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Y OF MEDICINE NATIOr ; A'V X a. / s&f * t^ \ a. < JZZl \ t W- > 5 < ,—eA ^ ;r»— / 3- ^\ /Zz/%^ ? %^?E ^? vaan tvnouvn 3Ni3ia3w jo Aavaan tvnouvn 3NiDia3w jo Aavaan tvnouvn snidiqsw jo Aavaan 'X \ i / X -3 X 1Y OF MEDICINE " NATIONAL LIBRARY OF MEDICINE " NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF vaan tvnouvn snidiqsw jo Aavaan tvnouvn 3NIDIQ3W jo Aavaan tvnouvn snidiqsw jo Aavaan M -x i > I NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF Y OF MEDICINE NATIONAL LIBRARY OF MEDICINE 1 A ^^^ t S When called to guide a patient through an illness the physician should be constantly a watchman, and a therapeutist only when neces- sity arises. A TEXT-BOOK OF 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, *>» PKOFESSOK OF THERAPEUTICS AND MATERIA MEDICA IN THE JEFFERSON MEDICAL COLLEGE OF PHILADELPHIA : PHYSICIAN TO THE JEFFERSON MEDICAL COLLEGE HOSPITAL; LAUREATE OF THE EOYAL ACADEMY OF MEDICINE IN BELGIUM, OF THE MEDICAL SOCIETY OF LONDON; CORRESPONDING FELLOW OF THE SOCIEDAD ESPANOLA DE HIGIENK OF MADRID; MEMBER OF THE ASSOCIATION OF AMERICAN PHYSICIANS; AUTHOR OF "A TEXT-BOOK OF PRACTICAL DIAGNOSIS," ETC. SIXTH EDITION, ENLARGED, THOROUGHLY REVISED AND LARGELY RE-WRITTEN. LEA BROTHERS & CO., PHILADELPHIA AND NEW YORK. 1897. Zoo \ to*"} Entered according to Act of Congress, in the year 1897, by LEA BROTH BUS & CO., in the Office of the Librarian of Congress. All rights reserved. WESTOOTT & THOMSON, ELEOTROTVPERS PMILADA. THIS VOLUME IS DEDICATED TO Dr. J. WILLIAM WHITE, PKOFESSOR OF CLINICAL SURGERY IN THE UNIVERSITY OP PENNSYLVANIAj AS AN EVIDENCE OF FRIENDSHIP AND ESTEEM, B Y THE AUTHOR PREFACE TO THE SIXTH EDITION. Although the number of copies printed of the fifth edition of this work was almost three times as great as was the case with earlier editions, they have been rapidly exhausted and the author has been called upon within two years to prepare the manuscript for the sixth edition. The original object of the book was to present the physi- cian and student with a well-digested and concise, yet practically use- ful, statement of the best methods of treating disease. It was written for the reason that the author appreciated as a practitioner and teacher that many of the works upon this subject contain a vast amount of information so compiled as to be almost useless because the reader is forced to discover for himself what is worthy of his confidence. For this reason remedies which are so rarely employed as to be curiosities are not discussed in this volume, and the space so saved is utilized in rendering rational the application of well-tried remedies both new and old. Many books after appearing in several editions lose a large part of their original value because the statements that have been added are so confused with the original text that its conciseness is destroyed. Recognizing this fact, the author has rewritten a very considerable portion of the present edition in order to render the statements in the text clear and concise. He has also endeavored so to arrange the work that it can be readily used in conjunction with his Text-book of Practical Diagnosis. As this volume is not intended as a year-book for the record of all things in therapeutics, only those measures which have proved useful and reliable in therapeutics are included. For this reason nothing is said of the use of serum in the treatment of many infectious processes in which it has proved itself of little or no avail, for instance in strep- tococcus infection or tuberculosis, or in croupous pneumonia. Philadelphia, 222 South Fifteenth Street, Rki'tember, 1897. PREFACE TO THE FOURTH EDITION. The Fourth Edition of this work having been called for in less than four years after the appearance of the first, the Author has taken advantage of the opportunity to rewrite and add to many of the articles on drugs, remedial measures, and diseases, and to insert practical information concerning the value and prescription of the really useful new remedies. Articles on Methylene Blue, Chloralose, Pyrogallol, Condurango, Convallaria, Duboisine, and other remedies have been added to the part of the work dealing with drugs. In the part dealing with Remedial Measures other than Drugs articles have been written on Hypodermoclysis and Enteroclysis, Lavage, and upon Mineral Springs and Climatic Treatment. The latter* article is not intended to be exhaustive, but to give the general practitioner an idea of the therapeutic value of certain well-known resorts, in order that he may offer rational advice to his patients as to where they should go in search of health. Several new articles in the part devoted to the Treatment of Individual Diseases have been inserted, and new or modified applications of the older remedies carefully noted throughout the entire book. In addition to these changes, the work has been revised in such a way as to render it uniform with the new U. S. Pharmacopoeia. As that authority directs the use of the metric system, the doses of all drugs are given in both Apothecaries' and Metric weights, thus (15 to 30 grains [1.0-2.0]), so that the physician may conveniently use either system, but it is to be clearly understood that where the doses are expressed in both systems, side by side, no attempt has been made to make the metric amounts more than approximate the quantities given in Troy weight. 10 PREFACE TO THE FOURTH EDITION. The fact that one fluidounce is nearly represented by 30 cc, while one solid ounce is represented approximately by 32 grammes, causes confusion. The author has therefore adopted the method advised by Oldberg in his valuable and well-known "Manual of Weights and Measures," and used 32 cubic centimetres or grammes as equivalent to 1 ounce, whether liquid or solid. The Author desires to express his appreciation of the care with which Dr. de Schweinitz has revised the articles on Diseases of the Eye; Dr. Hirst, those on the Puerperal State; and Dr. Martin, those on Syphilis and Genito-urinary Diseases and Antisepsis. The arti- cles on the treatment of diseases of the upper air-passages have been rewritten or revised by the Author. It is hoped that this new edition will prove even more useful than its predecessors to the doctor who needs a book for ready reference in daily practice. Philadelphia, 222 South Fifteenth Steeet. 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 know- ledge 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 hand 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 12 PREFACE TO THE FIRST EDITION. depended largely on the fact that many physicians of the past have 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 every one 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 PREFACE TO THE FIRST EDITION 13 with equal propriety be called a spinal sedative or a cerebral seda- tive, or caffeine be classed as a cerebral stimulant, a circulatory stim- ulant, or a diuretic. In order to make the book move 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 elec- tricity has heretofore commonly found a place in most text-books on therapeutics, but has been advisedly omitted in this instance, since electrical 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. G. E. de Schweinitz has contributed the articles on the treatment of diseases of the eye; Dr. Edward Martin, 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. Sept., 1890. 37^> fC CONTENTS. PART I. PAUli General Therapeutical Considerations.......... 17 PART II. Drugs.............................. 41 PART III. Remedial Measures other than Drugs..........383 Foods for the Sick......................43n PART IV. Diseases.............................437 Table of Doses of Medicines.................67 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 ^ to -jL (0.003-0.006) of a grain, may be given to stimulate the respiration and heart. Untoward Effects.—Aconite may cause in susceptible persons a vesicular, or even a pustular, eruption, or instead intense itching of the skin may be developed. 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 effects being uniformly explain- able by its known physiological action. It is used chiefly for its influence as a cardiac and circulatory sedative, for its effects on the peripheral 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 tension. In the early stages of all acute inflammations aco- nite is of service. It may be applied locally over superficial nerves in neuralgia in the form of an ointment (2 grains [0.1] to 1 drachm [4.0], or as the oleate of aconitine, 2 grains [0.1" of the oleate to 100 [6.0] of sweet oil). In the earlier 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, given with a hot drink and a hot sitz bath, 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 sthenic pneumonia if great arterial excitement is present. Aconite is by far the best circulatory and nervous sedative for children suffering from sthenic fevers, particularly of the irritative type. 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 if given in the earliest stages. In nervous palpitation of the heart and in the palpitation of exces- sive cardiac hypertrophy aconite is very valuable. In many cases of this character where there is not only hypertrophy, but irregular inner- vation, the use of a prescription containing aconite and digitalis proves of service, for the minute doses of digitalis stimulate the vagus nerves, and the aconite not only steadies the heart, but also counteracts the stimulant effect of the digitalis on the heart muscle: 50 DRUGS. R.—Tine, aeon it..............f.^ss (2.0). Tine, digital..............f^ss (2.0). Tine, belladonna?...........fj5J (4.0). Tine, gentian, comp.......q. s. ad f^iij (90.0).—M. S.—Teaspoonful every six hours. In the epistaxis of full-blooded people aconite often affords great relief. Full doses of Duquesnebs crystalline aconitine are of value in some cases of obstinate neuralgia. Administration.—As a general rule, small divided doses of the drug in the form of the tincture, ^ to ^ a drop (0.015-0.03) given every fifteen minutes, will act better than a full dose given at once, unless the condition of the patient requires very active treatment. Preparations.—Tincture of aconite (Tinctura Aconiti, TJ. 8. and B. P.) is used in the dose of 1 to 5 drops (0.06-0.3) in water, re- peated every hour if needed so often. A very useful way of employ- ing it is in the form of tablet triturates. The extract of aconite Extractum Aconiti, TJ. 8.) is given in the dose of ^ to f- of a grain 0.015-0.045), while of the abstract (which is no longer official) 1 grain (0.05) is used. The fluid extract (Extractum Aconiti Fluidum, TJ. S.) is given in the dose of 1 to 2 minims (0.05-0.1). Fleming's tincture ought never to be used. The active principle aconitine is not official in the TJ. 8. P. Its dose is ^fa to y^-g- of a grain (0.0003- 0.0006), but it ought never to be used internally. The B. P. prepa- rations that are not official in the TJ. 8. 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 A to 1 grain (0.03-0.06). ' 2 * ADONIS VERNALIS. From Adonis vernalis, a plant indigenous in Europe and Asia, is derived a glucoside, Adonidin. When given to one of the mammalia —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. Within the last few years adonis vernalis and bromides have been combined in the treat- ment of epilepsy with asserted success. The dose of adonidin is \ to ? of a grain (0.008-0.016) 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 table- spoonful (16.0) may be given every four hours. A GARICIN—ALCOHOL. 51 AGARICIN. Agaric, or Touchwood, or Punk, has been used in the Southern United States very largely in the dose of 5 grains (0.3) 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 extraordi- nary results, under these circumstances, by certain German and English physicians, in the dose of from l'to 2 grains (0.05-0.1) every five hours. Its physiological action is unknown, but it is sup- posed to act upon the nerve-filaments in the sweat-glands. The writer has employed it frequently 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. Sometimes agaricin causes nausea and diarrhoea. 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 four forms—namely, as Alcohol, U. 8., containing 91 per cent, by weight of the spirit and 9 per cent, of water; Alcohol Absolution, U. 8., containing not more than 1 per cent, by weight of water; Alcohol Deodoratum, containing 92.5 per cent, by weight of alcohol; and Alcohol Dilutum, TJ. 8., or dilute alcohol, 41 per cent, by weight 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 alco- hol," 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, when given in very full dose, 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 paralyses them afterward. By the primary stimulation of the brain it increases the rapidity, but not the depth, of thought, and it increases the reflex activity of the spinal cord, the muscles, and the nerves. In large doses it produces lack of co-ordination by depression of the brain and lower nervous system, the loss of co-ordi- nation being due largely to impairment of sensation, so that the power of touch and the muscle sense is interfered with. This makes a drunken man fail to recognize the angles or uneven surfaces of sur- rounding objects, and the impaired mental power and disordered judg- ment, 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 accelorator nerves, 52 DR UGS. but Castillo denies any such influence. Wood teaches that the effect of alcohol is not through any action upon these nerves, but upon the heart itself, and is probably correct in his belief. Along with the stim- ulation 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 alco- hol 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 in 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 body'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, when used in moderation, it assists the process; for by reason of its irritant and stimulating properties it induces the secretion of an excess of the digestive juice. When exces- sive amounts are ingested it disorders digestion by inhibiting the action of the digestive ferments. Therapeutics.—The employment of alcohol in disease can here be only briefly alluded to, special mention of its indications being named when the diseases in which it is used are discussed. (See Part IV.) Its chief uses are as a rapidly-acting stimulant in all forms of cardiac failure due to shock or to poisons, and as a systemic support and stim- ulant in low fevers and prolonged wasting diseases, in old age, and in convalescence from acute disease. In both croupous and catarrhal pneumonia alcohol is useful, and particularly is this true when these affections occur in children. (See Pneumonia, Part IV.) Some additional conditions, to state them specifically, in which alcohol is indicated are fainting, snake-bite, surgical shock, and chronic ALCOHOL. 53 pneumonia in its later stages, and excessive wasting due to prolonged suppuration. It is also useful in poisoning by depressant drugs, such as aconite or antimony. Alcohol should never be given in the presence of circulatory excite, ment, but whenever the circulation fails during the progress of an acute disease it is useful. In the pneumonia of children, whether it be croupous or catarrhal, brandy or whiskey is very useful in the dose of 5 to 60 drops (0.3-4.0) every two hours in a little water or milk. (See Administration.) In exhausting fevers, such as typhoid or typhus, alcohol finds its true usefulness. While it is well to give alcohol in many cases of enteric fever 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 appe- tite is failing and adynamia is a pressing symptom, alcohol is indi- cated ; 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. Sometimes ordinary whiskey or brandy will in severe typhoid fever disorder the stomach. The physician "should then em- ploy an old brandy or wine which has acquired an aroma which is called a •' bouquet." In persistent vomiting small doses of good brandy poured on cracked ice will often do much good. Alcohol is not only of service internally, but it is also useful exter- nally as a wash or evaporating lotion over bruises, inflamed joints, and wounds of a contused character. It acts as a cooling and anti- eeptic dressing. It is also useful for washing the skin of invalids, and "salt and whiskey" applied by rubbing is a good mixture to stimu- late the skin of unhealthy persons. Acute Poisoning.—In advanced poisoning by alcohol, with coma and total relaxation, external heat and hypodermic injections of digi- talis and strychnine are indicated if the heart or respiration seems to be failing. Belladonna should be administered to stimulate the vaso- motor system if the skin is relaxed and clammy, and counter-irrita- tion to the back of the neck is to be employed if any brain symptoms are 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 sub- stances 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 (2.8) of jalap powder or ^ of a grain (0.01) of elaterium should be employed); or full doses of calomel followed by a saline may be given if milder effects are sought. For the morning vomiting of drunkards Fowler's solution of arsenic is often a valuable remedy. In view of the frequency with which alcoholic and opium poison- ing are confused, the following table is appended, which will be found 54 DRUGS. of value in making a differential diagnosis as to the condition of the patient: Alcoholism and Opium Poisoning. Alcoholism. Opium Poisoning. 1. Pupils normal or dilated. 1. Pupils contracted. 2. Kespiration nearly normal. Pulse 2. Kespiration and pulse slow and full. rapid, and finally feeble. 3. Face may be pallid. 3. Face suffused and cyanosed. 4. Skin cool, perhaps moist. 4. Skin warmer than in alcoholic poi- soning. 5. Pulse rapid, at first strong, then 5. Pulse slow, strong, and full till late weak. in poisoning. There is scarcely any difference as to consciousness in the two conditions. In medico-legal cases the urine should be saved in hermetically sealed vessels for examination. Acute Alcoholism and Apoplexy. A Icoholism. Apoplexy. 1. Pulse rapid, compressible, and weak. 1. Pulse apt to be strong and slow. 2. Skin moist, or relaxed and cool. 2. Skin hot or dry. 3. Bodily temperature lowered. 3. Bodily temperature raised. 4. Pupils equally contracted or dilated; 4. Pupils unequal. generally dilated. 5. No hemiplegia. 5. Hemiplegia: one side tossed, the other remaining motionless. 6. Breathing not so stertorous nor so 6. Kespiration stertorous, the lips being one-sided in lips. inflated on one side on expiration. 7. No facial palsy. 7. Facial palsy. 8. Unconsciousness may not be com- 8. Unconsciousness complete. plete. The smell of alcohol in the breath is no guide, as acute alcoholism may have caused the rupture of a cerebral blood-vessel. Chronic Poisoning, or the Alcohol Habit.—Chronic poisoning by alcohol results in very characteristic changes in the tissues. As the liver receives the alcohol from the stomach diluted only by the portal blood, it is often affected very early, and cirrhosis of this organ comes on with its accompanying gastric and nutritional symptoms. Mental disturbances are common, and neuritis may develop in its painful forms or produce paralysis or symptoms resembling locomotor ataxia.1 The treatment of chronic alcoholic poisoning may be carried out in two ways: First, by the isolation of the patient and the complete withdrawal of the drug at once; secondly, by a better plan, a gradual tapering-off in the daily amount of the spirit. In either instance isolation must be abso- lute, and all smuggling of alcohol to or by the patient prevented. The attendants must be absolutely trustworthy. Careful scrutiny of bed- clothes and closets will often be rewarded by finding hidden whiskey- bottles. The depression of the patient when recovering from alcohol- ism 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 exceedingly valuable and nutritious preparation under these circumstances. In the treatment of the atonic stomach of drunkards nothing does so well as the following pill: 6 1 See author's work on Diagnosis, Lea Brothers & Co. 1896. ALCOHOL. 55 R.—O eoresin. capsici............n\,x(0.65). Oleicaryophvlh ...........T^x (0.65). Hydraig.chlor.mit...........gr. xx (1.3). AloeSocotnn;,.............gr. xl (2.65).-M. Ft. in pil. No. xx. S.—One three times a day after or before meals. If this pill fails to move the bowels, a saline purgative should be used. The following are the principal points in the differential diagnosis of Chronic Alcoholism and the General 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. J 6. Mental symptoms temporarily re- 6. Mental state made worse by alcohol. moved, or at any rate improved, by al- cohol. 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 instantaneous, 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 eggnog, the latter being the " heavier " of the two so far as diges- tion is concerned. In fevers of a typhoid type the dose of whiskey or brandy should be for an adult from 1 to 4 tablespoonfuls every three or four hours. More than a pint in twenty-four hours is rarely re- quired, but this amount often does great good and is not excessive. When brandy or whiskey is given to children, the following rules as to dosage may be used as indicating the approximate proper dose: 5 to 10 drops every four hours for a child of 1 month old; 10 to 20 drops for a child of 2 months old; 20 to 30 drops for a child of 3 months old ; 30 to 40 drops for a child over 3 months old ; 60 drops for a child over 4 months old. In some cases, however, it is well to use half these doses every two hours. In all cases the liquor should be diluted with hot or cool water. Wine-whey is very light and useful. Mulled wine and champagne are particularly useful in the treatment of irri- table stomach. (See Foods for the Sick.) Champagne when used as a medicinal stimulant should always be as devoid of sugar as possible —that is, what is known as " extra dry." Gin is rarely employed as 56 DR UGS. a stimulant, except when the kidneys are torpid. Stout and porter are of value in wasting diseases, in convalescence from acute diseases, and for nursing women. Contraindications.—All states of cerebral excitement, unless due to exhaustion, acute inflammations, the alcoholic habit, apoplexy, meningitis, acute nephritis, aneurysm, and advanced atheroma, con- traindfcate the use of alcohol, as does also the history of the alcoholic habit. The official preparations of alcohol are as follows: Whiskey (Spiritus Frumenti, TJ. 8.) should be at least three years old, and be made, in America, from rye for medicinal purposes. Brandy (Spiritus ViniGallici, TJ. 8. and B. P.) is obtained by the distillation of fermented grapes or fruits, and should be from three to five years old before use. Cologne-water (Spiritus Odoratus) is used solely as a lotion and perfume. Red Wine( Vinum Rubrum, TJ. 8.) is made from grapes not deprived of their skins. White Wine (Vinum Album,) is the fermented juice of grapes the skins of which have been removed. Dilute Alcohol (Alcohol Dilution, TJ. SA deodorized alcohol (Alcohol Deodoratum, TJ. S.), pure alcohol (Alcohol, TJ. S.), and absolute alcohol (Alcohol Absolutum) are also official. The unofficial preparations are: Rum, which is made from the fermentation of molasses, and con- tains about 40 to 45 per cent, of alcohol. Gin is made from rye or barley, with the addition of juniper-berries and hops. (Good gin and the Spiritm Juuiperi Compositus of the TJ. S. Pharmacopoeia are virtually identical therapeutically.) When diuresis is required and atony of the kidneys is present, without inflammation, 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) 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) has about 30 per cent, of alcohol in it. It is not official in the TJ. S. P. Beer is made by a slow fermentation, while ale is made by a more rapid fermentation at a higher heat. Most of the beer in America contains about 4-6 per cent, of alcohol. Porter resembles the other malt liquors closely, except that it contains more solids, due to a scorching of the grain by a high heat. The B. P. preparations that are not official in the TJ. 8. P are rectified spirit (Spiritus Rectificatus), proof spirit (Spiritus Tenuior) sherry (Vinum Xericum), amylic alcohol (Alcohol Amylicum) and Mistura Spiritus Vint Gallici, which is a useful, pleasant, and nutri- tious stimulant made by beating up the yoks 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." ALL IUM—A LLSPICE—A LMONDS. 57 ALLIUM. Garlic, or Allium Sativum, TJ. S., is a stimulant to digestion, owing to the volatile oil it contains, which by its somewhat irritating proper- ties 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 disagreeable 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 the oil of garlic may be given in emulsion in the dose of 1 or 2 drops (0.05-0.1). It ought not to be given dur- ing 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 Avith 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 con- vulsions 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 (0.1-0.3) to relieve ner- vous vomiting. The dose of the syrup (Syrupus Allii, TJ. 8.) for a child is 1 drachm (4.0), but 4 drachms (16.0) may be given to an adult. ALLSPICE. Allspice, or Pimenta ( U. 8. and B. P.), is the nearly ripe fruit of Pimenta officinalis, a tree of the West Indies. It contains an official volatile oil (Oleum Pimentee, U. S. 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 (0.06-0.3). Aqua Pimenta' (B. P.) is given in the dose of 1 to 2 ounces (32.0-64.0). ALMONDS. Almonds are official in the form of the bitter almonds (Amygdalus Amara, TJ. S. and B. P.) and the sweet almonds (Amygdalus Dulcis, TJ S and B. P.). Bitter almonds develop hydrocyanic acid in the presence of water, bv 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 an 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 an ounce of sweet almonds are rubbed up with thirty grains of gum arable and two drachms of sugar, to which is added gradually a half-pint of distilled water, the mixture being then 58 DRUGS. strained, an emollient and soothing drink is formed, which is very useful in irritations of the stomach and intestines and of the air-pas- sages and pharynx. The expressed or fixed oil of almonds is a useful demulcent, and has been recommended in the cough of phthisis, given in the dose of a feAv drops in emulsion. Bitter almonds give off an oil (Oleum Amygdalce Amarce, TJ. 8.) which is exceedingly poisonous, owing to the prussic acid which it contains, and it is said that one drop Avill 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, as they 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: an emulsion (Emulsum Amygdalce, TJ. S. and B. P.), dose 1 to 2 ounces (32.0-64.0); a syrup (Syrupus Amygdalce, TJ. S.), dose 2 drachms to 2 ounces (8.0- 64.0); a compound powder (Pulvis Amygdalce Compositus, B. P.), given in the dose of 1 to 2 drachms (4.0-8.0); and the oil (Oleum Amygdala? Expression, TJ. 8. and B. P.), the dose of which is 1 to 4 drachms (4.0-16.0) Aqua Amygdala; Amarce (U. S.) is prepared from the oil of bitter almonds. The dose is 30 to 60 drops (2.0-4.0). ALOES. Aloes, or Aloe of the TJ. 8. P., is derived from Aloe Perri/i or Aloe vera. In the TJ. S. P. of 1890 the first is called Socotrine'aloes (Aloe Socotrina, TJ. 8.), the second Barbadoes aloes (Aloe Barbaden- sis, TJ. 8., B. P). Aloes is the inspissated or dried juice of the leaves of the plant. It is also probably derived from several other species. Aloes contains an active principle known as aloin (Aloinum TJ. S) which is a crystalline substance. As aloin 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 he 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 m 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 ALOES. 59 is said to act thoroughly. It is eliminated by the milk of nursing women, and will cause purgation in an infant 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 and 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 constipation, but it is distinctly harmful if continued for any length of time, as it seems to produce atony of the bowel. Owing to its bit- ter properties it acts as a tonic to the stomach, and is often given Avith iron to promote the absorption of this metal by stimulating the liver and by preventing any constipation Avhich might be produced by the chalybeate. When taken in a large enough dose to produce a copious passage, aloes nearly ahvays produces a feeling of Aveight and fulness in the region of the rectum after the evacuation, and the Avriter has seen severe rectal catarrh produced in this A\ay. If given alone it is very apt to produce griping, and it ought always to be combined Avith other drugs Avhose tendency is to prevent intestinal spasm. In cases of hcemorrhoids occurring in persons suffering from gen- eral 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 Avith tonics to relieve the consti- pation so often a pressing symptom in these cases. In amenorrhosa dependent upon atony of the sexual system, or anaemia, or constipa- tion, 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 healing of old or neiv fissures of mucous membranes, and even in bed- gores. The glycerole of aloes is to be made by evaporating four to eight parts of tincture of aloes and gradually adding thirty parts of glycerin. Contraindications.—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 Avomen should use aloes most carefully, lest abortion be produced, and if hepatic congestion or inflammation is present it ought not to be used. Fever is said to contraindicate the use of aloes, as does also rectal catarrh. Administration.—Aloes is generally given in a pill, combined a\ ith spices and belladonna. (See Constipation, Part IV.) The dose should be about 1 to 5 grains (0.06-0.3) as a laxative, and 10 grains (0.6) as a purge. The Aloe Purificata, TJ. 8. P., should always be used. The official preparations most commonly employed are the pill of aloes (Pilules Aloes, TJ. S. and B. P.), 2 grains (0.12) each of aloes and soap; the pill of aloes and myrrh (1'ifnice Aloes et Myrrha; V. S. and B. P.), 2 grains (0.12) of each constituent; the pill of aloes and mastich (Pilulce Aloes et Mastichcs, TJ. >S'.), 2 grains (0.12) of aloes, or the "Lady Webster dinner pill;" the pill of aloes and iron (Pilule Aloes et Ferri, U. 8. and B. P.), 1 grain (0.06) of aloes and 60 DR UGS. 1 grain (0.06) of dried sulphate of iron; and the pill of aloes and asafoetida (I'iluhe Aloes et AsafcetJhc, TJ. 8. and B. P.), containing 4 grains (0.20) of aloes, asafoetida, and soap. The dose of all these is one to tAVO pills. Aloes is also official as Extractum Aloes Aquo- sum, dose 1 to 2 grains (0.06-0.12). The liquid preparations are the tincture (Tinctura Aloes, TJ. 8. and B. P.), dose 1 to 3 fluidrachms (4.0-12,0); the tincture of aloes and myrrh (Tinctura Aloes et Myrrha-, TJ. S.),1 dose 1 to 2 fluidrachms (4.0-8.0); and the wine of aloes ( Vinum Aloes, B. P.), containing cardamoms and ginger, the dose of which is i to 1 drachm (2.0-4.0) or even 2 drachms (8.0). The B. P. preparations, besides those given, are Aloin, given in the dose of | to 2 grains (0.03-0.12); the Decoctum Aloes Oompositum, dose ^ to 2 ounces (16.0-04.0); and the extracts, Extractum Aloes Socotrinre and the Extraction Aloes Barbadensis, the dose of each of which is 2 to 6 grains (0.1-0.3). Enema Aloes, given in the dose of 10 ounces (320.0), is composed of aloes 40 grains (2.65), carbonate of po- tassium 15 grains (1.0), and mucilage of starch 10 fluidounces (320.0). ALUM. Alum (Alumen, TJ. S. and B. P.) is the sulphate of aluminum and potassium in the TJ. 8. P., but in the B. P. both it and the sulphate of aluminum and ammonium crystallized from a Avatery solution are official. At present much of the alum of commerce is made in the manu- facture of coal-gas for illuminating purposes, and it is therefore very cheap. It occurs in the form of octahedral crystals, and has an astrin- gent taste and acid reaction. After the crystals are exposed to the air for some time they become covered Avith a white coating. Physiological Action.—When alum is brought in contact with r mucous membrane it "produces Avhitening, 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 blood-vessels and capillaries. Large amounts given for any length of time seem to increase secretion. Poisoning.—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 rid 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-1 3- 32 0) on a swab will be found very useful. It would be of much service in Ins condition were it not that it posseses a destructive action on the teeth In hemorrhage, when the leaking blood-vessels can be directly reached, alum is a remarkable hemostatic, aiding in the arrest of the bleeding m three ways-namely, by coagulating the albumin, by con- stnnging the parts, and by crystallizing when applied in large amount on lint, and thereby affording a surface which is rough and aids coagu- 1 Sometimes called Elixir Proprietatis. .4 MBER. 61 lation. In hemorrhage after tooth-extraction its application is a very useful treatment. Dissolved in water or alcohol, 2 grains to the ounce (0.1 to 32.0), it makes an exceedingly efficient application for sponging in night-sweats or localized sweating of the feet or hands. In haemop- tysis a fine spray of a strong solution of alum, 20 grains to the ounce (1.3-32.0), 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 bronchorrhoea 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 leucorrhaa, in the strength of from 10 to 20 grains to the ounce (0.65-1.3 to 32.0) of Avater, 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 SAVollen surface of the gland. In ingrowing toe-nail with granulations a piece of twisted absorbent cotton soaked in strong alum solution and inserted under the edge of the nail will in most instances do a great deal toAvard a cure. Dried alum (Alumen Exsiccatum, TJ. 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 possibility of its exercising an evil effect on the teeth should not be forgotten Avhen this treatment is resorted to. Internally, alum has been used in diabetes, gastralgia, and dysen- tery of an acute and chronic type. In lead colic it seems to be of value in conjunction Avith morphine to allay the pain. At one time alum Avas largely employed in membranous croup in emetic dose for the dislodging of the membrane and for the astringent effect exer- cised as it Avas swallowed and expelled. The emetic dose of poAvdered alum is a heaping teaspoonful for a child or a tablespoonful for an adult. Alum may be used as an antidote in acute lead-poisoning, as it is a soluble sulphate and also an emetic. 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 Bohemia, and is used in the form of the oil (Oleum Suceini), 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 1 to 3 parts of olive oil applied to the back and front of the chest is of service. 62 DRUGS. In adults suffering from acute laryngitis with an extension of the inflammation into the bronchial tubes full doses of sodium bromide given internally, with this proportion of amber oil and olive oil rubbed into the'neck and chest, are very useful. The dose internally is 2 to 6 minims (0.1-0.3) given in emulsion. AMMONIA (NH3). Ammonia is a gas of a very acrid, burning taste and sensation, capable of producing death very rapidly, Avhen inhaled, by inflam- mation of the air-passages and the spasm of the glottis Avhich 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 rapid death by spasm or oedema of the glottis, and if a strong solution of it is swallowed, the same accident may occur. After more moderate inhalations severe bronchitis or pulmonary oedema may develop. 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 con- vulsive movements had their origin in the brain. The drug in moder- ate 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, but if the drug be in very weak solu- tion, it seems to increase its functional activity. Circulation.—Upon the circulation ammonia acts as a powerful but fleeting stimulant, increasing the pulse-rate, pulse-force, and arterial pressure. The cause of the increased pulse-rate depends upon stimula- tion 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 ventricles much increased. The rise of arte- rial pressure is due to the increased amount of blood pumped into the arteries by the stimulated heart, and probably by a stimulant action on the vaso-motor 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 vasomotor centre, it probably increases the functional activity of both. If by means of intravenous injection the ammonia reaches the heart in large amount in concentrated form, this organ ceases to beat at once, owing to paralysis of its muscular walls. J ui TiHEv. ?L°i°D-—In m1oderate amounts the drug has no effect on the blood, but when injected in po.sonous quantities it causes the blood to tail to take up the oxygen, according to Feltz and Ritter • /rPKiATi°N,"~Th6 inJ*ec1tion.of a^onia in moderate quantities into the blood causes an acceleration of the rate of respiration due to a stimulation of the respiratory centre, the respiratory movements AMMONIA. 63 becoming not only more full, but more rapid. If the drug is inhaled in small amounts or swalloAved, the same action is seen in a less degree, the changes both in breathing and circulation being 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 interest. 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 opportunity to use the more stable and slowly-acting drugs. These emergencies 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 Avhere rapid cardiac stim- ulation is needed. It is claimed, Avithout great justification, that ammo- nia will aid in preventing heart-clot or thrombosis in cases of severe hemorrhage and in pneumonia. 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 subcutaneous 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 prolonged diseases the employment of ammonia is not particularly advisable, OAving to its fugacious action, although it is largely used, for the frequent administration necessarily required is apt to produce gastric disorder. Some persons claim that ammonia is useful as a sedative in drunkenness, but this is doubtful. In gastric acidity due to fermentation, with the development of abnormal acids, ammonia is the most active remedy Ave can employ, but is not to be given if acute irritation of the stomach exists. Locally applied, strong ammonia-water may be used to produce a blister by placing a few drops on the skin under an inverted Avatch- glass. Ammonia-water may also be applied, often Avith great relief, to the spot stung by insects. The waters of ammonia are used exter- nally in stimulating liniments, and hypodermically when the drug is so given. The stronger Avater ought not to be employed for the latter purpose. The aromatic spirit is generally used internally in the dose of \ drachm to 1 drachm (2.0-4.0), 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 Avater (Aqua Ammonias For- tior, TJ. 8. ; Liquor Ammo nice Fortior, B. P.), containing 28 per cent. by weight of the gas, and the weaker water (Aqua Ammonice, TJ. 8. ; 64 DRUGS. Liquor Ammonice, B. P.), which should contain about 10 per cent. by weight of the gas. The spirit of ammonia (Spiritus Ammonite, TJ S)i* given in the dose of 30 to 60 minims (2.0-4.0) in water, and the aromatic spirit of ammonia (Spiritus Ammonia; Aromaticus U. 8 and B P.) in the dose of 25 to 60 minims (1.5-4.0) in water. The latter preparation is composed of carbonate of ammonium, the oils of nutmeg, lemon, and lavender, with alcohol and ammonia-water. Spiritus Ammonice Fcetidus (B. P.) contains asafoetida and is used in place of the aromatic spirit. Ammonia liniment (Linimentum Am- monice, TJ. S. and B. P.) is used over tender joints and muscles. AMMONIAC. Ammoniac (Ammoniacum, U. 8. and B. P.) is a resinous gum obtained from Dorema Ammoniacum, and is used very little m 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 (0.65-2.0) in pills in cases of chronic bronchitis devoid of any active inflammatory process. It is official in the form of the plaster of ammoniac and mercury (Em- plastrum Ammoniaci cum Kydrargyro, TJ. S. and B. P.), which is used as a stimulant over enlarged glands. Finally, there is the emul- sion of ammoniac (Emulsum Ammoniaci, TJ. 8. and B. P.), used in chronic bronchitis in the dose of a tablespoonful (16.0). AMMONIUM (NH4). The following salts of ammonium are official, and are used for various purposes: Acetate of Ammonium. Acetate of Ammonium is used in medicine in the form of the spirit of Mindererus (Liquor Ammonii Acetatis, TJ. S. and B. P.), dose 1 to 2 fluidrachms (4.0-8.0), for the purpose of acting as an antacid in gastric indigestion, and also as a mild diaphoretic which is inferior to sweet spirit of nitre. Benzoate of Ammonium. Benzoate of Ammonium (Ammonii Benzoas, TJ. S. and B. P.) is employed chiefly for its diuretic influences, which depend entirely upon the benzoic acid present in the compound. It should be kept in Avell-stoppered bottles. As benzoic acid is eliminated as hippuric acid and ammonia as nitric acid, this drug may be employed in cases where the physician desires to make the urine decidedly acid: as, for example, in patients suffering from catarrh of the bladder, when the urine is loaded with phosphates, Avhich are dissolved by this acidulation. The dose is 10 to 30 grains (0.6-2.0), which should be dissolved in water or, better, administered in cachets or capsules. AMMONIUM. 65 Bromide of Ammonium. Bromide of Ammonium (Ammonii Bromidum, TJ. 8. and B. P.) is really a crystalline salt, but is generally found in commerce as a white granular poAvder, which, Avhen 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 SAvalloAved, 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 loAver 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 take place. In a series of studies undertaken by the Avriter to deter- mine the exact effect of the drug it Avas found that the spinal cord Avas depressed, both on its motor and sensory sides, Avhile the nerves and muscles escaped. These results are in accord with those of other investigators, Avho 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 Avith the heart. In medicinal dose it is distinctly stimulant to the circulation, but not sufficiently so to render it valuable as a circulatory stimulant, to the exclusion of other more powerful preparations. Therapeutics.—The bromide of ammonium may be used in nearly every instance Avhere bromide of potassium may be employed, and possesses the distinct advantage of being less depressant to the gen- eral system than the latter drug. It is, however, more 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 Avith it in some cases Avith success. (See article on Epilepsy, Part IV.) According to DaCosta, the drug is of very distinct value in rheumatism in the dose of 60 to 80 grains (4.0-5.3) a day, well diluted Avith water, although its manner of action in this disease is not knoAvn. The usual dose is 10 to 30 grains (0.65-2.0). It is incompatible Avith spirit of nitrous ether. Carbonate of Ammonium. Carbonate of Ammonium (Ammonii Carbonas, V. 8. and B. P.) undoubtedly has an action exactly like that of the liquid preparations of ammonia, and is used either alone or with the chloride in the treatment of bronchitis, particularly Avhen this disease occurs in babies and young children. It is also largely employed by surgeons in the treatment of children after a surgical operation to overcome the respiratory and circulatory depression produced by the anaesthetic. 5 66 DRUGS. The dose is 2 to 10 grains (0.1-0.65) in syrup of acacia and water. It is a rapidly-acting cardiac and respiratory stimulant. R. Ammonii carbonat...........gr. xlviij (3.0). Svrup. acacioe ...........*.->J <32.0). Aquwdest............q. s. ad f.^iij (96.0).—M. S.—Teaspoonful (4.0) every two hours for a child of three or four years. Chloride of Ammonium. The Chloride or Muriate of Ammonium (Ammonii Chloridum, TJ. 8. 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 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 treatment 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 intestinal catarrhs of children of a very subacute type, and it is the routine treatment for all such cases which come under observation at the hospitals and elsewhere Avhere the author has charge. The dose is 2 to 15 grains (0.1-1.0), preferably given with liquorice and water to mask the taste. R. Ammonii chloridi ............^ij (8.0). Extract glycyrrhiz. fl...........f 5j (32.0). Aquae dest.............q. s. ad f giij (96.0).—M. S.—Teaspoonful (4.0) t. d. after meals for a child of five to ten years. The chloride of ammonium may, hoAvever, be given in compressed pills, provided a large draught of water or milk is taken simulta- neously to protect the stomach. (See article on Bronchitis for other prescriptions.) Gillespie asserts that 10 grains (0.65) of chloride of ammonium given half an hour before meals gives extraordinary relief in painful dyspepsia due to hyperacidity of the stomach. Iodide of Ammonium. Iodide of Ammonium (Ammonii Iodidum, TJ. 8.) should be kept in dark, well-stoppered bottles, and if deeply colored should not be dispensed. It may be employed in the dose of 2 to 5 grains (0.1-0.3) in all cases Avhere the iodide of potassium is indicated, and seems to AMYL NITRITE. 67 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 (2.0) 0f the salt to the ounce (32.0) 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. Valerianate of Ammonium (Ammonii Valerianas, TJ. S.) is the salt of ammonium commonly used in the nervous unrest of pregnant or hysterical Avomen. 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 dessertspoonful, or it is combined with the bromides, under Avhich circumstances it is much more efficacious. The dose of the salt itself is 10 to 15 grains (0.65-1.0). The sulphate of ammonium is never used in medicine. The phos- phate of ammonium is employed in rheumatism in the dose of 10 to 20 grains (0.65-1.3). It is no longer official. The B. P. preparations besides those already given are: Sulphide of Ammonium, Oxalate of Ammonium, Liquor Ammonii Citratis, dose 2 to 6 fluidrachms (8.0-24.0); Liquor Ammonii Citratis Fortior, dose 30 minims to 2 fluidrachms (2.0-8.0); Liquor Ammonii Acetatis For- tior. dose 25 to 75 minims (1.6-5.0). AMYL NITRITE. Amyl Nitrite (Amyl Nitris, TJ. 8. and B. P.) is a very volatile, someAvhat 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. Nitrite of amyl should be protected from light, heat, and fire. 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 forci- bly, 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 shoAv 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 68 DRUGS. exceedingly rapid, Avhile 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 Avhich, the resistance being taken aAvay, the heart beats faster. The fall of arterial pressure is due to depres- sion of the vasomotor centres and the muscular coats of the blood- vessels. 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 oxyhemoglobin into methsemoglobin. Urine axd 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. Teaiperature.—If the nitrite of amyl be employed for any length of time, a most remarkable fall in bodily temperature ensues, which is probably due to diminished oxidation, but possibly to some effect on the heat-centres governing heat-production and dissipation. The vascular 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 dysmenorrhcea Avith uterine spasm it often gives great relief. Nitrite of amyl has been used in cases of sea-sick- ness as a prophylactic and cure with considerable success. In cardiac failure from fright or anaesthetics amyl nitrite is often of great value in single Avhiffs. If it does not act at once under these circumstancs, 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 hypodermic- ally, 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 lhe physician should warn the patient that the effect of the dri.o- is sudden and alarming, and in nervous cases should direct that the inhalations be made gently, as a very full inhalation may produce unpleasant 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 (0.15). One or more of these may A NTHRA R OBIN—A N T1M0N F. 69 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 fin- gers. These are, of course, to be avoided. ANTHRAROBIN. Anthrarobin, which Avas originally discovered by Liebermann, seems to possess equal value Avith its relative chrysarobin, and to be capable of acting as efficaciously as this substance in the treatment of skin diseases. It is a yelloAvish powder, tolerably stable in a dry atmosphere, not soluble in acids or Avater, but readily soluble in dilute alkaline solution or alcohol, at first making a solution of a brown color, Avhich, 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 Avash. 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 chrysarobin, 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 Avell corked, such a mixture remains good for a Aveek. ANTIMONY. Antimony itself is rarely used in medicine, oAving to its insolubil- ity, but is generally employed as the tartrate of antimony and potas- sium, or Tartar Emetic (Antimonii et Potassii Tartras, TJ. 8. ; Anti- moniion Tartar at um, B. P.), or in the form of the sulphide (Anti- monii Sulphidum, TJ. 8.); purified sulphide (Antimonii Sulphidum Purification, TJ. 8. ; Antimonium Nigrum Purification, B. P.); and sulphurated antimony {Antimonium Sulphnratum, U. 8. and B. P.), sometimes called Kermes Mineral. The last three drugs are very rarelv employed, and are unreliable preparations, although some prac- titioners use kermes mineral as an alterative circulatory depressant and sedative expectorant in the dose of i grain (0.01) every hour or two. As an emetic the dose of Kermes Mineral is 1 to 4 grains (0.05- 0.2). The oxide of antimony (Antimonii Oxidum, I. S.) forms part of the Pulvis Antimonialis. Tartar Emetic. Tartar Emetic (Antimonii et Potassii Tartras, TJ. 8.; Antimonium Tartaratum, B. P.) is made by boiling the oxide of antimony with 70 DR UVS. 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 alco- hol 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 tan- nic 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 readily cause a large amount of irritation if the part be delicate. If kept in contact Avith a mucous membrane, very distinct inflammatory changes occur, and if it be applied to the skin for any length of time, redness, folloAved by acne of a pustular character, appears, which finally ends in ulceration and sloughing if the use of the drug is per- sisted in. Under these circumstances the vitality of the parts seems interfered with, and, as a result, healing takes place very sIoavIv 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 Avhen an animal is under its influence sensation to heat and acids is lost before the ordinary sense of touch is destroyed. The convulsions Avhich sometimes ensue after poisonous doses in the lower animals are due to ansemia of the brain brought on by the cir- culatory 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 loAvers 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 Avails of the blood-vessels, 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 poAver. When poisonous doses are employed, death ensues after great cir- culatory and respiratory depression/as Avill be seen below. The heart is found after death relaxed and flabby and utterly dead to all stimuli although in one of the loAver animals, such as the frog, if the dose has not been very excessive and digitalis is freely employed, the heart may be made to beat again. In men, it is hardly necessary to state, the dig- italis must be used early to render much service. The drug in poison- ous doses is thought to depress the peripheral ends of the va^us 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 ANTIMONY. 71 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 mucus into the bronchial tubes that the patient is drowned in his own secretions, which he is too Aveak to expel. Stomach and Intestines.—Antimony in toxic doses is a power- ful 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. Very full doses produce watery purging, attended Avith some grip- ing 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 folloAV poisonous doses, and purging is an effort at elimination. Poisoning.—When toxic doses of tartar emetic are taken, the pulse at first becomes slightly weaker and sloAver, the skin becomes moist and relaxed, a general sense of relaxation comes on, and simultaneously a sensation of severe nausea and gastric distress appears. FolloAving this condition violent vomiting asserts itself. The ejected mass consists of the contents of the stomach—mucus, bile, and Avatery fluids, and perhaps blood. Purging appears almost as early as the vomiting, and consists first of the normal contents of the intes- tines, then mucus, then bile, and, very rarely, blood. These signs may rapidly pass away and the characteristic peculiar " rice-Avater " stools1 of antimonial poisoning appear. The general condition of the patient is noAv most serious. The face is pinched, livid, and cov- ered Avith a cold SAveat. The pulse is rapid and shuttle-like—to and fro—or lost at the Avrist; the arterial tension is almost nil. The res- pirations are faint and fluttering, and so shalloAV as hardly to be seen or heard. Cramps in the calves of the legs attack the patient, due to the abstraction of Avater from the tissues by the violent purging, and the temperature falls loAver and loAver 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 during an epidemic Avithout a history of the case or a chemical analysis of the secretions, Avhich 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 toAvels and not raise the head from the ground; the head, indeed, should generally be placed loAver than the 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 a good opportunity to state that the secretions and excretions of a person dving 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 holding 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. 72 DRUGS. heels. External heat, alcohol, and digitalis should be used thor- oughly, and opium should be employed hypodermically to allay pain and irritation, unless the respirations are too feeble. If the opium is greatly needed because of pain, and yet seems contraindicated because of depression, it should be accompanied by strychnine to stimulate the respiratory centre and overcome any depression produced by the opium. Fatty degeneration of all organs may occur after acute antimonial poisoning. Therapeutics.—Tartar emetic is employed for at least five separate purposes, the most usual of Avhich 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 Avere at one time, on account of the introduction of other drugs. Suffice it to state that all states of sthenic inflammation with a bounding pulse, high fever, and symptoms showing the patient to be possessed of robust constitution permit of its use, while ail asthenic conditions most emphatically contraindicate its employment. In the treatment of colds, to break forming diseases, and to allay inflammation it is given in moderate dose. It is useful in sthenic bronchitis as an expectorant. Under these circumstances it may be given in emetic dose; or, if emesis is not desirable, minute amounts given hourly are of value, such as ^ of a grain (0.001) every hour, or a teaspoonful of a solution of 1 grain (0.05) to ^ a pint (250 cc.) every hour may be used. This is a particularly useful method in children, as the solution is tasteless and it does not pro- duce 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, and often aborts an attack Avhen given in the same dose as just described. As an emetic antimony is slow but forcible. It ought not to be used in cases of poisoning by other drugs, 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 changes are rapidly progressing. If one good-sized emetic dose is not sufficient to produce vomiting, it should not be repeated, but some other emetic or the stomach-pump be used, lest antimonial poisoning complicate the case. The emetic dose must be large enough to be effective, or none at all should be given. If this rule is dis- obeyed, systemic changes come on with undesirable severity in those cases where emesis fails to occur because of small doses. As a counter-irritant antimony is employed in the form of an oint- ment whenever a very 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 undesirable owing to its disagreeable effects, such as nausea and intestinal dis- turbance, and because other, more pleasant, drugs act equally well Administration.—The dose of tartar emetic when there is an excited circulation is ^ to ^ of a grain (0.003-0.006) every three ANTIPYRIN. 73 hours until an effect is obtained. As an emetic the dose is J to 1 grain (0.03-0.06). The wine of antimony (Vinum Antimonii, TJ. S. ■ I mum Antimoniale, B. P.) contains only 2 grains of tartar emetic to each ounce, and may be used in the dose of i to 1 teaspoonful (2.0-4.0). or, as an emetic, in the dose of 1 to 2 tablespoonfuls (15.0-30.0). The compound pill of antimony (Piluhe Antimonii Compositce, U. 8., or Plummer's pill) is used as an alterative, and contains sulphurated anti- mony 1 a grain (0.03), calomel 1 a grain (0.03), guaiac 1 grain (0.06), and tragacanth ; the dose is one to three pills. The ointment of antimony (Unguentum Antimonii Tartarati) is used externally as a counter-irritant spread on a rag or piece of lint. Antimonial powder (Pulvis Antinwnialis, TJ. 8. and B. P.), or James's powder, contains oxide of antimony and phosphate of calcium, and is given occasionally as an antipyretic in the treatment of rheumatism and fever in the dose of 3 to 10 grains (0.15-0.65); it is best given in a pill. The compound syrup of squill (Syrupus Scilhv Compositus, TJ. 8.), otherwise known as '• Coxe's hive syrup,*' contains three-fourths of a grain (0.045) of tartar emetic to the ounce. The dose is 20 to 30 drops (1.3-2.0) 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. ANTIPYRIN. Antipyrin is a derivative of coal-tar. its chemical name being phe- nyldimethylpyrazolon. It is also called Phenozonum (B. P.). It was discovered by Ludwig Knorr in 1884, and introduced into medicine by Filehne. Antipyrin is a Avhite powder of a someAvhat bitter taste, and is very soluble in Avater, less so in ether, alcohol, and chloroform. When antipyrin is given to a man in full medicinal amount, it causes a sensation of buzzing and tightness of the head not unlike that produced by quinine. The bodily temperature, if normal, is depressed a fraction 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 sAveat breaks out over the entire body, Avhich is more severe if fever has previously existed. Large doses sometimes cause nausea and vomiting. Physiological Action.—Nervous System.—When a large poisonous dose of antipyrin is given to one of the loAver animals, relaxation, utter loss of reflex action, and total inability to move come on at once, and death ensues. SomeAvhat 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 convul- sion 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. 1 See author's Boylston Prize Essay of Harvard University on Antipyretics, Phil- adelphia, 1891. 74 DRUGS. The cause of this failure of reflexes is depression of the sensory nerves and the receptive centres of the spinal cord. Medicinal amounts must, therefore, be regarded as very distinct nervous seda- tives, aetino- much more actively on the nerves of sensation than on those of motion. Injected beneath the skin or applied to a mucous membrane, antipyrin is a poAverful local anaesthetic, the anaesthesia lasting often for several days. Circulation.—The studies of a very large number of pharma- cologists prove most conclusively that antipyrin 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 antipyrin is certainly not a cardiac stimulant. The writer is confident, however, that antipyrin is not so distinctly a cardiac depressant as some think. Large, poisonous doses loAver blood-pressure, unless convulsions are present, when the pressure 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 unless the circulation is feeble. In many of the cases where vascular depression and collapse have folloAved 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 antipyrin in the ordinary individual, but in poi- sonous 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 in become crenated and shrivelled. Respiration.—When antipyrin 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 breathing more rapid. Temperature.—In normal men and animals antipyrin in medi- cinal dose may be considered as Avithout effect so far as bodily tempera- ture is concerned. In fevered animals it has been found to loAver 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 Avhen no sweating occurs. It may, therefore, be considered that the drug directly affects the nervous heat-mechanism of the body. Kidneys, Tissue-avaste, and Urine.—A large number of studies made upon man and the loAver animals by competent investigators have brought about very considerable advances in our knowledge of the influence of antipyrin upon tissue-waste. It is useless to burden this volume with a discussion of their methods and results, which mav be found in the author's Exxuy on Antipyretics. Suffice it'to say that, ANTIPYRIN. 75 Ayhile all observers are not agreed as to the effects produced, the deduc- tions apparently to be draAvn are that the drug diminishes the quan- tity 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 antipyrin goes on very rapidly indeed, and begins almost at once after its ingestion. Maragliano and Reihlen state 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 to be eliminated for twenty-four or perhaps thirty-six hours. According to Pavlinow, part of the antipyrin ingested is eliminated by the salivary glands. Poisoning.—The treatment of poisoning by antipyrin 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.—Antipyrin exerts a very distinct antiseptic action in small amounts, delays all forms of fermentation, and destroys germs Avhen it is present in large quantity. Therapeutics.—Antipyrin is employed in medicine for tAvo 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, antipyrin should be given in a feAv full 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, and the constant dosing Avill produce a gradual saturation of the system without causing a fall of temperature. On the other hand, too large doses may depress the temperature to a point beloAV normal and induce collapse. In the article on Fevers (Part IV.) the conditions are indicated in which the drug is best employed, these being the sthenic fevers as a rule, or instances Avhere excessive outbursts of fever necessitate prompt reduction of temperature. In excessively high tem- perature in pneumonia it may prove of great value, and in scarlet fever and smallpox antipyrin is of service in some instances, although in pneumonia, as a rule, the condition of the patient indicates the use of cold to the chest as a local measure for the reduction of congestion or cold sponging to relieve fever. (See Pneumonia.) The use of the cold applications is ahvays to be preferred to antipyrin in the reduc- tion of fever, since they are safer, more reliable, and do not strain the kidneys, reduce the blood, or depress the heart in feeble patients. (See Cold and Fever.) When cold Avater cannot be used, then antipyrin may be employed. In phthisis antipyrin generally increases the sweat- ing, produces oppression, and either fails to act as an antipyretic or produces collapse by exercising too great an effect. In sunstroke it frequently fails to influence the temperature, and ought not to be used. Be the fever Avhat it may, provided it be associated with any dis- eased process, antipyrin is absolutely useless so far as any influence over the course of the disease itself is concerned. It is a remedy to 70 DR UGS. be used in the treatment of the symptom, not for the removal of the cause of the fever. As an analgesic antipyrin 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 antipyrin. In deep-seated pains due to disease of the organs of the body, in inflammations and similar dis- turbances, antipyrin is useless. In neuralgic affections of all kinds it finds its sphere, particularly if the disorder be rheumatic, gouty, or due to nervous depression from nervous exhaustion or disease. Under the latter circumstances it is best combined Avith 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, hoAvever, to increase sweating in acute articular rheumatism. In gout it is stated to have a specific curative effect upon the disease over and 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 Avas thought that its use would relieve the pains of labor entirely, but this has, unfortunately, proved untrue. It may, hoAvever, be tried, Avhen the suffering is very severe, in the dose of 15 grains (1.0). In the severe lancinating or darting pains of locomotor ataxia, and in the laryngeal and gastric crises compli- cating this disease, antipyrin 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 antipyrin with asserted great success in diabetes mellitus. In such instances the disease often depends on a gouty diathesis, and can be well relieved by salicylates. Antipyrin may be used hypodermically in the region 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 severe. Antipyrin is a very useful remedy in epilepsy. (See Epilepsy.) In ivhooping cough antipyrin has more frequently given relief 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 (0.1) every four or five hours, the patient being watched for cyanosis and the drug stopped as soon as this symptom appears. Antipyrin generally decreases the frequency rather than the severity of the attacks of couo-h. In malarial diseases antipyrin certainly exercises no antiperiodic influence, although it controls the febrile paroxysms to a great extent. Yet, Avhile this is the opinion of the majority of those who have used it, it cannot be said that every observer has reached similar conclu- sions. 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 Avhere antipyrin has been reported as acting as an antiperiodic it has simply loAvered the fever, and so seemed to affect the disease. In acute roryza the temporary relief produced by applying cocaine to the engorged Schneiderian membrane may be prolonged indefinitely ANTIPYRIN. 77 by the use of a spray of antipyrin in the strength of 4 per cent. This produces a smarting sensation, Avhich speedily passes aAvay. The same treatment is of value in inflammations of the larynx and pharynx. Should cocaine solutions not precede the antipyrin, the primary irri- tant effects persist unless the strength of the solution of antipyrin is reduced to 1 or 2 per cent. It is ahvays better to precede its use by cocaine. Locally applied, antipyrin possesses very distinct luemostatic prop- erties, and for this purpose may be used in a 4 per cent, solution, either in liquid or in a spray. Lender these circumstances it seems to act not by producing clots, Avhich are disadvantageous from the standpoint of antisepsis, but by constringing the bleeding vessels. This haemostatic property is very materially increased if a solution of tannic acid is added to it, when it forms a glutinous precipitate Avhich controls the hemorrhage. The precipitate is best applied by means of a SAvab. Antipyrin may be given Avith cocaine in suppository to check bleed- ing from hemorrhoids and relieve rectal pain. The cocaine must be used to prevent the antipyrin from causing pain when the suppository is first introduced. Untoward Effects.—Aside from the results of poisonous doses, a cer- tain number of cases taking this drug present slight cyanosis or duski- ness 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; SAveating is a very common symptom of the untoAvard influence of antipyrin, and pricking or tingling of the skin is not. uncommonly seen. By far the largest number of these cases, hoAvever, suffer from disorders associ- ated with the skin, and erythematous patches may be seen every- where, 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 pub- lished the statistics, collected from medical literature, of 121 cases of untoward effects exercised by antipyrin.l An analysis of these shoAvs that females were much more frequently affected than males, and that the most susceptible age Avas decidedly that of full adult life __namelv, from thirty to forty years in both sexes. The dose caus- ing these effects Avas most commonly a moderate one—from 10 to 15 grains (0.65-1.0), or even from 4 to 10 grains (0.2-0.65). 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 men- tioned. 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, m ordi- nary cases of disease that patients exhibiting untoward effects of anti- pyrin are not in any acute danger, although the symptoms may be temporarily most alarming. Typhoid fever seems, according to the !See author's Boylston Prize Essay on Antipyretics, Philadelphia, 1891. 78 DRUGS. statistics collected by the writer, to be the disease in which this unex- pected influence manifests itself most frequently, but this may be due to the fact that it is so common a malady and is so frequently treated by means of antipyretics. Falck has collected a large number of cases of antipyrinism, and quotes Pusinelli as having seen vomiting often folloAV the use of this drug. Antipyrin very distinctly increases susceptibility of patients to tak- ing cold, and ought not to be employed by those Avho are forced to go out of doors in cold Aveather. Administration.—Owing to the solubility of antipyrin, it is most readily given in a little Avater in a Avineglass or spoon. If its slight taste is disliked, it may be dissolved in any one of the aromatic Avaters or in syrup of bitter orange-peel or some similar vehicle. Most per- sons prefer to take it Avith water. The amount Avhich may be given at a dose is 5 to 20 grains (0.3-1.3), but 3 to 5 grains (0.3) is the best dose in most cases, at least until it is seen Iioav Avell it is borne. Incompatibles.—When added to SAveet spirit of nitre, antipyrin in the course of a feAv moments produces a blue, changing to a dark- green, color, owing to the formation of iso-nitroso-antipyrin, Avhich is not poisonous, but Avhen in the form of a dry powder is readily oxidized on exposure to slight heat. If this color is not formed, the spirit of nitre lacks its nitrous ether and is Avorthless, so that Ave have not only another incompatibility to remember, but a new means of testing the therapeutic value of all samples of SAveet spirit of nitre Avhich may be dispensed by druggists. Calomel and antipyrin have also been found to be incompatible. ANTITOXIN. This general term '• antitoxin " is now applied to the blood-serum 0- animals naturally, or rendered artificially, immune to a given infectious disease, and depends upon the discovery that such serum renders a per- son receiving it partly or completely immune to that disease. Because of the source of the remedial agent this plan of treatment is sometimes called serum-therapy or orrhotherapy. In only one disease has this method really given us reliable and good results—namely, in diphtheria, in which malady the subcutaneous injection of antitoxic serum has proved itself a specific means of cure. (See article on Diphtheria.) The same plan of treatment has been tried in tetanus and all the eruptive fevers, and even in infection by the streptococcus, but the results as yet are not such as to render it of any value to the general practitioner. Theoretically, the Avide extension of serum-therapeutics is correct; practically, the results desired are not obtained except in the disease diphtheria. APIOL. Apiol itself is a camphoraceous body, derived from common parsley or Petroselinum. As its melting-point is very low, it cannot be kept in solid form, and is ahvays dispensed in 75 per cent, solution. So far as APOMORPHINE. 79 is knoAvn 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 amenorrhoea, given in the dose of 2 to 8 minims (0.1-0.5) three times a day for a Aveek before the proper date for menstruation. It should be given, if pos- sible, in capsules, owing to its bad taste. It is said not to possess any abortive influences, although it is often taken Avith this object in vieAV. Apiol is imported from France in capsules containing a little less than 3 minims (0.15), and is also put up in soft elastic capsules in this country. 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,°Avhich rapidly undergo decomposition Avhen exposed to the air. The drug should be kept in dark bottles well stoppered. A very important point to remember is that solutions rapidly decompose, and, if employed, mav produce poisonous symptoms. The drug ought to be freshly dissolved each time it is used. If the salt imparts an emerald- green color to 100 parts of Avater when shaken a few times, it should be rejected, unless it is found that the water contains small amounts of ammonia, which is supposed to be active in causing such a change. According to Bover and Ouinard, there are two kinds of apomor- phine sold. Each has a physiological effect different from the other. The crystalline form, which is the one always to be employed, causes, in overdose, irritation, spasms, trismus, vertigo, and hyperaesthesia; while the amorphous (never to be used) causes collapse, hypothermia, general weakness, feebleness of the heart and respiration, and anaesthesia. Physiological Action.—One of the best studies of this drug is that of Reichert, who found that in poisonous doses it produces convulsions, and finally paralysis, both of which are 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 paralyzed by poisonous doses, and even the muscles become poisoned and incap- able of contraction. Medicinal doses have no effect. Circulation.—Apomorphine increases the rapidity and force ot 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. 80 DRUGS. Vomitinu.—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 Avhere an emetic may be employed. In poisoning from other drugs, particu- larly depressants and narcotics, we have little knoAvledge of its safety, but, unless the stupor or circulatory change is very profound, the drug may be used Avith 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 Avhen it is necessary to quiet irritation or Avhen the secretion Avhich has been poured out is very scanty. Untoward Effects.—Apomorphine rarely causes disagreeable effects, but there are cases on record in Avhich it has produced serious symp- toms, even Avhen given in ordinary doses. These symptoms have con- sisted in depression and collapse. One-fifteenth of a grain has caused death in a Avoman Avho had bronchitis, but Avas otherwise healthy. Probably in these cases the amorphous form already named Avas used. Administration.—The drug when used as an emetic should ahvays be given hypodermically and the solution be freshly prepared. The emetic dose is about -^ of a grain (0.006), but as much as 4/ (0.01) may be used in strong patients. The expectorant dose is ^ to -^ of a grain (0.0015-0.003) by the mouth. No nausea is usually felt. The drug nearly ahvays acts badly in children, and it is better not to use it in this class of patients. The salt used is Apomorphince Hydrochloras, TJ. S. and B. P. An injection (Injectio Apomorphince Hypodermiea)—2 grains (0.1) dissolved in 100 minims (6.5) of cam- phor-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 position in domestic medicine as a local and internal remedy in sprains and bruises and in the treatment of passive hemorrhages, amenor- rhoea, and similar states. Two parts of the plant are official—the arnica-floAvers (Arnica? Flores, TJ. 8.) and the root (Arnicce Radix, TJ. 8., Arnicce Rhizoma, B. P.). Physiological Action.—When arnica is applied to a delicate skin, it produces burning and irritation, and even extensive skin lesions! According to the studies of the author, it sIoavs 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 ARSENIC. 81 used, the dose of the tincture (Tinctura Amice Radicis, TJ. 8.) is 15 to 30 drops (1.0-2.0), and the same amount of the tincture of the flowers (Tinctura Arnicce Florum, TJ. S.) may be employed. The solid (Extraction Arnicce Radicis, TJ. 8.) and the fluid extract of the root (Extractum Arnicce Radicis Fluidum) are also official. The dose of these preparations is 3 to 5 grains (0.15-0.3) and 5 to 10 minims (0.3-0.65) respectively. The plaster (Emplastrum Arnicce, TJ. S.) is very useful for external applications. The tincture of arnica is the preparation usually applied to sprains and bruises, and the alcohol contained in this preparation 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 (2,0-4.0). ARSENIC. Arsenic (Arsenicum) itself is never employed in medicine, but it is used in the form of arsenous acid or the arsenates of sodium, potassium, or copper. Arsenous acid (Acidum Arsenosion, TJ. 8.; Acidum Arseniosum, B. P.) is derived from arsenic-bearing ores by roasting them in a reverberatory furnace, Avhen it rises in the form of a vapor Avhich adheres to the Avails of the furnace, requiring a second sublimation, owing to the first deposit being quite impure. It is soluble in water, is without odor, and Avhen heated gives off the smell of garlic. Physiological Action.—The changes produced in man by poisonous doses Avill be found considered under the heading of Poisoning, and the writer will now confine himself to a study of the effects of medici- nal amounts. Applied to the normal skin, arsenous acid produces no change of any moment whatever, but if the surface be broken or a Avound or sore exist, its action is very poAverful, 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 Avarts, 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.'' Absorption.—Arsenic is slowly absorbed. Nervous System.—When small amounts of arsenic are given to animals, particularly those of the loAver 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 experiments have proved that the sensory tract of the spinal cord is at fault. Ultimately, however, the motor system also fails and com- plete motor palsy ensues. Arsenic in poisonous amount acts as a depressant poison to all protoplasm Avith Avhich it may come in con- tact (Ringer and Murrell). In medicinal amounts the drug acts as a nervous excitant and as a stimulant to the trophic nervous apparatus. 6 S2 DRUGS. 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 pres- sure is due to vasomotor depression with relaxation of the general blood-vessels, more especially those of the abdominal cavity. Accord- ing to Lesser, small "doses cause it to act as a cardiac stimulant, increasing the pulse-rate. Arsenic is absorbed by the blood-vessels. Respiration.—In small amounts arsenic very distinctly stimulates the respiratory centre, and Lesser asserts that small doses stimulate the peripheral ends of the vagi in the lungs, but that in toxic quan- tities arsenic acts as a powerful respiratory depressant. Elimination.—Arsenic escapes from the body chiefly by the kid- neys, skin, and boAvels, but usually does not appear for from fourteen to sixty hours after its ingestion in medicinal amount. In poisoning the purging which is produced carries off' much of the drug, but after me- dicinal 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 ayIio 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, hoAvever, greatly increase nitrogenous metamorphosis. Therapeutics.—Arsenic is used in chorea, in Avhich it is almost a specific, acting in an unknoAvn manner. Small doses should be given at first, and later on the dose should be increased rapidly, as patients soon get accustomed to the drug. Cases are on record, hoA\eArer, in Avhich the too rapid increase of the drug in medicinal doses has developed arsenical neuritis. As a tonic combined with iron it is invaluable in malarial anamiia and cachexia. In atony of the mucous membrane of the stomach and intestines it is exceedingly useful, and in ordinary anemia and debility, combined Avith a simple bitter tonic, it is invaluable. Arsenic offers the best chance of saving cases of per- nicious anemia. In feucocythemia and pseudo-leukcemia arsenic is again the remedy, and it must be constantly given up to the point of intolerance to be of value. In the latter disease good results have fol- loAved its use Avhen intraglandular and intrasplenic injections of 4 drops (0.2) of Fowler's solution were used, and any case of severe anaemia where the stomach is disordered may be treated by givino- three times the ordinary dose by the rectum in starch-water or by its use hypoderm- ically in the proportion of 4 parts of water and 1 of Fowler's solution. In malaria it acts as a prophylactic, as a cure, and as an aid to conva- lescence. When the attacks of intermittent fever are far apart, arsenic is useful as an antiperiodic, quinine being Avithheld for use during the attack itself. Arsenic is of value, too, for the improvement of depraved mucous membranes of the respiratory tract, particularly in those per- sons avIio have not true tuberculosis, but phthisical tendencies; that is individuals avIio continually have colds in the head, chest, or elsewhere. ARSENIC. 83 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 maybe stopped just when doing good. Pemphigus, lichen, and lepra all yield to its influence in mos* instances. In the treatment of diabetes and pruritus vulva? the drug is said to be of A'alue Avhen given internally. In gouty diabetes the use of the carbonate of lithium and the arsenate of sodium is often of great service. In asthma, particularly Avhere the mucous membranes are at fault, arsenic is one of the best remedies that Ave have, either given internally or smoked in arsenic cigarettes, Avhich are to be made as follows:1 R.—Belladonna? foliorum..........gr. xevj. Hvoscyam. foliorum...........gr. xlv. Stramonii foliorum...........gr. xlv. Extract, opii............. gr. iv. Tabaci.................gr. lxxx. Aquae.................Oj.—M. Ft. sol. et adde. Potassii nitratis.............gr. clx. Potassii arsenitis............gr. ccexx.—M. Bibulous paper is to be wetted with this compound, and after drying is to be rolled up and smoked as a cigarette. A more simple procedure is to Avet bibulous paper in a solution of arsenite of potassium of the strength of 15 grains to the ounce. In chronic rheumatism arsenic is very \raluable in certain cases, but often fails to be of service. In coryza, in 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 Avith some chance of success, and is often of value in the vomiting of hand-fed babies Avho are suffering from chronic gastric catarrh. It is also useful in the morning vomiting of drunkards. In atonic dyspepsia associated with chronic diarrhea and Avith evidences of dysentery arsenic is of service, and in small amounts it is very valuable in frequently repeated doses (y$o oi> a grain (0.0006) every hour) in all forms of serous diarrhea. For gastric atony or torpidity the folloAving prescription is use- ful, but if irritation of the stomach is present it should not be employed: 1 Philadelphia Hospital Pharmacopoeia. 84 DRUGS. R.—Liq. potassii arsenitis...........f^ss (2.0). Tr. nucis vomica? ........... f.5J (4.0). Aqua?..............q. s. ad f^iij i%.Oi. —M. S.—Teaspoonful (4.0) t. d. in water after meals. In old persons Avhose feet become swollen and hot after prolonged standing, and Avho have shortness of breath on exertion, arsenic does good, particularly if the cause be cardiac feebleness, when it increases the efficacy of digitalis or strychnine so greatly as to be generally indi- cated Avhen these drugs are given. Locally applied to ivarts and other groAvths of the skin for several days in the form of Liquor Arsenicalis (B. P.) or Liquor Aridi Ar- senosi (TJ. S.) or of FoAvler's solution, it causes the groAvth 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 po- tassa before the arsenical liquor is applied. The same treatment may be used for corns, and salicylic acid can be employed in a similar manner, but is not so efficient. Where large growths Avith Avide surfaces are to be attacked the physician must use arsenic most boldly or not at all. The danger of absorption is only escaped Avhen 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 1 ounce each of arsenious acid and poAvdered gum acacia to 5 drachms of Avater 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 Avatch 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 SAvelling 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, and afterward to a true effusion. (See UntoAvard Effects.) The official preparations are: arsenous acid (Acidum Arsenosupi, U. S., Acidum Arseniosum, B. P.), the dose of Avhich is ^Ao 4^ of a grain (0.0015-0.003); the solution of the arsenite of potassium (LiquorPotassii Arsenitis, TJ. 8. ; Liquor Arsenicalis, B. P.) or Fow- ler's solution, the dose of Avhich at first is from 1 to 5 drops (0.05-0.3) in water; the solution of arsenate of sodium (Liquor Sodii Arsenatis, V. 8. and B. P.), or Pearson's solution, the dose of Avhich is 1 to 5 drops (0.05-0.3), and the solution of arsenous acid (Liquor Acidi Arsenosi, TJ. 8.), the dose of which is 1 to 5 drops (0.05-0.3). This is more irritating to the stomach than the other preparations. The iodide of arsenic enters into Donovan's solution (Liquor Arseni et Hydrargyri Iodidi, U. S. and B. P.), the dose of which is 1 to 3 drops (0.05-0.15), Avell diluted. Iodide of arsenic (Arseni Iodidum U. S. and B. P.) is given in ^ grain (0.0015) doses, and arsenate of sodium (Sodii Arsenas, U. S. and B. P.) in the dose of JW to -L nf * grain (0.003-0.006). ^ 10 ARSENIC. 85 Untoward Effects.—If arsenic is taken in full dose by a sus- ceptible person, it may cause a marked dermatitis, with a sensation of severe burning in the skin. Pustulations may occur, and Falck asserts that an erysipelatous state may arise. Almost any form of skin lesion may folloAV its use internally or externally, but nearly all show irrita- tion of the true skin. Even a scarlatiniform eruption folloAved by des- quamations may ensue. In other cases the mucous membranes become inflamed and coryza and disorders may develop. (See Administration.) Acute Poisoning.—Arsenic is a gastro-intestinal irritant, producing, Avhen taken in poisonous dose, violent vomiting and purging, Avith great pain in the oesophagus, stomach, and entire belly. The passages finally become Avatery and resemble " rice-Avater " stools, but are to be separated from those of cholera and antimonial poisoning by the pres- ence of blood and, if necessary, by chemical analysis. The mucous membrane is stripped off the boAvel and appears in shreds in the pas- sages. Very commonly about the third day, if the patient survives so long, an intermission in the attack appears, Avhich -will be folloAved by a return of all the symptoms, so that the physician must not give a favorable prognosis. In this symptom (remission) the course of arsen- ical poisoning resembles phosphorus-poisoning and yelloAV fever. Death generally occurs about the fourth or sixth day, and on or about the third day a peculiar skin eruption sometimes appears Avhich may be of any character. In rare cases sudden pain, collapse, and death may take place after the ingestion cf the poison. Widespread multiple neuritis may be brought on. A typical change ahvays present in acute poisoning when the patient lives for any length of time is fatty degen- eration of all the tissues. Treatment of Acute Poisoning.—In addition to Avashing out the stomach by the stomach-pump, applying external heat and stim- ulants, 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 beloAV.) The first is to be prepared by the precipitation 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 effi- cacious, but the precipitate has to be repeatedly Avashed 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. Monsel's solution and the so-called dialyzed iron may be employed in place of the tinc- ture, but Monsel's salt is too irritating, and dialyzed iron is so readily precipitated that it needs no alkali, but may be given pure. Magnesia is a useful antidote Avhen used alone. Lender the name Ferri Oxidum Hydration cum Magnesia the TJ. S. P. recognizes an antidote for arsenic: this is often called the " anti- dot urn arseniciJ The TJ. S. P. directs that this antidote should be kept on hand for immediate use in the folloAving manner: Mix 13J fluidrachms (50.0) of the official solution of the tersulphate of iron (Liquor Ferri Tersulphatis) Avith 4J ounces (100.0) of Avater, and keep the mixture in a well-stoppered bottle. Rub 150 grains (10.0) of magnesia with a little Avater to a smooth and thin mixture ; transfer it to a bottle capable of holding 32 ounces (1000.0), and fill the bottle 86 DRUGS. with Avater. When the antidote is to be used, add the magnesia solu- tion slowly to the iron solution and shake together until a homoge- neous mass results. (See Iron, Hydrated, Sesquioxide of.) After the use of the antidote emetics should be used, opium should be administered to allay irritation 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 sIioavs itself in great irritation of the air- passages, in the development of nephritis, 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 localized loss of motor power. These anaesthetic areas are generally confined to the extremities, and extend only to the first or the second joint above. Sometimes the multiple neuritis produced by arsenic produces symptoms which resemble those of locomotor ataxia, to a very considerable extent. In other cases the action on the skin is the more marked, and various acute inflammatory conditions are produced. 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. The prolonged use of arsenic, according to de Schweinitz, may produce vitreous opacities. ASAFCBTIDA. Asafoetida, TJ. 8. and B. P., is a gum obtained by making an incision into the root of the Ferula foetida. 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 Sensa- tion of warmth and acts as a stimulant and carminative in the ali- mentary canal. Therapeutics.—Asafoetida is used in medicine as a carminative which will particularly affect the lower boAvel, and is useful in the intestinal indigestion of old persons when associated with flatulence, and in the flatulent colic of children. In the form of rectal injections it is of value for the relief of the tympanites of children and in that of adults during typhoid fever. It is also used as a stimulating expec- torant 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 Asafoetidce, TJ, S.), of Avhich two or three may be taken, each one containing 3 grains (0.15); the emulsion or milk of asafoetida (Emul- sum Asafostide, TJ. 8.), the dose of which is J to 1 ounce (16.0-32.0) • ASPID1UM. 87 and the tincture (Tinctura Asafetide, TJ. S. and B. P), 1 to 1 fluid- drachm (2.0-4.0). The suppositories contain Avhat is equal to 40 drops (3.0) of the tincture; and the plaster of asafoetida (Emplastrum Asafoetide) is used Avhere a faint counter-irritant and antispasmodic is needed. When intestinal indigestion and flatulence occurs in old people the folloAving pill is of service: R.—Ex. nucis vomica?..........gr. v (0.30). Ex. kola?.............gr. iij (0.15). Asafoetida?............gr. xl (2.6).—M. Ft. in pil. No. xx. S.—One night and morning. The B. P. preparations not official in the TJ. S. P. are Enema Asafetide and Pilula Asafetidce Composita, composed of asafoetida, galbanum, and myrrh; dose 5 to 15 grains (0.35-1.0). ASPIDIUM. Aspidium, U. 8.. Filix-mas. B. P., or Male Fern, the rhizome of Dryopteris Filix-mas 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 vermi- fuges except pelletierin. When employed the directions and precau- tions given in the article on Worms must be strictly followed (Part IV.)- Male fern taken in overdose is capable of producing poisoning, and according to Quivill causes Avhen taken in overdose irritation of the gastro-intestinal mucous membrane and diarrhoea. If absorbed it acts on the central nervous system and causes paralysis, collapse, and death. The form and method by Avhich it is eliminated are unknown. It may in overdose cause albuminuria and glycosuria. To go beyond 1J drachms of the oleoresin (6.0) at a dose is dangerous. 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, TJ. 8.); dose \ to 1 fluid- drachm in capsules, or as follows: R.—Oleoresin. aspidii 1 --„ , ,0 ^ Tinct. vanilla? }........aa ^xlv ^' Pulv. acacia?...........^ss (2.0). Aq. destillat............f £j (32.0).—M. S.—Take entire amount after fasting, and follow in two hours by a full dose of sulphate of magnesium. The dose of the liquid extract (Extractum Filicis Liquidum) of the B. P. is 15 minims to 1 fluidrachm (1.0-4.0). Katamaya and Okamoto, two Japanese investigators, and Poulssen, all state that castor and other oils should not be used after filix-mas is given, as oils increase the absorption of the active principle, and so pre- dispose to the development of poisoning. 88 DRUGS. AZEDARAOH. Azedarach is the bark of the Melia Azcdarach, 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 berries have but little toxic poAver, and children may eat of them largely without ill effect, but the bark itself is poisonous when taken in overdose, and produces symptoms resembling those of poison- ing by spigelia or belladonna. 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 1^- pints (750 cc.) of water until there only remains a pint (500) of liquid. Of this from 1 to 2 tablespoonfuls (16.0-32.0) are to be given a child, and repeated every tAvo hours until the boAvels are opened. It has also been used as a fluid extract prepared by the ordinary means Avith 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 Avhich 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 loAver animals is given us by this substance. It will be remembered that Brunton and Ringer of London, Robert 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 circulatory 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, and at the same time increases the volume of blood thrown out of the ventricle. They have also found that barium increases blood-pressure, and Robert has, by a series of careful experiments, concluded that it brings about this change by an action on the mus- cular coats of the blood-vessels. 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 sloAving of the pulse is not due to inhibitory influence, but depends solely upon the stimu- lation of the heart-muscle, although it would seem probable that the vasomotor 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. BELLADONNA. 89 Therapeutics.—Barium chloride mav be used in all forms of car- diac disease m which failure of the heart-muscle is present. In the treatment 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. \\ bile its volume is increased, it does not give that sensation of tenseness to the finger that does the pulse produced by 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 (0 3 ■ 3° 0) of water, and of this 1 or 2 teaspoonfuls (4.0-8.0) is to be given three times a day. BELLADONNA. Belladonna is botanically known as Atmpa Belladonna, and is official m the form of the root (Belladonna? Radix. U. S. and B. P) and leaves {BJfadm.r ^^ and relief under these circumstances can only be obtained when the uteius is treated and the bromides administered. In convulsion* in children and adults, combined with chloial, bro- mides are most efficient, and are sometimes of service in »»™t»«™ of urine due to vesical spasm. In seminal emissions due to a moibid excitability of the centres in the spinal cord bromide of potassium is one of the best remedies we have, and in satyriasis and nymphomania {t ' In aS where uirdue irritability of the pharynx and larynx prevents 102 DRUGS examination of these parts, one or two full doses will render an exami- nation easy of performance by decreasing the local reflex activity. 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 [4.0-8.0] 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 abduc- tor 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 cor- tex, prevents this accident. In whooping cough Avith 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 +he drug may be used to decrease reflex irritation and prevent convulsions, and it will decrease the night-screaming of children—Avhich 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 eve- 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 ir. sick headache. It ought not to be used in bilious headache, Avhich Avill often be made worse by it: R.—Antipyrini............gr. xxv (1.65). Caffeinse citratae .......... gr. x (0.65). Potassii bromidi........gr. xxv (1.65).—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 (0.3-0.65) night and morning. In cases where the epochs folloAv one another too closely the drug should be used continuously. 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 (0.3-0.65) three times a dav for several days before the patient sails in order to quiet the vomiting BROMIDES. 103 centre. After sea-sickness begins they should not be given in ordi- nary solution, but in an effervescing draught made as follows: R.—Acid, citric.............oij iS.O). Aquiedest.............fgiv (128.0).—M. Ft. sol. R.—Potassii bromidi..........3J (4.0). Potassii bicarbonatis........3J (4.0). Aquadest.............f.^iv (128.0).—M. Ft. sol. S.—A tablespoonful (16.0) 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 prolonged etherization or other states. If the vomiting is excessive, the dose ought to be reduced to 2 teaspoonfuls (8.0) 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 (2.0). Tinct. opii deodorat.........gtt. xxx (2.0). Aqu* amyli..........f gvj (192.0).—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 the use of 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 (0.3-X.O) a day. . Use of Bromides in Poisoning.—Bromides are useful in all convul- sive attacks consequent upon the ingestion of poisons, except those due to cardiac sedatives which depress the circulation at the base of the brain, and they may be used to allay any nervous symptoms which are of an excited'nature, to prevent excessive vomiting, to produce sleep, and to quiet delirium, and even to allay pain. Poisoning.—Acute poisoning by the bromides is rare, but if halt to one ounce is taken they produce a warmth in the epigastrium, general feebleness, frontal headache, stupidity, aphasia, and amnesia. The pulse-rate falls from 15 to 20 beats; the pulse is irregular and compressible. Recovery takes place, as a rule, unless pulmonary oedema sets in. Effects of Prolonged Use, or Bromism.—After the drug has been used for some time acne 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 dav. Duririir this time he can be aroused, but at once falls to sleep a destillat..........q. s. ad f^vj (190.0).—M. S —Tablespoontul (16.0), in water, at a dose at night, to be repeated once. Shake well before using. In headaches at the menopause cannabis indica is useful, and if the headaches are associated with constipation and anaemia, iron and aloes should be given simultaneously. Where headaches are due to retinal asthenopia a very useful prescription, according to de Schweinitz, is as follows: R.—Tr. nucis vomica?...........f^ij (8.0). Tr. cannabis indica;..........f^ij (8.0).—M. S.—15 drops (1.0), in water, twice or thrice a day. The following prescription has been found to be very efficient in the hands of the author in treating gastralgia and similar forms of pain: R .—Tr. capsici.............fjjij (8.0). Tr. cannabis ind. ... .....f^ss (16.0). Tr. opii deodorati .........fgj (32.0). Spt. chloroformi ..........f*j (32.0). Spt. lavandul. comp.......q s. ad f|iv (128.0).—M. S.—Teaspoonful (4.0) every hour until pain is relieved. In cases of uterine subinvolution, chronic inflammation, and irrita- tion cannabis indica is of great value, and it has been found of service in metrorrhagia and nervous and spasmodic dysmenorrhea. Not only does it relieve the pain, but it seems to act favorably upon the mus- cular 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 Avriters in the cases in Avhich 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 that it does not constipate, nor does it cause after-depression and nausea. On the contrary, there is often an increase rather than a decrease of the appetite under its influence. In the Anglo-Saxon race the cannabis-indica habit is practically unknoAvn, but in the East Indies Avhen used to excess it sometimes causes maniacal insanity, from which the patient nearly ahvays recovers after some days, weeks, or months. 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. has proved efficacious in the author's hands for a number of years. The physician should always employ some preparation knoAvn by him to be active by personal trial before condemning the drug as a failure in a given case. 120 DR UGS. The dose of the solid extract (Extraction Cannabis Indice, U. 8. and B. P.) is from \ to J grain (0.015-0.03), that of the fluid extract (Extractum Cannabis Indice Fluidum, U. S.) from 4 to 20 minims (0.3-1.3), and that of the tincture (Tinctura Cannabis Indice, U. 8. and B. P.) from 15 minims to 1 drachm (1.0-4.0). CANTHARIS. Cantharis (U. 8. and B. P.), or " Spanish Fly," is really a beetle, known as the Cantharis vesicatoria, and as such appears with irides- cent coverings or wing-sheaths of a bluish or greenish hue. The insects come chiefly from Spain, Italy, and Sicily, and from the south- ern 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 acti\re principle, but cantharidin is not medicinally employed. Physiological Action.—Locally applied to the skin, cantharides causes irritation and finally vesication. The blister produced may be quite large, and enough of the drug may be absorbed to cause fever and nervous ex- citement. The ingestion of a moderate dose of cantharides produces a sensation of Avarmth in the stomach and slight stimulation of the genito- urinary system, particularly the kidneys and urinary tracts. Large amounts produce great pain in the lumbar region, burning in the blad- der and along the entire urethra, priapism, agonizing vesical tenesmus, widespread acute nephritis, bloody urine, Avhich is scanty at first, and finally suppressed, with great irritation of the external openings of the genito-urinan' apparatus. The inflammatory changes Avhich are pro- duced 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 and 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 Avhere 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 Avriter has seen it used it has made matters much Averse, although it is supposed to decrease the quantity of the albumin and blood. In the later stages, Avhere the kid- neys are relaxed and torpid or Avhere albuminuria comes on on the slightest exertion, cantharides in the dose of 1 drop (0.05) of the tinc- ture three times a day are of great service. In cases of chronic parenchymatous nephritis, particularly Avhere alcoholism is the cause of the disease and the kidneys are inactive can- tharidal tincture is very useful. In pyelitis and in chronic cystitis it is CANTHARIS. 121 of service, and it has been recommended very highly in drop doses in irritability of the bladder in Avomen 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 occurring in some elderly or nervous females when coughing, sneezing, or laughing, and will often given relief after many years of suffering. In chordee, in the dose of 1 drop (0.05) twice or thrice daily, it is sometimes of service. For impotence depending upon sexual excess Ringer asserts that the use of 10 to 15 drops (0.65-1.0) 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 when given in almost toxic dose. In gleet of a very chronic type and in prostatorrhea it is of service. Dermatologists have used cantharides internally as a remedy in psoriasis, eczema, lichen, and prurigo, with asserted great success. The dose should not be large enough to irritate the stomach or kidneys. Externally, cantharides are used in the production of blisters for the purpose of causing the absorption of effusions 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 con- gestions and inflammations the use of cantharides as a counter-irritant is often contraindicated because of this danger. Huchard and others have reported cases in which, Avithout any previous disease of the kidney, a cantharidal blister has produced violent acute nephritis, "with uraemia therefrom. In the proportion of 1 drop (0.05) of the tincture of cantharides to 40 (2.65) of Avater it is said to be a very good appli- cation for burns, but how it acts is not known. Administration.—The dose of the tincture (Tinctura Cantharidis, U. S. and B. P.) is from 1 to 10 drops (0.05-0.65), and it is the only preparation used internally. The cerate (Ceratum Cantharidis, U. 8.) is used, spread upon a rag, to produce a blister, and the cerate of the extract, Avhich is no longer official, is used for the same purposes and in the same manner. The cantharidal collodion (Collodium Canthari- datum, U. S.) is a method of applying the blister Avhich 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 (Churta Cantharidis, B. P.) are used as blisters, but are weak in action. The liniment of cantharides (linimentum Canthari- dis, Liquor Episp.'isticus, B. P.) is employed as a counter-irritant. "Wanning plaster -: (Emplasfrum Piris (Jantharidatunc U. S) is a mild counter-irritant to be employed Avhere a blister is thought to be too severe. The preparations of the B. P.. other than those named, are Acetum Cantharidis, Charta Epispastica, Emplasfrum Calefaciens, Emplasfrum Cantharidis, and Tuguentum Cantliaridis. 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 Avater and dried Avith a towel, Avhich should be rough enough 122 DRUGS. to produce reddening of the cuticle. After this the skin should be Avet with vinegar, and Avhile wet the blister is to be applied. CAPSICUM. Capsicum, U. 8., Capsici Eructus, 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, Avhich, when ripe, are scarlet red and possess a very hot, burning taste. The active principle is capsicine, which is a dark reddish liquid, or, in other words, is a volatile alkaloid. Physiological Action.—Locally applied to the skin or mucous membranes, 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 capsicum will cause a chronic or subacute gastritis with pain and discomfort over the liver and stomach. If single large doses are used renal irritation and inflammation ensue, Avith strangury and high-colored urine. Taken internally, capsicum is said to act as a circulatory 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. When the patient is suffering from 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 for the purpose of increasing the appetite. As a remedy for subacute alcoholism it is quite useful, since by its stimu- lating effect and hot sensation it often satisfies, at least to some degree, the craving for liquor. Under these circumstances it should be used in the dose of 5 to 10 drops (0.3-0.65) of the tincture even7 four or five hours, or as the oleoresin in pill in the dose of J to 1 grain (0.03-0.05). The following prescription has been found of great service in these cases: R.—Tr. capsici..............f^ijss (10.0). Tr. opii deodorat..........f^ij (8.0). Spt. a?ther. nitrosi ..... f^iv (16.0). Tr. lavandula? comp.......q. s. ad fjiv (128.0).—M. S.—Dessertspoonful (8.0) 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 development 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 considerable service, and it tends to" check albumi- nuria, 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 kid- ney. The tincture is to be given under these circumstances in the dose of 20 drops (1.3) or less, but in some cases Avhich are very chronic, as much as 40 drops (2.65) may be used. In sore throat and simple tonsillitis the tincture of capsicum and glycerin, half and half, CARBOLIC ACID. 123 are very 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. Capsicum may be used as a gastro-intestinal stimulant to aid in the absorption of other drugs. Applied externally, capsicum acts as a counter-irritant, 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 mav be employed bv saturating blotting- paper, time and time again, in the tincture of capsicum, alloAving it to dry between each dip. This paper should finally be placed when Avarm and wet over the part, and held closely to the skin by a compress. Capsicum plaster (Emplastrum Capsici, U. 8.) is useful in lumbago and rheumatism Avhen placed over the affected muscles, and in headache Avhen applied to the nape of the neck. The tincture is sometimes painted over chilblains Avhich are unbroken. The following 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 Avarm place in twice their Aveight of rectified spirits of wine. Dissolve gum arabic in Avater 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 Avill be cloudy and opaque. Take sheets of silk or tissue-paper; give them, Avith the brush, a coat of the mixture; 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 blistered, 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 likeAvise allays rheumatic pains in the joints." The dose of capsicum is 1 to 2 grains (0.05-0.1) in poAvder, on food or in pill. The dose of the tincture of capsicum (Tinctura Cap- sici, U S. and B. P.) is 10 to 30 drops (0.65-2.0), and of the oleo- resin (Oleoresina Capsici, U. 8.) J to i grain (0.015-0.03). The dose of the fluid extract (Extractum Capsici Fluidum, U. 8.) is 1 to 3 minims (0.05-0.15). The plaster (Emplastrum Capsici) is useful for external applications. CARBOLIC ACID. Carbolic Acid (Acidum Garbolicum, U. 8. and B. P.) is also knoAvn as Phenol, Phenylic Alcohol, and Phenic Acid. Not only is it an acid, but in addition it is an alcohol of the peculiar group knoAvn as the phenols, Avhich are derived from coal-tar by a process of distillation. Carbolic acid is sold in several grades, No. 1 being the purest. Both Nos. 1 and 2 are crystalline, Avhile Nos. 3, 4, and 5 are impure. because of the presence of cresylic acid and other foreign substances. 121 DR UGS. Only No. 1 should be ordered Avhen carbolic acid is to be given by the mouth. It has a peculiar characteristic odor, and varies in color according to its method of preparation and purity. It is soluble in 20 per cent. of water, but it is liquefied by the addition of 6 per cent, of water. Carbolic acid should be kept in dark amber-colored, well-stoppered bottles. If the crystals be exposed to the air, they undergo liquefaction, and in consequence the purest carbolic acid is usually prescribed in drop doses rather than in grains. It is soluble in alcohol, ether, chlo- roform, glycerin, and most oils. It unites with alkaline bases to form salts, carbolates, but these are very readily decomposed even by the feeblest acids, such as carbonic acid. Physiological Action.—Locally applied to the skin, carbolic acid produces at first a burning sensation, accompanied by a diffuse redden- ing of the surface. If the solution be strong, the part at once becomes temporarily painful, then bleached and numb, so that tactile sensibility is destroyed. Applied to mucous membranes, it causes similar changes, but to a more marked degree, and may even act as a moderately severe caustic of a superficial type. Owing to the local coagulation of albu- min produced by it, it cannot penetrate the tissues very deeply. Nervous System.—Carbolic acid acts as a depressant and para- lyzant to the peripheral sensory nerves Avhen locally applied. Upon the higher centres in the brain the acid produces a condition of depression and stupor. The convulsions Avhich sometimes occur after toxic doses have been taken 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 car- diac muscle is affected. These changes folloAv 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 changes, according to SalkoAvski 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 respiratory centres. Temperature.—Carbolic acid acts as a feeble depressant to nor- mal bodily temperature even when given in medicinal dose, and also de- creases 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 for this purpose. Kidneys and Elimination.—When carbolic acid is given in over- dose the kidneys may become so irritated that total urinary suppression may occur. When taken in large quantity it causes the urine to become broAvnish-black. This discoloration is due to an oxidized educt of car- bolic acid which is not yet isolated. Carbolic acid is eliminated in the urine as asulphocarbolate of sodium and potassium and as glyco-uronic acid and hydrochinon. Part of it is burnt up in the body. CARBOLIC ACID. 125 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 and chronic poisoning by carbolic acid are identical, they may be considered together. Carbolic acid is one of the most deadly and rapidly-acting poisons known, although this fact does not seem to'be generally recognized. If a large lethal dose be sAvalloAved by a man, he may drop dead from its effects before he can go more than a few feet from the spot where he stood when drinking the drug, or he may live a few hours. In cases Avhere death has occurred suddenly from taking this acid the direct 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 Avet with sweat, the face pinched and anxious. Collapse, Avith 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 Avill shoAV 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 Avith dark grumous blood, and 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 Avide- spread type often folloAvs carbolic-acid poisoning. Langerhaus has noted that in some of these cases evidences of croupous pneumonia exist. A very common symptom is hoarseness of the voice, due to an effect on the larynx after the drug is absorbed, and not from its local influence. A large number of cases are on record in Avhich carbolic-acid poi- soning has been produced by its absorption from surgical dressings. One of the earliest signs of such an accident is the darkened, smoky hue of the urine and a slight nervous unrest or cerebral disturbance. Very often pain in the lumbar region indicates kidney strain and irri- tation. The dressings should be, of course, at once removed. Treatment of Poisoninu.—The chemical antidote to carbolic acid is any soluble sulphate, such as Epsom or Glauber salts, Avhich form insoluble sulpho-carbolates. As tbese salts folloAV the acid into the blood-vessels 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 hypodermic injection of cardiac and respiratory stimu- lants, such as digitalis and strychnine, morphine to relieve pain, and the use of counter-irritation over the abdomen. Emetics and the 126 DRUGS. 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, neverthe- less, has a very favorable effect in certain states. In nervous vomiting or in that due "to gastric irritation the drug does good in ^- to 2-drop (0.03-0.10) doses by depressing the sensory nerves in the stomach. In diarAea depending upon fermentation from 2 to 4 drops (0.10- 0.20) of Uie acid do great good, particularly if combined Avith 10 to 20 grains (0.65-1.3) of bismuth administered in powder or capsule. In gangrene and tuberculosis of the lung a spray of the acid in Avater in the strength of 5 to 15 drops (0.3-1.0) to the ounce (32.0) may do some good, and at least control the cough and relieve the irritation and tickling in the throat.1 Creosote is, however, generally preferred in these conditions at the present time. Externally the acid is very largely employed as an antiseptic lotion and in solutions in Avhich to place instruments while operating. The solutions for this purpose should be in the proportion of 1 of acid to 20 of Avater. (See Antiseptics.) Carbolic acid is rarely used directly over ivounds in dressings at present unless the dressing be one of carbolized oil. Other drugs have supplanted it. The use of the carbolized spray over Avounds 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 Avill be found of value Avhen used in a spray or mouth- wash in the proportion of 1 part to 75 parts of water, and in ordi- nary sore throat or that due to sepsis in the strength of 1 part to 100 of water it will be found, Avhen applied on a SAvab or by a gargle, to relieve the pain and inflammation. In the treatment of burns carbolized sweet oil in the proportion of 1 drachm (4.0) of the acid to each 6 ounces (192.0) makes one of the best dressings that can be used. Bv means of the local anaesthesia produced by the acid, minor operations. such as eversion of an ingrowing toe-nail or opening a felon, may be performed by soaking 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 (0.65) of the acid to 2 drachms (8.0) of glycerin and 2 drachms (8.0) of water, or, better still, 4 drachms (16.0) of* SAveet oil. In enlarged glands Avhich have not yet gone on to suppuration intraglandular injections of carbolic acid by means of 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 (0.3-0.15) of this solution is sufficient for each gland. In the treat- ment of buboes 10 minims (0.65) of a solution of 8 grains (0.5) to the ounce (32.0) may be injected into the swelling, the skin- being first benumbed by an 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. 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. 127 In the form of an ointment carbolic acid mav be used in the strength of 10 minims to the ounce (0.65 : 30.0) of simple cerate, particularly in cases of subacute eczema Avhere there is a great amount of weeping and itching. As a disinfectant carbolic acid ranks among the poorest: 1 to 2 per cent, solutions, hoAvever. kill most spores and germs. Administration.—Carbolic-acid ointment (Unguentum Acidi Car- bolici, U. 8. and B. P.) and the glycerite (Clycerita Acidi Garbolici, U. 8.) are the only official preparations of carbolic acid in the U. S. P. In the B. P. the folloAving preparations are official: Acidum Carbolicum Liquefaction, given in the dose of 1 to 2 minims (0.05- 0.10); G-lyceritum Acidi Garbolici; and Suppositoria Acidi Garbolici cum Sapone, each suppository containing 1 grain (0.05) of carbolic acid. CARBON (CHARCOAL). Carbo Ligni, U. S. and B. P., or Charcoal, is prepared by the exposure of soft Avood to a red heat, air being prevented from coming in contact with the wood during the process. Charcoal Avhen used for medicinal purposes should be a black, brittle, someAvhat shiny, porous substance, devoid of taste and odor, and completely insoluble in Avater. Therapeutics.—Charcoal is used externally as an application to old sores or sloughs to act as a deodorant and antiseptic. This it accom- plishes by the absorption of any liquids Avhich may be present, thereby depriving germs of a nidus, and by its distinct oxidizing poAver. It may be applied in the form of a dry poAvder or in a poul- tice, Avhich is, hoAvever, so uncleanly that other antiseptic dressings are better. The poultice (Cut#a long time it seriously depresses the respiration. Bromide of ethyl has been found of the greatest value by Montgomery of Philadelphia as an 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 HaAv- ley 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 physician's directions, because of the fleeting influence of the drug, than Avhen chloroform or ether is taken, and it is not so apt to cause post-partum hemorrhage through uterine 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 instances nervous twitchings, and even tetanic spasms, have been known to follow its employment. These tetanic symptoms are, how- ever, fleeting and generally of little importance. Nausea and vomit- ing rarely folloAv 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 for but a brief period, but when taken should be inhaled freely. It cannot be given carelessly with good effect. If a good sample is employed, 15 minims to 3 drachms (3.0-12.0) is a sufficient amount to induce anaesthesia. 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 Avith other anaesthetics. ETHYL IODIDE. This is a colorless, non-inflammable liquid, Avhich 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. 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. EUCAINE HYDROCHLORATE. 199 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 inhalation for the treatment of subacute or chronic catarrh of the air- passages and for the purpose of rapidly impressing the system Avith iodine for alterative purposes, for it is the iodine in the remedy Avhich produces the curative effects desired. In catarrhal states of the bron- chial tubes the stimulating effect of the iodine is supposed to cause free secretion and to prevent abnormal thickening of the mucus and dilatation of the air-passages. For this reason iodide of ethyl is sup- posed to be of service in, asthma and its resulting emphysema. Very recently BartholoAv has recommended this drug in the treatment of pneumonia. It is said by that Avriter to be particularly useful in the later stages of this disease, to aid in producing resolution, but the author has never seen it produce much effect. Administration.—10 to 20 drops (0.65-1.3) may be placed upon a handkerchief and inhaled, or a small vial filled Avith 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. EUCAINE HYDROCHLORATE. Eucaine hydrochlorate is a synthetic substance having a chemical formula closely resembling cocaine, and for this reason it was thought probable by Leibreich and Vinci, working in the Pharmacological In- stitute in Berlin, that it might have a similar anaesthetic effect. This has been found to be the case, and the drug is now marketed as a substi- tute for cocaine, it being claimed that it does not affect the heart as does the latter drug. Eucaine, however, does not cause a primary con- traction of the blood-vessels Avhen locally applied, as does cocaine, but a hyperaemia of the parts affected. Used by the process for producing infiltration anaesthesia (see Cocaine), it produces considerable pain before acting as an anaesthetic. In ophthalmic practice it is em- ployed in 2 per cent, solution, and to ordinary mucous membranes in 10 per cent, solution—that is, from 10 to 48 grains to the ounce of water. One advantage of eucaine is that it forms a permanent solution Avith water in 10 per cent, solution. Further, eucaine solutions can be boiled before they are used without causing decomposition of the drug. Eucaine hydrochlorate possesses a distinct disadvantage in its in- ability to cause primary contraction of the blood-vessels when locally applied, and this effect of cocaine is often most valuable to overcome local engorgement. Eucaine is also capable of producing internal effects resembling those due to overdoses of cocaine, and these must be treated by the use of strong coffee, alcohol, digitalis, and strychnine. If the case is pressing ether, ammonia, and nitroglycerin may be used as rapidly-acting stimulants. Eucaine hydrochlorate is an expensive drug at present. 200 DRUGS. EUCALYPTUS. Eucalyptus, U. S., is the leaves of the Eucalyptus globulus, or blue- gum tree, a native of Australia, but groAvn at present all over the Avorld. Its chief medicinal constituent is the oil of eucalyptus (Oleum Eucalypti, U. 3.), from Avhich is derived Euccdyptol, U. 8., Avhich is a camphorous body obtained by redistillation Avith 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. 10 to 20 drops (0.65-1.3) taken internally cause slight stimulation, fol- loAved by a sense of calm, Avhile 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 sen- sation in the loAver limbs may occur. If death takes place, it is due to respiratory failure. The drug is eliminated by the skin, kidneys, boAvels, 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. Therapeutics.—Eucalyptus is used in malarial fever Avhere quinine cannot be had, nor be borne by the patient owing to idiosyncrasy. In bronchitis, in an emulsion or in capsule, it is of great value in the later stages (see Bronchitis), since in its elimination by the lungs it acts locally upon the inflamed mucous membrane, and it may be used in the subacute forms of gonorrhea in the same manner. The following pre- scription Avill ansAver: R.—Olei eucalypti.............f^j (4.0). Olei amygdalae dulc...........f^j (4.0).—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, U. 8., is obtained from oil of eucalytus, and is largely employed by rhinologists and others in lotions and other nasal appli- cations It may be used in solutions of fatty oils, but is insoluble in lAvater, although it is soluble in alcohol and ether. Administration.—The fluid extract (Extractum Eucalypti Fluidum, U. 8.) is given in the dose of 10 drops to 2 drachms (8.0), the oil (Ohum Eucalypti, U. 8. and B. P.) in the dose of 5 drops (0.35). The dose of eucalyptol is 5 grains (0.35) in capsule. Unguentum Eucalypti is official in the B. P., but is seldom used. EUONYMUS. Euonymus, U. S., or Wahoo, is the bark of Euonymus Atropurpu- reus, a native plant of the United States. It contains an active prin- EUPA TORIUM—EUROPHEN. 201 ciple, Euonymin, B. P. As a laxative its action is very slow and moderate, but it is thought to act particularly on the liver, and may be used Avhen mild hepatic torpor is present. Administration.—The dose of the solid extract (Extractum Euonymi, U. 8., Extractum Euonymi Siccum) is 3 to 10 grains (0.15-0.65). Of euonymin the dose is J to 1 grain (0.03-0.05). EUPATORIUM. Eupatorium, U. S., Thoroughwort or Boneset, is the leaves of the Eupatoriuni perfoliatum, an American plant which is very largely used as a simple bitter tonic and diaphoretic in household medicine. The drug is generally given in hot infusion in cases of arrested men- struation 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 (500 cc.) 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 (2.0-4.0). EUPHORBIA PILULIPERA. This herb is sometimes called Snake-Aveed or Cat's-hair, and is a native of Australia and the West Indies, Avhere, like stramonium, it groAvs profusely as a Aveed by the wayside. Physiological Action.—In toxic doses the drug kills small ani- mals by failure of the respiration and circulation, these two vital functions being greatly affected by doses Avhich exert no great influ- ence on the rest of the body. In full dose it may cause some gastric irritation. Therapeutics.—Euphorbia pilulifera is one of the latest remedies introduced into medicine for the relief and cure of asthma, in Avhich disease the results obtained, after other remedies fail, are very extra- ordinary if the reports of those Avho have given it a thorough trial can be accepted Avithout reserve. As yet we do not know the form of asthma Avhich is most relieved by its use, and its employment is purely empirical. 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 1 drachm (2.0-4.0). The decoction is made by adding a " handful of stalks with the leaves on them to 2 quarts (2 litres) of boiling water, and boiling down to IJ quarts (1J litres)." Of this decoction the dose is a small wineglass- ful (64.0) three times a day. (See Asthma.) EUROPHEN. Europhen is the result of the action of iodine on isobutylorthocre- Bol in the presence of an alkali, and appears as a fine yelloAV poAvder, 202 DRUGS. soluble in alcohol, ether, chloroform, and oils, but insoluble in Avater. Introduced because it was hoped that it might prove a useful substi- tute for iodoform, its usefulness is still undecided, OAving to the short time that it has been before the profession. One advantage claimed for it is that it parts Avith its iodine very sloAvly, and so is not apt to produce toxic symptoms as rapidly as does iodoform. For this very reason, however, it lacks the remedial power of the older drug, except in those instances in which a drying powder is needed Avhich Avill keep the wound pure by making it too dry to be favorable to the groAvth of germs. When such an action is desired, europhen pos- sesses the additional advantage of being five times as bulky as iodo- form. 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 use- less 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 iodoform, but experience Avill probably prove it to be more irritating than the latter drug. The internal dose is 1 to 3 grains (0.05-0.15) in cases of syphilis. Europhen is incompat- ible Avith metallic oxides and the preparations of mercury, and also with the starch and zinc paste largely used by dermatologists. EXALGINE. This substance is really methyl-acetanilid, and closely resembles acetanilid or antifebrin in its effects. It is given for the same pur- poses as is acetanilid and antipyrine—namely, for the relief of pain in locomotor ataxia and other nervous affections—but never as an antipyretic. When used, exalgine should be given night and morn- ing as a rule, so that the doses shall not be near together. The beginning dose should be from 2 to 4 grains (0.1-0.2), and not more than 15 grains (1.0) should be given in twenty-four hours. It is stated by those who have used the drug that fever contraindicates its employment. The following prescriptions will be found applicable: R — Exalgini..............gr. xxx (2.0). Tincturae aurant. dulcis.......f^ij (8.0).—M. Ft. in sol. et adde Syr. aurantii..........f^ss (16.0). Aquae menth. piperit. . . . q. s. ad ffiv (128.0).—M. S.—A tablespoonful night and morning. Or, R.—Exalgini........ .....gr. xxx (2.0). Spt. frumenti...........fjss (16.0).—M. Ft. in sol. et adde Syr. simplicis...........f5j (32.0). Aquae dest._.......q. s. ad fgiv (128.0).—M. S.—Tablespoonful night and morning. FLAXSEED. 203 FLAXSEED. Flaxseed or Linseed (Linum, U. S.) is the seed of Union usita- tissimum. or flax from which linen is made; it is official in the B. P. as Lini Semina. These seeds contain an oil and a mucilage, the first of which is largely used in the arts, and the second is sometimes em- ployed in medicine. The oil (Oleum Lini, U. 8. 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, bronchitis, gastritis, nephritis, and similar states, in the form of flax- seed tea. This is prepared by mixing together 3 drachms (12.0) of flaxseed, not ground, 30 grains (2.0) of extract of liquorice, 10 ounces (320.0) of boiling Avater, and allowing 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 noAv be made more tasteful and useful by the addition of a little lemon-juice and sugar and by the placing of from 1 to 2 drachms (4.0-8.0) of gum arabic in the pitcher containing it. If the cough is excessive, a little paregoric may be added. Linseed oil is used sometimes as a laxative in the dose of 2 ounces (64.0), and is said to be of service when so given in the treatment of hemorrhoids. Flaxseed meal (Lini Farina, B. P.) is employed universally Avhen moistened as a useful poultice. Under the name of Carron oil an emulsion of lime-water and lin- seed oil, equal parts, is the standard application for limited or exten- sive burns. An infusion of linseed (Infusum Lini) and a poultice (Cataplasma Lini) are official in the B. P. FORMIC ALDEHYDE (FORMALDEHYDE). Formic aldehyde is a gaseous body difficult of application because of its physical characteristics, but nevertheless possessing very great poAver as a disinfectant or germicide. It is prepared by subjecting methyl alcohol to oxidation, and almost every instrument-maker has a device Avhereby this gas may be generated, and the room formerly occu- pied by a sick person thereby disinfected far more efficaciously than can be accomplished by burning sulphur. The doors and windows of the room should be tightly shut during the process of disinfection and for several hours after the formaldehyde generator is exhausted. As the gas is exceedingly irritating to the eyes and respiratory passages, no one should attempt to enter the room. After the disinfection is completed the room should be aired for some hours, or, if it must be used at once, it may be rendered capable of habitation by spraying a 20 per cent. solution of ammonia to neutralize the acid atmosphere. The great ad- vantage of formaldehyde for these purposes is the fact that it permeates every nook and cranny, and yet does no injury to colored fabrics, as does chlorine gas under similar circumstances. Such generators as have been named can be had for about four dollars. 204 DRUGS. A solution of formic aldehyde in the strength of 40 per cent, has been Avidely used of late for disinfectant and antiseptic purposes. For all these purposes it is usually diluted still further by the addition of water. A 1 per cent, solution is usually quite active enough for sur- gical antisepsis, and is far less poisonous than is the bichloride of mer- cury. A similar percentage, or a little stronger, may be used to pre- serve pathological specimens, and it is stated that in the proportion of 1 to 32,000 it Avill preserve milk for several days. Taken internally in small amounts, it does not possess any toxic properties. Concentrated undiluted formaldehyde solution may be used for the purpose of cauterizing syphilitic sores. The safety, efficiency, and cheapness of formaldehyde gas as a dis- infectant, and of the solution, render this agent a most valuable one. GALLIC ACID. Acidum Gcdlicum (U. 8. and B. P.) is usually prepared from tannic acid. It occurs in nearly colorless, long, needle-like crystals, Avhich are soluble in 100 parts of cold water, 4^ parts of alcohol, and 3 parts of boiling Avater. Physiological Action.—Gallic acid is an astringent, but not a coag- ulator of blood. Locally applied in bleeding, it is useless, but given internally in hemorrhages which cannot be acted upon by the direct locally application of tannic acid, it is useful as a haemostatic because it contracts the blood-vessels. It is eliminated from the body by the kidneys as gallic acid. Therapeutics.—Gallic acid may be used with some success in hema- turia, hemoptysis, colliquative sweats, and in chronic bronchitis Avith 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 kid- neys and in acute or chronic diarrhea gallic acid may be used Avith advantage, lu the form of the ointment it is useful in the treatment of psoriasis, and in the cure of ulcers and sores which are acti vely discharging. A very useful application to external hemorrhoids is equal parts of stramonium ointment and gallic acid. Administration.—Gallic acid is given in the dose of 2 to 40 grains (0.1-2.6) in pill or solution. It ought never to be used with any salt of iron, as it is chemically incompatible. The preparations used locally are Unguentum Acidi Grallici and Gilycerinum Acidi Grallici, B. P., given in the dose of 10 to 60 minims (0.65-4.0). Nut-gall. Nut-galls (Calla, U. S. and B. P.) are the small excrescences found upon the oak (Quercus lusitanica) formed by the ova of the fly Cynips Galle tinctorie. Their sole value depends upon the tannic acid con- tained in them, and they are official in the form of the tincture (Tinc- tura Calle,U. 8. and B. P.), dose \ to 2 fluidrachms (2.0-8.0), and GA ULTHERIA—GELSEMIUM. 205 the ointment (Unguentum Gallic, U. S. and B. P.). Unguentum Galle cum Opio is official in the B. P., and is used as an astringent and sedative ointment. GAULTHERIA. Wintergreen, or Gaultheria procumbens, is an American ever- green containing a volatile oil. The oil possesses a peculiar, exceed- ingly penetrating odor and a warm aromatic taste. It is about 96 per cent, salicylate of methyl. Salicylate of Methyl (Methyl Sali- cylatis, U. 8.) is an artificial product made official in the last revision of the U. S. P. Physiological Action.—OAving to the large amount of salicylate of methyl contained in the oil, its physiological action is almost identical with that of salicylic acid. Therapeutics.—Aside from its use as a flavoring substance, oil of gaultheria is largely used in place of the ordinary salicylates in all forms of rheumatism. 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 (7.0) a day, but if 60 drops (4.0) three times a day do no good, push- ing it further is practically useless. Very few patients can take more than 30 drops a day. Aery recently Lannois and Limousin of Lyons has highly recom- mended the application of this oil to acute and chronic rheumatic joints. The oil is placed on lint, and then the lint is wrapped around the part affected, evaporation being prevented by applying a gutta-percha cover- ino-. They assert that this treatment gives rapid relief, although they admit that after it the skin may desquamate. The spirit of gaultheria (Spiritus Gaultherie, U. S.) is given in the dose of 10 to 20 minims (0.65-1.3). GELSEMIUM. Gelsemium, U. 8. and B. P., or Yellow Jasmine, as used in med- icine is the rhizome of the Gelsemium sempervirens, a climbing plant of the Southern United States. It contains an alkaloid, gelsemine, 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, act- ing particularly on the heart. It paralyzes the vagus and lowers blood pressure. Respiration.—Gelsemium kills by paralyzing the respiratory cen- tres (Sanderson, Ringer, and Murrell). Temperature.—In overdose the drug loAvers bodily heat very markedly. 206 DRUGS. Eye.—Gelsemium is a mydriatic of considerable poAver, causing. when dropped into the eye, Avide dilatation of the pupil, a result due to paralysis of the oculo-motor nerve peripherally. Therapeutics.—Gelsemium is used in headache and migraine depend- ing on nervous troubles or upon eye-strain. It is particularly useful in combination Avith cannabis indica. (See Cannabis Indica and Migraine.) In malarial fever it is said to be of great seiwice, but this is doubt- ful. In the early stages of pneumonia and pleurisy it has been highly spoken of by BartholoAV. Gelsemium has also been found of value in asthma, whooping cough, laryngismus stridulus, and nervous cough. In localized mus- cular spasm, such as 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 gelsemine as equal to atropine in effect, but much more transient in its influence. He uses a solution of 8 grains of gelsemine to the ounce (0.5: 32.0) of Avater, 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 poison- ing are ptosis and dropping of the jaAv. These are preceded by a sensation of languor, a desire to lie doAvn, relaxation, and muscular Aveakness. Gelsemium is apt to cause temporary internal squint, OAving to its paralyzant action on the sixth pair of cranial nerves. The pulse becomes rapid and feeble, the skin Avet 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. Sensation 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 and digitalis, the application of external 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 (Extraction Gelsemii Fluidum, U. S.) is given in the dose of 5 to 10 minims (0.35-0.65), and the tincture (Tinctura Gelsemii, U. 8. and B. P.) 10 to 20 drops (0.65-1.3). In some parts of the United States physicians largely employ a very strong unofficial tincture of gelsemium, the dose of Avhich is 1 to 2 drops. Gelsemine may be used in the dose of ^ of a grain (0.001). Extractum Gelsemii Alcoholicum, B. P., is given in the dose of 4 to 1- grain (0.008-0.015). GENTIAN. Gentiana, U. S., is the root of the Gentiana lutea, or YelloAV Gentian, a European plant. It contains gentianine and gentisic acid, and has a bitter taste. This drug is official in the B. P. as Gentiana Radix. Therapeutics.—Gentian is one of the most efficacious bitter tonics GERA NIU3I—GINGER. 207 that Ave possess. In the anorexia folloAving acute diseases and in gout and malarial poisoning with dyspepsia it is of service. Combined Avith bicarbonate of sodium, it is of great service in the treatment of the subacute 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 1 drachm to a wine- glassful (4.0-64.0), the fluid extract (Extractum Gentiane Fluidum, U. 8.) in the dose of 30 drops to 1 drachm (2.0-4.0), and the solid extract (Extraction Gentiane, U. 8. and B. P.) in the dose of 1 to 8 grains (0.05-0.40). Infusion Gentiane Composition, B. P., is given in the dose of 1 to 2 fluidounces (32.0-64.0). The compound tincture and compound infusion are composed of gentian, bitter orange-peel, and cardamoms. The folloAving prescription is an excellent one for use in convalescence from prolonged fevers: R.—Acid, nitro-hydrochlor. dil........f gj vel fgij (4.0-8.0). Tr. nucis vomicae......... . f ^j (4.0).' Tr. cardamomi comp..........f Sij (64.0). Tr. gentian* comp......q. s. ad f^iv (128.0).—M. S.—Teaspoonful (4.0) in water after meals. GERANIUM. Geranium, U. S., is the rhizome of Geranium maculatum. It contains tannic and gallic acids, and is useful as an astringent in cases of serous diarrhea. 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 tasteless. The dose of the drug itself is 20 to 60 grains (1.3- 4.0), and that of the fluid extract (Extractum Geranii Fluidum, U. S.) I to 1 fluidrachm (2.0-4.0). GINGER. Zingiber, U. 8. and B. P., is the rhizome of Zingiber officinale, a plant of Hindostan, Jamaica, and other tropical countries. Black ginger is the dried rhizome Avith its bark, Avhile 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 cramps due to suppres- sion from exposure to cold. Ginger is often combined with purgative medicines to stop griping and for its pleasant flavor. Of itself it is decidedly constipating, and Avhen 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 (0.65-2.0), well diluted; the tincture (Tinctura Zingiberis, U. 8. and B. P.), dose 20 drops to 2 drachms (1.3-8.0); the syrup (Syrupus Zingiberis, U. 8. and 208 DRUGS. B. P.), dose 30 drops to 2 drachms (2.0-8.0); the oleoresin (Oleoresina Zingiberis, U. 8.), close \ to 1 drop (0.03-0.05), well diluted or in pill; and the troches (Trochisci Zingiberis, U. 8.) used as stimulants to salivary secretion. In the B. P. a stronger tincture, Tinctura Zingiberis Fortior, is official, dose 5 to 20 minims (0.35-1.30). GLYCERIN. Glycerinum, U. S. and B. P., is a liquid obtained by the decom- position and distillation of fats. It possesses great power in absorb- ing water and of dissolving many substances. Even if pure it irri- tates the skin of susceptible persons Avhen applied locally by its absorp- tion of Avater, and often causes a slight rash. Physiological Action.—Injected into the circulation in large amounts, glycerin causes convulsions, Avhich are due to its hygroscopic 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. Other clinicians, however, disagree Avith him and use it con- stantly for this purpose Avith asserted advantage. Therapeutics.—Glycerin may be employed as a SAveetening agent in the food of diabetics and in cases Avhere sugar cannot be used. It has also been given as a laxative in 1- or 2-drachm (4.0-8.0) doses by the mouth, and in enema—1 to 4 drachms (4.0-16.0) Avith or without equal parts of Avater. In some cases it may be used in suppository in the official Suppositoria Glycerina, U. 8. This latter method is very successful in chronic constipation. Its continued use by sup- pository may, howTever, result in rectal irritation. As an antiseptic it is used for preserving specimens and for keep- ing alkaloids in solution 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 Avater. If used on the skin, it should be diluted one- half with Avater. in cases of impacted cerumen in the external audi- tory canal glycerin is often of service in softening the mass. The uses of glycerin, other than those mentioned, are many. In the proportion of equal parts of glycerin and Avater it makes a very useful mouth-wash for the sore and dry mouth of typhoid fever and for the remoAral of sordes. The same Avash, Avith lemon-juice added to it, is very agreeable and will relieve the dry, glazed tongue of advanced phthisis. OAving to the fact that glycerin is hygroscopic, it may be used as a depletant on a pledget of cotton in congestion of the uterine cervix, the tampon being reneAved daily. (See Boric Acid and Boroglyceride.) For the prevention of bed-sores Ringer recommends the daily Abash- ing and rubbing of the part likely to be affected, followed by the application of glycerin, and a draAv-sheet placed smoothly against the patient to protect the bedding. Glycerin and Avhiskey is a favorite household remedy for colds and GOLD—GRINDELIA ROBUSTA. 209 coughs, but is not very useful. Glycerite of starch (Glyceritum jAmyti, U. b. and B. P.) is used as a protective over superficial irri- tations of the skin. Glycerite of yolk of egg (Glyceritum Vitelli, U. A.) is used in making emulsions. A very useful ointment for the application of medicinal substances to the skm 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 solution rather than by mechanical suspension. The B. P. preparations of glycerin are as follows: Glycerinum Acidi Garbolici, Glycerinum Acidi Galliri, Glycerinum Acidi Tannici, Glycerinum Aluminis, Glycerinum Boracis, Glycerinum Plumbi Sub- acetatis, and Glycerinum Tragacanthe. GOLD. Gold itself is not official in the U. 8. 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. 8.). The dose of this substance is 2V to ^ of a grain (0.003- 0.006) once, twice, or thrice a day. The author has not found it of much value. Gold has also been strongly recommended for indiges- tion Avith epigastric pain after eating when looseness of the bowels is present, and it is said to act as a powerful sexual stimulant and to be of service in impotence dependent upon inability to obtain an erection or Avhen there is deficient glandular action. In overdoses the drug causes gastro-enteritis. Magruder has recommended chloride of gold and sodium in the treatment of pertussis. GRINDELIA ROBUSTA. Grindelia, TJ. 8., is an American plant (Grindelia robusta) con- taining a resin, a volatile oil, and an alkaloid. Physiological Action.—Upon the lower animals and man this drug is not very poAverful 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 (1.3-4.0) of the fluid extract (Extractum Grindelie Fluidum, U. 8.), or by inhaling the fumes of burning grindelia-leaves, Avhich are previously soaked in a solution of nitre, dried, and burned on a plate or rolled into a cigarette and smoked. In clironic cystitis it stimulates the bladder and is of great service. By diluting it 1 to 10 Avith Avater it forms one of the best lotions that we have for the relief of the dermatitis produced by poi- son ivy or Rhus Toxicodendron. 14 210 DRUGS. Administration.—The only preparation Avhich is official is the fluid extract (Extractum Grindelie Fluidum, U. 8.), dose 20 to 60 drops (1.3-4.0). GUAIAC. Lignum Vitae, or Guaiacum officinale, a West Indian tree, is used in medicine in two forms—namely, as guaiac Avood (Guaiaci Lignum, U. S. and B. P.), Avhich is in raspings and enters into the compound syrup of sarsaparilla, and guaiac resin (Guaiaci Iiesina, U. 8. and B. P.), or guaiac, which is soluble in alcohol, ether, and chloroform, but is insoluble in Avater. Therapeutics.—Guaiac has been largely used in syphilis, but is noAv rarely, if ever, so emploA7ed. Given in acute tonsillitis in the dose of 30 grains in an emulsion made by the use of white of egg, it will often abort the disease. In rheumatism it has been largely used. The ammoniated tincture of guaiac is sometimes employed in the treatment of sore throat, particularly if it be rheumatic in type, but is a disagreeable preparation to take into the mouth, and the sali- cylates may always be used in its place. Administration.—The tincture (Tinctura Guaiaci, U. S.) is given in the dose of 5 to 60 drops (0.35-4.0), and the ammoniated tincture (Tinctura Guaiaci Ammoniata, U. S. and B. P.) is used in the same dose, preferably in milk. Mistura Guaiaci, B. P., is given in the dose of 1 to 2 fluidounces (32.0-64.0). GUAIACOL. Guaiacol is a liquid constituting from 60 to 90 per cent, of creo- sote. It is obtained by the distillation of beechwood creosote, fol- lowed by a complicated process which it is not necessary to describe. In other cases guaiacol is obtained from beechwood creosote by pre- cipitation 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 practition- ers, chiefly in Europe, for the treatment of tuberculosis as a substitute for creosote, because it is the principal ingredient of that drug. (See Creosote.) It was thought by Guttmann, Sommerbrodt, and others that the good effect of creosote 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 creosote produce their good effects by forming compounds Avith the toxines or poisonous albuminoids formed by the bacilli, Avhich are then eliminated from the body. The same rules govern the use of guaiacol as govern the employment of creosote. It is best given with brandy, Avine, or other G UAI A COL CA RB ON A TE. 211 alcoholic drink, or in capsules with cod-liver or sweet oil. 5 or 10 drops (0.35-0.65) of guaiacol may be added to a pitcher of hot water and the vapor inhaled three or four times a day in cases of subacute and chronic bronchitis. The dose by the stomacii is 5 to 20 minims (0.35-1.5). Recent clinical observations prove conclusively that guaiacol pos- sesses poAverful antipyretic influences. As pointed out by Sciolla in 1893, guaiacol when painted on the skin of a febrile patient causes a pronounced fall of temperature, Avhich begins soon after the applica- tion is made, but is not fully accomplished for from two to three hours. The application may be made to the skin of the abdomen, thighs, or chest, about 30 to 40 drops (2.0-2.6) being used with a brush. When a full effect is required, it is Avell to place an imper- meable dressing over the part painted to prevent evaporation and aid absorption. These applications may be resorted to as often as is necessary for the reduction of the fever, and, although the fall of temperature is sometimes very rapid and very great—as much as 7° F. in two hours—DaCosta has never seen serious nervous or car- diac symptoms produced, but other observers have noted such unto- ward results. The temperature is very apt to speedily rise after the reduction, and this rise is often preceded by a chill. These appli- cations cannot supplant the cold bath, although they undoubtedly do reduce the temperature. The true sphere of usefulness to be assigned to guaiacol as an antipyretic seems to be that of a less valuable therapeutic measure than the bath, and one equally poAver- ful and about as dangerous as are the antipyretic drugs of coal-tar derivation. When used externally in the fever of tuberculosis its action is very satisfactory, but the presence of cavities contraindicates its use, it is said. The studies of Stolzenberg show that if frequently and constantly used guaiacol produces in febrile patients a tendency toward depression. Thayer finds that great SAveating and depression generally follow its external use in fevers. Probably future reports will develop the fact that in cases of renal irritation guaiacol will prove harmful. Guaiacol has been used by painting it on the affected part in the treatment of superficial neuralgias, and in deep-seated nerve-pains, as in sciatica, it has been given hypodermically in the dose of 2 minims in 10 minims of spirit of chloroform deeply into the neighborhood of the painful nerve. If guaiacol is placed upon the skin by means of a small compress, which has been Avet with it and bound tightly to the part, local anaes- thesia is rapidly developed, but if it is left in place too long, it may be absorbed in sufficient amount to cause depression or a fall of tem- perature. Belfield highly recommends painting the scrotum with guaiacol 15 minims (1.0) and glycerin 45 minims (3.0) for orchitis. A serious objection to the external use of guaiacol is its disagree- able odor. 212 DR UGS. GUAIACOL CARBONATE. Carbonate of guaiacol is a white, crystalline powder, consisting of 91 per cent, of pure guaiacol and 9 per cent, of carbonic acid. This powder is insoluble in water, neutral in reaction, and is said to be Avith- out any irritating effect on the stomach. Taken by the healthy indi- vidual, it is decomposed into guaiacol and carbonic acid in the boAvel, but not in the stomach, and it is used for this reason, as salol is, as an intestinal antiseptic in the various forms of fermentative dico-rhea and typhoid fever. The drug is said to be sloAvly absorbed, but after ab- sorption is rapidly eliminated. Its therapeutic applications in tuber- culosis are practically identical with those of pure guaiacol, save that it is more readily borne by the stomach than the latter drug. Guaiacol carbonate may be given in capsule or pill, or it may be given in dry powder on the tongue in the dose of 2 to 10 grains (0.10-0.65). Usually in typhoid fever the dose is about 2 grains (0.10) every three hours, and in tuberculosis of the lungs 5 grains (0.35) three times a day. HJEMATOXYLON. Hematoxylon, U.S., Hccmatoxyli Lignum, B. P., or LogAvood, is the heart-wood of Hematoxylon campechianum, a tree of the Amer- ican 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, OAving to its agreeable taste. (See article on Diar- rhoea.). 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. If the urine is alka- line, the color may be violet or red. 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 (0.6-2.0), and Decoctum Haoua- toxyli, B. P. in the dose of 1 to 2 fluidounces (32.0-64.0). An unofficial fluid extract is often to be found in the shops. The dose of this is h to 2 fluidrachms (2.0-4.0). (See article on Diarrhoea.) HAMAMELIS. Hamamelis, U. S., Witch-hazel, or Hamamelis virginiana, is a plant of the United States, devoid of any true active principle, but possessing extraordinary remedial power. Therapeutics.—Hamamelis is to be employed in relaxed sore throat resulting in congestion and hyperaemia upon exposure or Avhere mild catarrhal states are present. Similarly, we employ it in an atomizer, after attacks of acute coryza, to tone up the nasal mucous membrane. The strength of the solution should be 20 to 60 minims (1.3-4.0) of the distilled extract to the ounce (32.0) of water. Hamamelis when taken internally is often wonderfully successful in the treatment of uterine oozing from small blood-vessels, seems to do good even in hematemesis HOFFMANN'S ANODYNE. 213 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 rapidly relieves the angry-looking skin surrounding the ulcer. 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 bleeding and the so-called blind piles. (See Hemorrhoids.) Administration.—The one official preparation in the U. 8. P. is the fluid extract (Extractum Hamamelidis Fluidum, U. 8.; Liquidum, B. P.), dose 5 to 20 drops (0.35-1.30). The dose of the distilled extract, which is not official and is a perfectly clear liquid, is from 30 drops to 1 drachm (2.0-4.0), and this is much the best preparation for internal and external use. Unfortunately, the preparations of the drug vary very much both in odor and efficacy. Some of the pro- prietary preparations of witch-hazel are more active than those ordi- narily 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 Avithout exposure to the air. HOFFMANN'S ANODYNE. Spiritus ^Etheris Gompositus, U. S. and B. P., consists of alco- hol, ether, and the heavy oil of Avine. The Avriter has experimentally studied very thoroughly the action of the last-named ingredient, and finds: First. That the belief in heavy oil of Avine 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 Avhich 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 Avine. On animal temperature, as ascertained by the thermometer in the rectum, the heavy oil of Avine exercises no influence, even when the arterial pressure is very Ioav. That large doses of the heavy oil of Avine are in no Avay possessed of toxic effects is proved by the fact that 30 cc. of the drug, given by the mouth to a small dog weighing tAvelve 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 caused by the presence of an oily sub- stance. Therapeutics.—Hoffmann's anodyne is the best carminative that Ave 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, Avhile the heavy oil of wine acts, perhaps, 214 DRUGS. 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 ahvays be given in capsules or in cold water, preferably ice-cold, in order to prevent too rapid volatilization of the ether and consequent difficulty in swallowing the liquid. The dose is 1 to 2 drachms (4 0-8.0) to an adult. HOMATROPINE. Homatropine is an artificial alkaloid obtained by prolonged and gentle heating of a solution of equivalent quantities of tropine1 and toluic acid in hydrochloric acid. The hydrobromate of homatropine (Homatropine Hydrobromas, B. P.) is a crystallizable salt of hom- atropine soluble in 10 parts of distilled Avater. Hydrobromate of homatropine, properly applied by frequent instil- lations, is a reliable mydriatic for the correction of anomalies of refrac- tion in healthy eyes. Experience is not at hand to determine its value for this purpose in eyes affected with retinal-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 hom- atropine is far removed, even when repeated instillations have been made, and its temporary action upon the pulse causes no inconvenience to the patient. Slight hyperaemia of the conjunctiva almost invaria- bly follow its use, but true conjunctivitis, if it occurs at all, must be excessively rare. According to the studies of Dr. de Schweinitz and the Avriter, the drug has a physiological action closely allied to that of atropine, from which it is derived. Homatropine mydriasis generally lasts from thirty-six to forty-eight hours, that of hyoscyamine eight to nine days, and that of atropine ten to tAvelve days. For the pro- duction of ordinary mydriasis the drug should be used in solution of the strength of 4 grains (0.20) to the ounce (32.0) of distilled Avater, which is to be dropped into the eye every five or ten minutes. As the drug is expensive, only a feAv 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 pecu- liar 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 1 Tropine is a product obtained by splitting up atropine into tropine and tropic acid. HOPS. 215 in those parts of the country where the bees have had access to moun- tain laurel and similar plants. Therapeutics.—Honey is used as a vehicle 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 membrane, 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 Avater. This is generally used as a vehicle for more active remedies in gargles or even for expectorant mixtures. Melted and strained honey, to which a small proportion of glycerin is added, is knoAvn as Mel Despumatum, U. S., and Mel De- puration, B. P. There are also a honey of roses (Mel Rose, U. 8.) and a confection (Confectio Rose, U. S.), used as vehicles for other drugs. HOPS. Humulus, U. S., is the strobiles of ordinary hops, or Humulus Lupulus. These contain a liquid volatile alkaloid, lupuline, and a bitter principle, lupulinic acid. Hops are known under the name of 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. 8. P. and Lupulus in the B. P. This confusion has been increased by the fact that the alkaloid of hops is called lupuline, Avhile the poAvder which is found on the strobiles is called lupulin. Those preparations in the U. 8. P. having the Avord "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 irrita- bility, 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 Avay 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 Avhich the pillow is moistened. Administration.—The tincture (Tinctura Humuli,U. 8.) is given m the dose of | to 3 ounces (16.0-96.0). Lupulin (Lupidinum, U. 8. and B. P.), Avhich is the powder found on the strobiles of hops, is given in the dose of 2 to 5 grains (0.1-0.35) or more; the oleoresin of lupulin (Oleoresina Lupulini, U. 8.) is given in dose of 10 to 40 drops (0.65-2.65) in capsules; and the fluid extract (ExtractumLupu- lini Fluidum, U. 8.), in the dose of 30 to 120 drops (2.0-8.0). The preparations of the B. P. are the extract of hops (Extractum Lupuli), dose 5 to 10 grains (0.35-0.65); the infusion (Infusum Lupuli), dose 1 to 2 fluidounces (32.0-64.0); and the tincture (Tinctura Lupuli), dose |- to 2 fluidrachms (2.0-8.0). 216 DRUGS. HOPE'S CAMPHOR MIXTURE. This is a mixture originally made Avith nitrous acid, but largely used at present Avith nitric acid, owing to the fact that nitrous acid is changed into nitric acid a\ hen Avater is added to it. The nitrous acid is, hoAvever, more efficacious than nitric acid in the serous or choleraic diarrheas Avhich it is used to combat. The formula is as folloAvs: R.—Acidi nitrosi.............f^j (4.0). Aquae camphorse...........f,5vnJ (256.0). Et adde Tinct. opii.............gtt. xl (2.65).—M. S.—One-fourth of this in water every three or four hours. HYDRASTIS. Hydrastis, U. S., is the rhizome of the Hydrastis canadensis, con- taining two alkaloids, knoAvn as hydrastine and berberine, and, per- haps, xanthopuccin. Physiological Action.—In poisonous doses hydrastis may cause con- vulsions folloAved 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, Avhen injected into the jugular vein, causes a primary fall of arterial pressure, succeeded by a decided rise, and the studies of Cerna have proved that it is an active poison producing spinal convulsions folloAved by paralysis. Therapeutics.—Hydrastis is of service in clironic 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 loAvered 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 antimalarial influence. One of the best remedial measures that Ave have in the later stages of gonorrhea, Avhen the acute period has passed, is the local and internal use of hydrastis. If it is used as an injection, 5 grains (0.3) of the commercial hydrastine to each ounce (32.0) of Avater , should be employed twice a day. If this is not used, the following infusion will be found of service: Take 1 drachm of the poAvdered root and add it to 8 ounces of boiling Avater; J to 1 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 membranes of the stomach. Administration.—The fluid extract (Extractum Hydrastis Fluidum, U. 8. ; Liquidum, B. P.) may be given in the dose of 5 to 30 drops (0.30-2 0), while the dose of the tincture (Tinctura Hydrastis, U. 8.) HYDROBROMIC ACID—HYDROCYANIC ACID. 217 is from 30 drops to 2 drachms (2.0-8.0). The Glyceritum Hydrastis, U. S., is used as a healing application to mucous membranes. Much doubt exists as to the dose of hydrastine. This arises from the fact that two forms of it are sold. The most commonly seen is a dark-broAvn mass Avhich is very impure, and contains berberine and other substances. Its dose is 3 to 10 grains (0.15-0.65). The pure hydrastine, as made by Merck, is given in the dose of \ to \ grain (0.016-0.03). Ilydrastinine hydrochlorate, an artificial alkaloid of hydrastine, has become official in the U. 8. P. of 1890. HYDROBROMIC ACID. (See Bromides.) HYDROCHLORIC ACID. Acidum Hydroehloricum (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. It should be kept in dark- colored bottles. In the strength of tAvo-tenths of 1 per cent, it is normally present in the gastric juice, and aids the pepsin in the con- version of proteids into peptones and in the formation of pepsin from pepsinogen. Therapeutics.—Hydrochloric acid is a much overrated remedy in dyspepsia. With new methods of studying gastric secretions we have learned that proper dieting and the use of lavage will do great good in ordinary dyspepsias, and this acid now finds comparatively rare and far more rational uses. These are its employments: to aid digestion dur- ing and after fevers, when this acid is apt to be absent from the gastric juice, particularly in typhoid fevers. In cases of gastric cancer, Avhen this acid is ahvays absent from the gastric secretion, and in the sick stomach following an alcoholic debauch, it is of great service. In some cases of chronic gastric catarrh in which there is atrophy of the gastric tubules, it should be used freely. The dose of the dilute acid (Acidum Hydroehloricum Dilutum, U. S. andi?. P.) is 5 to 10 drops (0.36-1.3). This acid is combined Avith nitric acid to form dilute nitro-hydro- chloric acid (Acidum Nitro-hydrochloricum Dilutum, U. S. and B. P.), the dose of which is 10 to 30 minims (0.65-2.0); also the pure acid (Acidum Nitro-hydrochloricum, U. S.), dose 1 to 5 minims (0.05-0.35). 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, and the use of opium to relieve pain and irritation. HYDROCYANIC ACID. Hydrocyanic or Prussic Acid is a transparent, colorless, very volatile liquid, giving rise to vertigo when inhaled in minute amounts and capable of producing death if the fumes be concentrated. If the 218 DRUGS. bottle containing the pure drug be opened, it should be done where there is sufficient draught between windows to prevent any contamina- tion of the atmosphere of the room by the acid. Pure hydrocyanic acid is never used in medicine ; the form employed is the dilute acid (Acidum Hydrocyanieum Dilutum, U. 8. 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) of the lethal poisons, 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 respiratory centre and the heart, being eliminated almost immediately afterward. Because of its fleeting character, the survival of a patient twenty or thirty min- utes after the ingestion of a poisonous dose is a favorable sign for his recovery. 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 vital parts are killed at once if much of it is present. Poisoning.—When a lethal dose of hydrocyanic acid is taken, 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 large enough to result in immediate death. In the first of these stages there are difficult respiration, sIoav cardiac action, and disturbed cerebration. In the second stage, which is convulsive, Ave find Avild cries, dilated pupils, unconsciousness, vomiting, spasmodic urination and defecation, erections of the penis, and ejaculations of semen. In the third stage there are asphyxia, collapse, and paralysis, ending in death. The blood is found to be dark and venous-looking, but does not give the spectrum 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 hydro- cyanic acid is marked, but this rapidly passes away, owing to the vol- atility of the drug. The only poisoning producing symptoms resembling those which have just been described is that produced by nitrobenzole or essence of mirbane, Avhich has a someAvhat similar odor, but which is, hoAvever, 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, Avhere, OAving to a hypersesthesia of the mucous mem- branes, the taking of food produces discomfort. In 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 OAving to the extreme volatility of the drug it only acts for the moment, and that a dose every ten or fifteen minutes is necessary to produce any HYDROGEN PEROXIDE. 219 real effect. However this may be in theory, practically the acid cer- tainly does aid in relieving cough. In these states the following pre- scription Avill be found of service: R.—Acid, hydrocyan. dil..........f ^j (4.0). Syrup, pruni virg...........f giij (9&0).—M. b.—Teaspoonful (4.0) every four or five hours to an adult. In enteralgia or neuralgia of the intestines dilute prussic acid is often a very useful remedy. Externally, fhe drug is useful in pruritus and other forms of itch- ing skin diseases, and the folloAving formula will be found of service in pruritus vulvcc : R.—Hydrarg. chlor. corros.........gr. jss (0.09). Acid, hydrocyanic, dil.........f gj (4.0). Aquse amygdal. amarae........f ^vj (192.0).—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 (0.05-0.35). In certain forms of irritable cough inhala- tions of the vapor (Vapor Acidi Hydrocyanici, B. P.) are recom- mended ; this is prepared by adding 10 to 15 minims (0.65-1.0) of the diluted acid to 1 fluidrachm (4.0) of water, which is then placed in a suitable apparatus from which is inhaled the vapor that arises. HYDROGEN PEROXIDE. Peroxide of Hydrogen is a clear, odorless, syrupy fluid of a specific gravity of 1.452, possessing a harsh, bitter taste. It is readily sol- uble in water, and its chemical formula is H202. Pure peroxide of hydrogen is never used in medicine, but in solutions of varying strength. The ordinary solution, as found in the shops and that now official (Aqua HydrogeniiDioxidi, U. 8.), is about 3 per cent., or, as it is generally called, a 10-volume solution. This term, " 10 volumes," signifies that it can yield 10 volumes of available oxygen; and it is upon this yield of oxygen that its activity depends. The specific gravity of this official solution is 1.006 to 1.012 at 59°. The reaction is acid, but this is due to a small amount of acid added to the solution to preserve it. The official solution of peroxide of hydrogen, Avhile the most stable that can be prepared, is nevertheless readily deterio- rated by exposure to heat, sunlight, or prolonged shaking. If placed in an absolutely clean, smooth glass vessel, it may be concentrated for immediate use by exposing it to a temperature of 140° F.; but exposure to a temperature above this point may result in its decompo- sition Avith explosive violence. Practically, this means of concentra- tion is not convenient for the practitioner, and the ordinary official solution fulfils all ordinary requirements unless it has deteriorated by age. The great difficulty in the use of the solution of the peroxide is its liability to undergo change and become practically worthless. Wallian states that as a rough test for the value of a given solution a 220 DRUGS. few crystals of permanganate of potassium may be placed in a test- tube, and 1 or 2 drachms (4.0-8.0) of the solution added. The vio- lence of the resulting effervescence is in direct ratio to its value as a remedial agent. Therapeutics.—The most valuable use of the peroxide-of-hydrogen solution in medicine is in the treatment of diphtheria. So far as Ave know, it is the best application for the destruction and removal of the false membrane. There is no injury to the normal tissues, nor is there the danger of poisoning which sometimes folloAvs the use of such drugs as carbolic acid. Applied to the false membrane, there is at once an active effervescence with some local tingling of the part. The mem- brane can afterward be removed in shreds. The solution should be applied by means of a SAvab or spray, but if the latter is used a glass atomizer must be employed, as the peroxide is decomposed by coming in contact with metals. In the treatment of abscess-cavities, tubercular or septic in cha- racter, the peroxide of hydrogen is a very valuable application, and its use will often decide the presence of pus, since when it meets Avith this material active effervescence ensues. Similarly, it is a valuable preparation for cleansing ulcers and malignant growths which have ulcerated. The employment of the peroxide internally, with the idea that it Avill yield oxygen to the body in cases where this gas is lack- ing, is futile. Even if the oxygen entered the blood, the amount disengaged from a possible dose Avould be too small to be of any value. It is stated that the application of this liquid to the spot suffering from a hornet's sting will give instant relief. Where the peroxide is used as a gargle it may produce pain through its attacking cavities in the teeth or the metallic substances Avith Avhich they are filled. Taken internally, the peroxide of hydrogen is not poisonous. The internal dose of the Aqua Hydrogenii Dioxidi of the U. 8. P. is from 1 to 4 drachms (4.0-16.0), well diluted with water, and taken from a porcelain, not a metal, cup or spoon. It possesses no distinct value in internal medication. HYOSCYAMUS. Hyoscyamus, U. S., or Henbane, is a plant of the Northern United States and Europe. The leaves (Hyoseyami Folia, B. P.) only are used, and from them are obtained tAvo alkaloids—one known as hyos- cyamine, the other as hyoscine. The first has practically the same physiological action as atropine, save that it is much more sedative in its effects on the nervous system. (See Belladonna.) The second is quite different in its influence over the body. The only marked differ- ence in the action of hyoscyamine and atropine is in the mydriasis pro- duced by each. While that of atropine lasts, in man, from tAvelve to fourteen days, hyoscyamine generally remains for only seven to nine days. Sometimes the development of mydriasis is preceded by violent pain in the eye due to a cramp of the ciliary muscle. If so, the drug HYOSCYAMUS. 221 must be pushed to overcome the spasm. The strength of the solution to be used is 2 grains (0.1) to the ounce (32.0). OAving 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 Avhere pain is due to spasm. It has been particularly recommended in nervous cough, in ■whooping cough, and 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 Avith 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 and hydrobromate. The dose of the tincture (Tinctura Hyoscyami, U. S. and B. P.) is 30 drops to 1 drachm (2.0-4.0); the alcoholic extract (Extractum Hyoscyami, U. S. and B. P.), dose 1 to 3 grains (0.05-0.15); the alkaloid (Hyoscyamine Sulphas vel Hydrobromas, U. S.), dose -^ to ^ of a grain (0.001- 0.0015); and the fluid extract (Extractum Hyoscyami Fluidum, U. 8.), dose 5 to 30 drops (0.35-2.0). The B. P. preparation, besides those given, is the juice (Succus Hyoscyami), dose 30 minims to 1 fluidrachm (2.0-4.0). Hyoscine. This is one of the alkaloids derived from hyoscyamus, and is a powerful nervous sedative in some cases. Much if not all the so-called hyoscine of the stores is in reality scopolamine, derived from Scopolia atropoides. 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, Avhich is due to paralysis of the spinal cord and not of the nerve-trunks. Upon the circulation it has little effect, but it is Avorthy of note that it does influence the vagus nerves, as does atropine, stimulating them at first, and finally paralyzing them, although the contrary has been asserted. In any event, the circu- latory effect is a minor one. In cases where hyoscine has acted in excess, or where an overdose has been given, pilocarpine may be used as a physiological antidote in full doses if the heart is sound. Therapeutics.—Hyoscine is of value as a hypnotic in a very lim- ited 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 vio- lent struggles against proper control or refuse to swallow or retain food. The drug may be given to such persons, hypodermically, in the dose of yi-g- to Jq of a grain (0.0006), or by the mouth in the dose of J^ to -fo of a grain (0.0008). The fact that it possesses no taste and is small in bulk renders it readily employed. In some 222 DRUGS. 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 patients 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 untoward effects are common. Hyoscine is certainly of great value in spermatorrhea and noc- turnal emissions. The drug is contraindicated in the sore throat of scarlet fever, as it may cause glottic spasm. In the insomnia of heart disease Avith 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. Hyoscine is official in the form of Hyoscine Hydrobromate (Hyos- cine Hydrobromas, U. 8.). HYPNAL. The chemical name of this substance is monochloral-antipyrine, and it is, as its name indicates, a compound of chloral and antipyrine. There is also a dichloral-antipyrine, which contains more chloral. The compound is employed in treating those patients who suffer from pain and insomnia combined, the antipyrine relieving the pain and the chloral producing sleep. Opium is the only drug known Avhich 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. In cough arising from bronchitis or phthisis, and causing by its con- stancy loss of sleep, and in neuralgic insomnia, hypnal will be found of service. The dose is from 5 to 20 grains (0.35-1.3), best given Avith simple syrup and Avater or Avith syrup of orange-peel, or it may be used as follows : R — Hypnal...............gr. xv (1.0). Chartreuse.............fxj (4.0). Distilled water..........fjss (16.0).—M. S.—The entire amount to be taken in one dose. ICHTHYOL. The substance sold in the shops and employed in medicine under the name of ichthyol is really a salt formed" by the bibasic acid, ichthyo-sulphuric or sulpho-ichthyolic acid with ammonium. In other 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. ICHTHYOL. 223 words, it is ammonium ichthyol, Avhich is a semi-solid substance. The ichthyo-sulphuric acid itself is derived from a crude oil, Avhich in turn is obtained by destructive distillation from a deposit of fossil fish found in the Tyrol Mountains. When combined with sodium, forming sodium ichthyol, a more solid substance than ammonium ichthyol is formed, which can be employed if it is desired to use the drug in pill form. Both the ammonium and sodium ichthyol contain about 10 per cent. of sulphur, and it is largely upon this that their therapeutic activity depends. They are both soluble in water, and have a dark-brown, tarry appearance. Their disagreeable odor depends upon an inseparable volatile oil. Therapeutics.—Ichthyol is Avithout doubt one of the most remark- able substances introduced for medicinal purposes within the last few years, both because of its curious origin and its therapeutic value in a large variety of ailments. In the author's hands it has proved most efficacious in the treatment of the inflamed areas in acute articular rheumatism. When used in this disease an ointment composed as fol- Ioavs is to be smeared over the inflamed part, and then spread on lint, Avhich is Avrapped about the limb. This usually relieves the pain and tenderness of the part to a great extent. The same application, accom- panied by rubbing or applying massage to the joint, is of value for the pain and stiffness met with after the acute manifestation of the disease has passed by : R.—Ichthyol.........3ij (8.0). 01. citronellse.......gtt. xv vel xxx (1.0-2.0). Adipis..........S (32.0).—M. Sometimes the quantity of ichthyol in this prescription can be in- creased to three or four drachms with advantage. The same prescrip- tion is also the best external treatment of erysipelas that we have. The skin should be carefully and gently washed, and then anointed with the ointment and covered by lint smeared Avith this ointment. If the disease be in the skin of the face, holes are to be cut in the lint for the mouth, nose, and eyes. Ichthyol is also a very useful drug in the treatment of chronic skin diseases associated with atony and induration of the deeper layers of the skin, such as acne, eczema, and even lupus and keloid in their chronic stages. It is always better to use ichthyol in ointment form, but some practitioners have employed it by painting it on in watery solution with a camel's-hair brush. In frost-bites, chilblains, and in burns it is of service, and AgneAv has recommended it highly Avhen rubbed into lymphatic enlargements. Ichthyol has proved remarkably efficacious in removing peri-uterine and other pel- vic exudations Avhen used as a salve or in a vaginal suppository. For acute sprains, and for the removal of the swelling folloAving such injuries, its influence is extraordinary if it be Avell rubbed into the part affected. In severe cases of cracked nipples, with much induration, an oint- ment of ichthyol, 1 drachm to 4 (4.0-16.0) of lanolin, will prove of value, but it must be wiped off before each nursing or the child will not take the breast. Often the odor remains and prevents nursing. 224 DRUGS. The dose of ichthyol internally is 1 to 10 grains (0.05-0.65), given in pill. Untoward Effects.—Bergerio and Peroni have both reported dis- agreeable symptoms from the intra-uterine application of ichthyol after curetting. As the drug ought not to be so used, such reports are of little practical value. IODIDE OP AMMONIUM. (See Ammonium Iodide.) IODIDE OP ETHYL. (See Ethyl Iodide.) IODIDE OP POTASSIUM. The physiological effects of iodide of potassium (Potassii Iodidum, U. 8. and B. P.) are entirely comparable to those of iodine itself (see Iodine), but it is employed for somewhat different purposes, is less irritant, more readily given, and perhaps more readily absorbed. When it is given in very large doses or for a long period of time, the fact that the potassium base is a depressant poison is to be remembered, and it is well to use iodide of sodium instead. Physiological Action.—Circulation.—Upon this part of the sys- tem Avhen in health 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), but if atheroma of the blood-vessels be present with hich arterial tension in association with it, iodide of potassium acts as a valu- able remedy in reducing the vascular spasm. It therefore lowers arte- rial pressure. Absorption and Elimination.—Iodide of potassium is very rapidly absorbed and eliminated, appearing in the urine, according to Doux, in thirteen minutes after it is ingested, and the daily amount excreted equals about 80 per cent, of the dose taken. All traces of the iodide in the urine cease four or five days after the last dose is administered (Elhers). Therapeutics.—The medicinal uses 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 attention to the fact that the drug is generally well borne in large amounts by advanced syphilitics, although this is not always the case. The term "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 IODIDE OF POTASSIUM. 225 that large doses of the iodide are borne without inconvenience. This resistance does not always prove the presence of syphilis, nor does the absence of this resistance prove the absence of this disease. Persons having hereditary asthma, gout, rheumatism, or some similar diathetic malady often resist the iodide, and, on the other hand, some syphilitics are affected with " iodism " after very small doses. In treating syphilis the drug should be used in the dose of 10 grains (0.65) three times a day, and this amount gradually increased a grain a day until symp- toms of " iodism " occur. The quantity borne often amounts to from 100 to 200 grains (6.0-13.0) a day, and as much as 400 grains may be taken by some persons. The best Avay 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 sarsaparilla. To a tablespoonful of the latter the patient is to add the iodide solution, beginning with 10 drops (0.65) three times a day, and increasing a drop every twenty-four hours. The iodide acts more slowly as an antisyphilitic than does mercury. In tertiary syphilis the iodide is invaluable. In nervous syphilis, be its manifestations what they may, iodide of potassium is the standard remedy, only being supplanted by mercury Avhen it is necessary to break down a groAvth Avhose existence is a daily nienace to the patient's life, as, for example, a brain tumor which causes pressure near vital areas. It is not of value in sclerotic post-syphilitic changes nor in locomotor ataxia due to syphilis, except in the earliest stages. 2. Metallic Poisoning.—Owing to the fact that iodide of potas- sium forms double soluble salts Avith 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. Antirheumatic.—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 it may be employed in chronic pleurisy, pericarditis, and hydrocephalus to cause absorption of the fluids. In these conditions, however, it often fails and cannot be relied upon. In aneurism, particularly that of the aorta, the drug often does good, but its value rests largely upon the cause of the disease. If it is due to syphilis, the aneurism may yield very rapidly to the drug, and the pain, swelling, and pulsation gradually decrease. In asthma iodide of potassium is valuable if the disease is of the pure bronchial type, but it ought not to be employed if the cause is associated with gastric irritation or indigestion, as it makes the condi- tion of the stomach Averse. In bronchitis and intestinal catarrh where the condition of the mucous membranes is semi-chronic, and not relieved by chloride of ammonium, iodide of potassium should be used. If the bronchitis is chronic and the secretion profuse (bronchorrhoea), iodide 15 226 DRUGS. of potassium will make it Avorse. The dose for an adult in all these instances should be about 3 to 5 grains (0.15-0.3) three times a day. In pulmonary emphysema iodide of potassium is often of great value. In chronic nephritis small doses (5 grains (0.35) 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 given with great care. If the drug is Avell borne, it will cause an extraordinary increase in the urinary Aoav, and Avill relieve very rapidly indeed any dropsy which may be present. In bronchocele the employment of iodide of potassium internally and tincture of iodine externally is the best treatment Ave can use,, and in acute coryza, or " cold in the head," 10 grains (0.65) of the iodide taken at the beginning of the trouble Avill often abort the attack. In hepatic cirrhosis, in its early stages, the iodide often does good, and in arteriosclerosis or atheroma of the blood-vessels it is of great service, according to many English, French, and American Avriters. Thus in the latter conditions a combination of iodide of sodium or po- tassium with a little digitalis Avill relieve vascular spasm and support a feeble heart. 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, external 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 contraindicated in phthisis, except in the fibroid form and in those cases which are dependent upon syphilis as an. underlying dys- crasia, as they aid in the breaking 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 diges- tion and gastric irritability come on. The acne can nearly always be prevented by giving arsenic at the same time Avith the iodide." In some cases petechial rashes break out on the legs, while in others great mental and physical depression appears, so that listlessness or melan- cholia may develop. Sometimes iodide of potassium causes diarrhoea. 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. Eisner has reported a case in which death due to this cause followed the administration of 30 grains of the iodide of potassium. Multiple hemorrhages from the skin and mucous membrane occurred. If bulla? or blebs follow the use of the iodides or other rashes appear, it is said that atropine will afford relief. Sometimes the iodide of ammonium or iodide of sodium will be borne Avhen the iodide of potassium will not. IODIDE OF SODIUM—IODINE. 227 Administration.—The iodide of potassium, owing to its exceed- ingly disagreeable taste, should be given with the compound svrup of sarsaparilla, extract of liquorice, or in milk. Large amounts of these vehicles are to be used. A good way to give it, when the physician fears it will disorder the stomach, is to add the drupermanent cure that we have. The sac should first be emptied by the use of a trocar and canula, and the iodine alone or mixed with glycerin injected with a syringe, and then alloAved to escape. As the pain 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 (320.0) of the tincture may be injected, but it is to be remembered that certain dangerous symptoms may arise. After the injection of tincture of iodine into the pleural cavity in cases of hydrothorax violent 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. In empyema a solution of iodine 6 grains (0.37), iodide of potas- sium 6 grains (0.37), and water 1 pint (500 cc), 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 three instances: 1. In the chronic forms of phthisis (fibroid lung). When the expectoration is abundant and Avhen 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 Avith 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. 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, Avith 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. IODOFORM. 231 Ringer generally adopts the following simple, handy, cleanly, and effectual plan of inhalation : Heat well a jug capable of holding*about 2 pints, by rinsing with boiling water, then partly fill with boiling water, into which pour 20 to 30 drops (1.3-2.0) 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 morn- ing 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 fumes of tincture of 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 Iodi, U. S. 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 has recently been largely used in the vomiting of pregnancy with very good results. The dose is 5 to 10 drops (0.35-0.65), well diluted. Under the name of Lugol's solution (Liquor Iodi Gompositus, U. 8.) iodine is frequently used internally; the dose is 5 to 10 drops (0.35- 0.65), in Avater. The B. P. preparations not official in the U. 8. P. are the liniment (Linimentum Iodi), the solution (Liquor Iodi), and Vapor Iodi, which is prepared by adding 1 fluidrachm (4.0) of iodine to 1 fluidounce (32.0) of water, Avhich is gently heated and the rising vapor inhaled. Within recent years a so-called colorless tincture of iodine has been sold Avhich has obvious advantages, and is made by the following process, according to Curtmann and Aiken of St. Louis : Take of iodine 1^ ounces (48.0), alcohol 13 fluidounces (416.0), of stronger water of ammonia 3 fluidounces (96.0). Dissolve the iodine in the alcohol and add the ammonia. Allow to stand for four weeks with repeated shaking. Or the preparation may be made hastily by using an excess of ammonia, and aftenvard cautiously adding enough hydro- chloric acid to render the liquid only feeble alkaline. Iodide of nitrogen may be precipitated, Avhich is explosive. Unguentum Iodi, U. 8. and B. P., is used locally over enlarged glands. In the case of children or adults Avho have delicate skins the ointment should be diluted one-half Avith lard. This ointment should ahvays be freshly made. Contraindications.—Iodine is contraindicated in renal diseases, except in small doses, during the progress of acute inflammation, and whenever tissues are rapidly undergoing degenerative changes. IODOFORM. Iodoform (lodoformum, U. S. and B. P.) occurs in small saffron- colored crystals Avhich possess a poAverful characteristic, penetrating 232 DRUGS. odor and strong taste. It is soluble in alcohol, ether, chloroform, benzol, and in fixed and volatile oils, but is insoluble in Avater. Physiological Action.—The effects of iodoform upon the circulation, respiration, and other vital functions are very slight Avhen the drug is used as a surgical dressing in ordinary amounts or Avhen it is given by the mouth in average doses. It acts as an anaesthetic upon mucous membranes, and produces those changes Avhich Ave are Avont, for Avant of a better term, to call "alterative," in the tissues Avith Avhich it comes in contact. Iodoform is eliminated in the urine as iodine or as alkaline iodides, chiefly iodide of sodium. The drug also escapes by the saliva. Poisoning.—If applied to an absorbing surface in susceptible indi- viduals, iodoform may cause general systemic poisoning. This poison- ing may be mild, in Avhich case we have a general feeling of malaise. Avith nausea and the perception of various odors Avhich are in reality not present. There may be headache and vomiting. If the system is still more impressed by the drug, these symptoms are folloAved by cerebral excitement, insomnia, loss of memory, loss of appetite, and a rapid pulse. In very grave cases convulsive movements and maniacal delir- ium, alternating Avith coma, may be the dominant symptoms. The pulse is small and rapid, and there is often retention of urine or hsema- turia. Loebisch asserts that the mental excitement cannot be quieted by narcotics. If death occurs, the heart and respiration fail simultane- ously. In addition to the fatty degeneration which such poisoning pro- duces in all the vital organs, there is sometimes found an cedematous condition of the pia mater or a loAV-grade leptomeningitis. These symptoms seem to occur more commonly in the aged. In the graver cases the onset of the poisoning is apt to be sudden, though from tAventy-four hours to several days usually elapse between the appli- cation of the drug and the onset of the symptoms of poisoning. Treatment of the poisoning by iodoform consists, according to Soul- lier, in the administration of bicarbonate of sodium to unite with the iodine and so aid in its elimination; the use of alcoholic stimulants to support the system; the employment of diuretics, and Avrapping'the patient in hot blankets to encourage free SAveating, so relieving the kidneys. Kocher advises saline transfusion in such cases. Untoward Effects.—It is not to be forgotten that iodoform Avhen applied as a dressing may produce less violent symptoms than those just described, and capable, because of their aberrant character, of seriously misleading the physician. Thus a scarlatinal rash may develop with fever, malaise, and nervous disturbances. Therapeutics.—Iodoform is used chiefly as a surgical dressing. It is antiseptic, but not germicidal. Germs may be found in poAvdered iodoform, and will even grow in it. When used locally, the drug does good by absorbing the liquids of the Avound, and thereby removing the nidus for germ-growth, and Avhen applied to large moist surfaces gives off free iodine and acts as well as a protective. There can be no doubt that iodoform Avhen applied to a Avound does good, not by destroying the bacteria directly or indirectly, but by inducing chemical changes in their toxines. IODOFORM. 233 In syphilitic sores the following dressing will be found of great service: Iodoform, 20 grains (1.3); oil of eucalyptus, \ fluidounce (16.0); or a powder of iodoform h an ounce (16.0), camphor 75 grains (5.0), and essence of roses 2 drops (0.1), may be employed. In eczenaa, with tingling and itching, the following application'will give relief (Ringer): R.—Iodoformi.............gr. iv (0.2). Olei eucalypti............fzj (4.0). Petrolati..............gj (82.0).—M. IS.—Apply locally. Internally, iodoform is used in tertiary syphilis in all its forms in the dose of from 1 to 5 grains (0.05-0.35). Bartholow recommends it most highly in catarrhal jaundice and in the early stages of hepatic cirrhosis ; indeed, he thinks its persistent use in small dose will cure the latter affection. The influence of iodoform upon the tubercle bacillus is very great, and it is noAV largely used in the treatment of tubercular disease of the joints and pleure. The pus is allowed to escape under antiseptic pre- cautions ; the cavity is washed out Avith warm boric-acid or carbolic-acid solutions of low strength, and from 1 to 6 drachms (4.0-24.0) of an emulsion of iodoform and sterilized sweet oil are injected and alloAved to remain. The strength of the iodoform-and-oil emulsion should usually be 10 per cent. Should the abscess-cavity fail to heal after these injections have been repeated every feAv days for some time, it must be reopened, scraped, and injected again or packed Avith iodoform gauze. The iodoform also promotes healing through its alterative influ- ence, Avhich aids in the absorption of the inflammatory exudate. Should tubercular glands be present, injections may be made into them even if pus has not formed. Used by means of a powder-blower, iodoform will often relieve the hoarseness and discomfort of laryngeal phthisis, but it must be pulver- ized most minutely. Sometimes a spray may be used, which should consist of spirits of turpentine and SAveet oil, half-and-half, and contain 2 grains (0.10) of iodoform to each ounce (32.0). This mixture may also be used in chronic 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 injection into the back of 30 minims (2.0) of a 1 :100 solution of iodoform in oil of SAveet almonds, but this treatment has not generally found favor, in this country at least. For fissure of the anus and irritated hemorrhoids 5 grains (0.35) of iodoform in a suppository may be placed in the rectum, and after it has remained there a feAV minutes defecation may he had without pain. The pain following operations on the female perineum may also be much relieved in this manner. In the tenesmus of cholera infantum an injec- tion of 1 ounce (32.0) of sweet oil Avith 5 grains (0.35) of iodoform will give great relief if used after or before enteroclysis. Administration.—The ointment of iodoform ( Unguentum Iodoformi, U. 8. and B. P.) is useful when applied over foetid sores. It should ahvays be freshly made. The drug itself may be given in 1- to 5-grain 234 DRUGS. (0.05-0.35) doses three times a day. The suppositories (Suppositoria Iodoformi) are official in the B. P. ; each one contains 3 grains (0.15) 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 Avith 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 Avith a favorable effect on the dis- eased process. Cerna has found iodol of very great service in dia- betes when given internally, in the dose of from 2 to 6 grains (0.1- 0.3) three times a day, and it is said to be of value in tertiary syph- ilis 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. Ingalls recommends the folloAving prescription in cases of eczema or abrasions of the upper lip and nostrils: R.—Acid, carbolic............n\,vj (0.3). 01. rosse..............n^v (0.3). Iodol................gr. xxv (1.65). Lanolin..............|ss (16.0).—M. IPECACUANHA. Ipecacuanha, U. S. and B. P., or Ipecac, is the root of (Jqdiaelis Ipecacuanha, a small shrub of Brazil. It contains an alkaloid, eme- tine, and ipecacuanhic acid. Physiological Action.—Locally applied to mucous membranes, ipe- cac acts as an irritant, and if applied for a long period to the skin produces vesicles and irritation. Very minute doses have little notice- able effect, but large ones produce nausea, relaxation, Aromiting, 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. The drug acts as a depres- sant to the spinal cord (Pecholier), and it also depresses the heart if given in large doses and retained by the stomach. Ipecac is elimi- nated by the kidneys, the gastro-intestinal mucous membrane, and the skin (Binz). If emetine is given in lethal dose to one of the lower animals, death is due to failure of respiration. Therapeutics.—Ipecac is used as an emetic where a fairly rapid action is required. It is particularly useful in cases Avhere the stom- ach of a child is overloaded Avith 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 bronchitis often causes digestive disorders, by reason of the mucus coughed up from the lungs being at once swallowed instead of spit IPECACUANHA. 235 out of the mouth. In these cases the stomach may be relieved and the state of the lungs improved by the use of an emetic dose of syrup of ipecac, 2 to 3 drachms (8.0-12.0). 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 stimulates the depressed stomach up to a normal tone. The proper dose of ipecac for this purpose is \ to h a grain (0.016-0.03) 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. 1 drop of the wine or -J- to J grain of the pow- dered ipecac, repeated for six or seven doses, 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 are small amounts of arsenic or hydrochloric acid. Ipecac is also said to possess marked oxytocic properties, similar to quinine, when given in small doses, 10 to"l5 drops (0.65-1.0), of the wine every two or three hours. 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 folloAving manner: The powdered ipecac is to be administered in the dose of 60 grains (4.0) at once to produce vomiting. After vomiting has taken place small doses of 3 grains (0.2) 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 Avith 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 (0.2) every two hours. No less a per- son than the great Trousseau asserted that ipecac was a hemostatic, and it is said to be a 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 Avith water. While the throat may seem temporarily Avorse, the shortness of breath rapidly decreases and a great improvement takes place in the cough. In order to pre- vent the Avine Avhich collects in the mouth from being swallowed, and nausea and vomiting thereby induced, the patient should be directed to rinse his mouth thoroughly every few minutes. The inhalation should not last at first over three or four minutes, and, until it is 236 DRUGS. known how well the patient will bear the application, the wine should be diluted twice or thrice with water and alcohol, equal parts. It is stated that powdered ipecac made into a paste and smeared on the skin will greatly relieve the pain and swelling produced by the stings of bees. Administration.—The syrup (Syrupus Ipecacuanhe, U. 8.) is given in the dose of -^ to 1 drachm (2.0—4.0) as an expectorant, or in the same dose as an emetic to an infant. The wine ( Vinum Ipecacuanhe, B. P.) is given in the same dose as the syrup, and the fluid extract (Extractum Ipecacuanhe Fluidum, U. 8.) in the dose of 30 drops (2.0) as an emetic to an adult. The troches (Trochisci Ipecacuanhe, U. 8. and B. P.) contain |- of a grain (0.016) each. Trochisci Mor- phine et Ipecacuanhe, U. S. and B. P., each of which contain -^ of a grain (0.002) of morphine and -^ of a grain (0.006) of ipecac, are used in sore throat, dissolved in the mouth. Dover's powder (Pulvis Ipecacuanhe et Opii, U. 8.; Pulvis Ipecacuanhe Compositus, B. P.) is given in the dose of 5 to 15 grains (0.35-1.0) It contains 1 grain (0.05) of opium. 1 grain (0.05) of ipecac, and 8 grains (0.5) of sugar of milk. (See Opium.) Emetine may be given in the dose of y1^ to ^ grain (0.006—0.012) as an emetic, but is very rarely so employed. The British preparations are the pill of ipecac and squill (Pilula Ipecacuanhe cum Scilla, B. P.) Avhich is given in the dose of 5 to 10 grains (0.35—0.65) and the vinegar of ipecac (Acetum Ipecacuanha', B. P.), Avhich is given in the dose of 5 to 30 drops (0.3-2.6) as expec- torants. IRON. Iron (Ferrum, U. S. and B. P.) is a metal Avhich is used both as a medicine and a food—a food because it forms part of the body Avhen taken into the organism and is used by the system in the making of blood. The number of its official salts and compounds is far in excess of the needs of practical physicians, and half the preparations are 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. Much discussion has arisen as to Avhether iron Avhen given as a drug in the form of one of the inorganic salts is absorbed. One theory has been that only the organic iron of the food is absorbed, and that metallic iron Avhen given freely allows this absorption to go on both by stimulating the bowel and by enter- ing into combination Avith the sulphuretted hydrogen in the intestine, thus permitting the organic iron to escape into the system. That both forms of iron are absorbed and eliminated is noAV certain. (For a discussion of some of these views see article on Anaemia.) If, however, iron is given in excessive doses, much of it remains unabsorbed, is changed into the sulphide of iron in the boAvels, and escapes with the fasces. Careful studies have shown that the iron, Avhen once absorbed, IRON. 237 escapes from the body very slowly, and that its pathway of escape is not by the bile or in the urine, but by the Avails of the intestine Avhich excrete it, so that^ it may be recovered from the fasces. It has been asserted that it is never released from the body, but this is untrue. Whether it acts as a stimulant to blood-manufacture or simply supplies the glands Avith blood-making material Ave do not knoAv, but the latter is probably the correct vieAv. Iron causes oxidation to go on more rapidly by reason of its peculiar power of converting oxygen into ozone, and in this manner acts as a stimulant to nutrition and bodily activity. 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 sloAvly redissolved. Nearly all iron preparations are capable of acting as more or less poweful astringents, and so are apt to cause constipation and to disorder digestion if given in large doses. The most astringent of all of these preparations are Monsel's salt (the Ferri Subsulphas, U. 8., B. P.) and the sulphate (Ferri Sulphas, U. 8. and B. P.) Closely following these in astringency are the ain- monio-ferric alum, (Ferri et Ammonii Sulphas, U. 8.) and the chloride of iron (Ferri Chloridum). The least astringent preparations are Quevenne's iron, or iron by hydrogen (Fcrrum Rcdactum, U. 8. and B. P.), and carbonate of iron (Ferri Carbonas Saccharatus, U. 8. and B. P.), and Basham's Mixture (Liquor Ferri et Ammonii Acetatis, U. 8.), and the citrates, tartrates, and the lactate and phosphate of iron. Therapeutics.—The chief indications for the administration of iron are those forms of anemia (see Anaemia) characterized by a decrease in the normal quantity of haemoglobin in the blood as determined by the haemoglobinometer, as, for example, chlorosis, and its chief contraindica- tion is plethora. When used in small dose Q- to ^ grain—0.016-0.03), it is quite as efficacious as in large amounts, and less apt to disorder the stomach, but the doses given in this article are the classical ones usually prescribed by physicians. In some cases of aneemia 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 elimination of iron is constantly present. Large doses compensate for this leakage and afford the quantity needed for physiological purposes. It should not be used as a tonic unless some direct indication for its employment is present, and no drug is more abused in this respect than iron. As every preparation possesses some peculiarity, the use of each Avill be considered separately. Ammonio-ferric Alum. Ammonio-ferric Alum (Ferri et Ammonii Sulpha's, U. S.) is often given in cases in atonic leucorrhea associated with chlorotic tendencies in the dose of 2 to 5 grains (0.1-0.35). It is quite astringent, and should not be given in cases of gastric irritability, as it is not suited to such a condition. 238 DRUGS. Aromatic Mixture of Iron. The Aromatic Mixture of Iron (3Iistura Ferri Aromatica, B. P.) contains so little iron that it should not be administered in cases Avhere a very marked chalybeate influence is desired; it is, hoAvever, a useful tonic for cases of debility and slight anemia folloAving long illnesses, given in the dose of 1 to 2 fluidounces (32.0—64.0) after meals. Aro- matic mixture of iron contains cinchona-bark, calumba, cloves, iron, compound tincture of cardamoms, tincture of orange-peel, and pepper- mint-water. Arsenate of Iron. Arsenate of Iron (Ferri Arsenas, B. P.) is used in the dose of TB" T0 tV gram ^n anaemic subjects who are suffering from the dry, scaly forms of skin disease which indicate the use of arsenic. (See Arsenic.) It is also of value in the anaunia of chronic diarrhoea, as both iron and arsenic are useful, not only for the anaemia, but for the control of the intestinal disorder. Basham's Mixture. Under the name of Basham's Mixture (Liquor Ferri et Ammonii Acetatis, U. 8.) a very useful and elegant preparation of iron is employed. It is particularly useful in the anemia of Brighfs dis- ease, and it acts as a diuretic and diaphoretic. 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 (4.0-32.0), well diluted. Bromide of Iron. Bromide of Iron (Ferri Bromidum) is said by DaCosta to be use- ful in anemia, when this state is associated with chorea, in the dose of 5 to 20 grains (0.35-1.3) given in syrup. In other nervous dis- eases accompanied by anaemia and insomnia the syrup of the bromide of iron (Syrupus Ferri Bromidi) is useful in the dose of J to 1 fluid- drachm (2.0-4.0), but its sedative properties are not sufficiently marked to render it of much value in overcoming true insomnia unless it is fortified by one of the other bromides. 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 Carbonatis, U. S. and B. P., sometimes called "Blaud's pill," or in Griffith's pill, Avhich also contains myrrh. IRON. 239 The dose is about 3 grains (0.15), and this preparation of iron is largely used for the treatment of amenorrhea dependent upon anaemia. Under the name of Mistura Ferri Composita, TJ. 8., or Griffith's mixture, and B. P., we have a liquid preparation used for the same purposes as the pills just named, in the dose of 1 to 2 tablespoonfuls (16.0-32.0). Ma*xa Ferri Carbonatis, U. 8., sometimes called Vallet's mass, is given in pills in the dose of from 1 to 10 grains (0.05-0.65). Chloride of Iron. Tincture of the Chloride of Iron (Tinctura Ferri Chloridi, U. S.), often called Tincture of the Muriate of Iron, is one of the best and most useful preparations of iron that Ave 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 and 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, TJ. S.) is 1 to 3 grains (0.06—0.18). 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. (See Ery- sipelas.) 10 drops (0.65), well diluted, every hour is not too much if the stomach of the patient does not rebel. 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 in 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 prepa- rations are generally supposed to raise blood-pressure, he asserts that iu this instance the blood-pressure is lowered. The dose of Liquor Ferri Chloridi, U. 8., is 4 to 10 drops (0.2-0.65). It is rarely used internally, but chiefly as an astringent of great power. Liquor Ferri Chloridi is identical Avith Liquor Ferri Perchloridi, B. P. Tinctura Ferri Perchloridi, B. P., is used internally in the dose of 10 to 20 minims (0.65—1.3). As a local application tincture of the chloride of iron is useful in diphtheria and membranous croup, and even in tonsillitis. In each of these maladies large doses of the tincture internally, Avith counter- irritation over the neck, are most useful. When used internally it should be Avell diluted Avith water and taken through a glass tube to protect the teeth. The strong solution of perchloride of iron (Licpuor 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, because they are readily added to liquid prescriptions, and 240 DRUGS. they are also of value because they are very slightly irritant and astrin- gent and do not disorder the alimentary canal. Ferri Citras, U. S., and Ferri et Ammonii Citras, U. S. and B. P., occur in garnet-red scales and are given in the dose of 5 grains (0.35). The solution of the citrate of iron (Liquor Ferri Citratis, U. S.) is given in the dose of 10 minims (0.65). The Ferri et Quinhie Citras, B. P., and the Ferri et Strychnine Citras, U. 8., and B. P., are given in the dose of 5 to 15 grains (0.35-1.0) and 1 to 3 grains (0.05-0.15), respectively. The new official Ferri et Quinine Citras Solubilis, U. 8., is given in the dose of 1 to 2 grains (0.05-0.10). Besides these citrates there are three tartrates—(Ferri et Ammonii Tartras, U. S., and Ferri et Potassii Tartras, I . S., and Ferrum Tar- taratum, B. P., all given in the dose of 5 grains (0.35). Dialyzed Iron. Dialyzed iron (Ferrum Dialysatum) 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 (0.35-1.3) in water three times a day. Sometimes river-Avater, if it contains much inorganic or organic matter, will precipitate it. OAving to the instability of dialyzed iron, it may be used without any further preparation as an antidote to arsenic. Liquor Ferri Dialysati, B. P., is given in the dose of 10 to 30 minims (0.65-2.0). 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. The resulting precipitate is the antidote, and the supernatant liquid is to be poured off. If ammonia is used, the precipitate must be washed Avith water several times to get rid of the alkali, which will render the antidote too irritant to be swallowed if it is alloAved 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 precipitated. The magnesia should be freely added, as too much of it cannot be given. The official antidote to arsenic is Ferri Oxidum Hydration cum Magnesia, U. 8. In the Prussian Pharmacopoeia this is knoAvn as the Antidotum Arsenici. (See Arsenic, Poisoning by, for official method of preparing antidote.) Iodide of Iron. The Syrup of the Iodide of Iron (Syrupus Ferri lodidi, U. S. and B. P.) is a transparent liquid of a SAveet, iron-like taste. It should contain no free iodine, and if it strikes a blue color with starch should IRON. 241 be discarded. It is largely used in anemia 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 on tW°, ITVS 1S/2 t0 3 dl*°ps (°-1-0-15), well diluted, and to an adult 30 to 40 drops (2.0-2.65) in water, to be taken through a glass tube to protect the teeth. The saccharated iodide of iron (Ferri lodidum Saccharatum, U. 8.) is used in place of the syrup in the dose of 2 to 5 grains (0.1-0.3). The official pills (Pilula Ferri lodidi, U. S. and B. P.) each contain i- of a gram (0.01) of reduced iron and \ of a grain (0.075) of iodine, and are given in the dose of one to three pills. Lactate of Iron. The Lactate of Iron (Ferri Lactas, U. S.) is soluble in 48 parts of water, and is given in the dose of 5 grains (0.35). It is used for the same purposes as the other preparations of iron. Lactate of iron is one of the ingredients of SyrupusHypophosphitum cumFerro, U. 8., the dose of which is J to 1 fluidrachm (2.0-4.0). Ferri Subsulphas, or Monsel's Salt. Monsel's Solution (Liquor Ferri Subsulphatis, U. S.), 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 employed where a hemorrhage is to be attacked through the circu- lation, but only when the solution can come in direct contact with the bleeding spot. The objection to its use is the hard, black, and dirty clot which it forms on coming in contact with the blood. In hemop- tysis Monsel's solution should be used in fine spray consisting of from 10 to 60 drops (0.65-4.0) 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 solu- tion should be used, locally applied. In nose-bleed Monsel's solution may be employed diluted one-half or pure, but its use is not to be commended, because of the hard, black clot which is formed and the uncomfortable sensations and pain produced in the nasal chambers. Plugging the nostrils, and if need be the posterior nares, with pledgets of cotton is generally sufficiently efficacious. For the intestinal hemorrhage occurring during or after typhoid fever Monsel's solution has been given, but ought not to be so employed, as it is decomposed in the stomach before it reaches the intestine. In its stead Monsel's salt (Ferri Subsulphas, U. S.) should be given in pills of 3 grains (0.15) 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 and repeated in an hour in pressing cases. Hematemesis due to bleeding in the stomach may be treated by 3-drop (0.15) doses of the solution in a little Avater. It must be remembered, hoAvever, that the drug is irritating. In tonsillitis and pharyngitis a most efficient application is pure 16 242 DRUGS. 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 often 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) is given in the dose of 2 to 3 grains (0.1-0.15). It possesses no advantages peculiar to itself. Phosphates of Iron. There are two phosphates of iron—Ferri Phosphas Solubilis, U. S. and B. P., and Ferri Pyrophosphas Solubilis, U. 8. Phosphate of iron itself is very insoluble and is rarely used. The official forms are, however, quite soluble, and useful in the dose of 2 to 5 grains (0.1-0.35). Syrupus Fori Phosphatus, B. P., is given in the dose of 1 fluidrachm (4.0). Phosphate of iron is one of the ingredients of the syrup of iron, quinine, and strychnine (Syrupus Ferri, Quinine et Strychnine Phosphatum, U. 8.), which is given in the dose of 1 fluidrachm (4.0). Reduced Iron. Quevenne's Iron (Ferrum Reductum, U. S. and B. P.) is an iron- gray or reddish powder which is frequently adulterated Avith 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 Redacti, B. P.), each lozenge containing 1 grain (0.05) 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 Sulphas, U. S. and B. P.) is used inter- nally in the dose of 5 grains (0.35) in pill form in chronic diarrhea. Externally, in a solution of the strength of 5 to 25 grains to the ounce (0.35-1.65 : 32.0), it is used as an astringent lotion. Tavo other forms of the sulphate are also employed—namely, the dried (Ferri Sulphas Exsiccatus, U. 8. and B. P.) and the granulated (Ferri Sulphas Granulatus, U. S. and B. P.), each of Avhich is given in the dose of 3 grains (0.18). Valerianate of Iron. Valerianate of Iron (Ferri Valerian as, U. S.) is sometimes useful in hysteria with anemia, given in the dose of 1 grain (0.06) or more. JALAP. 243 Wines of Iron. The Bitter Wine of Iron (Vinum Ferri Amarum, U. S.) is useful as a bitter tonic in anemia in both children and adults, and mav be ad- vantageously accompanied with cod-liver oil. It is given in aldose of 1 to 2 fluidrachms (4.0-8.0) or more. This wine is composed of soluble citrate of iron and quinine, tincture of sweet orange-peel, syrup, and stronger Avhite Avine. Wine of the Citrate of Iron, or Vinum Ferri Citratis, U. S. and B. P., is composed of the citrate of iron and ammonium, tincture of sweet orange-peel, syrup, and stronger Avhite wine. The dose is identi- cal with that of the bitter wine, and it is used for the same purposes. Hydrated Peroxide of Iron (Ferri Pero.ridum Hydratum, B. P.) is used in the dose of 5 to 30 grains (0.35-2.0). From the last prepa- ration iron plaster (Emplastrum Ferri, B. P.) is made. The plaster of iron official in the U. S. is prepared from the hydrated oxide of iron. The folloAving preparations of iron are also official: Liquor Ferri Acetatis, U. S., dose 15 minims to 1 fluidrachm (1.0-4.0), and Liquor Ferri Acetatis Fortior, B. P., dose 1 to 8 minims (0.05-0.6). 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 laxa- tive or purges are used. The state of the boAvels should ahvays be inquired into when iron is being used, and laxatives given whenever constipation is present and iron is being administered. In rheumatic and gouty persons frontal headaches are a common symptom Avhen iron is given, and purgatives will not generally give relief. Garrod and Haig have shown that iron decreases the elimination of uric acid, which may account for the production of headache in the case of rheumatic patients under its influence. Sometimes 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 Ipomea Jala pa, a native of Mexico. It contains tAvo 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 tasteless- ness is a useful active cathartic in children if given in the proper dose —namely, 1 to 2 grains (0.05-0.10) in \ an ounce of syrup of rhubarb. 244 DRUGS Combined with calomel, it is preferred to all other purges by some practitioners, particularly 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 (1.0-2.65), Avhich is composed of 35 parts of jalap and 65 parts of bitartrate of potassium; and the resin (Resina Jalape, U. 8. and B. P.), dose for an adult 2 to 4 grains (0.1-0.2). 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 J a grain (0.016-0.03). The tincture (Tinctura Jalape, B. P.) is given in the dose of \ to 1 fluidrachm (2.0-4.0); the extract (Extractum Jalape, U. S. and B. P.) is used in the dose of 5 to 15 grains (0.35-1.0). JEQUIFJTY. This is a plant known as Abrus precatorius, the seeds of Avhich are poisonous Avhen applied to a wound. An active principle, abrin, is composed of paraglobulin and a-phytalbumose, Avhich closely resem- ble snake-venom in their action. Jequirity is never used internally in medicine in this country. An infusion of the powdered seeds, made by adding | a drachm to an ounce (2.0 : 32.0) of water at 140° F. may be painted Avith a brush on the inside of the eyelids in cases of chronic granular conjunctivitis, in order to produce an acute diph- theritic inflammation which will so change the chronic process present as to permit of a cure. If an excessive action is developed, it may be controlled by hot compresses made of very dilute solutions of cor- rosive sublimate. The solution of the drug undergoes decomposition Avith great rapidity, and should be freshly prepared each time it is used, or 4 to 8 grains (0.2-0.5) of boric acid should be added to preserve it. The drug is a poAverful cardiac depressant poison Avhen injected into the circulation. Whether the seeds produce poisoning when SAvalloAved is doubtful, some asserting that they cause gastro-enteritis, others that they are harmless. Probably much depends on the activity of diges- tion at the time of ingestion. JUNIPER. Juniperus is the fruit or berry of Juniperus communis, an ever- green of Northern Europe and America. It contains a volatile oil and an amorphous principle, juniperin. Physiological Action.—Juniper acts as a gastric stimulant and tonic, 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 tract 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 KA MALA—KA OLIN—KINO. 245 attack of acute Bright's disease when reaction has set in and the secre- ting 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 Avhich the renal con- dition corresponds to that just described, juniper is also useful. In old persons a sensation of iveight across the lumbar region is often quickly 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, caraAvay, and fennel, combined with alcohol and water, in the dose of 1 to 4 drachms (4.0-16.0). Gin is virtually identical Avith the compound spirit. The infusion of juniper is made by add- ing an ounce (32.0) of the berries to a pint (h a litre) of boiling Avater and alloAving it to stand in a Avarm place for an hour. The entire quantity is to be taken in tAventy-four hours, and the infusion is often combined Avith acetate of potassium or an ounce (32.0) of the bitar- trate of potassium in the treatment of dropsy. The spirit (Spiritus Juniperi, U. 8. and B. P.) is given in the dose of 30 minims to 1 drachm (2.0-4.0). The oil (Oleum Juniperi, U. S. and B. P.) is used in the dose of 1 to 4 minims (0.06-0.3). KAMALA. Kamala, U. S. and B. P., or Rottlera, as it is sometimes called, is the glands and hairs from the capsules of Mallotus philippiensis, a plant of Abyssinia, India, and China, and Australia. In contains an active principle, rottlerin, Avhich is not official. Given in the dose of 1 to 2 drachms (4.0-8.0), kamala acts as a drastic and as a remedy for tape-worm, and is sometimes used for the removal of the ascaris lumbricoides. It should be administered in syrup in Avhich is placed some hyoscyamus to prevent griping, and the dose is to be repeated in eight hours if no effect is produced. (See Worms.) KAOLIN. Kaolin is a soft Avhite poAvder, a decomposition-product of mineral deposits containing feldspar. It is used externally as a dusting pow- der 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 astringent in the treatment of serous diarrhea. It is official in the form of the tincture (Tinctura. Kino, TJ. 8. and B. P.), and is given in the dose of 1 fluidrachm (4.0). Kino may be used as a gargle in sore throat and for relaxation of the uvula. Under the name of Com- pound Powder of Kino (Pulvis Kino Compositus, B. P.) an efficient and pleasant antidiarrhea powder is used. This powder is not official 246 DRUGS. in the TJ. S. P. The formula for each powder is 15 grains (1.0) of poAvdered kino, 4 (0.2) of poAvdered cinnamon, and 1 (0.05) of poAv- dered opium. KOLA. This drug is the nut of Kola acuminata, a tree groAving in certain parts of Africa. The nut depends for its chief medicinal activity upon the caffeine which it contains. In addition to this alkaloid it contains some theobromine and kolatannic acid, Avhich latter ingredi- ent may explain the good results which have followed the use of kola in cases of diarrhoea. Physiological Action.—The physiological action of kola is, as far as we know, nearly identical Avith its near relatives coffee and coca. Therapeutics.—In cases of feeble heart associated Avith general debil- ity kola often proves a valuable stimulant to the heart and general sys- tem, as Avell as to the kidneys. It has also been used Avith asserted success in sea-sickness and to sober drunken persons, although the latter power is to be doubted. Its use will sometimes relieve sick and neuralgic headache. Recently a large number of semi-proprietary articles have been introduced to the laity with the statement that they increase muscular strength. Except for their temporary stimulating power they are useless for this purpose. The drug is, however, of value in cases of uterine inertia during labor in the dose of 30 drops (2.0) of the fluid extract. Administration.—Kola is not official. It may be given in the form of the fluid extract (Extractum Kole Fluidum), dose 10 to 30 minims (0.65-2.0), or in an elixir. LANOLIN. Lanolin, which is practically the Adeps Lane Hydrosus of the U. S. and B. P., is a fat derived from the avooI of the common sheep, and is a Avhitish substance of peculiar stability, very difficult of saponification, and incapable of becoming rancid. Unna states that ointments of acids, hydrogen peroxide, and other substances may be made by it. One great objection to lanolin is its stickiness, Avhich is avoided by adding one-third of vaseline. Lanolin is supposed to possess very remarkable penetrating poAvers when applied to the skin in cases Avhere much infiltration is present, particularly if it is com- bined with resorcin or some similar medicament. In itself it has little curative poAver, and is but little better than lard, suet, or any common fat as a basis for ointments. In some cases, Avhich are rare, it Avill cause irritation of the skin. LEAD. Plumbum, or Lead, is a metal possessing more or less poAver over the organism according to the salts Avhich are employed. It is not official as lead itself. LEAD. 247 Physiological Action.—Lead, in one of its soluble salts, if applied to a mucous membrane, by reason of its astringent effect, produces a blanching which is particularly noticeable where the redness of inflam- mation has previously been present. It has little effect Avhen given in a 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 of the soluble salts is the nitrate, the next the subacetate, and the least poisonous of the soluble salts is the acetate. The insoluble salts rarely cause acute poisoning, but frequently produce chronic plumbism. 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 vomiting of white, milky-looking liquids or white curds mixed A\ith food. The Avhite color is due to the presence of chloride of lead formed by the acid of the gastric juice. The pain rapidly increases in severity, and diarrhoea due to gastro- enteritis may be set up, or, in other cases, obstinate constipation is present. The passages are generally black, this color 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 compressible. The face is anxious and pale or livid. The thirst is excessive, and cramps in the calves of the legs or muscular twitchings may ensue. It is said that the characteristic blue line on the gums may occur in acute poisoning, but this is rarely if ever seen. If coma comes on in the course of acute lead poisoning, death is almost certain. The treatment consists in the use of the chemical antidote, a sol- uble 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 always at hand, are readily soluble, and, in excess, act as purges which Avill wash out the intestinal canal. Hot applications should be applied to the belly and feet, and the pain and irritation which are present should be relieved by opium. Chronic Poisoning.—Chronic lead poisoning is rarely produced by the soluble salts of lead, nearly ahvays 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 occurrence of rare, anomalous symptoms in a given case should at once bring to the mind of the physician the thought of lead poisoning or syphilis. Chronic poisoning occurs in painters, manufacturers of lead salts, and every one Avho is largely throAvn in contact with the metal in the arts. It occurs from the use of hair-dyes containing the acetate of lead, from drinking Avater Avhich has passed through neAv lead pipe, and even from the biting of silk threads loaded with lead to increase their weight. Chromate of lead has been used to color sponge-cake Avhen ecro-s Avere thought too dear, and has killed many persons. Millers 248 DRUGS. Avho have filled the holes in grindstones Avith lead have caused wide- spread epidemics of Avhat has been called "dry cholera," and many persons have suffered from lead poisoning from eating apple-butter kept in jars glazed Avith lead. One of the most prominent, but by no means the most constant, symptoms of chronic plumbism is bilateral Avrist-drop, due to palsy of the extensor muscles of the forearm. The short extensor of the thumb generally escapes the drug's influence, as does also the supi- nator longus. Sometimes internal squint arises from paralysis of the external rectus muscles by the lead. Another very common symptom is colic centering around the umbilicus and radiating through the belly and loins. Obstinate constipation often accompanies these symptoms, and the faeces, Avhen passed, are white and clay-colored, owing to a deficient secretion of bile. During an attack of lead colic the arterial tension is increased very markedly, the tongue is coated and Avhitish, and the bowels are obsti- nately confined. If these early Avarnings are disregarded and the exposure to the lead is continued, cerebral symptoms may come on, the result of eneephalopathia saturnina, or saturnine cerebritis. Saturnine epi- lepsy is not very rare. If convulsions come on, death generally ensues. The convulsions in some cases are not due to a cerebral effect of the lead, but to uraemia due to 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 chronic lead poisoning. If a patient with chronic lead poisoning have a urine Avith a persistent Ioav specific gravity, the prognosis is grave, as evidencing advanced kidney involvement. Asthma due to the inhalation of lead-dust is sometimes met Avith. 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 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 atro- phied, and finally changed into fibrous cords. Anterior poliomyelitis may be present, but true locomotor ataxia is rarely caused. If ataxic symptoms exist, they are most probably dependent on pseudo-tabes produced by a plumbic multiple neuritis, and can be separated from true tabes dorsalis by the absence of several of the important true tabetic symptoms—such as slow onset, the Argyll-Robertson pupil, etc. —while the presence of marked wasting and loss of poAver, with ten- derness over the nerve-trunks, points to neuritis. 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 Gar- rod 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 in the bile. LEAD. 249 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 Avith opium to prevent pain, are indicated, and alum and opium or morphine are said to be almost specifics, the alum in 2-grain doses, the others in full amounts. In many cases purges fail to move the boAvels of a person suffering from chronic lead poisoning, and succeed only Avhen 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, and a pilocarpine SAveat may be resorted to. To aid in the elimination of the lead, iodide of potassium, Avhich forms double soluble salts in the tissues Avith the metal, is to be used, 10 to 20 grains (0.65-1.3) 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 in the same mixture as 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 employed, and, if not, the galvanic current should be used. Curiously enough, partial voluntary power sometimes returns before the muscles will react at all to electricity. It is said that baths of sulphuret of potassium do good in chronic plumbism, 5 or 6 ounces (160.0) of the salt to each bath, Avhich is to be given in a wooden tub. The patient should afterwards be well soaped, then thoroughly rinsed off, and rubbed down Avith a rough towel. As the salts of lead are used for different purposes, the therapeu- tics of each one will be taken up separately. Acetate of Lead. Acetate of Lead (Plunibi 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 employed, in the following pill in the treatment of serous diarrhea : R.—Plumbi acetat............gr. xl (2.65). Pulv. opii.............gr. x (0.65). Camphora?.............gr. xl (2.65).—M. Ft. in pil. No. xx. S.—One every four hours. This pill may also be given in cases of dysentery. The acetate of lead in proportion of 1-8 grains (0.06-0.5) to the ounce of water may be used as an injection for gonorrhoea. Lead acetate is also a useful application for the dermatitis produced 250 DRUGS. by poison ivy, as this drug precipitates the sticky, non-volatile oil of Rhus toxicodendron, recently studied by Pfaff. The acetate of lead should be dissolved in alcohol in the proportion of half a grain to the ounce (0.03-30.0) and used as a wash. After this the inflamed parts should be treated by cooling applications, but ointments are not to be used, as they dissolve the poisonous oil and spread the irritation. Administration.—The B. P. recognizes the following preparations of lead acetate: Pilula Plumbi cum Opio, dose 3 to 5 grains (0.1- 0.3); Suppositoria Plumbi Composita, each suppository containing 1 grain (0.06) of opium to 3 grains (0.18) of lead acetate; and an oint- ment (Unguentum Plumbi Acetatis). Carbonate of Lead. Carbonate of Lead (Plumbi Carbonas, U. 8. and B. P.), or White Lead, is insoluble, and is used as a coating or dressing for burns, scalds, or ulcers Avhen rubbed up with linseed or other oil, or in the form of the ointment (Unguentum Plumbi Carbonatis, U. S. and B. P.). If a wide surface is covered Avith this ointment, it may cause lead poisoning by absorption. Carbonate of lead may be used in the treatment of sunburn in the following prescription: R.—Plumbi carbonat. . . Pulv. amyli .... Unguent, aqua? rosa? . Olei olivae..... S.—Apply to the inflamed skin Iodide of Lead. Iodide of Lead (Plumbi Iodidum, U. S. and B. P.) is occasion- ally employed in medicine; the dose is J to 2 grains (0.03-0.1). Emplastrum Plumbi lodidi, P. B., and Unguentum Plumbi lodidi, U. 8. and B. P., are useful as external astringent and alterative applications, but are rarely used. Liquor Plumbi Subacetatis. Liquor Plumbi Subacetatis, U. 8. and B. P., or Goulard's Extract, is a colorless liquid, much used externally, Avhen diluted Avith lauda- num, for sprains, bruises, and local inflammations, under the name of "lead-water and laudanum." "L. and L.," as it is often called in the hospitals, is a useful application in the dermatitis produced by poison ivy. The proportion should be 4 parts of the pure lead-water, diluted with 16 parts of Avater, 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 Subacetatis Dilutus, U. S. and B. P.), and as such is too weak for ordinary use, although it is commonly employed. The strong solution should be used in the strength of from 1 to 4 ounces (32.0-128.0) to the pint (500 cc.) of water. This solution should never be employed if the skin is broken, 33 (4.0). 3" (4.0). 5j (32.0). f#j (8.0).- -M. LEPTANDRA. 251 as absorption may occur, and, what is more important still, the drug prevents healing by constringing and Avhitening the edges of the wound. If some bread-crumbs be saturated with the solution just named 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 in character. It should be applied once or tAvice a day, and it is well to folloAv the application of lead with a weak sulphur bath or alkaline wash. (See Eczema.) Lead-water is also useful in pruritus pudendi. The cerate (Cera- tum Plumbi Subacetatis, U. S.), the liniment (Linimentum Plumbi Subacetatis), and the glycerin (Glycerinum Plumbi Subacetatis, 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 prep- aration of lead plaster (Emplastrum Plumbi, U. 8. and B. P.), some- times called " Diachylon," and this is in turn employed for the manu- facture of resin plaster (Emplastrum Resine, U. S. and B. P.). It is also used in the preparation of the solution of subacetate of lead. Hebra recommended for sioeating 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 internally, 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 Avater-closets, dissolves the solder in drain-pipes, and is not a good preparation for general use. LEPTANDRA. The medicinal portion of Veronica virginica is the rhizome and rootlet, from Avhich are made the official extract of leptandra (Extrac- tum Leptandre, U. 8.) and the fluid extract (Extractum Leptandre Fluidum, U. 8.). The dose of the former is from 1 to 8 grains (0.06-0.5) and of the fluid extract 5 to 40 minims (0.3-2.6). Physiological Action.—Very feAV experiments have been made as to the action of this remedy, and the only ones of importance are those of Rutherford and Vignal, Avho found that it possesses a mod- erate 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 leptan- dra also believe it to be of the greatest value in the indigestion of the 252 DRUGS. intestinal type sometimes called "duodenal atony." (See also Podo- phyllin.) The following pill is a good method of using the drug in these cases: R.—Ext. chirat*.............gr. xx (1.3). Ext. leptandra?............gr. xx (1.3).—M. Ft. in pil. No. x. S.—One pill after each meal. Under the name of leptandrin Ave have an impure resin which is given in the dose of 2 to 5 grains (0.1-0.3). An alkaloid of doubtful existence is called leptandrine. LIPANIN. Lipanin is an 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 (4.0) Avhich may be increased to 4 drachms (16.0). This mixture has been found of value in most of the wasting diseases in which cod-liver oil is em- ployed, and in the opinion of von Mering its efficacy is greatly increased if the hypophosphites of lime and sodium are used at the same time in the dose of 10 grains (0.65) 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 Avater 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. 8. and B. P.) is used in a dose anywhere from 5 to 120 grains (0.35- 8.0). The pure extract (Extractum Glycyrrhize Purum, U. 8.) is used in the same quantities as the ordinary extract. The fluid extract t (Extractum Glycyrrhize Fluidum, U. S.) or the liquid extract (Extrac- tum Glycyrrhize Liquidum, B. P.) is used in 1- to 2-drachm (4.0-8.0) doses. Under the name of BroAvn Mixture or " Compound Liquorice Mixture " a very efficient expectorant solution is official (Mistura Glycyrrhize Composita, U. S.), Avhich contains as its most important ingredients 12 parts of paregoric, 6 parts of Avine of antimony, and 3 parts of sweet spirit of nitre. The dose of Brown Mixture is 1 to 4 drachms (4.0-16.0). Pulvis Glycyrrhize Compositus, U. 8. and B. P., or compound licorice poAvder, contains, according to the U. 8. P., 18 per cent, of senna, 23.6 per cent, of liquorice, 4 per cent, of oil of fennel, 8 per cent, of washed sulphur, and 50 per cent, of sugar. Ac- LIQUOR POTASSM—LITHIUM. 253 cording 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 (4.0-16.0). It is largely used as an efficient laxative after childbirth and in cases which suffer from constipation chiefly due to the inactivity consequent upon being in bed. The troches (Trochisci Glycyrrhize et Opii, U. S. and B. P.) contain ^ grain (0.003) of opium and 2 grains (0.1) of extract of liquorice. Finally Ave have Glycyrrhizinum Ammonia-turn, 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 (0.3-1.0). LIQUOR POTASS^. Liquor Potasse, U. 8. 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 cases of ingrowing toe-nail it is often used to soften the nail prior to packing Avith cotton or partial evulsion. Its dose is 5 to 30 drops (0.35-2.0) well diluted Avith Avater. LITHIUM. Lithium is used in several forms, but its salts may be divided into tAvo classes—those which act as lithium and those which act as the acids forming them. In the first class Ave have the carbonate (Lithii Carbonas, U. 8. and B. P.), dose 2 to 10 grains (0.1-0.65), the citrate (Lithii Citras, U. 8. and B. P.), dose 5 to 20 grains (0.3-1.3), and the effervescent citrate (Lithii Citras Effervescens, U. S.), dose 1 to 4 drachms (4.0-16.0). In the second class we find the benzoate (Lithii Benzoas, U. 8.), dose 5 to 30 grains (0.3-2.0); Lithii Bromidum, U. S., dose 10 to 40 grains (0.65-2.65), and Lithii Solicylas, U. 8., dose 10 to 30 grains (0.65-2.0). 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. 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 phos- phate in the blood, and practically leaves the uric acid to itself. This is an important point, since it proves that the large amount of Avater generally taken Avith lithia has more to do with relieving gout than has the lithia. 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 (3.3) of the carbonate, 90 grains (6.0) of crystallized citric acid, and 254 DRUGS. Avarm distilled water 1 fluidounce (32.0). 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 -^ of a grain (0.002) of arsenite of sodium and 10 grains (0.65) of the lithium salt three times a day. It is worthy of note that in some cases citrate of lithium will dis- order the stomach and produce vomiting. Lithia-water, or the preparation of the British Pharmacopoeia, Liquor Lithie Effervescens, is useful in gout in quantities of 5 to 10 ounces (160.0-320.0) at a time. (For the use of other salts of lithium see the articles on the Bro- mides, Salicylic Acid, and Benzoic Acid.) (See also article on Mineral Springs.) 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, lobe- line, and lobelic acid. Physiological Action.—When taken in overdose lobelia causes eme- sis, intense prostration, a feeble pulse, pale skin, livid face, muscular 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, the latter change being due to the asphyxia which it finally produces. Ultimately it paralyzes the respi- ratory centre and the peripheral vagi. The treatment of the poisoning is to administer opium to stop irritation and vomiting, to give alcohol and ammonia to support the heart, and the use of external heat. Therapeutics.—Lobelia is used chiefly as an antiasthmatic, and has been equally 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 Sydney 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 Avith cardiac disease, lobelia should never be employed. The drug should be taken in the dose of \ a drachm (2.0) to 1 drachm (4.0) of the tincture at the first sign of an attack, or in 10-drop (0.65) doses every fifteen minutes until distinct nausea occurs or relief is obtained. If the heart is feeble, its use is contraindicated. In atonic constipation with great dryness of the faeces 10 drops (0.65) of the tincture of lobelia at bed-time are often of service, particularly if it is combined Avith cascara sagrada. (See Cascara Sagrada.) Administration.—Lobelia is given in the form of the tincture (Tine- L YCOPODIUM—L Y SOL—MA GNESIA. 255 tura Lobelie, U. S.), in the dose of 10 to 30 drops (0.65-2.0), or 1 to 2 drachms (4.0-8.0) as an emetic. The vinegar i Acetum Lobelie) is no longer official, but is given in the dose of 20 to 30 drops (1.65- 2.0), and the fluid extract (Extractum Lobelie Fluidum, U. 8.) in the dose of 1 to 5 drops (0.05-0.35), or as an emetic in the dose of 15 drops (L0). 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 (32.0) to the pint (\ litre) of Avater. The preparations of the B. P. are the Tinctura Lobelie, dose 10 minims to -1- drachm (0.65-2.0), and Tinctura Lobelie ^Etherea, dose 10 to 30 minims (0.65-2.0). LYCOPODIUM. Lycopoclium, 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 Avhich 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 Avith alcohol that part of tar oil Avhich boils betAveen 190° and 200° C, and is a brownish, clear, oily fluid, smelling somewhat like creo- sote. It is used for the same antiseptic purposes as creolin (see Creo- lin), but possesses the advantage of forming a clear, soapy fluid when mixed with Avater, in which instruments can be seen. If small instru- ments are used, the solution is so soapy that it renders them too slippery for ready use. Those who have used lysol claim that it does not affect the skin of the operator's hands except to render it 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 mem- branes, a solution of lysol should not be stronger than 2 per cent. MAGNESIA. Magnesia is the oxide of magnesium, made by exposing the car- bonate of magnesium to a red heat. It is used in the form of the light magnesia (Magnesia Levis) as a dusting poAvder. . The troches (Trochisci Magnesia') each contain 3 grains (0.015). Magnesia is an antidote to arsenic, and Avhen employed to precip- itate a soluble preparation of iron it forms the Antidotum Arsenici (Ferri Oxidum Hydratum cum Magnesia, U. 8.). 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 in internal medicine except as a feeble antacid. Magnesia and the carbonate of magnesium may be used interchangeably. 256 DRUGS. MAGNESIUM. Magnesium is a metal never used as such, but ahvays 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-Avater and in caves or in the Avater coming from the latter. The citrate and car- bonate are derived from the sulphate. The carbonate is insoluble in water and alcohol. The others are soluble. Magnesium Carbonate. The Carbonate of Magnesium (Magnesii Carbonas, U. S.) is official in the form of the heavy and light powder (Magnesii Carbonas Pon- der osa vel Levis, B. P.), and 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 Avhite cubes rubbed on the skin to prevent ex- cessive perspiration and as a cosmetic. The heavy magnesium 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 stom- ach or intestines contain much acid from fermentative 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 (0.3-4.0). 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 (32.0-64.0) as a laxative. Magnesium Citrate. The Citrate of Magnesium (Magnesii 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, U. 8. and B. P.), Avhich is effervescent and should never be used unless freshly prepared. It is made by adding bicar- bonate of potassium to a syrupy solution of the citrate of magnesium containing an excess of acid, and corking the bottle tightly, the cork being tied down Avith a strong cord. Care should be taken that the bottle is a strong one, as the development of large amounts of carbonic acid gas may burst it if it be Aveak. The dose is half to one bottle, which contains about 12 ounces (360 cc). It is too irritating 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 Efifervescens, TJ. 8.) is less agreeable to take than the solution just named. It should be dissolved in water, about 1 to 3 drachms (15.0-45.0) of the salt being used in each dose, and swallowed Avhile the solution is effervescing. It must be kept in bottles tightly corked. MANGANESE—MANNA. 257 Magnesium Sulphate. Sulphate of Magnesium (Magnesii Sulphas, U. S. and B. P.) is a white granular powder of neutral reaction, salty taste, and is soluble in water. It is the form generally known by the laity as "salts," although in some parts of the country this term 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 blood- vessels. 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 Avill abstract salts from the tissues and replace them with water. The recollection of these facts readily makes clear the mode of action of magnesium sulphate. Whenever a thorough purgative action is re- quired—that is, Avhere depletion of the intestine or absorption of exu- dations 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 Avith the double pur- pose of unloading the bowels and acting as a depletant. The best mix- ture for this purpose seems to be that proposed by Watkins—namely, 2 ounces (64.0) of magnesium, 1 ounce (32.0) of glycerin, and 4 ounces (128.0) of water. In cases of dropsy the use of concentrated solutions is particularly nec- essary if free Avatery evacuations are desired, and from 1 to 2 ounces should be given before breakfast or on an empty stomach in as little water as will dissolve the salt. (See Dropsy.) Generally it is better to give this quantity divided into small doses every fifteen minutes till it is all taken. 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 Avhen 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 Dioxidum, U. 8. and B. P.) and the sulphate (Mangani Sulphas, U. 8.). The first of these, under the name binoxide of manganese, has been highly praised in conenorrhea dependent upon functional disturbance and ansemia. The dose is 3 to 5 grains (0.15- 0.3) 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 (0.05-0.1). MANNA. Manna, U. S. and B. P., is the concrete saccharine exudation of Fraxinus Ornus, a tree of Europe. It occurs in roundish masses 17 258 DRUGS. of varying size, looking somewhat like a gray-colored gum arable. It has a sweet taste and odor. Sometimes the taste is a little bitter. Therapeutics.—Manna is the most feeble of the laxatives, and 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 (4.0-8.0) 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 power- ful drugs, chiefly to cover their taste. It may be combined with advantage with rhubarb and senna, and it enters into the official Infusum Senne Gompositum, U. S., the dose of which is from 1 to 4 fluidounces (3.20-64.0). MATRICARIA. Matricaria, U. 8., German Chamomile, consists in the flower-heads of Matricaria Ohamomilla, a European plant, possessing mild bitter tonic properties Avhen given in moderate dose. In larger amounts it acts as an emetic and anthelmintic. In the form of an infusion of the strength of 1 to 2 ounces to the pint (32.0-64.0: J litre) it has been largely used as a diaphoretic, and, in small doses, to prevent colic in teething children. MENTHOL. (See Peppekmint.) MERCURY. Hydrargyrum, U. 8. 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 Avhen the jaws are firmly and quickly closed, foetid breath, sponginess of the gums, which finally may bleed at the slightest touch, SAvelling of the tongue, and, most prominent of all, excessive salivation, a condition some- times 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 develop 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 doAvn and decomposition of the tissues the patient dies. The blood is affected, and becomes very thin, fluid, and poor in its corpus- cular elements. These symptoms ensue on the use of mercury in continued doses, and rarely folloAv exposure to the drug in the pro- cesses of the arts. In the arts—as, for instance, in the making of MERCURY. 259 looking-glasses—workmen are often affected by various trains of symptoms varying very Avidely in their course. In some cases the nervous system becomes chiefly affected. Tremors of all sorts arise, paralysis agitans is developed Avith its typical characteristics, and Avidely different changes and degenerations in the spinal cord ensue; but it is Avorthy of note that the ocular muscles are rarely involved in mercurial tremor, while in disseminated sclerosis nystagmus is not rare. Similarly the tremors of mercurial poisoning often affect the head and neck alone, while in paralysis agitans this is rarely the case. Chorea often comes on in clironic mercurial poisoning, and the occur- rence of choreic movements in an adult should cause inquiry as to any possible exposure to mercury. In other cases broAvnish discoloration of the skin, resembling Addison's disease, appears. Blindness, deafness, sensory disturbances, such as hyperesthesia and anaesthesia, are devel- oped, and localized wasting of muscles or groups of muscles may assert itself. In still other cases the blood becomes impoverished and mer- curial cachexia is developed. It is worthy of note that children under three years are rarely sali- vated 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. Absokption.—The question as to the form in Avhich mercury finds entrance into the system is one of interest and importance. According to certain Avriters 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. Some have 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 subdi- vision 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. Elimination.—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 these parts are actively engaged in its elimination, the drug nevertheless rapidly accumulates in the body. 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 modi- fied by Souchow and Michaelowsky, Avhich permits of the easy detec- tion of the ToVo- of a grain (0.00006) in an ounce (32.0). After a single dose of mercury the elimination of the drug is rapid, and sometimes complete in tAventy-four hours, but if a continuous treat- ment is interrupted, its excretion continues for some time, and Kuss- maul 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 can be readily eliminated for many Aveeks from the kidneys Avhen the body is saturated is about ^ of a grain (0.004) daily. 260 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 germ- icide ; 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. As an Antisyphilitic.—In syphilis mercury is to be given, not because the patient shoAvs symptoms of this or that stage of the dis- ease, but because the conditions present call for its employment. Many Avriters have insisted that it ought only to be employed in the second- ary stages, and, while this is, as a general rule, correct, certain condi- tions may call for it at any time. (See Syphilis.) Of all the preparations of mercury used in the treatment of syphilis, the protoiodide is the most popular, and deservedly so. (See article on 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 up- Avard into the centre of the cup, thereby forming a raised centre Avith a little ditch about it. The top of this projection is flattened, and on its apex is placed the calomel Avhich is to be sublimed. The sur- rounding ditch is then filled Avith hot water, and the cup placed over an alcohol flame, which disengages the vapor of the calomel and Avater. 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 (0.3), and the mouth should be rinsed out to prevent mercurial stomatitis unless a local action on the buccal mucous membrane is desired. Not more than eight or ten inspira- tions should be taken at one sitting. If general fumigations are to be practised, the patient places the lamp and cup with 30 grains (2.0) of calomel on it under a chair, on which he sits Avrapped in a heavy blanket. We believe that the ultimate conclusion of the profession in regard to the hypodermic injection of mercurials in syphilis will certainly be identical with, that governing its use of quinine in malarial fever. There can be no doubt that a certain number of instances do arise in Avhich, by reason of severe infection, susceptibility of the patient, or inability to take mercury by the ordinary means, hypodermic injec- tions are absolutely necessary. In the same way that Ave give qui- nine by the mouth, the rectum, and hypodermically in pernicious malarial fever, so do Ave give mercury by the mouth, by inunctions, by sublimation, and by the hypodermic needle in malignant syphilis. The reasons for believing that hypodermic injections of mercurials are not to be resorted to as a routine treatment of syphilis are several. In the first place, all forms of hypodermic medication possess disad- MERCURY. 261 vantages not possessed by the use of drugs by the mouth. There is ahvays some danger of entering a vein, of producing an abscess, or of causing local pain. When mercurials are so employed, the danger of abscess, of pain, or of milder inflammatory manifestations is greatly increased, and the presence of an indurated spot where the hypodermic injection has been given proves that it is not the simplest form of medication in syphilis. Of the mercurial preparations which are best administered hypodermically in syphilis, the tAvo which sur- pass all others are undoubtedly the bichloride of mercury, in the dose of l grain, dissolved in 10 or 15 drops of distilled Avater, every second or third day, or gray oil (Oleum Cine ream), which Avas first introduced into medicine by Lang of Vienna. (See Gray Oil, under Mercury.) In all cases the injection should be given slowly and deeply into some portion of the body in Avhich the tissues are loose, as the buttock or the broad of the back, and the skin of the part where the injection is to be made should be carefully washed and sterilized by green soap and alcohol. The intravenous injection of bichloride of mercury has been proved so dangerous as to be properly considered unjustifiable. As A Purge.—The employment of mercury as a purge or laxative having a special action on the liver is constantly resorted to. The tAvo preparations used are blue mass and calomel, but the latter is more active. They both cause soft or watery stools, according to the dose in Avhich 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 Avhether mercury affects the liver, and Avhether the peculiar greenish or brownish-yellow stools produced by it are due to the presence of bile or mercury. If there is one point firmly fixed in the mind of the average practitioner of medicine, it is that the mild chloride of mercury increases the quantity of bile in the intestine. If such a believer is questioned as to Avhether this increased amount of biliary fluid is due to a true increase in secretion or simply to an increase in the floAv of bile from the gall-bladder, he Avill either state that he is unable to ansAver the question or that he believes that it is an increased secretion. Practically, the position of the profession in general in regard to the purgative influence of calomel is that the drug exercises a stim- ulating effect upon the biliary gland. Careful experimentation upon the loAver animals by several competent observers, and careful studies made by physiological chemists, fail, hoAvever, to give us very much light upon this subject. It is held by some that calomel never acts as calomel, but is converted by the hydrochloric acid of the gastric juice into corrosive sublimate, and that this drug then stimulates the liver to increased activity. On the other hand, the best chemical investigations shoAv positively that the feeble acidity of the gastric juice and the temperature to which the calomel is exposed are not favorable to the conversion of a sufficient quantity of calomel into corrosive sublimate to account for an}7 hepatic influence. Thus it Avas found by Rutherford and Vignal, 262 DRUGS. in their well-knoAvn series of studies upon the influence of drugs upon the secretion of bile, that if 5 grains of calomel are subjected, at 100° F., for seventeen hours to the action of normal gastric juice, not more than -^ of a grain of mercuric chloride is produced. As calomel does not remain in the human stomach for more than a night at the utmost, and generally but a very feAV hours, it is not likely that as much as -£% of a grain of mercuric chloride is produced from the moderately large dose of 5 grains. In contradiction of this, Bucheim, Winkler, and others assert that no conversion Avhatever takes place at the temperature of the body, and Jaennel's later studies support this view. The other theory as to the change Avhich takes place in calomel prior to its action upon the liver is that it escapes into the intestine, where it is decomposed and the gray oxide of mercury precipitated, which may, hoAvever, be held in solution by any fatty materials, Avhich, being mixed with alkaline liquids, practically form soaps. It is thought by Wood and others that this is the more probable result, particularly in view of the fact that calomel acts more like blue mass than cor- rosive sublimate. Further than this, these opinions are confirmed by the fact, Avith which all of us are familiar, that the hepatic influence of calomel is much more positively asserted if at the same time small doses of the bicarbonate of sodium are administered. Under these circumstances the bicarbonate of sodium naturally diminishes, to some extent at least, the acidity of the gastric contents, and also directly or indirectly tends to increase the alkalinity of the contents of the duodenum. As if to increase the complexity of the problem, the studies of Rutherford and Vignal seem to prove conclusively that in the dog, at least, mercuric chloride has a direct stimulant effect upon the hepatic cells; whereas, calomel, Avhile producing purgation by increas- ing the secretion of the intestinal glands, in no way increases the true secretion of bile; and this would seem to indicate that, after all, the influence of calomel upon the liver is due to a very minute portion of it being changed into corrosive sublimate. Probably the truth of the matter is, that we have as yet no definite scientific explanation of how calomel really does act. It may be that the solution of the problem lies in the hepatic influence exercised by the presence of minute quan- tities of corrosive sublimate, and the purgative effect produced by that portion of the calomel Avhich has not been converted into the strong chloride of mercury. This is rendered the more likely in vieAV of the fact that the corrosive sublimate has been found a feeble intestinal stimulant, while the calomel has been found to produce active purga- tion in dogs, Avithout producing an increase in biliary flow, when the drug has been introduced into the duodenum. It has been suggested, too, that calomel itself may stimulate the bile-expelling mechanism, Avhile the minute portion of corrosive sub- limate increases the secretion of the liquid; and, again, that by means of the purgative effect that it produces certain substances which have been in the intestine are immediately removed, and, as a consequence, a depressant influence upon the hepatic cells no longer exists. MERCURY. 263 While, at first sight, the argument seems a forcible one that a vast clinical experience in regard to calomel is far superior to any series of experiments on dogs, it is only just to remember that in the entire series of remedies supposed to produce an hepatic effect calomel is the only one Avhich failed to influence the liver of the dog as the others influenced the liver of man. Quite a number of physicians have studied the effect of the various so-called cholagogue drugs upon the flow of bile in human beings who have had biliary fistula. The most recent and perhaps the best study is that of Pfaff and Balch upon a woman Avith a biliary fistula. Calomel and the bichloride of mercury seemed invariably in her case to decrease rather than increase the biliary flow. Ox-gall was the only drug Avhich did increase it. This subject also is of interest to the practical physician in rela- tion to the administration of calomel in compressed tablets or other preparations Avhen mixed with Avhat might be called excipients. Under these circumstances, if one of the excipients is bicarbonate of sodium, the tablet almost ahvays undergoes a change and becomes of a gray color. Those Avho have used pills or tablets of calomel which have been kept for a long period of time seem to be universally in accord Avith the statement that they have lost the hepatic effect Avhich a recently-prepared powder always possesses. Thus it has been fre- quently found that no biliary Aoav occurs under the use of stale tab- lets, whereas free bilious purging follows the administration of freshly- prepared poAvders. 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 ahvays be given in the treatment of malarial disease before quinine is used if a thorough action of the antiperiodic is required. As a Disinfectant.—The disinfectant and germicidal power of bichloride of mercury and of the biniodide is very well established by clinical experience and experimental investigation. The strength of the bichloride in solution 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 unit- ing Avith the albumin of the tissues to form an insoluble and useless albuminate. The same is true of the use of mercury biniodide. As an Antiphlogistic.—The antiphlogistic or anti-inflammatory action of mercury is very marked indeed, but its employment is abso- lutely limited under these circumstances to one variety of inflamma- tion—namely, the sthenic or dynamic form. In inflammation arising during the course of some exhausting disease mercury is not only con- traindicated, but harmful. Thus, if a man in health is stricken with pleurisy or peritonitis or meningitis or any acute inflammation of a 264 DRUGS. serous membrane, be the cause Avhat 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 increas- ing the exudation. When mercury is given as an antiphlogistic, opium is often combined with it to relieve the pain and irritation and to prevent purging. In meningitis arising from head injuries this is a routine treatment, and may be carried out by the use of powders containing \ grain (0.015) of calomel and \ grain (0.015) of powdered opium every hour till 1 or IJ grains (0.05-0.07) 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, and should be given in full dose. The bichloride may be used in small doses in place of the calomel, and does not, of course, produce the same tend- ency to laxity of the boAvels. On the other hand, it often seems to be less efficacious. Mercury in myocarditis and pericarditis is also of service, and cer- tainly exerts distinct prophylactic power in the early stages of diphtheria and membranous croup. (See Diphtheria.) One of the best ways to employ any of the various forms of mer- cury is in the form of triturates, Avhich may be prepared by triturating 10 parts of the drug with 90 parts of milk-sugar. The minute sub- division of the medicament aids in its efficiency, because of its more ready absorption. Leaving the general subject of mercury, we may now consider each individual preparation. Ammoniated Mercury. White Precipitate, or Ammoniated Mercury of the strength of 10 per cent. Avith lard (Hydrargyrum Ammoniatum, U. S. and B. P.), is used in an ointment (Unguentum Hydrargyri Ammoniati, U. 8. and B. P.) in various skin affections, when a stimulating application is needed, as, for example, in psoriasis and clironic dry eczema. It is also sometimes employed as a parasiticide in cases of tinea. The official ointment should generally be diluted with lard, as it is far too strong and will often induce a dermatitis if used undiluted. In ozena, Avhether syphilitic or not, Trousseau has recommended the employment of the following powder as a snuff: R.—Hydrargyri ammoniati........gr. iv (0.2). Pulv. sacchar. alb..........~ss (16.0).—M. S.—To be used as a snuff, after thoroughly blowing the nose. The red precipitate may be used instead of the Avhite. The treat- ment removes the stench and may cure the complaint. It may, hoAv- MERCURY. 265 ever, irritate the mucous membrane, in which case it should be used in the strength of 2 grains to the J ounce (0.1 : 16.0). It is never used internally. Bichloride of Mercury. The Bichloride of Mercury, or Corrosive Sublimate (Hydrargyrum Chloridum Corrosivum, U. S. ; Hydrargyri Perchloridum, B. P.), as it is called, is an exceedingly poisonous and irritating substance when taken internally in concentrated form. Taken internally, it causes violent pain in the stomach, vomiting, purging of mucus, blood, and the contents of the intestine, collapse, syncope, and death. If taken in poisonous amount, the patient should be made to swalloAv large quantities 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 stric- tures, 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 1 grain (0.012) 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 Avell disinfected. The best place for the injection is in the gluteal region or betAveen 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, as in chronic Bright's disease. In diphtheria it may be used to prevent fibrinous exudation as readily as calomel (see Diphtheria), and in ton- sillitis, where the inflammation is severe, it is often used Avith great service. In small amounts—that is, in gl(7 to ^ of a grain (0.0015-0.0017) three times a day—the bichloride is one of the best remedies Avhich Ave possess for the treatment of anemia depending upon a deficient num- ber of blood-cells. If the anaemia is syphilitic in origin, it is, of course, peculiarly useful. Bichloride of mercury is of value in minute doses of ^^ to -^ of a grain (0.0003) for 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 (0.03) in 5 ounces (160.0) of Avater, and a tea- spoonful given every hour until relief is obtained. The Avater used in making the solution should be distilled, and it may be Avell to add to it a little tartaric acid to prevent precipitation of the bichloride by organic matter AArhich may have gotten into the water. This treat- ment is particularly useful in mucous diarrhea in Avhich blood and mucus are thoroughly mixed. Patients in the dispensaries often speak of these passages as containing " corruption," and others think they 266 DRUGS. consist of "lumps of flesh," OAving 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 2 teaspoonfuls of the solution instead of 1. 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 Avhen, it being found that the abdomen was exposed to the air, the mother Avas forced to apply and keep on the child a flannel binder. In some cases in which an obstinate syphiloderm is present J an ounce (16.0) of corrosive sublimate and 1 ounce (32.0) of chloride of ammonium may be added to a warm bath, Avhich should be taken every feAV days. J a grain (0.03) of the bichloride of mercury in 6 ounces (192.0) of Avater 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 (0.1) of bichloride to the ounce (32.0) 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 -1- grain (0.03) of the perchloride of mercury to 1 ounce (32.0) of water, with ^ grain (0.03) of ammonium chloride to hold it in solu- tion. (For the antiseptic uses of the bichloride of mercury see Antiseptics and Disinfectants.) Biniodide of Mercury. Mercury Biniodide (Hydrargyri Iodidum Rubrum, U. S. and B.P.) is a bright-red poAvder, 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 -^ to y1^ of a grain (0.003- 0.006). (See Syphilis.) An ointment (UnguentumHydrargyri lodidi 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 (4.0 : i litre) of lime-water. It is used as a stimulant application for Avashing 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 MERCURY. 267 contains ^ grain (0.02) of mercury, and it may be given in the dose of from | to 20 grains (0.03-1.3) for the same laxative purposes for Avhich we use calomel. Blue mass is rarely used to produce systemic effects. Calomel. Calomel (HydrargyriChloridum Mite,U. 8.; Hydrargyri Subchlo- ridum, B. P.), or the Mild Chloride of Mercury, is an insoluble salt which is, nevertheless, freely absorbed. Calomel when used as a laxative purge should be given in the dose of ^ to h grain (0.01-0.03) every half-hour or every fifteen minutes until 1 or 2 grains (0.05-0.1) are taken, as it will act as efficiently in this Avay as if 10 grains (0.65) are given at one dose, and there is no dan- ger of producing ptyalism. The reason that small doses are as efficient as large ones lies in the fact that only the calomel Avhich 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 intes- tinal juice in the reduction of the salt. If purgation does not occur after a dose of calomel, a saline purge may be given at the end of tAventy-four hours, and this must always be used if large doses of the mercurial are employed, to avoid possible mercurialization. Mercury in the form of calomel is very largely used hypodermic- ally, 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 Avater with the calomel, in the proportion of 5 parts each to 50 parts of Avater. It should 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 gan- grene, has folloAved its employment in this Avay. (See also Salicylate of Mercury and Bichloride 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 favor- able change in the number and character of the stools appears. Cal- omel is not to be used if great asthenia complicates the disease. In children Avho seem constantly " under the weather " and never quite Avell, who have flatulence, fetid breath, and ill-smelling, pasty stools, calomel often gives great relief in the dose of ^ of a grain (0.003) 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 conges- tion £ of a grain (0.01) of calomel every half-hour until 1 grain (0.<)6) is taken will often bring relief. Calomel is generally prescribed in conjunction with sugar of milk, Avhite sugar, or bicarbonate of sodium, Avhich are added to increase the bulk and Avieldiness of the powder, and, in the case of the latter ingredient, to increase its activity. Owing to its lack of taste, calomel 268 DRUGS. is often placed on the tongue in children, but for this class of patients white sugar is to be used in small quantity, as the other vehicles are less agreeable. The most agreeable form of administration is by means of triturates. It is important to remember that calomel, Avhen used as an anti- syphilitic, produces salivation very much earlier than the other mer- curials. Sometimes calomel is of value when dusted into the eye in cases of phlyctenular conjunctivitis which are strumous. This practice must not be resorted to if iodine or iodides are being taken inter- nally, as the iodine is eliminated by the tears and forms a compound which burns the conjunctiva. A very important use of calomel, and one which has been brought forward very recently as neAv, but Avhich 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 (0.05) thrice a day, and if a diuretic influence does not assert itself in forty-eight hours it should not be continued. Hoav calomel acts to produce the increased urinary flow under these circumstances Ave do not know. Some suppose that it aids the absorp- tion of liquid from dropsical tissues, and so increases urinary secre- tion ; others think that it stimulates the renal epithelium to greater activity. The latter seems the least probable of the two, but neither theory has been proved correct, although experimentation supports the vieAv first named. The full urinary effect of the drug is not felt till the second or third day of its use, and speedily passes away, par- ticularly as purging is often induced very early. Still another use of calomel is in typhoid fever, in which disease it has been highly recommended in small repeated doses, particularly if constipation is present. In the opinion of the author this is disadvantageous as a routine measure and entirely uncalled for, although in the very early stages of the disease, Avhen the bowels are confined and the tongue coated, a dose of 1 grain (0.05) in fourths with a little bicarbonate of sodium is useful. Sydney Ringer has called attention to the fact that in constipa- tion or in "biliousness" podophyllin does more good than calomel, provided 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 efficient. The author has proved the correctness of this assertion so frequently that he is convinced of its truth. Calomel has been recommended in the condition of anorexia and depression following acute diseases, and when the tongue is covered by a thick yelloAV coat it is the remedy for the gastro-intestinal tor- por ahvays 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 Avhich will MERCURY. 269 occur. Ringer asserts that in a peculiar form of vomiting occurring in very young children, which comes on immediately after the food is SAvallowed, the rejection of milk being forcible, and perhaps so sudden that it is not even curdled, and Avhich is not accompanied by much straining, calomel will often give relief Avhen 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 TV of a grain (0.005) every hour, or, if preferred, gray poAvder in the dose of ^ of a grain (0.02) every hour for three doses is equally efficient in these cases. Calomel in a fine poAvder will often remove syphilitic condylomata if dusted over them for some time, and an ointment made of 1 drachm (4.0) of calomel to 1 ounce (32.0) 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 fol- loAving prescription may be given for its use: R.—Hydrarg. chlor. mit..........gr. xl (2.65). Magnesine carbonatis.........gr. xl (2.65). Unguent, aquae rosse.........§j (30.0).—M. Gray Oil. Gray Oil is prepared as follows: 2 drachms (8.0) of lanolin is rubbed up Avith enough chloroform to emulsify it. The rubbing process is continued until most of the chloroform is evaporated, and Avhile the mixture is still in a fluid state metallic mercury, in double the amount of lanolin, 4 drachms (16.0) is added and the tritu- ration continued. By this means an ointment of mercury is left which equals 2 parts of mercury and 1 of lanolin. This is some- times called Strong Gray Ointment. For hypodermic injection 3 parts of this gray ointment are added to 1 part of olive oil, or it may be still further diluted by adding olive oil in the proportion of half- and-half. Of this mixture 1 to 2 minims (0.05-0.1) may be injected every second or third day. With some practitioners this preparation is considered much better than any other for hypodermic use in syphilis. Mercury with Chalk. Mercury Avith Chalk [Hydrargyrum cum Greta, U. S. and B. P.), or Gray PoAvder, 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 (0.06-0.65). Chil- dren suffering from syphilitic marasmus seem fairly to fatten on it. This preparation is also of service in the syphilis of adults, and may be employed Avhenever the laxative effect of mercury is not desired. In the treatment of infantile diarrlieu with Avatery, colorless stools 270 DRUGS. containing undigested food gray powder in small doses is often very useful. Mercury Ointment. The Ointment of Mercury, Mercurial Ointment (Unguentum Hydrargyri, U. S. and B. P.), sometimes called Blue Ointment, is made by rubbing up mercury with suet and lard until the mercury is extinguished, or, in other Avords, until the globules of mercury cannot be seen with a magnifying power of ten diameters. The ointment of mercury is used externally in certain skin affec- tions and for the purpose of influencing the general system in cases where the drug cannot Avell be taken by the mouth. In syphilis a\ here 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, and 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 Avhere it is readily absorbed, and very rapidly influences the system of the patient. In 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 frequently, as their saturation with the drug aids in producing the impression 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 mercu- rialization. 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 ointment 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 Avhere 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 Avill 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, MERCURY. 271 U. S. and B. P., are used for the same purposes as is the ointment of mercury. The plaster is made Avith 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, penetrating 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 Avith advantage in lupus until the surface of the growth is level Avith the skin. The surrounding parts should be protected by lard or oil. As this treatment is very painful, the spot may be first cocainized and aftenvard covered Avith flexible collodion. Citrine Ointment (Unguentum Hydrargyri Nitratis, U. S. and B. P.) is used as a stimulating application in cases of chronic skin diseases of the scalp and trunk. It is too strong for ordinary use, and should be diluted one-half or less Avith lard according to the stim- ulating effect required; the dilute ointment is official in the B. P. as Unguentum Hydrargyri Nitratis Dilution. Oxides of Mercury. The Yellow and Red Oxide of Mercury (Hydrargyri Oxidum Flavum, U. S. and B. P. and Hydrargyri Oxidum Rubrum), U. S. and B. P..), Red Precipitate, are used largely as a dressing for syph- ilitic sores Avhen diluted about one-half with chalk or other poAvder. If used pure, they are someAvhat caustic. From the yelloAV oxide is made the Oleate of Mercury (Oleatum Hydrargyri, U. S. and B. P.), Avhich 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 -^ to ^ of a grain (0.001-0.0012) in a triturate. Red Precipitate Ointment (Unguentum Hydrargyri Oxidi Rubri, U. 8. and B. P.) and the Ointment of the YcIIoav Oxide (Unguentum Hydrargyri Oxidi Flavi, U. 8.) are largely used, diluted one-half with lard, for chronic scaly skin affections, in obstinate conjunctivitis, and in granular lids and styes. (See Styes.) They should ahvays be freshly prepared. Protiodide of Mercury. Mercury Protiodide (Hydrargyri lodidum Flavum, U. S.) is much more mild than the biniodide, and is given for exactly the same purposes. It is very useful in chronic Bright's disease. It is to be remembered as the best mercurial preparation for ordinary cases of syphilis. The dose is jr to \ of a grain (0.01-0.016) three times a day. 272 DRUGS. Yellow Sulphate of Mercury. Hydrargyri Subsulphas Flavus, 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 Avould recommend great care in its use. The dose for a tAvo-year-old child is 2 to 5 grains (0.1-0.35), repeated in fifteen minutes if necessary. If as much as 5 grains (0.35) has been given, and emesis does not follow, other emetics or the stomach-pump must be used to pre- vent gastro-intestinal irritation. Yellow Wash. YelloAV Wash (Lotio Hydrargyri Flora, B. P.) is made by adding 30 grains (2.0) of corrosive sublimate to a pint (^ litre) of lime-Avater. It is used for the same purposes as the black Avash already mentioned, but is much more stimulating in its influence. Incompatibles.—Bichloride of mercury should never be given with any other substance except iodide of potassium and chloride of ammo- nium, 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 redissolved and the resulting mixture is highly alterative. Calomel should never be given with iodides or bromides, and hydro- chloric acid may convert it into the bichloride if the acid is present in any amount. It is also incompatible with antipyrin. METHYL BLUB. Methyl Blue or Methyl Violet is an aniline dye often sold under the name of Pyoktanin. When used medicinally, it must be perfectly pure and deprived of its usual contaminating matter, arsenic, Avhich if present causes local irritation of the part to which it is applied. Pyok- tanin was introduced to professional notice under this name by Still- ing as an antiseptic, but careful study has proved it to be of very feeble poAver over the groAvth of germs. In all conditions of the eye in Avhich antiseptic lotions are indicated pyoktanin has been stated to be of value, but elseAvhere in surgery it is practically useless as an antiseptic. 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, con- junctivitis, both simple and phlyctenular, and in the treatment of corneal ulcer. When so employed it should be applied in the strength of 1 to 1000 of water. It should be remembered that any pure aniline dye may be used in place of pyoktanin. Thus some physicians have used yellow pyok- tanin or auramine. Methyl blue and similar aniline substances are largely employed by some persons in the treatment of malignant neoplasms. The solution METHYL CHLORIDE—METHYLENE BLUE. 273 (1 to 500 of water) should be filtered through hot asbestos to render it sterile, and every antiseptic precaution carefully adhered to in giving the injection. The dose is J to 3 drachms (2.0-12.0) of this solution every other day or every third day, and the injection is to be given either into the groAvth itself if it is large, or just at the side, in the healthy tissues, if it is small. Too much should not be injected into one spot, lest it cause a slough. This treatment does not cure the disease. It relieves pain and so quiets the patient, and in rare cases stops the groAvth of the tumor. If the groAvth sloughs, complete anti- septic dressing is necessary. An antiseptic pyoktanin-gauze dressing should ahvays be used while the treatment is going on. 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 as it strikes the skin. It is usually kept in a small flask which has its end fused into a fine point. This is broken off, and the heat of the hand volatilizes the druo-, which is then forced out of the flask in a fine spray. The nozzle should be held ten to tAvelve inches from the part to be frozen. The skin of the part to be anaesthetized should be Avashed with soap and ether to remove all fatty substances before the spray is used. Under these circumstances the skin becomes pale in a few seconds, and afterward perfectly Avhite and 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 two to four minutes, as local death of the tissues may result. A great advantage of the spray of methyl over that of ether is its slight inflammability and rapidity of action. Methyl chloride is to be distinctly separated from methyl- ene chloride. The first is monochlormethane, the second dichlorme- thane. METHYLENE BLUE. Methylene Blue is to be distinctly separated in the mind of the student from methyl blue, which is practically what is known by the trade name "Pyoktanin." Methylene blue has been employed in the treatment of malignant groivths and in malarial fevers Avith asserted success, although its suc- cessful use in the first group of cases is decidedly problematical. When used in the treatment of sarcoma and cancer, from 1 to 2 grains (0.03- 0.12) in Avatery solution are injected directly into the growth. The neoplasm, it is said, ceases to grow, shrinks, and comes away, leaving a fairly healthy sloughing surface. This treatment is so uncertain that it should only be tried in inoperable cases. In malarial fever of the intermittent type methylene blue seems to possess very distinct curative powers if avc can rely on the studies 18 274 DRUGS. of Thayer, Kasembeck, Mya. and others. It is not so poAverful as quinine by any means, but has its chief sphere of usefulness in patients avIio cannot take quinine or Avhere quinine has been tried unsuccess- fully. This antimalarial influence is due to its destruction of the Plasmodium, malorice, but its administration must be continued after the attacks have ceased and for some little time after the physician fails to find the micro-organism in the blood, as relapses are common. Particularly good results seem to folloAv the use of methylene blue in children suffering from malaria. UntOAvard symptoms from its use are not common, but Avhen they do occur consist in slight vertigo, nausea, and some strangury. The urine is always blue from the elimination of the drug through the kidneys. Recently Levy has employed methylene blue in the dose of from 1 to 2 grains (0.05—0.1) four times a day in the treatment of migraine. It is to be given in capsule with kola. He states that as much as 15 grains (1.0) may be given in a day with safety. The dose is 2 to 4 grains (0.1-0.2) every four hours to adults, or 1 to 2 grains (0.05-0.1) to children of five years, preferably given in capsule. 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, Avhich process may be hindered by the addition of a little absolute alcohol. 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 anaesthesia. 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 methylene chloride has been widely em- ployed. This preparation is, of course, to be distinguished from true methylene chloride. The amount of this mixture used to produce anaesthesia is 1 to 2 drachms (4.0-8.0) for minor and 3 to 6 drachms (12.0-24.0) for major operations. The term "methylene chloride" has also been applied to a mixture of chloroform and methyl chloride. MEZEREUM. Mezereum, U. 8. (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 external!}7 as a counter-irritant in the form of the ointment M USK—M USTA RD. 275 (Unguentum Mezerei). It enters into the compound syrup, fluid extract, and decoction of sarsaparilla. The official preparations of mezereum are the fluid extract (Extractum Mezerei Fluidum, U. 8.) and the ethereal extract (Extraction Mezerei JEthereum, B. P.), both of Avhich are used as external irritants. MUSK. Musk (Moschus, U. S. and B. P.) is obtained from the preputial follicles of the Moschus moschiferus or musk deer of Thibet, and is a substance possessing the most remarkable penetrating poAvers, so far as odor is concerned. Very little of the musk for sale in the shops is pure, and most of it is not musk at all. Its price varies very greatly, but if sold for less than tAventy-five cents a grain it is probably worth- less or impure. Therapeutics.—For some unknown reason musk acts as a diffusible stimulant and supports the system. It'is also an antispasmodic and nervous sedative. In all low fevers Avhere the strength of the patient is fast ebbing aAvay and the nervous symptoms are those of the most advanced depression, rectal injections of musk in starch-Avater should be employed. The dose should be 5 to 10 grains (0.35-0.65). This drug is of value where either 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 poAver and the expense is a needless one. 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 (2.0-4.0), and of musk itself 5 to 10 grains (0.35-0.65). MUSTARD. Mustard is official in the form of Sinapis alba, U. S., and Sin- apis Albe Semina, B. P., or white mustard, derived from the seeds of Brassica alba, and Sinapis nigra, U. S., and Sinapis Nigra Semina, B. P., or black mustard, derived from the seeds of Brassica nigra. Both of these contain an irritant oil (Oleum Sinapis Volatile, U. 8. ; 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 Avater in the proportion of 2 table- spoonsful to a glass of Avater. 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 in excess. Its internal use is contraindicated during the existence of acute gastritis and all states of gastro-intestinal irritation. When used as a counter-irritant mustard is applied to relieve the pain of colic due to flatulence and acute inflammation of the thoracic and abdominal viscera, that due to muscular rheumatism, vifiamcd joints, and neuralgia, and it may be applied at the nape of the neck 276 DRUGS. 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 feAV minutes, and it should be mixed with Avheat flour in the proportion of half-and-half Avhen used upon persons having tender skins. Children generally will not stand more than one-fourth mus- tard. The plaster should be made with warm Avater 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 applying 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 sometimes given in the treatment of the atonic stomach of drunkards in the dose of \ to h a drop (0.016-0.03). Chart a Sinapis, U. 8. 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 one or tAvo layers of thin and moistened linen should be placed betAveen the skin and the sinapism to prevent too great an action. (See Counter-irritation.) The compound liniment (Linimentum Sinapis Gompositum, U. S. 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 Com- miphora Myrrha, a tree of Arabia. It occurs in dark-colored tears, and contains an active principle, myrrhin. Therapeutics.—Myrrh, in medicinal amount, is a stimulant to the circulation and to the uterine and the bronchial mucous membranes. In amenorrhea due to functional inactivity or anemia, " 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 Avith a small brush or by the end of the finger to spongy or tender gums. In leucorrhea depending upon uterine trouble and in clironic cystitis myrrh is often of service. Sometimes it enters into expec- torant mixtures given in the later stages of bronchitis. The dose of the tincture (Tinctura Myrrioc, TJ, 8. and B. P.) is 10 to 30 drops (0.65-2.0). It also enters into the composition of Pilule Aloes et Myrrhe, U. S. and B. P., dose two to five pills, and Tinctura Aloes et Mqrrlie, U. 8. and B. P., the dose of Avhich is 1 to 2 fluidrachms (4.0-8.0). NAPHTHALIN, or NAPHTALENE. Naphthalinum, U. 8., is a coal-tar derivative occurring in color- less mica-like crystals, possessing a peculiar smell, and soluble in NAPHTOL—NITRATE OF POTASSIUM. 277 alcohol to some slight extent. Helbing states that naphthalin Avhen pure is colorless and without action on moist litmus-paper. It should also dissolve in concentrated sulphuric acid Avithout color Avhen gently warmed. After it is taken for some time, or even after the first dose, the patient will state that Avhen 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 asso- ciated Avith 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 h grain (0.01-0.015) every tAvo or four hours, but adults may take as much as 5 to 10 grains (0.35-0.65). More than this will dis- order the stomach. The drug should be given in poAvder, with sugar, or in capsule. It has not been as Avidely employed as Avas expected when it first came before the profession, and certainly often fails to do good. In cats and rabbits naphthalin. Avhen administered continuously for a considerable period of time, produces cataract. NAPHTOL. Naphtol (U. S.), often called Beta-naphtol, has been introduced in the U. S. P. of 1890. It is used for precisely the same purposes as naphthalin internally, and is generally artificially prepared from naphtalin. It is also used in antiseptic dressings. The dose is 2 to 5 grains (0.15-0.3). NITRATE OF POTASSIUM. Nitre (Potassii Nitras, U. 8. 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 Avhen taken in overdose symptoms of violent gastro-enteritis. While it does not affect the blood, it is more irritant than the chlorate. 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 rheuma- tism, the dose should be 1 ounce (32.0) in a pint (| litre) of barley- Avater or syrup of acacia and Avater, to be taken in divided doses of a tablespoonful every three hours. Nitrate-of-potassium papers (Charta J'otassii Nitratis, U. 8.) 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 Avater. They are rolled into cigarettes and smoked by asthmatics, or burned in a pan and the fumes arising from them 278 DRUGS. inhaled. Their efficacy may be increased in cases Avhere the respira- tory mucous membrane is irritable by dipping them in compound tinc- ture of benzoin and exposing to the air long enough to dry. They should then be protected from the air until used. The paper should be moderately thin bibulous paper. NITRATE OP SILVER. Nitrate of Silver (Argenti Nitras, U. 8. and B. P.) is a heavy crystalline salt of silver readily soluble in its oavo Aveight of water. " It is official as the pure nitrate (Argenti Nitras, TJ. 8. and B. P.) and as the sticks or fused rolls (Argenti Nitras Fusus, U. 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, nitrate of silver causes a broAvn and finally a black stain, which is clue to the formation of an oxide of silver. Physiological Action.—Nitrate of silver is one of the feAV astrin- gent substances which are applicable to inflamed mucous membranes, as it is, Avith lead, bismuth, and zinc, one of the few drugs of this class Avhich is not irritant as well as astringent. Locally applied, it acts in pure form as a powerful caustic, which is, however, very superficial in its effects, as the drug coagulates the albumin Avith Avhich 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 em- ployment in 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 in the belly, Avith vomiting and purging, comes on. At the same time evidences of widespread gas- tro-enteritis develop. The abdominal Avails are knotted and hard, and perhaps scaphoid. The face is anxious and livid and covered Avith a sAveat. When the vomiting occurs the ejecta are seen to be brown or blackish, or even Avhite and curdy. The lips are stained Avhite, but they rapidly become broAvn, then black. In some cases the nervous symptoms are severe and convulsions Avith delirium may occur. The convulsions are epileptiform. Death ensues either from gastro- enteritis or from centric respiratory failure, accompanied by a profuse exudation of liquid mucus into the bronchial tubes. 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 and protecting the mucous membranes of the oesophagus and stomach from the action of the irri- tant. 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. NITRATE OF SILVER. 279 Argyria, as chronic silver poisoning is called, is caused by the continued 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 tlie discoloration may be slightly modified in some cases 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 Ave possess if combined with extract of hyoscyamus or opium and given in pill form. In chronic gastric catarrh and gastritis nitrate of silver is very useful when the patient is troubled wuth sour eructations or Avhen vomiting occurs after meals. When used in these states it should be given h -jU to \-grain (0.01- 0.16) doses, half to one hour before each meal, in order that the stomach may be exposed 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 stom- ach Avithout being chemically changed. In ulceration of the cecum and rectum and in acute and chronic dysentery the disease may be at- tacked by rectal or colonic injections of nitrate of silver. If the caecum is involved, the solution must be given in large quantity in order to reach the part affected, but if the rectum is diseased, the amount of liquid injected should not exceed 4 ounces, the boAvel in either case being Avashed out beforehand by warm Avater to rid it of faeces. Soap and Avater and salt and Avater must not be used for this purpose, as the soap or salt Avhich remains in the boAvel Avill prevent the silver salt from acting. The strength of the solution employed should be 1 drachm to 3 pints (4.0 : 1500 cc.) of water in caecal trouble, and 3 grains (0.18) to each 4 ounces (128.0) in rectal trouble. If the latter con- dition is very obstinate and chronic, the strength may be raised to 5 grains (0.3) to each 4 ounces (128.0). Whenever nitrate-of-silver injections are used in this way, a solu- tion of salt and Avater 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 Avith sufficient thoroughness. Nitrate of silver is the only remedy of any value in idiopathic anterior and posterior spinal sclerosis, but often fails. Nitrate of silver has been largely used in epilepsy and chorea, but is noAv seldom so employed, and does little good in most cases. Dr. William Pepper speaks highly of the continual administration of nitrate of silver in pill form in the dose of ^ to \ grain (0.01- 0.015) 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 Avill often prevent the pitting of small-pox if on the fourth or fifth day the vesicles are punctured by a needle dipped in a solution of nitrate 280 DRUGS. of silver in the strength of 20 grains (1.3) to the ounce (32.0) of water. Others simply paint the skin over the eruption with a solution of 5 to 10 grains (0.35-0.65) to the ounce, claiming that this method is equally effective and prevents inflammation and sup- puration. 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. Painted in strong solution over the scrotum in the early stages of orchitis or ejndidymitis, it will often relieve the pain and SAvelling, 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 solutions of silver nitrate are to be used in varying strength. Some- times after slight exposure to cold or dampness the posterior Avail of the pharynx suddenly becomes sore and niAv, feeling as if the mucous membrane had been scarified. A solution of nitrate of silver Avill relieve this, and if it is employed in the strength of 60 grains (4.0) to the ounce (32.0) of Avater, the application -will be more efficacious and less painful than if Aveaker solutions' are employed. In laryngeal phthisis a spray used from an atomizer in the strength of \ to 2 grains (0.03-0.1) to the ounce (32.0) of A\Tater 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 and frequency and of obtaining a good night's rest. The appli- cations should be made Avhen the stomach is empty, as they are apt to bring on retching. The end of the atomizer must be Avithin the mouth or the skin of the face Avill be stained. In the later subacute stages of gonorrhea an injection of nitrate of silver of the strength of gr. \ (0.025) to 3 ounces (90.0) is very useful. In uterine ulceration and in leucorrhea Avhen the cervix is boggy and tender, the application of the solid nitrate-of-silver stick is of service. Its use is often followed by headache about the vertex, and this in turn is to be relieved by 10-grain (0.65) doses of the bromides. In pruritus pud end i vel ani and vulva' a solution of 4 to 6 grains (0.25-0.40) to the ounce (32.0) should be painted Avith 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 solu- tion of nitrate of silver of the strength of 20 grains (L3) to the ounce (32.0) is applied Avith a brush to the part. This measure fails in paralytics. Boils which begin in a small limited papule wdth 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 nitrate of silver in stick form or in solution is largely and success- fully employed. (See Conjunctivitis.) NITRIC ACID. 281 When it is desired to remove nitrate-of-silver stains, they should be Avashed Avith a solution made of cyanide of potassium 2| drachms (10.0), iodine 15 grains (1.0), and water 3 ounces (96.0); or dissolve 15 grains (1.0) corrosive sublimate in 7 ounces (200.0) of boiled water, add about 45 grains (3.0) of cooking salt (a scant teaspoonful) just before using, lay the stained materials in it for about five minutes, and then Avash them tAvo or three times. Administration.—The dose of nitrate of silver is ^ to \ of a grain (0.01-0.015) 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 wdien given continuously should be discontinued for tAvo Aveeks at the end of the eighth week, as it is so slowly eliminated as to accumulate in the body and cause argyria, but LeAvin and Soullier as- sert that the smallest aggregate amount on record which has produced argyria is 1 ounce. NITRIC ACID. Nitric Acid (Acidum Nitricum, U. 8. and B. P.), the strongest and most corrosive of the mineral acids used in medicine, is a clear liquid, becoming slightly yelloAV Avith age. It should be kept in dark, glass-stoppered bottles. Physiological Action.—Nitric acid acts, when in pure form, upon the tissues of the body as a poAverful caustic. Applied to the mucous membranes, well diluted, it acts as an irritant or astringent, and Avhen taken internally it exerts a stimulating influence over the secretory glands of the stomach and small intestines. It does not tend to relax the boAvels, as does nitro-hydrochloric acid. Continued for a long period of time in small doses, it is said to cause some salivation and looseness of the teeth. Nitric acid coagulates albumin. Poisoning.—When nitric acid is taken in concentrated form it pro- duces a Avidespread gastro-enteritis, great pain in the mouth, oesoph- agus, 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 boAvels, such as stric- ture 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 boAvels and the urine may be bloody. The antidotes are any alkali of a mild type, as magnesium, chalk, or AvhiteAvash from the Avails 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 tissues, 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 neutralize its effects as soon as it has acted deeply enough. Nitric 282 DRUGS. acid is also used externally in a dilute form, 5 to 30 drops (0.35-0.65) to the ounce, as a stimulant and astringent to indolent ulcers. Internally, nitric acid is used as a tonic and astringent. In the oxcdic-acid diathesis when oxaluria is present, nitric acid will give relief Avhen 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 (0.25) 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 feAV drops of nitric acid xv ill often give relief. In intestinal dyspepsia coming on some hours after meals, and in Avhich not only discomfort but pain may be felt in the hypochon- drium, nitric acid Avith some simple bitter tonic is most efficient, and it Avill often cure the green diarrhea of children, particularly in the summer, bringing about these changes not only by its astringent poAver, but also by its stimulating effect on the intestinal glands. Combined Avith some good pepsin, it will give relief in the chronic diarrhea of children associated with lientery, and in Avhich the stools may be pasty or Avatery and at the same time ill-smelling. Ringer recommends the employment of nitric acid in the treat- ment of piles. The strong acid should be used, and simply touched to one or two points, not SAvept over the Avhole surface. The pain is very slight, or none at all may be felt. xV 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 (2.0-4.0) to a pint (500 cc.) of Avater is of sendee in bleeding hemorrhoids, arresting the bleeding, con- stringing 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 (0.25-1.0), well diluted, and taken through a tube to protect the teeth. NITRITE OP 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 (0.25-0.3), although much larger doses have been employed. These larger doses are, how- ever, not devoid of danger. Nitrite of potassium is eliminated by the lungs and by the kidneys as a nitrate. (See Nitro-glycerin.) 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, NITR O-GL YCER1N. 283 it is less rapidly broken up in 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 iden- tical with that of the rest of the nitrite group. The dose of cobalto- nitrite of potassium is 1 grain (0.03) every three hours. NITRO-GLYCERIN. Nitro-glycerin is a compound Avhich, in its pure state, is used largely as an explosive, but it is employed in medicine in a dilute form as a useful drug in those instances Avhere a someAvhat rapid and powerful effect is to be exercised over the vascular system. Its physiological action is identical Avith that of the other nitrites, such as the amyl ■nitrite (Avhich see), 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 (0.06-0.12) of a 1 per cent, solution in a little Avater 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 60 drops may be administered. Often good results are only obtained by giving ascending doses. It is noteAvorthy that patients rapidly become immune to the drug, and Reading has recorded a case in Avhich, after a year of treatment, 1 drachm (4.0) of 10 per cent, solution Avas taken daily Avith good effect. D. D. SteAvart has also reported similar cases. The drug is largely em- ployed in angina pectoris, and sometimes in epilepsy and chorea and in gastralgia. DaCosta and others have highly recommended this drug in the treatment of chronic parenchymatous nephritis, as it very distinctly decreases the escape of albumin from the kidneys. In interstitial nephritis, Avith cardiac disturbance resulting from the renal changes, in Avhich there is a marked increase in arterial pres- sure, so that auscultation 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 and relieving the heart of strain. When attacks of angina pectoris seem to be accompanied 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. Humphreys asserts that nitro-glycerin is a most valuable drug in vomiting of all kinds, except that of pregnancy and peritonitis. The solution used in medicine is too Aveak to be explo- sive. Tablets of nitro-glycerin (Tabelle Nitro-glycerini, B. P.) each contain y^- of a grain (0.0006). Nitro-glycerin is sometimes called trinitrine or glonoin. The U. S. P. of 1890 has introduced a Spiritus Glonoini, Avhich is an alcoholic solution of glonoin. It should be kept in tightly-stoppered tins, never in glass, and be stored in a cool place, aAvay from heat. Its explosiveness is in direct ratio to the evaporation of its alcohol. The dose of the spirit is the same as that of the watery solution—namely, 1 to 2 drops (0.05-0.1). The Avatery solution is not explosive. 284 DR UGS. NITRO-HYDROCHLORIC ACID. Nitro-hydrochloric Acid (Acidum Nitro-hydrochloricum, U. 8.) is a liquid giving off a distinct odor, and possessed of a very caustic poAver. 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.), in which form it is useless except as an ordinary acid. When we wish to use the acid for its OAvn peculiar effects, the official dilute acid ought ahvays to be supplanted by the freshly-mixed strong acid and be of an orange color. If this cannot be obtained, the physi- cian 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 prepared every few days. Poisoning.—The symptoms caused by poisonous doses are those of violent gastro-enteritis Avith vomiting and purging of bloody materials. Death may occur from perforation of the alimentary canal, from inflam- mation 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, Avhitewash, soap, and oils, Avith 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 Aoav its action is quite marked, and it may even cause bilious purging if administered in full doses for some days. It is therefore largely used in hepatic torpor, either acute or chronic, and in the early stages of hepatic cirrhosis should always be resorted to. In the chronic hepatitis 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-intes- tinal 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 sloAvly and carefully adding together 2 parts of nitric acid. 3 parts of hydro- chloric acid, and after twenty minutes mixing carefully Avith these dis- tilled Avater 5 parts. For the general bath (in a Avooden tub) take 5 pailfuls of Avater, 64 fluidounces (2 litres +) of the acid mixture, and enough boiling Avater to raise the temperature to 98°. Keep the patient in the bath tAventy minutes. Then rub him thoroughly with Avarm tOAvels and place him in a dry, Avarm bed. For the foot-bath add 6 ounces (180.0) of the acid to 2 gallons (7 litres) of Avater at 98°, and bathe the thighs and calves of the legs for tAventy minutes with a sponge Avet with the mixture. This is a very useful treatment, NITROUS OXIDE. 285 according to Stille, for cases of alcoholic hepatic torpor. If in either case the skin becomes irritated less acid is to be used. In ordinary so-called biliousness, Avhich is not biliousness, but intestinal indigestion, this acid is often of great service. (See Indi- gestion and Biliousness.) It is also of value in dysenteric diarrhea where the dysentery rests upon defective secretory action on the part of the glands A\hich pour out the proper fluids for digestion. Another very important action of nitrohydrochloric acid is the re- medial influence it exerts in cases suffering from oxaluria, particularly if this be associated Avith melancholia or great depression of spirits. Administration.—The strong freshly-mixed acid should be given to the adult in the dose of 1 to 3 drops (0.05-0.IS) three times a day, Avell diluted, and taken through a tube, after meals. If the patient is intelligent, he should be ordered | ounce (16.0) of the pure acid and told hoAV to drop it. If he is not, the physician must order it partly or entirely diluted in the prescription, and in so small an amount that it may be reneAved before it loses any of its poAver. 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 dis- tance aAvay from the face when the cork is withdraAvn, as the acid, if it is fresh, may spurt out and burn the eyes and face. NITROUS OXIDE. Nitrous oxide or nitrogen monoxide is sometimes called protoxide of nitrogen or "laughing gas." Its poAver of relieving pain Avas first recognized by Sir Humphrey Davy just one hundred years ago. As Avith ether, so Avith nitrous oxide, its first use as a surgical anaesthetic was by an American, Horace Wells, a dentist. This gas is obtained by a complicated process Avhich requires the use of such cumbersome apparatus that its manufacture is out of the question for the ordinary practitioner of medicine, Avhile 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 SAveet taste. It may be kept in gase- ous form or liquefied and allowed to become gaseous as it is used. Physiological Action.—OAving 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 Avhen the inhalations are full and deep, and only comes on in the majority of cases Avhere the gas is taken in small amounts or very sIoavIv. 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 nos- trils are closed. Under these circumstances the face becomes for a moment flushed, then of a deadly pallor, and finally the jaAv drops if the effect is very great. At this time anaesthesia is complete and the operation is to be rapidly performed. OAving to the fact that Avhen pure it is devoid of irritant properties, this gas can be used Avhen ether and chloroform are contraindicated. According to the most recent studies upon this gas jWood and 286 DRUGS. Cerna), it causes at first a rise of arterial pressure, folloAved by a fall if the asphyxia caused by its inhalation is very severe. The anaes- thesia may be due in part to the non-oxygenation of the blood during the time the gas is in this fluid, but the gas produces anaesthesia aside from any such influence. It has been thought that the use of this drug produces temporary glycosuria, but recent studies render this doubt- ful, to say the least. Where permanent glycosuria has been pro- duced, some injury to the vascular system in the region of the dia- betic centre in the floor of the fourth ventricle has in all probability occurred. The gas ought not to be given to those Avho are adA-anced in years or have atheromatous blood-vessels, since the rise of arterial pressure consequent upon the asphyxia may rupture a cerebral blood- vessel 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 feAV 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 Avhich is its brevity of action, since its continued administration is dangerous; the other, the difficulty in carrying it about from place to place. It possesses a great advantage in almost absolute safety, very feAV deaths having been caused by it directly. It is the safest of all anaesthetics, not even excepting cocaine, Avhich latter drug has largely supplanted the gas for many minor surgical operations. When teeth are to be extracted, a plug or cork is placed betAveen the jaws before the gas is given, to keep them apart. Under these circumstances the cork should ahvays be attached to a string, so that if it slips into the back part of the mouth it may be Avithdrawn before it chokes the patient to death. Oxygen gas may be combined with nitrous oxide gas with as great advantage as with the vapor of ether or chloroform, although its use may delay to a slight extent the development of anaesthesia. The fol- lowing classes of persons, according to HeAvitt, do better with the mix- ture of oxygen and nitrous oxide than with the nitrous oxide alone: 1. Children (who with nitrous oxide alone are liable to inconvenient jactitation); 2. Anaemic and debilitated patients, who, like children, quickly exhibit muscular contractions, and, in addition to this, remain but a very short time under the influence of nitrous oxide alone ; 3. Any one who has previously exhibited great susceptibility to nitrous oxide per se (such patients are difficult subjects to manage in dental practice because of the short period of available anaesthesia) V 4. Patients who, under nitrous oxide alone, have experienced highly unpleasant sensations ; 5. Patients very advanced in years ; 6. Patients with very large tonsils; 7. Patients suffering from heart or lung affections. NUCLEIN. The animal body has several methods of protecting itself from the attacks of infecting micro-organisms. One of these is by phagocytosis, or the devouring of the germs by the cells of the body; the other is by NUTMEG. 287 the protective or germicidal influence of the blood-serum. It has been proved that the latter poAver depends upon the presence in the blood of certain proteid-like bodies rich in phosphorus, Avhich can also be derived from cell-nuclei and other sources, such as yeast-cells and many animal tissues. Nuclein is a Aveakly acid body composed of nucleic acid and some form of proteid matter, and it not only increases the germicidal poAver of the blood-serum Avhen it is given to man or one of the loAver animals, but in addition it causes a great increase of leu- cocytosis, Avhich of course aids in phagocytosis and probably results in the production of still more nuclein from the leucocytes. Nuclein, as placed upon the market, is manufactured, as a rule, from yeast. It is prepared in many different Avays and much of it is unreli- able and possesses none of the characteristics of true nuclein. Very recently Chittenden of Yale University has analyzed the various nu- clein preparations on the market; and he finds a preparation called "nuclein standard" to contain no phosphorus, and, as phosphorus is a prominent constituent of nuclein, he says it "seems obvious that the solution contains no nuclein." tk Protonuclein," another preparation of this character, contained 1.25 per cent, of phosphorus, and therefore contains in all probability nuclein, and the improved nuclein solution of Parke, Davis & Co., which is a 1 per cent, solution of pure nucleinic acid from yeast, contained 6 per cent, of phosphorus, " Avhich would imply the presence of even more than 1 per cent, of such a nucleic acid" (Chittenden). It is evident, therefore, that this preparation of nuclein is a good one to use in testing this neAv method of treatment. Therapeutics.—Nuclein is used Avith asserted great success in the treatment of the ordinary forms of pulmonary tuberculosis and for septicaemia. Theoretically it should prove useful in combating any infectious process. Administration.—The proper Avay to use the nuclein solution just named is to give 10 to 60 minims (0.65-4.0) hypodermically once, tAvice, or thrice a day with careful antiseptic precautions, or to give a teaspoonful (4.0) in a wineglassful of Avater on an empty stomach thrice during the day and at bed-time. Contraindications.—The nucleins should not be given for a long period of time to gouty persons ; these patients usually have uric-acid troubles under their use, as nuclein is an antecedent of uric acid. NUTMEG. Myristica, 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 sedative, 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 Myris- tice, U. 8. and B. P.) is given in the dose of 1 to 3 drops (0.05- 0.15). The spirit or essence (Spiritus Myristica', U. 8. and B. P.) is used in the dose of 1 to 2 fluidrachms (4.0-8.0). Several cases of poisoning by nutmeg are reported, the most recent 288 DRUGS. by Dr. Reading of Woodbury, N. J. The symptoms closely resem- ble those produced by excessive doses of cannabis indica. NUX VOMICA. Nux Vomica (U. 8. and B. P.) is the seeds or beans of the Strych- nos Nux-vomica, an East Indian tree. It contains two alkaloids, strychnine and brucine, and depends largely for its medicinal poAver 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 loAver animals in full medicinal dose it increases reflex activity, res- piratory rate, pulse-force, arterial pressure, the 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, precedes the convulsions, and if artificial respiration is not used the animal dies from failure of respiration. If death takes place from 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 con- vulsing impulses Avhich 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 gan- glia, A\hile the rise of arterial pressure Avhich it causes is due to stimulation of the vasomotor centre. If very poisonous doses are injected intravenously, a fall of arterial pressure occurs instead of a rise, Avhich is due to vasomotor depression and paralysis. Respiration.—Strychnine is one of the most constant and pow- erful stimulants to the respiratory centre that Ave have, and it not only increases the rate, but the respiratory capacity. Temperattue.—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.—When a poisonous dose of strychnine is taken, it acts either suddenly or gradually. If suddenly, the man or animal may be, Avithout any premonition, thrown several feet and becomes 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 convul- NUX VOMICA. 289 sions 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 sidewise or the flexion of the body is forAvard (emprosthotonos). The eyes are open and fixed, the corners of the mouth draAvn back into risus sardonicus, and respiration during a severe convulsion is impossible, owing to the respiratory faiuscles being in a state of tetanic rigidity. The slightest noise, draught of air, or touch may cause a convul- sion 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 Avhich 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 fail- ure 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 ordinary fatal dose of strychnine to cause death in animals 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 amyl, and mean- while employ the stomach-pump, using the nitrite to prevent any con- vulsive tendencies during the operation. Draughts of water contain- ing tannic acid, as the chemical antidote, are to be administered, and after the stomach is Avashed out 60 grains (4.0) of bromide of potas- sium and 20 grains (1.3) of chloral in solution are to be given. These are the physiological antidotes, for the bromide of potassium depresses the sensory tracts of the spinal cord, and the chloral depresses the motor tracts. If the convulsions prevent swallowing, the patient must be chloroformed Avith care, and the physiological antidotes given in starch-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 sIoav. Nitrite of amyl is 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 these circumstances. These drugs should be gently given betAveen the paroxysms. 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 are preserved in strychnine poisoning unless the asphyxia destroys them. 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, Avhile in strychnine poisoning it comes last. The convulsions of tetanus rarely, if ever, completely relax, while those of strychnine do have 19 290 DRUGS. 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 sAvalloAved. 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 throAv much light on the case and aid very materially in the separation of the tAvo conditions, Avhile the peculiar variations in cutaneous sensibility, such as areas of hyperaesthesia and anaesthesia, Avhich are so characteristic of hysteria, may render the diagnosis pos- sible. As the treatment of all these states is virtually identical, the employment of the measures just suggested may be resorted to in each instance, and the diagnosis made aftenvard. Therapeutics.—Nux vomica, or its chief alkaloid strychnine, is used for several purposes in medicine. OA\ing 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 inflammation, as after an apoplexy or in acute infantile palsy, it is distinctly harmful. Some persons who have suffered from 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 Avay Avhatever, as the nerves are already inflamed, and are not to be still further irritated by the emplo}7ment of nervous excit- ants. In progressive 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 alco- hol strychnine is almost a specific, and in eye-strain resulting from insufficiency 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 Avith 3 drops (0.15) three times a day, and increase the amount 2 drops (0.1) a day until distinct physiological effects are produced. Sometimes 60 drops (4.0) may be taken in tAventy- four hours after tolerance is reached. In pneumonia and all other acute diseases in Avhich sudden collapse is liable to occur strychnine is of the greatest service at the time of need. Often it will pull the patient out of a sinking attack which seems certain to end in death. It should be used freely by the hypo- dermic needle, and is often aided in producing its good effects by the addition of y^ to yiy grain (0.0004-0.0006) of atropine to each injec- tion. (See Pneumonia and Shock.) 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, with arrest of the heart or respiration during the use of this anaesthetic the OPIUM. 291 physician should give hypodermic injections of TL grain (0.006) of strychnine as a powerful, rapidly-acting cardiac and respiratory stimu- lant, which dose may be repeated in ten minutes if no effect is produced. Strychnine is a very valuable remedy in surgical shock, and is a better antidote to opium than is belladonna. In dyspnea from any cause, such as that of old persons suffering from winter cough or bronchorrhoea, in emphysema, phthisis, and in shortness of breath, strychnine is of service, and it is a valuable drug for the treatment of opium-poisoning, because it preserves the reflexes and stimulates the respiratory centre. 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 intestines. In cases in which a lesion exists in the brain, strychnine may be used to keep up the nutrition of a limb Avhich 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. According to Ringer, sick headaches, due to errors in diet and Avithout much nausea, can be put aside for the day by the use of 1 drop (0.05) of the tincture of nux vomica in a teaspoonful (4.0) of Avater every five or ten minutes until 10 drops (0.65) are taken. Untoward Effects.—Care should be exercised in giving strychnine to children, as they are more susceptible to the drug than are adults. The proper beginning dose of strychnine by the mouth for a child of five or six is not more than yl^- grain (0.0006). In some cases of ex- hausting disease the prolonged use of full doses of strychnine may pro- duce a talkative delirium Avith great peevishness, and, if the drug is continued, this condition may pass into a state of temporary insan- ity. Brunton asserts that nux vomica may induce malarial chills in those predisposed to them. He also asserts that strychnine acts more poAverfully when given by the rectum than by the mouth. This is doubtful. Administration.—The extract of nux vomica (Extractum Nucis Vomicae, U. 8. and B. P.) is given in the dose of jr to \ of a grain (0.01-0.016); the fluid extract (Extractum Nucis Vomice Fluidum, U. S.), in the dose of 1 to 5 drops (0.05-0.3); the tincture (Tinctura Nucis Vomice, U. S. and B. P.), in the dose of 5 to 30 drops (0.3- 2.0). Strychnine Sulphas, U. 8. and B. P., is given hypodermically in the dose of -^ to 2V °f a grain (0.002-0.003), and by the mouth in the same amounts. In cases of severe surgical shock as much as J grain (0.016) may be used hypodermically. OPIUM. Opium (U. S. and B. P.) is the juice or milky exudation appear- ing 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 Avorld. Good opium, according to the U. 8. P., should contain at least 9 per cent, of crystalline morphine, but the poAvdered opium (Pulvis 292 DRUGS. Opii, U. S.) should contain not less than 13 or more than 15 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 Avhich are morphine, codeine, narcotine, thebaine, narceine, papaver- ine, pseudomorphine, and laudanine. It also contains meconic acid and meconine. Physiological Action.—The action of opium upon man and the loAver animals varies Avith the degree of intelligence or cerebral development. It quiets the brain and excites the spinal cord. Nervous System.—The dominant action of opium upon man is to produce nervous sedation in small doses and sleep AAhen given in larger amounts. Sometimes, however, in persons Avho are accustomed to its use, it produces a state of restless insomnia or quiet, Avakeful apathy. When given to frogs it often produces tetanic convulsions. OAving to its primary stimulant effect on the spinal cord. In dogs it increases the reflexes and produces droAvsiness, and in man sleep. If, hoAvever, the patient be a member of one of the lower races or a young child, the spinal irritation may be as manifest as the cerebral sedation. If large doses are given, sleep is produced in all animals, and both the brain and spinal cord are depressed. The sensory, nerves are also markedly benumbed, and the motor nerves may finally be rendered inactive. Circulation.—Small therapeutic doses of opium have no effect upon the circulation, but large ones slow the pulse, increase its force, and slightly raise arterial pressure. The sloAving 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 chiefly to the increased heart-action. After poisonous doses the pulse becomes rapid and feeble, due to depression of the vasomotor centre and the heart, and the gradually increasing asphyxia. Respiration.—In very minute doses opium is a feeble stimulant, or at least not a depressant, to the function of respiration. In over- dose it is one of the most poAverful paralyzants of the respiratory cen- tres in the medulla oblongata, causing death by this action. Temperature.—The bodily temperature is raised slightly by full doses and lowered by poisonous amounts of opium. Tissue-avaste.—Opium acts as a preventive to tissue-Avaste. increas- ing the elimination of urea and other results of nitrogenous break- down. Elimination.—The drug escapes from the body, if given in excess. as morphine, by way of the intestines and kidneys, but most of it is destroyed by oxidation in the liver and tissues.' 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 poisoning, recovery is much aided, as by this means reabsorption is prevented. Pepil.—Opium contracts the pupils by a centric stimulation of OPIUM. 293 the oculo-motor nerves, and perhaps by depression of the sympathetic fibres. Stomach, Intestines, and Secretion.—Opium depresses the motor activity of the stomach and 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 sIoav, full pulse, a Avarm, 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 Avhich the person feels self-satisfied and contented. The duration of this agree- able 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 aAvakened 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 becomes at first more cyanotic, then pale and livid; the respirations, Avhich have been eight to ten to the minute, are noAv only four or five, and finally such prolonged pauses occur that all hope of another res- piration is lost by the attendant. While the sIoav breathing is at first deep, it noAV rapidly becomes shalloAV, and muscular relaxation is present to the greatest degree. The skin, previously dry, is Avet Avith the SAveat of death, the patient is so deeply narcotized that nothing can arouse him, and he dies from respiratory failure, although the heart ceases almost simultaneously from the asphyxia. The pupils do not dilate in the third stage, except in the relaxation of death. Treatment op Acute Poisoning.—After employing the usual methods resorted to for the purpose of unloading the stomach, and after giving permanganate of potassium or tannic acid, preferably the former, as the chemical antidote, the patient should receive one or tAvo cups of strong black coffee, hot and concentrated. The heat in the liquid is useful in maintaining bodily temperature, and the caf- feine stimulates the respiratory centre and keeps the man aAvake. Coffee should be used even before any symptoms come on, in order to 294 DRUGS. put them off if possible. If strychnine is at hand and the respirations are becoming very sIoav, -^ to -^ of a grain (0.003-0.006) should be given hypodermically. Strychnine is 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 in opium poisoning, as the action of these two drugs (opium and atropine) on the eye is not directly 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 extrem- ities. Much emphasis has been placed on keeping the patient aAvake, and it has been thought that the cause of death was the deep sleep. This is not so. The man must be kept aAvake in order that he will supplement the efforts of his depressed respiratory centres by volun- tary 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 SAvitches or by keeping him Avalking up and down between tAvo attendants. Both of these measures are rep- rehensible if anything better can be done—the first method because it covers the patient Avith cuts and bruises, the second because it may aid in the production of death by exhaustion. If an ordinary med- ical faradic battery is at hand, the full force of the current may be alloAved to come in contact Avith the skin from two small poles Avet with salt water, or, better still, the dry or Avire electric brush should be SAvept over the body while the negative pole is held in the hand of the patient or pressed against his skin. This causes the most exqui- site pain in the normal individual, but if the brush is kept moving will not cause any bruises or discoloration. (See Asphyxia.) Arti- ficial respiration may be resorted to. As already pointed out Avhen discussing the elimination of opium, the dose is eliminated into the stomach from the blood-vessels and then reabsorbed. Frequent washing out of the stomach is therefore advis- able in treating cases of poisoning. Chronic Poisoning.—Morphine or opium Avhen 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 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 Avrings his or her hands, and begs, screams, hoAvls, or yells for mor- phine, only to break doAvn and cry on being refused the customary dose. Diarrhoea of a serous type and most violent in character, with cramps in the muscles, may assert itself, and must be controlled by astringents and an active line of treatment as far as possible free from opium. (See Diarrhoea.) OPIUM. 295 A characteristic symptom of chronic opium-eating is the develop- ment of the most remarkable and clever lying in previously truthful persons. In the same 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 in a surreptitious manner, and may even have the drug in his mouth at the moment he speaks. It Avill often be found hidden in the seams of the clothing in small packages, and the nurse must be absolutely reliable, above bribery, and for ever 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 Avay to treat such cases is to " taper off" the daily dose, and to decrease by a sixth or a fourth the total cus- tomary amount in each twenty-four hours. The sudden complete withdraAval of the drug is an unnecessarily severe measure, and its AvithdraAval in a sloAver manner than that named is simply prolonging the treatment beyond reasonable limits. Cocaine has been used to tide over the crisis after the withdraAval of morphine, but too fre- quently the patient passes from opium to the cocaine, and finally to the alcohol habit, all of which are equally bad. If the circulation flags, digitalis and strychnine may be given and the remaining symp- toms treated as common sense indicates. Sometimes paregoric is taken in excess, and the writer has seen and treated a case in which over a pint of paregoric Avas taken every day. When a mother is an opium-eater, the neAV-born child often 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 Avill be spoken of seriatim, the minor uses of the drug being considered afterward. These are pain, insomnia, inflammation and irritation, over-secretion, and systemic strain. Pain.—Opium, as is knoAvn to every one, is the best remedy that Ave possess for the relief of all forms of pain, except in those instances where neuralgia exists, when antipyrin and its fellow-compounds exceed it in medicinal value because they have no marked after- effects. In one form of pain opium is not to be employed—namely, that arising from cerebral congestion and cerebritis, for it is distinctly contraindicated in 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 spasm, and in dysmenorrhea, belladonna and opium given together will relieve the spasm and pain, and yet so counteract each other elsewhere in the body as to be devoid of effect upon other organs. Persons suffering from pain will ahvays bear very much larger amounts of opium than painless individuals. Insomnia.—Opium, Avhile capable of producing sleep in almost every case in Avhich 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 Avhere the sleeplessness is due to pain. If constantly used for the relief of insomnia or pain, the opium habit is rapidly contracted, 296 DRUGS. and for this reason the use of this drug should be alternated with chloral, cannabis indica. and other soporific drugs. In some cases chloral and morphine, ay hen given in small doses in combination, will so act upon the brain as to produce sleep. Thus, in the following prescription, the dose of both active ingredi- ents is much smaller than Avould be needed if either one Avas used alone, yet the result sought by their use—namely, sleep—is readily produced: R.—Morphinse sulph.............gr. ij (0.10). Chloralis...............3j (4.0). Syrupi...............f5j (32.0). A"quii> dest............q. s. f^'ij (G4.0).—M. S.—Dessertspoonful (8.0) at nine p. m., and, if needed, again at ten or eleven o'clock 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 Ave cannot explain, and both small and large doses are particularly valuable in inflammation 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 irritation of small-pox. Sometimes intense irritation or inflammation produces so great an effect upon unstriped muscular fibres as to cause spasm or paralysis, as in retention of urine, cystitis, or the constipation folloAving inflammation of the boAvels due to the ingestion of irritating foods ; under these cir- cumstances the employment of opium is indicated, and is usually very successful. In irritative coughs morphine given in syrup of wild-cherry bark does good in the dose of y1^ to y1^ of a grain (0.005). Opium is often used, or its alkaloid morphine, to allay nervous excitement and cough in cases of hemoptysis. In some cases of irritable cough, due to a tickling sensation in the larynx much relief can be had by inhaling the steam arising from a cup of boiling Avater in Avhich has been placed a drachm or tAvo of pare- goric. Whenever a cough is in excess—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 its use than before, its use must be stopped, as the increase in the number of rales indicates an increase in the accumulation of mucus. In the treatment of strangury due to cystitis, and in rectal inflam- mation, provided they are not acute, and after operation on the pelvic organs, suppositories of the strength of T or \ of a grain (0.016-0.03) of the watery extract of opium are very useful. In excessive vomit- ing from any cause, except it be from a previous dose of opium, an enema of deodorized laudanum 30 drops (2.0) and starch-water 4 ounces (12.S.0), Avith 20 grains (1.3) of bromide of sodium, will be found of value. (See Vomiting, Part IX.) For sprains and bruises lead-Avater-and-laudanum is one of the best OPIUM. 297 applications. (See Article on Lead.) If the skin is broken, the lau- danum may be used alone to relieve pain, and, by its alcohol, will act as an antiseptic. Opium is also a useful drug in the treatment of inter- nal and external burns to relieve the pain and irritation. Over-secretion.—In serous diarrhea, diabetes insipidus, and mel- litus, and in the treatment of over-secretion on the part of all secre- ting surfaces except the skin, opium may be used. It is said to decrease the amount of urine before decreasing the amount of the sugar in diabetes. HoAvever this may be, the employ- ment of morphine or codeine in diabetes is a very valuable form of treatment. The doses should be rapidly increased, as the effect is only obtained by ascending amounts, and diabetic patients seem peculiarly immune to the nervous influence of this drug and its alka- loids. Morphine is, therapeutically, the more poAverful of the tAvo alkaloids. Neither of them, probably, cures the disease, but so modifies it as to make life bearable and happy. (See article on Diabetes, Part IV.) Opium should not be used to arrest an attack of mucous diarrhea until after the mucus, which is already present in the boAvel, has been SAvept out of the intestinal canal by a dose of castor oil or magnesium sulphate. Minute doses of -^ to ^ of a grain (0.001) of morphine will sometimes check summer diarrhea in children at once Avhen given hypodermically. (See article on Diarrhoea.) Morphine 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. Systemic Strain.—In prolonged strain upon the system, as in great physical or nervous effort, or more frequently in old age to smooth out the cares of the remaining years of life and decrease Avorry, opium is useful, but its use in young persons is most dangerous, as it is almost certain to produce the opium habit. In asthenic fevers opium 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 interfere Avith his breathing and so hasten death. In muscular rheumatism and similar states, and Avhen a "cold" has been taken, opium in the form of Dover's poAvder in the dose of 5 to 10 grains (0.31-0.65) Avill often produce a cure, particularly if employed in combination Avith hot drinks and a hot foot-bath. Cam- phor can often be added to the Dover's powder with advantage. (See Coryza, Part IV.) In heart disease, particularly of the mitral valves, the patient can often breathe easily only Avhen aAvake, starting up Avhen he hills asleep and gasping for breath. It is stated by some Avriters that morphine will relieve this state and permit sleep, but that it Avill not be of service in aortic disease. While this may be partly true, 298 DRUGS. the drug will often give great relief in all forms of cardiac dyspnea, and ought ahvays to be tried Avith caution, although it is contraindi- cated if the heart has undergone fatty degeneration. 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 stim- ulation by the drug, and, Avhile this is no doubt correct, the other car- diac stimulants, such as digitalis, will fail Avhen morphine succeeds. The presence of cyanosis and lividity is said to be no contraindication to the hypodermic use of morphine under these circumstances, provided the dose is not unreasonably large. The drug should be given hypo- dermically for this purpose. 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. For this reason, unless there is an excess of acid present in the stomach, it is Avell not to give opium or morphine at meal-times, but some time after. Opium itself is used in the form of the poAvder (Pulvis Opii, U. S.) in the dose of from \ to 1 grain (0.016—0.05). The solid preparations are the deodorized opium (Ojn'um Deodoratum, U. 8.), Avhich is de- prived of its narcotine, dose J to 1 grain (0.03-0.05); the pills of opium (Pilule Opii, U. S.), each containing 1 grain (0.05); and the Avatery extract (Extractum Opii, U. S. and B. P.), dose \ to | a grain (0.016-0.03). Of the liquid preparations avc have paregoric (Tinctura Opii Campiiorata, U. 8.; Tinctura t'amphore Composita. B. P.), dose 1 drachm to 2 tablespoonfuls (4.0-32.0); laudanum (Tinctura Opii, U. S. and B. P.), dose 10 to 30 drops (0.65-2.0) ; the deodo- rized tincture (Tinctura Opii Deodorati, U. 8.), dose 10 to 30 drops (0.65-2.0) ; the Vinum Opii, U. 8. and B. P.—or, as it is sometimes called, Sydenham's Laudanum—dose 10 to 30 drops (0.65-2.0); and Acetum Opii, U. S., or Black Drop, dose 10 to 30 drops (0.65-2.0). As all the liquid preparations of opium are of 10 per cent, strength, except paregoric, Avhich is about 2 grains to the ounce, the dose of all of them except paregoric is identical. This is a fact to be remembered by students. Under the name of Dover's PoAvder (Pulvis Ipecacuanha' et Opii, U. 8.) a poAvder containing 1 grain (0.05) of poAvdered opium, 1 grain (0.05) of poAvdered ipecac, and 8 grains (0.50) of sugar of milk is largely used. This is more efficacious if separated into fifths and taken in di- vided doses. The tincture of ipecac and opium (Tinctura Ipecacuanha et Opii, U. S.) is given in the dose of 4 to 15 minims (0.3-1.0). The preparations of opium official in the B. P., other than those already named, are—Confectio Opii, dose 5 to 20 grains (0.3-1.3); Extractum Opii Liquidum, dose 4 to 20 minims (0.3-1.3); Pulvis Opii Compositus, composed of opium, pepper, ginger, caraAvay-fruit, and tragacanth, dose 2 to 5 grains (0.1-0.35); Tinctura Opii Ammo- niota, dose J to 1 drachm (2.0-4.0); and Trocliisci Opii (y1^ grain [0.006] of opium in each), dose one to four. Pilula Saponis Com- posita, B. P., is purely a preparation of opium. It is sometimes necessary to give this drug to patients Avithout their knowledge, and OPIUM. 299 it may be prescribed in this Avay, 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 ^ a drachm (2.0) of the tincture of opium and 2 ounces (64.0) of starch mucilage. Untoward Effects.—When opium is given to some persons it pro- duces for some hours marked Avakefulness folloAved by sleep, and in many patients produces after its primary influence great nausea, and sometimes vomiting. The mental depression may be simply over- Avhehning, and the very fact of having to drag out existence is a curse. By far the most effective mode of preventing these very distressing effects of opium or its derivatives is to administer Avith this drug about 2^-q grain of nitroglycerin. One of the chief causes, hoAvever, of the nausea produced by the use of opium or morphine is the change in the body of morphine into oxy-dimorphine, Avhich is eliminated into the stomach and there reabsorbed, and then induces these secondary effects. It is also a fact that these symptoms can be largely done away with by the use of 20 grains (1.3) 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 tincture or deodorized opium itself. Whenever it is possible these preparations should be used to the exclusion of the others. 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 pass off than the uric acid is set free in the blood, and as a result depression 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 untoAvard symptoms come on coffee and stimulants may be used with advantage to overcome them. In some persons the use of opium is followed by the development of an erythematous rash which may go on to desquamation. Children bear opium badly, and some children are very much more susceptible than others to its influence. One-eighth grain of morphine has caused death in an adult AA-hen given hypodermically, probably because it entered a vein. Sometimes the drug causes collapse, or in other cases an eruption upon the skin of the body. The use of repeated doses of morphine for several days often sets up obstinate vomiting, due probably to the change of the drug into oxy- dimorphine or apomorphine. Codeine. (See p. 159.) Morphine. Morphiua, U. S. and B. P., is the chief alkaloid of opium, but OAving to its insolubility is rarely used, being generally given in the form of the sulphate. 300 DRUGS Sulphate of Morphine (Morphine Sulphas, U. 8. and B. P.) is given in the dose of | to £ grain (0.008-0.03), either by the mouth or hvpodermically. Besides the sulphate of morphine we have the acetate (Morphine Acetas, U. 8. and B. P.) and the muriate (Morphine Ily- droehloras, U. 8. and B. P.), both given in the dose of ^ to % grain (0.008-0.03). In the U. S. Pharmacopoeia of 1870 a solution of mor- phine (Liquor Morphine Sulphatis, B. P.), Avas official, dose 1 to 2 drachms (4.0-8.0), but it is no longer official and should not be called for. Magendie's solution of morphine is sixteen times as strong as this liquor just named (16 grains to the ounce), and is not official. The words " Liquor Morphinse Sulphatis " will often cause Magendie's so- lution to be dispensed in New York State, and care should be taken that poisoning does not result. Pulvis Morphine Compositus, U. 8.. or Tuliy's Powder, is given in the dose of 10 grains (0.65). It con- tains sulphate of morphine, camphor, licorice and precipitated calcium carbonate. It is used to break up forming colds and as a nervous seda- tive. Troches of morphine and ipecac (Trochisci Morphine et lpecac- uanhce, U. S.) are given one or two at a time. The following additional preparations of morphine are official in the B. P.: Liquor Morphine Hydrochloratis, dose 10 to 40 minims (0.65- 2.65); Tinctura Chloroformi et Moiyhine, dose 5 to 10 minims (0.35- 0.65); Suppositoria DIorphine and Suppositoria Morphine cum Sapone. each suppository containing ^ grain (0.03) of morphine; Trocliisci Morphine and Trocliisci Morphine et Ipecacuanhe, each lozenge con- taining -^g- of a grain (0.002) of morphine, dose 1 to 4. Liquor Mor- phine Acetatis is given in 20- to 40-minin (2.65) doses. Injectio Morphince Hypodermica, B. P.. contains 1 grain (0.05) of the acetate of morphine in each 10 minims (0.65) of Avater. Incompatibles.—Morphine is incompatible Avith potassium perman- ganate and Avith tannic or gallic acid or astringent solutions containing them, with alkalies, such as potassium, sodium, and ammonium, but Avith the chloride of ammonium it is not incompatible. With tincture of chloride of iron it forms a deep-red color (meconic acid). OX-GALL. Inspissated Ox-gall (Fel Boris, U. 8.) is, as its name implies, dried ox-bile, derived from the gall-bladder of the common ox (Bos Taurus). It is used in medicine for the purpose of relieving certain forms of indigestion which depend upon deficient secretion of bile or Avhich occur in persons who digest fats Avith difficulty. In full doses it is apt to cause some looseness of the boAvels, and it may be given Avith the object of producing this condition. When it is used the fact should be remembered that bile prevents the gastric juice from acting upon pro- teid or albuminous substances, shrivelling them up, and in addition so alters the gastric liquids as to decrease their digestive poAver. We knoAv, therefore, that this drug must be administered some hours after meals, as a rule, or, in other words, Avhen 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 OXIDE OF ZINC. 301 (0.35-1.0). Purified Ox-gall (Fel Boris Purification, U. S. ; Fel Bovinum Purificatum, B. P.) is given in the same dose as the inspis- sated 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, Avhich constituents are mixed thoroughly, 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. 8. and B. P., Avhich is insoluble in water. In the form of the oxide-of-zinc ointment (Unguentum Zinci Oxidi, U. S. and B. P.) this drug affords one of the most generally used applica- tions in the treatment of skin diseases, burns, and sores. In all states Avhere the surface of the skin is dry it is contraindi- cated, but Avhere the eruption is moist it is useful. In the treatment of the chloasma of pregnancy the folloAving prescription is of service : R.—Zinci oxidi.............gr. iij (0.18). Hydrarg. ammoniat..........gr. j (0.06). Olei theobromBe...........^ijss (10.0). Olei ricini ............3yss (10.0). Essent. rosas........... gtt. x (0.65).—M. S.—Apply to the face night and morning. In eczema Avith many vesicles use— R.—Pulv. camphorae..........Jss (2.0). Pulv. zinc, oxidi..........giij (12.0). Glycerini.............gtt. xl (2.65). Adipis benzoinati .......Sj (32.0).—M. S.—Apply to the part without other treatment or precede it by powdered bis- muth. Under the name of Unna's Dressing (composed of gelatin 4 parts, water 10 parts, glycerin 10 parts, and zinc oxide 4 parts) is a useful ap- plication for ulcers and eczematous patches on the legs or arms. It is par- ticularly useful for leg ulcers. The gelatin and cold water are put in a basin over a fire and a solution made; then the glycerin is added, and then the oxide of zinc is sloAvly added, with constant stirring. After the mixture is complete it is poured into a can and allowed to cool, Avhen it is ready for use. This application decreases SAvelling and is soothing and supporting. It is applied as folloAvs : The part affected is Avell Avashed with water and soap, and then Avith alcohol. The paint having been Avarmed and melted, a large three-inch paint-brush is used to apply a coating to the limb all around the ulcer, and over this a single layer of gauze is applied. The gauze bandage should be tAvo inches Avide. The bandage must be laid on evenly and the ulcer cov- ered by a pad of absorbent cotton. After one layer is applied it is cut and another coat of paint applied over it. Then another layer of gauze and another of paint are used, until several layers are in place. It is best to begin at the toes and Avork up toAvard the knee. All parts should be equally well covered. Finally the entire dressing is covered 302 DR UGS. by a cotton roller bandage, which is removed in twenty-four hours, leaving Avhat looks like a white rubber dressing on the limb. If the liquid°from the ulcer oozes through the dressing profusely, a window is to be cut over the ulcer, and it can be locally treated by astringents or other measures. The patient should keep the limb elevated for a day or two, but can then walk Avith far more comfort than if a rubber sup- porting bandage is used. In powdered form zinc oxide is useful in the treatment of intertrigo and for conjunctivitis. Mixed with bismuth subnitrate and pepsin, it is largely used by some practitioners in the treatment of the summer diarrhea of infants or adults. In the night-sweats of debility or of phthisis oxide of zinc in the following formula has been highly recommended, but the prescription probably depends largely for its action on the second ingredient: R.—Zinci oxidi.............gr. xxx (2.0). Extract, belladonnse.........gr. iij (0.18.)—M. Ft. in pil. No. x. S.—One at night before going to bed. BartholoAv recommends the oxide of zinc for cases of asthma and whooping cough, given to an adult in the manner j ust indicated. OXYGEN, OXYGEN-WATER. The gas Oxygen is now Avidely used in medical and surgical practice in three Avays, 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. (See Hydrogen Peroxide.) Inhalations of oxygen are useful in the second and third stages of pneumonia Avhere the patient seems about to die from deficient aera- tion 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). In phthisis and other exhausting diseases oxygen will allay dyspnoea and oppression. Oxygen inhalations are also of service in the treat- ment of anemia in all its forms and give relief even in pernicious anemia and in leukemia. Often a mixture of oxygen gas 60 parts and nitrous oxide gas 40 parts is used as a stimulant inhalation and nervous sedative. The clinical results which have so far been obtained from the admin- istration of ether and chloroform vapor when combined with oxygen gas seem to prove beyond all doubt that the oxygen decreases the dan- ger of the anaesthetic and to a large extent obviates the difficulties which surround the administration of these drugs, and most of the untoward effects which we are accustomed to meet with as a conse- quence of their use. Thus, Avhen oxygen is given with ether, vomit- ing is less frequently met Avith, excessive pallor is rarely seen, and post-operative depression seems to be largely avoided. OXYGEN, OXYGEN-WATER. 303 As a general rule, however, it has been the custom of physicicans and surgeons who have employed oxygen gas in combination Avith ether or chloroform, to place the anaesthetic in a wash-bottle and then to allow the oxygen gas to pass through it in such a way that the patient received in the inhaler a mixture of anaesthetic vapor and oxygen, the mixture being made by the passage of the oxygen gas through the liquid anaesthetic in the bottle. An evident disadvantage of this arrangement is that the quantity of anaesthetic Avhich is volatilized can only be in direct proportion to the volume of oxygen gas which is forced through the Avash-bottle, and therefore Avith every increase in the quantity of vapor Avhich the patient receives he must also receive an increased quantity of oxygen. It has been claimed, too, by those Avho have employed the ether and oxygen combination most frequently, that in a large proportion of cases a greater length of time is required for the anaesthetizing of the patient, and that in some cases it seems almost impossible to get the patient under the direct influence of the drug. This difficulty lies in the fact that as soon as a large quantity of oxygen gas is used to convey a large quantity of anaesthetic vapor to the lungs, the patient rapidly passes into a condition Avhich is called by physiologists apncea. The respiratory centre is no longer irritated by the normal proportions of carbonic acid in the blood, and therefore sends out feeble respiratory impulses; and as the patient does not breathe as rapidly or as deeply as before, the result is that very small quantities of the anaesthetic are taken into the body. The apparatus which the Avriter has employed Avith success, and which he suggests as a substitute for the one heretofore employed, con- sists of a someAvhat funnel-shaped piece of leather having a greater diameter in one direction than in another, into Avhich is fitted as an inner lining a piece of soft felt or spongio-piline almost a quarter of an inch thick. In the under surface of the leather cone is inserted a small metal tube, and at the opening of this tube a small hole is cut in the spongio-piline. The ether is then poured upon the spongio-piline in the cone, in the apex of which is placed some absorbent cotton. The oxygen enters the cone by means of a rubber tube attached to the metal entrance Avhich has been mentioned. By this arrangement several obj ects are accomplished. In the first place the supply of oxygen can be delivered to the patient in varying quantities without altering the amount of anaesthetic which is being given. In the second place, any quantity of anaesthetic can be employed without necessarily increasing the oxygen. Thirdly, the leather cone prevents the rapid evaporation of ether from the outer side of the spongio-piline. And fourth, the spongio-piline, being much more porous than an ordinary towel, will retain a large quantity of ether in liquid form when this drug is poured upon it. Finally, if desired, the same apparatus can be used for the administration of chloroform by removing the metal cap on the smaller end of the cone, as in this Avay the patient will receive not only the anaesthetic vapor and the oxygen, but also fresh air through the end of the cone, in such quantities as the phy- sician deems Avise. In these cases it is best to use the attachment known as the Krohne and Sesemann " respiration-indicator," which consists of a small feather on a pivot which moves to and fro with the motions 304 DRUGS. of respiration, thereby providing the physician with a gauge as to the rapidity and force of the respiratory movements. The soft felt is very cheap, and a fresh piece can be used for each patient. In conclusion, the writer cannot condemn too strongly the method of employing chloroform vapor and oxygen by passing the oxygen directly through the chloroform without the free administration of air in addition, for, after all, air is what we are intended to breathe, and not oxygen gas alone, although it may be advantageous at times to add an increased quantity of oxygen to the air. Still more severe condemnation should be directed toAvard the attach- ment which is placed on some of the Junker inhalers, and which con- sists of a small rubber bag which, instead of acting as a reservoir of fresh anaesthetic vapor and oxygen, is inflated and collapsed by the expiration and the inspiration of the patient, who does not receive even fresh oxygen and anaesthetic vapor, much less fresh air, but, on the contrary, inhales again and again air, oxygen, and vapor which are loaded with the impurities of frequent expiratory efforts. (For the directions for using oxygen with nitrous oxide as an anaes- thetic see the article on Nitrous Oxide.) In the preparation of the solution of oxygen gas the Avater 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 draAvn off by means of a tap such as is used in siphons or for champagne bottles. Birch of England has found that the addition 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, and when taken in the body it has proved of the greatest service in chronic dyspepsia, persistent vomiting, and headaches both digestive and neuralgic. In constipation depending upon 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 Avater should be swalloAved as soon as possible after it is taken out of the bottle wThich has contained it. In some cases where general systemic torpor is present oxygen- water taken after each meal, or even more frequently, may be used Avith advantage. One or two tumblerfuls may be taken each time. PANCREATIN AND PANCREATIC EXTRACTS. Under these names a number of firms noAv sell an extract from the pancreatic gland or juice, and the U. S. P. recognizes such a product under the name of Pancreatinum. It contains, or should contain, the four pancreatic ferments—trypsin, Avhich digests proteids (meat, eggs, etc.); steapsin, Avhich splits up and emulsifies the fats; amylopsin, Avhich has diastatic poAver (that is, converts starch into sugar), and finally a milk-curdling ferment. A preparation equally useful Avith the commercial pancreatin may be made by the physician in the folloAving 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 PAPAIN, PAPAYOTIN, AND PAPOID—PARALDEHYDE. 305 it up fine, 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 (4.0-8.0). Or, better still, as follows: Wash and chop up fine 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 of glycerin. This must stand forty-eight hours and then be filtered, and be used in doses of 30 drops (2.0) to each glass of milk. (For the use of pancreatin in artificial digestion see the article on Pep- tonized Foods in Part III.) Pancreatin, as prepared for the market, is a dry powder, given in the dose of 2 to 20 grains (0.1-1.3) after meals or during them. Pancreatin should usually be prescribed with bicarbonate of sodium to aid it in its digestive action. It is indicated in all cases of lienterie diarrhea and in many cases of deficient digestion. Pancreatin, or the poAvdered pancreas, may also be freely used in those cases of diabetes mellitus in Avhich the disease depends upon a lesion of the pancreatic gland, as carcinoma or atrophy from other cause. Some doubt has been cast upon the usefulness of the employment of pancreatin in foods unless this ferment was allowed to act upon the aliment before it Avas SAvalloAved by the patient, on the ground that pancreatin is destroyed and rendered inert in the presence of the acid Avhich it meets in the stomach. 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 pan- creatic action. It is during this preliminary period that the work of the pancreatin is accomplished. Pancreatin or peptonized foods should not be employed unless really needed, nor continued for any length of time, as digestion is finally impaired by atrophy of the glands arising from disuse. The dose of pancreatin is from 2 to 10 grains (0.01-0.65). PAPAIN, PAPAYOTIN, AND PAPOID. Papain, Papayotin, and Papoid are names given to a digestive fer- ment derived from the juice of Carica Papaya. This ferment pos- sesses the poAver of changing proteids into peptones in the presence of an acid or an alkali, or even in a neutral mixture, thereby differ- ing from pepsin and pancreatin. This power wrould be of very great value, since the drug would then be useful in all forms of dyspepsia, were it not that careful experimentation renders it doubtful as to whether papain, papayotin, or papoid can really supplant either of the animal ferments named above. The dose of all these products is from 1 to 8 grains (0.05—0.6) given in solution, or better in pill. The plant itself, taken internally, has the reputation of being capable of causing abortion. PARALDEHYDE. Paraldehydum, U. 8. and B. P., is a form of aldehyde used as a soporific and nervous sedative, and is a clear, colorless liquid with an 20 306 DRUGS. ethereal odor and a burning, folloAved by a cool, taste. It should be kept in dark, well-stoppered bottles in a cool place. Paraldehyde is readily soluble in alcohol, moderately so in Avater, less so in hot water. It possesses the great disadvantages of being necessarily given in large dose and having a disagreeable taste and odor. It is also very apt to disorder the stomach. Paraldehyde kills Avhen taken in overdose by respiratory failure, but is not so depressant to the heart as is chloral. The drug soon loses its power as a soporific. The dose is 20 drops to 1 drachm (1.3-4.0) in capsules, or, better still, it may be used, after the formula of Yvon, as folloAvs : R.—Paraldehyde.............3yss (10.0). Alcoholis (90 per cent.)........f gjss (45.0). Tincturse vanillse...........f.^ss (2.0). Aquas...............fjj (32.0). Syrupi simplicis.......q. s. ad f.^iv (128.0).—M. S.—A dessertspoonful (8.0) every half-hour until sleep is obtained. PAREIRA. Pareira, U. S. (Pareire Radix, B. P.), is the root of Chondoden- dron tomentosum, a plant of Peru and Brazil, and is used as a diu- retic of an alterative or stimulant character and for the relief of chronic inflammations of the genito-urinary tract in general, such as pyelitis, cystitis of a subacute type, and similar pathological states. The dose of the unofficial infusion is a wineglassful (32.0), and the fluid extract (Extractum Pareire Fluidum, U. S.) is given in the dose of a teaspoonful (4.0) three times a day. The B. P. prepara- tions of this drug are—the decoction (Decoctum Pareire), dose 1 to 2 ounces (32.0-64.0); the extract (Extractum Pareire), dose 10 to 20 grains (0.65-1.3); and Extractum Pareire Liquidum, dose 1 to 2 drachms (4.0-8.0). PENTAL. Pental is an impure amylene first described in 1844 and used in 1856. It at once dropped out of notice until a feAV years ago, Avhen it was brought forward as an anaesthetic for use in minor or brief operations. Pental is a colorless liquid, insoluble in water, but read- ily mixed with ether, chloroform, or alcohol. It is very inflammable, but not affected by exposure to light and air. Physiological Action.—Our knoAvledge of the physiological action of pental is exceedingly limited. Wood and Cerna, from a very incomplete 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 any length of time. If it is to be taken for but a few minutes, an ordinary chloroform mask or towel may be used. The quantity to be employed for the production of anaesthesia is about 2 to 3 drachms (8.0-12.0). Pental is an anaesthetic Avhich PEPO—PEPPER—PEPPERMINT. 307 so far promises very little, and which will probably be used by a very limited number of practitioners, as it possesses no particular advan- tages over older and safer anaesthetics. It is, hoAvever, right to state that some surgeons employ it with great satisfaction. Thus, Phillip asserts that it is regarded as indispensable in the Children's Hospital of Berlin, as it acts very rapidly, produces little excitement, and per- mits rapid return to consciousness. It has been given in this insti- tution one thousand times. PEPO. Pepo (Cucurbita Pepo), U. S., Pumpkin-seed, the seed of the ordi- nary 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 Avorm. The outer coverings of the seeds should be removed, and the remaining part rubbed up into an emulsion with Avater or into an electuary Avith sugar, the dose of the seed being 2 ounces (64.0). This mass should be taken on an empty stomach, and folloAved in from one to two hours by an active purge. PEPPER. Piper, U. S., or Black Pepper (Piper Nigrum, B. P.), is the unripe fruit of Piper nigrum, a vine of India, Java, Borneo, and Siam. It contains a neutral principle, piperin, Avhich is official. Therapeutics.—Black pepper may be used externally 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 contraindicated Avhenever acute inflammation is present, as in acute gonorrhoea. It may be used in the treatment of great intestinal flatulence with marked relief. Piperin (Piperinum, TJ. S.) has been used as an antiperiodic Avith varying success, and is given in the dose of 1 to 5 grains (0.05-0.25). The oleoresin of pepper (Oleoresina Piper is, U. S.) is given in the dose of I to 2 drops (0.016-0.1) 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 (4.0-8.0). PEPPERMINT. Mentha Piperita, TJ. 8., is official in the form of the leaves and tops of Mentha piperita. It has an aromatic odor and taste and con- tains an oil. Locally applied, the oil acts as an irritant and local anaes- thetic. From this oil is obtained menthol, a camphoraceous substance of a hot, burning taste, possessing marked power as a local anaesthetic. (See Menthol on next page.) Therapeutics.—Peppermint is used very largely as a domestic rem- edy for flatulence and infantile colic. Sometimes the oil is added to 308 DRUGS. purgative pills to prevent griping, and it may be employed to cover the taste of many medicines Avhich 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 Avith nervous symptoms, the following will be found of value: R.—Chloralis............ gr. xvj (1.0). Potassii bromidi..........gr. xxxij (2.0). Aq. menth. piperit.........f^ij (64.0).—M. S.— Teaspoonful (4.0) 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 sometimes 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 (Oleion Menthe Piperita', U. 8. and B. P.), dose 1 to 4 drops (0.05-0.25); the spirit (Spiritus Menthe Piperite, U. S. and B. P.), dose 10 to 30 drops (0.65-2.0); the water (Aqua Menthe Piperite, U. S. and B. P.), dose 1 to 2 drachms (4.0-8.0); and, finally, as the Troches (Trocliisci Menthe Piperite, TJ. 8.), to be held in the mouth in indef- inite number. Essentia Menthe Piperita1, B. P., is given in the dose of 10 to 20 minims (0.65-1.3). Menthol. Menthol, U. 8., or Mint Stearopten, or, as it is sometimes called, Mint Camphor, is derived chiefly from the essential oil of peppermint. It occurs in colorless prismatic crystals with a strong odor of pepper- mint. Upon it rests much, if not all, of the therapeutic acthity of peppermint. Menthol is slightly soluble in water, very soluble in alcohol, ether, and in oils. Menthol has been used in the vomiting of pregnancy with great advantage in hourly doses of a teaspoonful of the folloAving: R.—Menthol . . Spt. frumenti Syrupi . . . Menthol has also been used as a carminative and in gastralgia in the close of from 1 to 2 grains (0.05-0.1) three times a day in pill or in alcoholic solution. It is contraindicated 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 for migraine. Menthol when used as a depletant on the mucous membranes of gr. xv (1.0). fzvj (24.0). f 5J (32.0). PEPPERMINT. 309 the throat or nose causes a contraction of the local blood-vessels, 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 a solution of about 1 grain (0.05) to the ounce (32.0) of water, or, better still, 3 grains (0.25) of menthol in \ an ounce (16.0) of albolene. (See Coryza, Part IV.) Another very useful method of applying menthol is by means of a simple inhaler consisting of a small glass tube of about one-quarter of an inch in diameter and two and a half inches in length. Both ends are closed by a piece of gauze and tAvo 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 only smelled, but inhaled. Care should be taken that the crystals are not allowed to enter the nostril, as they are almost cauterant in power. Sometimes, Avhere great excoriation of the alae of the nose exists, the too persistent use of the menthol may produce small herpetic spots about the nostrils. Emplastrum Menthol, B. P., is used as a mild local irritant and anaesthetic. PEPSIN. Pepsinum, U. S. and B. P., is the digestive ferment of the gas- tric juice. That sold in the shops is generally derived from the pig, and is prepared by many persons in many ways. Much of the pep- sin of the market contains more peptone than pepsin, and much mucus and albumin. Used Avith hydrochloric acid in weak solution, pepsin carries out the digestive action of the stomach. Pepsin con- taining peptone has the peculiar musty smell of peptone, and if the peptone is in excess will absorb moisture and become sticky on ex- posure to the air. According to the U. 8. P. of 1890, official pepsin must have the poAver to digest three thousand times its weight of albumin. Therapeutics.—Pepsin is a much-overrated remedy for indigestion. Pancreatin will always be found more serviceable, and should be given either immediately or one or two hours after meals. Pepsin should be used immediately after the food or with it. Hydrochloric acid should always be given, as its presence converts any pepsinogen in the gastric tubules into pepsin. Pepsin is official in the U. 8. P. as Pepsinum and Pepsinum Saccharatum. The dose of the latter must be 20 to 30 grains (1.3—2.0) to be of any service. It is a weak and almost use- less preparation, largely made up of milk-sugar. Liquor Pepsini is given in the dose of 2 drachms (8.0). Pure pepsin should be given in 5- to 15-grain (0.35-1.0) doses. A very useful and readily taken liquid preparation is Pepsin Cor- dial, Avhich is given in the dose of 1 to 2 drachms (4.0-8.0) after meals. A nutritious article of diet can be made by adding one teaspoonful of this cordial to a half pint of warm milk, and allowing it to cool, thereby forming " curds and whey." (See Part III.) 310 DRUGS. 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 Avater. In the presence of moisture it rapidly gives up the oxygen which it contains and becomes the binoxide of manganese. By reason of this oxidizing power the permanganate of potassium is useful as an antiseptic and deodorant. It should not be employed as a disinfectant, because its action is too fleeting, but in saturated solu- tion, followed by oxalic-acid solution, it proves itself the best disinfec- tant for the hands in surgical practice. (See Antisepsis.) Permanganate of potassium is given in the same dose for amenor- rhea as the binoxide of manganese, but is much less efficacious. It is also very apt to irritate the stomach. The permanganate is thought to be usefnl in dyspepsia, flatulence, lithemia, and obesity, and in the former states is certainly of service, being a destroyer of the abnormal products by oxidation. OAving to this oxidizing power, 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 also be injected hypodermi- cally about the seat of the bite. Permanganate of potassium is the best antidote in poisoning by morphine and that caused by many other vegetable alkaloids. Owing to its rapid evolution of oxygen, 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 SAvab in the sore throat of diphtheria and scarlet fever. The solution used should be from 20 to 60 grains (1.3-4.0) to the pint (\ litre) ; the former is used on mucous membranes, the latter for sores and wounds. In fetid rhinitis and otitis media permanganate solution is useful as a Avash in the proportion of 1 grain (0.05) to the ounce (32.0). 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 Avill explode. A solution (Liquor Potassii Pcrmangana- tis) is official in the B. P. PETROLATUM. Under the name of Petrolatum Mode, U. S., or Soft Petrola- tum, or Unguentum Petrolei, is sold a semi-solid substance derived from certain kinds of petroleum, and sometimes called Cosmoline or Vaseline. Ovring to its soothing powers and non-rancidity, it is used as an emollient dressing in sores and skin affections. It has no value except as a protective, and may be given in capsules in cases of gas- tro-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 ointment base for medicines for the skin. Under the name of fluid or liquid petrolatum (Petrolatum Liquidum, U. 8.) a fluid form is sold, which is much used in the form of a spray PHENA CETIN. 311 in the treatment of rhinitis and after irritant applications to the nasal cavities. The U. S. P. now recognizes, in addition to these two preparations, Petrolatum Spissum, which has the consistence of a cerate. PHENACETIN. Phenacetin (Phenocetinum, B. P.) is a coal-tar product introduced several years ago as an antipyretic of the same character as antipyrin, and, Avhile 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, Avhich produces irritation of the kidneys, 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 phenacetin in the proportion of one- fifth. If the phenacetin is impure, it will become purple, then red, and finally blue. Physiological Action.—Unfortunately, our knoAvledge of the phys- iological action of phenacetin upon the nervous system is not as thorough as is desirable. We knoAv, however, that it is a distinct nervous sedative, and that it acts particularly on the spinal cord in its sensory tracts. Upon the circulation the drug has little or no effect, unless given in doses far above those generally employed or continued in overdose for some time. The blood after the ingestion of these doses becomes dark and blackish from the formation of methaemoglobin, and the urine becomes dark yelloAV 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 increasing the dissipation of heat. Therapeutics.—Our knoAvledge concerning the influence of phen- acetin upon the human body in disease may be divided into two separate parts in much the same manner that Ave divide the uses of antipyrin—namely, its uses as an antipyretic and as an analgesic. Like the other members of the antipyretic group Avhich 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 Avas first attempted by Hinsberg 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 (0.15-0.5), was quite extraordinary. Very shortly after the paper of these Avriters 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 successors, that the fall of fever does not occur for nearly half 312 DRUGS. an hour after the dose is taken, and that the stage of apyrexia con- tinues for from four to eight hours afterward. As a general rule, SAveating 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 under its influence. 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 tAventy years phenacetin 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 poAver 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 phenacetin seldom have as powerful an antipyretic influence as even- ing doses. Tavo morning doses are only equal to one evening dose in most cases. The conclusions of Kohler have been confirmed by Hoppe in a long series of studies, and this Avriter also points out the deleterious excess of apyrexia Avhich sometimes comes on in debilitated cases of phthisis under its use. One of the advantages of having several drugs belonging to one , class is the benefit often derived from the use of one Avhere another has failed. Thus Ilueber found that in several instances phenacetin Avas successful where antipyrin had not acted, and believes it to be the more poAverful drug of the tAvo—a conclusion also reached by Heusner, Avho thinks that 15 grains (1.0) of phenacetin are equal to half as much acetanilid and to 30 grains (2.0) of antipyrin. Lepine, who has studied Avith 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 as to phenacetin are, in the author's belief, far too favorable, for, Avhile he has found the drug to possess powerful antipyretic activity and to be useful in nearly all the fevers Avhere anti- pyrin can be employed, 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 Avorthy of rapid and certain reduction; neither does he believe it to be as safe as antipyrin. Upon the nervous system phenacetin acts as an antineuralgic—is of service in migraine and ordinary headache, from eye-strain, in the pains of tabes dorsolis, in intercostal neuralgia, and in rheumatism. Sometimes it cures these troubles Avhen antipyrin fails. Altogether, we may consider phenacetin a rival of antipyrin in the poAver to relieve pain. For neuralgia the folloAving prescription may be ordered: R.—Phenacetin.............gr. x (0.65). Caffeinae citratis...........gr. v (0.35). Sacchar. lactis ...........gr. xx (1.3).—M. j?t. in chart No. v. S.—One powder every two hours while pain lasts. PHENOCOLL—PHOSPHATE OF SODIUM. 313 In subacute rheumatism and in the lumbar or muscular pains of influenza a powder or pill of 4 grains (0.3) of phenacetin and 5 grains (0.35) of salol given three or four times a day is most efficient. Under the name " Lactophenin" a nearly related compound of phenacetin is sometimes used for the same purposes. In phenacetin one atom of hydrogen is replaced by an acetic-acid radical; in lacto- phenin this atom of hydrogen is replaced by a lactic-acid radical. Similarly ''apolysin'' is made by replacing the atom of hydrogen by a citric-acid radical. It is also used as a substitute for phenacetin. As phenacetin is sometimes called acetphenetidin, lactophenin might be called lactophenetidin and apolysin citphenetidin. It is asserted that apolysin differs from the other drugs just named in that in it there are ' tAvo complete citric-acid groups, and that it is much less poisonous than phenacetin. The dose is about the same as that of phenacetin, or a little larger, about 5-10 grains (0.30-0.65) three times a day. PHENOCOLL. Phenocoll is a compound closely allied to phenacetin. It is ahvays used in the form of the hydrochloride of phenocoll, which occurs in a fine Avhite powder, quite soluble in Avater and forming a neutral solution. It is incompatible with alkalies. It is used as an antipyretic. Physiological Action.—A number of studies of the action of phe- nocoll 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 so great a sAveat when the fever falls as do its near antipyretic relatives. Von Mering has shoAvn that phenocoll has little lethal poAver, but Ott asserts that in poisonous dose it kills by failure of respiration, and causes paraplegia, cyanosis, and depression of the heart. Therapeutics.—Whatever advantages further clinical experience will shoAv this drug to possess over its older fellows in the antipyretic field, it can never be widely used as a remedy for fever, since no drug is now generally employed for this effect except in a limited class of cases. As pointed out in the article on the treatment of Fever, anti- pyretic 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 antipyrin or acetanilid, but, like these drugs, is contraindicated in advanced exhausting diseases, such as con- sumption. A number of clinicians have tried phenocoll hydrochloride for the relief of rheumatism and to remove neuralgic pain, Avith asserted success. As yet it has not been used largely enough to ensure its continuance as a remedy of positive value, except in cases of malarial fever, in Avhich it seems to possess distinct remedial power, The dose of phenocoll hydrochloride is 5 to 8 grains (0.35-0.6) two to five times a day. It is best given in capsule. 314 DRUGS. PHOSPHATE OF SODIUM. Sodii Phosphas, U. S. and B. P., is a preparation which has been used with the idea that it can supplant phosphorus. This is, of course, an error, as it has an entirely different effect. It is particularly useful for bottle-fed children, who continually alternate betAveen diarrhea and constipation, and is also useful for rickets. It should be added to each bottle of milk in the dose of 2 to 4 grains (0.1-0.2). Phosphate of sodium in small doses is slightly laxative, and large doses are purga- tive. Bartholow believes phosphate of sodium to be the best remedy that we have in hepatic cirrhosis and jaundice. To adults it should be given in the dose of 20 grains to 2 drachms (1.3-8.0) once, tAvice, or thrice a day according to the laxative effect desired. Many cases of general wretchedness or headache due to an excess of uric acid in the blood are relieved by the acid phosphate of sodium or of calcium, since both 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 continued use of these so-called acid phosphates is therefore ultimately harmful in gouty or rheumatic persons. (For an explanation of the purgative action of all salines see article on Magnesium Sulphate.) PHOSPHIDE OP ZINC. Zinci Phosphidum, U. S., is often used in place of phosphorus, OAving to its greater stability and readiness of administration. The dose is ^ of a grain (0.006) three times a day. It is used in gela- tin-coated pills. PHOSPHORIC ACID. The pure acid is very rarely employed in medicine, but when given is used in 2- to 8-drop (O.i-0.5) doses. In the form of dilute phosphoric acid (Acidum Phosphoricum Dilutum, U. 8. and B. P.) it is widely employed in the close of 20 drops to 1 drachm (1.3-4.0) as a tonic and gastric stimulant. It is not a food to the nervous sys- tem, does not resemble phosphorus 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 that organ in the digestion of food. PHOSPHORUS. Phosphorus, U. 8. and B. P., is a non-metallic element, gener- ally obtained from bones, and is very soluble in oils, less so in ether and alcohol. Its odor is very characteristic and peculiar. When placed in a dark room after exposure to light it is luminous, and if PHOSPHORUS. 315 exposed to the air will ignite. It should be kept in tightly-stoppered bottles under Avater. Very commonly it is contaminated by arsenic and sulphur. Physiological Action.—Phosphorus is found in 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 and 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 groAvth of bones phosphorus has a most remarkable influence, causing, when it is given to young animals, great increase in the size of these parts. The first change noted is an enlargement, Avhich consists in a jelly-like mass containing little or no bone salts, and this is finally converted into a very hard material Avhich 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 in view of the thorough studies of Wegner. 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 Avith its odor, and burning pain in the oesophagus, stomach, and abdo- men becomes a pressing symptom. Vomiting and purging now assert themselves, and both the matters which are vomited and those A\rhich are passed from the bowels may be luminous in the dark, OAving 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 be present instead of purging. Very soon the liver increases in size, and gives rise to general hypochondriac pain and tenderness as Avell 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 hope- ful prognosis, but in the course of a feAv hours jaundice begins in the conjunctiva and then extends over the entire body. With the onset of jaundice the vomiting and pain return Avith reneAved 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 of fecal matter Avhich are 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 inflammation Avhich has been produced in the liver. Later, nervous symptoms ensue. Muscular tAvitchings, headache, vertigo, Avild delirium, erotic convulsions, and finally unconsciousness and 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 vital organs, which consist in wide- spread fatty degeneration. These fatty changes occur even in the acute form of the poisoning. Atrophy of the liver, destruction of the 316 DRUGS. gastric tubules, pancreatic involvement, and kidney degenerations aid in producing the ultimately fatal results. During the poisoning by phosphorus the urine is scanty and per- haps albuminous, and is peculiar because of the unusual substances which are found in it. The most unusual of these is sarcolactic acid, which results from the breaking doAvn of the muscular tissues. Leucin and tyrosin are also found, and tube-casts Avith fatty globules in them are seen. Free fat-globules may also occur. Bile acids and bile col- oring matter are found in large amount, and the urine is generally dark-colored for this reason- As phosphorus is eliminated in the urine as hypophosphoric 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 loAver jaw, which may be widespread or limited. It never occurs in those who have no solution of continuity in the teeth or gums, and for this reason it is necessary that the employes in match-factories should have their teeth and gums constantly attended to. It has been said that pans containing turpentine Avhen set around the Avork-room Avill protect the Avorkmen, but this is certainly incorrect. Treatment of Acute Poisoning.—The antidote to phosphorus is generally taught to be the sulphate of copper, Avhich will also 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.—OAving to its influence on the development of bone, phosphorus is very useful in rachitis and osteomalacia. It is also useful in the sweats of general or nervous debility and in nervous exhaustion, and in some cases of melancholia depending upon over- work. 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, and in convalescence it is of service in aiding to build up the shattered forces of a patient. In the sequel;e of acute and chronic alcoholism and in morphio- monio it is of service. Phosphorus is also employed in sexual exhaustion or abuse. In boils and carbuncles and similar disorders phosphorus is very useful, particularly so in acne indurata. In pneu- monia some physicians use minute doses Avith the belief that it aids in the production of resolution, one of the most enthusiastic of these being Dr. Boardman Reed. In the neuralgia from nerve-depression and in cerebral softening and meningitis of a chronic type phosphorus often does good. PHYSOSTIGMA. 317 The dose of phosphorus is ^ to -fo of a grain (0.0006-0.0012) in pill form (Pilule Phosphori, U. S. and B. P.) but it may be grad- ually pushed to ^L- of a grain (0.003) if urgently needed. Phospho- rated oil (Oleum Phosplwratum, U. S. and B. P.) and Spiritus Phos- phori, U. S., are given in the dose of 1 to 5 minims (0.05-0.35). Elixir Phosphori (U. S.) is given in the dose of 15 minims to 1 drachm (1.0-4.0). The beginning dose of phosphorus should not be above y^ of a grain (0.0006), for fear of some idiosyncrasy. PHYSOSTIGMA. Physostigma. U. S. (Physostigmatis Semen, B. P.), is a seed derived from Physostigma venenosum. a tree of West Africa, often called Calabar bean. It contains tAvo alkaloids, eserine or physostig- mine and calabarine. The former is the most important from a med- ical point of view. Physiological Action.—When a moderate dose of physostigma is given by the mouth it often produces some pain in the stomach and a sense of oppression and Aveakness. The pulse becomes sIoav, the respi- ration is depressed, and the pupils are contracted. Calabar bean in poisonous dose is a general paralyzant, but if the alkaloid calabarine be present in excess, it may be a convulsant. Nervous System.—On the spinal cord in poisonous dose this drug acts as a depressant poison, particularly affecting the sensory tracts. On the motor nerves it exerts no influence unless given in toxic doses, when it depresses their peripheral ends. The sensory nerves escape, but sometimes even they are involved. On the voluntary muscles the drug in these doses causes tAvitchings. In medicinal doses the drug is a stim- ulant to unstriped muscular fibre and acts as a mild nervous sedative. Circulation.—Calabar bean causes little circulatory change, but poisonous doses at first produce a rise of arterial pressure, due to a direct stimulation of the heart and of the muscular coats of the vessels. It sIoavs the pulse by peripheral stimulation of the vagi. In medicinal dose its circulatory effect is not marked, but is depressant rather than stimulant. Respiration.—In moderate amount Calabar bean does not affect respiration, but in poisonous dose it produces death by paralysis of the respiratory centre. Pupil.—Physostigma causes myosis or contraction of the pupil by stimulation of the oculo-motor nerves peripherally, but not by depres- sion of the sympathetic fibres, and by causing contraction of the blood- vessels of the iris. It decreases intraocular tension, produces tempo- rarily an increase in the power of accommodation for near objects, and then causes spasm of accommodation. The myosis usually develops in about eight to fourteen minutes after the drug is dropped into the eye, and reaches its maximum in thirty minutes, lasting for from six to eight hours. The partial influence may last, however, for from four to five days. 318 DRUGS. Alimentary Tract.—Physostigma is a stimulant to intestinal peristalsis, increasing the muscular activity in the wyalls of the gut and aetino; as a tonic to these fibres. Poisoning.—Poisonous doses of physostigma cause muscular trem- ors, followed by complete muscular relaxtion. The pupils contract, the respirations become sIoav and irregular, and all reflex action fails. Vomiting or purging may or may not occur. Treatment of Poisoning.—This consists in the use of atropine, which is the physiological antidote, in 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 has been employed in many affections, such as trismus neonatorum, tetanus, and other spasms, with only moderately good results. It is, hoAvever, of value in atony of the bladder and intestines and in catarrh of the boAvels. The author has used it with advantage in cases of gastric and intestinal dilatation, combined with nux vomica. In broncliial asthma and emphysema it will aid in the expulsion of the mucus by its influence over the muscular fibres in the Avails of the air-tubes. It is also useful in purgative pills to stimulate the muscular fibres of the intestine. (See Constipation.) Administration.—Physostigma is used in the form of the extract (Extractum Physostigmatis, TJ. S. and B. P.) in the dose of \ of a grain (0.008), which may be readily increased to J of a grain (0.016). The tincture (Tinctura Physostigmatis, U. 8.) is given in the dose of 5 to 20 drops (0.3-1.35). This tincture is twice as strong as that official in the U. S. P. of 1880. Eserine is usually employed in the form of one of its salts (Physo- stigmina, B. P.). Physostigmine Salicylas, U. 8., and Physostig- mine Sulphas, U. 8., may be used in the dose of -£$ of a grain (0.0008) three times a day. The sulphate is much more soluble, and is generally to be employed. The salicylate is largely used, neverthe- less, by ophthalmologists. In the eye, of the strength of 1 to 2 grains to the ounce (0.05-0.1: 32.0) of Avater, eserine is used in the treatment of corneal ulcerations and for the relief of glaucoma and for the relief of high intraocular tension. If, for any reason, atropine mydriasis is to be rapidly overcome, eserine is to be used, but it is not so poAverful as atropine, and it will require larger amounts of the solution to produce contraction than it took of atropine to cause mydriasis. Lamella Physostigmine, B. P., each contain yoVs" °f a gra,in (0.00006) of physostigmine. The dose of both salts of eserine is yTo^To of a grain (0.0006-0.0008.) PICRIC ACID. Picric Acid or Trinitrophenol occurs in light-yelloAv scales or needles Avithout odor, and is chiefly used in the arts as dye. Its uses in medicine are very limited. Recently it has been found exceed- ingly efficacious in solution in the treatment of burns and scalds. This solution is made as MIoavs : PILOCARPUS. 319 R.—Acid, picric............ gr. lxxv (5.0). Alcohol.............f^iiss (75.0). Aquae destillata' .........Oij (1000 c.c).—M. After the burn is cleansed of dirt and charred clothing, strips of ster- ilized gauze are soaked in this solution and applied to the part. Over this is placed a pad of dry absorbent cotton Avhich is fastened by a light bandage. The dressing rapidly dries, and may be left in place for several days. It is then moistened with the solution so as to soften it, is removed, and then a fresh dressing is applied for a week. All blis- ters should be pricked. This dressing relieves pain, stops suppuration, and leaves a smooth cicatrix. PILOCARPUS. Pilocarpus, U. S. (Jaborandi, B. P.), is derived from the South American tree, Pilocarpus Selloanus or Pilocarpus Jaborandi. It contains tAvo alkaloids, knoAvn as pilocarpine and jaborine, a volatile oil, and other minor constituents. The alkaloid pilocarpine is non- crystallizable and occurs as a soft mass, but the salts of pilocarpine are crystallizable. Jaborine is never used in medicine, and has an effect antagonistic to pilocarpine, or like atropine. Physiological Action.—When jaborandi is taken in medicinal dose by a healthy man, it causes a deep flushing of the face and neck, fol- loAved by the outbreak of a profuse SAveat, Avhich, though beginning in these regions, rapidly spreads over the entire body. Accompany- ing the SAveat, the salivation is often exceedingly profuse, so that salha 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, according to Ringer, Avith children, who will often take as much as 60 grains (4.0) 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. Nera^ous 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 motor and sensory nerves in man are not affected. 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 than as a stimulant, and, Avhile 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 pres- sure, in moderate quantities, the first change being due to an action on the inhibitory centres in the heart or on the peripheral vagi. Ringer, 1 The writer has reported a case (see Idiosyncrasy) where a woman of thirty years received | of a grain of the muriate of pilocarpine hypodermically in half an hour without any effect. 320 DRUGS. on the other hand, has proved that it slows the beat of the ventricles in the frog Avhen 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 sIoav the pulse, but quickens it very markedly, often as much as forty to fifty beats per minute. The rise of arterial pressure seen in the animal is often replaced by a fall of pressure in man, and, though the pulse in ani- mals is generally made stronger from its use, in man it is generally made Aveaker. Stomach.—Jaborandi sometimes produces nausea and vomiting by irritating the stomach and perhaps the vomiting centre. Temperature.—Jaborandi loAvers bodily temperature to a con- siderable degree, probably by the dilatation of the peripheral capil- laries and the profuse SAveat Avhich it produces. This fall is some- times preceded by a brief rise. Kidneys and Tissue-avaste.—Upon the kidneys jaborandi acts verv 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 in disease the excretion of urea is largely increased under the influence of this drug. Eye.—Jaborandi contracts the pupil by stimulating the peripheral ends of the oculo-motor nerve in the iris. Skin and Secretion.—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 alka- line. The SAveating is not primarily due to vasomotor palsy, but to stimulation of the ends of the nerves supplying the glands and of the SAveat-glands themselves. The SAveat usually lasts about two to three hours. Sometimes excessive salivary secretion supplants that of the skin. Pilocarpine increases the gastric, salivary, and lachrymal secretions, as Avell as that of the skin and kidneys. It also seems to have con- siderable influence over the secretion of milk. Therapeutics.—Jaborandi, or, better still, its alkaloid, pilocarpine, is of some value for the relief of dropsy of the renal type. In that due to cardiac disease it is generally too depressing, and the author knoAvs of a case in which a fatal result speedily 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.) Better than all these is thoracentesis. Spauhling and de SchAveinitz have both recommended very highly the hypodermic use of pilocarpine in the dose of -^ to i1^ grain (0.005-0.006) a day for opacities of the vitreous honor of the eye. The fluid extract of jaborandi may be employed, but is apt to nauseate the patient. Diaphoresis should not be produced. Because PILOCARPUS. 321 of its myotic influence on the pupil pilocarpine is of very great value in the treatment of all conditions of the eye associated with increased intraocular pressure. It is so good a myotic as to be rapidly supplant- ing eserine for this purpose with some clinicians. The strength of pilo- carpine solution for this purpose is 1 to 4 grains (0.06-0.25) to the ounce (30.0). It should be dropped into the eye, 1 or 2 drops at a time, every hour until the patient is relieved. Pilocarpine is also use- ful as an ocular tonic to relieve eye-pain after excessive use of the eyes, in the strength of -^ grain (0.006), to the ounce (30.0). A few drops of this solution may be dropped into the eye three times a day. This solution should have a little boric acid (4 grains) added to it to prevent fungus groAvth. (See Asthenopia.) Clinical reports show that pilo- carpine in small doses is a very good remedy in tobacco and alcoholic amblyopia. Mitkowski has tried pilocarpine in catarrhal jaundice of a persistent type Avith great benefit, in the hypodermic dose of ^ grain (0.01) every other day for three Aveeks. In uremic poisoning pilocarpine is theoreti- cally the most efficient and rapidly acting remedy that Ave have, and when used in Bright's disease it may be of value in several ways—first, by removing the strain on the kidneys ; second, by eliminating the uraemic poison; and third, by decreasing the inflammatory condition in the kidneys by lowering the blood-pressure, which, it will be remembered, is the more constant effect of the drug in man. Care should ahvays be used in the use of the drug lest cardiac depression ensue, and alcohol or strychnine may often be used with advantage to guard against this accident. The general consensus of opinion is that in the nephritis of middle years or advanced life Avith cardiac changes it is contraindicated. The author never uses it in chronic renal disease of the parenchyma. In the uraemic convulsions of pregnancy pilocarpine, while theoretically useful, has been proved by experience to do more harm than good through its depressing influences, although the drug in small doses cer- tainly increases renal activity. The hypodermic dose of pilocarpine as a renal stimulant should be about -^ to -^ of a grain (0.002-0.003). In some forms of profuse sweating, such as come on at night in cases of general debility, pilocarpine, if given hypodermically or by the mouth about two hours before the sweat in the dose of -^ of a grain (0.003), is often useful even where atropine fails. The good effect is produced by stimulating the sweat-glands and so overcoming their atony. DaCosta, Salinger, and Barr have highly recommended the hypo- dermic injection of pilocarpine in erysipelas as a preventive and cura- tive measure in the early stages of this disease, and their reports are so encouraging as to warrant a careful trial of the method. The proper dose is ^ grain (0.01) every three hours until free sweating ensues. After this is accomplished the doses may be repeated every four or six hours. The author would fear that such active treatment might seriously affect the strength of the patient unless stimulants were also used. In cases of obstinate aural vertigo a most efficient treatment is the hypodermic use of pilocarpine every feAv days in sufficient dose to pro- 21 322 DRUGS. duce some salivation. The patient has to lie doAvn or go to bed after the dose is given. Pilocarpine certainly has a decided effect in encouraging the growth of hair, and applied 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 application for baldness: R. - Extract, pilocarpi fluid.........f 5j (32.0). Tinctune cantharidis.........f 5ss (16.0). Liniment, saponis...........f ^jss (48.0).—M. The author has found the following prescription peculiarly effica- cious in falling of the hair: R.—Extract, pilocarpi fluid. .........f.^j (4.0). Tr. capsici ...........fgj (32.0). Tr. cantharidis............f Jss (2.0). 01. ricini...............f ^j (4.0). Alcohol............q. s. f Jiv (128.0).—M. S.—Apply with friction in spots to the scalp, night and morning. Antagonisms of Jaborandi.—Jaborandi is a physiological antidote to atropine and to agaricin. Four times the dose of pilocarpine must be used to equal a dose of atropine. Vomiting produced by pilocarpus is to be antagonized by morphine. Untoward Effects.—Dimness of vision, vomiting, and sudden col- lapse, swelling of the salivary glands and tonsils, hiccough and strang- ling are sometimes met with after using pilocarpus. Sometimes bloody leucorrhcea is seen. Administration.—The dose of jaborandi is 40 grains (2.65), used in the form of the powdered leaves in infusion. The fluid extract (Extractum Pilocarpi Fluidum, U. S.) should be used in the dose of 30 drops to 1 drachm (2.0-4.0). Pilocarpine is far superior to jabo- randi, in that it does not so often produce nausea and vomiting. It is used in the form of the hydrochlorate (Pilocarpine Hydroehloras, U. S.), in the dose of from \ to J of a grain (0.008-0.03) hypoder- mically, or \ to \ of a grain (0.015-0.03) by the mouth. The preparations of the B. P. are—the extract (Extractum Jabo- randi), dose 2 to 10 grains (0.1-0.65); the infusion (Infusum Jabo- randi), dose 1 to 2 fluidounces (32.0-64.0); the tincture (Tinctura Jaborandi), dose \ to J fluidounce (8.0-16.0); and the nitrate of pilo- carpine (Pilocarpine Nitras), dose -^ to J grain (0.003-0.03). PIPERAZINE. This is a substance, the chemical formula of Avhich is C4HI0N2, Avhich has been recently introduced into medicine for the treating of the uric-acid diathesis. It is not stable, and Avhen 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 PISCIDIA ERYTHRINA. 323 twelve times as much as will carbonate of lithium, Avhile it is also entirely soluble in Avater, 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. Experiments have been made to determine this point Avith very satis- factory results, but repeated clinical observation has shown that the administration of the drug causes an increase in the amount of urea in the urine with a decrease in the uric acid, indicating that under its influence 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 in cases Avhere the excess of uric acid in the urine tends to pro- duce irritation of the bladder. Similarly, its action has been found of value in treating vesical irritation due to this cause by Avashing out the bladder Avith a solution of piperazine of the strength of 1 per cent. Piperazine has also been injected into uric-acid deposits about the body or applied to the broken-doAvn surfaces of these deposits in 1 per cent, solution, but the author has not been favorably impressed with this method, and Avould advise against its use—first, because it does little if any good, and, second, because the method is painful and apt to cause sloughs by interfering with nutrition of the skin, which is already lacking in health. The dose of piperazine is 15 grains (1.0) in tAventy-four hours. It is best given by dissolving this amount of the drug in 1 pint Q- litre) of Avater, and directing the patient to take a wineglassful of the solu- tion frequently through the day. OAving 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 Avriter has failed to obtain any results from the use of this drug in his practice. Stewart has noted, as untoward effects of full doses of piperazine, tremors, hallucinations, and clonic spasms. 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 and analgesic do not compare Avith those of opium, but it is stated to be devoid of the unpleasant after-effects 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 indica- tions 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 \ to 2 drachms (2.0-8.0); of the solid extract, 2 to 10 grains (0.1- 324 DRUGS. « 0.65). The alkaloid piscidine is not known to represent ah the prop- erties 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 Avood-tar. It is used for various purposes, according to its derivation. Burgundy Pitch (Pix Burgundica, U. S. and B. P.) is derived from Nonvay spruce, or Abies excelsa, a plant of Europe and Asia. It softens and melts at the temperature of the body and is use- ful for plasters. In muscular rheumatism and in chronic bronchitis pitch is a mild and fairly useful local remedy for external use. In the form of the plaster (Emplastrum Pic is Burgundice, U. 8. and B. P.) and in the form of warming plaster (Emplastrum Puis Contharidatum, U. 8.) it is employed for the relief of deep-seated sprains and bruises, and acts as a mild counter-irritant, Avhich may blister a tender skin. Canada Pitch (Pix Canadensis, B. P.) is obtained from the hemlock spruce of Canada and the United States, and is used for the same purposes as Burgundy pitch. The Canada-pitch plaster (Emplastrum Picis Canadensis) is employed for the same conditions as the plaster of Burgundy pitch. Tar. Under the name of Pix Liquida, U. S. and B. P., or Tar, we have an empyreumatic oleoresin obtained by destructive distillation from Finns palustris 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 Ave obtain oil of tar (Oleum Picis Liquide, U. S.), "which is sometimes used for bronchitis by inha- lations from an atomizer, but is not a particularly use 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 (0.1) pills and as a remedy for gastro-intestinal catarrh. Externally, it is used in psori- asis and other skin diseases needing stimulation. For the relief of obstinate diarrhea Wood has highly recommended a mixture of tar made as follows : Add a pint of tar to a gallon of lime-water, and alloAv this solution to stand one week, stirring it every few hours. Decant the clear liquid and percolate it through powdered wild-cherry bark. allowing 1 ounce of the bark to be present for each pint passed through it. The dose is a A\ineglassful (30.0). In chronic bronchitis tar-Avater is largely used, as a popular rem- edy, in Europe and England. Tar-Avater is made by shaking 1 part of tar Avith 4 parts of Avater several times during tAventy-four hours, decanting, and filtering. The dose is from 1 to 2 pints (^-1 litre) a day as a drink. It at first increases the expectoration, but finally decreases it. Syrup of Tar (Syrupus Picis Liquide, U. S.) is simply SAveet- ened tar-water. PODOPHYLLUM. 325 In skin diseases of the dry, scaly sort, such as psoriasis, tar oint- ment (Unguentum Picis Liquide, U. S. and B. P.), equal parts of tar and suet, is very useful if frequently applied, or the following may be used: R.—Sulphur.prsecipitat. 1 .. „ . ,„.., Picis liquid* }........aa 3VJ (24.0). Saponis viridis "I .. z.. ,a.M Adipis }..........aa 3y (64-°)- Pulv. cret.ie..............giv (16.0). If the skin is tender, this prescription should be diluted with lard. Sometimes children Avill suffer from a persistent dry chronic eczema which resists all treatment; the folloAving may then be employed with advantage: R — Picis liquid..............,^ss (2.0). Sulphur, prsecip............,^ss (2.0). Unguent, zinc, oxidi..........3J (32.0). S.—Apply night and morning. Tar 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, AA'hite wine, and honey, of each J a pint, dilute acetic acid 1 ounce, and 3 quarts of boiling Avater, and shaking constantly at a temperature of 160° F. for several hours. It is then set aside to stand for some days and repeatedly filtered or strained through muslin. The dose is 1 to 4 ounces (32.0-128.0). It may be used instead of tar-water or tar-syrup. PODOPHYLLUM. Podophyllum, U. 8. (Podophylli Rhizoma, 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 official 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. The author has found the follow- ing prescription useful in cases of intestinal flatulence and indigestion with constipation : R.—Podophyllin . Euonymin Leptandrin Ext. chiratse . CreasotiE . • Ft. in pil. No. xx gr. v (0.26). gr. v (0.26). gr. v (0.26). gr. xlv (2.8). gr. x (0.65).—M. In children one or tAvo months old who have hard, stony stools podo- 326 DRUGS. phyllin is a good remedy. The dose should be given by dissolving a grain of the resin in a drachm of alcohol and using 2 drops or more of this on sugar once or tAvice a day. In children who suffer from summer 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 ^ to -^ of a grain (0.001-0.0012), repeated every few hours, is of service, seeming to control the passages and make them normal. This treatment will often succeed when all else fads. 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 tor- pid. It should not be employed if the vomiting is due to irritation or inflammation of the stomach. Administration.—Podophyllum is used in the form of the extract (Extractum Podophylli, TJ. 8.), dose 1 to 5 grains (0.05-0.35); the fluid extract (Extractum Podophylli Fluidum, U. S.), dose 2 to 20 drops (0.1-1.3); and, more commonly than all, as the Resina Podo- phylli, U. S. and P. B., or podophyllin, which is the best preparation. The dose of this preparation is from ^ to -^of a grain (0.003-0.006) as a feeble laxative, and from y1^ to \ a grain (0.006-0.03) as a purge. The tincture of the resin (Tinctura Podophylli, B. P.) is given in the dose of 15 minims to 1 drachm (1.0—4.0). POMEGRANATE. Although Grranatum ( 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 Avhich four are used —namely, the tannate, the sulphate, the hydrobromate, and the hydro- chloride. The first is most commonly employed, and is a yellowish powder possessing an astringent taste. It is soluble in 700 parts of water and 80 of alcohol. Its physiological action needs further inves- tigation, but the drug in poisonous amounts paralyzes the peripheral ends of the motor nerves in a manner closely resembling the action of curare. Sensibility is preserved. The loss of power is chiefly mani- fested in the lower limbs, in which at first there may be cramps. Tnere may also be nausea and vomiting. Therapeutics.—Originally, pomegranate was largely used in the form of the rind of the fruit in decoction as a vegetable astringent, but this practice has ceased because of its disagreeable taste and effect upon the stomach. The ailments Avhich were supposed to indicate its em- ployment were serous diarrhoea and profuse sweats. In some tropical countries the bark of the root is used as a vermifuge, and it is very efficient in removing the tape-worm. It is said that the bark of the root of the wild shrub is much more efficacious than that of the cul- tivated and more handsome plant. To be efficacious the dose of the PRUNUS VIRGINIANA—PYROGALLOL. 327 decoction of the bark must be large. The drug is prepared by soak- ing 2 ounces (64.0) of the bark in 2 pints (1 litre) of water for tAventy-four hours and then boiling doAvn to a pint (| litre). A Avine- glassful (32.0) of this is the dose Avhich is generally given, and it may be repeated every hour until the Avhole amount is taken. The objec- tion to this line of treatment 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 Avorm, and it is ahvays neces- sary to starve the patient for tAvelve hours before the remedy is tried. The dose of pelletierine is 3 to 5 grains (0.25-0.35), and the tan- nate is the salt ahvays employed. Practically, the only pelletierine used is that of Tanret, and his preparation is a syrupy solution in each bottle of Avhich is one dose of the drug. As large doses as 20 grains (1.3) of pelletierine have been used, but as very serious paralytic symptoms have ensued after the inges- tion of 5 grains by a susceptible Avoman, not more than this amount should be given. When pelletierine is used it should always be fol- loAved in two hours by a purge. Those Avho have used it most place great reliance on it. The B. P. contains one official preparation of pomegranate— namely, the Decoction Cranati Radicis, the dose of which is 1 to 2 fluidounces (32.0-64.0). PRUNUS VIRGINIANA. Primus Virginiona, U. 8.—Wild Cherry, as it is incorrectly called —is the bark of Primus serotina, a large tree of the United States and Canada. It contains tAvo substances, known as emulsin and amygdalin, Avhich Avhen they come together in Avater form hydro- cyanic 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. S.), dose J to 1 ounce (16.0-32.0), and the fluid extract (Extractum Pruni Virginiane Fluidum, U. S.), dose 30 drops to 1 drachm (2.0-4.0). The syrup (Syrupus Pruni Virginiane, U. S.) is given in the dose of 1 to 4 drachms (4.0-16.0). PYROGALLOL. Pyrogallol, U. 8., sometimes called Pyrogallic Acid, is a triatomic phenol obtained by dry distillation of gallic acid, and should be kept in dark, well-stoppered bottles. It occurs in light Avhite scales or crys- tals, has no odor, but a bitter taste. If exposed to the light, it becomes 328 DRUGS. dark. It is soluble in 2| parts of water, and readily so in ether and alcohol. Therapeutics.—Pyrogallol is used in parasitic skin diseases, in ointment, in the strength of 30 to 100 grains (2.0-7.0) to the ounce (32.0). The stronger ointments exercise a mild caustic effect. It may be employed in place of chrysarobin in psoriasis. Unfortu- nately, it stains the skin a deep brown. PYOKTANIN. (See Methyl Blue.) QUASSIA. Quassia, U. S. (Quassie Lignum, B. P.), is the wood of Pierena excelsa, a large tree of Jamaica and other islands of the West Indian group. It contains an active principle, named quassin, Avhich is 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 as a tonic, is supposed to be particularly useful in the anorexia follow- ing malarial fevers, and has even been thought to possess antiperiodic power. In simple dyspepsia Avith eructations after meals, not due to gastritis, it is very serviceable. In the treatment of seat-worms (Oxyuris vermicular is), 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 boAvel should be Avell Avashed out by soap and water, and | pint to a pint of an infusion, made by adding 1 or 2 ounces (32.0-64.0) of quassia chips to a pint (i litre) of Avater, 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 Avith 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 i a drachm to 1 drachm (2.0-4.0), the fluid extract (Extractum Quassie Fluidum, TJ. 8.) J a drachm (2.0), and the extract (Extractum Quassie, TJ. 8. and B. P.) 1 to 3 grains (0.05-0.15). The infusion (Infusum Quassie, B. P.) is given in the dose of J to 2 ounces (16.0-64.0), and is made by macerating 1 drachm (4.0) of quassia with 10 ounces (320.0) of water, and allow- ing it to stand twenty-four hours or more. QUERCUS ALBA. Quercus Alba, U S., or White Oak, in infusion is used as an astringent injection in gonorrhea and vaginitis in the female, where RESIN, OR ROSIN—RESORCIN. 329 a large amount of fluid is necessarily employed. It is also used in prolapse of the rectum, in hemorrhoids, in leucorrhea, 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 of the strength of 1 ounce to the' pint (32.0 : i litre). In the form of the poAvdered 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. Resina, 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 Avhen inhaled are said to be of value in cases of chronic bronchitis. Ceratum Resince, U. S., is used in chilblains and superficial scalds, and Emplastrum Resine, U. S. and B. P., is adhesive plaster. Unguentum Resince is a B. P. preparation used for the same purposes as the plaster or cerate. RESORCIN. Resorcin, U. S. (metadioxybenzol), is the weta-compound of the group of Avhich hydrochinone is the para- and pyrocatechin the ortho-, and 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 mem- branes, and when taken internally in poisonous doses causes deafness, giddiness, salivation, profuse SAveat, unconsciousness, and clonic con- vulsions. The heart of the dog under its influence is at first slowed by vagal stimulation, and then becomes very rapid from vagal palsy. Therapeutics.—Resorcin has been found of service as a remedy for ivhooping cough, given in the dose of 10 drops (0.65) 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 psori- asis. In these states an ointment of the following character, well applied, is of service : R.—Kesorcin...............3J (4.0). Zinci oxidi..............3J (4.0). Ung. aquae rosse ... ......3x (40.0).—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. 330 DRUGS. Resorcin is also of service in Aveak solution in allaying itching of the skin due to erythematous eczema. For this purpose it should be used in watery solutions of about 10 to 15 grains to the ounce, and a little salt added to aid in its absorption by the skin. This should be dabbed, not rubbed, on the part: R— Kesorcin...........gr. xv (1.0). Glycerin............"lx (0.65). Liquor calcis...........fgj (30.0).—M. In sloAvly spreading epithelioma of the face the following plaster, recommended by Hartzell, is useful: R— Resorcin............gr. lxxii (5.0). Ceree flav. et pulv. resinse.....3jss. (6.0) 01. olivse....... . . . q. s.—AI. Within the last few years resorcin has been employed with good results in the treatment of gastric ulcer in the dose of 2 to 4 grains (0.1-0.2) before each meal in pill or capsule. It is supposed to act by reason of its analgesic, antiseptic, and haemostatic power. 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, Avhich 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 Radix, P. B.), is the root of Rheum offici- nale, a plant of Thibet, but which is cultivated in America and else- where. It is also derived from China, and this variety is known as Chinese rhubarb. Several alkaloids are contained in it, all of which are unimportant and 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. OAving to the astringent properties possessed by rhubarb, it does not 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 Avhich 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 RHUS AROMATICA—RHUS GLABRA. 331 beyond those directly produced by the dose. In the summer diarrhea of children, when the stools are green, rhubarb is often used to empty the boAvels of fermentative products before direct treatment is instituted. Rhubarb, because of its chrysophan, may stain alkaline urine car- mine or acid urine yelloAV. Administration.—The preparations of rhubarb are unnecessarily numerous. Rhubarb itself may be given in the dose of 20 grains (1.3) in poAvder, and small pieces of the root are habitually cheAved 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 (0.35-0.65) in pills. Pilule Rhei, TJ. 8., of Avhich each pill contains 3 grains (0.25) of rhubarb, is given in the dose of one to three pills (0.05-0.25); and Pilule Rhei Compositus, U. 8. and B. P., which contain 2 grains (0.1) of rhubarb and H (0.09) of aloes, are given in the same dose. Pul- vis Rhei Compositus, U. 8. and B. P., contains rhubarb, magnesia, and ginger, and is given in the dose of 20 to 40 grains (1.3-2.6); Ex- traction Rhei Fluidum, U. S., is given in the dose of 20 to 30 minims (1.3-2.0). Syrupus Rhei, U. S. and B. P., is given in the dose of 1 drachm (4.0) to a babe, and 4 drachms (16.0) to an adult, although rarely used for older persons. Syrupus Rhei Aromaticus, U. 8., is given in the same dose and to the same class of cases. Tinctura Rhei, U. S. and B. P.. is used in the dose of 1 to 2 drachms (4.0- 8.0), and Vinum Rhei, B P., in the dose of 1 to 4 drachms (4.0-16.0). Tinctura Rhei Aromatica, U. S., is used in the dose of \ to 1 drachm (2.0-4.0), and Tinctura Rhei Dulcis, U. S., 2 to 3 drachms (8.0-12.0). The aromatic spirit is commonly employed for children, and the com- pound pills for adults. Infusion Rhei, B. P., is given in the dose of 1 to 2 ounces (32.0-64.0), and Mistura Rhei et Sode, U. 8., in the dose of 2 drachms to 3 ounces (8.0-96.0). RHUS AROMATICA. SAveet Sumac is unofficial, but has been so largely used of late that it deserves notice. In hematuria, monorrhagia, diabetes insip- idus, and in urinary incontinence in children depending upon vesical atony it has been highly praised. In the latter affection a sufficient amount of experience has been acquired to shoAv 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 (1.0) of this preparation. Adults may take from 15 to 60 drops (1.0-4.0). The drug is best given with glycerin and Avater. RHUS GLABRA. Rhus Glabra, U. S., Smooth Sumac, is the fruit of Rhus glabra, and contains tannic and malic acids as its chief constituents of me- 332 DRUGS. dicinal value. In the fluid extract (Extractum Rhois Grlabre Fluidum, U. S.) Ave 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. Potassi et Sodii Tartras, U. 8. (Soda Tartarata, B. P.), is largely used as a saline cathartic in the dose of ^ an ounce (16.0), and is preferred by many patients to Epsom salts because its taste is not so disagreeable. It is, however, more irritating. Rochelle salt is the purgative constituent of Seidlitz powder. ROSA CENTIPOLIA. Rosa Centifolia, U. S. (Rosa' Centifolia Petola, B. P.), Pale Rose, possesses almost no medicinal value, but is mentioned because its official preparations are largely used in practice. Aqua Rose, U. S. and B. P., is used as 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. 8., 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 Aveather. ROSA GALLICA. Rosa Gallien, U. S. (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 Rose Fluidum, U. 8., dose 5 drops to 2 drachms (0.35-8.0), used to flavor other extracts, and the Confectio Rosonis Mollis, U. 8.), which is to be thoroughly rubbed into the part Avhen used medicinally, Avell washed off, and afterAvard simple cerate or some other soothing salve applied. Soap Liniment (Linimentum Saponis, U. 8. 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. R.—Tinct. aconiti 1 Tinct. belladonna? >........aa f^ij (8.0). Tinct. opii j Liniment, saponis ......q. s. ad f^vj (192.0).—M. Soap Plaster (Emplastrum Saponis, U. S.) is used as a thick, heavy protective for bed-sores or where bed-sores are feared. It is also used as a support about sprained joints. SODIO-SALICYLATE OP THEOBROMINE. This compound, knoAvn as diuretin (or sodio-theobromine-salicy- late), deriA'es its name from the extraordinary power Avhich it is said to possess of producing a great increase in the urinary flow from the kidneys. This power depends entirely upon the theobromine, Avhich is a crystallizable, bitter, and volatile alkaloid, closely allied to caf- 350 DRUGS. feine and xanthine, and derived from the seeds of Theobroma Cacao, or the source of ordinary chocolate. OAving to the insolubility of theo- bromine, it has been found necessary to combine it Avith sodium salicy- late, as under these conditions it is readily absorbed. The diuretic properties of this alkaloid were first discovered during aperies of experiments made by Schroder in Strasburg in 1889, who found that the diuresis produced in man and the loAver animals Avas very marked. A large number of clinical trials in Europe and America have confirmed his observations, but there are a number of cases in which it signally fails, particularly in chronic Bright's disease. Theobromine does not have so stimulating 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 increases 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 administration; but it is probable that the drug is useful in almost all conditions 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 contraindication 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 and liquids in the urine under the influence of this drug have been made, but the fact that it stimulates the epithelium or secreting structures of the kidney would indicate 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 (4.0-8.0) in twenty-four hours, preferably in divided doses of from 10 to 20 grains (0.65-1.3) in capsule or in Avarm Avater. 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 Avriter has tried sodio-salicylate of theobromine he has failed to see any effect produced, and, while he has no confidence in the drug, he mentions it because others claim to have obtained good results from its use. SODIUM. Sodium is a metallic element, the salts of which are usually white and colorless. It is not used in medicine, but many of its salts are employed. While potassium acts as a depressant to the body, sodium seems to exert comparatively little effect upon the animal economy. The salts vary in their poAver Avith the acid forming them. (See Ben- zoate of Sodium, Chloride of Sodium, Salicylate of Sodium, etc.) SODIUM ETHYLATE—SODIUM SULPHATE. 351 Acetate of Sodium (Sodii Acetas, U 8. and B. P.) is rarely if ever used in medicine as a substitute for acetate of potassium. The dose is 20 to 40 grains (1.3-2.65) three times a day. SODIUM ETHYLATE. Sodium Ethylate is a Avhitish poAvder, 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 Avith a glass rod. Soon after this application a crust forms, which should not be detached for two or three Aveeks, 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. solution of cocaine may be used hypodermically at the spot to be cauterized. It is worthy of remembrance that moles and small birth- marks, or naevi, may be relieved by a similar application. SODIUM HYPOSULPHITE. Hyposulphite of Sodium, or Thiosulphite of Sodium, occurs in large, transparent, colorless plates Avhich effloresce when exposed to the air. It has slight alkaline reaction, is soluble in about equal parts of water, but insoluble in alcohol. Therapeutics.—Hyposulphite of sodium is used in the proportion of 1 drachm (4.0) to the ounce (32.0) of water or lard in the treat- ment of parasitic skin diseases, particularly those due to the tri- cophyton fungus, such as pityriasis versicolor. It is also very useful, locally applied, in poisoning from poison ivy, and in cases of pruritus due to other causes, in the strength of ^ a drachm (2.0) to the ounce (32.0) of water. In malarial hematuria hyposulphite of sodium is often given with advantage in the dose of from 10 to 30 grains (0.65- 2.0) every four hours. How it acts in this condition we do not know. SODIUM SULPHATE. Sodii Sulphas, TJ. S. and B. P., or Glauber's salt, is one of the most irritant of the saline purges, rarely used in medicine for human beings. but largely employed by veterinarians. The purgative dose for man is half an ounce to an ounce (16.0-32.0). If any intestinal inflam- mation is present, it is contraindicated. It produces large watery stools, with a good deal of griping. Sulphate of sodium is a promi- 352 DRUGS. nent constituent of Carlsbad water, Hunyadi Janos, Hunyadi Arpad, and similar waters. (For an explanation of the action of salines in producing purgation, see Magnesium Sulphate.) Reverdin has recently claimed that small doses of 2 grains (0.1) of sulphate of sodium every hour are of great value in controlling capil- lary hemorrhages and for graver hemorrhages. It must be given by the mouth or intravenously. If given hypodermically he asserts it is useless. SOLANUM CAROLINENSE. Solanum Carolinense, or Horse Nettle, is a low perennial plant of the natural order Solanacee, a native of the South-eastern United States. According to some studies made by Thornton the drug depresses the cerebrum, but excites the spinal cord. It has been introduced into medicine for the purpose of relieving epilepsy, particularly when the disease occurs in childhood. In a limited employment of the drug the Avriter has found it very serviceable in diminishing the frequency and severity of the attacks. The beginning dose of the fluid extract is 15 to 60 minims (1.0-4.0) three times a day, but it can be increased to as much as a drachm at a dose Avith advantage. 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 SAveet spirit of nitre. The dose is 20 to 40 drops (1.3-2.6) in liquorice-water or syrup of raspberry, and the sleep produced by it is said to last seven to eight hours. No very definite reports have yet been made concerning it, but in a number of cases in which the Avriter has used it it has acted very well, although droAvsiness is usually present on the next day. SOZOIODOL. Sozoiodol is an antiseptic preparation first made and employed by one of our OAvn countrymen in San Francisco, but at that time the preparation of it was so imperfectly carried out that foreign matters made it too irritating for general use, and it was discarded, only to be better prepared and more Avidely used in German}' some years later. Therapeutics.—Sozoiodol has been found of value as an antiseptic and disinfectant in the treatment of wounds which are in an unhealthy state, and for acute stomatitis and pharyngeal catarrh it may be employed locally in the form of a 5 per cent, watery solution. It has also been found useful in acute purulent conjunctivitis and in oph- thalmia neonatorum, in the proportion of 2 parts of sozoiodol to 30 SPIGELIA. 353 parts of Avater. In urethritis of a specific type we may employ the preparation knoAvn 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 gynaecological cases, particularly in catarrh of the cervix uteri, Nitschman uses sozoiodol in 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. 8., Pinkroot, is the root and rhizome of Spigelia marilandica, 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 move- ments, amounting almost to a cough. Soon after the pupils become Avidely dilated, the eyeball is turned inward, and at the same time the orbit becomes fixed in this position, so that the eye cannot follow any object, such as a pencil, Avhen it is moved from side to side. Constant retching, Avith no result, noAv comes on, the animal standing and apparently 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 noAv passes off, and at this time signs of muscular weakness and lack of co-ordination 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 and no longer moist. Muscular poAver is progressively lost, so that the dog fre- quently falls Avhen endeavoring to Avalk, but sensation does not seem to be affected. About this period the animal lies down and passes into a deep sleep, Avhich, 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 sIoav, 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. Therapeutics.—Spigelia is one of the most efficient remedies in the treatment of roiovl-worms, and is not dangerous when given Avith care. When employed for the removal of worms the usual precaution should be taken in regard to the ingestion of food (see article on Worms), and the drug should be followed by a purge to sweep out the worm while it is narcotized. 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 extract (Extractum Spigelie Fluidum, U. 8.) is 2 drachms (8.0); 23 354 DR UGS. that of the unofficial fluid extract of spigelia and senna (Extractum Spigel'm et Senne Fluidum) is I to 1 drachm (2.0-4.0) for a child of two years of age; h an ounce (16.0) is the dose for an 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 remem- bered that this latter mixture is no longer official. SQUILL. Scilla, U. S. and B. P., is the sliced bulb of Urginea maritima, a plant of the countries bordering on the Mediterranean. It con- tains scillin, scillipicrin, and scillitoxin, all of Avhich possess poison- ous properties and none of Avhich are used in medicine alone, except by a few persons. Poisoning.—In poisonous doses squill produces vomiting, purging, dulness, stupor, intermittent palsy, convulsions, and death in 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 Bright's disease or renal con- gestion from cardiac trouble. In cardiac dropsy, combined Avith 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, and abdomen. Squill is usually given in dropsy, in pill form, as folloAvs: R .—Pulv. scilla?..............gr. x (0.65). Pulv. digital, fol............ $j (1.3).—M. 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 beginning of 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 the dose of 30 drops to 1 drachm (2.0-4.0) for an adult. As it contains antimony, it should be given Avith care. Administration.—The fluid extract (Extractum Scille Fluidum, U. 8.) is given in the dose of 1 to 5 drops (0.05-0.3); the tincture ('Tincture Scille, U. S. and B. P.) in the dose of 5 to 30 drops (0.3-2.0); the vinegar of squill (Acetum Scille, U. S. and B. P.) in the dose of 10 drops to J drachm (0.65-2.0). The compound syrup (Syrupus Scilla; Compositus, U. 8.), or Coxe's Hive Syrup, is com- posed of squill, tartrate of antimony and potassium, precipitated phos- phate of calcium, alcohol, sugar, and water, and is given in the dose STARCH—STILLING IA. 355 of 20 drops (1.3) as a sedative to an adult and 1 drachm (4.0) as an emetic to a child. The folloAving prescription will be found useful in bronchitis in its subacute stages in a child of one to five years: R.—Vini ipecac...............fgj (4.0). Tinctura? scilla?............f£jj (8.6). Syr. tolutan..............f^v (20.0). Aqua?..............f^j (32.0).—M. S.—Teaspoonful (4.0) every three or four hours. The plain syrup (Syrupus Scille, U. S. and B. P.) is given in the dose of i to 1 drachm (2.0-4.0), the honey (Oxymel Scille, B. P.) in the dose of J to 1 drachm (2.0-4.0), and the compound pill (Pilule Scille Composita, B. P.) in the dose of 5 to 10 grains (0.3-0.65). STARCH. Amylum, U. 8. and B. P., is Avheat starch, but good corn starch is usually employed by many persons. In very fine powder starch is used as a dusting poAvder in intertrigo or chafing. Its more import- ant uses are, hoAvever, its employment in the form of starch-Avater for carrying drugs into the rectum, and in the form of a poultice for cases of skin disease Avhere it is desired to remove crusts. Starch-Avater is made by boiling starch in the proportion of 2 table- spoonfuls to 1 pint of water, Avhich is then boiled to paste and diluted by the addition of Avarm Avater to the consistency of syrup. Starch- water is not only useful as a vehicle for drugs given by the rectum, but as a sedative injection in proctitis and rectal irritation. The starch poultice is made by boiling the starch to a pasty con- sistence or adding enough boiling Avater to a paste made by rubbing cold Avater and starch together to produce a gelatinous mass. 30 grains (2.0) of boric acid to the ounce (32.0) render it antiseptic. STILLINGIA. Stillingia, U. S., Queen's Boot, is the root of Stillingia sylvatica, a plant of the United States, the active principle of Avhich is stil- lingin. Physiological Action.—There can be no doubt that this drug acts in tAvo Avays : first, by its immediate effects on the system, and second, by its more sloAvly-shoAvn 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 con- stipation, as it increases intestinal secretion, and it is even said to act as a specific in hemorrhoids dependent largely for their existence upon hepatic engorgement and intestinal atony. Bartholow recommends the following prescription under these cir- cumstances : 356 DRUGS. R .—Extract, stillingiee fluid.........f 3v (20.0). Tinctura? belladonna? ~\ Tinctura? nucis vomica? V . . . . aa f 3J (4.0).—M. Tinctura? physostigmatis J S.—20 drops (1.3) 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 anremic or strumous, and who never have any appetite, or are subject to mid- dle-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 Stillingie Fluidum, TJ. S.), which should always be made of the fresh root, the dose of which is 10 to 60 drops (0.65-4.0). STRAMONIUM. Jamestown Weed, or Datura Stramonium, is official in the form of the leaves (Stramonii Folia, U. 8.) 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 Seminis, U. S. and B. P.) is used in the dose of ^ to J grain (0.01-0.03), the fluid extract (Extractum Stramonii Seminis Fluidum, U. S.) in the dose of 1 to 5 drops (0.05-0.35), and the tincture (Tinctura Stramonii, U. 8. and B. P.) in the dose of 5 to 30 drops (0.3-2.0). It should be remembered that this tincture is nearly tAvice as strong as the tincture prepared according to the U. S. P. of 1880. The ointment (Unguentum Stramonii, U. 8.) is used for the same purposes as is belladonna ointment. The dose of daturine is t|-q- to -^ of a grain (0.0005-0.0008). STRONTIUM. This substance has lately been introduced into medicine in the form of the bromide (Strontii Bromidum, U. S.), lactate (Strontii Lactas, U. S.), iodide (Strontii Iodidum, U. S.) and phosphate, largely through the studies of Laborde, Se"e, 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 Avell-knoAvn disadvantages of the potassium salt are avoided. The dose of bromide of strontium is from 30 to 60 grains (2.0-4.0). In addition to the ordinary effect of bromides, Se'e found the bromide of strontium to be very useful in overcoming attacks of gastric indigestion associated Avith pain in the STROPHANTHUS. 357 stomach and hyperacidity ; and the author has confirmed this state- ment. 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 contraindicated in the presence of the uraemia and the high fever of acute parenchymatous nephritis. In chronic parenchyma- tous nephritis, such as is due to rheumatism or gout, it is of value. Unfortunately, as soon as the lactate of strontium is withdraAvn the albuminuria is apt to recur. The dose of the lactate of strontium is 60 to 100 grains (4.0-7.0) a day. Strontium possesses no toxic power Avhatever, and overdoses are not followed by any bad consequences. If the strontium is contaminated by barium, serious effects are produced. The Avriter has often been much disappointed in the use of the lactate of strontium in albuminuria, but others of Avide experience seem to regard it as very constant in pro- ducing good results. STROPHANTHUS. Strophanthus, U. S. and B. P., is an African plant (Strophanthus hispidus), from the seed of Avhich the natives make tombe* arrow- poison. There are many varieties of Strophanthus. The active principle is strophanthin, from Avhich is derived strophanthidin. It has been claimed that strophanthus contains a local anaesthetic prin- ciple, but Dr. de Sclnveinitz and the author found it to be possessed of this poAver only in dogs and not in man. Therapeutics.—Strophanthus 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 folloAv its use. On the other hand, strophanthus generally gives good results in this class of cases. As every one knoAvs, there are a certain number of cases where digitalis 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 those instances Avhere digitalis fails, and this is particularly true in children. It will relieve cardiac dropsy by its action on the heart, but does not possess marked diuretic properties. Untoward Effects.—Strophanthus Avhen given in full dose frequently causes diarrhoea. Administration.—Strophanthus is given in the form of the tincture (Tinctura Strophanthi, U. 8. and B. P.) in the dose of 3 to 6 drops (0.2-0.35) three times a day. Strophanthin may be given hypo- dermically in the dose of ^ to ^ of a grain (0.0006-0.0012). Its effects Avhen so used are said to last a week, but this statement can scarcely be correct. 358 DRUGS. SUGAR. Saccharum, U. S. (Saccharum Purification, B. P.), is the refined juice of Saccharum officinarum, or Sugar-cane, or the juice obtained from the Sugar-beet. It is an antiputrefactive, but not an antifer- mentative. Mixed with iron preparations, it prevents oxidation. As it is a hydrocarbon, it is a nutrient and a developer of adipose tissue, or, in other Avords, is a food. Its use is contraindicated 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 Avhey 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. 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 poAvders where such drugs as podophyllin and calomel are prescribed. Recent studies, both scientific and clinical, have shoAvn lactose to be possessed of very great diuretic power Avhen given in full doses. The advantage claimed for lactose as a diuretic is its direct action on the kidney and the slight effect exercised upon 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 (8.0-16.0), given daily, dissolved in a quart (1 litre) 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 clin- ical fact that the addition of lactose to the milk of bottle-fed babies always causes profuse diuresis. SULPHATE OP ZINC. Zinci Sulphas, U. S. and B. P., is a white, somewhat efflorescent salt, of a sharp acid taste, and is soluble in Avater. In large amounts it acts as an irritant, and is employed as an irritant peripheral emetic in the dose of 10 to 30 grains (0.65-2.0). It is not so severe as sul- phate of copper in its emetic and poisonous properties, and may be repeated if the first dose does not produce vomiting. In weak solu- tions it may be used as an astringent application by injection in gon- orrhea and other affections of the urethral mucous membrane. In 2-grain (0.1) pills it is sometimes given in serous diarrheas, particu- larly if it be combined with opium or minute doses of podophyllin (^ of a grain [0.001] at a dose). In conjunctivitis and other eye affec- tions the drug is used in the form of a wash. (See Conjunctivitis.) SULPHOCARBOLATES OE SODIUM AND ZINC—SULPHON. IL. 359 SULPHOCARBOLATES OP SODIUM AND ZINC. The sulphocarbolates of zinc and sodium are largely employed by some practitioners as mild antiseptic local stimulants, either in pow- der or in solution, on ulcers and sores. Much more commonly they are given internally for the production of gastro-intestinal antisepsis Avhen there is diarrhea Avith betid, ill-smelling stools, as in the boAvel disorders of hot Aveather in children or adults or in the course of typhoid fever. Hoav much good they do in the latter disease, so far as the disease itself is concerned, is uncertain, but they undoubtedly render the stools less foul and tend to check the diarrhoea. The sul- phocarbolate of zinc is the better of the tAvo for these purposes. The dose is 2 to 3 grains (0.1-0.15) in pill four or five times a day. The sulphocarbolates are probably eliminated from the body unchanged. SULPHONAL. Sulphonal, B. P., is a synthetically prepared substance first manu- factured 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 Avater, 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 neAv hypnotic have been carried out recently. Smith of London has studied its action on the activity of tissue-change, and also attempted to determine the changes in the drug during its pas- sage through the body. Without taking up space Avith a full consid- eration of his method of experimentation, we find that his conclusions may be summed up as folloAvs : 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. Another paper upon the physiological action of sulphonal has been published by Dr. Wil- liam F. Shick of Easton, Pa., who has found, by a series of experi- ments, first, that sulphonal Avhen given by the stomach acts very sIoavIv, on account of its insolubility, but that subcutaneously in Avarm solution it is much more active. The drug Avas also found to produce a general relaxation of the muscles, and a staggering gait after its hypnotic poAver 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 nerve-centres. He also found a decreased reflex activity, and believes this lessening to be due to stimulation of SetschenoAv's reflex inhibi- tory centre. On the circulation the drug was found to have but little poAver. 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 Avas found to act as a depressant Avhen given in full doses. 360 DR UGS. Therapeutics.—Sulphonal finds its place in medicine as a somni- facient or hypnotic, valuable Avhen functional nervous insomnia is present, useless where advanced disease, such as cardiac trouble, is responsible for the Avakefulness. In insanity it often produces sleep, and is of great service in the various mental disturbances character- ized by lack of sleep and often affecting persons of unsound mind. Sulphonal may be defined very briefly by any one Avho has largely used it or watched the reports made of its progress. This definition is that the drug does possess sleep-producing poAver of moderate amount—not equal to chloral, but greater than that of paraldehyde— and that it will sometimes succeed Avhere the other hypnotics fail. Administration.—Sulphonal being virtually insoluble in cold Avater, it may be given in large capsules or in mucilage of acacia, so as to be held in suspension until SAvallowed. 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 SAvalloAved it should be taken before precipitation occurs as the result of cooling. Sulphonal should be used several hours—say two or three—before the patient retires. If taken late at night, the patient frequently fails to get to sleep until the morning hours, and is heavy and drowsy all the next day. This difficulty is partly avoided by the use of a hot solution, but even then is apt to arise. The dose is 20 to 40 grains (1.3—2.6). It is Avise not to use sulphonal continuously for more than a feAV days. Untoward Effects.—When sulphonal is taken in full dose for long periods of time, great sleepiness and weariness, Avith an unsteady gait, develop, which may go on to paralysis of the loAver extremities if the use of the drug is persisted in. In some cases the paralysis is progressive, and in others hyperesthesia and abnormal sensations develop. In all such cases there is great disturbance of digestion with scanty secretion of urine, Avhich contains an unusual substance, giving this secretion the color of port Avine (hgematoporphyrinuria). Sulphonal often produces heaviness and a staggering gait the day after it is taken. There are numbers of cases of death on record from acute and chronic poisoning by sulphonal. In both classes of cases the death was by respiratory failure preceded by deep unconsciousness. SULPHUR. Sulphur is a non-metallic element official in three forms in the U. 8. P.—namely, as Sulphur Sublimation, U. 8. and B. P., or sub- limed or flowers of sulphur; Sulphur Precipitation, U. 8. and B. P., or precipitated sulphur; and Sulphur Lotum, U. 8. and B. P., or washed sulphur. Much confusion exists among students as to the differences between these various forms of sulphur. Sulphur itself is an element Avhich is prepared for medicinal uses by being heated and sublimed (Sulphur Sublimation), or floAvers of sulphur. Sulphur lotum, or Avashed sul- phur, is prepared in order to get rid of sulphuric acid and other con- taminating substances, and is made from sublimed sulphur. Sulphur SULPHUR. 361 pnecipitatum is also made from sublimed sulphur, and is more bland and minutely subdivided. Some believe it differs from sublimed sulphur in its therapeutic properties by reason of a small amount of Avater 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 yelloAV color with a strong odor of hydrogen sul- phide. The 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 Avorthy of note that sulphur will sometimes overcome constipation Avhen nothing else will give relief. It is particularly valuable in the treatment of constipation where there are hemorrhoids, and in chronic t^ieumatism and sciatica it is thought by some to effect a cure. Sulphur is of great service in the treatment of chv&nic 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 Avith sulphuretted hydrogen was simply a revival of a custom of our great-grandfathers, Avho often used sulphur-Avaters by the mouth in the treatment of catarrhs or other disorders of mucous membranes. Bergeon took the trouble to go to the rectum to accomplish Avhat Avas done tAvo hundred years ago by the mouth, and the only novel part of his method Avas his filthy Avay of using the remedy. Graves recommended 5 to 10 grains (0.35- 0.65) of sulphur three times a day Avherever bronchial secretion Avas 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 poAvdered form, but combination Avith an ointment makes it at once active. EAren irritations of the skin may ensue from its constant use in concen- trated form. In scabies, or itch, sulphur ointment ( Unguentum Sulphuris, U. 8. and B. P.) is the best remedy Ave have. The female parasite burrows under the epiderm and deposits the ova as she moves about, Avhile the male does not burroAv, but stays on the surface. The ointment y\ ill kill him, as he is readily attacked, but the female is protected by her burrowing propensities. To get at her and the ova the burroAvs must be opened, and this may be accomplished by a thorough soaking of the body Avith soap and Avater, thereby softening the epiderm covering the parasite, Avhich can then readily be removed by rubbing the patient with a rough towel. The toAvel 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 362 DRUGS. skin be Avell 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 Avomen often suffer from acne, particularly about the men- strual epoch, the skin also becoming at this time sallow and muddy. Ringer recommends the folloAving lotion as one Avhich is very success- ful in promoting a cure: R— Sulphuris sublimati.........3J (4.0). Glvcerini ............• f.3.j (4.0). Aqua? rosa>...... .......f.^viij (256.0).—M. S.—Apply as a wash once or twice daily. Administration.—Sulphur is given in the dose of 10 to 20 grains (0.65-1.3) three times a day as an alterative, and from 1 to 2 drachms (4.0-8.0) 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 (0.65-8.0). 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 medicinal mineral acids, and Avhen absorbed it unites Avith bases to form sulphates, and is so eliminated by the kidneys, the lower boAvel, and the skin. It coagulates albumin. 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 dependent 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 par- tial 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, AvhitCAvash off the Avails, and soap. Opium and 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 com- monly used internally, as it fulfils several pressing indications. As SUMBUL—SUPRARENAL GLAND. 363 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 dur- ing an epidemic of cholera some years since every case Avhich received sulphuric acid improved or failed to be attacked, Avhereas those Avho did not receive it were either very ill or died. The proper Avay to use the drug as a prophylactic during cholera epidemics is in the form of "sulphuric-acid lemonade," made so that each wineglassful of Avater contains 5 drops (0.35) of the aromatic sulphuric acid. The same solution may be used in acute lead poison- ing in order to form an insoluble sulphate of lead, and may be taken by artisans exposed to clironic lead poisoning as a prophylactic for the same purpose. As sulphuric acid is eliminated by the skin, it is often useful in the night-siveats of phthisis combined with belladonna or morphine. Administration.—The dose of the dilute acid (Acidum Sulphuricum Dilution, U. 8. and B. P.) is 10 to 20 drops (0.65-1.3), and of the aromatic acid (Acidum Sulphur icum Aromaticum, U. S. and B. P.) 5 to 20 drops (0.35-1.3). The latter is the best preparation for gen- eral use. It contains ginger and oil of cinnamon. Both should be thoroughly diluted before they are administered. SUMBUL. Sumbul, TJ. S., is the root of Ferula Sumbul, a large plant of Northern Asia. The dose of the root (Sumbul Radix, B. P.) is 10 to 40 grains (0.65-2.65). On the nervous system sumbul acts as an efficient nerve tonic, and was very largely employed by Goodell in cases of nervous exhaustion and in the unrest of nervous females. It is official in the tincture (Tinctura Sumbul, TJ. S. and B. P.), dose 1 to 4 drachms (4.0-16.0). Goodell uses the following formula: R — Extract, sumbul............gr. xx (1.3). Ferri sulph. exsiccat..........gr. xx (1.3). Asafoetida?............gr. x (0.65). Acid, arsenosi............gr. \ (0.03).—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 Avhich it is made is a good sample. SUPRARENAL GLAND. The use of thyroid and other glands for medicinal purposes has led to the employment of the adrenal gland, or its extract, in the treatment of disease in which this gland is found so disorganized as to be unable to carry out its function of internal secretion—as, for example, Addi- son's disease. It has been found by Oliver, Schafer, Abel, and others, that an extract from these glands possesses a very distinct physiological 361 DR UGS. action, which consists chiefly in a great rise of arterial pressure, ap- parently produced by stimulation of the muscular coats of the blood- vessels ; but Avhile it causes such positive effects in ordinary doses, over- doses do not seem to possess markedly toxic influences in man or animals. Because of this effect, and also because suprarenal extract increases muscular tone generally, the extract may be employed in cases of relax- ation of the vasomotor system, in neurasthenia, in cardiac feebleness, and perhaps in cases of purpura. It has been used Avith asserted great success in the treatment of diabetes insipidus. Suprarenal extract is also said by some to be of value in cases of anemia of the pernicious type with enlargement of the liver and spleen. Usually when suprarenal gland is used the effect is produced very slowly. It is best given by the stomach, and neither the acid nor the pepsin have any effect upon it. Careful investigation shoAvs beyond a doubt that the powdered gland, dried in vacuo, and given in tablet in the dose of 3 to 5 grains (0.18-0.30), three times a day, is the most efficacious preparation. SWEET SPIRIT OF NITRE. SAveet Spirit of Nitre (Spiritus ^Etheris Nitrosi, U. 8. and B. P.), or Spirit of Nitrous Ether, is a mixture of alcohol, Avater, and ethyl nitrite. It is upon this last constituent that most of its value as a remedial agent depends. The drug Avhen sold by pharmacists or others Avho 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 to dis- cover this absence is to add a grain or two of antipyrin to a \ ounce or less of the spirit. If the ethyl nitrite be present, a purple color fol- lowed by a green precipitate will be formed. This green precipitate is iso-nitroso-antipyrin, Avhich 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, accord- ing to the manner in Avhich it is administered. If given in very full doses, it rapidly produces the cyanosis cha- racteristic of the full effects of any one of the nitrites. (See Amyl Nitrite.) Therapeutics.—There is probably no drug so Avidely employed by the laity as a household remedy which is so potent for good, and yet so harmless, if wrongly used, as is this one. Physicians often place less reliance upon it than it deserves, and m nearly every instance where it fails it is either not indicated or the nitrite has escaped and left it poAverless. 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: TAMARINDS—TANNIC ACID. 365 R.—Potassii citratis..........%] to .^ij (4.0-8.0). Spt. a?theris nitrosi.........f ass (16.0). Aqirv...........q. s. ad f^iv (^S.Ol—M. S.—Dessertspoonful (8.0) 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 gen- eral atony of the system, it may be Avell to substitute the following pill for the belladonna: R.—Acid, arsenosi............gr. \ (0.016). Extract, nucis vomica?........gr. ij (0.1). Quinina? sulphatis..... . . . . gr. xx (1.3).—M. Ft. in pil. No. xx. S.—One pill t. d. after meals. The diuretic action of SAveet spirit of nitre is best obtained by using the drug in ice-cold water and keeping the patient lightly cov- ered and cool. On the other hand, if a diaphoretic influence is desired, it may be given simultaneously Avith warm lemonade, and the patient should be Avell 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 condi- tions in the latter class as Avell. SAveet spirit of nitre is a distinct antispasmodic, and can be Avell employed Avhere slight nervous excitement accompanies fevers or in other states associated Avith irritation in infancy. The dose for an adult is from 20 drops to 1 drachm (1.3-4.0), and for a child of one year 5 to 10 drops (0.35-0.65). It should always be given in cool Avater to the latter class of patients. TAMARINDS. Tamarindus, U. 8. 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 poAver over that of any ordinary fruits, such as apples, but it enters into the confection of senna (Confectio Sen nee, TJ. 8. and B. P.). Patients often find tamarinds a very agreeable laxative Avhen they are taken before going to bed or eaten as a confection after meals. TANNIC ACID. This acid Avhen pure is an uncrystallizable, Avhite or yellowish- white poAvder Avithout bitter taste and very soluble in Avater or glyce- rin. 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 alkaloid to a crude drug, so far as the active portion of these vegetable astringents is concerned. Tannic acid is derived from nut- gall. 366 DRUGS 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 blood-vessels. 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 Ave learn from this that tannic acid is to be used to check hemorrhage only Avhere the drug can be brought in direct contact with the bleed- ing point. If a hemorrhage is to be reached through the circulation, as in renal bleeding, gallic acid is to be given, as it is absorbed at once Avithout 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 membranes or parts of the skin which are exposed to much rubbing, as in the case of the nipples of a primipara, or Avhere the feet become mace- rated and sore or SAveat profusely on exercise being taken. In the treatment of hemoptysis tannic acid may be dissolved in water in the proportion of 5 to 10 grains (0.35-0.65) to the ounce (32.0) and used in a fine spray delivered from an atomizer. Glycerite of tannin is made by adding 2 ounces (64.0) of tannic acid to a \ pint (250 cc.) of glycerin, and mixing at a gentle heat until solution occurs. It is use- ful as an application to sloiv ulcers and depressed mucous membranes, as after an attack of stomatitis. In hemorrhoids 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 leu- corrhea. Administration.—The dose of tannic acid is 2 to 10 grains (0.1- 0.65), best given in pill. The official preparations are—the troches (Trochisci Acidi Tannici, U. 8.), each containing 1 grain of tannin; the Glyceritum Acidi Tannici, U. S.; Collodium Stypticum, U. 8.; and an ointment (Unguentum Acidi Tannici, U. S.). The B. P. preparations are—Glyceritum Acidi Tannici; Suppositoria Acidi Tannici, each containing 3 grains (0.15); and Trochisci Acidi Tan- nici, of Avhich each contains ^ grain (0.03) of the acid. TANSY. Tansy (Tanacetum, U. S.). The leaves and tops of Tanacetum vulgare yield a volatile oil (Oleum Tanaceti) Avhich possesses em- menagogue poAvers 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 (0.05- 0.15). TAR—TEREBENE. 367 In domestic medicine tansy tea, made by adding 1 ounce (32.0) of the leaves or tops to 1 pint (\ litre) of Avater, and given in the dose of 1 to 2 ounces (32.0-64.0), is largely employed as a remedy for amenorrhea. TAR. (See p. 324.) TARAXACUM. Taraxacum, U. S., Dandelion, is a very old remedy for hepatic torpor and the dyspepsia resulting therefrom. It should be prepared from the fresh leaves or roots, as the dried, stale plant is inert. From disregard of this fact much disappointment has arisen. OAving to its being bitter it acts as a tonic. The extract (Extractum Taraxaci, U. S. and B. P.), dose 5 to 30 grains (0.35-2.0), and the fluid extract (Extractum Taraxaci Fluidum, U. 8.), dose 1 to 3 drachms (4.0-12.0), are the only official preparations. Succus Taraxaci, B. P., is given in the dose of 1 to 2 drachms (4.0-8.0); Decoc- tum Taraxaci. B. P., is administered in the dose of 2 to 4 ounces (64.0-128.0). ' TARTARIC ACID. Acidum Tartar icum. U. S. and B. P., is derived from crude potassium bitartrate, and is much less poAverful 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 com- monly employed to act upon sodium or potassium bicarbonate to form effervescent drinks. (See Seidlitz PoAvder and Effervescing Draughts.) The dose is 5 to 20 grains (0.35-1.3). When tartaric acid is taken in poisonous dose, lime-Avater, alkalies, and magnesium are the antidotes, and opium is to be given to allay irritation. If necessary, emetics are to be used. TEREBENE. Terebenum, U. 8., is a liquid substance, clear, colorless, insoluble in Avater, having a peculiar odor like that of new pine saAvdust, and is made by the action of sulphuric acid upon oil of turpentine, which is then distilled at about 160° F. Therapeutics.—Terebene is a very useful stimulating expectorant, to be used in 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 Avay 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 368 DRUGS. ethyl, and chloroform, placed on a sponge and held some tAvo 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 cap- sules in the dose of 5 to 10 minims (0.35-0.65), or by dropping it on 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 (Terpini Hydras, U. 8.) is prepared by a certain process, unnecessary to explain, from a mixture of pure oil of tur- pentine, alcohol, and nitric acid. In this manner large, colorless crys- tals, without odor and with a faint taste, are formed, and 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 10 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, Avhile only useful in a limited number of conditions, certainly seems to be very useful in the variety of diseases named. The dose as generally given is 2 to 3 grains (0.1-0.15), but it may given in the dose of 15 to 20 grains (1.0-1.3) 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. Thus: R.—Terpin. hydrat............gr. lxxv (5.0). Spt. vini gallici...........fgij (60.0). Syrup, lactucarii, Syrup, tolutan............aa, fgiij (90.0).—M. S.—1 to 2 dessertspoonfuls (0.8-15.0; three or four times a day. Or we may prescribe— R.— Terpin. hydrat........... \ gr. xl (2.65). Acid, benzoic............ gr. xl (2.65). Codeina?..............gr. v (0.3).—M. Ft, in pil. No. xx. s- S.— 1 pill three or four times a day. TERPINOL. Terpinol is derived from terpine hydrate by boiling the latter with dilute mineral acids. Terpinol occurs as an oily substance smelling THA PSIA—THIOL—TH10SINA MINE. 369 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 (0.5-1.3), 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. THAPSIA. Thapsia garganica is an umbelliferous plant of South-eastern Europe, employed for the purpose of producing a blister. It is gen- erally used under these circumstances in the form of a plaster. The resin, obtained from the bark of the root, is the form in Avhich 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, as the latter drug possesses the disadvantage of having a disagreeable odor. It is derived from broAvn-colored paraffin or gas oils by a complicated process. The product obtained is evaporated in vacuo to a thin extract called Thiolum Liquidum, or still further to dry- ness, or Thiolum Siccum. The liquid thiol occurs as a thin broAvnish- black neutral fluid, smelling someAvhat like birch oil. It is slightly soluble in alcohol and ether, but quite soluble in Avater, forming a clear mixture, Avhich is rendered more perfect by the addition of glycerin. Thiol sicca may appear in lustrous scales. Therapeutics.—The question Avhich arises at once in regard to thiol is, Avhether 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 poAvers not met with in any other form of sulphur compound previously knoAvn. Thiol has been used largely by skilful observers in diseases of the skin in moist eczema, scrofulosis of the skin, and in syphilides Avith asserted good results. In cases of moist eczema the thiol is used, after first wash- ing the part Avith an antiseptic solution, if it is dusted over the skin in the form of poAvder. Bidder has treated the disease by using com- presses Avet Avith thiol in 10 per cent, solution. While it is claimed that thiol will relieve exudations about joints and elseAvhere in as effective a manner as ichthyol, sufficient evidence as to this point is not yet before us. Thiol is much cheaper than ichthyol. THIOSINAMINE. Thiosinamine is a preparation derived from volatile oil of horse- radish, or more commonly from the volatile oil of mustard seed, by the 24 370 DRUGS. addition of alcohol and ammonia water and exposing it to heat. Under these conditions crystals of thiosinamine are deposited in prisms which are soluble in 2 parts of Avarm water, and in alcohol or ether. A solu- tion of- it should not redden litmus paper. This substance is used in medicine for the cure of lupus in scars, and keloid, and it has been used with asserted success in malignant growths. In a case of keloid the drug in 10 per cent, solution in absolute alcohol may be injected directly into the part affected in the dose of 10 to 20 minims (0.65-1.3) every third or fourth day. The part receiving the injection usually becomes congested and swollen and dark in hue. There is often a great increase in the urine, and per- haps nausea and vomiting, and great pain Avhere the injection is given. In cases of lupus it may be injected locally or at a distant spot, and produces a reaction like that caused by tuberculin. The drug may also be given internally in the dose of 4 to 6 grains (0.2-0.4) once a day. THYMOL. Thymol, U. S. and B. P., is derived from the oil of thyme and other volatile oils, and occurs in large crystals. It is almost insoluble in water, but is freely soluble in hits and oils. Thymol is irritant, but antiseptic and disinfectant, and has been employed in typhoid fever as an intestinal antiseptic by Henry and others. Under these conditions it should be used in gelatin-coated pill, and a glass of water or milk taken to avoid the burning sensation. In the treat- ment of stomatitis or tenderness of the gums after mercurialization the folloAving mouth-wash may be used: R.—Thymol..............gr. x (0.65). Sodii boratis............gr. xv (1.0). Aqua?...............fgij (64.0).—M. S.—Place a teaspoonful (4.0) of this in \ a tumblerful of water and use as a gargle. Thymol has been used for dressing Avounds, but is too costly. In summer Aveather it cannot be employed, because of its power of attract- ing flies, Avhich make the patient's life miserable. The dose is \ to 2 grains (0.03-0.1), in capsule or in Avafer, and 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 (2.0) in twenty-four hours may be given as an intestinal antiseptic. If very large amounts (10O grains [7.0]) are taken in a day, poi- soning 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 diiodide, 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 THYMUS GLAND—THYROID GLAND. 371 has accumulated as to its exact value, but the result of a careful examination of clinical reports is that in some respects it is a better drug than iodoform and in others not so good. Tichhoff and Neisser state that Avhen taken internally thymol iodide is incapable of causing toxemia, but this can only be true wdien moderately large doses are given. Upon cocci and bacilli thymol iodide has less poAver than iodoform. In regard to the poAver of this drug in healing wounds or sores, the decision has been reached that Avhenever secretion is free it is contraindicated, as the thymol seems to increase moisture. On the other hand, in those instances Avhere in disease of the skin or mucous membrane an undue dryness is present the effect produced is often favorable. Upon lupus little effect is produced unless the sur- face is first curetted. Finely-poAvdered thymol iodide has been found of very unusual value in the treatment of interstitial keratitis by de SchAveinitz and Wallace AAhen dusted into the eye each day. In an ointment of \ to 1 drachm to the ounce of lard (2.0-4.0 : 32.0) thy- mol iodide may be used in psoriasis, but it is not as useful as is chrysarobin in this affection. THYMUS GLAND. The Thymus Gland has been used quite largely in certain diseases on the same principle as that governing the use of the thyroid, namely, that this gland possesses the function of internal secretion and will therefore benefit certain systemic conditions in persons in Avhoin the thymus Avas atrophied too early in life. Others have used it as a sub- stitute for the thyroid, intentionally or by mistake. Its chief use has been in the treatment of goitre (not exophthalmic). It does not produce any disagreeable effects as does the thyroid. Usually the beginning dose is half an ounce (15.0) administered sev- eral times a Aveek. This dose is soon increased to an ounce (30.0) once a Aveek. In this country Parke, Davis 3)< Mucil. acacia? ...........f^ss (16.0). Aquse...............f'?x (320 0)__M S.—To be injected as an enema for the relief of tympanites' and to'aid in the removal ol hardened fceces. Stir thoroughly before using. The Liniment of Turpentine (Linimentum Terebinthine, U. S. and B. P.) is largely used as a stimulating application to sprains and enlarged joints. Turpentine is of service in ringivorm, applied with a brush to the part affected. The following preparations are official in the B. P.: Confectio Terebinthine,Jose 1 to 2 drachms (4.0-8.0); Enema Terebinthine, Lnguentum Terebinthine, and Linimentum Terebinthine Aceticum. UVA URSI—VALERIAN. 377 I he ointment of turpentine is used as a counter-irritant and stimu- lant 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.—Uya ursi is employed in medicine as a weak, astrin- gent diuretic, possessing alterative power over the genito-urinary appa- ratus. It is used in pyelitis, cystitis, and 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 (0.15-0.35). The dose of the extract (Extractum Uve Ursi, U. 8.) is 1 to 4 grains (0.05-0.2), of the fluid extract (Extraction Uve Ursi Fluidum, TJ. 8.) is 2 to 4 drachms (8.0-16.0) three times a day. An infusion (Infusum Uve Ursi) is official in the B. P. dose 1 to 2 ounces (32.0-64.0). VALERIAN. Valerian (Valeriana, TJ. 8.) is the rhizome and rootlet of Vale- riana officinalis, a plant of Europe, but cultivated in America. It is official in the B. P. as Valeriane Rhizoma. Its active principle is apparently a volatile oil (Oleum Valeriane). It also contains valerianic acid. Physiological Action.—Valerian is a very feeble depressant to the nervous system, tending to produce nervous rest. In cats it excites 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 sometimes nausea and vomit- ing. 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 insom- nia. 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 Valeriana' Fluidum, TJ. 8.), is given in the dose of 1 fluidrachm (4.0), and the ammoniated tincture (Tinctura Valerianic Amnion lata, U. 8. and B. P.), in the dose of 1 to 3 drachms (4.0-12.0). These 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 Valeri- ane, U. S. and B. P.) is 1 to 3 drachms (4.0-12.0). The dose of the oil (Oleum Valeriane is 2 to 4 drops (0.05-0.2). An infusion (In- fusum Valeriane) is official in the B. P. in the dose of 1 to 2 ounces (32.0-64.0). 378 DRUGS. VALERIANIC ACID. Acidum Valerianicum is an 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 Avhich are employed, partly for their sedative effects and partly for their influence as tonics. The dose of Zinci Valerianas is J to 3 grains (0.03-0.15), that of Quinine Valerianas, U. 8., 1 to 3 grains (0.05-0.15), of Ferri Valerianas 2 to 10 grains (0.1-0.65), and of Ammonii Valerianas 2 to 10 grains (0.1-0.65). Under the name of " the pill of the three valerianates" Goodell recommends the folloAving in nervousness and hysteria : R.—Quinina? valerianat. ~| Ferri valerianat. >....... aa J}j (1.3).—M. Ammon. valerianat. j Ft. in pil. Xo. xx. S.—One or two three times a day. VERATRINA. Veratrina, U. 8. and B. P., is an alkaloid derived from the seeds of Asagrea officinalis, 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 excites the spinal cord and the volun- tary 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 sIoavs 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 ahvays causes a fall of bodily heat. Poisoning.—The symptoms of poisoning in man are collapse, a pale, cold, Avet skin, pinched features, and a rapid, thready pulse, accompanied by violent vomiting and .muscular tremors. Tetanic 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 parts affected by muscular rheumatism and rheumatic joints and over neu- ralgic nerves. The official ointment (Unguentum Veratrine, U. S. VERATRUM VIRIDE. 379 and B. P.) or the oleate (pleaturn Veratrine, TJ. 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 Vi'ride, 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 Rhizoma. It probably contains a number of principles, the chief of Avhich are, however, jervine and veratroidine. Veratrum viride is the safest and best circulatory depressant that Ave 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 com- plete effect is studied. Jervine. When jervine is given in full toxic dose it causes great sloAvness of movement, relaxation of the muscles, through which thrills con- tinually run, and finally the animal falls to the ground. Violent epi- leptiform convulsions may noAv 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 ahvays increased and pours from the mouth. Death results by failure of the respira- tory 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 Ioav, 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 vasomotor centres. The convulsions are due to the disturbance of the circulation at the base of the brain (Wood), and the spinal 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 over- dose causes vomiting and purging. The muscular twitchings and convulsions 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 pneumogastric centres, but finally quickens it if given in very large doses, by paralyzing the peripheral vagi. 380 DRUGS. 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 : u Veratrum viride slows the pulse by a direct depressant action on the heart-muscle (jervine) and by stim- ulating 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 poAverful drugs we have, is one of the least dangerous, since it almost invariably 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 circula- tory sedative in acute, sthenic, or dynamic inflammations. In pneu- monia, pleurisy, acute hepatitis, peritonitis, and cerebritis it is of the greatest value if given at the proper stage, when only congestion or hypergemia is present. After the onset of the lesions following this period its use is not only valueless, but malpractice. The only objec- tion to the employment of veratrum viride in peritonitis and cerebritis lies in its tendency to produce vomiting, Avhich is, of course, harmful when the peritoneum is inflamed. For this reason aconite is preferred to veratrum viride in peritonitis. (h\"ing to its physiological influence veratrum viride bleeds a man into his own blood-vessels, and the indi- cations for its use are the same in inflammation as they Avould be for bleeding. In puerperal fever it has been highly recommended, but must be most carefully employed. With a large number of practi- tioners veratrum viride is considered by far the best remedy in puer- peral eclampsia. If given in this condition the dose must be large, as much as 20 to 30 drops (1.3-2.0) of the tincture. If SAvalloAv- ing is difficult, it may be used hypodermically in half the dose, pro- vided the circulation is carefully Avatched to avoid too great depres- sion. It acts in eclampsia chiefly by its depressant effect on the motor tracts of the spinal cord. It is also of value in excessive car- diac hypertrophy and in the irritable heart of strong, healthy men. In aneurism Avhere the circulatory disturbance is great and the arterial pressure high the drug may be used, Avith great care, to decrease the pressure and prevent rupture of the diseased vessel. Contraindications.—Veratrum viride is contraindicated 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 Avay disturb and irritate the abdominal contents. Administration.—The drug in inflammation should be given every half-hour or hour, and at least 1 drop (0.05) 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 shoAV that the drug is exerting its influence, and it should now be withdraAvn VIENNA PASTE—WARBURG'S TINCTURE. 381 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 (0.35- 0.65) of laudanum should be given fifteen minutes before each dose of veratrum viride. The best preparations to employ is the tincture (Tinctura Veratri Viridis, U. 8. and B. P.), dose 1 to 3 drops (0.05- 0.15). The fluid extract (Extractum Veratri Viridis Fluidum, U. 8.) is given in the dose of 1 to 3 drops (0.05-0.15). 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 Calce, U. S., is a milder and more manageable eschar- otic 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 consid- erably altered, and some of the preparations now sold as Warburg's tincture contain none of the original ingredients. Further than this, some of these ingredients are now not obtainable. It ought to be made as folloAvs, if possible: Aqueous extract of aloes........... 28 grains. Rhubarb.................448 " Angelica-seed................448 " Elecampane . ............... 224 " Saffron...................224 " Fennel...................224 " Gentian..................112 " Zedoary-root..............• • ■ 112 " Cubeb...................112 " Mvrrh............•......112 " White agaric................112 " Camphor..................112 " Sulphate of quinine......_ •......1280 " 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, Avhich have been pre- viously pulverized, added to them. The entire mass, less the quinine, is then digested for twelve 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 sul- phate of quinine added and dissolved. Therapeutics.—Warburg's tincture, next to pilocarpine, is the most powerful sweat-producer that we have, and possesses in addition very remarkable antimalarial power. In this last respect it far exceeds quinine as a remedy in pernicious malarial regions for acute attacks 382 DR UGS. and as a prophylactic. Its advantages over quinine rest in its favor- able action Avhere congestions accompany the paroxysm. Administration.—To be of any value Warburg's tincture should be given according to the folloAving rules: The boAvels of the patient should be first opened thoroughly by a saline purge, and J an ounce (16.0) of the tincture should be given in one dose undiluted, no drink being taken. After the lapse of two or three hours a second | ounce (16.0) is given in the same way, and very shortly a profuse sweat appears, Avhich often marks the crisis of the disease, and recovery soon takes place. ZINC ACETATE. Zinci Acetas, U. S. and B. P., occurs in the form of white mica- ceous crystals, Avhich are efflorescent and quite soluble in water. It acts as a decided astringent to the skin and mucous membranes, but is less astringent than the sulphate of zinc. It is used as a collyrium in eye diseases, such as conjunctivitis, in the strength of 1 to 2 grains (0.05-0.1) to the ounce (30.0). In gonorrhea it is often employed instead of the acetate of lead in injections of the strength of 1 to 20 grains (0.05-1.3) to the ounce (32.0) of rose-Avater. The treatment of poisoning by acetate of zinc is that adapted to gastro-enteritis. (See Gastro-enteritis, Part IV.) Chronic poisoning by zinc is very rare; the symptoms consist in muscular palsies, neuritis, and cachexia. 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 relieving pain, SAvelling, 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 Avriter takes two darning-needles, places them in boiling Avater to render them aseptic, inserts them at right angles to the skin to the depth of one to one and a half inches, and allows them to' remain in place for several minutes. They are then sloAvly AvithdraAvn, 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, Avith his usual clear clinical insight, noted that this treatment is more successful in those Avho have bilateral pain than in those Avho have one side affected, and the Avriter has found this statement invariably true. In sciatica acupuncture is less successful than it is in lumbago, but is ahvays to be tried. The needle should be carried doAvn until it reaches the nerve, and perhaps pierces its sheath, and it must be absolutely aseptic. BartholoAv has recommended the use of a hypo- dermic needle for the simultaneous injection of a feAV minims of chlo- roform or morphine. Sometimes the best results are reached from inserting the needle immediately beloAv where the nerve finds exit from the pelvis. In other cases it is asserted that the insertion of a needle on the sound side over a spot corresponding to that Avhich is sore 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 meas- ure. When the skin of the limbs becomes so tense Avith an effusion as to endanger its life, the tension should be relieved 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, 383 381 REMEDIAL MEASURES OTHER THAN DRUGS. Avhile incisions remain open and permit free drainage. Immediately after the incisions are made the parts are to be dressed Avith cotton previously saturated with boric-acid solution and dried, or by absorb- ent cotton sterilized by baking it in an oven. It is hardly necessary to point out that the incision must be made under antiseptic precau- tions. (See Antiseptics.) ANTISEPTICS. The term "antiseptic," as generally used, does not necessarily imply the poAver to destroy pathogenic germs. Any substance which inhibits the groAvth of micro-organisms, which destroys or renders innocuous the poisonous products of their action upon the tissues of the body, or Avhich retards or prevents the absorption of such products is properly termed antiseptic. Since germicides necessarily possess antiseptic attributes, they should, strictly speaking, be classed with antiseptics; 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 Avill be considered. Some of these—as, for instance, carbolic acid and bichloride of mercury—are efficacious solely from their germicidal properties. Others, and of this class iodoform is the most important 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 Avhich have within recent years received warm commendation at the hands of individual Avriters, there are comparatively feAV which have retained the confidence of the profession after prolonged trial. Only these few well-proven drugs Avill 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 haAre shown that this salt is efficacious as a germicide in a watery solution of 1 : 50,000. He stated, hoAvever, that Avhere albumin Avas present the bichloride Avas decomposed and rendered inert. The same change Avas observed Avhen solutions Avere allowed to stand for some length of time, even Avhen distilled water was used as a solvent. By the addition of either sodium chloride or a weak acid such decomposi- tion Avas 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 Aveight of sodium chloride. Since whenever bichloride solutions are used in Avounds 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. 385 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 Avith it, as stated above, an acid Avhich Avill not in itself be unduly irritating to raw surfaces. This end is accomplished by tartaric acid. In making up a solution 1 part of bichloride and 5 parts of tartaric acid are added to as much Avater as is needed. Thus, in making up a solution of 1 : 1000 for surgical purposes, the folloAving prescription may be employed: R.—Hydrarg. chlorid. corros. . . . . gr. xv (1.0). Acid, tartaric.......gr. xv vel ^j (4.0). Aqua? dest.............Oij (1 litre).—M. Bichloride solutions are used in the strengths of 1 : 500, 1 : 1000, 1 : 2000, and 1 : 4000 in the treatment of ordinary wounds. For the irrigation of large cavities solutions of a strength greater than 1 : 10,000 should rarely be employed, and even these dilute lotions have, Avhen used in the peritoneal cavity, given rise to toxic symp- toms. The 1 : 2000 solution is the one generally employed for steril- izing wounds and irrigating during operations. The stronger solu- tions of 1 : 500 or 1 : 1000 are used in cleansing the surface of the body. The ordinary method of preparing a surface of the body for opera- tion is as folloAvs : The part is first thoroughly scrubbed Avith green soap and Avarm Avater, is shaved, and is Avashed again as before. It is then cleansed Avith alcohol or ether, after which a scrubbing Avith bichloride solution of 1 : 500 should folloAv, and should be continued for at least two minutes. If no surgical interference is immediately indicated, the Avhole operative region should be enveloped in towels Avrung out in a solution of 1 : 1000 or 1 : 2000, and kept thus protected until the sur- geon is prepared to operate. The moment the skin is incised no lotion stronger than 1 : 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: 500 bichloride solution and subsequently washed and Avrung out in a 1 : 4000 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 : 20 and 1 : 40. The carbolic acid of commerce is found in a liquid form, dissolved in alcohol, and represents a strength of about 05 per cent. In making the solution for surgical purposes an ounce of this liquid is added to 20 or 40 ounces of water, accord- ing to the strength of the solution desired. Although carbolic acid is soluble in 15 parts of water, this solution does not take place imme- diately, and in making solutions of a strength of 1 : 20 either the water must be hot or a certain amount of time and considerable agi- 25 3S() REMEDIAL MEASURES OTHER THAN DRUGS. tation of the mixture are required, otherwise globules of almost pure carbolic acid are deposited in the bottom of the tray or vessel into Avhich the solution is poured, and these, by coining in contact Avith instruments or Avith the hands of the operator, exert an undesirable cauterant effect. The 1 : 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 Avhich will be required in a solution of this strength, and Avhen the surgeon is ready to use these instruments the solution is diluted to 1: 40 by the addition of an equal volume of Avater 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 : 40. A property possessed by carbolic acid, Avhich renders it an unsafe medium for the impregnation of gauze, is its volatility. After an exposure 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 in the preparation of the deeper layers of the dressing, which come in immediate contact Avith the lips of the Avound. Since all antiseptics are more or less irritating to raAv surfaces, heal- ing Avill be promoted by a sterile rather than by an antiseptic appli- cation. By moistening a piece of boiled and sun-dried gauze, suf- ficiently large to cover the Avound-edges, in a carbolic solution of 1 : 20 the antisepticity of this dressing is assured, and in a very feAV hours the heat of the body causes the entire evaporation of all the carbolic acid, leaving a sterile, non-irritating surface in contact Avith the Avound. If protective is used or oiled silk is applied beneath the dressing, these materials should be treated with carbolic acid in the same Avay. 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 : 40 causes so much benumbing of tactile sensibility that manipulative skill is seriously interfered Avith. 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 Avhich 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. Bichloride-carbolic Acid Solution.—Since bichloride, though the most poAverful antiseptic, has but little penetrating poAver and is rendered inert by albumin, and since carbolic, though of more feeble antiseptic strength, possesses the very qualities of penetration and non-neutralization Avhich bichloride lacks, it Avould seem natural that the best results might be obtained by a judicious mixing of these two antiseptics. In recent times this procedure has been adopted in many clinics and Avith most satisfactory results. For cleansing the hands and purifying operation areas, in place of a simple bichloride mixture a solution Avhich represents bichloride ANTISEPTICS. 387 1 : 500 and carbolic acid 1 : 40 is employed. Immediately before ope- ration all sponges are wrung out from this solution. For flushing wounds, for cleansing sponges during the course of operation, and for the final soaking of the antiseptic dressing imme- diately before its application, a solution of bichloride of mercury 1 : 4000 and carbolic acid 1 : 100 is employed. The method of preparing these solutions is of course exceedingly simple. If crude drugs are used, these are put into a given measure of Avater in sufficient quantity to represent the strength desired, but when, as is frequently the case, these solutions are made up in stand- ard solutions, some thought is required to avoid mistake. Thus, given a standard solution of 1 : 2000 bichloride and one of 1 : 50 carbolic, mixture of these tAvo Avould make the lotion customarily employed in clinical practice—i e. bichloride 1 : 4000 and carbolic 1 : 100. The calculation involved in making this solution from standard lotions of carbolic 1 : 20 and bichloride 1: 1000 is somewhat intricate, and liable to result in error; hence it is best either to pre- pare the entire solution freshly each time or to keep on hand prepa- rations of such strength that the calculation is easily and quickly made. 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 Avell 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 Avhich is made up of iodoform, and that injections of such germs, mingled Avith large quantities of iodoform, produce the characteristic effect upon living tissues Avith almost as great cer- tainty as though this drug had not been used; furthermore, it has been shoAvn that iodoform is not even sterile, and that as employed by surgeons it Avas frequently a cause of infecting previously aseptic wounds. In spite of this overwhelming evidence against it the drug steadily groAvs in favor. Recent researches have explained, in part at least, the reason for this contradiction between experimental and practical results. It has been Avell said that the human body is not a test-tube, and that bacteriological research cannot supplant the evidence of clinical observation. Elaborate investigation shoAved that this drug acted as a poAverful 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 Avay 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 Avithout the presence of micro-organisms, can gen- erate pus, but that Avhere such ptomaines are mixed Avith iodoform before infection no pus is formed. If these septic chemical compounds are rendered inert, a poAverful adjuvant to the destructive action of the germ upon living cells is removed, and thus the system is often 388 REMEDIAL MEASURES OTHER THAN DRUGS. enabled to overcome one enemy Avhere two Avould 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 1:1000 bichloride solution destroys all micro-organisms, and the powder, after being washed with freshly- distilled Avater, may then be used without fear of producing infection. It Avill be readily understood from the foregoing that iodoform is of little service in aseptic Avounds; 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. drainage. Particular care should be exerted to see that the exuda- tion from the surfaces of the Avound 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 opening of which is tied a single layer of antiseptic gauze ; through this the iodo- form is sprinkled as desired over Avound surfaces. Kreolin, or Creolin, a preparation obtained from English coal by dry distillation, has been steadily and rapidly groAving in popular favor, and because of its feeble toxic action is often preferred to car- bolic acid. In addition to its poAverful germicidal effect, it is non- irritant and practically non-toxic. The claim first advanced that this preparation Avas absolutely non-poisonous can no longer be supported, since cases have been reported where toxic symptoms have folloAved its use: these Ave re probably due to individual idiosyncrasy, a factor Avhich we can never hope entirely to overcome. It is certainly true that kreolin is the least poisonous of all the poAverful antiseptics heretofore used. As an additional advantage, in place of the harsh, irritating effect produced upon surfaces by 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 germ- icide in strengths of less than 1 : 100, its power being someAvhat beloAv 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 an 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, hoAvever, for cleansing the hands, a 5 per cent, solution neither cracking the skin nor benumbing the sensory nerves. In irrigating large Avounds, cavities of the body, and particularly as a means of preventing sepsis or aborting it in gynaecological Avork, kreolin can be Avarmly commended. It may be employed in a strength of from 0.2 to 5 per cent. ANTISEPTICS. 389 Barring the opacity of its emulsion in Avater, it would be the medium par excellence for rendering instruments sterile and main- taining 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 Avhat 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. 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 tAvo applica- tions, a septic wound into one Avhich is sterile and Avhich will promptly heal. It is used in the strength of from 5 per cent, up to full con- centration. Its disadvantages lie in the fact that it is expensive, that from higher acidity it is often irritating, 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 in strength that it is impossible to determine to Avhat extent they should be diluted or what may be their potency when applied. When this drug is poured into a suppurating sinus or cavity an ebullition takes place, Avhich ceases only Avhen the drug is exhausted or the infected surfaces are rendered sterile. 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 Avhen the field of operation is probably infected by pre-exist- ing pus-formation. Although bacteriological research has shoAvn that this agent possesses feeble antiseptic poAver, clinical experience dem- onstrates its great value when applied to infected surfaces. Lately the Sulpho-carbolate of Zinc has to a great extent replaced the chlo- ride, as it is less toxic and irritating and far more potent. For the sterilization of mucous surfaces a saturated aqueous solu- tion of Boric Acid is commonly employed. Double Cyanide of Mercury and Zinc. This is the latest antiseptic prepared and extensively used by Lister. Though it has not become Avidely popular. Lister's commen- dation of it is so Avarm that a general description of its use is in place. The drug comes to the surgeon in the form of a fine poAvder. When employed for charging a dressing it is diffused by means of pestle and mortar in solution of bichloride of mercury (1 : 4000) in sufficient abundance to drench the fabric thoroughly, for Avhich 4 imperial pints to 100 grains of the salt will be found adequate. This will give a percentage of betAveen 2 and 3 of the cyanide to the dry gauze. The gauze should ahvays 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 in a folded sheet. It may afterward be conveniently kept moist by wrapping it in a piece of mackintosh cloth. When 390 REMEDIAL MEASURES OTHER THAN DRUGS. obtained dry from the manufacturer it should be moistened again with a Aveak corrosive-sublimate solution before it is used." The advantages claimed for this dressing are that it is not irritat- ing to the skin, and that the antiseptic substance is not soluble, hence is not Avashed out by discharges. An omission of the details of cleansing the hands of the surgeon and assistants in preparing for an antiseptic operation is scarcely permissible in writing upon the subject of antisepsis. The most approved method is as folloAvs: The hands and forearms are thoroughly brushed in hot soap-suds for several minutes, after Avhich the nails are carefully cleaned by a knife and brush, and the Avashing 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 bichloride (1 : 1000), and during the course of the operation are occasionally avashed 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 Avhich has not been previously sterilized, the hands should be enveloped in towels wrung out in 1 : 1000 solution or immediately washed again. Another method Avhich has been found by Kelly to be the best, bac- teriologically and practically, is to cleanse the hands and nails by scrubbing with hot Avater and soap, and then to immerse the hands and arms in a saturated solution of permanganate of potassium made with hot Avater. After this the skin is decolorized by immersion in a saturated solution of oxalic acid. Finally, the oxalic acid is Avashed off with hot sterilized Avater. ANTITOXIN FOR DIPHTHERIA. (See Diphtheria.) CLIMATIC TREATMENT. (See Springs and Climates.) COLD AS A REMEDY. Cold, or the rapid abstraction of heat, is a remedial measure that can nearly always be obtained, and is possessed of very great power for good in 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, and its general application for the purpose of affecting the entire body. When cold is applied for its limited and local action it is always used Avith two objects in view—namely, to cause localized contraction of blood-vessels which through inflammation are engorged so that the parts are reddened and SAvollen, 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. COLD AS A REMEDY. 391 For these reasons cold, in some form, is a popular remedy for a burn or sprain or any injury likely to be folloAved by inflammatory processes. In some cases, it is true, hot Avater or dry heat is equally efficacious, and this fact will be referred to again Avhen speaking of heat. (See Heat.) It may, however, be stated, as an almost invaria- ble rule, that the choice of heat or cold is to be governed by the sen- sations of the patient, Avho will generally assert that one of the two is the more agreeable. Cold or heat causes relief of pain in inflammation by producing contraction of the local blood-vessel Avails. 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 aAvay. A very useful remedy for the sprain of an ankle Avhen it is a recent accident is to let the patient sit Avith the foot elevated, Avith 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 Avealth 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 the bladder directly on the skin, surrounding it with a toAvel, 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, chiefly for anaesthetic purposes, it is customary in hospital and private practice to use a piece of ice sprinkled Avith a little fine salt, and held against the skin by means of a towel in the hands of the physician. Actual freezing can often be produced very rapidly in this manner. Where a more rapid 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, Avhich 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 liquid of a sweetish smell and taste, used as a substitute for rhigolene as a local anaesthetic through the intense cold produced by its evaporation. The fluid is directed against the skin over the involved area by means of a nozzle attached to the cylinder containing it. (See Ethyl and Methyl Chloride.) It is hardly necessary for the writer to repeat that, as the last three liquids 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 employed in neuralgia of the supraorbital nerve, Avhere, OAving to the superficial position of these fibres, the cold can readily reach them. 392 REMEDIAL MEASURES OTHER THAN DRUGS. The skin should be distinctly whitened and blanched, 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 weeks in obstinate cases. Sometimes cold is used to benumb the skin or subcutaneous tissues in cases Avhere a minor surgical operation is to be performed, and it is undoubtedly superior to cocaine Avhere one wishes to open boils or small abscesses. It is also valuable Avhen 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 a Avell-recognized therapeutic measure of great practical and physiological interest, and is closely associated Avith the subject of counter-irritation. (See Counter-irritation.) According to Winter- nitz, cold applied to the feet affects the cerebral circulation, cold to the thighs the circulation in the lungs, and cold to the back the cir- culation around about the pituitary region. That these assertions are true Ave do not positively know, but the fact that Winternitz has reached them by a series of experimental studies indicates their cor- rectness 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 Avith no small degree of suc- cess 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 Avater, and mixing it thoroughly Avith 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 Avill not sag to the loAver border, and Avrapped around the chest, the mass being thoroughly covered by a layer of Avell-oiled silk. Cold has also been highly-recommended Avhen used in pneumonia in another manner, and by no less prominent an authority than Xiemeyer, Avho speaks of it as folloAvs : " 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 which have been dipped in cold Avater and Avrung out. The compresses must be reapplied every five minutes. Unpleasant as this procedure is in almost all cases, yet even after a feAV 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 surpris- ing condition of improvement throughout the entire duration of the attack, so that their outAvard symptoms Avould hardly lead one to imagine the grave internal disorder. The relatives of the patient, too, who do not fail to perceive the improvement, noAv readily assist in the treatment to Avhich at first they were opposed. In a few cases, COLD AS A REMEDY. 393 and only in a feAV, the use of cold affords no relief, and the trouble- some manipulation for its application increases the distress of the suf- ferers 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 Avith cold compresses, and, according to the statements of Smoler, it is exceptional for a patient not to feel material relief from this treat- ment. I should only ascribe a palliative influence to their use had not the duration of the disease in many instances been decidedly shortened and the convalescence hastened by means of their energetic and methodical employment. In fact, in but feAv cases have we seen the disease delay its departure until the seventh day. Many have improved on the fifth, and a very large number as early as the third day; nay, I have repeatedly found it impossible to keep patients Avith recent pneumonia in the hospital for a longer period than a Aveek. Cold is rightly regarded as one of the most efficient antiphlo- gistics in inflammation of external organs. Its action is directly tonic upon the relaxed tissues and dilated capillaries." In endocarditis, and especially in pericarditis, do Ave find an ice- bag placed over the heart a valuable remedial procedure, for it relieves palpitation and quiets the heart, decreases the pain and diminishes the inflammation. The use of a cold bath for the purpose of increasing the tone of the system is as old a custom as any Avhich Ave have, but, like all other things in medicine, cannot be used Avithout distinct indications for its employment, or, to speak more correctly, the absence of cer- tain contraindications. The most universal exception to its use which Ave find is that class of persons Avith Avhom bathing of any kind, par- ticularly Avhen 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 exhaus- tion and general loss of vivacity and vitality occur as a result of too frequent bathing. This is the case more especially Avith daily bathers Avho use cold or warm fresh Avater, particularly if the bath be taken in the morning. Before passing on to a consideration of the physiological action of a bath, and Avhy and Avhen Ave should m^g it, it is proper to call attention 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 tAvice a Aveek, and replaced in the interval by a nightly spong- ing off Avith salt and Avhiskey or salt and Avater. Through practical experience and much experimental research of a more or less reliable character, Ave now knoAV that the folloAving phenomena accompany the use of a cold bath in a healthy person Avith Avhom such a bath agrees : On entering the Avater 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, hoAvever, reaction sets in, and the extremities, heretofore blue, trembling, and 394 REMEDIAL MEASURES OTHER THAN DRUGS. covered Avith cutis anserina, become warmer and flushed. The pulse is increased in force and frequency, and the respirations are deeper and more thoroughly performed. As a result of this each portion of the body receives a more perfect supply of blood and feels rejuve- nated. FolloAving this stage of exhilaration, a third comes on, in which the blueness and depression of the first stage recur in an exag- gerated degree, but this condition does not ensue unless the person remains too long in the water. If he leaves the bath Avhile in the acme of his exhilaration, the stimulus may remain with him through- out 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 loAvering 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 feAV 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 Avith its fel- lows, Avhich are driven to all parts of the system. This is not a mere figurative way of putting the matter, for cold always contracts blood-vessels 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 Avhy persons "catch cold," or, more technically speaking, are attacked by local or general conges- tions. One person avIio is weak may never reach the stage of stimu- lation of which Ave have just been speaking, because his system has not enough units of force in it to unite and expend them upon the functional activities named, and, as a consequence, the blood, Avhich 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 and 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 evi- dences, therefore, of circulatory and systemic depression or have con- gestion of the lungs, liver, or other parts. In the strong person exactly the same state of affairs obtains in the third stage of depres- sion, 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-Avater bathing. Cold effusions to the head, and, better still, the use of an ice-bag, COLD AS A REMEDY. 395 have long held a high position in the treatment of meningitis and head injuries, and a hot bottle to the feet and cold to the head will often cause sleep in persons who habitually suffer from insomnia. This is particularly the case with those persons who have wakefulness from mental overwork. On the other hand, cases with insomnia from cerebral anaemia do well if a cold plunge-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 ner- vous irritability, which the heat quiets, Avhereas the insomnia of cere- bral anaemia is relieved by a cold plunge by reason of the increased circulatory activity produced by the bath. When cold is to be applied to the head continuously, it is often convenient to employ a coil made of rubber tubing and 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 knoAvs that nothing is so refreshing and so preventive of muscular stiffness after severe exercise and sweating as a cold plunge- or shoAver-bath ; but he also recognizes the fact that a plunge is all that is permissible, and it is only the person Avho possesses the healthy circulatory power Avhich 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 favorite remedy for nocturnal seminal emissions Avith some practitioners, and the scrotum may be submerged in a tumbler of cold Avater for a feAV minutes at night for a similar purpose. A very useful treatment of dysentery is to gently inject into the rectum about one 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 to 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 Avater 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 Avater upon any living tissue is, of course, a Avell-understood fact, and has been employed in the arrest of hemorrhage, in the treatment of inflammation, and in various conditions. But it has only been in exceptional cases, and 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. 396 REMEDIAL MEASURES OTHER THAN DRUGS. " The bidet, as I have now for a few years prescribed it, should be of the variety Avhich can be attached to the water-closet seat habit- ually used by the patient. It should have a nozzle capable of throw- ing a stream of about the calibre of an ordinary lead-pencil or a lit- tle less. The head of water should be sufficient to make it impinge upon the parts exposed to it Avith enough force to excite there a little sensation of smarting or tingling. That degree of force Avill, for example, be sufficient to enable the patient to take an enema, or, if a female, to take a vaginal injection. The bidet pipe should be mov- able 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 surrounding parts. It should also have connection Avith the hot and cold water-supply of the house, so that the water may be used of any temperature Avhich the physician may prescribe or which the sensa- tions of the patient may make desirable. Stopcocks 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 Avater-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 thera- peutic purposes. " The diseases in Avhich it may be desirable to use this method of treatment may be divided into tAvo classes : First, those affecting the loAver end of the bowel and its outlet; second, those involving the genito-urinary system. Among the first the most important are hem- orrhoids, 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, tAvice daily, of the bidet, one immediately after the daily stool, and for the second time, by preference, just before going to bed. As a rule, in all the midAvinter months the ordinary temperature of the Schuylkill Avater is that to be preferred, although I am largely gov- erned by the feelings of the patient in this respect. An enema should be taken at each of these times, the lower portion of the rec- tum being thus thoroughly Avashed out at least tAvice daily, after which the stream of water is alloAved to play upon the affected region for a period of from five to fifteen minutes. The ordinary and useful effect of cool sponging or Avashing immediately after stool in cases of hemorrhoids is by this means enormously increased. Internal hemorrhoids will, under this treatment, in many cases almost entirely disappear, unless they are exceedingly large and have been frequently inflamed or strangulated and badly neglected; external hemorrhoids, 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 instances in Avhich 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 COLD AS A REMEDY. 397 list of patients; and they speak in the warmest manner of the great comfort derived from this simple method of treatment. " 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, parasites, neuroses, and a number of other causes, varying from eat- ing of shell-fish or excessive smoking to alleged hereditary predis- position. There are very feAV practitioners of any experience who have not discovered hoAv difficult it is in any particular case of pru- ritus to assign distinctly the annoying symptoms to any one of these causes. Often the Avhole list may be carefully gone through and eliminated, or the proper remedies may be applied successively, as different theories are adopted, Avithout the slightest benefit resulting. Ointments, lotions, and ordinary cool bathing will be tried in great variety, but Avithout avail, and such patients "will often go from one physician to another or fall into the hands of quacks while seeking proper professional relief. My list of cases of this character Avhich I have noAv 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, Avith variations of the temperature of the Avater 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 Avidely distinct conditions, and the uniformity Avith Avhich they have yielded to this simple treatment has led me to regard with suspicion the orthodox etiology of the disease. In procidentia ani and in slight cases of prolapsus recti I have had very satisfactory, though of course less striking, results. In a feAV instances the trouble almost entirely disappeared, and in all of them it Avas distinctly relieved. These cases require for their successful treatment a much longer application of the douche, and the Avater should, in my judgment, be at one or the other extreme of temperature—either quite cool or as hot as can be com- fortably borne. "lam quite aAvare that the use of cold Avater in these affections is not in the least a novel plan of treatment; but the method under consideration combines the effects of temperature with a sufficient force of the stream, and admits of the prolonged application of the remedy Avithout effort on the part of the patient, Avho is in the most suitable position for this treatment—practical points Avhich induced me to make this mention of my results in rectal and anal cases. " Agnew says of pruritus that among the local remedies frequent ablutions Avith cold water should be mentioned, and of prolapsus ani et recti that ' in all cases Avhere remedies have proved unavailing, or where patients have declined an operation, much good may be done by douching the parts with cold water and applying an oiled com- press ;' and Allingham says of the same class of cases that ' the fre- quent 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. "Mv second class of cases includes, chiefly, certain prostatic 398 REMEDIAL MEASURES OTHER THAN DRUGS. troubles, varicocele, atonic impotence in the male, and pruritus of the vulva or 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 sper- matic veins becoming stationary, long relaxed and pendulous scro- tums become firm and much smaller, and the mental condition of the patient, Avhich is so important an element in many of these cases, shares in the improvement. In chronic prostatitis, a most intractable and distressing ailment 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 Avith frequent cold enemata given in the same manner; and 1 believe to-day that if I had to discard all therapeutic measures but one in these cases, I Avould retain this one. In a certain number of cases of impotence associated with general muscular Aveakness, loss of tone, lack of general strength and vitality, accompanied 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 tAvo cases of pruritus vulva? my results have been good, though less striking than in similar disease affecting the region of the anus. In vaginitis, Avhere the Avoman has sufficient intelligence to learn hoAv to take an injection by means of the bidet, it offers an admirable method of cleansing the vagina, of carrying aAvay 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, OAving to the disinclination of these patients to procure the bidet, and OAving to their irregular habits of life and their fre- quent changes of residence; but I have seen enough of its good results to make me feel confident that it is a valuable addition to our therapeutic agencies. "After all, in every one of the cases Avhich 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 Avhich it merits." Cold in Fevers. The proper manner to employ cold Avater 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, uncomfortable, and sleepless, yet has not a temperature fraught with any harm. Such a case may be sponged off Avith tepid water or Avith a little alcohol and Avater, or salt and Avhiskey, with great benefit in the production of sleep, the reduction of fever, and the advantage of ner- vous quiet. Sometimes the sponging is successful when used only COLD AS A REMEDY. 399 over the arms and legs, but more frequently it should be extended at least to the spinal column. If tepid sponging does not loAver the fever in a given case, then ordinary cool tap-Avater should be employed; and it is Avell to remem- ber that the secret of successful sponging lies in the use of a sponge not saturated to overfloAving. but only sufficiently Avet to leave a thin film of moisture on the skin, Avhich cools the patient by its rapid evaporation and does not Avet the clothes and the bed. There are many cases Avhere sponging, even Avith ice-water, fails to reduce the fever, and in these the fever must be loAvered by the "cold pack," as it has been called. The name is unfortunate, as it is indicative of a very severe exposure, Avhich really does not occur. The application is carried out as folloAvs: A small canvas cot should be placed by the side of the bed of the patient and covered by a large rubber cloth, Avhich, 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 Avatering-pot for flowers allowed to play upon his body from end to end. The temperature of the Avater depends upon the effect required. The bed should be so arranged that the Avater Avill 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. Another point of very great importance is that cold should be applied to the head Avhile the patient is being bathed. During this procedure the thermometer should be placed in the mouth or pushed deeply into the rectum, and the fall in the tempera- ture Avatched. 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 Avith tOAvels, and the bed-clothing consist of only a sheet, or a sheet and one blanket in cold weather. Above all things, it must be remem- bered that the patient is not to be wrapped up in a blanket, and not onlv this, but that he must not be placed in a blanket Avhile still in a Avet sheet. The Avet sheet, if surrounded by a blanket, soon places the patient in a typical llussian or warm moist bath, calculated to to raise instead of loAver the fever. Where sunstroke (thermic fever) is present the patient may have chopped ice applied or be put directly into a bath-tub of icc-A\ater, but in any event the attendants must rub the patient's skin to bring the hot blood to the surface and prevent congestions Cold Avater may also be injected into the boAvel in cases Avhere the skin is cold, but the central temperature very high. (See Enteroclysis.) The treatment of rheumatic hyperpyrexia by cold is quite as suit- able as is this treatment of other fevers Avhen the hyperpyrexia is so excessive as to endanger life. 400 REMEDIAL MEASURES OTHER THAN DRUGS. The presence of pneumonia and bronchitis does not contraindicate the use of cold in fevers, and no fear of " cold being taken " need exist unless the bodily temperature is loAvered beloAv the normal point. According to Liebermeister, intestinal hemorrhages contraindicate the use of cold, but this statement has been contradicted by no less a Avriter than Wunderlich. (For Brand's cold-bath 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 dis- tant 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 sound physiological laAVS, and is so logical as to have been described by the founder of homoeopathy as useless. The entire basis for the employment of counter-irritation rests upon reflex action, or the conduction of a nervous impulse to a centre, which, Avhen 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 purposes: The first is for affecting inflammations or congestions; the second for causing the absorption or removal of inflammatory depos- its after true inflammation has ceased; Avhile the third purpose is for the relief of pain; and the fourth for the effect which can be exer- cised upon the general system by blisters in systemic disease. In the same manner that we can divide the indications for coun- ter-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 actually inflamed area, but a little to one side of it or at a spot known to be connected intimately Avith the diseased area by nerve-fibres. Thus, it is Avell knoAvn 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 applica- tion of a blister to the spot Avhere the pain is felt, but to the point upon the vertebral column Avhere the nerve at fault takes its exit. The reason for this is that pain is ahvays referred to the peripheral end of an irritated nerve, and pleurodynia or abdominal pain often arises from vertebral disease or inflammation about the spinal liga- ments or the foramina 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, Avhere the pain is felt, but at the seat of the trouble—namely, the hip. Counter-irritation is contraindicated by the presence of any acute inflammation directly under the spot where it is proposed to place a blister; that is, if any reddening of the skin CO UNTER-IRRITA TION. 401 is present the blister or 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 Avhich is small in area—say as large as a Lima bean—and of comparatively slight action, healing rapidly after its pri- mary effects have passed by. Among the inflammatory affections in Avhich Ave find counter-irri- tation very 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 enlarged 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 contraindication to the use of counter-irritation, blisters undoubtedly do good at such times. In pneumonia or pleurisy, along Avith the use of veratrum viride in the very earliest stages of the disease, a cantharidal blister of the size of a silver dollar should be applied near the spot Avhere 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 peri- tonitis the blisters are best applied directly over the seat of tender- ness, and in cerebritis at the nape of the neck. In gleet a little can- tharidal collodion may be painted along the under surface of the penis or upon the perineum with great advantage in obstinate cases. Where an inflammatory process 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 caustic soda or arsenic. The rea- son for using these is that they all cause so much tissue-change in the part that the counter-irritation is very prolonged. Sometimes antimo- nial ointment is applied constantly until a slough forms, to accomplish the same purposes. For the removal of the products of inflammation we resort to can- tharidal blisters or drugs possessing poAvers as local irritants and at the same time as alteratives. Thus, in pleurisy Avith effusion 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 Avhich folloAvs 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 applying the blister is, as a rule, immediately under the arm, about two or three inches below the axilla. The blister, Avhile it is useful in causing absorption in chronic effusions and deposits about joints, is not so good as are alterative irritants; for example, iodine, Avhich 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, 26 402 REMEDIAL MEASURES OTHER THAN DRUGS. particularly 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 elseAvhere. 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 skin lesions behind to remind the patient of his attack. Every one Avho 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 Avriter 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 Avill neverthe- less do good. If neuralgic, a little menthol or oil of peppermint may be applied over the course of the nerve—Avhich application, if it be supraorbital, Avill require care lest the oil gain access to the eye. For the treatment of pain in the belly or chest or elseAvhere we have four means of producing counter-irritation in the shape of rube- facients : The first is mustard ; the second, capsicum ; the third, the turpentine stupe; and the fourth, the spice poultice. The mustard plaster should be made by mixing mustard flour with Avarm vinegar or Avater, 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 only one-fourth mustard. The plaster is made by placing a stout piece of paper on a table and putting over it a piece of heavy muslin or linen. On this is smeared the mus- tard, and over the mustard mass is placed a thin piece of linen, Avhich prevents the poultice from adhering to the skin and modifies the burning according to its density. By folding the edges of the paper so that it resembles a picture-frame Ave have at a hand a cheap, effective, and strong plaster, the back of which is supported by the paper. The spice plaster is made by mixing equal parts of allspice, cloves, cinnamon, and nutmegs, and adding thereto one-half 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. 403 This plaster may be allowed to remain over the affected parts for hours or even days, and is very useful in the treatment of gastric catarrh and indigestion, particularly those forms occurring in children. The turpentine stupe (see Turpentine) is not to be alloAved 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 SAveet oil, to which may be added carbolic acid in the proportion of 1 : 100. The carbolic acid not only acts as an antiseptic, but as a local anaesthetic, Avhile the oil acts as a protective from contact Avith 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 Avith dry cotton ; if they are large, the blebs should be punctured at their most dependent part with an anti- septic 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 nor- mal 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 Ave mean by the terms employed when speaking of this subject. At present we recognize that the word "germicide" is a term applicable solely to agents capable of killing the lower forms of life, Avhereas "antiseptics" are substances which simply render the material Avith Avhich 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 shooting them would stop all groAvth and be germicidal, Avhereas the destruction of crops in these same parts Avould only be antiseptic; or, in other words, the people might remain, but would have to starve to death. (See article on Antiseptics.) We noAv speak of germicides as disinfectants, but never of anti- septics as disinfectants if we use these terms correctly. "Germicide " and "disinfectants" are therefore synonymous words. From Avhat has just been said it is evident that Ave should always resort to disinfectants rather than antiseptics, for although the latter are good, the former are better. We have three Avays 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 may be extended to everything about the patient if it is necessary to 404 REMEDIAL MEASURES OTHER THAN DRUGS. stamp out a brisk epidemic before it can get Avell under Avay. The second is the use of moist heat in the form of superheated steam, or, better still for common purposes, the use of boiling Avater; and, 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 tAvo hours. Very often the bed-clothes are taken from a sick-room, trailed through the house, and finally deposited at any spot until a conve- nient time for boiling them occurs. This is radically Avrong and capa- ble of causing a Avidespread 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 Avater, or, better still, in a corrosive-sublimate solution of the strength of 1 : 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 Avet and plunged into a clothes-boiler in Avhich the Avater is actively boiling. 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 Avhich arises from the surface of the Avater. The active boiling should be continued for one or tAvo hours, and Avater be continually added to prevent scorch- ing 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, and no food should be in the room. If boiling cannot be resorted to for any reason, the clothes mav be soaked in a 1 : 500 solution of corrosive sublimate or a 1 : 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 usually employed, is perfectly useless, OAving to leaking AvindoAvs 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 windoAv- and door-cracks Avith cotton or soft paper. Broken roll-sulphur is moistened with alcohol, Avhich 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 Avash the floor, sills, and casings, using a scrubbing-brush, hot Avater, and soap. The Avater remaining in the bucket should aftenvard be boiled to kill the germs Avhich may be in it. This scrubbing being accomplished, the same surfaces should be scrubbed a second time with a solution of corrosive sublimate (1 : 500 or 1 : 1000), and left Avet, so that the salt of mer- cury may remain on them. Cracks and crannies are to receive par- ticular attention. If corrosive sublimate cannot be used, then car- bolic acid (1 : 10 or 1 : 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- ENTEROCLYSIS. 405 room, but after the case has vacated the premises the windows should remain open for Aveeks 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 ahvays be received in a vessel containing enough corrosive sublimate solution (1 : 500) to kill all germs, and to prevent their escape into the air or into water or food Avhen the discharges are throAvn away. The disinfect- ant 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 remoAred and emptied at once in such a manner that it cannot contaminate any Avater or food. Its contents should not be throAvn upon the ground, as the air will dry them and cause the germs to fly in the form of dust anyAvhere and everyAvhere. In very con- tagious diseases bathing or SAvabbing off the patient Avith weak anti- septics may be tried. Thus 1 : 10,000 of bichloride of mercury may be used and the patient afterward Aviped off' a\ ith a wet tOAveh In other instances a 1:100 solution of carbolic acid in SAveet oil may be employed to soften the skin, decrease itching, and disinfect the patient. The question as to Avhich are the best disinfectant substances is one Avhich has attracted the attention of physicians and original inves- tigators for years. The result of a vast amount of study and experi- ence shoAvs that corrosive sublimate is the best of all disinfectants in the proportion of 1 : 250 to 1 : 500, or even weaker, but 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 Avhen albumin is present, its uselessness Avhere lead pipes are present, and, above all, its expense. Chlorinated lime depends entirely upon its chlorine for any disinfectant poAver Avhich it may possess. Chlorine gas itself is not readily handled, but the lime enables us to put it Avhere Ave will. It cannot be employed to disinfect colored fabrics, as it bleaches them. (See Formaldehyde, Part II.) Whenever chlorinated lime is bought the physician should see that all the chlorine has not departed from it, as most of the material kept in the stores is so old as to be Avorthless. 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 ovev* the surface of the mass of filth. It is useless to place chlorinated lime around the room for the pur- pose 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, Avhile largely used as a disinfectant by some persons, is in reality only an antiseptic. ENTEROCLYSIS. Enteroclysis, or the washing out of the bowel by means of large and sloAvly injected clysters for the purpose of medicating or cleans- 406 REMEDIAL MEASURES OTHER THAN DRUGS. ing both the large and small intestine, has within the last few years become one of the most valuable therapeutic measures Ave possess. Not only is it of value for the purposes named, but for the relief of intestinal obstruction, for the preservation of bodily heat by the use of hot Avater, and for the reduction of fever by the use of cold water. The treatment of choleraic diarrhoea in all its forms by enterocly- sis Avas first used by Cantani within the last decade. The method yielded such good results in his hands that he enthusiastically employed it in a large number of cases, and caused a number of other physicians to use it. The method consists in the sIoav irri- gation of the large and small bowel by Avay of the rectum by means of a solution urged on by the hydrostatic pressure of a fountain- syringe. The solution contains as its chief constituents tannic acid, Avhich is added in the proportion of from 1 to 5 drachms to 2 quarts of water, Avith 1| ounces of wine of opium. Carbolic acid is too poisonous, salicylic acid too insoluble, corro- sive sublimate too poisonous and too easily decomposed, to be used in this manner. In some cases Cantani employed a mixture made of Infusion of chamomile-flowers...... 2000 parts. Tannic acid............... 10 " Gum arabic............... 30 " Tincture of opium............ 2 " Cantani considers that the passage of the ileo-caecal valve is essen- tial for the success of his methods, and if this is the case the report- ers Avho have failed to obtain satisfactory results from this treatment have probably failed to do more than irrigate the colon. The import- ance of irrigating the ileum is great, since it is in this portion of the alimentary canal that the cholera germs are most active. Nor is this treatment by tannic-acid injections founded upon mere empiricism, for Cantani and others have found that tannic acid, in the strength of 1 per cent., inhibits the growth of intestinal germs in one and a half hours at 98° F., while \ per cent, in six hours seriously impairs their vitality. Cantani also asserts that tannic acid neutralizes the toxines formed by these micro-organisms. This treatment therefore contracts the leaking blood-vessels, stops the growth of the bacilli, prevents the absorption of toxines, acidifies the intestine, stimulates the nervous sys- tem, Avarms the body, prevents anuria, and avoids collapse. Many clinicians, however, do not believe that it is possible for the fluid to get by the ileo-caecal valve unless so great hydrostatic pressure is used as to be dangerous. The employment of irrigation of the colon in cases of dysentery is by no means of recent date. It is only, however, within the last feAV years that this method of treatment has been Avidely employed or considered. Aside from the fact that Ave can bring medicaments in direct contact with the diseased mucous membranes, there is no doubt whatever that the mere passage of water at suitable temperatures over the bowel-wall is of value, since by this means Ave remove mucus and pus, and so dilute the poisons manufactured by the germs of the disease ENTEROCLYSIS. 407 that their further action is largely inhibited. In adults the use of irri- gation in dysentery should be carefully carried out by means of an infloAv and outflow tube, the first being attached to a fountain syringe. The outfloAv tube must be large enough to permit of the liquid leaving the bowel Avith a readiness equal to that of its inflow, and must be so straight and patulous as to permit of the fluid carrying away Avith it any flakes of mucous or other foreign matter from the boAvel. The method em- ployed in giving the injection, the temperature of the water, and the gentleness of the operation are exceedingly important, and will be dis- cussed on the succeeding page. The amount of water employed in irri- gation of the boAvel in dysentery is not to be measured by quarts, but by results. It should continue to Aoav in until it comes from the out- floAv tube perfectly clear, shoAving that our object—namely, thorough cleansing of the boAvel—has been accomplished. The best medica- ment to be added to the Avater is boric acid or tannic acid, each of Avhich is harmless and capable of doing much good. The question as to what is the best method of treating a case of intestinal obstruction by other than operative means is one Avhich is of interest to the physician as Avell as the surgeon. Such cases gen- erally come into the hands of the general practitioner first, and it is for him to decide, as a rule, whether the surgeon shall be called in consultation. Measures devoted to the relief of the patient without the use of the knife are first to be tried. No one Avho has studied this subject can doubt that enteroclysis is the best form of treatment which Ave can apply. Used properly, there is little danger of its doing harm, and much chance of its accomplishing good. The author is not one of those who place much confidence in the reports of cases of volvulus overcome by this means. The true indication for rectal injections is intussusception or obstruction due to impacted faeces. A very important point to be decided in connection Avith this sub- ject is the amount of pressure that can be used in the stream of Avater Avhich is employed, the length of time during Avhich the injection may be given, and, finally, the temperature and character of the fluid injected. As is well knoAvn, the great majority of cases of intussus- ception take place at the ileo-caecal valve, and, if not here, in the sig- moid flexure. Pressure by injection is therefore readily brought to bear on the area involved. It has been claimed that certain pressures Avill cause rupture of the peritoneal coat of the intestine, but Martin and the Avriter failed to produce this lesion in the dog by any pressure Ave could employ, since before this occurred the liquid passed through the stomach and mouth. To employ a pressure exceeding eight pounds is, however, distinctly dangerous, not because the intestinal wall in health will not stand this, as a rule, but because it is near the injury line, and if any disease or softening of the boAvel exist, it is almost cer- tain to cause rupture. A pressure of from two to five pounds is, as a rule, as much as may be employed, and this pressure should be obtained by degrees, starting the injection at such a point of pressure that it amounts to hardly more than a trickle, and increasing the pressure as the antagonism of" the boAvel is overcome. Finally, when the bowel is fully distended up to the point of obstruction, the pressure on the no 408 REMEDIAL MEASURES OTHER THAN DRUGS. longer moving column of water may be increased, if necessary, to six or eight pounds by raising the bag of water not more than three feet. In infants, in Avhom invagination so often occurs, a pressure greater than tAvo pounds is dangerous, and it is of vital importance that the pressure be employed properly, otherwise it will do more harm than good in several ways. As a rule, in our anxiety to give the patient relief at once we are inclined to use too much force and too large a bulk of water, and think that active force, if such a term may be used, is to be resorted to. Those who have seen these cases have learned by experience the harmfulness of such measures, and have also learned how great is the expulsive poAver of the boAvel Avhen it is excited to contraction. If this power be brought into activity, it will be almost impossible to inject fluid into the rectum, and, worse than all, the mus- cular fibres of the intussuscipiens take a still tighter grasp on the intussusceptum. The dangerous practice of using a Davidson or any other kind of artificial-force syringe in the treatment of this class of cases is to be condemned. Three unreported cases of rupture of the bowel and death from the employment of the Davidson syringe for this purpose have occurred, because the amount of force used Avas indeterminable, and because it was injected with a jerking instead of a constant floAV. The amount of fluid injected should be large, and if it is impossible to get a large amount into the bowel, it is probably because the inflow has been so rapid as to excite intestinal opposition. If, by a slow trickle of water into the boAvel, gradually increasing the pressure, we are unable to give relief in forty-five minutes, it is necessary either to give this treatment up as useless, or else alloAV the liquid to flow away and resort to the measure again in some hours. Practical experience has shoAvn that the second or third injection sometimes succeeds, prob- ably because it is more skilfully given and the first has prepared the way for the others, but it is to be remembered that the chances for reduction of the obstruction are best with the first injection if it is properly given. Frequently-repeated small injections are abso- lutely unjustifiable. Finally, the author cannot leave this subject Avithout saying a Avord concerning the temperature of the injected liquid and its constitution. An injection of this kind goes into the very heat-citadels of the body, and if too cold, as it often is, produces dangerous chilling of organs Avhich are ordinarily especially protected from cold by the omental apron and intestines. By repeated experiment Ave found that Avater at 65° F. loAvered the bodily heat three degrees in thirty minutes. The use of colder water than this (52° F.) resulted in death in twelve hours, and the post-mortem shoAved intense congestion of the colon, Mrhich contained bloody mucus. The use of Avater of too high a temperature is also dangerous, lest it produce heat-stroke. Of course no one would use Avater hot enough to produce local harm, yet it is necessary to have just enough heat and no more. Martin and the author proved that the use of Avater at 115° F. caused in tAventy-five minutes a rise of bodily tempera- ture in the axilla of nearly five degres, and developed marked symp- HE A T. 409 toms of heat-dyspnoea. The temperature Avhich it is right to employ Ave found to be 101° to 103° F. as the water entered the bowel, or even as high as 104° F. in the water-bag if a long tube was used, as under these circumstances the Avater is rapidly cooled. An interest- ing result of these experiments as to heat is that Avhen cold water Avas used it took four times as long to make the injection as Avhen moderately Avarm water Avas employed. If very large injections are used, a normal saline solution of 7 : 1000 (1 drachm to 1 pint) should be employed to avoid the abstrac- tion of vital salts from the intestinal Avail, Avith consequent passage of Avater into the tissues, making them boggy, according to the laAv of osmosis. Such injections are very useful to relieve thirst and keep the kidneys active after abdominal operations. In regard to the effect of distention of the boAvel by injection on the circulation and respiration, there is practically none, but the pas- sage of large amounts of Avarmed fluid directly into the closed ab- dominal cavity causes death rapidly. HEAT. Heat is used locally for a number of purposes in the same manner as is cold, and, as Avas 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 Avhich will give him the greater 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, thereby regaining the use of the limb. To carry this out effectively, a piece of rubber tubing of small size should be led from a Avooden bucket, Avhich, 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 Avater by suction a continuous but very small stream can be made to Aoav from the bucket, while by means of another sim- ilar arrangement running either from another tub—or, better still, from a hot-water spigot—a small stream of hot Avater continually enters to take the place of that AvithdraAvn by the first siphon. Under these circumstances a very constant temperature of the Avater can readily be maintained. The high degree of heat Avhich can be borne by gradually 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. BetAveen these soak- ings the part should be dressed with lead-water and laudanum, and rubbed noAv 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 neAvspaper to afford a smooth surface over which to pass the iron and to protect the parts from too great heat. 410 REMEDIAL MEASURES OTHER THAN DRUGS. In chordee the best means for rapid relief, other than the use of drugs or general relaxants, such as amyl nitrate, is to steep the penis in hot Avater. 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 Avetting spongiopiline Avith 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 dysmenorrhea 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 Avhere uterine congestion results in leucorrhoea or a sensation of weight in the pelvis. Sometimes attacks of torticollis may be sub- dued by applying hot compresses to the sterno-mastoid muscle. In universal or partial spasm of the body, as Avell as that repre- sented 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 immediately wrapped in a Avoollen blanket which has been dipped in hot Avater and the excess of Avater Avrung out of it. Over this Avet 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 SAveating comes on. This hot pack will sometimes quiet a case of chorea Avhich has resisted all forms of treatment so far as drugs are concerned. Cases of insomnia are often benefited by a similar expedient, and mild cases of sleeplessness will occasionally rest quietly after 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 in those cases of severe chorea in Avhich the child can stand the first shock of 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 profuse. Cold should be applied to the head to relieve cerebral hyperemia 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 skin or kidneys 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 establish- ments found in all large cities. 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 cham- HEAT. 411 her he lingers until the system becomes accustomed to the high tem- perature, and perspiration is Avell established before he enters the hottest room, Avhere he remains for a varying length of time accord- ing to the advice of his physician or his own Avhim 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 SAveat, and also relieves any overheating by abstracting many units of heat. The cold water in the centre of the body causes con- traction of the blood-vessels in these parts, and the blood, rushing to the surface, causes the SAveat-glands to pour out their secretion. FolloAving the stay in the Avarm room, the individual passes into still another chamber, Avhere he is shampooed from head to foot, Avell rubbed, and the blood made to circulate through the skin. The shoAver-bath is then used, at first hot or Avarm, and finally changed to a dash of cold, or, better still, the patient plunges into a long tank, swims to the other end, and is there met by an attendant Avho rapidly dries his skin, Avraps a cover round him, and shoAvs him to a lounge, Avhere 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. RevieAving for a moment the effects of this bath, Ave find that the first two-thirds are devoted to the opening and stimulation of the pores of the skin, Avhile the last third is devoted to the contraction of these pores and their supplying blood-vessels. In other Avords, it is necessary to use the cold to prevent gradual chilling of limited areas, which Avould result in internal congestion. If the patient receives a cold douche, the natural rebound prevents congestion of a permanent nature, Avhereas if he is exposed to cold a long time, these stagnated areas become permanently diseased. The physician must ahvays remember 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 Aveak 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 emunctories of the body Avhereby 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 frequent repetition of the bath causes functional hypertrophy of the sweat-glands, and eventually enables them to do more work, or, in other Avords, 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 bath once, twice, or thrice a week with the object of abstracting the excess of impurities Avhich the impaired kidneys cannot remove. The frequency of the bath depends, therefore, upon the rapidity Avith Avhich the effete materials accumulate. In a case of Bright's disease the patient should not attempt to use the room containing high heat at first, and should be accompanied by a medical attendant 412 REMEDIAL MEASURES OTHER THAN DRUGS. to watch for untoward effects, particularly if the heart is diseased or uraemia is already shoAvn by headache or other signs. If sweat- ing 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 expo- sure to heat, and fever is generally present. In subacute and chronic rheumatism the case is different, and the enlarged joints or inflamed 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 nasal cavities or other parts of the body, at an early formative stage, can often be aborted by a good Turkish bath, and when further developed are often greatly relieved by the same means. If, hoAvever, congestion of the lung, pneumonia, or chronic bronchitis, with emphysema or a dilated Aveak heart, are present, the bath may be dangerous. In acute pharyngitis, in Avhich the pharynx feels like a raw surface or "as if it Avere 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, Avhich readily alloAv the blood in them to become chilled, and the individual consequently suffers from internal local congestions. Tavo separate means of treating such cases exist. The first set will do Avell on minute doses of arsenous acid (grain j-^ to -£-$) three times a day, used for Aveeks; the second will be cured of their habit by the use of a Turkish bath tAvice or thrice a week, since by this means the peripheral capillaries are toned up and made more active. The Turkish bath, as thoroughly carried out in large cities, is not obtainable for those living elseAvhere, so it is Avell to describe a home modification Avhich, Avith attention to detail and care, may prove almost, if not quite, as effective a remedy. The patient is placed upon a chair, naked, and under the chair a small alcohol lamp is put, Avhich is lighted. The individual is now Avrapped thoroughly, chair and all, Avith one or two large blankets, and the heat of the lamp soon causes profuse sweating. Many cases are, hoAvever, on record Avhere the lamp has been upset and the patient badly burned. The best Avay 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 Avhich is placed under the blanket, so that the hot air and vapor may surround the body. If the tube be covered Avith 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 HEAT. 413 in an oven, may be placed under the chair, or small heated logs may be substituted. When the patient is too feeble to leave the bed, then it is Avise to place an alcohol lamp at the foot of the couch, with an inverted funnel attached to a tube Avhich passes under the bed-clothes in such a Avay as not to bring the hot air directly against the skin of the patient. The bed-clothing may be slightly raised to alloAv the hot air to enter. This is a valuable mode of using external heat in cases of shock. The vapor of the alcohol lamp tends to SAveat the patient. 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 Avell in con- sequence. In its place the patient may be given a warm pack, Avhich consists in Avrapping him in a sheet and surrounding him with large blankets Avrung out of Avater as hot as can be borne, which are in turn covered Avith a dry blanket to prevent cooling. (See page 386.) This method of treatment is useful in the same states as is the Turkish bath, but is more rarely used. The Avarm pack just named is also employed to develop the rash of any of the exanthematous fevers Avhen it is suppressed by cold or is not " Avell out" on the skin. The temperature of the patient must be Avatched, lest he fails to have SAveating and 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 Avicker chair under which is placed a bucket of hot Avater. The patient is surrounded by a blanket, and a hot iron or stone is put into the Avater, causing the development of a great amount of steam. A valuable method for using moist heat in a mild form is the "bronchitis tent." (See article on Bronchitis.) 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 and renal engorgement, they are not safe and should not 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 Avas applied, where possible, by means of partial hot-air baths to the affected part for half an hour twice a day, the diseased area being enveloped in hot flannel immediately afteiwvard, and remaining so protected until the next hot-air bath. The temperature never exceeded 116° F. (46.6° C). When the eruption was on the back or neck or on some part which could not be inserted in a hot-air chamber, India-rubber hot-water bottles or tubes, through which hot water Avas kept flowing, were employed. When both arms or legs were affected in a symmetrical manner, 414 REMEDIAL MEASURES OTHER THAN DRUGS. the treatment was confined to one side, the other being left untreated for the purpose of comparison. The results shoAved that the heat treatment acted very energetically and beneficially on syphilides, both Avhen employed alone instead of mercurials and iodides, and also Avhen used in conjunction Avith these remedies. Often heat proved beneficial when the ordinary specifics had failed. Among other observations it Avas noted that hard chancres healed and the induration disappeared in from eight to sixteen days; roseola and papular erythema disappeared in from four to eight days; various forms of papular and impetiginous syphilides, Avith marked pigmenta- tion, disappeared in from eight to tAventy-one days; non-ulcerated tubercles and gummata disappeared in from seven to twenty-four days, but those Avhich had already begun to ulcerate required from one to six Aveeks; periostitis Avas cured in from ten to tAventy-four days; ostoses Avere not affected; syphilitic ulcers, consequent on the break- ing doAvn of gummatous periostitis, required treatment of from six Aveeks to three months or more, Avhile necrosis of bone frequently required many months' treatment before the sequestra could be got aAvay. HYPODERMOCLYSIS. Hypodermoclysis is a method of supplying fluid to the body to replace that lost through excessive purging as in cholera, or in cases of hemorrhage. Further, it may be used to Avash from the body various impurities circulating in the blood or other liquids and to flush out the kidneys. It consists in the introduction into the subcu- taneous tissues of normal saline solution, Avhich is rapidly absorbed by the vessels. As is Avell knoAvn, a quantity of liquid equal to four times that of the normal amount may be passed directly into the veins with- out producing a rise of blood-pressure, and experiment has shoAvn that within fifteen minutes after the fluid flows into the subcutaneous tissues an increased Aoav from the kidneys takes place. It is not safe to infuse a greater quantity of liquid than 1 drachm to each pound of body- Aveight in each fifteen minutes, as, if this amount is exceeded, the accumulation of the liquid in the system is so great that the tissues become bathed and finally droAvned, because the kidneys cannot excrete the liquid fast enough. In the best article on this subject yet published in this country, Hildebrand of San Francisco carefully indicates the limits to Avhich the method may be carried, and shows that if the pro- portions already named be preserved, the operation of hypodermoclysis of normal saline solution may be prolonged indefinitely, and that as the process goes on the urine becomes paler and is loAvered in specific gravity until it is practically identical with the infloAving stream. To carry out the operation the sterilized liquid to be infused—namely, 7 parts of sodium chloride to 1000 parts of Avater (3| grains to the ounce)—is placed in a glass jar Avhich is absolutely aseptic, and to which the air only gains access by means of a glass tube filled with sterilized cotton. From the loAver part of the vessel leads a tube to Avhich is attached a trocar also rendered absolutely sterile. The skin over the place Avhere the liquid is to enter is to be rendered absolutely sterile, IN TEA VENO US INJECTION— KA TA PHORESIS. 415 and the trocar is then inserted into the subcutaneous tissues of the thighs, or, preferably, of the abdomen, and the liquid allowed to flow at the rate named, the pressure being obtained by raising the con- tainer tAvo or three feet above the belly-Avail. As the liquid enters a SAvelling appears in the subcutaneous tissues, Avhich soon disappears after the infusion ceases, and is much aided in its absorption by the use of massage. When hypodermoclysis is employed after hemorrhage the results are often extraordinary, and Cantani, Avho has used the method to overcome the drying of the tissues in cholera, praises it most highly, as does also his critic, Oser. The cyanosis decreases rapidly, the pulse improves Avonderfully, and the respirations are no longer dif- ficult. Sahli of Berne has used hypodermoclysis with very good results in the treatment of uraemia, and he thinks that not only are the poisons Avashed out of the system by this method, but in addition that the dilution of the poisons prevents them from acting so forcibly. In septicaemia, diabetic coma, and similar states this method of treat- ment should be employed and results carefully recorded and reported. In cases of surgical shock warm saline fluid used by hypoder- moclysis is often of great service. (See also Intravenous Injection ; Transfusion). INTRAVENOUS INJECTION. The intravenous injection of medicines is a method Avhich is to be employed only under extraordinary circumstances and with only a feAV drugs. Thus in the case of snake-bite it may be advisable to resort to such an injection of diluted aqua ammonia or ether, or even Avarm brandy or Avhiskey. 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 temporary 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 diffi- cult to puncture one without wounding the opposite wall of the vessel. Again, phlebitis is a very probable sequel, and thrombosis and embo- lism are by no means impossible. It is needless to say that the solution of the drug which is injected into a vein should ahvays be of a neutral or alkaline reaction in order to avoid coagulation of the blood. (See Transfusion.) KATA.PHORESIS. By the term " kataphoresis " we mean a method resorted to by physicians having for its purpose the introduction into the body of drugs through the influence of electricity. Correctly speaking, kata- phoresis is an osmosis of medicaments through the tissues, the osmosis being carried on by the galvanic current and the drug being carried through the tissues between the two poles. Quinine, iodide 416 REMEDIAL MEASURES OTHER THAN DRUGS. 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 Avith the medicament to be used, and the constant current employed, the current being reversed every feAV 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, Avhen the patient's stomach cannot bear drugs, kataphoresis Avith iodides over the part affected 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. LAVAGE. This is a term applied to washing out of the stomach in cases of gastric dilatation, fermentative dyspepsia, and more rarely in cases of gastric carcinoma. It is particularly valuable in the two first- named conditions, not merely for its curative power, but also to rid the stomach of mucus and render it clean before fresh food is placed in it. Originally proposed by Epotius in 1863, it has been most widely employed in children by Epstein, who in one article alone records its employment in 286 cases of gastric disease in infancy, the patients being less than one year of age. Epstein employs a No. 8 or a No. 10 Nedaton catheter for the tube, and warm Avater holding in solution a little benzoate of magnesium or boric acid, the latter being resorted to chiefly when fermentation- and decomposition-products are present. If none of these conditions are present, ordinary Avater will usually suffice. The liquid employed should always be warmed. Others—as, for example, Lorez—use the ordinary catheter, of the size known as No. 13 or No. 15, in children, but for an adult a tube should be used of at least four and a half to five feet, of Avhich eighteen inches pass into the mouth, the remain- ing portion reaching to the basin when lowered to alloAv siphonage. 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 Avith the technique of the method. The tube should be more like a holloAv bougie than a cathe- ter, in order that its calibre may be great enough to carry off some of the semi-solid materials present. If this rule is not carried out, two evil results folloAv: In the first place, the tube and its apertures rapidly, or even at once, become clogged; secondly, the liquid is drained away, leaving behind a mass Avhich is semi-solid, to be sure, and less bulky, but Avhich is nevertheless the quintessence of the nastiness of fermentation, and quite as qualified to leaven any fresh food on its entrance as the liquid would be. LEECHING. 417 The holes in the gastric end of the tube should therefore be of suf- ficient size to take in fairly large masses. In some cases the ordinary siphon may be used, but Avhere there is any solid food or resistance suction by means of a stomach-pump is necessary. The best tube is No. 10, made of red Para rubber with a closed end and lateral holes. The methods by Avhich lavage is employed, further than those Ave have named, are as follows: The tube should be passed back- Avard against the roof of the mouth, so that by folloAving 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. At the same time the patient should be directed to swallow. The mucus in the throat sufficiently lubricates the tube, and oil is to be avoided. If gagging is excessive, the pharynx may be first painted with cocaine. The irritability of the pharynx usually rapidly disap- pears, and it is surprising how quickly the patient may become accus- tomed to the operation, and submit to it without any feeling of dis- comfort. After the tube has reached the stomach a small funnel is to be fitted in its external end, which is then held above the head of the patient while Avater prepared in the way we have mentioned is poured into it until the stomach is filled, when the funnel end is Ioav- ered and the stomach is emptied by siphonage. The stomach-pump has one very serious disadvantage, which is present with eA'en more force in the case of a child than in an adult— namely, the danger of injury to the coats of the organ. This appa- ratus is also more costly and cumbersome, and 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, if a catheter is used and on account of the lack of intelligent 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 catheter before it is introduced, and the tube should always be at least thirty inches in length. LEECHING. Leeching is a method of abstracting blood for the purpose of relieving 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 coagulation of blood, and this accounts for the persistent hemorrhage 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 meningitis they may be 27 418 REMEDIAL MEASURES OTHER THAN DRUGS. applied to the temples or to the nape of the neck, and in the treat- ment 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 they should be applied 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. In all cases the skin should be carefully washed before the leech is used. When the leech has taken enough blood, it can be made to let go its hold by sprinkling it with salt. Each leech will take about 1 drachm of blood. Leech-bites should be watched lest prolonged consecutive bleeding exhaust the patient. In case of such an accident styptics are to be employed. As leech-bites make permanent scars, the ani- mal should not be applied on the face or other exposed surface of the skin. 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 exhausted 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 menstruation, and uterine or ovarian pain. In males mental, sexual, or physical vigor may be impaired, owing to pro- longed 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 Avith surpris- ing results. Before describing the method in detail it is proper to state that its 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 as careful with its funds that remain as a bank should be under the same cir- cumstances. It having been decided that the rest cure is to be employed, the directions are given as folloAvs: A bright, airy, easily-cleaned, and 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 Aveeks, as may be necessary, and during this time is REST CURE. 419 alloAved to see no one except the nurse and the doctor, since the pres- ence of friends requires conversation and mental effort. The patient, in severe cases, must be fed by the nurse, in order to avoid the expend- iture of the force required in the movements of the arms. No sitting up in bed is alloAved, and if any reading is done it must be done by the nurse, Avho can read aloud for an hour a day. In the case of Avomen 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 Avhich is massage or rubbing of the body, the second elec- tricity. By the kneading and rubbing of the muscles and skin the liquids in the tissues are absorbed and poured into the lymph-spaces and a healthy blush is brought to the skin. This passive exercise 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 muscles 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 expenditure of nerve-force, though they keep up the general nutrition. The fol- lowing 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 raAV as the case requires. * a. m. The nurse is to sponge the patient Avith tepid water or with cold and hot water alternately, to stimulate the skin and circu- lation, the body being Avell Avrapped in a blanket, except the leg or portion Avhich is being bathed. After this the nurse should dry the part last Avetted with a rough towel, using some friction to stimulate the skin. 8.30 a. m. Breakfast. Boiled, poached, or scrambled eggs, milk toast, Avater 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 and 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 Avould be thought. If the stomach rebels at over-feeding, 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 had its resources so scattered as to be unable to carry out any physiological act perfectly. 420 REMEDIAL MEASURES OTHER THAN DRUGS. For the treatment to be successful the rules laid down should be rigidly folloAved and never remitted for a single hour. MINERAL SPRINGS AND CLIMATE. This article is intended to give the practitioner and student a gen- eral idea of Avhere to send patients Avho can afford to resort to treat- ment depending upon watering-places and climates. It is manifestly impossible to include the names of all the health-resorts, and the object has been to indicate the diseases Avhich are benefited by these treatments, taking certain Avell-knoAvn resorts as types of each class. Springs. Medicinal springs are usually resorted to for the double purpose of drinking and bathing in the waters, although in many instances one of these methods so far exceeds the other in popularity that it alone is employed. For general purposes Ave may divide these medicinal or beneficial Avaters into four classes—namely, those which act, first, by their purity chiefly ; second, by the presence of more or less active alkaline ingredients; third, by the heat Avhich the Avaters contain as they leave the earth; and, fourth, by reason of the sulphur and iron Avhich they contain. The first class—namely, those which act by reason of their purity—are indicated chiefly in cases where through high living or other cause the system becomes laden Avith impurities through imperfect elimination of tissue-Avaste. Most of the popular lithia waters depend chiefly upon this ability to dissolve effete materials, and very little upon the lithia, which is often present in very small amount. (See Lithium.) Aside from their purity, they also act by reason of the salts of sodium and calcium which they contain. Good results follow their use in the uric-acid diathesis where the urine is scanty, high-colored, and acid. They do good in cases of irritable bladder by washing out this viscus with mild urine in large quantities, and because of this influence are credited with wonderful cures of vesical calculus. When vesical calculi have broken doAvn Avhile these waters Avere being taken, the fortunate result has been coincidence rather than medicinal interference. It is impossible for them to dis- solve stones, but their constant use may prevent the formation of neAv ones. Perhaps the best representative of such waters is Londonderry lithia water. A subdivision of this class consists of those waters Avhich contain somewhat larger amounts of mineral substances, chiefly potassium, sodium, and calcium salts. Because of the poAver possessed by alka- line salts in aiding in oxidation, these waters are used in cases Avhere the effete matters of the body seem to escape only partly oxidized, and where the kidneys, and perhaps the liver, seem torpid. Such springs are the Kissingen and Vichy at Saratoga. If very mild purgative prop- erties are also desired, the Geyser Spring at Saratoga may be used. In MINERAL SPRINGS AND CLIMATE. 421 Europe the most famous springs of this class are at Vichy (Grande Grille), Vals, and Contrexeville in France, and Kissingen in Bavaria. The second class of springs are those Avhich contain salts of sodium, calcium, potassium, and magnesium in sufficient amount to possess very active diuretic and purgative properties. They find their thera- peutic application in cases of hepatic torpor or congestion associated with gouty or rheumatic tendencies, particularly in those individuals Avho have been high livers, avIio lay on too much fat, so clogging their organs, and, finally, in those Avho through illness or exposure to hot climates have subacute or chronic atony of the liver, of the organs of digestion, and of the lymphatics. Nearly ahvays these patients also suffer from more or less constipation and gastro-intestinal catarrh, and are often obese. The sulphate of sodium is an ingredient of many purgative mineral Avaters, and the activity of a water depends very often on the percentage of this salt which is present. The pur- gative action of a Avater also depends upon the time at Avhich it is taken. When taken on an empty stomach it is of course more active. When taken early in the morning before eating and at the natural temperature such a Avater produces a loose Avatery movement, not only unloading the boAvel of faecal matter, but by its alkalinity loosen- ing catarrhal secretions and unloading the liver of congestion. The quantity to be taken in twenty-four hours varies from 1 to 4 pints, but^this question can only be decided by the local physician, Avho studies the effect of the water on the patient. The best-known waters of this class are the Champion, Congress, Hathorn, and Carlsbad Springs at Saratoga, New York, the Crab Orchard in Kentucky, and the springs of Carlsbad and Marienbad in Bohemia, and Friederich- shall in Germany. The hot springs depend chiefly on their heat, as already stated, and differ in chemical composition. They find their value in the treatment of chronic skin diseases, specific or otherwise, and also are useful in aiding in the treatment of rheumatism, gout, and syphilis. Their good results are produced by their heat, Avhich varies from 93° F. to 150° F., and the advantages ahvays derived from properly employed hydrotherapeutic measures. It is in chronic or subacute cases that they do the most good. Hot baths are also of great value in the treatment of chancroid and malignant syphilis. The results achieved depend upon the increased activity of the skin, the improve- ment of the peripheral circulation, and the increased poAvers of absorp- tion produced through increased cellular activity. Patients should ahvays select a competent local physician at such places. In cases of syphilis the methods of treatment to be followed are as follows: The patient should take the bath at a temperature of 90° F., and remain in it for about twenty minutes. After this he is rapidly but thoroughly dried by an attendant, who at once proceeds to rub into the skin of one thigh an amount of mercurial ointment varying from a few grains to a drachm. This is well rubbed into, not smeared over, the skin of a different limb after each bath. The number of baths and inunctions depends upon the condition and necessities of the case, 422 REMEDIAL MEASURES OTHER THAN DRUGS. care being exercised not to push the mercury too freely in those Avho are very susceptible to its use. These baths also aid in the absorp- tion of mercury Avhen it is administered by means of fumigation. The most celebrated of these springs are the Hot Springs of Arkansas and those found at Aix-la-Chapelle in Germany. As types of the fourth class of springs Ave have the White Sulphur Springs in West Virginia and the Richfield Springs in New York, Avhich are used for the relief of catarrhal inflammations of the mucous membranes of the alimentary canal and respiratory passages, and more rarely for catarrhal states of the genito-urinary tract. Not only do they exert the peculiar remedial poAvers long known to belong to sulphur and its compounds by reason of the sulphuretted hydrogen gas contained in them, but they also possess distinct purgative effects. Their chief mineral constituents consist of sulphate of sodium and magnesium, Avhich unload the bowels and portal system in the same manner as do the Champion, Congress, Hathorn, and Carlsbad Springs at Saratoga and those at Crab Orchard. Taking the White Sulphur as a type of its class, it is better than the Saratoga springs in catarrhal states for the reasons given. Rockbridge Alum Spring in Virginia is used in cases of chronic diarrhoea Avith very useful results in many cases. It is not so useful in acute inflammations of the intestine as in the diarrhoea due to chronic disorder. As iron is present in it and in most alum springs in considerable amount, this water is useful in anaemic cases, but is contraindicated by fevers, by chronic congestions, chiefly of the liver, and by plethora. Often in place of alum we find salines associated with the iron, and these Avaters are particularly indicated in the catarrhs associated Avith anaemia. Such a spring exists at Bedford, Pennsylvania. In Europe the chief iron springs are at St. Moritz in Switzerland and Tunbridge Wells in England. Neither of these contains much sulphur or alum. Climates. The practitioner is most frequently consulted as to the possible benefit of climatic changes by persons suffering from pulmonary dis- ease, such as tuberculosis of the lungs, asthma, chronic bronchitis, and emphysema—more rarely by those convalescing from pneumonia or other severe acute illness. The general rules to be followed in all cases are—first, choose a climate having as large a number of clear days as possible, in order that an out-of-door life in the sunshine may be had in plenty; second, the nearest place to the home Avhich is available in order to avoid fatigue, expense, and home-sickness; and third, see that the resort chosen has comfortable accommodations, good drug-supplies, and a capable physician to be called in case of need. In a case of tuberculosis and in all patients suffering from the pulmonary com- plaints named above the following rules may be adhered to, except in persons suffering from attacks of acute bronchitis, Avho always need a climate providing moisture and Avarmth. Some tubercular MINERAL SPRINGS AND CLIMATE. 423 patients do best in a high, dry air, and others in a loAver and more moist temperature—the first being represented by that of Colorado Springs (6000 feet) in America and by San Moritz (6000 feet) and Davos Platz (5000 feet) in SAvitzerland, Avhere the altitude is not only very great, but the air very cold in Avinter. The days in these places are many of them clear, but apt to be Avindy. Feeble persons cannot stand high Avinds, as a rule. The second climate is repre- sented by that of Florida. In many cases, however, some more moderate climate is useful, and this can be obtained in LoAver California, as at San Diego, a place where there is virtually perpetual summer, or at Asheville, N. C. (2200 feet), or Thomasville, Georgia (330 feet), Avhere the air is moderately dry and the climate not subject to sudden changes of temperature or to frequent storms. In other Avords, a spot is desirable where a patient can remain the year round, and, if well enough, engage in business, avoiding the cold, sharp March winds of the Middle, Eastern, or North-Avestern 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 very many cases the various health-resorts have to be chosen by experiment, not by judgment beforehand. In cases of phthisis Avith profuse bronchial secretion a high, dry climate is generally the better, but in cases which suffer from dryness of the air-passages a sea-voyage or a Avarm moist climate is better, on general principles. It is probably true, however, that high altitudes and rarefied air are not to be sought where a distinct tendency to hemorrhage is present, unless the ascent or removal to the rarefied air is very gradual, several Aveeks being passed before the lung is exposed to the low pressure of great heights. The cases in Avhich high altitudes do good are those Avhich have poor thoracic development or chronic pleurisy Avith deficient expansion of the lung after tapping. The folloAving excellent advice given by White in his General Thera/ieutics, is Avorthy of repe- tition : " It is of such importance that only suitable cases should be sent to high altitudes that Ave must point out those that are unsuitable : " 1. Those in Avhom there is considerable affection of the bronchial tubes, for the dryness of the climate increases the kind of bronchitis which commonly accompanies phthisis. " 2. Patients Avith much emphysema or bronchiectasis, because of the probably diminished absorption of oxygen and the difficulty of respiration experienced on first arriving. " 3. Patients Avith disease of the heart must not go to a high alti- tude, because of its effect upon the pulse and upon respiration. " 4. Cases liable to acute febrile attacks, Avhether or not these indicate an occasional increase of mischief in the lungs, should remain on a low level. " 5. Patients Avho are very excitable or suffer from insomnia should not go, for a visit to a place at a great elevation promotes these symptoms. Women do not acclimatize so Avell as men. 424 REMEDIAL MEASURES OTHER THAN DRUGS. " 6. Cases in which there are very extensive lesions, or Avhich are very advanced, are unsuitable. " Pneumonic phthisis, if at all acute, is made worse by a high altitude. " 8. Patients Avho cannot take exercise should not go. " 9. The very old and the very young had better be treated at home. " 10. Sir Andrew Clark (London Lancet, January 5, 1889) states that patients who go to Alpine health-resorts suffering from albumin- uria, or those who develop it Avhilst there, seldom derive any good from their change. " There are many conditions which have been thought to contra- indicate this treatment, but which do not, and they had therefore better be mentioned. They are— "Pulmonary Hemorrhage.—It is now known that this, so far from being a contraindication 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 any active changes in the lungs, it is often improved. " Simple Diarrhcea and Simple Dyspepsia.—These are both benefited. " Night-saveats.—There is a common belief that these forbid this treatment; on the contrary, they often disappear on removal to a high altitude. "The Presexce of Cavities.—This is not a contraindication, unless a very large area of lung is destroyed. " There is no need, after these tAvo lists, to say what cases are suit- able for this climatic treatment: it may, however, be observed that those in which there is threatened phthisis, Avith a strong hereditary predisposition, and those of imperfect thoracic development, are much benefited. According to most authorities, it cannot be too strongly urged that so long as the condition and disease of the patient alloAV the reverse indications to be neglected a mountain climate should be tried." To these rules the author Avould add the folloAving invariable rule: viz. Do not send a case aAvay to die. If the disease is so far advanced that no good can be derived from a trip abroad, it is cruel to make a wretched patient exhaust his strength, his money, and his happiness by seeking health which it is impossible for him to obtain. A patient of the writer's returned on one occasion from a stay of a feAV 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 feAV more years surrounded by a crowd of coughing, haAvking, and Avasting consumptives." This reply evi- dences clearly the necessity of avoiding " consumptive resorts " as much as possible in these cases, and in directing the mind of the patient from depressing thoughts and his OAvn ailment. In the treatment of renal and cardiac disease high altitudes are not particularly desirable. The chief desideratum is out-of-door life, SUSPENSION. 425 with avoidance of chilling of the skin by sudden changes in tempera- ture or strong Avinds. San Diego represents the necessary climate in such cases. There is a class of persons avIio often have no actual disease of a chronic type, Avho nevertheless pass healthier lives if aAvay from rig- orous climates for at least part of the year. Without having acquired tuberculosis, their lungs are delicate naturally or because of attacks of disease, or, again, they become asthmatic or rheumatic in cold weather. In this country Asheville, N. C, and Thomasville, Ga., or San Diego or Coronado Beach, California, afford the climate desired, Avhile in Europe patients are sent to Avhat is knoAvn as the " Riviera," Avhich is the district bordering on the Mediterranean Sea from Genoa to Nice and Avhich is dotted with climatic resorts. This district has often as many as tAvo hundred clear days between October 1st and May 1st. In the French Riviera the resorts are Cannes, Nice, Monaco, Monte Carlo, and Mentone; in the Italian Riviera, Bordi- ghera and San Remo. In Naples and Spezzia the climate is more damp and colder, but nevertheless quite sunny. So much depends upon the location of the hotels in these places, as far as their salubrity in relation to air and dampness is concerned, that the patient should ahvays consult a local physician before settling doAvn permanently at any of these resorts. SUSPENSION. The treatment of locomotor ataxia and allied affections by means of suspending the patient has, during the last few years, been found so valuable for the relief of symptoms as to have taken a permanent place in therapeutics. The method is not confined to cases depend- ing upon diseases of the vertebrae 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, and tinglings, as Avell as the muscular contractions, Avhich often trouble the patient very greatly, are all relieved, and in some cases wralking is possible Avhere, before the treatment, crutches Avere entirely relied upon. The knee-jerk, Avhen 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, Avhich 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 Aveight of the patient should be equally distributed betAveen the shoul- 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 tAvo inches—once a day, for thirty seconds at first, which may gradually be increased to ten minutes. The SAvinging should be resorted to at first every second or 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 426 REMEDIAL MEASURES OTHER THAN DRUGS. 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 jerking or sudden. The same rule as to gentleness applies to the raising of the patient. TRANSFUSION. The term Transfusion was originally applied in medicine to the transference of blood from a healthy person (the donor) to the sick patient (the receiver), who was usually suffering from the results of profuse hemorrhage. When direct transfusion Avas not resorted to the blood Avas defibrinated after being drawn from the arm of the donor and the serum injected into the vein of the sick man. Both of these plans are now practically obsolete, for it has been proved that the blood-corpuscles of the donor always die in the vessels of the receiver and the kidneys are overwhelmed by an effort to eliminate the results of their destruction. Further, it is almost impossible to perform trans- fusion of pure or defibrinated blood Avithout producing clots Avhich will form emboli in the vessels of the patient. Finally, we noAv know that the blood-serum of one man differs greatly from that of another in its physiological effects and is not to be regarded as identical with the serum that is lacking in the patient. The use of milk as a transfusion fluid has been found to result in albuminuria, in infections of various kinds, and in the development of emboli. It ought never to be used for this purpose. At the present time the profession employ a saline solution, injected gently into a vein of the arm or leg, not only to overcome the collapse of hemorrhage, but—far more important—for the relief of various forms of toxaemia. Commonly in hemorrhage and in toxaunia hypo- dermoclysis is used, as already described, because the danger of embo- lism and the possible results of opening a vein are not to be disregarded. Therefore, while hypodermoclysis is the safest and preferable method ordinarily, on the other hand when the case is very urgent, or the tissues are cedematous from dropsy, or the circulation is so feeble that absorption is impossible, then the intra- or endo-venous injection is to be employed Avithout hesitation. Various formula exist for the preparation of the so-called normal saline solution. Some persons are satisfied to employ the ordinary solution of common salt in the strength of -fa of 1 per cent. (H drachms to the quart), in distilled and sterilized water. Others prefer to use a formula suggested by the well-knoAvn French clinician Prof. Hayem, as follows: Sodium sulphate............10.0 Sodium chloride............5.0 Distilled water.............1000 c.cm. A still better solution, however—because it at once supplants the blood which has been lost or is impure, and because it supports the heart, is— TRANSFUSION. 127 Calcium chloride...........0.15 Potassium chloride..........0.05 Sodium chloride............3.75 Sterilized water............500 c.cm. The method of injection is as follows: The thoroughly sterilized saline solution, after being warmed to the temperature of 101° F., is placed in a warm glass irrigation-flask. The patient's skin over the elbow is bared and sterilized; the skin over one of the veins, which is made prominent by a bandage about the upper arm, is incised by a scalpel, and the sheath of the vein raised by means of a pair of dis- secting forceps. This sheath is thoroughly dissected off the vein until this vessel lies free of any attachments for the space of half an inch. A small and gentle bull-dog clip is applied on the vein at the proximal end of the incision so as to keep the lower part of the vein full of blood. A ligature is noAv passed around the vein at the distal end of the incision and tied. Another ligature is then passed under the vein and left untied. The distended area of the vein, betAveen the ligature which has been tied and the clip, is now snipped by means of a pair of fine scissors; and a glass canula, previously dipped in the saline solution to prevent the feAv drops of blood from coagulating on its tip, is inserted into the opening in the vein. The loose ligature is now tied around it and the vein, to hold the canula in place. This canula should have a shoulder at its tip to prevent the ligature from slipping off, and its other end should be attached to a piece of sterile rubber tubing not more than four inches long. By means of a sterilized glass pipette some of the saline is now run into the rubber and glass canula until all air is displaced and they are filled to the utmost. The saline is then alloAved to Aoav out of the tubing attached to the irrigator, which is armed by a glass tip, till all the air is displaced, Avhen one tube is slipped inside the other. By this means all danger of air-embolism is excluded. The irrigator is noAv held about tAvo feet above the arm and the fluid alloAved to sloAvly enter the vein, a half hour being spent in injecting about a quart. As the injection is given the pulse begins to improve, the respirations are deeper and less hurried and if fever is present the temperature usually falls. The patient is evidently better but soon enters the critical stage, Avhich may come on in from tAvo to thirty minutes. There is often a violent chill, a strong rapid pulse, and in the course of three-quarters of an hour a flushing of the skin folloAved by a profuse SAveat. The respira- tion may be labored. The kidneys also increase the urinary flow and sometimes water escapes from the bowel. Several hours later the real benefit appears in convalescence or marked improvement. The conditions in Avhich the intravenous injections are to be per- formed are severe hemorrhage, toxemia arising from the various forms of infection as in septicemia, urannia, and the comatose state in diabetes mellitus. They can be employed in threatened eclampsia, and even in the toxemias of the infectious fevers. The author has used them in uraemic and septic intoxication with the best results. The principle of this treatment is that it causes the rapid elimination of impurities from the body. 428 REMEDIAL MEASURES OTHER THAN DRUGS. This method is to be regarded as a fairly promising method of treat- ment for cases otherwise doomed to death, and will afford permanent or temporary relief according to the severity of the underlying disease. When diabetes exists or Bright's disease is present the benefit is often only temporary. The European clinicians are loud in their praises of the results they have obtained by this plan in the various forms of sepsis. Abdominal transfusion of both saline solutions and milk have been successfully carried out, the reason 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 alloAved to sloAvly flow into the belly. This method is not to be relied on Avhere 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 purposes or have even seen it done by some one else. Furthermore, it is to be feared that many of the younger physicians would hardly knoAv 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 Avhich every one may be called upon to resort to. Like many therapeutic measures, it was sadly abused in the early part of this cen- tury, and people Avere bled when taken ill Avith the same regularity that they Avere put to bed. The indications for venesection are as clear and Avell defined as are the indications for any remedy. Briefly stated, Ave 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 contraindications. 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 blood-vessels. Having made clear the general indications for the use of venesec- tion, Ave may pass on to state some of the diseases in Avhich it may 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 congestions affecting the lung, pleura, cerebral membranes, or peri- toneum. (See Pneumonia.) By the abstraction of blood the vascular tension is lowered and the engorged area relieved. In the first place, the congested area is made up of relaxed blood-vessels, whereas the remaining blood-vessels of the body are tense, and, as a consequence, the blood is urged to the spot already engorged. In the second place, the abstraction of blood from the tense blood-vessels renders the gen- VENESECTION. 429 eral pressure lower than that in 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 increased intracranial hemorrhage. Bleeding is therefore strongly indicated, not only to prevent inflammation, but also to prevent further leakage into the brain-substance. The method by Avhich venesection is practised is yet to be described. It is a very simple operation if an assistant is present to make pres- sure on the vein or entire arm. Often this pressure is best exercised by means of a handkerchief or bandage tightly tAvisted 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, Avith 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 Ave may remove the bandage above and apply a compress over the incised vein, Avhich 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 in it one of Parke, Davis & Co.'s peptonizing tablets, or the contents of one of Fairchild's peptonizing tubes, and a teacupful of cold Avater, 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 may be submerged in it without pain. If complete digestion of the milk is desired, this application of heat may be continued as long as twenty minutes, but in most cases five minutes are sufficient. If carried on longer than five minutes, the milk will become bitter and disagreeable to the taste through the development of peptone in 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 the ice is not available the Avater-bath should be quickly brought to a boil in order to prevent further action of the ferment, and the bottle corked and then be put in a cool place. This recipe may be used where it is thought necessary to digest the milk before it is SAvallowed. Where Ave desire simply to aid digestion it is best to folloAv the directions already given, except that the bottle is not heated, but at once placed upon ice and allowed to remain there, being slightly Avarmed Avhen 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 causing 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 folloAving the directions given in the first recipe, except that it must remain in the hot Avater for no less than tAvo 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, Avithout the milk becoming curdled. Peptonized milk punch is made from milk prepared in the Avay 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. 430 PEPTONIZED ENEMA. 431 A very refreshing and agreeable drink may be made by diluting peptonized milk one-half with highly-charged carbonic-acid water, and swallowing it Avhile effervescing. PEPTONIZED BEEP. The following method of preparing Peptonized Beef is recom- mended by the Fairchilds, and is very useful, as is also peptonized oyster stew, as first introduced by the author's friend, the late Dr. N. A. Randolph. Take \ pound of finely-minced raw lean beef; cold Avater, 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 J a pint of cold water and the liquor poured from the meat, and add Extracti pancreatis..........20 grains (1.3). Sodii bicarb..............15 " (1.0). Shake Avell together, and set aside in a warm place, at about 110° to 115° F., 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 Avith 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 assimilation in the body. Peptonized Oysters.—Peptonized Oysters are prepared by mincing six to tAvelve large oysters, and adding to them, Avhen mixed with a moderate amount of their OAvn liquid, 5 grains (0.35) of pancreatin or peptonizing powTder and 20 grains (1.3) of sodium bicarbonate. The cup containing this mixture is noAv placed in warm water at 100° F., and allowed to remain there from ten to tAventy 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 diges- tion, and served Avith pepper and salt as required. Any condiment or flavoring substance may be used. PEPTONIZED ENEMA. A very useful nutrient enema may be prepared by following the directions given above for peptonizing milk, except that an egg, yelk and Avhite, should be beaten up in the milk before the ferment is added. The effect of this enema may be increased by the addition of a teaspoonful to an ounce of Avhiskey or wine. This should be warm when injected into the rectum. 432 FOODS FOR THE SICK. DIGESTED GRUEL. Digested Gruel may be made by taking thoroughly boiled hot gruel made from oatmeal, barley, Avheat, or from arrow-root, to the amount of J pint (250 cc), and adding thereto, while it is hot, \ pint (250 cc.) of fresh, cold milk; to this may now be added the contents of one peptonizing tablet or tube, and the mixture allowed to stand in moderately hot Avater or in a Avarm place for twenty minutes before it is placed upon ice. KOUMYSS. This is a preparation of milk Avhich is very useful for children and 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 (500 cc.) of cool, perfectly fresh milk 2 teaspoonfuls (8.0) of sugar, and place it, after shaking thoroughly, in a clear beer or claret bottle. Then add \ of a cake of Fleischman's compressed Vienna yeast, and tightly cork the bottle, standing it in a wTarm 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 spurt all over the room. The best thing to use when about to open a bottle of 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 Avith 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-Avater to each tumblerful of milk. The lightly-boiled yelks of tAvo 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 Avater. Starch foods to be avoided as much as possible. BEEF TEA. 433 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 wTell-mashed potato, moistened with gravy. Rice and milk. Supper, 6 P. m. : Milk. Bread and butter. For drink: Boiled or filtered water. Diet for a Child One Year Old (5 meals a day). First meal, 7 a. m. : 2 teaspoonfuls of grated flour-ball (prepared as directed below) in J a pint of milk. Second meal, 10.30 a. m. : ^ a pint of milk with 4 tablespoonfuls of lime-Avater. 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— unbolted, if possible—tie it up very tightly in a pudding-bag; put it in a pot of boiling Avater early in the morning, and 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, and 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 well all the time. Diet for a Child from Six to Tioelve 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; Avarm milk enough to make \ 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. BEEP 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, and 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. 28 434 FOODS FOR THE SICK. Or, take 2 pounds of beef, without fat or bone, half a breakfast- cupful of cold Avater; place it in a jar in a saucepan of Avater. Sim- mer four hours. RESTORATIVE BEEP ESSENCE (Ringer). Take 1 pound of fresh beef, free from fat, chop it up fine, and pour over it 8 ounces of soft Avater, add 5 or 6 drops of hydrochloric acid and 50 or 60 grains of common salt; stir it Avell, 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 2 ounces more of water. The liquid thus obtained is of a red color, possessing the taste of soup. It should be taken cold, a teacupful at a time. If preferred Avarm, 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 lean 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 Avith 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 \ a 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 Avell, and serve. BARLEY-WATER. To prepare barley-water, put two good-sized teaspoonfuls of washed pearl barley Avith 1 pint of cold water in a saucepan, and boil slowly doAvn to two-thirds. Strain. Barley-water for Adults. Take of finest barley \ pound; to this add 1 quart of Avater and boil to 1 pint; strain and add 1 quart of boiled milk. To this add 6 ounces each of brandy and lime-Avater; sweeten to taste; flavor with nutmeg and rind of lemon rubbed with sugar. This forms a most nourishing and palatable drink Avhen kept cold on ice. RICE-WATER. Rice-Avater is made by boiling 2 ounces of clean rice in 2 quarts of water for an hour and a half. BRAN BREAD FOR DIABETICS. 435 WINE-WHEY. Boil 1 pint of fresh milk; Avhile 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 Avhey. ALMOND BREAD FOR DIABETICS. Take of blanched SAveet almonds \ pound; beat them as fine as possible in a stone 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 Avater acidulated Avith vinegar; mix this paste thoroughly Avith 3 ounces of butter and 2 eggs. Next add the yelks of 3 eggs and a little salt, and stir Avell 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 sIoav fire. BRAN BREAD FOR DIABETICS. Take a sufficient quantity (say 1 quart) of Avheat bran; boil it in two successive Avaters for a quarter of an hour, each time straining it through a sieve; then Avash it Avell Avith cold Avater (on the sieve) until the Avater runs off perfectly clear; squeeze the bran in a cloth as dry as possible, 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 Avill be fit for grinding. The bran thus prepared must be ground in a fine mill and sifted through a Avire sieve of such fineness as to require the use of a brush to pass it through; that Avhich 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, \\ ounces (or 2 ounces if desired) of butter, and about J pint of milk; mix the eggs Avith a little of the milk, and Avarm the butter Avith the other portion; then stir the Avhole Avell together, add- ing a little nutmeg or 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 Avith curd or any of the soft cheeses. "It is important that the above directions as to washing and dry- ing the bran should be exactly followed, in order that it may be freed from starch and rendered more friable. The bran in its com- mon state is soft, and not easily reduced to fine powder. In some seasons of the year, or if the cake has not been Avell prepared, it changes more rapidly than is convenient, owing to moisture. This 436 FOODS FOR THE SICK. 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 Avineglassful of sherry or any other Avine. 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 Avine is employed. The vessel for heating the wine should be scrupulously clean. WATERED TOAST. BroAvn 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 'magined, and is useful Avhere milk toast is distasteful. JUNKET. Add from ^ to 1 teaspoonful of Parke, Davis & Co.'s pepsin cor- dial or Fairchild's essence of pepsin to a pint of milk, which should be at body-heat. Place the milk in a cool place, and after the curd has formed serve cold and flavor with powdered nutmeg or vanilla. If there be too great feebleness of digestion to digest the curd, the liquid Avhey may be given, as it contains the salts and soluble albu- minoids of milk. PART IV. DISEASES. ABORTION. The treatment of abortion divides itself into three parts: the first for its preArention, the second for its arrest Avhen threatened, the third for its proper care Avhen inevitable. In the preventive means Ave 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 he 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 anaemia, 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 wor- ries, 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 boAvels being kept in order by fresh fruits in moderate quantity or by mild laxatives, such as cascara sagrada in small doses and com- pound liquorice poAvder. 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, and aloes are not to be used if they can be avoided. If the Avoman be exceedingly stout and pleth- oric, 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 Avhere we must choose the least of two evils. Strychnine, Avhich stimulates the spinal cord, should never be employed, and cantharides, oil of erigeron, and manganese ought not to be used unless they are for some reason 437 438 DISEASES. 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 Avhich the abortion is brought on by malarial poisoning, Avhen it will act as a preventive. The only drug which seems to be of any service as a prophylactic to be taken all through pregnancy is the fluid extract of viburnum prunifolium, the dose of which is \ to 1 drachm (2.0-4.0). 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 (0.65-1.3) 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 Ave have. While viburnum prunifolium may be resorted to, Ave do not knoAV 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 overheating and taking cold, and receive by the hypodermic needle \ grain (0.016) of morphine, or, better still, a rectal injection of warm starch-Avater containing 30 drops (2.0) 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 (0.016-0.03), should be used. Ice-cold drinks should be given, and no tea or coffee allowed. This treatment quiets the uterus, allays ner- vousness and restlessness, and at least puts off the abortion for a feAV hours. Venesection has been practised in very plethoric Avomen with advantage. When an abortion is inevitable, it is to be treated by measures directed to the avoidance of hemorrhages, the thorough delivery of the ovum and its appendages, and the prevention of inflammation and septi- caemia. For the prevention of hemorrhage 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 ceiwix until the bleeding is controlled, and, Avhile 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 Avine. Generally after twenty-four hours the removal of the tampons will shoAv the ovum to be in the vagina, but if part of it remains in the uterus, the folloAving measures should be resorted to : The administration of ergot should be stopped unless the hemorrhages are severe, and the uterine cavity ABSCESS. 439 is to be cleared by the use of the fingers of the attendant, who grasps the membranes and draws them away. In skilful hands the curette may be employed. 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 may be applied to the inner surface of the uterus as a haemostatic, antiseptic, and alter- ative, or, better still, the uterus should be douched with a 2 per cent. solution of creolin in Avarm water, about a quart being used. 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 Aveeks, 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 then become septic. (See Puerperal Diseases.) Should fever arise, the uterus should be carefully curetted and the intra-uterine douches of creolin continued until the fever disappears. ABSCESS. The medical treatment of abscess resolves itself into the use of drugs to prevent the further formation of pus, to cause its fatty degen- eration and absorption, to quiet the systemic disturbance if the inflam- mation be severe, and to support the body if the suppuration be pro- longed or in large amount or if debility exists. The treatment may also be divided into that suited to acute and that to chronic abscess. As acute abscess in its early stages is simply a localized inflamma- tion Avith hyperemia and an outpouring of leucocytes, it may often be modified 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 SAvelling is superficial, a poultice, made by moistening bread- crumbs Avith lead-Avater, should be placed over it, or lead-water may be placed on lint and applied in this Avay. 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 (0.3-0.65) of a 2 per cent, solution of carbolic acid injected into the SAvelling. This method has been found of singular efficacy in bubo Avhere pus seemed just about to form. It is almost ahvays curative, but should not be used in a stronger or Aveaker 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 (1.3-2.6 : 32.0) of Avater, by means of a camel's-hair brush, all over the skin, covering the area involved, or by the use of the tincture of iodine in a similar manner. Internally, calx sulphurata, in the dose of fa grain (0.006) given every hour or tAvo, may be used as an abortive, or at least to promote 440 DISEASES. arrest and cause absorption. If it becomes evident that pus is going to form, then resort must be had to poultices, which by their heat and moisture will aid in the formation of pus by favoring the escape of leucocytes and by softening the tissues. The best form of poultice for this purpose is to use lint which has been saturated with a 1: 4000 solution of mercuric chloride, the moisture being retained by a piece of rubber dam placed over the lint. If pus forms and fluctuation ensues, the abscess should be freely opened, drained, Avashed out by a solution of carbolic acid in the strength of 1: 20, or of bichloride solution 1: 5000, and dressed with antiseptic gauze. If it is tubercular, 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 (1.3) of iodoform should be so used in the treatment of tuber- cular abscess, as larger amounts have caused poisoning. A very good treatment for sIoav abscess is to Avash out the cavity with a 10-volume solution of peroxide of hydrogen, provided there is a free exit for the gas which is given off. If the abscess is chronic (cold abscess) and associated Avith great Aveakness, resort must be had to the internal use of iron in the form of the tincture of the chloride, cod-liver oil with hypophosphites, qui- nine as a tonic to prevent hectic fever, and the use of nutritious, easily-digested food. Alcohol may be used and should be given with milk or in egg-nogg. The following tonic pill or solution is of service: R.—Strychninae sulph...........gr. j (0.05). Ferri redact.............gr. xv (1.0). Quininae sulph............gr. xx (1.3).—M. Ft. in pil. No. xx. S.—One t. d. after meals. Or, R.—Tr. cinchona comp. "| Tr. gentian, comp. >......aa f^iij (96.0).—M. Tr. cardamom, comp. j S.—Dessertspoonful (8.0) t. d. after meals. Having described the means of treatment, it is to be explained how these measures act. The aconite quiets the circulation and thereby relieves the inflammation, the lead-water acts locally as an astringent and sedative, Avhile the belladonna by its action on the blood-vessels contracts the dilated capillaries and allays pain. When carbolic acid is injected into an enlarged gland, it acts as an anaes- thetic, as an antiseptic, and as an astringent and stimulant. The nitrate-of-silver applications act by constringing the blood-vessels, 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 unknoAvn. The object in using the antiseptic irrigations is self-evident, and the employment of iodoform in tubercular abscess rests upon the studies ACNE. 441 of Bruns of Tubingen and many others, Avho have found by experi- ment that the use of 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 of hypophosphites and iron to replace the loss is necessary, and of cod-liver oil and tonics to increase the blood-corpuscles and the abil- ity to assimilate 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 Avhich will often aid in the cure and prevent a relapse if used in small doses for a long period; that is, 1 to 3 drops (0.06-0.18) of Fowler's solution three times a day for a month or two. This is particularly useful if debility and anaemia underlie the disease. If the anaemia be marked, the proper treatment is that directed to the cure of this condition (see Anaemia); if obstinate constipation is present, relief must be obtained by saline purges and the boAvels kept in order by cascara sagrada or some similar drug. If scrofulosis exists, cod-liver oil is of great ser- vice, or if much pustulation is present, calx sulphurata, in the dose of fa to -|- of a grain (0.006-0.008), may be used in pill form three times a day. In menstrual acne sulphur may be used internally to open the boAvels and applied as a wash to the face in the folloAving form: R.—Sulphuris..............3j (4.0). Glycerini..............f|j (32.0). Aquse rosae..........q s. ad fjviij (250.0).—M. S.—Apply twice or thrice a day. Or the folloAving may be used in cases of severe inflamed acne: R. —Sulphuris iodidi ...... gr. xxx (2.0). Cerati simplicis ......... ,§j (32.0).—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 Avith hot water and castile soap, or even Avith the tincture of green soap, and well rubbed with a wet towel. After this the folloAving salve may be thoroughly applied: R.—Sulphur, precip...............3SS< ^T0!1"'}..............aa§ss.-M. Adepis. J " S.—Apply as directed. If the green soap causes irritation, some bland application should folioav 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 (0.65-1.3 : 32.0), be applied. Mer- curial ointment may also be used to relieve induration, but several 442 DISEASES. days must elapse between its use and that of sulphur, as a black sul- phuret of mercury may be formed and stain the face. The diet should be carefully regulated and fatty foods avoided. ADENITIS. Adenitis is an inflammation of the lymphatic glands, generally arising from scrofulosis, unless there be some speeific trouble, such as syphilis, present. Less commonly it occurs in the neck from the irri- 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 use of the ointment is stopped as soon as any reddening of the skin appears or if fluctuation develops. If the ointment cannot be used, the tincture of iodine should be thor- oughly painted over the SAvelling with a brush, but this treatment is less efficacious. The following prescription makes a useful application : R.—Ichthyol..............-?iv (16.0). Adipis benzoinat...........gij (64.0).—M. S.—Rub a small piece of the ointment into the swelling t. d. Syrup of the iodide of iron, in the dose of 5 to 20 drops (0.35- 1.3), 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 redden- ing shoAvs 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 doAvn or is ready for lancing. Lancing is better than alloAving the abscess to break, as the scar left in after years is a mere line instead of a large cicatrix. If the enlargement be tuberculous—and a large number of these cases are so infected—the following treatment, recommended by Treves and Grunfeld, is of value and should be insisted upon. The entire removal of the glands should be effected by dissection alone; directors, handles of scalpels, or fingers should be used to separate 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, Avhen, by continuing the dissec- tion, the operator may gradually get to the back of the gland, remov- ing portions of the mass at a time. The cavity should be packed Avith iodoform gauze, and the Avails scraped if an abscess has existed. ALCOHOLISM. (See Alcohol.) ALOPECIA. This disease, Avhen 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 Avith linimentum cantharidis AMBLYOPIA AND AMAUROSIS. 443 (liquor epispasticus). Three coats of this liquid should be employed, and each coat alloAved to dry before the next is applied. In other cases an ointment of chrysarobin, \ to 1 drachm (2.0-4.0) to the ounce (32.0) of lanolin, may be used, but care must be exercised that too much staining of the skin and clothes does not result. Another equally good application is 2 grains (0.1) of mercury bichloride to 1 drachm (4.0) of rectified spirit and 7 drachms (28.0) of oil of turpen- tine. This mixture maybe rubbed in Avith the finger over and around the patch. If the patient's skin will stand it, 5 grains (0.3) of the corrosive sublimate may be used in place of 2 grains (0.1). 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. hoAvever, also include cases of partial or complete blind- ness in Avhich optic-nerve atrophy subsequently develops, and are often used to describe ocular disorders not limited by the definitions here employed. 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 Avhen 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.; (b) local diseases or conditions—hemorrhoids, hemorrhage, 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 uraemic amaurosis, emmena- gogues, and tonics, especially hypodermics of strychnine. As local measures repeated fly-blisters to the temples, Avet and dry cups, and the constant electric current are used. The nape of the neck may be cauterized. 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. . . . . aa 7ii (8.0 . Unguent, zinci oxidi J a j \ i Petrolati.........gss (16.0).—M. _ S.—To be applied after removing the scabs by the use of a lotion composed of 1 part of bay rum and 3 parts of water. The internal treatment is directed to the cure of any disordered function Avhich 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 tor- por by mercury, podophyllin, or, better still, by freshly-prepared 520 DISEASES undiluted nitro-hydrochloric acid added to Avater; 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 counteracted by the employment of lithium citrate and colchicum or potassium iodide. If the kidneys are at fault because of torpidity, the diuretic potassium 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 poAver, 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 FoAvler's solution, or arsenous acid may be given. EMISSIONS. Seminal emissions occur as the result of sexual abuse, whereby a condition of hyperexcitation 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, Avhich reflexly irritate the genitalia or the nerves, and to a number of other similar causes. These emis- sions also occur Avith some periodicity in normal males who are con- tinent and chaste, and under these circumstances are not to be inter- fered Avith by treatment, unless the emissions become excessive. The former types are, however, proper for medical treatment, and their cure consists in the avoidance of unchaste literature and lasciv- ious 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 avoided. The patient should sleep on a hard hair mattress, not be too heavily covered, and should avoid 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 aAvakes and turns on his side. The drugs to be used are bromide of potassium or sodium in 20-grain (1.3) doses at bed- time, or chloral may be taken in the same amount. Hyoscine is cer- tainly of value in the dose of jfa grain (0.0006). 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 "marriage," which the patient may interpret in its legitimate light or not as he pleases. It is worthy of note that all irritations of the urinary bladder and ENDOCARDITIS. 521 other parts of the genito-urinary system should be removed, and it is often of value to administer citrate of potassium in 20-grain (1.3) doses, in water, three times a day, to render the urine non-irritating and alkaline. Stimulating foods and drinks are to be interdicted, and condiments, such as pepper and mustard, avoided. Sometimes, Avhen 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 Avell as to give medicines. Many per- sons, believing that emissions are ahvays an evidence of disease, read books on such subjects Avhich are sold by quacks and soon find their Avay to the hands of these persons, or sensibly consult a regular physi- cian. Half the treatment in these instances consists in assuring the 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 complete belief. ENDOCARDITIS. Endocarditis occurs sometimes as a single manifestation of disease ; sometimes as a symptom, Avith 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 antirheumatic or antilithic remedies, such as the iodides. The iodides are not, hoAvever, indicated if any rapid changes of a degenerative type are at work. In acute sthenic endocarditis, associated with great vascular disturb- ance and much cardiac embarrassment or irregularity, there is no rem- edy so useful in the early stages as full doses of tincture of aconite, 2 to 3 drops (0.1-0.15), given every hour until the physiological symptoms of its influence are felt, or, in its place, with equal efficacy may be em- ployed the tincture of veratrum viride (2 to 3 drops [0.1-0.15]). At the same time calomel and opium may be used, the calomel for its anti- phlogistic influence, and the opium to control the purgative tendencies of the mercurial. Thus Ave may use \ grain (0.015) of calomel every two hours and fa grain (0.006) of morphine, heeches should be placed over the prsecordium in a goodly number, and if these are not obtainable wet cups are to be employed. In most cases it is better to apply an ice- bag over the heart. This depletion is only of service Avhen the disease is seen early enough to alloAv us to limit the inflammatory process. 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 pneumo- gastric irritation which it produces. Aconite and other depressants are contraindicated at this time. Absolute rest upon the back is to 522 DISEASES. be insisted upon, and it is recommended, in those cases Avhere 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 chieflv 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 Avith, since it often resists the influences of all the standard remedies, and drives the practitioner from drug to drug in the hope of finding one which will be at least alleviating in its effects. For this reason the author has in this article included many of the drugs Avhich 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 treatment 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 in 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 operative 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 in 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 reports are constantly made of cases Avhere it has failed ; but many cases prove that the remedy is undoubtedly responsible for a cure when it is pushed in a suitable manner, and in the vast majority of instances the seizures are so decreased, both in violence and fre- quency, that its use may be said to be indicated in every case of the disease. In a very small minority, however, it signally fails, and in a still smaller number of cases it is useless unless combined Avith some other drug whose 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 Avhich 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 with the salt employed to a considerable extent, and depend upon the character of the disease and the tern- EPILEPSY. 523 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 Avhich 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 re- garded, for if it is violent enough to endanger life, remedies must be pushed even beyond the point of tolerance. The Avriter has heard a very celebrated physician cause much amusement among his auditors by detailing an instance of an epileptic who Avas getting well, and would have recovered if he had not died. His explanation was, that the man Avas syphilitic, and Avas receiving moderate doses of iodide and bromide of potassium, Avhich Avere sIoavIv benefiting him, and Avould have cured him had not a single severe fit produced death in the mean Avhile. 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 (0.65) thrice a day ; and Avhile this may seem a very small quantity, it will be found that it can be rapidly increased in amount without causing the gastric distress produced by the sudden use of larger doses. Each day an additional 10 grains may be added, until at the end of a Aveek the patient is taking 80 grains (5.3) in each twenty- four hours. There are very feAV cases Avhich will not become com- pletely saturated Avith the drug if this is done, and there are very few in Avhich a more rapid arrival at bromism is needed. If, however, 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, Avith regularly recurring fits, the greatest good is obtained by pushing the drug in ascending doses for one week, and then for the succeeding week only enough is given to preserve the general effects of the medicament. By doing this the stomacii 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 Avhen 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 which are given Avith 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 524 DISEASES. when the substance is as irritant and depressing as potassium. If taken after meals the appetite is not decreased, but there are feAv who can take a dose of 10 or 20 grains (0.65-1.3) of bromide of potas- sium before breakfast without suffering from indigestion. It has been held by some that the drug should be taken in minute doses, fre- quently repeated, in order to keep the patient constantly under its influence. This is an example of therapeutic ignorance, because bromides are slowly eliminated, and this frequent administration pos- sesses the disadvantages of being inconvenient, annoying, and apt to disorder the stomach. In this connection it is not to be forgotten that the use of full doses of the bromides, particularly in epileptics of an advanced type, sometimes causes maniacal outbursts in place of the epileptic attacks. In other instances the patients become morose and homicidal. (See article by author in Therapeutic Gazette, June, 1897.) Cases are on record in Avhich the persistent use of large doses of the bromides has resulted in bronchitis with profuse and dangerous exuda- tion, causing suffocative bronchitis. 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 dose only at this time, and but a few grains 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 seems to have produced a complete cure, and this results in careless- ness in the regularity of administration. The patient should be impressed by the fact that every day passed Avithout a fit is a step forward, 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 sloAvly 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 knoAvn 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 very great extent. Not only is this pointed to by clinical facts, but the Avell-knoAvn 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 Avas necessary in order to cause response in the limbs than Avas normal, and that it Avas difficult to produce epileptic attacks by means of the electrical stimulation of the motor areas, even when currents very much stronger than those which com- monly produce such a result Avere used. He also found that this EPILEPSY. 525 lessened irritability was increased still further if the drug was 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. There is one more point to Avhich attention must be called, and that is the fact that Avhen the bromides are taken for any length of time they produce bromism, Avhich 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. (See Bromide of Potassium.) The bromide salts of gold, iron, sodium, lithium, nickel, and ammonium have all been used in epilepsy Avith good results, but, except in certain instances, they fail to act as well as that of potas- sium, unless given in larger doses. There are several circumstances, hoAvever, under Avhich each one possesses marked advantages, and may suceed Avhere potassium has failed. In all cases of epilepsy complicated Avith anaemia the bromide of iron should be employed, but Avhere there is plethora it Avill 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 poAverful 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. The bromide of lithium has been highly recommended in intract- able cases by Weir Mitchell, who even states that it may be given in one-half the dose of the potassium salt Avith 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 experi- ments made by the writer some years since he found it virtually iden- tical 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 and disorders the stomach quite readily. It ought always to be used, when used at all, Avith some other drugs, the ammonium salt only acting as an adj uvant. 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 J to 3 drachms (2.0-12.0) in a tumblerful of sAveetened Avater. The bromate of potassium has been used by Mitchell in doses of not more than 5 to 10 grains (0.3-0.05) with good results, but is more dangerous and scarcely of greater value. There can be no doubt that in some instances Avhat is knoAvn as the mixed treatment is successful Avhen all else fails. This consists most commonly of a prescription in which the bromides of potassium, sodium, and ammonium take part. Why this combination acts better than any one of the salts alone no one knoAvs, but it is certainly a clinical fact. 526 DISEASES. Bechterew has recommended the joint use of the bromides with adonis vernalis in epilepsy as follows: R.—Potassii bromidi ......... giij (12.0). Infus. adonis vernal.......f 5vi f 180.0). Aquse destillat. ..... q. s. f.^yj ' 180.0).—M. S.—A dessertspoonful three times a day. Sometimes codeine is combined Avith this prescription. Within the last few years it has been claimed by Flechsig that the use of opium for a long period of time is useful in the treatment of epilepsy. He gives the opium in ascending doses during a period of six Aveeks, beginning Avith {- grain (0.018) three times a day and going as high as 5 grains (0.33) three times a day. This method de- creases the frequency and severity of the fits for several months in some cases, but does not cause a cure. It succeeds best in old cases and is not useful in recent ones. In still other cases digitalis, Avhen used along Avith one of the bro- mides, 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, Avhere 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 Avhether it does any more good in nocturnal attacks than in others. Another combination A-ery much employed and lauded is bromide of potassium with belladonna, the mydriatic being almost useless alone, but of great antiquity in its use in epilepsy. Like the mix- ture 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 the nervous system than upon the circulatory apparatus, it has been thought that its influence for good depended upon this effect, but the experiments 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 Avas held that belladonna acted on the spinal cord and peripheral nerves under such circumstances, but it should be remembered that we now 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 Avhether it irritates the motor centres of the cortex. In his hands repeated small doses or one large dose in no Avay retarded the convulsions com- monly produced by stimulation of the brain. Both these investigators are therefore in accord. Under these circumstances it affects rather the motor nerve-endings than the central nervous apparatus. 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 when combined with any other drug, unless it be EPILEPSY. 527 Avith the bromides. Although it is at present rarely so used, the author believes, from his own studies, that it is of value, for he found that it distinctly lessens reflex action and acts poAverfully upon the higher nervous centres in the brain. Its use and value in migraine are undeniably of the greatest importance, and epilepsy and migraine are often very closely allied. Nitrate of silver was brought into use long before the value of more recent drugs was knoAvn. Every one is agreed that it is with- out power for good, save when it is used constantly for a long time. As the drug is eliminated very slowly, it rapidly accumulates3in the body, and argyria soon comes on. It may be used, after all else fails, in doses of £ to £ grain (0.01-0.15) thrice a day after meals, the mucous membrane of the inside of the lips and the conjunctiva being carefully watched for the early signs of chronic silver poisoning. We certainly have no knoAvledge as to its influence on the nervous sys- tem ; 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 haut mal, in the dose of 1 drop (0.05) 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 an attack is expected or Avhen the cardiac action is defective. Its great lethal poAver should never be forgotten. The use of the nitrite of amyl is not for the purpose of directly curing the disease, but of Avarding off impending attacks, the warn- ing of Avhich is given by an aura of sIoav progression. It increases the severity of petit mal, but in epileptics Avho have a prolonged aura Ave may use nitrite-of-amyl pearls, Avhich consist in small glass beads containing a feAV 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 probably dependent on. its action on the blood or circulation. Its influence on the spinal cord and nerves is much more marked and direct, and it is most certainly a very powerful spinal depressant. As its influence over unstriated muscular fibre is very great, it affects the vasomotor 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, hoAvever, necessarily correct. Nitrite of amyl puts aside an 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 methgemoglobin produced, the sudden change in the cerebral nutrition and state is easily understood. In the treatment of the "status epilepticus " nitrite of amyl is of great value in stopping the seizures, and may be used under these 528 DISEASES. circumstances 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 Avhen respiration is being carried on that it can enter the lungs and do its Avork. Another valued method in treating the status epilepticus is free bloodletting. The nitrite of ammonium or of sodium should be used internally to sup- plement the nitrite of amyl. The use of anaesthetics during an attack of epilepsy is virtually useless, and in some cases dangerous, for ether is too slow in its effects, and may, by its irritant vapors, increase the tendency to laryngeal spasm or cause lung complications. Further than this, if uraemia is the cause of the fit—and this fact is unknoAvn in every case until the individual is carefully examined—the ether may increase the inflam- mation 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 in such cases the convulsions must be stopped at all hazards, but the prefer- ence should be always for amyl nitrite. The iodide of potassium is entirely useless in epilepsy unless the disease is due to syphilis, when 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 Avell knoAvn, syphilitics usually bear the drug extremely well, and the author knows of one instance where no' less than 800 grains (53.0) were taken every twenty-four hours, with rapid improvement as a result. This point is strongly insisted upon by all therapeutists and syphilographers, notably among whom stands Fournier. 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 with mercury in order to break doAvn the growth without delay, lest a seizure cause death by glottic closure, producing asphyxia or some similar accident. Chloral hydrate is a remedy Avhich has been only partly tried in epilepsy, and its usefulness is not as yet determined. It possesses the marked disadvantage, as compared Avith the bromides, of being a very fatal poison, which is an important fact to be borne in mind by the physician Avhen giving it to a patient Avhose mind is already Aveak- ened by the disease or naturally stupid, and Avho 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 m*uch more lauded rem- edies, since it exerts its chief influence on the motor patliAvays of the spinal cord and quiets the motor portion of the cerebral cortex, and also produces sleep. Seppilli has proved this by direct experimenta- tion after the method employed by Albertoni. Its use, combined Avith 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 given Avell diluted and after meals. EPILEPSY. 529 Of the more recent remedies, acetanilid certainly stands in the foremost rank, and bids fair in some instances to rival the bromides. Professor Germain-See, the author, and some others have reported cases Avhich 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 was brought to the author Avith a beginning epilepsy he would use the bromides, but, if the disease Avas chronic, acetanilid. Antipyrin has been recommended by Lemoine in certain forms of epilepsy, but is condemned in many cases. In those who suffer from menstrual epilepsy, so called, or in those in Avhom 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 which are asso- ciated with migraine. In these cases the results Avere better than Avith the bromides, but in the idiopathic simple varieties it was use- less. Mairet and Combemale have used the drug in the epileptiform mania Avith satisfactory results. In the epilepsy of childhood Solanum Carolinense in the form of the fluid extract, in the dose of 2 to 15 minims (0.1-1 cc), is a useful drug. The value of the treatment of epilepsy by borax has not received very wide recognition. Perhaps the most thorough studies of its effects have been those of GoAvers in England and Folsom in America. It would seem that some cases which are obstinate under ordinary treat- ment are benefited by borax, but it is certainly not to be commonly employed. The dose generally given is about 15 grains (1.0). (See Borax.) In children suffering from frequently recurring epileptic attacks the presence of worms 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 injection of a strong infusion of quassia of such a strength that there are 2 ounces (64.0) of quassia to each pint (500 cc.) of water. In girls, Avhere the removal of the worms from the rectum is not folloAved by relief, a careful examination of the vagina should be made, and quassia employed in somewhat weaker solution, as very commonly intense inflammation is there present, produced by migra- tory movements of rectal parasites. If the quassia is unobtainable in any case, a saturated solution of chloride of sodium may be employed. A very important point, Avhich is constantly brought before the physician Avho is treating epilepsy, is that of diet. Nearly every patient who suffers from this disease inquires what he shall eat. Very feAV researches of a thorough character have ever been carried out on a large scale to determine the things Avhich may or may not be in- gested. Of course, nearly every one of us knoAvs from our personal experience that red meats are hurtful, particularly in children. Curi- ously enough, the influence of diet in one research covering a number of cases of chronic epilepsy seemed to be of little moment. Thus, Merson examined 24 such cases, putting 12 of them on a purely vege- table, and 12 on a purely nitrogenous, diet. The result, after this 34 530 DISEASES. study had been continued for tAvo months, ay as that the vegetarians had had a feAV less fits than the others, but the difference was so slight as to be of almost no weight in determining the question. Some authors at the present day believe this opinion as to the harmfulness of meats to be erroneous, and Gowers is one of them. EPISTAXIS. Nose-bleed depends upon many causes, the chief of Avhich are traumatisms, plethora, and the presence of ulcerations in the nasal chambers. 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 it 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 exces- sive. When it is excessive or must be controlled for any reason, the measures 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 (0.1-0.2) of one of them, folloAved in a half-hour by a smaller dose, if necessary. The value of these drugs depends upon their poAver of loAvering blood- pressure, and in consequence decreasing the leakage from the break in the Avail of 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 alum in solution, may be snuffed up the nostril, and tannic acid, in poAvder or in solution, may be used with advantage. If this does not control the hemorrhage, an atomized spray of Monsel's solution, in the strength of 30 drops to 4 ounces (2.0 : 128.0) of Avater, may be of service. Ergot in the form of the fluid extract in the dose of 1 drachm (4.0) may be given, or its wine in the dose of a Avineglassful (32.0) employed. Sometimes, Avhen the oozing is sIoav, doses of turpentine taken internally, oil of erige- ron, or hamamelis, do good. All these remedies act as styptics Avhen locally applied, by causing coagulation of the fibrin and the formation of a clot, while the inter- nal remedies produce local contraction of the blood-vessels in the con- gested area. The non-medicinal measures to be employed if the bleeding is severe consist in plugging the anterior nares Avith pledgets of cotton or pieces of lint soaked in vinegar. If this does not control the hemorrhage, the posterior nares may also be closed by plugs, and compression of the facial artery of the same side as the bleeding nos- tril be made upon the superior maxilla near the nose, thus decreasing the blood-supply. The head must be kept raised, and the patient must not bend over a basin or Avear a tight collar. A piece of bacon fat cut to fit and placed in the nostril may stop epistaxis which has resisted all other measures. As a household remedy vinegar may be injected into the nostrils, or lemon-juice r^ay be employed in the same Avay. ERYSIPELAS. 531 Sometimes, if the patient raises one or both hands high above the head, the hemorrhage 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 away 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 hemorrhage by causing localized annemia. Where the nasal hemorrhage 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 performed if possible. ERYSIPELAS. This disease is noAv generally recognized as dependent for its existence upon a germ. The streptococcus of erysipelas is practi- cally identical Avith that of pus. and the disease is at first a distinctly local one. The changes Avhich have come forAvard in its treatment are chiefly the local measures, while 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 which the nervous and circulatory systems give evidence of reflex irritation and the pulse is hard and full. These remedies are contraindicated if any tendency to Aveakness exists. DaCosta has recommended, and others have car- ried out with success, the practice of using pilocarpine in sweating dose (| to -^ grain hypodermically) in these early stages. (See Pilo- carpus.) As Avith aconite and veratrum viride, it is to be remembered that this use of pilocarpine is not to be resorted to if debility exists. The internal treatment of erysipelas par excellence is the plentiful use of the tincture of the chloride of iron—20 to 30 drops (1.3-2.0), or even 40 drops (2.65), four times a day. The diet should be reg- ulated and the boAvels kept in good order, while any excessive febrile movement is to be treated by the use of antipyretic drugs, such as antipyrin, or, better still, by cold bathing. Where the patient passes into the typhoid state supportive measures must be used and alcoholic stimulants 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 of bitters, is particularly indicated if the recovery of strength is sIoav. The local treatment of erysipelas is very varied, but in the majority of cases resort may be had to but one method. By far the best dressing for the general run of cases of erysipelas is a modification of that of Von Nussbaum, Avhich the author has tried 532 DISEASES. in a great number of cases Avith success. The skin of the part involved is carefully cleansed with Castile soap of the purest form, and then it is Avashed off by a 1:1000 solution of bichloride of mercury. The skin is dried Avith a soft tOAvel, and a thick coating of ichthyol Avith vaseline or lanolin applied, the strength of this ointment being half and half. Over 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 with any thinning substance, will be found of service in an emergency. The plan recommended by Higginbottom, of applying nitrate of silver, is sometimes successful. It consists in the use of a solution of the strength of 80 grains to 4 drachms (5.3 : 16.0) of distilled water, Avhich is thoroughly applied Avith a camel's-hair brush over the entire inflamed area and for a little space beyond. The application must be made tAvice or thrice to secure a good coating. This treat- ment Avill often arrest the inflammation and prevent its spread, but has caused sloughing. 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 betAveen 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 Avho 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 man 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 stim- ulation ; of exhaustion, not only stimulation, but feeding and protec- tion 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. SAvelling of the feet occurs chiefly in tAvo classes of cases, excepting, of course, in dropsy, Avhich makes a third class. The two classes named are old persons taking too little or too much exercise, and who FEVER, AND ITS TREATMENT. 533 may have gouty or rheumatic tendencies, and those avIio by constant standing or walking cause congestion of the lower extremities, chiefly by fatigue, or by Avearing bad shoes, or by running over uneven ground, causing bruising. Where the SAvelling takes place in the first class, small doses of arsenic, in the dose of fa to fa grain (0.001-0.0015), often do good, and careful examination should be made of the cir- culatory, renal, and respiratory apparatus to discover any weak points, such as vascular relaxation or tendencies to varicosities. The dis- tilled or fluid extract of hamamelis is often of service in the dose of \ to 1 drachm (2.0-4.0) of the former and 10 to 20 drops (0.65-1.3) of the latter preparation. In some cases absolute rest of the feet will be necessary before a 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 SAveating 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 toughen 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 water and glycerin, rubbed over the feet night and morning. If the sweating is very severe, clean stockings should be worn each day, the stockings being previously soaked in a strong solution of borax and dried. The folloAving prescription affords a useful powder: R.—Pulv. acidi salicyliei......gr. xx vel xl (1.3-2.65). Pulv. acidi borici.......ppj (8.0). Pulv. amyli......q. s. ad Sj (32.0).—M. S.—To be dusted over the feet night and morning, after washing and thoroughly dry- ing 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 perverted functional activity of heat-centres. The first may be rep- resented by the fever of any infectious disease ; the second, by the so- called hysterical hyperpyrexia. Turning from the general question of fever to those methods and drugs which combat it the rule of practice should be to control all fevers by the use of cold sponging or bathing and resort to antipyretic drugs as little as possible. The value of a drug Avhich can decrease high temperature by influ- encing heat-production alone cannot be over-estimated, and while sev- eral drugs seem to influence this part of the heat apparatus more than that portion connected Avith the dissipation of heat, we have no sub- 534 DISEASES. stance which is distinctly and solely capable of exercising an inhib- itory power over the development of heat in the body. For practical purposes we may therefore divide antipyretics into three great classes: First, the substances which allay or prevent fever by inhibiting its production ; second, the drugs which possess the power of decreasing bodily temperature by increasing the dissipation and decreasing the production of heat; and third, the compounds which 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-Avay between, 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 content with : the third is the one used by our forefathers. The objection to the use of all antipyretic drugs is that they de- press the patient and decrease his power of resisting disease. Before Ave consider the uses of these drugs in fevers it is necessary to define what we mean by hyperpyrexia. As given by most writers upon the subject of fever, this term is applied to any state in Avhich the temperature reaches 106° or 107° F., but the presence of a high temperature alone does not constitute the sole indication for treatment, the physician being governed by the state of the patient Avho is labor- ing under the malady. A temperature of 106° F. in a young healthy man suffering from an attack of some disease of short duration does not mean very great danger, but a temperature of 103° day in and day out in typhoid fever does mean danger, and must be carefully attended to. 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 knoAvledge, place them as follows: First, those Avhich decrease heat-production alone are not known. Second, those Avhich act both on dissipation and pro- duction are antipyrin, acetanilid, carbolic acid, salicylic acid, similar substances, and quinine. In this class, also, should be placed cold bathing, Avhich probably decreases heat-production as Avell as increases heat-dissipation. Third, those drugs which only dissipate heat, as far as Ave knoAv—namely, the great group of cardiac sedatives and their allies. No one is more sensible of the fact than the writer that this arrangement of the subject is partly artificial, but in the present state of our knoAvledge it is probably the best Ave can do. Though a number of writers have claimed that certain antipyretic remedies of equal power act Avith different results in different diseases, the writer has never been able to see any such distinction, and we must be guided rather by experience as to the value of some particular antipyretic in all diseases than by any other rule. All observers are not in accord, hoAvever, as to the best one of this class. While phe- nacetin has been spoken of very highly by some authorities, the Avriter has heard it equally condemned by others, and, although Ringer prefers antipyrin, Mitchell Bruce relies chiefly on acetanilid. In America many persons prefer acetanilid. FEVER, AND ITS TREATMENT 535 It may be said that Ave have only three measures for the relief of fever Avhich are reliable and have stood the test of time. These are the employment of antipyrin and acetanilid, and the use of cold. (For the mode of using antipyrin and acetanilid see pp. 45 and 75, and for the use of cold see p. 391.) A very important question arises as to the value of 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 Avhere trained nurses are on hand to admin- ister it, but Avhere only members of the family are in care of the sick man, and Avhere 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 can- not be used more carelessly than antipyretic drugs, and it is probable that Avhen 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 in Fevers, Part III.) (For the use of guaiacol externally in fever see article on Guaiacol.) Sthenic Fevers. The application of antipyretics to the febrile temperatures occur- ring in sthenic cases has an entirely different purpose from their employ- ment in a prolonged low fever of the adynamic type. There can be little doubt that in the sudden excessive outbursts of febrile tempera- ture in a child from functional disorder, but with no acute disease un- derlying it, antipyretics are of value, and there are also reasons for their employment in the treatment of children and adults in order to favor popular prejudice. In America, at least, a physician visiting a case of croupous pneumonia for the first time, and finding the patient with a high fever, often 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 pro- longed enough to necessitate the use of antipyrin day in and day out for Aveeks 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 dru^s should be most carefully Avatched, because the kidneys are in danger and the disturbances accompanying the fever may last a long time. In pneumonia and erysipelas in strong persons antipyretics may be used. Lasting about a Aveek in their febrile activity, these diseases are sometimes accompanied by sudden hyperpyrexia, which must be over- come. Usually it is best to accomplish this by the use of cold spon- ging or bathing, but sometimes where these methods cannot be used we are forced to employ antipyretic drugs. In thermic fever, or sunstroke, the employment of antipyretics is 536 DISEASES. often useless. The excessively rapid upward rush of the temperature responds in no Avay to drugs, and there are cases on record in which the use of antipyrin has utterly failed of good result. Thus, in one case reported by Singer a man suffering from thermic fever, with a temper- ature of 108 degrees, received 50 grains (3.3) of antipyrin hypodermi- cally at 6 P. m. ; at 7 p. m. he received 10 grains (0.65) more under the skin; at 8 p. M. 20 grains (1.3) more; and at 9.30 another 20 grains (1.3) were used Avithout effect. In other words. 100 grains (6.0) in three hours and a half proved useless. In children suffering from excessive heat during summer Aveather antipyrin seems to be very use- ful, and has been highly recommended by Demme. It must be used with caution lest collapse be induced, and the author much prefers the use of cool sponging or baths. 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 Avell founded in a large number of typhoid-fever cases, logical reasoning endorses its correctness. Even if antipyretics Avere perfectly innocuous, their constant use in fever would but give the already overstrained kidneys the task of their excretion, while the stomach, sufficiently disturbed by necessary med- icines and illness, has enough to do Avithout the addition of an addi- tional load. Further than this, we know that these drugs are not perfectly harmless, and Ave also know that they act on the protoplasm of the body, and in consequence must gradually lose their power, which is not the case Avith the cold pack. The writer 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 upAvard after its depression. (For Brand's treatment see Typhoid Fever.) Further than this, fever will sometimes resist all doses of antipyretics we can give or all that it is safe to give, but no fever can resist the cold bath. In diseases of a more chronic type, particularly those represented by phthisis, antipyretics are of doubtful value, owing to the increased SAveating Avhich is so apt to be produced, and unless the patient seems to be particularly robust they should not be employed except in the smallest effectual doses. FRECKLES AND CHLOASMA. The removal of freckles is readily accomplished, but their return is inevitable if any exposure to the sun or wind occurs. One of the best applications for their removal is a solution of corrosive sublimate, in water, varying in strength from 1 to 4 grains to the ounce (0.05- GASTRALG1A. 537 0.2 : 32.0). and applied night and morning until the skin shoAvs 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 allowed to play is a saturated solution of boric acid in Avater, applied in the same manner as is the solution of bichloride of mercury. Another remedy is lactic acid, 10 grains to a drachm (0.05 : 4.0) of Avater, used in the same manner as the solution of the bichloride of mercury. The folloAving prescription is recommended by Unna : R.—Bismuth oxidi A „ Pulv. amyli f .......aa gr. xxx (2.0). Kaolini ............3j (4.0). Glycerini...........hjij (8.0). Aqua' rosse........q. s. ad ffij (64.0).—M. S. Paint on spots and allow to dry, washing the drug off before each new appli- cation. Or the folloAving may be used : R.—Zinci oxidi...........gr. iij (0.2). Hydrarg. ammoniati.......gr. iss (0.08). 01. theobroma?.........f^ijss (10 0). 01. ricini............f^ijss (10.0). Essent. rosa>.........gtt. x (0.65).—M. S.—Apply night and morning. GASTRALGIA.' The treatment of gastralgia may be divided into two parts—that directed to the relief of the attack Avhen it is present, and that de- voted to the prevention of other attacks. During the acute stage hot applications and drinks, aromatic and locally stimulating Avarm infusions, a few drops of chloroform, or brandy or Avhiskey hot and concentrated, or 30 or 40 drops (2.0-2.65) 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 Avith surprising success. Emesis and purgation are sometimes indicated, 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 betAveen the attacks must vary Avith the cause and with the general condition of health. A careful 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 well as all purgatives Avhich Avould Aveaken the 1 See article written by author in Keating's Cyclopcedia of Diseases of Children, vol. iii. 538 DISEASES. digestion. Any marked disturbance of digestion should be corrected ; 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 (4.0). Vini ferri amari........ . q. s. ad f^iv (128.0).—M. S.—From 30 to 60 minims (2.0-4.0) in water after meals, three times daily, for a child of six years, or twice this quantity for an adult. Or, R.—Tincturse ferri chloridi.........f|j (32.0). Acidi hvdrochlorici diluti "I -- e-z„ mco\ \\ T . • ... . }.....aa tzss (lb.O).—JY1. Liquor acidi arsenosi j ° S.—From 4 to 20 drops (0.2-1.3) in water after meals, three times daily. Occasionally even better results are secured by the use of cod-liver oil in emulsion with the hypophosphites. The solution of bromide of strontium (Paraf-Javal) is a valuable one in gastralgia in the dose of a tablespoonful (16.0) three times a day. It is well, in cases where the pain is very severe, to combine with 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 neurotic state exists, it may be necessary to alternate all other treatment with the bromides or with the preparations of valerian, or the following prescription may be used: R.—Acid, hydrocyanic, dil.........f^j (4.0). Ext. cannab. indicae fl.........f^j (4.0). Tr. hyoscyam............f^j (4.0). Spt. chloroformi ..........f^ij (8.0).—M. S.—30 minims (2.0) t. d. in water for an adult. 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 Keating's Cyclopedia of Diseases of Children embodies so thoroughly the ideas which the writer desires to express 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 cha- racter 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 GASTRIC CATARRH, ACUTE. 539 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 hypenemic from the inflamma- tion, and, as the normal viscus becomes physiologically hyperjemic on the ingestion of food, Ave would add to the congestion of the blood- vessels did Ave alloAv more nourishment to enter the stomach. 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 pro- longs the trouble. As the attack passes off small amounts of food may be given Avhich should be of a kind readily digested and not likely to become easily decomposed or rendered acrid by the mucus in the stomach. Milk Avith a large percentage of lime-Avater 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 anorexia is complete, and small pieces of ice may be administered for its relief. Commonly it va ill be found that the patient rapidly improves up to a certain point, then stops improving or relapses. This is sometimes due to an accumulation of mucus, Avhich Avhen mixed Avith food causes it to undergo 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, Avhich can only be overcome by prolonged and careful treatment adapted to the improvement of the general health. Sodium bicarbonate Avith compound infusion or compound tincture of gentian may be used during convalescence, and small sips of effer- vescing draughts are useful. If constipation exists and vomiting for- bids 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, will settle the stomach, move the bowels, and often carry away mucus. If there is much epigastric distress, a spice poultice is often of service. Sweets and starches are to be rigidly denied the patient. If anae- mia exists, iron may be used, but this is rarely needed. 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 carefully resorted to than 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 employed after inflammation has passed away, 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 often beneficial, and should be always used, in moderation, Avith the food. 540 DISEASES. GASTRIC CATARRH (CHRONIC). Chronic gastric catarrh is a condition of the stomach commonly seen in this country in a more or less Avell developed form. It is often asso- ciated Avith much indigestion and the eructation of sour liquids, or even with active vomiting. The secretions of the stomach are nearly ahvays abnormal, and fermentative changes are constantly present in the gas- tric contents. Lavage is almost always to be resorted to for its relief. (See Part III. for Lavage.) 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, and, if great hyperacidity exists, the administration of the subnitrate of bismuth. Often, however, the better remedy is bicarbonate of sodium in the dose of 5 to 20 grains. In many instances the patient Avill be greatly benefited by the use of a Seidlitz poAvder or Carlsbad salt' or Saratoga Carlsbad Avater before breakfast each morning, as this washes out the stomach, dissolves the mucus, and unloads the mucous membrane of its congestion, at the same time overcoming any engorge- ment of the liver. Constipation is nearly always present, and should be removed by appropriate drugs, such as cascara sagrada, of which the best preparation is the fluid extract, rendered free from bitter taste by certain large manufacturers in this country, such as Parke, Davis ..........aa gr xij (1.0). Alum. crud. j Aq. destil..............f^vj (192.0).—M. S.—Locally. Dilute if painful. When the gonorrhoea has already assumed a markedly inflamma- tory type, Avith SAvelling and oedema of the penis, redness and ever- sion of the meatus, and great sensitiveness of the urethra, no injec- tion should be employed. The penis should be Avrapped in cloths kept Avet Avith alcohol and Avater or lead-water and laudanum. With the subsidence of acute inflammatory symptoms and the appearance of copious discharge the injection treatment may be inaugurated. It must be remembered that injections may in themselves prevent the discharge from entirely disappearing. Hence, as the symptoms ame- liorate 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 import- ant in all forms and stages of gonorrhoea. It is almost universally accepted that certain drugs, such as copaiba, cubebs, and oil of san- dahvood, Avhen eliminated through the kidneys, possess the power of inhibiting the groAvth of the gonococci or of destroying their vitality. Bacteriological research has shoAvn that of this class of remedies copaiba alone possesses such power. To this drug may be added salol, Avhich has been proved by laboratory and clinical tests to exert a powerful germicidal action upon the gonococcus. Clinical experience has shown that oil of sandahvood is of great value in the treatment 548 DISEASES. of acute gonorrhoea. An excellent formula for the administration of balsams is the folloAving : R.—01. santal...............gr. v (0.3). Balsam copaib............. Tti,v (0.3). Ol. cinnamom.............Tl\j (0.05).—M. Encapsulate. These capsules should be taken one hour after meals, from six to twelve being adrnin- tered. 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; this may be repeated in the night if painful erections persist. Lupulin in 30-grain (2.0) doses is also endorsed. When practicable, opium or belladonna suppositories, or hypodermic injections into or about the perineum of morphine gr. \ (0.015) and atropine gr. fa (0.001), 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 demulcent drinks and by the employment of bicarbonate of sodium or citrate of potas- sium in sufficient doses to render the urine but slightly acid. Either of these drugs is conveniently administered in the form of compressed tablets, taken one or two hours after meals in 10-grain (0.65) 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 water 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 (0.1) of aconite repeated every tAvo or three hours is folloAved by marked relief. In regard to the general treatment of a patient suffering from gonorrhoeal urethritis rest in bed is particularly desirable. This, hoAvever, is rarely possible, and the surgeon must be content Avith enforcing the avoidance of all active exertion and the observance of as much rest of mind and body as is compatible with the 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 insistence 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 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 GONORRHOEA. 549 any form of venereal excitement must be strictly interdicted. Finally, prolonged warm baths lasting from half an hour to tAvo hours seem to exert a favorable influence upon 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 tAvo or three Aveeks. During the very acute symptoms local treatment applied to any portion of the urethral canal probably aggravates the condi- tion, and even the internal administration of balsams and antiseptics must be employed Avith very great caution, their use being suspended at once if the inflammation seems to be aggravated by their employ- ment. Hence, Avhen in the third Aveek 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 boAvels 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 belladonna, administered either hypodermically or in the form of a suppository. When the acute symptoms subside the quantity of anti- septics 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 Avhich 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 apply- ing 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 (32.0) of the injection is forced into the membranous 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 folloAving: Nitrate of silver, grain I to 1 (0.015-0.05); distilled water, 3j (32.0); carbolic acid, 1 grain to the ounce. Any of the injections used in anterior urethritis may also be then employed. These injections should be made tAvice a week. 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 Avhole canal Avith uniform intensity; hence, efficient treatment must be directed not to the Avhole 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 portion. If the disease is located in the anterior urethra, it will commonly be found to depend upon the existence of a struc- ture of large calibre. The passage of sounds of full size—cutting 550 DISEASES. the meatus if this is necessary for their introduction—Avill be folloAved by prompt relief in such cases. The sounds should be used not more frequently than tAvice a Aveek, and should be most caiefully 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 doAvn to the membranous portion of the urethra, and injecting through it once daily 3 ounces (96.0) of a i-grain-to-the-ounce (0.0^5 : 32.0) solution of nitrate of silver. When the general catarrhal condition is materially modified, by means of an ordinary hard-rubber endo- scope 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 extrem- ity of a long applicator. Nitrate of silver or sulphate of copper, 20 grains to the ounce (1.3 : 32.0), may be employed. Unna has devised a most successful treatment for obstinate cases of gonorrhoea. He advises coating the sounds Avith the following mixture: R.—01. cocae...............^iij (96.0). Cer?e flav...............'^ss (2.0). Argent, nitratis............gr. xv (1.0). Balsam. Peruvian...........£ss (2.0).—M. This is liquefied in a Avater-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 appli- cation is made to the entire urethra. Practically, however, their employment is often folloAved 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 apparatus 3 or 4 drops (0.25-0.3) of a solution varying in strength from 0.1 per cent, to 5 per cent, may be employed. Finger recommends the folloAving ointment : R.—Argent, nitratis vel cupri sulph.....gr. xv (1.0). Lanolin................^Hj (96.6).' 01. olivie..............3jss (6.0).—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 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 Aoavs through its interior. It must be borne in mind that chronic gonorrhoea is commonly due GONORRHOEA. 551 to unskilful or not sufficiently prolonged treatment of the acute stages. Not only should the treatment of acute gonorrhtea be continued until the gonococci have entirely vanished, but for fully tAvo Aveeks after the disappearance of all symptoms of inflammation. The same rule holds good in regard to the chronic manifestations of the disease. Only after careful examination of the urine fails to shoAv any sign of inflammatory trouble for at least two Aveeks should the treatment be suspended; and this should not take place suddenly, but the intervals betAveen the applications be gradually increased in length, the patient being carefully Avatched in the mean time. Per contra, it must not be forgotten that long-continued irritant treatment may in itself indefinitely prolong a urethral discharge. Hence it is Avise to suspend all injections in certain cases, and to examine the discharge carefully, as found in the urine, to determine Avhether or not the continuance of symptoms is dependent upon this cause. There is a mucous secretion Avhich quite frequently folloAvs gonor- rhoea, but Avhich is in no Avay dependent upon the persistence of this disease. Microscopic examination 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 Avhich may occur in the course of an acute or subacute gonorrhoea are balanitis, balano- posthitis, prostatitis, and epididymitis. Balanitis and balctno-poxthitis are treated by perfect cleanliness. The discharge must be thoroughly washed out, and the surface must be dried and 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 (0.2 : 32.0), 1 per cent, boric acid, or 1.5 per cent, carbolic acid; nitrate of silver is particularly valuable, and in the proportion of 1 grain to the ounce (0.O5 : 32.0) 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 and the parts having been thoroughly Avashed, dusting poAvder, such as tannin or oxide of 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 draAvn forAvard. This dressing is to be repeated three times daily. If the phimosis is so tight that the prepuce cannot be retracted, cleansing, astringent injections, and Avrapping the penis in one or tAvo 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, cir- cumcision is indicated. Prostatitis rarely develops before the second or third Aveek in the course of urethritis. Where the acute symptoms are fairly developed direct local treatment is of little avail. Best in bed, light diet, care- 552 DISEASES. ful regulation of the boAvels, medication to render the urine bland and unirritating, elevation of the pelvis, local depletion by means of leeches applied to the perineum, and the administration of morphine and belladonna, either by means of suppository or by hypodermic injection, represent the general treatment of all inflammatory condi- tions at or about the neck of the bladder. In the great majority of cases prostatitis undergoes prompt resolution, and this is more poAver- fully influenced by rectal injections than by any other method of treatment. For this purpose a tAvo-Avay rectal tube must be employed, the nozzle of Avhich is directed against the projection of the prostate into the boAvel. From 2 to 4 quarts (2 to 4 litres) of water, either very cold or as hot as can be borne, are alloAved to Aoav into the rec- tum by gravity, this arrangement of the tubes alloAving the injection to floAv out as rapidly as it Aoavs in. This treatment should be re- peated three or four times a day. When, in spite of careful treat- ment and the free use of anodynes and antispasmodics, there is reten- tion of urine, a soft cathether should be passed into the bladder and alloAved 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 positively determined upon. It is true that the pus collection usually is spontaneously discharged into the urethra, but this result cannot certainly be depended upon, and, at best, is an unsatisfactory termi- nation 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 and local applications to the prostatic urethra. In addition rectal injections, by means of the tAvo-Avay tube, are very efficient in producing a cure. Epididymitis requires rest in bed, cessation of all local treatment directed against the gonorihcea. 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 toAvard spontaneous resolution. The testicles may be supported by a hand- kerchief bandage, the base of Avhich is passed beneath the scrotum while the ends and apex are secured in front to a circular band pass- ing 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. Since it is usually impossible for a patient suffering from gonor- rhceal epididymitis to keep to his bed, a treatment must be devised which Avill alloAv him to attend to his business, and at the same time will prevent 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 GONORRHOEA. 553 the injured testicle. For this purpose a number of adhesive resin strips, each half an inch Avide and long enough to pass three-fourths around the swelled testicle, are cut. The first strip encircles the scrotum betAveen the affected testicle and the body, tightly imprison- ing the former in a pouch of skin. The succeeding strips are then placed, each overlapping 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 resol- vent influences of heat and moisture, is offered in the dressing pro- posed by Horand-Langlebert. 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 Avith tapes to alloAv of close fitting. Unless there be decided SAvelling of the spermatic cord, this dressing usually alloAvs the patient to attend to his business, and is folloAved by as prompt resolution as though con- finement to bed had been insisted upon. When the acute symptoms have disappeared attention must be directed to the removal of infil- tration, Avhich 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 (0.25) in lanolin sj (32.0). or of equal parts of mercury ointment and belladonna ointment, or by ichthyol, Avith lard half and half, and by the internal administration of iodide of potassium, 10 to 20 grains (0.65-1.3) 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, hoAvever, 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 Avith 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, excepting in chil- dren and young girls. In addition to the general treatment of inflam- mation, local treatment directed to cleansing thoroughly the inflamed surfaces of discharge and acting upon them by a strong antiseptic lotion will be folloAved by a rapid cure. The patient is instructed to irrio-ate the vagina three times daily Avith 2 pints (1 litre) of bichlo- ride-of-mercury solution, 1 : 4000, thrown in by means of a fountain svrino-e. For this fluid to reach every portion of the diseased mucous membrane it is necessary that the" patient should lie upon her back 554 DISEASES. 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 prolonged 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 (0.25-2.65 : 32.0). 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 Avashed Avith 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 Avord used to signify a series of manifestations occurring chiefly in those Avho have led a lazy, sluggish life and have lived on the fat of the land, and partaken more frequently of alcoholic beverages than of Avater; or it occurs in persons who do not live in this Avay, but Avhose ancestors will 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 feAV Americans have gout in its marked and characteristic forms, OAving to the active life pursued, and to the fact that the inhabitants of the Western hemisphere drink large amounts of Avater, thereby contin- ually dissolving effete matters in the system and Avashing them away. The therapeutic importance of pure Avater in this state is remark- able, 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-Avay, and by continually drinking water Avashes 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 Avith salts that they deposit them Avherever a spot is found Avhich is easy of access, just as Avater laden with lime forms a deposit on the sides of its bed Avhen a drought comes on, and dissolves and removes these formations Avhen a freshet takes place. Very often, Avhen such Avaters are not attainable, satisfactory results will be reached by ordi- nary distilled Avater, the insipid taste of Avhich can be overcome by charging it Avith carbonic acid gas. When an acute attack of gout comes on, it is generally situated, as is Avell knoAvn, in the joint of the big toe or other toes, but it may involve any part of the body, even to the heart and the abdominal viscera. By far the best remedy for the relief of the pain is mor- GOUT. 555 phine, which should be given hypodermically. 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 gas- tro-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 (1.3) at first, and increased by 1 drop (0.05) every four hours until relief is obtained or symptoms of poison- ing appear as noted above. In other instances the method of adminis- tration suggested in the article on Colchicum may be resorted to. The local treatment of gout, Avhen it is active, consists in the appli- cation of a number of remedies. For hospital practice a very useful mixture is made by adding 1 part of bicarbonate of sodium to"9 parts of linseed oil. The joint is then Avrapped in a piece of lint soaked Avith this concoction. In other cases collodion may be applied in one or tAvo good coats, not more, Avith relief, and in still others oil of pep- permint has been recommended. It is to be remembered, hoAvever, that the inflamed joints are not to be treated by depletion through leeches or bleeding, as by this means they ultimately become Avorse; or, in other words, the treatment of gouty inflamed joints is not iden- tical Avith 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 (1.0) at four or five o'clock in the afternoon, will sometimes give relief; this drug should ahvays be combined Avith 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 Avhich are not fatty nor rich, but plain and nourishing. Milk and eggs, the Avhite meat of chicken, and fruits cooked Avithout sugar being added are alloAved, tea and coffee being used only in modera- tion. If any Avine is taken, it must be folloAved by copious draughts of pure water, and this last article should be used ad libitum. On the other hand, pastries, and, more than all, SAveet Avines, are the 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 potassium bromide and chloral, the former drug being the safest and best. Nothing should be done in the neighborhood of gouty joints Avhich will injure the skin, as it is easily disorganized and its injury may lead to erysipelas. 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 o-rains to the ounce (0.35-0.65 : 32.0) of Avater, on lint wound around the parts. Where the skin is broken and will not heal, this treat- ment often permits healing by dissolving the crystals in the wound which prevent the approximation of the edges and so cause local irri- tation. Iodine ointment or the tincture of iodine is often placed around chronic gouty joints with advantageous results. 556 DISEASES. A standard remedy in subacute or chronic gout is arsenic, and its administration in the form of 3 drops (0.15) of Fowler's solution, with either perfectly pure or lithiated water, is ahvays 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 Avater devoid of salts, and the administration of colchicum. potassium iodide, and arsenic, are the greater points about Avhich 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 sloAver 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 Post-partum Hemorrhage.) Under this heading; the author will consider all forms of hemor- rhage Avhich can be controlled by drugs or measures not directly sur- gical in their scope, with the exception of epistaxis, Avhich has already been spoken of. Whenever a hemorrhage 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 Avhich 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- 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 which are antihemorrhagic should be used by the mouth. As these forms of hemorrhage are generally given separate names, they will be so considered. In all forms of hemorrhage in Avhich the Aoav has been sufficiently great to endanger the patient's life resort should be had to hypoder- moclysis or to transfusion. (See Hypodermoclysis and Transfusion, Part'lII.) Menorrhagia is an excessive Aoav of menstrual blood, either excess- ive in quantity during tAvo or three days or prolonging itself over an unusual number of days, Avhile metrorrhagia is a state in which bleeding takes place from the uterus independent of menstruation and at any period of the month, or even after the menopause has occurred. HEMORRHAGE. 557 Menorrhagia, or excessive menstruation, is not to be judged by the amount of the Aoav, but by Avhether the loss is sufficient to cause decrease of health or to indicate disease. In some cases it is a means of relieving plethora. "\\ hen the physician decides that something should be done to improve the condition of the patient, Avhen suffering either from menorrhagia or metrorrhagia, it will be necessary for him to find out Avhether a polypus or other form of uterine disease is directly responsible for the trouble, and in the mean time to employ drugs knoAvn to act favorably upon uterine hemorrhage. 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 better for oozing and for cases Avhere there is a continual " sIioav." The fluid extract of ergot may be given in varying dose, from 10 to 60 drops (0.05-4.0), according to the necessities of the case, and the oil of erigeron in capsules in the dose of from 3 to 5 minims (0.15-0.3), 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 (0.65) once or twice a day is often very serviceable indeed, and the distilled extract of hamamelis in the dose of 1 drachm (4.0) three times a day is almost as useful. Cannabis indica, if an actiAre sample is obtainable, is also said to be of service, but the Avriter has never used it to any extent. Oil of cinnamon in the dose of J drachm (2.0) is very efficacious in the sIoav oozing of some cases Avhere erige- ron 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 hemorrhage from the lung, is nearly always due to tubercular ulceration of a small or large blood-vessel, and the life of the patient depends in reality more upon the rapidity Avith 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 Avay 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 and coughing. The only occasions on Avhich inhalations of styptics are of service are those in Avhich the hemorrhage 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 in an atomizer which will throAv a fine spray—sufficiently fine to enter the smallest air-tubes Avith the inspiratory Avave of air. A very good fluid is one made from Monsel's solution, as follows: R —Liquor, ferri subsulphat.......gtt. xx to xxx (2.0). A que dest.............f^iv (128.0).—M. g—Use in an atomizer every few minutes. 558 DISEASES. Or the folloAving: l R.—Acid, tannic............gr. xx (1.3). Glycerini.............f^ij (8.0). Aqiue dest..........q.s. ad fgiij (96.0).—M. S.—Use in an atomizer. Or, R.—Aluminis.............gr. vj (0.4). Aquae dest.............fjiij' (96.0).—M. S.—Use in an atomizer. Some clinicians advise that the patient should swallow, Avhether the hemorrhage be acute or not, not less than 1 to 1| drachms (4.0- 6.0) of the fluid extract of ergot, or a solution made by adding 20 grains of gallic acid to 1 ounce (1.3 : 32.0) of Avater. 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 constringes the tissues and forms a clot, Avhereas gallic acid does not coagulate the blood. There is no doubt that of all the internal remedies for hemorrhage from the lungs, aconite is the best. Careful studies shoAv that ergot causes primarily an increased Aoav of blood to the lung, although its dominant and final action is to cause contraction of the blood-vessels. Hemorrhage from the lung is to be regarded as any other hemorrhage. 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 low a point as is safe. The rule to folloAv is best stated as folloAvs : If the patient is seen early in the attack, give full doses of aconite to prevent further hemorrhage. If when seen so late that he is too much exsanguinated to use sedatives, place his head lower 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 stimu- lants can only increase the hemorrhage by increasing the pumping poAver of the heart and by dislodging the clot from the eroded blood-vessel. Daremburg and Yeo have employed ice or ice-cold compresses to the scrotum or vulva in such cases, and claim good results from this use of cold. To allay nervous excitement many writers advise that a hypodermic injection of morphine should be used. The author is convinced that this treatment is irrational, for morphine is a circulatory stimulant, and by increasing the power of the heart increases the hemorrhage. Chloral and the bromides are much better remedies, and should be given by the mouth, or, if vomiting is present, they should be given by the rectum, dissolved in starch-Avater. (See Chloral and Bromides.) Sometimes the patient can point directly to the spot Avhere the hemorrhage exists, and under these circumstances a dry cup or a piece of ice placed over this point may prove useful. 1 If the Monsel does not stop the hemorrhage, the tannic acid will probably fail, but, more important still, the two should not be used together, as the tannate of iron will be formed, which is as black as ink. HEMORRHAGE. 559 Afcer an attack of haemoptysis there is great danger in many cases of a traumatic pneumonia being set up by the presence of the extrav- asated 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 requires Hematemesis.—This depends either upon some injury to the stom- ach 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 hemorrhages" to treat, because by ordering the patient to swallow styptic drugs Ave can act directly upon the bleeding surface.1 In such a case small pieces of ice should be swallowed frequently, and this may be accompanied by 3 drops (0.15) 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 (1.3-4.0), but the two should never be given at once in the same case. (See foot-note to p. 539.) Monsel's salt may be given in pill in the dose of 2 to 3 grains (0.1-0.15). The acetate of lead is also of value in pill form in the dose of 2 to 3 grains (0.1-0.15) Avith morphine or opium. Tincture of the chloride"of iron, the sul- phate of iron, turpentine, ipecac, ergot, and hamamelis may all be used, the last three particularly in slow or passive hemorrhages. Sometimes nitrate of silver in the dose of \ of a grain (0.016) in pill form is of service if the hemorrhage is a sIoav 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 hemorrhoids, medication must be by Avay of the anus. Hemorrhage of the first class is best combated by the applica- tion of a small piece of ice to the belly and by the use of Monsel's salt (ferri subsulphas) : 3 grains (0.15) made into a pill 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 which are of service are sulphuric acid in the dose of 5 to 10 drops (0.3-0.65) in water in acute or passive bleeding, or turpentine given in capsule, or, better still, in emulsion with acacia in the dose of 10 drops (0.65) every half-hour, particularly Avhen the hemorrhage is not active. Acetate of lead and camphor in the folloAving pill may be "of service in some cases : 1 Hematemesis 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 hsematemesis should, of course, be sep- arated from those dependent upon some lesion in the stomach itself. 560 DISEASES. R.—Plumbi acetatis...........gr. v (0.3). Camphoree.............gr. x (0.65).—M. Ft. in pil. No. v. S.—One pill every hour. Where the hemorrhage 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 Avhen the bleeding is to be stopped at once, the others Avhere it is sought to remove 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 Avater. In the second Ave find nitrate of silver, the sulphates of copper and of iron, and the chlorate of potassium. The alum solution used should be fairly strong, 10 grains to the ounce (0.05 : 32.0); the copper, 5 grains to the ounce (0.3 : 32.0); the Monsel's salt, 10 grains to the ounce (0.65 : 32.0); or ^ to 1 drachm of Monsel's solution to each 2 ounces (64.0) of Avater. The tannic acid should be used in the strength of 20 grains to the ounce (1.3 : 32.0) of Avater and glycerin. When chlorate of potassium is used it should be employed in saturated solution in small injections (25 grains to the ounce [1.65 : 32.0]), or Aveaker if the injection be a large one (10 grains to the ounce [0.65 : 32.0]). These injections should be carefully given, and the success or failure attending the treatment of these states depends as much upon the technique of the operation as upon the injection of the medicinal substance. It should never be forgotten that an injection designed for local medication 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 (128.0) at the utmost, and preferably 2 ounces (64.0) unless the diseased area is high up. An enema is given in bulk so as to cause distention and excite the boAvel to movement, Avhereas from a medicinal injection no movement is desired. Again, the apparatus for sending in the fiuid ought not to be a "family" or ordinary syringe, but a fountain syringe, the pressure being hydrostatic. This may be dispensed with if the injec- tion 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 ahvays be gradual and easy. If resistance is met with, 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 Avarm liquid may be needed. In these cases those drugs Avhich are capable of absorption and the production of poisonous symptoms are not to be used except in small amounts. (See Enteroclysis. Part III.) Where the injection is to reach high up into the boAvel the patient should be put in the lithotomy position with the buttocks elevated. Sometimes in dysentery the injection of a pint to a quart of ice- cold water has a most favorable effect upon bloody purging. Whenever a medicated injection is to be used for the cure of ulcers which cause hemorrhage, the entire tract which is to be invaded HEMORRHAGE. 561 should be Avashed out Avith pure Avater or Avith a saline or soapy liquid, in order to dislodge mucus and feces, which prevent the drugs from acting on the boAvel-Avall. Hematuria is a condition in Avhich blood appears in the urine, and may be divided into tAvo classes—that in which the blood comes from the kidney or bladder, and that in which it comes from the urethra. In the first class the blood is always Avell mixed with the urine. Avhich 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 which the blood is in 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 Nephritis should be read ; Avhile, if the hemorrhage is due to the presence of a lesion in the bladder, the directions governing the use of turpentine, erigeron, or ergot, as given for Menorrha- gia and Metrorrhagia, should be folloAved. or if any morbid groAvth be present it should be removed. Sometimes 10 to 20 grains (0.65- 1.3) of camphor in divided doses are of service, given in pill form, Avhile in others cannabis indica is of value. Gallic acid, in 20-grain (1.3) (loses, may be used, and is very val- uable. If the hemorrhage is alarming, injections of astringent Avashes, such as 2 or 3 grains of alum to the ounce of Avater, should be injected into the bladder. It must be remembered, however, that this simply fills the bladder Avith clots, Avhich are not readily passed and are liable to become septic. A very useful prescription is— R.—A eid. gallic.............*j (4 0). Acid, sulphuric, dil.........f^ij (8.0). Aquae . . ._.......q. s. ad f'i'ij (96.0).—M. S.—Teaspoonful (4.0) in water every four hours. If the hematuria be malarial, quinine has been employed, but in a large number of cases it makes the hematuria worse; and in the Southern United States, Avhere severe malarial poisoning is often seen, physicians ought never to use the drug for malarial hematuria. The value of quinine consists in its ability to prevent further attacks rather than to relieve the result of the attack—namely, the hematuria. Hyposulphite of sodium is a most useful remedy in malarial hematuria in the dose of 5 to 15 grains (0.3-1.0) every five hours. Some prac- titioners use as much as a drachm of hyposulphite of sodium every tAvo hours till purgation takes place, give morphine and atropine hypo- dermically to relieve pain and quiet the stomach, apply cups over the kidneys, and give water to drink so as to freely flush the kidneys. Post-partum hemorrhage is to be controlled by the use of friction and kneading or grasping the dilated uterus through the relaxed ab- dominal Avail; by the use of drachm doses of the fluid extract of ergot or a wineglassful of the Avine of ergot; and by the irritation of the uterine wall by passing the hand, Avhich must be absolutely aseptic, up through the vagina into the uterine cavity. Sometimes ice may be 562 DISEA SES. passed up the vagina and into the uterine cavity Avith success in stop- ping the bleeding, and 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. Hemorrhoids are vascular dilatations of capillaries, arteries, or ven- ules situated outside or inside of the sphincter am, or are composed, in the case of Avhat are called external piles, of tags of skin Avhich are more or less vascular and become troublesome Avhen inflamed. The internal pile, if large, is apt to prolapse and to become strangulated by the sphincter muscle. It is covered by mucous membrane, and is sometimes very small or like a mulberry in shape, consisting of a tuft of capillaries, a loop of an arteriole, or of a venule. The capillary or arterial hemorrhoid is apt to be bright red, and to bleed profusely Avhen touched or Avhen scraped by hard faeces. The venous tuft also bleeds, but not so freely, and the blood is not so bright in color. In cases in Avhich the hemorrhoids " come doAvn "—that is, pass out through the anus, so being in danger of becoming stran- gulated—the protruding mass should be washed Avith cold Avater, thereby at once cleansing the mass and reducing its congestion, and then gently pushed back Avith the fingers, Avhich should be Avell oiled. Care should be taken that an external hemorrhoid is not mistaken for an internal pile, since if an external growth is pushed through the sphincter, it also becomes strangulated. The treatment of internal hemorrhoids is to a great extent iden- tical Avith that of the external variety. A suppository may be used, made up as folloAvs, if there is a tendency to slight hemorrhage: R.—Acid, gallic.................gr. xx (1.3). Extract, opii...............gr. j (0.05). Extract, belladonnas............gr. ij (0.1). 01. theobroma;...............q. s.—M. Ft. in suppos. No. x. S.—Use one every night, or distilled witch-hazel extract may be injected into the rectum. If the hemorrhage is profuse, the physician should use a speculum, find the bleeding point, and touch, it Avith strong nitric acid, folloAved by the suppository named above. If this is done, the boAvels should be confined for some days, until the spot under the slough made by the acid can heal. If the prolapsed hemorrhoid is inflamed and difficult of reduction, the folloAving ointment of Mathews may be ordered: R.—Cocain. hydrochlor..........gr. xij (0.8). Iodoformi ...... ......gj (4.0). Extract, opii.............gr. xxx (2.0). Petrolati...............gj (32.0).—M. S.—Use as a salve. If the pile still refuses to be reduced, place the patient in bed and apply hot poultices, and if this fails operation is demanded. HEADACHE. 563 lhe treatment of external piles themselves consists in the mainte- nance of the most rigid cleanliness. Immediately after each move- ment the parts should be thoroughly washed by means of a sponge dipped m cold water, or better still, by the use of the bidet or a nozzle attached to a fountain syringe or to the general water-supply. After they are thoroughly cleansed, it is well to bathe them with distilled extract of hamamelis. Often it is well to precede the regular morn- ing evacuation by a cold rectal injection of pure water to soften the faeces, but more important still to decrease congestion. If the inflam- mation of the external piles is very acute and profound, the patient should be placed in bed and the cold injections frequently repeated or hot poultices applied to the anus. After the acute stage is passed a lotion of lead-Avater and laudanum (laudanum fgss to dilute lead- water f^ij) may be used. The injection of carbolic acid into hemorrhoids is a dangerous practice, but if employed only 1 drop is to be used. In addition to these applications there are important general rules to be observed. The patient's habits should be so arranged that his daily act of defecation is at night before going to bed, rather than in the morn- ing, as under these circumstances the rest in bed relieves congestion and soreness, Avhich the maintenance of the erect posture might make Avorse. Plethoric persons should not use upholstered chairs for office or lounging purposes, as the heat of the body relaxes the rectal tis- sues. A cane-seated chair is best, or an air-cushion Avith a holloAv centre. The liver plays a most important part in relation to hemor- rhoids, and, if it is congested, congestion of the hemorrhoidal veins is very apt to ensue. The connection between the liver and the hemorrhoidal plexus is most intimate, since the plexus is formed by the superior hemorrhoidal veins, Avhich are branches of the inferior mesenteric, and the middle and inferior hemorrhoidal veins, Avhich terminate in the internal iliac. The portal venous system is com- posed in part of the inferior mesenteric vein, and any obstruction to venous Aoav in the liver at once results in engorgement of the hemorrhoidal plexus. (For the surgical treatment of piles reference must be made to surgical Avorks.) HEADACHE. (For Neuralgic Headaches, see Neuralgia ; for Bilious Headache, see Biliousness.) Probably no single source of pain compares in its frequency to headache, chieAy because it is essentially a symptom of many dis- eased processes or functional disturbances, and nothing more. It may arise from eye-strain, from brain disease, from anaemia, from uraemia, from plethora, from nervous breakdoAvn, and from a multi- tude of causes Avhich, if they were all recounted, would cover many pages of this book.1 The only forms of headache Avhich will be con- 1 See article on Headache in the author's Practical DiaavoMs, Lea Brothers & Co. 564 DISEASES. sidered here are those due to congestion or those Avhich arise from fatigue. Congestive headaches, dependent upon an engorgement of the cere- bral vessels Avith blood, are to be treated in a number of Avays, 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, Ave find tAvo methods of promoting a cure. The first consists in the use of ergot, Avhich will cause contraction of the dilated vessels; the second, in the employment of vascular sedatives, Avhich will produce arterial depression and so remove congestion. Sometimes one of these methods Avill succeed where the other fails, and it is almost impossible to tell beforehand Avhich case should have one drug and Avhich another. It is to be remembered that Avhen the congestion is due to vascular relaxation and Aveakness the vascular sedatives are contraindicated. The use of a hot mustard foot-bath is of great value, and a mus- tard plaster or dry cup applied to the nape of the neck is often of service in congestive headaches, Avhile in severe cases an ice-bag applied to the head or leeching behind the ears or on the temples may be re- sorted 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, but these remedies cannot be used if there is much retinal irritability. In many instances a combination of caffeine, bromide of potassium, and antipyrin is very successful, as follows : R.—Caffeinse citratis...........gr. xl (2.(to). Potassii bromidi...........3iv (16.0). Antipyrini.............3y (8.0j.—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 antipyrin and bromide can be used. (See articles on Antipyrin, Acetanilid, and Phenacetin.) Another useful prescription is— R.—Extract, guaranse.........gr. x vel xx (0.65-1.3). Ext. apii graveol.........gr. x (0.65).—M. Ft. in capsul. vel chart, vel pil. No. x. S.—One every half hour till relieved or three are taken. 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 wearing 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 Avho can afford it if they are sufferers from nervous headaches. A form of headache which is often very severe, sometimes fieeting, HEART DISEASE. 565 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 (0.3-1.0), Avhile others rely on the iodide or acetate of potassium. In cases where anemia is present Peabody uses the following pre- scription, which is compatible, Avhereas most of the preparations of iron and salicylic acid are incompatible: R.—Acid, salicylic............gr. xx (1.3). Ferri pyrophosphat.........gr. v (0.3). Sodii piiosphatis..........gr. j (0.05). a ™. A(lliafdest.............f^ss (16.0).—M. o-—This is to betaken every three hours. Cohen has used the folloAving, which is more pleasant to the taste: R.—Sodii salicylatis..........^iv (16.0). Glycerini".............f§ij (64.0). 01. gaultheriae...........tt^xx (1.3). Tr. ferri chloridi..........f^iv (16.0). Acid, citrici............gr. x (0.65). Liq. ammonii citratis, B. P.1 . q. s. ad ffiv (128.0).—M. S.—Dessertspoonful (8.0) in water twice, thrice, or four times a day. 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 (16.0). Potassii acetatis Potassii iodidi V.....aa f^v (20.0). Tr. cimicifugsR racemosse) Aqua;............q.s. ad fgiv (128.0).—M. S.—Teaspoonful (4.0) every four hours. HEART DISEASE. (For Treatment of Angixa Pectoris see p. 451.) The Avriter 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 with the treatment, although the ultimate result of the case is someAvhat dependent upon these conditions. It matters not Avhether the leak in a Aralve be minute or great, provided the heart can still do its Avork ; the condition of the cardiac muscle is the important factor to be considered. If an irreparable leak exists in a pump Avhich cannot be stopped for repairs, the question is not, Can Ave cure that leak ? but rather whether Ave can Avork the pump with enough force and rapidity to obtain all the water needed for the 1 Liquor ammonii citratis, B. P., is made by adding 5 fluidounces (imperial meas.) of strong solution of citrate of ammonium to 15 fluidounces (imperial meas.) of dis- tilled water. The stronger solution of citrate of ammonium is made by taking 12 ounces (avoirdupois) of citric acid, strong solution of ammonia 11 fluidounces, and adding enough distilled water to make 24 fluidounces (imperial meas.). 566 DISEASES. maintenance of life. Some physicians use heart tonics, such as digitalis, Avhenever they find a valve diseased, as if to mend the broken valve. Nothing can be more erroneous, for a valve once injured is never re- generated. It should be an invariable rule with every physician in examining a patient Avith 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 almost to escape notice, treatment is to be instituted; but, on the other hand, if the murmur heard on auscul- tation 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 in the remembrance that the stunting of the body and the sloAvness of groAvth are not merely the result of heart trouble, Avhereby the tissues do not increase in size from lack of nourishment, but occur for a special purpose. Let us suppose that a child of eight or nine years has scarlet fever or rheumatism, Avhich leaves the cardiac valves impaired in function for a feAV days, or hours at least, the question must arise in the heart: " Can I properly fill all the blood- vessels?" If the heart can supply the vessels, the child lives, but is stunted, because Nature is wise enough to understand that the strug- gling heart has all it can do to supply even a stunted frame, and realizes that a rapidly increasing area of blood-vessel surface in a groAv- ing child would exhaust the cardiac muscle. The physician should not permit the parents to worry over this lack of growth, but by the use of gentle gymnastics or tonics, and attention to the care of the general health, he is enabled to improve the cardiac condition. As soon as this organ is strong enough to permit of growth, growth Avill take place. In the general treatment of heart disease in persons who have until recently had no signs of heart failure the most important thing for the physician to prescribe is rest. A tired heart cannot supply an active body. Having made these preliminary remarks, let us turn to the direct application of drugs to heart disease, the chief drug in the list being, of course, digitalis. The value of digitalis may be said to rest upon a number of infiuences possessed by it. In the first place, evidence is constantly accumulating to shoAv that digitalis increases the nutrition of the heart-muscle by the stimulating infiuence which it exerts on the pneumogastric nerve, this nerve having been partly proved to be a trophic nerve of the heart. Aside from any such nervous inAuence, 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. Tavo 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 into the aorta, or, in other words, during systole. HEART DISEASE. 567 The other hypothesis rests upon the belief that the contracting muscle prevents a free circulation of blood through the cardiac blood-vessels, 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 in the observation that a muscle when firmly contracted ahvays presses upon its supplying blood-vessels, and particularly interferes with capillary Aoav. The heart of one of the loAver animals, if carefully Avatched after the chest-Avail is removed, Avill ahvays be found to become paler during systole and redder during diastole, and if Avounded Avill 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 Avhen in the arteries, but Avhile 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 groAvth under the action of digitalis is only Avhat one Avould expect, for we have learned Avhen studying this drug that it prolongs diastole and increases the force and volume of the systolic Avave of blood. In other Avords, digitalis fills the coronary arteries almost to bursting, and so, Avhen diastole occurs, not only fioods the cardiac capillaries Avith blood, but prolongs the period during Avhich the interchange between the blood-stream and tissues takes place. There is still another Avay in which digitalis does good in cardiac disease by reason of its peculiar powers. Normally, the heart beats fast or sIoav according to the demands for blood made upon it by the system, and its action is varied by the calls Avhich it receives from the tissues. In heart disease, Avith failure of compensation owing to the leaky valves, the tissues are starved, and continually send messages for more nourishment to the cardiac muscle, Avhich finally becomes exhausted by its endeavors to supply their Avants, and beats noAv fast and now slow, uncertain Avhat to do. If digitalis is given, the vagi render the cardiac action regular and effective, acting as regulators and directors of its energies, thereby supplying the tissues and using the remaining poAver of the heart to the greatest advantage, in addi- tion to improving its blood-supply by the methods already described. The starving tissues of the body having been satisfied, as Wood has eloquently expressed it, " the angry messengers from the periphery cease their callings, and the heart is at peace and in comfort " From Avhat has been said it becomes evident that this drug, digi- talis, does good whenever the heart is weak 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 valvular lesions still remains to be described, and before doing so the 568 DISEASES. author desires to remind the reader that a patient under the full influ- ence of digitalis ought to maintain the recumbent posture. (See article on Digitalis.) Further, the drug tends to accumulate, and therefore it should be stopped for several days at the end of each Aveek of its use. Taking up the most common condition, that of mitral regurgitation, we find that in this disease the blood passes, in its normal flow, 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, OAving to disease of these valves, it can, in part at least, slip back into the auricle from Avhich it came, rather than pass out into the high pressure of the arterial system. The ventricle, therefore, propels blood in tAvo directions—in the Avrong way and in the right Avay. If the leak is large enough to permit of the regurgitation of a large part of the blood, then death occurs. Digitalis does good in mitral regurgitation, because, by increasing the force of the ventricle, 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 cir- culation. 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, Avhich is the vital question in the case. Sometimes relief does not occur, and the patient is made Avorse by digitalis, because the leak is increased as much as the normal Aoav. In mitral obstruction the difficulty is that the blood cannot enter the ventricle Avith sufficient rapidity, and this part of the heart con- tracts before it is Avell filled. V>y the prolongation of diastole the blood is given sufficient time to enter and the ventricle is filled, send- ing out into the system a large Avave of blood Avhen 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 from the obstruction on the left side of the heart. In aortic stenosis there is obstruction to the normal Aoav of blood out of the heart, and the digitalis is needed to increase the ventric- ular 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 regurgi- tant flow, but in many cases the drug fails, because the prolongation of diastole gives so much more time for the blood to Aoav backAvard into the dilating ventricle. The cardiac remedies to be used in such cases are strophanthus, in the form of the tincture, close 3 to 5 drops (0.15-0.3), adonidin, dose ^ to |- grain (0.013-0.025), and sparteine | grain (0.025). These remedies may also be used in the other forms of cardiac disease Avhere digitalis fails. It is important to remember, however, that some cases of aortic regurgitation do improve, at least temporarily, under digitalis. HEART DISEASE. 569 Physicians often meet with cases of severe cardiac disease in Avhich there are present a laboring heart, distended jugulars, and cyanosis, indicating engorgement of the right ventricle. This is to be relieved by free venesection from the arm, and, after the engorgement is re- moved, bv the use of digitalis. In many cases of cardiac disease there is associated with the heart lesion general debility and anannia. These cases should be treated not only by the use of heart tonics, but also by iron, arsenic, simple bitters, and, if constipation is present, by mild purgatives. In cardiac dropsy digitalis and the other heart stimulants do good by raising blood-pressure and pulse-force, and in some instances by stimulating the kidneys to increased efforts at elimination. (See Dropsy.) In these cases, too, the patient will often be greatly bene- fitted if he receive every feAV days a dose of one of the hydragogue cathartics, which will relieve his dropsy and unload the portal circula- tion. On the other hand, if the heart is feeble and the arterial tension is high, we not only have to give nitroglycerin to relax the spasm, but it is best to employ a cardiac tonic which at the same time that it stimu- lates the heart will not raise arterial pressure, as, for example, stro- phanthus. in preference to digitalis, Avhich stimulates the arterial system and increases the tension. In sudden cardiac failure from weakness or poisons the use of ether and ammonia is to be resorted to at once, and these are to be followed by alcohol and digitalis if necessary. The ammonia is a direct heart-stimulant, as are also the alcohol and ether. 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. Iron is to be used if the irritability 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 Avhere arhythmia is present. In other cases of arhythmia the patient will be more benefited by the use of cactus grandiflorus and sparteine, and sometimes a prescription of aco- nite and digitalis, as suggested in the article on Aconite. Ringer rec- ommends the use of veratrine ointment over the pneeordium in many of these cases. In cases of cardiac dilatation and asthenia digitalis is often very useful; but should the patient be advanced in years and have a ten- dency to arterio-sclerosis Ave should, simultaneously with its use, give nitroglycerin to relieve any arterial spasm which will resist the action of the heart. Cardiac hypertrophy is rarely seen Avithout some other lesion ac- companying it, but it may occur from prolonged and excessive exer- cise or other cause. It is to be treated by perfect rest and avoidance of excessive exercise, and by the use of moderate amounts of food of a non-stimulating character. Wines and coffee should be forbidden, and small amounts of veratrine ointment or a belladonna plaster may be placed over the pnecordium if the action of the heart is very exces- 570 DISEASES. sive. Both palpitation of the heart and cardiac hypertrophy are very favorably influenced in many cases by aconite or veratrum viride. Physicians Avho are in the habit of seeing young men professionally Avill constantly have their attention called to a condition of shortness of breath on exertion, palpitation, or violent pulsation of the heart, and in some instances the development of severe symptoms which, at first glance, may seem to be those of true angina pectoris. In many of these youths there will be a history of the excessive use of tobacco, or that they have left college, Avhere they have been indulging in severe ath- letic exercise, such as running or bicycle-racing, and have gone into business, where they lead a most sedentary life. In these cases the condition which exists is comparable to the condition which exists in a steamer Avhose engines are too strong for her hull. The heart, Avhich has heretofore been supplying the body of an athlete with blood, now finds itself too strong for the sedentary individual. There is prob- ably no remedy Avhich will give such good results under these circum- stances as aconite, given in the dose of 1 minim (0.05) of the fluid extract or 2 to 3 minims (0.1-0.15) of the tincture three times a day, partic- ularly if at the same time a good belladonna plaster about four inches square is applied over the praecordium. Many cases of tobacco heart, in Avhich there is arhythmia, with an excessive cardiac impulse over the prascordium, with palpitation on exertion, will be benefited bv aconite used in this Avay ; but Avhere the heart seems much depressed, so that the apex-beat is feeble and the first and second sounds are not clearly heard, aconite will seldom, if ever, do good. In that form of functional cardiac disorder due to indigestion aco- nite is not capable of producing the results Avhich are obtained in the cases which Ave have just mentioned. It may, however, be used as a remedy of value at the same time that the physician is directing his attention to the cause of the trouble—namely, the gastro-intestinal disorder, with the treatment of which this article has nothing to do. Here, again, a condition of cardiac feebleness contraindicates the employment of this drug. Passing to the employment of aconite in cases of true cardiac dis- ease, we find that a careful study of a certain number of cases will soon show the physician that this drug is capable of doing more good in some instances than is digitalis. The history of the following case illustrates this point: A man, aged nineteen, was brought to the hospital suffering from aortic obstruction, and as a result of this was attacked with dyspnoea on the slightest exertion, marked cardiac arhythmia, with palpitation, some giddiness, and a tendency to nose-bleed. He stated that in the early part of the year, and for several years preceding it, he had been a deck-hand on a coastwise vessel, where he performed hard manual labor, notwithstanding the condition of cardiac disease which was present, and of which he kneAv nothing. During this time he suf- fered from no symptoms indicating cardiac disorder. In other words, compensatory hypertrophy was complete. Because of the exposure incident to the work he was forced, under the advice of a physician, to earn his living on shore. He was unsuccessful in trying to obtain HEP A T1T1S. 571 employment, and a prolonged period of muscular inactivity folloAved. As a consequence of this the cardiac hypertrophy, Avhich had hitherto been compensatory, Avas noAv excessive" and he suffered from marked cardiac palpitation, Avith disordered circulation in the extremities, and from a considerable amount of cough. Very early in the study of the case it Avas recognized that these disorders Avere due to the excess of cardiac hypertrophy, and not to failure in compensation, and, as a consequence, that a cardiac depressant Avas indicated rather than a cardiac stimulant in the shape of digitalis. He Avas given from 1 to 2 minims (0.05-0.1) of the fluid extract of aconite three times a day, and during the continuance of this treatment Avas purposely confined to his bed. At the end of the Aveek so much improvement had taken place in his condition that he Avas alloAved to rise and go about the Avard as he Avished, and after four Aveeks, the medicine being continued during this period, he Avas so Avell that he Avas discharged from the hospital, Avith no other evidence of cardiac disorder than physical examination would show. When aconite is used, rest in bed is essential, in order that the heart may not be excited to great activity by exercise of the limbs, and also because the recumbent posture alloAvs the physician to use larger doses of the drug. An exceedingly useful treatment of valvular disease Avith or Avith- out excessive cardiac hypertrophy is rest in bed Avithout medication. The results in some cases are extraordinary. Fatty heart occurs in tAvo forms—that in which true fatty degen- eration has taken place in the muscular fibre, and that in Avhich there is a deposit of fat about the heart and betAveen the fibres. Nothing of any importance can be done for the first state, but much for the second. In neither form is digitalis of much value. If given it should be com- bined Avith nux vomica, or nux vomica may be given alone in full doses. The patient suffering from this latter form of heart trouble is- nearly ahvays obese, and should abstain from fats and rich foods, from all SAveet Avines 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 generally be effected in the end, Avith marked improvement in the cardiac action. (See Obesity.) HEPATITIS. (Acute 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 pro- duced 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 wounds or sores. The same may be said of the hepa- 572 DISEASES. titis of hot climates, Avhich is generally subacute or chronic. The pain, SAvelling, and general symptoms of the acute form of inflamma- tion 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 tAvo kinds : the first, medicinal: the second, dietetic. The patient, if the attack be acute or severe, will commonly be found in bed, OAving 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 one to three 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 (0.05) of calomel given in fractional doses. In regard to internal medication, the phy- sician should recollect that hepatitis is, like every inflammation, a local hyperemia 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 treatment, it may 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 in- flamed organ will form so strong an 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 con- stitutional evidence of its presence, as by night-SAveats, hectic, or rigors, is a sign for immediate interference Avith the purulent collec- tion by the physician. If amoebic dysentery exists, it must be cured as rapidly as possible by the measures generally employed for this purpose. (See Dysentery.) The diet during the early and later stages of acute hepatitis should be limited to those articles of food which are easily digested and assim- ilated, and rich or greasy dishes are to be excluded. " Strong foods," 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 Part III.) 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 and iron being used. In the treatment of the subacute or chronic hepatitis of hot climates no remedy compares to freshly-prepared strong nitromuriatic acid, used both externally and internally. The acid should be a deep 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. HICCOUGH. 573 lemon color, and be mixed Avith water only Avhen about to be taken, in the dose of 3 to 4 drops (0.15-0.2) three times a day. This rem- edy is contraindicated in acute hepatitis, because it acts by stimulating the organ, and Avould only increase the severity of the acute form of the disease if administered at this time. Externally, it is to be used by mixing it Avith Avater 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 (4.0-12.0 : 500 cc.) of Avarm Avater and applying it over the liver. If 3 fluidrachms (12.0) irritate the skin too greatly, the smaller quantity should be employed. This applica- tion causes a tingling of the skin and a localized sweat. The hepatitis due to syphilis generally shows itself as a cirrhosis, and is to be treated by antisyphilitic 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 knoAvn to result in apparent cure or arrest of the disease. In all forms of clironic hepatitis iodide of potassium is a useful remedy in the dose of from 5 to 10 grains (0.3-0.65) three times a day, or larger amounts may be used if the disease be due to syphilis. 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 exhausting 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 Avhich 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 continuous and 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 feAV 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 (0.1-0.15) well diluted. Children should only have £ to 1 drop (0.025-0.05) of the tincture, Avell diluted. Spirit of camphor, or the tincture of valerian, in the dose of 1 drachm (4.0), may be serviceable, and Hoffmann's anodyne is peculiarly appro- priate in the dose of 1 drachm (4.0) in starch-water. In the hiccough of typhoid fever nothing compares to musk, 10 grains (0.65) by the rectum, and, if this cannot be used, oil of amber may be given by the mouth in the dose of 5 to 10 drops (0.3-0.65) in capsule or emul- sion, and followed by a drink of milk to prevent irritation of the stomach. 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. 574 DISEASES. In cases Avhere the affection comes on after meals and is due to indigestion, a course of tonic treatment w ill often give relief. Thus nux vomica in pill or tincture, accompanied by some dilute mineral acid, such as hydrochloric or nitric, may be employed, or R.—Sodii bicarb............."j/4.0). Tinct. nucis vom..........f"j (4.0). Tinct. cardamomi......q. s. ad f^iij (96.0).—M. S.—Teaspoonful (4.0) before each meal. If the symptom be uraemic, a hot pack or a hypodermic injection of hydrochlorate of pilocarpine may be found of service, unless contra- indicated by advanced depression and systemic Aveakness. INCONTINENCE OF URINE. Incontinence of urine may be classified either according to its forms or the methods of its treatment. Four varieties maybe 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 Avhich 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 and conse- quent paralytic distention. Taking up the consideration of the first forms—namely, those occurring in children, in Avhich the trouble is generally nocturnal— the complete history and the present condition of the case must be discovered. Many of the most obstinate cases will yield when the urine is made constantly 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 redun- dant prepuce, particularly if this be tight and smegma and urine be found back of it in large or small quantity. The cause of the incon- tinence in both these conditions is reflex irritation of the bladder-Avails, by irritation at the end of the penis or in the vagina, and the rea- son that alkalies do good is that they render the urine, which is con- centrated and irritating, dilute, alkaline, and mild. Belladonna 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 ahvays useful : R.—Potassii citratis...........^ss (16.0). Spt. aetheris nitrosi.........f^vj (24 0). Aquse............q. s. ad f^j (32.0).—M. S.—Dessertspoonful (8.0) every four hours in equal quantity of water. INCONTINENCE OF URINE. 575 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 Avhich is Avanted. Sometimes these cases are dependent not so much upon vesical irritability as upon Aveakness of the spinal centres governing the bladder. If this be the case, the urine should first be rendered mild and then remedies should be directed to the improvement of these parts. The folloAving pill or the succeeding solution should be administered: R.—Acid, arsenosi ..........gr f (0.02). Extract, nucis vomicae.......gr. ij (0.1).-—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 arsenitis......gtt. xxiv (1.6). Tinct. nucis vomicae........gtt. xvj (1.0). Aquae...........q. s. ad f=iij (96.0).—M. S.—Teaspoonful (4.0) three times daily after meals for a child of eight or ten years. This mixture is so bitter as to be exceedingly disagreeable, and FoAvler's solution may often be used alone in the dose of \ to 1 drop (0.025-0.05), 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 employed 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 or whipping the child, as they never do good, and, the fault being beyond the child's control, the unjust punishment makes him sullen, or through nervousness, aug- mented by such treatment, his trouble becomes Avorse. In some cases it may be necessary, in order to cure the habit, to let the child drink diuretic waters for'years. The patient should ahvays be taken up from bed when the parents retire for the night and made to evacuate the bladder. For 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 with distention. If the dis- order 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 with 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 1:10,000 solution of bichloride of mercury, or 1:100 of carbolic acid, or 1:100 of boric acid. 576 DISEASES. INDIGESTION (GASTRIC AND INTESTINAL). Under the heading "■ Biliousness " the Avriter has already described many of the conditions arising out of indigestion, and, this being the case, the consideration of that state knoAvn as dyspepsia or indigestion will only receive attention at this point in so far as its cure is con- cerned, Avithout the relief of the symptoms produced. Lack of gastric digestion depends for its existence upon a verv great number of causes, and is ahvays a symptom, not a disease. It occurs during the course of short or prolonged fevers from atony of the gastric Avails and glands, from lack of secretion of the proper character, from hypersecretion of mucus by the mucous glands, and by fermentative changes in the food, or as the result of any one or all of these conditions, 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, and these in turn, being absorbed, produce toxic symptoms. Sometimes it is due to organic changes in the abdominal viscera, as carcinoma or ulcer, and sometimes to acute or chronic gastritis. In each of these states the treatment is, of course, different, because Avidely-separated causative factors must be removed. The indigestion attendant upon the course of fevers can nearly ahvays 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 recognized Avhen we recall the investigations of Hoppe-Seyler upon the quality of the gastric juice of a patient suffering from typhus fever, for he found that no hydro- chloric acid was present. I ff'elmann has also found in a similar study that the peptone-forming secretion of the stomach ceases entirely during fever. Where indigestion results from the presence of gastric catarrh the remedies applicable to such a state must be resorted to. (See Gastric Catarrh.) The studies made within recent years upon the chemical conditions of the gastric contents have changed our methods of treatment from being empirical to being rational, for Ave now know that disorders of digestion depend on deficient or excessive acidity of the gastric juice, deficient formation of pepsin, deficient motility of the gastric Avails, and other less important causes. Before carrying out any line of treatment the physician must therefore decide, if possible, as to the underlying cause of the dyspepsia found in each case, and his decision may be based on well-described subjective symptoms by the patient, or upon this description aided, or it may be replaced, by examination of the stomach-contents after a "test-meal." In those cases in which the dyspeptic symptoms result from imper- fect mastication and insalivation of food it is evident that careful eating rules are to be given the patient, Avith the additional advice, which is equally good in all cases, that exact meal-hours shall be adhered to, since irregularity in meal-hours results in imperfect diges- tion as commonly as irregularity of habit in regard to defecation INDIGESTION. 577 results in constipation. If the dyspeptic symptoms are due to deficient secretion of gastric juice, particularly if it is found that hydrochloric acid is the chief deficient element, one of two plans presents itself for employment. In many cases it will be found that the administra- tion of small doses of bicarbonate of sodium, 5 to 10 grains (0.3-0.65), before each meal will cause a free secretion of gastric juice, particu- larly if it be given simultaneously with bitter substances which act as stimulants to the gastric mucosa. These facts are not based solely on the apparent improvement in the patient, but also upon careful chemical studies of the acidity of the gastric juice by means of the stomach-tube. In mild cases the taking of a glass of Vichy water before each meal serves to provide sufficient sodium to produce good effects. The bitter substances Avhich it is best to employ in cases of deficient acidity of the gastric juice are, among the simple bitters, such drugs as quassia, cascarilla, Colombo, and gentian. Among the peculiar bitters Ave have nux vomica, quinine, rhubarb, and con- durango. These may be employed in the folloAving forms: R.—Sodii bicarbonatis.......^j (4.0). Tinct. nucis vomicae......f^j vel. ij (4.0 vel 8.0). Tinct. gentian, comp. . . q. s ad fjiij (96.0).— M. S.—Teaspoonful to a desertspoonful (4.0 to 8.0) before meals. If the stomach is lazy and atonic, but Avith no true disease which im- pairs its secreting power, an alkali will, in the majority of cases, prove to be the best drug; but if, on the other hand, there is deficient gas- tric secretion through atrophy of the gastric tubules or carcinoma of the stomach, the use of hydrochloric acid is the better plan. Under these circumstances the folloAving prescription may be ordered: R— Acid, hydrochloric, dil.........f^j (4.0). Ext. condurango fl...........fijj (32.0). Tine, cardamomi comp......q. s. ad fjiij (96.0).—M. S.—Dessertspoonful with or after each meal in water. The symptoms manifested by persons needing the treatment first named are variable, but generally of sufficient constancy in type to be fairly pathognomonic. There is generally loss of appetite, some impairment in general health and nutrition, and marked difficulty in digesting food, particularly if it be in solid form. Complaint is usually made of a sensation of Aveight after eating, without any real pain, but indigestion is not complete, owing to the food being finally dis- posed of in the duodenum. Often because of the delay in gastric digestion there is some belching of gas due to fermentation of the food in the presence of Avarmth and moisture, and without the anti- septic influence of the gastric juice. If any food is brought up with the belching, it is unaltered or changed only by fermentation. Examina- tion of the stomach-contents for hydrochloric acid by the phloroglucin- vanillin test will speedily confirm the diagnosis of absence of hydro- chloric acid, and this confirmation should be sought for in every case. In the cases of gastric indigestion depending upon hypersecretion of the acid of the juice a line of treatment quite at variance with that 37 57S DISEASES. just discussed must be instituted. This may be divided into the direct and indirect forms, including the remedies Avhich distinctly decrease gastric secretion and those Avhich antagonize or overcome its acidity after it is poured out from the glands. In the first-class Ave find both general and local nervous and glanular sedatives, and in the second alkaline drugs. Of the first class Ave have hyoscyamus, belladonna, and opium from the vegetable kingdom, and the bromides, bismuth, and nitrate of silver from the mineral. Of the second class Ave have massive doses of sodium bicarbonate taken during or after meals, ammo- nia, generally in the form of the aromatic spirit, and magnesia and chalk. As many, if not all, of the cases suffering from hyperacidity are of a nervous temperament, these drugs do good by quieting reflex activity throughout the nervous system connected Avith digestion, and by a local action on peripheral nerves, or on the glands themselves, diminish secretion. Of particular value for this purpose is hyoscy- amus, Avhich very markedly decreases gastric secretion directly and indirectly, and at the same time relieves gastric pain by its local sedative influence. Taking gastric ulcer as a typical instance of a condition of excessive secretion of hydrochloric acid, it will be found that the fol- lowing pill, combined Avith an absolute milk diet or, for the first feAV days, allowing only rectal alimentation by peptonized food, will be most useful: R.—Argenti nitratis....... Extract hyoscyami..... Ft. in pil. No. xx. S.—One pill one hour before taking food Sometimes in place of this pill it is wise, particularly if no ulcer exists, to give 10 to 20 grains (0.65-1.5) of bromide of strontium one hour before meals, and in any case AAhere this fails to control excessive secretion of acid full doses of sodium bicarbonate may be given, 20 or 30 grains (1.5 or 2.0) or more, after each meal. The bromide had better be given in solution. If the stomach is very irri- table and there is a tendency to vomiting, a powder composed as follows is often useful: R.—Acid, carbolic, (cryst.) . Bismuthi subnitrat. Ft. in chart. No. xx. g.—One t. i. d. with or before food The symptoms manifested by the patients requiring this treatment are as follows : There is often a constant sense of gnawing or hollow- ness in the stomach, which is sometimes temporarily allayed by the taking of food. The patient is, as a rule, of a nervous temperament and in a condition of nervous depression due to some exhausting cause. Tenderness and even pain in the epigastrium may be produced by superficial or deep palpation, or the patient may complain that the pressure of his clothes is distressing. If ulcer of the stomach is gr. v (0 3). gr. x (0.65).—M. .......T^ xx (1.5). .......gr. cc. (14.0).—M. INDIGESTION. 579 present, all the characteristic symptoms of that lesion may be found. When belching occurs, there is often vomiting of sour masses or acid eructations or heartburn. Gastralgia more or less severe may also occur. In cases where testing the stomach-contents shows that the exces- sive acidity is not due to hydrochloric acid, but to the acids of fer- mentation, the use of the sedative drugs we have named is of no avail for obvious reasons, but m their place we may employ sodium bicar- bonate as a palliative, and antiseptic or antifermentative drugs, such as thymol, creosote, chloral, and sodium hyposulphite, as direct reme- dial agents. Lavage of the stomach should also be resorted to. In still other cases a mixture containing chloral and hyposul- phite of sodium is useful because of its antiseptic influence. (See Chloral.) Often these cases are relieved if all fats, and butter in particu- lar, are excluded from their diet-list. If much gas is developed and a sensation of weight in the stom- ach is felt after eating, so that the patient feels as if the food lay undigested in that organ, the folloAving prescription may be used, but is contraindicated if the stomach is tender on deep palpation, or, in other words, if acute irritation or inflammation of the stomach is present. It is useful in atonic states of the stomach, and it is surprising Iioav much relief may be afforded by the use in such cases either of this prescrip- tion or of one of the volatile oils, such as oil of cinnamon, given in capsule or pill after meals. R.—Oleoresin. capsici............TTLij (0.1). Pepsin, vel pancreatin...........gr. xx (1.35). Pulv. zingiberis.......... . . . gr. xx (1.35). Carbo ligni...............gr. xl (2.65). Creosoti ................n^x (0.65).—M. Ft. in pil. No. xx. S.—One after eating. 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 extent the normal juices by some artificial ferment. These ferments should be given Avith the meals or the food predigested before it is taken. The pancreatin should be given in full dose (5 to 10 grains [0.3- 0.65]), Avith bicarbonate of sodium, and alkaline mineral Avaters used if the urine is concentrated. (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 pain is due to the accumulation of flatus in the small intestine, or more com- monly to its pressing upAvard at the angle Avhere 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: 580 DISEASES. R.—Acid, nitric, dil.............fgj (4.0). Tinct. cardamom, comp..........f^vj (192.0).—M. S.—Dessertspoonful (8.0) in water four times a day. In old persons flatulence of the large boAvel is frequently found, and is often associated Avith atony of the muscular coats of the gut. Under these circumstances the folloAving prescriptions will be found of service: R.—Asafoetidae...............gr. xl (2.6). Extract, nucis vomicae.........gr. iv (0.25). Extract, physostigmatis.........gr. iij (0.18). Oleoresin. capsici...........tt\,x (0.65).—M. Ft. in pil. No. xx. S.—One pill three times a day, two hours after meals. Or, R.—Tinct. belladonna? ...........f^ij (8.0). Tinct. physostigmatis.........f^j (4.0). Spt. camphora?..........q. s. ad f jiij (96.0).—M. S.—Teaspoonful (4.0) two hours after meals or whenever needed. Where intestinal indigestion results in lientery the treatment becomes entirely changed, except in regard to the use of a predi- gested milk diet, and efforts must be made to increase the secretion of the glands of the intestinal Avail. Often minute doses of mercury bichloride or podophyllin may do this, fa to fa grain (0.001—0.0010) of the first or second, respectively. More commonly, however, the mixture of nitric acid, given above, will be the proper treatment, or perhaps the following if the liver is found to be torpid: R.—Acid, nitro-hydrochlor. (not dil.) . . . f^ss vel f^j (2.0-4.0). Infus. gentiana? comp......q. s. ad fjvj (192.0).—M. S.—Dessertspoonful (8.0) every four hours or after meals, in water. Chloroform spirit is often valuable in these cases in the dose of 20 drops (1.3). (See Chloroform.) INFLUENZA. The disease known as influenza affects various individuals so differently, and presents so many symptoms associated with 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 complications. Greater in importance than the employment of drugs must be regarded continuous rest, and 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, with 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 INFLUENZA. 581 that just mentioned. Under these circumstances the author does not believe that it is Avell for the physician to resort to any of the rem- edies Avhich have been so largely used during the last few years, and Avhich are knoAvn as the "antipyretics" or the derivatives of coal- tar. _ Although originally introduced for the purpose of reducing febrile temperatures, practical experience has taught us that their sphere of action is very limited under these circumstances, and the author almost never gives antipyrin, phenacetin, or acetanilid 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 Avith 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 complica- tions are by no means unusual, large doses are contraindicated 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 doses 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 in influenza. If any of the coal-tar products are used either for the relief of fever or of pain, phenacetin and acetanilid should be chosen. Ex- periments made in America and in Germany on animals have proved that phenacetin is far less toxic in its relations to the heart than is antipyrin or acetanilid, and Avhile it has in a number of instances seemed more apt to produce cyanosis in man than either of the other drugs, this cyanosis rarely, if ever, has been associated with any other dangerous symptoms. Indeed, it is quite extraordinary the amount of cyanosis Avhich phenacetin may produce Avithout the respiration becoming greatly disordered, very much less cyanosis when caused by acetanilid or antipyrin being accompanied by much more alarming symptoms. A very favorite combination Avith prac- titioners who have had a large experience is one of salol and phena- cetin. The action of the phenacetin 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 power different from that possessed by either of these two constituents alone, for neither carbolic acid nor salicylic acid has much poAver in the relief of pain Avhen used alone, unless, as in the case of carbolic acid, it is 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 unknoAvn Avay associated Avith the condition Avhich Ave have called " rheumatism," and in Avhich salicylic acid does good in an unknoAvn manner. Salicylic acid alone might be equally use- ful 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 Avhich have been in use 582 DISEASES. 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 solu- tion 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 circulation, and of being readily taken by the patient Avithout danger of disordering the stomach at this time or later on, Avhich 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 10 to 15 grains (0.65—1.0) three times a day to an adult. 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 antipyretics just spoken of. It is true that the patients themselves and the friends of the patients will some- times protest against Avhat 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 Liebermeister as it is carried out by its originators. Most of them forego the very import- ant portion 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 Avet sheet, by sponging, or a cold bath Avithout using anv measures Avhich are di- rected against internal congestion. (See Cold and Fever.) 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 Aveak and exhausted, the duration of the febrile portion of the malady does not extend beyond a few days. Clinical experience and physiological study have proved that it is not the tem- perature of 105° or 106° F. Avhich is distinctly dangerous, but the continuation of this temperature for many hours Avhich 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 tempera- ture of 104.5°or 105° is not particularly alarming in the condition which Ave are considering, unless there are symptoms pointing to the fact that the patient is being injured by an excessive temperature, as may be indicated by somnolence and an exceedingly dry skin as Avell as cerebral symptoms. Of course, if renal trouble, associated Avith 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 condition to be overcome by the use of drugs. It seems to be the general consensus of opinion, both in America and in England, that any measures of a depleting character are dis- tinctly harmful in influenza, even at its earliest stages, and Ave would INFLUENZA. 583 naturally expect that this would be the conclusion arrived at by phy- sicians who treat their patients rationally. Although influenza is a short-lived disease, there is probably no malady in which the patient goes so quickly into a condition of profound depression, or even exhaus- tion, as in this one. The abstraction of blood from a vein or by the use of cups should not be resorted to, as it will increase the exhaustion. Before the system has a chance to recover from the onset of the attack it will be still further depressed by the therapeutic measures of the physician Avho is unAvise enough to bleed. 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 Avho 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 Aralue. Associated Avith this condition, the skin is frequently covered with 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," Avould seem to cover to a very large extent the indications Avhich are present at this period ; yet the author's experience, Avhich may differ from that of some of his readers, is that the cardiac stimulant Avhich 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 any medi- cament, and that we have not had the patience to wait and allow such a slowly-acting remedy as digitalis to take effect. Be this as it may, the author regards strychnine as infinitely preferable to foxglove Avhen these symptoms appear; and he has been able to prevent their appearance, 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 strug- gle with the profound condition of exhaustion Avhich is present. In an adult we can see no reason why fa of a grain (0.003) may not be given three or four times in tAventy-four hours, and in some cases we have given it every four hours Avithout producing any of the symp- toms of an overdose of strychnine. Divided doses are better than a few very large ones. The author knows of no better illustration of the fact that in some conditions we are to give drugs for effect rather than according to customary dose than the employment of strychnine in influenza, and the physician Avho is timorous in the presence of this frequent com- plication, depression, certainly increases the patient's danger. As Avith everything else, the drug should be carefully Avatched, 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 instances Avhere the collapse comes on suddenly the strychnine should be administered hypodermically and followed by full doses by 581 DISEASES. the mouth, in order to keep up the full effect exercised by the drug upon the nervous and circulatory systems. In some cases it will be found that the blood-paths seem to be so relaxed and atonic that the strychnine is unable to produce a sufficient vascular effect to bring the patient out of his difficulties, and under these circumstances very good results folloAv the combination of belladonna Avith strychnine, the belladonna being, as Ave Avell know, a poAverful vasomotor stim- ulant 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 con- valescence. It is proper to point out, hoAvever, that strychnine is not a drug suitable for the purpose of producing constant stimulation. It is a whip to the nervous system, and if used in too large a dose for too long a time the overwhipped system fags out. 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 results or in influencing the prognosis as to the ultimate recovery of the case, and in cases of pneumonia complicating grippe, in which delirium is the prominent symptom, it appears that delirium is not to be regarded in the same light as similar manifestations complicating ordinary pneumonia or other diseases. The delirium may be either talkative or muttering, but does not in the majority of cases require treatment, passing aAvay Avith the fever and rarely extending into the stage of exhaustion. For the irritative cough steam inhalations, laden in the first stage Avith benzoin or other innocuous and sedative substances, seem par- ticularly useful. For the bronchitis Avhich is often present it is gen- erally sufficient to administer the ordinary mixtures, containing ipecac and potassium citrate, in the earliest stages, and to folloAv them by chloride of ammonium and cubebs in the later stages. The author does not think that the compound liquorice mixture containing anti- mony should be given in the second stage of influenza. A complica- tion too apt to occur at this time is oedema of the lung or a Avide- spread bronchitis, Avith a profound exudation Avhich bids fair to droAvn the patient in his OAvn secretions. Antimony is not only a substance depressing to the circulatory and respiratory systems, but aids very materially in causing the peculiar excess of secretion Avhich has just been spoken of. It may be necessary to use bromides if the cough is excessive, or to replace them by codeine or very small doses of morphine. In many cases still better results will be obtained by a good preparation of cannabis indica, Avhich may be pushed until it relieves the cough Avithout 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 Avill be generally found that the insomnia comes after the attack rather than during it, or in any event INSOMNIA. 585 it will not require attention until the patient is convalescent. Under these circumstances chloral or chloralamide, or even sulphonal, mav 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 sulphonal 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 Avhich are sometimes bitterly com- plained of by the patient either during or after the attack, small doses of bromide Avith 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 blood-ves- 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 in the earlv stages of influenza it is generally advisable to administer either castor oil or in other cases half an ounce (16.0) of the sulphate of magnesium, or for more fastidious patients the citrate of magnesium. A full purga- tive effect of any of these salines seems to lessen the fever Avhen the bowels are unloaded. Care should be taken that the dose of the purga- tive is not excessively large, as it will Aveaken the patient as much as would bleeding. For the constipation folloAving the attack probably no drug is as efficient as cascara sagrada, combined perhaps Avith aloin. (See Constipation.) If diarrhoea supplants the constipation, the ordinary astringents, such as aromatic sulphuric acid or haematox- ylon, will be found sufficiently active. (See Diarrhoea.) INSOMNIA. Insomnia is a condition complicating many diseases, and arises from such a host of causes that the physician may not be able to discover them for some days after the patient is first seen. As a general rule, a patient consulting a physician Avith this symptom expects a prescription to be given at once and the cause of the insomnia found out afterward. Under these circumstances the physician may safely employ several druf*s according to the information that he has concerning the patient's state. One of the most common remedies is chloral given in the following manner: R.—Chloralis...............3iij (12.0). Syrup.................f#v (16.0). Aquae cinnamomi.......q. s. ad f^iij (96.0).—M. S.—Dessertspoonful (8.0) at night. Or, R.—Butyl chloral-hydrat..........gj (4.0). 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 contraindicated, resort may be had to the bromide of potassium •586 DISEASES. or sodium, and if the patient is a female these drugs should always be accompanied by a small dose of arsenic, generally in the form of Fowler's solution, 1 to 3 drops (0.05-0.15) three times a day, in order to avoid all danger of the production of acne. The following pre- scription is useful: R.—Potassii bromid.............%ij (8.0). Liq. potassii arsenit...........fjss(2.0). Aqua3 cinnamomi.........q. s. ad f^vj (192.0).—M. S.—One to two dessertspoonfuls (8.0-16.0) at night. In many cases larger amounts of the bromide will be needed. Where the sleeplessness is due to pain, chloral is of little A'alue and bromides are Avorth but little more. Under these circumstances by resorting to Avhat is known as the "crossed action of drugs," Ave can often obtain a very good effect. Thus morphine and chloral both act on the brain to produce sleep, or, in other Avords, 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 fol- loAving is therefore a useful combination, either Avhere one drug fails or when dangerously large doses of either alone have to be used to obtain the desired result: R.—Morphinse sulphatis.........gr. iv (0.2). Chloralis..............^ij (8.0). Syrup................f§ij (60.0). Aqua? - • • •........q-a. ad fSjiv (128.0).— M. S.—Dessertspoonful (8.0) at night. In cases where insomnia is due to mania hyoscine is said to be very useful, given in the dose of Tfa to fa grain (0.0007) by the mouth or Tfa to t^q- grain (0.0006) by the hypodermic needle. OAving to its tastelessness the poAvder may be put on the tongue, and it is best to order a little sugar of milk or Avhite sugar (1 grain) to be added to each dose of hyoscine, in order to give it bulk. Where insomnia follows 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 relieving the cerebral congestion by a hot foot-bath or the use of a hot-Avater bag at the feet while cold is applied to the head. During the last feAV years a very large number of remedies have been introduced as hypnotics, such as somnal, paraldehyde, chloral- amide, sulphonal, trional, amylene hydrate, hypnal, and others. Not one of these is comparable in therapeutic activity Avith the older rem- edies. Of these the best, from every point of vieAv, are sulphonal and trional. The dose of sulphonal and trional is 10 to 20 grains (0.65- 1.3) in poAvder, but, as they are large in bulk and hard to SAvalloAV, they should be used in a prescription made up as folloAvs: R.—Sulphonal.............gr. xxx (2.0) Syrupi simplicis..........f^ij (8.0). Mucilaginis acaciae.........f^ij (8.0). Aquae destillat.........q. s. ad fsj (32.0).—M. S.—Half to all of this at one dose, as may be needed. INTERMITTENT FEVER. 587 In other instances sulphonal may be dissolved in very hot water, and the solution swallowed before it cools sufficiently to permit precipi- Chloralamide may be used in the dose of 15 to 60 grains (1.0-4.0), dissolved in wine or given in capsule. Paraldehyde is given in the dose of 20 to 60 minims (1.3-4.0). As it is disagreeable in odor and taste, it must be given in 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 excep- tion of hypnal, has no effect in insomnia from pain. Somnal is used in the dose of 10 to 40 minims (0.65-2.65) with liquorice and Avater, and possesses considerable power. In the treatment of insomnia it should be remembered that if pos- sible those drugs should be used which will quiet the part of the brain which is most active. Thus if the patient tosses much, Ave use bro- mides and chloral as motor depressants. If sensation is active, bro- mides and the hot pack are used to act as sensory quietants. In some cases horseback exercise taken late in the afternoon does good, particularly if the patient follows a sedentary life. Many per- sons AA'ho are usually sleepless will obtain a refreshing slumber by tak- ing 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 aAvake during the night. INTERMITTENT FEVER. In all forms of intermittent fever, Avhether the attacks are diurnal, quotidian, tertian, or quartan, the best remedy for their prevention is quinine, Avhich should under these circumstances be given ahout two or three hours before the attack is expected, so as to be absorbed and be physiologically active Avhen 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. Experience has proved that quinine never acts as favor- ably if constipation is present as when the boAvels 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 (0.010-0.016) of calomel every fifteen minutes until a grain (0.05) is taken, or by a dose of podophyllin amounting to fa to \ grain (0.006-0.008). If podophyllin is used, a longer time should be alloAved before the antiperiodic is given, because of the sIoav 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 Avith the exigencies of the case, which in turn generally depend upon the region in Avhich the patient lives 588 DISEASES. or has lived. 10 to 15 grains (0.65-1.0) in one dose are generally sufficient in the Eastern and Northern States, but as much as 20 to 45 (1.3-3.0), or even 60 grains (4.0) may be required in the south- ern parts of the United States and elsewhere. When still larger doses are employed, the drug should be given partly hypodermically and partly by the rectum in suppository or in solution, as well as by the stomach, as this viscus Avill rarely withstand 60 grains (4.0) of quinine without irritation. (For the best salts for hypodermic use, see article on Cinchona.) 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 Avhere the attacks are several days apart small doses of quinine of from 3 to 6 grains (0.15-0.3) are to be taken daily betAveen the paroxysms, or, Avhat is better, arsenic may be given in moderate dose for its antiperiodic influence during the intermission. In this manner the quinine acts Avith full force Avhen 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, overcome it, not by depletants, unless the case is very sthenic, but by stimulants, such as strychnine or 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 (8.0) of the poAvdered drug to an adult, or by 20 grains (1.3) of sulphate of zinc. It is almost useless to give quinine at this time, as absorption from the stomach and subcutaneous tissues is almost entirely absent. Alcoholic stimu- lants 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, meas- ures must be used to control it. Chloroform may be inhaled, and immediately preceded by laudanum by the bowel or mouth. If the laudanum is given by the mouth, a little ether or chloroform may be added to the dose of the opiate. The opium may be used hypoderm- ically in the form of morphine in the dose of ^ of a grain (0.01) com- bined Avith fa of a grain (0.001) 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 antipyrin, or, better still, the ice-pack. These measures have seldom to be used, as the fever is generally too fugitive to need such treatment. The SAveating stage needs no particular treatment, unless exhaus- tion is caused by it, Avhen stimulants may be cautiously used as needed, and large draughts of water at ordinary temperatures swal- lowed. Many measures have been resorted to to put off a malarial attack, the chief of Avhich is the use of ether or chloroform anaesthetization IRITIS. 589 at the time of the expected paroxysm, of nitrite of amyl or of the nitrite of potassium or sodium in 10-grain (0.65) dose for the same purpose. Where the "chill habit" exists and depends largely upon nervousness, it has been broken by misplacing the hands of the clock, and so getting the patient past the time for his attacks without his knoAvledge. 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 dis- ease, the Plasmodium malarie of Marchiafava and Celli, or, as it is sometimes called, the malarial germ of haveran or the htematozobn of malaria. It is worth remembering that methylene blue possesses antimala- rial properties in the dose of 1 to 4 grains (0.05-0.2). (See Methyl- ene Blue.) 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 tuberculo- sis. Metastatic iritis occurs in pyaemia, relapsing fever, etc. The most marked symptoms are severe brow pain; fine ciliary injection ; discoloration of the iris and immobility of the pupil, due to the for- mation 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, scopolamine, 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—Avater, chamomile infusion, or laurel-Avater (1 : 15). In traumatic iritis iced compresses are suitable in the early stages, but not in the later periods and 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 a serious therapeutical blunder. In serous iritis, or that variety in Avhich there is a hypersecretion of the aqueous humor, Avhich becomes turbid, and a precipitate of dark spots occurs upon the membrane of Descemet, atropine must be cautiously instilled, owing to the tend- ency to increased tension. If this occurs, paracentesis of the cornea may be needed, and pilocarpine should be given internally if the vit- reous becomes opaque. Subconjunctival injections of sublimate (2-5 drops of a 1: 2000 solution) are recommended in syphilitic iritis, and, if the inflamma- tion is not too acute, produce good results. In true syphilitic iritis mercury must be pushed to the point of tolerance, but it is not necessary to salivate the patient. Any form 590 DISEASES. 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 medi- cation in the opinion of many authors. After the mercurial impres- sion has been made and the pupil is Avell dilated, potassium iodide, either alone or in combination Avith bichloride of mercury, is indicated. In plastic iritis, appearing six to eight months after the disappear- ance of the secondary symptoms, this latter treatment Avithout the previous use of mercury has been recommended. Carmichael's plan, consisting in the administration of drachm doses of turpentine, in addition to Avhich 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 Zolli- coffer's mixture is an excellent remedy. Potassium iodide should be administered in gonorrhceal iritis, and relief occasionally folloAvs a pilocarpine sweat. In all forms of iritis the treatment of the consti- tutional disorder which has occasioned the local inflammation is neces- sary, and if the iritis becomes purulent surgical interference is usually required. In any variety of iritis the intense pain should be alle- viated 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 with a breach in the continuity of the corneal surface, it is termed corneal ulcer, and four characteristic symptoms supply the indications for local treat- ment: (1) photophobia, or dread of light; (2) blepharospasm, or spas- modic contraction of the orbicularis muscle; (3) congestion of the blood-vessels; (4) pain ; Avhile any existing dyscrasia or constitutional condition upon Avhich 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 betAveen the ages of five and fifteen years, and in the vast majority of cases the result of inherited syphilis. No local measure is sufficient, antisyphilitic treat- ment being of paramount importance. During the height of the ciliary congestion warm antiseptic lotions and atropine are indicated, the latter especially to prevent the tendency to iritis. Severe pain may be alleviated 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, KER A TITIS. 591 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 Avhich has been described. The coexisting constitutional disturbances must be combated Avith 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, which become yellow, break doAvn, and leave an open ulcer (phlyctenular ulcer), to Avhich runs a leash of injected blood-vessels. The disease is common in children, often folloAvs in the Avake of the exanthemata, and is so frequently associated Avith a strumous diathesis that it Avas formerly called strumous ophthalmia. In the majority of cases there is coexisting nasal disease, especially adenoid vegetations, Avhich is responsible for the frequent relapses of the disorder, even if does not cause it. Congestion may be relieved by frequent irrigation Avith a warm boric-acid solution. Pain and irritation call for the use of atropine drops (4 grains to the ounce [0.2 : 32.0]), Avhich should be continued until the ulcer is covered Avith regenerated epithelium, when the process of cicatrization may be hastened by the insertion daily into the conjunctival sac of a small quantity of yelloAv-oxide-of-mercury salve or dusting it Avith finely-poAvdered calomel, providing the patient is not taking at the same time any form of iodine. During the whole treatment the eyes should be protected by dark glasses and the sub- ject permitted to go out into the open air. All local treatment will prove unsatisfactory unless associated with strict hygiene, carefully regulated diet, and constitutional measures—tonics and alteratives— and the treatment of the naso-pharyngeal lesions. 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 Avater on the closed eyelids, or by touching with blue-stone the ulcer- ated fissure at the external commissural angle, which is commonly an exciting cause of the spasmodic closure of the lids. 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 the anterior chamber, the condition is called hypopyon and the dis- ease hypopyon keratitis. These conditions require prompt treatment— namely, frequent application of hot compresses, Avhich may be advan- 592 DISEASES. tageously composed of slightly carbolized Avater, atropine drops, or, in the opinion of many, eserine (J to 2 grains to the ounce [0.03- 0.1 : 32.0]). If the abscess forms, the pus should be evacuated by a formal operation, either by dividing the anterior surface or by per- forming the operation after the manner of Saemisch. In addition to the types of disease Avhich have been described Ave have the examples of sloughing or infective ulcers, Avhich are seen under a variety of conditions, and often are directly traceable to an injury, being more common in elderly people. The tendency of all these ulcers is to spread, from Avhence 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 averted by a pressure bandage. This is made by placing upon the eye a wad of antiseptic cotton, over Avhich, in figure-of-eight turns, a flannel roller is applied. If in spite of this the process continues, the folloAving measures have met Avith the greatest success: Touching the margin of the ulcer Avith a strong solution of nitrate of silver, 10 to 20 grains to the ounce (0.65-1.3 : 32.0), care being taken that the ulcer alone receives the application; scraping the floor of the ulcer Avith a small curette or spud and dusting upon its surface iodoform; finally—and this, in cases in Avhich the ulceration is not too extensive, is the best method—the use of the actual cautery. In every case of sloughing ulcer the lachrymal passages must be explored for obstruction. Sequelae 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 Avhite, they are irremediable by local medication and require sur- gical interference for optical relief. If, however, they are diffuse, much good will folloAv systematic massage of the cornea, aided by the introduction of a small particle of yellow-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 Avhole 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 Avith a battery, the cathode being placed directly on the previously anaesthetized cornea and the anode on the cheek. LACHRYMAL ABSCESS. Lachrymal abscess results from suppuration in a chronically dis- tended lachrymal sac, owing to the presence of obstruction in the LARYNGITIS, ACUTE. 593 nasal duct, and exists as a SAvelling under the skin at the inner can- thus, pressure upon the surface causing an escape of pus through the canaliculi. The treatment is practically confined to surgical inter- ference—that is, division of the canaliculi and Avashing out the dis- tended sac with 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 outAvard. In purulent discharge from the lachrymo-nasal duct solutions of blue pyoktanin (1 : 1000), injected through the passage, favorably modify the unhealthy secretions. Much comfort will ensue from the use of hot compresses over the inflamed area. These may be made in the ordinary way, or are still more efficacious if composed of a lead lotion, the ordinary lead-Avater and laudanum ansAvering the purpose very Avell. LARYNGITIS (ACUTE). The treatment of acute laryngitis is identical in many respects with that directed against acute inflammatory processes elseAvhere. It may be divided into local, external, and internal methods. The condition of the larynx Avhen acutely inflamed is that of intense hyper- emia and irritation, and the object of the physician must be to allav this irritability. This is best accomplished by the use of compound tincture of benzoin, Avhich is placed in boiling hot Avater (1 ounce to the pint [32.0: 500 cc.]), and the steam inhaled as it rises from a pitcher or as it passes out of the nozzle of a deep coffee-pot. A better apparatus, if it can be obtained, is a can or Avide-mouthed bottle arranged with one long and one short tube like a Wolff bottle, the air being drawn into the larynx through the short tube. This inhalation should be resorted to six or eight times a day, but the patient must not go out of doors or into a cold room, as the steam relaxes the parts involved and renders them more susceptible to cold. Sometimes advantage is gained by adding to this inhalation 1 grain (0.05) of menthol. If the patient is unable to remain in an equable temperature, then the steam-inhaler should be supplanted by the use by the physician of an Oliver nebu- lizer, and in this atomizer should be placed a mixture as folloAvs : R — Menthol...............gr. ii] (0.15). Albolene...............fgj (32.01— M. S.—Use as a spray. The patient is directed to gently inhale this vapor, which because of its lightness readily passes deeply into the air-passages, and has the effect of soothing rather than irritating them as does the spray from an atomizer. Rarely in the very acute stages of laryngitis should the physician employ a watery spray to Avash the laryngeal mucous membrane, as it is apt to increase the irritation. If any aqueous spray is used, as may be necessary when the irritation has resulted from the inhalation of dust, it may be made up as follows: 38 594 DISEASES. R.-Sodii chlorid..........gr. xv (1.0). Acid, boric............gr. x (0.65). Sodii borat...........gr. x (0.65). Aquae ros;e...........fjiij (90.0).—M. S.—Use as a spray. The external treatment, if the inflammation is exceedingly severe and the patient can be confined to bed, is a mustard plaster or hot application over the larynx, care being taken that the volatile mus- tard does not render the inhaled air irritating to the larynx. A mus- tard foot-bath and a Avarm drink on going to bed are useful. The internal treatment should consist in opening the boAvels with calomel and a saline purgative if constipation is present, and in the adminstration of full doses of aconite and bromide of sodium or potas- sium, as folloAvs : R.—Tine, aconiti..........U\,xij vel xxiv (1.0-1.6). Sodii bromidi..........spj (8.0). Syr. lactucarii (Aubergier) .... f^j (32.0). Aquse..........q. s. ad fgiij (96.0).—M. S.—Dessertspoonful (8.0) every hour for six or eight doses. This prescription may in many cases be continued until convalescence, as it stops cough, quiets the inflamed area, and allays arterial excite- ment. Often it is best to omit the aconite after the first few days. By the second day the patient should be directed to make a heavy application of tincture of iodine over the trachea and episternal notch, as high as is possible Avithout the stain sliOAving above the collar. In children and in some adults this is wrell substituted by oil of amber and sweet oil in the proportion of 1 to 3 parts rubbed on the skin. For the stiffness folloAving the inflammation preparations of coca are very useful, given internally, and tonics to the general system are needed. LEUCORRHCEA. This is a condition—vulgarly known as the " whites "—consisting in a hypersecretion from those glands which 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 Avhich is a condition of the system when it is " run down " from any cause, with perverted functions of the glands or their sur- roundings. In some persons, who seem perfectly strong and well it would appear to be due to an effort of the system to overcome plethora. The character of the discharge varies Avith almost every case. In some instances it is thick and tenacious, in others so liquid as to trickle (Ioavii the limbs in a stream and greatly soil the clothing. In most of the latter cases catarrh of the Fallopian tubes or ovarian irri- tation and tenderness will be present. Where the secretion is very thick and tenacious it generally arises from the cervical canal, Avhile that from disorder of the vaginal wall alone, independent of other morbid conditions, may be either thick or thin. LEUCORRHOEA. 595 The treatment of these forms of leucorrhoea may be divided into tAvo parts—one, that directed to the remedying of the morbid process through the use of drugs by the mouth; the other, by their employ- ment locally. It is needless to state that in that form dependent upon excessive lactation or other exhausting manner of life tonics of an active cha- racter are needed. As a general rule, anaemia will be present, and the folloAving pill will be found of service: R.—Acid, arsenosi...........gr. \ (0.016). Ferri redacti............gr. v (0.25). Quininae sulph............§j (1.3).—M. Ft. in pil. No. xx. S.—One pill three times a day, after meals, for an adult. Or, R.—Tr. cinchona? comp..........f-?ij (64.0). Tr. gentian, comp.......q. s. ad fjiv (128.0).—M. S.—Dessertspoonful (8.0) three times a day, after meals.1 Sometimes small doses of the sulphate of iron are better for this purpose, OAving to its astringent properties, but Avhen any prepara- tions of iron are used care must be taken that the boAvels are kept active and that the stomach is not disordered. Associated Avith the use of these internal remedies should be a moderate amount of exer- cise and the avoidance of late hours and rich foods. The local applications Avhich are of value in these states consist in counter-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 with 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 Avith a mixture of iodine, carbolic acid, and chloral, such as is used by Dr. Goodell, as follows: R.—Iodi resublimat.........^iv (16.0). Acid, carbol. crystal. | . aa £ (32.0). Chloralis J oj \ / Rub 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 folloAving pill may also be employed: R.—Hydrarg. chlor. corros......gr. \ (0.03). 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 1 In both these prescriptions tiie small amount of iron and arsenic given will prob- ablv be noted, but this is done advisedly, as iron and arsenic do as much good to the blood in small as in large amounts under most circumstances. (See Iron.) 596 DISEASES. by adding 1 ounce (32.0) of poAvdered Avhite-oak bark to each pint (500 cc.) of water, or tannic acid and glycerin in the proportion of 1 ounce to 2 quarts (32.0 : 2 litres) of warm water. Ringer recom- mends the folloAving: R .—Sodii bicarbonatis........3J (4.0). Tinctura; belladonna?......f.^ij (8.0). Aquse.............Oj (500 cc.).—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 h drachm to 1 pint (2.0 : 500 cc.) of water. In purulent vaginitis, specific or other- wise, the folloAving injection is serviceable: R.—Creolin.............f^ss vel f^ij (2.0-8.0). Ext. hydrast. canaden. fl......f^ijss (10.0). Aquse.............fgviij (256.0).—M. S.—Add 2 tablespoonfuls to a pint (32.0: 500 cc.) of hot water, shake thoroughly, and use as an injection. Sometimes a tampon thoroughly saturated with a poAvder 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 Avhich these applica- tions are made. Generally a pint of the solution is placed in a basin over which the Avoman squats, and by means of a syringe forces the liquid into the vagina as fast as it runs out, thereby filling the syringe joints Avith the dissolved secretions, and returning to the vagina as soon as they Aoav away the impurities Avhich have left it. The only proper way to give such an injection is to have the solution in one basin, to the extent of 1 gallon (4 litres), 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............fgj (4.0). Alumin. sulph...........f^j (4.0). Glycerini.............f|vj (192.0).—M. S.—A tablespoonful (16.0) to each quart (1 litre) 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, pulmonary catarrhs, fever, etc.), or from local infection; under the latter circumstance they may assume a gangrenous type. The treat- ment is that for any form of abscess—poultices, preferably in the form of hot compresses, early incisions, antiseptic 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 :s frequently the result of MALARIAL FEVER—MANIA, ACUTE. 597 lifting heavy weights or it results from other strains. In many cases acupuncture is very useful, particularly if the trouble is bilateral. (See Part III.) Sometimes after the employment of this measure the patient can straighten the back at once and retain that position. In other instances antipyrin or acetanilid, in 5- to 10-grain (0.35-0.65) doses of the former and 2- to 4-grain (0.1-0.2) doses of the latter, are of service, and iodide of potassium and salicylic acid are not to be for- gotten if the condition of the patient "does not rapidly improve. Phenacetin and salol are also useful, combined or alone. A large hot poultice applied to the back is often efficacious in obstinate cases. Sometimes the use of a hot foot-bath and a Dover's poAvder on going to bed will produce a cure, and ironing the back Avith an ordinary hot laundry iron at a proper heat, a piece of neAvspaper or cloth being placed over the skin under the iron, is very efficient. Counter-irrita- tion in the shape of a blister, a mustard plaster, or capsicum draft will 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 and Pernicious Mala- rial FEArER.) 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 to denote temporary measures suitable for cases Avhich are brief in their course. In those cases Avhich 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 (1.3-2.0) of the fluid extract three times a day, Avhile for the rapid quieting of the patient Ave may use hyoscine hydrobromate in the dose of jfa grain (0.0006). In other instances, if the kidneys and heart are healthy, full doses of chloral may be used, and if an active preparation of cannabis indica can be had, at least 1 grain (0.05) of the solid extract or J to 1 drachm (2.0-4.0) of the tincture should be employed. Cannabis indica Avill be found particularly serviceable if 60 grains (4.0) of one of the bromides can be combined Avith it. Where a patient suffering from mania is so violent that nothing can be done Avith him, he should be held, and an emetic dose of fa grain (0.005) of apomorphine be given hypodermically to produce vom- iting and so relax the muscular system, or he may be tied or anaesthet- ized 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. 598 DISEASES. MELANCHOLIA. This is not the place for the 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 Avho are alienists. There is one form of melancholia, however, which may often be rapidly relieved by a simple measure. It is that dependent upon the condition of the system in Avhich oxaluria is present. Whenever an individual complains of melancholia the urine should be examined, and if any oxalate crystals are found, undiluted, fresh nitromuriatic acid should be given in the dose of 5 drops (0.3) after each meal in a half-tumblerful or more of Avater. In order to guard against errors in diagnosis it is well to remember that pears, tomatoes, rhu- barb, 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 area is relieved of its excess of blood, because, the pressure being less elseAvhere, the blood obeys the law that liquids ahvays 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 effusion. The proper dose of veratrum viride in the form of the tincture is 3 drops (0.15) every hour until the skin becomes moist or nausea is developed.1 The tincture of aconite is also useful in full dose. If great arterial excitement is present, venesection may be practised (see Bleeding), but veratrum viride and aconite are better remedies if they are at hand. Associated with these two drugs we should em- ploy mercury and opium, the first for its antiphlogistic influence, the second for its poAver in allaying irritation. \ grain (0.016) of pow- dered opium and \ grain (0.03) of calomel may be given every hour until the full effect of the opium or mercury is manifested. In some instances the deodorized tincture of opium (Tinctura opii deodorati) is better than the crude drug, in the dose of 2 to 5 drops (0.1-0.25) every one or two hours. Sometimes belladonna is of great service, and this is particularly the case Avhere the drugs already named are 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 menin- gitis, lest if vomiting come on the disease be made worse. MIGRAINE—MUSCLE VOLITANTES—MYALGIA. 599 contraindicated because of a condition of weakness or asthenia. In both conditions ergot is of value in allaying the congestion, but its period for exerting a favorable 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 its antipyretic effect, and leeches may be put at the nape of the neck Avith advantage. As the disease advances and the nervous disorders of the affection become marked, nervous sedatives are required to allay the tAvitchings, muscular spasms, or convulsions, and for this purpose no drugs are to be com- pared 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 (0.65), and the bromides given in the dose of from 5 to 40 grains (0.3-2.65). If coma comes on, a large blister should be applied to the nape of the neck. Quinine has been recommended in meningitis, but it is absolutely contraindicated, 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 neces- sarily supportive, OAving to the reaction consequent upon great ner- vous 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 with the food if weakness is present, and a very simple or milk diet insisted upon. MIGRAINE. (See Neuralgia.) MUSCLE VOLITANTES. Muscee volitantes is the name applied to the dark specks which patients frequently see floating across their fields of vision, especially if the eves are directed toward a bright sky or a white page. Usually they indicate no disease of the vitreous humor, and the ophthalmo- scope fails to detect abnormal changes. They are attributed to tor- pidity 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, rheu- matic taint, or inflammation due to cold. Here, as in many other 600 DISEASES. states, the treatment is to be divided into the external and the inter- nal 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 ammonium will be of service in 10- or 20-grain (0.05-1.3) doses given in a solution Avith extract of liquorice. (For prescription see Bronchitis.) Other remedies which may be tried Avith a good chance of success are full doses of a good fluid extract of cimicifuga (20 drops to 1 drachm [1.3-4.0]) or the citrate or acetate of potassium in 20-grain (1.3) doses. The local medications are numerous, but only a feAV can be consid- ered as Avorthy of routine employment. The chief one is iodine, in the form of the pure ointment or diluted one-half Avith lard if the skin is easily irritated. Another method is to employ a liniment, Avell rubbed into the skin, made up as folloAvs: R.—Tr. belladonna;............ffcj (4.0). Tr. aconiti..............f^ij (8.0). Tr. opii...............f#j (8.0). Liniment, saponis.......q. s. ad f^vj (192.0).—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 the successful treatment of this state. NASAL CATARRH (ATROPHIC). In atrophic nasal catarrh the nostrils are roomy and the mucous membrane red and 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, Avhich 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 overpoAvering stench. This form of catarrh causes loss of the sense of smell, and the odor is not recognized by the patient him- self. Ulceration 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, Avhich 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 naso-pharynx and the healing of abraded or ulcerated surfaces. NASAL CATARRH, CHRONIC. 601 The early removal of dead bone is imperative, and what secreting surface remains must be stimulated as far as possible, to compensate, in a measure, for the glands that are hopelessly destroyed. In other Avords, our efforts are directed toAvard producing a com/wnsatory hyper- trophy of the glandular tissue that remains. Therefore Avith the use of antisepsis Ave combine alteratives and local stimulation. The nose should be thoroughly cleansed with an alkaline wash— Dobell's solution—warmed to increase its solvent power. 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 Avash. Its OAvn pungent odor masks some- Avhat the offensive odor. Permanganate of potassium may be used in Aveak solutions, but it is painful except Avhen sensation is entirely lost. Peroxide of hydrogen is recommended, but the Avriter has had no experience in using it over such an extensive surface. The solutions are best applied by means of an atomizer or post- 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 alloAved to reaccumulate or much time Avill 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 Avith alteratives. PoAvders of nitrate of silver in starch, varying in strength from 1 to 10 grains to 2J drachms (0.65-10.0) of the latter, may be blown into the nostrils by means of an insufflator. Cover gently the Avhole surface Avith 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 fluid- ounce (0.05-0.05 : 32.0), gives better results at other times Avhen applied to the mucous membrane. Avoid over-stimulating, and so exhausting, the glands Avhich 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 physi- cian should employ iodide of potassium to increase nasal secretions 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, Avhich 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 in the loAver ranks that it most frequently reaches its later stages and its worst forms. This does not result from lack of opportunity for treat- 602 DISEASES. ment, but from the ignorance or indifference Avhich this class show to diseases while there is no suffering and no interference Avith business. 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 poAver 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 shoAving a tendency to change sides. This change is most noticeable in turning in bed, the lower side usually stopping, and on 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 first indications for treatment are the reduction of inflamma- tion and restoration of the breathing-space. As the chief function of the nose is respiratory, the re-establish- ment of free nasal respiration, combined Avith the liberal use of anti- septic 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 wash recommended on page 493. 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 Avhen snuffed from a cup the solution should be artificially Avarmed. This Avash may be used two or more times a day. The nasal douche should never be used Avhere there is nasal ob- struction, 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 feAv days Avith good results. A solution composed of equal parts of distilled extract of hamamelis and water 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 (0.3 : 32.0), 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 (0.35 : 32.0), with enough potassium iodide to make a solution. Apply this by means of a piece of absorbent cotton on the end of an applicator, along the floor of the nose, until it reaches the pharynx. It is need- NEPHRITIS, ACUTE. 603 less to say that such an application as this should be made Avith 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 shown 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. NEPHRITIS (ACUTE). The treatment of acute nephritis accompanied by any active inflammatory change requires intelligent care. The pain in 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 elseAvhere, for the reduction of inflammation circulatory depress- ants 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, Avhich must be given cautiously, as these drugs are not readily eliminated Avhen 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 feAV hours. Should the urine be scanty and of high specific gravity, and constipation be present, a purgative dose (^ an ounce [16.0]) of sulphate of mag- nesium should be used to aid in the elimination of impurities by the bowel. Warm mucilaginous drinks, as flaxseed tea, are of service, and the use of the citrate of potassium and the SAveet spirit of nitre with copious draughts of pure Avater should be resorted to to increase urinary flow. If dropsy or symptoms of uraemia come on, they may be relieved by the use of hydragogue purges, such as elaterium, which is partic- ularly useful in that it is supposed to aid in the elimination of the urea by the bowel. Jaborandi or pilocarpine may be used to SAveat the patient at this time or in the earlier stages with advantage; £ grain (0.008) of the hydrochlorate should be given hypodermically, and repeated in fifteen minutes if no sweat appears ; but it should never be forgotten that Avhen the heart is feeble or the patient very sus- ceptible pilocarpine may produce serious collapse. This can sometimes be guarded against by the use of strychnine in J^-grain (0.003) doses. Hot-air baths are often useful to provoke a SAveat. (See Heat, in Part III.) Generally these cases go on to recovery, although convalescence is often someAvhat prolonged. 604 DISEASES. 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 digi- talis 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 persistently atonic, 5- to 1 drop (0.01-0.05) of the tincture of cantharides at each dose may be used, and, as anaemia is often a prominent symptom, tincture of the chloride of iron, Avhich is both a diuretic and a tonic, should be resorted to. If renal hemorrhage is excessive, gallic acid and ergot are indi- cated to control the bleeding. A milk diet should be rigidly enforced. (See Uraemia.) NEPHRITIS (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 Ave 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 Avhich 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 Avarm 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. Many physicians direct that skimmed milk be used. The author believes that this advice is not Avise, as it deprives the patient of the nutritive fats, which he needs and Avhich are not contraindicated, whereas the proteids of skimmed milk, Avhile the best form of albuminoid food Ave can give, are not advantageous, but have to be used to maintain nutrition. If the cream in the milk dis- agrees Avith the patient, it may be removed in part or diluted by the addition of water. Beyond this we can do little toward a cure. To allay symptoms Ave can do much, and the albuminuria can be greatly decreased by the use of digitalis, squill, the acetate and bitartrate of potassium, and the iodides; nor should the bichloride and protiodide of mercury be forgotten, as they are very valuable indeed. These rem- edies are also of value to relieve the dropsy, and the most efficacious treatment of all is a combination of the bitartrate of potassium and juniper-berries, so that 1 ounce (32.0) of the former is dissolved in 1 pint (500 cc.) of an infusion of the latter and taken in twenty-four hours. A most valuable aid in decreasing the albuminuria is the use of 1 to 3 drops of tincture of cantharides in Avater three times a day, particularly if the kidney seems torpid and is secreting too little urine. If dropsy develops, hydragogue purges are useful, such as NEURALGIA. 605 jalap and elaterium, and hot baths, Turkish or Russian, are to be given, not only to relieve the dropsy, but to so hypertrophy the excre- tory glands of the skin that they will be able through greater activity to relieve the kidneys. (See Heat.) Sugar of milk may be given in the dose of 40 to 80 grains (2.05-5.5) 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 chronic interstitial forms of this disease Bartholow has highly recommended the use of the chloride of gold and sodium in the dose of fa to fa grain (0.003-0.006). The anaemia is to be com- bated by the use of the tincture of the chloride of iron, or Basham's Mixture (see Iron), and oxygen inhalations. The arsenite of sodium and the carbonate or citrate of lithium are also said to be of value in chronic contracted kidney, particularly if it is dependent upon a gouty taint. The dose of the former should be fa grain (0.003), and of the latter 5 grains (0.35), three times a day. (See Ureemia). NEURALGIA. Like headache, neuralgia gives rise to most of the suffering expe- rienced by active persons Avho are not sick enough for bed and by those Avho are confined to bed by other diseases. It affects members of every Avalk of life, and may be so severe as entirely to incapacitate the most poAverful of men. The causes of neuralgia are very A^arious, but they may be briefly stated to depend chiefly upon malnutrition, over-Avork, nervous excite- ment Avith consequent reaction, and to reflex irritation from diseased organs, as in the case of supraorbital neuralgia from eye-strain or ovarian irritation or uterine inflammation. Nerves functionally dis- eased are ahvays more or less active than normal; that is, hyper- excited or hypo-ex cited, above or below par. In both cases they must be brought back to their normal tone by appropriate remedies, and these consist in nervous excitants and nervous sedatives. To o-ive a nerve already depressed the additional depression of a bromide, or a nerve excited the additional excitement of strychnine, Avould be absurd. From Avhat has just been said it becomes evident that the physician must ahvays determine the condition of the system of his patient and the causes of that condition before administering remedies. The treatment of this condition of neuralgia from its curative stand- point may be divided into the use of tonics, nutritives, and palliatives. Where neuralgia is associated with anaemia no hope of permanent relief can be looked for unless iron and arsenic are used until the anaemia is cured, and it is often necessary to combine Avith these drugs the use of cod-liver oil and bitter tonics. These are the cases, too in which nux vomica and strychnine raise the depressed nerves to increased activity, and so bring relief. Hoav they do this is not known but we knoAv enough to recognize one or two important facts. Strychnine is certainly a nervous stimulant, and is also a stimulant 006 DISEASES. to the anterior columns of the spinal 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 trib- utary 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, Avhile 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 Avhich are convalescing from acute fevers. Sometimes malarial poisoning produces a violent form of supra- orbital pain knoAvn as " broAV ague," Avhich 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 evil general effect. By these terms the writer refers to antipyrin, acetanilid, and phenacetin, all of which possess Avonderful poAver 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 ahvays remember that their field of service is that of neuralgic pain, not other pains. Antipyrin is to be used in the dose of 5 to 20 grains (0.3-1.3) for ordinary neuralgia or the pain arising from the crisis of locomotor ataxia, acetanilid in the dose of 3 to 8 grains (0.18-0.5) for the same purposes, and phenacetin in the same amount as acetanilid. Upon these remedies, combined Avith caffeine and the bromides according to circumstances, Ave noAv depend, and the following pre- scriptions Avill be found of service: R— Antipyrini............^j vel sjij (4 0-8.0). Caffeinae citratis..........gr. xx\l.3).—M. Ft. in chart No. x. S.—One every thirty minutes till relieved. The following may be of use also: R.—Antipyrini.......... Potassii bromidi....... Ft. in chart No. x. S.—One every thirty minutes till relieved Or, when the caffeine in the first prescription causes nervousness, R.—Antipyrini............3J vel ,^ij (4.0-8.0). Caffeinse citratis..........gr. x (0.65). Potassii bromidi.........giij (12.0).—M. Ft. in chart No. x. S.—One as above. In any one of these prescriptions acetanilid or phenacetin may be substituted for the antipyrin. • • 3J vel 3*1 (4.0-8.0). . . 3iij (12.0) .-M. NIPPLES, SORE. 607 A very effective remedy in some cases of neuralgia of the fifth nerve is croton chloral in from 5- to 20-grain (0.3-1.3) doses in pills of 5 grains (0.3) each. fo v ; F In some cases of anaemic neuralgia of the head nitrite-of-amy] inhalations have proved useful, probably by reason of the cephalic flushing produced by this drug. A very 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 with an ether, chloride of methyl, or rhigolene spray, or by the application of a small package of. finely-chopped ice and salt to the part. Within the last few years the treatment of neuralgia by kataphoresis (see Part III.) has come into prominence, and consists in the use of some local anaesthetic, such as chloroform, Avhich is applied over the part on a small piece of lint, and a galvanic current used through the pledget which is attached to the positiA^e pole. Under these circumstances the anaesthetic passes through the skin and affects the nerve. A very useful local injection in localized neuralgia is -^ to 4; of a grain (0.016) of morphine, but the danger of beginning the morphine habit is to be remembered Avhen treating chronic cases. Sometimes acupuncture (see Part III.) 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 knoAvn as migraine. This affection is very severe in its manifesta- tions, and is often most obstinate in yielding to treatment. Com- monly it is associated with eye-strain or cerebral disease or other sim- ilar cause, 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 (1.3) of the tincture of cannabis indica every hour if a good preparation can be had, or by the use of | to J grain (0.016-0.30) of the solid extract every two hours, accompanied by 10 to 20 drops (0.65-1.3) of tincture of gelsemium. (See article on Headache.) NIPPLES (SORE). Whenever the nipples become sore, so that it is impossible for the mother to alloAV the child to nurse, a solution of cocaine of the strength of 4 grains to the ounce (0.2 : 32.0) should be applied to the part, and washed off carefully just before the child sucks. Following the nursing, a solution of boric acid, of the strength of 20 grains to the ounce (1.3 : 32.0) of Avater or mucilage of acacia, may be used over the part, the nipple being thoroughly dried beforehand. Where the fissures are deep and sIoav to heal the tip of a stick of silver nitrate may be applied to them with advantage. Some practitioners employ tincture of benzoin over the inflamed part, and glycerite of tannin is 608 DISEASES. often of value. Cleanliness, dryness, and care of the breast previous to parturition 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, various dis- comforts, 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 betAveen 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 and bulk of the body requires severe muscular effort. It is Avorthy of note, also, that a layer of fat over the body increases the vascular surface very greatly, and in consequence gives the heart the labor of supplying a larger number of blood-vessels. 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 de- posit of obese materials, in the same way that the members of one family have large bones, while those of another have small bones. The etiology of obesity, outside of the causes just named, are very numerous, but the chief one is over-indulgence in food. 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 himself in regard to the amount of food Avhich is consumed and ingested. One often sees large, poAverful, Aviry men, Avho eat little, sit beside others, not so poAverful or large, Avho eat excessively, and who appa- rently do not suffer from indigestion in consequence. Neither of these two groups becomes excessively fat, because one represents a grate Avhich burns its fuel so that there is no Avaste, AA'hile the other resem- bles a grate in Avhich 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 require varying amounts of coal, so do different men assimilate 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 easily " often eats more than a day-laborer—of far richer foods, too—and Avonders Avhy 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 will say that he eats just enough to keep him from feeling empty betAveen meals; but this does not alter the case in the least. The proper amount of food for a man is not what his appetite or gastric viscus calls for, but what his sys- OBESITY. 609 tern needs. To this further reference will be made Avhen considering the diet for obesity, found beloAv. The very presence of fat aids in the deposition of it, for, by act- ing as a non-conducting pad all over the body, it prevents the dissi- pation of heat, and so decreases the combustion of those substances which, when not used for the manufacture of heat, are deposited as fat. Again, Ave nearly always find that obese persons take alcohol with their food, thereby increasing the fat in their bodies; for, find- ing that they cannot digest all the substances which greediness makes them SAvalloAV, they take alcohol to stimulate their digestive apparatus to increased efforts and assimilation. Further than this, alcohol adds force to the body, and preserves the tissues by substituting itself for food in the oxidizing 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, Avhich 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 corpulence rests solely upon the conditions named. In all instances the diet is the important point for the bestowal of «are. Referenc^has already been made to the fact that the needs of the system are tn^^jterion by Avhich Ave judge the amount of food oecessary to each cale, not the sensations in the stomach. The use of coca by the natives of South America enables them to withstand hunger and privation, not because it gives tissue to the body, but because it paralyzes the sensory nerves in the stomach and relieves the sensation of holloAvness or Aveakness which Ave are accustomed to overcome in this country, in the absence of food, by tightening our belts. Every one Avho has undergone severe mental or physical labor and missed a regular meal Avill 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 powers 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 way as a careful speculator keeps his shares of stock—namely, one part in active use for speculation, the other half for reserve incase 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 were, the consumptive would be notorious for his appetite, instead of being noteworthy for his anorexia. The food of the patient suffering from obesity is to be cut down 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 39 610 DISEASES. roots or tubers, contain a large amount of fibre useless to the body. By the use of a carefully arranged vegetable diet in obesity Ave 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 mate- rials 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 physio- logically correct, as both forms of food are ahvays 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 service in the treatment of obesity: Breakfast: One or tAvo cups of coffee or tea, without milk or sugar, but sweetened with a fraction of a grain of saccharin. 3 ounces of toasted or ordinary Avhite bread or 6 ounces of bran bread. Enough butter may be used to make the bread palatable—not more than 1 ounce. Sliced ra-Av tomatoes Avith vinegar or cooked tomatoes without any sugar or fats. This diet may be vajiCd by the use of salt or fresh fish either at breakfast or at dinner. Noon meal (dinner): One soup-plate of bouillon, consomme, Ju- lienne, or other thin soup, or Liebig's or Mosquera's beef jelly, fol- loAved by one piece of the white meat of any form of fowl or a small bird. Sometimes a small piece, the size of one's hand, of rare beef or mut- ton, but no fat, may be allowed, and this should be accompanied by string-beans, celery, steAved or raw, spinach, kale, cabbage, beans, asparagus, leeks, and young onions. FolloAving this, lettuce Avith vinegar and 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 two soft-boiled eggs, which may also be poached, but not fried, a few 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 hun- ger during the night, the patient may take a meal of panada or soak Graham or bran crackers or biscuits in Avater and flavor the mass with salt and pepper. The reduction of diet is generally best accomplished sloAvly, 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 not drink freely of Avater, unless sweating is established sufficiently freely to prevent the accumu- lation of the liquid in the vessels and tissues. Very often a cold bath will, by its dissipation of heat, cause PERICARDITIS. 611 destruction of fat, Avhich Avill be burnt up in the body in the manu- facture 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 repeated each day or a Turkish bath used instead. The bowels 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 blood-vessels are engorged, the circulation in the capillaries is sIoav and a deposit of fat is apt to result. Where proper exercise is impossible the rest cure, Avith massage, electricity, passive exertion, and an absolute skimmed-milk diet, may be resorted to, particularly in those persons knoAvn as "fat anaemics," Avho have not enough red corpuscles in their blood to carry sufficient oxygen 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 prsecordium, and at the same time sufficiently large doses of veratrum viride or aconite resorted to to depress the circulation, and by the dilatation of the blood-vessels elsewhere to draw off the blood from the inflamed area. To prevent the outpouring of a plastic exudate capable of undergoing organiza- tion and forming adhesions, calomel should be given in |-grain (0.03) doses every hour, combined Avith enough opium to prevent purgation. An ice-bag placed over the praecordium not only relieves the pain, quiets the circulation, and reduces the temperature, but also acts favor- ably in modifying the severity of the inflammation. Where the case passes from the acute stage of inflammation to that in which effusion takes place, the treatment changes at once, and becomes supportive if the system shoAVS signs of failure. The fric- tion-sounds of the first stage are now lost, and the heart-sounds may be feeble or muffled in tone by reason of the effusion present. Digi- talis, alcohol, or caffeine may be used if the heart shows signs of fail- ure, but Avhen digitalis is used its influence should be carefully watched, since the employment of this drug produces a very full diastole or dilatation of the ventricles, and these are already cramped for space in Avhich 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 away very gradually. Often it is best to use a long needle attached to a hypodermic syringe in order to be sure that there is fluid. The best place for making the puncture is the fourth or fifth intercostal space, very close to the left edge of the sternum. Should pus be present, free drainage must be gradually established. In other instances, if the patient is strong, it is only necessary to administer hydragogue purges, such as jalap (20 grains [1.3] of the compound jalap powder), or elaterium \ grain (0.01), or a saline purgative in concentrated form, before breakfast. Often a blister over the praecordium is of service. 612 DISEASES. PERITONITIS (ACUTE). The views of the best minds in the medical profession concerning the treatment of peritonitis have ehanged radically in the last ten years, chiefly through the advances made in abdominal surgery and bacteriological research. These opportunities for study have shoAvn that peritonitis never arises as a strictly primary condition, but is due in every case to the infection of the peritoneum by micro-organ- isms, benign or malign, Avhich are originally found in the intestines or other portions of the abdominal viscera. Even Avhen peritonitis folloAvs directly upon injury, the actual cause of the pathological process is the escape of micro-organisms through the devitalized wall of the intestine, and the severity of the attacks depends in turn upon the vital resistance of the patient, the degree of infection, and the rapidity Avith Avhich a plastic exudate is throAvn out to encapsulate the inflamed area. It is not possible in this short article to discuss the facts noAv knoAvn in regard to the etiology and pathology of acute peritonitis. Suffice it to state, one of the germs found normally as a benign inhabitant of the intestine becomes at once, on entrance into the peritoneal cavity, malignant and capable of producing rapidly-fatal peritonitis. Nor is actual rupture of the boAvel or appendix vermi- formis necessary for this infection, since it has been shoAvn that this germ, the bacillus coli communis, rapidly migrates through the bowel- Avall as soon as it becomes inflamed or congested in all its coats. Streptococci and staphylococci, finding access to this cavity, also produce violent inflammation. It has been found that the perito- neum Avill destroy many infecting germs in the healthy man if its vitality is not impaired, but if it is impaired a mild infection starts up severe inflammation. Having learned, then, that acute peritonitis is ahvays secondary to some local cause or to some general infection, the first thing for the therapeutist to do, being called in to a case of this disease, is to deter- mine Avhat the provoking agent is, in order that his treatment may be directed against the cause rather than the effect. This cause is noAv known, in the great majority of cases, to be Appendicitis (which, see), the inflammatory process being spread by infection from this source. In women it is not uncommonly due to more or less obscure pelvic disease, or, again, it may arise from abscess and other severe diseases of the liver, spleen, pancreas, or stomach. Finally, it should never be forgotten that intestinal obstruction is a frequent cause of peritonitis. The physician may rest assured that if he cannot find the provoking cause, it is his OAvn fault, and not that the case is purely idiopathic. Having found the cause, treatment is of course to be at once insti- tuted, and is medical or surgical—more commonly the latter than the former, since nearly all the provoking causes of this disease are at most only palliated by medicinal treatment, Avhile they can sometimes be removed by surgical interference. Fortunately for those Avho can only obtain medicinal treatment, nature does much to aid in produ- PERITONITIS. 613 cing a cure in many cases by limiting the disease through its localiza- tion by Avails of lymph, so that many cases of peritonitis recover with- out active medicinal or surgical care. In the pelvis this localization of the process is very apt to take place unless the infection folloAv childbirth, Avhen septic diffuse peritonitis may arise, which is nearly always fatal. If the trouble arise in the appendix vermiformis, this condition may be treated in its early stages by the means suggested in the arti- cle on Appendicitis, but at the very first sign of the spread of the inflammation, or of its becoming locally very severe, or of general sys- temic disturbance, the surgeon must be called in. The difficulty is that in many cases requiring operation, the operation is performed too late through the hesitancy of the patient, his friends, the physician, or even of the operator himself. If the local trouble does not seem to be spreading and the patient's general condition is favorable, ope- ration should be postponed indefinitely or until a state of quiescence is reached, Avhen the prospects of recovery from operative interference are better. If there is reason to believe that an abscess has ruptured into the peritoneal cavity, or if perforation of the boAvel is followed by severe general symptoms of widespread peritoneal difficulty, ope- ration should be resorted to at once. In deciding the question, hoAvever, as to whether a case of periton- itis requires surgical interference, the physician at the present time is in an unfortunate position. There can be no doubt that there are many records in medicine Avhich prove most conclusively that lives have been saved through operative interference Avhich would have been undoubtedly lost had the surgeon not come to the rescue. On the other hand, there are cases in Avhich a fatal result has followed an operation, and in Avhich the physician has bitterly reproached him- self that he consented to surgical interference, for as he looks back over the case he perceives that the operation has distinctly aided in causing the loss of life. At the present time each case must be decided upon its individual merits, and the physician or surgeon in giving advice to the family in regard to a Avell-developed case of peri- tonitis should ahvays be careful to let them understand distinctly that the condition of the patient is most alarming, and the chances of life poor whether the treatment be medical or surgical, since in many instances neither form of remedial measure can possibly produce good results. In other words, the relatives should clearly understand that Avhether medicinal measures or surgical procedures are resorted to, the patient has only a fighting chance. The folloAving case illustrates the value of surgical interference in peritonitis : M-----Avas taken ill at twelve midnight, Avith violent pain in the belly, and Avas seen by the Avriter the folloA\ing evening at eight o'clock. At this time all the physical signs of a Avidely-diffused peritonitis Avere present. The belly was hard and board-like, the pulse was exceedingly rapid, the respirations fifty-six, and there Avas o-reat pain. Careful physical examination of the belly and a study of the patient's history failed to reveal any cause near or remote for 614 DISEASES. the attack, he having been in perfect health up to the time at which the pain began. After consultation with an eminent surgeon it was lecided that his condition Avas so pressing that death under medicinal treatment Avas assured, and that, Avhile operative interference offered but a faint chance of success, it ay as the only measure Avhich could be resorted to. Accordingly, at tAvelve o'clock that night, just tAventy- four hours after the pain began, the patient Avas operated upon, the incision being made in the median line for the purpose of exploring the belly, Avith the hope that an exciting cause for the attack might be found. On opening the belly it was found that acute intestinal obstruction had taken place through the boAvel being tAvisted over an old inflammatory band. After this obstruction had been reduced the appendix Avas examined, and found to be in a condition of acute in- flammation, and for this reason it was removed. It was noted that the peritoneal surfaces of the intestines and of the abdominal wall Avas intensely hyperaemic and red and lacking in their normal appearance. The operation lasted an hour and a half, and the patient recovered after a desperate struggle for life Avhich lasted for Aveeks, during which time his attendants several times gave up all hope of his re- covery. Had no operation been permitted, death Avould certainly have resulted from the intestinal obstruction if not from the appendicitis, and had the median incision not been made, but the appendix alone sought for by a lateral incision, the obstruction Avould have been overlooked, and the death recorded as one due to general peritonitis following appendicitis for Avhich an operation had been performed unsuccessfully. On the other hand, the Avriter saAv a case in Avhich the conditions before operation were apparently identical Avith that just named, in Avhich appendicitis and obstruction were discovered at the operation, and in which death took place as early or earlier than it would have occurred had operative interference not been resorted to. These two cases are mentioned for the purpose of emphasizing the fact that a definite prognosis as to the results of treatment, either surgical or medicinal, in peritonitis is not possible. Aside from the surgical treatment, Avhich is an absolute essential in many cases of peritonitis, Ave have at hand medicinal methods which are of some value early in the attack and Avhere operation is refused or considered inadvisable. The first of these is the use of opium, given until the pain is partly removed and the respirations decreased to twelve or fourteen per minute. The patient should never be so narcotized as to have no pain on abdominal palpation or be unable to answer questions. On the other hand, it should be remembered that cases of peritonitis bear large doses of opium without effect. The dose should be pushed till the desired effect is obtained, and not be measured in grains. Cases are on record in which many hundred grains of opium have been given in a few days, with recovery as a result. For many years physicians of repute have regarded mercury as the drug above all others capable of modifying inflammations of serous membranes, particularly if combined Avith opium. Half-grain doses of calomel may be used every hour for twenty-four hours. An ice- PERITONITIS, CHRONIC. 615 bag or a turpentine stupe may be put over the the area originating the trouble. If the case is very sthenic, leeches may be used on the belly, but this is not advisable in most cases, as the patient may later need the blood to preserve his strength. Should vomiting be a press- ing symptom, it is best controlled by the use of tAvo grains of ace- tanilid every tAvo or three hours Avith brandy and ice. Medication is best carried out by the hypodermic needle or the rectal injection. The thirst in many cases of peritonitis is excessive, and ought to be relieved by giving small pieces of ice Avith or Avithout a little white of egg poured over it. Even small amounts of Avater are not to be forbidden, since the vomiting is reflex, and the water alloAvs the vom- iting to take the place of the more exhausting retching. If collapse is threatened, the best remedy is probably the extract of hyoscyamus by the rectum in injection or suppository, since this drug, while it contracts the vessels and soothes the nervous system, does not tend to produce disagreeable symptoms as does belladonna. The question of the use of purgatives in cases of peritonitis has been much discussed. The Avriter believes that in cases of perito- nitis folloAving operation, where the operator knoAvs the intestine is intact, saline purgatives, such as teaspoonful doses of a saturated solution of magnesium sulphate every ten or fifteen minutes, may be used in many cases Avith good effects ; but if there is any pos- sibility of the peritonitis being caused by perforation or obstruc- tion, their use is absolutely contraindicated, since if used the con- tents of the gut may be Avashed into the peritoneal cavity or the obstruction be rendered more complete. The saline purgative not only empties the boAvel, but in addition, by the free watery flow pro- duced, depletes the inflamed peritoneum. When there seems to be a probability that the pain may be due to the ingestion of bad food, and signs of perforation are absent, purgatives may be used to remove the offending articles. Should the patient be feeble, purgation is contraindicated. The tympanitis, which may be a prominent symptom, may be relieved in some cases by the use of the rectal tube or of injections into the bowel of milk of asafoetida or turpentine emulsion. This book is not the place for the consideration of the surgical procedures to be folloAved, but it may be stated that in septic peri- tonitis in all cases it is a question of operation Avith probable death, or no operation Avith certain death. In obscure cases of general peri- tonitis, where the cause of the disease cannot be found by ordinary methods of diagnosis, the Avriter believes that exploratory incision should be done, and after the cause is removed the belly-cavity well washed out Avith hot normal saline solution, and drainage-tube or gauze left in for at least tAventy-four hours. PERITONITIS (CHRONIC). Chronic peritonitis is very apt to be circumscribed and to exist in connection Avith chronic appendicular trouble or in females in connec- 616 DISEASES. tion with diseases of the organs of generation. The most diffuse and curable form of the disease is that knoAvn as tubercular peritonitis, in which cures have been safely reached through abdominal incision Avith or Avithout drainage or the dusting in of iodoform. Of all forms of organic disease affecting the abdominal area and of a chronic type, none offer such results to the physician and surgeon as does this, and operation ought ahvays to be advised and urged upon the patient most strenuously. Care should be taken, hoAvever, to separate the subacute or chronic process, termed tubercular peritonitis, from the malignant and acute form called tuberculosis of the peritoneum, Avhich is often only a manifestation of a general infection. PERNICIOUS MALARIAL FEVER. This is one of the most acutely dangerous diseases known to man if it be fully developed, and requires the greatest activity and skill on the part of the physician, Avho may be called upon to treat a large number of widely 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, Avhich may amount to 60 or 100 grains (4.0 or 7.0), by the mouth, by the boAvel, and hypodermically. The manner in Avhich quinine acts in malarial poisoning is noAv generally conceded to depend upon its influence over the malarial germ of Laveran, which has been so Avell 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 Ave have at last obtained a knoAv- ledge as to the manner in Avhich quinine does good, Avhich in its absence was a constant opprobrium to scientific medicine. The say- ing that "As soon as the physiologist and pathologist tell the thera- peutist Avhat disease is, the latter will tell hoAv 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 Inter- mittent and Remittent Fevers.) PLEURITIS, OR PLEURISY. It is to be remembered that an inflammation of the pleura is in many ways identical with inflammatory processes elseAvhere. The treatment of this disease in its early stages is therefore identical with other inflammatory diseases, or, in other words, the use of vene- section, or, better still, of tincture of veratrum viride or aconite, to bleed the man into his own blood-vessels, is to be resorted to if the patient is seen in the earliest stages and is strong and full-blooded. The use of blisters or cups at this time does little good and gives unnecessary pain. When the pain from the pleurisy is excessive and the movements PLEURUTS, OR PLEURISY. 617 of respiration greatly increase the discomfort, strapping the chest- wall may be resorted to. This is done for the purpose of immobil- izing the chest. The straps should consist of adhesive plaster, tAvo and a half inches wide, and should be long enough to reach from the middle line of the vertebrae to the sternum or a little beyond its middle line. They should be applied tightly during expiration, slightly overlapping one another at a right angle to the spine, and not in the line of the ribs. The old idea that pleurisy was usually due to cold rather than to an infecting micro-organism led to the enveloping of the chest in poultices. These soil the clothing, speedily get cold, and are very uncomfortable. They have been supplanted almost entirely by the cotton jacket, Avhich is much better. It consists of one or tAvo thicknesses of carded cotton basted inside a thin undershirt, as fur is placed in a fur-lined coat. On the outside of the shirt oil-silk should be basted. By using this Ave envelop the chest in a Avarm poultice, because the heat of the bodv keeps the cotton at the proper temperature, Avhile the oil-silk, by pre- venting evaporation of the moisture exhaled from the skin, soon causes the cotton to be moist as well as Avarm. Even the cotton jacket is losing its popularity, as the fever of the patient makes a hot jacket almost unbearable and it does very little real good. Further, its re- moval is very apt to result in a chill. 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, and the absence of a friction-sound denote the passage of 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 laro-e to cause marked dyspnoea on exertion, or reaches to the third interspace anteriorly, and is not readily removed by the administration of salicylic acid in the dose of 1 to 2 drachms (4.0-8.0) a day, or saline purges given 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. This operation should be done at once Avithout the use of drugs if the dysp- noea is urgent. The physical signs at this time, it will be remembered, consist in flatness 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 effu- sion is sacculated. BloAving or bronchial breathing at the apex of the lung Avhen this organ is compressed upward by the fluid beneath it is often heard. If the effusion is on the right side, the apex beat of the heart is apt to be displaced to the left. If it is on the left side, there is obliteration of Traube's semilunar space, Avhich is a spot at about the level of the sixth and seventh ribs anteriorly below the nipple, Avhere there is usually a tympanitic note on percussion. During this stao-e of effusion blisters have been largely used in aiding in the ab- sorption of the liquid Avhich is present. 618 DISEASES. PLEURODYNIA. This condition, being one of intercostal neuralgia, should be treated according to the directions given under the headings of Neuralgia and Counter-irritation. PNEUMONIA. Pneumonia is a term loosely applied to tAvo very different forms of disease—namely, that acute infectious process due to an infection by the micrococcus lanceolatus and called croupous pneumonia, and that form following as a rule some other disease which has exhausted the patient's strength and due in some cases to various forms of infection, namely, catarrhal pneumonia. These tAvo distinct diseases have been confused by the common term pneumonia, and yet are very different conditions as to their pathology and treatment. Croupous Pneumonia. Croupous pneumonia usually attacks the strong and hearty rather than the feeble and exhausted, but both types of cases may be affected. The treatment can be divided, when we study it, into that devoted to the stage of onset, the stage of consolidation, and the stage of ab- sorption of the exudate and convalescence; and it will be governed by the state of the patient's pulse, the sounds of his heart, and his general condition as to strength, as well as the degree of respiratory embarrassment which is present. There can be no routine treatment of croupous pneumonia; each case must be a law to itself, and there is no such thing as the depletant treatment to be advocated on the one hand, or the stimulant treatment to be lauded on the other. Further than this, it must be remembered that as croupous pneumonia is an acute infectious disease the patient may die not from pulmonary consolidation or cardiac distention, but from the malignancy of the infection. One man with an entire lung consolidated may have slight evidences of general infection or toxaemia, another with a small area of lung involved may be overwhelmed by toxaemia within a feAV hours. For this and other reasons we can divide all cases of croupous pneumonia into three groups—those that are doomed to death by the malignancy of the in- fection, those that are but slightly ill by reason of mild infection, and those who between these tAvo extremes of severity need careful medical aid to accomplish recovery. The first class die do what Ave will, the second class get well almost Avithout help, the third need all the help possible to survive. It is to this last class that our treatment must be chiefly directed. In the very earliest stages of the disease occurring in a healthy, sthenic individual Avho has been seized Avith a chill folloAved by fever and a bounding, angry pulse, Avith marked anxiety and nervous excite- ment, it is proper to freely bleed from a vein in the arm to the extent of a pint (see Part III.), or in its stead to use veratrum viride or aco- nite to relax the systemic blood-vessels and " bleed him into his own vessels" by making it easier for the blood to pass into the general PNEUMONIA. 619 arterial system than into the lung Avhich is inflamed. These sedative drugs also quiet the excited heart and prevent it from pumping so much blood into the engorged lung. A hot foot-bath at this time will also tend to relieve thoracic congestion. If veratrum viride or aconite are used they should be given in minim doses of the tincture every half-hour till five or ten doses have been used or until the patient's pulse becomes less angry and his skin becomes moist. Veratrum vir- ide is the best drug of the tAvo for adults. If violent pain in the chest is present it is to be relieved by small doses of morphine or Dover's poAvder. This treatment is devoted to an attempt to limit the degree of inflammatory action as far as possible. It may be aided, if it is thought Avise, by Avet cups over the engorged lung. The depressant treatment of croupous pneumonia is, however, lim- ited in its application to the very beginning of the malady and to those persons avIio have a bounding circulation. It is absolutely contraindi- cated after consolidation has taken place or if the patient is feeble. Because of the fact that its usefulness is confined to this early stage it cannot be employed in many cases, because the physician is not called till after this stage has passed by. Its use in a case with a feeble pulse or in one who is adynamic or feeble is absolutely contraindi- cated. In the majority of cases the physician is called after the consolida- tion has occurred, and he must noAv be a watchman all the time and a therapeutist only Avhen treatment is actually needed. Every man who is suffering from pneumonia does not need active treatment. A cer- tain number of cases get Avell without treatment and do so sooner than if meddlesome therapeutics hinders them. The treatment usually neces- sary is to combat fever, if it becomes excessive, to support the heart if it seems feeble or congested, to keep the kidneys in a state of active secretion, and to see that constipation is relieved. In the treatment of the fever the physician should remember that it is not to be regarded as a dangerous symptom unless it rises to 103° and remains at this point for some hours, for in a febrile disease running a short course fever is not only not harmful, but there is reason to believe that when present to a moderate degree it is actually beneficial.1 When the fever does rise to a point above 103° it should be reduced by spong- ing Avith cold water, active friction being used at the same time. (See Part III., on Cold.) There is absolutely no danger of the patient " taking more cold," although this is generally doubted by the laity. If the fever has a tendency to be excessive and if the heart's action is tumultuous an ice-bag may be placed over the heart, and this will be particularly useful if, as is often the case, there is a tendency to pericar- ditis. If it is desired to apply cold over a greater area of the chest than the prsecordium an ice-jacket may be employed, but it possesses the disadvantage of being a wet application, do what avc will to protect the bedding. This ice-jacket is to be made of cracked ice and sawdust mixed and sewed up tight in an oil-silk covering Avhich is basted to an undershirt to keep its shape. This treatment has been said to greatly 1 See article on " The Role of Fever in the Modification of Disease," in the Thera- peutic Gazette for February, 1896. 620 DISEASES. reduce the inflammatory process in the lung, but of this there are grave doubts. The use of-antipyretic drugs is not good practice. They tend to depress the heart, to relax the blood-vessels, and apparently render the patient more susceptible to his infection. Sponging will generally control the fever if it is properly employed, or, if it fails, then a cold bath may be required if the fever is really very excessive. (See Cold, in Part III.) For the support of the heart we may employ several circulatory stimulants. If the patient is a feeble case with lack of vitality and relaxation of his muscles, then alcohol in the form of a good whiskey or brandy given in Avater after food every three or four hours in the dose of from half an ounce to an ounce is useful. Sometimes more than this must be given, particularly if the patient has been accustomed to the use of the drug. In other cases less is needed. For the laboring heart Avith almost empty arteries no drug compares with digitalis, and if the skin is moist or the blood-vessels relaxed, so that the pulse is gaseous, then belladonna should be combined Avith it. The writer usually gives 5 drops (0.3) of the tincture of digitalis every eight hours, Avith 5 drops (0.3) of tincture of belladonna every four hours. (See Digitalis and Belladonna.) If necessary, both of these drugs may be given in larger dose, but usually these doses are sufficient. If the fever is very high the digitalis will have to be supplanted by the alco- holic stimulants or strychnine for a few doses. The question as to whether the patient's pulse is of the proper strength is one of import- ance : very often the quiet pulse of a patient lying in bed will be taken by the inexperienced as an evidence of true cardiac feebleness, when if the physician feels his OAvn pulse he Avill be surprised to find it no stronger than that of his patient. A feeble apex beat, a feeble second sound at the second right costal cartilage (aortic valve) and an accen- tuated second sound at the second left costal cartilage (pulmonary valve) Avill reveal the fact that active stimulation is needed, for the Aveak apex beat and the soft second (aortic) sound, show that the heart is feeble and the arterial Avails relaxed, and this means a Ioav arterial pressure. Further, the accentuated second sound on the right side indicates pul- monary congestion and a tendency to failure of the right side of the heart from obstruction to the flow of blood in the lungs. Should the action of the heart become labored, the jugular veins distended and pulsating, and the radial pulse Aveak, Avhile the face is cyanotic, then free venesection (Part III.) is to be practised. It will often save an apparently desperate case. Digitalis in the presence of this condition is not rapid enough in its effects. Strychnine should be given in full dose hypodermically, fa-fa of a grain (0.003-0.006). and with it, if the skin is moist or SAveating. fa-§ of a grain of atropine (0.0004), and both these drugs should be repeated in an hour if needed. At the same time it is Avell to give \ drachm (2.0) of aro- matic spirit of ammonia every tAvo hours in cold Avater or 1 drachm (4.0) of Hoffman's anodyne in cold Avater every hour. Oxygen inhala- tions may be used at this time with benefit, particularly if cyanosis is marked. (See Oxygen.) PNEUMONIA. 621 Should crisis come on at this time, active supportant treatment, such as that just described, will be needed. Many patients die in crisis for the Avant of active stimulation. The secretion of the kidneys is best maintained by the use of some alkaline diuretic, such as SAveet spirit of nitre and citrate of potassium, and if necessary a little gin may be given to support the heart and aid in maintaining renal activity. Having detailed this treatment of the second stage, that for the third stage is to be considered. For the thorough understanding of this Ave should remember that this stage consists in the breaking down or resolution of the exudations and in their absorption and expulsion from the chest. At this time the entire diseased area is crowded Avith secretions which have been formed, dead epithelial cells, and all the morbid sub- stances Avhich have accumulated. The local surfaces are depressed by the reaction folloAving 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 Avill soften deposits and stimulate depressed vesicles and bronchial tubes. Bv far the most valuable class of drugs to be here employed are those Avhich will increase the secretion from mucous membranes without acting as cardiac depressants. Under the article on Bronchitis the action of these drugs will be found more thoroughly explained, but it will suffice to point out, at this time, the method of their administra- tion. First and foremost stands the chloride of ammonium, a drug Avhose elimination takes place largely through the lungs, and Avhich acts most happily in aiding in the loosening of the cough and secretions. Its only disadvantage is its salty taste, Avhich in many cases renders it disagreeable to the patient, while its irritant properties may disorder the action of the stomach, although if this organ is depressed and atonic this drug often improves its condition. This drug may be given in compressed pills, or, what is far better, in such a mixture as here follows: R.—Ammonii chloridi............Z\\ (8.0). Extract, glycyrrhiza? fl.........,^ij (8.0). Aquse dest...............*3»j (96.0).—M. g—Teaspoonful (4.0) in water every four hours during the day. If the cough be in excess of the expectoration—that is, if the cough often fa?ls to bring up phlegm and is due to tickling or irrita- tion—it may be relieved by the addition of a little morphine to this mixture, as follows : R.—Morphinae sulph.........gr.j vel gr. ij (0.05-0.1). Ammonii chloridi.......3}i (8.0). Extract, glycyrrhiza? fl......ziv (10.0). Aqu*de?t .........|vj (192.0).-M. S—Dessertspoonful (8.0) every four hours. If much more morphine than this is used, it will tend to stop secretion. 622 DISEASES. When the chloride of ammonium fails to act favorably, the car- bonate maybe 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 folloAving prescription is valuable: R.—Ammonii chloridi....... Ammonii bromidi....... Ammonii carbonat....... Extract, glycyrrhiza? fl..... Aqu;c dest........... S.—Dessertspoonful (8.0) every four hours (For other remedies for this stage see Bronchitis.) Nutritious broths, milk, and, if necessary, predigested foods, should be given with the regularity Avith which medicine would be given from the beginning to the end of the attack. Catarrhal Pneumonia. The main difference in the treatment of Catarrhal Pneumonia in distinction from the treatment of croupous pneumonia lies in the fact that first, last, and all the time the treatment is to be stimulant in its character if any treatment other than rest in bed is resorted to. Catarrhal pneumonia usually arises out of an acute bronchitis or is superimposed upon some exhausting disease which has sapped the vitality. ToAvard its close expectorants are even more useful than in croupous pneumonia, and every care should be taken that the catarrhal process does not pass by insidious degrees into a hidden tuberculosis. All cases in Avhich recovery is abnormally sIoav should be suspected of tubercular infection. 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, gout, or renal disease, or other similar causes. The treatment consists, first, in the removal of the cause, and, next, in 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 waters 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 Aarious constituents, a number of which 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: 33 (4-0). 3J (4-0). 3J (4.0). Siij (12.0). fgvj (192.0).-M. PUERPERAL DISEASES. 623 R. -Acidi carbolici.........f^j vel f.^ij (4.0-8.0). Aquse dest.........q. s. ad Oj (500 cc.).—M. S-—Apply as a lotion several times a day. Or, R.—Liquor carbon, detergen.1 .... f^ij (8.0). Aquse..........q. s. ad 6j(500 cc.).—M. S.—Apply as a lotion. Or an ointment made as follows is serviceable: R-—Acidi carbolici.........gtt. v vel xx (0.3-1.3). Adipis benzoinatus......gj (32.0). Petrolati ...........3J (4.0).—M. S.—Apply as an ointment. In other cases 10 to 20 minims (0.65-1.3) of chloroform may be used in 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 effectiA'ely. 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, and 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 (1.3 : 32.0) of Avater, cocaine having been previously applied to relieve the pain of the application. (See article on Cold.) Brinton has highly recommended poAvdered teucrium scordium in the dose of 20 grains (1.3) three times a day. Allingham has used with advantage a piece of ivory shaped like a rubber nipple and provided Avith a circular shield. This is slipped into the bowel at night and serves to keep the surfaces apart. 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 which 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 which shall denote infection of the genitalia after delivery, a Avord should be coined strictly limited in sense to mean the pathological conditions which result from the activity of pathogenic microbes along the Avhole genital tract. This classification is necessary for a clear and sys- tematic description of the treatment of diseases in the puerperal state. 1 For method of preparing this liquor see article on Eczema. 624 DISEASES. 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 decomposition 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 which infection occurs. Therefore, in any case after labor in Avhich there is fever that cannot be explained by some evi- dent cause independent of the genitalia, it is safe to assume ptomaine 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 Avriter's routine application of this principle in practice is as follows: If the temperature after delivery remains over 100° F. for twenty-four hours without evident cause independent of the genitalia, he Avashes out the uterine cavity Avith at least 1 quart (1 litre) either of bichloride-of-mercury solution, 1 : 2000, or a 2 per cent, solution of creolin. The former is more convenient in private practice, be- cause the tablets of corrosive sublimate can be easily carried about in one's instrument-bag. To ensure the entrance of the antiseptic fluid to the fundus and its free exit from the cervical canal an intra-uterine catheter is desirable. Of all those upon the market, the best is that manufactured by Lentz, an instrument-maker of Philadelphia. If, however, the cervical canal is patulous, as it usually is after labor, a hard-rubber catheter attached to a Davidson's or fountain svringe ansAvers the purpose perfectly. In the majority of cases this treatment will bring the temperature doAvn to normal Avithin twenty-four hours. If fever does not disap- pear within this time or perhaps rises even higher, the second indica- tion must be met. The infected albuminous substance within 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 wall itself from the slightest injury; for not only can the uterine muscle be per- forated by a curette in clumsy hands, but slight Avounds of the uterine substance with this instrument may be enough to inoculate the gen- eral system Avith the germs Avhose acthuty has been confined before to the uterine cavity. The writer's manner of employing this plan of treatment after labor is as folloAvs: The anterior lip of the cervix is seized with a double tenaculum and pulled gently dowmvard; a cleansing uterine 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 upAvard and AvithdraAvn from the cervical canal, a finger in the vagina meet- ing its tip as it emerges in order to help extract any substances which may be caught by and entangled in it. Next the placental forceps is inserted, and an effort made to grasp PUERPERAL DISEASES. 625 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 writer has many temperature charts in his possession which shoAv the success of this treatment Avhen 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 treatment 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 an inflammatory action has begun in the uterine walls or Avithin the tract of the tubes. One of the earliest, 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 Avhich they must Avage Avith the invading micro- organisms. This is best accomplished by the administration of as large a quantity of nutriment as the patient can stand Avithout rebel- lion of the stomach or bowels, and the exhibition of a large quantity of alcoholic stimulant. Cases of this sort not infrequently require more than a pint of Avhiskey 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 Avill recover. There may be some in Avhich metastasis to important organs occurs so early as to render all treatment of no avail. There will be others in Avhich the peri- toneum is early infected, and in Avhich the septic peritonitis develops rapidly and to an extensive degree. It is in such cases that laparot- omy and evacuation of the septic matter, usually pus, Avithin the peri- toneum will occasionally save life. The physician must guard him- self, hoAvever, 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 treatment, even although the evidence of suppuration within the cavity is slight. The Avriter has in mind a case in Avhich an operation Avas performed ten days post-partum for septic peritonitis : a very small quantity of purulent lymph Avas found upon one ovary, which was greatly enlarged and contained a small quantity of sero-pus. The ovary Avas removed and the abdomen closed Avithout drainage, as there Avas no other evidence of suppuration Avithin it. Thirty-six hours later the patient died, and the peritoneal cavity was found filled with pus Avhich had accu- mulated in that short space of time. In the early stages of the peritoneal infection, if the subject is vigorous, not exhausted by a prolonged labor or other depressing causes, the administration of saline purgatives in concentrated solution Avill often effect brilliant results. 40 626 DISEASES. The Avriter'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° F. to normal in the course of tAvelve hours, and with the reduction of temperature all the symptoms of peritonitis, Avhich Avere Avell marked, entirely disappeared. In the treatment of microbic activity along the parturient tract after labor it should never be forgotten that the point by Avhich the microbes invade the system may be anyAvhere from the fundus of the uterus to the parturient outlet; therefore the practitioner should never neglect to examine carefully all the loAver parturient tract, in order to detect, if possible, an ulcerated surface covered by diphtheritic membrane, Avhich if overlooked might be the entrance-point for a fatal infection. These unhealthy surfaces are best detected by the use of a cylindrical speculum of clouded glass introduced so that the cervix appears Avithin its inner end, and then AvithdraAvn, so that the A-aginal mucous membrane as it prolapses into the end of the speculum may be examined, and treated if necessary throughout its Avhole extent. If an unhealthy, ulcerated wound is thus discovered, the Avriter's practice is to apply to it a solu- tion of nitrate of silver 40 or 60 grains to the ounce (2.65 : 32.0). In the vast majority of cases this application will promote an exfolia- tion of the unhealthy membrane and the appearance of healthy gran- ulation tissue Avithin a feAV days. It may, in 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 vesical mucous membrane cells by the pressure and stretching to Avhich they are subjected. After labor, therefore, they are not in a condition to resist the attacks of micro- organisms should these in any Avay gain access to the vesical cavitv. 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 Avithout the intervention of an instrument which would directly carry them into the vesical cavity and deposit them in that situation. Once arrived Avithin the bladder, the microbes attack the depressed bladder-cells, and very often gain a lodgment 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, however, 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 infection of the pelves of the kidneys after the micro-organisms have migrated along the ureters. During their migration their presence has not been manifested by any symptoms. In the majority of cases PUERPERAL DISEASES. 627 even the symptoms of pyelitis w ill disappear after a time, and the patient will make a good recovery ; but in 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 suppuration of the kidneys and surrounding tissue, Avith fatal results, or, as the Avriter 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 sep- tic cystitis after labor, should always be on the watch for it, and should adopt an energetic treatment immediately upon its discovery. 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 | of 1 per cent, solution of creolin. One injection of a quart of this solution through a two-Avay catheter is usually sufficient. Occasion- ally it is necessary to repeat it or to folloAv it by several injections of boric-acid solution. In susceptible individuals creolin causes too much pain to be employed. A 1 : 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 Avill of course be useless. Perhaps the most uncommon point of septic infection after labor is the rectum. The writer has, however, 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 diagnosticate such a case until after death, and therefore treatment directed toAvard this form of infection will usually not be adopted. Next in frequency to the parturient tract and the urinary system as a reo-ion 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 and 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 ^land-substance, and support of the breasts by a suitable mammary binder. To these should be added, in the acute stage of inflammation, fomentations of very hot Avater, and, later, the application of cloths Avrung out in lead-water and laudanum, renewed every three hours. Unless the infection has been of a virulent nature and the amount 628 DISEASES. 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 in- fectious diseases Avhich can, under any circumstances, attack the adult female, and their treatment differs in no respect during the puer- perium from that adopted under ordinary circumstances, unless there should be developed some local complications. Non-infectious Diseases of the Puerperium. Anomalies of Involution.—Superinvention, an exaggeration of that process by Avhich the uterus is reduced to its normal size after labor, only manifests itself, as a rule, after the puerperal state is com- pleted, and therefore its treatment need not be further considered. Subinvolution, an arrested or retarded return of the uterus to its normal condition and dimensions after labor, is one of the commonest complications with Avhich the obstetrician has to deal in the manage- ment of the puerperium. The cause of subinvolution is always a local one. General conditions, as acute fevers and so on, have no influence Avhatever upon the process of involution unless they are accompanied by some local complication. There are tAvo causes Avhich prevent the involution of the uterus Avhich 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 Avhich calls an excessive amount of blood to the uterine body, as, for instance, small fibroids Avithin its Avails or hypertrophied deciduous membrane remaining adherent to its inner surface. On the other hand, subinvolution may be the result of mechanical obstruc- tion to the contraction of the uterine walls and the reduction of the cavity of the uterus to the normal size. As an example of this avc have a retained placenta or a submucous fibroid or adhesions dragging the uterus out of place and preventing its contraction, or, most com- monly perhaps, an over-distended bladder and rectum. In those conditions Avhich 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 medica- tion. If there is an hypertrophied endometrium retained Avithin the uterus, a curette will most quickly and effectually hasten involution. In cases of heart disease in Avhich the blood-current is sluggish and dammed back into the large veins of the trunk digitalis will be the most effective remedy to overcome the subinvolution. There may be an active hyperaemia associated Avith inflammatory action, either in the uterine Avail 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 PUERPERAL DISEASES. 629 of course be removed before one can expect a good result from treat- ment. In the case of retained adherent placenta every effort must be made to remove the placental tissue. In the case of submucous fibroids their removal must be attempted if there is any hope of safely accomplishing 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 Avith the bladder or rectum, in deep granulating Avounds in the vagina, or in ulcerated sores. In the case of fistula a cure can sometimes be effected without operative interference by touching up the edges of the fistulous tract with nitric acid, in order to excite an outpouring of granulation tissue in the hope that it may plug up the opening. In deep tears, which have not been primarily united, application of a solution of nitrate of silver w ill hasten the cure and prevent infection of the Avounded surface. If ulceration occurs, the ulcerated spots are to be carefully Avatched and treated in the same manner. Hemorrhages from the birth-canal after labor depend upon a num- ber of Avell-known causes, Avhich must be sought out and corrected before the bleeding will cease. Most frequently the cause of a hem- orrhage w ill be found in retained placental fragments in utero, which must be removed. Frequently displacements of the uterus will be found as a cause, and correction of the displacement will 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 pos- sible, Avhile an attempt is made to limit the bleeding by the applica- tion of direct cold, preferably by means of a Barnes bag dilated with ice-Avater, which must be removed from time to time in order to allow the lochia to escape. After rupture or incision of these blood-tumors the cavity left behind must be carefully disinfected Avith the bichlo- ride-of-mercury solution or creolin, and, if necessary to control further bleeding, Avell packed Avith iodoform gauze. Of all forms of bleeding, that Avhich occurs directly after labor in consequence of inertia uteri, knoAvn as post-partum hemorrhage, is the most frequent, the most alarming and dangerous in its manifesta- tions and consequences. No one should attend a case of obstetrics without having in mind a clearly-defined programme to be put in immediate execution Avhen called upon to deal with this frequent and dangerous complication. There are two indications to be met: First, to control the hemorrhage, and, second, to treat the after-condition. The first indication is met by the following plan of treatment: 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 Avails is irritated by the move- ments of the operator's fingers. 630 DISEASES. 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 down over the uterine surface. Next, hot water at a temperature of 116° or 120° F. should be injected into the uterine cavity. If one happens to have the necessary appliances at hand (a small Gaiffe battery, which can be carried in an ordinary instrument-bag), a strong faradic current can be applied to the uterine muscle. Finally, as a last resort, the uterine cavity may be packed with long strips of iodoform gauze in the manner suggested by Duhrssen and carried out by a number of observers with gratifying success. Drugs, as the styptic salts of iron, and especially Monsel's solu- tion, have been recommended from time to time as intra-uterine appli- cations in the case of post-partum hemorrhage, but they are dangerous, for the coagulation produced by them may extend far into the uterine vessels, and 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 hemorrhage (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 hemorrhage. 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 controlling the hemorrhage the nurse should administer a hypodermic injection of ether if symptoms of shock or collapse are manifested. After the bleeding has ceased it is well to administer an enema of a pint of hot water, which maintains 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-water, and a little Avarm milk if the stomach will retain it. As soon as reaction is Avell established a half-pint (250 cc.) of hot beef-tea should be administered, and a hypodermic of -^ grain (0.008) of morphine given in order to secure quiet and rest and to get the stimulant qualities Avhich this drug undoubtedly possesses. Occasionally measures must be adopted to retain enough blood within 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 extremities from below upward, in order to secure as large a quantity of blood as possible within the vessels of the trunk and brain. Actual transfusion of a T6T-of-l-per-cent. solution of com- mon salt into the blood-vessels is required when there are profound PUERPERAL DISEASES. 631 exhaustion and depression after hemorrhage. It has been demon- strated that it is not necessary to throw this solution directly into the blood-vessels, as interstitial injection seems to ansAver the pur- pose equally Avell. The milk secretion during the puerperal state presents abnormal- ities Avhich call for treatment. One may have to deal with anomalies of quantity or quality. The most frequent anomaly of quantity in milk secretion is unfortunately one of defect. Insufficient milk-supply depends 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. When the lack of milk is due to some intercurrent affection in the puerperal state the treatment must be directed toward this complication before the milk-supply can be re-established in normal quantity. It may be the consequence of hemorrhages or of diarrhoea, or the result of an acute febrile attack during lactation, or of inflammation Avithin 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 extraordinary 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, hoAvever, has been definitely disproved by careful observations recently 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 diseases interfering with milk secretion described above it should be borne in mind that on the dis- appearance of the abnormal general or local condition milk secretion can be successfullv re-established, even though it be absent for days or Aveeks. 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 in those cases Avhere 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 subse- quent births. This remedy will, hoAvever, often prove ineffective and 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 flow 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 Aoav 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 632 DISEASES. recommended to secure the proper contraction of the sphincter muscles of the lactiferous 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 Avarmly recommended. The remedy should be tried, for its use seems rational. Chloral has been shown to be very effective in diminishing the quantity of milk. This drug, therefore, is worthy of trial. It has recently been declared that antipyrine, in 2^-grain (0.12) 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 diminish the casein, and fat will increase the sugar; a diet rich in meat, especially if reinforced with alcoholic stimulants, w ill increase the fat and casein, but will diminish the sugar. If the mother's milk is evidently disagreeing Avith 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 nursing Avoman, espe- cially Avith a milk diet, Avith the idea Avhich prevails extensively among the laity that the cow's milk poured into the stomach appears again in the mammary gland. It is usually sufficient for a nursing woman to observe the ordinary diet which agrees with her under all circum- stances, Avith the addition perhaps of a half-pint of milk midway between 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 (0.3) of pyrophosphate of iron will be an advantage. There is found in every pregnant Avoman some alteration in the constitution of the blood, which 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 Avatery element. In some cases this change is much exaggerated, until an intense degree of anaemia appears in the puerperal state which, 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 feAV Aveeks. In some cases arsenic alone suc- ceeds 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 noAv knoAvn to justify the following statement: PUERPERA L DISEASES. 633 1. The cell-activity of mother and foetus produces excrementitious substances Avhich will surely prove virulently poisonous to the Avhole organism unless they are voided or made harmless by the excretory organs.1 2. The organs in the childbearing Avoman 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- sibly by direct irritation of the brain-substance. As a result of intense muscular action the circulation is interfered Avith, and blood is determined 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 without 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 hemorrhage, or if the patient is from any cause Aveak and anaemic, bloodletting is not called for. In the ordinary case, hoAv- 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 (0.1) mixed Avith SAveet oil may be placed upon the tongr.e. Directions should at the same time be given to Avring out three or, better, four old blankets in boiling Avater; these are to be Avrapped around the legs, trunk, and arms, and well covered over Avith 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 tin; brain. In this Avay one eliminates the cause of eclamp- tic convulsions as quickly and thoroughly as possible from the blood, directly and indirectly through the skin and bowels. The latter may be acted upon by |- grain of elaterium rubbed up in butter, or by compound jalap poAvder and calomel, instead of resorting to the croton oil. Pilocarpine seemed at one time an ideal remedy to secure diaph- oresis in eclamptic cases, but it has lately fallen into Avell-deserved disrepute. It much increases the danger of pulmonary oedema, and is too profound a depressant. It is no longer employed by experienced 1 Harold C. Ernst, American System of Obstetrics, vol. ii. p. 431. 634 DISEASES. and educated obstetricians. The second indication is best met by an anaesthetic. Usually the convulsion first shoAvs its approach in the eyes : these should be closely Avatched, 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 Avrapped in blankets 1 drachm (4.0) each of chloral and bromide of potassium in starch-Avater 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 their enthusiastic advocates in this connection. They may be held in reserve in case the plan of treatment described needs reinforce- ment. If convulsions come on during labor, the child should be rapidly extracted as soon as the os is Avell dilated, but not before, because efforts to dilate the os would be very apt to increase the convulsions, and would attract the physician's attention from the woman's most threatening danger. Moreover, the os dilates naturally Avith 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 between the teeth a brush-handle wrapped in a handkerchief or by draAving a toAvel into the mouth like a bit. Well-meaning but ign.)- 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 fact that the patient's condition, chiefly as regards temperature, does not have normal intervals, but has periods of only temporary improvement, or, in other words, 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 in the cold stage; 3. The patient, not having periods for complete or partial recovery, rapidly loses strength. The safety of the patient depends upon the use of large doses of quinine to cut short the pyrexial stage, the doses used being from 20 to 30 grains (1.3-2.0), preceded by a good-sized purgative dose of calomel, say 3 to 4 grains (0.15-0.2). If vomiting is too vio- lent to permit of the retention of the quinine, it must be used by the rectum and hypodermically, and the stomach and intestines be swept out by the use of divided doses of Seidlitz powder or citrate or sul- phate of magnesium. If purgatives are used, they should precede the quinine by tAventy minutes, as otherwise the latter drug is swept out into the bowels, Avhere it is rendered useless by reason of its pre- cipitation by the alkaline juices there present. Many clinicians claim RETINITIS—RHEUMATISM, ACUTE ARTICULAR. 635 that remittent fever is chiefly benefited by quinine during the remis- sion, and cinchonism during the pyrexial stage undoubtedly increases the discomfort of the patient. If pyrexia is excessive, relief must be sought in the cold pack and antipyrine. The best treatment of the vomiting is the use of small doses of morphine, or 3- to 5-drop (0.15-0.3) doses of the spirit of chloro- form in from 30 drops to 1 drachm (2.0-4.0) of cherry-laurel water. Aconite may also be used if the patient is strong enough. (See Vomiting.) If the belly is tender, a turpentine stupe should be applied. (See Turpentine.) If intestinal hemorrhages occur, gallic and tannic acids or Mon- sel's salt, in the dose of 3 grains (0.15) in hard pills, may be used, and cold cloths be placed over the belly. (See Hemorrhage.) If haematuria appears, quinine must be avoided unless the neces- sity for its employment is absolute because of the frequent recur- rence of paroxysms. Quinine in some cases increases the haema- turia. (See Collective Investigation by author in Therapeutic Gazette, July, 1892.) The treatment of comralescence consists in the use of tonics, such as quassia, calumba, gentian, Huxham's tincture, arsenic, and purga- tives when needed, with attention to the kidneys, the potassium salts being employed to keep these organs active. (See Intermittent Fever.) RETINITIS. Retinitis, or inflammation of the retina, often associated with cho- roiditis, 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 eve-strain, which is to be relieved by the prolonged use of atro- pine 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 hoAv 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 empiricism, 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 636 DISEASES. to the relief of the pain and of the local manifestations of the dis- ease. When an acute attack of rheumatism comes on, it is nearly ahvays accompanied by a high temperature, a bounding pulse, and all the evi- dences of the active systemic disturbance accompanying inflammatory outbreaks, which, in this particular instance, involve the joints. We may therefore use at such times the remedies which Ave have learned are best able to combat inflammation—namely, aconite and veratrum viride. So powerful are these drugs in the early stages of acute rheumatism that some persons have believed them to be possessed of a specific antirheumatic power. This is, however, highly unlikely, as they act no better here than in other inflammatory conditions else- where. The proper manner in Avhich to use the tincture of aconite under these circumstances, in a strong, healthy individual, is to administer 3 drops (0.15) at once in a little Avater. and follow it by a teaspoonful of a mixture containing 5 drops (0.3) of tincture of aconite and 2 ounces (64.0) of water, every half-hour until perspiration on the skin betokens circulatory depression through the action of the drug. If this is not used, veratrum viride in the same proportions may be given. The advantages 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 sweat. Whenever these drugs are employed the patient must be strong and hearty, not debil- itated or Aveak, and it is to be noted that this treatment is not to be resorted to carelessly. Finally, care is to be taken that the symp- toms 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 depressant drugs, alcoholic stimulants are particularly needed. Simultaneously Avith these internal measures a solution of bicar- bonate of sodium, 20 grains to the ounce (1.3 : 32.0), may be applied to the joints involved, by means of lint Avet Avith this solution, with relief to the sense of heat or burning, or ice-cold compresses may be tried. In other cases relief may be obtained by applying hot cloths saturated Avith the so-called Fuller's lotion—namely, carbonate of sodium 6 drachms (24.0), laudanum 10 ounces (320.0), glycerin 2 ounces (04.0), and water 9 ounces (288.0). Sometimes great relief is obtained by fixation of the joints by means of splints. A most valuable application to the inflamed joints of rheumatism, either during the acute stage or afterward Avhen they remain swollen and enlarged, is: R.—Ichthyol............giv vel 3j (16.0-32.0). Adipis............ |ij (64.6).—M. S.—Rub in well and apply about the inflamed part on lint. In other cases the acute stages of the inflammation mav be com- bated with advantage, particularly where there is gastric disorder, by the local application of salicylic acid made into an ointment with an RHEUMATISM, ACUTE ARTICULAR. 637 animal fat, not vaseline or glycerin, as it is not absorbed Avhen so mixed. According to Bourget, this treatment is best suited to blondes and young persons, as absorption is more rapid in this class of patients. The folloAving salve may be prescribed: R.—Acid, salicylic.............gj (4.0). 01. terebinthin.............hlxxx (2.0). Lanolin................§j (320).—M. High fever is to be controlled by the same measures as the high fever of any other disease—by the cold pack, cold bath, or sponging Avith tepid or cold water, and by antipyretics. 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, acetanilid, or antipyrin. The general opinion of the profession seems to be that these three remedies stand in the order here placed in regard to their efficiency. but it is also true that one will often succeed when the other fails, and it is worthy of note that success or failure generally asserts itself rapidly ; that is, the drug used gives relief in from twenty-four to seventy- two hours or fails altogether. It is most important to remember that salicylic acid only protects the cardiac valves and the entire endocardium from the ravages of the disease by shortening the attack, and not by any direct influence, and in addition that this acid, by reason of the profuse SAveats often produced by it and its tendency to cause cardiac depression, must be watched lest it act unfavorably on the general systemic state. Taking up salicylic acid first, we find that its proper 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 Avay that Ave use quinine on the advent of a malarial parox- ysm—namely, in full dose. It is useless to give salicylates in 5- or 10-grain (0.3-0.65) doses three times a day ; they must be given in 20-grain (1-3) doses, morn- ing, noon, and night, or oftener, or not at all. If the sweats are too severe or the stomach rebels, they may be stopped, but not decreased in amount unless for good reason. Further than this, if salicylic acid is used for tAvo or three days in this Avay, 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. (See article on Salicylic Acid.) A very efficient substitute for salicylic acid is the oil of gaultheria (wintergreen), Avhich contains over 90 per cent, of salicylate of methyl. The dose should be 10 to 20 drops (0.65-1.3) on a teaspoonful of sugar or in capsule or emulsion three times a day, after meals. (See article on Gaultheria.) Antipyrin and acetanilid may both be considered together, since their action is identical in rheumatism. The author believes that antipyrin, while often relieving the pain more than the acetanilid, nevertheless does not act so favorably in decreasing the duration of the disease. The dose of the first should be 5 to 10 grains (0.3-0.65) 638 DISEASES. three times a day; of the second, 4 to 8 grains (0.2-0.6) at the same intervals. The studies of Guttmann Avith acetanilid 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 cases which had refused to yield to the iodides and salicylates, although all of these cases Avere of the severe 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 antipyrin or acetanilid may do good in a case of rheumatism in three entirely separate and distinct Avays, any one of Avhich 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 power must be of value under such circum- stances, because of the loAvering of the fever Avhich folloAvs its admin- istration, Avith the resulting quieting of an excited system, and in putting aside the delirium associated Avith a condition of hyperpy- rexia. Not only does such a drug act favorably in this manner, but the analgesic effects of such a substance must exert a poAverful influ- ence for good. By benumbing the sensibility of the patient to the excruciating pain consequent upon movement, and so putting aside the nervous Avear and tear of sleeplessness and suffering, the patient's state must be improved, or at least not gixnv Avorse from the exhaus- tion of the long hours of agony. Further than this, it Avould seem probable that acetanilid possesses a direct antirheumatic influence, allaying the disease-processes even in those forms where, pain being largely absent, the improvement must be real and not apparent. The intention of the author is not to extol the value of acetanilid and antipyrin in rheumatism to the exclusion of other means of re- lief, nor to recommend their use before the more thoroughly tried sali- cylates and iodides, but to draAv to their standard a certain number of cases Avhich persistently resist treatment of the ordinary stamp, and Avhich put the physician to his Avit's end for a change of treatment at least promising some chance of relief. Many of the readers of this book have doubtless seen such cases, and many of them must havre learned by sad experience that acute articular rheumatism is in many cases bound to run a course of so many Aveeks or days, do Avhat we will. Under these circumstances nothing acts further than a pal- liative, and the patient and his friends become impatient for a change. The author has found that acetanilid in such cases will often relieve the pain, and so permit a refreshing sleep, in doses of from 4 to 8 grains (0.2—0.6) three times a day, and that these amounts do not cause the excessive SAveating which the necessarily large doses of salicylate are sure to produce—SAveats which leave the patient often- times almost dyspnoeic from very Aveakness. Whether this temporary relief produces such changes in the system as to permit of a better battle against the disease, or Avhether it actually counteracts the rheu- matic poison, Ave know not; but Ave do know that after the use of ace- tanilid the relief is not only temporary, but often permanent, and RHEUMATISM, ACUTE ARTICULAR. 639 that a very distinct step in advance is made toward the close of the attack if any influence at all is felt. The following prescription, which is of additional value because the caffeine supports the heart and increases urinary secretion, is recommended: R.—Acetanilid..............gr. xl (2.6). Caftein................gr. xx (1.3). Camphor, monobromat.........gr. xx (1.3).—M. Ft. in capsul. vel pil. Xo. xx. S.—One every three hours or three times a day. Phenacetin is often very useful Avhen used in rheumatism, partic- ularly if combined with salol. Passing from Avhat 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 Avhere the first group fail because the disease is obsti- nate. Of these the chief is the iodide of potassium, folloAved by the acetate, bicarbonate, and citrate of potassium. If the iodide is used, the folloAving prescription is of service: R— Potassii iodidi ...•■•.......3j (32.0). Syr. sarsaparilla? comp.........fijvj (192.0).—M. S.—Dessertspoonful (8.0) 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 (1.3-2.0) of the bicarbonate of potassium may be taken every four or five hours in water flavored Avith cinnamon 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 folloAvs : R.— Potassii iodidi.......3j vel gij (32.0-64.0). Vini colchici radicis.....f^ij vel ft^ss (8.0-16.0). Syr. sarsaparilla' comp. . q. s. ad f^vj vel f^xij (192.0-384.0).—M. S.—Dessertspoonful (8.0) three times a day, after meals. 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 sub- stance to be changed into a soluble form ready for elimination. The other drugs used in acute rheumatism are numerous, but only a few of them deserve attention here. There is abundant evidence on record that full doses (10 to 30 drops [0.65-2.0]), of the fluid extract of cimicifuga if given every five hours will decrease the red- ness and pain of the joints and shorten the attack in some cases. Again, certain species of rhus, as rhus toxicodendron, are useful if fresh preparations are at hand. The dose of rhus toxicodendron is 640 DISEASES. fa to 1 drop (0.006-0.05) of a tincture made by adding 1 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 Avith tincture of iodine if blis- ters are not used, and in the application of veratrine ointment or iodine ointment around the joint. (See Veratrina.) Salol, Avhich 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 Avorthy 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 and Salophen.) RHEUMATISM (CHRONIC). Chronic rheumatism is one of the most difficult and obstinate dis- eases Avith Avhich Ave have to deal. In some cases the acute form just considered merges slowdy 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- tism is somewhat 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 and colchicum, so that in the majority of instances the pre- scription of iodide, sarsaparilla, and colchicum given in the article on Acute Rheumatism is indicated. When anaemia or weakness is pres- ent, cod-liver oil is often of great service, and it is Avorthy of note that this useful nutritive remedy was first brought into therapeutics by the fishwives of Holland, Avho found it useful in the attacks of rheu- matism to which their husbands were subjected through exposure. When the oil is thoroughly rubbed into chronically-inflamed joints it is almost 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, and Cold.) Liniments are always called for, for two reasons: First, they relieve pain and do good to the parts, if not from their medicinal properties at least by the rubbing which accom- panies their application: second, because they give the patient some- RHE UMA TISM, CHR ONIC. 641 thing to do or to have done, and therefore impress him Avith the object-lesson that his attendants are attendant and alive to his suffer- ing and need of sympathy and care. Among the loAver classes the belief in liniments is very Avidespread, and their use Avill often instil into the minds of the friends a far greater confidence than the most logical of treatments with the lini- ment left out of the list of remedial measures. The folloAving liniments will be found very useful under these circumstances: R— Tr. aconiti...........f^ij (8.0). Tr. opii............f'*j (32.0). Olei terebinthina?........f|j vel f^ij (32.0-64.0). Linimenti saponis . . . . q. s. ad f.$viij (256.0).—M. S.—Poison. Use as a liniment three times a daw Or, R.—Aquse ammonia? fort.......f^iv (16.0). Olei cajuputi.........fzj (4.0). Tr. belladonna?.........f%j vel f|ij (32.0-64.0). Linimenti camphora? . . q. s. ad f^viij (256.0).—M. S.—Poison. Use as a liniment. 0 R.—Tr. opii Tr. aconit. J-.....aa fjiv (16.0). Aqua? ammon. fort. Linimenti chloroformi.....f^vj (192.0).—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: R.—Veratrina?...........gr. xxx (1.6). Hydrargyri iodidi flav. '.....,^j (4.0). Petrolati...........gij (04.0).—M. S.—Use as an ointment over the joints. This ointment ought not to be Avidely distributed, and the pulse and respiration should be Avatched, 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 dis- ease, and accompanied in some cases by pain, the following ointment is serviceable: R.—Unguent, iodi.........|j (32.0). Adipis............^iv vel gj (16.0-32.0).—M. S.—Apply locally. Or, still better, R.—Ichthyol............ziv to |j (16.0-32.0). Adipis............Jj (32.0).—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 white flannel, and it is never beneficially "medi- 41 612 DISEASES. cated," as claimed in the stores. The only advantage of reel flannel is that, as it is dyed, the avooI is often better for not being thoroughly bleached, and is in larger amount. The disadvantages of red flannel are that if the patient SAveats it stains the clothes, and 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, Avith corresponding enlargement of the organic portion of the bone, or, in other words, the cartilaginous parts. Generally the term is applied solely to designate bony troubles, but every practising physician sees cases where the manifestations of rickets are empha- sized 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 partly because the stomach cannot secrete properly-formed juices from imperfectly-nourished glands. 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, and iron, Avhile the digestive tonics are the simple bitters, physostigma, and mineral acids. The bone tonics and stim- ulants are lime salts, phosphorus, and phosphate of zinc. Tonic treatment is best carried out in young children by the admin- istration of quinine in the form of quinine chocolates or by the use of strychnine in the dose of -^hi to TFo °f a grain (0.0003-0.0006) in sugar-coated pink granules. Arsenite of copper in the dose of fas of a grain (0.0006) in tablet triturate three times a day is also useful. A very useful preparation is the following: R— Olei morrhua?............f^vj (24.0). Svr. calcis lactophosphat. 1 _. „... ._„ .. ,, Liquor calcis }.....aa fgnj (96.0).-M. S.—i- to 1 teaspoonful (2.0-4.0) two or three times a day. Shake thoroughly. Nux vomica is so bitter as to be difficult of administration to young children, and when given only \ to \ of a drop (0.008-0.016) 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 SCARLET FEVER. 643 to 1 drop (0.006-0.05) 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 (0.15-1.5). Aqua> dest.......q. s. ad f$iij (96.0).—M. S.—Teaspoonful (4.0) every four or five hours during the day. Or, R.—Svrupi ferri iodidi..........gtt. v vel xx (0.3-1.3). Syrupi..........q. s. ad f$iij (96.0).—M. S.—Teaspoonful (4.0) three times a day, after meals. Here, again, arsenite of copper is a particularly valuable remedy. The salts of lime and sodium are of direct benefit to the bones, forming by their presence in health a large proportion of the osseous system, and therefore they may be considered as foods rather than drugs. Very often their administration to nursing mothers or preg- nant women saves the maternal teeth from caries and preserves the general health of the mother and child. The following prescription may be used: R.—Syrupi calcis lactophosphatis......fjiv (128.0). S.—J to 1 teaspoonful (2.0-4.0) three times a day, after meals. The reasons for the use of phosphorus are clear, from what has been said of that drug Avhen speaking of it elsewhere in this book, as it acts as a direct and powerful stimulant of bone-growTth. Phosphorus is best given to children in the form of very small sugar-coated pills (fa-$ gr. [0.0003]), such as are put up in the form knoAvn as '• pink granules " by manufacturing chemists. Phosphate of lime and phosphate of sodium are valuable remedies in rhachitis. They are never to be used in large doses, because they Avill not be assimilated and will only disorder the stomach. The proper dose of each is 1 to 2 grains (0.05-0.1), placed in the milk, Avhere their presence vs ill not be noted. The ventilation of the rooms where 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 Avhiskey, 1 drachm (4.0) of salt to a pint of Avhiskey, is of still greater service. Special attention should be paid to the development of the mus- cles by massage and passive movements, as these parts are ahvays Aveak. Walking must not be alloAved too early, as it may cause bony deformities. SCARLET FEVER. This disease, the most fatal of all the exanthematous diseases of childhood, requires the greatest care in its treatment. Complica- tions constantly arise requiring skill on the part of the attendant, and it is upon his success in treating these outbreaks, as well 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, Avhich they have used, act as abortifacients of the attack, decreasing its severity, its duration, and the probability of 644 DISEASES. complications. Thus, one European physician has used salicylates with wonderful results, if his claims are true, for he found them to prevent all complications and even to remove them when present. He gives, throughout the entire attack and for some days after defer- vescence has ensued, the following: R— Sodii salicylat.............gr. xlviij (3.0). Aqua? destillat.........■ • ■ • ftd (?.0)., ,, Svr. aurantii..........q. s. ad ffiij (96.0).—M. S—Teaspoonful '(4.0) every hour during the day and every two or three hours at night, in a little water. In this country J. C. Wilson has employed chloral throughout the entire attack, with asserted good results, in the following manner; but in the opinion of the author this method is not the best for most cases, unless the nervous manifestations are very marked, Avhen the chloral treatment 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 and 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 tAvo or three years a dose of from 1 to 2 grains (0.05-0.1) may be given, the dosage being grad- ually increased Avith older children, that for adolescents reaching 5 grains (0.3). 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 Avhich are so distressing in the well-developed forms of the 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 Avhich 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 Avhole 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 mus- cular 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 favor- ablv 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. Its acrid after-taste is best masked by its administra- tion in Aubergier's syrup of lactucarium, diluted, thus: R.—Chloralis............gr. xxx (2.0). ^up.lactucarii(Aubergier)| _ _ fgss vel f^ (16.0_32.0).-M. S.—A teaspoonful (4.0) in iced water every two, three, or four hours. SCARLET FEVER. 645 " 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 Avith plenty of pure water, and, if possible, this Avater should be obtained from a spring contain- ing a Ioav percentage of solids, as Poland Avater, Avhich is Avidely 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 or distilled Avater. This makes an effervescing draught Avhich may be taken Avhile bubbling or not as the child desires. The object of this treatment is to flush out the kidneys, and to so 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 poison- ous and irritating poAvers. In other cases a prescription containing SAveet spirit of nitre and citrate of potassium proves useful, as folloAvs: R—Spt. a?ther. nitros............fSj (32.0). Potassii citratis............^ij (8.0). Aqua-.............q. s. ad fgvj (192.0).— M. S.—Teaspoonful (4.0) every two hours if the urine is high-colored. The convulsions Avhich sometimes usher in an attack are to be treated by 5-grain (0.3) doses of chloral and 10 to 20 grains (0.65-1.3) of bromide of sodium for a child of five to eight years. The convul- sions of the advanced stages are often uraemic, and must be treated accordingly. 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 toAvard making the pathAvay to health smooth and free from pitfalls and obstructions. Probably the most common complications calling for treatment, Avhen the kidneys have been treated in the way just spoken of, are hiorh temperature or fever, and sore throat or angina. The fever is to be controlled in these cases in precisely the same Avay that it is in all other conditions in Avhich it is present. It is best to attempt to keep it down beloAv 101°, or at least beloAv 102° F., by tepid spong- ing, which also allays the itching of the skin, or, if the fever still rises, by the use of colder water, or even the cold pack if the parents will alloAv it. Generally the popular fear that the application of cold to the surface will drive the eruption "inward" is so strong as to make the cold pack objectionable in the eyes of the friends; but if the temperature reaches 105° F., the physician must assert the fallacy of this belief and insist on its use. (See Cold, Part III.) If sup- pression of the rash does occur, we must use the wet pack. (See Heat, Part III.) Antipyrin and acetanilid, to be sure, may both be used, but it is Avorthy of note that each of these may produce collapse or other complication if large doses are necessitated by an obstinately 646 DISEASES. high temperature. If these complications ensue, alcohol will be indi- cated. 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 particu- larly hot and the fever is high, an ice-bag or a head-coil of rubber tubing is to be employed, and through the latter water may be circu- lated at Avhatever temperature is thought best. (See Cold, Part III.) 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 an 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 Avetting of the clothes by the condensation of moisture on the surface of the bag. This treatment should be used during the entire attack if needed, and the contents of the bag reneAved 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 SAvelling 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, OAving to its irri- tant effects upon the kidneys and stomach and its general influence on the blood. In some cases Avhere the eruption fades or is never very prominent 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 while the body is enveloped in the blanket. (See Heat.) This often brings out in an hour or tAvo a bright scarlet rash, and the child falls asleep and wakes up free from delirium and high fever. The itching and burning of the skin in many cases of scarlet fever are annoying symptoms, and they may become really dangerous. The author has recently carried out a series of experiments shoAving that fever of high degree can be brought on solely through nervous irri- tation, thus explaining a fact long Avell known to clinicians—nam el v, that the relief of this dermal irritation in scarlet fever mav be fol- lowed by a fall of temperature. To relieve this symptom it will often be found advisable to cover the entire skin with a thin layer of vase- line or cosmoline or benzoated lard, or, in other cases, as an antisep- tic and local anaesthetic, carbolized oil may be applied (2 drops of carbolic acid to each 2 ounces [0.1 : 64.0] of olive oil). In other cases almond oil should be used. If nephritis comes on and 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 remove dropsy, and to aid in the removal of effete matter by producing catharsis. SAveating may also be produced by the employment of heat obtained by the use of bottles of hot Avater or hot bricks placed about the patient, Avho is first wrapped in blankets, so arranged that sweating will come on, and SCIATICA. 647 so that the bottles cannot burn the skin. The thermometer must be placed in the mouth to foretell any danger from heat-stroke if the SAveat 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 is useful, Avhile 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 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 writer Avas one in which a stout man weighing about tAvo hundred and fifty pounds acted as "coupler" on a sAvitching engine, and, though Avonderfully agile for his Aveight, provoked the disease in the leg on Avhich he always first struck the ground Avhen jumping from the platform of the moving locomotive. The treatment for all cases is both internal and external. The internal 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 (3.0) 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 antipyrin or acetanilid may be used. The local treatment of sciatica is quite various. One of the favor- ite methods is to inject deeply into the flesh, just over or about the exit of the nerve from the pelvis, 10 to 20 minims (0.65-1.3) of chlo- roform, or instead of the chloroform |- to \ grain (0.01-0.016) of mor- phine, in 30 minims (2.0) of water Avhich has first been distilled and sterilized, may be used with equally good results and less danger of sloughing. Other physicians prefer acupuncture, the needle being driven doAvn 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 Avith a little ichthyol ointment or lard, to pass the end of the rod back and forth over the tender area, using as much pressure as can be borne. By this means massage or pressure on the nerve is accomplished. In other cases the daily use of an ether or rhigolene spray over the part is effective, or kataphoresis may be resorted to. In still others, from three to five large wet or dry cups, preferably the wet, may be placed 64 s DISEASES. along the course of the sciatic nerve Avith great advantage. In many cases absolute rest of the limb, obtained by placing it in splints, has to be adhered to before cure can be possible. IIot-Avater bags should be placed continually about the exit of the sciatic nerve from the pelvis. 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. SCLERITIS. Scleritis, or inflammation of the sclera, consists in a bluish-red, someAvhat elevated patch, Avith 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 Avater; later, the infiltration may be subdued Avith yelloAv-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, Avithout iritis, Avhich does not yield to these measures, eserine, usually accompanied by pilocarpine SAveats, should be tried, and even the actual cautery has been recommended. The disease in many instances is associated Avith rheumatism, syphilis, scrofula, anaemia, and menstrual disorders: these must ahvays 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 seaside, 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, and 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 someAvhat 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 shoAvn at first, a liking for it rapidly develops, so that the Avriter has seen chil- dren cry for it Avhen the oil Avas discontinued. It is nearly ahvavs best to combine the lactophosphates or the hypophosphites Avith the oil Avhen it is given in these cases. Whenever anaemia is present, syrup of the iodide (4'iron is useful in from 1- to 10-drop (0.05-0.65) doses, according to the age of the child, as follows: R— Syrupi ferri iodidi..........f^ss vel f#j (2.0-8.0). Aqua? dest...........q. s. ad f^iij (96.6).—M. S-—Teaspoonful (4.0) in water three times a day, after meals, to a child of one year. SCURVY. 64(J In these same cases -g^ grain (0.001) of arsenous acid or y^ grain (0.0000) of corrosive sublimate may be given to a child of three or four years, in the form of tablet triturates, or the folloAving pre- scriptions may be used: R.—Liquor potassii arsenitis........tt\,xvj (1.0). Aqua? destillat.............fgij (64.0).—M. S.—Teaspoonful (4.0) three times a dav, after food. Or, R.—Hvdrarg. chlor. corros. . . gr. TV vel gr. \ (0.006-0.012). Aqua? destillat.......f~ij (64.0).—M. S.—Teaspoonful (4.0) every five hours, after food. The use of the iodides is generally contraindicated in those cases where softening and breaking down of the glands are going on rap- idly. In their place Ave may employ the phosphates of lime or sodium in from 1- to 2-grain (0.05-0.1) doses several times a day, and if sup- puration is active the sulphurate of calcium, given by placing 1 grain (0.05) of it in half a tumblerful of water and giving a teaspoonful hourly. This mixture should be made fresh every day to prevent its becoming oxidized. Where enlargement of the cervical glands takes place, iodine ointment, diluted, one-half of lard, should be Avell rubbed into the part tAvice daily, but it should be stopped at once if any signs of softening or fluctuation appear or if the skin becomes reddened. In cases in Avhich these enlargements are persistent, ichthyol ointment is to be rubbed in, using the folloAving formula: R.—Ichthyol.............#j vel iij (8.0-12.0). Adipis.............3j (32.0).—M. S.—Apply locally. If this is not folloAved by a cure, the glands should be excised or scraped and the cavity packed Avith iodoform, as in the majority of cases these enlargements will be found to be distinctly tuberculous. (See Adenitis.) SCURVY. Scorbutus is caused so frequently by dietetic 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 Avhat they may, Avhich have caused the disease in 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 away is devoid of any evil influence, and may be cooled and SAveetened 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. 650 DISEASES. By far the more common form of scurvy is seen in bottle-fed babies. The child may or may not have rachitic manifestations. Generally it loses animation, becomes listless and peevish, evidently suffers pain in its body and limbs Avhen it is lifted from the bed, and looks feeble and wan. The gums become spongy and SAvollen and have an ecchy- motic appearance, and light Woavs produce bruises out of proportion to the severity of the injury. The treatment of infantile scurvy is a complete rearrangement of the child's diet-list, and varying its food. No one baby food should be used to the exclusion of another, and sterilized milk is to be supplanted, if possible, by fresh neAv milk. 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 Ave may understand the methods indicated. Every physiologist recognizes the fact that the body, particularly in its most vital parts, is controlled by inhibi- tory and accelerator nerves or nerve-cells, which govern the functions of all organs. Normally these two forces of inhibition and acceleration act in such away as to be perfectly balanced, but abnormally they may either of them become excessive and overcome the other. Further than this, Ave must remember that all conditions of great functional activity are ultimately folloAved by a reaction Avhich amounts to depression or exhaustion. Shock consists in an over-stimulation of the inhibitory apparatus which governs the heart and respiration, ultimately folio ay ed. by ex- haustion of inhibition, so that the pulse and breathing become rapid and shallow instead of sIoav. Various degrees of shock can be readily recognized, and the severity of the condition ahvays depends upon the constitution of the individual. Every one has heard a nervous Avoman say, "You frightened me so that my heart stood still," and again, a moment later, "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 raihvay 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 knoAV that a violent blow upon the belly-Avail just over the solar plexus will 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 in this region. This period of inhibitory excitement 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 blood-vessels are relaxed and the normal resistance to the heart is taken away. The heat beats wildly and fast for the same reason that a locomotive's Avheels fly round Avhen the track is slippery—or, in other words, nor- mal resistance is lost. SMALLPOX. 651 The capillaries in this 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 (0.001-0.0012) of sulphate of atropine hypodermically, and the application of external heat to main- tain the bodily temperature, the fall of which is a factor of great importance, but generally 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 Avill 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 sedative to it. This is, hoAvever, a comparatively un- important fact, for it is another action of atropine which makes it valuable. If the vagus be very much stimulated, a safe dose of atro- pine cannot quiet it, but in the second stage, which we most com- monly have to treat, a safe dose does not act so much upon the vagus as upon the A'asomotor system, and by preventing the dilatation of the blood-vessels of the body thereby provides blood-paths of normal tone and tenseness, Avhich do not hold all the blood in stagnant pools where 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 powerful vasomotor and cardiac influence. 20 drops (1.3) 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, Part III.) In many cases of surgical shock hypodermoclysis of hot saline solutions is of the greatest value, particularly if much blood has been lost. (See Hypodermoclysis, Part III.) SMALLPOX. The treatment of smallpox is not specific, simply because it is one of those diseases which run a given course and which we cannot abort. We can only treat the various symptoms Avhich present them- selves, and by the modification of these manifestations prevent com- plications 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 con- taining tincture of aconite, spirit of nitre, and spirit of Mindererus (liquor ammonii acetatis), while the headache or backache may be con- trolled by small doses of antipyrin or acetanilid. Mustard plasters are not to be used for the backache, as the dermal irritation will increase the eruption. Insomnia and restlessness, if excessive, are to be quieted 652 DISEASES. 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 remem- bered that the time of onset of the secondary fever, the eighth day, is one of grave import to the patient. Before its arrival the treat- ment of the case must be so managed that strength is saved for this strain, and tincture of the chloride of iron, in 5- to 10- (0.3-0.65) el- even 20-drop (1.3) doses, may be resorted to to give strength to the patient and to affect specifically the pyaemic fever. The pulse should be Avatched, and if it flags brandy and Avhiskey should be freely but wisely used. At the same time nourishment in the shape of eggnog, 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 every means in our power, particular care being taken to prevent its development on the face. One of the means Avhich 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 heaAry 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 in most cases, 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 : 100) is useful to check irritation. 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 insects 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 application of ordinary or flexible collodion may be made, which is improved in its action by the addition of 1 part of mercury bichlo- ride to 1000 of the collodion, or, if preferred, salicylic acid may be added in the proportion of 5 grains to the ounce (0.3 : 32.0). Some- times a solution of carbolic acid, 1: 100 or 1: 50, Avhen sponged over the parts exposed, not only relieves the itching of mosquito-bites, but keeps aAvay the mosquitoes. In other instances the stings are relieved and cooled by the use of dilute or pure vinegar. In snake-bite the best treatment is that introduced by Weir Mitchell and Reichert—namely, the local application of perman- ganate of potassium to the part, Avhich should be thoroughly filled with the drug, and full doses given hypodermically about the Avound, the salt being diluted three-fourths with water and followed by full STOMATITIS. 653 doses of alcohol by the mouth. The secret of successful treatment consists, hoAvever, in the use of a ligature or a cleansing of the Avound as soon after its reception as possible, thereby preventing the absorp- tion 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 Avhich some- times have a reddened zone around them, and Avhich result in minute or large ulcers. The best treatment, if the kidneys are not acutely inflamed, is the use of the folloAving prescription, Avhich largely depends for its value upon the potassium salt used: R.—Potassii chlorat...........3j (4.0). Tinct. mvrrh............gtt xx (1.3). Elixir calisaya?...........f^iij (96.0). —M. S.—Teaspoonful in water every four hours. As the chlorate of potassium is eliminated Avith the saliva, it not only does good Avhen taken into the mouth, but is active all the time 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 Avhich is very efficient in stomatitis is borax, used as a mouth-Avash, in the strength of 10 to 15 grains to 1 ounce (0.65-1.0 : 32.0) of water and honey, as follows: R.—Sodii horatis ...........gr. xxx (2.0). Mel. purificati...........f.^iij (12.0). Aqua?............q. s. ad fgiij (96.0).—M. S.—To be used on a swab or as a mouth-wash overy four hours. This also may be used internally in adults. In many cases peroxide of hydrogen in the proportion of 1 ounce (32.0) of a 15-volume solution to 8 ounces (256.0) of water proves a valuable mouth-Avash. If the liver is at fault and is torpid, nitromuriatic acid is useful, and Avhen the spots do not readily yield to treatment they may be touched Avith the tip of a stick of silver nitrate, Avhich treatment, while it is momentarily painful, is very efficacious. Nearly always with this disease in childhood there is considerable fever, vomiting, and wakefulness at night, with fretfulness and 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 washed with boric- acid solution after each nursing. A Avarm foot-bath at night is often 654 DISEASES. necessary to produce rest, and 10 drops (0.65) 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 (0.05-0.65), according to age, three times a day, is of service, and may be added to the mixtures already named, or, better still, given alone, well diluted Avith syrup and Avater. After the attack 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 (2 grains to 1 ounce [0.1: 32.0]), by painting the surface Avith an ethereal solution of collodion, or, according to Abadie, by the application of a saturated solution of boric acid. Pain may be alleviated Avith 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 ill health, that tonics are indicated, and that they most fre- quently 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 affec- tion produced by exposure of the body to any form of high tempera- ture, 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 excessive 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 knoAvn as heat- exhaustion. The condition of thermic fever is very frequently seen, Avhile 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 col- lapse due to a general failure of vital poAver and the chilling of the body. In heat-exhaustion, too, the vascular system is greatly relaxed and depressed, and the circulation is at its loAvest ebb. The treatment of these two states is, of course, radically different. SUNSTROKE. 655 When a patient has thermic fever and is brought under the care of the physician, the first thing to be done is to loosen the clothing—if possible, remove it—and if the pulse be bounding, the face cyanotic, and the heart laboring, to freely bleed him. At the same time cold should be applied 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 with a rubber blanket, and ice-Avater 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 sur- face. Care should be taken that the temperature, Avhen it once begins to fall, does not drop suddenly beloAv the normal and cause collapse. If the clinical thermometer in tha mouth or rectum shoAvs that the temperature has fallen to 100.5° F. or 101° F., the cold application should be stopped, and the patient alloAved to lie on the bed covered only Avith a thin sheet. The bodily temperature must be constantly 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 mechanism of heat-production and dissipation, or to the fact that, Avhile the surface of the body is cooled by the ice, the innermost viscera are still in high fever and rapidly heat the surface as soon as the ice is taken aAvay. Antipyretics'have been found to be almost useless in the hyperpyrexia of sunstroke, and 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 menin- gitis to develop, accompanied, it may be, by little or no fever, but characterized by violent darting headache, which is made worse on lying down or on sudden movement. The treatment of this state must5 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 prominent veins in the arm. (See Venesection.) _ Sometimes a violent attack of epistaxis saves the man's life, when it would have been lost through the ignorance of his attendant. If life is preserved Avithout 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 contraindicated under these circumstances, because of the congestion of the meninges to which they predispose by their physiological effcts. The treatment of heat-exhaustion consists in the use of heat instead of cold, in order to restore the bodily temperature. Just here, how- ever 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-exhaus- tion since a rectal thermometer may show the central or real tem- perature of the body to be in a condition of hyperpyrexia. Of course 656 DISEASES. 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 placing the patient in a bath at 105° to 110° F., 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 Avatched, 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 sIoav to convalesce, and require tonics and careful Avatching for a long time. Indeed, in many instances the system seems to receive a shock from which it takes several Aveeks or months or 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 Avell proved to possess the poAver of distinctly counteracting the effects of the disease. In regard to the method of administration and the period of the disease in Avhich any or all of these drugs can be given to the best advantage there is a Avide diversity of opinion. FolloAving the teach- ing 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 followed 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 manifestations 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 the addition of mercury if necessary. Against this treatment, hoAvever, 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 prog- ress to spontaneous cure, and that the secondary eruption in such cases disappears in from two 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 admin- istered. We have, then, three methods of treatment proposed, each advo- cated by a formidable array of authorities : 1. The expectant treatment. SYPHILIS. 657 2. The treatment by iodides, folloAved, if necessary, by mercury. 3. The continued treatment, beginning Avith mercury and ending with iodides or the combination of the two drugs. By the expectant treatment is implied abstinence from all medica- tion intended to directly counteract the syphilitic virus : if possible the patient should lead an active, out-of-door life, the diet should be mos" carefully regulated, and the treatment should be purely symp- tomatic, tonics being administered Avhen required, the sore throat being combated by astringent gargles, particularly those containing chlorate of potassium or malic acid, together Avith direct local appli- cations, Avhile the eruption on the exposed parts of the body is con- trolled by the application of heat. Even in the mildest cases there is nothing to be said in favor of this treatment. Where the primary lesion is large and persistent; Avhere the period of secondary incuba- tion is less than seven Aveeks ; Avhere the papular eruption is uni- versal, is confluent, and is accompanied by the simultaneous appear- ance of mucous patches ; Avhere the lymphatic enlargement is very marked and persistent; and Avhere the disease attacks a depraved con- stitution,—the expectant plan offers little hope of accomplishing a cure. Here the second and third methods of treatment are absolutely 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 Avith the administration of 5 grains (0.3) three times a day, and in- creasing steadily 5 grains (0.3) 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 Avhich, if the syphilitic lesions are not favorably modified, inunctions of mercury are employed. a drachm (4.0) of mercurial ointment being rubbed in every other day. The iodide should be continued for from six to tAvelve months after the disappearance of all symptoms, relapses being combated by tem- porarily 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 tAvo 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 Avas surely syphilitic. Many surgeons begin this treatment from the time that the inguinal glands on both sides become characteristic in shape and size. Others wait until there is general lymphatic involvement, 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 mercury with chalk represent the forms usually employed when the drug is administered by the stomach. Of these the protiodide is to be preferred, and the 42 658 DISEASES. effort of the surgeon is directed first toAvard determining Avhat is termed the "tonic" dose. With this end in vieAv, j grain (0.016) 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 meaiiAvhile carefully watched. The drug usually manifests its physiological effects by griping pains accompanied by tAvo or more Avatery passages from the boAvels, or by foetid breath and slight ten- derness of the gums. The quantity taken to produce this effect represents the extreme limit to Avhich 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 Avhich 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 Avith this dose for eighteen months. If during this time local symptoms appear which show 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 this case the breath and the mouth will shoAv Avhen the full effect of the medicine is obtained. Manifestations of the disease occurring during mercuric treatment must receive local treatment. The surface eruption is combated by mercuric ointments and Avashes 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 mercury. When these patches occur about the genitals, Avashing Avith 1 : 2000 bichloride solution and dusting Avith calomel and bismuth will 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 (0.010) doses of calomel, repeated overy two hours. The periostitis yields most read- ily to gentle, long-continued mercuric inunction, supplemented by the application of pressure bandages. When the integrity of any vital organ is threatened there should be no hesitation in pushing the mercury treatment, and in supple- menting it, if favorable results do not folloAv promptly, by large doses of iodide of potassium. After the first eighteen months iodide of potassium is generally indicated. This is commonly given together Avith the mercury, con- stituting the mixed treatment. The folloAving formula, or one similar to it, may be employed: R.—Potassii iodidi.........-ij Vel ^iv (8.0-16.0). Hydrarg. chlor. corros......gr. ss (0.03). Syrup, aurant. cort......f^j -;32.0). Aqua?..........q.s. adf^ij (64.0).—M. S.—Teaspoonful (4.0) three times a day. When this prescription is put up a precipitate is formed and then dissolved. SYPHILIS. 659 This mixture, or iodide of potassium Avithout the mercury, admin- istered in 5- to 10-grain (0.3-0.65) 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 solu- tion. 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 Avhich 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 by looseness of 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 well borne the physician should at once employ some other salt; the bichloride, in y^-grain (0.005) doses three times a day, is efficacious. Blue mass Avill often act favorably Avhen other preparations cannot be tolerated. Its combination Avith iron is desirable, and the following formula rep- resents one of the most valuable of the antisyphilitic pills: R.—Mass. hydrargyri..........gr. xxx (2.0). Pulv. ferri chloridi.........gr. xv (1.0).—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 Avhen it is desired to promptly cure eruptions on the surface of the body or when it is most import- ant 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 Avhich the mercuric preparation can be volatilized. The patient is seated in a chair entirely naked; several blankets are Avrapped around his neck, and beneath the tent thus formed a large vessel of steaming Avater is placed. When the skin is thoroughly softened J drachm (2.0) of calomel is sublimed bv means of the lamp. These baths may be repeated every night until the mercuric foetor of the breath is observed or until the specific symptoms disappear. (See articles on Mercury and on Heat.) Inunction represents the most efficient Avay of administering the mercuric treatment. When the stomach is intolerant of drugs, or Avhen, administered by the mouth in full doses, they do not favorably modify the symptoms, inunctions are indicated. The patient is instructed to take a Avarm bath, and the mercury is then well rubbed in over the inner surface of the forearm and arm 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 more cleanly, but less efficient. 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 (4.0) 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 worn over this. 660 DISEASES. The next night the opposite arm and side of the body are utilized as the seat of inunction; the folloAving night the right groin and the inner surface of the right thigh and leg; next, the same regions of the opposite side of the body; finally, the anterior surface of the chest and abdomen. In this Avay 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: xVfter a thorough soaking of the patient's feet in hot Avater, from ^ to 1 drachm (2.0-4.0) of a 20 per cent, oleate of mercury 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 Avear, night and day, a pair of ayooI- len 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 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 tAvelve to eighteen inunctions. The hypodermic administration of mercury is in this country lim- ited to those feAv cases which do not seem to respond to the drug when given by the mouth or by inunction. Although many prepara- tions of mercury have been lauded as most efficacious Avhen used hypo- dermically, the best formula seems to be that recommended by Hebra. This consists of a solution of 1 per cent, of bichloride of mercury in a 6 per cent, sodium-chloride solution; the resulting mixture is per- fectly clear and is readily prepared. 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 ^ to ^ grain (0.01-0.02) of the sublimate being administered. The nates are selected as the seat of the injection, the solution being driven Avell into the muscles of each side every other day. TAventy injections are usually sufficient to cause the disappearance of all symp- toms. 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 pro- duce severe and even fatal ptyalism. The ulcerations often found as tertiary manifestations of syphilis 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 Avhere there is marked anaemia or physical Aveakness cod-liver oil, stimulants in moderation, compound syrup of the hypophosphites, and other tonic and nutritive courses of treatment must be carefully administered. 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 cachectic individuals, running a rapid and virulent course, unchecked, TETA N US—TONSILLITIS. 661 nay aggravated, by specific treatment, and responding feebly, if at all, to the most careful hygienic and tonic regimen. In such cases a strong extract of sarsaparilla is sometimes of service. TETANUS. The treatment of tetanus is quite independent of its causation, so far at least as drugs are concerned, and 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.) The value of the antitoxin for tetanus has not been sufficiently studied as yet to justify its general employment. TONSILLITIS. Inflammation of the tonsils occurs in three forms: superficial tonsillitis, in Avhich the mucous membrane covering the tonsils becomes inflamed through extension of a pharyngitis ; follicular tonsillitis, in which the follicles are chiefly involved and pour out an excessive secretion; and, finally, true tonsillitis, in Avhich the gland itself suffers from severe, Avidespread inflammation phlegmonous in type. In all these forms the treatment to be instituted at the beginning is practically identical. The boAvels should be opened by a saline pur- gative, Avhich in some cases should be preceded by small doses of calomel, the diet should be liquid and nutritious, and a fever and diuretic mixture should be given freely as folloAvs: R.—Tine, aconiti.........n\,xij vel xxiv (1.0-1.6). Spt. a?theris nitros.......f5j (32.0). Liq. potassii citratis . . . q. s. ad f jiij (96.0).—M. S.—Dessertspoonful every three hours. Locally, a solution of nitrate of silver, 60 grains to the ounce (4.0 : 32.0), should be applied Avith a camel's-hair brush or Avith a cotton applicator. Externally, an ice-bag should be applied about the throat, and as soon as the purgative has acted and the fever is reduced by the mixture just given, full doses of the tincture of the chloride of iron should be administered (20 drops [1.3] every three or four hours), in plenty of Avater, Avhich preferably should be Vichy or one of the good lithia Avaters. In inflammatory involvement of the entire tonsil active scarifica- tion in the early stages may be of service in limiting the severity of the attack. In some instances hot fomentations about the neck and hot gargles seem to be more beneficial than the use of ice. Often a mild antiseptic gargle of carbolic acid (1 : 100 of Avater) will relieve the pain and the foetor of the breath. Finally, it should be remembered that rheumatic persons suffer severely at times from tonsillitis, and the best remedies for this form of tonsillitis are the salicylates or guaiac. 662 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 tAvo lines—the first devoted to the cure of the disposition or inclination 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 pro- phylaxis, or true prevention, is the object really to be sought after, although it is certainly true that many cases of early tuberculosis are curable. Recent studies have shoAvn most conclusively that tubercu- losis is capable of being transmitted from man to man if air laden with the bacilli is breathed, and if the lungs are in a fit state of depressed vitality, from any cause, to afford a favorable field for the growth of the germ and the development of its poison. Cases of pulmonary consumption follow, rudely speaking, four Avell-defined lines. A very early stage sometimes comes to the care of the physician, and it is that in Avhich 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 and exercise is distasteful. A slight daily chill, in morning or evening, and fever develop, and the physician Avho is care- less treats the case as one of mild malarial poisoning. Careful exam- ination, hoAvever, will shoAv an area in the lung, generally near the apex on one or both sides, Avhere slight prolongation of expiration Avith a harsh inspiratory sound is heard, and Avhere percussion will give impaired resonance or dulness. In 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 sweat, a loss of flesh and vigor, Avith, more prominent than all, a hard cough, sudden in its onset and rap- idly becoming excessive Avith profuse expectoration, are the dominant symptoms. The Avasting is extraordinary, the sweats are constant, and death may come in a few Aveeks. This is the form knoAvn as "galloping consumption." The third variety is ushered in by a gradual loss of vigor or a sen- sation of being a little umvell, or is brought before the patient's mind by a sudden acute hemorrhage, or several hemorrhages rapidly suc- ceeding one another. This variety passes along its course more or less rapidly. Sometimes death soon ensues from a fatal hemorrhage; 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 Avho gradually pass from bad to Avorse: First, they "catch a cold," Avhich hangs on longer than it ought, and, as soon as they are Avell, this is folloAved by another one, which is found more difficult to cure, until finally there is ahvays a cough. Soon Avasting comes on, strength is lost, and a long period of months or years ensues during which the progress TUBERCULOSIS. 663 of the case is now sIoav, noAv fast, the condition noAv better, now Avorse, until death ensues from Avasting, pneumonia, or some other com- plication. These forms and stages have been roughly outlined, so that a dis- cussion of their treatment might be taken up Avith a clear idea of Avhat 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 occu- pation, this occupation must be given up and one undertaken Avhich 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 occu- pation previously folloAved: 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 Avettings in the rain will do little or no harm if the patient is properly protected by the wearing 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. (See Part III., article on Climate.) The medicinal measures to be carried out in all cases of phthisis, except that knoAvn as the galloping form, are not numerous if Ave confine 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-licer 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 change* 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 some value as a curative and of great value as a palliative is creosote, first introduced by Bouchard some thirteen years ago, but only recently Avidely employed. Many cures have been claimed from its use in 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 discomfort, particularly when the disease is fully established, and the opinion expressed by Striimpell expresses so Avell the thought Avhich the author was about to write when he read StriimpeH's article that his Avords are here 0.001-0.003 gm. 1 1 or T7 ¥ gr- 0.006-0.015 gm. 0.0005-0.002 gm. 1-i gr. 0.008-0.015 gm. 15-60 gr. 1.0-4.0 gm. 2-10 gr. 0.12-0.06 gm. 15 min.-l fl. dr. 1.0-4.0 gm. 4-2 fl. dr. 2.0-8.0 gm. 1-3 fl. dr. 4.0-12.0 gm. 2-8 gr. 0.12-0.5 gm. 5-15 min. 0.3-1.0 gm. 2-5 gr. 0.12-0.3 gm. 15-30 min. 1.0-2.0 gm. tV-1 gr- 0.004-0.008 gm. 1 - 1 o-r So 57 gr- 0.001-0.003 gm. 10-20 min. 0.6-1.2 gm. 30 min. 2.0 gm. 4-1 fl. dr. 2.0-4.0 gm. 15-40 min. 1.0-2.5 gm. 15-60 min. 1.0-4.0 gm. 10-15 min. 0.6-1.0 gm. 15-30 min. 1.0-2.0 gm. 5-10 min. 0.3-0.6 gm. 2-5 gr. 0.12-0.3 gm. 1-3 gr. 0.06-0.18 gm. 4-1 fl. dr. 2.0-4.0 gm. 4-1 fl. dr. 2.0-4.0 gm. 5-30 min. 0.3-2.0 gm. 3-6 gr. 0.18-0.36 gm. 1-2 fl. dr. 4.0-8.0 gm. 1-2 fl. dr. 4.0-8.0 gm. 1-2 fl. dr. 4.0-8.0 gm. 4-2 fl. dr. 2.0-8.0 gm. 1-4 gr. 0.03-0.25 gm. 2-10 min. 0.12-0.6 gm. 1-2 gr. 0.06-0.12 gm. 1-1 gr- 0.03-0.06 gm. 2-5 min. 0.12-0.3 gm. 5-10 min. 0.3-0.6 gm. 1-4 fl. dr. 4.0-8.0 gm. 2-3 gr. 0.12-0.2 gm. 4-1 fl. dr. 2.0-4.0 gm. 1-2 fl. dr. 4.0-8.0 gm. 20-30 min. 1.2-2.0 gm. 10-30 min. 0.6-2.0 gm. 1-3 gr. 0.06-0.18 gm. 15-30 min. 1.0-2.0 gm. 5-20 gr. 0.3-1.2 gm. T 2 gr- 0.008-0.03 gm. 686 DOSES OF MEDICINES. Dose. Gold and sodium chloride...... Gossypiuni-root, fluid extract of bark of Granati radicis cortex, fluid extract . . , Grindelia, fluid extract of..... Guaiac, ammoniated tincture of . . . resin of............. tincture of............. Guaiacol............., Guarana.............. fluid extract of........... Gurjun. See Balsam. Hematoxylon............ extract of. ............ fluid extract of........... Hamamelis, fluid extract of...... Hedeoma, oil of........... Helleborein............. Helleborus niger, extract of ..... . fluid extract of.......... tincture of............ Hepatica, fluid extract of....... Hops, extract of........... fluid extract of........... tincture of............ Hydrangea, fluid extract of...... Hydrastine............. Hydrastis, extract of......... fluid extract of........... tincture of............ Hyoscine hydrobromate....... Hyoscyamine sulphate........ Hyoscyamus, abstract of........ alcoholic extract of......... extract of........ . . . . fluid extract of flowers....... of seeds ............ tincture of flowers......... of seeds............ Hypnal ... ........... Hypnone.............. Hypophosphites, syrup of....... with iron, svrup of......... Ichthyol . ." ............ Ignatia, abstract of.......... extract of............. fluid extract of........... tincture of............. Iodine, compound solution of..... tincture of............. Iodoform............ Iodol ................. Ipecacuanha, emetic......... expectorant........... abstract of............. fluid extract of, emetic....... syrup of.............. wine of, emetic........... expectorant.......... Iridin or Irisin........... Iris, extract of............ fluid extract of......... Apothecaries' Weights and Measures. TO 20 gr- 4-1 fl. dr. 1-2 fl. dr. 4-1 fl. dr. 30-60 min. 10-20 gr. 30-60 min. 4-3 gr. 10-30 gr. 10-30 min. Metric System. 10 10 30 30 min. 2 i To" 1 2 5 10 30 3 30 1 30 i r 3 10 30 i Too" T2TT 2- 1 2- '-20 gr. -20 gr. -60 min. -2 fl. dr. -5 min. "igr- -2 gr- _ -15 min. -15 min. 60 min. -15 gr. -60 min. -2 fl. dr. -60 min. -igr- -10 gr. -30 min. -60 min. -bo gr. -£o gr- -3gr. -2 gr. -3 gr. -15 min. 5 min. -30 min. -30 min. -1 gr. -5gr. 1 fl. dr. 1 fl. dr. -4gr. -3gr. -1 gr. -6 min. -15 min. 5 min. -15 min. -3gr. -2gr. -30 gr. 1 gr. -30 gr. -30 min. -1 fl. dr. -6 fl. dr. -15 min. -5 gr. -3 gr. -15 min. 0.001-0.003 gm. 2.0-4.0 gm. 4.0-8.0 gm. 2.0-4.0 gm. 2.0-4.0 gm. 0.6-1.2 gm. 2.0-4.0 gm. 0.03-0.18 gm. 0.6-2.0 gm. 0.6-2.0 gm. 1.2 gm. -1.2 gm. -4.0 gm. -8.0 gm. -0.3 gm. -0.016 gm. -0.12 gm. -1.0 gm. -1.0 gm. -4.0 gm. -1.0 gm. -4.0 gm. -8.0 gm. -4.0 gm. 0.03 gm. 0.6 gm. 2.0 gm. -4.0 gm. -0.001 gm. 0.001 gm. 0.2 gm. 0.12 gm. -0.2 gm. -1.0 gm. 0.3 gm. -2.0 gm. -2.0 gm. -0.06 gm. -0.3 gm. 4.0 gm. 4.0 gm. -0.25 gm. -0.2 gm. 0.06 gm. -0.35 gm. -1.0 gm. 0.3 gm. 1.0 gm. -0.2 gm. 0.12 gm. -2.0 gm -0.06 gm. -2.0 gm. -2.0 gm. -4.0 gm. -24.0 gm. -1.0 gm. 0.3 gm. 0.18 gm. 1.0 gm. 0.6 0.6 2.0 2.0 0.12 0.006 0.03 0.3 0.6 2.0 0.2 2.0 4.0 2.0 0.015 0.2 0.6 2.0 00006 0.0005- 0.12 0.06- 0.12 0.3 l.o 1.0 0.03 0.06 0.1 0.06 0.015 0.06 0.3 0.3 0.06 0.03 1.0 0.01 0.3 1.0- 2.0- 12.0 0.3- 0.06 0.06- 0.3 DOSES OF MEDICINES. 68" Remedy. Iron acetate, tincture of . . and ammonium citrate sulphate...... tartrate ....... arsenate....... benzoate ....... bitter wine of..... bromide........ syrup of..... . carbonate, saccharated chloride....... tincture of..... and cinchonidia citrate . citrate........ compound mixture of . dialyzed........ solution of...... hydrated oxide of . . . hypophosphite..... syrup of....... iodide........ syrup of....... lactate ........ magnetic oxide of . . . malate........ nitrate, solution . . . phosphate....... pomate........ and potassium tartrate . pyrophosphate..... and quinia citrate . . . reduced........ saccharated carbonate of and strychnine citrate . subcarbonate..... subsulphate...... sulphate ....... dried........ valerianate...... wine of the citrate of. . Jaborandi, extract of ■ . . fluid extract of. • . Jalap.......... abstract of....... compound powder of . . extract of....... alcoholic extract of . . . fluid extract of..... resin of..... tincture of...... Juglans, extract of ... . fluid extract of..... Juniperus, fluid extract of, Kairin......... Kamala......... fluid extract of..... Kino......... fluid extract of..... tincture of . . Kola, fluid extract of . . . Koosso. See Brayera Dose. Apothecaries' Metric Weights and Measures. System. 15-30 min. 1.0-2.0 gm. 5-10 gr. 0.3-0.6 gm. 5-10 gr. 0.3-0.6 gm. 5-15 gr. 0.3-1.0 gm. ¥o~2u gr- 0.0015-0.003 gm. 1-5 gr. 0.06-0.3 gm. 1-2 fl. dr. 4.0-8.0 gm. 1-5 gr. 0.06-0.3 gm. 15-60 min. 1.0 4.0 gm. 5-15 gr. 0.3-1.0 gm. 1-3 gr. 0.06-0.18 gm. 10-30 min. 0.6-2.0 gm. 5-10 gr. 0.3-0.6 gm. 5-10 gr. 0.3-0.6 gm. 1-2 fl. oz. 30.0-60.0 gm. 5-15 min. 0.3-1.0 gm. 10-30 min. 0.6-2.0 gm. Tablespoonful doses in arsenical poisoning 5-10 gr. 0.3-0.6 gm. 1 fl. dr. 4.0 gm. 1-5 gr. 0.06-0.3 gm. 10-30 min. 0.6-2.0 gm. 1-5 gr. 0.06-0.3 gm. 5-10 gr. 0.3-0.6 gm. 5-15 gr. 0.3-1.0 gm. 8-15 min. 0.5-1.0 gm. 1-5 gr. 0.06-0.3 gm. 5-15 gr. 0.3-1.0 gm. 10-30 gr. 0.6-2.0 gm. 2-5 gr. 0.12-0.3 gm. 5-10 gr. 0.3-0.6 gm. 3-6 gr. 0.2-0.4 gm. 5-15 gr. 0.3-1.0 gm. 1-3 gr. 0.06-0.18 gm. 5-30 gr. 0.3-2.0 gm. 1-3 gr. 0.06-0.18 gm. 1-3 gr. 0.06-0.18 gm. 1-2 gr. 0.03-0.12 gm. 1-3 gr. 0.06-0.18 gm. 4-1 fl. dr. 2.0-4.0 gm. 2-5 gr. 0.12-0.3 gm. 10-60 min. 0.6-4.0 gm. 5-30 gr. 0.3-2.0 gm. 5-10 gr. 0 3-0.6 gm. }, dr. 2.00 gm. 5-10 gr. 0.3-0.6 gm. 3-6 gr. 0.18-0.35 gm. 15-30 min. 1.0-2.0 gm. 4-8 gr. 0.25-0.5 gm. 4-2 fl. dr. 2.0-8.0 gm. 5-20 gr. 0.3-1.2 gm. 1-2 fl. dr. 4.0-8.0 gm. 30-60 min. 2.0-4.0 gm. 2-10 gr. 0.12-0.6 gm. 1-2 dr. 4.0-8.0 gin. 30-60 min. 2.0-4.0 gm. 10-30 gr. 0.6-2.0 gm. 15-30 min. 1.0-2.0 gm. 4-2 fl. dr. 2.0-8.0 gm. 10-30 min. 0.65-2.0 gm. 688 DOSES OF MEDICINES. Dose. Krameria............... extract of ............. fluid extract of............ syrup of............... tincture of.............. Lactucarium.............. fluid extract of........... syrup of............... Lappa, fluid extract of......... Lead acetate.............. iodide................ Leptandra .............. extract of............. fluid extract of............ Leptandrin . ........... Lime, solution of............ syrup of.............. Liquor potassse, sodse, etc. See Potassa, Soda, etc. Liquorice, compound mixture of . . . . powder of.............. Lithium benzoate........... bromide.............. carbonate.............. citrate ............. salicylate............. Lobelia, fluid extract of......... tincture of.............. Lupulin.............. fluid extract of............ oleoresin of............. tincture of.............. Magnesia............... Magnesium carbonate.......... sulphate.............. sulphite............... Male fern, oleoresin of......... Malt, extract of............ Manganese binoxide.......... sulphate.............. Manna............... Matico............... fluid extract of............ tincture of............. Matricaria, fluid extract of....... Menispermum, fluid extract of..... Menthol............... Mercury with chalk.......... corrosive chloride of......... cyanide............ formamidate (1 per cent, solution) . . . green iodide of............ mass of (blue pill).......... mild chloride of ........... red iodide of............. salicylate.............. tannate............... yellow subsulphate of......... Mezereum, extract of.......... fluid extract of............ Morphine and its salts......... Apothecaries' Weights and Measures. 10-20 gr. 5-15 gr. 20-30 min. 1-4 fl. dr. 4-2 fl. dr. 10-15 gr. 10-30 min. 1-3 fl. dr. 30-60 min. 1-3 gr. 1-3 gr. 20-40 gr. 3-10 gr. 30-60 min. 2-4 gr. 1-4 dr. 15-30 min. 1-4 fl. dr. 1-1 dr. 5-10 gr. 2-10 gr. 2-10 gr. 2-10 gr. 2-10 gr. 1-5 min. 10-30 min. 5-10 gr. 10-15 min. 2-5 gr. 4-2 fl. dr. 10-30 gr. 10 gr.-l dr. 2 dr.-l oz. 10-30 gr. 30 min.-l fl. dr. 1-2 fl. dr. 2-4 gr. 2-10 gr. 1-2 oz. 4-2 dr. 4-1 fl. dr. 4-2 fl. dr. 10-30 min. 30-60 min. 2gr. 2-10 gr. Metric System. TfWe gr- tW gr- 5-15 min. i-i gr. 3-10 gr. 1-5 gr. J___1_ err 3 2 1 6 gr- 1-1 gr- i-1 gr. i-1 gr- 4-1 gr. 3-10 min. tW gr- 0.6-1.2 gm. 0.3-1.0 gm. 1.2-2.0 gm. 4.0-16.0 gm. 2.0-8.00 gm. 0.6-1.0 gm. 0.6-2.0 gm. 4.0-12.0 gm. 2.0-4.0 gm. 0.03-0.18 gm. 0.03-0.18 gm. 1.2-2.5 gm. 0.18-0.6 gm. 2.0-4.0 gm. 0.12-0.25 gm. 4.0-15.0 gm. 1.0-2.0 gm. 4.0 2.0 0.3 0.12 0.12 0.12 0.12 0.06- 0.6 0.3 0.6 0.12 2.0 0.6 0.6 8.0- 0.6 2.0 4.0 0.12 0.12 32.0 2.0 2.0- 2.0 0.6 2.0 0.12 0.002- 0.004 0.3- 0.01 0.2 0.008 0.002- 0.03 0.03- 0.015- 0.03- 0.18- ' 0.004 -16.0 gm. -4.0 gm. -0.6 gm. -0.6 gm. -0.6 gm. -0.6 gm. -0.6 gm. -0.3 gm. -2.0 gm. -0.6 gm. -1.0 gm. -0.3 gm. -8.0 gm. -2.0 gm. -4.0 gm. -32.0 gm. -2.0 gm. -4.0 gm. -8.0 gm. -0.25 gm. -0.6 gm. -64.0 gm. -8.0 gm. -4.0 gm. -8.0 gm. -2.0 gm. -4.0 gm. 0.12 gm. -0.6 gm. -0.004 gm. -0.008 gm. -1.0 gm. -0.03 gm. 0.6 gm. 0.3 gm. -0.004 gm. -0.06 gm. -0.06 gm. -0.06 gm. -0.06 gm. -0.6 gm. 0.03 gm. Remedy. Morrhuol . . Musk . tincture of Mvrrh . . . extract of ... . fluid extract of. . tincture of. . . . Pelletierine sulphate tannate .... Peppermint, oil of . spirit of..... Pepsin, pure.... liquor of . . . saccharated Petroselinum, fluid extract of...... Phenacetin............. Phosphorated oil........... Phosphorus.............. Physostigma, extract of......... fluid extract of. . . ........ tincture of............. Physostigmine salicylate........ sulphate.............. Phytolacca, abstract of......... berries, fluid extract of........ root, extract of............ fluid extract of........... tincture of............. Phytolaccin.............. Picrotoxin.............. Pilocarpine and its salts......... Pilocarpus, abstract of......... fluid extract of............ Pimenta, fluid extract of........ Piper methysticum, fluid extract of. . . . nigrum, fluid extract of........ 44 Dose. Apothecaries' Metric Weights and Measures. System, 1-5 gr. 0.06-0.3 gm. 2-ir. gr. 0.1-1.0 gm. 15-60 min. 1.0-4.0 gm. 10-30 gr. 0.6-2.0 gm. 15-30 min. 1.0-2.0 gin. 2-3 gr. 0.12-0.18 gin. 2-10 gr. 0.12-0.6 gm. 2-10 gr. 0.12-0.6 gm. 1-1 gr- 0.01-0.03 gm. 3gr. 0.18 gm. 1-4 fl. dr. 4.0-16.0 gm. 1 min. 0.06 gm. i-1 gr. 0.015-0.06 gm. l-i o-r 8 2 &'• 0.008-0.03 gm. 1-5 min. 0.06-0.3 gm. 10-20 min. 0.6-1.2 gm. 4-2 fl. dr. 2.0-8.0 gm. 10-40 gr. 0.6-2.5 gm. i-1 gr- 0.01-0.03 gm. i-l gr. 0.015-0.06 gm. 5-15 min. 0.3-1.0 gm. 5-15 min. 0.3-1.0 gm. 10-20 gr. 0.6-1.2 gm. 1-2 gr. 0.03-0.12 gm. 15-30 min. 1.0-2.0 gm. 1-5 gr. 0.00-0.3 gm. 1-3 gr. 0.06-0.18 gm. 20-00 min. 1.2-4.0 gm. i-1 dr. 2.0-4.0 gm. 10-30 gr. 0.6-2.0 gm. 4-1 fl. dr. 2.0-4.0 gm. 1 fl. dr. 4.0 gm. 2-5 gr. 0.12-0.3 gm. 1-5 gr. 0.06-0.3 gm. 2-5 min. 0.12-0.3 gm. 30-60 min. 2.0-4.0 gm. 15 gr.-l dr. 1.0-4.0 gm. 2-4 fl. dr. 8.0-15.0 gm. 30 gr.-1, oz. 2.0-16.0 gm. 1-2 fl. dr. 4.0-8.0 gm. 2-5 gr. 0.12-0.3 gm. 3-5 min. 0.18-0.3 gm. -rio-77 gr- 0.0006-0.0008 gm. tW gr. 0.004-0.01 gm. 1-3 min. 0.00-0.18 gm. 5-10 min. 0.3-0.6 gm. Tiny"t~s gr- 0.0005-0.0008 gm. 1 - 1 or T2o ¥0" gr- 0.0005-0.0008 gm. 5-15 gr. 0.3-1.00 gm. 5-30 min. 0.12-2.0 gm. 1-3 gr. 0.06-0.18 gm. 5-30 min. 0.3-2.0 gm. 10-60 min. 0.6-4.0 gm, 2-3 gr. 0.12-0.18 gm. *Wj gr- 0.001-0.002 gm. s'H gr. 0.001-0.03 gm. 5-20 gr. 0.3-1.2 gm. 15-60 min. 1.0-4.0 gm. 15-45 min. 1.2-3.0 gm. 15 min.-l fl. dr. 1.0-4.0 gm. 15-45 min. 1.0-3.0 gm. DOSES OF MEDICINES. 689 Dose. tincture of........'...... Myrtol.............. Naphthaline.............. Naphthol............... Narceine............... Narcotine.............. Nectandra, fluid extract of....... Nitroglycerin (1 per cent, solution). . . . Nux vomica, abstract of......... extract of.............. fluid extract of............ tincture of............. Opium, camphorated tincture of (paregoric) confection of............ extract of.............. powder ............... tincture of (laudanum)........ wine of ............... Pancreatin.............. Papaver, extract of........... fluid extract of............ Papayotin............... Paracotoin.............. Paraldehyde.............. 690 DOSES OF MEDICINES. Dose. Piper nigrum, oleoresin of ... . Piperine............ Piscidia erythrina, extract of . . fluid extract of........ powder of.......... Podophyllum, abstract of..... resin of............ Pomegranate, bark of....... Poppy. See Papaver. Potassa, solution of (liquor potassa;) Potassium acetate......... bicarbonate.......... bitartrate............ bromide............. carbonate............ chlorate............. citrate ............. solution of............ cyanide............. ferrocyanide........... hypophosphite.......... iodide ... ........ mixture of the citrate of..... nitrate ............. permanganate......... and sodium tartrate....... sulphate............ sulphide ............ sulphite............. tartrate............. Prinos.............. fluid extract........... Pulsatilla, fluid extract of...... Pyrethrnrn, tincture of....... Pyridine............. Pyrodine............ Quassia, extract of......... fluid extract of.......... tincture of........... Quebracho, fluid extract of . . Quercus, fluid extract of....... Quinidine............. Quinine and salts......... arsenate............ Quinoidin............. Resorcin............. Rhamnus catharticus, fluid extract of . Rhubarb............. aromatic syrup of........ tincture of......... . . compound powder of....... extract of............ fluid extract of.......... and soda, mixture of....... sweet tincture of......... syrup of............. tincture of......... wine of ............. Rhus, aromatic fluid extract of. . . . glabra (cortex), fluid extract of . . (fructus), fluid extract of ... . Apothecaries' Weights and Measures. Metric Svstum. 15 10 30 1-3 gr. 1-8 gr. 1-2 gr. 10-30 min. 5-15 gr. 3-5 gr. i-i gr- 20-30 gr. 5-20 min. gr.-l dr. 10-40 gr. 1-5 gr. gr.-l dr. 5-30 gr. 5-15 gr. 15-60 gr. 2-4 fl. dr. Tb-8" gr- 10-15 gr. 5-15 gr. 2-15 gr. 4 fl. oz. 5-15 gr. 1-2 gr. i-l oz. gn-2 dr. 1-10 gr. 15-30 gr. dr.-l oz. gr.-l dr. 30-60 min. 2-5 min. 10-30 min. 1-3 gr. 1-3 gr. 1-5 gr. 30-60 min. 4-2 fl. dr. 20-60 min. 30-60 min. 1-30 gr. 1-30 gr. i-1 gr. 10-30 gr. 5-10 gr. 30-60 min. 2-30 gr. 1-4 fl. dr. 4-1 fl. dr. 4-1 dr. 5-15 gr. 15-40 min. i-1 fl. dr. 1-4 fl. dr. 1-4 fl. dr. 1-4 fl. dr. 1-2 fl. dr. 15-60 min. 30-60 min. 30-60 min. 0.06-0.2 gm. 0.06-0.5 gm. 0.06-0.12 "gm 0.6-2.0 gm. 0.3-1.0 am. 0.6-0.3 gm. 0.008-0.03 gm 1.2-2.0 gm. 0.3 1.0 0.0 0.06- 0.6 0.3- 0.3- 1.0- 8.0- 0.004- 0.6- 0.3- 0.12- 0.3- 0.06- 15.0- 2.0- 0.06- 1.0 4.0 2.0 2.0 0.12 0.6 0.06 0.06 0.06- 2.0 2.0 1.2 2.0 0.06 0.0(1 0.01 0.6 0 3 2.0 0.12 4.0 2.0 2.0 0.3 1.0 2.0 4.0 4.0 4.0 4.0 10 2.0 2.0 -1.2 gm. 4.0 gm. -2.5 gm. -0.3 gm. -4.0 gm. -2.0 gm. -1.0 gm. -4.0 gm. -16.0 gm. 0.008 gm. -1.0 gm. -1.0 gm. -1.0 gm. 15.0 gm. -1.0 gm. -0.12 gm. -30 0 gm. 8.0 gm. -0.6 gm. -2.0 gm. -32.0 gm. -4.0 gm. -4.0 gm. 0.3 gm. 2.0 gm. 0.18 gm. 0.18 gm. 0.3 gm. -4.0 gm. -8.0 gm. -4.0 gm. -4.00 gm. -2.0 gm. -2.0 gm. -0.06 gm. -2.0 gm. -0.6 gm. -4.0 gm. -2.0 gm. -16.0 gm. -4.0 gm. 4.0 gm. -1.0 gm. -2.5 gm. -4.0 gm. -16.0'gm. -16.0 gm. -16.0 gm. -8.0 gm. -4.0 gm -4.0 -m. -4.0 gm. DOSES OF MEDICINES. 691 Remedy. Rhus toxicodendron......... Roses, fluid extract of......... syrup of............. Rubus, fluid extract of........ RuiiK'x, fluid extract of........ Ruta, fluid extract of......... Sabina, fluid extract of........ Saccharin.............. Salicin.............. Salix, fluid extract of......... Salol............... Salvia, fluid extract of........ Sambucus, fluid extract of....... Sandal-wood, oil of......... Sanguinaria............. fluid extract of.......... tincture of............ Santonica............. . fluid extract of........... Santonin ............. Sarsaparilla, compound fluid extract of . compound syrup of......... fluid extract of........... Sassafras, fluid extract of....... Savine, oil of............ Scammony............. resin of.............. Scoparius, fluid extract of....... Scutellaria, fluid extract of...... Scutellarine............. Senega, abstract of.......... fluid extract of........... syrup of.............. Senna............... compound infusion of........ confection of............ fluid extract of........... infusion of............ syrup of.............. tincture of............. Serpentaria, fluid extract of..... tincture of............ Silver iodide. .......... nitrate .............. oxide ............... Simaruba, fluid extract of....... Soda, solution of (liquor sodse)..... So !ium acetate............ arsenate.............. benzoate............. bicarbonate............ bisulphite............. borate .............. bromide.............. carbonate ............. chlorate.............. citrate.............. hypophosphite........... hyposulphite........... iodide.............. nitrite.............. Dose. Apothecaries' Metric eights and Measures. System, 1-6 min. 0.06-0.4 gm. i-2 fl. dr. 2.0-8.0 gm. 1-2 fl. dr. 4.0-8.0 gm. 1-2 fl. dr. 2.0-8.0 gm. 30-60 min. 2.0-4.0 gm. 15-30 min. 1.0-2.0 em. 5-15 min. 0.3-1.0 gm. i-1 gr. 0.03-0.25 gm. 10-30 gr. 0.6-2.0 gm. i-2 fl. dr. 2.0-8.0 gm. 10-20 gr. 0.6-1.2 gm. i-2 fl. dr. 2.0-8.0 gm. i-2 fl. dr. 2.0-8.0 gm. 15-20 min. 1.0-1.2 gm. 1-5 gr. 0.06-0.3 gm. 5-10 min. 0.3-0.6 gm. 10-40 min. 0.6-2.5 gm. 10-30 gr. 0.6-2.0 gm. 15-60 min. 1.0-4.0 gm. 1-4 gr. 0.06-0.25 gm. i-2 fl. dr. 2.0-8.0 gm. 1-4 fl. dr. 4.0-16.0 gm. 4-2 fl. dr. 2.0-8.0 gm. i-2 fl. dr. 2.0-8.0 gm. 2-5 min. 0.12-0.3 gm. 5-15 gr. 0.3-1.0 gm. 2-10 gr. 0.12-0.6 gm. -i-1 fl. dr. 2.0-4.0 gm. 1 -2 fl. dr. 4.0-8.0 gm. 1-3 gr. 0.06-0.18 gm. 4-10 gr. 0.25-0.6 gm. 8-15 min. 0.5-1.0 gm. 1-2 fl. dr. 2.0-8.0 gm. 10-60 gr. 0.6-4.0 gm. 1-2 oz. 32.0-64.0 gm. 1-2 dr. 4.0-8.0 gm. 1-4 fl. dr. 4.0-15.0 gm. 4 fl. oz. 125.0 gm. 1-4 fl. dr. 4 0-16.0 gm. 2 fl. dr.-l fl. oz. 8.0-30.0 gm. 30 min.-l fl. dr. 2.0-4.0 gm. 4-2 fl. dr. 2.0-8.0 gm. i-2 gr. 0.03-0.12 gm. i"i gr- 0.015-0.03 gm. i-1 gr- 0.03-0.06 gm. 15-30 min. 1.0-2.0 gm. 5-20 min. 0.3-1.2 gm. 15 gr.-l dr. 1.0-4.0 gm. 1 - 1 or cs To gr- 0.001-0.006 gm. 5-30 gr. 0.3-2.0 gm. 10-30 gr. 0.6-2.0 gm. 10-30 gr. 0.6-2.0 gm. 10-30 gr. 0.6-2.0 gm. 10-30 gr. 0.6-2.0 gm. 10-30 gr. 0.6-2.0 gm. 5-30 gr. 0.3-2.0 gm. 1-10 dr. 4.0-40.0 gm. 5-15 gr. 0.3-1.0 gm. 10-30 gr. 0.6-2.0 gm. 5-20 gr. 0.3-1.2 gm. 1-4 gr. 0.06-0.25 gm. 692 DOSES OF MEDICINES. Remedy. Sodium phosphate...... salicylate......... sulphate.......... sulphite.......... Sparteine sulphate...... Spigelia, fluid extract of. . . . and senna, fluid extract of . . Squill, compound fluid extract of syrup of......... fluid extract of.....• • syrup of.......... tincture of........ Stillingia, fluid extract of . . . Stramonium, extract of . . . fluid extract of...... leaves, alcoholic extract of tincture of..... - seeds, extract of...... tincture of........ Strontium bromide...... iodide........... lactate .......... phosphate......... Strophanthus, tincture of . . . Strophantin......... Strychnine and its salts .... Sulphonal.......... Sulphur........... Sumbul, fluid extract of . . . . tincture of......... Taraxacum, extract of ... . fluid extract of....... Terebene .......... Terpine hydrate ....... Terpinol.......... Thallin, sulphate of...... tartrate of......... Theine.......... Thuja, fluid extract of ... . Thymol........... Toxicodendron, fluid extract of Triticmn, fluid extract of ■ • • Turpentine, oil of...... Urethane.......... Ustilago maidis, fluid extract of Uva ursi, fluid extract of . ■ . Valerian, abstract of..... ammoniated tincture of . ■ - extract of......... fluid extract of....... oil of........... tincture of........ Veratrine.......... Veratrum viride, abstract of . . fluid extract of....... tincture of......... Verbena, fluid extract of . . . Viburnum, fluid extract of . . Vinegar. See Acetum. Wahoo. See Euonymus. Wild-cherry bark...... Dose. Apothecaries' Weights and Measures. 2-10 gr. 10-20 gr. 1-4 dr. 10-30 gr. uV gr- 15-60 min. 4-2 fl. dr. 5-30 min. 15-30 min. 5-30 min. 4-1 fl. dr. 10-60 min. 15-60 min. igr- 1-4 min. i-i gr- 8-15 min. i-i gr-. 6-15 min. 20-30 gr. 10-20 gr. 20-30 gr. 20-30 gr. 3-8 min. 1___J_ „,. T20 60 &*■ eWe gr- 15-30 gr. 1-3 dr. 15-60 min. 10-30 min. 5-15 gr. 4-1 fl. dr. 5-10 min. 2-5 gr. A gr- 1-5 gr. 1-5 gr. 1-2 gr. 10-15 gr. 1-5 gr. 1-5 min. 1-2 fl. dr. 5-30 min. 10-30 gr. 15-60 min. 4-1 fl. dr. 10-15 gr. 4-2 fl. dr. 5-15 gr. 4-1 fl. dr. 4-5 min. i-2 fl. dr. 6 -0.3 gm. 1-4.0 gm. 1-8.0 gm. 2.0-4.0 gm. DOSES OF MEDICINES. 693 Dose. Wild-cherry bark, fluid extract of infusion of......... syrup of........... Wintergreen, oil of....... Wormseed, oil of. . • ■ • • Xanthoxylum bark, fluid extract of fruit, fluid extract of..... Zinc acetate.......... bromide........... iodide........... oxide............ phosphide .......... sulphate (alterative)..... (emetic")........ syrup of iodide of...... valerianate......... Zingiber. See Ginger._________ Apothecaries' Weights and Measures. 30-60 min. 1-2 fl. oz. 2-4 fl. dr. 1-20 min. 4-8 min. 15-30 min. 15-30 min. 1-2 gr. 4-2 gr. 1-3 gr. 2-8 gr. A-A gr- i-1 gr- 10-30 gr. 20-40 min. 1-4 gr. Metric System. 2.0- 30.0- 8.0- 0.06- 0.24- 1.0- 1.0- 0.06- 0.03 0.03 0.12 0.003 0.015 0.6 1.2 0.06 4.0 gm. 60.0 gm. 16.0 gm. -1.2 gm. 0.5 gm. -2.0 gm. 2.0 gm. -0.12 gm. -0.12 gm. -0.18 gm. -0.5 gm. -0.006 gm. -0.06 gm. -2.0 gm. -2.5 gra. -0.2 gm. TABLES OF RELATIVE WEIGHTS AND MEASURES IX THE METRIC AND APOTHECARIES' SYSTEMS. (See Oldberg's Manual of Weights and Measures.) Milligrammes in Grains. Milligramme. 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 Grain. STio" STSTS _i 2 07* 1 T50 1 T20 1_ Too 1 90 1 SO 1 TO" Milligrammes. 1 1.2 1.6 2 3 4 5 6 7 — Tf(J — 1 So — _1_ -- 40 1 — sv 1 — 'Jo — 1 — To 1 — T2 — 1 — TTJ — 1 — V Milligrammes. 8 9 10 .= 12 16 20 30 60 Centigrammes in Grains. Centigrammes (or Cent.) 1 o = 3 4 5 = Centigrammes. (or Cent.) Grains. Centigrammes (or Cent.) Graii 6 = 1 18 = 3 7 = 11 25 = 4 9 = U 50 = 8 10 = If 75 = 12 12 = 2 100 = 16 Grammes in Grains. Grammes. Grains. Grammes. Grains. Grammes. Grains 0.001 = l 60 11 = 176 27 = 432 0.010 = l 12 = 192 28 = 448 0.100 = 1 2 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 = 144 26 = 416 100 = 1600 10 = 160 695 696 RELATIVE WEIGHTS AND MEASURES. Cubic Cextimetres (or Fluidgrammes) in U. S. Apothecaries' Fluidrachms. ibi U.S. Cubic U.S. Cubic U. S. me ties. Fluidrachms. Centimetres Fluidrachms. Centimetres Fluidrachms. 1 = 1 9 = 21 Z4 16 = 4 2 = l 10 = 91 -"2" 20 = 5 3 = 3 4 11 = 03 24 = 6 4 = 1 12 = 3 28 = 7 5 = 1"1 13 = 3i 32 = 8 6 = 11 14 = 31 48 = 12 7 = If 15 = 3f 64 = 16 8 = 2 INDEX OF DRUGS AND ABOKTIFACIEXTS, 30 Abrin, 244 Absolute alcohol, 51, 56 Absorption of drugs, 27 Abstract of aconite, 50 Abstracts, 22 Acacia, 41 Acacia? gummi, 41 A. C. E. mixture, 197 Aceta, 22 Acetanilid, 41 Acetanilidum, 41 Acetate of ammonium, 64 of copper. 178 of lead, 249 of morphine, 300 of potassium, 46 of sodium, 351 of zinc, 382 Acetic acid, 46 Acetum, 46 cantharidis, 121 ipecacuanha?, 236 lobelia?, 254 opii, 298 sanguinaria?, 341 scilla?, 354 Acid infusion of roses, 332 nitrate of mercury, 271 tartrate of potassium, 97 Acidum aceticum, 46 dilutum, 46 glaciale, 46 arseniosum, 81, 84 arsenosum, 81, 84 benzoicum, 95 boricum, 99, 3*9 carbolicurn, 123 liquefactum, 127 chromicum, 153 citricum, 163 gallicuru, 204 liydrobromicum dilutum, 105 hydroehloricum, 217 dilutum, 217 hydrocyanicum, 217 dilutum, 21- nitricum, 281 dilutum, 2*2 nitro-hvdrochloricum, 217, 284 dilutum, 217, 281 phosphoricum dilutum, 314 picricum, 318 salicylicum, 334 sulphuricum, 362 aromaticum, 363 dilutum, 363 tannicum, 365 REMEDIAL MEASURES. Acidum tartaricum, 367 trichloraceticum, 373 valerian icum, 378 Aconine, 47 Aconite, 47 leaves, 50 liniment, 50 ointment, 50 Aconiti folia, 50 Aconitine, 47, 50 Duquesnel's crystalline, 50 Action of drugs, direct, 19 duration of, 28 indirect, 19 modes of, 19 Acupuncture, 383 Adeps benzoinatus, 95 lana? hydrosus, 246 Adhesive plaster, 329 Administering drugs, modes of, 19 Adonidin, 50 Adonis vernalis, 50 jEther, 192 purus, 192 Agaric, 51 Agaricin, 51 Alcohol, 51, 56 absolutum, 51, 56 amylicum, 51, 56 deodoratum, 51, 56 dilutum, 51, 56 ethylicum, 51 phenvlic, 123 Ale, 56 Alkaloids. 23 Allium. 57 syrup of, 57 Allspice, 57 Almond bread, 57, 435 Almonds, 57 bitter, 57 sweet, 57 Aloe, 58 barbadensis. 58 purificata, 59 socotrina, 58 Aloes, 5s Aloin, 58, 60 Aloinum, 58 Alteratives, 30, 36 Alum, 60 Alumen, 60 exsiccatum, 61 Amber, 61 American wormseed, 133 Ammonia, 62 liniment, 61 Ammoniac, 61 697 698 INDEX OF DRUGS. Ammoniacum, 64 Ammoniated mercury, 264 tincture of guaiac, 210 of valerian, 377 Ammonii acetas, 64 benzoas. 64 bromidum, 65 carbonas, 65 chloridum, 66 iodiduni. 66 oxalas, 67 phosphas, 67 sulphas, 67 sulphis, 67 valerianas, 67, 378 Ammonio-ferric alum, 237 Ammonium, 64 Amygdala amara, 57 dulcis, 57 Amygdalin, 327 Amyl nitrite, 67 Amylic alcohol, 51, 56 Amylum, 355 Ana-sthesia bv infiltration, 166 Anaesthetics, 30, 36 Anaphrodisiacs, 30 Antacids, 30, 36 Anthelmintics, 30, 36 Anthrarobin, 69 Antiarthritics, 30 Antidotum arsenici, 85, 240, 255 Antifebrin, 41 Antihydrotics, 30 Antimalarials, 36 Antimonial powder, 69, 73 Antimonii et potassii tartras, 69 oxidum, 69 sulphidum, 69 purificatum, 69 Antimonium nigrum purificatum, 69 sulphuratum, 69 tartaratum, 69 Antimony, 69 Antiperiodics, 30, 36 Antiphlogistics, 30 Antipyretics, 36 Antipvrin, 73 Antiseptics, 36, 384 Antispasmodics, 37 Antitoxin, 78 Aphrodisiacs, 30 Apiol, 78 Apolysin, 313 Apomorphina? hydrochloras, 80 Apomorphine, 79 Aqua ammonia', 64 fortior, 63 amygdalae amara?, 58 camphora?, 116 chloroformi, 152 cinnamomi, 162 creosoti, 1*0 hydrogenii dioxidi, 219, 220 mentha? piperita?, 308 pimenta?, 57 rosa?, 332 Aquae, 23 Arbutin, 377 Argenti et potassii nitras, 281 nitras, 27* dilutus, 281 fusus, 278 Argvria, 27* Aristol, 80, 370 Arnica, 80 no res, 80 radix, 80 rhizoma, 80 Aromatic chalk powder, 112 with opium, 113 mixture of iron, 238 powder, 162 spirit of ammonia. 64 sulphuric acid, 303 syrup of rhubarb, 331 tincture of rhubarb, 331 Arsenate of iron, 238 of sodium, 84 Arsenic, *1 Arsenicum, *1 Arseni iodidum, 84 Arsenous acid, 81, 84 Asafoetida, 86 Aspidium, 87 Astringents, 30, 37 Atomization, 21 Atrophia? sulphas, 89, 93 Atropine, *9 Auramine, 272 Ami et sodii chloridum, 209 Azedarach, ** BALM OF GILEAD," 374 Balsam of copaiba. 176 Barbadoes aloes, 58 Barium chloride, 88 Barley-water, 431 Basham's mixture, 237, 238 Bath, Eussian, 413 Turkish, 410 Bearberry, 377 Beechwood creosote, 178 Beef essence, 434 peptonized, 431 tea, 433 Beer. 56 Belladonna, 89 folia, 89 liniment, 93 ointment, 93 plaster, 93 radix, *9 Benzoate of ammonium, 64 of bismuth, 94 of lithium, 253 Benzoated lard. 95 Benzoic acid, 94 Benzoin, 94 Benzoinum, 94 Berberine, 113, 216 Beta-naphthol, 277 Bicarbonate of potassium, 95 of sodium, 95 Bichloride-carbolic acid solution, 386 Bichloride of mercury, 265 as an antiseptic, 384 Bimuriate of quinine and urea, 160 Biniodide of mercury, 266 Binoxide of manganese, 257 Bismuth, 95 benzoate, 94 salicylate, 333 subgallate, 97 INDEX OF DRUGS. Bismuthi carbonas, 96 citras, 96 et ammonii citras, 96 subcarbonas, 95 subnitras, 95 Bismuthum, 95 Bisulphate of quinine, 159 Bitartrate of potassium, 97 Bitter almonds, 57 wine of iron, 243 Bitters, 31 Black cohosh, 154 draught, 347 drop, 298 ginger, 207 mustard, 275 oxide of manganese, 257 pepper, 307 snake-root, 154 wash, 266 Blaud's pill, 238 Bleeding, 428 Blood-root, 341 Blue mass, 266 ointment, 270 pill, 266 Boneset, 201 Bonjean's ergotin, 192 Boric acid, 98, 389 Borate of sodium, 98 Borated lint, 99 Borax, 93 Boroglycerin, 99 Bran bread, 435 Brandy,56 Brayera, 182 Bromide of ammonium, 65 of calcium, 104, 110 of gold, 104 of ethvl. 197 of iron, 238 of lithium, 104, 253 of nickel, 105 of potassium, 100 of sodium, 105 of strontium, 356 Bromides. 100 Bromine, 105 Bromoform, 106 Bronchitis tents, 468 Broom, 345 Brown mixture, 252 Brucine. 288 Bryonia, 106 Bryony,106 Buchu,107 folia, 107 Burgundy pitch, 324 Butyl-chloral hydras, 181 pACTUS GRANDIFLOEUS, 108 \J Caffeina citrata, 10* effervescens, 108 Caffeine, 108 Cajuput oil, 110 Calabar bean, 317 Calabarine, 317 Calamine, 12* Calcii bromidum, 104, 110 carbonas praecipitatus, 110 chloridum, 110 hydras, 114 Calcii hypophosphis, 110 phosphas pnecipitutus, 110 sulphas, 110, 112 Calcium, 110 Calcined magnesia, 255 California buckthorn, 129 Calomel, 267 ointment, 269 Calumba, 113 Calumbine, 113 Calumbo, 113 Calx, 113 chlorata, 140 chlorinata, 140 sulphurata, 114 Camphor, 114 liniment, 116 water, 116 Camphora moiiobromata, 116 Camphorated alcohol, 116 oil, 115 tincture of opium, 293 Camphoric acid, 117 Canada pitch, 324 Cannabis Americana, 117 Indica, 117 Cantharidal cerate, 121 collodion, 121, 173 liniment, 121 paper, 121 Cantharidin, 120 Cantharis, 120 Capsici fructus, 122 Capsicine, 122 Capsicum, 122 fruit, 122 plaster, 123 Carbo ligni, 127 Carbolic acid, 123 as an antiseptic, 385 ointment, 127 Carbon,127 Carbonate of ammonium, 65 of bismuth, 96 of creosote, 180 of guaiacol, 212 of iron, 237, 238 of lead, 250 of lithium, 253 of magnesium, 256 of potassium, 128 of zinc, 12* Cardamom, 12* seed, 129 Cardiac sedatives, 31. 37 stimulants. 31, 37 Carminative powder, 162 Carminatives, 31 Carron oil, 114, 203 Caryophyllus, 163 Cascara cordial, 129 sagrada, 129 Cassia fistula, 130 Cassia? pulpa, 130 Castile soap. 349 Castor oil, 130 Cataplasma carbonis, 127 conii, 175 lini, 203 sinapis, 276 Cataplasms, 23 Catechu, 131 700 INDEX Cathartics, 31 Cat's-hair, 201 Caustic potash, 132 soda, 133 Cayenne pepper, 122 Cerates, 23 Ceratum camphora?, 116 cantharidis, 121 plumbi subacetatis, 251 resina?, 329 Cerii oxalas, 133 Chalk, 112 mixture, 110 Champagne, extra dry, 55 Charcoal, 127 poultice, 127 Charta cantharidis, 121 epispastica, 121 potassii nitratis, 277 sinapis, 276 Charta?, 23 Chenopodium, 133 Chimaphila, 133 Chinoidinum, 160, 161 Chirata, 134 Chireta, 134 Chloral, 134 hydras, 134 Chloralamide, 137 Chloralose, 138 Chlorate of potassium, 138 Chloride of ammonium, 66 of barium, 88 of calcium, 110 of gold and sodium. 209 of iron, 237, 239 of mercury, corrosive, 265 mild, 267 of sodium, 140 of zinc, 140 as an antiseptic, 389 Chlorinated lime, 140 Chlorine gas, 141 Chlorobrom, 138 Chlorodyne, 141 Chloroform, 141 liniment, 152 water, 152 Chloroformum, 141 purificatum, 142 venale, 142 Cliolagogues, 31 Chromic acid, 153 Chrysarobin, 153 ointment, 153 Cimicifuga, 154 racemosa, 154 rhizoma, 154 Cinchona, 154 calisaya, 154 condaminea, 154 cortex, 154 micrantha, 155 pale, 155 pitayensis, 155 red, 155 rubra, 155 cortex, 155 succirubra, 155 yellow, 155 Cinchonicine, 155 Cinchonidine, 155, 160 OF DRUGS. Cincbonidime sulphas, 161 Cinchonidinum, 160 Ciuchonina? sulphas, 155, 161 Cinchonine, 160 Cinnamic acid, 162 Cinnamon, 161 Cinnamon-water, 162 Cinnamomum cortex, 161 Citrate of bismuth, 96 of bismuth and. ammonium, 96 of caffeine, 108 of iron, 239 of iron and ammonium, 240 of iron and quinine, 240 of iron and strychnine, 240 of lithium, 253 of magnesium, 256 of potassium, 162 Citric acid, 163 Citrine ointment, 271 Classification of drugs, 36 Climates, 422 Cloves, 163 Clyster, 20 Cobalto-nitrite of potassium, 282 Coca, 164 Cocaina? hydrochloras, 164 Cocaine, 164 Codeine, 167, 292 Cod-liver oil, 168 Coffee, 108. 171 Colchicine, 171, 172 Colchicum, 171 corms, 171 seed, 171 Cold as a remedy, 390 bath, 393 cream, 332 pack, 399 Collodion, 172 Collodium, 172 cautharidatum, 121, 173 flexile, 173 stypticum, 173, 366 vesicans, 173 Colocynth, 173 Colocynthidis pulpa, 165 Cologne-water, 53 Columbic acid, 113 Columbo, 113 Combination of drugs for joint effect, 34 Commercial oxide of zinc, 301 Compound cathartic pill, 174 effervescing powder, 346 decoction of aloes, 60 of sarsaparilla, 343 extract of colocynth, 174 fluid extract of sarsaparilla, 343 infusion of gentian, 207 of senna, 258, 347 liniment of camphor, 116 of mustard, 276 mixture of iron, 239 of liquorice, 252 of senna, 348 pill of antimony, 73 of asafcetidaj 86 of colocynth, 174 of conium, 175 of rhubarb, 331 of scammony, 344 of soap, 298 INDEX OF DRUGS. 701 Compound pill of squill, 355 powder of almonds. 58 of catechu, 132 of chalk, 112 of cinnamon, 162 of elaterin. 189 of ipecac, 236 of jalap, 244 of kino, 245 of liquorice, 252, 348 of morphine, 300 of opium, 298 of rhubarb, 331 of scammony, 344 solution of iodine, 231 spirit of ether, 213 of juniper, 211 suppositories of lead, 250 syrup of sarsaparilla, 210, 343 of squill, 73, 354 tincture of benzoin, 95 of camphor, 116 of cardamom, 129 of catechu, 132 of chloroform, 152 of cinchona, 161 of gentian, 207 Condurango, 174 Confectio opii, 293 piperis, 307 rosa?, 215, 332 scammonii, 344 senna?, 130, 347, 365 sulphuris, 361 terebinthina?, 376 Confections, 23 Conii folia, 175 fructus, 175 Coniine, 175 Conium, 174 Conserves, 22 Contraindications for drugs, 29 Convallamarin. 176 Convallaria, 170 Convolvulin, 243 Copaiba, 176 Copper, 177 Cornutine, 190 Corrosive chloride of mercury, 265 sublimate, 265 Cosmoline, 310 Counter-irritants, 31, 37 Counter-irritation, 400 Coxe's hive-syrup, 73, 347, 354 Cream of tartar, 97 Creolin, 1*0 as an antiseptic, 388 Creosotal, 1*0 Creosote, 178 carbonate, 180 Cresol, 178 Creta prseparata, 112 Croton chloral, 181 oil, 181 liniment, 182 Cubeba, 182 Cubebic acid, 182 Cubebin, 182 Cubebs, 182 Cupri acetas, 178 nitras, 17* sulphas, 177 Cuprum, 177 Cusso, 182 Cyanide of potassium, 183 ■ DANDELION, 367 Daturine, 356 Decoction of azedarach, 18* of chimaphila, 134 Decoctions, 23 Decoctum aloes compositurn, 60 cinchonae, 161 granati radicis, 327 haematoxyli, 212 pareirae, 306 quercus, 329 sarsae, 343 compositum, 343 sarsaparillae compositum, 343 scoparii, 346 taraxaci, 367 Definition of therapeutics, 18 Definitions of drugs, 29 Demulcents, 31 Deodorized alcohol, 51, 56 opium, 298 tincture of opium, 298 Dermatol, 97, 183 Diachylon, 251 Dialyzed iron, 240 Diaphoretics, 32, 37 Diastase, 183 Diet for child six to twelve months old, 433 one year old, 433 two years old, 433 seven years old, 432 lists, 432 Diethyl-sulphon-dimethyl-methane, 359 Digestants, 37 Digested gruel, 432 Digitalin, 1*4, 1*8 Digitalis, 183 folia, 183, 188 Digitin, 184 Digitonin, 134 Digitoxin, 184 Dilute acetic acid, 46 alcohol, 51, 56 hydrobromic acid, 105 hydrochloric acid, 217 hydrocyanic acid,* 218 nitric acid, 2*2 nitro-hydrochloric acid, 217 phosphoric acid, 314 solution of subacetate of lead, 250 sulphuric acid, 363 Disinfectants, 37 Disinfection, 403 Diuretics, 32, 3* Diuretin, 349 Dobell's solution, 98 Donovan's solution, 84 Dosage, 24 by the rectum, 26 hypodermic. 25 Double cyanide dressing, 389 Dover's powder, 236, 298 Dried alum, 61 sulphate of iron, 242 Drugs, absorption of, 27 classification of, 30 702 INDEX OF DRUGS. Drugs, combination of, for joint eflect, duration of action of, 28 indications and contraindications 29 modes of action of, 19 of administering. 19 strength and reliability of, 2- Duboisine, 188 Duquesuel's crystalline aconitine, 47 ECBOLIC ACID, 190 Ecgouiue, 164 Effervescing citrate of caffeine, 108 of lithium, 253 draught, 162 powder, 95 solution of lithium, 254 Egg-flip, 56- -nog, 55 Elaterin, 189 Elaterium, 189 Electuaries, 22 Eliminators, 32, 38 Elixir phosphori. 297 proprietatis, 61 roborans, 161 Elixirs, 23 Emetics. 32, 38 direct, 32, 3* peripheral, 32, 38 Emetine, 234, 236 Emmenagogues, 32, 38 direct, 32, 3* indirect, 32, 3* Emplastra, 23 Emplastrum ammoniaci cum hydrargvro, 64 arnica?, 81 asafoetidse, *7 belladonna?, 93 califaciens, 121 cantharidis, 121 capsici, 123 ferri, 243 hydrargyri, 270 menthol* 309 opii, 299 picis burgundica?, 324 canadensis, 324 cantharidatum, 121, 324 plumbi, 251 iodidi, 250 resina?, 251, 329 saponis, 349 Emulsin, 327 Emulsion of bitter almonds, 58 of sweet almonds. 58 Emulsum ammoniaci, 64 amygdala?. 5* asafoetida?. 86 chloroformi, 152 Endermic medication, 22 Enema, 20 aloes, 60 asafoetida?, *7 magnesii sulphatis, 257 opii, 299 peptonized, 431 terebinthinae, 376 Enteroclysis, 405 Ergot, 190 34 Ergotic acid, 190 Ergotin, 190, 192 for, I Ergotinic acid. 190 Ergotinum, 192 Erigeron, 192 Erythroxylon. 164 Escharotics, 37 Eserine, 317 Essentia inentlia? piperita?, 308 Ether, 192 Ethyl alcohol, 51 bromide, 197 iodide, 19* Eucaine hydrochlorate. 199 Eucalyptol, 200 Eucalyptus, 200 Euonymin, 201 Euonymus, 200 Eupatorium, 201 Euphorbia pilulifera, 201 Europhen, 201 Exalgine, 202 Expectorants, 32, 38 sedative, 32. 38 stimulating, 32, 38 Extracts, 23 Extractum aconiti, 50 aloes aquosum, 60 barbadensis, 60 socotrina^. 60 arnicae radicis. 81 calumba?, 113 cannabis indicae, 120 cascara? sagrada*, 129 cimicifuga?, 154 cinchona?, 161 colchici, 172 aceticum, 172 radicis, 172 colocynthidis, 174 compositum, 174, 344 conii. 175 digitalis, 188 ergota?, 192 euonymi, 201 gentiana?, 207 glycyrrhiza?, 252 purum, 252 haematoxyli, 212 hyoscyami. 221 jaborandi. 322 jalapa?, 241 leptandra?, 251 lupuli, 215 nucis vomica?, 291 opii. 298 pareira?, 306 physostigmatis, 318 podophylli, 326 quassia?, 328 rhei, 331 stramonii seminis, 356 taraxaci, 367 uva ursi, 377 Extractum mezerei a?thereum, 275 Extractum belladonna? foliorum alcoholi cum, 93 conii alcoholicum, 175 gelsemii alcoholicum, 206 Extractum aconiti fluidum, 50 arnica? radicis fluidum, 81 belladonna? radicis fluidum, 93 INDEX OF DRUGS. 703 Extractum buchu fluidum, 107 calumba? fluidum, 113 cannabis indica? fluidum, 120 capsici fluidum, 123 chimaphihe fluidum, 134 chirata? fluidum, 134 cimicifuga' fluidum, 154 cinchona? fluidum, 161 coca1 fluidum, 167 colchici radicis fluidum, 172 seminis fluidum, 172 conii fluidum, 175 convallaria? fluidum, 176 cubeba.' fluidum, 182 cusso fluidum, 182 digitalis fluidum, 1^8 ergotte fluidum, 192 eucalypti fluidum, 200 eupatorii fluidum, 201 gelsemii fluidum, 206 gentiana? fluidum, 207 geranii fluidum. 207 glycyrrhiza? fluidum, 252 grindelia? fluidum, 209, 210 hamamelidis fluidum, 213 hydrastis fluidum. 210 hyoscyami fluidum, 221 ipecacuanha; fluidum, 236 kola? fluidum, 246 leptandrae fluidum, 251 lobelia? fluidum, 255 lupulini fluidum, 215 mezerei fluidum, 275 nucis vomicae fluidum, 291 pareirae fluidum, 306 pilocarpi fluidum, 322 podophylli fluidum, 326 pruni Virginiana? fluidum, 327 quassia? fluidum, 32* rhamni Purshiana? fluidum, 129 rhei fluidum, 331 rhois glabra? fluidum, 332 rosa? fluidum, 332 sabina? fluidum, 343 sanguinaria? fluidum, 341 sarsaparilla? fluidum, 343 compositum, 343 scilla? fluidum, 354 scoparii fluidum, 316 senega? fluidum, 347 sen me. fluidum, 347 serpentaria? fluidum, 348 spigelia? fluidum, 353 et senna? fluidum, 354 stillingia? fluidum, 356 stramonii seminis fluidum, 356 taraxaci fluidum, 367 uva: ursi fluidum, 377 Valeriana? fluidum, 377 veratri viridis fluidum, 3*0 zingiberis fluidum, 207 Extractum cascara? sagrada? liquidum, 129 coca? liquidum, 192 ergotic liquidum, 192 filicis liquidum, 87 glycyrrhiza? liquidum, 252 hamamelidis liquidum, 213 hydrastis liquidum, 216 opii liquidum, 278 pareirse liquidum, 300 sarsa? liquidum, 345 Extractum euonymi siccum, 201 ijiTL BOVIS, 300 purificatuin, 301 Ferri arsenas, 238 bromidum, 238 carbonas saccharatus, 237, 238 chloridum, 237, 339 citras, 240 et ammonii citras, 240 sulphas, 237 tartras, 240 et potassii tartras, 240 et quininae citras, 240 solubilis, 240 et strychnina? citras, 240 iodidum saccliaratum, 241 lactas, 241 oxalas, 242 oxidum hydratum, 240 cum magnesia, 85, 240, 255 peroxidum hydratum, 243 phosphas solubilis. 242 pyrophosphas solubilis, 242 subsulphas, 237, 241 sulphas, 237, 242 exsiccatus, 242 granulatus, 242 valerianas, 242, 37* Ferrum, 236 dialysatum, 240 reductuni, 237, 242 tartaratum, 240 Ferula fcetida, 86 Filix mas, 87 Flaxseed, 203 meal, 203 oil, 203 poultice, 203 tea, 203 Fleabane, 192 Flemming's tincture of aconite, 50 Flexible collodion, 173 Flowers of sulphur, 360 Fluid extracts, 23 Flying blister, 401 Foods for the sick, 430 Foot-bath, 409 Formaldehyde, 203 Formic aldehyde, 203 Fowler's solution, 84 Fusel oil, 51 GALEA, 204 Gallic acid, 204 ointment, 204 Gambier, 132 Garlic, 57 Gaultheria, 205 Gelsemine, 205, 206 Gelseminie acid, 205 i Gelsemium, 205 General therapeutical considerations, 17 Gentian, 206 Gentiana? radix, 206 Geranium, 207 German chamomile, 258 soft soap, 349 Germicides, 403 Germs, mode of destroying, 403 Gin, 56 Ginger, 207 Glacial acetic acid, 46 704 INDEX OF DRUGS. Glauber's salt, 351 Glonoin, 283 Glycerin, 20* Glycerins, 20 Glycerinum acidi carbolici, 209 gallici, 204, 209 tannici. 209 aluminis, 61, 209 boracis, 99, 209 plumbi subacetatis, 209, 251 tragacantb.se, 209 Glycerita, 23 Glyceritum acidi carbolici, 127 tannici, 366 amyli, 209 boroglycerini. 99 hydrastis, 216 vitelli, 209 Glycerole of aloes, 59 Glycyrrhiza, 552 Glycyrrhiza? radix, 252 Glycyrrhizinum ammoniatum, 253 Goa powder, 153 Gold, 209 bromide of, 104 Goodell's pill of the three valerianates, 378 sumbul pill, 363 Goulard's extract, 250 Granatum, 326 Granulated citrate of magnesium, 256 Gray oil, 269 powder, 269 Green iodide of mercury, 271 soap, 349 Griffith's mixture, 239 pills, 238 Grindelia, 209 Guaiac, 210 resin, 210 wood, 210 Guaiaci lignum, 210 resina, 210 Guaiacol, 210 carbonate, 212 Gum acacia, 41 arabic, 41 H.EMATOXYLI LIGNUM, 212 Hsematoxylon, 212 Hamamelis, 212 Heat, 409 Heavy magnesium, 256 Hemlock fruit, 175 leaves, 175 Henbane, 220 Hoffmann's anodyne, 213 Homatropine hydrobromate, 214 Home modification of Turkish bath, 412 Honey, 214 of borax, 99 of rose, 215, 332 of squill, 355 Hop poultice, 215 Hope's camphor mixture, 216 Hops, 215 Horse-nettle, 352 House mixture, 349 Humulus, 215 Husband's magnesia, 255 Huxham's tincture, 161, 348 Hydrargyri chloridum corrosivum, 265 Hydrargyri chloridum mite, 267 iodidum flavum, 271 rubrum, 266 oxidum flavum, 271 rubrum, 271 perchloridum, 265 subchloridum, 267 subsulphas flavus, 272 Hydrargyrum, 258 ammoniatum, 264 cum creta, 269 Hydrastine, 216, 217 Hydrastinine, hydrochlorate, 217 Hydrastis, 216 Hydrate of chloral, 134 of lime, 114 Hydrated oxide of iron with magnesium, 85, 240, 255 peroxide of iron, 243 sesquioxide of iron, 85, 240 Hydrobromate of homatropine, 214 of hyoscine, 222 of hyoscyamine, 221 of quinine, 159 Hydrobromic acid, 105 Hydrobromide of coniine, 175 Hydrochlorate of apomorphine, 80 of cocaine, 164 of eucaine, 199 of hydrastinine, 217 of morphine, 300 of pilocarpine, 322 of quinine, 159 Hydrochloric acid, 217 Hydrochloride of phenocoll, 313 Hydrocyanic acid, 217 Hydrogen peroxide, 219 as an antiseptic, 3-9 Hyoscine, 220, 221 hydrobromate, 222 Hyoscyami folia, 220 Hyosc.yamime hydrobromas, 221 sulphas, 221 vel hydrobromas, 221 Hyoscyamine, 220 Hyoscvamus leaves, 220 Hypnal. 222 Hypnotics, 33, 38 Hypodermic medication, 20 injection of apomorphine, 80 Hypodermoclysis, 414 Hypophosphite of calcium, 110 of sodium, 351 Hyposulphite of sodium, 351 TOE JACKET, 392 1 poultice, 392 Ichthyol, 222 Idiosyncrasy, 26 Incompatibility, 34 Indian hemp, 117 poke, 379 Indications for drugs, 29 Infiltration anaesthesia, 166 Infusions, 23 Infusum brayerae, 1*2 buchu,107 calumba', 113 caryophylli, 164 catechu, 132 chirata?, 134 INDEX OF DRUGS. 705 Infusum cinchonae, 161 acidum, 161 columbae, 113 cusso, 183 digitalis, 188 ergotae, 192 gentiana? compositum, 207 jaborandi, 322 krameria?, 246 lini, 203 lupuli, 215 pruni Virginiana?, 327 quassia?, 323 rhei, 331 rosae acidum, 332 seunae, 348 compositum, 258, 347 senega?, 347 serpentaria?, 348 uvse ursi, 377 Valeriana', 377 Inhalations, 21 Injectio apoinorphinae hypodermica, 80 ergotini hypodermica, 192 morphina? hypodermica, 300 Intravenous injection, 415 Inunctions, 22 Iodide of ammonium, 66 of arsenic, 84 of ethyl, 198 of iron. 240 of lead, 250 of potassium. 224 of sodium, 227 of strontium, 356 of thymol, 370 Iodine, 227 liniment, 231 ointment, 231 Iodoform, 231 as an antiseptic, 387 ointment, 233 Iodol, 234 Iodothyrine, 373 Ioduin, 227 Ipecac, 231 Ipecacuanha, 234 Iron, 236 by hydrogen, 237 plaster, 243 JABORANDI, 319 *) Jaborin, 319 Jalap, 243 Jalapin, 243 Jamaica dogwood, 323 Jamestown weed, 356 James's powder, 73 Jequirity, 244 Jervine, 379 Joint effects of drugs, 28 Juniper, 244 Juniperin, 244 Junket, 436 T^ AM ALA, 245 IV Kaolin, 245 Kataphoresis, 415 Kermes mineral, 69 Kino, 245 45 Kola, 246 Koosin, 182 Kousso, 182 Koumvss, 432 Kreolin, 388 LACTATE OF IRON, 241 of strontium. 356 Lactophenin, 313 Lactose, 358 Lady Webster dinner pills, 59 Lamella? atrophia?, 93 cocaina?, 167 physostigminae, 318 Lanoliu, 246 Laudanine, 292 Laudanum, 298 Laughing gas, 285 Lavage, 416 Lavements, 20 Lead, 246 plaster, 251 Lead-water and laudanum, 250 Leeches, 417 Leeching, 417 Ledoyen's disinfectant solution, 251 Lemon-juice, 163 Leptandra, 251 Leptandrin, 251 Levant wormseed, 341 Light magnesia. 256 Lignum vita?, 210 Lime, 113 water, 113 Lingual traction, 195 Lini farina, 203 semina, 203 Linimentum aconiti, 50 ammonia?, 64 belladonnae, 93, calcis, 114 camphora?, 116 compositum, 116 cantharidis, 121 chloroformi. 152 crotonis, 182 hydrargvri. 270 iodi, 23f opii, 299 potassii iodidi cum sapone, 227 plumbi subacetatis, 251 saponis, 116, 349 mollis, 349 sinapis compositum, 276 terebinthina?, 376 aceticum, 376 Linseed, 203 oil, 203 poultice, 203 Li num. 203 Lipanin, 252 Liquor acidi arsenosi, 84 cliromici, 153 ammonia?, 04 acetatis, 04, fortior, 63, 67 ammonii citratis, 67 fortior, 67 antimonii chloridi, 73 arseni et hydrargyri iodidi, 84 arsenicalis, 84 706 INDEX OF DRUGS. Liquor arsenici hydrochloricus, 84 atropina? sulphatis, 93 bismuthi et ammonii citratis, 96 calcis, 113 chlorinata?, 141 saccharatus, 114 carbonis detergens, 519 epispasticus, 121 ferri acetatis, 243 fortior, 243 et ammonii acetatis, 237, 238 chloridi, 239 citratis, 240 dialysatus, 240 perchloridi, 239 fortior, 239 subsulphatis, 241 tersulphatis, 85 hydrargyri nitratis, 271 perchloridi, 266 iodi, 231 compositus, 231 lithii effervescens, 254 magnesii carbonatis, 256 citratis, 256 morphina? acetatis, 300 hydrochloratis, 300 sulphatis, 300 pepsini, 309 plumbi subacetatis, 250 dilutus, 250 potassa?, 253 potassii arsenitis, 81 citratis, 95, 102 permanganatis, 310 soda?, 132 sodii arsenates, 84 silicatis, 348 zinci chloridi, 140 Liquorice, 252 root, 252 Lister's dressing, 365 Litharge, 251 Lithia-water, 254 Lithii benzoas, 253 bromidum, 104, 253 carbonas, 253 citras, 253 effervescens, 253 salicylas, 253 Lithiumj 253 Lobelia, 254 Logwood, 212 Lotio hydrargyri flava, 272 nigra, 266 Lozenges, 23 Lugol's solution, 231 Lunar caustic, 278 Lupuline, 215 Lupulinic acid, 215 Lupulus, 215 Lycopodium, 255 Lysol, 255 MAGENDIE'S SOLUTION, 300 Magnesia, 255 levis, 255 ponderosa, 241 Magnesii carbonas. 256 ponderosa vel levis, 256 citras, 256 Magnesii citras effervescens, 256 sulphas, 257 Magnesium, 256 Male fern, 87 Mandrake, 325 Manganese, 257 Mangani dioxidum, 257 sulphas, 257 Manganum, 257 Manna, 257 Massa copaiba?, 177 ferri carbonatis, 239 hydrargyri, 200 Matricaria, 258 May apple, 325 Meconic acid, 292 Meconine, 292 Mel, 214 boracis, 99 depuratum, 215 despumatum, 215 rosa?, 215 Mentha piperita, 307 Menthol, 308 Mercurial ointment, 270 oleate. 270, 271 i pills, 206 plaster, 271 suppositories, 270 Mercury, 258 salicylate, 334 with chalk. 269 Methyl acetanilid, 202 blue, 272 chloride, 273 salicylas, 205 violet, 272 Methylene blue, 273 chloride, 274 mixture, 151 Mezerei cortex, 274 Mezereum, 274 ointment, 274 Mild chloride of mercuiv, 267 Milk of asafoetida. 86 of sulphur, 361 -punch,55 peptonized, 430 -sugar, 358 Mineral springs, 420 Mint camphor, 308 stearopten, 308 Mistura creosoti, 180 creta?, 110 ferri aromatica, 238 ferri composita, 239 glycyrrhiza? composita, 252 guaiaci, 210 potassii citratis, 162 rhei et soda?, 331 scammonii, 344 senna? composita, 348 spiritus vini gallici, 56 Mitigated caustic, 281 Modes of action of drugs, 19 of administering drugs, 19 Monkshood, 47 Monobromated camphor, 116 Monochloral-antipyrin, 222 Monsel's salt, 237. 241 solution, 241 Morphina? acetas, 300 INDEX OF DRUGS. Morphina' hydrochloras, 300 sulphas, 300 Morphine. 299 Moschus, 275 Mucilage of acacia, 41 Mucilago acaciae, 41 Mulled wine, 55, 436 Muriate of ammonium, 66 of morphine, 300 Musk. 275 Mustard, 275 papers, 276 plaster, 276. 402 Mydriatics, 33 Myotics, 33 Myristica, 287 Myrrh, 276 VAPHTHALIX. 276 1\ Xaphthol, 277 Narceine, 292 Narcotine, 292 Nervous sedatives, 33, 38 stimulants, 33. 39 Neutral mixture, 95, 162 Nickel, bromide of, 105 Nitrate of copper. 17* of lead, 251 of mercury, 271 of pilocarpine, 322 of potassium, 277 of silver, 27* Nitre, 277 Xitric acid, 2*1 Xitrite of amy], 67 of potassium, 282 Xitroglycerin, 283 Nitro-hydrochloric acid, 217, 284 Xitrous oxide, 2*5 Xorwood's tincture of veratrum viride, 381 Xuclein, 286 Nut-gall, 204, 365 Nutmeg, 2*7 Nux vomica, 288 OIL OF AMBEE, 61 of tar, 324 of vitriol. 362 Ointment of aconitine, 50 of ammoniated mercury, 264 of antimony, 73 of atropine, 93 of belladonna, 93 of calomel, 269 of cantharides, 121 of carbolic acid, 127 of carbonate of lead, 250 of chrysarobin, 153 of creosote, 1*0 of eucalyptus, 200 of gallic acid, 201 of galls, 205 with opium, 205 of iodide of lead, 250 of potassium, 227 of iodine. 231 of iodoform, 233 of lead acetate, 250 of mercury, 270 Ointment of mezereum, 274 of nitrate of mercury, 271 of oxide of zinc, 301 of red iodide of mercury, 266 oxide of mercury, 271 of resin, 329 of rose-water, 332 of salicylic acid, 338 of savine, 344 of stramonium, 356 of sulphur, 361 of tannic acid, 366 of tar, 325 of tartrate of antimony, 73 of turpentine, 376 of veratrine, 378 of yellow oxide of mercury, 271 Ointments, 24 Oleatum hydrargyri. 270, 271 veratrina?, 379 Oleoresina aspidii, 87 capsici, 123 cubeba?, 182 lupulini, 215 pi peris, 307 zingiberis, 208 Oleum amygdala? amara?, 58 expressum, 58 cajuputi, 110 caryophylli, 163 chenopodii, 133 cinereum, 261 cinnamomi, 162 copaiba, 176, 177 crotonis, 181 cubeba?, 1*2 erigerontis, 192 eucalypti, 200 gaultheria?, 205 jecoris aselli, 168 juniperi, 245 lini, 203 mentha? piperita?, 301 morrhua?, 168 myristicae, 2*7 picis liquids?, 324 pimenta?, 57 phosphoratum, 317 ricini, 130 ruta?, 333 sabina?, 343 santali, 340 sinapis, 275 volatile, 275 suceini, 61 tanaceti, 366 terebinthina?, 375 rectificatum, 375 tiglii, 1*1 valerianic, 377 Opium, 291 deodoratum, 29* Opodeldoc, 349 Oxalate of ammonium, 67 of cerium, 133 of iron, 242 Ox-gall, 300 Oxide of antimony, 69 of calcium, 113 of lead, 251 of mercury, 271 of zinc, 301 708 INDEX 01 Oxygen, 302 Oxygen-water, 302 Oxymel, 215 scilla?, 355 Oxytocics, 32, 38 PALE CINCHONA, 155 rose, 332 Pancreatin, 304 Papain, 305 Papaverine, 292 Papayotin, 305 Papers, 22 Papoid, 305 Paraldehyde, 305 Paregoric, 298 Pareira, 306 Pareirae radix, 306 Parsley, 7* Pearson's solution, 84 Pelletierine, 326 Pental, 306 Pepo, 307 Pepper, 307 Peppermint, 308 Peppermint-water, 309 Pepsin, 309 cordial, 309 Pepsinum saccharatum, 309 Peptonized beef, 431 enema, 431 milk, 430 -punch,430 oysters, 431 Permanganate of potassium, 310 Peroxide of hydrogen, 219, 309 Petrolatum, 310 liquidum, 310 inolle, 310 spissum, 311 Petroselinum, 78 Phenacetin, 311 Phenic acid, 123 Phenocoll, 313 hydrochloride, 313 Phenol, 123 Phenozone, 73 Phenyl-dimethyl-pyrazolon, 73 Phenylic alcohol, 123 Phlebotomy, 428 Phosphate of ammonium, 67 of iron, 242 of sodium, 314 of strontium, 356 Phosphide of zinc. 314 Phosphorated oil, 317 Phosphoric acid, 314 Phosphorus, 314 Physostigma, 317 Physostigmatis semen, 317 Physostigmina, 317 Physostigmina? salicylas, 318 sulphas, 318 Phvsostigmine, 297 Picric acid, 318 Pill of three valerianates, 378 Pills, 23 Pilocarpina? hydrochloras, 322 nitras, 322 Pilocarpine, 319 Pilocarpus, 319 DRUGS. Pilula asafoetida? composita, *6 colocynthidis composita, 174 et hyoscyami, 174 conii composita, 175 ferri carbonatis, 238 hydrargyri, 266 ipecacuanha? cum scilla, 236 plumbi cum opio, 250 saponis composita, 298 scammonii composita, 344 scilla? composita, 355 Pilula? aloes, 59 et asafoetida?, 60 et ferri, 59 et mastiches, 59 et myrrha?, 59, 276 antimonii composita?, 73 asafoetida?, 86 cathartica? composita?, 174 vegetabiles, 174 ferri iodidi, 241 opii, 298 phosphori, 317 rhei, 331 composita?, 331 Pimenta, 57 Pinkroot, 353 Piper, 307 nigrum, 307 Piperazine, 322 Piperin, 307 Pipsissewa, 133 Piscidia erythrina, 323 Pitch, 324 Pix, 324 burgundica, 324 canadensis, 324 liquida, 324 Plaster of ammoniac with mercury, 64 of arnica, 81 of asafoetida, 87 of belladonna, 93 of Burgundy pitch, 324 of Canada pitch, 324 of cantharides, 121 of capsicum, 123 of iodide of lead, 250 of iron, 243 of lead, 251 of menthol, 309 of mercury, 270 of opium, 299 of resin, 251, 329 of soap, 349 of tar, 324 Plasters, 23 Plumbi acetas, 249 carbonas, 250 iodidum, 250 nitras, 251 oxidum, 251 Plumbum, 246 Plummer's pills, 73 Podophylli rhizoma, 325 Podophyllin, 325 Podophyllum. 325 Poke-root, 379 Pomegranate, 326 Port wine, 56 Porter, 56 Potash papers, 263 Potassa, 132 INDEX OF DRUGS. 709 Potassa caustica, 132 cum calce, 113, 132, 381 Potassii acetas. 46 bicarbonas, 95 bitartras, 97 bromidum, 100 carbonas, 12* chloras, 138 citras. 162 effervescens, 162 cyanidum, 183 iodidum, 224 nitras, 277 permanganas, 310 et sodii tartras, 332 tartras acida, 97 Potassium nitrite, 282 Precipitated carbonate of calcium, 110 of zinc, 128 phosphate of calcium, 110 sulphur, 360 Prepared chalk, 112 Pride of China, 88 Proof spirit, 56 Protiodide of mercury, 271 Protonuclein, 287 Prunus Virginiana, 327 Prussic acid, 217 Pseudomorphine, 292 Pulvis amygdala? compositus, 58 antimonialis, 69, 73 aromaticus, 129, 162 catechu compositus, 132 cinnamomi compositus, 162 , creta? aromaticus, 112 compositus, 112 cum opio, 113 effervescens compositus, 346 elaterini compositus, 189 glycyrrhiza? compositus, 252, 348 ipecacuanha? compositus, 236 et opii, 236, 298 jalapse compositus, 244 kino compositus, 245 morphina? compositus, 300 opii, 29* compositus, 29* rhei compositus, 331 scammonii compositus, 344 Pumpkin-seed, 307 Punch, milk-, 55 Punk, 51 Purging cassia, 130 Purified aloes, 59 ox-gall, 301 sulphide of antimony, 69 Pyoktanin, 272 Pyrogallic acid, 327 Pyrogallol, 327 Pyrophosphate of iron, 212 QUASSIA, 328 Ouassia? lignum, 328 Queen's root, 355 Quercus alba, 328 Lusitanica, 204 tinctoria, 329 Quevenne's iron, 237, 242 Quicksilver, 258 Quinicine, 155 Quinidina? sulphas, 161 Quinina? bimuriatica carbamas, 160 bisulphas, 159 hydrobromas, 159 hydrochloras, 159 sulphas, 159 valerianas, 159, 378 Quinine, 154 chocolates, 159, 160 RASPBEREY, 332 Rectal medication, 20 Eectified spirit, 56 Eed cinchona, 155 iodide of mercury, 266 oxide of mercury, 271 precipitate, 271 ointment, 271 rose, 332 wine, 56 Eeduced iron, 237, 242 Reliability and strength of drugs, 28 Remedial measures other than drugs, 383 Remedv, cold as a, 390 Resin, 329 cerate, 329 ointment, 329 plaster, 251, 329 Resina, 329 jalapa?, 244 podophylli, 326 scammonii, 344 Resorcin, 329 Rest cure, 41* Restorative beef essence, 434 Revulsives, 33 Rheum, 330 radix, 330 Ehigolene, 330 Ehubarb, 330 Ehus aromatica, 331 glabra, 331 Bice-water, 434 Roborants, 33 Eochelle salt, 332 Rosa centifolia, 332 gallica, 332 Rose-water, 332 Rosin, 329 Rottlera, 245 Eubus idaeus, 332 Rue, 333 Rules for dosage, 24 Rum, 56 Russian bath, 413 SABINA, 343 Saccharated carbonate of iron, 237. 238 iodide of iron, 241 pepsin, 309 solution of iime, 114 Saccharin, 333 Saccharum, 358 lactis, 35* oflicinarum, 35* pur$\catuin, 358 Sal pruned!..'. 277 Salicylate of bismuth, 333 of lithium, 253 of mercury, 334 of methyl', 205 710 INDEX OF DRUGS. Salicylate of physostigmine, 318 of sodium, 339 Salicylic acid, 334 ointment, 338 Salol, 339 Salophen, 340 Salt, 140 Saltpetre, 277 Salts, 257 Sandalwood, 340 oil, 340 Sanguinaria, 341 Santonin, 341 Santoninate of sodium, 342 Santoninic acid, 341 Santoninum, 341 Sapo, 349 duris, 349 mollis, 349 Sarsa? radix, 343 Sarsaparilla, 343 Savina? cacumina, 343 Savine, 343 ointment, 344 Scammonium, 344 Scammony, 344 Scilla, 354 Scillin, 354 Scillipikrin, 354 Scillitoxin, 354 Sclerotinic acid, 190 Scoparii cacumina, 345 Scoparin, 345 Scoparius, 345 Scopolamine, 344 Seidlitz powder, 322, 346 Senega, 326 Senega? radix, 326 Senna, 347 Alexandrina, 347 Indica, 347 Serpentaria, 348 rhizoma, 348 Sherry, 56 Silicate of potassium, 348 of sodium, 348 Sinapis alba, 275 alba? semina, 275 nigra, 275 nigra? semina, 275 Sinapisma, 276 Slaked lime, 114 Smooth sumach, 331 Snake-weed, 201 Soap, 349 liniment, 116, 349 plaster, 349 Socotrine aloes, 58 Soda, 133 caustica, 133 tartarata. 332 Sodii acetas, 351 arsenas, 84 bicarbonas, 95 boras, 98 bromidum, 105 chloridum, 140 hyposulphis, 351 iodidum, 227 phosphas, 314 et potassii tartras, 332 salicylas, 339 Sodii santoninas, 342 sulphas, 351 Sodio-theobromine salicylate, 349 Sodium, 350 chloride, 140 ethylate, 350 hyposulphite, 351 iodide, 227 sulphate, 351 Soft petrolatum, 310 Solanum Carolinense, 352 Soluble glass, 348 Solution of acetate of ammonium, 64 of iron, 243 of morphine, 300 of ammonia, 64 of arsenate of potassium, 84 of sodium, 84 of arsenous acid, 84 of carbonate of magnesium, 256 of chloride of antimony, 73 of zinc, 140 of chlorinated lime, 141 of chromic acid, 153 of citrate of ammonium, 67 of bismuth and ammonium, 96 of iron, 240 of potassium, 95, 162 of hydrochlorate of morphine, 300 of iodide of arsenic and mercury, 84 of iodine, 231 of lime, 113 of nitrate of mercury, 271 of pepsin, 309 of perchloride of mercury, 266 of permanganate of potassium, 310 of persulphate of iron, 241 of potassa, 253 of soda, 132 of subacetate of lead, 250 of sulphate of atropine, 93 of morphine, 300 of tersulphate of iron. 85 Somnal, 352 Sozoiodol, 352 Spanish fly, 120 Sparteine, 345 Sphacelinic acid, 190 Spice plaster, 402 Spigelia, 353 Spirit of Mindererus, 64 of turpentine, 375 spray, 22 Spiritus aetheris compositus, 213 nitrosi, 364 ammonia?, 64 aromaticus, 64 fcetidus, 64 cajuputi, 110 camphora?, 116 chloroformi, 152 cinnamomi, 162 frumenti, 56 gaultheria?, 205 glonoini, 283 juniperi, 245 compositus, 56, 245 menthae piperita?, 308 myristicae, 237 odoratus, 56 phosphori, 317 rectificatus, 56 INDEX OF DRUGS. 711 Spiritus tenuior, 56 vini gallici, 56 Springs, mineral, 420 Squill, 354 Squirting cucumber, 189 Starch, 355 poultice, 355 water, 355 Stillingia, 355 Stramonii folia, 356 semen, 356 Stramonium, 356 Strength, relative, of drugs, 27 Stronger water of ammonia, 63 Strontium, 356 bromide, 356 iodide, 356 lactate, 356 phosphate, 356 Strophanthin, 357 Strophanthus, 357 Strychnina? sulphas, 291 Strychnine, 288 Styptic collodion, 173 Subcarbonate of bismuth, 96 Subgallate of bismuth, 97 Sublimed sulphur, 360 Subnitrate of bismuth, 95 Subsulphate of iron, 237, 241 Suecinum, 61 Succus belladonna?, 93 conii, 175 hyoscyami, 221 limonis, 163 scoparii. 346 taraxaci, 367 Smrar. 35* of lead, 249 of milk, 358 Sulphate of aluminum, 60 of ammonium, 67 of atropine, -9, 93 of calcium, 110, 112 of cinchonidine, 161 of cinchonine, 161 of copper, 177 of hyoscyamine, 221 of iron, 237, 242 and ammonium, 237 of magnesium, 257 of manganese, 257 of morphine, 300 of physostigmine, 318 of quinidine, 161 of quinine, 160 of sodium, 351 of sparteine, 345 of strychnine, 291 of zinc, 35* Sulphide of ammonium, 67 of antimony, 69 Sulphocarbolate of sodium, 349 of zinc, 359 Sulphonal, 359 Sulphur, 360 lotum, 360 ointment, 361 pra?cipitatum, 360 sublimatum, 300 Sulphurated antimony, 69 lime, 114 Sulphuric acid, 362 Sumach, smooth, 331 sweet, 331 Sumbul, 363 pill, Goodell's, 363 radix, 363 Suppositoria acidi carbolici cum sapone, 127 tannici, 366 asafoetida', *7 glycerina?, 208 hydrargyri, 270 iodoformi, 234 morphina?, 300 cum sapone, 300 plumbi composita, 250 Suppositories, 21, 23 Suprarenal gland, 363 Suspension, 425 Swamp hellebore, 379 Sweet almonds, 57 spirit of nitre, 364 sumach, 331 Sydenham's laudanum, 298 Syrup of acacia, 41 of tar, 324 Syrupus acacia?, 41 acidi citrici, 163 allii, 57 amygdala?, 58 calci lactophosphatis, 112 chloralis, 136 ferri bromidi, 238 iodidi, 240 phosphatis, 242 quininae et strychnina? phospha- tum, 242 hypophosphitum, 112 cum ferro, 241 ipecacuanhas, 236 limonis, 163 picis liquids?, 324 pruni Virginiana?, 327 rhei, 331 aromaticus, 331 rosa?, 332 rubi idad, 332 sarsaparilla? compositus, 210, 343 scilla?, 355 compositus, 73, 354 senega?, 347 sennae, 317 zingiberis, 207 TABELL.E NITROGLYCERINI, 283 Tablets, 23 of nitroglycerin, 283 Taeniin, 182 ' Taka-diastase, 183 Tamarinds, 365 Tamarindus, 365 Tanacetum, 366 Tannate of quinine, 159 Tannic acid, 365 Tansy, 366 tea, 367 Tar, 324 ointment, 325 water, 324 Taraxacum, 367 Tartar emetic, 69 Tartaric acid, 367 Tartrate of antimony and potassium, 69 712 INDEX OF DRUGS. Tartrate of iron and ammonium, 240 and potassium. 240 of potassium and sodium, 332 Terebene, 367 Terebinthina, 374 Terpine hydrate, 368 Terpinol, 368 Tetronal, 374 Thapsia, 369 Thebaine, 292 Theine, 108 Theobromine, 246, 349 Therapeutical considerations, general, 1 nihilism, 17 Therapeutics, definition of, 18 Thiol, 369 Thiolum liquidum, 369 siccum, 369 Thiosinamine, 369 Thiosulphite of sodium, 351 Thoroughwort, 201 Thymol, 370 iodide. 370 Thymus gland, 371 Thyroid gland, 371 Thyrcoidine, 373 Tinctura aconiti, 50 aloes, 60 et myrrha?, 60, 276 arnica?, 81 floruni, 81 radicis, 81 asafoetida?. so belladonna? foliorum, 93 benzoini, 95 composita, 95 bryonia?, 106 buchu,107 calumba?, 113 camphora? composita, 116, 298 cannabis indica?, 120 cantharidis, 121 capsici, 123 cardamomi, 129 composita, 129 catechu, 132 composita, 132 chiratae, 131 chloroformi composita, 152 et morphinae, 152, 300 cimicifuga?, 154 cinchona?, 161 composita, 161, 348 cinnamomi, 162 colchici seminis, 172 conii, 175 convallariae, 176 cubeba?, 132 digitalis, 183 ergotae, 192 ferri chloridi, 239 perchloridi, 239 gallae, 204 gelsemii. 206 gentiana? composita, 207 guaiaci, 210 ammoniata, 210 humuli, 215 hydrastis, 216 hyoscyami, 221 iodi, 231 colorless, 231 Tinctura ipecacuanha? et opii, 298 jaborandi. 322 jalapa?. 244 kino, 245 lobelia?, 254 aetherea, 255 lupuli, 215 moschi, 275 myrrha?, 276 nucis vomicae, 291 opii, 298 ammoniata. 298 campborata, 29* deodorati, 29* physostigmatis, 318 podophylli, 326 quassia?, 328 quininae ammoniata, 161 rhei, 331 aromatica, 331 dulcis, 331 sabina?, 344 sanguinaria?, 341 scilla?, 346 senega?, 347 senna?, 348 serpentaria?, 348 stramonii, 356 strophanthi, 357 sumbul, 363 Valeriana?, 377 ammoniata, 377 veratri viridis, 381 zingiberis, 207 fortior, 208 Tinctures, 24 Tonics, 33, 39 Touchwood, 51 Transfusion, 426 Tribromethane, 106 Trichloracetic acid, 373 Trikresol, 374 Trinitrin, 283 Trinitrophenol, 318 Trional, 374 Triturates, 24 Trituratio elaterini, 1*9 Troches, 24 Trochisci acidi benzoici, 95 tannici, 366 bismuthi, 96 catechu, 132 creta?, 112 cubeba'. 182 ferri redact i, 242 glycyrrhiza' et opii, 253 ipecacuanhae, 236 magnesia?, 255 nientha? piperita', 30* morphina?, 300 et ipecacuanha?. 236, 300 opii, 298 potassii chloratis, 140 santonini, 342 sodii santoninatis. 342 zingiberis, 208 Tropic acid, 214 Tropine, 214 Tully's powder. 300 Turkish bath, 410 home modification of, 412 Turpentine, 374 INDEX OF DRUGS. 713 Turpentine liniment, 376 ointment, 376 stupe, 375 Turpeth mineral, 272 u XGUENTUM ACIDI CARBOLICI, 127 gallici, 204 salicylici, 33- tannici. 366 aconitina?, 50 antimonii tartarati, 73 aqua? rosa>, 332 atropinae, 93 belladonna?, 93 cantharidis, 121 cetacei, 95 chrysarobini, 153 creosoti, 1*0 eucalypti, 200 galla?, 205 cum opio, 205 hydrargyri, 270 ammoniati, 264 iodidi rubri, 266 nitratis. 271 dilutum, 271 oxidi flavi, 271 rubri, 271 subchloridi, 269 iodi, 231 iodoformi, 233 mezerei, 275 petrolei, 310 picis liquidae, 325 plumbi acetatis, 250 carbonatis, 250 iodidi, 250 potassii iodidi, 227 resinae, 329 sabina?, 314 stramonii, 356 sulphuris, 361 terebinthina?, 376 veratrina?, 37* zinci oxidi, 301 Unna's dressing, 301 Ursin, 377 Uva ursi, 377 Uva? ursi folia, 377 UALERIAN, 377 \ Valeriana? rhizoma, 377 Valerianate of ammonium, 67, 378 of iron, 242, 37* of quinine, 159, 378 of zinc, 378 Valerianic acid, 378 Vallet's mass, 239 Vapor acidi hydrocyanici, 219 chlori, 141 conii, 175 creosoti, 180 iodi, 231 Vaseline. 310 Vasomotor depressants, 33, 39 stimulants, 33, 39 Venesection, 42* Veratri viridis rhizoma, 3,79 Veratrina, 37* Veratrine ointment, 378 Veratroidine, 379 Veratrum viride, 379 Vienna paste, 3*1 mixture, 151 Vinegar, 46 of lobelia, 254 of opium, 293 of sanguinaria, 341 of squill, 351 Vinegars. 22 Vinum album, 56 aloes, 60 antiinoniale, 73 antimonii, 73 colchici, 172 radicis, 172 seminis, 172 ergotae, 192 ferri, 243 aniarum, 243 citratis, 243 ipecacuanha?, 236 opii, 29- picis, 325 portense, 56 quininae, 161 rhei, 331 rubrum, 56 xericum, 56 Virginia snake-root, 34* WAHOO, 200 \ V Warburg's tincture, 381 Warming plaster, 121, 324 Wash, black, 266 yellow, 272 Washed sulphur, 360 Water of chloroform, 152 Watered toast, 436 Wet pack, 410 Whiskey, 56 White ginger, 207 lead, 250 mustard, 275 oak, 328 precipitate, 264 ointment, 264 wine, 56 Whytt's tincture, 161 Wild cherry, .'527 Wine, 56 of aloes, 60 of antimony,73 of citrate of iron, 242 of colchicum-root, 172 of colchicum-seed, 172 of ergot, 192 of iron, 243 .- bitter, 243 of ipecac, 236 of opium, 29* of rhubarb, 331 of tar, 325 whey, 55, 435 Wines, 24 Wintergreen, 205 Witch-hazel, 212 Wormseed, 133 714 INDEX OF DRUGS. .^ANTHOPUCCINE, 216 \TELLOW CINCHONA, 155 I gentian, 206 iodide of mercury, 271 jasmine, 205 oxide of mercury, 271 prussiate of potassium, 177 pyoktanin, 272 sulphate of mercury, 272 wash, 272 Young's rule for dosage, 24 ZIXCI ACETAS, 382 carbonas, 128 praecipitatus, 128 I chloridum, 140, 3*9 oxidum, 301 venale, 301 phosphidum, 314 sulphas, 358 sulpho-carbolas, 359 as an antiseptic, 389 valerianas, 377 Zingiber, 207 INDEX OF DISEASES AND REMEDIES. ABORTION, 437 Cascara sagrada, or compound liquorice powder, as a laxative for associated con- stipation ; if these fail, rhubarb or castor oil, 437 Cimicifuga, fluid extract, gtt. 10 to 20 (0.65-1.3), night and morning, as a pro- phylactic, 438 Creolin (2 per cent, solution), should be in- jected after removal of the membranes, or if fever should follow, 439 Curettement, 439 Diet and hygiene, 437 Elaterium, jalap, scammony, strychnine, erigeron, cantharides, contraindicated, unless very necessary, 437 Ergot and quinine, in small doses, with perfect vest for one or two weeks, and antiseptic irrigation as an after-treat- ment, 439 Iodine, applied to the inner surface of uterus, after removal of membranes, as a hemostatic and antiseptic, 439 Opium or morphine, best agents to quiet uterus if abortion threatens, 438 Podophyllin, senna, salines in active doses, and aloes, not to be used if they can be avoided, 437 Quinine, useful in malarial poisoning, as a preventive; in other cases contraindi- cated, 438 Saline purges contraindicated, except in plethoric women, 437 Sponges should not be used as tampons, 438 Tampons of absorbent cotton, dusted with iodoform, followed later by ergot, if abortion is inevitable, 438 Venesection useful in plethoric women to prevent, 438 Viburnum prunifolium, fluid extract, drachm 1 to 1£ (4.0-6.0], taken during pregnancy as a prophylactic, 438 ABSCESS, 439 Aconite or veratrum viride, in full dose, often aborts, 439 Alcohol, given with milk, in cold abscess, 440 Belladonna ointment, locally applied, to abort; or tincture, internally, if aco- nite is not at hand, 439 Calx sulphurata, gr. ifo (0.006) every hour or two, useful to abort or cause absorp- tion, 439 Carbolic acid, minims 5 to 10 ('0.3-0.65) of 2 per cent, solution, injected into gland threatening suppuration, 439 Cod-liver oil with hypophosphites, quinine, and iron, useful in cold abscess, 440 Hydrogen peroxide, 10 per cent, solution, to wash out cavity of tubercular or slow abscess, 220, 440 Incision, if pus forms, followed by irriga- tion with carbolic acid (1: 20) or bichlo- ride solution (1 : 5000) and antiseptic dressing, 440 Iodine, locally applied, may abort, 439 Iodoform gauze, packed into cavity, or ethereal solution injected after aspira- tion, and antiseptic dressing, useful iu tubercular abscess, 440 Lead-water, applied on bread-crumb poul- tice or lint, in early stage, to abort, 439 Nitrate of silver, gr. 20 to 40 (1.3-3.0) to the ounce, locally applied, may abort, 439 Poultices to assist maturation, 440 Prescriptions for tonics, in cold abscess, 440 ACIDITY. Ammonia, the most active remedy in gas- tric acidity, contraindicated if acute irritation exists, 63 Bicarbonate of sodium, in form of effer- vescing powder, valuable iu gastric acidity, 95 Bismuth a slow and feeble antacid, 96 Carbonate of calcium, precipitated, best antacid in intestinal acidity. Ill Cerium oxalate, used in some cases of gas- tric acidity instead of bismuth, 133 Charcoal useful in some cases of " sour stomach," 127 Lime-water, 113 Liquor potassa- useful both for gastric and urinary acidity, 253 Magnesium a useful antacid, 256 ACNE, 441 Calx sulphurata. gr. ^ to £ (0.006-o.oOS) in pill, thrice daily, in pustular acne, 114, 441 Carbolic acid touched to pustules, after in- cision, 441 Cod-liver oil, if scrofulosis exists, 441 Fowler's solution often cures and prevents relapse, dose gtt. 1 to 3 (0.05-0.15) thrice daily for a month or two, 441 Green or Castile soap used in face-bath night and morning, followed by brisk rubbing; if irritation ensues, simple cerate or emulsion of bitter almonds will relieve, 441 715 716 INDEX OF DISEASES AND REMEDIES. Ichthyol, 20 parts to 100 of lard, well rubbed in, when induration is great, 223, 441 Mercurial ointment, to relieve induration, several days intervening between its use and that of sulphur, 441 Phosphorus especially useful in acne indu- rata, 310 Resorcin, gr. 10 to 20 to the ounce (0.65- 1.3 : 32.0) of lard, when induration is great, 441 Saline purges, followed by cascara sagrada or similar remedy, to regulate bowels, if dependent upon obstinate constipa- tion, 141 Sulphur internally and as a wash or oint- ment for women with disordered men- struation, prescription for, 362, 441 ADDISON'S DISEASE. Suprarenal gland, 363 ADENITIS, 442 Ichthyol, prescription for, 442 Iodine ointment and lard, equal parts, ap- plied by inunction night and morning, or tincture, as a paint, stopping applica- tion on appearance of redness or fluc- tuation, 442 Iron, syrup of the iodide, gtt. 5 to 20 (0.3- 1.45) in children, 442 Lancing preferable to allowing abscess to break, 442 Poultice, when redness or fluctuation ap- pears, 442 Removal of gland by dissection, if enlarge- ment is scrofulous, 442 Tonics, to improve systemic condition, 442 ALBUMINURIA. (See Beight's Disease.) Gallic acid, if due to atony of kidneys, 204 Strontium lactate, if due to renal atony, ALCOHOLISM. (See Poisoning from Alcohol.) ALOPECIA, 442 Chrysarobin, drachm £ to 1 (2.0-4.0) to lan- olin 1 ounce (32.0), 443 Corrosive sublimate, gr. 2 to 5 (0.1-0.3) to rectified spirit 1 drachm (4.0) and oil of turpentine 7 drachms (28.0), 443 Liquor epispasticus painted over bald spot after loose hairs have been depilated, 442 Pilocarpine, locally applied, often stimu- lates new growth; too much causes small pustules around follicles; pre- scription for, 322 AMBLYOPIA AND AMAUROSIS, 443 Antipyrin, 444 Bromide of potassium, 444 Cauterization of nape of neck, 443 Correction of optical errors, when arising from congenital trouble or non-use, 443 Cups, wet and dry, 443 Digitalis in toxic cases, 444 Electricity, constant current, 443 Emmenagogues, if due to menstrual dis- orders, 443 Fly-blister to temple in some cases, 443 Iodide of potassium, 443 Lactate of zinc, 444 Mercury, when due to syphilis, 443 Metallo-therapy, may be tried in hysterical cases, 443 Nitrate of silver, 444 Nitrite of amyl, inhalations, 444 Nitro-glycerin, 444 Nux vomica iu ascending doses in tobacco or alcoholic cases, 290 Phosphorus, 444 Pilocarpine, in uraemic, tobacco, or alcohol amaurosis, 321, 443 Salicylates, 444 Stretching the optic nerve, 444 Strychnine, hypodermically, after irrita- tion has subsided, 443, 444 Suspension, and injections of testicular juice, 444 AMENORRHEA, 444 Aloes, as a specific, when dependent upon constipation, atony of sexual system, or anaemia, 59, 445 Apiol, 3 to 10 minims (0.15-0.64) in capsule thrice daily for a week before date of menstruation, 79, 445 Arnica, 80 Binoxide of manganese, gr. 1 to 3 (0.05- 0.15), taken for two weeks before time of menstruation, 257, 445 Cantharides, as a stimulant, if due to atony or depression, 120 Cimicifuga, fluid extract, gtt. 30 (2.0), at the proper time for a flow, 154, 445 Dewees's einmenagogue mixture, 445 Eupatorium, in hot infusion, if due to cold, 201 Goodell's prescription for, 445 Griffith's pills, largely used when depend- ent upon anaemia, 239 Hot sitz-bath, for several nights before period; mustard added often increases its efficacy, 445 Iron and myrrh, a standard remedy if due to atony or anaemia, 276, 445 Oil of rue, gtt, 5 (0.3), in capsule, thrice daily, 445 Potassium permanganate, useful, but infe- rior to binoxide of manganese, 310, 445 Salines inferior to aloes if due to constipa- tion, 445 Savine, gtt, 5 (0.3), in capsule, thrice daily, to stimulate uterus, 343, 445 Tansy, gtt. 5 (0.3), in capsule, thrice daily, or in form of tansy tea, 445 ANAEMIA, 445 Aromatic mixture of iron, 238 Arsenate of iron in anaemia of chronic diarrhoea, 238 Arsenic, not to exceed gr. ^ (0.004) daily alone or combined with iron, valuable! 449; very valuable in pernicious and malarial amemia. 82 Arsenite of copper, 17*. 449 Beta-naphthol. when due to intestinal in- digestion, 44* INDEX OF DISEASES AND REMEDIES. 717 Bitters, simple or aromatic, in conjunction with iron, when stomach and intestines are atonic, 44* Blaud's pill, 44* Bromide of iron, gr. 5 to 20 (0.3-1.3), in syrup, useful when there is chorea, 23* Bullock's blood, fresh or dried, given by enema when iron fails, 449 Carbonate of iron, 44* Chloride of iron, useful because of its tonic I properties, 239 Dialyzed iron, 240 Diet and hygiene, 449 Hypophosphites and phosphate of lime, with cod-liver oil, iron, and quinine, when anaemia is due to childbearing and lactation, 112, 44* Iodide of iron, syrup of, largely used in strumous and scrofulous anaemias, 241 I Iron, 237, 447 Mercury bichloride or calomel, especially valuable in syphilitic cases. Inunctions of mercurial ointment, once a day or every other day, of service in all forms of anaemia, 205, 44* Oxygen inhalations of value, 302 Quevenne's iron, 44* Quinine in malarial cases, and in tonic doses in all other anaemias, 41* Reduced iron, with laxatives and mineral acids for their effects on intestines and liver, in uncomplicated cases, 449 Salol, when due to decomposition products, 44-^ Sulphate of iron or some other astringent preparation in conjunction with mild purges, when tongue is broad, flabby and white, 44* Suprarenal gland useful in pernicious type, 364 ANAL FISSURE, 449 Carbolic acid, 1 drop (0.05), applied to fis- sure to effect cure; in addition when hemorrhoids are present, a lotion of tannic acid, glycerin, and water, 450 (Jastor oil, to relieve bowels if sulphur can- not be used, 450 Flexible collodion painted over spot, may relieve, 450 Iodoform suppositories, gr. 2 to 10 (0.1- 0.65), relieve pain of defecation ; bella- donna, gr. } (0.016) to be added when there is spasm of sphincter, 450 Potassium bromide, drachms 14 to the ounce (6.0: 32.0) of glycerin, locally ap- plied to fissure by means of a brusb, highly recommended, 450 Sulphur, 20 to 40 grains (1.3-2.6), combined with powdered cinnamon or aromatic powder, at night to render passages soft, 450 ANEURYSM, 450 Aconite, inferior to veratrum viride as a cardiac sedative, 450 Chloroform inhalation if dyspnoea is great, 451 Digitalis, contraindicated, 450 Iodide of potassium, in large doses, asso- ciated with restricted diet and rest in bed ; more valuable in syphilitic than in other forms of the disease, 225, 450 Morphine, gr. £ (0.008), combined with croton chloral, gr. 10 (0.65), in sleepless- ness due to pain, 451 Veratrum viride, gtt. 1 to 2 (0.05-0.1), twice or thrice daily if heart is excitable and vascular tension high, 380, 450 ANGINA PECTORIS, 451 Aconite, useful between attacks, 452 Alcohol, instead of nitrites, when there is vascular relaxation, 451 Antipyrin, gr. 20 (1.3), valuable in some cases, 451 Arsenic, in full dose long continued, and elimination of causes of nerve-storm, 452 Cactus grandiflorus, in some cases, 108 Digitalis, when heart is weak, 451 Ether, in 1-drachm (4.0) doses in ice-water or capsule, to nervous females, often aborts, 451 Hoffmann's anodyne, often the best rem- edy, 214, 451 Morphine, gr. i to i (0.016-0.03) hypoder- mically, when nitrite of amyl fails to relieve, 452 Nitrite of amyl, inhalation of a few drops from handkerchief during attack, 63, 451 Nitrite of sodium or potassium, gr. 3 (0.15), thrice daily, useless unless arterial ten- sion is high and heart throbbing. 282, 451 Nitro-glycerin, gtt. 1 (0.05) of a 1 per cent. solution during attack, 283, 451 Phosphorus, gr. j^ (0.0006), after meals, often of value, 452 Prescription for use between attacks, 452 Stomach-pump may be required when due to overloaded stomach. 452 Tonics combined with careful diet and hy- giene necessary to a cure, 452 ANOREXIA, 452 Calomel, useful when following acute dis- ease ; nitro-muriatic acid, however, gen- erally preferable, 268 Capsicum, in convalescence, acts most fav- orably, 122 Chimaphila, in dropsical patients, as a tonic and diuretic, 134 Eupatorium useful in, 201 Gentian, 207 Prescriptions for tonics, 452 Quassia, especially valuable when follow- ing malarial fever, 328 APOPLEXY, 453 Belladonna, hypodermically, if respiration fail, 454 Croton oil, gtt. 1 (0.05) with sweet oil gtt. 5 (0.3), as a depletant cathartic, 453 Elaterium, gr. i (0.01), as a depletant cathartic, 453 Ice to the head, 453 Iodide of potassium, in large doses several days after attack, when clot has firmly formed, to promote absorption, 453 Massage and electricity, applied to muscles 718 INDEX OF DISEASES AND REMEDIES. to prevent atrophy; contraindicated if inflammation exist, 453 Mercury, 453 Mustard plaster to feet, or mustard foot- bath and ice to head, keeping head high and feet low, 453 Opium and calomel, gr. J (0.016) of each every four hours, if meningitis arise, 453 ' Stimulants contraindicated, 454 Strychnine, hypodermically, if respiration fail; is also useful to stimulate trophic centres in cord, 453 Venesection, if patient is full-blooded, to prevent inflammation and further leak- age, 453 Veratrum viride or aconite, when venesec- tion is impossible, to lower blood-pres- sure, 453 APPENDICITIS, 454 Absolute rest necessary, 454 Ice-bag or leeches, applied to appendicular region, 454 Magnesium sulphate or citrate. 455 Opium or morphine (after the bowels have moved), to relieve pain and act as an antiphlogistic, 455 Surgical treatment, 455 ARTHRITIS. Bicarbonate of sodium, applied to part on lint, to allay pain, 95 Lithium carbonate and citrate, prevent deposit in joints from rheumatoid ar- thritis, 253 Mustard plaster, as a counter-irritant, 275 Veratrine ointment, 378 ASCARIS LUMBRICOIDES. (See Worms.) ASCITES. (See Dropsy.) ASPHYXIA, 455 Ammonia, injected intravenously into leg, to stimulate heart and respiration, 63 Artificial respiration, Sylvester's method, 435 Electricity, only to be used as a peripheral irritant to restore respiration, 450 Laborde's lingual traction of great value. 456 Oxygen inhalations, 302 Rules regarding position of patient, 456 ASTHENOPIA, 456 Cannabis indica, in retinal asthenopia, pre- scription for, 119 Eserine or pilocarpine, weak solution, as a stimulant to ciliary muscles, 457 Glasses, combined with prisms if necessary, to correct optical defects, 456 Hot compresses, 457 Massage, rest, salt baths, strychnine, and iron, if due to neurasthenia, 456 Strychnine or tincture of nux vomica in large doses, to stimulate ciliary muscles, 457 ASTHMA, 457 Aconite, in early stages, 49 Arsenic, internally or smoked in cigarettes, best reined v when mucous membrane is at fault, *:;'. 460 Belladonna, combined with morphine, very useful, 92, 45* Bromide of potassium or sodium, gr. 30 (2.0), half an hour before retiring. 460 Bronchitis-tent, 460 Chloral, rarely useful; if pushed, danger- ous, 136 Chloroform, inhaled, relaxes spasm ; also useful in form of liniment applied to chest, to abort, 152, 458 Cocaine, applied to nasal cavities, if due to nasal disorders, 460 Cofl'ee, a cup of strong black, during parox- ysm, 109, 459 Compressed and rarefied air, 460 Diet and hygiene, 460 Ethyl iodide, to increase secretions and prevent thickening, 199 Euphorbia pilulifera, -J to 1 drachm (2.0- 4.0) of the fluid extract, 201, 459 Gelsemium, 206 Grindelia, fluid extract of, gtt. 20 to 60 (1.3-4.0), or leaves soaked in nitre smoked as cigarettes, or fumes of burn- ing leaves inhaled, exceedingly useful, 209. 460 Iodide of potassium, useful in bronchial, harmful in gastric type, 225, 460 Lobelia, tincture gtt. 10 (0.65) every four hours, if attack threaten; in emetic dose if heart be strong, when spasm is present, 254, 458 Morphine, hypodermically, gr. J to J (0.01- 0.016), alone or combined with atropine, 458 Nitrate of potassium alone or combined with belladonna, in form of cigarettes or inhalations of fumes, often relieves, 277, 45* Nitrite of amy], 3 to 6 drops (0.15-0.3) on handkerchief, inhaled with care, re- lieves spasm, 68, 459 Nitro-glycerin, serviceable if bronchial mu- cous membranes are engorged, 283, 459 Oil of amber, 61 Oxygen, inhalations when cyanosis is ex- treme, 460 Physostigma, in bronchial asthma, to aid in expelling mucus, 318 Sandalwood oil, useful in catarrhal cases, 341 Tobacco-smoking often efficacious in pa- tients not accustomed to it, 45s, 459 Zinc oxide, prescription for, 302 ATONY. Arsenic, in gastric and intestinal atony, 82, Calumba, valuable in gastro-intestinal atony following fevers, 113 Capsicum, one of the best remedies in gas- tric atony due to debility and alcohol- ism, 122 Cardamom, with bitter tonics and mineral acid, in gastro-intestinal atony, 128 Chimaphila, useful as a stimulating diu- retic in atonic renal conditions, 133 Hydrastis, indicated in atony of mucous membranes, 216 INDEX OF DISEASES AND REMEDIES. 719 Leptandra, in duodenal atony, 252 Lime salts, useful in atony of'mucous mem- branes, 111 Pepper, in atony of genito-urinary mucous membranes, 307 Physostigma, in intestinal and vesical atony. 31* Strychnine, in intestinal atony, 291 AURAL VERTIGO. Pilocarpine, 321 BALANITIS AND BALANO-POSTHITIS 551 Astringent solutions, to cleanse parts, zinc chloride (gr. 4 to the ounce [0.2 : 32.0] i, boric acid (1 per cent.), carbolic acid (1.5 per cent.) ; silver nitrate (gr. 1 to the ounce [0.05:32.0]) especially valu- able, 551 Lead-water, dilute, as a wet dressing, pre- ceded by astringent washes, in phimo- sis ; if inflammation increase, circum- cise, 551 Silver-nitrate stick, touched to ulcerations, 551 Tannin or zinc oxide, as a dusting powder, after retracting prepuce and cleansing parts, followed by returning prepuce over absorbent cotton, 551 BALDNESS. (See Alopecia.) BED-SORES, 460 Aloes, glycerole of, as a local application, 59 Alum, with spirit of camphor and white of egg, locally applied, to prevent, 461 Catechu, with lead subacetate, locally applied, to harden skin, 461 Glycerin application daily, after washing and rubbing part, to prevent, 20- Incision, followed by irrigation, if sores tend to burrow. 461 Iron, tincture of chloride, gtt. 20 (1.3) every four hours as a tonic, 461 Nitrate of silver (gr. 20 to the ounce [1.3: 32.0]), painted over threatening part, to abort. If ulcers form and are sluggish, same solution may be used, 280, 461 Salt and whiskey, rubbed over skin to harden it (drachms 2 to the pint [8.0: 500.0]), 461 Soap plaster, applied to sore after washing with bichloride solution (1 to 5000) and dusting with iodoform, 349, 461 Supportive measures and increased amount of food, if sloughs are large, 461 Zinc ointment, on squares of lint, sometimes used in lieu of soap plaster, 461 BILIOUSNESS, 461 Aconite, antagonizes the poisonous alka- loids which cause slow pulse, high arte- rial tension, etc., 464 Ammonium chloride, gr. 5 (0.3) thrice daily, if associated with catarrh, 464 Bromides and chloral, if nervousness and irritation are present, 464 Calomel, gr. £ (0.01) in powder every fifteen minutes until six are taken, followed in four hours by a saline, if stools be light, 203, 463 Chirata, extract of, gr. 5 (0.3), in hepatic torpor, prescription for, 464 Diet, 463 Euonymus, extract of, gr. 3 (0.15), 464 Horseback riding combined with gym- nastic movements especially valuable, 464 Ipecac, powdered, gr. 30 to 60 (2.0-4.0) or apomorphine, gr. ^ (0.OO4) hypoder- mically, may relieve in first stage, 463 Leptandra, where liver is torpid, 251 Mustard plaster or cup to nape of neck, if face is flushed ; foot-bath also of service, 464 Nitro-muriatic acid, gtt. 3 (0.15), thrice daily in water, of great service, 285, 464 Opium, antagonizes the poisonous alkaloid which causes hot skin, rapid pulse, di- lated pupils, etc., 464 Podophyllin, gr. £ (0.01), if stools be dark, 463 Protiodide of mercury, gr. ^V to ^ (0.001- 0.0016), in trituration, thrice daily, if due to catarrh, 464 Salines, if attack is sudden, to sweep out poisonous matter, 463 Salol or salophen, in 10 gr. (0.65) doses, useful as an intestinal antiseptic, 464 Stillingia, fluid extract of, dose 20 drops (1.3), 464 BLEPHARITIS, 465 Boric-acid lotion when there is accompany- ing conjunctivitis, 465 Chloral, 5 per cent, solution, to remove scabs and crusts, 465 Creolin, 1 to 2 per cent, solution, useful as a wash, 181 Methyl blue, 272 Ointments, dilute citrine, Pagenstecher's (yellow oxide of mercury, 1 gr. [0.05], vaseline, 1 drachm [4.0]), pyrogallic acid, milk of sulphur (3 per cent.), lo- cally applied after removal of crusts. 465* Silver nitrate, touched to crater-like ab- scesses, gives good results, 465 Sodium bicarbonate or biborate solution, gr. 8 to ounce (0.5:32.0), to remove scabs and crusts, 465 BOILS, 465 Atomized sprays useful in, 22 Belladonna, locally applied to relieve pain and inflammation, 466 Calcium sulphurate hastens pointing and prevents formation of new ones; use- less in boils of diabetes, 114, 465 Camphorated alcohol, applied over boils in formative stage, then wiped dry, fol- lowed by camphorated oil, to abort, 116, 466 Carbolic acid, 5 per cent, strength, injected into apex of boil when formation is assured, to abort, 126, 466 Chloride of calcium, added to poultice, hastens maturation, 111 720 IN DEN OF DISEASES AND REMEDIES. Collodion painted over inflamed spot, to abort, 173; if pus form it may be ab- sorbed, if not, evacuate by incision, 465 Egg-shells baked and eaten, for successive crops, 114 Opium, locally applied to relieve pain and inflammation, 466 Phosphorus, 316 Poultices, containing sweet oil and lauda- num, to assist maturation, 466 Prescription for ointment, 466 Silver nitrate (gr. 20 to the ounce T1.3: 32.0]), painted over part, mav abort, 280, 465 BREATH, FCETID. Camphor, as a mouth-wash, 115 BREASTS (INFLAMED), 466 Aconite or veratrum viride, to depress cir- culation, 466 Belladonna, internally or as an ointment, before and after inflammation, with sponge compresses to breast, 92, 466 Breast-pump, if milk continues to form, 466 Purges, mild saline, 466 BONE DISEASE. Iodide of iron, syrup of, if anasmia exist, 229 Iodine ointment, diluted one-half, or tinc- ture, locally applied, 229 BROMIDROSIS. Belladonna, 91 Borax of great value, 98 Carbonate of calcium, precipitated, a useful application, 111 Salicylic acid, used as a dusting powder, prescription for, 337 BRONCHITIS, 466 Aconite, alone or combined with sweet spirit of nitre, in initial stage, 49, 467 Amber, oil of, and olive oil (1:3), applied to back and front of chest, iu iufautile bronchitis, 61 Ammoniac, useful in old forms devoid of inflammation, 64 Ammonium carbonate, alone or with the chloride, especially useful in children ; gr. 2 to 10 (0.1-0.65) in syrup of acacia, 65 Ammonium chloride, in second stage, to stimulate bronchial tubes, prescription for, 469 Apomorphine, gr. ^ to £ (0.006-0.015), as an expectorant in subacute stage; if exudation accumulates rapidly, gr. ^a to ^ (0.003-0.000', hypodermically, as an emetic, 80, 470 Asafoetida as a stimulating expectorant, 86 Astringent sprays, often of value if secre- tion be excessive; tannic acid (gr. 2 to 3 to the ounce [0.1-0.15:32.0]), alum solution (a few grains to saturation), Monsel's solution (10 to 15 drops to the ounce [0.65-1.0: 32.0J), lead acetate (gr. 1 to 5 to the ounce [0.05-0.3 : 32.0J), 471 Belladonna, to check excessive secretion and stimulate respiration, 470 Benzoic acid, 95 Bronchitis tent, 468 Caffeine, or strong coffee, to stimulate res- piration if suffocation threatens, 470 Camphor, in old or atonic cases, 115 Cimicifuga in chronic bronchitis, 154 Codeine, recommended when cough is ex- cessive, 168, 469 Creosote, recommended in chronic bron- chitis, 179 Croton oil and sweet oil (half and half), sometimes applied to chest, 1*1 Cubebs or copaiba, as expectorants, liable to derange stomach, 176, 1*2, 470 Digitalis, if heart be feeble, 470 Dover's powder, gr. 5 to 10 (0.30-0.65), with a hot drink, useful in early stage. 467 Ethyl iodide, 5 to 10 drops (0.3-0.65), in- haled from a handkerchief every few hours in the later stages to loosen secre- tions, 199 Eucalyptus oil, valuable in later stages; dose, gtt. 1 to 5 (0.05-0.3), in capsule, every three hours, 200, 470 Euphorbia pilulifera, i to 1 drachm (2.0- 4.0) of fluid extract in chronic bronchi- tis, 201 Flaxseed tea, a useful demulcent, 203 Gallic acid for profuse expectoration, 204 Grindelia, very useful in later stages, 209 Guaiacol vapor inhalations very valuable, 211 Hypnal for cough, 222 Inhalations of steam from boiling water, to relieve bronchial soreness, 468 Iodine externally, 229 Iodide of potassium, often useful when am- monium salts fail, contraindicated if se- cretion is excessive, 225 Iodoform, to lessen cough and fetid dis- charge, 233 Ipecac, to unload stomach, 234; as a seda- tive expectorant, 235; to promote secre- tion in first stage, also as an emetic when exudation accumulates rapidly and suffocation threatens, 470 Mustard foot-bath, with drinks of hot whis- key or brandy, in early stages, 467 Myrrh, with expectorant mixtures, useful in later stages, 276 Oro-nasal respirator with terebene, iodide of ethyl and chloroform, 469 Oxygen inhalations, when dyspnoea is great, 302, 470 Potassium citrate with ipecac, to aid in formation of secretion, prescriptions, 162, 467 Potassium cyanide for excessive cough, 183 Pyridine as an inhalation, 469 Resin, inhalations of fumes, 329 Sandalwood oil, in later stages, dose 5 to 10 minims, 341, 470 Sanguinaria, 341 Senega, a stimulating expectorant in sub- acute and chronic stages, 346 Squill, inferior to other drugs as an expec- torant, 354 Strychnine, to stimulate respiration, if suf- focation threatens, 471 Tar, 324 INDEX OF DISEASES AND REMEDIES. 721 Tartar emetic, as an expectorant, gr. ^ (0.001) hourly, or 1 drachm (4.0) of solu- tion (gr. 2 to the pint [0.1 : 500.0]), or as an emetic in sthenic cases, 72 Terebene, if ammonium chloride fails; dose, 5 to 10 minims (0.3-0.65), in cap- sule or emulsion; must be stopped if kidneys or stomach are irritated ; or used in an inhaler with equal parts of iodide of ethyl and chloroform, 367, 469 Terpine hydrate or terpinol in subacute or chronic types, 368. 470 Turpentine, inhalations or applied to chest, for children, diluted one-half with sweet oil, 376, 469 Water, hot and cold dashes, if death is imminent from suffocation, 471 BRONCHOCELE. Ointment of biniodide of mercury, useful in, 266 Potassium iodide internally, and tincture of iodine externally, 227 Thymus gland in, 371 BRONCHORRHIEA. Alum, solution gr. 20 to the ounce (1.3 : 32.0); applied in fine spray, 61 Gallic acid, 204 BRUISES. Alcohol, as a lotion, very useful, 53 Arnica, 80 Liquor plumbi subacetatis, locally applied ; strength 1 to 4 ounces to the pint (32.0- 128.0 : 500.0); contraindicated, if skin is broken ; also useful as lead-water and laudanum (water 16, lead-water 4, laud- anum 1), 250, 296 Warming plaster, 324 BUBO. Carbolic acid, solution (gr. 8 to the ounce [0.6:32.0],), 10-minim injections, pre- ceded by ether spray, 126 Incision, at first sign of suppuration, fol- lowed by washing with either bichloride solution (1 to 1000), hydrogen peroxide {\ strength), or zinc chloride (gr. 40 to the ounce [2.5 : 32.0]), 475 Iodine, painted around spot, with compress and spica bandage, or hot bag over swelling, 474 BURNS AND SCALDS, 471 Anaesthesia, chloroform in, 472 Antipyrin in solution and ointment, 472 Bath in the treatment of, 471 Boric acid, solution, a useful dressing, 98, 472 Calcium carbonate, precipitated, as a dress- ing, 111 Cantharides, tincture of (1 : 40), locally applied on lint if burn is not diffuse, 472 Carbolized sweet oil, cosmoline, or simple cerate, useful application to counter- irritation burns, 126 Cold cream, as a dressing, 332 Digitalis, in shock, if circulation fails to respond to less powerful stimulants, 471 Ichthyol ointment, 223 Iodoform in ointment with other drugs in severe burns, 472 Lead carbonate, as an ointment, or, with linseed or other oils, as a dressing, 250 Lime-water and linseed oil, equal parts, the best dressing, 114. Carbolic acid is of service, added iu proportion of 1 to 20, 472 Morphine and atropine, gr. \ to \ (0.016- 0.03) of former to gr. ^ (0.001) of latter, to allay pain, 471 Picric acid the best dressing, 318, 472 Potassium citrate with sweet spirit of nitre, if urine is high-colored, 472 Poultice, applied to counter-irritation blis- ter, relieves pain; when blister forms, puncture if large, allow to break if small, and dress with absorbent cotton, 403 Salicylic acid, prescription for, 337 Sodium carbonate solution often relieves pain, 472 Stimulants, if shock is severe, 471 Zinc oxide, 301 CANCER (GASTRIC). Arsenic, small doses often repeated, to re- lieve vomiting and pain in gastric can- cer, 83 Condurango, in the dose of 1 drachm (4.0) of the fluid extract, 174 Hydrochloric acid, 217 CANCRUM ORIS. Arsenic internally, *3 Boric acid, as a mouth-wash, 98 CARBUNCLE. Carbolic acid, solution (gr. 8 to the ounce [0.6 : 32.0]), hypodermic injections, to abort, 126 Phosphorus, 316 CARIES. Lime salts, especially valuable in dental caries of nursing women, 112 CATARRH OF AIR-PASSAGES. (See Nasal Catarrh.) Alum solution (gr. 20 to the ounce [1.3 : 32.0]), applied in fine spray, 61 Arsenic, internally, 83 Camphor, of service in old and atonic cases, 115 Sozoiodol, applied locally in 5 per cent. solution, 353 CATARRH OF BLADDER. Ammonium benzoate, to render urine acid, 64 Juniper, a valuable stimulant in chronic cases, 244 CATARRH OF UTERUS. Hydrastis, 216 Sozoiodol, in powder, applied by tampon in catarrh of cervix uteri, 353 46 722 INDEX OF DISEASES AND REMEDIES. CEREBRAL DISEASES. Blisters, to nape of neck in cerebritis, 401 Croton oil, in cerebral congestion, 1*1 Elaterium, in cerebral congestion, 1*9 Phosphorus, often of service in cerebral softening, 316 Veratrum viride, of greatest value in cere- britis duriug stage of hyperaemia, after that period harmful, 380 CHANCRE. Nitric acid, used as a caustic, surrounding tissues being protected by oil, 281 CHANCROID, 473. Acetanilid, used in a dry powder, 45 Actual cautery, the most destructive caus- tic, 473 Benzoate of bismuth, 94 Bismuth and zinc oxide, or calomel and bismuth, are substitutes for iodoform, 474 Carbolic acid, as a wet dressing (gr. 5 to water oz. 1 [0.3 : 32.0]), 474 Cocaine, 20 per cent, solution to relieve pain of cauterization, 473 Hot sitz-bath or general warm bath, 474 Iodoform, the best dusting-powder after cauterizing, also useful as a palliative treatment, preceded by nitric acid wash (3j to water Oj [4.0:500.0]), in erosive chancroid, 173 Iodol or aristol, as a substitute for iodo- form, 474 Nitric acid, a good caustic, surrounding tissue being protected by oil, 281, 473 Salicylic acid in powder or oiutment, 337 Sulphuric acid with charcoal, a good caustic and after dressing, 473 Tannin, combined with dusting-powder (1 : 4), if discharge is profuse, 474 CHAPPING. Calcium carbonate, precipitated, as a local protective in intertrigo of infants, 110 Camphor, added to precipitated calcium carbouate, useful in intertrigo, 116 Carbonate of zinc, in infantile forms, pre- scription for, 128 Cold cream, a useful application, 332 Light magnesia, as a dusting-powder in in- tertrigo, 256 Lycopodium, as a dusting-powder, 255 Starch as a dusting-powder in intertrigo, 355 Zinc oxide, in powder form, useful in in- tertrigo, 302 CHILBLAINS. Alum, as a wash, 61 Capsicum, tincture, painted over parts or applied as a paper, prescription for, 123 Ceratum resina?, 329 Ichthyol ointment, 223 Iodine ointment and lard, equal parts, gives great relief, 229 CHLOROSIS. (See Anaemia.) CHOLERA (ASIATIC), 475 Camphor in the form of camphorated wine, of the greatest service in controlling cramps, 475 Enemata of warm salt solution (3j to Oj [4.0 to 500.0J), highly recommended by Italian observers, 476 Enteroclysis, associated with hot baths, very valuable, 476 Ether, subcutaneously, as a diffusible stim- ulant, 476 Hypodermoclysis, very useful, 476 Opium, 475 Purgatives, contraindicated, unless bad food has been taken, 475 Quarantine, and strict hygiene, as a pro- phylactic, 475 Salol and salophen, 476 Sulphuric acid, with camphor, to control diarrhoea, 363, 476 Tannic acid, by enemata (3i-viij to Oj [4.0-32.0 : 500.0]), 477 CHOLERA INFANTUM, 477. Arsenic, to check vomiting, prescription for, 479 Beef-juice, as a food especially valuable, 477 Brandy, if vomiting is active and collapse threatens, a few drops to drachm (4.0) of nourishment, 477 Castor oil, with paregoric to empty bowels and allay irritation, 478 Cold drinks, cracked ice, and antipyretics, if rectal temperature is above normal, 477 Diet, 477 Enteroclysis, very valuable, 4*0 Hot drinks, applications and baths if rectal temperature is subnormal, temperature being watched, 477 Iodoform and oil injections to relieve tenes- mus, 233 Irrigation of bowels, 4-M) Laudanum, gtt. 10 (0.65) and starch-water, oz. 2 (64.0), by enema, and calomel gr, ^ (0.005) or gray powder gr. \ (0.01) by mouth, to control vomiting and purg- ing, if severe, 479 Mustard or spice plaster, over belly, always useful, 478, 479 Podophyllin, if stools are of peculiar pasty color, 47* Predigested milk or beef-juice, the best food. 478 Prescriptions for, 479 CHOLERA MORBUS, 480 Camphor, 115 Castor oil, with laudanum, to sweep out intestines, before diarrhoea mixture is used, 480 Ipecac, gr. 3 (0.15) every two hours, often of service, 235 Mustard or capsicum plaster, over abdo- men, 1*0 Prescription for, 480 Salol, prescription for, 340 CHORDEE, 548 Aconite, often relieves, 49 INDEX OF DISEASES AND REMEDIES. 723 Belladonna internally, and ointment ap- plied to under surface of penis, 92 Bromide of potassium, dr. 1 (4.0), with chloral, gr. x (0.6), at bedtime, repeated during night if necessary, 548 Camphor with bromides, very useful in some cases, 115 Cantharides, gtt. 1 (0.05), thrice daily, 121 Hot sitz-bath and steeping penis in hot water before retiring, relieves, 410 Lupulin, gr. 30, 548 Morphine, gr. i (0.010). with atropine gr. b>5 (0.001), hypodermically into peri- neum, to relieve, 54* Opium or belladonna suppositories, to re- lieve, 548 CHOREA, 480 Arsenic, in ascending doses; discontinue if symptoms of poisoning ensue, 82, 481 Bromides with chloral, when there is in- somnia, prescription for, 481 Chloral, 136 Chloroform inhalations when excessive, 151 Cimicifuga alone, or with iron, verv useful, 194, 481 Hot pack, at bedtime if muscular jerkings are severe, 481 Monobromated camphor, 117 Nitro-glycerin, 2*3 Quinine in full doses, 158 Salicylates or iodides of value, if asso- ciated with rheumatism, 481 Silver oxide and nitrate, occasionally used, not reliable, 279 CINCHONISM. Potassium bromide, as a preventive, 103 CIRRHOSIS OF LIVER. (See Hepatic Cirrhosis.) COLDS. (See Coryza.) COLIC. Asafoetida, useful in children, 86 Chloral and bromide, when severe in chil- dren ; prescription for, 136 Ether internally, very useful, 197 Hoffmann's anodyne, 213 Hyoscyamus, 221 Matricaria, infusion, to prevent, in teeth- ing children, 258 Mustard plaster, i to £ strength if skin is tender, 275 Peppermint in infantile colic, 307, 308 Rue, as a carminative, 333 COLIC (HEPATIC), 481 Belladonna, in full dose, to relax spasm, 92 Benzoate of sodium, 483 Calomel, if liver be very torpid, 483 Chloroform or ether inhalations to relieve pain during spasm, 152, 482 Diet, 483 Hot applications over liver, as a relaxant, 482 Horse-back riding, 483 Morphine, gr. \ to \ (0.016-0.03) with atro- pine gr. fa (0.001) hypodermically, to relieve pain, 432 Olive or cotton-seed oil, 1-J pints (750.0), during attack; ether, drachm 1 (4.0), may be added with advantage, 481 Opium with belladonna, to relieve pain and spasm, 295 Salicylate of sodium, 4*3 Turpentine, useful in, 481 COLIC (RENAL). Belladonna, in full dose, 92 Chloroform, a few inhalations often re- lieve, 152 Opium with belladonna relieves spasm and pain, 295 COLLAPSE. Belladonna as a vasomotor stimulant, 91 Digitalis, 187 Ether, by mouth, inhalation, or hypoder- mically, of great service, 197 CONDYLOMATA. Calomel, as a dusting powder, often re- moves, 269 CONGESTION. Croton oil, as a revulsive in cerebral con- gestion, 181 Digitalis, relieves stasis of congested lung in typhoid state, and congestion of the kidneys, 187 Elaterium, in cerebral congestion, 189 Ergot of service, especially with digitalis, 191 Glycerin, on cotton tampon, as a depletant in uterine congestion, 208 Jalap useful in plethora with cerebral con- gestion, 243 Juniper, often relieves congested kidneys, 244 CONJUNCTIVA (BURNS OF), 485 Atropine incorporated with liquid vaseline instilled into eye, to prevent iritis, 485 Cod-liver oil instilled into eye after re- moval of foreign matter, 485 Gold-beater's skin inserted between lids and eyeball, or breaking up granula- tions, prevents corneal inflammation, 485 Neutralization of foreign matter, if acid or alkaline, 485 CONJUNCTIVA (CHEMOSIS OF), 488 Astringent washes, especially alum, 488 Nicking swollen tissue with scissors, 488 Warm moist compresses, 488 CONJUNCTIVA (HEMORRHAGE BE- NEATH), 488 Boric-acid or cocaine wash, when conjunc- tival irritation exists, 488 Massage of globe through closed lid, to aid absorption of blood, 488 CONJUNCTIVA (XEROSIS OF), 488 Glycerin, almond oil, cod-liver oil, or weak alkaline washes, 488 724 INDEX OF DISEASES AND REMEDIES. CONJUNCTIVITIS (CHRONIC), 486 Acetate of zinc, gr. 1-2 (0.05-0.1) to the ounce (30.0), 382 Boric acid, wash (gr. 10 to the ounce [0.65 : 32.0]), cocaine, gr. 2 (0.1), may be added if there is no corneal ulcer; for this condition salt, gr. 4 to the ounce (0.3 : 32.0), may be substituted, 486 Copper, crystal, or a solution (gr. 1 to 3 to the ounce [0.05-0.15 : 32.0]), applied to diseased spot, if subacute, 178 Correction of any refraction error, 486 Lapis divinus, 4*6 Tannin and glycerin (gr. 10 to the ounce [0.65 : 32.0J), as an application, 486 Yellow oxide or sulphate of mercury salve, or alum crystal, useful application, 486 Zinc oxide, in powder, or the sulphate in the form of a wash, 358 CONJUNCTIVITIS DIPHTHERITIC), 488 Atropine instilled, 4*8 Boric-acid or bichloride solution, frequent- ly applied in early stages, 488 Cade, oil of (strength 1 to 10), 483 Citric-acid ointment or lemon-juice, locally applied, 488 Hot compresses, 438 Quinine, solution (gr. 3 to the ounce [0.15 : 32.0]), 488 Silver nitrate, same as in purulent con- junctivitis, 4*8 Sulphur, insufflations, 488 CONJUNCTIVITIS (FOLLICULAR), 487 Alum, crystal applied locally if due to atropine instillations, 487 Astringent and antiseptic lotions, 487 Calomel, as a dusting-powder, alone or with bismuth, aristol, or iodoform, 487 Copper sulphate, as an ointment (gr. J to the drachm [0.03 : 4.0]), 487 CONJUNCTIVITIS (GRANULAR), 487 Atropine, instillations, in acute forms, 487 Boric acid or salicylic acid, solution, as a wash in acute forms, 487 Boroglyceride (20 to 50 per cent.), applied to chronic granulations, 487 Carbolic acid, applied pure, to chronic granulations; excess removed with water, 487 Copper sulphate, crystal, applied to chronic granulations, 4*7 Corrosive sublimate solution (1 : 200 or 1 : 500), applied every second day in chronic forms, preceded by cocaine; eyes also being irrigated thrice daily with sublimate solution (1:7000), 487 Crushing granulations, often satisfactory, 4*7 Excision of granulations when isolated, 487 Glycerole of tannin, applied to chronic granulations, 487 Grattage, 4*8 Jequirity infusion (3 per cent.) painted on inner side of eyelids, of use, 244, 488 Leeches, to temple, to reduce inflammation in acute stage, 487 Liquor potassa?, beta-uaphthol, iodoform, aristol in powder or salve, yellow-oxide ointment, calomel, or hydrastin may be tried, 487 Scarification, not advisable, 487 Silver nitrate, stick or solution (gr. 10 to the ounce [0.65 : 32.0], applied daily, if there is discharge; neutralize excess with salt solution, 280, 487 Yellow oxide of mercury, ointment, with lard, equal parts, in chronic types, 271 CONJUNCTIVITIS (LACHRYMAL), 480 Treatment same as for chronic type. CONJUNCTIVITIS (MUCO-PURULENT). Treatment same as for purulent type. CONJUNCTIVITIS (PURULENT), 485 Atropine or eserine, if corneal ulcer ap- pears, 486 Bichloride of mercury (1 : 8000), or boric acid (saturated solution), as a wash, used hourly, 485 Boroglycerin, 99 Hot compress, in lieu of cold, if vitality of cornea is threatened, 485 Iced compress in early stage, to reduce in- flammation, 465 Leeching, useful if inflammation is high, contraindicated in infants, 486 Permanganate of potassium, aqua chlorini, sulphocarbolic acid solution, alum sul- phate, zinc sulphate, creolin (1 per cent.), or iodoform ointment may be tried, 486 Peroxide of hydrogen useful as a cleansing agent, 465 Pyoktanin, not satisfactory, 486 Silver nitrate, stick or solution (gr. 10 to the ounce [0.65 : 32.0], touched to lids after they have been cleansed of pus, excess neutralized with salt solution ; 2 per cent, solution dropped in new- born infant's eves to prevent, 485 Sozoiodol (2 : 30), 352 CONJUNCTIVITIS (SIMPLE), 484 Atropine usually unnecessary unless cor- neal ulcer is present, 484 Boric acid, lotion (gr. 10 to the ounce [0.65:32.0]), 484 Compresses, dipped in cold water and hamamelis (equal parts), to allay in- flammation, 484 Creolin solution (1 per cent.), 484 Mercury, bichloride solution (1:10,000;, if discharge is great, 484 Peroxide of hydrogen, 485 Poultices and bandages contraindicated. 484 Pyoktanin (1 : 1000), 485 Silver nitrate, solution (gr. 2 to 5 to the ounce [0.1-0.3 : 32.0]), if there is muco- purulent discharge. If discharge is ex- cessive employ gr. 10 to the ounce (0.65: 32.0]), and neutralize excess with salt solution or wash with tepid water, 484 Smoked glasses, 484 Sodium biborate, gr. 4 to 8 to 5j (0.3 to 0.5:32.0), 484 INDEX OF DISEASES AND REMEDIES. 725 Taunin and glycerin (gr. 10 to the ounce j Amyl nitrite, 0.65:32.0]), or alum crystal if there is a chronic tendency, 485 Zinc oxide, 302 Zinc sulphate, solution (gr. 1 to 2 to the ounce [0.05-0.1 : 32.0], alone or with boric acid, if there is chronic tendency, 358, 484 CONSTIPATION, 489 Aloes, 59; and podophyllin, with other drugs useful for temporary use; pre- scription for, 492 Belladonna, 92 Bryonia, when intestinal secretions are de- ficient, 107 Cascara sagrada, the best curative agent, dose gtt. 10 to 20 (0.05-1.3) of fluid ex- tract or drachm 1 (4.0) to 6 (24.0) of cordial, 129, 491 Castor oil, ultimately harmful in all cases, 130, 491 Colocynth, jalap, or senna, not to be used constantly, 491 Compound cathartic pill, sometimes neces- sary, 492 Diet, of extreme importance, 489 Enemata, as a routine treatment, harmful, 492 Glycerin, suppositories or enemata, often 'used. 208, 492 Gymnastic movements, horseback riding, or massage, with regulated diet, 490 Hunyadi, Carlsbad, or Friedrichshall wa- ters, rarely of value in chronic forms, 491 Leptandra, fluid extract of, in intestinal atony, 252 Lobelia, in combination with cascara sa- grada, useful in atonic forms, 254 Magnesium sulphate by the mouth or by enema, 257 Manna, as a laxative fruit for adults, or drachms 1 to 2 (4.0-8.0) to bottle of milk, for infants, 25*. 491 Mercury, as an habitual purgative harmful, 491 Opium in reflex constipation, 492 Oxygen-water, before retiring, in constipa- tion due to intestinal atony, 304 Phosphate of sodium, useful in rickety chil- dren, 2 to 4 (0.1-0.2); or adults, 313, 491 Pilula cathartica vegetabilis, may be re- quired, 492 Rhubarb, usually harmful; in some cases iu children useful, 330, 491 Salines, simply to unload bowels, 491 Seidlitz powder, 326 Senna, said to be useful in constipation of pregnancy, particularly if combined with cascara sagrada, 317 Soap suppositories, useful in children, 349 Stillingia, recommended when habitual; prescriptions for, 355 Sulphur, especially valuable if hemorrhoids are present, 361 Tobacco, sometimes used, but harmful, 492 CONVULSIONS. Allium, as a poultice, over spine or feet in infantile spinal or cerebral convulsions, 57 Chloral with bromide, in infants ; also use- ful alone iu ura?mic and puerperal con- vulsions, if no acute renal trouble exists, 101, 136 Chloroform, 151 CORNS, 493 Fowler's solution, locally applied, 84 Salicylic acid, the best application, formula for, 336, 493 Silver nitrate, solution (gr. 60 to the ounce [4.0:32.0]), applied to soft corns every four or five days, 493 CORYZA, 493 Aconite, useful in early stages, 49 Allium, as a poultice to breast, or in emul- sion or boiled in milk, for children, 57 Arsenic, taken for months, often cures per- sistent colds, 83 Antipyrin, in 2 to 4 per cent, solution as a spray, preceded by a cocaine spray, 76, 494 Belladonna in, 92 Bromides useful in headache, 494 Camphor, as a snuff, or inhalation of spirit, or fumes, when sneezing and lachryma- tion are excessive, 115 Cocaine, a few minims of a 4 per cent, solu- tion dropped into nostril, followed by lotion (see prescription) with atomizer, or cocaine (1 part), morphine (1 part), and bismuth (7 parts) as a snuff, 166, 493 Cubebs, as a snuff during stage of secretion, 182 Glycerin, applied alone by brush or spray, often of service, 208 Hamamelis, useful after acute stage is past, 212 Hot mustard foot-bath with hot draught or Dover's powder, followed by rest in bed, may relieve, 494 Inhalation of tincture of iodine, 231 Iodide of potassium, at begiuuing will often abort, 226 Menthol, very useful, 309 Prescription for wash, 493 Quinine, internally, combined with chlo- ride of ammonium, useful after secre- tion is established, 494; also useful as a spray, 160 Sweet spirit of nitre, 494 Tartar emetic, 72 COUGH. Acacia, as a mucilaginous drink with flax- seed and liquorice, to loosen hacking cough, 41 Almonds, essential oil of, in emulsion, as a demulcent in cough of phthisis, 58 Belladonna, the best remedy in nervous cough, 92 Cannabis indica, a useful adjunct to cough mixtures, 118 Chloroform, useful, added to cough mix- tures for irritant cough, 152 Codeine, useful in nervous cough, 168 Flaxseed tea, alone or with paregoric, a useful demulcent in excessive cough, 203 ES AND REMEDIES. 726 INDEX OF DISE\- Gelsemium in nervous cough, 206 Honey, 215 Hydrocyanic acid, highly recommended, prescription for, 218 Hyoscyamus in nervous cough, 221 Hypnal, 222 Iodine, as a paint over supraclavicular spaces, in irritative cough, 229 Ipecac, in spray, useful in chronic winter cough, 235 Morphine, in wild-cherry syrup, useful in irritative cough and when cough is greater than necessary to expel mucus, 296 Paregoric (1 drachm [4.0]) in hot water, from which the stream is inhaled, use- ful in irritative form of cough, 296 Sandalwood pil for excessive cough follow- ing influenza, 341 Syrupus pruni Virginiana?, as a vehicle for cough mixtures, 327 CRAMPS. Belladonna, internally or locally as a lini- ment, 92 Chlorodyne, for stomach cramp, 141 Ginger, especially useful in menstrual cramp due to cold, 207. (See Dysmenor- rhcea.) CRETINISM. Thyroid gland very useful, 373 CROUP (MEMBRANOUS;. (See Diphtheria.) CROUP (SPASMODIC), 494 Aconite, useful, 49 Amyl nitrite, inhalations, if paroxysm is severe, 68, 495 Antimonial wine, drachm 1, to cause vom- iting if paroxysm is severe, 495 Belladonna, bromides, chloral, or opium in small doses at bedtime, as a preventive, 491 Bromides and lactucarium, 494 Cold cloth around neck, and child placed at once in hot bath, air of room being moistened by steam, 495 Menthol, useful, 495 Prophylactic measures, 474 Sanguinaria, as au emetic, unfavorable, 341 CYSTITIS (ACUTE), 495 Aconite in full dose, with sweet spirit of nitre and potassium citrate if there is fever; prescription for, 495 Belladonna, alone or with aconite, espe- cially useful if due to cold; dose gtt. 5 to 10 (0.3-0.65) thrice daily, 495 Boric acid, to render urine acid, 98 Cannabis indica, preferable to opium for relieving pain, 118, 496 Copaiba, 176 Creolin, as a vesical wash (1 to 2 per cent. solution) in cystitis of women, 180 Flaxseed tea, as a demulcent, 203 Hot compress over bladder, should not con- tain irritants, 495, 496 Hot sitz-bath and enemata, to relieve bear- ing-down pain, 495, 496 Hygienic measures, 496 Laudanum, gtt. 30 (2.0), to starch-water oz. 2 (64.0), in enema, to relieve bear- ing-down pain, 495 Leeches to perineum or cups to sacrum, 495 Opium, belladonna, or iodoform supposi- tory, to allay bearing-down pain, 296, 495 Quinine, contraindicated, 496 Salines, in early stage to evacuate bowel, 496 Salol, gr. 10 (0.65) thrice daily if inflamma- tion becomes purulent, 496 DEBILITY. Arsenic, with bitter tonics, very useful, 82 Calomel, in debility of children, often re- lieves, 267 Capsicum for gastric atony, 122 Eupatorium, a good tonic, 201 Lime salts, 112 Phosphorus, of service in sexual debility, 316 DELIRIUM TREMENS. Chloral, of great service used cautiously, 136 Croton oil, 181 Hops, 215 Hyoscine, in insomnia, 221 Monobromated camphor, when nervous twitching is troublesome, 117 Valerian with morphine, frequently used 377 CYSTITIS (CHRONIC), 496 Arbutin, gr. 3 to 5 (0.15-0.3), or fluid extract of buchu or uva ursi, £ to 1£ drachms (2.0-6.0), to improve vesical mucous membrane when inflammation is of sub- acute type, 377. 497 Benzoic or boric acid, gr. 5 to 10 (0.3-0.65) in pill, to render urine alkaline, 94, 496 Buchu, 107 Cantharides, 120 Creolin solution (1 to 2 per cent.) as a vesi- cal douche, 497 Grindelia, as a vesical stimulant, 209 Juniper of value, 244 Mercury, bichloride solution (1 :10,000), as an injection to cleanse bladder, 496 Myrrh often of service, 276 Opium suppositories, gr. \ to \ (0.016-0.03), very useful, 296 Pareira, 306 Potassium salts, except bitartrate, to ren- der urine alkaline when mucus is ex- cessive, 496 Salol, 496 Sandalwood oil, 341 Silver nitrate, solution (gr. 1 to oz. 4 [0.05: 128.0], increased gradually to gr. 2 to oz. 1 [0.1:32.0]), as an injection when discharge is mucopurulent, followed by salt solution if pain is severe, 496 Strychnine and cantharides, when vesical atony is great, 197 Turpentine, oil of sandalwood, cubeb, or copaiba, useful when vesical atony is great, 497 INDEX OF DISEASES AND REMEDIES. DIABETES INSIPIDUS, 497 Arsenic, 83 Belladonna or opium, if due to nervous irritability, 497 Carbonate or citrate of lithium, gr. 10 (0.65), with sodium arsenite, gr. fa (0.002), val- uable iu gouty types, 254 Ergot, in combination with bromide of sodium, 192, 497 Gallic acid, alone or with opium, one of the best remedies, 204, 497 Opium, 297 Rhus aromatica, highly recommended, 331 Strychnine and sulphate of iron, as tonics, 497 Suprarenal gland useful in, 364 DIABETES MELLITUS, 497 Acidulated water or non-purgative alkaline water, to allay thirst, 499 Almond bread or bran bread, as a food for diabetics, 57, 435 Alum, 61 Antipyrin, 76. and arsenate of sodium and carbonate of lithium when of gouty origin, S3 Carbonate of sodium, by intravenous in- jection in diabetic coma, 500 Chloride of gold and sodium, gr. fa (0.006), recommended, 498 Codeine, in ascending doses, beginning gr. 1 to 5 (0.05-0.25), thrice daily, 108 Colchicum and iodides, in gouty tyTpes, 498 Diet, 497 Ergot, highly recommended, 498 Ether, hypodermically, to support heart in diabetic coma, 500 Gallic acid, with opium, one of the best remedies, 204 Glycerin or saccharin, as sweetening agents to replace sugar, 20*. 333, 499 Iodol, gr. 2 to 6 (0.1-0.3), thrice daily, rec- ommended, 234 Iron, lacto-phosphates of lime and sodium, strychnine and astringents, if cachexia comes on, 499 Jambul, gr. 5 to 30 (0.3-2.0), once to thrice daily, said to be very useful in some cases, 499 Lime-water, 113 Lithium carbonate or citrate, with arsenic, very useful, if due to gout, 83, 254, 498 Morphine, very useful in ascending doses, 498 Opium, gr. i to \ (0.016-0.03), thrice daily, largely used, 297. 498 Pancreatin, when the disease is due to a lesion of the pancreas, 305 Purgatives, restricted diet, and exercise, if due to high living and sedentary habits, 49* Salicylates and iodide of potassium, if due to rheumatic or gouty taint, 498 Transfusion, in dietetic coma, 500 DIARRHOZA, 500 Allspice, 57 Ammonium chloride, gr. 5 (0.3) every four hours, best remedy in persistent catar- rhal states, 501 Arsenic, 83 Belladonna, may be used in serous types, 91 Bichloride of mercury, gr. -j^ (0.00031, hourly, if stools be slimy and bloody, 205, 503 Bismuth, with carbolic acid, gtt. 1 or 2 (0.05-0.1) highly recommended in se- rous and summer diarrhoeas. 96, 502 Cajuput, gtt, 10 to 20 (0.65-1.3) in serous forms, 110 Calomel, followed by a saline, useful in sthenic cases of summer diarrhoea, 503 Calumba, in summer and serous diarrhoeas, prescription for, 113 Camphor, useful in serous but never in mucous types, 115, 502 Carbolic acid, especially useful as an intes- tinal antiseptic, 126, 502 Castor oil, with laudanum and sodium bi- carbonate, to unload bowel and render it alkaline, 131, 500 Catechu, alone or with opium, iu serous types, prescription for, 132 Chalk mixture, with kino and catechu, in serous diarrhoeas, prescription for, 110 Charcoal, useful in acid and fermentative types, 128 Chirata, nitro-muriatic acid, or, better still, nitric acid and cardamoms, in mucous type, prescription for, 501 Chlorate of potassium for acute rectal catarrh with mucous diarrhoea, 139 Chlorodvne, largely used in serous types, 141 Chloroform, with astringents and opium, very useful after removal of irritant cause, 152. 502 Cinnamon, as a stimulant in serous types, 161 Cloves, 163 Copper sulphate, gr. J (0.016) with opium, gr. 1 (0.06) in pill, or in enema, (gr. 5 to 20 to the ounce [0.3-1.3 : 32.0]), if due to ulceration, 178 Creolin iu enterocolitis, 5 : 1000 of water, 181 Diet, for summer diarrhoea, 500, 502 Enteroclysis, when mucous form becomes chronic, 501 Ergot, sometimes useful in serous types, 191 Gallic acid, 204 Geranium, 1 or 2 roots, boiled in pint of milk, of great service in infantile types, 207 Ginger, a good addition to diarrhoea mix- tures, 207 Guaiacol carbonate, in fermentative forms of, 212 Ha?matoxylon, useful in children, because of agreeable taste, 212 Hope's camphor mixture, in serous and choleraic types, 2Hi Ipecac, gr. i to -V (0.016-0.03), thrice daily, useful in summer diarrhoea of children, 235, 503 Kino powder, formula for, 215, 501 Lead acetate, with opium and camphor in serous types, prescription for, 249, 501 Morcurv, with chalk or calomel, in hepatic disorder, 269, 502 Morphine, gr. fa to fa (0.0008-0.0012) hypo- 728 INDEX OF DISEASES AND REMEDIES. dermically, often checks summer diar- rhoea in children, 297 Mustard plaster, or other counter-irritants, to abdomen, 500 Naphthalin or naphthol, in fetid and sum- mer diarrhoeas, 277, 502 Nitrate of silver and hyoscyamus, or lead acetate and opium, in mucous diarrhoea, prescription for, 501 Nitro-muriatic acid, or podophyllin, gr. fa to fa (0.0012-0.0016), in summer diar- rhoea, if duodenum is at fault, 285 Nutmeg, useful in serous tvpes, 287 Opium, 297, 502 Pancreatin in lientferic diarrhoea, 305 Pepsin with hydrochloric acid in summer diarrhoea, if gastric digestion is deficient, 503 Phosphate of sodium, lime salts, and com- mon salt in summer types, if rickets is present, 313, 503 Podophyllin, 326 Potassium iodide, gr. 3 to 5 (0.15-0.3), if catarrhal state is obstinate, 501 Precipitated carbonate of calcium, in serous diarrhoea, 110 Raspberry-leaves, used in domestic medi- cine, 332 Rhubarb, often useful, preceding direct treatment in summer diarrhoea, 331 Salol combined with chalk mixture, 502 Sulphate of iron in chronic forms, 242 Sulphocarbolate of zinc, 2 grains (0.1) every three hours ; of service in summer diar- rhoea, 502 Sulphocarbolates, 359 Sulphuric acid, especially valuable in serous types, prescription for, 363, 501, 502 Tannic acid, in atonic or serous types, 366 Tar mixture, highly recommended in ob- stinate types, formula for, 324 Thymol, naphthalin, and especially sali- cylic acid, useful as intestinal antisep- tics, in summer diarrhoea, 502 Zinc oxide, in summer tvpes, prescription for, 302 Zinc sulphate, 2-grain (0.1) pills, especially useful with opium, or podophyllin, gr. fa (0.001), in serous types, 358 DIARRHOEA (CHRONIC), 504 Arsenic, 83 Bismuthi et ammonii citras, in chronic se- rous tvpes, 90 Diet, 504* Iron sulphate, gr. 5 (0.3) in pill, in chronic types. 242 Nitric acid, with a bitter tonic, useful in green diarrluea of children ; combined with Fairchild's essence of pepsin, re- lieves chronic types in children, 282 Operative procedures when due to lesions of the rectum, 505 Silver nitrate in pill form, or in other cases rectal injections of this drug, gr. 2 to oz. 1 (0.1 : 32.0), followed by iodoform sup- pository, of greatest benefit, 505 Sodium bicarbonate, gr. 5 to 20 (0.3-1.3), and iodoform suppositories, by their combined action, give great relief, 505 DILATATION (GASTRIC AND INTES- TINAL). Physostigma with nux vomica, 318 DIPHTHERIA, 505 Aconite, in early stages, 49 Alum, 61 Antitoxin, of great value; 5 to 10 cubic centimetres should be thrown into the connective tissues of the back. A spe- cial syringe is used for this purpose, and should be perfectly aseptic, 78, 506 Boric acid, 98 Calomel, by sublimation, of great good in some cases, 506 Carbolic acid (1 : 100) in the form of spray or gargle, 126 Chlorate of potassium, contraindicated for internal use, because of danger to the kidnevs. It may be applied upon a swab, 139, 506 Corrosive sublimate, gr. fa (0.0012), or calo- mel, gr. \ to \ (0.01-0.015) every hour, unless diarrhoea or ptyalism be pro- duced, 264, 265, 505 Ice-bags to the neck, ice in the mouth and the tincture of the chloride of iron in- ternally, if glandular suppuration threatens, 506 Iodine, inhalations, 218 Irrigation of the nasal chambers useful in, 505 Lime-water as spray or application very useful in, 114 Loeffler's application (menthol, dr. 2^ [10.0], dissolved in dr. 9 [36.0] of toluol; add dr. 1 [4.0] of liquor ferri chloridi and absolute alcohol, fl. oz. 2 [60.0] J, 510 Milk diet, 505 Monsel's solution, as a topical application, 242 Oxygen inhalations, strychnine, and atro- pine if suffocation is imminent. In- tubation or tracheotomy may be neces- sary. 506 Peroxide of hydrogen is the best local ap- plication. May be applied on a swab or as a spray (1:4), to remove false mem- brane, 220, 505 Potassium permanganate, solution (gr. 20 to the pint [1.3 : 500.0]), applied as a swab or gargle, 310 Salt solutiou (7 : 1000>, as a spray in nasal diphtheria, 505 Tincture of the chloride of iron. 239 Tonics, such as quinine, strychnine, and the chloride of iron, as supportive meas- ures, 505 Turpentine, by inhalation, prescription for. 506 DROPSY, 510 Acupuncture, less favorable than incisions, only to be resorted to after other rem- edies fail, 513 Caffeine, in cardiac or renal dropsy, 109; in torpidity of kidneys, 513 Calomel and digitalis, in renal and cardiac types, 268, 512 Colocynth, compound extract of, gr. 2 to 6 (0.1-0.3), 173, 512 INDEX OF DISEASES AND REMEDIES. 729 Copaiba, of service in slow renal types, 176 Digitalis, gtt. 5 to 10 (0 3-0.65), with can- tharides, gtt, 1 (0.05), thrice daily, in renal torpidity due to heart trouble, 513 Elaterium, especially useful in renal dropsy, 189, 512 Jalap, compound powder of, gr. 20 to 30 (1.3-2.0), with potassium bitartrate, gr. 10 (0.65), added, especially serviceable in renal dropsy, 243, 512 Magnesium sulphate, in concentrated solu- tion, before breakfast, 257 Milk diet, very useful, 513 Paracentesis abdominis, very useful in as- cites, 513 Pilocarpine, useful in localized and renal dropsv, contraindicated in cardiac types, 320, 513 Potassium iodide, in hepatic cirrhosis and localized effusions, to remove liquid, 513 Scoparius, infusion, may be used, 346 Senega, rarely of value, 346 Squill with digitalis, prescription for, 354, 513 Strophanthus in cardiac dropsy, 357 Sugar of milk, useful as a diuretic, 358, 512 Tapping in ascites, the best method, 513 DYSENTERY, 500 Alum, internally, 61 Arsenic, 83 Bichloride of mercury, gr. yjj-j (0.0006) (or gr. \ [0.025] in water 5 ounces [160.0], teaspoonful hourly till relieved), 504 Bichloride of mercury, injections (1 : 5000), followed by solution (1 : 30,009) to pre- vent toxic effect by absorption, 266, 504 Boracic acid, oj to Oj (4.0 : 500.0), or sul- phocarbolate of zinc, gr. 15 to 1 quart (1.0 : 10U0.0), very useful as rectal in- jection, 504 Calomel, in purgative dose, contraindicated if weakness exists, 267, 503 Continuous irrigation with two-way tube, of great value, 503 Copaiba. 176 Creolin enemata, 181 Ergot, useful in bloody stools, 191 Hamamelis, injections, if much blood is present, 503 Ice-water, injections, if due to inflamma- tion, used only in strong persons, 503 Ipecac, best remedy in acute dysentery, 23.5. 501 Lead acetate, with opium and camphor, prescription for, 249 Nitro-hydrochloric acid, if due to defective action of secretory glands, 285 Prescription for enema, 503 Quinine injections useful in amoebic dys- entery, 160, 504 Silver nitrate, rectal injections (gr. 10 to 20 to the pint [0.6-1.3:500.0]), if ulcers are chronic; followed by salt solution if action is too severe, 279, ,504 Tannic acid (3j T4.0] to water Oj [500.0]), in the form of intestinal irrigation, o04 DYSMENORRHCEA, 514 Amyl nitrite, often relieves, 68 Antipyrin or acetanilid, in neuralgic at- tacks, in other cases of doubtful value, 76, 515 Belladonna, suppository, gr. \ (0.03) of ex- tract, or ointment applied to os ; tinc- ture, internally, useful to relax spasm, 92, 514 Camphor with acetanilid, in pill, useful in nervous cases, 115 Cannabis indica and gelsemium, often of service, 119, 515 Cimicifuga iu neuralgic form, 515 Epsom salts or aloes, if constipation is present, 514 Ether or bromide of ethyl, 515 Gelsemium in spasmodic forms, 206 Hot sitz-bath, followed by turpentine stupe, and Dover's powder, gr. 10 (0.05;, often relieves, 514 Iron, strychnine, and quinine, as tonics, with rest and horseback riding for anae- mic and run-down patients, 515 Opium, to relieve spasm and pain, contra- indicated, 295, 515 Piscidia .erythrina, extract, in the dose of from \ to 2 fluidrachms (2.0-8.0), 323 Potassium bromide, 102 Water, cold and hot, alternately dashed over loins in atonic cases, 515 DYSPEPSIA. (See Indigestion.) Arsenic, useful in atonic types associated with chronic diarrhoea, 83 Bismuth, when due to acid fermentation, 96 Bismuth snbgallate in fermentative dys- pepsia, 97 Gentian, 207 Hydrastis, as an antiseptic and curative agent iu chronic types, 216 Hydrochloric acid, if gastric secretion is deficient, 217 Lavage in fermentative dyspepsia, 416 Nitric acid with bitter tonics often relieves intestinal types, 2*2 Oxygen-water, often useful in chronic types, 304 Permanganate of potassium, 310 Quassia, useful, if not due to gastritis, 32* Serpentaria, as a tonic in atonic types. 348 Strontium bromide, in painful dyspepsia, 356 Terebene, useful as an antiseptic in fer- mentative dyspepsia, 368 DYSPNCEA, 515 Ammonium carbonate, as a respiratory and cardiac stimulant, 516 Arsenic, continuously employed, useful in emphysema and chronic pulmonary in- flammation, 516 Dry cupping over back, when due to car- diac or pulmonary trouble, 516 Hvoscine, contraindicated, 516 Morphine, gr. i to i (0.008-0.016), night and morning, often cures, when due to nervous or cardiac disorders, 298, 516 Opium, if due to nervous disorders, 516 Strychnine, in idiopathic types and when rno INDEX OF DISEASES AND REMEDIES. due to bronchorrhoea in old people, 291, 516 Thoracentesis if there is pleural effusion, 516 EAR (DISEASES OF). Bismuth subgallate useful in purulent otitis media, 97 Glycerin, useful to soften impacted ceru- 'men, 208 Potassium permanganate, solution, useful in purulent otitis media, 310 EARACHE, 516 Cardiac sedatives, 517 Chloroform, on swab, behind and in front of ear in otalgia, 517 Cocaine, gtt. 1 to 3 (0.5-0.15), dropped into nostril, followed by spray if mucous membrane is engorged, 517 Heat, dry, applied to head on affected side, 516 Inflation of Eustachian tube with Politzer's air-bag, 517 Leeching behind ear, to relieve pain, 516 Menthol and albolene spray, following co- caine, 517 Poultices, oil, and laudanum, contraindi- cated, 516 Puncture of tympanum, if it bulge, fol- lowed by careful cleansing and insuffla- tion of boric acid, 517 Tincture of belladonna and of opium dropped into the ear, 517 Water, hot as can be borne, dropped into ear gives great relief, 517 ECLAMPSIA, 632 Amyl nitrite, dangerous, 68 Chloral and bromide, each 1 drachm (4.0), by rectum, before applying hot pack. 634 Chloroform, pushed rapidly as possible, at onset of attack, 634 Elaterium, gr. i (0.016), rubbed up with butter, or compound jalap powder and calomel, may be substituted for croton oil, 633 Ether, as an anaesthetic, contraindicated, 634 Extraction of child rapidly as possible, if attack comes on during labor, 634 Ice-bag to head while in warm pack, 633 Morphine, veratrum viride, and amyl ni- trite, may be held in reserve, to be used if necessary, 634 Pilocarpine, contraindicated, 633 Venesection, hot wet pack, and croton oil, gtt. 2 (0.1), with sweet oil on tongue, to eliminate poison, 033 Veratrum viride in full doses, 380 ECZEMA, 51* Ammoniated mercury in chronic dry form, 264 Arsenic, only when skin is very dry, 83, 520 Bismuth subgallate? in weeping eczema, 97 Black wash of value in, 266 Calamine in moist eczema, 128 Cantharis, internally in small doses, 121 Carbolic-acid ointment (minims 10 [0.65] to cerate 1 ounce [32.0]), to prevent itch- ing, 127 Dermatol in weeping eczema, 97 Green soap, 349, 519 Hygienic measures and diet, 51* Ichthvol ointment, highly recommended, 223 Internal treatment, 519 Iron, syrup of iodide, in young children with anaemia and debility, 241 Kaolin as a dusting-powder, 245 Lead, dilute solution of subacetate, a useful lotion, 251 Liquor carbonis detergens, in acute cases, 519 McCall Anderson's ointment, 518 Methyl blue in eczema of the eyelids, 272 Ointments, prescriptions for, 301, 329, 519 Poultices, or olive oil with carbolic acid, (gtt. 1 to 2 to the ounce [0.05-0.1: 32.0]) followed by soap and water, necessary in some cases to soften scales, before use of ointment, 51* Prescription of iodol, as an ointment, about nose and lip, 234 Resorcin ointment (gr. 2 to 30 to the ounce [0.1-2.0:32.0]), locally applied in sub- acute tvpes; in chronic form ointment (gr. 2 to 10 to the ounce [0.1-0.65 : 32.0]), 329, 519; solution gr. x-xv (0.6-1.0) to f^j (32.0) in itching of erythematous form, 330 Salicylic acid ointment (gr. 30 to 60 [2.0- 4.0] to lard 1 ounce [32.0j), in chronic or weeping types, 337, 519 Starch poultice, in crusty eczema, 355 Tar ointment, in chronic forms, 325, 519 Thiol, as a dusting-powder, preceded by an antiseptic wash, especially suited to moist eczema, 369 Unna's dressing, 301 Zinc carbonate, as a protective powder in weeping eczema, 128 Zinc oxide, as a dusting-powder or oint- ment in early stages, applied directly or on lint, generally preceded by black wash, 518 EMISSIONS, 520 Bromide of sodium or potassium, gr. 20 (1.3), at bedtime, valuable in spinal irri- tability, 101, 520 Chloral, gr. 20 (1.3,), at bedtime, 520 Cold douches to perineum and scrotum, 520 Hygienic measures, 520 Hyoscine, gr. ^ (0.0006), of great value, 222, 520 Monobromated camphor very useful in spermatorrhoea, 117 Potassium citrate, gr. 20 (1.3), thrice daily, to render urine non-irritating, 521 Strychnine and arsenic, in full dose, of great service in genital atony, 521 Warm bath before retiring, often useful 520 EMPHYSEMA OF LUNGS. Cod-liver oil, useful, 169 INDEX OF DISEASES AND REMEDIES. 73] Ethyl iodide, 199 Euphorbia pilulifera, J to 1 drachm (2.0- 4.0) of the fluid extract, 201 Iodide of potassium, 226 Physostigma, aids in expelling mucus, 318 Strychnine, 291 EMPYEMA. Iodine, gr. 6 (0.4) ; pota-wiim iodide, gr. 6 (0.4) ; water, 1 pint (5i)J.0», as an irri- gating fluid, used daily, 230 ENDOCARDITIS, 521 Aconite, tincture of, gtt. 2 to 3 (0.1-0.15), hourly, in early stage of acute sthenic types. 521 Antirheumatics, antilithics, or iodides, if due to diathetic taint, 521 Calomel, gr. i (0.016), with morphine, gr. fa (0.006), every two hours, in early stages, 264, 521 ' Digitalis, to strengthen heart in later stages, 521 Ice-bag over praecordium, 521 Iron, tincture of chloride, associated with supportive treatment, in purulent types, 522 Leeches or wet cups, iu early stages, to abort, 521 Lithium citrate or acetate, or citrate of potassium, to prevent calcareous deposit in valves, 522 Mercury, in full dose, in sthenic cases, 264 Veratrum viride, used for same purposes as aconite, 521 ENTERITIS. (See Dysentery and Diar- rhoea, j EPIDIDYMITIS, 552 Guaiacol used locally highly recommended, 211 Heat, moisture, and pressure, in later stages, to relieve induration, 553 Horand-Langlebert's dressing, 553 Ice-bags, 552 Iodide of potassium, gr. 10 to 20 (0.65-1.3), thrice daily, to remove induration, 553 Iodine, painted over scrotum, said to be beneficial, 552 Mercury and belladonna ointments, equal parts, or iodine, gr. 4 (0.25), with lano- lin, ounce 1 (32.0), locally applied, to relieve induration, 553 Punctures, useful to relieve tension and al- leviate pain, 552 Rest in bed, elevation of pelvis and testi- cles, cessation of local gonorrhoeal treat- j ment and administering treatment for acute inflammation, 552 Silver nitrate, solution, painted over scro- tum, in early stage, may relieve, 2*0, 552 Strapping and suspending testicle, to re- duce inflammation, 553 EPILEPSY, 522 Acetanilid, 44, 529 Adonis vernalis with bromides have been found useful, 50, 526 Ammonium or sodium nitrite, used to sup- plement amyl nitrite, 528 Amyl nitrite, inhalations, when aura is perceived and also in status epilepticus to relax spasm, 68, 527 Anaesthetics contraindicated in all cases except status epilepticus, when chloro- form may be used to control attack, 528 Antifebrin and antipyrin especially use- ful in chronic cases when bromides fail, 76, 529 Belladonna, with bromides, recommended, 526 Bleeding harmful, except in marked cere- bral congestion or for the status epilep- ticus, 52* Boric acid has been used with asserted suc- cess, 99, 529 Bromate of potassium, 525 Bromide of ammonium, should be used with other drugs, 65, 525. of calcium, 104 of gold, 104 of iron, when anaemia is present. 525 of lithium, highly recommended in some cases, 105, 525 of nickel, 525 of potassium, the most reliable, in as- cending dose, 101, 522 of sodium, not so apt to disorder stom- ach, 525 Cannabis indica, 526 Chloral, alone or with bromides, well di- luted, after meals, used with care, 136, 528 Diet, 529 Digitalis, with bromides, useful in some cases, 526 Duboisiue, especially in psychic forms, 189 Hydrobromic acid, liable to derange diges- tion, 525 Iodide of potassium, useless except in syphilitics, 528 Mercury, instead of potassium iodide, when due to gumma, 528 Mixed treatment, 525 Monobromated camphor, 117 Nitro-glycerin, useful in some cases of petit mal, 2*3, 525 Opium with gelsemium, only to be used when other remedies fail; also a pro- longed course of, in ascending doses, useful in old cases, 526 Potassium nitrite, 282 Quassia injections, when due to worms ; if not obtainable, sodium chloride solu- tion may be used, 529 Silver nitrate, may be tried when other remedies fail, 279, 527 Solanum carolinense, fluid extract of, 2 to 15 minims (0.1-1.0), thrice daily, in the epilepsy of childhood, 351', 529 Strontium bromide, 356 Tartar emetic ointment, as a counter-irri- tant at back of neck, 72 EPISTAXIS, 530 Acetanilid, used locally, has been recom- mended, 45 INDEX OF DISEASES AND REMEDIES. Acetic acid, locally applied, to arrest, 46 Acouite or veratrum viride, tincture, gtt. 2 to 4 (0.1-0.2), in sthenic cases, followed in thirty minutes by smaller doses, if necessary, 50, 530 Alum powder, pure or half-and-half with starch, as a snuff, 530 Bacon fat inserted as a plug in nostril, may arrest, 530 Compression of facial artery may be neces- sary, 530 Ergot, turpentine, hamamelis, or oil of erigeron, internally, in slow oozing, 191, 530 Hot foot-bath, or hot- or cold-water bags applied to dorsal vertebra?, may arrest, 531 Ice applied to nose, may arrest, 531 Ipecac, in nauseating doses, recommended, 530 Monsel's solution, in spray (gtt. 30 to 4 ounces [2.0:128.0]), only to be tried when other remedies fail; very dis- agreeable, 530 Oil of erigeron, 192 Plugging anterior and posterior nares, if necessary, with cotton or lint soaked in vinegar, 530 Tannic acid, in powder or solution, snuffed up nostril, 530 Vinegar or lemon-juice injected into nos- tril, 530 EPITHELIOMA. Acid nitrate of mercury, applied to part with glass rod, 271 Arsenous acid and gum acacia (of each 1 ounce [32.0] to water 5 fluidrachms [20.0]), locally applied, 84 Resorcin, in epithelioma of the face, 330 ERYSIPELAS, 531 Alcoholic stimulants if patient passes into typhoid state, 531 Antipyrin, to control fever, 531 Bitters and iron, during convalescence, as tonics, 531 Boric acid, as a lotion, 98 Ichthyol ointment and vaseline, half and half, locally applied, preceded by wash- ing with castile soap, followed by bi- chloride solution (1 : 1000), 223, 532 Iodine, tincture, painted around inflamed edges, to arrest, 230 Iron, tincture of chloride, gtt. 20 to 40 (1.3-2.6), thrice daily, best internal treatment, 239, 531 Pilocarpine, gr. $ to £ (0.008-0.01), hypo- dermically, contraindicated in debility; also injected around borders of inflam- mation in some cases, to arrest, 321, 531 Silver nitrate, solution (gr. 80 to the £ ounce [5.0:16.0]), applied twice or thrice, to arrest, 280, 522. Veratrum viride or aconite, in early stages of sthenic cases, 531 White-lead paint, locally applied, when ichthyol is not at hand, 532 EXHAUSTION AND DEPRESSION, 532 Stimulants, 532 EXOPHTHALMIC GOITRE. Belladonna relieves some cases, 92, 93 Sparteine, 345 FAINTING. Alcohol, 52 FEET (SWOLLEN, TENDER, OR SWEAT- ING), 532 Arsenic, gr. fa to fa (0.001-0.0015), in swell- ing of old persons, 533 Borax, stockings soaked in saturated solu- tiou aud dried, each day, when sweat- ing is excessive, 533 Carbonate of calcium, precipitated, locally applied to sweating feet, 110 Cotton instead of woollen stockings may aid cure, 533 Hamamelis, distilled or fluid extract, drachm i to 1 (2.0-4.0)' of former, or gtt. 10 to 20 (0.65-1.3) of latter, 533 Lead plaster and linseed oil, equal parts, applied on linen to feet, every third day, for sweating, 251 Prescription for dusting-powder, 533 Rest, absolute, of feet, may be necessary in swollen feet, 533 Salicylic acid and borax, equal parts, in water and glycerin, best application to sweating and tender feet, 533 FELON. Bread-crumbs saturated with liquor plumbi subacetatis, as a poultice, to abort, 251 Silver nitrate, solution, applied early, to abort, 280 FEVER, 533 Acetanilid, 44, 534 Aconite, the best depressant for sthenic types in children, 49 Alcohol, as a systemic support and stimu- lant in low fevers, 52, 53 Ammonia for sudden cardiac failure iu, 63 Antimonial powder as an antipyretic, 73 Antipyretics, useful in most sthenic fevers, often fail in thermic fever, 535 Antipyrin, 75, 535 Brand's method, 669 Camphor a diffusible stimulant in adynamic fevers, 115 Coca a supportive and stimulant in low fevers, 167 Cold applications and baths, 534 Cold packs and baths, in asthenic types, to be relied on first; if impracticable, then antipyretics, 535 Digitalis, in small doses, valuable in ex- hausting fevers, 187 Guaiacol, useful in, 211 Hydrochloric acid an adjuvant to digestion 217 Musk, by rectal injections, valuable in low stages, 275 Neutral mixture, useful, as a febrifuge, es- pecially in children, 162 Phenacetin, 311 INDEX OF DISEASES AND REMEDIES. 733 FIBROIDS. Ergot, used as an expulsive and curative remedy, 192 FLATULENCE. Aromatic powder, 161 Asafoetida, 86 Camphor, 115 Capsicum, prevents formation of gas, 122 Charcoal, 127 Chloroform, gtt. 1 to 2 (0.05-0.1), or spirit, gtt. 10 to 20 (0.65-1.:!), will relieve, 152 Cloves, a useful tonic and stimulant, 163 Ginger, 207 Hoffmann's anodyne, the best carminative, 213 Ipecac, 235 Pepper, 307 Peppermint, 307 Podophyllin with euonymin, leptandra, chirata, and creosote, 325 Potassium permanganate, 310 Turpentine, prescriptions for, 376 FRECKLES AND CHLOASMA, 536 Almonds, emulsion of, supposed to be of value, 58 Boric acid, saturated solution, applied same as corrosive sublimate wash, 98, 537 Corrosive sublimate (gr. 1 to 4 to the ounce [0.05-0.25:32.0]), applied night and morning until irritation appears, then stop for some days and again renew, 536 Lactic acid (gr. 10 to the drachm [0.65 : 4.0]), applied same as corrosive subli- mate, 537 Prescription for chloasma of pregnancy, 301 Prescriptions for, 537 FURUNCLES. (See Boils.) GALACTORRHEA, 631 Antipyrin, gr. 2\ (0.125), thrice daily, said to decrease secretion, 632 Caustic, introduced into uterus, successful in some cases by inducing menstrual flow, 631 Chloral should be tried, 632 Compression of gland with applications of belladonna ointment and potassium iodide internally, usually relieves, 631 Diet, 632 Electricity, generally ineffective, 632 Ergot, long continued, highly recom- mended, 632 Malt, wine-glassful at midday and evening meals, useful addition to diet; pyro- phosphate of iron, gr. 5 (0.3), in addi- tion, if anaemia is present, 632 Warm douches, 631 GANGRENE. Bromine, as an escharotic in hospital gan- grene, 106 Carbolic acid or creosote, spray (gtt. 5 to 10 to the ounce [0.3-0.65 : 32.0]), useful iu pulmonary gangrene, 126 Nitric acid, to destroy tissue, 281 GASTRALGIA, 537 Acetanilid, 44 Alum, 61 Arsenic with iron, the most reliable rem- edy, prescription for, 538 Bismuth and pepsin, 1 to H hours after meals, to prevent pain, 96, 53* Bromide of strontium, a valuable remedy, 538 Bromides or valerian, alternated with other treatment if case is neurotic, 538 Cannabis indica, prescription for, 119 Cod-liver oil in emulsion with hypophos- phites, occasionally better thau arsenic and iron, 53* Counter-irritation and a vigorous revul- sive, especially useful in hysteria, 537 Cyanide of potassium, dilute hydrocyanic acid or chloroform as a substitute for bismuth, if it favors constipation, 538 Diet and hygiene, 537 Emesis and purgation, when due to indi- gestible food, 537 Hot applications, stimulating infusions, chloroform, hot brandy or whiskey or laudanum, gtt. 30 (2.0) to 60 (4.0\ during acute stage, 537 Hydrocyanic acid, useful in nervous types, 218 Massage, enemata, diet, or suppositories of gluten, glycerin, or soap, to overcome constipation, 538 Menthol, 308 Nitro-glycerin, 233 Potassium nitrite, gr. 4 to 5 (0.25-0.3), 282 Salicylic acid, used in paroxysmal forms, 337 GASTRIC CATARRH (ACUTE), 538 Ammonium muriate, useful in subacute forms in children, prescription for, 66 Diet, principal point in treatment, 538 Effervescing draughts, useful in convales- cence, 539 Emetic, mild, to dislodge fermenting mass, if present, 539 Ice, to quench thirst, if anorexia is great, 539 Iron, if anaemia exists, 539 Milk, with large percentage of lime-water, 539 Pepsin and hydrochloric acid, 539 Salicylic acid, valuable in vomiting, 337 Salt, in moderation, with food, 539 Seidlitz powder, one-fourth of one powder every fifteen minutes, to settle stomach and remove fermenting mucus, 539 Sodium bicarbonate with gentian, useful in convalescence and in children, 539 Spice poultice to relieve epigastric distress, 539 Tartar emetic, given early, in acute attack of children, may abort, 72 GASTRIC CATARRH (CHRONIC), 542 Apomorphine, as an emetic, to throw off mucus, 80 Arsenic for the vomiting, in hand-fed babies, 83 Bismuth subnitrate, added to prescription, if hyperacidity exists, 540 734 INDEX OF DISEASES AND REMEDIES. Cascara sagrada, if constipation exists, 540 Charcoal, prescription for, 127 Diet, such as koumyss, light broths, and matzoon, 540 Hydrochloric acid, if due to atrophy of the gastric tubules, 217, 540 Lavage almost always to be used, 510 Silver nitrate and hyoscyamus, with coun- ter-irritation and regulated diet, 221, 279, 540 GASTRIC DILATATION. Cod-liver oil, by stomach or inunction, if due to rhachitis, 541 Diet, 541 Enemas, nutrient, often useful, especially in older children, 541 Faradization of gastric walls recently in- troduced, 542 Gentian and calumba, useful as tonics, 542 Iodide of iron, syrup of, lacto-phosphates of lime, or phosphate of sodium, iu stru- mous diathesis, 541 Lavage, 544 Physostigma, tincture, gtt. 5 to 10 (0.3-0.65), or extract, gr. i to i (0.008-0.016), to im- prove muscular coats, 542 GASTRIC ULCER, 542 Arsenic, 83 Bismuth and sodium bicarbonate, as an as- tringent and sedative, and to these may be added morphine or codeine for pain, 96, 543 Carlsbad salts, magnesium sulphate, or so- dium phosphate, for relief of constipa- tion, 543 Cocaine, gr. i (0.016), alone or combined with bismuth, to control vomiting, 543 Counter-irritation, mild, continuous, over belly, to relieve pain, 542, 543 Creosote or carbolic acid, for vomiting, 543 Diet and hygiene, 542, 543 Massage and electricity, 543 Monsel's solution, cold compresses, or tur- pentine, may be given to check hemat- emesis, 543 Morphine for pain or collapse following perforation, 543 Rectal alimentation, of great service, 542 iiesorcin useful in some cases, 330 Silver nitrate with hyoscyamus in pill, half to one hour before meals, 543 Spice plaster, useful as a mild continuous counter-irritant, 543 Stimulants, cardiac, guardedly adminis- tered, external heat and rubbing, in collapse following hemorrhage or per- foration, 544 GASTRITIS (ACUTE), 544 Belladonna, internally, and flaxseed poul- tice over epigastrium and chest, if col- lapse threatens, 544 Bismuth, as an astringent and sedative, 96 Flaxseed tea, a useful demulcent, 203 Mucilaginous drinks and albuminous sub- stances freely given, 511 Oils, to prevent spread of inflammation, 544 Opium, in fluid form, to relieve pain and irritation, 544 Warm water, internally, or stomach-pump, to unload stomach at onset, 544 GASTRO-ENTERITIS, 544 Castor oil or magnesium sulphate, to sweep out poison, 545 Morphine, hypodermically, to allay pain, followed or preceded by mild, rapidly acting emetic, if irritating substance re- mains, 545 Opium and sulphuric acid, with hot appli- cations or plasters to belly, to control irritation and diarrhoea, 545 GASTRO-INTESTINAL CATARRH. Carlsbad, Vichy, or other alkaline mineral water of purgative nowers, often useful, 421 Diet for seven-year-old child, 432 Garlic, as a poultice to belly almost equal to spice poultice, 57 Gentian with bicarbonate of sodium useful in children. 207 Hydrastis, especially useful if due to alco- holism, 216 Salicylate of bismuth in the presence of fermentation or putrefaction, 333 Sanguinaria, of service if jaundice is pres- ent, 341 Sodium bicarbonate, 10 to 20 grains, 95 Tar, in 2-gr. (0.1) pills, 324 GIDDINESS. Cod-liver oil with quinine, valuable in old age, 169 Ergot and bromides useful, 169, 191 GLANDS (DISEASED). Ammoniac plaster, as a stimulant to en- larged glands, 04 Ammonium iodide and glycerin (gr. 30 to the ounce [2.0 : 32.0]), locally applied to enlarged tonsils, 66 Carbolic acid (2 per cent, solution), injected into glands threatening suppuration, 126 Cod-liver oil, in lymphatic enlargements, 169 Ichthyol ointment, valuable as an inunc- tion in lymphatic enlargements, 223 Iodine, the best remedy for enlargements, 228 Mercury ointment as an inunction in en- larged glands, 270 Potassium iodide for enlargements of the cervical glands, 226 GLAUCOMA, 545 Atropine, contraindicated, 545 Eserine (gr. 1 to 2 to the ounce [0.05-0.1 : 32.0]), or pilocarpine nitrate (gr. 2 to 4 to the ounce [0.1-0.2 : 32.0]), dropped into eye if operation is delayed, 318 545 Hot compresses, leeches, and opiates to re- lieve pain, 545 Iridectomy, the only curative treatment, 545 Pilocarpine in, 321 INDEX OF DISEASES AND REMEDIES. OjO GLEET. Bichloride of mercury, injection (gr. 1 to water ounces 6 [0.025:192.0]), every three or four hours, 266 Cantharidal collodion, applied to under surface of penis, or perineum, 401 Cantharides, 121 Sandalwood oil, 341 Turpentine, internally, 376 Uva ursi, 377 GOITRE. (See Bronchocele.) GONORRHOEA (ACUTE), 546 Aconite, gtt. 2 (0.1), every two or three hours, if inflammation is high, 548 Almond emulsion, diminishes burning on urination, 58 Benzoic acid, with cannabis indica, useful in later stages, 94 Bicarbonate of sodium or potassium citrate, gr. 10 (0.65), after meals, increasing, if necessary ; relieves ardor urinae, 548 Cannabis indica, often used in later stages instead of copaiba and cubebs, 119 Cinnamon oil, by injection or spray, 161 Cocaine, solution (4 per cent.), instilled into urethra before urination, diminishes ardor urinae, 548 Copaiba, to relieve ardor urina? and stimu- late mucous membrane in later stage, 176. 547 Cubebs, useful in later stage, 182, 547 Diet and hygiene, 548 Erigeron oil, occasionally used instead of copaiba and cubebs, 192 Eucalyptus, valuable in subacute stages, 200 Hot sitz-bath, prolonged, and hot-water in- jections, useful in females, 554 Hydrastis, one of the best remedies, locally and internally in later stages: also as a vaginal wash for females, 216, 547 Lead acetate, injection, gr. 1 to * to the ounce (0.05-0.6:32.0), 249 Lead-water and laudanum, or alcohol and water, applied on a cloth to penis, dur- ing inflammation, 547 Mercury bichloride (1: 20,000 or 1: 40,000), in large quantities to flush urethra ; iu females, 2 pints of solution (1:4000), thrice daily, to irrigate vagina, 546, 553 Opium or belladonna, hypodermically or in suppository, to control pain in posterior urethritis, at same time discontinuing active treatment, and observing strict hygiene and diet, 549 Prescription for infusion, 216 Prescriptions for injection for posterior ure- thritis, 549 Quercus alba, injections, useful in females, 328 Salol, 547 Sandalwood oil, 547 Silver nitrate, injections (gr. i to 3 ounces [0.025:90.0]), useful in subacute stage; in females, gr. 4 to 60 to the ounce (0.2-4.0:32.0), painted over vagina, fol- lowed by astringent cotton tampon, 280, 547 Urinating with penis in hot water, to re- lieve ardor urina?, 543 Warm baths, lasting one-half to two hours, useful in early stage, 548 Zinc acetate, injection, gr. 1 to 20 to ounce (0.05-1.3 : 30.0) of rose-water, 382 Zinc chloride, injection, gr. 1-2 to the ounce (0.05-0.1: 32), occasionally used in second stage, 140 Zinc sozoiodol, 2 per cent, solution, 353 Zinc sulphate, weak solution, as an astrin- gent injection, 358, 547 GONORRHOEA (CHRONIC), 550 Bichloride of mercury useful in, 266 Copper sulphate or silver nitrate, solution as an application, after dilatation, to focus of inflammation, 550 Dilatation, if stricture exists, 549 Prescriptions for, 550 Pressure and use of cold, often valuable, 550 Sandalwood oil, to stimulate depraved mu- cous membrane, 341 Silver nitrate, solution, if discharge per- sists after dilatation; also in posterior urethritis, 550 Unna's treatment with coated sounds, pre- scription for, 550 Uva ursi, 377 GOUT, 554 Antipyrin, said to have a specific effect, 76 Chloral, in insomnia, 537 Chloroform liniment, applied over affected part, 152 Cod-liver oil, 169, 556 Colchicum, wine of the root, gtt. 20 (1.3), increasing by gtt. 1 (0.05) every four hours, until symptoms are relieved or appear toxic, in acute types, 171, 555 Collodion, not more than one or two coats; also useful with iodine, 173, 555 Colocynth with hyoscyamus, to unload the bowels, prescription for, 174 Diet, 555 Fowler's solution, gtt. 3 (0.15) in water, a standard remedy in subacute and chronic types, 556 Gentian, 207 Iodide of iron, syrup of, and cod-liver oil if anaemia is present, 556 Iodide of potassium, to relieve night pains; also with colchicum, in chronic gout, 555 Iodine, ointment or tincture, locally ap- plied to chronic gouty joints, 555 Leeches or venesection, contraindicated, 555 Lithium carbonate or citrate (gr. 5 to 10 to the ounce [0.3-0.65 : 32.0]), locally ap- plied to dissolve deposit around joints, 253, 555 Morphine, hypodermically, near paiuful spot to relieve acute pain, 555 Peppermint oil, locally applied, 555 Potassium bromide, the best remedy for in- somnia, 555 Potassium permanganate, 310 Salicylates in large dose may be useful in, 336 736 INDEX OF DISEASES AND REMEDIES. Sodium bicarbonate and linseed oil (1 : 9), locally applied to joints, 555 Stimulants, ether hypodermically, opium except in brain or kidney disturbances; diuretic and alkaline drinks and coun- ter-irritation, in retrocedent gout, 556 Water, distilled or medicinal, in large amounts, 556 GRANULAR LIDS. (See Conjunctivitis, Granular.) GRAVES'S DISEASE. (See Exophthal- mic Goitre.) GRIPING. Allspice or ginger, to prevent griping of purgatives, 57, 207 GROWTHS (PATHOLOGICAL). Acid nitrate of mercury, 271 Caustic potash, or soda, occasionally used to destroy, 132 Chromic acid, as a caustic, to destroy growths on skin or mucous membranes, 153 Injections of tincture of iodine in ovarian tumors, 230 Lime as an escharotic on hairy growths, 113 Methylene blue, 273 Nitric acid, 281 Pyoktanin, 273 Sodium ethylate to remove hairy growths, 351 Thiosinamine has been used with some success in malignant growths, 370 GUMS (DISEASES OF). Burnt alum, useful applied to swollen gums, 61 Catechu, as a mouth-wash, for spongy gums, 132 Cocaine, locally applied, in soreness and tenderness of gums, 165 Iodine, solution (gr. 1 to the ounce [0.05: 32.0]), locally applied, followed by rins- ing mouth, when gums are retracted, 230 Myrrh, tincture, locally applied, to spongy or tender gums, 276 HAY FEVER. Arsenic, 83 Cocaine, with bismuth and morphine, as a snuff, 166 Resorcin, solution, 2 percent., in spray, 329 Terpine hydrate, in full dose, 368 HEADACHE, 563 Acetanilid, 44 Belladonna, valuable in young people, 93 Bleeding, 564 Caffeine, with antipyrin or sodium bro- mide, iu nervous headache, 109, 564 Camphor, with acetanilid or antipyrin, in nervous headache, 115 Cannabis indica, when at menopause or due to retinal asthenopia, 119 Capsicum plaster to nape of neck, 123 Cimicifuga, if due to eye-strain, 154 Colchicum, in gouty headache, 564 Croton chloral, if due to eye-strain or asso- ciated with sick stomach, 181 Cup, to nape of neck, in congestion, 564 Ergot, if due to congestion, 191 Eucalyptus, if headache be rheumatic or malarial, 200 Gelsemium, if due to nervous troubles or eye-strain, 206 Hydrobromic acid, if due to eye-strain in nervous women, 105 Ice-bag, applied to head, or leeches behind ears, in severe cases, 564 Kola, very useful in elixir or tincture for sick and neuralgic headaches, 246 Liquor magnesii citratis, iu sick headache. 256 Magnesium carbonate, gr. 5 to 60 (0.3-4.0), in sick headache due to gastric acidity, 256 Mustard foot-bath and plaster to nape of neck, in congestion, 276, 564 Nux vomica, gtt. 1 (0.05) every five or ten minutes till 10 drops (0.65) are taken. in sick headache, 291 Oxygen-water, 304 Phenacetin, if due to eye-strain or neural- gia, 312 Potassium bromide, 101 Prescriptions for, 504. 565 Salicylic acid or iodide or acetate of potas- sium, if due to gout, 565 Sodium bicarbonate, as an antacid in sick headache, 95 Strychnine or nux vomica, in sick head- aches or if due to eye-strain, 291, 564 HEART DISEASE, 565 Aconite or veratrum viride, often useful in palpitation and hypertrophy, 49, 569 Adonidin, often of service when digitalis fails, 50, 508 Ammonia and ether, followed by digitalis and alcohol, in heart failure, 63, 569 Amyl nitrite, in single whiffs, often relieves cardiac failure, 68 Barium chloride, in heart failure, *9 Belladonna, when arhythmia is present, 569 ; and in palpitation, 91 Cactus grandiflorus, useful in valvular dis- ease with incompetency, cardiac weak- ness and palpitation, 108, 569 Caffeine, very useful, 109 Camphor in palpitation, 115 Cimicifuga, as a tonic in fatty and irritable heart when digitalis fails, 154 Convallaria majalis, in cardiac arhythmia, 176 Diet and exercise, in fatty degeneration, when fat is deposited between muscular fibres, 571 Digestive remedies, in palpitation due to indigestion, 569 Digitalis, to be tried in all heart troubles, except in simple or compensatory hyper- trophy, 187, 566 Hoffmann's anodyne, very useful in palpi- tation due to indigestion or tobacco, 213 Hydragogue cathartics for the dropsy and portal engorgement, 569 INDEX OF DISEASES AND REMEDIES. 737 Iron, in palpitation due to anaemia, 569 Iron, arsenic and simple bitters for asso- ciated debility and anosmia, 569 Kola, useful in cases with debility, 246 Nitro-glycerin, when arterial tension is high,569 Nux vomica, in palpitation, as a stimulant 569 Opium, if dyspnoea prevents sleep, 297 Sparteine, in arhythmia or palpitation, also as a substitute for digitalis, if it fails, 345, 569 Strophanthus, if digitalis fails, 357, 568 Suprarenal gland, 364 Venesection followed by digitalis for over- distended right ventricle, 569 Veratrine ointment, locally in palpitation, 569 Veratrum viride, 380 HEMATEMESIS, 559 Ergot, hamamelis, or ipecac, in slow bleed- ing, 559 Ice, cracked, swallowed frequently, accom- panied by Monsel's solution, gtt. 3 (0.151 in a half-tumblerful of water, every fifteen minutes, 559 Iron, tincture of chloride, or turpentine, internally, if passive, 559 Lead acetate with morphine or opium, gr. 2 to 3 (0.1-0.15), in pill, 559 Monsel's salt, gr. 2 to 3 (0.1-0.15), in pill, 241, 559 Silver nitrate, gr. \ (0.015) in pill, in slow bleeding, 559 Tannic acid, gr. 20 (1.3), to drachm of water: must not be given with Monsel's solution, 559 HEMATURIA, 561 Alum, gr. 2 to 3 (0.1-0.15) to water 1 ounce (32.0), injected into bladder, if alarming, 561 Camphor, gr. 10 to 20 (0.6-1.3), in divided doses, in pill, 561 Cannabis indica, useful in some cases, 561 Ergot, 561 Erigeron, 561 Gallic acid, gr. 20 (1.3), very valuable, 204 Hamamelis, injected daily into bladder, or used internally, 213 Hyposulphite of sodium, 5 to 15 grs. (0.3- 1.0), if due to malaria, 351, 561 Prescription for, 561 Quinine, usually harmful, unless due to malaria, 561 Rhus aromatica, 331 Styptic injections, should be used only when bleeding is alarming, 561 Turpentine, 376, 561 HEMOPHILIA. Calcium chloride, 111 HEMOPTYSIS, 557 Acetanilid, has been recommended, 45 Aconite, to prevent pneumonia following, contraindicated in exhaustion, 558 Alum, solution (gr. 20 to the ounce [1.3 : 32.0]), in fine spray, 61 47 Chloral and bromides, to allay nervous ex- citement, 558 Ergot, fluid extract, 1 to \\ drachms (4.0- 6.0), internally, 553 Gallic acid, gr. 20 to the ounce (1.3 : 32.0) of water, when ergot is not at hand, 204, 558 Hamamelis, 213 Ice or dry cup over bleeding spot, 558 Ice or ice-cold compresses to the scrotum or vulva in, 558 Ipecac, in small doses, very effective, 235 Morphine, hypodermically, to allay ner- vousness and cough, 296, 558 Tannic acid, Monsel's solution, or alum, used in spray, as styptics, prescriptions for, 241, 366, 557, 558 HEMORRHAGE, 556 Alum, a useful styptic, applied to bleeding vessel, 60 Antipyriu, 77 Arnica, 80 Cinnamon in uterine hemorrhage, 161 Compress, soaked in antiseptic liquid or filled with antiseptic powder, preferable to styptics, 556 Hamamelis, useful for uterine oozing, and bleeding from the bladder, 212, 213 Hypodermoclysis, 415 Ligation preferable to styptics, when appli- cable, 556 Monsel's solution, 241 Oil of erigeron, 192 Packing-of astringents, if bleeding point cannot be reached by compression, or for ligation, 556 Sulphate of sodium by the mouth or intra- venously ; useless hypodermically, 352 Tannic acid, 366 Transfusion, 427 HEMORRHAGE INTESTINAL), 559. (See also Hemorrhage.) Enemas, styptic, for hemorrhage from rec- tum or colon ; alum (gr. 10 to the ounce [0.65 : 32.0]), copper (gr. 5 to the ounce [0.3 : 32.0]), Monsel's solution (dr. 1 to 2 ounces [4.0 : 64.0]), Monsel's salt (gr. 10 the ounce [0.65 : 32.0], or drachm \ [2.0] to water 2 ounces [64.0]), chlorate of potash (gr. 10 to 25 to the ounce [0.6-1.6 : 32.0]), and tannic acid (gr. 20 to ounce [1.3: 32.0] of glycerin and water, 560 Ergot, 559 Ice, by mouth, and to the belly, 722, and Monsel's salt, gr. 3 (0.15), in hard pill, every half-hour or oftener, 559 Ice-water injections in bloody purging of dysentery, 560 Lead acetate and camphor, in pill, of ser- vice in some cases, 559 Monsel's solution not advisable, 241 Sulphuric acid, gtt. 5 to 10 (0.3-0.65) in water, 559 Tannic acid, in solution or pill, when Mon- sel's salt is not at hand, 559 Turpentine, in capsule or emulsion, when bleeding is not active, 376, 559 738 INDEX OF DISEASES AND REMEDIES. HEMORRHOIDS, 502 Aloes, 59, 543 Cocaine and iodoform ointment, prescrip- tion for, 562 Cold-water injectious in the morning, re- lieve congestion and cause easv evacua- tion, 395, 563 Ergot, sometimes useful in bleeding piles, 192 Gallic acid and ointment of stramonium, equal parts, 204 Gallic acid and opium, suppository, pre- scription for, 562 Hamamelis, internally or as a lotion or in- jection, 213, 563 Iodoform suppository, if ulceration is pres- ent, 233 Linseed oil, 203 Nitric acid, lightly touched to one or two points, 282, 562 Potassium chlorate, with laudanum, as an injection, 139 Poultice, to effect reduction, 562 Quercus alba, as an astringent wash, 329 Stillingia, prescription for, 355 Sulphur, to produce soft passages, 361 Tannic acid, suppositories in bleeding piles, 366 HEPATIC ABSCESS, 571 Active treatment for dysentery, if present, 572 Ammonium muriate, thought to be of value, 66 Aspiration, when pus forms, 572 Diet, 572 Quinine aud iron, after abscess develops, 572 HEPATIC CIRRHOSIS. Ammonium chloride, 66 Iodoform, highly recommended, 233 Nitro-muriatic acid, in early stages, 285 Potassium iodide, ofteu useful in early stages, 226 Sodium phosphate very useful, 314 HEPATITIS (ACUTE), 571 Aconite, in early stages, 572 Cantharidal blister, small, over right hypo- chondrium ; if impracticable, use mus- tard plaster, 572 Hot cloths, over counter-irritant, may re- lieve pain and aid in formation of blis- ter, 572 Saline purgatives, preceded by calomel, gr. 1 (0.05), in divided doses, if constipation exists, 572 Sweet spirit of nitre with potassium citrate, or diuretic waters, to regulate kidnevs, 572 Veratrum viride, 380, 572 HEPATITIS (CHRONIC AND SUBACUTE), 571 Ammonium chloride, useful in subacute forms, 66 Antisyphilitic treatment, if due to syph- ilis, 573 Aspiration, frequently repeated, may effect a cure, 573 Nitro-muriatic acid, internally and exter- nally, most useful remedy, 285, 572 Potassium iodide, useful iu all cases, 573 HERNIA. Chloroform or ether inhalations, to relax muscles during reduction, 151, 197 HYDROCEPHALUS. Potassium iodide, to cause absorption of fluids, 225 HYSTERIA. Calcium bromide, 104 Hops, as a nervous sedative, 215 Monobromated camphor, to produce sleep, 117 Oil of amber, 61 " Pill of three valerianates," recommended, 378 Potassium bromide, 101 Valerian, 377 Valerianate of ammonium, 67 Valerianate of iron if associated with anaemia, 242 IMPOTENCE. Cannabis indica, with strychnine, nux vomica, or ergot, if no organic trouble exists, prescription for, 118 Cantharis, with nux vomica and iron, may restore sexual power if loss is due to excess, 121 Cold douche to perineum and testicles, in atonic types, 374 Gold, chloride of, and sodium, gr. fa (0.003), 209 INCONTINENCE OF URINE, 574 Alkalies, 574 Antiseptic fluids, to cleanse bladder, in paralysis, 575 HICCOUGH, 573 Amyl nitrite, 573 Belladonna, 92 Camphor, spirit of, dose 1 drachm (4.0), 115, 572 Capsicum, tincture, gtt. 2 to 3 (0.1-0.15), 573 Chloral, 136 Chloroform, 573 Ether, inhaled or sprayed on epigastrium, 197, 573 Hoffmann's anodyne, especially valuable, 213, 573 Musk, gr. 10 (0.65), given by rectum, valu- able in all cases, especially in typhoid fever, 275, 573 Nux vomica, accompanied by mineral acids, if due to indigestion, 574 Oil of amber, gtt, 5 to 10 (0.3-0.65), in cap- sule, one of the best remedies, 61, 573 Pilocarpine hydrochlorate, hypodermically, if due to ura?mia, 574 Valerian, tincture of, dose 1 drachm (4.0), 573 HYDROCELE. Iodine, injections, after evacuation of the sac, the best curative remedy, 230 INDEX OF DISEASES AND REMEDIES. 739 -Aiseuic, wiui nux vomica, in weakness of spinal centres, prescription for, 575 Belladonna, if due to vesical spasm, 92, 575 Bromides with chloral, if due to vesical spasm, 101 Buchu, with sweet spirit of nitre, valuable in some cases, 107 Cantharides, gtt. 1 (0.05), with alkaline diuretics, thrice daily, in adults, 121, 575 Catheterization, in retention or paralvsis, 575 Circumcision, if prepuce is redundant, re- lieves some cases, 574 Diuretic waters, used for years, necessary in some cases, 575 Fowler's solution, gtt. \ to 1 (0.025-0.05), in clironic types due to atony, 575 Hyoscyamus, if due to irritable bladder, 221 Potassium citrate when due to acidity, 162 Rhus aromatica, in incontinence of chil- dren, due to atony, 331 Santonin, often valuable when other reme- dies fail, 342 Strychnine, 575 Sweet spirit of nitre and potassium citrate, if urine is dark and concentrated, pre- scription for, 364, 574 INDIGESTION (GASTRIC AND INTES- TINAL), 576 Alcohol, in adynamic types, 579 Alkalies, before meals in atonic states, dur- ing or after meals when the secretion of acid is excessive, 577, 578 Ammonium chloride, in painful forms, 66 Asafoetida, in indigestion of old age, asso- ciated with flatulence, 86, 580 Bicarbonate of sodium with bitters, 577 Bitter tonics, useful in atony, contraindi- cated in gastric irritation, 578 Bromide of strontium, in excessive secre- tion, when not due to ulcer, 356, 578 Bryonia, when dependent upon gastric or intestinal atony, 106 Carbolic acid and bismuth, 578 Chirata, if liver is torpid or constipation is present, 134 Chloroform, gtt. xx (1.3), often of great value, 580 Chloral, creosote, sodium hyposulphite, or thymol, with lavage, when fermentation is excessive, 579 Diastase when starchy foods are not di- gested, 183 Diet, 577 Fats, excluded in fermentative types, 579 Gold, chloride of, and sodium, when epi- gastric pain is present, 209 Hydrochloric acid, combined with carda- moms, in atrophy of the gastric tubules, cancer, or intestinal dyspepsia, 577 Hyoscyamus, belladonna, opium, bromides, and bismuth, where there is hyperacid- ity, 578 Lavage, 579 Leptandra, of great value in intestinal types, prescription for, 252 Nitrate of silver, especially where an ulcer is present, 57* Nitro-hydrochloric acid or nitric acid, val- uable in many cases, 282, 284, 579 Ox-gall, 300 Pancreatin, with sodium bicarbonate and alkaline mineral waters, in intestinal types, 579 Papain, 305 Podophyllin or mercury in lientery, 580 Prescription for torpid liver of indigestion, 580 Prescription for flatulence of intestinal in- digestion, 579 Salol in intestinal form with fermentation, 340 Serpentaria, as a tonic, 348 Strychnine, quinine, and nux vomica, use- ful tonics, 578 Volatile oils, prescription for, 579 Yellow oxide of mercury, gr. fa or fa (0.001-0.0012), in trituration, if there is foul belching or ill-smelling stools, 271 INFLAMMATION. Cannabis indica, valuable in chronic types, 119 Cocaine, in acute types, prescription for, 165 Flaxseed for inflamed mucous membranes, 203 Hop poultice, 215 Liquor plumbi subacetatis, useful as a top- ical application, 250 Opium, 296 Sulphurated lime useful to check, 114 Tartar emetic, in sthenic inflammations, 72 Turpentine stupe, 375 Veratrum viride, 380 INFLUENZA, 580 Aconite, sweet spirit of nitre, and citrate of potassium iu combination, valuable in early stage, 582 Alcohol, 534 Antipyrin, phenacetin, and acetanilid should only be used in small doses to allay pain, 581 Belladonna, combined with strychnine, if there be vasomotor paresis, 583 Bromides, if cough be excessive, 584 Cannabis indica, often valuable if pushed, for irritative cough, 5*4 Chloral, chloralamide, or sulphonal, for in- somnia, 585 Cold bath, preferable to antipyretics for re- duction of temperature, 582 Cups, contraindicated, 5*3 Ergot, cannabis indica, with bromides, often relieve vertigo, 5*5 Monobromated camphor, 117 Phenacetin, 312 Salol and phenacetin, valuable in combi- nation, to allay irritation and pain, 581 Sandalwood oil, for excessive cough, 341 Steam inhalations, laden with vaporized drugs, for cough, 584 Strychnine, preferable to digitalis if there be tendency to collapse, 583 INSANITY. (See Mania, Acute). 740 INDEX OF DISEASES AND REMEDIES. INSOMNIA, 585 Amylene hydrate, useless if due to pain, 586 Bath, cold in cerebral anaemia, hot in ner- vous irritability, 393 Bromide of potassium with Fowler's solu- tion, in nervous females, prescription for, 586 Cannabis indica, prescription for, 119 Chloral, useful if not due to pain, prescrip- tion for, 136, 585 Chloralamide, gr. 15 to 60 (1.0-4.0), in wine or capsule, in nervous insomnia, 137, 586 Chloralose, 2 to 7 grains (0.1-0.5), in cap- sule, 138 Chlorobrom for insomnia of melancholia and acute mania, 138 Croton chloral, preferable to chloral, if due to pain, 131 Duboisine more useful thau hyoscine, 138 Hop pillow, 215 Hot-water bags to feet and cold to head, if due to cerebral hyperemia, 586 Hyoscine, gr. Tfo to fa (0.0006-0.0008), by mouth, or gr. tfff to TJn (0.0004-0.0006), hypodermically, in mauia or hysteria, 221, 586 Hypnal, useful in insomnia due to pain, 222, 586 Morphine with chloral, if due to pain, pre- scription for, 586 Opium, only to be used in pain, 295 Paraldehyde, 305, 586 Potassium bromide, in nervousness and overwork, 102 Scopolamine, if due to nervousness, 345 Somnal, minims 10 to 40 (0.65-2.6), in liquorice and water, 352, 586 Sulphonal, prescription for, may be given in hot water, 360, 586 Tetronal, useful, 374 Trional, in 15-grain (1.0) doses, 374, 586 Valerian, in nervousness, 377 INTERMITTENT FEVER, 587 Alcohol, contraindicated, during chill, 588 Anaesthetization, has been employed to put off paroxysm, 5*8 Arsenic, in intervals between attacks, as an antiperiodic, 82. 588 Calomel, gr. £ to 1 (0.01-0.015), every fif- teen minutes until 1 grain (0.06) is taken, four or five hours before quinine, if constipation is present, 557 Chloroform inhalations, preceded by lauda- num, bv mouth or rectum, or morphine, gr. I 0X01), with atropine, gr. fa (0.001), hypodermically, if death threatens dur- ing chill, 58* Cool drinks and sponging, in fevered stage, 5*8 Digitalis or strychnine, to relieve internal congestion during chill, 588 Eupatorium useful in, 201 Ice-pack, if fever is long continued and ex- cessive, 588 Ipecac or zinc sulphate, as an emetic, if chill follows full meal, 588 Methylene blue, 1 to 4 grains (0.05-0.2), 273 Phenocoll, sometimes useful, 313 Podophyllin, gr. fa to | (0.006-0.007), pre- ceding quinine, if constipation is pres- ent, 537 Potassium or sodium nitrite, gr. 10 (0.65), have been employed to put off attack, 5*9 Quinine, as a prophylactic and antiperiodic, 5*7 INTERTRIGO. See Chapping.) INTESTINAL CATARRH. Ammonium chloride, useful in subacute types, 66 Chlorate of potassium, injections (gr. 20 to the ounce [1.3:32.0]), in acute rectal catarrh, 139 Iodide of potassium, if ammonium chlo- ride fails to relieve, 225 Leptandra, fluid extract, dose 20 minims to 1 drachm (1.3-4.0), 251 Salol, 339 INVOLUTION (ANOMALIES OF), 628 Cannabis indica, of great value iu subinvo- lution, 119 Cimicifuga in subinvolution, 154 Curette in subinvolution due to retention of hypertrophic endometrium, 62* Digitalis in subinvolution due to sluggish circulation, 628 Ergot, quinine, and strychnine, in pill, if due to fibroids, 628 Purgatives, disinfectants, and possibly hot water locally applied, if due to inflam- mation, 628 Removal of placenta, if adherent, 629 IRITIS, 589 Atropine, the best local remedy, 92 Counter-irritation, 589 Daturine, scopolamine, or duboisine, when atropine cannot be used, 5*9 Iced compress, in early stage of traumatic iritis, 589 Iodide of potassium, alone or with mer- cury bichloride, following mercurial impression in syphilitics, 590 Leeches and dry heat or hot fomentations, to relieve pain, 5*9 Mercury, preferably by inunction, if due to syphilis, 589 Morphine, if pain is severe, 590 Paracentesis, 589 Pilocarpine, internally if vitreous becomes opaque, also in gonorrhceal types, 589 Salicylic acid or oil of gaultheria, followed later by potassium iodide, in rheumatic iritis, 590 Saline laxatives, during course of disease, followed by iron, after cessation of spe- cific treatment, 590 Scopolamine in early stages of, and in plastic, 344 Turpentine accompanied by potassium iodide, in plastic iritis, following sec- oudary syphilis, 590 Zollicoffer's mixture, useful in chronic types, 590 INDEX OF DISEASES AND REMEDIES. 741 IRRITABILITY. Almonds, as a drink in irritability of in- testines and air-passages, 58 Cantharis, recommended in irritable blad- der of women and children, 121 Cimicifuga, in uterine irritability, 154 Hops, in vesical irritability, 215 Hydrocyanic acid in irritability of the stomach, 218 Hyoscyamus for vesical irritability with incontinence, 221 Petrolatum, as a soothing agent in gasto- intestinal types, 310 Piperazine, iu bladder irritation due to ex- cess of uric acid, 323 Potassium bromide, in irritability of phar- ynx, 101 JAUNDICE. Calomel, gr. \ (0.01), every half-hour till gr. \ (0.025) is taken, if due to cold, 267 Carbolic acid, gr. 10 (0.65), with water and glycerin, each 2 drachms (8.0.', locally applied in itching of jaundice, 126 Citric acid, in catarrhal form, 163 Hydrastis, useful in subacute types, 216 Iodoform, highly recommended, 233 Manganese sulphate, may be tried iu mala- rial types, 257 Pilocarpine, useful unless due to malignant disease, 321 Salol, said to be of value, 339 Sodium phosphate, of value, 314 JOINTS (ENLARGED). Tartar emetic ointment, 72 Turpentine liniment, 376 KELOID. Ichthyol ointment, 223 Thiosinamine, 10 per cent, solution in al- cohol, injected into the growth, 370 KERATITIS (INTERSTITIAL), 590 Antiseptic lotions, in marked ciliary con- gestion, 590 Antisyphilitic treatment, if due to syph- ilis, 590 Atropine, in ciliary congestion, to prevent iritis, 590 Leeches, to temple to relieve pain, if pa- tient is not too young for bleeding, 590 Thymol iodide, as a dusting powder, 371 KERATITIS (PHLYCTENULAR), 591 Atropine, to relieve pain, 591 Boric acid, solution, to relieve congestion, 591 Cocaine, not advisable in photophobia, 591 Cold-water douche on closed eyelid, to re- lieve photophobia, 591 Creolin, 181 Dark glasses, to protect eyes, 591 Tonics and alteratives, with strict hygiene and regulated diet, associated with local treatment, 591 Yellow oxide of mercury, ointment, or calomel as a dusting powder to hasten cicatrization, contraindicated if iodine is being given, 591 KERATITIS (SUPPURATING), 591 Antiseptic lotions, to limit sloughing, 592 Cautery, actual, best means of preventing perforation, 592 Curetting floor of ulcer, if perforation threatens, 592 Eserine or atropine, instilled into eye, to limit sloughing, 592 Hot compresses, 591 Massage of cornea and introduction of yellow-oxide ointment, to remove scars of ulcers, 592 * Pressure bandage, if perforation threatens, 592 LACHRYMAL ABSCESS, 592 Blue pyoktanin (1:1000), injected through external opening if there is purulent discharge, 593 Division of canaliculi and washing out sac with antiseptic fluids, and insertion of probes into ducts after inflammation subsides, to restore patulency, 593 Hot compresses, composed of lead-water and laudanum, to relieve pain, 593 Puncture of abscess, if rupture threatens, 593 LARYNGISMUS STRIDULUS. Amyl nitrite, 68 Belladonna, 92 Bromide of potassium, 102 Gelsemium, 206 LARYNGITIS (ACUTE), 593 Abstinence from talking, with bland and unirritating but nutritious diet during attack, 594 Aconite, to control fever, 594 Antipyrin, as a spray, 77 Bromides, useful in full doses, 60 to 120 grains (4.0-8.0) a day, 102, 594 Calomel, small and repeated doses, fol- lowed by saline purges, along with hot mustard foot-bath and demulcent drinks, 594 Creosote spray in subacute laryngitis, 179 Cubebs cigarettes, useful for hoarseness of subacute forms, 182 Dover's powder, if necessary, to give rest, 296 Iodine, painted over throat, useful on third or fourth day, 594 Oil of amber and olive oil, half and half, well rubbed into the skirr of the neck and chest, 62, 594 Silver nitrate, 280 Steam inhalations, charged with benzoin; often advantageous to add menthol, 94, 593 LEPRA. Arsenic, 83 LEUCOCYTH.EMIA. Arsenic, very useful in full ascending doses, 82 742 INDEX OF DISEASES AND REMEDIES. LEUCORRHOZA, 594 Alum, gr. 10 to 20 to the ounce (0.05-1.3 : 32.0), as a vaginal wash, 61 Ammonio-ferric alum gr. 2 to 5 (0.1-0.25), in atonic types, 237 Belladonna, gr. 1 to 2 (0.05-0.1), with tan- nic acid, gr. 6 to 3 (0.5), applied on cot- ton, in disease of uterine cervix, 91 Cantharidal collodion, applied over groins to produce blister, 595 Goodell's prescription for, 595 Haematoxylon, used internally, of service, 212 Hot sitz-bath, or vaginal injections of hot water,if due to uterine congestiou, 410 Hydrastis, injections, 216 Iron, with tonics, if due to excessive lacta- tion or exhausting life, 595 Myrrh, if due to uterine trouble, 276 Nitrate of silver, when there is cervical ulceration, 280 Potassium permanganate (drachm i [2.0] to water 1 pint [500.0]), as an injec- tion, if discharge is foetid, 596 Prescription for injection, 596 Ringer's prescription for wash, 596 Tampon, saturated with iodoform and tan- nic acid, 366, 596 White-oak bark (ounce 1 [32.0] to water 1 pint [500.0], or tannic acid and glyce- rin (ounce 1 [32.0] to 2 quarts [2 litres] of water), as an injection, 329, 596 LICHEN. Arsenic, usually cures, 83 Cantharides, 121 LID ABSCESSES, 596 Treatment, same as for other abscesses, 596 LITH^MIA. (See Gout.) LOCOMOTOR ATAXIA. Acetanilid, 44 Antipyrin, relieves lancinating pains, 76 Exalgine, prescriptions for, 202 Phenacetin, 312 Potassium bromide, to prevent laryngeal crises, 102 Suspension, 425 LUMBAGO, 596 Acupuncture, often relieves, especially if pain is bilateral, 597 Antifebrin, dose, gr. 4 to 8 (0.2-0.5), 597 Antipyrin, dose, gr. 10 to 20 (0.65-1.3), 597 Chloroform liniment, 152 Cod-liver oil, 169 Foot-bath and Dover's powder, before re- tiring, often relieves, 597 Ice-bag or ether spray to loins, if hot ap- plications fail, 597 Ironing back with laundry iron, skin being protected by cloth or paper, very efficient, 597 Monobromated camphor, with other drugs, very useful, 117 Mustard or capsicum plaster or blister, over painful spot, may relieve, 597 Phenacetin and salol, of each 5 grains (0.3), 597 Potassium iodide or salicylic acid, if re- covery is slow, 225. 597 Salicylic acid useful, 336 Turpentine, gtt. 20 (1.3), said to be useful, 376 LUPUS. Acid nitrate of mercury, 291 Europhen, in ointment or powder, 202 Ichthyol ointment, 223 Iodine, as a paint, to retard spread, 229 Thiosinamine, useful in, 370 MALARIAL FEVER. (See Intermittent and Remittent Fevers.) Antipyrin, 76 Arsenic, as a cure and prophylactic, 82 Calomel, 263 Eucalyptus, instead of quinine, when it cannot be borne, 200 Gelsemium, of doubtful value, 206 Gentian, in malaria associated with dys- pepsia, 207 Hydrastis, said to be antimalarial, 216 Iodine externally and iodide of potassium internally for enlargement of the spleen, 226 Methylene blue, 1-4 grains (0.05-0.2), 273 Phenocoll, useful iu some cases, 313 Pilocarpine, may be used to abort, 320 Piperin has been used with varying suc- cess, 307 Quinine, the best remedy as a prophylactic and a cure, 157 Warburg's tincture, excels quinine in per- nicious malarial regions, 381 MANIA (ACUTE >, 597 Anaesthetics, or apomorphine in emetic dose, to relax muscular system, if pa- tient is very violent, so that other rem- edies may be administered, 597 Bromide of potassium, as a soporific, 102 Cannabis indica, with large dose of bro- mides, particularly serviceable, 597 Chloral, in full doses, if kidneys are healthy, 597 Chloroform for insomnia, 138 Cimicifuga, fluid extract, gtt. 20 to 30 (1.3- 2.0), thrice daily, iu cases occurring after confinement not due to permanent causes, 597 Cold douche to head while body is im- mersed in hot water, often of service, 597 Duboisine, for insomnia, 188 Hyoscine hydrobromate, gr. TJff (0.0006), when necessary to quiet patient quickly, 597 Morphine, in full dose, may be required to quiet patient, 597 Scopolamine as a soporific, 345 Sulphonal as a hypnotic, 360 MARASMUS. Cod-liver oil inunctions, one of the best remedies, 169 MASTITIS. (See Breast, Inflamed.) INDEX OF DISEASES AND REMEDIES. 743 MELANCHOLIA, 598 Chloroform for insomnia, 138 Nitro-muriatic acid gtt. 5 (0.3 \ in water after meals, if associated with oxaluria, 285, 598 Phosphorus, useful in some cases due to overwork, 316 MENINGITIS (ACUTE), 598 Aconite or veratrum viride. in early stages to depress circulation, 598 Alcohol, given with food in second stage, if there be asthenia, 599 Belladonna, often useful, especially when opium and calomel arc contraindicated, 598 Blister to nape of neck, in early stage, to prevent effusion ; also in comatose state, 598, 599 Bromides and chloral, best agents to allay nervous symptoms, 599 Calomel, gr. \ (0.025), with opium gr. \ (0.012), every half-hour, in early stage, until effect is manifested; the deodor- ized tincture, gtt. 2 to 5 (0.1-0.3), every two hours, or less, preferable to powder of opium in some cases, 264, 598 Ergot, in stage of exudation, 599 Ice-bag to head, in early stage, 599 Leeches to nape of neck, iu early stage, 599 Milk diet, in second stage, 599 Opium, useful in second stage, 295, 598 Quinine, contraindicated in acute stage, 599 Venesection in early stage of sthenic cases, if aconite or veratrum viride is not at hand,598 MENINGITIS (CHRONIC). Phosphorus, 316 MENOPAUSE. Bromide of potassium, iu uervous disor- ders, 101 Cannabis indica, alone or with aloes and iron, if anaemia or constipation exist, in headaches of the menopause, 119 Eau de Cologne, saturated with camphor, locally applied in headache or drowsi- ness, 116 Valerianate of ammonium, in uervous dis- orders, 67 MENORRHAGIA AND METRORRHAGIA, 556 Bromide of potassium or sodium, gr. 10 (0.65i once or twice daily, if bleeding is irregular, 102, 557 Cannabis indica, recommended, 119, 557 Cinnamon oil, drachm \ (2.0), when erig- eron is not at hand, in oozing flow, 557 Dry cups, over sacrum, if due to conges- tion, 557 Ergot, fluid extract, gtt, 10 to 60 (0.65-4.0\ best remedy in active bleeding, 191, 557 Erigeron, oil of, minims 3 to 5 (0.15-0.3), in capsule or emulsion, the best remedy for oozing, 557 Hamamelis, distilled extract, drachm 1 (4.0), thrice daily, in irregular bleeding, 557 Monsel's solution (50 per cent.) full strength locally applied, if due to polypus, 241 Rhus aromatica, highly recommended in menorrhagia, 331 Rue, in atonic menorrhagia, 333 Savine, oil of, gtt. 5 to 10 (0.3-0.05), in cap- sule or emulsion, every three or four hours, as a tonic in menorrhagia, 343 Turpentine, often of value, 376 MIGRAINE, 607 Amyl nitrite, 08 Bromide of potassium, with caffeine, almost a specific, if due to eye-strain, 102 Cannabis indica, tincture, gtt. 20 (1.3 S hourly, or extract, gr. \ to \ (0.015-0.03', every two hours, best treatment, 118, 607 Croton chloral, very efficient, especially if fifth nerve is involved, 1*1 Gelsemium, with cannabis indica, to abort, 206, 607 Methylene blue, gr. 1 to 2 (0.06-0.1) in capsule, 274 Phenacetin, 312 Salicylic acid, of great service in rheu- matic types, 336 MILK DEFICIENCY, 631 Electricity, 631 Treatment for intercurrent affection, if due to such cause, 631 MORPHIOMANIA. (See Poisoning prom Opium, Chronic). Bromide of potassium, 102 Phosphorus, of service in sequelae of mor- phiomania, 316 MUCOUS MEMBRANES DISEASES OF). Acacia, as a mucilaginous drink in irrita- tion and inflammation of upper air- passages, 41 Bismuth, as an astringent, to inflamed membranes, 95 Flaxseed, as a soothing demulcent, 203 Glycerole of aloes, locally applied to fis- sures, valuable, 59 Opium, suppositories, gr. \ (0.015^, useful in rectal inflammation, if not an acute catarrh, 296 Pareira, useful in chronic genito-urinary inflammation, 306 Terebene, useful in subacute and chronic genito-urinary inflammation, instead of sandalwood or copaiba, 368 Zinc sulphate, weak solution, as an astrin- gent, 358 MUSCS VOLITANTES, 599 Alteratives and correction of anomalies of refraction. 599 MUSCULAR STIFFNESS. Hot laundry iron passed over part, skin being protected by layers of paper or cloth, often relieves, 409 744 INDEX OF DISEASES AND REMEDIES. MYALGIA, 599 Ammonium chloride, if due to cold or bruises, 600 Camphor liniment, 116 Chloroform liniment, 600 Cimicifuga, fluid extract, gtt. 20 to 1 drachm (1.3-4.0), 600 Clove oil, added to liniment, as a counter- irritant, 164 Iodide of potassium or salicylates, if due to rheumatism, 600 Iodine ointment, pure or diluted with lard, 600 Massage or good rubbing, very necessary, 600 Potassium acetate or citrate, gr. 20 (1.3), may be tried, 600 Poultices, hot as can be borne, 600 Prescription for liniment, 600 MYXEDEMA. Thyroid gland, or extract of, a specific for, 373 NASAL CATARRH (ATROPHIC), 600 Dobell's solution, as a cleansing wash ; car- bolic acid may be increased, or thymol and eucalyptus substituted for it, to re- lieve odor, 601 Galvano-cautery, or strong silver nitrate solution, if ulcerations are present, 601 Hydrogen peroxide, 601 Iodine and glycerin (gr. 6 to 8 to the ounce [0.4-0.5:32.0]), with potassium iodide sufficient to make solution, valuable, locally- applied, 601 Listerine, may be added to Dobell's solu- tion, to relieve odor, 601 Potassium iodide internally, tonics and stimulants to mucous membrane, and attention to activity of skin, 601 Potassium permanganate, useful; painful if sensation is not entirely lost, 601 Removal of necrosed bone, 601 Silver nitrate and starch (gr. 1 to 10 [0.05- 0.65] to drachms 2i [10.0] \ as an insuf- flation powder, or solution (gr. 1 to 10 to the ounce [0.05-0.65:32.0]), better, in some cases, locally applied, 601 NASAL CATARRH (CHRONIC), 601 Arsenic, 83 Camphor, 115 Ferric alum (gr. 5 to the ounce [0.3 : 32.0]), useful, in spray, in later stage, 602 Galvano-cautery or snare, to remove hy- pertrophic tissue remaining after acute stage, 216, 603 Hydrastis, dilute solution, or distilled ex- tract of hamamelis and water, equal parts, useful in spray, in acute stage, 602 Iodine and glycerin (gr. 6 to 8 to the ounce [0.4-0.6 : 32.0]), with potassium iodide, sufficient to make solution, locally ap- plied, 602 Prescription for alkaline wash, 493 NAUSEA. (See Vomiting.) Hoffmann's anodyne, when due to exces- sive use of tobacco, 214 Hydrocyanic acid, dilute, gtt. 20 (1.3), in water, often useful, 218 Lime-water, 114 NEPHRITIS (ACUTE), 603 Aconite, to depress circulation, 603 Blisters contraindicated, 603 Bromides or opium, given cautiously, if aconite fails to quiet restlessness, 603 Cafleine, in later stages, 604 Cannabis indica, if hematuria is present, also to allay pain over kidneys, 119, 603 Cantharides, I drop (0.025) of tincture, about fifth day, when kidneys are atonic, also if hematuria is present, 120, 603 Citrate of potassium and sweet spirit of nitre, to increase' flow of urine, 603 Cups or leeches over loins if urine is scanty, 603 Digitalis, with squill or calomel, gradually increased, followed by gin or compound spirit of juniper in later stages, 604 Elaterium, to relieve dropsy, 603 Flaxseed tea, as a demulcent, 203, 603 Gallic acid and ergot, to control excessive hematuria, 604 Hot-air baths, useful to provoke sweat, 603 Iron, if anaemia be present, also to decrease albuminuria, 604 Juniper, to re-establish secretion, after in- flammation has subsided, 245, 603 Milk diet, 603 Pilocarpine hydrochlorate, gr. fa to | (0.003-0.008), hypodermically, if urae- mia threatens, repeated in fifteen min- utes if no sweat appears, but guarded by strychnine when the heart is weak, 321, 603 Potassium bitartrate, 97, 98 Sulphate of magnesium, 5ss (16.0), to aid in elimination of toxic products by bowel, 603 Turkish bath, to aid in eliminating effete products, used with care, 411 NEPHRITIS (CHRONIC), 604 Basham's mixture for anaemia, 238 Bichloride of mercury, 265, 604 Buttermilk useful, 605 Cannabis indica, to allay pain over kid- ueys, also if hematuria is present, 119 Cantharides, particularly useful if due to alcoholism, 120, 604 ' Capsicum, to check albuminuria, 122 Chloride of gold and sodium has been rec- ommended in interstitial forms, 209, 605 Chloride of iron if anaemia is present; also to decrease albuminuria, 239, 605 Digitalis, to decrease albuminuria, 604 Elaterium or jalap, to relieve dropsy, 604 Juniper of value, 604 Lithium, carbonate or citrate, in goutv cases, 605 Milk diet, 604 Nitro-glycerin useful in ascending doses in clironic parenchymatous nephritis, 283 Oxygen inhalations, 605 Potassium acetate or bitartrate, alone, or, better, with gin or compound infusion of juniper, 97, 604 INDEX OF DISEASES AND REMEDIES. ■45 Potassium iodide, gr. 5 (0.3), thrice dailv. used with great care, 226 Protiodide of mercury useful, 271, 604 Sodium arsenite, gr.* fa (0.003) in goutv cases, 605 Squill, 354, 604 Strontium lactate for the relief of albu- minuria, 357 Sugar of milk, 605 Tapping to relieve ascites, 605 Turkish and Russian baths, relieve dropsy by increasing action of skin, 605 NERVOUSNESS Bromides, 101 Camphor, as a sedative, 115 Hops, as a sedative, 215 Lime salts, 112 Musk, useful in nervous excitement and collapse ; only to be used through crisis, 275 Phosphorus, in nervous debility and ex- haustion, 316 " Pill of three valerianates,"' highly recom- mended, 378 Rest-cure very useful where nervousness is due to exhaustion, 41* Strychnine, in functional nervous atony or depression, 290 Suprarenal gland, 364 Sumbul, prescription for, 363 Sweet spirit of nitre, in nervoui excitement of fever and other nervous states of in- fancy, 365 Valerian, alone or with other drugs, 377 NEURALGIA, 605 Acetanilid, useful, especially with mono- bromated camphor, 44 Aconite ointment (gr. 2 to the drachm [0.1: 4.0]), or oleate of aconitine (gr. 2 [0.1] to sweet oil 100 [6.0]), useful applied over painful spot, if limited in area, 49, 607 Acupuncture, nerve-stretching, or neurec- tomy necessary in some cases, 607 Ammonium chloride, in ovarian neuralgia, 66 Amyl nitrite, inhalations, when due to anaemia, 607 Antipyrin, very useful, especially in gout, rheumatism, or nervous depression, 76, 606 Belladonna, 91 Bromide of potassium with caffeine, almost a specific, 606 Prescription for, 102, 606 Camphor liniment, locally applied, to re- lieve pain, 116 Chloralamide, 137 Chloroform liniment, as a local anaesthetic, 152 Cimicifuga, especially useful in ovarian tvpes, 154 Cod-liver oil, 169 Croton chloral, gr. 5 to 20 (0.3-1.3), in 5- grain pills, often effective in brow neur- algia, 181, 607 Duquesnel's crystalline aconitine in obsti- nate forms, 50 Freezing parts with ether or rhigolene spray or by small package of ice and salt,* 197, 607 Guaiacol used locally, of value in, 211 Hydrocyanic acid, useful in intestinal neur- algia, 21* Iodide of potassium, may be tried in rheu- matic neuralgia, 225 Iron and arsenic, in anaemia; often neces- sary to associate with them bitter tonics and cod-liver oil, 605 Kataphoresis, 415, 607 Menthol, locally, 308 Morphine, gr. -J, to j (0.013), injected into painful spot, if localized ; not advisable in chronic cases, 607 Muriate of ammonium, useful in ovarian types, 66 Mustard plaster, as a counter-irritant, 275 Nux vomica or strychnine, if nerve is de- pressed by anaemia, 605 Peppermint oil, locally applied on cloth over painful spot, 308 Phenacetin, gr. 3 to 8 (0.15-0.6), very use- ful, prescription for, 312 Phenocoll, 313 Phosphorus, if due to nervous exhaustion, 316, 606 Potassium iodide, 225 Prescriptions containing antipyrin with bromides and caffeine, 606 Quinine, if due to malaria, 158, 606 Rest-cure very useful in exhausted patients, 418 Salol, if due to exposure, 339 Specific remedies, if due to scrofulosis or syphilis, 600 Turkish bath, may relieve, if due to rheu- matism or gout, 412 Veratrine ointment, locally applied over neuralgic nerve, 378 NIGHT-SCREAMING. Bromide of potassium, 102 NIGHT-SWEATS. Acetic acid, as a lotion, diluted one-half, 46 Agaricin, of doubtful value, 51 Alum dissolved in water or alcohol, efficient application for sponging, 61 Belladonna, best remedy, 91 Camphoric acid, the best of all remedies, 117 Ergot, 191 Gallic acid, 204 Pilocarpine, gr. fa (0.003) hypodermically, two hours before sweat, often useful, even when atropine fails, 321 Sulphuric acid, with belladonna or mor- phine, often useful, 363 Zinc oxide, prescription for, 302 NIPPLES (SORE), 607 Benzoin, tincture, locally applied, 607 Boric acid (gr. 20 to the ounce [1.3 : 32.0]), or mucilage of acacia, applied after nursing, nipple being dried beforehand, 607 Breast-pump or nipple-sliield may be neces- sary to effect cure, 608 Cocaine (gr. 4 to the ounce [0.2 : 32.0]), ap- 746 INDEX OF DISEASES AND REMEDIES. plied and washed off before nursing, if breast is very painful, 165, 607 Ichthyol, when indurated, 223 Silver-nitrate stick touched to fissure, if deep and slow to heal, 607 Tannin, glycerite of, locally applied, 607 NYMPHOMANIA. Bromide of potassium, of great service, 101 OBESITY, 608 Acetic acid, harmful, 46 Cold bath, 610 Diet, 609 Laxative fruits and purges, to regulate bowels, 611 Massage, passive movements, absolute skimmed-milk diet, and electricity, if exercise is impracticable, 611 Potassium permanganate, 310 Saline purges, 611 Thyroid gland, 373 Turkish bath, 611 OPHTHALMIA. (See Conjunctivitis.) OPIUM HABIT. (See Poisoning from Opium, Chronic.) ORCHITIS. (See Epididymitis.) OSTEOMALACIA. Phosphorus, 316 OTORRHEA. Creolin, solution (1: 500), used with syringe, 181 OXALURIA. Nitric acid, 281 Nitro-hydrochloric acid, 285 OZ.ENA. Prescription for insufflation powder, 264 PARALYSIS AGITANS. Cannabis indica, to quiet tremors, 118 Chloral, of great service, 136 Duboisine sulphate, of some use, 189 Sparteine, 346 PARASITES. Bichloride of mercury (gr. 2 [0.1] to water oz. 1 [32.0]), applied thrice daily in para- sitic skin diseases, 266 Cajuput oil, applied pure, will destroy pe- diculi, 110 Chrysarobin, gr. \ (0.008\ internally, or the ointment, with benzoated lard (1:4 or 5), locally applied, in parasitic skin diseases; must not be used on face, 153 Hyposulphite of sodium, 1 drachm to the ounce (4.0 : 32.0), for parasitic skin dis- ease, 351 Mercurial ointment, useful to destroy pe- diculus pubis or other parasites, 270 Oil of cloves, 163 Pyrogallol, 30 grains to ounce (2.0 : 32.0), for parasitic skin disease or psoriasis, 328 Volatile or fixed oils, useful to destroy, 270 PARTURITION. Antipyrin, for pains, of doubtful value, 76 Castor oil, to relieve constipation, 130 Cimicifuga, 154 Quinine, as a stimulant to uterus, 157 PEMPHIGUS. Arsenic, 83 PERICARDITIS, 611 Aconite, to allay inflammation and quiet heart, 49, 611 Alcohol, digitalis, or caffeine, if heart shows signs of failure, 611 Aspiration, gradual, if exudation endangers life, 611 Blister, over praecordium, often useful, 611 Calomel, gr. \ (0.025), with opium, hourly, to prevent exudation, 611 Elaterium, useful in effusions, 189 Ice-bag over the praecordium, very useful, 393 Iodide of potassium, to aid in absorption of fluid, 225 Jalap, compound powder of, gr. 20 (1.3); or elaterium, gr. \ (0.01); or saline purga- tive, before breakfast, useful in sthenic cases, to remove effusion, 611 Leeches, 5 to 10, over praecordium, accom- panied by large dose of veratrum viride in early stage of sthenic cases, 611 Opium, to allay inflammation, 296 PERITONITIS (ACUTE , 612 Acetanilid, 015 Calomel, \ gr. (0.025) every hour, prefer- ably combined with opium, 263, 614 Hyoscyamus, by suppository or injection, in collapse, 615 Ice, with white of egg, for thirst. Vomit- ing does not contraindicate small amounts of water, 615 Ice-bag or turpentine stupe to abdomen ; leeches in sthenic cases, (515 Opium, pushed until pain is relieved, but never to the point of obtunding intelli- gence, 296, 614 Salines, useful in cases following surgical operations, but contraindicated by fee- bleness, perforation, or obstruction, 615 Surgical procedures, often necessary. When diagnosis is obscure or in septic general peritonitis, exploratory incision is justi- fied, 612 Rectal tube, milk of asafoetida or turpen- tine injections, in tympanites, 615 Veratrum viride, 380 PERITONITIS (CHRONIC), 615 Incision, with or without drainage and iodoform, useful in tubercular peri- tonitis, 616 PERNICIOUS MALARIAL FEVER, 616 Quinine, large doses, in solution, by mouth, rectum, or hypodermically, 158, 616 INDEX OF DISEASES AND REMEDIES. 747 PHARYNGITIS. Antipyrin in 4 per cent, spray, 77 Cocaine, gives temporary relief; after-effects bad, 165 Cubebs, troches of, used in chronic types, 182 Monsel's solution, pure or diluted one-half with glycerin, applied on pledgets of cotton or camel's-hair brush, 241 Peroxide of hydrogen, 220 Salol, in 5-gr. '(0.3) doses, 339 Silver nitrate solutiou, in varying strength, locally applied, 280 PHTHISIS. (See Tuberculosis.) PLEURITIS, or PLEURISY, 616 Aconite or veratrum viride, preferable to venesection, in early stage, 616 Aspiration, when hydragogue purges fail to remove effusion, 617 Calomel, in sthenic cases to prevent exuda- tion, 263 Cantharidal blister, two inches below axilla, aids absorption of effusion, 401 Cotton jacket, 617 Digitalis or alcohol, if pulse weakens in second stage, 617 Elaterium or jalap, useful to remove effu- sion, 189, 617 Gelsemium, 206 Ice-poultice or jacket, used with success in sthenic cases, 392 Iodide of potassium, used in chronic stage, to aid absorption, 225 Iodine, locally applied, to abort, and aid absorption of fluid, 229 Pilocarpine, 320 Salicylates, very useful for the removal of effusion, 336, 617 Saline purges, in second stage, to remove effusion, 617 Strapping chest, if respiratory movements are very painful, 617 Veratrum viride, 3*0 PLEURODYNIA. (See Neuralgia.) PNEUMONIA, 618 Aconite, preferable to veratrum viride, in early stage, in children, 618 Alcohol, inferior to digitalis, as a cardiac stimulant in the second stage in adults, but better than in children, 52, 620 Ammonia useful for adults and children, 620 Ammonium bromide and carbonate may be used if the chloride fails, 622 Ammonium chloride, as an expectorant in third stage, 621 Antipyrin, of great value, if fever is exces- sive, 75 Belladonna, very useful if there are evi- dences of collapse, 92, (520 Bleeding, cupping, or cardiac sedatives, in sthenic cases, 618 Citrate of potassium, to maintain renal activity, 621 Cold bath, sometimes necessary for high fever, 620 Cold sponging for fever, 619 Cups, di'y and wet, in first stage, 619 Digitalis, tincture, gtt. 5 (0.3) every four hours, accompanied by belladonna, gtt. 5 (0.3), carefully watched in second stage, 620 Dover's powder for pain at onset, 619 Ethyl iodide, causes resolution, 199 Gelsemium, in early stages, 206 Gin, to maintain renal activity, 621 Hoffmann's anodyne, useful, 620 Hot foot-bath, useful at onset, 619 Ice-bag to heart if fever be high and heart tumultuous, 619 Ice-poultice or jacket, highly recommended in first stage of sthenic cases, 392, 619 Iodide of potassium, in later stages to ab- sorb exudates, 326 Morphine, for pain at onset, and for exces- sive cough, 619 Oxygen inhalations, if asphyxia threatens, 302, 620 Phosphorus, 316 Prescriptions, containing ammonium chlo- ride, to loosen cough of second stage, 621 Quinine, gr. 2 (0.1), thrice daily, in suppos- itory, in lobar pneumonia of children, 158 Strychnine as a respiratory and circulatory stimulant in second stage and as an ad- juvant to digitalis, 620 Sweet spirit of uitre to maintain renal ac- tivity, 621 Venesection, in early stage of sthenic cases, cardiac depressants preferable, and late when heart is laboring and veins dis- tended, 428, 618, 620 Veratrum viride, preferable to aconite, in early stage, in adults, 380, 618 POISONING FROM— Acetanilid. Supportive measures, stimulants, external heat, belladonna to maintain blood-pres- sure, strychnine to counteract respira- tory failure, and oxygen inhalations to overcome cyanosis, 44 Acetate of Zinc. Treatment same as for gastro-enteritis, 544 Acetic Acid. Large amounts of milk, alkaline liquids, and general treatment for gastro-enteri- tis, 47 Aconite. Keep patient in prone position, with feet higher than head. Hot applications; emetics contraindicated; evacuate stom- ach by siphon or stomach-pump. Ether hypodermically, followed by alcohol, and this by digital'is. Artificial respiration and amyl nitrite, a few whiffs, no more, if heart fails ; Atropine; Strychnine, 48 Alcohol (Acute . External heat, digitalis and strychnine hy- podermically, in coma, if heart fails. Belladonna, if skin is relaxed and 748 INDEX OF DISEASES AND REMEDIES. clammy, and counter-irritation to nape of neck, for brain symptoms. After- treatment, ammonia, spices, spirit of Mindererus; emollients iu gastritis. Ice, aconite, hydrochloric acid, or ipecac in minute dose, and counter-irritation for vomiting. Jalap, gr. 40 (2.6), elaterium, gr. \ (0.011), or calomel and salines, as purgatives, 53 Fowler's solution for morning vomiting, 83 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 prescriptions (pages 55, 122), 54 Antimony. Large doses of tannic acid, external heat, alcohol, digitalis, and opium hypoderm- ically, if respiration is not too feeble. If necessary to use opium, it should be accompanied by strychnine. Prone po- sition, the patient vomiting into towels. Stomach-pump, if vomiting is absent, 71; Atropine, 93 Antipyrin. Maintain bodily heat, stimulants, atropine, and oxygen inhalations, if cyanosis is alarming, 75 Arsenic (Acute and Chronic . Stomach-pump, external heat, stimulants, and the chemical antidote, hydrated sesquioxide of iron and magnesia. Mag- nesia also useful by itself. Opium should follow antidote, 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, 85 Belladonna. External heat if collapse supervene, and strychnine to support respiration. The physiological antidote, opium, may be carefully given, 93 Carbolic Acid. Soluble sulphates, as Epsom or Glauber salts, warm mucilaginous drinks, hot applications to extremities, digitalis, strychnine, and counter-irritation over abdomen. Emetics and stomach-pump should be used if possible, 125 Chloral. External heat, emetics in early and stom- ach-pump in later stages. Strychnine or atropine to stimulate respiration. Digitalis, preceded by ether, ammonia, brandy, or whiskey. Prone position, feet being elevated, 135 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 down- ward. Compression of the abdomen and limbs; compression and massage of the praecordium. Atropine, strychnine, and digitalis to stimulate the heart and respiration. Laborde's lingual traction, 146 Cocaine. Ammonia, coffee, strychnine, ether and alcohol. If convulsive in type, treat same as strychnine poisoning, 167 Colchicum. Tannic acid, emetics, and stomach-pump. Opium to relieve pain, and oils. Atro- pine and stimulants if collapse comes on, 172 Conium. Emetics or stomach-pump, strychnine as a nervous and respiratory stimulant, external heat and cardiac stimulants, if circulation fails, 176 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; instead, mustard plaster over abdomen and opium internally are to be employed, 177 Corrosive Sublimate. Large amounts of white of egg, followed by stomach-pump, external heat, stimu- lants, 265 Croton Oil. Treatment same as for gastro-enteritis, 544 Digitalis. Tannic acid as a chemical antidote, emetics or stomach-pump, external heat to abdo- men and aconite as a physiological anti- dote. Maintain horizontal position, 186 Elaterium. Treatment same as for gastro-enteritis, 544 Ether. Artificial respiration, lowering head if face is pale; strychnine, atropine, and digi- talis hypodermically, or intravenous in- jection of ammonia to stimulate heart and respiration ; frictions and hot appli- cations ; ether dashed on chest and ab- domen ; Laborde's method of traction of the tongue, 195 Eucaine. Treatment like that of cocaine intoxica- tion, 167 Gelsemium. Emetics and stomach-pump, digitalis, atro- pine, and ammonia as cardiac stirnu- INDEX OF DISEASES AND REMEDIES. 749 lants; external heat, strychnine, and atropine for respiratory centre, 206 Iodine. Emetics or stomach-pump, large amounts of starch, hot applications, and hypo- dermic injections of alcohol, ammonia, atropine, digitalis, or strychnine, 228 Iodoform. Sodium bicarbonate to combine with iodine, alcohol, diuretics, and hot blankets; saline transfusion, 232 Lead (Acute). Epsom or Glauber's salts, in large amounts; alum; emetics or stomach-pump. Hot applications and opium to relieve pain, 247 Lead (Chronic . Jalap and calomel with opium or alum, gr. 2 (0.1), in full dose, valuable in lead colic. Blister to back of neck, revulsives and pilocarpine in cerebral inflamma- tion. Iodide of.potassium to eliminate lead. Strychnine in progressive paral- ysis. Electricity and baths of sulphuret of potassium, 249 Mineral Acids. Alkalies, such as magnesium, lime, white- wash, and soap as antidotes; white of egg, external heat, oils, and opium, to relieve irritation. Monsel's Solution. Soap, 242 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; maintain bodily heat, 278 Nitrate of Silver (Chronic . Iodide of potassium, to aid in elimiuating poison, 279 Nux Vomica and its Alkaloids. Inhalations of amyl nitrite, to prevent con- vulsive tendencies, at the same time use stomach-pump. Tannic acid followed by physiological antidotes, potassium bromide, gr. 60 (2.01, with chloral, gr. 20 (1.3). If convulsions prevent swal- lowing, chloroform patient carefully and give antidotes by rectum in starch- water. Amyl nitrite, hypodermically, if relaxation does not occur, 2*9 Opium (Acute). Emetics or stomach-pump, tannic acid, black coffee, electricity, and other meas- ures to keep patient awake. Atropine or strychnine, hypodermically, if res- piration fails. Alcohol, ammonia, and external heat. Artificial respiration may be necessary; repeated washing out of stomach. Permanganate of potas- sium, 293 Opium (Chronic*. Decrease a sixth or fourth of customary amount each twenty-four hours. Co- caine not advisable as a substitute, as the cocaine-habit may be established. Digitalis and strychnine if heart fails, 295 Phosphorus. Permanganate of potassium, 1 per cent, so- lution, or peroxide of hydrogen. Sul- phate of copper is too poisonous in itself, 316 Physostigma. Atropine as a physiological antidote, exter- nal heat, and cardiac and respiratory stimulants, 318 Scammony. Treatment same as for gastro enteritis, 544 Strychnine. (See Nux Vomica.) Veratrum Viride. Prone position, head higher than feet; atropine, strychnine, external heat, and cardiac stimulants, 380 POST-PARTUM HEMORRHAGE, 561, 629 Auto-transfusion, or actual transfusion of weak salt solution, necessary in some cases, 630 Beef-tea, i pint (250.0), and morphine, gr. £ (0.01) hypodermically, after reac- tion is established, 630 Enema, of hot water, 1 pint (500.0), after cessation of bleeding, 630 Ergot, as a cure and prophylactic, 191, 630 Ether, hypodermically, if symptoms of shock are manifested, followed by small doses of hot, strong brandy and water, and warm milk, 630 Hirst's method of controlling, 629 Suture, if due to laceration, 630 PRIAPISM. Hops, 215 PROLAPSUS ANI AND RECTI. Injection of cold or hot water, often re- lieves, 396 Quercus alba, infusion, 329 PROSTATITIS, 551 Cold-water injections and perineal douches, 39*. 552 Local treatment to prostatic urethra, and use of cold steel sounds in chronic types, 552 Perineal incision, to evacuate pus, if ab- scess forms, 552 Rest in bed, regulation of bowels, leeches to perineum, medication to render urine alkaline, and morphine hypodermically or in suppository, 552 Soft catheter, allowed to remain in blad- 750 INDEX OF DISEASES AND REMEDIES. der, if retention of urine is persistent, 552 PROSTATORRHCEA. Cantharides, 121 PRURIGO. Cantharides, 121 PRURITUS, 622 Alum solution in pruritus vulva?, 61 Arsenic, quinine, bitter tonics, cod-liver oil, alkaline diuretics or mineral waters in debility, and avoidance of condi- ments if mouth of vagina or urethra is affected, 622 Boric acid, 98 Calomel and lard (1 drachm to the ounce [4.0 : 32.0]), locally applied, 269 Carbolic acid, 623 Chloride of calcium, prescription for, 111 Cocaine, relieves temporarily, 623 Cold douche and injections highly recom- mended in pruritus ani and vulvae, 398 Goulard's extract, dilute, useful iu pru- ritus pudendi, 251 Hydrocyanic acid, locally applied, 218 Ivory plug for, 623 Prescriptions for lotions and ointments, 623 Salicylic acid, prescription for, 336 Silver nitrate (gr. 20 to the ounce [1.3 : 32.0]), locally applied, preceded by co- caine, if itching is intense; a 4- to 6- grain (0.2-0.3) solution may relieve itching of pruritus pudendi, ani, and vulva?, 280, 623 Sodium bicarbonate or borax (1 drachm to the pint [4.0 : 500.0]), as a wash, 622 Teucrium scordium, highly recommended by Brinton, 623 PSEUDO-LEUKEMIA. Arsenic internally, and injections of Fow- ler's solution into glands, 82 PSORIASIS. Ammoniated mercury in, 264 Anthrarobin, 69 Aristol, 371 Arsenic, 83 Cantharides, 121 Chrysarobin, gr. J (0.008) internally, or the ointment with benzoated lard (1 to 4 or 5), locally applied, face excepted; prescription for application, 153 Gallic acid, ointment, 204 Pyrogallol, 30 grains to ounce (2.0 : 32.0) of lard, 328 Resorcin, prescription for, 329 Tar, locally applied, 324 Thymol iodide, 371 Thyroid gland in, 373 PTYALISM. Alum, applied on swab, in mercurial ptyal- ism, 61 Belladonna, in idiopathic or mercurial types, 91 PUERPERAL DISEASES, 623 (For treatment see special titles.) PUERPERAL FEVER, 624 Antipyretics, best abstained from as long as possible, 625 Bichloride of mercury (1 : 2000), or creolin (2 per cent.) solutions, as antiseptic in- jections, 624 Boric acid, creolin (2 per cent.), or bichlo- ride (1 : 8000;, solutions, as injections into bladder, to prevent septic cystitis, 627 Curette or placental forceps, to remove membranes if fever continues after an- tiseptic injections, 624 Epsom salts, concentrated solution, 2 drachms (8.0) every fifteen minutes, if peritonitis develops, 626 Laparotomy occasionally saves life, if sep- tic peritonitis develops, 625 Nutriment in large amounts and alcoholic stimulants, if symptoms of systemic in- vasion arise, 625 Silver nitrate (gr. 40 to 60 to the ounce [2.6-4.0:32.0]), locally applied to un- healthy ulcerated wounds; zinc chlo- ride solution may be necessary, 626 Veratrum viride, 380 PURPURA HEMORRHAGICA. Suprarenal gland, 364 Turpentine, 376 PYELITIS. Buchu in chronic types, 107 Cantharides, 120 Copaiba, 176 Juniper, as a tonic in chronic types, 244 Pareira. 306 Uva ursi, 377 QUINSY. Aconite, in early stage, 49 Salicylic acid, gr. 3 (0.15), hourly, acts as a specific, especially if due to rheuma- tism, 336 REMITTENT FEVER, 634 Antipyrin, or cold pack, if fever is exces- sive, 635 Eupatorium, 201 Monsel's salt, gallic or tannic acid inter- nally, if intestinal hemorrhage occurs, 635 ' Morphine, spirit of chloroform, or aconite, in sthenic cases, to control vomiting, 635 Phenocoll, 5 to 8 grains (0.3-0.6), 313 Quinine, gr. 20 to 30 (1.3-2.0), preceded by calomel, gr. 3 to 4 (0.15-0.2); if not re- tained, administer by rectum, or hypo- dermically, with divided doses of Seid- litz powder by mouth, 157, 634 Tonics, potassium salts, to regulate kid- neys, and purgatives, if necessary, during convalescence, 635 Turpentine stupe, if belly is tender, 635 RETINITIS, 635 Atropine, dark glasses, and later suitable lenses, if due to eye-strain, 635 INDEX OF DISEASES AND REMEDIES. 751 RHEUMATISM (ACUTE ARTICULAR), 635 Acetanilid, relieves pain and fever, 44, 637 Acetate of potassium, 46 Aconite, or veratrum viride, useful at onset of inflammation in sthenic cases, 636 Alcohol, in depression, 636 Ammonium bromide and phosphate, 65, 67 Antimonial powder as an antipyretic, 73 Antipyrin, gr. 10 to 20 (0.65-1*3), or anti- febrin, gr. 4 to 8 (0.2-0.4), often verv valuable, 76, 637 Benzoic acid, drachms 2 to 3, daily, said to be a specific, 94 Bicarbonate or citrate of potassium, gr. 20 to 30 (1.3-2.0), in water, every five hours, in obstinate, cases, 639 Bicarbonate of sodium, 95 Blisters over joints, useful after systemic disturbance is past, 640 Camphor liniment, 116 Capsicum plaster, 123 Cimicifuga, shortens attack and relieves pain in some cases. 154, 639 Colchicum, prescription for, 639 Cold pack, if fever threatens life, 637 Fuller's lotion, applied on hot cloths to joints, 636 Guaiac, 210 Ice-cold compress, may relieve inflamed joints, 636 Ichthyol, ointment valuable, applied to joints, prescription for, 223, 636 Iodine, ointment or tincture, painted over parts, 640 Lemon- or lime-juice, or citric acid, bene- ficial in nearly all cases, 163, 640 Oil of gaultheria, useful as a substitute for salicylic acid: also used as a local ap- plication to the joints, 205, 037 01. suceini, applied locally over joints, 61 Phenacetin, alone or with salol, 312, 639 Phenocoll, 313 Potassium iodide, useful in subacute or ob- stinate types, prescription for, 225, 639 Potassium nitrate, 277 Rhus toxicodendron, especially useful for night pains, 639 Salicylic acid, gr. 20 (1.3) thrice daily; if untoward symptoms arise it must be stopped, 335, 637 Salicylic acid, applied to joints in a salve when stomach is irritable, 337, 636 Salol, useful as a substitute for salicylic acid ; dangerous in large doses, 339, 640 Sodium bicarbonate (gr. 20 to the ounce [1.3 : 32.0]), to inflamed joints, 636 Splints for fixation of limbs, may relieve greatly, 636 Veratrine ointment, used locally, applied to joints, 640 RHEUMATISM (CHRONIC), 640 Arsenic, useful in some case, 83 Cimicifuga, sometimes relieves, 154 Citric acid, 163 Cod-liver oil, internally, in weakness or anaemia; also useful rubbed into joints, 169, 640 Colchicum, with iodide of potassium, pre- scription for, 172 Ichthyol, the best remedy for joints, 641 Iodine, locally applied, 229, 641 Liniments, prescriptions for, 641 Ointments, prescriptions for, 641 Potassium iodide, colchicum, and sarsapa- rilla, usually indicated ; see prescrip- tions, 225, 640 Salophen, 340 Sulphur, 361 Turkish or Russian baths, very valuable, 640 Veratrine ointment, gives greatest relief in some cases, prescription for, 378, 641 RHEUMATISM (MUSCULAR). Burgundy pitch, a mild local remedy, 324 Croton oil liniment, 182 Dover's powder, iu conjunction with hot drinks and hot foot-bath, often cures, 297 Mustard, as a counter-irritant, 275 Veratrine ointment, locally applied, 378 RHINITIS. Creolin (1 : 1000), as a nasal douche, 181 Fluid cosmoline, in spray, 311 Potassium permanganate, solution, in fcetid rhinitis, 310 RHUS POISONING. Grindelia, 2<)9 Infusion of lobelia, 255 Lead acetate, 249 Liquor plumbi subacetatis, 250 RICKETS, 642 Arsenite of copper, 643 Cinchona, or strychnine, 642 Cod-liver oil, prescription for, 169, 642 Cool sponging or rubbing with salt and whiskey (1 drachm to the pint [4.0 : 500.0]), useful at night, 643 Hypophosphites and lactophosphates useful, *112 Iodide of iron, syrup of, if scrofulous tend- ency or anaemia exists, prescriptions for, 642* 643 Lime salts, phosphorus, zinc phosphate, as bone tonics, 642 Massage and passive movements, 643 Mineral acids, physostigma, and simple bitters, as digestive tonics, 642 Nux vomica, rarely given because of bit- terness, 642 Phosphate of lime or sodium, gr. 1 to 2 (0.05-0.1), in child's milk, 643 Phosphorus (gr. yfo [0.0006]), in sugar- coated pill, 316, 643 Quinine, cod-liver oil, nux vomica, and iron as general tonics, 642 Sodium and lime salts, useful in nursing and pregnant women, 643 RINGWORM. (SecTixKA Circinata.) SATYRIASIS. Potassium bromide, one of the best rem- edies, 101 SCABIES. Sulphur, the best remedy, 301 752 INDEX OF DISEASES AND REMEDIES. SCARLET FEVER, 643 Aconite, harmful if constantly employed, 49 Alcohol, indicated in collapse, 646 Antipyrin or acetanilid, may produce col- lapse in large doses, 75, (545 Bromide of sodium, with chloral, useful when convulsion ushers in attack, 645 Carbolic acid (gtt. 2 [0.1] to olive oil oz. 2 [64.0]), benzoated lard, vaseline, cosmo- line, or almond oil, useful, locally ap- plied, to allay itching, 646 Chloral, very useful, prescription for, 644 Chlorate of potassium, locally applied, by spray or swab, in sore throat, 646 Cold sponging, useful; pack must be em- ployed if fever is excessive, (545 Ice applied externally and held in mouth, to prevent swelling of throat, 646 Ice-bag or rubber head-coil to head, if very hot, 646 Jalap, compound powder, with potassium bitartrate, or hot dry applications, to produce sweat, in nephritis, 636 Juniper, in later stages, if there is renal atony, 245 Potassium citrate and sweet spirit of nitre, prescription for, 645 Quinine, unsuccessful in most cases, 646 Salicylic acid, highly recommended, pre- scription for, 644 Strychnine, iron, simple bitters, quinine or Basham's mixture, in convalescence, 647 Warm wet pack, useful to bring out rash, 645 Water, pure, such as Vichy or Poland, in large amounts, 645 SCIATICA, 647 Absolute rest of limb in splints very need- ful, 648 Acetanilid and antipyrin, 44, 647 Acupuncture, recommended, 647 Cod-liver oil, of service in obstinate cases, 169, 648 Chloroform, deeply injected over exit of nerve, a favorite remedy, 152, 647 Ether or rhigolene sprayed on part, often effective, 647 Kataphoresis, may be tried, 647 Liniments for rheumatism, may be tried, 648 Massage of nerve with glass rod, 647 Morphine, injected over course of nerve, 647 Nerve-stretching, (548 Potassium bitartrate or citrate, gr. 40 (2.6), thrice daily, in plenty of water, to reg- ulate kidneys, 647 Potassium iodide, 225 Remedies for rheumatism, often relieve, 647 Salicvlic acid, 336 Sulphur, 361 Wet or dry cups, highly beneficial over course of nerve, (547 SCLERITIS, 648 Atropine, boric acid, and hot-water com- presses, in early stage, 648 Eserine, with pilocarpine sweats or cautery, in stubborn episcleritis without iritis, 648 Specific treatment, in syphilitic cases, 648 Yellow-oxide ointment, associated with massage, to subdue iuflltratiou, 648 SCLEROSIS. Antipyrin, 7(5 Nitrate of silver, 279 SCROFULOSIS, 648 Arsenic or corrosive sublimate useful if anaemia is present, prescriptions for, 649 Calcium chloride, 111 Cod-liver oil, the best remedy, 169, 648 Diet and exercise, 648 Europhen in scrofuloderm, 202 Excision, or scraping gland, and packing with iodoform gauze if other treat- ments fail, 649 Hypophosphite of calcium, 111 Ichthyol ointment, useful, rubbed into per- sistent enlargements, prescription for, 649 Iodine ointment and lard, equal parts, rubbed into glands, stopping at first sign of reddening or fluctuation, 649 Iron, syrup of the iodide, in anaemia, pre- scription for, 241, 648 Lactophosphates, or hypophosphites, with cod-liver oil, useful in young children, 648 Phosphate of sodium or lime, if glands are breaking down, 111, 649 Sulphurate of calcium, if suppuration is active, 649 Thiol, recommended in scrofulous skin dis- eases, 369 SCURVY, 649 Arsenic and iron, of service in most cases, 649 Citric acid, if lemon-juice is not obtainable, 163, 649 Diet, 649, 650 Lemon- or lime-juice, particularly indi- cated, 649 SEA-SICKNESS. Bromides, the best prophylactics, 102 Chloralamide and potassium bromide, 138 Nitrite of amyl, 68 Kola, 246 SHOCK, 650 Alcohol, 52 Atropine, gr. fa to fa (0.001), hypodermi- cally, with hot applications, very useful in first or second stage, 92, (551 Digitalis, valuable as an adjuvant to atro- pine, 1*7, 651 Heat, external, very useful, 651 Hypodermoclysis, useful, 651 Strychnine, very valuable, 291 SKIN DISEASES. Arsenate of iron, 238 Arsenic, in dry, scaly types, 83 INDEX OF DISEASES AND REMEDIES. 753 Bismuth subgallate when there is much secretion, 97 Boro-glycerin, 99 Cod-liver oil, in strumous types, Kill Copper sulphate gr. fa (0.005), thrice daily, if arsenic is not well borne, 17* Corrosive sublimate, oz. \ (16.0), and am- monium chloride, oz. 1 (32.0), useful, added to bath, in syphiloderm, 266 Hydrocyanic acid, in itching types, pre- scription for, 218 Ichthyol in those forms associated with atony and induration of the deeper layers, 223 Ointment of biniodide and of yellow oxide and lard, in equal parts, useful applica- tion, 266, 271 Petrolatum, as an emollient dressing, 310 Tar and suet, equal parts, locally applied except on face, 325 Unguentum hydrargyri ammoniati, 264 Zinc oxide ointment, 301 SMALLPOX, 651 Aconite, with spirits of nitre and Min- dererus. useful as a fever mixture, 651 Antipyrin or acetanilid, to control head- ache and backache, 75, 651 Brandy and whiskey, if pulse fails, 652 Bromides and chloral, in insomnia; latter must be used carefully, 652 Carbolic acid and sweet oil (1: 100), as an ointment to check irritation, 652 Chlorate of potassium with tincture of myrrh, as a mouth-wash, 652 Flexible collodion, glycerite of starch, or simple cerate, locally applied, to prevent itching, 652 Iron, tincture of the chloride, to give strength and act as a specific, 652 Salicylic acid and vaseline, or cold cream (4 :10D), best local application, 652 Silver nitrate, locally applied, to prevent pitting, 279, 652 SORDES. Glycerin and water, equal parts, useful as a mouth-wash, 208 SORES. Acetic acid, in old sores, 46 Black wash, useful for syphilitic sores, 266 Camphor, locally applied, as a stimulant in indolent sores, 115 Charcoal, applied to old sores, as a deodor- ant and antiseptic, 127 Cold cream, as an emollient dressing, 332 Dried alum a useful dressing, 61 Formaldehyde solution useful for cauter- izing svphilitic sores, 204 Gallic acid, 204 Iodoform, gr. 20 1.3', with oil of eucalyp- tus, oz. i (16.0 , or iodoform, oz. J (16.0), camphor, gr. 75 (5.0), and essence of roses, gtt. 2 '0.1), as a dressing for syph- ilitic sores, 233 I'ctrolatum, as an emollient dressing, 310 Potassium pjcrmanganate (gr. 60 to the pint [4.0 :500.0]), as a wash, 310 Quercus alba, powdered, as a poultice, to check discharge, 329 Red or yellow oxide of mercury a good dressing for syphilitic sores, 271 Salicylic acid ointment, 2 per cent., for sores from riding in a saddle, 336 Sulphuric acid, sometimes used as an es- charotic in venereal sores, 362 Zinc-oxide ointment, 301 SORE THROAT. Aconite, in early stage, 49 Alum (gr. 20 to the ounce [1.3: 32.0]), lo- cally applied on swab, 60 Arsenic, 83 Belladonna, of greatest service in some cases, 92 Capsicum, tincture of, and glycerin, 122 Carbolic acid (1:100), in spray, in ulcerated types, 126 Catechu, as a gargle or in troches, 132 Copper sulphate (gr. 4 to the ounce [0.2: 32.0]), often of service in relaxed sore throat, 178 Guaiac, 210 Hamamelis, in relaxed sore throat, 212 Hydrogen peroxide (2 per cent, strength), in spray, in foetid types, 220 Kino, as a gargle, 245 Myrrh, tincture of, diluted one half, as a gargle, in ulcerated types, 276 Potassium chlorate gargle in anginose form, prescription for, 139 Quercus alba, useful as a gargle, 329 Quinine (gr. 1 to 2 to the ounce [0.05-0.1: 32.0]), in spray, in foetid sore throat, 160 Rhus glabra, with glycerin and water, use- ful as a gargle, 332 SPASMS. Belladonna, useful in urethral, anal, and vesical spasm, 92 Bromides in spasmodic contractions, 101 Cannabis indica useful in vesical spasm, 118 Conium, useful, if due to irritation of nerve-trunk, 175 Ether, inhalation, relieves local spasms, 197 Gelsemium in localized muscular spasms, 206 Hyoscyamus in local spasm or where pain is due to spasm, 221 Nitrite of amyl, of service to relax, (58 SPERMATORRHEA. (See Emissions.) SPRAINS. Arnica, 80 Camphor liniment, 116 Cold applications, useful in sprained ankle, 3,91 Croton oil liniment, 182 Hot foot-bath, prolonged for hours, very useful in sprained ankle, 409 Ichthyol ointment, well rubbed in, very useful, 223 Lead-water and laudanum, 250, 296 Soap liniment, 349 Soap plaster, used as a support to sprained joints, 349 Soluble glass, 318 754 INDEX OF DISEASES AND REMEDIES. Turpentine liniment, 376 Warming plaster, 324 STINGS AND BITES, 652 Ammonia or alkaline liquids, locally ap- plied to neutralize poison, 652 Carbolic acid (1 : 50 or 100), sponged over part, useful in mosquito-bites, 652 Corrosive sublimate, with flexible collodion (1:1000), painted over part; salicylic acid a useful addition, 652 Hydrogen peroxide applied locally to hor- net's sting, of great value, 220 Ipecac paste for stings of bees, 236 Ligature, or cleansing of wound, at once, to prevent absorption in snake-bite, 653 Potassium permanganate, applied and in- jected around snake-bite, followed by alcohol in full dose, 652 Vinegar, dilute or pure, locally applied, often relieves insect-bites, 652 STOMATITIS, 653 Borax, as a mouth-wash, prescription for, 98,'653 Bromide of potassium or sodium, gr. 1 to 3 (0.05-0.15), thrice daily, when nervous irritability is excessive, (554 Carbolic acid, as a mouth-wash, 126 Cleansing nipples, in breast-fed babies, 653 Cocaine, before cauterization, 165 Nitrate of silver, stick touched to sore spots when they fail to yield to other treatment, 280, 653 Nitric acid, gtt. 3 (0.15), in water, taken through tube, 281 Nitro-muriatic acid, indicated when he- patic torpor exists, 653 Peroxide of hydrogen, 653 Potassium chlorate, prescription for, 139, 653 Salicylic acid (1:250), as a mouth-wash, after blisters have broken, to allay pain, 336 Salines or rhubarb, if constipation exist, 653 Sozoiodol (5 per cent, solution), locally ap- plied, 352 Sweet spirit of nitre, 10 drops (0.65), well diluted, to a one- or two-year-old child, and a warm foot-bath, before retiring, j to produce rest, 654 Thymol, prescription for, 370 Tonics and careful diet after the attack, 654 STYES, 654 Boric acid (saturated solution), collodion (ethereal solution), or red or yellow ox- ide of mercury salve (gr. 2 to the ounce [0.1-32.0]), locally applied, to abort, 654 Calcium sulphurate, if they tend to return, 654 Hot compresses, to alleviate pain, 654 Incision, as soon as pus forms, 654 Tonics, if general health is poor, 654 SUBINVOLUTION OF UTERUS. (See volution, Anomalies of.) In- SUNBURN. Almonds, in emulsion, 58 Carbonate of lead, prescription for, 250 SUNSTROKE, 654 Antipyretics, almost useless, 75, 655 Hot baths (105° to 110° F.), or hot bottles or bricks, in heat exhaustion, 656 Ice, application to chest, back, and abdo- meu, as quickly as possible, in thermic fever, 655 Salicylic acid, quinine, and similar drugs contraindicated, 655 Tonics, during convalescence in heat ex- haustion, 656 Venesection, best treatment, if face be cya- notic and heart laboring, and if menin- gitis threatens, after thermic fever, 655 Veratrum viride may be used if meningi- tis threatens, 655 SYNCOPE. Ammonia, if due to shock or indigestion, 63 SYNOVITIS. Carbolic acid (2 per cent, strength), as an injection in chronic types, 126 Counter-irritation, 401 Iodine, 229 SYPHILIS, 656 Biniodide of mercury, 266 Bismuth and calomel, as a dusting-powder, or bichloride solution 11 : 2000), locally applied to mucous patches about geni- talia, 658 Calomel, gr. £ 10.011), every two hours, for cephalalgia, 658 Cod-liver oil, useful in advanced cases, 169, 660 Expectant plan of treatment, 657 Formaldehyde solution, useful for cauter- izing sores, 204 Hypodermic injections of mercury, 265, * 659 Iodides, followed if necessary by mercury, recommended by some, 224, 656 Iodoform, gr. 1 to 5 (0.05-0.25), internally in tertiary stage, and the ointment ap- plied to ulcers, very useful, 233, 660 Iodol, in tertiary stage, 234 Mercurial ointment, by inunction, 270, 659 Mercury, at beginning of secondary stage, followed later by the iodides, 656 Mercury, by fumigation, general and local, 260 Mercury, with chalk, chiefly employed in infantile syphilis, 269 Mixed treatment, 658 Ointments and washes of mercury, and hot applications, to combat surface erup- tions, 658 Prescription for blue mass and iron, 659 Prescription for potassium iodide and mer- curv, to be used after first eighteen months, 658 Pressure bandage and mercurial inunctions for periostitis, 658 Protiodide of mercury, 271, 658 INDEX OF DISEASES AND REMEDIES. 755 Russian baths, highly recommended, 413 Salicylate of mercury hypodermically, 334 Sarsaparilla, a useful adjunct to potassium iodide, 343, 661 Shampooing and local application of croton oil or cantharides, as a lotion, to com- bat alopecia, 65* Silver nitrate, copper sulphate, chromic acid solution (20 per cent.) or acid ni- trate of mercury, locally applied to mu- cous patches, in mouth, 658 Stillingia, used as an aid to other drugs, 355 Thiol, in syphilides, 369 Tonic and general treatment, 660 Vapor baths, hypodermic injections, or in- unctions, useful modes of applying mer- cury if it cannot be taken bv mouth, 659 SYSTEMIC STRAIN. Opium, useful in prolonged physical strain, 297 Quinine, gr. 2 to 4 (0.1-0.2), useful to pre- vent exhaustion following physical and mental strain, 158 TABES DORSALIS. (See Locomotor Ataxia.) Chloralamide, prescription for, 138 TAPE-WORM. (See Worms. TEETHING. Bromide of potassium, to prevent convul- sions, 102 TETANUS, 661. (See Poisoning from Strychnine.) Amyl nitrite, to relieve and prevent, 68 Antitoxin, value of, not established, 78 Chloral and bromide of potassium, by mouth or rectum, 136 Fowler's solution, said to be almost specific in some cases, 661 Physostigma, of moderate value, 318 TINEA CAPITIS. Lime-water, locally applied, 114 TINEA CIRCINATA. Borax, strong solution, locally applied, 98 Iodine, applied with camel's-hair brush, 230 Turpentine, useful, applied with a brush, 376 TINEA TARSI. Copper, crystal, or weak solution, applied to diseased eyelid, 178 TINEA TONSURANS. Borax, strong solution, locally applied, 98 Iodine, applied with camel's-hair brush, 230 Oil of cajuput, applied pure, 110 TOE-NAIL flNGROWING . Absorbent cotton, soaked in strong alum solution, and inserted under nail. 61 Liquor potassa?, to soften nail prior to pack- ing with cotton or partial evulsion, 253 TONSILLITIS, 661 Alum stick, deeply applied, 61 Ammonium iodide, for enlarged tonsils, 66 Capsicum and glycerin, 122 Carbolic acid, solution (1 : 100), as an anti- septic gargle, 661 Glycerin and tincture of capsicum, equal parts, applied by swab, 122 Guaiac, 210 Hydrogen peroxide (2 per cent, strength), in spray, in ulcerative types, 220 Ice-bag to throat and pieces of ice in mouth, also internally in full doses, 661 Iron, tincture of the chloride, locally ap- plied, 239, 661 Monsel's solution, pure, applied with cam- el's-hair brush, 241 Nitrate of silver, applied locally, 661 Salicylates, are valuable in rheumatic cases, 336, 661 Saline purgative, followed by fever mixture of aconite, sweet spirit of nitre, and po- tassium citrate, 661 TOOTHACHE. Creosote, applied on cotton, often relieves, 180 Oil of cloves, inserted into cavity on cot- ton, 163 Oil of peppermint, applied on cotton, 308 TORPOR. Acetate of potassium, in hepatic torpor, 46 Ammonium chloride, in hepatic torpor, 66 Arsenic, in gastric torpor, 83 Citric acid, in hepatic torpor, 163 Euonymus, in mild hepatic torpor, 201 Lactophosphates and hypophosphites, use- ful in hepatic torpor, 112 Xitro-hvdrochloric acid, in torpor of liver, 285 * Oxygen-water, after meals, useful in sys- temic torpor, 304 Potassium acetate, exceedingly useful in hepatic torpor, 46 Russian and Turkish baths, useful in tor- pidity of skin and kidneys, 410 Taraxacum, in hepatic torpor, 367 TORTICOLLIS. Belladonna, injected into muscle, 92 Gelsemium, 206 TREMOR. Hyoscine, 222 Sparteine, 346 TUBERCULOSIS, 662 Acetanilid, generally acts unfavorably, 44 Agaricin, of doubtful value in night-sweats, 51 Almonds, essential oil of, recommended in cough, 58 Alum (gr. 10 to 20 to the ounce [0.65-1.3 : 32.0]), or sulphuric acid (1 drachm to the pint [4.0:500.0]), useful, sponged over body in night-sweats, 665 756 INDEX OF DISEASES AND REMEDIES. Antipyrin, harmful, 75 Arsenic, in phthisis, 83, and in phthisical tendencies, 82 Atropine, gr. fa to fa (0.001), hypodermi- cally, in excessive night-sweats, 665 Blister, small, useful over new pleuritic spots, 664 Camphoric acid, gr. 20 to 30 (1.3-2.0), in- valuable, 666 Cannabis indica, 118, 664 Carbolic acid (gtt. 5 to 15 to the ounce [0.3- 1.0: 32.0]), in spray, 126 Chloride of calcium, 111 Chloroform, spirit of, used by inhaler, often relieves cough, 664 Climatic treatment, 422 Codeine, recommended in excessive cough, 168 Cod-liver oil, rules for its use, 663 Copper in tubercular tendencies, 178 Creosote, internally, in spray or by inhaler, often relieves cough and discomfort; contraindicated if fever and haemopty- sis are present; prescription for, 179, 663 Glycerin and water equal parts, with lem- on-juice, useful as a mouth-wash, 208 Guaiacol, useful in, 210, 211 HydrogeD, peroxide (2 per cent, strength), in fine spray in laryngeal phthisis, 220 Hypnal for cough, 222 Inhalations of steam from corrosive subli- mate solution (1 : 10,000), stopping at first sign of mercurial effects, in laryn- geal phthisis; precede inhalation with cocaine-sprav (4 per cent, solution), 664 Iodine, useful, painted over new pleuritic spots, also useful in chronic cases as an inhalation, 228, 664 Iodoform with small amount of powdered talc and a little morphine, useful when puffed iuto the larynx in laryngeal tu- berculosis, 665; also used in spray, 233 Iodoform emulsion (10 per centJ, useful in tubercular abscess, 233 Iodol, of use in tubercular laryngitis, 234 Lactic acid applications (10 to 60 per cent. solution), in laryngeal tuberculosis, using cocaine-spray first to relieve pain, 665 Lactophosphates and hypophosphites, 112 Morphine and wild-cherry bark in cough, prescription for, 664 Nuclein, 2*7 Oil of cloves, 163 Opium, may be given in last stage, to re- lieve pain and discomfort, 297 Oxygen, inhalations in dyspnoea, 302 Pilocarpine, gr. fa (0.003), one to two hours before sweat, sometimes arrests ; if it or atropine fails alone, give them together, 665 Potassium cyanide, in excessive cough, pre- scription for, 183 Silver nitrate (gr. \ to 2 to the ounce [0.03- 0.1 : 32.0]), in spray, may be tried in laryngeal types, 2*0 Strychnine, in dyspnoea, 291 Sulphuric acid, internally, may relieve night-sweats, 665 TYPHOID FEVER, 666. (See Fever.) Acetanilid, generally acts unfavorably, 44 Alcohol, useful throughout course of dis- ease, 53, 667 Asafoetida. by rectal injections, in tympa- nites, *6 Belladonna in case of collapse or vaso-motor relaxation, 92 Brand's method of cold bathing, 669 Calomel, gr. \ (0.011), every fifteen min- utes, till gr. 1 (0.05) is taken, followed by magnesium sulphate, \ ounce (16.0\ if constipation lasts two days, 268, 668 Cascara sagrada for constipation, 668 Enemas, to be tried first, if constipation lasts over two days, 668 Glycerin and water, equal parts, with a little lemon-juice, as a mouth-wash, if sordes are present, 208, 668 Guaiacol, an antipyretic in, 211 Guaiacol carbonate, an intestinal antiseptic of value, 212 Hydrochloric acid, dilute, gtt. 5 (0.3) every few hours, or, if bowels are inactive, ni- tro-hydrochloric acid, gtt. 3 (0.15), 217, 668 Lime-water added to milk, if vomiting threatens, 668 Liquorice powder, drachm 1 (4.0), if consti- pation lasts over two days, 668 Milk diet, 66* Morphine in large dose, if perforation oc- curs, 669 Opium for insomnia, 296 Phosphorus, if uervous system is affected, 316 Prescription for diarrhoea, 668 Quinine inferior to new antipyretics, 158 Rest and diet, 666 Silver nitrate, gr. \ to i (0.011-0.015), high- ly recommended, 279 Sulphocarbolate of zinc, useful, 359 Thymol as an intestinal antiseptic, 370 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, 375, 669 (For remedies for complications—intesti- nal hemorrhage, pneumonia, and pleurisy —see their titles.) ULCERS. Alcohol, a useful local application, 53 Aristol, 370 Benzoate of bismuth, as a dressing for in- dolent or sloughing ulcers, 94 Burnt alum, as a dressing for old ulcers, 61 Caustic potash, as an escharotic for exu- berant ulcers, 132 Chimaphila, said to be of service in stru- mous ulcers, 134 Conium, used locally to relieve pain, 175 Copper, in solid or powder form, locally applied to indolent ulcers, 178 Creolin, solution (1: 100), as a douche for nasal ulcers, 1*1 Dried alum, useful, 61 Europhen, in 10 per cent, ointment, in leg ulcers, 202 Gallic-acid ointment, in actively discharg- ing ulcers, 204 INDEX OF DISEASES AND REMEDIES. 757 Hamamelis, locally applied on a cloth, re- lieves leg ulcers, 213 Hot pack to increase activity of skin, 670 Hydrogen peroxide, a useful application, 219 Lime, as an escharotic iu old ulcers, 113 Methyl blue in corneal ulcers, 272 Nitric acid, as a caustic for phagedenic ulcers, or a solution (gtt. 5 to 30 to the ounce [0.3-2.0 : 32.0]), locally applied to indolent types, 281 Ointment of lead carbonate as a dressing, 250 Potassium permanganate (gr. 60 to the pint [4.0 : 500.0]), as an antiseptic wash, 310 Precipitated carbonate of calcium, as a dry dressing, 111 Silver nitrate, in hard pills, for intestinal ulcers, and by injection for rectal and caecal ulcers, 279 Sulphuric acid, sometimes used as an es- charotic in slow ulcers, 362 Unna's dressing, 301 UR.SMIA, 670 Bromides for convulsions, 671 Chloral and chloroform for convulsions, 671 Elaterium thought to aid elimination of of poison bv the bowel, 189, 671 Hot pack, 670 * Hypodermoclysis, 671 Pilocarpine, a most efficient remedy, 321, 671 Strychnine, followed by digitalis, for heart failure, 671 Transfusion of salt solution of great value, 671 Urethan for convulsions, iu large doses, 671 Venesection, very useful, 671 URIC-ACID DIATHESIS. Acetate of potassium, 46 Lime-water, 114 Piperazine in the dose of 15 grains (1.0) a day in 1 pint (500.0) of water, 322, 323 * URTICARIA. Calcium chloride, to prevent, 111 UTERINE INERTIA. Kola useful. 246 Quinine not of great value, 15* UVULA (RELAXED). Capsicum, tincture of, and glycerin, equal parts, as a gargle, 123 Kino, as a gargle, 245 VARICOCELE. Cold water, applied by bidet, highly recom- mended, 398 VARICOSE VEINS. Barium chloride, internally and locally ap- plied, said to be of value, 89 VITREOUS DISEASES, 671 Antisyphilitic treatment, if due to syphilis, 672 Galvanism, 672 Leeches, in early stage, if due to inflam- mation, 672 Pilocarpine, hvpodermicallv, in opacities, 320, 672 VOMITING, (572 Acetanilid, very useful, 45, 673 Allium-juice, gtt. 2-5 (0.1-0.3), useful in nervous vomiting, 57 Arsenic in vomiting of pregnancy, and of hand-fed babies, and of drunkards, 83, 674 Bismuth and aconite may be of service, prescription for, 96, 673 Brandv poured on cracked ice very useful, 53, 673 Bromide of potassium, effervescing, 103 Bromide of sodium, with laudanum as a rectal injection, prescription for, 103, 673 Calomel, 268 Carbolic acid or creosote, with bismuth, useful in acidity and fermentation, pre- scription for, 126, 673 Chloroform, gtt. 1 to 2 (0.05-0.1), in water, 673 Cloves, oil of, sometimes controls, 164 Cocaine or aconite, if due to hyperexcita- bility of stomach, 167, 673 Enema of laudanum and bromide of so- dium, 296 Enenias, partially digested, if vomiting is incoercible, 675 Faradism sometimes gives relief, 674 Fowler's solution, gtt. i to 1 (0.025-0.05), every two hours, useful in nausea fol- lowing debauch, 53, 674 Hydrochloric acid, gtt. 5 to 15 (0.3-1.0), in water, every two hours, in alcoholic nausea, 217, 674 Hydrocyanic acid, dilute, gtt. 2 to 6 (0.1- ' 0.3),'in water, 218, 673 Ice-bag, to nape of neck, lumbar region, or epigastrium, 674 Iodine and carbolic acid, gtt. 1 (0.05) of each iu dr. 2 (8.0) of water, 673 Ipecac, in small doses, if due to gastric de- pression, 235, (574 Lime-water, added to milk, may relieve nausea, 114, 674 Mustard plaster over stomach, useful in all cases, 674 Nitro-glvcerin, very useful in some cases, 283, (574 Nux vomica, if due to gastric depression, prescription for, 674 Oxygen-water, of great service, 304 Peptonized milk, best food, 674 Podophyllin, useful in gastric depression and hepatic torpor, 326 Seidlitz powder, often settles stomach, if due to constipation, 346 VOMITING OF PREGNANCY. Aconite, as a nervous sedative, 49 Arsenic, may be tried, 83 Bromide of potassium, as an effervescing ES AND REMEDIES. 758 INDEX OF draught, or with opium by enema, pre- scriptions for, 103 Cerium oxalate, gr. 2 to 5 (0.1-0.25), in pill, every four or five hours, 133 Cocaine, useful to decrease irritability, 167 Iodine, tincture of, largely used of late with good results, 231 Ipecac wine, gtt. 1 (0.05), or powder, gr. 2 (0.1), useful in some cases, 235 Menthol, very useful, 308 WARTS. Acetic and salicylic acids combined, 46 Chromic acid (gr. 100 to the ounce [6.5: 32.0]), locally applied, to remove, 153 Fowler's solution, locally applied, 84 Glacial acetic acid, useful to remove, 46 Nitric acid, as a caustic, 281 Salicylic acid, locally applied, 84 Trichloracetic acid, useful, 373 WHITE SWELLING. Iodine, 230 WHOOPING COUGH, 675 Aconite or veratrum viride, if vascular en- gorgement is excessive, 675 Amber, oil of, 61 Amyl nitrite, when paroxysms interfere with respiration, 68, 675 Antipyrin, gr. 2 (0.025-0.15), every five hours, probably the best remedy, 76, 675 Belladonna, tincture of, gtt. h (0.025), thrice daily, to child of one or two years, 92 Benzine, 676 Bromoform, prescription for, 106, 676 Bronchitis tent, to modify severity of at- tacks, 676 Carburetted hydrogen, 675 Chloral, 136 Chloride of gold and sodium has been rec- ommended, 209 Chloroform, a few whiffs, if paroxysms in- terfere with respiration, 151, 675 Gelsemium, 206 Hyoscyamus, probably better than bella- donna, 221 Milk, in small amounts, may overcome vomiting following paroxysms, 663 Monobromated camphor, 117 Quinine (gr. 1 to the ounce [0.05:32.0]), in spray, useful, also of service in ex- posed children as a prophylactic, 158, 675 Resorcin, gtt. 10 (0.65), of a 2 per cent, so- lution, internally, or, better, in spray, 329 Silver nitrate (gr. £ to 1 to the ounce [0.025- 0.05:32.0]), in spray, used when stom- ach is empty, 280 WORMS, 676 Aspidium, very efficient against tape-worm, prescription for, 87, (577 Azedarach, a useful remedy against round- worms, 88 Brayera, as an infusion, or fluid extract, against round-worms, 677 Calomel, should follow or precede all drugs used for tape-worm, 677 Castor oil, or a saline purgative, should fol- low remedies for round-worms, 677 Chenopodium, oil of, gtt. 5 to 20 (0.3-1.3), on sugar, to remove round-worms, 133, 676 Chloroform, should not be used against tape-worm, 152 Cusso in tape-worm, 182 Kamala, drachms 1 to 2 (4.0-8.0), in syrup, against tape-worms, 245 Koosin, gr. 40 (2.6), to adult, against round- worms, contraindicated in pregnant women, 677 Matricaria, 258 Pelletierine, gr. 1 to 2 (0.05-0.1), in capsule, best remedy against tape-worm, 677 Pepo, ounce 2 (64.0), in confection, against tape-worm, 307, 677 Pomegranate, useful in tape-worm, 326 Quassia injections, preceded by soap and water, most useful remedy against seat- worms, 328, 677 Rue, should not be used against round- worms, 333 Rules for diet preceding taeniacides, 676 Salicylic acid, gr. 8 (0.6), hourly, till gr. 40 (2.6) are taken, against rouud-worms, or as an injection against seat-worms, prescription for, 337 Santonin, gr. i to i (0.016-0.3), in troches, for child, against round-worms, 342, 676 Spigelia, alone, or, better, with senna, to remove round-worms, 353, 676 Turpentine and castor oil, equal parts, effi- cient, but somewhat dangerous, against tape-worm, 376 Zinc oxide, prescription for, 302 WOUNDS. Acetanilid as a dusting powder, 45 Alcohol very useful in contused wounds, 53 Collodion, as an air-tight dressing for small wounds, 173 Oil of cinnamon, 161 Potassium permanganate (gr. 20 to 60 to the pint [1.3-4.0:500.0]), as an anti- septic wash, 310 Salicylic acid, 337 Sozoiodol, as an antiseptic and disinfectant in diseased wounds, 352 YELLOW FEVER. Cocaine of great value as a stimulant and anti-emetic, 167 Catalogue of Books PUBLISHED BY Lea Brothers & Company, 706, 708 & 710 Sansom St., Philadelphia. HI Fifth Ave. (Cor. 18th St.), New York. The books in the annexed list will be sent by mail, post-paid, to any Post-Office in the United States, on receipt of the printed prices. No risks of the mail, however, are assumed either on money or books. Intending purchasers will therefore in most cases find it more convenient to deal with the nearest bookseller. STANDARD MEDICAL PERIODICALS. 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