blood.  If this  fluid be overladen Avith
carbon  dioxide it  sends out more impulses and rids itself  of the gas
by  the increased  respiratory effort; or, if an  excess  of oxygen is
present, it sends out  feAver impulses until the normal  balance is  re-
stored.   If, hoAvever, the  carbon dioxide  is not rapidly eliminated the 
572
DISEASES.
combined effect of the gas and effort speedily decrease the respiratory
activity.   It is  also  to  be  remembered that Marckwald has proved
that the pneumogastric nerves are the regulators of the impulses sent
out by the respiratory centre, so that  a  perfect rhythm is obtained.
The asphyxia due to the laming of a  lung  by pneumonia increases
the number of  respiratory efforts, and  in consequence  the  labor
of the vagus is  increased.   Very  commonly Ave  see cases of pneu-
monia in which  the  breathing is hobbling, with a distinctly altered
rhythm—uoav  fast,  now sIoav ;  noAV full,  noAV deep.   In  these the
breathing becomes regular  and  quiet  after  digitalis is used in the
proper amount, a result often accorded  to the cardiac influence of the
drug, but largely due  to  its effects  on  the  respiratory portion of the
vagus nerves.  The  same advantages are gained  by a  regulated re-
spiratory effort on the part of the lungs as are obtained  in the case  of
the steadied heart.
  In  those  cases Avhere  digitalis  is pushed too far, these  favorable
effects are replaced by the most unfavorable conditions, as has already
been described in the  discussion  of the action of  this drug in  heart
disease.   Here,.as elseAvhere, over-stimulation  is  as bad as lack  of
proper tone.
  Strychnine is used to carry out an object supplementary to  that  of
digitalis, for it has been proved to be one of  the most reliable and
powerful stimulants  upon the  respiratory centres  that  we have, and
they are apt to  be exhausted  by rapid breathing.  It  also prevents
general nervous depression and aids in the maintenance of a circula-
tory balance by its stimulating effect on the vasomotor system and
heart  muscle.
  The employment  of alcohol in the  second stage of  pneumonia  is
based upon the same principle as  is the  use of digitalis.   It is inferior
to the latter drug because it  stimulates the heart and increases its
force but does not afford it the  nutrition  that digitalis can give  it.
That  is to say, it stimulates  and causes the expenditure of all the
poAver the heart is capable of, but does not replace the tissue destroyed
by the effort.  Further than this, it possesses the disadvantage of act-
ing for a comparatively short time, dose for  dose, and tending to  cause
cerebral excitement or heaviness if it is pushed to the point of stimu-
lation required by the circulatory condition.  In persons addicted  to
the excessive use  of alcohol  it either fails to act, produces effects con-
trary  of  those desired,  or  actually aids  the disease  process.   The
danger of the patient forming the alcoholic  habit is also to be remem-
bered.
  Having detailed this  treatment of the second stage,  that for the
third stage is to be considered.   For the thorough understanding  of
this we should remember that this stage consists in  the breaking down
or resolution of the exudations and iu their absorption and expulsion
from the chest.
  At this time  the  entire  diseased area is crowded with  secretions
which have  been  formed, dead epithelial cells, and all the morbid sub-
stances which have accumulated.   The  local surfaces are depressed by 
PNEUMONIA.
573
the reaction following upon the excitement of inflammation, and their
tone is below par.   The object of the physician must be to stimulate
these areas so that  they may throAv off the old and take on  a new
functional activity, and for this purpose remedies are to be used which
will soften deposits and stimulate depressed vesicles and bronchial tubes
   By far the most Araluable class of drugs  to be  here employed are
those  Avhich  Avill increase the secretions  from mucous  membranes
without acting as  cardiac depressants.  Antimony  is a  remarkable
drug for the production of a large secretion, but is often  too depress-
ing to the heart after the prolonged  strain to Avhich  it has been sub-
jected.   Under the  article on  Bronchitis the action of these drugs will
be found more thoroughly explained, but it Avill suffice to point out,
at this time, the method of their administration.
   First and foremost stands the chloride of ammonium, a drug whose
elimination takes place largely through the lungs, aud Avhich acts most
happily in  aiding in the loosening of the cough aud secretions.  Its
only disadvantage is its  salty taste, Avhich  in many cases renders  it
disagreeable to the patient, Avhile its irritant properties may disorder
the  action  of the stomach, although if this organ  is  depressed and
atonic this drug often improves its condition. The drug may be given
in compressed pills, or what is  far better,  in such  a  mixture as here
folloAvs :
          I£.—Ammonii chloridi    .    .    .    .   •   ^ij-
              Extract. glycyrrhiza? fl.    .    .    .      3ij.
              Aquae dest.......f ^ iij.   M.
    S.—Teaspoonful in water every four hours during the day.
   If the cough be in excess of the expectoration, that is, if the cough
often fails to bring up phlegm and  is due  to tickling  or irritation, it
may be relieved  by the addition of a little  morphine to -this mixture,
as folloAvs :
          I£.—Morphinae sulph.     .    .    .    gr. j vel gr. ij.
              Ammonii chloridi    .....  3ij.
              Extract- glycyrrhiza^ fl.                  ,^iv.
              Aquae dest.     .     .    .    •    .   .  f^vj.    M.
    S.—Dessertspoonful every four hours.

   If much  more morphine  than this  is  used  it  will tend to stop
secretion.
   AVhen the chloride of ammonium fails  to act favorably, the car-
bonate may be called into use for its local and circulatory action, and,
in addition, the  bromide of ammonium may be employed  to allay the
cough if morphine  cannot be used.  The following  prescription  is
valuable:
          R.—Ammonii chlorid......3j.
              Ammonii bromid.    .....    3J.
              Ammonii carbonat.   .   .   .     •   •    3J-
              Extract, glycyrrhiza? fl.   .   .     .   .    3 "J•
              Aquae dest........fjvj-   M.
    S.—Dessertspoonful every Tour hours.
For other remedies for this stage, see Bronchitis. 
574
DISEASES.
  So far, the treatment given has dealt Avith a routine case;  let us
suppose that things run less smoothly and  complications arise.  It
Avill  be impossible, in a book on Therapeutics, to explain  the causes
of all  the  dangers which may present themselves; one  of the  most
common of these is  an increase in the area of the  consolidation or its
development  elsewhere, or, in  other  words, a secoud  attack super-
imposed on  the first.  The treatment of this  most dangerous  state
of affairs  requires the greatest  care, skill, aud  intelligence, and con-
sists primarily, not in the use of cardiac sedatives, but in the admin-
istration of digitalis and stimulants, in  order to drive out the  blood
from the new congestion, or to  enable the  system to bear the strain.
A blister or dry or wet cup  thoroughly applied  a little to one side of
the spot involved, may aid  iu the removal of the congestion,  and the
application of mustard plasters to the feet is indicated, or a  turpentine
stupe may be applied to the entire  chest.   The use of expectorants
stimulating to  the lungs is to  be stopped  at once, and  nourishment
given  in small amounts, carefully prepared, and frequently adminis-
tered.   It  is  to be remembered,  however, that above all  things the
physician must use  his judgment,  and  if  he finds that sufficient
strength yet remains to  his  patient for the second attack to partake
of a dynamic or sthenic character similar to that of the  first he  must
use bleeding,  leeching, cupping,  or cardiac sedatives.
  If the consolidation  be  very widespread  in any case,  the entire
heart becomes strained by the venous congestion and arterial tension,
due to the partial asphyxia,  while there  is also danger of death  from
lack of oxidizing space for the blood.   No better treatment exists,
under these  circumstances,  than the inhalation  of oxygen, either
almost pure or mixed with air.   By this means even a small  patch of
lung offers sufficient oxygen to  the blood to cause its necessary oxida-
tion.  Th's gas may be obtained in small  cylinders,  Avhich,  by  com-
pression of the gas, hold forty gallons, at several large establishments,
notably at the offices of the S. S. White Dental Company, Avhich has
agencies in all the large cities of the United States, or it  may  be made
by the physician himself in the  following manner: Take 4 ounces of
chlorate of potassium—Avhich must not contain a single  chip or  piece
of organic matter—and add  to  it an equal  quantity of peroxide of
manganese.  These should  be placed  in a retort or strong flask, and
an alcohol-lamp placed under  it.  The gas  as it is generated escapes
through a tube, Avhich  should pass into a large jar of Avater, so that
the gas, as it bubbles up, may become cooled and purified; a second
tube may now lead the gas to an inhaler  over the patient's mouth.  It
should  be  remembered, howeArer, that chlorate  of  potassium  may ex-
plode if contaminated by the smallest piece of organic matter.1
  The period in the treatment  of pneumonia when  simple poultices
do  the greatest service, and the  only time when  they are to be em-
ployed  for valid reasons, is  during the second and third stages of the

  1 Several firms manufacture small yet complete forms of apparatus for the manu-
facture and clinical application of oxygen.  The cost varies from 825 to 850. 
PRURITUS.
575
disease, when clinical experience shoAvs that they are of value in aid-
ing in the production of resolution and in loosening the cough.   How
they act,  except by increasing the  external warmth and moisture of
the parts, Ave do  not know, unless by the production of some reflex
influence  exerted  upon the lungs from  the skin by  means of the
nerves.  Unless the attendant is unusually intelligent and well trained,
the common poultice does more harm than good, because it is allowed
to get cold, or the patient is chilled when it is changed.   The proper
application is the cotton  and oiled-silk jacket, particularly in young
and restless children.
   The remarks Avhich  have just been made deal entirely Avith simple
poultices, and not with those  possessing drugs  in their mass, such as
those agents belonging to the counter-irritant group of drugs.   By far
the most  commonly used  substance under these circumstances is mus-
tard,  and its addition to the mass at once  alloAvs this method  of treat-
ment to be employed in the first as well as in the later  stages.


                          PRURITUS.

   Itching of the skin or mucous membranes about the openings of the
body is a very common state, and Avhile it may be dependent upon local
causes, such  as lice or fleas, it more commonly is due to some  systemic
condition, such  as  debility, diabetes,  albuminuria, or other similar
causes. The treatment consists, first, in the removal of the cause, and,
next,  iu the  local treatment of the condition.  There is generally no
redness or eruption, except that due to scratching.
   Internally, arsenic,  quinine,  bitter  tonics,  cod-liver oil,  alkaline
diuretics,  or mineral Avaters are useful in  debilitated  cases,  and an
avoidance of condiments, such as mustard or pepper, is needful if the
disease affects the  mouth of the urethra or vagina.
   The local treatment of pruritus consists in the use of  lotions, salves,
or ointments made up of  various constituents, a number of Avhich are
capable of acting  as local anaesthetics.  Very often, bathing the parts
Avith 1 drachm of bicarbonate of sodium or  of borax to a pint of cold
water  gives  relief temporarily, or the following formulae  will be of
service :
         Be.—Acidi carbolici    ....    f^j vel f gij.
             Aquae dest......q. s. ad Oj.     M.
    S.—Apply as a lotion several times a day.

         B-—Liquor, carbon, detergen.'.....f^ij.
             Aquae......q. s. ad Oj.   M.
    S.—Apply as a lotion.
Or an ointment made as follows is  serviceable :
         B •—Acidi carbolici   ....    gtt. v vel xx.
             Adipis benzoinatis.....3j.
             Petrolati.......3J.   M.
    S.—Apply as an ointment.
1 For method of preparing this liquor, see 457. 
576
DISEASES.
   In other cases 10 to 20 minims of chloroform may be used iu place
of the carbolic acid.
   Cocaine may be painted over the parts, but it should rarely be used
in ointment, as fats prevent its acting effectively.  It  should also be
remembered that the anal and vaginal mucous membranes are so thick
that  strong  solutions  of cocaine are necessary to  produce anaesthesia
aud  that the effects of cocaine are only temporary.   Where the itching
is very obstinate  the parts may be painted with a solution  of nitrate
of silver of  the strength of 20  grains to the ounce of Avater, cocaine
having been previously applied to relieve the pain of the application.
(See  article  on Cold.)  Brinton  has highly recommended teucrium
scordium in  the dose of  20 grains three times a day.


                   PUERPERAL DISEASES.

   The  diseases of  the puerperium  may be divided into two broad
classes—infectious  and  non-infectious.   The  first class  should  be
further subdivided into (1) those infectious diseases in Avhich the point
of infection  has been  someAvhere along  the  parturient tract, and (2)
those in Avhich the infecting poison has entered the  body by some other
channel.   Under  sub-heading 1  come all those diseased  conditions,
grouped together under  the very inadequate generic terms " puerperal
fever," "puerperal septicaemia,"  "puerperal infection," and the  like,
none of which truly express the condition  present.  If it is necessary in
medical nomenclature to have a single term Avhich shall denote infec-
tion  of the genitalia after delivery, a Avord  should be coined strictly
limited in sense to mean the pathological  conditious Avhich result from
the activity  of pathogenic microbes along the Avhole genital tract.
This classification is necessary for a clear and systematic  description
of the treatmeut of diseases in the puerperal state.
   The  Treatment of Infection along the Genital Tract after Labor.—
By far the most common form of infection along the genital tract after
labor is the absorption of ptomaines from the infection and decomposi-
tion  of membranes, fragments of placenta or blood Avithin the uterus.
This condition will be found in more than 75 per cent, of all  cases in
Avhich infection  occurs.   Therefore, in any case, after labor, in AArhich
there is fever that cannot be explained by some evident cause  inde-
pendent of the genitalia, it is  safe to assume  ptoma'iue  poisoning and
to act accordingly.  The indications are plain : to destroy the microbes
and  thus at  once stop the  manufacture of their poisonous products,
and, if necessary, to remove their habitat.
   The writer's routine application of this principle in practice  is  as
follows : If  the temperature  after delivery remains  over 100° for
tAventy-four hours without evident cause independent of the genitalia,
he Avashes out the  uterine cavity  Avith  at least  1 quart  either  of
bichloride  of mercury solution,  1 : 2000,  or a 2 per cent, solution  of
creolin.  The former is  more  convenient  in private practice  because
the tablets of corrosive sublimate can be easily carried about  in one's 
PUERPERAL  DISEASES.
577
instrument bag.   To  insure  the  entrance  of the antiseptic fluid to
the fundus and its free exit from the cervical canal, au intra-uterine
catheter is  desirable.   Of all  those upon  the  market, the best is that
manufactured by  Lentz,  an instrument-maker of Philadelphia.   If,
hoAvever, the cervical  canal is patulous, as it usually is after labor, a
hard  rubber catheter  attached  to a Davidson's or fountain syringe
answers the purpose perfectly.
   In  the majority of cases  this treatment Avill  bring the temperature
down to normal within twenty-four hours.   If fever does not dis-
appear within  this time, or  perhaps rises  even  higher,  the  second
indication  must be met.   The  iufected albuminous  substance Avithin
the uterine cavity must be removed in  order  to  deprive the micro-
organisms of their feeding-ground.   This is best accomplished by  the
use of the curette and the placental forceps, care being taken in  the
employment of the former instrument to guard the uterine Avail itself
from  the  slightest injury, for not only can the uterine muscle be per-
forated by a curette in clumsy hands, but slight wounds of the uterine
substance Avith  this instrument may be enough to inoculate the general
system with the germs whose  activity has been  confined before to  the
uterine cavity.
   The Avriter's manner of employing this  plan  of treatment  after
labor is as follows :
   The anterior lip of the cervix is seized with a double tenaculum
and pulled gently dowmward ;  a cleansing  uteriue  douche  is  then
given in  order to disinfect the field of operation; next the curette is
inserted to the  fundus, and the Avhole interior  of the uterus is carefully
gone  over Avith the instrument.  First the fundus and then each of  the
four sides; then the curette is turned Avith the scraping surface upward
and withdraAvn from the cervical canal, a finger in the vagina meeting;
its tip as it emerges  in order to  help  extract any substance Avhich may
be caught by and  entangled in it.
   Next the placental  forceps is inserted and an effort made to grasp
any material  lying loose  Avithin  the cavity  or still  attached to  the
uterine walls.  It is usually best to  repeat  each of these  manoeuvres
several  times until nothing more can be brought away except a little
clear  blood.
   Then the  uterine cavity is again thoroughly washed  out.   The
Avriter has many  temperature charts in his possession Avhich show
the success  of  this  treatment,  when simple uterine irrigation  has
failed.  Occasionally it is  necessary to  repeat the irrigation, and even
the curetting,  for several  successive days.   If, as   rarely happens,
this treatmeut  should prove  unsuccessful and the temperature should
remain elevated in spite of irrigation and the use  of  the curette and
placental forceps, one must assume either that general systemic infec-
tion has occurred, or,  at least, that au inflammatory action has begun
iu the uterine walls or Avithin the  tract of the tubes.   One of the ear-
liest, surest signs of systemic  invasion is the appearance of peritonitis.
   In  such a case the only available treatment is to support the body-
cells in the combat which they must wage  with the  invading micro-
                                 37 
578
DISEASES.
 organisms.   This is  best  accomplished by the  administration of as
 large  a quantity of nutriment as the patient can stand without  re-
 bellion of the stomach or bowels, and the exhibition of a large quan-
 tity of alcoholic stimulant.   Cases of this sort not infrequently require
 more  than a pint of whiskey or brandy in  the twenty-four  hours.
 Occasionally measures will be required  to reduce an exaggerated ele-
 vation of  the temperature,  but this is best avoided as long as possible,
 for  antipyretic  treatment is  usually depressing and ill  suited to the
 patient's adynamic condition.
   With this  plan of treatment,  about three-quarters of the cases of
 general  septic infection after labor will recover.   There may  be some
 in which metastasis to important organs occurs so early as  to render
 all  treatment of no avail.   There will  be  others in which the peri-
 toneum is  early infected, and in which  the septic peritonitis develops
 rapidly and to an extensive  degree.  It is in such cases that laparotomy
 and eA'acuation of  the septic matter, usually pus, Avithin the peri-
 toneum will occasionally save life.  The  physiciau must guard him-
 self, however, from the disposition which is  prevalent at this day, to
 operate too early and  unnecessarily.  After operation, drainage of the
 peritoneal  cavity is an essential feature of the treatmeut, even although
 the  evidence  of suppuration withiu the cavity is  slight.  The writer
 has  in mind a case in which an operation was performed ten days post-
 partum, for septic peritonitis; a very small quantity of purulent lymph
 Avas found upon one ovary, which Avas  greatly enlarged and contained
 a small quantity of sero-pus.  The ovary  was  removed and  the abdo-
 men closed Avithout drainage, as there Avas no other evidence  of suppu-
 ration within it.   Thirty-six hours later the  patient died, and  the
 peritonea]  cavity was  found filled with pus Avhich had accumulated in
 that short space of time.   In the early stages  of the peritoneal infec-
 tion, if the subject is vigorous, not exhausted by a prolonged labor or
 other depressing causes, the administration of saline purgatives in con-
 centrated solution will often effect brilliant results.
   The writer's  custom is to give a dessertspoonful of a concentrated
 solution of Epsom salts every fifteen minutes  until free evacuation of
 the bowels is  secured.   He has seen the temperature reduced by this
 plan of treatment from 104° to normal, in the  course of twelve hours,
 and  with the reduction of temperature all the symptoms of peritonitis,
 which were well marked, entirely disappeared.  In the  treatment of
 microbic activity along the parturient tract after labor, it should never
 be forgotten that the point by which the microbes invade the  system
 may be anywhere from the fundus of the uterus to the parturient out-
 let, therefore the practitioner should never  neglect to examine care-
 fully all the lower parturient tract, in order to detect, if possible, an
 ulcerated surface covered by diphtheritic membrane, which if over-
 looked might be the  entrance-point  for a fatal infection.  These un-
 healthy surfaces are best detected by the use of a cylindrical  speculum
 of clouded  glass introduced so that the cervix appears  within its inner
end and then withdrawn, so that the vaginal mucous  membrane as it
prolapses into the end  of the speculum  may be examined, and treated 
PUERPERAL  DISEASES.
579
if necessary throughout its Avhole extent.  If an unhealthy, ulcerated
Avound is thus discovered, the writer's practice is to apply to it a solu-
tion of nitrate of silver 40 or 60  grains to the ounce.  In the vast
majority of cases this application will promote an exfoliation of the
unhealthy membrane, and the appearance of healthy granulation tissue
within a feAv days.
   It may, iu some  cases, be necessary to employ a stronger applica-
tion, as the solution of chloride of zinc, but  the writer has not been
driven to its use.   The most common  point of infection outside the
parturient  tract after  labor is some portion of the urinary  apparatus,
almost invariably the bladder.   The process of parturition necessarily
diminishes the vitality of the Aresical  mucous  membrane cells by the
pressure aud stretching to  Avhich they  are subjected.  After  labor,
therefore, they are not in a  coudition  to  resist the attacks of micro-
organisms, should these in  any Avay gain access to the vesical cavity.
Most commonly microbes are  introduced into the bladder by a cath-
eter.  This, hoAvever, is not necessary, as it has been plainly demon-
strated  that they can  wander from  the vaginal canal through the
urethra into the bladder without the intervention of an instrument
which Avould directly carry them into the vesical  cavity and  deposit
them iu that situation.  Once arrived within the bladder the microbes
attack  the depressed  bladder  cells, and very often gain a  lodgement
in the vesical  mucous membrane.   This is  manifested by the  usual
symptoms of septic  cystitis, fever, pus in the urine, pain on pressure
over the hypogastrium, and pain and difficulty in micturition.  The
duration of  these symptoms is, as a rule, not very long.   The  fever
subsides, and the symptoms of cystitis  disappear.  After an interval
of some days, hoAvever, there is again a sharp outbreak of fever, with
pain in the region of the  kidneys, and the reappearance of pus, or at
least of numerous microbes  in the  urine.  This indicates a septic in-
fection of the  pelves of the  kidneys after the microorganisms  have
migrated along the ureters.   During their migration their presence has
not been manifested by auy symptoms.   In the majority of cases even
the symptoms of pyelitis will disappear after a time, and  the patient
will make a good  recovery;  but  iu  a  certain proportion there is a
systemic infection by the direct passage of microbes or their products
from the kidneys into the blood.  There may be an extensive suppu-
ration of the kidneys and surrounding tissue, with fatal results, or, as
the writer has seen in  several cases,  the symptoms of general systemic
infection become so grave as for a  long  time to threaten the patient's
life.  In  the  Avorse cases  of bladder  infection the mucous  lining
sloughs, peritonitis develops, and the patient  dies before  the disease
has time to spread to the kidneys.
   The practitioner,  bearing in mind the serious consequences of septic
cystitis after labor, should  always be  on the  Avatch for it, and should
adopt,  immediately  upon its discovery, an energetic  treatment.   A
thorough  disinfection  of  the bladder will remove all present symp-
toms, and prevent the occurrence  of grave  and possibly fatal after-
complications.  To accomplish this purpose the Avriter employs a one- 
580
DISEASES.
half of one per cent, solution of creolin.   One injection of a quart of
this solution through a tAVO-way catheter is usually sufficient.  Occa-
sionally it is necessary to repeat it, or to follow it by several injections
of boric acid solution.   In  susceptible individuals creolin causes too
much pain to be employed.   A  1 to 8000 bichloride of mercury solu-
tion may be substituted  for it, or, in mild cases,  a solution of boric
acid alone will be sufficient.
  If, in spite of all precautions, infection of the kidneys should ensue,
a vigorously stimulating and supportive plan of  treatment affords the
only hope of success.   If extensive suppuration occurs in the  kidneys,
all treatment will, of course, be useless.
  Perhaps the most uncommon  point of septic infection after labor is
the rectum.  The writer has, hoAvever, seen one fatal case of  this sort
—from the  use, no doubt, of a dirty syringe-nozzle in the hands of a
careless nurse.  It would be difficult, or perhaps impossible, to diag-
nosticate  such a  case  until after  death,  and,  therefore,  treatment
directed toward this form of infection will usually not be adopted.
  Next in frequency to the parturient tract and the urinary system as
a region of  infection after labor come  the  breasts.  Infection of the
nipples, and a consequent mammary inflammation, or suppuration, is
one of the most troublesome minor complications that the obstetrician
is called upon to treat.  By careful  preparation of the nipple during
the last month of  pregnancy, and by extreme care to  secure perfect
cleanliness during the period of lactation,  infection of the breasts can
almost surely be avoided.   If it occurs, the first effort should be to
limit its extent aud degree, and to prevent, if  possible, suppuration.
The best  means  to accomplish  this end are derivation of the blood
from the  mammary glands  by an  active  purge, compression of the
gland-substance, and support of the breasts by  a  suitable mammary
binder.
  To these should be added, in the acute stage of inflammation, fomen-
tations of very hot  water, and, later, the application of cloths wrung
out in lead-Avater and laudanum, renewed every three  hours.   Unless
the infection has been of a virulent nature, and the amount of infective
material large, this plan of treatment will  almost surely dissipate the
inflammation and prevent suppuration.
  The other infectious fevers of the puerperal state include the infec-
tious diseases which can, under auy circumstances, attack the adult
female, and their treatment differs in no respect during the puerperium
from  that adopted  under ordinary circumstances, unless there should
be developed some local complications.

        Non-infectious Diseases of the Puerperium.

  Anomalies of Involution.—Super-involution, an exaggeration of that
process  by whicli the uterus is reduced  to  its normal  size after labor,
only manifests  itself, as a rule, after the puerperal state is completed,
and, therefore,  its treatment need not be further considered.
  Subinvolution,  an arrested or  retarded return of the uterus to its 
PUERPERAL  DISEASES.                 581
normal coudition and dimensions after labor, is one of the commonest
complications with which the obstetrician has  to deal in the manage-
ment of the puerperium.  The cause of subinvolution is ahvays a local
one.  General conditions, as acute fevers and so on, have no influence
whatever upon the process of involution unless they are accompanied
by some local complication.
  There  are two causes which  prevent  the involution of the uterus
which  must be borne in mind Avhen  one is called  upon to treat this
condition.   The involution may be prevented, on the one hand, by
anything which calls an excessive amount of blood to the uterine
body, as, for instance, small fibroids within  its  Avails or hypertrophied
deciduous membrane remaining adherent to  its  inner surface.  On the
other hand, subinvolution may be the result of mechanical obstruction
to the  contraction of the uterine Avails and the  reduction of its cavity
to the normal size.  As an example of this Ave have a retained placenta
or a submucous fibroid or adhesions dragging  the uterus out of place
and preventing its  contraction, or most  commonly, perhaps, an over-
distended bladder and rectum.
  In those  conditions which result in a  hyperaemia of the uterus the
cause of  an excessive blood-supply must be sought out and removed
before  one can remedy the subinvolution.
  If small fibroids can be  detected,  the administration of quinine,
ergot, and  strychnine, in pill form, has been found most useful.  If
practical, a faradic current may be employed in  addition to medication.
If there is a hypertrophied endometrium retained within the uterus a
curette will most quickly and effectually hasten involution.  In cases
of heart disease in which the blood-current is  sluggish and dammed
back into the large veins of the trunk, digitalis will be the most effec-
tive remedy to overcome the subinvolution.  There may be an active
hyperaemia  associated Avith  inflammatory action, either in the uterine
wall or upon its peritoneal covering or in its annexa;  in this case the
inflammation must be overcome by disinfection, the use of purgatives,
and, possibly, the local application of hot water, before involution can
be  secured.  When  there  is mechanical obstruction  to  the return of
the Avomb to its normal  dimensions the hindrance must, of  course, be
removed before one can  expect a good result from  treatment.  In the
case of retained adherent placenta every effort must  be made to re-
move the  placental tissue.   In the case of submucous fibroids their
removal must be attempted if there is any hope of safely accomplish-
ing it.
  There is no  case of labor which does  not leave  behind,  in the par-
turient tract, some  injury to the maternal structures.  Usually these
are slight in degree, manifesting no symptoms and healing spontane-
ously.   Occasionally the injury done  results in fistula, communicating
with the bladder or rectum, in deep granulating wounds in the vagina,
or in ulcerated sores.
  In the case of fistula a cure can sometimes be effected Avithout oper-
ative interference by touching up the edges of  the  fistulous tract with
nitric acid,  in order to excite an outpouring of granulation tissue in 
582
DISEASES.
the hope that it may plug up the opening.  In deep tears, Avhich have
not been primarily united, application of a solution of nitrate of sihTer
will hasten the cure and prevent infection of the Avounded surface.  It
ulceration occurs, the  ulcerated spots are to be  carefully Avatched and
treated in the same manner.
   Haemorrhages  from the birth-canal after  labor depend upon a num-
ber  of well-known causes, Avhich must be sought out and corrected
before the bleeding will cease.   Most frequently, the cause of a haem-
orrhage will be found  in retained placental  fragmeuts in utero,  which
must be removed.  Not infrequently, displacements of the uterus will
be found as a cause, and correction of the  displacement Avill stop the
bleeding.
   In interstitial  bleeding, after labor, resulting in  haematoma,  care
must be taken  to preserve the parts in as aseptic a condition as  possi-
ble, Avhile an attempt  is made to limit the bleeding by the application
of direct cold,  preferably by means of a Barnes bag dilated with ice-
water, which must be removed  from time to time in order to alloAV the
lochia to escape.   After rupture or incision of these blood tumors the
cavity left behind must be carefully disinfected  Avith the  bichloride of
mercury solution or creolin, and, if necessary to control further bleed-
ing, Avell packed  Avith  iodoform gauze.
   Of all forms of bleeding, that which occurs directly after labor, in
consequence of inertia  uteri, knoAvn as post-partum haemorrhage, is the
most frequent of occurrence, and the most alarming and dangerous in
its  manifestations aud consequences.   No one should attend a case of
obstetrics Avithout having in mind a  clearly-defined  programme to be
put in immediate execution Avhen called upon to  deal Avith  this frequent
and  dangerous complication.   There  are two indications to be met.
First, to control the haemorrhage, and, second, to treat the after-condi-
tion  The first indication is met by the following plan of treatmeut:
   External stimulation of the uterus by kneading and rubbing through
abdominal Avails, as is practised in Crede's method of expressing the
placenta.
   Next carry the other hand into the uterus  and remove any  blood-
clots, pieces of placenta, or membrane that may be found there, so that
the internal surface of the uterine walls is irritated by the movements
of the operator's  fingers.
   Next apply  a small piece of ice upon the abdomen externally and
carry another piece the size of a hen's egg into the uterine  cavity.  The
use of cold must not be persisted in for more than a minute at most, for
its ultimate action is depressing and relaxing.
   Next soak a  clean linen handkerchief in  vinegar, carry it up to the
fundus and squeeze it out so that the  vinegar  shall run doAvn over the
uterine surface.
  Next, hot water at a temperature of 116°  or 120° should be injected
into the uterine cavity.
   If one happens to have the  necessary appliances  at hand (a small
Gaiffe battery,  Avhich can be carried in an ordiuary iustrument-bag), a
strong faradic current  can be applied to the uterine muscle. 
PUERPERAL  DISEASES.                 583
   Finally, as a last resort, the uterine cavity may be packed with long
strips of iodoform  gauze in the manner suggested by Diihrssen and
carried  out by a number of observers with gratifying success.
   Drugs, as  the styptic salts of iron, aud especially Monsel's solution,
have been recommended from time to time as iutra-uterine applications
in  the  case of post-partum  haemorrhage, but they are dangerous, for
the  coagulation produced by them may extend far into the uterine
vessels, aud the clots must be broken up by putrefaction, exposing the
patient  to the danger of septic poisoning.
   This programme is to be carried out in the order given ;  if the
milder measures suffice, of course the more radical plans of treatment
will not  be  employed.   Excessive  haemorrhage (post-partum) from
lacerations along  the genital canal  can  be controlled by well-placed
sutures.
   Bearing in mind this  plan of treatment, it is almost inconceivable
that an intelligent and skilful practitioner should lose a case of post-
partum haemorrhage.
   The physician should give ergot in full dose  by the mouth, and, if
need be, hypodermically.
   Treatment of the After-condition—While the physician is busy con-
trolling the  haemorrhage, the nurse  should administer a hypodermic
injection of ether, if symptoms of shock  or  collapse are manifested.
After the bleeding has ceased  it is Avell to administer an enema  of a
pint of hot Avater, which  maiutains the patient's temperature, relieves
the  shock and  by its irritation promotes  contraction of the uterine
muscle.   This  should be succeeded by  small  doses of  hot, strong
brandy-and-AArater, and a  little Avarm milk  if the stomach will retain
it.   As soon as reaction is Avell established, a half-pint of hot beef-tea
should  be administered and a hypodermic of  ^ grain of morphine
given in order to secure quiet and  rest and to get the  stimulant quali-
ties  which this drug  undoubtedly possesses.  Occasionally measures
must be adopted to retain enough  blood Avithin  the large vessels and
in the heart  to prevent excessive cerebral  anaemia or cardiac failure.
This is best done by auto-transfusion ; that is,  by bandaging the ex-
tremities  from below upward in order to secure as large a quantity of
blood as possible Avithin the vessels of  the trunk and brain.   Actual
transfusion of a r6^- of 1  per cent,  solution of common salt  into  the
bloodvessels  is required when there is profound exhaustion and de-
pression after haemorrhage.   It has been  demonstrated that it is not
necessary to throAv this solution directly into the bloodvessels, as inter-
stitial injections seem to ansAver the purpose equally well.
   The milk secretion during the puerperal state presents abnormalities
which  call for treatment.  One may have to deal Avith anomalies of
quantity or quality.  The most frequent anomaly of quantity in milk
secretion is unfortunately one of defect.   Insufficient milk supply de-
pends on a number of causes.   Perhaps the most frequent is  a lack of
development of the glandular tissue, and in this form  of insufficient
milk secretion no treatment can be of avail.  Where the lack of milk
is due to some intercurrent affection in the puerperal state the treat- 
584                         DISEASES.
ment must be directed toAvard this complication before the milk supply
can  be  reestablished in normal quantity.  It may be the consequence
of haemorrhages or of diarrhoea or the result of an  acute febrile attack
during lactation or of inflammation within the gland itself.   Serious
organic disease may also be a cause, and insufficient nourishment  must
be held accountable in  some cases.   Profound emotions exert an ex-
traordinary influence upon lactation in altering both the quantity and
the quality of the milk.  It has long been supposed that the return
of menstruation has a disastrous influence upon milk secretion.  This,
however,  has  been  definitely  disproved by careful observations re-
cently conducted in Austria.   The return of normal  menstruation
Avithout complications  has no  apparent  influence,  as a rule, upon the
quantity or quality of the woman's  milk.  In all  the temporary dis-
eases interfering with  milk secretion described  above, it  should  be
borne iu mind that on the disappearance  of the abnormal general  or
local condition, milk secretion can  be successfully reestablished, even
though  it be absent for days  or weeks.   Electricity has been much
vaunted of late as a remedy  for  insufficient lactation.  It may  be
applicable in cases  of torpidity of the mammary gland, or iu those
cases where lactation has been suppressed on the birth of a first child,
and where the mammary gland, therefore, does not respond  readily to
the stimulus of subsequent births.  This remedy will, hoAvever, often
prove ineffective aud disappointing.
   Instances of excessive milk secretion are not infrequently met with.
In the milder and simpler forms they can  be  managed  by  regulation
of the  diet and free  purgation.   Galactorrhoea, a constant Aoav of
milk from the breasts, is one of the most stubborn forms of excessive
milk secretion.   Tavo measures can usually be relied on to give relief:
firm compression of the mammary gland with  the application of bella-
donna ointment, or  the  administration  internally of iodide  of potas-
sium.  In some cases of this character  milk  secretion  stops sponta-
neously with the return of menstruation, and in a certain  proportion of
cases a treatment to secure a discharge of blood from the uterus has
been successful in stopping the flow of milk.  Success has been obtained
with Simpson's plan of introducing a piece of caustic within the uterus
in order to bring back the menstrual  Aoav.  Warm douches have been
used successfully for this purpose.   Electricity has been  recommended
to secure the proper contraction of the sphincter  muscles of the lac-
tiferous ducts, but as this is usually a result  and not a cause of the
galactorrhoea, the use of electricity  must prove in the vast majority of
cases ineffective.  The long-continued administration of ergot has been
warmly recommended.  Tlie remedy should be tried, for its use seems
rational.  Chloral has been shown to be very effective iu diminishing
the quantity of milk.  This drug, therefore, is worthy of trial.  It has
recently been declared that antipyrine in 2^-grain doses, three times a
day, will diminish milk secretion.   The drug, hoAvever, has not been
tested often enough to demonstrate its power.   Quantitative anomalies
in the milk secretion must often depend upon an ill-regulated diet.  A
fatty diet will diminish the quantity of milk; a vegetable diet will 
PUERPERAL  DISEASES.                585
diminish the caseine, and  fat Avill increase the sugar; a diet rich in
meat, especially if reinforced  Avith alcoholic stimulants, will increase
the fat and caseine, but  will diminish  the  sugar.   If the mother's
milk  is evidently disagreeing  with the  nursing  infant, a chemical
analysis of it should be made, and on the result rules regulating the
diet should be adopted.  The most common mistake  in practice  is to
over-feed a nursiug woman, especially Avith a milk diet, with the idea
which prevails extensively among the laity that the coav's  milk poured
into the stomach appears again in the mammary gland.   It is usually
sufficient for a  nursing  Avoman to  observe  the ordinary diet which
agrees Avith her  under  all  circumstances, Avith the addition perhaps of
a half-pint of milk midway  betAveen the morning and  mid-day and
mid-day and evening  meals.  Occasionally a Avineglassful of malt at
the mid-day and evening meals is a useful addition to the diet, and in
anaemic patients the addition to the malt of 5 grains of pyrophos-
phate of iron will be an advantage.
  There is found in  every pregnant Avoman  some  alteration in the
constitution of the blood,  Avhich consists, roughly speaking, of a dimi-
nution of the  red  blood-corpuscles,  and of the albumin and the iron
in the blood, with an  increase in the white  blood-corpuscles and the
watery element.   In  some cases this change is  much  exaggerated,
until an intense degree of anaemia appears in the puerperal state Avhich,
in its severity, will simulate pernicious anaemia, or some fatal form of
blood-disease.   The anaemia of puerperal Avomen, however, even in
exaggerated cases, usually yields to treatment in a most gratifying
manner.  After the prolonged use of Blaud's pills, the writer has seen
the blood-corpuscles rise  from  less  than three to  nearly four and a
half millions, and  the  haemoglobin increase from 40 to 75 per cent., in
a few weeks.  In  some cases arsenic alone  succeeds where iron fails
completely.
                           Eclampsia.

  To  treat eclampsia  intelligently and successfully it is  necessary to
understand its etiology as fully as modern knoAvledge permits.   Al-
though the subject needs more light from future investigations, enough
is now knoAvn to justify the following statement:
  1. The cell activity of mother and foetus  produces excrementitious
substances which will  surely prove virulently  poisonous  to the Avhole
organism  unless they  are voided or made harmless  by the excretory
organs.1
  2. These organs in the  childbeariug woman  are often inadequate to
the disposal of effete material from the maternal and foetal bodies.
  3.  Consequently,  poisons,  of a nature not yet demonstrated, are
stored up in the maternal blood until,  by cumulative  action,  their
presence is manifested  in the eclamptic seizure and other  symptoms.
  4. The convulsions are probably the result  of an acute cerebral
anaemia brought about by violent  contraction of the arterioles; pos-

       1 Harold C Ernst: American System of Obstetrics, vol. ii. p. 431. 
586
DISEASES.
sibly by direct irritation  of  the  brain  substance.  As a result of in-
tense muscular action the circulation is interfered with and blood is
determiued to  non-muscular  regions, as the  brain, lungs, kidneys,
etc., to such a degree that the congestion of these  parts  become dan-
gerous,  leading to apoplexy  in the brain, oedema in the lungs, and
often a complete abrogation of renal function.
  The indications for treatment in convulsive seizures of this nature
are plain :
  First, to attack the fons et origo mali, and to eliminate the poisons
from the  blood as quickly and  in  as large  quantities as possible.
Second, to diminish nervous  sensibility and lessen muscular  poAver,
in order to reduce the convulsions in  vehemence, duration, and fre-
quency.   Third,  if convulsions occur during labor, to save the infant
Avithout adding to the risk  of the mother.   Fourth,  to guard the
Avoman from injury during the attack.
  The first indication is  met by venesection, diaphoresis and  cathar-
sis.  By the first, one  eliminates a certain quantity of poison along
with the  blood and  relaxes  the muscles.   If  there  is  sharp post-
partum haemorrhage, or if the patient is from auy  cause weak and
anaemic, bloodletting is not  called for.  In the ordinary  case, Iioav-
ever, Avith full pulse, congested head, the veins standing out upon the
neck and face, venesection is an undoubted  advantage.   While the
median basilic of one or both arms is  being opened, some croton  oil
should  be sent for and 2 drops  mixed Avith sweet oil  may be placed
upon the tongue.  Directions should  at the same time be given to
wring out three or, better, four old blankets  in  boiling water; these
are to be wrapped around the legs, trunk and  arms, and well covered
over with one  or  more dry blankets.   The sweating thus  induced is
profuse.   An ice-bag  must be put to  the head to prevent  over-con-
gestion of the brain.   In this  way one eliminates the cause of eclamptic
convulsions  as quickly and  thoroughly as possible  from  the  blood,
directly and  indirectly through the skin and boAvels.   The latter may
be acted upon  by £ grain elaterium rubbed up in  butter, or by com-
pound jalap poAvder and calomel, instead of resorting to the croton oil.
Pilocarpine seemed at one time an ideal remedy to secure diaphoresis
in eclamptic  cases, but it has  lately fallen into well-deserved disrepute.
It much increases the danger of pulmonary oedema and is too pro-
found  a depressant.   It  is no longer  employed by experienced and
educated obstetricians.   The second indication  is best  met   by  an
anaesthetic.   Usually the couvulsiou first shows its approach  in the
eyes; these  should be closely watched, so that on the first symptom
of the oncoming  attack chloroform may be at  once administered and
pushed  as rapidly as possible.  Ether  is inadmissible  in these cases,
for it is sIoav of action, congests the brain, and irritates  the kidneys.
Just before the Avoman is wrapped  in blankets,  1 drachm each of
chloral and  bromide of potassium  in starch-water  should be injected
into the rectum.    This  may  be repeated  in  an  hour if necessary.
Morphine, veratrum viride, and  inhalations  of nitrite  of amyl, have 
REMITTENT FEVER.
587
their enthusiastic advocates in this connection.  They may be held in
reserve, in case the plan of treatment described needs reinforcement.
  If convulsions come on duriug labor, the  child  should be rapidly
extracted  as soon as  the  os  is well dilated, but not before, because
efforts  to dilate the os Avould be very apt to increase the convulsions,
and Avould attract the  physician's attention from the woman's  most
threatening danger.   Moreover the os dilates naturally with unusual
rapidity during eclampsia.
  The only injury to  be  feared  during  eclamptic  attacks is wounds
of the tongue from the teeth.  This can be prevented by inserting be-
tAveen  the teeth  a brush-handle  Avrapped  in a  handkerchief, or  by
drawing a toAvel into the mouth like a bit.   Well-meaning but igno-
rant bystanders will sometimes throAv themselves upon  an eclamptic
patient to restrain her convulsions  by force.  This should be forbidden.
                     REMITTENT  FEVER.

   This is sometimes called bilious fever, by  reason of the  violent
 bilious vomiting and jaundice Avhich often accompany it.   It separates
 itself from intermittent fever by the factrthat the  patient's condition,
 chiefly as  regards temperature, does not  have  normal  intervals, but
 has  periods  of only temporary improvement, or,  in other Avords, the
 disease remits.
   For the proper treatment of  this fever, three things must be borne
 in mind:  1. It is more dangerous than intermittent fever.   2.  It  is
 dangerous in the hot stage, not  iu the  cold stage.   3. The patieut,
 not  having  periods for complete  or  partial recovery,  rapidly  loses
 strength.  The safety of the  patient  depends upou the use  of large
 doses of quinine to cut  short the pyrexial stage, the doses used being
 from 20 to 30 grains, preceded  by a good-sized purgatiAre dose of calo-
 mel, say 3 to 4  grains.   If vomiting  is too violent to permit of the
 retention of the quinine, it must be used by the rectum and  hypoder-
 mically,  and the stomach and intestines be swept out by the use  of
 divided doses of Seidlitz poAvder of citrate or sulphate of magnesium.  If
 purgatives are used, they should precede the quinine by twenty min-
 utes, as othenvise the latter drug  is swept out into the bowels, Avhere
 it is rendered useless  by reason of its  precipitation by the  alkaline
juices there present.  Many clinicians claim that remittent  fever  is
 chiefly benefited by quinine during the remission, and ciuchonism dur-
 ing the pyrexial stage increases the discomfort of the patient undoubt-
 edly.  If pyrexia is excessive, relief must be sought in the cold pack
 and  antipyrine.
   The best treatment of the Aromiting is the use of small  doses of mor-
 phine, or 3 to 5-drop doses of the spirit of chloroform in from 30 drops
 to 1 drachm of cherry-laurel water.  Aconite may also be used if the
 patient is strong enough.  (See  Vomitiug.)
   If the belly  is tender, a  turpentine stupe should be applied.  (See
 Turpentine.) 
588
DISEASES.
  If intestinal haemorrhages occur, gallic and tannic acids or Monsel's
salt, in the close of 3 grains in hard pills may be used, and cold cloths
be placed over the belly.  (See Haemorrhage.)
  If haematuria appears quinine must be avoided unless the necessity
for its employment is absolute, because the paroxysms recur frequently.
Quinine does the haematuria harm.   (See Collective Investigation by
author in  Therapeutic Gazette, July,  1892.)
  The treatment of convalescence consists in the use of tonics, such as
quassia, calumba, gentian, Huxham's tincture, arsenic, and purgatives
when needed,-with attention to the  kidneys, the potassium salts being
chiefly employed to keep them active.  (See Intermittent Fever.)
                          RETINITIS.

  Retinitis, or inflammation of the retina, often associated with chor-
oiditis,  is  commonly  the  result of  several constitutional diseases :
Bright's disease, diabetes, syphilis, etc.  In some cases no cause can
be found.   The general remedies must be directed according  to the
supposed cause, and the eyes must be protected from light and all
close Avork avoided.  Very distinct retinal irritation may be caused by
eye-strain,  which is to  be relieved  by the prolonged  use of  atropine
and dark glasses, and  later suitable lenses for the correction of any
existing error  in refraction.


           RHEUMATISM,  ACUTE  ARTICULAR.

  No better example of the fact that therapeutics is in advance  of
pathology  can be adduced than  the disease knoAvn as rheumatism.
The therapeutist cannot tell how he cures the condition designated by
this name,  simply because the pathologist cannot tell what the cause of
the disease is,  and when this information is forthcoming  from the one
side an explanation will be immediately given by the  other.  This
being the case, we must devote ourselves to the study of pure empiri-
cism,  and not  to logical pharmacology.
  The treatment of acute  articular rheumatism is divided  into that
portion devoted to the  cure of the disease process, and that directed to
the relief of the  pain and of the local manifestations of the disease.
   When an acute attack of rheumatism comes  on, it  is nearly  ahvays
accompanied by a high temperature, a bounding pulse, and  all, the
evidences  of active systemic disturbance  accompanying inflammatory
outbreaks, which, in this particular instance, involve  the joints.  We
may,  therefore, use at  such times the remedies  Avhich Ave have learned
are best able  to combat  inflammation,, namely aconite and veratrum
vinide.  So powerful are these drugs in the early stages of acute rheu-
matism that some persons  have believed them to be possessed of a
specific auti-rheumatic power.   This is, however, highly unlikely, as 
RHEUMATISM, ACUTE  ARTICULAR.          589
they  act  no better  here  than in  other inflammatory conditions else-
Avhere.
   The proper manner in  which to use  the tincture  of aconite under
these circumstances, in a strong healthy individual, is to administer
3 drops  at  once in a little water  and follow it by a teaspoonful of a
mixture  containing  5 drops  of tincture of aconite  and  2  ounces  of
Avater, every half-hour until perspiration on  the  skin  betokens circu-
latory depression through the action of the drug.   If this is not done
veratrum viride in the same  proportions may be used.   The advan-
tages of this treatment are numerous:  first, it allays the fever; second,
it  quiets  nervous excitability; third, it tends to prevent permanent
changes  in  the joints which are involved; and,  last of all, it aids in
the production of a SAveat.  Whenever  these drugs  are employed  the
patient must be strong and hearty, not debilitated or weak, and it is
to be noted that this treatment  is not to be resorted to carelessly.
Finally,  care is to be taken that the symptoms of depression from the
drug and the  disease combined do  not become  too severe.  Where
great exhaustion is primarily present, or ensues upon the use of depres-
sant drugs,  alcoholic stimulants are particularly needed.
   Simultaneously with these internal measures a solution of bicar-
bonate of sodium,  20 grains to the ounce, may be  applied to the joints
involved  by means of lint wet Avith this solutiou, with relief  to the
sense of  heat and burning, or ice-cold compresses may be tried.   In
other cases  relief may be obtained  by applying hot cloths saturated
with  the so-called  Fuller's lotion,  namely, carbonate of sodium 6
drachms, laudanum  10 ounces, glycerin  2  ounces,  and water  9
ounces.  Sometimes great relief is obtained by fixation of the joints
by means of splints.
   Immediately after the  system  has been thoroughly impressed  by
cardiac sedatives—or  at  once, and in their  place, if the case  is not
seen at first, or is Aveak—the physician  should resort to one of three
remedies, namely, salicylic acid or its salts, antipyrine, or acetanilide.
The  general opinion of  the profession seems to be that  these three
remedies stand in the order  here placed iu regard to their efficiency,
but  it is also true that one will  often succeed when the  other fails,
and it is Avorthy of note that success or failure generally asserts itself
rapidly—that is, the drug used gives relief in twenty-four or seventy-
two   hours, or fails altogether.   It  is  most  important to remember
that salicylic acid seems to  protect the  cardiac valves and the  entire
endocardium from the ravages of the disease more than do the other
two remedies, and in addition that this acid, by reason of the profuse
sweats often produced by  it and a tendency to  produce cardiac depres-
sion,  must be Avatched  lest it act unfavorably  on the general systemic
state.
  Taking up salicylic acid first, we  find  that  its  prober  use is often
misunderstood, and that it fails because of this fact.   Whenever acute
articular rheumatism appears, the  salicylic acid should  be pushed in
the same way that Ave  use quinine on  the  advent of a malarial par-
oxysm, namely, in full dose. 
590               .         DISEASES.
  It is useless to give the drug in 5 or 10 grain doses three times a
day;  it must be given in 20-grain doses morning, noon, and  night, or
not at all.   If the sweats are too severe, or the stomach rebels, the
drug may be stopped, but not decreased in amount, unless  for good
reason.   Further  than this, if salicylic acid is used for two or three
days in this way, and  produces  evidences of cinchonism, yet fails to
alter  materially the course or severity of the  trouble, it should be
withdrawn, as it will rarely, if ever, do any good after this time.
  A very efficient substitute for  salicylic acid is the oil of gaultheria
(wintergreen), which contains  about  90 per  cent, of salicylate of
methyl. The dose should be 10 to 20 drops on a teaspoonful of sugar,
or in  capsule or emulsion, three times a day, after meals.
  Antipyrine and acetanilide may both be considered  together, since
their  action  is identical  in  rheumatism.   The  author belieAres that
antipyrine, while often relieving the pain more than the acetanilide,
nevertheless does not act so favorably  in  decreasing the  duration of
the disease.  The dose of the first should  be  10 to 20 grains three
times a day; of the second, 4 to 8 grains at the same intervals.
  The studies of Guttmann  with acetanilide in a very large number
of cases of rheumatism,  embracing all its  forms,  both  chronic and
acute, have given most encouraging results, and  the author has seen
the drug act most happily in seATeral cases which had refused to yield
to the iodides and salicylates, although  all of these  cases Avere of the
sevTere acute form, suffering intense pain from the articular inflamma-
tion, but devoid  of any cardiac  complications.   It at once  becomes
evident that a drug such as antipyrine or acetanilide may do good in
a case of rheumatism iu three entirely separate and distinct ways, any
one of which may be active  at once, or all  active together,  hand-in-
hand  in the improvement of the  patient's  state.   Any  substance pos-
sessing strong antipyretic poAver  must be of value under such circum-
stances, because of the loAvering of the  fever Avhich follows its admin-
istration, with  the resulting  quieting  of an excited system, and in
putting aside the delirium associated  with  a condition  of hyperpy-
rexia.  Not only does such a drug act  favorably in this manner, but
the analgesic effects of such a substauce must exert a powerful influ-
ence for good.   By benumbing  the sensibility of the  patient to the
excruciating pain  consequent upon  movement, and so putting  aside
the nervous wear aud tear of sleeplessness and suffering, the  patient's
state must be improved, or, at least not groAV Avorse  from  the exhaus-
tion of the long hours of agony.  Further  than  this,  it Avould  seem
probable that acetanilide  possesses a direct  anti-rheumatic influence,
allaying the  disease processes even in  those forms  Avhere, pain being
largely absent, the improvement  must be real and not apparent.
  The intention of the author is not to extol the value of acetanilide
and antipyrine*in  rheumatism to the  exclusion of other means of
relief, nor to recommend its use before the more thoroughly tried sal-
icylates  and iodides, but to draw to  its  standard a certain number of
cases Avhich persistently  resist treatment of the  ordinary stamp and
which put the physician to his wit's end for a change of treatment at 
              RHEUMATISM, ACUTE  ARTICULAR.          591

least promising some  chauce of relief.   Many of the  readers of this
book  have doubtless seen such  cases, and many of them  must have
learned by sad experience that acute articular rheumatism is in many
cases  bound  to run a course of so many weeks or days, do what Ave
will.   Under  these circumstances nothing acts  further than a pal-
liative, and the patient aud his friends become impatient for a chauge.
The author has found  that acetanilide in such  cases will often relieve
the pain  and  so permit  a refreshing sleep, in doses of  from 4 to  8
grains three times a day, and that these  amounts do not cause the ex-
cessive SAveating which the necessarily large doses of salicylate are sure
to produce, SAveats which leave the patient oftentimes almost dyspnoeic
from  very Aveakness.   Whether this temporary  relief produces such
changes iu the system as to permit of a better battle  against the dis-
ease, or Avhether it actually counteracts the rheumatic poison, we know
not;  but  Ave  do knoAV that folloAving its employment the relief is not
only temporary but often permanent, and  that a very distinct step in
advance is made toAvard the close of the  attack if any influence at all
is felt.
   Phenacetine is often very useful when  used in rheumatism,  particu-
larly  if combined  with salol.
   Passing from what may be appropriately called the coal-tar treat-
ment of rheumatism, because all the drugs so far named for internal
use have  such a source, Ave come  to a list of remedies  heretofore
largely used  in rheumatism  in  place of the newer compounds, but
which are not so commonly employed to-day.
   These remedies act, as a  rule, in the subacute forms of rheumatism
or in  the cases where the first group fail because the disease is obstinate.
Of these the chief is the iodide of potassium folloAved by the acetate,
bicarbonate and citrate of potassium.  If the iodide is used  the fol-
lowing prescription is of service :

         B.—Potassii iodidi......,|j.
             Syr. sarsaparillse comp.    .   .   .   . f^vj.     M.
    S.—Dessertspopnful three times a day, after meals.

   In  other cases  it is best,  because  of  the  disagreeable taste of the
iodide, to give it in sugar-coated pill or in tablet form,  but care should
be  taken  that  milk or water is taken   at the same time to prevent
gastric irritation.
   Or, if preferred, 20 to 30  grains of  the bicarbonate of potassium
may be taken every four or five hours in Avater, flavored with cinna-
mon  for  the sake  of  the taste, or the citrate of potassium, which is
more  agreeable, may be taken in  equal  amount.   Sometimes a little
colchicum added to the prescription given above may be useful if the
case is very obstinate, as follows:

         B—Potassii iodidi   .   .   .       ^  vel ,|ij.
             Vini colchici radicis .    .    .   fgij  vel f|jss.
             Syr. sarsaparillse comp.   q. s. ad f gyj  vel f gxij.     M.
    S.—Dessertspoonful three times a day, after meals. 
592
DISEASES.
   Haig has proved that in rheumatism there is retention of uric acid,
and that  the use  of alkalies and the salicylates at once causes  this
substance to be changed into a soluble form ready for elimination.
   The other drugs used in acute  rheumatism are numerous,  but only
a feAV of them deserve attention here.   There is abundant evidence on
record that full doses, 10 to 30 drops, of the fluid extract of cimicifuga
if given every five hours will decrease the redness and pain of the
joints and shorten the attack in some cases.   Again, certain species of
rhus, as rhux toxicodendron, are  useful if fresh  preparations are at
hand.  The dose  of rhus toxicodendron is y1^ to 1 drop of a tincture
made by adding one part of the fresh leaves of poison-ivy to 2 parts
of alcohol, this dose being taken three times a day.   Where the pain
seems particularly severe at night this drug  is very valuable, according
to many careful students of therapeutics.
   Nearly every case of acute rheumatism will do better  if a strong
mixture  of lemon- or lime-juice and  Avater  be taken daily  in large
quantities.
   The local remedies in rheumatism are chiefly counter-irritants  and
sedatives.   Thus,  small or large  blisters applied around an inflamed
joint after the general systemic excitement is passed, may be of great
value  in restoring the suppleness of  the  joint and  in aiding in the
absorption of the effusion.  The remaining local treatment consists in
thoroughly painting the inflamed parts with tincture of iodine, if blis-
ters are  not used, and in  the application of veratrine ointment or
iodine ointment around the joint.  (See Veratrina.)
   A  most  valuable application to the inflamed joints of rheumatism,
either during the acute stage or aftenvard Avhen they remain swollen
and enlarged, is :
         R.—Ichthyol.....giv vel 3j.
             Adipis........§ ij.    M.
    S.—Apply about the part and rub in well.

   High fever is to be controlled by the same measures  as the  high
fever of any  other disease, by antipyretics, by the cold pack, cold bath,
or sponging with tepid or cold water.
   Salol, which is dissolved and absorbed solely in the intestine through
the action  of the juices  there  present, has been used in the place of
salicylic acid with success; but it is worthy of note that, as it  contains
40 per cent, of carbolic acid in addition to the salicylic acid, its use in
very large amounts is dangerous.  (See Salol, page 297.)
                 RHEUMATISM,  CHRONIC.

   Chronic rheumatism is  one of the most difficult and obstinate dis-
eases Avith Avhich we have to deal.  In  some cases the acute form just
considered merges sloAvly into the chronic form ; or, in other instances,
the disease gradually  comes on, increasing,  it may be, by exacerba-
tions  or by gradual progression.   The treatment of chronic rheuma- 
RHEUMATISM, CHRONIC.
593
tism  is someAvhat different from that of the more acute forms, and
approaches  that  of gout in some of its therapeutical indications.  In
other words, the salicylates  are not so useful in these cases as are the
iodides aud  colchicum, so that, in the majority of instances, the pre-
scription of iodide, sarsaparilla, and colchicum, given in the article on
Acute Rheumatism indicated.   When anaemia or Aveakness is present,
cod-liver  oil is often of great service, aud  it is  worthy of note that
this useful  nutritive remedy  was first brought into therapeutics by
the fisliAvives of Holland, Avho found it  useful in the attacks of  rheu-
matism to which their husbands Avere subjected through exposure.
   When  the oil is thoroughly rubbed into chronically inflamed joints
it is often as useful as when taken internally.
   The same  forms  of severe counter-irritation are not so useful  in
chronic rheumatism as  in  acute rheumatism, but  a very  valuable
therapeutic measure  in these cases is the use of the Russian or Turk-
ish bath or an improvised  SAveat by means of a lamp and a blanket.
(See  Heat,  page 360, and  Cold, page 344.)  Liniments are always
called for, for tAvo reasons : First, they relieve pain and do good  to
the parts, if not from their medicinal properties, at least by the rub-
bing  AA7hich accompanies their application; second, because  they give
the patient something to do, or to  have done, and therefore impress
him Avith the object-lesson that his  attendants are attendant  and  alive
to his suffering and need of sympathy and care.
   Among the  loAver classes the belief in  liniments is very Avidespread,
and their  use will often instil into the minds of the friends a far greater
confidence than  the most logical of treatments Avith the liniment left
out of the list of remedial measures.
   The following liniments will be found  very useful under  these
circumstances :
          ty.—Tr. aconiti.......^Z^-
             Tr. opii.......  f5J-
             Olei terebinthinae    .    .   .    fgjvelf.^ij.
             Linimenti saponis   .    .   .  q. s. ad  f^viij.   M.
    S.—Poison.  Use as a liniment  three times a day.

Or,
          B •—Aquse ammonii fort.
             Olei cajuputi
             Tr. belladonna?
             Linimenti camphorae
    S.—Poison.  Use as a liniment.

Or,
          B.—Tr. opii        I
             Tr. aconit.         j-  .    .    .       aa fgiv.
             Aquas ammon. fort. J
             Linimenti chloroformi     .    .    .    . fjvj.    M.
    S.—Poison.  Use as a liniment  to chronically inflamed muscles or joints.

   In other  instances the greatest relief is obtained  by employing the
following ointment of veratrine :
                                 38
     .  f.^iv.
 •    •  f3j.
 f3J velf.^ij.
q. s. ad  f^ viij.
M. 
594
DISEASES.
         B-—Veratrinse            \              rl;-t  ~:
             Hydrargyri iodidi viridi /
             Petrolati.......%'}■    M.
   S.—Use as an ointment over the joints.

  This ointment ought not to be widely distributed, and the pulse and
respiration should be watched, as the veratrine may be absorbed and
depression of a severe character set in.
  For the reduction of enlargements of the joints  due to the disease,
and  accompanied in some cases by pain, the folloAving ointments are
serviceable:
         B-—Unguent, iodinii......Jj-
             Adipis......Sivvel^j.    M.
   S.—Apply locally.

Or, still better :
         R— Ichthyol......^ivto  ,^j.
             Adipis........%].    M.
    S.—Eub into the joints thoroughly.

  Ichthyol is certainly the most efficient remedy that we have for the
enlarged and painful joints.
  The employment of red flannel over inflamed joints is no better
than the use of Avhite flannel, and it is never beneficially " medicated,"
as claimed in the stores.  The only advantage of red flannel is that, as
it is dyed, the wool  is  often better for not being thoroughly bleached,
and is in larger amount for this reason.  The  disadvantages of red
flannel are that it stains the clothes aud the possibility of its producing
irritation of the skin, or even systemic effects of an evil character.


                            RICKETS.

   Rickets may be defined as a state of the body of an infant or child
in which there is a  deficiency of the normal salts of the  bones and
tissues, with corresponding enlargement of the animal portion of the
bone,  or, in other words, the cartilaginous parts.  Generally the term
is applied solely to designate bony troubles, but every practising phy-
sician sees cases  where the manifestations of rickets are emphasized in
gastro-intestinal disorders rather than in bony deformities.  The chief
cause  of rickets in children, aside from  the  presence of any disease
such as  scrofulosis, is  inanition, that is,  non-nutrition of a specialized
form, or, in other words, bone-salts starvation.   This may  occur after
or  before birth, and  it is  quite common to see children,  born  of
mothers  ill-fed  or whose  assimilation of salts  is defective, with soft
bones or a distinct tendency to rickety development.
   The treatment of rickets is, therefore, largely dietetic and' devoted
to the improvement of the food and digestion.   No  part of the body
 fails in force more than the digestive apparatus in  the presence of this
disease, probably because  the alkalinity of the blood is altered, and 
RICKETS.
595
partly because the stomach cannot secrete properly formed juices from
imperfectly nourished glauds.
  The  medicines to be used  in  rickets are general tonics, digestive
tonics and stimulants, and bone tonics and stimulants, such as salts of
lime and phosphorus.  The general tonics are quinine, cod-liver  oil,
nux vomica aud iron, while the digestive tonics are the simple bitters,
physostigma and mineral  acids.  The bone tonics and stimulants  are
lime salts, phosphorus and phosphate of zinc.
  Tonic treatment is best carried out in young children by the  ad-
ministration of quinine in the form  of quinine chocolates or by  the
use of strychnine in the dose of -%fa to y^ of a grain in sugar-coated,
pink granules.  Arsenite of copper in the dose of y4^- of a grain in
tablet triturate three times a day  is also useful.
  A very  useful preparation is the following :
         B •—Olei morrhuae.......f<5vj.
             Syr. calcis lactophosphat  \           ak fl"'     M
             Liquor, calcis           J               3  J- •
    S.—One-half to one teaspoonful two or three times a day.  Shake thoroughly.
  Nux vomica is generally  so  bitter  as to be  rarely administered to
young children, and when given,  only £ to £ of a drop of the tincture
should  be  used, three times  a day.
  Where a distinct scrofulous  tendency exists and anaemia is  present
small doses of the  syrup of the  iodide of iron are of service, and fa
to 1 drop  may be  given three or four times a day to a child of  six
months or a year, thus :
         R.—Syrupi ferri iodidi   .    .     .  gtt. iij vel xxiv.
             Aquae dest......q. s. ad fgiij.    M.
    S.—Teaspoonful every four or five hours during the day.
Or,
         B.—Syrupi ferri iodidi   .    .    .   gtt. v vel xx.
             Syrupi.....q. s. ad fgiij.    M.
    S.—Teaspoonful three times a day, after meals.
  Here again the arsenite of copper becomes particularly valuable.
  The  salts of lime and sodium are of direct benefit  to  the  bones,
forming by their presence in health a  large proportion of the osseous
system, and, therefore, they may  be considered as foods rather than
drugs.   Very often their administration to nursing mothers or preg-
nant women saves  the  maternal teeth from  caries and preserves  the
general health of the mother and child.   The folloAving prescription
may be used :
         R.—Syrupi calcis lactophosphatis   .   .    . fgiv.
    S.—Half to one teaspoonful three times a day, after meals.

  The reasons for the use of phosphorus are clear, from what has been
said of that drug when speaking  of it elsewhere in this book, as it acts
as a direct and powerful stimulant"of bone growth.
  Phosphorus is best given to children  in the  form of very small,
sugar-coated  pills (-^fa gr.) such as are  put  up in the form known
as "pink granules"  by manufacturing chemists. 
596
DISEASES.
   Phosphate of lime and phosphate of sodium are valuable remedies
 in rhachitis.  They are never to be used in  large doses, because they
 will  not be assimilated, and  wil 1  only disorder the  stomach.  The
 proper dose of each is 1 to 2 grains, placed  in the  milk, Avhere their
 presence will not be noted.
   The ventilation of the rooms Avhere a child prone  to rickets  is
 kept should be excellent, not too hot or cold, and  free from draughts.
 A cool sponge-bath is useful at night if the  patient is strong enough,
 or a good rubbing with salt and whiskey, 1 drachm of salt to a pint
 of whiskey, is of still greater service.
   Special attention should be paid to the development of the muscles
 by massage and  passive movements, as  these parts are always Aveak.
 Walking must  not be  alloAved  too early, as it may  cause bony de-
 formities.

                       SCARLET FEVER.

   This  disease,  the most frequently  fatal of all the exanthematous
 diseases of childhood, requires  the greatest care  in its   treatment.
 Complications constantly arise,  requiring skill  on the part  of the
 attendant, and it is upon his success in treating these outbreaks, as
 Avell as in the general direction of the case, that the life of  the  patient
 chiefly depends.    It  has  been claimed  by certain  practitioners that
 one  or two remedies  which they have used act as abortifacients of
 the attack,  decreasing its  severity, duration, and  the probability of
 complications.  Thus, one European physician has used salicylic acid
 with Avonderful results, if his  claims are true, for he found it  to pre-
 vent  all complications, and  even to remove  them Avhen present.  He
 gives, throughout  the entire attack, aud for some  days after  defer-
 vescence has ensued, the following :

         R.—Acid, salicylic.......gr.  xlviij.
             Aquae destillat.......f ^ ij.
             Syr. aurantii   .   .     .    .   q. s. ad  fgiij.     M.
   S.—Teaspoonful every hour during the day and every two or three  hours at
 night.

   In this country Wilson has  employed  chloral throughout the entire
 attack with asserted  good results,  in the following manner,  but  in
 our opinion Wilson's method is  not  the best  for  most cases, unless
 the nervous manifestations are very marked, when  the chloral treat-
 ment is of great value.
   The  plan is as follows: "As soon as the patient is suspected or
 known to be  developing scarlatina, a laxative dose of calomel, pro-
 portionate to the  age aud general  condition, is administered.  Shortly
 thereafter chloral is given  in moderate doses, at intervals of  two or
 three hours, or longer, throughout the attack.   The dose varies with
 the age  of  the child; the frequency of its administration depends
 largely upon its  effect.  To  infants of  two or three years a dose of
 from  1 to  2 grains may be given, the  dosage  being gradually in-
creased with older children; that for adolescents reaching 5 graius. 
SCARLET FEVER.
597
The tranquillizing and sleep-producing effects of the drug are, in
most  instances, promptly realized, the patient  falling into a condition
of quietude instead of  the  restlessness and jactitation which are so
distressing in the well-developed disease.
  " The repetition of the dose should  not  be more frequent than is
necessary to maintain  this  condition of  quietude, a  condition  from
which the patient  may be easily aroused, and  into which he quickly
relapses Avhen left undisturbed.  It is neither  necessary nor desirable
to push  the drug  to the establishment  of a deeper sleep.  Profound
narcotism  is,  of course, to  be avoided.   The patient  may thus  be
kept in a condition of light  repose  throughout the whole duration of
the fever.   By this means not only is there obtained  relief from the
restlessness and distress of  the  active  period of disease,  but  much
wear  and tear of  the nervous   system, and  some exhaustion  from
muscular effort, are prevented.   Delirium  is controlled; the itching
and burning of the skin,  due  to the eruption, are allayed;  in a word,
the greater number of the  distressing  symptoms of  the disease are
favorably influenced by the  cautious and prolonged administration of
chloral hydrate in efficient doses."
  As  a  rule, the drug is easy of administration, and Avell borne by
the stomach.  Wilson has found its  acrid after-taste best masked by
its administration in Aubergier's  syrup  of lactucarium, diluted, thus :
         R.—Chloralis.......gr. xxx.
             Syrup, lactucarii  (Auberarier) 1  ..   »z    i^z-     ivr
             Aqu£          ^     *   7  aa  fgss-velfgj.     M.
    S.—A teaspoonful in iced water  every two, three, or four hours.

  " The administration of  nourishment immediately after the  medi-
cine is desirable.   The sleep-inducing properties of the drug manifest
themselves  rapidly, but are not  prolonged;  therefore,  its repetition
at intervals of two or three  hours is called for."
  From the very beginning of an  attack  to its end, unless diabetes
comes on, the child should  be supplied with plenty  of pure water,
and, if possible, this  water should  be  obtained from a spring con-
taining a Ioav percentage of solids, as Poland water, Avhich is widely
sold throughout this country.  If this is impossible, then Vichy water
may be  employed, or it may be used  by  obtaining  the granulated
Vichy salts sold by most large drug firms, and  adding this in small
amounts to pure filtered water.  This makes  an effervescing draught
which may be taken Avhile bubbling or not,  as the child desires.  The
object of this treatment is  to flush out the kidneys, and so to dilute the
effete matters, generated in the body by  the fever and the  germs of the
disease, that they lose, to  a great extent at least, their poisonous  and
irritating poAvers.
  In  other cases a prescription containing  sweet spirit of nitre and
citrate of potassium proves useful, as folloAvs :
         R.—Spt. aether, nitros......fgj.
             Potassii citratis......J^ij.
             Aquae......q. s. ad fjvj.     M.
    S.—Teaspoonful every two hours if urine is high-colored. 
598
DISEASES.
   The convulsions Avhich sometimes usher  in an attack are to be
treated by 5-grain doses of chloral and 10 to 20 grains of bromide of
sodium for  a child of  five to eight  years.  The convulsions of the
advanced stages are often  ursemic, and must be treated appropriately.
   The further  treatment of  the disease  rests upon  the  symptoms
alone.   We cannot cure  the  patient by the use of remedies, but we
can do much toward making the pathway to health smooth  and free
from pitfalls and obstructions.
   Probably the most common  complications  calling  for  treatment,
when the kidneys have been treated in  the way just  spoken of, are
high temperature, or fever, and sore-throat or  angina.   The fever  is
to be controlled in these  cases in precisely the same way that it is in
all other conditions in which it  is present.   It is best to  attempt to
keep it down  below  101°, or at least below 102°,  by  tepid sponging,
which  also  allays the  itching of the skin ; or, if the  fever still rises,
by the use of colder Avater, or even the cold pack, if the parents will
allow it.  Generally the popular fear  that the  applicatiou  of cold to
the surface will drive the eruption " iiiAvard " is so strong as  to make
the  cold pack objectionable in  the eyes  of the friends ; but, if the
temperature reaches 105°, the physician  must assert  the  fallacy of
this  belief,  and insist on its  use.  (See  Cold  Pack, page  352.)  If
suppression  of the rash does occur, Ave must use the Avet pack.  Anti-
pyrine and  acetanilide, to be sure, may both be used; but it is Avorthy
of note that each of these may produce collapse, or other  complica-
tion, if  large doses are necessitated by  obstinate  high temperature.
If these complications ensue, alcohol  will  be indicated.   Quinine has
been highly recommended  as  an antipyretic in scarlet fever,  but it is
of little value in the majority of cases, simply disordering the  stomach
and  irritating the kidneys, if used in doses large enough to be effective.
Where  the  head seems to be particularly hot and the fever is high,
an ice-bag or a head-coil of  rubber tubing is to  be  employed, and
through the latter Avater may be circulated at Avhatever temperature is
thought best.   (See Cold, page 347.)
   The treatment of the sore-throat of scarlet  fever is an  important
part of the care of the child in many cases.  Small pellets of ice may
be held in the mouth, and au ice-bag applied to the  outside of the
throat.   This is done by finely breaking up some  ice  and  placing  it
in a thin India-rubber bag about the neck, the surface of  the  bag
being covered by a cloth, to prevent too rapid  melting of the ice and
the wetting of the clotbes by the condensation of moisture on the
face  of the bag.  This treatment  should be  used during  the entire
attack, if needed, and the contents of the bag renewed as  often as
the water becomes at all warm from the heat of the body.  By this
means  the redness of the fauces  and the swelling of the glands of
the neck are prevented or relieved.   Chlorate of potassium may be
used in a spray or on a swab, but  never internally, owing to its irri-
tant  effects upon the kidneys aud stomach and its general influence on
the blood.
  In some cases where the eruption fades, or is never very prominent, 
SCIATICA.
599
it is of the greatest  importance that it be made active.  Under these
circumstances the child  may be placed in the warm wet pack, and, if
the head is very hot, cold applied to the vertex and throat, Avhile the
body is enveloped in the blauket.   (See Heat.)  This often brings out
in an hour or two a  bright scarlet  rash, and the child falls asleep and
Avakes up free from delirium and high fever.
   The itching and burning of  the skin in many cases  of scarlet fever
are annoying symptoms, aud they may become really dangerous.  The
author has recently carried out a series of experiments showing that
fever of  high degree can be brought on solely through nervous irri-
tation, thus explaining a fact long well known to  clinicians,  namely,
that the relief of this dermal irritation  in scarlet fever may be folloAved
by a fall  of temperature.  To relieve this symptom  it will often be
found advisable  to cover the entire skin Avith a thin layer of vaseline
or  cosmoline, or benzoated  lard, or, in other cases, as an antiseptic
and local anaesthetic, carbolized oil may be  applied (2 drops of car-
bolic  acid to  each  2 ounces of olive oil).  In  other cases almond oil
may be used.
   If nephritis comes on  aud is a pressing condition the greatest care
is  necessary, and  the object of the physician must be to make the skin,
disabled as it  is, carry out a sufficiently active eliminative  function to
relieve the kidneys  of any strain, to relieve dropsy, and to aid in the
removal  of effete matter by producing catharsis.   These effects are
best attained  by  the use of pilocarpine :  \ grain by the mouth, for a
child of ten years, or fa grain hypodermically.  If cardiac weakness
exists this drug cannot be given,  and we are forced to  the use  of from
5  to  10  grains  of  compound jalap  poAvder to  a child of  ten  or
twelve years,  to  which  should be  added 10  graius  of bitartrate of
potassium to  increase its efficiency.   SAveating may also be produced
by the employment of heat obtained by the use of bottles of hot water
or  hot  bricks placed about the  patient, who is  first  wrapped  in
blankets  so that the bottles cannot burn  the skin and so arranged
that sweating will come on.   The thermometer must be placed in the
mouth to foretell  any danger from heat-stroke if the sweat should  fail
to appear.  In such cases the hot pack is  of great value.   (See Heat.)
   The after-treatment of scarlet fever, during convalescence,  consists
in the use of Basham's mixture or the tincture of the chloride of iron
and in  the employment of simple bitters,  strychnine,  or quinine.
Fresh air, sea air, or mountain air are useful, while cold or exposure
to cold air or draughts is to be  carefully guarded against.
                           SCIATICA.

  Sciatica  is  an exceedingly obstinate  affection, in the majority of
cases  resisting the best  treatment  for Aveeks.  It seems  to be due to
rheumatic  taint in the majority of instances, and may sometimes be
cured by the  remedies used and described under the heading of acute
or chronic rheumatism.   In  other instances it  is  due to injury or 
600
DISEASES.
jarring of the  nerve, as by heavy persons  stepping off from a high
step to the hard  ground.   Thus the most obstinate case ever seen by
the Avriter was one in which a stout man AA^eighing  about 250 pounds
acted  as " coupler"  on a switching engine,  and though Avonderfully
agile  for  his Aveight,  provoked  the  disease in the leg  on Avhich he
always first struck the ground when jumping from  the platform of the
moving locomotive.
   The treatment  for all cases is  both internal and  external.   The in-
ternal treatment  may be the same as that already described  under
acute or chronic rheumatism, or in other instances consists in the use
of large doses of bitartrate or citrate  of potassium, 40 grains three
times  a day in plenty of  water  to  aid  in  the maintenance of  free
kidney action.   At the same time the amount of coffee and tea should
be cut doAvn as much as  possible, and  lemonade, strongly acid, be
taken  freely during the day.  If the  pain is  very excessive, morphine
should be given, or antipyrine or acetanilide  may be used.
   The local treatment of sciatica is quite various.  One of the favorite
methods is to  inject deeply into the flesh, just  over or about the exit
of the nerve from the pelvis, 10  to 20 minims  of  chloroform, or, in-
stead of the chloroform, ^  to \ grain of morphine in  30 minims of
water  which  has first been  distilled  and  sterilized,  may  be  used
with  equally good  results aud   less danger  of  sloughing.  Other
physicians prefer  acupuncture, the needle being  driven down until
the sheath of the nerve is punctured.   Still  another useful method is
to take a strong glass rod with a round, smooth end,  and after anointing
the skin over the course of the nerve with a little  ichthyol ointment
or lard, to pass the end of the rod back aud forth over the tender area,
using  as much pressure as can be borne.  By this  means massage or
pressure on the nerve is accomplished.   Iu other cases the daily use of
an ether or rhigolene  spray over the part is effective, or kataphoresis
may be resorted to.
   The liniments recommended in chronic rheumatism may be tried,
and  cod-liver oil  is of service in obstinate cases.   Sometimes nerve-
stretching must be performed before a cure is effected.
   Gundrum has employed wet cupping over  the course of the diseased
nerve to the number of 5 to 10 cups with very  extraordinary results.


                          SCLERITIS.

   Scleritis, or  inflammation of  the sclera,  consists in  a  bluish-red,
somewhat elevated patch, with implication of the overlying episcleral
tissue  (episcleritis).  In the earlier stages pain and photophobia, if
present, require  atropine and boric acid and compresses of hot water;
later, the infiltration may be subdued Avith yellow oxide of mercury
ointment, associated  with massage.  If the disease  spread and  impli-
cate the cornea and  iris, the treatment useful in ordinary iritis is in-
dicated.  In stubborn  episcleritis, without iritis, which does not yield
to these measures, eserine, usually accompanied by pilocarpine sweats, 
SCROFULOSIS.
601
should be tried, and even the actual  cautery has been recommended.
The disease in many instances is associated with rheumatism, syphilis,
scrofula, anaemia, and menstrual disorders—these must always receive
the needed constitutional treatment, especially if iritis or keratitis ensue.
Scleritis  is a disease hard to eradicate and subject to frequent relapses.
                         SCROFULOSIS.

   Scrofulosis is to be treated by hygienic measures rather than drugs ;
fresh air, residence by the  sea-side, proper out-door exercise, massage,
and dietetics, all of Avhich take precedence of medicines.
   If these necessary adjuncts to a cure are  obtainable the prognosis
is fair, to say the least, and the following drugs may be used, all of
them being  devoted to the improvement of the general  health, aud
not to any direct  influence over the scrofulous tendency in itself.   It
is hardly necessary to state that cod-liver oil, or its supposed active
principles combined under the name of morrhuol, is, perhaps, the best
remedy of all.  The oil should  be given in emulsion, being first pan-
creatized and so prepared as to be somewhat palatable, by the addition
of flavoring substances, if the child is old enough to appreciate such
flavors.  In  young children, Avhile distaste to the oil is often shown at
first,  a liking for it  rapidly develops, so that  the writer has seen chil-
dren  cry for it when the oil was  discontinued.   It is nearly always
best to combine the lactophosphates or the  hypophosphites with  the
oil when it is given in these cases.   Whenever anaemia is present  syrup
of the iodide of iron is useful in  from 1 to 10-drop doses, according to
the age of the child, as follows :
         R.—Syrupi ferri iodidi .   .   .    .  fgss vel f ,^ij.
             Aquae dest......q. s. ad fgiij.    M.
    S.—Teaspoonful in water three times a day, after meals, to a child of one year.

   In these same cases fa grain  of  arsenious acid or the -fa^ grain of
corrosive sublimate may be given  to  a child of three  or  four years,
in the form of tablet triturates,  or  the following prescription  may be
used :
         R.—Liquor, potassii arsenitis  ....   Tltxvj.
             Aquae destillat.......f ^ ij.     M.
    S.—Teaspoonful three times a day, after food.
         R.—Hydrarg. chlor. corros.  .    .    .  gr. T\j vel gr \.
             Aquae destillat.......fgij    M.
    S.—Teaspoonful every five hours,  after food.

   The use of the iodides is  generally contra-indicated in those cases
where softening  and  breaking doAvn of the  glands are  going  on
rapidly.   In their place Ave  may employ the phosphates of lime  or
sodium in from 1 to 2-grain doses several times a day, and if suppu-
ration is active the sulphurate of calcium, given  by placing 1 grain of
it in  half a  tumblerful of water  and giving a teaspoonful  hourly. 
602
DISEASES.
 This mixture should be made fresh every day to prevent its becoming
 oxidized.
   Where enlargement of the cervical glands takes place, iodine oint-
 ment, diluted with  one-half of lard, should  be well rubbed into the
 part  twice  daily, but stopped  at once if any signs of softening or
 fluctuation  appear, or if the skin becomes reddened.   Where these
 enlargements are persistent, ichthyol ointment is to be  rubbed in and
 ordered as follows:
         R.—Ichthyol.......3 j vel ij
             Adipis........gj.    M.
    S.—Apply locally.

   If this is not followed by a cure, the glands should be  excised or
 scraped  and the cavity packed Avith iodoform, as  in the majority of
 cases  these bodies Avill  be found to  be distinctly tuberculous.  (See
 Adenitis.)

                            SCURVY.

   Scorbutus is caused so frequently by dietectic  laAvlessness and its
 cure  is so  completely dependent  upon  the use of proper foods that
 almost no  drugs are to be  employed in its treatment.   The  avoidance
 of all salt meats, or  more important still, the avoidance  of those foods,
 be they A\diat they may, which have caused the disease iu a given case,
 is to be practised.
   The only remedies particularly indicated  are lemon-juice or lime-
 juice, or citric acid, the latter being far less valuable in all cases than
 the juice of the fresh fruit.  Where lemon-juice  causes indigestion,
 this effect may be avoided  by boiling the lemonade and allowing it to
 cool.  The boiling  precipitates certain poisonous and  irritating albu-
 minoids and  the supernatant liquid when taken aAvay is  devoid of
 any evil influence, and may he cooled and sweetened to suit the taste
 of the individual concerned.  Arsenic and iron are of service in most
 cases, and rest and quiet are to be insisted upon.


                             SHOCK.

   The medical treatment  of shock is very important, and the life of
 the patient depends upon the care exercised by the attendant;  but before
 describing the treatment it is in place to consider the causes of the con-
 dition and the state  of the injured person, so that we may understand
 the methods indicated.  Every physiologist recognizes the fact that the
 body, particularly in its most vital parts, is  controlled by  inhibitory
 and accelerator nerves or  nerve cells, which  govern the functions of
 all organs.   Normally these two  forces  of inhibition and acceleration
 act in such a way as to be  perfectly balanced, but abnormally they may
 either of them  become excessive and overcome the other.   Further
"than  this,  we must  remember that all conditions  of great functional 
SHOCK.                         603
activity are ultimately followed by a reaction which amounts  to  de-
pression or exhaustion.
  Shock consists in an  over-stimulation of the inhibitory apparatus
which  governs the heart aud respiration, ultimately followed  by  ex-
haustion of inhibition, so that the pulse and  breathing become rapid
and shallow instead of slow.   Various degrees of shock can be readily
recognized and  the severity of the condition always depends upon
the constitution of the individual.   Everyone has heard a nervous
woman say:  " You frightened  me so that my heart stood still," and
again,  a moment after :  " Just feel how fast  my heart is beating," and
we  all of us  know how any severe and sudden  shock  causes these
changes to appear in the pulse to some degree.   The same mechanism
is the cause of shock in railway, or other  injuries, only  it  is much
more severe, OAving to  the actual injury received, and its accompany-
ing terrors.   Many of the  readers of this  book probably know that
a violent blow upon the belly Avail, just over the solar  plexus, Avill
cause death, even in so large an animal as the ox, and every boy  has
had the " breath knocked out of him " by a blow of sufficient feeble-
ness not to be  lethal in  its influence.   When a dog or other  animal
is examined after  such  a death, the heart  is  always found in Avide
diastole, because the excited vagus nerve  has  held  it open in diastole
and  prevented contraction until the absence of  blood  in the brain
has resulted in death.
  This period of inhibitory excitement, Avhen  it occurs in man with-
out being severe enough to cause death, speedily gives place  to inhib-
itory exhaustion, and we have  a rapid pulse  from inhibitory palsy,
while through the palsy of the vasomotor system the bloodvessels are
relaxed and the normal resistance to the heart is  taken  away.  The
heart  beats wildly  and  fast  for the same reason  that a locomotive's
wheels fly round when the track is  slippery—or, in other  words,
normal resistance is lost.
  The capillaries in the second stage of shock are dilated, and the skin
is relaxed, moist, and cold from  excessive dissipation of heat.  This
is the more  prolonged stage of the  two, but  they both  need active
treatment.
  The patient will  rarely be seen in the first  stage of shock,  simply
because by the time the physician reaches him the second stage will
have come on.   In either event, the principal things to  be done are
the administration  of fa to fa grain of sulphate of atropine  hypoder-
mically, and the application of external  heat to maintain the bodily
temperature, the fall of which is a factor of  great importance, but gen-
erally  overlooked in attending  to an operation or other measures of
relief.   The  use of atropine is  peculiarly a triumph of experimental
therapeutics and rests upon logical deduction.   It will be remembered
that atropine  in full dose acts as a depressant to the vagus nerve,  and
as this nerve is over-active in the first  stage,  the drug acts as a seda-
tive to it.  This is, however, a comparatively unimportant fact, for it
is another action of atropine which makes it valuable.  If the vagus
be very much stimulated, a  safe dose  of atropine cannot quiet it,  but 
604                        DISEASES.
in the second stage, which Ave most commonly have to treat, a  safe
dose does not act so much upon the vagus as upon the vasomotor sys-
tem, and by preventing the dilatation of the bloodvessels of the body
thereby provides blood-paths of normal tone and tenseness, Avhich do
not hold all  the blood in stagnant pools Avhere it  is  not needed, but
carry it to the brain and vital parts.  Digitalis is a useful adjuvant to
atropine in the second stage of shock because of its poAverful vasomotor
and  cardiac  influence.   Twenty  drops  of the tincture of digitalis
should  be given hypodermically and repeated in an hour if the pulse
does not shoAV the influence of the drug at the end  of that time.
  The application of heat in the form of hot-water cans, hot bricks
or bottles, must  not be forgotten, care being taken that the patient is
not burned.   (See article on Heat, page 360.)
                          SMALLPOX.

   The treatment of smallpox is not specific, simply because it is one of
 those diseases which  run a given  course, and which Ave cannot abort.
 We can only treat the various symptoms which present themselves,
 and by the modification of these manifestations prevent complications
 and sequelae to some extent.   The fever is to be treated as is any fever
 of this class.  Often it can  be allayed by a mixture containing tinc-
 ture of aconite, spirit of nitre, and spirit of Mindererus (liquor ammonii
 acetatis), Avhile the headache  or backache  may be controlled by antipy-
 rine or acetanilide.  Mustard plasters are not to be used  for the back-
 ache, as the dermal irritation will increase the eruption.  Insomnia and
 restlessness, if excessive,  are to be quieted by the bromides or chloral,
 care being taken that  the doses of  the latter are not  large enough to
 depress the heart.  It must  be remembered that the time of onset of
 the_ secondary feyer, the eighth day, is  one  of grave import to  the
 patient.   Before its arrival the treatment of the case must be so man-
 aged that strength is saved for this strain, and tincture of the chloride
 of iron, in 5 to 10 or even 20-drop  doses, may be resorted to to give
 strength to the patient and to affect specifically the pyaemic fever. The
 pulse should be watched, and  if it  flags, brandy and whiskey should
 be freely but wisely  used.   At the same  time nourishment in  the
 shape  of  egguog, milk punch, or  beef-tea, should be pushed as freely
 as the digestion will alloAV.
   The peripheral irritation and itching of the eruption are a cause of
 the fever in part, and produce  much unrest and nervous irritability.
 The condition of the skin is,  therefore, to be looked after, and the pit-
 ting prevented, if possible, by eA-ery means  in our poAver, particular
 care being taken to prevent its appearing on  the  face.   One  of  the
 means which has  been  recommended to  prevent pitting is the use of
 flexible collodion,  and  another application is glycerite  of  starch  or
 simple cerate applied in a  heavy coating.   Some physicians recommend
 inserting the tip of a nitrate of silver stick into each vesicle as it rup-
tures, to prevent pitting.   All of these measures are futile iu most cases, 
STOMATITIS.
605
and the use of collodion is probably harmful in some instances.   The
best application to use is made up of 4 parts of  salicylic acid to 100
parts of vaseline or cold cream.  Sometimes, anointing the entire body
with  SAveet  oil slightly carbolized  (1 to 100) is useful to check  irri-
tation.
   If the  mouth is sore, a mouth-wash  of chlorate of potassium and
water may be used, flavored Avith a little tincture  of myrrh.
   Disinfection, good  ventilation, and the avoidance of much light are
necessary.

                     STINGS AND  BITES.

   The stings of nearly all small animals depend for their activity upon
formic acid, and are to be relieved by the use of dilute alkaline liquids,
or, better still, by the application of ammonia, or, instead, an applica-
tion of ordinary or flexible collodion may be made, which is improved
in its action by the addition of 1 part of mercury  bichloride to 1000
of  the  collodion,  or, if  preferred, salicylic acid may be added in the
proportion of 5 grains to the ounce.   Sometimes a solution of carbolic
acid,  1 to 100  or 1 to 50, when sponged over the parts  exposed, not
only  relieves the itching of mosquito bites, but keeps away the mos-
quitoes.   In other instances the stings are relieved  aud  cooled by the
use of dilute or pure  vinegar.
   In snake-bite the  best treatment is  that introduced by Weir Mit-
chell and Reichert, namely, the local application  of permanganate  of
potassium to the part, which should be thoroughly filled with the drug,
and full doses given  hypodermically about the Avound, the salt being
diluted three-fourths  with Avater, and followed by full doses of alcohol
by the mouth.   The  secret  of successful treatment consists, however,
in the use of a ligature or a cleansing of the wound as soon after its
reception  as possible, thereby preventing the absorption of the poison.


                          STOMATITIS.

   This annoying affection  is  most commonly seen in  children, and
is characterized by the appearance on the tip and  sides of the tongue,
lips, and lining membrane of the mouth of small  spots which some-
times have  a reddened zone around  them, and which result in minute
or large ulcers.
   The best treatment, if the kidneys are not acutely inflamed, is the
use of the following  prescription, Avhich largely depends for its value
upon the  potassium salt used :
         R.—Potassii chlorat.......3J.
             Tinct. myrrh.......gtt xx.
             Elixir, calisayae......fgiij-    M.
    S.—Teaspoonful in water every four hours.
  As the chlorate of potassium is eliminated with  the  saliva, it not
only does good Avhen  taken  into the mouth, but is active all the time 
606
DISEASES.
that it  is being eliminated.   If the stomach is disordered, the same
preparation  may be used  as  a mouth-wash.  Often constipation will
exist, and it should be removed by salines or by rhubarb in the form
of the aromatic syrup.   Another  remedy which is very efficient in
stomatitis is borax, used as a mouth-wash, in the strength of 10 to 15
grains to 1 ounce of water and honey, as follows :
         R .—Sodii boratis.......gr. xxx.
             Mel purificati......f.^iij-
             Aquae......q. s. ad  fgiij.    M.
    S.—To be used on a swab or as a mouth-wash every four hours.

   This also may be used internally in adults.
   In many  cases peroxide of hydrogen in the proportion of 1 ounce
of a fifteen-volume solution  to 8 ounces of water  proves a valuable
mouth-wash.
   If the  liver is at fault and is torpid, nitro-muriatic acid is useful,
and when the spots  do not .readily yield to treatment they may be
touched with the tip of a stick of silver  nitrate—which, while it is
momentarily painful, is very efficacious.
   Nearly ahvays with this disease  in  childhood there is considerable
fever, vomiting, and wakefulness at night, with fretfulness aud crying
during  the day and total refusal of food, not because hunger is absent,
but because the  food hurts  the mouth and is rejected with  a cry of
pain as soon as it touches the lips.   The food should be very soft milk
toast for older children, or milk with lime-water in  it in large amount
for infants  fed by the bottle.  If a child at the  breast be attacked, the
mother's  nipple  should be  carefully Avashed with boric acid  solution
after each nursing.   A Avarm foot-bath at night is often necessary to
produce rest, and 10  drops of sweet spirit of nitre thoroughly diluted
may be given Avith advantage to a  child  of  one or two years.   If the
irritability  of the nervous system is excessive, bromide of sodium or
potassium in the dose of from 1 to 10 grains, according to age, three
times a day, is of service, and may be added to the mixtures already
named, or better still, given alone.
   After the attack  is  past,  tonics and  a carefully selected  diet are
generally necessary.

                             STYES.

   Styes consist in a localized inflammation of one of the  glands in
 the margin of the lid or the surrounding  connective tissue.   Before
 suppuration is established abortive treatment may be practised by an
inunction with a salve of the red or yellow oxide of mercury (8 grains
to 1 drachm), by painting  the surface  with an ethereal  solution of
 collodion, or, according to Abadie, by the application of a saturated
 solution  of boric acid.   Pain may be alleviated with hot compresses
(water  110°  F.), frequently changed, and   as  soon  as pus  appears
 incision is necessary.  Associated conjunctivitis requires a boric  acid
 solution for its relief.  It should  be  remembered  that styes indicate 
SUNSTROKE.                       607
ill health,  that tonics are indicated, and  that they  most frequently
appear in the subjects of refractive error.   When they tend to come in
crops, the internal use of sulphurate of calcium has been recommended.
                         SUNSTROKE.

  Sunstroke, or, more correctly speaking, heat-stroke, is an  affection
produced  by exposure of the body to any form  of high  temperature,
whether the source  of heat be  the sun, a furnace, or the radiation of
heat from the earth.   For this  reason the condition may  occur  as
readily at midnight as at mid-day.
  Heat-stroke is to be  divided into tAvo classes, in one of which ex-
cessive exposure to heat upsets the balance of the thermal mechanism
of the body so that  fever  comes  on (thermic fever), in the other the
temperature is loAvered,  and forms  the condition known  as  heat-
exhaustion.
  The condition of thermic fever is very frequently seen, while heat-
exhaustion is rare.
  The danger of thermic fever  is that the excessive heat may cause
coagulation of the myosin in the heart muscle and of  the protoplasm
in the brain, and cause death, or that the same result may be reached
by paralysis of respiration.
  The danger of heat-exhaustion is that death may ensue from collapse
due to a general failure of vital  power  aud  the chilling of the body.
In  heat-exhaustion, too, the vascular system is greatly relaxed and
depressed, and the circulation is  at its lowest ebb.
  The treatment of these two  states is, of course, radically  different.
When a patient has thermic feA^er, and  is brought under the care of
the physician, the first thing to be done is to loosen the clothing—if
possible, remove it—at the same time applying  cold to the body, and
particularly to the  abdomen, back, and chest.  Better still, the  man
should be stripped, laid  upon a  bed, which must be  covered Avith a
rubber blanket, and ice-water  be applied  to the body by means of a
sponge,  or a piece of ice may be laid on the belly, while another  piece
is rubbed over the rest of the body.   While this is being  done the
surface of the patient's body must be thoroughly and briskly rubbed
in order to bring the hot blood to the cooled surface.
  Care  should be taken that the temperature, when it once  begins to
fall, does  not drop suddenly below the normal and cause collapse.  If
the clinical thermometer in the mouth or rectum  shows  that the
temperature has  fallen to  100.5° F.  or 101°  F., the cold  applica-
tion should be stopped, and the patient  allowed to  lie on  the bed
covered Avith a thin sheet only.    The bodily temperature must be con-
stantly watched, as it will probably bound up again in a few minutes,
and require  the  application  of more cold, used with the same care.
This  second rise is due either to the disorder of the nervous mechan-
ism of heat production  and  dissipation, or to the fact that, while the
surface of the body is  cooled by the ice, the innermost  viscera are still 
608
DISEASES.
in high fever and rapidly heat  the  surface as soon as the ice is taken
away.   Antipyretics have been found to be almost useless in the hyper-
pyrexia of sunstroke, and, at their best, are not to be relied  upon.
   After the fever has been reduced permanently, the danger is not all
passed, and it is the greatest mistake to discharge a patient as cured at
this time.  After two or three days it is very common for a meningitis
to  develop, accompanied, it  may be, by little or no fever,  but char-
acterized  by  violent  darting headache, which is  made worse on lying
down or on sudden movement.  The treatment of this state must be
bold, and venesection is the  only safe method  of obtaining relief,
although vascular sedatives, such as veratrum viride, may be employed.
The bleeding should  be copious  enough  to  impress the circulatory
system to some degree, and may be done by opening any of the promi-
nent veins in the arm. (See Venesection.)  Sometimes a violent attack
of epistaxis saves the man's life, Avhen it would have been lost through
the ignorance of  his  attendant.   If life is  preserved without vascular
depletion, secondary changes  in  the brain  may  ensue and produce
hemianopsia, optic atrophy, imbecility, or insanity.  Quinine, salicylic
acid, and  similar  substances, are all  contra-indicated  under these cir-
cumstances, because  of the congestion of the  meninges  to Avhich  they
predispose by their  physiological effects.
   The treatment  of heat-exhaustion consists in the use of  heat instead
of cold, in order to restore the bodily temperature.   Just here, however,
must be uttered a word of warning, namely,  that  the mere  fact that
the skin is cold does  not  prove the case to be one of  heat-exhaustion,
since a rectal thermometer may show the central or real  temperature
of the body to be in a condition of hyperpyrexia.   Of  course, such a
case should not receive hot, but cold rectal  injections, if the symptoms
require it.
   The bodily heat in heat-exhaustion is to  be raised  by  placiug the
patient  in a  bath at 105° to  110°, or by the use  of hot bricks or
bottles, care  being   taken that they do not burn the  patient.   The
bodily temperature  should also be watched, lest the other  extreme of
heat be reached.
   Cases of heat-exhaustion are not so apt to have meningitis  as are
cases  of sunstroke,  but they  are generally  slow to convalesce, and
require tonics and careful watching for a long time.  Indeed, in many
instances,  the system seems to receive a shock from which it takes
several weeks or months to recover.
                           SYPHILIS.

   In so far  as  the choice of  drugs is concerned, the treatment of
syphilis is exceedingly simple:  iodine, iodide of potassium, and mer-
cury practically represent  the  only  remedial  agents which are well
proved to possess the power of distinctly counteracting the effects of
the disease.
   In regard  to  the method of administration, and the period of the 
SYPHILIS.
609
disease in Avhich any or all of these drugs cau be given to the best
advantage, there  is  a  Avide  diversity of  opinion.  FolloAving the
teaching of Fournier, in this country the practice generally obtains
of administering mercury on the appearance of the first symptoms of
the secondary  stage  of syphilis ;  this  drug  is continued  for  from
tAvelve to eighteen months, and is then folloAved by a course of iodide
of potassium continued for from  six to tAvelve months.   If, after the
suspension of this treatment for six months, no manifestatious of dis-
ease appear, the patient is  regarded as cured.  Should  the disease
again break out,  the iodides are administered in increasing doses, sup-
plemented by tbe addition of mercury if necessary.
   Against this treatment, however, there have been many and vigor-
ous protests.   Every  syphilographer  knows that the disease is fre-
quently self-limited.   Zeissl states that a large number of cases pro-
gress to spontaneous cure, and that the secondary eruption in such
cases disappears in from  tAvo  to eight  months, after  which time the
patient is perfectly Avell, recidivity being far less common than Avhen
mercury has been employed  in the early stages of the disease.  The
treatment  by iodides, he thinks, should be commended  chiefly  after
the expectant plan; their effect is not so rapid as is that of  mercury;
they are  suitable, however, to all  stages  of the  disease.   When the
symptoms become so urgent that it is no  longer safe to depend upon
iodides, mercurial inunctions should be employed, the dosage of the
drug being regulated by its effect upon the symptoms, in all cases the
minimum  quantity necessary to accomplish  the result being adminis-
tered.
   We have, then, three  methods  of treatment proposed, each  advo-
cated by a formidable array of authorities :
   1. The expectant treatment.
   2. The  treatment by iodides, followed, if necessary, by mercury.
   3. The  continued  treatment, beginning with mercury, and ending
Avith iodide or the combination of the two drugs.
   By the expectant treatment  is implied  abstinence from all medica-
tion intended  to directly counteract the  syphilitic ATirus ;  if possible
the patient should lead an active, out-of-door life, the diet  should be
most carefully regulated,  and the treatment should be purely symp-
tomatic, tonics being administered  when required,  the sore-throat
being  combated  by astringent gargles,  particularly  those  containing
chlorate of potassium or malic acid, together with direct local applica-
tions, Avhile  the  eruption  on the exposed parts  of the body is con-
trolled by the  application of heat.  The  objection  to this  treatment
lies  in  the long persistence of the secondary eruption.   Where the
primary lesion is large and persistent;  Avhere the period of secondary
incubation is  less than seven Aveeks;  Avhere the  papular eruption  is
universal, is confluent, aud  is accompanied by the simultaneous ap-
pearance  of mucous patches;  Avhere  the lymphatic enlargement  is
very marked and persistent; and where the disease attacks a depraved
constitution, the  expectant plan  offers little hope of accomplishing a
                                 39 
610
DISEASES.
cure.   Here the second  and third methods  of treatment are clearly
indicated.
  By the second plan of treatment the iodides are administered, not
immediately on the  appearance of the secondary eruption, but after
this has  run  a course of several weeks, and is steadily increasing in
severity.  The iodide of potassium is chosen by preference, beginning
with the administration of 5 grains, three times a day, and increasing
steadily 5 grains a  day until either  the constitutional effects  of the
drug are manifested or the symptoms are favorably influenced. Should
iodism appear, the dose  is cut down one-half, and continued for one
or two Aveeks, after which, if the syphilitic lesions  are not favorably
modified, inunctions  of mercury are employed,  a drachm of mercurial
ointment being rubbed  in  every  other day.   The iodide should  be
continued for from six to twelve months after the disappearance of all
symptoms, relapses  being combated by  temporarily increasing  the
dose and by a course of mercurial inunctions.   If after the suspension
of the treatment the patient remains free  from all  manifestations of
syphilis for two years he can be fairly considered as cured.
  By the third method  of  treatment, and this is  the method most
commonly accepted  in practice, the patient is  placed upon  mercury
the moment the early secondary symptoms denote that the  primary
sore was surely syphilitic.  Many surgeons begin this treatment from
the time that the inguinal glands on both  sides become characteristic
in shape aud  size.   Others wait until there is  general lymphatic in-
volvement, while others believe that the mercury  should  not  be
administered  until roseola appears.
  In  regard  to the  particular preparations  of mercury to be  em-
ployed, the protiodide, blue mass, bichloride, and the  mild  chloride
represent the  forms  usually employed Avhen the drug is administered
by the stomach.   Of these the protiodide  is to be preferred, and  the
effort of the  surgeon  is directed  first toward determining what is
termed  the "tonic"  dose.   With this end in  view, f- grain of the
protiodide of mercury  is given, in pill form, three times  a day;  and
every second  day this  quantity is increased by one pill, the patient
being meamvhile carefully watched.   The  drug usually manifests its
physiological effects  by griping pains accompanied  by two  or more
watery passages  from the bowels, or by foetid  breath and slight ten-
derness of the gums.   The  quantity taken  to  produce this effect
represents the extreme  limit to which it is  safe to push the drug.   If
this  dose is  continued or increased  the  characteristic symptoms of
mercuric saturation  appear.  When the  surgeon  has determined  the
limit to which the drug can be safely pushed, this dose  is cut down
one-half, and, in the absence of further complications, the patient is
directed to continue  this treatment for eighteen months.   If, during
this  time local symptoms appear, Avhich  shoAV that the disease is not
thoroughly under control, the mercury must  again be pushed to  the
full dose, being reduced to the tonic dose as soon as the disappearance
of specific lesions permits of this.  Where comparatively small doses
of the protiodide produce pain and purging, opium may be added; in 
SYPHILIS.                        611
this  case the breath  and the mouth will show when the full effect of
the ^medicine  is  obtained.   Manifestations  of the disease  occurring
during mercuric treatmeut must receive local treatment.  The surface
eruption is combated by mercuric ointments and washes, and by the
application of heat.   (See Heat.)   Mucous patches in the mouth are
quickly healed by applications of solid nitrate of silver or sulphate of
copper, 20 per cent,  chromic acid solution, or the acid nitrate of mer-
cury.  AVhen  these  patches occur about the genitals, washing Avith
1 :2000  bichloride solution and  dusting Avith calomel and bismuth
Avill be found satisfactory.  Alopecia is combated  by shampooing and
by the application of strong stimulating  lotions containing croton oil
or tincture of cantharides.
   The  intense  cephalalgia is  combated  by ^ grain  doses of calomel,
repeated every tAvo  hours.   The periostitis  yields  most readily to
gentle long-continued mercuric inunction, supplemented by the appli-
cation of pressure bandages.
   When the integrity of any vital organ is threatened there should
be no hesitation in pushing the mercury treatment aud in supplement-
ing it, if favorable results  do not follow promptly, by large doses of
iodide of potassium.
   After the first eighteen months  iodide of potassium is generally in-
dicated.   This  is commonly given together Avith the mercury, consti-
tuting the mixed treatment.  The folloAving formula, or one similar to
it, may be employed :

         R.—Potassii iodidi.....^ij vel 3 iv.
             Hydrarg. chlor. corros.    ....   gr. ss.
             Syrup, aurant cort......fgj.
             Aquae......q. s. ad  fgij.     M.
    S.—Teaspoonful three times a day.

   When  this  prescription  is put up, a precipitate is formed and then
dissolved,  and an exceedingly  useful mixture is prepared.
   This mixture, or iodide of potassium Avithout the  mercury, admin-
istered in  5 to 10-grain doses  three times a day, is given for from six
to tAvelve  months  longer.   When the iodide is given alone it is most
conveniently administered in  the  form  of a saturated solution.  Of
this  a drop contains a grain of the  salt.   Milk seems to have the
poAver of  completely disguising  the  disagreeable taste  of the  drug.
Thereafter, specific  treatment is stopped,  unless symptoms arise, in
which case it  should be reneAved, and should be continued for many
months.
   The protiodide is  usually preferred,  because  the symptoms of its
constitutional  effect  are manifest  at first in the bowels, and because,
in  practice, it  has  been  found one  of  the most satisfactory  of all
preparations.   Where this  form  of mercury  is not Avell borne, the
physician  should at ouce employ some  other  salt;  the bichloride, in
fa grain doses three  times a day, is efficacious.   Blue mass Avill often
act favorably when other preparations cannot be tolerated.   Its com- 
612
DISEASES.
bination with  iron is desirable, and the following formula represents
one of the most valuable of the antisyphilitic pills :

         R.—Mass. hydrargyri.....gr. xxiv.
            Pulv. ferri chloridi.....gr. xij.   M.
    Ft. in pil. no. xii.  S—One three times a day.

  Where  mercury cannot  be administered by the mouth it may be
given by means of vapor baths, by inunctions, and by  hypodermic
injections.   The vapor baths are useful when it is desired  to promptly
cure eruptions on the surface of the body, or when it is most impor-
tant to bring  the disease  quickly  under  the  influence of mercury.
They are readily administered, the  only apparatus required being  an
alcohol lamp,  and a plate in which the  mercuric preparation can be
volatilized.  The patient is seated in  a chair entirely naked, several
blankets are wrapped around  his  neck,  and beneath  the  tent  thus
formed a large vessel of steaming water is placed.  When the skin
is thoroughly softened J drachm of calomel is  sublimed by means of
the lamp.   These baths may be repeated every night until  the mer-
curic foetor of the breath is  observed, or until the specific symptoms
disappear.   (See article on Mercury.)
  Inunction represents the most efficient way of administering the mer-
curic treatment.   When the stomach is intolerant of drugs, or when,
administered by the mouth in full doses, they do not favorably modify
the  symptoms, inunctions are   indicated.  The patient is instructed
to take a warm bath, and the mercury  is then well rubbed in over the
inner surface of the  forearm aud arm, the axilla, and along the side
of the chest,  for fifteen minutes.   Either  the  oleate of  mercury, 10
per cent.,  or the  ordinary mercury ointment is  commonly employed;
the former is someAvhat more cleanly.   The rubbings should be done
by  the patient, should be made over a large surface of the body, and
should be performed thoroughly; 1  drachm  of blue  ointment is
rubbed in daily.  A shirt kept for this  purpose  is then  put on next
to the skin, and the ordinary  clothing is Avorn over this.  The next
night  the opposite arm  and side of the  body are utilized as the seat
of inunction; the following  night  the right groin and the inner sur-
face of the  right thigh and  leg; next, the same regions of the oppo-
site side of the body; finally,  the  anterior surface  of  the  chest aud
abdomen.   In this way irritation of the  skin  is avoided.  Where it
is impossible  to  employ the inunctions in this way another means of
causing absorption of mercury through the skin, suggested by Sturgis,
will be found satisfactory.  After  a thorough soaking of  the patient's
feet in hot water, from \ to 1 drachm  of a 20 per cent, oleate of mer-
cury is rubbed vigorously into  the sole of one foot; the next night
the  sole of the other foot is treated  in  the same way.  The patient
is directed to  wear, night and day,  a pair of woollen socks; these  are
not changed for one Aveek.  Mercury may be taken by the mouth at
the same time inunctions are employed, Avhen it is desired to influence 
                            TETANUS.                        613

the system quickly.   In the late  periods of the disease very striking
effects are often obtained by supplementing the iodide treatment by a
course of twelve to eighteen inunctions.
  The  hypodermic administration of mercury is,  in  this country,
limited to those few cases Avhich do  not seem  to respond to the  drug
Avhen  giA^en by  the  mouth or  for  absorption  through  the  skin.
Although  many preparations of mercury  have been lauded as  most
efficacious  Avhen used hypodermically, the best formula seems to  be
that recommended by Hebra.   This consists of a solution of one per
cent,  of bichloride  of  mercury in  a  six  per  cent,  sodium chloride
solution; the resulting mixture is  perfectly clear and  is readily pre-
pared.  If it becomes turbid it should be throAvn aAvay.  Most rigid
antiseptic  precautions must be observed, as abscess  formation is not
uncommon.  One injection is  given daily, from fa to 4; grain of the
sublimate being administered.  The nates are selected as the seat of
the injection, the solution  being driven well into the muscles of each
side every other  day.  Twenty  injections are usually sufficient to
cause the  disappearance of all symptoms.  The employment of the
insoluble  preparations of mercury,  particularly  of calomel,  gives
much pain, frequently causes abscess, and is, at times, attended by a
continuous absorption,  Avhich may produce severe  and  even fatal
ptyalism.
   The  ulcerations often found as tertiary manifestations of the dis-
ease are treated according to  general  surgical principles.   The local
application of mercuric preparations  is of less service than during
the existence of the secondary lesions.   Iodoform is  peculiarly ser-
viceable.
   The  tonic and  general  treatment of syphilitic cases  must not be
forgotten ; fresh  air, exercise,  bathing, careful diet, regular  living, all
must be enjoined.    Moreover,  in certain cases where there  is marked
anaemia or physical weakness,  cod-liver oil, stimulants  in moderation,
compound syrup of the hypophosphites, and other tonic and nutritive
courses of treatment, must be carefully carried out.
   Although the treatment of an ordinary case of syphilis is simple
and satisfactory in its  results, it must be  remembered that there are
malignant forms  of the disease,  attacking by preference  feeble and
cachetic individuals, running a rapid and virulent course unchecked,
nay aggravated, by specific treatment, and  responding feebly, if  at
all, to the most careful hygienic and tonic regimen.


                            TETANUS.

   The treatment  of tetanus is quite  independent of its causation^so
far at least as drugs are concerned, and it is virtually identical with
that of strychnine poisoning, to Avhich the reader is referred.  It is
stated  that Fowler's solution acts almost as  a specific in some  cases.
(See Nux  Vomica.) 
614
DISEASES.
                       TUBERCULOSIS.

  Under this head will be considered pulmonary tuberculosis  as  a
type of all forms  of this  morbid  process.  Its treatment may  be
placed in two  lines—the first devoted to the cure of the disposition
or incliuation toAvard the disease, or the abortion of its early stages;
the second  directed  to the improvement of the patient's condition, so
that his progress through the disease may be made as comfortable as
possible.  Before doing this,  however, it  is proper  to state  that
prophylaxis, or true prevention, is the object really to be sought after.
Recent  studies have  shoAvn most conclusively  that tuberculosis  is
capable of being transmitted  from man to  man  or from husbaud to
wife, if the air laden with the bacilli is  breathed, and if the  lungs
are iu a fit  state of depressed vitality, from any cause, to afford  a
favorable field for  the  groAvth of the germ  and the development of
its poison.
   Cases of pulmonary  consumption  follow, rudely speaking, three
Avell-defined lines.   A very early stage sometimes comes to the care of
the physician, and  it  is that in which the folloAving history is given,
or a similar story is elicited.   A patient, previously strong and Avell,
or of poor health, as  the case may be, begins to lose vivacity.   Life
becomes a  burden aud exercise is distasteful.  A slight daily chill, in
morning or evening, and fever develop, and  the phyiscian who is care-
less treats the case as  one of mild malarial poisoning.   Careful exam-
ination, however, will show an area in the lung, generally near the
apex on either one  or both sides, where slight prolongation or expira-
tion with a harsh inspiratory  sound is heard, and where percussion
will give  impaired resonance  or  dulness.  Iu  other words, the first
stage of phthisis is present, and the physician must resort at once to
those active measures for the patient's relief Avhich will be considered
in a moment.
   In another form a chill, a SAveat, a sudden loss of flesh and vigor,
with, more prominent  than all,  a hard  cough, sudden  in  its  onset
and rapidly  becoming  excessive Avith profuse expectoration, are the
dominant symptoms.   The Avasting  is extraordinary, the sweats are
constant, and death may come in one or  tAvo Aveeks.  This is the
form known as " galloping consumption."
   The third variety is  ushered in by a  gradual  loss  of vigor  or  a
sensation of being a little unwell, or  is brought before the patient's
mind by a sudden acute haemorrhage or several haemorrhages rapidly
succeeding one another.  This variety drags out its course more or
less rapidly.   Sometimes death soon ensues from a fatal haemorrhage,
in other cases the disease keeps on for months and the  case dies  from
exhaustion.
   Last of all, the fourth class is  made up  of persons  who gradually
pass from  bad to worse. First, they " catch a cold," which hangs on
longer than  it ought, and, as  soon as they are Avell, this is folloAved
by another one Avhich is found more difficult to cure, until finally there 
TUBERCULOSIS.
615
is  ahvays  a  cough.  Soon Avasting comes  on, strength is lost, and a
long period  of  months or years ensues during Avhich the progress of
the case is noAV sIoav, now fast, the condition now better, now worse,
until death ensues from wasting or pneumonia,  or some other compli-
cation.
   These forms  and stages  have been roughly outlined, so that a dis-
cussion of their  treatment might be taken up with a clear idea of what
is  to be done.
   When a patient exhibits those physical signs  Avhich have been given
as evidences  of the early beginnings of phthisis, the physician should
institute certain hygienic and medicinal measures.  If the individual
be earning a livelihood by  following  some confining occupation, this
occupation must be given up and one undertaken which is carried on
in the  open air and yet not accompanied by  too great exposure.  Even
if exposure is incurred it is better  than the  occupation previously fol-
loAved  : thus, if the patient be a  bookkeeper, a printer, or a bookbinder,
or a clerk kept much at a desk in an ill-ventilated room.   A few wet-
tings  in the  rain will do little or no harm,  if properly treated by the
Aveariug of flannel shirts, which, Avhen Avet, are changed as soon as labor
ceases, as under these circumstances the danger of catching cold is at a
minimum.   If  the case is wealthy  enough to be  able to obtain a change
of climate and to stop all labor, only taking exercise for pleasure or
health, a change  is, of course,  of  value.   Some  of these patients do
best in a high, dry air, and others  in a lower and more moist tempera-
ture—the  first  being represented  by  that  of Colorado  and Saranac
Lake in the  Adirondacks, the second by that of Florida.
   In the majority of cases, hoAvever, some more moderate, or half and
half, climate is useful, and this  can be obtained in LoAver California,
as at San Diego, a place where there is  virtually perpetual summer.
In other words, a spot is desirable  where a patient can remain the year
round, and,  if  Avell enough, engage  in  business, avoiding the  cold,
sharp  March winds of  the Middle, Eastern, or NorthAvesteru States
and the necessity of leaving Florida on the  advent of summer.
   Physicians have attempted for years to formulate rules for  phthis-
ical patients  as  to the climate to be sought.   In the majority of cases
the various health-resorts  have to  be chosen by  experiment, not by
judgment beforehand.  It is  probably true,  hoAvever,  that high alti-
tudes  and  rarefied air are not to  be sought where a distinct tendency
to haemorrhage  is present, unless the ascent or removal to the  rarefied
air is very gradual, several weeks being passed  before the  lung is ex-
posed  to the  Ioav pressure of great heights.
   The following excellent  and  concise advice, given by Dr. W. Hale
White, in his book on General Therapeutics,1 is so worthy of repeti-
tion that it  is inserted here.   He says:  " It is  of such importance
that ouly suitable cases should be seut to  high altitudes, that Ave  must
point out those that are unsuitable :
   " 1.  Those in Avhom there is considerable affection of the bronchial

    1  A text-book of General Therapeutics.  Macmillan & Co., London, 1889. 
616
DISEASES.
tubes; for the dryness of the climate increases the kind of bronchitis
which commonly accompanies phthisis.
   " 2. Patients with much emphysema or bronchiectasis;  because of
the probably diminished  absorption  of oxygen and the difficulty of
respiration experienced on first arriving.
   " 3. Patients with disease of the heart must not go to a high altitude,
because of its effect upon the pulse and upon respiration.
   " 4. Cases liable to acute febrile attacks, Avhether or not these indi-
cate au occasional increase of mischief in the lungs, should remain on
a low level.
   " 5. Patients who are \Tery excitable or suffer from insomnia should
not go, for a visit to a place at a great elevation promotes these symp-
toms.  Women do not acclimatize so well as  men.
   " 6. Cases in which there are very extensive  lesions,  or Avhich are
very advanced, are unsuitable.
   " 7. Pneumonic phthisis, if at  all acute, is made worse by a high
altitude.
   " 8. Patients who cannot take exercise should not go.
   " 9. The very old and the very young had better be treated at home.
   " 10. Sir Andrew Clark states that patients who go to Alpine health
resorts suffering  from albuminuria,  or those Avho  develop  it whilst
there, seldom deri\Te any good from their change.
   " There are many conditions Avhich  have been thought to contra-
indicate this treatment, but which do not, and they had, therefore,
better be mentioned.  They are :
   " Pulmonary Haemorrhage.—It is now known that this, so far  from
being a contra-indication to treatment by high  altitudes, is actually
relieved by it.  The exact explanation cannot be given."
   (With this the  author of this book cannot agree.)
   " Fever.—If this is not excessive, and if it does not indicate auy
active changes in  the lungs, it is often decreased.
   " Simple Diarrhoea and Simple Dyspepsia.—These  are both benefited.
   " Night-sweats.—There is a common belief that these forbid this
treatment; on the contrary, they often disappear on  removal to a high
altitude.
   " The presence of Cavities.—This  is not a contra-indication, unless
a very large area  of lung is destroyed.
   " There is no need, after  these lists, to say what  cases are suitable
for this climatic  treatment; it may, however, be observed that those
in which there is  threatened phthisis, Avith  a strong  hereditary predis-
position, and those of imperfect thoracic development, are much bene-
fited.   According to most authorities, it cannot be too strongly urged
that, so long as the condition and  disease of the  patient alloAV the re-
verse indications to be neglected, a mountain climate should be tried."
   To  these rules  the  author Avould add the following invariable one,
Ariz., Do  not send a case away to die.   If the disease is so far ad-
vanced that no good can be  derived from a trip abroad, it is  cruel to
make  a Avretched  patient exhaust his  strength,  his money,  and his
happiness by seeking that health  Avhich it is impossible for him to 
TUBERCULOSIS.
617
obtain.   A patient  of the writer's  returned  on one occasion from  a
stay of a few days at a noted  Southern resort for consumptives, and,
when reprimanded  for his imprudence,  replied :  " Doctor,  I would
rather be  at  home, and  die at  once, than drag out a few more years
surrounded by a crowd of coughing, haAvking, and wasting consump-
tives."   This  reply clearly evidences  the necessity  of these cases
avoiding "consumptive resorts" as  much as possible, and of  directing
the mind of the patient  from depressing thoughts  and his  OAvn ail-
ment.
   The  medicinal measures to be carried out in all cases of phthisis,
except that known as the galloping  form, are not numerous if we con-
fine ourselves  to the  modes possessing any real  value.   For  many
years cod-liver oil has been sadly abused in the management of these
cases and has been given  at all stages, OAving to ignorance of its proper
use as a general  rule.  The Avriter believes that the following rules
are never to be departed  from :
   1. Never use cod-liver oil where the disease has passed  the primary
stages  of thickening of the lung and  roughening of the respiratory
sounds, unless fibroid changes are going  on, and the changes are very
slow indeed.
   2.  The use of cod-liver  oil when rapid degenerative  changes are
occurring in the lung is distinctly harmful, as  it is  not  of any service,
disorders the digestion, and destroys  the appetite.
   When  the  oil is  used  it should  be given as directed in the article
on Cod-liver Oil.
   A remedy of much Aralue as a curatiATe and of great value as a pal-
liative  is creasote, first introduced  by  Bouchard some  thirteen years
ago, but  ouly recently Avidely  employed.    Many  cures  have  been
claimed from its use iu the early stages of phthisis and  it  has  been
highly lauded  by a  number of European clinicians.   In the author's
experience it  is  merely a palliative to  the cough and general discom-
fort, at least after  the disease is really established, and the opinion
expressed by Strumpell expresses so Avell the thought Avhich the author
was about to write Avhen he read Striimpell's article that his words are
here given: "Taking it all in  ajl, we find that creasote, even in large
doses, has no injurious effect  in tuberculosis.  At times Ave  notice an
apparently  favorable  symptomatic effect.    We failed, however,  to
observe any real  influence exerted  by creasote on the progress of the
disease."
   When creasote is used internally it  is  best  given in the following
formula:
         R.—Creasoti (beechwood) .    .   gtt. xxxij vel fgj
             Tr. gentian.......f,zj.
             Alcoholis  .......  fgj.
             Vin. albae.....q. s. ad  fgiv    M.
    S.—Teaspoonful in water,  or wine, three times a day.

   Often a 1-drop dose three times  a day may be increased to 5 drops
in the same period with advantage, aud if given in ascending doses I
have frequently had patients take as much  as  90  minims a day, by 
618
DISEASES.
using a little more of the mixture each time it is taken.  Sometimes 1
or 2 drops in capsules are as useful as the formula just named.   (For
methods of administration, see Creasote.)
  Creasote may also be inhaled in the spray from a steam atomizer
or by means of  an inspirator fitted over  the nose and  mouth and
made of perforated  zinc Avith  a sponge at  the edge to hold the drug.
A very good  inhalation is to wet the sponge Avith creasote, alcohol, aud
water, equal  parts, or to use the creasote alone if coughing  is not too
severe.   Another useful mixture consists of equal  parts  of terebene,
iodide of ethyl,  and chloroform.   This last  mixture is  most useful
when the secretion is  tough and tenacious, and should not be used in
the presence  of acute irritation due to inflammation.  These inhalers
are very cheap, not easily broken, and readily Avorn.1
  If the cough  in phthisis  is excessive, a  little  spirit of chloroform
placed on the sponge of the inhaler will often relieve it, or a mixture
of morphine and Avild-cherry bark may be used as folloAvs :
         R.—Morphinae sulph.     .    .    .    gr. j vel ij.
             Syr. pruni Virginianae     .    .,    .   .fgiij.    M.
    S —Teaspoonful every three hours.
Or, the following:
         R.—Potassii cyanidi  ....    gr. j vel ij'.
             Morphinae sulph.     .    .    .    gr. j vel ij.
             Syr. pruni Virginianae     .    .    .   .fgiij.    M.
    S.—Teaspoonful every four hours.
  Very often during the course of phthisis,  localized spots of pleuritic
inflammation arise.   Without the  occurrence of  any exposure the
patient will remark, " Doctor, I think I have taken a little more  cold,
and I have a stitch here iu the chest."  The best treatment is to apply
a small blister or to paint the spot Avith iodine.
  (For the treatment of Haemoptysis, see Haemorrhage.)
  Laryngeal phthisis, one  of the most serious complications of this
disease, is  best prevented by ordering the patient to inhale the steam
arising from boiling water Avhich contains corrosive sublimate in the
proportion of 1 to 10,000.  If a proper watch is kept for evidences of
a general  mercurial effect and this measure  stopped  at  once Avhen
tenderness of the gums appears, no danger exists.   Before the inhala-
tion takes  place,  a spray of cocaine (4 per  cent,  solution)  should be
thoroughly used.
  The  treatment of laryngeal phthisis itself is  various.   The   best
method is that in which lactic acid is used.   By the  aid of a laryngeal
mirror aud a cotton applicator a 10 per cent, solution of lactic acid is
applied to  the spots which are involved.  As this  is generally  quite
painful, cocaine solution should first be used.  Gradually the strength
of the lactic acid solution should be  increased to 60 per cent, if the
weaker solutions do not check  the disease.  Very valuable  results
have been  obtained by this method.
  The second method in point of value is  that of iodoform insuffla-
1 They may be obtained from H. K. Mulford & Co., of Philadelphia. 
TYPHOID FEVER.
619
tions.   A  poAvder of iodoform  alone is too light for satisfactory pro-
pulsion into the  larynx, and powdered talc should be added to it in
small amount, as may also fa grain of morphine to each  drachm of
iodoform.   The odor is generally disagreeable to the patient, but if a
cocaine spray be  first employed and the operator is  skilful, very little
coughing is produced.   As iodoform is a local anaesthetic it relieves
the pain  in the  larynx,  acts as an antiseptic and alterative, and is
peculiarly  obnoxious to the bacillus tuberculosis.
   When the  night-sweats are very violent, hypodermic  injections of
atropine in the dose of fa to fa  grain are  useful in some cases, and the
efficiency of this treatment may be increased  by the use of an alum
sponge-bath at bedtime.   A solution  of  alum 10 to 20 grains  to  the
ounce may be sponged over the  body,  or  sulphuric acid may be added
to water in the proportion of 1 drachm  to the pint, and used in the
same way  as the  alum solution.
   Sulphuric acid is often given internally in these  cases  Avith  advan-
tage   Small  doses of pilocarpine amounting to 2V  grain, given from
one to two hours before the  sweat is expected, are  sometimes potent
for good.   The means by Avhich this  result is brought about are not
hard to seek.   The  drug in  any dose causes great stimulation of the
peripheral ends of the  nerves supplying  the SAveat-glands.   In many
instances  Ave  find excessive secretion  dependent  upon depression of
function,  as in a serous  diarrhoea or a local sweating of the feet.
These states pass away just as soon as the  parts  regain their  normal
tone through proper  treatment.   The  night-sweats of  phthisis are
improved  by pilocarpine, because this drug in all doses stimulates the
sweat-glands.  In large doses this stimulation amounts to free dia-
phoresis ; but in the minute doses such as fa to fa of a grain, the
stimulation just balances the depression, and a normal tone is acquired.
While it is true that pilocarpine and atropine are physiological antago-
nists, it will be found  practically beneficial to prescribe small doses of
both in such cases as refuse to respond to either one alone, as by their
antagonism they prevent over-action on other parts of the body, and
both act in harmony  in  so  influencing the sweat-glands as to be of
service  to  the patient.  Camphoric acid in 20  to  30-grain  doses is
invaluable in treating  night-sweats.


                       TYPHOID FEVER.

   Any attempt  to  review  the treatment  of  the disease  knoAvn  as
typhoid  fever Avould  be absolutely impossible,  OAving  to  the very
numerous  theories  and practices put  forward by various clinicians.
What is said  under  the general  heading of Fever, and under the con-
sideration  of  Cold, also under  Antipyrine  and  Acetanilide, gives a
sufficient indication as to the treatment of febrile movements; aud the
care  of the patient  beyond  this point,  in  nearly all cases, depends
upon the severity of the attack.
   Before  going  further, hoAvever, the Avriter desires  to insist very 
620
DISEASES.
strongly upon one fact, namely, that a case  of typhoid fever is not
curable in any degree.   No remedy yet found, except it act through
the prevention of complications, can shorten its course.  We can only
guide the patient safely to health when the storm of disease comes on,
and we cannot stop the storm.
   Not only should the facts of the  last paragraph be carefully borne
in mind, but the physician must remember that he is treating an ex-
hausting  disease.   Not a  disease which  runs a violent course for a
few days and strands the  patient sick and  weak, but comralescent,
upon  the shores  of health, but one in  which, after sapping his
strength for Aveeks, some sudden  intercurrent malady or accident may
ensue Avhich will speedily kill him if every possible grain  of strength
is not preserved for the  struggle.   The physician should  ahvays put
every case in which there is a suspicion of  typhoid  fever  to bed at
once and  keep him there till the disease has passed or fails to appear.
Every muscular movement  unnecessarily made is a  Avaste of force,
and, in  consequence, everything  should be done for the patient  and
not by him.  A bed-pan should  always be employed, the patient not
being allowed to  sit erect  upon a commode.   Remembering, too, the
force  consumed in difficult  digestion, the food should be liquid, free
from fat,  and  consist solely, if not entirely, of milk, and duriug con-
valescence, of an egg or a little arrowroot  or corn-starch.   Not only
is this recommendation  practically  correct at  the bedside, but it is
well based  on scientific  fact,  for  Brieger has  shown  that typhoid
bacilli do not  readily reproduce themseh7es and their  poisons in pep-
tone and  well-digested  milk, but do so very  actively in meat broths
or jelly which has not been  acted upon by the digestive juices.  He
has also found  that these  bacilli generate two  poisons, one of which
causes, when given to animals,  salivation, paralysis, and diarrhoea, the
other, violent and exhausting diarrhoea alone.  Milk diet is, therefore,
evidently better than broth diet in typhoid fever, and we once more
are able  to explain an empirical  fact  by a scientific discovery.  An-
other  reason for using  liquid instead of solid foods, beyond the diffi-
culty of digestion, is the fact that the solids  may irritate or perforate
the ulcers in the small intestines.
   Alcohol may be used in  all stages as  a stimulant,  as a giver of
force to the system, and as an aid to digestion.   A very large part of
the profession believes that the mere presence of an abnormally high
temperature contra-indicates the use of alcohol.  Mere high tempera-
ture does  not do so, however, and it  seems probable that many deaths
have resulted from putting into practice such  a belief.
   High temperature of a sthenic type, Avith a full, tense,  bounding
pulse, and all  the signs of a disease attacking one in the full vigor
of life, of course  precludes  its use; but in the high temperature of
advanced  typhoid, Avith the marked  asthenia  often present in that
stage, alcohol should be given constantly  in large amount.  Under
these circumstances the tissues which the man can afford to lose are
gone,  and much of the vital  portion of his system is greatly  en-
croached upon;  the alcohol yields force to the body, and is burnt up 
TYPHOID FEVER.
621
in great  part, keeping the flagging heart  pumping the tides of blood
through the lungs and systemic circulation, Avhen otherwise the very
cardiac depression would  produce  hypostatic congestion, if not  more
widespread circulatory engorgement.
   A no less useful and valuable result obtained by the use of alcohol
in the early stages of exhaustive fevers is the part that it plays in aid-
ing digestion.   The writer has elsewhere defined the difference between
the influence of alcohol in the artificial digestion of the test-tube and
that occurring in the stomach.  No one doubts that alcohol added to
a small amount of gastric juice in the test-tube, retards or prevents its
action ; but evidence is abundant to prove that ingestion of this drug
produces by its stimulating and irritant action a very decided increase
in the quantity of gastric juice secreted  over and above the amount
normally present.   Aside  from  experimental  evidence,  every-day
experience has taught the gourmand that  alcohol, in a  fairly concen-
trated form, enables  him  to digest an amount of food  Avhich  under
ordinary circumstances would remain unchanged in his stomach.
   The importance of aiding the flagging powers of the stomach is not
generally recognized ; but if one remembers the fact that at one time
during the course of a severe attack of typhoid, an occasion must come
when a struggle between the few remaining grains of strength and the
disease results in death or in  recovery, its importance becomes evi-
dent.  By  the ingestion and digestion  of more food early  in the
attack, a larger amount of vital force remains for use at a crisis, and
the chances of a recovery, to  say the least, are  increased.   Alcohol
may, therefore, be used all through the ordinary exhausting fevers—
for the purpose, in the first stage, of aiding digestion, and, in the later
stages of  supporting the system;  but  the physician ought not to use
it as a routine measure in every case without a rational idea of why
he does so.
   In those  cases in which a temporary loss of heart power is due to
haemorrhage or some sudden  severe depression, alcohol  is, above all
others, the remedy to be employed, in a  hot and concentrated form.
   That alcohol may be misused and cause great  harm, is of course
knoAvn to every practitioner of medicine.   So long as  it reduces the
temperature and lowers the rate of the pulse, causes a moist skin and
tongue, and quiets  nervous twitchings, it does good, and only up to
this point is it to be employed. If its administration is pushed after
this, the  tendency to adynamia becomes, under the over-use of the
drug, one of dynamia ; the pulse is no longer soft, but comes in angry,
bounding beats; the nervous symptoms change from Ioav, weak, mut-
tering delirium, Avith subsultus tendinum, to wild, incoherent callings
and strong tossings to and fro ; and by and by, when the influence of
the alcohol begins to cease, and even before this time, the S3;stem has
put forth  the strength of days in a few hours, and the man, having no
reserve strength, is dead.
   The treatment used by the  author  in  his wards at  the  Jefferson
Medical  College Hospital and St. Agnes' Hospital give him results 
622
DISEASES.
Avhich the application  of other methods have failed to give, aud is  as
follows:
   As soon as the patient enters the house he is Avashed or bathed and
placed in bed and required to remain  there.  He  is assured  that the
more quietly he lies the more mild and safe will be the course of his
attack, and is made to use a bed-pan and urinal and never alloAved to
get up.  He is also given five drops  of dilute hydrochloric acid in a
Avineglass of water every four hours,  or  if  the bowels are not actiAre,
nitro-muriatic acid is substituted  therefor, care being taken to employ
one, tAvo, or three drops of the strong, freshly mixed orange acid, accord-
ing to the degree of coating of the tongue.  The diet  is  strictly milk
diet, namely, a quart to a quart and a half a day, with a little salt  to
flavor it, as already described in  the article on Indigestion.   In some
cases koumyss acts very much better than milk.   Sometimes, if vomit-
ing is threatened, lime-Avater is added or the milk is peptonized or beef-
tea is temporarily employed.  In other instances the milk agrees with
the patient if it is partly diluted with plain soda or Apollinaris water.
   For the dry and sordes-covered tongue, a mouth-wash  of glycerin
and water, half and half, to which may be  added a little lemon-juice,
is  used.  If constipation is very obstinate and continues over two days
an injection is employed, aud if this, after  being used tAvice, fails  to
act, a dose of calomel ^  grain  every fifteen minutes, till a grain has
been taken, is prescribed, and if no movement  occurs in tAvelve hours,
is  followed by half an ounce of sulphate of magnesium, or, best of all,
a teaspoonful of liquorice powder is given.
   When diarrhoea  becomes troublesome, over  four or five passages a
day, the following will be of service:
         R.—Acid, sulph. aromat......f 3ij.
             Extract, haematoxyli fl.    ....  f.^iij.
             Syr. zingiberis......fgiij-    M.
    S.—Teaspoonful in water every hour until relieved.

   Just  so  soon as  any evidences of  tympanites or much meteorism
come on, turpentine is given as follows :
         R—01. terebinthinae......  f.^ij
             Syr. acaciae.     .        .    .   q. s. ad  fgiij.    M.
    Ft. in emulsion.  S.—Teaspoonful three times a day.

   At the same time it is Avell to employ a turpentine stupe over the
abdomen (see Turpentine). Where the tympanites is excessive it may  be
relieved by an  injection made up as follows  :
         R.—01. terebinthinae......f^jtoij.
             01. olivae.....        .    .  f giv.
             Mist, asafcetidae......Oj.    M.
    S.—Use as an injection.  Shake well before using.

   In the later stages of typhoid fever, as convalescence is approached,
turpentine is invaluable, as it causes  rapid healing of the intestinal
ulcers and  stops diarrhoea, preventing  relapses  through the absorption
of poisonous materials from the unhealed intestinal lesions. 
TYPHOID FEVER.
623
  For many days after the patient  begs hard for solid food it should
not be allowed, for he will ask for  it long before he should  have it,
but if the temperature remains normal for five days very soft boiled
rice may be used in broth.
  Sometimes curds and whey make  a pleasant change in the diet.
  The complications  of typhoid fever of the most serious import are
haemorrhage from the boAvel,  pneumonia and pleurisy, and perforation
of the gut.
  The haemorrhage from the  boAvel may be stopped as indicated under
that heading (Haemorrhage), aud  the  pneumonia or pleurisy should
be treated as are these diseases when free from complications  ; but it
is to be remembered that this is an asthenic or adynamic case Avhich must
not be bled or depressed, but  stimulated.  When perforation of the in-
testine appears, large doses of morphine should  be given  to relieve
pain, put aside collapse,  and allay irritation.   Warm  applications
should be  used over the  belly and  down  the limbs, and stimulants
given, if needed.
  Probably, in  the  future, surgery  will add another  triumph to the
art by devising some fairly safe plan of operative  interference in this
accident, which, if left alone, is almost always fatal.
  The method of cold  bathing, introduced by Brand, has given such
AAronderful  results in the  treatment  of this disease, and  has  been  so
thoroughly tried, both in  this country aud abroad, that its application
should be well understood and practised Avhenever it is possible to do
so.   The method consists in  immersing the patient every three hours
in a bath at a  temperature of 85°  F., or  as low as 75°  F. if neces-
sary, and allowing him to remain in the Avater until the temperature
falls to 100.5° or 101° ; the bath being used with the frequency named
as long as the  temperature is above 102°.   Before entering the bath
it is Avell to giAre the patient half to one ounce of whiskey in a little
milk or Avater to prevent  any depression from  his being moved into
the tub.  The patient will generally  complain bitterly of the cold, par-
ticularly at  first, and Avill  also appear somewhat  blue and chilly after
the bath, but these signs are  not to  alarm  the physician, unless there
is prolonged and persistent coldness, Avhen hot bottles should be applied
to the feet, and in some cases a little whiskey or brandy administered.
When the bath is given, cold should be applied  to the vertex to pre-
vent a congestion of the  head, Avhich, of course, is not under Avater.
The patient should either be  immersed or the directions given on page
352, in regard to the use of the  cold  pack, be  followed.  The bath
ought ahvays to be  near the bed, and a sufficient  number  of assistants
should be present to lift the patient without his putting forth any exer-
tion Avhatever, as this consumes his strength, Avhich must be preserved
with the greatest care.
  During the time the patient is in  the bath the nurse should rub the
surface of the body briskly in order to bring the blood to the surface,
and prevent congestions m internal organs.  In cases where the patient
objects so strongly to the cold bath that the physician cannot resort to
it, it is  sometimes possible to have the objections removed by putting 
624
DISEASES.
the patient in the water at 95°, and cooling the bath by the gradual
addition of cold Avater to 75°.
   It  is said that pneumonia,  intestinal  haemorrhage, menstruation,
nephritis and cardiac complications are none of them contra-indications
to this method of Brand,  but the author Avould  not resort to it if any
of these conditions were actively present.
   One fact more should be stated, namely :  That this method, while
not wholly doing away with all other treatment, generally makes other
measures unnecessary, although it is, of course,  advisable to  move the
bowels every few days, if constipation be present, by injections, and
to peptonize the milk if the digestion is faulty.
   The advantages gained  by Brand's method are a mortality 150 per
cent, less than any other known method, the absence of high fever, the
avoidance of disagreeable complications of all  kinds, and the produc-
tion of a rapid convalescence.
                   VITREOUS DISEASES.

   Vitreous opacities may be either dust-like, flaky, or dense and mem-
branous.  They impair vision in proportion to their number and den-
sity, and are to be detected with the ophthalmoscope.  Patients detect
them as floating dark spots in their field of vision, because the opacities
cast a shadow upon the retina.   If vitreous disease  is syphilitic, the
usual remedies are indicated.  Hypodermic  injections  of  pilocarpine
act favorably, and in the earlier stages  of the  inflammations of the
retina, choroid, iris, and ciliary body upon which the opacities depend,
leeches should be applied to the temple.  Galvanism  has been recom-
mended.

                           VOMITING.

   Vomiting  is, of course, a symptom, not a disease, and  arises from
a large number of causes, some of which are  very unimportant, others
very serious.   The most common  cause is  probably lack of proper
digestion, with all that this implies—that is, gastro-intestinal irrita-
tion and perversion of normal function.   Additional causes are cere-
bral haemorrhage, tubercular  meningitis, cerebritis, or uraemia, which
cause  irritates the vomiting centre, or diseases of the middle  lobe of
the cerebellum, or vertigo, Avhich is  probably largely dependent upon
disease of this lobe or the nerve-fibres going  to it.
   These latter states may all be considered as lesions of a centric char-
acter Avhich directly or indirectly cause the vomiting centre to send out
impulses.  On the other hand, it is worthy of note that, under certain
circumstances, vomiting  may be reflex and dependent upon irritation
of the nerves of the stomach or elseAvhere, which convey  impulses to
the muscles whose activity results in vomiting.   These conditions are
well  represented by  the vomiting  which comes on in  incarcerated 
VOMITING.
625
hernia, or in pregnancy, or in that occurring during the passage of renal
or hepatic calculi, or in indigestion. ,
   It is important to bear  in  mind that  peripheral vomiting due to
disorder of the gastric Avails may be dependent upon  two conditions.
The mucous membrane and its nerves  may be  over-excitable, or they
may be depressed.  For this reason Ave shall find that tAvo  modes of
treatment are necessary when this subject is considered beloAv.
   The mechanism of vomiting consists  in the closure of the pyloric
sphincter, the contraction of the gastric  muscles from the pylorus to
the cardia, and at the same time, and  more  important  than  these
movements, the  contraction of  the  supplementary respiratory and
abdominal muscles, Avhich so compress the stomach as to drive out its
contents through the open oesophagus.   The  violence of the muscular
contractions in the abdominal  Avails is greatest Avhen  the  stomach is
partly empty, and gives rise to the pain aud exhaustion accompanying
the condition known as retching.  The practical point to be learned
from this is that vomiting is ahvays easier Avhen the stomach is full;
so, if an emetic is given on au empty  stomach, as the popular expres-
sion runs, a large amount of liquid should precede or accompany it, if
possible.  Dogs vomit easily because of the development of the gastric
muscles, but they render  the effort easier by filling  the stomach Avith
air, and so  completely fill the  viscus that its walls  can contract on a
resisting mass.
   Having described the mode and causes of vomiting, it still remains
for us to consider its treatment.
   It is needless to  remark that the vomiting of  cerebral disease is
very intractable, and that very active agents  must be used to stop it.
Probably the vomiting following etherization  is centric, and should
be treated, as should all  forms of obstinate emesis, by the injection
into the rectum of 40 grains of sodium or potassium bromide and 20
drops of laudanum in 4 to 8 ounces of Avater.  If this does not stop the
vomiting a second injection may be given one hour after the first.
   When vomiting seems to be  due to  hyper-excitability of the gastric
mucous membrane, so that very small amounts of food Avhen swalloAved
are at once rejected, local anaesthetics and  depressants are needed, the
chief of these being cocaine and aconite.  Both of these drugs, hoAvever,
haATe disadA^antages, because in effective dose their general physiological
action may be very severe and almost poison the patient.  When  given
to act as anti-emetics, these drugs do so by acting as local anaesthetics,
or in other Avords by paralyzing the peripheral sensory nerves.  Cocaine
should  be given in  the  dose of 2 to 3 drops of a  4 per cent, watery
solution, every fifteen minutes  until 10 drops are taken.  The aconite
should  be used in the form of the tincture, the patient being placed
flat on  the  back, so as to withstand the  ensuing  cardiac depression
with the  least  inconvenience, and 2 to 5 drops of  the  drug given in
a little water every thirty minutes until  the rapidly weakening pulse
forbids  its further use.  This drug may be resorted to in all forms of
vomiting  due to irritability of  the stomach, but it is contra-indicated
                                40 
626
DISEASES.
in cases of debility or Aveakness.  Aconite is generally to be preferred
to cocaine.
   Sometimes a prescription of the following character is of service, the
bismuth acting as a coating to the walls of the stomach, protecting and
soothing them :
         R.—Bismuthi subnitrat......3 iij-
             Tr. aconiti.....gr. xx vel xxx.    M.
    Ft. chart no. x.  S.—One powder every half-hour.

   This prescription is very useful if the vomiting becomes excessive,
and is due to acidity or fermentation.
   In other cases of the same type the following is useful, and is to
be  preferred if,  owing to active fermentation,  the vomiting  is ex-
cessive (the creasote or carbolic acid being a local anaesthetic and anti-
septic) :
         R.—Acid, carbolic, vel creasoti (beechwood) gtt. x vel xx.
             Bismuthi subnitratis.....3 iij.  M.
    Ft. in chart no. x.  S.—One powder every hour.
   Sometimes pure chloroform  in 1 or 2-drop doses, in a little  water,
does good;  and dilute hydrocyanic acid, in the dose of 2 to 6 drops is
also of value in like instances, given in  a tablespoonful of water.
   The treatment of a  case of vomiting dependent  rather upon de-
pression and debility of the stomach than upon irritation, is directed
to the administration of gastric  and it may be  systemic stimulants.
The chief one of the gastric stimulants is ipecac  in  small doses, and
it is this employment of a drug generally resorted to for the produc-
tion of emesis by physicians,  Avhich has caused homoeopaths to claim
that the regular school obey the law of  similia  similibus  curantur and
infinitesimal doses.   The claim only holds good on its face, for  we do
not use an infinitesimal dose, and  obey no law, but use common sense.
Ipecac is an  irritant, even to the  skin, and it is  partly by its irritant
effects that it causes vomiting by  exciting the stomach to a point over
and above its  normal  condition.   In  the vomiting  depending upon
gastric debility and depression  small doses of ipecac do good, because
they irritate the stomach sufficiently to restore its  normal tone without
going to the  other extreme of hyper-excitation.  Under these circum-
stances drop doses of the wine of ipecac, or J of  a grain of the pow-
dered ipecac, every hour, is of the  greatest value, often succeeding after
all remedies have failed.
  In other instances  tincture of nux  vomica, given in 4; to 1-drop
doses, is  useful as follows :
         R.—Tinct. nucis vomicae ....  gtt. iv vel viij.
             Aquae cinnamomi   .    .    .    .    .    .    f gj.  M.
    S.—Teaspoonful every half-hour or hour.

  In the nausea and vomiting following an  alcoholic debauch \ to 1
drop of Fowler's solution every tAvo hours, or before  food, often gives
relief, and it may be used in  some cases in place of the nux vomica
and ipecac.   Another  useful  measure for the cure of alcoholic nausea 
WHOOPING-COUGH.
627
is  the  use of full doses of hydrochloric acid, 5, 10, or  15 drops of
the dilute acid  in half a tumblerful of water, repeated every  two
hours.
   In all  cases  of persistent vomiting  counter-irritation should  be
applied over  the  stomach  in the form of a mustard plaster, or, if
preferred, an  ice-bag may be applied to the nape of the neck, the
lumbar spine, or the epigastrium.
   The food given in cases of vomiting should be especially prepared.
It is ahvays best  to use peptonized milk  made  by using the pepton-
izing materials sold by all  the  large drug firms of reliability.  (See
article on Diet, page 372.)   Lime-water should  always be put in the
milk if it is not peptonized; the amount usually employed is perfectly
useless because of its smallness—at least 2 or 3 tablespoonfuls should
be placed in each glass of milk.
   Another point of importance is the quantity of liquid taken.  As
fast as the  patient vomits he is often fed with glasses full of liquid
by well-meaning  friends.   Instead of  this he  should have  only 1
or 2 teaspoonfuls of milk  every hour, half-hour, or fifteen minutes,
for it is better for him to retain a drachm than to take a quart and
vomit  it.
   Where vomiting is absolutely persistent, enemata previously partly
or entirely digested must be resorted to.
                     WHOOPING-COUGH.

   The remedies recommended for this disease are almost as numerous
as the members of the medical  profession, and every one of them is
worthless so far as a  cure is concerned.  Probably the very best drug
of all in the majority of cases  is  antipyrine.   Given in the dose of |
to 3 grains every five hours  according to the age of the child it will
nearly always decrease the number of paroxysms, but not the severity
of each individual attack.
   Where the child will submit to it there  is little doubt that quinine
in a very fine spray  will be of service in many cases, and it is very
useful, Avhen so used, as  a prophylactic in other children of the  same
family, who  it is  feared will be attacked  by the same disease.   The
strength  of  the  solution to be employed should be about 1 grain to
the ounce of water.
   There is  no doubt that carburetted hydrogen  as  inhaled  at gas
Avorks  is useful as a curative  measure is cases of whooping-cough.
   A very useful remedy in some cases is  belladonna  in the form of
the tincture,  in the dose of \ drop twice a day to a  child of one or
tAvo years.  Where great vascular engorgement ensues upon a severe
coughing spell, vascular sedatives are of service.   That is, in  those
cases in  which  haemorrhages from the  nose,  ears, and mouth  take
place, veratrum  viride or aconite may be used  unless  the  disease has
already so exhausted  the child that stimulants are needed, and cardiac
sedatives  are contra-indicated  by  the degree  of adynamia present. 
628
DISEASES.
 The reason for this  lies  in the folloAving facts : The vascular tension
 consequent upon the obstruction of respiration causes a rise  of  blood
 pressure  from  asphyxia, and  the haemorrhages or the conjunctival
 ecchymoses are due to rupture of the small bloodvessels under the
 increased strain.  By lowering vascular tension we prevent so  great
 a  spasm of the  bloodvessels  and avoid vascular rupture or dis-
 tention.
   Where paroxysms come on so rapidly as really to interfere  seriously
 with respiration, the child should take a whiff of chloroform poured
 over the parent's hand and so relax the spasm, while in other instances
 nitrite of amyl is equally serviceable  and always more safe.   Only 2
 to 3 drops of the nitrite of amyl  should be  used  at a time,  and this
 fact must be impressed upon the parents.
   Benzine has been found useful in certain cases of whooping-cough.
 It should be lightly sprinkled about the room or on the bed-clothing.
 In France it has been used internally in the dose of 10 to  15 drops
 for this affection.  This is scarcely to be recommended.
   The vomiting following the cough may be  overcome by using such
 minute amounts of milk as to enable nutrition to  go on Avithout at
 any time overloading the stomach, as, for example, a teaspoonful after
 each paroxysm of cough.

                           WORMS.

   Intestinal parasites may be  said to be represented by the Ascaris
 Lumbricoides,  or round-worm;  the   Taenia  Solium,  Taenia Media
 Canellata, and the Bothriocephalus Latus, or tape-worms ; and, finally,
 by the Oxyuris Vermicularis, sometimes called seat-, pin-, or thread-
 worms.
   The round-worm and tape-worm are to be  attacked by Avay of the
 patient's mouth, the  seat-Avorms  by  Avay of the anal opening ; but
 before mentioning the drugs to be employed  it is necessary to  insist
 upon  one or two important points, disregard of which will  result in
 failure in treatment.
   Whenever a round- or tape-worm is to be attacked, the patient  must
 be  starved for at least twelve  to twenty-four hours, in order that no
 food in the intestinal tract may protect the worm from the  action of
 the drug.  During this time a little  milk may be taken, and after a
 night of fasting, before breakfast, the anthelmintic must be SAvallowed.
 Further than this, nearly all of these drugs must be  folloAved by purges
 in order to dislodge the intruder Avhile he is paralyzed and has lost his
 hold; and in many instances  it is Avell to have a basin of salt and
 Avater ready so that Avhen  a passage occurs a  rectal injection may be
 given to wash out any segments  of the worm Avhich remain behind
 in the rectum.
  In the treatment of thread-Avorms  it is necessary to fill  the boAvel
thoroughly Avith soap and water to dislodge the faecal matter and ex-
pose the  Avorms in the folds  of  the mucous membrane.
  The drugs which are used against the round-worm are : Spigelia in 
WORMS.
629
the form of the fluid extract, dose 1 drachm to a child of two or three
years, or 2 drachms to an adult, or, better still, the fluid extract of
spigelia and senna, dose 2 to 3 drachms, given in divided doses to a
child.   Oil of chenopodium, dose 5 to 20 drops on sugar.   Santonin,
dose I to J grain to a child in the form of troche, made by using the
crystals, or as much as 2 to 4 grains to an adult.  (See Santonin.)
  Brayera, or kooso, is given for the removal of the same worm in the
form of an infusion, which is made by adding J ounce of the powdered
leaves  to 1 pint of water and mucilage of acacia, one-half of each.
This may be taken at one dose,  or the fluid extract may be given in
the dose of h ounce  to an adult,   Koosin may be given in 40-grain
doses in capsule to adults, but it should not be used against worms in
pregnant women, as  it may cause abortion.
  Unless the spigelia is used with senna it should always be followed
after from two to four hours by a full dose  of castor oil or a saline
purgative to SAveep out the Avorm,  and the same rule applies to all the
drugs mentioned above.
  The most efficient remedy against the tape-Avorm is pelletierine, the
acti\re  principle of pomegranate,  dose 1 to 2  grains in capsules;  or
pepo, or pumpkin-seeds (2 ounces), may be resorted to when deprived
of their outer  coating and rubbed into a paste Avith sugar.  Almost,
if not quite, as valuable a remedy is male  fern, or Filix mas, or, as it
is officially called, Aspidium.   Used in the form of the oleoresin (Oleo-
resina Aspidii),  in the dose of \ to 1 drachm to an adult, it should  be
followed in three or four hours by a calomel purge, aided by a saline.
Either the calomel or the increased amount of bile which is present is
apparently peculiarly abhorrent to  the tape-Avorm, and its free excretion
should folloAV the use of all the drugs just named.
  By far the most useful remedy for  seat-Avorms is  quassia used by
injection.   One  to two ounces of  powdered quassia  or quassia  chips
may be made into a decoction with a pint  of Avater, and half of this
injected into the rectum after it has been well cleansed with soap and
water.   The quassia  injection should be held for some minutes, and  in
children this may be accomplished by pressing upon the anal opening
the ball of the thumb covered by a pad formed from  a small folded
toAATel.   If this treatment fails to  bring away  all the worms in three
or four trials, either there are none present or the  bowel is not  thor-
oughly invaded  by the injection.   In some cases the worms infest the
colon, and forced injections are necessary. 
 
TABLE  OF  DOSES OF  REMEDIES.
          Remedies.            Dose.
 Abstract, aconiti  ....  J  to  J  g.
   aspidospermoe  ....  5  " 20  g.
   belladonna?.....£  '"' H  g.
   cannab. ind......1  "  3  g.
   conii.......1  "  2  g.
   digitalis......1  "  3  g.
   gelsemii......1  "  2  g.
   hyoscyami.....2  "  5  g.
   ignatia?......1  "  3  g.
   ipecac........3  " 30  g.
  jalapa?.......6  " 10  g.
   nucis vom......i  "  £  g-
  phytolaccas......5  " 15  g.
  pilocarpi......6  " 30  g.
  podophylli.....1  "  5  g.
  senegae......4  " 10  g.
  Valeriana?......10  " 15  g.
  veratr. vir......1  "  2  g.
Acetanilide......1   "  8  g.
Acetone.......5   " 20  m.
Acetphenetidine ....  2   "  6   g.
Acet. lobelia?.....15  " 30  m.
  opii........5   " 16  m.
  sanguinar......15   " 30  m.
  scilla?.......10   " 30  m.
Acid. acet. dil......60   " 90  m.
  arsenious......^   " ^  g.
  benzoic......5   " 15  g.
  boric.......5 ' " 10  g.
  carbolic......1  "  3  g.
  gallic.......3  "15  g.
  gall, in albuminuria .   .10  " 60  g.
  hydrobrom. (34 per cent.) 10  "15  g.
  hydrobrom. dil.  .  .   . 40 m. to 2 fl. d.
  hydrochlor......3  to 10 m.
  hydrochlor. dil.  .  .   .10  "30 m.
  hydrocyan. dil.   .  .   .  2  "  6 m.
  lactic.......15  " 60  g.
  nitric.......3  " 10 m.
  nitric dil.......10  " 30 m.
  nitro-hydrochlor. .   .  .  3  " 10 m.
  nitro-hydrochlor. dil.  .  5  "20 m.
  phosphoric (50 per cent.)   3  " 15  g.
           Remedies.
 Acid, phosphoric dil.   .  . 10
   salicylic......5
   sulphuric......2
   sulphuric dil.....5
   sulphuric arom.  ...  5
   sulphurous.....30
   tannic.......2
 Aconitina (white crystals) .  ?Jff
 Adonidin......£
 Agaricin.......1
 Aloe........2
 Aloinum.......£
 Alumen.......10
 Ammonii benzoas  .   .  .10
   bromid.......5
   carbon.......3
   chlorid.......10
   iodid........3
   phosph.......1
   picras .......   J
   sulph........3
   valer........3
 Amyl nitris......2
 Amylum iodatum  ...   3
 Antimonii etpot.tart.; diaph. ^
   et pot. tartr.; emetic.   .   1
   oxid........IJ
   oxysulphuret.....$
   sulphid.......£
   sulphuret......J
 Antipyrine......2
 Apiol........3
 Apomorph. hydrochlor.   . ^
 Aqua ammonia?   ....   6
  amygd. amar.....1
  camphora?.....\
  chlori.......]
  creasoti......1
  lauro-cerasi.....6
Arbutin.......5
Argenti iodidum  . .  .   .  \
  nitras.......\
  oxid........\
Dose.
to 30 m.
  20  g.
    5 m.
  30 m.
  30 m.
  60 m.
  10  g.
 ?h  £■
   i  g-
   4  g-
   5  g-
   2  g-
  15  g.
  20  g.
  30  g.
  10  g.
  30  g.
  15  g.
   5  g-
   i  g-
  15  g.
  15  g.
   5 m.
  30  g.
  h g-
   2  g-
   2  g-
   2 g-
   2  g-
   2  g.
  20 g.
   5  g-
 A g-
 30 m.
   2 fl.d.
  2 fl. oz.
  4 fl.d.
  4 fl.d.
 30  m.
 15
   1
  A
   2 
632
TABLE  OF  DOSES.
          Remedies.          Dosf
Arsenii iodidum  .   .  .   . ^  to
Asafoetida......5  "
Atropina......j^g "
Atropina? sulph.....T^-g "
Auri et sodii chlorid.  .   .  ■£$ "
Balsamum gurjunae  .  .   .20  "
Belladonna? fol.....1  "
  rad.........1  "
Benzanilide......1  "
Berberina......3  "
Berberinae sulph.....3  "
Bismuthi citras   .   .  .  •.  3  "
  et ammon. citr.....1  "
  salicylate......3  "
  subcarb.......6  "
  subnitr.......30  "
  tannas.......6  "
  valer........1  "
Brayera.......2  "
Brucina.......dz  "
Caffeina.......1  "
Caffeina? citras.....1  "
Calcii bromidum  ....  5  "
  carb........15  "
  hypophosphis  ....  3  "
  iodidum......1  "
Calcii phosphas  .... 15  "
Calx chloridum   ....  2  "
  sulphurata  ......  A  "
Camphora......3  "
  monobromata  ....  2  "
Cantharis......i  "
Capsicum......1  "
Castaneum......5  "
Castoreum......6  "
Catechu.......15  "
Caulophyllin.....i  "
Cerii nitras......1  "
  oxalas.......1  "
Chinoidinum.....3  "
Chinoline......5  "
Chloral.......3  "
Chloroformum.....1  "
Chrysarobinum   ....  3  "
Cinchona......15  "
Cinchonidina, and its salts  1  "
Cinchonina, and its  salts  .  1  "
Cinnamomum.....6  "
Cocaine.......1  "
Coca? fol........1  "
Codeina.......£  "
Colchicin......   . T$5 "
Colocynthin......i  "
Confectio senna?  ....  1  "
A	g	
20	g	
A	g	
&	g	
A	g	
30	m	
10	g	
5	g	
6	g	
10	g	
10	g	
15	g	
15	g	
15	g	
30	g	
60	g	
30	g	
3	g	
6	d	
A	g	
5	g	
5	g	
30	g	
60	g	
15	g	
3	g	
30	g	
5	g	
1	g	
10	g	
5	g	
2	g	
3	g	
10	g	
15	g	
30	g	
i	g	
3	g	
3	g	
30	g	
10	g	
20	g	
5	m	
15	g	
60	g	
30	g	
30	g	
30	g	
2	g	
3	g	
2	g	
ifc	g	
1	g	
2	d	
           Remedies.            Dose.
Coniina, and its salts  .  .  ^  to -£2
Convallamarin   ....£"  2
Copaiba.......15  " 60
Cota........1  "  2
Cotoina.......i  "  i
Creasotum......1  "  3
Creta prsepar......15  "75
Croton chloral.....1  "  5
Cubeba.......15  " 60
Cupri acetas......   I  "  i
  sulphas......i  "  i
Curare.......£2  "  J
Curarina.......^  " ^
Daturine.......tJu " ^5
Decoct, aloes comp.  ...   £  "  2
  sarsap. comp.....2  "  6
Digitalinum.....s1?  " 3*2
Digitalis folia.....i  "  2
Duboisina, and its  salts  .  T£^ " ^
Elaterinum ;  U. S. P., 1880  "■  " '
Elaterinum;  U.S. P., 1870  ^  "  J
Emetina, and  salts; emetic   J  "  J
  diapb........t£tf " ts\j
Emulsio hydrocyan....   £  "  1
Ergota........15  " 60
Ergotinum......2  "  8
Eserina, and  its salts  .  .  -fa  " ^j
Extr. aconiti  fol. fluid. .  .   1  "  5
  aconiti rad.; U.S. P., 1880  &  "  J
  aconiti rad. fluid.  .  .  .   \  " 2\
  aconiti fol. (B. P.).  .  .   \  "  i
  aconiti fol.;  U.S. P., 1870   i  "  i
  aletridis fl......15  " 30
  alni rubrse  fl.....15  " 30
  aloes aqueos.....\  "  3
  alston. constr. fl.   .  .  .   1
  angelicas rad. fl.   ...  30  " 60
  angustura? fl.....15  "45
  anthemidis.....2  " 10
  anthemidis fl.....30  " 60
  apocyni andros fl. .  .  .   5  "30
  apocyni cannab. fl.  .  .   8  " 30
  aralia? hisp. fl.....30  "50
  aralia? nudic. fl.   ...  30  " 60
  aralia? racem. fl.   ...  30  " 60
  araliae spin, fl.....30  "60
  areca? fl.......45  " 75
  ari triphylli fl.....15  "30
  arnica? flor......3
  arnicee fl.......5  " 15
  arnica? rad......2  "  5
  arnica? rad. fl.....5  " 15
  asari fl.......15  " 30
  asclep. incar. fl.   ...  15  " 30
fl.oz.
fl.oz.
 g-
2 fl.
8  g- 
TABLE  OF  DOSES.
633
          Remedies.
Extr. asclep. syr. fl.  .  .   .15
  asclep. tuber, fl.   ... 15
  aspidii fl.......1
  aspidospermse fl.   .  .   .15
  auranti cort. fl.....J
  azedarach fl......15
  baptisise fl......7
  bellad. alcoholic.  ...  J
  bellad. fol. (B P.) .  .   .  £
  bellad. fol. fl.   ....  3
  bellad. rad......£
  bellad. rad.  fl.....l
  berber. aquifol. fl.  .  .   .15
  berber. vulg. fl.....15
  boldi fl.......3
  brayera? fl......2
  bryoniae fl......15
  buchu fl.......£
  calami fl.......15
  calend. fl.......15
  calumba?......3
  calumba? fl......15
  canella? fl......15
  cannab. Amer. fl.  .  .   .  3
  cannab. ind......J
  cannab. ind. fl.....3
  capsici fl.......1
  cardam. comp. fl.  .  .   .15
  carnis.......15
  cascara? sagradse fl.  .   .10
  cascarilla? fl......J
  castana? fl......J
  catarise......i
  catechu liquid.....8
  caulophylli fl.....15
  chelidonii fl......15
  chelonisfl......30
  chimaph.  fl......|
  chionanthi fl.....f
  chirettse fl......£
  cimicifuga? fl.....8
  cinchona?.....15
  cinchona?  fl......30
  cinchonse  arom. fl.  .   .30
  cinchona? comp. fl.   .   .  £
  coca?.......1
  cocculi fl.......1
  colch. rad......i
  colch. rad. fl.....2
  colch. sem. fl.....1£
  collinsoniae fl.....30
  colocynth......1£
  colocynth. comp.  .  .   . li
  condurango fl.....8
Dose.
to 30 m.
" 30 m.
"  2 fl. d.
" 45 mv
" 2i fl. d.
" 75 m.
" 30 m.
"  £  g-
"  S  g.
"  6 m.
"  i  g-
"  3 m.
" 30 m.
" 30 m.
" 15 m.
"  4 fl. d.
" 60 m.
" 2£ fl.d.
" 60 m.
" 60 m.
" 10  g.
" 60 m.
" 60 m.
" 15 m.
"  1  g.
"  6 m.
"  3 m.
" 45 m.
" 60  g-
" 20 m.
" 2i fl. d.
"  2£  fl. d.
"   1  fl.d.
" 30 m.
" 30 m.
" 30 m.
" li fl.d
"  1 fl.d
" U fl.d
" 30 m
" 30   g
" 60 m
" 60 m
" H fl.
"2d
"3m
"  £   g
"4m
"6m
" 60 m
"  5   g
"  5   g
" 30 m
          Remedies.        ,    Dose.
Extr. conii fol. (B. P.)  .  .  1  to 2  g.
  conii fol.alc; U.S.P., 1870  1  "  £  g.
  conii fr. ale; U.S.P., 1880  \  "  1  g.
  conii fol. fl......1  "  2  m.
  conii fr. fl.;  U.S.P., 1880 1£  "  3  m.
  convallaria?  rad. fl.   .  .15  " 30  m.
  coptidis fl......30  " 60  m.
  corn. nor. fl......30  " 60  m.
  corydalis fl......15  " 30  m.
  coto fl........3  " 15  m.
  cubebae fl......15  " 30  m.
  cypripedii fl.  '.  .   .  . 15  " 60  m.
  damiana? fl......£  " 2£ fl. d.
  delphinii fl.......1  "  3  m.
  digitalis......£  "  £  g-
  digitalis fl.  .  .  •   .  .  1  "  6  m.
  dioscorea? fl......15  " 30  m.
  dita? fl........1  "  4  m.
  dracontii fl......30  " 60  m.
  droserae fl......5  " 10  m.
  dulcamara?.....5  " 15  g.
  dulcamara? fl  .  .   .  .  1  "  2 fl. d.
  ergotae.......1£  "  8  g.
  ergotae fl.......15  " 60  m.
  eriodictyi fl......15  " 30  m.
  erythroxyli  fl.....%  "  2 fl. d.
  ethoxycaffeine ....  2  "  4  g.
  eucalypti fl......15  " 60  m.
  euonymi fl......15  " 60  m,
  eupatorii fl.  . .  .   •  .30  " 60  m.
  euphorb. pilulifera? fl.  .  5  " 30  m.
  ferri pom.......3  " 15  g.
  frangulaefl......£  " 2£ fl.d.
  frankenia? fl.....8  " 15  m.
  galla? fl.......|  "  2 fl. d.
  gelsemii......\  "  1  g.
  gelsemii fl......5  " 10  m.
  gent, fl.......30  " 60  m.
  gent. comp. fl.....30  "60  m.
  geranii fl.......15  " 30  m.
  gei fl........15  "30  m.
  gillenia? fl......15  " 30  m.
  gossypii fl......15  " 45  m.
  granati rad.  cort. fl.  .  .   f  "  2 fl. d.
  grind, rob. fl.....30  " 60  m.
  grind, squarr. fl.  .   .  .  30  " 60  m.
  guaiaci ligni fl.....30  "60  m.
  guarana? fl......15  " 30  m.
  hsematoxyli.....8  " 30  g.
  haematoxyli  fl.....30  "60  m.
  hamamelid.  fl.....30  "90  m.
  helleb. nigris  ....£"  1  g.
  helleb. nigris fl.   ...   5  " 15 m.
  helonia? fl......8  " 30 m. 
634
TABLE  OF.  DOSES.
          Remedies.
Extr. hepatica? fl.....30
  humuli......3
  humuli fl......30
  hydrangea? fl.....30
  hydrastis......3
  hydrastis fl......8
  hyoscyami (B. P.j.  .   .  1
  hyoscyami ale.....1
  hyoscyami fol. fl.  .  .   .  3
  hyoscyami sem. fl.   .   .  2
   gnatia?......\
   gnatia? fl......1
   pecac. fl.......3
  iridis versicol.....3
  iridis versicol. fl.   .  .   .15
   aborandi fl......10
   alapa?; U. S.P., 1870   .  5
   alapae ale......3
   alapa? fl.......15
   uglandis......15
   uglandis fl......f
   unip. fl.......30
  kamalae fl......30
  kino, liquid.....15
  krameriae......5
  krameriae fl......30
  lactucae......5
  lactucae fl......15
  lactucarii fl......8
  lappae fl.......J
  laricis fl.......J
  leonuri fl.......30
  leptandra?.....3
  leptandrae fl.....30
  lobelia? fl.......1
  Lupuli fl.......5
  lycopi fl.......5
  malti.......1
  manzanitae fl.....£
  marrubii fl......1
  matico fl.......30
  matricaria?.....8
  menispermi  fl.....30
  methystica? fl.....15
  mezerei......£
  mezerei fl......3
  micromeria?.....15
  mitchella? fl......30
  myricse fl......30
  nectandra?.....1
  nucis vom......J
  nucis vom. fl.....1
  nuphar fl.......5
  nymphaeae fl.....5
Dose.			
to 60		m.	
a	15	g	
tt	60	m	
"	60	m	
tt	10	g	
tt	30	m	
it	4	g	
tt	2	g	
tt	15	m	
tt	8	m	
it	£	g	
tt	6	m	
tt	60	m	
tt	6	g	
tt	30	m	
tt	60	m	
tt	10	g	
tt	6	g	
"	30	m	
tt	30	g	
"	2	fl.	i
tt	60	m	
tt	60	m	
tt	30	m	
tt	15	g	
"	60	m	
tt	15	g-	
tt	60	m	
tt	30	m	
tt	1	fl.d	
tt	2	fl.d	
tt	60	m.	
tt	10	g	
"	60	m.	
"	5	m.	
tt	15	m.	
it	30	m.	
"	2£	d.	
"	2	fl.d	
it	2	fl.d	
"	60	m.	
"	30	m.	
it	60	m.	
it	60	m.	
"	1	g-	
tt	10	m.	
n	60	m.	
"	60	m.	
tt	60	m.	
"	4 fl.d		
tt	i	g-	
it	5	m.	
tt	15	m.	
"	10	m	
          Remedies.            Dose.
Extr. opii......£  to  £  g.
  papaveris......£   "  2  g.
  papaveris fl......15   " 45 m.
  pareiraefl......30   " 60 m.
  petroselina fl.....1   "  2 fl. d.
  phelandrii fl.....1  "  2 fl. d.
  phoradendri fl.....£   "  1 fl.d.
  physostigmatis  .   .  .   . ^   "  £  g.
  physostigmatis  fl.  .  .   .  1   "  3 m.
  Phytolacca? baccar. fl.   .  5  " 30 m.
  Phytolacca? rad.   .  .   .  1  "  3  g.
  Phytolacca? rad. fl. .  .   .  5  " 30 m.
  pilocarpi fl......15  " 60 m.
  pimenta? fl......15  " 45 m.
  piper nig.  fl......15  " 45 m,
  piscidia?......1  "  2  g.
  piscidia? fl......15  " 60 m.
  podophylli.....£  " 1£  g.
  podophylli fl.....8  " 30 m.
  polygoni fl......15  " 30 m.
  polygonati fl.....5  " 15 m.
  populi fl.......30  "60 m.
  prinos fl.......30  " 60 m.
  prun. virg. fl.....30  " 60 m.
  pteleae trifoliata  .  .   .15  "30 m.
  Pulsatillas  fl......2  "  5 m.
  quassiae......1  "  5  g.
  quassiae fl......30  " 60 m.
  quebracho fl.....20  " 60 in.
  quercus  fl......30  " 60 m.
  rhamni cath. ft. fl.   .   . 30  " 60 m.
  rhamni pur. cort. fl.  .   .30  "120 m.
  rhei........5  " 10  g.
  rhei fl........15  "45m.
  rhois arom. fl.....15  "60 m.
  rhois glabr. cort. fl.  .   .30  " 60 m.
  rhois glabr. fruct. fl.  .   .30  " 60 m.
  rhois toxicod. fl.  .  .   .  1  "   6 m.
  ricini fol. fl......£  "  l fl. d.
  rosa? fl........£  "   2 fl. d.
  rubi fl........15  " 60 m.
  rumicis fl......30  "  60 m.
  ruta? fl.......15  "  30 m.
  sabbatia? fl......30  "  60 m.
  sabina? fl.......5  "  15 m.
  salicis fl.......£  "   2 fl.d.
  salvia? fl.......£  "   2  fl. d.
  sambuci fl......£  "  2 fl. d.
  sanguin. fl......5  "  15 m.
  santali citr......£  "  1 fl. d.
  santonica?  fl......15  "60 m.
  sarsap. fl.......£  "  2 fl. d.
  sarsap. comp. fl.  .  .   .  £  "  2 fl. d.
  sassafras fl......£  "   2 fl. d. 
TABLE  OF  DOSES.
          Remedies.            Dose.
Extr. scilla? fl......5  to 30 m.
  scillae comp. fl.....5  " 30 m.
  scoparii fl......£  "  1 fl. d.
  Scutellariae fl.....£  "  2 fl. d.
  senecionis  fl.....1  "  2 fl.d.
  senega? fl.......8  " 15 m.
  sennse fl.......1  "  4 fl.d.
  serpeut. fl......30  " 60 m.
  simarubae fl......15  "30 m.
  solidag. fl......30  " 60 m.
  spigelia? fl......15  " 60 m.
  spigelia? et senna? fl. .  .   £  "  2 fl. d.
  stillingia? fl......£  "  2 fl. d.
  stillingiascomp.fl.   .  .   £  "  2 fl. d.
  stramonii (B. P.) .  .  .   £  "  1  g.
  stramonii fol. ale. .  .   .   J  "  §  g.
  stramonii fl......1  "  6 m.
  stramonii sem.....£  "  £  £■
  sumbul fl......15  " 60 m.
  taraxaci......5  " 15  g.
  taraxaci fl......£  "  2 fl.d.
  thuja? fl.......8   •' 15 m.
  toxicodendri fl.....1  "  5 m.
  trifol. prat, fl.....1  "  2 fl. d.
  trillii fl.......£  "  2 fl.d
  trit. rep. fl......1  "  4 fl. d.
  tussilag. fl......30  " 60 m.
  urtica? rad. fl.....5  " 15 m.
  ustilag. mayd. fl.  .  .  .  15  " 60 m.
  uva? ursi fl......30  " 60 m.
  vaccin. crassifol. fl.  .  .30  " 60 m.
  valerian.......5  " 15  g.
  valer. fl.......30  " 60 m.
  veratr. vir. fl.....2  "  8 m.
  verbena?......15  " 60 m.
  viburni opuli fl.   .  .  .   1  "  2 fl.d.
  viburni [prunifol.] fl.  .   1  "  2 fl.d.
  wahoo.......1  "  5
  xanthoxyli cort. fl.  .  .15  " 30 m.
  xanthoxyli fruct. fl. .  .15  " 30 m.
  zingiberis fl......8  " 30 m.
Fel bovis purif.  ....   3  "  6  g.
Ferri arsen.......fa  " ifa  g
  benzoas......1  "  5  g
  bromid.......1  "  5  g
  carb. sacch......4  " 15  g
  chlorid.......1  "  3  g
  citras.......5  " 10
                         .   5  "10
                         .   5  "10
                         .   5  "15
                         .   5  "10
                         .  15  " 60
                         .   5  "10
et ammon. citr..
et ammon. sulph.
et ammon. tartr.
et cinchonid. citr.
et pot. tartr. .  .
et quin. citr. .  .
          Remedies.            Dose.
Ferri  et strychn. citr.  .   .  1  to 3  g.
  hypophosphis  ....  5  " 10  g.
  iodidum......1  "  5   g.
  iodidum sacch.....2  "  3   g.
  lactas.......1  "  3  g.
  oxalas.......1  "  3  g.
  oxid. magnet.....5  " 10  g.
  oxid. hydrat.....£  "  2  oz.
  phosphas......1  "  5  g.
  pyrophosphas  ....  1  "  5  g.
  subcarb.......5  " 30  g.
  subsulphas.....1  "  3  g.
  sulphas......1  "  3  g.
  sulphas exsiccat.  .  .   .  £  " li  g.
  valer........1  "  3  g.
Ferrum dialys.....1  " 15 m.
  redact........1  "  5  g.
Fowler's solution ....  1  "  5 m.
Gamboge.......1  "  4  g.
Gaultheria, oil of.  .  .   .  2  " 10 m.
Gold bromide.....£  "  £  g.
  chloride of, and sodium . fa  " fa  g-
Guarana.......8  "30  g.
Helleborein......fa  "  i  g.
Hydrarg. chlor. corros..   .fa  "fa  g-
  chlor. mite.....£  "  8  g.
  cyanidum.....fa  "  i  g-
  c. creta......3  "  8  g.
  formamidatum (1 % sol.)  5  "15 m.
  iodid. flav......£  "  1  g.
  iodid. rubr......fa  " fa  g.
  iodid. vir.......£  "  1  g.
  oxidum flavum   .  .   . fa  "  i  g.
  salicylatis.....£  "  1  g.
  subsulphas flav.  ...£"£  g.
  tannas.......£  "  1  g.
Hydrastin......5  " 10  g.
Hydrobromic acid (dilute)  1  "  4  d.
Hydroquinone.....10  "15  g.
Hyoscine......T£T " fa  g.
Hyoscyamine, and its salts X£F " fa  g.
Hypnone......5  " 20 m.
Ichthyol.......3  "  4  g.
Infusum brayera?.  .  .   .  2  "  8 fl. oz
  caulophylli.....1  "  2  oz.
  digitalis......2  "  4 fl.d.
  senna? comp.....1  "  2 fl. oz
Iodoformum.....1  "  3  g.
Iodol........£  "  1  g-
Iodum.......fa  "  i  g-
Ipecacuanha \   P                   *'
 1           lemet.  .   . 15  " 30  g.
Jalapa.......15  " 30  g.
Kairin.......2  "  8  g. 
636
TABLE  OF  DOSE.S
          Remedies.
Kamala.......1
Kino........8
Lactucarium.....8
Leontin.......I
Lewinin.......50
Liq. ammon. acet.   ...  2
  acidi arseniosi ....  2
  arsen. et hydr.....2
  ferri chloridi   ....  2
  ferri dialys......1
  ferri nitrat......8
  pepsini......2
Liquor potassae   ....  5
  potassii arsenit.   ...  3
  potassii citrat.....2
  soda?.......5
  sodii arseniatis ....  3
Lithii benzoas.....2
  bromid.......1
  carbonas......2
  citras.......2
  salicylas......2
Lupulinum......5
Magnesia......15
Magnesii carb......15
  citr. gran......2
  sulphas......2
  sulphis......8
Manganese  binox.   ...  2
Mangani sulphas.   .  .  .- 1
Manna.......1
Massa copaiba?.....5
  ferri carb......5
  hydrarg.......1
Mist, ammoniaei ....  4
  asafoetida?......4
  chloroformi.....1
  creta?.......1
  ferri comp......£
  ferri et amm. acet.  .  .  £
  glycyrrh. comp.   ...  1
  magnes. et asafcet.  .  .  1
  potassii citr......£
  rhei et soda?.....J
Morphina, and its salts.  . fa
Morrhuol......1
Mosehus.......2
Naphthalinum   ....  2
Naphthol......2
Narceina.......£
Nitroglycerinum .   .  .  .  1
Nux vomica.....1
Oleoresina aspidii    ... 15
  capsici.......J
Dose.
to  2   d.
"  30   g.
"  15   g-
"   £   g.
 fo  sol.
"   8  fl.d.
"   7
"   7
"  10  m.
"  15  m.
"  15  m.
"   4  fl.c
"  30  m.
"   7
"   4  fl. (
"  30  m.
"   7
"   5
"   3   ~g.
" 5	g-
" 8	g-
" 10	g-
" 60	g-
" 60	g-
" 8	d.
" 8	d.
" 30	g
" 4	g-
" 10	g-
" 2	oz.
" 30	g-
" 15	g-
" 15	g-
" 8	fl.d.
" 8 fl. d.	
" 2	fl.d.
" 2	fl.oz.
" 2	fl.oz.
" 1	fl.oz.
" 4	fl.d.
" 4 fl. d.	
" 2	fl.oz.
" 1	fl.oz.
" £	g-
" 5	g-
" 15	g-
" 10	g-
" 10	g-
" £	g-
m.of 1	% sol.
" 5	g-
" 60	g-
" £	g-
           Remedies.
Oleoresina cubeba?  ...  5
  filicis.......30
  lupulini......2
  piperis.......1
  zingiberis......1
Oleum copaiba?   ....  8
  cubeba?......15
  erigeron......5
  eucalypti......5
  gaultheria?.....1
  phosphoratum ....  1
  sabina?.......1
  terebinth......5
  tiglii.......£
Opium (14 fo morphine)  .  I
Pancreatin......10
Papayotin......1
Paracotin......1
Paraldehyde.....20
Pearson's solution   ...  1
Pelletierine......2
Pepsinum purum.   .  .  . 15 £
  saccharatum.....30 j
Phenacetine.....2
Phosphoric acid  ....  £
Phosphorus......T£g
Physostigmina?  salic.  .  . T£5
  sulphas......T£j
Picrotoxinum.....fa
Pilocarpine, and its salts  .fa
Pil. aloes.......1
  aloes et asafoet.....2
  aloes et ferri.....1
  aloes et mast.....1
  aloes et myrrha?   ...  2
  antim. comp.....1
  asafoetida?......1
  cathart. comp.....1
  ferri comp......2
  ferri iodidi.....1
  galbani comp.....1
  opii........1
  phosphori.....1
  rhei........2
  rhei comp......2
Piperinum.....X  1
Plumbi acetas.....\
  iodidum......£
Potassii acetas.....15
  bicarb........8
  bitartr........1
  bromid.......8
  carb........8
  chloras.......8
Dose		
to 20		m.
u	60	m.
"	5	g-
a	3	g-
tt	3	g-
"	15	m.
it	30	m.
"	15	m.
tt	10	m.
a	20	m.
"	3	m.
"	3	m.
a	30	m.
"	1£	m.
a	1£	g-
it	20	g-
"	5	g-
"	3	g-
it	60	g-
"	5	m.
"	5	g-
.to£		oz.
p.	' 1	oz.
to	6	g-
It	1	d.
It	A	g-
"	A	g-
It	A	g-
"	£	g-
"	i	g-
It	3	pills
it	5	pills
I	3	pills
It	3	pills
tt	5	pills
"	3	pills
It	6	pills
"	4	pills.
It	5	pills.
tt	4	pills
tt	6	pills
"	2	pills
It	4	pills
II	5	pills
It	5	pills
It	8	g-
If	3	g-
It	3	g-
"	60	g
It	60	g-
"	2	g-
tt	60	g
It	30	g-
"	30	g-
 
TABLE  OF  DOSES.
637
           Remedies.
 Potassii citras.....15
   cyanid.......^
   et sodii tartr.....£
   hypophosphis   ....  5
   iodid........2
   nitras.......8
   sulphas......1
   sulphidum.....1
   sulphis......15
   tartras .......  l
 Pulv. antimonialis  ...  1
   aromat.......8
   cretae comp......8
   glycyrrh. comp.   ... 30
   ipecac, comp.....5
   jalapae comp.....30
   morphina? comp.  ...  8
   rhei comp......30
 Pyridine.......1
 Pyrodine.......1
 Quinidina, and its salts .  .  1
 Quinina, and its salts  .  .  1
 Quinina? arsenias ....  £
 Resina copaibae  ....  2
   guiaici.......10
  jalapa?.......2
   podophylli.....J
   scammonii.....2
 Resorcin.......2
 Rheum.......2
 Saccharin......£
 Salicinum......8
 Salicylate of bismuth  .  .  3
   of mercury.....fa
   of sodium.....5
Salol........10
Santonica......8
Santoninum.....1
Sapo........5
Scammonium.....3
Senna........8
Sodii acetas......15
  arsenias......fa
  benzoas   ......   5
  bicarb........8
  bisulphis......8
  boras.......8
  bromid.......8
  carb........8
  carb. exsicc......5
  chloras.......5
  hypophosphis ....  8
  hyposulphis.....8
  iodidum......5
Dose.
to 60
 15
 30
 15
  4
 10
 30
  8
  3
 30
 30
160
 15
 60
 10
" 5	g
" 3	g-
" 30	g
" 30	g
" 1	g
" 10	g-
" 20	g-
" 5	g-
" £	g-
" 5	g-
" 4	g-
" 30	g-
" 4	g-
" 30	g-
" 15	g-
of £	g-
to 60	g-
" 15	g-
" 60	g-
" 5	g-
" 30	g-
" 15	g
" 60	g
" 60	g-
" iV	g-
" 15	g-
" 30	g-
" 30	g-
" 30	g-
" 30	g-
" 30	g'
" 15	g-
" 30	g-
" 15	g-
" 30	g-
" 15	g-
10	g-
2	g-
30	g-
4	g-
60	m.
2	fl.d
30	m.
60	m.
30	m.
60	m.
60	m.
60	m.
30	g-
30	g-
20	g-
30	g-
t£(5	m.
h	g-
4	d.
2	fl.d.
           Remedies.            Dose.
 Sodii phosphas   .  .   .  .  2  to 15
   salicylas......5  " 30
   santoninas.....2
   sulphas......1
   sulphis......8
 Sparteine sulph.....\
 Spiritus aetheris compositus 30
   aether, nitrosi   ....   £
   ammonia?......8
   ammoniae arom.   ...  15
   camphorae  .....   8
   chloroformi.....15
   lavand. comp.....30
   menth. pip......30
 Strontium  bromidi  ...  20
   lactati.......20
   iodidi.......10
   phosphat......20
 Strophanthin.....jfo
 Strychnine, and its salts  .  fa
 Sulphur.......4
 Syr. calcii lactophos.   .  .   1
   calcis.......15  " 30 m.
   ferri bromidi   .   .  .  .15  " 60 ni.
   ferri iodidi.....15  " 40 m.
   ferri oxidi.....—  "  1 fl. d.
   ferri hypophosph..  .   .  —  "  1 fl. d.
   ferri quin. et strych. phos.  —  "1 fl.d.
   hypophosphit.....—  "  1 fl. d.
   hypophos ph. c. fer.  .  .  —  "  1 fl. d.
   ipecac........£  "  1 fl. d.
   krameriae......£  "  4 fl. d.
   lactucarii......1   "  3 fl. d.
   rhei........1   "  4 fl. d.
   rhei arom......1  "  4 fl. d.
   rosa?.......1  "  2 fl.d.
   sarsap. comp.   .   .  .  .   1  "  4 fl. d.
   scilla?.......£  "  1 fl.d.
   scillae comp......15  " 60 m.
  senega?......1   "  2 fl. d.
  sennae.......1  "  4 fl. d.
 Terebene ...     ...   5  " 10 m.
Terpine hydrate  .   .   .  .10  " 20  g.
Terpinol.......2  " 10 m.
Thallin.......1  "  3  g.
Theine.......1  "  2  g.
Thymol.......1 to  5  g.
Tinct. aconiti fol.....8  " 16 m.
  aconiti rad......1  "  5 m,
  aconiti rad. (Fleming's) .   §  " 2£ m.
  aloes (1880).....£  "  2 fl.d.
  aloes et myrrha?   .  .  .   1  "  2 fl. d.
  arnica? flor......8   " 30 m.
  arnicae rad......15  " 30 m. 
638
TABLE  OF  DOSES.
          Remedies.            Dose.
Tinct. asafoetidae  .  .   .  .  30  to 60 m.
  belladonnas.....8  " 15 m.
  bryonia?......15  " 30 m.
  calendula?.....16  " 30 m.
  calumbae......1  "  4 fl.d.
  cannabis ind.....15  " 30 m.
  cantharid......2  "  5 m.
  capsici.......8  " 15 m.
  catechu com.....£  "  2 fl. d.
  chiretta?......15  " 60 m.
  cimicifugae.....30  " 60 m.
  cinchona?......£  "  2 fl. d.
  cinchonae comp.  .   .  .   £  "  2 fl. d.
  colchici rad......5  " 15 m.
  colchici sem.....6  " 15 m.
  conii.......5  " 15 m.
  croci.......1  "  2 fl.d.
  cubebae......1  "  2 fl. d.
  digitalis......6  " 15 m.
  ferri acet.......15  " 30 m.
  ferri chloridi   .  .   .  .15  " 30 m.
  ferri chloridi aether.  .  .15  " 30 m.
  ferri pomati.....20  " 60 m.
  galla?.......£  "  2 fl. d.
  gelsemii......8  " 15 m.
  guaiaci......30  " 60 m.
  guaiaci ammon.  .   .  .30  "60 m.
  hellebori......10  " 15 in.
  humuli......1  " 2£ fl. d.
  hydrastis......30  " 90 m.
  hyoscyami fol.....15  " 30 m.
  hyoscyami sem.  .   .  .15  " 30 m.
  ignatia?......5  " 15 m.
  iodi........5  " 15 m,
  ipecac, et opii  .  .   .  .   5  " 15 m.
  jalapae.......$  "  2 fl.d.
  kino.......£  "  2 fl.d.
  krameria?......£  "  2 fl. d.
  lavand. comp.....£  "  2 fl. d.
  lobelia?......15  " 45 m.
  lupulini......£  "  2 fl.d.
  matico.......£  "  2 fl.d.
  moschi......15  " 60 m.
           Remedies.
Tinct. nucis vomicae.  .  .  8
  opii........8
  opii camph......8
  Phytolacca?.....8
  physostigmatis ....  5
  pyrethri......8
  quassia?......£
  rhei........1
  rhei arom......30
  rhei dulc......1
  sanguinaria?.....15
  scillae  .......  8
  serpentaria.....£
  stramon. fol.....8
  stramon. sem.....6
  sumbul.......8
  valer........£
  valer. ammon.....i
  veratr. vir......3
  zingiberis......15
Tritur. elaterini ....  J
Tully's powder  ....  2
Urethan.......10
Veratrina......fa
Vin. aloes......1
  antim.(exP-etantiPyret-20
         I emet.....2
  colch. rad......5
  colch. sem......10
  ergotae.......1
  ferri amar......\
  ferri citrat......£
  ipecac.   |exPect.   .  .  5
           i emet.  ...  3
  opii........5
  rhei ........  1
Zinci acetas......1
  bromid.......£
  iodid........J
  oxid........1
  phosphid.......fa
  sulphas emet.....15
  valerianas.....1
Dose		
to 20		m.
it	15	m.
tt	75	m.
tt	60	m.
tt	15	m.
a	30	m.
"	2	fl.d.
«	8	fl.d.
tt	75	m.
tt	4	fl.d.
"	70	m.
"	60	m.
«	2 fl.d.	
"	15	m.
a	15	m.
a	30	m.
a	2	fl.d.
a	2	fl.d.
a	10	m.
"	60	m.
u	£	g-
"	10	g-
a	15	g-
u	iV	g-
"	2	fl.d.
"	60	m.
a	3	d.
it	20	m.
a	40	m.
tt	3	fl.d.
tt	1	fl.d.
it	1	fl.d.
a	15	m.
"	6	fl.d.
"	15	m.
u	2	fl.d.
a	2	g
"	2	g
k	3	g-
"	10	g
"	£	g-
u	30	g-
 
TABLES  OF RELATIVE WEIGHTS AND MEASURES  IN THE
        METRIC AND APOTHECARIES' SYSTEMS.
           (See Oldberg's Manual of Weights and Measures.)
		Milligrammes			in Grains.			
Milligramme		Grain.	Milligrammes.		Grain.	Milligrammes.		Grain..
0.1	=	BoTJ	1	=	l So"	8	=	£
0.2	=	3THT	1.2	=	1 5TJ	9	=	i 7
0.3	=	l 7T00	1.6	=	1	10	=	£
0.4	=	l	2	=	1 30"	12	=	i
0.5	=	l T2T)	3	=	1 25	16	=	i 4
0.6	=	rbv	4	=	1 To	20	=	£
0.7	=	i wo	5	=	1 TZ	30	=	
0.S	=	1	6	=	1 TS	60	=	l
0.9	=	1 TO"	7	=	1			
		c	ENTTGRAMMES		in Grain	s.		
Centigrammes		Grain.	Centigrammes		Grains.	Centigrammes		Grains,
(or Cent.)			(or Cent.)			(or Cent.)		
1	=	1 6	6	=	1	18	=	3
2	=	£	7	=	U	25	=	4
3	=	i 2	9	=	U	50	=	8
4	=	I	10	=	U	75	=	12
5	=	5	12	=	2	100	=	16
			Grammes in		Grains.			
Grammes		Grains.	Grammes.		Grains.	Grammes.		Grains.
0.001	=	1 ST7	11	=	176	27	=	432
0.010	=:	£	12	=	192	28	=	448
0.100	=	if	13	=	208	29	=	464
0.250	=	4	14	=	224	30	=	480
0.500	=	8	15	=	240	31	—	496
0.750	=	12	16	=	256	32	=	512
1	=	16	17	=	272	33	=	528
1.50	=	24	18	=	288	34	=	544
2	=	32	19	=	304	35	=	560
3	=	48	20	=	320	36	=	576
4	=	64	21	=	336	37	=	592
5	=	80	22	—	352	• 38	=	608
6	—	96	23	=	368	39	=	624
7	=	112	24	=	384	40	=	640
8	=	128	25	=	400	50	=	800
9	=z	144	26	=	416	100	=	1600'
10	=	160						
 
640       RELATIVE  WEIGHTS AND  MEASURES.
Cubic Centimetres (or Fluidgrammes) in U. S. Apothecaries'
                     Fluidrachms.
Cubic		U.S.	Cubic		U S.	Cubic		u. s.
Jentimetres	Fluidrachms.		Centimetres.	Fluidrachms.		Centimetres.	Fl	lidrachms
1	=	1. 4	9	=	21	' 16	=	4
2	=	£	10	=	2£	20	=	5
3	=	4	11	=	n	24	=	6
4	—	1	12	=	3	28	=	7
5	=	H	13	=	3£	32	=	8
6	—	IJ	14	=	3£	48	=	12
7 8	=	H 2	15	=	3!	64	—	16
 
INDEX  OF  DRUGS  AND  REMEDIAL  MEASURES.
* Denotes official names and preparations of the B. P. not found in the U. S. P.
   Abortifacients, 29
     Absorption of drugs, 26
Abstractum aconiti, 47
   belladonnse, 88
   conii, 157
   digitalis, 168
   hyoscyami, 196
   ignatise, 199
   jalapae, 216
   nucis vomicae, 256
   podophylii, 285
   senegae, 304
Abstracts, 22
Acacia, 39
*Acaciae gummi, 39
Aceta, 22
Acetanilide, 39
Acetate of ammonium, 61
   of copper, 160
   of lead, 222
   of morphine 264
   of potassium, 43
   of sodium, 307
   of zinc, 44
Acetic acid, 44
Acetphenetidlne, 278
Acetum cantharidis, 114
   lobeliae, 226
   opii, 263
   sanguinariae, 299
   scill8e,3U
Acid infusion of roses, 292
   nitrate of mercury, 239
   tartrate of potassium, 91
Acidum aceticum, 44
       dilutum, 44
       glaciale, 44
   arseniosum, 76
   benzoicum, 89
   carbolicum, 115
   ♦carbolicum liquefactum, 118
   chromicum, 138
   citricum,  147
   gallicum, 181
   hydrobromicum dilutum, 99
   hydrochloricum, 193
       dilutum, 194
   hydrocyanicum, 194
   nitricum, 248
       dilutum, 249
   nitro-hydrochloricum, 194, 250
       dilutum, 194, 235, 250
   phosphoricum dilutum, 276
Acidum salicylicum, 293
   sulphuricum, 318
       aromaticum, 318
       dilutum, 318
   tannicum, 321
   tartaricum, 322
   valerianicum, 331
Aconite, 45
   *liniment, 47
   *ointment, 47
*Aconiti folia, 47
   *radix, 47
Aconitine, 47
Action of drugs, direct, 19
       duration of, 27
       indirect, 19
       modes of, 19
Acupuncture, 338
Adeps benzoinatus, 89
Adhesive plaster, 288
Administering drugs, mode of, 19
Adonidin, 47
Adonis vernalis, 47
^Ether, 171
   fortior, 171
   *purus,  171
Agaric, 48
Agaricin, 48
Alcohol, 48, 53
   *amylicum, 48, 53
   dilutum, 48, 53
   ethylicum, 48
   phenylic, 115
Alcoholic extract of belladonna, 8!
       of conium, 157
       of gelsemium, 183
       of hyoscyamus, 196
Ale, 53
Alkaloids, 23
Allium, 53
Allspice, 55
Almond bread, 54, 376
Almonds, 54
   bitter,  54
   sweet,  54
Aloe, 55
   *barbadensis, 55
   purificata, 55, 56
   socotrina, 55
*Aloin, 55
Alteratives, 29, 35
Alum, 57
Alumen, 57
41 
642
INDEX   OF  DRUGS.
 Alumen exsiccatum, 58
 Amber, 58
 American wormseed, 126
 Ammonia, 59
    liniment, 61
 Ammoniac, 64
 Ammoniacum, 64
 Ammoniated mercury, 234
    tincture of guaiac, 188
        of valerian, 330
 Ammonii acetas, 61
    benzoas, 61
    bromidum, 61, 97
    carbonas, 62
    chloridum, 62
    iodidum, 63
    oxalas, 63
    phosphas, 63
    sulphas, 63
    sulphis, 63
    valerianas, 63
 Ammonio-ferric alum, 211
 Ammonium, 61
 Amygdala amara, 54
    dulcis, 54
 Amyl nitrite, 64
 Amylic alcohol, 48, 53
 Anaesthetics, 29, 35
 Anaphrodisiacs, 29
 Antacids, 29, 35
 Anthelmintics, 29, 35
 Anthrarobin, 65
 Antiarthritics,  29
 Antidotum arsenici, 80, 213
 Antifebrin, 29
 Antihydrotics, 29
 Antimonial powder, 69
 Antimonii et potassii tartras, 66
    sulphidum, 66
       purificatum, 66
 *Antimonium nigrum purificatum, 66
    sulphuratum, 66
    *tartaratum, 66
 Antimony, 66
 Antiperiodics, 29, 35
 Antiphlogistics, 29, 35
 Antipyretics, 36
 Antipyrine, 70
 Antiseptics, 338
 Antispasmodics, 36
 Aphrodisiacs, 29
 Apiol, 74
 Apomorphinae hydrochloras, 76
 Apomorphine, 75
 Aqua ammoniae, 60
       fortior, 60
    amygdalae am arse, 55
    camphorae, 108
   *chloroformi, 138
    cinnamomi, 146
    creasoti, 161
    menthae piperita, 271
   *pimentae, 55
    rosae, 291
Aquae, 23
Arbutin, 330
*Argenti et potassii nitras, 232
    nitras, 245
       fusus, 245
       dilutus, 245
 Aristol, 76
 Arnica, 76
    flores, 70, 76
    radix, 70, 76
   *rhizoma, 70, 76
 Aromatic chalk powder, 105
   *chalk powder with opium, 105
    mixture of iron, 211
    powder, 122
    spirit of ammonia, 61
    sulphuric add, 319
    syrup of rhubarb, 290
    tincture of rhubarb, 290
 Arseniate of copper, 76
    of iron, 211
    of potassium, 76
    of sodium, 76
 Arsenic, 76
 Arsenicum, 76
 Arsenii iodidum, 80
 Arsenious acid, 76
 Asafoetida, 81
 Aspidium, 82
Astringents, 29, 35
Atomization,  20
Atropinae sulphas, 84, 88
Atropine, 84, 88
 Auri et sodii chloridum, 186
Azedarach, 82
 " T)ALM OF GILEAD,"328
   -D  Balsam of copaiba, 158
 Barbadoes aloes, 55
 Barium chloride, 83
 Barley water, 376
 Basham's mixture, 211
 Bath, Russian,  361
    Turkish, 361
 Bearberry, 330
 Beechwood creasote, 160
 Beef essence, 375
    peptonized, 373
    tea, 375
 Beer, 53
 Belladonna, 84
    folia, 84
    liniment, 88
    ointment, 88
    plaster, 88
    radix, 84
 Benzoate of ammonium, 61
    of bismuth, 88
    of lithium,  225
 Benzoated lard, 89
 Benzoic acid, 88
Benzoin, 88
Benzoinum, 88
Berberine, 105, 192
Bicarbonate of  potassium, 89
    of sodium, 89
Bichloride of mercury, 234
    as an antiseptic, 338
Bimuriate of quinine and urea, 144
Biniodide of mercury, 236
Binoxide of manganese, 229
Bismuth, 90
    benzoate, 88
    subgallate,  91
*Bismuthi carbonas, 90 
I
INDEX
OF  DRUGS.
 Bismuthi citras, 90
    et ammonii citras, 83, 90
    salicylate, 91
    subcarbonas, 90
    subgallate, 91
    subnitras, 90
 Bismuthum, 90,
 Bisulphate of quinine, 144
 Bisulphide of carbon, 121
 Bitartrate of potassium, 91
 Bitter almonds, 54
    wine of iron, 215
 Bitters, 30
 Black cohosh, 139
    draught, 305
    drop, 263
    ginger. 184
    mustard, 243
    oxide of manganese, 229
    pepper, 270
    snake-root, 139
    wash, 236
 Bleeding, 370
 Blood-root,  299
 Blue mass, 236
    ointment, 238
    pill, 236
 Boneset, 178
 Bonjean's ergotin, 171
 Boric acid, 92
 Borate of sodium, 92
 Borated lint, 92
 Borax, 92
 Boroglycerin, 92
 Bran bread, 377
 Brandy, 53
 Brayera, 93
 Bromide of ammonium, 61, 97
    of calcium, 98
    of gold, 98
    of ethyl, 175
    of iron, 211
    of lithium, 98, 225
    of nickel, 91, 98
    of potassium, 94
    of sodium, 99
    of strontium, 99. 312
Bromides, 94
Bromine, 99
Broom, 302
Brown mixture, 224
Brucine, 253
Bryonia,  99
Buchu, 100
    *folia, 100
Burgundy pitch, 284
Burnt alum, 58
*Butyl-chloral hydras, 162
pACTUS grandiflorus,.101
\J  Caffeinae citras, 102
Caffeine, 102
Cajuput oil, 103
Calabar bean, 279
Calabarine, 279
Calcium, 103
Calcii bromidum, 98,103
   carbonas  praecipitatus, 103
   chloridum, 103
 Calcii hydras, 106
    hypophosphis, 103
    phosphas praecipitatus, 103
 California buckthorn, 121
 Calomel, 236
    ointment, 238
 Calumba, 105
 Calumbine, 105
 Calumbo, 105
 Calx,  106
    chlorata, 132
   *chlorinata, 132
    sulphurata, 106
 Camphor, 106
    liniment, 108
    water, 108
 Camphora monobromata, 108
 Camphorated tincture of opium, 263
 Camphoric acid, 109
 Canada pitch, 284
 Cannabis Americana, 110
    Indica, 110
 Cantharidal collodion, 113,156
 Cantharidal cereate, 113
    liniment, 113
    paper, 113
 Cantharidin, 112
 Cantharis, 112
 *Capsici fructus, 114
 Capsicum, 114
    fruit, 114
    plaster, 115
 Carbo ligni, 119
 Carbolic acid, 115
    as an antiseptic, 339
    ointment, 118
 Carbon, 119
 Carbonate of ammonium, 62
   *of bismuth, 90
    of iron, 211
    of lead, 222
    of lithium, 225
    of magnesium, 228
    of potassium, 120
    of zinc, 120
 Carbonei bisulphidum, 120
 Cardamom, 122
    seed,122
 *Cardamomi semina, 122
 Cardiac sedatives, 30, 36
    stimulants,  30, 36
 Carminatives, 30
 Carron oil, 106
 Caryophyllus, 147
 Cascara cordial, 121
    sagrada, 121
 Cassia fistula, 122
 *Cassiae pulpa, 122
 Cathartics, 30
 Castile soap, 306
 Castor oil, 122
 *Cataplasma carbonis, 1119
   *conii, 158
   *lini, 181
   *sinapis, 243
Cataplasms, 23
Catechu, 124
Cat's-hair, 178
Caustic potash, 124
   soda, 124 
644
INDEX   OF  DRUGS.
Cayenne pepper, 114
Cerates, 23
Ceratum camphoroe, 108
    cantharidis, 113
    extracti cantharidis, 113
    plumbi subacetatis, 223
    resina, 288
Cerii oxalas, 125
Chalk mixture, 103
Champagne, 52
Charcoal, 119
    poultice, 119
Charta cantharidis, 113-
   *epispastica, 114
    potassii  nitratis, 245
    sinapis,  242
Chartse, 23
Chenopodium, 126
Chimaphila, 126
Chinoidinum, 140
Chirata, 126
Chiretta. 126
Chloral, 127
   *hydras,  121
Chloralamide, 129
Chlorate of  potassium, 130
Chloride of ammonium, 62
    of barium, 83
    of calcium, 103
    of gold and sodium, 186
    of iron,  212
    of mercury, corrosive, 234
    of mercury, mild, 236
    of sodium, 131
    of zinc,  132
       as an antiseptic, 342
Chlorinated lime, 132
Chlorine gas, 133
Chlorodyne, 133
Chloroform, 133
    liniment, 138
♦Chloroformum, 133
    purificatum, 133
    venale,  133
Cholagogues, 30
Chromic acid, 138
Chrysophanic  acid, 290
Chrysarobin, 139
    ointment,  139
Cimicifuga,  139
    racemosa,  139
   *rhizoma, 139
Cinchona, 140
  •  calisaya, 140
    condominea, 140
   *cortex, 140
    flava, 140
    micrantha, 140
    pale, 140
   *pitayensis, 140
    red, 140
    rubra, 140
   *rubra cortex, 140
    succirubra, 140
    yellow, 140
Cinchonicine,  140
Cinchonidine, 140
Cinchonidinae sulphas, 140, 145
Cinchonidinum, 145
Cinchoninae sulphas, 140, 145
Cinchonine, 140
Cinnamon, 146
    water, 146
*Cinnamomum cortex, 146
Citrate of bismuth, 90
    of bismuth and ammonium, 90
    of caffeine, 102
    of iron, 212
   *of iron and ammonium, 212
    of iron and quinine, 213
    of iron and strychnine, 213
    of lithium, 225
    of magnesium, 228
    of potassium, 146
Citric acid, 147
Citrine ointment, 240
Clarets, 53
Classification of drugs, 35
Cloves, 147
Cobalto-nitrate of potassium, 249
*Coca, 148
    erythroxylon, 148
*Cocainae hydrochloras, 149
Cocaine, 148
    phenate, 150
Codeine, 151
Cod-liver oil, 151
Coffee, 154
Colchicine, 154
Colchicum, 154
    corns, 154
    seed, 154
Cold as a remedy, 344
    cream, 291
    pack, 353
Collodion, 155
Collodium, 155
    cum cantharide, 113, 156
    flexible, 156
    stypticum, 156
   *vesicans, 156
Colocynth, 156
♦Colocynthidis pulpa,  156
Cologne water, 53
Columbo, 105
Combination of drugs for effect,  33
Commercial chloroform, 133
    oxide of zinc, 265
Compound cathartic pills, 157
    effervescing powder, 303
   *decoction of aloes, 57
       of sarsaparilla, 301
    extract of colocynth, 156
    fluid extract of sarsaparilla, 301
    infusion of gentian, 183
       of senna, 230
    liniment of camphor, 108
       of mustard, 243
    mixture of iron, 212
       of liquorice, 224
      *of senna, 305
    pill of antimony, 69
       of asafoetida, 82
      *of colocynth, 157
      *of conium, 158
       of iron, 211
       of rhubarb,  290
      *of scammony, 302
      *of soap, 263
      *of s uill, 311 
                               INDEX

♦Compound powder of almonds, 55
      *of catechu, 125
       of chalk, 105
      *of cinnamon, 146
      *of elaterin, 169
      *of ipecac, 210
       of jalap, 216
      *of kino, 218
       of liquorice, 224, 305
       of morphine, 264
      *of opium, 263
       of rhubarb, 290
      *of scammony, 302
    solution of iodine, 206
    spirit of ether, 190
       of juniper, 217
   ♦suppositories of lead, 222
    syrup of sarsaparilla, 301
       of squills, 70
    tincture of benzoin, 89
      *of camphor, 108
       of cardamom, 122
       of catechu, 125
      *of chloroform, 138
       of cinchona, 145
       of gentian, 183
♦Confectio opii, 263
   ♦piperis, 270
    rosae, 191, 291
   ♦scammonii, 302
    sennae, 122, 304
   ♦sulphuris, 318
    terebinthinae, 329
Confections, 23
♦Conii folia, 157
   ♦fructus, 157
Coniine, 157
Conium, 157
Conserves, 22
Contra-indications_for drugs, 29
Copaiba, 158
Copper, 159
Corrosive chloride of mercury, 234
    sublimate, 234
Cosmoline, 273
Counter-irritation, 354
Counter-irritants, 31, 36
Coxe's hive syrup, 70, 311
Cream of tartar, 91
Creasote, 160
Creolin, 161
    as an antiseptic, 341
Creta praeparata, 105
Croton chloral, 162
    oil, 162
      ♦liniment, 162
Cubebic acid, 163
Cubebin, 163
Cubebs, 163
Cupri acetas, 159
    nitras, 159
    sulphas, 159
Cuprum, 159
♦Cusso, 93
Cyanide of potassium, 163
   DANDELION, 322
     Daturine, 312
Decoctions, 23
OF   DRUGS.                          645

   ♦Decoctum aloes compositum, 57
      ♦cinchonae, 145
       granati radicis, 287
      ♦haematoxyli, 189
      ♦pareirae, 269
      ♦quercus, 288
      ♦sarsae, 301
          ♦compositum, 301
       sarsaparillae compositum, 301
      ♦scoparii, 303
      ♦taraxaci, 322
   Definition of therapeutics, 18
   Demulcents, 31
   Denarcotized opium, 262
   Deodorized tincture of opium, 263
   Dermatol, 91
   Diachylon, 223
   Dialyzed iron, 213
   Diaphoretics, 31, 36
   Diet for child six to twelve months old, 374
              one year old, 374
              two years old, 374
              seven years old, 374
       list, 374
   Diethyl-sulphon-dimethyl-methane, 315
   Digestants, 37
   Digitalin, 168
   Digitalis, 164
      ♦folii, 164
   Dilute acetic acid, 44
       alcohol, 48
       hydrobromic acid, 99
       hydrochloric acid, 194
       hydrocyanic acid, 194
       nitric acid, 249
       nitro-hydrochloric acid, 194, 252
       phosphoric acid, 276
       solution of subacetate of lead, 222
       sulphuric acid, 319
   Dimethyloxyquinizine, 70
   Dioxide of hydrogen, 266
   Disinfectants, 37
   Disinfection, 357
   Diuretics, 31, 37
   Diuretin, 306
   Donovan's solution, 80
   Dosage, 24
   Double cyanide dressing, ^343
   Dover's powder, 209, 263
   Dried sulphate of iron, 215
   Drugs, absorption of, 26
       classification of, 35
       duration^of action of, 27
       indications and contra-indications for, 29
       modes of administering, 19
       strength and reliability of, 27
   ECBOLIC acid, 169
    Ecgonine, 148
Effervescing draught, 147
   ♦solution of lithium, 226
"Egg-flip," 53
Egg-nog, 53
Elaterin, 168
Elaterium, 168
Electuaries, 22
Eliminators,^31, 37
Elixirs, 23
Emetics, 31, 37 
646
INDEX   OF  DRUGS.
 Emetine, 210
 Emmenagogues, 31, 37
 Emplastra, 23
 Emplastrum ammoniaei, 64
        cum hydrargyro, 64
    arnicae, 76
    asafetidae, 82
    belladonnae, 88
   ♦califaciens, 114
   ♦cantharidis, 114
    capsici, 115
   ♦ferri, 216
    hydrargyri,  239
   ♦opii, 263
   ♦peroxidum ferri, 216
    picis burgundicae, 284
    picis canadensis, 284
    picis cum cantharide, 113
    plumbi, 223
   ♦plumbi iodidi, 222
    resinae, 288
    saponis, 306
 Emulsions of bitter almonds, 54
    of sweet almonds, 54
 Endermic medication, 22
 Enema, 20
   ♦aloes, 57
   ♦asafoetidae, 82
   ♦magnesii sulphatis, 229
   ♦opii, 263
   ♦terebinthinae, 329
Ergot, 169
Ergotic acid, 169
Ergotin, 169
♦Ergotinum, 171
Erigeron, 171
Erythroxylon, 148
Eserine, 279
♦Essentia menthae piperitae, 271
Ether, 171
Ethyl alcohol, 48
    bromide, 175
    iodide, 176
    oxide, 160
Eucalyptol, 177
Eucalyptus, 177
Euonymin, 177
Euonymus, 177
Eupatorium, 178
Euphorbia pilulifera, 178
Europhen, 179
Exalgine, 180
Expectorants, 32, 37
Extracts, 23
Extractum aconiti, 46
   ♦aloes barbadensis,  57
      ♦socotrinae, 57
   arnicae radicis, 76
   ♦calumbae, 105
   cannabis indicae, 112
   ♦cascarae sagradae, 121
   cinchonae, 145
   ♦colchici, 155
   colchici radicis, 155
   colocynthidis, 156
   colocynthidis compositum, 156, 280
   ♦conii, 157,158
   digitalis, 168
   ergotae, 171
   euonymi, 178
I Extractum gentiame,  lS:i
    glycyrrhiza1, 224
        purum. 224
    hfcmatoxyli, 189
    ♦hyoscyami, 196
    jaborandi, 282
    ♦jalapae, 216
    krameriae, 218
    leptandrse, 223
    ♦lupuli, 192
    mezerei, 242
    ♦mezerei aethereum, 242
    nucis vomicae, 256
    opii, 262
    ♦pareiree, 269
    physostigmatis, 280
    podophylli, 2S5
    quassiae, 288
    rhei, 290
    stramonii, 312
    taraxaci, 322
♦Extractum colchici aceticum, 15.3
Extractum belladonnae alcoholicum, 88
    conii alcoholicum, 157
   ♦gelsemii alcoholicum, 183
    hyoscyami alcoholicum, 196
Extractum aconiti fluidum, 46
    arnicae radicis fluidum, 76
    belladonnae fluidum, 88
    brayerae fluidum, 94
    buchu fluidum, 101
    calumbae fluidum, 105
    cannabis indicse fluidum, 112
    capsici fluidum, 11.3
    chimaphilae fluidum, 126
    chiratae fluidum, 127
    cimicifugae fluidum,  140
    cinchonae fluidum, 145
    colchici radicis fluidum, 155
       seminis fluidum,  155
    conii fluidum, 158
    cubebee fluidum, 163
    digitalis fluidum, 168
    ergotae fluidum, 170
    erythroxyli fluidum,  150
    eucalypti fluidum,  178
    eupatorii fluidum, 178
    gelsemii fluidum, 183
    gentianae fluidum, 183
    geranii fluidum, 184
   . glycyrrhizae fluidum,  221
    grindeliae fluidum,  187
    hamamelidis fluidum, 189
    hydrastis fluidum, 193
    hyoscyami fluidum, 196
    ipecacuanhee fluidum, 209
    krameriae fluidum,  218
    leptandrae fluidum, 223
    lobeliee fluidum, 227
    lupulini fluidum, 192
    mezerei fluidum, 242
    nucis vomicae fluidum, 256
    pareirae fluidum, 269
    pilocarpi fluidum, 282
    podophylli fluidum, 286
    pruni virginianae fluidum, 287
    quassiae fluidum, 288
    rhei fluidum, 290
    rhus glabrae fluidum,  291
    rosae fluidum, 291 
INDEX
OF  DRUGS.                          647
Extractum sabinae fluidum, 303
    sanguinariae fluidum, 299
    sarsaparillae compositum fluidum, 301
       fluidum, 301
    scillae fluidum, 311
    senegae fluidum, 304
    sennae fluidum, 304
    serpentariae fluidum, 305
    spigeliae fluidum, 310
       et sennae fluidum, 310
    stillingiae fluidum, 312
    stramonii fluidum, 312
    taraxaci fluidum, 322
    uvae ursi fluidum, 330
    Valerianae fluidum, 330
    veratri viridis fluidum, 334
    zingiberis fluidum, 184
♦Extractum cascarae sagradae liquidum, 121
   ♦cinchonae liquidum, 145
   ♦cocae liquidum, 150
   ♦ergotae liquidum, 170
   ♦filicis liquidum, 82
   ♦glycyrrhizae liquidum, 224
   ♦opii liquidum, 263
   ♦pareirae liquidum, 269
   ♦sarsae liquidum, 301
    FEL bovis, 265
     inspissatum, 265
     purificatum, 265
 Ferri arsenias, 211
     bromidum, 211
     carbonas saccharatus, 211
     chloridum, 212
     citras, 212
     et ammonii citras, 212
        sulphas, 211
        tartras, 213
     et potassii tartras, 213
     et quininae citras, 213
     et strychninee citras, 213
     iodidum saccharatum, 213
     lactas, 214
     oxalas, 214
     oxidum hydratum, 213
            cum magnesio, 80, 213, 227
    ♦peroxidum hydratum, 216
     phosphas, 215
     pyrophosphas, 215
     subsulphatis, 214
     sulphas, 215
        exsiccatus, 215
       ♦granulata, 215
        praecipitatus, 215
    valerianas, 215
Ferrum, 210
    dialysatum, 213
    redactum, 215
   ♦tartaratum,  213
♦Filix mas, 82
Flaxseed, 180
    meal, 181
    oil, 180
    poultice, 181
    tea, 180
Fleabane, 171
Flemming's tincture of  aconite, 47
Flexible collodion, 156
Flowers of sulphur, 316
Fluid extracts, 23
Flying blister, 355
Foods for the sick, 372
Foot-bath, 360
Fowler's solution, 80
Fuller's lotion, 553
Fusel oil, 48
    GALLA, 181
      Gallic acid, 181
        ointment, 181
 Garlic, 53
 Gaultheria, 182
 Gelsemine, 182
 Gelsemium, 182
 General therapeutic considerations, 17
 Gentian, 183
 ♦Gentianae radix, 183
 Geranium, 184
 German chamomile, 230
    soft soap, 306
 Germicides, 357
 Germs, mode of destroying, 338
 Gin, 53
 Ginger, 184
 Glacial acetic acid, 44
 Glauber's salt,  308
 Glycerin, 184
 Glycerins, 20
 ♦Glycerinum acidi carbolici, 119, 186
        ♦gallici, 181,186
        ♦tannici, 186
    ♦aluminis, 58,186
    ♦boracis, 93, 186
    ♦plumbi subacetatis, 186, 223
    ♦tragacanthae, 186
 Glycerita, 23
 Glycerite of starch, 186
    of yolk of egg, 186
 Glyceritum amyli, 186
    vitelli, 186
 Glycyrrhiza, 224
 ♦Glycyrrhizae radix,  224
 Glycyrrhizinum ammoniatum, 224
 Goa powder, 139
 Gold, 186
    bromide of, 98
 Goodell's sumbul pill, 319
 Goulard's extract, 222
 Granatum, 286
 Granulated citrate of magnesium, 228
 Gray powder, 238
 Green iodide of mercury, 240
    soap, 306
 Griffith's pills, 211
 Grindelia, 186
 Guaiac, 187
    wood, 187
 Guaiaci lignum, 187
    resina, 187
Guaiacol, 188
Gum arabic, 39
Gurjun balsam, 188
    oil, 188
    HAMAMELIS, 189
     ♦Haematoxyli lignum, 189
Haematoxylon, 189 
648
INDEX  OF  DRUGS.
Heat, 360
Heavy magnesium, 228
Hemlock fruit, 157
    leaves, 157
Henbane, 196
Hoffmann's anodyne, 190
Homatropine hydrobromate, 190
Home modification of Turkish bath, 363
Honey, 191
   ♦of borax, 93
    of rose, 292
    of squill, 311
Hop poultice, 191
Hope's camphor mixture, 192
Hops, 191
House mixture, 306
Humulus, 191
Husband's magnesia, 227
Hydrargyri chloridum corrosivum, 234
       mite, 236!
    iodidum rubrum, 236
       viride, 240
    oxidum flavum, 240
       rubrum,  240
   ♦perchloridum, 234
   ♦subchloridum, 236
    subsulphas flavus, 240
Hydrargyrum, 230
    ammoniatum, 234
    cum creta, 238
Hydrastine, 192
Hydrastis, 192
Hydrate of chloral, 127
Hydrated oxide of iron with  magnesium,
      213
    peroxide of iron, 216
    sesquioxide of iron,  213
Hydriodic acid, 206
Hydrobromate of homatropine, 190
    of hyoscine,  197
    of quinine, 144
Hydrobromic acid, 99
Hydrobromide of coniin, 157
Hydrochlorate of apomorphine, 76
    of cocaine, 149
    of morphine, 264
    of pilocarpine, 282
    of quinine, 144
    of thallin, 324
Hydrochloric acid, 193
Hydrocyanic acid, 194
Hydrogen dioxide, 266
    peroxide, 266
       as an antiseptic,  342
Hyoscine, 196
♦Hyoscyami folia, 196
Hyoscyaminae sulphas, 196
Hyoscyamine, 196
Hyoscyamus leaves, 196
Hypnal, 197
Hypnotics, 32
Hypodermic medication, 21
    injection of apormorphine, 75
Hypophosphite of calcium, 103
TCE JACKET, 346
JL    poultice, 346
Ichthyol, 198
Idiosyncrasy, 25
Ignatia, 198
    bean, 198
Incompatibilities, 33
Indian hemp, 110
    poke, 332
Indications for drugs, 29
Infusions, 23
Infusum brayerae, 94
   ♦buchu, 101
   ♦calumbae, 105
   ♦caryophylli, 148
   ♦catechu, 125
   ♦chiratae, 127
   ♦cinchonae, 145
   ♦cinchonae acidum, 145
    columbae, 105
   ♦cusso, 94
    digitalis, 168
   ♦ergotae, 171
   ♦gentianae compositum, 183
   ♦jaborandi, 282
   ♦krameriae, 218
   ♦lini, 181
   ♦lupuli, 192
    pruni virginianae, 287
   ♦quassiae, 288
   ♦rhei, 290
   ♦rosae acidum, 292
   ♦senegae, 304
       compositum, 230, 305
   ♦serpentaria, 305
   ♦uvae ursi, 330
   ♦Valerianae, 330
Inhalations, 20
♦Injectio apomorphinae hypodermica,[7&
   ♦ergotini hypodermica, 171
   ♦morphinae hypodermica, 264
Intravenous injection, 364
Inunctions, 22
Iodide of ammonium, 63,199
    of arsenic, 80
    of ethyl, 176
    of iron, 213
    of lead, 222
    of potassium, 199
    of sodium, 202
    of strontium, 312
Iodine, 202
    liniment, 206
    ointment, 206
Iodoform, 206
    as an antiseptic, 340
    ointment, 207
Iodol, 208
Iodum, 202
Ipecac, 208
Iron, 210
    plaster, 216
   JABORANDI, 280
     Jalap, 216
Jalapin, 216
Jamaica dogwood, 29
Jamestown weed, 312
James's powder, 69
Jequirity, 217
Jervine, 332
Juniper, 217
Joint effects of drugs, 28 
INDEX  OF  DRUGS.
   KAMALA, 218
     Kaolin, 218
Kataphoresis, 365
Kino, 218
Koosin, 93
Kousso, 93
Koumyss, 374
Krameria, 218
    radix, 218
Kreolin, 341
   LACTATE OF IRON, 214
     of strontium, 312
Lactose, 218
Lady Webster dinner pills, 56
♦Lamellae atropinae, 88
   ♦cocainae, 150
   ♦physostigminae, 280
Lanolin, 219
Laudanine, 257
Laudanum, 263
Laughing gas, 252
Lead, 219
    acetate ointment, 222
    plaster, 223
    water and laudanum, 222
Leeches, 365
Ledoyen's disinfectant solution, 223
Lemon juice, 147
Leptandra, 223
Levant wormseed, 299
Light magnesium, 228
Lignum vitae, 187
Lime, 106
    water, 106
♦Lini farina, 181
   ♦semina, 180
♦Linimentum aconiti, 47
    ammoniae, 61
    belladonnae, 88
    calcis, 106
    camphorae, 106
      ♦compositum, 106
     cantharidis, 113
     chloroformi, 138
   ♦crotonis, 163
   ♦hydrargyri, 239
   ♦iodi, 206
   ♦opii, 263
    ♦potash iodidi cum sapone, 202
     plumbi subacetatis, 223
     saponis, 108, 306
     sinapis compositum, 243
     terebinthinae, 329
      ♦aceticum, 329
 Linseed, 180
     poultice, 180
 Linum, 180
 Lipanin, 224
 Liquor acidi arseniosi, 79
    ♦chromici, 139
    ♦ammoniae, 61
         acetatis, 61
           ♦fortior, 60, 63
    ♦ammonii citratis, 63
           ♦fortior, 63
    ♦antimonii chloridi, 79
    ♦arsenicalis, 79
    ♦arsenici hydrochloricus, 80
Liquor arsenii et hydrargyri iodidi, 80
   ♦atropinae sulphatis, 88
   ♦bismuthi et ammonii citras, 90
    calcis, 106
       ♦chlorinatae, 133
       ♦saccharatus, 106
    carbonis detergens, 457
   ♦epispasticus, 113
    ferri acetatis, 216
          ♦fortior, 216
        chloridi, 212
        citratis, 212
       ♦dialysatus, 213
        et quininae citratis, 213
       ♦perchloridi, 212
          ♦fortior, 212
        subsulphatis, 214
        tersulphatis, 80
    hydrargyri nitratis, 239
       ♦perchloridi, 235
   ♦iodi, 206
        compositus, 206
   ♦lithiae effervescens, 226
   ♦magnesii carbonatis, 228
        citratis, 228
   ♦morphinae acetatis, 264
       ♦hydrochloratis, 264
        sulphatis, 264
    pepsini, 272
    plumbi subacetatis. 222
            dilutus, 222
    potassae, 226
    potassii arsenitis, 79
        citratis, 83,146
       ♦permanganas, 272
    sod ae, 125
    sodii arseniatis, 80
    zinci chloridi, 132
 Liquorice,  224
    root, 224
 Lister's dressing, 343
 Litharge, 223
 Lithia water, 226
 Lithii bezoas, 225
    bromidum, 98, 225
     carbonas, 225
     citras,  225
     salicylas, 225
 Lithium, 225
 Lobelia, 226
 Log-wood, 189
 ♦Lotio hydrargyri flava, 247
         ♦nigra, 236
 Lozenges,  23
 Lugol's solution, 206
 Lunar caustic, 245
 Lupuline, 192
 ♦Lupulus, 192
 Lycopodium, 227
 Lysol, 227
   MACE, 253
     Magendie's solution, 264
Magnesia, 227
   levis, 227
   ponderosa, 227
Magnesii carbonate, 228
   citras, 228
       granulatus, 228 
650                          ind
Magnesii carbonas levis, 228
       ponderosa, 228
    sulphas, 228
Magnesium, 228
Male fern, 82
Mandrake, 285
Manganese, 229
Mangani oxidum nigrum, 229
    sulphas, 229
Manganum, 229
Manna, 229
Massa copaibae, 158
    hydrargyri, 236
Matricaria, 230
May apple, 285
Meconic acid. 257
Meconine, 257
Mel, 191
   ♦boracis, 93
   ♦depuratum, 191
    despumatum, 191
    rosae, 191, 292
Mentha piperata, 270
Menthol, 253
Mercurial ointment, 238
    oleate, 240
    pills, 236
    plaster, 239
    suppositories, 239
Mercury, 230
    with chalk, 238
Methyl acetanilide, 180
    chloride. 241
Methylene chloride, 241
♦Mezerei cortex, 242
Mezereum, 242
    ointment 242
Mild chloride of mercury, 236
Milk of asafoetida, 81
    of sulphur, 316
    punch, 52
       peptonized,  372
    sugar, 314
Mistura ammoniaei, 64
    amygdalae, 54
    asafoetidae, 81
    chloroformi, 138
   ♦creasoti. 161
    cretae, 103
   ♦ferri aromatica, 211
    ferri composita,  212
    ferri et ammonii acetatis, 211
    glycyrrhizae composita, 224
   ♦guaiaci, 188
    potash citratis, 146
    rhei et sodee, 290
   ♦scammonii, 302
   ♦sennae composita, 305
   ♦spiritus vini gallici, 53
Mitigated caustic, 248
Mode of action of drugs, 19
Modes of administering drugs, 19
Monkshood, 45
Monobronate of camphor, 108
Monsel's salt, 214
    solution, 214
Morphinae acetas, 264
    hydrochloras, 264
    sulphas, 264
Morphine, 264
X  OF  DRUGS.


       Moschus, 242
       Mucilage of acacia, 39
       Mucilago acaciae, 39
       Mulled wine, 377
       Muriate of ammonium, 62
          of morphine, 264
       Musk, 242
       Mustard,  243
          papers, 243
          plaster,  243, 356
       Mydriatics, 32
       Myotics, 32
       Myristica, 253
       Myrrh, 243
 TVTAPHTHALIN, 244
 IM  Narceine, 257
 Narcotine, 257
 Nervous sedatives, 32
     stimulants, 32, 38
 Neutral mixture, 146
 Nicotine, 327
 Nitrate of copper, 160
     of lead, 223
     of mercury, 239
    ♦of pilocarpine, 282
     of potassium, 244
     of silver, 245
 Nitre, 244
 Nitric acid, 248
 Nitrite of amyl, 64
     of potassium, 249
 Nitroglycerin, 250
 Nitro-hydrochloric acid, 194, 250
 Nitrous oxide, 252
| Norwood's tincture of veratrum viride, 334
 Nut-gall, 181
 Nutmeg, 253
 Nux vomica, 253
   OIL of tar, 284
     of vitriol, 318
Ointment of aconite, 47
    of ammoniated mercury, 234
    of antimony, 69
   ♦of atropine, 88
    of belladonna, 88
    of calomel, 238
   ♦of cantharides, 114
    of carbonate of lead, 222
    of chrysarobin, 139
   ♦of creasote, 161
   ♦of eucalyptus, 178
    of gallic acid, 181
    of galls, 181
      ♦with opium, 181
    oi iodide of lead, 222
       of potassium, 202
    of iodine, 206
    of iodoform, 207
   ♦of lead acetate, 222
    of mercury, 238
    of mezereum, 242
    of nitrate of mercury, 240
    of oxide of zinc, 265
    of petrolatum, 273
   ♦of red iodide of mercury, 236
       oxide of mercury, 236 
INDEX  OF  DRUGS.
651
Ointment of resin, 288
    of rose-water, 291
    of salicylic acid, 297
   ♦of savine, 302
    of stramonium, 312
    of sulphur, 317
    of tannic acid, 321
    of tar, 285
   ♦of tartrate of antimony, 69
   ♦of turpentine, 329
    of veratrine, 332
    of yellow oxide of mercury, 240
Ointments, 24
Oleatum hydrargyri,  240
    veratrinae, 332
Oleoresina aspidii, 82
    capsici,  115
    cubebae, 163
    lupulini, 192
    piperis,  270
    zingiberis, 184
Oleum amygdalae amarae, 54
        expressum, 54
    cajuputi, 103
    caryophylli, 147
    chenopodii, 126
    cinnamomi, 146
    copaibae, 158
   ♦crotonis, 162
    cubebae, 163
    erigerontis,  171
    eucalypti, 177
    gaultheriae, 182
    juniperi, 217
    lini, 180
    menthae piperatae, 270
    morrhuae, 151
    myristicae, 253
    picis liquidae, 284
    pimentae, 55
    phosphoratum, 279
    ricini, 122
    ruts, 292
    sabinae, 301
    santali, 298
   ♦sinapis, 243
        volatile, 243
    succini, 58
    tanacetum, 322
    terebinthinae, 328
    tiglii, 162
    valerinanae, 330
Opium, 257
    denarcotized, 262
Opodeldoc.  306
Ovalate of ammonium, 63
Oxalate of cerium, 125
    of iron, 214
Ox-gall, 265
Oxide of antimony, 66
    of calcium, 106
    of lead, 223
    of mercury, 240
    of zinc, 265
Oxygen, 266
    peroxide, 266
    water, 266
♦Oxymel, 191
    ♦scillae, 311
Oxytoxics, 32, 38
   PALE cinchona, 140
      rose, 291
Pancreatin, 267
Papain, 268
Papaverine, 257
Papers,  22
Papoid, 268
Paraldehyde, 268
Parachinanisol,  324
Paregoric,  263
Pareira, 269
Pareirae radix, 269
Parsley, 74
Pelletierine, 286
Pental,  269
Pepo, 269
Pepper, 270
Peppermint, 270
    water, 270
♦Pepsin, 271
Pepsinum  saccharatum, 272
Peptonized beef, 372
    gruel, 373
    milk, 373
        punch, 373
    oysters, 373
Permanganate of potassium, 272
Peroxide of hydrogen, 342
Petrolatum, 273
Petroselinum, 74
Phenacetine, 273
Phenate of cocaine, 150
Phenic  acid, 115
Phenocoll, 275
Phenol, 115
Phenylic alcohol, 115
Phlebotomy, 370
Phosphate of ammonium, 63
    of iron, 215
    of sodium, 276
    of strontium, 312
Phosphide of zinc, 276
Phosphorated oil, 279
Phosphoric acid, 276
Phosphorus, 276
♦Physostigma, 279
Physostigmatis semen, 279
♦Physostigmina, 279
Physostigmine, 279
Pill of three valerianates, 331
Pills, 23
Pilocarpinae hydrochloras, 282
    ♦nitras, 283
Pilocarpine, 280
♦Pilula asafoetidae composita, 82
   ♦colocynthidis composita, 157
       ♦et hyoscyami, 157
   ♦conii composita, 158
   ♦ferri carbonatis, 212
   ♦hydrargyri,  226
   ♦ipecacuanhae cum scilla, 210
    phosphori, 279
   ♦plumbi cum opio, 222
   ♦saponis composita, 263
   ♦scammonii composita, 302
   ♦scillae composita, 311
Pilulae aloes, 56
        et  asafoetidae, 56, 81
        et  ferri,  56
        et  mastiches, 56 
652
INDEX  OF  DRUGS.
 Pilulae aloes et myrrhae, 56, 244
     antimonii compositae, 69
     asafoetidae, 82
     cathartics compositae, 157
     ferri compositae, 211
        iodidi, 214
     opii, 262
     phosphori, 278
     rhei, 290
        compositae, 290
 Pimenta, 55
 Pinkroot, 309
 Piper, 270
     nigrum, 270
 Piperazine, 283
 Piperine, 270
 Pipsissewa, 126
 Piscidia erythrina, 283
 Pitch, 284
 Pix, 284
     burgundica, 284
     canadensis, 284
     liquida, 284
 Plaster of ammoniac, 64
     of ammoniac with mercury, 64
     of arnica, 76
     of asafoetida, 82
     of belladonna, 88
     of Burgundy pitch, 284
     of Canada pitch, 284
   *of cantharides, 114
     of capsicum, 115
   ♦of iron, 216
     of lead, 223
     of mercury, 239
   ♦of opium, 263
     of resin, 288
     of soap, 306
    of tar, 284
 Plasters, 23
 Plumbi acetas, 222
     carbonas, 222
    iodidum, 222
    nitras, 223
    oxidum, 223
 Plumbum, 219
 Podophyllum, 285
 ♦Podophylli rhizoma, 285
 Poke-root, 332
 Polygalic acid, 304
 Pomegranate, 286
 Port wine, 53
 Porter, 53
 Potassa, 125
   ♦caustica, 125
    cum calce, 125
 Potash papers, 244
 Potassii acetas, 43
    bicarbonas, 89
    bitartras, 91
    bromidum, 94
    carbonas, 120
    chloras,  130
    citras, 146
    cynanidum, 163
    iodidum, 199
    nitras, 244
   permanganas, 272
   ♦tartras acida, 91
Precipitated carbonate of calcium, 103
 Precipitated carbonate of zinc, 120
     phosphate of calcium, 103
     sulphate of iron, 215
     sulphur, 316
 Prepared chalk, 105
 Pride of China, 82
 Proof spirit, 53
 Protiodide of mercury, 240
 Prunus virginiana, 287
 Prussic acid, 194
 Pseudomorphine, 257
 Pterocarpi lignum, 298
 ♦Pulvis amygdalae compositus, 55
     antimonialis, 69
     aromaticus, 122, 146
   ♦catechu compositus, 125
   ♦cinnamomi compositus, 146
   ♦cretae aromaticus, 105
          ♦cum opio, 105
       compositus,  105
    effervescens compositus, 303
   ♦elaterini compositus, 169
    glycyrrhizae compositus, 305
   ♦ipecacuanhae compositus, 210, 263
       et opii, 210, 263
    jalapae compositus, 216
   ♦kino compositus, 218
    morphinae compositus, 264
    opii, 262
   ♦compositus, 263
    rhei compositus, 290
   ♦scammonii compositus, 302
Pumpkin seed, 269
Punch, milk. 52
Punk, 48
Pure ether, 171
Purging cassia, 122
Purified aloes, 55
    chloroform, 133
    ox-gall, 265
    sulphide of antimony, 66
Pyoktanin, 287
Pyridine, 327
Pyrophosphate of iron, 215
   Quassia, 287
     ♦Quassiae lignum, 287
Queen's root, 311
Quercus alba, 288
    tinctoria, 288
Quevenne's iron, 215
Quicksilver, 230
Quinicine, 140
Quinidinae sulphas, 145
Quininae bimuriatica carbamas, 144
    bisulphas, 144
    hydrobromas, 144
    hydrochloras, 144
    valerianas, 145
Quinine, 140
   RASPBERRY, 292
     Rectified spirit, 53
Red  cinchona, 140
   iodide of mercury, 236
   oxide of mercury, 240
   precipitate, 234, 240 
INDEX  OF  DRUGS.                         653
Red precipitate ointment, 234, 240
   rose, 291
   saunders, 298
   wine, 53
Reduced iron, 215
Remedial measures other than drugs, 337
Remedy, cold as a, 344
Resin, 288
    ointment, 288
    plaster, 223
Resina, 288
    jalapae, 216
    podophylli, 286
    scammonii, 302
Resorcin, 289
Rest cure, 366
Revulsives, 32
Rhatany, 218
Rheum, 289
   ♦radix, 289
 Rhigolene, 289
 Rhubarb,  289
 Rhus aromatica, 290
     glabra, 291
 Rice water, 376
 Roborants, 32
 Rochelle salt, 291
 Rosa  centifolia, 291
     gallica, 291
 Rose  water,  291
 Rosin, 288
 Rottlera, 218
 Rubus idaeus, 292
 Rue,  292
 Rules for dosage, 24
 Rum, 53
 Russian bath, 363
  SABINA, 301
    Saccharated iodide of iron, 213
   pepsin, 272
   ♦solution of lime, 106
Saccharin, 292
Saccharum, 313
   lactis, 313
   ofneinarum, 313
   ♦purificatum, 313
Sal prunella, 244
Salicylate of bismuth, 293
   of lithium, 225
   of mercury, 293
   of sodium, 297
Salicylic acid, 293
   ♦ointment, 297
Salol, 297
Salophen, 298
Salt, 131
Saltpetre, 244
Salts, 228
Sandalwood, 298
Sanguinaria, 299
Santalum rubrum, 298
Santonin, 299
Santoninate of sodium, 299
Santoninic acid, 299
Santoninum, 299
Sapo, 306
   ♦duris, 306
   ♦mollis,  306
Sapo viridis, 306
♦Sarsae radix, 301
Sarsaparilla, 301
♦Savinae cacumina, 301
Savine, 301
    ointment, 302
Scammonium, 302
Scammony, 302
Scilla, 310
Scillin, 310
Scillipikrin, 310
Scillitoxin, 310
Sclerotinic acid, 169
♦Scopari cacumina, 302
Scoparius, 302
Seidlitz powder, 303
Senega, 304
Senegae radix, 304
Senna, 304
   ♦alexandrina, 304
   ♦indica, 304
Serpentaria, 305
    ♦rhizoma, 305
Sherry, 53
Silicate of potassium, 305
Sinapis alba, 243
   ♦albae semina, 243
    nigra, 243
   ♦nigrae semina, 243
 Sinapisma, 243
 Slaked lime, 106
 Smooth sumach, 291
 Snake-weed, 178
 Soap,306
   "  liniment, 108, 306
     plaster, 306
 Socotrine aloes, 55
 Soda, 125
    ♦caustica, 125
    ♦tartarata, 291
 Sodii acetas, 307
     arsenias, 80
     bicarbonas, 89
     boras, 92
     bromidum, 99
     chloridum, 131
     et potassii tartras, 291
     iodidum, 202
     phosphas, 276
     salicylas, 297
     santoninas, 299
     sulphas, 308
  Sodio-salicylate of theobromine, 306
  Sodium, 307
     ethylate, 308
  Soluble glass, 305
  Solution of acetate of ammonium, 61
     of acetate of iron, 216
        ♦of morphine, 264
     of ammonia, 61
     of arseniate of potassium, 79
         of sodium, 80
     of arsenious acid, 79
     ♦of carbonate of magnesium, 228
     ♦of chloride of antimony, 70
         of zinc, 132
     *of chlorinated lime, 133
      of citrate of ammonium, 63
         of bismuth and ammonium, 90
         of iron, 213 
654
INDEX   OF  DRUGS.
Solution of citrate of iron and quinine, 213
       of potassium, 83
   ♦of hydrochlorate of morphine, 264
    of iodide of arsenic and mercury, 80
   ♦of iodine, 206
    of lime, 106
    of nitrate of mercury, 239
    of pepsin, 272
   ♦of perchloride of mercury, 235
   ♦of permanganate of potassium, 272
    of potassa, 226
    of soda, 125
    of subacetate of lead, 222
    of sulphate of atropine, 88
    of sulphate of morphine, 264
Somnal, 308
Sozoiodol, 308
Spanish fly, 112
Sparteine, 302
Spice plaster, 355
Spigelia, 309
Spirit of Mindererus, 61
    of turpentine, 328
Spiritus aetheris compositus, 190
       nitrosi, 319
    ammoniae, 61
       aromaticus, 61
      ♦fcetidus, 61
   ♦cajuputi, 103
    camphorae,  108
    chloroformi, 138
    cinnamomi, 146
    frumenti, 53
    gaultheriae, 182
    'uniperi, 53, 217
       compositus, 53, 217
    menthae piperitae,  270
    myristicae,  253
    odoratus, 53
   ♦rectificatus, 53
   ♦tenuior, 53
    vini gallici, 53
Squill, 310
Squirting cucumber, 168
Stillingia, 311
Stramonii folia, 312
    semen, 312
Stramonium, 312
Strength, relative, of drugs, 27
♦Stronger ether, 171
    water of ammonia, 60
   ♦solution of acetate of ammonia, 63
      ♦of iron, 212
      ♦of citrate of ammonia, 63
      ♦of perchloride of iron, 212
Strophanthin, 313
Strophanthus, 313
Strontium, 312
    bromide, 312
    iodide, 312
    lactate, 312
    phosphate, 312
Strychninae sulphas, 256
Strychnine, 253
Styptic collodion, 156
Subcarbonate of bismuth, 90
Subgallate of bismuth, 91
Sublimed sulphur, 316
Subnitrate of bismuth, 90
Subsulphate of iron, 214
Succinum, 58
♦Succus belladonnae, 88
   ♦conii, 158
   ♦hyoscami, 196
   ♦limonis, 147
   ♦scoparii, 302
   ♦taraxaci, 322
Sugar, 313
    of lead, 222
    of milk, 313
Sulphate of ammonium, 63
    of atropine, 84, 88
    of cinchonidine, 145
    of cinchonine, 145
    of copper, 159
    of hyoscyamus, 196
    of iron, 215
       and ammonium, 211
    of magnesium, 228
    of manganese, 228
    of morphine, 264
    of quinidine, 145
    of sodium, 308
    of strychnine, 256
    of thallin, 324
    of zinc, 314
♦Sulphide of ammonium, 63
    of antimony, 66
    of calcium, 315
Sulphides, 314
Sulpho-carbolate of zinc, 343
Sulphonal, 315
Sulphur, 316
    lotum, 316
    ointment, 317
    praecipitatum, 316
    sublimatum, 316
Sulphurated antimony,  66
    lime, 106
Sulphuric acid, 318
    ether, 171
Sumach, smooth, 291
    sweet, 290
Sumbul, 319
    pill, 319
   ♦radix, 319
♦Suppositoria acidi carbolici cum sapone, 119-
      ♦tannici, 321
   ♦hydrargyri, 239
   ♦iodoformi, 208
   ♦morphinae, 264
       ♦cum sapone, 264
   ♦plumbi composita, 222
Suppositories, 23
Suspension, 368
Swamp hellebore, 332
Sweet almonds, 54
    spirit of nitre, 319
    sumach, 290
Sydenham's laudanum,  263
Syrup of tar,  2x5
Syrupus acaciae, 39
    acidi citrici, 147
    acidi hydriodici, 206
    allii, 54
    amygdalae, 54
    calcilactophosphatis, 104
   ♦chloral, 129
    ferri  bromidi, 211   >
       iodidi, 213 
                               INDEX

♦Syrupus ferri phosphatis, 215
       quininae et strychninae phosphatum,:
    hypophosphatum, 104
       cum ferro, 214
    ipecacuanhce, 209
    krameriae, 218
   ♦limonis, 141
    picis liquidse, 285
    pruni virginianae, 287
    rhei, 290
        aromaticus, 290
    rosae, 292
    rubi idaei, 292
    sarsaparillae compositus, 301
    scillae, 311
        compositus, 77,311
    senegae, 304
    sennae, 305
    zingiberis, 184
  TABACUM, 327
     ♦folia, 327
♦Tabellae nitroglycerin!, 254
Tablets, 23
♦Tablets of nitroglycerin, 254
Tamarinds, 320
Tamarindus, 320
Tanacetum, 322
Tannate of quinine, 145
Tannic acid, 321
Tansy, 322
    tea, 322
Tar, 284
    ointment, 284
    water, 284
Taraxacum, 322
Tartar emetic, 66
Tartaric acid, 322
Tartrate of antimony and potassium, 66
    of iron and ammonium, 213
        and potassium, 213
    of potassium and sodium, 291
    of thallin, 324
Terebene, 322
Terebinthina, 327
Thapsia,  325
Terpinol, 323
Terpine hydrate, 323
Thallin, 324
Thebaine, 257
Theine, 101
Therapeutic considerations, 17
    nihilism, 17
Therapeutics, definition of, 18
Thiol, 325
Thiolum  liquidum, 325
    sicca, 325
Thoroughwort, 178
Thymol,  326
    iodide, 326
Tinctura  aconiti, 47
    aloes, 56
        et myrrhae, 56, 244
    ♦arnicae, 76
        florum, 76
    arnicae radix, 76
    asafoetidae. 81
    belladonnae, 88
    benzoini, 89
F  DRUGS.                          655


 Tinctura benzoini composita, 89
     bryoniae, 99
    ♦buchu, 101
     calumbae, 105
    ♦camphorae composita, 108,
     cannabis indica', 112
     cantharidis, 113
     capsici, 115
     cardamomi, 122
         composita, 122
    ♦catechu, 125
         composita, 125
     chiratae, 127
    ♦chloroformi composita, 138
          ♦et morphinae, 138, 264
     cimicifugae, 140
     cinchonae, 145
         composita, 145
     cinnamomi, 146
     colchici seminis, 155
     columbae, 105
     conii, 157
     cubebae, 163
     digitalis, 167
     ♦ergotae, 171
     ferri chloridi, 212
        ♦perchloridi, 212
     galloe. 181
     gelsemii, 183
     gentianae composita, 183
     guaiaci, 187
         ammoniata, 187
     humuli, 192
     hydrastis, 193
     hyoscyami, 196
     ignatiae, 199
     iodi, 205 ; colorless, 206
     ipecacuanhae et opii, 246
     ♦jaborandi, 282
     ♦jalapae, 216
      kino, 218
      krameriae, 218
      lobeliae, 226
         ♦etherea, 226
     ♦lupuli, 192
      moschi, 243
      myrrhae, 244
      nucis vomicae, 256
      opii, 263
          ♦ammoniata, 263
           camphorata, 263
           deodorata, 263
      physostigmatis, 280
     ♦podophylli, 286
      quassiae, 288
     ♦quininae ammoniata, 145
      rhei, 290
           aromatica, 290
           dulcis, 290
     ♦sabinae, 302
      sanguinariae, 299
      saponis viridis, 306
      scillae, 311
     ♦senegae, 304
      sennae, 305
      serpentariae, 305
      stramonii, 312
      sumbul, 319
      Valerianae, 330
           ammoniata, 330 
656                          INDEX
OF  DRUGS.
 Tinctura veratri viridis, 334
     zingiberis, 184
       ♦fortior, 184
 Tinctures, 24
 Tobacco, 327
 Tonics, 32, 38
 Touchwood, 48
 Transfusion, 368
 Triturates, 24
 Trituratio elaterini, 168
 Troches, 24
 ♦Trochisci acidi benzoici, 89
        tannici,  321
    ♦bismuthi, 90
     catechu, 125
     cretae, 105
     cubebae, 163
    ♦ferri redacti, 215
     glycyrrhizae et opii, 225
     ipecacuanhae, 209
     krameriae, 218
     magnesiae, 227
     menthae piperitae, 271
     morphinae, 209
        et ipecacuanhae, 209, 264
     opii, 263
     potassi chloratis, 131
   ♦santonini, 300
     sodii santoninatis, 300
     zingiberis, 184
Turkish bath, 361
       home mdification of, 362
Turpentine, 327
    liniment, 329
   ♦ointment, 329
    stupe, 328
Turpeth mineral, 240
  UNGUENTUM acidi carboUci, 118
     gallici, 181
    ♦salicylici, 297
     tannici, 321
  aconitinae, 47
 ♦antimonii tartarati, 69
  aquae rosae, 291
 ♦atropinae, 88
  belladonnae, 88
 ♦cantharidis, 114
 ♦cetacei, 89
  chrysarobini, 139
 ♦creasoti, 161
 ♦eucalypti, 178
  gallae, 181
    ♦cum opio, 181
  hydrargyri, 238
     ammoniati, 234
    ♦iodidi rubri, 236
  nitratis, 240
    ♦dilutum, 240
     oxidi  flavi, 240
         rubri, 240
    ♦subchloridi, 238
 iodidi, 206
 iodoformi, 207
 mezerei, 242
 petrolei, 273
 picis liquidse, 285
♦plumbi acetatis, 222
    carbonatis, 222
♦Unguentum plumbi iodidi, 222
    potassii iodidi, 202
   ♦resinae, 288
   ♦sabinae, 302
    stramoni, 312
    sulphuris, 317
   ♦terebinthinae,  329
    veratrinae, 332
    zinci oxidi, 265
Ursin, 330
Uva ursi, 330
*Uvae ursi folia, 330
     VALERIAN, 330
       Valeriana rhizoma, 330
 Valerianate of ammonium, 63
     of iron, 215
     of quinine, 145
     of zinc, 331
 Valerianic acid, 331
 ♦Vapor acidi hydrocyanici, 195
    ♦chlori, 133
    ♦conii, 158
    ♦creasoti,  161
    ♦iodi, 206
 Vaseline, 273
 Vasomotor depressants, 32, 38
     stimulants, 32, 38
 Venesection. 370
 ♦Veratri viridis rhizoma, 332
 Veratrina, 331
 Veratrine ointment, 332
 Veratroidine, 332
 Veratrum viride, 332
 Vienna paste, 125
 Vinegar, 44
    of lobelia, 226
    of opium, 263
    of sanguinaria, 299
    of squill, 311
 Vinegars, 22
 Vinum album, 53
    aloes, 56
   ♦antimoniale, 69
    antimonii, 69
   ♦colchici, 155
       radicis, 155
       seminis, 155
    ergotae, 171
   ♦ferri, 215
       amarum, 215
       ferri citratis, 215
    ipecacuanhae, 209
    opii, 263
    picis, 285
    portense, 53
   ♦quininae, 145
    rhei, 290
    rubrum, 53
    tabaci, 327
    xericum, 53
Virginia snake-root, 305
    WAHOO, 178
      Warburg's tincture, 334
Warming plaster, 113, 284
Wash, black, 236
    yellow, 241 
INDEX  OF  DRUGS.
657
Washed sulphur, 316
Watered toast, 378
Weaker water of ammonia, 60
Wet pack, 361
Whiskey, 53
White ginger, 184
    mustard, 243
    oak, 288
    precipitate, 234
       ointment, 234
Wild cherry, 287
Wine, 53
    of aloes, 56
    of antimony, 69
    of citrate of iron, 215
    of colchicum root, 155
        seed, 155
    of ergot, 171
    of iron, 215
        bitter, 215
    of ipecac, 209
    of opium, 263
    of rhubarb, 290
    of tar, 285
    of tobacco, 327
    whey, 376
Wines,  24
Wintergreen, 182
Witch-hazel, 189
Wood oil, 188
Wormseed, 126
VANTHOPUCCINE, 192
   YELLOW cinchona, 140
   jessamine, 182
   oxide of mercury, 240
   sulphate of mercury, 240
   wash, 241
Young's rule for dosage, 24
  ZINC, 335
   Zinci acetas, 44
   ♦carbonas, 120
      praecipitatus, 120
   chloridum, 132
   oxidum, 265
       venale, 265
   phosphidum, 276
   sulphas, 314
   valerianas, 331
Zingiber, 184
42 
 
INDEX  OF  DISEASES  AND  REMEDIES.
             ABORTION, 379
  Cascara sagrada, or  compound liquorice pow-
     der, as a laxative ; if they fail, rhubarb or
     castor oil, 379
  Cimicifuga, fluid extract, gtt. 10 to 20, night
     and morning, as a prophylactic, 380
  Diet and hygiene, 379
  Elaterium, jalap, scammony, strychnine,  eri-
     geron, cantharides, contra-indicated,  un-
     less very necessary, 378
  Ergot and quinine, in small doses, with per-
     fect rest for one or two weeks, and anti-
     septic irrigation as an after-treatment, 380
  Iodine, applied to the inner surface of uterus,
     after removal of membranes, as a haemo-
     static  and  antiseptic, 381
  Opium  or  morphine, best agents  to quiet
     uterus if abortion threatens, 380
 Podophyllin, senna, salines in active doses,
     and aloes not to be used if they can be
     avoided, 378
 Quinine, useful in  malarial poisoning, as a
     preventive;  in  other  cases  contra-indi-
     cated, 380
 Saline   purges contra-indicated,  except  in
     plethoric women, 378
 Sponges should not be used as tampons, 380
 Tampons  of absorbent cotton, dusted with
     iodoform, followed by ergot, if abortion is
     inevitable, 380
 Venesection useful  in plethoric  women to
     prevent, 380
 Viburnum prunifolium, fluid extract, drachm
     1 to 1%, taken during pregnancy as a pro-
     phylactic, 380

              ABRASIONS.
 Collodion, flexible, painted over part, to render
    wound water-proof and air-tight, 155

              ABSCESS, 381
 Aconite  or veratrum viride, in full dose, often
    aborts, 381
 Alcohol, given with milk, in cold abscess, 382
 Belladonna ointment, locally applied, to abort;
    or tincture, internally, if aconite is not at
    hand, 381
 Calx sulphurata, gr. 1-10 every hour or two,
    useful  to abort or cause absorption, 381
 Carbolic acid,  minims 5 to 10  of 2 per cent.
    solution,  injected  into gland threatening
    suppuration, 381
Cod-liver oil with hypophosphites, quinine and
    iron useful  in cold abscess, 382
Hydrogen  peroxide,  10 per cent, solution,  to
    wash out cavity of tubercular or slow ab-
    scess, 382
 Incision, if pus forms, followed by irrigation
     with carbolic acid (1 to 20) or bichloride
     solution (1 to 5000) aud antiseptic dressing,
     382
 Iodine, locally applied, may abort, 381
 Iodoform gauze, packed into cavity, or ethereal
     solution injected after aspiration, and anti-
     septic dressing, useful  in tubercular ab-
     scess, 382
 Lead-water, applied on bread-crumb poultice
     or lint, in early stage, to abort, 381
 Nitrate of  silver, gr.  20 to 40  to  the  ounce,
     locally applied, may abort, 381
 Poultices to assist maturation, 381
 Prescriptions for tonics, in cold abscess, 382

                ACIDITY.
 Ammonia,  the most active remedy in gastric
     acidity, contra-indicated if acute irritation
     exists, 60
 Bicarbonate of sodium, in form of effervescing
     powder, valuable in gastric acidity, 90
 Carbonate of  calcium, precipitated, best ant-
    acid in intestinal acidity, 103
 Cerium oxalate, used in some cases of gastric
    acidity instead of bismuth, 126
 Charcoal useful in some  cases of " sour sto-
    mach," 119
 Lime-water, 106
                ACNE,  383
 Calx sulphurata, gr. 1-10 to 1-8 in pill, thrice
    daily, in pustular acne, 383
 Carbolic acid  touched to pustules, after inci-
    sion, 383
 Cod-liver oil, if scrofulosis exists, 383
 Fowler's solution often  cures and prevents
    relapse,  dose gtt. 1 to 3 thrice  daily for a
    month or two, 383
 Green or castile soap  used in face-bath night
    and morning, followed by brisk rubbing;
    if irritation ensues, simple cerate or emul-
    sion of bitter almonds will relieve, 383
 Ichthyol, 20  parts to 100 of lard well rubbed in,
    when induration is great, 383
 Mercurial ointment,  to  relieve induration,
    several days intervening between its use
    and that of sulphur, 383
Phosphorus, especially useful in acne indurata,
    278
Resorcin, gr. 10 to 20 to the ounce of lard, when
    induration is great, 383
Saline purges,  followed by cascara sagrada or
    similar remedy, to  regulate bowels, if de-
    pendent upon obstinate constipation, 383
Sulphur internally and as a wash or ointment
    for women with disordered menstruation,
    prescription for, 383 
660           INDEX  OF   DISEASES  AND  REMEDIES.
             ADENITIS, 383
 Iodine ointment and lard, equal parts, applied
    by inunction, night and morning, or tinc-
    ture, as a paint, stopping  application on
    appearance of redness or fluctuation, 384
 Iron, syrup of the iodide, gtt. 5 to 10, in chil-
    dren, 384
 Lancing preferable to  allowing  abscess to
    break,  384
 Poultice, when redness or fluctuation appears,
    384
 Removal of gland by dissection,  if enlarge-
    ment is scrofulous, 384
 Prescription for ointment, 384
 Sulphides, 314

    ALBUMINURIA.  (See Bright's
                 Disease.)
 Gallic acid, if due to atony of kidneys, 181
 Strontium lactate, 312

  ALCOHOLISM.  (See Poisoning from
                 Alcohol.)

             ALOPECIA, 384
 Chrysarobin, drachm % to 1 to lanolin 1 ounce,
    384
 Corrosive sublimate, gr. 2 to 5 to rectified spirit
    1 drachm and oil of turpentine 7 drachms,
    385
 Liquor epispasticus painted  over bald spot
    after loose hairs have been depilated, 384
 Pilocarpine,  locally applied, often  stimulates
    new growth, too much causes  small pus-
    tules around follicles; prescription for, 282

 AMBLYOPIA AND  AMAUROSIS,
                    385
 Bromide of potassium, 386
 Cauterization of nape of neck, 386
 Correction of optical errors, when arising from
    congenital trouble or non-use of eyes, 385
 Cups, wet and dry, 386
 Digitalis in toxic cases, 386
 Electricity, constant current, 386
 Emmenagogues,  if due to menstrual disorders,
    385
 Fly-blister to temple in some cases, 385
 Iodide of potassium, 386
 Mercury, when due to syphilis, 386
 Metallo-therapy, may be tried in  hysterical
    cases, 385
 Nitrite of amyl, inhalations, 386
 Nitro-glycerin, 386
 Nux vomica in ascending doses in tobacco or
    alcoholic cases, 256
 Pilocarpine, in uraemic amaurosis, also useful
    when due to tobacco and alcohol, 282, 386
 Seton introduced into nape of neck, 385
 Salicylates, 386
 Strychnine,  hypodermically,  after irritation
    has subsided, 386

       . AMENORRHCEA, 386
Aloes,  as a specific, when dependent upon
    constipation, atony of sexual  system,  or
    anaemia, 56, 386
Apiol, 3 to  10 minims in  capsule thrice daily
    for a week before date of menstruation, 68,
    387
 Arnica, 76
 Binoxide of manganese, gr. 1 to 3, taken for
     two weeks before time  of menstruation,
     229
 Cantharides, as a stimulant, if due to atony or
     depression, 112
 Cimicifuga, fluid extract, gtt. 30, at the proper
     time for a flow, 387
 Dewees's emmenagogue mixture, 387
 Eupatorium, in hot infusion, if due to cold,
     178
 Goodell's prescription  for, 387
 Griffith's pills, largely used when  dependent
     upon anaemia, 211
 Hot sitz-bath, for several nights before period;
     mustard added often increases its efficacy,
    387
 Iron and myrrh, a standard remedy if due  to
    atony or anaemia, 244
 Oil of rue, gtt. 5, in capsule, thrice daily, 387
 Potassium  permanganate, useful, but inferior
    to binoxide of manganese, 387
 Salines inferior to aloes if due to constipation,
    386
 Savine, gtt 5, in capsule, thrice daily, to stim-
    ulate uterus, 301
 Tansy, gtt. 5, in  capsule thrice daily, or in
    form of tansy tea, 322

             ANAEMIA, 387
 Arsenic, not to exceed gr. 1-16 daily, alone or
    combined with iron, valuable, 78, 389
 Arsenite of copper, 389
 Bitters, simple or aromatic,  in conjunction
    with iron, when  stomach and intestines
    are atonic, 388
 Blaud's pill, 388
 Bromide of iron, gr.  5 to 20 in syrup,  useful
    when there is chorea, 211
 Bullock's blood, fresh or dried, given by enema
    when iron fails, 389
 Chloride of iron, useful because of its tonic
    properties, 212
 Diet and hygiene, 390
 Hypophosphites and phosphate of lime, with
    cod-liver oil, iron, and quinine, when anae-
    mia is due to childbearing and lactation,
    388
Intravenous injections, 368
Iodide of iron, syrup of, largely used in stru-
    mous and scrofulous anaemias, 213
Mercury, bichloride or calomel, especially val-
    uable in  syphilitic cases.  Inunctions of
    mercurial ointment, once a day or every
    other day, of  service in all forms of  an-
    aemia, 389
Quinine in  malarial cases, and in tonic doses
    in all other anaemias, 388
Reduced iron,  with  laxatives  and mineral
    acids for their effects on intestines and
    liver, in uncomplicated cases, 388
Sulphate of iron or some other astringent prep-
    aration in conjunction with mild purges,
    when tongue is broad, flabby, and  white,

         ANAL  FISSURE, 390
Carbolic acid, 1 drop applied to fissure to effect
    cure, in addition  when haemorrhoids  are
    present a lotion of tannic acid, glycerin,
    and water, 390 
                INDEX  OF  DISEAS

 Castor oil, to relieve bowels if sulphur cannot
    be used, 390
 Flexible collodion painted over spot, may re-
    lieve, 390
 Iodoform suppositories, gr. 2 to 5, relieve pain
    of  defaecation ;  belladonna, gr.  i/ to be
    added when there is spasm of sphincter,
    390
 Potassium bromide, drachm 1% to the ounce
    of glycerin, locally applied by means of a
    brush to fissure, highly recommended, 390
 Sulphur, teaspoonful combined with powdered
    cinnamon or aromatic powder at night to
    render passages soft, 390

             ANEURISM, 390

 Aconite, inferior to  veratrum viride as a  car-
    diac sedative, 391
 Chloroform inhalation if dyspnoea is great, 391
 Digitalis, contra-indica ted, 391
 Iodide of potassium, in large doses, associated
    with restricted diet and rest in bed ; more
    valuable in syphilitic than other forms of
    the disease, 200,  391
 Morphine, gr. 1-8, combined with croton chlo-
    ral, gr. 10, in sleeplessness due to pain, 391
 Veratrum viride, gtt. 1 to 2, twice or thrice
    daily if heart is excitable and vascular ten-
    sion high, 391

        ANGINA  PECTORIS, 391

 Alcohol, instead of nitrites, when there is vas-
    cular relaxation, 392
 Antipyrine, gr. 20, valuable in some cases, 392
 Arsenic, in full dose long continued, and elimi-
    nation of causes of nerve storm, necessary
    to effect cure, 392
 Cocaine, highly recommended, 392
 Digitalis, when heart is weak, 392
 Ether, in 1-drachm doses  in ice-water or cap-
    sule, to nervous  females, often aborts, 392
 Hoffmann's anodyne, often the best remedy,
    190
 Morphine, gr. % to  %, hypodermically, when
    nitrite of amyl fails to relieve, 392
 Nitrite of amyl, inhalation of a few drops from
    handkerchief during attack, 392
 Nitrite of  sodium or potassium,  gr. 3, thrice
    daily, useless unless arterial tension is high
    and heart throbbing, 249
 Nitro-glycerin, gt. 1  of a  1  per  cent, solution
    during attack, 280
 Phosphorus, gr.  1-100, after meals, often  of
    value, 392
 Stomach-pump may be required when  due to
    overloaded stomachu, 392
 Tonics combined with careful diet and hygiene
    necessary to a cure, 392

            ANOREXIA, 393

Bitter tonics, to improve appetite ;  contra-indi-
    cated if irritation be present, 393
Calomel, useful when following acute disease;
    nitro-muriatic acid,  however,  generally
    preferable, 238
Capsicum, in  convalescence, acts  most favor-
    ably, 114
Chimaphila, in dropsical  patients, as a tonic
    and diuretic, 126
ES   AND  REMEDIES.          661

 Gentian, 183
 Prescriptions for tonics, 393
 Quassia,  especially valuable when following
     malarial fever, 288

                APHONIA.
 Chlorine gas, 125

             APOPLEXY, 393

 Belladonna,  hypodermically, if  respiration
     fail, 394
 Croton oil, gt. 1 with sweet oil gtt. 5, as a de-
     pletant cathartic, 393
 Elaterium, gr."%, as a depletant cathartic, 393
 Iodide of potassium, in large doses several days
     after attack, when clot has firmly formed,
     to promote absorption, 394
 Massage and electricity, applied to muscles to
     prevent atrophy; contra-indicated if in-
     flammation exist, 394
 Mercury, 394
 Mustard plaster to feet, or mustard foot-bath
     and ice to head, keeping head high and
     feet low, 393
 Opium and calomel, gr. \i of each every four
     hours, if meningitis arise, 394
 Stimulants contra-indicated,.394
 Strychnine.hypodermieally, if respiration fail;
     also useful to stimulate trophic centres of
     cord,  394
 Venesection, if  patient is full-blooded, to pre-
     vent inflammation and further leakage, 393
 Veratrum viride or aconite, when venesection
     is impossible, to lower blood-pressure, 393

                ARGYRIA.
 Iodide of potassium may improve color  of
     skin,  246

              ARTHRITIS.

 Bicarbonate of sodium, applied to part on lint
    to allay pain, 90
 Lithium,  carbonate and citrate, prevent  de-
    posit in joints  from rheumatoid arthritis,
    225
 Mustard plaster, as a counter-irritant, 243
 Veratrine ointment,  locally applied to rheu-
    matic joints, 331

  ASCARIS LUMBRICOIDES.  (See
                  Worms.)

         ASCITES.  (See Dropsy.)

            ASPHYXIA, 394

 Ammonia, intravenously injected into leg, to
    stimulate  heart and respiration, 395
 Artificial respiration, Sylvester's method, 396
 Electricity, only te be used as a peripheral irri-
    tant to restore respiration, 395
 Oxygen inhalations, 266
 Rules regarding position of patient, 396
 Water, cold and hot, alternately dashed over
    body,  to stimulate respiration, 396

          ASTHENOPIA, 397

 Eserine or pilocarpine,  weak solution, as a
    stimulant to ciliary muscles, 397
 Glasses, combined with prisms if necessary, to
    correct optical defects, 397 
662          INDEX   OF  DISEAS1


Massage, rest, salt baths, strychnine, and iron,
    if due to neurasthenia, 397
Strychnine or tincture of nux vomica in large
    doses, to stimulate ciliary muscles, 397

              ASTHMA, 397

Aconite, in early stages, 47
Arsenic, internally or smoked in cigarettes,
    best remedy when  mucous membrane is
    at fault, 78
Belladonna, combined with morphine, very
    useful, 86, 398
Bromide of potassium or sodium, gr. 30,  half
    an hour before retiring, 400
Cannabis indica, sometimes of service, 111
Chloral, rarely  useful; if pushed, dangerous,
    129
Chloroform, inhaled, relaxes spasm; also use-
    ful in form of liniment applied to breast,
    to abort, 138
Cocaine, applied  to nasal cavities, if due to
    nasal disorders, 400
Coffee,  a cup of strong black, during parox-
    ysm, 102
Compressed and rarefied air, 400
Diet and hygiene, 400
Ethyl iodide, to increase secretion and prevent
    thickening, 177
Euphorbia pilulifera, %  to 1 drachm  of the
    fluid extract,  179, 399
Gelsemium, 183
Grindelia, fluid extraet of, gtt. 20 to 60, or leaves
    soaked in nitre  smoked as cigarettes, or
    fumes of burning leaves inhaled, exceed-
    ingly useful, 187, 399
Iodide of potassium, useful in bronchial, harm
    ful in gastric type, 200
Lobelia, tincture, gtt. 10 every four hours, if
    attack threaten ; in emetic dose if heart be
    strong, when spasm is present, 399
Morphine, hypodermically, gr. y6 to  %, alone
    or combined with atropine, 399
Nitrate of potassium, alone or combined with
    belladonna, in form of  cigarettes or  inha-
    lations of fumes, often relieves, 245
Nitrite of amyl, 3 to  6 drops on handkerchief,
    inhaled with care, relieves spasm, 399
Nitro-glycerin,  serviceable  if bronchial mu-
    cous membranes are engorged, 250
Oil of amber, 58
Oxygen, inhalations when cyanosis is  ex-
    treme, 400
Physostigma, in bronchial asthma, to aid in
    expelling mucus, 280
Tobacco-smoking often efficacious to patients
    not accustomed to it, 399

                 ATONY.
Calumba, valuable in  gastro-intestinal atony
    following fevers, 105
Capsicum, one of the best remedies in gastric
    atony due to debility and alcoholism, 114
Cardamom, with bitter tonics and mineral acid
    in  gastro-intestinal  atony; prescription
    for, 122
Chimaphila, useful as  a stimulating diuretic
    in atonic renal conditions, 126
Hydrastis,  indicated in atony of mucous mem-
    branes, 193
Leptandra, in duodenal atony, 224
£S  AND  REMEDIES.


 Lime salts, useful in atony of mucous mem-
     branes, 106
 Pepper, in atony  of genito-urinary  mucous
     membranes, 270
 Physostigma, in intestinal and vesical atony,
     280
 Strychnine, in intestinal atony, 255

    BALANITIS AND BALANO-
             POSTHITIS, 496
 Astringent solutions, to  cleanse parts,  zinc
     chloride (gr. 4 to the  ounce), boric acid
     (1 per cent.), carbolic acid (1.5 per cent.);
     silver nitrate (gr. 1 to the ounce) especially
     valuable, 496
 Lead-water, dilute, as a wet dressing, preceded
     by astringent washes,  in phimosis ; if in-
     flammatiou  increase, circumcise, 497
 Silver nitrate stick, touched to ulcerations, 496
 Tannin or zinc oxide, as  a  dusting-powder,
     after  retracting  prepuce  and cleansing
     parts, followed by returning prepuce over
     absorbent cotton, 496

       BALDNESS. (See Alopecia.)

             BED-SORES, 400
 Aloes, glycerole of,as a local application, 56
 Alum,  with spirit of camphor and white  of
     egg, locally applied, to prevent, 401
 Catechu, with lead acetate, locally applied, to
     harden skin, 401
 Glycerin, application daily, after washing and
     rubbing part, to prevent, 186
 Incision, followed by irrigation,  if sores  tend
     to burrow, 401
 Salt and whiskey, rubbed over skin to harden
     it (drachms 2 to the pint), 401
 Nitrate of silver (gr. 20 to  the ounce), painted
     over threatening part, to abort.   If ulcers
     form and are sluggish, same solution may
     be used, 401
 Soap plaster, applied to  sore after washing
     with bichloride  solution (1  to 5000) and
     dusting with iodoform, 401
 Supportive measures and increased amount of
     food, if sloughs are large, 401
 Zinc ointment, on squares of lint, sometimes
     used in lieu of soap plaster, 401

            BILIOUSNESS, 401

 Aconite, antagonizes the poisonous alkaloids
     which cause slow pulse, high arterial ten-
     sion, etc., 404
 Ammonium chloride, grs.  5, thrice  daily,  if
     associated with catarrh, 404
 Bromides and chloral if nervousness  and irri-
     tation are present, 404
 Calomel, gr. % in powder every 15  minutes
     until six are taken, followed in four hours
     by a saline, if stools be light, 403
 Chirata,  gr. 5, in hepatic torpor, 404
 Diet, 403
 Euonymus, extract of, dose 3 gr., 404
 Ipecac, powdered, gr. 30 to 60, or apomorphine,
     gr. 1-15 hypodermically, may relieve  in
     first stage. 403
 Leptandra, where liver is torpid, 224
 Mustard plaster or cup to nape of neck, if face
 |    is flushed, foot-bath also of service, 404 
INDEX   OF  DISEASES  AND   REMEDIES.          663
Nitro-muriatic acid,  gtt.  3,  thrice daily in
    water, of great service, 404
Opium, antagonizes  the poisonous  alkaloid
    which causes hot skin, rapid pulse, dilated
    pupils, etc., 404
Podophyllin, gr. %, if stools be dark, 403
Protiodide of mercury, gr. 1-60 to 1-40 in tritu-
    ration, thrice daily, if due to catarrh, 404
Salines, if attack is sudden, to sweep out poi-
    sonous matter, 403
Salol or salophen, in  10-gr. doses, useful as an
    intestinal antiseptic, 404
Stillingia, fluid extract of, dose 20 drops, 404

          BLEPHARITIS, 404
Boric acid  lotion when there is accompany-
    ing conjunctivitis, 405
Chloral, 5 per cent, solution,  to remove scabs
    and crusts, 405
Creolin, 1 to 2 per cent, solution, useful as a
    wash, 162
Ointments, dilute citrine, Pagenstecher's (yel-
    low oxide of mercury,  1 gr.;  vaseline, 1
    drachm), pyrogallic acid, milk of sulphur
    (3 per cent.), locally applied after  removal
    of crusts, 405
 Silver nitrate, touched  to crater-like abscesses
    gives good results, 405
 Sodium bicarbonate or biborate, solution (gr.
    8 to ounce), to remove scabs and crusts, 405

                 BOILS, 405
 Belladonna, locally applied to relieve pain and
    inflammation, 405
 Calcium sulphurata  hastens pointing and pre-
    vents formation of new  ones;  useless in
     boils of diabetes, 97, 405
 Camphorated alcohol,  applied over  boils in
     formative stage,  then wiped dry, followed
     by camphorated oil, to abort, 405
 Carbolic acid, 5 per cent, strength injected into
     apex of boil when formation is assured, to
     abort, 406
 Chloride of calcium, added to poultice, hastens
     maturation, 104
 Collodion painted over inflamed spot, to abort,
     if pus  form it  may be  absorbed, if not,
     evacuate, 405
 Egg-shells   baked and eaten, for successive
     crops,  106
 Opium, locally applied to relieve pain and in-
     flammation, 405
 Phosphorus, 278
 Poultices, containing sweet oil and laudanum,
     to assist maturation, 406
 Prescription for ointment, 406
 Silver nitrate (gr. 20 to the ounce), painted over
     part, may abort, 405

            BREATH, FCETID.
 Camphor,  as a mouth-wash,  108

       BREASTS, INFLAMED, 406
 Aconite or veratrum viride, to depress circula-
     tion, 406
 Belladonna, internally or as an ointment, be-
     fore and after inflammation, with sponge
     compresses to breast, 406
 Breast-pump, if milk continue to form, 406
 Purges, mild saline, 406
           BONE  DISEASE.
Iodine ointment, diluted %, or tincture, locally
    applied, 203
Iodide of iron, syrup of, if anaemia exist, 203

  BRIGHT'S  DISEASE, ACUTE, 406
Aconite, to depress circulation, 406
Blisters contra-indicated, 406
Bromides or opium, given cautiously, if aconite
    fails to quiet restlessness, 406
Buttermilk useful, 408
Cannabis indica, if haematuria is  present, also
    to allay pain over kidneys, 406
Cantharides, % drop doses of tincture, about
    fifth day, when kidneys are atonic, also if
    haematuria is present, 406
Citrate of potassium and sweet spirit of nitre,
    to increase flow of urine, 407
Cups or leeches, over loins if urine is scanty,
    407
Digitalis, with squill or calomel, gradually in-
    creased, followed by  gin or  compound
    spirit of juniper in later stages, 407
Elaterium, to relieve dropsy, 406
Flaxseed tea, as a demulcent, 407
Gallic acid and ergot, to  control excessive
    haematuria, 407
Iron, if anaemia be present, also to  decrease
    albuminuria, 407
Juniper, to reestablish secretion,  after inflam-
    mation has subsided, 217
Pilocarpine hydrochlorate, gr 1-20 to 1-8, hypo-
    dermically, if uraemia  threatens,  repeated
    in fifteen minutes if no sweat appears, 406
Potassium bitartrate, 92
Sugar of milk, 408
Turkish bath, to aid in eliminating effete pro-
    ducts, used with care, 362

BRIGHT'S DISEASE, CHRONIC,407

Bichloride of mercury, 407
Buttermilk useful, 408
Cannabis indica, to allay pain over kidneys,
    also if haematuria is present,  111
 Cantharides, particularly useful if due to alco-
    holism, 112
 Capsicum, to check albuminuria, 114
 Chloride of gold and sodium has been recom-
     mended in interstitial forms, 408
 Chloride of iron if anaemia is present; also to
     decrease albuminuria, 408
 Digitalis, to decrease albuminuria, 408
 Elaterium or jalap to relieve dropsy, 407
 Lithium,  carbonate or citrate,  gr.  5, thrice
     daily, said to be useful in gouty cases, 408
 Milk diet, 407
 Nitro-glycerin  useful in  ascending doses in
     chronic parenchymatous nephritis, 250
 Oxygen inhalations, 408
  Potassium acetate or  bitartrate,  alone,  or,
     better, with gin or compound infusion  of
     juniper, 407
 Potassium iodide, gr. 5, thrice daily, used with
     great care, 201
 Sodium arsenite, gr. 1-20, in gouty cases, 408
 Squill, 407
 Strontium lactate for the relief of albuminuria,
     312
 Tapping to relieve ascites, 408 
664           INDEX  OF  DISEASES  AND  REMEDIES.
Turkish and Russian baths, relieve dropsy by
   increasing action of skin, 407

           BROMIDROSIS.
Belladonna, 86
Borax of great value, 92
Salicylic acid, used as a dusting powder, pre-
   scription for, 296

           BRONCHITIS, 408

Aconite, to depress circulation in initial stage,
   47, 410
Amber, oil of, and olive oil (1 to 3),  applied to
   back and front of chest,  in infantile bron-
   chitis, 59
Ammoniac, useful in old forms devoid of in-
   flammation, 64
Ammonium carbonate, alone or with the chlo-
   ride, especially useful in children; gr. 2 to
   10 in syrup of acacia, 62
Ammonium chloride, in second stage, to stim-
   ulate bronchial  tubes, prescription for; it
   may be  applied  alone  in solution with
   atomizer or inhaled in fumes, 56, 411
Antimony, to decrease inflammation of first
   stage;  only to be  used  when  patient is
   strong and sthenic, 409
Apomorphine, gr. 1-10 to 1-5,  as an expectorant
   in subacute stage;  if exudation accumu-
   lates rapidly, gr. 1-20 to 1-10 hypodermi-
   cally, as an emetic, 412
Asafoetida as a stimulating expectorant, 81
Astringent sprays, often of value if secretion
   be excessive : tannic acid (gr. 2 to 3 to the
   ounce), alum solution (a few  grains to
   saturation),  Monsel's  solution  (10  to  15
   drops to the ounce), lead acetate (gr. 1 to 5
   to the ounce), 413
Balsam of Peru, or  tolu, with other drugs, to
    decrease secretion in chronic stage, 412
Belladonna, to check excessive secretion and
   stimulate respiration, 411
Benzoic acid, 89
Bronchitis tent, 409
Caffeine, or strong coffee, to  stimulate respira-
   tion if suffocation threatens, 413
Camphor, in old or atonic cases, 108
Codeine, recommended when cough is exces-
   sive, 151
Creasote, recommended in chronic bronchitis,
   160
Croton oil and sweet oil (half and half), some-
   times applied to chest, 163
Cubebs or copaiba, as  expectorants, liable to
   derange stomach, 412
Digitalis, if heart be  feeble, 413
Dry cups applied on each side of the vertebrae,
   at sixth rib, or mustard or spice plaster to
   chest may relieve congestion, 409
Ethyl iodide,  5 to  10 drops inhaled  from a
   handkerchief every few hours in the later
   stages to loosen secretions, 177
Eucalyptus oil, valuable in later stages ; dose,
    gr. 1 to 5 in capsule every three hours, 412
Euphorbia pilulifera,  half  to one  drachm of
   fluid extract in chronic  bronchitis, 179
Flaxseed tea, a useful demulcent, 180
Garlic, boiled in milk or as a poultice, in later
    stages, 411
Grindelia, very useful in later stages, 187
Gurjun oil, when a powerful expectorant is
    desired, 188
Inhalations of steam from boiling water, to
    relieve bronchial soreness, 409
Ipecac, to promote secretion in first stage, also
    as an emetic when exudation accumulates
    rapidly and suffocation threatens, 410
Iodide of potassium, often useful when  ammo-
    nium  salts fail, contra-indicated if secre-
    tion is excessive, 200
Morphine, gr. 1-24 to 1-12, or chloroform, to
    quiet excessive cough, 410
Myrrh, with expectorant mixtures, useful in
    later stages, 244
Mustard foot-bath, with drinks of hot whiskey
    or brandy, in early stages, 409
Oxygen inhalations, when dyspnoea is great,
    413
Physostigma, in old persons with dilated tubes,
    as an expectorant and  tonic to muscular
    fibres of tubes, 414
Pilocarpine, to produce copious perspiration
    when  patient is strong; nausea may be
    produced, 409
Potassium citrate with ipecac, to aid in forma-
    tion of secretion, prescriptions, 410
Prescription for excessive cough, 169
Pyridine as an inhalation, 411
Quinine, if fever be persistent, 410
Resin,  inhalations of fumes, said to be useful
    in chronic types, 288
Sandalwood oil, in later stages, dose  5 to 10
    minims, 412
Sanguinaria, 299
Senega, a stimulating expectorant  in subacute
    and chronic stages, 304
Squill, inferior to other drugs  as an  expec-
    torant, 412
Strychnine, to stimulate respiration, if suffo-
    cation threatens, 414
Tar, 285
Tartar emetic, as  an  expectorant, gr.  1-60
    hourly, or 1  drachm of solution (gr.  2 to
    the pint), or as an emetic in  sthenic cases,
    69
Terebene, if ammonium chloride fails; dose, 5
    to 10 minims in capsule or emulsion ; must
    be stopped if  kidneys or stomach are irri-
    tated,  or used in an inhaler  with equal
    parts  of iodide of ethyl and  chloroform,
    412
Terpine  hydrate  or  terpinol in subacute or
    chronic types, to clear tubes of mucus, 323
Turpentine, inhalations or applied to chest,
    for children, diluted one-half with sweet
    oil, 329
Veratrum viride, less severe than pilocarpine in
    first stage ; dose, 2 to 3 drops of tincture,
    409
Water, hot and  cold  dashes, if death is immi-
    nent from suffocation, 413

           BRONCHOCELE.

Potassium iodide internally, and tincture of
    iodine externally, best treatment, 201

          BRONCHORRHCEA.
Alum, applied in fine  spray; solution, gr. 20
    to the ounce, 58
Gallic acid, 181 
INDEX   OF  DISEASE
               BRUISES.
Arnica, 76
Liquor  plumbi  subacetatis, locally applied;
    strength, 1 to 4 ounces to the pint;  contra-
    indicated, if skin is broken ; also useful as
    lead-water and laudanum  (water 16, lead-
    water 4, laudanum 1), 222

                  BUBO.
Carbolic acid solution (gr. 8 to the ounce), 10-
    minim injections, preceded by ether spray,
    118
Incision, at first sign of suppuration, followed
    by washing with either bichloride solution
    (1 to 1000), hydrogen peroxide {% strength),
    or zinc chloride (gr. 40 to the ounce), 417
Iodine, painted around spot  with compress
    and spica bandage, or hot bag over swell-
    ing, 417

      BURNS AND  SCALDS, 414

Boric acid, solution, a useful dressing, 414
Calcium carbonate, precipitated, as a dressing,
    103
Cantharides, tincture of, (1 to  40),  locally ap-
    plied on lint if burn is not  diffuse, 414
Carbolized  sweet  oil, cosmoline  or simple
    cerate, useful application to counter-irrita-
    tion burns, 357
Ceratum resinae, as a local application, 288
Cold cream, as a dressing, 291
Digitalis, in  shock,  if circulation fails to re-
    spond to less powerful stimulants, 414
Ichthyol ointment, 198
Lead carbonate, as an ointment, or with oil, as
    a dressing, 222
Lime-water and  linseed oil, equal parts, the
    best dressing.  Carbolic acid  is of service,
    added in proportion of 1 to 20, 414
Morphine and atropine, gr. % to % of former
    to gr. 1-60 of latter, to allay pain, 414
Opium, to relieve pain, 261
Potassium citrate with sweet spirit of nitre, if
    urine is high-colored, 415
Poultice, applied to counter-irritation blister,
    relieves pain;  when blister  forms, punc-
    ture if large, allow to break  if small, and
    dress with absorbent cotton, 357
Sodium carbonate, solution, often relieves pain,
    415
Stimulants, if shock is severe, 414
Zinc oxide, 265

          CAMPHOR-HABIT.
Camphor monobromate, 109

                CANCER.
Arsenic, small doses often repeated, to relieve
    vomiting and pain in gastric cancer, 79

           CANCRUM  ORIS.
Arsenic internally, 79
Boric acid, as a mouth-wash, 92

             •CARBUNCLE.
Carbolic acid,  solution  (gr.  8  to the  ounce),
    hypodermic injections, to abort, 118
Phosphorus, 278
S  AND   REMEDIES.          665


                CARIES.
Lime salts, especially valuable in dental caries
   of nursing women, 104

  CATARRH OF  AIR-PASSAGES.
           (See Nasal Catarrh.)
Alum,  applied in fine spray (gr.  20  to  the
   ounce), 58
Arsenic, internally, 79
Camphor, of service in old or atonic cases, 107
Sozoiodol, applied locally in 5 per cent, solu-
   tion, 309

     CATARRH OF BLADDER.
Ammonium benzoate, to render urine acid, 61
Juniper, a valuable stimulant in chronic cases,
   217

      CATARRH  OF UTERUS.

Hydrastis, 193
Sozoiodol, in  powder, applied by tampon in
    catarrh of cervix  uteri, 309

       CEREBRAL DISEASES.
Blisters, to nape of neck in cerebritis, 355
Croton oil, in cerebral congestion, 162
Elaterium, in cerebral congestion, 186
Phosphorus, often of service in cerebral soften-
   ing, 278
Veratrum viride, of greatest value in cerebritis
   during stage  of  hyperaemia, after that
   period harmful, 333

               CHANCRE.
Nitric acid, used  as a  caustic, surrounding  tis-
   sues being protected by oil, 248

           CHANCROID, 415
Actual cautery, the most destructive caustic,
   415
Bismuth and zinc oxide,  or calomel and bis-
   muth, may be substituted for iodoform as
   a dusting-powder, 416
Carbolic acid, as a wet dressing (gr. 5 to water
   oz. 1), 416
Cocaine, 20 per cent,  solution, to relieve pain
   of cauterization, 415
Hot sitz-bath or general warm bath, 417
Iodoform, the best dusting-powder after cau-
   terizing, also useful as  a palliative treat-
   ment, preceded by nitric acid wash (dr.l to
   water Oj). in erosive chancroid, 416
Iodol or aristol, as a  substitute for iodoform,
   416
Nitric acid, a good caustic, surrounding tissue
   being protected by oil, 415
Opium, after cauterizing, 417
Salicylic acid in powder or ointment, 296
Sulphuric acid with charcoal, a good  caustic
   and after-dressing, 416
Tannin, combined with dusting powder (1 to
   4), if discharge is profuse, 416

              CHAPPING.
Calcium carbonate, precipitated, as a local pro-
   tective in intertrigo of infants, 103
Camphor, useful,  added to precipitated  cal-
   cium carbonate, in intertrigo, 107
Cold cream, a useful application, 291 
666           INDEX  OF  DISEASES  AND   REMEDIES.
Light magnesia, as a dusting-powder in inter-
    trigo, 228
Lycopodium, as a dusting-powder, 227
Zinc oxide,  in powder form, useful in inter-
    trigo, 265

             CHILBLAINS.

Alum, as a wash, 57
Capsicum, tincture, painted over parts or ap-
    plied as a paper, prescription for, 115
Ceratum resinae, 288
Ichthyol ointment, 198
Iodine ointment and  lard, equal  parts,  gives
    great relief, 204

      CHLOROSIS.   (See Anemia.)

      CHOLERA, ASIATIC, 417
Chloroform,  gtt. 3 to 5 hourly, of great service,
    418
Cocaine in small dose and turpentine stupe to
    belly, to control vomiting, 418
Fly blister, over vagi, beneath jaw, highly rec-
    ommended, 418
Friction of body and hot broths, give comfort,
    418
Morphine, hypodermically, if laudanum  can-
    not be taken by the mouth, 418
Quarantine and strict hygiene, as a prophylac-
    tic, 418
Sodium chloride,  intravenously or by rectum,
    highly recommended, 418
Sulphuric acid, alone or  with laudanum and
    camphor, to control diarrhoea, 417
" Vagus," treatment of, 418
Water, with tribasic  phosphate of lime and
    potassium chloride added, as a drink, or
    intravenously, 418

     CHOLERA INFANTUM, 419
Arsenic, to check vomiting, prescription for,
    419
Brandy,  if  vomiting is  active, and collapse
    threatens, a few drops to drachm of nour-
    ishment. 419
Castor oil, with paregoric, to empty bowels and
    allay irritation, 419
Cold drinks, pieces of ice and antipyretics, if
    rectal temperature is  above normal, 419
Diet, 420
Hot drinks, applications  and baths if rectal
    temperature  is  subnormal,  temperature
    being watched, 419
Irrigation of bowels with salt solution, 420
Laudanum,  gtt. 10, starch-water, drachm 3, by
    enema, and calomel gr. 1-12 or gray pow-
    der  gr. % by  mouth, to control vomiting
    and purging, if severe, 421
Mustard or spice plaster, over belly, always
    useful, 421
Podophyllin, if stools are of peculiar  pasty
    color. 420
Predigested  milk, the best food,  419
Prescriptions for, 421

      CHOLERA  MORBUS, 422

Camphor, 107
Castor oil, with laudanum, to  sweep out in-
    testines, before diarrhoea mixture is used,
    422
Ipecac, gr. 3 every two hours, often of service
    209
Mustard or capsicum plaster, over  abdomen,
    422
Prescription for, 422

               CHORDEE.
Aconite, often relieves, 47
Belladonna internally and ointment applied
    to under surface of penis, 86
Bromide of  potassium, dr. 1 at bedtime, re-
    peated during night if necessary, 493
Camphor with bromides, very useful in some
    cases, 107
Cantharides,  gtt. 1, thrice daily, 113
Hot sitz-bath and steeping penis  in  hot water
    before retiring, relieves, 360
Lupulin, gr. 30, 493
Morphine, gr. %, with atropine gr. 1-60, hypo-
    dermically into perineum, to relieve, 493
Opium or belladonna suppositories,  to relieve,
    493
              CHOREA, 422
Arsenic,  in  ascending  doses; discontinue if
    symptoms of poisoning ensue, 422
Bromides with chloral,  when there is insom-
    nia,  prescription for, 423
Chloral, 128
Chloroform inhalations  when excessive, 138
Cimicifuga alone, or  with iron, very useful,
    423
Hot pack, at bedtime if muscular jerkings are
    severe, 423
Monobromated camphor, 109
Nitro-glycerin, 250
Salicylates  or iodides of  value, if  associated
    with rheumatism, 423
Silver oxide  and nitrate, occasionally used,
    not reliable, 423

          CHOROIDITIS, 423
Venesection in early stage, followed by mer-
    cury or potassium iodide, 423

             CINCHONISM.
Potassium bromide, as a preventive, 97

CIRRHOSIS OF LIVER.  (See Hepatic
                 Cirrhosis.)

         COLDS.  (See Coryza.)

                 COLIC.
Asafoetida, useful in children, 81
Chloral  and bromide, when severe in children;
    prescription for, 128
Ether internally, very useful, 175
Hoffmann's anodyne, 190
Hyoscyamus, 196
Matricaria, infusion,  to prevent, in teething
    children, 230
Mustard plaster, 34 to % strength  if  skin is
    tender, 243.
Rue, as a carminative, 292

        COLIC, HEPATIC, 424.

Belladonna, in full dose, to relax spasm, 86
Chloroform or ether, inhalations to relieve pain
    during spasm, 424
Diet, 424 
INDEX  OF  DISEASES  AND   REMEDIES.          667
Hot applications over liver, as a relaxant, 424  I
Morphine, gr. 34 or % with atropine  gr. 1-60 |
   hypodermically, to relieve pain, 424
Olive oi  cotton-seed  oil, 1% pints,  during
   attack; ether, drachm 1,  may be added
   with advantage, 424
Opium with belladonna, to relieve  pain and
   spasm, 260

            COLIC,  RENAL.
Belladonna, in full dose, 86
Chloroform, a few inhalations often  relieve,
   138*
Opium  with belladonna relieves spasm and
   pain, 260
              COLLAPSE.
Digitalis, 167
Ether, by mouth, inhalations, or hypodermi-
    cally of great service, 175

           CONDYLOMATA.
Calomel, as a dusting-powder, often removes,
    238
             CONGESTION.
Croton  oil, as a revulsive in cerebral conges-
    tion, 162
Digitalis, relieves stasis of congested  lung in
    typhoid state, 167
Elaterium, in cerebral congestion, 168
Ergot of service, especially with digitalis, 170
Glycerin, on cotton tampon, as a  depletant in
    uterine congestion, 186
Juniper, often relieves congested kidneys, 217

  CONJUNCTIVA, BURNS OF, 425
Atropine incorporated with liquid vaseline in-
    stilled into eye, to prevent iritis, 425
Cod-liver oil, instilled into eye after  removal
    of foreign matter, 425
Gold-beater's skin inserted between  lids and
    eyeball or breaking up granulations pre-
    vent corneal inflammation, 425
Neutralization of  foreign matter, if acid or
    alkaline, 425

CONJUNCTIVA, CHEMOSIS  OF,428
Astringent washes, especially alum, 425
Nicking swollen tissue with scissors, 425
Warm moist compresses, 425

CONJUNCTIVA,  HAEMORRHAGE
             BENEATH, 429
Boric acid or cocaine wash, when conjunctival
    irritation exists, 429
Massage of globe through closed  lid, to aid ab-
    sorption of blood, 429

CONJUNCTIVA, XEROSIS OF, 429
Glycerin, almond oil, cod-liver oil or weak al-
    kaline washes, 429

 CONJUNCTIVITIS,  CHRONIC, 426
Boric acid, wash (gr. 10 to  the ounce), co-
    caine, gr. 2, may be added if there  is no
    corneal ulcer; for this condition salt, gr. 4
    to the ounce, may be substituted, 427
Copper, crystal, or a solution  (gr. 1 to 3 to the
    ounce),  applied to  diseased  spot, if sub-
    acute, 160
Correction of refraction error, if it be present,
   427
Eye-wash, to allay irritation, prescription for,
   92
Lapis divinis, 427
Tannin and glycerin (gr. 10 to the ounce), as an
   application, 427
Yellow oxide of mercury salve or alum crystal,
   useful applications, 427
Zinc oxide, in powder or the sulphate in the
   form of a wash, 265, 314

 CONJUNCTIVITIS, DIPHTHER-
                 ITIC, 428

Atropine, instilled, 428
Boric acid or bichloride  solution, frequently
   applied in early stages, 428
Cade, oil of (strength 1 to 10), 428
Citric acid ointment or lemon juice, locally ap-
   plied, 428
Hot compresses, 428
Quinine, solution (gr. 3 to the ounce), 428
Silver  nitrate, same as in purulent conjuncti-
    vitis, 428
Sulphur, insufflations, 428

   CONJUNCTIVITIS,  FOLLIC-
                ULAR, 427

Alum, crystal applied locally if due to atropine
    instillations, 427
Astringent and antiseptic lotions, 427
Calomel, as a dusting-powder, alone or with
    bismuth, aristol or iodoform, 427
Copper sulphate, as an ointment (gr. % to the
    drachm), 427

 CONJUNCTIVITIS,  GRANULAR,
                     427
Atropine, instillations, in acute forms, 428
Boric  acid  or  salicylic  acid, solution, as a
    wash in acute forms, 428
Boro-glyceride (20 to  50 per cent.), applied to
    chronic granulations, 428
Carbolic acid, applied pure, to chronic granu-
    lations ; excess removed with water, 427
Copper sulphate, crystal, applied to chronic
    granulations, 427
Corrosive  sublimate, solution  (1 to 200 or 1 to
    500), applied every second day in chronic
    forms,  preceded  by cocaine;   eyes also
    being  irrigated  thrice daily with solution
    (1  to 7000), 428
Crushing granulations, often satisfactory, 428
Excision of granulations when isolated, 428
Glycerole of tannin, applied to chronic granu-
    lations, 428
Jequirity,  rarely used, 428
Leeches, to temple, to reduce  inflammation in
    acute stage, 427
Liquor potassa, beta-naphthol, iodoform, aristol
    in powder or salve, yellow oxide  ointment,
    calomel, or hydrastine may be tried, 428
Scarification, not advisable, 428
Silver nitrate stick or solution (gr.  10 to  the
    ounce), applied daily, if there is discharge;
    neutralize excess with salt solution, 427
Yellow oxide of mercury ointment with lard,
    equal  parts, in chronic types, 240 
668          INDEX  OF  DISEASES  AND  REMEDIES.
   CONJUNCTIVITIS,  LACHRY-
                MAL, 427
Treatment same as for chronic type.

CONJUNCTIVITIS,  MUCO-PURU-
                LENT, 426
Treatment same as for purulent type.

     CONJUNCTIVITIS,  PURU-
                LENT, 425
Atropine or eserine, if corneal ulcer appears,
   426
Bichloride of  mercury  (1  to  7000), or boric
   acid (saturated  solution),-as a wash, used
   hourly, 426
Hot  compress, iu  lieu  of  cold, if vitality of
   cornea is threatened, 426
Ice compress, in early stage, to reduce inflam-
   mation, 426
Leeching useful if inflammation is high, con-
   tra-indicated in infants, 426
Permanganate of  potassium,  aqua  chlorini,
   sulpho-carbolic  acid solution, alum sul-
   phate, zinc sulphate, creolin (1 per cent.)
   or iodoform ointment may be tried, 426
Peroxide of hydrogen useful  as a cleansing
   agent, 426
Pyoktanin, not satisfactory, 426
Silver nitrate, stick or solution (gr. 10 to  the
   ounce), touched to  lids after cleansed of
   pus, excess neutralized with salt solution;
   2 per  cent, solution dropped in newborn
   infant's eyes to prevent, 426
Sozoiodol (2 to 30), 309

  CONJUNCTIVITIS, SIMPLE, 424
Alum curd or  solution (gr. 4 to S to the ounce),
   or application of stick, if there is chronic
   tendency,  425
Atropine usually unnecessary unless corneal
   ulcer is present, 425
Boric acid, lotion (gr. 10 to the ounce), 424
Cold compress, dipped  in  water, and  hama-
   melis (equal parts), to allay inflammation,
   425
Creolin solution (1  per cent.), 425
Mercury,  bichloride solution  (1  to  10,000) if
   discharge is great, 425
Poultices and bandages contra-indicated, 425
Pyoktanin (1 to 1000), 425
Silver nitrate, solution (gr. 2 to 5 to the ounce),
   if there is muco-purulent discharge.   If
   discharge is excessive employ gr. 10  to the
   ounce, and neutralize excess with salt solu-
   tion or wash with tepid water, 424
Smoked glasses, 425
Tannin and glycerin (gr. 10 to the ounce), or
   alum crystal if there is a chronic tendency,
   425
Zinc sulphate, solution (gr. 1 to 2 to the ounce),
   alone or with boric acid, if there is chronic
   tendency,  425

        CONSTIPATION, 429.
Aloes and podophyllin, with other drugs, use-
   ful for temporary use ; contra-indicated for
   continued use;  prescription for, 432
Alum, useful in some cases, 58
Belladonna, 87
Cascara sagrada, the best curative agent, dose
    gtt. 10 to 20 of fluid extract or drachm 1 to
    6 of cordial, 123, 432
Castor oil, following acute disease in children,
    ultimately harmful in all cases, 432
Colocynth, jalap, or senna, not to be used con-
    stantly, 431
Enemata, as a routine treatment harmful, 433
Glycerin, suppositories or enemata, often used,
    433
Gymnastic movements,  horseback riding, or
    massage, with regulated diet, 430
Hunyadi, Carlsbad, or Friedrichshall waters,
    rarely of value, 431
Leptandra, fluid extract of, in intestinal atony,
    224
Magnesium sulphate by the mouth or by enema,
    229
Manna, as a laxative fruit for adults or drachms
    1 to 2 to bottle of milk for infants; harmful
    if long continued, 432
Mercury as an  habitual purgative  harmful,
    432
Opium, 433
Oxygen water, before retiring, in constipation
    due to intestinal atony, 266
Phosphate  of sodium,  useful  in rickety chil-
    dren, gr. 2 to 4 in bottle of milk; or adult,
    gr. 30 to 60, 432
Rhubarb,  usually harmful, in some eases in
    children useful, 431
Salines, simply to unload bowels, not as a rou-
    tine treatment, 431
Seidlitz powder, 303
Soap suppositories useful  in children, 306
Stillingia, recommended, when habitual; pre-
    scription for, 311
Sulphur, especially valuable if haemorrhoids
    are present, 317
Tobacco, sometimes used, 433

           CONVULSIONS.
Allium, as  a poultice over spine or feet in in-
    fantile spinal or cerebral convulsions, 54
Amyl nitrite, 65
Chloral with bromide, in infants; also useful
    alone in uraemic  and puerperal convul-
    sions, if no acute renal trouble exists, 128

               CORNS, 423
Fowler's solution, locally applied, 79
Salicylic acid, the  best  application, formula
    for, 433
Silver nitrate, solution (gr. 60 to the ounce),
    applied to  soft corns every four or  five
    days, 433
              CORYZA,  433

Aconite, useful in early stages, 47
Allium, efficient though  disagreeable, in per-
    sistent  colds, as a poultice to breast or in
    emulsion or boiled in milk for  children,
    53
Arsenic, taken for months, often cures persist-
    ent colds, 78
Atropine with morphine, along with the  use
    of quinine, in stages of watery secretion,
    436
Calomel or blue pill followed by a saline, often
    does good, 436 
INDEX  OF  DISEASES  AND  REMEDIES.           669
 Camphor, as a snuff, or inhalation of spirit, or
     fumes, when sneezing and lachrymation
     are excessive, 108
 Cocaine  (1 part), morphine (1 part), and bis-
     muth (7 parts), as a snuff, 141
 Cosmoline, as a spray, soothing, 436
 Cubebs, as a snuff during stage of secretion,
     163
 Ferrier's snuff, following  alkaline wash, pre-
     scription for, 436
 Glycerin, with whiskey, not very useful; ap-
     plied  alone, by brush or  spray, often of
     service, 186
 Hot  mustard foot-bath with hot draught or
     Dover's powder, with  rest in bed, may re-
     lieve, 243
 Inhalations of steam charged  with cubebs or
     benzoin, 436
 Iodine, by inhalation, 192
 Menthol, very useful, 271
 Prescription for wash, 436
 Prophylactic  measures, 436
 Quinine, internally or in  spray (gr. 1  to 2 to
     the ounce),  143, 436
 Sweet spirit of nitre, 320
 Tartar emetic, useful in moderate doses, 69
 Turkish bath in early stage, aborts; later, re-
     lieves ;  also  a preventive in persons sus-
     ceptible to colds, 435
 Whiskey. 436

                 COUGH.

 Acacia, as a mucilaginous  drink with flaxseed
    and liquorice, to loosen hacking  cough,
    39
 Almonds, essential oil, in emulsion, as a de-
    mulcent in cough of phthisis, 54
 Belladonna, the best remedy in nervous  cough,
    86
 Cannabis indica, a useful adjunct to cough
    mixtures, 111
 Chloroform, useful, added to cough mixtures
    for irritant cough, 138
 Flaxseed tea, alone or with paregoric, a useful
    demulcent in excessive cough, 180
 Gelsemium, 183
 Hydrocyanic  acid, highly  recommended, pre-
    scription for, 195
 Hyoscyamus,  196
 Iodine,  as a paint,  over supra-clavicular
    spaces, in irritative cough, 203
 Ipecac, in  spray, useful  in chronic winter
    cough, 209
 Morphine in wild cherry syrup, useful in irri-
    tative  cough and  when cough  is greater
    than necessary to expel mucus, 261
 Paregoric (1 drachm) in hot water, from which
    the steam is inhaled,  useful in irritative
    form of cough, 261

                CRAMPS.

 Belladonna, internally or locally as a liniment,
    86
Chlorodyne, for stomach cramp, 133
Ginger, especially useful in menstrual cramp
    due to cold, 184.  (See Dysmenorrhoea.)

    CROUP, MEMBRANOUS, 446
             (See Diphtheria.)
       CROUP,  SPASMODIC, 437
 Aconite useful, 47
 Amyl  nitrite,  inhalations,  if paroxysm  is
    severe, 437
 Antimonial wine, drachm 1, to cause vomiting
    if paroxysm is severe, 437
 Belladonna,  bromides,  chloral, or opium in
    small doses at bedtime, as a preventive,
    437
 Bromides and lactucarium, 437
 Cold cloth around neck, and child placed at
    once in hot bath, air of room being moist-
    ened by steam, 437
 Menthol, useful, 437
 Prophylactic measures,  437
 Sanguinaria, as an emetic, unfavorable, 299
 Spongio-piline or flannel, wet with hot water,
    applied to neck and covered with oiled silk
    or cotton, 437    '

        CYSTITIS,  ACUTE, 438

 Aconite in full dose, with sweet spirit of nitre
    and potassium citrate if there is fever ; pre-
    scription for, 438
 Belladonna,  alone or with aconite, especially
    useful  if due to cold;  dose, gtt. 5 to 10
    thrice daily, 438
 Boric acid, to render urine acid, 92
 Cannabis indica,  preferable  to opium for re-
    lieving pain, 438
 Creolin, as a vesical wash (1 to 2 per cent, solu-
    tion) in cystitis of women, 162
 Flaxseed tea, as a demulcent, 180
 Hot compress over bladder, should not contain
    irritants, 438
 Hot sitz-bath and enemata, to relieve bearing-
    down pain, 438
 Hygienic measures, 438
 Laudanum, gtt. 30, to  starch-water,  oz. 2, in
    enema, to relieve bearing-down pain, 438
 Leeches to perineum or  cups to sacrum, 438
 Opium, belladonna, or  iodoform suppository,
    to allay bearing-down pain, 438
 Quinine, contra-indicated, 439

      CYSTITIS,  CHRONIC,  439
 Arbutin, gr. 3 to 5, or fluid extract of buchu or
    uva ursi, 34 to 134 drachms, to improve vesi-
    cal mucous membrane when inflammation
    is of subacute type,  439
 Benzoic or  boric  acid, gr. 5 to 10 in pill, to
    render urine alkaline, 439
 Creolin solution (1 to 2 per cent.), as a vesical
    douche, 440
 Grindelia. as a vesical stimulant, 187
 Mercury, bichloride solution (1 to 10,000), as an
    injection to cleanse bladder, 439
 Opium suppositories, gr. yx to 34, very useful,
    261
 Potassium salts, except bitartrate, to render
    urine alkaline when mucus is excessive,
    439
Turpentine, oil of sandalwood, cubeb, or co-
    paiba, useful when vesical atony is great,
    440
Silver nitrate, solution (gr. 1 to oz. 4, increased
    gradually to gr. 2 to  oz. 1), as an injection
    when discharge is muco-purulent, followed
    by salt solution if pain is severe, 439 
670           INDEX  OF  DISEASI


Strychnine  and  cantharides,  when vesical
    atony is great, 440

              DEBILITY.
Arsenic with bitter tonics, very useful, 78
Calomel, in debility of children, often relieves,
    237
Eupatorium, a good tonic, 17S
 Lime salts, 104
Phosphorus, of service in sexual debility, 278

       DELIRIUM TREMENS.
Chloral, of great service used cautiously, 128
Croton oil, 162
Hops, 192
Hyoscine, in insomnia, 197
Monobromated camphor,when nervous twitch-
    ing is troublesome, 109
Valerian with morphine, frequently used, 330

     DIABETES  INSIPIDUS, 440
Arsenic, 78
Belladonna or  opium, if  due  to nervous irri-
    tability, 440
 Carbonate  or citrate  of  lithium, gr. 10, with
    sodium arsenite, gr. 1-30, valuable in gouty
    types, 225
 Ergot, 440
 Gallic acid, alone or  with opium, one  of the
    best remedies, 440
 Rhus aromatica,  highly recommended,  290
 Strychnine  and sulphate of iron, as tonics, 440

     DIABETES MELLITUS, 440
 Acidulated water or  non-purgative alkaline
    water, to allay thirst,  442
 Almond bread, as a food for diabetics, 54, 376
 Alum, 58
 Bran bread, 377
 Chloride of gold  and sodium, gr. 1-10, recom-
    mended, 414
 Codeine, gr. 1 to 5, thrice daily, 441
 Colchicum and iodides, in gouty types, 441
 Diet, 440
 Ergot, highly recommended, 441
 Gallic acid, with opium, one of the best reme-
    dies, 181
 Glycerin or saccharin, as sweetening  agents
    to replace sugar, 441
 Iodol, gr. 2 to 6, thrice  daily, recommended,
    208
 Iron,  lacto-phosphates of lime and sodium,
    strychnine and  astringents, if cachexia
    comes on, 442
 Jambul, gr. 5 to  30, once to thrice daily, said
    to be very useful  in some cases, 442
 Lime-water, 106
 Lithium carbonate or citrate, with arsenic,
    very useful, if due to gout, 441
 Opium, gr. % to  %, thrice daily, largely used,
    441
 Purgatives, restricted diet and exercise, if due
    to high living and sedentary habits, 441
 Salicylates and iodide of potassium, if  due to
    rheumatic or gouty taint,  441

             DIARRHCEA, 442
 Ammonium chloride, gr. 5, every four hours,
    best remedy  in persistent  catarrhal states,
    443
IS  AND  REMEDIES.


Arsenic, 79
Belladonna, may be used in serous type, 86
Bichloride of mercury, gr. 1-100 hourly, if stools
    be slimy and bloody, 446
Bismuth, with carbolic acid, gtt. 1 or 2, highly
    recommended in serous and summer diar-
    rhoeas, 445
Bismuthi et ammonii citras, in chronic  serous
    types, 90
Cajuput, gtt. 10 to 20, in serous forms, 103
Calomel, followed by a saline, useful in sthenic
    cases of summer diarrhoea, 445
Calumba, in summer and serous  diarrhoeas,
    prescription for, 105
Camphor, useful in serous but never in mucous
    types, 107
Castor oil, with laudanum and sodium  bicar-
    bonate,  to unload bowel and render  it
    alkaline, 443
Catechu, alone or with opium, in serous types,
    prescription for, 124
Chalk mixture,  with kino and catechu, in
    serous diarrhoeas, prescription for, 103
Charcoal, useful in  acid and  fermentative
    types, 119
Chirata, nitro-muriatic  acid, or, better still,
    nitric acid  and  cardamoms,  in mucous
    type, prescription for, 443
Chlorodyne, largely used in serous types, 133
Chloroform, with astringents  and opium, very
    useful after removal of i rritant  cause, 138
Cinnamon, as a stimulant, in serous types, 146
Cloves, 148
Copper sulphate, gr.  #, with  opium, gr. 1 in
    pill, or in enema  (gr. 5 to 20 to the ounce),
    if due to ulceration, 160
Diet, for summer diarrhoea, 443
Ergot, sometimes useful in serous types, 170
Gallic acid, 181
Geranium, 1 or 2 roots, boiled  in  pint of milk,
    of great service in infantile types, 184
 Ginger, a good addition to diarrhoea mixtures,
    184
Haematoxylon, useful in children,  because of
    agreeable taste, 189
Hope's camphor mixture, in  serous and chol-
    eraic types, 192
Ipecac, gr. 34 to 34, thrice daily, useful in sum-
    mer diarrhoea of children, 445
Iron  sulphate, gr. 5 in pill, in chronic types,
    215
 Kino powder, formula for, 444
 Krameria, useful in serous types, 218
Lead acetate, with opium and  camphor, in
    serous type, prescription for, 222
 Mercury, with  chalk or calomel, in hepatic
    disorder, 444
 Morphine, gr. 1-80 to 1-50,  hypodermically,
    often checks summer diarrhoea in chil-
    dren, 262
 Mustard plaster, or other counter-irritants, to
    abdomen, 443
 Naphthalin, 445
 Nitrate of silver and hyoscyamus, or lead ace-
    tate and opium, in mucous diarrhoea, pre-
    scription for, 443
 Nitric acid, with a bitter tonic, useful in green
    diarrhoea of children; combined with Fair-
    child's essence of pepsin, relieves chronic
    types in children, 249 
INDEX  OF  DISEASES  AND  REMEDIES.           671
Nitro-muriatic acid, or podophyllin, gr. 1-50 to
    1-40, in summer diarrhoea, if duodenum is
    at fault, 445
Nutmeg,'useful  in  prescriptions for serous
    types, 253
Pepsin  with hydrochloric  acid, in  summer
    diarrhoea, if gastric digestion is deficient,
    445
Phosphate of sodium, lime salts, and common
    salt in summer types, if rickets is present,
    445
Potassium iodide, gr. 3 to 5, if catarrhal state
    is obstinate, 444
Raspberry leaves used in domestic medicine,
    292
Rhubarb, often useful, preceding direct treat-
    ment in summer diarrhoea, 290
Sulphuric acid,  especially valuable in serous
    types, prescription for, 444
Tannic acid, in atonic or serous types, 320
Tar mixture, highly recommended in obstinate
    types, formula for, 284
Thymol, naphthalin, and especially salicylic
    acid,  useful as  intestinal antiseptics, in
    summer diarrhoea, 445
Zinc oxide, in summer types, prescription for,
    266
Zinc sulphate, 2-grain pills, especially useful
    with  opium, or podophyllin, gr. 1-60, in
    serous types, 314

           DIPHTHERIA, 446

Aconite, in early stages, 47
Belladonna internally, accompanied by potas-
    sium chlorate, as a paint (5 to 15 grains to
    the  ounce)  to pharyngeal walls before
    membrane forms, 447
Boric acid with  glycerin (1 to 30), locally ap-
    plied, to remove membranes, 447
Carbolic acid (1 to 100) in form of spray or gar-
    gle, 118
Chlorate of potassium contra-indicated as an
    internal remedy, 449
Corrosive sublimate or calomel, gr. 1-48 hourly,
    followed by supportive measures, the best
    means to prevent or limit exudation, used
    only in sthenic cases, 447
Iodine, inhalations, 205
Iron, tincture of chloride,  externally and in-
    ternally, and  ice held in mouth and ap-
    plied to glands, if suppuration threatens,
    447, 449
Lime-water or lactic acid  solution (gr. 30 to
    the  ounce),  in spray, to aid solution  of
    membrane, 447
Monsel's solution, as a  topical application,
    valuable, 214
Oxygen inhalations, atropine, and strychnine,
    and finally intubation  or tracheotomy, if
    suffocation threatens, 449
Peroxide  of hydrogen applied  on  swab or
    spray to remove false membrane,  447
Potassium chlorate, applied on swab, danger-
    ous internally, 131
Potassium permanganate, solution (gr. 20 to the
    pint), applied as a swab or as a gargle, 272
Prescription for wash, 447
Sulphurous acid fumes as a  prophylactic, 447
Trypsin, applied by swab  or spray, to digest
    membrane, 447
Turpentine, 30 minims, with  spirit  of ether,
   three times a day. or by inhalation, 448

              DROPSY, 449
Acupuncture,  less favorable than  incisions,
   only to be resorted to after other remedies
   fail, 453
Adonidin, sparteine, or strophanthus, if other
   drugs fail, 453
Aspiration,  in local effusions or dropsy of
   hepatic cirrhosis, 453
Caffeine, in torpidity of kidneys, 452
Calomel and digitalis, in renal and cardiac
   types, 452
Colocynth,  compound extract of, gr. 2 to 6,
   451
Copaiba, of service in slow renal types, 158
Digitalis, gtt. 5 to 10, with cantharides, gtt. 1,
   thrice daily, in renal torpidity due to heart
   trouble, 452
Elaterium, especially useful in renal dropsy,
   451
lalap, compound powder of, gr. 20 to 30, with
    potassium bitartrate, gr. 10 added, espe-
    cially serviceable in renal dropsy, 451
Magnesium sulphate, in concentrated  solu-
    tion, before breakfast, 452
Milk diet very useful, 452
Pilocarpine, useful in localized dropsy, contra-
    indicated in cardiac types, 452
Potassium  iodide,  in hepatic cirrhosis  and
    localized effusions, to remove liquid, 453
Scoparius, infusion, may be used, 453
Senega, rarely of value, 304
Squill with digitalis, prescription for, 310, 452
Strophanthus, 313
Sugar of milk, useful as a diuretic, 452

            DYSENTERY, 445

Alum, internally, 58
Bichloride of mercury, gr. 1-100 (or gr. 34 iQ
    water  5 ounces), teaspoonful hourly till
    relieved, 446
Calomel, in purgative dose, contra-indicated
   if weakness exists, 448
Copaiba, 158
Ergot, useful in bloody stools, 170
Hamamelis, injections, if much blood is pres-
   ent, 446
Ice-water, injections, if due to inflammation,
    used only in strong persons, 446
Ipecac, best remedy in acute dysentery, 209
Lead acetate  with opium and camphor, pre-
    scription for, 222
Magnesium sulphate, 229
Nitro-hydrochloric acid,  if due  to  defective
    action of secretory glands, 251
Prescription for enema, 446
Silver nitrate, rectal injections (gr. 10 to 20 to
    the ounce), if ulcers are chronic; followed
    by salt solution  if action is too severe, 446
Tannic acid (dr. 1 to water Oj), in the form of
    intestinal irrigation, 446

        DYSMENORRHEA, 453

Amyl nitrite, often, relieves, 65
Antipyrine or acetanilide, in  neuralgic at-
    tacks,  in  other cases of doubtful value,
    454 
672           INDEX  OF  DISEASES  AND  REMEDIES.
Belladonna, suppository, gr. 34 0I" extract, or
    ointment applied to os; tincture,  inter-
    nally, useful to relax spasm, 453
Camphor with acetanilide or antifebrin, in
    pill, useful in nervous cases, 107
Cannabis indica and gelsemium, often of ser-
    vice, 454
Epsom salts or aloes, if constipation is present,
    453
Hot sitz-bath, followed by turpentine stupe,
    and Dover's powder, gr. 10, often relieves,
    453
Iron, strychnine, and quinine, as tonics, with
    rest and horseback riding for anaemic and
    run-down patients, 454
Opium with belladonna, to relieve spasm and
    pain, 454
Piscidia erythrina, extract, in the dose of from
    34 to 2 fluidrachms, 284
Potassium bromide, 96
Water, cold and hot alternately dashed over
    loins in atonic cases, 453

     DYSPEPSIA.   (See Indigestion.)
Arsenic, useful in atonic types associated with
    chronic diarrhoea, 79
Bismuth, when due to acid fermentation, 90
Hydrastis, as an antiseptic and curative agent
    in chronic types, 193
Hydrochloric acid, if gastric secretion is defi-
    cient, 193
Nitric acid with bitter tonics often  relieves in-
    testinal types, 249
Oxygen-water, often useful in chronic types,
    266
Permanganate of potassium, 272
Quassia, useful, if not due to gastritis, 288
Serpentaria, as a tonic in atonic types, 305
Strontium bromide in painful dyspepsia, 312
Terebene, useful as an antiseptic in fermenta-
    tive dyspepsia, 322

            DYSPNCEA, 454
Ammonium carbonate, as  a respiratory and
    cardiac stimulant, 455
Arsenic, continuously employed, useful in em-
    physema and chronic pulmonary inflam-
    mation, 455
Dry cupping over back, when due  to cardiac
    or pulmonary trouble, 455
Hyoscine, contra-indicated, 455
Morphine,  gr.  ^s  to 34 night and morning,
    often cures, when due to nervous or cardiac
    disorders, 455
Opium, if due to nervous disorders, 455
Strychnine, in idiopathic types and when due
    to bronchorrhcea in old people,  455
Thoracentesis, if there is pleural effusion, 455

            EARACHE, 455

Cardiac sedatives, 456
Dobell's solution, in fine spray, if cold in head
    is present, 456
Heat, dry, applied to head  on affected side,
    456
Leeching behind ear, to relieve pain, 456
 Poultices,  oil,  and  laudanum, contra-indi-
    cated,  456
 Puncture of tympanum, if it bulge, followed
    by  careful cleansing  and insufflations of
    boric acid, 456
 Water,  hot as can be borne, dropped into  ear
    gives great relief, 456

         EAR, DISEASES  OF.
 Glycerin, useful to soften impacted cerumen,
    186
 Potassium  permanganate,  solution, useful in
    otitis media, 272

            ECLAMPSIA, 585

 Chloral and bromide, each 1 drachm, by rec-
    tum, before applying hot pack, 586
 Chloroform,  pushed rapidly  as possible,  at
    onset of attack, 586
 Elaterium, gr.  %, rubbed up with butter, or
    compound jalap powder and calomel, may
    be substituted for croton oil, 586
 Ether, as an anaesthetic, contra-indicated, 586
 Extraction of child rapidly as possible, if  at-
    tack comes on during labor,  587
 Ice-bag to head while in warm pack, 586
 Morphine, veratrum viride, and amyl nitrite,
    may be held in reserve, to be used if neces-
    sary, 586
 Pilocarpine, contra-indicated, 586
 Venesection, hot wet pack, and croton oil, gtt.
    2, with sweet oil  on tongue, to eliminate
    poison, 586

              ECZEMA, 456
 Arsenic, only when skin is very dry, 458
 Bismuth subgallate in weeping eczema, 91
 Cantharis, internally in small doses, 113
 Carbolic acid ointment (minims 10 to cerate 1
    ounce), to prevent itching, 118, 457
 Dermatol in weeping eczema, 91
 Green soap, as a detergent stimulating appli-
    cation, 306
Hygienic measures and diet, 456
Ice-water injections, highly recommended  in
    eczema of anal margin, 350
Ichthyol ointment, highly recommended, 198
Internal treatment, 458
Iron, syrup of iodide, in young children with
    anaemia and debility, 213
Kaolin as a dusting-powder, 218
Lead, dilute  solution of subacetate, a  useful
    lotion, 223
Liquor carbonas detergens, in acute cases, 457
McCall Anderson's ointment, 457
Ointments, prescriptions for, 265, 289, 458
Poultices, or olive oil with carbolic acid (gtt.
    1 to 2 to the ounce), followed by soap and
    water, necessary in some  cases to soften
    scales, before use of ointment, 457
Resorcin ointment  (gr.  2 to 30 to the ounce),
    locally  applied  in  subacute types;  in
    chronic form, ointment (gr. 2 to 10 to the
    ounce), 458
Salicylic acid, ointment  (gr. 30 to 60 to lard 1
    ounce), in chronic or weeping types, 458 
INDEX  OF  DISEASES  AND  REMEDIES.          673
Sulphides, bath of, often beneficial, 314
Tar ointment, in chronic forms, 458
Thiol,  as a dusting-powder, preceded by  an
    antiseptic wash, especially suited to moist
    eczema, 325
Zinc carbonate,  as a  protective powder in
    weeping eczema, 121
Zinc oxide, as a  dusting-powder or  ointment
    in early stages, applied directly or on lint,
    generally preceded by black wash, 457

            EMISSIONS, 459
Bromide of sodium or potassium, gr. 20, at bed-
    time, valuable in spinal irritability, 459
Chloral, gr. 20, at bedtime, 459
Cold douches to perineum and scrotum, 459
Hygienic measures, 459
Hyoscine, gr. 1-100,  of great value, 459
Potassium citrate, gr. 20, thrice daily, to render
    urine non-irritating, 459
Strychnine and arsenic, in full dose, of great
    service in genital atony, 459
Warm bath before retiring, often useful, 459

     EMPHYSEMA OF LUNGS.
Cod-liver oil, useful, 153
Ethyl iodide, 177
Euphorbia pilulifera, 34  t0 1 drachm of  the
    fluid extract, 178
Iodide of potassium, 200
Physostigma, aids in expelling mucus, 279
 Strychnine, 256

               EMPYEMA.
Iodine,  gr. 6 ; potassium iodide, gr.  6 ; water,
    1 pint; as an irrigating fluid, used daily,
    205
          ENDOCARDITIS, 460
 Aconite, tincture of, gtt. 2 to 3, hourly, in early
    stage of acute sthenic types, 460
 Anti-rheumatics, anti-lithics, or iodides, if due
    to diathetic taint, 460
 Calomel, gr. 1-4, with morphine, gr. 1-10, every
    two hours, in early stages, 460
 Digitalis, to strengthen heart in later stages,
    460
 Iron, tincture of chloride, associated with  sup-
    portive treatment, in purulent types, 460
 Leeches or wet cups, in early stages, to abort,
    460
 Lithium citrate, or acetate, or citrate of potas-
    sium,  to prevent  calcareous deposit in
    valves, 460
 Mercury, in full dose, in sthenic cases, 233
 Veratrum viride, used for same purposes as
    aconite, 460

    ENTERITIS.  (See Dysentery and
                 Diarrhoea.)

           EPIDIDYMITIS, 497
 Heat, moisture, and pressure, in later stages, to
    relieve induration, 498
 Horand-Langlebert's dressing, 498
 Ice-bags, 497                       .
 Iodide of potassium, gr. 10 to  20, thrice daily,
    to remove induration, 498
 Iodine, painted over scrotum,  said to be bene-
    ficial,  497
Mercury and belladonna ointments,  equal
    parts, or iodine, gr. 4, with lanolin, ounce
    1, locally applied, to  relieve induration,
    498
Punctures, useful to relieve tension and alle-
    viate pain, 498
Rest in bed, elevation of pelvis and testicles,
    cessation of local gonorrhoeal treatment,
    and administering treatment for acute in-
    flammation, 497
Silver nitrate, solution, painted over scrotum,
    in early stage, may relieve, 497
Strapping and suspending testicle, to reduce
    inflammation, 498

             EPILEPSY, 460
Acetanilide, 43
Ammonium or sodium nitrite, used to supple-
    ment amyl nitrite, 468
Amyl nitrite, inhalations, when aura is per-
    ceived and also in status epilepticus to
    relax spasm, 467
Antifebrin and antipyrine, especially useful in
    chronic cases when bromides fail, 469
Belladonna, with bromides, recommended, 465
Bleeding, harmful, except in marked cerebral
    congestion, 470
Borax, of doubtful value,  470
Bromate of potassium, 462
Bromide of ammonium, should be used with
      other drugs, 465
    calcium, 98
    gold, 98
    iron, when anaemia is  present, 464
    lithium, highly recommended in some
      cases, 465
    nickel, 465
    potassium, the most reliable, in ascending
      dose, 462
    sodium, not so apt to disorder stomach, 99
 Cannabis indica, 466
 Chloral, alone or with bromides, well diluted,
    after meals, used with care, 469
 Diet, 470
 Digitalis, with bromides,  useful in some cases,
    465
 Gelsemium, with cannabis  indica, often of
    value, 466
 Hydrobromic acid, liable to derange digestion,
    465
 Iodide of potassium, very useful in syphilitics,
    468
 Iron, in malnutrition, 469
 Mercury,  instead of potassium  iodide, when
     due to gumma, 468
 Mixed treatment, 462
 Monobromated camphor, 109
 Nitro-glycerin, useful in  some cases of petit
     mal, 467
 Opium with gelsemium, only to be msed when
     other remedies fail, 466
 Potassium nitrite, 249
 Quassia injections,  when due to worms, if not
     obtainable, sodium chloride solution  may
     be used, 470
 Quinine and salicylic acid,  contra-indicated,
     470
 Silver nitrate, may be tried when other reme-
     dies fail, 467
 Strontium bromide, 312

43 
674          INDEX   OF  DISEASES  AND   REMEDIES.
Strychnine, contra-indicated, except in rare
    cases, 470
Zinc salts, seldom used of late, 467

            EPISTAXIS, 471

Acetanilide has been recommended, 43
Acetic acid, locally applied, to arrest, 44
Aconite or veratrum viride tincture, gtt. 2 to 4,
    in sthenic cases, followed in thirty minutes
    by smaller doses, if necessary, 47, 471
Alum powder, pure  or half and half with
    starch, as a snuff,  471
Bacon fat  inserted as a plug in nostril, may
    arrest, 472
Compression of facial  artery may be necessary,
    472
Ergot, turpentine, hamamelis, or oil of erige-
    ron, internally, in slow oozing, 471
Hot foot-bath, or hot or cold water bags ap-
    plied to dorsal vertebrae, may arrest, 472
Ice applied to nose may arrest, 472
Ipecac in nauseating  doses, recommended, 471
Monsel's solution, in spray (gtt. 30 to ounces 4),
    only to be tried when other remedies fail;
    very disagreeable, 471
Plugging anterior and posterior nares, if neces-
    sary, with cotton or lint soaked in vinegar,
    472
Tannic acid, in powder or solution, snuffed up
    nostril, 471
Vinegar or lemon-juice injected into nostril,
    471

           EPITHELIOMA.

Acid nitrate of mercury, applied to part with
    glass rod, 240
Arsenious acid and gum acacia (of each one
    ounce, to water five fluidrachms), locally
    applied, 79

           ERYSIPELAS, 472

Alcoholic stimulants  if patient passes into ty-
    phoid state, 473
Antipyrine, to control fever, 473
Belladonna, tincture,  internally, minims 4 to
    5, every four hours and locally applied on
    lint or ointment smeared over part, 473
Bitters  and  iron, during  convalescence, as
    tonics, 473
Boric acid, as a lotion, 92
Ichthyol ointment and vaseline, half and half,
    locally applied, preceded by washing with
    castile  soap, followed by bichloride solu-
    tion (1 to 1000), 473
Iodine,  tincture,  painted  around  inflamed
    edges, to arrest, 204
Iron, tincture of chloride, gtt. 20 to 40, thrice
    daily, best internal treatment, 473
Pilocarpine, gr. 1-8 to  1-6, hypodermically, con-
    tra-indicated  in  debility; also injected
    around borders of inflammation in some
    cases, to arrest. 472
Silver nitrate, solution (gr. 80 to the 34 ounce),
    applied twice or thrice, to arrest, 473
Veratrum viride, or aconite, in early stages of
    sthenic cases, 472
White lead paint, locally applied, when ich-
    thyol is not at hand, 473
         EXHAUSTION  AND
           DEPRESSION, 474
Stimulants, 474

    EXOPHTHALMIC GOITRE.

Belladonna relieves some cases, 87
Sparteine, 303

    EYELID, ECCHYMOSIS OF.
Alum, curd or solution,  to prevent discolora-
    tion, 57

              FAINTING.
Alcohol, 50

FEET,  SWOLLEN,  TENDER, OR
            SWEATING, 474
Arsenic, gr. 1-60 to 1-40, in swelling of old per-
    sons, 474
Borax, stockings soaked  in saturated solution
    and dried, each day,  when sweating is ex-
    cessive, 474
Carbonate of calcium, precipitated, locally ap-
    plied to sweating feet, 104
Cotton, instead of woollen stockings may aid
    cure, 474
Hamamelis, distilled, or fluid extract, drachm
    34 to 1 of former, or  gtt. 10 to 20 of latter,
    474
Lead plaster and linseed oil, equal  parts, ap-
    plied on linen to feet, every third day, for
    sweating, 223
Prescription for dusting-powder, 474
Rest, absolute, of feet, may be  necessary in
    swollen feet, 474
Salicylic acid and borax, equal parts, in water
    and glycerin, best application to sweating
    and tender feet, 474

                FELON.

Bread-crumbs saturated with liquor plumbi
    subacetatis, as a poultice, to abort, 223
Silver nitrate, solution, applied early, to abort,
    247

              FEVER, 475

Acetanilide, 42
Aconite, the best  depressant for sthenic types
    in children, 47
Alcohol, as a systemic support and stimulant
    in low fevers, 50
Antipyretics, useful  in  most sthenic fevers,
    often fail  in thermic fever, 477, 480
Antipyrine, 72
Brand's method, 623
Cold applications and baths, 346
Cold packs and baths, in asthenic types, to be
    relied on  first; if impracticable, then anti-
    pyretics, 480
Digitalis, in small dose,  valuable in exhaust-
    ing fevers, 167
Musk,  by rectal injections, valuable in low
    stages,  242
Neutral mixture, useful as a  febrifuge, espe-
    cially in children, 146
Phenacetine, 274
Salicylic acid and resorcin, inferior to other
    drugs as antipyretics, 289,294 
INDEX  OF  DISEASE
               FIBROIDS.
Ergot, used as an expulsive and curative rem-
    edy, 170

            FLATULENCE.
Aromatic powder, 146
Asafoetida, 81
Camphor, 107
Capsicum, prevents formation of gas, 114
Chloroform, gtt. 1 to 2, or spirit, gtt. 10 to 20,
    will relieve, 128  - /<$$
Cloves, a useful tonic and stimulant, 148
Hoffmann's anodyne,the best carminative, 190
Pepper, 270
Peppermint, 270
Potassium permanganate, 272
Turpentine, prescriptions for, 329

FRECKLES AND CHLOASMA, 481

Almonds, emulsion of, supposed to be of value,
    54
Boric acid,  saturated solution, applied same
    as corrosive sublimate wash, 481
Corrosive sublimate (gr. 1 to 4 to the ounce),
    applied night and morning until irritation
    appears, then stop for some days and again
    renew, 481
Lactic acid (gr. 10 to the drachm) applied same
    as corrosive sublimate, 481
Prescription for chloasma of pregnancy, 265
Prescriptions for, 481

      FURUNCLES. (See Boils.)

        GALACTORRHEA,  583.

Antipyrine, gr.234, thrice daily, said to decrease
    secretion, 584
Caustic, introduced  into uterus, successful in
    some cases by inducing menstrual flow, 584
Chloral should be tried, 584
Compression of gland with applications of bel-
    ladonna ointment and potassium iodide
    internally, usually relieves, 584
Diet, 585
Electricity, generally ineffective, 584
Ergot, long continued, highly recommended,
    584
Malt, wineglassful at midday and  evening
    meals, useful addition to  diet; pyrophos-
    phate of iron, gr. 5, in addition, if anaemia
    is present, 585
Warm douches, 584

              GANGRENE.

Bromine, as an  escharotic  in hospital gan-
    grene, 99
Carbolic acid, spray (gtt. 5 to 10 to the ounce),
    useful in pulmonary gangrene, 47
Nitric acid, to destroy tissue, 248

           GASTRALGIA, 481

Acetanilide,  42
Alum, 58
Arsenic with iron, the most reliable  remedy,
    prescription for, 482
Bismuth and pepsin, 1 to 134 hours after meals,
    to prevent pain, 482
Bromide of strontium, a valuable new remedy,
    482
IS  AND  REMEDIES.          675

Bromides or valerian,  alternated with  other
    treatment, if case is neurotic, 482
Cod-liver oil in emulsion with hypophosphites,
    occasionally better than arsenic and iron,
    482
Counter-irritation, and a vigorous revulsive,
    especially useful in hysteria, 482
Cyanide of potassium, dilute hydrocyanic acid
    or chloroform as a substitute for bismuth,
    if it favors constipation, 482
Diet and hygiene, 481
Emesis and purgation, when due to indigesti-
    ble food, 481
Hot  applications, stimulating infusions, hot
    brandy or whiskey or laudanum, gtt. 30 to
    60, during acute stage, 481
Hydrocyanic acid, useful in nervous types, 195
Massage, enemata,  diet, or  suppositories of
    gluten, glycerin, or soap, to overcome con-
    stipation, 482
Menthol, 271
Nitro-glycerin, 250
Potassium nitrite, gr. 3 to 5, 249
Prescriptions for, 482
Salicylic acid, useful in paroxysmal forms, 295

GASTRIC  CATARRH,  ACUTE,  483
Ammonium muriate, useful in subacute forms
    in children, 63
Diet, principal point in treatment, 483
Effervescing draughts.useful in convalescence,
    483
Emetic, mild, to dislodge fermenting mass, if
    present, 483
Ice, to quench thirst, if anorexia is great, 483
Iron, if anaemia exists, 483
Milk, with large percentage of lime-water, 483
Pepsin and hydrochloric acid, 484
 Salicylic acid, valuable in vomiting, 295
 Salt, in moderation with food, 484
Seidlitz powder.one-fourth of one powder every
    fifteen minutes, to settle stomach and re-
    move fermenting mucus, 483
Sodium  bicarbonate with gentian, useful in
    convalescence and in children, 483
Spice poultice, to relieve  epigastric distress,
    483
Tartar emetic, given early, in acute attack of
    children, may abort, 69

 GASTRIC   CATARRH,  CHRONIC,
                    484
Apomorphine, as an emetic, to throw off mucus,
    75
Bismuth subnitrate, added to prescription, it
    hyperacidity exists, 484
Cascara sagrada, if constipation exists, 484
Diet, such as koumyss, light broths, and mat-
    zoon, 484
Silver nitrate  and  hyoscyamus,  along with
    counter-irritation and regulated diet,  pre-
    scription for, 484

    GASTRIC  DILATATION, 484
Cod-liver oil, by stomach or inunction,  if due
    to rhachitis, 485
Diet, 486
Enemas,  nutrient, often useful, especially in
    older children, 487
Gentian and calumba, useful as tonics, 487 
676           INDEX  OF   DISEASES  AND  REMEDIES.
Iodide of iron, syrup of, lacto-phosphates of
    lime, or phosphate of sodium, in strumous
    diathesis, 485
Lavage, 485
Physostigma, tincture, gtt. 5 to 10, or extract,
    gr. 34 to 34. to improve muscular coats, 487

        GASTRIC ULCER, 487
Bismuth and sodium bicarbonate, as an astrin-
    gent and sedative, and  to these may be
    added morphine for pain, 488
Bromide of sodium, by rectum, to control vom-
    iting, prescription for, 488
Carlsbad salts, magnesium sulphate, or sodium
    phosphate, for relief of constipation, 488
Counter-irritation, mild continuous,over belly,
    to relieve pain, 488
Diet and hygiene, 487
Ergot  or  cracked ice, internally, to control
    haemorrhage,  488
Monsel's solution, cold compresses, turpentine,
    creasote, cocaine, or bismuth may be given
    to check haematemesis, 488
Prescriptions for,  488
Morphine for pain or collapse following per-
    foration, 489
Silver nitrate with hyoscyamus, opium or bel-
    ladonna in  pill,  half to one hour before
    meals, 488
Spice  plaster, useful as  a  mild continuous
    counter-irritant, 488
Stimulants, cardiac, guardedly administered,
    external heat and rubbing, in collapse fol-
    lowing haemorrhage or perforation, 489

       GASTRITIS, ACUTE, 489
Belladonna internally and  flaxseed poultice
    over epigastrium and chest, if collapse
    threatens, 489
Bismuth, as an astringent and sedative, 90
Flaxseed tea, a useful demulcent, 180
Mucilaginous  drinks and albuminous sub-
    stances freely given, 489
Oils, to prevent spread of inflammation, 489
Opium, in fluid form, to relieve pain and irri-
    tation, 489
Warm water, internally, or stomach-pump, to
    unload stomach, at onset, 489

      GASTRO-ENTERITIS, 489
Castor oil or magnesium sulphate, to  sweep
    out poison, 490
Morphine, hypodermically, to allay pain, fol-
    lowed or preceded by mild, rapidly acting
    emetic, if irritating substance remains, 490
Opium and sulphuric acid, with hot  applica-
    tions or plasters to belly to control irrita-
    tion and diarrhoea, 490

       GASTRO-INTESTINAL
               CATARRH.
Diet for seven-year-old child, 374
Garlic, as a poultice  to belly almost equal to
    spice poultice, 54
Hydrastis, especially useful if due to alcohol-
    ism, 193
Sanguinaria, of service if jaundice is present,
    299
Tar, in 2-gr. pills, 284
              GIDDINESS.
Cod-liver oil with quinine, valuable in old age,
    152
Ergot and bromides useful, 170

        GLANDS,  DISEASED.

Ammoniac plaster, as a stimulant to enlarged
    glands, 64
Ammonium iodide and glycerin (gr. 30 to  the
    ounce), locally applied to enlarged tonsils,
    63
Carbolic acid  (2 per cent,  solution), injected
    into glands threatening suppuration, 118
Carbon bisulphide, in  enlarged glands, 120
Cod-liver oil, in lymphatic enlargements, 152
Ichthyol ointment, valuable as an inunction
    in lymphatic enlargements, 198
Iodine, the best remedy for enlargements, 203
Mercury ointment as an inunction in enlarged
    glands, 239

            GLAUCOMA, 490

Atropine, contra-indicated, 491
Eserine (gr. 1 to 2 to the ounce), or pilocarpine
    nitrate (gr. 2 to 4 to the ounce),dropped into
    eye if operation is delayed, 491
Hot compresses, leeches, and opiates to relieve
    pain.491
Iridectomy, the only curative treatment, 490

                GLEET.

Bichloride  of  mercury, injection  (gr. 34  t0
    water ounces 6), every three or four hours,
    235
Cantharidal collodion, applied to under sur-
    face of penis, or perineum, 355
Cantharides, 113
Gurjun oil, 188
Turpentine, internally, 329
Uva ursi, 330

     GOITRE.  (See Bronchocele.)

     GONORRHOEA, ACUTE,491

Aconite,  gtt. 2, every two or three  hours, if
    inflammation is high, 493
Almond  emulsion, diminishes  burning  on
    urination,  54
Benzoic acid, with cannabis indica, useful in
    later stages, 89
Bicarbonate of sodium or  potassium citrate,
    gr. 10, after meals, increasing, if necessary;
    relieves ardor urinae, 493
Cannabis indica, often used instead of copaiba
    and cubebs, 111
Carbolic acid (gr. 1 to  the ounce), as an injec-
    tion in posterior urethritis, 494
Cocaine, solution (4  per cent.), instilled into
    urethra before urination, diminishes ardor
    urinae, 493
Copaiba, to relieve ardor urinae and stimulate
    mucous membrane in later stage, 158
Cubebs, useful in later stage, 163
Diet and hygiene, 493
Erigeron oil, occasionally used instead of co-
    paiba and cubebs,  171
Eucalyptus, valuable in subacute stages, 178
Gurjun  oil, of value in place  of copaiba and
    cubebs, 188 
INDEX  OF  DISEASES  AND  REMEDIES.
677
Hot sitz-bath, prolonged, and hot-water injec-
   tions, useful in females, 499
Hydrastis,  one of the best  remedies,  locally
   and internally in later  stages;  also as a
   vaginal wash for females, 193
Lead acetate, injection, gr. 1 to 8 to the ounce,
   222
Lead-water and laudanum,  or alcohol  and
    water, applied on a cloth  to penis, during
    inflammation, 492
Mercury, bichloride (1 to 20,000 or 1 to 40,000),
    in large quantities to  flush urethra :  in
    females, 2  pints of  solution (1 to 4000),
    thrice daily, to irrigate vagina, 491, 499
Opium or belladonna, hypodermically  or in
    suppository,  to control  pain  in posterior
    urethritis,  at same  time  discontinuing
    active treatment, and observing strict hy-
    giene and diet, 494
 Prescription for infusion, 193
 Prescriptions for injection for  posterior  ure-
    thritis, 494
 Quercus alba, injections, useful in  females,
    288
 Salol, cubebs, and copaiba,  prescription for,
    493
 Silver  nitrate,  injections (gr.  2  to 4 to the
    ounce),  useful  in  subacute  stage; in
     females, gr.  4 to 60 to  the  ounce, painted
     over vagina, followed by astringent cotton
     tampon, 247, 499
 Urinating with  penis in hot water, to relieve
     ardor urinae, 493
 Warm baths, lasting one-half  to two hours,
     useful in early stage, 494
 White's prescription for, 492
 Zinc acetate, injection, gr. 1 to 20  to ounce of
     rose water, 44
 Zinc chloride,  injection (gr.  1  to 2 to  the
     ounce), occasionally used in second stage,
      132
  Zinc sulphate, weak solution, as an astringent
      injection, 314

     GONORRHOEA, CHRONIC, 494
Copper sulphate or silver nitrate, solution as
   an application, after dilatation, to focus of
   inflammation, 495
Dilatation, if stricture exists, 495
Prescriptions for, 495
Pressure and use of cold, often valuable, 495
Sandalwood oil, to stimulate depraved mucous
   membrane, 299
Silver nitrate, solution, if discharge persists
   after dilatation; also in posterior urethritis,
   495
Uva ursi,  330
                GOUT, 499

Antipyrine, said to have a specific effect, 72
Baths of sulphides, 314
Blisters, flying, short  distance from inflamed
    joint, every few days, 501
Chloral, in insomnia, 500
Chloroform liniment,  applied  over affected
    part,  138
Cod-liver oil,  501                     .
Colchicum, wine of the root, gtt.  20,  increas-
    ing by gt. 1 everv four  hours,  till relief or
    symptoms appear toxic, in acute types, 500
Collodion, not  more than 1 or 2 coats;  also
   useful with iodine, 500
Diet, 500
Fowler's solution, gtt.  3  in water, a standand
   remedy  in  subacute and chronic types,
   501
Iodide of iron, syrup  of, and cod-liver  oil if
   anaemia is present, 501
Iodide of potassium, to  relieve  night pains ;
   also with colchicum, in chronic gout, 500
Iodine, ointment or tincture, locally applied
   to chronic gouty joints, 501
Leeches or venesection, contra-indicated, 500
Lithium carbonate or  citrate (gr. 5 to 10 to the
    ounce), locally applied, to dissolve deposit
    around joints, 501
 Morphine,  hypodermically, near painful spot
    to relieve acute pain, 500
 Peppermint oil, locally applied, 500
 Potassium bromide, the best remedy for  in-
    somnia, 500
 Sodium bicarbonate  and linseed oil (lto9),
    locally applied to joints, 500
 Stimulants, ether hypodermically, opium  ex-
    cept  in brain or kidney  disturbances;
    diuretic and alkaline drinks and counter-
    irritation, in retrocedent gout, 501
 Water, distilled or medicinal, in large amounts,
    499

        GRANULAR LIDS.  (See
         Conjunctivitis, Granular.)

       GRAVES'S  DISEASE.  (See
            Exophthalmic Goitre.)

                 GRIPING.
 Allspice or ginger, to prevent griping of pur-
     gatives, 55,184

    GROWTHS, PATHOLOGICAL.
 Caustic potash or soda, occasionally used, to
     destroy, 125'
 Chromic acid, as a caustic, to growths on skin
     or mucous membranes, 138
  Lime, as an escharotic on  hairy growths, 106
       GUMS, DISEASES  OF.
Burnt alum, useful applied to swollen gums,
    58
Catechu, as a mouth-wash,  for spongy gums,
    125
Cocaine, locally applied, in soreness and ten-
    derness of gums, 149
Iodine, solution (gr. 1 to  the ounce),  locally
    applied, followed by rinsing mouth, when
    gums are retracted, 204
Myrrh,  tincture, locally applied, to spongy or
    tender gums, 244

         HAEMATEMESIS, 504
Ergot, hamamelis  or ipecac, in slow bleeding,
    504
Ice, cracked,  swallowed frequently,  accom-
    panied by Monsel's solution gtt. 3 in a half
    tumblerful of water, every fifteen minutes,
    504
Iron, tincture of chloride, or turpentine, inter-
    nally, if passive, 504
Lead acetate with morphine or opium, gr. 2 to
    3, in pill, 504 
678           INDEX  OF  DISEASES  AND  REMEDIES.
Monsel's salt, gr. 2 to 3, in pill, 504
Silver nitrate, gr. 1-4  in pill, in slow bleed-
    ing, 504
Tannic  acid, gr. 20 to drachm of water ; must
    not  be given with Monsel's solution, 504

          HEMATURIA, 506
Alum, gr. 2 or 3 to  water, 1 ounce, injected
    into bladder, if alarming, 506
Camphor, gr. 10 to 20, in divided doses, in pill,
    506
Cannabis indica, useful in some cases, 506
Ergot, 506
Erigeron, 506
Gallic acid, gr. 20, very valuable, 506
Hamamelis, injected daily into bladder, 506
Prescription for, 506
Quinine, if due to malaria, 506
Rhus aromatica, 290
Styptic  injections, should only be used when
    bleeding is alarming, 506
Turpentine, 506

          HAEMOPTYSIS, 502
Acetanilide, has been recommended, 43
Aconite, to prevent pneumonia following, con-
    tra-indicated in exhaustion, 503
Alum,  solution  (gr.  20 to the ounce), in fine
    spray, 58
Chloral and bromides, to allay nervous excite-
    ment, 504
Ergot,  fluid extract, 1 to  134 drachms, inter-
    nally, 503
Gallic aid, gr. 20 to the  ounce of water, when
   . ergot is not at hand, 503
Hamamelis, 189
Ice or dry cup over bleeding spot, 504
Ipecac,  in small doses, very effective, 209
Morphine, hypodermically,  to allay nervous-
    ness, 503
Tannic acid, Monsel's solution or alum, used
    in spray, as styptics, prescriptions for, 503

         HEMORRHAGE,  501
Abdominal transfusion, 368
Alum,  a useful  styptic, applied to bleeding
    vessel, 57
Arnica, 76
Compress, soaked in antiseptic liquid or filled
    with antiseptic  powder, preferable  to
    styptics, 501
Intravenous injections, 364
Ligation preferable to styptics, when appli-
    cable, 501
Oil of erigeron, 171                        *
Packing or astringents, if bleeding point can-
    not be reached by compression or for liga.
    tion, 501
Tannic acid, 321

  HAEMORRHAGE, INTESTINAL,
         504.  (See also Hemorrhage.)
Enemas, styptic, for haemorrhage from rectum
    or colon ; alum  (gr. 10 to the ounce), cop-
    per (gr. 5 to the ounce), Monsel's solution
    (dr. 1 to 2 ounces), Monsel's salt (gr. 10 to
    the ounce, or drachm 34 to water 2 ounces),
    chlorate of potash (gr.  10  to  25 to  the
    ounce),  and tannic  acid (gr. 20 to ounce of
    glycerin and water), 505
Ergot, 504
Ice, by mouth, and Monsel's salt, gr. 3, in hard
    pill, every half-hour or oftener, 504
Ice-water injections in bloody purging of dys-
    entery, 506
Lead acetate and camphor, in pill, of service
    in some cases, 505
Monsel's solution not advisable, 214
Sulphuric acid, gtt. 5 to 10 in  water, 505
Tannic acid, in solution or pill, when Monsel's
    salt is not at hand, 505
Turpentine,  in  capsule  or emulsion,  when
    bleeding  is not active, 505

         HEMORRHOIDS, 507
Aloes, 507
Carbolic or acetic acid, locally applied, 508
Cold-water injections in  the morning, relieve
    congestion and cause easy evacuation, 507
Ergot, sometimes useful in bleeding piles, 170
Gallic acid  and opium, ointment, prescription
    for, 508
Hamamelis, internally or as a lotion or injec-
    tion, 507
Nitric acid, lightly  touched to one  or two
    points,  249, 508
Potassium chlorate, with laudanum, as  an in-
   jection, 131
Quercus alba, as an astringent wash, 288
Rhubarb root, gr.  10 to 20, chewed before re-
    tiring, to  relieve  constipation, 507
Stillingia, prescription for, 311
Sulphur, to produce soft passages, 317
Tannic acid, suppositories in bleeding piles,
    321
Tobacco, contra-indicated, 327
Wool tampons, 508

             HAY FEVER.
Arsenic, 79
Cocaine,  with bismuth and  morphine, as  a
    snuff, 150
Resorcin, solution 2 per cent., in spray, 289
Terpine hydrate, in full dose, 322

            HEADACHE, 508
Belladonna, valuable in young people, 87
Caffeine, with antipyrine or  sodium bromide,
    in nervous headache, 509
Capsicum plaster,  to nape of neck, 115
Cimicifuga, if due to eye-strain, 140
Croton chloral, if due to eye-strain  or asso-
    ciated with sick stomach, 162
Cup, to nape of neck, in congestion, 509
Ergot, if due to congestion, 170
Eucalyptus, 178
Gelsemium, if due to nervous troubles or eye-
    strain,  182
Hydrobromic acid, if due to  eye-strain in ner-
    vous women, 99
Ice-bag,  applied to  head, or leeches behind
    ears, in severe cases, 509
Liquor magnesii citratis, in sick headache, 228
Magnesium carbonate, gr. 5 to 60, in sick head-
    ache due to gastric acidity, 228
Mustard foot-bath and plaster to nape of neck,
    in congestion, 509
Nux vomica, gtt. 1 every five or ten  minutes
    till 10  drops are taken, in sick headache,
    256 
INDEX  OF  DISEASES  AND  REMEDIES.          679
Oxygen water, 226
Phenacetine, if due to eye-strain or neuralgia,
   275
Potassium bromide, 95
Prescriptions for, 509
Salicylic acid or iodide or acetate of potassium,
   if due to gout, 509
Sodium bicarbonate, as an  antacid  in sick
   headache, 89
Strychnine or nux vomica, if due to eye-strain,
   509
        HEART DISEASE, 510
Aconite or veratrum viride, often useful in
   palpitation and hypertrophy, 513
Adonidine,  often of service when  digitalis
   fails, 48, 513
Ammonia and ether, followed by digitalis and
   alcohol, in heart failure, 513
Amyl nitrite, in  single whiffs, often  relieves
   cardiac failure, 65
Barium chloride, in heart failure, 83
Belladonna, when arhythmia is present, 513
Cactus grandiflorus, useful in valvular disease
   with incompetency, 101
Camphor, in  palpitation, 107
Cimicifuga, as a tonic  in fatty and  irritable
    heart when digitalis fails, 140
Diet and exercise, in fatty degeneration, when
    fat is deposited between muscular fibres,
    514
Digestive remedies in palpitation due to indi-
    gestion, 513
Digitalis, to be tried in  all heart  troubles, ex-
    cept in  simple or compensatory  hyper-
    trophy, 511
Hoffmann's anodyne, very useful in palpita-
    tion due  to indigestion or tobacco, 190
Iron, in palpitation due to anaemia, 513
Nux vomica, in palpitation, as a stimulant,
    513
Opium, if dyspnoea prevents  sleep, 262
Sparteine, in arhythmia, or  palpitation,  also
    as a substitute for digitalis,  if it fails, 303,
    513
Strophanthus,  may be  tried  if digitalis fails,
    513
Veratrine ointment, recommended, applied to
    chest in some cases  of palpitation, 513

       HEPATIC  ABSCESS, 514
Active treatment for dysentery, if present, 515
Ammonium  muriate, thought to be of value,
    63
Aspiration, when pus forms,  515
Diet, 515
Quinine, after abscess develops, 515

        HEPATIC  CIRRHOSIS.
Ammonium  chloride, 63
Iodoform, highly recommended, 207
Potassium iodide, often useful in early stages,
    201
       HEPATITIS, ACUTE, 514
Aconite, in early stages, 514
Ammonium muriate, has been recommended,
    69
Cantharidal blister,  small,  over  right hypo-
    chondrium;  if impractible,  use  mustard
    plaster, 514
Hot cloths, over counter-irritant, may relieve
   pain and aid in formation of blister, 514
Saline purgatives, preceded by calomel, gr. 1,
   in divided doses, if constipation exists, 514
Sweet spirit of nitre with potassium citrate, or
   diuretic waters, to regulate kidneys, 514
Veratrum viride, rarely used, 514

   HEPATITIS, CHRONIC AND
            SUBACUTE, 515
Anti-syphilitic  treatment, if due  to  syphilis,
   515
Aspiration, frequently repeated, may effect a
   cure, 515
Nitro-muriatic acid, internally and externally,
    most useful remedy, 515
Potassium iodide, useful in all cases,  515

                HERNIA.
Chloroform, inhalations, to relax muscles dur-
   ing reduction, 137

            HICCOUGH, 516
Belladonna, 87
Camphor, spirit of, dose 1 drachm, 516
Capsicum, tincture, gtt.  2 to 3, 516
Chloral, 129
Chloroform, 516
Ether, inhaled or sprayed on epigastrium, 516
Hoffmann's anodyne, especially valuable, 516
Musk, gr. 10,  given by rectum, valuable in all
    cases, especially in typhoid fever, 516
Nux vomica,  accompanied by mineral acids, if
    due to indigestion, 516
Oil of amber, gtt. 5 to 10 in capsule, one of the
    best remedies, 516
Pilocarpine hydrochlorate, hypodermically, if
    due to uraemia, 516
Valerian, tincture of, dose 1 drachm,  516

            HOARSENESS.
Sulphides or sulphur water, if due to cold or
    speaking, 317

             HYDROCELE.
Iodine, injections after evacuation of the sac,
    the best curative remedy, 204

         HYDROCEPHALUS.

Potassium iodide, to cause absorption of fluids,
    200
              HYSTERIA.
Calcium bromide, 98
Hops, as a nervous sedative, 192
Monobromated camphor, to produce  sleep, 109
Oil of amber, 58
" Pill of three  valerianates," recommended,
    331
Potassium bromide, 95
Valerian, 330
Valerianate of ammonium, 63

             IMPOTENCE.

Cannabis indica, with strychnine,  nux vomica,
    or ergot,  if no organic trouble exists, 111
Cantharis with nux vomica  and iron, may
    restore sexual  power, if loss  is  due to
    excess, 113 
680           INDEX  OF  DISEASES  AND  REMEDIES.
(old douche  to  perineum  and  testicles,  in j Yellow oxide of mercury, gr. 1-60 or 1-50, in
   atonic types, 351                              trituration, if there is  foul belching or ill-
Gold, chloride of, and sodium, gr. 1-20,187         smelling stools, 240
INCONTINENCE OF URINE, 516
Antiseptic fluids, to cleanse bladder, in paral-
   ysis, 518
Arsenic with nux vomica, in weakness of spinal
   centres, prescription for, 517
Belladonna, if due to vesical spasm, 517
Buchu with sweet spirit of nitre, valuable in
   some cases, 100
Cantharides, gtt. 1, with   alkaline diuretics,
   thrice daily, in adults,  518
Catheterization, iu retention or paralysis, 518
Circumcision, if prepuce is  redundant, relieves
   some cases, 518
Diuretic waters, used  for years, necessary in
   some cases, 518
Fowler's solution, gt. 34 to 1, in chronic types
    due to atony, 517
Hyoscyamus, if due to irritable bladder, 196
Rhus aromatica, in incontinence of children,
    due to atony, 290
Santonin, often valuable when other remedies
    fail, 300
Sweet spirit of nitre and potassium  citrate, if
    urine is dark and concentrated, prescrip-
    tion for, 517

  INDIGESTION, GASTRIC AND
           INTESTINAL, 518

Alcohol, in adynamic types, 519
Ammonia, if due to large amounts of lactic
    and butyric acids, 521
 Asafoetida,  useful  in indigestion  associated
    with flatulence in old age, 81
Bitter tonics, useful in atony, contra-indicated
    in gastric irritation, formulae for, 519
Bromide of strontium, recommended  by See,
    312
 Chiretta, 126
 Diet, 521
 Gold, chloride of, and sodium, when epigastric
    pain is present, 187
 Hydrochloric acid  in gastric forms,  or com-
    bined with cardamoms, in intestinal indi-
    gestion, 193
 Leptandra, of great value in intestinal types,
    prescription for, 224
 Nitric  acid, if sour regurgitation is  present,
    after meals, 249, 522
 Nitro-hydrochloric  acid,  valuable  in many
     cases, 251
 Pancreatin with sodium  bicarbonate and al-
    kaline mineral waters, in intestinal types,
    521
 Pepsin and hydrochloric acid, if due to defi-
     cient secretion, 520
 Podophyllin or mercury, in lientery, 522
 Prescription for torpid liver of indigestion, 522
 Prescriptions for flatulence of intestinal indi-
     gestion, 522
 Salol, 521
 Salt, in increased amounts, if gastric digestion
     is imperfect, 520
 Serpentaria, as a tonic, 305
 Strychnine, quinine, and nux vomica, useful
     tonics, prescriptions for, 519
          INFLAMMATION.
Cannabis indica,  valuable  in  chronic types
    111
Cocaine, in acute types, prescription for, 149
Hop poultice,  192
Liquor plumbi subacetatis,  useful as a topical
    application, 222
Opium, 261
Veratrum viride, 333

           INFLUENZA,  522
Aconite, sweet spirit of nitre, and citrate of
    potassium  in combination,  valuable  in
    early stage, 524
Antipyrine,   phenacetine,  and  acetanilide
    should only be used in small dose to allay
    pain, 523
Belladonna, combined with strychnine if there
    be vasomotor paresis, 526
Bromides, if cough be excessive, 527
Cannabis indica, often valuable if pushed for
    irritative cough, 527
Chloral, chloralamid, or sulphonal, for in-
    somnia, 527
Cold bath, preferable to antipyretics for reduc-
    tion of temperature, 524
Cup, contra-indicated, 525
Ergot cannabis indica.  with bromides, often
    relieve vertigo, 527
Salol and phenacetine, valuable in combina-
    tion, to allay irritation and pain, 523
Steam inhalations, laden with vaporized drugs,
    for cough, 526
Strychnine, preferable to digitalis, if there be
    tendency to collapse, 526

    INSANITY.  (See Mania, Acute.)

             INSOMNIA,  527
 Amylene hydrate, useless if due to pain, 529
Bath, cold, in cerebral anaemia, hot in nervous
    irritability, 349
 Bromide of potassium with Fowler's solution
    in nervous females, prescription for, 528
 Cannabis indica, prescription for, 111
 Chloral, useful if not due to pain, prescription
    for, 528
 Chloralamide, gr. 15 to 60, in wine or capsule,
    in nervous insomnia, 529
 Croton chloral, preferable to chloral, if due to
    pain,162
 Hop pillow, 192
 Hot-water bags to feet and  cold to head, if due
    to cerebral hyperaemia, 528
 Hyoscine, gr. 1-100 to 1-90 by mouth, or gr. 1-110
    to 1-100 hypodermically, in mania or hys-
    teria, 528
 Hypnal, useful in insomnia due to pain, 197
 Morphine with chloral, if due to pain, pre-
     scription for, 528
 Opium, only to be used in pain, 261
 Paraldehyde, 268
 Potassium  bromide, in  nervousness and over-
:     work, 96
 Somnal, minims  10 to 40, in  liquorice and
     water,  529 
INDEX  OF  DISEASES  AND  REMEDIES.           681
Sulphonal, prescription for, may be given in
    hot water, 529
Valerian, in nervousness, 330

   INTERMITTENT  FEVER, 529

Alcohol, contra-indicated during chill, 530
Anaesthetization, has been employed to put off
    paroxysm, 531
Antipyrine, if fever is excessive, 531
Arsenic, in intervals between attacks, as an
    antiperiodic, 530
Calomel, gr. 34 to 34, every 15 minutes until 1
    grain is taken, 4 or 5 hours before quinine,
    if constipation is present, 530
Chloroform inhalations, preceded by lauda-
    num, by mouth or rectum, or morphine, gr.
    1-6, with atropine, gr. 1-60, hypodermically
    if death threatens during chill, 530
Cool  drinks and sponging, in fevered stage,
    531
Digitalis, to relieve internal congestion during
    chill, 531
Ice-pack, if fever  is long-continued and ex-
    cessive, 531
Ipecac, or  zinc sulphate as an emetic, if  chill
    follows full meal, 530
Podophyllin, gr. 1-10 to 1-8, preceding quinine,
    if constipation is present, 530
Potassium or sodium nitrite, gr. 10, have  been
    employed to put off attack, 531
Quinine, as a prophylactic and antiperiodic,
    530

     INTERTRIGO.  (See Chapping.)

      INTESTINAL CATARRH.

 Ammonium chloride, useful in subacute types,
    63
 Chlorate of potassium,  injections (gr. 20 to the
    ounce), in acute rectal catarrh, 131
 Iodide of potassium,  if ammonium chloride
    fails to relieve, 200
 Leptandra, fluid extract, dose 20 minims to 1
    drachm, 224
 Salol, 298

 INVOLUTION, ANOMALIES  OF,
                     544
 Cannabis indica, of great value in subinvolu-
    tion, 111
 Curette, in subinvolution due to retention of
    hypertrophic endometrium, 581
 Digitalis, in subinvolution due to sluggish cir-
    culation, 581
 Ergot, quinine, and strychnine, in pill, if due
    to fibroids, 581
 Purgatives, disinfectants,  and possibly hot
    water locally applied, if due to inflamma-
    tion, 581
 Removal of placenta, if adherent, 581

                IRITIS,  531

 Atropine,  the best local remedy, 531
 Counter-irritation, 356
 Daturine or duboisine, when atropine cannot
    be used, 532
 Iced compress, in early  stage  of traumatic
    iritis, 531
Iodide of potassium, alone or with mercury bi-
    chloride,  following mercurial  impression
    in syphilitics, 532
Leeches and  dry heat or hot fomentations, to
    relieve pain, 531
Mercury, preferably by inunction, if due  to
    syphilis, 532
Morphine, if  pain is severe, 532
Paracentesis, 532
Pilocarpine,  internally if vitreous  becomes
    opaque, also in gonorrhoeal types, 532
Salicylic acid  or oil of gaultheria, followed
    later by  potassium iodide, in rheumatic
    iritis, 532
Saline laxatives, during course of disease, fol-
    lowed by iron, after  cessation of specific
    treatment, 532
Turpentine accompanied by potassium iodide,
    in plastic iritis, following  secondary syph-
    ilis, 532
Zollicoffer's mixture, useful in chronic  types,
    532
           IRRITABILITY.

Almonds, as a drink in irritability of intestines
    and air-passages, 54
Cantharis, recommended in irritable bladder
    of women and children, 113
Cimicifuga, in  uterine irritability, 140
Hops, in vesical irritability, 191
Petrolatum,  as a soothing agent in gastro-
    intestinal types, 273
Potassium bromide, in irritability of pharynx,
    95
           ITCH.  (See Scabies.)

               JAUNDICE.

Calomel, gr. 1-6, every half-hour till gr. 34 is
    taken, if due to cold, 237
Carbolic acid, gr. 10, with water and glycerin,
    each 2 drachms, locally applied in itching
    of jaundice, 118
Citric acid, 147
 Hydrastis, useful in subacute types, 193
Iodoform, highly recommended, 207
 Leptandra fluid extract,  dose 30 minims to 1
    drachm, 224
 Manganese sulphate, may be  tried in malarial
    types, 229
 Pilocarpine, useful unless due to malignant
    disease, 282
 Salol, said to be of value, 298

         JOINTS, ENLARGED.
 Ammoniac plaster, a useful stimulant, 64

                 KELOID.
 Ichthyol ointment, 198

  KERATITIS,  INTERSTITIAL,  532
 Antiseptic lotions, in marked ciliary conges-
    tion, 533
 Anti-syphilitic treatment, if due to syphilis, 533
 Atropine, in  ciliary congestion,  to prevent
    iritis, 533
 Creolin, 162
 Leeches, to temple to relieve pain, if patient is
    not too young for bleeding, 533
 Thymol iodide, as a dusting-powder, 326 
682           INDEX  OF  DISEASES  AND  REMEDIES.
 KERATITIS, PHLYCTENULAR,
                    533
Atropine, to relieve pain, 533
Boric acid, solution, to relieve congestion, 533
Cocaine, not advisable in photophobia, 533
Cold-water douche on closed  eyelid, to relieve
    photophobia, 533
Dark glasses, to protect eyes, 533
Tonics and alteratives, with strict  hygienic
    and regulated diet, associated with local
    treatment, 533
Yellow oxide of mercury ointment, or calomel
    as a dusting powder to hasten cicatriza-
    tion, contra-indicated  if iodine  is being
    given, 533

 KERATITIS, SUPPURATING, 533
Antiseptic lotions, to limit sloughing,  534
Cautery, actual, best means of preventing per-
    foration, 534
Curetting  floor of ulcer, if perforation threat-
    ens, 534
Eserine or atropine, instilled into eye, to limit
    sloughing, 534
Hot compresses, 534
Massage of cornea and introduction of yellow
    oxide ointment, to remove scars of ulcers,
    534
Pressure-bandage, if perforation threatens, 534
Silver nitrate (gr. 10 to 20 to the ounce), touched
    to margins of ulcer, if perforation threat-
    ens, 534
    LACHRYMAL ABSCESS, 535
Blue pyoktanin (1 to 1000), injected  through
    external opening  if there is  purulent dis-
    charge, 535
Division of  canaliculi and  washing out sac
    with   antiseptic  fluids,  and insertion  of
    probes into ducts after inflammation sub-
    sides, to restore patulency, 535
Hot compresses composed of lead-water and
    laudanum, to relieve pain, 535
Puncture of abscess, if rupture threatens, 535

   LARYNGISMUS STRIDULUS.
Amyl nitrite, 65
Belladonna, 87
Gelsemium, 183

     LARYNGITIS, ACUTE,  535
Abstinence from talking, with bland and un-
    irritating but nutritious diet during attack,
    536
Aconite, with a diaphoretic to control fever,
    536
Alkaline and  astringent sprays, followed by
    insufflations of anodyne and astringent
    powders, 536
Bromide of sodium or potassium,  with small
    doses  of potassium cyanide, in excessive
    cough, 536
Bromides  useful in full doses, 60 to 120 grains a
    day, 96
Calomel, small and repeated doses,  followed
    by saline purges along with hot mustard
    foot-bath and demulcent drinks, 536
Dover's powder, if necessary, to give  rest, 208
Iodol, insufflations, in tubercular types, 536
Lozenges, preferable to gargles, 536
Oil of amber and olive oil, half and half, well
   rubbed  into  the skin of the neck and
   chest, 536
Silver nitrate, 247
Steam inhalations, charged with benzoin, cam-
   phor, or cubebs, 536
Tonics,  woollen  underwear,  fresh  air, and
   change of climate during convalescence,
   536
   LARYNGITIS, CHRONIC, 538
Formula for powder, as a protective to raw or
   ulcerated surfaces, 540
Silver nitrate,  strong solution,  pure salt  or
   mitigated stick, touched  to indolent  or
   granulating inter-arytenoid fissures, 538
Training of voice, removal  of nasal  obstruc-
   tions, and relief of irritation, necessary for
   cure in some cases, 540
Vapor  and powder  inhalations  and  other
   measures, same as for subacute types, 540

   LARYNGITIS, SUBACUTE, 536
Benzoin, camphor, fluid extract  of cubebs, or
   tar,  as inhalations, 537
Insufflation powders—zinc sulphate and milk
   sugar, equal parts, reduced;  tannic  acid
   reduced to 1-4 or 1-5 with iodoform, useful
   in abraded or ulcerated  surfaces, bismuth
   subnitrate or subcarbonate and morphine
   may be added if indicated ;  lead acetate,
   gr. 10 to 20 to the 34 ounce, with a little
   morphine acetate, 537
Lithia water, in laryngeal thickening, 537
Potassium iodide, in small doses, long contin-
   ued, with or without arsenic, in laryngeal
   thickening, 538
Remedies for acute types, usually sufficient to
   effect cure, 537
Tonics,  generous  diet, exercise, and  use  of
   woollen underwear, to prevent return, or
   development of chronic type, 538
Turkish baths and friction  of skin, in rheu-
   matic or gouty cases, 538
Zinc sulphate, ferric alum, tannic acid, or weak
   bichloride solution in spray,  538

          LEUCORRHCEA,  541
Alum,  gr. 10 to 20 to the ounce, as a vaginal
   wash, 53
Ammonio-ferric alum,  gr.  2  to  5, in atonic
   types, 197
Belladonna, gr. 1 to 2, with tannic acid, gr. 6 to
   8, applied on cotton, in  disease of uterine
   cervix, 86
Cantharidal collodion, applied over  groins to
   produce  blister, in catarrh  of Fallopian
   tubes or ovarian irritation, 542
Goodell's prescription for, 542
Hot  sitz-bath, or  vaginal  injections of  hot
   water, if due to uterine congestion, 360
Hydrastis injections, if due to relaxed vagina,
   193
Iron, with tonics, if due to excessive lactation
   or exhausting life, prescriptions for, 541
Myrrh,  if due to uterine trouble, 244
Potassium permanganate (drachm 34 to water
   1 pint), as an  injection,  if discharge  is
   foetid, 505
Prescription for injection, 542 
INDEX   OF  DISEAS
Ringer's prescription for wash, 542
Tampon, saturated with iodoform and tannic
    acid, equal parts, sometimes of service, 542
White-oak bark  (ounce 1 to water 1 pint), or
    tannic  acid  and  glycerin (ounce  1 to 2
    quarts of water), as an injection, 54

                LICHEN.

Arsenic, usually cures, 78
Bath of sulphides, often beneficial, 314
Cantharides, 113

           LID ABSCESS, 543
Treatment, same as for other abscesses, 543

        LITH-EJMIA.  (See Gout.)

       LOCOMOTOR ATAXIA.
Acetanilide, 42
Antipyrine, 73
Potassium  bromide,   to  prevent  laryngeal
    crises, 96
Suspension, 368

             LUMBAGO, 543

Acupuncture, often relieves, especially if pain
    is bilateral, 543
Antifebrin; dose, gr. 4 to 8, 543
Antipyrine ; dose, gr. 10 to 20, 543
Chloroform liniment, 138
Cod-liver oil, 153
Foot bath and Dover's powder, before  retiring,
    often relieves, 543
Ice-bag or ether spray to loins, if hot  applica-
    tions fail, 543
Ironing back with laundry iron, skin being
    protected by cloth or paper, very efficient,
    543
Monobromated  camphor, with other drugs,
    very useful,  109
Mustard or  capsicum  plaster or  blister, over
    painful spot, may relieve, 543
Phenacetine and salol, of each 5 grains, 543
Potassium iodide or salicylic acid, if recovery
    is slow,  543
Poultice, a large hot, to lumbar region,  useful
    in obstinate  cases, 543
Turpentine, gtt.  20, said to be useful, 329

                 LUPUS.

Acid nitrate of mercury, 240
Europhen, in ointment or powder, 179
Ichthyol ointment, 198
Iodine, as a paint, to retard spread, 204

         MALARIAL FEVER.

(See Intermittent and  Remittent Fevers.)
Antipyrine, 73
Arsenic, as a cure and  prophylactic, 78
Eucalyptus, instead of quinine when it cannot
    be borne, 178
Gelsemium, of doubtful value, 182
Gentian, in malaria associated with dyspepsia,
    183
Hydrastis, said to be anti-malarial, 193
Pilocarpine, may be used to abort, 282
Quinine, the best remedy as a  prophylactic
    and a cure, 142
S  AND  REMEDIES.           683


         MANIA, ACUTE, 544
Anaesthetics, or apomorphine in emetic dose,
   to relax muscular system, if patient is very
   violent, so that other remedies may be ad-
   ministered, 544
Bromide of potassium, as a soporific, 96
Cannabis indica with large dose of bromides,
   particularly serviceable, 544
Chloral, in  full doses, if kidneys are healthy,
   544
Cimicifuga, fluid extract, gtt. 20 to 30, thrice
   daily, in cases occurring after confinement
   not due to permanent causes, 544
Cold douche to head while body is immersed
   in hot water, often of service, 544
Hyoscine hydrobromate, gr. 1-100, when neces-
   sary to quiet patient rapidly, 544
Morphine,  in  full dose, may  be required  to
   quiet patient, 544

              MARASMUS.

Cod-liver oil  inunctions,  one of  the best
   remedies, 152

  MASTITIS.  (See Breast, Inflamed.)

         MELANCHOLIA, 544

Nitro-muriatic acid, gtt. 5, in water after meals,
   if associated with oxaluria, 544
Phosphorus, useful in some cases due to over-
   work, 278

     MENINGITIS, ACUTE,  544

Aconite or veratrum  viride, in early stages  to
   depress circulation, 545
Alcohol, given with food in second stage, if
   there be asthenia, 545
Belladonna,  often  useful,  especially  when
   opium and calomel  are  contra-indicated,
   545
Blister to nape of neck, in early stage, to pre-
   vent effusion ; also in comatose state, 545
Bromides and chloral,  best agents to  allay
   nervous symptoms, 545
Calomel, gr. 34, with opium, gr. 34> every half-
   hour, in early stage, until effect  is mani-
   fested ; the deodorized tincture, gtt. 2 to 5,
   every two  hours, or  less, preferable  to
   powder of opium, in some cases, 545
Ergot, in stage of exudation, 545
Ice-bag to head, in early stage, 545
Leeches to nape of neck, in early stage, 545
Milk diet, in second stage, 545
Opium,  useful in second stage, 545
Quinine, contra-indicated in acute stage, 545
Venesection in early stage of sthenic  cases, if
   aconite or veratrum viride are not at hand,
   545

      MENINGITIS, CHRONIC.

Phosphorus, 278

             MENOPAUSE.

Bromide of potassium, in nervous disorders,
   96
Cannabis indica, alone or with aloes and iron,
   if anaemia or constipation exist, in  head-
   aches of the menopause, 111 
684          INDEX  OF  DISEASES  AND  REMEDIES.
Eau de Cologne, saturated with camphor, lo-
    cally applied in headache or  drowsiness,
    108
Valerianate of ammonium, in nervous  disor-
    ders, 63

        MENORRHAGIA  AND
        METRORRHAGIA, 502

Bromide of potassium or sodium, gr. 10, once
    or twice daily, if bleeding is irregular, 96,
    502
Cannabis indica, recommended, 502
Cinnamon oil, drachm 34, when erigeron is not
    at hand, in oozing flow, 502
Dry cups, over sacrum, if due to congestion,
    502
Ergot, fluid extract, gtt. 10 to 60, best remedy
    in active bleeding, 502
Erigeron, oil of, minims 3 to 5, in capsule or
    emulsion, the best remedy for oozing, 502
Hamamelis, distilled extract, drachm 1,  thrice
    daily, in irregular bleeding, 502
Monsel's solution (50 per cent.) full strength,
    locally applied, if due to polypus, 214
Rhus aromatica, highly recommended in men-
    orrhagia, 290
Rue, in atonic menorrhagia, 292
Savine, oil of, gtt. 5 to 10, in capsule or  emul-
    sion, every three or four hours, as a tonic
    in menorrhagia, 301
 Turpentine, often of value, 329

             MIGRAINE, 555
 Amyl nitrite, 65
 Bromide of potassium, with caffeine, almost a
    specific, if due to eye-strain, 96
 Cannabis indica,  tincture, gtt. 20,  hourly, or
    extract, gr. % to 34> every two hours, best
    treatment, 555
 Croton chloral, very efficient, especially if fifth
    nerve is involved, 162
 Gelsemium, with cannabis indica,  to  abort,
     182, 555
 Salicylic acid, of great service, in  rheumatic
     types, 295

        MILK DEFICIENCY,  583
 Electricity, 584
 Treatment for intercurrent affection, if  due to
     that cause, 584

   MORPHIOMANIA.  (See  Poisoning—
            From Opium, Chronic.)
 Bromide of potassium, 96
 Phosphorus, of service in sequelae of morphio-
     mania, 278

        MUCOUS MEMBRANES,
              DISEASES  OF.

 Acacia, as a mucilaginous drink in irritation
     and inflammation of upper air-pas sages,
     39
 Bismuth, as  an astringent, to inflamed mem-
     branes, 90
 Flaxseed, as a soothing demulcent, 180
 Glycerole of aloes, locally applied to fissures,
     valuable, 5§
 Opium, suppositories, gr. 34> useful in rectal
     inflammation, if not an acute catarrh, 261
Pareira, useful in chronic genito-urinary  in-
    flammation, 269
Terebene, useful  in  subacute and chronic
    genito-urinary  inflammation,  instead  of
    sandalwood or copaiba, 323
Zinc sulphate, weak solution, as an astringent,
    314
    MUSCiE VOLITANTES, 546
Alteratives and correction of anomalies  of re-
    fraction,  546

      MUSCULAR STIFFNESS.
Hot laundry iron passed over part, skin  being
    protected by layers of paper or cloth, often
    relieves, 360
             MYALGIA, 546
Ammonium chloride, if due to cold or bruises,
    546
Camphor liniment,108
Chloroform liniment, 546
Cimicifuga, fluid extract, gtt. 20 to 1 drachm,
    546
Clove oil,  added to liniment, as  a counter-
    irritant, 148
Iodide of potassium or salicylates, if due to
    rheumatism, 546
Iodine ointment, pure, or diluted  with lard,
    546
Massage or good rubbing, very  necessary, 546
Potassium  acetate or citrate,  gr.  20, may  be
    tried, 546
Poultices, hot as can be borne, 546
Prescription for liniment, 546

NASAL CATARRH, ATROPHIC, 547
Dobell's solution,  as  a cleansing  wash ; car-
    bolic  acid  may be  increased, or thymol
    and eucalyptus substituted for it, to relieve
    odor, 547
Galvano-cautery, or strong silver nitrate solu-
    tion, if ulcerations are present, 548
Hydrogen  peroxide, 547
Iodine and glycerin (gr. 6 to 8 to the ounce),
    with potassium iodide sufficient to make
    solution, valuable, locally applied, 548
Listerine,  may be added to Dobell's solution,
    to relieve odor, 547
Potassium iodide, internally, tonics and stimu-
    lants to mucous membrane and attention
    to activity of skin, 548
Potassium permanganate, useful; painful if
    sensation is not entirely lost, 547
Removal of necrosed bone,  548
Silver nitrate and starch (gr. 1  to 10 to drachms
    234), as an insufflation powder, or solution
    (gr. 1 to  10 to the ounce), better, in some
    cases,  locally applied, 548

 NASAL CATARRH,  CHRONIC, 548
 Ferric  alum (gr. 5 to the ounce), useful,  in
    spray, in later stage, 552
 Galvano-cautery or snare, to remove hypertro-
    phic tissue remaining after acute stage, 552
 Hydrastis, dilute solution, or distilled extract
    of hamamelis and water, equal parts, use-
    ful in spray, in acute stage, 552
 Iodine and glycerin (gr. 6 to  8 to the ounce),
    with potassium iodide, sufficient to make
    solution, locally applied,  515 
INDEX  OF  DISEASES  AND  REMEDIES.
685
Prescription for alkaline wash, 547
Remedies for coryza, useful,  instituted  for a
    few days, 433

        NAUSEA.  (See Vomiting.)
Hoffmann's anodyne,  when  due to excessive
    use of tobacco, 190
Hydrocyanic acid,  dilute,  gtt. 20, in water,
    often useful, 195
Lime-water, 106

  NEPHRITIS.  (See Bright's Disease.)

           NERVOUSNESS.
Camphor, as a sedative, 107
Hops, as a sedative, 192
Musk, useful in nervous excitement and col-
    lapse ; only to be used through crisis, 242
Phosphorus, in nervous debility and exhaus-
    tion, 278
"Pill of three  valerianates," highly recom-
    mended, 331
Rest-cure very useful where nervousness is due
    to exhaustion, 366
 Strychnine, in functional nervous atony or de-
    pression, 255
 Sumbul, prescription for, 319
 Sweet spirit of mtre, in nervous excitement of
    fever and other nervous states of infancy,
    320
 Valerian,  alone or with other drugs, 330

             NEURALGIA, 552
 Acetanilide, useful, especially with monobro-
     mated camphor, 42
 Aconite ointment (gr.  2 to  the drachm), or
     oleate of aconitine (gr. 2 to sweet oil 100),
     useful applied over painful spot, if limited
     in area; if not, contra-indicated, 47, 554
 Acupuncture, nerve-stretching, or neurectomy
     necessary in some cases,  554
 Amyl nitrite, inhalations, when due to anae-
     mia, 554
 Antipyrine, gr. 5 to 20, very useful, 553
 Belladonna, 87
 Bromide  of potassium with caffeine, almost a
      specific, 554
  Camphor liniment, locally applied, to  relieve
      pain, 108
  Chloralamide, 130                      _
  Chloroform liniment, as a local anaesthetic, 140
  Cimicifuga, especially useful in ovarian types,
      138
  Cod-liver oil, 153
  Croton chloral, gr.  5 to 20, in 5-grain pills, often
      effective in brow neuralgia, 554
  Freezing parts with ether or  rhigolene spray, or
      by small package of ice and salt, successful
      if nerve is superficial, 554
  Hydrocyanic acid, useful in intestinal neu-
      ralgia, 195                      .
  Iodide of  potassium, may  be tried in rheu-
      matic neuralgia, 200
  Iron and arsenic,  in  anaemia, often necessary
      to associate with them  bitter  tonics  and
      cod-liver oil, 553
  Kataphoresis, 365,554     .....     -„fnl
  Morphine, gr. 1-5 to 1-4,  injected  into painful
      spot, if localized; not advisable in chronic
       cases, 554
Muriate of ammonium, useful in ovarian types,
   63
Mustard plaster, as a counter-irritant, 243
Nux vomica or strychnine, if nerve is depressed
   by anaemia, 553
Peppermint oil, locally applied on cloth over
   painful spot, 270
Phenacetine, gr. 3 to 8, very useful, 554
Phosphorus, if due to nervous exhaustion, 553
Prescription for, 275
Prescriptions containing antipyrine with bro-
    mides and caffeine, 554
Quinine, if due to malaria,  553
Rest-cure very useful in exhausted patients,
    366
Specific remedies, if due to  scrofulosis or syph-
    ilis, 553
Turkish bath, may relieve, if due to rheu-
    matism or gout, 261
Veratrine ointment, locally applied over neu-
    ralgic nerve,  337

         NIGHT-SCREAMING.

 Bromide of potassium, 96

           NIGHT-SWEATS.

 Acetic acid,  as a  lotion, diluted one-half, 44
 Agaricin, of doubtful value, 48
 Alum dissolved  in water or alcohol, efficient
    application for sponging, 57
 Belladonna, best remedy, 86
 Camphoric acid, the best of all remedies, 109
 Ergot, 170
 Gallic acid,  181
 Pilocarpine, gr. 1-20 hypodermically, two hours
    before sweat, often useful, even when atro-
     pine fails, 282
 Sulphuric acid,  with belladonna or morphine,
     often useful, 318
 Zinc oxide, prescription for, 266
         NIPPLES, SORE, 555

Benzoin, tincture locally applied, 555
Boric acid (gr. 20 to the ounce), or mucilage of
   acacia, applied after nursing, nipple being
   dried beforehand, 555
Breast-pump or nipple shield may be necessary
   to effect cure, 555
Cocaine  (gr. 4 to the  ounce),  applied and
   washed off before nursing, if breast is very
   painful, 555
Silver nitrate stick touched to Assure, if deep
   and slow to heal, 555
Tannin, glycerite of, locally applied, 555

           NYMPHOMANIA.

Bromide of potassium, of great service, 96

              OBESITY,  555

Acetic acid, harmful, 44
Cold bath, 558
Diet, 556
Laxative fruits and purges, to regulate bowels,
     558
 Massage,   passive    movements,   absolute
     skimmed-milk diet,  and'electricity, if
     exercise is impracticable, 558
 Potassium permanganate,  272 
ES  AND  REMEDIES.
686          INDEX  OF  DISEAS1

Saline purges, if liquid taken in drink is not
    rapidly eliminated, 558
Turkish bath, 558

 OPHTHALMIA.  (See Conjunctivitis.)

 OPIUM HABIT.  (See Poisoning from
             Opium, Chronic.)

     ORCHITIS.  (See Epididymitis.)

          OSTEOMALACIA.
Phosphorus, 278

             OTORRHCEA.
Creolin, solution (1 to 500), used with syringe,
    162
         OVARIAN TUMOR.
Iodine, 204

                OZ^INA.
Prescription for insufflation powder, 234

      PARALYSIS AGITANS.
Cannabis indica, to quiet tremors, 111
Chloral, of great service, 128

             PARASITES.

Bichloride of mercury (gr. 2 to water oz. 1), ap-
    plied thrice daily in parasitic skin diseases,
    235
Chrysarobin, gr. 1-8, internally, or the oint-
    ment,  with benzoated  lard (1 to  4 or 5),
    locally applied, in parasitic  skin diseases;
    must not be used on face, 139
Mercurial ointment, useful to destroy pedicu-
    lus pubis or other parasites,  239
Volatile or fixed oils, useful to destroy, 239

           PARTURITION.

Castor oil. to relieve constipation, 123
Chloral, if rigidity of os exists, 129
Cimicifuga, 140
Quinine, as a stimulant to uterus, 142

             PEMPHIGUS.
Arsenic, 78

         PERICARDITIS, 558

Aconite, to allay inflammation and quiet heart,
    47
Alcohol, digitalis, or caffeine, if heart shows
    signs of failure, 559
Aspiration, gradual, if exudation endangers
    life, 559
Blister, over praecordium, often useful, 559
Calomel.gr. 34. with opium, hourly, to prevent
    exudation, 559
Iodide of  potassium, to aid in  absorption of
    fluid, 200
Jalap, compound powder of, gr. 20; or elate-
    rium,  gr. 1-6; or saline purgative, before
    breakfast, useful in sthenic cases, to re-
    move effusion, 555
Leeches, 5 to 10,  over praecordium, accompa-
    nied by  large dose of veratrum viride, in
    early stage of sthenic cases,  558
Opium, to allay inflammation, 261
     PERITONITIS, ACUTE, 559
Aconite, preferable to veratrum viride, to de-
    press circulation, 559
Belladonna and opium, by mouth; if impossi-
    ble, by rectum, to  relieve  vomiting  and
    pain; also useful in obstinate constipation
    due to intestinal paralysis, 559
Leeches, 10 to 30, or mustard plaster to abdo-
    men, accompanied by opium and  bella-
    donna, given as above, to relieve pain  and
    vomiting in early stage, 559
Mercury, useful only in severe acute  forms
    due to traumatism or other causes, 560
Pancreatinized milk, frequently given during
    attack, also enjoining absolute rest, 560
Saline treatment, 561
Turpentine stupes, or turpentine, drachm 1:
    milk of asafoetida, oz, 3; and water, oz. 4,
    as an enema, if tympanites is present,  561
Venesection, valuable in early stage, if case is
    sthenic, 371
Veratrum viride, inferior  to aconite,  in early
    stage, 559

     PERNICIOUS MALARIAL
               FEVER, 563
Quinine, large doses, in solution,  by mouth.
    rectum, or hypodermically, 563

           PHARYNGITIS.
Cocaine, gives  temporary relief; after-effects
    bad, 149
Cubebs, troches of, used in chronic types, 163
Monsel's solution, pure or diluted one-half
    with glycerin, applied on pledget of  cot-
    ton or camel's-hair brush, 214
Peroxide of hydrogen, 267
Silver nitrate solution, in varying  strength,
    locally  applied, 247

    PHTHISIS.  (See Tuberculosis)

   PLEURITIS, or PLEURISY, 564
Aconite or veratrum viride, preferable to vene-
    section, in early stage, 564
Aspiration, when  hydragogue  purges fail to
    remove effusion, 565
Blisters, useful in early stage; also during stage
    of effusion,  564, 565
Calomel, in sthenic cases, to prevent exudation,
    564
Cantharidal blister, two inches  below axilla,
    aids absorption of effusion, 355
Cotton jacket, 564
Digitalis or alcohol, if pulse weakens in second
    stage, 565
Dry cup, contra-indicated over diseased area,
    may be employed over back, 564
Elaterium or jalap, useful to remove effusion,
    565
Gelsemium, 182
Ice-poultice or jacket, used with success in
    sthenic cases, 346
Iodide of potassium, used in chronic stage, to
    aid absorption, 200
Iodine, locally applied, to abort, and aid ab-
    sorption of fluid, 204
Poultices, 564
Saline purges, in second stage, to remove effu-
    sion, 564 
INDEX  OF  DISEASES  AND  REMEDIES.          687
Strapping chest, if respiratory movements are
    very painful, 564
Wet cups, useful in early stage, over inflamed
    spot, 564

  PLEURODYNIA.  (See Neuralgia.)

           PNEUMONIA, 565
Aconite, preferable to veratrum viride, in early
    stage,  in children, 567
Alcohol,  inferior to digitalis, as  a cardiac
    stimulant in the second stage, 572
Antimony, should only be used in sthenic cases,
    573
Antipyrine, of great value if fever is excessive,
    72
Blisters applied to one side of congested spot,
    in first stage;  immediately over spot in
    stage of resolution, 570
Cardiac stimulants,  if secondary attack is su-
    perimposed on first, 574
Cayenne  pepper, a  valuable counter-irritant,
    570
Chloral, not advisable, 569
Cotton jacket, 575
Cups, dry and wet, in first stage; also in secon-
    dary attack superimposed on first, 569
Digitalis,  tincture, gtt. 5, every four hours, ac-
    companied  by  strychnine, gr. 1-20, care-
    fully watched, in second stage, 570
Ethyl iodide, causes resolution, 177
Expectorants must  be  stopped, if secondary
    attack is superimposed on first, 574
Gelsemium, not advisable, 569
Ice-poultice or jacket highly recommended in
    first stage of sthenic cases, 346, 569
Leeching, bleeding, cupping or cardiac seda.
    tives,  in sthenic cases, if secondary attack
    is superimposed  on first, 574
Mustard plaster, to chest in first stage; to feet
    in secondary attack superimposed on first,
    570, 574
Oxygen inhalations, if asphyxia threatens, 574
Phosphorus,  278
Pilocarpine, hypodermically, only to be used
    in earliest stage, 569
Poultices, useful in second and third stages, 574
Prescriptions, containing ammonium chloride,
    to loosen cough of second stage, 573
Quinine, gr. 2, thrice daily, in suppository, in
    lobar  pneumonia of children, 143
Strychnine as  a respiratory and  circulating
    stimulant in second stage, 572
Turpentine stupe, in first stage ; also in second-
    ary attack superimposed on first, 570, 574
Venesection, in  early stage  of sthenic cases,
    cardiac depressants preferable, 370
Veratrum viride, preferable to aconite,.in early
    stage, in adults, 567

          POISONING FROM
               Acetanilide.
Supportive measures.stimulants.external heat,
    belladonna to maintain blood  pressure,
    strychnine  to counteract respiratory fail-
    ure, and oxygen inhalations to overcome
    cyanosis, 42.
             Acetate  of Zinc.
Treatment same as for gastro-enteritis, 489
              Acetic Acid.
Large amounts of milk, alkaline liquids, and
   general treatment for gastro-enteritis, 44

                 Aconite.

Keep patient in  prone position  with  feet
   higher  than  head.   Hot  applications;
   emetics contra-indicated; evacuate stom-
   ach  by siphon or stomach-pump.  Ether
   hypodermically, followed by alcohol and
   this by digitalis. Artificial respiration and
   amyl nitrite,  a few whiffs,  no more,  if
   heart fails, 46

             Alcohol,  Acute.

External heat, digitalis and strychnine  hy-
   podermically, in coma, if heart fails. Bel-
   ladonna, if skin is relaxed  and clammy,
   and counter-irritation to nape of neck, for
   brain symptoms.   After-treatment, ammo-
   nia, spices, spirit of Mindererus ;  emol-
   lients in gastritis.   Ice, aconite, or ipecac
   in minute dose, and counter-irritation for
   vomiting.  Jalap, gr. 40, elaterium, gr. 1-6,
   or calomel and salines, as purgatives, 50

           Alcohol, Chronic.

Withdrawal of drug, at once  or gradually.
   Highly seasoned broths, predigested foods,
   and morphine or coca,  in  small dose,  if
   weakness is marked.  Capsicum prescrip-
   tions (pages 51,114), 51

               Antimony.

Large doses of tannic acid, external heat, alco-
   hol, digitalis,  and  opium hypodermically,
   if respiration is not too feeble. Prone posi-
   tion,  the patient  vomiting  into  towels.
   Stomach-pump, if vomiting is absent, 68

               Antipyrine.

Maintain bodily heat, stimulants, atropine, and
   oxygen inhalations, if cyanosis  is alarm-
   ing, 72

     Arsenic, Acute and Chronic.

Stomach-pump, external heat, stimulants, and
   the chemical antidote, hydrated sesquiox-
   ide of iron and magnesia.  Magnesia  also
   useful by itself. Opium should follow anti-
   dote, to allay pain, also large draughts of
   water to flush kidneys and dilute poison.
   For chronic poisoning, iodide of potassium,
   tonics, electricity,  and out-of-door life, 80

             Carbolic Acid.
Soluble sulphates, as Epsom  or  Glauber salts,
   warm  mucilaginous drinks, hot applica-
   tions to extremities, digitalis, strychnine,
   and counter-irritation  over  abdomen.
   Emetics and stomach-pump should be used
   if possible, 116

          Carbon Bisulphide.
Potassium bromide and  chloral, if convulsive
   disorders exist, and circulatory stimulants
   if heart failure threatens, 120 
688          INDEX  OF  DISEASES   AND  REMEDIES.
                 Chloral.

External heat, emetics in early and stomach-
    pump in later stages.  Strychnine or atro-
    pine to  stimulate respiration.   Digitalis
    preceded by ether, ammonia, brandy, or
    whiskey. Prone  position, feet  being ele-
    vated, 128

               Chloroform.

Artificial respiration, ether and hot brandy
    hypodermically.  Poles of battery  with
    rapidly  interrupted  current swept  over
    body; not  over  diaphragm or phrenic
    nerve. Place patient with head downward.
    Atropine,  strychnine, and  digitalis  to
    stimulate heart and respiration, 135

               Colchicum.

Tannic acid, emetics, and stomach-pump.  Opi-
    um to relieve pain and oils to  soothe in-
    flamed mucous membranes.  Atropine and
    stimulants if collapse comes on,  155

                Conium,
Emetics  or  stomach-pump, strychnine  as a
    nervous and respiratory stimulant.external
    heat and cardiac stimulants, if circulation
    fails, 157

                 Copper.

Yellow prussiate of potassium, sweet oil, white
    of egg; followed instantly  by emetics or
    stomach-pump. If emesis or purgation is
    present emetics are  contra-indicated, in-
    stead, mustard plaster over abdomen and
    opium internally are to be employed, 159

         Corrosive Sublimate.

Large amounts of white of egg, followed by
    stomach-pump, external heat, stimulants,
    234
               Croton Oil.

Treatment same as for gastro-enteritis, 489

                Digitalis.

Tannic acid as a chemical antidote, emetics or
    stomach-pump, external heat to abdomen
    and aconite as a physiological antidote.
    Maintain horizontal position, 166

               Elaterium.

Treatment same as for gastro-enteritis, 487

                 Ether.

Artificial respiration, lowering head if  face is
    pale; strychnine,  atropine, and digitalis
    hyiodermically, or intravenous injection
    of ammonia to stimulate heart and respira-
    tion ; frictions and hot applications; ether
    dashed on chest and abdomen, 174

              Gelsemium.

Emetics and stomach-pump, digitalis, atropine,
    and ammonia as cardiac stimulants; exter-
    nal heat, strychnine, and atropine for re-
    spiratory centre, 183
                  Iodine.
 Emetics or stomach-pump, large amounts of
    starch, hot applications, and hypodermic
    injections of alcohol, ammonia, atropine,
    digitalis, or strychnine, 202

               Lead, Acute.
 Epsom  or Glauber salts,  in  large  amounts;
    emetics or stomach-pump, if vomiting pro-
    duced by the drug has not cleared stomach
    of all poison.  Hot applications and opium
    to relieve pain, 219

             Lead, Chronic.
 Jalap and calomel  with opium  or alum, gr.
    2, in  full  dose, valuable in lead colic.
    Blister to back of  neck, revulsives and
    pilocarpine  in   cerebral  inflammation.
    Iodide of potassium to eliminate lead.
    Strychnine in progressive paralysis. Elec-
    tricity and baths of sulphuret  of potas-
    sium, to restore lost function,  221

             Mineral  Acids.
 Alkalies, such as magnesium, lime, whitewash,
    and soap as antidotes; white of egg, ex-
    ternal heat,  oils and  opium, to  relieve
    irritation.

           Monsel's Solution.
 Soap, 214

        Nitrate  of Silver,  Acute.
 Common salt as the chemical antidote, opium
    and  oils to allay  irritation, also large
    amounts of milk and soap and water, 245

       Nitrate of  Silver, Chronic.
Iodide of potassium, to aid in eliminating poi-
    son, 246

      Nux Vomica and Alkaloids.
Inhalations of amyl nitrite, to prevent convul-
    sive tendencies, at the same time use stom-
    ach-pump.  Tannic acid followed by phys-
    iological antidotes, potassium  bromide, gr.
    60, with  chloral, gr. 20.  If convulsions
    prevent  swallowing, chloroform  patient
    carefully and give antidotes by rectum in
    starch-water.  Amyl nitrite,  hypodermi-
    cally, if relaxation does not occur, 254

             Opium, Acute.
Emetics or stomach-pump, tannic acid, black
    coffee, electricity, and other  measures to
    keep patient awake.  Atropine or  strych-
    nine, hypodermically, if respiration fails.
    Alcohol,  ammonia,  and  external heat.
    Artificial respiration  may be necessary, 258

            Opium, Chronic.
Decrease a sixth or fourth of customary amount
    each twenty-four hours.  Cocaine not ad-
    visable as a substitute, as the cocaine-habit
    may be established.  Digitalis if heart fails,
    260

              Phosphorus.
Sulphate of copper as the  chemical antidote,
    acts as an emetic if given in excess, 277 
               INDEX   OF  DISEASI


              Physostigma.
Atropine as a physiological antidote, external
    heat, and cardiac and  respiratory stimu-
    lants, 280

               Scammony.
Treatment same as for gastro-enteritis, 4M9

      Strychnine.  (See Nux Vomica ,)

                 Tobacco.
Strychnine, cardiac stimulants, external heat,
    and atropine, 327

            Veratrum Viride.
Prone position, head higher than feet; atropine.
    strychnine,  external  heat,  and cardiac
    stimulants, 333

POST-PARTUM  HAEMORRHAGE,
                     506
Auto-transfusion, or actual transfusion of weak
    salt solution, necessary in some cases, 583
Beef-tea, 34 pint, and morphine, gr. 1-8 hypo-
    dermically, after reaction is established,
    583
Enema, of hot water, 1 pint, after cessation of
    bleeding, 583
Ergot, as a cure and prophylactic, 507
Ether, hypodermically, if symptoms of shock
    are manifested, followed by small doses of
    hot, strong brandy and water, and  warm
    milk, 583
Hirst's method of controlling, 582
Suture, if due to laceration, 581

               PRIAPISM.
Hops, 192

  PROLAPSUS ANI  AND RECTI.
Injection of cold or hot water, often relieves,
    350
           PROSTATITIS, 497
Cold-water injections and  perineal douches,
    352
Local treatment to prostatic urethra, and use
    of cold steel sounds in chronic types, 497
Perineal incision, to evacuate pus, if abscess
    forms, 497
Rest  in bed, regulation of bowels,  leeches to
    perineum, medication  to render urine al-
    kaline, and morphine hypodermically or
    in suppository, 497
Soft catheter, allowed to remain in bladder, if
    retention of urine is persistent, 497

         PROSTATORRHCEA.

Cantharides, 113

                PRURIGO.

Cantharides, 113

             PRURITUS, 575
Alum solution as a wash in pruritus vulvae, 58
Arsenic, quinine, bitter tonics,  cod-liver oil,
    alkaline diuretics or mineral waters in de-
    bility,  and  avoidance of condiments if
    mouth of vagina or urethra  is affected,
    575
                                          44
S  AND  REMEDIES.           689


Calomel  and lard (1 drachm to the  ounce).
   locally applied, 238
Cocaine, relieves temporarily, 576
Cold douche and injections  highly recom-
   mended in pruritus ani and vulvae, 351
Goulard's extract, dilute, useful  in pruritus
   pudendi, 223
Hydrocyanic acid, locally applied, prescription
   for, 195
Prescription for lotions and ointments, 575
Salicylic acid, prescription for, 295
Silver  nitrate (gr. 20 to the ounce), locally ap-
    plied, preceded by  cocaine, if  itching is
    intense;  a 4- to 6-grain solution  may re-
    lieve itching of pruritus pudendi, ani, and
    vulvae, 247, 576
Sodium bicarbonate or borax (1 drachm to the
    pint) as a wash, relieves temporarily, 575
Teucrium scordium, highly recommended by
    Brinton, 576
Tobacco, 327
              PSORIASIS.
Anthrarobin, 66
Aristol, 326
Arsenic, 79
Baths  of sulphides, very useful, 314
Chrysarobin, gr. 1-8 internally, or the ointment
    with benzoated lard (1 to 4 or 5) locally ap-
    plied, face excepted, 139
Gallic acid ointment, 181
Prescription for application, 139
Resorcin, prescription for, 289
Tar, locally applied. 285
Thymol iodide, 326

              PTYALISM.
Alum  applied on swab, in mercurial ptyalism,
    58
Belladonna, in idiopathic or mercurial types,
    86

    PUERPERAL DISEASES,  576
For treatment, see special titles.

      PUERPERAL  FEVER,  576
Antipyretics, best abstained from  as long as
    possible, 578
Bichlorate of mercury (1 to 2000), or creolin
    (2  per cent.) solutions, as antiseptic injec-
    tions, 576
Boric  acid, creolin (2 per cent.), or bichloride
    (1  to 8000) solutions as injections into blad-
    der, to prevent septic cystitis, 580
Curette or placental forceps, to remove mem-
    branes if fever continues after antiseptic
    injections, 577
Epsom salts, concentrated solution, 2  drachms
    every  fifteen minutes,  if  peritonitis de-
    velops, 578
 Laparotomy, occasionally saves life,  if septic
    peritonitis develops, 578
 Nutriment in large  amounts  and alcoholic
    stimulants, if symptoms of systemic inva-
    sion arise, 578
Silver nitrate (gr. 40 to 60 to the ounce), locally
    applied to unhealthy ulcerated  wounds ;
    zinc chloride solution may be necessary,
    579
Veratrum viride, 333 
690          INDEX  OF  DISEASES  AND  REMEDIES.
   PURPURA  HEMORRHAGICA,
 Turpentine, 328

                PYELITIS.
 Buchu, in chronic types, 100
 Cantharides, 113
 Copaiba, 158
 Juniper, as a tonic in chronic types, 217
 Uva ursi, 330

                 QUINSY.
 Aconite, in early stage, 47
 Salicylic acid, gr. 3 hourly, acts as a specific,
    especially if due to rheumatism, 295

      REMITTENT  FEVER,  587
 Antipyrine, or cold pack, if fever is excessive,
    587
 Eupatorium, 178
 Monsel's salt, gallic or tannic acid internally,
    if intestinal haemorrhage occurs, 588
 Morphine, spirit of chloroform, or aconite, in
    sthenic cases,  to control vomiting, 587
 Quinine, gr. 20 to  30, preceded  by calomel, gr.
    3 to 4 ; if not retained, administer by rec-
    tum, or hypodermically, with divided doses
    of Seidlitz powder by mouth, 587
 Tonics, potassium salts, to regulate  kidneys,
    and purgatives, if necessary,  during con-
    valescence, 588
 Turpentine stupe, if belly is tender, 587

             RETINITIS, 588
 Atropine, dark glasses and later suitable lenses
    if due to eye-strain, 588

      RHEUMATISM,  ACUTE
            ARTICULAR,  588
Acetanilide, relieves pain and fever, 43, 590
 Acetate of potassium, 43
Aconite, or veratrum viride, useful at onset of
    inflammation in sthenic cases, 588
 Alcohol, in depression, 589
Ammonium bromide, 62
Antipyrine, gr. 10  to 20, or antifebrin, gr. 4  to
    8, often very valuable, 590
Benzoic  acid, drachm 2 to 3, daily, said to be
    a specific, 89
Bicarbonate or citrate of potassium, gr. 20  to
    30, in water, every five hours, in obstinate
    cases, 591
Blisters over joints,  useful after systemic dis-
    turbance is past, 592
Camphor liniment, 108
Capsicum plaster, 115
Cimicifuga, shortens attack and relieves pain
    in some cases,  592
Colchicum, prescription for, 591
Cold pack, if fever threatens life, 592
Fuller's lotion, applied on hot cloths to joints,
    589
Ice-cold compress,  may relieve inflamed joints,
    589
Ichthyol ointment, valuable applied to joints,
    prescription for, 592
Iodine,  ointment  or tincture, painted over
    parts, 592
Lemon- or lime-juice, or citric acid, beneficial
    in nearly all cases, 592
  Oil of gaultheria, useful as a substitute  for
     salicylic acid, 590
  Phenacetine, alone or with salol, 591
  Potassium iodide, useful in  subacute or obsti-
     nate types, prescription for, 591
  Potassium nitrate, 245
  Rhus  toxicodendron,  especially  useful  for
     night pains, 592
  Salicylic acid, gr. 20,  thrice daily, if untoward
     symptoms arise must be stopped, 589
  Salol, useful as a substitute for salicylic acid,
     dangerous in large doses,' 592
  Sodium bicarbonate  (gr. 20 to the  ounce), ap-
     plied on lint to inflamed joints, 589
  Splints for fixation  of  limbs, may  relieve
     greatly, 589
  Sulphur, 317
  Veratrine ointment,  useful locally applied to
     joints, 592

    RHEUMATISM,  CHRONIC, 593
  Arsenic, useful in some cases, 79
  Baths of sulphides, often useful, 314
  Cimicifuga, sometimes relieves, 140
  Citrate of potassium or sodium, gr. 30 to 60,
     before retiring, 295
  Cod-liver  oil, internally, in weakness  or an-
     aemia, also useful rubbed into joints, 593
  Ichthyol, the best remedy for joints, 594
  Iodine, locally applied, 594
  Liniments, prescriptions for, 593
  Ointments, prescriptions for, 594
  Potassium iodide, colchicum, and sarsaparilla,
     usually indicated ; see prescription, 593
i  Turkish or Russian baths, very valuable, 593
 Veratrine  ointment,  gives greatest relief  in
     some cases, prescription for, 594

    RHEUMATISM,  MUSCULAR.
 Burgundy pitch, a mild local remedy, 284
 Dover's powder, in conjunction with hot drinks
     and hot foot-bath, often cures, 262
 Mustard, as a counter-irritant, 243
 Veratrine ointment, locally applied, 331

                RHINITIS.
 Creolin (1 to 1000), as a nasal douche, 162
 Fluid cosmoline, in spray, 273
 Potassium  permanganate, solution, in  foetid
     rhinitis, 272

              RICKETS, 594
 Arsenite of copper, 595
 Cinchona, for  child of one year or  more, pre-
     scription for, 594
 Cod-liver oil, prescription for, 595
 Cool sponging or rubbing with salt and whis-
     key (1 drachm to the pint), useful at night,
     596
 Iodide of iron, syrup of, if scrofulous tendency
     or anaemia exists,  prescriptions for, 595
 Lime salts, phosphorus,  zinc  phosphate, and
     as bone tonics, 595
 Massage and passive movements, 596
 Mineral acids, physostigma and simple bitters,
     as digestive tonics, 595
 Nux vomica,  rarely given because of  bitter-
     ness, 595
 Phosphate of  lime or sodium,  gr.  1 to 2,  in
     child's milk, 596 
INDEX  OF  DISEASE
Phosphorus (gr.  1-100), in sugar-coated pill,
    595
Quinine, cod-liver oil, nux vomica, and iron
    as general tonics, 595
Sodium and lime salts, useful in nursing and
    pregnant women, 595

 RINGWOBM.  (See Tinea Circinata.)

             SATYRIASIS.

Potassium bromide, one of the best remedies,
    95
                SCABIES.

Sulphur, the best remedy, 317

        SCARLET  FEVER, 596

Aconite, harmful, 47
Alcohol, indicated in collapse, 598
Antipyrine or acetanilide,may produce collapse
    in large doses, 598
Bromide of sodium with chloral, useful when
    convulsion ushers in attack, 598
Carbolic acid  (gtt. 2 to olive oil  oz. 2), ben-
    zoated lard, vaseline, cosmoline, or almond
    oil, useful, locally applied,  to allay itch-
    ing, 599
Chloral, very useful, prescription for, 596
Chlorate of potassium, locally applied, by spray
    or swab, in sore-throat, 598
Cold sponging, useful; pack must be employed
    if fever is excessive, 598
Ice, applied externally and held in mouth, to
    prevent swelling of throat, 598
Ice-bag or rubber head-coil  to head, if very
    hot, 598
Jalap,  compound powder, with potassium bi-
    tartrate, or hot dry applications, to produce
    sweat, in nephritis, 599
Juniper, in later stages, if there is renal atony,
    217
Pilocarpine, best agent to produce sweating in
    nephritis;  contra-indicated  if heart  is
    weak, 599
Potassium citrate and sweet spirit of nitre,
    prescription for, 597
Quinine, unsuccessful in most cases, 598
Salicylic acid,  highly recommended, prescrip-
    tion for, 596
Strychnine, iron,  simple  bitters,  quinine,  or
    Basham's mixture, in convalescence, 599
Warm wet pack, useful to bring out rash, 599
Water,  pure,  as  Vichy or  Poland, in large
    amounts, 597

              SCIATICA. 599

Acupuncture, recommended, 600
Antifebrin and antipyrine, may prove useful,
    600
Cod-liver oil, of service in obstinate cases, 600
Chloroform, deeply injected over exit of nerve,
    a favorite remedy, 600
Ether or rhigolene, sprayed on part, often effec-
    tive, 600
Kataphoresis,  may be tried, 600
Liniments for rheumatism may be tried, 600
Massage of nerve with glass rod, 600
Morphine, injected over course of nerve, 600
Nerve-stretching, necessary in some cases, 600
,S  AND  REMEDIES.          691

Potassium bitartrate or citrate, gr. 40, thrice
    daily, in plenty of water, to regulate kid-
    neys, 600
Potassium iodide, 200
Remedies for rheumatism, often relieve, 600
Salicylic acid, 295
Sulphur, 311
Wet cups, highly beneficial over  course of
    nerve, 600

             SCLERITIS, 600

Atropine,  boric acid,  and  hot-water com-
    presses, to control pain in early stage, 600
Eserine, with pilocarpine sweats or cautery in
    stubborn episcleritis without iritis, 600
Yellow oxide ointment, associated  with mas-
    sage, to subdue infiltration, 600

               SCLEROSIS.
Antipyrine, 73
Nitrate of silver, 246

           SCROFULOSIS, 601

Arsenic or corrosive sublimate,useful if anaemia
    is present, prescriptions for, 601
Calcium chloride, 104
Cod-liver oil, the best remedy, 601
Diet and exercise, 601
Europhen in scrofuloderm, 179
Excision, or scraping gland, and packing with
    iodoform gauze, if other treatments fail,602
Ichthyol  ointment, useful, rubbed into persis-
    tent enlargements, prescription for, 602
Iodine ointment and lard, equal parts, rubbed
    into glands, stopping at first sign of red-
    dening or fluctuation, 602
Iron, syrup of the iodide, in anaemia,  prescrip-
    tion for, 601
Lactophosphates,  or  hypophosphates,  with
    cod-liver oil, useful in young children, 601
Phosphate of sodium or lime, if glands  are
    breaking down, 601
Sulphurate of calcium, if suppuration is active,
    601
Thiol, recommended in scrofulous  skin  dis-
    eases, 325

               SCURVY, 602

Arsenic and iron, of service in most cases,  566
Citric acid,  if lemon-juice is not obtainable,
    602
Diet, 602
Lemon- or lime-juice, particularly indicated,
    602

            SEA-SICKNESS.

Bromides, the best prophylactics, 9C
Nitrite of amyl, 58

      SEAT-WORMS.   (See Worms.)

                SHOCK, 602
Alcohol, 50
Atropine, gr. 1-60 to 1-50, hypodermically, with
    hot applications, very useful in first or
    second stage, 603
Digitalis, valuable as an adjuvant to atropine,
    604 
692           INDEX  OF  DISEASES  AND   REMEDIES.
          SKIN  DISEASES.
Arsenic, in dry, scaly types, 78
Cod-liver oil, in strumous types, 152
Copper sulphate, gr. 1-10, thrice daily, if arsenic
    is not well borne, 160
Corrosive sublimate,  oz. 34>  an(i ammonium
    chloride, oz.  1, useful, added to bath in
    syphiloderm, 235
Hydrocyanic acid,  in itching types, prescrip-
    tion for, 195
Ointment of yellow oxide and lard, in equal
    parts, a useful  application, 240
Petrolatum, as an emollient dressing, 273
Tar and suet, equal parts, locally applied ex-
    cept on face, 285
Unguentum hydrargyri ammoniati, 234
Zinc oxide ointment, 265
            SMALLPOX, 604
Aconite, with spirits  of nitre and Mindererus.
    useful as a  fever mixture, 604
Antipyrine or acetanilide, to control headache
    and backache,  604
Brandy and whiskey, if pulse fails, 604
Bromides and chloral, in insomnia; latter used
    carefully,  604
Carbolic acid and  sweet oil (1 to 100), as an
    ointment to check irritation, 605
Chlorate of potassium with tinctpre of myrrh,
    as a mouth-wash,  605
Flexible collodion, glycerite of starch or simple
    cerate, locally applied, to prevent itching,
    604
Iron, tincture of the chloride, to give strength
    and act as a specific, 604
Salicylic acid and vaseline, or cold cream (4 to
    100), best local  application, 605
Silver  nitrate, locally applied, to prevent pit-
    ting, 604
                SORDES.
Glycerin and water,  equal parts, useful as a
    mouth-wash, 186

                 SORES.
Black wash, useful  for syphilitic sores,  236
Camphor, locally applied,  as a stimulant in
    indolent sores, 108
Charcoal, applied to old sores, as a  deodorant
    and antiseptic, 119
Cold cream, as  an emollient dressing, 291
Iodoform, gr. 20, with oil of eucalyptus, oz. 34,
    or iodoform, oz. 34. camphor, gr.  75,  and
    essence  of roses,  gtt. 2, as a dressing for
    syphilitic sores, 207
Petrolatum, as an emollient dressing, 273
Potassium permanganate  (gr. 60 to the pint),
    as a wash, 272
Quercus  alba,  powdered, as a  poultice, to
    check discharge, 288
Red or  yellow oxide  of mercury, with chalk,
    equal parts, a good dressing for syphilitic
    sores, 240
Sulphuric acid, sometimes  used as an  eschar-
    otic in venereal sores, 318
Zinc oxide ointment, 265

           SORE-THROAT.
Aconite, in early  stage, 47
Alum (gr. 20 to  the  ounce), locally applied on
    swab, 57
Belladonna of greatest service in some cases,
    87
Capsicum, tincture of,  and glycerin, equal
    parts, locally applied on a swab, 114
Carbolic acid (1 to 100), in spray, in ulcerated
    types, 118
Catechu, as a gargle or in troches, 125
Copper sulphate (gr. 4 to the ounce), often of
    service in relaxed sore-throat, 160
Hydrogen peroxide  (2 per cent,  strength), in
    spray, in foetid types, 267
Kino, as a gargle, 218
Myrrh, tincture  of, diluted  one-half,  as a
    gargle, in ulcerated types, 244
Quercus alba, useful as a gargle, 288  .
Quinine  (gr. 1 to  2 to the ounce), in spray, in
    foetid sore-throat. 143
Rhus glabra, with glycerin and water, useful
    as a gargle, 291

                SPASMS.

Belladonna, useful  in  urethral,  anal,  and
    vesical spasms, 86
Cannabis indica, useful in vesical spasm, 111
Conium, useful, if due  to irritation of nerve-
    trunk, 157
Ether, inhalation, relieves local spasms, 173
Nitrite of amyl, of service to relax, 65

SPERMATORRHOEA.  (See Emissions.)

               SPRAINS.
Arnica, 76
Camphor liniment, 108
Cold applications, useful in sprained ankle,345
Hot foot-bath, prolonged for hours,  very  use-
    ful in sprained ankle, 360
Ichthyol ointment, well rubbed  in, very use-
    ful, 198
Lead-water and laudanum, 222
Soap liniment, 284
Soap plaster, used as  a support to sprained
    joints, 306
Turpentine liniment, 329

       STINGS  AND BITES, 605

Ammonia or alkaline liquids, locally applied
    to neutralize poison, 605
Carbolic acid (1 to 50  or 100), sponged over part,
    useful in mosquito-bites. 605
Corrosive sublimate, with  flexible  collodion
    (1  to 1000), painted over part; salicylic
    acid a useful addition, 605
Ligature, or cleansing of wound, at once, to
    prevent absorption in snake-bite, 605
Potassium permanganate, applied and injected
    around snake-bite, followed by alcohol in
    full dose, 605
Vinegar, dilute or pure, locally applied,  often
   •relieves insect-bites, 605

           STOMATITIS,  605

Borax, as a mouth-wash, prescription for, 606
Bromide of potassium  or sodium, gr. 1 to 3,
    thrice daily,  when nervous irritability is
    excessive,  606
Carbolic  acid, as a mouth-wash, 118
Cocaine,  locally applied, if spot is to be cauter-
    ized,  149 
INDEX  OF  DISEASES  AND  REMEDIES.          693
Nitrate of silver, stick touched to sore spots
    when they fail to yield to other treatment,
    606
Nitric acid, gtt.  3 in water, taken through
    tube, 249                             #
Nitro-muriatic  acid, indicated when hepatic
    torpor exists, 606
Peroxide of hydrogen, 606
Prescription for, 605
Salicylic acid (1 to 250), as a mouth-wash, after
    blisters have broken, to allay pain, 295
Salines or rhubarb, if constipation  exists, 606
Sozoiodol (5 per cent,  solution),  locally ap-
    plied, 309
Sweet spirit of nitre, 10 drops, well diluted, to
    a one- or two-year-old child, and a warm
    foot-bath, before retiring, to produce rest,
    606
Thymol, prescription for, 326
Tonics and careful diet after the attack, 606

                STYES, 606
Boric  acid  (saturated  solution),  collodion
    (ethereal solution), or red or yellow oxide
    of mercury salve (gr. 8 to the drachm),
    locally applied, to abort, 606
Calcium sulphurate, if they tend to return, 607
Hot compresses, to alleviate pain, 606
Incision, as soon as pus forms, 606
Tonics, if general health is poor, 606

  SUBINVOLUTION OF UTERUS.
      (See Involution, Anomalies of.)

               SUNBURN.
Almonds, in emulsion, 54

            SUNSTROKE, 607
Antipyretics, almost useless, 608
Hot baths (105° to 110°  F.),  or hot bottles or
    bricks, in heat exhaustion, 608
Ice application to chest, back, and abdomen,
    as quickly  as possible,  in thermic fever,
    607
Salicylic  acid,  quinine, and similar drugs
    contra-indicated, 60S
Tonics, during convalescence in heat exhaus-
    tion, 608
Venesection,  best treatment, if  meningitis
    threatens, after thermic fever, 608
Veratrum viride may be used if meningitis
    threatens, 608

                SYNCOPE.
Ammonia, if due to shock or indigestion, 00

               SYNOVITIS.
Carbolic acid (2 per cent, strength), as an in-
    jection in chronic types, 118
Counter-irritation, 355

              SYPHILIS, 608
Bismuth and calomel, as a dusting-powder, or
    bichloride  solution (1 to 2000), locally ap-
    plied to mucous patches about genitalia,

    611                           *
Calomel, gr. 34, every two  hours, for cephal-
    algia, 611
Cod-liver oil, useful in advanced cases, 613
Expectant plan of treatment, 609
Iodides,  followed  if necessary by mercury,
    recommended by some, 610
Iodoform, gr.  1  to 5,  internally in tertiary
    stage, and the ointment applied to ulcers,
    very useful, 207, 613
Mercury, at beginning  of secondary stage, fol-
    lowed later by the iodides, the most com-
    monly accepted treatment, 610
Mercury by fumigation, general and local, 232
Mercury, with chalk, chiefly employed in in-
    fantile syphilis, 238
Mixed treatment, 611
Ointments and  washes of mercury, and hot
    applications to combat surface eruptions,
    611
Prescription for blue mass and iron, 612
Prescription  for potassium iodide  and  mer-
    cury, to be used after first eighteen months,
    611
Pressure bandage and mercurial inunctions
    for periostitis, 611
Russian baths highly recommended, 362
Sarsaparilla,  a useful  adjunct to  potassium
    iodide, 301
Shampooing and local application of  croton
    oil or cantharides, as a lotion, to combat
    alopecia, 611
Silver nitrate, copper sulphate, chromic acid
    solution (20 per cent.), or acid nitrate of
    mercury .locally applied to mucous patches
    in mouth, 611
Stillingia, used as an aid to other drugs, 311
Thiol, in syphilides, 325
Tonic and general treatment, 613
Vapor baths, hypodermic  injections, or inunc-
    tions, useful modes of applying mercury,
    if it cannot be taken by mouth, 612

         SYSTEMIC STRAIN.
Quinine, gr. 2 to 4, useful to prevent exhaus-
    tion following physical and mental strain,
    143
Opium, useful in prolonged physical strain,
    262

 TABES  DORSALIS.   (See  Locomotor
                  Ataxia.)
 Chloralamide, 130

       TAPE-WORM.   (See Worms.)

               TEETHING.
 Bromide of potassium, to prevent convulsions,
    96

    TETANUS.  (See  Poisoning from
                Strychnine.)
 Amyl nitrite, to relieve and prevent, 65
 Chloral and bromide of potassium, by mouth
    or rectum, 128
 Fowler's solution said  to be almost specific in
    some cases, 613
 Physostigma, of moderate value, 286

           TINEA CAPITIS.
 Lime-water, locally applied, 106

          TINEA CIRCINATA.
Borax, strong solution, locally applied, 92 
694           INDEX  OF  DISEASES  AND  REMEDIES.
Iodine, applied with camel's-hair brush, 204
Turpentine, useful, applied with a brush, 329

            TINEA TARSI.
Copper, crystal, or weak solution, applied to
    diseased eyelid, 160

        TINEA TONSURANS.
Borax, strong solution, locally applied, 92
Iodine, applied with camel's-hair brush, 204
Oil of cajuput, applied pure, 103

     TOE-NAIL, INGROWING.
Absorbent cotton, soaked in strong alum solu-
    tion, and inserted under nail, 58
Liquor potassae, to soften nail prior to packing
    with cotton or partial evulsion, 226

            TONSILLITIS.
Alum stick, deeply applied, 58
Glycerin and  tincture of capsicum,  equal
    parts, applied by swab, 186
Hydrogen peroxide  (2 per cent, strength),  in
    spray, in ulcerative types, 267
Iron, tincture of the chloride, locally applied,
    212
Monsel's solution, pure, applied with camel's-
    hair brush, 214

            TOOTHACHE.
Creasote, applied oil cotton, often relieves, 161
Oil of cloves, inserted  into cavity on cotton,
    148
Oil of peppermint, applied on cotton, 270

               TORPOR.
Ammonium chloride, in hepatic torpor, 63
Euonymus, in mild hepatic torpor, 178
Lactophosphates and  hypophosphites,  useful
    in hepatic torpor, 104
Nitro-hydrochloric acid, in torpor of liver, 257
Oxygen water, after meals, useful in systemic
    torpor,  266
Potassium  acetate, exceedingly  useful in  he-
    patic torpor, 43
Russian and Turkish baths, useful in torpidity
    of skin and kidneys, 363
Taraxacum, in hepatic torpor, 322

           TORTICOLLIS.
Belladonna, injected into muscle, 86
Gelsemium, 183

         TUBERCULOSIS, 614
Acetanilide, generally acts unfavorably, 42
Almonds,  essential oil of, recommended  in
    cough,  54
Alum (gr. 10 to 20 to the ounce), or sulphuric
    acid (1 drachm to the pint), useful sponged
    over body in night-sweats, 619
Antipyrine, harmful, 72
Arsenic, in  phthisical tendencies, 78
Atropine, gr. 1-60 to 1-50,  hypodermically,  in
    excessive  night-sweats, 619
Blister, small, useful over new pleuritic spots,
    618
Camphoric acid, gr. 20 to 30, invaluable, 619
Cannabis indica, 110
Carbolic  acid  (gtt.  5 to 15 to the ounce),  in
    spray,117
Chloroform, spirit of, used by inhaler, often
    relieves cough, 618
Climatic treatment, 615
Codeine, recommended  in excessive cough,
  »142
Cod-liver oil, rules for its use, 617
Creasote, internally, in spray, or  by inhaler,
    often relieves cough and discomfort; con-
    tra-indicated if fever and haemoptysis are
    present; prescription for, 617
Glycerin and water,  equal  parts, with lemon-
    juice, useful as a mouth-wash,  186
Hydrogen peroxide (2 per  cent, strength), in
    fine spray in laryngeal phthisis, 267 '
Inhalations of steam from corrosive sublimate
    solution (1 to 10,000), stopping  at first sign
    of mercurial effects, in  laryngeal phthisis;
    precede inhalation with cocaine spray  (4
    per cent, solution), 618
Iodine,  useful,  painted over  new pleuritic
    spots, also useful  in chronic  cases as an
    inhalation, 204, 618
Iodoform with small amount of powdered talc
    and a little morphine, useful when puffed
    into the larynx in  laryngeal tuberculosis,
  '  619
Lactic acid applications (10 to 60  per cent.
    solution), in  laryngeal  tuberculosis, using
    cocaine spray first to relieve pain, 618
Lactophosphates and hypophosphites, useful
    in some cases, 104
Morphine and wild  cherry bark, in cough,
    prescription for, 618
Opium, may be given in last stage, to relieve
    pain and discomfort, 262
Oxygen, inhalations in dyspnoea, 267
Pilocarpine, gr. 1-20, one to two hours before
    sweat, sometimes arrests ; if it  or atropine
    fails alone, give them together, 619
Potassium  cyanide,  in excessive  cough,  pre-
    scription for, 164
Silver nitrate (gr.  34 t0 2 to the ounce), in
    spray, may be tried in laryngeal types, 247
Strychnine, in dyspnoea, 256
Sulphuric acid, internally,  may  relieve night-
    sweats, 619

 TYPHOID FEVER, 619.  (See Fever.)

Acetanilide, generally acts unfavorably, 42
Alcohol, useful throughout course of disease,
    621
Asafoetida, by rectal injections, in  tympanites,
    81
Brand's method of cold bathing, 623
Calomel, gr. 34, every fifteen minutes, till gr. 1
    is taken, followed by magnesium sulphate,
    34 ounce, if  constipation  lasts two days,
    622
Cold, 353, 623
Enemas, to be tried first, if constipation lasts
    over two  days, 622
Glycerin and water, equal  parts, with a little
    lemon-juice, as a mouth-wash, if sordes
    are present, 622
Hydrochloric  acid, dilute, gtt. 5, every  few
    hours,  or, if bowels are  inactive, nitro-
    hydrochloric acid, gtt.  3, 622
Lime-water added to milk, if vomiting threat-
    ens, 622 
INDEX   OF  DISEASES  AND   REMEDIES.          695
Liquorice powder,  drachm 1, if constipation
    lasts over two days, 622
Morphine in large dose, if perforation occurs,
    623
Phosphorus if nervous system is affected, 278
Prescription for diarrhoea, 622
Quinine inferior to new antipyretics, 143
Rest and diet, 621
Silver nitrate,  gr.  %  to H, highly  recom-
    mended, 247
Turpentine, in the form of stupes, enemata, or
    by  mouth, in tympanites, also useful in
    later stage, to relieve diarrhoea, heal ulcers,
    and prevent relapse, 622
  For remedies  for  complications—intestinal
haemorrhage,   pneumonia and  pleurisy—sec
their titles.
                 ULCERS.

Alcohol, a useful local application, 50
Aristol, 326
Benzoate of bismuth, as a dressing for indolent
    or sloughing ulcers, 88
Burnt alum, as a dressing for old ulcers, 58
Caustic potash, as an escharotic for exuberant
    ulcers, 125
Chimaphila, said to be  of service in strumous
    ulcers,  126
 Copper, in solid or powder form, locally ap-
    plied to indolent ulcers, 160
 Creolin,  solution (1 to 100), as  a douche  for
     nasal ulcers, 162
 Europhen, in 10 per  cent, ointment, in leg
     ulcers, 179
 Gallic acid ointment, in actively discharging
     ulcers, 181
 Hamamelis, locally applied on a cloth, relieves
     leg ulcers, 189
 Hydrogen peroxide, a useful application, 267
 Lime, as an escharotic in old ulcers, 106
 Nitric  acid, as a caustic for phagedaenic ulcers,
     or  a solution (gtt.  5 to 30 to the ounce),
     locally applied  to indolent types, 248
 Ointment of lead carbonate, as a dressing, 222
 Potassium  permanganate (gr. 60 to the pint),
     as an antiseptic wash, 272
 Precipitated  carbonate of  calcium, as a dry
     dressing, 104
 Silver nitrate, in hard pills for intestinal ulcers
     and  by  injections for rectal and caecal
     ulcers, 246
 Sulphuric  acid, sometimes used as an eschar-
     otic in slow ulcers, 318

                 UREMIA.
 Elaterium, thought to  aid elimination of poi-
     son by the bowel, 168
 Pilocarpine, the most efficient remedy, 282

        URIC ACID  DIATHESIS.

 Acetate of potassium, 44
 Lime-water, 106 ■
 Piperazine in the  dose of  15 grains a day in
     1 pint of water, 283
 Prescription  for prevention of  formation of
     calculi, 93
               URTICARIA.
 Ichthyol ointment, highly recommended, 196
         UVULA, RELAXED.
Capsicum,  tincture  of, and glycerin,  equal
    parts, as a gargle, 115
Kino, as a gargle, 218

            VARICOCELE.

Cold water, applied by bidet, highly recom-
    mended, 349

         VARICOSE VEINS.

Barium chloride,  internally and locally ap-
    plied, said to be of value, 83
Hamamelis, useful internally or injected into
    part, 189

     VITREOUS DISEASES, 624

Antisyphilitic treatment, if due to syphilis, 624
Galvanism, 624
Leeches, in early stage if due to inflammation,
    624
Pilocarpine, hypodermically, 624

            VOMITING, 624.

Bismuth and aconite  may be of service, pre-
    scription for, 626
Bromide of sodium  or potassium with  lauda-
    num, as  a rectal injection in obstinate
    cases, prescription for,  97, 695
Calomel, 238
Carbolic acid with bismuth, useful in acidity
    and fermentation,  prescription for, 626
■Chloroform, gtt. 1 to 2, in water, 626
Cloves, oil of, sometimes controls, 148
Cocaine or aconite, if due to hyper-excitability
    of stomach, 625
Enemas, partially digested, if vomiting is in-
    coercible, 627
Fowler's solution, gtt. 34 to 1. every two hours,
    useful in nausea  following debauch, also
    in  other cases, instead of  ipecac or nux
    vomica, 626
Hydrochloric acid, gtt. 5 to 15, in water, every
    two hours, in alcoholic nausea, 627
Hydrocyanic acid, dilute, gtt. 2 to 6, in water,
    195, 626
Ice-bag, to nape  of neck, lumbar region,  or
    epigastrium, 627
Ipecac, in small doses, if due to gastric depres-
    sion, 626
Lime-water, added to milk, may relieve nau-
    sea, 627
Mustard plaster over stomach, useful in all
    cases, 627
 Nux vomica, if due to gastric depression, pre-
    scription for, 626
 Oxygen water, of great service, 266
 Peptonized milk, best food, 627
 Podophyllin, useful in gastric depression and
    hepatic torpor, 285
 Seidlitz powder, often settles stomach, if due to
    constipation,  303

   VOMITING OF  PREGNANCY.

 Aconite, as a nervous sedative, 47
 Arsenic, may be tried, 79
 Bromide of  potassium,   as  an  effervescing
    draught,  or with opium by enema, pre-
    scriptions for, 97 
ES  AND  REMEDIES.
696          INDEX  OF  diseas:


Cerium oxalate, gr. 2 to 5 in pill, every four or
    five hours, 126
Cocaine, useful to decrease irritability, 150
Iodine, tincture of, largely used of late with
    good results, 206
Ipecac wine, gtt. 1, or powder, gr. 2, useful  in
    some cases, 209
Menthol, very useful, 271

                WARTS.
Acetic and salicylic acids combined, 44
Chromic acid (gr.-100 to the ounce), locally ap-
    plied, to remove, 139
Fowler's solution, locally applied, 79
Glacial acetic acid, useful to remove, 44
Nitric acid, as a caustic, 249

        WHITE SWELLING.
Iodine, 204

      WHOOPING-COUGH, 627
Aconite or veratrum  viride,  if  vascular en-
    gorgement is excessive,  627
Amber, oil of, 58
Amyl nitrite, when paroxysms interfere with
    respiration, 628
Antipyrine, gr. 34 to 3, every five hours, prob-
    ably the best remedy,  627
Belladonna, tincture of, gtt. 34. thrice daily,  to
    child of one or two years, 627
Benzine, 628
Cannabis indica, sometimes of service, 111
Carburetted hydrogen, 627
Chloral, 129
Chloride of gold and sodium has been recom-
    mended, 187
Chloroform,  a few whiffs if paroxysms inter-
    fere with respiration, 628
Gelsemium,  183
Hyoscyamus, probably better than belladonna,
    196
Milk, in small amounts, may overcome vomit-
    ing following paroxysms, 628
Monobromated camphor, 109
Prescription for, 266
Quinine (gr. 1 to the  ounce), in  spray useful,
    also of service in exposed children as a
    prophylactic, 143
Resorcin, gtt. 10 of a  2 per cent, solution in-
    ternally, or, better, in spray, 289
Silver nitrate (gr. 34 to 1 to the ounce), in spray,
    used when stomach is empty, 247

              WORMS, 628
Aspidium, very efficient against tape-worm,
    prescription for, 82, 629
Azedarach, a  useful  remedy  against  round-
    worms, 82
Brayera,  as  an  infusion,  or  fluid extract,
    against round-worms, 629
Calomel, should follow or  precede  all drugs
    used for tape-worm, 629
Castor oil, or a saline purgative, should  follow
    remedies for round worms, 629
Chenopodium, oil of, gtt. 5  to 20, on sugar, to
    remove round-worms, 629
Chloroform, should not be  used against tape-
    worm, 138
Kamala, drachms 1 to 2, in syrup, against tape-
    worm, 218
Koosin, gr. 40  to adult, against round-worms,
    contra-indicated in pregnant women, 629
Pelletierine, gr. 1 to 2, in capsule, best remedy
    against tape-worm, 629
Pepo, oz. 2, in confection, against tape-worm,
    629
Quassia injections, preceded by soap and water,
    most useful  remedy  against seat-worms,
    288
Rue, should not be used against round-worms,
    292
Rules for diet,  preceding taeniacides, 628
Salicylic acid, gr. 8, hourly till gr. 40 are  taken,
    against round-worms,  or as an injection
    against seat-worms, prescription for, 295
Santonin, gr. 34 to 34. in troches, for  child,
    against round-worms, 629
Spigelia, alone, or better, with senna, to re-
    move round-worms, 628
Turpentine and castor oil, equal parts, efficient
    but  somewhat dangerous,  against tape-
    worm, 329

               WOUNDS.
Collodion, as an  air-tight dressing  for small
    wounds, 155
Potassium permanganate (gr. 20 to  60  to  the
    pint), as an antiseptic wash, 272
Sozoiodol, as an antiseptic and disinfectant in
    diseased wounds, 309 
CO
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WASHINGTON MATTHEWS, M. D.,
C. S. MINOT, M.D.
H. C. YARROW, M. D.,
In two very handsome royal octavo  volumes containing  1574 pages,
                          with two colored plates.

Per Volume—Cloth, $6;  JLeather, $7; Half Morocco, Marbled Edges, $8.50.  For Sale
    by Subscription, only.  Specimen payes on application.  Address the Publishers.
  Its scope is one which will at once satisfy the
student and meet all the requirements of the med-
ical practitioner.  Clear and comprehensive defi-
nitions of words should form the prime feature of
any dictionary, and in this one  the chief aim
Beems to be to give the exact signification and the
different meanings of terms in use  in medicine
and the collateral sciences in language as terse as
is compatible with lucidity.  The work is remark-
able, too, for its fulness. The enumerations and
subdivisions under each word-heading are strik-
ingly complete, as regards alike the English tongue
and the languages chiefly employed by ancient
and modern science. It is impossible todo justice
to the dictionary by any casual illustration.  It
presents  to the  English  reader a thoroughly
scientific mode of acquiring a rich vocabulary and
offers an accurate and ready means of reference in
consulting works in any of the  three modern
continental languages which are richest in med-
ical literature.  To add to its usefulness as a work
of reference  some  valuable  tables are  given.
Another feature of the work is the accuracy of its
definitions, all of which have been checked by
comparison with many other  standard works in
the different languages it deals with.  Apart from
the boundless stores of information which may be
gained by the study of a good dictionary, one is
enabled by the work under notice to read intelli-
gently any technical  treatise in any of the four
chief modern languages.  There cannot be two
opinions as to the great value and usefulness of
this dictionary as a book of ready reference for all
sorts  and  conditions  of medical men. So far as
we have been able to see, no  subject has been
omitted, and in respect of completeness it will be
found distinctly superior to any medical lexicon
yet published.—The London Lancet, April 5,1890.
HABTSHOBNE, HENBY, A. M.9  M. X>., LL. D.,
      Lately Professor of Hygiene in the University of Pennsylvania.

    A Conspectus of the Medical Sciences; Containing Handbooks on Anatomy.
Physiology, Chemistry, Materia Medica,  Practice of  Medicine, Surgery and Obstetrics,
Second edition, thoroughly revised  and greatly improved.  In one  large royal 12mo.
volume of 1028 pages, with 477 illustrations.  Cloth, $4.25; leather, $5.00.
LUDLOW,  J. L., 31. !>.,
      Consulting Physician to the Philadelphia Hospital, etc.

    A Manual Of Examinations upon Anatomy, Physiology, Surgery, Practice of
Medicine, Obstetrics, Materia Medica, Chemistry, Pharmacy and Therapeutics.  To which
is added a Medical Formulary. Third edition, thoroughly revised, and greatly enlarged.  In
one 12mo. volume of 816 pages, with 370 illustrations.  Cloth, $3.25;  leather, $3.75.
    The arrangement of this volume in the form of question and  answer renders it espe-
cially suitable for the office examination of students, and for those preparing for graduation.
HOBLYN, BICEZABD !>., M. D.
    A Dictionary of  the Terms  Used in Medicine  and the  Collateral
Sciences.   Kevised, with numerous additions, by Isaac Hays, M. D., late editor of
The American Journal of the Medical Sciences.  In one large royal 12mo. volume of 520
double-columned pages.  Cloth, $1.50; leather, $2.00.
  It is the best book of definitions we have, and ought always to be upon the student's table.—Southern
Medical and Surgical Journal. 
Lea Brothers & Co.'s Publications—Anatomy, Dictionary.     5
GBAY, HENBY,  F. B. S.,
       Lecturer on Anatomy at St. George's Hospital, London.

    A^a£omy,  Descriptive  and Surgical.  Edited  by  T. Pickering Pick,
b. K.  C. S., Surgeon to and  Lecturer on Anatomy  at St.  George's Hospital, London,
Examiner  in  Anatomy, Eoyal College of  Surgeons of  England.  A new American from
the eleventh  enlarged  and improved London edition, thoroughly revised and re-edited
?£ " i^liam W. Keen, M. D., Professor of Surgery in the Jefferson Medical  College of
Philadelphia.  To which is added the second American from the latest English edition of
Landmarks,  Medical and Surgical, by Luther Holden, F. K. C. S.  In one imperial
octavo volume of 1098 pages, with 685 large and elaborate  engravings on wood.  Price of
edition in  black:  Cloth, $6; leather, $7; half Russia,  $7.50.  Price of edition in colors
(see below): Cloth, $7.25; leather, $8.25;  half Russia,  $8.75.
    This work covers a more extended range of subjects than is customary in the ordinary
text-books, giving not only the details necessary for the student, but also the application of
those details to the practice of medicine and surgery.   It thus forms both a guide for the
learner and_ an admirable work of reference  for the active  practitioner.   The engravings
form a special  feature in the work, many  of them being the  size of nature, nearly all
original, and having the names  of the various parts printed on  the  body of  the cut, in
place of figures of reference with descriptions  at the foot. In  this edition a new departure
has been taken by the issue of the work with the arteries, veins and nerves distinguished
by different colors.   The engravings thus form a complete and splendid series, which will
greatly assist the student in forming a clear idea of Anatomy,  and will also serve to refresh
the memory of those who may find in the exigencies of practice  the necessity of recall-
ing the details of the  dissecting-room.   Combining,  as it  does,  a complete Atlas of
Anatomy with a  thorough treatise on  systematic, descriptive and applied  Anatomy,
the work will be  found of great service to all physicians who receive students in their
offices, relieving both preceptor and pupil of much labor in laying the groundwork of a
thorough medical education.
    For the convenience of those who prefer not to pay the slight increase in cost necessi-
tated by the use of  colors, the volume is  published also in  black alone, and maintained
in this style at the price of former  editions, notwithstanding its largely increased size.
    Landmarks, Medical and Surgical, by the distinguished Anatomist, Mr. Luther Holden,
has been appended to the present edition as  it was to the previous one.   This work gives
in a clear, condensed and systematic way all the information by which the practitioner  can
determine  from the external surface of the body  the  position of internal  parts. Thus
complete, the  work  will  furnish all the assistance that can be rendered by  type  and
illustration in anatomical study.
  The most popular work on anatomy ever written.
It is sufficient to say of it that this edition, thanks
to its American editor, surpasses all other edi-
tions —Jour, of the Amer. Med. Ass'n, Dec. 31,1887.
  A work which for more than twenty years has
had the lead of all other text-books on anatomy
throughout the civilized world comes to hand in
such beauty of execution and accuracy of text
and illustration as  more than to make good the
large promise of the prospectus.  It would be in-
deed difficult to name a feature wherein the pres-
ent American edition of Gray could be mended
or bettered, and it needs no prophet to see that
the royal work is destined for many years to come
to hold the first place among anatomical text-
books.  The work is published with black and
colored plates.  It is a marvel of book-making.—
American Practitioner and News, Jan. 21,1888.
  Gray's Anatomy is  the most magnificent work
upon anatomy which has ever been published in
the English or any other language.—Cincinnati
Medical News, Nov. 1887.
  As the book now goes to the purchaser he is re-
ceiving the best work on anatomy that is published
in any language.— Virginia Med. Monthly, Dec. 1887.
  Gray's standard  Anatomy has been  and will be
for years the text-book for students.  The book
needs only to be examined to be perfectly under-
stood.—Medical Press of Western New York, Jan.
1888.
       Also for sale separate—

HOLDEN, LUTHEB, F. B. C. S.,
       Surgeon to St. Bartholomew's and the Foundling Hospitals, London.
     Landmarks, Medical and Surgical.  Second American from the latest revised
English edition, with additions by W. W. Keen, M. D., Professor of Artistic Anatomy in
the Penna. Academy of Fine Arts.  In one 12mo. volume of 148 pages.   Cloth, $1.00.


DUNGLISON, BOBLEY, M.D.,
       Late Professor of Institutes of Medicine in the Jefferson Medical College of Philadelphia.
     MEDICAL LEXICON; A Dictionary of Medical Science: Containing
a concise Explanation of the various Subjects and Terms of Anatomy, Physiology, Pathol-
ogy, Hygiene, Therapeutics, Pharmacology, Pharmacy, Surgery, Obstetrics, Medical Juris-
prudence and Dentistry, Notices of Climate and of Mineral Waters, Formulae for Officinal,
Empirical and Dietetic Preparations. With the Accentuation and Etymology of the Terms,
and  the French and other Synonymes, so as to constitute a French as well as an English
Medical Lexicon.  Edited by Kichard J.  Dunglison, M. D.   In one very large and
handsome royal octavo volume of  1139 pages.  Cloth, $6.50; leather, raised bands, $7.50;
very handsome half Russia, raised bands, $8.00.
   It has the  rare merit that it certainly  has  no rival in the English language for accuracy
---1 .rtont nf references.—London Medical Gazette. 
6              Lea  Brothers & Co.'s  Publications—Anatomy.
ALLEN,  HABBISON,  M. D.,
       Professor of Physiology in the University of Pennsylvania.
    A System of Human Anatomy, Including Its Medical and Surgical
Relations.  For  the use of Practitioners and Students of Medicine.  With an intro-
ductory  Section  on Histology.  By E.  O. Shakespeare,  M.  D.,  Ophthalmologist to
the Philadelphia Hospital.   Comprising 813  double-columned  quarto pages, with  380
illustrations on 109 full page lithographic plates, many of  which are  in colors, and  241
engravings  in the text.  In six  Sections,  each in a portfolio.  Price per Section, $3.50;
also bound  in one  volume, cloth, $23.00;  very handsome half Russia, raised bands  and
open  back,  $25.00.   For sale by subscription only.  Apply to the Publishers.
 It is to be considered a study of applied anatomy
iD  its widest sense—a systematic presentation of
such anatomical facts as can be applied to the
practice of medicine as well as of surgery.  Our
author  is  concise, accurate and practical in his
statements, and  succeeds admirably in infusing
an interest into the study of what is generally con-
sidered a dry subject.  The department of Histol-
ogy is  treated in a  masterly manner,  and the
ground is travelled over by one thoroughly famil-
iar with it.  The illustrations are made with great
care, and are simply superb. There Is as much
of practical application of anatomical points to
the every-day wants  of the medical clinician as
to those of the operating surgeon.  In fact, few
general practitioners will read the work without a
feeling of surprised gratification that so many
points, concerning which they may never have
thought before are so well presented for their con-
sideration. It is a work which is destined to be
the best of its kind in any language.—Medical
Record, Nov. 25,1882.
CLABKE, W. B., F.B.C.S. & LOCKWOOD,C. B., F.B.C.S.
       Demonstrators of Anatomy at St. Bartholomew's Hospital Medical School, London.
    The Dissector's Manual.  In one pocket-size 12mo. volume of 396  pages, with
49 illustrations.  Limp cloth, red edges, $1.50.  See Students' Series of Manuals, page 30.
  Messrs.Clarke and Lockwood have written a book
that can hardly be rivalled as a practical aid to the
dissector.  Their purpose,which is "how to de-
scribe the best way to display the anatomical
structure," has been fully attained. They excel in
a lucidity of demonstration and graphic terseness
of expression,  which only a long training and
intimate association with  students could have
 fiven.  With such a guide as this, accompanied
 y so attractive a commentary as Treves' Surgical
Applied Anatomy (same series), no student could
fail to be deeply and absorbingly interested in the
study of anatomy.—New Orleans Medical and Sur-
gical Journal, April, 1884.
HIBST, BABTONC, M.D., & BIEBSOL,  GEO. A., M.D.
     Professor of Obstetrics in the University            Professor of Anatomy and Embryology in
              of Pennsylvania.                          the University of Pennsylvania.
    Human Monstrosities.  Magnificent folio, containing about 150 pages of text,
illustrated with engravings, and 39 full-page,  photographic plates from  nature.  In  four
parts, price, each, $5.  Parts I. and II. just ready. Part III. shortly.  Limited edition, for
sale by subscription only.  Address the Publishers.
  This, the second part of what bids fair to be the
best teratological treatise extant, is fully up to the
previous volume  in point of excellence. The
plates are superbly executed and the illustrations
have been made with the specimens in the most
advantageous positions  for purposes of study.—
The Journal of the American Medical Association,
March 5,1892.
  We have already referred at length to the salient
points of this beautiful work, the second volume
of which, containing the description of monstrosi-
ties, is even more attractive than the first.  There
are more plates and less space devoted  to the
text   We can only repeat that the work is one
which reflects  great credit upon American ob-
stetric literature, and  deserves a place  in the
library of every specialist and student of anatomy.
—Medical Record, May 21,1892.
TBEVES, FBEDEBICK, F. B. C.  S.,
      Senior Demonstrator of Anatomy and Assistant Surgeon at the London Hospital.
    Surgical Applied Anatomy.  In one pocket-size 12mo. volume of 540 pages,
with 61 illustrations. Limp cloth, red edges, $2.00.   See Students' Series of Manuals, p. 30.

BELLAMY,  EDWABD, F. B. C. S.,
      Senior Assistant-Surgeon to the Charing-Cross Hospital, London.
    The Student's  Guide to Surgical Anatomy: Being a Description of the
most Important Surgical Regions of the Human Body, and intended as an Introduction to
Operative Surgery.  In one 12mo. volume of 300 pages, with 50 illustrations.  Cloth, $2.25.

WILSON, EBASMUS, F. B.  S.
    A  System  of  Human Anatomy, General  and  Special.   Edited by  W. H.
Gobrecht, M. D., Professor of General and Surgical Anatomy in the Medical College of
Ohio.  In  one large and handsome octavo volume of  616  pages, with 397 illustrations.
Cloth, $4.00; leather, $5.00._________________________

CLELAND,  JOHN, M. D., F. B. S.,
      Professor of Anatomy and Physiology in Queen's College, Galway.
    A  Directory for the Dissection  of the Human Body.  In one 12mo.
volume of 178 pages.  Cloth, $1.25.
HARTSHORNE'S HANDBOOK  OF ANATOMY
  AND PHYSIOLOGY.  Second edition, revised.
  In one royal 12mo. volume of 310 pages, with 220
  woodcuts. Cloth, $1.75.
HORNER'S SPECIAL ANATOMY AND HISTOL
  0GY;* Eighth edition, extensively revised and
  modified.  In two octavo volumes of 1007 MM.
  with 320 woodcuts. Cloth, $6.00.         '  S 8» 
Lea Brothers & Co.'s Publications—Phys., Physiol., Anat,  Chem.   7
DBAFEB,  JOHN  C, M.  D.,  LL.  D.,
       Professor of Chemistry in the University of the City of New York.

     Medical  Physics.  A Text-book for Students and Practitioners of Medicine,
one octavo volume of 734 pages, with 376 woodcuts, mostly original.  Cloth, $4.
  While all enlightened physicians will agree that
a knowledge of physics is desirable  for the medi-
cal student,  only those actually engaged in the
teaching of  the  primary subjects  can be  fully
aware of the difficulties encountered by students
who  attempt the  study of these subjects without
a knowledge of either  physics or  chemistry.
These are especially felt by the teacher of physi-
ology.
  It  is, however,  impossible for him to impart a
knowledge of the main facts of his subject and
establish them by reasons and experimental dem-
onstration, and at the same time  undertake  to
teach ab initio the principles of chemistry or phys-
ics.  Hence  the  desirability,  we  may say the
necessity, for some such work as the present one.
In
  No man in America was better fitted than Dr.
Draper for the task he undertook, and he has pro-
vided the student and practitioner of medicine
with a volume at once readable  and thorough.
Even to the student who has some knowledge of
physics this book is  useful, as it shows him its
applications to the profession that he has chosen.
Dr. Draper, as an old teacher, knew well the diffi-
culties to be encountered in bringing his subject
within the grasp of the average student, and that
he has succeeded so well proves  once more that
the  man to write for and examine students is the
one who has taught and is teaching them.  The
book is well printed and fully illustrated, and in
every way  deserves grateful recognition.—The
Montreal Medical Journal, July, 1890.
FOWEB,  HENBY, M. B.,  F. B.  C.  S.,
       Examiner in Physiology, Royal College of Surgeons of England.
     Human Physiology.  Second edition.  In one handsome pocket-size 12mo. vol-
ume of 509 pp., with 68 illustrations.  Cloth, $1.50.  See Students' Series of Manuals, p. 30.

BOBEBTSON, J.  McGBEGOB,  31. A., M. B.,
       Muirhead Demonstrator of Physiology, University of Glasgow.
     Physiological Physics.  In one 12mo. volume of 537 pages, with 219 illustra-
tions.   Limp cloth, $2.00.  See Students' Series of Manuals,  page 30.
                                            ments.  It will  be found of great value to  the
  The title of this work  sufficiently explains the
nature of its contents. It is designed as a man-
ual for the student of medicine, an auxiliary to
his text-book in physiology, and it would be particu-
larly useful as a guide to his laboratory experi-
practitioner.  It is a carefully prepared book of
reference, concise and accurate, and as such we
heartily recommend it.—Journal of the American
Medical Association, Dec. 6.1884.
DALTON,  JOHN  C,  M. D.,
       Professor Emeritus of Physiology in the College of Physicians and Surgeons, New York.
     Doctrines of the  Circulation of the  Blood.   A History of Physiological
Opinion and Discovery in  regard to the Circulation of the Blood.   In one handsome
12mo.  volume of 293 pages.  Cloth, $2.
  Dr. Dal ton's work is the fruit of the deep research
of a cultured mind, and to the busy practitioner it
cannot fail to be a source of instruction.  It will
inspire him with a feeling of gratitude and admir-
ation for those plodding workers of olden times,
who laid the foundation of the magnificent temple
of medical science as it now stands.—New Orleans
Medical and Surgical Journal, Aug. 1885.
  In the progress of physiological study no fact
was of greater  moment, none more completely
revolutionized the theories of teachers, than tha
discovery of the  circulation  of the blood.  This
explains the extraordinary interest it has  to all
medical historians.  The volume before us is one
of three or four which have been written within a
few years by American physicians.  It is in several
respects the most complete.  The volume, though
small in size, is one of the most creditable con-
tributions from an American pen to medical history
that has appeared.—Med. <fc Surg. Rep., Dec. 6,1884.
BELL, F. JEFFBEY, M. A.,
       Professor of Comparative Anatomy at King's Colleqe, London.
     Comparative Anatomy and Physiology.  In one 12mo. volume of 561 pages,
with 229 illustrations. Limp cloth, $2.00.  See Students' Series of Manuals, page 30.
  The manual is preeminently a student's book—  it the best  work  in existence  in  the  English
clear and  simple in  language and arrangement,  language to place in the hands of the  medical
It is well and abundantly illustrated, and is read-  student.—Bristol Medico-Chirurgical Journal, Mar.
able and interesting.  On the whole we consider  1886.
ELLIS, GEOBGE VINEB,
       Emeritus Professor of Anatomy in University College, London.
     Demonstrations  of  Anatomy.    Being a Guide to the  Knowledge  of  the
Human  Body by Dissection.   From the eighth and revised London edition.  In one very
handsome octavo volume of 716 pages, with 249 illustrations.  Cloth, $4.25; leather, $5.25.


BOBEBTS,  JOHN B.,  A. M., M. D.,
       Lecturer in Anatomy in the University of Pennsylvania.
     The Compend of  Anatomy.  For use in the dissecting-room and in preparing
for examinations.  In one  16mo.  volume of 196 pages.   Limp cloth, 75 cents.

     Wohler's Outlines of Organic Chemistry.  Edited by Fittig.  Translated
by Ira Remsen, M. D., Ph. D.  In one 12mo. volume of 550 pages.  Cloth, $3.

LEHM ANN'S MANUAL OF CHEMICAL PHYS- I CARPENTER'S PRIZE ESSAY ON THE USE AND
  IOLOGY.  In one octavo volume of 327 pages,
  with 41 illustrations.  Cloth, $2.25.
CARPENTER'S HUMAN PHYSIOLOGY.  Edited
  by Henry Powee.  In one octavo volume.
Abuse of Alcoholic Liquors in Health and Disj.
ease. With explanations of scientific words. Small
12mo.  178 pages.  Cloth, 60 cents. 
8     Lea  Brothers  &  Co.'s Publications—Physiology, Chemistry.
CHAPMAN, HENBY C,  M. D.,
       Professor of Institutes of Medicine and Medical Juris, in the Jefferson Med. Coll. of Philadelphia.
    A Treatise on  Human Physiology.   In  one handsome octavo volume  of
925 pages, with 605 fine engravings.   Cloth, $5.50; leather, $6.50.
  It represents  very fully  the  existing state of
physiology.  The present work has a special value
to the student and practitioner  as devoted more
to the practical  application of well-known truths
which the advance of science  has given to the
profession in this department, which may be con-
sidered the foundation of rational medicine.—Buf-
falo Medical and Surgical Journal, Dec. 1887.
  Matters which have a practical bearing on the
practice of medicine are lucidly  expressed; tech-
nical matters are given  in minute  detail; elabo-
rate directions are stated for the guidance of stu-
dents in the laboratory.  In every respect the
work fulfils  its  promise, whether as a  complete
treatise for the student or for the  physician ; for
the former it is so  complete that he need look no
farther, and the latter will find entertainment and
instruction in an admirable book of reference.—
North Carolina Medical Journal, Nov. 1887.
  The work certainly commends itself  to  both
student and practitioner. What is most demanded
by the progressive physician of to-day is an adap-
tation of physiology to practical therapeutics, and
this work is a decided improvement in this respect
over other works in the  market.  It will certainly
take place among the most valuable text-books.—
Medical Age, Nov. 25,1887.
  It is the production of an author delighted with
his work, and able  to inspire students with an en-
thusiasm akin to his  own.—American Practitioner
and News, Nov. 12,1887.
DALTON,  JOHN C, M.  D.,
       Professor of Physiology in the College of Physicians and Surgeons, New York, etc.
    A Treatise on  Human Physiology.   Designed for the use of Students and
Practitioners of Medicine.   Seventh edition, thoroughly revised and rewritten.   In one
very handsome octavo volume of 722 pages, with 252 beautiful engravings on wood.  Cloth,
$5.00; leather,  $6.00.
  From the first appearance of the book it has
been a favorite,  owing as well to the author's
renown as an oral teacher as to  the charm  of
simplicity with  which, as a  writer,  he  always
succeeds  in  investing  even  intricate subjects.
It must be gratifying to  him to observe the fre-
quency with which his work, written for students
and practitioners, is  quoted by other writers on
physiology.  This fact attests its  value, and,  in
great measure, its originality. It now needs no
such seal of approbation, however, for lhe thou-
sands who have studied it in its various editions
have never been in any doubt as to its sterling
worth.—N. Y. Medical Journal, Oct. 1882.
  Professor Dalton's well-known and deservedly-
appreciated work has long passed the stage at
which it could  be reviewed in the  ordinary sense.
The work is eminently one for  the medical prac-
titioner, since it treats mostfully of those branches
of physiology which have a direct  bearing on the
diagnosis and treatment of disease. The work is-
one which we can highly  recommend to  all our
readers.—Dublin Journal of Medical  Science, Feb.'83.
FOSTEB,  MICHAEL,  M. D., F.  B.  S.,
       Prelector in Physiology and Fellow of Trinity College, Cambridge, England.
     Text-Book of Physiology.   New (fourth) and  enlarged American from the
fifth and revised English edition, with notes and additions.  In one  handsome octavo vol-
ume of 1072 pages, with 282 illustrations.  Cloth, $4.50; leather, $5.50.
  The appearance of another edition of  Foster's
Physiology again reminds us of the continued
popularity of this most excellent work.  There
can be no doubt that this text-book not only con-
tinues to lead all others in the English language,
but that this last edition is superior to its prede-
cessors. It is evident that the author has devoted
a considerable amount of time and labor to its
preparation, nearly every page bearing evidences
of careful revision.  Although the work of the
American editor in former editions has been by
the author largely adopted in a modified form in
this revision, much was still left to be done by the
editor to render the work fully adapted to the wants
of our American students, so that the American
edition will undoubtedly continue to supply the
market on this side of the  Atlantic.  The work
has been published in the characteristic creditable
style of the Lea's, and owing to its enormous sale,
is offered at an extremely low price.—The Medical
and Surgical Reporter, Jan. 9,  1892.
SIMON,  W.,  Fh. D., M.  D.,
       Professor of Chemistry and Toxicology in the College of Physicians and Surgeons, Baltimore, and
       Professor of Chemistry in the Maryland College of Pharmacy.
     Manual of Chemistry. A Guide to Lectures and Laboratory work for Beginner*
in Chemistry.   A Text-book, specially adapted  for  Students of Pharmacy and Medicine.
New (third) edition.  In one 8vo. volume of 477 pages, with 44 woodcuts and 7 colored
plates  illustrating 56 of the most important chemical tests.  Cloth, $3.25.
                                             nothing to be desired. As a student's manual this
  Among the many works on chemistry offered
for the use of the medical student, there is prob-
ably none that outrivals Dr. Simon's work in prac-
tical arrangement and thoroughness. A special
feature of the book, and one that deserves the
greatest praise, is  the presence therein of the
beautiful  colored plates  representing  fifty-six
chemical reactions.  To say that they are splen-
didly  and  artistically executed hardly does them
justice.  They must convey to the mind of the
student lasting impressions of the color changes
that he has noted in his experiments in the labor-
atory, and the perusal of this work  must recall
them  vividly to recognition. The many  cuts are
well selected, and the make-up of the book leaves
work is of the highest order.— The Medical News,
February 20,1892.
  While possessing all the usual qualities of an
excellent text-book for the student or laboratory,
this "Manual" presents the unique advantage of
furnishing plates showing the variously shaded
colors of certain chemicals, etc., and their  re-
actions. The chapter on Urinalysis is excellent.
This "Chemhtry" is especially valuable to medi-
cal  students  and  practitioners,  as devoting so
much of detail to  descriptions of analyses, tests
etc., of those things with which the doctor has
mostly to deal.— Virginia  Medical Monthly  Jan-
uary, 1892.                             "'
CLOWES, FBANK,  D.  Sc, London,
       Senior Science-Master at the High School, Newcastle-under-Lyme, etc.
    An  Elementary  Treatise  on Practical  Chemistry and Qualitative
Inorganic Analysis.  Specially adapted  for use in the Laboratories of Schools  and
Colleges and by Beginners.   Third American from the fourth and revised English edition
In one 12mo. volume  of 387  pages,  with 55 illustrations.   f!lr>th  *9Sft 
Lea Brothers  &  Co.'s Publications—Chemistry.            9
FBANKLAND,E.,D. C.L.,F.B.S.,&JAPP, F.B.,F.I. C.,
Professor of Chemistry in the Normal School
          of Science, London.
Assist. Prof, of Chemistry in the Normal
     School of Science, London.
    Inorganic Chemistry.  In one handsome octavo  volume of 677 pages with 51
woodcuts and 2 plates.   Cloth, $3.75 ; leather, $4.75.
  This work should supersede other works of its  chemical knowledge is  behind the times, would
class in the medical colleges.  Itis certainly better  do well to study this work.  The descriptions and
adapted than any work upon chemistry.with which  demonstrations are made so plain that there is
we are acquainted, to impart that clear and full  no difficulty in understanding them.—Cincinnati
knowledge of the science which students of med-  Medical News, January, 1886.
icine should have. Physicians who feel that their
FOWNES, GEOBGE,  Fix. D.

    A  Manual  of Elementary Chemistry;  Theoretical and Practical.   Em-
bodying Watts' Physical and Inorganic Chemistry. New American, from the twelfth English
edition.  In one large royal 12mo.  volume of 1061 pages, with 168 illustrations on wood
and  a colored plate.  Cloth, $2.75; leather, $3.25.
                                            work  as one of the very best text-books   upon
                                            chemistry extant.—Cincinnati Med. News, Oct. '85.
                                              Of all the works on chemistry intended for the
  Fownes' Chemistry  has  been a standard text-
book upon chemistry for many years. Its merits
are very fully known by chemists and physicians
everywhere in this country and in England.  As
the science has advanced by the making of new
discoveries, the work has been revised so as to
keep it abreast of the times.  It has steadily
maintained its position as a  text-book with medi-
cal students. In this work are treated fully: Heat,
Light and Electricity, includin g Magnetism. The
influence exerted by these forces in chemical
action upon health and disease, etc., is of the most
important kind, and  should be familiar to every
medical  practitioner.  We  can  commend  the
use of medical  students, Fownes' Chemistry  is
perhaps the most widely used.  Its popularity is
based upon its excellence.  This last edition con-
tains all of  the  material found in the previous,
and it is also enriched by the addition of Watts
Physical and Inorganic Chemistry.  All of the mat-
ter is brought to the present standpoint of chemi-
cal knowledge.  We may safely predict for this
work a continuance of the fame and favor it enjoys
among medical  students.—New Orleans Medical
and Surgical Journal, March, 1886.
ATTFIELD, JOHN, M.  A., Ph. D., F.  I. C, F. B. S., Etc.
       Professor of Practical Chemistry to the Pharmaceutical Society of Great Britain, etc.
    Chemistry,  General, Medical and Pharmaceutical; Including the Chem-
istry of the  U. S.  Pharmacopoeia.  A Manual of the General Principles of the Science,
and their Application to Medicine and Pharmacy.  A new American, from the twelfth
English  edition, specially revised  by the Author for America.  In one handsome royal
12mo.  volume of 782 pages, with 88 illustrations.  Cloth, $2.75; leather, $3.25.
  Attfield's Chemistry is  the most popular book
among  students of medicine and pharmacy. This
popularity has a good, substantial basis.  It rests
upon real merits. Attfield's work combines in the
happiest manner a clear exposition of the theory
of chemistry with the practical application of this
knowledge to the  everyday dealings of the phy-
sician and pharmacist. His discernment is shown
not only in what he puts into his work, but also in
what he leaves out.   His book is precisely what
the title claims for it.  The admirable arrangement
of the text enables a reader to get a good idea of
chemistry without the aid of experiments, and
again it is a good laboratory guide, and finally it
contains such a mass of well-arranged information
that it will always serve as a handy book of refer-
ence.   He does not allow any unutilizable knowl-
edge to  slip into his book;  his long years  of
experience have produced a work which is both
scientific and  practical, and  which  shuts out
everything  in the  nature of a superfluity, and
therein lies the  secret of its success.   This last
edition shows the marks of  the latest progress
made in chemistry and chemical teaching.—New
Orleans Medical and Surgical Journal, Nov. 1889.
BLOXAM, CHABLES L.,
       Professor of Chemistry in King's College, London.
     Chemistry, Inorganic  and  Organic.   New American  from the fifth Lon-
don  edition,  thoroughly  revised  and  much improved.  In  one very  handsome octavo
volume of 727 pages, with 292 illustrations.  Cloth, $2.00;  leather, $3.00
  Comment from us on this standard work is al-
most superfluous.  It differs widely in scope and
aim from that of Attfield, and in its way is equally
beyond criticism.  It adopts the most direct meth-
ods in stating the principles, hypotheses and facts
of the science.  Its language is so terse and lucid,
and its arrangement of matter so logical  in se-
quence that  the student never has occasion to
complain that chemistry is a hard study. Much
attention is paid to experimental illustrations of
chemical principles  and phenomena,  and  the
mode of conducting these experiments. The book
maintains theposition it has always held as one of
the best manuals of general chemistry tn the Eng-
lish language.—Detroit Lancet, Feb. 1884.
LUFF, ABTHUB  P., M.D., B.Sc,
         Lecturer on Medical Jurisprudence and Toxicological Chemistry, St. Mary's Hospital Medical
            School, London.
     A Manual of Chemistry.   For the use of students of medicine.  In one 12mo.
vol. of 522 pp., with 36 engravings.  Cloth, $2.00.  See Students' Series of Manuals, p. 30.


GBEENE,  WILLIAM  H,  M.  D.,
       Demonstrator of Chemistry in the Medical Department of the University of Pennsylvania.
     A Manual of Medical Chemistry.  For the use of Students.  Based upon Bow-
man's  Medical Chemistry.  In one 12mo. volume of 310 pages, with 74 illus.  Cloth, $1.75.
  It is a concise manual of three hundred pages,  the recognition of compounds due to pathologlca.
  It is a co^f.® ™B""*1 "'  o{ the begt methods  conditions.  The  detection of poisons is treated
^^«i^2Haul^«^Sdso«h?^both  with sufficient fulness for the purpose of the stu-
foVtht!yes«maU?onqof^L*r normal constituenI and  dentor pnctitioner.-2to.fon JL of Chem. June '80. 
10           Lea  Brothers &  Co.'s Publications—Chem., Pharm.
VAVGHAN,  VICTOB C.,Ph.D., M.D.,
      Prof, of Phys. and Path. Chem. and Assoc. Prof, of Therap. and Mat. Med. in the Univ. of Mich.
                            and NOVY,  FBEDEBICK G., 31. D.
                                Instructor in Hygiene and Phys. Chem. in the Univ. of Mich.
    Ptomaines, Leucomaines and Bacterial Proteids; or the Chemical
Factors in the Causation of Disease.  New (second) edition.   In one handsome
12mo. volume of 389 pages.   Cloth, $2.25.
  The title of this volume brings prominently to | by those who had most need of its help, namely,
view the correct pathology of a host of diseases
Modern chemistry has furnished no more striking
evidence of its value than the discovery of these
ultimate causes of disease, a step which neces-
sarily precedes any rational knowledge of cure or
prevention. These successful methods of research
nave also thrown a flood of light upon the Leuco-
maines or Physiological Alkaloids. The literature
of the  subjects, already vast, was before the
preparation of this work scattered and unattainable
general practitioners.  For the student no more
important branch of chemistry exists. The early
demand for the second edition of a work on so
new a department of science, augurs well for the
curriculum in those colleges which  have already
made it a branch of study, and for the growing
promptness on the part of the profession to recog-
nize  and use the most enlightened methods for
the benefit of their  patients.— The Southern Prac-
titioner, December, 1891.
BEMSEN, IBA,  M.  D.,  Ph. D.,
      Professor of Chemistry in the Johns Hopkins University, Baltimore.
    Principles of Theoretical Chemistry, with special reference to the Constitu-
tion of Chemical Compounds. Fourth and thoroughly revised edition.  In one handsome
royal 12mo. volume of 325 pages.   Cloth, $2.00.  Just ready.
                 FROM THE PREFACE TO THE FOURTH EDITION.
    My object has been to help students to get clear ideas in regard to the foundations of
chemistry.  That the treatment has been regarded with favor is shown by the fact that
four editions of the book have been demanded in a comparatively short time, and further
by the fact that since the appearance of the last American edition it has been translated
into German  and  Italian.   I believe  that  all  changes  called for by the advance of the
science have  been  made and that this edition will be found abreast of the times.  The
chief addition is a short chapter on Solutions.

CHABLES,  T.   CBANSTOVN, M. D.,  F.  C. S., M. S.,
      Formerly Asst. Prof, and Demonst. of  Chemistry and Chemical Physics, Queen's College, Belfast.
    The  Elements  of  Physiological  and  Pathological  Chemistry.   A
Handbook for Medical Students and  Practitioners.   Containing a  general account of
Nutrition, Foods and Digestion, and the Chemistry of the Tissues, Organs, Secretions and
Excretions of the Body in Health and in Disease.  Together with the  methods for pre-
paring or separating their chief constituents, as  also for their examination  in detail, and
an outline syllabus of a practical course  of instruction for students.  In one handsome octavo
volume of 463 pages, with 38 woodcuts  and 1 colored plate.   Cloth, $3.50.
  Dr. Charles is fully impressed with the  impor-
tance and practical reach of his subject,  and he
has treated it in a competent and instructive man-
ner.  We cannot recommend a better book than
the present.  In fact, it fills a gap in medical text-
books, and that is a thing which can rarely be said
nowadays.  Dr. Charles has devoted much space
to the elucidation of urinary mysteries.  He does
this with much detail, and yet in a practical and
intelligible manner.  In fact, the author has filled
his book with many practical hints.—Medical Rec-
ord, December 20,1884.
, HOFFMANN, F., A.M., Ph.D.,  &  POWEB, F.B., Ph.D.,
       Public Analyst to the State of New York.    . Prof, of Anal. Chem. in the Phil. Coll. of Pharmacy.
     A Manual  of Chemical Analysis, as applied to the Examination of Medicinal
 Chemicals and their Preparations.  Being a Guide for the Determination of their Identity
 and Quality, and for the  Detection of Impurities and Adulterations.  For the use of
 Pharmacists, Physicians, Druggists and Manufacturing Chemists, and Pharmaceutical and
 Medical Students.  Third edition, entirely rewritten and much enlarged.   In one very
 handsome octavo volume of 621 pages, with 179 illustrations. Cloth, $4.25.

 PABBISH, EDWABD,
       Late Professor of the Theory and Practice of Pharmacy in the Philadelphia College of Pharmacy.
     A Treatise on Pharmacy:  Designed as a Text-book for the Student, and as a
 Guide for the Physician and Pharmaceutist.  With  many  Formulae and  Prescriptions.
 Fifth  edition, thoroughly  revised, by Thomas S. Wiegand, Ph. G.  In one handsome
 octavo volume of  1093  pages, with 256 illustrations.  Cloth, $5.00; leather, $6.00.
  No thorough-going pharmacist will fail to possess
 himself of so useful a guide  to practice,  and no
 physician who properly estimates the value of an
 accurate knowledge of the remedial agents  em-
 ployed by him in daily practice, so far as their
 miscibility, compatibility and mosteffective meth-
ods of combination are concerned, can afford to
leave this work out of the list of their works of
reference.  The country  practitioner, who must
always be in a measure his own pharmacist will
find it indispensable.—Louisville  Medical  News
March 29,1884.                             '
BALFE,  CHABLES H., M. D.,  F. B. C. P.,
      Assistant  Physician at the London Hospital.
    Clinical  Chemistry.  In one pocket-size  12mo. volume  of 314 pages,  with 16
illustrations.  Limp cloth, red edges, $1.50.  See Students' Series of Manuals, page 30.

 LASSEN'S  ELEMENTARY QUANTITATIVE I fessorof Chemistry in the Towne Scientific School
 ANALYSIS.  Translated, with notes and addi-  University of Penna. In one 12mo. volume of -v>l
 tions, by Edgar F. Smith, Ph. D , Assistant Pro- | pages,  with 36 illus.  Cloth, §2.00. 
Lea  Brothers  &  Co.'s Publications—Mat. Med., Therapeutics.  11
STILLE,  A., M.D.,LL.D., & MAISCH,  J. M.,Phar.D.,
Professor Emeritus of the Theory and Prac-
tice of Medicine and of Clinical Medicine
m  the University of Pennsylvania.
Prof, of Mat. Med. and Botany in Phila.
College of Pharmacy, Sec'y to the Ameri-
can Pharmaceutical Association.
  The  National  Dispensatory.

CONTAINING THE NATURAL HISTORY, CHEMISTRY, PHARMACY, ACTIONS AND USES OF
    MEDICINES, INCLUDING THOSE RECOGNIZED IN THE PHARMACOPCE/AS OF THE
          UNITED STATES, GREAT BRITAIN AND GERMANY, WITH NUMEROUS
                      REFERENCES TO THE FRENCH CODEX.

    Fourth edition revised, and covering the new British Pharmacopoeia.  In one mag-
nificent imperial octavo volume of 1794 pages, with  311 elaborate engravings.   Price
in cloth,  $7.25 ;  leather, raised bands, $8.00;  half  Kussia, $9.00.  \*This work will be
furnished with Patent Ready Reference Thumb-letter Index for $1.00 in  addition to the price
in any of the above styles of binding.
  It is with much pleasure that the fourth edition
of this magnificent work is received.  The authors
and publishers have reason to feel proud of this,
the most comprehensive, elaborate and accurate
work of the kind ever printed in this country. It
is no wonder that it has become the standard au-
thority for  both the medical  and pharmaceutical
profession, and that four editions have been re-
quired  to  supply the  constant and increasing
demand since its first appearance in 1879.  The
entire field has been gone over and the various
articles revised in accordance  with the  latest
developments regarding the attributes and thera-
peutical action of drugs.  The remedies of recent
discovery have received due attention.—Kansat
City Medical Index, Nov. 1887.
  We think it a matter for congratulation that the
profession of medicine and that of pharmacy have
shown such appreciation of this great work as to call
for four editions  within the comparatively brief
period of eight years. The matters with which it
deals are of so practical a nature that neither the
physician nor the pharmacist can do without the
latest text-books on them, especially those that are
so accurate and comprehensive as  this one.  The
book is in every way creditable both to the authors
and to the publishers.—New York Medical Journal,
May 21,1887.
MAISCH, JOHNM., Phar. D.,
      Professor of Materia Medica and Botany in the Philadelphia College of Pharmacy.
    A Manual of Organic Materia Medica; Being a Guide to Materia Medica of
the Vegetable and  Animal  Kingdoms.  For the use of Students, Druggists, Pharmacists
and Physicians.  New (fifth) edition, thoroughly revised.  In one very handsome 12mo.
volume of 544 pages, with 270 engravings.  Cloth, $3.00. Just ready.
    A notice of the previous edition is appended.
                                           fore his eyes.  That it answers its purposes in this
  For everyone interested in  materia medica,
Maisch's Manual, first published in 1882, and now
in its fourth edition, is an indispensable book.
For the American pharmaceutical student it is
the work which will give him the necessary knowl-
edge in the easiest way, partly because the text is
brief, concise, and free from unnecessary matter,
and partly because of the numerous illustrations,
which bring facts worth knowing immediately be-
respect the rapid succession of editions is the best
evidence. It is the favorite book of the Amei ican
student even outside of Maisch's several  hundred
personal  students.  The arrangement of its con-
tents shows the practical tendency of the book.
Maisch's system of classification is easy and com-
prehensive.—Pharmaceutische Zeitung, Germany,
18^0.
EDES, BOBEBT T., M. D.,
      Jackson Professor of Clinical Medicine in Harvard University, Medical Department.
    A Text-Book of Therapeutics .and Materia  Medica.   Intended for the
Use of Students and Practitioners.  Octavo,  544 pages.  Cloth, $3.50; leather, $4.50.
                                           or! having produced so good a one.—N. Y. Medical
                                           Journal, Feb. 18,1888.
                                            Dr. Edes' book represents better than any older
                                           book the practical therapeutics of the  present
                                           day.  The book is a thoroughly practical one.  The
                                           classification of remedies has reference  to their
                                           therapeutic action.—Pharmaceutical Era, Jan. 1888.
  It possesses all the essentials which we expect
in a book of its kind, such as conciseness, clear-
ness, a  judicious classification, and a reason-
able degree of dogmatism.  All the newest drugs
of promise are treated of.  The clinical index at
the end will be found very useful.  We heartily
commend the  book and congratulate the author
BBTJCE,  J. MITCHELL,  M. D.,  F. B.  C. P.,
      Physician and Lecturer on Materia Medica and Therapeutics at Charing Cross Hospital, London.
    Materia Medica and Therapeutics.  An Introduction to Bational Treatment.
Fifth edition. 12mo., 591 pages. Cloth, $1.50.   See Students' Series of Manuals, page 30.

GBIFFITH, BOBEBT  EGLESFIELD, M. D.
    A Universal Formulary, containing the Methods of Preparing and Adminis-
tering Officinal and other  Medicines.  The whole adapted to Physicians and Pharmaceut-
ists.   Third edition, thoroughly revised, with numerous additions, by John M. Maisch,
Phar. D. Professor of Materia Medica and Botany in the Philadelphia College of Pharmacy,
In one octavo volume of 775 pages, with 38 illustrations.   Cloth, $4.50; leather, $5.50.
HERMANN'S EXPERIMENTAL PHARMACOL-
  OGY. A Handbook of Methods for Determining
  the Physiological Action of Drugs.  Translated,
  with the Author's  permission, and  with exten-
  sive additions, by R. M. Smith, M. D.  12mo.,
  199 pages, with 32 illustrations.  Cloth, $1.50.
STILLE'S THERAPEUTICS AND  MATERIA
  MEDICA.  A Systematia Treatise on the Action
  and Uses of Medicinal Agents, including their
  Description and History.  Fourth edition, re-
  vised and enlarged.  In two octavo volumes, con-
  taining 1930 pages.  Cloth, 810.00; leather, 812.00. 
12   Lea Brothers & Co.'s Publications—Mat. Med., Therapeutics.
A   SYSTEM   OF   PRACTICAL   THERAPEUTICS
                BY  AMERICAN  AND  FOREIGN  AUTHORS.

          Edited  by  HOBART  AMORY  HARE,   M. D.,
     Professor of Therapeutics and Materia Medica in the Jefferson Medical College of Philadelphia.
Assisted  by  Walter Chrystie, M. D., Formerly  Instructor in Physical
                    Diagnosis  in the  University of Penna.
    In  a series of contributions  by seventy-eight eminent authorities.   In three large
octavo volumes of about 1100 pages each, with illustrations.   Vols. I., II. and III. just
ready.   Price, per volume: Cloth, $5.00; leather, $6.00; half Russia, $7.00.  For sale by
subscription only.  Address the Publishers.   Full prospectus free to any address on application.
                                           the medical literature of the day.—Nashville Jour-
  In our notices of the two preceding volumes
of this magnificent work we spoke highly of its
merits as an encyclopedic reference book, and
commended it to the profession as the most per-
fect work of the kind.  The third volume has
already appeared, following the other two in an
almost incredibly short time, and in every respect
the equal of its predecessors.  We feel that we
cannot say too much for this System. It is exactly
what the practitioner needs for daily reference.
All diseases are treated  of in their etiology,
pathology and symptomatology, and the applica-
tion of medicines  to  their management fully
 fiven. Every subject is handled by a writer who
 as devoted himself especially to its considera-
tion, so that the system is really a collection of
monographs by writers who are authorities upon
the subjects.  In the list of authors, of which
their are forty for this volume, we observe the
names of some  of  the  best-known  American
nal of Medicine and Surgery, July, 1892.
  The scope of this work is beyond that of any
previous one on the subject.  The goal, after all,
is the treatment of disease, and a work which con-
tributes to its  successful management is to be
looked upon as of vast use to humanity.  It can-
not be denied that therapeutic resources, whether
the treatment be confined to the mere administra-
tion of drugs, or allowed its more extended appli-
cation to the management of disease, have so
greatly multiplied within the last few years as to
render previous treatises of little value.  Herein
will be found the great value  of flare's encyclo-
pedic work, which groups together within a single
series of volumes the  most modern  methods
known in the management of disease, and espe-
cially deals with important subjects  comprehen-
sively, which could not be done in a more limited
treatise.   We cannot  commend  Hare's  System
physicians, who have distinguished themselves by \ of Practical  Therapeutics too highly; it stands
their works or their writings in the special departr I out first and foremost as a work to be consulted
ments in which they have labored.  No one who by authors, teachers, and physicians, throughout
desires to keep in the van of professional advance the world.—Buffalo Medical aud Surgical Journal,
can afford to be without it.  We unhesitatingly August, 1892.
commend it as a most valuable contribution to |
HABE,  HOBABT AMOBY,  B. Sc,  M.  D.,
      Professor of Materia Medica and Therapeutics in the Jefferson Medical College of Philadelphia;
      Secretary of the Convention for the Revision of the United States Pharmacopoeia of 1890.
    A Text-Book of Practical Therapeutics; With Especial Eeference to the
Application of Remedial Measures to Disease and their Employment upon a  Rational
Basis.   With special  chapters by  Drs.  G.  E. de  Schweinitz,  Edward  Martin,
J. Howard Reeves and  Barton  C. Hirst.  New (2d) and revised  edition.  In one
handsome octavo volume of 650  pages.  Cloth, $3.75; leather, $4.75.
  This work has  received the rare  distinction
among med ical works of reaching a second edition
six months after its first appearance.  Many new
prescriptions have also been inserted to illustrate
the best modes of applying remedies.   Among
other features of this practically helpful  treatise
which will make reference to it convenient and
profitable, are the arrangement of titles of drugs
and diseases in alphabetical order, according to
their English  names;  and a dose  list of drugs
officinal and unofficinal.  In addition to the  gen-
eral index, a copious and explanatory index of
diseases and remedies has been appended which
will render the contents easily accessible.— The
Medical Age, July 10,1891.
BBUNTON, T. LAJJDEB, M.D., D.Sc, F.B.S., F.B.C.P.,
      Lecturer on Materia Medica and Therapeutics at St. Bartholomew's Hospital, London, etc.

    A Text-Book of Pharmacology, Therapeutics and Materia Medica;
Including the Pharmacy, the Physiological Action and the Therapeutical Uses of Drugs.
Adapted to the U. S. Pharmacopoeia by Francis H. Williams, M. D., of Harvard Univer-
sity Medical School.   Third edition.   Octavo, 1305 pages, 230 illustrations.  Cloth, $5.50;
leather, $6.50.
                                          made in various directions in the art of therapeu-
                                          tics, and it now stands unrivalled in its thoroughly
                                          scientific presentation of the modes of drug action.
                                          No one who wishes to be fully up to the times in
                                          this science can afford to neglect the study of Dr.
                                          Brunton's work. The indexes are  excellent, and
                                          add not a little to the practical value of the book.
                                          —Medical Record, May 25,1889.
  No words of praise are needed for this work, for
it has already spoken for itself in former editions.
It was by unanimous consent placed among the
foremost books on the subject ever published in
any language, and the better it is known and studied
the more highly it is appreciated. The present
edition contains much new  matter, the insertion
of which has been necessitated by the advances
FABQUHABSON,  BOBEBT, M. D.,  F. B. C. P.,  LL. D.,
      Lecturer on Materia Medica at St. Mary's Hospital Medical School, London.
    A  Guide  to  Therapeutics  and  Materia Medica.  Fourth  American,
from the fourth English edition.  Enlarged and adapted to the U. S. Pharmacopoeia.  By
Frank Woodbury, M. D., Professor of Materia  Medica and Therapeutics and Clinical
Medicine in the  Medico-Chirurgical College of Philadelphia.  In one handsome 12mo
volume of 581 pages.   Cloth, $2.50.
  It may correctly be regarded as the most modern copceias, as well as considering all non-official but
work of its kind.  It is concise,  yet complete, importantnewdrugs.it becomes in facta miniature
Containing an account of all remedies that have dispensatory.—Pacific Medical Journal, June, 1889
a place in the British and United States Pharma- 
Lea Brothers & Co.'s Publications—Practice of Med.        13
FLINT,  AUSTIN, M.  D.,  LL.  D.,
   Prof, of the Principles and Practice of Med. and of Clin. Med. in Bellevue Hospital Medical College, N. Y.
    A Treatise on the Principles and Practice  of Medicine.  Designed for
the use  of Students and Practitioners of Medicine.  Sixth edition, thoroughly revised
and  rewritten by the  Author, assisted  by  William H. Welch, M. D., Professor of
Pathology, Johns Hopkins University, Baltimore, and Austin Flint, Jr., M. D., LL. D.,
Professor of Physiology, Bellevue Hospital Medical College, N. Y.  In one very handsome
octavo volume of 1160 pages, with illustrations.  Cloth, $5.50; leather, $6.50.
  No text-book on the  principles and  practice of
medicine has ever met in this country  with such
general approval by medical students and practi-
tioners as the work of Professor Flint.  In all the
medical colleges of the United States it is the fa-
vorite work upon Practice; and, as we have stated
before in alluding to it, there is no other medical
work that can be so generally found in the libra-
ries of physicians.  In  every state and territory
of this vast country the book that will be most likely
to be found in the office of a medical man, whether
in city, town, village, or at some cross-roads, is
Flint's  Practice. We  make this statement to a
considerable extent from personal observation, and
it is the testimony also of others.  An examina-
tion shows that very considerable changes have
been made in the sixth edition. The work may un-
doubtedly be regarded as fairly representing the
present state of the science of medicine, and as
reflecting the views  of those who exemplify in
their practice the present stage of progress of med-
ical art.—Cincinnati Medical New; Oct. 1886.
BBISTOWE,  JOHN SYEB,  M. D.,  LL. D., F. B.  S.,
       Senior Physician to and Lecturer on Medicine at St. Thomas' Hospital, London.
    A Treatise on the Science and Practice of Medicine.   Seventh edi-
tion.   In one large octavo volume of 1325 pages.  Cloth, $6.50; leather, $7.50.
                                             tion, systematic, scientific and practical, contain-
  Dr. Bristowe's now famous treatise appears in
its seventh edition.  It has long passed the stage
in which it requires critical examination or com-
mendation, and has thoroughly established itself
as among the most complete and useful of text-
books.—British Medical Journal, September 27,1890.
ing the  matured experience of a physician who
has every claim to  be  considered an authority,
and composed in a style which attracts the prac-
titioner as much as the student.  No one can say
that this book has obtained a success which was
It is a work that is  built on a stable  founda-  undeserved.—The Lancet, July 12,1890,
HABTSHOBNE,  HENBY, M.  D.,  LL. D.,
       Lately Professor of Hygiene in the University of Pennsylvania.
    Essentials  of the Principles  and Practice of Medicine.  A Handbook
for Students and Practitioners.  Fifth edition,  thoroughly revised and rewritten.   In one
royal 12mo. volume of 669 pages, with 144 illustrations.  Cloth, $2.75.
  Within the compass of 600 pages it treats of the 1 a better average of actual practical treatment than
history of medicine, general pathology,  general this one; and probably not one writer in our day
symptomatology, and physical diagnosis (including had a better opportunity than Dr. Hartshorne for
laryngoscope, ophthalmoscope, etc.), general ther- condensing all the views of eminent practitioners
apeutics, nosology, and special pathology and prac- into a 12mo.  The numerous illustrations will be
tice.   There is a wonderful amount of information very useful to students especially.  These essen-
containedin this work, and it is  one of the best tials are most valuable in affording the means to
of its kind that we have seen.—Glasgow Medical see at a glance the whole literature of any disease,
Journal, Nov. 1882.                            and the most valuable treatment.—Chicago Medical
  An indispensable book.  No work ever exhibited Journal and Examiner, April, 1882.
BEYNOLDS, J. BUSSELL,  M.  D.,
       Professor of the Principles and Practice of Medicine in University College, London.
    A System of Medicine.  With notes and  additions by Henry Hartshorne,
A. M., M. D.,late Professor of Hygiene in the University of Pennsylvania. ^ In three large
and handsome octavo volumes, containing 3056 double-columned pages, with 317 illustra-
tions.  Price per volume, cloth, $5.00;  sheep, $6.00; half Russia, raised bands, $6.50.
Per set, cloth, $15.00;  leather, $18.00; half Russia, $19.50.  Sold only by subscription.
COHEN, SOLOMON SOLIS, M. D.,
        Professor of Clinical Medicine and Applied Therapeutics in the Philadelphia Polyclinic.
    A  Handbook  of Applied Therapeutics.    Being a  Study of  Principles
Applicable and an Exposition of  Methods Employed in the Management of the Sick.
In one large 12mo. volume, with illustrations.  Preparing.
STILLE  ON  CHOLERA:  Its Origin,  History,
  Causation, Symptoms, Lesions, Prevention and
  Treatment.  In one handsome 12mo. volume of
  Ifn naees with a chart.  Cloth, $1.25.
WATSONS LECTURES ON THE  PRINCIPLES
  AND PRACTICE OF PHYSIC.  From  the fifth
  English edition. Edited with additions, and 190
  illustrations, by Hknry Haktshorne A. M., M. D
  late Professor of Hygiene in the  University of
  Pennsylvania.  In two large octavo volumes of
  1840 Daces   Cloth, $9.00; leather, $11.00.
FLINT  ON  PHTHISIS: ITS MORBID ANAT-
  OMY,  ETIOLOGY, SYMPTOMATIC EVENTS
  AND  COMPLICATIONS, FATALITY  AND
  PROGNOSIS, TREATMENT AND PHYSICAL
  DIAGNOSIS; in a series of Clinical Studies. In
  one octavo volume of 442 pa°;es. Cloth, $3.50.
FLINT'S  PRACTICAL  TREATISE  ON  THE
  DIAGNOSIS, PATHOLOGY AND TREATMENT
  OF DISEASES OF THE HEART.  Second re-
  vised and enlarged edition.  In one octavo vol-
  ume of 550 pagps, with a plate.  Cloth, 84.
FLINT'S ESSAYS ON CONSERVATIVE MEDI-
  CINE  AND  KINDRED TOPICS.  In one very
  handsome royal  12mo. volume of 210 pages
  Cloth, $1.38. 
14        Lea Brothers & Co.'s Publications—System of  Med.
For Sale by Subscription Only.
     A   System    of   Practical    Medicine.
                           BY AMERICAN AUTHORS.

             Edited by WILLIAM  PEPPER,  M. D.,  LL. D.,
   provost and professor of the theory and practice of medicine and of
              clinical medicine in the university of pennsylvania,

Assisted by Louis Starr, M. D.,  Clinical Professor of  the  Diseases  of  Children in the
                     Hospital of the University of Pennsylvania.

The complete work, in five volumes, containing 5573 pages, with 198 illustrations, is now ready.
    Price per volume, cloth, $5; leather, $6; half Russia, raised bands and open back, $7.
    In this great work American medicine is for  the first time reflected by itsworthiest
teachers, and presented in the full development of the practical utility which is its pre-
eminent characteristic.  The most able men—from the East and  the West, from the
North and  the South, from all the prominent centres  of education, and from all the
hospitals  which  afford special  opportunities for study and practice—have united  in
generous rivalry to bring together this vast aggregate of specialized experience.
    The distinguished editor has  so apportioned the work that to each  author has been
assigned the subject which he  is peculiarly fitted  to discuss, and  in which  his  views
will be accepted as  the latest  expression of scientific and  practical knowledge.   The
practitioner will therefore find these volumes a complete, authoritative and unfailing work
of reference, to which he may at all times turn with full certainty of finding what he needs
in its most recent aspect, whether he seeks information  on the general principles of medi-
cine, or minute guidance in the  treatment of special disease.  So wide is the scope of the
work that, with the exception of midwifery and matters  strictly surgical, it embraces the
whole domain of medicine, including the departments for which the physician is accustomed
to rely on special treatises, such as diseases of women and children, of the genito-urinary
organs, of the skin, of the nerves, hygiene and sanitary science, and medical ophthalmology
and otology.  Moreover, authors have inserted the formulas which they have found most
efficient in the treatment of the various affections.  It  may thus be truly regarded as a
Complete Library of Practical Medicine, and  the general practitioner possessing it
may feel secure that he will require little else in the daily round of professional duties.
     In spite of every effort to condense the vast amount of practical  information fur-
nished, it has been impossible to present it in less  than  5  large octavo volumes, containing
about 5600  beautifully printed  pages, and  embodying  the matter of about  15 ordinary
octavos.   Illustrations are introduced wherever requisite  to elucidate the text.
     A  detailed prospectus  will  be  sent to any  address on application to the  publishers.
  These two volumes bring this admirable work
to a close, and fully sustain the high standard
reached by the earlier volumes;  we have only
therefore to echo the eulogium  pronounced upon
them.  We would warmly congratulate the editor
and his collaborators at the conclusion of their
laborious task on the admirable manner in which.
from first to last, they have performed their several
duties.  They have  succeeded in producing a
work which will long remain a standard work of
reference,  to which practitioners  will look for
guidance,  and authors will  resort for facts.
From a literary point of view, the work is without
any serious blemish, and in respect of production,
it has the beautiful finish that Americans always
give their works.—Edinburgh Medical Journal, Jan.
1887.
  • * The greatest distinctively American work on
the practice of medicine, and, indeed, the super-
lative adjective would not be inappropriate were
even all other productions placed in comparison.
An examination of the five volumes is sufficient
to convince one of the magnitude of the enter-
prise, and of the success which has attended its
fulfilment.—The Medical Age, July 26,1886.
  This huge volume forms a fitting close to the
great system of medicine which in so short a time
has won so high a place in medical literature, and
has done  such credit to the profession in  this
country.  Among the twenty-three contributors
are the names of the leading neurolosists in
America, and most of the work in the volume is of
the highest order.—Boston Medical and Surgical
Journal, July 21,1887.
  We  consider it  one of the grandest works on
Practical Medicine in the English language. It is
a work of which the profession of this country can
feel  proud. Written  exclusively  by American
physicians who are acquainted with all the varie-
ties of climate in the United States, the character
of the soil, the manners and customs of the peo-
ple, etc., it is peculiarly  adapted  to  the wants
of American practitioners of  medicine, and it
seems to us that every one of them would desire
to have it.  It  has been  truly called a "Complete
Library of Practical Medicine," and the general
practitioner will require little  else in his round
of professional duties.—Cincinnati Medical News,
March, 1886.
  Each of the volumes is provided with a most
copious index, and the work altogether promises
to be one which  will add much to  the medical
literature of the present century, and reflect great
credit upon the scholarship and practical acumen
of its authors.—The London Lancet, Oct. 3, 1885.
  The feeling of proud satisfaction with which the
American profession sees this, its representative
system of practical medicine issued to the medi-
cal world, is fully justified by the character of the
work.  The entire caste of the system is in keep-
ing with the best thoughts of the leaders and fol-
lowers of our  home school of medicine, and the
combination of the scientific study of disease and
the practical application of exact and experimen-
tal knowledge to the treatment of human mal-
adies, makes every one  of us share in the pride
that has welcomed Dr. Pepper's labors.  Sheared
of the prolixity that wearies the readers of the
German school, the  articles glean these same
fields for all that is valuable.  It is the outcome
of American brains, and  is marked throughout
by much of the sturdy  independence of thought
and originality that is a  national characteristic
Yet nowhere is there lack of  study of the most
advanced views of the day.—North Carolina Medi-
cal Journal, Sept. 1886. 
Lea  Brothers & Co.'s Publications—Practice of Medicine.     15
LYMAN,  HENBY M.9  M.D.,
       Professor of the Principles and Practice of Medicine, Rush Medical College, Chicago.
     The Principles and Practice of Medicine. For the Use of Medical Students
and  Practitioners.  In one very handsome octavo volume of 925 pages, with 170 illustra-
tions.   Cloth, $4.75; leather, $5.75.  Just ready.
     The author has undertaken to present in this volume not only the results of his long
experience as a practitioner and teacher, but to make it representative of the  latest state
of knowledge in its department.  The work is assured of wide use as an unsurpassed guide
for the student and likewise for the practitioner.

 WHITLA,  WILLIAM,  M. D.,
       Professor of Materia Medica and Therapeutics in the Queen's College, Belfast.
     A Dictionary of Treatment; or Therapeutic Index, including Medi-
cal  and Surgical  Therapeutics.   Revised  and  adapted  to the  United  States
Pharmacopoeia.   In one square, octavo volume of 917  pages.  Cloth, $4.00.   Just  ready.
  Dr. Whitla has, we think, been fortunate in the
selection of a title for his latest work. We have
already dictionaries of medicine and dictionaries
of surgery; he now provides us with a dictionary
of treament.  And reference to the volume shows
that it really is what it professes  to be.  The sev-
eral diseased conditions are arranged in alphabet-
ical order, and  the methods—medical,  surgical,
dietetic, and climatic—by which they may be met,
considered. On every page we find clear and de-
tailed directions for treatment, supported by the
author's personal authority and experience, whilst
the recommendations of other competentobservers
are also critically examined.  The book abounds
with useful, practical hints and suggestions, and
the younger practitioner will find in it exactly the
help he so often needs in the treatment both of
those who are ill, and those who are ailing. At the
same time the most experienced members of the
profession may usefully consult its pages for the
purpose of learning what is really trustworthy in
the later therapeutic developments. The Diction-
ary is, in short, the recorded experience of a prac-
tical  scientific therapeutist,  who has  carefully
studied diseases and disorders at the bed-side and
in the consulting-room,  and has earnestly ad-
dressed himself to the cure and relief of his
patients.  Dr. Whitla is to be congratulated upon
the thoroughness with which he has realised his
idea.— The Glasgow Medical Journal, April, 1892.
FOTHEBGILL,  J.  M., M. D., Edin.,  M. B. C. P., Lond.,
       Physician to the City of London Hospital fo* Diseases of the Chest.
     The Practitioner's Handbook of Treatment;  Or, The Principles of Thera-
peutics.  Third edition. In one 8vo. vol. of 661 pages. Cloth, $3.75;  leather, $4.75
  To have a description of the normal physiologi-
cal processes of an  organ and of the methods of
treatment  of  its  morbid conditions  brought
together in a single chapter, and the relations
between the two clearly stated, cannot fail to prove
a great convenience to many thoughtful but busy
physicians.  The practical value of the volume is
greatly increased  by the introduction of many
prescriptions.  That the profession appreciates
that the author has undertaken an important work
and has accomplished it is shown by the demand
for this third edition.—N. Y. Med. Jour., June 11,'87.
  This  is a wonderful book. If there be such a
thing as "medicine made easy," this is the work to
accomplish this result.— Va. Med. Month., June,'87.
  It is an excellent, practical work on therapeutics,
well arranged and clearly expressed, useful to the
student and young practitioner, perhaps even to
the old.—Dublin Journal of Medical Science, March,
1888.
  We do not know a more readable, practical and
useful work on the treatment of disease than the
one we have now before us.—Pacific Medical and
Surgical Journal, October, 1887.
FINLAYSON, JAMES,  M. D., Editor,
       Physician and Lecturer on Clinical Medicine in the Glasgow Western Infirmary, etc.
    Clinical Manual for the  Study  of  Medical   Cases.   With Chapters
by Prof. Gairdner, Prof.  Stephenson, Dr. Robertson, Dr. Gemmell and Dr. Coats.  Second
edition.   In one 12mo. volume of 682 pages, with  158 illustrations.  Cloth, $2.50.
  We are pleased to see a second edition of this
admirable book.  It is  essentially a practical
treatise on medical diagnosis, in which every sign
and symptom of disease is carefully analyzed, and
their relative significance in the different affec-
tions in which they occur pointed out. From their
synthesis the student can accurately determine
the disease with which he has to deal.  The book
has no competitor, nor is it likely to have as long
as future editions maintain its present standard of
excellence.  The general practitioner will find
many practical hints in its pages, while a careful
study of the work will save him from many pitfalls
in diagnosis.—Liverpool Medico-Chirurgicat Jour-
nal, January, 1887.
MUSSEB,  JOHN  H,  M. D.,
       Assistant Professor of Clinical Medicine, University of Pennsylvania, Philadelphia.
    A Practical  Treatise on Medical Diagnosis.   For the Use of Students and
Practitioners.   In one octavo volume of about 650 pages.  Preparing.

HABEBSHON,  S.  O., M. D.,
       Senior Physician to and late Led. on Principles and Practice of Med. at Guy's Hospital, London.
     On the Diseases  of the Abdomen;   Comprising those of the Stomach, and
other parts of the Alimentary Canal, Oesophagus, Caecum, Intestines and Peritoneum. Second
American  from third enlarged and revised English  edition.  In one handsome octavo
volume of  554 pages, with illustrations.  Cloth, $3.50
  This valuable treatise on diseases of the stomach  -
and abdomen will be found a cyclopaedia of infor-
mation, systematically arranged, on all diseases of
the alimentary tract, from the mouth to the
rectum.  A  fair  proportion  of each chapter ia
devoted to symptoms, pathology, and therapeutics.
—New York Medical Journal, April, 1879.
TANNER'S MANUAL OF CLINICAL MEDICINE
  AND PHYSICAL DIAGNOSIS. Third American
  from the second London edition.  Revised and
  enlarged  by Tilbury Fox, M.D.  In one 12mo.
  volume of 362 pp., with illus. Cloth, $1.50.
A TREATISE ON FEVER.  By Robert D. Lyons,
  K. C. C.  In one 8vo. vol. of 364 pp.  Cloth, $2.25.
LECTURES 3N THE STUDY OF FEVER.  By
 A. Hudson , M. D., M. R. I. A.  In one octavo
 volume of 308 pages. Cloth, $2.50.
LA ROCHE ON YELLOW FEVER considered in
 its  Historical,  Pathological,  Etiological  and
 Therapeutical Relations. In two large and hand-
 some octavo volumes of 1468 pp.   Cloth, $7.00. 
16   Lea Brothers & Co.'s  Publications—Hygiene, Electr., Pract.
BABTHOLOW, BOBEBTS, A. M., M. D., LL. D.,
      Prof, of Materia Medica and General Therapeutics in the Jefferson Med. Coll. of Phila., etc.
    Medical Electricity.  A Practical  Treatise  on  the Applications of Electricity
to Medicine and Surgery.   Third edition.
pages, with 110 illustrations.  Cloth, $2.50.
  The fact that this work has reached its third edi-
tion in six years, and that it has been kept fully
abreast with the increasing use and knowledge of
electricity,demonstrates its claim to be considered
a practical treatise of tried value to the profession.
The matter added to the present edition embraces
In one very handsome octavo volume of 308


the most recent advances in electrical treatment.
The illustrations are abundant and clear, and the
work constitutes a full, clear and concise manual
well  adapted to the needs of both student and
practitioner.— The Medical News, May 14,1887.
YEO,  I.  BUBNEY,  M. D., F.  B.  C. P.,
      Professor of Clinical Therapeutics in King's  College, London,  and Physician to King's College
      Hospital.
    Food in Health and Disease.  In one 12mo. volume of 590 pages.  Cloth, $2.
See Series of Clinical Manuals, page 31.
  Dr.Yeo supplies in a compact form nearly all that
the practitioner requires to know on the subject of
diet.  The work is divided into two parts—food in
health and food in disease. Dr. Yeo has gathered
together from all quarters an immense amount of
useful information  within a comparatively small
compass, and he has arranged and digested his
materials with skill for the use of the practitioner.
We have seldom seen a book which more thor-
oughly realizes the object for which it was written
than this little work of Dr. Yeo.—British Medical
Journal, Feb. 8, 1890.
BICHABDSON,  B. W., M.D., LL. D.,  F.B.S.,
      Fellow of the Royal College of Physicians, London.
   Preventive Medicine.  In one octavo volume of 729 pages. Cloth, $4; leather, $5.
  Dr. Richardson has succeeded in producing a
work which is elevated in conception, comprehen-
sive in scope, scientific in character, systematic in
arrangement, and which is written in a clear, con-
cise and pleasant manner.  He evinces the happy
faculty or extracting the pith of what is known on
the subject, and of presenting it in a most simple,
intelligent and  practical  form.  There is perhaps
no similar work written for  the general  public
that contains such a complete, reliable and instruc-
tive collection of data upon the diseases common
to the race, their origins, causes, and the measures
for their prevention.  The descriptions of diseases
are  clear, chaste and scholarly; the discussion of
the question of disease is comprehensive, masterly
and fully abreast with the latest and best  knowl-
edge on the subject, and the preventive measures
advised are accurate, explicit and reliable.— The
American Journal of the Medical Sciences, April, 1884.
THE YEAB BOOK OF TBEATMENT FOB  1892.
    A  Comprehensive and Critical Review for Practitioners of Medi-
cine and Surgery.  In one 12mo. vol. of about 500 pages.  Cloth, $1.50.
         For special commutations with periodicals see pages 1 and 2.
  The "Year-Book" is too well known and  too
highly appreciated to need comment.  The im-
mense strides taken in the progress of medicine
in all its branches make it impossible for anyone
to keep up with the times. Hence the necessity
of the book in hand.  Its score of co-authors sift
out what is useful in literature and present it in a
concise and readable form.  Thus, with compara-
tively little  labor, the busy practitioner gets the
gist of medical literature the world over.  Every
branch of medicine is covered—new remedies, old
ones with new applications,  new operations, all
receiving attention.—Meaical Record, May 21, i892.
THE YEAB-BOOK OF TBEATMENT FOB  1891.
    12mo., 485 pages.  Cloth, $1.50.

THE YEAB- BOOKS of TBEATMENTfor '86, '87 and '90
    Similar to above.  12mo., 320-341 pages.   Limp cloth, $1.25 each.

SCHBEIBEB, JOSEPH,  M.  D.
    A  Manual  of  Treatment  by Massage  and  Methodical Muscle Ex-
ercise.   Translated by Walter Mendelson, M. D., of New York.   In one handsome
octavo volume of 274 pages, with 117 fine  engravings.
STURGE8'  INTRODUCTION TO THE STUDY
  OF CLINICAL  MEDICINE.  Being a Guide to
  the Investigation of Disease. In one handsome
  12mo. volume of 127 pages.  Cloth, $1.25.

DAVIS'  CLINICAL LECTURES  ON VARIOUS
  IMPORTANT  DISEASES.  By  N. S. Davis,
  M. D. Edited by Frank H. Davis, M. D. Second
  edition.  12mo. 287 pages.  Cloth, $1.75.

TODD'S CLINICAL LECTURES  ON CERTAIN
  ACUTE DISEASES.  In one octavo volume of
  320 pages. Cloth, $2.50.

PAVY'S TREATISE ON THE FUNCTION OF DI-
  GESTION; its Disorders and their Treatment.
  From the second London edition. In one octavo
  volume of 238 pages.  Cloth, $2.00.

BARLOW'S MANUAL OF THE PRACTICE OF
  MEDICINE.  With additions by D. F. Condie,
  M. D.  1 vol. 8vo., pp. 603.  Cloth, $2.50.
CHAMBERS' MANUAL OF DIET AND REGIMEN
  IN HEALTH AND SICKNESS.  In one hand
  some octavo volume of 302 pp. Cloth, $2.75.
HOLLAND'S MEDICAL NOTES AND REFLEC-
  TIONS. 1 vol. 8vo., pp. 493.  Cloth, $3.50.
FULLER ON DISEASES OF THE LUNGS AND
  AIR-PASSAGES.  Their Pathology, Physical Di-
  agnosis, Symptoms and Treatment.  From  the
  second  and revised English edition.   In  one
  octavo volume of 475 pages.  Cloth, $3.50.
WALSHE ON THE DISEASES OF THE HEART
  AND GREAT VESSELS.  Third American edi-
  tion. In 1 vol. 8vo., 416 pp.  Cloth, $3.00.
SLADE ON DIPHTHERIA; its Nature and Treat-
  ment, with an account of the History of its Pre-
  valence in various Countries. Second and revised
  edition.  In one 12mo. vol., 158 pp.   Cloth, $1.25.
SMITH ON CONSUMPTION; its Early and Reme-
  diable Stages.  1 vol. 8vo., 253 pp.  Cloth, $2.25.
LA ROCHE ON PNEUMONIA.  1 vol. 8vo. of 490
  pages.  Cloth, $3.00.
WILLIAMS ON PULMONARY CONSUMPTION •
  its Nature, Varieties and Treatment.  With an
  analysis of one thousand cases to exemplify its
  duration.  In one 8vo. vol. of 303 pp. Cloth, $2.50. 
Lea Brothers & Co.'s Publications—Phys. Diag., Throat, Hist.   17
FLINT, AUSTIN, M. D., LL. D.,
      Professor of the Principles and Practice of Medicine in Bellevue Hospital Medical College, N. Y.
     A Manual of Auscultation and Percussion;  Of the Physical Diagnosis oi
Diseases  of the  Lungs  and  Heart,  and  of Thoracic  Aneurism.    Fifth  edition.
Edited by James C. AVilson, M. D.,  Lecturer on Physical Diagnosis  in the Jefferson
Medical  College, Philadelphia.    In one handsome royal 12mo. volume of 274 pages, with
12 illustrations. Cloth, $1.75.
  This little book through its various editions has I oughness of Prof. Flint's investigations.  For stu-
probably  done  more to advance the science of dents it  is excellent.  Its value is shown Both in
physical exploration  of the chest than any other the arrangement of the material and in the clear,
dissertation upon the subject, and now in its fifth concise style of expression.  For the practitioner
edition it is as near perfect as it can be.  The it is a ready manual for reference.—North Amerv-
rapidity with which  previous editions were sold can Practitioner, January, 1891.
shows how the profession appreciated  the thor- |
BBOADBENT,  W. H.,  M. D., F. B. C. P.,
      Physician to and Lecturer on Medicine at St. Mary's Hospital, London.
    The Pulse.  In one 12mo. volume of 312 pages.  Cloth, $1.75.
ical Manuals, page 31.
See Series of Clin-
BBOWNE,  LENNOX,  F. B. C. S., E.,
      Senior Physician to the Central London Throat and Ear Hospital.
    The Throat  and Nose  and Their  Diseases.  Fourth and enlarged edition.
In one imperial octavo volume of about 750 pages, with 120 illustrations in color, and 235
engravings on wood.   Preparing.
    A notice of the previous edition is appended.
  The beautiful  and typical colored plates form  I tical text-book on diseases of the throat and nose
a valuable and instructive atlas, the equal of which  | extant.  We  are glad to learn that it is  being
is not to be found in any modern work, treating  j translated into French and German.—The Provin-
of these subjects.  Mr. Lennox Browne is to be  , cial Medical Journal, August 1,1890.
congratulated on having produced the best prac-  j
SEILEB,  CABL, M.  D.,
      Lecturer on Laryngoscopy in the  University of Pennsylvania.
    A Handbook of Diagnosis and Treatment of Diseases of the Throat,
Nose and Naso-Pharynx.  New (4th) edition. In one handsome royal 12mo. volume
of about 400 pages, with 101 illustrations and 2 colored  plates.  Preparing.
    A notice of the previous edition is appended.
  Few medical writers surpass this  author  in I of topics and methods.  The book deserves a large
ability to make his  meaning perfectly clear in a sale, especially among general practitioners—Chi-
few words, and in discrimination in selection, both | cago Medical Journal and Examiner, April, 1889.
COHEN, J. SOLIS, M. D.,
      Lecturer on Laryngoscopy and Diseases of the Throat and Chest in the Jefferson Medical College.
    Diseases of the Throat and Nasal Passages.   A Guide to the Diagnosis and
Treatment of Affections of the Pharynx, OZsophagus, Trachea, Larynx and Nares.  Third
edition, thoroughly revised and  rewritten, with a large number of new illustrations.  In
one very handsome octavo volume.  Preparing.
SCHAFEB, EDWABD A., F. B. S.,
      Jodrell Professor of Physiology in University College, London.
    The Essentials of Histology.   New (second) edition.  In one octavo volume
of 311 pages, with 325 illustrations.  Cloth, $3.00.  Just ready.
KLEIN, E.,  M.  D., F.  B. S.,
     Joint Lecturer on General Anat. and Phys. in the Med. School of St. Bartholomew's Hosp., London.
    Elements  of Histology.  Fourth edition.  In one 12mo. volume of 376 pages,
with 194 illus.  Limp cloth, $1.75.  See Students' Series of Manuals, page 30.
FLINT'S  PRACTICAL  TREATISE  ON THE
  PHYSICAL EXPLORATION OF THE CHEST
  AND  THE DIAGNOSIS OF DISEASES AF-
  FECTING  THE  RESPIRATORY  ORGANS.
  Second and revised edition.  In one handsome
  octavo volume of 591 P«ses.  Cloth H5°-
BROWNE ON KOCH'S REMEDY IN RELATION
  TO THROAT CONSUMPTION. In one octavo
  volume of 121 pages, with 45 illustrations, 4 of
  rohich are colored, and 17 charts, Cloth, $1.50.
GROSS' PRACTICAL TREATISE ON FOREIGN
  BODIES  IN THE  AIR-PASSAGES.   In  one
  octavo volume of 452 pages, with 59 illustrations.
  Cloth, $2.75.
WOODH BAD'S  PRACTICAL  PATHOLOGY.   A
  Manual for Students and Practitioners.   In one
  beautiful octavo volume of 497 pages, with  136
  exquisitely colored illustrations.
PEPPER'S  SURGICAL PATHOLOGY.  In one
  pocket-size 12mo. volume  of 511 pages, with 81
  illustrations.  Limp cloth, red edges, 12.00  See
  Students' Series of Manuals, page 31. 
18  Lea Brothers & Co.'s Pcblioations—Pathology, Bacteriology.
GIBBES,  HENEAGE, M.  D.,
       Professor of Patho'ogy in the University of Michigan, Medical Department.

    Practical Pathology and Morbid Histology.   In one very handsome octavo
volume of 314 pages, with 60 illustrations, mostly photographic.  Cloth, $2.75.
  This if, in part, an expansion of the little work   The work is throughout profusely illustrated with
published by the author some years ago, and his   reproductions of micro-photographs.  We may
acknowledged skill as a practical microscopist will   say that  the practical  histologist will gain much
give weight  to his instructions. Indeed, in ful-   useful information from the book.—The London
ness of directions as to the modes of investigating   Lancet, January 23,1892.
morbid tissues the book leaves little to be desired.
ABBOTT, A.  C., M.D.,
       First Assistant, Laboratory of Hygiene, University of Penna., Philadelphia.
    The Principles of Bacteriology:  a Practical Manual for Students and Physi-
cians.   In one 12mo. volume of 259 pages with 32 illustrations.  Cloth, $2.  Just ready.
  During the last decade numerous works on this
subject have been brought before the profession;
yet, while many of them are exhaustive treatises,
much of the laboratory technique requisite to the
needs of beginners was  omitted or most scantily
treated.  On reading this  manual of Dr. Abbott,
any one familiar with  the subject will readily
recognize the fact that the book is not merely a
compilation from other works,  but  one giving
evidence of the originality of the author, as well
as complete knowledge of the  practical details of
bacteriology  His "scheme for the study of an
organism"  furnishes an excellent guide to the
student.  Of equal importance is the chapter on
disinfectants, antiseptics and  skin  disinfection.
It will form a valuable addition to the literature
of laboratory technique and bacteriological inves-
tigation.— The Therapeutic Gazette, May 16,1892.
SENN,  NICHOLAS, M.D.,  Ph.D.,
       Professor of Surgery in Rush Medical College, Chicago.
    Surgical Bacteriology.   New  (second) edition.  In  one handsome octavo  of
268 pages, with 13 plates, of which 10 are colored, and 9 engravings.  Cloth, $2.
  The book is really a systematic collection in the  makes it possible for the busy practitioner, whose
most concise form of such results as are published  time for reading is limited and whose sources of
in current medical literature by the ablest workers  information are often few, to become conversant
in this field of surgical progress; and to these are  with the most modern and advanced ideas in sur-
added the author's own views and the results of  gical pathology, which  have "laid the foundation
his clinical experience and original investigations,  for the wonderful achievements of  modern sur-
The book is valuable to the student, but its chief  gery."—Annals of Surgery, March, 1892.
value  lies in the  fact that such a compilation
GBEEN, T.  HENBY, M. D.,
       Lecturer on Pathology and Morbid Anatomy at Charing-Cross Hospital Medical School, London.
    Pathology and Morbid Anatomy.  Sixth American from the seventh revised
English edition.  Octavo, 539 pp., with 167 engravings.  Cloth, $2.75.
  The  Pathology  and Morbid Anatomy  of  Dr.
Green is too well known by members of the medi-
cal profession to need any commendation.  There
is scarcely an intelligent physician anywhere who
has not the work in his library, for it is almost an
essential.  In fact it is better adapted to the wants
of general practitioners than any work of the kind
with which we are acquainted.   The works of
German authors upon pathology, which have been
translated into English, are  too abstruse for the
physician.  Dr. Green's work precisely meets his
wishes.  The cuts  exhibit  the  appearances  of
pathological structures just as they  are  seen
through the microscope.   The fact that it  is so
generally employed as a text-book by medical stu-
dents is evidence that we  have not spoken too
much in its favor.—Cincinnati  Medical News, Oct.
1889.
PAYNE,  JOSEPH F., M. D.,  F. B.  C.  P.,
       Senior Assistant Physician and Lecturer on Pathological Anatomy, St. Thomas' Hospital, London.

    A Manual of General Pathology.   Designed as  an Introduction to the Prac-
tice of Medicine.  Octavo of 524 pages, with 152 illus. and a colored plate.  Cloth, $3.50.
 Knowing, as a teacher and examiner, the exact
needs of medical students,  the author has in the
work  before us prepared for their especial use
what we do not hesitate to say is the best introduc-
tion to general  pathology  that we have yet ex-
amined.   A departure which  our author has
taken is the greater attention paid to the causa-
tion of disease, and more especially to the etiologi-
cal factors in those diseases now with reasonable
certainty ascribed to pathogenetic microbes.  In
this department hehas been very full and explicit,
not only in a descriptive manner, but in the tech-
nique of investigation.  The Appendix, giving
methods of research, is alone worth the price of the
book, several times over, to every student  of
pathology.—St. Louis Med. and Surg. Jour., Jan.'89.
COATS, JOSEPH, M.  D.,  F.  F. P.  S.,
      Pathologist to the Glasgow Western Infirmary.
    A  Treatise on  Pathology.  In one very handsome octavo volume of 829 pages
    , mo Wntifni ;n,,e^t;^   Cloth, $5.50;  leather, $6.50.                           '
with 339 beautiful illustrations.
  Medical students as well as physicians,  who
desire a work for study or reference, that treats
the subjects in the various departments in a very
thorough manner, but without prolixity, will cer-
tainly give  this one the preference to any  with
which we are acquainted. It sets forth the most
recent  discoveries, exhibits, in  an  interesting
manner, the changes  from a normal condition
effected In structures by disease, and points out
the characteristics of  various morbid agencies
so that they can be easily  recognized.  But  noi
limited to morbid anatomy, it explains fully how
the functions of organs  are disturbed by abnormal
conditions.—Cincinnati  Medical News, Oct. 1883 
Lea Brothers & Co.'s Publications—Nerv. and Ment. Dis., etc   19
GBAY, LANDON CABTEB, M.D.,
      Professor of Diseases of the Mind and Nervous System in tht New York Polyclinic.

    A Practical  Treatise  on Nervous and Mental Diseases.  In one 8vo.
volume of about 700 pages.  Kichly illustrated.  Shortly.

    This work is devoted purely to the practical aspects of nervous and mental diseases,
especial care being taken to present the fundamental knowledge essential to a grasp of its
subjects and to cast  everything  in the clearest possible form.   The series of illustrations
is rich and unique, embracing a large number of photographic  engravings  of exceptional
vividness and interest.  By the employment of a style  at once  concise and clear, and by
careful arrangement, the author is enabled to include an exposition of a vast  and important
subject in a condensed and convenient form.

BOSS, JAMES, M. D., F. B. C. P., LL. D.,
      Senior Assistant Physician to the Manchester Royal Infirmary.
    A  Handbook  on Diseases  of  the Nervous  System.   In
volume of 725 pages, with 184 illustrations.  Cloth, $4.50; leather, $5.50
  The author has rendered a great service to the
profession by  condensing into one volume the
principal facts pertaining  to neurology and nerv-
ous diseases as understood at the present time,
and he has succeeded  in producing a work at once
brief and practical yet scientific, without entering
into the discussion of theorists, or burdening the
mind with mooted questions.—Pacific Medical and
Surgical Journal and Western Lancet, May, 1886.
  This admirable work is intended for students of
medicine and for such medical men as have no time
for lengthy treatises.   In the present instance the
duty of arranging the vast store of material at the
one octavo
disposal of the author, and of abridging the de-
scription of the different aspects of nervous dis-
eases, has been performed with singular skill, and
the result is a concise and philosophical guide to
the department of medicine of which it treats.
Dr. Ross holds such a high scientific position that
any writings  which bear his name are naturally
expected to have the impress of a powerful intel-
lect.  In  every part  this handbook merits the
highest praise, and will no doubt be found of the
greatest value to the student as well as to the prac-
titioner.—Edinburgh Medical Journal, Jan. 1887.
HAMILTON, ALLAN McLANE, M. D.,
      Attending Physician at the Hospital for Epileptics and Paralytics, BlackwelVs Island, N. Y.

    Nervous Diseases;  Their Description and Treatment.  Second edition, thoroughly
revised and rewritten.  In one octavo volume of 598 pages, with 72 illustrations.  Cloth, $4.
                                           characterized this book as  the best of its kind in
                                           any language, which is a handsome endorsement
                                           from an exalted source. The improvements in the
  When the first edition of this good book appeared
we gave it our emphatic endorsement, and the
Eresent edition enhances our appreciation of the
 ook and its author as a safe guide to students of
clinical neurology.   One of the best  and most
critical of English neurological journals, Brain, has
new edition, and the additions to it, will justify its
purchase even by those  who possess the old.—
Alienist and Neurologist, April, 1882.
TUKE, DANIEL  HACK, M. D.,
      Joint Author of The Manual of Psychological Medicine, etc.

    Illustrations of the Influence of the Mind upon the Body in Health
and Disease.  Designed to elucidate the Action of the Imagination.  New edition
Thoroughly revised and rewritten.  In one 8vo. vol. of 467 pp., with 2 col. plates.  Cloth, $3
  It is impossible to peruse these interesting chap-
ters without being convinced of the author's per-
fect sincerity, impartiality, and  thorough mental
grasp.  Dr. Tuke  has exhibited the requisite
amount of scientific address on all occasions, and
the more intricate the phenomena the more firmly
has he adhered to a physiological and rational
method of interpretation. Guided by an enlight-
ened deduction, the author has reclaimed for
science a most interesting domain in psychology.
previously abandoned to charlatans and empirics.
This book, well conceived and well written, must
commend itself to every thoughtful understand-
ing.—New York Medical Journal, September 6,1884.
CLOTJSTON,  THOMAS  S.,  M. D., F. B.  C. P.,  L. B. C. S.,
       Lecturer on Mental Diseases in the University of Edinburgh.
     Clinical Lectures on Mental Diseases.  With an  Appendix,  containing  an
Abstract of the Statutes of the United States and of the Several States and  Territories  re-
lating to the Custody of the Insane.  By Charles F. Folsom, M. D., Assistant Professor
of Mental Diseases, Med. Dep. of Harvard Univ.  In one handsome octavo volume of 541
pages, with eight lithographic plates, four of which are beautifully colored.  Cloth, $4.

     H^"Dr. Folsom's Abstract may also be obtained separately in one octavo volume of

108 pages.  Cloth, $1.50.__________________________

SAVAGE,  GEOBGE  H., M. D.,
       Lecturer on Mental Diseases at Guy's Hospital, London.
     Insanity  and  Allied Neuroses, Practical  and Clinical.  In one 12mo. vol.
nf ^51  nasres  with 18 illus.  Cloth, $2.00.   See -Series of Clinical Manuals, page 31.
  Aa a handbook a guide to the  practitioner and I carefully selected, and as regards treatment sound
BHVHent the book fulfils an admirable purpose,  common sense is  everywhere apparent. Dr. Sav-
The  manyforms of insanity are described with  age has written an excellent manual for the prac-
chara^terfstic clearness, the illustrative cases are 1 titionerandstudent.-^mer. Jour, oflnsan., Apr.'85.
PLAYFAIB, W. S., M. D., F.  B.  C.  P.
    The Systematic  Treatment of Nerve Prostration and Hysteria.
one handsome small 12mo. volume of 97 pages.  Cloth, $1.00.
In
BLANDFORD ON INSANITY AND ITS TREAT-
  MENT   Lectures on the Treatment, Medical
  and Legal, of Insane Patients.. In one very hand-
  some octavo volume.
JONES' CLINICAL OBSERVATIONS ON FUNC-
  TIONAL  NERVOUS  DISORDERS.   Second
  American Edition.   In one  handsome octavo
  volume of 340 pages. Cloth, $3.25 
20            Lea Brothers & Co.'s  Publications—Surgery.
BOBEBTS,  JOHN B., M.D.,
      Professor of Anatomy and Surgery in the Philadelphia Polyclinic.  Professor of the Principles and
Practice of Surgery in the Woman's Medical College of Pennsylvania.  Lecturer in Anatomy in the Univer-
tity of Pennsylvania.
    The Principles and Practice of Modern Surgery.   For the use of Students
and Practitioners of Medicine and Surgery.  In one very handsome octavo volume of 780
pages, with 501 illustrations.  Cloth, $4.50; leather, $5.50.
  This work is a very comprehensive manual upon
general surgery, and will doubtless meet with a
favorable reception by the profession.   It, has a
thoroughly practical character, the subjects  are
treated with rare judgment, its conclusions are in
accord with those of the leading practitioners of
the art, and its literature is fully up to all the ad- )
vanced doctrines and methods of practice of the
present day.  Its general arrangement follows
this rule, and the author in his desire to be con-
cise and practical is at times almost dogmatic, but
this is entirely excusable considering the admira-
ble manner in which he has thus increased the
usefulness  of his work.—Med. Rec, Jan. 17, 1891.
ASHHUBST, JOHN,  Jr., M. D.,
      Barton Prof, of Surgery and Clin. Surgery in Univ. of Penna., Surgeon to the Penna. Hosp., Phila.
    The Principles  and  Practice of Surgery.   Fifth edition, enlarged  and
thoroughly  revised.  In one large and handsome octavo volume  of 1144  pages,  with
642 illustrations.   Cloth, $6; leather, $7.
  A complete and most excellent work on surgery.
It is only necessary to examine it to see at once
its excellence and real merit either as text-book
for the student or a guide for the general practi-
tioner.  It fully considers in detail every surgical
injury and disease to which the body is liable, and
every advance in surgery worth noting is to be
found in its proper place.  It is unquestionably the
best and most complete single volume on surgery,
in the English language, and cannot but receive
that continued appreciation which its merits justly
demand.—Southern Practitioner, Feb. 1890.
DBUITT,  BOBEBT,  M.  B.  C.  S.,  etc.
    Manual of Modern Surgery.  Twelfth  edition, thoroughly  revised by Stan-
ley Boyd, M. B., B. S., F. R. C. S.  In one 8vo. volume  of 965  pages, with 373  illustra-
tions.  Cloth, $4; leather, $5.
  Druitt's Surgery has been an exceedingly popu-
lar work in the profession.  It is stated that 50,000
copies have been sold in England, while  in the
United States, ever since its first issue, it has been
used as a text-book to a very large extent. Dur-
ing the late war in this country it was so  highly
appreciated that a copy was issued by the Govern-
ment to each surgeon.  The present edition, while
it has the same features peculiar to the work at
first, embodies all recent discoveries in surgery,
and is fully up to the  times.—Cincinnati Medical
News, September, 1887.
GANT,  FBEDEBICK JAMES,  F. B.  C. S.,
      Senior Surgeon to the Royal Free Hospital, London.
    The Student's Surgery.  A Multum in Parvo.  In one square  octavo volume
of 848 pages, with 159 engravings.  Cloth, $3.75.

GBOSS,  S.  D.,  M.  D., LL.  D.,  D. C.  L.   Oxon., LL. D.
          Cantab.,
      Emeritus Professor of Surgery in the Jefferson Medical College of Philadelphia.
    A System of Surgery:  Pathological,  Diagnostic,  Therapeutic and Operative.
Sixth edition, thoroughly revised and greatly improved.   In two large and beautifully
printed imperial octavo volumes containing 2382 pages, illustrated by 1623 engravings.
Strongly bound in leather, raised bands, $15;  very handsome half Bussia,  $16.

BALL,  CHABLES  B., M.  Ch., Dub., F. B. C. S., E.,
      Surgeon and Teacher at Sir P. Dun's Hospital,  Dublin.
    Diseases of the Rectum and  Anus.   In  one  12mo.  volume  of   417 pp.,
with 54 cuts, and 4 colored plates.   Cloth, $2.25.  See Series of Clinical Manuals 31.

YOUNG, JAMES K., M. D.,
      Instructor in Orthopozdic Surgery, University of Pennsylvania, Philadelphia.
    A Manual of Orthopaedic Surgery, Suitable for  Students and Prac-
titioners.   In one 12mo. volume  of about 400 pages, fully illustrated.  Preparing.

BUTLIN,  HENBY T., F. B.  C.  S.,
      Assistant Surgeon to St. Bartholomew's Hospital, London.
    Diseases  of  the Tongue.   In one 12mo. volume of 456 pages,  with 8 colored
plates and 3 woodcuts.  Cloth, $3.50.   See Series of Clinical Manuals, page  31.

GOULD, A.  PEABCE, M.  S.,  M.  B., F.  B.  C. S„
      Assistant Surgeon to Middlesex Hospital.
    Elements of Surgical Diagnosis.   In one pocket-size 12mo. volume of 589
pages.   Cloth, $2.00.  See Students' Series of Manuals, page 30.
PIRRIE'S  PRINCIPLES  AND PRACTICE OF
  SURGERY.  Edited by  John Neill, M. D. In
  one 8vo. vol. of 784 pp. with 316 illus.  Cloth, $3.75.
MILLER'S PRINCIPLES OF SURGERY. Fourth
  American from the third Edinburgh edition. In
  one 8vo. vol. of 638 pages, with 340 illustrations
  Cloth, $3.75.
MILLER'S PRACTICE OF SURGERY.  Fourth
  and revised American edition. In one large 8vo
  vol. of 682 pp., with 364 illustrations. Cloth 43.75. 
Lea  Brothers &  Co.'s Publications—Surgery            21
EBICHSEN,  JOHN E., F.  B.  S.,  F. B. C.  S.,
       Professor of Surgery in University College, London, etc.
    The Science and Art of Surgery; Being a Treatise on Surgical Injuries, Dis-
eases and Operations.   From the eighth and  enlarged English edition.  In two large 8vo.
volumes of  2316 pages, with 984 engravings on wood.  Cloth, $9;  leather, $11
  For many  years  this   classic  work  has been
made by preference  of  teachers the principal
text-book on surgery for medical students, while
through translations into the leading continental
languages it may be  said to guide  the surgical
teachings of  the civilized world.  No excellence
of the former edition has been dropped and no
discovery,  device  or  improvement  which has
marked  the progress of surgery during the last
decade has been omitted.  The  illustrations are
many and  executed in the highest style of art.
—Louisville Medical News, Feb. 14,1885.
BBYANT, THOMAS, F.  B.  C. S.,
       Surgeon and Lecturer on Surgery at Guy's Hospital, London.
    The Practice of Surgery.  Fourth American from the fourth and revised Eng-
lish edition.  In one large and very  handsome imperial octavo volume of 1040 pages, with
727 illustrations.  Cloth, $6.50;  leather, $7.50.
  The fourth edition of this work is fully abreast
of the times.  The author handles his  subjects
with that degree of judgment and skill which is
attained by years of patient toil and varied ex-
perience.  The present edition is a thorough re-
vision of those which preceded it, with much new
matter added.   His  diction is  so  graceful and
logical, and his  explanations  are so lucid, as to
place-the work among the highest order of text-
books for the medical student.  Almost every
topic in surgery is presented in such a form as to
enable the busy practitioner to review any subject
in every-day practice in a short time.  No time is
lost with useless theories or superfluous verbiage.
In short, the work is eminently clear, logical and
practical.-C7iicajro Med. Jour, and Examiner, Apr. '86.
WHABTON,  HEN BY B., M.D.,
       Demonstrator of Surgery and Lecturer on Surgical Diseases of Children in the Univ. of Penna.
    Minor Surgery and  Bandaging.  In one very handsome 12mo. volume of
498 pages, with 403 engravings, many being photographic.  Cloth, $3.00.
  This new work must take a first rank as soon as
examined. Bandaging is well described by words,
and the methods are illustrated by photographic
drawings, so as to make plain each step taken in
the application of bandages of various kinds to dif-
ferent parts of the body and extremities—including
the head. The various operations are likewise de-
scribed and illustrated, so that it would seem easy
for the tyro to do the gravest amputation. The va-
rious established operations are described in detail.
Hence this work becomes a most valuable compan-
ion-book to any of the more pretentious treatises
on surgery,  where simply the general advice  is
given to bandage, amputate, intubate, operate, etc.
For the student and young  surgeon, it is a very
valuable instruction book from which to learn how
to do what may be advised, in general terms, to be
done.—Virginia Medical Monthly, October 1891.
TBEVES,  FBEDEBICK,  F. B. C. S.,
       Surgeon and Lecturer on Anatomy at the London Hospital.
    A Manual of Operative Surgery.   In two octavo volumes containing 1550
pages, with 422 original engravings.  Complete work, cloth, $9; leather, $11.  Just ready.
  Mr. Treves in this admirable manual of opera-
tive surgery  has  in each instance practically
assumed that operation has been decided upon
and has then proceeded to give the various opera-
tive methods which may be employed, with  a
criticism of their comparative value and a detailed
and careful description of each particular stage
of their performance.  Especial attention has been
paid to the preparatory treatment of the patient
and to the  details of the after treatment of  the
case, and this is one of the most distinctive among
the many excellent features of the book. We have
no hesitation in declaring it the best work on the
subject in  the English language, and indeed, in
many respects, the best in any language.  It can-
not fail to be of the greatest use both to practical
surgeons  and to those general practitioners who,
owing to their isolation or to other circumstances,
are forced to do much of their own operative work.
We feel called upon to recommend the book so
strongly for the excellent judgment displayed in
the arduous task of selecting  from  among the
thousands of varying  procedures  those most
worthy of description; for the way in which the
still more difficult task  of choosing  among the
best of those has been accomplished; and for the
simple, clear,  straightforward manner in which
the information thus gathered from  all surgical
literature has been conveyed  to the  reader.—
Annals of  Surgery, March, 1892.
                            By the Same Author.
     The Student's Handbook of Surgical Operations.  In one square 12mo.
volume of 508 pages, with 94 illustrations.   Cloth, $2.50.  Just ready.

     A  Manual of Surgery.  In Treatises by Various Authors, edited by Treves.
In three 12mo.  volumes, containing  1866  pages,  with 213 engravings.  Price  per set,
cloth, $6.  See Students' Series of Manuals, page 30
  We have  here  the  opinions of  thirty-three
authors, in  an  encyclopaedic form for  easy and
ready reference.   The three volumes embrace
every variety of surgical affections likely to  be
met with, the paragraphs are short and pithy, and
the salient points and the beginnings of new sub-
jects are always printed in  extra-heavy type, so
that a person may find whatever information he
may  be in need of at a moment's glance.—Cin-
cinnati Lancet-Clinic, August 21,1886.
     Intestinal Obstruction.  In one pocket-size 12mo. volume of 522 pages, with 60
illustrations. Limp cloth, blue edges, $2.00.  See Series of  Clinical Manuals, page 31.

HOLMES,  TIMOTHY, M. A.,
       Suraeon and Lecturer on Surgery at St. George's Hospital, London.
     A s7Sem of Surgery; Theoretical and Practical.  IN TKEATISES BY
VAEIOUS AUTHORS.  American  edition, thoroughly revised and re-edited
bv John H Packard, M. D., Surgeon to the Episcopal Hospital, Philadelphia, assisted
bv a corps oif thirty-three of the most eminent American surgeons.  In three large octavo
volumes containing 3137 pages, with 979 illustrations on wood and 13 lithographic plates.
Price per set  cloth, $18.00; leather, $21.00.   Sold only by subscription. 
22    Lea Brothers  &  Co.'s Publications—Surgery* Frac, Disloc.
SMITH, STEPHEN,  M.  D.,
       Professor of Clinical Surgery in the University of the City of New York.
     The  Principles and  Practice of  Operative   Surgery.   Second  and
thoroughly revised edition.  In one very handsome octavo volume of 892 pages, with
1005 illustrations.   Cloth, $4.00; leather, $5.00.
                                            operative work.  It can be truly said that as a hand-
  This excellent and very valuable book is one of
the most satisfactory works on modern operative
surgery yet published.  Its author and publisher
have spared no pains to make it as far as possible
an ideal, and their efforts have given it a position
prominent among the recent works in this depart-
ment of surgery. The book is a compendium for
the modern surgeon.  The present edition is much
enlarged, and the text has been thoroughly revised,
so as to give the most improved methods in asep-
tic surgery, and the latest instruments known for
book for the student, a companion for the surgeon,
and even as a book of reference for the physician
not especially engaged in the practice or surgery,
this volume will long  hold a most conspicuous
place, and seldom will its readers, no matter how
unusual the subject,consult its pages in vain.   Its
compact form, excellent print, numerous illustra-
tions, and especially its  decidedly practical char-
acter, all combine to commend it.—Boston Medical
and Surgical Journal, May 10,1888.
HOLMES,  TIMOTHY,  M. A.,
      Surgeon and Lecturer on Surgery at St. George's Hospital, London.
    A  Treatise on  Surgery; Its Principles and Practice.  From  the fifth
English edition, edited by T. Pickering Pick, F. K. C. S.  In one octavo volume of 997
pages, with 428 illustrations.   Cloth, $6.00; leather, $7.00.
                                            for the general practitioner, teaching those things
                                            that are necessary to be known for the successful
                                            prosecution of the physician's career,  imparting
                                            nothing that in our present knowledge is consid-
                                            ered  unsafe, unscientific or inexpedient.—Pacific
                                            Medical Journal, July, 1889.
  To the younger members of the profession and
to others not acquainted with the book and its
merits, we take pleasure in recommending it as a
surgery complete, thorough, well-written, fully
illustrated, modern, a  work sufficiently volumi-
nous for the surgeon specialist, adequately concise
HAMILTON,  FBANK H, M. D., LL.  D.,
      Surgeon to Bellevue Hospital, New York.
    A Practical Treatise on  Fractures  and Dislocations.  New (8th) edi-
tion, revised and edited by Stephen Smith, A. M., M. D., Professor of Clinical Surgery
in the University of the City of New York.   In one very handsome octavo volume of 832
pages, with 507 illustrations.  Cloth, $5.50; leather, $6.50.
  The work of Dr. Hamilton is so well known that
a descriplion is almost unnecessary.  Its numer-
ous editions are convincing proof if any is needed,
of its value and popularity.  It is pre eminently
the authority on fractures and dislocations; and
universally quoted as such.  In the new edition it
has lost none of its former worth. The  additions
it has received by its recent revision make it a
work thoroughly in  accordance with modern
practice, theoretically, mechanically, aseptically.
The task of writing  a complete treatise on a sub-
ject of such magnitude is no easy one.  Dr. Smith
has aimed to make the present volume a correct
exponent of our knowledge of this department
of surgery.   In examining the volume one is at
once struck with the evidence of the vast amount
of labor its compilation and reconstruction must
have necessitated. The more one reads the more
one is impressed with its completeness. The work
has been accomplished, and has been done clearly,
concisely, excellently well.—Boston Medical arid
Surgical Journal, May 26,1892.
STIMSON, LEWIS A., B. A., M. D.,
       Professor of Clinical Surgery in the Medical Faculty of Univ. of City of N. Y.,
     A Manual  of Operative Surgery.   Second edition.  In one very handsome
royal 12mo. volume of 503 pages, with  342 illustrations.  Cloth,  $2.50.
  There is always room for a good book, so that
while many works on operative surgery must be
considered superfluous, that of Dr. Stimson has
held its own. The author knows the difficult art
of condensation.  Thus the manual serves as  a
work of reference,  and  at  the same time  as  a
handy  guide. It teaches what it professes, the
steps of operations.  In this edition  Dr. Stimson
has sought to indicate the changes that have been
effected in operative methods and procedures by
the antiseptic system, and has added an account
of many new operations  and  variations in the
steps of older  operations.  We do  not desire to
extol this manual above many excellent standard
British publications of the same class, still we be-
lieve that it contains much that is worthy of imi-
tation.—British Medical Journal, Jan. 22, 1887.
                              By the same Author.
    A Treatise on Fractures and Dislocations.   In two handsome octavo vol-
umes.  Vol. I., Fractures, 582 pages, 360 beautiful  illustrations.  Vol. II.,  Disloca-
tions, 540  pages, with  163 illustrations.  Complete work, cloth, $5.50; leather, $7.50.
Either volume separately, cloth, $3.00; leather, $4.00.
  The appearance of the second volume marks the
completion of the author's original plan of prepar-
ing a work  which  should  present in  the fullest
manner all that is known on the cognate subjects
of Fractures and Dislocations. The volume on
Fractures assumed at once the position of authority
on the subject, and its companion on Dislocations
will no doubt be similarly received.  The closing
volume of Dr. Stimson's work exhibits the surgery
of Dislocations as it is taught and practised by the
most eminent surgeons of the present time.  Con-
taining the results of such extended researches it
must for a long time be regarded as an authority
on all subjects pertaining to dislocations. Every
practitioner of surgery will feel it incumbent on
him to have it for constant reference.—Cincinnati
Medical News, May, 1888.
PICK,  T. PICKEBING,  F. B. C. S.,
       Surgeon to and Lecturer on Surgery at St. George's Hospital, London.
     Fractures and Dislocations.   In one 12mo.  volume  of 530  pages,  with  93
illustrations.  Limp cloth,  $2.00.  See Series of  Clinical Manuals, page 31.

MABSH,  HOWABD,  F.  B. C.  S.,
       Senior Assistant Surgeon to and Lecturer on Anatomy at St. Bartholomew's Hospital, London.
     Diseases of the Joints.   In one 12mo. volume  of 468 pages, with 64 woodcuts
and a colored plate.  Cloth, $2.00.  See Series of Clinical  Manuals, page 31. 
Lea Brothers & Co.'s Publications—Otology, Ophthalmology.   23
NOBBIS, WM. F., M. D., and  OLIVEB, CHAS. A., M. D.
       Clin. Prof, of Ophthalmology in Univ. of Pa.
  ,   -A- Text-Book of Ophthalmology.  In one octavo volume of about 800 pages
with illustrations.  In press.

BUBNETT, CHABLES H., A.  M., M. D.,
       Professor of Otology in the Philadelphia Polyclinic; President of the American Otological Society.
     The Ear,  Its Anatomy, Physiology and Diseases.   A Practical Treatise
for the use of Medical Students and Practitioners.   Second edition.  In one handsome
octavo volume of 580 pages, with 107 illustrations.  Cloth, $4.00; leather, $5.00.
                                            carried  out, and much  new matter added.  Dr
  We note with pleasure the appearance of a second
edition of this valuable work.  When it first came
out it was accepted by the profession as one of
the standard works on modern aural surgery in
the English language; and in  his second  edition
Dr. Burnett has fully maintained his reputation,
for the book is replete with valuable information
and suggestions.  The revision has been carefully
Burnett's work must be regarded as a very valua-
ble  contribution to aural surgery,  not only on
account of its  comprehensiveness, but because it
contains the results of the careful personal observa-
tion and experience of this eminentaural surgeon.
—London Lancet, Feb. 21,1885.
BEBBY, GEOBGE  A., M. B., F. B.  C.  S., Ed.,
       Ophthalmic Surgeon, Edinburgh Royal Infirmary.
    Diseases Of the Eye.  A Practical Treatise for Students of Ophthalmology.  New
(second) edition.  In one octavo volume of about 700 pages, with about 150 illustrations,
62 of which are beautifully colored.  Preparing.
    A notice of the previous edition is appended.
  This newest candidate for favor among ophthal-
mologioal students is designed to be purely clinical
in character and the plan is well adhered to.  We
have been forcibly struck by the rare good taste
in the selection of  what  is essential which per-
vades the book.  The author seems to have the
uncommon  faculty of viewing  his  subject as a
whole and seizing the salient points and not con-
fusing his reader—presumably a student  and a
novice—with a mass of details with no key to their
unravelling.  It is apparent that the literature ot
each subject has been gone over in a very thor-
ough manner.  The  fact that he was writing a
clinical treatise for beginners and not an encyclo-
paedia has always been present with the author.
The number and  excellence of the colored illus-
trations in the text deserve more than a passing
notice.—Archives of Ophthalmology, Sept. 1889.
NETTLESHIP, EDWABD, F. B.  C. S.,
       Ophthalmic Surgeon at St. Thomas' Hospital, London.  Surgeon to the Royal London {Moorfields}
          Ophthalmic Hospital.

    Diseases of  the Eye.  Fourth American from the fifth English edition, thor-
oughly revised.   With a {supplement on  the Detection  of Color Blindness, by Wil-
liam  Thomson,  M. D., Professor  of Ophthalmology in the Jefferson Medical College.
In one 12mo. volume of 500  pages, with 164 illustrations,  selections from Snellen's test-
types and formulae, and a colored plate.  Cloth, $2.00.
                                            important parts  of clinical  ophthalmology.  A
                                            supplement is made to the present edition on the
                                            practical  examination of railroad  employes as to
                                            color-blindness andacuteness of vision and hear-
                                            ing.   This  is well  written, and  contains good
                                            suggestions for those who may be called on to
                                            make  such examinations.—New  York Medical
  This is a well-known and a valuable work.  It
was primarily intended for the use of students,
and supplies" their needs admirably, but it is as
useful for the practitioner, or indeed more so.  It
does not presuppose the large amount of recondite
knowledge to be present which seems to  be as-
sumed in some of our larger works, is not tedious
from over-conciseness, and yet covers the more
Journal, December 13,1890.
JULEB, HENBY  E., F. B. C. S.,
       Senior Ass't Surgeon,Royal Westminster Ophthalmic Hosp.; la/te Clinical Ass't, Moorfields, London.
    A Handbook  of Ophthalmic  Science and Practice.  English Edition.
Handsome  8™. volume  of 442 pages,  with  125  woodcuts,  27  colored  plates, selec-
tions  from  Test-types of Jaeger  and  Snellen, and Holmgren's  Color-blindness  Test.
Cloth, $5.50;  leather, $6.50.
  It presents to the student concise descriptions
and typical illustrations of all important eye affec-
tions, placed in juxtaposition, so as to be grasped
at a glance.  Beyond a doubt it is the best illus-
trated handbook of ophthalmic science which has
ever appeared.  Then, what is  still better, these
illustrations are nearly all original.  We have ex-
amined this entire work with great care, and it
represents the commonly accepted views of ad-
vanced ophthalmologists. We can most heartily
commend this book to all medical students, prac-
titioners and specialists.—Detroit Lancet, Jan. '85.
CABTEB, B. BBUDENELL,  & FBOST, W.ADAMS,
                                  F. B. C. S.,                     E.  B. C. S.,
       Onhthalmic Surgeon to and Led. on Ophthal-        Ass't Ophthalmic Surgeon and Joint Led.
       mic Surgery at St. George's Hospital, London.        on Oph. Sur., St. George's Hosp., London.
     Ophthalmic Surgery.   In one  12mo. volume  of 559 pages, with  91 woodcuts,
color-blindness test,  test-types and  dots  and appendix of formulae.   Cloth, $2.25.  See
Series of Clinical Manuals, page 31.______________________

WFLLS ON THE EYE.  In one octavo volume.   LAWSON ON INJURIES TO THE EYE, ORBIT
LAURENCE AND MOON'S HANDY  BOOK OF    AND EYELIDS: Their Immediate and Remote
  ^SFf^^'K™^^    Effects. In one octavo volume of 404 pages, with
  ume  of 227 pages, with 65 illus. Cloth, $2.75.     92 illustrations.  Cloth, $3.50. 
24  Lea Brothers & Co.'s Publications—Urin. Dis., Dentistry, etc.


BOBEBTS,  SIB  WILLIAM, M.  D.,
      Lecturer on Medicine in the Manchester School of Medicine, etc.
    A Practical Treatise on Urinary and Renal Diseases, including Uri-
nary  Deposits.   Fourth American  from the fourth  London edition.  In  one hand-
some octavo volume of 609 pages, with 81 illustrations.  Cloth, $3.50.
  It may be said to be the best book in print on the [a completeness not found elsewhere in our lan-
subject of which it treats.—The American Journal  guage m its account of the different  affections.—
of the Medical Sciences, Jan. 1886.                  The Manchester Medical Chronicle, July, 1885.
  The peculiar value and finish of the book are in I   The value of this treatise as a guide book to the
a measure derived from its resolute  maintenance  physician in daily practice  can hardly be over-
of a clinical and practical character.  It is an un-  estimated.  That it is fully up to the level of our
rivalled exposition of  everything which relates ; present knowledge is a fact reflecting great credit
directly or indirectly to the  diagnosis, prognosis  upon Dr. Roberts, who has a wide reputation as a
and treatment of urinary diseases, and  possesses ] busy practitioner.—Medical Record, July 31,1886.

                             By the  Same Author.
    Diet and  Digestion.  In one 12mo. volume of 270 pp. Cloth, $1.50.   Just ready.

PUBDY,   CHABLES  W., M. D.,  Chicago.
    Bright's Disease and Allied Affections  of the Kidneys.  In one octavo
volume of 288 pages, with illustrations.  Cloth, $2.
  The object of this work is to " furnish a system
atic,  practical  and concise  description of the
pathology and treatment of the chief organic
diseases of the kidney associated with albuminu-
ria, which shall represent the most recent ad-
vances in our knowledge on these subjects ;" and
this definition of the object is a fair description of
the book.  The work is a useful one, giving in a
short space the theories, facts and treatments, and
 going more fully into their later developments.
 n treatment the writer is particularly strong,
steering clear of generalities,  and seldom omit-
ting, what text-books usually do, the unimportant
items which are all important to the general prac-
titioner.—The Manchester Medical Chronicle, Oct.
MOBBIS, HENBY, M. B.,  F. B. C. S.,
      Surgeon to and Lecturer on Surgery at Middlesex Hospital, London.
    Surgical Diseases of the Kidney.  In one 12mo. volume of 554 pages, with 40
woodcuts, and 6 colored plates. Limp cloth, $2.25. See Series of Clinical Manuals, page 31.
                                          he  took in hand.  It is a full and trustworthy
                                          book of reference, both for students and prac-
                                          titioners in search of guidance.  The illustrations
                                          in the text and the chromo-lithographs are beau-
                                          tifully executed.— The London Lancet,Feb. 26,1886.
  In  this manual we have a distinct addition to
surgical literature, which  gives information not
elsewhere to be met with in a single work.   Such
a book  was distinctly required, and  Mr. Morris
has very diligently and ably performed the task
LUCAS,  CLEMENT,  M. B.,  B. S., F. B.  C. S.,
       Senior Assistant Surgeon to Guy's Hospital, London.
     Diseases  of the  Urethra.  In one  12mo.  volume.   Preparing.   See  Serie$
of Clinical Manuals, page 4.

THOMPSON,  SIB HENBY,
       Surgeon and Professor of Clinical Surgery to University College Hospital, London.
     Lectures on Diseases of the Urinary Organs.  Second American from the
third English edition.   In one 8vo. volume of 203 pp., with 25 illustrations.  Cloth, $2.25.

                             By the  Same Author.
     On the Pathology and Treatment  of  Stricture of the  Urethra and
Urinary Fistulae.  From the third  English edition.  In one octavo volume of 359
pages, with 47 cuts and 3 plates.  Cloth, $3.50.

THE  AMEBIC AN SYSTEM  OF DENTISTBY.
     In Treatises by Various  Authors.   Edited by Wilbur  F. Litch, M.  D.,
D. D. S.,  Professor of  Prosthetic  Dentistry,  Materia Medica and Therapeutics in the
Pennsylvania College of Dental Surgery.  In three  very handsome octavo volumes con-
taining 3160 pages, with 1863 illustrations and 9 full-page plates.  Per volume, cloth, $6 •
leather,  $7 ; half Morocco,  gilt  top, $8.  The complete work is now ready.   For sale by
subscription only.
  As an encyclopaedia of Dentistry it has no su-
perior.  It should form a part of every dentist's
library, as the information it contains is of the
greatest value to all engaged in the practice of
dentistry.—American Jour. Dent. Sci., Sept. 1886.
  A grand system, big enough and good enough
and handsome enough  for a monument (which
doubtless it is), to mark an epoch in the history ol
dentistry. Dentists will be satisfied with it and
proud of it—they must.  It is sure to be precisely
what the student needs to put him  and  keep him
in the right  track, while the profession at  large
will receive  incalculable benefit from it.__Odonto-
graphic Journal, Jan. 1887.
COLEMAN, A.,  L. B. C.  P., F. B. C. S., Exam. L. D. S.,
      Senior Dent. Surg, and Led. on Dent. Surg, at St. Bartholomew's Hosp. and the Dent. Hosp London
    A Manual of  Dental Surgery and  Pathology.   Thoroughly revised and
adapted to the use of American Students,  by Thomas C. Stellwagen,  M. A. M  D
D. D. S., Prof, of Physiology in the Philadelphia Dental College.  In one handsome not*™
volume of 412 pages, with 331 illustrations.   Cloth, $3.25.
  It should be in the possession of every practi-
tioner in this country.  The part devoted to first
and second dentition and irregularities in the per-
manent teeth is fully worth the price.  In fact,
price should not be considered in purchasing such
called standard text-books could be-converted into
such publications as this, much good would result.
—Southern Dental Journal, May 1882.
Guide to
ON  RENAL DISEASES:  A Clinical I  one 12mo. vol. of 304 pages with 21 Illustrations
 their Diagnosis and Treatment.  In |  Cloth, 82.00. 
Lea Brothers & Co.'s Publications—Dis. of Men, Venereal, Skin.
GBOSS, SAMUEL  W., A.  M., M. D., LL. D.,
  Professor of the Principles of Surgery and of Clinical Surgery in the Jefferson Medical College of Phila.
    A Practical Treatise on Impotence,  Sterility, and Allied Disorders
of  the  Male  Sexual  Organs.  Fourth  edition,  thoroughly  revised  by F.  K.
Sturgis, M. D., Prof, of Diseases of the Genito-Urinary Organs and of Venereal Diseases,
N.  Y. Post Grad.  Med. School.  In one very handsome  octavo volume of 165 pages,
with 18 illustrations.   Cloth, $1.50.
                                            rhoea, and prostatorrhoea.  The book is a practical
                                            one and in addition to the scientific and very in-
                                            teresting discussions on etiology, symptoms, etc.,
                                            there are lines of treatment laid down  that  any
                                            practitioner can follow and which have met witn
                                            success in  the hands of author and editor.—Medi-
                                            cal Record, Feb. 25,1891.
  Three editions of Professor Gross' valuable book
have been exhausted, and  still the  demand is
unsupplied.  Dr. Sturgis has revised  and added
to the previous editions, and the new one appears
more complete and more valuable than before.
Four important and generally misunderstood sub-
jects are treated—impotence, sterility, spermator-
TAYLOB, B. W., A. M., M. D.,
       Clinical Professor of Genito-Urinary Diseasesin the College of Physicians and Surgeons, New York,
                Prof, of  Venereal and Skin Diseases in the University of Vermont.
    The Pathology  and Treatment of Venereal  Diseases.   Including the
results of recent investigations upon  the  subject.  Being the sixth edition of Bumstead
and Taylor.   Entirely  rewritten by Dr. Taylor.  Large 8vo.  volume, about 900 pages,
with about 150 engravings, as well as numerous chromo-lithographs.  In active preparation.
    A notice of the previous edition is appended.
                                           upon the subjects of which it treats, but also one
                                           which has no equal in other tongues for its clear,
                                           comprehensive  and practical  handling of its
  It is a splendid record  of honest labor, wide
research, just comparison, careful scrutiny and
original experience, which will always be held as
a high credit to American medical literature. This
is not only the best work in the English language
themes.—Am. Jour, of the Med. Sciences, Jan. 1884.
CULVEB,  E. M.,  31. D., and HAY DEN,  J.  B., M.D.
      Pathologist and Assistant Attending Surgeon,       Chief of Clinic Venereal Department, Van-
              Manhattan Hospital, N. Y.              derbilt Clinic, Col. of Phys. and Surgs , iv. r.
    A Manual  of Venereal  Diseases
33 illustrations.   Cloth, $1.75.
  This book is a practical treatise, presenting in a
condensed form the  essential features of our pres-
ent knowledge of the  three venereal diseases,
,  In one 12mo. volume of 289 pages, with


adopt as a guide.  The general practitioner needs
a few simple, concise and clearly presented laws,
in the execution of which he cannot fail either to
exit nUUWirugc ui liic  bine;*? *tuoir»i uic*.»ovo, *** mv ^^.^««v*^^ ~- ..-------  \c 1,-u     1 A'   in
syphilis, chancroid and  gonorrhea.  We have ex- cure or prevent the ravages of the maiaaies in
amined this work carefully and have come to the question and the  direful results which their pro-
conclusion that it is the most concise, direct and pagation  entails.—Buffalo Medical and burgieai
able treatise that has appeared  on the subject of Journal, May, 1892.
venereal diseases for the general practitioner to
COBNIL,  V. ,  Prof, to the Faculty of Medicine of Paris, and Physician to the Lourcine Hosp.
    Syphilis,  its Morbid  Anatomy, Diagnosis and Treatment.   Specially
revised by the Author, and translated with notes and additions by J. Henry C. biMES,
M. D., Demonstrator of Pathological Histology in the Univ. of Pa., and J. William
White,  M. D.,  Lecturer on Venereal Diseases, Univ. of Pa.  In one handsome octavo
volume'of 461 pages, with 84 very beautiful illustrations.   Cloth, $3.75.
                                           perusal without the feeling that his grasp of the
                                           wide and important  subject on which it treats is
                                           a  stronger and surer one.—The London Practi-
  The anatomy, the histology, the pathology and
the clinical features of syphilis are represented in
this work in their best, most practical and most
instructive form, and no one will rise from its
tioner, Jan. 1882.
HUTCHINSON,  JONATHAN,  F. B. S.,  F. B. C. S.,
       Consulting Surgeon to the London Hospital.
    Syphilis.  In one 12mo. volume of 542 pages, with 8 chromo-lithographs,

$2.25.   See Series of Clinical Manuals, page 31
  Those who have seen most of the disease and
those who have felt the real difficulties of diagno-
sis and treatment will most highly appreciate the
facts and suggestions which abound in  these
pages.  It is a worthy and valuable record, not
only of Mr. Hutchinson's very large experience
Cloth,
and power of observation, but of his patience and
assiduity in taking notes of his cases  and keep-
ing them  in a form available for such excellent
use as he has put them to in this volume.—London
Medical Record, Nov. 12,1887.
GHOSS  S. D., M.  D., LL. D., D. C. L„ etc.
    A Practical Treatise on the Diseases, Injuries  and Malformations
of  the  Urinary  Bladder, the  Prostate Gland and  the  Urethra.  Third
^ition?tnorough? revised by Samuel, W Gross, M. D.  In one octavo volume  of 574
pages, with 170 illustrations.  Cloth, $4.50._____________

PYE-SMITH,  P.  H„ M. D„ F. B.  S.,

      ~^*gX^of the Skin.  By Philip II.  Pve-Smith  M. D,
F R  g   physician to Guy's Hospital, London.  In one octavo volume of  450 pages,
with illustrations.  Preparing
tttt t TFR'S HANDBOOK OF SKIN DISEASES;
E o^Student^d0Iractitioners■J™™«*™»;
 can edition.  In one 12mo. volume of 353 pages,



le^ISr^^^
WILSON'S STUDENT'S BOOK OF CUTANEOUS
  MEDICINE  AND  DISEASES OF THE SKIN.
  In one handsome small octavo volume of 535
  pages. <. loth, $3.50.
FORMS OF  LOCAL DISEASE  AFFECTING
PRINCIPALLY THE ORGANS OF  GENERA-
TION.  In one 8vo. vol. of 246 pages.  Cloth, $2.25, 
26         Lea  Brothers & Co.'s Publications—Venereal, Skin.
TAYLOB, BOBEBT W„  A.M.,  M.D.,
       Clinical Professor of Genito- Urinarv Diseases in the College of Physicians and Surgeons, New York;
          Surgeon to the Department of Venereal and Skin Diseases of the New York Hospital;  Presi-
          dent of the American Dermatological Association.
    A Clinical Atlas of Venereal and  Skin Diseases:  Including  Diagnosis,
Prognosis  and  Treatment.  In  eight large folio parts,  measuring 14 x 18 inches, and
comprising 58 beautifully colored plates with 213  figures, and 431 pages of text with 85
engravings.  Complete work just ready.  Price  per part,  $2.50.  Bound  in one volume,
half Russia, $27 ; half Turkey Morocco, $28.  For sale by  subscription only.   Specimen
plates sent on receipt of 10 cents.  A full prospectus sent to  any address on application.
  It would be hard to use words which would per-
spicuously enough convey to the reader the great
value of this Clinical Atlas. This Atlas is more
complete even than an ordinary course of clinical
lectures, for in no one college  or hospital course
is it at all probable that all of the diseases herein
represented would be seen.  It is also more ser-
viceable to the majority of students than attend-
ance upon  clinical lectures,  for most of the
students who sit on remote seats in the lecture
hall cannot see the  subject as well as the office
studentcan examine these true-to-life chromo-lith-
ographs.  Comparing the text to a lecturer, it is
more satisfactory in exactness and fulness than
he would be likely to be in lecturing over a single
case.  Indeed, this Atlas is invaluable to the gen-
eral practitioner, for it enables the eye of the
physician to make diagnosis of a  given case of
skin manifestation by comparing the case with
the picture in the Atlas, where will be found also
the text of diagnosis, pathology, and full sections
on treatment.— Virginia Medical Monthly, Dec. 1889.
JACKSON,  GEOBGE THOMAS,  M.D.,
       Professor of Dermatology, Woman's Medical College of the New York Infirmary.
     The  Beady-Reference  Handbook of Diseases of the Skin.   In one
12mo. volume of 544 pages, with 50 illustrations.  Cloth, $2.75.  Just ready.
     This volume is devoted to the art of dermatology, to the practice of this department of
medicine in its latest development. No attempt has been made to discuss debatable ques-
tions, and pathology  and etiology do not receive as full consideration as symptomatology,
diagnosis and treatment.  The alphabetical arrangement of the different diseases has been
adopted as conducive to the greatest possible convenience in  use.  The pages are illus-
trated with a large number of engravings, many being photographic and vivid reproduc-
tions of  actual cases.  A handsome  lithographic  frontispiece adds to the beauty  and
usefulness of a volume for which a wide recognition is assured.
HABDAWAY,  W. A., M. D.,
      Professor of Skin Diseases in the Missouri Medical College, St. Louis.
   ' Manual  of Skin Diseases.   With Special Reference to Diagnosis and Treat-
ment.  For the use of Students and General Practitioners.  12mo., 440 pp.  Cloth, $3.
  Dr. Hardaway's large experience  as a teacher
and writer has admirably fitted him for the diffi-
cult task of preparing a book which, while suffi-
ciently elementary for the  student is yet suffi-
ciently thorough and comprehensive to serve as a
book of reference for the general practitioner.  It
embraces all essential points connected with the
diagnosis and treatment of diseases of the skin,
and we have no hesitation in commending it as
the best  manual  that has  yet appeared in this
department of Medicine.—Journal  of  Cutaneous
and Genito- Urinary Diseases.
HYDE, J.  NEYINS, A. 31.,  M. D.,
       Professor of Dermatology and Venereal Diseases in Rush Medical College, Chicago.
    A Practical Treatise on Diseases of the Skin.  For the use of Students and
Practitioners.   Second edition.   In  one handsome octavo volume  of 676 pages, with
2 colored plates and 85 beautiful and elaborate illustrations. Cloth, $4.50; leather, $5.50.
  His treatise  is like his clinical instruction,
admirably arranged,  attractive  in  diction, and
strikingly practical throughout.  No clearer de-
scription  of the various primary and consecutive
lesions of the skin is  to be met with  anywhere.
Dr. Hyde has  shown  himself a  comprehensive
reader of the latest literature, and  has incorpo-
rated into his  book all the best of that which
the past years have brought forth.  The prescrip-
tions and formulae are given in both common and
metric systems.  Text and illustrations are good,
and colored plates of rare cases lend additional
attractions.  Altogether it is a work exactly fitted
to the needs of a general practitioner, and no one
will make a mistake in purchasing it.—Medical
Press of Western New York, June, 1888.
JAMIESON,  W. ALLAN, M. D.,
       Lecturer on Diseases of the Skin, School of Medicine, Edinburgh.
    Diseases  of the  Skin.  A Manual for Students  and  Practitioners.    Third
edition, revised  and enlarged.   In one octavo  volume of 656 pages, with woodcut and
nine double-page chromo-lithographic illustrations.  Cloth, $6.00.   Just ready.
  In common with other special departments in
medicine, that of dermatology is rapidly approach-
ing an exactness in diagnosis and treatment which
fail ly places it at the front among the specialties.
This volume by Dr. Jamieson is a valuable one for
practitioners and students, as  it  is both full  and
concise without being unwieldy and voluminous__
The Jour, of the Amer. Med. Asso., March 19,1892.
FOX,  T, M. D., F.B. C. P., and FOX, T. C, B.A., M.B. C.S.,
   Physician to the Department for Skin Diseases,          Physician for Diseases of the Skin to the
       University College Hospital, London.                  Westminster Hospital, London.
    An Epitome of Skin Diseases.  With  Formulae.   For Students and Prac-
titioners.   Third edition, revised and enlarged.  In one 12mo. vol. of 238 pp. Cloth, $1.25.
  We cordially recommend Fox's Epitome to those
whose time is  limited and who wish  a  handy
manual to lie upon the table for instant reference.
Its alphabetical  arrangement is suited to this use,
for all one has to know is the name of the disease
and here are its description  and the appropriate
treatment at hand, ready for instant application 
Lea Brothers & Co.'s Publications—Dis. of Women.
The American  Systems of  Gynecology and  Obstetrics.

 A„+?ystei?.s of gynecology and Obstetrics, in  Treatises by American
AUtnors. Gynecology edited by Matthew D. Mann, A. M., M. D., Professor of Obstetrics
and ^7ne,cology in the  Medical Department of the University of Buffalo; and Obstet-
rics edited by  Barton  Cooke  Hirst, M. D., Associate Professor of Obstetrics in the
 University ot Pennsylvania, Philadelphia.  In four very handsome octavo volumes, con-
taining 6bU pages, 1092 engravings and 8 plates.  Complete work now ready.  Per vol-
U^j=   XX ft,   '  leather>  $6-00; half Eussia,  $7.00.   For sale by subscription  only.
Address the Publishers.  Full descriptive circular free on application.
LIST OF  CONTRIBUTORS.
      WILLIAM H. BAKER, M. D
      ROBERT BATTEY, M.D.
      SAMUEL C. BUSEY, M. IX,
      JAMES C. CAMERON, M. D
      HENRY C. COE, A. M., M. D.
      EDWARD P. DAVIS, M. D.,
      G. E. De SCHWEINITZ, M. D.,
      E. C. DUDLEY, A. B., M. D .
      B. McE. EMMET, M. D.,
      GEORGE J. ENGELMANN, M. D.,
      HENRY J. GARRIGUES, A. M., M. D.,
      WILLIAM GOODELL, A. M., M. D.,
      EGBERT H. GRANDIN, A. M., M. b.,
      SAMUEL W. GROSS, M. D.,
      ROBERT P. HARRIS, M. D.,
      GEORGE T. HARRISON, M. D.,
      BARTON C. HIRST, M. D.
      STEPHEN Y. HOWELL, M. D.,
      A. REEVES JACKSON, A. M., M. D.,
      W. W. JAGGARD, M. D.,
      EDWARD W. JENKS, M. D., LL. D.,
  These volumes are the contributions of the most
eminent gentlemen of this country in these de-
partments of the profession. Each contributor pre-
sents a monograph upon his special topic, so that
everything in the way of history, theory, methods,
and results is presented to our fullest need. As a
work of general reference, it will be found remarka-
bly full and instructive  in every direction of
inquiry.— The Obstetric  Gazette, September, 1889.
  One is at a loss to know what to say of this vol-
ume, for fear that just and merited praise may be
mistaken for flattery.  The papers of Drs.  Engel-
mann, Martin, Hirst, Jaggard and Reeve are incom-
parably beyond anything that can be found in
obstetrical works.—Journal of the American Medical
Association, Sept. 8,1888.
  In our notice of the "System of Practical Medi-
cine by American Authors," we made the  follow-
ing statement:—"It is  a  work of which the pro-
fession in this country can feel proud. Written
exclusively by American physicians who are ac-
quainted with all the varieties of  climate in the
      HOWARD A. KELLY, M. D.,
      CHARLES CARROLL LEE, M. D.,
      WILLIAM T. LUSK, M. D., LL. D.,
      J. HENDRIE LLOYD, M. D.,
      MATTHEW D. MANN, A. M., M. D.,
      H. NEWELL MARTIN, F. R.  S., M. D.,
      RICHARD B. MAURY, M. D.,
      C. D. PALMER, M. D.,
      ROSWELL PARK, M. D.,
      THEOPHILUS PARVIN, M. D., LL. D.,
      R. A. F. PENROSE, M. D., LL. D.,
      THADDEUS A. REAMY, A. M., M. D.,
      J. C. REEVE, M. D.,
      A. D. ROCKWELL, A. M., M. D.,
      ALEXANDER J. C. SKENE, M. D.,
      J. LEWIS SMITH,  M. D.,
      STEPHEN SMITH, M. D.,
      R. STANSBURY SUTTON, M. D.. LL. D.,
      T. GAILLARD THOMAS, M. D., LL. D.,
      ELY VAN DE WARKER, M. D.,
      W. GILL  WYLIE, M. D.
United States, the character of the soil, the man-
ners and customs of the people, etc., it is pecul-
iarly adapted to the wants of American practition-
ers of medicine, and it seems to us that every one
of them  would desire to have it."  Every word
thus expressed in regard to the "American Sys-
tem of Practical Medicine" is  applicable to the
"System  of  Gynecology by  American Authors."
It, like the  other, has  been written exclusively
by American physicians who are acquainted with
all the characteristics of American people, who are
well informed in regard to the peculiarities  of
American women, their manners, customs, modes
of living, etc.  As every practising physician is
called upon to treat diseases of females, and  as
they constitute a class  to which the family  phy-
sician must give attention, and  cannot pass  over
to a specialist, we do not know of a work in any
department of medicine that we should so strongly
recommend medical men generally purchasing.—
Cincinnati Med. News, July, 1887.
EMMET,  THOMAS  ADDIS,  M. D., LL. D.,
       Surgeon to the Woman's Hospital, New York, etc.
    The Principles and Practice of Gynaecology;  For the use of Students and
Practitioners  of Medicine.   Third edition, thoroughly revised.   In one large and very
handsome octavo volume of 880 pages, with  150 illustrations.   Cloth, $5;  leather, $6.
                                            the privilege thus offered them of perusing the
                                            views and practice of the author. His earnestness
                                            of purpose and conscientiousness are manifest.
  We are in doubt whether to  congratulate the
author more than the profession upon the appear-
ance of the third edition of this well-known work.
Embodying, as it does, the life-long experience of
one who has conspicuously distinguished himself
as a bold and  successful operator, and who has
devoted so much  attention  to the  specialty, we
feel sure the profession will not fail to appreciate
He gives not only his individual experience  but
endeavors to represent the actual state of gynae-
cological  science and art.—British Medical Jour-
nal, May 16,1885.
EDIS, ABTHUB  W., M. D., Lond., F.B. C.P., M.B. C.S.,
       Assist. Obstetric Physician to Middlesex Hospital, late Physician to British Lying-in Hospital.
     The  Diseases of Women.  Including  their  Pathology, Causation, Symptoms,
Diagnosis and Treatment.  A Manual for Students and Practitioners.  In one handsome
octavo volume of 576 pages, with 148 illustrations.  Cloth, $3.00; leather, $4.00.
  The special  qualities  which  are  conspicuous I among the  more common  methods of  treat-
are thoroughness in  covering the whole ground,  «
clearness of description and conciseness of state-
ment.   Another marked feature of the book is
the attention  paid to the details pf many minor
surgical  operations  and  procedures  as,  for
instance, the use of tents, application of leeches,
and  use of hot  water injections.   These  are
ment, and yet very little is said  about them in
many of the text-books.  The  book is one to be
warmly recommended especially to students  and
general practitioners, who need a concise but com-
plete resume of the whole  subject.  Specialists, too,
will find many useful hints in its pages.—Boston
Med. and Surg. Journ., March 2,1882.
HODGE ON DISEASES PECULIAR TO WOMEN
  Incl uding Displacements of the Uterus. Second
  edition, revised and enlarged.  In one beauti-
  fully  printed octavo volume of 519 pages, with
  original illustrations.  Cloth, $4.60.
WEST'S LECTURES ON THE DISEASES  OF
  WOMEN  Third American from the third Lon-
  don edition.  In one octavo volume of 543 pages.
  Cloth, $3.75; leather, $4.75.   , 
28      Lea Brothers & Co.'s Publications—Diseases of Women.
THOMAS, T. GAILLABD, and  MUNDE,  PAUL F.,
                          31. D., LL. D.,                               M. D.9
Emeritus Professor of Diseases of Women in the College      Professor of Gynecology in the New  York
         of Physicians and Surgeons, N. Y.                             Polyclinic.
    A Practical Treatise on the Diseases  of Women.   New (sixth) edition,
thoroughly revised and rewritten by Dr. Mtjnde.   In one  large and handsome  octavo
volume of 824 pages, with 347  illustrations, of which 201 are new.   Cloth, $5;  leather, $6.
  Probably no treatise ever written by an Ameri-
can author on a medical topic has been accepted
by more practitioners, as a standard text-book, or
read with pleasure and profit by more medical
students than Thomas on the diseases of women.
Next to the indescribable charm of listening to
Dr. Thomas' lectures and clinics, which have in
them the element of a captivating and inspiring
personality—which must be heard and felt to be
properly appreciated—is this volume, which in
classic excellence, elegance of diction and scholar-
ly and scientific statement must remain what it
long has been, a standard text-book both for prac-
titioner and student, at home and abroad, and an
enduring pride to American gynecologists.  In a
field by  no means new or wanting in  honorable
achievement, Dr. Munde has added to his already
enviable reputation by the manner in  which he
has acquitted  himself in an undertaking at once
so delicate  and difficult and for which he will
receive,  at the hands of the profession, their ac-
knowledgment.— The Brooklyn Med. Jour., Mar. '92.
TAIT,  LAWSON,  F.B.  C. S.,
       Professor of Gynecology in Queen's College, Birmingham; late President of the British  Gyne-
       cological Society; Fellow American Gynecological Society.
    Diseases of  Women and Abdominal  Surgery.  In two octavo volumes.
Volume  I., 554 pages,  62 engravings and 3 plates.   Cloth,  $3.  Volume II., preparing.
  The plan of the work does not indicate the regu-
lar system of a text book, and yet nearly every-
thing of disease pertaining to the various organs
receives a fair consideration.  The description of
diseased conditions is exceedingly clear, and the
treatment, medical or surgical, is very satisfactory.
Much of the text is  abundantly illustrated  with
cases, which add value in showing the results of
the suggested plans  of treatment.  We feel con-
fident that few gynecologists of the  country will
fail to place the work  in  their libraries.— The
Obstetric Gazette, March, 1890.
SUTTON, J. BLAND,  F. B. C. S.9
       Assistant Surgeon to the Middlesex Hospital, London.
     Surgical Diseases  of the Ovaries and  Fallopian Tubes, including
Tubal  Pregnancy.   In  one crown octavo volume of-544 pages with 119 engravings
and 5 colored plates.  Cloth, $3.  Just ready.
  To gynecologists the name of Mr. Sutton has that the  writer _has to say is stated in a clear,
long been familiar as that of a  conscientious
worker in pelvic pathology, as well  as a compara-
tive  anatomist of wide reputation. The present
volume contains the substance of valuable papers
which have been scattered throughout journals
and society reports during the past five or six
years, and deserves the careful attention of gen-
eral readers as well as of specialists.  Everything
practical  way.  The  author's style is  singularly
concise—almost epigrammatic. Statements which
in a less weighty authority might appear too dog-
matic gather force  by the  positive manner  in
which they are made.  We have no hesitation in
pronouncing it the best monograph of the kind
which has yet appeared.—Medical Record,  New
York, May 21, 1892.
DAVENPOBT, F.  H.,  M.  D.,
       Astistant in Gynaecology in the Medical Department of Harvard University, Boston.
     Diseases of Women, a  Manual of Non-Surgical  Gynaecology.   De-
signed especially for the Use of  Students and General Practitioners.    New (second)
edition.   In one  handsome  12mo. volume of 314  pages, with 107 illustrations.  Cloth,
$1.75.  Just ready.
  The admirable tact of the author has given us a
most excellent  book.  By omitting surgical gyn-
ecology and conditions of rare occurrence, as well
as discussions on rare and disputed points and
pathological anatomy, much space has been saved.
Much attention has been paid to the description
and elucidation of seemingly minor but actually
very important  points which are not found  in
ordinary text-books. The pages devoted to meth-
ods of examination  are deserving of the highest
commendation, as well as those devoted to a de-
scription of instruments and general methods of
treatment.  While not over-elaborate, they are
explicit and  markedly practical.   The  whole
work is in fact eminently practical, being devoted
almost exclusively to symptomatology and treat-
ment.  It is upon the latter subject that the value
of the book chiefly lies.—Gaillard's Medical  Jour-
nal, August, 1892.
MAY,  CHABLES H.,  M.  D.,
       Late House Surgeon to Mount Sinai Hospital, New York.
     A Manual of theDiseases of Women.  Being a concise and systematic expo-
sition  of the theory and practice of gynecologv.   Second edition, edited by L. S. Rau
M. D., Attending Gynecologist at the Harlem Hospital, X. Y.   In  one 12mo. volume of
360 pages, with 31  illustrations.   Cloth, $1.75.

                                            rapidly but has not the time to consult larger
                                            works.  We are much struck with the readiness
                                            and convenience with which one can refer to any
                                            subject contained in this volume. Carefully com-
                                            piled indexes and ample illustrations also enrich
                                            the work.  This manual will be  found to fulfil its
                                            purposes  very satisfactorily.—The Physician and
                                            Surgeon, June, 1890.
  This is a manual of gynecology in a very con-
densed form, and the fact that a second edition
has been called for indicates that it has met with
a favorable reception.   It is intended, the author
tells us, to aid the student who after having care-
fully perused larger works desires  to review the
subject, and he adds that it may be useful to the
practitioner who wishes to  refresh his memory 
Lea  Brothers  &  Co.'s Publications—Obstetrics, Dis. of Worn.  29
PABVIN,  THEOPHILUS, M.  D.,  LL.  D.,
       Prof, of Obstetrics and the Diseases of Women and Children in Jefferson Med. Coll., Phila.
     The Science and Art of Obstetrics.   Second edition.  In one handsome 8vo.
volume of 701 pages, with 239 engravings and a colored plate.  Cloth, $4.25; leather, $5.25.
nJ.h.en?e0c.°nf ^ition of this work is fully up to the | obstetric literature can be found a work which is
Kf«  ?n«!atei?f advancement of the obstetric art.
lhe  author  has succeeded  exceedingly well  in
incorporating new matter without apparently in-
creasing the size of his  work or interfering  with
the smoothness and grace of its literary construc-
tion   He is very felicitous in his descriptions of
conditions, and proves himself in this  respect a
scholar and  a master.  Rarely in the  range  of
 o comprehensive and yet compact and practical.
In such respect it is essentially a text book of the
first merit.  The treatment of the subjects gives a
real value to the work—the individualities of a
practical  teacher, a skilful obstetrician,  a close
thinker and a ripe scholar.—Medical Record, Jan.
17,1891.
PLAYFAIB,  W.  S., 31. D.,  F. B. C. P.,
       Professor of Obstetric Medicine in King's College, London, etc.
    A Treatise on the Science  and Practice of Midwifery.  Fifth Amer-
ican, from the seventh English edition.  Edited, with additions, by Robert P. Harris,
M. D.   In one handsome octavo volume of  664 pages, with 207 engravings and 5 plates.
Cloth,  $4.00;  leather, $5.00.
  Truly a wonderful book;  an epitome of all ob-
Btetrical knowledge, full, clear and concise. In
thirteen years it has reached seven editions.  It
is perhaps the most popular work of its kind ever
presented to the profession.  Beginning with the
anatomy and physiology of the organs concerned,
nothing is left  unwritten that the practical ac-
coucheur should  know. It seems  that every
conceivable physiological or pathological condi-
tion from the moment of conception to the time
of complete  involution has  had  the  author's
patient attention.  The  plates  and illustrations,
carefully studied, will teach the science of mid-
wifery.  The reader of this book will have before
him the very latest and best of obstetric practice,
and also of all the coincident troubles connected
therewith.—Southern Practitioner, Dec. 1889.
In one 12mo. volume of 450
KING,  A.  F. A., M.  D.,
       Professor of Obstetrics and Diseases of Women in the Medical Department of the Columbian Univer-
       sity, Washington, D. C, and in the University of Vermont, etc.
    A Manual of Obstetrics.   New (Fifth) edition.
pages, with 150 illustrations.  Cloth, $2 50.   Just ready.
    A notice of  the previous edition is appended.
  Dr. King, in the preface to the first aiition of
this manual, modestly states that  "its purpose is
to furnish a good  groundwork to the student at
the beginning of his obstetric studies."  Its pur
pose is attained; it  will  furnish a good ground-
work to the student who carefully reads it;  and
further, the busy practitioner should not scorn the
volume because written for students, as it con-
tains much valuable obstetric knowledge, some
of which  is not found  in more elaborate text-
books.  The  chapters on the  anatomy of the
female generative organs, menstruation, fecunda-
tion, the signs of pregnancy, and the diseases ol
pregnancy, are all excellent and clear; but it is in
the description of labor, both normal and abnor-
mal, that Dr. King is at his best.   Here his  style
is  so concise, and the illustrations  are so good,
that the veriest tyro could not fail to receive a clear
conception of labor, its complications and treat-
ment.  Of  the 141 illustrations it may  be safely
said that they all illustrate, and that the engraver's
work is excellent. From every standpoint we can
most heartily recommend the book both to practi-
tioner and student.—The Medical News, Dec. 7,1889.
BABNES,  BOBEBT,  M. D.,  and  FANCOUBT,  M.  D.,
       Phys. to the General Lying-in Hosp., Lond.           Obstetric Phys. to St. Thomas' Hosp., Land.
    A System  of Obstetric Medicine and Surgery, Theoretical and Clin-
ical.  For the Student and the Practitioner.  The Section on Embryology by Prof. Milnes
Marshall.   In one 8vo. volume of 872 pp., with 231 illustrations.  Cloth, $5; leather, $6.
                                            the best obstetrical opinions of the time in a
                                            readily accessible and condensed form, ought to
                                            own a copy of the book.—Journal of the American
  The immediate purpose of the work is to furnish
a handbook  of obstetric medicine and surgery
for the use of the student and practitioner.  It is
not an exaggeration to say of the book that it is
the best treatise in  the English language yet
published, and this will not be a surprise to those
who are acquainted  with the work of the  elder
Barnes.   Every practitioner who desires to have
Medical Association, June 12, 1886.
  The Authors have made a text-book which is in
every way quite worthy to take a place beside the
best treatises of the period.—New York Medical
Journal, July 2, 1887.
DUNCAN, J. MATTHEWS, M.D., LL. D., F. B. S. E., etc.
    Clinical Lectures on the Diseases  of Women;  Delivered in  Saint Bar-
tholomew's Hospital.   In one handsome octavo volume of 175 pages.  Cloth, $1.50.
                                             rule, adequately handled in the text-books; others
                                             of them, while bearing upon topics that are usually
                                             treated of at length in such works, yet bear such a
  They are in every way worthy of their author;
indeed, we look upon them as among the most
valuable of his contributions.  They are  all upon
matters of great interest to the general practitioner.
Some of thlm deal with subjects that are  not, as a
stamp of individuality that they deserve to  be
widely read.—N. Y. Medical Journal, March, 1880.
WINCKEL, F.
    A  Complete Treatise on the Pathology and Treatment of Childbed.
For Students and Practitioners.  Translated, with the consent of the Author, from the
second German edition, by J. R. Chadwick, M. D.  Octavo 484 pages.   Cloth, $4.00. 
30       Lea Brothers  & Co.'s Publications—Obstet., l>is. Childn.
SMITH, J.  LEWIS, M. D.,
       Clinical Professor of Diseases of Children in the Bellevue Hospital Medical College, N. Y.
     A Treatise on the Diseases of  Infancy and Childhood.  New (seventh)
edition,  thoroughly  revised  and  rewritten. In  one handsome octavo  volume of  881
pages, with 51 illustrations.  Cloth, $4.50;  leather, $5.50.
  We have always considered Dr. Smith's book as
one of the very best on the subject. It has always
been practical—a  field  book, theoretical where
theory has been deduced from  practical experi-
ence.  He takes his theory from the bedside and
the pathological laboratory. The very practical
character of this book has always appealed to us.
It is characteristic of Dr. Smith in all his writings
to collect whatever recommendations are found in
medical literature, and his search has been wide.
One seldom fails to find here a practical suggestion
after search in other works has been in vain.  In
the seventh edition we note a variety of changes
in accordance with the progress of the times. It
still stands foremost as the American  text-book.
The literary style could not be excelled, its advice
is always conservative and thorough, and the
evidence of research has long since  placed its
author in the front rank of medical teachers.—
The American Journal of the Medical Sciences, Dec.
1891.
  It has long been known as one of the ablest and
most trustworthy books on the subject, and the
latest edition is likely to add to its fame.—Edin-
burgh Medical Journal, August, 1892
  In the present edition we notice that many of
the chapters have been entirely rewritten.  Full
notice is taken of all the  recent advances that
have been made.  Many diseases not previously
treated of have received special chapters.  The
work is a very practical one.   Especial care has
been taken that the directions for treatment shall
be particular and full.  In no other work are such
cartful instructions given in the  details of infant
hygiene and  the artificial  feeding of infants.—
Montreal Medical Journal, Feb. 1891.
LANDIS, HENBY G., A.  M., M.  D.,
       Professor of Obstetrics and the Diseases of Women in Starling Medical College, Columbus, O.
    The  Management of Labor,  and  of the  Lying-in Period.   In one
handsome  12mo. volume of 334 pages, with 28 illustrations.  Cloth, $1.75.
  The author has designed to place in the hands I as we can see, nothing is omitted.  The advice is
of the young practitioner a book in which he can  sound, and the procedures are safe and practical.
find necessary information in an instant.  As far | Centralblatt fur Gynakologie, December 4,1886.

HEBMAN,   G.  EBNEST,  M.B.,  F.B. C. P.,
       Obstetric Physician to the London Hospital.
    First Lines  in Midwifery: a Guide to Attendance  on Natural Labor
for  Medical  Students  and Midwives.   In one 12mo. volume of 198 pages with
80 illustrations.  Cloth, $1.25.  Just ready.   See Student's Series of  Manuals, below.
                                             student and the educated midwife.   The work
                                             is  written in a plain,  simple  style,  and is  as
                                             much as  possible devoid of technical terms.  It
                                             will prove valuable to the beginner in midwifery
                                             and could be read with advantage by the majority
                                             of  practitioners, old  and  young.—The   Medical
                                             Fortnightly, April 15,1892.
  This work is designed to give such elementary
knowledge  as may be needed by a midwife or
student in the care of their first cases  of normal
labor, and it presents that knowledge  in a clear
and practical  way.— The American Journal of Ob-
stetrics, April, 1892.
  This is a little book, intended for the medical
OWEN, EDMUND, M. B., F.  B.  C. S.,
       Surgeon to the Children's Hospital, Great Ormond St., London.
     Surgical Diseases  of Children.  In one 12mo. volume of 525 pages, with  4
chromo-lithographic plates and 85 woodcuts.   Cloth, $2.  See Series of Clinical Manuals,
page 31.
                                             honestly recommended to both  students  and
  One is immediately struck on reading this book
with its agreeable style and the evidence it every-
where presents of the practical familiarity of its
author with his subject.  The book  may be
practitioners.  It is  full of sound information,
pleasantly given.—Annals of Surgery, May, 1886.
STUDENT'S SEBIES OF MANUALS.

   A Series of Fifteen Manuals, for the use of Students and Practitioners of Medicine and Surgery
written by eminent Teachers or Examiners, and issued in pocket-size 12mo volumes of 300-540 pageV
richly illustrated and at a low price.  The following volumes are now ready: Luff's Manual of Chem-
istry, |2; Herman's  First Lines in Midwifery, $1.25; Treves' Manual of Surgery, by various writers in
three volumes, per set, $6; each, $2;  Bell's Comparative Anatomy and Physiology, $2; Gould's Surgical
Diagnosis, $2; Robertson's Physiological Physics, $2; Bruce's Materia Medica and Therapeutics (4th edi-
tion), $1.50; Power's Human Physiology (2d edition), $1.50;  Clarke and Lockwood's DUsectors' Man-
ual, $1.50; Ralfe's  Clinical Chemistry, $1.50; Treves' Surgical Applied Anatomy, $2;  Pepper's Surgical
Pathology,  $2; and Klein's Elements of Histology (4th edition), $1.75.  The following is in press-
Pepper's Forensic Medicine.  For separate notices see index on last page.

                                             ASHWELL'S PRACTICAL TREATISE ON TTTT?
                                              DISEASES PECULIAR TO  WOMEN  Third
                                              American from  the third and revised' London
                                              edition.  In one 8vo. vol., pp. 520.  Cloth  ft3 fin
                                             MEIGS ON THE NATURE, SIGNS AND TRW at-
                                              MENT OF CHILDBED FEVER  In one 8vr"
                                              volume of 346 pages. Cloth. $2 00             '
                                             RAMSBOTHAM'S PRINCIPLES'  AND   ppjo
                                              TICE OF  OBSTETRIC  MEDICINE  ANn
                                              SURGERY.  In reference to  the Process  of
                                              Parturition. A new and enlarged edition, thor-
                                              oughly revised by the  Author.  With additions
                                              by W. V. Keating, M. D., Professor of Obstetrics
                                              etc., in the Jefferson Medical College of Phil*:
                                              delphia.   In one large and handsome imperial
                                              octavo volume  of  640 pages, with 64 full Da„'
                                              plates and 43 woodcuts in the text, containing
                                              all nearly 900 hnn.nt.ifnl fS<,n,oo  fiVrnnoW w~° ln
CONDIE'S  PRACTICAL TREATISE  ON  THE
  DISEASES OF CHILDREN.  Sixth edition, re-
  vised and augmented.  In one octavo volume of
  779Dages. Cloth. $5.25; leather. 86.25
LEISHMAN'S SYSTEM  OF MIDWIFERY, IN-
  CLUDING THE DISEASES OF PREGNANCY
  AND THE PUERPERAL STATE.  Fourth edi-
  tion. Octavo.
WEST ON SOME DISORDERS OF THE NERV-
  OUS SYSTEM IN CHILDHOOD.  In one small
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PARRY ON EXTRA-UTERINE  PREGNANCY'
  Its Clinical History, Diagnosis,  Prognosis and
  Treatment.  Octavo, 272 pages.   Cloth, $2.50.
CHURCHILL ON THE PUERPERAL FEVER
  AND OTHER DISEASES PECULIAR TO WO-
  MEN. In one 8vo. vol. of 464 pages.  Cloth, $2.60.
TANNER ON PREGNANCY.  Octavo, 490 pages,
  colored plates, 16 cuts.  Cloth, $4.25. 
Lea Brothers & Co.'s Publications—Med. Juris., Miscel.
SEBIES  OF CLINICAL MANUALS.
   In arranging for this Series it has been the design of the publishers to provide the profession with
a collection of authoritative monographs on important clinical subjects in a cheap and portable form.
  t vo'umes contain about 550 pages and are freely illustrated by chromo-lithographs and wood-
?v?  d    e fo1 lowing volumes are now ready:  Yeo on Foodin Health and Disease, $2; Broadbent on
fK  £"'*e> $1.75;  Carter* Frost's Ophthalmic Surgery, $2.25; Hutchinson on Syphilis, $2.25;  Ball on
the Rectum and Anus,  $2.25; Marsh on the Joints, $2; Owen on Surgical Diseases  of Children, $2;
Morris on Surgical Diseases of the Kidney, $2.25;  Pick on  Fractures and Dislocations, $2;  Butlin on
rpif ™onQue' $5-50; Treves on Intestinal Obstruction, $2; and Savage on Insanity and Allied Neuroses, $2.
lhe following is in active preparation:  Lucas  on Diseases of the Urethra.  For separate notices see
index on last page.

TAYLOB, ALFBED S., 31. D.,
       Lecturer on Medical Jurisprudence and Chemistry m Guy's Hospital, London.
    A  Manual of Medical Jurisprudence.   New American from the  twelfth
English edition.   Thoroughly revised by Clark Bell, Esq., of the New York Bar.  In
one octavo volume  of about  S00 pages, with 56 illustrations.  Just ready.  Cloth, $4.50;
leather, $5.50.

    This work is the authority recognized not only by the medical profession but also by the
Courts of all English-speaking countries.  The present (9th) American edition, being based
on the  llth English edition,  has had the benefit of  successive revisions by the foremost
medical  experts, and finally by a legal authority who has made the subject an especial study
from  the standpoint of American practice.

                               By the Same Author.
     Poisons in Relation  to Medical Jurisprudence and Medicine.   Third
American, from the third and revised English edition.  In one large octavo volume of 788
pages.   Cloth, $5.50;  leather, $6.50.

PEPPEB,  AUGUSTUS J., M. S.,  M. B.,  F.  B. C.  S.,
       Examiner in Forensic Medicine at the University of London.
     Forensic Medicine.   In one pocket-size 12mo. volume.  Preparing.  See Students'
Series of Manuals, below.

LEA, HENBY C.,LL. D.
     The  Formulary of  the Papal Penitentiary.
pages with a frontispiece.  Shortly.

                               By the same Author.
     Chapters  from the  Religious History of Spain.
of 522  pages.  Cloth, $2.50.
  The width, depth and thoroughness of research
which have earned Dr. Lea a high European place
as the ablest historian  the Inquisition  has yet
found are here applied to some side-issues of that
great subject. We have only to say of this volume
that it worthily complements the author's earlier
studies in ecclesiastical history.  His extensive
and minute learning, much of  it from  inedited
manuscripts in Mexico, appears  on every page.—
London Antiquary, Jan. 1891.
  After attentively reading the work one does not
know whether the author is a Catholic, a Protestant
In one  8vo volume of 221
-In one  12mo. volume
or a free-thinker.  This moderation deprives the
indictment of none of its force.  The facts and
the documents, of which the number and novelty
attest a patient erudition, are grouped in luminous
order and produce on the reader an effect all the
more powerful in that it seems the less designed.
When we add that the style is in every way excel-
lent, that it is  clear, sober and precise, we do full
justice to a work which reflects the highest honor
on the talents of the writer and on the method ot
the  modern  school  of history.—Revue Critique
d'Histoire et de Literature, Paris, Jan. 1891.
                              By the same Author.
     Superstition and Force: Essays on The Wager of Law, The Wager of
Battle,  The  Ordeal and Torture.   Kevised and  enlarged  edition.   In one hand-
some royal 12mo. volume of about 600 pages.  New (fourth) edition.  In press.

                              By the Same Author.
     Studies in Church History.  The Rise of the Temporal Power—Ben-
efit of Clergy—Excommunication—The Early Church and Slavery.  Sec-
ond and revised edition.   In one royal octavo volume of 605 pages.  Cloth, $2.50.
                                            complex or  conflicting forces.—Boston  Traveller.
                                              It is some years since we read the first edition
                                            of this work by Mr. Lea, and the impression made
                                            by it on us at  the time is confirmed by reperusal
                                            of it in this enlarged and improved form; namely,
                                            that it is a book of great research and  accuracy,
                                            full  of  varied  information on very interesting
                                            phases of church life and history.  It  discusses
                                            each subject with a rare fulness of dates and in-
                                            stances, and a curious  conscientiousness of veri-
                                            fication and citation of authorities.—Edinburgh
                                            Scotsman.
  The author is preeminently a scholar; he takes
up every topic allied with the leading theme and
traces it out to the minutest detail with a wealth
of knowledge and impartiality of treatment that
compel admiration.  The amount of information
compressed into  the book is extraordinary, and
the profuse citation of authorities and references
makes the work particularly valuable to the student
who desires an exhaustive review from original
sources.  In no other single volume is the develop-
ment of the primitive church traced with so much
clearness and with so definite  a perception  of
                              By the Same Author.
    An  Historical  Sketch  of  Sacerdotal  Celibacy  in  the  Christian
Church.  Second edition, enlarged.  1 n one octavo volume of 685 pages.  Cloth, $4.50.
  This subject has recently been treated with very
ereat learning and with admirable impartiality by
In American author, Mr. Henry C Lea, in his His-
tory of Sacerdotal Celibacy, which is certainly one
of the most valuable works that America has pro-
duced. Since the great history of Dean Milman,
I know no work  in English which has thrown
more light on the moral condition of the Middle
Ages, and none which is more fitted to dispel the
gross illusions concerning that period which posi-
tive writers and writers of a certain ecclesiastical
school have conspired to sustain.—Lecky's History
of European Morals, Chap. V. 
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Abbott's Bacteriology '  '        .     .
Allen's Anatomy      ....
American Journal of the Medical Sciences
American Systems of Gynecology and Obstetrics
American System of Practical Medicine .
American System of Dentistry
Ashhurst's Surgery    ....
Ashwell on Diseases of Women
Attfield's Chemistry
Ball on the Rectum and Anus
Barlow's Practice of Medicine
Barnes' System of Obstetric Medicine
Bartholow on Electricity
Basham on Renal Diseases .
Bell's Comparative Anatomy and Physiology   7, i
Bellamy's Surgical Anatomy
Berry on the Eye      ....
Billings' National Medical Dictionary   .     .    4
Blandford on Insanity      .    .     .     .19
Bloxam's Chemistry   .     .     .          .9
Bristowe's Practice of Medicine        .     .    13
Broadbent on the  Pulse     .     .     .     . 17,31
Browne on Koch's Remedy .     .     .     .    J7
Browne on the Throat, Nose and Ear   .     .    17
Brace's Materia Medica and Therapeutics    . 11,30
Brunton's Materia Medica and Therapeutics  .    12
Bryant's Practice of Surgery .     ...    21
Bumstead and Taylor on Venereal.  See Taylor.  25
Burnett on the Ear    .                         23
Butlin on the Tongue .                     . 20,31
Carpenter on the  Use and Abuse of Alcohol   .    7
Carpenter's Human Physiology  ...    7
Carter <fe Frost's Ophthalmic Surgery   .     .23,31
Chambers on Diet and Regimen  ...    16
Chapman's Human Physiology   ...    8
Charles' Physiological and Pathological Chem.    10
Churchill on Puerperal Fever    ...    30
Clarke and Lockwood's Dissectors' Manual   .  6,30
Classen's Quantitative Analysis  ...    10
Cleland's Dissector    ....
Clouston on Insanity  .
Clowes' Practical  Chemistry
Coats' Pathology
Cohen on the Throat
Cohen's Applied Therapeutics
Coleman's Dental Surgery
Condie on Diseases of Children
Cornil on Syphilis    ....
Cullerier & Bumstead on Venereal
Culver & Hayden on Venereal Diseases .
Dalton on the Circulation
Dalton's HumanPhysiologv
Davenport on Diseases of Women .
Davis' Clinical Lectures
Draper's Medical  Physics
Druitt's Modern Surgery
Duncan on Diseases of Women
Dungllson's Medical Dictionary
Edes' Materia Medica and Therapeutics
Edison Diseases of Women .
Ellis' Demonstrations of Anatomy
Emmet's Gynaecology
Erichsen's System or Surgery
Farquharson's Therapeutics and Mat. Med.
Finlayson's Clinical Diagnosis
Flint on Auscultation and Percussion
Flint on Phthisis      ....
Flint on Respiratory Organs
Flint on the Heart
Flint's Essays  .....
Flint's Practice of Medicine
Folsom's Laws of TJ. S. on Custody of Insane
Foster's Physiology   ....
Fothergill's Handbook of Treatment
Fownes' Elementary Chemistry  .
Fox on Diseases of the Skin .
Frankland and Japp's Inorganic Chemistry
Fuller on the Lungs and Air Passages  .
Gant's Student's Surgery
Gibbes' Practical  Pathology
Gould's Surgical Diagnosis  .
Gray's Anatomy  .         ...
Gray on Nervous and Mental Diseases  .
Green's Pathology and Morbid Anatomy
Greene's Medical  Chemistry .
Griffith's Universal Formulary
Gross on Foreign Bodies in Air-Passages
Gross on Impotence and Sterility  .
Gross on Urinary  Organs
Gross System of Surgery
Habershon on the Abdomen
Hamilton on Fractures and Dislocations
Hamilton on Nervous Diseases
Hare's Practical Therapeutics
Hare's System of Practical Therapeutics
Hardaway on the Skin
Hartshorne's Anatomy and Physiology .
Hartshorne's Conspectus of theMed. Sciences
Hartshorne's Essentials  of Medicine
Herman's First Lines in Midwifery
Hermann's Experimental Pharmacology
Hill on Syphilis .    .      .     .     .
Hillier's Handbook of Skin Diseases
Hirst & Piersol on Human Monstrosities
Hoblyn's Medical Dictionary
Hodge on Women
Hoffmann and Power's Chemical Analysis
Holden's Landmarks ....
Holland's Medical Notes and Reflections
Holmes' Principles and Practice of Surgery
Holmes'System of Surgery
Horner's Anatomy and Histology
Hudson on Fever    .           .
Hutchinson on Syphilis
Hyde on the Diseases of the Skin .
Jackson on the Skin .
Jamieson on the  Skin
Jones (C. Handfleld) on Nervous Disorders
20,
Juler's Ophthalmic Science and Practice
King's Manual of Obstetrics .
Klein's Histology
Landis on Labor
La Roche on Pneumonia, Malaria, etc.  .
La Roche on Yellow Fever .
Laurence and Moon's Ophthalmic Surgery
Lawson on the Eye, Orbit and Eyelid
Lea's Chapters from Religious History of Spain
Lea's Sacerdotal Celibacy
Lea's Studies in Church History
Lea's Superstition and Force
Lee on Syphilis  .     .          .
Lehmann's Chemical Physiology  .
Leishman's Midwifery
Lucas on Diseases of the Urethra .
Ludlow's Manual of Examinations
Luff's Manual of Chemistry
Lyman's Practice of Medicine
Lyons on Fever  .....
Maisch's Organic Materia Medica .
Marsh on the Joints
May on Diseases of Women .
Medical News    .....
Medical News Visiting List .
Medical News Physicians' Ledger .
Meigs on Childbed Fever
Miller's Practice of Surgery .
Miller's Principles of Surgery
Morris on Diseases of the Kidney .
Musser's Medical Diagnosis .
National Dispensatory
National Medical Dictionary
Nettleship on Diseases of the Eye .     .
Norris and Oliver on the Eye
Owen on Diseases of Children
Parrish's Practical Pharmacy
Parry on Extra-Uterine Pregnancy
Parvin's Midwifery   .      ...
Pavy on Digestion and its Disorders
Payne's General Pathology .
Pepper's System of Medicine
Pepper's Forensic Medicine .
Pepper's Surgical Pathology
Pick on Fractures and Dislocations
Pirrie's System of Surgery  .      .     .
Playfair on Nerve Prostration and Hysteria
Playfalr's Midwifery  ....
Power's Human Physiology .
Purdy on Bright's Disease and Allied Affections
Pye-Smith on the  Skin
Quiz Series      ....
Ralfe's Clinical Chemistry
Ramsbotham on Parturition
Remsen's Theoretical Chemistry  .
Reynolds'System of Medicine
Richardson's Preventive Medicine
Roberts on Diet and Digestion
Roberts on Urinary Diseases
Roberts'  Compend of Anatomy
Roberts' Surgery
Robertson's Physiological Physics
Ross on Nervous Diseases
Savage on Insanity, including Hysteria .
Schafer's Essentials of Histology,
Schreiber on Massage  .
Seiler on the Throat, Nose and Naso-Pharynx
Senn's Surgical  Bacteriology
Series of Clinical Manuals
Simon's Manual of Chemistry
Slade on Diphtheria   ....
Smith (Edward) on Consumption  .
Smith (J. Lewis) on Children
Smith's Operative Surgery
Stille on Cholera
Stilie & Maisch's National Dispensatory
StillG's Therapeutics and Materia Medica
Stimson on Fractures and Dislocations
Stimson's Operative Surgery
Students' Quiz Series  ....
Students' Series of Manuals .
Sturges' Clinical Medicine
Sutton on the Ovaries and Fallopian Tubes
Tait's Diseases of Women and Abdom. Surgery
Tanner on Signs and Diseases of Pregnancy
Tanner's Manual of Clinical Medicine  .
Taylor's Atlas of Venereal and Skin Diseases
Taylor on Venereal Diseases
Taylor on Poisons     ....
Taylor's Medical Jurisprudence
Thomas & Munde on Diseases of Women
Thompson on Stricture
Thompson on Urinary Organs
Todd on Acute Diseases    .      .
Treves' Manual of Surgery .
Treves' Operative  Surgery .
Treves' Students Handbook of Surg. Operations,  21
Treves' Surgical Applied Anatomy     .     .  6,30
Treves on Intestinal Obstruction  .     .     .21,31
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  19
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Tuke on the Influence of Mind on the Body
Vaughan <fe Novy's Ptomaines and Leucomaines
Visiting List, The Medical News  .
Walshe on the Heart  .
Watson's Practice of Physic .
Wells on the Eye
West on Diseases of Women
West on Nervous Disorders in Childhood
Wharton's Minor Surgery and Bandaging
Wbitla's Dictionary of Treatment
Williams on Consumption  ..."
Wilson's Handbook of Cutaneous Medicine
Wilson's Human Anatomy ..."
Wlnckel on  Pathol, and Treatment of Childhtui
WOhler's Organic Chemistry     .     .  UBa
Woodhead's Practical Pathology .
Year-Books of Treatment for 86, '87, '90, '91 W
Yeo on Food In Health and Disease     .  '
Young's Orthopaedic Surgery
16,30
  201 
 
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