54599999955 NLM 00104605 1 SURGEON GENERAL'S OFFICE LIBRARY lH ANNEX Section____________.__.-____________ Form 113c No. W. D.,S. G. O. J..9JIA?.... VERN»ENT PRINTING OITICE NLM001048057 General Practitioner. A MANUAL FOR THE PRACTICE OF MEDICINE, EMBRACING NEARLY ALL THE DISEASES OF THE VARIOUS BRANCHES OF THE HEALING ART, WITH THEIR SEVERAL DEFI- NITIONS, SYMPTOMS AND CAUSES. THE DESCRIPTIVE PART OF THE WOBK IS PRECEDED BY A CHOICE COLLECTION OF BEMEDIES IN THE FOBM OF Select Prescriptions, WITH FCTLL NOTES OF THEIB PROPEBTIES AND VALUE, AND CLEARLY STATED BULES AS TO THE MANNEB OF THEIR EXHIBITION. AN APPENDIX CONTAINS COMPABATIVE TABLES OF WEIGHTS AND MEASUBES, AND AN EXCELLENT METHOD OF TESTING URINE. ODORE STREHZ, M. 157"•< CHICAGO : PUBLISHED BY THE AUTHOR 1880. we c a»/r Entered aooobding to Act of Congress, In the Office of the Librarian of Congress, at Washington, D. C. in the year 1889, by Theodobk Strehz. & \ '**§ TO DR. JOH. NEP. RITTER VON NUSSBAUM, PROFESSOR AT THE ROYAL UNIVERSITY OF MUNICH, GERMANY, SURGEON IN CHIEF OF THE ARMY, ETC., ETC., IN RECOGNITION OF HIS DISTINGUISHED ABILITY AS A SURGEON AND HIS NOTED LABORS IN THE FIELD OF MEDICAL SCIENCE, TO- ' GETHER WITH HIS PERSONAL AMIABILITY AS GENTLEMAN AND FRIEND, THE AUTHOR TAKES PLEASURE IN DEDICATING THIS VOLUME. PREFACE. In launching this book into the sea of medical life, the author is very well aware that it is not a full ship; but among the smaller craft it is sure to take the rank of a trustworthy life-boat. As would be expected, the matter treated of in this work is neither new nor original; but the author claims for the form in which it has been pressed, not only originality, but real practical utility, and as it is expected to furnish to a large circle of the medical profession a veritable hand-book, "for reference, of service, in any case, whatever its nature may be" hopes that it will prove a true friend to many a practitioner into whose hands it should fall. To avoid a wrong interpretation of the above assertion it will be necessary to add, that "any given case" will have something of an analogon "of service" to the reflective physician. The therapeutical part, with an introductory paragraph on poisoning and other cases of emergency, which require prompt and energetic treatment, is presented in three divisions: Inter- nal, hypodermic, and external medication. The medicines for internal use are classified according to their physiological and therapeutical action in Chapter I, while the remedies for hypo- dermic medication (which form, after all, a part of them) are arranged alphabetically in Chapter II; and the topicals, with which are also classed electricity, hydropathic items, and those remedial agents used for inhalations, rectal, urethral, and vaginal medication—since they for the most part belong to the domain of surgery and collateral branches—are enumerated in Chapter III, under the heads of the various organs to which they are applied for curative purposes. The omission of many new, though perhaps important remedial agents, will be excused, because the reliability of the work must largely depend upon v. VI. Preface. the employment of drugs of known properties, and beyond the stage of experimentation. Part II. gives in concise form the essentials of the medical art, including Obstetrics, Gynaecology, Pediatrics, Neurology, Dermatology, and all those branches, which, being treated of in purely medical and surgical works but sparingly, if at all, represent that important part of sub- divisions which claim of late the special attention of thera- peutists. As by far the greater number of prescriptions are selected from standard works, though not authenticated by the names of their respective originators being attached to them, they may be used with perfect confidence; and the formulae, both of official and non-official compounds much in use, and to be pre- pared ex tempore, will be a welcome addition, especially to the country practitioner. The occasional dosage of these formulae and prescriptions, par excellence, in metric weight, is calculated to make him acqainted with a system which before long is sure to be adopted in the United States, as it is already in use in most European countries. Besides a table for converting one kind of weight into the other, the doses of all the remedies are given in apothecaries' weight, with its equivalent of the decimal system. I may mention that I have advisedly made an indiscriminate, though by no means exhaustive, use of the different names of one and the same rem?dy in the prescriptions for the purpose of bringing into full view the existing confusion, and if, with regard to V. e chemical?, I have given a preference to the no- menclature employed in Germany, it has been on the ground that it is the one in conformity with the symbols used in works on chemistry,not only in that country but also here and in England. In conclusion I wish to say that the views held in this work are strictly iu conformity with the teachings of authorities on the various subjects here and abroad—thus representing the present state of medical science—and I need scarcely add, that nobody will make me responsible for their correctness, as I am perfectly aware of their not infrequent collision with the opinions and theories of practitioners of undoubted ability. THEODORE STREHZ. CONTENTS. PART I. THERAPEUTICS. PAGE. Introductory—Drowning, Hanging, Strangula- tion, Asphyxia from breathing Noxious Gases, Poisoning,and other cases of emergency, which require prompt and energetic treatment, - - 1 CHAPTER I. INTERNAL MEDICATION. Section 1.—Recoxstructives, comprising Alter- atives, Antiperiodics, Antistrumous, Anti- syphilitics, Antiseptics, Antizyniotics, etc., with notes relating to their physiological action and their therapeutic value, besides rules to be observed in their exhibition in certain diseases, etc.........1 Section 2.— Sedatives, including Anodynes, Narcotics, Antispasmodics, Hypnotics, Anaes- thetics, etc. - - - - - - -20 Section 3.—Correctives and Eliminatives, com- prising Acids, Antacids, Expectorants, Dia- phoretics, Diuretics, etc. - - 40 Section 4.—Astringents, etc. 59 Section 5.—Restoratives, comprising Stimulants and Tonics, - - - - - - - 69 Section 6.—Cathartics,.....88 Section V.—Emetics,......99 Section 8.—Vermifuge, - - - - 102 CHAPTER II. HYPODERMIC MEDICATION, - - - 106 VIII. Contents. CHAPTER III. PAGE. EXTERNAL MEDICATION. 1. For Eye and Ear Diseases, - - 111 2. For the Air Passages and adjacent parts, including inhalations, - - 115 3. For Genitals of Man, - - - 122 4. For Female Genitals and Womb Dis- eases proper, - - - - - 124 5. For the Rectum, including Enemata, 134 6. For the Head, Face and Skin— 138 a, Erysipelas, Neuralgia, Rheumatism and Eruptive Fevers. b, Ulcers, Tumors and Skin Diseases proper. c, Affections from Heat and Cold. d, Bites and Stings of Insects, etc., and other Wounds. e, Hydropathic Items. f, Electricity. APPENDIX. 1. Table of Weights and Measures (Metric and Apothecaries'), - - - - 152 2. Analysis of Urine, - - - - - 154 PART II. A GENERAL NOSOCOMIUM CONSISTING IN AN ALPHABETICAL ARRANGE- MENT OF THE DISEASES, with their sev- eral definitions, symptoms {whenever possible pathognomic) and causes, together with diag- nostic hints, and the remedies usually em- ployed in their treatment, according to the present state of medical science, - - - 158 PART I. THERAPEUTICS. Introductory—Drowning, Strangulation, Pois- oning and other cases of emergency which require prompt and energetic treatment. (For other cases of Asphyxia, Insolation,Poisoned wounds, etc., see part II). Asphyxia from Drowning—Let the head hang down for two seconds, that the water may run out of the mouth. Now lay down the body with the head raised, wipe out the mouth and throat, draw the tongue well forward and dry the face; then have the wet clothes stripped off and the rest of the body rubbed dry. If breathing has not quite ceased, the nose and fauces may be tickled to excite sneezing, coughing or vomiting, and the circulation and respiratory acts should be roused by brisk friction, occasionally dashing cold water on the face, neck and chest, and then wiping them dry with a warm towel. If these means fail, Artificial Respir- ation.* Warm spiced wine may be given, if the patient can swallow, if not, it maybe introduced into the stom- ach by means of a flexible catheter and syringe. Warm * Marshall Hall's Plan—Have the patient placed on his chest, with one wrist under the forehead; then roll the body over on the side far enough to remove the pressure of its weight on the thorax, to facilitate respiration; now, after two seconds, return it to its normal position, in which you leave it also for two or three seconds. In this prone position the expir- atory act may be increased by some pressure with the hands along the back. These movements of alternate compression 2 Death From, Hanging. enemata, with salt and mustard, or of brandy and water, may be of service in the early stage, whilst the heart s action is faltering. One point is to be enforced: Treat the patient instantly on the spot, in the open air, freely exposing the face, neck and chest to the breeze, except in severe weather. Death from Hanging or Strangulation, which is usually induced by a mixed cause—suffocation and apoplexy (the latter, when the rope or strangling imple- ment has been applied so high on the neck, that the jugulars are more effectually compressed than the wind- pipe), seldom by dislocation of the neck, requires a similar treatment: dashing of cold water on chest and face; if the latter be turgid, bleeding from the jugular vein; and Artificial Respiration, (p. 1*). In cases not complicated with apoplexy, the diaphragm may be ex- cited by the passage of a galvanic current from the nape of the neck to the pit of the stomach. Asphyxia from Breathing Noxious Gases, is treated on the same principle: The body must be stripped at once, cold water dashed over the head and chest and Artificial Respiration, (p. 1*). Chest and limbs should be rubbed with stimulating embrocations, and electric shocks sent through chest and diaphragm may be tried. and expansion should be gently but perseveringly continued until natural respiration sets in, but no longer. By Pectoral Concussion—About fifteen consecutive move- ments are made with both fists, placed in the ileo-ooecal region, in the direction of the diaphragm and heart, followed each time by a few brisk slaps in rapid succession on the chest over the heart with the palm of the hand. The single movements must be performed with a certain vigor, as if the contents of the chest had to be forced out of the mouth. In all cases, before commencing artificial respiration, clear the mouth and air passages from obstruction. Poisoning. 3 Afterward the patient should be put in a warm bed and Stimulants given. Asphyxia from Lightning claims the same treatment: Stimulants internally and electricity are said to be here especially useful. Suspended Animation Induced by Intense Cold. —Here the body is first rubbed with snow or iced water, then with water of the usual temp., which is very gradually replaced by warmer water, when the patient is put to bed in a temperate room, where fric- tion with the warm hand should be continued for some time. (The same procedure is indicated if only part of the body is affected, because the sudden application of heat would be sure to cause mortification.) Volatile Essences applied to the nose; Stimulants internally or by injection; and, if necessary, Inflation of the lungs. Antidotes* to Anorganic Poisons.— Green of Paris and other arsenical preparations: The principal anti- dote is freshly prepared Hydrated Sesquioxide of Iron, given in large quantities (p. 80). Besides milk* gruel, Albumen (156); Magnes. (112); Aq. Calcis, etc. Mercury and its Salts: Albumen in the shape of the white of eggs (156). Catechu as infusion (p. 63); flour * General Treatment of Poisoning.—In addition to the treatment of Gastritis, which is always caused by acrid and corrosive poison", the evacuation and neutralization of the poisonous substance claim primary attention. Emetics (pp. 100 and 101) are to be promptly given, and, if they fail, the stomach- pump (297) must be resorted to, provided the poison be one which can be ejected. After having the stomach evacuated, the required antidote may be given, followed, if necessary, by Ca- thartics and Diuretics. In poisoning with corrosive acids the necessary antidote has to be given at once, and the vegetable irritants, as Aloes, Elaterium, Jalap, Croton, etc., require after the emetic warm and copious Demulcents, with Cordials or Narcotics, according to circumstances. Drowsiness or insensi- 4 Poisoning. and water, followed by an Emetic (p. 100). The stom- ach-pump. In chronic poisoning {Salivation) : Pot. chlor. or Pot. jod. (298 & 300) as gargle. Verdigris and other Copper preparations: Albumen (156); Pot. cyanat. (66); Milk; Tea. Infusion of Oak- bark, etc. (no acids). White Vitriol and other Zinc preparations: Albumen (156); Soda (p. 55); Tannin (p. 62); Milk; Oahbarh. If vomiting, plenty of warm water. Nitrate of Silver: Table salt in solution freely. Lead and its Salts: Magnes sulf. (p. 95); Sod. phosph. (p. 97); Acid, sulfuric, (p. 61); Alumen (p. 63). To relieve pain and spasms: Opium (p. 35). In the chronic form: Iodine (p. 15); Strychnine (p. 83). Tartar Emetic: Tannin (p. 62); Tea; Oakbark, etc. Besides Stimulants. Mineral Acids: Alkaline Carbonates or Soap; Plas- ter from the wall with milk or water; Chalk; Magnesia (112). In Sulfuric acid poisoning: Plaster or Soap without water, afterward flaxseed tea. In Oxalic acid poisoning: Chalk or Magnes. but no Alkalies. In Car- bolic acid poisoning: Soap or Magnesia; Sod. sulf. or bility as a consequence of narcotic poisoning may be treated with strong hot coffee, after the stomach has been evacuated by means of Purgatives, or Apomorph. hypod. (p. 107), or some other emetic; and if syncope or paralysis of the respiratory movements have been induced by the poison, Stimulants must be given to counteract the former, whilst the latter may be treated with cold affusions, irritation of the skin, artificial respiration, excitation of the Pneumogastric by Atropia, etc., etc. As the Antidotes act either chemically, by destroying the properties of the poison, or physiologically by their antagonistic power, it is of vital importance to arrive as soon as possible at a correct diagnosis. Poisoning. 5 Sulf. acid. (p. 16); Sacch. Calcium in strong solution. In Bichrom. acid, poisoning : Chalk or Magnesia with milk. Ammonia and Alkalies: Vinegar and Vegetable acids; Oil and Demulcents. Alcohol: Strong Coffee; Cold douche; Ammon. (p. 43); Salt (p. 101); Brom.(p.25); Cocaine(pp. 77 & 109). Brom.: Amylum; Magnesia (112); Ammonia (p.43). Chloral: Counter-irritants, Cardiac Stimulants and maintaining the bodily heat (as in Opium). Chlorine: Album. (156); Magnes.(l 12); Mucilag. drinks. Chloroform: Head low and feet elevated; Inhalation of Ammonia (316); Cold water to chest and ice to rec- tum. Brandy hypoderm.; Artificial Respiration (p. 1*). Creosot.: Albumen (156). Iodine: Amylum; flour and water; afterward vine- gar and water; and mucilaginous drinks. Phosphor.: Magnesia (112); Terebinthina (150). Antidotes (p. 3*) to Organic Poisons.—Aconite: Warmth, friction and veget. Astringents (p. 62); Opium (p. 35); Digital, (p. 78), to support the heart's action. Belladonna: Vegetable Astringents (p. 62); Morph. hypoderm. in small and repeated doses (p. 110); Jabor- andi (109); Apomorphine (p. 107). Calabar: Atropin (pp. 23 and 108), to antagonize the respiratory depression. Artificial Respiration (p. 1*). Cannabis like Opium. Cantharis: Opium (p. 35); Camphor, (p. 28); De- mulcents and warm bath. Colchicum Coffee; Tannin (p. 62); Demulcents and Stimulants. Digitalis (p. 78); Opium (pp. 35 & 48). Conium: Stimulants; Atrop. (pp.23 & 108); Strychnin (p. 83); Opium (pp. 35 & 110); Artif. Respiration (p. 1*). 6 Poisoning. Cyan. (Aq. laurocerasi—01. Amygd. am, etc.): Cu- prum(p.lOO); Ferrum (143); Ammonia (p. 43). Cold douche and Artificial Respiration (p. 1*). Digitalis: Horizontal position; Tea; Coffee; Stimu- lants; Tannin (p. 62); Albumen (156); Opium (p. 35). Ergot: Brandy and Demulcents with hot applica- tions to body. Digitalis (p. 78). Gelsemin: Brandy; Ammon. (p. 44); Digital, (p. 78); Bellad. (pp. 23 & 108); Artificial Respiration (p. 1*). Hyoscyamus like Belladonna. Lobelia: Brandy; Counter-irritation; Tannin, (p. 62); Anodynes (p. 20). Opium: Continuous motion; strong Coffee or Tea; cold Douche; Emetic (p. 101); Caffein (163); Tannin (p. 62); Cocaine (pp. 77 & 109); Bellad. (pp. 23 & 108); Digitalis (p. 78); Artificial Respiration (p. 1*). Santonin: Emetics and Laxatives (p. 104); Chloro- form (pp. 30 & 109). Strychnin: Coffee; Tea; Brandy (p. 73); Tannin (p. 62); Brom. (p. 27); Chloral (p. 30); Calabar (270); In- halationsofChlorof.orAmyl. (304&308).Infus.Chamom. p. os et p. anum; Tobacco-enema. Artif. Respir. (p. 1*). labaccum: Brandy (p. 72); Opium (p. 35); Digital. (p. 78); Strychnin (p. 83). Inhalation of Ammonia and Artificial Respiration (p. 1*). Veratrum viride: Brandy by mouth and rectum (p. 72); Ammonia (p. 43); Opium (p. 35); friction to body. Animal Poison (Snake-bite, etc.): Cauterization of wound with Arg. nitr. or Nitr. Acid (329). Alcoholic Stimulants (p. 72); Ammon. (p. 43); Cedron (p. 10). SECTION I. RECONSTRUCTIVES. They comprise Alteratives, Antiperiodics, Anti- strumous, Antisyphilitics, Antiseptics, Antizymot- ics, in fact, all those medicines which have a decided effect on certain cachectic conditions of the blood, and through either their destructive or reconstructive power assist the vis medicatrix naturce in her efforts to repro- duce the natural state of the various constituents of the human body. Acid, nitric, d: Alterative, Antilithic. Arsenic: Alterative Antiperiodic, Anticonvulsive, Nerve Tonic. Aurum: Antiscrofulous, Antisyphilitic. Baptisia: Antiseptic, Cathartic. Barium: Antiscrofulous, Anthelmintic. Cedron: Antiperiodic. Chinin.: Antiperiodic, Antiseptic, Antispasmodic, Antineuralgic, Antipyretic, Tonic. Chrom.: Antiseptic. Fucus: Alterative. Guayacum: Alterative, Diaphoretic, Stimulant. Hydrargyrum: Alterative, Antisyphilitic, Antiphlo- gistic, Cholagogue, Sialogogue, Cathartic. Iodum: Alterative, Antiscrofulous, Antisyphilitic. Naphthalin: Antiseptic. . Phenol: Antiseptic. 8 Reconstructives. Pulsatilla: Alterative, Emmenagogue. Resorcin: Antiseptic, Antipyretic, Haemostatic. Salicin: Antiperiodic, Antizymotic, Antiarthritic. Sarsaparilla: Alterative, Diuretic. Silicta: Antiarthritic. Sulfides: Antisuppurative. Sulfites: Antizymotic. Thymol: Antiseptic. Antiperiodics, Antiseptics, etc. 9 ft Acidi nitrici d. 3 j. Dec. Saizae Oj. To be taken during one or two days. Syphilis. 2a. B Arsenici iod. 0.2. Extr. Conii 2.5. F. pilulge 35, ut singular contineant 0.0057. j ter die p. cibum. Gout (rheumatic). Cutan. Erupt. 2b. B Liq. arsenic. Donov. 3 ij. Gtt. x ter die p. cibum. Tumor xoithin Brain. 2c. B Sol. arsenic. Fowl. 3 ij. Gtt. v. ter die p. cibum. Gastralgia. 3a. B Auri et Sod. Chlor. gr. j. Argillae 3ij. Divide in 20 p. aequales. j ter die. Spermatorrhea. Acidum nitricum dil.: gtt. Arsenicum album: " iod.: " Sol. Don.: " " Fowl.: Auri et Sodii Chlor. gr- gr- gtt. gtt. gr- 2—20 = 1-40—1-8 = 1-20—1-5 = 3—15 = 2—10 = 1-20—1-10= 0.15 —1.5. 0.0015—0.008. 0.003 0.2 0.12 0.003 —0.012. —1.0. —0.6. —0.006. Acid, nitric, dilutum is also used in Physometra. Gtt- viij—x sextis horis in Intermittens. See sections m & v- Arsenic must never be given on an empty stomach, and it must be stopped when there is itching of the con- junctiva. Its specific effects aside from the itching are: GMema and stiffness of the eyelids and face, tenderness of mouth, itching of the skin and uneasiness about the stomach. It is frequently used in Chronic Eczema, Lichen, and the scaly diseases—Lupus, Lepra, Psoriasis; and in some skin diseases it is valuable for subduing pain. It is also used in Chronic Bronchitis, Cystic Goitre, Chorea, and Vomiting of Drunkards. In Rheumatic Gout it is said to be superior to any other remedy, and in conjunction with Tannin it is pref- erable to Quinine. The average dose isgr. 1-10 ter die; gr. 1-20 ter die in Cancer or Irritable Uterus. 10 RECONSTRUCTIVES: Alteratives. 3b. 5a. B Auri et Sod. Chlor. 0.1. B Barii Chloridi Aquae destillatse 50.0. Extr. Conii & 2.0. Gtt. xx. ter die. Syphilis. Vini stibiat. 5.0. (secondary.) Aq. destillatie 20.0. (To increase to 50.) Gtt. xx—xxx tertiis horis. 4. Orchitis (chronic). B Tr. Baptisise Rd. 5b. " Gentian.cornp.^ 3 ij- B Barii chlorati 2.0. Glycerini § ss. Aq. destillatae 30.0. Gtt. v—xx omni hora. Gtt. v—x semel vel bis die. Typhus. (2 to 3 vears.) Scrofula. 4b. 6. B Tr. Baptisiae 3 ij. B Cedrcn. Simab. Elix. simpl. ad 3 ij. Cort. Cinchona.' T 0.5. 3 j hourly. Scarlatina. During cold stage. (malignant.) In tcrmittens. BaptisiaTr.: gtt. 20—60 = 0.65—2.0. Barii Chloridum:gr. 3—10 = 0.20—0.65. Fowler's Solution: gtt. v—x ter die in Intermittens. Arsen. chloro-phosph.: gtt. xv—xx ter die post cibum in Sexual Weakness, Nervous Exhaustion, Loss of Memory, or Threatening Insanity. Cigarettes made of paper, saturated with a strong solution of Sod. arsen. are smoked in Asthma. Donovan's Solution: Arsen. iod. Hydr. biiod. iTgr. xxxv, Aq. 3 viij. Auri et Sod. Chlor. is similar in its effects to Sublimate, but is most used in premature decline of sexual powers; and in Locomotor Ataxia, early and persistently exhib- ited, it will arrest the disease(?)—As sugar and other organic substances reduce the gold, the salt should be given in Aqua destillata, or as pill with Argilla. Baptisia is sometimes given in Diphtheria and in putrid ulceration of the buccal mucous membrane. Cedron is with the inhabitants of Dutch Guiana a popular antidote for snake bite. Dose, gr. j—ij. Antiperiodics, Antiseptics, etc. 11 7a. 7c. B Chinini Sulfatis B Chin, sulfurici Acid, sulf. d. 7 3 ss. Extr. Gentiange, "a 3j. Syr. Aurant. C. 3 ij. F. pilulae 24. Aq. font. | jv. j vel ij quartis horis. | j omni hora. Pneumonitis (\Jni\\ cinchonism; and to (abortive.) begin, if possible, in the 7b. sweating stage.) Intermittens B Chinini sulf. 3 ss. 8. Tr. Ferri chl n\ 3 ijss. B Cinchonid. tannici 1.0. Aquae fontanae 3 v. Syrupi Rhei 40.0. | ss quartis horis. 3 j bihorio vel tertiis horis. (The first dose may be Teething. doubled.) Septicemia. (with constipation.) Chin. Sulfas: gr. 1—40 = 0.065—2.6. Cinchonid.: gr. 3—30 = 0.2 —2.0. Quinine has a marked influence on pulse and temper- ature, lessening at the same time the amount of uric acid and urea in the urine. Taken for some time, or in large doses, it produces Cinchonism—tinnitus aurium, with partial deafness, coupled with severe headache; sometimes dimness of sight, (suffused eyes and dilated pupils) with flushed face; and not unfrequently de- lirium, even convulsions may supervene. In In- termittens and other fevers of malarial origin, it is the remedy, par excellence. In pernicious Intermittens Sj every 3 hours unless Cinchonism; per rectum the dose may be larger. In the varieties of Typhus, especially that termed Cerebro-Spinal Meningitis, it is given in similar doses, in conjunction with alcoholic stimulants. A ^j dose in Bronchitis is said to be abortive, and from &i to 3ij may be given in Typhoid before the evening exacerbation. It is contra-indicated during menstruation, as it may produce hypogastric pnin. See section v. Cinchonid. tann. 0.1—0.3 every hour or half hour in febrile diseases and Cholera Infantum; and in weak children, with worms, it is very valuable. See sec- vm. 12 RECONSTRUCTIVES: Alteratives. 9. 12a. B Pot. Chromatis 0.1. B Calomel, gr. xxjv. vel Bichrom. 0.01. Opiigr. jv. Aq. dest. 40.0. F. pil. 12. 3 j ter die Syphilis, j bis die until ptyalism; then (secondary.) every-other-night one. 10. Chancre. B Extr. Fuci vesiculosi Vel: Elix. simpl. T | j. B Mass. Hydrargyri 3 ss. 3 ij ter die. Adipositas. Opii gr. jv. 11 F. pilulae 16. Same. B Tr. Guayaci ammon. Vel: Tr. Cinchonae "a 3 j. B Hydr. iod. fl. gr. vj. 3 ij bis die e cyatho lactis. Extr. Conii 3j—ij. Rheumatism (chronic.) F. pilulae 24. Same. Chrom. Pot.: gr Bichrom. " gr. Fucus, Extr. fl.: Guay ac. Tr. amm.: Calomel: gr, Hydrarg. Massa.: Chrom. As organic substances reduce chromic acid, the salt must be dissolved in Aq. dest., or mixed with Argilla as pill. Pot. bichrom. in doses of 0.05 is sure to produce Gastro-enteritis, and may even cause death! Fucus requires the following diet: Roast meat, fish, fruit and vegetables; but no potatoes and other farina- ceous articles. (Bread, sparingly, and either stale or toasted.) Tea and coffee without milk and sugar, a little wine and Succus Citri to quench the thirst. Guayacum is also used in Syphilis; occasionally in Amenorrhoea and Dysmenorrhoea. Mercury (see Iodine) has to be suspended or stopped altogether as soon as salivation sets in. The latter is soonest produced by Blue Pill; Calomel comes next Calomel in larger than 2 gr. doses acts as a purgative. See sec. vi. Hydr. c. Creta, gr. 1 ter die is recommended . 1-6 - -5-6 = 0.01 - - 0.05 ter die, . 1-12- -1-4 = 0.005- - 0.015 " 3j- -3 = 4.0 - -12.0. 3 ss- -2 — 2.0 - - 8.0. .1-6 - -2 = 0.01 — - 0.13. gr.l - -15 = 0.065— - 1.0 Antiperiodics, Antiseptics^ etc. 13 12b. B Calomel, gr.j. °pii, gr. f to f Tertiis vel quartis horis. Dysentery 13- Gtt. xxx ex aqua bis die: B Hydr. c. Creta gr. ij. (6 years). 1 year:gtt. x. Every third night, followed Vaginal Discharge. in the morning by salts 3 j. (from Scrofula.) Jaundice. 14c. B Hydr. bichlor. gr.f. Pot. iod. $)j. Tr. Cinch onae Tr. Rhei T \ ss. 14a. B Hydrarg. bichlor. Ammon. chlor. ^ gr.j. Micae Panis, q. s. F. pilulae 12. j ter die post cibum. Tumor within Brain, 14b. B Hydr. bichlor. gr.j. * Tr. Ferri chlor. 3 ss. Extr. Fuci mar. fl. § jss. 1 j ter die ex aqua. Pharyngitis. (syphilitic.) 14d. B Hydr. Bichloridi gr.j. Pot. Iodidi ©ij. Extr. Cinchon. fl. § ss. vel Syr. Ferri iod. § j. Aq. fontanae ad § viij. | ss ter die ex aqua. Chancre. 15. B Hydrarg. biiodati 0.1. Pot. iodati 8.0. Pot. bicarb. 3.0. Decocti Sarzae 180.0. 1 ss ter die. Syphilis. (secondary and tertiary.) Hydr. Bichlor.: gr. 1-32—1-8 Hydr. Iod. rbr.: gr. 1-32—£ Hydr. Iod. v.: gr. 1-6 —2 Hydr. c. Creta: gr. 1—12 0.002—0.008. 0.002—0.008. 0.01 —0.13. 0.065—0.8. as preventive of secondary Syphilis; 0.02 ter die will relieve the swelling in Parotitis.(?) Hydr. Bichloridum (Hydrargyrum bichloratum) gr. 1-60—1-30 ter die ante cibum in Gastric Ulcer; and in chron. Diarrhoea this dose may be gradually increased. Hydrarg. Iodidum rbr. (biiodatum No. 15) in syphi- litic Iritis and Pharyngitis. Hydrargyrum iodatum flavum is the protoioduret. 14 RECONSTRUCTIVES: Alteratives. 16a. 18. B Pot. Iodidi 3 ij- B Pot. iod. 3 j. Inf. Quassiae f jv. Tr. Cinchonae 3 ss. | j bis die. Syphilis. Aq. font, ad § vj. (secondary.) § ss ter die. Pharyngitis. 16b. Vel : B Pot. iod. 3 j- B Pot. Iodidi Extr. Xantoxyl. fl. 3 ij. Pot. Bromidi Aq. Fontis 3" vj. Ammon. Chloridi ~ 3 j. 3" ss. ter die. Rheumatism. Aq. destillatae § vj. (chronic.) 19 a. ( With osdemat. extremities.) B Kalii iodati 3 iij- Syr. Ferri iodati § ij. 17a. Tr. Colombo 3 vj. B Kalii iodati 5.0. 3 ij ter die ex aqua. Natri bicarbonici 1.0. Chronic Peritonitis. Aquae fontanae 400.0. (pelvic.) § ss bis die. Pimples. 19b. (of young peopled) B.Pot iodati 8.0 17b. A*q. destillatae. 50.0. B Pot. iod. gr. ij. Ferri sulfurici 6.0. Pot. bicarb, gr. v. Post agitationem admisce: Extr. Sarz. fl. 3j. Tr. Cardam. comp. vel Ext. Cinchon. fl. gtt. viij. Syrupi simpl. 7 25.0. Aq. fontanae § j. 3 j ter die. Amenorrhea. 3 j bis die. Scrofula, (with headache and pains in (1 year.) pelvis.) Iod. Pot: gr. 3—30 = 0.2 — 2.0. Iod. Ferr. Syr.: gtt 15—45 = 1.0—3.0. ______________________(3ij = 7.5.) Iodine. Pot. iod. must not be given with narcotic alkalies, metal salts, acids and Aq. Amygdal. am. Its use has to be stopped for 5—10 days if there appear inflammatory eruptions of the skin. If in use, Calomel, even externally, must not be employed, as Hydr. iod. may form, nor Pot. chlor. or Syr. Ferr. iod. must be used, as Iodine may separate and produce intoxication. Antiperiodics, Antiseptics, etc. 15 20a. B lodi 2.0 Pot Iodidi 10.0 Aq. destillatae 250.0 3 ij terdie ante cibum ex vino rubro vel aqua. 1'araplegia. 20b. B" lodi 1.5. Pot iodati 3.0. Aquae destillatae 30.0. Gtt. v—xxx ter die ex aqua saccharata. (Liq. iodatus Lugol.) 20c. B lodi 1.0. Solve leni calore in Glycerini 100.0. 20d. B lodi 0.2. Alcoholis 2.0. Glycerini 200.0. 1 J—rs Per diem- Substitute of Ol. Jecoris. 21. B Naphthol. (Beta) Bism. salicylici Magn.carbon. ^ 0.3. This dose quartis horis. Furuncles. 22a. B Liq. antisept. P. 25.0. Tr. Catechu 15.0. Syr. simplicis 150.0. 3 ij semis horis. Cholera. Iodum: gr. \—1 lodi Tr.: gtt.2—10 Naphthalin. :gr. 2—8 Phenol: gtt. £—3 0.015—0.065. 0.065—0.32. 0.13 —0.5. 0.032—0.2. Iodism is characterized by Eruptions of Skin, Laryn- gitis, Intestinal Catarrh, Vertigo, Fainting, etc. Pot. iod. gr. 15— 3 j p. diem, if it be borne, in Lead Colic; gr. 5—-10 quater die in Cellulitis and second stage of acute Cerebral Meningitis. Syr. Ferri iodati gtt. xxx ter die in Scrofulaand Chlorosis. Forchildren: gtt. 15bis die (4 years); gtt. 6—10 ter die (2 years). In convulsions from loss of blood it is sometimes very valuable. Tr. lodi gtt. v ter die in Retention of Menses. In gtt. j doses it is said to check the vomiting in cholera; and t. die with Laudan. gtt. ij it is recommended as prophylactic. Iodine is also used in Fibroid, Uterine Cancer, Ovar- ian Dropsy, Bronchocele, Ringworm, etc. Napthalin is a good antif ermentative and germicide, and therefore recommended in intestinal disorders; it has been given as much as 3 j per diem. Naphthol 2,5 p. diem in Typhoid. 16 RECONSTRUCTIVES: Alteratives. 22b. 23b. B Acidi carbolici 5.0. B Extr. Pulsat. fl. 3 ss. Glycerolati Amyli 10.0. Aq. Menthae § jss. Radicis Calami 5.0. 3 j bihorio. Hysteria. Rad. Althaeae q. s. 24. Ut fiant pilulae 200. (quarum B Resorcini 1.0—2.0. singulae contineant 0.025). Aq. destill. 100.0. j quater die. Pruritus. Syr. Aurant Cort. 30.0. (To increase to 3 daily.) § ss bihorio. Intermittens. 23a. 25. B Hb. Pulsatillas R Salicini Extr. Pulsatillae T 5.0. Pepsini 'l 1.0. 01. Menthae pip. gtt. j. Glycerini 40.0. F. pilulae 75. Leni calore solutio efficiat j vel ij ter die. Amaurosis. 3 j ante cibum. Dyspepsia. Pulsat. Extr. fl.: gtt 2— 6 = 0.065__0.2. Pulsat Tr.: gtt 30—60 = 1.0. __2.o! Salicin: gr. 3—60 = 0.2. __4.0. Phenol is said to be excellent in tapeworm. (See section vm). Sod. sulfo-carbolic. 3j with Svrup bihorio in \ariola. Intoxication from repeated Carbol. applica- tions may be treated with Sod. sulf., vel Acidum sulf. dilutum: Sulfo-carbolic acid is formed, and the dark color of the urine soon disappears. Liq. antisepticus Pernes: Acid, carbol. 10.0. Aqua. dest. 300.0. Mixtis instilla. Bromi. 5.0. Pulsatilla is also employed in skin diseases, catarrhal affections of nares, fauces and larynx, urinary passages and intestines. Resorcin is equal to Quinine as antipyreticum, but by no means as tonic; to Phenol it is equal as antiseptic 1 he latter is a monhydroxylbenzol, whilst Resorcin is a dihydroxylbenzol. Salicin has not the disagreeable effects of Acidum sali- cyhcum; and Sod.salicyl. is also milder than the acid and therefore preferable; moreover, as it is decomposed by - Antiperiodics, Antiseptics, etc. 17 26a. 27. B Acidi salicylici 5.0. Spir. Vini Gallic! Vini Hispanici ~ 100.0. Syr. Aurant Cort 50.0. | j bihorio vel quartis horis. Vel: Diarrhma. B Acidi salicylici 10.0. Liq. Amm. acet 60.0. Aq. destillatae 230.0. 3" j omni hora. 26b. B Acid, salicyl. Sod. bicarb. IT 3 ss. Spir. Vini Gall. 3 ij. Glycerini 3 vj. Aq. font, ad f ij 3 ij omni hora. ( 4 years.) Vel: B Acid, salicyl. gr. xij. Cretae praep. gr. viij. Divide in 10 vel 6 partes. j every 2 or 4 hours. (2 months to 3 years.) Salicyl. Acid.: gr. 6—60 — 0.4 - Salicyl. Sod.: gr. 10—20 = 0.65- Same. B Acidi salicylici 5.0. Sod. phosph. 13.0. Liq. Amm. caust. 2.0. Glycerini Aq. fontanae T 10.0. H.somnisumenda. Typhus. 28. B Acidi salicylici gr. x. Natri salicylici gr. xv. Ter die. Rheumatism. (artic. acute.) 29a. B Sod. Salicylatis Sacchari ^ 1.0. Tales doses 5. j ex aqua. Migraine. 29b. B Sod. Salicylatis 6.0. Sod. Bicarbonatis 2.0. Glycerini Aquae fontanae ~ 25.0. The whole at once, or in 2 doses within \ hour. Typhus. -4.0. -2.6. Carbonic acid, the acid is liberated in the stomach. As antipyreticum, Salicin is inferior to Nitre, and in heart and kidney diseases, it is moreover contra-indicated. In intestinal disorders, which are due to fermentation and putrefaction in the alimentary canal, Sod. salicyl., espe- cially combined with Bismuth, has been lately much employed. Treble the quantity of Acid, salicylicum will replace Acidum earbolicum? Salicylismus. Tinnitus, Vertigo, Vomiting, Deafness, General Malaise, Urticaria, Petechiae, etc. Salicin. 0.3—1.5 bihorio vel tert, horis ante cibum 18 REC ON STRUCT IVES: Alteratives. 29c. 31. B Sodii Salicylatis B ?>ec- Sarzae comp. | iij. Sodii Bicarbonatis Liq. Potassae 3 ss. Tr. Cannab. Ind. 7 3 j. | ss bis die. Scrofula. Ext. Rhei fl. 3 iij- (3 years.) Atrophy. Elix. simplicis |j. 32. Aq. Fontis ad | iij. B Acidi silicici. 0.05—0.1. | ss bihorio. Cephalalgia. Sacchari Lactis. 0.05. (periodic.) Tales doses 12. Diabetes. (with constip. and languor), j ter die. 30. 33a. B Natri boro-salicyl. B Calcis sulfuratae Spir. Vini Gall. & 10.0. Gr.j bihorio. Boils,etc. Vini albi 150.0. Vel: Glycerini 40.0. R Sodii Sulfitis gr.x—xx. | ss bihorio vel tertiis horis. Tales doses No. 10. Gout, etc. j ter die. Thrush. Sarzaeco.Extr.fi.: gtt. 15—60 = 1.0 —4.0. Sulfid. Calcis: gr. ^—5 = 0.008—0.32. ex aqua in Catarrh and Diarrhoea; bis vel ter die as tonic. 2.0—4.0 during intermission in Intermittens. 2.5—6.0 in Typhus and Parametritis. Sod. and Acid. salicyl. (No. 28) in Neuralgia, Lumbago and Ischias. Sod. salicyl. 0.5 ter die in Polyuria. 0.5—2.0 omni hora vel bihorio: antipyretic. 1.0 quater die: anaphro- disiac. 3.0—6.0 ter die in Hectic Fever. 5.0—8.0 p. diem in Arthritis nodosa. Sod. salicyl. 5.0 — Acid, salicyl. 4.1. Sod. bicarbon. 2.5. Sod. boro-salicyl.: Borac. 20.0; Sod. bicarb. 9.0; Acid, salicyl. 55.0. (Acid, salicyl. combined with Acidum boricum has a bitter taste, though neither acid in itself is bitter). Acidum silicicum. is frequently used in Chronic Rheu- matism, and sometimes in Carcinoma. Sulfides (N. 33a) prevent or arrest suppuration. The Antiperiodics, Antiseptics, etc. 19 33b. B Sodii Sulfitis 3]— 3 ss. Bihorio vel tert. horis. (In caps, amylac.) Sarcina. ( Vomiting.) Vel: B Sodii Bisulfitis 3j. Glycerini Aq. Fontis T 3 j. 3 ii bis vel ter die. 33c. B Sod. hyposulf. 10.0. Aq. destillatae 50.0. Syrupi simplicis 100.0. 3 j ter die. Skin Diseases. 34 a. B Acidi thymici gr. v. Spir. Vini Gall. § jv. Glycerini § ij. 3 ij vel \ ss bihorio. Scarlatina 34b. B Thymoli Kali chlorici Chin, sulfurici Glycerini Spir.Vini Gallici 250.0 Acid, hydrochl. d. 1.0 3 j omni hora. Diphtheria (2—5 years.) 0.5. 5.0. 3.0. 80.0. Sulfis and Hypo.s. Sod.: gr. 3—20 = 0.2—1.3. same may be said of the Sulfites and Hyposulfitesy they avert putrefaction and suppuration. (Sodii Hyposulfis— Natrum subsulfurosum—is soluble in 01. Terebinthinae and deodorizes it almost wholly). Acidum thymicum is si milar to Phenol, but milder. Its depressing effect must be counteracted by the adminis- tration of Stimulants. See section vm. SECTION II. SEDATIVES. They include Anodynes, Antispasmodics, Narcot- ics, Hypnotics, Anaesthetics, etc. They have an exalting or depressing influence on the nervous system, thereby relieving pain, producing sleep, or causing insensibility, without affecting the structure of the nerve fibre. Aconite: Sedative, Anodyne, Antiphlogistic, Dia- phoretic, Diuretic. ^Ether: Sedative, Antispasmodic, Anaesthetic, Stimu- lant, Inebriant Amyl: Antispasmodic, Anaesthetic. Anilin: Antispasmodic. Antimony: Sedative, Antiphlogistic, Alterative, Expectorant, Emetic. Asa fcetida : Antispasmodic, Diffuse Stimulant, Ex- pectorant. Belladonna: Antispasmodic, Cardiac Tonic, Diu- retic, Deliriant Bromum: Antispasmodic. Camphor a: Antispasmodic, Sedative, Diaphoretic, Expectorant, Stimulant. Cannabis: Anodyne, Antispasmodic, Antineuralgic, Hypnotic. Castorkum: Antispasmodic, Stimulant. Sedatives. 21 Cerium: Nerve Tonic. Chloral: Antispasmodic, Sedative, Hypnotic. Chloroform: Antispasmodic, Anaesthetic, Anti- emetic. Coccus: Antispasmodic, Anodjne. Conium: Antispasmodic, Sedative, Anodyne. Curare: Sedative. Cyan.: Sedative, Antispasmodic, Cypripedium: Sedative (like Valeriana). Dioscorea: Antispasmodic, Alterative. Duboisin: Antispasmodic (like Belladonna), Gelsemium: Sedative. Grindelia: Antispasmodic. Hyoscyamus: Antispasmodic, Sedative, Hypnotic, Deliriant. Lactucarium: Antispasmodic, Sedative, Hypnotic, Diuretic, Laxative. Lycopodium: Antispasmodic, Diuretic, Aphrodisiac. Opium: Antispasmodic, Sedative, Diaphoretic, Diu- retic, Soporific. Ruta: Antispasmodic, Emmenagogue, Stimulant Valeriana: Antispasmodic, Sedative. Vanilin: Antispasmodic (like Moschus). Veratrum viride: Sedative. Viburnum prunifol: Sedative (uterine). Xanthium: Sedative. 22 SEDATIVES: Anodynes, 35a. B Extr. Aconiti gr. jv. Extr. Papaveris gr. xij. F. pilulae 4, j omni hora. Neuralgia. with a soothing rubefacient. 35b. B Tr. Aconiti gtt. viij. Aq. Amygd. am. c. Sp. nitrico-aeth. 2 3j. Aquae fontanae ad 3 j. 3 j bis vel ter die. Hypertrofjhy without valv. lesions. 35c. B Tr. Aconiti gtt. vj. Extr. Gelsem. fl. 3 ss. Kali nitrici 3j. Aquae destillatae § iij. 3 ss bihorio vel tert. horis. Nephritis. Urethritis. 35d. B Tr. Aconiti gtt. j. Glycerini § ss. Aq. destillatae ad § ij. | j omni hora. (1 year.) Febrile Diseases. 46. B iEth. acet. vel sulf. Alcoholis ^ 3 ij. Gtt. x—xxx ex aqua. Fainting. 37. B Amyl. aeth. nitrosi Alcoholis T 2.5. Gtt.ij—jv. Spasm. Glottid. 38. R Anilini sulfurici 0.05—0.15 ter die in pil. (0.14 p. diem.) Chorea. (13 years.) Epilepsy. After a few days the dose may be doubled. Aconit Rad. Tr.: gtt. 2—8 = 0.065. —0.26. 1-400—1-100= 0.00015—0.0006 gtt. 10— 3 ss= 0.25 —2.0. gtt. 20— 3 j =0.5 —4.0. gtt. 1—5 = 0.03 —0.15. gr. 1—4 =0.065 —0.25; 1.0 p.diem. Aconitin: gr. yEther acet.: iEther sulf.: Amyl Nitris: Anilin: Aconite: In febrile diseases, if skin hot and dry, and the pulse rapid and strong, see Yeratrum. If much pros- tration or the pulse becomes feeble, it must be stopped or given in smaller doses. Contra-indicated in asthenic cases. It is also used in sudden suppression of Menses, Tonso- litis, Pharyngitis, Pneumonia and Basedow's disease. In Headache, Pleuritis, Cellulitis, Tr. Aconit. gtt. j every 15 minutes for 1 or 2 hours; afterward gtt. j hourly. In Abortion, with Sod. salicyl. gr. xv every 3 hours. Antispasmodics, Narcotics, etc. 23 39a. 41a. B Tart emetici gr. jv. B Asae fcetidae. Aquae destillatae § jv. Extr. Valerianae ~ 3ij. 3 ij omni hora. Craving for Ferr. sulfurici T)j. Drink. F. pilulae 20. 39b. j mane nocteque. Chorea. B Tart, emetic, gr. v. VpI- Kali nitrici 3i- r> t< a r *-j -r •• tv -a • xt n $ I r. Asae foetidae 3 n. Divide in p. aeq. No. 6. ,p ^T , . • „ J • t. . i • « „• ^- lr- Valerianae * ss. j tert horis. ^ Antipyretic 3 . ter die FlatJent ^ B Atrop. Sulfatis 0.1. m 4lb- Strychn. Nitratis 0.2. ^ fr- As{e fotidae 10.0. Chin. Sulfatis 2.0. Tr- Castorei Canad. Pot. Bromidi Tr- Valeriana 7 5.0. Extr. Trifolii T 10.0. _ Tn °PX1 2-5- Rad. Althaeae 3.0. Gtt- 3°-50 ter dle- Hysteria. Rad. Artemisiae q. s. 42. F. pilulae 200. Epilepsy. B Pil- Atrop. gr. 1-120. j daily the first fortnight. Hora somni. Night Sweat. j bis die the next. 43a. j ter die afterward for one B Extr. Belladonnae 0.25. month (if they be borne; Aq. Laurocerasi 15.0. after this to decrease again. Gtt. xx—xxx quater die. Antim.Pot.Tart.: gr. £— 3 = 0.008—0.2. Asa foetida: gr. 5—30 = 0.32 —2.0. Asa f oet. Tr.: gtt. 20— 3 j = 1.0 —4.0. Atropia: gr. 1-200—1-50 = 0.0003 0.0012. Bellad. Extr.: gr. |— 2 = 0.032—0.13. Antimony. In the first stage of Rhinitis, Pharyngitis and Bronchial Catarrh. In Delirium of Typhoid, gr. 1-16—1-8 every £ hour. In No. 39b the Antimony may be increased in the next six powders to gr. vi. They are reputed to extinguish any fever. Belladonna (see Hyoscyamus) prevents secretion of milk, arrests profuse perspiration and prevents griping of some cathartics. In Asthma, Tr. Bell. gtt. x bihorio until vision affected. In Epilepsy, Extr. Bell. gr. 1-5 per diem. 24 SEDATIVES: Anodynes, 43b. B Extr. Belladonnae gr. j. B Syr. Belladonna? 30.0. Sacchari Lactis 3j. Aq. Laurocerasi 10.0. Divide in 10 partes. Aq. Flor Tilise 110.0. j hora somni. Pertussis. 3 ij bihorio. Pertussis. (1 year); double for 5-10 yrs. 44. 43c. B Extr.Berb. aquif.fl. § j. B Extr. Bellad. fl. gtt. viij. Ext.Viburniprunif. 3 ss. Spir. nitrico-aeth. 3j. Tr. Pulsatilla? 3j. Syrupi simplicis . Syr. Tolu, ad § jv. Aq. Cinnamomi 7 3 j. 3j ter die ante cibum. Gtt. ij for each year ter die Dysmenorrhcea. Preventive of Scarlatina. Leucorrhcea. 43d. 45a. B Extr. Bellad. fl. gtt. jv. B Bromi (gtt. 3) 0.1. Tr. Xantoxyl. gtt. x. Kalii bromati 0.25. Aq. Amygd. am. c. 3 j Aq. destillatae 120.0. Aq. Flor. Tiliae 3 iij. 3 j omni hora ex aqua. 3j every 15 vain.Hypertrophy. Diphtheria. Bellad. Extr. fl.: gtt. 1— 4 = 0.032—0.13. Bellad. Tr. " 8—30 -. = 0.025—1.0. Berberis,Extr. fl.: " 15—3j — 1.0 —4.0. Brom.: gr. 1-10—£ == 0.006—0.03. It is also used in Palpitation and Vesical Irritation. Berberis is said to be of especial benefit in Leucorrhcea, not dependent on mechanical causes. (See section v.) In Cardialgia it is sometimes of service. Brom must be much diluted if used internally; a solu- tion of 1-100 gtt 10—20 may be given hourly or every two hours. Acid, hydrobrom. dil. in 3 i doses makes with sugar-water a good lemonade, or with Sod. bicarb.( 3 ss) a pleasant efferverscing draught. Bromides reduce the amount of blood to the brain; reflex irritability of the spinal cord, and excitability of the generative organs. Lithii Bromidum (Lithium bromatum) by its anaesthetic influence through the Antispasmodics, Narcotics, etc. 25 45b. B Bromi (gtt. j.) 0.03. Kalii bromati 0.1. Aq. destill. 150.0. Syrupi simplicis 50.0. 3 ss omni hora. Croup. 46. B Acid, hydrobr. dil. 5.0. Aquae Menthae 200.0. Syr. Aurant. Cort. 50.0. | ss tertiis horis ex aqua. Dyspepsia. Vomiting of Pregnancy. 47. B Lithii Bromidi 5.0. Aq. destill. 200.0. Syr. Aurant. C. 50.0. | ss ter vel quater die. Epilepsy. Hysteria. 48a. B Pot. Bromidi 3j. Chlorali gr. v. Bihorio. Erysipelas. (if delirium.) 48b. B Kalii bromati 3.0—5.0. Chlorali 1.0—1.5. Sleepingpowder (in water). 48c. B Pot. bromati Chlorali ^ gr. v. Aq. fontanae § j. 3j every 15 minutes. (1 month.) Convidsions. 49a. B Pot. Bromidi 3 ss. Elix. Valer. amm. 3j- Spir. Vini Gallici 3" ss. Alcoholism. Acid, hydrobrom. dil. Brom. Ammonii: " Lithii: " Potassii: gtt. 15—3 i gr. 3— 30 gr. 3—15 gr. 4—40 1.0 —4.0. 0.2 —2.0. 0.2 —1.0. 0.25—2.6. afferent nerves, allays any excitement of spinal origin, like most Bromides; but as it does not affect the heart's action, like Pot. brom., it may be used for a long time without producing any apparent deleterious effects upon the circulation. It is, moreover more powerful than Potass., and as easily soluble; and may be combined with Belladonna, Cannabis, Chloral, Hyoscyamus, Opium, etc. Potassii Bromidum (Kalium bromatum) influences heart, respiration and temperature; too much used, it will cause low temperature, fatigue, slowness of speech, forgetfulness and general cachexia, etc. Aver- age dose, 0.3—1.0 bihorio vel tert horis. 1.0—3.0 bis 26 SEDATIVES: Anodynes, 49b. B Kal. bromati § ss. Extr. Cocae fl. 3 iij- Tr. Capsici 3 i. Elix. Val.amm. ad § jv. | ss every hour until re- lieved. ( Wakefulness after debauch, headache; and to allay itching.) 49c. B Pot. Bromidi Liq. Ferri Chloridi Tr. Strychnin. & Capsici 5.0 a 1.0. 2.0. 150.0. Aq. fontanae | ss quater die. Mixt potatorum. 50a. B Pot. brom. 3 iij. Extr. Cannab. fl. 3 ss. Aq. destillatae § vj. \ ss ter die. Asthma. 50b. B Pot. brom. " bicarb. 7 5.0. Extr. Gelsem. fl. 0.5. Aq. destill. 60.0. 3j ter die. Migraine. Neuralgia of Qnintus. (Especially dental nerves.) 51a. B Kalii bromati Chlorali, 1 3 ij- Morph. sulf urici, gr. jss. Aq. destillatae 3 vj. 3" ss ex aqua every 4 hours while in pain. Dysmenorrhea. ( Ovarian and membran.) 51b. B Pot. Bromidi 3 ij Sol. Morph. IT. S. 3 ij. 3 j bihorio while in pain. Abortion. Brom. Sod.: gr. 5—45 = 0.32—3.0. vel ter die. Sodii Bromidum (Natrium bromatum) is superior to the Potass., as it has none of its unpleasant effects, and moreover debilitates less the muscular sys- tem. Bromism: Idiotic expression, vacant look and stag- gering gait. Arsenic and Strychnine are recomrnended,if large doses have been employed, to prevent intoxication. In Epilepsy, Amm. brom. 0.5—1.5 ter die; children according to age; Lith. brom. gr. ij—x, well diluted. In severe cases either has to be used constantly for about 6 months. Pot. brom. 3j ter die, to be gradu- ally increased to 3 j pro. dosi until Bromism. In Per- tussis, Amm. brom. 0.1—0.4 ter die. In Hysteria, Lith. Antiperiodics, Antiseptics, etc. 27 51c. B Pot Bromidi 3ij— 3 j. Sol. Magendie gtt. ij. Syr. Acaciae 3 j. Aq. destillatae § iij. 3 ij ter die. Pertussis. (1 year) 52a. B Kalii bromati Ammon. brom. "£ 10.0. Aquae destillatae 50.0. 3 j omni hora. Delirium tremens. 52b. B Pot. Bromidi 30.0. Amm. Bromidi 7.5. Pot. Iodidi 4.0. " Bicarbon. 2.5. Inf. Colombo 180.0. 3j ter die ex aqua ante cibum et 3 j hora somni. Epilepsy. 2.0. 4.0. 53. B Kalii bromati Extr. Ergotae fl. T 3 ij. Spir. Amm. arom. Tr. Nuc. Vomic. a 3 j. Aq. Menthae ad § viij. | ss quartis horis. Haemorrhoids. 54a. *B Camphorae Ergotae G. arabici q. s. F. pilulae 50. j mane nocteque. Pollu- tions, (nocturn.) 54b. B Camphora' 3 ss. Extr. Hyoscyami vel Extr. Humuli T)\], Rad. Ipecac, gr. x. F. pilulae 20. Strangury. ij ter die. Spermatorrhoea. Camphora: gr. 2—10 = 0.13—0.65. Spiritus: gtt. 10—40 = 0.32—1.3. monobrom.: gr. 3—15 = 0.2 —1.0. brom. 0.5—2.5; in Delirium tremens and Spermatorr- hoea, 10.0 p. diem. In Cellulitis, Pot. brom. gr. xto 3j tert. horis; in Headache and Delirium of Pneumonia, 3j ter die. In Convulsions, gr. ij—v every half hour if necessary. (1 month—2 years.) Also in Enuresis, Spasm of Bladder and Rectum, Dentition and Strych- nine poisoning. Camphora allays nervousness and quiets restlessness, producing a general placidity of feeling. It is an effi- cient remedy in Strangury caused by Cantharides, and in some forms of Colic, especially of hysterical subjects. 28 SEDATIVES: Anodynes, 54c. B Camphorae Pulveris Doveri Extr. Hyoscyami ^ 3j F. pilulae 20 j mane nocteque. Dysmenorrhoea. (nervous.) 55a. B Camphorae 0.12. Amm. carbon. 0.5. Sacchari 1.2. Dentur tales doses 10. j semis horis. Cholera. Vel: B Camphor liquidae Tr. Valerianae ^ 5.0. Gtt. xx—xxx c. Sacch. 55b. B Camphorae 1.0. Mth. acetici 12.0. Tr. Opii 3.0. Gttx—xv. every 15 or 30 m. Cholera, (asphyct.) 55c. B Camphorae ^Eth. acetici 7 10.0. Tr. arom. acidae 5.0. Alcoholis 15.0. Gtt jv.—vj. Prevent ire of Cholera. 56. B Camphorae 3 ss. Sacchari 3" ss. Amygd. decort. No. 6. Contere, dein adde gradat. Aq. Menthae § viij. Pars 1-6 quartis horis. Neurcdgia. (hysteric.) Vel: B Camphorae 3.0. Chloroformii 17.0. Gtt. x ter die. Neuralgia. 57. B Ext. Cannabis Indie. Pulv. Valerianae & 3j. F. pilulae 40. j ter die. Hysteria. Cannab. Ind. Extr. fl.: git 1—4 =0.032- " Tr. gtt. 10—60 = 0.32 - -0.13. -2.0. In Congestion of Kidneys, gr. ij—v. may be given. In Dysmenorrhoea (ovarian), the Monobr. gr. v. Cannabis is in small doses stimulating to the nerves, especially the sexual; in large, hypnotic. It is some- times used in Tetanus, Acute Mania, etc., and although uncertain, it is often a very efiicaceous narcotic in Sleep- lessness, Neuralgia and other painful diseases. In Metrorrhagia and Dysmenorrhoea (ovarian and neuralgic), Tr. gtt xxv quartis horis. In Incontinence of Urine from paralysis vesicae, Extr. fl. gtt. ij bis die. Antispasmodics, Narcotics, etc. 29 58a. B Tr. Castorei 8.0. ^Etheris sulfurici 2.0. Vel: B Tr. Castorei 6.0. Spir. camphorati 4.0. Gtt. xv—xxx ter die. Hysteria. Vel: B Tr. Castorei 3 j. Tr. Camph. comp. Spr.Lavand.eomp.U § ss. 3 ss bihorio vel tertiis horis ex aqua. Hysteria. 58b. B Tr. Castorei " Valer. aeth. 1 10.0. " Opii crocat 5.0. Gtt, xv—xxx ter die. Same. Vel: B Tr. Castorei 40.0. " Valerianae 10.0. Aq. Laurocerasi 50.0. 3 ss tertiis horis. Same. Vel: B Tr. Castorei 3 j. xEtheris Laudani IT gtt x. Aquae Cinnamomi § jss. Same. Castor. Tr.: 3 ss- Cerii Oxalas: gr. 1- Chloral: gr. 10- 58c. B Tr. Castorei " Valerianae a 5.0. Spir. aetherei gtt. xv. Aq. Foeniculi 100.0. 3 ss tertiisvel quartis horis. Antispasmodic. Vel: B Tr. Castorei " Valerianae Liq. Amm. succ. T 3.0. Tr. Opii 1.0. Gtt. xv—xxv ter die. 59. B Cerii oxalici gr. v—x. Sacch. Lactis gr. ij. Dentur tales doses 6. j ter die. Cough. (Phthisis.) 60a. B Chlorali 5.0. Aq. destillatae 10.0. 3 j ex vino, cerivisiavel inf. s. lini. Liq. somniferus. 60b. B Chlorali 4.0. Glycerinae 40.0. Aq. Menthae 150.0. 3 ss ter die; Ijhorasomni. Mi.rt. anliphthisic. - 3 j = 2.0 —4.0. -5 = 0.065—0.32. -40 = 0.65 —2.6. Cerium is sometimes employed in Pertussis, 0.03 (1 year) 0.08 (7 years) once a day before breakfast. Chloral,a,s sedative:0.5—1.5 omnihoravelbihorio 0.1 —0.2 for children; as hypnotic: 2.5—5.0. For child- ren, 1—3 years: 1.0—1.5; 3—5 years: 2.0—3.0; 5—7 30 SEDATIVES: Anodynes, 60c. B Chlorali 20.0. Natri nitrosi 3.0. Tr. Stramonii 10.0. Aq. Menthae ad 120.0. 3 ii quartis horis. Asthma. 61a. B Chloroformii 10.0. Alcoholis 25.0. Tr. aromaticae 30.0. Gtt. xx—lx. Migraine. Neuralgia, etc. Vel: B Chloroformii 10.0. Tr. Valer. aeth. 20.0. Morphii acetici 0.1. Gtt. xxx ter die. Hysteria, etc. Vel: B Chloroformii 5.0. Alcoholis 40.0. Mixtis adde conquassando Syrupi simplicis 140.0. 3 ij— 1 ss pro dosi. Colic. Asthma. 5 10.0. 15.0. 75.0. 61b. Chloroformii 5.0 Tr. aromaticae 10.0 " amarae 30.0 3 j ex vino subinde. Sea-sickness, Vel: B Chloroformii Alcoholis Mixtis adde Glycerinae Turn fortiter conquassa. 62a. B Tr. Cocci Radem. 3 ss Aq. destillatae 3 iijss \ ss ter die ex aqua. Chronic NepJiritis (Painful and frequent mic turition.) 62b. B Cocci gr. x. Pot. bicarb Aq. Fontis 3 ij ter die. (1 year). 3j- Pertussis. Chloroform: gtt 6—30 = 0.16—0.78. Coccus: gr. 1-6—1-2 = 0.01—0.032. years: 3.0—4.0. In neuralgic Headache, gr. xlv. in three doses within one hour. In Tetanus, 2.0 ter die; 8.0 per diem. In Delirium tremens, 7.0. In Dysme- norrhoea (neuralgic and ovarian), 3j every 8 hours. In Enuresis nocturna, 0.5—1.5 in 2 or 3 doses half hourly in the evening. (3—10 years.) However, of the great- est value it is in Parturition, especially in case of rigid os: ±)\] in 2 doses within half an hour. Chloroform is contra-indicated in valvular lesions; and in acute febrile diseases it has to be used with care. Antiperiodics, Antiseptics, etc. 31 63. B Coniini 0.005. Alcoholis 1.0. Aq. destillatae 12.5. Gtt. xv—xxx ter die. Photophobia. 64a. B Ext Conii " HyoscyamiTgr.xv. Opii gr. jv. F. pilulae 6. Peritonitis. j nocte. (if much pain.) Vel: B Extracti Conii Pulveris Doveri ^ 3 ss. F. pilulae 12. j vel ij subinde. Same. 64b. B Extr. Conii fl. " Hyosc. fl. IT 3 ss. Sol. Chlorali (3ij) 3 ij. 3 ss at bedtime. Hypnotic. 65. B Curare gr. ^. Sacch. Lactis gr. ij. Dent. tal. dos. 6. j ter die until general pare- sis. Tetanus. Gr. ^ to be repeated in 15 min.; and after 1 hour gr. -h if necessary. Hydrophobia. 66 a." B Acidi hydrocyanici dil. m. iv. Pot. bicarb. gr. x. Aq. fontanae § ss. This dose bis die. Irritable Stomach. 66b. B Kalii cyanati 0.05, Aq. destillatae 5.0. Gtt. xv—xxx ter die. Gastralgia. Conii Extr.:gr.l—8 = 0 Coniin: gr. 1-60—1-30= 0. Curare: 1-60—1-12=0. Cyan. Pot: gr. |—£= 0. " Acid, hydroc. dil. gtt. ,065—0.5. 001—0.002; 0.003 p. diem. 001—0.005. 008—0.015. : 1—5 = 0.085—0.43. In Colic, gtt. xx at short intervals, with hot fomenta- tions. In Colica saturnina, gtt. v—xx tertiis horis. In Cholera and Congestion of Brain, 2.0—3.5; in com- mencement of Intermittens, 3 j in water to induce sleep. Conium causes muscular relaxation, and is employed in' enlargements of liver and abdominal organs. Its effects are much heightened when combined with Morphine. Cyan-traep- are of variable and consequently un- certain strength, and as they belong to the most deadly poisons, they have to be employed with the greatest 32 SEDATIVES: Anodynes, 67. 68b. B Aq. Amygd. am. c. ^ Aq. Laurocerasi Sod. Bicarb. ^ 3 ij. Tr. Hyoscyami 7 3 j- Aquae fontanae § vj. Vel Extracti fluidi gtt. xx. 3 ss vomitione urgente. Aq. Aurant. Fl. 3 ij- 68a. 3 j omni hora. Gastritis. B Aq. Laurocerasi 7.5. 68c Tr. Digitalis 5.0. _ . T . ,. n*.*. 4. a- t> 7 ■* *• B Aq. Laurocerasi 3 ss. Gtt. xx ter die. Palpitation. ^ T ■ * • , n j j • \ Liq. Amm. gtt. xvi. ^ (from valv. lesions.) Sy?. F1. Aurlntii i j. 3* Aq. Laurocerasi 2 Aq. Rosarum ad | jv. Tr. Valerianae I ss ter die' laryngitis. 69. Spir. aeth. sulf. camphora iqua. H^ Spasmus Glottidis. 3 j ter die. Migraine. camphorati IT 3 j- B Extr. Cypripedii fl 3 ss ex aqua. Hysteria. Aq. Aurant. Fl. ^. 5.0 Cyan. Aq. Laurocerasi: gtt. 5— 3 ss = 0.3 —2.0. " " Amygd. am. c.:gtt. 20— 50 = 1.2 —3.2. 01. Amygd. am. aeth.: gtt. ^— £ = 0.015—0.03. Cypriped. Extr. fl.: gtt 15— 30 = 0.5 —1.0. caution. Acidum hydrocyan. dil. contains 2 p. cent of anhydrous acid. About gtt. ij should be given at the beginning and gradually increased until its effect is obtained; and the intervals need not exceed two hours, as it is improbable that the drug exerts any influence whatever upon the system one hour after ingestion. (Scheele's medicinal acid contains 5 p. cent, of anhy- drous, therefore 2 in. of it are equal to 5 m. of the U. S. acid). Potass, cyan, is sometimes used instead of the acid, as it is less liable to undergo decomposition. Aqua Amygdal. U. S. is mostly used as a vehicle, though it should not be given in larger than 3 ij doses. Cypripediumis a very valuable nerve tonic in hysteria, and all cases of nervous irritability; and in certain diseases it is Dreferable to Opium, producing no constipation. tispas?nodies, Narcotics, etc. 33 B Extr. Dioscoreae fl. = ss " Cypripedii 11. " Helon. fl. ~ 3 ij. 3 ss— 3 j omni hora. Colic. (bilious.) 71. B Extr. Gelsem. fluidi Elix. simp]. ~ 3j. Gtt, x—xxx bihorio vel tert. horis. • Wakefulness. 72. B Extr. Grindel. rob. fl. Glycerinae" § ss. 3 j every 15 min. during fit, afterward gtt. xv—xx ter die- Asthma. 73a. B Extr.Hyosc.gr.x— 3 ss. Pulv. Liquiritiae q. s. F. pilulae 10. Peritonitis. j bis die. (if much pain.) 73b. B Tr. Hyoscyami gtt. xv. Spir. Ammon. foet. 3 ss. Aq. Amygd. am. c. 3 j. Aq. destill. q. s. ad 3 ij. 3 J ter die. Laryngismus (1 year.) stridulus. 73c. B Tr. Hyoscyami 3 ij. Vini Ipecacuanhae 3 j. Gtt. xx subinde. (3 months.) Pertussis. Dioscor. Extr. fl. gtt. 10— 30 = 0.32—1 0 Gelsemium " gtt. 3— 20 = 0.1 -065 Hyoscyamus « gtt. 5— 20 = 0 16—0 05 Tr.: gtt 20—3 j = 1.0 —4.0." Gelsemium in too strong doses produces dilatation of pupils and Ptosis; afterward difficult respiration and paralysis of tongue and muscles. In Cellulitis it may be given until dilatation of pupil or .Ptosis, and it is best to begin with small doses- Extr ,0 °a°5~?A (gtt' 'J-"J") In ^othache, Tr. gtt. x—xx (3 doses the most necessary). In Delirium tremens, gtt v bihorio vel tert. horis; besides milk until vomiting ceases Ilynsryamus may be given until dry throat and dilata- tion of pupils. Hyoscyamin, Daturin and D.iboisin are identical,and similar to Atropin (as Stram. to Belladonn.) To procure sleep in children (2 years), Tr. gtt x hora somni; in Spasm of Limbs, gtt. iij bis die; (1 month); in Strangury, git nj—vj bihorio in 3j of water. 34 SEDATIVES: Anodynes, 74. B Lactucarii 5.0. Rd. Althaeae 0.5. Mucil. Acaciae q. s. F. pilulae 50. Asthma. j hora somni. Cough. 75a. B Tr. Lobeliae " (Digitalis) Aq. Laurocerasi Spir. aetherei a 5.0. 3 ss omni hora. Asthma. 75b. B Tr. Lobeliae 15.0. Olei Anethi gtt. v. Aq. destillatae 185.0. | j tertiis horis. Asthma. 75 c. B Tr. Lobeliae 3 ij- " Hyoscyami Spir. aetherei ^ 3 iij. Tr. Digitalis 3 ss. Mixt.Camphoraead % vj. | ss pro re nata, vel durante paroxysmo. Asthma. Lactucarium: gr. 3 —12 = 0.2—0.8. Lobelia Tr. gtt. 20— 3 ij = 1.0—8.0. Lactucarium is similar to Stramonium, but milder; it is occasionally used in nervous irritation and where Opium is to be avoided. In conjunction with Cam- phora monobromata it seems to be of especial benefit in phthisical cough. Lobelia is milder than Nicotine and must be employed with caution. (Girls working at manufactures of tobacco get weakness of muscles, with or without Anaemia). Too strong doses produce Vomiting, Diarrhoea, Giddiness, Contraction of Pupils and Convulsions. Its action as emetic is too violent for its safe administration, but it may be used as enema to fulfill the indications of Tobacco. It is most employed in Asthma, Angina pec- toris, Neuralgia of heart and the dry and spasmodic cough from Hyperaesthesia of Pneumogastric: Tr. m. iij—v every 15 minutes, or gtt. xv every hour until slight nausea and relaxation. Its efficiency in these cases may be increased by giving it in conjunction with Ammon. brom. or iod. It has been recommended in habitual Constipa- tion, from atony of the muscular coat of the bowels. Antiperioctics, Antiseptics, etc. 35 76a. 77a. B Lycopodii 10.0. R Tr. Opii Extr. Viburni fl. 6.0. " " camph. 7 \ ss. Syr. Althaeae 20.0. « Valerianae 3 ij. Aq. destillatae 64.0. " Rhei aquos. 3j. 3 ij— 3 ss omni hora. ^Eth. sulf. gtt. xxx. Cramp. Tr. Aconiti gtt. xv. 76b. Dose, gtt. xx—xxv. B Lycopodii 3j. Vel: Pulv. aromat gr. x. Tr. Opii 1.0. Vanilini gr. ij. « Valer. aeth. 20.0. Boleti cervini gr. v. Vini Ipecacuanhae 3.0. D.tal.dos.6 in caps, amylac. 01. Menth. pip. 0.15. j hora somni. Aphrodisiac. Gtt xxx subinde. Cholera. Lycopodium: gr. 20—40 = 1.3 —2.6. Opium: gr. \— 1 = 0.032—0.065. " Tr.: gtt. 6—24 = 0.25 —1.0. Opium: In all painful affections, but especially use- ful in inflammation of serous membranes, as Peritonitis, Pleuritis, Meningitis, etc. To a weak and dilated heart it is a tonic; it strengthens the heart's action, increasing the arterial tension and making the pulse fuller and firmer. It has, moreover, a specific influence on the action of orbicular muscles, such as the uterus, impart- ing an increased force of contraction, strikingly in con- trast with Belladonna, Hyoscyamus and other narcotics, which relax the muscular fibre. In order to avoid large doses and,yet increase or modify the effect of Opium it is sometimes advantageous to combine it with other soothing remedies (Nos. 51, 54, 61, etc). In gastrointes- tinal disorders Opium should not be used if there be deficiency in proper secretion, as it arrests all secretions except that of skin, and in cases of Pneumonia it should not be given in full doses if there is an accumulation of mucous secretion in the bronchial tubes. As regards 36 SEDATIVES: Anodynes, 77b. B Tr. Opii gtt. lx. Acidi nitr. dil. gtt. jv. Spir. nitrico-seth. 3 j- Mixt. Camphorae 3 jv § ss post sing. sed. liquidas. Diarrhfua. 77c. B Tr. Opii gtt. x. Acid. nitr. dil. gtt. j. Mixt. Camphorae § j. Aq. destillatae § ij. 3 ij postsing.sedesliquidas. (3 years.) Cholera Infant. 77d. B Tr. Opii 0.5. Spir. nitrico-seth. 2.0. Aq. Fl. Aurantii 100.0. 3 ss bihorio. After pains. lie. B Tr. Opii gtt. xv—xx. Spiritus Carvi 3 ss. Aq. Menthae 3 j. During ft. vel Morph. gr. £—4- on tongue; to be repeat-d in | h. or 1 h. if necessary. Gastralgia. Morphina: gr. ^—£ = 0.008—0.015. 0.2 p. diem; 0.0005—0.003 for children. Bright's Disease, there is no fear of Opium being dan- gerous, on account of the blood being surcharged with urea; on the contrary, it will fender the nervous system more tolerant of the uraemic poison. Children of less than 2 years should never have Opium, but if indicated Morphium is to be preferred. The latter affects the bowels and head less than Opium; neither does it inter- fere with the secretions of the mucous membrane, nor is it diaphoretic; but it affects more the contractility of the bladder. In using large doses of Opium, pupil, breathing and its soporific effect should be watched: somnolence should never become so great that the patient could not easily be aroused; and respiration should not be reduced below 12p. min. (Morph. gr. j in 2 injections within 2 hours has produced deep narcotism; on the other hand, Opium gr. xxjv in Dysentery have been given with good result within 24 hours.) In spurious Insolation (if only faintness, pale skin, pulse weak and pupils dilated, etc.), it may be of ser- Antispasmodics, Narcotics, etc. 37 78a. 79a. B Tr. Opii camph. 3 ss. B Pulv. Doveri gr. v. Aq. Amygd. am. c. " aromat gr. ij. Extr. Liquir. fl. 7 3 ij- This dose every 6 or 8 hrs. " Bell. fl. gtt. viij. if necessary. Aq. foeniculi ad § vj. vel Morph. gr. 1-8—1-6. 3 ss tertiis horis. Cough. Diarrhoea. 78b. 79b. B Tr. Opii camph. 3 j- B Pulv- Doveri gr. x. Extr. Bell. fl. gtt j. vel Morph. sulf. gr. \. « Ipecac, fl. gtt. jv. vel Codein. gr. |. " Glycyrrhiznefl. 3 j. Hora somni with toddy and Aquas Anisi ad | ij. a hot pediluvium. 3 j bihorio. Cough. Bronchitis. (4 months.) (abortive.) Opii Tr. camph.: gtt. 20—3 j— = 1-0 —4.0. Codeina: gr. i— 1| = 0.015—0.1. vice: Tr. Opii gtt x, with brandy § ss. (In true Inso- lation it would be dangerous; see part II.) In Cerebrospinal Meningitis, Opium gr. j every hour or two. In Cellulitis and Endometritis, gr. j tert horis, avoiding narcotism. In Enteritis, Tr. gtt. xv—xx with turpentine stupes. In Convulsions from exhaustion, gtt. i with v of brandy to infants of less than 1 year. In Trismus nascentium, gtt. j omni hora. In Vomiting and Nausea of Pregnancy, Sol. Magendie gtt. ij—nj ex aqua. In Peritonitis (general or pelvic), Morph. gr. £—* bihorio. In Asiatic Cholera, gr. j on tongue, to be re- peated in half hour until dejections cease. Here, as well as in sporadic Cholera, Morph. may be given again at once if rejected; but if again rejected, Opium may be tried in enema, and if this be once or twice quickly returned, then hypodermically. Either remedy should not be repeated before half an hour, as a shorter inter- val might produce narcotism. In Diabetes mellitus, Codein gr. £ ter die, to be increased gradually to gr. 13. 38 SEDATIVES: Anodynes, 80a. -,80c. B Morph. acetici 0.1. B Morphin. Acetatis 0.25. Glycerinae 20.0. Aceti puri 5.0. Aq. Cinnamon. 100.0. Aq. destillatae 30.0. Aq. destill. 180.0. Gtt. x hora somni. 3 ss tert. vel quartis horis. Hypochondriasis. 80b. 81. I£ Morph. sulfur, gr. j. B Aceti Rutae (§ j) Oj. Atrop. sulfur, gr.-£. 3 j ter die. Chorea. Cerii oxalici 82. Sacch. Lactis T 3 ss. B Tr. Valerianae 30.0. Divide in part aequal No. 16. Spiritus aetherei 4.0. jquaterdie. Gastric Ulcer. Gtt. xx—lx subinde. Colic. Ruta, Extr. fl. gtt. 20 - -40 = 0.65- - 1.0. Valer a a gtt. 15- -3j== 1.0 - - 4.0. a Tr.: 3j- - |ss= 4.0 - -16.0. Tr. Opii git. 20 =gr. j; 2r. Opii ceimph. 3 ss = gr. j. Sol. Morph. U. S. § j =gr. j; Magendie, 3 ss = gr. j. Syr. Morph.: Morph. acet. 0.1, Acid. acet. dil. gtt.v. Syr. spl. 200.0. ( 3 j =0.002 pro dosi). Pulv. Ipecac comp.: Pot. sulf. gr. viij. Ipecac, and Opium, 7 gr. j. Chlorodyne: Morph. sulf. gr. jv, Extr Cannab. gr. viij. Chloroform, 3 j, 01. Menthae pip. gtt. jv. Tr. Capsic. gtt. ij, Alcoh. et Glycerin, ad | j. Dose, gtt. 20; forchildren, gtt. 3—8, according to age. Ruta has a decided influence on the uterus and is used in Amenorrhoea as well as in Uterine Hemorrhage; in the latter, when it is dependent on an atonic state of the organ. It may be given gr. 15— 3 ss. ter die in infusion. It is sometimes very effective in Colic, especially of hysterical subjects. Valeriana'^ as Antispasmodic one of the most popular remedies in Germany. Especially valuable in Hysteria and some cases of Hypochondriasis (Nos. 41, 58, 77). Antispasmodics, Narcotics, etc. 39 83 B Vanilini 0.05^- -0.15. Bis vel ter die. Antispasmodic, 84a. B Veratrini 0.05. Alcoholis 2.0. Syr. simplicis 50.0. Aq, Fontis 120.0. 3 ss bihorio until sick feel- ing. Febrile Diseases. 84b. B Tr. Veratri viridi 1.0. Syr. simplicis 30.0. Aq. fontanae 100.0. | ss every 15 or 30 minutes. (Children 3 j.) Cholera. 84c. B Tr. Veratri vir. gtt x, Syr. Scillae comp. 3 ij. " tolutani ad § ij. 3 j tertiis horis. (4 years.) Bronchitis. 85. B Extr. Viburn. prunif. fl. Extr. Helon. fl. T 3 ij- " Dioscor. fl. 3 j. Gtt. x—xxx ter die. Dysmenorrhoea. (neuralgic.) 86. B Extr. Xanth. spin. fl. Gtt. x—xx ter die. Hydrophobia. Vanillin: Veratrum Tr. Veratrin: Viburn. Extr. fl Xanth. Extr. fl.: gr- gtt gr- gr. |_2 =0.03—0.13 ter die. 2—12 =0.065—0.4. 1-40—1-12=0.0015—0.005 ter die. 3 88— 3jss=2 0—6.0. 2—10 =0.1—0.6 ter die. Veratrum: In febrile diseases where pulse is weak and rapid. (See Aconite.) As soon as nausea or diaphoresis begins, it has to be stopped or at least to be diminished. In puerperal convulsions hypodermically (page 110). In Abortion, Cellulitis, etc. Tr. m. j —ij bihorio with Sod. salicyl. gr. xv tert. horis. Viburnum is used in Uterine Hemorrhage, and as prophylactic in Abortion, threatening or habitual. In Dysmenorrhoea (without mechanical obstruction), Extr. Viburn. comp. fl. 0.5—1.0 ter vel quater die. In Cramps of legs or feet, Tr. gtt. x ter die. Xanthium (No. 86 )has to be used at least for a month, though its efficiency is more than doubtful. For child- ren is the dose 0.3. SECTION III. CORRECTIVES AND ELIMINATIVES. Under this head are counted Acids, Antacids, Ex- pectorants, Diaphoretics, Diuretics, and all those medicines which correct and improve digestion by sup- plying the system with the required material; or which eliminate various substances from the body by increas- ing the activity of the secretory glands at fault. Acidum citricum: Refrigerant, Antiscorbutic. Acidum hydrochlor. D.:Antalkaline,Antiphosphatic, Alterative. Acidum nitricum dil: Antilithic, Alterative. Acidum nitro-muriaticum d.: Antilithic, Antiphos- phatic, Antisyphilitic. Ammonium: Antacid, Diaphoretic, Diuretic, Expec- torant, Stimulant. Apomorphina: Expectorant, Emetic. Benzixum: Vermifuge. Benzoin: Expectorant, Antispasmodic. Bismuthum: Antacid, Antiseptic, Stimulant. Blatta: Diuretic. Buchu: Diuretic, Stimulant, Tonic. Cantiiaris: Diuretic, Stimulant. Carbo: Antacid, Absorbent. Cimicifuga: Diaphoretic, Diuretic, Anodyne. Colchk um: Diuretic, Antiarthritic, Sedative. 40 Correctives and Eliminatives. 41 Copaiva: Diuretic, Stimulant, Cathartic. Creta: Antacid. Digitalis: Diuretic, Tonic. Jaborandi: Diaphoretic, Sialogogue. Lithium: Antacid, Diuretic. Magnesia: Antacid. Opium: Narcotic. (See section n.) Pareira: Diuretic, Astringent, Tonic, Sedative. Potassium et Sodium: Antacid, Diuretic, Refriger- ant. Sanguinaria: Expectorant, Alterative, Refrigerant, Emmenagogue, Emetic. Scilla: Diuretic, Expectorant, Stimulant. Toxicodendron: Diaphoretic, Diuretic, Stimulant. 42 CORRECTIVES and ELIMINATIVES: 87. 89. B Acidi citrici 5.0. B Acidi nitr. d. 3 jss. Glycerinae 100.0. Tr. Card. comp. 3 ij. Aquae Fontis ad 1000.0. Aq. Fl. Aurant. 3 j. During the day. Potus Syr. simplicis ad . § vj. Diabeticorum. 3 ij omni hora vel bihorio. 88. (2 years.) Pertussis. B Acid, hydrochlor. d. 3 j. 90a. Glycerinae 3 j. B Acidi nitro-mur. dil. Aq. fontanae ad | viij. Spir. nitrico-aeth. ^ 3 ij. 3" ss bihorio and as gargle. Aq. fontanae ad § viij. (4—7 years.) Scarlatina. § ss ter die. Oxaluria. Acid, citricum: gr. 10—30 = 0.65—2.0. " hydrochl. d.: gtt. 5—30 = 0.35—2.15 " nitr. dil.: gtt. 2—20 = 0.15—1.5. " nitro-mur. d.: gtt. 2—20 = 0.14—1.4. Vegetable Acids form, properly diluted, refreshing drinks in febrile diseases. Acid. citr. is more used than Acid. acet. because the latter produces often Colic or Diarrhoea; however in Typhus, Scarlatina, etc., vinegar is preferable. Acid. tart, is a good substitute to citric acid, on account of its being cheaper. Acid. citr. 3j to sugarwater Oj is a refreshing lemonade. Succus Citri et Aqua, iT will often afford relief in Vomiting of Preg- nancy. Acidum aceticvm dilutum (Vinegar), 1:7 Aqua. Mineral. Acids, when properly diluted, allay not only thirst, but increase also the appetite. They correct moreover the morbid alkalinity of the blood in Typhoid and other essential fevers; and in Dyspepsia, when de- pendent on a deficiency of the gastric fluid, they are of great benefit, especially when combined with vegetable tonics. See section v. In Kater (Alcoholism): Acid. mur. d. gtt. viij—x e cyatho aquae. In Diarrhoea: Acid. nitr. d. gtt. j—ij ex aqua (it acts sometimes like a charm.) See part II. In Oxaluria: Acid, nitrohydro- Acids, Antacids, Expectorants, etc. 43 90b. B Acid, nitro-mur. d. 3 jss. Extr. Pareirae fl. 3 ss. Aq. fontanae ad 3" vj. 3 ss ter die p. cibum ex aqua. Phosphates. 91. B Acidi phosph. dil. Tr. Card. comp. ^ | j. Inf. Colombo 3 jv. 3 j ter die p. cibum. Same. 92a. B Liq. Amm. acet. 3 ij. Spir. nitrico-aeth. § ss. Mixt. Camph. ad 3" viij. P. -% quartis horis. Dropsy. 92b. B Liq.Am. Acet. 3 j— 3 jv. Spir. nitr. aeth. 3 j— 3 iij Tr. Aconiti gtt. j—iij. Bihorio (if pulse full and bounding.) Erysijielas. 92c. B Liq. Amm. acet. § jv. Tart, emetici gr. j. 3 ij every half hour with water until eruption re- appears. Con vulsions. (in Scarlatina, etc.) 93a. B Ammon. carbonici Extr. Colombo fl. T 3 ss. Tr. Cardam. comp. 3 ij. Aquae Fontis § vj. | j bis die. Flatulency. (in gouty habits.) 93b. B Ammon. Carbonatis 3 j. Extr. Senegae fl. 3 ij. " Scillae fl. 3 j. vel Tr. Scillae § ss. Syr. tolutani 3" j. Aq. fontanae ad § viij. | ss ter die. Cough. Acid, phosph. d. gtt. 10—60 = 0.65— 4.0. Ammon. Acet. Liq.: 3 ss— f ss = 2.0 —16.0. " Carbonas: gr. 3—10 = 0.2 — 0.65 chlor. dil. gtt. x—xv ex aqua on empty stomach, espec- ially if taste foul or insipid. Ammonii Acet as (Ammonum aceticum) is in small doses refrigerant, and in large ones diaphoretic and diuretic. It is readily prepared ex tempore by neutral- izing Acidum aceticum dilutum (m. xxvij: 3" j) with Ammon. carb. (gr. xxiv.) In Dropsy, § ss ter die ex aqua. In Congestive Dys- menorrhaea, 3 ij ter die ex aqua. In Convulsions from suppressed eruption of Scarlatina, to a child of 3 years, 3 j ex aqua every 10 minutes after a mustard bath. 44 CORRECTIVES and ELIMINATIVES: 94a. B Ammon. Chloridi Extr. Eucalypti fl. " Glycyrrh. fl.a 3ij- Tr. Opii camph. § ss. Aq. Fontis ad § viij. § ss tert horis. Phthisis. Vel: B Ammon. muriatici Succi LiquiritiaelT 5.0. (Tart emet 0.05.) Aq. fontanae ad 200.0. | ss bihorio. Catarrh. 94b. B Ammon. Chloridi. Potass. Iodidi ^ 3 j. Succi Glycyrrhizae 3 ij. Aq. Foeniculi § vj. | ss ter die. Emphysem. 94c. B Ammon. chlorati 1.5. " picrin. 0.06. Succi Liquiritiae 4.0. Aq. fontanae 100.0. 3 ij omni hora. Pertussis. (I—2 years; 3j, 6 months or less.) 94d. B Ammon. chlorati 3 ij. Extr. Xanthii fl. 3j. Aq. Melissae § viij. 3 j ter die. Hydrophobia. 95. B Tr. Apium mellif. 3 ss. " Pulsatilla? 3 ij. Elix. simplicis ad 3 jv. 3 j ter die. Masturbation. (nocturnal emissions.) Ammon. Chloridum: " Liquor: " Spir. arom.: " Picras: gr. 3—15 = 0.2 —1.0. gtt. 5—30 = 0.32 —2.0. gtt. 15— 3 j = 1-0 —4.0. gr. £__1 ' = 0.015—0.065. Aqua Ammonite. Aside from being used in acidity and flatulence, it is the physiological antidote to Alcohol, and a very good stimulant for speedily arousing the vascular and respiratory system; therefore, its employ- ment in Syncope, low forms of fever, etc. It is best given as Spir. Ammon. arom.; yet as antacid, stimulant and stomachic, Ammonii Carbonas is generally pre- ferred, (p. 73.) Ammonii Chloridum is not admissible if there be much inflammation. In Kater (Alcoholism): Aqua Ammoniae gtt x—xxx e cyatho aquar, in Diabetes: Ammon. chlor. 1.25 quartis horis; in Intermittens: 3 j of the same during intermis- sion; in Facial and Dental Neuralgia: gr. x—3j bihorio. Acids, Antacids, Expectorants, etc. 45 96a. B Apomorph. hydrochlor. 0.01—0.03. Acid, hydrochl. d.gtt. v. Syr. simplicis 50.0. Aq. Fontis 100.0. 3 ss bihorio. Asthma. (pituitosa.) 96b. B Apomorphini gr. j. Acid, hydrochl.d. gtt.jv. Syrupi simplicis § j. Aq. Melissae § iij. 3 j omni hora. Cough. 3 years, ( 3 ij: 7 years). 97. B Benzin. lithanthr. 5.0. Olei Carvi 1.0. Spiritus aetherei 10.0. Gtt. xx—xxx ter die post cibum. Flatulency. 98. B Acidi benzoici 2.0. (Sod. bicarb. 5.0.) Sod. phosph. 10.0. (Tr. Hyoscyam. 10.0.) Aq. Cinnamomi 200.0. § sster die. Lithiasis. 98b. B Natri benzoici 2.5. " silicici 1.2. Extr. Aconiti 0.2. " Colchici 0.6. Saponis medicati 0.5. F. pilulae 20. Chronic ij—jv ter die. Cystitis. 98c. B Magn. Benzoatis 7.5. Glycerini 20.0. Syr. simplicis 00.0. Aq. destillatae 100.0. | ss bihorio vel tertiis horis. Gravel. Apomorphin gr. 1-30—1-8 = 0.002—0.008. Benzoin. Acid.: gr. 8—30 = 0.5 —2.0. Apomorphin is a prompt emetic and mostly used hypodermically, especially in narcotic poisoning, (p.3*.) As expectorant it may be given 0.001—0.003 tert. horis. Benzoin resembles in its effects Myrrh. Acidum benzoicum abstracts in its passage through the system nitrogen from the elements of urea, being changed into hippuric acid, hence its use in uraemic poisoning. Sodii Benzoas is more easily soluble and tastes less sharp: 13.3 = 10.0 Acid. The effect of the Soda on the blood is greater than that of Acid, salicyl., and it is the best dialytic by inclination to Lithiasis. Natrum benzoicum 46 CORRECTIVES and ELIMINATIVES: 99a. B Bismuthi nitrici pr. Calcar carbon. ^"5.0. Opii 0.25. Divide in partes 10. j bis die ante cibum. Chronic Diarrhoea. Vel: B Bism. subnitric'i Cretae praepar. "^ gr. v. Morph sulfuric! gr. 1-6. Dentur tales doses 6. j tertiis horis. Diarrhoea. (in Erysipelas^) 99b. B Bism. Subnitratis 3j. Sod. Bicarb, gr. v. Morphime gr. 16. Dentur tales doses 6. j tertiis horis. Dysentery. 99c. B Bismuthi Subnitr. 3j. Pulv. aromat. gr. v. D. tal.dos. 6 in caps, amylac. j post cibum. Pyrosis. 99d. B Bism. subnitrici Natri bicarb. T gr. xv. Tr. Opii camph. 3 ij. Syr. simplicis 3 j. Aquae fontanae § ij. 3 j tertiis horis. Diarrluea. (3 months). Vel: B Bism. subnitr. gr. x. Hydr. c. Creta gr. iij. Opii gr. ss. Sacchari 3j. Divide in partes 10. j tertiis horis. (3-months.) Bism. Subcarb.: Subnitras. gr- gr' 5_30 = 0.32—2.0. 5—30 = 0.32—2.0. and lemonade are quite sufficient to render alkaline urine of normal reaction. In Red Gravel, Acid, benzoic, gr. v—x ter die. In Phosphates, Gout, Albuminuria, Incontinence of Urine, Laryngitis (chron. with hoarseness) etc., No. 98a, or Sodii Benzoas, 0.1—1.0 quater die e cyatho aquae—the water to assist its dissolving property. In Diphtheria, | ss— 3 vj in 24 hours. In Tuberculosis, Magn. ben- zoic. 0.15—1.0 bihorio vel quartis horis is curative (?). Bism. iiitricumpr. is very valuable in that form of Dyspepsia where the formation of sulfurated hydrogen is a prominent symptom. In many cases the efficiency of Bism. Praep. is materially increased by combining them with Napthol, Salicin and other antiseptic agents. See p. 15 et sequelae. Acids, Antacids, Expectorants, etc. 47 100. B Blattae orientalis Sacch. Lact. 7 °-2—°-6- Dentur tales doses 6. j ter die. Dropsy. 101. B Inf. Fol. Buchu § viij. (ex 3 ij.) Daily in divided doses for about a week. Incontinence of Urine. 102. B Cantharid. pulv. Scillae Radicis Mass. Hydrarg. 7 gr. xij. Folior. Digitalis gr. ij. F. pilulae 12. j bis die. Albuminuria. 103. B Carbonis vegetab. 3 j. Pulv. aromat gr. x. Divide in partes 6. j post cibum. Flatulency. 104. B Extr. Cimicif. fl. 3j- Aq. Menthae § jss. 3 j ter die. Chorea. 105a. B Vini Colchici 12.0. Tr. Opii 2.0. Gtt. xx ter die. Gleet. 105b. B Vini Colchici 18.0. Tr. Opii crocat 2.0. Gtt. xx—lx tert. vel quartis. horis. Asthma. Buchu Extr. fl.: 3 ss— 3 j Cantharides: gr. 1-6—I " Tr. gtt. 4—15 CarboLigni.: gr. 10—40 Cimicifuga, Extr. fl.: gtt. 15— 3 ss ColchicumVinum S. gtt. 15— 3 j 2.0 —4.0. 0.01—0.065. 0.13—0.5. 0.65—2.6. 1.0 —2.0. 1.0 —4.0. Buchu (Diosma crenulata), or Uva Ursi, as infusion, to be taken ad libitum, or Extr. fl. 3 j ter die, is more or less valuable in all affections of the genito-urinary tract. Cantharis (p. 75) is mostly used in diseases of the urino genital apparatus, upon which it has a powerful influence. At the appearance of strangury or priapism, which latter is sometimes very painful and obstinate, it must be discontinued and Camphor given, (p. 5.) In Albuminuria, to remove the congestion of the kid- neys; in Retention of Menses, Tr. Cantharidum gtt. x ter die; in Incontinence of Urine from paralysis of neck of bladder, the same dose in linseed tea. 48 CORRECTIVES and ELIM1NATIVES. 105c. B Tr. Colchici Sem. " Guayaci Gtt. xxx—xl ter die. Vel: B Tr. Colchici S. " Aconiti " Digitalis Vinialbi q. s. ad 1000.0. 8 c. c. bis die. Rheumatism. 105d. B Tr. Colchici S. 3 ij. Kalii iodati 3 ss. Aq. destillatae § iij. \ ss ter die. Neuralgia. 10.0, 25.0. 10.0. 5.0. 106a. B Copaivae 3 iij- Mucil. Acaciae § j. Tr. Ferri chlor. 3 ij. Aq. Fontis ad 3 viij. § ss— | j ter die post cibum. Gonorrhoea. Vel: B Copaivae 50.0. Alcoholis 10.0. 01. Menth. pip. 0.5. Gtt. xl—1 quater die ex aqua saccharata. Gonorrheea. (if chronic.) Colchic. Extr. fl.: gtt " Tr.: gtt. Copaiva: gtt. 5—20 = 0.2—0.65. 15— 3 j= 0.5—4.0. 15_3j= 1.0—4.0. Colchicum is by no means a true diuretic—its action on the kidneys being no greater than it is on the skin, liver and mucous membrane; but it has a decided anti- arthritic influence, not only on account of its diminishing the uric acid in the urine, but also probably arresting fermentation of this acid in the blood. Its effect should be watched as it produces in too strong doses Gastritis, bloody stools, etc., with great nervous excitement. (See p. 5.) It is generally administered till an effect is pro- duced on the bowels, unless it is desirable to act more on the skin, when it must be combined with Opium. Copaiva acts analogous to the Terebinthinates, stimu- lating the secretions from the mucous membrane. It is almost exclusively used in Gonorrhoea and will act here under proper directions to a certainty. Though of benefit in painful hemorrhoidal affections and the chronic form of Bronchitis, Diarrhoea and Dysentry, it is seldom Acids, Antacids, Expectorants, etc. 49 106b. B Copaivae 3 ij—3 iij. Liq. Potassae § ss. Tr. Aloes comp. 3 ij. Aquae fontanae ad § viij. 3 j ter die post cibum. Gonorrhoea. Vel: B Copaivae 3 ij— 3 iij. Pepsin, in frust. 3 ss. Aq. Fontis ad § viij. | j ter die post cibum. 106c. B Copaivae 30.0. Chloroformii 3.0. Tr. Ferr. acet. aeth. 10.0. Gtt. xl—1 ter die. Vel: B Copaivae 25.0. Tr. arom. acidae 5.0. Gtt. xv—xx quater die. Vel: B Copaivae 01. Terebinth. 7 3 ij. Gtt xx quater die. Cystitis. 107. B Cretae praep. gr. xij. Calomelanos gr. vj. Opii gr. j. Divide in partes 12. j bis die. Dysentery. (6 months.) Vel: B Pulv. Cretae comp. gr. ij. " Cretae comp. cum Opio gr. j. After each stool, or every hour. (1 year.) (3 years: double the dose— 5 years: treble—10 years: treble every half hour.) Diarrhoea. Creta Mixt.: " Pulv. CO. 1 ss— 1 j = 16.0—32.0. . 15_ 3 j = 1.0— 4.0. employed on account of its horrible taste. Liquor Potassae and Pepsin emulsify it; but if combined with vegetable or mineral styptics, Acacia must be used for that purpose. Combined with 01. terebinthinae (in Cystitis) it makes the alkaline urine soon sour. The best way of taking Copaiva is to swallow two or three capsules before a meal, or at bedtime, and to take the other ingredients of the mixture separately. Pidv. Cretce comp.: Creta, li; Acacia, 1; Sacchar. p. 2\. Pulv. Cretce comp. c. Opio: 3ij = gr. j. Mixt. Cretce: Pulv. Cretae comp. 3j; Aq. Fontis § j. In Vomiting of Pregnancy: Aq. Calcis cum Lacte. 50 CORRECTIVES and ELIMINA TIVES: 108a. B Tr. Digitalis Vini Colch. Sem. 7 3 ij. Kali nitrici 3 j. Roob Juniperi § j. Aq. Fontis ad § viij. 3 j bihorio. Dropsy. Vel: B Tr. Digitalis 3 ij. " Scillae Syr. Aurant. C. 7 | j- Mixt. Camph. ad § v iij. | ss ter die. Vel: B Tr. Digitalis § ss. " Apocyni § j. Aquae Fontis ad § viij. | j quater die. 108b. B Tr. Digitalis Vini Colchici S. 7 10.0. Spir. muriatico-aeth. 2.0. Gtt. xx quartis horis. Hydrothorax. 109. B Inf. Folior. Jaborandi (ex 10.0) 200.0. Pars semis at once; of the rest | ss hourly with as much wine. Poisoning by Atropin. 110a. B Lith. benzo-salicyl. 3 jss. Extr. Hydrang. fl. § ij. Aq. fontanae § vj. 3 i j ter die. Hematuria. 1 diem. Digitalis: gr. £— 2 =0.032—0.13;i-°Pf " Extr. fl. gtt. 5—40=0.18—1.3. " Tr.: gtt. 10—80 =0.32 —2.6. JaborandiExtr.fi.: gtt. 15—3j=l-0 —4.0. Pilocarpin: gr. 1-30— £=0.002—0.02. Digitalis (p. 78), slows the pulse and is occasionally valuable in Spasmodic Neuralgia, Genital Irritation and Insanity. The tincture may be given in 3 ss doses in delirium of Typhoid. Jabr>randi usually produces after 10 minutes adminis- tration profuse ptyalism, nausea and diaphoresis. Its antidotal power (No. 109) is based upon the fact that it slows the heart's action by stimulating the same ner- vous apparatus which is paralyzedbyBelladonna,namely, the intra-cranial inhibitory apparatus. Pilocarpin some- times causes headache, vomiting, singultus, dysuria, cold extremities and collapse. Duboisin, Atropin and Daturin are the antidotes; secretions of skin and contraction of Acids, Antacids, Expectorants, etc. 51 110b. B Lith. benzo-salicyl. 3 jss. Extr. Gelsem. fl. gtt. x. ;' Hyoscyami fl. 3 ij- " Hydrangeae fl. § ij. (Pot. brom. § ss.) Ilia. B Magn. carbon. % ss. Spir.Lavand. comp. 3 jss. Olei Carvi gtt. vj. Aq. fontanae § jv. | j subinde. Diarrhoea. Aq.Fontis ad § viij. 111b. 3 ss quartis horis ex aqua. B Magnes. carbon. § ss. Cystitis. Extr. Rhei. fluidi 110c. Spir. Amm. arom.7 3 ij. B Lithii citrici 4.0. Aq. Foeniculi ad 3" jv. Glycerini 30.0. | j bis vel ter die. Diarrhoea. 4 c. c. bis die. Gout. 112a. Vel: B Magn. ustae 10.0. B Lithii Citratis 3 j. Aq. fontanae 100.0. (Tr. Colchic. S. 3j.) Glycerini 40.0. Aquae fontanae |vj. 16 c. c. every 15—30 min. § ss bis vel ter die ex aqua. Poisoning by acids, etc. Lithii Carb.: gr. 2 — 8 = 0.13—0.5. " Citras: gr. 2 _ 8 = 0.13—0.5. Magn. carb.: gr. 15 — 3 ij = 1.0 —8.0. " usta: gr. 15 — 3j =1.0 —4.0. pupils are stopped at once (see Hyoscyamus, p. 33). Pilocarpin is advantageously used in Uraemia of Ty- phoid, if hydragogues are contra-indicated by abdom- inal symptoms; but it should not be employed in heart and lung diseases; nor in hydrops of pregnants. In Ascites: Extr. Jaborandi fl. 3 j hora somni. In Neuralgia, Nervi Quinti, 3 ss—3 j before the expected return of the fit. In Uraemia of Typhoid and Perni- cious Intermittens, Pilocarpin hydrochlor. gr. \. Lithium: The salts of Lithium are double the strength of those of Potassium. As Litholyticum: Lithium ben- zoicum 0.1 —0.2 tertiis horis; Lith. carbonicum 0.2—0.5 ter die (1.5 per diem). 52 CORRECTIVES and ELIMINATIVES: 112b. B Magn. ustae gr. vj. Aquae Fontis § jss. 3 j ter die. Stomatitis. (8 months.) 113a. B Tr. Opii camph. § ss. Extr. Scillae fl. 3 j. Mucil. Acaciae § ij. Syr. Pruni Virg. § j. Aq. fontanae ad § vj. | ss subinde. Bronchitis. 113b. B Tr. Opii camph. 3 ij. (Amnion, chlor. ±)].) Extr. Bellad. fl. gtt ij. " Ipecac, fl. gtt jv. Aq. Laurocerasi 3 j. " Anisi ad .3 jv. 3 ij tertiis horis. (3 years.) 114. B Extr. Pareirae fl. § j. Spir. Junip. comp. § ij. Acidi benzoici 3 j. Morphii sulfurici gr. j. 3 j ter die. Irritable Bladder. 115. B Picis liquid, pulv. 20.0. Vini Hispanici 1000.0. Sepone interdum agitando per diem, turn filtra. 3 j pro dosi. Chronic Bronchitis. 116. B Tr.Pimpin^llae 20.0. Syr. Morphini Aq. Melissae 7 100.0. 3 ij tertiis vel quartis horis. Hoarseness. Pareira Extr. fl.: 3 PimpinellaTr. gtt ss— 3 j = 2.0—4.0. 20—3 j = 1.0—4.0. Lithii Citras 10.0 = Acid. citr. 9.6 and Lith. carb. 5.3. The average dose is from 0.5—-1.0 ter die. Both the Carbonate and Citrate are very valuable in Gout, from the fact of their low combining power, and the great solubility of the Urate of Lithium, thus enabling them to eliminate easier the uric acid from the system. They are best given Jargely diluted, and the Carbonate in Carbonic acid water. Magnesia is a favorite laxative for infants—its com- bination with Rhubarb is known in Germany as Infant's powder par excellence. See section vi. Pareira is an excellent remedy in chronic diseases of the urinary passages, particularly chronic Inflammation of the Bladder; it is also slightly aperient Pix liquida pulv.=P\x liquida p. 1; Carbo Lignip. ij. Acids, Antacids, Expectorants, etc. 53 117a. B Pot. Acetatis § ss. Tr. Rhei 3 x. Vini stibiati 3 ij. Gtt. v—x ter die. (To in- crease to 30.) Rickets. 117b. B Kali acetici 5.0. Oxym. Scillae Syr. simplicis 7 15.0. Aq. Petroselini 125.0. 16 c. c. bihorio. Diuretic. 118a. B Liq. Potassae Spir. nitrico-aeth. 7 3 ij - Extr. Gen.t comp. fl. 3 ss. vel Tr. Gent. comp. § ss. Aq. fontanae § vj. | j ter die. Cardialgia. 118b. B Kali carbonici 3 j. Spir. nitrico-aeth. 3 ij. Tr. Cinnam. comp. § ss. Inf.Gent.comp.ad § viij. | ssterdie. Ovar. Dropsy. 119a, B Pot. Bicarb. 3 ij- vel Liq. Potassae § ss. Extr. Hyoscyami fl 3 ss. vel Tr. Hyoscyami 3 iij- Mixt. Camphor, ad § viij. | j ter die post cibum. Red Gravel. 119b. B Kali bicarbonici 3 jss. Ammon. carbonici 3 ss. Aquae fontanae | vj. 3" j bis die. Antilithic. Potass. Acetas: " Liquor: Carb. " Bicarb.: gr. 5—30 = 0.32—2.0. gtt. 5—30 = 0.32—2.0. gr. 5—30 = 0.32—2.0. gr. 5—30 0.3 2—2.0. Potassii Acetas (Kali aceticum) like all alkaline salts containing a vegetable acid, is changed in the stomach into a carbonate, and eliminated by the kidneys, making the urine usually alkaline. In large doses a gentle cathartic, it is in small ones diuretic, increasing the flow of urine, yet diminishing both the uric acid and urea, hence it prevents more or less the formation of uric acid calculi. It is much employed in acute Rheu- matism and Dropsies; and it has also been found useful as an alterative in cutaneous affections. Salts of Potassium or Sodium used as antacids (with vegetable tonics) in Dyspepsia,accompanied with excess of acid in the primae viae, promote the digestion of fatty 54 CORRECTIVES and ELIMINATIVES: 119c. B Pot. Bicarbonat. 3 j. " Iodidi gr. xij. Aquae destillatae § vj. 3 ss bis die. Bronchitis. 119d. %, Kali bicarbonici Spir. Amm.arom.7 3j. Aq. destillatae 3 jv. 3 j ter die cum Acidi citrici gr. 15 antea in Aqua solut. Chron. Vomiting. 120a. B Sod. Bicarb. 3 iij - Spir.Lavand. comp. 3 ss. Aq. destillatae § vj. 3 ss tertiis vel quartis horis. Jaundice. Vel: ' B Natri bicarb. 3 ij- Rad. Rhei 3 ss. Cort. Cinchona" § j. F. pulvis. 3 j ter die. 120b. B Sod. Bicarbonatis 3 j- " Nitratis 3 ss. Aq. fontanae § iij. 3 j omni hora. (4 years.) Diphtheria. 120c. B Natri bicarbonici gr. x. Ferri c. Saccharo Bism. subnitr.7gr. viij. D. tal. dos. 6 in caps. amyl. j ter die post cibum. Endocarditis. Sod. Bicarb.: gr. 5—60 = 0.32—4.0. matter. Their action in Gout and acute Rheumatism depends also on the neutralization of the excess of acid with which the blood is charged. By neutralizing the acid, the alkalies relieve also the irritability of the urinary organs; hence their use in Ardo Urinre accomp- anying Gonorrhoea, Pruritus Ani, Uterine and Cutane- ous Irritation, etc. The preparations of Sodium are less irritating and less depressing than those of Potassium; and though they are inferior as antilithics, being less powerful solvents of uric acid, they are better antidys- peptics. In the treatment of Red Gravel, etc., the exhibition of the alkalies should be but sufficient to neutralize the urine; for, if it be made alkaline, the phosphate formed may be deposited around the uric acid calculi. Liquor Potassce is more irritant to the stomach than Pot. bicarb.; therefore less eligible for protracted use. Acids, Antacids, Expectorants, etc. 55 121a. 121c. B Pot. Chloratis 3 ij- B Pot Chloratis 3ij. Acid.hyd-ochlor.d. 3 ss. Tr. Ferri Chlor. 3j. Syr. simplicis § j. " Digitalis 3 ss. Aq. fontanae § v. Aq. fontanae § iij. | ss— | j quartis horis. 3 ij bihorio. Scarlatina. Bronchitis. (4 years.) 121b. 122a. B Kali chlorici 10.0 B Kali. nitr. 3ij—3j. " nitrici 5.0 Tr. Aconiti gtt. iv. Extr. Hyoscyami 1.0 vel Tart, emetic, gr.ij. Syr. simplicis 30.0 Aq. Melissae § jv. Aq. Fontis q. s. ad 200.0" 3 ss tertiis horis. 5 ss bihorio Febr. Diseases. Pleuritis. Pot. Chlor.: gr. 5—30 = 0.32—2.0. " Citras: gr. 3—30 = 0.2 — 2.0. " Nitras: gr. 3—20 = 0.2 — 1.3. Sod. Boras: gr. 2—20 = 0.13— 1.3. " Nitras: gr. 10—40 = 0.65— 2.6. Potassii Carbonas (Kali carbonicum) is especially useful in torpor of the liver. Sodii Bicarbonas (Kali bicarbonicum) in large doses — 3 j— 3 iij p. diem—should not be used for more than ten consecutive days, to avoid superalkalinity of the blood. From 3j— 3 ijss, followed by Acid, tartaricum gr. xv—3v areused as a diagnostic test in dilatation of the stomach. Borax, which is also a mild refrigerant, is chiefly used for its emmenagogue properties. Potassii Citras (Kali citricum) is an excellent refri- gerant, and generally given as Potio lliveri: Pot. bicarb. and Acidum citricum a 1.0 separately dissolved in a little water. To be mixed and taken with sugar water as an effervescing draught. (In Vomiting of Pregnancy.) In defective Menstruation: Borax, 0.5—1.5. In Dia- betes Mellitus: Sod. bicarb. 3jper diem,to be increased to 3 iij daily for about a week in each month. In artic. 56 CORRECTIVES and ELIMINATIVES: 2.5. 5.0. 8.0. 155.0. 122b. B Kali nitrici " bicarb. 7 3 j- Aq. Amygd. am. c. 3 ij. Aq. fontanae § vj. | ss tertiis horis. Bronchitis. 122c. B Pot. Nitratis Sod. Nitratis Succi Liquiritiae Aq. Foeniculi 3 ij omni hora. 7—9 years. ( 3 j bihorio 1—3 years.) Febrile Diseases. 122d. B Pot. Nitratis Aq. Laurocerasi 7 7.5. (Extr. Hyoscyami 0.4.) Syr. Papaveris 30.0. Aq.Fontis q. s. ad 250.0. | ss omni hora vel bihorio. Gonorrhoea. 122e. B Potass. Nitratis Succi Glycyrrhiz. 7 7.5. Extr. Hyoscyami 1.0. Liq. Amm. anisati 15.0. Aq. fontanae ad 250.0. 16c.c. bihorio vel tertiis horis. Bronchitis. Vel: B Kali nitrici Kalii iodati 7 3 j- Extr. Senegae fl. 3 ij- Syr. tolutani 3 j. Aq. Anisi ad § vj. | ss ter die. Emphysem. 123a. B Kali nitrici 3 ss. Tr. Digitalis gtt. xx. Aq. fontanae 3 iij. 3 j tertiis vel quartis horis. Abortion. (If feverish and plethoric.) Rheumatism (acute), Sod. vel Potass, bicarb. 3 j— 3 ij bihorio vel tertiis horis until urine alkaline. Potassii Chloras (Kali chloricum) 0.5 as dose. See Iodine, section 1. 4 0—8.0 p. diem for adults. 2.0 p. diem: (3 years;) 1.25 infants; in Stomatitis: Oj) § iij 3ijbisvelterdie. (8 months); in Scarlatina: 3j to Oj of water as drink during the day. (4 years.) Potassii Nitras (Kali nitricum) is a valuable refriger- ant and sedative in fevers; in doses of gr. x— 3 ss it is diaphoretic and diuretic. See Salicin p. 17. In doses of 10.O__20.0 it may cause death. Sodii Nitras (Natrum nitricum) is milder, and much used as drink, especially in Dysentery: § ss— % j per diem in a mucilaginous vehicle. Sodii Nitris (Natrum nitrosum—No. 60c.) is seldom employed as a remedial agent. Acids, Antacids, Expectorants, etc. 57 123b. B Potassii Nitratis Tr. Digitalis 7 3 j. Aq. Melissae § jv. 3 ss tertiis horis. Pleuritis. (if effusion.) 123c. B Pot. Nitratis 3 j- Tr. Digitalis 3 ij- Aq. fontanae § vj. | ss sextis horis. Dropsy (5 years.) from Scarlatina. Vel: B Pot Nitratis 3j. Tr. Digital. 3 j. Spir. nitrico-aeth. 3 ij- Syr. simplicis § j. Aq. fontanae ad § viij. | ss bihorio vel tertiis horis. (4 years.) 124a. B Kali nitrici 3 ss. Pulv. Doveri gr. xxjv. Divide in partes 6. j quartis horis until diapho- resis. Ascites. (12 years.) (from cold.) 124b. B Kali nitrici " sulf.7 0.5—1.0. Pulvis temperans. (More than 3.0 are objectionable.) Excitement from Fright. 125a. B Natri phosphorici 50.0. " bicarbonici 5.0. Aquae Fontanae 600.0. During the day with Acid. citr. 5.0. Rheumatism. Sodii Phosph.: 3 j— i j = 4.0—32.0. In acute articular Rheumatism, Pot. nitr. gr. v quartis horis; vel Sod. Nitras 1.0—3.0 bihorio vel tert. horis. (The same dose of the latter salt in Dysentery.) In Choleralnfantum and Scrofula: Solutio Natri nitrici(l 0.0) 40.0 — 3 ij omni hora vel bihorio ex aqua. In febrile diseases of children, Sol. Kali nitrici (gr. x) | ij with Tinctura Aconiti gtt. j: 3 j bihorio; infants should have half this dose. Sodii Phosphas (Natrum phosphoricum) is mostly used on account of its laxative property. See section vi. In Gravel: 2.0—6.0 ter die; vel Sod. phosph. ammon. gr. x ter die. Sodii Chloridum (Natrium chloratum 3 j— § j during intermission is said to cut sometimes the fever in Intermittens. (See page 101.) 58 CORRECTIVES and ELIMINATIVES. 125b. B Sodii Phosphatis 10.0. Acidi benzoici 1.5. Aq. fontanae 180.0. In 5 doses during the day. Gravel. 126a. B Scillae pulv. gr. iij. Opii gr. ss. Cinnamomi gr. x. Dentur tales doses 6. j bis die. Cardiac Dropsy. 126b. B Extr. Scillae fluidi " Ipecac, fl. 7 gtt. x. « Bellad. fl. gtt. j. Aq. Laurocerasi gtt. xv. Syr. Acaciae Aq. Anisi 7 1 ]• 3 ss omni hora. Cough. (5 weeks.) 127. B Extr. Toxicod. fl. 3 j. Gtt. ij ter die. Neuralgia. Scilla: " Extr. fl.: « Tr.: Toxicod. Extr. gr. 1—3 = 0.065—0.2. gtt. 2—10 = 0.065—0.32. gtt. 10—60 = 0.32 —2.0. gtt 1—10 = 0.032—0.32. Scilla promotes, in small doses, secretions from the mucous membranes and the kidneys—its diuretic effect being much the most marked. In large doses it excites nausea and vomiting, accompanied sometimes by purg- ing; and in excessive doses it acts as acro-narcotic poison —24 gr. having proved fatal. In cardiac dropsies it is generally combined with Digitalis; and Calomel is often added with a view to its action on the absorbents. It is, however, contra-indicated in cases complicated with degeneration of the kidneys or inflammation of the bladder; nor should it be used in inflammatory bron- chial affections, though it is an excellent expectorant in chronic cases. Acetum Scillce =1:10 Acidum aceticum dilutum. Syrupus Scillae = Acetum p. ij, Sacharum p. iij. Rhus toxicodendron is sometimes used in Chronic Eczemata, Gout and Amaurosis. It is, however, little reliable, and its effects have to be closely watched. SECTION IV. ASTRINGENTS Suspend the ex- and secretions of the various organs, or restrain profluvia or hemorrhage, by producing con- traction of the muscular fibre, or by coagulating the albumen of the blood. Acidum gallicum: Astringent. Acidum sulfuricum dil.: Astringent, Refrigerant, Antiphosphatic. Acidum tannicum: Astringent. Agaeicus: Astringent. Alumen: Astringent, Antispasmodic, Antiseptic. Arge>ttum: Astringent. Capsella bursa pastoris: Astringent Catechu: Astringent, Tonic. Cinkamonum : Astringent, Aromatic, Stimulant. Coto: Astringent Creosot.: Astringent, Antiseptic, Antiscorbutic. Cuprum: Astringent, Anticonvulsive, Tonic, Emetic. Ergota: Astringent, Oxytocic. Erigeron: Astringent, Diuretic, Tonic, Stimulant. Ferrum: Astringent, Tonic. Hjemamelis: Astringent, Sedative. Kino: Astringent. Macis: Astringent, Aromatic, 60 ASTRINGENTS. Plumbum: Astringent, Sedative. Ratanha: Astringent. Rhus aromatica: Astringent. Terebinthina : Astringent, Expectorant, Anthel- mintic. Uva ursi: Astringent, Diuretic, Stimulant. ASTRINGENTS. 61 128a. 128c. B Acidi gallici gr. v. B Acidi gallici ±)]. Opii gr. ss. Extr. Cannab. Ind. gr.v. Dentur tales doses 4. F. pilulae 5. j tertiis vel quartis horis. j hora somni. Sweats. Haemoptysis. (Colliquative^) 128b. 129a. B Acidi gallici gr. xv. B Acidi sulf. dil. 3 ij. Tr. Hyoscyami 3 j- Syr. Aurant. C. § j. Aquae fontanae 3 iij. Aq. Fontis ad § viij. 1 j ter die. Hcematuria. 3 j ter die. Night-siveats. Acidum gallicum: gr. 5—20 = 0.32—1.3. " sulf. dil.: gtt. 10—30 = 0.75—2.3. " " arom.: gtt. 10—30 = 0.75—2.3. Elix. acid. Halleri: gtt 2—15=0.15—1.0. Acidum gallicum given by the stomach, is more efficacious than Tannin. Gr. jv.—vj in pill quartis vel sextis horis in Albuminuria, Diabetes, Hemorrhage from Carcinoma, etc. Acidum sulfur icum dilutum is chiefly used in Typhoid, Colliquative Perspirations, Cholera and Choleric Diarr- hoea; and it is the best corrective for Phosphatic Lithi- asis. As astringent it is given from gtt. xx—xxx ter die ex aqua; and it should be sucked through a glass tube, to prevent injuring the teeth. (Acidum sulfur icum aromaticum—Tr. aromatica acida—is more agreeable to take. See sections 111. and v.) In Gastritis, gtt. xv ter die ex aqua; in Purpura gtt. v—xv bihorio; and in Lead Colic it may be given as lemonade— 3 j in sugar water Oj during the day. Acidum sulfuricum aromaticum: Alcohol 3xjv. adde gradatim Acidi sulfurici 3 ij. Post refrigerationem adde Tr. Zingiberis 3 j; 01. Menth. p. gtt. j; Alcohol, q. s. ut f. § ijss. Elix. acidum Halleri—Acid, sulfur, pars j; (Mixt. sulf. acida.) Alcohol, partes iij. 62 ASTRINGENTS. 129b. B Acidi sulf. diluti Extr. Ergotae fl. 7 3 ij. Aq. fontanae ad § viij. § j ter die. Metrorrhagia. 129c. B Acid. sulf. dil. 3 ij- Tr. Cinnamomi § j. Syr. Aurant. C. § ij. 3 j ter die. Chlorosis. 130a. B Acidi tannici " benzoici 7 3j- Sacchari albi 3 j- F. pulveres No. 20. j bihorio. Pertussis. (3 years.) 130b. B Acidi tannici gr. vj. Extr. Bellad. fl. gtt. jv. " Conii fl. gtt. xvj. Syr. Flor. Aurant § ij. Aq. fontanae § vj. 3 ij bihorio vel tertiis horis. (3 years.) Pertussis. 131. B Agaricin gr. j. Extr. Hyoscyami Rd. Altha-ae 7 gr. iij. F. pilulae 6. Consperguntur Pulvere Cinnamomi j vel ij hora somni. Night-sweats. Phthisis. 132a. B Aluminis 3 jss. Aquae Fontis § v. Syr. simplicis § j. | ss bis die. Menorrhagia. 132b. B Aluminis 3 ss. Aq. Melissae Syr. simplicis a § ij. 3 j tertiis vel quartis horis. (3 years.) Pertussis. 132c. B Aluminis 0.4. Opii 0.03. Dentur tales doses 5. j bis vel ter die. Diarrhoea. Acid, tannic: gr. 2- Agaricin: gr. 1-12- Alumen: gr. 8- -10 = 0.13 —0.65. - + = 0.005—0.032. -30 = 0.5 —2.0. Tannin. It is believed that, owing to its coagulating influence on albumen, it is not absorbed in the stomach, and cannot produce constitutional effects,until converted into gallic acid—hence, given by the stomach this is preferable;—but the gallic acid is probably again changed in the blood into Tannin by combining with Glucose. In Nightsweats, Tannin gr. ss—ij hora somni; in atonic Menorrhagia gr. ij tertiis horis in pill. ASTBINGENTS. 63 132d. B Aluminis 3 j— 3 ij. Tr. Opii gtt. xl. Syr. simplicis 3 ij. Aquae Fontis § vj. 3 j tertiis horis. Lead Colic. 133. B Argenti nitrici gr. ss. Aq. Cinnamomi | iij. Syr. Flor. Aurantii § j. 3 j quartis horis. Diarrhoea. (non-inflammatory'.) (3 years.) 134a. B Tr. Caps. B. Past § ss. Elix. simplicis 3 jss. 3 j ter die. Enuresis nocturna. 134b. B Tr. Caps. Bursae Past. Syr. simplicis 7 1 j- Extr. Uvae Ursi fl. ' Scutell. fl. 7 3 ss. 3 ss ter die ante cibum. Same. 135a. B Catechu Cort. Cinchonae Pulv. aromatici 3 j ter die. Pulvis Ebriosorum. 135b. B Catechu gr. xv. Pulv. Cretae comp. cum F. pulvis Opio 3j. After each stool. Diarrhoea. 40.0. 20.0. 10.0. Argenti Nitras: gr. \— 1 = 0.015—0.065. Catechu: gr. 10—30 = 0.65 —2.0. Alumen is a powerful astringent; in large quantities the astriction may be followed by vomiting and purg- ing; even inflammation will set in. To prevent nausea it may be combined with aromatics; but it is perhaps most palatable in the form of whey, prepared by boiling 3 ij with milk Oj and straining. (Dose 3 ij.) In Gastralgia: Alum. gr. x ter die in caps, amylac. (Astringents, mineral and vegetable, when used to check morbid discharges from the bowels, are better combined with Opium, as they do not restrain the peristaltic movements of the intestines without the latter.) Capsella Bursa Pastoris is a very popular remedy in some parts of Germany for diarrhoea and almost all forms of hemorrhages. About 25.0 of the fresh, or 10.0 of the dried herb to one pint of water as tea, which is to be taken in 3 doses at intervals of two or three hours. 64 ASTRINGENTS. 135c. B Tinct Catechu 3 j- " Ratanhae 3 jss. " Opii gtt. xv. Mixt. Cret. comp.* § jss. After each stool. Dysentery. 135d. B Tr. Catechu " Ratanh.7gtt.x—3j. Mixt. Cretae comp. \ ij. 3 j bis vel ter die. Diarrhoea Ablactator. 136. B Tr. Cinnamomi Elix. simplicis 7 1 j- Tr. arom. acidae 3 j. 3 j ter die. Palpitation. 137. B Cotoinae 0.05—0.08. vel Paracotoin. 0.15—0.25. Alcoholis dil. 10.0. Glycerini 30.0. Aq. destillatae 120.0. | ss omni hora vel bihorio. Diarrhoea. 138a. B Creosoti gtt. vj.^ Saponis med. 3j. F. pilulae 6. j after each vomiting. Vel: B Creosoti gtt. vj. Acid, acetici dil. 3 j. Aq. fontanae 3 vj. 3 j bihorio vel tertiis horis. 138b. B Creosoti gtt. x. Acaciae 3 ij. Aquae Fontis § jv. | j i-extis horis. Dysentery. 138c. B Creosoti 5.0. Alcoholis 20.0. Glycerini 225.0. 4 c. c. ter vel quater die. Tuberculosis. 138d. B Creosoti gtt. j. Syrupi Acaciae 3 j. 3 j bihorio. Vomiting. (1 year.) Catechu Tr.: gtt. 20— 3 j = 1.0 —4.0. Cinnamom.: gr. 10—20 = 0.65 —1.3. " Tr. gtt. 20— 3 j = 1.0 —4.0. Cotoina: gr. 1—3 = 0.065—0.2. Creosot: gtt. 1—3 = 0.065—0.2. Cinnamonum is more of an aromatic stimulant than astringent, and chiefly used for its flavor. Creosot is an efficient remedy in Gastric Irritation and Haematemesis. In chronic Bronchitis, Creosot. 0.1—0.4 per diem in Malaga or 01. Jecoris is excellent; but it has to be used for a long time. ASTRINGENTS. 65 Vel: B Aq. Creosoti § ij. iEtheris gtt. x. Syr. simplicis § j. 3 ij ter die. Cholera (3 years.) Infantum. 139. B Cupri sulf. gr. v—x. Opii gr. x. F. pilulae 10. j ter die. Dysentery. 140a. B Ergotae pulveratae Cinnamomi 70-5. Dentur tales doses 5. j every 10-15 min. ex aqua. Vel: B Secalis cornuti Elaeosacch. Chamomili. Boracis 7 0.5. Pulvis obstetricus. 140b. B Extr. Ergotae 1.0. Tannini 2.0. Aq. fontanae 225.0. "" ssooinihora. Hematuria. Vel: B Extr. Ergotae fl. 3 ij. " Digitalis fl. " Ipecac, fl. 7 3 j- 3 ss— 3 j pro dosi. Haemoptysis. Cupri Sulphas: gr. Ergot. Extr. fl.: gtt " Tr. Ergotina: gr. i—10 = 0.015— 0.65. 10—3 j = 0.32 — 4.0. 3 j—3 iij =4.0 —12.0. 3—10 = 0.2 — 0.65. Cuprum (pp. 77 & 100) is occasionally of great benefit in some of the most obstinate forms of diarrhoea, and it is said to be a sure taenicide. See section viii. Ergot (Secale cornutum) is used in all kinds of hem- orrhages; in Dysmenorrhoea, and to expel hydatids or polypi from the uterus; it is also valuable in Paralysis of the bladder. Being a most reliable oxytoxic its chief use is in midwifery, especially after delivery, to prevent flooding, etc. If taken too much it produces Ergotism, which assumes two forms, one attended with convul- sions, the other with dry gangrene on the limbs. In Diabetes Insipidus: Extr. fl. 3 j ter die; in Pulmon- ary Hemorrhage, 3 j— 3 ij omni hora vel media hora si opus est; in hemorrhage from Subinvolution, Hyper- plasia, Soft Engorgement, with profuse menstruation, Polypi, etc., Tr. 3 j ex aqua bis vel ter die. 66 ASTRINGENTS. 141. B Extr. Erigerontis fl. 3 ij- Elix. simplicis ad f ij. 3 j ter die. Incontinence of Urine. 142. B Tr. Ferr. acet. aeth. 25.0. " Cinchonae 50.0. Acidi citrici 3.0. Glycerinae 22.0. Gtt. xxx—lx ter die ex vino. Scorbut. 143a. B Tr. Ferri chlor. 3 iij- Spir. nitrico-aeth. 3 vj. Tr. Cantharidum 3 ss. Aq. fontanae ad § viij. P. sexta bis die. Gleet. Spermatorrhoea. 143b. B Tr. Ferri chlorati 3 j- Aq. Cinnamomi 3 vj. 1 j ter die. Haemoptysis. 143c. B Tr. Ferri Chloridi 3 j- Ferri Sulphatis gr. x. Aq. Fontis § j. Followed by Pot. Carb. 3j, dissolved in water. Cyan Poisoning. 144. B Liq. Ferri Nitrat. 3 j- vel " " Subsulphatis . 3ij—3jv- Syrupi simplicis § j. Aq. destillatae § v. | ss ter die. Diarrhoea. (icith Anaemia.) Erigeron Extr. fl.: 3ss— 3j=2.0 —4.0. Ferrum acet. Tr. gtt. 20—3j=0.7 —4.0. " chlor. Liq.: gtt. 2—10 =0.13 —0.65. a u "pr . gtt 10—60 = 0.35 —2.0. " nitr. Liq.: gtt. 2—12 =0.13 —0.8. " subsulf.Liq, :gtt. 1— 8 = 0.065—0.5. Erigeron Canadense is mostly used in nephritic dis- eases, Gravel and Hemorrhages. Oleum Erigerontis, gtt. 5—20 bihorio in Metrorrhagia. Ferrum—Though the preparations of iron are more or less astringent, they are chiefly used as tonics. See section v. As astringent, Tr. Ferri Chloridi (Tr. Ferri chlorati)—Liq. Ferri Chlor. partes 35 et Alcohol, partes 65—is generally preferred, which has moreover some specific action on the urino-genital apparatus. Liq. Ferri nitr. may be replaced by Liq. Ferri chlor. (pond. spec. 1.48) et Aq. p. 2. Liq. Ferri subsulf (Monsel's Solu- tion): Gtt. 1—3 ex aqua in Haematemesis. ASTRINGENTS. 67 145. B Tr. Kino 3 ss— 3j- Mixt. Cret. comp. § ij. 3 j tertiis horis. Diarrhoza Ablactatormn. 146. B Olei Macidis 2.0. Spiritus aetherei 25.0. Gtt. xij bihorio. Colic. (hepatic.) 147. B Plumbi Acetatis gr. j. Opii gr. i. Dentur tales doses 6. j ter die. Dysentery. Vel: B Plumbi acetici gr.ij—iij. Opii gr. ss. Placenta Prosvia. 148. B Extr. Ratanhae 5.0. Aq. Cinnamomi 150.0. Mixt. sulf. acid. 1.5. Syr. Aurant. C. 25.0. 16 c. c. omni hora vel bihorio. Metrorrhagia. Vel: B Extr. Ratanhae Glycerini 7 10.0. Glycerolati simpl. 80.0. 3 j omni hora vel bihorio. 149. B Extr.Rhud.arom.fi. | ss. Tr. Strychni gtt. x. " Ferri chlorati 3 j. Elix. simplicis - 3 iij- Gtt. xx ter die post cibum. Incontinence of Urine. 150a. B 01. Terebinthinae 5.0. JEtheris 20.0. Gtt. xv—xxx ex aqua sacch. mane nocteque. Hepatic Colic. 150b. B 01. Terebinthinae Sodii Bicarbonat 7 3 j- Mucil. Acaciae § j. Mixt. Amygdalar. § vij. Pars sexta quartis horis. Hcematuria. Kino Tr.: 3 ss— 3 ij PlumbiAcetas.gr. 1—3 Ratanh. Tr.: 3 j— 3 Ij Terebinth. 01. gtt. 10— § ss 2.0 — 8.0. 0.065— 0.2. 4.0 — 8.0. 0.65 —16.0. Kino and Ratanha (Krameria) are similar to Catechu (p. 63,) and much used in Pediatrics. Plumbum: A prolonged use of the preparations of lead in chronic diseases is more or less dangerous, from their liability of poisoning the system, known generally by 68 ASTRINGENTS. 150c. B 01. Terebinth. 30.0. Vitell. Ovorum No. 2. Aq. Menth. pip. 250.0. Syr. simplicis 50.0. 16 c. c. every \ hour; after- wards every hour. Phosphor Poisoning. 151a. B Extr. Uvae Ursi 10.0. Sacchari albi 50.0. Divide in 30 partes aequales Pulv. £ quater die. Gravel. 151b. B Dec. Uvae Ursi 200.0. Tr. Catechu Syr. Zingiberis 7 15.0. 32 c. c. bihorio. Gonorrhoea secundaria. Vel: B Extr. Uvae Ursi fl. 3 ij. Tr. Kino Syr. Zingiberis 7 1 ss. Aq. fontanae § iij. | j quartis horis. Incontinence of Urine. Uva Ursi, Extr. fl.: 3 ss— 3 j = 2.0—4.0. the characteristic discoloration of the gums, etc. The most common form of lead poisoning is that known as painter's colic. Some forms are characterized by par- alysis or painful cramps. Oleum Terebinthinm is best given with some mucilage. Pulvis Saponis makes a good emulsion with it in the proportion of 0.66: 30.0, or 1:50. Hyposulfite of Soda deodorizes it. See Sulfites, section i. In Typhoid, where the abdomen is tympanitic, the tongue dry and the bowels ulcerated, gtt. 5—20 of the oil on sugar every hour or two; 3 j tertiis horis in Haema- turia; the same dose every other day in Neuralgia. Uva Ursi (Arctostaphylum) has a particular control over discharges from mucous surfaces; hence its use in Catarrh of the Bladder,chronic Bronchitis with profuse discharge, etc., etc. SECTION V. RESTORATIVES. They ultimately restore general health, by either gradually, but permanently, invigorating nerve-force: Tonics; or by rapidly, though but temporarily, rousing the vital functions of the organism: Stimulants. Acida Mineral: Tonic, Astringent. Albumen: Nutrient Alcohol: Stimulant Ammonlum: Stimulant, Antacid. Argentum: Tonic. Arnica: Stimulant. Bebeeria: Tonic, Antiperiodic. Berberis: Tonic, Antiperiodic, Cathartic. Caffein: Stimulant, Antiseptic. Cantharis: Stimulant, Tonic, Diuretic. Capsicum: Stimulant. Chininum: Tonic, Stimulant, Antiperiodic. Coca: Tonic, Stimulant Cuprum: Tonic, Astringent. Digitalis: Tonic, Diuretic. Ergota: Stimulant, Astringent. Ferrum: Tonic, Astringent. Gentiana: Tonic. Glycerina: Tonic, Nutritive, Laxative. Guarana: Tonic, Astringent. Helokias: Stimulant 70 RESTORATIVES. Hydrastis: Tonic, Alterative, Antiperiodic, Chola- gogue, Deobstruant. Ipecacuanha: Tonic, Emetic. Manganum: Stimulant, Antiseptic. Nux Vomica: Stimulant, Tonic. Pancreatinum: Digestive. Paraguayensis, Ilex: Tonic. Pepsina: Digestive. Pepton: Digestive. Phosphorus: Stimulant, Tonic. Rheum: Tonic, Astringent, Cholagogue. Sabina: Uterine Stimulant. Zincum: Tonic, Stimulant. Stimulants and Tonics. 71 152a. B Acid, hydrochlor. d. Tr. Zingiberis 7 3 ij- " Nuc. Vomicar. 3 j- Syr. C. Aurantior. § j. Aq. destillatae ad § viij. | j ter die post cibum. Dilatation of Stomach. 152b. B Acid, hydrochlor. dil. gtt. xl. Tr. Nuc. Vom. gtt. xx. Aq. Cinnamomi § j. 3 j ter die. (4 years.) 153. B Acid, nitro-mur. dil. Tr. Zingiberis 7 3 ij. Tr. Nuc. Vomicae 3 j. Aq. fontanae ad § viij. § j ter die post cibum. Dyspepsia. 3 iij- 3 jss. j- I V11J- 154a. B Acid, phosph. d. Tr. Ferri chlor. Syr. simplicis \ Aq. Menthae ad. | ss ter die post cibum. Same, if Anosmia. 154b. B Acid, phosph. dil. § ss. Tr. Nucum Vomic. 3 ij- Syr. simplicis § j. Aq. fontanae ad § viij. | ss ter die. Hectic. 155a. B Acid, sulfurici diluti Tr. Card. comp. 7 3 ij. " Nucis Vomicae 3 j. (Tr. Cinchon. co.) § ss. Syr. simplicis § j. Aq. destillatae ad § viij. | j ter die post cibum. Dyspepsia. Acid, hydrochlor. d.: gtt. " nitro-mur. d.: gtt. " phosphor, d.: gtt. " sulfuricum d.: gtt. 5_30 = 0.35—2.15. 2—20 = 0.15—1.5. 10—60 = 0.65—4.0. 10—30 = 0.65—2.3. Mineral Acids are usually classed with tonics, and though they exert a considerable corroborant influence on the system, their action is in many respects peculiar. See sections in. and iv. Acidum nitro-muriaticum should not be given with mercurials. Acidum phosphoricum is very valuable in Softening of the Brain. In Hysteria, Defective Menstruation and Spermatorrhoea, 5.0—15.0 per diem. Acidum hydrochloratum dilutum, 1:3 Aqua; Acidum nitricum dilutum, 1:4£. 72 RESTORATIVES. 155b. 155c. B Acid, sulfurici d. 3 j- B Acid- sulf- dil- 3 jss. Tr. Cardam. comp. Spir. aetherei § ss. " Gent. comp. 7 i j. Glycerinae § j. Infusi Colombo § jv. Aq. fontanae ad \ viij. | ss ter die. Chlorosis. § j quater die. Restorative. Induration of Cervix. (after illness.) Acid, nitrohydrochlor. dilutum, 3 et 4:25. The mixed acids are left in a bottle for 24 hours, sometimes shaken, and then the 25 parts of water added. Acidum sulfuricum dilutum, 1:5 Aqua. (p. 61.) Alcohol is the best stimulant to rouse and support the system in asthenic diseases, exhausting hemorrhages and suppuration; and after the use of the wet sheet, etc., if there be a sensation of chilliness. In Typhoid, etc., it probably acts as a physiological antidote to the blood poison, and should be given in the very first stages of the fever. Brandy, ^ ss— § j hourly (Vinum, 3 j every 6—8 hours) if much prostration, pulse being above 120; or if the systole becomes less intense and resembles more the second sound, as it will produce more force and less frequency of the pulse, even reduce temperature and diminish delirium. (If excitement is produced, it is not indicated, or the doses are too large.) In Diphtheria, with or without Quinine, as much as can be borne without producing Alcoholism, is said to be curative. In Dysentery, if great prostration (40 oz. in 24 hours have produced no excitement.) In functional disorders of the stomach it is generally beneficial; but in Gastritis, brandy frequently produces distress. In Diarrhoea, if much prostration, to child of 5—8 months gtt. v in 3 j of milk every 2 hours; the same in collapse of Cholera Infantum. In Sporadic Cholera, % oz. with water at short intervals, if much prostration and it be borne; in Asiatic, with water for thirst, and % oz. with 2 oz. of tea as enema every half hour or hour during collapse; in Pneumonia, if pulse frequent, thrilling, but Stimulants and Tonics. 73 156. 158a. B Album. Ovorum No. 4. B Ammon. Carb. 3j. Aq. fontanae 1000.0. Spir. aetherei 3j. Cyathus viuosus every 5— Aq. Menth. pip. § vj. 10 minutes. P. quartasubinde. Syncope. Sublimate Poisoning. 158b. 157a. B Ammon. carb. gr. xxv. B Spir. Ammon. arom. Tr. Card. comp. 3 ij. " aetherei 7 3 j. Aq. Fontis § iij. " Vini Gallici 3 ij. Pars semis cum Acid. citr. 3 ss—3 jprodosi. Syncope. gr. xv. Insolation. 157b. 158c. B Spir. Ammon. arom. 3j. B Ammon. carbon. 3j. Tr. Card. comp. § ij. Tr. Cardam. comp. Syr. Zingiberis § j. " Cinchon. 7 3 ij. 3 ij semis horis ex aqua. Aq. fontanae ad § vj. Cholera, x ss ter die. Embolism. Ammon. arom. Sp. gtt.: 20— 3 j = 1.0—4.0. Ammon. Carbon.: gr. 3—10 = 0.2—0.65. compressible. (To child of 14 months 1 oz. was given hourly, besides Ammon. carb. and Morph. and the pulse fell from 200 to 120, and respiration from 120 to 50 per minute.) In Yellow Fever, per os et per anum, to sustain the strength; in Cerebro-spinal Meningitis; in Angina Pectoris; in Insolation or Passive Hyperaemia or Embolic Apoplexy, etc. In Tetanus it may be given until intoxication. Ammonii Carbonas (p. 43) is especially valuable in Pneumonia; but it is also employed in expediting the eruption of exanthematous fevers, either as Carbonate pure in powder or watery solution; or converted into the Acetate. With Camphora (No. 55) it is sometimes of especial value in Cholera; and combined with Aci- dum salicylicum, both its internal and external use has been recommended to counteract the effects of snake poison. 74 RESTORATIVES: 158d. B Ammon. Carb. 3j- Extr. Chelidonii fl. vel " Stilling, fl. 3 iij- Aq. Menthae ad 3 vj. | ss ter die. Icterus. 159a. B Ammon. Carbon. 3jv. Ferri Tartratis 3 ss. Syr. Zingiberis § j. Inf. Colombo § vij. | ss ter die. Hysteria. 159b. B Ammon. carbonici Ferri ammoniati 7 3j. Syr. Zingiberis § j. Inf. Colombo § v- | j ter die. Alcoholism. 160a. B Argenti nitrici cryst gr- ij—]>■ Micae Panis Acaciae 7 gr- x- F. pilulae 12. Paralysis. j ter die. (bulbar.) (for several weeks.) 160b. B Argent, oxydat. gr. vj. Extr. Hyosc. gr. xxjv. F. pilulae 12. j bis vel ter die. Epilepsy. 161. B Bebeeriae sulfuric. 2.0. Acid. sulf. dil. gtt. xxv. Syr. C. Aurantior. 30.0. Aq. destillatae 160.0. 16 c. c. ter die. Tonic. Argent. Nitras: gr. Argent Oxid.: gr. Arnica Tr.: gtt. Bebeer. Sulfas.: gr. i— 1 = 0.015—0.065. i— 2 = 0.015—0.13. 15—3j = 0.5 —4.0. 5—3j = 0.32 —4.0. Argenti Nitras (Argentum nitricum) is one of the most valuable remedies in Epilepsy. It is also used in Locomotor Ataxia and Chorea. If used for some time it has the effect of discoloring the skin, which is not the case with the oxide. In Chorea and Neuralgia: Arg. iodatum 0.004—0.01 ter die; vel Arg. cyanatum 0.002—0.006 ter die. Argent, iod. 0.1 = Arg. nitr. et Kal. iodatum 7 0.07. Arnica is occasionally of value in Amaurosis, Paraly- sis and other nervous affections. Tr. gtt. xx__xxx in nervous headache with Tinnitus aurium. Bebeerinum (from Nectandra Rodiaei) and Berberina (from Berberis vulgaris and Hydrastis Canadensis) are said to be tonics of first order (page 24.) Stimulants aud Tonics. 75 162. B Extr. Berberis fl. 3 j. Extr. Cocae fl. § ss. " Cypripedii fl. " Valerianae fl. 7 3 ij. Elix. simplicis 3 ij. 3 j ter die ante cibum. Uterine Tonic. 163. B Coffeini citrici 1.0. Alcoholis diluti 16.0. Chloroformii 12.5. Gtt. xv—xx semis horis. Migraine. 164a. B Tr. Cantharidum " Capsici " Colombo 7 3 j- Mucilag. Acaciae ad 3 ij. 3 j ter die. Menorrhagia. B Tr. 164b. Cantharidum " Cinchon. comp. " Ferri chlorati " Myr/hae 7 3 ij- Gtt. xx ter die. Spermatorrhoea. 165. B Capsici pulv. Sacchari albi Divide in p. 4. j omni hora. 166a. B Chinin. sulfur, gr. xv. Acid. sulf. diluti 3j. Tr. Cardam. comp. " Humuli JT 3 iij. Inf. Rosarum ad § vj. | ss bis vel ter die. Chlorosis. 3ij. 3j- Delirium, tremens. Berber, aquif. Caffeina: Cantharis Tr.: Capsicum: " Tr. Extr. fl.: gtt. 20— 3 j = 1.0 —4.0. gr. 1— 2 == 0.065—0.13. gtt 4—15 =0.13 —0.5. gr. 2—10 =0.13—0.65. : gtt. 10— 3 j = 0.32 —4.0. Caffeina (Coffeinum) in headache may be given 0.03—0.05 every half hour or hour; 0.05—02. every 2—4 hours. Cantharis (Cantharides) must be used with caution. See page 47. Capsicum is often used as an adjunct, to rouse the susceptibility of the stomach, chiefly in the Dyspepsia of drunkards: Tr. 3 j— 3 ij. Quiniuce Sulphas (Chininum sulfuricum) is very much used as stomachic or general tonic; only where gastric susceptibility exists, as in convalescence from acute diseases, some of the simple bitters are preferable. 76 RESTORATIVES: 166b. B Quininae Sulphatis Acid. sulf. dil. 7 3j. Syr. Zingiberis § jv. 3 j ter die. Anaemia. 166c. B Chinini sulfurici 3 ss. Pulveris Rhei 3 j- Divide in partes 30. Same. j ter die. (with Anasarca.) Vel: B Chinini sulfurici 3 ss. Extr. Gentianae 3ij. Pilul. Rhei comp. 3jv. F. pilulae 30. j ter die. Vel: B Chinini sulfurici 3ij. Rad. Zingiberis 3j. F. pilulae 20. Menorrhagia, j ter die. Mania. 167a. B Chinin. sulf. 3ij. Ferri sulfurici 3j. Acid. sulf. arom. gtt. x. Divide in 20 partes aequales in capsul. gelatinos. j ter die ante cibum. Pelvic Abscess. J 167b. B Quininae Sulphatis 3j. Tr. Ferri Chloridi 3 ss. Syr. C. Aurant. f j. Aq. destillatae § vij 3 j bis vel ter die. Pulmon. Gangrene. Vel: B Tr. Cinchonae " Gentianae 7 Liq. Potassae 3 ij. Aq. Menthae § vj. | j bis vel ter die. Same. 167c. B Tr. Cinchon. comp. " Colombo " Gentianae " Quassiae 7 §" j- Morph. sulf. gr. j—ij. 3 j ter vel quater die. Delirium tremens. 168a. B Cocain. hydrochl. gr. j. Alcoholis q. s. Aq. destillatae § ss. 3 j every ^ hour if neces- sary. Vomiting of Pregnancy. Cinchon. Tr.: 3 j— 3 iij := 4.0—12.0. In Anasarca, etc., it is supposed to restore the lost albumen to the blood. See page 11. As tonic to child of 4 years may be given gr. -} bis die; in Dropsy from Dysentery, gr. |- ter die. (3 years.) Cocaine. Aside from being a most valuable local anaesthetic, it is one of the best remedies in affections of a nervous nature, General Debility, Hysteria, Spinal Irritation; it is also used in Anaemia and Consumption. Stimulants and Tonics. 77 168b. 170. B Cocaini hydrochlor. B Cupri ammoniati 1.5. gr. iij. Aq. destillatae 25.0. Alcoholis diluti Gtt. v bis die. Chorea. Glycerinae Vel: Aq. destillatae 7 3 ij. B Cupri ammoniati 3]. 3 ss— 3 j ter vel quater die. Micae Panis q. s. Angina Pectoris. F. pilulae 40. 169. j hora somni. Epilepsy. B Tr. Cupri acet. R. 3 j. 171a. Aq. destillatae 5 jv. B Inf. Digital. ( 3 j) § vij. 3 j ter die post cibum. Syr. Cinnamomi § j. Albuminuria. % j hora somni. Epilepsy. Cupr. ammoniat: gr. £— 1 = 0.015—0.065. Digital. Extr. fl.:gtt. 5—40 = 0.18 —1.3. In Angina Pectoris it does not shorten the paroxysms, but it relieves them, and after a few days use they disappear altogether. It is also a reliable aphrodisiac, and in Alcoholism it is said to be the remedy par ex- cellence, as it will even produce disgust of 1he drinking habit. Unfortunately, if not given with care, it may produce Cocainism, which is to Morphinism what a full grown oak is to a sapling. See pp. 109, 112 and 115. As cardiac stimulant it is usually given in doses of grain \—1 bis vel ter die. In Seasickness, Cocaine 1 per cent, solution gtt.v ter die on apiece of ice. Extractum Cocaefl. 3 ij—■ § ss in timidity (for public speakers.) Extractum Cocob fluidum 3 j = gr. \\ of Cocaine (?). Cupri Sulphas (Cuprum sulfuricum) is mostly used as astringent; as tonic, in doses of gr. £—1 in pill, repeated, so as not to occasion vomiting, it is a good remedy in obstinate Intermittens, Neuralgia and essen- tial nervous diseases, (p. 65.) Tr. Cupri acetici Rade- macheri is very efficacious in Bright's Disease. (After 3 weeks use the albumen in the urine is usually much diminished, and scarcely any blood left.) Cuprum 78 RESTORATIVES: 17 lb. 172a. B Tr. Digitalis B Ergotinae Spir. aetherei 7 5.0. Ferri sulfurici Tr. Colombo 10.0. Aloes 7 gr. x. 4 c. c. bis die. Palpitation. F. pilulae 10. 171c. j mane nocteque. B Tr. Digitalis 3j. Vel: Spir. nitrico aeth. § ss. B Tr. Ergotae 3 ij- Tr. Cardam. comp. § j, Syr. Croci | ij. Aq. fontanae ad § vj. Dec. Aloes comp. § vj. | j bis die. Valv. Lesions. 3 ss ter die. Amenorrhea. Digitalis Tr.: gtt. 10—80 = 0.32—2.6. ammoniatum 0.1—0.15 per diem in Neuralgia Nervi Quinti is said to be almost specific. Digitalis is very useful in most heart diseases—Dilata- tion, fatty degeneration, failure or irritability of heart's action, and valvular lesions, etc., provided the action be feeble, as it increases the force of the cardiac contrac- tion and diminishes the irregular movement—in incom- plicated Hypertrophy it is, of course, objectionable. On account of its diuretic property it is frequently employed in dropsical effusions, especially in conjunction with Colehi cum (p. 50) or Potassium (p.96); even as embrocation it is of value (p. 144.) (As cardiac tonic, Strophanthus is said to be superior to Digitalis, as, aside from not causing the slightest disturbance to digestion,it is neither depressing nor cumulative in its effects.) Inf. Digitalis (No. 171) in Epilepsy should be given in 1 oz. doses only for one week; in the second week it may be increased to l^oz. and the third to 2 oz., until sickness of stomach and dilatation of pupil, when the dose has to be reduced. In Insomnia and forgetfulness of old people: Extractum fluidum gtt. v tertiis horis; in Delirium tremens: Tr, 3 j in 2 doses after an interval of 4 hours. Ergot (p. 65) is a special stimulant to the spinal marrow and the uterus, hence the remedy par excellence Stimulants and Tonics. 79 172b. 173b. B Extr. Ergotae B Ferri carbon, gr. xxjv. Camphorae 7 gr. x. Radicis Rhei F. pilulae 10. " Zingiberis j bis die. Spermatorrhoea. Extr. Gentian 7 gr. xij. 172c. F. pilulae 12. B Extr. Ergotae fl. 4.0. j ter die. Meteorism. " Viburni fl. 6.0. 174a. Gtt. xv ter vel quater die. B Liq. Ferri sesquichlorati Dysmenorrhoea. Syr. simplicis 7 10.0. 173a. Mixtis adde B Tr. Ferri acetici 3 j- Liq. Ammoni caust. Syr. Zingiberis § j. Spir. Menthae p. 7 5.0. Aq. Pimenti ad 3 vj. Gtt. xx—xl ter die ex aqua. Steel drops. 0.7 —4.0. 0.32—1.0. 0.13—0.65. 0.35—2.0. in all cases of uterine inaction, unless the coexistence of certain circumstances prohibits its use. Combined with iron it is very often of benefit in Incontinence of Urine. The addition of Strychnine gr. 1-20 (No. 172a) is some- times particularly useful. (Ergotina is another name of the Extract of Ergot, which has a share in the existing confusion of the present nomenclature—see my re- marks on this subject in Preface.) Ferrum introduced into the stomach is changed into a sulfuret, and it is only during this process that its absorption takes place. Ferri Chloridum (Ferrum chloratum) is the most effective iron salt, a non-poison- ous antiseptic, antizymotic and haemostatic, and milder than Ferri Sulphas, (p. 66.) The liquor taken with Glycerin or with milk will lose the styptic taste, nor will the teeth suffer. No. 174b contains 3 percent. Ferrum, and if the chloride be of 1.26 spec, gravity, the proportion to Glycerin would be = 33:67. Ferri Car- I] ter die. Exhaut ition. Fen- . acet. Tr.: gtt. 20- -3j = ce carbon.: gr. 5- -15 = u chlor. Liq. :gtt 2- -10 = a " Tr.: gtt. 10- -60 = 80 RESTORATIVES: 174b. 175b. B Liq. Ferri chlor. 20.0. B Eerri Sulphatis (pond, specif. 1.48.) Sodii Bicarbonatis Glycerinae 80.0. Extr. Gentianae 7 5.0. 3 j— 3 iij ter die e lacte. F. pilulae 75. iij—jv daily. 174c. Vel: B Liq. Ferri Chloridi 2.5. B Eerri sulfurici 5.0. Glycerini 97.5. Extr. Myrrhae 4 c. c. every ^ hour. Croup. Galbani 7 15.0. 175a. F. pilulae 150. B Ferri sulfurici 3j. v quater die. Chlorosis. Extr. Gentianae 3ij. Vel: F. pilulae 40. B Sol.Ferri et Pot.Tartrat. ij bis die. Urethral (20.0—30.0) 200.0. (j: 7 years.) Inversion. § ij as drink. Ferr. dialysatum: gtt. 10—40 = 0.65 —2.6. " oxyd. hydr.: gr. 5—20 = 0.32—1.3. " sulfuricum: gr. ' 1— 3 = 0.065—0.2. Ferro-Kali tartar.: gr. 2—8=0.13 —0.5. bonas (Ferrum carbonicum) gr. iij bis die to improve digestion. In Chorea from fright. (6—10 years.) Ferrum dialysatum gtt. ij—v bis vel ter die in Heartburn. It is almost tasteless, and with water perfectly miscible. Ferri Oxidum hydratum (Ferrum oxydatum) is easily dissolved in the stomach, therefore small doses of it have the same effect as big ones of the other oxides. Fresh prepared, it is of special value in poisoning with Arsenic, for which reason a bottle with Liq. Ferri ter- sulf. should be always at hand. An expeditious pre- paration of the hydrated oxide of iron in cases of arseni- cal poisoning may be performed in the following manner: To Liq. Ammon. U. S. P. 240.0, previously diluted by double its quantity of water, add Liq. Ferri tersulf. 300.0, previously diluted by 3 liters of water, constantly stirring. Pour the whole on a muslin strainer, and after having pressed with the hand the water all out Stimulants and Tonics. 81 176a. 177. B Ferri Vin. amar. § iijss. B Inf. Gentian, comp. Tr. Nuc. Vomic. § ss. vel Inf. Colombo § vj. Sol. Potass, arsen. 3 ij. Liquor. Potassae 3 iij. 3 j ter die post cibum ex 3 ss ter die. Induration aqua. Same. of Cervix. 176b. 178. B Ferri Vin. dulc. B Extr. Guaranae fluidi Tr. Colombo 7 3 jv. Elix. Valer. ammon. Kalii bromati 3 v. Glycerini 7 | j. 3 ij ter die ex aqua. 3 j— 3 ij terdie. Heartburn. Pelvic Peritonitis. Cephalalgia. Ferri Vinum: 3 j— 3 jv = 4.0—16.0. Gentiana Extr. fl.: gtt. 20— 3 J = 1.0— 4.0. " Tr. 3 j— 3 ij = 4.0— 8.0. Glycerinum: 3 ss—§j =2.0—32.0. Guarana Extr. fl.: gtt. 20— 3 j = 1.0— 4.0. of the precipitate, add errbugh water to make the whole 600.0 (about 20 oz.) Gentiana lutea possesses in a high degree the tonic powers which characterize the simple bitters; therefore its value in cases of debility of the digestive organs, or where a general tonic is required. Glycerinum (Glycerina) is, like alcohol, an indifferent and very hygroscopic substance; and Glycerinismus, chronic or acute, is said to be likewise similar to Alco- holism. It is used in Phthisis as nutritive instead of cod liveroil; in Diabetes mellitus, 150.0—200.0 daily, instead of sugar; and sometimes in Dyspepsia (3.0—5.0 after meals),especially if feces hard and dry. Barring a few chemicals, which like Argenti Nitras, Potassii Perman- ganas and Acidum chromicum, are decomposed by it, Glycerina is, on account of its great solvent power, one of the mostimportant menstrua we possess—100 parts, for instance, will readily dissolve 10 p.of Acid^benzoicum, the same quantity of Acidum boricum,40 p. of Alum, 50 p. of Tannin and 60 p. of Borax. 82 RESTORATIVES: 179. 181. B Extr. Helon. fl. § j. B Vin. Ipecacuanh. 3 ss. Glycerinae § ij. Gtt. iij omni hora. I es ter die. Hysteria. Vomiting of Pregnancy. Uterine Tonic. 182. 180a. B PQt- Permang. gr. ij—v. B Hydrastin. gr. vj. Aq. destillatae § ss. Extr. Capsici gr. j. This dose ter die. F. pilulae 6. Insomnia. Amenorrhea. j ter die. Irritable Stomach. 183. 180b. B Extr. Strychni gr. x. B Hydrastin. 3 ss. " Hyoscyami Extr. Nuc. Vom. gr. jv. Chinin. sulfurici 7 3j- F. pilulae 16. Consp.Cinnam. F. pilulae 20. j ante cibum. Dyspepsia, j ante prandium. Phthisis. Helonias Extr. fl.: Hydrastis " fl Ipecacuanh. Vin. Mang.Pot.Per.: Nux Vom. Extr. Ipecacuanha is chiefly used as emetic. See section vn. As tonic and stomachic, gr. 1-10 subinde; in Dys- entery, one 3 ss dose in capsul. amyl. v. galatin. every night, after having prepared an hour before its adminis- tration the stomach by Opium (gr. j) p. os, or by Mor- phinum hypodermically. (p. 110.) In Convulsions from eruptive fevers, gr. -^—£ every 10 minutes. (3 years.) Permanganas Potassii (Potassae Permanganas—Kali hypermanganicum) though excellent in Dysmenorrhoea from torpor, is contra-indicated in the congestive and obstructive forms. In defective Menstruation its use should be commenced a few days previous to the men- strual period. Sometimes it is employed in Impotence from Anaemia and depression. In the administration of it, glycerin or alcoholic menstrua must be avoided, as it is decomposed by them. ..: 3ss- -3j — 2.0 — - 4.0. .:gtt 20- -3jv = 1.0 — -16.0. .:gtt 3— -3j = 0.1 — ■ 4.0. gr. i- - 5 = 0.032— - 0.32. : gr. h- - 1 = 0.008— - 0.065. gtt. 5— -20 = 0.16 — - 0.65. Stimulants and Tonics. 83 184a. 184b. B Strychuinae Nitratis 0.1. B Strychn. nitrici gr. ij. Glycerini 10.0. Conf. Rosarum q. s. Gtt. jv—xij (0.002—0.006) F. pilulae 24. bis vel ter die. Paralysis, j bis die. Paraplegia. Vel: 184c. B Strychnini gr. j. B Tr. Strychnini 5.0. Acidi acetici gtt. ij. Aq. Laurocerasi 10.0. Elix. simplicis § ij. Gtt. x mane nocteque. 3 j mane nocteque. Vomiting of Pregnancy. Strychnina gr. 1-60—£ = 0.001—0.008. Nux Vomica (Strychnos) is the remedy par excellence in torpid or paralytic conditions of the motor and sensi- tive nerves, or of the muscular fibre, if not dependent on structural lesions; hence its value in lead palsy and paralysis from drunkenness. It is no less useful in Par- alysis, the consequence of cerebral hemorrhage, which continues often for an indefinite time after the absorp- tion of the effused blood, as in Amaurosis without cere- bral complications. As general tonic, whenever there is a loss of nerve power, Impotence, Spermatorrhoea, In- continence of Urine, etc., it seldom fails to give satisfac- tion. It has, however, to be used with caution, though a tolerance for it is soon established in the system. In Vomiting of Pregnancy, Tr. Nucis Vomicae gtt. ij—iij bihorio; in Gastralgia or Chronic Vomiting, Ex1r. Strychni gr. £, vel Strychninum gr. 1-10 ter die; in Chorea, gr. 1-25. Action and dose of the various salts of Strychnina are about the same. (0.01 is the strong- est dose, and 0.03 per diem—0.05 may kill.) The best Antidote is Chloral 2.0— 4.0 or Morphium (1:2 parts Strychn.) in Aq. Amygdalar. amarar. cone. (See page 6.) Tr. Strychnini—Strychnin, 0.1. Alcohol, dil. 20.0. (1.0=0.005.) 84 RESTORATIVES: 185. B Pancreatini Acaciae 7 5.0. Natri carbonici Boracis 7 1.0. Aq. fontanae 10.0. Olei Jecoris 60.0. Aq. Menthae pip. 20.0. 8 c. c. subinde. Debility. 186. B Extr. Paraguayens. fl. Elix. simplicis 7 | j- 3 j- 3 i]ter die. Exhaustion. 187a B Pepsini 2.0. Salicini 1.0. Glycerinae 50.0. 4 c. c. pro dosi. 187b. B Pepsini 3jv. Acid, hydrochl. d 3j. vel " nitrici dil. vel " phosphorici d. Tr. Nuc. Vom. 7 3 ij. Glycerinae § ij. Aq. Fontis ad 3 viij. | ss ter die post cibum. Dyspepsia. 187c. B Pepsini gr. xv. Acid, phosph. d. gtt. xv. Tr. Cinnamomi 3 ij- Syr. simplicis Aq. fontanae 7 § j- 3 j omni hora. Cholera Infantum. Pancreatin: Pepsinum: gr- gr- 5—25 = 0.32—1.6. 5—15 = 0.32—1.0. Pancreatin is a good digestive, especially of fatty matter, and may be given in alcohol or glycerin. Ilex Paraguayensis furnishes a beverage, which in some parts of S. America fills the place of our tea and coffee; but it does not exalt the peripheral nerves like the former. It is very efficient in exhaustion from hunger and fatigue. Pepsine dissolves albuminoid substances and converts them into peptones; but it is, without an acid, inert, and its best solvent is hydrochlor. acid. Whilst pure Pepsine will dissolve 450 times its weight of albumen, the saccharated Pepsine, U. S. P., dissolves only 50. It is probably more efticient in the treatment of children than of adults. Cancer, Erosions and Ulcers of the stomach prohibit its exhibition; in these cases Pepton would be indicated, as this enters the blood without previously undergoing digestion. Stimulants and Tonics. 85 188. 189c. B Pepti pultif. 25.0. B Phosphori gr. j. Lactis 1000.0. Strychnini gr. jss. As food. Convalescens Ferri carbonici 3 ij. of Infants. Chin, sulfurici 3 j. 189a. F.pil. 100. Consp. Cinnam. B Phosphori gr. ij. 190. 01. Terebinthinae 3ij. R Tr. Rhei vinosae 50.0. Spir. Rosmarini 3j. " Cardam.comp. 10.0. ^Etheris ad 3 ijss. 16 c. c. ex vino. Stomachic. Gtt. vj bihorio. 191. Palsy of tongue. R Radicis Rhei 3j. 189b. Natri bicarbonici B Elix. Phosphori et Tr. Colombo. 7 3 ij. Damian. § ij. Aq. Menthae ad § vj. 3 j ter die. Impotence. 3ijtd. Prurituspudendi Phosphorus: gr. 1-60—1-12 = 0.001—0.005. Rheum: gr. 5—30 = 0.32 —2.0. " Extr. fl.: gtt. 30—60 =1.0 —2.0. Phosphor is much employed in degeneration of nerve tissue and in nervous exhaustion, especially in Neuralgia and cerebral softening. In overdoses it is a most violent blood-poison; if chronic: Ptyalism,inflammation of gums and respiratory organs, with bleeding ulcers inthe mouth; if acute: Gastro-enteritis, faintings, cramps, paralysis, etc. As tonic it may be given in doses of from 0.0003 —0.0005 ter die; and in Impotence, etc., 0.001—0.005; but the use of Zinc, phosph. is decidedly preferable. As for Damiana (189b) it produces Polyuresis, with excitement of the sexual organs, but it may be thor- oughly replaced by Bucco or Ferrum. After its use for 2—3 months the sexual functions are said to be re- established, which result is perhaps better obtained with small doses of Ferri Chloridum, Quinine and Aromatics. Rheum (p. 94) is only in small doses a tonic and also a little astringent. (Nos.ll7 & 166.) As digestive it is given in doses of from 0.2—0.5. 86 RESTOKAT1 VES: 192a. B Olei Sabinae 2.5. Tr. Colocynthidis " Capsici 7 5.0. " Arnicae 10.0. Gtt. x—xx quater die ex aqua sacch. Paralysis. 192b. B Summitatum Sabinae Cort. Cinchona 7 15.0. F. Infusum 250.0. Syr. Cinnamomi 30.0. 3 ss bihorio. Metrorrhagia. 193. B Zinci Oxidi 3 j. Extr. Valerianae 3 ss. F. pilulae 30. j ter die p. cibum. Chorea. 194a. B Zinci phosphorici 1.0. Acid, phosphor. 7.5. Tr. Cinchonae 10.0. Gtt. xxv ter die ex aqua. Epilepsy. 194b. B Zinci Phosphidi gr. jv. Rd. Althaea q. s. F. pilulae 12. j ter die. Sclerosis. (Cerebrospinal.) 194c. B Zinci phosph. gr. j—iij. Sacchari albi 3j. Divide in partes 10. j ter die. Impotence Tabes Dorsiadis. Sabina Oleum: Zincum oxydat: " phosph.: gtt. 1—4 = 0.032—0.13. gr. 1—5 = 0.065—0.32. gr. 1-16—£ = 0.004—0.02. Sabina is one of the best uterine stimulants, and much used in hemorrhage after abortion. Ol. Sabina, 0.05— 0.2 (gtt 1—6) bis vel ter die with brandy in Paralysis. Zinc Preparations are similar in their effect to the preparations of copper, but milder. Zinci Acetas (Zincum aceticum) gr. 4—6 per diem in mucilage is sometimes used in Delirium tremens. Zinci Bromidum is preferable to the Chloride in Tremor senilis, Hysteria, Paralysis, Epilepsy: 0.005—0.015 ter vel quater die ex aqua; 0.02 maximum. Zincum cya- natum is best given as powder: 0.005—0.015 ter die; 0.03 maxim.—0.1 per diem. Zincum oxydat urn in gr. iv doses ter die, has been found of great service in the profuse perspirations of Phthisis. No. 193: Each week the quantity may be increased by gr. ij per diem until Stimulants and Tonics. 87 195a. B Zinci Sulphatis gr. x. Extr. Anthemidis 3 ss. F. pil. 10. Consp.Lycopodio. j ter die. Oxaluria. 195b. B Zinci sulfurici Extr. Hyoscyam. 7 3 ss. (Extr. Gentian. 3j.) F. pilulae 30. Nervous j ter die. Exhaustion. 196a. B Zinci valerian, gr. ij—x. Extr. Anthemid. gr. iij. Ter die. Same. 196b. B Zinci Valerianatis 0.1. Elix. simplicis 50.0. Aq. fontanae 100.0. 16 c. c. every half hour. Migraine. Hysteria. Zincum sulfuric. " valerian. gr. £_30 = 0.032—2.0. gr. £— 2 = 0.032—0.13. gr. xlv are reached. Zinci Phosphidum (Zincum phos- phoricum) supplements Phosphorus for internal use, and is much easier to employ. Zinci Sulphas (Zincum sul. furicum) is often used as emetic in cases of poisoning. See section vn. As tonic it is of great value in Oxaluria (195), especially if nitromuriatic acid is given at the same time. (p. 72.) Gr. j once daily in Chorea from fright, which may be increased to gr. vj. daily to child of 6 years. SECTION VI. CATHARTICS Remove retained feces, morbid secretions or poison, by producing alvine evacuations, with or without irritation, increased peristalsis and effusion of serum from the bowels, or of bile from the liver; they relieve spasm or congestion and inflammatory action of the general sys- tem; promote absorption; stimulate the secretions of the liver and purify the blood, invigorating and refreshing at the same time the circulatory and nervous powers. 1.—Laxative: Fruit, Glycerina, Oleum Olivarum, Oleum Ricini, Sulfur, etc. 2.—Laxative and Cholagogue: Mercurial Cathar- tics. 3.—Mildly Hydeagogue: Saline Cathartics. 4.—Mildly Acrid: Rhamnus Frangula, Senna, etc. 5.—Mildly Acrid and Cholagogue: Rheum, Aloes, etc. 6.—Drastic: Colocynthis, Elaterium, Cambogia, Jalapa, Scammonium, Oleum Tiglii, etc. 7.—Drastic and Cholagogue: Colchicum, Podo- phyllin, etc. (88) CATHARTICS. 89 197a. B Extr. Aloes Ferri sulf. 7 3 j. (Rad. Rhei 3ss.) F. pilulae 30. Chlorosis. j vel ij hora somni. 197b. B Aloes gr. xxjv. Acid. sulf. fortiss. gttvj. F. pilulae 6. ij quarta quaque hora. Vel: B Aloes Rad. Rhei 7 3j. Sapon. med. 3 ss. F. pilulae 30. j vel ij subinde. Palpitation. Prolapsus Uteri. 197c. B Aloes Mass. Hydrarg. 7 gr. jv. Saponis medicati gr. ij. F. pilulae 2. Sumatur hora somni. Pruritus pudendi. 198. B Extracti Aloes 4.0. Tartar! emetici 0.25. F. pilulae 60. ij bis vel ter die. Insanity. 199a. B Extracti Aloes 3j. Asae foetidae 3ij. Extr. Nuc. \ omicae " Belladonn.7 gr. x. F. pilulae 20. j anteprandium. Hysteria. Aloes, which is also slightly tonic and emmenagogue, ranks as purgative between Rheum and Senna, being rather slow in its effect. It is chiefly used in Dyspep- sia with constipation, dependent on a torpid condition of the large intestine or liver, and in Hemorrhoids; as revulsive in cerebral affections and in defective men- struation; but it is objectionable in diseases of thegen- ito-urinary apparatus, pregnancy, etc., on account of its special action on the large intestine and the pelvic vis- cera generally. The dose is gr. v—x; Tr. § ss—|j; Tr. Aloes c. Myrrha 3 j— 3 ij. Ferrum sulfuricum increases its action, and prevents, moreover, griping. In Constipation from retained feces: Tr. Aloes cum Myrrha 3j ter die; in Hysterical Meteorismus: Decoc- tum Aloes semel vel bis die; in defective Menstruation: Pilulae Aloes cum Myrrha gr. v hora somni (to begin a day or two before Menstruation). No. 197b is a very powerful aperient. 90 CATHARTICS. 199b. B Extracti Aloes Chinin. sulfurici (Ferri sulf.) 7 3j. Extr. Nuc. Vomicar. " Hyoscyam.7 gr. x. F. pil. 20. j p. prandium. 200. B Dec. Aloes comp. § viij. Potass. Bicarb. 3 ss. Tr. Aurant. Cort. 3 ij- Cyathus vinos, omni mane. Gout. 201. B Tr. Aloes c. Myrrha 3 ij- Ferri sulfurici gr. ij. Syr. Rhei arom. § iij. 3 ij ter die. Gastro-intestin. (8 years.) Catarrh. 202. B Extr. Colchici acetici Hydr. c. Creta 7 3j- Extr. Colocynth. cO. 3ij. F. pilulae 20. Chronic j hora somni. Diseases. 203a. B Extr. Colocynth. comp. Sapon. med. 7 3ij- 01. Juniperi gtt. xl. F. pilulae 20. j bis die. Meteorismus. 203b. B Extr. Colocynth. comp. Chin, sulfurici 7 3j- Camphorae 3jv. F. pilulae 40. j ter die. Same. 203c. B Extr. Colocynth. comp. Calomelanos 7 gr. vj. Pulv. antimon. gr. j. F. pilulae 3. S. hora somni. Congestive Dysmenorrhea. 204a. . B Extr. Colocynth. co. 3 ss. " Hyoscyami 3j. Mass. Hydrarg. gr. xij. F. pilulae 12. Constipation. j v.ij subinde. (pregnancy.) Colchicum (p. 48) combined with Salines is much employed where torpor of portal circulation in gouty habits. In Constipation from retained feces: Tinctur. gtt. v—x post cibum. Colocynthis is mostly used to unload the bowels ia obstinate constipation; but it acts sometimes very violently, even in small doses, and in overdoses it may produce dangerous enteritis. Dose gr. v—x. It is usually given as pill. Piluloz Colocynthidis comp.: Extr. Colocynthid. p. 16. Aloes p. 50, Scammonium et Sapo 7 p. 14. Cardamomum p. 6, Alcohol p. 10. CATHARTICS. 91 204b. B Pil- Colocynth. comp. " Galbani comp.7 3j. Ferri oxydati gr. xij. Theriacae q. s. F. pilulae 12. ij bis die. Mastodynia. 205. B Elaterii gr. ij. Extr. Taraxaci gr. x. F. pilulae 8. j tertiis horis. Dropsy. 206a. B Pil- Cambog. comp. 3 j. Mass. Hpdrarg. 3 ss. F. pilulae 30. Constipation. ij subinde, (habitual.) 206b. B Pil. Cambog. comp. 3 jss. Chinini sulfurici 3 j. F. pilulae 30. j semel vel bis die. Vulvar Enterocele. 207. B Glycerinae § ij. Kali bitartarici 3j. | j as dose. Laxative. 208a. B Calomelanos 3j. Opii 3 ss. Tart, emetici gr. x. F. pilulae 40. j ter die. Hepatitis. Elaterium is, perhaps, the most important of the hydragogues, being generally used in dropsical affec- tions, and also frequently as revulsive in cerebral dis- eases. Its action is no less violent than that of either Camboge or Colocynthis, and has proved even fatal in overdoses; but if administered in divided doses its effect can easily be regulated. In Bright's Disease, to prevent Uraemia, gr. 1-16—\ hourly until purgation. Cambogia (Gutti) is also very violent in its action, andoverdoses have proved fatal. Itis usually employed in obstinate Constipation, combined with milder cathar- tics, in order to accelerate their action. Pil. cathartic, comp.—Extr. Colocynth. comp. 8.40. Abstract. Jalapae et Calomel 7 6.50. Cambogia 1.60.—Pilulae 100. Pil. Cambogice comp.—Aloes, Cambogia, Pulv. aroma- ticus^T2.5. Sapo5.0. Syr. simplex q. s. F. pilulae ponderis 0.15. Dose 2—4. Glycerin is more used as menstruum and nutritive than as laxative. See page 81. 92 CATHARTICS. 208b. 209b. B Calomelanos gr. x. B Calomelanos gr. jv. Ipecacuanhae gr. j. Jalapae gr. vj. Afterward Salts. Jaundice. Pulv. antimon. gr. j. 208c. Afterwards Senna. Dropsy. B Calomelanos gr. vj. (after Scarlatina.) Rad. Rhei gr. xij. (5 years.) Later 01. Ricini. 210. Chlorosis, g Calomelanos gr. vj. 209a. Pol. Digitalis gr. ij. B Calomelanos gr. x. F. pilulae 2. Jalapae gr. xv. j hora somni. Anasarca Pulv. antimon. gr. ij. from gestation. Followed by Senna. To be followed in the morn- Epilepsy, ing by ^ oz. of Salts. Jalapa is mostly used with Cream of Tartar (1:2) as Pulvis Jalapae compositus in cerebral and dropsical affec- tions; and with Calomel in bilious fever. It is apower- fulhydragogue,causingoften much pain,and an overdose may produce dangerous hyperaesthesia. The dose varies from gr. xv—xxx; in combination: gr. x. Mercurial Cathartics are frequently employed with a view of combining a purgative action with an increased flow of bile (many practitioners object to Mercury and use other drugs, especially Podophyllin instead), but are never administered without being followed by some other cathartic, to insure a full action. Calomel is given in doses of from gr. vj—xij, followed in 4—6 hours by \ oz.—1 oz. of Salts, Senna or Castor oil; for children larger doses are required in proportion than for adults, gr. ij—vj being the dose for a child from 2—6 years old, though, generally speaking, Grey Powder is preferable in Pediatrics. Blue Pill is milder than Calomel, and forms, with Black draught, all over England a popular remedy for biliousness. In Suppression of Menses, Calomel gr. x, followed after 6 hours by Senna, or some other cathartic; in CATHARTICS. 93 211. 213. B Massae Hydrargyri B Olei Olivarum § vj. Sapon. med. 7 grs. xij. In one dose, or | ss half Asae foetidae gr. vj. hourly after a day's fasting. F. pilulae 6. Constipation. Hepatic Colic. j vel ij h. s. (of pregnants.) 214 212. B Podophyllin. gr. j. B Hydrarg. c. Creta Spir. Vini Gallici 3j- Rad Rhei 7 gr. ij. Syr. simplicis § iij. Ipecacuanh. gr. 1-6. 3 j semel vel bis die. Convulsion's Gastro-intestinal from teething. (8 years.) Catarrh. defective Menstruation at the climacteric period, with Jalapa (No. 209); in profuse Menstruation from undue lactation, with Rheum (No. 208.) In Constipation of children (1—4 years): gr. ij with jv—vj of Jalapa. Hydrargyrum cum Creta, gr. x—xij in Amenorrhoea, Palpitation from constipation, etc.; gr. jv in Paralysis for children of 1—2 years; gr. ij in Laryngismus stri- dulus from dentition (6 months); gr. j followed by Manna or Oleum Ricini 3 ss (5 weeks.) See section i. Oleum Olivo' (No. 213) is said to facilitate the passage of the gall-stones: The patient, after having swallowed the oil, should recline on the left side, with the hips higher than the shoulders. Podophyllin has a special determination to the upper part of the alimentary canal, and as it combines with its hydragogue property a decided cholagogue action, it is an excellent substitute for Mercury, especially in Func- tional Hepatic affections. As alterative it is occasion- ally of great service in Scrofula. Dose of Extractum fluidum: gtt. 20 — 3 ss=1.0—2.0. Podophyllin: gr. ± — j = 0.015—0.065. (0.005—0.015 for children of 6 months to 4 years; 0.02: 5 to 14 years; 0.03: over 14 years.) 94 CATHARTICS.\ 215a. B Extr. Frangulae fluidi Sodii Bicarbon. 7 3 ij- Tr. Colombo vel Tr. Nuc. Vomic. 3 j. Aq. Menthae ad § vj. | ss ter die ante cibum. (12 years.) Palpitation. 215b. Pulveris Rhei gr. x. Natri bicarbonici Sacchari 7 3 j. Olei Lavandulae gtt. v. Primo mane e cochlearibus duobus aquae sumendus. Constipation. 216a. B Extr. Rhei 3 ss. " Gentianae 3j. Sapon. med. gr. x. F. pilulae 20. ij bis vel ter die. Prolapsus Uteri. 216b. B Syrupi Rhei 20.0. " Sennae 10.0. Tr. Zingiberis 1.0. Aperient. 217a. B Olei Ricini 3 j. Tr. Opii gtt. j. For Infants. Rhamnus frangula is a mild acrid cathartic, similar to Rheum, but not so slow in its operation; thus proving a good and cheap substitute for the latter. The griping which it somtimes produces may be avoided by the addition of aromatics. Dose of Extractum fluidum: gtt. 20—3j = 1.0—4.0. Rheum is rather a slow cathartic; but it never causes inflammation of the alimentary canal. It is much em- ployed in cases of Diarrhoea, on account of its secondary astringent effect; and in Dyspepsia, on account of its stomachic and tonic properties. (See pp. 51 & 85.) As a mere cathartic it may be fully replaced by Rhamnus. Dose of root and fluid extract as stomachic laxative: gr. v—x; as purgative: 3j— 3 j; of Tr.: 3 ss— § j; and of Syrup: 3 j for an infant. No. 215b is said to be the most perfect combination of rhubarb; the lavender hides its flavor completely. ' Syr, Rhei: Extr. Rhei fl. 3 j; Tr. Cinnamomi T)ij; Pot.Carbonas gr.v; Syr. simplex § jv. CATHARTICS. 95 217b. B Olei Ricini 6.0. " Terebinthinae 4.0. Acaciae Aq. fontanae 7 40.0. 16 c. c. bihorio. Tympanitis. (Typhus.) 218a, B Magn. Carbonatis Rad. Rhei 7 3 ij- Aq. Cinnamomi § viij. | ss omni mane. Inversion. 218b. B Magnes. c. Rheo gr. x. Aquae Foeniculi § ij. 3 j ter die. Constipation. (3 months.) 219a. B Magn. sulfuricae § j. Ferri sulfurici gr. viij. vel Acidi sulf. dil. 3 ss. Aq. Menthae § viij. 3 j omni mane e cyatho aquae. Aperient and tonic. Vel: B Magn. Sulphatis Pot. Tartratis 7 \ ss. Tart, emetici gr. j. vel Ferri Sulphatis gr. x. Aq. Fontis § viij. 219b. B Magn. sulf. 3 j— § ss. Chin, sulfurici gr. ij. vel Tr. Nuc. Vom. gtt. xv. Aq. fontanae § jss. Primo mane ex aqua. 219c. B Magn. sulfuric. 3 ij- Ferri sulfurici gr. vj. Acidi sulf. dil. 3 ss. Infusi Gentianae § vj. § ss bis die. Amenorrhoea. 220a. B Kali tartarici gr. xv. " bicarbonici gr. xij. Magnesia?, gr. vj. Primo mane e cyatho aquae. Chronic Diseases. Castor Oil is perhaps the safest laxative used in gynae- cological and pediatric praxis, as it will open the bowels with the least possible irritation; hence its value in inflammations about the abdomen and pelvis; in affec- tions of the rectum and womb; in Pregnancy, Hernia, Typhus, etc. Dose § ss— f j; children: 3 j — § ss. In habitual Costiveness occasional massage or several articles of diet, which have a laxative property, will be frequently of assistance: oatmeal, bran, molasses, honey, and particularly ripe or dried fruit, as apples, prunes, tamarinds, etc. Salines: Magnesia (p.52,) though laxative, is gener- ally used as antacid, and mostly in pediatrics. Dose as 96 CATHARTICS. 220b. B Potass. Tartratis 3j. Jalapae gr. xij. Vel: Tympanitis. B Pot. Bitartratis 3 ij- Jalapae 3j- Dropsy. (to prevent Uraemia.) 220c. B Kali bitartarici 3 vj. Extr. Digitalis fl. 3 ss. Aq. fontanae § vj. | j ter die. Pleuritis. (if effusion.) 221. B Sodii Sulphatis 10.0- Extr. Taraxaci fl. 5.0. Aq. destillatae 50.0. Syrupi Rhei 25.0. 4 c. c. bihorio. Icterus Neonatorum. 222. B Sodii Phosphatis Mannae 7 3 j- Aquae Fceniculi § j. 3 ij ter die. Constipation. (3 years.) 223a. B Foliorum Sennae Semin. Anisi 7 § j- Aquae bulliente Oj. Colaturae adde Pot. Bitartratis § j. | jss every morning before breakfast. 223b. B Inf. Sennae comp. § jss. Spir. Nuc. Moschat § j. Syrupi Rhei § ij. | ss ter die. Prolapsus Vagine. laxative: 3j ex aqua vel lacte. Magnesii Sulphas (Magnesia sulfurica) is a mild refrigerant purgative, generally used with Senna. Dose § ss — § j. With Ferrum and other tonics (No. 209) it is of service in chronic diseases —ulceration of cervix, uteri, Cervical Endometritis, Engorgement of breast, etc.—to drain the congested abdominal veins and to brace the system. Potassii Bitartras (Kali bitartaricum) is in doses of 3 j— 3 ij a gentle diuretic and refrigerant aperient, useful in fevers; in doses of § ss— 1 j it has hydragogue properties, and is frequently used in Dropsies. Potassii Tartras, though similar to Cream of Tartar, is much less used: No. 220a, especially if the urine red. (Like Pot. Acetas both salts change in the stomach into carbonates. See page 53.) Potassii et Sodii Tartras (Tartarus natronatus) is generally employed in the form of Seid- litz powder, and well adapted to gouty habits and cases CATHARTICS. 97 223c. B Extr. Sennae fluid. Magn. sulfur. 7 3 ij- Tr. Jalapae Mannae 7 3 j- Aq. fontanae § jv. Vel: After Calomel. B Extr. Sennae fl. Magn, Sulphatis Tr. Jalapae 7 3 j. Aquae Fontis § ij. (5 years.) 223d. B Extr. Sennae fl. 3 ss " Frangulae fl. 3 ij. " Gentian, comp. fl. Sodii Bicarbon 7 3 j. Aq. fontanae \ vj. \ ss ter die ante cibum. Gastro-intestinal Catarrh. Vel: B Extr. Sennae fl. § ss. Ammonii chlorati 3 j. Aquae Anisi § vj. § ss ter die ante cibum. (If there be Jaundice.) 223e. B Extr. Sennae fl. T)ij. " Frangulae fl. 3j. " Gentian, comp. fl. Natri bicarbonici 7 3 ss. Aquae Anisi q. s. ad § ij. 3 j ter die ante cibum vel tertiis horis. (2-5 years.) 224a. B Sulfuris depurati Kali bitartarici Sacchari albi Olei Citri gtt. j. 3 j ter die ex aqua. Hemorrhoids ■ 20.0. '40.0. of uric acid diathesis; but it should not be given in the phosphatic, as it renders the urine alkaline. Sodii Sul- phas .(Natrum sulfuricum) is similar to Magn. Sulphas, but more bitter, and perhaps more nauseous. Sodii Phosphas is, on account of its agreeable taste, well adapted to all cases of children and delicate persons, especially where there is a deficiency of phosphor, and saline matter,it being a constituent of theblood in healih. Dose 15.0—50.0; in Constipation, with red urine, 3 iij every morning ex aqua. See page 5 7. Senna is a prompt and efficient cathartic, acting on the entire track of the intestinal canal, and producing watery feculent stools; hence its use in febrile and in- flammatory cases. The addition of bitters promotes its activity, and its tendency to gripe may be avoided by aromatics or neutral salts. Dose of Extractum fluidum, 98 CATHARTICS. 224b. B Sulf. praecipitati 3j- Magnesiae 3jv. Divide in partes 4. j hora somni ex aqua vel lacte. Same. 225a. B Olei Tiglii gtt. ij. Ipecacuanhae gr. ij. Calomelanos 3j. F. pilulae 10. Amenorrhoea. j quartis horis. 225b. B Olei Tiglii gtt vj-viij. Sacchari albi 3 j. Aquae fontanae 3 ij. Pars semis, and in 3 hours the rest, if necessary. Coma (if pulse strong). 225c. B Olei Tiglii 0.1. Sacchari albi 10.0. Acaciae Tr. Card. comp. 7 2.0. Aq. destillatae 60.0. 4 c. c. several times daily. Meningitis. 226. B Saponis Tiglii gr. vj. Pil. Colocynthidis c. Hyoscyam.gr. xxjv. Calomelanos 3 ss. F. pilulae 12. j bis vel ter die. Epilepsy from suppressed Menses. (With Magn. sulf. 3 j every morning). 2.0—8.0 bis vel ter die; 0.3—1.0 bihorio. In Constipa- tion of pregnancy: Electuarium e Senna 3 j— 3 ij bis die. Sulfur is a mild laxative, having at the same time a gentle stimulating property to the skin and mucous membrane; hence its value in chronic cutaneou's dis- eases. Dose, 3 j— § ss in treacle or milk. The choice between Sulfur depuratum and Sulfur praeclpitatum is a matter of taste, there being no difference in their effects. Croton Oil is, from the speediness of its action, still more than from the smallness of the dose required, a most valuable purgative in cerebral disorders, especially Coma. Even an external application to the abdomen- mixed with 01. Olivarum—will produce catharsis. Occa- sionally it is used in obstinate Constipation. The dose is gtt. j—ij, though sometimes as much as gtt. viij—x may be taken without affecting the bowels. SECTION VII. EMETICS Remove not only Indigesta and otherwise deleterious substances from the stomach, by exciting that viscus to discharge its contents through the mouth, but expel also foreign bodies if lodged in the throat or oesophagus. They, moreover, relieve spasm, promote perspiration and expectoration, and assist in the removal of obstruc- tions in the viscera generally. Alumen. Antimonii et Potassii Tartras. Apomorphinum. Cupri Sulphas. Hydrargyri Subsulphas flavus. Ipecacuanha. Sin apis. Sodii Chloridum. Zinci Sulphas. Emetics are contra-indicated in Congestion of the Brain, Hernia, Pregnancy, etc. 100 EMETICS. 227a. 228a. B Ipecacuanhae gr. xv. B Cupri sulfurici 1.0. Tart, emetici gr. j—ij. Sacchari Lactis 5.0. Dentur tales doses 3. Divide in partes 10. j every 15 minutes until j every 15 minutes until emesis. emesis. 227b. (3-7 years.) Croup. B Ipecacuanhae gr. jv. 228b. Tart, emetici gr. \. B Cupri sulfurici 1.0. With warm water. Aq. destillatae 40.0. (3 years.) Scarlatina. In 2 doses within 15 min. (if throat stuffed.) Opium poisoning. Ipecacuanha, is the emetic in all cases where a simple evacuation is required, mild and sure, and therefore well adapted in spasmodic Croup, acute Bronchitis of chil- dren, etc. The vomiting is promoted by the free use of tepid water; if excessive, it must be checked by de- mulcents, opiates and counter-irritation. Dose, gr. xv—xx; as nauseant, gr. \—ij ter die; as diaphoretic and expectorant, gr. \—\\ and as tonic, gr. l-10terdie. (p.82.) The fluid extract 3 ss— 3 j; Vin urn Ipecacuanhae § ss— § j; Syrupus Ipecacuanhae 3 ss— 3 j for children of 1—2 years; gtt. v—xx as expectorant. In commencement of Cholera: Pulv. Ipecacuanh. gr.vj (6 years.) In Fits: gr. iij—v (2 years.) Vinum Ipecacuanhae: Extractum fluidum 1.25. Vinum ad 20.0. Syrupus Ipecacuanhe:~Extr. fluidum 1.0. Syrupus simplex ad 20.0. Antimonii et Potassii Tartras (Stibio-Kali-tartari- cum—Tartarus stibiatus s. emeticus) Emetic Tartar is very valuable in Parturition if os rigid, and the skin hot and dry. See page 23. Vinum Antimonii (Vinum stibiatum) 1:250 Vinum. Cupri Sulphas (pp. 65 & 11)— gr. v—x in poisoning by Opium; 1.0 in poisoning by Potassii Cyanidum. Alumen (pp. 62 & 63): Dose as emetic, gr. viij—xxx EMETICS. 101 = 0.5—2.0. Teaspoonful ( 3 ss) in Croup; tablespoonful in poisoning with Opium. Apomorphin'^ especially valuable where insensibility prevents the administration of an emetic by mouth. See Hypodermic Medication, chapter n. llydrargyri Subsulphas Jlavus (Hydrargyrum sulfuri- cum). Gr. iij—v. of Turpeth Mineral is sometimes used in true Croup. Sinapis is especially useful in atonic conditions of the stomach. Dose 3j—3ij = 4.0—8.0. One tea or tablespoonful in poisoning by Opium. Sodii Cldoridum (p. 57.) A tablespoonful of salt in warm water in Alcohol poisoning. Zinci Sulphas (p. 86) is perhaps the most reliable emetic in cases of narcotic poisoning. Dose, gr. xx—xxx. SECTION VIII. VERMIFUGE Destroy certain parasites in the human body, by either an antiseptic and inherent vermicidal power, or by in- vigorating the intestinal canal; and thus preventing the accumulation of mucous and slimy matter, without which these animals cannot exist. Agents which destroy the round worm (Ascaris): Cinchonidinum, Naphthalinum, Santoninum and Spigelia. The following either expel or kill the tapeworm (Taeniei): Aspidium ( Filix mas), Chloroform., Cuprum oxydatum nigrum, Granatum (Punica),Pepo(Cucur- bita), Phenolum, Terebinthina, Thymolum. In Trichinosis (Trichiniasis) have been successfully used Benzinum & Salicinum. VERMIFUGJE. 103 229. B Cinchonid. tannici Ferri oxyd. hydr. 7 1-0 Divide in partes 10. j hourly during forenoon. Ascarides. 230. B Santonini Sacchari albi 7 gr. iij. Dentur tales doses 12. j ter die. Same. 231. B Rad. Spigeliae gr. vj. Calomelanos gr. jv. Followed by Oleum Ricini. (10 years.) Chorea from worms. Vel: B Rad. Spigeliae § ss. Foliorum Sennae 3 ij- Fiat Infusum § jv. 1 ss bis die. (4 years.) 232. B Acid, carbol. gtt. viij. Glycerinae § ij. Aq. Fontis § vj. § ss— | j hourly for one day, followed by a cathartic. Taenia. 233. B Cupri oxydati nigri 6.0. Calcariae carbonicae 2.0. Boli albi laevigat 12.0. Glycerinae 10.0. F. pilulae 120. ij quater die for one week, then iij each time. Same. 234. B 01. Filic. maris 3 j- Mucil. Acaciae q. s. Fiat Emulsio. Sumatur hora somni e lacte. Same. Cinchonidinum tannicum cum Ferro (p. 11) is an excellent remedy in round worms; but the pin worm is more easily destroyed by appropriate enemata followed by tonics. (Nos. 376 & 377.) The dose is gr. iij—xxx =0.2—2.0. Napthalin (p. 15) has been recommended in doses of from $}—jv per diem; for children under 3 years gr. ij—iij bis die. Also as taenicide. Santonintan (Santonina) in strong doses produces thoughtlessness and chromatopsia in weak children; and 0.5 may kill. (p. 6.) It should be followed always by a brisk purgative. Maxim, dose: 0.1; 0.5 per diem; 2doses of 0.025 each during forenoon to child of 1 or 2 years; 3 doses in the same space of time to child of 104 VERMIFUGE. Vel: Vel. B Extr. Filicis aetherei B Emuls. Sem. Cucurbit. " Granat C. Rd. (ex § ij parat) § viij. 7 2.5. This dose several days in Cort. Rad. Granatiq. s. succession. Same. F. pilulae 40. Lycopodio Vel: conspergantur. B CI. Terebinthinae § ij. iij after a milk-breakfast. Mucil. Acaciae § ss. 235. Aq. fontanae q. s. B Dec. Granati Cort. Rd. Fiat Emulsio § vj. (ex | ijss) 3 xij. Tr. aromaticae 3 ij. In the course of the fore- Pars quarta every half hour. noon. Same. Same. 3 or 4 years; 2 doses of 0.05 each during forenoon: 5 or 6 years; 3 doses—7 or 8 years. Spigelia should also be followed by a brisk purgative. Dose of Extractum fluidum: 3 j— 3 ij=4.0—8.0. Extr. Spigeliae c. Senna fl. § ss ter die. Acidumcarbolicum (p. 16.) Dose gr.£-iij=0.032-0.2. As the worm is nourished by the contents of the small intestines by endosmosis, no fat nor farinaceous food should be given; only beef tea freely. Aspidium Filix mas—The oleoresin is more effective than the extract; but no dinner or supper must be taken to obtain a good effect of the oil. The practice of giving the remedy for tapeworm to fasting patients has lately been condemned. Its administration cne hour or two after a full meal is said to be at least as effective and decidedly less irritating to stomach and intestines. Dose of the oil, gtt. 15—30 = 1.0 — 2.0; of the extract, gtt. 10—20 = 0.65—1.3. Cuprum oxydatum nigrum is said to kill the worm without producing the slightest inconvenience to its victim; but during the time that the pills are taken, acid drinks must be avoided. Granatum—The bark of the root has never failed in my hands, but it must be fresh, and I took care to have VERMIFUGE. 105 236. 237. B Benzini 3 ij- B Acidi salicylici 10.0. Succi Glycyrrhizae Solve in Mucil. Acaciae 7 1 j. Alcoholis puri 1000.0. Aq. Menth. q. s. ad 3 vj. Turn adde § ss omni hora vel bihorio. Olei Carvi 2.5. Trichinosis. Tr. aromaticae 50.0. Vel: Syr. simplicis 950.0. B Benzini 3j. 32 c. c. after having eaten Glycerinae § viij. pork suspected to contain § ssomni hora vel semihora. Trichinae. the root dug in my presence. Dose gr. xv— 3 j = 1-0 —1.0; of Extractum fluidum gtt. xx—xc = 0.65—3.0. (If there be any doubt about the freshness of the root Pelletierine should be taken.) Ol. Terebinth. 3 ij bis die for 2 days, followed by Oleum Ricini % ss and to be repeated in 4 hours unless the bowels open freely, to child of 5 years. See page 68. Chloroform (p. 30) has been given in doses of gtt. 30 half-hourly; or in 3 j dose before breakfast in conjunc- tion with Ol. Ricini et Tiglii (gtt j: § j). Thymol (p 19) is recommended as a perfectly safe remedy for tapeworm, if its depressing effect is counter- balanced by a simultaneous administration of brandy or some other stimulant. It is exhibited in gr. x doses every 15 minutes until 3 ij are taken, the last dose to be followed by some cathartic. It appears, however, that Acidum thymicum may be completely replaced by Acidum salicylicum. See page 16. Benzin (p. 45) may be given in doses of 0.065—0.65. CHAPTER II. HYPODERMIC MEDICATION. The nature of the remedies used in Hypodermic Medication prevents this form of administering medi- cines from overstepping certain limits in the art of heal- ing; yet in many cases where we can avail ourselves of it, we must confess that it is an invaluable auxiliary. The great advantage of subcutaneous injections lies not only in the rapid absorption and consequent imme- diate action of the remedy on the system,but still more in the fact that they may be employed with the full effect of the remedial agent, where absorption from the stomach is altogether out of question on account of its irritability, as in pernicious fevers, cholera, etc., and last, but not least, where the condition of the patient pre- cludes the exhibition of a medicine in any other way, as in cases attended with more or less insensibility of the sensorium. HYPODERMIC MEDICATION. 107 238. Solut. Acidi arseniosi 1 per cent. gtt. iij__v. vel Sol. Fowleri p. j; Aq. dest. p. ij. 0.6—1.0 during the fit. Asthma, (p. 11). 8—10 injections suffice. In Chorea gtt iij for child of 4—7 years, every other day; gtt. v: 11—14 years. (15—20 injections per month.) 239. Solut. Acid, carbol. (1.0) 30.0; 1.0 as injec- tion. (Superiorto Quinine?) Intermittens, (p. 16.) In Acute Rheumatism (articular), Lumbago and Erysipelas, one syringeful near the affected joints once a day of a 2 per cent, solution. A parenchymatous injection of the same strength is employed for inflamed glands and all kinds of tumors. 240. Apomorphin. hydrochlor. 0.12; Aq. dest. 10.0. Per penicillum lanae vitreae funde (1.0 = 0.012). One syringeful (0.005) during the aura. Epilepsy. Aside from being shortened, the paroxysm, if it should re- appear at all, will be extremely mild—perhaps only a fainting—which may be ultimately cured by using later aboutO.0025. (?) 0.006—0.012 in Croup or Diphtheria. Solutio Apomorph. (gr. j) 3 ijss. Dose, min. v—xx. Being a prompt emetic, it is especially valuable where insensibility prevents the administration of an emetic by mouth. See sections in & vn. A successful use of the hypodermic syringe is only to be expected if the following rules are borne in mind and acted upon: 1. The remedial agent has to be of the greatest purity, hence the necessity of using fresh solutions. The menstruum may be distilled water, or, what is as good, filtered rainwater. If, however, we wish to keep a solution for some time, Bichloride of Mercury in the proportion of 1:5000 as menstruum is sure to prevent decomposition? (By employing Sol. Hydr. bichlor. [0.1] 500.0, we have in 8 drops 0.0001, or 1-G( 0 grain.) Moreover, the solution should be perfectly neutral and always filtered,and 108 HYPODERMIC MEDICATION 241. Atrop. sulf. gr. j; Aqua pura 3 xv. (10 min.= 1-90 gr.). Dose, min. v—xx. Gr. 1-90 in Congestion of the brain (feeling like a tight band round the head, heavy breathing, eyes bloodshot, etc.) Gr. 1-30 every half hour in poisoning by Opium, (p. 23.) For Atrop. cum Morph. see No. 255b. 242. Caffein. gr. x; Alcohol & Aq. dest. ana 3 jss (1 min.= gr. 1-18). Dose, min. jv—xviij 243. Camphora gr. v; Alcohol 3 j- Dose, min. vj— xxx. See section n. 244. Chinin. bisulf. 3j; Acidum boracicum gr. ij; Morph. gr. £; Aq. dest. § j. Gtt. viij=gr. j. The effect of Quinine hypodermically is about four times greater than when taken by mouth, and in this composition the risk of abscesses at the place of injection is rendered like nil. The Carbamide (1—2:10 Aqua) is said to produce neither an irritating effect. 245. Chloral, pars j; Aq. pura partes ij. Dose, min. viij—x. Restlessness. See page 30. there will be no danger of inflammatory swellings or abscesses about the part where the injection has been made. 2. The injection should be made where there is the most abundant supply of cellular tissue—abdom^ti, arm, thigh, back and oalves of the legs; and in case of repetition, another spot should be chosen, to prevent irritation of the part. (Bony pro- minences, inflamed parts and veins are to be avoided.) 3. Before making the puncture, the air contained in the syringe should be expelled, by everting the instrument and pressing the piston just far enough to have at the needle's point a show of the liquid employed. Lastly, having at the place selected drawn up the skin in a tense fold with two fingers, the needle should be thrust as far as possible into the subcutaneous tissue, and the remedy very slowly injected. After withdrawing the needle, it is well to apply the finger over the puncture for a short time, to prevent any escape of the liquid injected. HYPODERMIC MEDICATION. 109 246. Chloroform, min. v—x in Neuralgia, Nervous Excitement, Morbus nauticum. See section n. 247. Cocain. gr. j; Aq. dest. gtt. x bis die. Alco- holism. (Effect within 5 minutes?) In smaller doses it is employed in Melancholia, Insanity, Chorea gravior, Spinal Irritation, etc. See pages 77, 112 & 115. As anaestheticum gttviij of a 4 per cent, solution injected at the anterior and the same quantity at the posterior base of the tumor. Sebaceous Cyst. (After 25 minutes a linear incision may be made and the sac pulled out). 248. Coniin. 0.1; Alcohol 10.0; Aq. dest. 40.0. One syringef ul(=l .0=0.002). (This dose double is the strong- est to be admitted?) Asthma, Convulsions, Neuralgia. 249. Daturin. gr. ss; Aqua | j. Dose, min. jv—x. 250. Digitalin.gr. ss; Alcohol, Aq. dest.7 3 ij. Dose, min. jv.—viij vel Tr. Digitalis min. x. Insolatio. (p. 50.) 251. Duboisin. sulf. 0.05; Aq. dest. 20.0. 0.1—0.3 (=0.00025—0.00075) as injection. Strongest dose: 0.4. Antidote to Pilocarpin. See Hyoscyamus. (p. 33). 252. Ergotin. gr. xv; Alcohol & Glycerin. 7 3 ijss. Dose, min. v—xxx. (min. 1 = 1-20 gr.) Extr. Ergotae fluidum min. x. (p. 65). 253. Sol. Ferri citr. 10 per cent, gtt. xv daily in Chlorosis (if irritable stomach). 254. Hydrarg. bichloratum 0.25—0.5; Aqua pura & Glycerin. 7 15.0. Once every third or fourth day in the arm. Syphilis. 255a. Sol. Morph.Magendie gtt. x every 8 or 12 hours in Dysmenorrhoea. In Hematocele, if there be great prostratioD, it may be repeated in £ hour if it fail to give HO HYPODERMIC MEDICATION. relief. In Cellulitis, Uterine Colic, Pelvic Peritonitis, etc. Morphium gr. 1-5 in Gastralgia,etc. In Cholera, if it has been rejected by mouth. See page 38. 255b. Morph. sulfur, gr. xxjv; Atropin, gr. j; 01. Amygdal. am. aeth. gtt. j; Aqua pura § ij. min. x = Morph. gr. \. & Atropin. gr. 1-96. Morphin. c. Atropin. is usually dosed in proportions of gr. £: 1-100__gr. }: 1.120—gr.±: 1-150—gr. 1-6: 1-180—gr. ^: 1-200, etc. 256a. Physostigma. The Calabar bean has been em- ployed with good effect in Trismus Neonatorum: gtt. j—v of Sol. Extracti (gr. ijss: 3 j). 256b. Pilocarpin. gr. 1.5; Aqua gtt. x. 2—3 minutes after the chill has fairly begun. Intermittens. Pilo- carpin gr. i—1-6; Aqua gtt. x. See Jaborandi, page 50. 257. Strychn. nitricum 0.06; Aq. dest. 7.5. £ syringe- ful near the sacrum. Enuresis nocturna. (2-4 injections are sure to cure?) Strychn. nitr. 0.1; Aq. dest. 20.0 (1.0=0.005); vel Aq. pura 12.5 (1.0=0.008). Strychnin. nitricum gr. ss; Aqua dest. § ss. Dose, min. jv—xv. See Nux Vomica, section v. 258. Veratrin. 0.1; Acidum aceticum dil. gtt. xij; Alcohol. 2.0; Aq. dest. ad 20.0. See section n. 0.25—0.5 — 0.75 to be injected. (0.00125—0.0025 — 0.00375). Puerperal Convulsions. 259. Woorara 0.1: Aq. dest. 10.0. Funde per lanam vitream. To begin with 0.15 to 0.2. Epilepsy. Woorara 0.3; Aq. dest. 5.0; Acid, hydrochlor. d. gtt. j. For eight injections. Blepharospasmus. Woorara gr. j; Aq. 3 iij. Dose, min. v—x. (In Hydrophobia 0.2 have been in- jected within five hours with success). It may be used until relaxation of muscles ensue. See Curare, section ii. CHAPTER III. TOPICALS Act chiefly locally, though some of them, by being ab- sorbed, will affect organs more or less remote from the place of application. DISEASES OF EYE AND EAR. 260. Solutio Acid, borac. (1.0) 30.0. Conjunctivitis purulenta. Acidum boracicum pulv. applied once a day to the lids with a camel's hair brush is excellent in Granular Lids and Trachoma; it is also used in indolent Ulcers of the Cornea. A saturated solution of Boric acid (4 per cent.) is sometimes used as menstruum for Cocaine and other Alkaloids. 261. Solutio Argenti Nitratis (0.03) 15.0. Detur ad vitrum nigrum. Gtt j to be dropped into the inner angle of the eye bis vel ter die. Conjunctivitis catarrhalis. 0.15:15.0 Aqua: To be applied once a day with a camel's hair brush, and to be immediately wiped off with another brush dipped in a solution of Sodii Chloridum. (The surplus of the caustic is thus made inert, forming Argenti Chlorid. which is insoluble). Gonorrheal Ophthalmia. (If the inflammation be severe, two or three leeches 112 TOPICALS: should be applied to the inner angle of the eye or to the templesand a cathartic given. In case ofpain,w&rm water compresses, with laudanum, over the eye will be useful, 262. Atrop. purum 0.05: Aq. dest. 150.0. To apply to cornea every three hours. Iritis. Atrop. 0.05—0.2; Ol. Ricini 30.0. Keratitis. Atrop. sulf. 0.05 — 0.08; Aqua destillata 10.0. vel Atrop. 0.1; Glycerol, simplex 20.0. vel Atropin. 0.01; Glycerin. 5.0; Aq. dest. 10.0. vel Atrop. purum 0.1—0.15; Acid, salicylicum 0.05; Aqua dest. 20.0. Collyrium stillatitium. 263. Cocain. gr. v; Atrop. gr. ss; Ungt. Petrolei 3 ij. To be applied with a camel's hair brush. Ophthalmia. (To relieve pain). Solutio Cocaini hydrochlorati 4 per cent. gtt. j—ij to the inner angle of the eye at intervals of three minutes, as anaesthetic, for the removal of for- eign bodies from the cornea. The effect is produced within ten minutes. (A lens of 3-inch focus is required by some for the operation, which is performed best by means of a cataract needle.) See page 115. 264. Extr. Conii 2.0. Aqua destillata 1.0; Glycerol- atumsimplex 20.0. To rub around the eye. Photophobia. Coniinum 0.01; Alcohol dilutus 1.0; Aq. destillata 12.5. Blepharismus (scrofulous). 265. Duboisin. sulf. 0.05—0.08; Aq. destillata 15.0. Collyr. stillatitium. (For dilating the pupil it is quicker in action than Atropin. See Hyoscyamus, page 33.) 266. Hydrargyrum amidato-chloratum 0.25—0.35; Unguentum simplex 5.0. Applicatur bis vel ter die. Blenorrhoea palpebrarum. Ungt. Hydrarg. rbr. (1:8) 3 i. Ungt. Cetacei 3 ij; vel Hydr. oxyd. rbr. gr. j; Zinc. sulf.gr. ij; Ungt. simplex 3 ij. Ophthalmia Tarsi. Diseases of Eye and Ear. 113 267. Hydrarg. bichlorat gr. j; Ammon. chlor. gr. iv. Aqua | vj. Apply three times a day. Ophthalmia Neonatorum. Conjunctivitis scrophulosa. 268. Calomel is dusted over the affected part with a camel's hair brush. In Conjunctivitis phlyctenulosa Macula-, Cornece, etc. See Iodine, page 14. Hydr. oxyd. rbr. gr. xv; Tutia gr. vi; Adeps 3 ij. To be smeared in the edge of the lid night and morning. Albugo. Lencoma. 269. Iodoform., Balsamum peruvianum 7 f- o. Ungt. Petrolei4.0. Conjunctivitis, Keratitis. Iodol. 3 j, Ungt. Petrol. § ss. Chronic Conjunctivitis. Iodoform or Iodol dusted over the sore has been lately usedin Ulcus Cornea?^ (Iodol is the inodorous substitute of Iodoform, and is said to be superior to the latter. It may be used on tampons for abscesses, etc., in most cases where Iodo- form is indicated. See No. 280). 270. Physostigmin. purum 0.01; Sol. Acid, boric. 4 per cent. 100.0. vel Eserin. salicylicum 0.1; Aq. dest. 30.0—50.0. To effect myosis. Iritis. Physostigmin like Muscarin causes myosis and ptyalism. (Antidote: Belladonna, as in Poisoning by Mushrooms.) 271. Strychnin, nitricum 0.1; Glycerina 10.0. vel Strychn. purum 1.0; Ol. Amygdalarum 12.0. Gtt. xv —xx bis die over the eye or forehead. Amaurosis. 272. Veratrin. 0.5—1.5; Alcohol. 30.0. Amaurosis, Amblyopia, Neuralgia, etc. 273. Spiritus Vini Gallici 3 ss; Aq. § iij. Collyrium. Liq. Plumbi gtt. xv; Liq. Opii sedat. 3 j; Aq. dest. 3 vj; vel Sol. Zinci sulf. (gr. j) § j. Alumen, Cuprum sulfuri- cum, Zincum aceticum (gr. j: § j) make also good collyria. 114 TOPICALS: 274. Acid, carbolicum gtt. x; 01. Succini gtt. v; 01. Hyoscyami 5.0; 01. Olivarum 30.0. Guttas aliquot ad aurem bis die. Partial Deafness, Otalgia, Otorrhea, Ulcus, etc. Acid, salicylicum 2.0; Alcohol. 40.0. Aq. dest. 60.0. Applicatur bis die ad aurem. Otorrhcea. 275. Pulvis Aluminis blown in the auditory passage once a day is of great value in Otorrhcea with Fungoid Growth. 276. Solutio Atrop. (0.03:15.0) gtt. iij— v dropped into the ear and allowed to remain there for 10—15 minutes. Otalgia, especially nocturnal. (Child under 3 years; when over 10 years 0.1:15.0.) Chloral, Cam- phora ±)\j; Glycerin. 3iij; Ol. Amygdalarum 3j- On cotton. Otalgia. 277. Aq. Calcis & Lac 7 1 j; Tinct Myrrhae gtt xij. Otorrhoea (inflammatory). 278. Ol.camphoratum 5.0; Ol. Cayeputi2.5. Partial Deafness, Rheumatic Otalgia. Ol. Camphorae 15.0; 01. Amygdalarum 30.0; Liquor Ammon. anisatus gtt. viij. Hypocophosis asthenica, etc. 279. Ungt. Hydrarg. nitric & Ol. Amygdal. ana in Chronic Inflammation of the auditory canal in children, after cessation of discharge. 280. Iodol. 25.0; Glycerin. 100.0. Acute Otitis. See preceding page, No. 269. 281. Sol. Zinci sulfurici 0.05:25.0. Otorrhcea. Sol. Potass. Permanganatis 0.1:25.0 (if fetid discharge). 282. Tr. Opii 2.0; Ol. Olivarum 8.0. Otitis externa. (Besides an emollient poultice—onion or poppies—over the ear, and if necessary two or three leeches round the mastoid process, and perhaps a brisk cathartic.) Diseases of Air Passages, etc. 115 DISEASES OF THE AIR PASSAGES AND ADJACENT PARTS. 283. Tinctura Catechu 20.0; Tr. Cinnamomi 10.0; Aq. Menth. spirituosa 150.0. 16 c. c. with water as mouth-wash. Tr. Catechu, Tr. Cinnamomi, Tr. Ratanhae 7 25.0; Tr. Chinae 10.0: Tr. Myrrhae 15.0; Spir. Coch- lear. 50.0; Bals. peruvianum 1.0. vel Tr. Catechu 80.0; Tr. Guayaci, Tr. Ratanh. 7 40.0; Tr. Caryophyll. 30.0; Tr. Myrrh. 160.0; Spir. Cochleariae 20.0; Ol. Cinnamom. gtt xx; Ol. Rosarum gtt. j; Alcohol & Aqua 7 315.0. 284. Borax et Saccharum, ana. A little on tongue bis die. Stomatitis. (I use invariably a watery solution, without either saccharum or mel.) 285. Solutio Cocaini 4 per cent, rubbed on the gums twice within three or four minutes will quiet an infant, produce sleep, and even stop diarrhoea. Teething. On absorbent cotton, or applied with a camel's hair brush to the mucous membrane of nose and fauces, it is employed in Catarrh and Hay Fever. (In the asthmatic form it is useless, and better to have at once recourse to Lobelia, Chloroform, Nitre fumigations or inhalations of seda- tive preparations.) Cocaine applied to the pharynx in Hysterical Vomiting frequently gives prompt, relief. See pages 77 & 109. 286. Hydrargyrum bichloratum 0.5; Glycerin.50.0. Syphilitic Ulcers, etc. 287. Potassii Chloras et Saccharum, ana. A little on tongue (besides steam, No. 418). Diphtheria. Acid. salicyl.,Bism. Subnitr. ana. To be blown into the mouth. 288. Solutio Arg. nitr. (gr. v) § j. To be applied once a day. See page 111. (Besides frequent cleansing 116 TOPICALS: of nose with milk or soap and water.) Ozcena. Argentum nitricum (3j: I j). Admovetur ter die ope penicilli camellinivelprobong armata spongia durante inspiratio. Laryngitis (acute or chronic, ulcer or no). 289a. Acid, carbol. 4.0; Glycerin.; Aqua 7 50.0. Ozcena. Kali hypermanganicum (gr.ij — v:|j,) vel Acidum chromicum 0.3; Aq. dest. 300.0. 289b. Acidum carbolicum et Alcohol ^ 10.0; Liq. Ammon. 12.0; Aq. dest. 20.0. Wide mouthed bottle of 50.0 should be filled with this to one-third, and then cotton q. s. to suck it up. For smelling in Catarrh. 290. Natrum bicarbon. et Borax7 3 ss; Glycerin. \ j; Aq. font. I* jv. As spray into the nose. — Sol. Zinci chlor. (gr. ij) § j; vel Sol. Zinci sulfo-carbol. (gr. v) § j. vel Glycerolatum Tannini (2)ij) f j. Apply with a cotton-wrapped probe. Catarrh. 291. Sol. Sanguinar. cone. (min. x) to be injected into the substance is said to be specific in Polypus of Nose. 292. Iodum 0.12; Pot. Iodidum 2.5; Aq. dest. 30.0. 0.3—0.5, as submucous injection; vel Solutio Kalii iodati 2 per cent. Hypertrophy of Tonsils. 293., Tinct.Iodi ^ ss; Acid.carbol. 3 jss; Glycerin 3 ij- Once or twice a day to the thickened or ulcerated part. In painful deglutition of Laryngeal Tuberculosis. 294. Pot. Chloras gr. x; Pot. Permang., Acid, salicyl. ana gr. v; Aqua § j. Applicatur ter die. Diphtheria. (In Croup, Sore Throat, and other internal inflammations of the throat, Acid, aceticum is sometimes applied by means of blotting paper, cambric or lint as blister.) 295. Laryngotomy, In urgent cases, a penknife is Diseases of Air Passages, etc. 117 passed horizontally through both skin and cryco-thyroid membrane at once—the latter may be felt as a soft de- pression an inch below the pomum Adami—after which the opening may be enlarged laterally to the required extent. 296. Catheter in Laryngismus stridulus. Any cathe- ter may be employed which can be passed through the rima glottidis (moistened with Cocain.4 per cent)? 297. Bougie in Stricture of (Esophagus. The patient sits upright, with the head thrown as far back as possi- ble, and the mouth wide open. A curved bougie, gently warmed and oiled, is passed down the pharynx, taking cure that its point slides along the spine. To prevent cough by interference with the epiglottis, the patient should protrude the tongue as far as possible, or perform the act of deglutition, just when the bougie is entering the pharynx. (Cocain may be sometimes of service.) A Stomach pump is managed in the same way. Some- times a gag is placed in the patient's mouth (especially if he be insane),havingahole for the tube to pass through. Before beginning to pump a pint or two of water should be injected into the stomach, and the pumping water in and out should be repeated until it returns colorless. 298a. Antiseptic Gargles. Acidum carbolicum 3j; Glycerin. | j; Aqua fontana | v. Scarlatina. Sol. Kali hypermanganici (gr. x) f v. Fetid Breath. Iodum 1.0; Pot. Iodid. 2,0; Aq. dest 200.0. Salivatio mercurialis. Sol. Hydrargyr. bichlor. (gr. ss) 1 ij; Aq. Calcis | vj. Diphtheria. (The sublimate is used on account of its parasiticide properties, and the lime-water for its dis- solving action upon the membrane.) 118 TOP1CALS: 298b. Solutio Acidi carbolici (3j: § vj) will suffice in mild cases of Diphtheria, without any other medication. It has to be used every half hour until the redness di- minishes, when it must be employed lukewarm, whilst every two or three hours Priessnitz's compress (which has to be warm also, when the inflammation becomes less) is applied to the throat: A linen handkerchief or rag, folded about four times and dipped in cold water, is put around the neck (not dripping wet) and covered with oiled silk or some woolen cloth, that by overlap- ping it on both sides will prevent evaporation. 299. Astringent Gargles. Acidum tannicum3j; Spir. Vini Gallici § ss; Glycerin, § j; Aq. Camphorae ad § viij. Relaxed Throat. Alum. 3 j; Acid. sulf. d. 3j; Dec. Cinchon. 1 vj. vel Kali chloricum 3j; Tr. Ferri chlor. 3ij; Glycerin. | j; Aq. font. § vij. Scarlatina. 300. Cooling and Sialogogue Gargles for Acute In- flammations. Acid, hydrochlor. dil. 3 ss; Glycerin. § j; Aq. font. | vij. Pot. Chloras, Pot. Nitras, vel Borax 3 j; Aq. font. | viij. Scarlatina, etc. 301. Stimulating Gargles. Tr. Capsici 3 j— 3 ij, vel Tr. Pyrethri 3 iij; Aq. font. § viij. Acute Pharyngitis. Acid, nitricum gtt 'jv; Glycerin. §j; Aq. font § iij. As gargle or spray. Hoarseness. 302. Acid.carbol. 3 ss; Pot.chlor. 3 ij; Glycerin. § ij; Aq. font. § vj. To be inhaled from a hot plate ter die. Pertussis* Solutio Acidi carbolici (gr. ij__3j)§j. Per atomizer. Pulmonary Gangrene, Phthisis. ♦Inhalations of any kind should not exceed ten minutes at a time, and the first sittings may be from five to eight minutes. Moreover, they should never be performed after a full meal, and Diseases of Air Passages, etc. 119 303. Solutio Tannin, (gr. ij—3j) § j. Per atomizer. Chron. Catarrh, Laryngeal Ulceration, CEdema Glottidis. 304a. ^57ther. chlor. q. vis, from a handkerchief. Dyspnoea (Phthisis). Mih. sulf. in Emphysema senilis. 304b. iEther. p. jx; Chloroform, p. 1. An anaestheti- cum. Some use a mixture of Ether, Chloroform and Alcohol; and Ether pure to continue the anaesthesia dur- ing the operation. (As a rule Ether is safer than Chloroform; but it is contra-indicated in Kidney dis- eases, Pneumonia and Bronchitis. In valv. lesions either are contra-indicated, unless there is compensating en- largement. In fatty or weak heart they are also object- ionable, though Ether less than Chloroform. In opera- tions, as Kelotomy, those involving the peritoneum, and the removal of deep-seated tumors in the vicinity of large vessels, Chloroform is preferable). In any case, respiration, pulse and pupil should be watched, and after insensibility of the conjunctiva is established, its admin- istration should be regulated by the state of the pupils, i. e., the pupils should remain contracted, and only when they dilate, the anaestheticum should be reapplied, bear- ing in mind that a sudden dilatation of the contracted pupil during the application of Chloroform denotes danger. If there is fear or nervous depression, the administration of Chloroform should be preceded by a stimulant and a little morphine. the patient should not expose himself to the fresh air before an hour after the operation. No more than five to eight inspira- tions per minute should be made, the depth of which have to be regulated according to the distance of the air passages to be reached. 120 TOPICALS: 305. Sol. Aluminis ( 3 j) 1 ij- To be inhaled for five minutes from a hot plate. Haemoptysis. 306. Solutio Ammonii chlorati (gr. ij—x) § j. Per atomizer. Laryngeal Catarrh. 307. Aq. Amygdalar. amar. cone. § j. Per atomizer, several times a day. Cough. 308. Amyl. aether, nitr. et Alcohol. 7 2.5. Gtt. v—x to be inhaled from handkerchief. Angina pectoris, Dyspnoea, Neuralgia, Spasmus Glottidis, Epilepsy, etc. 309. Solutio Argenti nitrici (gr. ss—x) § j. Per atomizer. Pharyngitis. The small dose in the follicu- lar and the large dose in the ulcerative form.) 310. Liq. Pot. arsen. gtt j—x; Aq. destillata |j Per atomizer. Nervous Asthma. Sometimes the fumes of burning writing paper, which has been imbued with Sol. Fowleri 1.0 (gtt. xviij) and dried, gives relief. 311. Aq. Asaefoetid. § j. Peratomizer. Asthma,etc. 312. Extr. Bellad. 0.025: Pot. Bromidum 4.0; Liq. Ammon. Acet. 5.0; Aq. dest. 60.0. To be inhaled ter die from a hot plate until dilatation of pupil. (A two or three days' cure?) vel Sol. Kal. brom. 4—5 per cent. Gtt. xx ter die as inhalation. Pertussis. 313. Bromum (gtt. jx), Pot. Bromidum 0.3; Aqua dest. 150.0. On a sponge or cotton in a tube of paraffine paper, to be placed before nose and mouth for five to ten minutes, and hourly repeated. Croup, Diphtheria. 314. Camphora 3 j; iEther sulfuricus § ss. A few drops to be inhaled. Cephalalgia nervosa. Diseases of Air Passages, etc. 121 315. R Extr. Cannab. fl. gtt. j—jv, vel Tr. gtt. x—xx; Aq. dest. 3J. Per atomiser. Irritating Cough. 316. R Chloroform, part, v; 01. Terebinth, pars j. Anaesthetic. (01. Terebinth, is said to prevent (Edema. Antidote: Pulv. aerophor. As an Emetic. Amyl or Am- monia to smell at.) Chloroform, gtt. iij—jv at the time. Trismus nascentium. See No. 304. 317. IJ Sod. chlor. gr. v—x; Aq. font. |j. Per ato- mizer. Expectorant. Liq. Sod. chlor. 3ss—j; Aq. font. fj. Phthisis. (If breath or expectoration offensive.) 318. R Cocain. gr. viij; Pot. chlor., Aq. Amygdal. am. a 3j; Aq. dest. § viij. From a hot plate bis die for a few miuutes. Pertussis. 319. R Extr. Conii fl. gtt. v—xv; Aq. font. 3J. Per atomizer. Cough (Phthisis). Vel: Extr. Hyoscyam. fl. gtt. v—x\; vel Morph. sulf. gr. £. 320. R Tr. Ferri chlor. 3j, vel Liq. Ferri sub- sulf. 3ss; Aq. font. 3J. Per atomizer. Hoemoptysis. 321a. R Tr. lodi, Chloroform, a 10.0; Acid, carbol. gtt. xv. Gtt. v from a glass tube placed in hot water to be inhaled bis die by the nose. Nasal Catarrh. (A one day's cold cure?) 321b. R Sol. Pot. iod. (gr. ij—xx) |j. Per atomizer. Emphysema., Chron. Bronchitis. 322. R 01. Junip. Bacc. 3ss. To be dropped on a sponge dipped in hot water and squeezed for inhalation ter die. Dropsy. (Where the state of the stomach pre- cludes the internal use of diuretics.) 323. R Inf. Picis. liq. f j. Per atomizer. Gangrene. 122 TOPICALS : 324. R 01. Terebinth, gtt. ij; Magn. carb. q: s.; Aq. font. 3J. Per atomizer. Bronchitis, Emphysema. Vel: 01. Terebinth, q. v.; Aq. bulliente q. 1. Gangrene. 325. R Sol. Sod. nitr. (10.0) 40.0. Liquore plagulae quatuor ad quinque chartse bibulae imbuantur et calore non adhibito siccentur. Asthma. (| sheet to be burnt at the time.) DISEASES OF MALE GENITALS, ETC. 326. R Bism. nitr. 15.0; Aq. dest. 200.0. Injiciatur ter die.* Gonorrhoea (secundaria.) 327. R Acid, carbol. 3j; Glycerin. 3SS; Aq. font. |vj. As injection in Gonorrhoea; as lotion in Chancroid. Sol. Acid, carbol. (gtt. j) 3j; Alcohol, gtt. ij. Gtt. x—xx as injection in Bubo. (It must be injected deep into the bubo, and pain and inflammation will rapidly subside?) 328. R Sol. Acid, chrom. (0.3) 300.0. Injection. Gonorrhoea. 329. R Calomel. 3j; Aq. Calcis ^vj. Blackwash Chancroid. (If the chancroid be under six days old, Nitr. acid is preferable; but this has to be done care- fully, with a pointed stick—like a match, for instance.) 330. R Sol. Cocain. 4$ gtt. x; Aq. dest. 3ss. To be injected. Chordee. A solution of this strength is suf- ficient to render the introduction of a catheter painless; *The injections must be made after urination, and may be done as often as 4 times a day, each time keeping the liquid in contact with the sore for about one minute, by holding the penis upwards. Diseases of Male Genitals, etc. 123 and a 4 per cent, solution, undiluted, is very valuable in cauterization and excision of Condylomata. In operating on Stricture, 3ss may be injected in three doses, at inter- vals of ten minutes, each time to be retained a little. Then the urethrotome may be introduced, and the canal cut to No. 40 of French scale if necesssary (from 3^ inches back of meatus to corona).* In Phimosis, as hypodermic injection of 12m. at the dorsal base of the penis, and after 15 minutes 5m. more if necessary. The operation may be commenced as soon as the penis has turned dumb, cold and blue, using a clamp. Hemorrhage will be but little, as the haemostatic action of Cocain is very marked. (Or the solution may be painted over the external surface of the foreskin and over the mucus membrane several times within half an hour, by means of a camel's hair brush.) See No. 263. 331. R Sol. Ferri et Pot. tart. (20.0—30.0) 200.0. As lotion. Phaged. Chancre. Vel: Iodol, see No. 269. 332. R Tr. lodi, Aq. dest. a 3j—3ij- Injection. Hydrocele. The tumor is grasped from behind and a trocar passed into it, taking care to point the instrument after penetration upwards, to prevent wounding of the testicle. Now the canula is pushed well into the sac, to allow the fluid to escape. This dose is injected by means of a glass syringe, the nozzle of which is made to fit the canula. *Aspiration of the Bladder in Stricture from ure- thral or prostatic disease. The puncture of the bladder must be made at the most prominent and tense part of the tumor, and exactly in the median line. (Once or twice a day until the urethral passage is re-established.) 124 TOPIC A LS: 333. R Tr. Opii 3j; Pot. brom. 3j; Glycerin. =ss; Aq. font. fijss. Four injections daily. Gonorrhoea. Vel: Liq. Ferri dialysati ^ss; Aq. dest. 3SS—3J. Vel: Extr. Hydrast. fl. 3ij; Aq. font. =jv. Injiciatur bis die. 334. R Sol. Pot. permang. (gr. x) %v. Gonorrhoea. If chronic, gr. v—x : 1). The same strength may be used in suppurating Bubo, after having drawn off the contents with an aspirator, if it be^still intact. See page 82. 335. R Sol. Resorcin. 5 per cent. Two to three in- jections. Cystitis. If chronic, 5—10 per cent. (397.) 336. R Sol. Zinci chlor. (0.2—0.4) 100.0. As injection. Gonorrhoea. Vel: Sol. Zinci sulfo-carbol. (gr. xv) 3viij. Vel: Liq. Plumbi 3j; Zinci sulf. gr. x; Aq. font. 3viij. Vel: Liq. Plumbi, Spir. V. Gall, a 3j; Aq. dest. fviij. Vel: Zinci sulf. 0.2; Alumin. 1.0; Aq. dest. 100.0, turn adde Sol. Tannini (1.0) 100.0. DISEASES OF FEMALE GENITALS, THE WOMB, ETC. 337. R Sol. Acid, carbol. (3j) Oj. As wash in Pru- ritus Vulva. Vel: Sol. Zinci sulfo-carbol. (3j) 31J. Vel: Infus. Tabacci. Vel: (Acid, carbol. 3j), Plumbi acet. 3j; Tr. Opii fij; Aq. font, ad Oj. Lead and opium wash. Dossils of lint soaked in it and placed in the vulva. Vulvitis. 338. R Sol. Zinci sulf. (3ss) §v. As wash. Leucor- rhcea of children. (The vulva has to be bathed twice a day, after having washed it with soap and water.) Diseases of Female Genitals, etc. 125 339. R Hydr. bichlor. 3ss.; Tr. Opii §j; Aq. font. | vij. To be applied bis die. Pruritus Vulvce. Camph. 3 j; Amyli 3 v. Apply once a day. Pr.pudendi. 340. R Acid, tannic. 3ss; Bism. nitr. 3j; Opii gr. x. To be dusted over the sore. Chancroid. Vel. Pot. permang (334). Cupri acet. v. Alum, usti, Sabin. p. a 3j. To be dusted over the excrescences once a day. Condylo- mata. Vaginitis from warts. 341. R Alum. p. q. v. In a linen bag placed in con- tact with the Cervix, and held in place by a tampon (369). Metrorrhagia (Cancer). Vel. Tannin 3 ij, applied dry. Catheter in Retention of Urine.—The instru- ment is to be introduced in an oblique direction from without inward in the urethra of a healthy, ummpregn'ated woman; but in certain diseases, or the latter staged preg- nancy the other extremity of the catheter must be depressed as soon as it enters the meatus, the urethra, on account of the ascent of the uterus having become nearly perpendicular, so as to pass along the internal surface of the symph. pubis. In case of retention of urine, when arising from undue pressure against the neck of the blad- der by the gravid uterus, where in spite of the removal of this pressure by the elbow and knee position, the urine can not be voided, the catheter will enter with more facility than in any other position. In every case of disease, with or without hemorrhage, unless the cause be palpable, it is advisable to examine systematically the entire uterus and its surrounding tis- sues in the following manner : 1. The cervix should be 126 TO PICALS: 342. R Sod. chlor. p. j; Aq. frigore concret p. ij. In a linen bag, to be carried up to the ulcerated surface by means of a speculum. Carcinoma. (After removal the pain begins again.) 343. R Sol. Arg. nitr. (gr. x) =j. To be applied every other day. Vulvitis follicul. et purulenta. y2 dr. to 1 oz. in Endometritis. 1 dr. to 1 oz. applied to vagina by means of a sponge-probang, after having cleansed it, once a week. Leucorrhcea. (Afterwards a Glycerine- tampon [369] for 24 hours.) Arg. nitr. in baculo, applied to erosions, ulcerations, etc., of the Os about once a week, is the best and most simple procedure; every application should, however, be followed b'y the salt-wash (261), and it should be, moreover, covered by a Carbol-tampon, saturated in Glycerine (369), or it may be protected by a coating of stypt. Collod. (415). investigated by touch, the speculum and the uterine probe. 2. The uterus and the whole pelvis should be ex- amined by conjoined manipulation, palpation and rectal touch. 3. The cervix should be dilated by tents, and the cavity of the body explored by the introduction of the index finger, by the sound and the curette. (It will re- quire generally three and even four tents to open the cavity of the body fully to the finger.) The examination may be made on a table, covered with a blanket, shawl, or rug of some kind, and provided with a small pillow. Should it be necessary to employ a bed, the leaf of a dining table or a wide board may be slipped across the mattress, under the upper sheet and covering, so as to get a hard surface to lie upon. Diseases of Female Genitals, etc. 127 344. R Sol. Acid, chrom. (3j) ?j. Endometritis. % oz. to 1 oz. to destroy the glands of the cervical canal. Cystic Degeneration. Vel: Hydr. nitr. acid, vel Sol. Zinci chlor. (3j) 3J. 345. R Liq. Ferri persulf. 3j; Glycerin. 3J. To be applied twice a day (besides dusting with Amylum, Bism. or Lycopod.) Vulvitis follicul. et purulenta. 346. R Plumb, acet. 3j; Acid, hydrocyan. dil. 3ij; Cacao fj. Apply after having washed the part with cold water. Vulvitis (if Pruritus). Borac. v. Plumb, acet. 3ij; Glycerin. 1 j, by means of vaginal tampon (369). 347. R Hydr. bichlor. gr. ij; Aq. Calcis 3J. Con- dylomata. Vel: Cupr. sulf. in baculo. To be applied every five or six days — Cupr. sulf. p. x; Borac. p ij; Pulvis subtilissimus c. Aq. font, fiat massa ex qua formatur bacillae. In a first examination the patient should always lie upon her back, with the buttocks very near the edge of the board, the clothing loose around the waist, and the knees drawn up to relax the abdominal walls. When small tumors exist behind and disconnected with the uterus, or where enlarged or prolapsed ovaries are to be sought for, or in case Sim's speculum or one of its modifications should be necessary, the patient should be placed in Sim's position, that is, on the left side, in such a way that breast and stomach are inclined towards the plane of the table. The left arm must be drawn behind the patient, so as to let her rest on the left side of the chest, and the right leg be so flexed as to let the right knee lie just above 128 TOPICALS : 348. R Tr. lodi, Glycerin, a 3ij. Granular Degen- eration. Vel: Tr. Ferri chlor. 3ij; Aq. font. 3J. To be applied once or twice.a week. Iodoform, gr. xv ; Pot. iod., Glycerin, a 3ij; Alcohol 3vj. Twice a week to cervix. Cervical Hyperplasia. 349. R Zinc, chlor., Aq. dest. a q. s. To touch the affected part once a day; and every 3 hours a douche to the vagina. Afterwards an occlusion-pad (371). Puer- peral Diphtheria. (A suppository of Iodoform [374] in rectum will be of service; and, if the uterus be affected, a warm intra-uterine injection of Sublim. [397] must be made.) 350. R Ungt. Atrop. (gr. ij) 3J. To be applied to the vaginal wall in Congest, and Nerv. Dysmenorrhoea, Vaginismus, etc. Vel: Ungt. Bellad. (3j) 3J, vel Ungt. Hyoscyami, Opii, Stramonii, etc. Ungt. Atrop. is also valuable in Pruritus Vulvce. the left—the lower trochanter must be by two or three inches nearer the examiner than the upper, or the use of a speculum will not be successful. Speculum. With the exception of Thomas' telescopic speculum, cylindrical instruments render, on account of their length, probing through them, or an examination by touch, quite impossible; as in anteversion it is as difficult to get the cervix into the field, as it is to carry applica- tions to the fundus. It will be best in most cases to employ Sim's speculum, (if there can be had an assistant) or, what may be still better, a modification of the latter. If a cylindrical or valvular speculum is used, the patient lies on her back, whilst the physician sits on a chair. Diseases of Female Genitals, etc. 129 351. R Bism. nitr. 3j; Acid, oleic. |j. Solve leni calore, turn adde Ungt. Petrol. 3J. To be applied on cotton. Ulceration of Os. Vel: Iodof. 3]; Acid, oleic. |j. 352. R Ungt. Creosoti 3J. Applicat. mane nocteque. Pruritus vulvce. Vel: Ungt. Chloroform, vel Chloro- form. 3j; 01. Amygdal. ~j. 353. R Ungt. mercurial., Cerae flavae, Adip. suilli, a |ss. To lubricate the os uteri bis die, whilst the abdomen is rubbed once a day with the following: lodi gr. v; Pot. iod. 3j ; Ungt. mercurial, fss; Axung. Porci ?j. To check the growth of Fibrous Tumors. Ungt. Calomel. (3j) |j. Condylomata. 354. R Iodof. 3ss ; Cacao |j. To be introduced into the womb by means of an applicator. Endometritis. Vel: Cacao in Subinvolution. (The applicator—a silver tube of \ inch diameter, and 8 inches long—is filled by forcing it into the mass for about 2^ inches, and then discharged into the uterus.) 355. R Acid, salicyl., Ungt. Petrol, a iss. On a sponge- tent of one inch, to be introduced into the cervical canal— to remain for 12 hours—twice a week. Cerv. Endometritis. The finger, having been thoroughly lubricated with soap, is now passed into the vagina to ascertain the position of the cervix, after which the speculum may be well oiled and gently inserted. I he Sound. While the patient lies on her back, the position of the uterus, resp. the direction of the cer- vical canal must be ascertained by passing the finger first into the fornix vagina?, over its posterior surface, and then alongithe base.oflthe bladder, over its anterior 13° TOPICALS : 356. R Extr. Bellad. gr. j; Sapon. gr. iv; Cacao 3ss. As suppository at night. Vaginismus. Vel: Iodof. 1.0, Cacao 25.0. Anoayne. Vel: Extr. Bellad. gr. v; Acid. tannic. 3ij; Cacao 3J. Suppositoria 20. One at night. Pruritus Vulvce. 357. R Zinc. oxyd. gr. iij; (Extr. Opii v. Bellad. gr. j); Cacao 3ss. As vaginal suppository, once or twice a day. Granular degeneration. (Instead of Zinc may be used Alum gr. iij, Plumb, acet. gr. v, Tannin gr. ij, Ungt. mer- curial, gr. x, etc.) 358. R Tr. Opii 3J; Glycerin. 31J; Aq. calid. Cij. Emollient vaginal injection, to be used daily for 20 to 30 minutes. Vaginitis, Hyperplasia. Other emollient injec- tions are: Dec. Amyli; Dec. Hordei; Dec. Ulmi; Inf. Conii; Inf. Humuli; Inf. Hyoscyami; Inf. Lini; Aq. Calcis; Aq. Picis, etc. (In Subinvolution, 1 y2 gall, hot water—1200 to 1250—against the cervix, will stimulate and thus produce absorption of the redundant tissue.) wall. The speculum is then introduced, the patient retaining the dorsal decubitus, if a short cylindrical instru- ment be employed; and being turned on the left side if Sim's or one of its varieties be used. As the probe will only pass if it has been properly curved, it must be bent again and again, until the direction of the canal is fully discovered (sometimes the inflection given to the sound must be the arc of a small circle; sometimes a sharp angle; sometimes even a spiral twist is required). Tents. As a general rule, laminaria (sea-tangle) tents are preferable to sponge tents, as they do not become Diseases of Female Genitals, etc. r3* 359. R Zinc. sulf. 3j; Glycerin, rj; (Tr. Opii §ss-j;) Dec. Hordei v. Aq. calid. Cj. Astringent injection, to be used daily for 10 to 20 min. Granular Degeneration, Pruritus Vagince. (Zinc. sulf. may be replaced by 2 dr. of Alum, Plumb., or Tannin.) 360. R Acid, tannic. 3J; Glycerin, riv. Y^ oz. to 1 litre of tepid water morning and night. Leucorrhcea. Vel: Liq. Ferri dialysati p. ij, Aq. font. p-j. Tannin. 3ss; Morph. gr. ij; Glycerin. §iv. On cotton (369) after having painted the vagina with Arg. nitr. (343). Vaginitis. 361. R Ferri sulf. 3j; Dec. Quercus Oj. 2 oz. to be injected bis die. Prolapsus Vagince. (The iron may be replaced by Alum, et Zinc, a 3j.) In Gonorrhoea Mangan (334). or Phenol (327), or 1 dr. of Alum or Zinc to one quart of water daily. 362. R Acid. nitr. d. 3j; Aq. font. Oj. in mucous and muco-purulent discharges of Carcinoma. putrid like the latter, and may therefore be retained for 24 hours and more. They may be medicated with Morph., Iod. or anything soluble in water (they do not absorb alcoholic solutions or Glycerine), and then dried again to be kept for use. It will be, however, advisable to steep them before use in a solution of Carbolic acid or some other antiseptic. Though they rarely produce any pain or irritation if just before introduction placed for a few minutes in warm water to soften them, it is better to insert several small tents than one large one, as the small ones expand more rapidly than a large one. If the uterus be low in the pelvis and its neck dilated, 132 TOPICALS: 363. R Sol. Alum. (gr. xij) 311J. Cauliflower (serous discharge). Vel: Liq. Ferri perchlor. 3ij; Aq. font. rij. vel Inf. Matico; vel Tannin. If fetor: Sol. Calc. chlor. (3ij) Oj. vel Dec. Carotae. vel Creosoti 3j; Dec. Lini Oj. 364. Sol. Arg. nitr. (3j) 5iv. One syringeful every 2 or 3 days. Urethritis. 365. R Tr. Opii 3ss; Aq. tepid. 3Jss. Carcinoma (if pain), vel Chloral. 3ss; Aq. font. fss. To inject at night, Vaginismus. Vel: Pot. brom., Chloral, a gr. xv; Aq. font. |ss. On cotton, by speculum. (It has to be retained by a tampon of dry cotton, with a thread for removal—369.) Neuralg. or Congest. Dysmenorrhoea, partial closure of Os. a tent may be held in the bite of any pair of uterine dressing forceps and slipped in without the speculum, the woman lying on her back. In ordinary cases they may be introduced through the short cylindrical specu- lum, though in all cases it is most easily done with Sim's: The uterus being fixed and held by a tenaculum, the tent, grasped by a pair of mouse-tooth forceps, is directed in coincidence with the axis of the uterus, as ascertained by the probe, and gently pushed through the cervix. The patient has then to remain in bed until its removal, which is done after from 12 to 24 hours by traction upon the thread attached to it (the cord should always be fastened at the upper extremity of the tent and passed through it). As this mode of diagnosis and treatment is more or less dangerous, the following rules should be observed: 1, No force whatever should be employed, and, should the tent not pass the os internum, it either should be bent so as to follow more "accurately the cervical canal [as Diseases of Female Genitals, etc. 133 366. R Liq. Ferri perchlor. §ss; Aq. font. §ij. 2 syringe- fuls, and, if necessary, to be repeated. Carcinoma (if Hemorrhage). Vel: Liq. Ferri persulf. p. j; Aq. font. part, iv, with a tampon, which fills the vagina (by spec- ulum) ; vel Sol. Zinci sulf. (3j) f xij, as injection. 367. Sol. Ferri persulf. p. j; Aq. font. p. ij. Vel: Tr. lodi for injections of the uterus, after dilatation of cervical canal. In serious cases of Metrorrhagia. 368. Acid, carbol., Alcohol, a |j to a quart of hot ^ water as injection of the uterus. Flooding horn Abortion. 369. Carbol- Tampon and Pessary: A wad of absorb- ent cotton—prepared of fine cotton having been im- mersed for about 3 days in a cone. sol. of Bicarb, of Soda, squeezed and washed repeatedly in clean water, and dried in the sun—is dipped in Sol. Acid, carbol (gr. x) fxij, and may now be used, saturated in Glycerine or medicated. (It acts at the same time as local hydragogue, disgorging the tissues.) Uterine Displacements, Granular Degenera- tion, Vulvitis, etc.,—most valuable after the application of Caustics to cervix and vagina. ascertained by the probe, or exchanged for a smaller one. 2, It should on no account be introduced at the physi- cian's office, as the patient has to be confined at once to the recumbent position. 3, A tent should never be used where there has been chronic pelvic peritonitis. 4, It should not be allowed to remain in the uterus more than 24 hours, when the vagina should be washed out with an antiseptic lotion, and, if any pain, chilliness or discomfort follow, Opium should be given freely and perfect rest enjoined. 5, The patient should remain in bed for at least 24 hours longer, even if there be no pain, etc. 134 TOPICALS : 370. Tampon in Hemorrhage from Abortion, etc., a piece of cloth or lint of about 6x6 inches, dry or soaked in Glycerine, is centrally to be placed over a finger or catheter, and thus introduced into the cervical canal. Then the finger having been retracted, the points of the four corners of the linen must be pushed likewise into the canal. This procedure has to be repeated with one or two pieces more until the desired object is obtained. 371. Occlusion-Pad for Lying-in-women. Absorbent cotton wet with Sol. Hydr. bichlor. (gr. ij) 3viij is placed over the vulva and covered with oiled silk; on this is put another layer of absorbent cotton, and a piece of muslin to be attached to binder. Prevention of Diphtheria. DISEASES OF THE RECTUM, ETC. 372. Acid, carbol., 01. Olivar. a 3SS; Iodof. vel Morph., vel Chloral, q. v. As injection into the substance. Hcemorrhoides. Or the surface of the protruded piles be- ing wiped with lint, a portion of it, (the size of a 5-cent- piece,) is dapped with a wooden stick dipped in cone. Nitric or Carbol. acid. When this has taken effect, any superfluous acid is to be mopped up, some ointment or grease applied, and the parts returned. The patient should keep in bed and the bowels not disturbed for 48 hours. When the slough caused by the acid separates, the surface generally cicatrizes speedily, and leaves the part brazed up and healthy. Diseases of the Rectum, etc. 135 373. Extr. Hyoscyami t.o; Extr. Opii 0.5; Aq. font. 5.0. Solve, turn admisce Glycerolat. simpl. 60.0. Applicatur bis die. Piles. Vel: Iodof., Bals. peruv. a 1.0; Ungt. Petrol. 4.0. Zinc. oyxd. 50; Glycerolati simpl. 25.0. Fissura Ani, etc. 374. Iodof. gr. xv; Cacao gr. x. F. supposit. Diph- theria puerperal. Iodof. 3ss; Cacao 3jss. Div. in 6 sup- positoria. One every night, alternately in vagina and rec- tum. Uterine Excitement; Ovarian Dysmenorrhoea. Vel: Iodof. 2.5; Cacao 40.0. F. 10 supposit (354 and 356). 375. Extr. Bellad. gr. ss; Opii gr. j—iij; Cacao 3). F. supposit. Oxaluria (if pain). Vel: Extr. Conii gr. ij; Extr. Hyoscyami gr. iij; Cacao 3]. Vel: Extr. Bellad. gr.j; Opii gr. iij; Asae foet. 3ss; Cacao 3jss. F. 6 supposit. Uterine Irritation; Dysmenorrhea membr. Vel: Extr. Bellad., Morph. a gr. ij; Cacao 3ij- F. 6 supposit. One every 4 hours until pain subsides. Abortion. 376. Ungt. Hydr. nitr. gr. ij; Cacao 3ss. F. 6 supposit. One at night. Oxyuris. Vel: Inf. Absynth. v. Quassia? 31J. As enema. Trichocephalus. Vel: Sol. Acid, carbol. (3j) §ij; v. Acet Vini as injection.* Enemata. Independent of their employment in womb and rectal diseases, they are of much use in hastening the action of Cathartics, taken by mouth, or in the removal of feculent accumulations in the rectum. They relieve, moreover, frequently tympanitis, and for the purpose of revulsion they are most valuable, to say nothing of their value in alimentation in cases of irritable stomach. 136 TOPICALS: 377. Tr. Ferri chlor. 3ij; Aq. Calcis §jv. Half the dose each time for 2 consecutive nights to be injected and followed the next day by a Cathartic. Ascarides. Vel: Syr. Allii, 01. Terebinth, a 3SS; Inf. Lini 5vj. As enema. 378. Tr. Kino, Tr. Catechu a 3ss; Tr. Hyoscyami Ij; Aq. font. 31J. 3j—ij to be injected twice a day, after hav- ing returned the part by pressure with an oiled sponge. Prolapsus Ani. Vel: Tr. Ferri chlor. 3ss; Inf. Quass. 3viij. Also of use in Invagination of rectum. 379. Chloral, gr. iij—viij; Muc. Acac. 3j- As enema. Infantile Convulsions. Urcemic Coma. Vel: Acet. Vini, Aq. font, a ^ss, as revulsive; vel 01. Olivar., Aq. tepid, a 3SS, to maintain a soluble state of the bowels after having given a purgative. Convulsions from teething. 380. Spir. Vini Gall. 3SS; Inf. Theae 3 Ij - To be in- jected every half hour. Asiat. Cholera. Sp. Vini G. 3j; Aq. font. 3SS. As enema during the fit. Laryngism. stridul. 381. Tr. Opii 3ss—ij; Sol. Amyli ^iij. To be injected directly after evacuation and repeated once or twice if it be quickly rejected. Dysentery, Sporadic Cholera. Tr. Opii, Tr. Asae'foet. a 3j; Dec. Amyli §iij. As enema and to be repeated after one hour if necessary. Colic. Tr. Opii gtt x; Tr. Bellad. gtt xx; Tr. Asa? foet. 3ij; Aq. tepid. 1 iij. As enema to be retained. Metnbr. Dysmenorrh. Tr. Opii gtt xx vel Tr. Hyoscyami 3j; Aq. tepid, siij. As enema every night until quickening. To prevent Abortion. 382. Sol. Acid, carbol. (0.15—0.2) 150.0. As enema. Diarrhoea and Rectal Diseases (children 0.05: 120.0). Diseases of the Rectum, etc. 137 383. Ext. Ergotae fl. 3 ij; Aq. font, § ij. As enema. Ulcus stomachale. 384. Sol. Chinini bisulfurici v. Chin, hydrochlor. amorph. as enema. Intermittens, etc. See page 11. 385. 01. Ricini § iij; (01. Tiglii gtt. jv;) Kali carb. gr. xv; Sapo3j; Aq. fervida Oj. Apoplexy. 01. Tere- binth. | j; Muc. Acac. § ij; Dec. Hordei Oj. Insolatio. 01. Terebinth. 12.0; Camphora 1.5; 01. Olivar. 60.0; Vitellum Ovi 1; Dec. Hordei 300.0. For 2 or 3 enemata. Tympanitis. Syr. commun, vulgo Molasse, 01. Olivar. 7 1 ij; Sapo. q. 1.; Aq. tepida Oj; vel Sol. Sod. Chlor. ( 3 ij) % jv. As derivative. Scarlatina. 386. Aq. fervida § viij—Infusum Sennae ( § ss) Oj. vel Sol. Magn. sulf. (§ ij) Oj. Purgative. 387. Pepton. p. j; Aqua fervida p. ij. As enema. Scraped meat 5 oz.; finely chopped pancreas l£ oz.; water 3 oz. Nutrient enemata may be composed of very strongbeef or mutton broth,(not to exceed 4 ounces) without salt or spice. They should be preceded by a large enema to clean the bowels; and if the rectum will not retain them a little Laudanum may be added. SKIN DISEASES, ETC. 388. Ferrum sulf. 0.4; Natrium chlor. 10.0; Aqua 100.0. vel Fol. Jaborandi 20.0; Aq. Coloniensis 200.0; Macera. Hairwash. Ammon. carb. 3j; Borax 3 ij; Glycerin. § ss; Aqua § jv; Spir. Myrist. Oj. Shampoo. Sod. sulfuret. 3.0; Calc. usta et Amylum IT 10.0. Mixed with water to apply to the part. Depilatorius. 138 TOPICALS: 389. Oleum Ricini |j; Spir. Vini Gallici § vij. Diseased Hair-roots. Bals. peruv. 20.0; 01. Ricini 50.0. To apply to scalp. As dressing vaPanaritium twice a day. 390. Naphthol 5.0, Bals. peruvianum 2.5, Alcohol & Glycerin,1T 20.0; Ol. Bergamott 1.0. To apply bis die. Pityriasis, Lichen, Scabies, etc. Borax 1.5; Glycerin 30.0; Aq. Rosar. 100.0; Aq. Coloniensis 20.0; Tr. Quillajae 50.0. Pityriasis. Stinking Sweat. Sol.Boracis ( I j) Oj; vel Sol. Kali carb. ( § ss) Oj if much itching: To wash the head in the morning, having oiled it the night before. Ungt. Calomel ( 3 j: § j) if Alopeciec. Borax 10.0; Kali carb. & chlor. T 5.0; Aq. Aurant. flor., Aq. Rosar. T 75.0; Glycerin 30.0. Moles, Freckles, etc. 391. Cuprum oleatum 3ij; Lanolin § j. To apply bis die. Tinea favus. Ungt. Zinci § j. After having detached the scab by moistening it with a Solution of Sod. Carb. ( 3 j: § j) and the application of a bread and milk poultice. Crusta lactea. 392. Bism. nitr. praec, Hydr. praecip. album £ 5.0; Glycerol. Amyli 20.0. Cosmetique blanc. Kal. iod. 5.0; Natr. bicarb. 1.0; Aq. font. 400.0. Pimples. 393. Bism. nitr. pr., Zinc. oxyd. "^ 2.5; Glycerol. simplex 30.0. Intertrigo. Zinc, tannic. 10.0; Glycerol. simplex 30.0. Tinctura Benzoes 2.0. vel Alcohol and Albumen. Decubitus. 394. Sod. Boro-salicyl. 20.0; Aqua font 100.0; Spir. Lavandul. comp. 50.0. vel Borax 3 ij; Chloral 3 ss; Aq. fl. Aurant. & Rosar. "^ § iij. Pruritus, Urticaria, etc. Glycerin |j; Aq. Coloniensis § v. vel Unguentum Petrolei. Pruritus from Scarlatina.. Skin Diseases, etc. 139 395. Acid, salicyl. 3.0; Amylum 10.0; Talcum 87.0. F. pulvis anthydroticus; vel Acidum nitricum gtt. x Aq. font. Oj, as wash. Sweating feet. 396. Plumb, aceticum 25.0—50.0; Alum. 12.5—25.0. Aq. dest. 500.0. With lint as dressing to foul ulcers. Resorcin 2.5; Glycerin 10.0; Tr. Benzoes comp. 40.0; Aqua 100.0; vel Resorcin & Ungt. Petrolei ana, as dressing for poisoned wounds, accompanied by inflamma- tion of Lympliatics. 397. Hydrarg. bichlorat 1.0; Acid, hydrochlor. 2.0; Aq. destill. 10.0; vel Sublimate 1.0; Natr. chlor. & Acid. acet. IT 0.5; Aq. dest 10.0. Each for 1000.0 of warm water as disinfecting wash for hands, etc. For irriga- tion of wounds a solution of 1:2000 will be sufficient; and for internal organs, e. g., the uterus, it should not be stronger than 1:5000.* *Antiseptic Wound Treatment.—After having thoroughly cleansed the wound with warm boro-salicylated water (399) and dried it with absorbent cotton, the edges of the cut are brought in apposition and retained there by means of plaster, with or without catgut sutures, care being taken to avoid ten- sion; as it is better to have the wound gaping than its edges dragged by sutures, especially if the tissue is damaged or un- healthy. Now it is dressed with three layers of antiseptic gauze (416a) saturated with boro-glyceride and covered by a few gamgee pads (absorbent cotton covered with antiseptic gauze), which are held in place by means of a gauze bandage. If there be much laceration and bleeding, the vessels must be picked up with forceps and tied with catgut. Then having placed in the wound a drainage tube, or if it be small, a few strands of catgut (which are absorbed in due time), the edges may be brought together with silk sutures, if practicable, and the following dressing applied: The wound being moderately dusted with iodoform, is covered with gauze—provided with holes for the tubes—likewise dusted with iodoform, after having been wrung out of sublimate water (297), over which are placed a few gamgee pads. The whole to be retained by means of a gauze bandage. Nussbaum prefers in all cases, where there is a possibility of 140 TOPICALS: 398. Acid, carbol. 10.0; Aqua 300.0;, Brom. 5.0. Dissecting wounds. Acid, carbol. & Alcohol ?1. 0; Glycerol, spl. 50.0. Ulcers. Acid, carbol. 0.5; Zinc. oxyd. 1.0; Liq. Plumbi & Tr. Arnicae *£ gtt x; Ungt. Petrol. 15.0. Eczema, Herpes, etc. Acid, carbol. 4.0; Ungt. Petrolei 50.0. To apply twice a week. Sycosis, Lupus, etc. Creosot 5.0; Alcohol. 10.0; Glycerin 85.0. Erysipelas. Phenol. 1.0; Ol. Olivar. 40.0. Carbolic Oil. 399. Acid, salicyl. 1.0; Alcohol. 2.0. (Tr. Benzoes 1.0); Lanolin. 4.0; vel Pix liq. 10.0; Glycerol, spl. 30.0; vel Bism. nitr. cryst 5.0; Aqua & Glycerin. 7 2.5; turn adde Glycerin ad 100.0. Herpes facialis, Ulcers, etc. Acid, salicyl. 2.0; Acid, boric. 12.0; Aq. calida 1000.0. Wash for simple cuts, etc. 400. Extr. Opii, Extr. Bellad., Glycerin ? 3 j; Ungt. Resinae \ j. Boils. Acid, arsen. gr. ij; Ungt. Petrol. ^ j. Onychia maligna. Calomel, gr. jv; Aq. Calcis § j. The ploughing, carbolized gauze moistened with phenol water 23^:100, or a 20 per cent, iodoform gauze, soaked in a solution of boric acid, covered with a few layers of dry gauze and salicylated wadding, which he keeps in place by means of an impermeable bandage. Two points ought to be borne in mind: 1. Tbe wound must be redressed in order to remove the drain- age tubes, which has to be done in a day or two, according to tbe discharge; or if there is much pain or hemorrhage; though the dressing need not be changed because serum has oozed through it—antiseptic cotton covered over the moist places will here suffice. 2. Each time a wound is dressed, the hands should be disinfected with sublimate (397), and the required instru- ments (forceps, needles, etc.) with phenol 5:100, after having immersed them for a short time in boiling water. In fact, all the articles, which come in contact with the wound, should have been previously sterilized—cotton, catgut, silk, drainage tubes (416 a .5? a tit* GO 1. HINIM8. .055 .10 .16 .22 .28 .32 .38 .45 .50 .55 .65 .76 .80 .90 1.12 1.40 1.70 .06 .12 .18 .24 .30 .36 .42 .50 .55 .60 .72 .85 .90 1.00 1.25 1.55 1.90 .08 .15 .24 .32 .40 .48 .55 .65 .73 .80 .96 1.12 1.20 1.32 1.60 2.00 2.50 MINIMS. 35_______ 40_______ 50........ 60(f3j)~ 72_______ 80........ 90 (f 3 jss). 96........ 100_______ 120(f3ij)-150 (f 3 ijss) 160_______ 180 (f 3 iij)-210(f 3 iijss) 240(f3jv). ffj------- fljv------ 2.00 2.25 2.80 3.40 4.05 4.50 5.10 5.40 5.60 6.75 8.50 9.00 10.10 11.80 13.50 27.0 2.20 2.50 3.12 3.75 4.50 5.00 5.60 6.00 6.25 7.50 9.50 10.00 11.25 13.00 15.00 30.0 2.90 2____..... 3.30 3........._ 4.15 4.......... 5.00 5____..... 6.00 6________ 6.65 7......___ 7.50 8.....____ 8.00 9......__. 10.......... 12.......... 8.30 10.00 12.50 14.......... 13.30 15________ 15.00 16_______ 17.50 20. 25. ......... 20.00 40.0 30........... 108.0 120.0 160.0 Age. 1 to 3 months. 4 to 12 " . 1 to 8 years... 4 to 5 " ... 6 to 8 " ... 9 to 12 " ... Dose. .1-16 .1-10 .1-6 .1-4 .1-3 .1-2 Age. 13 to 16 years. 17 to 20 21 to 50 51 to 60 61 to 70 80 to 90 Dose. ...2-3 ...3-4 ...1 ...3-4 ...2-3 ...1-2 A FEW OBSERVATIONS ON URINE AND HOW TO TEST IT. The quantity of urine passed by a healthy person in 24 hours varies from 30—40 ounces, and its color will likewise vary very much, being like the quantity, in intimate relation with the ingesta. Though usually of a light amber or straw color, it may take all possible shades between water and porter. Among drugs that have a decided coloring influence on the urine, which, in some instances, might be taken for blood, may be mentioned Curcuma, Rheum, Frangula, Senna and Santonin.—A few drops of hydrochloric acid will settle the question, in as much bloody urine undergoes no change. Very pale urine, if not the consequence of much drinking, may be due to Anosmia, Chlorosis, Hysteria, Diabetes, etc., etc. High colored urine indicates generally an excess of acid, and unless the result of good living, is symtomatic of febrile diseases. A smoky tint is diagnostic of the presence of blood. Deep yellow or greenish brown indicates bile due to hepatic disorders. Dark brown or black urine is generally due to rapid morbid changes in the blood and tissues, and occurs in infectious and other severe diseases. Cloudy or filmy urine is generally alkaline and indi- cates the presence of mucus; white opaque and viscid— (154) Analysis. 155 mucus or pus or earthy salts, singly or jointly. Turbid urine of a creamy yellow color at the bottom is mostly acid and contains pus. Froth on healthy urine readily disappears, but if it be permanent the presence of albumen or the constitu- ents of bile may be suspected. The odor of urine is also of much importance. A smell of Ammonia indicates catarrhal inflammation of the bladder; that of Sulfurated Hydrogen occurs in Typhoid and Cholera, and is a bad omen. (The admin- istration of 01. terebinth, produces a smell of violets). The specific gravity of urine averages about 1020. If higher, sugar or uric acid are most likely to be present: a low spec, gravity is frequently observed in Hysteria and anaimic conditions; in chronic Bright's disease and in Diuresis from any cause. Blood and fibrin may be detected by the microscope, and the presence of serum is ascertained by the discovery of its albumen, on account of which serous urine is commonly called albuminous urine. The urine to be examined should be always a portion of the whole quantity passed in 24 hours, because that passed in the morning frequently contains no albumen, whilst that voided later, does. Urine, not distinctly acid, should be rendered so before testing for albumen, by adding a drop or two of nitric or acetic acid; and if it be permanently turbid from any cause, it should be filtered before boiling. In that case the presence of mucus or pus maybe suspected, whilst a turbid urine becoming clear by boiling contains urates. (If the urine has not been acidulated before boiling, the cloud or 156 A Few Observations On Urine opacity, which may appear might be due to the presence of Earthy Phosphates, which, of course, will be redis- solved on the addition of the acid). Renal casts should always be sought for, if albumen is detected: Allow the urine to settle for a few hours in a tall glass, then, after having poured off all the top, place a drop of the residuum under the microscope,where the fibrin will readily be distinguished. Sugar. Unless the spec, gravity of the urine rise above 1030, it is of no practical value to examine on sugar, in as much, 15 grs. of it are excreted daily through the kidneys by a healthy person. Put a few drachms of urine in a test-tube, add the same quantity of Liq. Potassce, and heat to boiling-point over a spirit lamp, when, according to the quantity of sugar present in the urine, it will assume a dark-brown, even black color. *It is, however, necessary to remove any albumen before testing for sugar, by boiling the urine in question with a drop of acid, and subsequent filtration. If there be no albumen, and a few drops of nitric acid be added, the dark color will disappear, the urine exhaling a smell of molasses. (Aside from albuminous urine, a urine high colored or containing an excess of Phosphates, will considerably darken on boiling with caustic alkalies). To estimate the amount of sugar, put two 12 oz. bottles, each containing 4 ounces of the urine to be tested, for 24 hours in a warm place, the one tightly corked and the other with a piece of yeast, the size of a chestnut, thrown into the urine and not corked. The difference in the spec, gravity will give the number of grains of sugar contained in the fluid ounce. And How To Test It. 157 Mucus and Pus. Pus produces a thick sediment at the bottom of the urine, which is rendered viscid and gelatinous by the addition of about half its quantity of Liq. Potassos; whilst urine containing mucus, which is stringy and floating rope-like within it, becomes more fluid and limpid under these circumstances. (Pus from the bladder will probably be mixed with mucus consti- tuting muco-purulent matter.) Bilepigment may be detected by shaking the sus- pected urine with a small quantity of Chloroform. If bile be present, a yellow sediment will form, consisting of bilirubin crystals.* Spermatozoa}. Allow about a quart of the urine to be tested to settle for a few hours in a tall glass, decant, and divide the rest of about 8 ounces in two pointed champagne glasses to settle for another 5 or 6 hours, after having added to the one a little Picric acid. Decant again and place a drop of the urine remaining in the two glasses under the microscope. To detect Spermatozoon in linen, a few threads of the stained piece should be moistened with a drop of Gallic acid, dissolved in water, to which must be added after about 10 min. a drop of Sol. Ferri chlor. dil. A few threads may now be prepared in the usual man- ner for microscopical examination, by means of a needle in a drop of glycerine. *Boiling of the acidulated urine in a test-tube, will in most cases suffice. Originally turbid urine, remaining so when boil- ing, contains Mucus or Pus—clearing up: Urates; whilst ori- ginally clear urine becoming turbid by heat, contains either Albumen or Phosphates, the latter if it clears up by the addition of an acid. Compare Urinary Deposits, part II.) THE SECOND AND THIRD VOLUME OF The General Practitioner (SEE CONTENTS OF THIS VOLUME), Will respectively appear in December, IH&9 and February, 1890. The order, accompanied by $1.C0, or for the whole work (3 volumes) $3.00, should be registered and addressed to DR. STREHZ. 380 Wells Street, Chicago, III.. U.S.A. PART II. An* Alphabetical Arrangement of the Diseases, with their several definitions, symptoms (whenever /pos- sible pathognomic), and causes, together with diagnostic hints, and the remedies usually employed in their treat- ment. Abortion—Expulsion of the contents of the gravid uterus, before the seventh month of utero-gestation, *'. e. before the viability of the foetus; attended by pain, which is marked by distinct intervals, like those in labor, and more or less hemorrhage, which, unlike that from delayed menstruation, usually precedes the pains, the os being at the same time more open—see Labor. Aside from blows, falls, or acute disease of the mother, and morbid conditions of the foetus, it may be caused by strong emotions; irritation of nerves—of the trifacial, from the extraction of a tooth;—excessive sexual ex- citement; violent purgation; anaemia; tumor in utero, ulceration of cervix, etc., etc. Treatment—Until dila- tation of the os, or the partial extrusion of the ovum is obvious, abortion may be prevented sometimes by complete rest; Merph. with Brom. (51) internally, and Bell., Opium, etc., as suppository, or enema (375 according to the size of the tubes, exist on both sides, and may be heard best at the back. Diagnostic are the sputa, which, consisting of mucus from both the larger and smaller bronchi, will fioat on water, the mucus of the latter, on account of its greater specific gravity—not being mixed with air, like the former—hanging rojnc- likeinto it. A rise of temperature to 103 or 104 de- grees and dull percussion are signs of complications— see Broncho-pneumonitis. Treatment as indicated for bronchitis of the larger tubes; especially inhalation of warm vapor by keeping the atmosphere of the room charged with steam. To excite deep inspirations and prevent atelectasis the child may have cold affusions directed toward the nuca, after having been placed in Bronchocelc. 181 a warm bath. I use, whenever practicable, the wet pack (420), with Priesnitz' compress (298). A nutritious diet with brandy (73), and tonics are of the greatest importance. Broncho Pxv\jMOxiTis(Bronchopneumo?iiaInfantum) —Lobular Pneumonitis is a lobular inflammation of the lung tissue, superadded to the bronchial affection, and incident chiefly to childhood. Being characterized by the symptoms of bronchitis capillaris, it cannot be differ- entiated from it, unless a high temperature, but above all, dullness can be demonstrated—a resiculo-tympanitic sound on percussion at the upper lobes indicates emphy- sematous lobules. As the pyrexia is proportionate to the acuteness of the bronchial inflammation and to the extent of lung involved, the affection, which will also occur in the course of pertussis,and be a sequel of other diseases, especially of eruptive fevers, may be of great severity, or comparatively devoid of danger. In very young children it is usually preceded and accompanied by apneumatosis. The most frequent termination of the lobular inflammation is as in lobar pneumonitis in resolution, the inflammatory product undergoing fatty degeneration, which, after having been emulsified with the transuded serum, is absorbed. The caseous meta- morphosis leads to the development of phthisis. Treat- ment is that of bronch. capill., as there are no other means but the cold affusions for the prevention of atelectasis. Bronchocele (Basedovfs Disease—Hypertrophy of 1hyroidBody and Prominence of the Eyeballs)—Exoph- thalmic Goitre is associated with functional disease of the heart, throbbing of the arteries, loud whirring— ancemic purr—during the systole, and in the arteries and veins; and consequent great nervous excitement. 182 Bubo. Treatment should be anti-hysterical—Valeriana & Ferrum (pp. 29 & 79); Brom or Conium (pp. 24 & 31); Barium or Jod (pp. 10 & 14); with purgatives (p. 89); or Aconite (p. 22). Locally, Jod (20), or Phenol as injection (372 & 398). If apoplexy or suffocation is threatening, the seton, electrolysis (p. 149), or the knife. Bubo—An inflammatory swelling of a lymphatic gland, especially in the groin, due to some kind of irri- tation; but usually in connection with a venereal sore or gonorrhoea. Treatment like that of abscess. After in- flammation has subsided the tumor will often disperse by painting it with Iodine (20 & 402); pressure by means of a pad and bandage, event, cold water compresses, in conjunction with purgatives (219). If, however, the skin becomes thin and shining, a free and vertical incision should be made to prevent pocketing of the matter. If the bubo be specific, an anti-syphilitio treatment is indi- cated—see Syphilis. The indolent bubo, when followed by infiltration and threatening abscess, requires tonics (p. 76), with Iodine or small blisters (408) locally. Burns and Scalds. See Combustio. Cachexia. Malarial—A depraved state of the sys- tem due to slow but continued absorption of malaria poison, or following protracted cases of intermittens. The peculiar hydraemic condition is characterized prin- cipally by an enlargement of the spleen (ague cake), and a sallow, more or less oedematous face. Quinine is the remedy (pp. 11 & 75). See Fever (Intermittens). Calculi. Biliary—Stone-like concretions in the gall- bladder. See Colic (hepatic). Calculi, renal—Stones in the kidney are usually composed of lithic acid, known by the deposit of red Calculi. 183 sand from the urine; calculi of oxalate of lime are less common; andphosphatic stone, which indicates incipient disease of the organ, is still more rare. The presence of stone is characterized by pain in one or both loins, irritation and retraction of the testicles; occasional in- flammation of the-organ, and sometimes bloody urine. Treatment—Next to diluents and diuretics, as Vichy water and Potassium (pp. 53 & 6), mild aperients (pp. 96 & 7), and warm enemata. In case of inflammation, a warm bath, fomentations or ice with sedatives (p. 20); if the inflammation very severe, leeches or cupping. The pass- age of the stone through the ureter causes sudden and severe pain in the loins and groin, subsequently in the testicles and inside the thigh, with spasmodic contractions of the former, accompanied by violent vomiting, faint- ness and collapse, and may last from two to three days. Treatment consists of plenty of diluents; the warm bath, and emollient enemata (386), with large doses of Opium and Chloral (pp. 30 & 35), or Chloroform inhalations (304). Calculi. Vesical—Stone in the bladder is either from the urine or from the mucus of the bladder, dependent on prostatic disease; or if foreign bodies are introduced into the bladder to serve as nuclei, in which case they consist of phosphates. The symptoms are: Irritability of the bladder, with frequent desire to make water; occasional sudden stoppage of the stream; occasional passage of blood; occasional pain at the neck of the bladder, always most severe after micturition; and a pain in the glans penis. Sooner or later the urine becomes alkaline, and loaded with viscid mucus and phosphate of lime. Treatment—After the existence of the stone has been ascertained by means of a sound, litholysis: Acid. 184 Carbuncle. nitric, d. injected as in chronic cystitis, will reduce the size of phosphatic calculi, or dissolve them sometimes altogether. The continued use of Vichy water, or a solu- tion of Sodii Bicarbonas, saturated with carbonic acid, will also disintegrate lithic calculi. See Urinary De- posits. In obstinate cases recourse must be taken to lithotrity or lithotomy. Calvities (Baldness). See Head. Cancer. See Carcinoma. Cancrum Oris (Stomatitis gangrenosa). See Mouth. Carbuncle (Anthrax)—An exaggerated boil of a gan- grenous nature, sometimes attended with fever, and always dependent on a vitiated state of the blood. Treatment—Fomentations and a brisk purgative (p. 92). Afterward Ungt. Belladonna or Phcnol-lod (400 & 402), if very painful; or Iodine (20) to produce vesication; and if necessary, free radiating incisions at early stage. In- ternally, sulfides (pp. 18 & 19); Opium (p. 35), and tonics (pp. 71 & 76), in conjunction with a generous diet, in- cluding wine and brandy. See Abscess. For Carbuncle of genitals see Vulva (Vulvitis gangrenosa). Carcinoma—A peculiar malignant growth, making constant progress, destroying and causing absorption of the invaded tissue, tending towards suppuration and infection of the lymphatic glands, thus reproducing itself at distant parts, and even recurring after extirpation. Cancerous tumors are characterized by a stony hardness and severe pain of an intermittent and neuralgic kind, felt in the tumor itself as a sharp stabbing or burning sensation, and followed sooner or later by general cachectic symptoms. Treatment—Injections of Arg. nitr., Phenol and Pepsin (327, 98 & 103), or Ozonewater Carcinoma. 185 (0.1:500.0) may be tried; but if they fail to arrest the growth, extirpation before the corresponding lymphatics become affected is the safest plan. If not practicable, Opium (p. 35) and tonics (p. 76), with Belladonna plaster or Chloroform liniment (411), for the relief of the neu- ralgia. After ulceration, according to circumstances, either soothing applications, Opium (358, 65 & 400); Bell., Chloroform, Iodoform (350,51 & 75); Bism. (351 & 93), etc.; or stimulating ones—b/ackwash (400);yeast poultice; astringents—Tannin, Zinc or Iron (338, 41, 45 & 77); or antiseptics—Phenol, Creosote (337 & 52), etc. A small bag of charcoal, dry and wrapped in flannel, may be laid over the wound to absorb the effluvia. (Poultices should not be applied too warm for fear of excoriating the surrounding skin; though it may be remedied by dusting the part with bismuth or tannin. Carcinoma Ventriculi—Cancer of the stomach is at- tended by pain of a burning and lancinating character, which increases upon pressure; by vomiting of sarcina and blood; and often by a peculiar greenish-yellow com- plexion, the so-called cancerous cachexia. Treatment— Above all, a nourishing diet, as eggs, buttermilk, etc.; if necessary, Pepton (p. 84) and rectal alimentation (387). Cathartics should be avoided. If pain or vomiting, Arsenic or Bismuth (pp. 10 & 46). Chian Turpentine is recommended. (There are four varieties of Carcinoma: the medullary, the most malignant and vascular; the colloid, which is the least vascular and malignant; the epithelial; and scirrhvs, which latter is of a stony hard- ness, slow growth, and consists principally of a dense fibrous tissue). # Carcinoma Uteri is most frequently medullary cancer, 186 Carcinoma. presenting the features of fungus hoematodes. The epithelioma, which attacks the mucous membrane of the os, may present itself either in ulceration of this mem- brane, or in the development of caidiflower excrescences. In the incipient stage, where the only symptom may be menorrhagia, the os having a nodulated and hard surface, cauterization with Argentum nitricum or Potassa c. Calce at intervals of five or six days, without paying attention to the discharge of blood, may avert still the disease, as they will improve the condition of those parts and pro- mote a slough of the cancerous mass. If, however, more advanced—the womb enlarged, immovable, the lips everted and ragged with deep ulceration, much hardness in the surrounding tissue, the vagina and rectum both being involved in the induration, attended by profuse loss of blood (see Hemorrhage); mucous, mucopurulent or serous, sometimes very fetid discharges; by pains in the hips, thighs and uterus; with increased weight, ex- treme prostration, frequent vertigo and sick stomach— Treatment can be but palliative. Cauterization for temp- orary relief, with Iodine (20); Chrom, Benzol, Mangan (402 & 3); Cuprum, Liq. Hydr. nitr. (344 & 47), etc. But the speculum must not be unnecessarily introduced, as it will aggravate the pain and may cause flooding. To alleviate pam, Arsenic, Silicium or Hyoscyamus (pp. 10, 19 & 27); and locally Opium (365 & 75); Be/ladonnaor Chloral(350 & 65); Iodoform and Conium (373 & 75); if nothing of avail, ice (312), or a blister to sacrum, dressed with about two grains of Morphia, and repeated according to the emergency. In mucous or serous dis- charges, Acid, nitric, Alum,Creosote (362 & 63). Consti- pation should be relieved by the use of enemata (38<5). Catarrh. 187 Cardiac Disease. See Heart. Cardialgia. See Dyspepsia. Caries—Ulceration of the soft part of a bone de- pendent on some constitutional disorder (scrophulosis, syphilis, etc.), requires appropriate Treatment of cause, and locally injections of Acidum nitricum v. phosphoricum dil., after having removed the diseased part by forceps or gauge. See Necrosis. Carphologia. See Subsultus tendinum. Caruncle urethral. See Urethra. Catalepsy—A form of hysterical coma, the sensory functions, volition and consciousness being suspended; with the addition of a peculiar wax-like rigidity of the voluntary muscles, retaining the limbs or the different parts of the body, in any position, in which they may have been placed by the hands of others. Treatment as in hysterical coma. If the paroxysm should last for weeks or months, forcible alimentation must be resorted to; afterward any derangement of the organs of genera- tion should be attended to. Catarrh or Cold par excellence (Schnupfen) is a catarrhal inflammation, which extends over more or less of the mucous membrane that lines the tract, leading from the nose to the lungs, its distinctive name being derived from the particular part affected, as cold in the head, coldin the throat, cold in the chest, etc. Treatment as indicated, in bronchitis, coryza, pharyngitis, etc.— Pulsatilla and Antimony (pp. 16 & 23); Ferrum, Cocaine or Phenol (285, 89 & 99); Alum, Iodine (299 & 321, etc. For Cervical and Intestinal Catarrh see Uterus (En- dometritis), resp. Enteritis. Cellulitis, periuterine. See Uterus. 188 Cepludalgia. Cephalalgia—Headache is a neuralgic affection, sup- posed to depend upon either spasm or paralysis of the muscular fibres of the arteries within the skull, which is produced by a vaso-motor influence of some toxical agent, acting on the sympathetic nerves. Treatment according to cause: If from constipation, cathartics (p. 88); if congestion, Aconite or Ergot (pp. 22 & 65); if syphilitic, Iodine (pp. 14 & 15); if from defective menstruation, Brom (50 & 53); Veratrum (p. 39). In sick headache, Caffein, Guarana (178,163 & 242); if periodic, Salicin (29); if throbbing pain in brow, Arsenic (p. 10). In migraine, Brom, Caffein, Cyan, Cypripedium (66 & 69); Arnica (p. 74); Chloral (pp. 30 & 109); Camphora (54, 243 & 314); Cannabis (p. 2S); Valeriana or Zine (19:1 & 96); Chloroform or Amyl (37, 246 & 308); Aconite or Veratrum externally (410),etc. See Neuralgia (trifacial). Cephalhematoma—A tumor consisting of an extra- vasation of blood under the scalp, caused by pressure on the head during parturition, which is soft, painless and slightly compressible. Treatment—Evaporating lotions and gentle pressure by the cross-wise application of strips of Emplastrum adhcesivum, to assist absorption. Cerebral Disease. See Brain. Cerebro spinal Meningitis. See Meningitis. Cervicodynia. See Myalgia, Cervix Uteri. See Uterus. Cessation of Mexkes. See Menopause. Chancre. See Syphilis. Chancroid—Soft chancre is a highly contagious, suppurating ulcer of venereal origin; and though, when- ever oculated, it may be followed by suppuration of the nearest lymphatic gland (see Bubo); it is but a local Cholera. 189 disease, independent of syphilis, and, therefore, without secondary symptoms, which, however, does not exclude the co-existence of a chancre. Treatment__If the sore should not be a week old, it may be cauterized with Acidum nitricum (329); if older, Mercury (347). Other applications are: Cuprum, Mangan, Tannin, Phenol (327 & 340); Iodoform, Jodol or Ferrum (269 & 331). The latter three are of special benefit in phagedena. If syphilis is suspected, Mercury and Iodine (pp. 13 & 15). Chicken-pox ( Varicelli). See Eruptive fevers. Chilblains. See Perniones. Chlorosis— Green Sickness is a neuropathic affection, occurring in girls at or near the period of puberty, and dependent on an anaemic state of the blood in conjunc- tion with a faulty evolution of the sexual organs. It is generally characterized by a greenish complexion and perversion of appetite, as a craving for chalk, slate and the like. See Anaemia. Treatment—Aside from a gen- erous diet with out-of-door life and mental hygiene according to indications: Pancreatin, Aloes, Calomel (185, 97 & 208); Ferrum and Quinine (166, 75 & 253); Acidum sulfuricum (129 & 55); Iod and Strychnine (pp. 15, 82 & 83); Arsenic (p. 10); Cocaine (168 & 247), etc. Artificial suppression of the menses for a few times by injections of cold or warm water, with absolute rest in bed, has been recommended in cases where hysteria is a prominent symptom. Cholera morbus (Cholera nostras)—Sporadic cholera is a functional affection of the alimentary canal, pro- duced mostly by indigestion. Its chief characteristics are: Violent vomiting, speedily followed by purging, and accompanied by colic pains, anxiety, restlessness and 190 Cholera. exhaustion. In severe cases there may be aphonia, cramps of the legs, etc.; but the attacks seldom prove fatal. Generally the various symptoms soon diminish, and after a few hours disappear altogether, even without remedial interference. Treatment—Opium (77,255 &381); Brom or Camphora (pp. 27 & 28); Ipecacuanha (p. 100), if necessary. A small piece of ice or a tablespoonful of water and no more may be allowed at short intervals, to appease a little the intense thirst. Brandy (p. 73), if much prostration. Of other remedies may be mentioned Chloroform (p. 31); Veratrum, Phenol (22, 84 & 382), etc. Cholera Infantum (Summer Complaint)—This name embraces different distinct affections, occurring in child- ren under two years of age during the hot season, especi- ally from June to September: Sporadic cholera, diar- rhoea from indigestion, enteritis, colo-enteritis and dysen- tery. See these. The development of hydrocephaloid during any of these affections is, at least to the young child, almost always fatal. Treatment—Bismuth, Creta, Catechu (99, 107 & 135); Cinchonidin, Brom or Chloro- form (pp. 12, 27 & 31); Camphora, Opium (55 & 77); Argentum, Cotoin, Pepsin (133, 37 & 87); Phenol as enema (382). Sometimes an emetic is required (p. 100). If much thirst, Nitre (p. 57); if much prostration, brandy (p. 73); if^vomiting, Creosote (138) and Mustard to epigastrium, etc. Cholera Asiatica—Epidemic cholera is a miasmatic contagious disease of the alimentary canal, dependent on some specific germ, which finds its way into it, and pre- ceded generally by a simple diarrhoea. It is characterized by violent purging—copious liquid discharges, the so- called rice-water stools—and vomiting, conjoined with Chorea. 191 great prostration, coolness of skin or cold perspiration, and sometimes cramps of the muscles; and, if not arrest- ed, followed speedily by collapse—the algid or cyanosed stage. Treatment—Prophylactically it will be well to avoid over-fatigue and undue excitement from whatever source; no unnecessary exposure to night air, and par- ticular attention to diet: Lobster, oysters and pork, with cabbage, peas and beans, especially green corn, cucum- bers, melons and the like, should be banished from the table for the time being. Premonitory diarrhoea (which is considered by some a salutary process to eliminate the poison), unless already of some duration, may some- times be stopped by Calomel (208), followed by Castor oil; Camphora and Ammonia (55 & 157), are often of use. The best remedy is perhaps Morphium (pp. 37, 38 & 110). Phenol (22), and Cocaine (168 & 247) are also recom- mended. To control vomiting, ice and brandy (p. 73), m collapse the latter per rectum (380), with external warmth—blankets, hot stones, etc. Iodine (p. 15) is said to promptly check vomiting. To arrest cramp, a warm enema of salt (386) is sometimes beneficial. In my hands has invariably proved successful the modified pack (420), with lemonade: 20 drops of Acidum sulfuricum dilutum in sugar water (p. 61), ad libitum. Chordee. See Gonorrhoea. Chorea—St. Vitus Dance is a neurose, characterized by irregular clonic contractions of more or less of the voluntary muscles, especially of the face and extremities, giving rise to movements which are either involuntary or not under the control of the will. Treatment—Next to removal of cause, as anaemia, worms, etc., invigorat- ing measures in conjunction with tonics—Arsenic alone 192 Colic. (pp. 9 & 107), or if jactitations prevent sleep, combined with Chloral (60); Ferrum (167), etc; Argentum and Zinc (pp. 74, 86 & 87); Cuprum (170); Strychn. (p. 83); Phy- sostigm (270); Cocaine (p. 109); Anil (38); Asa foetida and flwfa (41 & 81); Cimicifuga (104); Aconite and Conium (pp. 22 & 31); 0/ew/w Jecoris (185), etc. Clergyman's Sore Throat. See Pharyngitis (chronic). Coccyodynia. See Myalgia. Coitus. Painful. See Dyspareunia. Cold. See Catarrh. Colica Intestinalis—An affection of the alimentary canal, characterized by paroxysmal spasmodic pains in the umbilical region, accompanied occasionally by vomit- ing, and dependent on a weak and irritable state of the digestive system. Treatment—If from indigestion—cra- pulous, Opium (pp. 35 & 38); if from constipation, Brom (pp. 24-27); if from hepatic derangement—bilious, fomentations, etc.; if tympanitic, Dioscorea, Valeriana, Vani/.(10, 82 & 83); Opium, Chloroform or Asa fcBtida (77, 61 & 41). In children, Aqua Calcis, etc. See Enteralgia. Colic. Hepatic—A paroxysm of pain about the right hypochondriu.Ti or epigastrium, often extending into the chest and right shoulder, due to the passage of a gall-stone. It is always accompanied by vomiting. See Calculi. Treatment—For the relief of pain, Morphine (77 & 225); Atrop. and Chloroform (241 & 304), with ice or fomentations locally; alkalies (pp. 53, 57 & 97). Of special benefit are said to be Macis, Oleum Olivarum and Oleum Therebinthince (146, 150 & 213). For Benai and Urinary—, Saturnine—(Painter's) and Uterine Colic, see Calculi, resp. Enteralgia from lead or Dysmenorr- hoea (obstructive). Combustio. 193 Coma—A lethargic state, lasting from a few hours to several days, and dependent among other causes, on cerebral congestion and insufficient supply of arterial blood to the brain; internal and external toxical agents, etc, etc. (It is also a pathological element in some neuroses, a3 hysteria, epilepsy and catalepsy.) Treatment —If from cerebral exhaustion, nerve tonics and brandy (pp. 70 & 72); if from alcoholism (dead drunk), the ce/d douche. In semi-coma or somnolency, due to ner- vous exhaustion, strong coffee. In coma of typhoid, sinapism or blister (408) to back of neck. If dependent on uraemia, saline hydragogues (p. 96), or Tiglium (225), unless contra-indicated, in which case Pilocarp. hypod. (pp. 50 & 110). In hysterical coma—characterized by profound but tranquil sleep, without stertor, the pupils readily responding to light—aside from the douche, enemata of 01. Tereb. or Asa fcBt. (385). In unknown cases of sudden coma, if uraemia be suspected, though there should be no dropsy or other symptoms of it pre- sent, a little urine should be drawn off and examined with reference to albumen, casts and specific gravity. Combustio (Burns and Scalds)—Lesions produced by the application of heat have to be treated according to the damage done. Cotton to exclude the air; Copaiva, Glycerin,Collodion or Cocaine (405 & 15). Avery popular application is Aqua Calcis cum Oleo Lini; if extensive, Phenol or Iodoform (405); from phosphor, Caustic. Very severe burns (of second degree) should, after having been bathed with warm turpentine, be dressed with Ungt. Resince or Linim. Therebinth on lint, and the whole cov- ered with cotton. The dressing should remain as long as possible—any loose portions of it should be replaced by 194 Constipation. fresh ointment, the old having been clipped off—and not be removed unless there is profuse discharge or bad smell from the wound. Burns in the granulating stage may be touched with the alcoholic extract of Quebracho, until it forms a scab, under which healing is said to rapidly take place. Collapse must be treated with brandy and beef tea; pain with Opium (p. 37). Remaining ulcers have to be managed according to their nature— see Ulcers. Proper attention should be paid to the cicatrix, on account of its liability to become excessively hard, and cartilaginous, and to contract in such a way as to occasion most serious deformities. In such cases it may be necessary to dissect it up from the parts beneath, and then filling up the gap by transplanting a portion of sound skin from the neighborhood. Condylomata. See Syphilis. Confinement. See Labor. Congestion of Brain and Uterus. See Brain (Hy. peraemia) resp. Uterus (Hyperplasia). Conjunctivitis. See Eye. Constipation (Costiveness, Obstipation)—A func- tional disorder of the large intestine, unless dependent on some lesion of the alimentary canal, characterized by a faulty defecation, as regards the intervals between the single acts, the sufficiency in, and quality of the evacua- tions, due partly to a diminished secretion of the bowels partly to an impaired contractile power by distention— as in habitual constipation—or to both; or to mechanical obstruction—as in females during gestation, etc. It pro- duces generally a feeling of pressure and weight in the perineum, combined with flatulency, diarrhoea or colic pains; sometimes it gives rise to headache, palpitations Convulsions. 195 ^nd general malaise, and very often it is the cause of hemorrhoids. Treatment according to cause. If torpor or retained feces, especially in full or gouty habits, Aloes and Colchicum (pp. 88-90); Potass. (220); Senna (pp. 97 & 98). If habitual, Fruit fpp. 88 & 95); Glycerin (207); Aloes, c. N. Vom. (199); Podoph. (p. 93); Lobelia (p. 34). If urine red, Sod. Phosph. (p. 97); if flatulency, Colocynthis (203); if very obstinate, Croton (p. 98), or enemata (385); if deficient secretion, Ammon. (223). In chronic disease, if weakness or general malaise, tonic salines, Rhamnus or Rheum (215, 216 & 19), etc. For the use of women during pregnancy there might, aside from fruit, glycerin, salines, senna and the popular castor oil, be enumerated still a host of cathar- tics, as Mercury (pp. 92 & 93); Gamboge, Magnesia cum Rheo (218), etc., etc., to chose from; but for the welfare of the patient it will, as a rule, be better to confine the treatment as far as possible to massage and simple ene- mata (385), which, in connection with a proper diet, will answer in most cases. In order to derive from massage the desired effect, the rubbing should be commenced in the ileo-coecal region and follow the course of the colon. In habitual constipation of children the operation is best performed in the morning. Consumption (Phthisis). See Lung. Convulsions. Epileptiform—Automatic movements of various parts of the body, marked usually by clonic spasm, dependent on irritation of the spinal cord from a multitude of causes, and occurring frequently in child- ren and pregnant women. Treatment—If from uraemia, Brom (pp. 25 & 27); Chloral and Chloroform (60, 304 sea and vomiting; (jaundice, if the duodenum is in- volved). The acute form is generally a consequence of over-indulgence in eating and drinking, the use of dra- stics and poisoning with acrid substances; sometimes it is due to cold, when the body is heated and perspiring. Subacute it arises from dietetic errors or from arrest of digestion through exposure to cold, over-exertion, etc.; whilst the chronic form is usually referable to some prior morbid condition,especially valvular lesions,chronic pleuritis, emphysema and cirrhosis, which lead to it by obstructing the circulation in the portal system. (This form occurs also in tuberculosis, oxaluria and Bright's disease.) The Treatment of the acute and subacute form embraces mild purgatives, followed by anodynes and regu- lation of diet. Aloes (201); Opium (p. 37); fomenta- tions will be sometimes of service. Compare Gastritis- In chronic enteritis the cause must be removed as far as possible. Argentum, Cuprum, Plumbum (133, 139 & 47). See Diarrhoea. Enterocele. See Hernia (entero-vaginal). Entozoa intestinales. See Helminthiasis. Enuresis. See Bladder (Paralysis vesicae). Ephidrosis—A morbid and excessive secretion of the sudorific glands, generally a concomitant of catarrhal and rheumatic affections. Treatment—Acidum sulfuri- cum v. gallicum, Arctostaphylum (pp. 61 & 68), etc. In night-sweats, Ergot, Quinine or Atropia (pp. 76, 78 & 23); Tannin or Agaricin with Pulvis Ooveri (pp. 62 & 63) are particularly recommended. For sweating feet, a wash Epilepsy. 219 containing Acidum nitricum, or a powder with Acidum salicylicum (395), or Vinegar; if fetor, Borax, Soda, Man- gan or Phenol (334, 390 & 98). Epididymitis. See Testes. Epilepsy—Le grand mal of the French is a chronic, paroxysmal neurose, characterized by a sudden and com- plete loss of conciousness, associated with tonic and clonic convulsions; respiration during the former nearly suspended, during the latter irregular and labored; ejec- tion of foamy saliva, frequently mixed with blood; sometimes urine is voided and feces are expelled, even a seminal emission may take place. The attack may last from a few minutes to half an hour, and is followed by more or less exhaustion, and a disposition to sleep. In some cases the fit consists only of vertigo, a moment- ary loss of consciousness and a state of confusion or deep abstraction. These are called epileptoid attacks —le petit mal of the French. The morbid condition giving rise to epilepsy is seated in the medulla oblongata and pons Varolii/ however, the toxic agent is as yet unknown. Intra-cranial lesions and cerebral anaemia are sometimes connected with it, and of other causes may be named intemperance, venereal excesses, lead poisoning and phimosis, even intestinal worms. Treat- ment according to cause—Calomel (207); Amyl(37 & 308); Belladonna (pp. 23 & 24); Anilin or Camphora (38 & 50); Digitalis (171); Apomorphin(240); Woorara(259); Argent- um, Capsicum and Zinc (160, 170 & 194); Lithium (110); if suppressed menses be the cause, Croton (225), etc. Of all the remedies Brom (pp. 26 & 27) takes the lead, as it may be taken for years, if care be taken to discon- tinue it for a few days whenever Bromism is produced. 220 Erysipelas. Epistaxis. See Hemorrhage from the nose. Epithelioma. See Carcinoma. Epulis. See Mouth. Erosions of Cervix. See Uterus (Degeneration). Eruptions or Exanthemata. See Skin. Eruptive fever. See Fever. Erysipelas—A diffuse inflammation of a low type, affecting the skin: simple erysipelas, or skin and areolar tissue: phlegmonous erysipelas, with a tendency to spread, and accompanied by fever—the high temp, being diag- nostic. It attacks generally the face, spreading to scalp, throat or trunk; but it will affect with predilection in- jured parts all over the body. Treatment as in septi- cemia and according to the severity of the case—Warm poppy fomentations; flour, dusted over the inflamed sur- face; cotton as cover, or pressure by means of bandages; Argenti Nitras, Ichthyol, Cocaine, etc. (404 & 5); Naph- thol, Creosote (390 & 98), or Phenol as injection (p. 107). A hypodermic injection of Sub/imats (0.0006) bis die is *aid to be very efficient. Minute punctures, about 2 mm. deep, may be made with the point of a lancet in simple; deep incisions, about 3 cm. long, carried to the diseased tissue in phlegmon. Rapid strokes with a red hot iron over the erysipelatous surface, previously covered with a thick layer of felt, so as to strongly warm the affected part, are also recommended. Internally, sulfides (pp. 18 & 19); Mangan (p. 82); Brom (48), it delirium. Aconite (p. 22) is said to act abortive in the sthenic type, with Lead and Opium wash (337), applied hot, and the com- presses covered with oiled silk. Ammon. and Terebinth. (pp. 43 & 67), in cardiac weakness. If constipation, enemata (385 & 86); if diarrhoea and sickness (from Eye. 221 irritable stomach), Bismuth or Mercury (pp. 46 & 93). If there be bilious vomiting in idiopathic erysipelas, it is well to purge—a hot Mustard poultice over the epi- gastrium gives sometimes instantaneous relief. Bella- donna (p. 24) in idiopathic facial. In the rest, brandy ([). 72) as support, and tonics—Ferrum (pp. 66 & 79) is only of service in simple facial, if idiopathic; and Quinine is in all cases, if not dangerous, at least useless, as the dilatation, that precedes the contraction of the blood- vessels, does harm. Erythema. See Skin. Exanthemata and Exanthematous Fevers. See Eruptions and Fevers. Excitement (Nervous) will in many cases yield to a Seid/itz powder, Brom (p. 25), or Nitre (124). The latter is particulary useful, if caused by fright. See Hysteria. Excoriations. See Skin (Intertrigo). Exhaustion. See Debility. Eye— Ophthalmitis is called the inflammation,in which all the inner structures of the eye are more or less in- volved. It is characterized by a bright pink red of the sclerotica; the iris discolorated from increased vascu- larity or effusion, sometimes adhering to the capsule of the lens, sometimes bulging; in severe cases enlarge- ment of the whole eyeball, swelling of the lids, chemosis, scalding tears and suppuration—the latter is indicated by shiverings. It is accompanied by agonizing pain, and generally caused by injuries or sympathetically in consequence of disorganization of its fellow. Treatment —Removal of foreign bodies, chemical irritants, etc., as far as possible; perfect rest of the eye by keeping it closed and cold compresses. At the same time purgatives 222 Eye. (p. 88), and to allay pain, Opium or Cocaine (pp. 35 & 112). Prolapse of the iris in consequence of penetrating wounds of the cornea, may sometimes be reduced by closing the eye and very gently rubbing the lid against the cornea, and afterward exposing it to a strong light, to cause the pupil to contract. Atropia or Physostigmin (pp. 112 & 13). A foreign body having passed deep into the globe of the eye, so that it cannot be extracted, if it cause no irritation, may be allowed to remain, as it might become encysted; otherwise it will be well to enucleate the eyeball at once, to prevent the loss of the other eye from sympathetic ophthalmitis. Foreign bodies inside the lids may easily be removed by everting these; when in the cornea, Cocaine (263) will be useful. For injuries with acids or alkalies, or for removal of particles of lime or mortar, syringing with water is the best and readiest remedy. Blows on the eye are generally followed by ecchymosis; sometimes by an effusion of blood in the anterior chamber, which, however, is mostly absorbed within a fortnight, if in- flammation be kept down. A deposit of pus in the anterior chamber (hypopio)i) is mostly a consequence of acute iritis—see Keratitis suppurativa. Iritis—Inflammation of theiris, which always involves other interior parts of the eye, thus constituting in reality ophthalmitis, is generally dependent on a rheumatic or syphilitic taint. It is characterized by discoloration of the iris, irregular contraction, immobility of pupil, more or less vascularity of the sclerotica, making the whole eye appear of a pink redness, associated with dimness of vision, intolerance of light, and pain — especially a neuralgic aching of the brow and parts around the Cornea. 223 orbit in nocturnal paroxysms. Treatment is directed to the special cause; for the relief of pain, Atropia (262). Cornea—Acute Keratitis, characterized by a red and opaque cornea, with a highly vascular sclerotica around it, and leading sometimes to ulceration, is frequently a consequence of neglected injury. Treatment—Next to rest, fomentations, and if it be necessary, a few leeches to the temples, or tapping of the anterior chamber. A nourishing diet in conjunction with tonics (p. 70) is sometimes required. Keratitis p>^'cnvl>ymatosa—^t\\xxno\xs corneitis has, in addition to the above characteristics, a tendency to in- flammation of the iris and retina. The cornea becomes unusually prominent. Treatment—Jf acute, fomenta- tions and cathartics (p. 88); for the chronic form, re- peated blisters (408) to temples and behind the ear, with tonics and alteratives—Jodine (p. 14); Quinine and Iron (p. 76); Oleum Jecoris (p. 84), etc. Keratitis phlyctenidosa begins with a phlyctenula on the epithelium of the cornea, which becomes a nodule, changes soon into a vesicle, and ultimately an ulcer, being accompanied with great intolerance of light, so that the lids keep spasmodically closed, and the tears gush forth on every attempt to open them. If the pimple forms on the conjunctiva (Conjunctivitis phlyc- tenulosa) there is less photophobia. The disease lasts about ten days, but generally recurs. Treatment—Aside from cathartics and tonics, poppy fomentations and small blisters behind the ear; afterward Calomel (268). Pho- tophobia and Blepharospasm are sometimes relieved by Conium (63 & 264), or Woorara (259). Keratitis suppurativa—Either an abscess on the sur- 224 Eye. face of the cornea, usually called ulceration of the cornea, or an interstitial abscess—a yellow pus spot with a sharp edge, or diffused in any part of the cornea. In the latter form the pus should be evacuated early by tapping the aqueous tumor after having applied Atropin (262) to prevent prolapse of the iris. Ulcus Corneal—When as consequence of a scrofulous phlyctenula, the ulcer is generally deep, and tends to perforate the cornea, leaving an opaque cicatrix; when arising from other causes, it is often superficial. Again ulcers may form on a surface that is already rendered nebulous or opaque by inflammation. The general treatment as in phlyctenular inflammation; locally, fre- quent fomentations; Bor or Iodoform (263 & 69), and keeping the eye warm and closed with cotton and a light bandage. Conjunctivitis catarrhalis—Inflammation of the con- junctiva is characterized by increased lachrymal secre- tion, a mucous or muco-purulent discharge, attended with smarting, heat, stiffness and dryness of the eye, and a feeling as if sand had got into it. It is dependent on cold, local irritation, and sometimes on a weak constitu- tion. Treatment—Lotions of Zinc, Alum, etc. (261 & 75), and, perhaps, tonics (p. 70). In the chronic form Iodo- form (269) may be tried. Conjunctivitis purulenta—A violent inflammation with a thick, purulent discharge, which supervenes after one or two days duration, and may lead to ulceration or sloughing of the cornea, followed by inflammation of the internal parts of the eye. The form called contag- ious or Egyptian ophthalmia is not so destvuctive as the gonorrhoea/ variety, which develops very soon after the Conjunctiva. -/25 contact with urethral pus. Opthalmia Neonatorum, which is generally produced by a vaginal discharge from the mother, specific or no, will, if neglected, also terminate in ophthalmitis. Treatment—Aside from rest mid cathartics (p. 88), Argenti Nitras (261), -with cold compresses and Bor (260) locally. Hard chemosis, which is overlapping the cornea, should be freely incised. In infants, an early treatment with weak astringent lotions, as thea, combined with cleanliness, will generally suffice (261 & 67). Granulations on the conjunctiva consist either of en- larged papillae, and* are a sequel of chronic conjuncti- vitis or of an injudicious treatment with irritating applications; or they are enlarged lymph cells (trach- oma) in appearance, not unlike sago, which frequently co-exist with catarrhal or purulent conjunctivitis. They require a tonic treatment; locally, Bor (260); and some- times scarification. If chronic the part should be squeezed by means of trachoma forceps so as to com- pletely express the follicular contents. Pterigium—A morbid formation of the conjunctiva, a triangular portion of which, with the apex toward tbe cornea, becomes thickened, elevated, red and fleshy, and may spread over the cornea, so as to obstruct vision. It depends on continued exposure to heat. Treatment— The growth should be seized close to the cornea with a tenaculum forceps, cut quite across and dissected off toward the internal canthus, taking care not to extirpate the semilunar fold and caruncle. Nebula—A partial opacity of the cornea, which results from effusion between the corneal layers or between the cornea and conjunctiva from inflammation or healing 226 Eye. ulcers. It will in time disappear without any treatment whatever. Arcussenilis is called a circumferencial lunated opacity of the cornea, depending on fatty degeneration, and supposed to be associated with alike condition of the heart. Leucoma or Albugo is a white cicatrix, produced through loss of corneal substance from ulceration, which is indelible—if it retains its vascularity it is called Pannus. Staphyloma of the cornea is said to exist when a por- tion or the whole of the cornea, disorganized by injury or disease, has perished, and the cicatrix, with which the iris has become covered, bulges befcrre the pressure of the humors and forms an opaque, white prominence. Treatment—If growing it should always be removed to prevent further disorganization. Having transfixed the tumor with a needle or hook, it may be sliced off close to the eyelid, and cotton with a bandage applied. If the lens be present it must be taken out. Hernia Corneas—When the cornea is nearly perfor- ated by an ulcer, a thin vesicle is apt to protrude from the aperture, consisting of the posterior elastic mem- brane. The eye has to be kept closed for a few days by means of a bandage, to insure speedy cicatrization.' Hordeolum—A stye is a small painful boil at the edge of the lid, having its seat in the follicle of a cil- ium. It is always dependent on a debilitated constitu- tion. Treatment—Aside from alteratives and tonics (pp. 8 & 69) to invigorate the general health, poultices or fomentations locally; afterward perhaps Ungt. Hydr. nitr. (266). The so-called tarsal tumor, which consists of one of the acini of the Maibomian glands of the lid, is situated very near, but never on, the margin of the lid, Palpebral. 227 like hordeolum. It may be cut across with a small scapel, and the contents squeezed out. Eczema Palpebrarum ( Ophthalmia Tarsi)—A usually chronic eczematous inflammation of the palpebral con- junctiva and the edge of the eyelids, with a morbid secre- tion of the Maibomian glands (so that the lids will stick together and become encrusted with dried secretion during sleep), leading frequently to ulceration of the lids, disease of the hair follicles, and loss of the eye- lashes; even to thickening and subsequent inversion of the edge of the lids. It mostly occurs to weakly persons with disordered digestion. Treatment—The lashes should be cut off, the eyes bathed with warm water several times daily, and at night the edges of the lids be smeared with lard or Ungt. Hydr. nitr. (266). At the same time aperients (p. 88); alteratives and tonics (pp. 8 & 69), and if possible, change of air. Trichiasis—A growing inward of the eyelashes, lead- ing to inflammation or ulceration of the cornea, and depending on some changes in the fibro-cellular tissue, in which the ciliary follicles lie. Treatment—If pluck- ing of the offending ciliae will not answer, roots and bulbs must be extirpated with the knife. Ectropion—Eversion of the eyelid, caused by a thick- ening of the conjunctiva, owing to chronic inflammation or to a cicatrix on the cheek; often it is a consequence of the cicatrization resulting from the healing of abs- cesses at the edge of the orbit. Entropion—Inversion of the lid, produced by the unnatural action of that por- tion of the orbicularis palpebrarum which covers the edges of the tarsal cartilage. Operation is the remedy. lagophthalmos—Hare-eye is called the inability of 228 Eye. closing the palpebrae, and depends either on cicatrices or upon inaction of the orbicidaris through palsy of the portio dura. In the latter case fomentations, a blister behind the ear, and aperients (p. 88), may suffice, unless it be due to some specific disease. Ptosis—A falling of the upper eyelid, whereby the eye is more or less closed, and depending on inaction of the levator palpebral, in consequence of paralysis of the third nerve or on senile loss of power of the muscle; or it follows injury to the eyelid, whereby the nerve supply is more or less destroyed. In the first case, if it is at- tended with headache, giddiness and other signs of brain disturbance, the treatment should consist of rest, with purgatives, and locally, cold compresses; if caused by exposure to draught, tonics may be employed. In cases where general measures fail, a surgical operation. Symblepharon—Union of the eyelid to the ball, produced by ulceration of the lid and the surface of the globe in consequence of some accident, is generally irremediable. Pediculi—These parasites lodge sometimes about the roots of the eyelashes, and produce obstinate itching. Unguentum mercuriale is the remedy. Epipjhora—Kn over-secretion of tears, so that they run over the cheeks from irritability of the lachrymal gland or a hyperaemic state of the conjunctiva, common in scrophulous children. Aside from warm local appli- cations, purgatives, alteratives and tonics. Xerophthalmos— Dryness of the eye from deficiency of the mucous secretion of the conjunctiva in conse- quence of severe inflammation or too much cauteriza- tion, and may be relieved by applying milk or Glycerin. Lachrymal Apparatus. 229 Stillicidium lachrymarum—Watering of the eye is caused by an over-flow of tears in consequence of an obstruction somewhere in the lachrymal apparatus. If the punta lachrymalia be closed in consequence of in- flammation in their neighborhood, it is only temporary; if congenita], it is incurable. In other cases a caniculus is generally obstructed as well, which should he slit open at once, and prevented from closing again, by passing for a few days occasionally a probe into it. Sometime* there is obstruction of the nasal duct in consequence of a thickening of its lining membrane, not uncommon in scrophulous persons, attended with a perpetual watering of one eye and dryness of the corresponding nostril. This is characterized by a small tumor by the side of the nose, which consists of the lachrymal sac distended with tears and pus, and the contents of which can be squeezed upward through the punta, and down ward into the nose if the obstruction is not quite com- plete. The best plan is to slit open a caniculus and pass from there twice a week a style into the nasal duct (to be kept there half an hour) until the stricture is overcome. Dacryocystitis—Inflammation of the sac is known by redness, swelling and pain at the side of the nose, im- plicating the conjunctiva and eyelids, and attended with fever and headache. Treatment—If acute, leeches, cold compresses and cathartics (p. 88); if the pain becomes throbbing, the sac more and more distended, and its contents cannot be pressed down into the nose, the impediment within the nasal duct must be removed by catheterization as indicated. In the chronic form, an astringent (273) may be applied twice a day to the inner angle of the eye, to be transmitted to the sac by strong and 230 Eye. repeated inspirations, with mouth and nose well closed. Fistula lachrymalis signifies a fistular opening at the inner corner of the eye, communicating with the lachry- mal sac, the ordinary consequence of an obstruction of the nasal duct, if not in time relieved. Synechia anterior et posterior consists of an adhesion of the iris to the cornea or capsule in consequence of organization of lymph from protracted iritis. Artificial pupilhj iridectomy. In Atresia iridis, which is dependent on the same cause, iridectomy is also the only remedy. Myosis—Inability of pupil to dilate, attended with " great obscurity in vision, and sometimes with injury to the sympathetic of the neck. Attention to general health and rest to the eye—Atropin does harm. Mydriasis—A preternatural dilatation of the pupil, which does not contract on exposure to light, caused by any injury of the brain affecting the tubercula quadri- gemina, as in apoplexy and compression, or on a derange- ment of the nerves supplying the iris, in which case it may be attended with ptosis—from paralysis of the third tierve;—or it may even depend on gastric irritation and general debility. It is often an attendant of confirmed amaurosis. Ergot or Strychn. (pp. 78 & 83), in conjunc- tion with blisters to the temples, are sometimes of use. Cataract (Grauer Staar of the Germans)—Opacity of the lens or of the capsule, or of both. Operation. Glaucoma—Choroiditis with diffuse imbibition by the vitreous body, which latter increases the intraocular pressure, terminating in disorganization and total blind- ness, is characterized by a stony hardness of the eyeball, a steamy looking cornea, and a dilated and fixed pupil. In the acute form—glaucoma fulminans—which occurs Vision. 23 i generally in feeble constitutions of elderly people, there is at the same time a violent neuralgic pain in the eye and throughout the ophthalmic branches of the fifth nerve. Treatment- -Next to rest, cold compresses, leeches and tapping of the anterior chamber. Iridectomy if chronic. Asthenopia or weakness of sight (muscce volitantes), if dependent on hypermetropia, may be ameliorated by spectacles. If associated with intolerance of light, it is usually an accompaniment of short sight, easily recog- nized by the contracted brow and half closed, continu- ally winking eyelids. Amaurosis and Amblyopia—Blindness is often asso- ciated with some disease of the brain or spinal marrow —embolism of the central artery of the retina is a com- mon cause of blindness. Treatment—Pulsatilla (23), or Nux Vomica (p. 83) may be tried, and Strychn. or Veratrin (271 & 72) locally. Impaired vision, which may be a consequence of atrophy of the optic nerve, detached retina, retinitis, displacement of the lens, etc., is seldom amenable to amelioration. Myopia—Short sight dependent on the fact that par- allel rays are brought to a focus before they reach the retina on account of either the refracting power of the eye being too great, or its antero-posterior axis too long. Use of carefully adjusted spectacles. Presbyopia or far sightedness is called a narrowing of the range of accomo- dation, owing to changes in the lens and ciliary muscle. Hypermetropia is the converse of myopia: Parallel rays of light are not brought to a focus on the retina, but behind it, owing to the refracting power of the eye being too low, or the optic axis too short. It being one of the most common causes of asthenopia or impaired vision, 232 Eye. and of convergent strabismus, it should be corrected by well selected convex spectacles. Astigmatismus {irre- gular refraction)—When different meridians of the same eye have different powers of refraction, characterized by the fact that whilst some lines or objects are seen clear, the neighboring ones look blurred. It may be owing to original conformation, cicatrized ulcers, or a conical condition of the cornea; or to disease or displacement of the lens. In Keratoconus, where the abnormal bulg- ing of the cornea causes first shortsightedness, but by degrees inability to see anything at all on account of too great refracting power, a concave glass or a perfor- ated diaphragm, or the two combined, will sometimes remedy the faulty refraction; but an artificial pupil by iridodesis will be more satisfactory. Strabismus—Squinting signifies a want of parallelism in the position and motion of the two eyeballs. It is called convergent, when the affected eye is turned in- ward, which form occurs generally in young people, and is frequently due to hyperopia. When the eye is turned outward, as chiefly met with in elderly people :(being due to a myopic condition or to partial paralysis of the internal rectus), it is called divergent. Moreover, squinting mayresultfrom congenital imperfection; it may be induced by using one eye constantly, or by imitating squinting persons. Sometimes it is a sequel of fever; and a disordered digestion, teething, worms, fright and fits of passion are known to give rise to it. Frequently it is caused by some disturbance in the brain, being often the precursor of acute hydrocephalus and convul- sions in children; and when it is accompanied by drop- ping of the eyelids, sleepiness, torpor of the intellect, or a Febrile Diseases. 233 staggering gait, some mischief within the head may fairly be anticipated. Treatment—Squinting of not more than a few weeks duration may often be removed by a judicious management of the case, having for object the strengthening of the weak eye by exercise: Shutting up the sound one; wearing goggles; placing black patches on the nose, etc. If the squinting is of long standing, the internal resp. external rectus must be divided to in- sure a cure, provided the antagonist be not paralyzed— if the disparity in vision is too great this operation will neither be of lasting benefit. Fainting. See Syncope. Falling of Womb (Prolapsus uteri). See Uterus (Displacements). Ffbricula—An ephemeral form of simple or essent- ial fever, being not secondary to a local affection, but primary or idiopathic. It is associated with anorexia, constipation, headache, and more or less pain in the limbs, and lasts generally from one to three, seldom more, days. Treatment embraces refrigerants (p. 57); saline laxatives (p. 97); and, perhaps, anodynes (p. 20). Febrile Diseases —Local affections, attended with elevation of temperature and increased frequency of the heart's action—the so-called symptomatic fever. Treat- ment—Aconite or Veratrum (35 & S4); Nitre (pp. 55-57); Cinchonid in (p. 12), etc. Feet, sweating. See Ephidrosis. Fetor oris (Stomatodysodia). See Mouth. Fever. Bilious. See Fever (remittent). Fever. Continued. See Typhoid, Typhus, Relaps- ing and Erysipelatous fever Fever. Eruptive or Exanthematous. See Scar- 234 Fever. latina, Morbilli, Rubeola, Roseola,Varicelli and Variola —the latter for differential diagnosis. Fever. Essential—An idiopathic fever, character- ized by continuity or periodicity; or by specific erup- tions of the skin, constituting those general diseases known as continued, periodical and exanthemetousfevers. Fever. Gastric. See Gastritis. Fever. Hay. See Asthma. Fever. Hectic. An insidious' fever, which accom- panies chronic disease, especially suppuration, and characterized by daily paroxysms of chills, followed by dry heat and sour perspiration, and a marked tendency to diarrhcea,leadingsooneror later to emaciation. Treat- ment relates to the cause. Salicin (p. 18); Phosphor (154), and other tonics. Fever. Intermittent (Fever and Ague, Swamp fever, the Snakes, etc.)—A periodical fever, due to a special morbific agent, known as malaria, and charact- erized by febrile paroxysms, which occur at definite in- tervals, thus constituting various types of the disease: The quotidian, if the paroxysm occurs every day—the tertian, if every other day—quartan, if every fourth day; and consisting generally of three distinct periods, a cold, a hot, and a sweating stage, followed always by a per- fectly apyrexial interval. It is called pernicious, if it is associated with symptoms dangerous in themselves: In- tense jaundice—Icteric Intermittents- haematuria or hemorrhage in other situations- Hemorrhagic!; vomit- ingand purging- Choleraic!.; cold extremities—Algid I; restlessness and prostration—Asthenic I. In the com- atose or apoplectic form the coma is sometimes preceded by delirium or convulsions. Treatment—Quinine (p. 11) Pelapsing. 835 directly after the paroxysm; if irritability of stomach, the tasteless tannate, especially in children—gr. v ter die to child of 3 years. Or it may be administered per a,mm or hypodermically (384 & 244). For rectal injections, the bisulfate, muriate or bromide are preferable to the sulfate on account of their greater solubility. In the hot stage, sponging (420). Of other remedies may be mentioned Acidum nitricum, Cedron (pp. 9 & 10); Salicin, Resorcin (pp. 14 & 16); Ammon. andTab/esalt(pp. 44 & 96); Bebeeria, Cocaine, Cuprum (pp. 14-1S); Phenol or Pilocar- pin hypoderm. (pp. 51, 107 & no)—the latter injected before the paroxysm is said to prevent the same. In chronic intermittens, Arsenic (p. 10) is perhaps the best remedy—0.C005 or one drop of Fowler's solution ter die may be safely given to a child of 3 years—but it must be used for some time. The pernicious form has t<. be treated symptcmatically. Opium (p. 35) in restlessness, convulsions, diarrhoea, etc.; Chloroform (p. 31) to induce sleep; Camphora externally (409) in cold stage; brandy (p. 72), and other stimulants as support, if necessary. As the pernicious paroxysm is always precededby at least one devoid of danger, it is of importance to prevent another. Anaemia and general dropsy as sequel requires Ferrum (pp. 76 & 79). In enlargement of spleen—ague cake, Quinine (pp. 11 & 76); Brom and Ergot (pp. 24 &, 65, with Belladonna plaster (411), etc. Fever. Periodical. See Fever (Intermiti.t-.n-;. Jie- mittent, Typho-malarial and Yellow fever). Fever. Puerperal. See Puerperal fever. Fever. Relapsing (Typhus recurrens, Ilunger^e.xt) A form of continued fever, contagious, and withoraf a prodromic stage, characterized by sudden paroxysm, 236 Fever. which are ushered in by a chill, and may last from two to ten d.iys, being separated by a thorough apyrexial period of a similar duration; frequently attended by nausea and vomiting, and above all, by muscular pains, which will continue during the intermission. The paroxysms are supposed to be due to broods of spirilla', as they terminate with their existence, and reappear with a fresh brood. Treatment—Aside from a milk diet, and, in asthenic cases, brandy (p. 72), sponging or the wet sheet (420), with salines (p. 96), and if neces- sary anodynes (p. 20). Afterward tonics (p. 76). Fever. Remittent—A periodical fever, dependent like intermittens on malaria, and characterized by dis- tinct remissions, which may take place at intervals cor- responding to those of apyrexia in the various types of the latter, and associated with gastric symptoms: nausea and vomiting, with some tenderness over the epigas trium. Treatment essentially that of intermittens — Sponging or the wet sheet (420), as in typhoid, if the skin is very hot and dry. The malignant form—Jungle fever—standing in the same relation to pernicious inter- mittens as the simple forms to each other, claims the treatment of that disease. '* Fever. Scarlet. See Scarlatina. Fever. Typho-malarial—Being as the name sug- gests, produced by the combined action of malaria poi- son and the especial cause of typhoid, it is also charact- erized by the symptoms of both of these diseases: Periodicity of fever, diarrhoea, tympanitis and iliac tenderness, connected with abdominal lesions, in con- junction with the ataxic series, as delirium, subsultus tendinum, etc., according to the proportions in which Fractures. 237 they may stand to each other in the different cases. The treatment is, of course, anti-periodic and anti-typhoid. Fever. Yellow—An essential fever of a miasmatic- infectious nature, and peculiar to warm climates, where it occurs sporadically and epidemically. It is of more or less intensity, without a particular distinctive char- acter, generally ushered in abruptly by a chill, and last- ing from a few hours to three days—when, in mild cases, reconvalescence may take place —followed after a short time of comparative ease by black vomit, yellowness of skiii, especially of the conjunctiva, hemorrhage, a notable fall of the pulse (sometimes to 30 p. minute), and all signs of collapse. The treatment is symptomatically: Aside from a milk with lime-water diet, sponging (420). In gastric irritability and vomiting, ice per os; sinapism to epigastrium, and internally Creosot (p. 64); Cyan or Chloroform (pp. 30-32), or Pilocarpin (pp. 51 & 110). Restlessness requires Opium (p. 35); hemorrhage, Ergot (p. 65); and prostration, brandy (p. 73) per anum, if not retained by the stomach. Fibroid. See Uterus. Final cessation of menses. See Menopause. Fissure of anus. See Anus. Fistula. Fecal, urinary and vaginal. See Vagina. Fit. See Convulsions. Flatulency. See Tympanitis. Flexions. See Uterus (displacements). Fluor albus. See Leucorrhcea. Fractures are solutions of continuity of a bone, as wounds are of the soft parts. A fracture is called simple when there is no wound communicating with it; com- pound, when there is such a wound; and complicated. 238 Fractures. where there is laceration of an artery or joint, or other additional injury. Comminuted it is said to be if the bone is broken into more than two pieces at one place, multiple, if broken at different places, or more than one bone in the same limb. It is characterized by deformity. preternatural mobility and crepitus in conjunction with more or less pain, swelling and helplessness of the in- jured part, spasm of the muscles, and sometimes con- siderable subcutaneous ecchymosis. However, deform- ity may be absent in fracture of the ribs, pelvis and scapula, and the other signs are sometimes wanting in impacted fracture, or when the bones are held firmly by muscular spasm. Treatment—While the upper end of the limb is held steadily by one assistant, the lower is extended, i. e., firmly, gradually and gently drawn in such a direction as to restore the limb to the proper length and shape; the surgeon meanwhile manipulating with his fingers, and placing the fragments in their correct position. Chloroform (304) may, if necessary, be ad- ministered to prevent pain and spasm. Under con- tinued extension the whole of the fractured limb should then be bandaged from its extremity, for the purpose of preventing contraction of the muscles and swelling. Now,layers of wadding or old linen to fill up all hollows may be applied, a strip of stout tape laid lengthwise on the limb, and the whole evenly covered with layers of bandages of old linen, well soaked in starch or dextrine. If the apparatus has to be got off or loosened (as in case of swelling), it may be lifted with the tape and easily ripped up by means of scissors as a complete mould, and without wounding the skin—if dampened with boiling water it can be softened and put on again more com- Gangrene. 239 fortably, but sufficiently tight to keep the parts steadily in their place. (Plaster of Paris is also a good material). Wounds and doubtful bruises should be left uncovered, and every newly-set fracture, especially if done up in a circular bandage, should be examined after six hours: If the fingers or toes are blue or benumbed, there would be a possibility of gangrene. The remaining treatment must be conducted on general principles. Cordials (p. 72) to restore the patient from the shock of the in- jury; the catheter—usually required after fracture of the leg; aperients (p. 88), cold lotions and leeches must be employed at the discretion of the practitioner. Opium in grain doses 1-3 times a day, and if need be, with Co/ocynthis, may be given to allay pain and irritation. (For consolidation fractures require from 30-40 days. Freckles. See Skin. Fright. See Excitement. Frostbites. See Perniones. Furunculus (Boil)—A circumscribed, round and hard swelling from inflammation of true skin, attended with pain and tenderness, and ending in suppuration. It is caused by unwholesome food and depressing influences generally. For treatment see Carbuncle—Poultices with purgatives (p. 88); Napthol (21), and, perhaps, the knife. If indolent, Creosote, Opium, Iodine (398, *00 & 402). Gallstones. See Calculi (biliary). Gangrene—A mortification of tissue in consequence of inflammatory action or obstruction in the circulation, etc., accomp>anied by putrefaction; or dependent on some constitutional cause, and the result of deficient supply of blood, etc., the dead part becoming dry and hard: This constitutes dry gangrene, whilst the former is called 240 GustroUfui. humid or moist, the decomposed effusion being known as slough. Treatment according to causation, with local applications of Phenol, Brom (398); Chrom or Salicin (344 & 99); in hospital gangrene, 01. Terebinth, Creosote or Acidum nitricum (352 & 72). See Phagedaena. For Pulmonary Gangrene see Lung. Gastralgia (Gastrodynia)—A neuralgic affection of the stomach, frequently associated with spasmodic con- tractions, so as to give the pains a griping character (colic), and accompanied sometimes by vomiting and dyspeptic symptoms. In the chronic form the pain occurs either in more or less frequent paroxysms; or it is continuous with occasional exacerbations. Treatment —Fomentations cr a sinapism to epigastrium; and inter- nally, Belladonna, Brom or Hyoscyamus (pp. 22 & 23); Cyan (66)—Morphine is objectionable—Bismuth in large doses (p. 46); Spir. cethereus or brandy; Nux Vomica or Pepsin (pp. 83 & 84); Alum (p. 63); Arsenic and Quinine (pp. 9 & 11); Argentum (p. 74), etc. SeeColicaintestinalis. Gastritis—Gastric Catarrh, if accompanied with considerable pyrexia, Gastric Fever is called an inrlam- mation of the stomach, caused mostly by abuse of alco- hol and dietetic excesses, and characterized by distress- ing pain in the epigastric region, which is increased on pressure; nausea and vomiting; intense thirst; and, unless the consequence of irritant poison, constipation. In acrid poisoning there is genercdly diarrhcea, vomiting of bloody matter, and burning pain in mouth, fauces and oesophagus. Treatment—Aside from fomentations, tur- pentine stupes or sinapisms to epigastrium, Morphine at once (77 & 255); ice to allay the thirst, and milk with Aq. Calcis as diet. Emetics and cathartics are contra- Gastritis. 241 indicated; instead of the latter, enemata (385 & 86), if necessary. In the toxical form emetics or the stomach- pump to commence with; then, to neutralize the poison, the appropriate antidote. In poisoning from an acid emetics are of 'n<> use. In subacute gastritis (bilious attack) there exists sometimes irresistible desire to provoke vomiting by voluntary efforts on account of a secretion in the otherwise empty stomach, very much like that known as tenesmus, and produced by the particular form of inflammation. In the chronic form, nausea and vom- iting, with anorexia and habitual thirst is more likely to occur tlkan in functional disease; but still more char- acteristic is the tenderness in the epigastric region, which is here continuous, and not only during digestion as in dyspepsia. Chronic gastritis moreover results frequently from long continued nervous congestion of tbe stomach, caused by obstacles to the circulation in the liver, lungs and heart; and it is also present in certain cases of renal disease, because the carb. of ammonia, which is formed from the decomposition of urea, acts as a local irritant, when eliminated by the gastric mucosa. Treatment— Aside from a diet consisting of articles which are digested in the small intestines—neither meat nor stimu- lants )n,ust be, allowed—Cyan or Opium may be given (p. 35); or Hyoscyamus, Arsenic, Argentum, Ammon. (p. 44); Tannin or Creosote (pp. 62 & 64); if vomiting of glazing- matter, Alum, Hydrastis (p. 82), if from drink; and in atony or debility after the acute symptoms have passed, Nux Vomica and acids (pp. 61 & 71). See Dyspepsia. Gastric Ulcer. See Stomach. Gastro-intestinal Catarrh. See Enteritis. Gastrodynia. See Gastralgia. 243 Globus hystericus. Gastrorrhagia (Gastrorrhoea). See Hemorrhage (from stomach). Gestation. See Pregnancy. Gingivitis parenchymatosa (Stomatitis ulcerosa). See Mouth. Glands. See Lymphatics. Gleet. See Gonorrhoea;. Globus hystericus—The result of primary irritation of the uterine nerves, which is transmitted through the whole chain of ganglia to the nerves of the oesophagus and trachea, producing here spasm. See Hysteria. Glossitis. See Mouth. J* Glottis. OSdema. See Larynx. Goitre. See Bronchocele. Gonorrhoea (Urethritis)—A suppurative inflamma- tion of the mucosa of the genitals, produced occasion- ally by gout—if attended with acid and irritating urine) — and several other irritants; but generally it is due to contagion from matter of a mucous mem- brane in a similar condition, and characterized by a purulent discharge, scalding urine, and sometimes chardee (a painful crooked state of the penis during erection). It may be complicated with balanitis (a sup- purative inflammation of the mucosa covering the glans), hemorrhage from the urethra, bubo, phimosis, orchitis, etc., and in severe cases the inflammation may reach the bladder, and cause even irritation of the kidneys. Treat- ment according to cause. In the acute stage, saline cathartics (p. 69); Aconite or Nitre (35 & 122); if ard<> urince, Potass, (p. 54). Afterward Copaiva (106) in con- junction with injections of Zinc,Plumbum,etc. (3 2 7,333-36). If chordee, Camphora or Cocaine (54 sit- 252 Heart. uation of the right border and the base of the heart be- ing generally but little changed. If the first sound is loud, prolonged and booming, the apex-biat be felt by the hand to be abnormally strong, especially if there be a heaving elevation of the praecordia with the vertricu- lar systole, hypertrophy predominates; but if the first .sound is weak, short and valvular, and the beating, if felt at all, feeble, dilatation is in excess. Treatment is not required in hypertrophy when compensatory; other- wise the excessive action of the heart must be modera- ted by aperients (p. 96), Aconite (35); Bell., Cyan (43 eriostealv}hitlow>, consisting in periostitis of a sup- purative character, which may lead to necrosis of the phalanx; and tendinous whitlow (thecal abscess), affect- Ovaries. 327 ing the tendinous sheath, a free incision should be made at once: The knife must be carried deep enough to feel the bone and tendon, so as fairly to open the sheath of the latter. If matter has extended into the palm, an- other incision should be made upon a director—in or- der to avoid the digital artery—till the pus freely escapes. Oophoritis. See Ovaritis. Ophthalmia. See Eye. Orchitis. See Testes. Os Uteri. See Uterus. Otalgia. Otitis. Otorrhcea. See Ear. Ovaries—Atrophy may, aside from being a physio- logical action constituting the menopause, be the result of acute ovaritis, pelvic peritonitis or cellulitis, in which case general tonics (p. 69) may be of some use; in con- junction with uterine irritation, produced by the intro- duction of a tent once or twice a month, provided in- flammatory action be not excited; or electricity (p. 149); or—marriage. The same treatment is indicated in cases of imperfect development of the ovaries. Displacement of the Ovaries is not only a consequence of any displacement of the uterus—pregnancy—or ab- dominal viscera; but will result also from inflammation, hypertrophy and other affections of the organ itself, the prolapse generally being attended by hernia of the Fal- lopian tubes, or some portions of the intestines or omen- tum. They mostly fall, when their weight is increased, into the cul-de sac of Douglas; rarely into the inguinal canals, or through them into the dartoid sacs of the labia majora,where they show a monthly intumescence, which creates much local disturbance, and keeps the part swell- ed, heated and tender until ovulation is passed. Treat- 328 Ovaries. ment—Reposition by taxis and keeping it in situ by a proper truss, pessary or bandage is all that can be done. See Chronic Ovaritis, next page. Octrritis acuta is characterized by severe pain in one cr the other iliac fossa, with increase of heat, fever and perhaps chills. By conjoined manipulation the ovary is felt enlarged, exquisitely sensitive, and generally de- pressed in the pelvis. These symptoms may subside by resolution; or pus ma}' be formed in the gland, which may discharge into the peritoneum, rectum, vagina or bladder. It may be caused by gonorrhoea, and disturb- ances of menstruation; but mostly it is associated with pelvic peritonitis or cellulitis. Treatment—Aside from perfect rest, leeches over the diseased organ, at the groin or around the anus. A poultice over the hypogas- trium, if its weight give no pain, and Opium freely by mouth and rectum (p. 35). The chronic form being characterized by a dull pain over one or both of the ova- ries, which probably will be augmented by menstrua- tion, is, as a primary affection, creating uterine disorder, as frequent as it is secondary to uterine disease. In case of prolapse there will be pain on sexual intercourse; pain in rectum and down the thighs; pain and exhaustion af- ter defecation; leucorrhcea, irregular menstruation; and sometimes inability to stand or walk. If both ovaries are diseased, sterility is the consequence. Whilst in some cases the symptoms are entirely physical, in others the mind and nervous system will be found much involv- ed—epilepsy is often a result. Aside from a deviation of the uterus from its normal axis, from the os of which a mucous plug generally will protrude, there will be found in Douglas' pouch On &ne or both sides of the Tumors. 329 uterus the ovary as a round, soft body, about the size of a walnut, which, when caught between two fingers in conjoined manipulation will prove very sensitive, and produce often nausea and a tendency to hysteria. Treat- ment is generally of no avail, though in time recovery may take place. If the ovaries be prolapsed, they may be sustained by a light ring pessary; and if the displac- ed uterus press upon them, it should be kept in position. At the same time anodynes, Brom (p. 24) etc., and coun- terirritation (409); with vaginal injections if necessary (358 etseq.). Sexual intercourse should be limited. Ovarian Tumors are either solid (fibroma, carcinoma), or cystic (cysto-fibroma or sarcoma, cysto-carciuoma, der- moid cysts, ovarian cysts, and cystomata). They must not be confounded with pelvic cysts, which closely re- semble them, nor with other abdominal enlargements. Treatment—Ovariotomy if practicable, constitutes in most cases the radical cure—it is the last resource and gener- ally the only one left. In ovarian dropsy tapping (p. 144) may be resorted to, either through the linea alba, mid- way between the symphysis pubis and umbilicus, or through the linea semilunaris, according to the position of the most depending part of the tumor, or per vagi- nam, if it has descended so far, that fluctuation may be recognized there. Previous to the operation a broad bandage should be placed around the abdomen—if the patient be in the sitting posture—and tightened in pro- portion as the fluid escapes,to give support to the abdo- men; but especially to prevent sg?icope from too sudden a passage of blood from the brain. If the linea alba is chosen for paracentesis, the bladder must have been evac- uated; and care has to be taken not to thrust the trocar 330 Ovaries. into a plexus of veins, which is not uncommon on the abdominal surface—the engorgement being produced by obstructed circulation,—or the intestines, which might intervene between the abdominal wall and outer sur- face of the ovary—to be readily ascertained by the ab- sence of resonance on percussion. In choosing on the other hand, the linea semilunaris, the epigrastric artery, which passes obliquely upward toward the umbilicus, and the pulsations of which generally can be made out, is to be avoided. In case the vagina should be preferred, a curved trocar has to be introduced into that organ, along the finger;'and the ovary penetrated just behind the cervix uteri, taking care to direct the instrument as it enters the tumor, upward, in order to avoid injury to either tbe uterus or rectum. The end of the canula must be left in the ovary, and so fastened as to allow the free escape of the fluid. Afterwards an embrocation of Digi- talis (413) to the abdomen with a view of increasing diuresis, and occasionally Gamboge (p. 91) to regulate the bowels. Sometimes a tumor may be found in the triangular fossa between womb and rectum, too small to detect fluctuation. Six leeches applied to the tumor, either in the iliac fossa or in the vagina once a fortnight in conjunction with salines (p. 95); and a nitric acid is- sue upon the side of the sacrum, may not only check the growth, but diminish its size. Patting the tumor with the fingers several times a day, and internally muriate of lime is said to reduce it also. Oxaluria. See Urinary Deposits. Oxyuris vermicularis. See Helminthiasis. OzaENA. See Nose. Palpitation. See Heart. Paraplegia. 331 Palsy, Shaking. See Tremor; for Palsy of the tcngue—Paralysis of the ninth nerve, page 337. Panaritium. See Onychia. Paralysis, which may affect both, sensory and mo- tor nerves, signifies more or less loss of either, sensibili- ty or of voluntary motion. Complete loss of sensibili- ty is anossthesia; but if the sensibility to pain be only lost, whilst, with regard to the other impressions, as heat or cold, it remains normal, it is called analgesia—as may be observed sometimes e. g. in disease of the spine or lead poisoning. Again, paralysis of motor nerves (akin- esis) is paralysis par excellence, if complete; but if the power of motion be only impaired, it is called paresis. The various forms of paralysis are either functional, or they are due to inflammatory or structural lesions, which, if situated in the brain or spinal cord, are known as cen- tral; if without, peripheral. In the former reflex and electrical excitability are preserved, whilst in the latter they are soon lost, and the affected muscles rapidly be- come atrophied. Hemiplegia is unilateral, the paraly- sis affecting the side opj>osite to the one of the brain, in which the lesion is seated. If functional, it may be hys- terical, or follow neuroses as epilepsy, chorea and the like, even mental excitement, and will generally disap- pear in a few days. Paraplegia is mostly a consequence of spinal disease, the lower extremities being paralyzed, if the lumbar portion be affected; whilst a disease higher up in the cer- vical portion will involve the upper extremities. Func- tional paraplegia is the most frequent form of hysteri- cal paralysis, as it often stands in causative relation to diseases of the uterus and ovaries. 332 Paralysis. Acute Ascending Paralysis is characterized by paresis, beginning in the feet, becoming gradually complete pa- ralysis, and extending successively over the whole limbs, the trunk and upper extremities. The respiratory mus- cles become affected, producing dyspnoea, followed soon by those concerned in speech, mastication and degluti- tion; but the bladder and rectum are not involved, and the intellect remains intact. The disease, the etiology of which has yet to be found out, proves generally fatal in a couple of weeks. Treatment—Aside from sustain- ing nourishment in conjunction with alcohol (p. 72); gal- vanism (p. 148) or the wet pack (420); or Strychnine (184) and Iodine (p. 14). Bulbar or Glosso-Labio-Largngeal Paralgsis, being due to morbid changes in the medulla oblongata, even- tuating in atrophy and the disappearance of motor gang- lion-cells in this situation, is always chronic, and fre- quently combined with progressive muscular atrophy. It is characterized by progressive diminution of volun- tary power over the tongue and the muscles of the palate and lips, so that speech becomes impossible, deglutition more and more difficult, food and drink being often re- turned through the nostrils; whilst the face assumes an expression, as if about to weep. By degrees the laryn- geal muscles become paralyzed, causing aphonia; and paresis of the muscles of respiration may soon follow. Treatment is as hopeless as in the preceding disease. Electricity,Argentum (160);Phosphor(189); Iodine (p-14); Belladonna (p. 23); Ergot (p. 78) are generally employed. When deglutition becomes very difficult, good nutrition, which is of most importance, must be accomplished by means of an oesophagal tube (297) or per rectum (387). Paralysis. 333 In the acute form caused by embolism or thrombosis of branches of the vertebral arteries going to tbe medulla oblongata, or of hemorrhage in this situation, a success- ful treatment has better chances. General Paralysis (Dementia paralytica)—The pa- ralysis of the insane is a structural affection of thebrain characterized by an incomplete paralysis—hence, also called general paresis—and associated with extravagant delusions leading to more or less complete dementia. It is supposed to be due to moral shocks, as loss of friends, bankruptcy", remorse, etc., however it has been attributed also to intemperance. Treatment can be but palliative, and as proper attention to diet and hygiene are of most importance, an asylum for the insane is per- haps the best place for its execution. The Calabar bean (256) has been recommended. Spinal General Parcdysis—Exclusive the paralysis of .the insane, general paralysis is spinal, and if functional, it may be connected with hysteria, or it may be due to cold, exhaustion, etc.; sometimes it is a sequel of diph- theria. The muscles of all the limbs may be simulta- neously or successively affected; and the paralysis may be complete, or there may be different degrees of pare- sis, with or without anaesthesia. If there is insanity, it is accidental; and tbe facial muscles are not affected. Recovery may take place in a few days, but generally it takes many months. The treatment of functional paralvsis involves a due regard to anaemia and exhaus- tion, or cystitis, phymosis and other local diseases sus- pected to stand in causative relation by means of reflex action or otherwise. Aside from this, electricity (p. 148), massage and frictions with stimulating embrocations (409) 334 Paralysis. may be tried. Above all, passive movements, in com- plete, and daily exercises of the paralyzed muscles in in- complete paralysis. Sometimes douches of alternately cold and warm water (420) are useful. Of drugs may be mentioned: Strychnine, Phosphor, Sabina,Ergot (p. 69); Iodine (p. 14); Mercury (p. 93). Spinal Paralysis from acute inflammation of the an- terior gray substance (anterior poliomyelitis) is espe- cially incident to childhood, and characterized by a sud- den fit of fever, accompanied by a pain in the spine and extremities, by more or less vertigo, somnolence or coma—sometimes by convulsions—and followed invari- ably by paralysis, which at first is mostly confined to one extremity, though sometimes attacking not only the others, but also various muscles of the trunk, without however involving sensory nerves. In adults, the cere- bral symptoms, which accompany the initial fever are less marked, and the paralysis, as a rule, is less obsti- nate, though those muscles which do not improve at all, become rapidly atrophied. As a number of deformities will result from this disease in case the paralysis be per- manent, e. g. short limbs, clubfoot, a judicious treatment is all important. If the affection be soon enough recog- nized, the indications are those of acute myelitis: Purgatives (p. 88) in conjunction with cupping or leeching and cold applications to the spine; or dry cupping, blis- ters (408) and mercurial ointment according to the degree of inflammation. Internally, Ergot (p. 78); Belladonna (p. 23); Iodine (p. 14), etc. Later, the galvanic current, (p. 148), if continued steadily for some time may restore the motor power of the paralyzed muscles, even if their susceptibility to the Faradic current have been lost. The Paralysis. 335 pack (420) or massage are sometimes useful. In the rest, invigoration of the constitution with tonics (p. 69). Atropine Spinal Paralysis, due to chronic anterior poliomyelitis, is characterized by a more gradual devel- opment of paralysis, combined with progressive atrophy; and though the irregular distribution of the paralyzed muscles is analogous to that of the acute form, complete recovery is here more likely. From progressive mus- cular atrophy it is distinguished by the fact that paraly- sis precedes the atrophic degeneration of the muscles, in the former the reverse taking place. Spasmodic Spinal Paralysis, called also Primary Latercd Sclerosis on account of the induration, which causes it, affecting the lateral columns of the cord, is characterized by tremor, stiffness, and spasmodic twitch- ings in addition to the paralysis, with a peculiar hipp- ing gait, the feet touching the ground only with the toes, as it were, whilst the body is bent forward as if about to fall. This spastic gait is distinctive, as contrasted with purelg paralytic or ataxic gait (lateral sclerosis is often combined with posterior spinal sclero- sis—see Ataxia). Treatment is like that of other sclero- tic affections, galvanism, hydropathy (pp. 146—149), etc. Strychnine is contra-indicated. For Paralysis agitans, see Tremor. Paralysis from Lead, which is usually preceded by lead-colic, may be general, but as a rule only the exten- sors of the upper and lower limbs are affected, the for- mer being characterized by palsy of the hand, known as wrist-drop; the latter by dropping at the ankle. The treatment has for object the elimination of the poison. Iodine (p. 14) etc., see Enteralgia. For the paralysis is 336 Paralysis. indicated the Faradic current and Strychnine (184). Pa- ralysis from Mercury is always preceded by mercurial tremor and salivation; and that from Copper by gastro- duodenitis. Paralysis of the third Nerve is characterized by ptosis, diverging strabismus, protrusion of the eyeball, and dila- tation! of pupil; and unless connected with cerebral dis- ease, may be due to cold, or over-exertion, or to injury near the eye. If the paralysis is limited to the upper branch of the oculo-motorius, ptosis exists without stra- bismus or dilatation of pupil; if, on the other hand, the inferior branch alone be affected, there will be strabis- mus and dilatation of pupil, without ptosis—in either case it will probably be peripheral. Paralysis of the fifth Nerve, if accompanied by symptoms denoting brain disease, is central; peripheral paralysis—the cause of which, though extra-cerebral may be intra cranial—is gen- erally characterized by ulceration of the cornea, with red- ness and swelling of the face. The motor portion of the tri- geminus maybe affected either separately or in conjunc- tion with the sensory divisions. Bilateral paralysis of the motor portion occurs in cases of bulbar paralysis. If the motor or third division alone is affected, there will be loss of masticating power. If the different sensory branches, (the ophthalmic, the superior and inferior maxillary) be affected separately, the loss or impairment will be con- fined to the portions of skin and mucous membrane sup- plied by the branches of the paralyzed division. Paraly- sis of the sixth Nerve, which is characterized by con- verging strabismus, occurs sometimes in cases of cere- bral meningitis and in connection with lesions giving rise to hemiplegia. If functional, it may be due to neuri- Paralysis. 337 tis or to syphilis. Paralysis of the Motor portion of the seventh pair (Mimetic or BelVs Paralysis), if bilater- al—diplegia facicdis—is characterized by immobility of the whole face, just as if it was covered by a mask. If unilateral, only one side is immovable, which con- trasts strangely with the sound side, especially in talk- ing or smiling; or when the cheeks and lips of the af- fected side are puffed outward by each expiration, as sometimes will be the case. Facial parcdysis accom- panied by paralysis of the abducens denotes a central lesion, these nerves arising both in the floor of the fourth ventricle. The absence of reflex movement is evidence that it is peripheral: If winking be not produced by touching the eyeball; the sensibility of the latter being preserved, it is peripheral; but if the eye be closed in- voluntarily by touching the conjunctiva, when the vol- untary power is lost, it is central. In cases of facial paralysis dependent on neuritis caused by cold, or wrhen it is functional, recovery may take place in a few weeks. If it continues for 2—3 months without improvement, it is probably not functional; but if not dependent on central lesions, it proceeds from either disease of the nerve or something pressing on it, that occasions ob- struction. Paralysis of the eighth Nerve affecting some- times the pharynx as a sequel of diphtheria, is limited to that division, called glossopharyngeal; in conjunction with paralysis of the par vagum, it occurs in various cerebral diseases, which produce deep coma, causing difficult deglutition with slow respiration, and preced- ing a fatal termination. Paralysis of the ninth Nerve (Palsy of the tongue) on both sides is incident to bulbar paralysis, and characterized by inability to articulate, 338 Parotitis. and protrude the tongue. If the hypoglossus be affect- ed on one side, the tongue, when protruded will deviate from a straight line, its apex pointing to the side of the seat of the paralysis. Parametritis. See Uterus (Cellulitis). Paraphimosis. See Penis. Paraplegia. See Paralysis. Paraproctitis. See Proctitis. Parkinson's Disease. See Tremor. Paronychia. See Onychia. Parotitis or Mumps is an infectious and contagious disease, being due to some specific poison and occurring sometimes epidemically. It is characterized by an in- flammatory swelling of theparotis and surrounding con- nective tissue, associated usually with headache, fever and general malaise. Occasionally the submaxillary glands are involved; and in severe cases delirium and other cerebral symptoms may be present. As a compli- cation of typhus, pneumonitis, etc., suppuration mostly takes place. Treatment—The idiopathic form requires, aside from a bland diet and purgatives (p. 88), soothing fomentations in conjunction with anodynes (p. 20), if the pain be considerable. In severe cases, leeches, and Mer- cury (p. 13) in alterative doses. Parulis (Guniboil). See Mouth. Parturition. See Labor. Pathophobia. See Hypochondriasis. Penis—Phimosis is a constriction of the orifice of the foreskin, so that the glans cannot be uncovered with- out difficulty, if at all, and is either congenital or caused by contracted cicatrices. The radical cure consists in circumcision or slitting. In the former, the end of the Peritonitis. 339 foreskin should be drawn out, and being held between the blades of a pair of forceps, cut straight off; after which the mucous lining of the foreskin must be cut up to the corona, so as quite to uncover the glans. In slitt- ing, a director may be introduced between the glans and prepuce, an.d a curved pointed bistoury passed along the groove. In the adult, 4 or 5 sutures should be made through the margin of the incision, so as to draw to- gether the edge of the skin and of the mucous lining of the prepuce, that they may unite by adhesion. Cocaine (330) maybe used as anaesthetic. Paraphimosis is said to exist when a tight prepuce is pulled back over the glans, constricting it, and causing it to swell. Generally it is the result of inflammation following impure con- nection. Treatment—The glans well oiled, and covered with a bit of lint is compressed with the fingers of one hand, so as to squeeze the blood out of it, whilst the prepuce is drawn forward with the other. If this should fail, the constricting part of the prepuce must be divided. Pericarditis. See Heart. Perichondritis (Laryngeal) is an inflammation of the tissues immediately surrounding the laryngeal car- tilages; generally suppurative, culminating in necrosis of the cartilage, and as a rule, the result of phthisical and syphilitic ulcers. Periostitis. See Syphilis. Peritonitis__An inflammation of the serous mem- brane lining the cavity of the abdomen and covering the abdominal viscera, is exclusive the idiopathic form from cold, due to a variety of causes, e. g., to perforation of the intestines, inflammation of the female generative organs, especially during childbed, or to the discharge 340 Peritonitis. of pus, etc., from whatever cause, into the peritoneal cavity. The acute form is generally characterized by severe pain and great tenderness over the abdomen with tympanites and considerable pyrexia (the tympanites, in consequence of paralysis of the muscular coat of the in- testine may be so great as to produce dyspnoea accom- panied by cyanosis). The expression of the face looks haggard and pinched, the upper lip if elevated and drawn tightly over the teeth, is pathognomic. There is, as a rule, extreme prostration and sometimes obstinate singultus. On the other hand the disease may be perfectly latent or the local symptoms altogether obscured by the presence of some other affection. The chronic form being charac- terized by exudation, if following acute, may be like the latter, idiopathic, and develop insidiously; but usually it is secondary to tuberculosis, ascites, and similar diseases. Treatment—Locally, turpentine stupes, simple fomenta- tions or cold compresses every few minutes, whatever most grateful to the sufferer; and Morphine (pp. 36 & 37) internally, taking care to avoid narcotism. Cathar- tics ought not to be given, even if constipation should last for a week or more — an accumulation of feces may be removed by simple enemata. Quinine (p. 11) or Aconite (p. 22) according to the severity of the fever. Chloral, Conium, or Hyoscyamus (60, 64 & 73) according to circumstances. Alcohol (p. 72) as support. In the chronic form the co-existing or causative disease requires attention. Pelvic Peritonitis, which may be caused by inflammation of adjacent parts—peri-uterine cellulitis, endometritis, ovaritis—; by parturition or abortion, gon- orrhoea, uterine colic, etc., etc.; even by the use of tents, the uterine sound or injections into the uterus is char- Peritonitis. 341 acterized by all the symptoms, which mark general peri- tonitis, only the slighter degree of severity and the localization of pain and tenderness pointing to the par- tial nature of the affection, excepting some cases, in which mental alienation occurs, as this will occasionally develop into absolute insanity. At the same time there may be felt a swelling in the recto-vaginal space or at the side of the uterus, which latter will be more or less fixed and displaced. If there be formation of pus, the sense of tumefaction or fluctuation may disappear, as this discharges itself; but if the effused lymph become or- ganized, it remains hard for a long time. Exclusive the fixation of the displaced womb, the inflammation may result in abscess or atrophy of the ovaries, or oblitera- tion or dropsy of the Fallopian tubes, followed as a mat- ter of course by menstrual irregularities and sterility. Chronic Pelvic Peritonitis accompanies generally tuber- culous or uterine disease; becomes sometimes aggravat- ed at the periods of ovulation; or may recur after long intervals of absence, from the most trivial cause, appear- ing and disappearing often for years. Treatment of the acute form as indicated in general peritonitis, Morphia un- til perfect ease be obtained; and the bladder ought to be emptied by the catheter (p. 125). In the 2d stage, where lymph has been the chief, perhaps the only, product of inflammation, Tinct. Jodi may be painted over the hypo- gastrium once a day for a few weeks. In chronic cases, tonics are the remedies, especially Ferrum cum Jodo v. Bromo (19 & 176); and sexual intercourse should be for- bidden. If in spite of the sero-purulent collection the patient be doing well, it should be left to empty itself spontaneously, else it must be evacuated by aspiration, 342 Perniones. after which the sac has co be washed out with a weak solution of Phenol or Tinctura Jodi in warm water. Perityphlitis. See Typhlitis. Perniones (Frostbite, Chilblains). In consequence of severe cold a stagnation of blood in the veins is pro- duced in the affected part, which assumes at once a dull purplish-red color. Soon, however, the blood is expelled by the contraction of the tissues, and the part becomes pale, motionless and insensible. This condition is called a frostbite, and the best remedy is rubbing the frost- bitten part with snow, which after a time may be re- placed by cold water (see page 3). Chilblains show, like burns, three degrees: 1st, redness and swelling with itching; 2d, vesication, the skin around being bluish or purple; 3d, ulceration or sloughing—gangrene will re- sult if cold be applied continuously. The treatment of chilblains of the first and second degree consists in friction with snow, cold water and stimulating liniments, Terebinthina, Phenol or Acid, nitric. (406 & 409), Mercury, Copaiva (404 & 405), etc. For ulcerating frostbites, Que- bracho (see Combustio, page 194). Pertussis—Hooping or Whooping Cough is an infec- tious disease, incident chiefly to childhood, and char- acterized by a paroxysmal cough, preceded for some days by a common cold, with more or less fever. The fits of coughing occur in numerous, short, rapid and spasmodic movements, followed by a prolonged sonor- ous-sounding inspiration, and expectoration of mucus, or occasional vomiting. The treatment has to be directed mainly to the neuropathic element: Brom and Belladonna (43, 46, 51,130 & 312); Coccionella, Hyoscyamus, or Alum (62, 73 & 132); Acid, nitr., or Picrin (89 & 94); Phenol Pharyngitis. 343 or Cocaine (302 & 318) as inhalation, etc. Cerium (p. 29) is frequently of service; and fumigations of Sulfur (417) are said to be specific. PhagedaEna is a severe ulceration, in which copious exudation and infiltration go hand in hand with rapid decomposition. It is accompanied either by acute in- flammation and fever, the margin of the sore being highly painful, swelled and red; or by atony and debili- ty, the margin being pale, flabby and livid. Generally, it is due to a constitutional disease; and if affecting the mouth or genitals of children, it is called cancrum oris and noma, and if sloughing, it is known as hospital gan- grene. Treatment embraces soothing and antiseptic ap- plications with proper attention to the constitutional disease. See Gangrene. Pharynx—For removal of foreign bodies in the throat, see QEsophagus. Pharyngitis acuta is an inflammation of the mucous membrane of the fauces extending upward—sometimes reaching the posterior nares—, and more or less down- ward. If lowr down, and the larynx not affected, there is painful deglutition; and a disposition for continued acts of swallowing, in conjunction with a peculiar cough, which, produced by a forcible current of expired air be- ing brought to bear on the pharynx, has a remarkably deep and rough sound—the so-called throat cough. Sometimes the inflammation involves the tonsils and Eustachian tubes, causing more or less deafness, (throat deafness). Treatment—Aside from aperients (p. 88); fomentations, cold comprsssss or Acid. acet. (294 j& 298) to throat; and as gargles, Nitre or Capsicum (300 & 301). At the same time Aconite, Antimony or Kali chloricum 344 Pharyngitis. (pp. 23 & 55) as required. The chronic form (Catarrh par excellence) is very obstinate, and presents frequent- ly a granulated appearance at the posterior wrall of the pharynx—granular or follicular pharyngitis. As long as the inflammation is limited to the fauces, there are no particular symptoms; but generally the larynx will be- come slightly affected, so as to give rise to a dry hack- ing cough, and a little hoarseness, especially after much talking; hence it has been called the "Clergyman's sore throat." The Treatment consists in tonics (p. 70); Iodine (14 & 18); and topical applications: Argenti Nitras (288 & 309); Potasii Ch/oras, or Tannin (299, 300 & 303); Ammonii Chloridum, Ferri Ch/oras, Brom, Jodum (306, 313, 320 & 321), etc. Retropharyngeal Abscess—An inflammation of the are- olar tissue between the mucous membrane of the pharynx and the vertebral column, culminating in suppuration, and characterized by severe pain, especially during deglutition. It is generally a consequence of caries of the cervical vertebrae. The bistoury. Sometimes the ab- scess may be opened with the nail of the finger. Phimosis. See Penis. Phlebitis—Inflammation of a vein is characterized by a red, hard, and cord-like line, tender to the touch, and oc- casionally accompanied by sick headache and feverish- ness. The idiopathic form is frequently a consequence of varicose veins, and is in that case most marked in the superficial veins of the leg or thigh, the saphena and her tributaries. Treatment consists aside from rest, in fo- mentations and purgatives, followed by acid tonics, Iron and Quinine (pp. 71 & 76): or Iodine (p. 14); and blisters along the course of the vein (408). The traumatic form Pica. 345 requires, moreover, poultices, early incision of abscesses; Opium (p. 35), to relieve pain, and a generous diet. Rest after a wound, so as not to disturb the coagula, is just as important as are proper local applications, to prevent access of air, and produce firm coagulation. See note on page 139. Phlegmasia alba dolens—Milk-leg or swelled leg consists essentially in inflammation of the crural or iliac veins, occurring especially in women after delivery, and dependent on their reception of poisonous fluid, having its source in the fetid discharges of the uterus, which infect the open veins of the organ. It is characterized by a most excruciating pain along the thigh, leg and foot, accompanied by a white, shiny swelling, tenderness on pressure, and enlarged lymphatics. Milk and lochia us- ually diminish, and in severe cases there will be suppu- ration. Treatment—Turpentine stupes or leeches; Opium (p. 35), if much pain, and a purgative (p. 88) if required. See Septicaemia. After the acute stage, diuretics (p. 40) with stimulating frictions (409), and bandaging the limb from the toes upward. All lowering measures are hurtful. See Puerperal Fever. Phlegmon. See Abscess. Phosphuria. See Urinary Deposits. Photophobia. See Eye. Phthisis Pulmonum. See Lungs; LargngealPhthisis —Larynx. Physometra. See Uterus. Pica (Longings)—A perversion of appetite, consist- ing in a craving for innutritious substances, as chalk, charcoal, etc., peculiar to pregnant and hysterical wom- en. See Malacia. 346 Placenta. Piles. See Haemorrhoids. Pimples (Acne) and Pityriasis. See Skin. Placenta previa is called the attachment of the placenta to the uterine wall just over the os, so that it may be felt overlying the latter like a spongy mass, and occasioning already wreeks before the term flooding on account of the dilatation of the cervical canal. (See Hemorrhage). If bleeeding persist, premature labor must be induced. When after 10 orl2 hours the os is suf- ficiently dilated by a tampon, detach the placenta as far as necessary; get hold of the child's feet, and de- liver as soon as possible, taking care to immediately af- terwards remove the placenta altogether; and make the uterus contract. Or, puncture after the removal of the tampon the membrane through the placenta with a male catheter, and slowly draw off the Liquor Amnii. The head will now come down and may act like a compress on the bleeding vessels. If not, introduce the finger and detach the placenta all around the os as far as you can get. If flooding still continue, a warm styptic solu- tion of iron should be injected between the detached portion of the placenta and the uterine surface by means of a flexible gum catheter attached to a syringe. Pleuritis—Pleurisy is an inflammation of the pleura, characterized, like pneumonia, by three stages. It is generally ushered in by a chill and a sharp pain, of a lancinating character in the side of the chest, which in deep inspiration cuts the breath, increasing soon to such an extent as to make respiration very rapid and super- ficial. At the same time there is a dry, short cough, dyspnoea and frequently high fever. Auscultation will reveal the pathognomic friction murmur. The acute Pleuritis. 347 symptoms subside to a certain degree when effusion takes place, producing more or less immobility of that side of the chest and disappearance or even bulging of the intercostal spaces, whilst the movements of the op- posite side are proportionally increased. After absorp- tion, as showm by vesicular breathing and vocal reson- ance extending to the base of the chest, considerable dulness remains for some weeks. Treatment—In the first stage, aside from a saline cathartic (p. 96), and Opium (p. 35), for relief of pain and cough, sedatives — Aconite (p. 22), especially with Nitre (p. 55), are indi- cated. Locally, fomentations, Turpentine stupes or cold compresses (an ice-bladder is very convenient). Leeches or cups are sometimes of service. After effusion has taken place, hydragogues and diuretics—Elaterium, Po- tassa, Digitalis (205 & 220 & 123), and Iodine as sorbe- facient. A generous diet with restriction in liquids; and if necessary, tonics (p. 70), and perhaps alcohol (p. 72). Chronic Pleuritis, though following sometimes the acute form, is generally subacute from the first, and, unless like the latter, due to cold or trauma, a sequel or concomitant of other diseases. As a rule it is develop- ed imperceptibly, pain and other subjective symptoms either wanting or but slight; whilst the existence of an effusion is well pronounced. There are, however, cases in which the presence of liquid can be only demonstrat- ed by exploration. A hypodermic syringe with a strong needle will answer very well for an exploring puncture, and should be resorted to in all cases of pleuritic effus- ions to ascertain its character, the more so as it is per- fectly harmless. Treatment is the same as indicated in acute pleurisy after exudation having taken place; un- 348 Pleuritis. less aspiration be preferred. A small trocar and a ca- nula, provided with a stop cock and fitted to a screw upon the flexible suction-tube of Davidson's syringe may be used for the withdrawal of the liquid, care be- ing taken that it is done very slowly, and suspended al- together if it give rise to cough or dyspnoea. In Cir- cumscribed Pleurisy, which is usually secondary to some pulmonary affection, as phthisis or pneumonitis, and differing from general pleuritis in not giving rise to effusion, medication is rarely required. Empl. Bell. (411) applied to the painful part is generally useful. Suppurative Pleuritis, Empyema or Pyothorax is a variety of both acute and chronic pleuritis, with essen- tially the same symptoms, the only difference being that the effused liquid, instead of being sero-fibrinous, is composed of pus—hence the more serious character of the disease. It may be suspected, if in spite of hydra- gogues and diuretics, the effusion continues to increase; on the other hand, the appearance of a fluctuating tumor is diagnostic in as much spontaneous perforation of the walls of the chest is sure to occur sooner or later, unless perforation of the lung takes place, (when the pus, finding its way into the air passages will be expectorat- ed, constituting, on account of the access of air into the pleural cavity, pneumo-thorax). Treatment—Aspiration as in chronic pleuritis, especially if the lung has been perforated. If, however, this operation repeatedly per- formed should not suffice, thoracentesis must be resorted to. This has to be done at the bottom of the pleural sac, so that the pus may escape freely, and the orifice should be kept open by the introduction of an oakum tent. The cavity should be, moreover, daily cleaned Pleurodynia,. 349 with Aqua phenylata, (1 %) injected by means of David- son's syringe, to which has been fitted a double-tubed catheter. Half a drachm or one drachm of a solution of Naphthol in alcohol and water, in the proportion of 3: 16 + 32, as intra-pleural injection, is said to have proved very efficient, if employed twice a day. Pleuritis with Pneumothorax (Pneumohydro-, Pneumo- pyo-, or Pneumo-lucmathorax) denoting the presence of air and liquid in the pleural cavity, may develop quite im- perceptibly and remain even latent; generally, however, perforation of the lung is characterized by acute pain, severe dyspnoea with accelerated respiration and more or less lividity of the face. Pathognomic of the pres- ence of air and liquid are the amphoric breathing and voice with a tinkling and splashing sound upon succuss- ion. Aside from being due to trauma, or a consequence of suppurative pleuritis (see same), it occurs in connec- tion with phthisis—occasionally it is produced in certain cases of circumscribed pulmonary gangrene. Treatment: Opium (p. 35), soothing applications to the chest, and ethereal preparations (410 & 411), are indicated as palli- atives. The chest may be punctured to relieve the dyspnoea arising from dilatation of the affected side. Aside from this, tonics (p. 69), with a generous diet and alcohol (p. 72). Pleurodynia—A rheumatic affection of the muscles of the chest, which is, however, to be discriminated from intercostal neuralgia. Both are characterized by pain, cough and other symptoms pertaining to pleuritis or pneumonitis, but they want the physical signs of those diseases. Moreover the rheumatic pain is, as a rule, more marked in movements of the body than in the 350 Pneumothorax. respiratory movements. Treatment as indicated in my- algia—fomentations or Empl. Bell. (411), are sometimes of use; and if from uterine irritation Cimicifuga (p. 47) may do some good. Pneumonitis. See Lung. Pneumorrhagia. See Hemorrhage from the lungs. Pneumothorax—Presence of air in the pleural cavity, without pleuritis (see same), is generally connected with emphysema, and characterized by obliteration of the intercostal spaces and amphoric respiration, attended with deficiency of breath on exercise, and an occasional sharp pain in some part of the chest. Treatment—As the perforation will heal up without particular medication, a puncture of the chest is not advisable. Soothing appli- cations (410 & 411) are sometimes beneficial. Poisoning. See Table of Poisons, (p. 3). Poisoned Wounds—Wounds. Poliomyelitis. See Paralysis (spinal). Pollutiones Nocturnal. See Impotenz. Polydipsia signifies an excessive craving for liquids. Polyphagia (bulimia) a craving for food. Polyuria—Hgdruria is called a morbid excess of water in the urine, and increase of the latter. A symp- tom occurring in various cerebral and renal diseases. See Diabetes. Polypus signifies any sort of pedunculated tumor, be it of a warty or epithelial, cystic, hydatid or mucous character. Occasionally they are composed of granula- tions, as the common aural polypus. The most frequent is the mucous polypus, which is very vascular; and the common gelatinous variety, which is of the consistence of a jelly, slightly streaked with blood vessels and attached Pregnancy. 351 by a narrow neck to the mucous membrane. Fibrinous clots attached to the interior of the heart are sometimes called polypi. For their treatment see the various organs where they are developed—Uterus, Nose, etc. Porrigo. See Head, (Tinea favus, capitis, and ton- surans). Pregnancy—Being in the familg way is called in a woman the time of gravidity: from the time of concep- tion (reckoned usually as the cessation of the catamenial flow) until the time when the expulsion of the contents of the gravid uterus takes place. It is characterized in the course of the first month by a more or less elevated temperature of the vagina, sponginess of the cervical portion of the uterus, the transverse opening of the os changing into a more circular form, and occasionally an umbilical pain. Moreover the womb is descending for the first six weeks of gestation. After two months the mammae will become somewhat sensitive, the areola around the nipple becoming puffy and of a darker hue; and four weeks later the womb will be found already as a hard tumor slightly above the os pubis in front, and its rhythmic contraction may be felt at intervals of from 5—10 min. by placing the hand lightly over it. When the term is half expired (4-^ months), the first move- ment of the foetus will be felt by the mother: The time of quickening. Now the question of gestation can be settled affirmatively by the bruit placentaire, the pulsations of the foetal heart, and the passive movement —ballottement. Aside from any disease which may occur during the time of pregnancy, there are certain affections peculiar to this state, as vomiting or morning sickness, dysuria, oedema, etc., etc. Treatment of dys- 352 Pregnancy. uria: If owing to displacement of the uterus, as ante- or retroversion, the position must be corrected. If due to pressure of the gravid uterus upon the neck of the bladder, the catheter (p. 125). If from any other cause Strychnine or Camphora (pp. 27 & 83) see Bladder. In oedema associated with albuminuria, Calomel (210); after- wards Quinine (166). See Anasarca. If diarrhoea be due to a peculiar condition of the ganglionic system, calming enemata (381). Vaginitis, even granular, should be treated only by frequent injections of warm water (358), especially in nervous women. See Leucorrhcea. For the treatment of morning sickness, constipation and diarrhoea, see Vomiting, etc. Pregnancy. Extra-uterine—Ectopic gestation, if it can be positively diagnosed, maybe successfully treated by the Faradic current (p. 150); after rupture, laparoto- my will be indicated. Premature Labor. See Labor. Priapismus—More or less permanent erection and rigidity of the penis without concupiscence, in contradis- tinction of satyriasis and due to irritation of some kind. It is an occasional symptom of leucocythaemia, myelitis, peritonitis and some other diseases. Procidentia uteri. See Uterus. Proctitis and Paraproctitis—Inflammation of the rectum and surrounding connective tissue, which may simulate dysentery, as regards the presence of mucus and blood in the dejections, together with tenesmus, is either due to piles, fecal impaction etc., or a consequence of some inflammatory process in the adjacent parts. On introducing the finger into the rectum, a hard, painful tumor may be felt, which may suppurate and ultimately Prostate. 353 produce a fistula. The treatment consists in the re- moval of the cause. Profuse Menstruation (Menorrhagia). See Hemor- rhage from the Uterus. Prolapsus Ani. See Anus; Prolaps. Vesicce—Blad- der; Prolaps. Urethra}—Urethra; Prolaps. Vagince and £7im—Vagina and Uterus. Prosopalgia. See Neuralgia (trifacial). Prostate—Acute Prostatitis is generally a conse- quence of gonorrhoea; but it may be due to stricture, calculus and other sources of irritation. It is character- ized by a throbbing pain about the neck of the bladder, tenderness and swelling of the gland on examination per rectum, in conjunction with painful and frequent micturition. In case of suppuration, the gland will pre- sent a tense, fluctuating tumor, and rigors followed by high fever will set in, with violent straining and futile efforts to urinate. Treatment embraces rest, fomenta- tions—leeches if necessary — with Morphium and Bell. suppositories (375); or enemata with Opium (381), and the catheter. If an abscess form, this may be open- ed from the rectum, with a long narrow-bladed knife, cutting only at the point, unless it burst into the urethra. Chronic Abscess, which is an occasional consequence of tuberculous deposit from scrophula, may be suspected, if rigors follow the symptoms of inflammation, and the gland be felt as an elastic enlargement, tender to the touch. It should at once be punctured through the rec- tum, unless it has already opened there or in the urethra. At the same time tonics (p. 69) will be advisable. Chron- ic Inflammation with enlargement from interstitial de- posit may be a sequel of the acute, and should be treat- 354 Prostate. ed according to circumstances, by hot baths; Buchu, Par- eira and Cantharis (jpn. 47 & 52) or small doses of Mer- cury and Iodine (p. 12). Hypjertrophy, consisting in an enlargement of the muscular structure, and incidentally of the glandular ele- ments, is almost peculiar to advanced life, and charac- terized by difficulty in making water, sense of weight in the perineum and tenesmus as-from internal piles, with occasional fits of complete retention of urine, which may be brought on by cold or excess in venery. In proportion as the obstacle increases, the bladder re- mains distended, whilst the urine continually dribbles away, and chronic cystitis is the consequence, which sooner or later is followed by disorganization of the kidneys. Aside from the introduction of a catheter at regular intervals, in order to get rid of the residual urine and the prevention of constipation, the irritation of the bladder must be alleviated (see same); whilst occasional fits of pain or congestion must be treated by leeches and hot baths in conjunction with proper diet. Prostration. See Debility. Prurigo. See Skin. Pruritus Ani, see Anus; Pruritus pudendi—Vulva; Pruritus of skin—Skin. Pseudo-LeucocythaEMIa. See Leucocythaemia. Psoriasis. See Skin. Pterigium. See Eye. Ptosis. See Paralysis of third nerve. Ptyalism (Salivation, Sialorrhcea)—An excessive secretion of saliva may be due to a variety of causes, especially to catarrhal affections of mouth and fauces, or of the alimentary canal, even of the organs of gener- Puerperal Fever. 355 ation. Sometimes pregnancy is the cause, and some- times influences of a purely psychical nature will give rise to it. The most violent form of salivation is gen- erally a consequence of the use or abuse of mercury. For the treatment see Mouth (Stomatitis ulcerosa). Puerperal Fever is an infectious and contagious disease, produced, for the most part, by micrococci, which result from infection of the uterus and abraded vagina in consequence of parturition, and usually com- plicating or complicated by inflammatory lesions within the pelvis or abdomen, thus constituting the many varie- ties of this affection. The lesions referred to as gener- ally co-existent with the blood-poisoning, manifest them- selves primarily as vaginitis, metritis, pelvic peritonitis and cellulitis, phlebitis and lymphangitis; and of second- ary origin, may be mentioned in addition to pleuritis and meningitis, purulent inflammation of the joints, pyaemia and circumscribed inflammation of the subcu- tanous areolar tissue. The fever makes its appear- ance in, from two to nine days, following confinement; and pursues frequently a favorable course, terminating after several days; but even under most discouraging circumstances hope of recovery should not be abandon- ed, though there are cases, which will prove fatal in less than a week. Nevertheless, prevention is better than cure, and since we know that infection arises, either from wounds or rents in the genital tract, or by absorp- tion from surfaces not wounded, but laid bare by the process of parturition, we know also, that puerperal fe- ver can be very often prevented by the liberal use of nail brush, soap and water: Keep hands and instruments surgically clean (see note on page 139), whenever you 356 Puerperal. are called to assist a puerpera, and if, in a suspicious case, you properly guard against direct infection, puer- peral fever will be next to an impossibility, with the exception of those extremely rare cases, where it can be traced to colonies of bacteria, which, in the shape of purulent deposits (the result of old inflammations) will probably be present somewhere in the pelvic tissue or Fallopian tubes. From what has been said it is evident that the symp- toms will vary, as much in character as in degree of severity. Barring fever and pain, there will be consid- erable sensitiveness on pressure over the womb, with partial suppression of lochia, if Metritis develop. If M. suppurativa ensues, the fever increases, chills are more frequent, and a fetid diarrhoea is generally the precursor of death; whilst simple inflammation of the womb may in, from 5—8 weeks end in recovery. M. gangrenosa, where vagina and vulva become involved, runs also usu- ally a fatal course. In Peritonitis, there will be tympa- nites, vomiting and coliky pains in conjunction with co- pious perspiration; the face will grow dark and flushed, and the temperature often reach 105°. Marked consti- pation is sometimes present, which may be followed by a critical or colliquative diarrhoea. In Putrid Infection, which is supposed to be an auto-genetic lesion, due to retention of any material in the sexual organs, which may have decomposed, there is in addition to repeated chills, fever and high temperature, a fetid and per- sistent diarrhoea frequently in conjunction with a foul discharge from the uterus, terminating as a rule in death. Pyaemia, which appears seldom before the eighth day after confinement (very often much later) and which is Fever. 357 identical with the surgical lesion, begins invariably with an intense chill, the pulse rising rapidly to 130 and the temperature to 106° or 107°, followed by profuse sweat- ing, localized inflammation and abscesses. As purulent collections may occur in any part of the body, in the liver and spleen (pyaemic abscesses in the lungs and kid- neys result frequently from emboli, formed by disinte- gration of an infected venous thrombus), or in any of the synovial membranes of the joints, a fatal termination is also here the rule. Phlegmasia clolens, which appears generally during the second or third week after labor, oc- curring mostly in the leg, is characterized by great swell- ing, the veins being felt sometimes like hard, knotted cords; and a shining whiteness of the skin coupled with pain and great tenderness. The exudation may be ab- sorbed in five or six weeks; however sometimes suppura- tive phlebitis will develop, abscesses form, and occasion- ally a thrombus, having undergone purulent softening, will give rise to infected emboli, which may, in turn, orig- inate metastatic abscesses in different parts of the body. Treatment—When after parturition, fever, chill, foul lochia, and other symptoms of sepsis make their appear- ance, the uterus should be searched at once for any se- condines, even if lesions exist, to account for them; and it should like the vagina, be thoroughly washed with phenol, mangan or sublimate water (334, 368 & 397). Poultices and fomentations (337) may be required; or Zinc, chlor. (349) and an occlusion pad (371). At the same time according to circumstances Aconite with Sa- licin (p. 22); Quinine and Opium (pp. 11 & 35); and above all stimulants (p. 72). As alcohol, in puerperal fever, is not only well tolerated, but reduces also the temper- 358 Puerperal Fever. ature, some practitioners rely, after the appearance of constitutional symptoms, solely upon its employment in conjunction with lukewarm baths. Brandy or cognac may be given with the yolk of an egg in doses of 1 to 2 teaspoonfuls every hour. The baths are indicated by failure of nutrition, incipient somnolence, delirium and cardiac weakness (small and quick pulse). One or two baths a day, with or without cold affusions, and last- ing for 5 to 10 minutes are sufficient. Contra-indica- tions are collapse, fresh metastases, and venous (femor- al) thromboses. Milk, eggs, broth and meat in small quantities ought to constitute the sole diet. Obstipation, even if peritonitis should set in, is to be relieved by 01. Bicini; violent abdominal pains require the ice-bag and opiates; and to allay nausea ice per os or sinapisms to epigastrium. See the heads of the complicating diseases. Pulmonary Disease. See Lungs; Pulmonary Hemor- rhage—Hemorrhage. Pulse, if quick and strong, indicates fever, inflamma- tion, etc.; if quick and weak—depression; quick, small and thready—great prostration, especially from loss of blood; variable in rapidity and force—nervous irritation; jerk- ing—valvular lesions; double—continued fevers; inter- mittent—obstructed circulation; irregular— disturbances of circulation and respiration, or functions of the brain, puerperal diseases, etc. The pulse of infants is best to be ascertained, when the child is sleeping, though there can be much more learned from the expression of the face, breathing, heart-beat, etc. See Tem- perature. Purpura simplex (Purples)—This cutaneous disease is characterized by small spots on the skin from minute Pyaemia. 359 extravasations of blood, and attended mostly by lan- guor and debility with general malaise. If accompan- ied by hemorrhage, especially from mucous surfaces, it is called P. hemorrhagica or Morbus maculosus Werl- hofii. The treatment of the idiopathic form is similar to that of scurvy, and consists aside from an appropri- ate diet,of hcemostatics and tonics: Chininum cum Ferro (p. 76); Acidum sulfuricum v. gallicum (p. 61); Terebin- thina (p. 67) etc. Pyaemia—A condition of blood-poisoning, which in- duces fever, accompanied either by severe gastroente- ritis and visceral congestions, or by certain local lesions, which are chiefly venous thrombosis, embolic abscesses in the viscera, acute suppurations of the serous mem- branes and joints, multiple abscesses in the connective tissue, and cutaneous eruptions. The fever, ushered in by shiverings,is characterized by a very high temperature —it may exceed 107.5°—accompanied by offensive per- spiration in conjunction with the usual symptoms of septicaemia. Suppuration is profuse and may take the shape of carbuncles, pustules or erysipelas. The first onset of pyaemia may be difficult to distinguish from severe ague; and sometimes the joint inflammation causes it to be mistaken for acute rheumatism. The predisposing causes are those, that produce a low state of constitution, and render the blood incapable of form- ing a firm clot; such as profuse loss of blood, depriva- tion of food, unhealthy air, organic disease of the kid- neys and other viscera; even mental anxiety. The im- mediate cause may, aside from infection and contagion, be disturbance of the coagulum in a vein; as by exer- cise of an arm after venesection, or imprudent move- 360 Pyaemia. ments after parturition; the presence of septic fluids near orifices of veins, unhealthy suppuration in the neighborhood of the urethra, or of the mastoid cells. However, it may follow mere bruises without wounds, exanthemata, cholera or diarrhoea. Treatment—Quinine should be given at once, with or without Iron (p. 11). If suppuration is established, Acid. sulf. with bark (p. 71). Alcohol (p. 72) as support, Pyrexia requires the ice-cap and sponging (420). Sleep must be procured by Mor- phia. Locally leeches and fomentations or poultices if much pain and tenderness; and whenever suppuration or a puriform deposit takes place, incisions are neces- sary, on the same plan as in phlegmonous erysipelas. See Septicaemia. Pyelitis (Suppurative Nephritis). See Kidney. Pyothorax. See Pleuritis suppurativa. Pyrosis. See Dyspepsia. Quinsy. See Tonsillitis. Rabies canina. See Hydrophobia. Ranula. See Mouth (TongueV Rectum—Foreign bodies in the shape of small bones, apple cores, etc., that have passed the alimentary canal, or pins and other things, which have been introduced into the anus, may be removed by proper forceps, after having previously dilated the rectum, by passing into the anus several fingers coated with lard, or by means of a speculum. Ulcers within the rectum, if influenced by the sphinc- ter ani are seldom cured without the knife; if however out of its reach, soothing enemata (381); Phenol (382); Borax (290) and applications of Argentum nitricum (343) may be resorted to, after having administered a purga- Rectum. 361 five (p. 96), which latter may be followed by Acid, nitro- mur. (p. 71) and other tonics, to bring the secretions into a healthy state. For Piles see Haemorrhoids and Hemorrhage. Invagination of the rectum, either due to protracted constipation or the abuse of warm enemata, is charac- terized by the upper part of the bowel lying within the lower, so that the passage on examination with the fin- ger is found obstructed by a tumor having in its centre the natural opening of the bowel. This state is attend- ed with great distress, a constant feeling of weight and desire to pass motions without being able to do so. Treatment consists in aperients with Nux Vomica (219); and astringent injections (378). See Intussusception. Stricture—A chronic thickening and contraction of the mucous lining, so as to form a ring encroaching on the rectal canal is generally situated at from 2—4 inches from the anus, and unless of a cancerous nature is a consequence of contracting ulcers from dysentery, etc. If unrelieved it may lead to ulceration of the rectum above the stricture with aggravation of all the symp- toms, as pain, straining and difficulty in defecation, more or less associated with pains in the back and loins, to- gether with irritation of bladder, anus and uterus. Treat- ment—Aside from aperients (p. 88) and injections to in- sure soft stools, a bougie capable of being passed comfort- ably through the stricture, should be introduced once in three days, and allowed to remain for 15—20 minutes. The size of the bougie has to be gradually increased. Spasmodic Stricture, which is characterized by spasmo- dic pains and great difficulty in evacuating the bowels, will generally yield to antispasmodics (p. 27) combined 362 Regurgitation. with soothing injections (365 & 381) and a proper diet. For Rectocele see Hernia (recto-vaginal); and for other rectal affections—Anus. Regurgitation is mostly a symptom of indigestion, though it very much varies in its character. The liquid thrown up by the stomach may be entirely sour if there be present an organic acid, as'acetic, butyric, or lactic; it may be acrid, appearing to scald the throat; it may be insipid, pasty or foul, having the odor and taste of rotten eggs, the latter denoting putrefactive changes. If the regurgitation occur during the progress of stomach-di- gestion, the acidity is usually due to chemical changes of the ingesta; but if it occur when the stomach con- tains no food, it may come from the gastric glands. For the treatment see Dyspepsia (Pyrosis). The acidity of the stomach during digestion may be prevented some- times by a few drops of Acidum hydrochloratum. Relapsing Fever. See Fever (relapsing). Renal Diseases. See Kidneys. Respiration—The'abdominal form occurs whenever there is great pain in using the thorax (pleuritis, etc.); or if the brain gets an insufficient supply of blood (croup, etc). Cervical respiration predominates when there is considerable exertion of the upper ribs, the sterno-cleido mastiodeus and other muscles of the neck, as in advanced stages of pulmonary and cardiac affections, obstruc tion or disease of the larynx, etc. The thoracic form again is called into play when there is obstruction to the action of the diaphragm, as in abdominal enlarge- ments, by dropsy, etc., etc. Stertorous breathing, oc- curring in cerebral oppression, depends on relaxation of the velum palati; whilst the so-called Cheyne-Stokes re- Rhachitis. 363 spiration, which may be observed sometimes in fatty de- generation of the heart, is nearly always due to cerebral anaemia: It consists of a period of apparently perfect absence of breath, succeeded by feeble and short inspi- rations, which gradually increase in strength and depth, until the respiratory act is carried to the highest pitch of which it seems capable, when the respirations, pursu- ing a descending scale, regularly diminish until the com- mencement of another apnoeal period. Respiration proves a valuable remembrancer when using large doses of Opium (p. 36). Yawning and Sighing immoderately is frequently hys- terical; after an attack of hemiplegia, they are unfavor- able signs. Retention of Menses. See Amenorrhoea. Retention of Urine (see Ischuria) may arise from causes functional or organic: Want of power of the muscular coat of the bladder, diseases of the prostate, calculi or foreign bodies blocking up the urethra, pres- sure from without, spasmodic or permanent stricture, hysteria, etc. For treatment see Bladder. Retroflexion and Retroversion. See Uterus. Rhachitis is a constitutional disease of early child- hood, frequently connected with scrophula, and arising from hereditary taint, or from improper food, or by be- ing too long and exclusively confined to breast-milk (phosphate of lime should be mixed daily into the food of pregnant women and nurses). Rickets are character- ized by an imperfect development, atrophy and distor- tion of the bones, becoming very manifest in the bend- ing of the shafts of the long bones and a thickening of their articular extremities, a narrow prominent chest 364 Rheumatism. (pigeon-breasted), and a variously curved spine. The treatment is similar to that of scrophula: Aside from animal food, cold sponging and fresh air, Calcii v. Sodii Phosphas (125 & 222); Potassa (31 & 117); Iodine (17). Rheumatismus articulosus acutus is an essential fever, self-limited, and due to a morbid state of the sys- tem, involving a rheumatic diathesis. It is, aside from occasional complications with bronchitis, pleurisy and pneumonitis, often connected with heart disease, and characterized by inflammation of the joints, several of which may be affected at the same time, or singly in ir- regular succession. Excruciating pain, more or less pyrexia, and profuse, sour-smelling perspiration are usu- ally accompaniments; and the blood is highly fibrinous, whilst the urine is loaded with uric acid. Treatment— Salicin (pp. 17 & 18), given alternately with alkalies, will in most cases cut short the disease. If fever high Qui- nine (p. 11); Aconite with Salicin or Nitre (pp. 22 &55); or sponging, resp. the wet pack (420). For the relief of pain Chloral or Brom (pp. 26 & 30); Phenol or Coniin hypo- dermically (pp. 107 & 9). The affected joints should be wrapped up at once in cotton. Other remedies in use are: Nitre (p- 57); Sod. phosph. (p. 58); Lithium (p. 50); Digitalis (p. 51). In subacute and chronic rheumatism the list of remedial agents may be still further enlarged: Silicium (p. 19); Guagac or Iodine (11 & 16); Co/chicum or Cimicifuga (104 & 5); Xantoxylon (43); and locally, stimulating embrocations, Iodine (20); Ammonia, etc. (409). Cascara gtt. 15 ter die has been successfully used. For Muscidar Rheumatism see Myalgia; for Rheumatoid Arthritis—Arthritis. Rhinitis. See Nose. Sarcina. 365 Rickets. See Rhachitis. Ringworm (Dermatomycosis tonsurans). See Head (Tinea tonsurans). Roseola—Rose Rash or Fedse Measles consist in ir- regular, rose-colored spots on the skin, which do not itch, and the redness of which disappears on pressure. It is frequently seen in children during dentition, but perhaps as often in cases of typhus, syphilis, and oth- er diseases, especially of catarrhal affections. No treat- ment required. Rubeola (Roetheln of the Germans)—An eruptive fe- ver of the mildest form occurring sporadically in chil- dren, and characterized by small, round, more or less itching spots or papules, which appear first in the face, and may be associated with a slight nasal catarrh and photophobia; but never with bronchitis catarrhalis, a con- stant companion of measles. They are, moreover, easily to be distinguished from the latter, by their disappearance in one or two days, without leaving any trace. No treat- ment required. Rupia. See Skin. Salivation. (Ptyalism). See Mouth (Stomatitis ulcerosa). Salpingitis (Inflammation of the Fallopian Tubes). See Uterus (Cellulitis). Salpingocyesis seu Graviditas tubaria (tubal preg- nancy). See Pregnancy (extra-uterine). Sarcina ventriculi—A fungus found en masse and generally in company with the yeast-fungus in the liquid, thrown up from the stomach, constituting a variety of vomiting, which occurs in certain cases of dyspepsia, and which originates probably in consequence of undue 366 Satyriasis. retention of the contents within the stomach from py- loric obstruction or some other cause. Sarcinae are dis- tinguished microscopically by their oblong or square form, and by their being divided by lines into four equal squares, so that they resemble a package, tied with a cord, as the name sarcina denotes. The vomited matter containing sarcina emits an odor of fermenting wort, and is covered after a few hours standing with a mass of yeast-like froth. Sulfites (33) are said to destroy the fungus. Regulation of diet is, however, all important, especially in dyspeptics; hence the bene- fit, frequently derived from the hygienic discipline, which the hydropathic system enforces upon such patients. Satyriasis is a morbid and excessive sexual desire in males. It is occasionally a symptom in hydrophobia. Brom or Camphora (pp. 24-28), is usually employed. Salicin (p. 18), is said to be sometimes of service. Scabies. See Skin. Scald head (Tinea favus). See Head. Scalds. See Combustio. Scapulodynia. See Myalgia. Scarlatina—Scarlet fever is an eruptive fever of a highly contagious nature, and as a rule much more seri- ous than measles. It is like the latter disease character- ized by an efflorescence, preceded in children sometimes by an eclamptic fit; but generally by a sudden attack of vomiting, high fever and redness of fauces, in which situation the eruption appears prior to the invasion of the skin. The cutaneous eruption, which usually begins after about 24 hours, affects generally first the chest and upper extremities, and is of a scarlet color, so that in some cases the surface of tbe body appears not unlike Scarlatina. 367 a boiled lobster. At the same time the throat is more or less affected, and some swelling of the tonsils is, like the pathognomic strawberry-tongue,one of the early symp- toms. The rash may stand for, from 4 to 10 days, be- fore desquamation begins, which either consists of simple exfoliation of the cuticle, and takes the form of minute branny scales, or of shreds of the epidermis in large pieces. A frequent sequel of this disease is renal disorder with dropsy. In Scarlatina anginosa, the affection of the throat may be so severe, as to en- danger life; whilst the hemorrhagic form is almost in- variably fatal. Treatment—According to the severity of the fever, Aconite (pp. 22 & 55); Veratrum (p. 39); or Quinine (p. 11); with or without sponging, the wet sheet or pack (420). Acid, hydrochloratum and Potassii Chloras (pp. 42, 55 & 56), .will usually suffice in mild cases. Some physicians prefer Salicin or Thymol (pp. 18 & 19); the temperature is said to fall rapidly after the use of acid, salicyl. (26). Baptisia & Mercury (pp. 10 & 13) have been sometimes of service. Locally cold compresses and gargles with Phenol, Tannin, etc. (298- 300). An emetic (227) if the throat much stuffed; and if there be determination to the head, enemata (386). If restlessness, Brom or Hyoscyamus (pp. 33 & 55). Belladonna (43) is frequently used as preventive. In uraemia, saline purgatives or Elaterium (pp. 91 & 96). As support, brandy (p. 72) in form of milk punch, etc., with a nutritious diet. Scarlatina rheumatica—Dengue is an epidemic, self- limited affection, with a short prodromic stage—an- orexia, languor and general malaise—characterized by a paroxysm of fever, which may last from a few 368 Scorbutus. hours to several days, in conjunction with rheumatic pains, and followed generally by an eruption, either papular or vesicular. Coryza, pharyngitis, and enlarge- ment of cervical glands are occasional complications; and hemorrhage from the nose, mouth, bowels or uterus may occur. Diagnostic are the severe pains all over the body, in head, eyes, muscles of neck, loins and extremi- ties; hence the significant appellation, breakbone fever. Treatment—Aconite with Salicin (p. 22); and sedatives, Belladonna orOpium(nn. 24 &35). Brandy will sometimes do good. If constipation, Iodine with Co/chicum (p. 48). Sciatica. See Neuralgia. Sclerosis. Cerebro-spinal, See Brain. Scorbutus—Scurvy is a morbid state of the system, due to want or insufficiency of certain principles in food necessary for nutrition, and characterized by debility, associated with mental and physical depression and general malaise. Diagnostic is sponginess of the gums, fetor oris, and extravasation of blood beneath the skin. Sometimes there is hemorrhage from mucous surfaces, as from the nose and bowels. Treatment embraces tonics, especially mineral acids (p. 71); Ferrum (142), in conjunction with lemons and other fruit; fresh meat, milk and farinaceous food. Scrofula—Struma, called also Hingis Evil, is a mor- bid condition of the system, caused, unless hereditary, by improper food, in conjunction with unhealthy air dur- ing the first years of childhood. It is characterized by a tendency to various inflammatory and ulcerative pro- cesses, as swellings of the absorbent glands, especially those of the neck; persistent swelling and catarrhal in- flammation of the nose; swelling and thickening of Septicaemia. 369 the upper lip; abscesses; cutaneous eruptions; and caries of the bone. Most frequently we meet the chronic swelling of the lymphatic glands about the neck, behind the ear, under the jaw and in the clavicular region. Scrofulous gummata, which begin as small infiltrations or nodes in the skin, constitute another form of scrofu- loderma. They are of a livid red color involving the entire skin, spread more and more to soften at different points to small ulcers, with burrowing sinuses, which form a sort of communication between them. Another variety is characterized by the formation of papillary wart-like or fungous growths, of a pale, bright dusky or violaceous red color, which soon ulcerate, with a thin discharge and some crusting. As a fourth variety of scrofuloderma may be mentioned, small, hard and fiat papides with a raised violaceous areola. Treatment—A good nourishing diet in conjunction with Ol.Jecoris (2D & 185), and alkalies (pp. 18 & 53); Iodine or Mercury (pp. 13—15); and an occasional purgative (pp. 92 & 97), constitute the chief remedial measures. Natr. nitric, or phosphor, (p. 57) is sometimes indicated. Calomel v. Hydrarg. c. Creta (p. 92) twice or thrice a week at bed- time, with a saline every morning (p. 95) and mineral acids (p. 71) according to circumstances, is also recom- mended. In obstinate cases Aurum or Barium (p. 10), may be tried. Ungt. Zinci locally. See Leucocythaemia and Lymphatics. Scurvy. See Scorbutus. Seasickness. See Morbus nauticus. Sebaceous Cyst. See Cyst and Skin (Wen). Septicaemia occurs like traumatic or symptomatic fe- ver, which accompanies inflammation from injury, and 370 Septicaemia. the hectic form, consequent upon prolonged suppuration in connection with wounds, operations, etc.; but whilst those, depending also on blood-poisoning will disap- pear, if the local mischief can be remedied, septicaemia will continue, though the prime cause be removed; and it may be very severe, though the latter be but insignifi- cant. The nature of the poison is not mere putrefac- tion; but something that has a perverted vitality; for the fluids of a putrid subject are less likely to infect a post-mortem operator, than the fluid from a fresh corpse of a puerperal fever victim. The diagnosis of Septic- aemia and Pyaemia, following wounds or injuries, is easy enough; but when there has been no lesion to ac- count for it, it may be extremely difficult. It should not be mistaken for typhus, cerebro-spinal meningitis, acute rheumatism, and inflammation of the kidneys or bladder. From typhoid it may be differentiated by the fact, that the latter is never complicated with a pustular or papular exanthem, with a hemorrhagic basis. In ad- dition to a rise of temperature to from 101—103°, there will be in severer cases of septicaemia profuse vomiting, fetid diarrhoea or dysentery; the disease may even take the form of erysipelas, phlegmasia dolens or pyaemia, and any of these forms may beget any other: Thus, the poison of erysipelas may beget puerperal fever— this is said of any form to exist, if the patient be a puer- pera—and the child of the fevered mother may die of erysipelas. Treatment—If the patient after any injury, etc., is seized with uneasiness, cold shivering and light- headedness, the temp, exceeding 101°, some form of septicaemia may be suspected, and an energetic treat- ment is imperative: Any pus that may be anywhere Skin. 371 retained, must be got rid of. At the same time a good stimulant, brandy and water or hot negus (p. 72) and Quinine (7). See the various forms. Aconite with Sal- icin (p. 22), locally Phenol, Zinc, chlor. etc. (337 & 349). Sexual Weakness. See Impotenz. Shaking Palsy. See Tremor. Singultus—Hiccough is supposed to be caused by a chronic spasm of the diaphragm in conjunction with partial or complete closure of the glottis, producing quick, abrupt and sounding inspirations. Treatment— Whilst simple hiccough will wear off without remedial aid, or be stopped by a pinch of snuff, drinking water, swallowing a piece of ice, or a sudden fright, as caused e. g. by an unexpected slap on the back, the application of Cocaine or the inhalation of Chloroform will gener- ally cure the more obstinate form. If persistent, Chlo- ral 3 ss to produce a sound sleep; or Camphora (p. 27). Sometimes Morphium or Pilocarpin hypodermically (254 & 56) will be of service. One drop of a one-per-cent solution of Nitro-glycerine, bihorio, has been employed successfully, in a case where all the sedatives in turn had been tried in vain. Skin diseases—In these are included affections of the sebaceous follicles, pigmentations and neoplasms; whilst diseases of the head, of the sudorific glands, and those where the skin forms only part of the disease, as ro- seola, erysipelas, furuncles, lupus, etc. are treated of in alphabetic order. Scrofulodermata and syphilitic ex- anthemata, which latter are known by the characteris- tic copper color, and by the fact that they never itch, claim a specific treatment; whilst eruptions, which are met with as concomitants of disorders, affecting the 372 Skin. generative organs in the female, require proper atten- tion to the disease, with which they maybe in connection. A diffuse but slight dermatitis, characterized by uni- form redness of the skin, with more or less puffiness, is called Erythema, and requires no treatment unless it be accompanied by much itching. That form, produced by pressure during a protracted illness and eventuating in bedsores, may be washed with Arnica or brandy and water—see Decubitus. Another form, Intertrigo, oc- curring between folds of the skin in infants or fat peo- ple (or of any person between the legs from walking), may, after having been washed with soap and water, be dusted with Camphorated powder, Lycopodium or Zinc (339 & 393). Pruritus, which consists of a most vio- lent itching and is generally attributed to nervous irri- tation, proves sometimes a most obstinate disease, that requires, as a rule, internal medication—Alkalies (pp. 53 & 54); Phenol,Sulfur or tonics (pp. 16,69 & 98). Locally, Borax, Camphora, Iodoform and Cyan (346,390-94 & 409). Prurigo, which has the constant itching in common with pruritus, is a papular eruption. The minute papu- les neither ulcerate not wet, but if they are scratched or pricked with a needle, they exude a serous fluid, which dries into scabs. The disease, mostly due to want of cleanliness, is sometimes extremely obstinate. A pseudo- prurigo is produced by the bite of vermin, as lice, etc. Treatment as indicated in pruritus. Lichen, a papular eruption, differs from prurigo in that the papules itch but little if at all, and in the fact that when pricked, blood is exuded. There are two forms, L. Scrofuloso- rum and L. ruber; the latter, which may be distinguished from psoriasis, by not forming circles, ie generally associat- Pemphigo. 373 ed with tuberculosis. Treatment—Alkalies (pp. 53 & 54); Iodine (pp. 14 & 15); Cod liver oil (20 & 185); Arse- nic (p. 9); Cantharis (p. 47); etc. Naphthol (390) is some- times used externally. Herpes—Clusters of minute vesicles, often preceded by local irritation, especially a sensation of burning, and cutaneous neuralgia, and frequently connected with acute catarrh of the stomach. Treatment is seldom re- quired—Quinine (p. 76) is sometimes employed in H labialis, if due to mental excitement. In H Iris and circinnatus, Cuprum (391)-; Iodoform (401); etc. In H Zoster, Morph. oleic, Argent, nitric. (409); Phenol, Bis- muth (398 & 99); etc. In II. prceputialis, which occurs often in men, who have had chancre, Calomel (353). In II. progenitalis, which appears sometimes on the labia of women in the climacteric period, hot fomentations. Eczema—Minute vesicles developed on red and slightly raised surfaces, drying off in scabs and always combined with violent itching. It may be caused by want of cleanliness, any kind of local irritation or improper food; sometimes it is symptomatic of defective menstruation, scrofula and other diseases. Treatment is to be direct- ed to the cause—Alteratives, Arsenic (p. 9); Pulsatilla (p. 16); etc. Locally^, especially in Eczema of the ex- tremities (Salzfluss), Tar, Alum or Phenol (397-99) ac- cording to the form, whether simplex, rubrum—where the skin is more inflamed; or impetiginoides—in case of pustules. In Eczema of the genitals, Cocaine, Borax or Argentum (285, 390 & 404). In Eczema facialis, Mercury, Zinc, Naphthol or Salicin (390, 91 & 99). See Head (Crusta lactea). Pemphigo—Large bullae filled with serum, to be met 374 Skin. with chiefly in infants, suffering from congenital syphi- lis. Treatment—In the idiopathic form, P. vulgaris, Sulfur (p. 98); dusting with Amylum or Lycopodium and an occasional bath. If malignant, P. foliaceus—where the bullae unite to raise big patches of the epidermis, and which proves generally fatal—Arsenic (p. 9) may be tried. Rupia—Flattened bullae, filled with serum, which gradually become opaque and purulent, and finally dry into oyster-shell-like scabs, under which the skin is ul- cerated. Treatment is directed to the cachexy, which may have given rise to it—syphilis, scrofula, etc. Impetigo—Small pustules, slightly elevated and ter- minating in a laminated scab, occurring usually on the extremities of scrofulous subjects, in conjunction with eczema. Treatment—After having removed the scab by some kind of grease, Bismuth with Zinc or Tannin (340 & 393). Ecthyma—Large, prominent or flat pustules, encircled by an inflamed margin and leading to ulcers, occurs sometimes symptomatically in malarial fevers and other acute diseases; but generally it is due to some cachec- tic state of the blood. Treatment—Iodine (pp. 14 & 15); Oleum Jecoris (20 & 185); Quinine (p. 76); etc. Locally warm bathing and dusting with Lycopodium, etc. Black or yellow wash (329) after removal of the scab. Psoriasis scutellata seu Lepra vulgaris, which, though frequently hereditary, is never dependent on a cachec- tic state of the blood, if we except the syphilitic form, consists of the hypertrophied cuticle being raised, so as to produce a rough and scaly appearance of the skin. Treatment—Aside from warm baths, and local applica- tions, as Creosote or Tar (398 & 99), alkalies (pp. 53 & Comedo. 375 54) are usually given. Phenol and Iodine (pp. 14-16) may be tried; or Cantharis and Sulfur (pp. 47 & 98). Arsenic (p. 9) is said to improve it after a week's use. Ichthyosis—Large scales like those of a fish, which may cover the larger part of the body. Treatment is but palliative, Glycerine or oil with warm bathing. Urticaria or Nettle rash consists of an eruption simi- lar to that, produced on the skin by nettle, and is gener- ally accompanied by fever. In some people it is caus- ed by eating oysters, strawberries, copaiva, etc.; how- ever often it is connected with depressing mental influ- ences, disorders of the digestive system or of the sex- ual organs. Treatment according to cause—Alkalies (pp. 53 & 57), Co/chicum (105) in gouty persons, etc. To al- lay the itching, Borax or Chloroform (394 & 410). Comedones and Milia consist of inspissated sebum, which blocks up the mouth of diseased sebaceous folli- cles, and may give rise to the formation of a true re- tention cyst or of acne papules. While the comedo will appear as a black point anywhere on the face, es- pecially on the nose, milia may be seen as white no- dules chiefly under the eye or on the palpebrae. Treat- ment—The comedo is easily removed by pressing the plug out with the fingers or a watch-key; milia are bet- ter destroyed by electrolysis, as employed for the re- moval of superfluous hair (p. 149); though the contents of the white tumors may also be scraped out with the curette, after having incised the skin that covers them. Eau de Cologne may subsequently be used as a wash to keep the orifice patent. Acnepustulosa and indurata, which are inflamed sebaceous follicles with or without suppuration, require also the dermal curette. Pimples 376 Skin. which make the life of a youth often so burdensome, will sometimes be benefited by sulfites, Iodine or Naphthol (17, 21 & 33), with Soda (392) locally. Acne rosacea (Schnappsnase), which consists in hypertrophy of the areolar tissue and skin of the nose, in conjunction with enlarged sebaceous follicles, and mottled with di- lated veins, requires in its first stage also the curette; and if drinking be discontinued Sulfur internally and as wash (7:50 Aqua) maybe of service. Sublimate (0.03 : 100.0), to paint the nose with every night is also used in this stage. In the second stage, aside from cu- retting acne papules and pustules, the dilated vessels must be punctured with a needle or cut with a multiple scarifier, after which cold compresses may be applied. The procedure should be performed every day or every other day, aud only part of the affected area of skin should be operated upon at a time. Electrolysis (p. 149) is also employed; but the current should be very weak, and the needle has to be introduced into the lar- ger vessels. In the third stage, where perivascular over- growth has taken place, the shrinkage of the new tis- sue causing the gradual disappearance of the blood ves- sels, and the part enlarging more and more, excision is the only remedy. Ephelidae s. Lentigo—Freckles are pigmentary depos- its on the skin of the size of a lentil seed. Bismuth and Borax (392) are frequently used as wash. Chloasma uterinum—A mole may be treated in the same way. Nosvipigmentosi may also be removed by electrolysis: Acid, chrom. (1:4) and Acid, carbol. (1:2) upon the need- les have been employed. Parasitic moles (pityriasis versicolor seu dermatomycosis microsporina) are due to Clavus. 311 a fungus, and are easily removed by washing them with Aqua phenylata (1%) and soft soap. Verruca—Warts and vegetations consist in a hypertro- phy of the papillae and cuticle. A variety, Condylomata (Feigwarzenof the Germans), which are clothed with a thin cuticle, grow principally on the inside of the thighs, perineum, about the anus, and within the prepuce or vulva. Highly vascular and easily bleeding; or pale and indolent; broad and flat; or tall and stalked—ficus—, they discharge a thin ichor, and are always caused by the irritation of gonorrhoeal or syphilitic discharges, com- bined with want of cleanliness. Treatment—For the removal of ordinary warts, electrolysis (p. 149) may be employed as in hypertrichosis. The needle should be passed through the base of the growth in various direc- tions, and a moderate current allowed to flow for a few minutes in each. If an electrical apparatus is not handy, they may be snipped off with a knife or curved scissors, and then touched with caustic. Solutio Fowleri applied once a day, is said to destroy them within a fortnight. Acid, nitric, acetic, and chromic. (329 & 403) are also used, especially for condylomata. See Syphilis. Clavus—Corns are growths of thick cuticle, not mere- ly lying upon the true skin, like callosities, but penetrat- ing it. There are two kinds, the hard and the soft corn, the former being situated on the surface of the foot, where the cuticle can become dry and hard; the soft between the toes, where the cuticle is soft and spongy. Treatment—Next to proper fitting footwear, a pediluvium of at least half an hour's duration every night, is perhaps the most effective remedy. Of the many lo- cal applications in use, may be mentioned Salicin-Col- 378 Skin. lodion, consisting of acid, salicylic, part 1, morphia p. 2, and Extr. Cannabis fluid, p. 12, to 200 parts Collodion. This is applied to the corn, previously closely pared, un- til a film forms. Callosities (Callus or Tylosis) re- quire the bath. Wens are encysted tumors, most common on the head, face and shoulders, consisting of obstructed sebaceous glands or else of erratically-developed cutaneous cysts. The matter contained is a collection of epidermic scales with hairs, oil-globules and crystals of cholesterine, and has received the name of atheroma or steatoma, from its resemblance to gruel or suet. Suppuration, ulceration, and fungous granulation of the interior of the cyst sometimes occur. Treatment—If an aperture is visible and the tumor is not very large, it may be opened by a probe or director, and the contents be pressed out. How- ever, it is better to extirpate it entirely by running a scalpel through it, seizing the cut edge of the cyst and gently tearing it out with a touch or two from the knife. If the wen is much inflamed, it may be laid open by a free incision, as much of the cyst as possible got away with the contents, and then filled with lint and Ungt. Creosoti or 01. carbol. (398), to suppurate and contract. Cheloid tumors consist of a hypertrophy of the tis- sue of the true skin, intermixed with newly-developed fibrous or cicatricial tissue. They are generally devel- oped on sites of cicatrices, even on leech bites and on ears, that have been pierced for earrings, they may be seen. Iodine and Arsenic (pp. 9 & 14) are mostly em- ployed and Scarification, as in acne rosacea, is recom- mended, since extirpation is of no avail. Molluscum epitheliale seu contagiosum is characterized Scabies. 379 by rounded, wart-like papules, varying in size from a pin head to that of a pea, and occurring usually in the face, especially the eyelids, cheeks and chin. They fre- quently look like drops of white wax upon the skin, or like a pearl button flattened on top, constricted around the base, and with a dark aperture in the center, from which can sometimes be squeezed a milky fluid. Eventu- ally they terminate by disintegration. Treatment—If ap- plications of Ungt. Hyrarg. alb. or Sulfur fail to destroy them, the ligature or the cautery may be employed; or they may be opened with a knife or scraped away with the curette. The bottom of the cavity should afterwards be touched with caustic. Molluscum pZbrosum seu Fi- broma molluscum is a chronic hypertrophic affection of the skin, consisting in sessile or pendulous growths of cutaneous connective tissue, which may cover the whole body. The tumors may be excised or ligatured. The gal- vano-cautery and electrolysis (p. 149) are also employed. Scabies—Itch consists in an eruption of pustules and vesicles, appearing usually between the fingers and toes, about the wrists, at the elbows and knees, accompanied by severe itching; especially after getting warm in bed, and due to the irritation, which is caused by the bur- rowing of a parasite (Acarus scabiei). Treatment—Sto- rax, Sulfur, Potassa or Napththol (390) as ointment will kill the parasite. To hasten the cure these applica- tions may be preceded by rubbing the parts daily with soft soap, followed by a warm bath. Sleeplessness. See Insomnia. Small pox. See Variola. Snakebite. See Wounds. Soor (Stomatomycosis). See Mouth. 380 Spasms. Sore throat, Clergyman's. See Pharyngitis (chron). Spasms—Cramps are painful contractions of muscles, irrespective of affections of which they are symptomat- ic, as tetanus, etc. Tonic spasm of the sterno-cleido- mastoideus constitutes the Caput obstipum. In clonic spasms the trapezius is mostly implicated, and if uni- lateral, the muscles of the face will help in cutting wry faces;—bilateral they are called Salaam spasms (Komplimentirkraempfe of the Germans). See Wry- neck. Writers cramp (grapho-spasmus—Chorea Scrip- torum) requires rest of the hand for a long time; chang- ing the size of the pen may be tried; Galvanism (p.148) may be of service. In cramps of the legs or feet, Lycopo- dium (76); Viburnum (p. 39). Sleeping on an inclined plane is recommended: the bed being a foot higher at the head than at the feet. For Spasmus Glottidis, see Larynx; for Spasm. Vaginae—Vaginismus; Sp. Vesicas —Bladder; Sjyasms in Infants—Convulsions, etc. Spermatorrhoea. See Impotenz. Spine—Myelitis. Inflammation of the spinal cord, if acute, takes generally the form of softening; whilst if chronic, it appears as induration or sclerosis. Acute myelitis, being characterized by fever, violent pain in the back, and complete paraplegia, with loss of power over bladder and rectum, is, aside from injuries, gener- ally due to cold and wet; though it may also occur dur- ing acute rheumatism. Treatment—Leeches or cupping with ice-bag to spine; blisters and warm baths; above all, absolute rest, the decubitus being as much as possible on the abdomen. Internally Ergot and Belladonna |pp. 23 & 65)with a view of contracting the arteries of the cord. Mercurialization (12) is recommended. Strychnos is Spine. 381 contra-indicated. In the chronic form, where there is superadded wasting of the paralyzed muscles and a ten- dency to gangrenous ulceration, next to rest and contra- irritation (409 & 10) over spine, Belladonna and elec- tricity (p. 148). Co/chicum (p. 48) or alkalies (p. 53,) if indicated by the state of the urine. Spinal Irritation is a neuropathic affection, charac- terized by pain and tenderness over the spine in con- nection with some other disorder, and mostly due to an anaemic or hysterical condition: If there be intercostal and cervico-occipital neuralgia, nervous cough, pal- pitation, vomiting and singultus, the cervical or dorsal vertebrae will be found upon pressure to be tender; whilst tympanites, colic and dysuria are associated with lumbar tenderness. Treatment—Aside from proper attention to the causative affection, Veratrum or Choloroform (410 & 11) locally. Anodynes maybe called for—Aconite, Belladonna or Brom (pp. 22-27); Cocaine and lodoform- Collodion (pp. 77 & 109). See Neuralgia. Spina bifida—Hgdrorachitis is a congenital affection, in which the vertebrae of the lumbar or sacral portion are cleft or deficient, so that the spinal membranes yield to the pressure of the subarachnoid fluid, which they contain, and bulge out, forming a fluctuating tumor of variable size in the middle line of the back. Hydro- rachitis is generally accompanied by paralysis of the bladder, rectum and lower extremities; though in the rest the infant may be perfectly well. Gentle pressure is all that can be done in the way of treatment. Curvature of the Spine may be lateral—from debili- ty of the ligaments and muscles of the spinal column; angular (Pott's Curvature), produced by softening and 282 Spine. absorption of the intervertebral substance and caries of the bodies of the vertebrae, due to scrofula; or directly forward or backward, mostly seated in the upper part of the back and always a consequenee of rickets. Pott's Curvature generally begins with a dull pain, especially in adults, aggravated by motion. If the disease is situat- ed in the dorsal vertebrae, there may be tightness of the chest with difficulty of breathing; and if in the cer- vical, one or both arms may be palsied, and inability of carrying the head without supporting it. Sooner or later scrofulous abcesses may form, accompanied by hectic and great constitutional derangement. Next to a con- stitutional treatment, generous diet and general hygienic measures, perfect rest is indispensable, and may to a cer- tain degree nearly always be insured by proper mechan- ical appliances. If the back be very weak, the patient should, when not moving about, neither sit much nor stand, but maintain as much as possible a reclining posi- tion on a hard surface. In Pott's Curvature, however, where the horizontal posture is absolutely necessary, the patient must by no means be taught to lie on his back. Issues on the sides of the diseased vertebra will do no good in scrofulous subjects; but leeches maybe applied to relieve occasional accessions of pain and tenderness. Spleen. Enlargement—Ague Cake occurs in connec- tion with acute specific or infectious diseases, and with certain chronic affections. Treatment according to the associations belonging to it. If due to malaria, Qui- nine (p. 11); Salicin (p. 16); if owing to leucocythaemia, Ferrum, Ergot (pp. 78 & 79) Brom (p. 25) etc. Sprains—A violent stretching of tendon, ligament or fascia, with or without rupture of some of their fibres Sterilitas. 383 and blood-vessels, constitute a sprain. It produces in- stant severe pain, often attended with faintness, great tumefaction and ecchymosis, and subsequent weakness and stiffness. If the part is not kept at rest and the knee or some other large joint affected, there will be in- flammation and fever that may lead to serious, even fa- tal results. Treatment—In slight cases, perfect rest, in conjunction with cold water applications and a bandage may suffice; but if a large joint, e. g. the knee, be affect- ed, the patient should go to bed, and the knee should be confined by a splint behind, and held in place by a bandage comfortably applied. During the first day or two the object is to allay pain, and to anticipate inflam- matory effusion by cold affusion or warm fomentations and plain diet. If inflammatory pain, i. e. throbbing heat and swelling, should be developed, leeches should be applied. That the reparative process may not be disturbed, the part should now be supported by a a firm bandage, once daily douched with cold water and per- haps rubbed with a stimulating liniment (409). If af- ter a sprain, the injured part is subject to fits of inflam- mation, and very slow in recovering its powers, Iodine (p. 14) will be indicated as in chronic rheumatism. Stammering—The inability of uttering certain words or syllables with fluency, unless due to lesions in the medulla oblongata or spinal marrow, may be treated successfully by gymnastic respiration in conjunction with pronunciation, making the patient say "her" before each word beginning with a consonant. Sterilitas—Barreness is the consequence of a mul- titude of causes; it will be caused through impossibility of the entrance of the seminal fluid into the uterus, as 384 Sterilitas. is the case in cervical endometritis, etc.; by the preven- tion of the production of a healthy ovule (from chronic ovaritis, etc.); by preventing the passage of the ovule into the uterus (from stricture or obliteration of the Fallopian tubes); by destroyed vitality of semen or the prevented fixation of the impregnated ovum, a result of endometritis; membranous dysmenorrhoea, menorrha- gia or metrorrhagia, abnormal growths, etc. The most frequent causes are glandular cervical endometritis; ar- eolar hyperplasia from subinvolution of uterus; leucor- rhoea and other morbid discharges, either by causing death of the spermatozoa or by changing the lining membrane of the uterus; obesity, by impairing the function of the ovaries; flexions and versions; and ex- cessive sexual intercourse. Treatment—Removal of cause if possible. If it is due to a congested state of the uterus, or to atonicity, suction at the breast may re- move it: in the former case as derivative; in the latter, through the reflex action it produces, securing contrac- tion of the flaccid uterus. If stricture of cervix, dila- tation; if its vaginal portion should be projecting, or conical, the bilateral operation for its enlargement, or amputation, if necessary. Steatoma or Atheroma. See Skin (Wen). Stomach—Dilatation or Gastrectasia, mostly due to pyloric obstruction produced by cicatrices of old ulcers, cancer and similar causes, is characterized by an ab- normal prominence of the epigastric region, extend- ing more or less over the umbilicus; and a periodic vomiting at intervals of a day or two, containing the ingesta of the previous day—The amount of dilatation may be ascertained by means of soda (p. 55). Treatment Stricture. 885 demands above all regulation of diet: Saccharine and amylaceous articles should be avoided on account of their tendency to fermentation. Peptonized food (on. 84 & 137) is sometimes of service. At the same time tonics, especially Strychnos (152). Ulcus rotundums. perforans occurs either in the lower part of the oesophagus, in the stomach, or in the upper part of the intestine; and is generally produced by the solvent action of the gastric juice. Gastric ulcers are characterized by a gnawing, circumscribed pain coming on directly after meals; tenderness on pressure in the same place; and vomiting and hemorrhage usually asso- ciated with constipation. Treatment—Aside from pep- tonized food (p. 84); or milk as diet (if vomiting has ceased), or rectal alimentation (p. 137), Sublimate (p. 13). For the relief of pain, Morphinum (pp. 38 & 110); and in case of hemorrhage, ice per os and Ergot per anum (383). | For other stomachal diseases see the several heads as Gastritis, Gastralgia, Enteritis, Dyspepsia, Hemorrhage (Haematemesis), etc. Stomatitis—Stomacace (Stomatitis ulcerosa)—Stom atodysodia (Fetor Oris)—Stomatomycosis, etc. See Mouth. Strangury—Painful micturition, the urine being passed only in drops, is a constant symptom in chronic cystitis and spasmus vesicae. See Bladder. Stone. See Calculi. Stricture—Permanent stricture of Male urethra arises from repeated gonorrhoea, intemperance, unheal- thy condition of the urine, etc. Treatment—A bougie or catheter a boule is the best instrument for overcom- ing stricture, or prostatic obstructions. It should be 386 Stricture. passed every three or more days, and allowed to remain each time for about 5 minutes, by which time the pa- tient may complain of faintness. This procedure (un- der chloroform if necessary) must be repeated with a gradual increase of the size of the instrument, until the canal is restored to its natural calibre—it is expedient to pass a sound once a fortnight for a few months af- terwards. If the stricture is very old, hard and grizly, or in cases of very irritable urethra, or where there is a false passage already, metallic sounds are preferable. Electrolysis (p. 148) is now recommended as a sure remedy, on the supposition that a chemical decompo- sition of the strictured part is produced by the negative electrode, resultiug in a scar, which is soft and but slightlg or not at all retractile, similar to that, resulting from alkalies; whilst the cicatrix produced by the posi- tive pole, is as hard and retractile as one caused by acids or burns. The lumen of the stricture is enlarged by a dissolution of cicatricial tissue, and the character of that tissue so altered that it no longer contracts. The sittings should take place at intervals of, from a fort- night to a month, and only mild currents should be used. The exposed end of the bougie-electrode, which con- sists of a stiff but pliable piano or copper wire, insulat- ed with gum elastic or soft rubber-material, should be egg or acorn-shaped. For the treatment of Spasmodic Stricture, which may be due to wet and cold, irritating urine, gout, sexual excitement, piles, ascarides, and oth- er sources of intestinal irritation, see Bladder, (Reten- tion of urine). If from gonorrhoea or indulgence in liq- uor, or cantharides—whether taken internally or ap- plied as blister—this form is usually associated with Syncope. 387 inflammation. For Stricture of female urethra, see Ure- thra; for Stricture of rectum— Rectal Diseases; of Cer- vix Uteri—Uterus; etc. Subinvolution of Uterus. See Uterus. Subsultus tendinum—Movements of the wrist, per- ceptible to the touch, constitute one of the ataxic symp- toms in typhoid, which denote gravity. Subsultus is usually associated with grasping at invisible objects (carphologia) and fumbling with the bed-clothes, etc. Summer complaint. See Cholera Infantum. Sunstroke. See Insolatio. Suppression of Menses and of Urine. See Amenor- rhoea, resp. Ischuria. Suppuration—One of the terminations of inflamma- tion, the product of which is pus; and though essential- ly a morbid process, it is customary to speak of healthy pus, if it accompanies the beneficial process of granula- tion. See Abscess. Sweat. Profuse or Stinking. See Ephidrosis. Syncope—Complete and sudden loss of sensation and motion with diminuition or suspension of the pul- sations of the heart and respiratory movements, charac- terized by a death-like pallor of the face—convulsions even may occur—and due to a sudden deficiency of ar- terial blood in the brain, caused by either, direct loss of blood or by too feeble action of the heart. Treatment —Recumbency, with the head low down and some cold water dashed in the face, with perhaps some stimulant, brandy, ether (36); or Ammonia (pp. 44 & 73) will gener- ally suffice to shorten a fit of fainting. Compression of the abdominal aorta and of the arteries of the upper ex- tremities may sometimes be required. See Insolatio. 388 Syphilis. Synovitis. See Joints. Syphilis—Whilst the soft chancre may stand as the type of a spreading ulcer (see Chancroid), the true or hard chancre may be an insignificant pimple, which, however, is the starting point of a peculiar cachectic state of the system, called Syphilis, creating a multi- plicity of diseases, which is just as astonishing as it is with regard to the time in which they may appear, or to the difference in the severity; and due to a specific vi- rus, usually communicated by impure sexual intercourse. As a rule the primary sore, which is characterized by a circumscribed induration with very scanty discharge, if any—ulceration, inflammation and suppuration, if present, being accidental—and healing without medica- tion, is situated somewhere on the genitals; but it may be met with on the lips, the fingers and elsewhere. The sore is mostly accompanied by inflammation of the glands in the groin (bubo), which is usually multiple and indolent. About six weeks after this primary affec- tion, secondary symptoms make their appearance: A crop of copper-colored blotches on the skin of the arm or chest; raised mucous patches on the lips, palate or throat; scabs from little pimples on the scalp and fall- ing of the hair, attended with more or less malaise, headache or rheumatism. When the first outbreak has disappeared, there is a liability of a relapse and a fresh set of symptoms: perhaps iritis; nodes on the bones; scaly patches on hands and feet with headache and pains in the bones. However there is no invariable order, for periostitis may be the first and only symptom, with no eruption whatever. Rarely six months will pass before the first outbreak appears; but sequelae may occur after Syphilis. 389 more than twenty years. As regards the diagnosis of chancre, it has to be borne in mind that the syphilitic character of the primary lesion, whether it consist in a raised pimple, a fissure, a shallow ulcer or a mere ex- coriation, may not be apparent for some weeks; and moreover, that some other lesion may co-exist. Herpes praputialis, which may be confounded with chancre, begins with extreme itching and a sense of heat; the red patches are soon surmounted by minute, very trans- parent vesicles, which in about 24 hours having become larger and opaque, will be confluent on the third day, and break a few days later leaving a slight ulcer: This being touched with caustic, may become hard like that of chancre. Again, there may appear on the prepuce minute aphthous-looking points, which do not pain and are perfectly harmless, though they may be rather ob- stinate, some of them healing, while others are break- ing out. Psoriasis praeputii, consisting of very painful, irritable and bleeding cracks or fissures around the edge of the prepuce must not be forgotten. From ba- lanitis, chancre is easily to be discriminated by the ex- tent of the excoriations, and—if phimosis be preseut— by the profuse discharge and the pain being not con- fined to one spot, which are diagnostic of the former. Finally it should be recollected that, as chancre may in- fect the smallest, hard, discolored spot, crack, fissure, etc., anywhere, an enlargement of the nearest lymphat' ics should be looked for—above the elbow if the finger be infected, below the jaw if the lips. Treatment—As the primary sore will heal of itself in three to six weeks, anv simple application will do, be it Sod. Bicarb, or Calomel (286 & 329), Mercury internally will hasten the 390 Syphilis. healing process; but as it by no means will avert sec- ondary symptoms, and moreover, inflammation or spread- ing ulceration forbid its use (see Chancroid) it is gener- ally safer to do without it; unless one believes in small doses of Hydrargyrum cum Creta, which is said to pre- vent induration, when exhibited for about six months (p. 12). For the treatment of inflammation of the in- guinal glands, see Bubo. For the various eruptions the steam bath is a good auxiliary; and if pimples or patches should prove very obstinate, Ungt. Hydr. nitr. more or less diluted, will accelerate the cure. For loss of hair a po- made containing a little of the same ointment will be useful. Condylomata (see Warts—Skin), and ulcers require applications of Mercury (286 & 353); Cuprum (340 & 47): Cocaine (330); or Mangan (402); and Acid. nitric, especially in foul ulcers of the velum and alas nasi. In sore throat, caustic (288); or Sublimate (286, 298 & 371*). For gummata Iodine (401 & 2). The pain of nodes is frequently relieved by blisters. The remedies for constitutional syphilis are Mercury, Iodine and Chrom (pp. 12-14 & 110); Aurum (3) Sarsaparilla (1); and tonics—Quinine (pp. 75 & 6) Acid, nitro-mur. (p. 71); etc. Mercury should not be given, if the general health be much impaired; and it should be suspended or abandoned altogether, if robust persons get thinner, weaker and haggard under its use. Tabes dorsualis. See Ataxia loco-motor. Taenia (Tapeworm). See Helminthiasis. Teeth— Toothache (Odontalgia) from inflammation of the pulp is characterized by agonizing pain, the teeth becoming tender and loose; the periosteum and gum inflamed, and an abscess may form. See Parulis Temperature. 391 (Mouth). Treatment—Creosote, Cajeput, Chloroform, Cocaine (285) etc. on cotton inserted into the pulp-cavi- ty are the usual remedies. Neuralgic toothache, which is very common in the earlier months of pregnancy and characterized by paroxysms, is best treated by large doses of Quinine (p. 11) together with aperients (p. 88) and alteratives. Gelsemium (p. 33) is much recommend- ed. The rheumatic form, which is characterized by the pain "flying about the jaw," and affecting several teeth in turn, will be relieved by blue-pill and aperients with small doses of Colchicum (p. 90), followed by Ammon. hydrochlor. in half-drachm doses every four hours, or Iodine (18). Caries—a softening and decay, which will gradually spread till it reaches the central cavity of the tooth—requires filling; and Necrosis—if the tooth is black, unsightly and loose in the socket—demands extraction in case of causing inconvenience. For Teeth- ing see Dentition. Telangiectases, where there is very little or no peri- vascular connective tissue new growth (see Naevus) may more or less be destroyed by scarification, linear or punctate, as in acne rosacea, and with or without Chrom or Phenol on the needles, as sometimes used in pigment- ary deposits. However it may be well to inject Cocaine (247) or freeze the part with ether spray before opera- ting. Pressure will control the subsequent bleeding. Afterward the part is to be washed with alcohol and covered with a thick layer of Collodion (415). Temperature—If the normal heat of the body be measured within the axilla and taken as ranging be- tween 97.5° to 99.5° (in the rectum and vagina the temp. will be about one degree higher) 101° will indicate a 392 Temperature. febrile state of a mild form, and as the degree of tem- perature bears a direct relation to the amount of waste products furnished by the body, a rise of the ther- mometer above this, will be proportionate to the severi- ty of the pyrexia. Hyperpyrexia, the temperature call- ed of, and above 107.5°, which sometimes occurs in rheumatism, scarlatina and pyaemia or after some inju- ries of the brain, is usually a fatal sign. The lowest extreme of temperature (77°) is occasionally met with in the cold stage of cholera. It also falls suddenly in some cases of pneumonitis, typhoid and puerperal fever. A fall of the temperature is considered moie grave than a like rise, one degree below the standard denoting even more danger than 2^° above. In order to measure the temperature, which is usually higher in the evening than in the morning, and which can best be ascertained between 7 and 9 a. m., and between 4 and 6 p. m., the thermometer should be left in the axilla for at least three minutes, remembering at the same time, that the pulse may rise ten beats per minute for every degree of the thermometer. Tenesmus—An urgent and distressing sensation, as if a discharge from the intestines, resp. bladder must take place, although none can be effected. See Dy- sentery and Bladder. Testicles (Testiculi—Didymi)—Acute inflammation of the testis—Orchitis seu Hernia humoralis—is char- acterized by aching pain, involving the cord and ex- tending to the loins, followed by swelling of the epi- didymis (Epididymitis), with exquisite tenderness, vom- iting and fever. It mostly occurs in conjunction with gonorrhoea through an extension of inflammation from Tetanus. 393 the urethra; especially in persons who indulge in liquor, or neglect wearing a suspensory while employing injec- tions. Treatment—Suspensory bandage and ice with leeches, if necessary, and purgatives (p. 8S), Antimony and Opium (pp. 23 & 3 7). Afterwards Lead and Opium (337) or Belladonna ointment (350). A deep puncture made into the body of the testis with a thin, sharp knife relieves instantaneously, and requires as after- treatment only an aperient with cooling lotions. After the acute stage compression by means of strips of ad- hesive plaster: The uppermost strap being placed round the spermatic cord immediately above the testicle, and the skin protected by a strip of lint to prevent cutting, the straps are applied in the long axis of the testis, radiat- ing across the centre of the scrotum below, so as to cover the whole organ. Chronic inflammation of the testis (Sarcocele) is characterized by more or less tenderness, swelling and hardness, with occasional pain, and fre- quently accompanied by some effusion (Hgdro-sarcocele). Unless a sequel of the acute form, it may be caused by chronic rheumatism or syphilis, but generally it is due to stricture of the urethra. Treatment—Aside from the constitutional treatment and the wearing of a suspensory, cold lotions, Tinct.Jodi, Iodoform (401) etc. Barium (5) is said to be useful. Neuralgia of the testis and cord, which is characterized by paroxysms of pain with ten- derness and slight swelling, requires aside from leeches, lotions and Opium and Belladonna ointment, tonics: Qui- nine (p. 76); Ferrum (p. 79), etc. Tetanus is characterized by persisting rigidity of the muscles of the jaw and of the greater part of the mus- cles of voluntary motion, with paroxysms of tonic spasms, 394 Tetanus. probably owing to an intensely increased excitability of the spinal cord. If confined to the 5th and 7th nerves, it constitutes lock-jaw (trismus), affecting the muscles of the neck and lower jaw. The mouth in some of these cases cannot be opened by any force and its angles are drawn backward and upward, causing the expression called urisus sardonicus." In the paroxysms of spasm, which are superadded to the persistent rigidity of the muscles, the body is generally bent backwards, (opistho- tonos), sometimes forward (emprosthotonos), seldom sideways (pleurosthotonos). Aside from the idiopathic form, due to cold and visceral irritation (especially of the womb), it is most liable to follow lacerated, poison- ed, and punctured wounds of the hands and feet; gun- shot wounds; compound fractures; the pressure of bul- lets and foreign bodies. Treatment—Above all remov- al of cause. Of remedies may be named Curare (65), Amyl (308), Chloral and Chloroform (p. 30), or Brom (p. 24); Opium (p. 35) and Strychnos (p. 83). If from strychnine poison, see Table (p. 6). At the same time nutrient enemata (387) and brandy (p. 73), etc. If chron- ic, shower bath, aperients (p. 88) and tonics (p. 69); Cannabis or Ge/semium (pp. 28 & 33) and Physostigmine (256). In hysterical tetanus Valeriana (p. 38) Hyos- cyamus (p. 33) and aperients. In trismus infantum seu neonatorum, whether due to the mother's milk, the re- tention of meconium, or the inflammation of the umbilical arteries from tying, it is nearly always fatal: The warm bath, Castor oil, Physostigmine and Chloroform (256 & 316) or Opium (p. 37) are the usual remedies. Throat. See the affections of the various parts, which are generally enumerated under that head: Tonsillitis. 395 Pharyngitis, Laryngitis, Catarrh (Cold in the throat), etc. Thrush (Stomatomycosis). See Mouth. Tic douloureux. See Neuralgia (trifacial). Tinea. See Head. Tinnitus aurium. See Ear. Tongue. (See Mouth)—The tongue furnishes most valuable diagnostic hints: If thick and flabby, showing indentations from pressure of teeth, it indicates gastric and nervous irritation; if sharp and pointed - irritation or inflammation of the brain; if pale-anaemia; affections of spleen; and after severe hemorrhages, if very red— inflammation of the gastric or intestinal mucosa; if red or a white coating, with prominent papillae (strawberry- tongue)—scarlatina; if red on edges and tip, or a red dry streak in centre—typhoid and gastric fevers; a thick, white coating—gastric derangement; a thick, yellow fur—biliary derangement; a dark, brown coating—ma- lignant fever; if dry, blackish and tremulous—abdomi- inal typhus; if lead colored—cholera and mortification of lungs and stomach; if bluish—impeded circulation; if aphthous—thrush of infants; visceral diseases tend- ing towards a fatal termination; and last stage of phthisis. If the tongue is protruded very slowly and not drawn back again—exhaustion or congestion or some pressure on the brain; if tremulous—in acute dis- eases of evil import; if, when protruded, it points to one side—hemiplegia of the organ; immobility and tremb- ling—torpor of the brain. Tonsillitis (Quinsy)—Inflammation of the tonsils, mostly due to cold, is characterized by redness, rapid swelling of the part, throbbing pain when matter is formed, difficult deglutition, with foul tongue, head- 396 Tonsillitis. ache and fever. Treatment—Cold compresses and ice to be sucked or hot fomentations, inhalations of steam, with gargles (300) and a brisk purgative. Aconite ox Anti- mony (p. 23); Hydrarg. c Creta (p. 13). An application of Argentum nitricum (1:4 Aqua) will generally reduce tension and pain; probably prevent suppuration; and if done within the first twenty-four hours, may even abort the disease. As diet, milk, gruel and broth. If the gland continues to swell or occasions embarrasment to breathing, an incision should be made to unload the vessels and give exit to matter, if present: The tongue being kept down with the left forefinger, a straight bis- toury, wrapped round with lint, except an inch and a half of its point, is passed directly into the tumor, and made to cut its way out towards the median line. Chronic follicular tonsillitis, being characterized by small white bodies, projecting from the orifices of the follicles is generally connected with the so-called Cler- gyman's sore throat, see Pharyngitis. Chronic enlarge- ment of the tonsils is a frequent sequel of inflammation, especially of repeated catarrh in scrofulous children, and leads often to throat-deafness. Aside from a tonic treatment, as Ferrumjodatum (p. 14) Quinine (p. 76) Cod liver oil etc., astringent gargles (299); inhalations of hot water with twenty drops Creosote or Tinctura Jodi; Argentum nitricum (gr. xx: § j Aqua); or Tinctura Jodi by means of a sponge-probang; or a submucous injection of Iodine (292). Toothache (Odontalgia). See Teeth. Tophi arthritici. See Arthritis. Torticollis. See Wry-neck. Trachoma. See Eye. Trichinosis 397 Trance. (Ecstasy)—A condition in which the mind, absorbed in a dominant idea, becomes insensible to sur- rounding objects, the body remaining in some cases, immovably fixed, as in catalepsy. Tremor—Alternate contractions and relaxations of muscles in rapid succession. Aside from being inci- dent to old age or due to poisoning with mercury— Tr. mercurialis—, or as consequence of certain lesions of the brain, it occurs as a result of the abuse of spir- its, habitual use of opium, nicotism and sexual excesses, when it is functional, the tremulousness affecting es- pecially the hand, seldom extending to the lower ex- tremities. Treatment—Removal of cause, if possible, and tonics (p.69); in Tr. mercurialis, Iodine (p. 14); in Tr. senilis, Morphinum and Zinc (80 & 195) may be tried. Trembling, characterized by feeble, rapidly recurring and rhythmical movements, increased under mental excite- ment and physical exertion, and followed sooner or la- ter by paresis is called shaking palsy or Parkinsons Disease (Paralysis agitans). Here the remedies are: Tonics—Arsenic (p. 9) Barium (p. 10); Strychnos (p. 83); or Ergot (p. 78); andsedatives—Belladonna,Brom,Canna- bis, Chloral etc. (pp. 23-30). Trichiasis. See Eye. Trichinosis—(Trichiniasis) is a disease caused by Trichina spiralis, a parasite of about 1 mm. in length, which, belonging to the class nematoda, is found in the muscles of swine. The disease is characterized by ab- dominal pains, vomiting and diarrhcea, followed soon by pains in the muscles, together with more or less con- stitutional disturbance. The symptoms occur within ten days after eating trichinous pork in an uncooked or 398 Tuberculosis. not sufficiently cooked state, that is, as soon as the young worms have been produced and become developed, so as to begin their migration towards the muscles. The parasites, having been in the muscular tissue of the pork in a quiescent state—coiled up within a cyst—by the process of digestion are set free in the stomach, whence they pass into the intestines, where they prodigiously increase in size and number. They then penetrate the mucosa of the intestine, and rapidly find their way to the different muscles, where they become again encyst- ed, and though quiescent, will retain their vitality for an indefinite time. Treatment—The usual remedies employed, are Benzin, Phenol and Salicin (pp. 103 & 105). Trichomycosis (Tinea Sycosis). See Head. Trismus. See Tetanus. Tuberculosis is an infectious disease, caused by the tubercle bacillus, and characterized by the production of tissue and of inflammatory products, which appear both, in the form of nodules and as a more diffuse inflamma- tion, and which rapidly undergo caseation. Treatment is essentially of a hygienic nature in conjunction with tonics, especially Ferrum and 01. Jecoris (pp. 15, 79 & 84), whatever the seat of the local process may be. See Chronic Laryngitis and Phthisis (Larynx & Lungs). Tumor signifies increase in volume by the growth of new tissue, which does not perform any physiological function. As swellings, due to inflammatory processes, oedematous infiltration or hypertrophy, etc. are no real tumors, though frequently called so in "common par- lance," their description with treatment will be found elsewhere, T. albus—Joints; encysted, vaginal—Vagi- na; vulvar and pelvic bloody—Haematocele; vascular oj Tympanites. 399 meatus (urethral caruncle)—Urethra; fecal (retained fe- ces)— Constipation, etc. Treatment according to the nature of the growth; in some cases parenchymatous in- jections of Phenol (239) are recommended. In malig- nant forms, Argentum nitricum (403) or an injection of an acidulated solution of Pepsin? For ovarian tumors see Ovaries; for malignant tumors— Carcinoma. Tympanites (Meteorismus)—An accumulation of gas in the' stomach, small intestines or peritoneum. If in the latter, it constitutes sometimes a most distressing symptom of peritonitis, which may easily be distinguish- ed from the other forms by the disappearance of the liver sound, on percussion, the tympanitic resonance hav- ing extended over that organ, so as to change at once into the full lung-tone. Barring this, and those forms which develop occasionally in other acute diseases, tym- panites occurs mostly in dyspeptic disorders, and in connection with some uterine diseases. If indigestion be the cause, the gas is derived from either, putrefac- tive or fermentative changes in the ingesta; if irrita- tion of the uterine nerves, the abdominal ganglia, to- gether with the solar and semi-lunar plexus may be sec- ondarily affected, in consequence of which the diges- tive functions suffer, leading to sudden secretions of gas. (The disability to expel the gas is the consequence of a paralytic state of the muscular fibres of the intestines due to over-distention or defective nerve-power, see Hysteria). Treatment according to cause—Vegetables and other articles of diet, which easily ferment, must be avoided. If hysterical, tonics, especially Iron and Qui- nine (pp. 76 & 79). Sometimes a tumblerful of cold water by its tonic impression on the intestinal canal will 400 Typhlitis. be of service. Or Aloes, Colocynthis and Jalap (pp. 89, 90 & 96). In very troublesome cases, an elastic tube may be introduced into the rectum and carried up the bowels for several inches above the promontory of the sacrum, which will give immediate relief, unless there is excrementitious matter in the intestines, which must be removed by Terebinthina (217 & 385). See Dyspepsia. Typhlitis ( Typhlo-Enteritis, Ccecitis)—Inflamma- tion of the coecum is characterized by pain and tender- ness corresponding to the situation, attended by vomit- ing, diarrhoea, and more or less fever. It is generally associated with inflammation of that portion of the pe- ritoneum, which covers the coecum, with the additional symptom of circumscribed tympanites in consequence of paralysis of the muscular tunic; and chiefly due to detention of feces and the presence of irritating sub- stances. Sometimes it leads to fecal abscess (Perity- phlitis). Treatment—Rest; poultices and mild laxatives —01. Bicini or small doses of Salts; or what is still bet- ter three times daily an enema, given through a long flexible tube, which is carried upward to the sigmoid flexure. For pain, Opium (p. 35); if an abscess is form- ed, aspiration as soon as fluctuation is felt. Typhoid (Typhus abdominalis—Ileo-typhus)—Con- tinued or enteric fever is an infectious disease, mostly due to drinking of polluted water, with lesions of the intestinal lymphatic structures, which are specific and always associated with enlargement of the mesenter- ic glands, especially those in immediate relation to the Peyerian patches and solitary follicles, and charac- terized by a long prodromic stage: Chills, irregularly recurring, and followed sometimes by perspirations; Typhoid. 401 loss of appetite, mental irritability, frontal headache, with pains in the loins and limbs; looseness of bowels, and frequently epistaxis. In the first days of the fever wakefulness is a prominent symptom; this is soon fol- lowed by a pseudo-somnolent state (coma-vigil) and a kind of muttering delirium (typho-mania), with car- phologia and subsultus tendinum, terminating occasional- ly in true coma. About the 7th day from the time of taking to the bed, there appear usually on the chest iso- lated papules of a pink color, whilst in the latter part of tbe disease miliary vesicles (sudamina) are common. A gradual rise from day to day of the thermometer, with its oscillations of about one degree and a half be- tweeen morning and evening temperature for the first week is diagnostic; and so is tympanites, tenderness or pain and a gurgling noise, on pressure in the ileo-coe- cal region with the diarrhoea, which looks not unlike pea soup. There may be however constipation and sometimes hemorrhage from the bowels. Walking cases of typhoid (Typhus ambulatorius) are those, in which the symptoms are so slight, that the patient need not take to the bed. Barring complications, which are many and various, the treatment is the same as employ- ed in all essential fevers—Aside from Quinine (p. 11); Salicin (27 &29); Baptisia (4); Veratrum (p. 39); etc., Sponging, or the wet sheet with sprinkling, or the pack (420), whenever the axillary temp, reaches 103°, or that of rectum 102^°. At the same time supporting meas- ures: Brandy (p. 72) and food at intervals of from 2-4 hours—milk, eggs, broth, etc. If headache, the ice- cap; if insomnia or delirium, Opium, Brom or Hyoscyamus (pp. 27, 33 & 35); Antimony or Digitalis (pp. 23 & 50). 402 Typhoid. Constipation requires enemata (385); diarrhcea, Alum or Bismuth (pp. 46 & 62); tympanites, which depends on a paralytic condition as result from enteritis or peritoni- tis, may be relieved by Terebinthina (pp. 68, 95 & 137); and externally with hot fomentations. Hemorrhage de- mands astringents—Ergot, Creosote or Plumbum cum Opio (pp. 64-67), or Terebinthina and cold compresses to abdomen; coma, blisters (408 ) or sinapisms to nuka— if dependent on uraemia, saline hydragogues (p. 96) un- less contra-indicated by abdominal symptoms, in which case Pilocarpin (p. 50). In children and infants a warm bath will generally answer better than a cold one or the pack; but very of- ten cold applications to the heart are quite sufficient to reduce the temperature. Quinine should only be em- ployed in persistent enlargement of the spleen, as it is liable to produce diarrhoea or tenesmus. Antipyrin may be given instead, but in conjunction with a cardiac Stimulant, in order to avoid any debilitating effect on the heart: gr. v ter v. quater die to child of three years. In tympanites, cold applications or enemata of cold wa- ter are sometimes serviceable,though as a general rule 01. Terebinth. (385) will do more good. In diarrhcea Naph- tha/in gr. ss-j bihorio; or Salol gr. j-iij at the same in- tervals, will generally improve the stools and diminish their number. Constipation should, as a rule, not be in- terfered with, at any rate, if peritonitis present; other- wise enemata of warm water, perhaps with 01. Terebinth. will usually suffice in the most obstinate cases. Or 01. Bicini 3 ss-j every few hours; or small doses of Calo- mel (gr. ss-j). Perforations require aside from cold compresses to abdomen and hot applications to feet, Ulcer. 403 Opium in conjunction withstimu/ants; hemorrhage should be treated with ice to the right hypochondrium, and in- ternally, Alum or Plumbum with Opium and Digitalis (p. 50). Half a minim of Tinct. Opii every hour or two, will act both as a cardiac-stimulant and astringent. When there is the slightest brain complication not de- pending on the infection itself or anaemia, neither opium nor alcohol must be given, though it may appear indi- cated by the condition of the heart; however the for- mer is well tolerated, and relieves sleeplessness and the general irritability, if the cerebral symptoms belong to anaemia or to the infection alone. Before the tenth day after the fever has disappeared no solid food should be allowed. Raw fruit must not be given under any cir- cumstances; and the little patient should be kept still in bed for at least a fortnight after the disappearance of the fever. Typhus (Typhus exanthematicus—Ship fever, etc.), is a continued fever, usually due to contagion in conjunc- tion with broken health from deprivations and hard- ship incident to poverty. The symptoms during the de- velopment of the disease are essentially those of ty- phoid, with the exception of the pathognomics of that disease. Moreover the prodromic stage is very short or wanting; and a copious persisting eruption (if present) of dark red maculae appears already in the first few days of this fever, the skin assuming nearly all over a dusky hue. Treatment similar to that of typhoid; Sali- cin (p. 18) is particularly recommended. Ulcer—An open sore from softening and disinteg- ration of structure in consequence of a wound, bruise, abscess, injury or disease. Treatment—Cleanliness, 404 Ulcer. rest, bandaging or strapping and exclusion of air, with purgatives, and if necessary anodynes for the relief of pain in conjunction with proper attention to the gener- al health, are the chief points. The healing ulcer or common sore should be covered with dry lint, if there be much discharge; else a dressing with simple oint- ment or Ungt. Zinci, which should not be changed oft- ener than every three days. If the granulations should be too luxuriant, it may be touched with lunar caustic; or it may be treated with lotions (Zinc or Phenol, etc). Inflamed and irritable ulcers require poultices, with or without Poppy, Opium or Conium; afterwards Liquor Plumbi or Blackwash (400). The foul or sloughing ul- cer is best treated with Bismuth, Creosote, Mercury, Be- sorcin, Phenol or Salicin (393-399). The indolent sore requires similar applications, after having applied strips of adhesive plaster two-thirds round the limb, from one inch below the ulcer to one inch above it. A thick lay- er of phenol-gauze should be put over the dressing, af- ter which the limb has to be bandaged from the toes to the knee. Varicose "ulcers of the leg must be band- aged. In syphilitic and scrofulous ulcers Iodoform (401) is usually employed. For ulceration of bladder, see Bladder; for ulceration of cervix—Uterus (Degenera- tion); of cornea—Eye; etc. Ulcus ventriculi (Gastric ulcer). See Stomach. Umbilicus (Prolapse and Bleeding). See Hernia urn- bilicalis, resp. Menstruatio vicaria. In the new-born the navel will sometimes suppurate, even before the stump has dropped off, which, unless arising from want of cleanliness, is generally due to a leucorrhoeal discharge from the vagina of the mother. Urethra. 405 In syphilitic infants the navelstump, inteadof mummi- tying on the fourth or fifth day, as is normal, will remain soft and attached for perhaps more than a fortnight, thus exposing them to navel inflammation and septic infection. To prevent such a gangrenous or putrid con- dition, not only the cord should be tied with an aseptic ligature (416), and cut with scissors, which have been made aseptic by passing them through a flame; but also the stump should be wrapped in a piece of burnt linen (with a hole for its passage), after having been washed with bor water (260), and cautiously dried. If in spite of these precautions the navel should ulcerate, or proud flesh sprout from its side, the part must be dusted twice a day with Calomel (400). Argentum nitricum 2%, as used for the prevention of gonorrheal ophthalmia, is also recommended. Uraemia— Uraemio poisoning is characterized by coma, epileptiform convulsions and sometimes delirium, even amaurosis, preceded generally by headache, vom- iting and diarrhoea. It is due to an accumulation of ex- crementitious substances, especially urea, in the blood, in consequence of impaired or interrupted functions of the kidneys. The urine contains albumen and as a rule dropsy is present. For treatment see Coma. Urethra (Male). See Gonorrhoea resp. Stricture. Urethra (Female)—Urethritis in women occurs mostly after hard labor; but it may be also a conse- quence of a faulty introduction of the catheter during pregnancy, and is characterized by great tenderness on passing the finger along the course of the urethra; more or less discharge, and frequent micturition. Treatment consists in saline purgatives (p. 95); diluents—Nitrum 406 Urethra. gr. x ter die in Decocto Lini; Aconite (35) and perhaps Buchu (p. 47). Locally Argentum nitricum (364), espe- cially if there should be some ulceration at the border of the meatus. Prolapsus Urethrce known also as procidentia and eversio urethras consists of prolapse of the mucous mem- brane, which encircles the meatus like a roseate projec- tion, and unless the result of hard labor, depends on a relaxation of the part in connection with a broken-down health. It is characterized by much sensitiveness, great liability to bleed, and difficult and painful mic- turition. Sooner or later it may cause pruritus vulvae, with a leucorrhoeal discharge and even ulceration from the parts being exposed to friction of the dress, etc. From caruncle, polypus or angioma it may be easily differentiated by its entirely surrounding the meatus. Treatment—The patient being anaesthetized, the pro- lapsed tissue should be drawn down with tooth-forceps and removed by encircling it with the galvano-caustic wire, placing for some days a catheter in the bladder if necessary. Existing ulceration should be treated first with caustic. Sometimes astringent infections (859 et seq.) with attention to the general health will effect a cure—Magnesia (218); Ferrum (175); etc. Urethral Caruncle—A vascular tumor, soft and frag- ile, varying in size from that of a pea to that of a pul- let's egg, situated on the border of the meatus, some- times extending up the canal. It is almost always ac- companied by a mucous discharge, excessive pain in sexual intercourse, in walking and micturition; and will sooner or later affect the general health by causing ner- vousness and depression of spirits. Treatment—After Urine. 407 having covered the adjacent parts with hardened lard, so as simply to expose the tumor, it is freely touched with Acid, nitric. (329), which may be repeated after a few days if necessary; or it may be cut off, and Potassa fusa, or solid Cloride of Zinc, applied to the surface, to prevent its reproduction. If Potass has been employed the parts should, after its use, be washed with diluted vinegar; if Zinc, they should be well oiled. If it is necessary to introduce the caustic within the urethra, it must be by means of a porte-caustic. The best opera- tion is however with the gcdvano-cautery, since by this means the hemorrhage, which is sometimes very pro- fuse, is not only stayed, but a relapse is also prevented. Before the operation the patient should be thoroughly anaesthetized, and the labia well separated by an assistant on each side. When the urethra has been invaded, it should be thoroughly stretched by small retractors, held by assistants, and the growths thus exposed be cut off with scissors, or scraped from their attachment by a steel curette. After removal they should be touched with Arg. nitr., Acid, nitric, fumans, or the actual cautery. Angioma, which affects the urethro-vaginal tubercle or anterior half of the urethro-vaginal septum, attaining sometimes a large size, so as to project between the la- bia, requires the same treatment. It can easily be dif- ferentiated from caruncle by its want of sensitiveness. Stricture, which is characterized by difficult mictu- rition, pain upon pressure along the urethra, and some- times a mucous discharge, is best treated by mechanical dilatation with graduated bougies. Urine (see page 154)—Incontinence occurs in most inflammatory affections of the urinary organs, nervous 408 Urine. diseases, paralysis, etc., see Bladder; for Retention, (inability of expelling the urine, though the bladder is filled), being due to deficiency of contractile power of the bladder, stricture of the urethra, etc., see Reten- tion; for Suppression from inaction of the kidneys, the bladder being empty, see Ischuria; and for Haematuria (the passage of blood with the urine), see Hemorrhage from the kidneys. Urinary Deposits, if precipitated from the urine, af- ter it has been voided, are called sediments; if how- ever already formed in the bladder or kidneys, they are known as gravel. Red gravel, consisting of lithic or uric acid crystals, tinged with coloring matter, indicates generally a highly acid state of the urine, and forms the sediment observed in fevers, gout and chronic diseases of the liver. It may exist with highly plethoric condi- tions, and may, on the other hand, be a sign of debility and malassimilation. The amorphous Uthates of ammo- nia, soda, and lime, form a very common sediment, vary- ing in color from nearly wrhite or yellow to dark red. Oxalate of lime, presenting letter-envelope-like crys- tals, which are easily recognized under the microscope, is generally deposited from acid urine containing lith- ates, and indicates feeble assimilation and exhaustion of the nervous system. The phosphatic deposits, aside from being a result of irritate bladder with excessive secre- tion of mucus, caused by a primarily over-acid urine, which on account of its urea being decomposed into carbonate of ammonia, has turned alkaline, are due to a primarily alkaline, or insufficiently acid state of the urine, mostly dependent on excessive acidity of the stomach. Unless arising from changes in the bladder, the Uterus. 409 phosphates usually indicate anaemic dyspepsia or undue wear-and-tear of the brain from overwork. A fit of gravel is generally accompanied by pains in loins and hips; aching of the testicles; and frequent micturition. Sometimes there is languor, fits of headache, sour perspiration and nettle-rash, with despondency and other symptoms of indigestion, or a disordered state of the constitution; especially in Oxaluria. Treatment ac- cording to causation—In red gravel of robust and strong persons, aside from a bland diet, Liquor Potassa (119); or Benzoin (pp. 45 & 46 & 58) with occasionally a purga- tive (p. 97). In feeble persons a nutritious diet with tonics (p. 69), especially Acid, nitro-mur. (pp. 42 & 43), which is also indicated in oxaluria and phosphuria, in fact in all cases, where taste is foul or flabby, denoting impaired digestion. If there are sour eructations, flat- ulency, etc., whether the urine be alkaline or not, alkalies in small doses (p. 53). Chloral (p. 29) as hyp- notic; and in oxalic and phosphatic cases, Conium or Be/I.suppositories (375), to allay local irritation; or Co- caine (see Neuralgia). Of other remedies may be men- tioned, for lithiasis, Lithium and Arctostaphylum (pp. 51 &6S); for phosphuria, Acid. sulf. (pp. 61 & 72); for oxa- luria, Ferrum (pp. 79-81); Quinine (p. 76); Zinc and Strychnos (pp. 83 & 86). Urticaria. See Skin. Uterus—In the majority of cases, a diseased uterus, which has been fqr a long time in an abnormal condi- tion, will be found enlarged and displaced; there will be most likely catarrh of the lining membrane, a granu- lar condition of cervix; and probably, slightly enlarged and sensitive ovaries. A proper examination (p. 126) 410 Uterus. of the womb has to be made, whenever existing symp- toms of a female disease cannot be explained otherwise. Displacements—In anteversion, there are sometimes no symptoms whatever; generally, however, the pres- sure of the os against the posterior vaginal wall will in- duce dysmenorrhoea and sterility; whilst the pressure of the fundus against the bladder and the cervix against the rectum will cause there irritation. In the former there will be a state, bordering upon cystitis; and in the latter, tenesmus and pain; besides neuralgia in con- sequence of compression of the nerves, and more or less difficulty in locomotion. Anteversion is generally com- bined with flexion, and if it is complete, the uterus will be found lying at an angle of 90° to the normal—the axis being taken to be a line passing from the umbilicus to the point of os coccygis; if partial, the angle may not exceed 45°. Treatment—The patient should be placed upon her back on a table, after having previously emp- tied the bladder by a catheter and removed all tight clothing from the abdomen. Then two fingers, well oiled, should be passed into the vagina so as to reach with their tips the body of the uterus, which will have forced the walls of the bladder down before it, and the patient directed to take a deep breath. Now, while the latter expels the air gently by a prolonged expiration, the operator presses up the body of the uterus with the fingers in the vagina, and the abdominal viscera and fundus with the other hand on the abdomen. After the fundus is lifted, the hand on the abdomen must keep it up until the cervix has been pulled forward towards the symphysis with the fingers in the vagina. The reten- tion of the uterus in position is generally effected by an Displacements. 411 internal pessary; but if we have no skill in its use, it is better to employ one with a stem arching over the perineum, or going over the symphysis and anterior ab- dominal walls. A still safer plan for the inexperienced is to merely lift the displaced organ without rectifying the anterior displacement and keeping it in that posi- tion by the ordinary ring - or GarieVs air pessary in conjunction with the abdominal pad of wood or cork. Retroversion sometimes gives neither rise to any symptoms, though a fixed, gnawing pain in the back, discomfort in walking, and pain in defecation with te- nesmus of rectum and bladder are common. Very se- vere symptoms are sure to follow sudden retroversion, the result of succussion: The patient falls to the ground, and is unable to rise, suffers from suppression of urine and feces; and is often in such agony that the face is bathed with perspiration, and the pulse becomes weak and fluttering. Like anteversion, it may produce con- gestion, areolar hyperplasia, dysmenorrhoea, sterility, etc; and the pressure of the fundus on the sacral plexus causes at times complete paraplegia. Retroversion has three degrees: The uterine axis lying to that of the superior straight at an angle of 45°; 90°, (thus lying across the pelvis); and 133°, the cervix being thrown up, and the fundus descending. Treatment—Standing at the back of the patient, who is placed in Sim's position (p. 127), we introduce index and middle finger of the right hand to the fundus, their palmar surfaces being directed to the rectum: The uterus is now lifted upon the inner surface of the fingers, until it becomes erect, then their dorsal surfaces (the back of the nails) are made to push the organ over into the normal position. 412 Uterus. Or a sponge, fixed in a sponge-holder may be introduc- ed and pressed into the fornix vaginae—this latter pro- cedure may be made still more effective by carrying an- other sponge-staff up the rectum. If it can't be reduc- ed in this way, the patient is made to kneel upon a tahle, with the chest resting on it. Two fingers of the right hand are now carried against the fundus, elevating it forcibly, whilst the patient, after having taken a deep breath makes a profound expiration. Should this plan fail too, the buttocks should be still more raised by placing cushions under the knees, and the attempt re- peated with twTo fingers in the rectum. In cases, requir- ing no particular force, Sim's repositor may be employ- ed, or, if not handy, the uterine sound: Having intro- duced it, the handle should be held with the left hand, and while the tips of the fingers of the other hand press upon the staff near its middle, thus making of the sound a lever; it must be pushed back gently to the perineum. This movement will lift the uterus and partially restore it. Now the tip of the sound is made to revolve very gently, and the uterus carried into a condition of ante- version. For its retention in situ a tampon of carbol- ized cotton, or a sponge, saturated with carbolized gly- cerine, either of the size of a small hen's egg, may be carefully pushed as far as possible into the fornix va- ginae, the uterus being held in a state of complete an- teversion by means of a repositor or sound. Then the sound being removed, a large roll of aseptic cotton should be placed below the cervix and a little anterior to it, so as to lift this part up into the hollow of the sa- crum against the roll in the fornix. The tampon (369) may be retained for 48 hours without inconvenience. Af- Displacements. 413 terwards, when a pessary is employed, care should be taken, that it create no discomfort, as in such a case a most violent cellulitis may result. In fact, pessaries should be ahoays controlled, as besides cellulitis or peri- tonitis they may produce not only vesico, recto and utero-vaginal fistulas, but even pass out of the vagina into the rectum or bladder. While a pessary is kept in the vagina, daily vaginal injections should be made (358 et seq.). Flexion is quite frequent, \n slight degrees, in nulli- parous women, without constituting a disease; during childhood it is even the rule. As at the point of any flexion the cervical canal is always more or less closed, the ingress of fluids is prevented, and sterility com- monly results; at the same time is the egress so much interfered with, as to produce dysmenorrhoea, haemato- metra, hydrometra, and accumulations of mucus, which latter again results in endometritis, and even hemato- cele by regurgitation. A consequence of venous hyper- semia, arising from hindered reflux of blood at the point of flexion is oedema with tumefaction and genuine hy- pertrophy of the body of the uterus. In fact, neck and body will become tumid, tender and painful, the mucous lining so congested as to secrete excessive amounts of mucus and blood; and the tissues of the organ, excited to excessive growth by prolonged blood stasis, undergo in time marked hypergenesis. Besides these consequen- ces there may be a tendency to abortion, menorrhagia, ovaritis and salpingitis, granular degeneration, uterine neuralgia, pelvic peritonitis, cystitis and rectitis. With regard to Anteflexion, a certain degree of it may exist for years, without the development of symptoms. Sooner 414 Uterus. or later there will be, however, pain over the hypogas- trium, in groins and back, increased by locomotion and sexual intercourse; with irritable bladder, leucorrhoea, dysmenorrhoea, neuralgia, and all kinds of nervous dis- turbances. In Retroflexion there will be in addition, severe backache, weight in the rectum with tenesmus; uterine colic or tenesmus, and gastric disorders. Treatment of reducible flexion—body bent forward, axis of neck normal. The bowels having been evacuat- ed, pelvic and vaginal irritation removed by warm in- jections and rest in the dorsal decubitus, the uterus sound is introduced to the fundus as straight as it can be made to pass, and then the handle, being held in one hand, is carried to the symphysis, whilst the tips of the fingers of the other are pressed against the shaft of the sound near the middle, so as to make a fulcrum, by which manoeuvre the flexed uterus is elevated and brought towards the hollow of the sacrum. Now the sound should be very gently rotated so as to complete retro- version with partial retroflexion. The patient should remain in bed for a few days. Cutter's pessary (modi- fied) may be applied, and the abdomen pressed inwards by means of an ordinary obstetric bandage with a fold- ed towel under it as a compress. In case of pain the bulb of the pessary should be replaced by a soft sponge, which is however to be removed every 24 hours. In Flexion with neck bent forward, the axis of body being normal, the sound, slightly bent forward, should be car- ried to the fundus, and the body thrown backwards, where it must be held for several minutes, in order to straighten the uterine canal. Now Hard's pessary, which must exactly fit and fill the vagina, may be in- Displacements. 415 troduced to keep the cervix backward; care being taken that it does not get incarcerated, which will sometimes happen, especially if the pessary is too small. After- wards Mtig's ring should be worn for some time, to pre- vent the upward and forward pressure of the vagina. As in any form of flexion there is generally more or less con- traction of the cervical canal, it is well to finish the cure by dilating it with graduated sounds. Irreducible flexions, which mostly are congenital and one wall of the uterus well developed by excessive growth whilst the other is atrophied, may be corrected with the intra-uterine stem, provided the patient can bear it; or the knife. Before the introduction of the stem, the cervix, if found to be too contracted, should be dilated by one or more sea- tangle tents (p. 130), which for the time will straighten the uterus and dilate the canal. After introduction the patient should be kept in bed for several days, and upon leaving it, should be very careful in her movements for some time. During menstruation the instrument must be removed; likewise when there is pain, chilliness or feeling of general languor and discomfort. In Retroflexion the patient is placed on her left side, with the left hand drawn behind the body. The oper- ator stands now behind her, his face looking towards her occiput, and the line of the anterior surface of his body being about on a level with one passing through the patients body at the base of the sacrum. He now passes two fingers of his right hand, after having lubri- cated them, with their palmar surfaces towards the pos- terior wall of the vagina up to the fundus. Then, bend- . ing forwards, he, by the tips of his fingers, pushes the fundus upwards, while, by their bases he retracts the 416 Uterus. perineum, elevates the posterior vaginal wall, and ad- mits air freely to the vagina. If this method should fail, the knee-chest position may be tried. Should the sound be used, it must be introduced but slightly bent to the uterus: Holding the handle in the left, the tips of the fingers of the other hand should be placed on the shaft to carry it towards the perineum as far as possible. The uterus being now to a certain degree straightened and elevated, the sound should be rotated so as to throw the fundus forward, at the same time the handle of the in- strument held in one hand has to be carried towards the patient's back, so as to advance the tip as far as possible towards the abdominal wall. For its reten- tion, any pessary will be of use, provided the fundus be light and easily reducible; but if it be heavy or rebell- ious, Cutter's will be preferable—the stem pessary will only be indicated, if the vagina unites so low to the cer- vix as not to leave a post-cervical space. If there be much tenderness, a sponge or the inflated soft rubber pessary may be advisable; or still better the fornix may be packed with medicated cotton or sponge to elevate the whole uterus as in retroversion. Irreducible flexions, due to old false membranous at- tachments are better left alone, unless the patient is very much suffering from the displacement, as in treat- ing it, we always incur the risk of peritonitis. In case the flexion be due to parenchymatous alteration, all that can be done, is to bend the body cautiously forward once or twice a week, by means of the sound or reposi- tor and then keep it in anterior inclination with a retro- flexion pessary or Cutter's modification. Sometimes the fornix should be filled with a soft moist sponge and Displacements. 417 the body sustained by a tampon of cotton in the vagina. In these cases the patient should be kept very quiet, and all pain should be soothed by the free use of Opium to prevent peritonitis. Lateroflexion of the uterus, which is either a conse- quence of disease of its proper tissue or of direct pres- sure, requires generally the intra-uterine stem. Prolapsus Uteri may even in the third degree remain without marked symptoms; but generally congestion, areolar hyperplasia and granular degeneration occur, which render it sensitive and intolerant of pressure or friction. In the first degree, the fingers passed up the vagina, will meet the os low down in the pelvis, pressing upon the floor; in the second degree—the patient being examined standing—the os will be found at the ostium vaginae, prevented from extruding only by the resist- ance of the sphincter mjuscles. As congestion and hy- perplasia affect not only the parenchyma of the uterus, but also the mucous membrane and submucous tissue, endometritis is invariably a consequence of prolapsus. The vagina, which as the uterus descends is inverted, makes constant traction upon the os externum by its cer- vical attachment, until the canal becomes completely everted, turning the os internum literally into the exter- nal and only os uteri, the real os externum having disap- peared by expansion. Dislocation of the bladder, which by uterine descent may happen to such extent, that, if a catheter be introduced, it will pass downwards and backwards is also a grave complication, since traction and dislocation not only tend to the production of cys- titis, but this is further induced by reflex irritation and by decomposition of urine, retained in the pocket, 418 Uterus. formed by the inverted wall of the bladder. By a similar process prolapse of the anterior wall of the rec- tum occurs, and results in fecal impaction at this point. Sudden or acute falling of the womb may come on from any great effort, a fall, or violent contraction of the abdominal muscles, acting upon a womb which is en- larged by hyperplasia, subinvolution, pregnancy or tu- mor. It may even occur to a uterus normal in size and constituency: In an instant the patient feels that some- thing has given way within her, becomes prostrate and much alarmed, suffering pain of an expulsive charac- ter. Should in these cases reduction not be effected at once, violent pain will be felt over the sacrum and groins and the degree of traction exerted upon the pel- vic peritoneum may result in dangerous inflammation. Treatment—The patient, after thorough evacuation of the rectum and bladder, if this be possible, should be placed upon her knees and chest, in order to cause grav- itation of the pelvic and abdominal viscera towards the diaphragm. She should kneel upon the floor or a table and ten or fifteen minutes should be allowed to elapse before any efforts are made at reduction, in which time tbe existing congestion of the viscera will greatly di- minish. The operator then taking the cervix into the grasp of his index, middle and ring-fingers, pushes the uterus firmly upwards in coincidence with the axis of the inferior strait, steadying at the same time the pa- tient by placing the left hand upon her back. The pres- sure has to be kept up for fifteen minutes and longer until the uterus is restored to its place. It remains now to adopt proper measures in order to sustain the organ in situ, which, as a rule, is no easy matter. If for in- Displacements. 419 stance, the prolapse is associated with subinvolution, prolapse of the vagina, and rupture of the perineum, a most frequent combination, the three factors—increased iceight, feeble supports, and traction—have to be taken into account. To prevent pressure from above, it will be imperative to avoid the accumulation of urine or fe- ces, and to shun tight clothing; the use of skirt-support- ers will be of more or less advantage. Means for di- minishing the uterine weight are, treatment of inflam- mation, hypertrophy or congestion; removal of growths and perhaps amputation of the cervix. Means for strengthening or supplementing uterine supports are, aside from douches, cold hip baths, and recumbent pos- ture, local astringents—Tannin, Alum or Iron (359-61) in conjunction with an invigorating diet, sea bathing and general tonics—Ergot, Ferrum, Strichnos (pp. 78- 83); and a pessary, provided a morbid condition of the part does not forbid its use. Sometimes an india-rubber ball is preferable, as it is soft and unresisting. Care, however should be taken, that the air is squeezed out, and that the hole is looking towards the vulva, so that it may again become distended, as soon as it is prop- erly lodged in the vagina. Moreover a string should be attached to it, that the patient may be able to re- move it daily to have it cleaned. If the uterus thus has been fixed, a cold hip-bath and morning and night an injection of cold water or Alum and Zinc in connec- tion with a cathartic—Bheum cum Aloes (197 & 216) will do a great deal of good. Before resorting to a pessary the patient should be kept in the recumbent posture for a few days with the feet of the bedstead elevated about six inches, for the purpose of allowing congestion to 420 Uterus, pass off. At the same time mild cathartics (p. 91) to remove fecal matter and stimulate circulation, may be given with astringent vaginal injections to harden the tissues for the reception of the pessary, and to cause contraction of the distended superficial blood vessels of the vagina. If the weight of the uterus be but moder- ate, an internal pessary will do—Meig's elastic ring, Hodge's, Smith's, etc.—provided it does not distend the vagina, and can be worn without discomfort. It should however be kept clean by irrigation with an astringent at least once a day, and should be examined from time to time, to make sure that it is not cutting into the tis- sue. If the uterus be too heavy or the prolapse of the 3d degree (procidentia uteri), Cutter's pessary with a stem curbing over the perineum, will be preferable. The cup at its extremity receives the cervix, and the in- strument can easily be removed at night, and replaced in the morning by the patient herself. As regards the means for preventing traction by the vagina, partial re- lief may sometimes be obtained by applying to the weak part a pad or cushion filled with cotton, hair, or air, com- bined with an abdominal supporter, to which it may be attached. In Procidentia, especially during pregnancy, a soft compress with a T bandage, for the support, to- gether with a mild aperient to keep up a soluble state of the bowels. The proper remedy is, of course, the res- toration of the perineal body (perineorrhaphy), and the narrowing of the vagina (elytrorrhaphy). Simple Prolapse may sometimes be cured in from six to eight weeks, by the daily performance of a process of massage and uterine elevation in conjunction with cer- tain gymnastics. The elevation of the uterus cannot be Displacements. 421 carried out without the aid of an assistant, who, with one hand, has to push up the uterus in the vagina, keep- ing it in a state of anteflexion, while he puts his other hand on the abdomen, exactly over the uterus. The operator, standing at the foot of the table, on which the patient is lying, lays now his two hands, strongly supinated, flat on the abdomen, the fingers being point- ed towards the pubes, and grasping the fundus between them,raises the uterus gently but steadily upwards, in the pelvic axis. When the organ has been elevated as far as is possible (which may be as much over its normal level, as it had been prolapsed), it is allowed to slip from between the hands, and sink slowly until its de- scent is arrested by the assistant's finger, which has re- mained in the vagina to fix, and keep it in a condition of anteflexion. This movement of elevation is repeated two or three times at each sitting, a few minutes inter- val being allowed between each, during which time the assistant massages the fundus in order to stimulate it to contract. To carry out the second or gymnastic move- ment, the patient should be placed in the exaggerated stone position, and closing the knees and thighs, she should elevate the sacrum, so that the body rests on the elbows and feet only. In this position, the operator forcibly separates the knees, whilst the patient resists him as much as possible. Having repeated this proced- ure about three times, a contrary movement - the pa- tient lying with the knees widely separated, and the oper- ator bringing them forcibly together—is now practiced for as many times; when the patient should turn over on the face and remain in that position for about ten minutes, which closes the sitting. 422 Uterus. Inversion is generally a cause of mismanagement in the removal of the placenta after childbirth. The uterus should be fixed with one hand near the symphysis pubis, whilst the tips of the fingers of the other hand are plac- ed in the middle of the projecting part and pushed up- wards, indenting the uterus until the point has passed through the os, when it will get into its place as easy as possible. When the uterus is again right, the hand must not be retracted too suddenly, as it might invert again. The bowels should be kept in a soluble state by salines (218). Uterine Colic. See Menstruation and Ovaries. Uterine irritation is mostly a consequence of de- fective menstruation, and liable to produce a host of nervous disorders—neuralgia, convulsions, paralysis, even epilepsy. At each menstrual crisis the peripheral extremities of the spinal nerves, which are distributed on the cervix uteri, as well as the extremities of the sym- pathetic, which pass to the upper portion of the womb, being subjected to unusal irritation, this irritation may be transmitted directly by the spinal nerves, and indi- rectly by the sympathetic filaments to the brain and spinal marrow. Treatment is directed to the causative disease—Potassa (p. 54); Brom (p. 26); Morphia (255); Arsenic (p. 10); Argentum (p. 74); etc. Locally suppos- itories of Iodoform or Belladonna (Si4 & 75). Endometritis acuta is characterized by a swollen and very sensitive cervix; a discharge clear and albu- minous-looking, or consisting of long tenacious shreds of cervical mucus, which comes from the gaping os uteri; accompanied by pain in the back, and groins; burning in the vagina, which sometimes is very dry and Inflammations. 423 hot; and vesical and rectal tenesmus. Occasionally there is tympanites or diarrhoea, due to reflex irritation of the rectal nerves. It is caused by direct injury; cold from exposure during menstruation or stoppage of same; ex- cessive venery; etc., etc.; and may be complicated with vaginitis, cystitis, pruritus vulvae and various eruptive disorders. When occurring in the non-puerperal slate, it may without treatment go on to recovery; some- times it will eventuate in the chronic form of mucous inflammation, or in a slight hyperplasia; but if the in- flammation should extend, it may even prove fatal. Treatment—Complete rest; a warm linseed poultice cov- ered with oiled silk, over the hypogastrium; and for the relief of pain, Opium (p. 37). No cathartics unless con- stipation. As soon as the discharge becomes more co- pious, emollient injections (358) three times a day. Chronic Cervical Endometritis —Cervical Leucorrhoea is characterized by a glairy mucus, discharged by the glands of Naboth, which are especially involved in the morbid action, producing soon abrasion round the os. The hypertrophy, which by degrees develops in the villi, is called granular degeneration. The usual symp- toms are, dragging sensations about the pelvis, pain in back and loins and menstrual aberration. Sooner or la- ter nervousness will supervene and sometimes a disor- dered digestion, coupled with nausea and even vomit- ing. Occasionally the disease is complicated with an ever- sion of the os and lower portion of the canal to such an extent as to keep up inflammation there by the friction of the membrane thus exposed, against the floor of the pelvis. Other complications are a very troublesome va- ginitis, cystitis and a cervical hyperplasia, which will 424 Uterus. produce great pain during coition. Of the many causes, which give rise to this disease, may be named artificial abortion, excessive coition, vaginitis, obstructive dys- menorrhoea, laceration of cervix, polypi, displacements, and pessaries. Though an alterative influence, which ex- erts a complete change in the economy, as parturition, a change of habits, and the like, may result in a cure, the disease is usually very obstinate—the mildest case last- ing about six months under the best treatment; and in multiparous women it generally passes into cervical hy- perplasia with its train of ailments, which will cause a life of misery. Treatment—Saline cathartics combin- ed with tonics—Magnesia (219), to keep the bowels in a soluble state; Acid, nitro-mur. (p. 71) in enfeebled digestion; and Brom (p. 25 et seq.), if much nervousness; with emollient injections (358) twice a day as in endo- metritis. If the os be contracted, it must be above all dilated, which is best done by snipping the external fibres of the os with scissors for one-fourth of an inch, touching the raw surfaces with caustic, to prevent union, and keeping a plug of greased lint or cotton in the ca- nal for a week; or a tent (p. 130) or sponge may be used, as they, to a certain extent, are also free from danger, as long as theg do not penetrate the os internum. After dilatation the mucus may be removed in the following manner: After having slipped upon the extremity of a long-piped hard-rubber syringe (of 1 oz. capacity), which can be worked with one hand, a bit of gutta-percha tubing, the free portion of which projects half an inch, it is introduced as far as the os internum, when the pis- ton is powerfully retracted. If the matter is purulent or starchy and not tenacious, a stream of water may be Inflammations. 425 projected from this syringe against the cervix, and the whole removed by suction; or this may be done by a small pledget of cotton, wrapped round a probe. The latter instrument will also answer for the application of the remedial agent to the canal—a strong solution of Zinc, Salicin or Iodine (343, 348, 354 & 55). A very good plan is to rub a probe, coated with caustic, against every part of the investing membrane, and dipping it carefully in its convolutions. After the application a stream of water should be projected against the cervix, after which some cotton saturated in Glycerine (369) may be placed over it. The cotton has to be removed in twelve hours (by means of a thread which has been attached to it for that purpose). Or the probe with the cotton, which has been soaked in the solution selected —zinc, copper^ iron, lead or bismuth with opium, con- ium, or hyoscyamus, etc., etc.—is passed into the cervi- cal canal so as to engage within the os internum, when the cotton may be slid off by means of the slide and left within the canal. After twelve hours it has to be removed. In cases where a glairy and very tenacious plug of mucus is hanging from the os, the glands must be de- stroyed with Acid, nitric, fumans or chromicum (344). This has to be followed, like the other applications by an injection of water and a wad of cotton. In ten days or a fortnight a slough of the cervical mucosa will take place, after which the surface should be painted over twice a week with Argenti Nitras. If these means should prove ineffectual, the glands must be removed by Sim's curette. Chronic Corporeal Endometritis (Uterine Catarrh or 426 Uterus. Uterine Leucorrhcea)—Internal Metritis lasts generally for years; and though it may confine itself to the mucous membrane, as arule it will gradually excite congestion and exuberant growth in the adjacentparenchyma—hyperpla- sia; sometimes a want of nutrition may take place, event- uating in distention. Barring the pain in the back, groins and hypogastrium, there is often tympanites, symptoms of pregnancy and nervous disorders—especially neural- gia confined to the crown of the head. The most prom- inent symptom however is a profuse leucorrhoea more or less tinged with blood, particularly for some time after menstruation, which latter is also faulty—either pro- fuse or too scanty. The most frequent complications are: Displacement, granular degeneration of cervix, vaginitis and pruritus vulvae. Treatment is similar to that of cervi- cal endometritis: Improvement of general health and lo- cal applications—Chrom, Zinc, Ferrum (344 & 48); and hot douches. Internally, Strychnos (172), but without Ferrum, if menorrhagia; and other tonics. As regards intra-uterine injections, they should never be made with- out securing an immediate reflux (by a double-canula sy- ringe), the os internum must be properly dilated, or a tent (p. 130) must be previously used. In fact, injections should never be used in a sharply flexed uterus before replacement, never just before or after a menstrual pe- riod; and never when pelvic peritonitis or periuterine cellulitis has recently existed. At the same time care should be taken never to inject with force, and to allow no air in the syringe. It is best to begin always with a weak alkaline injection of warm water (not below 85°) to test the tolerance of the uterus; and the organ should always be washed out before a stronger solution is used, Hyperplasia. 427 which should be of the same temperature. The patient has then to lie down until all sense of discomfort has passed; if however there should be uterine colic or pain of some sort, Opium must be given freely. Intra-uterine scarification is another way of assisting the cure; but if there are fungoid granulations, mucous cysts or po- lypi, the little copper curette is preferable. Areolar Hyperplasia of the Uterus—Chronic paren- chymatous Metritis is no inflammatory process, but con- sists of a proliferation or hypertrophy of the areolar or connective tissue of the uterus, accompanied by con- gestion and nervous hyperaesthesia. It is, as a rule, a consequence of subinvolution; but it may result from displacements, cervical endometritis, or sexual inter- course; from the latter, when excessively indulged in, shortly before or after the menstrual period, as the uterus, being an erectile organ, is subject to active phys- iological congestion. Sometimes cardiac diseases and abdominal tumors, which produce blood stasis and oedema in the feet, the labia majora and the parts about the vagina, will affect the uterus in the same way. Cer- vical Hyperplasia is characterized by a swollen and pain- ful cervix, which may be as large as a small orange and fill the vagina, compressing the rectum to such an ex- tent, as to interfere with its functions. On account of the displacement caused by the great weight, the con- gestion is still increased, and the patient suffers, until the menopause at least from endometritis, granulation and the ordinary symptoms of displacement—some- times however atrophy will take place. If the affection be general or corporeal, the symptoms attendant on the mentioned diseases are still of a graver nature: A dull, 428 Uterus. heavy, dragging pain through the pelvis, much increased by walking; pain in defecation and coitus, before and during menstruation; pressure on rectum with tenesmus and hemorrhoids; on bladder with vesical tenesmus; nausea and vomiting; darkening of the areolae of the breasts; great nervous disturbance and sterility. Neo- plasms and periuterine inflammation may be confounded with corporeal hyperplasia in its first stage; the latter however will fix the uterus, create hardness and swell- ings in the iliac fossae and pouch of Douglas; whilst in fibrous growth, conjoined manipulation and the sound will assist in the diagnosis. Internal metritis may be also suspected in comparative young women, though all the signs of early pregnancy are present, provided men- struation is not suspended. The second stage of areolar hyperplasia or sclerosis might be confounded with scir- rhus; but there is no cachexia, nor tendency to hemor- rhage; and a sponge-tent will soften the tissue and not leave the cervix hard. Treatment must be first directed towards the complications, which usually accompany hyperplasia (the more so, as in most cases nothing be- yond can be done)—displacements, fungoid growths, granular degeneration, laceration of cervix, and vagini- tis. Prolapse will be benefited, by means of Meig's pes- sary; retroversion by Hodge's double lever or one of its varieties. Fungoid growths, this source of congestion, metrorrhagia and leucorrhoea must be removed by gent- ly scraping the whole cavity with the wire-loop curette; and laceration of cervix, which aside from congestion, causes not only neuralgia but intense nervous irritation, both, immediate and reflex, and which is frequently over- looked, especially if the excoriated walls of the cervix Hgperplasia. 429 have been treated for some time by caustics, should be repaired by fixing in the parts of the severed lips tena- cula and then to approximate them as accurately a3 pos- sible. Before the suture is applied, their inner surfaces have to be, of course, thoroughly pared. The complica- tions being removed, there remains a large, heavy uterus, the tissue of which is exuberant, the blood vessels en- larged and the nerves in a condition of hyperaesthesia. This state requires, barring general treatment with rest, great discrimination with regard to local applications. If the uterus is very tender a few ounces of blood may be taken occasionally by puncture or scarification: A sharp and narrow bistoury or tenotomy knife is passed up to the os internum, and cutting through the mucous membrane and the superficial layer of muscular tissue, it is withdrawn through the external os. In cases of amenorrhoea, three or four leeches may be applied through a speculum of sufficient size to contain the en- tire vaginal portion of the cervix, after the latter hav- ing been thoroughly cleansed and the os been plugged with a pledget of cotton, to which is attached a thread for removal. Now a few punctures should be made in- to the cervix, the leeches thrown in and the speculum filled with some cotton, pushed towards the bleeding surface. When they have ceased sucking, all clots of blood should be removed by a sponge or some cotton. and after the withdrawal of the speculum, a large sponge, squeezed out of warm water, should be placed over the vulva. After this, in fact, after any kind of lo- cal depletion, the patient should be kept for some hours perfectly quiet. Once a week an alterative—Tinct. Jodi comp. or Iodoform (348), may be applied by means of a 430 Uterus. brush of pig's bristles to the os internum; or even to the fundus, should endometritis exist, and over the whole cervix, to be repeated as soon as it has dried, and then covered with a tampon (369). Should the hyper- aemiabe persistent,counter irritants— vesicating collodion, prepared with Acidum aceticum may be applied by means of a camel's hair brush to the whole vaginal cer- vix and os, followed a few minutes after by a stream of cold water, projected upon it to prevent any escape into the vagina. Afterwards the Glycerine-tampon should be applied for its hydragogue effect, whilst the patient is kept perfectly quiet for several days. The vagina must be cleansed with warm injections, and as soon as the discharge shows a tendency to cease, the blistering may be repeated. Vesication may be also produced by ap- plying Argentum nitricum, which after having destroyed the epithelial covering and sloughed off, leaves a gran- ulating surface, that may be dressed with glycerine or any of the alteratives. If injections (358) are used, they may be put in a tub, across which there is a board for the patient to sit on. Instead of Davidson's syringe, a fountain syringe is often preferable, as the patient may then lie on a lounge, with the buttocks projecting over its edge and the feet supported upon the floor, without tiring herself with the working of the instru- ment. If the cervix should be too bulky, a part of its vaginal portion may be removed by encircling it with the galvano-caustic wire. As regards the general treat- ment, ferruginous and vegetable tonics—Potassa, Acid. sulf. (155 & 173-177) in case of spanaemia; and altera- tives to the bowels in conjunction with a nourishing diet may be tried. During the stage of enlargement Degeneration. 431 (before contraction of the exuberant tissue has occurred), Ergot (p. 65) will be of value, if kept up for some time. Chronic (soft) Engorgement from passive congestion with loss of tonicity in the blood vessels, which is always accompanied by profuse menstruation, and not uncom- mon in the climacteric period, requires cold injections into the rectum (about 8 oz.); internally Tinct. Ergotce ( 3 j bis die), and regulation of bowels. Sometimes Buta or Borax (pp. 38 & 55) will answer very well—In chronic engorgement with amenorrhoea, a dozen of leeches ap- plied to vulva, and the bleeding to be promoted by fo- mentations, with Calomel (p. 92) at night, if necessary or salines (p. 96) as circumstances may indicate; and the whole procedure to be repeated at the time of the ex- pected menses, when there is much bearing-down pain. In induration or hard engorgement, revulsive bleedings from the arm every fortnight with saline aperients, or slight scarifications twice a week, if necessary; but the best remedy perhaps is Hydrargyrum jodatum flavum (12) if not contra-indicated by the general state of health. Granular Degeneration of Cervix presents various forms: In abrasion the epithelial covering is removed and the villi are destroyed; if the papillae increase in size and project like granulations, the looped capillaries, which they contain, become also hypertrophic and va- ricose and naturally bleed easily, constituting the vari- cose ulcer. If the surface becomes coated with a false membrane, it is called the diphtheric ulcer. Eversion of the cervix with increase of the villous hypertrophy in the crested folds of the everted membrane represents the fungous ulcer or coxcomb granulation. The light forms may produce no symptoms whatever; however 432 Uterus. the severer ones will be characterized by more or less pain in back and loins; leucorrhoea, profuse menstrua- tion; sometimes hemorrhage after intercourse; tendency to anaemia; nervous disorders and perhaps hysteria. Bar- ring diseases which keep the villi of the cervix con- stantly bathed in an ichorous fluid, cervical degenera- tion will be caused by any influence producing conges- tion of the uterus, or anything, which keeps up friction against the cervix. On the other hand, the affection will keep up a hyperaemia in the neighboring parts, and will even exert a reflex influence on the ovaries. Treat- ment—Aside from special attention to the general health, copious injections should be made daily—Zinc, Alum, Tannin, etc. (359); sometimes suppositories are of use (357). Argenti Nitras (343) with a coating of styptic collodion (415) may be applied once a week. (The latter does not only protect the part from friction and dis- charges, but acts also as a direct alterative, and dimin- ishes congestion by compressing the excoriated villi with their increased vascularity). Other alteratives are: Cuprum, Ferrum, Iodine, Phenol and Chrom (344,47, 48, 51 &67). In simple eversion the hemorrhoidal mucous membrane must be destroyed by touching it with Acid. nitric, fumans (329); or it may be cut off with scissors. If it be due to laceration, the edges of the cervical fis- sures should be accurately united by deep sutures of sil- ver wire, after having pared them with long scissors. In coxcomb granulation, the growths must first be snipp- ed as close as possible to the mucous membrane with a pair of long-handled scissors, or scraped off by means of a steel curette, before making the local application. If the congestion can not be mastered by means of the Subinvolution. 433 various applications, a few superficial incisions in the sub mucous tissue of the cervix with a curved bistoury, as indicated in hyperplasia, may be tried. Well fitting pessaries, supporters, etc, will occasionally be of value! Cystic or Pollicular Degeneration, called also Acne, Her- pes, oxAphthai of the Uterus, is an inflammation of the mucous glands of the vaginal cervix, characterized by a number of vesicles of the size of a millet seed, which after bursting, leave depressions, where the papillae un- dergo hypertrophy and appear like red, elevated tuber- cles of the size of a hemp seed. The disease is gener- ally secondary to cervical endometritis, hyperplasia and granular degeneration. Treatment—The cysts should be opened with a bistoury and then thoroughly cauter ized with Arg. nitr., Chrom, or Hydr. nitr. acid. (344). If this should be of no avail, the vaginal face of the cer- vix must be removed by means of the bistoury, scissors or still better by the ga/vano-caustic wire. Cystic Degeneration of the Chorion is called the pe- culiar metamorphosis of this membrane, which it may undergo, when, having remained attached to the uterine walls after expulsion or death of the embryo. See Hydatids. Subinvolution—The uterus is said to be in this state, if, after delivery, the retrograde evolution has been checked or retarded by certain influences, so that it re- mains flabby and large. About the fourth day after the birth of a child the muscular fibres of the uterus be- gin to undergo fatty degeneration, the fat thus formed, is absorbed and the organ usually has required its nor- mal size about the eighth week. Subinvolution consti- tutes the chief cause of all chronic uterine disorders. 434 Uterus. Treatment—Ergot (p. 65) with or without injections of hot water (358); Uva Ursi (151) is sometimes used, and Cacao locally (354). See Areolar Hyperplasia. Stricture of the Cervical Caned, which is one of the causesof dysmenorrhoea and sterility, maybe remedied by means of graduated bougies, tents (pp. 129 & 130), or expanding instruments; sometimes a superficial incision through the whole course of the canal (with a narrow- bladed bistoury, if a hysterotome be not at hand) may be necessary. A sound should be left in position for several minutes, and upon its removal, another may be inserted, until the distention deemed practicable at one sitting is attained, which ought to be done at least ten times at intervals of from 5-7 days. Or a small-sized metallic male catheter may be glided on the index finger of the left hand previously introduced into the vagina. On reaching the os the handle must be de- pressed in order to give an upward direction to the curved portion of the instrument corresponding to the axis of the uterus. After having entered the cervix, a few oscillatory movements may be given to the instru- ment, and then it may be withdrawn.' If very painful, Chloral (365). See Dysmenorrhoea. Imperforate Os Uteri unless congenital, is the result of injury, as injudicious probing the womb, which is sometimes done by women in order to abort, and which may result in closure of the canal. It will soon cause enlargement of the womb from retained menstruation, (Haemometra), accompanied with symptoms of pregnan- cy, as morning sickness and tumefied breasts, which ha" to be borne in mind in cases of young girls whose repu- tation is criticized. Diagnostic is the closure, resp. Neuralgia. 435 entire absence of the two lips of the os, instead of which there may be found in the middle and lower portion of the uterus, corresponding with the os, a slight circular depression. Treatment—The index finger of the left hand being introduced into the vagina, up to the central and lower portion of the cervix, to serve as guide, a curved trocar is carried with the other hand and made to penetrate the womb from below upwards, parallel to the axis of that organ. In order to prevent the closure of the cut, a soft bougie must be kept there for a few da^vs, whilst the patient remains in a recumbent position. Hydrometra is produced by the accumulation of the fluid (secreted as a consequence of chronic endometri- tis) due to some obstruction in the cervical canal, and occurring frequently in elderly women. Aside from the enlargement, there will be from time to time colic pains of a bearing-down character. Treatment—Re moval of the liquid by means of sounds, tents or trocar. Physometra signifies the accumulation of gas in the cav- ity, easily to be recognized by the tympanitic sound on percussion. Treatment—After removal of the gas, Mer- cury (p. 12) until ptyalism, followed by Acid, nitric (p. 9) and tonics (p. 61). Noiralgia of the uterus is characterized by pain, in- creased by sexual intercourse, and accompanied gener- ally by a mucous discharge. Sometimes there is a p>ain in the back, sometimes in the lower portion of the ab- domen or in the loins, sometimes it is limited to the urethra; it may go and come; it maybe periodic; and it may be so severe as to make coition impossible—it may even produce convulsions or mania. This rheumatism of the womb or hysteralgia has an analogon in the 436* Uterus. specific pain of the testicles in the male, and in the neu- ralgia of the labia externa in the female; the former be- ing propagated through the ileo-scrotal, and the latter through the ileo-pudendal nerve from the lumbar region. The catarrh is here but the result of a peculiar state of the uterine nerves,like the increased secretion of saliva, s affected by a savory dish. Treatment—If sympto- matic of disease of the womb, this has to be attended to; otherwise powerful revulsives to the spine, as a ni- tric acid issue on the side of the lumbar vertebrae, with cauterization of the os uteri or even an incision of the cervix. Ungt. Belladonnw or injections of Opium (381) will occasionally relieve. If marked by periodicity, Quinine (p. 11). Rupture of the womb is accompanied by severe pain and a noise like a loud click, and the child will be felt high up near the umbilicus. Here is Ctcsarian section indicated and prompt action necessary: A cut of six inches at least should be made, if necessary to the um- bilicus, but half an inch on the side of it. After remov- al of the child, with placenta, the blood, Liq. Amnii, etc., the uterus must be sown up again, as the stitches will not hurt in the peritoneal cavity. Moles are generally made up by polypoid and fibrous growths, blood clots, and the membrane of congestive dysmenorrhoea; but sometimes they are connected with pregnancy, when they consist of a part or the whole of the foetal shell or placenta. As a rule, the whole of the products of conception is swept away by uterine cor tractions, in case the life of the foetus has been destroy- ed by adverse influences; sometimes however the shell of membranes will cling to its attachment and become Hydatids. 4Z', to a certain extent organized, to be expelled as an an- omalous substance, which resembles the product of con- ception at the second month. The condition may be suspected, when, aside from uterine enlargement there appear menorrhagia or metrorrhagia, hypogastric weight and uterine tenesmus with uneasiness; and in cases connected with pregnancy, cessation of the signs be- longing to that state. Treatment—After having prov- ed its existence by microscopical examination of a small piece of the mass, removed for that purpose (if necessa- ry), the cervix should be fully dilated by tents (p. 130), and uterine action caused by the persistent use of Ergot (p. 65). Should this fail, the mass must be removed with a large uterine scoop, or by traction with the pla- cental forceps. Hydatids consist of small, oblong sacs, which are pedi- culated and distended by a serous fluid, so as to appear like a bunch of grapes; and if due to tbe presence of the acephalocyst, very dangerous on account of the hemor- rhage, which generally is more profuse than that occur- ring at child-birth. See Cystic Degeneration of Chor- ion. Aside from the usual signs of pregnancy, as en- largement of the womb, nausea and vomiting, which are associated with this disease, there are at certain in- tervals bearing-down pains, accompanied by a discharge of a watery liquid, which constitutes the distinctive fea- ture; for, as the hydatids increase in volume, the most dependent ones will irritate the neck of the uterus, thus causing contraction and their rupture: hence the period- ical discharge of water. During the process of expul- sion of the hydatid masses, there is generally profuse hemorrhage. See the latter for treatment. 438 Uterus. Polypi, which always give rise to irregularities in the menstruation, especially to much loss of blood, vary in size from that of a pea to that of a foetal head. In the mucous species, which is essentially vascular, there is more loss of blood, than in the fibrous type, though the hemorrhage is by no means in proportion to the size; on the other hand, the menses will invariably be more abun dantthan usual, since at that time the mucous membrane, which invests the tumor, becomes naturally congested. Aside from the hemorrhage there is frequently a mucous discharge—a result of the irritation, to which the mucous lining is subjected—and bearing-down pains, if its size and situation should be such as to cause contractions of the uterus. In addition there may be irritable bladder and in proportion to the existing anaemia, prostration, palpitation of the heart, etc., etc. Treatment—When the existence of the growth has been ascertained by means of a sound, Ergot (p. 65) should be given, to throw it into the vagina, where, guided by the index finger of the left hand, its pedicle may be seized with the small calculus forceps and twisted off. Afterwards vaginal injections of cold water twice a day with tonics (p. 76) internally. If the finger can be insinuated within the uterus, and a stalk be found, the ligature may be applied, and the pedicle will slough in about thirty-six hours. (If pain, the ligature has, of course, to be loosened again, as in that case, the polyp being insensible, the cervix would be implicated). If however the parts are very much relaxed, and the tumor small, it may be removed by torsion with the finger. If a polyp has been excised and there is much bleeding, the stump of the pedicle may be twisted once or twice by means of forceps. A Tumors. 439 polypus of the mucous species can be brought away but by fragments, as it is too soft and has no resistance. The removal should be followed by a cold injection daily for a few days. See Hemorrhage. The fibrous tumor, which develops within the uterus or on one of the lips of the os, is covered by mucous membrane; if it grows from the external surface of the womb, it is covered by peritoneum; and the insterstitial has its origin amid the muscular fibres of the organ. Whilst the ovarian tumor is situated in one of the iliac fos- sae, the fibroid lies centrally; in the former the os uteri be- comes elevated, in the latter it is thrown downwards. The whole train of symptoms, indicating gestation, may be occasioned by the enlargement of the womb, produc- ed by its presence except the peculiar emphysematous con- dition of the areola of the breast, so characteristic of pregnancy—frequent desire to pass water; constipation with painful- evacuation; swelling and feeling of numb- ness in the lower limbs, and suppression of menses. There may be hemorrhoids, prolapse of the mucous membrane of the rectum, and profuse hemorrhage with great emaciation. The bladder will sometimes become so much distended, that ureters and kidneys may be in- volved, so as to produce coma. Treatment—As the tu- mor is occasionally spontaneously absorbed, Iodine (p. 15) may be tried, with Unguentum mercuria/e (353). Sometimes it may be expelled by Ergot (p. 65). If the tu- mor projects into the vagina, or is within reach of the fin- o-er in the cavity of the womb, it may be separated with the finger or knife, after having divided the mucous membrane. For Cancer of the Womb and Bloody Tumor of the pelvis see Carcinoma, resp. Haematocele. 440 Uterus. Parametritis—Periuterine Cellulitis or Periuterine Phlegmon, consists in an inflammation of the adipose and areolar tissue of the broad ligaments and of that im- mediately in contact with the utei us at its junction with the vagina and bladder; and is in severe cases general- ly associated with pelvic peritonitis, ovaritis and salpin- gitis. Exclusive from parturition and abortion, it may be caused by direct injury from coition, caustic applica- tions, pessaries, operations or blows; and it may be sec- ondary to metritis and ovaritis. Parametritis may re- sult in destruction or atrophy of the ovaries, and in a permanent displacement of the uterus in consequence of strong adhesions,the product of the inflammatory process. Cellulitis proper usually passes off in, from two to three weeks by resolution; but if suppuration sets in, it will run a most tedious course; and any one of its complica- tions may become chronic. In acute cases, following parturition, suppuration may take place in a few days; though generally it does not occur for two or three weeks. The symptoms depend as a rule, on the severi- ty of the disease; but though the acute form may show all the signs of inflammation, fever, chills and pain, combinedperhaps with dysuria or metrorrhagia, there are cases, marked only by extreme weakness, some sense of pulsation with weight about the pelvis, and hectic in the evening. In the chronic form, there may be for months after delivery general weakness with fever towards evening, but without pain; only now and then a throbb- ing, especially tension and weight about the organ, which is increased by walking, defecation, and urination, will remind the mother of her past trouble. At the be- ginning of the disease, a very sensitive little swelling may Abscess. 441 be detected on one side of the uterus, by conjoined ma- nipulation (p. 125), which, as effusion (the second stage) advances, and induration occurs in the areolar tissue af- fected, will form a tumor as large as a walnut or orange, situated in the tissue around the cervix, or in one of the broad ligaments. In the third stage the uterus will be found more or less displaced in the direction opposite to the accumulated pus. (In a chronic case, the effused matter may remain hard for months, withont showing signs of softening). Treatment—Before effusion, or at least before its complete organization, leeches should, in the case of a strong patient, be at once applied to the hypogastrium, followed by poultices every hour or two. Internally Salicin (p. 18), in conjunction with refriger- ants and sedatives - Nitre, Aconite, Veratrum or Gelsem- ium (pp. 56, 22, 33 & 39). Opium (pp. 37 & 110) through- out the acute stage to relieve pain and keep the bowels constipated. Afterwards Jod or Brom (pp. 15 & 27), and laxatives (p. 88), especially Mercurials (p. 92) to keep the bowels in a soluble state and to disgorge the veins of the pelvis by acting on tlie liver. A valuable auxiliary will be the warm douche for fifteen minutes twice a day, which in the latter part of the disease may be slightly medicated with common salt or Tinct. Jodi. The treatment of the suppurative stage is indicated in the next paragraph. Pelvic Abscess unless consisting of tuberculous ma- terial, deposited somewhere in the pelvic tissue, is either the result of a suppurative action in the walls of a cavi- ty formed by an ovarian cyst or haematocele; or, what is most frequent, it is an inflammatory suppuration in the areolar tissue, the ovaries, tubes, the pelvic peritoneum 442 Vaccination. or the parenchyma of the uterus. The formation of pus is characterized by the symptoms of abscess in other situations: Chills, followed by fever with profuse per- spirations, etc., etc. When left to themselves, these ab- scesses may open spontaneously and discharge through any part, viscus or foramen, and gradually heal (those, which result from puerperal cellulitis, usually discharge through the abdominal wall, whilst those, occurring in the non-puerperal form, open mostly into the vagina or rectum); or they may burrow into the tissue, to open by long fistulous tracts into some organ, as the large intes- tine or sigmoid flexure, or they may discharge into the peritoneum. Treatment—A generous diet, alcohol and tonics (p. 72). If it be decided to open the abscess, the patient should be placed on the left side, and Sim's specu- lum being introduced, the pus be drawn off by aspira- tion. If there is any doubt about the nature of the tu- mor, it should be previously explored by means of a hy- podermic syringe or an exploring needle. Whether the vagina, rectum or the abdominal wall be chosen for the operation, an anaesthetic to insure perfect quietude, will be essential to a safe cure. If the abdominal wall is to be opened by trocar or bistoury, adhesion of the layers of the serous membrane should be caused first by means of a nitric acid issue. After removal of the pus, the sac may be filled with Tinct. Jodi et Aqua x, to be drawn off again at once; and to prevent closure of the opening, it may be touched with Arg. nitr. or Sol. Ferri persulf.; or some rubber tubing may be left in it. Vaccination—The matter should be taken on the seventh or eighth day, before an inflamed areola is spread around the vesicle; and it should be lymph, clear Vagina. 443 and transparent, not purulent or discolored by blood. If it is desired to preserve the lymph, it may be taken on ivory points or pointed quills; or, what is still better, it should be withdrawn from the vesicles in glass capillary tubes, which are to be sealed at once by means of a spir- it-lamp. The scab, which exfoliates, and falls off be- tween the eighteenth and twenty-fifth day, made into a paste with water, is also used; but the lymph is to be preferred to the crust, though inclosed in wax, and cov- ered with tin-foil, the latter will retain its activity for a considerable time. As regards the introduction of the virus, the situation for it should be on the outside of the left arm, near the insertion of the deltoid, and should be done by means of slight punctures or minute scarifica- tions, made with a common lancet, or by scraping away the epidermis with the ivory point, having before moist- ened the dried lymph by a momentary exposure to steam. It need scarcely be mentioned, that, whenever possible, the lymph should be applied directly from one arm to another. Vagina— Vaginismus consistsinan exquisite sensibility of the vagina, due to a hyperaesthetic condition of thecar- unculae after laceration of the hymen during normal coi- tion, which whenever touched, causes irregular or spasmo- dic contractions of the organ, so that even a finger can- not be introduced. An attempt at intercourse is utterly impossible, on account of the agonizing pain the act produces. See Dyspareunia. Treatment—In the symp- tomatic spasm, which is continuous, and may be the result from disease of the uterus, vagina or rectum; even from hemorrhoids and prolapse of intestines, the cause must be removed. The idiopathic form, which is 444 Vagina. of an intermittent character, requires injections of warm water, medicated or not (365); Belladonna or Iodoform (350 & 56); or Cocaine (330) and other soothing appli- cations. Sometimes it may be necessary to remove the hymen with scissors, or to incise the perineum. In most cases it will be sufficient to introduce into the vagina a large plug of cotton or a conical glass speculum to be re- tained there, by means of a T bandage, for about half an hour every day. Should the introduction of the plug or dilator be too painful, the patient must be anaesthe- tized, and the ostium vagince distended by a trivalve or quadrivalve. Vaginal Discharges are either mucous, purulent, muco- purulent or watery, according to the part affected, and the disease, which gives rise to it. In addition to the causes enumerated under the head of leucorrhoea, there may be mentioned still a mucous discharge due to salpin- gitis, when the products of inflammation escape through uterus and vagina. In these cases a tumor generally marks the position of the Ecdlopian tube, resp. tubes, and considerable pain about the part, followed by a sud- den sensation of giving way usually precedes the dis- charge, which at these times is more or less profuse. In children a mucous discharge frequently accompanies scarlatina and other exhausting diseases; sometimes it is connected with dentition, if there be a scrofulous habit, and occasionally it may be traced to want of cleanliness; but the most common cause is without doubt local irritation, in consequence of the presence of thread-worms in the rectum or their migration into the vulva. Treatment—Aside from Zinc (338) locally, en- emata (377) with Colomel, followed by 01. Bicini every Vaginitis. 445 third night, if due to worms. In scrofulosis Mercury, Iodine or Potassa (pp. 13,15 & 18), preceded by a cathar- tic (p. 93). Vaginal discharges in adults are more fully discussed in the paragraph on leucorrhoea. If from nervous disturbance, it must be treated with applica- tions to the spine, blisters, cauterization, issues, or the red-hot iron. If it be due to excrescences in the vagi- na and vestibulum—a result from want of cleanliness, chronic inflammation of those parts, or sequelae of ven- ereal disease—applications of Cuprum (340) will be of service; or the warts may be excised with a pair of curv- ed scissors, whilst they are grasped with a tenaculum or a pair of small forceps, and the cut surface cauterized with lunar caustic. Vaginitis catarrhalis, which may be produced by ex- posure to cold, injury from parturition, pessaries or coi- tus, disordered state of the blood and the like causes, is characterized by more or less swelling of labia and va- gina, throbbing heat and great tenderness on intro- duction of the finger, in conjunction with excoriations of the part around the vulva, profuse purulent leucor- rhoea, frequent desire to pass water, and violent pel- vic pains. Sometimes the inflammation extends to the cervix uteri, and the speculum will usually reveal the vagina much congested, its surface abraded, and in severe cases covered with follicular ulcerations. Urethritis, endometritis, salpingitis and pelvic peritonitis may be complications. The specific form, caused by infection, cannot be differ- entiated from a discharge arising from intrinsic sources; but may be suspected if the inflammation develops with great activity and violence especially in women, 446 Vagina. previously free from vaginal discharges; if it be accom- panied with marked urethritis and bubo; and if it has been trasmitted to the male by coition. The granular form is generally chronic, and without being necessari- ly specific, may produce in the male gonorrhoea. When occurring during pregnancy, accompanied by pruritus vulvae and lichenous eruptions about the pubes, this form will, after parturition, usually disappear without medication. Treatment—In the acute stage, a cathartic (pp. 92 & 96); or Nitre (p. 56) in conjunction with soothing injec- tions (358), and if necessary anodyne suppositories in rectum (375). To relieve ardor urince, akalies (p. 54). Later, Copaiva (p. 48), with astringent injections (336 & 361). In severe cases, whether specific or no, or chronic ones, if very obstinate, it may be required to paint the vagina twice a week with Argentum (343)—a bivalve will suffice for this procedure, if Sim's speculum should not be at hand—, and then to introduce a medicated tampon (359 & 60), just large enough, to prevent the sur- faces of the vagina from rubbing against each other. When the disease becomes less severe, the tampons, which should remain in the vagina for two days at a time, may be thoroughly covered with boracic acid in powder. During pregnancy, especially of very nervous women, only injections of tepid water, resp. frequent ablutions should be used. If complicated with endome- tritis, the cervix should thoroughly be dilated (not with tents, but under ether, if necessary), and a strip of io- doform gauze passed into the uterus, so as to protrude from the os, for the purpose of establishing a free drainage. See Endometritis. Fistula. 447 Atresia Vaginw—Imperforate vagina consists in a complete closure of the orifice of the vagina by the hy- men, which on account of its retaining the menstrual blood, will be found slightly bulging. Aside from per- cussion of the enlarged uterus, which may be felt some- times several inches above the superior strait, the dis- tension by fluid of the vagina can easily be ascertained by means of a finger in the rectum and a catheter in the bladder. Treatment—A crucial incision should be made with a bistoury to evacuate the blood, and septicaemia from putrid matter prevented by warm antiseptic injec- tions (368 & 397); then, after havingthe abdomen prop- erly bandaged, the patient should be confined to the bed for a few days. Cystic Tumor of the Vagina consists in the enlarge- ment of one or more follicles in consequence of obstruc- tion of the orifice, caused by inflammatory action. It is movable and painless, and if very small, will not cause any annoyance, if large, it will however not only in- terfere with defecation but also with coition and par- turition. Treatment—A free incision into the tumor, followed for a few days by injections with soap and water. For Vaginal Prolapse, Cystocele, Rectocele and Enterocele, see Hernia. Fistula— Vesico-vaginal, signifies a communication be- tween the bladder and vagina, generally a result from sloughing of the parts after a tedious labor, and char- acterized by constant dribbling of urine. Treatment— As soon as it is discovered, the patient should be made to lie on her stomach, and the healing promoted by a wash of soap and water, or astringent injections (359-61). Sometimes it is expedient to apply the cautery at a black 448 Varicelli. heat to the edges of the fistula at intervals of, from ten to thirty days, so as to prevent sloughing; or in old cases, caustic to the thickened edges; and as a tempo- rary relief a sponge pessary to retain the dribbling. If these means fail, an operation must be resorted to. In recto-vagincd fistula there are in addition mild laxatives indicated (p. 95); but if after a time, the aperture does not close, it must be operated upon. Varicelli—A specific eruption of vesicles, which af- ter the fifth day begin to dry into little scabs. The eruption, which is generally preceded for twenty-four hours by a slight constitutional disturbance, is usually called chickenpox, if the size of the vesicles does not ex- ceed that of a lentil; they take the name of swinepox, if they are as big as a split cherry stone. Medication not required. Varicocele or Spermatocele signifies a varicose state of the spermatic cord, induced by weakness of ve- nous structure, combined with obtruction to the return of blood through corpulency, constipation and the like. If affecting both sides, it is like piles (varix of the hem- orrhoidal veins), an accompaniment of enlarged and dis- eased liver pressing upon the vena cava inferior. In women the enlargement of the veins of the labia forms a soft tumor, which on walking increases in size and causes pain; but which disappears in the recumbent po- sition. Treatment in males—A suspensory with cold and astringent lotions to scrotum (299); in females, aside from cold bathing, a truss or T bandage with a pad. Varicose Veins or Varix—Dilated veins, which pre- sent a tortuous, knotted and convoluted appearance, where valves are incapable of preventing the reflux of the Variola. 419 blood, and affecting,aside from the scrotum (varicocele) and rectum (hemorrhoids), usually the legs. They cause not only pain, weight and fatigue on taking exercise, but lead often to excoriations of the skin and even ulcers. Treatment—Firm pressure by means of a pad and band- age or elastic stockings, with cold and astringent lotions (Ferr. chlor.) will generally give relief, especially if con- stipation be avoided. As.a radical cure, Faradization (p. 150); or subcutaneous acupressure, by which the in- clusion of skin in the ligature, and consequently much pain and soreness, are obviated, may be performed. Variola—Smallpox designates an eruptive fever, eminently contagious, which, when occurring in subjects who have been vaccinated, is called Varioloid or Modi- fied Smallpox, on account of the disease being rendered less violent by the vaccine. It is characterized by a re- mittent fever, followed in two or three days by an ex- anthem, which appears before, or at least simultaneously with the cutaneous eruption, in mouth and throat, as round and whitish spots, peculiar to eruptions on mu- cous membrane. The papules on the skin which gen- erally show first on the face, neck and wrists, whence they spread over the body, are to the touch granular, hard, and deep-seated. They turn soon into vesicles, which, presenting an umbilicated shape—the pathognom- ic central depression—form, after having become pus- tules, ultimately, a scab. Scarlatina and measles are easily differentiated; for, aside from the nasal catarrh, which precedes the one, and the throat affection, which accompanies the other, in neither is the fever remitting or ceasing with the appearance of the exanthem; and as regards varicelli, the eruption is from the first vesicular, 450 Vertigo. without taking into account the insignificance of the whole disease. Moreover a mustard plaster applied to any part of the body, will not only bring out the erup- tion 24-36 hours sooner than usual, so that a diagnosis may be made on the first day of the fever; but by this means the eruption may be also invited to a particular part—abdomen, etc.—and thus the pitting of the face avoided; or in malignant cases, a fatal termination. Treatment—Sulfo-carbol and sulfites (pp. 16 & 19), in conjunction with evaporating lotions; or Iodine, Chloro- form, Collodion, etc. (413 & 414), and evacuation of the vesicles by means of a fine needle to prevent the dis- figuration caused by pitting. Iodoform (401) is said to prevent pustules. In hyperpyrexia, sponging or the wet sheet (420). Version. See Uterus (Displacements). Vertigo—Dizziness or swimming of the head is, un- less a symptom of some cerebral or womb disease, an individual functional affection (Meniere's disease), char- acterized by a sensation, similar to that, caused by con- tinued rotatory movements, so as to be unable to stand without support, combined with forgetfulness. It is incident, e. g. to excessive venery, and smoking of too much or too strong tobacco. Treatment according to cause—Digital, (p. 78); in aural vertigo, Quinine (p. 76). Vision. See Eye. Vomiting and Nausea—A sick feeling combined or no, with a forcible ejection of the contents of the stom- ach through the mouth, may be due to cerebral or kid- ney disease, or to gastritis, gastric ulcer and other les- ions of the stomach; but it occurs also in cases of chron- ic dyspepsia, where the stomach seems to be intolerant Vulva. 451 of all forms of nourishment; sometimes rupture is the cause (see Hernia—p. 262); and in women, it is fre- quently a sign of pregnancy. Treatment—Belladonna, Camphora, Cyan or Chloroform (43, 56, 61 & 67), Creo- sote and Strychnos (138 & 184), all are employed, and will occasionally be of service; or Calomel v. Hydr. c. Creta in small doses; a small piece of ice swallowed, will act sometimes like a charm. Bismuth or Pepsin (pp. 46 & 84), see Dyspepsia; Aq. Calcis or Potass (119) if chronic; Alum (p. 62) in consumption from cough; if sarcina, sulfites (33), see Sarcina. In vomiting of pregnancy, in addition to those named, Brom, Ipecacuanha (46 & 181); Aq. Calcis c. Lacte or Acid, citric, (pp. 42 & 56); Cerium and Morphia (pp. 29 &37); if hysterical,Cocaine (pp. 77 & 115); if from alcoholism, Gelsemium, Capsicum (pp. 33 & 75); Sol. Fowl, half a drop in water half-hourly. Iodine (p. 15), is said to check the vomiting in cholera. Vomiting in infants, if from mother's milk, will stop upon weaning. Vulva—Hypermsthesia. Excessive sensibility may involve the whole surface of the vulva, or it may be confined to the vestibule, one labium (minus), or to the meatus. In any case it makes sexual intercourse very painful, even with a large and otherwise healthy ostium vagince. Unless due to an irritable caruncle (see Ure- thra), it is either idiopathic, or associated with chronic vulvitis. Treatment is essentially local—Alum, Borax, Tannin (340 & 46); Belladonna or Cocaine (350 & 396); though tonic cathartics (p. 95) may be sometimes of service. Pruritus Vulvce—Itching of the part has a multitude of causes: Exclusive local inflammations, as vulvitis or vaginitis: or irritation nroduced bv vaginal discharges^ 452 Vulva. eruptions, or parasites, it may be due to scrofula, sup- pression of menses, excessive heat of the season, indo- lent habits, and not seldom, to want of cleanliness. Pru- ritus pudendi is sometimes constant, sometimes inter- mittent, and may ultimately lead to complete nervous derangement and a general break-down of the constitu- tion. Treatment—Above all, removal of cause, if pos- sible. Calomel or salines (pp. 92 & 96), if plethora; So- da or Aloes (191 & 197) according to indications. Lo- cally, Alum, Borax, Plumbum, Phenol (337 & 46); Cam- phora, Bismuth,Zinc(339,345 & 59); Chloroform andCre- osote or Atropin (350, 51 & 56). In diabetes, the parts should be bathed and protected with some ointment after urination; and where bristly hairs are found on the mu- cous surface of the labia majora they should be remov- ed. A magnifying glass (263) may sometimes be nec- essary to discover them. Vulvitis—Inflammation of the vulva is characterized by swelling and heat of the parts, attended by burning and itching; and if the urethra be involved, scalding in micturition. In the purulent form this first stage will be followed by superficial ulcers, which may appear all over the surface of the vulva; whilst in the follicular form the increased, sometimes very offensive smelling secretion, is limited to the glands—if the muciparous follicles are chiefly affected, the mucosa of the vulva, especially on the edges of the lower vaginal rugae, the nymphce and carunculos, will be found intensely red in spots or patches, which bleed on the slightest irritation; and if the sebaceous and piliferous glands are principal- ly involved, little red papillae will cover the surface of the labia majora et minora, and the base of the clitoris. Inflammations. 453 Both forms may result from vaginitis, exanthemata/want of cleanliness, friction and onanism, or excessive vene- ry, Treatment—Saline cathartics (p. 96) with cooling and emollient applications (337). Afterwards Argentum nitricum or Ferrum persulf. (343 & 45). The parts should be constantly kept dusted with Lycopodium, Bismuth or starch. The gangrenous form begins with a small patch or vesicle of a blackish hue, which leaves soon an ulcer. As the purplish oedematous state of the labia, in con- junction with the grave constitutional symptoms, show- ing its connection with puerperal and other continued fevers, renders the diagnosis perfectly easy—with diph- theria it cannot possibly be confounded on account of the absence of false membranes—there should be no delay for a prompt and energetic treatment. Aside from a nu- tritious diet, wine and other stimulants, a powerful caus- tic: The actual cautery or Acidum nitricum vel hydro- chloratum should be used at once for destroying the gan- grenous spots (the patient being anaesthetized), and then the whole covered with antiseptic poultices. Internally Chininum cum Ferro (p. 11). Noma affects sometimes the labiapudendi of young female children: After two or three days of low fever, the little patient is observed to suffer considerable while making water; and on ex- amination the labia present a livid, erysipelatous red* ness and vesications, that are rapidly followed by pha- gedenic ulcers. The disease, which, in its causes, na- ture and symptoms resembles cancrum oris, must be treated on the same principles as the latter affection. Phlegmonous Inflammation of the labia majora com- mences like acute abscess elsewhere, with fever; throbb- 454 Vulva. ing pain; bright redness; and much swelling: firm in the center and oedematous around. The formation of pus is indicated by an abatement of the fever and pain, which latter is converted into a sense of weight and tension. Care must be taken to differentiate phlegmon from enterocele (see Hernia pudendi) or displacement of an ovary. Serous engorgement and bloody tumor (see Hydrocele resp. Haematocele), even oedema labio- rum and vulvitis have been mistaken for it. Treatment —Saline cathartics (p. 95) with cold compresses or lead and opium wash (337) at the beginning; afterwards poul- tices, and as soon as there are signs of fluctuation, the knife. Abscess of the vulvo-vaginal glands is characterized by a hard, painful, and perhaps fluctuating tumor about the size of a small egg, with a limited and distinct globular outline, which is easily distinguished from a cyst by the presence of inflammation. Treatment like that indicated for phlegmonous inflammation. If the abscess does not open of itself: the lancet. Hypertrophy of Nymphm unless congenital, is gener- ally due to excessive excitement, or syphilis. If they are so much changed as to interfere with sexual inter- course or walking, they must be excised with curved scissors, after having passed anumber of threads through the roots, so that the borders of the wound may be brought together and united by first intention. As a rule, cauterization of the cut surface suffices to stop the bleeding; for though the labia interna are more vascu- lar than the externa, the vessels are too small to pro- duce much hemorrhage. Eruptive Diseases of the Vulva usually create sooner Wounds. 455 or later vulvitis, which has to be taken into account in the treatment of the latter, since they require the same remedies as they do in other parts of the body. Pruri- tus is one of the most constant signs, and the itching, which it produces often first attracts attention to their presence. In prurigo the vulvlPpresents large, scattered papules, which are generally denuded at their points of cuticle. lichen shows more numerous papules, which rest upon a thickened and somewhat indurated surface. Acne consists in engorgement of the sebaceous folli- cles, which stud the labial surfaces. Eczema, which in diabetes and vesico-vaginal fistula often constitutes a very troublesome complication, presents vesicles, which, as an acute disorder, may rapidly heal again; but some- times there are successive crops of them, which will ex- haust the strength of the patient in consequence of the nervous excitement and irritability they occasion. Erg- sipelas and Erythema are always accompanied by graver symptoms, than when affecting other parts. Wakefulness. See Insomnia. Warts. See Skin (Neoplasms). Weakness. See Debility, resp. Impotenz. Whites. See Leucorrhoea. Whitlow. See Onychia. Worms. See Helminthiasis. Wounds__A solution of continuity or separation of continuous parts by violence, is usually directed from the cutaneous or mucous surfaces; but sometimes it is caused within the body by broken bones, etc. Incised wounds (those made by a clean-cutting instrument), which are usually produced with the least violence, gen- erally admit most easily of repair, while lacerated and 456 Wounds. contused ones are more prone to slough or suppurate, though they do not bleed much. Punctured wounds are dangerous from the possibility that deep-seated ex- travasation of blood or abscess may follow. Treat- ment consists in checking bleeding, which in most cases may be accomplished b^ a raised position, moderate pressure, cold compresses and styptic applications (415 & 16), see Hemorrhage; removal of foreign bodies (with forceps or sponge and water); bringing the divided parts into their natural position and keeping them in union—which may be obtained with strips of adhesive plaster, covered by a compress or bandage, with collo- dion or by sutures (interrupted, twisted, continuous or quill, as maybe required); and lastly by preventing sup- puration and fever—which is most effectually done by the antiseptic method (p. 139). If any small portion of the body (as finger, part of nose for instance), has been completely cut off, it may unite again, even after several hours, if it is reap- plied, retained with plaster or by sutures, and wrapped up, so as to preserve its temperature. Open wounds will heal best by forming a scab: Pledgets of lint, soaked in blood, friars balsam, or Quebracho are placed on the wound to there adhere; or by the use of simple water dressing with some antiseptic. If there be pain, rest- lessness and shivering, an incision may be necessary. Punctured wounds should be kept at perfect rest and bandaged sufficient firmly to prevent subcutaneous ooz- ing of the blood, which is the most likely cause of in- flammation. Gun-shot wounds of the thorax or abdo- men are always followed by more or less collapse, from which the patient should not be roused too soon, Wounds. 457 if large vessels are supposed to have been injured. He should be placed on a bed, with his head low, and care- fully watched in order to prevent the collapse from go- ing too far, by the judicious application of stimulants, warmth, etc. In case of hemorrhage, pressure and the ligature (if intermediary, which may occur after reac- tion has taken place, or secondary, which may take place up to the 25th day after the injury, the same treatment, see Hemorrhage). The exploration of the wound should be made, if possible, before swelling and oedema have come on. Sometimes the right forefinger, aided by counter-pressure of the other hand will suffice, espe- cially if the wound be dilated, to allow its entrance; but generally probes for this purpose have to be resorted to. The extraction of the ball is best accomplished by means of forceps; for small, loose fragments, a bullet- scoop may be of service. Gun-shot wounds of the scalp with fracture of the skull should be carefully examined with the finger, if there is a depression. In this case the depressed bone should be lifted by means of an ele- vator, especially if there are symptoms of compression; if not, the operation may be delayed until cerebral symptoms appear. In fracture of the skull without de- pression, cold compresses to the head, in conjunction with cathartics (p. 88), and rest. The formation of pus, which would be indicated by severe rigors with head symptoms, coming on from fifteen to thirty days after the injury, requires evacuation, after having removed a portion of bone with the trephine. Gun-shot wounds of the face are sometimes complicated with injury to the brain. Plastic surgery may be occasionally desirable, and ligature of the carotis necessary (416). All loose 45S Wounds. spicula of bone should be removed, the parts by sutures adjusted, and covered with light antiseptic dressings. If the jaw be fractured, it should be maintained in posi- tion by means of the perforated wire or gutta-percha splint. Wounds of arteries require first of all, firm pressure to arrest the bleeding, by means of a finger on the vessel; in wide and deep wounds, by placing the fin- ger on the exact spots where the blood issues from; by tying a handkerchief with a stone round the limb and twisting it tightly with a stick in default of a tourni- quet. If the arteries are numerous and small, pressure by means of cold compresses in conjunction with styp- tics will suffice, Tinct. vel Liq. Ferri chlorati, Argentum nitricum, 01. Terebinthina}, Creosote. A pinch or a pull with the forceps will often cause small vessels to cease bleeding. Many obstinate hemorrhages from small ves- sels cease, when the wound is cleared of coagulum, and the bleeding part sluiced with cold water, and exposed to the air for some time, before it is bound up again. The actual cautery at black heat will be indicated for arteries, that either cannot be tied, or are too diseased to hold the ligature. If the vessels are large, the liga- ture (416), or still better, acupressure or torsion will be the proper thing. The method of employing acupressure is either, by passing a needle of, from three to six inches in length (according to the thickness of the wound) through one of the flaps of a wound over the vessel in the same way as we would fasten with a pin the stalk of a flower to our coat; or a sewing needle is passed behind the vessel, and a fine iron wire having been slipped over its point, is brought over the vessel tightly enough to close it, and Wounds. 459 secured with a slight twist round the eye-end. Torsion is performed by drawing out the vessel from its sheath by a pair of broad-pointed spring-forceps, and then twisting it round freely as far as its natural connections above will allow; or by fixing the vessel with one pair of forceps a quarter or half an inch from the end, and then twisting the end with another pair till it does not untwist itself. Arteries situated immediately over a bone may be closed with a graduated compress. A puncture or partial division of an artery is generally more troublesome than complete division, as neither contraction nor retraction of the vessel can take place; therefore small arteries should in these cases be completely divided. In cases of arterial hemorrhage, which there is dif- ficulty in restraining by ligature or otherwise, the pa- tient should be kept in the recumbent posture. The diet should consist of milk, broth, and such substances, which nourish without stimulating; and Opium (p. 35) may be given to tranquilize the heart's action. If life is endangered by the loss of blood, the head must be kept low; beef-tea with brandy (p. 72) be given frequent- ly by spoonfuls, and small doses of Opium every three or four hours. As a last resource, transfusion should be resorted to. Wounds of veins are as a rule easily closed by pres- sure in conjunction with a raised position; sometimes however they may require the ligature or acupressure. Wounds from stings and bites of insects must be cau- terized with Aqua Ammonia), Acid. nitr. or Soda (407). A wound from a bite of a rabid animal should be well sucked, a ligature put above the bitten part, and as soon as possi- ble cut out and freely cauterized with Argenti Nitras. In 460' Wryneck. Snakebite, brandy may be exhibited freely; Ammonii Carbonas or Cedron (pp. 10 & 73); Mangan (403) has been recommended. Poisoned wounds (Ptomain) from dissection or from operation will cause blood poisoning: Inflammation of the glands, abscesses, erysipelas, etc., accompanied by constitutional symptoms. They claim aside from tonics (p. 71) and cathartics (p. 71) an antisep tic treatment: Resorcin, Mercury or Phenol (396-98). Zinc or Benzol (403); Medicated cotton (416) etc., see Septicaemia. Wristdrop. See Paralysis from lead poison. Writer's Cramp. See Spasm. Wryneck ( Caput obstipum)—A peculiar distortion, in which the head is bent down towards one shoulder, the face being turned to the opposite side; and unless congenital, dependent on some intra-cranial or spinal affection of the spinal accessory; or what is more usual, an inflammatory spasm of one of the sterno-cleido-mas- toidei, which feels hot and tender, and upon the slight- est motion, painful, (see Spasm and Myalgia—Torti- collis rheumaticus). Treatment—In fresh cases, next to perfect rest, poultices and fomentations, a generous diet in conjunction with cathartics (p. 88) and tonics, espe- cially Quinine and Zinc (pp. 77 & 87). The use of a ma- chine or gutta-percha collar with a chin and shoulder piece, to keep up extension in cases of no long duration. The congenital form will probably require division of the sternal origin of the muscles. Yellow Fever. See Fever. 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